DESCRIPTION CPT HCPCS Code Service Type Kaplan General Hospital Price Inpatient or Outpatient Uninsured Discount Price BCBS Reimbursement Aetna Reimbursement Cigna Reimbursement Humana Reimbursement United Healthcare Reimbursement Verity Reimbursment PHCS Reimbursement Unidentified Contract Low Unidentified Cotnract High CT Ablation Liver Cryo 47383 OR SERVICES "$21,953.00 " Outpatient "$10,976.50 " "$18,307.97 " "$14,269.45 " "$15,367.10 " "$14,488.98 " "$2,239.00 " "$7,683.55 " "$17,562.40 " "$2,239.00 " "$18,307.97 " XR Carotid Cerebral Left 36223 OR SERVICES "$5,526.00 " Outpatient "$2,763.00 " "$9,922.25 " "$3,591.90 " "$3,868.20 " "$3,647.16 " "$2,239.00 " "$1,934.10 " "$4,420.80 " "$1,934.10 " "$9,922.25 " XR Carotid Cerebral Left 36223 OR SERVICES "$5,526.00 " Outpatient "$2,763.00 " "$9,922.25 " "$3,591.90 " "$3,868.20 " "$3,647.16 " "$2,239.00 " "$1,934.10 " "$4,420.80 " "$1,934.10 " "$9,922.25 " Space OAR 55874 OR SERVICES "$6,184.00 " Outpatient "$3,092.00 " "$5,311.46 " "$4,019.60 " "$4,328.80 " "$4,081.44 " "$2,239.00 " "$2,164.40 " "$4,947.20 " "$2,164.40 " "$5,311.46 " Lithotripsy 50590 ESWT "$6,121.00 " Outpatient "$3,060.50 " "$11,731.76 " "$3,978.65 " "$4,284.70 " "$4,039.86 " "$2,239.00 " "$2,142.35 " "$4,896.80 " "$2,142.35 " "$11,731.76 " CT Insert Cath Intraperitoneal 49418 OR SERVICES "$11,902.00 " Outpatient "$5,951.00 " "$9,925.85 " "$7,736.30 " "$8,331.40 " "$7,855.32 " "$1,368.00 " "$4,165.70 " "$9,521.60 " "$1,368.00 " "$9,925.85 " CT Biliary Each Addl Cath Exchange 47536 OR SERVICES "$11,668.00 " Outpatient "$5,834.00 " "$9,731.33 " "$7,584.20 " "$8,167.60 " "$7,700.88 " "$1,368.00 " "$4,083.80 " "$9,334.40 " "$1,368.00 " "$9,731.33 " CT Biliary Int/Ext - Ext Cath Exchange 47536 OR SERVICES "$11,668.00 " Outpatient "$5,834.00 " "$9,731.33 " "$7,584.20 " "$8,167.60 " "$7,700.88 " "$1,368.00 " "$4,083.80 " "$9,334.40 " "$1,368.00 " "$9,731.33 " CT Biliary Ext - Int/Ext Cath Convers. 47535 OR SERVICES "$11,668.00 " Outpatient "$5,834.00 " "$9,731.33 " "$7,584.20 " "$8,167.60 " "$7,700.88 " "$1,368.00 " "$4,083.80 " "$9,334.40 " "$1,368.00 " "$9,731.33 " CT Drainage Biliary w Ext Cath 47533 OR SERVICES "$11,668.00 " Outpatient "$5,834.00 " "$9,731.33 " "$7,584.20 " "$8,167.60 " "$7,700.88 " "$1,368.00 " "$4,083.80 " "$9,334.40 " "$1,368.00 " "$9,731.33 " CT Injection Cholang. w/ New Access 47532 OR SERVICES "$11,668.00 " Outpatient "$5,834.00 " "$9,731.33 " "$7,584.20 " "$8,167.60 " "$7,700.88 " "$1,368.00 " "$4,083.80 " "$9,334.40 " "$1,368.00 " "$9,731.33 " CT Cholecystostomy w/ Cath ins 47490 OR SERVICES "$10,868.00 " Outpatient "$5,434.00 " "$9,063.76 " "$7,064.20 " "$7,607.60 " "$7,172.88 " "$1,368.00 " "$3,803.80 " "$8,694.40 " "$1,368.00 " "$9,063.76 " CT Injection Cholang. w/ Existing Access 47531 OR SERVICES "$1,885.00 " Outpatient $942.50 "$1,572.10 " "$1,225.25 " "$1,319.50 " "$1,244.10 " "$1,368.00 " $659.75 "$1,508.00 " $659.75 "$1,572.10 " CT Insert Cath Nephroureteral 50433 OR SERVICES "$8,074.00 " Outpatient "$4,037.00 " "$6,733.45 " "$5,248.10 " "$5,651.80 " "$5,328.84 " "$1,131.00 " "$2,825.90 " "$6,459.20 " "$1,131.00 " "$6,733.45 " "Decompression fasciotomy, forearm and/or wrist, flexor and extensor compartment, with debridement of" 25025 OR SERVICES "$7,431.00 " Outpatient "$3,715.50 " "$6,367.29 " "$4,830.15 " "$5,201.70 " "$4,904.46 " "$1,131.00 " "$2,600.85 " "$5,944.80 " "$1,131.00 " "$6,367.29 " CT Aspir Bladder w/Suprapubic Cath Ins 51102 OR SERVICES "$6,865.00 " Outpatient "$3,432.50 " "$5,726.77 " "$4,462.25 " "$4,805.50 " "$4,530.90 " "$1,131.00 " "$2,402.75 " "$5,492.00 " "$1,131.00 " "$5,726.77 " "Proximal humerus with manipulation, w/wo traction - Closed Treatment Fracture of" 23605 EMERG ROOM $156.00 Outpatient $78.00 $915.07 $101.40 $109.20 $102.96 "$1,131.00 " $54.60 $124.80 $54.60 "$1,131.00 " Insertion PICC Line w Imaging - Bedside Procedure Performed 36573 TREATMENT RM $446.00 Outpatient $223.00 "$4,888.36 " $289.90 $312.20 $294.36 $617.00 $156.10 $356.80 $156.10 "$4,888.36 " PICC Line Insertion w Imaging (PICC Team only) - Bedside Procedure Performed 36573 TREATMENT RM "$1,445.00 " Outpatient $722.50 "$4,888.36 " $939.25 "$1,011.50 " $953.70 $617.00 $505.75 "$1,156.00 " $505.75 "$4,888.36 " Insertion PICC Line w Imaging 36573 TREATMENT RM $446.00 Outpatient $223.00 "$4,888.36 " $289.90 $312.20 $294.36 $617.00 $156.10 $356.80 $156.10 "$4,888.36 " PICC Line Insertion w Imaging (PICC Team only) 36573 TREATMENT RM "$1,445.00 " Outpatient $722.50 "$4,888.36 " $939.25 "$1,011.50 " $953.70 $617.00 $505.75 "$1,156.00 " $505.75 "$4,888.36 " "Laryngoscopy, Diagnostic w/wo tracheoscopy - Bedside Procedure Performed" 31525 TREATMENT RM "$4,800.00 " Outpatient "$2,400.00 " "$4,112.52 " "$3,120.00 " "$3,360.00 " "$3,168.00 " $617.00 "$1,680.00 " "$3,840.00 " $617.00 "$4,112.52 " BTN SPT 6CM NSL STRL LF 9124105 C9727 SUPPLY/IMPLANTS $920.00 Outpatient $460.00 "$3,799.36 " $598.00 $644.00 $607.20 $617.00 $322.00 $736.00 $322.00 "$3,799.36 " CNN ESCP FRNTL SIN 5MM 44X16MM JCB SIL FLXB RDLCNT FSC-1 C9727 SUPPLY/IMPLANTS $609.00 Outpatient $304.50 "$3,799.36 " $395.85 $426.30 $401.94 $617.00 $213.15 $487.20 $213.15 "$3,799.36 " CNN ESCP FRNTL SIN 4MM 42X12MM JCB ULSMTH + SIL DAISY FLWR FSC-PD C9727 SUPPLY/IMPLANTS $554.00 Outpatient $277.00 "$3,799.36 " $360.10 $387.80 $365.64 $617.00 $193.90 $443.20 $193.90 "$3,799.36 " Bill Surg BM Asp and BX 38222 38222 PATHOLOGY LAB "$2,732.00 " Outpatient "$1,366.00 " "$2,553.17 " "$1,775.80 " "$1,912.40 " "$1,803.12 " $617.00 $956.20 "$2,185.60 " $617.00 "$2,553.17 " MRI Breast Biopsy 1st Lesion 19085 OR/MINOR "$4,338.00 " Outpatient "$2,169.00 " "$1,164.34 " "$2,819.70 " "$3,036.60 " "$2,863.08 " $617.00 "$1,518.30 " "$3,470.40 " $617.00 "$3,470.40 " CT Drainage Abscess Retroperit Perc 49406 OR SERVICES "$2,048.00 " Outpatient "$1,024.00 " "$5,467.73 " "$1,331.20 " "$1,433.60 " "$1,351.68 " $617.00 $716.80 "$1,638.40 " $617.00 "$5,467.73 " CT Drain Abscess Retroperit Perc 49406 OR SERVICES "$2,048.00 " Outpatient "$1,024.00 " "$5,467.73 " "$1,331.20 " "$1,433.60 " "$1,351.68 " $617.00 $716.80 "$1,638.40 " $617.00 "$5,467.73 " CT Drainage Appendiceal Abscess 49406 OR SERVICES "$5,472.00 " Outpatient "$2,736.00 " "$5,467.73 " "$3,556.80 " "$3,830.40 " "$3,611.52 " $617.00 "$1,915.20 " "$4,377.60 " $617.00 "$5,467.73 " CT Drainage Subphrenic/diagphrenic 49406 OR SERVICES "$5,472.00 " Outpatient "$2,736.00 " "$5,467.73 " "$3,556.80 " "$3,830.40 " "$3,611.52 " $617.00 "$1,915.20 " "$4,377.60 " $617.00 "$5,467.73 " CT Drainage Lung/Mediastinum 49405 OR SERVICES "$5,472.00 " Outpatient "$2,736.00 " "$5,467.73 " "$3,556.80 " "$3,830.40 " "$3,611.52 " $617.00 "$1,915.20 " "$4,377.60 " $617.00 "$5,467.73 " CT Drainage Renal 49405 OR SERVICES "$5,472.00 " Outpatient "$2,736.00 " "$5,467.73 " "$3,556.80 " "$3,830.40 " "$3,611.52 " $617.00 "$1,915.20 " "$4,377.60 " $617.00 "$5,467.73 " CT Drainage Spleen 49405 OR SERVICES "$5,472.00 " Outpatient "$2,736.00 " "$5,467.73 " "$3,556.80 " "$3,830.40 " "$3,611.52 " $617.00 "$1,915.20 " "$4,377.60 " $617.00 "$5,467.73 " CT Placement of Interstitial Devices 49411 OR SERVICES "$5,169.00 " Outpatient "$2,584.50 " "$4,310.86 " "$3,359.85 " "$3,618.30 " "$3,411.54 " $617.00 "$1,809.15 " "$4,135.20 " $617.00 "$4,310.86 " CT NonRad Abscess/Cyst Cath Exchange 49423 OR SERVICES "$3,232.00 " Outpatient "$1,616.00 " "$2,769.46 " "$2,100.80 " "$2,262.40 " "$2,133.12 " $617.00 "$1,131.20 " "$2,585.60 " $617.00 "$2,769.46 " Bone marrow biopsy and aspiration - Bedside Procedure Performed 38222 OR SERVICES "$2,653.00 " Outpatient "$1,326.50 " "$2,553.17 " "$1,724.45 " "$1,857.10 " "$1,750.98 " $617.00 $928.55 "$2,122.40 " $617.00 "$2,553.17 " CT Biopsy Bone Deep 20225 OR SERVICES "$2,215.00 " Outpatient "$1,107.50 " "$1,846.37 " "$1,439.75 " "$1,550.50 " "$1,461.90 " $617.00 $775.25 "$1,772.00 " $617.00 "$1,846.37 " Abdominal Paracentesis 49083 OR SERVICES $669.00 Outpatient $334.50 "$1,723.22 " $434.85 $468.30 $441.54 $617.00 $234.15 $535.20 $234.15 "$1,723.22 " CT Biopsy Renal Bil 50200 OR SERVICES "$1,991.00 " Outpatient $995.50 "$1,660.83 " "$1,294.15 " "$1,393.70 " "$1,314.06 " $617.00 $696.85 "$1,592.80 " $617.00 "$1,660.83 " CT Biopsy Renal Left 50200 OR SERVICES "$1,991.00 " Outpatient $995.50 "$1,660.83 " "$1,294.15 " "$1,393.70 " "$1,314.06 " $617.00 $696.85 "$1,592.80 " $617.00 "$1,660.83 " CT Biopsy Renal Right 50200 OR SERVICES "$1,991.00 " Outpatient $995.50 "$1,660.83 " "$1,294.15 " "$1,393.70 " "$1,314.06 " $617.00 $696.85 "$1,592.80 " $617.00 "$1,660.83 " US Biopsy Abdominal/Retro Perc 49180 OR SERVICES "$2,778.00 " Outpatient "$1,389.00 " "$1,660.83 " "$1,805.70 " "$1,944.60 " "$1,833.48 " $617.00 $972.30 "$2,222.40 " $617.00 "$2,222.40 " US Biopsy Liver Core 47000 OR SERVICES "$2,778.00 " Outpatient "$1,389.00 " "$1,660.83 " "$1,805.70 " "$1,944.60 " "$1,833.48 " $617.00 $972.30 "$2,222.40 " $617.00 "$2,222.40 " CT Biopsy Pleura 32400 OR SERVICES "$1,915.00 " Outpatient $957.50 "$1,596.95 " "$1,244.75 " "$1,340.50 " "$1,263.90 " $617.00 $670.25 "$1,532.00 " $617.00 "$1,596.95 " CT Biopsy Pleura 32400 OR SERVICES "$1,915.00 " Outpatient $957.50 "$1,596.95 " "$1,244.75 " "$1,340.50 " "$1,263.90 " $617.00 $670.25 "$1,532.00 " $617.00 "$1,596.95 " CT Biopsy Spinal Cord 62269 OR SERVICES "$1,420.00 " Outpatient $710.00 "$1,184.22 " $923.00 $994.00 $937.20 $617.00 $497.00 "$1,136.00 " $497.00 "$1,184.22 " MRI Biopsy Axilla 38505 OR SERVICES "$4,098.00 " Outpatient "$2,049.00 " $953.19 "$2,663.70 " "$2,868.60 " "$2,704.68 " $617.00 "$1,434.30 " "$3,278.40 " $617.00 "$3,278.40 " US Biopsy Axilla 38505 OR SERVICES "$4,098.00 " Outpatient "$2,049.00 " $953.19 "$2,663.70 " "$2,868.60 " "$2,704.68 " $617.00 "$1,434.30 " "$3,278.40 " $617.00 "$3,278.40 " MG Biopsy Breast W/O imaging guidance 19100 OR SERVICES "$1,143.00 " Outpatient $571.50 $953.19 $742.95 $800.10 $754.38 $617.00 $400.05 $914.40 $400.05 $953.19 Introduction long gastrointestinal tube 44500 OR SERVICES $891.00 Outpatient $445.50 $618.96 $579.15 $623.70 $588.06 $617.00 $311.85 $712.80 $311.85 $712.80 CT Aspir Bladder Trocar/Intracatheter 51101 OR SERVICES $368.00 Outpatient $184.00 $306.64 $239.20 $257.60 $242.88 $617.00 $128.80 $294.40 $128.80 $617.00 Lower GI Endoscopy W/Submucosal Injection 45381 GASTR-INTS SVS "$1,299.00 " Outpatient $649.50 "$1,146.80 " $844.35 $909.30 $857.34 $617.00 $454.65 "$1,039.20 " $454.65 "$1,146.80 " Knee - Closed Treatment Disloaction of 27552 EMERG ROOM "$4,488.00 " Outpatient "$2,244.00 " "$3,814.88 " "$2,917.20 " "$3,141.60 " "$2,962.08 " $617.00 "$1,570.80 " "$3,590.40 " $617.00 "$3,814.88 " Hip Post Arthroplasty Dislocation W/Regional or General Anes - Closed Treatment Disloaction of 27266 EMERG ROOM "$4,476.00 " Outpatient "$2,238.00 " "$3,814.88 " "$2,909.40 " "$3,133.20 " "$2,954.16 " $617.00 "$1,566.60 " "$3,580.80 " $617.00 "$3,814.88 " Elbow - Closed Reduction Dislocation of 24605 EMERG ROOM "$1,195.00 " Outpatient $597.50 "$3,814.88 " $776.75 $836.50 $788.70 $617.00 $418.25 $956.00 $418.25 "$3,814.88 " Shoulder with manipulation w/anesthesia - Closed Treatment Disloaction of 23655 EMERG ROOM "$1,195.00 " Outpatient $597.50 "$3,814.88 " $776.75 $836.50 $788.70 $617.00 $418.25 $956.00 $418.25 "$3,814.88 " "Over 30 cm - Layer Closure Wd Neck, Etc Intermed" 12047 EMERG ROOM "$1,323.00 " Outpatient $661.50 "$1,124.07 " $859.95 $926.10 $873.18 $617.00 $463.05 "$1,058.40 " $463.05 "$1,124.07 " "Over 30 cm - Layer Closure Wd Scalp, Etc Intermed" 12037 EMERG ROOM "$1,323.00 " Outpatient $661.50 "$1,124.07 " $859.95 $926.10 $873.18 $617.00 $463.05 "$1,058.40 " $463.05 "$1,124.07 " Distal tibia - Closed Treatment Fracture of 27825 EMERG ROOM "$1,076.00 " Outpatient $538.00 $915.07 $699.40 $753.20 $710.16 $617.00 $376.60 $860.80 $376.60 $915.07 Tibial shaft with manipulation - Closed Treatment Fracture of 27752 EMERG ROOM $156.00 Outpatient $78.00 $915.07 $101.40 $109.20 $102.96 $617.00 $54.60 $124.80 $54.60 $915.07 Tibia w/o manipulation - Closed Treatment Fracture of 27532 EMERG ROOM $389.00 Outpatient $194.50 $915.07 $252.85 $272.30 $256.74 $617.00 $136.15 $311.20 $136.15 $915.07 Nasal bone - Closed Treatment Fracture of 21315 EMERG ROOM $650.00 Outpatient $325.00 $553.01 $422.50 $455.00 $429.00 $617.00 $227.50 $520.00 $227.50 $617.00 Talus fracture with manipulation - Closed Treatment Fracture of 28435 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $617.00 $188.30 $430.40 $188.30 $617.00 Medial malleolus with manipulation - Closed Treatment Fracture of 27762 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $617.00 $188.30 $430.40 $188.30 $617.00 Femur - Closed Treatment Fracture of 27502 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $617.00 $188.30 $430.40 $188.30 $617.00 colonoscopy flex w/tumor removal - Colonoscopy PC 45385 CLINIC "$1,266.00 " Outpatient $633.00 "$1,146.80 " $822.90 $886.20 $835.56 $617.00 $443.10 "$1,012.80 " $443.10 "$1,146.80 " colonoscopy flex w/biopsy - Colonoscopy PC 45380 CLINIC "$1,013.00 " Outpatient $506.50 "$1,146.80 " $658.45 $709.10 $668.58 $617.00 $354.55 $810.40 $354.55 "$1,146.80 " Perc Clsr Transcath Lt Atrial Apndge W Implant 33340 CARDIAC CATH LAB "$7,930.00 " Outpatient "$3,965.00 " "$6,795.54 " "$5,154.50 " "$5,551.00 " "$5,233.80 " $617.00 "$2,775.50 " "$6,344.00 " $617.00 "$6,795.54 " PICC Line Insertion (PICC Team only) - Bedside Procedure Performed 36569 TREATMENT RM "$1,445.00 " Outpatient $722.50 "$2,189.56 " $939.25 "$1,011.50 " $953.70 $385.00 $505.75 "$1,156.00 " $385.00 "$2,189.56 " PICC/Midline Insertion (PICC Team only) - Bedside Procedure Performed 36569 TREATMENT RM "$1,445.00 " Outpatient $722.50 "$2,189.56 " $939.25 "$1,011.50 " $953.70 $385.00 $505.75 "$1,156.00 " $385.00 "$2,189.56 " Insertion of PICC Line 36569 TREATMENT RM $446.00 Outpatient $223.00 "$2,189.56 " $289.90 $312.20 $294.36 $385.00 $156.10 $356.80 $156.10 "$2,189.56 " US Fluid Collection Drainage 10030 OR/MINOR $856.00 Outpatient $428.00 $713.66 $556.40 $599.20 $564.96 $385.00 $299.60 $684.80 $299.60 $713.66 MRI Breast Localization 1st Lesion 19287 OR/MINOR "$3,515.00 " Outpatient "$1,757.50 " $439.16 "$2,284.75 " "$2,460.50 " "$2,319.90 " $385.00 "$1,230.25 " "$2,812.00 " $385.00 "$2,812.00 " Inj Hip w Steroid G0260 OR SERVICES "$3,137.00 " Outpatient "$1,568.50 " "$2,615.61 " "$2,039.05 " "$2,195.90 " "$2,070.42 " $385.00 "$1,097.95 " "$2,509.60 " $385.00 "$2,615.61 " FNA Biopsy U/S 1st Lesion 10005 OR SERVICES "$2,935.00 " Outpatient "$1,467.50 " "$2,589.55 " "$1,907.75 " "$2,054.50 " "$1,937.10 " $385.00 "$1,027.25 " "$2,348.00 " $385.00 "$2,589.55 " CT Nephrostomy Cath Exchange 50435 OR SERVICES "$2,812.00 " Outpatient "$1,406.00 " "$2,344.34 " "$1,827.80 " "$1,968.40 " "$1,855.92 " $385.00 $984.20 "$2,249.60 " $385.00 "$2,344.34 " US Nephrostomy Cath Exchange 50435 OR SERVICES "$2,812.00 " Outpatient "$1,406.00 " "$2,344.34 " "$1,827.80 " "$1,968.40 " "$1,855.92 " $385.00 $984.20 "$2,249.60 " $385.00 "$2,344.34 " XR Nephrostomy Cath Exchange 50435 OR SERVICES "$2,812.00 " Outpatient "$1,406.00 " "$2,344.34 " "$1,827.80 " "$1,968.40 " "$1,855.92 " $385.00 $984.20 "$2,249.60 " $385.00 "$2,344.34 " CT Nephrostomy-Nephroureteral Convers 50434 OR SERVICES "$2,812.00 " Outpatient "$1,406.00 " "$2,344.34 " "$1,827.80 " "$1,968.40 " "$1,855.92 " $385.00 $984.20 "$2,249.60 " $385.00 "$2,344.34 " "Removed tunneled central venous cath w/ sub-q port or pump, - Bedside Procedure Performed" 36590 OR SERVICES "$2,454.00 " Outpatient "$1,227.00 " "$2,189.56 " "$1,595.10 " "$1,717.80 " "$1,619.64 " $385.00 $858.90 "$1,963.20 " $385.00 "$2,189.56 " Removed tunneled central venous cath w/o sub-q port or pump - Bedside Procedure Performed 36589 OR SERVICES "$2,457.00 " Outpatient "$1,228.50 " "$2,189.56 " "$1,597.05 " "$1,719.90 " "$1,621.62 " $385.00 $859.95 "$1,965.60 " $385.00 "$2,189.56 " Thoracentesis w/o Imaging - Bedside Procedure Performed 32554 OR SERVICES "$2,169.00 " Outpatient "$1,084.50 " "$1,843.32 " "$1,409.85 " "$1,518.30 " "$1,431.54 " $385.00 $759.15 "$1,735.20 " $385.00 "$1,843.32 " Thoracentesis w/o Imaging 32554 OR SERVICES "$2,169.00 " Outpatient "$1,084.50 " "$1,843.32 " "$1,409.85 " "$1,518.30 " "$1,431.54 " $385.00 $759.15 "$1,735.20 " $385.00 "$1,843.32 " CT Drainage Pleura w Cath Insert 32557 OR SERVICES "$2,210.00 " Outpatient "$1,105.00 " "$1,843.32 " "$1,436.50 " "$1,547.00 " "$1,458.60 " $385.00 $773.50 "$1,768.00 " $385.00 "$1,843.32 " Insert - Chest Tube Activity: 32551 OR SERVICES "$1,050.00 " Outpatient $525.00 "$1,481.13 " $682.50 $735.00 $693.00 $385.00 $367.50 $840.00 $367.50 "$1,481.13 " CT Biopsy Bone Superficial 20220 OR SERVICES "$1,323.00 " Outpatient $661.50 "$1,103.43 " $859.95 $926.10 $873.18 $385.00 $463.05 "$1,058.40 " $385.00 "$1,103.43 " CT Drainage Soft Tissue 10030 OR SERVICES $856.00 Outpatient $428.00 $713.66 $556.40 $599.20 $564.96 $385.00 $299.60 $684.80 $299.60 $713.66 US Drainage Specimen W Catheter 10030 OR SERVICES "$1,135.00 " Outpatient $567.50 $713.66 $737.75 $794.50 $749.10 $385.00 $397.25 $908.00 $385.00 $908.00 US Drainage Specimen W Catheter 10030 OR SERVICES "$1,135.00 " Outpatient $567.50 $713.66 $737.75 $794.50 $749.10 $385.00 $397.25 $908.00 $385.00 $908.00 Bone Marrow Biopsy - Bedside Procedure Performed 38221 OR SERVICES $197.00 Outpatient $98.50 $711.73 $128.05 $137.90 $130.02 $385.00 $68.95 $157.60 $68.95 $711.73 CT Biopsy Bone Marrow 38221 OR SERVICES $853.00 Outpatient $426.50 $711.73 $554.45 $597.10 $562.98 $385.00 $298.55 $682.40 $298.55 $711.73 Lumbar Puncture - Bedside Procedure Performed 62270 OR SERVICES $982.00 Outpatient $491.00 $477.29 $638.30 $687.40 $648.12 $385.00 $343.70 $785.60 $343.70 $785.60 US Breast Cyst Aspiration 1st Lesion 19000 OR SERVICES "$1,309.00 " Outpatient $654.50 $472.72 $850.85 $916.30 $863.94 $385.00 $458.15 "$1,047.20 " $385.00 "$1,047.20 " Drain Heart Sac or Pericardiocentesis 33016 EMERG ROOM "$1,082.00 " Outpatient $541.00 Not Applicable: Bundled with Procedure $703.30 $757.40 $714.12 $385.00 $378.70 $865.60 $378.70 $865.60 Bimallaolar ankle - Closed Treatment Fracture of 27810 EMERG ROOM "$1,076.00 " Outpatient $538.00 $915.07 $699.40 $753.20 $710.16 $385.00 $376.60 $860.80 $376.60 $915.07 Radius and ulna - Closed Treatment Fracture of 25605 EMERG ROOM $834.00 Outpatient $417.00 $915.07 $542.10 $583.80 $550.44 $385.00 $291.90 $667.20 $291.90 $915.07 Radius with manipulation - Closed Treatment Fracture of 25505 EMERG ROOM "$1,076.00 " Outpatient $538.00 $915.07 $699.40 $753.20 $710.16 $385.00 $376.60 $860.80 $376.60 $915.07 Shoulder - Closed Treatment Fracture of 23665 EMERG ROOM "$1,195.00 " Outpatient $597.50 $915.07 $776.75 $836.50 $788.70 $385.00 $418.25 $956.00 $385.00 $956.00 External Pacing Temporary 92953 EMERG ROOM $794.00 Outpatient $397.00 $653.88 $516.10 $555.80 $524.04 $385.00 $277.90 $635.20 $277.90 $653.88 Bimalleolar ankle with manipulation - Closed Treatment Fracture of 27818 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $385.00 $188.30 $430.40 $188.30 $457.53 Fibula with manipulation - Closed Treatment Fracture of 27781 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $385.00 $188.30 $430.40 $188.30 $457.53 XR Lumbar Spinal Puncture Therap w guide 62329 DX X-RAY $709.00 Outpatient $354.50 Not Applicable: Bundled with Procedure $460.85 $496.30 $467.94 $385.00 $248.15 $567.20 $248.15 $567.20 XR Lumbar Spinal Puncture w Guidance 62328 DX X-RAY $709.00 Outpatient $354.50 Not Applicable: Bundled with Procedure $460.85 $496.30 $467.94 $385.00 $248.15 $567.20 $248.15 $567.20 XR Fluoro FNA Inj/Asp 10007 DX X-RAY "$2,935.00 " Outpatient "$1,467.50 " "$2,589.55 " "$1,907.75 " "$2,054.50 " "$1,937.10 " $385.00 "$1,027.25 " "$2,348.00 " $385.00 "$2,589.55 " XR Lumbar Spinal Puncture Therapeutic 62272 DX X-RAY $556.00 Outpatient $278.00 $477.29 $361.40 $389.20 $366.96 $385.00 $194.60 $444.80 $194.60 $477.29 Urine Capacity Measure 51798 ULTRASOUND $745.00 Outpatient $372.50 $169.78 $484.25 $521.50 $491.70 $142.00 $260.75 $596.00 $142.00 $596.00 Drainage of skin abcess - Bedside Procedure Performed 10060 TREATMENT RM $614.00 Outpatient $307.00 $526.68 $399.10 $429.80 $405.24 $142.00 $214.90 $491.20 $142.00 $526.68 Insert indwelling - Urinary Catheter Activity Type 51702 TREATMENT RM $308.00 Outpatient $154.00 $328.12 $200.20 $215.60 $203.28 $142.00 $107.80 $246.40 $107.80 $328.12 Insert indwelling - Urinary Catheter Activity: 51702 TREATMENT RM $308.00 Outpatient $154.00 $328.12 $200.20 $215.60 $203.28 $142.00 $107.80 $246.40 $107.80 $328.12 Insert in & out - Urinary Catheter Activity Type 51701 TREATMENT RM $130.00 Outpatient $65.00 $328.12 $84.50 $91.00 $85.80 $142.00 $45.50 $104.00 $45.50 $328.12 Insert in & out - Urinary Catheter Activity: 51701 TREATMENT RM $130.00 Outpatient $65.00 $328.12 $84.50 $91.00 $85.80 $142.00 $45.50 $104.00 $45.50 $328.12 Insertion Foley Catheter 51702 TREATMENT RM $318.00 Outpatient $159.00 $328.12 $206.70 $222.60 $209.88 $142.00 $111.30 $254.40 $111.30 $328.12 Catherization UA 51701 TREATMENT RM $134.00 Outpatient $67.00 $328.12 $87.10 $93.80 $88.44 $142.00 $46.90 $107.20 $46.90 $328.12 Venous Access Blood Collection 36591 TREATMENT RM $274.00 Outpatient $137.00 $225.84 $178.10 $191.80 $180.84 $142.00 $95.90 $219.20 $95.90 $225.84 PICC Line Declot (PICC Team only) - Bedside Procedure Performed 36593 TREATMENT RM $801.00 Outpatient $400.50 $220.20 $520.65 $560.70 $528.66 $142.00 $280.35 $640.80 $142.00 $640.80 PICC/Midline Declot (PICC Team only) - Bedside Procedure Performed 36593 TREATMENT RM $801.00 Outpatient $400.50 $220.20 $520.65 $560.70 $528.66 $142.00 $280.35 $640.80 $142.00 $640.80 Declot PICC Line 36593 TREATMENT RM $824.00 Outpatient $412.00 $220.20 $535.60 $576.80 $543.84 $142.00 $288.40 $659.20 $142.00 $659.20 Bladder Scan Indications 51798 TREATMENT RM $208.00 Outpatient $104.00 $169.78 $135.20 $145.60 $137.28 $142.00 $72.80 $166.40 $72.80 $169.78 Artificial Airway Suction 31720 RESPIRATORY SVC $257.00 Outpatient $128.50 $213.70 $167.05 $179.90 $169.62 $142.00 $89.95 $205.60 $89.95 $213.70 Catheter Aspiration Nasotracheal 31720 RESPIRATORY SVC $257.00 Outpatient $128.50 $213.70 $167.05 $179.90 $169.62 $142.00 $89.95 $205.60 $89.95 $213.70 Sputum Induction 31720 RESPIRATORY SVC $44.00 Outpatient $22.00 $213.70 $28.60 $30.80 $29.04 $142.00 $15.40 $35.20 $15.40 $213.70 Sputum Induction/Collection 31720 RESPIRATORY SVC $44.00 Outpatient $22.00 $213.70 $28.60 $30.80 $29.04 $142.00 $15.40 $35.20 $15.40 $213.70 Arterial Puncture 36600 RESPIRATORY SVC $14.00 Outpatient $7.00 $1.89 $9.10 $9.80 $9.24 $142.00 $4.90 $11.20 $1.89 $142.00 Arterial Puncture - Respiratory Therapy Equipment In Use 36600 RESPIRATORY SVC $14.00 Outpatient $7.00 $1.89 $9.10 $9.80 $9.24 $142.00 $4.90 $11.20 $1.89 $142.00 PT Debridment with pulsavac/whirlpool large wound 97598 PHYSICAL THERAPY $281.00 Outpatient $140.50 $227.07 $182.65 $196.70 $97.00 $142.00 $98.35 $224.80 $97.00 $227.07 PT Debridment with pulsavac/whirlpool small wound 97597 PHYSICAL THERAPY $247.00 Outpatient $123.50 $181.56 $160.55 $172.90 $97.00 $142.00 $86.45 $197.60 $86.45 $197.60 Fetal Non-Stress Test - Maternity Bedside Procedures 59025 OTHER DX SVS $423.00 Outpatient $211.50 $376.87 $274.95 $296.10 $279.18 $142.00 $148.05 $338.40 $142.00 $376.87 Fetal non-stress test 59025 OTHER DX SVS $435.00 Outpatient $217.50 $376.87 $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 $376.87 Clinic- venous access dev declot 36593 OR/MINOR $824.00 Outpatient $412.00 $220.20 $535.60 $576.80 $543.84 $142.00 $288.40 $659.20 $142.00 $659.20 MRI Breast Localization Addl Lesion 19288 OR/MINOR $223.00 Outpatient $111.50 $1.89 $144.95 $156.10 $147.18 $142.00 $78.05 $178.40 $1.89 $178.40 MRI Breast Biopsy Addl Lesion 19086 OR/MINOR $165.00 Outpatient $82.50 $1.89 $107.25 $115.50 $108.90 $142.00 $57.75 $132.00 $1.89 $142.00 US NonRad Endovenous Ablation Addl Veins 36479 OR SERVICES "$9,106.00 " Outpatient "$4,553.00 " "$7,682.37 " "$5,918.90 " "$6,374.20 " "$6,009.96 " $142.00 "$3,187.10 " "$7,284.80 " $142.00 "$7,682.37 " CT FNA additional lesion 10010 OR SERVICES $449.00 Outpatient $224.50 "$1,243.87 " $291.85 $314.30 $296.34 $142.00 $157.15 $359.20 $142.00 "$1,243.87 " CT Abscess I&D Subq Comp/Mult 10061 OR SERVICES "$1,224.00 " Outpatient $612.00 "$1,020.34 " $795.60 $856.80 $807.84 $142.00 $428.40 $979.20 $142.00 "$1,020.34 " US Aspir/Inject Major Jnt/Bursa 20611 OR SERVICES "$1,128.00 " Outpatient $564.00 $944.08 $733.20 $789.60 $744.48 $142.00 $394.80 $902.40 $142.00 $944.08 CT Inj Artho Knee 27369 OR SERVICES $978.00 Outpatient $489.00 $924.10 $635.70 $684.60 $645.48 $142.00 $342.30 $782.40 $142.00 $924.10 MRI Inj Arthro Knee 27369 OR SERVICES $978.00 Outpatient $489.00 $924.10 $635.70 $684.60 $645.48 $142.00 $342.30 $782.40 $142.00 $924.10 MG Biopsy Breast Skin Punch 1st Lesion 11104 OR SERVICES "$1,309.00 " Outpatient $654.50 $788.70 $850.85 $916.30 $863.94 $142.00 $458.15 "$1,047.20 " $142.00 "$1,047.20 " CT Aspir Bladder Needle 51100 OR SERVICES $713.00 Outpatient $356.50 $594.47 $463.45 $499.10 $470.58 $142.00 $249.55 $570.40 $142.00 $594.47 CT Myelogram Inj 62284 OR SERVICES $822.00 Outpatient $411.00 $425.15 $534.30 $575.40 $542.52 $142.00 $287.70 $657.60 $142.00 $657.60 CT Injection SI Joint Bil 27096 OR SERVICES $418.00 Outpatient $209.00 $348.08 $271.70 $292.60 $275.88 $142.00 $146.30 $334.40 $142.00 $348.08 CT Injection SI Joint Lt 27096 OR SERVICES $418.00 Outpatient $209.00 $348.08 $271.70 $292.60 $275.88 $142.00 $146.30 $334.40 $142.00 $348.08 CT Injection SI Joint Rt 27096 OR SERVICES $418.00 Outpatient $209.00 $348.08 $271.70 $292.60 $275.88 $142.00 $146.30 $334.40 $142.00 $348.08 US FNA additional lesion 10006 OR SERVICES $449.00 Outpatient $224.50 $282.49 $291.85 $314.30 $296.34 $142.00 $157.15 $359.20 $142.00 $359.20 US FNA Additional Lesion 10006 OR SERVICES $462.00 Outpatient $231.00 $282.49 $300.30 $323.40 $304.92 $142.00 $161.70 $369.60 $142.00 $369.60 MG Biopsy Breast Skin Punch Addl Lesion 11105 OR SERVICES $449.00 Outpatient $224.50 $272.75 $291.85 $314.30 $296.34 $142.00 $157.15 $359.20 $142.00 $359.20 Cath/Intro of saline or contrast SIS/HSG 58340 OR SERVICES $247.00 Outpatient $123.50 $197.01 $160.55 $172.90 $163.02 $142.00 $86.45 $197.60 $86.45 $197.60 CT Aspir / Inj Minor Jnt/Bursa 20600 OR SERVICES $136.00 Outpatient $68.00 $113.03 $88.40 $95.20 $89.76 $142.00 $47.60 $108.80 $47.60 $142.00 MRI FNA additional lesion 10012 OR SERVICES $449.00 Outpatient $224.50 Not Applicable: Bundled with Procedure $291.85 $314.30 $296.34 $142.00 $157.15 $359.20 $142.00 $359.20 Collect Blood PICC or Central Catheter 36592 LABORATORY $221.00 Outpatient $110.50 $182.26 $143.65 $154.70 $145.86 $142.00 $77.35 $176.80 $77.35 $182.26 Interphalangeal Joint of Toe w/ Anesthesia - Closed Treatment Disloaction of 28665 EMERG ROOM "$4,488.00 " Outpatient "$2,244.00 " "$3,814.88 " "$2,917.20 " "$3,141.60 " "$2,962.08 " $142.00 "$1,570.80 " "$3,590.40 " $142.00 "$3,814.88 " Patella with Anesthesia - Closed Reduction Dislocation of 27562 EMERG ROOM "$4,488.00 " Outpatient "$2,244.00 " "$3,814.88 " "$2,917.20 " "$3,141.60 " "$2,962.08 " $142.00 "$1,570.80 " "$3,590.40 " $142.00 "$3,814.88 " Interphalangeal W/Anes - Closed Treatment Disloaction of 26775 EMERG ROOM "$4,488.00 " Outpatient "$2,244.00 " "$3,814.88 " "$2,917.20 " "$3,141.60 " "$2,962.08 " $142.00 "$1,570.80 " "$3,590.40 " $142.00 "$3,814.88 " Arterial Catherterization 36620 EMERG ROOM "$3,458.00 " Outpatient "$1,729.00 " "$2,962.42 " "$2,247.70 " "$2,420.60 " "$2,282.28 " $142.00 "$1,210.30 " "$2,766.40 " $142.00 "$2,962.42 " "2.6 - 7.5 cm - Repair Wd Lesion Eyelid, Etc Complex" 13152 EMERG ROOM $669.00 Outpatient $334.50 "$1,758.35 " $434.85 $468.30 $441.54 $142.00 $234.15 $535.20 $142.00 "$1,758.35 " "1.1 - 2.5 cm - Repair Wd Lesion Eyelid, Etc Complex" 13151 EMERG ROOM $669.00 Outpatient $334.50 "$1,758.35 " $434.85 $468.30 $441.54 $142.00 $234.15 $535.20 $142.00 "$1,758.35 " "2.6-7.5 cm - Repair Wd Lesion Forehead, Etc Complex" 13132 EMERG ROOM $669.00 Outpatient $334.50 "$1,758.35 " $434.85 $468.30 $441.54 $142.00 $234.15 $535.20 $142.00 "$1,758.35 " 2.6-7.5 cm - Repair Wd Lesion Trunk Compex 13101 EMERG ROOM $669.00 Outpatient $334.50 "$1,758.35 " $434.85 $468.30 $441.54 $142.00 $234.15 $535.20 $142.00 "$1,758.35 " 1.1 - 2.5 cm - Repair Wd Lesion Trunk Compex 13100 EMERG ROOM $669.00 Outpatient $334.50 "$1,758.35 " $434.85 $468.30 $441.54 $142.00 $234.15 $535.20 $142.00 "$1,758.35 " "Repair Wd Superficial, Dehiscence" 12020 EMERG ROOM "$2,132.00 " Outpatient "$1,066.00 " "$1,758.35 " "$1,385.80 " "$1,492.40 " "$1,407.12 " $142.00 $746.20 "$1,705.60 " $142.00 "$1,758.35 " Injection Drug Eye 67028 EMERG ROOM "$1,487.00 " Outpatient $743.50 "$1,274.85 " $966.55 "$1,040.90 " $981.42 $142.00 $520.45 "$1,189.60 " $142.00 "$1,274.85 " Repair Wd Lesion Eyelid Ea Add 5cm Comp 13153 EMERG ROOM $689.00 Outpatient $344.50 "$1,124.07 " $447.85 $482.30 $454.74 $142.00 $241.15 $551.20 $142.00 "$1,124.07 " Repair Lac Face Complex Ea Add'l 5cm 13133 EMERG ROOM $689.00 Outpatient $344.50 "$1,124.07 " $447.85 $482.30 $454.74 $142.00 $241.15 $551.20 $142.00 "$1,124.07 " "1.1 - 2.5 cm - Repair Wd Lesion Forehead, Etc Complex" 13131 EMERG ROOM $669.00 Outpatient $334.50 "$1,124.07 " $434.85 $468.30 $441.54 $142.00 $234.15 $535.20 $142.00 "$1,124.07 " "2.6-7.5 cm - Repair Wd Lesion Scalp, Etc Complex" 13121 EMERG ROOM $669.00 Outpatient $334.50 "$1,124.07 " $434.85 $468.30 $441.54 $142.00 $234.15 $535.20 $142.00 "$1,124.07 " "1.1 - 2.5 cm - Repair Wd Lesion Scalp, Etc Complex" 13120 EMERG ROOM $669.00 Outpatient $334.50 "$1,124.07 " $434.85 $468.30 $441.54 $142.00 $234.15 $535.20 $142.00 "$1,124.07 " Repair Wd Lesion Trunk Ea Add 5cm Comp 13102 EMERG ROOM $689.00 Outpatient $344.50 "$1,124.07 " $447.85 $482.30 $454.74 $142.00 $241.15 $551.20 $142.00 "$1,124.07 " Over 30 cm - Layer Closure Wd Face Intermed 12057 EMERG ROOM "$1,323.00 " Outpatient $661.50 "$1,124.07 " $859.95 $926.10 $873.18 $142.00 $463.05 "$1,058.40 " $142.00 "$1,124.07 " 20.1 - 30 cm - Layer Closure Wd Face Intermed 12056 EMERG ROOM "$1,323.00 " Outpatient $661.50 "$1,124.07 " $859.95 $926.10 $873.18 $142.00 $463.05 "$1,058.40 " $142.00 "$1,124.07 " 12.6 - 20 cm - Layer Closure Wd Face Intermed 12055 EMERG ROOM $149.00 Outpatient $74.50 "$1,124.07 " $96.85 $104.30 $98.34 $142.00 $52.15 $119.20 $52.15 "$1,124.07 " 5.1-7.5 cm - Layer Closure Wd Face Intermed 12053 EMERG ROOM $435.00 Outpatient $217.50 "$1,124.07 " $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 "$1,124.07 " 2.6-5.0 cm - Layer Closure Wd Face Intermed 12052 EMERG ROOM $435.00 Outpatient $217.50 "$1,124.07 " $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 "$1,124.07 " 0-2.5 cm - Layer Closure Wd Face Intermed 12051 EMERG ROOM $435.00 Outpatient $217.50 "$1,124.07 " $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 "$1,124.07 " "20.1 - 30 cm - Layer Closure Wd Neck, Etc Intermed" 12046 EMERG ROOM "$1,323.00 " Outpatient $661.50 "$1,124.07 " $859.95 $926.10 $873.18 $142.00 $463.05 "$1,058.40 " $142.00 "$1,124.07 " "12.6 - 20 cm - Layer Closure Wd Neck, Etc Intermed" 12045 EMERG ROOM "$1,323.00 " Outpatient $661.50 "$1,124.07 " $859.95 $926.10 $873.18 $142.00 $463.05 "$1,058.40 " $142.00 "$1,124.07 " "7.6 - 12.5 cm - Layer Closure Wd Neck, Etc Intermed" 12044 EMERG ROOM $26.00 Outpatient $13.00 "$1,124.07 " $16.90 $18.20 $17.16 $142.00 $9.10 $20.80 $9.10 "$1,124.07 " "2.6-7.5 cm - Layer Closure Wd Neck, Etc Intermed" 12042 EMERG ROOM $435.00 Outpatient $217.50 "$1,124.07 " $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 "$1,124.07 " "20.1 - 30 cm - Layer Closure Wd Scalp, Etc Intermed" 12036 EMERG ROOM $435.00 Outpatient $217.50 "$1,124.07 " $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 "$1,124.07 " "12.6 - 20 cm - Layer Closure Wd Scalp, Etc Intermed" 12035 EMERG ROOM $435.00 Outpatient $217.50 "$1,124.07 " $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 "$1,124.07 " "7.6 - 12.5 cm - Layer Closure Wd Scalp, Etc Intermed" 12034 EMERG ROOM $435.00 Outpatient $217.50 "$1,124.07 " $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 "$1,124.07 " "2.6-7.5 cm - Layer Closure Wd Scalp, Etc Intermed" 12032 EMERG ROOM $435.00 Outpatient $217.50 "$1,124.07 " $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 "$1,124.07 " "0-2.5 cm - Layer Closure Wd Scalp, Etc Intermed" 12031 EMERG ROOM $435.00 Outpatient $217.50 "$1,124.07 " $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 "$1,124.07 " "Repair Wd Superficial, Dehiscence w/Pack" 12021 EMERG ROOM "$1,363.00 " Outpatient $681.50 "$1,124.07 " $885.95 $954.10 $899.58 $142.00 $477.05 "$1,090.40 " $142.00 "$1,124.07 " "Over 30 cm - Repair Face Wd Superficial, Simple" 12018 EMERG ROOM "$1,323.00 " Outpatient $661.50 "$1,124.07 " $859.95 $926.10 $873.18 $142.00 $463.05 "$1,058.40 " $142.00 "$1,124.07 " Change Peg Tube 43762 EMERG ROOM "$1,091.00 " Outpatient $545.50 "$1,034.41 " $709.15 $763.70 $720.06 $142.00 $381.85 $872.80 $142.00 "$1,034.41 " "Toe with manipulation, not great toe - Closed Treatment Fracture of" 28515 EMERG ROOM "$1,076.00 " Outpatient $538.00 $915.07 $699.40 $753.20 $710.16 $142.00 $376.60 $860.80 $142.00 $915.07 Distal fibular with manipulation - Closed Treatment Fracture of 27788 EMERG ROOM $389.00 Outpatient $194.50 $915.07 $252.85 $272.30 $256.74 $142.00 $136.15 $311.20 $136.15 $915.07 Patella - Closed Reduction Dislocation of 27560 EMERG ROOM $389.00 Outpatient $194.50 $915.07 $252.85 $272.30 $256.74 $142.00 $136.15 $311.20 $136.15 $915.07 Hip with manipulation - Closed Treatment Disloaction of 27265 EMERG ROOM "$1,076.00 " Outpatient $538.00 $915.07 $699.40 $753.20 $710.16 $142.00 $376.60 $860.80 $142.00 $915.07 Femur head - Closed Reduction Fracture of 27250 EMERG ROOM "$1,076.00 " Outpatient $538.00 $915.07 $699.40 $753.20 $710.16 $142.00 $376.60 $860.80 $142.00 $915.07 Articulated metacarpal or interphalal joint - Closed Treatment Fracture of 26742 EMERG ROOM "$1,076.00 " Outpatient $538.00 $915.07 $699.40 $753.20 $710.16 $142.00 $376.60 $860.80 $142.00 $915.07 Metacarpal with manipulation - Closed Treatment Fracture of 26605 EMERG ROOM $165.00 Outpatient $82.50 $915.07 $107.25 $115.50 $108.90 $142.00 $57.75 $132.00 $57.75 $915.07 Ulnar styloid - Closed Treatment Fracture of 25650 EMERG ROOM "$1,076.00 " Outpatient $538.00 $915.07 $699.40 $753.20 $710.16 $142.00 $376.60 $860.80 $142.00 $915.07 Wrist with manipulation - Closed Treatment Fracture of 25635 EMERG ROOM "$1,076.00 " Outpatient $538.00 $915.07 $699.40 $753.20 $710.16 $142.00 $376.60 $860.80 $142.00 $915.07 Radius w/o manipulation - Closed Treatment Fracture of 25600 EMERG ROOM "$1,076.00 " Outpatient $538.00 $915.07 $699.40 $753.20 $710.16 $142.00 $376.60 $860.80 $142.00 $915.07 Radius and ulna with manipulation - Closed Treatment Fracture of 25565 EMERG ROOM $389.00 Outpatient $194.50 $915.07 $252.85 $272.30 $256.74 $142.00 $136.15 $311.20 $136.15 $915.07 Proximal end ulna with manipulation - Closed Treatment Fracture of 24675 EMERG ROOM "$1,076.00 " Outpatient $538.00 $915.07 $699.40 $753.20 $710.16 $142.00 $376.60 $860.80 $142.00 $915.07 Radial head or neck fracture; with manipulation - Closed Treatment of Radial Head 24655 EMERG ROOM "$1,076.00 " Outpatient $538.00 $915.07 $699.40 $753.20 $710.16 $142.00 $376.60 $860.80 $142.00 $915.07 Elbow - Closed Treatment Disloaction of 24600 EMERG ROOM $389.00 Outpatient $194.50 $915.07 $252.85 $272.30 $256.74 $142.00 $136.15 $311.20 $136.15 $915.07 Humeral condylar with manipulation - Closed Reduction Fracture of 24577 EMERG ROOM "$1,076.00 " Outpatient $538.00 $915.07 $699.40 $753.20 $710.16 $142.00 $376.60 $860.80 $142.00 $915.07 Supracondylar/transcondylar humeral with manipulation - Closed Reduction Fracture of 24535 EMERG ROOM "$1,076.00 " Outpatient $538.00 $915.07 $699.40 $753.20 $710.16 $142.00 $376.60 $860.80 $142.00 $915.07 "Humeral shaft with manipulation, w/wo traction - Closed Treatment Fracture of" 24505 EMERG ROOM $286.00 Outpatient $143.00 $915.07 $185.90 $200.20 $188.76 $142.00 $100.10 $228.80 $100.10 $915.07 Shoulder with manipulation w/o anesthesia - Closed Treatment Disloaction of 23650 EMERG ROOM $294.00 Outpatient $147.00 $915.07 $191.10 $205.80 $194.04 $142.00 $102.90 $235.20 $102.90 $915.07 Thrombolytic Therapy Stroke 37195 EMERG ROOM $900.00 Outpatient $450.00 $771.77 $585.00 $630.00 $594.00 $142.00 $315.00 $720.00 $142.00 $771.77 "CPR,ED" 92950 EMERG ROOM $830.00 Outpatient $415.00 $653.88 $539.50 $581.00 $547.80 $142.00 $290.50 $664.00 $142.00 $664.00 Inj Nerve Block Facial Alveolar Block 64999 EMERG ROOM $611.00 Outpatient $305.50 $602.94 $397.15 $427.70 $403.26 $142.00 $213.85 $488.80 $142.00 $602.94 Temporomandibular - Closed Treatment Disloaction of 21480 EMERG ROOM $137.00 Outpatient $68.50 $553.01 $89.05 $95.90 $90.42 $142.00 $47.95 $109.60 $47.95 $553.01 Interphalangeal - Closed Reduction Dislocation of 28660 EMERG ROOM $293.00 Outpatient $146.50 $457.53 $190.45 $205.10 $193.38 $142.00 $102.55 $234.40 $102.55 $457.53 Interphalangeal Joint of Toe w/o Anesthesia - Closed Treatment Disloaction of 28660 EMERG ROOM $293.00 Outpatient $146.50 $457.53 $190.45 $205.10 $193.38 $142.00 $102.55 $234.40 $102.55 $457.53 Metalarsophalangeal joint - Closed Treatment Fracture of 28630 EMERG ROOM $293.00 Outpatient $146.50 $457.53 $190.45 $205.10 $193.38 $142.00 $102.55 $234.40 $102.55 $457.53 "Tarsal, w/o anesth - Closed Treatment Disloaction of" 28540 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Great toe with manipulation - Closed Treatment Fracture of 28495 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Great toe - Closed Treatment Fracture of 28490 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Distal fibula - Closed Reduction Fracture of 27786 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Tibial shaft - Closed Treatment Fracture of 27750 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Interphalangeal W/O Anes - Closed Treatment Disloaction of 26770 EMERG ROOM $293.00 Outpatient $146.50 $457.53 $190.45 $205.10 $193.38 $142.00 $102.55 $234.40 $102.55 $457.53 Distal phalangeal with manipulation - Closed Treatment Fracture of 26755 EMERG ROOM $168.00 Outpatient $84.00 $457.53 $109.20 $117.60 $110.88 $142.00 $58.80 $134.40 $58.80 $457.53 Finger with manipulaiton - Closed Treatment Fracture of 26725 EMERG ROOM $293.00 Outpatient $146.50 $457.53 $190.45 $205.10 $193.38 $142.00 $102.55 $234.40 $102.55 $457.53 Phalangeal shaft with manipulaiton - Closed Treatment Fracture of 26725 EMERG ROOM $293.00 Outpatient $146.50 $457.53 $190.45 $205.10 $193.38 $142.00 $102.55 $234.40 $102.55 $457.53 Metacarpophalangeal - Closed Treatment Fracture of 26700 EMERG ROOM $293.00 Outpatient $146.50 $457.53 $190.45 $205.10 $193.38 $142.00 $102.55 $234.40 $102.55 $457.53 Carpometacarpal other than thumb with manipulation each join - Closed Treatment Disloaction of 26670 EMERG ROOM $156.00 Outpatient $78.00 $457.53 $101.40 $109.20 $102.96 $142.00 $54.60 $124.80 $54.60 $457.53 Compometacarpal with manipulation - Closed Treatment Fracture of 26645 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Metacarpal - Closed Reduction Fracture of 26600 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Distal radioulnar - Closed Treatment Fracture of 25675 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Radiocarpal or intercarpal joint disloc w/mani - Closed Treatment Disloaction of 25660 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Ulnar - Closed Treatment Fracture of 25530 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Radial head sublaxation in child w/manipulation - Closed Treatment of Radial Head 24640 EMERG ROOM $389.00 Outpatient $194.50 $457.53 $252.85 $272.30 $256.74 $142.00 $136.15 $311.20 $136.15 $457.53 Humeral condylar - Closed Reduction Fracture of 24576 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Humeral epicondylar with manipulation - Closed Reduction Fracture of 24565 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Supracondylar/transcondylar humeral - Closed Reduction Fracture of 24530 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Humeral shaft - Closed Reduction Fracture of 24500 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Scapula and shoulder - Closed Treatment Fracture of 23575 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Scapula - Closed Treatment Fracture of 23570 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Clavicle w/o maniupulation - Closed Treatment Fracture of 23500 EMERG ROOM $538.00 Outpatient $269.00 $457.53 $349.70 $376.60 $355.08 $142.00 $188.30 $430.40 $142.00 $457.53 Repair Lac Complex Ea Add'l 5cm or Less 13122 EMERG ROOM $689.00 Outpatient $344.50 $383.29 $447.85 $482.30 $454.74 $142.00 $241.15 $551.20 $142.00 $551.20 7.6 - 12.5 cm - Layer Closure Wd Face Intermed 12054 EMERG ROOM $435.00 Outpatient $217.50 $383.29 $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 $383.29 "0-2.5 cm - Layer Closure Wd Neck, Etc Intermed" 12041 EMERG ROOM $435.00 Outpatient $217.50 $383.29 $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 $383.29 "20.1 - 30 cm - Repair Face Wd Superficial, Simple" 12017 EMERG ROOM $452.00 Outpatient $226.00 $383.29 $293.80 $316.40 $298.32 $142.00 $158.20 $361.60 $142.00 $383.29 "12.6 - 20 cm - Repair Face Wd Superficial, Simple" 12016 EMERG ROOM $452.00 Outpatient $226.00 $383.29 $293.80 $316.40 $298.32 $142.00 $158.20 $361.60 $142.00 $383.29 "7.6 - 12.5 cm - Repair Face Wd Superficial, Simple" 12015 EMERG ROOM $435.00 Outpatient $217.50 $383.29 $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 $383.29 "5.1-7.5 cm - Repair Face Wd Superficial, Simple" 12014 EMERG ROOM $435.00 Outpatient $217.50 $383.29 $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 $383.29 "2.6-5.0 cm - Repair Face Wd Superficial, Simple" 12013 EMERG ROOM $435.00 Outpatient $217.50 $383.29 $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 $383.29 "0 - 1.0 cm - Repair Wd Lesion Eyelid, Etc Complex" 12011 EMERG ROOM $435.00 Outpatient $217.50 $383.29 $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 $383.29 "0-2.5 cm - Repair Face Wd Superficial, Simple" 12011 EMERG ROOM $435.00 Outpatient $217.50 $383.29 $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 $383.29 "Over 30 cm - Repair Scalp, Etc Wd Superficial, Simple" 12007 EMERG ROOM $452.00 Outpatient $226.00 $383.29 $293.80 $316.40 $298.32 $142.00 $158.20 $361.60 $142.00 $383.29 "20.1 - 30 cm - Repair Scalp, Etc Wd Superficial, Simple" 12006 EMERG ROOM $435.00 Outpatient $217.50 $383.29 $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 $383.29 "12.6 - 20 cm - Repair Scalp, Etc Wd Superficial, Simple" 12005 EMERG ROOM $459.00 Outpatient $229.50 $383.29 $298.35 $321.30 $302.94 $142.00 $160.65 $367.20 $142.00 $383.29 "7.6 - 12.5 cm - Repair Scalp, Etc Wd Superficial, Simple" 12004 EMERG ROOM $435.00 Outpatient $217.50 $383.29 $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 $383.29 "2.6-7.5 cm - Repair Scalp, Etc Wd Superficial, Simple" 12002 EMERG ROOM $435.00 Outpatient $217.50 $383.29 $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 $383.29 "0-2.5 cm - Repair Scalp, Etc Wd Superficial, Simple" 12001 EMERG ROOM $435.00 Outpatient $217.50 $383.29 $282.75 $304.50 $287.10 $142.00 $152.25 $348.00 $142.00 $383.29 Place intraosseous needle for infusion 36680 EMERG ROOM $283.00 Outpatient $141.50 $248.87 $183.95 $198.10 $186.78 $142.00 $99.05 $226.40 $99.05 $248.87 Post Void Bladder Scan 51798 EMERG ROOM $208.00 Outpatient $104.00 $169.78 $135.20 $145.60 $137.28 $142.00 $72.80 $166.40 $72.80 $169.78 Post void bladder scan 51798 EMERG ROOM $208.00 Outpatient $104.00 $169.78 $135.20 $145.60 $137.28 $142.00 $72.80 $166.40 $72.80 $169.78 Post Void Residual Catheterization Amt 51798 EMERG ROOM $208.00 Outpatient $104.00 $169.78 $135.20 $145.60 $137.28 $142.00 $72.80 $166.40 $72.80 $169.78 US Breast Localization Addl Lesion 19286 DX X-RAY $322.00 Outpatient $161.00 $1.89 $209.30 $225.40 $212.52 $142.00 $112.70 $257.60 $1.89 $257.60 Code/CPR 92950 CARDIOLOGY $334.00 Outpatient $167.00 $653.88 $217.10 $233.80 $220.44 $142.00 $116.90 $267.20 $116.90 $653.88 Blood Volume Infused: 36430 BLOOD/ADMIN "$1,073.00 " Outpatient $536.50 $968.74 $697.45 $751.10 $708.18 $142.00 $375.55 $858.40 $142.00 $968.74 Fresh Frozen Plasma Amount Transfused 36430 BLOOD/ADMIN "$1,073.00 " Outpatient $536.50 $968.74 $697.45 $751.10 $708.18 $142.00 $375.55 $858.40 $142.00 $968.74 Red Blood Cells Amount Transfused 36430 BLOOD/ADMIN "$1,073.00 " Outpatient $536.50 $968.74 $697.45 $751.10 $708.18 $142.00 $375.55 $858.40 $142.00 $968.74 Single Donor Platelets Amt Transfused 36430 BLOOD/ADMIN "$1,073.00 " Outpatient $536.50 $968.74 $697.45 $751.10 $708.18 $142.00 $375.55 $858.40 $142.00 $968.74 Blood Volume Infused 36430 BLOOD/ADMIN "$1,073.00 " Outpatient $536.50 $968.74 $697.45 $751.10 $708.18 $142.00 $375.55 $858.40 $142.00 $968.74 Admin Vaccine Pneumo - Vaccines G0009 VACCINE ADMIN $44.00 Outpatient $22.00 Not Applicable: Bundled with Procedure $28.60 $30.80 $29.04 $21.00 $15.40 $35.20 $15.40 $35.20 Admin Vaccin Flu - Clinic- Vaccines G0008 VACCINE ADMIN $37.00 Outpatient $18.50 Not Applicable: Bundled with Procedure $24.05 $25.90 $24.42 $21.00 $12.95 $29.60 $12.95 $29.60 Admin Vaccine Pneumo - Clinic- Vaccines G0009 VACCINE ADMIN $37.00 Outpatient $18.50 Not Applicable: Bundled with Procedure $24.05 $25.90 $24.42 $21.00 $12.95 $29.60 $12.95 $29.60 Pneumonia Vaccine Administration G0009 VACCINE ADMIN $42.00 Outpatient $21.00 Not Applicable: Bundled with Procedure $27.30 $29.40 $27.72 $21.00 $14.70 $33.60 $14.70 $33.60 Influenza Vaccine Administration VACCINE ADMIN $75.00 Outpatient $37.50 Not Applicable: Bundled with Procedure $48.75 $52.50 $49.50 $21.00 $26.25 $60.00 $21.00 $60.00 Moderna Covid-19 Vaccine Administration – Second Dose 0012A VACCINE ADMIN $32.00 Outpatient $16.00 Not Applicable: Bundled with Procedure $20.80 $22.40 $21.12 $21.00 $11.20 $25.60 $11.20 $25.60 Moderna Covid-19 Vaccine Administration – First Dose 0011A VACCINE ADMIN $19.00 Outpatient $9.50 Not Applicable: Bundled with Procedure $12.35 $13.30 $12.54 $21.00 $6.65 $15.20 $6.65 $21.00 Pfizer-Biontech Covid-19 Vaccine Administration - Second Dose 0002A VACCINE ADMIN $32.00 Outpatient $16.00 Not Applicable: Bundled with Procedure $20.80 $22.40 $21.12 $21.00 $11.20 $25.60 $11.20 $25.60 Flu Vaccine Given G0008 VACCINE ADMIN $38.00 Outpatient $19.00 Not Applicable: Bundled with Procedure $24.70 $26.60 $25.08 $21.00 $13.30 $30.40 $13.30 $30.40 Pneumoccal Vaccine Given G0009 VACCINE ADMIN $38.00 Outpatient $19.00 Not Applicable: Bundled with Procedure $24.70 $26.60 $25.08 $21.00 $13.30 $30.40 $13.30 $30.40 Vaccines initial 90471 VACCINE ADMIN $66.00 Outpatient $33.00 $19.31 $42.90 $46.20 $43.56 $21.00 $23.10 $52.80 $19.31 $52.80 Vaccines initial 90471 PC 90471 VACCINE ADMIN $66.00 Outpatient $33.00 $19.31 $42.90 $46.20 $43.56 $21.00 $23.10 $52.80 $19.31 $52.80 Clinic- Vaccines VFC Initial 90471 VACCINE ADMIN $66.00 Outpatient $33.00 $19.31 $42.90 $46.20 $43.56 $21.00 $23.10 $52.80 $19.31 $52.80 Clinic- Vaccines initial 90471 VACCINE ADMIN $66.00 Outpatient $33.00 $19.31 $42.90 $46.20 $43.56 $21.00 $23.10 $52.80 $19.31 $52.80 Immunization Administration 90471 VACCINE ADMIN $66.00 Outpatient $33.00 $19.31 $42.90 $46.20 $43.56 $21.00 $23.10 $52.80 $19.31 $52.80 Vaccines Add 90472 PC 90472 VACCINE ADMIN $66.00 Outpatient $33.00 $14.92 $42.90 $46.20 $43.56 $21.00 $23.10 $52.80 $14.92 $52.80 Clinic- Vaccines Add 90472 VACCINE ADMIN $66.00 Outpatient $33.00 $14.92 $42.90 $46.20 $43.56 $21.00 $23.10 $52.80 $14.92 $52.80 Immunization Admin each additional vaccine 90472 VACCINE ADMIN $66.00 Outpatient $33.00 $14.92 $42.90 $46.20 $43.56 $21.00 $23.10 $52.80 $14.92 $52.80 Telemetry Monitoring NURSING INCREM $65.00 Outpatient $32.50 Not Applicable: Bundled with Procedure $42.25 $45.50 $42.90 Not Applicable $22.75 $52.00 $22.75 $52.00 Telemetry - Cardiac Monitor Type NURSING INCREM $63.00 Outpatient $31.50 Not Applicable: Bundled with Procedure $40.95 $44.10 $41.58 Not Applicable $22.05 $50.40 $22.05 $50.40 10361-0778-31 - barium sulfate 700 mg Tab DRUGS/INCIDENT RAD $29.00 Outpatient $14.50 Not Applicable: Bundled with Procedure $18.21 $20.30 $19.14 Not Applicable $10.15 $23.20 $10.15 $23.20 50419-0188-01 - gadopentetate dimeglumine 46.9% Soln J3490 DRUGS/INCIDENT RAD $527.00 Outpatient $263.50 Not Applicable: Bundled with Procedure $330.96 $368.90 $347.82 Not Applicable $184.45 $421.60 $184.45 $421.60 MultiHance 15ml vial A9578 DRUGS/INCIDENT RAD $32.00 Outpatient $16.00 $2.05 $20.80 $22.40 $21.12 Not Applicable $11.20 $25.60 $2.05 $25.60 Gastroview 30 ml bottle Q9963 DRUGS/INCIDENT RAD $12.00 Outpatient $6.00 $0.21 $7.80 $8.40 $7.92 Not Applicable $4.20 $9.60 $0.21 $9.60 Isovue 370mg per mL Q9967 DRUGS/INCIDENT RAD $10.00 Outpatient $5.00 $0.13 $6.50 $7.00 $6.60 Not Applicable $3.50 $8.00 $0.13 $8.00 Nonionic Contrast 350-399mg per ml Q9967 DRUGS/INCIDENT RAD $3.00 Outpatient $1.50 $0.13 $1.95 $2.10 $1.98 Not Applicable $1.05 $2.40 $0.13 $2.40 Nonionic Contrast 300-349mg per ml Q9967 DRUGS/INCIDENT RAD $7.00 Outpatient $3.50 $0.13 $4.55 $4.90 $4.62 Not Applicable $2.45 $5.60 $0.13 $5.60 Clinic- Infusion Proph/Therap < = 1 hr 96365 IV THERAPY $136.00 Outpatient $68.00 $141.01 $88.40 $95.20 $89.76 $104.00 $47.60 $108.80 $47.60 $141.01 IV Infusion Thera Prophylaxis 1st Hr 96365 IV THERAPY $141.00 Outpatient $70.50 $141.01 $91.65 $98.70 $93.06 $104.00 $49.35 $112.80 $49.35 $141.01 IV Infusion Thera Prophylaxis 1st Hr 96365 IV THERAPY $141.00 Outpatient $70.50 $141.01 $91.65 $98.70 $93.06 $104.00 $49.35 $112.80 $49.35 $141.01 IInfusion therapy prophylaxis dx 1st hr 96365 IV THERAPY $136.00 Outpatient $68.00 $141.01 $88.40 $95.20 $89.76 $104.00 $47.60 $108.80 $47.60 $141.01 Clinic- infusion hydration < = 1 hr 96360 IV THERAPY $257.00 Outpatient $128.50 $115.65 $167.05 $179.90 $169.62 $104.00 $89.95 $205.60 $89.95 $205.60 IV Infusion for Hydration up to 1 Hr 96360 IV THERAPY $264.00 Outpatient $132.00 $115.65 $171.60 $184.80 $174.24 $104.00 $92.40 $211.20 $92.40 $211.20 IV Infusion for Hydration up to 1 Hr 96360 IV THERAPY $264.00 Outpatient $132.00 $115.65 $171.60 $184.80 $174.24 $104.00 $92.40 $211.20 $92.40 $211.20 IV Infusion for Hydration; up to 1 hr 96360 IV THERAPY $257.00 Outpatient $128.50 $115.65 $167.05 $179.90 $169.62 $104.00 $89.95 $205.60 $89.95 $205.60 Injection IV Initial Push 96374 IV THERAPY $142.00 Outpatient $71.00 $110.42 $92.30 $99.40 $93.72 $104.00 $49.70 $113.60 $49.70 $113.60 Injection IV Initial Push 96374 IV THERAPY $142.00 Outpatient $71.00 $110.42 $92.30 $99.40 $93.72 $104.00 $49.70 $113.60 $49.70 $113.60 Clinic- Infusion add sequential 96367 IV THERAPY $136.00 Outpatient $68.00 $72.73 $88.40 $95.20 $89.76 $104.00 $47.60 $108.80 $47.60 $108.80 IV Infusion Therapy Prophylaxis Dx 96367 IV THERAPY $141.00 Outpatient $70.50 $72.73 $91.65 $98.70 $93.06 $104.00 $49.35 $112.80 $49.35 $112.80 IV Infusion Therapy Prophylaxis Dx 96367 IV THERAPY $141.00 Outpatient $70.50 $72.73 $91.65 $98.70 $93.06 $104.00 $49.35 $112.80 $49.35 $112.80 IV Infusion therapy prophylaxis dx add infus 96367 IV THERAPY $136.00 Outpatient $68.00 $72.73 $88.40 $95.20 $89.76 $104.00 $47.60 $108.80 $47.60 $108.80 Injection IV Add'l Seq Push New Drug 96375 IV THERAPY $142.00 Outpatient $71.00 $48.79 $92.30 $99.40 $93.72 $104.00 $49.70 $113.60 $48.79 $113.60 Injection IV Add'l Seq Push New Drug 96375 IV THERAPY $142.00 Outpatient $71.00 $48.79 $92.30 $99.40 $93.72 $104.00 $49.70 $113.60 $48.79 $113.60 Ultrasound POC ULTRASOUND $186.00 Outpatient $93.00 Not Applicable: Bundled with Procedure $120.90 $130.20 $122.76 $290.00 $65.10 $148.80 $65.10 $290.00 Ultrasound Doppler Complete Add-On 93975 ULTRASOUND $954.00 Outpatient $477.00 $547.03 $620.10 $667.80 $629.64 $290.00 $333.90 $763.20 $290.00 $763.20 US Arterial Upper Extremity Bilateral 93930 ULTRASOUND $555.00 Outpatient $277.50 $547.03 $360.75 $388.50 $366.30 $290.00 $194.25 $444.00 $194.25 $547.03 US Cardiac Arterial Upper Ext Bilat 93930 ULTRASOUND $555.00 Outpatient $277.50 $547.03 $360.75 $388.50 $366.30 $290.00 $194.25 $444.00 $194.25 $547.03 US Arterial Lower Extremity Bilateral 93925 ULTRASOUND $793.00 Outpatient $396.50 $547.03 $515.45 $555.10 $523.38 $290.00 $277.55 $634.40 $277.55 $634.40 US Cardiac Arterial Lower Ext Bilat 93925 ULTRASOUND $793.00 Outpatient $396.50 $547.03 $515.45 $555.10 $523.38 $290.00 $277.55 $634.40 $277.55 $634.40 Echo Needle Placement 76942 ULTRASOUND $458.00 Outpatient $229.00 $287.30 $297.70 $320.60 $302.28 $290.00 $160.30 $366.40 $160.30 $366.40 US Needle Placement 76942 ULTRASOUND $458.00 Outpatient $229.00 $287.30 $297.70 $320.60 $302.28 $290.00 $160.30 $366.40 $160.30 $366.40 US Needle Placement 76942 ULTRASOUND $458.00 Outpatient $229.00 $287.30 $297.70 $320.60 $302.28 $290.00 $160.30 $366.40 $160.30 $366.40 US Procedure Guidance 76942 ULTRASOUND $458.00 Outpatient $229.00 $287.30 $297.70 $320.60 $302.28 $290.00 $160.30 $366.40 $160.30 $366.40 US Fetal Echo/Color 76825 ULTRASOUND $811.00 Outpatient $405.50 $282.74 $527.15 $567.70 $535.26 $290.00 $283.85 $648.80 $282.74 $648.80 US Fetal Echo/Color 76825 ULTRASOUND $811.00 Outpatient $405.50 $282.74 $527.15 $567.70 $535.26 $290.00 $283.85 $648.80 $282.74 $648.80 US Transplant Kidney w Doppler 76776 ULTRASOUND $279.00 Outpatient $139.50 $238.51 $181.35 $195.30 $184.14 $290.00 $97.65 $223.20 $97.65 $290.00 US Transplant Kidney w Doppler 76776 ULTRASOUND $279.00 Outpatient $139.50 $238.51 $181.35 $195.30 $184.14 $290.00 $97.65 $223.20 $97.65 $290.00 US Other Soft Tissue 76999 ULTRASOUND $125.00 Outpatient $62.50 $232.36 $81.25 $87.50 $82.50 $290.00 $43.75 $100.00 $43.75 $290.00 US Other Soft Tissue 76999 ULTRASOUND $125.00 Outpatient $62.50 $232.36 $81.25 $87.50 $82.50 $290.00 $43.75 $100.00 $43.75 $290.00 US Transrectal 76872 ULTRASOUND $399.00 Outpatient $199.50 $225.18 $259.35 $279.30 $263.34 $290.00 $139.65 $319.20 $139.65 $319.20 US Transrectal 76872 ULTRASOUND $399.00 Outpatient $199.50 $225.18 $259.35 $279.30 $263.34 $290.00 $139.65 $319.20 $139.65 $319.20 US Guidance Surgery 76998 ULTRASOUND $834.00 Outpatient $417.00 $223.08 $542.10 $583.80 $550.44 $290.00 $291.90 $667.20 $223.08 $667.20 US Guidance Surgery 76998 ULTRASOUND $834.00 Outpatient $417.00 $223.08 $542.10 $583.80 $550.44 $290.00 $291.90 $667.20 $223.08 $667.20 US NonRad Guidance Surgery 76998 ULTRASOUND $834.00 Outpatient $417.00 $223.08 $542.10 $583.80 $550.44 $290.00 $291.90 $667.20 $223.08 $667.20 US NonRad Guidance Surgery 76998 ULTRASOUND $834.00 Outpatient $417.00 $223.08 $542.10 $583.80 $550.44 $290.00 $291.90 $667.20 $223.08 $667.20 US NonRad OB Eval W Detail Fetal 76811 ULTRASOUND $779.00 Outpatient $389.50 $219.33 $506.35 $545.30 $514.14 $290.00 $272.65 $623.20 $219.33 $623.20 US NonRad OB Eval W Detail Fetal 76811 ULTRASOUND $779.00 Outpatient $389.50 $219.33 $506.35 $545.30 $514.14 $290.00 $272.65 $623.20 $219.33 $623.20 US OB Eval W Detail Fetal 76811 ULTRASOUND $779.00 Outpatient $389.50 $219.33 $506.35 $545.30 $514.14 $290.00 $272.65 $623.20 $219.33 $623.20 US OB Eval W Detail Fetal 76811 ULTRASOUND $779.00 Outpatient $389.50 $219.33 $506.35 $545.30 $514.14 $290.00 $272.65 $623.20 $219.33 $623.20 US Extremity Left Complete 76881 ULTRASOUND $571.00 Outpatient $285.50 $212.66 $371.15 $399.70 $376.86 $290.00 $199.85 $456.80 $199.85 $456.80 US Extremity Right Complete 76881 ULTRASOUND $571.00 Outpatient $285.50 $212.66 $371.15 $399.70 $376.86 $290.00 $199.85 $456.80 $199.85 $456.80 US Extremity Left Complete 76881 ULTRASOUND $571.00 Outpatient $285.50 $212.66 $371.15 $399.70 $376.86 $290.00 $199.85 $456.80 $199.85 $456.80 US Extremity Right Complete 76881 ULTRASOUND $571.00 Outpatient $285.50 $212.66 $371.15 $399.70 $376.86 $290.00 $199.85 $456.80 $199.85 $456.80 US Abdomen Complete 76700 ULTRASOUND $828.00 Outpatient $414.00 $211.82 $538.20 $579.60 $546.48 $290.00 $289.80 $662.40 $211.82 $662.40 US Abdomen Complete 76700 ULTRASOUND $828.00 Outpatient $414.00 $211.82 $538.20 $579.60 $546.48 $290.00 $289.80 $662.40 $211.82 $662.40 US Retroperitoneum Complete 76770 ULTRASOUND $666.00 Outpatient $333.00 $205.16 $432.90 $466.20 $439.56 $290.00 $233.10 $532.80 $205.16 $532.80 US Retroperitoneum Complete 76770 ULTRASOUND $506.00 Outpatient $253.00 $205.16 $328.90 $354.20 $333.96 $290.00 $177.10 $404.80 $177.10 $404.80 US Retroperitoneum Complete w Doppler 76770 ULTRASOUND "$1,460.00 " Outpatient $730.00 $205.16 $949.00 "$1,022.00 " $963.60 $290.00 $511.00 "$1,168.00 " $205.16 "$1,168.00 " US Retroperitoneum Complete w Doppler 76770 ULTRASOUND "$1,460.00 " Outpatient $730.00 $205.16 $949.00 "$1,022.00 " $963.60 $290.00 $511.00 "$1,168.00 " $205.16 "$1,168.00 " US Scrotum 76870 ULTRASOUND $542.00 Outpatient $271.00 $192.64 $352.30 $379.40 $357.72 $290.00 $189.70 $433.60 $189.70 $433.60 US Scrotum 76870 ULTRASOUND $542.00 Outpatient $271.00 $192.64 $352.30 $379.40 $357.72 $290.00 $189.70 $433.60 $189.70 $433.60 US Scrotum w/ Doppler 76870 ULTRASOUND $571.00 Outpatient $285.50 $192.64 $371.15 $399.70 $376.86 $290.00 $199.85 $456.80 $192.64 $456.80 US Central Pelvic Non-OB 76856 ULTRASOUND $709.00 Outpatient $354.50 $190.16 $460.85 $496.30 $467.94 $290.00 $248.15 $567.20 $190.16 $567.20 US Pelvic Non-Obstetrics 76856 ULTRASOUND $709.00 Outpatient $354.50 $190.16 $460.85 $496.30 $467.94 $290.00 $248.15 $567.20 $190.16 $567.20 US Pelvic Non-Obsetrics 76856 ULTRASOUND $709.00 Outpatient $354.50 $190.16 $460.85 $496.30 $467.94 $290.00 $248.15 $567.20 $190.16 $567.20 US Pelvic Non-OB w Transvag if needed 76856 ULTRASOUND $709.00 Outpatient $354.50 $190.16 $460.85 $496.30 $467.94 $290.00 $248.15 $567.20 $190.16 $567.20 US Womens Pelvic Non-OB 76856 ULTRASOUND $709.00 Outpatient $354.50 $190.16 $460.85 $496.30 $467.94 $290.00 $248.15 $567.20 $190.16 $567.20 Transvaginal Non-OB Add on 76830 ULTRASOUND $709.00 Outpatient $354.50 $190.16 $460.85 $496.30 $467.94 $290.00 $248.15 $567.20 $190.16 $567.20 US Central Transvaginal Non-OB 76830 ULTRASOUND $709.00 Outpatient $354.50 $190.16 $460.85 $496.30 $467.94 $290.00 $248.15 $567.20 $190.16 $567.20 US Transvaginal Non-OB 76830 ULTRASOUND $709.00 Outpatient $354.50 $190.16 $460.85 $496.30 $467.94 $290.00 $248.15 $567.20 $190.16 $567.20 US Transvaginal Non-OB 76830 ULTRASOUND $709.00 Outpatient $354.50 $190.16 $460.85 $496.30 $467.94 $290.00 $248.15 $567.20 $190.16 $567.20 US Soft Tissue Head and Neck 76536 ULTRASOUND $757.00 Outpatient $378.50 $186.81 $492.05 $529.90 $499.62 $290.00 $264.95 $605.60 $186.81 $605.60 US Soft Tissue Head and Neck 76536 ULTRASOUND $757.00 Outpatient $378.50 $186.81 $492.05 $529.90 $499.62 $290.00 $264.95 $605.60 $186.81 $605.60 US Thyroid 76536 ULTRASOUND $575.00 Outpatient $287.50 $186.81 $373.75 $402.50 $379.50 $290.00 $201.25 $460.00 $186.81 $460.00 US Thyroid 76536 ULTRASOUND $575.00 Outpatient $287.50 $186.81 $373.75 $402.50 $379.50 $290.00 $201.25 $460.00 $186.81 $460.00 FAST Scan Aorta add on 76775 ULTRASOUND $443.00 Outpatient $221.50 $177.62 $287.95 $310.10 $292.38 $290.00 $155.05 $354.40 $155.05 $354.40 US AAA NON-SCREENING 76775 ULTRASOUND $666.00 Outpatient $333.00 $177.62 $432.90 $466.20 $439.56 $290.00 $233.10 $532.80 $177.62 $532.80 US Retroperitoneum Limited 76775 ULTRASOUND $443.00 Outpatient $221.50 $177.62 $287.95 $310.10 $292.38 $290.00 $155.05 $354.40 $155.05 $354.40 US Retroperitoneum Limited 76775 ULTRASOUND $443.00 Outpatient $221.50 $177.62 $287.95 $310.10 $292.38 $290.00 $155.05 $354.40 $155.05 $354.40 US OB 1st Trimester 76801 ULTRASOUND $681.00 Outpatient $340.50 $175.14 $442.65 $476.70 $449.46 $290.00 $238.35 $544.80 $175.14 $544.80 US OB 1st Trimester 76801 ULTRASOUND $681.00 Outpatient $340.50 $175.14 $442.65 $476.70 $449.46 $290.00 $238.35 $544.80 $175.14 $544.80 US OB 1st Trimester w Transvag if needed 76801 ULTRASOUND $681.00 Outpatient $340.50 $175.14 $442.65 $476.70 $449.46 $290.00 $238.35 $544.80 $175.14 $544.80 US Abdomen Limited 76705 ULTRASOUND $666.00 Outpatient $333.00 $163.43 $432.90 $466.20 $439.56 $290.00 $233.10 $532.80 $163.43 $532.80 US ER FAST Scan 76705 ULTRASOUND $666.00 Outpatient $333.00 $163.43 $432.90 $466.20 $439.56 $290.00 $233.10 $532.80 $163.43 $532.80 US AAA Screening 76706 ULTRASOUND $420.00 Outpatient $210.00 $157.56 $273.00 $294.00 $277.20 $290.00 $147.00 $336.00 $147.00 $336.00 US Spinal Canal 76800 ULTRASOUND $747.00 Outpatient $373.50 $156.77 $485.55 $522.90 $493.02 $290.00 $261.45 $597.60 $156.77 $597.60 US Spinal Canal 76800 ULTRASOUND $747.00 Outpatient $373.50 $156.77 $485.55 $522.90 $493.02 $290.00 $261.45 $597.60 $156.77 $597.60 US Guidance Ablation 76940 ULTRASOUND $171.00 Outpatient $85.50 $151.16 $111.15 $119.70 $112.86 $290.00 $59.85 $136.80 $59.85 $290.00 US Ultrasound Guidance Ablation 76940 ULTRASOUND $171.00 Outpatient $85.50 $151.16 $111.15 $119.70 $112.86 $290.00 $59.85 $136.80 $59.85 $290.00 US Biophysical Profile W Non Stress 76818 ULTRASOUND $839.00 Outpatient $419.50 $150.10 $545.35 $587.30 $553.74 $290.00 $293.65 $671.20 $150.10 $671.20 US Biophysical Profile W Non Stress 76818 ULTRASOUND $839.00 Outpatient $419.50 $150.10 $545.35 $587.30 $553.74 $290.00 $293.65 $671.20 $150.10 $671.20 US NonRad Biophysical Profile W NonStres 76818 ULTRASOUND $839.00 Outpatient $419.50 $150.10 $545.35 $587.30 $553.74 $290.00 $293.65 $671.20 $150.10 $671.20 US NonRad Biophysical Profile W NonStres 76818 ULTRASOUND $839.00 Outpatient $419.50 $150.10 $545.35 $587.30 $553.74 $290.00 $293.65 $671.20 $150.10 $671.20 US Infant Hips WO Manipulation 76886 ULTRASOUND $174.00 Outpatient $87.00 $144.27 $113.10 $121.80 $114.84 $290.00 $60.90 $139.20 $60.90 $290.00 US Infant Hips WO Manipulation 76886 ULTRASOUND $174.00 Outpatient $87.00 $144.27 $113.10 $121.80 $114.84 $290.00 $60.90 $139.20 $60.90 $290.00 US Hips 76885 ULTRASOUND $125.00 Outpatient $62.50 $144.27 $81.25 $87.50 $82.50 $290.00 $43.75 $100.00 $43.75 $290.00 US Hips 76885 ULTRASOUND $125.00 Outpatient $62.50 $144.27 $81.25 $87.50 $82.50 $290.00 $43.75 $100.00 $43.75 $290.00 US ER Pelvic Non OB 76857 ULTRASOUND $589.00 Outpatient $294.50 $144.27 $382.85 $412.30 $388.74 $290.00 $206.15 $471.20 $144.27 $471.20 US ER Pelvic OB 76857 ULTRASOUND $589.00 Outpatient $294.50 $144.27 $382.85 $412.30 $388.74 $290.00 $206.15 $471.20 $144.27 $471.20 US ER Pelvic Non OB 76857 ULTRASOUND $589.00 Outpatient $294.50 $144.27 $382.85 $412.30 $388.74 $290.00 $206.15 $471.20 $144.27 $471.20 US ER Pelvic OB 76857 ULTRASOUND $589.00 Outpatient $294.50 $144.27 $382.85 $412.30 $388.74 $290.00 $206.15 $471.20 $144.27 $471.20 US NonRad Pelvic Non-OB Limited 76857 ULTRASOUND $589.00 Outpatient $294.50 $144.27 $382.85 $412.30 $388.74 $290.00 $206.15 $471.20 $144.27 $471.20 US Pelvic Non-Obstetrics Limited 76857 ULTRASOUND $589.00 Outpatient $294.50 $144.27 $382.85 $412.30 $388.74 $290.00 $206.15 $471.20 $144.27 $471.20 US Pelvic Non-Obstetrics Limited 76857 ULTRASOUND $589.00 Outpatient $294.50 $144.27 $382.85 $412.30 $388.74 $290.00 $206.15 $471.20 $144.27 $471.20 US NonRad OB Re-eval of Fetus 76816 ULTRASOUND $681.00 Outpatient $340.50 $144.27 $442.65 $476.70 $449.46 $290.00 $238.35 $544.80 $144.27 $544.80 US NonRad OB Re-eval of Fetus 76816 ULTRASOUND $681.00 Outpatient $340.50 $144.27 $442.65 $476.70 $449.46 $290.00 $238.35 $544.80 $144.27 $544.80 US OB Re-eval of Fetus 76816 ULTRASOUND $681.00 Outpatient $340.50 $144.27 $442.65 $476.70 $449.46 $290.00 $238.35 $544.80 $144.27 $544.80 US OB Re-eval of Fetus 76816 ULTRASOUND $681.00 Outpatient $340.50 $144.27 $442.65 $476.70 $449.46 $290.00 $238.35 $544.80 $144.27 $544.80 US NonRad OB Re-eval of Fetus Addl Ges 76812 ULTRASOUND $145.00 Outpatient $72.50 $144.27 $94.25 $101.50 $95.70 $290.00 $50.75 $116.00 $50.75 $290.00 US OB Eval W Detail Fetal Add'l Gest 76812 ULTRASOUND $589.00 Outpatient $294.50 $144.27 $382.85 $412.30 $388.74 $290.00 $206.15 $471.20 $144.27 $471.20 US OB Eval W Detail Fetal Add'l Gest 76812 ULTRASOUND $589.00 Outpatient $294.50 $144.27 $382.85 $412.30 $388.74 $290.00 $206.15 $471.20 $144.27 $471.20 US Brain 76506 ULTRASOUND $767.00 Outpatient $383.50 $144.27 $498.55 $536.90 $506.22 $290.00 $268.45 $613.60 $144.27 $613.60 US Brain 76506 ULTRASOUND $767.00 Outpatient $383.50 $144.27 $498.55 $536.90 $506.22 $290.00 $268.45 $613.60 $144.27 $613.60 US Axilla 76642 ULTRASOUND $422.00 Outpatient $211.00 $143.43 $274.30 $295.40 $278.52 $290.00 $147.70 $337.60 $143.43 $337.60 US Axilla 76642 ULTRASOUND $422.00 Outpatient $211.00 $143.43 $274.30 $295.40 $278.52 $290.00 $147.70 $337.60 $143.43 $337.60 US Breast Left Limited 76642 ULTRASOUND $422.00 Outpatient $211.00 $143.43 $274.30 $295.40 $278.52 $290.00 $147.70 $337.60 $143.43 $337.60 US Breast Right Limited 76642 ULTRASOUND $422.00 Outpatient $211.00 $143.43 $274.30 $295.40 $278.52 $290.00 $147.70 $337.60 $143.43 $337.60 US Breast Left Limited 76642 ULTRASOUND $422.00 Outpatient $211.00 $143.43 $274.30 $295.40 $278.52 $290.00 $147.70 $337.60 $143.43 $337.60 US Breast Right Limited 76642 ULTRASOUND $422.00 Outpatient $211.00 $143.43 $274.30 $295.40 $278.52 $290.00 $147.70 $337.60 $143.43 $337.60 US Breast Left Complete 76641 ULTRASOUND $453.00 Outpatient $226.50 $143.43 $294.45 $317.10 $298.98 $290.00 $158.55 $362.40 $143.43 $362.40 US Breast Left Complete 76641 ULTRASOUND $453.00 Outpatient $226.50 $143.43 $294.45 $317.10 $298.98 $290.00 $158.55 $362.40 $143.43 $362.40 US Breast Right Complete 76641 ULTRASOUND $453.00 Outpatient $226.50 $143.43 $294.45 $317.10 $298.98 $290.00 $158.55 $362.40 $143.43 $362.40 US Breast Right Complete 76641 ULTRASOUND $453.00 Outpatient $226.50 $143.43 $294.45 $317.10 $298.98 $290.00 $158.55 $362.40 $143.43 $362.40 US Breast Bilateral Complete 76641 ULTRASOUND $905.00 Outpatient $452.50 $143.43 $588.25 $633.50 $597.30 $290.00 $316.75 $724.00 $143.43 $724.00 Transvaginal OB Add on 76817 ULTRASOUND $681.00 Outpatient $340.50 $141.77 $442.65 $476.70 $449.46 $290.00 $238.35 $544.80 $141.77 $544.80 US NonRad OB Transvaginal 76817 ULTRASOUND $681.00 Outpatient $340.50 $141.77 $442.65 $476.70 $449.46 $290.00 $238.35 $544.80 $141.77 $544.80 US NonRad OB Transvaginal 76817 ULTRASOUND $681.00 Outpatient $340.50 $141.77 $442.65 $476.70 $449.46 $290.00 $238.35 $544.80 $141.77 $544.80 US OB Transvaginal 76817 ULTRASOUND $681.00 Outpatient $340.50 $141.77 $442.65 $476.70 $449.46 $290.00 $238.35 $544.80 $141.77 $544.80 US OB Transvaginal 76817 ULTRASOUND $681.00 Outpatient $340.50 $141.77 $442.65 $476.70 $449.46 $290.00 $238.35 $544.80 $141.77 $544.80 US Fetal Middle Cerebral Artery 76821 ULTRASOUND $464.00 Outpatient $232.00 $134.27 $301.60 $324.80 $306.24 $290.00 $162.40 $371.20 $134.27 $371.20 US Fetal Middle Cerebral Artery 76821 ULTRASOUND $464.00 Outpatient $232.00 $134.27 $301.60 $324.80 $306.24 $290.00 $162.40 $371.20 $134.27 $371.20 US NonRad Fetal Middle Cerebral Artery 76821 ULTRASOUND $464.00 Outpatient $232.00 $134.27 $301.60 $324.80 $306.24 $290.00 $162.40 $371.20 $134.27 $371.20 US NonRad Fetal Middle Cerebral Artery 76821 ULTRASOUND $464.00 Outpatient $232.00 $134.27 $301.60 $324.80 $306.24 $290.00 $162.40 $371.20 $134.27 $371.20 FAST Scan Chest add on 76604 ULTRASOUND $555.00 Outpatient $277.50 $128.43 $360.75 $388.50 $366.30 $290.00 $194.25 $444.00 $128.43 $444.00 US Chest 76604 ULTRASOUND $555.00 Outpatient $277.50 $128.43 $360.75 $388.50 $366.30 $290.00 $194.25 $444.00 $128.43 $444.00 US Chest 76604 ULTRASOUND $555.00 Outpatient $277.50 $128.43 $360.75 $388.50 $366.30 $290.00 $194.25 $444.00 $128.43 $444.00 US Soft Tissue on Back 76604 ULTRASOUND $125.00 Outpatient $62.50 $128.43 $81.25 $87.50 $82.50 $290.00 $43.75 $100.00 $43.75 $290.00 US NonRad OB Limited 76815 ULTRASOUND $589.00 Outpatient $294.50 $127.60 $382.85 $412.30 $388.74 $290.00 $206.15 $471.20 $127.60 $471.20 US NonRad OB Limited 76815 ULTRASOUND $589.00 Outpatient $294.50 $127.60 $382.85 $412.30 $388.74 $290.00 $206.15 $471.20 $127.60 $471.20 US Obstetrics Limited 76815 ULTRASOUND $589.00 Outpatient $294.50 $127.60 $382.85 $412.30 $388.74 $290.00 $206.15 $471.20 $127.60 $471.20 US Obstetrics Limited 76815 ULTRASOUND $589.00 Outpatient $294.50 $127.60 $382.85 $412.30 $388.74 $290.00 $206.15 $471.20 $127.60 $471.20 US Biophysical Profile W/O Non Stress 76819 ULTRASOUND $642.00 Outpatient $321.00 $116.73 $417.30 $449.40 $423.72 $290.00 $224.70 $513.60 $116.73 $513.60 US Biophysical Profile W/O Non Stress 76819 ULTRASOUND $642.00 Outpatient $321.00 $116.73 $417.30 $449.40 $423.72 $290.00 $224.70 $513.60 $116.73 $513.60 US NonRad Biophysical Profile W/O Non Stress 76819 ULTRASOUND $642.00 Outpatient $321.00 $116.73 $417.30 $449.40 $423.72 $290.00 $224.70 $513.60 $116.73 $513.60 US NonRad Biophysical Profile W/O Non S 76819 ULTRASOUND $642.00 Outpatient $321.00 $116.73 $417.30 $449.40 $423.72 $290.00 $224.70 $513.60 $116.73 $513.60 US ER Ocular 76512 ULTRASOUND $105.00 Outpatient $52.50 $87.56 $68.25 $73.50 $69.30 $290.00 $36.75 $84.00 $36.75 $290.00 US ER Ocular 76512 ULTRASOUND $105.00 Outpatient $52.50 $87.56 $68.25 $73.50 $69.30 $290.00 $36.75 $84.00 $36.75 $290.00 US ER Ocular FB 76529 ULTRASOUND $103.00 Outpatient $51.50 $85.87 $66.95 $72.10 $67.98 $290.00 $36.05 $82.40 $36.05 $290.00 US ER Ocular FB 76529 ULTRASOUND $103.00 Outpatient $51.50 $85.87 $66.95 $72.10 $67.98 $290.00 $36.05 $82.40 $36.05 $290.00 US NonRad 1st Trimester Addl Gestation 76802 ULTRASOUND $423.00 Outpatient $211.50 $64.19 $274.95 $296.10 $279.18 $290.00 $148.05 $338.40 $64.19 $338.40 US OB 1st Trimester Additional Gest 76802 ULTRASOUND $404.00 Outpatient $202.00 $64.19 $262.60 $282.80 $266.64 $290.00 $141.40 $323.20 $64.19 $323.20 US OB 1st Trimester Additional Gest 76802 ULTRASOUND $404.00 Outpatient $202.00 $64.19 $262.60 $282.80 $266.64 $290.00 $141.40 $323.20 $64.19 $323.20 US Amniocentesis 76946 ULTRASOUND $964.00 Outpatient $482.00 $47.50 $626.60 $674.80 $636.24 $290.00 $337.40 $771.20 $47.50 $771.20 US Amniocentesis 76946 ULTRASOUND $964.00 Outpatient $482.00 $47.50 $626.60 $674.80 $636.24 $290.00 $337.40 $771.20 $47.50 $771.20 US NonRad Amniocentesis 76946 ULTRASOUND $964.00 Outpatient $482.00 $47.50 $626.60 $674.80 $636.24 $290.00 $337.40 $771.20 $47.50 $771.20 US NonRad Amniocentesis 76946 ULTRASOUND $964.00 Outpatient $482.00 $47.50 $626.60 $674.80 $636.24 $290.00 $337.40 $771.20 $47.50 $771.20 US ER Vascular Access 76937 ULTRASOUND $49.00 Outpatient $24.50 $41.67 $31.85 $34.30 $32.34 $290.00 $17.15 $39.20 $17.15 $290.00 US ER Vascular Access 76937 ULTRASOUND $49.00 Outpatient $24.50 $41.67 $31.85 $34.30 $32.34 $290.00 $17.15 $39.20 $17.15 $290.00 US Guidance Vasc Access 76937 ULTRASOUND $49.00 Outpatient $24.50 $41.67 $31.85 $34.30 $32.34 $290.00 $17.15 $39.20 $17.15 $290.00 US Extremity Left Limited 76882 ULTRASOUND $542.00 Outpatient $271.00 $24.98 $352.30 $379.40 $357.72 $290.00 $189.70 $433.60 $24.98 $433.60 US Extremity Right Limited 76882 ULTRASOUND $542.00 Outpatient $271.00 $24.98 $352.30 $379.40 $357.72 $290.00 $189.70 $433.60 $24.98 $433.60 US Extremity Left Limited 76882 ULTRASOUND $542.00 Outpatient $271.00 $24.98 $352.30 $379.40 $357.72 $290.00 $189.70 $433.60 $24.98 $433.60 US Extremity Right Limited 76882 ULTRASOUND $542.00 Outpatient $271.00 $24.98 $352.30 $379.40 $357.72 $290.00 $189.70 $433.60 $24.98 $433.60 Clinic- Infusion add hr 96366 IV THERAPY $136.00 Outpatient $68.00 $45.21 $88.40 $95.20 $89.76 $104.00 $47.60 $108.80 $45.21 $108.80 IV Infusion Thera Prophylaxis Ea Add Hr 96366 IV THERAPY $141.00 Outpatient $70.50 $45.21 $91.65 $98.70 $93.06 $104.00 $49.35 $112.80 $45.21 $112.80 IV Infusion Thera Prophylaxis Ea Add Hr 96366 IV THERAPY $141.00 Outpatient $70.50 $45.21 $91.65 $98.70 $93.06 $104.00 $49.35 $112.80 $45.21 $112.80 IV Infusion therapy prophylaxis dx add hrs 96366 IV THERAPY $136.00 Outpatient $68.00 $45.21 $88.40 $95.20 $89.76 $104.00 $47.60 $108.80 $45.21 $108.80 Clinic- Infusion Concurrent 96368 IV THERAPY $136.00 Outpatient $68.00 $42.29 $88.40 $95.20 $89.76 $104.00 $47.60 $108.80 $42.29 $108.80 IV Infusion Concurrent not Hydration 96368 IV THERAPY $141.00 Outpatient $70.50 $42.29 $91.65 $98.70 $93.06 $104.00 $49.35 $112.80 $42.29 $112.80 IV Infusion Concurrent not Hydration 96368 IV THERAPY $141.00 Outpatient $70.50 $42.29 $91.65 $98.70 $93.06 $104.00 $49.35 $112.80 $42.29 $112.80 IV Infusion concurrently other than hydration 96368 IV THERAPY $136.00 Outpatient $68.00 $42.29 $88.40 $95.20 $89.76 $104.00 $47.60 $108.80 $42.29 $108.80 Injection Subcutaeous Intramuscular 96372 IV THERAPY $58.00 Outpatient $29.00 $39.24 $37.70 $40.60 $38.28 $104.00 $20.30 $46.40 $20.30 $104.00 Injection Subcutaeous/ Intramuscular 96372 IV THERAPY $58.00 Outpatient $29.00 $39.24 $37.70 $40.60 $38.28 $104.00 $20.30 $46.40 $20.30 $104.00 "Ther/Proph/Diag Inj, SC/IM" 96372 IV THERAPY $56.00 Outpatient $28.00 $39.24 $36.40 $39.20 $36.96 $104.00 $19.60 $44.80 $19.60 $104.00 Specimen Collect In and Out Cath - Urinary Catheter Activity: P9612 TREATMENT RM $27.00 Outpatient $13.50 $10.80 $17.55 $18.90 $17.82 $3.00 $9.45 $21.60 $3.00 $21.60 Clinic- infusion hydration add hr 96361 IV THERAPY $74.00 Outpatient $37.00 $35.02 $48.10 $51.80 $48.84 $104.00 $25.90 $59.20 $25.90 $104.00 TROC 23GA 1 VLV ESCP BL5283 TAKEHOME SUPPLY $577.00 Outpatient $288.50 Not Applicable: Bundled with Procedure $375.05 $403.90 $380.82 Not Applicable: Bundled with Procedure $201.95 $461.60 $201.95 $461.60 BIT DRL SHRT PRLC 2.7MM CNN QCK CNCT DISP 71173502 SUPPLY/OTHER $599.00 Outpatient $299.50 Not Applicable: Bundled with Procedure $389.35 $419.30 $395.34 Not Applicable: Bundled with Procedure $209.65 $479.20 $209.65 $479.20 BIT DRL 140MM 2MM QC D MRK NS 323.062 SUPPLY/OTHER "$1,036.00 " Outpatient $518.00 Not Applicable: Bundled with Procedure $673.40 $725.20 $683.76 Not Applicable: Bundled with Procedure $362.60 $828.80 $362.60 $828.80 CAP ESCPSL DEXTRUS VLNK HAP02 SUPPLY/OTHER "$2,309.00 " Outpatient "$1,154.50 " Not Applicable: Bundled with Procedure "$1,500.85 " "$1,616.30 " "$1,523.94 " Not Applicable: Bundled with Procedure $808.15 "$1,847.20 " $808.15 "$1,847.20 " DBS MONITORING SERVICES DBSMONITORING SUPPLY/OTHER "$9,783.00 " Outpatient "$4,891.50 " Not Applicable: Bundled with Procedure "$6,358.95 " "$6,848.10 " "$6,456.78 " Not Applicable: Bundled with Procedure "$3,424.05 " "$7,826.40 " "$3,424.05 " "$7,826.40 " HEAD HUM 18MM 46MM 42MM SHLDR CMPRH VERSA-DIAL 113032 SUPPLY/OTHER "$8,061.00 " Outpatient "$4,030.50 " Not Applicable: Bundled with Procedure "$5,239.65 " "$5,642.70 " "$5,320.26 " Not Applicable: Bundled with Procedure "$2,821.35 " "$6,448.80 " "$2,821.35 " "$6,448.80 " KIT ACC PRFLRN PRC LQ 5ML 8065900163 SUPPLY/OTHER "$2,371.00 " Outpatient "$1,185.50 " Not Applicable: Bundled with Procedure "$1,541.15 " "$1,659.70 " "$1,564.86 " Not Applicable: Bundled with Procedure $829.85 "$1,896.80 " $829.85 "$1,896.80 " KIT MNTR FORE-SIGHT LG SM STAT 2 SNSR BTRY CRBRL OXM 10433-001 SUPPLY/OTHER $512.00 Outpatient $256.00 Not Applicable: Bundled with Procedure $332.80 $358.40 $337.92 Not Applicable: Bundled with Procedure $179.20 $409.60 $179.20 $409.60 SYS EMBL SYR ONX18 DMTH SLFXD 1.5ML 1ML 105-7100-060 SUPPLY/OTHER "$10,248.00 " Outpatient "$5,124.00 " Not Applicable: Bundled with Procedure "$6,661.20 " "$7,173.60 " "$6,763.68 " Not Applicable: Bundled with Procedure "$3,586.80 " "$8,198.40 " "$3,586.80 " "$8,198.40 " PLATE BONE ZAVATION L68 MM SPINE CERVICAL 4 LEVEL NONSTERILE 30-0468 C1713 SUPPLY/OTHER "$5,369.00 " Outpatient "$2,684.50 " "$1,219.74 " "$3,489.85 " "$3,758.30 " "$3,543.54 " Not Applicable: Bundled with Procedure "$1,879.15 " "$4,295.20 " "$1,219.74 " "$4,295.20 " ROD PRE BENT 55MM RSS10-55 C1713 SUPPLY/OTHER "$1,370.00 " Outpatient $685.00 "$1,219.74 " $890.50 $959.00 $904.20 Not Applicable: Bundled with Procedure $479.50 "$1,096.00 " $479.50 "$1,219.74 " DISC INTERVERTEBRAL MOBI-C TITANIUM HA D17 MM STANDARD W19 MB3795 SUPPLY/IMPLANTS "$24,700.00 " Outpatient "$12,350.00 " Not Applicable: Bundled with Procedure "$16,055.00 " "$17,290.00 " "$16,302.00 " Not Applicable: Bundled with Procedure "$8,645.00 " "$19,760.00 " "$8,645.00 " "$19,760.00 " 14MM X 16MM 7 LORDOTIC 8MM INTERBODY SPC-1416-0708 SUPPLY/IMPLANTS "$5,871.00 " Outpatient "$2,935.50 " Not Applicable: Bundled with Procedure "$3,816.15 " "$4,109.70 " "$3,874.86 " Not Applicable: Bundled with Procedure "$2,054.85 " "$4,696.80 " "$2,054.85 " "$4,696.80 " 21MM WATCHMAN LAA CLOSURE DEVICE M635WU21060 SUPPLY/IMPLANTS "$83,173.00 " Outpatient "$41,586.50 " Not Applicable: Bundled with Procedure "$54,062.45 " "$58,221.10 " "$54,894.18 " Not Applicable: Bundled with Procedure "$29,110.55 " "$66,538.40 " "$29,110.55 " "$66,538.40 " 24MM WATCHMAN LAA CLOSURE DEVICE M635WU24060 SUPPLY/IMPLANTS "$83,173.00 " Outpatient "$41,586.50 " Not Applicable: Bundled with Procedure "$54,062.45 " "$58,221.10 " "$54,894.18 " Not Applicable: Bundled with Procedure "$29,110.55 " "$66,538.40 " "$29,110.55 " "$66,538.40 " 27MM WATCHMAN LAA CLOSURE DEVICE M635WU27060 SUPPLY/IMPLANTS "$83,173.00 " Outpatient "$41,586.50 " Not Applicable: Bundled with Procedure "$54,062.45 " "$58,221.10 " "$54,894.18 " Not Applicable: Bundled with Procedure "$29,110.55 " "$66,538.40 " "$29,110.55 " "$66,538.40 " 30MM WATCHMAN LAA CLOSURE DEVICE M635WU30060 SUPPLY/IMPLANTS "$83,173.00 " Outpatient "$41,586.50 " Not Applicable: Bundled with Procedure "$54,062.45 " "$58,221.10 " "$54,894.18 " Not Applicable: Bundled with Procedure "$29,110.55 " "$66,538.40 " "$29,110.55 " "$66,538.40 " 33MM WATCHMAN LAA CLOSURE DEVICE M635WU33060 SUPPLY/IMPLANTS "$83,173.00 " Outpatient "$41,586.50 " Not Applicable: Bundled with Procedure "$54,062.45 " "$58,221.10 " "$54,894.18 " Not Applicable: Bundled with Procedure "$29,110.55 " "$66,538.40 " "$29,110.55 " "$66,538.40 " 5.5 LITTER IMPELLA 0550-0008 SUPPLY/IMPLANTS "$171,238.00 " Outpatient "$85,619.00 " Not Applicable: Bundled with Procedure "$111,304.70 " "$119,866.60 " "$113,017.08 " Not Applicable: Bundled with Procedure "$59,933.30 " "$136,990.40 " "$59,933.30 " "$136,990.40 " ABS CO2 MUL WHT TO VIOL CHG .8KG MDSRB SODA LIME DISP M1173310 SUPPLY/IMPLANTS $518.00 Outpatient $259.00 Not Applicable: Bundled with Procedure $336.70 $362.60 $341.88 Not Applicable: Bundled with Procedure $181.30 $414.40 $181.30 $414.40 ACHILLES TENDON WITH WHOLE BONE BLOCK NOT OVER AGE 40 43200 SUPPLY/IMPLANTS "$12,458.00 " Outpatient "$6,229.00 " Not Applicable: Bundled with Procedure "$8,097.70 " "$8,720.60 " "$8,222.28 " Not Applicable: Bundled with Procedure "$4,360.30 " "$9,966.40 " "$4,360.30 " "$9,966.40 " ADH SRG BIOGL SFT TIS BSA GLUT PREFL SYR 3 SPRDR 4 STD TIP BG3510-5-US SUPPLY/IMPLANTS "$4,037.00 " Outpatient "$2,018.50 " Not Applicable: Bundled with Procedure "$2,624.05 " "$2,825.90 " "$2,664.42 " Not Applicable: Bundled with Procedure "$1,412.95 " "$3,229.60 " "$1,412.95 " "$3,229.60 " ALLOGRAFT PLUG OATS KIT 16MM ABS-1982-16S SUPPLY/IMPLANTS "$3,783.00 " Outpatient "$1,891.50 " Not Applicable: Bundled with Procedure "$2,458.95 " "$2,648.10 " "$2,496.78 " Not Applicable: Bundled with Procedure "$1,324.05 " "$3,026.40 " "$1,324.05 " "$3,026.40 " ALLOSYNC COTTON WEDGE 20MM X 7.5MM ABS-2800-2075 SUPPLY/IMPLANTS "$8,195.00 " Outpatient "$4,097.50 " Not Applicable: Bundled with Procedure "$5,326.75 " "$5,736.50 " "$5,408.70 " Not Applicable: Bundled with Procedure "$2,868.25 " "$6,556.00 " "$2,868.25 " "$6,556.00 " ANCH SUT 2 CP-2 G2QKAN+ ETH 212034 SUPPLY/IMPLANTS "$1,841.00 " Outpatient $920.50 Not Applicable: Bundled with Procedure "$1,196.65 " "$1,288.70 " "$1,215.06 " Not Applicable: Bundled with Procedure $644.35 "$1,472.80 " $644.35 "$1,472.80 " ANCH SUT 5.5MM 2 FT CSCR FWR TIGERWIRE 2 DRV MECH VNT BCMPS AR-1927BCF SUPPLY/IMPLANTS "$2,650.00 " Outpatient "$1,325.00 " Not Applicable: Bundled with Procedure "$1,722.50 " "$1,855.00 " "$1,749.00 " Not Applicable: Bundled with Procedure $927.50 "$2,120.00 " $927.50 "$2,120.00 " ANCH SUT 4.75MM SWIVELOCK SHLDR SLF PNCH VNT BCMPS PEEK 24.5 AR-2324BCM SUPPLY/IMPLANTS "$2,936.00 " Outpatient "$1,468.00 " Not Applicable: Bundled with Procedure "$1,908.40 " "$2,055.20 " "$1,937.76 " Not Applicable: Bundled with Procedure "$1,027.60 " "$2,348.80 " "$1,027.60 " "$2,348.80 " ANCH SUT 3.5MM SWIVELOCK SHLDR BCMPS 15.8MM AR-2325BCC SUPPLY/IMPLANTS "$2,798.00 " Outpatient "$1,399.00 " Not Applicable: Bundled with Procedure "$1,818.70 " "$1,958.60 " "$1,846.68 " Not Applicable: Bundled with Procedure $979.30 "$2,238.40 " $979.30 "$2,238.40 " ANCH SUT 3MM 2 SUT TK TGTL BCMPS 14.5MM STRL DISP AR-1934BCFT SUPPLY/IMPLANTS "$2,650.00 " Outpatient "$1,325.00 " Not Applicable: Bundled with Procedure "$1,722.50 " "$1,855.00 " "$1,749.00 " Not Applicable: Bundled with Procedure $927.50 "$2,120.00 " $927.50 "$2,120.00 " ANCH SUT 4.5MM FTPRNT ULT PEEK-OPTM 72202901 SUPPLY/IMPLANTS "$2,280.00 " Outpatient "$1,140.00 " Not Applicable: Bundled with Procedure "$1,482.00 " "$1,596.00 " "$1,504.80 " Not Applicable: Bundled with Procedure $798.00 "$1,824.00 " $798.00 "$1,824.00 " ANCH SUT 1 DMD PT SUT TK S JNT 2 NDL FBRWR BCMPS STRL AR-8934BCNF SUPPLY/IMPLANTS "$2,653.00 " Outpatient "$1,326.50 " Not Applicable: Bundled with Procedure "$1,724.45 " "$1,857.10 " "$1,750.98 " Not Applicable: Bundled with Procedure $928.55 "$2,122.40 " $928.55 "$2,122.40 " ANCH SUT 6.5MM 2 FT CSCR FWR TI 16.3MM AR-1929SF-3 SUPPLY/IMPLANTS "$1,997.00 " Outpatient $998.50 Not Applicable: Bundled with Procedure "$1,298.05 " "$1,397.90 " "$1,318.02 " Not Applicable: Bundled with Procedure $698.95 "$1,597.60 " $698.95 "$1,597.60 " ANNULOPLASTY RING CONTOUR 3-D 30MM 690R SUPPLY/IMPLANTS "$10,516.00 " Outpatient "$5,258.00 " Not Applicable: Bundled with Procedure "$6,835.40 " "$7,361.20 " "$6,940.56 " Not Applicable: Bundled with Procedure "$3,680.60 " "$8,412.80 " "$3,680.60 " "$8,412.80 " ANNULOPLASTY RING SEGUIN SJM SARP-26 SARP-26 SUPPLY/IMPLANTS "$7,706.00 " Outpatient "$3,853.00 " Not Applicable: Bundled with Procedure "$5,008.90 " "$5,394.20 " "$5,085.96 " Not Applicable: Bundled with Procedure "$2,697.10 " "$6,164.80 " "$2,697.10 " "$6,164.80 " ANNULOPLASTY RING CONTOUR 34MM 690R34 SUPPLY/IMPLANTS "$9,273.00 " Outpatient "$4,636.50 " Not Applicable: Bundled with Procedure "$6,027.45 " "$6,491.10 " "$6,120.18 " Not Applicable: Bundled with Procedure "$3,245.55 " "$7,418.40 " "$3,245.55 " "$7,418.40 " ARCH EXTERNAL FIXATION OD140 MM FOOT 4934-6-140 SUPPLY/IMPLANTS "$6,943.00 " Outpatient "$3,471.50 " Not Applicable: Bundled with Procedure "$4,512.95 " "$4,860.10 " "$4,582.38 " Not Applicable: Bundled with Procedure "$2,430.05 " "$5,554.40 " "$2,430.05 " "$5,554.40 " "ARTACENT FLEX AMNIOTIC MEMBRANE, 2X2MM ART1202" SUPPLY/IMPLANTS "$3,002.00 " Outpatient "$1,501.00 " Not Applicable: Bundled with Procedure "$1,951.30 " "$2,101.40 " "$1,981.32 " Not Applicable: Bundled with Procedure "$1,050.70 " "$2,401.60 " "$1,050.70 " "$2,401.60 " ASMB CBLPN 483MM 1.3MM 4MM CBL RD SS SET 2 CRMP PSR 65MM 223205021 SUPPLY/IMPLANTS "$2,466.00 " Outpatient "$1,233.00 " Not Applicable: Bundled with Procedure "$1,602.90 " "$1,726.20 " "$1,627.56 " Not Applicable: Bundled with Procedure $863.10 "$1,972.80 " $863.10 "$1,972.80 " ATCH ROD MR CONDITIONAL LG MLPN CLP NS 390.003 SUPPLY/IMPLANTS "$2,682.00 " Outpatient "$1,341.00 " Not Applicable: Bundled with Procedure "$1,743.30 " "$1,877.40 " "$1,770.12 " Not Applicable: Bundled with Procedure $938.70 "$2,145.60 " $938.70 "$2,145.60 " ATCH ROD MED MLPN ROD ATCH MRI SAFE MED MLPN CLP NS 390.034 SUPPLY/IMPLANTS "$2,754.00 " Outpatient "$1,377.00 " Not Applicable: Bundled with Procedure "$1,790.10 " "$1,927.80 " "$1,817.64 " Not Applicable: Bundled with Procedure $963.90 "$2,203.20 " $963.90 "$2,203.20 " AUG FEM 5MM TL STAB KN POST TRTHLN 6 5543-A-600 SUPPLY/IMPLANTS "$7,004.00 " Outpatient "$3,502.00 " Not Applicable: Bundled with Procedure "$4,552.60 " "$4,902.80 " "$4,622.64 " Not Applicable: Bundled with Procedure "$2,451.40 " "$5,603.20 " "$2,451.40 " "$5,603.20 " AUG FEM 10MM TL STAB BKWRD BLCK POST KN TRTHLN 3 5544-A-300 SUPPLY/IMPLANTS "$5,913.00 " Outpatient "$2,956.50 " Not Applicable: Bundled with Procedure "$3,843.45 " "$4,139.10 " "$3,902.58 " Not Applicable: Bundled with Procedure "$2,069.55 " "$4,730.40 " "$2,069.55 " "$4,730.40 " AUG FEM 5MM TL STAB KN POST TRTHLN 3 5543-A-300 SUPPLY/IMPLANTS "$5,632.00 " Outpatient "$2,816.00 " Not Applicable: Bundled with Procedure "$3,660.80 " "$3,942.40 " "$3,717.12 " Not Applicable: Bundled with Procedure "$1,971.20 " "$4,505.60 " "$1,971.20 " "$4,505.60 " AXIUM PRIME COIL 3.5MM X 8CM APB-3 5-8-3D-ES SUPPLY/IMPLANTS "$8,780.00 " Outpatient "$4,390.00 " Not Applicable: Bundled with Procedure "$5,707.00 " "$6,146.00 " "$5,794.80 " Not Applicable: Bundled with Procedure "$3,073.00 " "$7,024.00 " "$3,073.00 " "$7,024.00 " AXIUM PRIME COIL HELIX EV3 APB-1-1-HX-ES SUPPLY/IMPLANTS "$8,868.00 " Outpatient "$4,434.00 " Not Applicable: Bundled with Procedure "$5,764.20 " "$6,207.60 " "$5,852.88 " Not Applicable: Bundled with Procedure "$3,103.80 " "$7,094.40 " "$3,103.80 " "$7,094.40 " BALLAST DBM IN RESORBABLE MESH 85X11MM 02-8000-115 SUPPLY/IMPLANTS "$8,195.00 " Outpatient "$4,097.50 " Not Applicable: Bundled with Procedure "$5,326.75 " "$5,736.50 " "$5,408.70 " Not Applicable: Bundled with Procedure "$2,868.25 " "$6,556.00 " "$2,868.25 " "$6,556.00 " BAND ANLPLS 27MM ATS SMLS 2 FLLY FLXB 700FC27 SUPPLY/IMPLANTS "$10,248.00 " Outpatient "$5,124.00 " Not Applicable: Bundled with Procedure "$6,661.20 " "$7,173.60 " "$6,763.68 " Not Applicable: Bundled with Procedure "$3,586.80 " "$8,198.40 " "$3,586.80 " "$8,198.40 " BAND ANLPLS 27MM SJM T SIL BA IMPRG FLXB SURE LCK DLV SYS TAB-27 SUPPLY/IMPLANTS "$7,337.00 " Outpatient "$3,668.50 " Not Applicable: Bundled with Procedure "$4,769.05 " "$5,135.90 " "$4,842.42 " Not Applicable: Bundled with Procedure "$2,567.95 " "$5,869.60 " "$2,567.95 " "$5,869.60 " BIOCOR STENTED TISSUE MITRAL VALVE BIO-25MM-00 SUPPLY/IMPLANTS "$23,582.00 " Outpatient "$11,791.00 " Not Applicable: Bundled with Procedure "$15,328.30 " "$16,507.40 " "$15,564.12 " Not Applicable: Bundled with Procedure "$8,253.70 " "$18,865.60 " "$8,253.70 " "$18,865.60 " BIT DRL 195MM 3 FLUT 4MM QC NS 315.4 SUPPLY/IMPLANTS $975.00 Outpatient $487.50 Not Applicable: Bundled with Procedure $633.75 $682.50 $643.50 Not Applicable: Bundled with Procedure $341.25 $780.00 $341.25 $780.00 BIT DRILL SHORT L185 MM OD5.5 MM COUNTERBORE NONSTERILE REUS 2351-5500 SUPPLY/IMPLANTS $881.00 Outpatient $440.50 Not Applicable: Bundled with Procedure $572.65 $616.70 $581.46 Not Applicable: Bundled with Procedure $308.35 $704.80 $308.35 $704.80 BLCK SNTH TISS SM SIL CURVILINEAR CHIN CSC-S SUPPLY/IMPLANTS "$1,226.00 " Outpatient $613.00 Not Applicable: Bundled with Procedure $796.90 $858.20 $809.16 Not Applicable: Bundled with Procedure $429.10 $980.80 $429.10 $980.80 BLDE IM FX 100MM 11MM HLX TI TROCH CNN NS AU 456.305 SUPPLY/IMPLANTS "$3,534.00 " Outpatient "$1,767.00 " Not Applicable: Bundled with Procedure "$2,297.10 " "$2,473.80 " "$2,332.44 " Not Applicable: Bundled with Procedure "$1,236.90 " "$2,827.20 " "$1,236.90 " "$2,827.20 " BLDE IM NL AU 100MM 11MM HLCL TROCH TI CNN STRL 456.305S SUPPLY/IMPLANTS "$3,336.00 " Outpatient "$1,668.00 " Not Applicable: Bundled with Procedure "$2,168.40 " "$2,335.20 " "$2,201.76 " Not Applicable: Bundled with Procedure "$1,167.60 " "$2,668.80 " "$1,167.60 " "$2,668.80 " BLDE IM FX 105MM 11MM HLX TI TROCH CNN NS AU 456.306 SUPPLY/IMPLANTS "$3,146.00 " Outpatient "$1,573.00 " Not Applicable: Bundled with Procedure "$2,044.90 " "$2,202.20 " "$2,076.36 " Not Applicable: Bundled with Procedure "$1,101.10 " "$2,516.80 " "$1,101.10 " "$2,516.80 " BLDE IM NL AU 90MM 11MM HLCL TROCH TI CNN NS 456.303 SUPPLY/IMPLANTS "$3,527.00 " Outpatient "$1,763.50 " Not Applicable: Bundled with Procedure "$2,292.55 " "$2,468.90 " "$2,327.82 " Not Applicable: Bundled with Procedure "$1,234.45 " "$2,821.60 " "$1,234.45 " "$2,821.60 " BLDE IM NL AU 90MM 11MM HLCL TROCH TI CNN STRL 456.303S SUPPLY/IMPLANTS "$3,336.00 " Outpatient "$1,668.00 " Not Applicable: Bundled with Procedure "$2,168.40 " "$2,335.20 " "$2,201.76 " Not Applicable: Bundled with Procedure "$1,167.60 " "$2,668.80 " "$1,167.60 " "$2,668.80 " BLDE IM NL AU 95MM 11MM HLCL TROCH TI CNN STRL 456.304S SUPPLY/IMPLANTS "$3,796.00 " Outpatient "$1,898.00 " Not Applicable: Bundled with Procedure "$2,467.40 " "$2,657.20 " "$2,505.36 " Not Applicable: Bundled with Procedure "$1,328.60 " "$3,036.80 " "$1,328.60 " "$3,036.80 " BLN SZ 3.5CM 6FR AMPLZR II .035IN CV 3 LUM FLXB SHFT RADOPQ 9-SB-018 SUPPLY/IMPLANTS "$1,572.00 " Outpatient $786.00 Not Applicable: Bundled with Procedure "$1,021.80 " "$1,100.40 " "$1,037.52 " Not Applicable: Bundled with Procedure $550.20 "$1,257.60 " $550.20 "$1,257.60 " BLN SZ 4.5CM 7FR 27MM AMPLZR II .035IN CV 3 LUM CATH FLXB 9-SB-024 SUPPLY/IMPLANTS "$1,572.00 " Outpatient $786.00 Not Applicable: Bundled with Procedure "$1,021.80 " "$1,100.40 " "$1,037.52 " Not Applicable: Bundled with Procedure $550.20 "$1,257.60 " $550.20 "$1,257.60 " BNDG KRLX MED LF GZE 3.6YDX3.4IN 6 PLY ABS WVN CTTN STRL 6725 SUPPLY/IMPLANTS $571.00 Outpatient $285.50 Not Applicable: Bundled with Procedure $371.15 $399.70 $376.86 Not Applicable: Bundled with Procedure $199.85 $456.80 $199.85 $456.80 BONE BIOACTIVE GRAFT PUTTY-SMALL(3.75G) SGF-037 SUPPLY/IMPLANTS "$3,945.00 " Outpatient "$1,972.50 " Not Applicable: Bundled with Procedure "$2,564.25 " "$2,761.50 " "$2,603.70 " Not Applicable: Bundled with Procedure "$1,380.75 " "$3,156.00 " "$1,380.75 " "$3,156.00 " BONE CELLULAR VIVIGEN 15CC BL-1500-004 SUPPLY/IMPLANTS "$21,263.00 " Outpatient "$10,631.50 " Not Applicable: Bundled with Procedure "$13,820.95 " "$14,884.10 " "$14,033.58 " Not Applicable: Bundled with Procedure "$7,442.05 " "$17,010.40 " "$7,442.05 " "$17,010.40 " BONE CELLULAR VIVIGEN 1CC BL-1500-001 SUPPLY/IMPLANTS "$2,555.00 " Outpatient "$1,277.50 " Not Applicable: Bundled with Procedure "$1,660.75 " "$1,788.50 " "$1,686.30 " Not Applicable: Bundled with Procedure $894.25 "$2,044.00 " $894.25 "$2,044.00 " BONE CELLULAR VIVIGEN 5CC BL-1500-002 SUPPLY/IMPLANTS "$9,348.00 " Outpatient "$4,674.00 " Not Applicable: Bundled with Procedure "$6,076.20 " "$6,543.60 " "$6,169.68 " Not Applicable: Bundled with Procedure "$3,271.80 " "$7,478.40 " "$3,271.80 " "$7,478.40 " BONE FOUNDATION ACDF 6MM 99301-06 SUPPLY/IMPLANTS "$5,870.00 " Outpatient "$2,935.00 " Not Applicable: Bundled with Procedure "$3,815.50 " "$4,109.00 " "$3,874.20 " Not Applicable: Bundled with Procedure "$2,054.50 " "$4,696.00 " "$2,054.50 " "$4,696.00 " BREAST SIZERS MODERATE PLUS PROFILES RSZ-3501BC SUPPLY/IMPLANTS "$1,198.00 " Outpatient $599.00 Not Applicable: Bundled with Procedure $778.70 $838.60 $790.68 Not Applicable: Bundled with Procedure $419.30 $958.40 $419.30 $958.40 BREAST IMPLANT 320ML MM-410320 SUPPLY/IMPLANTS "$6,588.00 " Outpatient "$3,294.00 " Not Applicable: Bundled with Procedure "$4,282.20 " "$4,611.60 " "$4,348.08 " Not Applicable: Bundled with Procedure "$2,305.80 " "$5,270.40 " "$2,305.80 " "$5,270.40 " BREAST IMPLANT SIZER 340 MSZ-X340 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 Not Applicable: Bundled with Procedure $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,141.60 " BREAST IMPLANT SIZER 350 MSZ-FM350 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 Not Applicable: Bundled with Procedure $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,141.60 " BREAST IMPLANT SIZER 320 MSZ-MM320 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 Not Applicable: Bundled with Procedure $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,141.60 " BREAST TISSUE EXPANDER 133S-MV-11-T SUPPLY/IMPLANTS "$6,277.00 " Outpatient "$3,138.50 " Not Applicable: Bundled with Procedure "$4,080.05 " "$4,393.90 " "$4,142.82 " Not Applicable: Bundled with Procedure "$2,196.95 " "$5,021.60 " "$2,196.95 " "$5,021.60 " BRR ADH 3X2.5IN SPRFLM 4 SECT ABS ADH STRL LF DISP 6380-01 SUPPLY/IMPLANTS "$1,577.00 " Outpatient $788.50 Not Applicable: Bundled with Procedure "$1,025.05 " "$1,103.90 " "$1,040.82 " Not Applicable: Bundled with Procedure $551.95 "$1,261.60 " $551.95 "$1,261.60 " BSHNG DRL WRE RECON PERITROCHANTERIC NL SYS 27927 SUPPLY/IMPLANTS "$2,314.00 " Outpatient "$1,157.00 " Not Applicable: Bundled with Procedure "$1,504.10 " "$1,619.80 " "$1,527.24 " Not Applicable: Bundled with Procedure $809.90 "$1,851.20 " $809.90 "$1,851.20 " BSPLT TIB 7 UNV KN TRTHLN COCR 5521-B-700 SUPPLY/IMPLANTS "$8,072.00 " Outpatient "$4,036.00 " Not Applicable: Bundled with Procedure "$5,246.80 " "$5,650.40 " "$5,327.52 " Not Applicable: Bundled with Procedure "$2,825.20 " "$6,457.60 " "$2,825.20 " "$6,457.60 " BSPLT TIB 4 KN TRTHLN TRITANIUM 5536-B-400 SUPPLY/IMPLANTS "$7,913.00 " Outpatient "$3,956.50 " Not Applicable: Bundled with Procedure "$5,143.45 " "$5,539.10 " "$5,222.58 " Not Applicable: Bundled with Procedure "$2,769.55 " "$6,330.40 " "$2,769.55 " "$6,330.40 " BTN GSTRM 2CM 18FR RADOPQ LOPRFL TPR DIST TIP PROX ANRFLX V 0120-18-2.0 SUPPLY/IMPLANTS $505.00 Outpatient $252.50 Not Applicable: Bundled with Procedure $328.25 $353.50 $333.30 Not Applicable: Bundled with Procedure $176.75 $404.00 $176.75 $404.00 BTN GSTRM 2CM 24FR RADOPQ LOPRFL TPR DIST TIP PROX ANRFLX V 0120-24-2.0 SUPPLY/IMPLANTS $505.00 Outpatient $252.50 Not Applicable: Bundled with Procedure $328.25 $353.50 $333.30 Not Applicable: Bundled with Procedure $176.75 $404.00 $176.75 $404.00 BURR STIMLOC HOLE COVER 924256 SUPPLY/IMPLANTS $586.00 Outpatient $293.00 Not Applicable: Bundled with Procedure $380.90 $410.20 $386.76 Not Applicable: Bundled with Procedure $205.10 $468.80 $205.10 $468.80 C-TAPER 0 HEAD TRIAL 1150-2500R SUPPLY/IMPLANTS $643.00 Outpatient $321.50 Not Applicable: Bundled with Procedure $417.95 $450.10 $424.38 Not Applicable: Bundled with Procedure $225.05 $514.40 $225.05 $514.40 C-TAPER-3 HEAD TRIAL 1150-2513R SUPPLY/IMPLANTS $643.00 Outpatient $321.50 Not Applicable: Bundled with Procedure $417.95 $450.10 $424.38 Not Applicable: Bundled with Procedure $225.05 $514.40 $225.05 $514.40 CAGE SPNL 14X4-6MM ROI-C VERTEBRIDGE 12MM PEEK OPTM LT1 CRV MC1342P SUPPLY/IMPLANTS "$12,230.00 " Outpatient "$6,115.00 " Not Applicable: Bundled with Procedure "$7,949.50 " "$8,561.00 " "$8,071.80 " Not Applicable: Bundled with Procedure "$4,280.50 " "$9,784.00 " "$4,280.50 " "$9,784.00 " CAGE SPNL 14X6-8MM ROI-C VERTEBRIDGE 12MM PEEK-OPTM LT1 CRV MC1344P SUPPLY/IMPLANTS "$12,230.00 " Outpatient "$6,115.00 " Not Applicable: Bundled with Procedure "$7,949.50 " "$8,561.00 " "$8,071.80 " Not Applicable: Bundled with Procedure "$4,280.50 " "$9,784.00 " "$4,280.50 " "$9,784.00 " CAGE SPNL 15.5X5-7MM ROI-C VERTEBRIDGE 12MM PEEK-OPTM LT1 MC1353P SUPPLY/IMPLANTS "$12,230.00 " Outpatient "$6,115.00 " Not Applicable: Bundled with Procedure "$7,949.50 " "$8,561.00 " "$8,071.80 " Not Applicable: Bundled with Procedure "$4,280.50 " "$9,784.00 " "$4,280.50 " "$9,784.00 " CAGE SPNL 15.5X6-8MM ROI-C VERTEBRIDGE 12MM PEEK-OPTM LT1 MC1354P SUPPLY/IMPLANTS "$7,826.00 " Outpatient "$3,913.00 " Not Applicable: Bundled with Procedure "$5,086.90 " "$5,478.20 " "$5,165.16 " Not Applicable: Bundled with Procedure "$2,739.10 " "$6,260.80 " "$2,739.10 " "$6,260.80 " CAGE SPNL 15.5X4-6MM ROI-C VERTEBRIDGE 14MM PEEK-OPTM LT1 MC1322P SUPPLY/IMPLANTS "$12,230.00 " Outpatient "$6,115.00 " Not Applicable: Bundled with Procedure "$7,949.50 " "$8,561.00 " "$8,071.80 " Not Applicable: Bundled with Procedure "$4,280.50 " "$9,784.00 " "$4,280.50 " "$9,784.00 " CAGE SPNL 15.5X5-7MM ROI-C VERTEBRIDGE 14MM PEEK-OPTM LT1 MC1323P SUPPLY/IMPLANTS "$7,826.00 " Outpatient "$3,913.00 " Not Applicable: Bundled with Procedure "$5,086.90 " "$5,478.20 " "$5,165.16 " Not Applicable: Bundled with Procedure "$2,739.10 " "$6,260.80 " "$2,739.10 " "$6,260.80 " CAGE SPNL 17X5-7MM ROI-C VERTEBRIDGE 14MM PEEK-OPTM LT1 CRV MC1333P SUPPLY/IMPLANTS "$12,230.00 " Outpatient "$6,115.00 " Not Applicable: Bundled with Procedure "$7,949.50 " "$8,561.00 " "$8,071.80 " Not Applicable: Bundled with Procedure "$4,280.50 " "$9,784.00 " "$4,280.50 " "$9,784.00 " CAGE SPNL 50X18X10MM CRNT XL PEEK RADOPQ TLIF NS LF 6910850 SUPPLY/IMPLANTS "$20,055.00 " Outpatient "$10,027.50 " Not Applicable: Bundled with Procedure "$13,035.75 " "$14,038.50 " "$13,236.30 " Not Applicable: Bundled with Procedure "$7,019.25 " "$16,044.00 " "$7,019.25 " "$16,044.00 " CAGE SPNL 45X18X10MM CRNT XL PEEK RADOPQ TLIF NS LF 6910845 SUPPLY/IMPLANTS "$30,336.00 " Outpatient "$15,168.00 " Not Applicable: Bundled with Procedure "$19,718.40 " "$21,235.20 " "$20,021.76 " Not Applicable: Bundled with Procedure "$10,617.60 " "$24,268.80 " "$10,617.60 " "$24,268.80 " CAGE SPNL 32MM 18MM VLIFT TI LMBR INTRBD FS NS LF 48291832 SUPPLY/IMPLANTS "$20,055.00 " Outpatient "$10,027.50 " Not Applicable: Bundled with Procedure "$13,035.75 " "$14,038.50 " "$13,236.30 " Not Applicable: Bundled with Procedure "$7,019.25 " "$16,044.00 " "$7,019.25 " "$16,044.00 " CAGE SPNL 5MM BENGAL 7D STD CFRP CRV INTRBD FS NS LF 187301105 SUPPLY/IMPLANTS "$7,826.00 " Outpatient "$3,913.00 " Not Applicable: Bundled with Procedure "$5,086.90 " "$5,478.20 " "$5,165.16 " Not Applicable: Bundled with Procedure "$2,739.10 " "$6,260.80 " "$2,739.10 " "$6,260.80 " CAGE SAMSON CARPECTOMY 20MM 13520 SUPPLY/IMPLANTS "$21,522.00 " Outpatient "$10,761.00 " Not Applicable: Bundled with Procedure "$13,989.30 " "$15,065.40 " "$14,204.52 " Not Applicable: Bundled with Procedure "$7,532.70 " "$17,217.60 " "$7,532.70 " "$17,217.60 " CAGE SPNL 34X24X12MM BRIGADE 12D TI NS LF 6951234 SUPPLY/IMPLANTS "$30,328.00 " Outpatient "$15,164.00 " Not Applicable: Bundled with Procedure "$19,713.20 " "$21,229.60 " "$20,016.48 " Not Applicable: Bundled with Procedure "$10,614.80 " "$24,262.40 " "$10,614.80 " "$24,262.40 " CAGE SPNL 15.5X5.2-8MM ROI-C VERTEBRIDGE 7D LRDTC 14MM TPR CMC 1424 P SUPPLY/IMPLANTS "$13,695.00 " Outpatient "$6,847.50 " Not Applicable: Bundled with Procedure "$8,901.75 " "$9,586.50 " "$9,038.70 " Not Applicable: Bundled with Procedure "$4,793.25 " "$10,956.00 " "$4,793.25 " "$10,956.00 " CAGE SPNL 14X12X6MM BRECKENRIDGE 5D PEEK ACDF NS LF 8824-4506 SUPPLY/IMPLANTS "$9,800.00 " Outpatient "$4,900.00 " Not Applicable: Bundled with Procedure "$6,370.00 " "$6,860.00 " "$6,468.00 " Not Applicable: Bundled with Procedure "$3,430.00 " "$7,840.00 " "$3,430.00 " "$7,840.00 " CAGE SPNL 34X24X14MM BRIGADE 8D TI NS LF 6941434 SUPPLY/IMPLANTS "$19,552.00 " Outpatient "$9,776.00 " Not Applicable: Bundled with Procedure "$12,708.80 " "$13,686.40 " "$12,904.32 " Not Applicable: Bundled with Procedure "$6,843.20 " "$15,641.60 " "$6,843.20 " "$15,641.60 " CAGE SPNL 34X24X12MM BRIGADE 8D TI NS LF 6941234 SUPPLY/IMPLANTS "$19,552.00 " Outpatient "$9,776.00 " Not Applicable: Bundled with Procedure "$12,708.80 " "$13,686.40 " "$12,904.32 " Not Applicable: Bundled with Procedure "$6,843.20 " "$15,641.60 " "$6,843.20 " "$15,641.60 " CAGE SPNL 40X16MM ENDOSKELETON TAS 12D LRDTC 27MM XL TI ALIF 2312-0316 SUPPLY/IMPLANTS "$29,327.00 " Outpatient "$14,663.50 " Not Applicable: Bundled with Procedure "$19,062.55 " "$20,528.90 " "$19,355.82 " Not Applicable: Bundled with Procedure "$10,264.45 " "$23,461.60 " "$10,264.45 " "$23,461.60 " CAP END 0MM T40 12MM TI XPRT IM NL SYS FEM CNN XTN SLF RTN 04.003.000S SUPPLY/IMPLANTS "$1,470.00 " Outpatient $735.00 Not Applicable: Bundled with Procedure $955.50 "$1,029.00 " $970.20 Not Applicable: Bundled with Procedure $514.50 "$1,176.00 " $514.50 "$1,176.00 " CAP END 0MM T40 TI XPRT IM NL SYS TIB CNN STRDR STRL AU 04.004.000S SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 Not Applicable: Bundled with Procedure "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " CARTILAGE COSTAL 1.2 X 4.6 CM AT526FD SUPPLY/IMPLANTS "$3,424.00 " Outpatient "$1,712.00 " Not Applicable: Bundled with Procedure "$2,225.60 " "$2,396.80 " "$2,259.84 " Not Applicable: Bundled with Procedure "$1,198.40 " "$2,739.20 " "$1,198.40 " "$2,739.20 " CARTLIDGE RIB 7CM AT528FF SUPPLY/IMPLANTS "$4,404.00 " Outpatient "$2,202.00 " Not Applicable: Bundled with Procedure "$2,862.60 " "$3,082.80 " "$2,906.64 " Not Applicable: Bundled with Procedure "$1,541.40 " "$3,523.20 " "$1,541.40 " "$3,523.20 " "CARTLIDGE COASTAL 1.0 X 4.0CM, FROZEN AT524FF" SUPPLY/IMPLANTS "$3,934.00 " Outpatient "$1,967.00 " Not Applicable: Bundled with Procedure "$2,557.10 " "$2,753.80 " "$2,596.44 " Not Applicable: Bundled with Procedure "$1,376.90 " "$3,147.20 " "$1,376.90 " "$3,147.20 " CASE INST LCK LG FRAG SYS NS 8299-52-000 SUPPLY/IMPLANTS "$36,993.00 " Outpatient "$18,496.50 " Not Applicable: Bundled with Procedure "$24,045.45 " "$25,895.10 " "$24,415.38 " Not Applicable: Bundled with Procedure "$12,947.55 " "$29,594.40 " "$12,947.55 " "$29,594.40 " CASE STRL MOD LCP 2.4 MM PLT 60.111.002 SUPPLY/IMPLANTS "$4,847.00 " Outpatient "$2,423.50 " Not Applicable: Bundled with Procedure "$3,150.55 " "$3,392.90 " "$3,199.02 " Not Applicable: Bundled with Procedure "$1,696.45 " "$3,877.60 " "$1,696.45 " "$3,877.60 " CATH BLNDIL 40MM 80CM 14MM ARMADA OTW LOPRFL TIP ACPT .035IN B1140-040 SUPPLY/IMPLANTS $913.00 Outpatient $456.50 Not Applicable: Bundled with Procedure $593.45 $639.10 $602.58 Not Applicable: Bundled with Procedure $319.55 $730.40 $319.55 $730.40 CATH BLNDIL 120MM 135CM 6MM STELLAREX OTW 2 LUM TPR TIP AB35SX060120135 SUPPLY/IMPLANTS "$6,966.00 " Outpatient "$3,483.00 " Not Applicable: Bundled with Procedure "$4,527.90 " "$4,876.20 " "$4,597.56 " Not Applicable: Bundled with Procedure "$2,438.10 " "$5,572.80 " "$2,438.10 " "$5,572.80 " CATH CV PALINDROME 28FR 45CM 2 LUM VENATRAC 8888145041 SUPPLY/IMPLANTS "$1,140.00 " Outpatient $570.00 Not Applicable: Bundled with Procedure $741.00 $798.00 $752.40 Not Applicable: Bundled with Procedure $399.00 $912.00 $399.00 $912.00 CATH DRN 7CM RT ANG VNTRC ACFL 821232 SUPPLY/IMPLANTS "$1,209.00 " Outpatient $604.50 Not Applicable: Bundled with Procedure $785.85 $846.30 $797.94 Not Applicable: Bundled with Procedure $423.15 $967.20 $423.15 $967.20 CATH DRN 9CM RT ANG VNTRC ACFL 821233 SUPPLY/IMPLANTS "$1,209.00 " Outpatient $604.50 Not Applicable: Bundled with Procedure $785.85 $846.30 $797.94 Not Applicable: Bundled with Procedure $423.15 $967.20 $423.15 $967.20 CATH DRN 8FR 35CM VNTRC LL CNCT WTRT CAP CLP KT STRL 951303 SUPPLY/IMPLANTS $915.00 Outpatient $457.50 Not Applicable: Bundled with Procedure $594.75 $640.50 $603.90 Not Applicable: Bundled with Procedure $320.25 $732.00 $320.25 $732.00 CATH DRG DLV 5IN ONQ SKR DEHP STRL PM020 SUPPLY/IMPLANTS $571.00 Outpatient $285.50 Not Applicable: Bundled with Procedure $371.15 $399.70 $376.86 Not Applicable: Bundled with Procedure $199.85 $456.80 $199.85 $456.80 CATH DRN 35CM CSF VNTRC EDS II SIL STRG STY CRV TROC LL CNCT 821705 SUPPLY/IMPLANTS "$1,400.00 " Outpatient $700.00 Not Applicable: Bundled with Procedure $910.00 $980.00 $924.00 Not Applicable: Bundled with Procedure $490.00 "$1,120.00 " $490.00 "$1,120.00 " CATH DRN 10FR 25CM LOOP APD FLXM MTL HDRPH REG DRMTR FLXB M001271350 SUPPLY/IMPLANTS $431.00 Outpatient $215.50 Not Applicable: Bundled with Procedure $280.15 $301.70 $284.46 Not Applicable: Bundled with Procedure $150.85 $344.80 $150.85 $344.80 CATH DRN 8FR 25CM LOOP FLXM MTL HDRPH REG DRMTR STF CNN LG M001271340 SUPPLY/IMPLANTS $431.00 Outpatient $215.50 Not Applicable: Bundled with Procedure $280.15 $301.70 $284.46 Not Applicable: Bundled with Procedure $150.85 $344.80 $150.85 $344.80 CATH DRN 6FR 25CM LOOP APD FLXM MTL HDRPH FLXB STF CNN REG M001271330 SUPPLY/IMPLANTS $461.00 Outpatient $230.50 Not Applicable: Bundled with Procedure $299.65 $322.70 $304.26 Not Applicable: Bundled with Procedure $161.35 $368.80 $161.35 $368.80 CATH THRMB PENUMBRA SYS MAX 4.7-3.8FR .035IN 153CM 157CM 3MAXC SUPPLY/IMPLANTS "$6,798.00 " Outpatient "$3,399.00 " Not Applicable: Bundled with Procedure "$4,418.70 " "$4,758.60 " "$4,486.68 " Not Applicable: Bundled with Procedure "$2,379.30 " "$5,438.40 " "$2,379.30 " "$5,438.40 " CATHETER LACRIMAL LACRICATH PEDIATRIC L20 CM L15 MM OD3 MM L DCP315-UNIT SUPPLY/IMPLANTS "$1,746.00 " Outpatient $873.00 Not Applicable: Bundled with Procedure "$1,134.90 " "$1,222.20 " "$1,152.36 " Not Applicable: Bundled with Procedure $611.10 "$1,396.80 " $611.10 "$1,396.80 " CATHETER WAVELINQ 4F ENDOAVF SYSTEM WQ4300 SUPPLY/IMPLANTS "$34,248.00 " Outpatient "$17,124.00 " Not Applicable: Bundled with Procedure "$22,261.20 " "$23,973.60 " "$22,603.68 " Not Applicable: Bundled with Procedure "$11,986.80 " "$27,398.40 " "$11,986.80 " "$27,398.40 " CBL ORTH LCP 750MM SS 1.7MM LNG BN CRMP CRLGE STRL 298.801.01S SUPPLY/IMPLANTS "$2,786.00 " Outpatient "$1,393.00 " Not Applicable: Bundled with Procedure "$1,810.90 " "$1,950.20 " "$1,838.76 " Not Applicable: Bundled with Procedure $975.10 "$2,228.80 " $975.10 "$2,228.80 " CBL ORTH CRV CRLGE 750MM TI COCR 1.7MM CRMP STRL 611.105.01S SUPPLY/IMPLANTS "$2,907.00 " Outpatient "$1,453.50 " Not Applicable: Bundled with Procedure "$1,889.55 " "$2,034.90 " "$1,918.62 " Not Applicable: Bundled with Procedure "$1,017.45 " "$2,325.60 " "$1,017.45 " "$2,325.60 " CBL ORTH ZIPFIX PEEK STRNL NDL FLXB SLF LCK RND EDG STRL 08.501.001.05S SUPPLY/IMPLANTS "$2,372.00 " Outpatient "$1,186.00 " Not Applicable: Bundled with Procedure "$1,541.80 " "$1,660.40 " "$1,565.52 " Not Applicable: Bundled with Procedure $830.20 "$1,897.60 " $830.20 "$1,897.60 " CEMENT BONE VERTAPLEX HV 0607-687-000 SUPPLY/IMPLANTS $628.00 Outpatient $314.00 Not Applicable: Bundled with Procedure $408.20 $439.60 $414.48 Not Applicable: Bundled with Procedure $219.80 $502.40 $219.80 $502.40 CHIN IMPLANT XS CSC-XS SUPPLY/IMPLANTS "$1,311.00 " Outpatient $655.50 Not Applicable: Bundled with Procedure $852.15 $917.70 $865.26 Not Applicable: Bundled with Procedure $458.85 "$1,048.80 " $458.85 "$1,048.80 " CLIP ANRSM 3MM 3.5MM YSRG STD 6.5MM OPN CRBRL TI STRG FEN FE597K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 8.3MM YSRG STD 6.8MM OPN CRBRL TI CRV SLT PERM FE752K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 9MM YSRG 7MM OPN STD PHYNOX PERM STRL FE750K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 9MM YSRG STD 6.7MM OPN CRV CEREBRUM PHYNOX TEMP FE755K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 8.4MM YSRG 6.8MM OPN STD SLT CRV CEREBRUM PHYNOX FE753K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 5MM YSRG MN 4MM OPN CRBRL TI CRV PERM STRL LF FE724K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 6.6MM YSRG MN 4.4MM OPN CRBRL TI SLT CRV PERM FE722K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 7MM 4.6MM YSRG STD MN PHYNOX PERM FE720K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 9MM YSRG STD 7MM OPN PHYNOX SYS TEMP FEN FE751K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 13.8MM YSRG STD 8.7MM OPN SLT CRV CEREBRUM TI FE783K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM SLVR 7MM YSRG 5.7MM OPN STD CRBRL PHYNOX PERM MRI FE746K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM SLVR 6.5MM YSRG 6MM OPN STD CEREBRUM PHYNOX TI FE742K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM SLVR 5MM YSRG 4MM OPN MN STD CRBRL PHYNOX PERM FE710K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 15MM YSRG STD 9.2MM OPN CRBRL TI STRG TEMP STRL FE781K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 9MM 5MM YSRG STD 9.1MM OPN CRBRL TI STRG FEN PERM FE650K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 4.7MM YSRG MN 4MM OPN CRBRL TI ANG LAT PERM STRL FE807K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 5MM 2.5MM YSRG 8MM OPN STD BYNT CRBRL PHYNOX PERM FE770K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 8MM YSRG STD 6.5MM OPN CRBRL TI CRV PERM STRL LF FE764K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 10.6MM YSRG STD 7.8MM OPN CRBRL TI FWD ANG PERM FE623K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 11.8MM YSRG STD 8.4MM OPN CRBRL TI FWD ANG PERM FE763K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 6.1MM YSRG STD 6.5MM OPN CRBRL TI FWD ANG PERM FE603K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 8MM YSRG STD 6.2MM OPN CRBRL TI FWD ANG PERM STRL FE613K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 5MM YSRG MN 4MM OPN CRBRL STRG NAR PERM STRL LF FE690K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 7MM YSRG MN 5.7MM OPN CRBRL TI CRV PERM STRL LF FE728K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 4MM YSRG MN 7MM OPN CRBRL TI CRV PERM STRL LF FE727K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 4MM YSRG MN 3.6MM OPN CRBRL TI CRV NAR PERM STRL FE694K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM SLVR 2.8MM YSRG 3.2MM OPN MN PHYNOX PERM MRI SAFE FE682K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 4.7MM YSRG MN 3.8MM OPN CRBRL TI SLT CRV PERM FE692K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 3MM YSRG MN 3.3MM OPN CRBRL TI STRG PERM STRL LF FE700K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 3MM YSRG 3.3MM OPN MN NAR STRG PHYNOX PERM STRL FE680K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 7MM YSRG STD 7.2MM OPN CRBRL TI ANG OVR PERM STRL FE830K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 5MM 3.5MM YSRG 8MM OPN STD BYNT CRBRL PHYNOX PERM FE771K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 5MM YSRG STD 5.6MM OPN CRBRL TI RT ANG STRL LF FE819K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 11.3MM YSRG STD 8.2MM OPN CRBRL TI SPN PERM STRL FE833K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 6MM 3.5MM YSRG 1.47NW 7.4MM OPN STD PHYNOX SYS FE600K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 10/6.4MM 5MM YSRG 5.5MM OPN STD PHYNOX PERM FEN FE664K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 5MM YSRG 7.9MM OPN STD BYNT CRBRL TI PERM FE648K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 5MM 5MM YSRG STD 5MM OPN CRBRL TI RL DNWRD FEN FE891K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 12MM 5MM YSRG STD 10.3MM OPN CRBRL TI STRG FEN FE660K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 5MM 5MM YSRG STD 7MM OPN CRBRL TI STRG LAT FEN FE881K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 7.5/10.6MM 5MM YSRG 7.2MM OPN STD CRBRL PHYNOX FE652K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 11MM YSRG 7.8MM CRBRL TI STRG TEMP STRL LF DISP FE760K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 20MM YSRG STD 11.4MM OPN PHYNOX TEMP STRG STRL FE791K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM AU 2.8MM YSRG 3.2MM OPN MN CRBRL PHYNOX TEMP MRI FE683K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM AU YSRG 4.6MM OPN MN PHYNOX TEMP MRI SAFE 7MM FE721K SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " Not Applicable: Bundled with Procedure "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLIP ANRSM 5MM 3.5MM YSRG 1.47NW 4.9MM OPN STD PHYNOX SYS FE604K SUPPLY/IMPLANTS "$2,248.00 " Outpatient "$1,124.00 " Not Applicable: Bundled with Procedure "$1,461.20 " "$1,573.60 " "$1,483.68 " Not Applicable: Bundled with Procedure $786.80 "$1,798.40 " $786.80 "$1,798.40 " CLIP ANRSM 7.5MM 5MM YSRG STD 5MM OPN CRBRL TI CRV DN FEN FE775K SUPPLY/IMPLANTS "$1,826.00 " Outpatient $913.00 Not Applicable: Bundled with Procedure "$1,186.90 " "$1,278.20 " "$1,205.16 " Not Applicable: Bundled with Procedure $639.10 "$1,460.80 " $639.10 "$1,460.80 " CLIP HMST RADOPQ PRELD STRL DISP RSL 235CM 2.8MM 11MM OPN M00522611 SUPPLY/IMPLANTS "$1,311.00 " Outpatient $655.50 Not Applicable: Bundled with Procedure $852.15 $917.70 $865.26 Not Applicable: Bundled with Procedure $458.85 "$1,048.80 " $458.85 "$1,048.80 " CLP XTRNFX 4MM DIST RDS FXTR ADJ MR CONDITIONAL NS 390.051 SUPPLY/IMPLANTS "$4,951.00 " Outpatient "$2,475.50 " Not Applicable: Bundled with Procedure "$3,218.15 " "$3,465.70 " "$3,267.66 " Not Applicable: Bundled with Procedure "$1,732.85 " "$3,960.80 " "$1,732.85 " "$3,960.80 " CLP XTRNFX LG CMBN MR CONDITIONAL NS 390.005 SUPPLY/IMPLANTS "$4,186.00 " Outpatient "$2,093.00 " Not Applicable: Bundled with Procedure "$2,720.90 " "$2,930.20 " "$2,762.76 " Not Applicable: Bundled with Procedure "$1,465.10 " "$3,348.80 " "$1,465.10 " "$3,348.80 " CLP XTRNFX LG 4 PSTN MLPN MR CONDITIONAL NS 390.004 SUPPLY/IMPLANTS "$4,481.00 " Outpatient "$2,240.50 " Not Applicable: Bundled with Procedure "$2,912.65 " "$3,136.70 " "$2,957.46 " Not Applicable: Bundled with Procedure "$1,568.35 " "$3,584.80 " "$1,568.35 " "$3,584.80 " CLP XTRNFX LG 6 PSTN MLPN MR CONDITIONAL 390.002 SUPPLY/IMPLANTS "$4,785.00 " Outpatient "$2,392.50 " Not Applicable: Bundled with Procedure "$3,110.25 " "$3,349.50 " "$3,158.10 " Not Applicable: Bundled with Procedure "$1,674.75 " "$3,828.00 " "$1,674.75 " "$3,828.00 " CLP XTRNFX LG OPN ADJ NS 390.008 SUPPLY/IMPLANTS "$3,116.00 " Outpatient "$1,558.00 " Not Applicable: Bundled with Procedure "$2,025.40 " "$2,181.20 " "$2,056.56 " Not Applicable: Bundled with Procedure "$1,090.60 " "$2,492.80 " "$1,090.60 " "$2,492.80 " CLP XTRNFX MED 3MM THRD ROD CMBN MR SF NS 390.031 SUPPLY/IMPLANTS "$3,047.00 " Outpatient "$1,523.50 " Not Applicable: Bundled with Procedure "$1,980.55 " "$2,132.90 " "$2,011.02 " Not Applicable: Bundled with Procedure "$1,066.45 " "$2,437.60 " "$1,066.45 " "$2,437.60 " CLP XTRNFX MED 4 POSISTION MLPN MR SF NS 390.033 SUPPLY/IMPLANTS "$3,952.00 " Outpatient "$1,976.00 " Not Applicable: Bundled with Procedure "$2,568.80 " "$2,766.40 " "$2,608.32 " Not Applicable: Bundled with Procedure "$1,383.20 " "$3,161.60 " "$1,383.20 " "$3,161.60 " CLP XTRNFX MED OPN ADJ NS 390.035 SUPPLY/IMPLANTS "$2,691.00 " Outpatient "$1,345.50 " Not Applicable: Bundled with Procedure "$1,749.15 " "$1,883.70 " "$1,776.06 " Not Applicable: Bundled with Procedure $941.85 "$2,152.80 " $941.85 "$2,152.80 " CMNT BN HYDROSET BN SUB VOID FIL CA PHOS 3ML INJ BCMPT 79-43903 SUPPLY/IMPLANTS "$4,347.00 " Outpatient "$2,173.50 " Not Applicable: Bundled with Procedure "$2,825.55 " "$3,042.90 " "$2,869.02 " Not Applicable: Bundled with Procedure "$1,521.45 " "$3,477.60 " "$1,521.45 " "$3,477.60 " CMNT BN KYPHON XPEDE PMMA STRL CX01A SUPPLY/IMPLANTS "$1,721.00 " Outpatient $860.50 Not Applicable: Bundled with Procedure "$1,118.65 " "$1,204.70 " "$1,135.86 " Not Applicable: Bundled with Procedure $602.35 "$1,376.80 " $602.35 "$1,376.80 " CMNT BN SMPX PTBR RADOPQ FD 6197-9-010 SUPPLY/IMPLANTS "$1,608.00 " Outpatient $804.00 Not Applicable: Bundled with Procedure "$1,045.20 " "$1,125.60 " "$1,061.28 " Not Applicable: Bundled with Procedure $562.80 "$1,286.40 " $562.80 "$1,286.40 " CMNT BN CMW 2 20GM FST ST STRL 3322020 SUPPLY/IMPLANTS $637.00 Outpatient $318.50 Not Applicable: Bundled with Procedure $414.05 $445.90 $420.42 Not Applicable: Bundled with Procedure $222.95 $509.60 $222.95 $509.60 CMNT BN HYDROSET BN SUB CA PHOS 10CC INJ 7943910 SUPPLY/IMPLANTS "$13,414.00 " Outpatient "$6,707.00 " Not Applicable: Bundled with Procedure "$8,719.10 " "$9,389.80 " "$8,853.24 " Not Applicable: Bundled with Procedure "$4,694.90 " "$10,731.20 " "$4,694.90 " "$10,731.20 " CMNT BN CBLT 40GM HVISC STRL 402282 SUPPLY/IMPLANTS $649.00 Outpatient $324.50 Not Applicable: Bundled with Procedure $421.85 $454.30 $428.34 Not Applicable: Bundled with Procedure $227.15 $519.20 $227.15 $519.20 CMNT BN HYDROSET BN SUB VOID FIL CA PHOS 15CC INJ OSTCNDC 7943915 SUPPLY/IMPLANTS "$19,300.00 " Outpatient "$9,650.00 " Not Applicable: Bundled with Procedure "$12,545.00 " "$13,510.00 " "$12,738.00 " Not Applicable: Bundled with Procedure "$6,755.00 " "$15,440.00 " "$6,755.00 " "$15,440.00 " CMNT BN PLC R 40GM GRN 111214001 SUPPLY/IMPLANTS $975.00 Outpatient $487.50 Not Applicable: Bundled with Procedure $633.75 $682.50 $643.50 Not Applicable: Bundled with Procedure $341.25 $780.00 $341.25 $780.00 CMPNT FEM 6 KN RT TL STAB TRTHLN COCR 5512-F-602 SUPPLY/IMPLANTS "$29,854.00 " Outpatient "$14,927.00 " Not Applicable: Bundled with Procedure "$19,405.10 " "$20,897.80 " "$19,703.64 " Not Applicable: Bundled with Procedure "$10,448.90 " "$23,883.20 " "$10,448.90 " "$23,883.20 " CMPNT FEM 3 KN LT TL STAB TRTHLN COCR 5512-F-301 SUPPLY/IMPLANTS "$29,581.00 " Outpatient "$14,790.50 " Not Applicable: Bundled with Procedure "$19,227.65 " "$20,706.70 " "$19,523.46 " Not Applicable: Bundled with Procedure "$10,353.35 " "$23,664.80 " "$10,353.35 " "$23,664.80 " CMPNT PTLR 11MM 40MM ASYM TRTHLN X3 KN SUP INFR 5551-G-401 SUPPLY/IMPLANTS "$3,765.00 " Outpatient "$1,882.50 " Not Applicable: Bundled with Procedure "$2,447.25 " "$2,635.50 " "$2,484.90 " Not Applicable: Bundled with Procedure "$1,317.75 " "$3,012.00 " "$1,317.75 " "$3,012.00 " CMPNT HUM 100MM 5MM DSCVR ELB LT FLNG 114906 SUPPLY/IMPLANTS "$17,492.00 " Outpatient "$8,746.00 " Not Applicable: Bundled with Procedure "$11,369.80 " "$12,244.40 " "$11,544.72 " Not Applicable: Bundled with Procedure "$6,122.20 " "$13,993.60 " "$6,122.20 " "$13,993.60 " CMPNT SUBTALAR 14MM 10MM PROSTOP + CNCV FT/ANKL TI POLY L AR-4210B-14 SUPPLY/IMPLANTS "$9,038.00 " Outpatient "$4,519.00 " Not Applicable: Bundled with Procedure "$5,874.70 " "$6,326.60 " "$5,965.08 " Not Applicable: Bundled with Procedure "$3,163.30 " "$7,230.40 " "$3,163.30 " "$7,230.40 " CNCT SPNL 10MM VRTX LAT CLS 7756067 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " Not Applicable: Bundled with Procedure "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,711.85 " "$3,912.80 " CNDT VLV 21MM ATS OP AOR MECH CNDT 502AG21 SUPPLY/IMPLANTS "$25,802.00 " Outpatient "$12,901.00 " Not Applicable: Bundled with Procedure "$16,771.30 " "$18,061.40 " "$17,029.32 " Not Applicable: Bundled with Procedure "$9,030.70 " "$20,641.60 " "$9,030.70 " "$20,641.60 " CNTRLZR STM 9MM HIP DIST PMMA PSTNR STRL 162656 SUPPLY/IMPLANTS $810.00 Outpatient $405.00 Not Applicable: Bundled with Procedure $526.50 $567.00 $534.60 Not Applicable: Bundled with Procedure $283.50 $648.00 $283.50 $648.00 CNTRSNK DRL 2MM 3.5MM CORT 4MM CANC SCR 310.89 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 Not Applicable: Bundled with Procedure $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 $808.00 CNTRSNK DRL 2.4MM CNN 3.5/4MM SCR 310.86 SUPPLY/IMPLANTS "$2,241.00 " Outpatient "$1,120.50 " Not Applicable: Bundled with Procedure "$1,456.65 " "$1,568.70 " "$1,479.06 " Not Applicable: Bundled with Procedure $784.35 "$1,792.80 " $784.35 "$1,792.80 " CNTRSNK DRL 1.5/2 MM CORT SCR 310.88 SUPPLY/IMPLANTS $936.00 Outpatient $468.00 Not Applicable: Bundled with Procedure $608.40 $655.20 $617.76 Not Applicable: Bundled with Procedure $327.60 $748.80 $327.60 $748.80 CNTRSNK DRL 2.7 MM CORT SCR 310.87 SUPPLY/IMPLANTS "$1,066.00 " Outpatient $533.00 Not Applicable: Bundled with Procedure $692.90 $746.20 $703.56 Not Applicable: Bundled with Procedure $373.10 $852.80 $373.10 $852.80 COIL 018 14MM X 34CM AZUR CX DETACHABLE 45-781434 SUPPLY/IMPLANTS "$3,669.00 " Outpatient "$1,834.50 " Not Applicable: Bundled with Procedure "$2,384.85 " "$2,568.30 " "$2,421.54 " Not Applicable: Bundled with Procedure "$1,284.15 " "$2,935.20 " "$1,284.15 " "$2,935.20 " COIL AXIUM PRIME 1.5MM X 4 CM APB-1.5-4-3D-ES SUPPLY/IMPLANTS "$8,780.00 " Outpatient "$4,390.00 " Not Applicable: Bundled with Procedure "$5,707.00 " "$6,146.00 " "$5,794.80 " Not Applicable: Bundled with Procedure "$3,073.00 " "$7,024.00 " "$3,073.00 " "$7,024.00 " COIL DETACHABLE 0.018 12 X 20 75-481220 SUPPLY/IMPLANTS "$4,480.00 " Outpatient "$2,240.00 " Not Applicable: Bundled with Procedure "$2,912.00 " "$3,136.00 " "$2,956.80 " Not Applicable: Bundled with Procedure "$1,568.00 " "$3,584.00 " "$1,568.00 " "$3,584.00 " COIL EMBL 15CM 10MM .021IN AZUR PLTN DDRGL .018IN 135CM PERI 45-481015 SUPPLY/IMPLANTS "$4,452.00 " Outpatient "$2,226.00 " Not Applicable: Bundled with Procedure "$2,893.80 " "$3,116.40 " "$2,938.32 " Not Applicable: Bundled with Procedure "$1,558.20 " "$3,561.60 " "$1,558.20 " "$3,561.60 " COIL EMBL 20CM 10MM AZUR HDRCL 18 COILS DTCH 45-481020 SUPPLY/IMPLANTS "$4,697.00 " Outpatient "$2,348.50 " Not Applicable: Bundled with Procedure "$3,053.05 " "$3,287.90 " "$3,100.02 " Not Applicable: Bundled with Procedure "$1,643.95 " "$3,757.60 " "$1,643.95 " "$3,757.60 " COIL EMBL 15CM 15MM AZUR HDRCL 18 COILS DTCH 45-481515 SUPPLY/IMPLANTS "$4,452.00 " Outpatient "$2,226.00 " Not Applicable: Bundled with Procedure "$2,893.80 " "$3,116.40 " "$2,938.32 " Not Applicable: Bundled with Procedure "$1,558.20 " "$3,561.60 " "$1,558.20 " "$3,561.60 " COIL EMBL 20CM 15MM AZUR HDRCL 18 COILS DTCH 45-481520 SUPPLY/IMPLANTS "$4,697.00 " Outpatient "$2,348.50 " Not Applicable: Bundled with Procedure "$3,053.05 " "$3,287.90 " "$3,100.02 " Not Applicable: Bundled with Procedure "$1,643.95 " "$3,757.60 " "$1,643.95 " "$3,757.60 " COIL EMBL 20CM 20MM .018IN AZUR HDRCL PLTN DDRGL PLMR PERI 45-482020 SUPPLY/IMPLANTS "$4,697.00 " Outpatient "$2,348.50 " Not Applicable: Bundled with Procedure "$3,053.05 " "$3,287.90 " "$3,100.02 " Not Applicable: Bundled with Procedure "$1,643.95 " "$3,757.60 " "$1,643.95 " "$3,757.60 " COIL EMBL 50CM 20MM .021IN AZUR PLTN .018IN 150CM PERI FRME 45-682050 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " Not Applicable: Bundled with Procedure "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,711.85 " "$3,912.80 " COIL EMBL 4CM 3MM AZUR HDRCL DDRGL .018IN PERI PSH PERM MECH 45-280304 SUPPLY/IMPLANTS "$1,130.00 " Outpatient $565.00 Not Applicable: Bundled with Procedure $734.50 $791.00 $745.80 Not Applicable: Bundled with Procedure $395.50 $904.00 $395.50 $904.00 COIL EMBL 10CM 4MM .018IN AZUR PLTN DDRGL 135CM PERI DTCH 45-480410 SUPPLY/IMPLANTS "$4,186.00 " Outpatient "$2,093.00 " Not Applicable: Bundled with Procedure "$2,720.90 " "$2,930.20 " "$2,762.76 " Not Applicable: Bundled with Procedure "$1,465.10 " "$3,348.80 " "$1,465.10 " "$3,348.80 " COIL EMBL 10CM 6MM .021IN AZUR PLTN DDRGL .018IN 135CM PERI 45-480610 SUPPLY/IMPLANTS "$4,186.00 " Outpatient "$2,093.00 " Not Applicable: Bundled with Procedure "$2,720.90 " "$2,930.20 " "$2,762.76 " Not Applicable: Bundled with Procedure "$1,465.10 " "$3,348.80 " "$1,465.10 " "$3,348.80 " COIL EMBL 10CM 8MM .021IN AZUR PLTN DDRGL .018IN 135CM PERI 45-480810 SUPPLY/IMPLANTS "$4,159.00 " Outpatient "$2,079.50 " Not Applicable: Bundled with Procedure "$2,703.35 " "$2,911.30 " "$2,744.94 " Not Applicable: Bundled with Procedure "$1,455.65 " "$3,327.20 " "$1,455.65 " "$3,327.20 " COIL EMBL 15CM 8MM .021IN AZUR PLTN DDRGL .018IN 135CM PERI 45-480815 SUPPLY/IMPLANTS "$4,452.00 " Outpatient "$2,226.00 " Not Applicable: Bundled with Procedure "$2,893.80 " "$3,116.40 " "$2,938.32 " Not Applicable: Bundled with Procedure "$1,558.20 " "$3,561.60 " "$1,558.20 " "$3,561.60 " COIL EMBL 20CM 8MM AZUR HDRCL 18 COILS DTCH 45-480820 SUPPLY/IMPLANTS "$4,697.00 " Outpatient "$2,348.50 " Not Applicable: Bundled with Procedure "$3,053.05 " "$3,287.90 " "$3,100.02 " Not Applicable: Bundled with Procedure "$1,643.95 " "$3,757.60 " "$1,643.95 " "$3,757.60 " COIL EMBL 3CM 2MM HELIPAQ CERECYTE HLX 10 MCIOL THOROUGH PK CHE10020330 SUPPLY/IMPLANTS "$5,907.00 " Outpatient "$2,953.50 " Not Applicable: Bundled with Procedure "$3,839.55 " "$4,134.90 " "$3,898.62 " Not Applicable: Bundled with Procedure "$2,067.45 " "$4,725.60 " "$2,067.45 " "$4,725.60 " COIL EMBL 4CM 3MM CERECYTE 10 HLCL CHE100304-30 SUPPLY/IMPLANTS "$5,907.00 " Outpatient "$2,953.50 " Not Applicable: Bundled with Procedure "$3,839.55 " "$4,134.90 " "$3,898.62 " Not Applicable: Bundled with Procedure "$2,067.45 " "$4,725.60 " "$2,067.45 " "$4,725.60 " COIL EMBL 30MM 4MM VORTX 4MM VASC 35 COIL PSH OCL M0013732041 SUPPLY/IMPLANTS $438.00 Outpatient $219.00 Not Applicable: Bundled with Procedure $284.70 $306.60 $289.08 Not Applicable: Bundled with Procedure $153.30 $350.40 $153.30 $350.40 COIL EMBL 5CM 5-2MM TRND MCL PLTN STRL ACPT .081IN CATH AVM G08356 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 4CM 4-2MM TRND MCL PLTN STRL ACPT .081IN CATH AVM G47417 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL AZUR DTCH CNTRLR 45-4001 SUPPLY/IMPLANTS "$1,015.00 " Outpatient $507.50 Not Applicable: Bundled with Procedure $659.75 $710.50 $669.90 Not Applicable: Bundled with Procedure $355.25 $812.00 $355.25 $812.00 COIL EMBL 5CM 3MM .021IN AZUR PLTN DDRGL .018IN 135CM PERI 45-480305 SUPPLY/IMPLANTS "$4,306.00 " Outpatient "$2,153.00 " Not Applicable: Bundled with Procedure "$2,798.90 " "$3,014.20 " "$2,841.96 " Not Applicable: Bundled with Procedure "$1,507.10 " "$3,444.80 " "$1,507.10 " "$3,444.80 " COIL EMBL 2CM 2MM AZUR HDRCL PLTN DDRGL 18D .018IN PERI DTCH 45-480202 SUPPLY/IMPLANTS "$4,306.00 " Outpatient "$2,153.00 " Not Applicable: Bundled with Procedure "$2,798.90 " "$3,014.20 " "$2,841.96 " Not Applicable: Bundled with Procedure "$1,507.10 " "$3,444.80 " "$1,507.10 " "$3,444.80 " COIL EMBL 12.5CM 10-5MM TRND PLTN SM STD ARTERIOVENOUS ACPT G10413 SUPPLY/IMPLANTS $449.00 Outpatient $224.50 Not Applicable: Bundled with Procedure $291.85 $314.30 $296.34 Not Applicable: Bundled with Procedure $157.15 $359.20 $157.15 $359.20 COIL EMBL 8.2CM 8-5MM TRND PLTN STRL ACPT .035IN GW AVM G10412 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 8CM 3MM TRGT 360D DTCH SFT M0035473080 SUPPLY/IMPLANTS "$8,780.00 " Outpatient "$4,390.00 " Not Applicable: Bundled with Procedure "$5,707.00 " "$6,146.00 " "$5,794.80 " Not Applicable: Bundled with Procedure "$3,073.00 " "$7,024.00 " "$3,073.00 " "$7,024.00 " COIL EMBL 3CM 2MM TRGT 360D DTCH ULT M0035422030 SUPPLY/IMPLANTS "$9,269.00 " Outpatient "$4,634.50 " Not Applicable: Bundled with Procedure "$6,024.85 " "$6,488.30 " "$6,117.54 " Not Applicable: Bundled with Procedure "$3,244.15 " "$7,415.20 " "$3,244.15 " "$7,415.20 " COIL EMBL 4CM 2.5MM TRGT 360D DTCH ULT M0035422540 SUPPLY/IMPLANTS "$9,269.00 " Outpatient "$4,634.50 " Not Applicable: Bundled with Procedure "$6,024.85 " "$6,488.30 " "$6,117.54 " Not Applicable: Bundled with Procedure "$3,244.15 " "$7,415.20 " "$3,244.15 " "$7,415.20 " COIL EMBL 26CM 10MM .021IN AZUR PLTN .018IN 150CM FRME ELC 45-681026 SUPPLY/IMPLANTS "$4,404.00 " Outpatient "$2,202.00 " Not Applicable: Bundled with Procedure "$2,862.60 " "$3,082.80 " "$2,906.64 " Not Applicable: Bundled with Procedure "$1,541.40 " "$3,523.20 " "$1,541.40 " "$3,523.20 " COIL EMBL 10CM 4MM TRGT 360D DTCH SFT M0035474100 SUPPLY/IMPLANTS "$8,780.00 " Outpatient "$4,390.00 " Not Applicable: Bundled with Procedure "$5,707.00 " "$6,146.00 " "$5,794.80 " Not Applicable: Bundled with Procedure "$3,073.00 " "$7,024.00 " "$3,073.00 " "$7,024.00 " COIL EMBL 6CM 3MM TRGT 360D DTCH ULT M0035423060 SUPPLY/IMPLANTS "$10,178.00 " Outpatient "$5,089.00 " Not Applicable: Bundled with Procedure "$6,615.70 " "$7,124.60 " "$6,717.48 " Not Applicable: Bundled with Procedure "$3,562.30 " "$8,142.40 " "$3,562.30 " "$8,142.40 " COIL EMBL 5CM 8MM MREYE PLTN A/V 2 LOOP STRL ACPT .038IN GW G42463 SUPPLY/IMPLANTS $471.00 Outpatient $235.50 Not Applicable: Bundled with Procedure $306.15 $329.70 $310.86 Not Applicable: Bundled with Procedure $164.85 $376.80 $164.85 $376.80 COIL EMBL 8CM 8-4MM TRND PLTN STRL ACPT .035IN GW AVM G10411 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 8CM 7-3MM TRND PLTN ARTERIOVENOUS ACPT .035IN CATH G47522 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 5.8CM 6-3MM TRND PLTN STRL ACPT .035IN GW AVM G10416 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 4CM 2MM AZUR HDRCL PLTN DDRGL 18D .018IN PERI DTCH 45-480204 SUPPLY/IMPLANTS "$4,306.00 " Outpatient "$2,153.00 " Not Applicable: Bundled with Procedure "$2,798.90 " "$3,014.20 " "$2,841.96 " Not Applicable: Bundled with Procedure "$1,507.10 " "$3,444.80 " "$1,507.10 " "$3,444.80 " COIL EMBL 5CM 4MM AZUR .018IN 45-480405 SUPPLY/IMPLANTS "$4,306.00 " Outpatient "$2,153.00 " Not Applicable: Bundled with Procedure "$2,798.90 " "$3,014.20 " "$2,841.96 " Not Applicable: Bundled with Procedure "$1,507.10 " "$3,444.80 " "$1,507.10 " "$3,444.80 " COIL EMBL 8CM 4MM TRGT 360D DTCH SFT M0035474080 SUPPLY/IMPLANTS "$8,780.00 " Outpatient "$4,390.00 " Not Applicable: Bundled with Procedure "$5,707.00 " "$6,146.00 " "$5,794.80 " Not Applicable: Bundled with Procedure "$3,073.00 " "$7,024.00 " "$3,073.00 " "$7,024.00 " COIL EMBL 15CM 10MM .038IN AZUR PLTN DDRGL .035IN 135CM PERI 45-451015 SUPPLY/IMPLANTS "$6,848.00 " Outpatient "$3,424.00 " Not Applicable: Bundled with Procedure "$4,451.20 " "$4,793.60 " "$4,519.68 " Not Applicable: Bundled with Procedure "$2,396.80 " "$5,478.40 " "$2,396.80 " "$5,478.40 " COIL EMBL 10CM 6MM .038IN AZUR PLTN DDRGL .035IN 135CM PERI 45-450610 SUPPLY/IMPLANTS "$12,718.00 " Outpatient "$6,359.00 " Not Applicable: Bundled with Procedure "$8,266.70 " "$8,902.60 " "$8,393.88 " Not Applicable: Bundled with Procedure "$4,451.30 " "$10,174.40 " "$4,451.30 " "$10,174.40 " COIL EMBL 34MM 14MM AZUR PLTN .018IN FRME NONHYDROGEL DTCH 45-681434 SUPPLY/IMPLANTS "$4,648.00 " Outpatient "$2,324.00 " Not Applicable: Bundled with Procedure "$3,021.20 " "$3,253.60 " "$3,067.68 " Not Applicable: Bundled with Procedure "$1,626.80 " "$3,718.40 " "$1,626.80 " "$3,718.40 " COIL EMBL 6CM 4MM DELTAPLUSH DELTAWIND CERECYTE 10 MCIOL FRM CPL10040630 SUPPLY/IMPLANTS "$6,623.00 " Outpatient "$3,311.50 " Not Applicable: Bundled with Procedure "$4,304.95 " "$4,636.10 " "$4,371.18 " Not Applicable: Bundled with Procedure "$2,318.05 " "$5,298.40 " "$2,318.05 " "$5,298.40 " COIL EMBL 20CM 8MM AZUR FRM 45-680820 SUPPLY/IMPLANTS "$4,159.00 " Outpatient "$2,079.50 " Not Applicable: Bundled with Procedure "$2,703.35 " "$2,911.30 " "$2,744.94 " Not Applicable: Bundled with Procedure "$1,455.65 " "$3,327.20 " "$1,455.65 " "$3,327.20 " COIL EMBL 30CM 15MM .018IN AZUR HDRCL PLTN DDRGL PLMR PERI 45-481530 SUPPLY/IMPLANTS "$5,705.00 " Outpatient "$2,852.50 " Not Applicable: Bundled with Procedure "$3,708.25 " "$3,993.50 " "$3,765.30 " Not Applicable: Bundled with Procedure "$1,996.75 " "$4,564.00 " "$1,996.75 " "$4,564.00 " COIL EMBL 15CM 12MM .021IN AZUR PLTN DDRGL .018IN 135CM PERI 45-481215 SUPPLY/IMPLANTS "$4,485.00 " Outpatient "$2,242.50 " Not Applicable: Bundled with Procedure "$2,915.25 " "$3,139.50 " "$2,960.10 " Not Applicable: Bundled with Procedure "$1,569.75 " "$3,588.00 " "$1,569.75 " "$3,588.00 " COIL EMBL 2CM 3-2MM TRND MCL PLTN STRL ACPT .081IN CATH AVM G08261 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 15CM 6MM TRGT 3D DTCH M0036156150 SUPPLY/IMPLANTS "$9,074.00 " Outpatient "$4,537.00 " Not Applicable: Bundled with Procedure "$5,898.10 " "$6,351.80 " "$5,988.84 " Not Applicable: Bundled with Procedure "$3,175.90 " "$7,259.20 " "$3,175.90 " "$7,259.20 " COIL EMBL 10CM 5MM TRGT 360D DTCH SFT M0035475100 SUPPLY/IMPLANTS "$9,074.00 " Outpatient "$4,537.00 " Not Applicable: Bundled with Procedure "$5,898.10 " "$6,351.80 " "$5,988.84 " Not Applicable: Bundled with Procedure "$3,175.90 " "$7,259.20 " "$3,175.90 " "$7,259.20 " COIL EMBL 6CM 2MM TRGT 360D DTCH ULT M0035422060 SUPPLY/IMPLANTS "$10,178.00 " Outpatient "$5,089.00 " Not Applicable: Bundled with Procedure "$6,615.70 " "$7,124.60 " "$6,717.48 " Not Applicable: Bundled with Procedure "$3,562.30 " "$8,142.40 " "$3,562.30 " "$8,142.40 " COIL EMBL 4CM 3MM TRGT 360D DTCH ULT M0035423040 SUPPLY/IMPLANTS "$9,588.00 " Outpatient "$4,794.00 " Not Applicable: Bundled with Procedure "$6,232.20 " "$6,711.60 " "$6,328.08 " Not Applicable: Bundled with Procedure "$3,355.80 " "$7,670.40 " "$3,355.80 " "$7,670.40 " COIL EMBL 4CM 2MM TRGT 360D DTCH SFT M0035472040 SUPPLY/IMPLANTS "$9,074.00 " Outpatient "$4,537.00 " Not Applicable: Bundled with Procedure "$5,898.10 " "$6,351.80 " "$5,988.84 " Not Applicable: Bundled with Procedure "$3,175.90 " "$7,259.20 " "$3,175.90 " "$7,259.20 " COIL EMBL 4CM 2MM TRGT 360D DTCH ULT M0035422040 SUPPLY/IMPLANTS "$10,178.00 " Outpatient "$5,089.00 " Not Applicable: Bundled with Procedure "$6,615.70 " "$7,124.60 " "$6,717.48 " Not Applicable: Bundled with Procedure "$3,562.30 " "$8,142.40 " "$3,562.30 " "$8,142.40 " COIL EMBL 20CM 20MM AZUR DDRGL PERI DTCH 35 SYS 45-452020 SUPPLY/IMPLANTS "$7,337.00 " Outpatient "$3,668.50 " Not Applicable: Bundled with Procedure "$4,769.05 " "$5,135.90 " "$4,842.42 " Not Applicable: Bundled with Procedure "$2,567.95 " "$5,869.60 " "$2,567.95 " "$5,869.60 " COIL EMBL 30CM 15MM AZUR DDRGL PERI DTCH 35 SYS 45-451530 SUPPLY/IMPLANTS "$7,826.00 " Outpatient "$3,913.00 " Not Applicable: Bundled with Procedure "$5,086.90 " "$5,478.20 " "$5,165.16 " Not Applicable: Bundled with Procedure "$2,739.10 " "$6,260.80 " "$2,739.10 " "$6,260.80 " COIL EMBL 15CM 12MM .038IN AZUR PLTN DDRGL .035IN 135CM PERI 45-451215 SUPPLY/IMPLANTS "$6,848.00 " Outpatient "$3,424.00 " Not Applicable: Bundled with Procedure "$4,451.20 " "$4,793.60 " "$4,519.68 " Not Applicable: Bundled with Procedure "$2,396.80 " "$5,478.40 " "$2,396.80 " "$5,478.40 " COIL EMBL 15CM 8MM .038IN AZUR PLTN DDRGL .035IN 135CM PERI 45-450815 SUPPLY/IMPLANTS "$6,848.00 " Outpatient "$3,424.00 " Not Applicable: Bundled with Procedure "$4,451.20 " "$4,793.60 " "$4,519.68 " Not Applicable: Bundled with Procedure "$2,396.80 " "$5,478.40 " "$2,396.80 " "$5,478.40 " COIL EMBL 30CM 20MM .038IN AZUR PLTN .035IN 150CM FRME ELC 45-652050 SUPPLY/IMPLANTS "$7,337.00 " Outpatient "$3,668.50 " Not Applicable: Bundled with Procedure "$4,769.05 " "$5,135.90 " "$4,842.42 " Not Applicable: Bundled with Procedure "$2,567.95 " "$5,869.60 " "$2,567.95 " "$5,869.60 " COIL EMBL 34CM 14MM AZUR HDRCL PLTN .035IN PERI DTCH 45-651434 SUPPLY/IMPLANTS "$6,848.00 " Outpatient "$3,424.00 " Not Applicable: Bundled with Procedure "$4,451.20 " "$4,793.60 " "$4,519.68 " Not Applicable: Bundled with Procedure "$2,396.80 " "$5,478.40 " "$2,396.80 " "$5,478.40 " COIL EMBL 26CM 10MM .038IN AZUR PLTN .035IN 150CM FRME ELC 45-651026 SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 7CM 6-2MM TRND MCL PLTN STRL ACPT .081IN CATH AVM G08259 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 15CM 7MM TRGT 360D STD DTCH M0035467150 SUPPLY/IMPLANTS "$9,588.00 " Outpatient "$4,794.00 " Not Applicable: Bundled with Procedure "$6,232.20 " "$6,711.60 " "$6,328.08 " Not Applicable: Bundled with Procedure "$3,355.80 " "$7,670.40 " "$3,355.80 " "$7,670.40 " COIL EMBL 20CM 8MM TRGT 360D STD DTCH M0035468200 SUPPLY/IMPLANTS "$9,588.00 " Outpatient "$4,794.00 " Not Applicable: Bundled with Procedure "$6,232.20 " "$6,711.60 " "$6,328.08 " Not Applicable: Bundled with Procedure "$3,355.80 " "$7,670.40 " "$3,355.80 " "$7,670.40 " COIL EMBL 20CM 9MM TRGT 360D STD DTCH M0035469200 SUPPLY/IMPLANTS "$9,588.00 " Outpatient "$4,794.00 " Not Applicable: Bundled with Procedure "$6,232.20 " "$6,711.60 " "$6,328.08 " Not Applicable: Bundled with Procedure "$3,355.80 " "$7,670.40 " "$3,355.80 " "$7,670.40 " COIL EMBL 30CM 10MM TRGT 360D STD DTCH M0035461030 SUPPLY/IMPLANTS "$9,588.00 " Outpatient "$4,794.00 " Not Applicable: Bundled with Procedure "$6,232.20 " "$6,711.60 " "$6,328.08 " Not Applicable: Bundled with Procedure "$3,355.80 " "$7,670.40 " "$3,355.80 " "$7,670.40 " COIL EMBL 6CM 3MM TRGT 360D DTCH SFT M0035473060 SUPPLY/IMPLANTS "$9,074.00 " Outpatient "$4,537.00 " Not Applicable: Bundled with Procedure "$5,898.10 " "$6,351.80 " "$5,988.84 " Not Applicable: Bundled with Procedure "$3,175.90 " "$7,259.20 " "$3,175.90 " "$7,259.20 " COIL EMBL 6CM 4MM TRGT 360D DTCH SFT M0035474060 SUPPLY/IMPLANTS "$9,074.00 " Outpatient "$4,537.00 " Not Applicable: Bundled with Procedure "$5,898.10 " "$6,351.80 " "$5,988.84 " Not Applicable: Bundled with Procedure "$3,175.90 " "$7,259.20 " "$3,175.90 " "$7,259.20 " COIL EMBL 15CM 5MM TRGT 360D DTCH SFT M0035475150 SUPPLY/IMPLANTS "$9,074.00 " Outpatient "$4,537.00 " Not Applicable: Bundled with Procedure "$5,898.10 " "$6,351.80 " "$5,988.84 " Not Applicable: Bundled with Procedure "$3,175.90 " "$7,259.20 " "$3,175.90 " "$7,259.20 " COIL EMBL 10CM 6MM TRGT 360D DTCH SFT M0035476100 SUPPLY/IMPLANTS "$9,074.00 " Outpatient "$4,537.00 " Not Applicable: Bundled with Procedure "$5,898.10 " "$6,351.80 " "$5,988.84 " Not Applicable: Bundled with Procedure "$3,175.90 " "$7,259.20 " "$3,175.90 " "$7,259.20 " COIL EMBL 15CM 6MM TRGT 360D DTCH SFT M0035476150 SUPPLY/IMPLANTS "$9,074.00 " Outpatient "$4,537.00 " Not Applicable: Bundled with Procedure "$5,898.10 " "$6,351.80 " "$5,988.84 " Not Applicable: Bundled with Procedure "$3,175.90 " "$7,259.20 " "$3,175.90 " "$7,259.20 " COIL EMBL 15CM 7MM TRGT 360D DTCH SFT M0035477150 SUPPLY/IMPLANTS "$9,074.00 " Outpatient "$4,537.00 " Not Applicable: Bundled with Procedure "$5,898.10 " "$6,351.80 " "$5,988.84 " Not Applicable: Bundled with Procedure "$3,175.90 " "$7,259.20 " "$3,175.90 " "$7,259.20 " COIL EMBL 20CM 7MM TRGT PLTN DTCH SFT M0035477200 SUPPLY/IMPLANTS "$9,074.00 " Outpatient "$4,537.00 " Not Applicable: Bundled with Procedure "$5,898.10 " "$6,351.80 " "$5,988.84 " Not Applicable: Bundled with Procedure "$3,175.90 " "$7,259.20 " "$3,175.90 " "$7,259.20 " COIL EMBL 20CM 8MM TRGT 360D DTCH SFT M0035478200 SUPPLY/IMPLANTS "$9,074.00 " Outpatient "$4,537.00 " Not Applicable: Bundled with Procedure "$5,898.10 " "$6,351.80 " "$5,988.84 " Not Applicable: Bundled with Procedure "$3,175.90 " "$7,259.20 " "$3,175.90 " "$7,259.20 " COIL EMBL 2CM 1MM TRGT NANO 360D DTCH M0035421020 SUPPLY/IMPLANTS "$9,588.00 " Outpatient "$4,794.00 " Not Applicable: Bundled with Procedure "$6,232.20 " "$6,711.60 " "$6,328.08 " Not Applicable: Bundled with Procedure "$3,355.80 " "$7,670.40 " "$3,355.80 " "$7,670.40 " COIL EMBL 3CM 1.5MM TRGT NANO 360D DTCH M0035421530 SUPPLY/IMPLANTS "$10,178.00 " Outpatient "$5,089.00 " Not Applicable: Bundled with Procedure "$6,615.70 " "$7,124.60 " "$6,717.48 " Not Applicable: Bundled with Procedure "$3,562.30 " "$8,142.40 " "$3,562.30 " "$8,142.40 " COIL EMBL 4CM 1.5MM TRGT 360D DTCH ULT M0035421540 SUPPLY/IMPLANTS "$9,588.00 " Outpatient "$4,794.00 " Not Applicable: Bundled with Procedure "$6,232.20 " "$6,711.60 " "$6,328.08 " Not Applicable: Bundled with Procedure "$3,355.80 " "$7,670.40 " "$3,355.80 " "$7,670.40 " COIL EMBL 6CM 4MM TRGT 360D DTCH ULT M0035424060 SUPPLY/IMPLANTS "$9,588.00 " Outpatient "$4,794.00 " Not Applicable: Bundled with Procedure "$6,232.20 " "$6,711.60 " "$6,328.08 " Not Applicable: Bundled with Procedure "$3,355.80 " "$7,670.40 " "$3,355.80 " "$7,670.40 " COIL EMBL 1CM 1MM TRGT HLCL DTCH ULT M0035431010 SUPPLY/IMPLANTS "$6,554.00 " Outpatient "$3,277.00 " Not Applicable: Bundled with Procedure "$4,260.10 " "$4,587.80 " "$4,325.64 " Not Applicable: Bundled with Procedure "$2,293.90 " "$5,243.20 " "$2,293.90 " "$5,243.20 " COIL EMBL 2CM 1MM TRGT HLCL DTCH ULT M0035431020 SUPPLY/IMPLANTS "$6,554.00 " Outpatient "$3,277.00 " Not Applicable: Bundled with Procedure "$4,260.10 " "$4,587.80 " "$4,325.64 " Not Applicable: Bundled with Procedure "$2,293.90 " "$5,243.20 " "$2,293.90 " "$5,243.20 " COIL EMBL 2CM 1.5MM TRGT HLCL DTCH ULT M0035431520 SUPPLY/IMPLANTS "$6,554.00 " Outpatient "$3,277.00 " Not Applicable: Bundled with Procedure "$4,260.10 " "$4,587.80 " "$4,325.64 " Not Applicable: Bundled with Procedure "$2,293.90 " "$5,243.20 " "$2,293.90 " "$5,243.20 " COIL EMBL 2CM 2MM TRGT HLX DTCH ULT M0035432020 SUPPLY/IMPLANTS "$6,554.00 " Outpatient "$3,277.00 " Not Applicable: Bundled with Procedure "$4,260.10 " "$4,587.80 " "$4,325.64 " Not Applicable: Bundled with Procedure "$2,293.90 " "$5,243.20 " "$2,293.90 " "$5,243.20 " COIL EMBL 3CM 2MM TRGT HLCL DTCH ULT M0035432030 SUPPLY/IMPLANTS "$6,554.00 " Outpatient "$3,277.00 " Not Applicable: Bundled with Procedure "$4,260.10 " "$4,587.80 " "$4,325.64 " Not Applicable: Bundled with Procedure "$2,293.90 " "$5,243.20 " "$2,293.90 " "$5,243.20 " COIL EMBL 4CM 2.5MM TRGT HLX DTCH ULT M0035432540 SUPPLY/IMPLANTS "$6,554.00 " Outpatient "$3,277.00 " Not Applicable: Bundled with Procedure "$4,260.10 " "$4,587.80 " "$4,325.64 " Not Applicable: Bundled with Procedure "$2,293.90 " "$5,243.20 " "$2,293.90 " "$5,243.20 " COIL EMBL 10CM 5MM TRGT 360D DTCH ULT M0035425100 SUPPLY/IMPLANTS "$10,178.00 " Outpatient "$5,089.00 " Not Applicable: Bundled with Procedure "$6,615.70 " "$7,124.60 " "$6,717.48 " Not Applicable: Bundled with Procedure "$3,562.30 " "$8,142.40 " "$3,562.30 " "$8,142.40 " COIL EMBL 8CM 4MM TRGT 360D DTCH ULT M0035424080 SUPPLY/IMPLANTS "$10,187.00 " Outpatient "$5,093.50 " Not Applicable: Bundled with Procedure "$6,621.55 " "$7,130.90 " "$6,723.42 " Not Applicable: Bundled with Procedure "$3,565.45 " "$8,149.60 " "$3,565.45 " "$8,149.60 " COIL EMBL 25CM 8MM TRGT 3D DTCH M0036158250 SUPPLY/IMPLANTS "$9,074.00 " Outpatient "$4,537.00 " Not Applicable: Bundled with Procedure "$5,898.10 " "$6,351.80 " "$5,988.84 " Not Applicable: Bundled with Procedure "$3,175.90 " "$7,259.20 " "$3,175.90 " "$7,259.20 " COIL EMBOLIZATION PLATINUM 5MM X 4MM MWCE-18S-5/4 TORNADO SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 3CM .25-.52IN SS ART ACPT .025-.038IN GW G04433 SUPPLY/IMPLANTS $457.00 Outpatient $228.50 Not Applicable: Bundled with Procedure $297.05 $319.90 $301.62 Not Applicable: Bundled with Procedure $159.95 $365.60 $159.95 $365.60 COIL EMBL 14CM 3MM .018IN NST PLTN 14.9 LOOP SFT RADOPC STRL G26987 SUPPLY/IMPLANTS $657.00 Outpatient $328.50 Not Applicable: Bundled with Procedure $427.05 $459.90 $433.62 Not Applicable: Bundled with Procedure $229.95 $525.60 $229.95 $525.60 COIL EMBL 14CM 4MM NST PLTN .018IN 11.1 LOOP SFT RADOPC STRL G26988 SUPPLY/IMPLANTS $457.00 Outpatient $228.50 Not Applicable: Bundled with Procedure $297.05 $319.90 $301.62 Not Applicable: Bundled with Procedure $159.95 $365.60 $159.95 $365.60 COIL EMBL 4CM 2MM .0115IN AXIUM PLTN .2921MM HLX DTCH QC-2-4-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 6CM 2MM .0115IN AXIUM PLTN .2921MM 3D DTCH QC-2-6-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 12CM 3.5MM AXIUM 3D QC-3.5-12-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 6CM 3.5MM AXIUM 3D QC-3.5-6-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 4CM 3MM .0115IN AXIUM PLTN .2921MM 3D DTCH QC-3-4-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 4CM 3MM .0115IN AXIUM PLTN .2921MM HLX DTCH QC-3-4-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 6CM 3MM .0115IN AXIUM PLTN .2921MM 3D DTCH QC-3-6-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 6CM 3MM .0115IN AXIUM PLTN .2921MM HLX DTCH QC-3-6-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 8CM 3MM .0115IN AXIUM PLTN .2921MM 3D DTCH QC-3-8-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 8CM 3MM .0115IN AXIUM PLTN .2921MM HLX DTCH QC-3-8-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 10CM 4MM .0125IN AXIUM PLTN .3175MM 3D DTCH QC-4-10-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 10CM 4MM .0125IN AXIUM PLTN .3175MM HLX DTCH QC-4-10-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 12CM 4MM .0125IN AXIUM PLTN .3175MM 3D DTCH QC-4-12-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 6CM 4MM .0125IN AXIUM PLTN .3175MM 3D DTCH QC-4-6-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 8CM 4MM .0125IN AXIUM PLTN .3175MM 3D DTCH QC-4-8-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 8CM 4MM .0125IN AXIUM PLTN .3175MM HLX DTCH QC-4-8-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 10CM 5MM .0125IN AXIUM PLTN .3175MM 3D DTCH QC-5-10-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 15CM 5MM .0125IN AXIUM PLTN .3175MM 3D DTCH QC-5-15-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 15CM 5MM .0125IN AXIUM PLTN .3175MM HLX DTCH QC-5-15-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 8CM 5MM .0125IN AXIUM PLTN .3175MM 3D DTCH QC-5-8-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 10CM 6MM .0125IN AXIUM PLTN .3175MM 3D DTCH QC-6-10-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 15CM 6MM .0125IN AXIUM PLTN .3175MM 3D DTCH QC-6-15-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 20CM 6MM .0125IN AXIUM PLTN .3175MM HLX DTCH QC-6-20-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 15CM 7MM .0135IN AXIUM PLTN .3429MM 3D DTCH QC-7-15-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 20CM 7MM .0135IN AXIUM PLTN .3429MM 3D DTCH QC-7-20-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 20CM 7MM .0135IN AXIUM PLTN .3429MM HLX DTCH QC-7-20-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 15CM 8MM .0135IN AXIUM PLTN .3429MM 3D DTCH QC-8-15-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 20CM 8MM .0135IN AXIUM PLTN .3429MM 3D DTCH QC-8-20-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 20CM 8MM .0135IN AXIUM PLTN .3429MM HLX DTCH QC-8-20-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 30CM 8MM .0135IN AXIUM PLTN .3429MM HLX DTCH QC-8-30-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 20CM 9MM .0135IN AXIUM PLTN .3429MM 3D DTCH QC-9-20-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 10CM 4MM .0115IN AXIUM PRM HLX NRVSC DTCH SSFT APB-4-10-HX-SS SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 8CM 4MM .0115IN AXIUM PRM HLX NRVSC DTCH SSFT APB-4-8-HX-SS SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 3CM 1.5MM AXIUM HLX QC-1.5-3-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 12CM 6MM .0115IN AXIUM PRM LATTICEFX HLX NRVSC APB-6-12-HX-SS SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 4CM 1.5MM AXIUM HLX QC-1.5-4-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 2CM 2.5MM AXIUM HLX QC-2.5-2-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 4CM 2.5MM AXIUM 3D QC-2.5-4-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 2CM 2.5MM AXIUM 3D QC-2.5-2-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 20CM 10MM .0135IN AXIUM PLTN .3429MM 3D DTCH QC-10-20-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 30CM 12MM .0145IN AXIUM PLTN .3683MM HLX DTCH QC-12-30-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 20CM 10MM .0135IN AXIUM PLTN .3429MM HLX DTCH QC-10-20-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 4CM 2.5MM AXIUM HLX QC-2.5-4-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 6CM 2.5MM AXIUM 3D QC-2.5-6-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 4CM 2MM .0115IN AXIUM PLTN .2921MM 3D DTCH QC-2-4-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 1CM 2MM .0115IN AXIUM PLTN .2921MM HLX DTCH QC-2-1-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 8CM 2.5MM AXIUM 3D QC-2.5-8-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 3CM 2MM .0115IN AXIUM PLTN .2921MM HLX DTCH QC-2-3-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 2CM 2MM .0115IN AXIUM PLTN .2921MM HLX DTCH QC-2-2-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 6CM 2.5MM AXIUM HLX QC-2.5-6-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 2CM 2MM .0115IN AXIUM PLTN .2921MM 3D DTCH QC-2-2-3D SUPPLY/IMPLANTS "$6,360.00 " Outpatient "$3,180.00 " Not Applicable: Bundled with Procedure "$4,134.00 " "$4,452.00 " "$4,197.60 " Not Applicable: Bundled with Procedure "$2,226.00 " "$5,088.00 " "$2,226.00 " "$5,088.00 " COIL EMBL 6CM 2MM .0115IN AXIUM PLTN .2921MM HLX DTCH QC-2-6-HELIX SUPPLY/IMPLANTS "$5,321.00 " Outpatient "$2,660.50 " Not Applicable: Bundled with Procedure "$3,458.65 " "$3,724.70 " "$3,511.86 " Not Applicable: Bundled with Procedure "$1,862.35 " "$4,256.80 " "$1,862.35 " "$4,256.80 " COIL EMBL 2CM 3MM .018IN AZUR HDRCL PLTN DDRGL PLMR PERI 18 45-480302 SUPPLY/IMPLANTS "$4,306.00 " Outpatient "$2,153.00 " Not Applicable: Bundled with Procedure "$2,798.90 " "$3,014.20 " "$2,841.96 " Not Applicable: Bundled with Procedure "$1,507.10 " "$3,444.80 " "$1,507.10 " "$3,444.80 " COIL EMBL 13CM 4MM .021-.027IN AZUR CX PLTN DDRGL HDRPH PLMR 45-780413 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " Not Applicable: Bundled with Procedure "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,711.85 " "$3,912.80 " COIL EMBL 16CM 5MM .021-.027IN AZUR CX DDRGL .018IN PERI 45-780516 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " Not Applicable: Bundled with Procedure "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,711.85 " "$3,912.80 " COIL EMBL 30CM 20MM AZUR DDRGL PERI DTCH 35 SYS 45-452030 SUPPLY/IMPLANTS "$7,826.00 " Outpatient "$3,913.00 " Not Applicable: Bundled with Procedure "$5,086.90 " "$5,478.20 " "$5,165.16 " Not Applicable: Bundled with Procedure "$2,739.10 " "$6,260.80 " "$2,739.10 " "$6,260.80 " COIL EMBL 20CM 12MM .038IN AZUR PLTN DDRGL .035IN 135CM PERI 45-451220 SUPPLY/IMPLANTS "$7,337.00 " Outpatient "$3,668.50 " Not Applicable: Bundled with Procedure "$4,769.05 " "$5,135.90 " "$4,842.42 " Not Applicable: Bundled with Procedure "$2,567.95 " "$5,869.60 " "$2,567.95 " "$5,869.60 " COIL EMBL 20CM 10MM AZUR DDRGL PERI DTCH 35 SYS 45-451020 SUPPLY/IMPLANTS "$7,337.00 " Outpatient "$3,668.50 " Not Applicable: Bundled with Procedure "$4,769.05 " "$5,135.90 " "$4,842.42 " Not Applicable: Bundled with Procedure "$2,567.95 " "$5,869.60 " "$2,567.95 " "$5,869.60 " COIL EMBL 20CM 8MM .038IN AZUR PLTN DDRGL .035IN 135CM PERI 45-450820 SUPPLY/IMPLANTS "$7,337.00 " Outpatient "$3,668.50 " Not Applicable: Bundled with Procedure "$4,769.05 " "$5,135.90 " "$4,842.42 " Not Applicable: Bundled with Procedure "$2,567.95 " "$5,869.60 " "$2,567.95 " "$5,869.60 " COIL EMBL 4.1CM 5-3MM TRND PLTN .035IN STD SM ARTERIOVENOUS G47520 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 2.6CM 4-3MM TRND PLTN STRL ACPT .035IN GW AVM G47519 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 8-5MM TRND PLTN SS SNTH FBR ACPT .035IN GW G03230 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 30CM 20MM .018IN AZUR HDRCL PLTN PERI 18 COIL DTCH 45-482030 SUPPLY/IMPLANTS "$5,705.00 " Outpatient "$2,852.50 " Not Applicable: Bundled with Procedure "$3,708.25 " "$3,993.50 " "$3,765.30 " Not Applicable: Bundled with Procedure "$1,996.75 " "$4,564.00 " "$1,996.75 " "$4,564.00 " COIL EMBL 40CM 20MM .021-.027IN AZUR CX HDRCL DDRGL .018IN 45-782040 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " Not Applicable: Bundled with Procedure "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,711.85 " "$3,912.80 " COIL EMBL 20CM 6MM .021-.027IN AZUR CX DDRGL .018IN PERI 45-780620 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " Not Applicable: Bundled with Procedure "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,711.85 " "$3,912.80 " COIL EMBL 24CM 7MM .021-.027IN AZUR CX DDRGL .018IN PERI 45-780724 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " Not Applicable: Bundled with Procedure "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,711.85 " "$3,912.80 " COIL EMBL 28CM 8MM .021-.027IN AZUR CX HDRCL DDRGL .018IN 45-780828 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " Not Applicable: Bundled with Procedure "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,711.85 " "$3,912.80 " COIL EMBL 7CM 6MM NST PLTN SNTH FBR .035IN PERI 3.7 LOOP SFT G52743 SUPPLY/IMPLANTS $507.00 Outpatient $253.50 Not Applicable: Bundled with Procedure $329.55 $354.90 $334.62 Not Applicable: Bundled with Procedure $177.45 $405.60 $177.45 $405.60 COIL EMBL 7CM 8MM NST PLTN SNTH FBR .035IN PERI 2.8 LOOP SFT G52744 SUPPLY/IMPLANTS $507.00 Outpatient $253.50 Not Applicable: Bundled with Procedure $329.55 $354.90 $334.62 Not Applicable: Bundled with Procedure $177.45 $405.60 $177.45 $405.60 COIL EMBL 7CM 10MM NST PLTN SNTH FBR .035IN PERI 2.2 LOOP G52745 SUPPLY/IMPLANTS $507.00 Outpatient $253.50 Not Applicable: Bundled with Procedure $329.55 $354.90 $334.62 Not Applicable: Bundled with Procedure $177.45 $405.60 $177.45 $405.60 COIL EMBL 14CM 6MM NST PLTN SNTH FBR A/V 7.4 LOOP CATH END G47354 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 14CM 8MM NST PLTN SNTH FBR A/V 5.6 LOOP CATH END G47355 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 14CM 10MM NST PLTN SNTH FBR A/V 4.5 LOOP CATH END G26991 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 3CM 4MM .038IN G04460 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 60CM .02IN 16MM PENUMBRA COIL 400 RUBY STD PERI RBY2C1660 SUPPLY/IMPLANTS "$8,273.00 " Outpatient "$4,136.50 " Not Applicable: Bundled with Procedure "$5,377.45 " "$5,791.10 " "$5,460.18 " Not Applicable: Bundled with Procedure "$2,895.55 " "$6,618.40 " "$2,895.55 " "$6,618.40 " COIL EMBL 35CM .02IN 8MM PENUMBRA COIL 400 RUBY PERI CMPLX RBY4C0835 SUPPLY/IMPLANTS "$7,784.00 " Outpatient "$3,892.00 " Not Applicable: Bundled with Procedure "$5,059.60 " "$5,448.80 " "$5,137.44 " Not Applicable: Bundled with Procedure "$2,724.40 " "$6,227.20 " "$2,724.40 " "$6,227.20 " COIL EMBL 32CM 10MM .021-.027IN AZUR CX HDRCL DDRGL .018IN 45-781032 SUPPLY/IMPLANTS "$3,669.00 " Outpatient "$1,834.50 " Not Applicable: Bundled with Procedure "$2,384.85 " "$2,568.30 " "$2,421.54 " Not Applicable: Bundled with Procedure "$1,284.15 " "$2,935.20 " "$1,284.15 " "$2,935.20 " COIL EMBL 2CM 2MM AZUR HDRCL DDRGL .018IN PERI PSH PERM MECH 45-280202 SUPPLY/IMPLANTS $828.00 Outpatient $414.00 Not Applicable: Bundled with Procedure $538.20 $579.60 $546.48 Not Applicable: Bundled with Procedure $289.80 $662.40 $289.80 $662.40 COIL EMBL 4CM 4MM AZUR HDRCL .018IN PERI PSH 18 SYS 45-280404 SUPPLY/IMPLANTS "$1,130.00 " Outpatient $565.00 Not Applicable: Bundled with Procedure $734.50 $791.00 $745.80 Not Applicable: Bundled with Procedure $395.50 $904.00 $395.50 $904.00 COIL EMBL 4CM 5MM AZUR HDRCL .018IN PERI PSH 18 SYS 45-280504 SUPPLY/IMPLANTS "$1,130.00 " Outpatient $565.00 Not Applicable: Bundled with Procedure $734.50 $791.00 $745.80 Not Applicable: Bundled with Procedure $395.50 $904.00 $395.50 $904.00 COIL EMBL 8CM 15MM SS FBR VASC 1.7 LOOP LD CRTDG STRL ACPT G01232 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 8CM 10MM 2.5MM SS .038IN LOOP STRL G01279 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 5CM 12MM 1.3IN SS .038IN LOOP VASC STRL G02036 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 20CM 6MM AZUR DDRGL PERI DTCH 35 SYS 45-450620 SUPPLY/IMPLANTS "$7,337.00 " Outpatient "$3,668.50 " Not Applicable: Bundled with Procedure "$4,769.05 " "$5,135.90 " "$4,842.42 " Not Applicable: Bundled with Procedure "$2,567.95 " "$5,869.60 " "$2,567.95 " "$5,869.60 " COIL EMBL 9CM 7-3MM TRND PLTN .018IN TPR MIC ARTERIOVENOUS G09218 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 9.5CM 8-4MM TRND MCL PLTN .018IN MCIOL SFT SPC G09215 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 14.2CM 10-4MM TRND PLTN .018IN MCIOL SFT SPC PUSH G09217 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 12.5CM 10-4MM TRND PLTN STRL ACPT .035IN GW AVM G10428 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 Not Applicable: Bundled with Procedure $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 $437.60 COIL EMBL 4CM 2.5MM .0108IN AXIUM PRM 3D DTCH X SFT APB-2.5-4-3D-ES SUPPLY/IMPLANTS "$8,780.00 " Outpatient "$4,390.00 " Not Applicable: Bundled with Procedure "$5,707.00 " "$6,146.00 " "$5,794.80 " Not Applicable: Bundled with Procedure "$3,073.00 " "$7,024.00 " "$3,073.00 " "$7,024.00 " COIL EMBL 2CM 1.5MM AXIUM PRM 3D X SFT APB-1.5-2-3D-ES SUPPLY/IMPLANTS "$8,780.00 " Outpatient "$4,390.00 " Not Applicable: Bundled with Procedure "$5,707.00 " "$6,146.00 " "$5,794.80 " Not Applicable: Bundled with Procedure "$3,073.00 " "$7,024.00 " "$3,073.00 " "$7,024.00 " COIL EMBL 30CM 9MM CONCERTO LATTICEFX NYL FBR PP HLX PERI NV-9-30-HELIX SUPPLY/IMPLANTS "$2,911.00 " Outpatient "$1,455.50 " Not Applicable: Bundled with Procedure "$1,892.15 " "$2,037.70 " "$1,921.26 " Not Applicable: Bundled with Procedure "$1,018.85 " "$2,328.80 " "$1,018.85 " "$2,328.80 " COIL EMBL 30CM 10MM CONCERTO LATTICEFX NYL FBR PP HLX PERI NV-10-30-HELIX SUPPLY/IMPLANTS "$2,911.00 " Outpatient "$1,455.50 " Not Applicable: Bundled with Procedure "$1,892.15 " "$2,037.70 " "$1,921.26 " Not Applicable: Bundled with Procedure "$1,018.85 " "$2,328.80 " "$1,018.85 " "$2,328.80 " COIL EMBL 30CM 12MM CONCERTO LATTICEFX PGLA FBR PP HLX DTCH PV-12-30-HELIX SUPPLY/IMPLANTS "$2,911.00 " Outpatient "$1,455.50 " Not Applicable: Bundled with Procedure "$1,892.15 " "$2,037.70 " "$1,921.26 " Not Applicable: Bundled with Procedure "$1,018.85 " "$2,328.80 " "$1,018.85 " "$2,328.80 " COIL EMBL 30CM 14MM CONCERTO LATTICEFX PGLA FBR PP HLX DTCH PV-14-30-HELIX SUPPLY/IMPLANTS "$2,911.00 " Outpatient "$1,455.50 " Not Applicable: Bundled with Procedure "$1,892.15 " "$2,037.70 " "$1,921.26 " Not Applicable: Bundled with Procedure "$1,018.85 " "$2,328.80 " "$1,018.85 " "$2,328.80 " COIL EMBL 40CM 16MM CONCERTO LATTICEFX PGLA FBR PP HLX DTCH PV-16-40-HELIX SUPPLY/IMPLANTS "$2,911.00 " Outpatient "$1,455.50 " Not Applicable: Bundled with Procedure "$1,892.15 " "$2,037.70 " "$1,921.26 " Not Applicable: Bundled with Procedure "$1,018.85 " "$2,328.80 " "$1,018.85 " "$2,328.80 " COIL EMBL 40CM 18MM CONCERTO LATTICEFX PGLA FBR PP HLX DTCH PV-18-40-HELIX SUPPLY/IMPLANTS "$2,911.00 " Outpatient "$1,455.50 " Not Applicable: Bundled with Procedure "$1,892.15 " "$2,037.70 " "$1,921.26 " Not Applicable: Bundled with Procedure "$1,018.85 " "$2,328.80 " "$1,018.85 " "$2,328.80 " COIL EMBL 50CM 20MM CONCERTO LATTICEFX PGLA FBR PP HLX DTCH PV-20-50-HELIX SUPPLY/IMPLANTS "$2,911.00 " Outpatient "$1,455.50 " Not Applicable: Bundled with Procedure "$1,892.15 " "$2,037.70 " "$1,921.26 " Not Applicable: Bundled with Procedure "$1,018.85 " "$2,328.80 " "$1,018.85 " "$2,328.80 " COIL EMBL 4CM 3MM AXIUM PRM 3D X SFT APB-3-4-3D-ES SUPPLY/IMPLANTS "$8,780.00 " Outpatient "$4,390.00 " Not Applicable: Bundled with Procedure "$5,707.00 " "$6,146.00 " "$5,794.80 " Not Applicable: Bundled with Procedure "$3,073.00 " "$7,024.00 " "$3,073.00 " "$7,024.00 " COIL EMBL 6CM 3MM AXIUM PRM 3D X SFT APB-3-6-3D-ES SUPPLY/IMPLANTS "$8,780.00 " Outpatient "$4,390.00 " Not Applicable: Bundled with Procedure "$5,707.00 " "$6,146.00 " "$5,794.80 " Not Applicable: Bundled with Procedure "$3,073.00 " "$7,024.00 " "$3,073.00 " "$7,024.00 " COIL EMBL 3CM 2MM AXIUM PRM 3D X SFT APB-2-3-3D-ES SUPPLY/IMPLANTS "$8,780.00 " Outpatient "$4,390.00 " Not Applicable: Bundled with Procedure "$5,707.00 " "$6,146.00 " "$5,794.80 " Not Applicable: Bundled with Procedure "$3,073.00 " "$7,024.00 " "$3,073.00 " "$7,024.00 " COIL EMBL 4CM 2MM AXIUM PRM 3D X SFT APB-2-4-3D-ES SUPPLY/IMPLANTS "$8,780.00 " Outpatient "$4,390.00 " Not Applicable: Bundled with Procedure "$5,707.00 " "$6,146.00 " "$5,794.80 " Not Applicable: Bundled with Procedure "$3,073.00 " "$7,024.00 " "$3,073.00 " "$7,024.00 " COIL EMBL 6CM 3MM INTLK FBR IDC 2D 18 COIL DTCH OCL M001361500 SUPPLY/IMPLANTS "$2,708.00 " Outpatient "$1,354.00 " Not Applicable: Bundled with Procedure "$1,760.20 " "$1,895.60 " "$1,787.28 " Not Applicable: Bundled with Procedure $947.80 "$2,166.40 " $947.80 "$2,166.40 " COIL EMBL 8CM 4MM INTLK FBR IDC 2D 18 COIL DTCH OCL M001361520 SUPPLY/IMPLANTS "$2,708.00 " Outpatient "$1,354.00 " Not Applicable: Bundled with Procedure "$1,760.20 " "$1,895.60 " "$1,787.28 " Not Applicable: Bundled with Procedure $947.80 "$2,166.40 " $947.80 "$2,166.40 " COIL EMBL 10CM 6MM INTLK FBR IDC DCRN PLTN STDLN 2D 18 COIL M001361560 SUPPLY/IMPLANTS "$2,708.00 " Outpatient "$1,354.00 " Not Applicable: Bundled with Procedure "$1,760.20 " "$1,895.60 " "$1,787.28 " Not Applicable: Bundled with Procedure $947.80 "$2,166.40 " $947.80 "$2,166.40 " COIL EMBL 6CM 3.5MM AXIUM PRM 3D X SFT APB-3.5-6-3D-ES SUPPLY/IMPLANTS "$8,780.00 " Outpatient "$4,390.00 " Not Applicable: Bundled with Procedure "$5,707.00 " "$6,146.00 " "$5,794.80 " Not Applicable: Bundled with Procedure "$3,073.00 " "$7,024.00 " "$3,073.00 " "$7,024.00 " COIL EMBL 8CM 3MM AXIUM PRM 3D X SFT APB-3-8-3D-ES SUPPLY/IMPLANTS "$8,780.00 " Outpatient "$4,390.00 " Not Applicable: Bundled with Procedure "$5,707.00 " "$6,146.00 " "$5,794.80 " Not Applicable: Bundled with Procedure "$3,073.00 " "$7,024.00 " "$3,073.00 " "$7,024.00 " COIL EMBOLIZATION PIPELINE FLEX 4.25MM X 25MM PED-425-25 SUPPLY/IMPLANTS "$75,717.00 " Outpatient "$37,858.50 " Not Applicable: Bundled with Procedure "$49,216.05 " "$53,001.90 " "$49,973.22 " Not Applicable: Bundled with Procedure "$26,500.95 " "$60,573.60 " "$26,500.95 " "$60,573.60 " COIL EMBL 50CM 18MM INTLK FBR IDC DCRN PLTN LNG LGTH 2D 18 M001361940 SUPPLY/IMPLANTS "$4,293.00 " Outpatient "$2,146.50 " Not Applicable: Bundled with Procedure "$2,790.45 " "$3,005.10 " "$2,833.38 " Not Applicable: Bundled with Procedure "$1,502.55 " "$3,434.40 " "$1,502.55 " "$3,434.40 " COIL EMBL 4CM 2MM INTLK IDC DCRN PLTN .018IN 2D HLX OCL SYS M0013612040 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 10CM 3MM INTLK IDC DCRN PLTN .018IN 2D HLX OCL SYS M0013613100 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 6CM 3MM INTLK IDC DCRN PLTN .018IN 2D HLX OCL SYS M0013613060 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 4CM 12MM INTLK IDC DCRN PLTN .018IN 2D HLX OCL SYS M0013614120 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 4CM 4MM INTLK IDC DCRN PLTN .018IN 2D HLX OCL SYS M0013614040 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 8CM 4MM INTLK IDC DCRN PLTN .018IN 2D HLX OCL SYS M0013614080 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 8CM 5MM INTLK IDC PLTN FBR .018IN 2D HLX OCL SYS M0013615080 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 30MM 4MM PLTN FBR 2D HLCL 2.9MM 35 COIL PSH M0013724031 SUPPLY/IMPLANTS "$2,127.00 " Outpatient "$1,063.50 " Not Applicable: Bundled with Procedure "$1,382.55 " "$1,488.90 " "$1,403.82 " Not Applicable: Bundled with Procedure $744.45 "$1,701.60 " $744.45 "$1,701.60 " COIL EMBL 30CM 14MM INTLK FBR IDC STDLN 2D 18 COIL OCL SYS M001361640 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 22MM 3MM VORTX PLTN FBR .18MM 20.5MM OCL M0013812031 SUPPLY/IMPLANTS "$2,838.00 " Outpatient "$1,419.00 " Not Applicable: Bundled with Procedure "$1,844.70 " "$1,986.60 " "$1,873.08 " Not Applicable: Bundled with Procedure $993.30 "$2,270.40 " $993.30 "$2,270.40 " COIL EMBL 42MM 2-4MM VORTX PLTN FBR 18 COIL M0013812041 SUPPLY/IMPLANTS "$2,838.00 " Outpatient "$1,419.00 " Not Applicable: Bundled with Procedure "$1,844.70 " "$1,986.60 " "$1,873.08 " Not Applicable: Bundled with Procedure $993.30 "$2,270.40 " $993.30 "$2,270.40 " COIL EMBL 50.5MM 5MM VORTX PLTN FBR .018IN 60MM PUSHABILITY M0013812051 SUPPLY/IMPLANTS "$2,838.00 " Outpatient "$1,419.00 " Not Applicable: Bundled with Procedure "$1,844.70 " "$1,986.60 " "$1,873.08 " Not Applicable: Bundled with Procedure $993.30 "$2,270.40 " $993.30 "$2,270.40 " COIL EMBL 85MM 2-6MM VORTX PLTN FBR 18 COIL M0013812061 SUPPLY/IMPLANTS "$2,838.00 " Outpatient "$1,419.00 " Not Applicable: Bundled with Procedure "$1,844.70 " "$1,986.60 " "$1,873.08 " Not Applicable: Bundled with Procedure $993.30 "$2,270.40 " $993.30 "$2,270.40 " COIL EMBL 5MM 6MM VORTX 53MM VASC 35 COIL PSH OCL M0013733061 SUPPLY/IMPLANTS "$2,127.00 " Outpatient "$1,063.50 " Not Applicable: Bundled with Procedure "$1,382.55 " "$1,488.90 " "$1,403.82 " Not Applicable: Bundled with Procedure $744.45 "$1,701.60 " $744.45 "$1,701.60 " COIL EMBL 67MM 7MM VORTX 5.5MM VASC 35 COIL PSH OCL M0013733071 SUPPLY/IMPLANTS "$2,127.00 " Outpatient "$1,063.50 " Not Applicable: Bundled with Procedure "$1,382.55 " "$1,488.90 " "$1,403.82 " Not Applicable: Bundled with Procedure $744.45 "$1,701.60 " $744.45 "$1,701.60 " COIL EMBL 20MM 3MM PLTN FBR 2D HLCL 2.6MM 35 COIL PSH M0013723021 SUPPLY/IMPLANTS "$2,127.00 " Outpatient "$1,063.50 " Not Applicable: Bundled with Procedure "$1,382.55 " "$1,488.90 " "$1,403.82 " Not Applicable: Bundled with Procedure $744.45 "$1,701.60 " $744.45 "$1,701.60 " COIL EMBL 40MM 3MM PLTN FBR .035IN 2D HLX M0013723041 SUPPLY/IMPLANTS "$2,127.00 " Outpatient "$1,063.50 " Not Applicable: Bundled with Procedure "$1,382.55 " "$1,488.90 " "$1,403.82 " Not Applicable: Bundled with Procedure $744.45 "$1,701.60 " $744.45 "$1,701.60 " COIL EMBL 3.7MM 4MM INTLK VORTX FBR IDC PLTN DMD 41MM 18 M0013822041 SUPPLY/IMPLANTS "$2,820.00 " Outpatient "$1,410.00 " Not Applicable: Bundled with Procedure "$1,833.00 " "$1,974.00 " "$1,861.20 " Not Applicable: Bundled with Procedure $987.00 "$2,256.00 " $987.00 "$2,256.00 " COIL EMBL 30MM 5MM PLTN FBR 2D HLCL 2.4MM 35 COIL PSH M0013725031 SUPPLY/IMPLANTS "$2,127.00 " Outpatient "$1,063.50 " Not Applicable: Bundled with Procedure "$1,382.55 " "$1,488.90 " "$1,403.82 " Not Applicable: Bundled with Procedure $744.45 "$1,701.60 " $744.45 "$1,701.60 " COIL EMBL 35MM 5MM VORTX 4.5MM VASC 35 COIL PSH OCL M0013733051 SUPPLY/IMPLANTS "$2,127.00 " Outpatient "$1,063.50 " Not Applicable: Bundled with Procedure "$1,382.55 " "$1,488.90 " "$1,403.82 " Not Applicable: Bundled with Procedure $744.45 "$1,701.60 " $744.45 "$1,701.60 " COIL EMBL 5.5MM 5MM INTLK VORTX FBR IDC PLTN DMD 58MM 18 M0013822051 SUPPLY/IMPLANTS "$2,820.00 " Outpatient "$1,410.00 " Not Applicable: Bundled with Procedure "$1,833.00 " "$1,974.00 " "$1,861.20 " Not Applicable: Bundled with Procedure $987.00 "$2,256.00 " $987.00 "$2,256.00 " COIL EMBL 4MM 5MM PLTN .035IN 2D HLCL 50MM PSH M0013725051 SUPPLY/IMPLANTS "$2,127.00 " Outpatient "$1,063.50 " Not Applicable: Bundled with Procedure "$1,382.55 " "$1,488.90 " "$1,403.82 " Not Applicable: Bundled with Procedure $744.45 "$1,701.60 " $744.45 "$1,701.60 " COIL EMBL 40MM 6MM PLTN FBR 2D HLCL 2.6MM 35 COIL PSH M0013726041 SUPPLY/IMPLANTS "$2,127.00 " Outpatient "$1,063.50 " Not Applicable: Bundled with Procedure "$1,382.55 " "$1,488.90 " "$1,403.82 " Not Applicable: Bundled with Procedure $744.45 "$1,701.60 " $744.45 "$1,701.60 " COIL EMBL 6.7MM 6MM INTLK VORTX FBR IDC PLTN DMD 80MM 18 M0013822061 SUPPLY/IMPLANTS "$2,820.00 " Outpatient "$1,410.00 " Not Applicable: Bundled with Procedure "$1,833.00 " "$1,974.00 " "$1,861.20 " Not Applicable: Bundled with Procedure $987.00 "$2,256.00 " $987.00 "$2,256.00 " COIL EMBL 7MM 7MM PLTN .035IN 2D HLCL 40MM PSH M0013727041 SUPPLY/IMPLANTS "$2,127.00 " Outpatient "$1,063.50 " Not Applicable: Bundled with Procedure "$1,382.55 " "$1,488.90 " "$1,403.82 " Not Applicable: Bundled with Procedure $744.45 "$1,701.60 " $744.45 "$1,701.60 " COIL EMBL 60MM 9MM PLTN FBR 2D HLCL 2.7MM 35 COIL PSH M0013729061 SUPPLY/IMPLANTS "$2,127.00 " Outpatient "$1,063.50 " Not Applicable: Bundled with Procedure "$1,382.55 " "$1,488.90 " "$1,403.82 " Not Applicable: Bundled with Procedure $744.45 "$1,701.60 " $744.45 "$1,701.60 " COIL EMBL 17MM 11MM CMPLX PLTN FBR .018IN HLCL 70MM M0013120771 SUPPLY/IMPLANTS "$2,350.00 " Outpatient "$1,175.00 " Not Applicable: Bundled with Procedure "$1,527.50 " "$1,645.00 " "$1,551.00 " Not Applicable: Bundled with Procedure $822.50 "$1,880.00 " $822.50 "$1,880.00 " COIL EMBL 2MM 2MM PLTN FBR .018IN HLCL STRG 2MM M0013120021 SUPPLY/IMPLANTS "$1,576.00 " Outpatient $788.00 Not Applicable: Bundled with Procedure "$1,024.40 " "$1,103.20 " "$1,040.16 " Not Applicable: Bundled with Procedure $551.60 "$1,260.80 " $551.60 "$1,260.80 " COIL EMBL 50MM 2MM PLTN 10MM PERI INTRO PSH FBR M0013120211 SUPPLY/IMPLANTS "$2,294.00 " Outpatient "$1,147.00 " Not Applicable: Bundled with Procedure "$1,491.10 " "$1,605.80 " "$1,514.04 " Not Applicable: Bundled with Procedure $802.90 "$1,835.20 " $802.90 "$1,835.20 " COIL EMBL 4MM 4MM 2 DCRN PLTN FBR .018IN HLX CMPLX 20MM M0013120221 SUPPLY/IMPLANTS "$2,294.00 " Outpatient "$1,147.00 " Not Applicable: Bundled with Procedure "$1,491.10 " "$1,605.80 " "$1,514.04 " Not Applicable: Bundled with Procedure $802.90 "$1,835.20 " $802.90 "$1,835.20 " COIL EMBL 30MM 4MM PLTN FBR .018IN HLX CMPLX M0013120431 SUPPLY/IMPLANTS "$2,350.00 " Outpatient "$1,175.00 " Not Applicable: Bundled with Procedure "$1,527.50 " "$1,645.00 " "$1,551.00 " Not Applicable: Bundled with Procedure $822.50 "$1,880.00 " $822.50 "$1,880.00 " COIL EMBL 50MM 2MM PLTN FBR STRG 5MM 18 COIL M0013120051 SUPPLY/IMPLANTS "$1,576.00 " Outpatient $788.00 Not Applicable: Bundled with Procedure "$1,024.40 " "$1,103.20 " "$1,040.16 " Not Applicable: Bundled with Procedure $551.60 "$1,260.80 " $551.60 "$1,260.80 " COIL EMBL 6MM 6MM PLTN FBR .018IN HLCL CMPLX 30MM PSH INTRO M0013120331 SUPPLY/IMPLANTS "$2,294.00 " Outpatient "$1,147.00 " Not Applicable: Bundled with Procedure "$1,491.10 " "$1,605.80 " "$1,514.04 " Not Applicable: Bundled with Procedure $802.90 "$1,835.20 " $802.90 "$1,835.20 " COIL EMBL 20CM 10MM INTLK FBR IDC 2D 18 COIL DTCH OCL M001361590 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 20CM 10MM INTLK FBR IDC DCRN PLTN STDLN 2D 35 COIL M001363600 SUPPLY/IMPLANTS "$3,653.00 " Outpatient "$1,826.50 " Not Applicable: Bundled with Procedure "$2,374.45 " "$2,557.10 " "$2,410.98 " Not Applicable: Bundled with Procedure "$1,278.55 " "$2,922.40 " "$1,278.55 " "$2,922.40 " COIL EMBL 25CM 10MM INTLK FBR IDC CUBE 35 COIL DTCH OCL M001363790 SUPPLY/IMPLANTS "$3,653.00 " Outpatient "$1,826.50 " Not Applicable: Bundled with Procedure "$2,374.45 " "$2,557.10 " "$2,410.98 " Not Applicable: Bundled with Procedure "$1,278.55 " "$2,922.40 " "$1,278.55 " "$2,922.40 " COIL EMBL 30CM 10MM INTLK FBR IDC .018IN 2D DTCH OCL M001361600 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 40CM 10MM INTLK FBR IDC DCRN PLTN STDLN 2D 35 COIL M001363610 SUPPLY/IMPLANTS "$4,885.00 " Outpatient "$2,442.50 " Not Applicable: Bundled with Procedure "$3,175.25 " "$3,419.50 " "$3,224.10 " Not Applicable: Bundled with Procedure "$1,709.75 " "$3,908.00 " "$1,709.75 " "$3,908.00 " COIL EMBL 40CM 10MM INTLK FBR IDC CUBE 35 COIL DTCH OCL M001363800 SUPPLY/IMPLANTS "$4,885.00 " Outpatient "$2,442.50 " Not Applicable: Bundled with Procedure "$3,175.25 " "$3,419.50 " "$3,224.10 " Not Applicable: Bundled with Procedure "$1,709.75 " "$3,908.00 " "$1,709.75 " "$3,908.00 " COIL EMBL 50CM 10MM INTLK FBR IDC DCRN PLTN LNG LGTH 2D 18 M001361920 SUPPLY/IMPLANTS "$4,293.00 " Outpatient "$2,146.50 " Not Applicable: Bundled with Procedure "$2,790.45 " "$3,005.10 " "$2,833.38 " Not Applicable: Bundled with Procedure "$1,502.55 " "$3,434.40 " "$1,502.55 " "$3,434.40 " COIL EMBL 14MM 10MM CMPLX PLTN FBR .018IN HLCL 60MM M0013120661 SUPPLY/IMPLANTS "$2,350.00 " Outpatient "$1,175.00 " Not Applicable: Bundled with Procedure "$1,527.50 " "$1,645.00 " "$1,551.00 " Not Applicable: Bundled with Procedure $822.50 "$1,880.00 " $822.50 "$1,880.00 " COIL EMBL 20CM 12MM INTLK FBR IDC PLTN DTCH OCL M001361610 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 20CM 12MM INTLK FBR IDC 2D HLCL 35 COIL DTCH OCL M001363620 SUPPLY/IMPLANTS "$3,653.00 " Outpatient "$1,826.50 " Not Applicable: Bundled with Procedure "$2,374.45 " "$2,557.10 " "$2,410.98 " Not Applicable: Bundled with Procedure "$1,278.55 " "$2,922.40 " "$1,278.55 " "$2,922.40 " COIL EMBL 30CM 12MM INTLK FBR IDC 2D 18 COIL DTCH OCL M001361620 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 40CM 12MM INTLK FBR IDC .035IN 2D HLCL DTCH OCL M001363630 SUPPLY/IMPLANTS "$4,885.00 " Outpatient "$2,442.50 " Not Applicable: Bundled with Procedure "$3,175.25 " "$3,419.50 " "$3,224.10 " Not Applicable: Bundled with Procedure "$1,709.75 " "$3,908.00 " "$1,709.75 " "$3,908.00 " COIL EMBL 20CM 14MM INTLK IDC PLTN FBR .018IN 2D HLX TPR 18 M001361630 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 20CM 15MM INTLK FBR IDC DCRN PLTN STDLN 2D 35 COIL M001363640 SUPPLY/IMPLANTS "$3,653.00 " Outpatient "$1,826.50 " Not Applicable: Bundled with Procedure "$2,374.45 " "$2,557.10 " "$2,410.98 " Not Applicable: Bundled with Procedure "$1,278.55 " "$2,922.40 " "$1,278.55 " "$2,922.40 " COIL EMBL 25CM 15MM INTLK FBR IDC DCRN PLTN .035IN CUBE 35 M001363810 SUPPLY/IMPLANTS "$3,653.00 " Outpatient "$1,826.50 " Not Applicable: Bundled with Procedure "$2,374.45 " "$2,557.10 " "$2,410.98 " Not Applicable: Bundled with Procedure "$1,278.55 " "$2,922.40 " "$1,278.55 " "$2,922.40 " COIL EMBL 40CM 15MM INTLK FBR IDC DCRN PLTN STDLN 2D 35 COIL M001363650 SUPPLY/IMPLANTS "$4,885.00 " Outpatient "$2,442.50 " Not Applicable: Bundled with Procedure "$3,175.25 " "$3,419.50 " "$3,224.10 " Not Applicable: Bundled with Procedure "$1,709.75 " "$3,908.00 " "$1,709.75 " "$3,908.00 " COIL EMBL 40CM 15MM INTLK FBR IDC CUBE 35 COIL DTCH OCL M001363820 SUPPLY/IMPLANTS "$4,885.00 " Outpatient "$2,442.50 " Not Applicable: Bundled with Procedure "$3,175.25 " "$3,419.50 " "$3,224.10 " Not Applicable: Bundled with Procedure "$1,709.75 " "$3,908.00 " "$1,709.75 " "$3,908.00 " COIL EMBL 20CM 18MM INTLK DCRN .018IN STD 2D HLCL DTCH ARM 5 M001363660 SUPPLY/IMPLANTS "$3,653.00 " Outpatient "$1,826.50 " Not Applicable: Bundled with Procedure "$2,374.45 " "$2,557.10 " "$2,410.98 " Not Applicable: Bundled with Procedure "$1,278.55 " "$2,922.40 " "$1,278.55 " "$2,922.40 " COIL EMBL 40CM 18MM INTLK FBR IDC DCRN PLTN STDLN 2D 35 COIL M001363670 SUPPLY/IMPLANTS "$4,885.00 " Outpatient "$2,442.50 " Not Applicable: Bundled with Procedure "$3,175.25 " "$3,419.50 " "$3,224.10 " Not Applicable: Bundled with Procedure "$1,709.75 " "$3,908.00 " "$1,709.75 " "$3,908.00 " COIL EMBL 50CM 14MM INTLK FBR IDC DCRN PLTN LNG LGTH 2D 18 M001361930 SUPPLY/IMPLANTS "$4,293.00 " Outpatient "$2,146.50 " Not Applicable: Bundled with Procedure "$2,790.45 " "$3,005.10 " "$2,833.38 " Not Applicable: Bundled with Procedure "$1,502.55 " "$3,434.40 " "$1,502.55 " "$3,434.40 " COIL EMBL 40CM 20MM INTLK FBR IDC DCRN PLTN CUBE 35 COIL M001363830 SUPPLY/IMPLANTS "$4,885.00 " Outpatient "$2,442.50 " Not Applicable: Bundled with Procedure "$3,175.25 " "$3,419.50 " "$3,224.10 " Not Applicable: Bundled with Procedure "$1,709.75 " "$3,908.00 " "$1,709.75 " "$3,908.00 " COIL EMBL 50CM 20MM INTLK FBR IDC DCRN PLTN .018IN LNG LGTH M001361950 SUPPLY/IMPLANTS "$4,293.00 " Outpatient "$2,146.50 " Not Applicable: Bundled with Procedure "$2,790.45 " "$3,005.10 " "$2,833.38 " Not Applicable: Bundled with Procedure "$1,502.55 " "$3,434.40 " "$1,502.55 " "$3,434.40 " COIL EMBL 60CM 22MM INTLK FBR IDC DCRN PLTN LNG LGTH 2D 18 M001361960 SUPPLY/IMPLANTS "$4,293.00 " Outpatient "$2,146.50 " Not Applicable: Bundled with Procedure "$2,790.45 " "$3,005.10 " "$2,833.38 " Not Applicable: Bundled with Procedure "$1,502.55 " "$3,434.40 " "$1,502.55 " "$3,434.40 " COIL EMBL 8CM 6MM INTLK FBR IDC VORTX DMD 18 COIL DTCH OCL M001361770 SUPPLY/IMPLANTS "$2,708.00 " Outpatient "$1,354.00 " Not Applicable: Bundled with Procedure "$1,760.20 " "$1,895.60 " "$1,787.28 " Not Applicable: Bundled with Procedure $947.80 "$2,166.40 " $947.80 "$2,166.40 " COIL EMBL 4CM 2MM INTLK FBR IDC DCRN PLTN STDLN 2D OCL SYS M001361480 SUPPLY/IMPLANTS "$2,753.00 " Outpatient "$1,376.50 " Not Applicable: Bundled with Procedure "$1,789.45 " "$1,927.10 " "$1,816.98 " Not Applicable: Bundled with Procedure $963.55 "$2,202.40 " $963.55 "$2,202.40 " COIL EMBL 6CM 2MM INTLK IDC PLTN FBR .018IN STDLN 2D OCL SYS M001361490 SUPPLY/IMPLANTS "$2,753.00 " Outpatient "$1,376.50 " Not Applicable: Bundled with Procedure "$1,789.45 " "$1,927.10 " "$1,816.98 " Not Applicable: Bundled with Procedure $963.55 "$2,202.40 " $963.55 "$2,202.40 " COIL EMBL 12CM 3MM INTLK IDC PLTN FBR 2D HLX 18 COIL OCL SYS M001361510 SUPPLY/IMPLANTS "$2,708.00 " Outpatient "$1,354.00 " Not Applicable: Bundled with Procedure "$1,760.20 " "$1,895.60 " "$1,787.28 " Not Applicable: Bundled with Procedure $947.80 "$2,166.40 " $947.80 "$2,166.40 " COIL EMBL 2.3CM 3MM INTLK FBR IDC VORTX DMD 18 COIL DTCH OCL M001361740 SUPPLY/IMPLANTS "$2,708.00 " Outpatient "$1,354.00 " Not Applicable: Bundled with Procedure "$1,760.20 " "$1,895.60 " "$1,787.28 " Not Applicable: Bundled with Procedure $947.80 "$2,166.40 " $947.80 "$2,166.40 " COIL EMBL 4CM 3MM INTLK IDC FBR .035IN 2D OCL M001363500 SUPPLY/IMPLANTS "$2,844.00 " Outpatient "$1,422.00 " Not Applicable: Bundled with Procedure "$1,848.60 " "$1,990.80 " "$1,877.04 " Not Applicable: Bundled with Procedure $995.40 "$2,275.20 " $995.40 "$2,275.20 " COIL EMBL 15CM 4MM INTLK IDC PLTN FBR 2D HLX 8 COIL OCL SYS M001361530 SUPPLY/IMPLANTS "$2,708.00 " Outpatient "$1,354.00 " Not Applicable: Bundled with Procedure "$1,760.20 " "$1,895.60 " "$1,787.28 " Not Applicable: Bundled with Procedure $947.80 "$2,166.40 " $947.80 "$2,166.40 " COIL EMBL 4.1CM 4MM INTLK FBR IDC VORTX DMD 18 COIL DTCH OCL M001361750 SUPPLY/IMPLANTS "$2,708.00 " Outpatient "$1,354.00 " Not Applicable: Bundled with Procedure "$1,760.20 " "$1,895.60 " "$1,787.28 " Not Applicable: Bundled with Procedure $947.80 "$2,166.40 " $947.80 "$2,166.40 " COIL EMBL 15CM 5MM INTLK IDC PLTN FBR 2D HLX 8 COIL OCL SYS M001361550 SUPPLY/IMPLANTS "$2,708.00 " Outpatient "$1,354.00 " Not Applicable: Bundled with Procedure "$1,760.20 " "$1,895.60 " "$1,787.28 " Not Applicable: Bundled with Procedure $947.80 "$2,166.40 " $947.80 "$2,166.40 " COIL EMBL 5.8CM 5MM INTLK FBR IDC VORTX DMD 18 COIL DTCH OCL M001361760 SUPPLY/IMPLANTS "$2,708.00 " Outpatient "$1,354.00 " Not Applicable: Bundled with Procedure "$1,760.20 " "$1,895.60 " "$1,787.28 " Not Applicable: Bundled with Procedure $947.80 "$2,166.40 " $947.80 "$2,166.40 " COIL EMBL 8CM 5MM INTLK FBR IDC 2D 18 COIL DTCH OCL M001361540 SUPPLY/IMPLANTS "$2,708.00 " Outpatient "$1,354.00 " Not Applicable: Bundled with Procedure "$1,760.20 " "$1,895.60 " "$1,787.28 " Not Applicable: Bundled with Procedure $947.80 "$2,166.40 " $947.80 "$2,166.40 " COIL EMBL 10CM 6MM INTLK FBR IDC DCRN PLTN CUBE 35 COIL DTCH M001363720 SUPPLY/IMPLANTS "$2,844.00 " Outpatient "$1,422.00 " Not Applicable: Bundled with Procedure "$1,848.60 " "$1,990.80 " "$1,877.04 " Not Applicable: Bundled with Procedure $995.40 "$2,275.20 " $995.40 "$2,275.20 " COIL EMBL 10CM 6MM INTLK FBR IDC .035IN 2D OCL DTCH M001363540 SUPPLY/IMPLANTS "$2,844.00 " Outpatient "$1,422.00 " Not Applicable: Bundled with Procedure "$1,848.60 " "$1,990.80 " "$1,877.04 " Not Applicable: Bundled with Procedure $995.40 "$2,275.20 " $995.40 "$2,275.20 " COIL EMBL 20CM 6MM INTLK FBR IDC 2D 18 COIL DTCH OCL M001361570 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 20CM 6MM INTLK FBR IDC DCRN PLTN STDLN 2D 35 COIL M001363550 SUPPLY/IMPLANTS "$3,653.00 " Outpatient "$1,826.50 " Not Applicable: Bundled with Procedure "$2,374.45 " "$2,557.10 " "$2,410.98 " Not Applicable: Bundled with Procedure "$1,278.55 " "$2,922.40 " "$1,278.55 " "$2,922.40 " COIL EMBL 20CM 6MM INTLK FBR IDC DCRN PLTN CUBE 35 COIL DTCH M001363730 SUPPLY/IMPLANTS "$3,653.00 " Outpatient "$1,826.50 " Not Applicable: Bundled with Procedure "$2,374.45 " "$2,557.10 " "$2,410.98 " Not Applicable: Bundled with Procedure "$1,278.55 " "$2,922.40 " "$1,278.55 " "$2,922.40 " COIL EMBL 10CM 8MM INTLK IDC DCRN PLTN .018IN 2D HLX OCL SYS M001363570 SUPPLY/IMPLANTS "$2,844.00 " Outpatient "$1,422.00 " Not Applicable: Bundled with Procedure "$1,848.60 " "$1,990.80 " "$1,877.04 " Not Applicable: Bundled with Procedure $995.40 "$2,275.20 " $995.40 "$2,275.20 " COIL EMBL 14CM 8MM INTLK IDC FBR .035IN DMD OCL M001363930 SUPPLY/IMPLANTS "$2,844.00 " Outpatient "$1,422.00 " Not Applicable: Bundled with Procedure "$1,848.60 " "$1,990.80 " "$1,877.04 " Not Applicable: Bundled with Procedure $995.40 "$2,275.20 " $995.40 "$2,275.20 " COIL EMBL 20CM 8MM INTLK FBR IDC .018IN 2D DTCH OCL M001361580 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 20CM 8MM INTLK FBR IDC DCRN PLTN STDLN 2D OCL SYS M001363580 SUPPLY/IMPLANTS "$3,653.00 " Outpatient "$1,826.50 " Not Applicable: Bundled with Procedure "$2,374.45 " "$2,557.10 " "$2,410.98 " Not Applicable: Bundled with Procedure "$1,278.55 " "$2,922.40 " "$1,278.55 " "$2,922.40 " COIL EMBL 20CM 8MM INTLK FBR IDC DCRN PLTN CUBE 35 COIL DTCH M001363760 SUPPLY/IMPLANTS "$3,653.00 " Outpatient "$1,826.50 " Not Applicable: Bundled with Procedure "$2,374.45 " "$2,557.10 " "$2,410.98 " Not Applicable: Bundled with Procedure "$1,278.55 " "$2,922.40 " "$1,278.55 " "$2,922.40 " COIL EMBL 40CM 8MM INTLK FBR IDC DCRN PLTN STDLN 2D 35 COIL M001363590 SUPPLY/IMPLANTS "$4,885.00 " Outpatient "$2,442.50 " Not Applicable: Bundled with Procedure "$3,175.25 " "$3,419.50 " "$3,224.10 " Not Applicable: Bundled with Procedure "$1,709.75 " "$3,908.00 " "$1,709.75 " "$3,908.00 " COIL EMBL 12MM 8MM CMPLX PLTN FBR .018IN HLCL 50MM M0013120551 SUPPLY/IMPLANTS "$2,350.00 " Outpatient "$1,175.00 " Not Applicable: Bundled with Procedure "$1,527.50 " "$1,645.00 " "$1,551.00 " Not Applicable: Bundled with Procedure $822.50 "$1,880.00 " $822.50 "$1,880.00 " COIL EMBL 10MM 7MM CMPLX PLTN FBR .018IN HLCL 40MM M0013120441 SUPPLY/IMPLANTS "$2,350.00 " Outpatient "$1,175.00 " Not Applicable: Bundled with Procedure "$1,527.50 " "$1,645.00 " "$1,551.00 " Not Applicable: Bundled with Procedure $822.50 "$1,880.00 " $822.50 "$1,880.00 " COIL EMBL 12CM 5MM INTLK IDC 2D 18 COIL SFT M0013615120 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL EMBL 4.5CM 4MM INTLK FBR IDC DCRN PLTN DMD 35 COIL DTCH M001363910 SUPPLY/IMPLANTS "$2,844.00 " Outpatient "$1,422.00 " Not Applicable: Bundled with Procedure "$1,848.60 " "$1,990.80 " "$1,877.04 " Not Applicable: Bundled with Procedure $995.40 "$2,275.20 " $995.40 "$2,275.20 " COIL EMBL 6CM 4MM INTLK FBR .035IN CUBE OCL SYS DTCH M001363700 SUPPLY/IMPLANTS "$2,844.00 " Outpatient "$1,422.00 " Not Applicable: Bundled with Procedure "$1,848.60 " "$1,990.80 " "$1,877.04 " Not Applicable: Bundled with Procedure $995.40 "$2,275.20 " $995.40 "$2,275.20 " COIL EMBL 9CM 6MM INTLK FBR IDC .035IN DMD DTCH OCL M001363920 SUPPLY/IMPLANTS "$2,844.00 " Outpatient "$1,422.00 " Not Applicable: Bundled with Procedure "$1,848.60 " "$1,990.80 " "$1,877.04 " Not Applicable: Bundled with Procedure $995.40 "$2,275.20 " $995.40 "$2,275.20 " COIL EMBL 39CM 20MM AZUR CX DDRGL POR .035IN PERI DTCH CX 45-752039 SUPPLY/IMPLANTS "$6,848.00 " Outpatient "$3,424.00 " Not Applicable: Bundled with Procedure "$4,451.20 " "$4,793.60 " "$4,519.68 " Not Applicable: Bundled with Procedure "$2,396.80 " "$5,478.40 " "$2,396.80 " "$5,478.40 " COIL EMBL 32CM 16MM AZUR CX DDRGL POR .035IN PERI DTCH SFT 45-751632 SUPPLY/IMPLANTS "$6,848.00 " Outpatient "$3,424.00 " Not Applicable: Bundled with Procedure "$4,451.20 " "$4,793.60 " "$4,519.68 " Not Applicable: Bundled with Procedure "$2,396.80 " "$5,478.40 " "$2,396.80 " "$5,478.40 " COIL EMBL 6CM 2.5MM AXIUM PRM 3D X SFT APB-2.5-6-3D-ES SUPPLY/IMPLANTS "$8,780.00 " Outpatient "$4,390.00 " Not Applicable: Bundled with Procedure "$5,707.00 " "$6,146.00 " "$5,794.80 " Not Applicable: Bundled with Procedure "$3,073.00 " "$7,024.00 " "$3,073.00 " "$7,024.00 " COIL EMBL 15CM 6MM .038IN AZUR PLTN DDRGL .035IN 135CM PERI 45-450615 SUPPLY/IMPLANTS "$6,844.00 " Outpatient "$3,422.00 " Not Applicable: Bundled with Procedure "$4,448.60 " "$4,790.80 " "$4,517.04 " Not Applicable: Bundled with Procedure "$2,395.40 " "$5,475.20 " "$2,395.40 " "$5,475.20 " COIL EMBL 11CM 5MM AZUR CX DDRGL POR .035IN PERI DTCH SFT 45-750511 SUPPLY/IMPLANTS "$6,844.00 " Outpatient "$3,422.00 " Not Applicable: Bundled with Procedure "$4,448.60 " "$4,790.80 " "$4,517.04 " Not Applicable: Bundled with Procedure "$2,395.40 " "$5,475.20 " "$2,395.40 " "$5,475.20 " COIL EMBL 17CM 6MM AZUR CX DDRGL POR .035IN PERI DTCH CX 45-750617 SUPPLY/IMPLANTS "$6,844.00 " Outpatient "$3,422.00 " Not Applicable: Bundled with Procedure "$4,448.60 " "$4,790.80 " "$4,517.04 " Not Applicable: Bundled with Procedure "$2,395.40 " "$5,475.20 " "$2,395.40 " "$5,475.20 " COIL EMBL 5CM 4MM .038IN AZUR PLTN DDRGL .035IN 135CM PERI 45-450405 SUPPLY/IMPLANTS "$5,866.00 " Outpatient "$2,933.00 " Not Applicable: Bundled with Procedure "$3,812.90 " "$4,106.20 " "$3,871.56 " Not Applicable: Bundled with Procedure "$2,053.10 " "$4,692.80 " "$2,053.10 " "$4,692.80 " COIL EMBL 24CM 8MM AZUR CX DDRGL POR .035IN PERI DTCH SFT 45-750824 SUPPLY/IMPLANTS "$6,844.00 " Outpatient "$3,422.00 " Not Applicable: Bundled with Procedure "$4,448.60 " "$4,790.80 " "$4,517.04 " Not Applicable: Bundled with Procedure "$2,395.40 " "$5,475.20 " "$2,395.40 " "$5,475.20 " COIL EMBL 30CM 11MM TRGT 360D DTCH SFT M0035471130 SUPPLY/IMPLANTS "$10,215.00 " Outpatient "$5,107.50 " Not Applicable: Bundled with Procedure "$6,639.75 " "$7,150.50 " "$6,741.90 " Not Applicable: Bundled with Procedure "$3,575.25 " "$8,172.00 " "$3,575.25 " "$8,172.00 " COIL EMBL 4CM 3MM TRGT NANO 360D DTCH SFT M0035443040 SUPPLY/IMPLANTS "$10,215.00 " Outpatient "$5,107.50 " Not Applicable: Bundled with Procedure "$6,639.75 " "$7,150.50 " "$6,741.90 " Not Applicable: Bundled with Procedure "$3,575.25 " "$8,172.00 " "$3,575.25 " "$8,172.00 " COIL EMBL 6CM 3MM NANO TRGT DTCH SOFTEST TCH STRL M0035443060 SUPPLY/IMPLANTS "$10,215.00 " Outpatient "$5,107.50 " Not Applicable: Bundled with Procedure "$6,639.75 " "$7,150.50 " "$6,741.90 " Not Applicable: Bundled with Procedure "$3,575.25 " "$8,172.00 " "$3,575.25 " "$8,172.00 " COIL EMBL 15CM 5MM TRGT 360D DTCH ULT M0035425150 SUPPLY/IMPLANTS "$10,178.00 " Outpatient "$5,089.00 " Not Applicable: Bundled with Procedure "$6,615.70 " "$7,124.60 " "$6,717.48 " Not Applicable: Bundled with Procedure "$3,562.30 " "$8,142.40 " "$3,562.30 " "$8,142.40 " COIL EMBL 10CM 4.5MM TRGT 360D DTCH ULT M0035424510 SUPPLY/IMPLANTS "$10,178.00 " Outpatient "$5,089.00 " Not Applicable: Bundled with Procedure "$6,615.70 " "$7,124.60 " "$6,717.48 " Not Applicable: Bundled with Procedure "$3,562.30 " "$8,142.40 " "$3,562.30 " "$8,142.40 " COIL EMBL 4CM 2MM TRGT NANO 360D DTCH M0035442040 SUPPLY/IMPLANTS "$10,215.00 " Outpatient "$5,107.50 " Not Applicable: Bundled with Procedure "$6,639.75 " "$7,150.50 " "$6,741.90 " Not Applicable: Bundled with Procedure "$3,575.25 " "$8,172.00 " "$3,575.25 " "$8,172.00 " COIL EMBL 30CM 9MM TRGT 360D DTCH SFT M0035479300 SUPPLY/IMPLANTS "$10,215.00 " Outpatient "$5,107.50 " Not Applicable: Bundled with Procedure "$6,639.75 " "$7,150.50 " "$6,741.90 " Not Applicable: Bundled with Procedure "$3,575.25 " "$8,172.00 " "$3,575.25 " "$8,172.00 " COIL EMBL 6MM 3MM TRGT 3D DTCH CNSIS FRM SMTH STAB EXCLS M0036153060 SUPPLY/IMPLANTS "$10,215.00 " Outpatient "$5,107.50 " Not Applicable: Bundled with Procedure "$6,639.75 " "$7,150.50 " "$6,741.90 " Not Applicable: Bundled with Procedure "$3,575.25 " "$8,172.00 " "$3,575.25 " "$8,172.00 " COIL EMBL 8CM 4MM TRGT 3D DTCH M0036154080 SUPPLY/IMPLANTS "$10,215.00 " Outpatient "$5,107.50 " Not Applicable: Bundled with Procedure "$6,639.75 " "$7,150.50 " "$6,741.90 " Not Applicable: Bundled with Procedure "$3,575.25 " "$8,172.00 " "$3,575.25 " "$8,172.00 " COIL EMBL 3CM 1MM TRGT 360D DTCH ULT M0035421030 SUPPLY/IMPLANTS "$10,178.00 " Outpatient "$5,089.00 " Not Applicable: Bundled with Procedure "$6,615.70 " "$7,124.60 " "$6,717.48 " Not Applicable: Bundled with Procedure "$3,562.30 " "$8,142.40 " "$3,562.30 " "$8,142.40 " COIL EMBL 6CM 3.5MM NANO TRGT DTCH SOFTEST TCH STRL M0035443560 SUPPLY/IMPLANTS "$10,215.00 " Outpatient "$5,107.50 " Not Applicable: Bundled with Procedure "$6,639.75 " "$7,150.50 " "$6,741.90 " Not Applicable: Bundled with Procedure "$3,575.25 " "$8,172.00 " "$3,575.25 " "$8,172.00 " COIL EMBL 10MM 5MM TRGT 3D GMTR DTCH STAB FNDTN PROVEN PRFRM M0036155100 SUPPLY/IMPLANTS "$10,510.00 " Outpatient "$5,255.00 " Not Applicable: Bundled with Procedure "$6,831.50 " "$7,357.00 " "$6,936.60 " Not Applicable: Bundled with Procedure "$3,678.50 " "$8,408.00 " "$3,678.50 " "$8,408.00 " COIL EMBL 15CM 7MM TRGT 3D DTCH M0036157150 SUPPLY/IMPLANTS "$10,185.00 " Outpatient "$5,092.50 " Not Applicable: Bundled with Procedure "$6,620.25 " "$7,129.50 " "$6,722.10 " Not Applicable: Bundled with Procedure "$3,564.75 " "$8,148.00 " "$3,564.75 " "$8,148.00 " COIL EMBL 3CM 2MM TRGT NANO 360D DTCH SFT M0035442030 SUPPLY/IMPLANTS "$10,209.00 " Outpatient "$5,104.50 " Not Applicable: Bundled with Procedure "$6,635.85 " "$7,146.30 " "$6,737.94 " Not Applicable: Bundled with Procedure "$3,573.15 " "$8,167.20 " "$3,573.15 " "$8,167.20 " COIL EMBL 30CM 10MM TRGT 3D DTCH 615103 SUPPLY/IMPLANTS "$10,189.00 " Outpatient "$5,094.50 " Not Applicable: Bundled with Procedure "$6,622.85 " "$7,132.30 " "$6,724.74 " Not Applicable: Bundled with Procedure "$3,566.15 " "$8,151.20 " "$3,566.15 " "$8,151.20 " COIL EMBL 8CM 3MM TRGT 360D DTCH ULT M0035423080 SUPPLY/IMPLANTS "$10,187.00 " Outpatient "$5,093.50 " Not Applicable: Bundled with Procedure "$6,621.55 " "$7,130.90 " "$6,723.42 " Not Applicable: Bundled with Procedure "$3,565.45 " "$8,149.60 " "$3,565.45 " "$8,149.60 " COIL EMBL 8CM 3.5MM TRGT 360D DTCH ULT M0035423580 SUPPLY/IMPLANTS "$10,178.00 " Outpatient "$5,089.00 " Not Applicable: Bundled with Procedure "$6,615.70 " "$7,124.60 " "$6,717.48 " Not Applicable: Bundled with Procedure "$3,562.30 " "$8,142.40 " "$3,562.30 " "$8,142.40 " COIL EMBL 20CM 9MM TRGT 360D DTCH SFT M0035479200 SUPPLY/IMPLANTS "$10,187.00 " Outpatient "$5,093.50 " Not Applicable: Bundled with Procedure "$6,621.55 " "$7,130.90 " "$6,723.42 " Not Applicable: Bundled with Procedure "$3,565.45 " "$8,149.60 " "$3,565.45 " "$8,149.60 " COIL EMBL 20CM 6MM XL TRGT LG DTCH SFT SMTH STAB DLV STRL M0036126200 SUPPLY/IMPLANTS "$13,243.00 " Outpatient "$6,621.50 " Not Applicable: Bundled with Procedure "$8,607.95 " "$9,270.10 " "$8,740.38 " Not Applicable: Bundled with Procedure "$4,635.05 " "$10,594.40 " "$4,635.05 " "$10,594.40 " COIL EMBL 30CM 12MM TRGT 360D DTCH SFT M0035471230 SUPPLY/IMPLANTS "$10,187.00 " Outpatient "$5,093.50 " Not Applicable: Bundled with Procedure "$6,621.55 " "$7,130.90 " "$6,723.42 " Not Applicable: Bundled with Procedure "$3,565.45 " "$8,149.60 " "$3,565.45 " "$8,149.60 " COIL EMBL 4CM 2.5MM NANO TRGT DTCH SOFTEST TCH STRL M0035442540 SUPPLY/IMPLANTS "$10,187.00 " Outpatient "$5,093.50 " Not Applicable: Bundled with Procedure "$6,621.55 " "$7,130.90 " "$6,723.42 " Not Applicable: Bundled with Procedure "$3,565.45 " "$8,149.60 " "$3,565.45 " "$8,149.60 " COIL EMBL 2CM 1.5MM TRGT NANO 360D DTCH M003542152 SUPPLY/IMPLANTS "$9,061.00 " Outpatient "$4,530.50 " Not Applicable: Bundled with Procedure "$5,889.65 " "$6,342.70 " "$5,980.26 " Not Applicable: Bundled with Procedure "$3,171.35 " "$7,248.80 " "$3,171.35 " "$7,248.80 " "COIL EMBOLIZATION DECHBLE TARGET 360 SOFT, PT, 6MM X 15CM 547615" SUPPLY/IMPLANTS "$10,070.00 " Outpatient "$5,035.00 " Not Applicable: Bundled with Procedure "$6,545.50 " "$7,049.00 " "$6,646.20 " Not Applicable: Bundled with Procedure "$3,524.50 " "$8,056.00 " "$3,524.50 " "$8,056.00 " COIL EMBOLIZATION TARGET PLATINUM L20 CM OD6 MM DETACHABLE S M0035476200 SUPPLY/IMPLANTS "$10,070.00 " Outpatient "$5,035.00 " Not Applicable: Bundled with Procedure "$6,545.50 " "$7,049.00 " "$6,646.20 " Not Applicable: Bundled with Procedure "$3,524.50 " "$8,056.00 " "$3,524.50 " "$8,056.00 " COIL EMBL 30CM 7MM TRGT 360D 547730 SUPPLY/IMPLANTS "$10,093.00 " Outpatient "$5,046.50 " Not Applicable: Bundled with Procedure "$6,560.45 " "$7,065.10 " "$6,661.38 " Not Applicable: Bundled with Procedure "$3,532.55 " "$8,074.40 " "$3,532.55 " "$8,074.40 " COIL EMBOLIZATION XL TARGET LARGE L50 CM OD16 MM DETACHABLE M0036121650 SUPPLY/IMPLANTS "$13,338.00 " Outpatient "$6,669.00 " Not Applicable: Bundled with Procedure "$8,669.70 " "$9,336.60 " "$8,803.08 " Not Applicable: Bundled with Procedure "$4,668.30 " "$10,670.40 " "$4,668.30 " "$10,670.40 " COIL EMBOLIZATION TARGET PLATINUM STANDARD L30 CM OD14 MM DE M0035471430 SUPPLY/IMPLANTS "$10,096.00 " Outpatient "$5,048.00 " Not Applicable: Bundled with Procedure "$6,562.40 " "$7,067.20 " "$6,663.36 " Not Applicable: Bundled with Procedure "$3,533.60 " "$8,076.80 " "$3,533.60 " "$8,076.80 " COIL EMBOLIZATION TARGET 360 D L30 CM OD10 MM DETACHABLE SOF M0035471030 SUPPLY/IMPLANTS "$10,096.00 " Outpatient "$5,048.00 " Not Applicable: Bundled with Procedure "$6,562.40 " "$7,067.20 " "$6,663.36 " Not Applicable: Bundled with Procedure "$3,533.60 " "$8,076.80 " "$3,533.60 " "$8,076.80 " COIL EMBOLIZATION TARGET PLATINUM 360 D L15 CM OD4 MM DETACH M0035424150 SUPPLY/IMPLANTS "$10,096.00 " Outpatient "$5,048.00 " Not Applicable: Bundled with Procedure "$6,562.40 " "$7,067.20 " "$6,663.36 " Not Applicable: Bundled with Procedure "$3,533.60 " "$8,076.80 " "$3,533.60 " "$8,076.80 " COIL EMBOLIZATION TARGET PLATINUM 360 D STANDARD LARGE L30 C M0035477300 SUPPLY/IMPLANTS "$10,096.00 " Outpatient "$5,048.00 " Not Applicable: Bundled with Procedure "$6,562.40 " "$7,067.20 " "$6,663.36 " Not Applicable: Bundled with Procedure "$3,533.60 " "$8,076.80 " "$3,533.60 " "$8,076.80 " COIL EMBOLIZATION AZUR CX HYDROGEL L24 CM L150 CM OD13 MM OD 45-751324 SUPPLY/IMPLANTS "$6,850.00 " Outpatient "$3,425.00 " Not Applicable: Bundled with Procedure "$4,452.50 " "$4,795.00 " "$4,521.00 " Not Applicable: Bundled with Procedure "$2,397.50 " "$5,480.00 " "$2,397.50 " "$5,480.00 " COIL EMBOLIZATION MICRO FRAMING 12MM DIA 20CML HYDROGEL PERI 45-481220 SUPPLY/IMPLANTS "$4,392.00 " Outpatient "$2,196.00 " Not Applicable: Bundled with Procedure "$2,854.80 " "$3,074.40 " "$2,898.72 " Not Applicable: Bundled with Procedure "$1,537.20 " "$3,513.60 " "$1,537.20 " "$3,513.60 " COIL EMBOLIZATION MICRO 0.035IN ID 6-3MM DIA 5.8CML PLATINUM G47521 SUPPLY/IMPLANTS $631.00 Outpatient $315.50 Not Applicable: Bundled with Procedure $410.15 $441.70 $416.46 Not Applicable: Bundled with Procedure $220.85 $504.80 $220.85 $504.80 COIL EMBOLIZATION TARGET PLATINUM 360 D L10 CM OD4 MM DETACH M0035424100 SUPPLY/IMPLANTS "$9,801.00 " Outpatient "$4,900.50 " Not Applicable: Bundled with Procedure "$6,370.65 " "$6,860.70 " "$6,468.66 " Not Applicable: Bundled with Procedure "$3,430.35 " "$7,840.80 " "$3,430.35 " "$7,840.80 " COIL EMBOLIZATION MICRO 6-2MM DIA 7CML PLATINUM SYNTHETIC FI G47419 SUPPLY/IMPLANTS $631.00 Outpatient $315.50 Not Applicable: Bundled with Procedure $410.15 $441.70 $416.46 Not Applicable: Bundled with Procedure $220.85 $504.80 $220.85 $504.80 COIL EMBOLIZATION MICRO 0.018IN ID 7-3MM DIA 9CML PLATINUM S G47420 SUPPLY/IMPLANTS $631.00 Outpatient $315.50 Not Applicable: Bundled with Procedure $410.15 $441.70 $416.46 Not Applicable: Bundled with Procedure $220.85 $504.80 $220.85 $504.80 COIL EMBOLIZATION 10MM X 19CM 0.035IN DETACHABLE SINGLE USE 45-751019 SUPPLY/IMPLANTS "$5,187.00 " Outpatient "$2,593.50 " Not Applicable: Bundled with Procedure "$3,371.55 " "$3,630.90 " "$3,423.42 " Not Applicable: Bundled with Procedure "$1,815.45 " "$4,149.60 " "$1,815.45 " "$4,149.60 " COIL EMBOLIZATION 3.75MM DIA 14MML 75% COBALT CHROMIUM 25% P PED-375-14 SUPPLY/IMPLANTS "$65,963.00 " Outpatient "$32,981.50 " Not Applicable: Bundled with Procedure "$42,875.95 " "$46,174.10 " "$43,535.58 " Not Applicable: Bundled with Procedure "$23,087.05 " "$52,770.40 " "$23,087.05 " "$52,770.40 " COIL EMBOLIZATION 3.5MM DIA 16MML 75% COBALT CHROMIUM 25% PL PED-350-16 SUPPLY/IMPLANTS "$65,963.00 " Outpatient "$32,981.50 " Not Applicable: Bundled with Procedure "$42,875.95 " "$46,174.10 " "$43,535.58 " Not Applicable: Bundled with Procedure "$23,087.05 " "$52,770.40 " "$23,087.05 " "$52,770.40 " COIL EMBOLIZATION 2MM DIA LOOP 2CML DETACHABLE 45-780202 SUPPLY/IMPLANTS "$3,563.00 " Outpatient "$1,781.50 " Not Applicable: Bundled with Procedure "$2,315.95 " "$2,494.10 " "$2,351.58 " Not Applicable: Bundled with Procedure "$1,247.05 " "$2,850.40 " "$1,247.05 " "$2,850.40 " COIL EMBOLIZATION INTERLOCK IDC L2 CM OD2 MM 18 COIL SOFT 2D M0033612020 SUPPLY/IMPLANTS "$2,040.00 " Outpatient "$1,020.00 " Not Applicable: Bundled with Procedure "$1,326.00 " "$1,428.00 " "$1,346.40 " Not Applicable: Bundled with Procedure $714.00 "$1,632.00 " $714.00 "$1,632.00 " COIL IDC-18 2MM X 2 SOFT 361202 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " Not Applicable: Bundled with Procedure "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " COIL TARGET SOFT 360 16MM X 50CM M003612165 SUPPLY/IMPLANTS "$13,231.00 " Outpatient "$6,615.50 " Not Applicable: Bundled with Procedure "$8,600.15 " "$9,261.70 " "$8,732.46 " Not Applicable: Bundled with Procedure "$4,630.85 " "$10,584.80 " "$4,630.85 " "$10,584.80 " COIL TARGET 360 SOFT 10MM X 30CM M003547103 SUPPLY/IMPLANTS "$9,061.00 " Outpatient "$4,530.50 " Not Applicable: Bundled with Procedure "$5,889.65 " "$6,342.70 " "$5,980.26 " Not Applicable: Bundled with Procedure "$3,171.35 " "$7,248.80 " "$3,171.35 " "$7,248.80 " COIL TARGET ULTRA 360 4MM X 10MM 542410 SUPPLY/IMPLANTS "$10,176.00 " Outpatient "$5,088.00 " Not Applicable: Bundled with Procedure "$6,614.40 " "$7,123.20 " "$6,716.16 " Not Applicable: Bundled with Procedure "$3,561.60 " "$8,140.80 " "$3,561.60 " "$8,140.80 " COIL TARGET ULTRA 360 4MM X 15MM 542415 SUPPLY/IMPLANTS "$10,176.00 " Outpatient "$5,088.00 " Not Applicable: Bundled with Procedure "$6,614.40 " "$7,123.20 " "$6,716.16 " Not Applicable: Bundled with Procedure "$3,561.60 " "$8,140.80 " "$3,561.60 " "$8,140.80 " COIL VASCULAR PERIPHERAL SYSTEM 0.035IN 12CML X 8MM DIA DETA 45-750812 SUPPLY/IMPLANTS "$5,187.00 " Outpatient "$2,593.50 " Not Applicable: Bundled with Procedure "$3,371.55 " "$3,630.90 " "$3,423.42 " Not Applicable: Bundled with Procedure "$1,815.45 " "$4,149.60 " "$1,815.45 " "$4,149.60 " COILS TARGET 360 SOFT 13MM X 30CM M003547133 SUPPLY/IMPLANTS "$9,061.00 " Outpatient "$4,530.50 " Not Applicable: Bundled with Procedure "$5,889.65 " "$6,342.70 " "$5,980.26 " Not Applicable: Bundled with Procedure "$3,171.35 " "$7,248.80 " "$3,171.35 " "$7,248.80 " COILS TARGET 360 SOFT 13MM X 30CM M003547143 SUPPLY/IMPLANTS "$9,061.00 " Outpatient "$4,530.50 " Not Applicable: Bundled with Procedure "$5,889.65 " "$6,342.70 " "$5,980.26 " Not Applicable: Bundled with Procedure "$3,171.35 " "$7,248.80 " "$3,171.35 " "$7,248.80 " COMPONENT FEMORAL GMRS STANDARD L65 MM KNEE LEFT STERILE 6495-2-030 SUPPLY/IMPLANTS "$30,194.00 " Outpatient "$15,097.00 " Not Applicable: Bundled with Procedure "$19,626.10 " "$21,135.80 " "$19,928.04 " Not Applicable: Bundled with Procedure "$10,567.90 " "$24,155.20 " "$10,567.90 " "$24,155.20 " CONNECTOR SIDE LOADING DOMINO 77914555 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " Not Applicable: Bundled with Procedure "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,711.85 " "$3,912.80 " COUPLING EXTERNAL FIXATION HOFFMANN 3 PIN TO ROD DELTA MULTI 4922-1-025 SUPPLY/IMPLANTS "$4,160.00 " Outpatient "$2,080.00 " Not Applicable: Bundled with Procedure "$2,704.00 " "$2,912.00 " "$2,745.60 " Not Applicable: Bundled with Procedure "$1,456.00 " "$3,328.00 " "$1,456.00 " "$3,328.00 " CRANIAL CUSTOM IMPLANT 78-10030-1 78-10030-1 SUPPLY/IMPLANTS "$78,943.00 " Outpatient "$39,471.50 " Not Applicable: Bundled with Procedure "$51,312.95 " "$55,260.10 " "$52,102.38 " Not Applicable: Bundled with Procedure "$27,630.05 " "$63,154.40 " "$27,630.05 " "$63,154.40 " CRANIOPLASTY IMPLANT PK619483 PK619483 SUPPLY/IMPLANTS "$41,519.00 " Outpatient "$20,759.50 " Not Applicable: Bundled with Procedure "$26,987.35 " "$29,063.30 " "$27,402.54 " Not Applicable: Bundled with Procedure "$14,531.65 " "$33,215.20 " "$14,531.65 " "$33,215.20 " CRANIOPLASTY SKULL FLAP PK619980 SUPPLY/IMPLANTS "$43,961.00 " Outpatient "$21,980.50 " Not Applicable: Bundled with Procedure "$28,574.65 " "$30,772.70 " "$29,014.26 " Not Applicable: Bundled with Procedure "$15,386.35 " "$35,168.80 " "$15,386.35 " "$35,168.80 " CRR GFT 8X3IN MSGRFT II DRMCR II 1.5:1 PLTU GRV SKN STRL LF 219501200 SUPPLY/IMPLANTS "$3,402.00 " Outpatient "$1,701.00 " Not Applicable: Bundled with Procedure "$2,211.30 " "$2,381.40 " "$2,245.32 " Not Applicable: Bundled with Procedure "$1,190.70 " "$2,721.60 " "$1,190.70 " "$2,721.60 " CSST TRCH PRVX XTRAFLOW HME HEAT AND MOIST EXCHGR NS DISP 7291 SUPPLY/IMPLANTS $498.00 Outpatient $249.00 Not Applicable: Bundled with Procedure $323.70 $348.60 $328.68 Not Applicable: Bundled with Procedure $174.30 $398.40 $174.30 $398.40 CSST TRCH HME PRVX NRM FLW 7242 SUPPLY/IMPLANTS $531.00 Outpatient $265.50 Not Applicable: Bundled with Procedure $345.15 $371.70 $350.46 Not Applicable: Bundled with Procedure $185.85 $424.80 $185.85 $424.80 CTR ENDART DSCT TRANSECTION RMT MULTITASC 6 55CM 6.5MM 4.5MM 4500-04 SUPPLY/IMPLANTS "$11,231.00 " Outpatient "$5,615.50 " Not Applicable: Bundled with Procedure "$7,300.15 " "$7,861.70 " "$7,412.46 " Not Applicable: Bundled with Procedure "$3,930.85 " "$8,984.80 " "$3,930.85 " "$8,984.80 " CTR ENDART ENDORE MULTITASC 7 55CM 7.5MM 5.5MM DSCT 4500-05 SUPPLY/IMPLANTS "$11,231.00 " Outpatient "$5,615.50 " Not Applicable: Bundled with Procedure "$7,300.15 " "$7,861.70 " "$7,412.46 " Not Applicable: Bundled with Procedure "$3,930.85 " "$8,984.80 " "$3,930.85 " "$8,984.80 " CTR ENDART ENDORE MULTITASC 8 55CM 8.5MM 6.5MM DSCT 4500-06 SUPPLY/IMPLANTS "$11,231.00 " Outpatient "$5,615.50 " Not Applicable: Bundled with Procedure "$7,300.15 " "$7,861.70 " "$7,412.46 " Not Applicable: Bundled with Procedure "$3,930.85 " "$8,984.80 " "$3,930.85 " "$8,984.80 " CTR ENDART ENDORE MULTITASC 9 55CM 9.5MM 7.5MM DSCT 4500-07 SUPPLY/IMPLANTS "$11,231.00 " Outpatient "$5,615.50 " Not Applicable: Bundled with Procedure "$7,300.15 " "$7,861.70 " "$7,412.46 " Not Applicable: Bundled with Procedure "$3,930.85 " "$8,984.80 " "$3,930.85 " "$8,984.80 " CTR ENDART DSCT TRANSECTION RMT MULTITASC 11 55CM 11.5MM 9.5 4500-09 SUPPLY/IMPLANTS "$11,231.00 " Outpatient "$5,615.50 " Not Applicable: Bundled with Procedure "$7,300.15 " "$7,861.70 " "$7,412.46 " Not Applicable: Bundled with Procedure "$3,930.85 " "$8,984.80 " "$3,930.85 " "$8,984.80 " CTR ENDART DSCT TRANSECTION RMT MULTITASC 12 55CM 12.5MM 4500-10 SUPPLY/IMPLANTS "$11,231.00 " Outpatient "$5,615.50 " Not Applicable: Bundled with Procedure "$7,300.15 " "$7,861.70 " "$7,412.46 " Not Applicable: Bundled with Procedure "$3,930.85 " "$8,984.80 " "$3,930.85 " "$8,984.80 " CVR BUR HL SPNE 13.5MM BNT 19-1019 SUPPLY/IMPLANTS $931.00 Outpatient $465.50 Not Applicable: Bundled with Procedure $605.15 $651.70 $614.46 Not Applicable: Bundled with Procedure $325.85 $744.80 $325.85 $744.80 CVR BUR HL CRNMXF .4MM 14MM TAB LOPRFL UNV NEURO III NS 5334514 SUPPLY/IMPLANTS "$1,118.00 " Outpatient $559.00 Not Applicable: Bundled with Procedure $726.70 $782.60 $737.88 Not Applicable: Bundled with Procedure $391.30 $894.40 $391.30 $894.40 DART FX 14MM 1.3MM DRTSTK MNSCS POLY L LACTD CO D L LACTD AR-3007B-14 SUPPLY/IMPLANTS $958.00 Outpatient $479.00 Not Applicable: Bundled with Procedure $622.70 $670.60 $632.28 Not Applicable: Bundled with Procedure $335.30 $766.40 $335.30 $766.40 DEV BN BX 2 CONE TPR SPNE XPNDR KPHX XPR LL FIT SPEC CLT CNN F07A SUPPLY/IMPLANTS $741.00 Outpatient $370.50 Not Applicable: Bundled with Procedure $481.65 $518.70 $489.06 Not Applicable: Bundled with Procedure $259.35 $592.80 $259.35 $592.80 DEV FX ABSORBATACK 5MM 30 TACK ABS TACK PLSTR CPLYMR LAPSCP ABSTACK30 SUPPLY/IMPLANTS "$3,152.00 " Outpatient "$1,576.00 " Not Applicable: Bundled with Procedure "$2,048.80 " "$2,206.40 " "$2,080.32 " Not Applicable: Bundled with Procedure "$1,103.20 " "$2,521.60 " "$1,103.20 " "$2,521.60 " DEV FX 5MM SECURESTRAP 25 ABS STRAP MESH DISP HRN REPR STRAP25 SUPPLY/IMPLANTS "$2,814.00 " Outpatient "$1,407.00 " Not Applicable: Bundled with Procedure "$1,829.10 " "$1,969.80 " "$1,857.24 " Not Applicable: Bundled with Procedure $984.90 "$2,251.20 " $984.90 "$2,251.20 " DEV FX ANKL ZIPTIGHT SS 909857 SUPPLY/IMPLANTS "$4,125.00 " Outpatient "$2,062.50 " Not Applicable: Bundled with Procedure "$2,681.25 " "$2,887.50 " "$2,722.50 " Not Applicable: Bundled with Procedure "$1,443.75 " "$3,300.00 " "$1,443.75 " "$3,300.00 " DEV SUT 1 HND OP FULL THK ESCP FLXB CNCH OVERSTITCH DISP CNH-G01-000 SUPPLY/IMPLANTS $559.00 Outpatient $279.50 Not Applicable: Bundled with Procedure $363.35 $391.30 $368.94 Not Applicable: Bundled with Procedure $195.65 $447.20 $195.65 $447.20 DEV SUT 2.8MM 165CM 1 HND OP UNQ CNCH FLXB ESCP RLD TISS HLX THX-165-028 SUPPLY/IMPLANTS "$1,248.00 " Outpatient $624.00 Not Applicable: Bundled with Procedure $811.20 $873.60 $823.68 Not Applicable: Bundled with Procedure $436.80 $998.40 $436.80 $998.40 DEV THRMB 180CM 6MM SOLITARE SCFLD RADOPQ 20MM ACPT .027IN SFR3-6-20-10 SUPPLY/IMPLANTS "$37,270.00 " Outpatient "$18,635.00 " Not Applicable: Bundled with Procedure "$24,225.50 " "$26,089.00 " "$24,598.20 " Not Applicable: Bundled with Procedure "$13,044.50 " "$29,816.00 " "$13,044.50 " "$29,816.00 " DEV THRMB 180CM 4MM SOLITARE SCFLD RADOPQ 20MM ACPT .021IN SFR3-4-20-10 SUPPLY/IMPLANTS "$37,245.00 " Outpatient "$18,622.50 " Not Applicable: Bundled with Procedure "$24,209.25 " "$26,071.50 " "$24,581.70 " Not Applicable: Bundled with Procedure "$13,035.75 " "$29,796.00 " "$13,035.75 " "$29,796.00 " DEVICE SEPTAL OCCLUDER 8MM 9-ASD-008 SUPPLY/IMPLANTS "$32,394.00 " Outpatient "$16,197.00 " Not Applicable: Bundled with Procedure "$21,056.10 " "$22,675.80 " "$21,380.04 " Not Applicable: Bundled with Procedure "$11,337.90 " "$25,915.20 " "$11,337.90 " "$25,915.20 " DEVICE 34MM SEPTAL OCCLUDER 9-ASD-034 SUPPLY/IMPLANTS "$32,394.00 " Outpatient "$16,197.00 " Not Applicable: Bundled with Procedure "$21,056.10 " "$22,675.80 " "$21,380.04 " Not Applicable: Bundled with Procedure "$11,337.90 " "$25,915.20 " "$11,337.90 " "$25,915.20 " DEVICE 13MM SEPTAL OCCLUDER 9-ASD-013 SUPPLY/IMPLANTS "$32,394.00 " Outpatient "$16,197.00 " Not Applicable: Bundled with Procedure "$21,056.10 " "$22,675.80 " "$21,380.04 " Not Applicable: Bundled with Procedure "$11,337.90 " "$25,915.20 " "$11,337.90 " "$25,915.20 " DEVICE 28MM SEPTAL OCCLUDER 9-ASD-028 SUPPLY/IMPLANTS "$32,394.00 " Outpatient "$16,197.00 " Not Applicable: Bundled with Procedure "$21,056.10 " "$22,675.80 " "$21,380.04 " Not Applicable: Bundled with Procedure "$11,337.90 " "$25,915.20 " "$11,337.90 " "$25,915.20 " DEVICE EMBOLIZATION PIPELINE FLEX L16 MM OD4.5 MM NEUROVASCU PED-450-16 SUPPLY/IMPLANTS "$67,942.00 " Outpatient "$33,971.00 " Not Applicable: Bundled with Procedure "$44,162.30 " "$47,559.40 " "$44,841.72 " Not Applicable: Bundled with Procedure "$23,779.70 " "$54,353.60 " "$23,779.70 " "$54,353.60 " DEVICE EMBOLIZATION PIPELINE FLEX L16 MM OD4 MM NEUROVASCULA PED-400-16 SUPPLY/IMPLANTS "$75,492.00 " Outpatient "$37,746.00 " Not Applicable: Bundled with Procedure "$49,069.80 " "$52,844.40 " "$49,824.72 " Not Applicable: Bundled with Procedure "$26,422.20 " "$60,393.60 " "$26,422.20 " "$60,393.60 " DEVISE MULTI TASCO DISSECTION TRANSECTION 10.0 X 12.0 MM X 55CM 4500-08 SUPPLY/IMPLANTS "$11,231.00 " Outpatient "$5,615.50 " Not Applicable: Bundled with Procedure "$7,300.15 " "$7,861.70 " "$7,412.46 " Not Applicable: Bundled with Procedure "$3,930.85 " "$8,984.80 " "$3,930.85 " "$8,984.80 " DEVISE MULTI TASCO DISSECTION TRANSECTION 10.0 X 12.0 MM X 55CM 4500-08 SUPPLY/IMPLANTS "$11,231.00 " Outpatient "$5,615.50 " Not Applicable: Bundled with Procedure "$7,300.15 " "$7,861.70 " "$7,412.46 " Not Applicable: Bundled with Procedure "$3,930.85 " "$8,984.80 " "$3,930.85 " "$8,984.80 " DFBR CRD AMPLIA MRI CRT-D LV DF-4 IMPL QDPL LTX STRL DTMB1QQ SUPPLY/IMPLANTS "$130,463.00 " Outpatient "$65,231.50 " Not Applicable: Bundled with Procedure "$84,800.95 " "$91,324.10 " "$86,105.58 " Not Applicable: Bundled with Procedure "$45,662.05 " "$104,370.40 " "$45,662.05 " "$104,370.40 " DIL ESCP QTM TTC 180CM 24FR .035IN 3CM BD BLN CATH TRCR M G22656 SUPPLY/IMPLANTS $913.00 Outpatient $456.50 Not Applicable: Bundled with Procedure $593.45 $639.10 $602.58 Not Applicable: Bundled with Procedure $319.55 $730.40 $319.55 $730.40 DIL ESCP QTM TTC 180CM 30FR 6.8-4.5FR .035IN 3CM BD BLN CATH G22657 SUPPLY/IMPLANTS $913.00 Outpatient $456.50 Not Applicable: Bundled with Procedure $593.45 $639.10 $602.58 Not Applicable: Bundled with Procedure $319.55 $730.40 $319.55 $730.40 DIL SXTNT II CD HZN LG SRG INSL DISP 8675424 SUPPLY/IMPLANTS "$1,026.00 " Outpatient $513.00 Not Applicable: Bundled with Procedure $666.90 $718.20 $677.16 Not Applicable: Bundled with Procedure $359.10 $820.80 $359.10 $820.80 DISC INTVRTB 17X5MM MOBI-C 13MM SPNE CRV COCRMO TI UHMWPE HA MB 3375 SUPPLY/IMPLANTS "$34,239.00 " Outpatient "$17,119.50 " Not Applicable: Bundled with Procedure "$22,255.35 " "$23,967.30 " "$22,597.74 " Not Applicable: Bundled with Procedure "$11,983.65 " "$27,391.20 " "$11,983.65 " "$27,391.20 " DISC INTVRTB 15X5MM MOBI-C 13MM SPNE CRV COCRMO TI UHMWPE HA MB 3355 SUPPLY/IMPLANTS "$46,468.00 " Outpatient "$23,234.00 " Not Applicable: Bundled with Procedure "$30,204.20 " "$32,527.60 " "$30,668.88 " Not Applicable: Bundled with Procedure "$16,263.80 " "$37,174.40 " "$16,263.80 " "$37,174.40 " DISC INTERVERTEBRAL MOBI-C D17 MM STANDARD W17 MM X H5 MM MB3775 SUPPLY/IMPLANTS "$27,353.00 " Outpatient "$13,676.50 " Not Applicable: Bundled with Procedure "$17,779.45 " "$19,147.10 " "$18,052.98 " Not Applicable: Bundled with Procedure "$9,573.55 " "$21,882.40 " "$9,573.55 " "$21,882.40 " DISC INTERVERTEBRAL MOBI-C D17 MM STANDARD W17 MM X H7 MM ST MB3777 SUPPLY/IMPLANTS "$25,378.00 " Outpatient "$12,689.00 " Not Applicable: Bundled with Procedure "$16,495.70 " "$17,764.60 " "$16,749.48 " Not Applicable: Bundled with Procedure "$8,882.30 " "$20,302.40 " "$8,882.30 " "$20,302.40 " DISC INTERVERTEBRAL PRODISC-C COCR TITANIUM UHMWPE LARGE H5 09.820.045S SUPPLY/IMPLANTS "$22,899.00 " Outpatient "$11,449.50 " Not Applicable: Bundled with Procedure "$14,884.35 " "$16,029.30 " "$15,113.34 " Not Applicable: Bundled with Procedure "$8,014.65 " "$18,319.20 " "$8,014.65 " "$18,319.20 " DRAIN INTEGRA ACCUDRAIN 8401 8401 SUPPLY/IMPLANTS "$2,280.00 " Outpatient "$1,140.00 " Not Applicable: Bundled with Procedure "$1,482.00 " "$1,596.00 " "$1,504.80 " Not Applicable: Bundled with Procedure $798.00 "$1,824.00 " $798.00 "$1,824.00 " DRILL BIT 2.2MM 50851222 SUPPLY/IMPLANTS "$1,529.00 " Outpatient $764.50 Not Applicable: Bundled with Procedure $993.85 "$1,070.30 " "$1,009.14 " Not Applicable: Bundled with Procedure $535.15 "$1,223.20 " $535.15 "$1,223.20 " DRILL 17MM X067-0571 SUPPLY/IMPLANTS $855.00 Outpatient $427.50 Not Applicable: Bundled with Procedure $555.75 $598.50 $564.30 Not Applicable: Bundled with Procedure $299.25 $684.00 $299.25 $684.00 DRILL 16MM X067-0573 SUPPLY/IMPLANTS $855.00 Outpatient $427.50 Not Applicable: Bundled with Procedure $555.75 $598.50 $564.30 Not Applicable: Bundled with Procedure $299.25 $684.00 $299.25 $684.00 "DRILL GUIDE, COMP/POLYAS 2.0MM DRILO, T8 703684" SUPPLY/IMPLANTS "$1,733.00 " Outpatient $866.50 Not Applicable: Bundled with Procedure "$1,126.45 " "$1,213.10 " "$1,143.78 " Not Applicable: Bundled with Procedure $606.55 "$1,386.40 " $606.55 "$1,386.40 " DRL SRG 115MM STP MNDB TRAUMAONE 26MM 1.6MM 46-1007 SUPPLY/IMPLANTS "$1,444.00 " Outpatient $722.00 Not Applicable: Bundled with Procedure $938.60 "$1,010.80 " $953.04 Not Applicable: Bundled with Procedure $505.40 "$1,155.20 " $505.40 "$1,155.20 " DRL SRG STRL 3.5 MM LABRAL SWIVELOCK AR-2325D-ST SUPPLY/IMPLANTS $855.00 Outpatient $427.50 Not Applicable: Bundled with Procedure $555.75 $598.50 $564.30 Not Applicable: Bundled with Procedure $299.25 $684.00 $299.25 $684.00 DRL SRG LG PRFL DISP 5MM SCR AR-8750-05 SUPPLY/IMPLANTS "$1,141.00 " Outpatient $570.50 Not Applicable: Bundled with Procedure $741.65 $798.70 $753.06 Not Applicable: Bundled with Procedure $399.35 $912.80 $399.35 $912.80 DRSG WND 5X4IN BVN CLGN GAG THN STRL DISP 54051T SUPPLY/IMPLANTS "$21,816.00 " Outpatient "$10,908.00 " Not Applicable: Bundled with Procedure "$14,180.40 " "$15,271.20 " "$14,398.56 " Not Applicable: Bundled with Procedure "$7,635.60 " "$17,452.80 " "$7,635.60 " "$17,452.80 " DSTRCT WRE WRNCH A FSHR ALN OLV SRG 10735 SUPPLY/IMPLANTS "$2,314.00 " Outpatient "$1,157.00 " Not Applicable: Bundled with Procedure "$1,504.10 " "$1,619.80 " "$1,527.24 " Not Applicable: Bundled with Procedure $809.90 "$1,851.20 " $809.90 "$1,851.20 " ELTRD ESURG 8MM 5MM BALL END COAG YLW 26050 NK SUPPLY/IMPLANTS "$3,828.00 " Outpatient "$1,914.00 " Not Applicable: Bundled with Procedure "$2,488.20 " "$2,679.60 " "$2,526.48 " Not Applicable: Bundled with Procedure "$1,339.80 " "$3,062.40 " "$1,339.80 " "$3,062.40 " ENV ABS MED 2.7X2.5IN POLYARYLATE MINOCYCLINE RFMPN TYRX NMRM6122 SUPPLY/IMPLANTS "$9,759.00 " Outpatient "$4,879.50 " Not Applicable: Bundled with Procedure "$6,343.35 " "$6,831.30 " "$6,440.94 " Not Applicable: Bundled with Procedure "$3,415.65 " "$7,807.20 " "$3,415.65 " "$7,807.20 " ENV TISS 6.9X6.5CM CORMATRIX CANGAROO ECM MED PRCN CMCV-009-MED SUPPLY/IMPLANTS "$4,641.00 " Outpatient "$2,320.50 " Not Applicable: Bundled with Procedure "$3,016.65 " "$3,248.70 " "$3,063.06 " Not Applicable: Bundled with Procedure "$1,624.35 " "$3,712.80 " "$1,624.35 " "$3,712.80 " ESOPHAGEAL STENT 12CM X 25MM G5226 SUPPLY/IMPLANTS "$7,215.00 " Outpatient "$3,607.50 " Not Applicable: Bundled with Procedure "$4,689.75 " "$5,050.50 " "$4,761.90 " Not Applicable: Bundled with Procedure "$2,525.25 " "$5,772.00 " "$2,525.25 " "$5,772.00 " ETEX EQUIVABONE 10CC 76-6022 SUPPLY/IMPLANTS "$23,943.00 " Outpatient "$11,971.50 " Not Applicable: Bundled with Procedure "$15,562.95 " "$16,760.10 " "$15,802.38 " Not Applicable: Bundled with Procedure "$8,380.05 " "$19,154.40 " "$8,380.05 " "$19,154.40 " EXCHGR HME ES BRTHG LESS MCS PRD LOPRFL DSGN XTRAMOIST PRVX 7290 SUPPLY/IMPLANTS $498.00 Outpatient $249.00 Not Applicable: Bundled with Procedure $323.70 $348.60 $328.68 Not Applicable: Bundled with Procedure $174.30 $398.40 $174.30 $398.40 FBRC CV 4X1IN BARD THK.61MM SVG PLSTR PTFE FLMN KNIT STRL LF 7942 SUPPLY/IMPLANTS $521.00 Outpatient $260.50 Not Applicable: Bundled with Procedure $338.65 $364.70 $343.86 Not Applicable: Bundled with Procedure $182.35 $416.80 $182.35 $416.80 FBRC CV 4X4IN BARD THK.61MM SVG PLSTR PTFE FLMN KNIT STRL 7828 SUPPLY/IMPLANTS $554.00 Outpatient $277.00 Not Applicable: Bundled with Procedure $360.10 $387.80 $365.64 Not Applicable: Bundled with Procedure $193.90 $443.20 $193.90 $443.20 FELT CV 4X4IN THK1.65MM PTFE PTCH STRL 7836 SUPPLY/IMPLANTS $503.00 Outpatient $251.50 Not Applicable: Bundled with Procedure $326.95 $352.10 $331.98 Not Applicable: Bundled with Procedure $176.05 $402.40 $176.05 $402.40 FIL BN VOID 1CC DBX ALGRF PTTY FRZDR 38010 SUPPLY/IMPLANTS $935.00 Outpatient $467.50 Not Applicable: Bundled with Procedure $607.75 $654.50 $617.10 Not Applicable: Bundled with Procedure $327.25 $748.00 $327.25 $748.00 FIL BN VOID 2.5CC DBX ALGRF PTTY FRZDR 38025 SUPPLY/IMPLANTS "$2,583.00 " Outpatient "$1,291.50 " Not Applicable: Bundled with Procedure "$1,678.95 " "$1,808.10 " "$1,704.78 " Not Applicable: Bundled with Procedure $904.05 "$2,066.40 " $904.05 "$2,066.40 " FIL BN VOID 10CC DBX ALGRF PTTY FRZDR 38100 SUPPLY/IMPLANTS "$5,485.00 " Outpatient "$2,742.50 " Not Applicable: Bundled with Procedure "$3,565.25 " "$3,839.50 " "$3,620.10 " Not Applicable: Bundled with Procedure "$1,919.75 " "$4,388.00 " "$1,919.75 " "$4,388.00 " FIL BN VOID 5CC DBX ALGRF PTTY FRZDR 38050 SUPPLY/IMPLANTS "$3,208.00 " Outpatient "$1,604.00 " Not Applicable: Bundled with Procedure "$2,085.20 " "$2,245.60 " "$2,117.28 " Not Applicable: Bundled with Procedure "$1,122.80 " "$2,566.40 " "$1,122.80 " "$2,566.40 " FIL BN VOID 10CC DBX ALGRF FRZDR MX 58100 SUPPLY/IMPLANTS "$6,124.00 " Outpatient "$3,062.00 " Not Applicable: Bundled with Procedure "$3,980.60 " "$4,286.80 " "$4,041.84 " Not Applicable: Bundled with Procedure "$2,143.40 " "$4,899.20 " "$2,143.40 " "$4,899.20 " FIL BN VOID 5CC DBX ALGRF FRZDR MX 58050 SUPPLY/IMPLANTS "$3,900.00 " Outpatient "$1,950.00 " Not Applicable: Bundled with Procedure "$2,535.00 " "$2,730.00 " "$2,574.00 " Not Applicable: Bundled with Procedure "$1,365.00 " "$3,120.00 " "$1,365.00 " "$3,120.00 " FIL BN VOID 10ML DBM GRFTN ALGRF PTTY JR T43110 SUPPLY/IMPLANTS "$5,260.00 " Outpatient "$2,630.00 " Not Applicable: Bundled with Procedure "$3,419.00 " "$3,682.00 " "$3,471.60 " Not Applicable: Bundled with Procedure "$1,841.00 " "$4,208.00 " "$1,841.00 " "$4,208.00 " FIXATION HOFFMAN 3 EXTERNAL 4922-09-940S SUPPLY/IMPLANTS "$27,752.00 " Outpatient "$13,876.00 " Not Applicable: Bundled with Procedure "$18,038.80 " "$19,426.40 " "$18,316.32 " Not Applicable: Bundled with Procedure "$9,713.20 " "$22,201.60 " "$9,713.20 " "$22,201.60 " FLTR IVC 70CM DLV SHTH CRV PSHR STRL LF 32- MM 5FR OPTN ELT 352506070E SUPPLY/IMPLANTS "$5,133.00 " Outpatient "$2,566.50 " Not Applicable: Bundled with Procedure "$3,336.45 " "$3,593.10 " "$3,387.78 " Not Applicable: Bundled with Procedure "$1,796.55 " "$4,106.40 " "$1,796.55 " "$4,106.40 " FLTR VASC 12FR PERI VC FEM GRNFLD INTRO SYS TI M001503010 SUPPLY/IMPLANTS "$4,629.00 " Outpatient "$2,314.50 " Not Applicable: Bundled with Procedure "$3,008.85 " "$3,240.30 " "$3,055.14 " Not Applicable: Bundled with Procedure "$1,620.15 " "$3,703.20 " "$1,620.15 " "$3,703.20 " FLTR VASC 12FR PERI VC JUG GRNFLD INTRO SYS TI M001503000 SUPPLY/IMPLANTS "$4,872.00 " Outpatient "$2,436.00 " Not Applicable: Bundled with Procedure "$3,166.80 " "$3,410.40 " "$3,215.52 " Not Applicable: Bundled with Procedure "$1,705.20 " "$3,897.60 " "$1,705.20 " "$3,897.60 " GA D LCP 2 MM 2.4 MM SCR 319.006 SUPPLY/IMPLANTS "$3,566.00 " Outpatient "$1,783.00 " Not Applicable: Bundled with Procedure "$2,317.90 " "$2,496.20 " "$2,353.56 " Not Applicable: Bundled with Procedure "$1,248.10 " "$2,852.80 " "$1,248.10 " "$2,852.80 " GAUGE LOCKDOWN LENGTH LDLG SUPPLY/IMPLANTS "$1,142.00 " Outpatient $571.00 Not Applicable: Bundled with Procedure $742.30 $799.40 $753.72 Not Applicable: Bundled with Procedure $399.70 $913.60 $399.70 $913.60 GD 62CM 16FR AAA DFLC TIP HELI-FX SRG 28MM HG-16-62-28 SUPPLY/IMPLANTS "$8,607.00 " Outpatient "$4,303.50 " Not Applicable: Bundled with Procedure "$5,594.55 " "$6,024.90 " "$5,680.62 " Not Applicable: Bundled with Procedure "$3,012.45 " "$6,885.60 " "$3,012.45 " "$6,885.60 " GD DRL 2.8MM THRD LCP 2.8MM NS 3.5 LCK SCR 312.648 SUPPLY/IMPLANTS $679.00 Outpatient $339.50 Not Applicable: Bundled with Procedure $441.35 $475.30 $448.14 Not Applicable: Bundled with Procedure $237.65 $543.20 $237.65 $543.20 GFT BN RHBMP-2 BVN CLGN 26MM 8CC ABS SPNG STRL H2O SYR NDL 7510800 SUPPLY/IMPLANTS "$26,452.00 " Outpatient "$13,226.00 " Not Applicable: Bundled with Procedure "$17,193.80 " "$18,516.40 " "$17,458.32 " Not Applicable: Bundled with Procedure "$9,258.20 " "$21,161.60 " "$9,258.20 " "$21,161.60 " GFT BN DBM 10ML PO 500R GRNL PRMX PST INTRGR + DBMW10 SUPPLY/IMPLANTS "$7,778.00 " Outpatient "$3,889.00 " Not Applicable: Bundled with Procedure "$5,055.70 " "$5,444.60 " "$5,133.48 " Not Applicable: Bundled with Procedure "$2,722.30 " "$6,222.40 " "$2,722.30 " "$6,222.40 " GFT BN DBM 5ML PO 500R GRNL PRMX PST INTRGR + DBMW05 SUPPLY/IMPLANTS "$5,054.00 " Outpatient "$2,527.00 " Not Applicable: Bundled with Procedure "$3,285.10 " "$3,537.80 " "$3,335.64 " Not Applicable: Bundled with Procedure "$1,768.90 " "$4,043.20 " "$1,768.90 " "$4,043.20 " GFT BN RHBMP-2 BVN CLGN 2X1IN 5.6CC VL ABS SYR NDL INFS MED 7510400 SUPPLY/IMPLANTS "$23,934.00 " Outpatient "$11,967.00 " Not Applicable: Bundled with Procedure "$15,557.10 " "$16,753.80 " "$15,796.44 " Not Applicable: Bundled with Procedure "$8,376.90 " "$19,147.20 " "$8,376.90 " "$19,147.20 " GFT BN DBM 5X2.5CM PLIF GRFTN 42210 SUPPLY/IMPLANTS "$7,401.00 " Outpatient "$3,700.50 " Not Applicable: Bundled with Procedure "$4,810.65 " "$5,180.70 " "$4,884.66 " Not Applicable: Bundled with Procedure "$2,590.35 " "$5,920.80 " "$2,590.35 " "$5,920.80 " GFT BN DBM 5CC PTTY JR GRFTN T43105 SUPPLY/IMPLANTS "$3,232.00 " Outpatient "$1,616.00 " Not Applicable: Bundled with Procedure "$2,100.80 " "$2,262.40 " "$2,133.12 " Not Applicable: Bundled with Procedure "$1,131.20 " "$2,585.60 " "$1,131.20 " "$2,585.60 " GFT BN CORT FEM 200X20MM STRUT FRZN VG FCS SUPPLY/IMPLANTS "$2,508.00 " Outpatient "$1,254.00 " Not Applicable: Bundled with Procedure "$1,630.20 " "$1,755.60 " "$1,655.28 " Not Applicable: Bundled with Procedure $877.80 "$2,006.40 " $877.80 "$2,006.40 " GFT BN CORT CNC 1-3MM 30ML FRZDR CHP 110130 SUPPLY/IMPLANTS "$1,996.00 " Outpatient $998.00 Not Applicable: Bundled with Procedure "$1,297.40 " "$1,397.20 " "$1,317.36 " Not Applicable: Bundled with Procedure $698.60 "$1,596.80 " $698.60 "$1,596.80 " GFT BN CANC ALGRF FRZN VIABLE CELL MORSELIZE TRN ELT SM 410001 SUPPLY/IMPLANTS "$3,287.00 " Outpatient "$1,643.50 " Not Applicable: Bundled with Procedure "$2,136.55 " "$2,300.90 " "$2,169.42 " Not Applicable: Bundled with Procedure "$1,150.45 " "$2,629.60 " "$1,150.45 " "$2,629.60 " GFT BN 2.5CC MTRX OSTINDC PTNT NONIMMUNOGENIC ORIOS BORS025 SUPPLY/IMPLANTS "$5,479.00 " Outpatient "$2,739.50 " Not Applicable: Bundled with Procedure "$3,561.35 " "$3,835.30 " "$3,616.14 " Not Applicable: Bundled with Procedure "$1,917.65 " "$4,383.20 " "$1,917.65 " "$4,383.20 " GFT BN COSTAL CRTLG SEG 3-10X10-30CM ALGRF FRZN THK3-20MM 450030 SUPPLY/IMPLANTS "$2,210.00 " Outpatient "$1,105.00 " Not Applicable: Bundled with Procedure "$1,436.50 " "$1,547.00 " "$1,458.60 " Not Applicable: Bundled with Procedure $773.50 "$1,768.00 " $773.50 "$1,768.00 " GFT BN 5CC MTRX OSTINDC PTNT NONIMMUNOGENIC ORIOS BORS005 SUPPLY/IMPLANTS "$9,810.00 " Outpatient "$4,905.00 " Not Applicable: Bundled with Procedure "$6,376.50 " "$6,867.00 " "$6,474.60 " Not Applicable: Bundled with Procedure "$3,433.50 " "$7,848.00 " "$3,433.50 " "$7,848.00 " GFT BN 25-29MM ALGRF REV DWL FLEXIGRAFT PRESERVON STD 14MM PRD14 SUPPLY/IMPLANTS "$5,621.00 " Outpatient "$2,810.50 " Not Applicable: Bundled with Procedure "$3,653.65 " "$3,934.70 " "$3,709.86 " Not Applicable: Bundled with Procedure "$1,967.35 " "$4,496.80 " "$1,967.35 " "$4,496.80 " GFT BN CORT CNC DMNR 10CC ALGRF VIVIGEN BL-1500-003 SUPPLY/IMPLANTS "$17,047.00 " Outpatient "$8,523.50 " Not Applicable: Bundled with Procedure "$11,080.55 " "$11,932.90 " "$11,251.02 " Not Applicable: Bundled with Procedure "$5,966.45 " "$13,637.60 " "$5,966.45 " "$13,637.60 " GFT BN 10CC MTRX OSTINDC PTNT NONIMMUNOGENIC ORIOS BORS010 SUPPLY/IMPLANTS "$18,363.00 " Outpatient "$9,181.50 " Not Applicable: Bundled with Procedure "$11,935.95 " "$12,854.10 " "$12,119.58 " Not Applicable: Bundled with Procedure "$6,427.05 " "$14,690.40 " "$6,427.05 " "$14,690.40 " GFT BN VIABLE BN MTRX POR CANC 10CC MLD SCFLD BIO4 3102-2110 SUPPLY/IMPLANTS "$26,029.00 " Outpatient "$13,014.50 " Not Applicable: Bundled with Procedure "$16,918.85 " "$18,220.30 " "$17,179.14 " Not Applicable: Bundled with Procedure "$9,110.15 " "$20,823.20 " "$9,110.15 " "$20,823.20 " GFT BN ALGRF PTTY PROPEL SM STRL LF 5020001 SUPPLY/IMPLANTS $868.00 Outpatient $434.00 Not Applicable: Bundled with Procedure $564.20 $607.60 $572.88 Not Applicable: Bundled with Procedure $303.80 $694.40 $303.80 $694.40 GFT BN VIABLE BN MTRX 5CC ALGRF BIO4 PS51005 SUPPLY/IMPLANTS "$8,549.00 " Outpatient "$4,274.50 " Not Applicable: Bundled with Procedure "$5,556.85 " "$5,984.30 " "$5,642.34 " Not Applicable: Bundled with Procedure "$2,992.15 " "$6,839.20 " "$2,992.15 " "$6,839.20 " GFT BN 3CC AUG K20003010 SUPPLY/IMPLANTS "$17,073.00 " Outpatient "$8,536.50 " Not Applicable: Bundled with Procedure "$11,097.45 " "$11,951.10 " "$11,268.18 " Not Applicable: Bundled with Procedure "$5,975.55 " "$13,658.40 " "$5,975.55 " "$13,658.40 " GFT BN 1CC ALGRF PTTY SYR I FCTR 700010 SUPPLY/IMPLANTS "$2,688.00 " Outpatient "$1,344.00 " Not Applicable: Bundled with Procedure "$1,747.20 " "$1,881.60 " "$1,774.08 " Not Applicable: Bundled with Procedure $940.80 "$2,150.40 " $940.80 "$2,150.40 " GFT EVAS 40MM 7MM FLAIR FLR ARTERIOVENOUS EPTFE 2 LYR FAF07040 SUPPLY/IMPLANTS "$11,731.00 " Outpatient "$5,865.50 " Not Applicable: Bundled with Procedure "$7,625.15 " "$8,211.70 " "$7,742.46 " Not Applicable: Bundled with Procedure "$4,105.85 " "$9,384.80 " "$4,105.85 " "$9,384.80 " GFT SFT TIS 7X4CM SPND TTPL FSCA LATA ALGRF DEHYDRATE GMA 937201 SUPPLY/IMPLANTS "$3,913.00 " Outpatient "$1,956.50 " Not Applicable: Bundled with Procedure "$2,543.45 " "$2,739.10 " "$2,582.58 " Not Applicable: Bundled with Procedure "$1,369.55 " "$3,130.40 " "$1,369.55 " "$3,130.40 " GFT SFT TIS 3X1IN DRGN + CRNL DURA BVN CLGN MTRX PTCH RSRB DP5013 SUPPLY/IMPLANTS "$2,149.00 " Outpatient "$1,074.50 " Not Applicable: Bundled with Procedure "$1,396.85 " "$1,504.30 " "$1,418.34 " Not Applicable: Bundled with Procedure $752.15 "$1,719.20 " $752.15 "$1,719.20 " GFT SFT TIS 3X3IN DRGN + CRNL DURA BVN CLGN MTRX PTCH RSRB DP-1033 SUPPLY/IMPLANTS "$3,452.00 " Outpatient "$1,726.00 " Not Applicable: Bundled with Procedure "$2,243.80 " "$2,416.40 " "$2,278.32 " Not Applicable: Bundled with Procedure "$1,208.20 " "$2,761.60 " "$1,208.20 " "$2,761.60 " GFT SFT TIS 2.5X2CM AMNIOGRAFT A THK50-100UM AMNIO MEMBR AG-2520 SUPPLY/IMPLANTS "$3,399.00 " Outpatient "$1,699.50 " Not Applicable: Bundled with Procedure "$2,209.35 " "$2,379.30 " "$2,243.34 " Not Applicable: Bundled with Procedure "$1,189.65 " "$2,719.20 " "$1,189.65 " "$2,719.20 " GFT SFT TIS 12X2CM AMNIOFIX PURION AMNIO MEMBR SHT APS-5212 SUPPLY/IMPLANTS "$5,870.00 " Outpatient "$2,935.00 " Not Applicable: Bundled with Procedure "$3,815.50 " "$4,109.00 " "$3,874.20 " Not Applicable: Bundled with Procedure "$2,054.50 " "$4,696.00 " "$2,054.50 " "$4,696.00 " GFT SFT TIS EPIFIX 14MM AMNIO MEMBR DISK GS-5140 SUPPLY/IMPLANTS "$1,783.00 " Outpatient $891.50 Not Applicable: Bundled with Procedure "$1,158.95 " "$1,248.10 " "$1,176.78 " Not Applicable: Bundled with Procedure $624.05 "$1,426.40 " $624.05 "$1,426.40 " GFT SFT TIS BIODESIGN SURGISIS .4CM PRCN SM INTST SUBMUCOSA G54613 SUPPLY/IMPLANTS "$5,108.00 " Outpatient "$2,554.00 " Not Applicable: Bundled with Procedure "$3,320.20 " "$3,575.60 " "$3,371.28 " Not Applicable: Bundled with Procedure "$1,787.80 " "$4,086.40 " "$1,787.80 " "$4,086.40 " GFT SFT TIS BIODESIGN SURGISIS .7CM PRCN SM INTST SUBMUCOSA G54614 SUPPLY/IMPLANTS "$5,108.00 " Outpatient "$2,554.00 " Not Applicable: Bundled with Procedure "$3,320.20 " "$3,575.60 " "$3,371.28 " Not Applicable: Bundled with Procedure "$1,787.80 " "$4,086.40 " "$1,787.80 " "$4,086.40 " GFT SFT TIS EPIFIX 4.5SQ CM DHACM ALGRF GS-5024 SUPPLY/IMPLANTS "$4,072.00 " Outpatient "$2,036.00 " Not Applicable: Bundled with Procedure "$2,646.80 " "$2,850.40 " "$2,687.52 " Not Applicable: Bundled with Procedure "$1,425.20 " "$3,257.60 " "$1,425.20 " "$3,257.60 " GFT SFT TIS 2X1CM NEOX CORD 1K THK1MM 2SQ CM AMNIO MEMBR UMB NX-10-2010 SUPPLY/IMPLANTS "$2,254.00 " Outpatient "$1,127.00 " Not Applicable: Bundled with Procedure "$1,465.10 " "$1,577.80 " "$1,487.64 " Not Applicable: Bundled with Procedure $788.90 "$1,803.20 " $788.90 "$1,803.20 " GFT SFT TIS 2X2CM NEOX CORD 1K THK1MM 4SQ CM AMNIO MEMBR UMB NX-10-2020 SUPPLY/IMPLANTS "$3,885.00 " Outpatient "$1,942.50 " Not Applicable: Bundled with Procedure "$2,525.25 " "$2,719.50 " "$2,564.10 " Not Applicable: Bundled with Procedure "$1,359.75 " "$3,108.00 " "$1,359.75 " "$3,108.00 " GFT SFT TIS 4X3CM NEOX AMNIO MEMBR CRPRS THICKER DRBLE INCR NX-10-4030 SUPPLY/IMPLANTS "$7,302.00 " Outpatient "$3,651.00 " Not Applicable: Bundled with Procedure "$4,746.30 " "$5,111.40 " "$4,819.32 " Not Applicable: Bundled with Procedure "$2,555.70 " "$5,841.60 " "$2,555.70 " "$5,841.60 " GFT SFT TIS 6X3CM NEOX AMNIO MEMBR CRPRS THICKER DRBLE INCR NX-10-6030 SUPPLY/IMPLANTS "$9,746.00 " Outpatient "$4,873.00 " Not Applicable: Bundled with Procedure "$6,334.90 " "$6,822.20 " "$6,432.36 " Not Applicable: Bundled with Procedure "$3,411.10 " "$7,796.80 " "$3,411.10 " "$7,796.80 " GFT SFT TIS 8X3CM NEOX CRYOTEK 1MM THK 24SQ CM AMNIO MEMBR NX-10-8030 SUPPLY/IMPLANTS "$15,119.00 " Outpatient "$7,559.50 " Not Applicable: Bundled with Procedure "$9,827.35 " "$10,583.30 " "$9,978.54 " Not Applicable: Bundled with Procedure "$5,291.65 " "$12,095.20 " "$5,291.65 " "$12,095.20 " GFT SKN 8X4CM ALLOPATCH THK.4-.8MM ACLR DRML ALGRF WC0418 SUPPLY/IMPLANTS "$7,531.00 " Outpatient "$3,765.50 " Not Applicable: Bundled with Procedure "$4,895.15 " "$5,271.70 " "$4,970.46 " Not Applicable: Bundled with Procedure "$2,635.85 " "$6,024.80 " "$2,635.85 " "$6,024.80 " GFT SNTH TISS ULTHN 127X76X.85MM PE POR MDPR SHT SMTH TRNS 7214 SUPPLY/IMPLANTS "$6,046.00 " Outpatient "$3,023.00 " Not Applicable: Bundled with Procedure "$3,929.90 " "$4,232.20 " "$3,990.36 " Not Applicable: Bundled with Procedure "$2,116.10 " "$4,836.80 " "$2,116.10 " "$4,836.80 " GFT SNTH TISS ULTHN 50X38X.85MM PE POR MDPR SHT SMTH TRNS 7210 SUPPLY/IMPLANTS "$2,108.00 " Outpatient "$1,054.00 " Not Applicable: Bundled with Procedure "$1,370.20 " "$1,475.60 " "$1,391.28 " Not Applicable: Bundled with Procedure $737.80 "$1,686.40 " $737.80 "$1,686.40 " GFT SNTH TISS 50X38X1.5MM PE MDPR SHT POR CRNMXF STRL 6330 SUPPLY/IMPLANTS "$1,484.00 " Outpatient $742.00 Not Applicable: Bundled with Procedure $964.60 "$1,038.80 " $979.44 Not Applicable: Bundled with Procedure $519.40 "$1,187.20 " $519.40 "$1,187.20 " GFT SNTH TISS MICROTHIN 76X127MM PE MDPR SHT POR CRNFCL STRL 8662 SUPPLY/IMPLANTS "$2,887.00 " Outpatient "$1,443.50 " Not Applicable: Bundled with Procedure "$1,876.55 " "$2,020.90 " "$1,905.42 " Not Applicable: Bundled with Procedure "$1,010.45 " "$2,309.60 " "$1,010.45 " "$2,309.60 " GFT SNTH TISS CA PHOS CA SLF 4CC PRO-DNS INJ BCMPS RGNRT 87SR0404 SUPPLY/IMPLANTS "$9,542.00 " Outpatient "$4,771.00 " Not Applicable: Bundled with Procedure "$6,202.30 " "$6,679.40 " "$6,297.72 " Not Applicable: Bundled with Procedure "$3,339.70 " "$7,633.60 " "$3,339.70 " "$7,633.60 " GFT SNTH TISS ULTHN 76X50X.85MM PE POR MDPR SHT SMTH TRNS 7212 SUPPLY/IMPLANTS "$5,522.00 " Outpatient "$2,761.00 " Not Applicable: Bundled with Procedure "$3,589.30 " "$3,865.40 " "$3,644.52 " Not Applicable: Bundled with Procedure "$1,932.70 " "$4,417.60 " "$1,932.70 " "$4,417.60 " GFT SNTH TISS MDPR CSTM MDFC 54440510 SUPPLY/IMPLANTS "$74,973.00 " Outpatient "$37,486.50 " Not Applicable: Bundled with Procedure "$48,732.45 " "$52,481.10 " "$49,482.18 " Not Applicable: Bundled with Procedure "$26,240.55 " "$59,978.40 " "$26,240.55 " "$59,978.40 " GFT STNT 51MM 12MM AORFIX 90- D DIST XTD AAA SG-HDE-12-51-A13-20 SUPPLY/IMPLANTS "$9,783.00 " Outpatient "$4,891.50 " Not Applicable: Bundled with Procedure "$6,358.95 " "$6,848.10 " "$6,456.78 " Not Applicable: Bundled with Procedure "$3,424.05 " "$7,826.40 " "$3,424.05 " "$7,826.40 " GFT STNT 49MM 25MM 18FR ENDURANT II EVAS PLSTR NTNL AOR XTN ETCF2525C49E SUPPLY/IMPLANTS "$18,992.00 " Outpatient "$9,496.00 " Not Applicable: Bundled with Procedure "$12,344.80 " "$13,294.40 " "$12,534.72 " Not Applicable: Bundled with Procedure "$6,647.20 " "$15,193.60 " "$6,647.20 " "$15,193.60 " GFT STNT 140MM 18-14MM 14MM 11FR TRIVASCULAR OV PRM OV IX 13 TV-IL1418140-J SUPPLY/IMPLANTS "$23,213.00 " Outpatient "$11,606.50 " Not Applicable: Bundled with Procedure "$15,088.45 " "$16,249.10 " "$15,320.58 " Not Applicable: Bundled with Procedure "$8,124.55 " "$18,570.40 " "$8,124.55 " "$18,570.40 " GFT STNT 120MM 16-14MM 14MM 11FR TRIVASCULAR OV PRM OV IX 13 TV-IL1416120-J SUPPLY/IMPLANTS "$23,213.00 " Outpatient "$11,606.50 " Not Applicable: Bundled with Procedure "$15,088.45 " "$16,249.10 " "$15,320.58 " Not Applicable: Bundled with Procedure "$8,124.55 " "$18,570.40 " "$8,124.55 " "$18,570.40 " GFT STNT 60MM 9MM 9FR FLN + EVAS EPTFE C 2 LYR KINK RST INR FEM09060 SUPPLY/IMPLANTS "$14,619.00 " Outpatient "$7,309.50 " Not Applicable: Bundled with Procedure "$9,502.35 " "$10,233.30 " "$9,648.54 " Not Applicable: Bundled with Procedure "$5,116.65 " "$11,695.20 " "$5,116.65 " "$11,695.20 " GFT STNT VALIANT CAPTIVIA TPR THOR DLV SYS VAMF4642C150TU SUPPLY/IMPLANTS "$84,017.00 " Outpatient "$42,008.50 " Not Applicable: Bundled with Procedure "$54,611.05 " "$58,811.90 " "$55,451.22 " Not Applicable: Bundled with Procedure "$29,405.95 " "$67,213.60 " "$29,405.95 " "$67,213.60 " GRAFT TU STR 10MM 15CM HEMASHIELD 95110 SUPPLY/IMPLANTS "$2,309.00 " Outpatient "$1,154.50 " Not Applicable: Bundled with Procedure "$1,500.85 " "$1,616.30 " "$1,523.94 " Not Applicable: Bundled with Procedure $808.15 "$1,847.20 " $808.15 "$1,847.20 " GRAFT PROPATEN HT070050A SUPPLY/IMPLANTS "$13,339.00 " Outpatient "$6,669.50 " Not Applicable: Bundled with Procedure "$8,670.35 " "$9,337.30 " "$8,803.74 " Not Applicable: Bundled with Procedure "$4,668.65 " "$10,671.20 " "$4,668.65 " "$10,671.20 " GRAFT BONE BIOACTIVE 7.5G SGF-075 SUPPLY/IMPLANTS "$7,884.00 " Outpatient "$3,942.00 " Not Applicable: Bundled with Procedure "$5,124.60 " "$5,518.80 " "$5,203.44 " Not Applicable: Bundled with Procedure "$2,759.40 " "$6,307.20 " "$2,759.40 " "$6,307.20 " GRAFT SOFT TISSUE NEOX CORD 1K AMNIOTIC MEMBRANE UMBILICAL CORD THK1 MM 6 SQ CM L3 CM X W2 CM ALLOGR SUPPLY/IMPLANTS "$5,838.00 " Outpatient "$2,919.00 " Not Applicable: Bundled with Procedure "$3,794.70 " "$4,086.60 " "$3,853.08 " Not Applicable: Bundled with Procedure "$2,043.30 " "$4,670.40 " "$2,043.30 " "$4,670.40 " GRAFT SOFT TISSUE BIODFENCE G3 PLACENTAL MEMBRANE ALLOGRAFT MIS TUBE DF020206 SUPPLY/IMPLANTS "$10,144.00 " Outpatient "$5,072.00 " Not Applicable: Bundled with Procedure "$6,593.60 " "$7,100.80 " "$6,695.04 " Not Applicable: Bundled with Procedure "$3,550.40 " "$8,115.20 " "$3,550.40 " "$8,115.20 " GRAFT STENT ENDURANT IIS NITINOL PLATINUM POLYESTER 2 BRANCH L103 MM OD14-23 MM ODSEC18 FR INFRAREN SUPPLY/IMPLANTS "$25,212.00 " Outpatient "$12,606.00 " Not Applicable: Bundled with Procedure "$16,387.80 " "$17,648.40 " "$16,639.92 " Not Applicable: Bundled with Procedure "$8,824.20 " "$20,169.60 " "$8,824.20 " "$20,169.60 " GRAFT SOFT TISSUE BIODFENCE G3 PLACENTAL MEMBRANE ALLOGRAFT MIS TUBE DF-020206 SUPPLY/IMPLANTS "$13,119.00 " Outpatient "$6,559.50 " Not Applicable: Bundled with Procedure "$8,527.35 " "$9,183.30 " "$8,658.54 " Not Applicable: Bundled with Procedure "$4,591.65 " "$10,495.20 " "$4,591.65 " "$10,495.20 " GRAFT STENT VALIANT CAPTIVIA TAPER L150 MM OD34 MM ID30 MM E VAMF3430C150TU SUPPLY/IMPLANTS "$83,941.00 " Outpatient "$41,970.50 " Not Applicable: Bundled with Procedure "$54,561.65 " "$58,758.70 " "$55,401.06 " Not Applicable: Bundled with Procedure "$29,379.35 " "$67,152.80 " "$29,379.35 " "$67,152.80 " GRAFT ENDOVASCULAR GORE EXCLUDER 23MM X 4CM X 12MM RLT231216 SUPPLY/IMPLANTS "$49,998.00 " Outpatient "$24,999.00 " Not Applicable: Bundled with Procedure "$32,498.70 " "$34,998.60 " "$32,998.68 " Not Applicable: Bundled with Procedure "$17,499.30 " "$39,998.40 " "$17,499.30 " "$39,998.40 " GRAFT SOFT TISSUE AMNIOFILL 500 MG ALLOGRAFT AF-0500 SUPPLY/IMPLANTS "$5,613.00 " Outpatient "$2,806.50 " Not Applicable: Bundled with Procedure "$3,648.45 " "$3,929.10 " "$3,704.58 " Not Applicable: Bundled with Procedure "$1,964.55 " "$4,490.40 " "$1,964.55 " "$4,490.40 " GRAFT ENDOVASCULAR GORE EXCLUDER C3 NITINOL EPTFE L18 CM OD2 RLT281218 SUPPLY/IMPLANTS "$48,541.00 " Outpatient "$24,270.50 " Not Applicable: Bundled with Procedure "$31,551.65 " "$33,978.70 " "$32,037.06 " Not Applicable: Bundled with Procedure "$16,989.35 " "$38,832.80 " "$16,989.35 " "$38,832.80 " GRAFT ENDOVASCULAR GORE EXCLUDER C3 NITINOL EPTFE L18 CM OD2 RLT261418 SUPPLY/IMPLANTS "$50,124.00 " Outpatient "$25,062.00 " Not Applicable: Bundled with Procedure "$32,580.60 " "$35,086.80 " "$33,081.84 " Not Applicable: Bundled with Procedure "$17,543.40 " "$40,099.20 " "$17,543.40 " "$40,099.20 " GRAFT ENDOVASCULAR 32MM X150MM THORACIC STENT SYSTEM STERILE 28M332155322290U SUPPLY/IMPLANTS "$78,280.00 " Outpatient "$39,140.00 " Not Applicable: Bundled with Procedure "$50,882.00 " "$54,796.00 " "$51,664.80 " Not Applicable: Bundled with Procedure "$27,398.00 " "$62,624.00 " "$27,398.00 " "$62,624.00 " GRIP CBL 2MM DLMLS 2MM MED HIP TROCH VIT 6704-3-080 SUPPLY/IMPLANTS "$5,293.00 " Outpatient "$2,646.50 " Not Applicable: Bundled with Procedure "$3,440.45 " "$3,705.10 " "$3,493.38 " Not Applicable: Bundled with Procedure "$1,852.55 " "$4,234.40 " "$1,852.55 " "$4,234.40 " GUIDEWIRE ORTHOPEDIC T2 TITANIUM L800 MM OD3 MM SMOOTH TIP S 1806-0090S SUPPLY/IMPLANTS $789.00 Outpatient $394.50 Not Applicable: Bundled with Procedure $512.85 $552.30 $520.74 Not Applicable: Bundled with Procedure $276.15 $631.20 $276.15 $631.20 GW ESCP .025IN JGWR DRM TIP EGLD NTNL 450CM 5CM BIL KINK RST M00556561 SUPPLY/IMPLANTS $828.00 Outpatient $414.00 Not Applicable: Bundled with Procedure $538.20 $579.60 $546.48 Not Applicable: Bundled with Procedure $289.80 $662.40 $289.80 $662.40 GW ORTH 3.2MM 400MM THRD TIB NS 357.399 SUPPLY/IMPLANTS $670.00 Outpatient $335.00 Not Applicable: Bundled with Procedure $435.50 $469.00 $442.20 Not Applicable: Bundled with Procedure $234.50 $536.00 $234.50 $536.00 GW VASC 180CM .035IN CRDS STORQ ANG SLX SS PTFE 10CM STRBL 503456J SUPPLY/IMPLANTS "$1,599.00 " Outpatient $799.50 Not Applicable: Bundled with Procedure "$1,039.35 " "$1,119.30 " "$1,055.34 " Not Applicable: Bundled with Procedure $559.65 "$1,279.20 " $559.65 "$1,279.20 " HEAD BP 47MM 28MM UHR UNV HIP COCR UHMWPE UH1-47-28 SUPPLY/IMPLANTS "$4,037.00 " Outpatient "$2,018.50 " Not Applicable: Bundled with Procedure "$2,624.05 " "$2,825.90 " "$2,664.42 " Not Applicable: Bundled with Procedure "$1,412.95 " "$3,229.60 " "$1,412.95 " "$3,229.60 " HEAD BP 46MM 28MM UHR UNV HIP COCR UHMWPE UH1-46-28 SUPPLY/IMPLANTS "$4,037.00 " Outpatient "$2,018.50 " Not Applicable: Bundled with Procedure "$2,624.05 " "$2,825.90 " "$2,664.42 " Not Applicable: Bundled with Procedure "$1,412.95 " "$3,229.60 " "$1,412.95 " "$3,229.60 " HEAD BP 45MM 28MM UHR UNV HIP COCR UHMWPE UH1-45-28 SUPPLY/IMPLANTS "$4,037.00 " Outpatient "$2,018.50 " Not Applicable: Bundled with Procedure "$2,624.05 " "$2,825.90 " "$2,664.42 " Not Applicable: Bundled with Procedure "$1,412.95 " "$3,229.60 " "$1,412.95 " "$3,229.60 " HEAD BP 56MM 28MM UHR UNV HIP COCR UHMWPE UH1-56-28 SUPPLY/IMPLANTS "$4,037.00 " Outpatient "$2,018.50 " Not Applicable: Bundled with Procedure "$2,624.05 " "$2,825.90 " "$2,664.42 " Not Applicable: Bundled with Procedure "$1,412.95 " "$3,229.60 " "$1,412.95 " "$3,229.60 " HERNIA MESH T510 SUPPLY/IMPLANTS "$1,227.00 " Outpatient $613.50 Not Applicable: Bundled with Procedure $797.55 $858.90 $809.82 Not Applicable: Bundled with Procedure $429.45 $981.60 $429.45 $981.60 HINGE EXTERNAL FIXATION HALF 4933-0-801 SUPPLY/IMPLANTS $682.00 Outpatient $341.00 Not Applicable: Bundled with Procedure $443.30 $477.40 $450.12 Not Applicable: Bundled with Procedure $238.70 $545.60 $238.70 $545.60 IMPL BROW FX PLLC ACD PLGLY DRLBT INS TL UNDERNEATH SCR ETN CFD-080-0177 SUPPLY/IMPLANTS "$1,498.00 " Outpatient $749.00 Not Applicable: Bundled with Procedure $973.70 "$1,048.60 " $988.68 Not Applicable: Bundled with Procedure $524.30 "$1,198.40 " $524.30 "$1,198.40 " IMPL BRST 750CC X FULL PRFL SMTH SHL CHSV GEL 1 LUM PTCH SRX-750 SUPPLY/IMPLANTS "$3,881.00 " Outpatient "$1,940.50 " Not Applicable: Bundled with Procedure "$2,522.65 " "$2,716.70 " "$2,561.46 " Not Applicable: Bundled with Procedure "$1,358.35 " "$3,104.80 " "$1,358.35 " "$3,104.80 " IMPL CRNL LG CSTM 54440300 SUPPLY/IMPLANTS "$76,606.00 " Outpatient "$38,303.00 " Not Applicable: Bundled with Procedure "$49,793.90 " "$53,624.20 " "$50,559.96 " Not Applicable: Bundled with Procedure "$26,812.10 " "$61,284.80 " "$26,812.10 " "$61,284.80 " IMPL EYLD THK.6MM STD RND SPHR TPR PLTN 1MM HL SLEEK SMTH LL 6014 SUPPLY/IMPLANTS "$2,650.00 " Outpatient "$1,325.00 " Not Applicable: Bundled with Procedure "$1,722.50 " "$1,855.00 " "$1,749.00 " Not Applicable: Bundled with Procedure $927.50 "$2,120.00 " $927.50 "$2,120.00 " IMPL FX 1 XPN AMRPH BABSR PUL OUT STRTH STRNG BTRNSF 50MM 5 AR-1351LB SUPPLY/IMPLANTS "$2,355.00 " Outpatient "$1,177.50 " Not Applicable: Bundled with Procedure "$1,530.75 " "$1,648.50 " "$1,554.30 " Not Applicable: Bundled with Procedure $824.25 "$1,884.00 " $824.25 "$1,884.00 " IMPL FX RECON SCR GRAFTBOLT 10MM TIB STRL AR-5100-10 SUPPLY/IMPLANTS "$2,764.00 " Outpatient "$1,382.00 " Not Applicable: Bundled with Procedure "$1,796.60 " "$1,934.80 " "$1,824.24 " Not Applicable: Bundled with Procedure $967.40 "$2,211.20 " $967.40 "$2,211.20 " IMPL OPTH 250SQ MM SIL 1 QDRNT INS FX SUT HL RCS KNT CPB BG103-250 SUPPLY/IMPLANTS "$3,772.00 " Outpatient "$1,886.00 " Not Applicable: Bundled with Procedure "$2,451.80 " "$2,640.40 " "$2,489.52 " Not Applicable: Bundled with Procedure "$1,320.20 " "$3,017.60 " "$1,320.20 " "$3,017.60 " IMPL VOCAL CORD CA HAP WATERBASED INJ SYR THNWL NDL PROLARYN 8044M0K5 SUPPLY/IMPLANTS "$2,531.00 " Outpatient "$1,265.50 " Not Applicable: Bundled with Procedure "$1,645.15 " "$1,771.70 " "$1,670.46 " Not Applicable: Bundled with Procedure $885.85 "$2,024.80 " $885.85 "$2,024.80 " IMPL VOCAL CORD WATERBASED INJ TEMP PROLARYN GEL 1ML STRL LF 8602M0K5 SUPPLY/IMPLANTS "$2,531.00 " Outpatient "$1,265.50 " Not Applicable: Bundled with Procedure "$1,645.15 " "$1,771.70 " "$1,670.46 " Not Applicable: Bundled with Procedure $885.85 "$2,024.80 " $885.85 "$2,024.80 " IMPLANT CHIN CSC-LGE CSC-LGE SUPPLY/IMPLANTS "$1,282.00 " Outpatient $641.00 Not Applicable: Bundled with Procedure $833.30 $897.40 $846.12 Not Applicable: Bundled with Procedure $448.70 "$1,025.60 " $448.70 "$1,025.60 " IMPLANT CHIN CSC-M CSC-M SUPPLY/IMPLANTS "$1,226.00 " Outpatient $613.00 Not Applicable: Bundled with Procedure $796.90 $858.20 $809.16 Not Applicable: Bundled with Procedure $429.10 $980.80 $429.10 $980.80 IMPLANT CHIN CSC-XLGE CSC-XLGE SUPPLY/IMPLANTS $997.00 Outpatient $498.50 Not Applicable: Bundled with Procedure $648.05 $697.90 $658.02 Not Applicable: Bundled with Procedure $348.95 $797.60 $348.95 $797.60 IMPLANT CHIN ANATOMICAL CONFORM EXTENDED SMALL CEAC-S SUPPLY/IMPLANTS "$1,796.00 " Outpatient $898.00 Not Applicable: Bundled with Procedure "$1,167.40 " "$1,257.20 " "$1,185.36 " Not Applicable: Bundled with Procedure $628.60 "$1,436.80 " $628.60 "$1,436.80 " IMPLANT CHIN ANATOMICAL CONFORM EXTENDED MEDIUM CEAC-M SUPPLY/IMPLANTS "$1,796.00 " Outpatient $898.00 Not Applicable: Bundled with Procedure "$1,167.40 " "$1,257.20 " "$1,185.36 " Not Applicable: Bundled with Procedure $628.60 "$1,436.80 " $628.60 "$1,436.80 " IMPLANT CHIN ANATOMICAL CONFORM EXTENDED XL CEAC-XL SUPPLY/IMPLANTS "$1,796.00 " Outpatient $898.00 Not Applicable: Bundled with Procedure "$1,167.40 " "$1,257.20 " "$1,185.36 " Not Applicable: Bundled with Procedure $628.60 "$1,436.80 " $628.60 "$1,436.80 " IMPLANT CUSTOM MALAR JANITA 16-0269 4353 SUPPLY/IMPLANTS "$18,329.00 " Outpatient "$9,164.50 " Not Applicable: Bundled with Procedure "$11,913.85 " "$12,830.30 " "$12,097.14 " Not Applicable: Bundled with Procedure "$6,415.15 " "$14,663.20 " "$6,415.15 " "$14,663.20 " IMPLANT NASAL LATERA ABSORBABLE LATSYS01 SUPPLY/IMPLANTS "$6,467.00 " Outpatient "$3,233.50 " Not Applicable: Bundled with Procedure "$4,203.55 " "$4,526.90 " "$4,268.22 " Not Applicable: Bundled with Procedure "$2,263.45 " "$5,173.60 " "$2,263.45 " "$5,173.60 " IMPLANT SYSTEM FIBULOCK STERILE AR-8973DS SUPPLY/IMPLANTS "$3,417.00 " Outpatient "$1,708.50 " Not Applicable: Bundled with Procedure "$2,221.05 " "$2,391.90 " "$2,255.22 " Not Applicable: Bundled with Procedure "$1,195.95 " "$2,733.60 " "$1,195.95 " "$2,733.60 " IMPLANT PARIETAL TEMPORAL COLOMB RT PK621642 SUPPLY/IMPLANTS "$53,682.00 " Outpatient "$26,841.00 " Not Applicable: Bundled with Procedure "$34,893.30 " "$37,577.40 " "$35,430.12 " Not Applicable: Bundled with Procedure "$18,788.70 " "$42,945.60 " "$18,788.70 " "$42,945.60 " IMPLANT SYSTEM STERNALOCK 360 SYSTEM MLTI 74-0004 SUPPLY/IMPLANTS "$17,608.00 " Outpatient "$8,804.00 " Not Applicable: Bundled with Procedure "$11,445.20 " "$12,325.60 " "$11,621.28 " Not Applicable: Bundled with Procedure "$6,162.80 " "$14,086.40 " "$6,162.80 " "$14,086.40 " IMPLANT BREAST NATRELLE INSPIRA SILICONE FULL PROFILE ROUND SRF-605 SUPPLY/IMPLANTS "$5,012.00 " Outpatient "$2,506.00 " Not Applicable: Bundled with Procedure "$3,257.80 " "$3,508.40 " "$3,307.92 " Not Applicable: Bundled with Procedure "$1,754.20 " "$4,009.60 " "$1,754.20 " "$4,009.60 " INS ACTB HIP ANTM DL MBL MDLR X3 MBL BR HIP 22.2 MM FEM HD 1236-2-242 SUPPLY/IMPLANTS "$7,803.00 " Outpatient "$3,901.50 " Not Applicable: Bundled with Procedure "$5,071.95 " "$5,462.10 " "$5,149.98 " Not Applicable: Bundled with Procedure "$2,731.05 " "$6,242.40 " "$2,731.05 " "$6,242.40 " INS TIB 3 19MM KN X3 TL STAB + TRTHLN 5537-G-319 SUPPLY/IMPLANTS "$8,579.00 " Outpatient "$4,289.50 " Not Applicable: Bundled with Procedure "$5,576.35 " "$6,005.30 " "$5,662.14 " Not Applicable: Bundled with Procedure "$3,002.65 " "$6,863.20 " "$3,002.65 " "$6,863.20 " INS TIB 6 11MM KN X3 CRCTE SUB TRTHLN 5531-G-611 SUPPLY/IMPLANTS "$6,726.00 " Outpatient "$3,363.00 " Not Applicable: Bundled with Procedure "$4,371.90 " "$4,708.20 " "$4,439.16 " Not Applicable: Bundled with Procedure "$2,354.10 " "$5,380.80 " "$2,354.10 " "$5,380.80 " INS TIB 3 11MM KN X3 CR TRTHLN 5530-G-311 SUPPLY/IMPLANTS "$7,541.00 " Outpatient "$3,770.50 " Not Applicable: Bundled with Procedure "$4,901.65 " "$5,278.70 " "$4,977.06 " Not Applicable: Bundled with Procedure "$2,639.35 " "$6,032.80 " "$2,639.35 " "$6,032.80 " INS TIB 7 9MM KN X3 POST STAB BRNG TRTHLN 5532G709 SUPPLY/IMPLANTS "$7,541.00 " Outpatient "$3,770.50 " Not Applicable: Bundled with Procedure "$4,901.65 " "$5,278.70 " "$4,977.06 " Not Applicable: Bundled with Procedure "$2,639.35 " "$6,032.80 " "$2,639.35 " "$6,032.80 " INS TIB 6 11MM KN X3 POST STAB BRNG TRTHLN 5532-G-611 SUPPLY/IMPLANTS "$6,726.00 " Outpatient "$3,363.00 " Not Applicable: Bundled with Procedure "$4,371.90 " "$4,708.20 " "$4,439.16 " Not Applicable: Bundled with Procedure "$2,354.10 " "$5,380.80 " "$2,354.10 " "$5,380.80 " INS TIB 4 9MM KN X3 CRCTE SUB TRTHLN 5531G409 SUPPLY/IMPLANTS "$6,726.00 " Outpatient "$3,363.00 " Not Applicable: Bundled with Procedure "$4,371.90 " "$4,708.20 " "$4,439.16 " Not Applicable: Bundled with Procedure "$2,354.10 " "$5,380.80 " "$2,354.10 " "$5,380.80 " INS TIB 6 9MM KN X3 CRCTE SUB TRTHLN 5531G609 SUPPLY/IMPLANTS "$6,726.00 " Outpatient "$3,363.00 " Not Applicable: Bundled with Procedure "$4,371.90 " "$4,708.20 " "$4,439.16 " Not Applicable: Bundled with Procedure "$2,354.10 " "$5,380.80 " "$2,354.10 " "$5,380.80 " INTRO ORTH XPR KYPHON OSTEO INTRO STY TROC HNDL CNN DISP WHT T34B SUPPLY/IMPLANTS "$2,109.00 " Outpatient "$1,054.50 " Not Applicable: Bundled with Procedure "$1,370.85 " "$1,476.30 " "$1,391.94 " Not Applicable: Bundled with Procedure $738.15 "$1,687.20 " $738.15 "$1,687.20 " INTRO ORTH KPHX XPR OSTEO INTRO 33MM INTGR T24A SUPPLY/IMPLANTS "$5,307.00 " Outpatient "$2,653.50 " Not Applicable: Bundled with Procedure "$3,449.55 " "$3,714.90 " "$3,502.62 " Not Applicable: Bundled with Procedure "$1,857.45 " "$4,245.60 " "$1,857.45 " "$4,245.60 " INTRO SHTH CPS DRCT 10.06FR RT CRV STRL LF DISP DS2C023 SUPPLY/IMPLANTS "$3,738.00 " Outpatient "$1,869.00 " Not Applicable: Bundled with Procedure "$2,429.70 " "$2,616.60 " "$2,467.08 " Not Applicable: Bundled with Procedure "$1,308.30 " "$2,990.40 " "$1,308.30 " "$2,990.40 " JIG PSTN 130D JMB 903002092 SUPPLY/IMPLANTS "$29,005.00 " Outpatient "$14,502.50 " Not Applicable: Bundled with Procedure "$18,853.25 " "$20,303.50 " "$19,143.30 " Not Applicable: Bundled with Procedure "$10,151.75 " "$23,204.00 " "$10,151.75 " "$23,204.00 " JONES TUBE 4.0 X 22 4022 SUPPLY/IMPLANTS "$1,257.00 " Outpatient $628.50 Not Applicable: Bundled with Procedure $817.05 $879.90 $829.62 Not Applicable: Bundled with Procedure $439.95 "$1,005.60 " $439.95 "$1,005.60 " KIT AOR VLV 18FR CERTITUDE SAPIEN 3 ATRION ASCENDRA 23MM 9600CT23A SUPPLY/IMPLANTS "$158,853.00 " Outpatient "$79,426.50 " Not Applicable: Bundled with Procedure "$103,254.45 " "$111,197.10 " "$104,842.98 " Not Applicable: Bundled with Procedure "$55,598.55 " "$127,082.40 " "$55,598.55 " "$127,082.40 " KIT AOR VLV 21FR CERTITUDE SAPIEN 3 ATRION ASCENDRA 29MM 9600CT29A SUPPLY/IMPLANTS "$158,853.00 " Outpatient "$79,426.50 " Not Applicable: Bundled with Procedure "$103,254.45 " "$111,197.10 " "$104,842.98 " Not Applicable: Bundled with Procedure "$55,598.55 " "$127,082.40 " "$55,598.55 " "$127,082.40 " KIT ARTHROSCOPIC FIXATION TIGERTAPE SUTURELASSO 2 MM OD3 MM AR-2271 SUPPLY/IMPLANTS "$5,505.00 " Outpatient "$2,752.50 " Not Applicable: Bundled with Procedure "$3,578.25 " "$3,853.50 " "$3,633.30 " Not Applicable: Bundled with Procedure "$1,926.75 " "$4,404.00 " "$1,926.75 " "$4,404.00 " KIT BLOOD PUMP PROTEKDUO TANDEMHEART OD29 FR VENO VENOUS CAN 5720-2916 SUPPLY/IMPLANTS "$95,404.00 " Outpatient "$47,702.00 " Not Applicable: Bundled with Procedure "$62,012.60 " "$66,782.80 " "$62,966.64 " Not Applicable: Bundled with Procedure "$33,391.40 " "$76,323.20 " "$33,391.40 " "$76,323.20 " KIT BLOOD PUMP PROTEKDUO TANDEMHEART OD31 FR VENO VENOUS CAN 5720-3118 SUPPLY/IMPLANTS "$95,404.00 " Outpatient "$47,702.00 " Not Applicable: Bundled with Procedure "$62,012.60 " "$66,782.80 " "$62,966.64 " Not Applicable: Bundled with Procedure "$33,391.40 " "$76,323.20 " "$33,391.40 " "$76,323.20 " KIT BLOOD PUMP PROTEKDUO TANDEMHEART MINI OD31 FR VENO VENOU 5720-3631 SUPPLY/IMPLANTS "$85,619.00 " Outpatient "$42,809.50 " Not Applicable: Bundled with Procedure "$55,652.35 " "$59,933.30 " "$56,508.54 " Not Applicable: Bundled with Procedure "$29,966.65 " "$68,495.20 " "$29,966.65 " "$68,495.20 " KIT CATH 19CM 10FR 19A/22V CM TNDM-CATH STRL 2 LUM 6 SH KT BFS-6 SUPPLY/IMPLANTS "$1,345.00 " Outpatient $672.50 Not Applicable: Bundled with Procedure $874.25 $941.50 $887.70 Not Applicable: Bundled with Procedure $470.75 "$1,076.00 " $470.75 "$1,076.00 " KIT CRNTMY SEPS SLIDOCAINE EPI STRL DISP 11-0401-CAL SUPPLY/IMPLANTS "$8,446.00 " Outpatient "$4,223.00 " Not Applicable: Bundled with Procedure "$5,489.90 " "$5,912.20 " "$5,574.36 " Not Applicable: Bundled with Procedure "$2,956.10 " "$6,756.80 " "$2,956.10 " "$6,756.80 " KIT DIL GW INS NDL SCPL PCTV SHTH FLSH PORT .035IN 180CM 18 200-120 SUPPLY/IMPLANTS $770.00 Outpatient $385.00 Not Applicable: Bundled with Procedure $500.50 $539.00 $508.20 Not Applicable: Bundled with Procedure $269.50 $616.00 $269.50 $616.00 KIT ESCP INST TGHTRP KNTLS STRL DESMOSIS REPR ASCP TI AR-8926T SUPPLY/IMPLANTS "$6,153.00 " Outpatient "$3,076.50 " Not Applicable: Bundled with Procedure "$3,999.45 " "$4,307.10 " "$4,060.98 " Not Applicable: Bundled with Procedure "$2,153.55 " "$4,922.40 " "$2,153.55 " "$4,922.40 " KIT IMPL 10X9MM SPD 1.5X1.5MM SE-0910 SUPPLY/IMPLANTS "$4,767.00 " Outpatient "$2,383.50 " Not Applicable: Bundled with Procedure "$3,098.55 " "$3,336.90 " "$3,146.22 " Not Applicable: Bundled with Procedure "$1,668.45 " "$3,813.60 " "$1,668.45 " "$3,813.60 " KIT INST STRG SPR DISP AR-3600D SUPPLY/IMPLANTS "$1,426.00 " Outpatient $713.00 Not Applicable: Bundled with Procedure $926.90 $998.20 $941.16 Not Applicable: Bundled with Procedure $499.10 "$1,140.80 " $499.10 "$1,140.80 " KIT NRSTM 40CM STIMLOC .5MM SPC LD 3389S-40 SUPPLY/IMPLANTS "$15,407.00 " Outpatient "$7,703.50 " Not Applicable: Bundled with Procedure "$10,014.55 " "$10,784.90 " "$10,168.62 " Not Applicable: Bundled with Procedure "$5,392.45 " "$12,325.60 " "$5,392.45 " "$12,325.60 " KIT NRSTM SENZA CHRGR NS LF REUSE CHGR1000 SUPPLY/IMPLANTS "$4,881.00 " Outpatient "$2,440.50 " Not Applicable: Bundled with Procedure "$3,172.65 " "$3,416.70 " "$3,221.46 " Not Applicable: Bundled with Procedure "$1,708.35 " "$3,904.80 " "$1,708.35 " "$3,904.80 " KIT PG 14FR SIL PUSH RADOPQ MC SLK STRL LF DISP 7150-14 SUPPLY/IMPLANTS $455.00 Outpatient $227.50 Not Applicable: Bundled with Procedure $295.75 $318.50 $300.30 Not Applicable: Bundled with Procedure $159.25 $364.00 $159.25 $364.00 KIT PRC 2 TRTHLN CR DISP TIB 5555-2322 SUPPLY/IMPLANTS $514.00 Outpatient $257.00 Not Applicable: Bundled with Procedure $334.10 $359.80 $339.24 Not Applicable: Bundled with Procedure $179.90 $411.20 $179.90 $411.20 KIT RSN REPR CRNL REPR TY 2 PWDR LQ CMPLT SET CRNPLST 75 PPM 431280 SUPPLY/IMPLANTS "$5,925.00 " Outpatient "$2,962.50 " Not Applicable: Bundled with Procedure "$3,851.25 " "$4,147.50 " "$3,910.50 " Not Applicable: Bundled with Procedure "$2,073.75 " "$4,740.00 " "$2,073.75 " "$4,740.00 " KIT SCR 20MM 3MM MOTOBAND CP LCK STRL 1500-3020 SUPPLY/IMPLANTS "$1,416.00 " Outpatient $708.00 Not Applicable: Bundled with Procedure $920.40 $991.20 $934.56 Not Applicable: Bundled with Procedure $495.60 "$1,132.80 " $495.60 "$1,132.80 " KIT STNT 22CM 8FR .038IN PGTL CRV TPR URETER GLDX PRCFLX DRN M001245630 SUPPLY/IMPLANTS "$1,138.00 " Outpatient $569.00 Not Applicable: Bundled with Procedure $739.70 $796.60 $751.08 Not Applicable: Bundled with Procedure $398.30 $910.40 $398.30 $910.40 KIT STNT 26CM 8FR .038IN LG REG PGTL CRV URET PRCFLX GLDX M001245650 SUPPLY/IMPLANTS "$1,138.00 " Outpatient $569.00 Not Applicable: Bundled with Procedure $739.70 $796.60 $751.08 Not Applicable: Bundled with Procedure $398.30 $910.40 $398.30 $910.40 KIT TISS CLSR COSL SLNT 4ML STRL LF DISP 934071 SUPPLY/IMPLANTS "$2,769.00 " Outpatient "$1,384.50 " Not Applicable: Bundled with Procedure "$1,799.85 " "$1,938.30 " "$1,827.54 " Not Applicable: Bundled with Procedure $969.15 "$2,215.20 " $969.15 "$2,215.20 " KIT TISS CLSR EVICEL FBRN SLNT 1ML 3901 SUPPLY/IMPLANTS $692.00 Outpatient $346.00 Not Applicable: Bundled with Procedure $449.80 $484.40 $456.72 Not Applicable: Bundled with Procedure $242.20 $553.60 $242.20 $553.60 KIT TISS CLSR EVICEL FBRN SLNT 2ML 3902 SUPPLY/IMPLANTS "$1,279.00 " Outpatient $639.50 Not Applicable: Bundled with Procedure $831.35 $895.30 $844.14 Not Applicable: Bundled with Procedure $447.65 "$1,023.20 " $447.65 "$1,023.20 " KIT TISS CLSR EVICEL FBRN SLNT 5ML 3905 SUPPLY/IMPLANTS "$2,801.00 " Outpatient "$1,400.50 " Not Applicable: Bundled with Procedure "$1,820.65 " "$1,960.70 " "$1,848.66 " Not Applicable: Bundled with Procedure $980.35 "$2,240.80 " $980.35 "$2,240.80 " LDS INST PDW 092001 92001 SUPPLY/IMPLANTS "$1,913.00 " Outpatient $956.50 Not Applicable: Bundled with Procedure "$1,243.45 " "$1,339.10 " "$1,262.58 " Not Applicable: Bundled with Procedure $669.55 "$1,530.40 " $669.55 "$1,530.40 " LEAD PCNG 86CM 4.3FR LV QUICKFLEX BP STRBL TIP OPTIM INSL 1258T/86 SUPPLY/IMPLANTS "$8,315.00 " Outpatient "$4,157.50 " Not Applicable: Bundled with Procedure "$5,404.75 " "$5,820.50 " "$5,487.90 " Not Applicable: Bundled with Procedure "$2,910.25 " "$6,652.00 " "$2,910.25 " "$6,652.00 " LEAD PCNG 45CM 9FR Q-TRK TRPLR ELTRD PU 3400 SUPPLY/IMPLANTS "$24,457.00 " Outpatient "$12,228.50 " Not Applicable: Bundled with Procedure "$15,897.05 " "$17,119.90 " "$16,141.62 " Not Applicable: Bundled with Procedure "$8,559.95 " "$19,565.60 " "$8,559.95 " "$19,565.60 " LEAD PCNG 86CM 3.9-5.2FR 2.6FR LT VNTRC ACTY X4 OTW QDPL LNG 4677 SUPPLY/IMPLANTS "$11,739.00 " Outpatient "$5,869.50 " Not Applicable: Bundled with Procedure "$7,630.35 " "$8,217.30 " "$7,747.74 " Not Applicable: Bundled with Procedure "$4,108.65 " "$9,391.20 " "$4,108.65 " "$9,391.20 " LEAD WIRE MULTI-STAGE 302775-2001 SUPPLY/IMPLANTS "$2,565.00 " Outpatient "$1,282.50 " Not Applicable: Bundled with Procedure "$1,667.25 " "$1,795.50 " "$1,692.90 " Not Applicable: Bundled with Procedure $897.75 "$2,052.00 " $897.75 "$2,052.00 " LENS SINGLE MIRROR K30-1015 SUPPLY/IMPLANTS $649.00 Outpatient $324.50 Not Applicable: Bundled with Procedure $421.85 $454.30 $428.34 Not Applicable: Bundled with Procedure $227.15 $519.20 $227.15 $519.20 LENS THINPROFILE PLATINUM 1.0GM LL6010 SUPPLY/IMPLANTS "$2,398.00 " Outpatient "$1,199.00 " Not Applicable: Bundled with Procedure "$1,558.70 " "$1,678.60 " "$1,582.68 " Not Applicable: Bundled with Procedure $839.30 "$1,918.40 " $839.30 "$1,918.40 " LINER BIPOLAR TANDEM COCR UHMWPE OD50 MM ID28 MM ACETABULAR 71322050 SUPPLY/IMPLANTS "$4,392.00 " Outpatient "$2,196.00 " Not Applicable: Bundled with Procedure "$2,854.80 " "$3,074.40 " "$2,898.72 " Not Applicable: Bundled with Procedure "$1,537.20 " "$3,513.60 " "$1,537.20 " "$3,513.60 " LINR ACTB 36MM C COCR 2 MBL MDLR MDM HIP 626-00-36C SUPPLY/IMPLANTS "$7,803.00 " Outpatient "$3,901.50 " Not Applicable: Bundled with Procedure "$5,071.95 " "$5,462.10 " "$5,149.98 " Not Applicable: Bundled with Procedure "$2,731.05 " "$6,242.40 " "$2,731.05 " "$6,242.40 " LINR ACTB 60MM 36MM MM NTRL VIVACIT-E HIP CONTIN 885101436 SUPPLY/IMPLANTS "$8,946.00 " Outpatient "$4,473.00 " Not Applicable: Bundled with Procedure "$5,814.90 " "$6,262.20 " "$5,904.36 " Not Applicable: Bundled with Procedure "$3,131.10 " "$7,156.80 " "$3,131.10 " "$7,156.80 " LINR ACTB 60MM 36MM MM ELEV LNGVT HIP CONTIN 875201436 SUPPLY/IMPLANTS "$4,400.00 " Outpatient "$2,200.00 " Not Applicable: Bundled with Procedure "$2,860.00 " "$3,080.00 " "$2,904.00 " Not Applicable: Bundled with Procedure "$1,540.00 " "$3,520.00 " "$1,540.00 " "$3,520.00 " LINR ACTB 56MM 36MM KK ELEV LNGVT HIP CONTIN 875201236 SUPPLY/IMPLANTS "$4,400.00 " Outpatient "$2,200.00 " Not Applicable: Bundled with Procedure "$2,860.00 " "$3,080.00 " "$2,904.00 " Not Applicable: Bundled with Procedure "$1,540.00 " "$3,520.00 " "$1,540.00 " "$3,520.00 " LOCKDOWN AC DEVICE 11CM LD110 SUPPLY/IMPLANTS "$13,299.00 " Outpatient "$6,649.50 " Not Applicable: Bundled with Procedure "$8,644.35 " "$9,309.30 " "$8,777.34 " Not Applicable: Bundled with Procedure "$4,654.65 " "$10,639.20 " "$4,654.65 " "$10,639.20 " MAGSEED -18G 12CM SM18112001 SUPPLY/IMPLANTS "$2,540.00 " Outpatient "$1,270.00 " Not Applicable: Bundled with Procedure "$1,651.00 " "$1,778.00 " "$1,676.40 " Not Applicable: Bundled with Procedure $889.00 "$2,032.00 " $889.00 "$2,032.00 " MAGSEED -18G 20CM SM18120001 SUPPLY/IMPLANTS "$2,540.00 " Outpatient "$1,270.00 " Not Applicable: Bundled with Procedure "$1,651.00 " "$1,778.00 " "$1,676.40 " Not Applicable: Bundled with Procedure $889.00 "$2,032.00 " $889.00 "$2,032.00 " MAJOR JOINT REPLACEMENT OR REATTACHMENT WITHOUT MCC HIP DRG DRG 470DS SUPPLY/IMPLANTS "$21,981.00 " Outpatient "$10,990.50 " Not Applicable: Bundled with Procedure "$14,287.65 " "$15,386.70 " "$14,507.46 " Not Applicable: Bundled with Procedure "$7,693.35 " "$17,584.80 " "$7,693.35 " "$17,584.80 " MARKER- SUTURE TYPE 2.0MM MTNW88786A SUPPLY/IMPLANTS "$1,050.00 " Outpatient $525.00 Not Applicable: Bundled with Procedure $682.50 $735.00 $693.00 Not Applicable: Bundled with Procedure $367.50 $840.00 $367.50 $840.00 MATRIX BONUS CC 48-1802 SUPPLY/IMPLANTS "$4,697.00 " Outpatient "$2,348.50 " Not Applicable: Bundled with Procedure "$3,053.05 " "$3,287.90 " "$3,100.02 " Not Applicable: Bundled with Procedure "$1,643.95 " "$3,757.60 " "$1,643.95 " "$3,757.60 " MATRIX COLLAGEN BIOACTIVE 20CC MCCBA2012 SUPPLY/IMPLANTS "$15,580.00 " Outpatient "$7,790.00 " Not Applicable: Bundled with Procedure "$10,127.00 " "$10,906.00 " "$10,282.80 " Not Applicable: Bundled with Procedure "$5,453.00 " "$12,464.00 " "$5,453.00 " "$12,464.00 " MCTH 135CM 30CM 2.8-2.5FR .021IN CRBRVASC TRNST NYL PTFE 600330 SUPPLY/IMPLANTS "$2,273.00 " Outpatient "$1,136.50 " Not Applicable: Bundled with Procedure "$1,477.45 " "$1,591.10 " "$1,500.18 " Not Applicable: Bundled with Procedure $795.55 "$1,818.40 " $795.55 "$1,818.40 " MCTH STRG 150CM 6CM CRBRVASC EXCLS XT-27 1 MRKR FLXB PSHP M003XT2750810 SUPPLY/IMPLANTS "$5,088.00 " Outpatient "$2,544.00 " Not Applicable: Bundled with Procedure "$3,307.20 " "$3,561.60 " "$3,358.08 " Not Applicable: Bundled with Procedure "$1,780.80 " "$4,070.40 " "$1,780.80 " "$4,070.40 " MESH 14X10IN RECT PP BARD MRLX MFL AU STD FLT SHT SRG STRL 112660 SUPPLY/IMPLANTS "$1,254.00 " Outpatient $627.00 Not Applicable: Bundled with Procedure $815.10 $877.80 $827.64 Not Applicable: Bundled with Procedure $438.90 "$1,003.20 " $438.90 "$1,003.20 " MESH 15CMX10CMX1MM OVL CHG DIACETATE SLVR CARB DLMSH + HL 1DLMCP03 SUPPLY/IMPLANTS "$2,748.00 " Outpatient "$1,374.00 " Not Applicable: Bundled with Procedure "$1,786.20 " "$1,923.60 " "$1,813.68 " Not Applicable: Bundled with Procedure $961.80 "$2,198.40 " $961.80 "$2,198.40 " MESH 10X8IN ELLIPSE VENTRALIGHT ST ECHO PSSPRFLM PP DDRGL 5955810 SUPPLY/IMPLANTS "$8,681.00 " Outpatient "$4,340.50 " Not Applicable: Bundled with Procedure "$5,642.65 " "$6,076.70 " "$5,729.46 " Not Applicable: Bundled with Procedure "$3,038.35 " "$6,944.80 " "$3,038.35 " "$6,944.80 " MESH 12X12IN FLT ULTRAPRO PRT ABS LTWT SRG STRL HRN REPR UML1 SUPPLY/IMPLANTS "$2,964.00 " Outpatient "$1,482.00 " Not Applicable: Bundled with Procedure "$1,926.60 " "$2,074.80 " "$1,956.24 " Not Applicable: Bundled with Procedure "$1,037.40 " "$2,371.20 " "$1,037.40 " "$2,371.20 " MESH 15X10CM OVL SYNECOR GORE KNIT FLM SRG GKFV1015 SUPPLY/IMPLANTS "$3,617.00 " Outpatient "$1,808.50 " Not Applicable: Bundled with Procedure "$2,351.05 " "$2,531.90 " "$2,387.22 " Not Applicable: Bundled with Procedure "$1,265.95 " "$2,893.60 " "$1,265.95 " "$2,893.60 " MESH 10X15CM PP PCL MACROPOROUS PARIETENE DS COMP ABS FLM LG PPDS1510 SUPPLY/IMPLANTS "$1,789.00 " Outpatient $894.50 Not Applicable: Bundled with Procedure "$1,162.85 " "$1,252.30 " "$1,180.74 " Not Applicable: Bundled with Procedure $626.15 "$1,431.20 " $626.15 "$1,431.20 " MESH 35.4CM THK200UM 2.8SQ MM Y UPSYLON ELNG PRFL LTWT LG M0068318200 SUPPLY/IMPLANTS "$3,697.00 " Outpatient "$1,848.50 " Not Applicable: Bundled with Procedure "$2,403.05 " "$2,587.90 " "$2,440.02 " Not Applicable: Bundled with Procedure "$1,293.95 " "$2,957.60 " "$1,293.95 " "$2,957.60 " MESH 4X3IN RECT POLY-4-HB PHASIX SEPRA MFL RSRB SRG HRN REPR 1200710 SUPPLY/IMPLANTS "$6,971.00 " Outpatient "$3,485.50 " Not Applicable: Bundled with Procedure "$4,531.15 " "$4,879.70 " "$4,600.86 " Not Applicable: Bundled with Procedure "$2,439.85 " "$5,576.80 " "$2,439.85 " "$5,576.80 " MESH 55X55X.5MM CRNL PUR FRNTL NONLOAD BRNG APL 7005145 SUPPLY/IMPLANTS "$11,994.00 " Outpatient "$5,997.00 " Not Applicable: Bundled with Procedure "$7,796.10 " "$8,395.80 " "$7,916.04 " Not Applicable: Bundled with Procedure "$4,197.90 " "$9,595.20 " "$4,197.90 " "$9,595.20 " MESH 6X3IN FLT PLGCPRN-25 PP ULTRAPRO PRT ABS LTWT SRG STRL UMR3 SUPPLY/IMPLANTS "$3,132.00 " Outpatient "$1,566.00 " Not Applicable: Bundled with Procedure "$2,035.80 " "$2,192.40 " "$2,067.12 " Not Applicable: Bundled with Procedure "$1,096.20 " "$2,505.60 " "$1,096.20 " "$2,505.60 " MESH GROIN 4X1IN RECT PP BARD MRLX MFL AU STD FLT SHT SRG 112640 SUPPLY/IMPLANTS $454.00 Outpatient $227.00 Not Applicable: Bundled with Procedure $295.10 $317.80 $299.64 Not Applicable: Bundled with Procedure $158.90 $363.20 $158.90 $363.20 MESH GROIN 12X2IN RECT PP BARD MRLX MFL AU STD FLT SHT SRG 112670 SUPPLY/IMPLANTS $666.00 Outpatient $333.00 Not Applicable: Bundled with Procedure $432.90 $466.20 $439.56 Not Applicable: Bundled with Procedure $233.10 $532.80 $233.10 $532.80 MESH GROIN LT 7X5IN XL 3D CRV PP 3DMAX CNTR SL EDG SRG STRL 115312 SUPPLY/IMPLANTS "$1,425.00 " Outpatient $712.50 Not Applicable: Bundled with Procedure $926.25 $997.50 $940.50 Not Applicable: Bundled with Procedure $498.75 "$1,140.00 " $498.75 "$1,140.00 " MESH GROIN RT 6X4IN LG 3D CRV CNTR PP BARD 3DMAX SL EDG SRG 0115321 SUPPLY/IMPLANTS $982.00 Outpatient $491.00 Not Applicable: Bundled with Procedure $638.30 $687.40 $648.12 Not Applicable: Bundled with Procedure $343.70 $785.60 $343.70 $785.60 MESH GROIN RT 7X5IN XL 3D CRV PP 3DMAX CNTR SL EDG SRG STRL 115322 SUPPLY/IMPLANTS "$1,423.00 " Outpatient $711.50 Not Applicable: Bundled with Procedure $924.95 $996.10 $939.18 Not Applicable: Bundled with Procedure $498.05 "$1,138.40 " $498.05 "$1,138.40 " MESH SFT TIS 19X15CM THK1MM GRTX CHG DIACETATE SLVR CARB 1DLMCP04 SUPPLY/IMPLANTS "$5,884.00 " Outpatient "$2,942.00 " Not Applicable: Bundled with Procedure "$3,824.60 " "$4,118.80 " "$3,883.44 " Not Applicable: Bundled with Procedure "$2,059.40 " "$4,707.20 " "$2,059.40 " "$4,707.20 " MESH TISS 30X20CM BIO-A BABSR REINF SCFLD SRG FS2030 SUPPLY/IMPLANTS "$21,522.00 " Outpatient "$10,761.00 " Not Applicable: Bundled with Procedure "$13,989.30 " "$15,065.40 " "$14,204.52 " Not Applicable: Bundled with Procedure "$7,532.70 " "$17,217.60 " "$7,532.70 " "$17,217.60 " MESH THICK SMALL PANEL 85MM X 53MM 1.5/0.13 01-7185 SUPPLY/IMPLANTS "$8,053.00 " Outpatient "$4,026.50 " Not Applicable: Bundled with Procedure "$5,234.45 " "$5,637.10 " "$5,314.98 " Not Applicable: Bundled with Procedure "$2,818.55 " "$6,442.40 " "$2,818.55 " "$6,442.40 " MESH VNTRL 8X4IN RECT SPRFLM PP DDRGL SPRMSH IP SEPRA MFL 5959480 SUPPLY/IMPLANTS "$3,552.00 " Outpatient "$1,776.00 " Not Applicable: Bundled with Procedure "$2,308.80 " "$2,486.40 " "$2,344.32 " Not Applicable: Bundled with Procedure "$1,243.20 " "$2,841.60 " "$1,243.20 " "$2,841.60 " MESH VNTRL 8X6IN RECT SPRFLM PP DDRGL SPRMSH IP SEPRA MFL 5955680 SUPPLY/IMPLANTS "$5,968.00 " Outpatient "$2,984.00 " Not Applicable: Bundled with Procedure "$3,879.20 " "$4,177.60 " "$3,938.88 " Not Applicable: Bundled with Procedure "$2,088.80 " "$4,774.40 " "$2,088.80 " "$4,774.40 " METATARSAL MGT-890-40MT SUPPLY/IMPLANTS "$11,252.00 " Outpatient "$5,626.00 " Not Applicable: Bundled with Procedure "$7,313.80 " "$7,876.40 " "$7,426.32 " Not Applicable: Bundled with Procedure "$3,938.20 " "$9,001.60 " "$3,938.20 " "$9,001.60 " MITRAL VALVE MECHANICAL SZ 25MM 20.8MM ID 25.5 50ODM25 SUPPLY/IMPLANTS "$13,210.00 " Outpatient "$6,605.00 " Not Applicable: Bundled with Procedure "$8,586.50 " "$9,247.00 " "$8,718.60 " Not Applicable: Bundled with Procedure "$4,623.50 " "$10,568.00 " "$4,623.50 " "$10,568.00 " MOBI-C CERVICAL DISC 17X19 H6 MB3796 SUPPLY/IMPLANTS "$25,441.00 " Outpatient "$12,720.50 " Not Applicable: Bundled with Procedure "$16,536.65 " "$17,808.70 " "$16,791.06 " Not Applicable: Bundled with Procedure "$8,904.35 " "$20,352.80 " "$8,904.35 " "$20,352.80 " MRKR BRSTBIO 18GA MAGSEED 7CM SM18107001 SUPPLY/IMPLANTS "$2,956.00 " Outpatient "$1,478.00 " Not Applicable: Bundled with Procedure "$1,921.40 " "$2,069.20 " "$1,950.96 " Not Applicable: Bundled with Procedure "$1,034.60 " "$2,364.80 " "$1,034.60 " "$2,364.80 " MTRX TISS 4X2CM ALDRM THK.53-1.02MM MED ACLR DERM ALGRF 102011 SUPPLY/IMPLANTS "$2,823.00 " Outpatient "$1,411.50 " Not Applicable: Bundled with Procedure "$1,834.95 " "$1,976.10 " "$1,863.18 " Not Applicable: Bundled with Procedure $988.05 "$2,258.40 " $988.05 "$2,258.40 " MTRX TISS 4X2CM ALDRM THN ACLR DERM ALGRF RGNRT FRZDR 102010 SUPPLY/IMPLANTS "$2,823.00 " Outpatient "$1,411.50 " Not Applicable: Bundled with Procedure "$1,834.95 " "$1,976.10 " "$1,863.18 " Not Applicable: Bundled with Procedure $988.05 "$2,258.40 " $988.05 "$2,258.40 " NAIL IM 320MM 9MM 130D LNG CNN TFN-ADV LAT RLF CUT TI COCR 04.037.953S SUPPLY/IMPLANTS "$12,922.00 " Outpatient "$6,461.00 " Not Applicable: Bundled with Procedure "$8,399.30 " "$9,045.40 " "$8,528.52 " Not Applicable: Bundled with Procedure "$4,522.70 " "$10,337.60 " "$4,522.70 " "$10,337.60 " NATRELLE TE SMOOTH 133S-FX-11-T WITH FOURTE 133S-FX-11-T SUPPLY/IMPLANTS "$6,277.00 " Outpatient "$3,138.50 " Not Applicable: Bundled with Procedure "$4,080.05 " "$4,393.90 " "$4,142.82 " Not Applicable: Bundled with Procedure "$2,196.95 " "$5,021.60 " "$2,196.95 " "$5,021.60 " NATRELLE TE SMOOTH 133S-MV-12-T WITH FOURTE 133S-MV-12-T SUPPLY/IMPLANTS "$6,277.00 " Outpatient "$3,138.50 " Not Applicable: Bundled with Procedure "$4,080.05 " "$4,393.90 " "$4,142.82 " Not Applicable: Bundled with Procedure "$2,196.95 " "$5,021.60 " "$2,196.95 " "$5,021.60 " NDL BX BCN EUS FNF 22GA F-22-05 SUPPLY/IMPLANTS "$8,060.00 " Outpatient "$4,030.00 " Not Applicable: Bundled with Procedure "$5,239.00 " "$5,642.00 " "$5,319.60 " Not Applicable: Bundled with Procedure "$2,821.00 " "$6,448.00 " "$2,821.00 " "$6,448.00 " NDL SPNL SXTNT II CD HZN 2 TROC PK ROD INS 8670015 SUPPLY/IMPLANTS $739.00 Outpatient $369.50 Not Applicable: Bundled with Procedure $480.35 $517.30 $487.74 Not Applicable: Bundled with Procedure $258.65 $591.20 $258.65 $591.20 NDL SPNL MTRX SXTNT II CD HZN 2GA XPAK TROC ROD INS SYS 8670215 SUPPLY/IMPLANTS $931.00 Outpatient $465.50 Not Applicable: Bundled with Procedure $605.15 $651.70 $614.46 Not Applicable: Bundled with Procedure $325.85 $744.80 $325.85 $744.80 OLIVE WIRE 2X550MM STERILE 21425 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 Not Applicable: Bundled with Procedure $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 $756.80 OMNIA BUNDLE KIT 1080-LW SUPPLY/IMPLANTS "$110,082.00 " Outpatient "$55,041.00 " Not Applicable: Bundled with Procedure "$71,553.30 " "$77,057.40 " "$72,654.12 " Not Applicable: Bundled with Procedure "$38,528.70 " "$88,065.60 " "$38,528.70 " "$88,065.60 " OSTEO-LINK DEMINERALIZED BONE MATRIX 5CC 290-34-0005 SUPPLY/IMPLANTS "$4,770.00 " Outpatient "$2,385.00 " Not Applicable: Bundled with Procedure "$3,100.50 " "$3,339.00 " "$3,148.20 " Not Applicable: Bundled with Procedure "$1,669.50 " "$3,816.00 " "$1,669.50 " "$3,816.00 " PACK VITRTM VISCUOUS FL CNTRL SYR NDL CNN CNSTL ENGAUGE RBR 8065750957 SUPPLY/IMPLANTS $467.00 Outpatient $233.50 Not Applicable: Bundled with Procedure $303.55 $326.90 $308.22 Not Applicable: Bundled with Procedure $163.45 $373.60 $163.45 $373.60 PIN FX IBALANCE HTO AR-13422 SUPPLY/IMPLANTS "$1,832.00 " Outpatient $916.00 Not Applicable: Bundled with Procedure "$1,190.80 " "$1,282.40 " "$1,209.12 " Not Applicable: Bundled with Procedure $641.20 "$1,465.60 " $641.20 "$1,465.60 " PIN GUIDE INFINITY 2.4 MM OD3.5 MM SPADE TIP KGP035 SUPPLY/IMPLANTS "$1,867.00 " Outpatient $933.50 Not Applicable: Bundled with Procedure "$1,213.55 " "$1,306.90 " "$1,232.22 " Not Applicable: Bundled with Procedure $653.45 "$1,493.60 " $653.45 "$1,493.60 " PIN HALF HOFFMANN II APEX STAINLESS STEEL MICRO L45 MM L20 M 5080-2-020 SUPPLY/IMPLANTS $450.00 Outpatient $225.00 Not Applicable: Bundled with Procedure $292.50 $315.00 $297.00 Not Applicable: Bundled with Procedure $157.50 $360.00 $157.50 $360.00 PIN HMRHG 12IN 10MM HMRHG OC TI STD PRESACRAL PLVC APL SRR CR1007 SUPPLY/IMPLANTS "$2,138.00 " Outpatient "$1,069.00 " Not Applicable: Bundled with Procedure "$1,389.70 " "$1,496.60 " "$1,411.08 " Not Applicable: Bundled with Procedure $748.30 "$1,710.40 " $748.30 "$1,710.40 " PIN PSTN 4.5MM LCP SS CRLGE THRD STRL 298.803S SUPPLY/IMPLANTS "$1,354.00 " Outpatient $677.00 Not Applicable: Bundled with Procedure $880.10 $947.80 $893.64 Not Applicable: Bundled with Procedure $473.90 "$1,083.20 " $473.90 "$1,083.20 " PINN SECTOR W/GRIPTION 54MM 121732054 SUPPLY/IMPLANTS "$4,893.00 " Outpatient "$2,446.50 " Not Applicable: Bundled with Procedure "$3,180.45 " "$3,425.10 " "$3,229.38 " Not Applicable: Bundled with Procedure "$1,712.55 " "$3,914.40 " "$1,712.55 " "$3,914.40 " PIPELINE FLEX EMBOL. DEVICE 4.5MM X 14MM PED-450-14 SUPPLY/IMPLANTS "$65,963.00 " Outpatient "$32,981.50 " Not Applicable: Bundled with Procedure "$42,875.95 " "$46,174.10 " "$43,535.58 " Not Applicable: Bundled with Procedure "$23,087.05 " "$52,770.40 " "$23,087.05 " "$52,770.40 " PIPELINE FLEX EMBOL DEVICE 3.25 MM X 14 MM PED-325-14 SUPPLY/IMPLANTS "$65,963.00 " Outpatient "$32,981.50 " Not Applicable: Bundled with Procedure "$42,875.95 " "$46,174.10 " "$43,535.58 " Not Applicable: Bundled with Procedure "$23,087.05 " "$52,770.40 " "$23,087.05 " "$52,770.40 " PLATE BONE CAYMAN BUTTRESS L22 MM X W17 MM SPINE NONSTERILE 1408-40F22 SUPPLY/IMPLANTS "$7,125.00 " Outpatient "$3,562.50 " Not Applicable: Bundled with Procedure "$4,631.25 " "$4,987.50 " "$4,702.50 " Not Applicable: Bundled with Procedure "$2,493.75 " "$5,700.00 " "$2,493.75 " "$5,700.00 " PLT 1.25MM STRG MNDB TI 2X2 HL MATRIXMANDIBLE DCP BN NS 04.503.710 SUPPLY/IMPLANTS "$2,142.00 " Outpatient "$1,071.00 " Not Applicable: Bundled with Procedure "$1,392.30 " "$1,499.40 " "$1,413.72 " Not Applicable: Bundled with Procedure $749.70 "$1,713.60 " $749.70 "$1,713.60 " PLT 105MM CLVCL RT SS 6 HL LAT XTN PRECONTOUR LMT CNTCT LCP 02.112.090 SUPPLY/IMPLANTS "$5,132.00 " Outpatient "$2,566.00 " Not Applicable: Bundled with Procedure "$3,335.80 " "$3,592.40 " "$3,387.12 " Not Applicable: Bundled with Procedure "$1,796.20 " "$4,105.60 " "$1,796.20 " "$4,105.60 " PLT 10X5X.7MM STD MED BX MDFC TI 4 HL MATRIXMIDFACE BN NS 04.503.390 SUPPLY/IMPLANTS "$1,892.00 " Outpatient $946.00 Not Applicable: Bundled with Procedure "$1,229.80 " "$1,324.40 " "$1,248.72 " Not Applicable: Bundled with Procedure $662.20 "$1,513.60 " $662.20 "$1,513.60 " PLT 114X16X5.4MM 95D SHRT BRL FEM DIST SS 6 HL LOPRFL DCS 281.96 SUPPLY/IMPLANTS "$5,479.00 " Outpatient "$2,739.50 " Not Applicable: Bundled with Procedure "$3,561.35 " "$3,835.30 " "$3,616.14 " Not Applicable: Bundled with Procedure "$1,917.65 " "$4,383.20 " "$1,917.65 " "$4,383.20 " PLT 112MM 15MM CLVCL RT SS 7 HL HK PRECONTOUR RND SHFT PRFL 241.104S SUPPLY/IMPLANTS "$4,751.00 " Outpatient "$2,375.50 " Not Applicable: Bundled with Procedure "$3,088.15 " "$3,325.70 " "$3,135.66 " Not Applicable: Bundled with Procedure "$1,662.85 " "$3,800.80 " "$1,662.85 " "$3,800.80 " PLT 120MM CLVCL LT SUP SS 7 HL LAT XTN PRECONTOUR LMT CNTCT 02.112.093S SUPPLY/IMPLANTS "$5,517.00 " Outpatient "$2,758.50 " Not Applicable: Bundled with Procedure "$3,586.05 " "$3,861.90 " "$3,641.22 " Not Applicable: Bundled with Procedure "$1,930.95 " "$4,413.60 " "$1,930.95 " "$4,413.60 " PLT 129X11X3.3MM SS 10 HL LC DCP BN NS 3.5MM SCR SM FRAG SET 223.6 SUPPLY/IMPLANTS $739.00 Outpatient $369.50 Not Applicable: Bundled with Procedure $480.35 $517.30 $487.74 Not Applicable: Bundled with Procedure $258.65 $591.20 $258.65 $591.20 PLT 146X16X5.4MM 95D SHRT BRL FEM DIST SS 8 HL LOPRFL DCS 281.98 SUPPLY/IMPLANTS "$4,771.00 " Outpatient "$2,385.50 " Not Applicable: Bundled with Procedure "$3,101.15 " "$3,339.70 " "$3,148.86 " Not Applicable: Bundled with Procedure "$1,669.85 " "$3,816.80 " "$1,669.85 " "$3,816.80 " PLT 175MM TIB LT DIST ALAT SS 10X3X 5 HL AXSOS BN NS 3.5/4MM 437410 SUPPLY/IMPLANTS "$7,653.00 " Outpatient "$3,826.50 " Not Applicable: Bundled with Procedure "$4,974.45 " "$5,357.10 " "$5,050.98 " Not Applicable: Bundled with Procedure "$2,678.55 " "$6,122.40 " "$2,678.55 " "$6,122.40 " PLT 176MM HUM LT PROX LAT TI 10 HL AXSOS 3 BN NS 627210 SUPPLY/IMPLANTS "$11,649.00 " Outpatient "$5,824.50 " Not Applicable: Bundled with Procedure "$7,571.85 " "$8,154.30 " "$7,688.34 " Not Applicable: Bundled with Procedure "$4,077.15 " "$9,319.20 " "$4,077.15 " "$9,319.20 " PLT 178X16X5.4MM 95D SHRT BRL FEM DIST SS 10 HL LOPRFL DCS 281.9 SUPPLY/IMPLANTS "$4,771.00 " Outpatient "$2,385.50 " Not Applicable: Bundled with Procedure "$3,101.15 " "$3,339.70 " "$3,148.86 " Not Applicable: Bundled with Procedure "$1,669.85 " "$3,816.80 " "$1,669.85 " "$3,816.80 " PLT 175.3X24.4MM STD RDS LT VOLR DIST TI 12 HL LOPRFL FX ANG DVRAXXL SUPPLY/IMPLANTS "$7,327.00 " Outpatient "$3,663.50 " Not Applicable: Bundled with Procedure "$4,762.55 " "$5,128.90 " "$4,835.82 " Not Applicable: Bundled with Procedure "$2,564.45 " "$5,861.60 " "$2,564.45 " "$5,861.60 " PLT 175.3X24.4MM STD RDS RT VOLR DIST TI 12 HL LOPRFL FX ANG DVRAXXR SUPPLY/IMPLANTS "$7,327.00 " Outpatient "$3,663.50 " Not Applicable: Bundled with Procedure "$4,762.55 " "$5,128.90 " "$4,835.82 " Not Applicable: Bundled with Procedure "$2,564.45 " "$5,861.60 " "$2,564.45 " "$5,861.60 " PLT 196X17.5X5.2MM BRD SS 11 HL LC DCP BN NS 4.5MM SCR LG 226.61 SUPPLY/IMPLANTS $788.00 Outpatient $394.00 Not Applicable: Bundled with Procedure $512.20 $551.60 $520.08 Not Applicable: Bundled with Procedure $275.80 $630.40 $275.80 $630.40 PLT 196X13.5X4.2MM NAR SS 11 HL LC DCP BN NS 4.5MM SCR LG 224.61 SUPPLY/IMPLANTS "$1,295.00 " Outpatient $647.50 Not Applicable: Bundled with Procedure $841.75 $906.50 $854.70 Not Applicable: Bundled with Procedure $453.25 "$1,036.00 " $453.25 "$1,036.00 " PLT 1MM BRD MN MNDB TI 2X2 HL MLBL TNSNBND MATRIXMANDIBLE BN 04.503.750 SUPPLY/IMPLANTS "$2,763.00 " Outpatient "$1,381.50 " Not Applicable: Bundled with Procedure "$1,795.95 " "$1,934.10 " "$1,823.58 " Not Applicable: Bundled with Procedure $967.05 "$2,210.40 " $967.05 "$2,210.40 " PLT 232X13.5X4.2MM NAR SS 13 HL LC DCP BN NS 4.5MM SCR LG 224.63 SUPPLY/IMPLANTS "$1,295.00 " Outpatient $647.50 Not Applicable: Bundled with Procedure $841.75 $906.50 $854.70 Not Applicable: Bundled with Procedure $453.25 "$1,036.00 " $453.25 "$1,036.00 " PLT 30.5X6.5X1.8MM SM FT TMX INLN FSN CNTR CNTR RGN THRD HL 824077023 SUPPLY/IMPLANTS "$3,023.00 " Outpatient "$1,511.50 " Not Applicable: Bundled with Procedure "$1,964.95 " "$2,116.10 " "$1,995.18 " Not Applicable: Bundled with Procedure "$1,058.05 " "$2,418.40 " "$1,058.05 " "$2,418.40 " PLT 42.5MM SPNE CRV ANT TI LCK ATLNTS TRANSLATIONAL BN NS 6190042 SUPPLY/IMPLANTS "$8,315.00 " Outpatient "$4,157.50 " Not Applicable: Bundled with Procedure "$5,404.75 " "$5,820.50 " "$5,487.90 " Not Applicable: Bundled with Procedure "$2,910.25 " "$6,652.00 " "$2,910.25 " "$6,652.00 " PLT 42MM NAR RDS LT DIST VOLR SS 6 HLE/HD 2 HL SHFT 2 CLMN 02.111.521S SUPPLY/IMPLANTS "$5,526.00 " Outpatient "$2,763.00 " Not Applicable: Bundled with Procedure "$3,591.90 " "$3,868.20 " "$3,647.16 " Not Applicable: Bundled with Procedure "$1,934.10 " "$4,420.80 " "$1,934.10 " "$4,420.80 " PLT 45MM RDS LT DIST VOLR SS 6 HLE/HD 2 HL SHFT 2 CLMN VA 02.111.621S SUPPLY/IMPLANTS "$5,974.00 " Outpatient "$2,987.00 " Not Applicable: Bundled with Procedure "$3,883.10 " "$4,181.80 " "$3,942.84 " Not Applicable: Bundled with Procedure "$2,090.90 " "$4,779.20 " "$2,090.90 " "$4,779.20 " PLT 51MM NAR RDS RT DIST VOLR SS 6 HLE/HD 3 HL SHFT 2 CLMN 02.111.530S SUPPLY/IMPLANTS "$5,733.00 " Outpatient "$2,866.50 " Not Applicable: Bundled with Procedure "$3,726.45 " "$4,013.10 " "$3,783.78 " Not Applicable: Bundled with Procedure "$2,006.55 " "$4,586.40 " "$2,006.55 " "$4,586.40 " PLT 51.3X24.4MM SHRT RDS RT VOLR DIST TI 3 HL LOPRFL FX ANG DVRASR SUPPLY/IMPLANTS "$3,786.00 " Outpatient "$1,893.00 " Not Applicable: Bundled with Procedure "$2,460.90 " "$2,650.20 " "$2,498.76 " Not Applicable: Bundled with Procedure "$1,325.10 " "$3,028.80 " "$1,325.10 " "$3,028.80 " PLT 51X22MM NAR RDS LT VOLR DIST VA ACLC 2 BN NS 2.3MM SCR 70-0358 SUPPLY/IMPLANTS "$4,736.00 " Outpatient "$2,368.00 " Not Applicable: Bundled with Procedure "$3,078.40 " "$3,315.20 " "$3,125.76 " Not Applicable: Bundled with Procedure "$1,657.60 " "$3,788.80 " "$1,657.60 " "$3,788.80 " PLT 52MM 10D MED 1ST MTP LT SS VA FSN LOPRFL LCP BN STRL 02.211.241S SUPPLY/IMPLANTS "$5,683.00 " Outpatient "$2,841.50 " Not Applicable: Bundled with Procedure "$3,693.95 " "$3,978.10 " "$3,750.78 " Not Applicable: Bundled with Procedure "$1,989.05 " "$4,546.40 " "$1,989.05 " "$4,546.40 " PLT 57.2X21.6MM NAR RDS RT VOLR DIST TI 4 HL LOPRFL FX ANG DVRANR SUPPLY/IMPLANTS "$3,786.00 " Outpatient "$1,893.00 " Not Applicable: Bundled with Procedure "$2,460.90 " "$2,650.20 " "$2,498.76 " Not Applicable: Bundled with Procedure "$1,325.10 " "$3,028.80 " "$1,325.10 " "$3,028.80 " PLT 62MM FIB RDS TIB ULNA SS 3 HL SHRP HK LOPRFL PRECONTOUR 02.113.103S SUPPLY/IMPLANTS "$3,504.00 " Outpatient "$1,752.00 " Not Applicable: Bundled with Procedure "$2,277.60 " "$2,452.80 " "$2,312.64 " Not Applicable: Bundled with Procedure "$1,226.40 " "$2,803.20 " "$1,226.40 " "$2,803.20 " PLT 66MM STD RDS RT VOLR DIST SS 6 HLE/HD 4 HL SHFT 2 CLMN 02.111.640 SUPPLY/IMPLANTS "$5,331.00 " Outpatient "$2,665.50 " Not Applicable: Bundled with Procedure "$3,465.15 " "$3,731.70 " "$3,518.46 " Not Applicable: Bundled with Procedure "$1,865.85 " "$4,264.80 " "$1,865.85 " "$4,264.80 " PLT 88MM MED HUM LT DIST P/L SS 4 HL VA TPR TIP RND PRFL LCP 02.117.304S SUPPLY/IMPLANTS "$6,419.00 " Outpatient "$3,209.50 " Not Applicable: Bundled with Procedure "$4,172.35 " "$4,493.30 " "$4,236.54 " Not Applicable: Bundled with Procedure "$2,246.65 " "$5,135.20 " "$2,246.65 " "$5,135.20 " PLT 99MM 18MM CLVCL LT SS 6 HL HK PRECONTOUR RND SHFT PRFL 241.097S SUPPLY/IMPLANTS "$4,997.00 " Outpatient "$2,498.50 " Not Applicable: Bundled with Procedure "$3,248.05 " "$3,497.90 " "$3,298.02 " Not Applicable: Bundled with Procedure "$1,748.95 " "$3,997.60 " "$1,748.95 " "$3,997.60 " PLT ANLY SMX SMPL 1500 SAP 400A 10445691 SUPPLY/IMPLANTS $43.00 Outpatient $21.50 Not Applicable: Bundled with Procedure $27.95 $30.10 $28.38 Not Applicable: Bundled with Procedure $15.05 $34.40 $15.05 $34.40 PLT CNDYL TI RECON GRPH CA BN NS 690.604 SUPPLY/IMPLANTS "$2,584.00 " Outpatient "$1,292.00 " Not Applicable: Bundled with Procedure "$1,679.60 " "$1,808.80 " "$1,705.44 " Not Applicable: Bundled with Procedure $904.40 "$2,067.20 " $904.40 "$2,067.20 " PLT CRNL FSFLP BN NS SD800.434 SUPPLY/IMPLANTS "$49,978.00 " Outpatient "$24,989.00 " Not Applicable: Bundled with Procedure "$32,485.70 " "$34,984.60 " "$32,985.48 " Not Applicable: Bundled with Procedure "$17,492.30 " "$39,982.40 " "$17,492.30 " "$39,982.40 " PLT ELB LCK CMPLT SET BN 231218100 SUPPLY/IMPLANTS "$59,013.00 " Outpatient "$29,506.50 " Not Applicable: Bundled with Procedure "$38,358.45 " "$41,309.10 " "$38,948.58 " Not Applicable: Bundled with Procedure "$20,654.55 " "$47,210.40 " "$20,654.55 " "$47,210.40 " PLT LG LT ORBT FLR MESH CNTR ANTM EZ MODIFICATION MN SHRP 2451509 SUPPLY/IMPLANTS "$9,458.00 " Outpatient "$4,729.00 " Not Applicable: Bundled with Procedure "$6,147.70 " "$6,620.60 " "$6,242.28 " Not Applicable: Bundled with Procedure "$3,310.30 " "$7,566.40 " "$3,310.30 " "$7,566.40 " PLT LNG ELB TRY LID BN 231218121 SUPPLY/IMPLANTS "$1,859.00 " Outpatient $929.50 Not Applicable: Bundled with Procedure "$1,208.35 " "$1,301.30 " "$1,226.94 " Not Applicable: Bundled with Procedure $650.65 "$1,487.20 " $650.65 "$1,487.20 " PLT NSL VIOL 50X40X.15MM PDS RECT PDO FLXB PRFR ZFP8 SUPPLY/IMPLANTS "$1,704.00 " Outpatient $852.00 Not Applicable: Bundled with Procedure "$1,107.60 " "$1,192.80 " "$1,124.64 " Not Applicable: Bundled with Procedure $596.40 "$1,363.20 " $596.40 "$1,363.20 " PLT RDS RT VOLR DIST SS 7 HL SHFT LCP BN STRL 02.110.007S SUPPLY/IMPLANTS "$9,729.00 " Outpatient "$4,864.50 " Not Applicable: Bundled with Procedure "$6,323.85 " "$6,810.30 " "$6,421.14 " Not Applicable: Bundled with Procedure "$3,405.15 " "$7,783.20 " "$3,405.15 " "$7,783.20 " PLT SM FT TMX INLN FSN ALPS BN NS 3.5MM SCR 824077024 SUPPLY/IMPLANTS "$3,282.00 " Outpatient "$1,641.00 " Not Applicable: Bundled with Procedure "$2,133.30 " "$2,297.40 " "$2,166.12 " Not Applicable: Bundled with Procedure "$1,148.70 " "$2,625.60 " "$1,148.70 " "$2,625.60 " PLT STRG CRNMXF 4 HL GAP BN 43-1004 SUPPLY/IMPLANTS "$3,774.00 " Outpatient "$1,887.00 " Not Applicable: Bundled with Procedure "$2,453.10 " "$2,641.80 " "$2,490.84 " Not Applicable: Bundled with Procedure "$1,320.90 " "$3,019.20 " "$1,320.90 " "$3,019.20 " PLT T SS 3 HLE/HD 8 HL SHFT LOPRFL CUT TO LGTH LCP CMBN BN 02.114.006 SUPPLY/IMPLANTS "$2,691.00 " Outpatient "$1,345.50 " Not Applicable: Bundled with Procedure "$1,749.15 " "$1,883.70 " "$1,776.06 " Not Applicable: Bundled with Procedure $941.85 "$2,152.80 " $941.85 "$2,152.80 " PLUG BN CMNT 7 UHMWPE 20MM HIP B0070200 SUPPLY/IMPLANTS $649.00 Outpatient $324.50 Not Applicable: Bundled with Procedure $421.85 $454.30 $428.34 Not Applicable: Bundled with Procedure $227.15 $519.20 $227.15 $519.20 PLUG BONE CEMENT LARGE OD14-17 MM INTRAMEDULLARY CANAL STERI 130613 SUPPLY/IMPLANTS $748.00 Outpatient $374.00 Not Applicable: Bundled with Procedure $486.20 $523.60 $493.68 Not Applicable: Bundled with Procedure $261.80 $598.40 $261.80 $598.40 PORCINE COLLAGEN WOUND MATRIX WITH PHMB ANTIMICROBIAL 1.6CM PURAPLYAM-COM16 SUPPLY/IMPLANTS "$2,254.00 " Outpatient "$1,127.00 " Not Applicable: Bundled with Procedure "$1,465.10 " "$1,577.80 " "$1,487.64 " Not Applicable: Bundled with Procedure $788.90 "$1,803.20 " $788.90 "$1,803.20 " PORT HND ACC 120MM WND RTRCTR MRK PEN INCS TMPLT CAP ALEXIS C8XX2 SUPPLY/IMPLANTS "$2,570.00 " Outpatient "$1,285.00 " Not Applicable: Bundled with Procedure "$1,670.50 " "$1,799.00 " "$1,696.20 " Not Applicable: Bundled with Procedure $899.50 "$2,056.00 " $899.50 "$2,056.00 " POWDER TALC STERILE 1680 SUPPLY/IMPLANTS $698.00 Outpatient $349.00 Not Applicable: Bundled with Procedure $453.70 $488.60 $460.68 Not Applicable: Bundled with Procedure $244.30 $558.40 $244.30 $558.40 PREP MICROBIOTA LWR DLV FMP250 SUPPLY/IMPLANTS "$2,766.00 " Outpatient "$1,383.00 " Not Applicable: Bundled with Procedure "$1,797.90 " "$1,936.20 " "$1,825.56 " Not Applicable: Bundled with Procedure $968.10 "$2,212.80 " $968.10 "$2,212.80 " PREP MICROBIOTA UPR DLV FMP30 SUPPLY/IMPLANTS "$2,766.00 " Outpatient "$1,383.00 " Not Applicable: Bundled with Procedure "$1,797.90 " "$1,936.20 " "$1,825.56 " Not Applicable: Bundled with Procedure $968.10 "$2,212.80 " $968.10 "$2,212.80 " PRODISC C IMPLANT LARGE 6MM STERILE 09.820.046S SUPPLY/IMPLANTS "$22,899.00 " Outpatient "$11,449.50 " Not Applicable: Bundled with Procedure "$14,884.35 " "$16,029.30 " "$15,113.34 " Not Applicable: Bundled with Procedure "$8,014.65 " "$18,319.20 " "$8,014.65 " "$18,319.20 " PROLARYN INJECTABLE IMP. GEL 8602U0 SUPPLY/IMPLANTS "$3,055.00 " Outpatient "$1,527.50 " Not Applicable: Bundled with Procedure "$1,985.75 " "$2,138.50 " "$2,016.30 " Not Applicable: Bundled with Procedure "$1,069.25 " "$2,444.00 " "$1,069.25 " "$2,444.00 " PROS TSTCLR TOROSA INFS LN NDL SAL LG 4.9X2.9CM STRL DISP 450-1329 SUPPLY/IMPLANTS "$6,844.00 " Outpatient "$3,422.00 " Not Applicable: Bundled with Procedure "$4,448.60 " "$4,790.80 " "$4,517.04 " Not Applicable: Bundled with Procedure "$2,395.40 " "$5,475.20 " "$2,395.40 " "$5,475.20 " PROS VOICE 6MM PRVX 2 TE LO ARFLW RST SAFE PLC SIL STRL 7217 SUPPLY/IMPLANTS "$1,420.00 " Outpatient $710.00 Not Applicable: Bundled with Procedure $923.00 $994.00 $937.20 Not Applicable: Bundled with Procedure $497.00 "$1,136.00 " $497.00 "$1,136.00 " PROS VOICE 8MM PRVX 2 TE LO ARFLW RST SAFE PLC SIL STRL 7218 SUPPLY/IMPLANTS "$1,420.00 " Outpatient $710.00 Not Applicable: Bundled with Procedure $923.00 $994.00 $937.20 Not Applicable: Bundled with Procedure $497.00 "$1,136.00 " $497.00 "$1,136.00 " PROS VOICE 10MM PRVX 2 TRACHEOESOPHAGUS LO ARFLW RST SAFE 7219 SUPPLY/IMPLANTS "$1,420.00 " Outpatient $710.00 Not Applicable: Bundled with Procedure $923.00 $994.00 $937.20 Not Applicable: Bundled with Procedure $497.00 "$1,136.00 " $497.00 "$1,136.00 " PROS VOICE 12.5MM PRVX 2 TE LO ARFLW RST SAFE PLC SIL STRL 7221 SUPPLY/IMPLANTS "$1,420.00 " Outpatient $710.00 Not Applicable: Bundled with Procedure $923.00 $994.00 $937.20 Not Applicable: Bundled with Procedure $497.00 "$1,136.00 " $497.00 "$1,136.00 " PROS VOICE 15MM 22.5FR PRVX 2 LO ARFLW RST SAFE PLC XRY DTCT 7224 SUPPLY/IMPLANTS "$1,420.00 " Outpatient $710.00 Not Applicable: Bundled with Procedure $923.00 $994.00 $937.20 Not Applicable: Bundled with Procedure $497.00 "$1,136.00 " $497.00 "$1,136.00 " PROS VOICE 6MM 17FR PRVX NID TE NS 7101 SUPPLY/IMPLANTS $525.00 Outpatient $262.50 Not Applicable: Bundled with Procedure $341.25 $367.50 $346.50 Not Applicable: Bundled with Procedure $183.75 $420.00 $183.75 $420.00 PROS VOICE 8MM 17FR PRVX NID VOCAL CORD LO ARFLW RST NS 7102 SUPPLY/IMPLANTS $525.00 Outpatient $262.50 Not Applicable: Bundled with Procedure $341.25 $367.50 $346.50 Not Applicable: Bundled with Procedure $183.75 $420.00 $183.75 $420.00 PROS VOICE 10MM 17FR PRVX NID VOCAL CORD LO ARFLW RST NS 7103 SUPPLY/IMPLANTS $525.00 Outpatient $262.50 Not Applicable: Bundled with Procedure $341.25 $367.50 $346.50 Not Applicable: Bundled with Procedure $183.75 $420.00 $183.75 $420.00 PROS VOICE 12MM 17FR PRVX NID VOCAL CORD LO ARFLW RST NS 7104 SUPPLY/IMPLANTS $525.00 Outpatient $262.50 Not Applicable: Bundled with Procedure $341.25 $367.50 $346.50 Not Applicable: Bundled with Procedure $183.75 $420.00 $183.75 $420.00 PROS VOICE 14MM 17FR PRVX NID VOCAL CORD LO ARFLW RST NS 7105 SUPPLY/IMPLANTS $525.00 Outpatient $262.50 Not Applicable: Bundled with Procedure $341.25 $367.50 $346.50 Not Applicable: Bundled with Procedure $183.75 $420.00 $183.75 $420.00 PROS VOICE 18MM 17FR PRVX NID NONINDWELLING REM CLEANABLE 7106 SUPPLY/IMPLANTS $525.00 Outpatient $262.50 Not Applicable: Bundled with Procedure $341.25 $367.50 $346.50 Not Applicable: Bundled with Procedure $183.75 $420.00 $183.75 $420.00 PROS VOICE 6MM 20FR PRVX NID NONINDWELLING REM CLEANABLE 7111 SUPPLY/IMPLANTS $525.00 Outpatient $262.50 Not Applicable: Bundled with Procedure $341.25 $367.50 $346.50 Not Applicable: Bundled with Procedure $183.75 $420.00 $183.75 $420.00 PROS VOICE 8MM 20FR PRVX NID SF MDLN ARFLW RST PT INS STNG 7112 SUPPLY/IMPLANTS $525.00 Outpatient $262.50 Not Applicable: Bundled with Procedure $341.25 $367.50 $346.50 Not Applicable: Bundled with Procedure $183.75 $420.00 $183.75 $420.00 PROS VOICE 10MM 20FR PRVX NID SF MDLN ARFLW RST PT INS STNG 7113 SUPPLY/IMPLANTS $525.00 Outpatient $262.50 Not Applicable: Bundled with Procedure $341.25 $367.50 $346.50 Not Applicable: Bundled with Procedure $183.75 $420.00 $183.75 $420.00 PROS VOICE 14MM 20FR PRVX NID VOCAL CORD BLU RING LO ARFLW 7114 SUPPLY/IMPLANTS $525.00 Outpatient $262.50 Not Applicable: Bundled with Procedure $341.25 $367.50 $346.50 Not Applicable: Bundled with Procedure $183.75 $420.00 $183.75 $420.00 PROS VOICE 12MM 20FR PRVX NID VOCAL CORD BLU RING LO ARFLW 7115 SUPPLY/IMPLANTS $525.00 Outpatient $262.50 Not Applicable: Bundled with Procedure $341.25 $367.50 $346.50 Not Applicable: Bundled with Procedure $183.75 $420.00 $183.75 $420.00 PROS VOICE 18MM 20FR PRVX NID NONINDWELLING REM CLEANABLE 7116 SUPPLY/IMPLANTS $525.00 Outpatient $262.50 Not Applicable: Bundled with Procedure $341.25 $367.50 $346.50 Not Applicable: Bundled with Procedure $183.75 $420.00 $183.75 $420.00 PROS VOICE PRVX CSST HFLO TRNLU HEAT AND MOIST EXCHGR ONLY 7243 SUPPLY/IMPLANTS $531.00 Outpatient $265.50 Not Applicable: Bundled with Procedure $345.15 $371.70 $350.46 Not Applicable: Bundled with Procedure $185.85 $424.80 $185.85 $424.80 PROS VOICE 4MM 16FR BLM-SNG TE LP 11-902-06 SUPPLY/IMPLANTS $557.00 Outpatient $278.50 Not Applicable: Bundled with Procedure $362.05 $389.90 $367.62 Not Applicable: Bundled with Procedure $194.95 $445.60 $194.95 $445.60 PROS VOICE 10MM 16FR BLM-SNG 1 WY FLP VLV LP PT CHANGEABLE BE6010 SUPPLY/IMPLANTS $439.00 Outpatient $219.50 Not Applicable: Bundled with Procedure $285.35 $307.30 $289.74 Not Applicable: Bundled with Procedure $153.65 $351.20 $153.65 $351.20 PROS VOICE 12MM 16FR BLM-SNG TE 1 WY FLP VLV LP SIL LP16-012 SUPPLY/IMPLANTS $439.00 Outpatient $219.50 Not Applicable: Bundled with Procedure $285.35 $307.30 $289.74 Not Applicable: Bundled with Procedure $153.65 $351.20 $153.65 $351.20 PROS VOICE 10MM 16FR BLM-SNG 1 WY FLP VLV LP RX INCR RST 11-902-04 SUPPLY/IMPLANTS $557.00 Outpatient $278.50 Not Applicable: Bundled with Procedure $362.05 $389.90 $367.62 Not Applicable: Bundled with Procedure $194.95 $445.60 $194.95 $445.60 PROS VOICE 20MM 16FR BLM-SNG LP INDWL SPCL LGTH RX 11-902-05 SUPPLY/IMPLANTS $559.00 Outpatient $279.50 Not Applicable: Bundled with Procedure $363.35 $391.30 $368.94 Not Applicable: Bundled with Procedure $195.65 $447.20 $195.65 $447.20 PROS VOICE 4MM 20FR BLM-SNG 1 WY FLP VLV LP PT CHANGEABLE 11-251-06 SUPPLY/IMPLANTS $557.00 Outpatient $278.50 Not Applicable: Bundled with Procedure $362.05 $389.90 $367.62 Not Applicable: Bundled with Procedure $194.95 $445.60 $194.95 $445.60 PROS VOICE 16MM 20FR BLM-SNG 1 WY FLP VLV LP PT CHANGEABLE 11-251-04 SUPPLY/IMPLANTS $557.00 Outpatient $278.50 Not Applicable: Bundled with Procedure $362.05 $389.90 $367.62 Not Applicable: Bundled with Procedure $194.95 $445.60 $194.95 $445.60 PROS VOICE 20MM 20FR BLM-SNG 1 WY FLP VLV LP RX INCR RST 11-251-05 SUPPLY/IMPLANTS $557.00 Outpatient $278.50 Not Applicable: Bundled with Procedure $362.05 $389.90 $367.62 Not Applicable: Bundled with Procedure $194.95 $445.60 $194.95 $445.60 PROS VOICE 4MM 16FR BLM-SNG ADV CLS INDWL NS IN1604-NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 6MM 16FR BLM-SNG CLS INDWL NS IN1606-NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 8MM 16FR BLM-SNG CLS INDWL NS IN1608-NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 10MM 16FR BLM-SNG CLS INDWL NS IN1610-NS SUPPLY/IMPLANTS "$1,129.00 " Outpatient $564.50 Not Applicable: Bundled with Procedure $733.85 $790.30 $745.14 Not Applicable: Bundled with Procedure $395.15 $903.20 $395.15 $903.20 PROS VOICE 12MM 16FR BLM-SNG CLS INDWL 2ND NS IN1612-NS SUPPLY/IMPLANTS "$1,129.00 " Outpatient $564.50 Not Applicable: Bundled with Procedure $733.85 $790.30 $745.14 Not Applicable: Bundled with Procedure $395.15 $903.20 $395.15 $903.20 PROS VOICE 14MM 16FR BLM-SNG CLS INDWL NS IN 1614 NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 16MM 16FR BLM-SNG CLS INDWL 2ND NS IN 1616 NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 18MM 16FR BLM-SNG CLS INDWL OPTN GEL CAP INS CLN IN1618-NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 20MM 16FR BLM-SNG CLS INDWL OPTN GEL CAP INS CLN IN1620-NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 22MM 16FR BLM-SNG CLS INDWL OPTN GEL CAP INS CLN IN1622-NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 4MM 20FR BLM-SNG CLS INDWL NS IN2004-NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE LG RING 6MM 20FR CLS BLM-SNG ESPH KT INDWELL IN2006-NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 8MM 20FR BLM-SNG TE INDWELL INSRTR FLNG INTRO GEL IN2008-NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 10MM 20FR BLM-SNG CLS INDWL NS IN 2010 NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 12MM 20FR BLM-SNG CLS INDWL 2ND NS IN2012-NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE RING 14MM 20FR CLS BLM-SNG INDWELL RADOPQ NS IN2014-NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 16MM 20FR BLM-SNG CLS INDWL 2ND NS IN 2016 NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 18MM 20FR BLM-SNG CLS INDWL NS IN2018-NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 20MM 20FR BLM-SNG CLS INDWL NS IN2020-NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE 22MM 20FR BLM-SNG CLS INDWL NS IN2022-NS SUPPLY/IMPLANTS "$1,073.00 " Outpatient $536.50 Not Applicable: Bundled with Procedure $697.45 $751.10 $708.18 Not Applicable: Bundled with Procedure $375.55 $858.40 $375.55 $858.40 PROS VOICE BGE PRVX HME SPLSH CSST NRM NS DISP 7242C SUPPLY/IMPLANTS $531.00 Outpatient $265.50 Not Applicable: Bundled with Procedure $345.15 $371.70 $350.46 Not Applicable: Bundled with Procedure $185.85 $424.80 $185.85 $424.80 PROS VOICE BGE PRVX HME SPLSH CSST HFLO NS DISP 7243C SUPPLY/IMPLANTS $531.00 Outpatient $265.50 Not Applicable: Bundled with Procedure $345.15 $371.70 $350.46 Not Applicable: Bundled with Procedure $185.85 $424.80 $185.85 $424.80 PROS VOICE 10MM 17FR VEGA PRVX QCK CLN RX STRL 8113 SUPPLY/IMPLANTS "$1,402.00 " Outpatient $701.00 Not Applicable: Bundled with Procedure $911.30 $981.40 $925.32 Not Applicable: Bundled with Procedure $490.70 "$1,121.60 " $490.70 "$1,121.60 " PROS VOICE 12.5MM 17FR PRVX VEGA 8114 SUPPLY/IMPLANTS "$1,402.00 " Outpatient $701.00 Not Applicable: Bundled with Procedure $911.30 $981.40 $925.32 Not Applicable: Bundled with Procedure $490.70 "$1,121.60 " $490.70 "$1,121.60 " PROSA WITH PROGAV 2.0 AND PAEDIATRIC BURRHOLE RESERVOIR 14MM FX997T SUPPLY/IMPLANTS "$35,001.00 " Outpatient "$17,500.50 " Not Applicable: Bundled with Procedure "$22,750.65 " "$24,500.70 " "$23,100.66 " Not Applicable: Bundled with Procedure "$12,250.35 " "$28,000.80 " "$12,250.35 " "$28,000.80 " PROSTHESIS VOICE SIZER 20 FR WITH 3 INSERTERS NEW BE2036 SUPPLY/IMPLANTS $536.00 Outpatient $268.00 Not Applicable: Bundled with Procedure $348.40 $375.20 $353.76 Not Applicable: Bundled with Procedure $187.60 $428.80 $187.60 $428.80 PROSTHESIS EAR ROBINSON STAPES N002 SUPPLY/IMPLANTS "$1,317.00 " Outpatient $658.50 Not Applicable: Bundled with Procedure $856.05 $921.90 $869.22 Not Applicable: Bundled with Procedure $460.95 "$1,053.60 " $460.95 "$1,053.60 " PROSTHESIS VOICE INDEWLLING 8MM 20 FR AS2008-NS SUPPLY/IMPLANTS "$1,790.00 " Outpatient $895.00 Not Applicable: Bundled with Procedure "$1,163.50 " "$1,253.00 " "$1,181.40 " Not Applicable: Bundled with Procedure $626.50 "$1,432.00 " $626.50 "$1,432.00 " PSR CRV WORM SUT ASCP STRL AR-1268 SUPPLY/IMPLANTS "$1,170.00 " Outpatient $585.00 Not Applicable: Bundled with Procedure $760.50 $819.00 $772.20 Not Applicable: Bundled with Procedure $409.50 $936.00 $409.50 $936.00 PSR SUTLSO MIC SM CRV BNT 6IN 1.25MM BRD ES REPR MAJ MTRS AR-8701 SUPPLY/IMPLANTS "$1,282.00 " Outpatient $641.00 Not Applicable: Bundled with Procedure $833.30 $897.40 $846.12 Not Applicable: Bundled with Procedure $448.70 "$1,025.60 " $448.70 "$1,025.60 " RADIESSE VOLUME ADVANTAGE 1.5CC 8063M0K2 SUPPLY/IMPLANTS "$1,997.00 " Outpatient $998.50 Not Applicable: Bundled with Procedure "$1,298.05 " "$1,397.90 " "$1,318.02 " Not Applicable: Bundled with Procedure $698.95 "$1,597.60 " $698.95 "$1,597.60 " REVERSE SHOULDER CONTRACT PRICE RVSR SUPPLY/IMPLANTS "$51,322.00 " Outpatient "$25,661.00 " Not Applicable: Bundled with Procedure "$33,359.30 " "$35,925.40 " "$33,872.52 " Not Applicable: Bundled with Procedure "$17,962.70 " "$41,057.60 " "$17,962.70 " "$41,057.60 " RING ANLPLS 25MM MTRL/TRCSPD FLXB SMLS STRL LF 700FF25 SUPPLY/IMPLANTS "$10,248.00 " Outpatient "$5,124.00 " Not Applicable: Bundled with Procedure "$6,661.20 " "$7,173.60 " "$6,763.68 " Not Applicable: Bundled with Procedure "$3,586.80 " "$8,198.40 " "$3,586.80 " "$8,198.40 " RING ANLPLS 27MM MTRL FLLY FLXB SMLS 700FF27 SUPPLY/IMPLANTS "$10,248.00 " Outpatient "$5,124.00 " Not Applicable: Bundled with Procedure "$6,661.20 " "$7,173.60 " "$6,763.68 " Not Applicable: Bundled with Procedure "$3,586.80 " "$8,198.40 " "$3,586.80 " "$8,198.40 " RING ANLPLS 29MM MTRL/TRCSPD FLXB ANT BAND ATS SMLS PLSTR 700FF29 SUPPLY/IMPLANTS "$4,750.00 " Outpatient "$2,375.00 " Not Applicable: Bundled with Procedure "$3,087.50 " "$3,325.00 " "$3,135.00 " Not Applicable: Bundled with Procedure "$1,662.50 " "$3,800.00 " "$1,662.50 " "$3,800.00 " RING ANLPLS 26MM TRCSD CNTR 3D TI SIL PLSTR FBRC 33MM HRT 690R26 SUPPLY/IMPLANTS "$12,474.00 " Outpatient "$6,237.00 " Not Applicable: Bundled with Procedure "$8,108.10 " "$8,731.80 " "$8,232.84 " Not Applicable: Bundled with Procedure "$4,365.90 " "$9,979.20 " "$4,365.90 " "$9,979.20 " RING ANLPLS 29MM FLXB SURE LCK DLV SYS PCUT C SJM T SIL BA TAB-29 SUPPLY/IMPLANTS "$7,337.00 " Outpatient "$3,668.50 " Not Applicable: Bundled with Procedure "$4,769.05 " "$5,135.90 " "$4,842.42 " Not Applicable: Bundled with Procedure "$2,567.95 " "$5,869.60 " "$2,567.95 " "$5,869.60 " RING ANLPLS 26MM TRCSD SEAM 2 WRP ED MC3 TI PLSTR SIL RBR 4900T26 SUPPLY/IMPLANTS "$11,243.00 " Outpatient "$5,621.50 " Not Applicable: Bundled with Procedure "$7,307.95 " "$7,870.10 " "$7,420.38 " Not Applicable: Bundled with Procedure "$3,935.05 " "$8,994.40 " "$3,935.05 " "$8,994.40 " RING ANLPLS 28MM TRCSD SEAM 2 WRP ED MC3 TI PLSTR SIL RBR 4900T28 SUPPLY/IMPLANTS "$11,243.00 " Outpatient "$5,621.50 " Not Applicable: Bundled with Procedure "$7,307.95 " "$7,870.10 " "$7,420.38 " Not Applicable: Bundled with Procedure "$3,935.05 " "$8,994.40 " "$3,935.05 " "$8,994.40 " RING ANLPLS 30MM TRCSD 1 SEAM 2 WRP ANTM ED MC3 TI SIL RBR 4900T30 SUPPLY/IMPLANTS "$11,243.00 " Outpatient "$5,621.50 " Not Applicable: Bundled with Procedure "$7,307.95 " "$7,870.10 " "$7,420.38 " Not Applicable: Bundled with Procedure "$3,935.05 " "$8,994.40 " "$3,935.05 " "$8,994.40 " RING ANLPLS 32MM TRCSD ED MC3 3D ANG DN 4900T32 SUPPLY/IMPLANTS "$11,243.00 " Outpatient "$5,621.50 " Not Applicable: Bundled with Procedure "$7,307.95 " "$7,870.10 " "$7,420.38 " Not Applicable: Bundled with Procedure "$3,935.05 " "$8,994.40 " "$3,935.05 " "$8,994.40 " RING ANLPLS 34MM TRCSD 1 SEAM 2 WRP ANTM ED MC3 TI SIL RBR 4900T34 SUPPLY/IMPLANTS "$11,243.00 " Outpatient "$5,621.50 " Not Applicable: Bundled with Procedure "$7,307.95 " "$7,870.10 " "$7,420.38 " Not Applicable: Bundled with Procedure "$3,935.05 " "$8,994.40 " "$3,935.05 " "$8,994.40 " RING ANLPLS 36MM TRCSD 1 SEAM 2 WRP ANTM ED MC3 TI SIL RBR 4900T36 SUPPLY/IMPLANTS "$11,243.00 " Outpatient "$5,621.50 " Not Applicable: Bundled with Procedure "$7,307.95 " "$7,870.10 " "$7,420.38 " Not Applicable: Bundled with Procedure "$3,935.05 " "$8,994.40 " "$3,935.05 " "$8,994.40 " RING ANLPLS 26MM MTRL C-E PH II 5200M26 SUPPLY/IMPLANTS "$12,709.00 " Outpatient "$6,354.50 " Not Applicable: Bundled with Procedure "$8,260.85 " "$8,896.30 " "$8,387.94 " Not Applicable: Bundled with Procedure "$4,448.15 " "$10,167.20 " "$4,448.15 " "$10,167.20 " RING ANLPLS 28MM MTRL C-E PH II 5200M28 SUPPLY/IMPLANTS "$12,709.00 " Outpatient "$6,354.50 " Not Applicable: Bundled with Procedure "$8,260.85 " "$8,896.30 " "$8,387.94 " Not Applicable: Bundled with Procedure "$4,448.15 " "$10,167.20 " "$4,448.15 " "$10,167.20 " RING ANLPLS 30MM MTRL C-E PH II 5200M30 SUPPLY/IMPLANTS "$12,709.00 " Outpatient "$6,354.50 " Not Applicable: Bundled with Procedure "$8,260.85 " "$8,896.30 " "$8,387.94 " Not Applicable: Bundled with Procedure "$4,448.15 " "$10,167.20 " "$4,448.15 " "$10,167.20 " RING ANLPLS 32MM MTRL C-E PH II 5200M32 SUPPLY/IMPLANTS "$12,709.00 " Outpatient "$6,354.50 " Not Applicable: Bundled with Procedure "$8,260.85 " "$8,896.30 " "$8,387.94 " Not Applicable: Bundled with Procedure "$4,448.15 " "$10,167.20 " "$4,448.15 " "$10,167.20 " RING ANLPLS 34MM MTRL C-E PH II 5200M34 SUPPLY/IMPLANTS "$12,709.00 " Outpatient "$6,354.50 " Not Applicable: Bundled with Procedure "$8,260.85 " "$8,896.30 " "$8,387.94 " Not Applicable: Bundled with Procedure "$4,448.15 " "$10,167.20 " "$4,448.15 " "$10,167.20 " RING ANLPLS 36MM MTRL HLDR C-E PH II COCR SIL PLSTR STRL 5200M36 SUPPLY/IMPLANTS "$12,709.00 " Outpatient "$6,354.50 " Not Applicable: Bundled with Procedure "$8,260.85 " "$8,896.30 " "$8,387.94 " Not Applicable: Bundled with Procedure "$4,448.15 " "$10,167.20 " "$4,448.15 " "$10,167.20 " RING ANLPLS 38MM MTRL C-E PH II 5200M38 SUPPLY/IMPLANTS "$12,709.00 " Outpatient "$6,354.50 " Not Applicable: Bundled with Procedure "$8,260.85 " "$8,896.30 " "$8,387.94 " Not Applicable: Bundled with Procedure "$4,448.15 " "$10,167.20 " "$4,448.15 " "$10,167.20 " RING ANLPLS 40MM MTRL HLDR SW C-E PH II COCR SIL PLSTR STRL 5200M40 SUPPLY/IMPLANTS "$12,709.00 " Outpatient "$6,354.50 " Not Applicable: Bundled with Procedure "$8,260.85 " "$8,896.30 " "$8,387.94 " Not Applicable: Bundled with Procedure "$4,448.15 " "$10,167.20 " "$4,448.15 " "$10,167.20 " RING ANLPLS 34MM 28MM 27MM SMRG SJM SGN SARP-28 SUPPLY/IMPLANTS "$7,700.00 " Outpatient "$3,850.00 " Not Applicable: Bundled with Procedure "$5,005.00 " "$5,390.00 " "$5,082.00 " Not Applicable: Bundled with Procedure "$2,695.00 " "$6,160.00 " "$2,695.00 " "$6,160.00 " RING ANLPLS 32MM TRCSD CNTR 3D TI SIL PLSTR FBRC 33MM HRT 690R32 SUPPLY/IMPLANTS "$10,510.00 " Outpatient "$5,255.00 " Not Applicable: Bundled with Procedure "$6,831.50 " "$7,357.00 " "$6,936.60 " Not Applicable: Bundled with Procedure "$3,678.50 " "$8,408.00 " "$3,678.50 " "$8,408.00 " RING ANNULOPLASTY 36MM DIA 3D CONTOURED CONTOUR 3D 690R36 SUPPLY/IMPLANTS "$9,296.00 " Outpatient "$4,648.00 " Not Applicable: Bundled with Procedure "$6,042.40 " "$6,507.20 " "$6,135.36 " Not Applicable: Bundled with Procedure "$3,253.60 " "$7,436.80 " "$3,253.60 " "$7,436.80 " RING ANNULOPLASTY CONTOUR 3D 387.2 SQ MM CONTOUR H3.3 MM OD2 690R28 SUPPLY/IMPLANTS "$9,296.00 " Outpatient "$4,648.00 " Not Applicable: Bundled with Procedure "$6,042.40 " "$6,507.20 " "$6,135.36 " Not Applicable: Bundled with Procedure "$3,253.60 " "$7,436.80 " "$3,253.60 " "$7,436.80 " RING EXTERNAL FIXATION HOFFMANN OD180 MM FULL NONSTERILE LAT 4933-2-180 SUPPLY/IMPLANTS "$5,258.00 " Outpatient "$2,629.00 " Not Applicable: Bundled with Procedure "$3,417.70 " "$3,680.60 " "$3,470.28 " Not Applicable: Bundled with Procedure "$1,840.30 " "$4,206.40 " "$1,840.30 " "$4,206.40 " RING EXTERNAL FIXATION HOFFMANN OD180 MM FULL NONSTERILE LAT 4933-3-180 SUPPLY/IMPLANTS "$4,905.00 " Outpatient "$2,452.50 " Not Applicable: Bundled with Procedure "$3,188.25 " "$3,433.50 " "$3,237.30 " Not Applicable: Bundled with Procedure "$1,716.75 " "$3,924.00 " "$1,716.75 " "$3,924.00 " RING EXTERNAL FIXATION HOFFMANN OD180 MM FULL NONSTERILE LAT 4933-4-180 SUPPLY/IMPLANTS "$4,560.00 " Outpatient "$2,280.00 " Not Applicable: Bundled with Procedure "$2,964.00 " "$3,192.00 " "$3,009.60 " Not Applicable: Bundled with Procedure "$1,596.00 " "$3,648.00 " "$1,596.00 " "$3,648.00 " RING EXTERNAL FIXATION ALUMINUM LONG OD140 MM FOOT 4934-2-140 SUPPLY/IMPLANTS "$6,077.00 " Outpatient "$3,038.50 " Not Applicable: Bundled with Procedure "$3,950.05 " "$4,253.90 " "$4,010.82 " Not Applicable: Bundled with Procedure "$2,126.95 " "$4,861.60 " "$2,126.95 " "$4,861.60 " RING EXTERNAL FIXATION ID140 MM 3/4 RING NONSTERILE HYBRID F 393.734 SUPPLY/IMPLANTS "$2,800.00 " Outpatient "$1,400.00 " Not Applicable: Bundled with Procedure "$1,820.00 " "$1,960.00 " "$1,848.00 " Not Applicable: Bundled with Procedure $980.00 "$2,240.00 " $980.00 "$2,240.00 " RING EXTERNAL FIXATION SIZE 3/4IN 205MM ID CARBON HYBRID MRI 393.722 SUPPLY/IMPLANTS "$3,381.00 " Outpatient "$1,690.50 " Not Applicable: Bundled with Procedure "$2,197.65 " "$2,366.70 " "$2,231.46 " Not Applicable: Bundled with Procedure "$1,183.35 " "$2,704.80 " "$1,183.35 " "$2,704.80 " RING TNSN 12MM STABILEYES SMCRC CPSLR PERSPEX CQ MNPLT EYLT STBL12US SUPPLY/IMPLANTS "$1,084.00 " Outpatient $542.00 Not Applicable: Bundled with Procedure $704.60 $758.80 $715.44 Not Applicable: Bundled with Procedure $379.40 $867.20 $379.40 $867.20 RING TNSN 13MM STABILEYES SMCRC CPSLR PERSPEX CQ MNPLT EYLT STBL13US SUPPLY/IMPLANTS "$1,084.00 " Outpatient $542.00 Not Applicable: Bundled with Procedure $704.60 $758.80 $715.44 Not Applicable: Bundled with Procedure $379.40 $867.20 $379.40 $867.20 RLD STPLR 75MMX4.5MM PRX TI THKTIS 4 ROW LNR CTR SFLOK OUT TRT75 SUPPLY/IMPLANTS $457.00 Outpatient $228.50 Not Applicable: Bundled with Procedure $297.05 $319.90 $301.62 Not Applicable: Bundled with Procedure $159.95 $365.60 $159.95 $365.60 RMR BTN SPRG TK2 SRG DISP 14599 SUPPLY/IMPLANTS "$1,659.00 " Outpatient $829.50 Not Applicable: Bundled with Procedure "$1,078.35 " "$1,161.30 " "$1,094.94 " Not Applicable: Bundled with Procedure $580.65 "$1,327.20 " $580.65 "$1,327.20 " RMR CNN 7MM ACL LOPRFL SRG STRL DISP AR-1407LP SUPPLY/IMPLANTS "$1,592.00 " Outpatient $796.00 Not Applicable: Bundled with Procedure "$1,034.80 " "$1,114.40 " "$1,050.72 " Not Applicable: Bundled with Procedure $557.20 "$1,273.60 " $557.20 "$1,273.60 " RMR FLXB GW SDCT 10MM PRS SNTL NI SS TI 476MM 3MM SRG NS LF 222801000 SUPPLY/IMPLANTS "$2,757.00 " Outpatient "$1,378.50 " Not Applicable: Bundled with Procedure "$1,792.05 " "$1,929.90 " "$1,819.62 " Not Applicable: Bundled with Procedure $964.95 "$2,205.60 " $964.95 "$2,205.60 " RMR HUB CAP SRG PL-SR40 SUPPLY/IMPLANTS "$2,897.00 " Outpatient "$1,448.50 " Not Applicable: Bundled with Procedure "$1,883.05 " "$2,027.90 " "$1,912.02 " Not Applicable: Bundled with Procedure "$1,013.95 " "$2,317.60 " "$1,013.95 " "$2,317.60 " ROD EXTERNAL FIXATION HOFFMANN 3 VECTRAN CARBON L100 MM OD11 4922-8-100 SUPPLY/IMPLANTS "$1,665.00 " Outpatient $832.50 Not Applicable: Bundled with Procedure "$1,082.25 " "$1,165.50 " "$1,098.90 " Not Applicable: Bundled with Procedure $582.75 "$1,332.00 " $582.75 "$1,332.00 " ROD PREBENT MIS 100MM 10705100 SUPPLY/IMPLANTS "$2,284.00 " Outpatient "$1,142.00 " Not Applicable: Bundled with Procedure "$1,484.60 " "$1,598.80 " "$1,507.44 " Not Applicable: Bundled with Procedure $799.40 "$1,827.20 " $799.40 "$1,827.20 " ROD RM 950MM 3MM STRG BALL TIP XPRT NL SYS STRL 351.76S SUPPLY/IMPLANTS "$1,317.00 " Outpatient $658.50 Not Applicable: Bundled with Procedure $856.05 $921.90 $869.22 Not Applicable: Bundled with Procedure $460.95 "$1,053.60 " $460.95 "$1,053.60 " ROD RM 850MM 2.5MM TI CLBRT STRL 359.083S SUPPLY/IMPLANTS "$1,115.00 " Outpatient $557.50 Not Applicable: Bundled with Procedure $724.75 $780.50 $735.90 Not Applicable: Bundled with Procedure $390.25 $892.00 $390.25 $892.00 ROD RM 950MM 2.5MM BALL TIP XTN IM NL STRL DISP 351.707S SUPPLY/IMPLANTS $780.00 Outpatient $390.00 Not Applicable: Bundled with Procedure $507.00 $546.00 $514.80 Not Applicable: Bundled with Procedure $273.00 $624.00 $273.00 $624.00 ROD XTRNFX 160MM 8MM MED CFBR NS 395.779 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 Not Applicable: Bundled with Procedure $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 $808.00 ROD XTRNFX 240MM 8MM DIST RDS CFBR NS 395.786 SUPPLY/IMPLANTS "$1,124.00 " Outpatient $562.00 Not Applicable: Bundled with Procedure $730.60 $786.80 $741.84 Not Applicable: Bundled with Procedure $393.40 $899.20 $393.40 $899.20 ROD XTRNFX 100MM 11MM CFBR SLF DRL NS 394.8 SUPPLY/IMPLANTS $765.00 Outpatient $382.50 Not Applicable: Bundled with Procedure $497.25 $535.50 $504.90 Not Applicable: Bundled with Procedure $267.75 $612.00 $267.75 $612.00 ROD XTRNFX 200MM 8MM RDS DIST CFBR NS 395.782 SUPPLY/IMPLANTS "$1,124.00 " Outpatient $562.00 Not Applicable: Bundled with Procedure $730.60 $786.80 $741.84 Not Applicable: Bundled with Procedure $393.40 $899.20 $393.40 $899.20 ROD XTRNFX 220MM 8MM CFBR 395.784 SUPPLY/IMPLANTS "$1,004.00 " Outpatient $502.00 Not Applicable: Bundled with Procedure $652.60 $702.80 $662.64 Not Applicable: Bundled with Procedure $351.40 $803.20 $351.40 $803.20 ROD XTRNFX 150MM 11MM CFBR MR CONDITIONAL NS 394.82 SUPPLY/IMPLANTS "$1,493.00 " Outpatient $746.50 Not Applicable: Bundled with Procedure $970.45 "$1,045.10 " $985.38 Not Applicable: Bundled with Procedure $522.55 "$1,194.40 " $522.55 "$1,194.40 " ROD XTRNFX 200MM 11MM CFBR MR CONDITIONAL NS 394.83 SUPPLY/IMPLANTS "$1,601.00 " Outpatient $800.50 Not Applicable: Bundled with Procedure "$1,040.65 " "$1,120.70 " "$1,056.66 " Not Applicable: Bundled with Procedure $560.35 "$1,280.80 " $560.35 "$1,280.80 " ROD XTRNFX 250MM 11MM CFBR MR CONDITIONAL NS 394.84 SUPPLY/IMPLANTS "$1,716.00 " Outpatient $858.00 Not Applicable: Bundled with Procedure "$1,115.40 " "$1,201.20 " "$1,132.56 " Not Applicable: Bundled with Procedure $600.60 "$1,372.80 " $600.60 "$1,372.80 " ROD XTRNFX 300MM 11MM CFBR MR CONDITIONAL NS 394.85 SUPPLY/IMPLANTS "$1,790.00 " Outpatient $895.00 Not Applicable: Bundled with Procedure "$1,163.50 " "$1,253.00 " "$1,181.40 " Not Applicable: Bundled with Procedure $626.50 "$1,432.00 " $626.50 "$1,432.00 " ROD XTRNFX 350MM 11MM CFBR MR CONDITIONAL NS 394.86 SUPPLY/IMPLANTS "$1,790.00 " Outpatient $895.00 Not Applicable: Bundled with Procedure "$1,163.50 " "$1,253.00 " "$1,181.40 " Not Applicable: Bundled with Procedure $626.50 "$1,432.00 " $626.50 "$1,432.00 " ROD XTRNFX 400MM 11MM CFBR MR CONDITIONAL NS 394.87 SUPPLY/IMPLANTS "$1,968.00 " Outpatient $984.00 Not Applicable: Bundled with Procedure "$1,279.20 " "$1,377.60 " "$1,298.88 " Not Applicable: Bundled with Procedure $688.80 "$1,574.40 " $688.80 "$1,574.40 " ROD XTRNFX 280MM 8MM DIST RDS CFBR NS 395.788 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 Not Applicable: Bundled with Procedure $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 $808.00 ROD XTRNFX YLW 300MM 8MM HFMN2 C CNCT MRI SAFE NCDTV 5028-8-300 SUPPLY/IMPLANTS "$1,170.00 " Outpatient $585.00 Not Applicable: Bundled with Procedure $760.50 $819.00 $772.20 Not Applicable: Bundled with Procedure $409.50 $936.00 $409.50 $936.00 RSRV SHNT OMYA CSF 2.5CM FLT BTM SD INLT 1.14ML STRL NL850-1212 SUPPLY/IMPLANTS "$1,953.00 " Outpatient $976.50 Not Applicable: Bundled with Procedure "$1,269.45 " "$1,367.10 " "$1,288.98 " Not Applicable: Bundled with Procedure $683.55 "$1,562.40 " $683.55 "$1,562.40 " RUBY COIL STANDARD 12MM X 40CM RBY2C1240 SUPPLY/IMPLANTS "$7,784.00 " Outpatient "$3,892.00 " Not Applicable: Bundled with Procedure "$5,059.60 " "$5,448.80 " "$5,137.44 " Not Applicable: Bundled with Procedure "$2,724.40 " "$6,227.20 " "$2,724.40 " "$6,227.20 " SCR BN SS 46MM 4.5MM 6.5MM 1.75MM P/T RVRS CUT FLUT CNN ST 214.546 SUPPLY/IMPLANTS "$1,295.00 " Outpatient $647.50 Not Applicable: Bundled with Procedure $841.75 $906.50 $854.70 Not Applicable: Bundled with Procedure $453.25 "$1,036.00 " $453.25 "$1,036.00 " SCR BN SS 48MM 4.5MM 6.5MM 1.75MM P/T RVRS CUT FLUT CNN ST 214.548 SUPPLY/IMPLANTS "$1,295.00 " Outpatient $647.50 Not Applicable: Bundled with Procedure $841.75 $906.50 $854.70 Not Applicable: Bundled with Procedure $453.25 "$1,036.00 " $453.25 "$1,036.00 " SCR BN SS 50MM 4.5MM 6.5MM 1.75MM P/T RVRS CUT FLUT CNN ST 214.55 SUPPLY/IMPLANTS "$1,448.00 " Outpatient $724.00 Not Applicable: Bundled with Procedure $941.20 "$1,013.60 " $955.68 Not Applicable: Bundled with Procedure $506.80 "$1,158.40 " $506.80 "$1,158.40 " SCR BN SS 46MM 4MM 5MM L/T RVRS CUT FLUT CNN ST SLF DRL SM 207.746 SUPPLY/IMPLANTS "$1,517.00 " Outpatient $758.50 Not Applicable: Bundled with Procedure $986.05 "$1,061.90 " "$1,001.22 " Not Applicable: Bundled with Procedure $530.95 "$1,213.60 " $530.95 "$1,213.60 " SCR BN SS 46MM 4MM 5MM 1.35MM ST RVRS CUT FLUT CNN ST SLF 207.646 SUPPLY/IMPLANTS "$1,420.00 " Outpatient $710.00 Not Applicable: Bundled with Procedure $923.00 $994.00 $937.20 Not Applicable: Bundled with Procedure $497.00 "$1,136.00 " $497.00 "$1,136.00 " SCR BN SS 48MM 4MM 5MM 1.35MM ST RVRS CUT FLUT CNN ST SLF 207.648 SUPPLY/IMPLANTS "$1,272.00 " Outpatient $636.00 Not Applicable: Bundled with Procedure $826.80 $890.40 $839.52 Not Applicable: Bundled with Procedure $445.20 "$1,017.60 " $445.20 "$1,017.60 " SCR BN SS 45MM 3.5MM 2.9MM T15 FT ST LCK STRDR CNCL HD NS 212.119 SUPPLY/IMPLANTS $855.00 Outpatient $427.50 Not Applicable: Bundled with Procedure $555.75 $598.50 $564.30 Not Applicable: Bundled with Procedure $299.25 $684.00 $299.25 $684.00 SCR BN SS 50MM 3.5MM 2.9MM T15 FT ST LCK STRDR CNCL HD NS 212.121 SUPPLY/IMPLANTS $815.00 Outpatient $407.50 Not Applicable: Bundled with Procedure $529.75 $570.50 $537.90 Not Applicable: Bundled with Procedure $285.25 $652.00 $285.25 $652.00 SCR HEADFRAME LNG RING STRL DISP DHRSL5 SUPPLY/IMPLANTS $436.00 Outpatient $218.00 Not Applicable: Bundled with Procedure $283.40 $305.20 $287.76 Not Applicable: Bundled with Procedure $152.60 $348.80 $152.60 $348.80 SEPRTR THRMB 142CM .035IN PENUMBRA SYS SEPRTR FLX 175CM .041 PSF041 SUPPLY/IMPLANTS "$14,624.00 " Outpatient "$7,312.00 " Not Applicable: Bundled with Procedure "$9,505.60 " "$10,236.80 " "$9,651.84 " Not Applicable: Bundled with Procedure "$5,118.40 " "$11,699.20 " "$5,118.40 " "$11,699.20 " SET HD LEN OPTIMIZE OPHTHSCP BIOM RDY DISP 175MM 54413 SUPPLY/IMPLANTS $855.00 Outpatient $427.50 Not Applicable: Bundled with Procedure $555.75 $598.50 $564.30 Not Applicable: Bundled with Procedure $299.25 $684.00 $299.25 $684.00 SET PIN UNIVERS REVERS STRL AR-9507S SUPPLY/IMPLANTS "$2,283.00 " Outpatient "$1,141.50 " Not Applicable: Bundled with Procedure "$1,483.95 " "$1,598.10 " "$1,506.78 " Not Applicable: Bundled with Procedure $799.05 "$1,826.40 " $799.05 "$1,826.40 " SET PIN UNIVERS II STERILE AR-9207S SUPPLY/IMPLANTS "$1,570.00 " Outpatient $785.00 Not Applicable: Bundled with Procedure "$1,020.50 " "$1,099.00 " "$1,036.20 " Not Applicable: Bundled with Procedure $549.50 "$1,256.00 " $549.50 "$1,256.00 " SHL ACTB 56MM HIP SECT PRCT PNCL 121722056 SUPPLY/IMPLANTS "$4,881.00 " Outpatient "$2,440.50 " Not Applicable: Bundled with Procedure "$3,172.65 " "$3,416.70 " "$3,221.46 " Not Applicable: Bundled with Procedure "$1,708.35 " "$3,904.80 " "$1,708.35 " "$3,904.80 " SHNT CRTD 8-14FR BARD BRENER TPR 13CM TY 1887 ACC T SD ARM 7755 SUPPLY/IMPLANTS $527.00 Outpatient $263.50 Not Applicable: Bundled with Procedure $342.55 $368.90 $347.82 Not Applicable: Bundled with Procedure $184.45 $421.60 $184.45 $421.60 SHNT CRTD 10-17FR BARD JVD TPR 27.5CM TY 1852 KINK RST PLSH 7714 SUPPLY/IMPLANTS $545.00 Outpatient $272.50 Not Applicable: Bundled with Procedure $354.25 $381.50 $359.70 Not Applicable: Bundled with Procedure $190.75 $436.00 $190.75 $436.00 SHNT NS PERITONEUM STD 90CM CSF 2.5MM 1.3MM STRL 43551 SUPPLY/IMPLANTS $839.00 Outpatient $419.50 Not Applicable: Bundled with Procedure $545.35 $587.30 $553.74 Not Applicable: Bundled with Procedure $293.65 $671.20 $293.65 $671.20 SHNT NS SPTZLR TOUHY 80CM CSF LMBPRTNL CATH NDL SIL 14GA NL8507210 SUPPLY/IMPLANTS "$3,221.00 " Outpatient "$1,610.50 " Not Applicable: Bundled with Procedure "$2,093.65 " "$2,254.70 " "$2,125.86 " Not Applicable: Bundled with Procedure "$1,127.35 " "$2,576.80 " "$1,127.35 " "$2,576.80 " SHNT NS VNTRC 15CM CSF DOME SNP ASMB TUBE STRL 24085 SUPPLY/IMPLANTS "$1,287.00 " Outpatient $643.50 Not Applicable: Bundled with Procedure $836.55 $900.90 $849.42 Not Applicable: Bundled with Procedure $450.45 "$1,029.60 " $450.45 "$1,029.60 " SHT SNTH 50X50X.8MM SQ CRNMXF SYNPOR NABSB BRR SRFC SMTH 08.510.120S SUPPLY/IMPLANTS "$2,252.00 " Outpatient "$1,126.00 " Not Applicable: Bundled with Procedure "$1,463.80 " "$1,576.40 " "$1,486.32 " Not Applicable: Bundled with Procedure $788.20 "$1,801.60 " $788.20 "$1,801.60 " SHT SNTH 50X50X1.5MM SQ CRNMXF SYNPOR NABSB BRR SRFC SMTH 08.510.130S SUPPLY/IMPLANTS "$2,252.00 " Outpatient "$1,126.00 " Not Applicable: Bundled with Procedure "$1,463.80 " "$1,576.40 " "$1,486.32 " Not Applicable: Bundled with Procedure $788.20 "$1,801.60 " $788.20 "$1,801.60 " SHT SNTH 50X50X3MM SQ CRNMXF SYNPOR NABSB BRR SRFC SMTH SMRG 08.510.140S SUPPLY/IMPLANTS "$4,309.00 " Outpatient "$2,154.50 " Not Applicable: Bundled with Procedure "$2,800.85 " "$3,016.30 " "$2,843.94 " Not Applicable: Bundled with Procedure "$1,508.15 " "$3,447.20 " "$1,508.15 " "$3,447.20 " SHT SNTH 50X50X.8MM SQ CRNMXF SYNPOR NABSB BRR SRFC SMTH 08.510.220S SUPPLY/IMPLANTS "$2,839.00 " Outpatient "$1,419.50 " Not Applicable: Bundled with Procedure "$1,845.35 " "$1,987.30 " "$1,873.74 " Not Applicable: Bundled with Procedure $993.65 "$2,271.20 " $993.65 "$2,271.20 " SHTH ASCP DART STRG MNSCS CNN STRL DISP AR-3007 SUPPLY/IMPLANTS $507.00 Outpatient $253.50 Not Applicable: Bundled with Procedure $329.55 $354.90 $334.62 Not Applicable: Bundled with Procedure $177.45 $405.60 $177.45 $405.60 SHTH ASCP DART 15D UP MNSCS CNN STRL DISP AR-3007-15 SUPPLY/IMPLANTS $507.00 Outpatient $253.50 Not Applicable: Bundled with Procedure $329.55 $354.90 $334.62 Not Applicable: Bundled with Procedure $177.45 $405.60 $177.45 $405.60 SHTH ASCP FX 30MM BINTRFX SM TIB 254629 SUPPLY/IMPLANTS "$2,121.00 " Outpatient "$1,060.50 " Not Applicable: Bundled with Procedure "$1,378.65 " "$1,484.70 " "$1,399.86 " Not Applicable: Bundled with Procedure $742.35 "$1,696.80 " $742.35 "$1,696.80 " SHUNT SENSOR CDI CDI1510H SUPPLY/IMPLANTS "$10,174.00 " Outpatient "$5,087.00 " Not Applicable: Bundled with Procedure "$6,613.10 " "$7,121.80 " "$6,714.84 " Not Applicable: Bundled with Procedure "$3,560.90 " "$8,139.20 " "$3,560.90 " "$8,139.20 " SIZER IMPLANT NATRELLE INSPIRA SILICONE P2 CM LOW PROFILE ROUND OD10.25 CM 125 CC BREAST GEL SMOOTH SUPPLY/IMPLANTS "$1,426.00 " Outpatient $713.00 Not Applicable: Bundled with Procedure $926.90 $998.20 $941.16 Not Applicable: Bundled with Procedure $499.10 "$1,140.80 " $499.10 "$1,140.80 " SIZER IMPLANT NATRELLE INSPIRA SILICONE P2.4 CM LOW PROFILE ROUND OD12 CM 230 CC BREAST GEL SMOOTH R SUPPLY/IMPLANTS "$1,426.00 " Outpatient $713.00 Not Applicable: Bundled with Procedure $926.90 $998.20 $941.16 Not Applicable: Bundled with Procedure $499.10 "$1,140.80 " $499.10 "$1,140.80 " SIZER IMPLANT NATRELLE INSPIRA SILICONE P5 CM FULL PROFILE R MSZ-F385 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 Not Applicable: Bundled with Procedure $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,141.60 " SIZER IMPLANT NATRELLE INSPIRA SILICONE P4.9 CM FULL PROFILE MSZ-F365 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 Not Applicable: Bundled with Procedure $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,141.60 " SIZER IMPLANT NATRELLE INSPIRA SILICONE P5 CM EXTRA FULL PRO MSZ-X285 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 Not Applicable: Bundled with Procedure $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,141.60 " SIZER IMPLANT NATRELLE INSPIRA SILICONE P5.6 CM EXTRA FULL P MSZ-X375 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 Not Applicable: Bundled with Procedure $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,141.60 " SIZER IMPLANT NATRELLE INSPIRA SILICONE P5.9 CM EXTRA FULL P MSZ-X420 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 Not Applicable: Bundled with Procedure $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,141.60 " SIZER IMPLANT NATRELLE INSPIRA SILICONE P6.6 CM EXTRA FULL P MSZ-X700 SUPPLY/IMPLANTS "$1,198.00 " Outpatient $599.00 Not Applicable: Bundled with Procedure $778.70 $838.60 $790.68 Not Applicable: Bundled with Procedure $419.30 $958.40 $419.30 $958.40 SIZER IMPLANT NATRELLE INSPIRA SILICONE P5.8 CM FULL PROFILE MSZ-F605 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 Not Applicable: Bundled with Procedure $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,141.60 " SIZER BREAST IMPLANT EXTRA FULL PROFILE 10CM DIA 4.5CM PROJE MSZ-X225 SUPPLY/IMPLANTS "$1,142.00 " Outpatient $571.00 Not Applicable: Bundled with Procedure $742.30 $799.40 $753.72 Not Applicable: Bundled with Procedure $399.70 $913.60 $399.70 $913.60 SIZER BREAST IMPLANT EXTRA-FULL PROFILE 13.25CM DIA 6.3CM RE MSZ-X560 SUPPLY/IMPLANTS "$1,142.00 " Outpatient $571.00 Not Applicable: Bundled with Procedure $742.30 $799.40 $753.72 Not Applicable: Bundled with Procedure $399.70 $913.60 $399.70 $913.60 SIZER BREAST IMPLANT EXTRA-FULL PROFILE 10.25CM DIA 4.8CM RE MSZ-X255 SUPPLY/IMPLANTS "$1,142.00 " Outpatient $571.00 Not Applicable: Bundled with Procedure $742.30 $799.40 $753.72 Not Applicable: Bundled with Procedure $399.70 $913.60 $399.70 $913.60 SIZER BREAST IMPLANT EXTRA-FULL PROFILE 12.25CM DIA 6.1CM RE MSZ-X470 SUPPLY/IMPLANTS "$1,142.00 " Outpatient $571.00 Not Applicable: Bundled with Procedure $742.30 $799.40 $753.72 Not Applicable: Bundled with Procedure $399.70 $913.60 $399.70 $913.60 SLNT DURA DURASEAL PG TRILYSINE AMINE 5ML 202050 SUPPLY/IMPLANTS "$4,003.00 " Outpatient "$2,001.50 " Not Applicable: Bundled with Procedure "$2,601.95 " "$2,802.10 " "$2,641.98 " Not Applicable: Bundled with Procedure "$1,401.05 " "$3,202.40 " "$1,401.05 " "$3,202.40 " SLV DRL 6MM 5MM SHRT THRD NS 395.921 SUPPLY/IMPLANTS $862.00 Outpatient $431.00 Not Applicable: Bundled with Procedure $560.30 $603.40 $568.92 Not Applicable: Bundled with Procedure $301.70 $689.60 $301.70 $689.60 SLV PRTC SYNFIX EVOL SCRDRVR AWL 03.835.012S SUPPLY/IMPLANTS $488.00 Outpatient $244.00 Not Applicable: Bundled with Procedure $317.20 $341.60 $322.08 Not Applicable: Bundled with Procedure $170.80 $390.40 $170.80 $390.40 SLV SPNL SYNFIX EVOL THRDLK 03.835.009S SUPPLY/IMPLANTS "$1,700.00 " Outpatient $850.00 Not Applicable: Bundled with Procedure "$1,105.00 " "$1,190.00 " "$1,122.00 " Not Applicable: Bundled with Procedure $595.00 "$1,360.00 " $595.00 "$1,360.00 " SLV TIB 45X27X40MM MBT KN MTPHSL POR REV STRL LF 129454110 SUPPLY/IMPLANTS "$13,379.00 " Outpatient "$6,689.50 " Not Applicable: Bundled with Procedure "$8,696.35 " "$9,365.30 " "$8,830.14 " Not Applicable: Bundled with Procedure "$4,682.65 " "$10,703.20 " "$4,682.65 " "$10,703.20 " SPCR ALGRF 10MM OSTSTM LRDTC CRV CORT CNC 45-5540 SUPPLY/IMPLANTS "$6,750.00 " Outpatient "$3,375.00 " Not Applicable: Bundled with Procedure "$4,387.50 " "$4,725.00 " "$4,455.00 " Not Applicable: Bundled with Procedure "$2,362.50 " "$5,400.00 " "$2,362.50 " "$5,400.00 " SPCR ALGRF 6MM OSTSTM LRDTC CRV CORT CNC 45-5536 SUPPLY/IMPLANTS "$5,551.00 " Outpatient "$2,775.50 " Not Applicable: Bundled with Procedure "$3,608.15 " "$3,885.70 " "$3,663.66 " Not Applicable: Bundled with Procedure "$1,942.85 " "$4,440.80 " "$1,942.85 " "$4,440.80 " SPCR ALGRF 7MM OSTSTM LRDTC CRV CORT CNC 45-5537 SUPPLY/IMPLANTS "$5,551.00 " Outpatient "$2,775.50 " Not Applicable: Bundled with Procedure "$3,608.15 " "$3,885.70 " "$3,663.66 " Not Applicable: Bundled with Procedure "$1,942.85 " "$4,440.80 " "$1,942.85 " "$4,440.80 " SPCR ALGRF 8MM OSTSTM LRDTC CRV CORT CNC 45-5538 SUPPLY/IMPLANTS "$6,750.00 " Outpatient "$3,375.00 " Not Applicable: Bundled with Procedure "$4,387.50 " "$4,725.00 " "$4,455.00 " Not Applicable: Bundled with Procedure "$2,362.50 " "$5,400.00 " "$2,362.50 " "$5,400.00 " SPCR ALGRF 14X7MM BIO AVS 4D 12MM LORDOSIS SPNE CRV CANC 77102074 SUPPLY/IMPLANTS "$5,870.00 " Outpatient "$2,935.00 " Not Applicable: Bundled with Procedure "$3,815.50 " "$4,109.00 " "$3,874.20 " Not Applicable: Bundled with Procedure "$2,054.50 " "$4,696.00 " "$2,054.50 " "$4,696.00 " SPHR EMBL GRN EMBSPH 700-900UM TRISACRYL GELTN PREFL 2ML SYR S820GH SUPPLY/IMPLANTS "$1,407.00 " Outpatient $703.50 Not Applicable: Bundled with Procedure $914.55 $984.90 $928.62 Not Applicable: Bundled with Procedure $492.45 "$1,125.60 " $492.45 "$1,125.60 " SPHR EMBL RED EMBSPH 500-700UM TRISACRYL GELTN PREFL 2ML SYR S620GH SUPPLY/IMPLANTS "$1,407.00 " Outpatient $703.50 Not Applicable: Bundled with Procedure $914.55 $984.90 $928.62 Not Applicable: Bundled with Procedure $492.45 "$1,125.60 " $492.45 "$1,125.60 " SPIRA C ACDF SPACER 6MM X 14 X 16MM SPC1416-0706 SUPPLY/IMPLANTS "$5,871.00 " Outpatient "$2,935.50 " Not Applicable: Bundled with Procedure "$3,816.15 " "$4,109.70 " "$3,874.86 " Not Applicable: Bundled with Procedure "$2,054.85 " "$4,696.80 " "$2,054.85 " "$4,696.80 " STAGED BILATERAL PLATFORM KIT W/D HARDWARE MP-KIT-02D-ST SUPPLY/IMPLANTS "$22,011.00 " Outpatient "$11,005.50 " Not Applicable: Bundled with Procedure "$14,307.15 " "$15,407.70 " "$14,527.26 " Not Applicable: Bundled with Procedure "$7,703.85 " "$17,608.80 " "$7,703.85 " "$17,608.80 " STENT GRAFT 24 X 96MM X 80 X 12MM SG-HBB-24-96-80-12-A SUPPLY/IMPLANTS "$58,695.00 " Outpatient "$29,347.50 " Not Applicable: Bundled with Procedure "$38,151.75 " "$41,086.50 " "$38,738.70 " Not Applicable: Bundled with Procedure "$20,543.25 " "$46,956.00 " "$20,543.25 " "$46,956.00 " STENT GRAFT 12 X 98MM SG-HBL-98-12-A13-20 SUPPLY/IMPLANTS "$9,783.00 " Outpatient "$4,891.50 " Not Applicable: Bundled with Procedure "$6,358.95 " "$6,848.10 " "$6,456.78 " Not Applicable: Bundled with Procedure "$3,424.05 " "$7,826.40 " "$3,424.05 " "$7,826.40 " STENT WINGSPAN SYSTEM 2.5 X 15 M003WS0250150 SUPPLY/IMPLANTS "$35,601.00 " Outpatient "$17,800.50 " Not Applicable: Bundled with Procedure "$23,140.65 " "$24,920.70 " "$23,496.66 " Not Applicable: Bundled with Procedure "$12,460.35 " "$28,480.80 " "$12,460.35 " "$28,480.80 " STENT WINGSPAN SYSTEM 3.0 X 15.0MM M003WS0300150 SUPPLY/IMPLANTS "$34,046.00 " Outpatient "$17,023.00 " Not Applicable: Bundled with Procedure "$22,129.90 " "$23,832.20 " "$22,470.36 " Not Applicable: Bundled with Procedure "$11,916.10 " "$27,236.80 " "$11,916.10 " "$27,236.80 " STIMULATOR NEUROMUSCULAR INTERSTIM TEST 353101 SUPPLY/IMPLANTS "$2,284.00 " Outpatient "$1,142.00 " Not Applicable: Bundled with Procedure "$1,484.60 " "$1,598.80 " "$1,507.44 " Not Applicable: Bundled with Procedure $799.40 "$1,827.20 " $799.40 "$1,827.20 " STNT DDNL 22-27MM 90MM 230CM DLV SYS WALLFLEX NTNL STRL DISP M00565020 SUPPLY/IMPLANTS "$12,791.00 " Outpatient "$6,395.50 " Not Applicable: Bundled with Procedure "$8,314.15 " "$8,953.70 " "$8,442.06 " Not Applicable: Bundled with Procedure "$4,476.85 " "$10,232.80 " "$4,476.85 " "$10,232.80 " STNT ESPH 23MM 18.5FR 10CM 120CM SLF XPD LOPRFL FLLY COVERED M00516730 SUPPLY/IMPLANTS "$12,136.00 " Outpatient "$6,068.00 " Not Applicable: Bundled with Procedure "$7,888.40 " "$8,495.20 " "$8,009.76 " Not Applicable: Bundled with Procedure "$4,247.60 " "$9,708.80 " "$4,247.60 " "$9,708.80 " STNT HEP 5MM 6FR SPRFC FEM ART ILIUM 15CM DLV SYS VBHN VBJ051502 SUPPLY/IMPLANTS "$18,440.00 " Outpatient "$9,220.00 " Not Applicable: Bundled with Procedure "$11,986.00 " "$12,908.00 " "$12,170.40 " Not Applicable: Bundled with Procedure "$6,454.00 " "$14,752.00 " "$6,454.00 " "$14,752.00 " STNT INTRCRAN 3MM 2.8-3FR .05IN 15MM 131CM RADOPQ SLF XPD M003SNF330150 SUPPLY/IMPLANTS "$21,326.00 " Outpatient "$10,663.00 " Not Applicable: Bundled with Procedure "$13,861.90 " "$14,928.20 " "$14,075.16 " Not Applicable: Bundled with Procedure "$7,464.10 " "$17,060.80 " "$7,464.10 " "$17,060.80 " STNT INTRCRAN 4.5MM 30MM NRFRM EZ MCDLVR SYS N3EZ4530 SUPPLY/IMPLANTS "$32,772.00 " Outpatient "$16,386.00 " Not Applicable: Bundled with Procedure "$21,301.80 " "$22,940.40 " "$21,629.52 " Not Applicable: Bundled with Procedure "$11,470.20 " "$26,217.60 " "$11,470.20 " "$26,217.60 " STNT INTRCRAN 3MM 15MM NRFRM EZ N3EZ3015 SUPPLY/IMPLANTS "$32,772.00 " Outpatient "$16,386.00 " Not Applicable: Bundled with Procedure "$21,301.80 " "$22,940.40 " "$21,629.52 " Not Applicable: Bundled with Procedure "$11,470.20 " "$26,217.60 " "$11,470.20 " "$26,217.60 " STNT INTRCRAN 4MM 30MM NRFRM EZ MCDLVR SYS N3EZ4030 SUPPLY/IMPLANTS "$33,727.00 " Outpatient "$16,863.50 " Not Applicable: Bundled with Procedure "$21,922.55 " "$23,608.90 " "$22,259.82 " Not Applicable: Bundled with Procedure "$11,804.45 " "$26,981.60 " "$11,804.45 " "$26,981.60 " STNT INTRCRAN 4MM 20MM NRFRM EZ MCDLVR SYS N3EZ4020 SUPPLY/IMPLANTS "$33,703.00 " Outpatient "$16,851.50 " Not Applicable: Bundled with Procedure "$21,906.95 " "$23,592.10 " "$22,243.98 " Not Applicable: Bundled with Procedure "$11,796.05 " "$26,962.40 " "$11,796.05 " "$26,962.40 " STNT INTRCRAN 45MM 21MM NRFRM ATLS SZAS4521 SUPPLY/IMPLANTS "$35,413.00 " Outpatient "$17,706.50 " Not Applicable: Bundled with Procedure "$23,018.45 " "$24,789.10 " "$23,372.58 " Not Applicable: Bundled with Procedure "$12,394.55 " "$28,330.40 " "$12,394.55 " "$28,330.40 " STNT INTRCRAN 2.5MM 3.5FR 20MM SLF XPD OTW BLN CATH VSL WL M003WS0250200 SUPPLY/IMPLANTS "$34,046.00 " Outpatient "$17,023.00 " Not Applicable: Bundled with Procedure "$22,129.90 " "$23,832.20 " "$22,470.36 " Not Applicable: Bundled with Procedure "$11,916.10 " "$27,236.80 " "$11,916.10 " "$27,236.80 " STNT INTRCRAN 3.5MM 3.5FR 20MM SLF XPD OTW BLN CATH VSL WL M003WS0350200 SUPPLY/IMPLANTS "$34,046.00 " Outpatient "$17,023.00 " Not Applicable: Bundled with Procedure "$22,129.90 " "$23,832.20 " "$22,470.36 " Not Applicable: Bundled with Procedure "$11,916.10 " "$27,236.80 " "$11,916.10 " "$27,236.80 " STPLR THKTIS 55MMX4.5MM 4 ROW LNR CTR SF LKOUT HVWR PRX TI TCT55 SUPPLY/IMPLANTS $589.00 Outpatient $294.50 Not Applicable: Bundled with Procedure $382.85 $412.30 $388.74 Not Applicable: Bundled with Procedure $206.15 $471.20 $206.15 $471.20 STPLR THKTIS 75MMX4.5MM 4 ROW LNR CTR SF LKOUT HVWR PRX TI TCT75 SUPPLY/IMPLANTS $913.00 Outpatient $456.50 Not Applicable: Bundled with Procedure $593.45 $639.10 $602.58 Not Applicable: Bundled with Procedure $319.55 $730.40 $319.55 $730.40 STPLR REG TISS 55MMX3.81MM 4 ROW LNR CTR CRTDG SFLOK OUT PRX TLC55 SUPPLY/IMPLANTS $560.00 Outpatient $280.00 Not Applicable: Bundled with Procedure $364.00 $392.00 $369.60 Not Applicable: Bundled with Procedure $196.00 $448.00 $196.00 $448.00 STPLR THN VASC TISS 55MMX2.59MM 4 ROW LNR CTR RLD SF LKOUT TVC55 SUPPLY/IMPLANTS $656.00 Outpatient $328.00 Not Applicable: Bundled with Procedure $426.40 $459.20 $432.96 Not Applicable: Bundled with Procedure $229.60 $524.80 $229.60 $524.80 STPLR REG TISS 30MMX3.5MM 2 ROW LNR CTR RLD PRX TI INTNL 1.5 TX30B SUPPLY/IMPLANTS $526.00 Outpatient $263.00 Not Applicable: Bundled with Procedure $341.90 $368.20 $347.16 Not Applicable: Bundled with Procedure $184.10 $420.80 $184.10 $420.80 STPLR THKTIS 30MMX4.8MM 2 ROW RLD LNR PRX TX TI INTNL 2MM TX30G SUPPLY/IMPLANTS $514.00 Outpatient $257.00 Not Applicable: Bundled with Procedure $334.10 $359.80 $339.24 Not Applicable: Bundled with Procedure $179.90 $411.20 $179.90 $411.20 STPLR THKTIS 60MMX4.8MM 2 ROW LNR RLD PRLL JAW CLSR PRX TI TX60G SUPPLY/IMPLANTS $533.00 Outpatient $266.50 Not Applicable: Bundled with Procedure $346.45 $373.10 $351.78 Not Applicable: Bundled with Procedure $186.55 $426.40 $186.55 $426.40 STPLR 340MM LNR CUT ECHLN FLX PWR + INTNL STD 60MM LF ESCP PSEE60A SUPPLY/IMPLANTS "$1,953.00 " Outpatient $976.50 Not Applicable: Bundled with Procedure "$1,269.45 " "$1,367.10 " "$1,288.98 " Not Applicable: Bundled with Procedure $683.55 "$1,562.40 " $683.55 "$1,562.40 " STPLR THKTIS 90MMX1.5-2.5MM 2 ROW LNR CTR ADJ HVWR PRX TI TLH90 SUPPLY/IMPLANTS $587.00 Outpatient $293.50 Not Applicable: Bundled with Procedure $381.55 $410.90 $387.42 Not Applicable: Bundled with Procedure $205.45 $469.60 $205.45 $469.60 STPLR 3.9X6.9X1MM .58MM 35 CNT FX HD ERG PSTL GRP HNDL RLD TLC10 SUPPLY/IMPLANTS $611.00 Outpatient $305.50 Not Applicable: Bundled with Procedure $397.15 $427.70 $403.26 Not Applicable: Bundled with Procedure $213.85 $488.80 $213.85 $488.80 STPLR 31MMX4.8MM LNR CUT SQZ HNDL LG ANSTM LIP DST EEA TI EEA31 SUPPLY/IMPLANTS "$3,477.00 " Outpatient "$1,738.50 " Not Applicable: Bundled with Procedure "$2,260.05 " "$2,433.90 " "$2,294.82 " Not Applicable: Bundled with Procedure "$1,216.95 " "$2,781.60 " "$1,216.95 " "$2,781.60 " SUT EBND EXC 2-0 V-5 30IN 2 ARM BRD 10 STRN GRN/WHT NABSB 10X52 SUPPLY/IMPLANTS "$2,711.00 " Outpatient "$1,355.50 " Not Applicable: Bundled with Procedure "$1,762.15 " "$1,897.70 " "$1,789.26 " Not Applicable: Bundled with Procedure $948.85 "$2,168.80 " $948.85 "$2,168.80 " SUT EBND EXC THK1.5MM 2-0 SH 36IN 2 ARM BRD 6 STRN FIRM PXX85 SUPPLY/IMPLANTS "$2,575.00 " Outpatient "$1,287.50 " Not Applicable: Bundled with Procedure "$1,673.75 " "$1,802.50 " "$1,699.50 " Not Applicable: Bundled with Procedure $901.25 "$2,060.00 " $901.25 "$2,060.00 " SUT FBRWR 2-0 BRD SWEDGE LO KNT PRFL MNSCS STRL DISP NABSB AR-7223 SUPPLY/IMPLANTS $531.00 Outpatient $265.50 Not Applicable: Bundled with Procedure $345.15 $371.70 $350.46 Not Applicable: Bundled with Procedure $185.85 $424.80 $185.85 $424.80 SUT GRTX CV-5 TTC-13 30IN 2 ARM MFL WHT NABSB 5M02A SUPPLY/IMPLANTS "$1,700.00 " Outpatient $850.00 Not Applicable: Bundled with Procedure "$1,105.00 " "$1,190.00 " "$1,122.00 " Not Applicable: Bundled with Procedure $595.00 "$1,360.00 " $595.00 "$1,360.00 " SUT GRTX CV-8 TTC-9 30IN 2 ARM MFL WHT SGL NABSB 8M02A SUPPLY/IMPLANTS "$1,940.00 " Outpatient $970.00 Not Applicable: Bundled with Procedure "$1,261.00 " "$1,358.00 " "$1,280.40 " Not Applicable: Bundled with Procedure $679.00 "$1,552.00 " $679.00 "$1,552.00 " SUT PLN 2-0 UR-6 27IN MFL ABS N873H SUPPLY/IMPLANTS $699.00 Outpatient $349.50 Not Applicable: Bundled with Procedure $454.35 $489.30 $461.34 Not Applicable: Bundled with Procedure $244.65 $559.20 $244.65 $559.20 SUT PRLN 7-0 BV-1 24IN 2 ARM MFL 4 STRN BLU NABSB M8702 SUPPLY/IMPLANTS "$2,740.00 " Outpatient "$1,370.00 " Not Applicable: Bundled with Procedure "$1,781.00 " "$1,918.00 " "$1,808.40 " Not Applicable: Bundled with Procedure $959.00 "$2,192.00 " $959.00 "$2,192.00 " SUT PRLN 6-0 C-1 24IN 2 ARM MFL BLU NABSB 8726H SUPPLY/IMPLANTS "$1,626.00 " Outpatient $813.00 Not Applicable: Bundled with Procedure "$1,056.90 " "$1,138.20 " "$1,073.16 " Not Applicable: Bundled with Procedure $569.10 "$1,300.80 " $569.10 "$1,300.80 " SUT PRLN 6-0 CC-1 30IN 2 ARM MFL BLU NABSB 8707H SUPPLY/IMPLANTS "$1,895.00 " Outpatient $947.50 Not Applicable: Bundled with Procedure "$1,231.75 " "$1,326.50 " "$1,250.70 " Not Applicable: Bundled with Procedure $663.25 "$1,516.00 " $663.25 "$1,516.00 " SUT VCL+ 2-0 CT1 27IN CR BRD 8 STRN ANBCTRL UD ABS ETVCPP42D SUPPLY/IMPLANTS $673.00 Outpatient $336.50 Not Applicable: Bundled with Procedure $437.45 $471.10 $444.18 Not Applicable: Bundled with Procedure $235.55 $538.40 $235.55 $538.40 SUTURE SLK PRMHND 0 PSL 30IN BRD 590H SUPPLY/IMPLANTS $680.00 Outpatient $340.00 Not Applicable: Bundled with Procedure $442.00 $476.00 $448.80 Not Applicable: Bundled with Procedure $238.00 $544.00 $238.00 $544.00 SUTURE ANCHOR FIBERTAK 1.6 AR-3600 SUPPLY/IMPLANTS "$2,653.00 " Outpatient "$1,326.50 " Not Applicable: Bundled with Procedure "$1,724.45 " "$1,857.10 " "$1,750.98 " Not Applicable: Bundled with Procedure $928.55 "$2,122.40 " $928.55 "$2,122.40 " SYNPOR SQUARE SHEET-DEMO 50X50MM3.0MM THICK 08.510.140D SUPPLY/IMPLANTS $498.00 Outpatient $249.00 Not Applicable: Bundled with Procedure $323.70 $348.60 $328.68 Not Applicable: Bundled with Procedure $174.30 $398.40 $174.30 $398.40 SYNPOR SMOOTH SQUARE SHEET 50MM X 50MM0.8MM THICK-DEMO 08.510.220D SUPPLY/IMPLANTS $466.00 Outpatient $233.00 Not Applicable: Bundled with Procedure $302.90 $326.20 $307.56 Not Applicable: Bundled with Procedure $163.10 $372.80 $163.10 $372.80 SYS ANLPLS HLDR SW C-E PH II MTRL COCR SIL PLSTR STRL HRT 5200 SUPPLY/IMPLANTS "$20,055.00 " Outpatient "$10,027.50 " Not Applicable: Bundled with Procedure "$13,035.75 " "$14,038.50 " "$13,236.30 " Not Applicable: Bundled with Procedure "$7,019.25 " "$16,044.00 " "$7,019.25 " "$16,044.00 " SYS ANLPLS 1 SEAM 2 WRP ANTM ED MC3 TRCSD TI SIL RBR PLSTR 4900 SUPPLY/IMPLANTS "$17,120.00 " Outpatient "$8,560.00 " Not Applicable: Bundled with Procedure "$11,128.00 " "$11,984.00 " "$11,299.20 " Not Applicable: Bundled with Procedure "$5,992.00 " "$13,696.00 " "$5,992.00 " "$13,696.00 " SYS ATHRCM MIC CRWN DIAMONDBACK 360 PERI 145CM 1.25MM ACPT 4 DBP-125MICRO145 SUPPLY/IMPLANTS "$16,607.00 " Outpatient "$8,303.50 " Not Applicable: Bundled with Procedure "$10,794.55 " "$11,624.90 " "$10,960.62 " Not Applicable: Bundled with Procedure "$5,812.45 " "$13,285.60 " "$5,812.45 " "$13,285.60 " SYS BLNDIL LGHT WRE INTGR RLV SPIN + MXL FRNTL SPND 16MM 6MM RSP0616MFS SUPPLY/IMPLANTS "$8,266.00 " Outpatient "$4,133.00 " Not Applicable: Bundled with Procedure "$5,372.90 " "$5,786.20 " "$5,455.56 " Not Applicable: Bundled with Procedure "$2,893.10 " "$6,612.80 " "$2,893.10 " "$6,612.80 " SYS BN CMNT PRP CMX KIT-01 SUPPLY/IMPLANTS "$1,278.00 " Outpatient $639.00 Not Applicable: Bundled with Procedure $830.70 $894.60 $843.48 Not Applicable: Bundled with Procedure $447.30 "$1,022.40 " $447.30 "$1,022.40 " SYS BN CMNT 1 2 CLEARMIX 414701 SUPPLY/IMPLANTS $814.00 Outpatient $407.00 Not Applicable: Bundled with Procedure $529.10 $569.80 $537.24 Not Applicable: Bundled with Procedure $284.90 $651.20 $284.90 $651.20 SYS BX PRELD BCN EUS FNF 22GA DSF-22-01 SUPPLY/IMPLANTS "$2,853.00 " Outpatient "$1,426.50 " Not Applicable: Bundled with Procedure "$1,854.45 " "$1,997.10 " "$1,882.98 " Not Applicable: Bundled with Procedure $998.55 "$2,282.40 " $998.55 "$2,282.40 " SYS COR STNT 19MM GFTMSTR SS EPTFE 4MM RX GFT SYS 1012582-19 SUPPLY/IMPLANTS "$11,716.00 " Outpatient "$5,858.00 " Not Applicable: Bundled with Procedure "$7,615.40 " "$8,201.20 " "$7,732.56 " Not Applicable: Bundled with Procedure "$4,100.60 " "$9,372.80 " "$4,100.60 " "$9,372.80 " SYS COR STNT 19MM GFTMSTR SS EPTFE 3.5MM RX GFT SYS 1012581-19 SUPPLY/IMPLANTS "$11,716.00 " Outpatient "$5,858.00 " Not Applicable: Bundled with Procedure "$7,615.40 " "$8,201.20 " "$7,732.56 " Not Applicable: Bundled with Procedure "$4,100.60 " "$9,372.80 " "$4,100.60 " "$9,372.80 " SYS COR STNT 19MM GFTMSTR SS EPTFE 2.8MM RX GFT SYS 1012580-19 SUPPLY/IMPLANTS "$11,716.00 " Outpatient "$5,858.00 " Not Applicable: Bundled with Procedure "$7,615.40 " "$8,201.20 " "$7,732.56 " Not Applicable: Bundled with Procedure "$4,100.60 " "$9,372.80 " "$4,100.60 " "$9,372.80 " SYS DRG DLV 10IN 8IN XPD KT TPL NDL CATH SLSKR ONQ PNBSTR PM040-A SUPPLY/IMPLANTS $855.00 Outpatient $427.50 Not Applicable: Bundled with Procedure $555.75 $598.50 $564.30 Not Applicable: Bundled with Procedure $299.25 $684.00 $299.25 $684.00 SYS EMBL PRTC 4-7MM 5-6FR CRTD GW RADOPQ EMBOSHIELD NAV6 190 22438-19 SUPPLY/IMPLANTS "$7,581.00 " Outpatient "$3,790.50 " Not Applicable: Bundled with Procedure "$4,927.65 " "$5,306.70 " "$5,003.46 " Not Applicable: Bundled with Procedure "$2,653.35 " "$6,064.80 " "$2,653.35 " "$6,064.80 " SYS FX 30 ABS FSTNR LOPRFL HLW COR ATRM BLNT TIP SORBAFIX 5 113116 SUPPLY/IMPLANTS "$2,666.00 " Outpatient "$1,333.00 " Not Applicable: Bundled with Procedure "$1,732.90 " "$1,866.20 " "$1,759.56 " Not Applicable: Bundled with Procedure $933.10 "$2,132.80 " $933.10 "$2,132.80 " SYS FX INTERNALBRACE ULN COLLATERAL LGMNT REPR AR-7715 SUPPLY/IMPLANTS "$8,236.00 " Outpatient "$4,118.00 " Not Applicable: Bundled with Procedure "$5,353.40 " "$5,765.20 " "$5,435.76 " Not Applicable: Bundled with Procedure "$2,882.60 " "$6,588.80 " "$2,882.60 " "$6,588.80 " SYS GSTRC BAND ACC PORT I ADJ CNCT RADOPQ LPBND AP OMNIFORM B-2245 SUPPLY/IMPLANTS "$15,431.00 " Outpatient "$7,715.50 " Not Applicable: Bundled with Procedure "$10,030.15 " "$10,801.70 " "$10,184.46 " Not Applicable: Bundled with Procedure "$5,400.85 " "$12,344.80 " "$5,400.85 " "$12,344.80 " SYS GSTRC BAND ACC PORT I ADJ CNCT RADOPQ LPBND AP OMNIFORM B-2240 SUPPLY/IMPLANTS "$15,431.00 " Outpatient "$7,715.50 " Not Applicable: Bundled with Procedure "$10,030.15 " "$10,801.70 " "$10,184.46 " Not Applicable: Bundled with Procedure "$5,400.85 " "$12,344.80 " "$5,400.85 " "$12,344.80 " SYS IMPL LINX 15 BEAD 1.5 TESLA GI GERD LXMC15 SUPPLY/IMPLANTS "$25,399.00 " Outpatient "$12,699.50 " Not Applicable: Bundled with Procedure "$16,509.35 " "$17,779.30 " "$16,763.34 " Not Applicable: Bundled with Procedure "$8,889.65 " "$20,319.20 " "$8,889.65 " "$20,319.20 " SYS SHNT PRGM VLV VNTRC CATH INFO MNL UNITIZE CDMN HKM ANG 823148 SUPPLY/IMPLANTS "$18,671.00 " Outpatient "$9,335.50 " Not Applicable: Bundled with Procedure "$12,136.15 " "$13,069.70 " "$12,322.86 " Not Applicable: Bundled with Procedure "$6,534.85 " "$14,936.80 " "$6,534.85 " "$14,936.80 " SYS URTH SPRT INCS SLNG DLV DEV MESH SOLYX ADV MIDURETHRAL 9 M0068507000 SUPPLY/IMPLANTS "$6,694.00 " Outpatient "$3,347.00 " Not Applicable: Bundled with Procedure "$4,351.10 " "$4,685.80 " "$4,418.04 " Not Applicable: Bundled with Procedure "$2,342.90 " "$5,355.20 " "$2,342.90 " "$5,355.20 " SZR BLM-SNG 16FR SIL SRG 3 INSRTR BE6036 SUPPLY/IMPLANTS $536.00 Outpatient $268.00 Not Applicable: Bundled with Procedure $348.40 $375.20 $353.76 Not Applicable: Bundled with Procedure $187.60 $428.80 $187.60 $428.80 SZR IMPL 12.8CM MEMORYGEL CHSV I P5.1CM HI PRFL RND BRST GEL RSZ-4504 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 Not Applicable: Bundled with Procedure "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " SZR IMPL 13.2CM MEMORYGEL CHSV I P5.3CM HI PRFL RND BRST GEL RSZ-5004 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 Not Applicable: Bundled with Procedure "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " SZR IMPL 14.4CM MEMORYGEL CHSV I P5.7CM HI PRFL RND BRST GEL RSZ-6504 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 Not Applicable: Bundled with Procedure "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " SZR IMPL 9.7CM MEMORYGEL CHSV I P4CM HI PRFL RND BRST GEL RSZ-2004S SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 Not Applicable: Bundled with Procedure "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " SZR IMPL 10.1CM MEMORYGEL CHSV I P4.2CM HI PRFL RND BRST GEL RSZ-2254 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 Not Applicable: Bundled with Procedure "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " SZR IMPL 10.5CM MEMORYGEL CHSV I P4.3CM HI PRFL RND BRST GEL RSZ-2504 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 Not Applicable: Bundled with Procedure "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " SZR IMPL 11.1CM MEMORYGEL P4.5CM HI PRFL RND BRST GEL RPSB RSZ-3004S SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 Not Applicable: Bundled with Procedure "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " SZR IMPL 11.4CM MEMORYGEL CHSV I P4.6CM HI PRFL RND BRST GEL RSZ-3254S SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 Not Applicable: Bundled with Procedure "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " SZR IMPL 12CM MEMORYGEL CHSV I P4.8CM HI PRFL RND BRST GEL RSZ-3754 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 Not Applicable: Bundled with Procedure "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " SZR IMPL 12.5CM MEMORYGEL CHSV I P5CM HI PRFL RND BRST GEL RSZ-4254 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 Not Applicable: Bundled with Procedure "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " SZR IMPL 13.6CM MEMORYGEL CHSV I P4.2CM MDRT + PRFL RND BRST RSZ-4501 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 Not Applicable: Bundled with Procedure "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " SZR IMPL 14.1CM MEMORYGEL CHSV I P4.3CM MDRT + PRFL RND BRST RSZ-5001 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 Not Applicable: Bundled with Procedure "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " SZR IMPL 14.6CM MEMORYGEL CHSV I P4.5CM MDRT + PRFL RND BRST RSZ-5501 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 Not Applicable: Bundled with Procedure "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " SZR IMPL 15CM MEMORYGEL CHSV I P4.6CM MDRT + PRFL RND BRST RSZ-6001 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 Not Applicable: Bundled with Procedure "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " SZR IMPL 12.75CM NATRELLE INSPIRA P6.2CM X FULL PRFL RND MSZ-X525 SUPPLY/IMPLANTS "$1,426.00 " Outpatient $713.00 Not Applicable: Bundled with Procedure $926.90 $998.20 $941.16 Not Applicable: Bundled with Procedure $499.10 "$1,140.80 " $499.10 "$1,140.80 " SZR IMPL 13.75CM NATRELLE INSPIRA P6.4CM X FULL PRFL RND MSZ-X615 SUPPLY/IMPLANTS "$1,426.00 " Outpatient $713.00 Not Applicable: Bundled with Procedure $926.90 $998.20 $941.16 Not Applicable: Bundled with Procedure $499.10 "$1,140.80 " $499.10 "$1,140.80 " SZR IMPL 14.5CM NATRELLE INSPIRA P6.7CM X FULL PRFL RND BRST MSZ-X750 SUPPLY/IMPLANTS "$1,199.00 " Outpatient $599.50 Not Applicable: Bundled with Procedure $779.35 $839.30 $791.34 Not Applicable: Bundled with Procedure $419.65 $959.20 $419.65 $959.20 TAP 1.7MM 3-4MM HEX SLF DRL CPLNG SRG DLT 70-71794 SUPPLY/IMPLANTS "$2,081.00 " Outpatient "$1,040.50 " Not Applicable: Bundled with Procedure "$1,352.65 " "$1,456.70 " "$1,373.46 " Not Applicable: Bundled with Procedure $728.35 "$1,664.80 " $728.35 "$1,664.80 " TAP 3.0MM SN-63907-30 SUPPLY/IMPLANTS "$2,760.00 " Outpatient "$1,380.00 " Not Applicable: Bundled with Procedure "$1,794.00 " "$1,932.00 " "$1,821.60 " Not Applicable: Bundled with Procedure $966.00 "$2,208.00 " $966.00 "$2,208.00 " TAP 46MM 111MM SRG 4MM CANC SCR 2.5MM DRLBT 311.34 SUPPLY/IMPLANTS $718.00 Outpatient $359.00 Not Applicable: Bundled with Procedure $466.70 $502.60 $473.88 Not Applicable: Bundled with Procedure $251.30 $574.40 $251.30 $574.40 TAP 50MM CLBRT SRG SPNE CANC 3.5MM CANC SCR NS 311.349 SUPPLY/IMPLANTS "$1,396.00 " Outpatient $698.00 Not Applicable: Bundled with Procedure $907.40 $977.20 $921.36 Not Applicable: Bundled with Procedure $488.60 "$1,116.80 " $488.60 "$1,116.80 " TAP 57MM 130MM SRG 4.5MM CORT SHFT SCR 3.2MM DRLBT 311.46 SUPPLY/IMPLANTS $713.00 Outpatient $356.50 Not Applicable: Bundled with Procedure $463.45 $499.10 $470.58 Not Applicable: Bundled with Procedure $249.55 $570.40 $249.55 $570.40 TAP 60MM 147MM CNN SRG 4MM SCR 2.7MM DRLBT 311.63 SUPPLY/IMPLANTS "$2,562.00 " Outpatient "$1,281.00 " Not Applicable: Bundled with Procedure "$1,665.30 " "$1,793.40 " "$1,690.92 " Not Applicable: Bundled with Procedure $896.70 "$2,049.60 " $896.70 "$2,049.60 " TAP AO SRG FT/ANKL 3.5 MM SCR 703898 SUPPLY/IMPLANTS "$1,243.00 " Outpatient $621.50 Not Applicable: Bundled with Procedure $807.95 $870.10 $820.38 Not Applicable: Bundled with Procedure $435.05 $994.40 $435.05 $994.40 TARGET COIL 360 ULTRA 5MM X 15CM 612515 SUPPLY/IMPLANTS "$13,243.00 " Outpatient "$6,621.50 " Not Applicable: Bundled with Procedure "$8,607.95 " "$9,270.10 " "$8,740.38 " Not Applicable: Bundled with Procedure "$4,635.05 " "$10,594.40 " "$4,635.05 " "$10,594.40 " TEMPLATE ROD L200 MM SPINE 1101-90068 SUPPLY/IMPLANTS $600.00 Outpatient $300.00 Not Applicable: Bundled with Procedure $390.00 $420.00 $396.00 Not Applicable: Bundled with Procedure $210.00 $480.00 $210.00 $480.00 TENDON TIBIALIS POSTERIOR 453316 SUPPLY/IMPLANTS "$8,315.00 " Outpatient "$4,157.50 " Not Applicable: Bundled with Procedure "$5,404.75 " "$5,820.50 " "$5,487.90 " Not Applicable: Bundled with Procedure "$2,910.25 " "$6,652.00 " "$2,910.25 " "$6,652.00 " TENDON ACHILLES WITH BONE 170908-002 SUPPLY/IMPLANTS "$10,746.00 " Outpatient "$5,373.00 " Not Applicable: Bundled with Procedure "$6,984.90 " "$7,522.20 " "$7,092.36 " Not Applicable: Bundled with Procedure "$3,761.10 " "$8,596.80 " "$3,761.10 " "$8,596.80 " TIBIALIS TENDON 9.5CM X 280MM DOUBLE STRANDED POSTERIOR DAP-002 SUPPLY/IMPLANTS "$10,264.00 " Outpatient "$5,132.00 " Not Applicable: Bundled with Procedure "$6,671.60 " "$7,184.80 " "$6,774.24 " Not Applicable: Bundled with Procedure "$3,592.40 " "$8,211.20 " "$3,592.40 " "$8,211.20 " "TIGER SHARK, CERVICAL S-TC10-1412009" SUPPLY/IMPLANTS "$9,785.00 " Outpatient "$4,892.50 " Not Applicable: Bundled with Procedure "$6,360.25 " "$6,849.50 " "$6,458.10 " Not Applicable: Bundled with Procedure "$3,424.75 " "$7,828.00 " "$3,424.75 " "$7,828.00 " TISSUE LANYARD 16MM DISK AGT-5160 SUPPLY/IMPLANTS "$9,269.00 " Outpatient "$4,634.50 " Not Applicable: Bundled with Procedure "$6,024.85 " "$6,488.30 " "$6,117.54 " Not Applicable: Bundled with Procedure "$3,244.15 " "$7,415.20 " "$3,244.15 " "$7,415.20 " TISSUE DSAEK PRECUT 15-0044-PC SUPPLY/IMPLANTS "$17,608.00 " Outpatient "$8,804.00 " Not Applicable: Bundled with Procedure "$11,445.20 " "$12,325.60 " "$11,621.28 " Not Applicable: Bundled with Procedure "$6,162.80 " "$14,086.40 " "$6,162.80 " "$14,086.40 " TISSUE EXPANDERS 133MX-13 SUPPLY/IMPLANTS "$6,809.00 " Outpatient "$3,404.50 " Not Applicable: Bundled with Procedure "$4,425.85 " "$4,766.30 " "$4,493.94 " Not Applicable: Bundled with Procedure "$2,383.15 " "$5,447.20 " "$2,383.15 " "$5,447.20 " TISSUE EXOSHAPE SOFT FASTNER TIBIAL 9MM X 30MM 1101000930 SUPPLY/IMPLANTS "$2,523.00 " Outpatient "$1,261.50 " Not Applicable: Bundled with Procedure "$1,639.95 " "$1,766.10 " "$1,665.18 " Not Applicable: Bundled with Procedure $883.05 "$2,018.40 " $883.05 "$2,018.40 " TISSUE EXPANDERS SMOOTH WITH FOURTE EXPANDER FILL SYSTEM 133S-FX-13-T SUPPLY/IMPLANTS "$9,078.00 " Outpatient "$4,539.00 " Not Applicable: Bundled with Procedure "$5,900.70 " "$6,354.60 " "$5,991.48 " Not Applicable: Bundled with Procedure "$3,177.30 " "$7,262.40 " "$3,177.30 " "$7,262.40 " TITAN TOUCH PUMP ASSEMBLY 517750 SUPPLY/IMPLANTS "$15,823.00 " Outpatient "$7,911.50 " Not Applicable: Bundled with Procedure "$10,284.95 " "$11,076.10 " "$10,443.18 " Not Applicable: Bundled with Procedure "$5,538.05 " "$12,658.40 " "$5,538.05 " "$12,658.40 " TMPLT SZ 2 CLMN VA 2.4 MM VA-LCP 2 CLMN VOLR DIST RDS PLT 03.111.120S SUPPLY/IMPLANTS "$1,284.00 " Outpatient $642.00 Not Applicable: Bundled with Procedure $834.60 $898.80 $847.44 Not Applicable: Bundled with Procedure $449.40 "$1,027.20 " $449.40 "$1,027.20 " TRAY INTRO XPR KPHPK 15/2 1ST FX KPE1003 SUPPLY/IMPLANTS "$15,629.00 " Outpatient "$7,814.50 " Not Applicable: Bundled with Procedure "$10,158.85 " "$10,940.30 " "$10,315.14 " Not Applicable: Bundled with Procedure "$5,470.15 " "$12,503.20 " "$5,470.15 " "$12,503.20 " TRAY INST RAPIDSORB RSRB CRNL CLP NS 305.88 SUPPLY/IMPLANTS "$3,900.00 " Outpatient "$1,950.00 " Not Applicable: Bundled with Procedure "$2,535.00 " "$2,730.00 " "$2,574.00 " Not Applicable: Bundled with Procedure "$1,365.00 " "$3,120.00 " "$1,365.00 " "$3,120.00 " TRAY TIB AS MX 71MM INTLK TI KN CR PRM CMNT 141213 SUPPLY/IMPLANTS "$8,080.00 " Outpatient "$4,040.00 " Not Applicable: Bundled with Procedure "$5,252.00 " "$5,656.00 " "$5,332.80 " Not Applicable: Bundled with Procedure "$2,828.00 " "$6,464.00 " "$2,828.00 " "$6,464.00 " TRIAL HIP LFIT +10 MM C TAPER OFFSET OD28 MM FEMORAL HEAD 06-2810 SUPPLY/IMPLANTS "$2,854.00 " Outpatient "$1,427.00 " Not Applicable: Bundled with Procedure "$1,855.10 " "$1,997.80 " "$1,883.64 " Not Applicable: Bundled with Procedure $998.90 "$2,283.20 " $998.90 "$2,283.20 " TROC LAPSCP PRMD 100MM 10-15MM VPRT+ RPF VERSASEAL + SFSHLD 179078P SUPPLY/IMPLANTS $853.00 Outpatient $426.50 Not Applicable: Bundled with Procedure $554.45 $597.10 $562.98 Not Applicable: Bundled with Procedure $298.55 $682.40 $298.55 $682.40 TUBE JJNSTM 57.9CM 16FR SIL MC SLK INFL RTNT BLN DCMPRS EXIT 0210-16 SUPPLY/IMPLANTS $923.00 Outpatient $461.50 Not Applicable: Bundled with Procedure $599.95 $646.10 $609.18 Not Applicable: Bundled with Procedure $323.05 $738.40 $323.05 $738.40 TUBE JONES 4.0MM X 16MM 4016 SUPPLY/IMPLANTS "$1,257.00 " Outpatient $628.50 Not Applicable: Bundled with Procedure $817.05 $879.90 $829.62 Not Applicable: Bundled with Procedure $439.95 "$1,005.60 " $439.95 "$1,005.60 " UNILATERAL PLATFORM KIT W/D HARDWARE MP-KIT-01D SUPPLY/IMPLANTS "$11,250.00 " Outpatient "$5,625.00 " Not Applicable: Bundled with Procedure "$7,312.50 " "$7,875.00 " "$7,425.00 " Not Applicable: Bundled with Procedure "$3,937.50 " "$9,000.00 " "$3,937.50 " "$9,000.00 " V40-3 HEAD TRIAL 1150-2413 SUPPLY/IMPLANTS $643.00 Outpatient $321.50 Not Applicable: Bundled with Procedure $417.95 $450.10 $424.38 Not Applicable: Bundled with Procedure $225.05 $514.40 $225.05 $514.40 V40-4 HEAD TRIAL 1150-2414 SUPPLY/IMPLANTS $643.00 Outpatient $321.50 Not Applicable: Bundled with Procedure $417.95 $450.10 $424.38 Not Applicable: Bundled with Procedure $225.05 $514.40 $225.05 $514.40 VALVE MITRAL HANCOCK T510 CINCH 25MM T510XXH SUPPLY/IMPLANTS "$24,213.00 " Outpatient "$12,106.50 " Not Applicable: Bundled with Procedure "$15,738.45 " "$16,949.10 " "$15,980.58 " Not Applicable: Bundled with Procedure "$8,474.55 " "$19,370.40 " "$8,474.55 " "$19,370.40 " VALVE AORTIC PERIMOUNT MAGNA SIZE 23 300023 SUPPLY/IMPLANTS "$27,861.00 " Outpatient "$13,930.50 " Not Applicable: Bundled with Procedure "$18,109.65 " "$19,502.70 " "$18,388.26 " Not Applicable: Bundled with Procedure "$9,751.35 " "$22,288.80 " "$9,751.35 " "$22,288.80 " VALVE MITRAL MITRACLIP BUNDLE SGC0301 1 CDS0601 NTR MBR0101 SUPPLY/IMPLANTS "$146,405.00 " Outpatient "$73,202.50 " Not Applicable: Bundled with Procedure "$95,163.25 " "$102,483.50 " "$96,627.30 " Not Applicable: Bundled with Procedure "$51,241.75 " "$117,124.00 " "$51,241.75 " "$117,124.00 " VALVE MITRAL MITRACLIP BUNDLE SGC0301 2 CDS0601 NTR MBR0102 SUPPLY/IMPLANTS "$146,405.00 " Outpatient "$73,202.50 " Not Applicable: Bundled with Procedure "$95,163.25 " "$102,483.50 " "$96,627.30 " Not Applicable: Bundled with Procedure "$51,241.75 " "$117,124.00 " "$51,241.75 " "$117,124.00 " VALVE MITRAL MITRACLIP BUNDLE SGC0301 3 CDS0601 NTR MBR0103 SUPPLY/IMPLANTS "$146,405.00 " Outpatient "$73,202.50 " Not Applicable: Bundled with Procedure "$95,163.25 " "$102,483.50 " "$96,627.30 " Not Applicable: Bundled with Procedure "$51,241.75 " "$117,124.00 " "$51,241.75 " "$117,124.00 " VALVE MITRAL MITRACLIP BUNDLE SGC0301 1 CDS0601 XTR MBR0201 SUPPLY/IMPLANTS "$146,405.00 " Outpatient "$73,202.50 " Not Applicable: Bundled with Procedure "$95,163.25 " "$102,483.50 " "$96,627.30 " Not Applicable: Bundled with Procedure "$51,241.75 " "$117,124.00 " "$51,241.75 " "$117,124.00 " VALVE MITRAL MITRACLIP BUNDLE SGC0301 2 CDS0601 XTR MBR0202 SUPPLY/IMPLANTS "$146,405.00 " Outpatient "$73,202.50 " Not Applicable: Bundled with Procedure "$95,163.25 " "$102,483.50 " "$96,627.30 " Not Applicable: Bundled with Procedure "$51,241.75 " "$117,124.00 " "$51,241.75 " "$117,124.00 " VALVE MITRAL MITRACLIP BUNDLE SGC0301 3 CDS0601 XTR MBR0203 SUPPLY/IMPLANTS "$146,405.00 " Outpatient "$73,202.50 " Not Applicable: Bundled with Procedure "$95,163.25 " "$102,483.50 " "$96,627.30 " Not Applicable: Bundled with Procedure "$51,241.75 " "$117,124.00 " "$51,241.75 " "$117,124.00 " VALVE MITRAL MITRACLIP BUNDLE SGC0301 1 CDS0601 NTR 1 CDS0601 XTR MBR0301 SUPPLY/IMPLANTS "$146,405.00 " Outpatient "$73,202.50 " Not Applicable: Bundled with Procedure "$95,163.25 " "$102,483.50 " "$96,627.30 " Not Applicable: Bundled with Procedure "$51,241.75 " "$117,124.00 " "$51,241.75 " "$117,124.00 " VALVE MITRAL MITRACLIP BUNDLE SGC0301 2 CDS0601 NTR 1 CDS0601 XTR MBR0302 SUPPLY/IMPLANTS "$146,405.00 " Outpatient "$73,202.50 " Not Applicable: Bundled with Procedure "$95,163.25 " "$102,483.50 " "$96,627.30 " Not Applicable: Bundled with Procedure "$51,241.75 " "$117,124.00 " "$51,241.75 " "$117,124.00 " VALVE MITRAL MITRACLIP BUNDLE 1 SGC0301 1 CDS0601 NTR 2 CDS0601 XTR MBR0303 SUPPLY/IMPLANTS "$146,405.00 " Outpatient "$73,202.50 " Not Applicable: Bundled with Procedure "$95,163.25 " "$102,483.50 " "$96,627.30 " Not Applicable: Bundled with Procedure "$51,241.75 " "$117,124.00 " "$51,241.75 " "$117,124.00 " VALVE AORTIC INSPIRIS RESILIA 11500A SUPPLY/IMPLANTS "$41,213.00 " Outpatient "$20,606.50 " Not Applicable: Bundled with Procedure "$26,788.45 " "$28,849.10 " "$27,200.58 " Not Applicable: Bundled with Procedure "$14,424.55 " "$32,970.40 " "$14,424.55 " "$32,970.40 " VALVE AORTIC ON-X CONFORM-X TITANIUM CARBON PTFE OD34 MM CYLINDRICAL H14.2 MM H17.8 MM OD25 MM ODSEC SUPPLY/IMPLANTS "$19,101.00 " Outpatient "$9,550.50 " Not Applicable: Bundled with Procedure "$12,415.65 " "$13,370.70 " "$12,606.66 " Not Applicable: Bundled with Procedure "$6,685.35 " "$15,280.80 " "$6,685.35 " "$15,280.80 " VALVE AORTIC EVOLUT PRO 26 MM EVOLUTPRO-26-US SUPPLY/IMPLANTS "$146,405.00 " Outpatient "$73,202.50 " Not Applicable: Bundled with Procedure "$95,163.25 " "$102,483.50 " "$96,627.30 " Not Applicable: Bundled with Procedure "$51,241.75 " "$117,124.00 " "$51,241.75 " "$117,124.00 " VALVE AORTIC EVOLUT PRO 23 MM EVOLUTPRO-23-US SUPPLY/IMPLANTS "$146,405.00 " Outpatient "$73,202.50 " Not Applicable: Bundled with Procedure "$95,163.25 " "$102,483.50 " "$96,627.30 " Not Applicable: Bundled with Procedure "$51,241.75 " "$117,124.00 " "$51,241.75 " "$117,124.00 " VALVE AORTIC MECHANICAL 22.8MM ID 27.5MM DIA ANNULUS 27MM PO 500FA27 SUPPLY/IMPLANTS "$15,861.00 " Outpatient "$7,930.50 " Not Applicable: Bundled with Procedure "$10,309.65 " "$11,102.70 " "$10,468.26 " Not Applicable: Bundled with Procedure "$5,551.35 " "$12,688.80 " "$5,551.35 " "$12,688.80 " VALVE SHUNT PROSA DIFFERENTIAL PRESSURE UNIT FV701T SUPPLY/IMPLANTS "$18,080.00 " Outpatient "$9,040.00 " Not Applicable: Bundled with Procedure "$11,752.00 " "$12,656.00 " "$11,932.80 " Not Applicable: Bundled with Procedure "$6,328.00 " "$14,464.00 " "$6,328.00 " "$14,464.00 " VALVE AORTIC COREVALVE EVOLUT PRO PORCINE PERICARDIUM 29 MM EVOLUTPRO-29-US SUPPLY/IMPLANTS "$146,405.00 " Outpatient "$73,202.50 " Not Applicable: Bundled with Procedure "$95,163.25 " "$102,483.50 " "$96,627.30 " Not Applicable: Bundled with Procedure "$51,241.75 " "$117,124.00 " "$51,241.75 " "$117,124.00 " VALVE AORTIC EPIC FLEXFIT LINX AC PORCINE PERICARDIAL LOW PR ESP100-25-00 SUPPLY/IMPLANTS "$23,582.00 " Outpatient "$11,791.00 " Not Applicable: Bundled with Procedure "$15,328.30 " "$16,507.40 " "$15,564.12 " Not Applicable: Bundled with Procedure "$8,253.70 " "$18,865.60 " "$8,253.70 " "$18,865.60 " VALVE AORTIC EPIC FLEXFIT LINX AC PORCINE PERICARDIAL LOW PR ESP100-19-00 SUPPLY/IMPLANTS "$23,582.00 " Outpatient "$11,791.00 " Not Applicable: Bundled with Procedure "$15,328.30 " "$16,507.40 " "$15,564.12 " Not Applicable: Bundled with Procedure "$8,253.70 " "$18,865.60 " "$8,253.70 " "$18,865.60 " VALVE AORTIC EPIC FLEXFIT LINX AC PORCINE PERICARDIAL LOW PR ESP100-27-00 SUPPLY/IMPLANTS "$23,582.00 " Outpatient "$11,791.00 " Not Applicable: Bundled with Procedure "$15,328.30 " "$16,507.40 " "$15,564.12 " Not Applicable: Bundled with Procedure "$8,253.70 " "$18,865.60 " "$8,253.70 " "$18,865.60 " VALVE AORTIC EPIC FLEXFIT LINX AC PORCINE PERICARDIAL LOW PR ESP100-23-00 SUPPLY/IMPLANTS "$23,582.00 " Outpatient "$11,791.00 " Not Applicable: Bundled with Procedure "$15,328.30 " "$16,507.40 " "$15,564.12 " Not Applicable: Bundled with Procedure "$8,253.70 " "$18,865.60 " "$8,253.70 " "$18,865.60 " VALVE AORTIC EPIC FLEXFIT LINX AC PORCINE PERICARDIAL LOW PR ESP100-21-00 SUPPLY/IMPLANTS "$23,582.00 " Outpatient "$11,791.00 " Not Applicable: Bundled with Procedure "$15,328.30 " "$16,507.40 " "$15,564.12 " Not Applicable: Bundled with Procedure "$8,253.70 " "$18,865.60 " "$8,253.70 " "$18,865.60 " VALVE AORTIC TRIFECTA GLIDE TITANIUM POLYESTER BOVINE PORCIN TFGT-25A SUPPLY/IMPLANTS "$29,355.00 " Outpatient "$14,677.50 " Not Applicable: Bundled with Procedure "$19,080.75 " "$20,548.50 " "$19,374.30 " Not Applicable: Bundled with Procedure "$10,274.25 " "$23,484.00 " "$10,274.25 " "$23,484.00 " VALVE AORTIC TRIFECTA GLIDE PORCINE BOVINE PERICARDIUM TITAN TFGT-27A SUPPLY/IMPLANTS "$29,355.00 " Outpatient "$14,677.50 " Not Applicable: Bundled with Procedure "$19,080.75 " "$20,548.50 " "$19,374.30 " Not Applicable: Bundled with Procedure "$10,274.25 " "$23,484.00 " "$10,274.25 " "$23,484.00 " VALVE MITRAL ATS OPEN PIVOT STANDARD OD31 MM MECHANICAL 500DM31 SUPPLY/IMPLANTS "$13,177.00 " Outpatient "$6,588.50 " Not Applicable: Bundled with Procedure "$8,565.05 " "$9,223.90 " "$8,696.82 " Not Applicable: Bundled with Procedure "$4,611.95 " "$10,541.60 " "$4,611.95 " "$10,541.60 " VALVE BIOCOR STENTED 31MM BIO-31MM-00 SUPPLY/IMPLANTS "$23,582.00 " Outpatient "$11,791.00 " Not Applicable: Bundled with Procedure "$15,328.30 " "$16,507.40 " "$15,564.12 " Not Applicable: Bundled with Procedure "$8,253.70 " "$18,865.60 " "$8,253.70 " "$18,865.60 " VALVE 33MM BIOCOR STENTED MITRAL BIO-33MM-00 SUPPLY/IMPLANTS "$23,582.00 " Outpatient "$11,791.00 " Not Applicable: Bundled with Procedure "$15,328.30 " "$16,507.40 " "$15,564.12 " Not Applicable: Bundled with Procedure "$8,253.70 " "$18,865.60 " "$8,253.70 " "$18,865.60 " VALVE AORTIC INSPIRIS RESILIA BOVINE PERICARDIUM SILICON RUB 11500A19 SUPPLY/IMPLANTS "$41,318.00 " Outpatient "$20,659.00 " Not Applicable: Bundled with Procedure "$26,856.70 " "$28,922.60 " "$27,269.88 " Not Applicable: Bundled with Procedure "$14,461.30 " "$33,054.40 " "$14,461.30 " "$33,054.40 " VALVE AORTIC EVOLUT PRO PLUS 34MM EVPROPLUS-34-US SUPPLY/IMPLANTS "$146,775.00 " Outpatient "$73,387.50 " Not Applicable: Bundled with Procedure "$95,403.75 " "$102,742.50 " "$96,871.50 " Not Applicable: Bundled with Procedure "$51,371.25 " "$117,420.00 " "$51,371.25 " "$117,420.00 " VALVE AORTIC SAPIEN 3 COMMANDER EDWARDS OD20 MM TRANSCATHETE S3UCM220A SUPPLY/IMPLANTS "$159,007.00 " Outpatient "$79,503.50 " Not Applicable: Bundled with Procedure "$103,354.55 " "$111,304.90 " "$104,944.62 " Not Applicable: Bundled with Procedure "$55,652.45 " "$127,205.60 " "$55,652.45 " "$127,205.60 " VALVE AORTIC SAPIEN 3 COMMANDER EDWARDS OD23 MM TRANSCATHETE S3UCM223A SUPPLY/IMPLANTS "$159,007.00 " Outpatient "$79,503.50 " Not Applicable: Bundled with Procedure "$103,354.55 " "$111,304.90 " "$104,944.62 " Not Applicable: Bundled with Procedure "$55,652.45 " "$127,205.60 " "$55,652.45 " "$127,205.60 " VALVE AORTIC SAPIEN 3 COMMANDER EDWARDS OD26 MM TRANSCATHETE S3UCM226A SUPPLY/IMPLANTS "$159,007.00 " Outpatient "$79,503.50 " Not Applicable: Bundled with Procedure "$103,354.55 " "$111,304.90 " "$104,944.62 " Not Applicable: Bundled with Procedure "$55,652.45 " "$127,205.60 " "$55,652.45 " "$127,205.60 " VALVE MITRAL OPEN PIVOT OD25 MM MECHANICAL STANDARD SERIES 500DM25 SUPPLY/IMPLANTS "$13,210.00 " Outpatient "$6,605.00 " Not Applicable: Bundled with Procedure "$8,586.50 " "$9,247.00 " "$8,718.60 " Not Applicable: Bundled with Procedure "$4,623.50 " "$10,568.00 " "$4,623.50 " "$10,568.00 " VISTASEAL FIBRIN SEALANT HUMAN 10ML VST10 SUPPLY/IMPLANTS "$2,742.00 " Outpatient "$1,371.00 " Not Applicable: Bundled with Procedure "$1,782.30 " "$1,919.40 " "$1,809.72 " Not Applicable: Bundled with Procedure $959.70 "$2,193.60 " $959.70 "$2,193.60 " VLV AOR 23MM ATS OP MECH GFT CNDT STRL 502AG23 SUPPLY/IMPLANTS "$25,802.00 " Outpatient "$12,901.00 " Not Applicable: Bundled with Procedure "$16,771.30 " "$18,061.40 " "$17,029.32 " Not Applicable: Bundled with Procedure "$9,030.70 " "$20,641.60 " "$9,030.70 " "$20,641.60 " VLV AOR 25MM ATS OP MECH GFT CNDT STRL 502AG25 SUPPLY/IMPLANTS "$17,365.00 " Outpatient "$8,682.50 " Not Applicable: Bundled with Procedure "$11,287.25 " "$12,155.50 " "$11,460.90 " Not Applicable: Bundled with Procedure "$6,077.75 " "$13,892.00 " "$6,077.75 " "$13,892.00 " VLV AOR 34MM 23MM FRSTL BPRTH PRCN 3MM ROOT STRL FR995-23 SUPPLY/IMPLANTS "$27,880.00 " Outpatient "$13,940.00 " Not Applicable: Bundled with Procedure "$18,122.00 " "$19,516.00 " "$18,400.80 " Not Applicable: Bundled with Procedure "$9,758.00 " "$22,304.00 " "$9,758.00 " "$22,304.00 " VLV AOR 9.3MM 16MM 14.8MM ATS OP AP360 MECH SW CUF RADOPQ AP 505DA16 SUPPLY/IMPLANTS "$25,802.00 " Outpatient "$12,901.00 " Not Applicable: Bundled with Procedure "$16,771.30 " "$18,061.40 " "$17,029.32 " Not Applicable: Bundled with Procedure "$9,030.70 " "$20,641.60 " "$9,030.70 " "$20,641.60 " VLV AOR 10.3MM 18MM 16.8MM ATS OP AP360 MECH SW CUF RADOPQ 505DA18 SUPPLY/IMPLANTS "$25,802.00 " Outpatient "$12,901.00 " Not Applicable: Bundled with Procedure "$16,771.30 " "$18,061.40 " "$17,029.32 " Not Applicable: Bundled with Procedure "$9,030.70 " "$20,641.60 " "$9,030.70 " "$20,641.60 " VLV AOR 20.2MM 18.8MM OPN PVT AP360 MECH CUF 20MM 505DA20 SUPPLY/IMPLANTS "$25,802.00 " Outpatient "$12,901.00 " Not Applicable: Bundled with Procedure "$16,771.30 " "$18,061.40 " "$17,029.32 " Not Applicable: Bundled with Procedure "$9,030.70 " "$20,641.60 " "$9,030.70 " "$20,641.60 " VLV AOR 16MM ATS OP MECH AP SER 505DA22 SUPPLY/IMPLANTS "$25,802.00 " Outpatient "$12,901.00 " Not Applicable: Bundled with Procedure "$16,771.30 " "$18,061.40 " "$17,029.32 " Not Applicable: Bundled with Procedure "$9,030.70 " "$20,641.60 " "$9,030.70 " "$20,641.60 " VLV AOR 24.2MM 22.8MM OPN PVT AP360 MECH CUF 24MM 505DA24 SUPPLY/IMPLANTS "$25,802.00 " Outpatient "$12,901.00 " Not Applicable: Bundled with Procedure "$16,771.30 " "$18,061.40 " "$17,029.32 " Not Applicable: Bundled with Procedure "$9,030.70 " "$20,641.60 " "$9,030.70 " "$20,641.60 " VLV AOR 26.2MM 24.8MM OPN PVT AP360 MECH CUF 26MM 505DA26 SUPPLY/IMPLANTS "$25,802.00 " Outpatient "$12,901.00 " Not Applicable: Bundled with Procedure "$16,771.30 " "$18,061.40 " "$17,029.32 " Not Applicable: Bundled with Procedure "$9,030.70 " "$20,641.60 " "$9,030.70 " "$20,641.60 " VLV AOR 20MM 29MM MSC UL CNCH STNT HLDR SW PRCN RING 305 305U229 SUPPLY/IMPLANTS "$30,328.00 " Outpatient "$15,164.00 " Not Applicable: Bundled with Procedure "$19,713.20 " "$21,229.60 " "$20,016.48 " Not Applicable: Bundled with Procedure "$10,614.80 " "$24,262.40 " "$10,614.80 " "$24,262.40 " VLV AOR 15MM 21MM HNCK II ULT CNCH BPRTH STNT HLDR SW RING T505U221 SUPPLY/IMPLANTS "$29,348.00 " Outpatient "$14,674.00 " Not Applicable: Bundled with Procedure "$19,076.20 " "$20,543.60 " "$19,369.68 " Not Applicable: Bundled with Procedure "$10,271.80 " "$23,478.40 " "$10,271.80 " "$23,478.40 " VLV AOR 13.5MM 19MM MSC UL CNCH BPRTH STNT HLDR SW RING PRCN 305U219 SUPPLY/IMPLANTS "$30,328.00 " Outpatient "$15,164.00 " Not Applicable: Bundled with Procedure "$19,713.20 " "$21,229.60 " "$20,016.48 " Not Applicable: Bundled with Procedure "$10,614.80 " "$24,262.40 " "$10,614.80 " "$24,262.40 " VLV AOR 15MM 21MM MSC UL CNCH STNT HLDR SW PRCN RING 305 305U221 SUPPLY/IMPLANTS "$30,328.00 " Outpatient "$15,164.00 " Not Applicable: Bundled with Procedure "$19,713.20 " "$21,229.60 " "$20,016.48 " Not Applicable: Bundled with Procedure "$10,614.80 " "$24,262.40 " "$10,614.80 " "$24,262.40 " VLV AOR 16MM 23MM MSC UL CNCH STNT HLDR SW PRCN RING 305 305U223 SUPPLY/IMPLANTS "$30,328.00 " Outpatient "$15,164.00 " Not Applicable: Bundled with Procedure "$19,713.20 " "$21,229.60 " "$20,016.48 " Not Applicable: Bundled with Procedure "$10,614.80 " "$24,262.40 " "$10,614.80 " "$24,262.40 " VLV AOR 17.5MM 25MM MSC UL CNCH BPRTH STNT HLDR SW RING PRCN 305U225 SUPPLY/IMPLANTS "$30,328.00 " Outpatient "$15,164.00 " Not Applicable: Bundled with Procedure "$19,713.20 " "$21,229.60 " "$20,016.48 " Not Applicable: Bundled with Procedure "$10,614.80 " "$24,262.40 " "$10,614.80 " "$24,262.40 " VLV AOR 18.5MM 27MM MSC UL CNCH BPRTH STNT HLDR SW RING PRCN 305U227 SUPPLY/IMPLANTS "$30,328.00 " Outpatient "$15,164.00 " Not Applicable: Bundled with Procedure "$19,713.20 " "$21,229.60 " "$20,016.48 " Not Applicable: Bundled with Procedure "$10,614.80 " "$24,262.40 " "$10,614.80 " "$24,262.40 " VLV AOR 17.5MM 25MM HNCK II ULT CNCH BPRTH STNT HLDR SW RING T505U225 SUPPLY/IMPLANTS "$29,348.00 " Outpatient "$14,674.00 " Not Applicable: Bundled with Procedure "$19,076.20 " "$20,543.60 " "$19,369.68 " Not Applicable: Bundled with Procedure "$10,271.80 " "$23,478.40 " "$10,271.80 " "$23,478.40 " VLV AOR 15MM 19MM 24MM TRIFECTA LINX AC STNT TISS LFLT UNQ TF-19A SUPPLY/IMPLANTS "$34,215.00 " Outpatient "$17,107.50 " Not Applicable: Bundled with Procedure "$22,239.75 " "$23,950.50 " "$22,581.90 " Not Applicable: Bundled with Procedure "$11,975.25 " "$27,372.00 " "$11,975.25 " "$27,372.00 " VLV AOR 18MM 25MM TRIFECTA BPRTH STNT CUF HLDR PRICRD TI TF-25A SUPPLY/IMPLANTS "$34,215.00 " Outpatient "$17,107.50 " Not Applicable: Bundled with Procedure "$22,239.75 " "$23,950.50 " "$22,581.90 " Not Applicable: Bundled with Procedure "$11,975.25 " "$27,372.00 " "$11,975.25 " "$27,372.00 " VLV AOR 17MM 23MM TRIFECTA BPRTH STNT CUF HLDR PRICRD TI TF-23A SUPPLY/IMPLANTS "$29,348.00 " Outpatient "$14,674.00 " Not Applicable: Bundled with Procedure "$19,076.20 " "$20,543.60 " "$19,369.68 " Not Applicable: Bundled with Procedure "$10,271.80 " "$23,478.40 " "$10,271.80 " "$23,478.40 " VLV AOR 19MM 16.7MM MSTR HP XPD CUF MECH ROT LFLT OPN 85D 19AEHPJ-505 SUPPLY/IMPLANTS "$23,815.00 " Outpatient "$11,907.50 " Not Applicable: Bundled with Procedure "$15,479.75 " "$16,670.50 " "$15,717.90 " Not Applicable: Bundled with Procedure "$8,335.25 " "$19,052.00 " "$8,335.25 " "$19,052.00 " VLV AOR 23MM 20.4MM MSTR HP XPD CUF MECH ROT LFLT OPN 85D 23AEHPJ-505 SUPPLY/IMPLANTS "$23,815.00 " Outpatient "$11,907.50 " Not Applicable: Bundled with Procedure "$15,479.75 " "$16,670.50 " "$15,717.90 " Not Applicable: Bundled with Procedure "$8,335.25 " "$19,052.00 " "$8,335.25 " "$19,052.00 " VLV AOR 16MM 26MM 21MM TRIFECTA DRBLE PROTRUSION FTG RST TI TF-21A SUPPLY/IMPLANTS "$34,215.00 " Outpatient "$17,107.50 " Not Applicable: Bundled with Procedure "$22,239.75 " "$23,950.50 " "$22,581.90 " Not Applicable: Bundled with Procedure "$11,975.25 " "$27,372.00 " "$11,975.25 " "$27,372.00 " VLV AOR 19MM 27MM TRIFECTA BPRTH STNT CUF HLDR PRICRD TI TF-27A SUPPLY/IMPLANTS "$34,215.00 " Outpatient "$17,107.50 " Not Applicable: Bundled with Procedure "$22,239.75 " "$23,950.50 " "$22,581.90 " Not Applicable: Bundled with Procedure "$11,975.25 " "$27,372.00 " "$11,975.25 " "$27,372.00 " VLV AOR 23MM 24MM GLWV VSLV MSTR HP MECH CNDT XPD CUF GFT 23VAVGJ-515 SUPPLY/IMPLANTS "$29,592.00 " Outpatient "$14,796.00 " Not Applicable: Bundled with Procedure "$19,234.80 " "$20,714.40 " "$19,530.72 " Not Applicable: Bundled with Procedure "$10,357.20 " "$23,673.60 " "$10,357.20 " "$23,673.60 " VLV AOR 10CM 19MM 20MM 16.7MM MSTR HP GLWV VSLV LO POR GFT 19VAVGJ-515 SUPPLY/IMPLANTS "$29,592.00 " Outpatient "$14,796.00 " Not Applicable: Bundled with Procedure "$19,234.80 " "$20,714.40 " "$19,530.72 " Not Applicable: Bundled with Procedure "$10,357.20 " "$23,673.60 " "$10,357.20 " "$23,673.60 " VLV AOR 10CM 21MM 22MM 18.6MM GLWV VSLV MSTR HP GFT XPD CUF 21VAVGJ-515 SUPPLY/IMPLANTS "$29,592.00 " Outpatient "$14,796.00 " Not Applicable: Bundled with Procedure "$19,234.80 " "$20,714.40 " "$19,530.72 " Not Applicable: Bundled with Procedure "$10,357.20 " "$23,673.60 " "$10,357.20 " "$23,673.60 " VLV AOR 10CM 27MM 36MM 28MM GLWV VSLV MSTR HP 0 PRECLOT COMP 27VAVGJ-515 SUPPLY/IMPLANTS "$29,592.00 " Outpatient "$14,796.00 " Not Applicable: Bundled with Procedure "$19,234.80 " "$20,714.40 " "$19,530.72 " Not Applicable: Bundled with Procedure "$10,357.20 " "$23,673.60 " "$10,357.20 " "$23,673.60 " VLV AOR 29MM 30MM GLWV VSLV MSTR HP MECH CNDT XPD CUF LO GFT 29VAVGJ-515 SUPPLY/IMPLANTS "$29,592.00 " Outpatient "$14,796.00 " Not Applicable: Bundled with Procedure "$19,234.80 " "$20,714.40 " "$19,530.72 " Not Applicable: Bundled with Procedure "$10,357.20 " "$23,673.60 " "$10,357.20 " "$23,673.60 " VLV AOR 25MM 26MM GLWV VSLV MSTR HP MECH CNDT XPD CUF GFT 25VAVGJ-515 SUPPLY/IMPLANTS "$29,592.00 " Outpatient "$14,796.00 " Not Applicable: Bundled with Procedure "$19,234.80 " "$20,714.40 " "$19,530.72 " Not Applicable: Bundled with Procedure "$10,357.20 " "$23,673.60 " "$10,357.20 " "$23,673.60 " VLV AOR 17MM 28MM 23MM TRIFECTA GLD LINX RADOPQ SW CUF TI TFGT-23A SUPPLY/IMPLANTS "$29,327.00 " Outpatient "$14,663.50 " Not Applicable: Bundled with Procedure "$19,062.55 " "$20,528.90 " "$19,355.82 " Not Applicable: Bundled with Procedure "$10,264.45 " "$23,461.60 " "$10,264.45 " "$23,461.60 " VLV AOR 19MM CRP-ED PRIMNT 300019MM SUPPLY/IMPLANTS "$27,861.00 " Outpatient "$13,930.50 " Not Applicable: Bundled with Procedure "$18,109.65 " "$19,502.70 " "$18,388.26 " Not Applicable: Bundled with Procedure "$9,751.35 " "$22,288.80 " "$9,751.35 " "$22,288.80 " VLV AOR 15MM 21MM 26MM 20MM CRP-ED PRIMNT MG THERMAFIX SUP 300021MM SUPPLY/IMPLANTS "$27,861.00 " Outpatient "$13,930.50 " Not Applicable: Bundled with Procedure "$18,109.65 " "$19,502.70 " "$18,388.26 " Not Applicable: Bundled with Procedure "$9,751.35 " "$22,288.80 " "$9,751.35 " "$22,288.80 " VLV AOR 25MM CRP-ED PRIMNT MG BPRTH PRICRD HRT STRL LF 300025MM SUPPLY/IMPLANTS "$27,861.00 " Outpatient "$13,930.50 " Not Applicable: Bundled with Procedure "$18,109.65 " "$19,502.70 " "$18,388.26 " Not Applicable: Bundled with Procedure "$9,751.35 " "$22,288.80 " "$9,751.35 " "$22,288.80 " VLV AOR 27MM CRP-ED PRIMNT MAGNA BIOPROSTHESES PRICRD 300027MM SUPPLY/IMPLANTS "$27,861.00 " Outpatient "$13,930.50 " Not Applicable: Bundled with Procedure "$18,109.65 " "$19,502.70 " "$18,388.26 " Not Applicable: Bundled with Procedure "$9,751.35 " "$22,288.80 " "$9,751.35 " "$22,288.80 " VLV AOR 19MM 29MM 34MM 28MM CRP-ED PRIMNT MG THERMAFIX SUP 300029MM SUPPLY/IMPLANTS "$26,533.00 " Outpatient "$13,266.50 " Not Applicable: Bundled with Procedure "$17,246.45 " "$18,573.10 " "$17,511.78 " Not Applicable: Bundled with Procedure "$9,286.55 " "$21,226.40 " "$9,286.55 " "$21,226.40 " VLV MTRL 27MM MSC CNCH 310C27 SUPPLY/IMPLANTS "$30,328.00 " Outpatient "$15,164.00 " Not Applicable: Bundled with Procedure "$19,713.20 " "$21,229.60 " "$20,016.48 " Not Applicable: Bundled with Procedure "$10,614.80 " "$24,262.40 " "$10,614.80 " "$24,262.40 " VLV MTRL STD 500DM27 SUPPLY/IMPLANTS "$25,802.00 " Outpatient "$12,901.00 " Not Applicable: Bundled with Procedure "$16,771.30 " "$18,061.40 " "$17,029.32 " Not Applicable: Bundled with Procedure "$9,030.70 " "$20,641.60 " "$9,030.70 " "$20,641.60 " VLV MTRL 29MM ATS OP MECH STD HRT 500DM29 SUPPLY/IMPLANTS "$24,334.00 " Outpatient "$12,167.00 " Not Applicable: Bundled with Procedure "$15,817.10 " "$17,033.80 " "$16,060.44 " Not Applicable: Bundled with Procedure "$8,516.90 " "$19,467.20 " "$8,516.90 " "$19,467.20 " VLV MTRL 33MM ATS OP MECH STD SER 500DM33 SUPPLY/IMPLANTS "$25,802.00 " Outpatient "$12,901.00 " Not Applicable: Bundled with Procedure "$16,771.30 " "$18,061.40 " "$17,029.32 " Not Applicable: Bundled with Procedure "$9,030.70 " "$20,641.60 " "$9,030.70 " "$20,641.60 " VLV MTRL 27MM 22.5MM MSTR SER LFLT ORFC CNTRL TRQ ROT MECH 27MJ-501 SUPPLY/IMPLANTS "$27,635.00 " Outpatient "$13,817.50 " Not Applicable: Bundled with Procedure "$17,962.75 " "$19,344.50 " "$18,239.10 " Not Applicable: Bundled with Procedure "$9,672.25 " "$22,108.00 " "$9,672.25 " "$22,108.00 " VLV MTRL 29MM 24.2MM MSTR SER LFLT ORFC CNTRL TRQ ROT MECH 29MJ-501 SUPPLY/IMPLANTS "$27,635.00 " Outpatient "$13,817.50 " Not Applicable: Bundled with Procedure "$17,962.75 " "$19,344.50 " "$18,239.10 " Not Applicable: Bundled with Procedure "$9,672.25 " "$22,108.00 " "$9,672.25 " "$22,108.00 " VLV MTRL 31MM 26.1MM MSTR-SER CUF LFLT OPN CNTRL TRQ ROT 31MJ-501 SUPPLY/IMPLANTS "$27,635.00 " Outpatient "$13,817.50 " Not Applicable: Bundled with Procedure "$17,962.75 " "$19,344.50 " "$18,239.10 " Not Applicable: Bundled with Procedure "$9,672.25 " "$22,108.00 " "$9,672.25 " "$22,108.00 " VLV MTRL 33MM 26.1MM MSTR-SER MECH STD CUF STY PYROLYTIC C 33MJ-501 SUPPLY/IMPLANTS "$26,388.00 " Outpatient "$13,194.00 " Not Applicable: Bundled with Procedure "$17,152.20 " "$18,471.60 " "$17,416.08 " Not Applicable: Bundled with Procedure "$9,235.80 " "$21,110.40 " "$9,235.80 " "$21,110.40 " VLV MTRL 25MM MSC CNCH 310C25 SUPPLY/IMPLANTS "$30,328.00 " Outpatient "$15,164.00 " Not Applicable: Bundled with Procedure "$19,713.20 " "$21,229.60 " "$20,016.48 " Not Applicable: Bundled with Procedure "$10,614.80 " "$24,262.40 " "$10,614.80 " "$24,262.40 " VLV MTRL 29MM 27MM EP FLEXFIT 19MM BPRTH STNT HLDR PRCN E100-29M-00 SUPPLY/IMPLANTS "$23,575.00 " Outpatient "$11,787.50 " Not Applicable: Bundled with Procedure "$15,323.75 " "$16,502.50 " "$15,559.50 " Not Applicable: Bundled with Procedure "$8,251.25 " "$18,860.00 " "$8,251.25 " "$18,860.00 " VLV MTRL 27MM 23MM EP FLEXFIT 16MM BPRTH STNT HLDR LOPRFL E100-27M-00 SUPPLY/IMPLANTS "$23,575.00 " Outpatient "$11,787.50 " Not Applicable: Bundled with Procedure "$15,323.75 " "$16,502.50 " "$15,559.50 " Not Applicable: Bundled with Procedure "$8,251.25 " "$18,860.00 " "$8,251.25 " "$18,860.00 " VLV MTRL 31MM 29MM EP FLEXFIT 20MM BPRTH STNT HLDR PRCN E100-31M-00 SUPPLY/IMPLANTS "$23,575.00 " Outpatient "$11,787.50 " Not Applicable: Bundled with Procedure "$15,323.75 " "$16,502.50 " "$15,559.50 " Not Applicable: Bundled with Procedure "$8,251.25 " "$18,860.00 " "$8,251.25 " "$18,860.00 " VLV MTRL 27MM HNCK II CNCH 19MM BPRTH STNT HLDR PRCN T510C27 SUPPLY/IMPLANTS "$27,880.00 " Outpatient "$13,940.00 " Not Applicable: Bundled with Procedure "$18,122.00 " "$19,516.00 " "$18,400.80 " Not Applicable: Bundled with Procedure "$9,758.00 " "$22,304.00 " "$9,758.00 " "$22,304.00 " VLV MTRL 29MM 38MM 26MM MSC CNCH 20.5MM BIO STNT SCLP SW 310C29 SUPPLY/IMPLANTS "$30,328.00 " Outpatient "$15,164.00 " Not Applicable: Bundled with Procedure "$19,713.20 " "$21,229.60 " "$20,016.48 " Not Applicable: Bundled with Procedure "$10,614.80 " "$24,262.40 " "$10,614.80 " "$24,262.40 " VLV MTRL 31MM 41MM 28MM MSC CNCH 22MM BIO STNT SCLP SEWN 310C31 SUPPLY/IMPLANTS "$30,328.00 " Outpatient "$15,164.00 " Not Applicable: Bundled with Procedure "$19,713.20 " "$21,229.60 " "$20,016.48 " Not Applicable: Bundled with Procedure "$10,614.80 " "$24,262.40 " "$10,614.80 " "$24,262.40 " VLV MTRL 33MM 43MM 30MM MSC CNCH 23MM BIO STNT SCLP SEWN 310C33 SUPPLY/IMPLANTS "$30,328.00 " Outpatient "$15,164.00 " Not Applicable: Bundled with Procedure "$19,713.20 " "$21,229.60 " "$20,016.48 " Not Applicable: Bundled with Procedure "$10,614.80 " "$24,262.40 " "$10,614.80 " "$24,262.40 " VLV MTRL 25MM 23MM EP FLEXFIT 16MM BPRTH STNT HLDR LOPRFL E100-25M-00 SUPPLY/IMPLANTS "$23,575.00 " Outpatient "$11,787.50 " Not Applicable: Bundled with Procedure "$15,323.75 " "$16,502.50 " "$15,559.50 " Not Applicable: Bundled with Procedure "$8,251.25 " "$18,860.00 " "$8,251.25 " "$18,860.00 " VLV MTRL 33MM 31MM EP FLEXFIT 20MM BPRTH STNT HLDR PRCN E100-33M-00 SUPPLY/IMPLANTS "$23,575.00 " Outpatient "$11,787.50 " Not Applicable: Bundled with Procedure "$15,323.75 " "$16,502.50 " "$15,559.50 " Not Applicable: Bundled with Procedure "$8,251.25 " "$18,860.00 " "$8,251.25 " "$18,860.00 " VLV MTRL 25MM CRP-ED PRIMNT MAGNA BPRTH EASE HRT 7300TFX25MM SUPPLY/IMPLANTS "$31,769.00 " Outpatient "$15,884.50 " Not Applicable: Bundled with Procedure "$20,649.85 " "$22,238.30 " "$20,967.54 " Not Applicable: Bundled with Procedure "$11,119.15 " "$25,415.20 " "$11,119.15 " "$25,415.20 " VLV MTRL 31MM MSTR HMSHLD 12CM MECH LO POR GFT MR 31CAVGJ-514 00 SUPPLY/IMPLANTS "$23,815.00 " Outpatient "$11,907.50 " Not Applicable: Bundled with Procedure "$15,479.75 " "$16,670.50 " "$15,717.90 " Not Applicable: Bundled with Procedure "$8,335.25 " "$19,052.00 " "$8,335.25 " "$19,052.00 " VLV SHNT HKM CSF UNITIZE DIST CATH PRGM INLN 120CM 14CM STRL 823844 SUPPLY/IMPLANTS "$18,671.00 " Outpatient "$9,335.50 " Not Applicable: Bundled with Procedure "$12,136.15 " "$13,069.70 " "$12,322.86 " Not Applicable: Bundled with Procedure "$6,534.85 " "$14,936.80 " "$6,534.85 " "$14,936.80 " VLV SHNT CDMN HKM PRGM INLN ADPR STRL 823164 SUPPLY/IMPLANTS "$17,780.00 " Outpatient "$8,890.00 " Not Applicable: Bundled with Procedure "$11,557.00 " "$12,446.00 " "$11,734.80 " Not Applicable: Bundled with Procedure "$6,223.00 " "$14,224.00 " "$6,223.00 " "$14,224.00 " VLV SHNT CHPV RT ANG VNTRC STRL 823184 SUPPLY/IMPLANTS "$18,671.00 " Outpatient "$9,335.50 " Not Applicable: Bundled with Procedure "$12,136.15 " "$13,069.70 " "$12,322.86 " Not Applicable: Bundled with Procedure "$6,534.85 " "$14,936.80 " "$6,534.85 " "$14,936.80 " VLV SHNT STRT2 2IN FULL PORT SM CSF 30MM 42856 SUPPLY/IMPLANTS "$19,455.00 " Outpatient "$9,727.50 " Not Applicable: Bundled with Procedure "$12,645.75 " "$13,618.50 " "$12,840.30 " Not Applicable: Bundled with Procedure "$6,809.25 " "$15,564.00 " "$6,809.25 " "$15,564.00 " VLV SHNT STRT2 CSF PRGM FLW CNTRL BALL SPRG MECH BGL REG 42866 SUPPLY/IMPLANTS "$19,455.00 " Outpatient "$9,727.50 " Not Applicable: Bundled with Procedure "$12,645.75 " "$13,618.50 " "$12,840.30 " Not Applicable: Bundled with Procedure "$6,809.25 " "$15,564.00 " "$6,809.25 " "$15,564.00 " VLVLTM 1.5MM 98CM IRR PORT CUT BLDE BLT HD HNDL HDR LMTR 1009-00 SUPPLY/IMPLANTS "$6,600.00 " Outpatient "$3,300.00 " Not Applicable: Bundled with Procedure "$4,290.00 " "$4,620.00 " "$4,356.00 " Not Applicable: Bundled with Procedure "$2,310.00 " "$5,280.00 " "$2,310.00 " "$5,280.00 " WAND ESURG ORNG RFLX UL PTR CBLTN SM D MRK TRBNT RDC EIC483501 SUPPLY/IMPLANTS "$1,396.00 " Outpatient $698.00 Not Applicable: Bundled with Procedure $907.40 $977.20 $921.36 Not Applicable: Bundled with Procedure $488.60 "$1,116.80 " $488.60 "$1,116.80 " WAND ESURG .8MM 1MM TPZ MCDBRDR 0D SM SHFT VRSTL QTM QTM 2 AC4330-01 SUPPLY/IMPLANTS "$1,309.00 " Outpatient $654.50 Not Applicable: Bundled with Procedure $850.85 $916.30 $863.94 Not Applicable: Bundled with Procedure $458.15 "$1,047.20 " $458.15 "$1,047.20 " WATCHMAN LAA PROCEDURE DEVICE WMPERPROCDEVICE25 SUPPLY/IMPLANTS "$82,963.00 " Outpatient "$41,481.50 " Not Applicable: Bundled with Procedure "$53,925.95 " "$58,074.10 " "$54,755.58 " Not Applicable: Bundled with Procedure "$29,037.05 " "$66,370.40 " "$29,037.05 " "$66,370.40 " WATCHMAN LAA PROCEDURE ACCESS SYSTEM WMPERPROTRUACC25 SUPPLY/IMPLANTS "$6,832.00 " Outpatient "$3,416.00 " Not Applicable: Bundled with Procedure "$4,440.80 " "$4,782.40 " "$4,509.12 " Not Applicable: Bundled with Procedure "$2,391.20 " "$5,465.60 " "$2,391.20 " "$5,465.60 " WATCHMAN TRUSEAL ACCESS SYSTEM SGL US M635TU70010 SUPPLY/IMPLANTS "$14,641.00 " Outpatient "$7,320.50 " Not Applicable: Bundled with Procedure "$9,516.65 " "$10,248.70 " "$9,663.06 " Not Applicable: Bundled with Procedure "$5,124.35 " "$11,712.80 " "$5,124.35 " "$11,712.80 " WATCHMAN TRUSEAL ACCESS SYSTEM DBL US M635TU70020 SUPPLY/IMPLANTS "$6,850.00 " Outpatient "$3,425.00 " Not Applicable: Bundled with Procedure "$4,452.50 " "$4,795.00 " "$4,521.00 " Not Applicable: Bundled with Procedure "$2,397.50 " "$5,480.00 " "$2,397.50 " "$5,480.00 " WATCHMAN TRUSEAL ACCESS SYSTEM ANT US M635TU70040 SUPPLY/IMPLANTS "$6,850.00 " Outpatient "$3,425.00 " Not Applicable: Bundled with Procedure "$4,452.50 " "$4,795.00 " "$4,521.00 " Not Applicable: Bundled with Procedure "$2,397.50 " "$5,480.00 " "$2,397.50 " "$5,480.00 " WEIGHT IMPLANT CONTOUR GOLD EYELID LL3012 SUPPLY/IMPLANTS "$2,254.00 " Outpatient "$1,127.00 " Not Applicable: Bundled with Procedure "$1,465.10 " "$1,577.80 " "$1,487.64 " Not Applicable: Bundled with Procedure $788.90 "$1,803.20 " $788.90 "$1,803.20 " WIRE CRLGE 1.25MM 10MR COIL SS NS 291.06 SUPPLY/IMPLANTS $474.00 Outpatient $237.00 Not Applicable: Bundled with Procedure $308.10 $331.80 $312.84 Not Applicable: Bundled with Procedure $165.90 $379.20 $165.90 $379.20 WIRE CRLGE KRSH 1MM 280MM EYE SS NS 291.01 SUPPLY/IMPLANTS $438.00 Outpatient $219.00 Not Applicable: Bundled with Procedure $284.70 $306.60 $289.08 Not Applicable: Bundled with Procedure $153.30 $350.40 $153.30 $350.40 WIRE FX KRSH 2.5MM 285MM TROC PNT SS NS 292.26 SUPPLY/IMPLANTS $764.00 Outpatient $382.00 Not Applicable: Bundled with Procedure $496.60 $534.80 $504.24 Not Applicable: Bundled with Procedure $267.40 $611.20 $267.40 $611.20 WIRE FX KRSH 2.5MM 150MM TROC PNT SS NS 292.25 SUPPLY/IMPLANTS $536.00 Outpatient $268.00 Not Applicable: Bundled with Procedure $348.40 $375.20 $353.76 Not Applicable: Bundled with Procedure $187.60 $428.80 $187.60 $428.80 WIRE FX KRSH T2 3.2MM 400MM RECON COCR STRL NL SYS 1806-3031S SUPPLY/IMPLANTS "$1,356.00 " Outpatient $678.00 Not Applicable: Bundled with Procedure $881.40 $949.20 $894.96 Not Applicable: Bundled with Procedure $474.60 "$1,084.80 " $474.60 "$1,084.80 " WIRE FX KRSH T2 3MM 285MM WCH STRL 1806-1417S SUPPLY/IMPLANTS "$1,133.00 " Outpatient $566.50 Not Applicable: Bundled with Procedure $736.45 $793.10 $747.78 Not Applicable: Bundled with Procedure $396.55 $906.40 $396.55 $906.40 WIRE FIXATION KIRSCHNER STAINLESS STEEL L400 MM OD2 MM SPADE 292.41 SUPPLY/IMPLANTS "$1,688.00 " Outpatient $844.00 Not Applicable: Bundled with Procedure "$1,097.20 " "$1,181.60 " "$1,114.08 " Not Applicable: Bundled with Procedure $590.80 "$1,350.40 " $590.80 "$1,350.40 " WIRE FIXATION KIRSCHNER L285 MM OD3 MM STERILE 2351-3028S SUPPLY/IMPLANTS $607.00 Outpatient $303.50 Not Applicable: Bundled with Procedure $394.55 $424.90 $400.62 Not Applicable: Bundled with Procedure $212.45 $485.60 $212.45 $485.60 WIRE FIXATION KIRSCHNER L400 MM OD3.2 MM THREAD RECONSTRUCTI 2351-3340S SUPPLY/IMPLANTS $688.00 Outpatient $344.00 Not Applicable: Bundled with Procedure $447.20 $481.60 $454.08 Not Applicable: Bundled with Procedure $240.80 $550.40 $240.80 $550.40 WIRE FIXATION VARIAX KIRSCHNER L200 MM OD2 MM DRILL NONSTERI 705135 SUPPLY/IMPLANTS "$1,419.00 " Outpatient $709.50 Not Applicable: Bundled with Procedure $922.35 $993.30 $936.54 Not Applicable: Bundled with Procedure $496.65 "$1,135.20 " $496.65 "$1,135.20 " WIRE TNSN A FSHR 1.5MM OLV TIP 10419 SUPPLY/IMPLANTS "$1,539.00 " Outpatient $769.50 Not Applicable: Bundled with Procedure "$1,000.35 " "$1,077.30 " "$1,015.74 " Not Applicable: Bundled with Procedure $538.65 "$1,231.20 " $538.65 "$1,231.20 " WSHR 2MM ORTH 2MM ASNS MIC SCR NS 40-20900 SUPPLY/IMPLANTS $540.00 Outpatient $270.00 Not Applicable: Bundled with Procedure $351.00 $378.00 $356.40 Not Applicable: Bundled with Procedure $189.00 $432.00 $189.00 $432.00 WSHR SPNL 17MM 17MM TI BNGF 9090117 SUPPLY/IMPLANTS "$1,653.00 " Outpatient $826.50 Not Applicable: Bundled with Procedure "$1,074.45 " "$1,157.10 " "$1,090.98 " Not Applicable: Bundled with Procedure $578.55 "$1,322.40 " $578.55 "$1,322.40 " WT EYLD THK.6MM PLTN THINPROFILE .8GM TX OF LAGAPHTHALMOS LL 6008 SUPPLY/IMPLANTS "$2,194.00 " Outpatient "$1,097.00 " Not Applicable: Bundled with Procedure "$1,426.10 " "$1,535.80 " "$1,448.04 " Not Applicable: Bundled with Procedure $767.90 "$1,755.20 " $767.90 "$1,755.20 " WT EYLD THK.6MM PLTN THINPROFILE 1.6GM SPHRCL CRVTR TPR LWR LL 6016 SUPPLY/IMPLANTS "$2,664.00 " Outpatient "$1,332.00 " Not Applicable: Bundled with Procedure "$1,731.60 " "$1,864.80 " "$1,758.24 " Not Applicable: Bundled with Procedure $932.40 "$2,131.20 " $932.40 "$2,131.20 " XPD TISS 13.2X13.8CM BRST 550ML STY 9300 TXTR SLF SL PTCH 3549314 SUPPLY/IMPLANTS "$8,048.00 " Outpatient "$4,024.00 " Not Applicable: Bundled with Procedure "$5,231.20 " "$5,633.60 " "$5,311.68 " Not Applicable: Bundled with Procedure "$2,816.80 " "$6,438.40 " "$2,816.80 " "$6,438.40 " XPD TISS 850CC STRL ARTOURA ULT HI PRFL RND LF TEXP140RUH SUPPLY/IMPLANTS "$10,394.00 " Outpatient "$5,197.00 " Not Applicable: Bundled with Procedure "$6,756.10 " "$7,275.80 " "$6,860.04 " Not Applicable: Bundled with Procedure "$3,637.90 " "$8,315.20 " "$3,637.90 " "$8,315.20 " XTRT STON 115CM 2.4FR 1CM 16 4WR BSKT TPLS UNDX HNDL G32701 SUPPLY/IMPLANTS "$1,046.00 " Outpatient $523.00 Not Applicable: Bundled with Procedure $679.90 $732.20 $690.36 Not Applicable: Bundled with Procedure $366.10 $836.80 $366.10 $836.80 THERASPHERE YTTRIUM 90 YTTRIUM-90 C2616 SUPPLY/IMPLANTS "$78,204.00 " Outpatient "$39,102.00 " "$69,652.08 " "$50,832.60 " "$54,742.80 " "$51,614.64 " Not Applicable: Bundled with Procedure "$27,371.40 " "$62,563.20 " "$27,371.40 " "$69,652.08 " GD NRV 3CM 2MM NRGN PERI BVN CLGN MTRX SEMIPERM STRL PNG230 C9352 SUPPLY/IMPLANTS "$9,885.00 " Outpatient "$4,942.50 " "$2,309.43 " "$6,425.25 " "$6,919.50 " "$6,524.10 " Not Applicable: Bundled with Procedure "$3,459.75 " "$7,908.00 " "$2,309.43 " "$7,908.00 " GD NRV 3CM 3MM NRGN PERI BVN CLGN MTRX SEMIPERM STRL PNG330 C9352 SUPPLY/IMPLANTS "$7,633.00 " Outpatient "$3,816.50 " "$2,309.43 " "$4,961.45 " "$5,343.10 " "$5,037.78 " Not Applicable: Bundled with Procedure "$2,671.55 " "$6,106.40 " "$2,309.43 " "$6,106.40 " GD NRV 2CM 4MM NRGN PERI CLGN MTRX RSRB BCMPT SEMIPERM TUBE PNG420 C9352 SUPPLY/IMPLANTS "$5,080.00 " Outpatient "$2,540.00 " "$2,309.43 " "$3,302.00 " "$3,556.00 " "$3,352.80 " Not Applicable: Bundled with Procedure "$1,778.00 " "$4,064.00 " "$1,778.00 " "$4,064.00 " GD NRV 3CM 5MM NRGN PERI BVN CLGN MTRX SEMIPERM STRL DISP PNG530 C9352 SUPPLY/IMPLANTS "$6,346.00 " Outpatient "$3,173.00 " "$2,309.43 " "$4,124.90 " "$4,442.20 " "$4,188.36 " Not Applicable: Bundled with Procedure "$2,221.10 " "$5,076.80 " "$2,221.10 " "$5,076.80 " GD NRV 3CM 6MM NRGN PERI BVN CLGN MTRX FLXB ABS TUBE BCMPT PNG630 C9352 SUPPLY/IMPLANTS "$7,420.00 " Outpatient "$3,710.00 " "$2,309.43 " "$4,823.00 " "$5,194.00 " "$4,897.20 " Not Applicable: Bundled with Procedure "$2,597.00 " "$5,936.00 " "$2,309.43 " "$5,936.00 " PRTC NRV 4CM 10MM NEURAWRAP PERI CLGN MTRX RSRB BCMPT STRL NW1040 C9353 SUPPLY/IMPLANTS "$6,827.00 " Outpatient "$3,413.50 " "$1,964.49 " "$4,437.55 " "$4,778.90 " "$4,505.82 " Not Applicable: Bundled with Procedure "$2,389.45 " "$5,461.60 " "$1,964.49 " "$5,461.60 " PRTC NRV 4CM 3MM NEURAWRAP PERI CLGN MTRX 2 PEEL ABS N-PYRG NW340 C9353 SUPPLY/IMPLANTS "$6,842.00 " Outpatient "$3,421.00 " "$1,964.49 " "$4,447.30 " "$4,789.40 " "$4,515.72 " Not Applicable: Bundled with Procedure "$2,394.70 " "$5,473.60 " "$1,964.49 " "$5,473.60 " PRTC NRV 4CM 7MM NEURAWRAP PERI BVN CLGN ABS BCMPT STRL NW740 C9353 SUPPLY/IMPLANTS "$6,842.00 " Outpatient "$3,421.00 " "$1,964.49 " "$4,447.30 " "$4,789.40 " "$4,515.72 " Not Applicable: Bundled with Procedure "$2,394.70 " "$5,473.60 " "$1,964.49 " "$5,473.60 " " LINER ACETABULAR NEUTRAL 32MM ID 48MM OD ALTRX PINNACLE 1221-32-048" C1713 SUPPLY/IMPLANTS "$2,850.00 " Outpatient "$1,425.00 " "$1,219.74 " "$1,852.50 " "$1,995.00 " "$1,881.00 " Not Applicable: Bundled with Procedure $997.50 "$2,280.00 " $997.50 "$2,280.00 " " UNICORTICAL CANCELLOUS SPACER 6MM LGAP506" C1713 SUPPLY/IMPLANTS "$4,513.00 " Outpatient "$2,256.50 " "$1,219.74 " "$2,933.45 " "$3,159.10 " "$2,978.58 " Not Applicable: Bundled with Procedure "$1,579.55 " "$3,610.40 " "$1,219.74 " "$3,610.40 " PIN EXTERNAL FIXATION 6MM DIA 250MML STAINLESS STEEL C- 5021-8-250 C1713 SUPPLY/IMPLANTS $605.00 Outpatient $302.50 "$1,219.74 " $393.25 $423.50 $399.30 Not Applicable: Bundled with Procedure $211.75 $484.00 $211.75 "$1,219.74 " PLATE BONE L108 MM ULNA LEFT PROXIMAL APL-PUP-6HL C1713 SUPPLY/IMPLANTS "$5,740.00 " Outpatient "$2,870.00 " "$1,219.74 " "$3,731.00 " "$4,018.00 " "$3,788.40 " Not Applicable: Bundled with Procedure "$2,009.00 " "$4,592.00 " "$1,219.74 " "$4,592.00 " ROD SPINAL CD HORIZON SOLERA COCRMO L45 MM OD5.5 MM CAP NON 651003045 C1713 SUPPLY/IMPLANTS "$1,939.00 " Outpatient $969.50 "$1,219.74 " "$1,260.35 " "$1,357.30 " "$1,279.74 " Not Applicable: Bundled with Procedure $678.65 "$1,551.20 " $678.65 "$1,551.20 " SCREW BONE CANNULATED COMPRESSION HEADLESS 4.5MM DIA 5MM DI 02.226.656 C1713 SUPPLY/IMPLANTS "$2,453.00 " Outpatient "$1,226.50 " "$1,219.74 " "$1,594.45 " "$1,717.10 " "$1,618.98 " Not Applicable: Bundled with Procedure $858.55 "$1,962.40 " $858.55 "$1,962.40 " SCREW BONE PROFICIENT L16 MM OD3.8 MM SPINE CERVICAL POSTER 21-8321 C1713 SUPPLY/IMPLANTS "$3,563.00 " Outpatient "$1,781.50 " "$1,219.74 " "$2,315.95 " "$2,494.10 " "$2,351.58 " Not Applicable: Bundled with Procedure "$1,247.05 " "$2,850.40 " "$1,219.74 " "$2,850.40 " SCREW BONE CERTEX TITANIUM FULL THREAD L10 MM OD3.5 MM SPIN X067-0020 C1713 SUPPLY/IMPLANTS "$3,563.00 " Outpatient "$1,781.50 " "$1,219.74 " "$2,315.95 " "$2,494.10 " "$2,351.58 " Not Applicable: Bundled with Procedure "$1,247.05 " "$2,850.40 " "$1,219.74 " "$2,850.40 " (BC12) 80MM NON-RIMMED SPEED PIN C1713 SUPPLY/IMPLANTS "$2,356.00 " Outpatient "$1,178.00 " "$1,219.74 " "$1,531.40 " "$1,649.20 " "$1,554.96 " Not Applicable: Bundled with Procedure $824.60 "$1,884.80 " $824.60 "$1,884.80 " (BC5) PINNACLE CANCELLOUS BONE SCREW 6.5MM X 30MM C1713 SUPPLY/IMPLANTS "$4,845.00 " Outpatient "$2,422.50 " "$1,219.74 " "$3,149.25 " "$3,391.50 " "$3,197.70 " Not Applicable: Bundled with Procedure "$1,695.75 " "$3,876.00 " "$1,219.74 " "$3,876.00 " (BC5) PINNACLE CANCELLOUS BONE SCREW 6.5MM X 20MM C1713 SUPPLY/IMPLANTS "$4,845.00 " Outpatient "$2,422.50 " "$1,219.74 " "$3,149.25 " "$3,391.50 " "$3,197.70 " Not Applicable: Bundled with Procedure "$1,695.75 " "$3,876.00 " "$1,219.74 " "$3,876.00 " (BC6) PINNACLE CANCELLOUS BONE SCREW 6.5MM X 15MM 1217-15-500 C1713 SUPPLY/IMPLANTS "$4,037.00 " Outpatient "$2,018.50 " "$1,219.74 " "$2,624.05 " "$2,825.90 " "$2,664.42 " Not Applicable: Bundled with Procedure "$1,412.95 " "$3,229.60 " "$1,219.74 " "$3,229.60 " (BC6) PINNACLE CANCELLOUS BONE SCREW C1713 SUPPLY/IMPLANTS "$4,037.00 " Outpatient "$2,018.50 " "$1,219.74 " "$2,624.05 " "$2,825.90 " "$2,664.42 " Not Applicable: Bundled with Procedure "$1,412.95 " "$3,229.60 " "$1,219.74 " "$3,229.60 " (BC6) PINNACLE CANCELLOUS BONE SCREW C1713 SUPPLY/IMPLANTS "$4,034.00 " Outpatient "$2,017.00 " "$1,219.74 " "$2,622.10 " "$2,823.80 " "$2,662.44 " Not Applicable: Bundled with Procedure "$1,411.90 " "$3,227.20 " "$1,219.74 " "$3,227.20 " (BC7) CANCELLOUS BONE SCREW 6.5MM X 20MM C1713 SUPPLY/IMPLANTS "$3,460.00 " Outpatient "$1,730.00 " "$1,219.74 " "$2,249.00 " "$2,422.00 " "$2,283.60 " Not Applicable: Bundled with Procedure "$1,211.00 " "$2,768.00 " "$1,211.00 " "$2,768.00 " (BC7) PINNACLE CANCELLOUS BONE SCREW C1713 SUPPLY/IMPLANTS $488.00 Outpatient $244.00 "$1,219.74 " $317.20 $341.60 $322.08 Not Applicable: Bundled with Procedure $170.80 $390.40 $170.80 "$1,219.74 " (BC7) PINNACLE CANCELLOUS BONE SCREW 1217-20-500 C1713 SUPPLY/IMPLANTS "$3,458.00 " Outpatient "$1,729.00 " "$1,219.74 " "$2,247.70 " "$2,420.60 " "$2,282.28 " Not Applicable: Bundled with Procedure "$1,210.30 " "$2,766.40 " "$1,210.30 " "$2,766.40 " (BC7) PINNACLE CANCELLOUS BONE SCREW C1713 SUPPLY/IMPLANTS "$3,458.00 " Outpatient "$1,729.00 " "$1,219.74 " "$2,247.70 " "$2,420.60 " "$2,282.28 " Not Applicable: Bundled with Procedure "$1,210.30 " "$2,766.40 " "$1,210.30 " "$2,766.40 " (BC8) PINNACLE CANCELLOUS BONE SCREW 6.5MM X 30MM C1713 SUPPLY/IMPLANTS "$4,706.00 " Outpatient "$2,353.00 " "$1,219.74 " "$3,058.90 " "$3,294.20 " "$3,105.96 " Not Applicable: Bundled with Procedure "$1,647.10 " "$3,764.80 " "$1,219.74 " "$3,764.80 " (BC8) PINNACLE CANCELLOUS BONE SCREW 6.5MM X 20MM C1713 SUPPLY/IMPLANTS "$4,706.00 " Outpatient "$2,353.00 " "$1,219.74 " "$3,058.90 " "$3,294.20 " "$3,105.96 " Not Applicable: Bundled with Procedure "$1,647.10 " "$3,764.80 " "$1,219.74 " "$3,764.80 " (BC8) PINNACLE CANCELLOUS BONE SCREW 6.5MM X 15MM C1713 SUPPLY/IMPLANTS "$4,706.00 " Outpatient "$2,353.00 " "$1,219.74 " "$3,058.90 " "$3,294.20 " "$3,105.96 " Not Applicable: Bundled with Procedure "$1,647.10 " "$3,764.80 " "$1,219.74 " "$3,764.80 " (BC9) DELTA XTEND LOCKING METAGIENE SCREW C1713 SUPPLY/IMPLANTS "$3,888.00 " Outpatient "$1,944.00 " "$1,219.74 " "$2,527.20 " "$2,721.60 " "$2,566.08 " Not Applicable: Bundled with Procedure "$1,360.80 " "$3,110.40 " "$1,219.74 " "$3,110.40 " 1.3MM TI CORTEX SCREW SLF-TPNG WSTARDRIVETM RECESS 4MM 400.334E C1713 SUPPLY/IMPLANTS $478.00 Outpatient $239.00 "$1,219.74 " $310.70 $334.60 $315.48 Not Applicable: Bundled with Procedure $167.30 $382.40 $167.30 "$1,219.74 " 1.3MM TI MF CORTEX SCREW SELF-TAPPING WITH FLUTES 13MM 400.633E C1713 SUPPLY/IMPLANTS $474.00 Outpatient $237.00 "$1,219.74 " $308.10 $331.80 $312.84 Not Applicable: Bundled with Procedure $165.90 $379.20 $165.90 "$1,219.74 " 1.5 x 5MM SCREW 91-1505 C1713 SUPPLY/IMPLANTS $617.00 Outpatient $308.50 "$1,219.74 " $401.05 $431.90 $407.22 Not Applicable: Bundled with Procedure $215.95 $493.60 $215.95 "$1,219.74 " 1.5MM SYSTEM 4 HOLE LONG STRAIGHT PLATE 01-7047 C1713 SUPPLY/IMPLANTS $674.00 Outpatient $337.00 "$1,219.74 " $438.10 $471.80 $444.84 Not Applicable: Bundled with Procedure $235.90 $539.20 $235.90 "$1,219.74 " 1.7MM TI EMERGENCY SCREW WITH PLUSDRIVETM RECESS 8MM 400.488E C1713 SUPPLY/IMPLANTS $498.00 Outpatient $249.00 "$1,219.74 " $323.70 $348.60 $328.68 Not Applicable: Bundled with Procedure $174.30 $398.40 $174.30 "$1,219.74 " 10040 CANCELLOUS 65 TAPER B60-10040 C1713 SUPPLY/IMPLANTS $896.00 Outpatient $448.00 "$1,219.74 " $582.40 $627.20 $591.36 Not Applicable: Bundled with Procedure $313.60 $716.80 $313.60 "$1,219.74 " 11MM CARBON FIBER CURVED BAR 210MM 520302021 C1713 SUPPLY/IMPLANTS "$2,563.00 " Outpatient "$1,281.50 " "$1,219.74 " "$1,665.95 " "$1,794.10 " "$1,691.58 " Not Applicable: Bundled with Procedure $897.05 "$2,050.40 " $897.05 "$2,050.40 " 11MM CARBON FIBER CURVED BAR 380MM 520302038 C1713 SUPPLY/IMPLANTS "$2,887.00 " Outpatient "$1,443.50 " "$1,219.74 " "$1,876.55 " "$2,020.90 " "$1,905.42 " Not Applicable: Bundled with Procedure "$1,010.45 " "$2,309.60 " "$1,010.45 " "$2,309.60 " 11MM CARBON FIBER CURVED BAR 500MM 520302050 C1713 SUPPLY/IMPLANTS "$3,047.00 " Outpatient "$1,523.50 " "$1,219.74 " "$1,980.55 " "$2,132.90 " "$2,011.02 " Not Applicable: Bundled with Procedure "$1,066.45 " "$2,437.60 " "$1,066.45 " "$2,437.60 " 11MM X 350MM GLASS FIBER BAR 520201135 C1713 SUPPLY/IMPLANTS "$1,417.00 " Outpatient $708.50 "$1,219.74 " $921.05 $991.90 $935.22 Not Applicable: Bundled with Procedure $495.95 "$1,133.60 " $495.95 "$1,219.74 " 11MM X 300MM GLASS FIBER BAR 520201130 C1713 SUPPLY/IMPLANTS "$1,375.00 " Outpatient $687.50 "$1,219.74 " $893.75 $962.50 $907.50 Not Applicable: Bundled with Procedure $481.25 "$1,100.00 " $481.25 "$1,219.74 " 11MM X 400MM GLASS FIBER BAR 520201140 C1713 SUPPLY/IMPLANTS "$1,542.00 " Outpatient $771.00 "$1,219.74 " "$1,002.30 " "$1,079.40 " "$1,017.72 " Not Applicable: Bundled with Procedure $539.70 "$1,233.60 " $539.70 "$1,233.60 " 11MM X 200MM GLASS FIBER BAR 520201120 C1713 SUPPLY/IMPLANTS "$1,207.00 " Outpatient $603.50 "$1,219.74 " $784.55 $844.90 $796.62 Not Applicable: Bundled with Procedure $422.45 $965.60 $422.45 "$1,219.74 " 11MM X 250MM GLASS FIBER BAR 520201125 C1713 SUPPLY/IMPLANTS "$1,332.00 " Outpatient $666.00 "$1,219.74 " $865.80 $932.40 $879.12 Not Applicable: Bundled with Procedure $466.20 "$1,065.60 " $466.20 "$1,219.74 " 11MM X 100MM GLASS FIBER BAR 520201110 C1713 SUPPLY/IMPLANTS $920.00 Outpatient $460.00 "$1,219.74 " $598.00 $644.00 $607.20 Not Applicable: Bundled with Procedure $322.00 $736.00 $322.00 "$1,219.74 " 11MM X 150MM GLASS FIBER BAR 520201115 C1713 SUPPLY/IMPLANTS $994.00 Outpatient $497.00 "$1,219.74 " $646.10 $695.80 $656.04 Not Applicable: Bundled with Procedure $347.90 $795.20 $347.90 "$1,219.74 " 11MM X 500MM GLASS FIBER BAR 520201150 C1713 SUPPLY/IMPLANTS "$1,486.00 " Outpatient $743.00 "$1,219.74 " $965.90 "$1,040.20 " $980.76 Not Applicable: Bundled with Procedure $520.10 "$1,188.80 " $520.10 "$1,219.74 " 11MM X 600MM GLASS FIBER BAR 520201160 C1713 SUPPLY/IMPLANTS "$1,634.00 " Outpatient $817.00 "$1,219.74 " "$1,062.10 " "$1,143.80 " "$1,078.44 " Not Applicable: Bundled with Procedure $571.90 "$1,307.20 " $571.90 "$1,307.20 " 11mm Bent Bar 175mm 520201018 C1713 SUPPLY/IMPLANTS "$2,660.00 " Outpatient "$1,330.00 " "$1,219.74 " "$1,729.00 " "$1,862.00 " "$1,755.60 " Not Applicable: Bundled with Procedure $931.00 "$2,128.00 " $931.00 "$2,128.00 " 12MM RESCUE SCREW 8427-4012 C1713 SUPPLY/IMPLANTS "$2,029.00 " Outpatient "$1,014.50 " "$1,219.74 " "$1,318.85 " "$1,420.30 " "$1,339.14 " Not Applicable: Bundled with Procedure $710.15 "$1,623.20 " $710.15 "$1,623.20 " 12MM SCREW 8427-3512 C1713 SUPPLY/IMPLANTS "$2,029.00 " Outpatient "$1,014.50 " "$1,219.74 " "$1,318.85 " "$1,420.30 " "$1,339.14 " Not Applicable: Bundled with Procedure $710.15 "$1,623.20 " $710.15 "$1,623.20 " 13030 CORTICAL 65 TAPER A6013030 C1713 SUPPLY/IMPLANTS $862.00 Outpatient $431.00 "$1,219.74 " $560.30 $603.40 $568.92 Not Applicable: Bundled with Procedure $301.70 $689.60 $301.70 "$1,219.74 " 14MM RESCUE SCREW 8427-4014 C1713 SUPPLY/IMPLANTS "$2,029.00 " Outpatient "$1,014.50 " "$1,219.74 " "$1,318.85 " "$1,420.30 " "$1,339.14 " Not Applicable: Bundled with Procedure $710.15 "$1,623.20 " $710.15 "$1,623.20 " 14MM SCREW 8427-3514 C1713 SUPPLY/IMPLANTS "$2,029.00 " Outpatient "$1,014.50 " "$1,219.74 " "$1,318.85 " "$1,420.30 " "$1,339.14 " Not Applicable: Bundled with Procedure $710.15 "$1,623.20 " $710.15 "$1,623.20 " 14MM X 3.75MM FIXED SELF-TAPPING SCREW 7-375F-142 C1713 SUPPLY/IMPLANTS "$1,108.00 " Outpatient $554.00 "$1,219.74 " $720.20 $775.60 $731.28 Not Applicable: Bundled with Procedure $387.80 $886.40 $387.80 "$1,219.74 " 16MM ONE LEVEL ANTERIOR CERVICAL P[LATE CYGNUS 7-1-16MT C1713 SUPPLY/IMPLANTS "$4,275.00 " Outpatient "$2,137.50 " "$1,219.74 " "$2,778.75 " "$2,992.50 " "$2,821.50 " Not Applicable: Bundled with Procedure "$1,496.25 " "$3,420.00 " "$1,219.74 " "$3,420.00 " 16MM RESCUE SCREW 8427-4016 C1713 SUPPLY/IMPLANTS "$2,029.00 " Outpatient "$1,014.50 " "$1,219.74 " "$1,318.85 " "$1,420.30 " "$1,339.14 " Not Applicable: Bundled with Procedure $710.15 "$1,623.20 " $710.15 "$1,623.20 " 16MM X 4.25MM FIXED SELF-TAPPING SCREW 7-425F-162 C1713 SUPPLY/IMPLANTS "$1,108.00 " Outpatient $554.00 "$1,219.74 " $720.20 $775.60 $731.28 Not Applicable: Bundled with Procedure $387.80 $886.40 $387.80 "$1,219.74 " 18090 CANCELLOUS 65 TAPER B60-18090 C1713 SUPPLY/IMPLANTS $862.00 Outpatient $431.00 "$1,219.74 " $560.30 $603.40 $568.92 Not Applicable: Bundled with Procedure $301.70 $689.60 $301.70 "$1,219.74 " 18mm x 3.75mm Variable Self-Tapping Screw 7-375V-182 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " 18mm x 4.25mm Variable Self-Tapping Screw CYGNUS 7-425V-182 C1713 SUPPLY/IMPLANTS "$1,142.00 " Outpatient $571.00 "$1,219.74 " $742.30 $799.40 $753.72 Not Applicable: Bundled with Procedure $399.70 $913.60 $399.70 "$1,219.74 " 2.0MM SMOOTH PEGS 24MM P24 C1713 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 "$1,219.74 " $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 "$1,219.74 " 2.0MM SMOOTH PEGS 20MM P20 C1713 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 "$1,219.74 " $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 "$1,219.74 " 2.0MM SMOOTH PEGS 18MM P18 C1713 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 "$1,219.74 " $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 "$1,219.74 " 2.0MM SMOOTH PEGS 14MM P14 C1713 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 "$1,219.74 " $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 "$1,219.74 " 2.0MM CURVILINEAR DISTRACTOR R100RIGHT 04.500.100 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " 2.0MM CURVILINEAR DISTRACTOR R100LEFT 04.500.101 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " 2.0MM CURVILINEAR DISTRACTOR R30RIGHT 04.500.130 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " 2.0MM CURVILINEAR DISTRACTOR R30LEFT 04.500.131 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " 2.0MM CURVILINEAR DISTRACTOR R50RIGHT 04.500.150 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " 2.0MM CURVILINEAR DISTRACTOR R50LEFT 04.500.151 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " 2.0MM CURVILINEAR DISTRACTOR R70RIGHT 04.500.170 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " 2.0MM CURVILINEAR DISTRACTOR R70LEFT 04.500.171 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " 2.4MM X 7MM DIAMETER SELF- DRILLING LOCKING SCREW GREEN 76-2407 C1713 SUPPLY/IMPLANTS "$1,011.00 " Outpatient $505.50 "$1,219.74 " $657.15 $707.70 $667.26 Not Applicable: Bundled with Procedure $353.85 $808.80 $353.85 "$1,219.74 " 2.5 THREADED PEGS 28MM TP28 C1713 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 "$1,219.74 " $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 "$1,219.74 " 2.5 THREADED PEGS 16MM TP16 C1713 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 "$1,219.74 " $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 "$1,219.74 " 2.5MM SCREW PEGS 18MM SP18 C1713 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 "$1,219.74 " $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 "$1,219.74 " 2.5MM TI CANN COMPRESSION HEADLESS SCREW- ST- 20MM 04.333.120 C1713 SUPPLY/IMPLANTS "$2,601.00 " Outpatient "$1,300.50 " "$1,219.74 " "$1,690.65 " "$1,820.70 " "$1,716.66 " Not Applicable: Bundled with Procedure $910.35 "$2,080.80 " $910.35 "$2,080.80 " 2.7MM TI MACHINE SCREW FOR CMF DISTRACTOR 04.315.000 C1713 SUPPLY/IMPLANTS "$1,300.00 " Outpatient $650.00 "$1,219.74 " $845.00 $910.00 $858.00 Not Applicable: Bundled with Procedure $455.00 "$1,040.00 " $455.00 "$1,219.74 " 20050 CORTICAL 65 TAPER A6020050 C1713 SUPPLY/IMPLANTS $862.00 Outpatient $431.00 "$1,219.74 " $560.30 $603.40 $568.92 Not Applicable: Bundled with Procedure $301.70 $689.60 $301.70 "$1,219.74 " 20080 CANCELLOUS 65 TAPER B60-20080 C1713 SUPPLY/IMPLANTS $862.00 Outpatient $431.00 "$1,219.74 " $560.30 $603.40 $568.92 Not Applicable: Bundled with Procedure $301.70 $689.60 $301.70 "$1,219.74 " 202735 PLATES BSE \T\ 230004000 C1713 SUPPLY/IMPLANTS "$21,796.00 " Outpatient "$10,898.00 " "$1,219.74 " "$14,167.40 " "$15,257.20 " "$14,385.36 " Not Applicable: Bundled with Procedure "$7,628.60 " "$17,436.80 " "$1,219.74 " "$17,436.80 " 202735 SCREWS BASE 230004500 C1713 SUPPLY/IMPLANTS "$15,510.00 " Outpatient "$7,755.00 " "$1,219.74 " "$10,081.50 " "$10,857.00 " "$10,236.60 " Not Applicable: Bundled with Procedure "$5,428.50 " "$12,408.00 " "$1,219.74 " "$12,408.00 " 27MM PERC JIG 482805000 C1713 SUPPLY/IMPLANTS "$1,501.00 " Outpatient $750.50 "$1,219.74 " $975.65 "$1,050.70 " $990.66 Not Applicable: Bundled with Procedure $525.35 "$1,200.80 " $525.35 "$1,219.74 " 2x7 MATRIX PLATE STRAIGHT GOLD BIOMET SP-2630 C1713 SUPPLY/IMPLANTS "$5,138.00 " Outpatient "$2,569.00 " "$1,219.74 " "$3,339.70 " "$3,596.60 " "$3,391.08 " Not Applicable: Bundled with Procedure "$1,798.30 " "$4,110.40 " "$1,219.74 " "$4,110.40 " "3-LEVEL, 60 mm CERVICAL PLATE 30-0360" C1713 SUPPLY/IMPLANTS "$5,382.00 " Outpatient "$2,691.00 " "$1,219.74 " "$3,498.30 " "$3,767.40 " "$3,552.12 " Not Applicable: Bundled with Procedure "$1,883.70 " "$4,305.60 " "$1,219.74 " "$4,305.60 " 3.0MM UNICORTICAL SCREW UCS7 C1713 SUPPLY/IMPLANTS $667.00 Outpatient $333.50 "$1,219.74 " $433.55 $466.90 $440.22 Not Applicable: Bundled with Procedure $233.45 $533.60 $233.45 "$1,219.74 " 3.5MM CORTICAL SCREW 16MM CS16 C1713 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 "$1,219.74 " $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 "$1,219.74 " 3.5MM CORTICAL SCREW 12MM CS12 C1713 SUPPLY/IMPLANTS $547.00 Outpatient $273.50 "$1,219.74 " $355.55 $382.90 $361.02 Not Applicable: Bundled with Procedure $191.45 $437.60 $191.45 "$1,219.74 " 3.5MM X 26MM POLYAXIAL SHAFT SCREW 97-3526 C1713 SUPPLY/IMPLANTS "$3,670.00 " Outpatient "$1,835.00 " "$1,219.74 " "$2,385.50 " "$2,569.00 " "$2,422.20 " Not Applicable: Bundled with Procedure "$1,284.50 " "$2,936.00 " "$1,219.74 " "$2,936.00 " 3.5mm x 24mm Polyaxial Screw 95-3524 C1713 SUPPLY/IMPLANTS "$3,670.00 " Outpatient "$1,835.00 " "$1,219.74 " "$2,385.50 " "$2,569.00 " "$2,422.20 " Not Applicable: Bundled with Procedure "$1,284.50 " "$2,936.00 " "$1,219.74 " "$2,936.00 " 32MM THREADED PIN ASIA 249037532 C1713 SUPPLY/IMPLANTS "$1,247.00 " Outpatient $623.50 "$1,219.74 " $810.55 $872.90 $823.02 Not Applicable: Bundled with Procedure $436.45 $997.60 $436.45 "$1,219.74 " 35 X 40MM ZIMMER MOTIONLOC SCREW SS 235904039 C1713 SUPPLY/IMPLANTS $789.00 Outpatient $394.50 "$1,219.74 " $512.85 $552.30 $520.74 Not Applicable: Bundled with Procedure $276.15 $631.20 $276.15 "$1,219.74 " 35 X 42MM ZIMMER MOTIONLOC SCREW SS 235904239 C1713 SUPPLY/IMPLANTS $789.00 Outpatient $394.50 "$1,219.74 " $512.85 $552.30 $520.74 Not Applicable: Bundled with Procedure $276.15 $631.20 $276.15 "$1,219.74 " 4.0MM TAP 7601-90006 C1713 SUPPLY/IMPLANTS "$2,825.00 " Outpatient "$1,412.50 " "$1,219.74 " "$1,836.25 " "$1,977.50 " "$1,864.50 " Not Applicable: Bundled with Procedure $988.75 "$2,260.00 " $988.75 "$2,260.00 " 4.5 MM TI CANN COMPRESION HEADLESS SCREW LT 75MM 04.334.575 C1713 SUPPLY/IMPLANTS "$2,601.00 " Outpatient "$1,300.50 " "$1,219.74 " "$1,690.65 " "$1,820.70 " "$1,716.66 " Not Applicable: Bundled with Procedure $910.35 "$2,080.80 " $910.35 "$2,080.80 " 4.5 X 190MM COBALT CHROME MIS ROD 1-51-45190 C1713 SUPPLY/IMPLANTS "$1,998.00 " Outpatient $999.00 "$1,219.74 " "$1,298.70 " "$1,398.60 " "$1,318.68 " Not Applicable: Bundled with Procedure $699.30 "$1,598.40 " $699.30 "$1,598.40 " 4.5 X 130MM COBALT CHROME MIS ROD 1-51-45130 C1713 SUPPLY/IMPLANTS "$1,998.00 " Outpatient $999.00 "$1,219.74 " "$1,298.70 " "$1,398.60 " "$1,318.68 " Not Applicable: Bundled with Procedure $699.30 "$1,598.40 " $699.30 "$1,598.40 " 4.5MM TI VA-LCP CRVD CONDYLAR 04.124.411 C1713 SUPPLY/IMPLANTS "$12,294.00 " Outpatient "$6,147.00 " "$1,219.74 " "$7,991.10 " "$8,605.80 " "$8,114.04 " Not Applicable: Bundled with Procedure "$4,302.90 " "$9,835.20 " "$1,219.74 " "$9,835.20 " 4.5MM TI CANN COMPRESSION HEADLESS SCREW LT 80MM 04.334.580 C1713 SUPPLY/IMPLANTS "$2,601.00 " Outpatient "$1,300.50 " "$1,219.74 " "$1,690.65 " "$1,820.70 " "$1,716.66 " Not Applicable: Bundled with Procedure $910.35 "$2,080.80 " $910.35 "$2,080.80 " 45 X 42MM ZIMMER MOTIONLOC SCREW SS 235904249 C1713 SUPPLY/IMPLANTS "$1,071.00 " Outpatient $535.50 "$1,219.74 " $696.15 $749.70 $706.86 Not Applicable: Bundled with Procedure $374.85 $856.80 $374.85 "$1,219.74 " 45 X 46MM ZIMMER MOTIONLOC SCREW SS 235904649 C1713 SUPPLY/IMPLANTS "$1,071.00 " Outpatient $535.50 "$1,219.74 " $696.15 $749.70 $706.86 Not Applicable: Bundled with Procedure $374.85 $856.80 $374.85 "$1,219.74 " 45 X 48MM ZIMMER MOTIONLOC SCREW SS 235904849 C1713 SUPPLY/IMPLANTS "$1,071.00 " Outpatient $535.50 "$1,219.74 " $696.15 $749.70 $706.86 Not Applicable: Bundled with Procedure $374.85 $856.80 $374.85 "$1,219.74 " 45 X 50MM ZIMMER MOTIONLOC SCREW SS 235905049 C1713 SUPPLY/IMPLANTS "$1,071.00 " Outpatient $535.50 "$1,219.74 " $696.15 $749.70 $706.86 Not Applicable: Bundled with Procedure $374.85 $856.80 $374.85 "$1,219.74 " 45 X 60MM ZIMMER MOTIONLOC SCREW SS STERILE 47235906049 C1713 SUPPLY/IMPLANTS "$1,071.00 " Outpatient $535.50 "$1,219.74 " $696.15 $749.70 $706.86 Not Applicable: Bundled with Procedure $374.85 $856.80 $374.85 "$1,219.74 " 455565 SCREWS BASE 230001500 C1713 SUPPLY/IMPLANTS "$26,796.00 " Outpatient "$13,398.00 " "$1,219.74 " "$17,417.40 " "$18,757.20 " "$17,685.36 " Not Applicable: Bundled with Procedure "$9,378.60 " "$21,436.80 " "$1,219.74 " "$21,436.80 " 455565 INST BASE AND 230002500 C1713 SUPPLY/IMPLANTS "$16,170.00 " Outpatient "$8,085.00 " "$1,219.74 " "$10,510.50 " "$11,319.00 " "$10,672.20 " Not Applicable: Bundled with Procedure "$5,659.50 " "$12,936.00 " "$1,219.74 " "$12,936.00 " 5.0 LOCKING/16MM 661116 C1713 SUPPLY/IMPLANTS $841.00 Outpatient $420.50 "$1,219.74 " $546.65 $588.70 $555.06 Not Applicable: Bundled with Procedure $294.35 $672.80 $294.35 "$1,219.74 " 5.0 LOCKING/22MM 661122 C1713 SUPPLY/IMPLANTS $841.00 Outpatient $420.50 "$1,219.74 " $546.65 $588.70 $555.06 Not Applicable: Bundled with Procedure $294.35 $672.80 $294.35 "$1,219.74 " 5.00MM VA LOCKING SCREW OPTILINK SLF TPNG STRDRV 38MM 42.231.238 C1713 SUPPLY/IMPLANTS "$1,409.00 " Outpatient $704.50 "$1,219.74 " $915.85 $986.30 $929.94 Not Applicable: Bundled with Procedure $493.15 "$1,127.20 " $493.15 "$1,219.74 " 5.0MM VAL SCREW/OPTILINKâ„¢ SLF-TPNG/STRDRV/46MM 42.231.246 C1713 SUPPLY/IMPLANTS "$1,409.00 " Outpatient $704.50 "$1,219.74 " $915.85 $986.30 $929.94 Not Applicable: Bundled with Procedure $493.15 "$1,127.20 " $493.15 "$1,219.74 " 5.0MM VAL SCREW/OPTILINKâ„¢ SLF-TPNG/STRDRV/80MM 42.231.280 C1713 SUPPLY/IMPLANTS "$1,409.00 " Outpatient $704.50 "$1,219.74 " $915.85 $986.30 $929.94 Not Applicable: Bundled with Procedure $493.15 "$1,127.20 " $493.15 "$1,219.74 " 5.0MM VAL SCREW/OPTILINKâ„¢ SLF-TPNG/STRDRV/85MM 42.231.285 C1713 SUPPLY/IMPLANTS "$1,409.00 " Outpatient $704.50 "$1,219.74 " $915.85 $986.30 $929.94 Not Applicable: Bundled with Procedure $493.15 "$1,127.20 " $493.15 "$1,219.74 " 5.0MM VAL SCREW/OPTILINKâ„¢ SLF-TPNG/STRDRV/90MM 42.231.290 C1713 SUPPLY/IMPLANTS "$1,409.00 " Outpatient $704.50 "$1,219.74 " $915.85 $986.30 $929.94 Not Applicable: Bundled with Procedure $493.15 "$1,127.20 " $493.15 "$1,219.74 " 5.0MM VA LOCKING SCREW OPTILINK SLF TPNG STRDRV 75MM 42.231.275 C1713 SUPPLY/IMPLANTS "$1,409.00 " Outpatient $704.50 "$1,219.74 " $915.85 $986.30 $929.94 Not Applicable: Bundled with Procedure $493.15 "$1,127.20 " $493.15 "$1,219.74 " 5.0MM CANNULATED VA LOCKING SCREW 80MM OPTILINK 42.231.680 C1713 SUPPLY/IMPLANTS "$1,907.00 " Outpatient $953.50 "$1,219.74 " "$1,239.55 " "$1,334.90 " "$1,258.62 " Not Applicable: Bundled with Procedure $667.45 "$1,525.60 " $667.45 "$1,525.60 " 60MM SCREW TRAY 249003000 C1713 SUPPLY/IMPLANTS "$4,289.00 " Outpatient "$2,144.50 " "$1,219.74 " "$2,787.85 " "$3,002.30 " "$2,830.74 " Not Applicable: Bundled with Procedure "$1,501.15 " "$3,431.20 " "$1,219.74 " "$3,431.20 " 7.5 LPSI SYSTEM IO-K03-IP-7.5SC C1713 SUPPLY/IMPLANTS "$23,943.00 " Outpatient "$11,971.50 " "$1,219.74 " "$15,562.95 " "$16,760.10 " "$15,802.38 " Not Applicable: Bundled with Procedure "$8,380.05 " "$19,154.40 " "$1,219.74 " "$19,154.40 " 8 MM BLUE RIB PLATE DHRBP1101 C1713 SUPPLY/IMPLANTS "$4,810.00 " Outpatient "$2,405.00 " "$1,219.74 " "$3,126.50 " "$3,367.00 " "$3,174.60 " Not Applicable: Bundled with Procedure "$1,683.50 " "$3,848.00 " "$1,219.74 " "$3,848.00 " 8 MM BLUE RIB PLATE SCREWS DHRBP1201 C1713 SUPPLY/IMPLANTS $636.00 Outpatient $318.00 "$1,219.74 " $413.40 $445.20 $419.76 Not Applicable: Bundled with Procedure $222.60 $508.80 $222.60 "$1,219.74 " 95 DEG DCS PLATE 10 HOLE178MM C1713 SUPPLY/IMPLANTS "$4,771.00 " Outpatient "$2,385.50 " "$1,219.74 " "$3,101.15 " "$3,339.70 " "$3,148.86 " Not Applicable: Bundled with Procedure "$1,669.85 " "$3,816.80 " "$1,219.74 " "$3,816.80 " ACE ALIGN PIN HOLDER 6029 C1713 SUPPLY/IMPLANTS "$2,013.00 " Outpatient "$1,006.50 " "$1,219.74 " "$1,308.45 " "$1,409.10 " "$1,328.58 " Not Applicable: Bundled with Procedure $704.55 "$1,610.40 " $704.55 "$1,610.40 " ACF SPACER 705091 C1713 SUPPLY/IMPLANTS "$4,690.00 " Outpatient "$2,345.00 " "$1,219.74 " "$3,048.50 " "$3,283.00 " "$3,095.40 " Not Applicable: Bundled with Procedure "$1,641.50 " "$3,752.00 " "$1,219.74 " "$3,752.00 " ACHILLES TENDON WITH BONE 21.5CMX1.7CM ACT-001 C1713 SUPPLY/IMPLANTS "$10,764.00 " Outpatient "$5,382.00 " "$1,219.74 " "$6,996.60 " "$7,534.80 " "$7,104.24 " Not Applicable: Bundled with Procedure "$3,767.40 " "$8,611.20 " "$1,219.74 " "$8,611.20 " ADJ SRG ORTH TI SLDR NS 447.111 C1713 SUPPLY/IMPLANTS $475.00 Outpatient $237.50 "$1,219.74 " $308.75 $332.50 $313.50 Not Applicable: Bundled with Procedure $166.25 $380.00 $166.25 "$1,219.74 " ADPR DRVR MDN OFST SS IM NL NS 224606301 C1713 SUPPLY/IMPLANTS "$2,779.00 " Outpatient "$1,389.50 " "$1,219.74 " "$1,806.35 " "$1,945.30 " "$1,834.14 " Not Applicable: Bundled with Procedure $972.65 "$2,223.20 " $972.65 "$2,223.20 " ADPR SRG MDN OBLQ TIB ULTEM HL IM NL NS 225500301 C1713 SUPPLY/IMPLANTS "$5,869.00 " Outpatient "$2,934.50 " "$1,219.74 " "$3,814.85 " "$4,108.30 " "$3,873.54 " Not Applicable: Bundled with Procedure "$2,054.15 " "$4,695.20 " "$1,219.74 " "$4,695.20 " ADPR SRG MDN OBLQ HUM ULTEM HD HL IM NL NS 225500401 C1713 SUPPLY/IMPLANTS "$5,286.00 " Outpatient "$2,643.00 " "$1,219.74 " "$3,435.90 " "$3,700.20 " "$3,488.76 " Not Applicable: Bundled with Procedure "$1,850.10 " "$4,228.80 " "$1,219.74 " "$4,228.80 " ADPR SRG NTR NL CNN XTRT CEPHALOMEDULLARY NL 249009011 C1713 SUPPLY/IMPLANTS "$1,616.00 " Outpatient $808.00 "$1,219.74 " "$1,050.40 " "$1,131.20 " "$1,066.56 " Not Applicable: Bundled with Procedure $565.60 "$1,292.80 " $565.60 "$1,292.80 " ADPR XTRNFX HFMN AP SHRT 3-6MM PIN LMB RECON FRM 4933-1-020 C1713 SUPPLY/IMPLANTS "$1,924.00 " Outpatient $962.00 "$1,219.74 " "$1,250.60 " "$1,346.80 " "$1,269.84 " Not Applicable: Bundled with Procedure $673.40 "$1,539.20 " $673.40 "$1,539.20 " ADPR XTRNFX HFMN AP LNG 3-6MM PIN LMB RECON FRM 4933-1-021 C1713 SUPPLY/IMPLANTS "$1,968.00 " Outpatient $984.00 "$1,219.74 " "$1,279.20 " "$1,377.60 " "$1,298.88 " Not Applicable: Bundled with Procedure $688.80 "$1,574.40 " $688.80 "$1,574.40 " ADPR XTRNFX A FSHR 90D PIN HLDR FA100542 C1713 SUPPLY/IMPLANTS "$2,057.00 " Outpatient "$1,028.50 " "$1,219.74 " "$1,337.05 " "$1,439.90 " "$1,357.62 " Not Applicable: Bundled with Procedure $719.95 "$1,645.60 " $719.95 "$1,645.60 " ADPR XTRNFX XS RING F MAC SYS 15280 C1713 SUPPLY/IMPLANTS "$3,047.00 " Outpatient "$1,523.50 " "$1,219.74 " "$1,980.55 " "$2,132.90 " "$2,011.02 " Not Applicable: Bundled with Procedure "$1,066.45 " "$2,437.60 " "$1,066.45 " "$2,437.60 " ADULT CARBON RAIL 350MM 6311 C1713 SUPPLY/IMPLANTS "$13,169.00 " Outpatient "$6,584.50 " "$1,219.74 " "$8,559.85 " "$9,218.30 " "$8,691.54 " Not Applicable: Bundled with Procedure "$4,609.15 " "$10,535.20 " "$1,219.74 " "$10,535.20 " ADVANCE LOCKING SCREW 0.5MM X 42.5 2361-5042S C1713 SUPPLY/IMPLANTS "$1,091.00 " Outpatient $545.50 "$1,219.74 " $709.15 $763.70 $720.06 Not Applicable: Bundled with Procedure $381.85 $872.80 $381.85 "$1,219.74 " AFFIXUS HIP FRACTURE NAIL - RIGHT 130 DEGREE 9MM X 300MM 8145-09-300 C1713 SUPPLY/IMPLANTS "$10,896.00 " Outpatient "$5,448.00 " "$1,219.74 " "$7,082.40 " "$7,627.20 " "$7,191.36 " Not Applicable: Bundled with Procedure "$3,813.60 " "$8,716.80 " "$1,219.74 " "$8,716.80 " AFFIXUS HIP FRACTURE NAIL-LEFT 130 X 11MM X 260MM 8146-11-260 C1713 SUPPLY/IMPLANTS "$10,896.00 " Outpatient "$5,448.00 " "$1,219.74 " "$7,082.40 " "$7,627.20 " "$7,191.36 " Not Applicable: Bundled with Procedure "$3,813.60 " "$8,716.80 " "$1,219.74 " "$8,716.80 " ALLOSYNC EVANS WEDGE 22MM X 22MM X 12MM ABS-2810-2212 C1713 SUPPLY/IMPLANTS "$8,074.00 " Outpatient "$4,037.00 " "$1,219.74 " "$5,248.10 " "$5,651.80 " "$5,328.84 " Not Applicable: Bundled with Procedure "$2,825.90 " "$6,459.20 " "$1,219.74 " "$6,459.20 " ALPS FOOT EXTENSION CASE 829960005 C1713 SUPPLY/IMPLANTS "$9,720.00 " Outpatient "$4,860.00 " "$1,219.74 " "$6,318.00 " "$6,804.00 " "$6,415.20 " Not Applicable: Bundled with Procedure "$3,402.00 " "$7,776.00 " "$1,219.74 " "$7,776.00 " ANCH SUT 2-0 V-5 MN QAN+ ETH 212033 C1713 SUPPLY/IMPLANTS "$2,132.00 " Outpatient "$1,066.00 " "$1,219.74 " "$1,385.80 " "$1,492.40 " "$1,407.12 " Not Applicable: Bundled with Procedure $746.20 "$1,705.60 " $746.20 "$1,705.60 " ANCH SUT 2.8MM 2 CP-2 QANCHR+ OTHCRD NDL NTNL 11.4MM STRL 222984 C1713 SUPPLY/IMPLANTS "$2,057.00 " Outpatient "$1,028.50 " "$1,219.74 " "$1,337.05 " "$1,439.90 " "$1,357.62 " Not Applicable: Bundled with Procedure $719.95 "$1,645.60 " $719.95 "$1,645.60 " ANCH SUT 3.5MM 2.3MM 0 SHRT .5 CRC 2 DMD PT CSCR FWR S JNT AR-1915SNF C1713 SUPPLY/IMPLANTS "$1,197.00 " Outpatient $598.50 "$1,219.74 " $778.05 $837.90 $790.02 Not Applicable: Bundled with Procedure $418.95 $957.60 $418.95 "$1,219.74 " ANCH SUT 5MM 2 CSCR FWR ROTR CUF BABSR HNDL INSRTR NDL 15MM AR-1920SNF C1713 SUPPLY/IMPLANTS "$1,226.00 " Outpatient $613.00 "$1,219.74 " $796.90 $858.20 $809.16 Not Applicable: Bundled with Procedure $429.10 $980.80 $429.10 "$1,219.74 " ANCH SUT 5.5MM 2 FT CSCR FWR 2 4 NDL PEEK 14.7MM STRL DISP AR-1927BCNF C1713 SUPPLY/IMPLANTS "$2,730.00 " Outpatient "$1,365.00 " "$1,219.74 " "$1,774.50 " "$1,911.00 " "$1,801.80 " Not Applicable: Bundled with Procedure $955.50 "$2,184.00 " $955.50 "$2,184.00 " ANCH SUT 3.5MM 2 CRKSCR ROTR CUF BABSR ST TI 12MM STRL DISP AR-1915S C1713 SUPPLY/IMPLANTS "$1,026.00 " Outpatient $513.00 "$1,219.74 " $666.90 $718.20 $677.16 Not Applicable: Bundled with Procedure $359.10 $820.80 $359.10 "$1,219.74 " ANCH SUT 7MM SWIVELOCK BCMPS 19.5MM TENODESIS AR-1662BC-7 C1713 SUPPLY/IMPLANTS "$3,043.00 " Outpatient "$1,521.50 " "$1,219.74 " "$1,977.95 " "$2,130.10 " "$2,008.38 " Not Applicable: Bundled with Procedure "$1,065.05 " "$2,434.40 " "$1,065.05 " "$2,434.40 " ANCH SUT 8MM SWIVELOCK TENODESIS SHLDR BICEPS FRK EYLT BCMPS AR-1662BC-8 C1713 SUPPLY/IMPLANTS "$2,833.00 " Outpatient "$1,416.50 " "$1,219.74 " "$1,841.45 " "$1,983.10 " "$1,869.78 " Not Applicable: Bundled with Procedure $991.55 "$2,266.40 " $991.55 "$2,266.40 " ANCH SUT 5.5MM SWIVELOCK C CLS EYLT PEEK-OPTM 19.1MM STRL AR-2323PSLC C1713 SUPPLY/IMPLANTS "$2,622.00 " Outpatient "$1,311.00 " "$1,219.74 " "$1,704.30 " "$1,835.40 " "$1,730.52 " Not Applicable: Bundled with Procedure $917.70 "$2,097.60 " $917.70 "$2,097.60 " ANCH SUT 5.5MM 2 FT CSCR FWR 2 PEEK 14.7MM STRL DISP AR-1927PSF C1713 SUPPLY/IMPLANTS "$2,326.00 " Outpatient "$1,163.00 " "$1,219.74 " "$1,511.90 " "$1,628.20 " "$1,535.16 " Not Applicable: Bundled with Procedure $814.10 "$1,860.80 " $814.10 "$1,860.80 " ANCH SUT 6.5MM 2 FT CSCR FWR 2 PEEK STRL DISP AR-1927PSF-65 C1713 SUPPLY/IMPLANTS "$2,406.00 " Outpatient "$1,203.00 " "$1,219.74 " "$1,563.90 " "$1,684.20 " "$1,587.96 " Not Applicable: Bundled with Procedure $842.10 "$1,924.80 " $842.10 "$1,924.80 " ANCH SUT 2.9MM PUSHLOCK BCMPS 15.5MM STRL DISP AR-1923BC C1713 SUPPLY/IMPLANTS "$2,657.00 " Outpatient "$1,328.50 " "$1,219.74 " "$1,727.05 " "$1,859.90 " "$1,753.62 " Not Applicable: Bundled with Procedure $929.95 "$2,125.60 " $929.95 "$2,125.60 " ANCH SUT 2.2MM 2-0 3/8 CRC MIC FT TPR CSCR FWR FT/ANKL 2 NDL AR-1318FT C1713 SUPPLY/IMPLANTS "$1,627.00 " Outpatient $813.50 "$1,219.74 " "$1,057.55 " "$1,138.90 " "$1,073.82 " Not Applicable: Bundled with Procedure $569.45 "$1,301.60 " $569.45 "$1,301.60 " ANCH SUT 2.7MM 2-0 3/8 CRC MN FT TPR CSCR FWR FT/ANKL NDL AR-1319FT C1713 SUPPLY/IMPLANTS "$2,326.00 " Outpatient "$1,163.00 " "$1,219.74 " "$1,511.90 " "$1,628.20 " "$1,535.16 " Not Applicable: Bundled with Procedure $814.10 "$1,860.80 " $814.10 "$1,860.80 " ANCH SUT 3.5MM 2 CSCR FWR ROTR CUF ST EYLT HNDL INSRTR TI 12 AR-1915SF C1713 SUPPLY/IMPLANTS "$1,591.00 " Outpatient $795.50 "$1,219.74 " "$1,034.15 " "$1,113.70 " "$1,050.06 " Not Applicable: Bundled with Procedure $556.85 "$1,272.80 " $556.85 "$1,272.80 " ANCH SUT 3.5MM PUSHLOCK BCMPS 19.5MM STRL DISP AR-1926BC C1713 SUPPLY/IMPLANTS "$2,280.00 " Outpatient "$1,140.00 " "$1,219.74 " "$1,482.00 " "$1,596.00 " "$1,504.80 " Not Applicable: Bundled with Procedure $798.00 "$1,824.00 " $798.00 "$1,824.00 " ANCH SUT 4.5MM 2 FT CSCR2 FWR 2 TI 14MM STRL DISP AR-1928SF-45 C1713 SUPPLY/IMPLANTS "$1,875.00 " Outpatient $937.50 "$1,219.74 " "$1,218.75 " "$1,312.50 " "$1,237.50 " Not Applicable: Bundled with Procedure $656.25 "$1,500.00 " $656.25 "$1,500.00 " ANCH SUT 4.6MM BCSCR PEEK AR-1927PSF-46 C1713 SUPPLY/IMPLANTS "$1,875.00 " Outpatient $937.50 "$1,219.74 " "$1,218.75 " "$1,312.50 " "$1,237.50 " Not Applicable: Bundled with Procedure $656.25 "$1,500.00 " $656.25 "$1,500.00 " ANCH SUT 2.5MM MN PUSHLOCK PEEK 8MM STRL AR-8825P C1713 SUPPLY/IMPLANTS "$2,520.00 " Outpatient "$1,260.00 " "$1,219.74 " "$1,638.00 " "$1,764.00 " "$1,663.20 " Not Applicable: Bundled with Procedure $882.00 "$2,016.00 " $882.00 "$2,016.00 " ANCH SUT 1.9MM 1 SUTUREFIX ULT ULBRD COBRAID PLSTR BLU 72203854 C1713 SUPPLY/IMPLANTS "$2,194.00 " Outpatient "$1,097.00 " "$1,219.74 " "$1,426.10 " "$1,535.80 " "$1,448.04 " Not Applicable: Bundled with Procedure $767.90 "$1,755.20 " $767.90 "$1,755.20 " ANCH SUT 1.7MM 5 2 STRG ULBRD SUTUREFIX ULT SHLDR 1 LD SFT 72203852 C1713 SUPPLY/IMPLANTS "$1,968.00 " Outpatient $984.00 "$1,219.74 " "$1,279.20 " "$1,377.60 " "$1,298.88 " Not Applicable: Bundled with Procedure $688.80 "$1,574.40 " $688.80 "$1,574.40 " ANCH SUT 1.45MM 1 SHRT JUGGERKNOT DRLBT SFT RGD 110005315 C1713 SUPPLY/IMPLANTS "$2,309.00 " Outpatient "$1,154.50 " "$1,219.74 " "$1,500.85 " "$1,616.30 " "$1,523.94 " Not Applicable: Bundled with Procedure $808.15 "$1,847.20 " $808.15 "$1,847.20 " ANCH SPNL 12MM COALITION MIS 1136.2012 C1713 SUPPLY/IMPLANTS "$1,140.00 " Outpatient $570.00 "$1,219.74 " $741.00 $798.00 $752.40 Not Applicable: Bundled with Procedure $399.00 $912.00 $399.00 "$1,219.74 " ANCH SUT 1.7MM 5 2 STRG SUTUREFIX ULT SHLDR 1 LD COBRAID SFT 72203853 C1713 SUPPLY/IMPLANTS "$2,939.00 " Outpatient "$1,469.50 " "$1,219.74 " "$1,910.35 " "$2,057.30 " "$1,939.74 " Not Applicable: Bundled with Procedure "$1,028.65 " "$2,351.20 " "$1,028.65 " "$2,351.20 " ANCH SUT 5MM FSTN RC OTHCRD VERSALOK ROTR CUF THRD STRL BLU 222993 C1713 SUPPLY/IMPLANTS "$2,371.00 " Outpatient "$1,185.50 " "$1,219.74 " "$1,541.15 " "$1,659.70 " "$1,564.86 " Not Applicable: Bundled with Procedure $829.85 "$1,896.80 " $829.85 "$1,896.80 " ANCH SUT 2.9MM SHRT PUSHLOCK CNN EYLT HNDL INSRTR BCMPS 12.5 AR-2923BC C1713 SUPPLY/IMPLANTS "$2,798.00 " Outpatient "$1,399.00 " "$1,219.74 " "$1,818.70 " "$1,958.60 " "$1,846.68 " Not Applicable: Bundled with Procedure $979.30 "$2,238.40 " $979.30 "$2,238.40 " ANCH SUT 4.5MM IBALANCE CORT 46MM HTO AR-13402-46 C1713 SUPPLY/IMPLANTS "$2,041.00 " Outpatient "$1,020.50 " "$1,219.74 " "$1,326.65 " "$1,428.70 " "$1,347.06 " Not Applicable: Bundled with Procedure $714.35 "$1,632.80 " $714.35 "$1,632.80 " ANCH SUT 4.5MM IBALANCE CORT 32MM HTO AR-13402-32 C1713 SUPPLY/IMPLANTS "$2,041.00 " Outpatient "$1,020.50 " "$1,219.74 " "$1,326.65 " "$1,428.70 " "$1,347.06 " Not Applicable: Bundled with Procedure $714.35 "$1,632.80 " $714.35 "$1,632.80 " ANCH SUT 4.5MM IBALANCE CORT 40MM HTO AR-13402-40 C1713 SUPPLY/IMPLANTS "$2,041.00 " Outpatient "$1,020.50 " "$1,219.74 " "$1,326.65 " "$1,428.70 " "$1,347.06 " Not Applicable: Bundled with Procedure $714.35 "$1,632.80 " $714.35 "$1,632.80 " ANCH SUT 6.5MM IBALANCE CANC 24MM HTO AR-13401-24 C1713 SUPPLY/IMPLANTS "$2,041.00 " Outpatient "$1,020.50 " "$1,219.74 " "$1,326.65 " "$1,428.70 " "$1,347.06 " Not Applicable: Bundled with Procedure $714.35 "$1,632.80 " $714.35 "$1,632.80 " ANCH SUT 2.9MM HEALIX TRANSTEND OTHCRD TI 222260 C1713 SUPPLY/IMPLANTS "$2,381.00 " Outpatient "$1,190.50 " "$1,219.74 " "$1,547.65 " "$1,666.70 " "$1,571.46 " Not Applicable: Bundled with Procedure $833.35 "$1,904.80 " $833.35 "$1,904.80 " ANCH SUT 4.75MM 2 HEALICOIL REGENESORB ULTRATAPE ULBRD SMTH 72203705 C1713 SUPPLY/IMPLANTS "$2,727.00 " Outpatient "$1,363.50 " "$1,219.74 " "$1,772.55 " "$1,908.90 " "$1,799.82 " Not Applicable: Bundled with Procedure $954.45 "$2,181.60 " $954.45 "$2,181.60 " ANCH SUT 5.5MM QUATTRO LNK 1 ROW KNTLS UNQ EYLT STRL SHLDR CM-9155 C1713 SUPPLY/IMPLANTS "$2,139.00 " Outpatient "$1,069.50 " "$1,219.74 " "$1,390.35 " "$1,497.30 " "$1,411.74 " Not Applicable: Bundled with Procedure $748.65 "$1,711.20 " $748.65 "$1,711.20 " ANCH SUT 2.9MM QUATTRO LNK KNTLS STRL SHLDR SYS ROTR CUF SOL CM-9129 C1713 SUPPLY/IMPLANTS "$1,997.00 " Outpatient $998.50 "$1,219.74 " "$1,298.05 " "$1,397.90 " "$1,318.02 " Not Applicable: Bundled with Procedure $698.95 "$1,597.60 " $698.95 "$1,597.60 " ANCH SUT 4.5MM QUATTRO LNK 1 ROW KNTLS UNQ EYLT STRL SHLDR CM-9145 C1713 SUPPLY/IMPLANTS "$2,139.00 " Outpatient "$1,069.50 " "$1,219.74 " "$1,390.35 " "$1,497.30 " "$1,411.74 " Not Applicable: Bundled with Procedure $748.65 "$1,711.20 " $748.65 "$1,711.20 " ANCH SUT 5.5MM FT 1.3MM CRKSCR SUTURETAPE BABSR BCMPS 14.7MM AR-1927BCT C1713 SUPPLY/IMPLANTS "$2,482.00 " Outpatient "$1,241.00 " "$1,219.74 " "$1,613.30 " "$1,737.40 " "$1,638.12 " Not Applicable: Bundled with Procedure $868.70 "$1,985.60 " $868.70 "$1,985.60 " ANCH SUT 6.8MM ALLTHREAD MXBRD KNTLS PEEK-OPTM PLMR 904844P C1713 SUPPLY/IMPLANTS "$1,921.00 " Outpatient $960.50 "$1,219.74 " "$1,248.65 " "$1,344.70 " "$1,267.86 " Not Applicable: Bundled with Procedure $672.35 "$1,536.80 " $672.35 "$1,536.80 " ANCH SUT 1.3MM 3-0 V-4 MIC QANCHR+ OTHCRD S JNT BABSR DRLBT 212843 C1713 SUPPLY/IMPLANTS "$2,740.00 " Outpatient "$1,370.00 " "$1,219.74 " "$1,781.00 " "$1,918.00 " "$1,808.40 " Not Applicable: Bundled with Procedure $959.00 "$2,192.00 " $959.00 "$2,192.00 " ANCH SUT 1 ARTHX FIBERTAK FBRWR NDL STRL LF DISP AR-8990 C1713 SUPPLY/IMPLANTS "$2,971.00 " Outpatient "$1,485.50 " "$1,219.74 " "$1,931.15 " "$2,079.70 " "$1,960.86 " Not Applicable: Bundled with Procedure "$1,039.85 " "$2,376.80 " "$1,039.85 " "$2,376.80 " ANCH SUT 4.75MM SWIVELOCK CLS EYLT VNT PEEK 19.1MM STRL DISP AR-2324PSLC C1713 SUPPLY/IMPLANTS "$2,141.00 " Outpatient "$1,070.50 " "$1,219.74 " "$1,391.65 " "$1,498.70 " "$1,413.06 " Not Applicable: Bundled with Procedure $749.35 "$1,712.80 " $749.35 "$1,712.80 " ANCH SUT 2MM 3-0 MINITAC DRBRD PRELD NDL DRL GD TI STRL 7210303 C1713 SUPPLY/IMPLANTS $943.00 Outpatient $471.50 "$1,219.74 " $612.95 $660.10 $622.38 Not Applicable: Bundled with Procedure $330.05 $754.40 $330.05 "$1,219.74 " ANCH SUT 3.5MM SWIVELOCK VNT PEEK-OPTM 14.8MM AR-2325PSLC C1713 SUPPLY/IMPLANTS "$2,141.00 " Outpatient "$1,070.50 " "$1,219.74 " "$1,391.65 " "$1,498.70 " "$1,413.06 " Not Applicable: Bundled with Procedure $749.35 "$1,712.80 " $749.35 "$1,712.80 " ANCH SUT 2.1MM JUGGERKNOTLESS SFT SS 110005198 C1713 SUPPLY/IMPLANTS "$1,943.00 " Outpatient $971.50 "$1,219.74 " "$1,262.95 " "$1,360.10 " "$1,282.38 " Not Applicable: Bundled with Procedure $680.05 "$1,554.40 " $680.05 "$1,554.40 " ANCH SUT 3MM 2 KNTLS SUT TK FBRWR PEEK 12.7MM AR-1938PS C1713 SUPPLY/IMPLANTS "$2,196.00 " Outpatient "$1,098.00 " "$1,219.74 " "$1,427.40 " "$1,537.20 " "$1,449.36 " Not Applicable: Bundled with Procedure $768.60 "$1,756.80 " $768.60 "$1,756.80 " ANCH SUT 5.5MM HEALIX OTHCRD NDL TI 222242 C1713 SUPPLY/IMPLANTS "$2,544.00 " Outpatient "$1,272.00 " "$1,219.74 " "$1,653.60 " "$1,780.80 " "$1,679.04 " Not Applicable: Bundled with Procedure $890.40 "$2,035.20 " $890.40 "$2,035.20 " ANCH SUT 2.9MM DRL CM9324ST C1713 SUPPLY/IMPLANTS "$1,284.00 " Outpatient $642.00 "$1,219.74 " $834.60 $898.80 $847.44 Not Applicable: Bundled with Procedure $449.40 "$1,027.20 " $449.40 "$1,219.74 " ANCH SUT 1.5MM 2-0 MCMT STITCHPACK ULFX PRELD NDL BRD PLSTR 10301 C1713 SUPPLY/IMPLANTS $993.00 Outpatient $496.50 "$1,219.74 " $645.45 $695.10 $655.38 Not Applicable: Bundled with Procedure $347.55 $794.40 $347.55 "$1,219.74 " ANCH SUT QUATTRO X TRU-LINK2 L38 IN HIGH STRTH NABSB COBRAID CM-0202 C1713 SUPPLY/IMPLANTS "$2,329.00 " Outpatient "$1,164.50 " "$1,219.74 " "$1,513.85 " "$1,630.30 " "$1,537.14 " Not Applicable: Bundled with Procedure $815.15 "$1,863.20 " $815.15 "$1,863.20 " ANCHORING PLATES LONG MC10006T C1713 SUPPLY/IMPLANTS "$13,695.00 " Outpatient "$6,847.50 " "$1,219.74 " "$8,901.75 " "$9,586.50 " "$9,038.70 " Not Applicable: Bundled with Procedure "$4,793.25 " "$10,956.00 " "$1,219.74 " "$10,956.00 " ANCHOR SUTURE SWIVELOCK TENODESIS PEEK L19.5 MM OD8 MM SHOULDER BICEPS FORK EYELET STERILE AR-1662PS C1713 SUPPLY/IMPLANTS "$2,312.00 " Outpatient "$1,156.00 " "$1,219.74 " "$1,502.80 " "$1,618.40 " "$1,525.92 " Not Applicable: Bundled with Procedure $809.20 "$1,849.60 " $809.20 "$1,849.60 " ANCHOR SUTURE OD2.9 MM DRILL CM-9324ST C1713 SUPPLY/IMPLANTS "$1,285.00 " Outpatient $642.50 "$1,219.74 " $835.25 $899.50 $848.10 Not Applicable: Bundled with Procedure $449.75 "$1,028.00 " $449.75 "$1,219.74 " ANCHOR SUTURE DX FIBERTAK AR-8990ST C1713 SUPPLY/IMPLANTS "$2,655.00 " Outpatient "$1,327.50 " "$1,219.74 " "$1,725.75 " "$1,858.50 " "$1,752.30 " Not Applicable: Bundled with Procedure $929.25 "$2,124.00 " $929.25 "$2,124.00 " ANCHOR HEALIX TI W/ORTHOCORD \T\ NEEDLES 222248 C1713 SUPPLY/IMPLANTS "$2,544.00 " Outpatient "$1,272.00 " "$1,219.74 " "$1,653.60 " "$1,780.80 " "$1,679.04 " Not Applicable: Bundled with Procedure $890.40 "$2,035.20 " $890.40 "$2,035.20 " ANCHOR SIDUS STEM SHOULDER HUMERAL 01.04555.120 C1713 SUPPLY/IMPLANTS "$24,743.00 " Outpatient "$12,371.50 " "$1,219.74 " "$16,082.95 " "$17,320.10 " "$16,330.38 " Not Applicable: Bundled with Procedure "$8,660.05 " "$19,794.40 " "$1,219.74 " "$19,794.40 " ANCHOR SUTURE Q-FIX OD1.8 MM 251800 C1713 SUPPLY/IMPLANTS "$3,758.00 " Outpatient "$1,879.00 " "$1,219.74 " "$2,442.70 " "$2,630.60 " "$2,480.28 " Not Applicable: Bundled with Procedure "$1,315.30 " "$3,006.40 " "$1,219.74 " "$3,006.40 " ANCHOR SUTURE FIBERTAK FIBERWIRE 2 CRUCIATE LIGAMENT BLUE WH AR-3600-2 C1713 SUPPLY/IMPLANTS "$1,941.00 " Outpatient $970.50 "$1,219.74 " "$1,261.65 " "$1,358.70 " "$1,281.06 " Not Applicable: Bundled with Procedure $679.35 "$1,552.80 " $679.35 "$1,552.80 " ANCHOR SUTURE Y-KNOT RC HI-FI 2 NEEDLE 2 LOAD SELF PUNCH DRI YRC02N C1713 SUPPLY/IMPLANTS "$2,126.00 " Outpatient "$1,063.00 " "$1,219.74 " "$1,381.90 " "$1,488.20 " "$1,403.16 " Not Applicable: Bundled with Procedure $744.10 "$1,700.80 " $744.10 "$1,700.80 " ANCHOR HUMERAL SIDUS H19 MM OD28 MM SHOULDER STEM FREE STERI 0104555120 C1713 SUPPLY/IMPLANTS "$9,273.00 " Outpatient "$4,636.50 " "$1,219.74 " "$6,027.45 " "$6,491.10 " "$6,120.18 " Not Applicable: Bundled with Procedure "$3,245.55 " "$7,418.40 " "$1,219.74 " "$7,418.40 " ANCHOR HUMERAL SIDUS SHOULDER STEM FREE STERILE LATEX FREE D 0104555110 C1713 SUPPLY/IMPLANTS "$28,793.00 " Outpatient "$14,396.50 " "$1,219.74 " "$18,715.45 " "$20,155.10 " "$19,003.38 " Not Applicable: Bundled with Procedure "$10,077.55 " "$23,034.40 " "$1,219.74 " "$23,034.40 " ANCHOR SUTURE IBALANCE L22 MM OD6.5 MM CANCELLOUS HIGH TIBIA AR-13401-22 C1713 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 "$1,219.74 " $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,219.74 " ANCHOR SUTURE IBALANCE L26 MM OD6.5 MM CANCELLOUS HIGH TIBIA AR-13401-26 C1713 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 "$1,219.74 " $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,219.74 " ANCHOR SUTURE IBALANCE L36 MM OD4.5 MM CORTICAL HIGH TIBIAL AR-13402-36 C1713 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 "$1,219.74 " $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,219.74 " ANCHOR SUTURE JUGGERSTITCH MAXBRAID POLYESTER 2-0 5 STERILE 110024773 C1713 SUPPLY/IMPLANTS "$1,769.00 " Outpatient $884.50 "$1,219.74 " "$1,149.85 " "$1,238.30 " "$1,167.54 " Not Applicable: Bundled with Procedure $619.15 "$1,415.20 " $619.15 "$1,415.20 " ANCHOR SUTURE PUSHLOCK BIOCOMPOSITE MINI L8 MM OD2.5 MM AR-8825BC C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " ANCHOR SUTURE MAXBRAID EASYSLIDE 2 OD3 MM NEEDLE 902569 C1713 SUPPLY/IMPLANTS "$2,676.00 " Outpatient "$1,338.00 " "$1,219.74 " "$1,739.40 " "$1,873.20 " "$1,766.16 " Not Applicable: Bundled with Procedure $936.60 "$2,140.80 " $936.60 "$2,140.80 " ANCHOR SUTURE FIBERTAK FIBERWIRE FLAT L1.3 MM ROTATOR CUFF T AR-3632 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " ANCHOR SUTURE SUTURETAK TIGERTAIL BIOCOMPOSITE 2 L14.5 MM OD AR-1934BCFT-2 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " ANCHOR SUTURE DELIVERY SYSTEM GRAFT AR-8826DS C1713 SUPPLY/IMPLANTS "$6,117.00 " Outpatient "$3,058.50 " "$1,219.74 " "$3,976.05 " "$4,281.90 " "$4,037.22 " Not Applicable: Bundled with Procedure "$2,140.95 " "$4,893.60 " "$1,219.74 " "$4,893.60 " ANCHOR SUTURE IBALANCE L28 MM OD6.5 MM CANCELLOUS HIGH TIBIA AR-13401-28 C1713 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 "$1,219.74 " $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,219.74 " ANCHOR SUTURE IBALANCE L32 MM OD6.5 MM CANCELLOUS HIGH TIBIA AR-13401-32 C1713 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 "$1,219.74 " $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,219.74 " ANCHOR SUTURE IBALANCE L34 MM OD4.5 MM CORTICAL HIGH TIBIAL AR-13402-34 C1713 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 "$1,219.74 " $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,219.74 " ANCHOR SUTURE FIBERTAK SUTURETAPE 1.3 MM 2 LOAD BLUE WHITE AR-3602-2 C1713 SUPPLY/IMPLANTS "$2,050.00 " Outpatient "$1,025.00 " "$1,219.74 " "$1,332.50 " "$1,435.00 " "$1,353.00 " Not Applicable: Bundled with Procedure $717.50 "$1,640.00 " $717.50 "$1,640.00 " ANCHR SCREW OPPOS BN-BN/SFT TISS-BN 7601-83535E C1713 SUPPLY/IMPLANTS "$2,850.00 " Outpatient "$1,425.00 " "$1,219.74 " "$1,852.50 " "$1,995.00 " "$1,881.00 " Not Applicable: Bundled with Procedure $997.50 "$2,280.00 " $997.50 "$2,280.00 " ANGULATING RAIL TO RING ADAPTER 6420 C1713 SUPPLY/IMPLANTS "$8,853.00 " Outpatient "$4,426.50 " "$1,219.74 " "$5,754.45 " "$6,197.10 " "$5,842.98 " Not Applicable: Bundled with Procedure "$3,098.55 " "$7,082.40 " "$1,219.74 " "$7,082.40 " ANKLE NAIL JIG NOSE 14-440054 C1713 SUPPLY/IMPLANTS "$3,493.00 " Outpatient "$1,746.50 " "$1,219.74 " "$2,270.45 " "$2,445.10 " "$2,305.38 " Not Applicable: Bundled with Procedure "$1,222.55 " "$2,794.40 " "$1,219.74 " "$2,794.40 " ANKLE HALF PIN TEMPFIX 818111000 C1713 SUPPLY/IMPLANTS "$11,001.00 " Outpatient "$5,500.50 " "$1,219.74 " "$7,150.65 " "$7,700.70 " "$7,260.66 " Not Applicable: Bundled with Procedure "$3,850.35 " "$8,800.80 " "$1,219.74 " "$8,800.80 " ANKLE HALF PIN TEMPFIX STER 8081-11-000 C1713 SUPPLY/IMPLANTS "$11,573.00 " Outpatient "$5,786.50 " "$1,219.74 " "$7,522.45 " "$8,101.10 " "$7,638.18 " Not Applicable: Bundled with Procedure "$4,050.55 " "$9,258.40 " "$1,219.74 " "$9,258.40 " ANKLE TRANS PIN LT TEMPFIX 818109000 C1713 SUPPLY/IMPLANTS "$12,908.00 " Outpatient "$6,454.00 " "$1,219.74 " "$8,390.20 " "$9,035.60 " "$8,519.28 " Not Applicable: Bundled with Procedure "$4,517.80 " "$10,326.40 " "$1,219.74 " "$10,326.40 " ANKLE TRANS PIN LT TEMPFIX STER 8081-09-000 C1713 SUPPLY/IMPLANTS "$13,617.00 " Outpatient "$6,808.50 " "$1,219.74 " "$8,851.05 " "$9,531.90 " "$8,987.22 " Not Applicable: Bundled with Procedure "$4,765.95 " "$10,893.60 " "$1,219.74 " "$10,893.60 " ANKLE TRANS PIN RT TEMPFIX STER 808110000 C1713 SUPPLY/IMPLANTS "$13,617.00 " Outpatient "$6,808.50 " "$1,219.74 " "$8,851.05 " "$9,531.90 " "$8,987.22 " Not Applicable: Bundled with Procedure "$4,765.95 " "$10,893.60 " "$1,219.74 " "$10,893.60 " ANNEX ADJACENT LEVEL SYSTEM 11-5040 C1713 SUPPLY/IMPLANTS "$21,375.00 " Outpatient "$10,687.50 " "$1,219.74 " "$13,893.75 " "$14,962.50 " "$14,107.50 " Not Applicable: Bundled with Procedure "$7,481.25 " "$17,100.00 " "$1,219.74 " "$17,100.00 " ANTE FEM TARG GDE 512 WD 249000110 C1713 SUPPLY/IMPLANTS "$33,937.00 " Outpatient "$16,968.50 " "$1,219.74 " "$22,059.05 " "$23,755.90 " "$22,398.42 " Not Applicable: Bundled with Procedure "$11,877.95 " "$27,149.60 " "$1,219.74 " "$27,149.60 " APEX PIN 2023-1-090 C1713 SUPPLY/IMPLANTS $969.00 Outpatient $484.50 "$1,219.74 " $629.85 $678.30 $639.54 Not Applicable: Bundled with Procedure $339.15 $775.20 $339.15 "$1,219.74 " APEX PIN 4MM X 120MM 5030-5-175 C1713 SUPPLY/IMPLANTS "$1,060.00 " Outpatient $530.00 "$1,219.74 " $689.00 $742.00 $699.60 Not Applicable: Bundled with Procedure $371.00 $848.00 $371.00 "$1,219.74 " APR IN CLP LG TI ANG JAW DIST TIP CLS ANTIBACKUP LAST LKOUT ER420 C1713 SUPPLY/IMPLANTS $532.00 Outpatient $266.00 "$1,219.74 " $345.80 $372.40 $351.12 Not Applicable: Bundled with Procedure $186.20 $425.60 $186.20 "$1,219.74 " ARCH BARS 5 INCH STRAIGHT MO50 C1713 SUPPLY/IMPLANTS "$1,236.00 " Outpatient $618.00 "$1,219.74 " $803.40 $865.20 $815.76 Not Applicable: Bundled with Procedure $432.60 $988.80 $432.60 "$1,219.74 " ARM DSTRCT 20MM XTN RGD 04.315.104 C1713 SUPPLY/IMPLANTS "$3,930.00 " Outpatient "$1,965.00 " "$1,219.74 " "$2,554.50 " "$2,751.00 " "$2,593.80 " Not Applicable: Bundled with Procedure "$1,375.50 " "$3,144.00 " "$1,219.74 " "$3,144.00 " ARM DSTRCT 60MM TI XTN FLXB REM NS 04.315.132 C1713 SUPPLY/IMPLANTS "$4,650.00 " Outpatient "$2,325.00 " "$1,219.74 " "$3,022.50 " "$3,255.00 " "$3,069.00 " Not Applicable: Bundled with Procedure "$1,627.50 " "$3,720.00 " "$1,219.74 " "$3,720.00 " ARM XTN 60MM TI COCR SIL RGD REM CRNMXF DSTRCT NS 04.315.112 C1713 SUPPLY/IMPLANTS "$3,930.00 " Outpatient "$1,965.00 " "$1,219.74 " "$2,554.50 " "$2,751.00 " "$2,593.80 " Not Applicable: Bundled with Procedure "$1,375.50 " "$3,144.00 " "$1,219.74 " "$3,144.00 " ASMB BOLT MDN SS NS 225500103 C1713 SUPPLY/IMPLANTS "$2,218.00 " Outpatient "$1,109.00 " "$1,219.74 " "$1,441.70 " "$1,552.60 " "$1,463.88 " Not Applicable: Bundled with Procedure $776.30 "$1,774.40 " $776.30 "$1,774.40 " ASMB CBLPN 91CM 1.8MM ZM CBL RD COCR CRLGE 14.5MMX4MM NCB 223200228 C1713 SUPPLY/IMPLANTS "$2,292.00 " Outpatient "$1,146.00 " "$1,219.74 " "$1,489.80 " "$1,604.40 " "$1,512.72 " Not Applicable: Bundled with Procedure $802.20 "$1,833.60 " $802.20 "$1,833.60 " ASMB XTRNFX HEADFRAME ADJ DSTRCT NS 390.1 C1713 SUPPLY/IMPLANTS "$25,150.00 " Outpatient "$12,575.00 " "$1,219.74 " "$16,347.50 " "$17,605.00 " "$16,599.00 " Not Applicable: Bundled with Procedure "$8,802.50 " "$20,120.00 " "$1,219.74 " "$20,120.00 " ASNIS III SS CANN SCR6.5X125MM 326525S C1713 SUPPLY/IMPLANTS "$1,197.00 " Outpatient $598.50 "$1,219.74 " $778.05 $837.90 $790.02 Not Applicable: Bundled with Procedure $418.95 $957.60 $418.95 "$1,219.74 " AXS CATALYST LOCKING SCREW 5.O X 55MM 661155 C1713 SUPPLY/IMPLANTS $840.00 Outpatient $420.00 "$1,219.74 " $546.00 $588.00 $554.40 Not Applicable: Bundled with Procedure $294.00 $672.00 $294.00 "$1,219.74 " BAR ARCH OMNIMAX PREFORM MXLMNDB FX 10298 C1713 SUPPLY/IMPLANTS "$2,780.00 " Outpatient "$1,390.00 " "$1,219.74 " "$1,807.00 " "$1,946.00 " "$1,834.80 " Not Applicable: Bundled with Procedure $973.00 "$2,224.00 " $973.00 "$2,224.00 " BAR SPNL 240MM 6MM SCRL SPNE SS THRD NS 296.765 C1713 SUPPLY/IMPLANTS "$3,303.00 " Outpatient "$1,651.50 " "$1,219.74 " "$2,146.95 " "$2,312.10 " "$2,179.98 " Not Applicable: Bundled with Procedure "$1,156.05 " "$2,642.40 " "$1,156.05 " "$2,642.40 " BAR TO BAR COUPLING 11 X 450MM 4922-1-011 C1713 SUPPLY/IMPLANTS "$3,283.00 " Outpatient "$1,641.50 " "$1,219.74 " "$2,133.95 " "$2,298.10 " "$2,166.78 " Not Applicable: Bundled with Procedure "$1,149.05 " "$2,626.40 " "$1,149.05 " "$2,626.40 " BAR XTRNFX 200MM 11MM XTRAFIX C LF 520301120 C1713 SUPPLY/IMPLANTS "$1,071.00 " Outpatient $535.50 "$1,219.74 " $696.15 $749.70 $706.86 Not Applicable: Bundled with Procedure $374.85 $856.80 $374.85 "$1,219.74 " BAR XTRNFX 250MM 11MM XTRAFIX C LF 520301125 C1713 SUPPLY/IMPLANTS "$1,183.00 " Outpatient $591.50 "$1,219.74 " $768.95 $828.10 $780.78 Not Applicable: Bundled with Procedure $414.05 $946.40 $414.05 "$1,219.74 " BAR XTRNFX 300MM 11MM XTRAFIX C LF 520301130 C1713 SUPPLY/IMPLANTS "$1,222.00 " Outpatient $611.00 "$1,219.74 " $794.30 $855.40 $806.52 Not Applicable: Bundled with Procedure $427.70 $977.60 $427.70 "$1,219.74 " BAR XTRNFX 400MM 11MM XTRAFIX C LF 520301140 C1713 SUPPLY/IMPLANTS "$1,372.00 " Outpatient $686.00 "$1,219.74 " $891.80 $960.40 $905.52 Not Applicable: Bundled with Procedure $480.20 "$1,097.60 " $480.20 "$1,219.74 " BAR XTRNFX 500MM 11MM XTRAFIX C LF 520301150 C1713 SUPPLY/IMPLANTS "$1,486.00 " Outpatient $743.00 "$1,219.74 " $965.90 "$1,040.20 " $980.76 Not Applicable: Bundled with Procedure $520.10 "$1,188.80 " $520.10 "$1,219.74 " BAR XTRNFX 400MM JTX CFBR NS DISP 71062400 C1713 SUPPLY/IMPLANTS "$2,070.00 " Outpatient "$1,035.00 " "$1,219.74 " "$1,345.50 " "$1,449.00 " "$1,366.20 " Not Applicable: Bundled with Procedure $724.50 "$1,656.00 " $724.50 "$1,656.00 " BASEPLATE TIBIAL LEGION HA POROUS 6 LEFT KNEE 71934165 C1713 SUPPLY/IMPLANTS "$4,893.00 " Outpatient "$2,446.50 " "$1,219.74 " "$3,180.45 " "$3,425.10 " "$3,229.38 " Not Applicable: Bundled with Procedure "$1,712.55 " "$3,914.40 " "$1,219.74 " "$3,914.40 " BASEPLATE GLENOID WITH SCREW 108-4528 105-0028 C1713 SUPPLY/IMPLANTS "$9,695.00 " Outpatient "$4,847.50 " "$1,219.74 " "$6,301.75 " "$6,786.50 " "$6,398.70 " Not Applicable: Bundled with Procedure "$3,393.25 " "$7,756.00 " "$1,219.74 " "$7,756.00 " BENDER PLATE THREAD 2.7 MM SCREW 231200107 C1713 SUPPLY/IMPLANTS $594.00 Outpatient $297.00 "$1,219.74 " $386.10 $415.80 $392.04 Not Applicable: Bundled with Procedure $207.90 $475.20 $207.90 "$1,219.74 " BENDING STICK 703971 C1713 SUPPLY/IMPLANTS "$1,568.00 " Outpatient $784.00 "$1,219.74 " "$1,019.20 " "$1,097.60 " "$1,034.88 " Not Applicable: Bundled with Procedure $548.80 "$1,254.40 " $548.80 "$1,254.40 " BENT UBAR 190MM 21280 C1713 SUPPLY/IMPLANTS "$1,266.00 " Outpatient $633.00 "$1,219.74 " $822.90 $886.20 $835.56 Not Applicable: Bundled with Procedure $443.10 "$1,012.80 " $443.10 "$1,219.74 " BENT UBAR 220MM 21285 C1713 SUPPLY/IMPLANTS "$1,266.00 " Outpatient $633.00 "$1,219.74 " $822.90 $886.20 $835.56 Not Applicable: Bundled with Procedure $443.10 "$1,012.80 " $443.10 "$1,219.74 " BENT UBAR 250MM 21290 C1713 SUPPLY/IMPLANTS "$1,266.00 " Outpatient $633.00 "$1,219.74 " $822.90 $886.20 $835.56 Not Applicable: Bundled with Procedure $443.10 "$1,012.80 " $443.10 "$1,219.74 " BILATERAL OR MULTIPLE MAJOR JOINT WITH MCC DRG 461 DRG 461SN C1713 SUPPLY/IMPLANTS "$56,752.00 " Outpatient "$28,376.00 " "$1,219.74 " "$36,888.80 " "$39,726.40 " "$37,456.32 " Not Applicable: Bundled with Procedure "$19,863.20 " "$45,401.60 " "$1,219.74 " "$45,401.60 " BILATERAL OR MULTIPLE MAJOR JOINT WITHOUT MCC DRG 462 DRG 462SN C1713 SUPPLY/IMPLANTS "$39,037.00 " Outpatient "$19,518.50 " "$1,219.74 " "$25,374.05 " "$27,325.90 " "$25,764.42 " Not Applicable: Bundled with Procedure "$13,662.95 " "$31,229.60 " "$1,219.74 " "$31,229.60 " BILATERAL OR MULTIPLE MAJOR JOINT WITH MCC DRG 461 DRG 461ZB C1713 SUPPLY/IMPLANTS "$56,752.00 " Outpatient "$28,376.00 " "$1,219.74 " "$36,888.80 " "$39,726.40 " "$37,456.32 " Not Applicable: Bundled with Procedure "$19,863.20 " "$45,401.60 " "$1,219.74 " "$45,401.60 " BILATERAL OR MULTIPLE MAJOR JOINT WITHOUT MCC DRG 462 DRG 462ZB C1713 SUPPLY/IMPLANTS "$39,037.00 " Outpatient "$19,518.50 " "$1,219.74 " "$25,374.05 " "$27,325.90 " "$25,764.42 " Not Applicable: Bundled with Procedure "$13,662.95 " "$31,229.60 " "$1,219.74 " "$31,229.60 " BILATERAL OR MULTIPLE MAJOR JOINT WITH MCC DRG 461 DRG 461DS C1713 SUPPLY/IMPLANTS "$56,752.00 " Outpatient "$28,376.00 " "$1,219.74 " "$36,888.80 " "$39,726.40 " "$37,456.32 " Not Applicable: Bundled with Procedure "$19,863.20 " "$45,401.60 " "$1,219.74 " "$45,401.60 " BILATERAL OR MULTIPLE MAJOR JOINT WITHOUT MCC DRG 462 DRG 462DS C1713 SUPPLY/IMPLANTS "$39,037.00 " Outpatient "$19,518.50 " "$1,219.74 " "$25,374.05 " "$27,325.90 " "$25,764.42 " Not Applicable: Bundled with Procedure "$13,662.95 " "$31,229.60 " "$1,219.74 " "$31,229.60 " BIOCARTILAGE 1 ML UMP-0118630153-13 C1713 SUPPLY/IMPLANTS "$3,669.00 " Outpatient "$1,834.50 " "$1,219.74 " "$2,384.85 " "$2,568.30 " "$2,421.54 " Not Applicable: Bundled with Procedure "$1,284.15 " "$2,935.20 " "$1,219.74 " "$2,935.20 " BIODRIVE WASHER TI MED PK5 191152S C1713 SUPPLY/IMPLANTS "$1,892.00 " Outpatient $946.00 "$1,219.74 " "$1,229.80 " "$1,324.40 " "$1,248.72 " Not Applicable: Bundled with Procedure $662.20 "$1,513.60 " $662.20 "$1,513.60 " BIT DRL 2.5MM 3.5MM PA SCR 48560323 C1713 SUPPLY/IMPLANTS "$1,612.00 " Outpatient $806.00 "$1,219.74 " "$1,047.80 " "$1,128.40 " "$1,063.92 " Not Applicable: Bundled with Procedure $564.20 "$1,289.60 " $564.20 "$1,289.60 " BIT DRL 3.2MM CNTR SCR CMPRH RVRS GLND PREP TRY 405883 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 2.7MM PERI SCR CMPRH RVRS GLND PREP TRY 405889 C1713 SUPPLY/IMPLANTS "$1,334.00 " Outpatient $667.00 "$1,219.74 " $867.10 $933.80 $880.44 Not Applicable: Bundled with Procedure $466.90 "$1,067.20 " $466.90 "$1,219.74 " BIT DRL 152MM SHRT PHNX 4.3MM TWST CROWE PNT DISP TIB NL SYS 27984 C1713 SUPPLY/IMPLANTS $839.00 Outpatient $419.50 "$1,219.74 " $545.35 $587.30 $553.74 Not Applicable: Bundled with Procedure $293.65 $671.20 $293.65 "$1,219.74 " BIT DRL 125MM SPS 2MM TWST CLBRT AO FIT NS 700346 C1713 SUPPLY/IMPLANTS "$1,260.00 " Outpatient $630.00 "$1,219.74 " $819.00 $882.00 $831.60 Not Applicable: Bundled with Procedure $441.00 "$1,008.00 " $441.00 "$1,219.74 " BIT DRL 125MM SPS 2.7MM TWST CLBRT AO FIT NS 700348 C1713 SUPPLY/IMPLANTS "$1,197.00 " Outpatient $598.50 "$1,219.74 " $778.05 $837.90 $790.02 Not Applicable: Bundled with Procedure $418.95 $957.60 $418.95 "$1,219.74 " BIT DRL 225MM 4 FLUT 3.2MM CNN NS 4.5MM SCR QC 03.226.039 C1713 SUPPLY/IMPLANTS "$2,570.00 " Outpatient "$1,285.00 " "$1,219.74 " "$1,670.50 " "$1,799.00 " "$1,696.20 " Not Applicable: Bundled with Procedure $899.50 "$2,056.00 " $899.50 "$2,056.00 " BIT DRL 180MM STD TWST SPS AXSOS 3.5MM AO FIT NS 4MM SCR 700353 C1713 SUPPLY/IMPLANTS "$1,654.00 " Outpatient $827.00 "$1,219.74 " "$1,075.10 " "$1,157.80 " "$1,091.64 " Not Applicable: Bundled with Procedure $578.90 "$1,323.20 " $578.90 "$1,323.20 " BIT DRL 60MM 2.5MM DISP 3.5MM NONLOCK SCR 58850025 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " BIT DRL 125MM MATRIXMANDIBLE 1.5MM JLTCH CPLNG CLBRT NS 03.503.476 C1713 SUPPLY/IMPLANTS "$1,108.00 " Outpatient $554.00 "$1,219.74 " $720.20 $775.60 $731.28 Not Applicable: Bundled with Procedure $387.80 $886.40 $387.80 "$1,219.74 " BIT DRL 32MM FIXOS 2.5MM CNN AO DRV XFO073200 C1713 SUPPLY/IMPLANTS "$1,557.00 " Outpatient $778.50 "$1,219.74 " "$1,012.05 " "$1,089.90 " "$1,027.62 " Not Applicable: Bundled with Procedure $544.95 "$1,245.60 " $544.95 "$1,245.60 " BIT DRL 285MM 3.1MM CLBRT 703617 C1713 SUPPLY/IMPLANTS $835.00 Outpatient $417.50 "$1,219.74 " $542.75 $584.50 $551.10 Not Applicable: Bundled with Procedure $292.25 $668.00 $292.25 "$1,219.74 " BIT DRL 489MM 6MM CNN TPR RECON 14-442023 C1713 SUPPLY/IMPLANTS "$8,072.00 " Outpatient "$4,036.00 " "$1,219.74 " "$5,246.80 " "$5,650.40 " "$5,327.52 " Not Applicable: Bundled with Procedure "$2,825.20 " "$6,457.60 " "$1,219.74 " "$6,457.60 " BIT DRL 300MM ASNS III 3.2MM NS 702626 C1713 SUPPLY/IMPLANTS $858.00 Outpatient $429.00 "$1,219.74 " $557.70 $600.60 $566.28 Not Applicable: Bundled with Procedure $300.30 $686.40 $300.30 "$1,219.74 " BIT DRL 3.5MM STRL DISP 703704 C1713 SUPPLY/IMPLANTS $924.00 Outpatient $462.00 "$1,219.74 " $600.60 $646.80 $609.84 Not Applicable: Bundled with Procedure $323.40 $739.20 $323.40 "$1,219.74 " BIT DRL 14MM STP TWST SPNE 4434-0214 C1713 SUPPLY/IMPLANTS "$1,596.00 " Outpatient $798.00 "$1,219.74 " "$1,037.40 " "$1,117.20 " "$1,053.36 " Not Applicable: Bundled with Procedure $558.60 "$1,276.80 " $558.60 "$1,276.80 " BIT DRL 35MM 4MM STP 1.6MM TWST 9216007 C1713 SUPPLY/IMPLANTS "$1,607.00 " Outpatient $803.50 "$1,219.74 " "$1,044.55 " "$1,124.90 " "$1,060.62 " Not Applicable: Bundled with Procedure $562.45 "$1,285.60 " $562.45 "$1,285.60 " BIT DRL 35MM 7MM 1.6MM TWST STP 9216035 C1713 SUPPLY/IMPLANTS "$2,064.00 " Outpatient "$1,032.00 " "$1,219.74 " "$1,341.60 " "$1,444.80 " "$1,362.24 " Not Applicable: Bundled with Procedure $722.40 "$1,651.20 " $722.40 "$1,651.20 " BIT DRVR 2MM INS MULTIDIRECT 214288007 C1713 SUPPLY/IMPLANTS $482.00 Outpatient $241.00 "$1,219.74 " $313.30 $337.40 $318.12 Not Applicable: Bundled with Procedure $168.70 $385.60 $168.70 "$1,219.74 " BIT DRL 60MM TMX 20MM 1.1MM QC 814099380 C1713 SUPPLY/IMPLANTS $462.00 Outpatient $231.00 "$1,219.74 " $300.30 $323.40 $304.92 Not Applicable: Bundled with Procedure $161.70 $369.60 $161.70 "$1,219.74 " BIT DRL 5IN SS 1/16IN STRL 180110000 C1713 SUPPLY/IMPLANTS $485.00 Outpatient $242.50 "$1,219.74 " $315.25 $339.50 $320.10 Not Applicable: Bundled with Procedure $169.75 $388.00 $169.75 "$1,219.74 " BIT DRL 5IN SS 5/64IN TWST STRL 180112000 C1713 SUPPLY/IMPLANTS $485.00 Outpatient $242.50 "$1,219.74 " $315.25 $339.50 $320.10 Not Applicable: Bundled with Procedure $169.75 $388.00 $169.75 "$1,219.74 " BIT DRL 5IN SS 3/32IN TWST STRL 180114000 C1713 SUPPLY/IMPLANTS $485.00 Outpatient $242.50 "$1,219.74 " $315.25 $339.50 $320.10 Not Applicable: Bundled with Procedure $169.75 $388.00 $169.75 "$1,219.74 " BIT DRL 5IN SS 7/64IN TWST STRL 180116000 C1713 SUPPLY/IMPLANTS $485.00 Outpatient $242.50 "$1,219.74 " $315.25 $339.50 $320.10 Not Applicable: Bundled with Procedure $169.75 $388.00 $169.75 "$1,219.74 " BIT DRL 5IN SS 1/8IN TWST STRL 180118000 C1713 SUPPLY/IMPLANTS $485.00 Outpatient $242.50 "$1,219.74 " $315.25 $339.50 $320.10 Not Applicable: Bundled with Procedure $169.75 $388.00 $169.75 "$1,219.74 " BIT DRL 5IN SS 5/32IN TWST STRL 180122000 C1713 SUPPLY/IMPLANTS $485.00 Outpatient $242.50 "$1,219.74 " $315.25 $339.50 $320.10 Not Applicable: Bundled with Procedure $169.75 $388.00 $169.75 "$1,219.74 " BIT DRL 152MM 26MM 3.8MM AO STY QC STRL 8242-72-000 C1713 SUPPLY/IMPLANTS $502.00 Outpatient $251.00 "$1,219.74 " $326.30 $351.40 $331.32 Not Applicable: Bundled with Procedure $175.70 $401.60 $175.70 "$1,219.74 " BIT DRL 80MM 2MM AO CNN 110018532 C1713 SUPPLY/IMPLANTS $502.00 Outpatient $251.00 "$1,219.74 " $326.30 $351.40 $331.32 Not Applicable: Bundled with Procedure $175.70 $401.60 $175.70 "$1,219.74 " BIT DRL FST SS 2.8MM STRL DISP PROX HUM PLT MDLR TRY SNP SYS DB28 C1713 SUPPLY/IMPLANTS $554.00 Outpatient $277.00 "$1,219.74 " $360.10 $387.80 $365.64 Not Applicable: Bundled with Procedure $193.90 $443.20 $193.90 "$1,219.74 " BIT DRL 3MM DISP 450088 C1713 SUPPLY/IMPLANTS $616.00 Outpatient $308.00 "$1,219.74 " $400.40 $431.20 $406.56 Not Applicable: Bundled with Procedure $215.60 $492.80 $215.60 "$1,219.74 " BIT DRL 3.9MM SLD DISP 450090 C1713 SUPPLY/IMPLANTS $616.00 Outpatient $308.00 "$1,219.74 " $400.40 $431.20 $406.56 Not Applicable: Bundled with Procedure $215.60 $492.80 $215.60 "$1,219.74 " BIT DRL LNG 3.5MM AO CNCT STRL 24315 C1713 SUPPLY/IMPLANTS $691.00 Outpatient $345.50 "$1,219.74 " $449.15 $483.70 $456.06 Not Applicable: Bundled with Procedure $241.85 $552.80 $241.85 "$1,219.74 " BIT DRL LNG 4MM AO CNCT STRL 24320 C1713 SUPPLY/IMPLANTS $691.00 Outpatient $345.50 "$1,219.74 " $449.15 $483.70 $456.06 Not Applicable: Bundled with Procedure $241.85 $552.80 $241.85 "$1,219.74 " BIT DRL MIC BIODRIVE 1.5MM CLBRT SLD 2MM SCR FT150B C1713 SUPPLY/IMPLANTS $771.00 Outpatient $385.50 "$1,219.74 " $501.15 $539.70 $508.86 Not Applicable: Bundled with Procedure $269.85 $616.80 $269.85 "$1,219.74 " BIT DRL MIC BIODRIVE 1.5MM SLD STRL DISP 2MM SCR FT150BS C1713 SUPPLY/IMPLANTS $771.00 Outpatient $385.50 "$1,219.74 " $501.15 $539.70 $508.86 Not Applicable: Bundled with Procedure $269.85 $616.80 $269.85 "$1,219.74 " BIT DRL MIC BIODRIVE 2MM SLD DISP 3MM SCR FT301B C1713 SUPPLY/IMPLANTS $771.00 Outpatient $385.50 "$1,219.74 " $501.15 $539.70 $508.86 Not Applicable: Bundled with Procedure $269.85 $616.80 $269.85 "$1,219.74 " BIT DRL MIC BIODRIVE 2MM SLD STRL DISP YLW 3MM SCR FT301BS C1713 SUPPLY/IMPLANTS $771.00 Outpatient $385.50 "$1,219.74 " $501.15 $539.70 $508.86 Not Applicable: Bundled with Procedure $269.85 $616.80 $269.85 "$1,219.74 " BIT DRL 3.5IN SS 1/16IN STRL 180010000 C1713 SUPPLY/IMPLANTS $780.00 Outpatient $390.00 "$1,219.74 " $507.00 $546.00 $514.80 Not Applicable: Bundled with Procedure $273.00 $624.00 $273.00 "$1,219.74 " BIT DRL 87.5MM SS 1.9MM STRL 180012000 C1713 SUPPLY/IMPLANTS $780.00 Outpatient $390.00 "$1,219.74 " $507.00 $546.00 $514.80 Not Applicable: Bundled with Procedure $273.00 $624.00 $273.00 "$1,219.74 " BIT DRL 87.5MM SS 2.3MM STRL 180014000 C1713 SUPPLY/IMPLANTS $780.00 Outpatient $390.00 "$1,219.74 " $507.00 $546.00 $514.80 Not Applicable: Bundled with Procedure $273.00 $624.00 $273.00 "$1,219.74 " BIT DRL 87.5MM SS 2.7MM STRL 180016000 C1713 SUPPLY/IMPLANTS $780.00 Outpatient $390.00 "$1,219.74 " $507.00 $546.00 $514.80 Not Applicable: Bundled with Procedure $273.00 $624.00 $273.00 "$1,219.74 " BIT DRL 87.5MM SS 3.1MM STRL 180018000 C1713 SUPPLY/IMPLANTS $780.00 Outpatient $390.00 "$1,219.74 " $507.00 $546.00 $514.80 Not Applicable: Bundled with Procedure $273.00 $624.00 $273.00 "$1,219.74 " BIT DRL 87.5MM SS 3.5MM STRL 180020000 C1713 SUPPLY/IMPLANTS $780.00 Outpatient $390.00 "$1,219.74 " $507.00 $546.00 $514.80 Not Applicable: Bundled with Procedure $273.00 $624.00 $273.00 "$1,219.74 " BIT DRL 87.5MM SS 3.9MM STRL 180022000 C1713 SUPPLY/IMPLANTS $780.00 Outpatient $390.00 "$1,219.74 " $507.00 $546.00 $514.80 Not Applicable: Bundled with Procedure $273.00 $624.00 $273.00 "$1,219.74 " BIT DRL 87.5MM SS 4.2MM STRL 180023000 C1713 SUPPLY/IMPLANTS $780.00 Outpatient $390.00 "$1,219.74 " $507.00 $546.00 $514.80 Not Applicable: Bundled with Procedure $273.00 $624.00 $273.00 "$1,219.74 " BIT DRL 87.5MM SS 4.6MM STRL 180024000 C1713 SUPPLY/IMPLANTS $780.00 Outpatient $390.00 "$1,219.74 " $507.00 $546.00 $514.80 Not Applicable: Bundled with Procedure $273.00 $624.00 $273.00 "$1,219.74 " BIT DRL 5IN SS 9/64IN TWST STRL 180120000 C1713 SUPPLY/IMPLANTS $780.00 Outpatient $390.00 "$1,219.74 " $507.00 $546.00 $514.80 Not Applicable: Bundled with Procedure $273.00 $624.00 $273.00 "$1,219.74 " BIT DRL 5IN SS 11/64IN TWST STRL 180123000 C1713 SUPPLY/IMPLANTS $780.00 Outpatient $390.00 "$1,219.74 " $507.00 $546.00 $514.80 Not Applicable: Bundled with Procedure $273.00 $624.00 $273.00 "$1,219.74 " BIT DRL 5IN SS 3/16IN TWST STRL 180124000 C1713 SUPPLY/IMPLANTS $780.00 Outpatient $390.00 "$1,219.74 " $507.00 $546.00 $514.80 Not Applicable: Bundled with Procedure $273.00 $624.00 $273.00 "$1,219.74 " BIT DRL 4.8MM ACC 12184 C1713 SUPPLY/IMPLANTS $844.00 Outpatient $422.00 "$1,219.74 " $548.60 $590.80 $557.04 Not Applicable: Bundled with Procedure $295.40 $675.20 $295.40 "$1,219.74 " BIT DRL 3.9MM CNN DISP 450091 C1713 SUPPLY/IMPLANTS $986.00 Outpatient $493.00 "$1,219.74 " $640.90 $690.20 $650.76 Not Applicable: Bundled with Procedure $345.10 $788.80 $345.10 "$1,219.74 " BIT DRL 13IN AIM 5.3MM STRL FEM DISP 820040000 C1713 SUPPLY/IMPLANTS $991.00 Outpatient $495.50 "$1,219.74 " $644.15 $693.70 $654.06 Not Applicable: Bundled with Procedure $346.85 $792.80 $346.85 "$1,219.74 " BIT DRL MIC BIODRIVE 1.6MM CNN STRL DISP 2.3MM SCR FT230BS C1713 SUPPLY/IMPLANTS $997.00 Outpatient $498.50 "$1,219.74 " $648.05 $697.90 $658.02 Not Applicable: Bundled with Procedure $348.95 $797.60 $348.95 "$1,219.74 " BIT DRL MIC BIODRIVE 1.9MM CNN STRL DISP 3MM SCR FT300BS C1713 SUPPLY/IMPLANTS $997.00 Outpatient $498.50 "$1,219.74 " $648.05 $697.90 $658.02 Not Applicable: Bundled with Procedure $348.95 $797.60 $348.95 "$1,219.74 " BIT DRL 4.3MM 245007 C1713 SUPPLY/IMPLANTS "$1,146.00 " Outpatient $573.00 "$1,219.74 " $744.90 $802.20 $756.36 Not Applicable: Bundled with Procedure $401.10 $916.80 $401.10 "$1,219.74 " BIT DRL 2.8MM TWST CROWE PNT END STRL 471833 C1713 SUPPLY/IMPLANTS "$1,187.00 " Outpatient $593.50 "$1,219.74 " $771.55 $830.90 $783.42 Not Applicable: Bundled with Procedure $415.45 $949.60 $415.45 "$1,219.74 " BIT DRL 3.5MM TWST CROWE PNT END STRL 471837 C1713 SUPPLY/IMPLANTS "$1,187.00 " Outpatient $593.50 "$1,219.74 " $771.55 $830.90 $783.42 Not Applicable: Bundled with Procedure $415.45 $949.60 $415.45 "$1,219.74 " BIT DRL 4.3MM STP TWST CROWE PNT END STRL 471845 C1713 SUPPLY/IMPLANTS "$1,187.00 " Outpatient $593.50 "$1,219.74 " $771.55 $830.90 $783.42 Not Applicable: Bundled with Procedure $415.45 $949.60 $415.45 "$1,219.74 " BIT DRL 4.5MM TWST ROTATED 471847 C1713 SUPPLY/IMPLANTS "$1,187.00 " Outpatient $593.50 "$1,219.74 " $771.55 $830.90 $783.42 Not Applicable: Bundled with Procedure $415.45 $949.60 $415.45 "$1,219.74 " BIT DRL 4.8MM TWST 471849 C1713 SUPPLY/IMPLANTS "$1,187.00 " Outpatient $593.50 "$1,219.74 " $771.55 $830.90 $783.42 Not Applicable: Bundled with Procedure $415.45 $949.60 $415.45 "$1,219.74 " BIT DRL 5MM TWST CROWE PNT END STRL 471851 C1713 SUPPLY/IMPLANTS "$1,187.00 " Outpatient $593.50 "$1,219.74 " $771.55 $830.90 $783.42 Not Applicable: Bundled with Procedure $415.45 $949.60 $415.45 "$1,219.74 " BIT DRL 2.7MM CNN SYS GC 24445 C1713 SUPPLY/IMPLANTS "$1,287.00 " Outpatient $643.50 "$1,219.74 " $836.55 $900.90 $849.42 Not Applicable: Bundled with Procedure $450.45 "$1,029.60 " $450.45 "$1,219.74 " BIT DRL POLYAX 5.5MM CNN CORT LAT DISP LCK PLT SYS 2141-23-000 C1713 SUPPLY/IMPLANTS "$1,300.00 " Outpatient $650.00 "$1,219.74 " $845.00 $910.00 $858.00 Not Applicable: Bundled with Procedure $455.00 "$1,040.00 " $455.00 "$1,219.74 " BIT DRL 300MM 4.8MM CNN STRL DISP 110008410 C1713 SUPPLY/IMPLANTS "$1,311.00 " Outpatient $655.50 "$1,219.74 " $852.15 $917.70 $865.26 Not Applicable: Bundled with Procedure $458.85 "$1,048.80 " $458.85 "$1,219.74 " BIT DRL 2MM CNN AO ADPR STRL DISP 110008402 C1713 SUPPLY/IMPLANTS "$1,311.00 " Outpatient $655.50 "$1,219.74 " $852.15 $917.70 $865.26 Not Applicable: Bundled with Procedure $458.85 "$1,048.80 " $458.85 "$1,219.74 " BIT DRL 5MM CNN STRL DISP 14629 C1713 SUPPLY/IMPLANTS "$1,356.00 " Outpatient $678.00 "$1,219.74 " $881.40 $949.20 $894.96 Not Applicable: Bundled with Procedure $474.60 "$1,084.80 " $474.60 "$1,219.74 " BIT DRL LNG 5MM CNN AO 214214012 C1713 SUPPLY/IMPLANTS "$1,369.00 " Outpatient $684.50 "$1,219.74 " $889.85 $958.30 $903.54 Not Applicable: Bundled with Procedure $479.15 "$1,095.20 " $479.15 "$1,219.74 " BIT DRL 2.7MM CNN STRL 245003 C1713 SUPPLY/IMPLANTS "$2,115.00 " Outpatient "$1,057.50 " "$1,219.74 " "$1,374.75 " "$1,480.50 " "$1,395.90 " Not Applicable: Bundled with Procedure $740.25 "$1,692.00 " $740.25 "$1,692.00 " BIT DRL 4.3MM CNN STRL DISP 245005 C1713 SUPPLY/IMPLANTS "$2,115.00 " Outpatient "$1,057.50 " "$1,219.74 " "$1,374.75 " "$1,480.50 " "$1,395.90 " Not Applicable: Bundled with Procedure $740.25 "$1,692.00 " $740.25 "$1,692.00 " BIT DRL HDSN 3.5MM CNN 14-450320 C1713 SUPPLY/IMPLANTS "$4,031.00 " Outpatient "$2,015.50 " "$1,219.74 " "$2,620.15 " "$2,821.70 " "$2,660.46 " Not Applicable: Bundled with Procedure "$1,410.85 " "$3,224.80 " "$1,219.74 " "$3,224.80 " BIT DRL MN HDSN 4.5MM CNN 14-450325 C1713 SUPPLY/IMPLANTS "$5,709.00 " Outpatient "$2,854.50 " "$1,219.74 " "$3,710.85 " "$3,996.30 " "$3,767.94 " Not Applicable: Bundled with Procedure "$1,998.15 " "$4,567.20 " "$1,219.74 " "$4,567.20 " BIT DRL MNMGNFX SS 3.5MM CNN 114201135 C1713 SUPPLY/IMPLANTS "$1,127.00 " Outpatient $563.50 "$1,219.74 " $732.55 $788.90 $743.82 Not Applicable: Bundled with Procedure $394.45 $901.60 $394.45 "$1,219.74 " BIT DRL 12.7CM HRBRT SS 3.8MM 1.72MM CNN PILT NS 115501400 C1713 SUPPLY/IMPLANTS $789.00 Outpatient $394.50 "$1,219.74 " $512.85 $552.30 $520.74 Not Applicable: Bundled with Procedure $276.15 $631.20 $276.15 "$1,219.74 " BIT DRL 12.7CM HRBRT SS 3.1MM 1.72MM CNN MAIN NS 115501500 C1713 SUPPLY/IMPLANTS $752.00 Outpatient $376.00 "$1,219.74 " $488.80 $526.40 $496.32 Not Applicable: Bundled with Procedure $263.20 $601.60 $263.20 "$1,219.74 " BIT DRL 12.7CM HRBRT SS 5.5MM 2.16MM CNN PILT NS 115502400 C1713 SUPPLY/IMPLANTS $714.00 Outpatient $357.00 "$1,219.74 " $464.10 $499.80 $471.24 Not Applicable: Bundled with Procedure $249.90 $571.20 $249.90 "$1,219.74 " BIT DRL 12.7CM HRBRT SS 4.6MM 2.16MM CNN MAIN NS 115502700 C1713 SUPPLY/IMPLANTS "$1,222.00 " Outpatient $611.00 "$1,219.74 " $794.30 $855.40 $806.52 Not Applicable: Bundled with Procedure $427.70 $977.60 $427.70 "$1,219.74 " BIT DRL CNTRSNK QCK CNCT MLR 230809700 C1713 SUPPLY/IMPLANTS $488.00 Outpatient $244.00 "$1,219.74 " $317.20 $341.60 $322.08 Not Applicable: Bundled with Procedure $170.80 $390.40 $170.80 "$1,219.74 " BIT DRL 2.4MM CLBRT AO 236603024 C1713 SUPPLY/IMPLANTS $801.00 Outpatient $400.50 "$1,219.74 " $520.65 $560.70 $528.66 Not Applicable: Bundled with Procedure $280.35 $640.80 $280.35 "$1,219.74 " BIT DRL 195MM NCB SS 3.3MM CNN QC NS MIS 200024117 C1713 SUPPLY/IMPLANTS "$1,078.00 " Outpatient $539.00 "$1,219.74 " $700.70 $754.60 $711.48 Not Applicable: Bundled with Procedure $377.30 $862.40 $377.30 "$1,219.74 " BIT DRL 195MM STD NCB 3.3MM QC FEM 200024118 C1713 SUPPLY/IMPLANTS $718.00 Outpatient $359.00 "$1,219.74 " $466.70 $502.60 $473.88 Not Applicable: Bundled with Procedure $251.30 $574.40 $251.30 "$1,219.74 " BIT DRL 230MM NCB 3.3MM HUM PROX MIS 200024215 C1713 SUPPLY/IMPLANTS $676.00 Outpatient $338.00 "$1,219.74 " $439.40 $473.20 $446.16 Not Applicable: Bundled with Procedure $236.60 $540.80 $236.60 "$1,219.74 " BIT DRL 195MM STD NCB SS 3.3MM QC CNN NS TIB PROX 200024233 C1713 SUPPLY/IMPLANTS "$1,902.00 " Outpatient $951.00 "$1,219.74 " "$1,236.30 " "$1,331.40 " "$1,255.32 " Not Applicable: Bundled with Procedure $665.70 "$1,521.60 " $665.70 "$1,521.60 " BIT DRL NCB 3MM 4MM SCR 200024301 C1713 SUPPLY/IMPLANTS $932.00 Outpatient $466.00 "$1,219.74 " $605.80 $652.40 $615.12 Not Applicable: Bundled with Procedure $326.20 $745.60 $326.20 "$1,219.74 " BIT DRL 245MM NCB 2.5MM QC 200024342 C1713 SUPPLY/IMPLANTS $657.00 Outpatient $328.50 "$1,219.74 " $427.05 $459.90 $433.62 Not Applicable: Bundled with Procedure $229.95 $525.60 $229.95 "$1,219.74 " BIT DRL 245MM NCB 3.3MM QC 200024344 C1713 SUPPLY/IMPLANTS $657.00 Outpatient $328.50 "$1,219.74 " $427.05 $459.90 $433.62 Not Applicable: Bundled with Procedure $229.95 $525.60 $229.95 "$1,219.74 " BIT DRL 24MM NCB 4.3MM QC 200024346 C1713 SUPPLY/IMPLANTS $657.00 Outpatient $328.50 "$1,219.74 " $427.05 $459.90 $433.62 Not Applicable: Bundled with Procedure $229.95 $525.60 $229.95 "$1,219.74 " BIT DRL 245MM NCB 4MM QC 200024360 C1713 SUPPLY/IMPLANTS $676.00 Outpatient $338.00 "$1,219.74 " $439.40 $473.20 $446.16 Not Applicable: Bundled with Procedure $236.60 $540.80 $236.60 "$1,219.74 " BIT DRL 24MM NCB 5MM 200024362 C1713 SUPPLY/IMPLANTS "$1,902.00 " Outpatient $951.00 "$1,219.74 " "$1,236.30 " "$1,331.40 " "$1,255.32 " Not Applicable: Bundled with Procedure $665.70 "$1,521.60 " $665.70 "$1,521.60 " BIT DRL 30MM NCB 3.3MM PERIPROSTHETIC QC FEM MIS 200024381 C1713 SUPPLY/IMPLANTS $572.00 Outpatient $286.00 "$1,219.74 " $371.80 $400.40 $377.52 Not Applicable: Bundled with Procedure $200.20 $457.60 $200.20 "$1,219.74 " BIT DRL 245MM NCB 2.5MM QC STRL 202024342 C1713 SUPPLY/IMPLANTS $676.00 Outpatient $338.00 "$1,219.74 " $439.40 $473.20 $446.16 Not Applicable: Bundled with Procedure $236.60 $540.80 $236.60 "$1,219.74 " BIT DRL 245MM NCB 3.3MM QC STRL 202024344 C1713 SUPPLY/IMPLANTS $676.00 Outpatient $338.00 "$1,219.74 " $439.40 $473.20 $446.16 Not Applicable: Bundled with Procedure $236.60 $540.80 $236.60 "$1,219.74 " BIT DRL 245MM NCB 4.3MM QC STRL 202024346 C1713 SUPPLY/IMPLANTS $676.00 Outpatient $338.00 "$1,219.74 " $439.40 $473.20 $446.16 Not Applicable: Bundled with Procedure $236.60 $540.80 $236.60 "$1,219.74 " BIT DRL 245MM NCB 4MM QC STRL 202024360 C1713 SUPPLY/IMPLANTS $676.00 Outpatient $338.00 "$1,219.74 " $439.40 $473.20 $446.16 Not Applicable: Bundled with Procedure $236.60 $540.80 $236.60 "$1,219.74 " BIT DRL 24MM NCB 5MM 202024362 C1713 SUPPLY/IMPLANTS $676.00 Outpatient $338.00 "$1,219.74 " $439.40 $473.20 $446.16 Not Applicable: Bundled with Procedure $236.60 $540.80 $236.60 "$1,219.74 " BIT DRL 82MM 8MM STP 1.5MM JLTCH CPLNG 2 FLUT NS 03.501.008 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM MATRIXRIB 10MM 1.5MM JLTCH CPLNG SLF STP NS 03.501.010 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM MATRIXRIB 12MM 1.5MM JLTCH CPLNG SLF STP NS 03.501.012 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM MATRIXRIB 14MM 1.5MM JLTCH CPLNG SLF STP NS 03.501.014 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM MATRIXRIB 16MM 1.5MM JLTCH CPLNG SLF STP NS 03.501.016 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM MATRIXRIB 18MM 1.5MM JLTCH CPLNG SLF STP NS 03.501.018 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 88MM MATRIXRIB 20MM 1.5MM JLTCH CPLNG SLF STP NS 03.501.020 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 88MM MATRIXRIB 22MM 1.5MM JLTCH CPLNG SLF STP NS 03.501.022 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 88MM MATRIXRIB TI 24MM 1.5MM JLTCH CPLNG SLF STP NS 03.501.024 C1713 SUPPLY/IMPLANTS $843.00 Outpatient $421.50 "$1,219.74 " $547.95 $590.10 $556.38 Not Applicable: Bundled with Procedure $295.05 $674.40 $295.05 "$1,219.74 " BIT DRL 135MM MATRIXRIB 14MM 2.2MM JLTCH CPLNG STP NS STRNM 03.501.044 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 135MM 16MM MATRIXRIB 2.2MM JLTCH CPLNG STP NS STRYK 03.501.046 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 135MM 18MM MATRIXRIB 2.2MM JLTCH CPLNG STP NS STRYK 03.501.048 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 125MM MATRIXRIB 5.5MM STP AO QC NS 03.501.085 C1713 SUPPLY/IMPLANTS "$1,596.00 " Outpatient $798.00 "$1,219.74 " "$1,037.40 " "$1,117.20 " "$1,053.36 " Not Applicable: Bundled with Procedure $558.60 "$1,276.80 " $558.60 "$1,276.80 " BIT DRL 82MM MATRIXRIB 10MM 1.8MM JLTCH CPLNG SLF STP NS 03.501.210 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM MATRIXRIB 12MM 1.8MM JLTCH CPLNG SLF STP NS 03.501.212 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM MATRIXRIB 14MM 1.8MM JLTCH CPLNG SLF STP NS 03.501.214 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM MATRIXRIB 16MM 1.8MM JLTCH CPLNG SLF STP NS 03.501.216 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM MATRIXRIB 18MM 1.8MM JLTCH CPLNG SLF STP NS 03.501.218 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 88MM MATRIXRIB 20MM 1.8MM JLTCH CPLNG SLF STP NS 03.501.220 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 88MM MATRIXRIB 22MM 1.8MM JLTCH CPLNG SLF STP NS 03.501.222 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 88MM MATRIXRIB TI 24MM 1.8MM JLTCH CPLNG SLF STP NS 03.501.224 C1713 SUPPLY/IMPLANTS $888.00 Outpatient $444.00 "$1,219.74 " $577.20 $621.60 $586.08 Not Applicable: Bundled with Procedure $310.80 $710.40 $310.80 "$1,219.74 " BIT DRL 82MM 10MM STP 1.5MM HEX CPLNG NS 03.501.410 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM 12MM STP 1.5MM HEX CPLNG NS 03.501.412 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM MATRIXRIB TI 14MM 1.5MM HEX CPLNG SLF STP NS 03.501.414 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM MATRIXRIB TI 16MM 1.5MM HEX CPLNG SLF STP NS 03.501.416 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM 18MM STP 1.5MM HEX CPLNG NS 03.501.418 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 88MM 20MM STP 1.5MM HEX CPLNG NS 03.501.420 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 88MM MATRIXRIB TI 22MM 1.5MM HEX CPLNG SLF STP NS 03.501.422 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 88MM MATRIXRIB TI 24MM 1.5MM HEX CPLNG SLF STP NS 03.501.424 C1713 SUPPLY/IMPLANTS $888.00 Outpatient $444.00 "$1,219.74 " $577.20 $621.60 $586.08 Not Applicable: Bundled with Procedure $310.80 $710.40 $310.80 "$1,219.74 " BIT DRL 82MM MATRIXRIB TI 10MM 1.8MM HEX CPLNG SLF STP NS 03.501.510 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM 12MM STP 1.8MM HEX CPLNG NS 03.501.512 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM MATRIXRIB TI 14MM 1.8MM HEX CPLNG SLF STP NS 03.501.514 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM MATRIXRIB TI 16MM 1.8MM HEX CPLNG SLF STP NS 03.501.516 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 82MM MATRIXRIB TI 18MM 1.8MM HEX CPLNG SLF STP NS 03.501.518 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 88MM MATRIXRIB TI 20MM 1.8MM HEX CPLNG SLF STP NS 03.501.520 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 88MM MATRIXRIB TI 22MM 1.8MM HEX CPLNG SLF STP NS 03.501.522 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 88MM MATRIXRIB TI 24MM 1.8MM HEX CPLNG SLF STP NS 03.501.524 C1713 SUPPLY/IMPLANTS $888.00 Outpatient $444.00 "$1,219.74 " $577.20 $621.60 $586.08 Not Applicable: Bundled with Procedure $310.80 $710.40 $310.80 "$1,219.74 " BIT DRL 135MM MATRIXRIB 6MM 2.2MM STP AO QC NS STRNM 03.501.606 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 135MM MATRIXRIB 8MM 2.2MM STP AO QC NS STRNM 03.501.608 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 135MM MATRIXRIB 10MM 2.2MM STP AO QC NS STRNM 03.501.610 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 135MM MATRIXRIB 12MM 2.2MM AO QC STP NS STRNM 03.501.612 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 135MM MATRIXRIB 14MM 2.2MM AO QC STP NS STRNM 03.501.614 C1713 SUPPLY/IMPLANTS "$1,010.00 " Outpatient $505.00 "$1,219.74 " $656.50 $707.00 $666.60 Not Applicable: Bundled with Procedure $353.50 $808.00 $353.50 "$1,219.74 " BIT DRL 6MM MATRIXRIB 2.2MM STP NS 90D SCRDRVR 03.501.756 C1713 SUPPLY/IMPLANTS "$1,626.00 " Outpatient $813.00 "$1,219.74 " "$1,056.90 " "$1,138.20 " "$1,073.16 " Not Applicable: Bundled with Procedure $569.10 "$1,300.80 " $569.10 "$1,300.80 " BIT DRL 8MM MATRIXRIB 2.2MM STP NS 90D SCRDRVR 03.501.758 C1713 SUPPLY/IMPLANTS "$1,626.00 " Outpatient $813.00 "$1,219.74 " "$1,056.90 " "$1,138.20 " "$1,073.16 " Not Applicable: Bundled with Procedure $569.10 "$1,300.80 " $569.10 "$1,300.80 " BIT DRL 10MM MATRIXRIB 2.2MM STP NS 90D SCRDRVR 03.501.760 C1713 SUPPLY/IMPLANTS "$1,626.00 " Outpatient $813.00 "$1,219.74 " "$1,056.90 " "$1,138.20 " "$1,073.16 " Not Applicable: Bundled with Procedure $569.10 "$1,300.80 " $569.10 "$1,300.80 " BIT DRL 12MM MATRIXRIB 2.2MM STP NS 90D SCRDRVR 03.501.762 C1713 SUPPLY/IMPLANTS "$1,626.00 " Outpatient $813.00 "$1,219.74 " "$1,056.90 " "$1,138.20 " "$1,073.16 " Not Applicable: Bundled with Procedure $569.10 "$1,300.80 " $569.10 "$1,300.80 " BIT DRL 14MM 2 FLUT MATRIXRIB 2.2MM STP NS 90D SCRDRVR 03.501.764 C1713 SUPPLY/IMPLANTS "$1,626.00 " Outpatient $813.00 "$1,219.74 " "$1,056.90 " "$1,138.20 " "$1,073.16 " Not Applicable: Bundled with Procedure $569.10 "$1,300.80 " $569.10 "$1,300.80 " BIT DRL 16MM MATRIXRIB 2.2MM STP NS 90D SCRDRVR 03.501.766 C1713 SUPPLY/IMPLANTS "$1,626.00 " Outpatient $813.00 "$1,219.74 " "$1,056.90 " "$1,138.20 " "$1,073.16 " Not Applicable: Bundled with Procedure $569.10 "$1,300.80 " $569.10 "$1,300.80 " BIT DRL 18MM MATRIXRIB 2.2MM STP NS 90D SCRDRVR 03.501.768 C1713 SUPPLY/IMPLANTS "$1,626.00 " Outpatient $813.00 "$1,219.74 " "$1,056.90 " "$1,138.20 " "$1,073.16 " Not Applicable: Bundled with Procedure $569.10 "$1,300.80 " $569.10 "$1,300.80 " BIT DRL 20MM MATRIXRIB 2.2MM STP NS 90D SCRDRVR 03.501.770 C1713 SUPPLY/IMPLANTS "$1,626.00 " Outpatient $813.00 "$1,219.74 " "$1,056.90 " "$1,138.20 " "$1,073.16 " Not Applicable: Bundled with Procedure $569.10 "$1,300.80 " $569.10 "$1,300.80 " BIT DRL 44.5MM MATRIXMIDFACE 3MM 1.25MM JLTCH CPLNG STP 03.503.103 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 44.5MM MATRIXMIDFACE 4MM 1.25MM JLTCH CPLNG STP 03.503.104 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 44.5MM MATRIXMIDFACE 6MM 1.25MM JLTCH CPLNG STP 03.503.106 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 44.5MM MATRIXMIDFACE 18MM 1.25MM 2 FLUT JLTCH CPLNG 03.503.118 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 80MM MATRIXMIDFACE 1.25MM JLTCH CPLNG WO STP NS 03.503.120 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 125MM MATRIXMIDFACE 1.25MM 2 FLUT JLTCH CPLNG NS 03.503.121 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 125MM MATRIXMIDFACE 8MM 1.25MM JLTCH STP NS PLT SYS 03.503.122 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 125MM MATRIXMIDFACE 18MM 1.25MM JLTCH STP NS 03.503.123 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 44.5MM MATRIXMIDFACE 3MM 1.25MM MNQK CPLNG STP NS 03.503.133 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 44.5MM MN MATRIXMIDFACE 6MM 1.25MM 2 FLUT MNQK CPLNG 03.503.136 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 44.5MM MN MATRIXMIDFACE 10MM 1.25MM 2 FLUT MNQK 03.503.140 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 44.5MM MN MATRIXMIDFACE 12MM 1.25MM 2 FLUT MNQK 03.503.142 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 44.5MM MN MATRIXMIDFACE 18MM 1.25MM MNQK CPLNG STP 03.503.148 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 80MM MATRIXMIDFACE 1.25MM 2 FLUT MNQK CPLNG NS 03.503.150 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 125MM MATRIXMIDFACE 1.25MM 2 FLUT MNQK CPLNG NS 03.503.151 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 125MM MN MATRIXMIDFACE 8MM 1.25MM 2 FLUT MNQK CPLNG 03.503.152 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 125MM MN MATRIXMIDFACE 18MM 1.25MM 2 FLUT MNQK CPLNG 03.503.153 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 50MM 4MM MATRIXMANDIBLE 1.5MM JLTCH CPLNG STP NS 03.503.404 C1713 SUPPLY/IMPLANTS $927.00 Outpatient $463.50 "$1,219.74 " $602.55 $648.90 $611.82 Not Applicable: Bundled with Procedure $324.45 $741.60 $324.45 "$1,219.74 " BIT DRL 50MM MATRIXMANDIBLE 12MM 1.5MM JLTCH CPLNG STP NS 03.503.412 C1713 SUPPLY/IMPLANTS $927.00 Outpatient $463.50 "$1,219.74 " $602.55 $648.90 $611.82 Not Applicable: Bundled with Procedure $324.45 $741.60 $324.45 "$1,219.74 " BIT DRL 145MM MATRIXMANDIBLE 1.5MM 2 FLUT JLTCH CPLNG NS 03.503.452 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 145MM MATRIXMANDIBLE 1.8MM 2 FLUT JLTCH CPLNG NS 03.503.462 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 145MM MATRIXMANDIBLE 2.4MM 2 FLUT JLTCH CPLNG NS 03.503.472 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 125MM MATRIXMANDIBLE 2.4MM JLTCH CPLNG CLBRT NS 03.503.478 C1713 SUPPLY/IMPLANTS "$1,143.00 " Outpatient $571.50 "$1,219.74 " $742.95 $800.10 $754.38 Not Applicable: Bundled with Procedure $400.05 $914.40 $400.05 "$1,219.74 " BIT DRL 125MM MATRIXMANDIBLE 1.5MM MNQK CPLNG CLBRT NS 03.503.479 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 125MM MATRIXMANDIBLE 1.8MM 2 FLUT MNQK CPLNG CLBRT 03.503.480 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 125MM MN MATRIXMANDIBLE 2.4MM 2 FLUT MNQK CPLNG 03.503.481 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 50MM MATRIXMANDIBLE 4MM 1.5MM 2 FLUT STP MNQK CPLNG 03.503.504 C1713 SUPPLY/IMPLANTS $927.00 Outpatient $463.50 "$1,219.74 " $602.55 $648.90 $611.82 Not Applicable: Bundled with Procedure $324.45 $741.60 $324.45 "$1,219.74 " BIT DRL 50MM MATRIXMANDIBLE 6MM 1.5MM 2 FLUT STP MNQK CPLNG 03.503.506 C1713 SUPPLY/IMPLANTS $927.00 Outpatient $463.50 "$1,219.74 " $602.55 $648.90 $611.82 Not Applicable: Bundled with Procedure $324.45 $741.60 $324.45 "$1,219.74 " BIT DRL 50MM MATRIXMANDIBLE 8MM 1.5MM 2 FLUT STP MNQK CPLNG 03.503.508 C1713 SUPPLY/IMPLANTS $927.00 Outpatient $463.50 "$1,219.74 " $602.55 $648.90 $611.82 Not Applicable: Bundled with Procedure $324.45 $741.60 $324.45 "$1,219.74 " BIT DRL 50MM MATRIXMANDIBLE 12MM 1.5MM 2 FLUT STP MNQK CPLNG 03.503.512 C1713 SUPPLY/IMPLANTS $927.00 Outpatient $463.50 "$1,219.74 " $602.55 $648.90 $611.82 Not Applicable: Bundled with Procedure $324.45 $741.60 $324.45 "$1,219.74 " BIT DRL 90MM MN MATRIXMANDIBLE 1.5MM 2 FLUT MNQK CPLNG NS 03.503.551 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 145MM MN MATRIXMANDIBLE TI 1.5MM 2 FLUT MNQK CPLNG 03.503.552 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 90MM MATRIXMANDIBLE 1.8MM 2 FLUT MNQK CPLNG NS 03.503.561 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 145MM MN MATRIXMANDIBLE TI 1.8MM MNQK CPLNG NS MNDB 03.503.562 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 90MM MATRIXMANDIBLE 2.4MM 2 FLUT MNQK CPLNG NS 03.503.571 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 145MM MN MATRIXMANDIBLE TI 2.4MM MNQK CPLNG NS MNDB 03.503.572 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 17MM MATRIXMIDFACE 10MM 1.25MM STP NS 90D SCRDRVR 03.505.026 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 19MM MATRIXMIDFACE 12MM 1.25MM STP NS 90D SCRDRVR 03.505.027 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 11MM 4MM 1.1MM STP NS 90D SCRDRVR 03.505.030 C1713 SUPPLY/IMPLANTS "$1,499.00 " Outpatient $749.50 "$1,219.74 " $974.35 "$1,049.30 " $989.34 Not Applicable: Bundled with Procedure $524.65 "$1,199.20 " $524.65 "$1,219.74 " BIT DRL 15MM 8MM 1.1MM STP NS 90D SCRDRVR 03.505.032 C1713 SUPPLY/IMPLANTS "$1,499.00 " Outpatient $749.50 "$1,219.74 " $974.35 "$1,049.30 " $989.34 Not Applicable: Bundled with Procedure $524.65 "$1,199.20 " $524.65 "$1,219.74 " BIT DRL 11MM MATRIXMIDFACE 4MM 1.1MM STP NS 90D SCRDRVR 03.505.035 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 13MM MATRIXMIDFACE 6MM 1.1MM STP NS 90D SCRDRVR 03.505.036 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 15MM MATRIXMIDFACE 8MM 1.1MM STP NS 90D SCRDRVR 03.505.037 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 13MM 6MM 1.5MM STP NS 90D SCRDRVR 03.505.041 C1713 SUPPLY/IMPLANTS "$1,499.00 " Outpatient $749.50 "$1,219.74 " $974.35 "$1,049.30 " $989.34 Not Applicable: Bundled with Procedure $524.65 "$1,199.20 " $524.65 "$1,219.74 " BIT DRL 8MM 1.5MM STP NS 03.505.044 C1713 SUPPLY/IMPLANTS "$1,499.00 " Outpatient $749.50 "$1,219.74 " $974.35 "$1,049.30 " $989.34 Not Applicable: Bundled with Procedure $524.65 "$1,199.20 " $524.65 "$1,219.74 " BIT DRL 12MM 1.5MM STP NS 03.505.047 C1713 SUPPLY/IMPLANTS "$1,499.00 " Outpatient $749.50 "$1,219.74 " $974.35 "$1,049.30 " $989.34 Not Applicable: Bundled with Procedure $524.65 "$1,199.20 " $524.65 "$1,219.74 " BIT DRL 15MM 8MM 1.8MM STP NS 90D SCRDRVR 03.505.054 C1713 SUPPLY/IMPLANTS "$1,499.00 " Outpatient $749.50 "$1,219.74 " $974.35 "$1,049.30 " $989.34 Not Applicable: Bundled with Procedure $524.65 "$1,199.20 " $524.65 "$1,219.74 " BIT DRL 19MM 12MM 1.8MM STP NS 90D SCRDRVR 03.505.057 C1713 SUPPLY/IMPLANTS "$1,499.00 " Outpatient $749.50 "$1,219.74 " $974.35 "$1,049.30 " $989.34 Not Applicable: Bundled with Procedure $524.65 "$1,199.20 " $524.65 "$1,219.74 " BIT DRL 21MM 4MM 1.5MM STP NS 90D SCRDRVR 03.505.065 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 23MM 2 FLUT 16MM 1.5MM 2 EDG STP WICK NS 90D SCRDRVR 03.505.066 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 25MM 2 FLUT 18MM 1.5MM 2 EDG STP WICK NS 90D SCRDRVR 03.505.067 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 13MM MATRIXMANDIBLE 6MM 1.5MM STP NS 90D SCRDRVR 03.505.075 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 15MM MATRIXMANDIBLE 8MM 1.5MM STP NS 90D SCRDRVR 03.505.076 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 19MM MATRIXMANDIBLE 12MM 1.5MM STP NS 90D SCRDRVR 03.505.078 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 13MM MATRIXMANDIBLE 6MM 1.8MM STP NS 90D SCRDRVR 03.505.081 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 15MM MATRIXMANDIBLE 8MM 1.8MM STP NS 90D SCRDRVR 03.505.082 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 19MM MATRIXMANDIBLE 12MM 1.8MM STP NS 90D SCRDRVR 03.505.084 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 21MM MATRIXMANDIBLE 14MM 1.8MM STP NS 90D SCRDRVR 03.505.085 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 23MM ANG RT MATRIXMANDIBLE 16MM 1.8MM STP NS 90D 03.505.086 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 25MM MATRIXMANDIBLE 18MM 1.8MM STP NS 90D SCRDRVR 03.505.087 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 13MM MATRIXMANDIBLE 6MM 2.4MM STP NS 90D SCRDRVR 03.505.091 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 15MM MATRIXMANDIBLE 8MM 2.4MM STP NS 90D SCRDRVR 03.505.092 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 19MM MATRIXMANDIBLE 12MM 2.4MM STP NS 90D SCRDRVR 03.505.094 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 13MM MTRX 6MM 1.4MM STP STRL 90D SCRDRVR 03.505.141 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 15MM MATRIXORTHOGNATHIC 8MM 1.4MM STP NS 90D SCRDRVR 03.505.144 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 19MM TI 12MM 1.4MM STP NS 90D SCRDRVR 03.505.147 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " BIT DRL 21MM TI 14MM 1.4MM STP NS 90D SCRDRVR 03.505.165 C1713 SUPPLY/IMPLANTS "$1,721.00 " Outpatient $860.50 "$1,219.74 " "$1,118.65 " "$1,204.70 " "$1,135.86 " Not Applicable: Bundled with Procedure $602.35 "$1,376.80 " $602.35 "$1,376.80 " BIT DRL 23MM TI 16MM 1.4MM STP NS 90D SCRDRVR 03.505.166 C1713 SUPPLY/IMPLANTS "$1,721.00 " Outpatient $860.50 "$1,219.74 " "$1,118.65 " "$1,204.70 " "$1,135.86 " Not Applicable: Bundled with Procedure $602.35 "$1,376.80 " $602.35 "$1,376.80 " BIT DRL 25MM TI 18MM 1.4MM STP NS 90D SCRDRVR 03.505.167 C1713 SUPPLY/IMPLANTS "$1,721.00 " Outpatient $860.50 "$1,219.74 " "$1,118.65 " "$1,204.70 " "$1,135.86 " Not Applicable: Bundled with Procedure $602.35 "$1,376.80 " $602.35 "$1,376.80 " BIT DRL 44.5MM 4MM MTRX 1.4MM JLTCH CPLNG STP NS 03.511.244 C1713 SUPPLY/IMPLANTS $927.00 Outpatient $463.50 "$1,219.74 " $602.55 $648.90 $611.82 Not Applicable: Bundled with Procedure $324.45 $741.60 $324.45 "$1,219.74 " BIT DRL 44.5MM MTRX 8MM 1.4MM STP NS JLTCH CPLNG 03.511.248 C1713 SUPPLY/IMPLANTS $927.00 Outpatient $463.50 "$1,219.74 " $602.55 $648.90 $611.82 Not Applicable: Bundled with Procedure $324.45 $741.60 $324.45 "$1,219.74 " BIT DRL 44.5MM MTRX 12MM 1.4MM STP NS JLTCH CPLNG 03.511.252 C1713 SUPPLY/IMPLANTS $927.00 Outpatient $463.50 "$1,219.74 " $602.55 $648.90 $611.82 Not Applicable: Bundled with Procedure $324.45 $741.60 $324.45 "$1,219.74 " BIT DRL 80MM MTRX 1.4MM WO STP NS JLTCH CPLNG 03.511.310 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 110MM MTRX 1.4MM WO STP NS JLTCH CPLNG 03.511.320 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 125MM MTRX 1.4MM WO STP NS JLTCH CPLNG 03.511.330 C1713 SUPPLY/IMPLANTS $988.00 Outpatient $494.00 "$1,219.74 " $642.20 $691.60 $652.08 Not Applicable: Bundled with Procedure $345.80 $790.40 $345.80 "$1,219.74 " BIT DRL 125MM MTRX 1.4MM CLBRT NS JLTCH CPLNG 03.511.340 C1713 SUPPLY/IMPLANTS "$1,143.00 " Outpatient $571.50 "$1,219.74 " $742.95 $800.10 $754.38 Not Applicable: Bundled with Procedure $400.05 $914.40 $400.05 "$1,219.74 " BIT DRL 100MM UNV TI 18MM 1.4MM JLTCH QC TROC CLBRT STP NS 03.511.342 C1713 SUPPLY/IMPLANTS "$1,143.00 " Outpatient $571.50 "$1,219.74 " $742.95 $800.10 $754.38 Not Applicable: Bundled with Procedure $400.05 $914.40 $400.05 "$1,219.74 " BIT DRL 125MM MTRX 1.4MM JLTCH CLBRT NS BSC TROC SYS 03.511.343 C1713 SUPPLY/IMPLANTS "$1,143.00 " Outpatient $571.50 "$1,219.74 " $742.95 $800.10 $754.38 Not Applicable: Bundled with Procedure $400.05 $914.40 $400.05 "$1,219.74 " BIT DRL 60MM 1.1MM QC NS 1.3MM SCR 310.11.98 C1713 SUPPLY/IMPLANTS $500.00 Outpatient $250.00 "$1,219.74 " $325.00 $350.00 $330.00 Not Applicable: Bundled with Procedure $175.00 $400.00 $175.00 "$1,219.74 " BIT DRL 44.5MM 3MM STP 3MM 1.3MM JLTCH CPLNG SLF STP NS 1.5 310.133 C1713 SUPPLY/IMPLANTS $799.00 Outpatient $399.50 "$1,219.74 " $519.35 $559.30 $527.34 Not Applicable: Bundled with Procedure $279.65 $639.20 $279.65 "$1,219.74 " BIT DRL 52MM 3MM STP 3MM 1.3MM JLTCH HEX CPLNG SLF STP NS 310.134 C1713 SUPPLY/IMPLANTS $799.00 Outpatient $399.50 "$1,219.74 " $519.35 $559.30 $527.34 Not Applicable: Bundled with Procedure $279.65 $639.20 $279.65 "$1,219.74 " BIT DRL 45MM 4MM 1.3MM JLTCH CPLNG CPLNG SLF STP NS STRYK 310.136 C1713 SUPPLY/IMPLANTS $799.00 Outpatient $399.50 "$1,219.74 " $519.35 $559.30 $527.34 Not Applicable: Bundled with Procedure $279.65 $639.20 $279.65 "$1,219.74 " BIT DRL 45MM 6MM STP 6MM 1.3MM JLTCH CPLNG SLF STP NS 1.5MM 310.137 C1713 SUPPLY/IMPLANTS $799.00 Outpatient $399.50 "$1,219.74 " $519.35 $559.30 $527.34 Not Applicable: Bundled with Procedure $279.65 $639.20 $279.65 "$1,219.74 " BIT DRL 52MM SS 4MM 1.3MM JLTCH HEX CPLNG SLF STP NS 1.5MM 310.138 C1713 SUPPLY/IMPLANTS $799.00 Outpatient $399.50 "$1,219.74 " $519.35 $559.30 $527.34 Not Applicable: Bundled with Procedure $279.65 $639.20 $279.65 "$1,219.74 " BIT DRL 52MM 6MM STP 6MM 1.3MM JLTCH HEX CPLNG SLF STP NS 310.139 C1713 SUPPLY/IMPLANTS $799.00 Outpatient $399.50 "$1,219.74 " $519.35 $559.30 $527.34 Not Applicable: Bundled with Procedure $279.65 $639.20 $279.65 "$1,219.74 " BIT DRL 85MM 1.5MM QC NS 2MM SCR 310.15.98 C1713 SUPPLY/IMPLANTS $500.00 Outpatient $250.00 "$1,219.74 " $325.00 $350.00 $330.00 Not Applicable: Bundled with Procedure $175.00 $400.00 $175.00 "$1,219.74 " BIT DRL 75MM 1.5MM JLTCH CPLNG WO SLF STP NS 1.5MM SCR 310.153 C1713 SUPPLY/IMPLANTS $909.00 Outpatient $454.50 "$1,219.74 " $590.85 $636.30 $599.94 Not Applicable: Bundled with Procedure $318.15 $727.20 $318.15 "$1,219.74 " BIT DRL 110MM 1.5MM QC NS 2MM SCR 310.16.98 C1713 SUPPLY/IMPLANTS $500.00 Outpatient $250.00 "$1,219.74 " $325.00 $350.00 $330.00 Not Applicable: Bundled with Procedure $175.00 $400.00 $175.00 "$1,219.74 " BIT DRL 125MM 8MM STP 8MM 1.5MM JLTCH QC STP NS 2MM SCR 310.17 C1713 SUPPLY/IMPLANTS $903.00 Outpatient $451.50 "$1,219.74 " $586.95 $632.10 $595.98 Not Applicable: Bundled with Procedure $316.05 $722.40 $316.05 "$1,219.74 " BIT DRL 125MM 8MM STP 8MM 1.5MM JLTCH CPLNG SLF STP NS 1.5MM 310.172 C1713 SUPPLY/IMPLANTS $903.00 Outpatient $451.50 "$1,219.74 " $586.95 $632.10 $595.98 Not Applicable: Bundled with Procedure $316.05 $722.40 $316.05 "$1,219.74 " BIT DRL 125MM 8MM STP MN 8MM 1.5MM MNQK CPLNG SLF STP NS 2MM 310.173 C1713 SUPPLY/IMPLANTS $903.00 Outpatient $451.50 "$1,219.74 " $586.95 $632.10 $595.98 Not Applicable: Bundled with Procedure $316.05 $722.40 $316.05 "$1,219.74 " BIT DRL 125MM 2MM QC NS 310.21.98 C1713 SUPPLY/IMPLANTS $561.00 Outpatient $280.50 "$1,219.74 " $364.65 $392.70 $370.26 Not Applicable: Bundled with Procedure $196.35 $448.80 $196.35 "$1,219.74 " BIT DRL 100MM MN 1.8MM MNQK CPLNG NS MNDB 310.513 C1713 SUPPLY/IMPLANTS $903.00 Outpatient $451.50 "$1,219.74 " $586.95 $632.10 $595.98 Not Applicable: Bundled with Procedure $316.05 $722.40 $316.05 "$1,219.74 " BIT DRL 125MM 1.8MM QC NS 310.52 C1713 SUPPLY/IMPLANTS $903.00 Outpatient $451.50 "$1,219.74 " $586.95 $632.10 $595.98 Not Applicable: Bundled with Procedure $316.05 $722.40 $316.05 "$1,219.74 " BIT DRL 125MM 1.8MM JLTCH CPLNG NS STRYK 310.522 C1713 SUPPLY/IMPLANTS $903.00 Outpatient $451.50 "$1,219.74 " $586.95 $632.10 $595.98 Not Applicable: Bundled with Procedure $316.05 $722.40 $316.05 "$1,219.74 " BIT DRL 125MM MN 1.8MM MNQK CPLNG NS 2.4MM SCR 310.523 C1713 SUPPLY/IMPLANTS $903.00 Outpatient $451.50 "$1,219.74 " $586.95 $632.10 $595.98 Not Applicable: Bundled with Procedure $316.05 $722.40 $316.05 "$1,219.74 " BIT DRL 100MM MN 2.4MM MNQK CPLNG NS 310.533 C1713 SUPPLY/IMPLANTS $903.00 Outpatient $451.50 "$1,219.74 " $586.95 $632.10 $595.98 Not Applicable: Bundled with Procedure $316.05 $722.40 $316.05 "$1,219.74 " BIT DRL 125MM 2.4MM QC NS 310.54 C1713 SUPPLY/IMPLANTS $903.00 Outpatient $451.50 "$1,219.74 " $586.95 $632.10 $595.98 Not Applicable: Bundled with Procedure $316.05 $722.40 $316.05 "$1,219.74 " BIT DRL 125MM SS 2.4MM JLTCH NS STRYK 310.542 C1713 SUPPLY/IMPLANTS $903.00 Outpatient $451.50 "$1,219.74 " $586.95 $632.10 $595.98 Not Applicable: Bundled with Procedure $316.05 $722.40 $316.05 "$1,219.74 " BIT DRL 125MM MN 1.8MM MNQK CPLNG NS 310.543 C1713 SUPPLY/IMPLANTS $903.00 Outpatient $451.50 "$1,219.74 " $586.95 $632.10 $595.98 Not Applicable: Bundled with Procedure $316.05 $722.40 $316.05 "$1,219.74 " BIT DRL 75MM 1.8MM JLTCH NS 310.562 C1713 SUPPLY/IMPLANTS $903.00 Outpatient $451.50 "$1,219.74 " $586.95 $632.10 $595.98 Not Applicable: Bundled with Procedure $316.05 $722.40 $316.05 "$1,219.74 " BIT DRL 50MM SS 1.5MM JLTCH NS STRYK 310.582 C1713 SUPPLY/IMPLANTS $903.00 Outpatient $451.50 "$1,219.74 " $586.95 $632.10 $595.98 Not Applicable: Bundled with Procedure $316.05 $722.40 $316.05 "$1,219.74 " BIT DRL 50MM 1.8MM JLTCH NS 310.592 C1713 SUPPLY/IMPLANTS $903.00 Outpatient $451.50 "$1,219.74 " $586.95 $632.10 $595.98 Not Applicable: Bundled with Procedure $316.05 $722.40 $316.05 "$1,219.74 " BIT DRL 14MM 981514 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BIT DRL 125MM JOURNEY BCS 1/8MM QCK CNCT PIN STRL BI 74012905 C1713 SUPPLY/IMPLANTS "$2,570.00 " Outpatient "$1,285.00 " "$1,219.74 " "$1,670.50 " "$1,799.00 " "$1,696.20 " Not Applicable: Bundled with Procedure $899.50 "$2,056.00 " $899.50 "$2,056.00 " BIT DRL 3 PIN SET STRL BMA-S90007S C1713 SUPPLY/IMPLANTS $518.00 Outpatient $259.00 "$1,219.74 " $336.70 $362.60 $341.88 Not Applicable: Bundled with Procedure $181.30 $414.40 $181.30 "$1,219.74 " BIT DRL 62MM 1.5MM KWR ATCH NS GLD HL 03.130.210 C1713 SUPPLY/IMPLANTS $618.00 Outpatient $309.00 "$1,219.74 " $401.70 $432.60 $407.88 Not Applicable: Bundled with Procedure $216.30 $494.40 $216.30 "$1,219.74 " BIT DRL 200MM 3.2MM GRY 4MM PIN 5085-2-032 C1713 SUPPLY/IMPLANTS $471.00 Outpatient $235.50 "$1,219.74 " $306.15 $329.70 $310.86 Not Applicable: Bundled with Procedure $164.85 $376.80 $164.85 "$1,219.74 " BIT DRILL L44.5 MM L6 MM OD.76 MM MINI QUICK COUPLING SELF S 316.286 C1713 SUPPLY/IMPLANTS "$1,032.00 " Outpatient $516.00 "$1,219.74 " $670.80 $722.40 $681.12 Not Applicable: Bundled with Procedure $361.20 $825.60 $361.20 "$1,219.74 " BIT DRILL L44.5 MM L8 MM OD.76 MM MINI QUICK COUPLING SELF S 316.288 C1713 SUPPLY/IMPLANTS "$1,032.00 " Outpatient $516.00 "$1,219.74 " $670.80 $722.40 $681.12 Not Applicable: Bundled with Procedure $361.20 $825.60 $361.20 "$1,219.74 " BIT DRILL L44.5 MM L10 MM OD.76 MM MINI QUICK COUPLING SELF 316.290 C1713 SUPPLY/IMPLANTS "$1,032.00 " Outpatient $516.00 "$1,219.74 " $670.80 $722.40 $681.12 Not Applicable: Bundled with Procedure $361.20 $825.60 $361.20 "$1,219.74 " BIT DRILL L44.5 MM L12 MM OD.76 MM MINI QUICK COUPLING SELF 316.292 C1713 SUPPLY/IMPLANTS "$1,032.00 " Outpatient $516.00 "$1,219.74 " $670.80 $722.40 $681.12 Not Applicable: Bundled with Procedure $361.20 $825.60 $361.20 "$1,219.74 " BIT SCRDRVR 178CM 6.4MM HIP SS 1 SLOT NS 89005000 C1713 SUPPLY/IMPLANTS $640.00 Outpatient $320.00 "$1,219.74 " $416.00 $448.00 $422.40 Not Applicable: Bundled with Procedure $224.00 $512.00 $224.00 "$1,219.74 " BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L85 MM OD10.35 MM CANNULATED NONSTERILE T C1713 SUPPLY/IMPLANTS "$3,994.00 " Outpatient "$1,997.00 " "$1,219.74 " "$2,596.10 " "$2,795.80 " "$2,636.04 " Not Applicable: Bundled with Procedure "$1,397.90 " "$3,195.20 " "$1,219.74 " "$3,195.20 " BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L9 04.038.395S C1713 SUPPLY/IMPLANTS "$4,392.00 " Outpatient "$2,196.00 " "$1,219.74 " "$2,854.80 " "$3,074.40 " "$2,898.72 " Not Applicable: Bundled with Procedure "$1,537.20 " "$3,513.60 " "$1,219.74 " "$3,513.60 " BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L7 04.038.375S C1713 SUPPLY/IMPLANTS "$4,392.00 " Outpatient "$2,196.00 " "$1,219.74 " "$2,854.80 " "$3,074.40 " "$2,898.72 " Not Applicable: Bundled with Procedure "$1,537.20 " "$3,513.60 " "$1,219.74 " "$3,513.60 " BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TI-6AL-7NB HELICAL L9 04.038.390S C1713 SUPPLY/IMPLANTS "$4,392.00 " Outpatient "$2,196.00 " "$1,219.74 " "$2,854.80 " "$3,074.40 " "$2,898.72 " Not Applicable: Bundled with Procedure "$1,537.20 " "$3,513.60 " "$1,219.74 " "$3,513.60 " BLADE SPIRAL TI 40MM FOR TI HUMERAL NAIL 462.640 C1713 SUPPLY/IMPLANTS "$3,353.00 " Outpatient "$1,676.50 " "$1,219.74 " "$2,179.45 " "$2,347.10 " "$2,212.98 " Not Applicable: Bundled with Procedure "$1,173.55 " "$2,682.40 " "$1,173.55 " "$2,682.40 " BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TITANIUM NIOBIUM ALUM 04.038.385S C1713 SUPPLY/IMPLANTS "$4,392.00 " Outpatient "$2,196.00 " "$1,219.74 " "$2,854.80 " "$3,074.40 " "$2,898.72 " Not Applicable: Bundled with Procedure "$1,537.20 " "$3,513.60 " "$1,219.74 " "$3,513.60 " BLADE 85MM STERILE TFNA FENESTRATED HELICAL 1035-50-000 C1713 SUPPLY/IMPLANTS "$2,569.00 " Outpatient "$1,284.50 " "$1,219.74 " "$1,669.85 " "$1,798.30 " "$1,695.54 " Not Applicable: Bundled with Procedure $899.15 "$2,055.20 " $899.15 "$2,055.20 " BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TITANIUM NIOBIUM ALUM 04.038.400S C1713 SUPPLY/IMPLANTS "$4,392.00 " Outpatient "$2,196.00 " "$1,219.74 " "$2,854.80 " "$3,074.40 " "$2,898.72 " Not Applicable: Bundled with Procedure "$1,537.20 " "$3,513.60 " "$1,219.74 " "$3,513.60 " BLADE INTRAMEDULLARY FIXATION TITANIUM SPIRAL L34 MM HUMERAL 462.634 C1713 SUPPLY/IMPLANTS "$3,361.00 " Outpatient "$1,680.50 " "$1,219.74 " "$2,184.65 " "$2,352.70 " "$2,218.26 " Not Applicable: Bundled with Procedure "$1,176.35 " "$2,688.80 " "$1,176.35 " "$2,688.80 " BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TITANIUM NIOBIUM ALUM 04.038.410S C1713 SUPPLY/IMPLANTS "$4,404.00 " Outpatient "$2,202.00 " "$1,219.74 " "$2,862.60 " "$3,082.80 " "$2,906.64 " Not Applicable: Bundled with Procedure "$1,541.40 " "$3,523.20 " "$1,219.74 " "$3,523.20 " BLADE INTRAMEDULLARY NAIL TFN-ADVANCED TITANIUM NIOBIUM ALUM 04.038.415S C1713 SUPPLY/IMPLANTS "$4,404.00 " Outpatient "$2,202.00 " "$1,219.74 " "$2,862.60 " "$3,082.80 " "$2,906.64 " Not Applicable: Bundled with Procedure "$1,541.40 " "$3,523.20 " "$1,219.74 " "$3,523.20 " BLADE TFNA FENESTRATED HELEICAL 80MM STERILE 04.038.380S C1713 SUPPLY/IMPLANTS "$4,404.00 " Outpatient "$2,202.00 " "$1,219.74 " "$2,862.60 " "$3,082.80 " "$2,906.64 " Not Applicable: Bundled with Procedure "$1,541.40 " "$3,523.20 " "$1,219.74 " "$3,523.20 " BLCK CUT CNN CORT SCR 3.5MM 246112004 C1713 SUPPLY/IMPLANTS "$2,110.00 " Outpatient "$1,055.00 " "$1,219.74 " "$1,371.50 " "$1,477.00 " "$1,392.60 " Not Applicable: Bundled with Procedure $738.50 "$1,688.00 " $738.50 "$1,688.00 " BLCK CUT CNN CORT SCR 4MM 246112005 C1713 SUPPLY/IMPLANTS "$2,110.00 " Outpatient "$1,055.00 " "$1,219.74 " "$1,371.50 " "$1,477.00 " "$1,392.60 " Not Applicable: Bundled with Procedure $738.50 "$1,688.00 " $738.50 "$1,688.00 " BLCK CUT SCR 8MM 246111007 C1713 SUPPLY/IMPLANTS "$2,553.00 " Outpatient "$1,276.50 " "$1,219.74 " "$1,659.45 " "$1,787.10 " "$1,684.98 " Not Applicable: Bundled with Procedure $893.55 "$2,042.40 " $893.55 "$2,042.40 " BLCK CUT CNN CORT SCR 4.5MM 2461-12-008 C1713 SUPPLY/IMPLANTS "$2,583.00 " Outpatient "$1,291.50 " "$1,219.74 " "$1,678.95 " "$1,808.10 " "$1,704.78 " Not Applicable: Bundled with Procedure $904.05 "$2,066.40 " $904.05 "$2,066.40 " BLCK CUT CNN CANC SCR 4.5MM 2461-12-009 C1713 SUPPLY/IMPLANTS "$2,583.00 " Outpatient "$1,291.50 " "$1,219.74 " "$1,678.95 " "$1,808.10 " "$1,704.78 " Not Applicable: Bundled with Procedure $904.05 "$2,066.40 " $904.05 "$2,066.40 " BLCK CUT CNN SM HD 3.5MM 246112006 C1713 SUPPLY/IMPLANTS "$2,672.00 " Outpatient "$1,336.00 " "$1,219.74 " "$1,736.80 " "$1,870.40 " "$1,763.52 " Not Applicable: Bundled with Procedure $935.20 "$2,137.60 " $935.20 "$2,137.60 " BLCK CUT SM CNN SCR RDC HD CANC 5MM 2461-12-010 C1713 SUPPLY/IMPLANTS "$2,827.00 " Outpatient "$1,413.50 " "$1,219.74 " "$1,837.55 " "$1,978.90 " "$1,865.82 " Not Applicable: Bundled with Procedure $989.45 "$2,261.60 " $989.45 "$2,261.60 " BLCK CUT SCR 6.5MM 246111004 C1713 SUPPLY/IMPLANTS "$3,907.00 " Outpatient "$1,953.50 " "$1,219.74 " "$2,539.55 " "$2,734.90 " "$2,578.62 " Not Applicable: Bundled with Procedure "$1,367.45 " "$3,125.60 " "$1,219.74 " "$3,125.60 " BLCK CUT BNDRG PLT INS TI STRNL MOD 305.695 C1713 SUPPLY/IMPLANTS $612.00 Outpatient $306.00 "$1,219.74 " $397.80 $428.40 $403.92 Not Applicable: Bundled with Procedure $214.20 $489.60 $214.20 "$1,219.74 " BLDE HRBRT SS SCPHD SRG BN SCR NS LF 115401700 C1713 SUPPLY/IMPLANTS "$6,869.00 " Outpatient "$3,434.50 " "$1,219.74 " "$4,464.85 " "$4,808.30 " "$4,533.54 " Not Applicable: Bundled with Procedure "$2,404.15 " "$5,495.20 " "$1,219.74 " "$5,495.20 " BLDE IM NL AU 70MM 12.5MM XPRT 3.2MM SPRL FEM TI CNN FRN CUT 04.013.046S C1713 SUPPLY/IMPLANTS "$3,531.00 " Outpatient "$1,765.50 " "$1,219.74 " "$2,295.15 " "$2,471.70 " "$2,330.46 " Not Applicable: Bundled with Procedure "$1,235.85 " "$2,824.80 " "$1,219.74 " "$2,824.80 " BLDE IM NL AU 55MM 12.5MM XPRT SPRL FEM TI CNN FRN CUT END 04.013.043S C1713 SUPPLY/IMPLANTS "$4,306.00 " Outpatient "$2,153.00 " "$1,219.74 " "$2,798.90 " "$3,014.20 " "$2,841.96 " Not Applicable: Bundled with Procedure "$1,507.10 " "$3,444.80 " "$1,219.74 " "$3,444.80 " BLDE IM NL AU 75MM 12.5MM XPRT 3.2MM SPRL FEM TI CNN FRN CUT 04.013.047S C1713 SUPPLY/IMPLANTS "$3,788.00 " Outpatient "$1,894.00 " "$1,219.74 " "$2,462.20 " "$2,651.60 " "$2,500.08 " Not Applicable: Bundled with Procedure "$1,325.80 " "$3,030.40 " "$1,219.74 " "$3,030.40 " BLDE RTRCTR 20MM MRS 3V SYS DOCK PIN 698.315S C1713 SUPPLY/IMPLANTS "$2,667.00 " Outpatient "$1,333.50 " "$1,219.74 " "$1,733.55 " "$1,866.90 " "$1,760.22 " Not Applicable: Bundled with Procedure $933.45 "$2,133.60 " $933.45 "$2,133.60 " BLDE RTRCTR SHIM INTRDSC LAT 2701-90060 C1713 SUPPLY/IMPLANTS "$1,138.00 " Outpatient $569.00 "$1,219.74 " $739.70 $796.60 $751.08 Not Applicable: Bundled with Procedure $398.30 $910.40 $398.30 "$1,219.74 " BLDE RASP 11X5MM SM TPS SS TEAR XCUT STRL 5100037113 C1713 SUPPLY/IMPLANTS $609.00 Outpatient $304.50 "$1,219.74 " $395.85 $426.30 $401.94 Not Applicable: Bundled with Procedure $213.15 $487.20 $213.15 "$1,219.74 " BLDE SW CNN HL PRM 141401 C1713 SUPPLY/IMPLANTS "$1,757.00 " Outpatient $878.50 "$1,219.74 " "$1,142.05 " "$1,229.90 " "$1,159.62 " Not Applicable: Bundled with Procedure $614.95 "$1,405.60 " $614.95 "$1,405.60 " BLDE SW CNN HL 2ND 141403 C1713 SUPPLY/IMPLANTS "$2,075.00 " Outpatient "$1,037.50 " "$1,219.74 " "$1,348.75 " "$1,452.50 " "$1,369.50 " Not Applicable: Bundled with Procedure $726.25 "$1,660.00 " $726.25 "$1,660.00 " BLDE STRG JIG HUENE HRBRT SS SCPHD SRG BN SCR NS LF 115401900 C1713 SUPPLY/IMPLANTS "$11,671.00 " Outpatient "$5,835.50 " "$1,219.74 " "$7,586.15 " "$8,169.70 " "$7,702.86 " Not Applicable: Bundled with Procedure "$4,084.85 " "$9,336.80 " "$1,219.74 " "$9,336.80 " BLDE SW 58X13X3MM THN RECIPROCATE .4MM NS SD520.005 C1713 SUPPLY/IMPLANTS "$1,124.00 " Outpatient $562.00 "$1,219.74 " $730.60 $786.80 $741.84 Not Applicable: Bundled with Procedure $393.40 $899.20 $393.40 "$1,219.74 " BLOCK ULTRAEXPANSE 14 X 14 X 14MM FD54214U C1713 SUPPLY/IMPLANTS "$12,217.00 " Outpatient "$6,108.50 " "$1,219.74 " "$7,941.05 " "$8,551.90 " "$8,063.22 " Not Applicable: Bundled with Procedure "$4,275.95 " "$9,773.60 " "$1,219.74 " "$9,773.60 " BLOCKER SPNL XIA 3 SPNE TI 48230000 C1713 SUPPLY/IMPLANTS "$1,110.00 " Outpatient $555.00 "$1,219.74 " $721.50 $777.00 $732.60 Not Applicable: Bundled with Procedure $388.50 $888.00 $388.50 "$1,219.74 " BLOCKER SPNL OASYS OCT 48551000 C1713 SUPPLY/IMPLANTS $913.00 Outpatient $456.50 "$1,219.74 " $593.45 $639.10 $602.58 Not Applicable: Bundled with Procedure $319.55 $730.40 $319.55 "$1,219.74 " BLOCKER SPNL MANTIS PDCL BLOCKER RDC 48289999 C1713 SUPPLY/IMPLANTS $865.00 Outpatient $432.50 "$1,219.74 " $562.25 $605.50 $570.90 Not Applicable: Bundled with Procedure $302.75 $692.00 $302.75 "$1,219.74 " BNDR PLT 2 SET THRD 2.7 MM SCR STRL 212000031 C1713 SUPPLY/IMPLANTS $623.00 Outpatient $311.50 "$1,219.74 " $404.95 $436.10 $411.18 Not Applicable: Bundled with Procedure $218.05 $498.40 $218.05 "$1,219.74 " BNDR PLT STRG 3.5MM MDL LAT ALPS 2312-18-003 C1713 SUPPLY/IMPLANTS "$1,226.00 " Outpatient $613.00 "$1,219.74 " $796.90 $858.20 $809.16 Not Applicable: Bundled with Procedure $429.10 $980.80 $429.10 "$1,219.74 " BNDR PLT L 3.5MM MDL LAT ALPS 2312-18-004 C1713 SUPPLY/IMPLANTS "$1,226.00 " Outpatient $613.00 "$1,219.74 " $796.90 $858.20 $809.16 Not Applicable: Bundled with Procedure $429.10 $980.80 $429.10 "$1,219.74 " BNDR PLT 2.5MM MDL LAT ALPS 2312-18-005 C1713 SUPPLY/IMPLANTS "$1,226.00 " Outpatient $613.00 "$1,219.74 " $796.90 $858.20 $809.16 Not Applicable: Bundled with Procedure $429.10 $980.80 $429.10 "$1,219.74 " BNDR PLT 3.5MM P/L OLCRN 2312-18-008 C1713 SUPPLY/IMPLANTS "$1,226.00 " Outpatient $613.00 "$1,219.74 " $796.90 $858.20 $809.16 Not Applicable: Bundled with Procedure $429.10 $980.80 $429.10 "$1,219.74 " BNDR PLT A L P S TL FT SYS 231220212 C1713 SUPPLY/IMPLANTS "$1,835.00 " Outpatient $917.50 "$1,219.74 " "$1,192.75 " "$1,284.50 " "$1,211.10 " Not Applicable: Bundled with Procedure $642.25 "$1,468.00 " $642.25 "$1,468.00 " BNDR PLT LNG ALPS 2312-18-001 C1713 SUPPLY/IMPLANTS "$2,080.00 " Outpatient "$1,040.00 " "$1,219.74 " "$1,352.00 " "$1,456.00 " "$1,372.80 " Not Applicable: Bundled with Procedure $728.00 "$1,664.00 " $728.00 "$1,664.00 " BNDR PLT COMP ANTM LCK PLT SYS 8163-01-017 C1713 SUPPLY/IMPLANTS "$4,075.00 " Outpatient "$2,037.50 " "$1,219.74 " "$2,648.75 " "$2,852.50 " "$2,689.50 " Not Applicable: Bundled with Procedure "$1,426.25 " "$3,260.00 " "$1,219.74 " "$3,260.00 " BNDR PLT 20.3CM PLV LVR HNDL SHFT SS PHNL 6.35CM 2.7-3.5-4MM 117901100 C1713 SUPPLY/IMPLANTS "$7,385.00 " Outpatient "$3,692.50 " "$1,219.74 " "$4,800.25 " "$5,169.50 " "$4,874.10 " Not Applicable: Bundled with Procedure "$2,584.75 " "$5,908.00 " "$1,219.74 " "$5,908.00 " BNDR PLT 21.3CM PLV LVR HNDL SHFT SS PHNL 3.5-4.5MM RECON 117901110 C1713 SUPPLY/IMPLANTS "$2,693.00 " Outpatient "$1,346.50 " "$1,219.74 " "$1,750.45 " "$1,885.10 " "$1,777.38 " Not Applicable: Bundled with Procedure $942.55 "$2,154.40 " $942.55 "$2,154.40 " BNDR PLT 18.7CM PLV LVR HNDL SHFT SS PHNL 2.7MM 3.5MM SCR NS 117901111 C1713 SUPPLY/IMPLANTS "$2,779.00 " Outpatient "$1,389.50 " "$1,219.74 " "$1,806.35 " "$1,945.30 " "$1,834.14 " Not Applicable: Bundled with Procedure $972.65 "$2,223.20 " $972.65 "$2,223.20 " BNDR PLT MN NON LCK MTRX NUERO NS 03.503.031 C1713 SUPPLY/IMPLANTS "$2,825.00 " Outpatient "$1,412.50 " "$1,219.74 " "$1,836.25 " "$1,977.50 " "$1,864.50 " Not Applicable: Bundled with Procedure $988.75 "$2,260.00 " $988.75 "$2,260.00 " BNDR PLT RT ANG 1MM 2MM 1.5MM 1.3MM NS 347.962 C1713 SUPPLY/IMPLANTS "$4,766.00 " Outpatient "$2,383.00 " "$1,219.74 " "$3,097.90 " "$3,336.20 " "$3,145.56 " Not Applicable: Bundled with Procedure "$1,668.10 " "$3,812.80 " "$1,219.74 " "$3,812.80 " BNDR PLT IN PLN MTRX THK.7 MM SD300.102 C1713 SUPPLY/IMPLANTS "$2,749.00 " Outpatient "$1,374.50 " "$1,219.74 " "$1,786.85 " "$1,924.30 " "$1,814.34 " Not Applicable: Bundled with Procedure $962.15 "$2,199.20 " $962.15 "$2,199.20 " BNDR PLT IN PLN MTRX THK.4 MM THK.5 MM SD300.103 C1713 SUPPLY/IMPLANTS "$2,749.00 " Outpatient "$1,374.50 " "$1,219.74 " "$1,786.85 " "$1,924.30 " "$1,814.34 " Not Applicable: Bundled with Procedure $962.15 "$2,199.20 " $962.15 "$2,199.20 " BNDR PLT RT ANG LNG HNDL SD347.969 C1713 SUPPLY/IMPLANTS "$9,349.00 " Outpatient "$4,674.50 " "$1,219.74 " "$6,076.85 " "$6,544.30 " "$6,170.34 " Not Applicable: Bundled with Procedure "$3,272.15 " "$7,479.20 " "$1,219.74 " "$7,479.20 " BNDR ROD DIGITIZER ARY BENDINI NS LF DISP 2040001 C1713 SUPPLY/IMPLANTS "$6,591.00 " Outpatient "$3,295.50 " "$1,219.74 " "$4,284.15 " "$4,613.70 " "$4,350.06 " Not Applicable: Bundled with Procedure "$2,306.85 " "$5,272.80 " "$1,219.74 " "$5,272.80 " BNDR ROD PED LCK NL SYS 124777 C1713 SUPPLY/IMPLANTS "$23,371.00 " Outpatient "$11,685.50 " "$1,219.74 " "$15,191.15 " "$16,359.70 " "$15,424.86 " Not Applicable: Bundled with Procedure "$8,179.85 " "$18,696.80 " "$1,219.74 " "$18,696.80 " BNDR SRG DIST TIB TAB ANTM LCK PLT SYS 8163-01-001 C1713 SUPPLY/IMPLANTS $868.00 Outpatient $434.00 "$1,219.74 " $564.20 $607.60 $572.88 Not Applicable: Bundled with Procedure $303.80 $694.40 $303.80 "$1,219.74 " BNDR SRG PLT OPTILOCK UPR XTRMT PLT SYS 36595 C1713 SUPPLY/IMPLANTS "$3,131.00 " Outpatient "$1,565.50 " "$1,219.74 " "$2,035.15 " "$2,191.70 " "$2,066.46 " Not Applicable: Bundled with Procedure "$1,095.85 " "$2,504.80 " "$1,095.85 " "$2,504.80 " BNDR SRG MID PLT 14-401419 C1713 SUPPLY/IMPLANTS "$7,465.00 " Outpatient "$3,732.50 " "$1,219.74 " "$4,852.25 " "$5,225.50 " "$4,926.90 " Not Applicable: Bundled with Procedure "$2,612.75 " "$5,972.00 " "$1,219.74 " "$5,972.00 " BNDR SRG 1.6MM KWR PERIART DIST RADL LCK PLT NS 236002901 C1713 SUPPLY/IMPLANTS "$4,354.00 " Outpatient "$2,177.00 " "$1,219.74 " "$2,830.10 " "$3,047.80 " "$2,873.64 " Not Applicable: Bundled with Procedure "$1,523.90 " "$3,483.20 " "$1,219.74 " "$3,483.20 " BNDR SRG RECON MESH 03.503.602 C1713 SUPPLY/IMPLANTS "$3,875.00 " Outpatient "$1,937.50 " "$1,219.74 " "$2,518.75 " "$2,712.50 " "$2,557.50 " Not Applicable: Bundled with Procedure "$1,356.25 " "$3,100.00 " "$1,219.74 " "$3,100.00 " BNDR SRG MESH HNDL SD306.511 C1713 SUPPLY/IMPLANTS "$3,038.00 " Outpatient "$1,519.00 " "$1,219.74 " "$1,974.70 " "$2,126.60 " "$2,005.08 " Not Applicable: Bundled with Procedure "$1,063.30 " "$2,430.40 " "$1,063.30 " "$2,430.40 " BODY DSTRCT 100MM RDS STRG TI MNDB CURVILINEAR NS 04.500.018 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " BODY DSTRCT 40MM RDS STRG TI MNDB RT CURVILINEAR 2MM LCK SCR 04.500.140 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " BODY DSTRCT 40MM RDS STRG TI MNDB LT CURVILINEAR 2MM LCK SCR 04.500.141 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " BODY DSTRCT 12MM TI ALVEOLAR STRG PLT NS 488.075 C1713 SUPPLY/IMPLANTS "$4,469.00 " Outpatient "$2,234.50 " "$1,219.74 " "$2,904.85 " "$3,128.30 " "$2,949.54 " Not Applicable: Bundled with Procedure "$1,564.15 " "$3,575.20 " "$1,219.74 " "$3,575.20 " BODY DSTRCT 16MM TI ALVEOLAR STRG PLT NS 488.076 C1713 SUPPLY/IMPLANTS "$4,469.00 " Outpatient "$2,234.50 " "$1,219.74 " "$2,904.85 " "$3,128.30 " "$2,949.54 " Not Applicable: Bundled with Procedure "$1,564.15 " "$3,575.20 " "$1,219.74 " "$3,575.20 " BODY HUMERAL GLOBAL UNITE POROCOAT 135 D OD12 MM SHOULDER ST 110040000 C1713 SUPPLY/IMPLANTS "$2,855.00 " Outpatient "$1,427.50 " "$1,219.74 " "$1,855.75 " "$1,998.50 " "$1,884.30 " Not Applicable: Bundled with Procedure $999.25 "$2,284.00 " $999.25 "$2,284.00 " BOLT CNCT ITST TRGT GD MDLR NS 225805209 C1713 SUPPLY/IMPLANTS $621.00 Outpatient $310.50 "$1,219.74 " $403.65 $434.70 $409.86 Not Applicable: Bundled with Procedure $217.35 $496.80 $217.35 "$1,219.74 " BOLT CNCT NTR NL STD CEPHALOMEDULLARY 249000302 C1713 SUPPLY/IMPLANTS $941.00 Outpatient $470.50 "$1,219.74 " $611.65 $658.70 $621.06 Not Applicable: Bundled with Procedure $329.35 $752.80 $329.35 "$1,219.74 " BOLT CNCT NTR NL RTRGD FEM 249000402 C1713 SUPPLY/IMPLANTS "$1,165.00 " Outpatient $582.50 "$1,219.74 " $757.25 $815.50 $768.90 Not Applicable: Bundled with Procedure $407.75 $932.00 $407.75 "$1,219.74 " BOLT CNCT NTR NL SM TIB 249000501 C1713 SUPPLY/IMPLANTS $941.00 Outpatient $470.50 "$1,219.74 " $611.65 $658.70 $621.06 Not Applicable: Bundled with Procedure $329.35 $752.80 $329.35 "$1,219.74 " BOLT CNCT NTR NL TLL TIB 249000507 C1713 SUPPLY/IMPLANTS $941.00 Outpatient $470.50 "$1,219.74 " $611.65 $658.70 $621.06 Not Applicable: Bundled with Procedure $329.35 $752.80 $329.35 "$1,219.74 " BOLT CNCT NTR NL ANTGRD SM FEM 249000801 C1713 SUPPLY/IMPLANTS $714.00 Outpatient $357.00 "$1,219.74 " $464.10 $499.80 $471.24 Not Applicable: Bundled with Procedure $249.90 $571.20 $249.90 "$1,219.74 " BOLT CNCT 144MM NCB-DF FEM SS TRGT DEV NS 200024073 C1713 SUPPLY/IMPLANTS "$1,332.00 " Outpatient $666.00 "$1,219.74 " $865.80 $932.40 $879.12 Not Applicable: Bundled with Procedure $466.20 "$1,065.60 " $466.20 "$1,219.74 " BOLT CNCT 153MM NCB-DF FEM SS STAB TRGT DEV NS 200024074 C1713 SUPPLY/IMPLANTS "$2,748.00 " Outpatient "$1,374.00 " "$1,219.74 " "$1,786.20 " "$1,923.60 " "$1,813.68 " Not Applicable: Bundled with Procedure $961.80 "$2,198.40 " $961.80 "$2,198.40 " BOLT CNCT NCB TIB PROX DIST STAB TRGT DEV NS 200024084 C1713 SUPPLY/IMPLANTS "$2,537.00 " Outpatient "$1,268.50 " "$1,219.74 " "$1,649.05 " "$1,775.90 " "$1,674.42 " Not Applicable: Bundled with Procedure $887.95 "$2,029.60 " $887.95 "$2,029.60 " BOLT CNCT NCB FEM PERIPROSTHETIC TRGT DEV MIS 200024380 C1713 SUPPLY/IMPLANTS "$1,816.00 " Outpatient $908.00 "$1,219.74 " "$1,180.40 " "$1,271.20 " "$1,198.56 " Not Applicable: Bundled with Procedure $635.60 "$1,452.80 " $635.60 "$1,452.80 " BOLT EXTERNAL FIXATION LONG HINGE 4934-1-016 C1713 SUPPLY/IMPLANTS $462.00 Outpatient $231.00 "$1,219.74 " $300.30 $323.40 $304.92 Not Applicable: Bundled with Procedure $161.70 $369.60 $161.70 "$1,219.74 " BOLT EXTERNAL FIXATION L105 MM STERILE FEMORAL NECK SYSTEM 04.168.305S C1713 SUPPLY/IMPLANTS "$2,826.00 " Outpatient "$1,413.00 " "$1,219.74 " "$1,836.90 " "$1,978.20 " "$1,865.16 " Not Applicable: Bundled with Procedure $989.10 "$2,260.80 " $989.10 "$2,260.80 " BOLT EXTERNAL FIXATION L95 MM STERILE FEMORAL NECK SYSTEM 04.168.295S C1713 SUPPLY/IMPLANTS "$2,742.00 " Outpatient "$1,371.00 " "$1,219.74 " "$1,782.30 " "$1,919.40 " "$1,809.72 " Not Applicable: Bundled with Procedure $959.70 "$2,193.60 " $959.70 "$2,193.60 " BOLT FOR FEMORAL NECK SYST. 90MM LGHT-STRL 04.168.290S C1713 SUPPLY/IMPLANTS "$2,825.00 " Outpatient "$1,412.50 " "$1,219.74 " "$1,836.25 " "$1,977.50 " "$1,864.50 " Not Applicable: Bundled with Procedure $988.75 "$2,260.00 " $988.75 "$2,260.00 " BOLT FOR FEMORAL NECK SYSTEM85MM LENGTH STERILE 04.168.285S C1713 SUPPLY/IMPLANTS "$2,825.00 " Outpatient "$1,412.50 " "$1,219.74 " "$1,836.25 " "$1,977.50 " "$1,864.50 " Not Applicable: Bundled with Procedure $988.75 "$2,260.00 " $988.75 "$2,260.00 " BOLT FOR FEMORAL NECK SYSTEM 75MM 04.168.275S C1713 SUPPLY/IMPLANTS "$2,825.00 " Outpatient "$1,412.50 " "$1,219.74 " "$1,836.25 " "$1,977.50 " "$1,864.50 " Not Applicable: Bundled with Procedure $988.75 "$2,260.00 " $988.75 "$2,260.00 " BOLT FOR FEM NECK SYSTM 80MM LNGTH STRL 04.168.280S C1713 SUPPLY/IMPLANTS "$2,826.00 " Outpatient "$1,413.00 " "$1,219.74 " "$1,836.90 " "$1,978.20 " "$1,865.16 " Not Applicable: Bundled with Procedure $989.10 "$2,260.80 " $989.10 "$2,260.80 " BOLT ILIAC 8.5 X 80MM 5508580 C1713 SUPPLY/IMPLANTS "$4,881.00 " Outpatient "$2,440.50 " "$1,219.74 " "$3,172.65 " "$3,416.70 " "$3,221.46 " Not Applicable: Bundled with Procedure "$1,708.35 " "$3,904.80 " "$1,219.74 " "$3,904.80 " BOLT LCK GRN 48MM 4.9MM 8MM TI ST TROC TIP HEX DRV IM NL SYS 459.48 C1713 SUPPLY/IMPLANTS "$1,197.00 " Outpatient $598.50 "$1,219.74 " $778.05 $837.90 $790.02 Not Applicable: Bundled with Procedure $418.95 $957.60 $418.95 "$1,219.74 " BOLT LCK MDN SS IM NL SYS RTRGD FEM INST NS 225500100 C1713 SUPPLY/IMPLANTS "$2,676.00 " Outpatient "$1,338.00 " "$1,219.74 " "$1,739.40 " "$1,873.20 " "$1,766.16 " Not Applicable: Bundled with Procedure $936.60 "$2,140.80 " $936.60 "$2,140.80 " BOLT LCK MDN SS WRNCH NS 225502700 C1713 SUPPLY/IMPLANTS "$2,693.00 " Outpatient "$1,346.50 " "$1,219.74 " "$1,750.45 " "$1,885.10 " "$1,777.38 " Not Applicable: Bundled with Procedure $942.55 "$2,154.40 " $942.55 "$2,154.40 " BOLT LCK MDN TIB PROX SS IM NL SYS MIS NS 225503304 C1713 SUPPLY/IMPLANTS "$2,142.00 " Outpatient "$1,071.00 " "$1,219.74 " "$1,392.30 " "$1,499.40 " "$1,413.72 " Not Applicable: Bundled with Procedure $749.70 "$1,713.60 " $749.70 "$1,713.60 " BOLT LCK MDN XLNG SS NS 225505800 C1713 SUPPLY/IMPLANTS "$2,773.00 " Outpatient "$1,386.50 " "$1,219.74 " "$1,802.45 " "$1,941.10 " "$1,830.18 " Not Applicable: Bundled with Procedure $970.55 "$2,218.40 " $970.55 "$2,218.40 " BOLT LCK ITST STD SS MIS ASIA 225808702 C1713 SUPPLY/IMPLANTS "$1,260.00 " Outpatient $630.00 "$1,219.74 " $819.00 $882.00 $831.60 Not Applicable: Bundled with Procedure $441.00 "$1,008.00 " $441.00 "$1,219.74 " BOLT ORTH 6MM POST 1530 C1713 SUPPLY/IMPLANTS $991.00 Outpatient $495.50 "$1,219.74 " $644.15 $693.70 $654.06 Not Applicable: Bundled with Procedure $346.85 $792.80 $346.85 "$1,219.74 " BOLT ORTH POLYAX UNV ANCH NUT PLT SYS 2141-09-001 C1713 SUPPLY/IMPLANTS "$1,300.00 " Outpatient $650.00 "$1,219.74 " $845.00 $910.00 $858.00 Not Applicable: Bundled with Procedure $455.00 "$1,040.00 " $455.00 "$1,219.74 " BOLT ORTH POLYAX UNV ANCH PLT SYS 2141-08-001 C1713 SUPPLY/IMPLANTS "$1,932.00 " Outpatient $966.00 "$1,219.74 " "$1,255.80 " "$1,352.40 " "$1,275.12 " Not Applicable: Bundled with Procedure $676.20 "$1,545.60 " $676.20 "$1,545.60 " BOLT ORTH VERSANAIL UNV JIG LCK 2810-17-010 C1713 SUPPLY/IMPLANTS "$1,977.00 " Outpatient $988.50 "$1,219.74 " "$1,285.05 " "$1,383.90 " "$1,304.82 " Not Applicable: Bundled with Procedure $691.95 "$1,581.60 " $691.95 "$1,581.60 " BOLT SPNL 35MM 5MM TI 7555035 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " BOLT SPNL 55MM 5.5MM XLP 7555055 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " BOLT SPNL 55MM 5.5MM DECADE LG PLT XLIF NS 7145555 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " BOLT SPNL 55MM 5MM DECADE SM THRD PLT XLIF NS 7145055 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " BOLT SPNL 60MM 5.5MM DECADE LG PLT XLIF NS 7145560 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " BOLT SPNL 60MM 5MM DECADE SM THRD PLT XLIF NS 7145060 C1713 SUPPLY/IMPLANTS "$6,731.00 " Outpatient "$3,365.50 " "$1,219.74 " "$4,375.15 " "$4,711.70 " "$4,442.46 " Not Applicable: Bundled with Procedure "$2,355.85 " "$5,384.80 " "$1,219.74 " "$5,384.80 " BOLT SPNL 50MM 5.5MM DECADE SM THRD PLT XLIF NS 7145150 C1713 SUPPLY/IMPLANTS "$6,731.00 " Outpatient "$3,365.50 " "$1,219.74 " "$4,375.15 " "$4,711.70 " "$4,442.46 " Not Applicable: Bundled with Procedure "$2,355.85 " "$5,384.80 " "$1,219.74 " "$5,384.80 " BOLT SPNL 50MM 5.5MM DECADE LG PLT XLIF NS 7145550 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " BOLT SPNL 55MM 6.5MM DECADE LG PLT XLIF NS 7146555 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " BOLT SPNL 45MM 5.5MM DECADE LG PLT XLIF NS 7145545 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " BOLT SPNL 45MM 5MM DECADE SM THRD PLT XLIF NS 7145045 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " BOLT SPNL RING LCK XTD 15219 C1713 SUPPLY/IMPLANTS $531.00 Outpatient $265.50 "$1,219.74 " $345.15 $371.70 $350.46 Not Applicable: Bundled with Procedure $185.85 $424.80 $185.85 "$1,219.74 " BOLT SPNL 50MM 5MM DECADE SM THRD PLT XLIF NS 7145050 C1713 SUPPLY/IMPLANTS "$6,731.00 " Outpatient "$3,365.50 " "$1,219.74 " "$4,375.15 " "$4,711.70 " "$4,442.46 " Not Applicable: Bundled with Procedure "$2,355.85 " "$5,384.80 " "$1,219.74 " "$5,384.80 " BOLT SPNL 40MM 5.5MM DECADE LG PLT XLIF NS 7145540 C1713 SUPPLY/IMPLANTS "$4,888.00 " Outpatient "$2,444.00 " "$1,219.74 " "$3,177.20 " "$3,421.60 " "$3,226.08 " Not Applicable: Bundled with Procedure "$1,710.80 " "$3,910.40 " "$1,219.74 " "$3,910.40 " BOLT SPNL 40MM 6.5MM DECADE LG PLT XLIF NS 7146540 C1713 SUPPLY/IMPLANTS "$4,888.00 " Outpatient "$2,444.00 " "$1,219.74 " "$3,177.20 " "$3,421.60 " "$3,226.08 " Not Applicable: Bundled with Procedure "$1,710.80 " "$3,910.40 " "$1,219.74 " "$3,910.40 " BOLT SPNL 30MM 5.5MM DECADE LG PLT XLIF NS 7145530 C1713 SUPPLY/IMPLANTS "$4,888.00 " Outpatient "$2,444.00 " "$1,219.74 " "$3,177.20 " "$3,421.60 " "$3,226.08 " Not Applicable: Bundled with Procedure "$1,710.80 " "$3,910.40 " "$1,219.74 " "$3,910.40 " BOLT SPNL 25MM 5MM BS TI VA NS 6955252 C1713 SUPPLY/IMPLANTS "$4,888.00 " Outpatient "$2,444.00 " "$1,219.74 " "$3,177.20 " "$3,421.60 " "$3,226.08 " Not Applicable: Bundled with Procedure "$1,710.80 " "$3,910.40 " "$1,219.74 " "$3,910.40 " BOLT SPNL 25MM 6MM BS TI VA NS 6956252 C1713 SUPPLY/IMPLANTS "$4,888.00 " Outpatient "$2,444.00 " "$1,219.74 " "$3,177.20 " "$3,421.60 " "$3,226.08 " Not Applicable: Bundled with Procedure "$1,710.80 " "$3,910.40 " "$1,219.74 " "$3,910.40 " BOLT SPNL 35MM 5MM DECADE SM THRD PLT XLIF NS 7145035 C1713 SUPPLY/IMPLANTS "$4,888.00 " Outpatient "$2,444.00 " "$1,219.74 " "$3,177.20 " "$3,421.60 " "$3,226.08 " Not Applicable: Bundled with Procedure "$1,710.80 " "$3,910.40 " "$1,219.74 " "$3,910.40 " BOLT SPNL 35MM 6.5MM DECADE LG PLT XLIF NS 7146535 C1713 SUPPLY/IMPLANTS "$4,888.00 " Outpatient "$2,444.00 " "$1,219.74 " "$3,177.20 " "$3,421.60 " "$3,226.08 " Not Applicable: Bundled with Procedure "$1,710.80 " "$3,910.40 " "$1,219.74 " "$3,910.40 " BOLT SPNL 25MM 5.5MM DECADE LG PLT XLIF NS 7145525 C1713 SUPPLY/IMPLANTS "$4,888.00 " Outpatient "$2,444.00 " "$1,219.74 " "$3,177.20 " "$3,421.60 " "$3,226.08 " Not Applicable: Bundled with Procedure "$1,710.80 " "$3,910.40 " "$1,219.74 " "$3,910.40 " BOLT SPNL 40MM 5MM DECADE SM THRD PLT XLIF NS 7145040 C1713 SUPPLY/IMPLANTS "$4,888.00 " Outpatient "$2,444.00 " "$1,219.74 " "$3,177.20 " "$3,421.60 " "$3,226.08 " Not Applicable: Bundled with Procedure "$1,710.80 " "$3,910.40 " "$1,219.74 " "$3,910.40 " BOLT SPNL 22.5MM 5MM BS TI FX ANG NS 6955221 C1713 SUPPLY/IMPLANTS "$4,885.00 " Outpatient "$2,442.50 " "$1,219.74 " "$3,175.25 " "$3,419.50 " "$3,224.10 " Not Applicable: Bundled with Procedure "$1,709.75 " "$3,908.00 " "$1,219.74 " "$3,908.00 " BOLT SPINAL DECADE LARGE L45 MM OD6.5 MM PLATE NONSTERILE XL 7146545 C1713 SUPPLY/IMPLANTS "$3,914.00 " Outpatient "$1,957.00 " "$1,219.74 " "$2,544.10 " "$2,739.80 " "$2,583.24 " Not Applicable: Bundled with Procedure "$1,369.90 " "$3,131.20 " "$1,219.74 " "$3,131.20 " BOLT SPINAL DECADE LARGE L50 MM OD6.5 MM PLATE NONSTERILE XL 7146550 C1713 SUPPLY/IMPLANTS "$3,914.00 " Outpatient "$1,957.00 " "$1,219.74 " "$2,544.10 " "$2,739.80 " "$2,583.24 " Not Applicable: Bundled with Procedure "$1,369.90 " "$3,131.20 " "$1,219.74 " "$3,131.20 " BOLT XTRT 2.7 2.8 MM SCR NS 309.29 C1713 SUPPLY/IMPLANTS $672.00 Outpatient $336.00 "$1,219.74 " $436.80 $470.40 $443.52 Not Applicable: Bundled with Procedure $235.20 $537.60 $235.20 "$1,219.74 " BOLT XTRNFX 1.5-2MM HFMN SHRT WRE LMB RECON FRM NS 4933-1-001 C1713 SUPPLY/IMPLANTS $491.00 Outpatient $245.50 "$1,219.74 " $319.15 $343.70 $324.06 Not Applicable: Bundled with Procedure $171.85 $392.80 $171.85 "$1,219.74 " BOLT XTRNFX 1.5-2MM HFMN MED WRE LMB RECON FRM 4933-1-002 C1713 SUPPLY/IMPLANTS $491.00 Outpatient $245.50 "$1,219.74 " $319.15 $343.70 $324.06 Not Applicable: Bundled with Procedure $171.85 $392.80 $171.85 "$1,219.74 " BOLT XTRNFX 1.5-2MM HFMN LNG WRE LMB RECON FRM 4933-1-003 C1713 SUPPLY/IMPLANTS $491.00 Outpatient $245.50 "$1,219.74 " $319.15 $343.70 $324.06 Not Applicable: Bundled with Procedure $171.85 $392.80 $171.85 "$1,219.74 " BOLT XTRNFX XS RING BS LVL MAC SYS 15245 C1713 SUPPLY/IMPLANTS $452.00 Outpatient $226.00 "$1,219.74 " $293.80 $316.40 $298.32 Not Applicable: Bundled with Procedure $158.20 $361.60 $158.20 "$1,219.74 " BOLT XTRNFX PHNX CNCT RTRGD FEM NL SYS STRL 14442021 C1713 SUPPLY/IMPLANTS $623.00 Outpatient $311.50 "$1,219.74 " $404.95 $436.10 $411.18 Not Applicable: Bundled with Procedure $218.05 $498.40 $218.05 "$1,219.74 " BOLT XTRNFX DNFX LCK SM C RL NS 6568 C1713 SUPPLY/IMPLANTS $633.00 Outpatient $316.50 "$1,219.74 " $411.45 $443.10 $417.78 Not Applicable: Bundled with Procedure $221.55 $506.40 $221.55 "$1,219.74 " BOLT XTRNFX CNCT 14440042 C1713 SUPPLY/IMPLANTS $982.00 Outpatient $491.00 "$1,219.74 " $638.30 $687.40 $648.12 Not Applicable: Bundled with Procedure $343.70 $785.60 $343.70 "$1,219.74 " BOLT XTRT 3.5MM CONE THRD 2.5/2.7/3.5/4MM SCR 8210-64-000 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BOLT XTRT 4.5MM CONE THRD 4.5/5MM SCR 8210-65-000 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BOLT XTRT 3.5MM CONE THRD 6.5/8MM SCR 8210-66-000 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " BOLT XTRNFX A FSHR HNG WRE 818050009 C1713 SUPPLY/IMPLANTS "$1,232.00 " Outpatient $616.00 "$1,219.74 " $800.80 $862.40 $813.12 Not Applicable: Bundled with Procedure $431.20 $985.60 $431.20 "$1,219.74 " BOLT XTRNFX PHNX CORELOCK FEM CNCT ANTGRD NL SYS 14442093 C1713 SUPPLY/IMPLANTS "$1,460.00 " Outpatient $730.00 "$1,219.74 " $949.00 "$1,022.00 " $963.60 Not Applicable: Bundled with Procedure $511.00 "$1,168.00 " $511.00 "$1,219.74 " BOLT XTRNFX A FSHR .445 CLEVIS 100162 C1713 SUPPLY/IMPLANTS "$1,557.00 " Outpatient $778.50 "$1,219.74 " "$1,012.05 " "$1,089.90 " "$1,027.62 " Not Applicable: Bundled with Procedure $544.95 "$1,245.60 " $544.95 "$1,245.60 " BOLT XTRNFX A FSHR .545 MED CLEVIS 100163 C1713 SUPPLY/IMPLANTS "$1,557.00 " Outpatient $778.50 "$1,219.74 " "$1,012.05 " "$1,089.90 " "$1,027.62 " Not Applicable: Bundled with Procedure $544.95 "$1,245.60 " $544.95 "$1,245.60 " BOLT XTRNFX A FSHR .669 LNG CLEVIS 100165 C1713 SUPPLY/IMPLANTS "$1,557.00 " Outpatient $778.50 "$1,219.74 " "$1,012.05 " "$1,089.90 " "$1,027.62 " Not Applicable: Bundled with Procedure $544.95 "$1,245.60 " $544.95 "$1,245.60 " BOLT XTRT VERSANAIL UNV HUM NL REM 2810-17-022 C1713 SUPPLY/IMPLANTS "$2,132.00 " Outpatient "$1,066.00 " "$1,219.74 " "$1,385.80 " "$1,492.40 " "$1,407.12 " Not Applicable: Bundled with Procedure $746.20 "$1,705.60 " $746.20 "$1,705.60 " BOLT XTRNFX APX 3-6 MM PIN 4933-1-022 C1713 SUPPLY/IMPLANTS "$1,331.00 " Outpatient $665.50 "$1,219.74 " $865.15 $931.70 $878.46 Not Applicable: Bundled with Procedure $465.85 "$1,064.80 " $465.85 "$1,219.74 " BONE CEMENT PALACOS R+G RADIOPAQUE WITH GENTAMICIN 40.8G 00-1113-140-01 C1713 SUPPLY/IMPLANTS "$1,747.00 " Outpatient $873.50 "$1,219.74 " "$1,135.55 " "$1,222.90 " "$1,153.02 " Not Applicable: Bundled with Procedure $611.45 "$1,397.60 " $611.45 "$1,397.60 " BONE CERAMENT VOID FILLER SIZE 5 A0210-09 C1713 SUPPLY/IMPLANTS "$5,505.00 " Outpatient "$2,752.50 " "$1,219.74 " "$3,578.25 " "$3,853.50 " "$3,633.30 " Not Applicable: Bundled with Procedure "$1,926.75 " "$4,404.00 " "$1,219.74 " "$4,404.00 " BONE CERAMENT VOID FILLER SIZE 10 A0210-08 C1713 SUPPLY/IMPLANTS "$10,397.00 " Outpatient "$5,198.50 " "$1,219.74 " "$6,758.05 " "$7,277.90 " "$6,862.02 " Not Applicable: Bundled with Procedure "$3,638.95 " "$8,317.60 " "$1,219.74 " "$8,317.60 " BONE CERAMENT VOID FILLER SIZE 18 A0210-11 C1713 SUPPLY/IMPLANTS "$18,715.00 " Outpatient "$9,357.50 " "$1,219.74 " "$12,164.75 " "$13,100.50 " "$12,351.90 " Not Applicable: Bundled with Procedure "$6,550.25 " "$14,972.00 " "$1,219.74 " "$14,972.00 " BONE GRAFT 4104-K5020DC 4104-K5020DC C1713 SUPPLY/IMPLANTS "$11,430.00 " Outpatient "$5,715.00 " "$1,219.74 " "$7,429.50 " "$8,001.00 " "$7,543.80 " Not Applicable: Bundled with Procedure "$4,000.50 " "$9,144.00 " "$1,219.74 " "$9,144.00 " BONE GRAFT I FACTOR 700-050 C1713 SUPPLY/IMPLANTS "$8,711.00 " Outpatient "$4,355.50 " "$1,219.74 " "$5,662.15 " "$6,097.70 " "$5,749.26 " Not Applicable: Bundled with Procedure "$3,048.85 " "$6,968.80 " "$1,219.74 " "$6,968.80 " BONE PIN 3.2 MM X 110MM 213524 C1713 SUPPLY/IMPLANTS $459.00 Outpatient $229.50 "$1,219.74 " $298.35 $321.30 $302.94 Not Applicable: Bundled with Procedure $160.65 $367.20 $160.65 "$1,219.74 " BONE PIN 32 X 140 111620 C1713 SUPPLY/IMPLANTS $594.00 Outpatient $297.00 "$1,219.74 " $386.10 $415.80 $392.04 Not Applicable: Bundled with Procedure $207.90 $475.20 $207.90 "$1,219.74 " BONE SCREW 1.7 X 12MM 59-17012 C1713 SUPPLY/IMPLANTS $556.00 Outpatient $278.00 "$1,219.74 " $361.40 $389.20 $366.96 Not Applicable: Bundled with Procedure $194.60 $444.80 $194.60 "$1,219.74 " BONE SCREW ACUTRAK 2 34MM AT2-534 C1713 SUPPLY/IMPLANTS "$2,371.00 " Outpatient "$1,185.50 " "$1,219.74 " "$1,541.15 " "$1,659.70 " "$1,564.86 " Not Applicable: Bundled with Procedure $829.85 "$1,896.80 " $829.85 "$1,896.80 " BONE SCREW 6.0X38MM 14038P C1713 SUPPLY/IMPLANTS $810.00 Outpatient $405.00 "$1,219.74 " $526.50 $567.00 $534.60 Not Applicable: Bundled with Procedure $283.50 $648.00 $283.50 "$1,219.74 " BONE SCREW SPACER 12MM 6180 C1713 SUPPLY/IMPLANTS "$1,192.00 " Outpatient $596.00 "$1,219.74 " $774.80 $834.40 $786.72 Not Applicable: Bundled with Procedure $417.20 $953.60 $417.20 "$1,219.74 " BONE SCREW SPACER 15MM 6185 C1713 SUPPLY/IMPLANTS "$1,192.00 " Outpatient $596.00 "$1,219.74 " $774.80 $834.40 $786.72 Not Applicable: Bundled with Procedure $417.20 $953.60 $417.20 "$1,219.74 " BONE SCREW T8 2.7MM L15MM 656415 C1713 SUPPLY/IMPLANTS $739.00 Outpatient $369.50 "$1,219.74 " $480.35 $517.30 $487.74 Not Applicable: Bundled with Procedure $258.65 $591.20 $258.65 "$1,219.74 " BONE SCREW T8 2.7MM L7MM 656407 C1713 SUPPLY/IMPLANTS $739.00 Outpatient $369.50 "$1,219.74 " $480.35 $517.30 $487.74 Not Applicable: Bundled with Procedure $258.65 $591.20 $258.65 "$1,219.74 " BONE SCREW 1.5MM DIA 5MML SELF-DRILLING LTX FREE 56-15905 C1713 SUPPLY/IMPLANTS $490.00 Outpatient $245.00 "$1,219.74 " $318.50 $343.00 $323.40 Not Applicable: Bundled with Procedure $171.50 $392.00 $171.50 "$1,219.74 " BONE SCREW T6 2.0MM L18MM 657718 C1713 SUPPLY/IMPLANTS $717.00 Outpatient $358.50 "$1,219.74 " $466.05 $501.90 $473.22 Not Applicable: Bundled with Procedure $250.95 $573.60 $250.95 "$1,219.74 " BONE SCREW T6 2.0MM L13MM 657713 C1713 SUPPLY/IMPLANTS $717.00 Outpatient $358.50 "$1,219.74 " $466.05 $501.90 $473.22 Not Applicable: Bundled with Procedure $250.95 $573.60 $250.95 "$1,219.74 " BONE SCREW T6 2.0MM L12MM 657712 C1713 SUPPLY/IMPLANTS $717.00 Outpatient $358.50 "$1,219.74 " $466.05 $501.90 $473.22 Not Applicable: Bundled with Procedure $250.95 $573.60 $250.95 "$1,219.74 " BONE SCREW 00-6520-65-20 00-6520-65-20 C1713 SUPPLY/IMPLANTS "$14,773.00 " Outpatient "$7,386.50 " "$1,219.74 " "$9,602.45 " "$10,341.10 " "$9,750.18 " Not Applicable: Bundled with Procedure "$5,170.55 " "$11,818.40 " "$1,219.74 " "$11,818.40 " BONNE TAP 5.5 62910-10 C1713 SUPPLY/IMPLANTS "$1,156.00 " Outpatient $578.00 "$1,219.74 " $751.40 $809.20 $762.96 Not Applicable: Bundled with Procedure $404.60 $924.80 $404.60 "$1,219.74 " BOX INST LFT OUT LCK LG FRAG SYS 8299-52-002 C1713 SUPPLY/IMPLANTS "$2,557.00 " Outpatient "$1,278.50 " "$1,219.74 " "$1,662.05 " "$1,789.90 " "$1,687.62 " Not Applicable: Bundled with Procedure $894.95 "$2,045.60 " $894.95 "$2,045.60 " BRCH SRG 13.7CM 1MM HRBRT/WPL CORT SS CNN NS 115200200 C1713 SUPPLY/IMPLANTS "$1,203.00 " Outpatient $601.50 "$1,219.74 " $781.95 $842.10 $793.98 Not Applicable: Bundled with Procedure $421.05 $962.40 $421.05 "$1,219.74 " BRIDGE MED ADJUSTABLE 5.5MM A11-2053 C1713 SUPPLY/IMPLANTS "$14,610.00 " Outpatient "$7,305.00 " "$1,219.74 " "$9,496.50 " "$10,227.00 " "$9,642.60 " Not Applicable: Bundled with Procedure "$5,113.50 " "$11,688.00 " "$1,219.74 " "$11,688.00 " BRIDGE ADJUSTABLE 5.5MM A11-2042 C1713 SUPPLY/IMPLANTS "$14,610.00 " Outpatient "$7,305.00 " "$1,219.74 " "$9,496.50 " "$10,227.00 " "$9,642.60 " Not Applicable: Bundled with Procedure "$5,113.50 " "$11,688.00 " "$1,219.74 " "$11,688.00 " BROAD LOCK PLATE 2.7 L56MM 6HOLES 629746 C1713 SUPPLY/IMPLANTS "$5,412.00 " Outpatient "$2,706.00 " "$1,219.74 " "$3,517.80 " "$3,788.40 " "$3,571.92 " Not Applicable: Bundled with Procedure "$1,894.20 " "$4,329.60 " "$1,219.74 " "$4,329.60 " BRR SKN 5.9X3.9IN SKRT SURGIMESH XB SIL MODL OK-1015 OPN UMB TINTRAOK1015 C1713 SUPPLY/IMPLANTS "$8,072.00 " Outpatient "$4,036.00 " "$1,219.74 " "$5,246.80 " "$5,650.40 " "$5,327.52 " Not Applicable: Bundled with Procedure "$2,825.20 " "$6,457.60 " "$1,219.74 " "$6,457.60 " BRR SKN 26X22CM SURGIMESH XB SIL TINTRAE2226 C1713 SUPPLY/IMPLANTS "$10,712.00 " Outpatient "$5,356.00 " "$1,219.74 " "$6,962.80 " "$7,498.40 " "$7,069.92 " Not Applicable: Bundled with Procedure "$3,749.20 " "$8,569.60 " "$1,219.74 " "$8,569.60 " BSHNG DRL RECON PERITROCHANTERIC NL SYS 27926 C1713 SUPPLY/IMPLANTS "$2,314.00 " Outpatient "$1,157.00 " "$1,219.74 " "$1,504.10 " "$1,619.80 " "$1,527.24 " Not Applicable: Bundled with Procedure $809.90 "$1,851.20 " $809.90 "$1,851.20 " BSHNG PROX 3.7MM MDN ULTEM IM NL NS 224100237 C1713 SUPPLY/IMPLANTS $752.00 Outpatient $376.00 "$1,219.74 " $488.80 $526.40 $496.32 Not Applicable: Bundled with Procedure $263.20 $601.60 $263.20 "$1,219.74 " BSHNG PROX 5MM MDN ULTEM IM NL NS 224100250 C1713 SUPPLY/IMPLANTS $752.00 Outpatient $376.00 "$1,219.74 " $488.80 $526.40 $496.32 Not Applicable: Bundled with Procedure $263.20 $601.60 $263.20 "$1,219.74 " BSHNG PROX 8MM MDN LNG ULTEM IM NL NS 224100280 C1713 SUPPLY/IMPLANTS $752.00 Outpatient $376.00 "$1,219.74 " $488.80 $526.40 $496.32 Not Applicable: Bundled with Procedure $263.20 $601.60 $263.20 "$1,219.74 " BSHNG DRL 5MM MDN FEM SS PIN MTL TRGT IM NL NS 225500450 C1713 SUPPLY/IMPLANTS "$1,486.00 " Outpatient $743.00 "$1,219.74 " $965.90 "$1,040.20 " $980.76 Not Applicable: Bundled with Procedure $520.10 "$1,188.80 " $520.10 "$1,219.74 " BSHNG DRL 8MM MDN FEM SS SCR MTL TRGT IM NL NS 225500480 C1713 SUPPLY/IMPLANTS "$1,879.00 " Outpatient $939.50 "$1,219.74 " "$1,221.35 " "$1,315.30 " "$1,240.14 " Not Applicable: Bundled with Procedure $657.65 "$1,503.20 " $657.65 "$1,503.20 " BSHNG FEM 8MM MDN SS SCR INTLK IM NL SYS NS 225500580 C1713 SUPPLY/IMPLANTS "$1,672.00 " Outpatient $836.00 "$1,219.74 " "$1,086.80 " "$1,170.40 " "$1,103.52 " Not Applicable: Bundled with Procedure $585.20 "$1,337.60 " $585.20 "$1,337.60 " BSHNG DRL 3.7MM MDN TIB HUM SS IM NL NS 225500637 C1713 SUPPLY/IMPLANTS "$1,203.00 " Outpatient $601.50 "$1,219.74 " $781.95 $842.10 $793.98 Not Applicable: Bundled with Procedure $421.05 $962.40 $421.05 "$1,219.74 " BSHNG DRL 8MM MDN TIB HUM SS SCR IM NL NS 225500680 C1713 SUPPLY/IMPLANTS "$2,179.00 " Outpatient "$1,089.50 " "$1,219.74 " "$1,416.35 " "$1,525.30 " "$1,438.14 " Not Applicable: Bundled with Procedure $762.65 "$1,743.20 " $762.65 "$1,743.20 " BSHNG DRL MDN ULTEM IM NS 225501504 C1713 SUPPLY/IMPLANTS $789.00 Outpatient $394.50 "$1,219.74 " $512.85 $552.30 $520.74 Not Applicable: Bundled with Procedure $276.15 $631.20 $276.15 "$1,219.74 " BSHNG DRL MDN PERC AL CENTERING IM NL NS 225505400 C1713 SUPPLY/IMPLANTS "$1,222.00 " Outpatient $611.00 "$1,219.74 " $794.30 $855.40 $806.52 Not Applicable: Bundled with Procedure $427.70 $977.60 $427.70 "$1,219.74 " BSHNG DRL ITST AL CENTERING IM NL NS 225809100 C1713 SUPPLY/IMPLANTS "$1,353.00 " Outpatient $676.50 "$1,219.74 " $879.45 $947.10 $892.98 Not Applicable: Bundled with Procedure $473.55 "$1,082.40 " $473.55 "$1,219.74 " BTB TIGHTROPE W/ DEPLOYING SUTURE 14-1588BTB-J C1713 SUPPLY/IMPLANTS "$2,539.00 " Outpatient "$1,269.50 " "$1,219.74 " "$1,650.35 " "$1,777.30 " "$1,675.74 " Not Applicable: Bundled with Procedure $888.65 "$2,031.20 " $888.65 "$2,031.20 " BTN CBL 3.5MM CBL RD HEX SS NS LTX 223200135 C1713 SUPPLY/IMPLANTS $452.00 Outpatient $226.00 "$1,219.74 " $293.80 $316.40 $298.32 Not Applicable: Bundled with Procedure $158.20 $361.60 $158.20 "$1,219.74 " BTN CBL 5MM CBL RD HEX SS NS 223200150 C1713 SUPPLY/IMPLANTS $452.00 Outpatient $226.00 "$1,219.74 " $293.80 $316.40 $298.32 Not Applicable: Bundled with Procedure $158.20 $361.60 $158.20 "$1,219.74 " BTN CBL 3.5MM HEX TI LG FRAG SYS LF 223200235 C1713 SUPPLY/IMPLANTS $452.00 Outpatient $226.00 "$1,219.74 " $293.80 $316.40 $298.32 Not Applicable: Bundled with Procedure $158.20 $361.60 $158.20 "$1,219.74 " BTN CBL 5MM CBL RD HEX TIV NS 223200250 C1713 SUPPLY/IMPLANTS $452.00 Outpatient $226.00 "$1,219.74 " $293.80 $316.40 $298.32 Not Applicable: Bundled with Procedure $158.20 $361.60 $158.20 "$1,219.74 " BTN FX 20MM 11MM RETROBUTTON XL FEM ACL CORT TI ASYM LOOP AR-1592 C1713 SUPPLY/IMPLANTS "$1,835.00 " Outpatient $917.50 "$1,219.74 " "$1,192.75 " "$1,284.50 " "$1,211.10 " Not Applicable: Bundled with Procedure $642.25 "$1,468.00 " $642.25 "$1,468.00 " BTN FX TGHTRP MN INSRTR AR-8913DS C1713 SUPPLY/IMPLANTS "$4,021.00 " Outpatient "$2,010.50 " "$1,219.74 " "$2,613.65 " "$2,814.70 " "$2,653.86 " Not Applicable: Bundled with Procedure "$1,407.35 " "$3,216.80 " "$1,219.74 " "$3,216.80 " BTN FX DOG BN AR-2270 C1713 SUPPLY/IMPLANTS "$2,849.00 " Outpatient "$1,424.50 " "$1,219.74 " "$1,851.85 " "$1,994.30 " "$1,880.34 " Not Applicable: Bundled with Procedure $997.15 "$2,279.20 " $997.15 "$2,279.20 " BTN FX 15MM GRAFTMAX CORT ADJ LOOP KN PRSV SYS BN TNDN BN FX KS-BTB C1713 SUPPLY/IMPLANTS "$1,653.00 " Outpatient $826.50 "$1,219.74 " "$1,074.45 " "$1,157.10 " "$1,090.98 " Not Applicable: Bundled with Procedure $578.55 "$1,322.40 " $578.55 "$1,322.40 " BUR 11 X 35 DEGREE 4927-2-240 C1713 SUPPLY/IMPLANTS "$2,134.00 " Outpatient "$1,067.00 " "$1,219.74 " "$1,387.10 " "$1,493.80 " "$1,408.44 " Not Applicable: Bundled with Procedure $746.90 "$1,707.20 " $746.90 "$1,707.20 " BUR ROUND MULTI FLUTE 3MM 5540-010-030 C1713 SUPPLY/IMPLANTS $918.00 Outpatient $459.00 "$1,219.74 " $596.70 $642.60 $605.88 Not Applicable: Bundled with Procedure $321.30 $734.40 $321.30 "$1,219.74 " BUR ROUND MULTI FLUTE 4MM 5540-010-040 C1713 SUPPLY/IMPLANTS $918.00 Outpatient $459.00 "$1,219.74 " $596.70 $642.60 $605.88 Not Applicable: Bundled with Procedure $321.30 $734.40 $321.30 "$1,219.74 " BURR 2 FLUT RND 2MM SRG LF 5540009020 C1713 SUPPLY/IMPLANTS "$1,426.00 " Outpatient $713.00 "$1,219.74 " $926.90 $998.20 $941.16 Not Applicable: Bundled with Procedure $499.10 "$1,140.80 " $499.10 "$1,219.74 " BURR DMD LNG FN RND 4MM 72MM SRG VISAO 31134068 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " BURR DMD RND 2MM SRG 5540012020 C1713 SUPPLY/IMPLANTS $918.00 Outpatient $459.00 "$1,219.74 " $596.70 $642.60 $605.88 Not Applicable: Bundled with Procedure $321.30 $734.40 $321.30 "$1,219.74 " BURR DMD RND 3MM SRG 5540012030 C1713 SUPPLY/IMPLANTS $918.00 Outpatient $459.00 "$1,219.74 " $596.70 $642.60 $605.88 Not Applicable: Bundled with Procedure $321.30 $734.40 $321.30 "$1,219.74 " BURR DMD RND 4MM SRG 5540012040 C1713 SUPPLY/IMPLANTS $918.00 Outpatient $459.00 "$1,219.74 " $596.70 $642.60 $605.88 Not Applicable: Bundled with Procedure $321.30 $734.40 $321.30 "$1,219.74 " BURR DMD RND 5MM SRG 5540012050 C1713 SUPPLY/IMPLANTS $918.00 Outpatient $459.00 "$1,219.74 " $596.70 $642.60 $605.88 Not Applicable: Bundled with Procedure $321.30 $734.40 $321.30 "$1,219.74 " BURR DMD RND 6MM SRG 5540012060 C1713 SUPPLY/IMPLANTS $918.00 Outpatient $459.00 "$1,219.74 " $596.70 $642.60 $605.88 Not Applicable: Bundled with Procedure $321.30 $734.40 $321.30 "$1,219.74 " BURR FLUT 6MM SRG ANSPACH LHD-6B-M C1713 SUPPLY/IMPLANTS $462.00 Outpatient $231.00 "$1,219.74 " $300.30 $323.40 $304.92 Not Applicable: Bundled with Procedure $161.70 $369.60 $161.70 "$1,219.74 " BURR HOLE 1.5 X 13MM 01-7306 C1713 SUPPLY/IMPLANTS "$1,279.00 " Outpatient $639.50 "$1,219.74 " $831.35 $895.30 $844.14 Not Applicable: Bundled with Procedure $447.65 "$1,023.20 " $447.65 "$1,219.74 " BURR MULTIFLUTE RND 5MM SRG LF 5540010050 C1713 SUPPLY/IMPLANTS $918.00 Outpatient $459.00 "$1,219.74 " $596.70 $642.60 $605.88 Not Applicable: Bundled with Procedure $321.30 $734.40 $321.30 "$1,219.74 " BURR MULTIFLUTE RND 6MM SRG LF 5540010060 C1713 SUPPLY/IMPLANTS $918.00 Outpatient $459.00 "$1,219.74 " $596.70 $642.60 $605.88 Not Applicable: Bundled with Procedure $321.30 $734.40 $321.30 "$1,219.74 " BURR RND FLUT 6MM SRG SFTCH RND FLUT AGRS SMTH END CUT ELT 5820010160 C1713 SUPPLY/IMPLANTS $797.00 Outpatient $398.50 "$1,219.74 " $518.05 $557.90 $526.02 Not Applicable: Bundled with Procedure $278.95 $637.60 $278.95 "$1,219.74 " BURR RND 4MM SRG RND SFTCH ELT STRL LF TPS ELT 582010140 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " BURR RND FLUT 3MM SRG SFTCH 5 NTCH TPS ELT OSTN STRL LF 5820010130 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " BURR SS LNG RND 4MM 72MM SRG AGRS CUT TL VISAO ULPWR STRL 31314068U C1713 SUPPLY/IMPLANTS $478.00 Outpatient $239.00 "$1,219.74 " $310.70 $334.60 $315.48 Not Applicable: Bundled with Procedure $167.30 $382.40 $167.30 "$1,219.74 " BURR SS MED RND 6MM 64MM SRG CUT TL VISAO STRL DISP 31316058U C1713 SUPPLY/IMPLANTS $478.00 Outpatient $239.00 "$1,219.74 " $310.70 $334.60 $315.48 Not Applicable: Bundled with Procedure $167.30 $382.40 $167.30 "$1,219.74 " BURR SS LNG RND STRG FLUT 1MM 72MM SRG TL GRD STRL VISAO 31311071 C1713 SUPPLY/IMPLANTS $430.00 Outpatient $215.00 "$1,219.74 " $279.50 $301.00 $283.80 Not Applicable: Bundled with Procedure $150.50 $344.00 $150.50 "$1,219.74 " BURR SS 80000 RPM LNG RND 2MM 72MM SRG TL AGRS CUT GRD STRL 31312070 C1713 SUPPLY/IMPLANTS $439.00 Outpatient $219.50 "$1,219.74 " $285.35 $307.30 $289.74 Not Applicable: Bundled with Procedure $153.65 $351.20 $153.65 "$1,219.74 " BURR SS LNG FLUT RND 3MM 72MM SRG AGRS CUT TL VISAO ULPWR 31313069U C1713 SUPPLY/IMPLANTS "$2,093.00 " Outpatient "$1,046.50 " "$1,219.74 " "$1,360.45 " "$1,465.10 " "$1,381.38 " Not Applicable: Bundled with Procedure $732.55 "$1,674.40 " $732.55 "$1,674.40 " BURR SS DMD 80000 RPM LNG FN RND 1MM 72MM SRG CUT VISAO DRL 31131071 C1713 SUPPLY/IMPLANTS $742.00 Outpatient $371.00 "$1,219.74 " $482.30 $519.40 $489.72 Not Applicable: Bundled with Procedure $259.70 $593.60 $259.70 "$1,219.74 " BURR SS DMD 80000 RPM LNG FN RND 2MM 72MM SRG GRD STRL VISAO 31132070 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " BURR SS DMD 80000 RPM LNG FN RND 3MM 72MM SRG CUT GRD STRL 31133069 C1713 SUPPLY/IMPLANTS $774.00 Outpatient $387.00 "$1,219.74 " $503.10 $541.80 $510.84 Not Applicable: Bundled with Procedure $270.90 $619.20 $270.90 "$1,219.74 " BUTTON FIXATION GRAFTMAX L15 MM CORTICAL ADJUSTABLE LOOP KNE KS-ALB C1713 SUPPLY/IMPLANTS "$1,322.00 " Outpatient $661.00 "$1,219.74 " $859.30 $925.40 $872.52 Not Applicable: Bundled with Procedure $462.70 "$1,057.60 " $462.70 "$1,219.74 " CABLE SLEEVE 2.0MM DALL MILES 6704-4-020 C1713 SUPPLY/IMPLANTS "$3,483.00 " Outpatient "$1,741.50 " "$1,219.74 " "$2,263.95 " "$2,438.10 " "$2,298.78 " Not Applicable: Bundled with Procedure "$1,219.05 " "$2,786.40 " "$1,219.05 " "$2,786.40 " CABLE ORTHOPEDIC SUPERCABLE POLYMER TITANIUM CLASP ISO-ELAST 35-100-1010 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " CADDY STRL LCK SCR 2.7MM 829953031 C1713 SUPPLY/IMPLANTS "$1,625.00 " Outpatient $812.50 "$1,219.74 " "$1,056.25 " "$1,137.50 " "$1,072.50 " Not Applicable: Bundled with Procedure $568.75 "$1,300.00 " $568.75 "$1,300.00 " CADDY SCR TOP TRY DRTSC C1713 SUPPLY/IMPLANTS "$2,484.00 " Outpatient "$1,242.00 " "$1,219.74 " "$1,614.60 " "$1,738.80 " "$1,639.44 " Not Applicable: Bundled with Procedure $869.40 "$1,987.20 " $869.40 "$1,987.20 " CADDY SCR LCK 5.5MM 8299-13-505 C1713 SUPPLY/IMPLANTS "$3,522.00 " Outpatient "$1,761.00 " "$1,219.74 " "$2,289.30 " "$2,465.40 " "$2,324.52 " Not Applicable: Bundled with Procedure "$1,232.70 " "$2,817.60 " "$1,219.74 " "$2,817.60 " CADDY SCR NLCKG 5.5MM 8299-13-506 C1713 SUPPLY/IMPLANTS "$3,786.00 " Outpatient "$1,893.00 " "$1,219.74 " "$2,460.90 " "$2,650.20 " "$2,498.76 " Not Applicable: Bundled with Procedure "$1,325.10 " "$3,028.80 " "$1,219.74 " "$3,028.80 " CADDY SCR LCK 4.5MM 8299-13-503 C1713 SUPPLY/IMPLANTS "$4,051.00 " Outpatient "$2,025.50 " "$1,219.74 " "$2,633.15 " "$2,835.70 " "$2,673.66 " Not Applicable: Bundled with Procedure "$1,417.85 " "$3,240.80 " "$1,219.74 " "$3,240.80 " CADDY SCR NLCKG 4.5MM 8299-13-504 C1713 SUPPLY/IMPLANTS "$4,232.00 " Outpatient "$2,116.00 " "$1,219.74 " "$2,750.80 " "$2,962.40 " "$2,793.12 " Not Applicable: Bundled with Procedure "$1,481.20 " "$3,385.60 " "$1,219.74 " "$3,385.60 " CADDY SCR LCK LG FRAG SET 6.5MM 8299-52-020 C1713 SUPPLY/IMPLANTS "$6,991.00 " Outpatient "$3,495.50 " "$1,219.74 " "$4,544.15 " "$4,893.70 " "$4,614.06 " Not Applicable: Bundled with Procedure "$2,446.85 " "$5,592.80 " "$1,219.74 " "$5,592.80 " CADDY SCR LCK SM FRAG PLT SYS 2.7-4MM 829951030 C1713 SUPPLY/IMPLANTS "$8,681.00 " Outpatient "$4,340.50 " "$1,219.74 " "$5,642.65 " "$6,076.70 " "$5,729.46 " Not Applicable: Bundled with Procedure "$3,038.35 " "$6,944.80 " "$1,219.74 " "$6,944.80 " CADDY SCR LCK LG FRAG SET 4.5/5.5MM 8299-52-010 C1713 SUPPLY/IMPLANTS "$8,814.00 " Outpatient "$4,407.00 " "$1,219.74 " "$5,729.10 " "$6,169.80 " "$5,817.24 " Not Applicable: Bundled with Procedure "$3,084.90 " "$7,051.20 " "$1,219.74 " "$7,051.20 " CADDY STRL ALPS PROX TIB SCR 829958104 C1713 SUPPLY/IMPLANTS "$9,661.00 " Outpatient "$4,830.50 " "$1,219.74 " "$6,279.65 " "$6,762.70 " "$6,376.26 " Not Applicable: Bundled with Procedure "$3,381.35 " "$7,728.80 " "$1,219.74 " "$7,728.80 " CADDY SCR 2.5MM 231218106 C1713 SUPPLY/IMPLANTS "$12,088.00 " Outpatient "$6,044.00 " "$1,219.74 " "$7,857.20 " "$8,461.60 " "$7,978.08 " Not Applicable: Bundled with Procedure "$4,230.80 " "$9,670.40 " "$1,219.74 " "$9,670.40 " CADDY SCR LCK SM FRAG PLT SYS 3.5-4MM 829951020 C1713 SUPPLY/IMPLANTS "$15,427.00 " Outpatient "$7,713.50 " "$1,219.74 " "$10,027.55 " "$10,798.90 " "$10,181.82 " Not Applicable: Bundled with Procedure "$5,399.45 " "$12,341.60 " "$1,219.74 " "$12,341.60 " CADDY SCR LCK 2.7MM 8299-53-030 C1713 SUPPLY/IMPLANTS "$15,584.00 " Outpatient "$7,792.00 " "$1,219.74 " "$10,129.60 " "$10,908.80 " "$10,285.44 " Not Applicable: Bundled with Procedure "$5,454.40 " "$12,467.20 " "$1,219.74 " "$12,467.20 " CADDY SCR 3.5 MM SCR PERIART 234803050 C1713 SUPPLY/IMPLANTS "$4,402.00 " Outpatient "$2,201.00 " "$1,219.74 " "$2,861.30 " "$3,081.40 " "$2,905.32 " Not Applicable: Bundled with Procedure "$1,540.70 " "$3,521.60 " "$1,219.74 " "$3,521.60 " CADDY SCR PERIART 234803400 C1713 SUPPLY/IMPLANTS "$13,124.00 " Outpatient "$6,562.00 " "$1,219.74 " "$8,530.60 " "$9,186.80 " "$8,661.84 " Not Applicable: Bundled with Procedure "$4,593.40 " "$10,499.20 " "$1,219.74 " "$10,499.20 " CADDY SCR LCK CA PRLC ELB PERIART 235800650 C1713 SUPPLY/IMPLANTS "$2,142.00 " Outpatient "$1,071.00 " "$1,219.74 " "$1,392.30 " "$1,499.40 " "$1,413.72 " Not Applicable: Bundled with Procedure $749.70 "$1,713.60 " $749.70 "$1,713.60 " CADDY SCR PRLC 5.5MM 235803955 C1713 SUPPLY/IMPLANTS "$6,626.00 " Outpatient "$3,313.00 " "$1,219.74 " "$4,306.90 " "$4,638.20 " "$4,373.16 " Not Applicable: Bundled with Procedure "$2,319.10 " "$5,300.80 " "$1,219.74 " "$5,300.80 " CADDY SCR PRLC 3.5MM 235804455 C1713 SUPPLY/IMPLANTS "$3,741.00 " Outpatient "$1,870.50 " "$1,219.74 " "$2,431.65 " "$2,618.70 " "$2,469.06 " Not Applicable: Bundled with Procedure "$1,309.35 " "$2,992.80 " "$1,219.74 " "$2,992.80 " CAGE COLIX 12 X 10 X 26MM X-034-0393 C1713 SUPPLY/IMPLANTS "$12,317.00 " Outpatient "$6,158.50 " "$1,219.74 " "$8,006.05 " "$8,621.90 " "$8,129.22 " Not Applicable: Bundled with Procedure "$4,310.95 " "$9,853.60 " "$1,219.74 " "$9,853.60 " CAGE COLIX 10 X 26 X 9MM X-034-0310 C1713 SUPPLY/IMPLANTS "$12,309.00 " Outpatient "$6,154.50 " "$1,219.74 " "$8,000.85 " "$8,616.30 " "$8,123.94 " Not Applicable: Bundled with Procedure "$4,308.15 " "$9,847.20 " "$1,219.74 " "$9,847.20 " CAGE FLEXFIT AT0913 C1713 SUPPLY/IMPLANTS "$26,883.00 " Outpatient "$13,441.50 " "$1,219.74 " "$17,473.95 " "$18,818.10 " "$17,742.78 " Not Applicable: Bundled with Procedure "$9,409.05 " "$21,506.40 " "$1,219.74 " "$21,506.40 " CAGE FLEXFIT AT0912 C1713 SUPPLY/IMPLANTS "$26,883.00 " Outpatient "$13,441.50 " "$1,219.74 " "$17,473.95 " "$18,818.10 " "$17,742.78 " Not Applicable: Bundled with Procedure "$9,409.05 " "$21,506.40 " "$1,219.74 " "$21,506.40 " CAGE FLXFIT AT0910 C1713 SUPPLY/IMPLANTS "$26,883.00 " Outpatient "$13,441.50 " "$1,219.74 " "$17,473.95 " "$18,818.10 " "$17,742.78 " Not Applicable: Bundled with Procedure "$9,409.05 " "$21,506.40 " "$1,219.74 " "$21,506.40 " CAGE FLXFIT AT0908 C1713 SUPPLY/IMPLANTS "$26,883.00 " Outpatient "$13,441.50 " "$1,219.74 " "$17,473.95 " "$18,818.10 " "$17,742.78 " Not Applicable: Bundled with Procedure "$9,409.05 " "$21,506.40 " "$1,219.74 " "$21,506.40 " CAGE FLXFIT AT0909 AT0909 C1713 SUPPLY/IMPLANTS "$26,883.00 " Outpatient "$13,441.50 " "$1,219.74 " "$17,473.95 " "$18,818.10 " "$17,742.78 " Not Applicable: Bundled with Procedure "$9,409.05 " "$21,506.40 " "$1,219.74 " "$21,506.40 " CAGE LATERAL 12 X 50 X 18 X 0 DRS7112 C1713 SUPPLY/IMPLANTS "$35,462.00 " Outpatient "$17,731.00 " "$1,219.74 " "$23,050.30 " "$24,823.40 " "$23,404.92 " Not Applicable: Bundled with Procedure "$12,411.70 " "$28,369.60 " "$1,219.74 " "$28,369.60 " CAGE LATERAL 14 X 50 X 18 X 0 DRS7114 C1713 SUPPLY/IMPLANTS "$20,055.00 " Outpatient "$10,027.50 " "$1,219.74 " "$13,035.75 " "$14,038.50 " "$13,236.30 " Not Applicable: Bundled with Procedure "$7,019.25 " "$16,044.00 " "$1,219.74 " "$16,044.00 " CAGE SPINAL CASCADIA TITANIUM POROUS 10 D L28 MM X W36 MM X 6101-2283613AL10-G2 C1713 SUPPLY/IMPLANTS "$23,513.00 " Outpatient "$11,756.50 " "$1,219.74 " "$15,283.45 " "$16,459.10 " "$15,518.58 " Not Applicable: Bundled with Procedure "$8,229.55 " "$18,810.40 " "$1,219.74 " "$18,810.40 " CANCELLOUS SCREW 6.5X105MM 1030-105 C1713 SUPPLY/IMPLANTS "$1,973.00 " Outpatient $986.50 "$1,219.74 " "$1,282.45 " "$1,381.10 " "$1,302.18 " Not Applicable: Bundled with Procedure $690.55 "$1,578.40 " $690.55 "$1,578.40 " CANCELLOUS CORTICAL SPACER 11.5 X 14.5 X 10MM 7 DEGREE 2504-21410L7 C1713 SUPPLY/IMPLANTS "$4,694.00 " Outpatient "$2,347.00 " "$1,219.74 " "$3,051.10 " "$3,285.80 " "$3,098.04 " Not Applicable: Bundled with Procedure "$1,642.90 " "$3,755.20 " "$1,219.74 " "$3,755.20 " CANCELLOUS BONE SCREW 6.5MM X 20MM C1713 SUPPLY/IMPLANTS $488.00 Outpatient $244.00 "$1,219.74 " $317.20 $341.60 $322.08 Not Applicable: Bundled with Procedure $170.80 $390.40 $170.80 "$1,219.74 " CANNULATED SCREW 3.0 X 24MM 40-30224S C1713 SUPPLY/IMPLANTS $779.00 Outpatient $389.50 "$1,219.74 " $506.35 $545.30 $514.14 Not Applicable: Bundled with Procedure $272.65 $623.20 $272.65 "$1,219.74 " CAP AEQ RVS FX--ALL INCLUSIVE CAP10102 C1713 SUPPLY/IMPLANTS "$51,358.00 " Outpatient "$25,679.00 " "$1,219.74 " "$33,382.70 " "$35,950.60 " "$33,896.28 " Not Applicable: Bundled with Procedure "$17,975.30 " "$41,086.40 " "$1,219.74 " "$41,086.40 " CAP END STD 8MM T2 IM NL FEM/TIB STRL 1822-0003S C1713 SUPPLY/IMPLANTS "$1,522.00 " Outpatient $761.00 "$1,219.74 " $989.30 "$1,065.40 " "$1,004.52 " Not Applicable: Bundled with Procedure $532.70 "$1,217.60 " $532.70 "$1,219.74 " CAP END STD 11.5MM TI 5MM T2 IM NL FEM STRL 1822-0005S C1713 SUPPLY/IMPLANTS "$1,596.00 " Outpatient $798.00 "$1,219.74 " "$1,037.40 " "$1,117.20 " "$1,053.36 " Not Applicable: Bundled with Procedure $558.60 "$1,276.80 " $558.60 "$1,276.80 " CAP END 5MM T40 12MM TI XPRT IM NL SYS FEM CNN XTN SLF RTN 04.003.001S C1713 SUPPLY/IMPLANTS "$1,219.00 " Outpatient $609.50 "$1,219.74 " $792.35 $853.30 $804.54 Not Applicable: Bundled with Procedure $426.65 $975.20 $426.65 "$1,219.74 " CAP END 0MM T25 TI XPRT NL SYS HUM STRDR AU 04.001.000 C1713 SUPPLY/IMPLANTS "$1,050.00 " Outpatient $525.00 "$1,219.74 " $682.50 $735.00 $693.00 Not Applicable: Bundled with Procedure $367.50 $840.00 $367.50 "$1,219.74 " CAP END 15MM T40 TI XPRT IM NL SYS TIB CNN XTN LCK HL STRDR 04.004.011S C1713 SUPPLY/IMPLANTS "$1,791.00 " Outpatient $895.50 "$1,219.74 " "$1,164.15 " "$1,253.70 " "$1,182.06 " Not Applicable: Bundled with Procedure $626.85 "$1,432.80 " $626.85 "$1,432.80 " CAP END 0MM T40 TI XPRT IM NL SYS FEM CNN XTD LCK STRDR STRL 04.013.000S C1713 SUPPLY/IMPLANTS "$1,470.00 " Outpatient $735.00 "$1,219.74 " $955.50 "$1,029.00 " $970.20 Not Applicable: Bundled with Procedure $514.50 "$1,176.00 " $514.50 "$1,219.74 " CAP END 5MM T40 TI XPRT IM NL SYS TIB CNN STRDR STRL AU 04.004.001S C1713 SUPPLY/IMPLANTS "$1,791.00 " Outpatient $895.50 "$1,219.74 " "$1,164.15 " "$1,253.70 " "$1,182.06 " Not Applicable: Bundled with Procedure $626.85 "$1,432.80 " $626.85 "$1,432.80 " CAP END IM NL HUM FLSH STRL 8003-01-001 C1713 SUPPLY/IMPLANTS $827.00 Outpatient $413.50 "$1,219.74 " $537.55 $578.90 $545.82 Not Applicable: Bundled with Procedure $289.45 $661.60 $289.45 "$1,219.74 " CAP END .5CM IM NL HUM STRL 8003-01-002 C1713 SUPPLY/IMPLANTS $827.00 Outpatient $413.50 "$1,219.74 " $537.55 $578.90 $545.82 Not Applicable: Bundled with Procedure $289.45 $661.60 $289.45 "$1,219.74 " CAP END 1CM IM NL HUM STRL 8003-01-003 C1713 SUPPLY/IMPLANTS $827.00 Outpatient $413.50 "$1,219.74 " $537.55 $578.90 $545.82 Not Applicable: Bundled with Procedure $289.45 $661.60 $289.45 "$1,219.74 " CAP END HUM FLSH MIDHOLE STRL 8003-01-004 C1713 SUPPLY/IMPLANTS $827.00 Outpatient $413.50 "$1,219.74 " $537.55 $578.90 $545.82 Not Applicable: Bundled with Procedure $289.45 $661.60 $289.45 "$1,219.74 " CAP END 0MM 14-441280 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END OFST 0MM 12MM LOPRFL 14-444180 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END 10MM OFST 14-440072 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END 15MM OFST 14-440073 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END 20MM OFST 14-440074 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END OFST 5MM 14-441281 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END OFST 10MM 14-441282 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END OFST 15MM 14-441283 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END OFST 20MM 14-441284 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END OFST 5MM 12MM LOPRFL 14-444181 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END OFST 10MM 12MM LOPRFL 14-444182 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END OFST 15MM 12MM LOPRFL 14-444183 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END OFST 20MM 12MM LOPRFL 14-444184 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END PHNX 5MM 13.5MM OFST 14-444191 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END PHNX 10MM 13.5MM OFST 14-444192 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END PHNX 13.5MM 15MM OFST 14-444193 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END PHNX 13.5MM 20MM OFST 14-444194 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END PHNX 5MM 15MM OFST 14-444195 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END PHNX 10MM 15MM OFST 14-444196 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END PHNX 15MM 15MM OFST 14-444197 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END PHNX 15MM 20MM OFST 14-444198 C1713 SUPPLY/IMPLANTS $946.00 Outpatient $473.00 "$1,219.74 " $614.90 $662.20 $624.36 Not Applicable: Bundled with Procedure $331.10 $756.80 $331.10 "$1,219.74 " CAP END VERSANAIL TIBIOTALOCALCANEAL ANKL FSN NL SYS IMPINGE 8007-00-000 C1713 SUPPLY/IMPLANTS $982.00 Outpatient $491.00 "$1,219.74 " $638.30 $687.40 $648.12 Not Applicable: Bundled with Procedure $343.70 $785.60 $343.70 "$1,219.74 " CAP END VERSANAIL IM NL STRL 8007-00-001 C1713 SUPPLY/IMPLANTS $982.00 Outpatient $491.00 "$1,219.74 " $638.30 $687.40 $648.12 Not Applicable: Bundled with Procedure $343.70 $785.60 $343.70 "$1,219.74 " CAP END VERSANAIL IM NL 2 HL IMPINGING STRL 8007-00-200 C1713 SUPPLY/IMPLANTS $982.00 Outpatient $491.00 "$1,219.74 " $638.30 $687.40 $648.12 Not Applicable: Bundled with Procedure $343.70 $785.60 $343.70 "$1,219.74 " CAP END VERSANAIL UNV 1ST SCR FLSH IMPINGE STRL 181701001 C1713 SUPPLY/IMPLANTS $991.00 Outpatient $495.50 "$1,219.74 " $644.15 $693.70 $654.06 Not Applicable: Bundled with Procedure $346.85 $792.80 $346.85 "$1,219.74 " CAP END VERSANAIL UNV 5MM TI FEM TIB CNN STRL 181300005 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " CAP END OD MM IM NL ORTH 29206 C1713 SUPPLY/IMPLANTS "$1,084.00 " Outpatient $542.00 "$1,219.74 " $704.60 $758.80 $715.44 Not Applicable: Bundled with Procedure $379.40 $867.20 $379.40 "$1,219.74 " CAP END 5MM TI IM NL ORTH 29207 C1713 SUPPLY/IMPLANTS "$1,084.00 " Outpatient $542.00 "$1,219.74 " $704.60 $758.80 $715.44 Not Applicable: Bundled with Procedure $379.40 $867.20 $379.40 "$1,219.74 " CAP END 10MM 29208 C1713 SUPPLY/IMPLANTS "$1,084.00 " Outpatient $542.00 "$1,219.74 " $704.60 $758.80 $715.44 Not Applicable: Bundled with Procedure $379.40 $867.20 $379.40 "$1,219.74 " CAP END 15MM 29209 C1713 SUPPLY/IMPLANTS "$1,084.00 " Outpatient $542.00 "$1,219.74 " $704.60 $758.80 $715.44 Not Applicable: Bundled with Procedure $379.40 $867.20 $379.40 "$1,219.74 " CAP END AFFIXUS NL HIP FEM FLSH 814503000 C1713 SUPPLY/IMPLANTS "$1,152.00 " Outpatient $576.00 "$1,219.74 " $748.80 $806.40 $760.32 Not Applicable: Bundled with Procedure $403.20 $921.60 $403.20 "$1,219.74 " CAP END 5MM NL HIP 814503005 C1713 SUPPLY/IMPLANTS "$1,152.00 " Outpatient $576.00 "$1,219.74 " $748.80 $806.40 $760.32 Not Applicable: Bundled with Procedure $403.20 $921.60 $403.20 "$1,219.74 " CAP END TI ARTHDS NL ANKL ARTHDS 345220 C1713 SUPPLY/IMPLANTS "$1,157.00 " Outpatient $578.50 "$1,219.74 " $752.05 $809.90 $763.62 Not Applicable: Bundled with Procedure $404.95 $925.60 $404.95 "$1,219.74 " CAP END AFFIXUS HIP FEM FLSH IMPINGE 814503101 C1713 SUPPLY/IMPLANTS "$1,192.00 " Outpatient $596.00 "$1,219.74 " $774.80 $834.40 $786.72 Not Applicable: Bundled with Procedure $417.20 $953.60 $417.20 "$1,219.74 " CAP END 0MM IM NL TROCH STRL 903208000 C1713 SUPPLY/IMPLANTS "$1,209.00 " Outpatient $604.50 "$1,219.74 " $785.85 $846.30 $797.94 Not Applicable: Bundled with Procedure $423.15 $967.20 $423.15 "$1,219.74 " CAP END TI LOPRFL 345211 C1713 SUPPLY/IMPLANTS "$1,287.00 " Outpatient $643.50 "$1,219.74 " $836.55 $900.90 $849.42 Not Applicable: Bundled with Procedure $450.45 "$1,029.60 " $450.45 "$1,219.74 " CAP END TI PED LCK NL 24200 C1713 SUPPLY/IMPLANTS "$1,465.00 " Outpatient $732.50 "$1,219.74 " $952.25 "$1,025.50 " $966.90 Not Applicable: Bundled with Procedure $512.75 "$1,172.00 " $512.75 "$1,219.74 " CAP END MDN SS 10MM IM NL SYS FEM XTD STRL 225200110 C1713 SUPPLY/IMPLANTS "$1,240.00 " Outpatient $620.00 "$1,219.74 " $806.00 $868.00 $818.40 Not Applicable: Bundled with Procedure $434.00 $992.00 $434.00 "$1,219.74 " CAP END MDN SS 15MM IM NL SYS FEM XTD STRL 225200115 C1713 SUPPLY/IMPLANTS "$1,353.00 " Outpatient $676.50 "$1,219.74 " $879.45 $947.10 $892.98 Not Applicable: Bundled with Procedure $473.55 "$1,082.40 " $473.55 "$1,219.74 " CAP END MDN SS IM NL SYS HUM LCK STRL 225200300 C1713 SUPPLY/IMPLANTS "$1,108.00 " Outpatient $554.00 "$1,219.74 " $720.20 $775.60 $731.28 Not Applicable: Bundled with Procedure $387.80 $886.40 $387.80 "$1,219.74 " CAP END MDN RTRGD SS IM NL SYS FEM LCK STRL 225200400 C1713 SUPPLY/IMPLANTS "$1,222.00 " Outpatient $611.00 "$1,219.74 " $794.30 $855.40 $806.52 Not Applicable: Bundled with Procedure $427.70 $977.60 $427.70 "$1,219.74 " CAP END ITST SS UHMWPE 0MM IM NL 1 PC SLD STRL 225900700 C1713 SUPPLY/IMPLANTS "$1,165.00 " Outpatient $582.50 "$1,219.74 " $757.25 $815.50 $768.90 Not Applicable: Bundled with Procedure $407.75 $932.00 $407.75 "$1,219.74 " CAP END ITST SS UHMWPE 5MM IM NL 1 PC SLD STRL 225900705 C1713 SUPPLY/IMPLANTS "$1,203.00 " Outpatient $601.50 "$1,219.74 " $781.95 $842.10 $793.98 Not Applicable: Bundled with Procedure $421.05 $962.40 $421.05 "$1,219.74 " CAP END ITST SS UHMWPE 10MM IM NL 1 PC SLD STRL 225900710 C1713 SUPPLY/IMPLANTS "$1,260.00 " Outpatient $630.00 "$1,219.74 " $819.00 $882.00 $831.60 Not Applicable: Bundled with Procedure $441.00 "$1,008.00 " $441.00 "$1,219.74 " CAP END ITST SS UHMWPE 15MM IM NL 1 PC SLD STRL 225900715 C1713 SUPPLY/IMPLANTS "$1,298.00 " Outpatient $649.00 "$1,219.74 " $843.70 $908.60 $856.68 Not Applicable: Bundled with Procedure $454.30 "$1,038.40 " $454.30 "$1,219.74 " CAP END ITST SS UHMWPE 20MM IM NL 1 PC SLD STRL 225900720 C1713 SUPPLY/IMPLANTS "$1,315.00 " Outpatient $657.50 "$1,219.74 " $854.75 $920.50 $867.90 Not Applicable: Bundled with Procedure $460.25 "$1,052.00 " $460.25 "$1,219.74 " CAP END ITST SS UHMWPE 0MM IM NL 1 PC LCK STRL 225900800 C1713 SUPPLY/IMPLANTS "$1,165.00 " Outpatient $582.50 "$1,219.74 " $757.25 $815.50 $768.90 Not Applicable: Bundled with Procedure $407.75 $932.00 $407.75 "$1,219.74 " CAP END ITST SS UHMWPE 5MM IM NL 1 PC LCK STRL 225900805 C1713 SUPPLY/IMPLANTS "$1,203.00 " Outpatient $601.50 "$1,219.74 " $781.95 $842.10 $793.98 Not Applicable: Bundled with Procedure $421.05 $962.40 $421.05 "$1,219.74 " CAP END ITST SS UHMWPE 10MM IM NL 1 PC LCK STRL 225900810 C1713 SUPPLY/IMPLANTS "$1,260.00 " Outpatient $630.00 "$1,219.74 " $819.00 $882.00 $831.60 Not Applicable: Bundled with Procedure $441.00 "$1,008.00 " $441.00 "$1,219.74 " CAP END ITST SS UHMWPE 15MM IM NL 1 PC LCK STRL 225900815 C1713 SUPPLY/IMPLANTS "$1,298.00 " Outpatient $649.00 "$1,219.74 " $843.70 $908.60 $856.68 Not Applicable: Bundled with Procedure $454.30 "$1,038.40 " $454.30 "$1,219.74 " CAP END ITST SS UHMWPE 20MM IM NL 1 PC LCK STRL 225900820 C1713 SUPPLY/IMPLANTS "$1,315.00 " Outpatient $657.50 "$1,219.74 " $854.75 $920.50 $867.90 Not Applicable: Bundled with Procedure $460.25 "$1,052.00 " $460.25 "$1,219.74 " CAP END ITST NTRL SS UHMWPE 0MM IM NL 1 PC STRL 225900900 C1713 SUPPLY/IMPLANTS "$1,165.00 " Outpatient $582.50 "$1,219.74 " $757.25 $815.50 $768.90 Not Applicable: Bundled with Procedure $407.75 $932.00 $407.75 "$1,219.74 " CAP END ITST NTRL SS UHMWPE 5MM IM NL 1 PC STRL 225900905 C1713 SUPPLY/IMPLANTS "$1,203.00 " Outpatient $601.50 "$1,219.74 " $781.95 $842.10 $793.98 Not Applicable: Bundled with Procedure $421.05 $962.40 $421.05 "$1,219.74 " CAP END ITST NTRL SS UHMWPE 10MM IM NL 1 PC STRL 225900910 C1713 SUPPLY/IMPLANTS "$1,260.00 " Outpatient $630.00 "$1,219.74 " $819.00 $882.00 $831.60 Not Applicable: Bundled with Procedure $441.00 "$1,008.00 " $441.00 "$1,219.74 " CAP END ITST NTRL SS UHMWPE 15MM IM NL 1 PC STRL 225900915 C1713 SUPPLY/IMPLANTS "$1,298.00 " Outpatient $649.00 "$1,219.74 " $843.70 $908.60 $856.68 Not Applicable: Bundled with Procedure $454.30 "$1,038.40 " $454.30 "$1,219.74 " CAP END ITST NTRL SS UHMWPE 20MM IM NL 1 PC STRL 225900920 C1713 SUPPLY/IMPLANTS "$1,315.00 " Outpatient $657.50 "$1,219.74 " $854.75 $920.50 $867.90 Not Applicable: Bundled with Procedure $460.25 "$1,052.00 " $460.25 "$1,219.74 " CAP END NCB 8MM 3.5MM TI6AL4V LCK 203150300 C1713 SUPPLY/IMPLANTS $910.00 Outpatient $455.00 "$1,219.74 " $591.50 $637.00 $600.60 Not Applicable: Bundled with Procedure $318.50 $728.00 $318.50 "$1,219.74 " CAP END NTR NL TI6AL4V 0MM FEM ANTGRD 47248700100 C1713 SUPPLY/IMPLANTS "$1,127.00 " Outpatient $563.50 "$1,219.74 " $732.55 $788.90 $743.82 Not Applicable: Bundled with Procedure $394.45 $901.60 $394.45 "$1,219.74 " CAP END NTR NL TI6AL4V 5MM FEM ANTGRD 47248700105 C1713 SUPPLY/IMPLANTS "$1,127.00 " Outpatient $563.50 "$1,219.74 " $732.55 $788.90 $743.82 Not Applicable: Bundled with Procedure $394.45 $901.60 $394.45 "$1,219.74 " CAP END NTR NL TI6AL4V 10MM FEM ANTGRD 47248700110 C1713 SUPPLY/IMPLANTS "$1,127.00 " Outpatient $563.50 "$1,219.74 " $732.55 $788.90 $743.82 Not Applicable: Bundled with Procedure $394.45 $901.60 $394.45 "$1,219.74 " CAP END NTR NL TI6AL4V 15MM FEM ANTGRD 47248700115 C1713 SUPPLY/IMPLANTS "$1,127.00 " Outpatient $563.50 "$1,219.74 " $732.55 $788.90 $743.82 Not Applicable: Bundled with Procedure $394.45 $901.60 $394.45 "$1,219.74 " CAP END NTR NL TI-6AL-4V 0MM CEPHALOMEDULLARY 47248700200 C1713 SUPPLY/IMPLANTS "$1,089.00 " Outpatient $544.50 "$1,219.74 " $707.85 $762.30 $718.74 Not Applicable: Bundled with Procedure $381.15 $871.20 $381.15 "$1,219.74 " CAP END NTR NL TI-6AL-4V 5MM CEPHALOMEDULLARY 47248700205 C1713 SUPPLY/IMPLANTS "$1,089.00 " Outpatient $544.50 "$1,219.74 " $707.85 $762.30 $718.74 Not Applicable: Bundled with Procedure $381.15 $871.20 $381.15 "$1,219.74 " CAP END NTR NL TI6AL4V 10MM PERIPROSTHETIC CEPHALOMEDULLARY 47248700210 C1713 SUPPLY/IMPLANTS "$1,089.00 " Outpatient $544.50 "$1,219.74 " $707.85 $762.30 $718.74 Not Applicable: Bundled with Procedure $381.15 $871.20 $381.15 "$1,219.74 " CAP END NTR NL TI-6AL-4V 15MM CEPHALOMEDULLARY 47248700215 C1713 SUPPLY/IMPLANTS "$1,089.00 " Outpatient $544.50 "$1,219.74 " $707.85 $762.30 $718.74 Not Applicable: Bundled with Procedure $381.15 $871.20 $381.15 "$1,219.74 " CAP END NTR NL TI 0MM TIB 47248700500 C1713 SUPPLY/IMPLANTS "$1,127.00 " Outpatient $563.50 "$1,219.74 " $732.55 $788.90 $743.82 Not Applicable: Bundled with Procedure $394.45 $901.60 $394.45 "$1,219.74 " CAP END NTR NL TI 5MM TIB 47248700505 C1713 SUPPLY/IMPLANTS "$1,127.00 " Outpatient $563.50 "$1,219.74 " $732.55 $788.90 $743.82 Not Applicable: Bundled with Procedure $394.45 $901.60 $394.45 "$1,219.74 " CAP END NTR NL TI 10MM IM NL TIB 47248700510 C1713 SUPPLY/IMPLANTS "$1,127.00 " Outpatient $563.50 "$1,219.74 " $732.55 $788.90 $743.82 Not Applicable: Bundled with Procedure $394.45 $901.60 $394.45 "$1,219.74 " CAP END NTR NL TI 15MM TIB 47248700515 C1713 SUPPLY/IMPLANTS "$1,127.00 " Outpatient $563.50 "$1,219.74 " $732.55 $788.90 $743.82 Not Applicable: Bundled with Procedure $394.45 $901.60 $394.45 "$1,219.74 " CAP END NTR NL TI6AL4V 0MM FEM RTRGD 47248700800 C1713 SUPPLY/IMPLANTS "$1,071.00 " Outpatient $535.50 "$1,219.74 " $696.15 $749.70 $706.86 Not Applicable: Bundled with Procedure $374.85 $856.80 $374.85 "$1,219.74 " CAP END NTR NL TI6AL4V 5MM FEM RTRGD 47248700805 C1713 SUPPLY/IMPLANTS "$1,071.00 " Outpatient $535.50 "$1,219.74 " $696.15 $749.70 $706.86 Not Applicable: Bundled with Procedure $374.85 $856.80 $374.85 "$1,219.74 " CAP END NTR NL TI6AL4V 10MM FEM RTRGD 47248700810 C1713 SUPPLY/IMPLANTS "$1,071.00 " Outpatient $535.50 "$1,219.74 " $696.15 $749.70 $706.86 Not Applicable: Bundled with Procedure $374.85 $856.80 $374.85 "$1,219.74 " CAP END NTR NL TI6AL4V 15MM FEM RTRGD 47248700815 C1713 SUPPLY/IMPLANTS "$1,071.00 " Outpatient $535.50 "$1,219.74 " $696.15 $749.70 $706.86 Not Applicable: Bundled with Procedure $374.85 $856.80 $374.85 "$1,219.74 " CAP END CMF DSTRCT REM 04.315.001 C1713 SUPPLY/IMPLANTS "$2,148.00 " Outpatient "$1,074.00 " "$1,219.74 " "$1,396.20 " "$1,503.60 " "$1,417.68 " Not Applicable: Bundled with Procedure $751.80 "$1,718.40 " $751.80 "$1,718.40 " CAP END 5MM XTRN MDFC DSTRCT HEX SCKT 390.13 C1713 SUPPLY/IMPLANTS $637.00 Outpatient $318.50 "$1,219.74 " $414.05 $445.90 $420.42 Not Applicable: Bundled with Procedure $222.95 $509.60 $222.95 "$1,219.74 " CAP END TITANIUM T25 STERILE GOLD EXPERT HINDFOOT ARTHRODESI 04.008.000S C1713 SUPPLY/IMPLANTS "$1,459.00 " Outpatient $729.50 "$1,219.74 " $948.35 "$1,021.30 " $962.94 Not Applicable: Bundled with Procedure $510.65 "$1,167.20 " $510.65 "$1,219.74 " CAP IM NL MDN FEM 225200100 C1713 SUPPLY/IMPLANTS "$1,183.00 " Outpatient $591.50 "$1,219.74 " $768.95 $828.10 $780.78 Not Applicable: Bundled with Procedure $414.05 $946.40 $414.05 "$1,219.74 " CAP IM NL 5MM MDN FEM XTD 225200105 C1713 SUPPLY/IMPLANTS "$1,222.00 " Outpatient $611.00 "$1,219.74 " $794.30 $855.40 $806.52 Not Applicable: Bundled with Procedure $427.70 $977.60 $427.70 "$1,219.74 " CAP LATITUDE ELBOW ULNAR MOYEN DYK068 C1713 SUPPLY/IMPLANTS "$6,218.00 " Outpatient "$3,109.00 " "$1,219.74 " "$4,041.70 " "$4,352.60 " "$4,103.88 " Not Applicable: Bundled with Procedure "$2,176.30 " "$4,974.40 " "$1,219.74 " "$4,974.40 " CAP LCK REVOLVE SPNL NS 185 C1713 SUPPLY/IMPLANTS "$1,110.00 " Outpatient $555.00 "$1,219.74 " $721.50 $777.00 $732.60 Not Applicable: Bundled with Procedure $388.50 $888.00 $388.50 "$1,219.74 " CAP LCK REVERE SPNL NS 124 C1713 SUPPLY/IMPLANTS "$1,110.00 " Outpatient $555.00 "$1,219.74 " $721.50 $777.00 $732.60 Not Applicable: Bundled with Procedure $388.50 $888.00 $388.50 "$1,219.74 " CAP LCK NCB TI6AL4V FEM STRL 202150300 C1713 SUPPLY/IMPLANTS $910.00 Outpatient $455.00 "$1,219.74 " $591.50 $637.00 $600.60 Not Applicable: Bundled with Procedure $318.50 $728.00 $318.50 "$1,219.74 " CAP LCK VAULT 13MM ALIF SPNE CLR CD NS 10-1002-13 C1713 SUPPLY/IMPLANTS "$1,110.00 " Outpatient $555.00 "$1,219.74 " $721.50 $777.00 $732.60 Not Applicable: Bundled with Procedure $388.50 $888.00 $388.50 "$1,219.74 " CAP LCK VAULT 11MM ALIF SPNE CLR CD NS 10-1002-11 C1713 SUPPLY/IMPLANTS "$1,110.00 " Outpatient $555.00 "$1,219.74 " $721.50 $777.00 $732.60 Not Applicable: Bundled with Procedure $388.50 $888.00 $388.50 "$1,219.74 " CAP LCK CREO MIS SPNL NS 1134.001 C1713 SUPPLY/IMPLANTS "$1,110.00 " Outpatient $555.00 "$1,219.74 " $721.50 $777.00 $732.60 Not Applicable: Bundled with Procedure $388.50 $888.00 $388.50 "$1,219.74 " CAP LCK QUARTEX SPNE THRD 1149.0001 C1713 SUPPLY/IMPLANTS $731.00 Outpatient $365.50 "$1,219.74 " $475.15 $511.70 $482.46 Not Applicable: Bundled with Procedure $255.85 $584.80 $255.85 "$1,219.74 " CAP LOCKING 8405-1000 C1713 SUPPLY/IMPLANTS $512.00 Outpatient $256.00 "$1,219.74 " $332.80 $358.40 $337.92 Not Applicable: Bundled with Procedure $179.20 $409.60 $179.20 "$1,219.74 " CAP LOCKING HIGH ANGLE 8405-1203 C1713 SUPPLY/IMPLANTS $512.00 Outpatient $256.00 "$1,219.74 " $332.80 $358.40 $337.92 Not Applicable: Bundled with Procedure $179.20 $409.60 $179.20 "$1,219.74 " CAP LOCKING SPINE 486610000 C1713 SUPPLY/IMPLANTS $520.00 Outpatient $260.00 "$1,219.74 " $338.00 $364.00 $343.20 Not Applicable: Bundled with Procedure $182.00 $416.00 $182.00 "$1,219.74 " CAP PCTV 5MM 71062007 C1713 SUPPLY/IMPLANTS "$3,411.00 " Outpatient "$1,705.50 " "$1,219.74 " "$2,217.15 " "$2,387.70 " "$2,251.26 " Not Applicable: Bundled with Procedure "$1,193.85 " "$2,728.80 " "$1,193.85 " "$2,728.80 " CAP PCTV SS HFMN XPRESS BLNT TIP CNT THRD BLU 50MM 5MM 5027-1-050 C1713 SUPPLY/IMPLANTS $462.00 Outpatient $231.00 "$1,219.74 " $300.30 $323.40 $304.92 Not Applicable: Bundled with Procedure $161.70 $369.60 $161.70 "$1,219.74 " CAP PCTV 5MM PREDRILL PIN TI A FSHR TIP 5MM FF-10551 C1713 SUPPLY/IMPLANTS $736.00 Outpatient $368.00 "$1,219.74 " $478.40 $515.20 $485.76 Not Applicable: Bundled with Procedure $257.60 $588.80 $257.60 "$1,219.74 " CAP PCTV PERIART PLT SYS OPTILOCK CL 26950 C1713 SUPPLY/IMPLANTS "$1,909.00 " Outpatient $954.50 "$1,219.74 " "$1,240.85 " "$1,336.30 " "$1,259.94 " Not Applicable: Bundled with Procedure $668.15 "$1,527.20 " $668.15 "$1,527.20 " CAP PCTV PLSTSL TRNFX NS 11MM 445209211 C1713 SUPPLY/IMPLANTS $602.00 Outpatient $301.00 "$1,219.74 " $391.30 $421.40 $397.32 Not Applicable: Bundled with Procedure $210.70 $481.60 $210.70 "$1,219.74 " CAP PCTV PLSTSL TRNFX NS 2.5-3MM 445209225 C1713 SUPPLY/IMPLANTS $602.00 Outpatient $301.00 "$1,219.74 " $391.30 $421.40 $397.32 Not Applicable: Bundled with Procedure $210.70 $481.60 $210.70 "$1,219.74 " CAP PCTV PLSTSL TRNFX NS 3.5/4MM 445209235 C1713 SUPPLY/IMPLANTS $602.00 Outpatient $301.00 "$1,219.74 " $391.30 $421.40 $397.32 Not Applicable: Bundled with Procedure $210.70 $481.60 $210.70 "$1,219.74 " CAP PCTV PLSTSL TRNFX NS 4.5/5MM 445209245 C1713 SUPPLY/IMPLANTS $602.00 Outpatient $301.00 "$1,219.74 " $391.30 $421.40 $397.32 Not Applicable: Bundled with Procedure $210.70 $481.60 $210.70 "$1,219.74 " CARBON FIBER BAR 6MM X 65MM 520300607 C1713 SUPPLY/IMPLANTS "$1,222.00 " Outpatient $611.00 "$1,219.74 " $794.30 $855.40 $806.52 Not Applicable: Bundled with Procedure $427.70 $977.60 $427.70 "$1,219.74 " CARBON FIBER BAR 6MM X 100MM 520300610 C1713 SUPPLY/IMPLANTS "$1,260.00 " Outpatient $630.00 "$1,219.74 " $819.00 $882.00 $831.60 Not Applicable: Bundled with Procedure $441.00 "$1,008.00 " $441.00 "$1,219.74 " CARBON FIBER BAR 6MM X 150MM 520300615 C1713 SUPPLY/IMPLANTS "$1,298.00 " Outpatient $649.00 "$1,219.74 " $843.70 $908.60 $856.68 Not Applicable: Bundled with Procedure $454.30 "$1,038.40 " $454.30 "$1,219.74 " CARBON FIBER BAR 6MM X 200MM 520300620 C1713 SUPPLY/IMPLANTS "$1,334.00 " Outpatient $667.00 "$1,219.74 " $867.10 $933.80 $880.44 Not Applicable: Bundled with Procedure $466.90 "$1,067.20 " $466.90 "$1,219.74 " CARBON FIBER BAR 6MM X 250MM 520300625 C1713 SUPPLY/IMPLANTS "$1,372.00 " Outpatient $686.00 "$1,219.74 " $891.80 $960.40 $905.52 Not Applicable: Bundled with Procedure $480.20 "$1,097.60 " $480.20 "$1,219.74 " CARBON FIBER BAR 6MM X 300MM 520300630 C1713 SUPPLY/IMPLANTS "$1,409.00 " Outpatient $704.50 "$1,219.74 " $915.85 $986.30 $929.94 Not Applicable: Bundled with Procedure $493.15 "$1,127.20 " $493.15 "$1,219.74 " CASE GRPH RADEL MOD IMPL NCB NS FEM DIST 200024604 C1713 SUPPLY/IMPLANTS "$3,665.00 " Outpatient "$1,832.50 " "$1,219.74 " "$2,382.25 " "$2,565.50 " "$2,418.90 " Not Applicable: Bundled with Procedure "$1,282.75 " "$2,932.00 " "$1,219.74 " "$2,932.00 " CASE GRPH SS MOD NCB-PT STD NS INST 200024803 C1713 SUPPLY/IMPLANTS "$3,427.00 " Outpatient "$1,713.50 " "$1,219.74 " "$2,227.55 " "$2,398.90 " "$2,261.82 " Not Applicable: Bundled with Procedure "$1,199.45 " "$2,741.60 " "$1,199.45 " "$2,741.60 " CASE GRPH SS MOD NCB-PT STD NS IMPL CNN SCR 200024804 C1713 SUPPLY/IMPLANTS "$2,830.00 " Outpatient "$1,415.00 " "$1,219.74 " "$1,839.50 " "$1,981.00 " "$1,867.80 " Not Applicable: Bundled with Procedure $990.50 "$2,264.00 " $990.50 "$2,264.00 " CASE GRPH SS MOD SCR RK NCB-PT STD NS 200024805 C1713 SUPPLY/IMPLANTS "$1,816.00 " Outpatient $908.00 "$1,219.74 " "$1,180.40 " "$1,271.20 " "$1,198.56 " Not Applicable: Bundled with Procedure $635.60 "$1,452.80 " $635.60 "$1,452.80 " CASE GRPH SS MOD NCB-PT STD NS MIS 200024806 C1713 SUPPLY/IMPLANTS "$2,958.00 " Outpatient "$1,479.00 " "$1,219.74 " "$1,922.70 " "$2,070.60 " "$1,952.28 " Not Applicable: Bundled with Procedure "$1,035.30 " "$2,366.40 " "$1,035.30 " "$2,366.40 " CASE GRPH FEM PLT BS STD NCB PERIPROSTHETIC PLT SYS 200024901 C1713 SUPPLY/IMPLANTS "$7,399.00 " Outpatient "$3,699.50 " "$1,219.74 " "$4,809.35 " "$5,179.30 " "$4,883.34 " Not Applicable: Bundled with Procedure "$2,589.65 " "$5,919.20 " "$1,219.74 " "$5,919.20 " CASE GRPH FEM SCR BS TRY STD NCB PERIPROSTHETIC PLT SYS 200024902 C1713 SUPPLY/IMPLANTS "$13,130.00 " Outpatient "$6,565.00 " "$1,219.74 " "$8,534.50 " "$9,191.00 " "$8,665.80 " Not Applicable: Bundled with Procedure "$4,595.50 " "$10,504.00 " "$1,219.74 " "$10,504.00 " CASE GRPH FEM SCR BS STD NCB PERIPROSTHETIC PLT SYS 200024903 C1713 SUPPLY/IMPLANTS "$5,913.00 " Outpatient "$2,956.50 " "$1,219.74 " "$3,843.45 " "$4,139.10 " "$3,902.58 " Not Applicable: Bundled with Procedure "$2,069.55 " "$4,730.40 " "$1,219.74 " "$4,730.40 " CASE GRPH SCR CADDY STD NCB PERIPROSTHETIC PLT SYS FEM 200024904 C1713 SUPPLY/IMPLANTS "$3,483.00 " Outpatient "$1,741.50 " "$1,219.74 " "$2,263.95 " "$2,438.10 " "$2,298.78 " Not Applicable: Bundled with Procedure "$1,219.05 " "$2,786.40 " "$1,219.05 " "$2,786.40 " CASE GRPH NCB PERIPROSTHETIC PLT SYS FEM SCR CADDY DP THRD 200024905 C1713 SUPPLY/IMPLANTS "$2,366.00 " Outpatient "$1,183.00 " "$1,219.74 " "$1,537.90 " "$1,656.20 " "$1,561.56 " Not Applicable: Bundled with Procedure $828.10 "$1,892.80 " $828.10 "$1,892.80 " CASE GRPH FEM SCR TRY STD NCB PERIPROSTHETIC PLT SYS 200024906 C1713 SUPPLY/IMPLANTS "$2,902.00 " Outpatient "$1,451.00 " "$1,219.74 " "$1,886.30 " "$2,031.40 " "$1,915.32 " Not Applicable: Bundled with Procedure "$1,015.70 " "$2,321.60 " "$1,015.70 " "$2,321.60 " CASE GRPH FEM SCR LCK CAP SPCR STD NCB PERIPROSTHETIC PLT 200024907 C1713 SUPPLY/IMPLANTS $804.00 Outpatient $402.00 "$1,219.74 " $522.60 $562.80 $530.64 Not Applicable: Bundled with Procedure $281.40 $643.20 $281.40 "$1,219.74 " CASE GRPH FEM BS NCB PERIPROSTHETIC PLT SYS 200024908 C1713 SUPPLY/IMPLANTS "$4,282.00 " Outpatient "$2,141.00 " "$1,219.74 " "$2,783.30 " "$2,997.40 " "$2,826.12 " Not Applicable: Bundled with Procedure "$1,498.70 " "$3,425.60 " "$1,219.74 " "$3,425.60 " CASE GRPH ADON BS NCB PERIPROSTHETIC PLT SYS FEM DIST 200024910 C1713 SUPPLY/IMPLANTS "$4,643.00 " Outpatient "$2,321.50 " "$1,219.74 " "$3,017.95 " "$3,250.10 " "$3,064.38 " Not Applicable: Bundled with Procedure "$1,625.05 " "$3,714.40 " "$1,219.74 " "$3,714.40 " CASE GRPH ADON SET NCB PERIPROSTHETIC TROCH PLT 200024930 C1713 SUPPLY/IMPLANTS "$12,007.00 " Outpatient "$6,003.50 " "$1,219.74 " "$7,804.55 " "$8,404.90 " "$7,924.62 " Not Applicable: Bundled with Procedure "$4,202.45 " "$9,605.60 " "$1,219.74 " "$9,605.60 " CASE GRPH ADON SET BS NCB PERIPROSTHETIC TROCH PLT 200024931 C1713 SUPPLY/IMPLANTS "$3,374.00 " Outpatient "$1,687.00 " "$1,219.74 " "$2,193.10 " "$2,361.80 " "$2,226.84 " Not Applicable: Bundled with Procedure "$1,180.90 " "$2,699.20 " "$1,180.90 " "$2,699.20 " CASE GRPH ADON SET SCR CADDY NCB PERIPROSTHETIC TROCH PLT 200024932 C1713 SUPPLY/IMPLANTS "$3,446.00 " Outpatient "$1,723.00 " "$1,219.74 " "$2,239.90 " "$2,412.20 " "$2,274.36 " Not Applicable: Bundled with Procedure "$1,206.10 " "$2,756.80 " "$1,206.10 " "$2,756.80 " CASE GRPH ADON SET TOP TRY NCB PERIPROSTHETIC TROCH PLT 200024933 C1713 SUPPLY/IMPLANTS "$2,504.00 " Outpatient "$1,252.00 " "$1,219.74 " "$1,627.60 " "$1,752.80 " "$1,652.64 " Not Applicable: Bundled with Procedure $876.40 "$2,003.20 " $876.40 "$2,003.20 " CASE GRPH ADON SET BTM TRY NCB PERIPROSTHETIC TROCH PLT 200024934 C1713 SUPPLY/IMPLANTS "$1,945.00 " Outpatient $972.50 "$1,219.74 " "$1,264.25 " "$1,361.50 " "$1,283.70 " Not Applicable: Bundled with Procedure $680.75 "$1,556.00 " $680.75 "$1,556.00 " CASE GRPH NS XTRN MDFC DSTRCT SYS 304.754 C1713 SUPPLY/IMPLANTS "$3,336.00 " Outpatient "$1,668.00 " "$1,219.74 " "$2,168.40 " "$2,335.20 " "$2,201.76 " Not Applicable: Bundled with Procedure "$1,167.60 " "$2,668.80 " "$1,167.60 " "$2,668.80 " CASE GRPH MED NS MATRIXMANDIBLE SYS 306.777 C1713 SUPPLY/IMPLANTS "$11,966.00 " Outpatient "$5,983.00 " "$1,219.74 " "$7,777.90 " "$8,376.20 " "$7,897.56 " Not Applicable: Bundled with Procedure "$4,188.10 " "$9,572.80 " "$1,219.74 " "$9,572.80 " CASE GRPH NS TI STRNL FX SYS CMBN SET THRX 60.501.601 C1713 SUPPLY/IMPLANTS "$5,368.00 " Outpatient "$2,684.00 " "$1,219.74 " "$3,489.20 " "$3,757.60 " "$3,542.88 " Not Applicable: Bundled with Procedure "$1,878.80 " "$4,294.40 " "$1,219.74 " "$4,294.40 " CASE GRPH 3 LVL NS AIR PEN DRV 60.550.050.98 C1713 SUPPLY/IMPLANTS "$2,403.00 " Outpatient "$1,201.50 " "$1,219.74 " "$1,561.95 " "$1,682.10 " "$1,585.98 " Not Applicable: Bundled with Procedure $841.05 "$1,922.40 " $841.05 "$1,922.40 " CASE INST OSSEOTI WDG FT/ANKL POR MTL RECON 597009 C1713 SUPPLY/IMPLANTS "$4,045.00 " Outpatient "$2,022.50 " "$1,219.74 " "$2,629.25 " "$2,831.50 " "$2,669.70 " Not Applicable: Bundled with Procedure "$1,415.75 " "$3,236.00 " "$1,219.74 " "$3,236.00 " CASE INST REUN LG SCR 450085 C1713 SUPPLY/IMPLANTS "$4,540.00 " Outpatient "$2,270.00 " "$1,219.74 " "$2,951.00 " "$3,178.00 " "$2,996.40 " Not Applicable: Bundled with Procedure "$1,589.00 " "$3,632.00 " "$1,219.74 " "$3,632.00 " CASE INST REUN SM SCR 450078 C1713 SUPPLY/IMPLANTS "$4,872.00 " Outpatient "$2,436.00 " "$1,219.74 " "$3,166.80 " "$3,410.40 " "$3,215.52 " Not Applicable: Bundled with Procedure "$1,705.20 " "$3,897.60 " "$1,219.74 " "$3,897.60 " CASE IMPL NS 3 MM CNN SCR 110008469 C1713 SUPPLY/IMPLANTS "$5,523.00 " Outpatient "$2,761.50 " "$1,219.74 " "$3,589.95 " "$3,866.10 " "$3,645.18 " Not Applicable: Bundled with Procedure "$1,933.05 " "$4,418.40 " "$1,219.74 " "$4,418.40 " CASE INST AFFIXUS 2 STRL DISP PROX FEM NL SYS 2112-01-000 C1713 SUPPLY/IMPLANTS "$8,947.00 " Outpatient "$4,473.50 " "$1,219.74 " "$5,815.55 " "$6,262.90 " "$5,905.02 " Not Applicable: Bundled with Procedure "$3,131.45 " "$7,157.60 " "$1,219.74 " "$7,157.60 " CASE INST AFFIXUS HIP FX NL SYS 211201800 C1713 SUPPLY/IMPLANTS "$9,371.00 " Outpatient "$4,685.50 " "$1,219.74 " "$6,091.15 " "$6,559.70 " "$6,184.86 " Not Applicable: Bundled with Procedure "$3,279.85 " "$7,496.80 " "$1,219.74 " "$7,496.80 " CASE IMPL NS 6.5 MM 8 MM CNN SCR 110008481 C1713 SUPPLY/IMPLANTS "$10,845.00 " Outpatient "$5,422.50 " "$1,219.74 " "$7,049.25 " "$7,591.50 " "$7,157.70 " Not Applicable: Bundled with Procedure "$3,795.75 " "$8,676.00 " "$1,219.74 " "$8,676.00 " CASE INST AFFIXUS 1 PROX FEM NL SYS 2112-01-001 C1713 SUPPLY/IMPLANTS "$10,952.00 " Outpatient "$5,476.00 " "$1,219.74 " "$7,118.80 " "$7,666.40 " "$7,228.32 " Not Applicable: Bundled with Procedure "$3,833.20 " "$8,761.60 " "$1,219.74 " "$8,761.60 " CASE IMPL NS 4 MM 5 MM CNN SCR 110008471 C1713 SUPPLY/IMPLANTS "$11,916.00 " Outpatient "$5,958.00 " "$1,219.74 " "$7,745.40 " "$8,341.20 " "$7,864.56 " Not Applicable: Bundled with Procedure "$4,170.60 " "$9,532.80 " "$1,219.74 " "$9,532.80 " CASE INST CMPLT PROX TIB ANTM LCK PLT SYS 8299-58-100 C1713 SUPPLY/IMPLANTS "$38,054.00 " Outpatient "$19,027.00 " "$1,219.74 " "$24,735.10 " "$26,637.80 " "$25,115.64 " Not Applicable: Bundled with Procedure "$13,318.90 " "$30,443.20 " "$1,219.74 " "$30,443.20 " CASE INST 4INX7.6CM KRSH AL WRE NS LF 42408000 C1713 SUPPLY/IMPLANTS "$1,260.00 " Outpatient $630.00 "$1,219.74 " $819.00 $882.00 $831.60 Not Applicable: Bundled with Procedure $441.00 "$1,008.00 " $441.00 "$1,219.74 " CASE INST 6INX10.2CM KRSH AL WRE NS LF 42408500 C1713 SUPPLY/IMPLANTS "$1,260.00 " Outpatient $630.00 "$1,219.74 " $819.00 $882.00 $831.60 Not Applicable: Bundled with Procedure $441.00 "$1,008.00 " $441.00 "$1,219.74 " CASE INST 9INX15.2CM SS PIN WRE NS LF 42409000 C1713 SUPPLY/IMPLANTS "$1,260.00 " Outpatient $630.00 "$1,219.74 " $819.00 $882.00 $831.60 Not Applicable: Bundled with Procedure $441.00 "$1,008.00 " $441.00 "$1,219.74 " CASE INST MNMGNFX PPS POLYETHERIMIDE CNN SCR NS 114208000 C1713 SUPPLY/IMPLANTS "$5,449.00 " Outpatient "$2,724.50 " "$1,219.74 " "$3,541.85 " "$3,814.30 " "$3,596.34 " Not Applicable: Bundled with Procedure "$1,907.15 " "$4,359.20 " "$1,219.74 " "$4,359.20 " CASE INST MGNFX PPS POLYETHERIMIDE CNN SCR NS 114608100 C1713 SUPPLY/IMPLANTS "$9,028.00 " Outpatient "$4,514.00 " "$1,219.74 " "$5,868.20 " "$6,319.60 " "$5,958.48 " Not Applicable: Bundled with Procedure "$3,159.80 " "$7,222.40 " "$1,219.74 " "$7,222.40 " CASE INST 5.5MM CNN SCR 114705501 C1713 SUPPLY/IMPLANTS "$18,424.00 " Outpatient "$9,212.00 " "$1,219.74 " "$11,975.60 " "$12,896.80 " "$12,159.84 " Not Applicable: Bundled with Procedure "$6,448.40 " "$14,739.20 " "$1,219.74 " "$14,739.20 " CASE INST 6.5 MM CNN SCR 114706501 C1713 SUPPLY/IMPLANTS "$18,096.00 " Outpatient "$9,048.00 " "$1,219.74 " "$11,762.40 " "$12,667.20 " "$11,943.36 " Not Applicable: Bundled with Procedure "$6,333.60 " "$14,476.80 " "$1,219.74 " "$14,476.80 " CASE INST 7 MM CNN SCR 114707001 C1713 SUPPLY/IMPLANTS "$26,730.00 " Outpatient "$13,365.00 " "$1,219.74 " "$17,374.50 " "$18,711.00 " "$17,641.80 " Not Applicable: Bundled with Procedure "$9,355.50 " "$21,384.00 " "$1,219.74 " "$21,384.00 " CASE INST TOP 7 MM 114707004 C1713 SUPPLY/IMPLANTS "$1,203.00 " Outpatient $601.50 "$1,219.74 " $781.95 $842.10 $793.98 Not Applicable: Bundled with Procedure $421.05 $962.40 $421.05 "$1,219.74 " CASE INST HUENE HRBRT/WPL POLYETHERIMIDE BN SCR NS 115409500 C1713 SUPPLY/IMPLANTS "$3,209.00 " Outpatient "$1,604.50 " "$1,219.74 " "$2,085.85 " "$2,246.30 " "$2,117.94 " Not Applicable: Bundled with Procedure "$1,123.15 " "$2,567.20 " "$1,123.15 " "$2,567.20 " CASE INST MGNFX PLV POLYETHERIMIDE RECON NS 117908000 C1713 SUPPLY/IMPLANTS "$2,708.00 " Outpatient "$1,354.00 " "$1,219.74 " "$1,760.20 " "$1,895.60 " "$1,787.28 " Not Applicable: Bundled with Procedure $947.80 "$2,166.40 " $947.80 "$2,166.40 " CASE INST POLYETHERIMIDE RECON DSTRCT NS 117908500 C1713 SUPPLY/IMPLANTS "$3,901.00 " Outpatient "$1,950.50 " "$1,219.74 " "$2,535.65 " "$2,730.70 " "$2,574.66 " Not Applicable: Bundled with Procedure "$1,365.35 " "$3,120.80 " "$1,219.74 " "$3,120.80 " CASE INST REM 119702000 C1713 SUPPLY/IMPLANTS "$3,402.00 " Outpatient "$1,701.00 " "$1,219.74 " "$2,211.30 " "$2,381.40 " "$2,245.32 " Not Applicable: Bundled with Procedure "$1,190.70 " "$2,721.60 " "$1,190.70 " "$2,721.60 " CASE INST AVN 119709500 C1713 SUPPLY/IMPLANTS "$7,512.00 " Outpatient "$3,756.00 " "$1,219.74 " "$4,882.80 " "$5,258.40 " "$4,957.92 " Not Applicable: Bundled with Procedure "$2,629.20 " "$6,009.60 " "$1,219.74 " "$6,009.60 " CASE INST INTRACONE IM AL RMR NS 142809000 C1713 SUPPLY/IMPLANTS "$5,352.00 " Outpatient "$2,676.00 " "$1,219.74 " "$3,478.80 " "$3,746.40 " "$3,532.32 " Not Applicable: Bundled with Procedure "$1,873.20 " "$4,281.60 " "$1,219.74 " "$4,281.60 " CASE INST CBL RD POLYETHERIMIDE NS 223209500 C1713 SUPPLY/IMPLANTS "$4,354.00 " Outpatient "$2,177.00 " "$1,219.74 " "$2,830.10 " "$3,047.80 " "$2,873.64 " Not Applicable: Bundled with Procedure "$1,523.90 " "$3,483.20 " "$1,219.74 " "$3,483.20 " CASE INST MDN LNG RMR 223707500 C1713 SUPPLY/IMPLANTS "$8,463.00 " Outpatient "$4,231.50 " "$1,219.74 " "$5,500.95 " "$5,924.10 " "$5,585.58 " Not Applicable: Bundled with Procedure "$2,962.05 " "$6,770.40 " "$1,219.74 " "$6,770.40 " CASE INST MDN SNTNL LNG RMR 223707700 C1713 SUPPLY/IMPLANTS "$2,330.00 " Outpatient "$1,165.00 " "$1,219.74 " "$1,514.50 " "$1,631.00 " "$1,537.80 " Not Applicable: Bundled with Procedure $815.50 "$1,864.00 " $815.50 "$1,864.00 " CASE INST MDN FNGR RDC 225503400 C1713 SUPPLY/IMPLANTS "$2,406.00 " Outpatient "$1,203.00 " "$1,219.74 " "$1,563.90 " "$1,684.20 " "$1,587.96 " Not Applicable: Bundled with Procedure $842.10 "$1,924.80 " $842.10 "$1,924.80 " CASE INST MDN PROX POLYETHERIMIDE TRGT GD IM NL NS 225505000 C1713 SUPPLY/IMPLANTS "$7,576.00 " Outpatient "$3,788.00 " "$1,219.74 " "$4,924.40 " "$5,303.20 " "$5,000.16 " Not Applicable: Bundled with Procedure "$2,651.60 " "$6,060.80 " "$1,219.74 " "$6,060.80 " CASE INST MDN TIB ANT POLYETHERIMIDE NS 225506200 C1713 SUPPLY/IMPLANTS "$10,802.00 " Outpatient "$5,401.00 " "$1,219.74 " "$7,021.30 " "$7,561.40 " "$7,129.32 " Not Applicable: Bundled with Procedure "$3,780.70 " "$8,641.60 " "$1,219.74 " "$8,641.60 " CASE INST ITST 225801000 C1713 SUPPLY/IMPLANTS "$6,754.00 " Outpatient "$3,377.00 " "$1,219.74 " "$4,390.10 " "$4,727.80 " "$4,457.64 " Not Applicable: Bundled with Procedure "$2,363.90 " "$5,403.20 " "$1,219.74 " "$5,403.20 " CASE INST LNG PERIART SCR 234706500 C1713 SUPPLY/IMPLANTS "$6,384.00 " Outpatient "$3,192.00 " "$1,219.74 " "$4,149.60 " "$4,468.80 " "$4,213.44 " Not Applicable: Bundled with Procedure "$2,234.40 " "$5,107.20 " "$1,219.74 " "$5,107.20 " CASE INST PERIART SCR BSPLT 234707655 C1713 SUPPLY/IMPLANTS "$3,710.00 " Outpatient "$1,855.00 " "$1,219.74 " "$2,411.50 " "$2,597.00 " "$2,448.60 " Not Applicable: Bundled with Procedure "$1,298.50 " "$2,968.00 " "$1,219.74 " "$2,968.00 " CASE INST LNR CLP 234709000 C1713 SUPPLY/IMPLANTS "$7,094.00 " Outpatient "$3,547.00 " "$1,219.74 " "$4,611.10 " "$4,965.80 " "$4,682.04 " Not Applicable: Bundled with Procedure "$2,482.90 " "$5,675.20 " "$1,219.74 " "$5,675.20 " CASE INST FIB PERIART LID PLT LF 234804050 C1713 SUPPLY/IMPLANTS "$6,111.00 " Outpatient "$3,055.50 " "$1,219.74 " "$3,972.15 " "$4,277.70 " "$4,033.26 " Not Applicable: Bundled with Procedure "$2,138.85 " "$4,888.80 " "$1,219.74 " "$4,888.80 " CASE INST 3.5/6.5MM PERIART SCR LID 234804500 C1713 SUPPLY/IMPLANTS "$11,495.00 " Outpatient "$5,747.50 " "$1,219.74 " "$7,471.75 " "$8,046.50 " "$7,586.70 " Not Applicable: Bundled with Procedure "$4,023.25 " "$9,196.00 " "$1,219.74 " "$9,196.00 " CASE INST 3.5/6.5MM PERIART LID 234805000 C1713 SUPPLY/IMPLANTS "$11,140.00 " Outpatient "$5,570.00 " "$1,219.74 " "$7,241.00 " "$7,798.00 " "$7,352.40 " Not Applicable: Bundled with Procedure "$3,899.00 " "$8,912.00 " "$1,219.74 " "$8,912.00 " CASE INST TIB PERIART PROX PLT LID 234805500 C1713 SUPPLY/IMPLANTS "$8,608.00 " Outpatient "$4,304.00 " "$1,219.74 " "$5,595.20 " "$6,025.60 " "$5,681.28 " Not Applicable: Bundled with Procedure "$3,012.80 " "$6,886.40 " "$1,219.74 " "$6,886.40 " CASE INST HUM PROX PERIART PLT LID 234806500 C1713 SUPPLY/IMPLANTS "$8,981.00 " Outpatient "$4,490.50 " "$1,219.74 " "$5,837.65 " "$6,286.70 " "$5,927.46 " Not Applicable: Bundled with Procedure "$3,143.35 " "$7,184.80 " "$1,219.74 " "$7,184.80 " CASE INST ELB PERIART PLT LID 234807000 C1713 SUPPLY/IMPLANTS "$5,030.00 " Outpatient "$2,515.00 " "$1,219.74 " "$3,269.50 " "$3,521.00 " "$3,319.80 " Not Applicable: Bundled with Procedure "$1,760.50 " "$4,024.00 " "$1,219.74 " "$4,024.00 " CASE INST FEM PERIART DIST PLT LID 234808000 C1713 SUPPLY/IMPLANTS "$7,707.00 " Outpatient "$3,853.50 " "$1,219.74 " "$5,009.55 " "$5,394.90 " "$5,086.62 " Not Applicable: Bundled with Procedure "$2,697.45 " "$6,165.60 " "$1,219.74 " "$6,165.60 " CASE INST ELB PERIART LCK PLT 235800000 C1713 SUPPLY/IMPLANTS "$10,158.00 " Outpatient "$5,079.00 " "$1,219.74 " "$6,602.70 " "$7,110.60 " "$6,704.28 " Not Applicable: Bundled with Procedure "$3,555.30 " "$8,126.40 " "$1,219.74 " "$8,126.40 " CASE INST PERIART ELB LCK PLT SYS 235800500 C1713 SUPPLY/IMPLANTS "$8,964.00 " Outpatient "$4,482.00 " "$1,219.74 " "$5,826.60 " "$6,274.80 " "$5,916.24 " Not Applicable: Bundled with Procedure "$3,137.40 " "$7,171.20 " "$1,219.74 " "$7,171.20 " CASE INST FEM DIST LAT PERIART LCK PLT JIG 235801005 C1713 SUPPLY/IMPLANTS "$3,836.00 " Outpatient "$1,918.00 " "$1,219.74 " "$2,493.40 " "$2,685.20 " "$2,531.76 " Not Applicable: Bundled with Procedure "$1,342.60 " "$3,068.80 " "$1,219.74 " "$3,068.80 " CASE INST TIB DIST PERIART LCK PLT JIG 235802005 C1713 SUPPLY/IMPLANTS "$5,256.00 " Outpatient "$2,628.00 " "$1,219.74 " "$3,416.40 " "$3,679.20 " "$3,468.96 " Not Applicable: Bundled with Procedure "$1,839.60 " "$4,204.80 " "$1,219.74 " "$4,204.80 " CASE INST RDS DIST PERIART LCK PLT JIG 235802505 C1713 SUPPLY/IMPLANTS "$17,911.00 " Outpatient "$8,955.50 " "$1,219.74 " "$11,642.15 " "$12,537.70 " "$11,821.26 " Not Applicable: Bundled with Procedure "$6,268.85 " "$14,328.80 " "$1,219.74 " "$14,328.80 " CASE INST PROX LAT PERIART LCK PLT JIG 235803005 C1713 SUPPLY/IMPLANTS "$5,336.00 " Outpatient "$2,668.00 " "$1,219.74 " "$3,468.40 " "$3,735.20 " "$3,521.76 " Not Applicable: Bundled with Procedure "$1,867.60 " "$4,268.80 " "$1,219.74 " "$4,268.80 " CASE INST 5.5MM 4.5MM PERIART LCK SCR 235803505 C1713 SUPPLY/IMPLANTS "$11,769.00 " Outpatient "$5,884.50 " "$1,219.74 " "$7,649.85 " "$8,238.30 " "$7,767.54 " Not Applicable: Bundled with Procedure "$4,119.15 " "$9,415.20 " "$1,219.74 " "$9,415.20 " CASE INST RDS DIST LCK SCR 235804505 C1713 SUPPLY/IMPLANTS "$13,961.00 " Outpatient "$6,980.50 " "$1,219.74 " "$9,074.65 " "$9,772.70 " "$9,214.26 " Not Applicable: Bundled with Procedure "$4,886.35 " "$11,168.80 " "$1,219.74 " "$11,168.80 " CASE INST TIB PROX LAT PERIART LCK PLT JIG 235805005 C1713 SUPPLY/IMPLANTS "$3,901.00 " Outpatient "$1,950.50 " "$1,219.74 " "$2,535.65 " "$2,730.70 " "$2,574.66 " Not Applicable: Bundled with Procedure "$1,365.35 " "$3,120.80 " "$1,219.74 " "$3,120.80 " CASE INST 2.7MM 3.5MM PERC LCK PLT JIG 235806000 C1713 SUPPLY/IMPLANTS "$14,220.00 " Outpatient "$7,110.00 " "$1,219.74 " "$9,243.00 " "$9,954.00 " "$9,385.20 " Not Applicable: Bundled with Procedure "$4,977.00 " "$11,376.00 " "$1,219.74 " "$11,376.00 " CASE INST 5.5X4.5IN ZPLP PERC INST 235806500 C1713 SUPPLY/IMPLANTS "$10,625.00 " Outpatient "$5,312.50 " "$1,219.74 " "$6,906.25 " "$7,437.50 " "$7,012.50 " Not Applicable: Bundled with Procedure "$3,718.75 " "$8,500.00 " "$1,219.74 " "$8,500.00 " CASE INST FIB PERIART DIST LAT LCK 235808000 C1713 SUPPLY/IMPLANTS "$5,901.00 " Outpatient "$2,950.50 " "$1,219.74 " "$3,835.65 " "$4,130.70 " "$3,894.66 " Not Applicable: Bundled with Procedure "$2,065.35 " "$4,720.80 " "$1,219.74 " "$4,720.80 " CASE INST 5.5/4.5 MM AUX SCR ZM PERIART LCK PLT 235808500 C1713 SUPPLY/IMPLANTS "$8,255.00 " Outpatient "$4,127.50 " "$1,219.74 " "$5,365.75 " "$5,778.50 " "$5,448.30 " Not Applicable: Bundled with Procedure "$2,889.25 " "$6,604.00 " "$1,219.74 " "$6,604.00 " CASE INST 3.5/2.7 MM AUX SCR ZM PERIART LCK PLT 235809500 C1713 SUPPLY/IMPLANTS "$7,128.00 " Outpatient "$3,564.00 " "$1,219.74 " "$4,633.20 " "$4,989.60 " "$4,704.48 " Not Applicable: Bundled with Procedure "$2,494.80 " "$5,702.40 " "$1,219.74 " "$5,702.40 " CASE INST NTR NL SM CEPHALOMEDULLARY SS AL 1OF 2 249004050 C1713 SUPPLY/IMPLANTS "$12,607.00 " Outpatient "$6,303.50 " "$1,219.74 " "$8,194.55 " "$8,824.90 " "$8,320.62 " Not Applicable: Bundled with Procedure "$4,412.45 " "$10,085.60 " "$1,219.74 " "$10,085.60 " CASE INST NTR NL SM CEPHALOMEDULLARY SS AL 2OF 2 249006350 C1713 SUPPLY/IMPLANTS "$12,576.00 " Outpatient "$6,288.00 " "$1,219.74 " "$8,174.40 " "$8,803.20 " "$8,300.16 " Not Applicable: Bundled with Procedure "$4,401.60 " "$10,060.80 " "$1,219.74 " "$10,060.80 " CASE INST NTR NL TLL TIB SS 1OF 2 249007500 C1713 SUPPLY/IMPLANTS "$6,481.00 " Outpatient "$3,240.50 " "$1,219.74 " "$4,212.65 " "$4,536.70 " "$4,277.46 " Not Applicable: Bundled with Procedure "$2,268.35 " "$5,184.80 " "$1,219.74 " "$5,184.80 " CASE INST NTR NL TLL TIB SS AL 1OF 2 249007550 C1713 SUPPLY/IMPLANTS "$6,481.00 " Outpatient "$3,240.50 " "$1,219.74 " "$4,212.65 " "$4,536.70 " "$4,277.46 " Not Applicable: Bundled with Procedure "$2,268.35 " "$5,184.80 " "$1,219.74 " "$5,184.80 " CASE INST NTR NL TLL TIB SS 2OF 2 249007900 C1713 SUPPLY/IMPLANTS "$6,481.00 " Outpatient "$3,240.50 " "$1,219.74 " "$4,212.65 " "$4,536.70 " "$4,277.46 " Not Applicable: Bundled with Procedure "$2,268.35 " "$5,184.80 " "$1,219.74 " "$5,184.80 " CASE INST NTR NL TLL TIB SS AL 2OF 2 249007950 C1713 SUPPLY/IMPLANTS "$6,481.00 " Outpatient "$3,240.50 " "$1,219.74 " "$4,212.65 " "$4,536.70 " "$4,277.46 " Not Applicable: Bundled with Procedure "$2,268.35 " "$5,184.80 " "$1,219.74 " "$5,184.80 " CASE INST NTR NL STD FEM SS ANTGRD 1OF 2 249008200 C1713 SUPPLY/IMPLANTS "$7,545.00 " Outpatient "$3,772.50 " "$1,219.74 " "$4,904.25 " "$5,281.50 " "$4,979.70 " Not Applicable: Bundled with Procedure "$2,640.75 " "$6,036.00 " "$1,219.74 " "$6,036.00 " CASE INST NTR NL STD FEM SS ANTGRD 2OF 2 249008500 C1713 SUPPLY/IMPLANTS "$7,062.00 " Outpatient "$3,531.00 " "$1,219.74 " "$4,590.30 " "$4,943.40 " "$4,660.92 " Not Applicable: Bundled with Procedure "$2,471.70 " "$5,649.60 " "$1,219.74 " "$5,649.60 " CASE INST SCP 261103500 C1713 SUPPLY/IMPLANTS "$2,517.00 " Outpatient "$1,258.50 " "$1,219.74 " "$1,636.05 " "$1,761.90 " "$1,661.22 " Not Applicable: Bundled with Procedure $880.95 "$2,013.60 " $880.95 "$2,013.60 " CASE INST MN FRAG 261107500 C1713 SUPPLY/IMPLANTS "$4,385.00 " Outpatient "$2,192.50 " "$1,219.74 " "$2,850.25 " "$3,069.50 " "$2,894.10 " Not Applicable: Bundled with Procedure "$1,534.75 " "$3,508.00 " "$1,219.74 " "$3,508.00 " CASE INST AL MN FRAG NS 480100500 C1713 SUPPLY/IMPLANTS $471.00 Outpatient $235.50 "$1,219.74 " $306.15 $329.70 $310.86 Not Applicable: Bundled with Procedure $164.85 $376.80 $164.85 "$1,219.74 " CASE INST AL DECAL DECAL SM NS PLV 480101000 C1713 SUPPLY/IMPLANTS $527.00 Outpatient $263.50 "$1,219.74 " $342.55 $368.90 $347.82 Not Applicable: Bundled with Procedure $184.45 $421.60 $184.45 "$1,219.74 " CASE IMPL AL DECAL PLV 480103000 C1713 SUPPLY/IMPLANTS "$4,418.00 " Outpatient "$2,209.00 " "$1,219.74 " "$2,871.70 " "$3,092.60 " "$2,915.88 " Not Applicable: Bundled with Procedure "$1,546.30 " "$3,534.40 " "$1,219.74 " "$3,534.40 " CASE INST SS RADEL AL 2 CMPR CNTR SM FRAG PLT NS 480103550 C1713 SUPPLY/IMPLANTS "$13,608.00 " Outpatient "$6,804.00 " "$1,219.74 " "$8,845.20 " "$9,525.60 " "$8,981.28 " Not Applicable: Bundled with Procedure "$4,762.80 " "$10,886.40 " "$1,219.74 " "$10,886.40 " CASE INST CNTR SS RADEL AL 2 CMPR BSC PLT 480104550 C1713 SUPPLY/IMPLANTS "$7,594.00 " Outpatient "$3,797.00 " "$1,219.74 " "$4,936.10 " "$5,315.80 " "$5,012.04 " Not Applicable: Bundled with Procedure "$2,657.90 " "$6,075.20 " "$1,219.74 " "$6,075.20 " CASE INST BSC FCP 4801 480105520 C1713 SUPPLY/IMPLANTS "$2,554.00 " Outpatient "$1,277.00 " "$1,219.74 " "$1,660.10 " "$1,787.80 " "$1,685.64 " Not Applicable: Bundled with Procedure $893.90 "$2,043.20 " $893.90 "$2,043.20 " CASE INST BSC FCP II 4801 480105550 C1713 SUPPLY/IMPLANTS "$4,676.00 " Outpatient "$2,338.00 " "$1,219.74 " "$3,039.40 " "$3,273.20 " "$3,086.16 " Not Applicable: Bundled with Procedure "$1,636.60 " "$3,740.80 " "$1,219.74 " "$3,740.80 " CASE INST PLV 4801 480107510 C1713 SUPPLY/IMPLANTS "$10,802.00 " Outpatient "$5,401.00 " "$1,219.74 " "$7,021.30 " "$7,561.40 " "$7,129.32 " Not Applicable: Bundled with Procedure "$3,780.70 " "$8,641.60 " "$1,219.74 " "$8,641.60 " CASE INST PLV 480107520 C1713 SUPPLY/IMPLANTS "$13,221.00 " Outpatient "$6,610.50 " "$1,219.74 " "$8,593.65 " "$9,254.70 " "$8,725.86 " Not Applicable: Bundled with Procedure "$4,627.35 " "$10,576.80 " "$1,219.74 " "$10,576.80 " CASE INST PLV CLP 4801 480107530 C1713 SUPPLY/IMPLANTS "$9,415.00 " Outpatient "$4,707.50 " "$1,219.74 " "$6,119.75 " "$6,590.50 " "$6,213.90 " Not Applicable: Bundled with Procedure "$3,295.25 " "$7,532.00 " "$1,219.74 " "$7,532.00 " CASE INST PLV SPCL CLP 4801 480107540 C1713 SUPPLY/IMPLANTS "$7,320.00 " Outpatient "$3,660.00 " "$1,219.74 " "$4,758.00 " "$5,124.00 " "$4,831.20 " Not Applicable: Bundled with Procedure "$2,562.00 " "$5,856.00 " "$1,219.74 " "$5,856.00 " CASE INST MN AUX SCR LF 480200500 C1713 SUPPLY/IMPLANTS "$5,386.00 " Outpatient "$2,693.00 " "$1,219.74 " "$3,500.90 " "$3,770.20 " "$3,554.76 " Not Applicable: Bundled with Procedure "$1,885.10 " "$4,308.80 " "$1,219.74 " "$4,308.80 " CASE INST 3.5 MM UNV LCK SYS NS 483609000 C1713 SUPPLY/IMPLANTS "$9,383.00 " Outpatient "$4,691.50 " "$1,219.74 " "$6,098.95 " "$6,568.10 " "$6,192.78 " Not Applicable: Bundled with Procedure "$3,284.05 " "$7,506.40 " "$1,219.74 " "$7,506.40 " CASE INST TI 2.7 MM SCR UNV LCK SYS 483809500 C1713 SUPPLY/IMPLANTS "$17,879.00 " Outpatient "$8,939.50 " "$1,219.74 " "$11,621.35 " "$12,515.30 " "$11,800.14 " Not Applicable: Bundled with Procedure "$6,257.65 " "$14,303.20 " "$1,219.74 " "$14,303.20 " CASE INST TI 3.5 MM UNV LCK SYS 484609000 C1713 SUPPLY/IMPLANTS "$17,669.00 " Outpatient "$8,834.50 " "$1,219.74 " "$11,484.85 " "$12,368.30 " "$11,661.54 " Not Applicable: Bundled with Procedure "$6,184.15 " "$14,135.20 " "$1,219.74 " "$14,135.20 " CASE INST MOD 2 MM TI MNDB LCK PLT SET NS 304.744 C1713 SUPPLY/IMPLANTS "$6,756.00 " Outpatient "$3,378.00 " "$1,219.74 " "$4,391.40 " "$4,729.20 " "$4,458.96 " Not Applicable: Bundled with Procedure "$2,364.60 " "$5,404.80 " "$1,219.74 " "$5,404.80 " CASE STRL SET GRPH IMPL LCP 690.347 C1713 SUPPLY/IMPLANTS "$9,005.00 " Outpatient "$4,502.50 " "$1,219.74 " "$5,853.25 " "$6,303.50 " "$5,943.30 " Not Applicable: Bundled with Procedure "$3,151.75 " "$7,204.00 " "$1,219.74 " "$7,204.00 " CASE STRL MN FRAG SET IMPL ST 305.575 C1713 SUPPLY/IMPLANTS "$5,851.00 " Outpatient "$2,925.50 " "$1,219.74 " "$3,803.15 " "$4,095.70 " "$3,861.66 " Not Applicable: Bundled with Procedure "$2,047.85 " "$4,680.80 " "$1,219.74 " "$4,680.80 " CASE STRL UNV RBN MOD 14647 C1713 SUPPLY/IMPLANTS "$2,160.00 " Outpatient "$1,080.00 " "$1,219.74 " "$1,404.00 " "$1,512.00 " "$1,425.60 " Not Applicable: Bundled with Procedure $756.00 "$1,728.00 " $756.00 "$1,728.00 " CASE STRL MOD 2.7 MM SCR PLT 8140-99-376 C1713 SUPPLY/IMPLANTS "$2,439.00 " Outpatient "$1,219.50 " "$1,219.74 " "$1,585.35 " "$1,707.30 " "$1,609.74 " Not Applicable: Bundled with Procedure $853.65 "$1,951.20 " $853.65 "$1,951.20 " CASE STRL 1 MOD 1.5 MM SCR PLT 8140-99-176 C1713 SUPPLY/IMPLANTS "$2,730.00 " Outpatient "$1,365.00 " "$1,219.74 " "$1,774.50 " "$1,911.00 " "$1,801.80 " Not Applicable: Bundled with Procedure $955.50 "$2,184.00 " $955.50 "$2,184.00 " CASE STRL 2 MOD 2 MM SCR PLT 8140-99-276 C1713 SUPPLY/IMPLANTS "$2,780.00 " Outpatient "$1,390.00 " "$1,219.74 " "$1,807.00 " "$1,946.00 " "$1,834.80 " Not Applicable: Bundled with Procedure $973.00 "$2,224.00 " $973.00 "$2,224.00 " CASE STRL MOD DCP TBLR RECON 13650 C1713 SUPPLY/IMPLANTS "$2,809.00 " Outpatient "$1,404.50 " "$1,219.74 " "$1,825.85 " "$1,966.30 " "$1,853.94 " Not Applicable: Bundled with Procedure $983.15 "$2,247.20 " $983.15 "$2,247.20 " CASE STRL CLVCL PIN 2129-60-000 C1713 SUPPLY/IMPLANTS "$2,676.00 " Outpatient "$1,338.00 " "$1,219.74 " "$1,739.40 " "$1,873.20 " "$1,766.16 " Not Applicable: Bundled with Procedure $936.60 "$2,140.80 " $936.60 "$2,140.80 " CASE STRL MOD 8241-95-000 C1713 SUPPLY/IMPLANTS "$2,695.00 " Outpatient "$1,347.50 " "$1,219.74 " "$1,751.75 " "$1,886.50 " "$1,778.70 " Not Applicable: Bundled with Procedure $943.25 "$2,156.00 " $943.25 "$2,156.00 " CASE STRL LFT LCK TIBPLT LG FRAG SET 8299-52-042 C1713 SUPPLY/IMPLANTS "$2,750.00 " Outpatient "$1,375.00 " "$1,219.74 " "$1,787.50 " "$1,925.00 " "$1,815.00 " Not Applicable: Bundled with Procedure $962.50 "$2,200.00 " $962.50 "$2,200.00 " CASE STRL BS OUTR LWR XTRMT 829953001 C1713 SUPPLY/IMPLANTS "$3,274.00 " Outpatient "$1,637.00 " "$1,219.74 " "$2,128.10 " "$2,291.80 " "$2,160.84 " Not Applicable: Bundled with Procedure "$1,145.90 " "$2,619.20 " "$1,145.90 " "$2,619.20 " CASE STRL STRL CNN HEX SCR 8299-17-000 C1713 SUPPLY/IMPLANTS "$3,435.00 " Outpatient "$1,717.50 " "$1,219.74 " "$2,232.75 " "$2,404.50 " "$2,267.10 " Not Applicable: Bundled with Procedure "$1,202.25 " "$2,748.00 " "$1,202.25 " "$2,748.00 " CASE STRL TRY 2 LCK PLT LG FRAG SET 8299-52-051 C1713 SUPPLY/IMPLANTS "$3,566.00 " Outpatient "$1,783.00 " "$1,219.74 " "$2,317.90 " "$2,496.20 " "$2,353.56 " Not Applicable: Bundled with Procedure "$1,248.10 " "$2,852.80 " "$1,219.74 " "$2,852.80 " CASE STRL REUN INST PIN 450072 C1713 SUPPLY/IMPLANTS "$4,021.00 " Outpatient "$2,010.50 " "$1,219.74 " "$2,613.65 " "$2,814.70 " "$2,653.86 " Not Applicable: Bundled with Procedure "$1,407.35 " "$3,216.80 " "$1,219.74 " "$3,216.80 " CASE STRL SCR LG FRAG 8299-18-000 C1713 SUPPLY/IMPLANTS "$4,056.00 " Outpatient "$2,028.00 " "$1,219.74 " "$2,636.40 " "$2,839.20 " "$2,676.96 " Not Applicable: Bundled with Procedure "$1,419.60 " "$3,244.80 " "$1,219.74 " "$3,244.80 " CASE STRL LCK OUTR LG FRAG SET 8299-52-041 C1713 SUPPLY/IMPLANTS "$4,467.00 " Outpatient "$2,233.50 " "$1,219.74 " "$2,903.55 " "$3,126.90 " "$2,948.22 " Not Applicable: Bundled with Procedure "$1,563.45 " "$3,573.60 " "$1,219.74 " "$3,573.60 " CASE STRL SCR TRY TK2 8299-14-000 C1713 SUPPLY/IMPLANTS "$4,550.00 " Outpatient "$2,275.00 " "$1,219.74 " "$2,957.50 " "$3,185.00 " "$3,003.00 " Not Applicable: Bundled with Procedure "$1,592.50 " "$3,640.00 " "$1,219.74 " "$3,640.00 " CASE STRL ALPS MIS CALCANEUS PLT 110010749 C1713 SUPPLY/IMPLANTS "$5,146.00 " Outpatient "$2,573.00 " "$1,219.74 " "$3,344.90 " "$3,602.20 " "$3,396.36 " Not Applicable: Bundled with Procedure "$1,801.10 " "$4,116.80 " "$1,219.74 " "$4,116.80 " CASE STRL CNCT ROD 200801004 C1713 SUPPLY/IMPLANTS "$5,343.00 " Outpatient "$2,671.50 " "$1,219.74 " "$3,472.95 " "$3,740.10 " "$3,526.38 " Not Applicable: Bundled with Procedure "$1,870.05 " "$4,274.40 " "$1,219.74 " "$4,274.40 " CASE STRL RING FRM 200801007 C1713 SUPPLY/IMPLANTS "$5,390.00 " Outpatient "$2,695.00 " "$1,219.74 " "$3,503.50 " "$3,773.00 " "$3,557.40 " Not Applicable: Bundled with Procedure "$1,886.50 " "$4,312.00 " "$1,219.74 " "$4,312.00 " CASE STRL TRY 1 LCK PLT LG FRAG SET 8299-52-050 C1713 SUPPLY/IMPLANTS "$5,732.00 " Outpatient "$2,866.00 " "$1,219.74 " "$3,725.80 " "$4,012.40 " "$3,783.12 " Not Applicable: Bundled with Procedure "$2,006.20 " "$4,585.60 " "$1,219.74 " "$4,585.60 " CASE STRL POLYAX FEM SCR 8299-13-000 C1713 SUPPLY/IMPLANTS "$6,124.00 " Outpatient "$3,062.00 " "$1,219.74 " "$3,980.60 " "$4,286.80 " "$4,041.84 " Not Applicable: Bundled with Procedure "$2,143.40 " "$4,899.20 " "$1,219.74 " "$4,899.20 " CASE STRL VERSANAIL 8299-23-000 C1713 SUPPLY/IMPLANTS "$6,364.00 " Outpatient "$3,182.00 " "$1,219.74 " "$4,136.60 " "$4,454.80 " "$4,200.24 " Not Applicable: Bundled with Procedure "$2,227.40 " "$5,091.20 " "$1,219.74 " "$5,091.20 " CASE STRL SM FRAG 8299-40-000 C1713 SUPPLY/IMPLANTS "$7,038.00 " Outpatient "$3,519.00 " "$1,219.74 " "$4,574.70 " "$4,926.60 " "$4,645.08 " Not Applicable: Bundled with Procedure "$2,463.30 " "$5,630.40 " "$1,219.74 " "$5,630.40 " CASE STRL TI MN FRAG SET 8140-99-476 C1713 SUPPLY/IMPLANTS "$7,162.00 " Outpatient "$3,581.00 " "$1,219.74 " "$4,655.30 " "$5,013.40 " "$4,726.92 " Not Applicable: Bundled with Procedure "$2,506.70 " "$5,729.60 " "$1,219.74 " "$5,729.60 " CASE STRL INST 595152 C1713 SUPPLY/IMPLANTS "$8,458.00 " Outpatient "$4,229.00 " "$1,219.74 " "$5,497.70 " "$5,920.60 " "$5,582.28 " Not Applicable: Bundled with Procedure "$2,960.30 " "$6,766.40 " "$1,219.74 " "$6,766.40 " CASE STRL LCK CMPLT LG FRAG SET 8299-52-040 C1713 SUPPLY/IMPLANTS "$11,930.00 " Outpatient "$5,965.00 " "$1,219.74 " "$7,754.50 " "$8,351.00 " "$7,873.80 " Not Applicable: Bundled with Procedure "$4,175.50 " "$9,544.00 " "$1,219.74 " "$9,544.00 " CASE STRL PA SCR 8299-13-200 C1713 SUPPLY/IMPLANTS "$12,381.00 " Outpatient "$6,190.50 " "$1,219.74 " "$8,047.65 " "$8,666.70 " "$8,171.46 " Not Applicable: Bundled with Procedure "$4,333.35 " "$9,904.80 " "$1,219.74 " "$9,904.80 " CASE STRL PA TIB SCR 8299-13-100 C1713 SUPPLY/IMPLANTS "$12,689.00 " Outpatient "$6,344.50 " "$1,219.74 " "$8,247.85 " "$8,882.30 " "$8,374.74 " Not Applicable: Bundled with Procedure "$4,441.15 " "$10,151.20 " "$1,219.74 " "$10,151.20 " CASE STRL VHS GRPH SET INST 595034 C1713 SUPPLY/IMPLANTS "$13,450.00 " Outpatient "$6,725.00 " "$1,219.74 " "$8,742.50 " "$9,415.00 " "$8,877.00 " Not Applicable: Bundled with Procedure "$4,707.50 " "$10,760.00 " "$1,219.74 " "$10,760.00 " CASE STRL BMP INST XPD CBL 592054 C1713 SUPPLY/IMPLANTS "$13,686.00 " Outpatient "$6,843.00 " "$1,219.74 " "$8,895.90 " "$9,580.20 " "$9,032.76 " Not Applicable: Bundled with Procedure "$4,790.10 " "$10,948.80 " "$1,219.74 " "$10,948.80 " CASE STRL CMPLT SM LWR XTRMT 8299-53-003 C1713 SUPPLY/IMPLANTS "$15,291.00 " Outpatient "$7,645.50 " "$1,219.74 " "$9,939.15 " "$10,703.70 " "$10,092.06 " Not Applicable: Bundled with Procedure "$5,351.85 " "$12,232.80 " "$1,219.74 " "$12,232.80 " CASE STRL CMPLT LWR XTRMT 8299-53-000 C1713 SUPPLY/IMPLANTS "$37,922.00 " Outpatient "$18,961.00 " "$1,219.74 " "$24,649.30 " "$26,545.40 " "$25,028.52 " Not Applicable: Bundled with Procedure "$13,272.70 " "$30,337.60 " "$1,219.74 " "$30,337.60 " CASE STRL PPS POLYETHERIMIDE CNN SCR MGNFX NS 114608200 C1713 SUPPLY/IMPLANTS "$7,385.00 " Outpatient "$3,692.50 " "$1,219.74 " "$4,800.25 " "$5,169.50 " "$4,874.10 " Not Applicable: Bundled with Procedure "$2,584.75 " "$5,908.00 " "$1,219.74 " "$5,908.00 " CASE STRL POLYETHERIMIDE CNN HRBRT NS LF BN SCR 115508500 C1713 SUPPLY/IMPLANTS "$5,030.00 " Outpatient "$2,515.00 " "$1,219.74 " "$3,269.50 " "$3,521.00 " "$3,319.80 " Not Applicable: Bundled with Procedure "$1,760.50 " "$4,024.00 " "$1,219.74 " "$4,024.00 " CASE STRL PPS VFX2 NS 119309000 C1713 SUPPLY/IMPLANTS "$7,288.00 " Outpatient "$3,644.00 " "$1,219.74 " "$4,737.20 " "$5,101.60 " "$4,810.08 " Not Applicable: Bundled with Procedure "$2,550.80 " "$5,830.40 " "$1,219.74 " "$5,830.40 " CASE STRL 34.6X34.6CM ANZD AL MNL INST 3.8CM NS LF 280009000 C1713 SUPPLY/IMPLANTS "$2,580.00 " Outpatient "$1,290.00 " "$1,219.74 " "$1,677.00 " "$1,806.00 " "$1,702.80 " Not Applicable: Bundled with Procedure $903.00 "$2,064.00 " $903.00 "$2,064.00 " CASE STRL 3.5 MM TI ULS 484608000 C1713 SUPPLY/IMPLANTS "$17,702.00 " Outpatient "$8,851.00 " "$1,219.74 " "$11,506.30 " "$12,391.40 " "$11,683.32 " Not Applicable: Bundled with Procedure "$6,195.70 " "$14,161.60 " "$1,219.74 " "$14,161.60 " CASE STRL MOD GRPH LOPR NRO CMPCT 304.634 C1713 SUPPLY/IMPLANTS "$3,470.00 " Outpatient "$1,735.00 " "$1,219.74 " "$2,255.50 " "$2,429.00 " "$2,290.20 " Not Applicable: Bundled with Procedure "$1,214.50 " "$2,776.00 " "$1,214.50 " "$2,776.00 " CASE STRL TRMA MOD 2 MM MNDB FX SYS 304.658 C1713 SUPPLY/IMPLANTS "$5,192.00 " Outpatient "$2,596.00 " "$1,219.74 " "$3,374.80 " "$3,634.40 " "$3,426.72 " Not Applicable: Bundled with Procedure "$1,817.20 " "$4,153.60 " "$1,219.74 " "$4,153.60 " CASE STRL MOD 1.5MM NS TI IMPL 304.661 C1713 SUPPLY/IMPLANTS "$4,821.00 " Outpatient "$2,410.50 " "$1,219.74 " "$3,133.65 " "$3,374.70 " "$3,181.86 " Not Applicable: Bundled with Procedure "$1,687.35 " "$3,856.80 " "$1,219.74 " "$3,856.80 " CASE STRL MOD 2MM NS TI IMPL 304.662 C1713 SUPPLY/IMPLANTS "$4,821.00 " Outpatient "$2,410.50 " "$1,219.74 " "$3,133.65 " "$3,374.70 " "$3,181.86 " Not Applicable: Bundled with Procedure "$1,687.35 " "$3,856.80 " "$1,219.74 " "$3,856.80 " CASE STRL MOD 1MM NS TI IMPL 304.663 C1713 SUPPLY/IMPLANTS "$4,821.00 " Outpatient "$2,410.50 " "$1,219.74 " "$3,133.65 " "$3,374.70 " "$3,181.86 " Not Applicable: Bundled with Procedure "$1,687.35 " "$3,856.80 " "$1,219.74 " "$3,856.80 " CASE STRL MOD NS 1.3 MM CRNFCL IMPL 304.672 C1713 SUPPLY/IMPLANTS "$5,041.00 " Outpatient "$2,520.50 " "$1,219.74 " "$3,276.65 " "$3,528.70 " "$3,327.06 " Not Applicable: Bundled with Procedure "$1,764.35 " "$4,032.80 " "$1,219.74 " "$4,032.80 " CASE STRL LCK PLT MOD 2 MM MNDB FX SYS 304.673 C1713 SUPPLY/IMPLANTS "$4,072.00 " Outpatient "$2,036.00 " "$1,219.74 " "$2,646.80 " "$2,850.40 " "$2,687.52 " Not Applicable: Bundled with Procedure "$1,425.20 " "$3,257.60 " "$1,219.74 " "$3,257.60 " CASE STRL MOD STD LOPR NRO CMPCT 304.674 C1713 SUPPLY/IMPLANTS "$3,470.00 " Outpatient "$1,735.00 " "$1,219.74 " "$2,255.50 " "$2,429.00 " "$2,290.20 " Not Applicable: Bundled with Procedure "$1,214.50 " "$2,776.00 " "$1,214.50 " "$2,776.00 " CASE STRL MOD NS LCK RECON PLT 304.701 C1713 SUPPLY/IMPLANTS "$4,821.00 " Outpatient "$2,410.50 " "$1,219.74 " "$3,133.65 " "$3,374.70 " "$3,181.86 " Not Applicable: Bundled with Procedure "$1,687.35 " "$3,856.80 " "$1,219.74 " "$3,856.80 " CASE STRL NS MXLFCL SCR 304.708 C1713 SUPPLY/IMPLANTS "$4,803.00 " Outpatient "$2,401.50 " "$1,219.74 " "$3,121.95 " "$3,362.10 " "$3,169.98 " Not Applicable: Bundled with Procedure "$1,681.05 " "$3,842.40 " "$1,219.74 " "$3,842.40 " CASE STRL GRPH 4 MOD LG MNDB MDLR FX SYS 304.73 C1713 SUPPLY/IMPLANTS "$9,663.00 " Outpatient "$4,831.50 " "$1,219.74 " "$6,280.95 " "$6,764.10 " "$6,377.58 " Not Applicable: Bundled with Procedure "$3,382.05 " "$7,730.40 " "$1,219.74 " "$7,730.40 " CASE STRL MOD MXL DSTRCT 304.753 C1713 SUPPLY/IMPLANTS "$4,309.00 " Outpatient "$2,154.50 " "$1,219.74 " "$2,800.85 " "$3,016.30 " "$2,843.94 " Not Applicable: Bundled with Procedure "$1,508.15 " "$3,447.20 " "$1,219.74 " "$3,447.20 " CASE STRL UNV INST DP LG NS 304.76 C1713 SUPPLY/IMPLANTS "$2,947.00 " Outpatient "$1,473.50 " "$1,219.74 " "$1,915.55 " "$2,062.90 " "$1,945.02 " Not Applicable: Bundled with Procedure "$1,031.45 " "$2,357.60 " "$1,031.45 " "$2,357.60 " CASE STRL GRPH 4 MOD MNDB MDLR FX SYS 304.78 C1713 SUPPLY/IMPLANTS "$9,370.00 " Outpatient "$4,685.00 " "$1,219.74 " "$6,090.50 " "$6,559.00 " "$6,184.20 " Not Applicable: Bundled with Procedure "$3,279.50 " "$7,496.00 " "$1,219.74 " "$7,496.00 " CASE STRL MOD CRNL CLP 304.793 C1713 SUPPLY/IMPLANTS "$3,638.00 " Outpatient "$1,819.00 " "$1,219.74 " "$2,364.70 " "$2,546.60 " "$2,401.08 " Not Applicable: Bundled with Procedure "$1,273.30 " "$2,910.40 " "$1,219.74 " "$2,910.40 " CASE STRL MOD TI MDFC DSTRCT 304.797 C1713 SUPPLY/IMPLANTS "$4,507.00 " Outpatient "$2,253.50 " "$1,219.74 " "$2,929.55 " "$3,154.90 " "$2,974.62 " Not Applicable: Bundled with Procedure "$1,577.45 " "$3,605.60 " "$1,219.74 " "$3,605.60 " CASE STRL GRPH MATRIXMIDFACE NS PLT SYS 306.601 C1713 SUPPLY/IMPLANTS "$5,497.00 " Outpatient "$2,748.50 " "$1,219.74 " "$3,573.05 " "$3,847.90 " "$3,628.02 " Not Applicable: Bundled with Procedure "$1,923.95 " "$4,397.60 " "$1,219.74 " "$4,397.60 " CASE STRL GNRC MOD MATRIXMIDFACE NS MATRIXMIDFACE SYS 306.61 C1713 SUPPLY/IMPLANTS "$4,434.00 " Outpatient "$2,217.00 " "$1,219.74 " "$2,882.10 " "$3,103.80 " "$2,926.44 " Not Applicable: Bundled with Procedure "$1,551.90 " "$3,547.20 " "$1,219.74 " "$3,547.20 " CASE STRL GRPH PLT MOD INS MATRIXMIDFACE NS .4 MM SCR PLT 306.614 C1713 SUPPLY/IMPLANTS "$1,976.00 " Outpatient $988.00 "$1,219.74 " "$1,284.40 " "$1,383.20 " "$1,304.16 " Not Applicable: Bundled with Procedure $691.60 "$1,580.80 " $691.60 "$1,580.80 " CASE STRL GRPH PLT MOD INS MATRIXMIDFACE NS .5 MM SCR PLT 306.615 C1713 SUPPLY/IMPLANTS "$1,976.00 " Outpatient $988.00 "$1,219.74 " "$1,284.40 " "$1,383.20 " "$1,304.16 " Not Applicable: Bundled with Procedure $691.60 "$1,580.80 " $691.60 "$1,580.80 " CASE STRL GRPH SCR MOD INS MATRIXMIDFACE NS PLT SYS 306.616 C1713 SUPPLY/IMPLANTS "$5,162.00 " Outpatient "$2,581.00 " "$1,219.74 " "$3,355.30 " "$3,613.40 " "$3,406.92 " Not Applicable: Bundled with Procedure "$1,806.70 " "$4,129.60 " "$1,219.74 " "$4,129.60 " CASE STRL GRPH PLT MOD INS MATRIXMIDFACE NS .7 MM SCR PLT 306.617 C1713 SUPPLY/IMPLANTS "$1,976.00 " Outpatient $988.00 "$1,219.74 " "$1,284.40 " "$1,383.20 " "$1,304.16 " Not Applicable: Bundled with Procedure $691.60 "$1,580.80 " $691.60 "$1,580.80 " CASE STRL GRPH PLT MOD INS MATRIXMIDFACE NS .8 MM SCR PLT 306.618 C1713 SUPPLY/IMPLANTS "$1,976.00 " Outpatient $988.00 "$1,219.74 " "$1,284.40 " "$1,383.20 " "$1,304.16 " Not Applicable: Bundled with Procedure $691.60 "$1,580.80 " $691.60 "$1,580.80 " CASE STRL GRPH MESH MOD ORBT PLT MATRIXMIDFACE NS PLT SYS 306.619 C1713 SUPPLY/IMPLANTS "$8,400.00 " Outpatient "$4,200.00 " "$1,219.74 " "$5,460.00 " "$5,880.00 " "$5,544.00 " Not Applicable: Bundled with Procedure "$2,940.00 " "$6,720.00 " "$1,219.74 " "$6,720.00 " CASE STRL GRPH MOD INST TRY MATRIXMIDFACE NS PLT SYS 306.626 C1713 SUPPLY/IMPLANTS "$3,031.00 " Outpatient "$1,515.50 " "$1,219.74 " "$1,970.15 " "$2,121.70 " "$2,000.46 " Not Applicable: Bundled with Procedure "$1,060.85 " "$2,424.80 " "$1,060.85 " "$2,424.80 " CASE STRL GRPH MOD DRLBT BLDE MATRIXMIDFACE NS PLT SYS 306.627 C1713 SUPPLY/IMPLANTS "$1,411.00 " Outpatient $705.50 "$1,219.74 " $917.15 $987.70 $931.26 Not Applicable: Bundled with Procedure $493.85 "$1,128.80 " $493.85 "$1,219.74 " CASE STRL GRPH NS MATRIXMANDILBE SYS 306.701 C1713 SUPPLY/IMPLANTS "$13,508.00 " Outpatient "$6,754.00 " "$1,219.74 " "$8,780.20 " "$9,455.60 " "$8,915.28 " Not Applicable: Bundled with Procedure "$4,727.80 " "$10,806.40 " "$1,219.74 " "$10,806.40 " CASE STRL GRPH BS NS MNDB XTRNFXTR SET 306.71 C1713 SUPPLY/IMPLANTS "$5,154.00 " Outpatient "$2,577.00 " "$1,219.74 " "$3,350.10 " "$3,607.80 " "$3,401.64 " Not Applicable: Bundled with Procedure "$1,803.90 " "$4,123.20 " "$1,219.74 " "$4,123.20 " CASE STRL GRPH LID NS MNDB XTRNFXTR SET 306.711 C1713 SUPPLY/IMPLANTS "$3,323.00 " Outpatient "$1,661.50 " "$1,219.74 " "$2,159.95 " "$2,326.10 " "$2,193.18 " Not Applicable: Bundled with Procedure "$1,163.05 " "$2,658.40 " "$1,163.05 " "$2,658.40 " CASE STRL GRPH BS NS MNDB XTRNFXTR II SET 306.72 C1713 SUPPLY/IMPLANTS "$4,835.00 " Outpatient "$2,417.50 " "$1,219.74 " "$3,142.75 " "$3,384.50 " "$3,191.10 " Not Applicable: Bundled with Procedure "$1,692.25 " "$3,868.00 " "$1,219.74 " "$3,868.00 " CASE STRL TROC MOD NS MATRIXMANDIBLE SYS 306.733 C1713 SUPPLY/IMPLANTS "$1,424.00 " Outpatient $712.00 "$1,219.74 " $925.60 $996.80 $939.84 Not Applicable: Bundled with Procedure $498.40 "$1,139.20 " $498.40 "$1,219.74 " CASE STRL PLT MOD SM NS MATRIXMANDIBLE SYS 306.74 C1713 SUPPLY/IMPLANTS "$8,634.00 " Outpatient "$4,317.00 " "$1,219.74 " "$5,612.10 " "$6,043.80 " "$5,698.44 " Not Applicable: Bundled with Procedure "$3,021.90 " "$6,907.20 " "$1,219.74 " "$6,907.20 " CASE STRL SCR MOD NS MATRIXMANDIBLE SYS 306.742 C1713 SUPPLY/IMPLANTS "$7,529.00 " Outpatient "$3,764.50 " "$1,219.74 " "$4,893.85 " "$5,270.30 " "$4,969.14 " Not Applicable: Bundled with Procedure "$2,635.15 " "$6,023.20 " "$1,219.74 " "$6,023.20 " CASE STRL PLT MOD LG NS MATRIXMANDIBLE SYS 306.749 C1713 SUPPLY/IMPLANTS "$14,343.00 " Outpatient "$7,171.50 " "$1,219.74 " "$9,322.95 " "$10,040.10 " "$9,466.38 " Not Applicable: Bundled with Procedure "$5,020.05 " "$11,474.40 " "$1,219.74 " "$11,474.40 " CBL ORTH COCR 1.6MM 120006 C1713 SUPPLY/IMPLANTS "$1,106.00 " Outpatient $553.00 "$1,219.74 " $718.90 $774.20 $729.96 Not Applicable: Bundled with Procedure $387.10 $884.80 $387.10 "$1,219.74 " CBL ORTH 2MM BALL TIP 350807 C1713 SUPPLY/IMPLANTS "$1,528.00 " Outpatient $764.00 "$1,219.74 " $993.20 "$1,069.60 " "$1,008.48 " Not Applicable: Bundled with Procedure $534.80 "$1,222.40 " $534.80 "$1,222.40 " CBL ORTH BMP 750MM SS 2MM HIP 350800 C1713 SUPPLY/IMPLANTS "$1,586.00 " Outpatient $793.00 "$1,219.74 " "$1,030.90 " "$1,110.20 " "$1,046.76 " Not Applicable: Bundled with Procedure $555.10 "$1,268.80 " $555.10 "$1,268.80 " CBL ORTH 750MM COCR 2MM 120002 C1713 SUPPLY/IMPLANTS "$1,835.00 " Outpatient $917.50 "$1,219.74 " "$1,192.75 " "$1,284.50 " "$1,211.10 " Not Applicable: Bundled with Procedure $642.25 "$1,468.00 " $642.25 "$1,468.00 " CBL ORTH BMP 750MM COCR 1.6MM HIP 120003 C1713 SUPPLY/IMPLANTS "$1,835.00 " Outpatient $917.50 "$1,219.74 " "$1,192.75 " "$1,284.50 " "$1,211.10 " Not Applicable: Bundled with Procedure $642.25 "$1,468.00 " $642.25 "$1,468.00 " CBL ORTH BMP TY II TENSOR 498007 C1713 SUPPLY/IMPLANTS "$16,136.00 " Outpatient "$8,068.00 " "$1,219.74 " "$10,488.40 " "$11,295.20 " "$10,649.76 " Not Applicable: Bundled with Procedure "$5,647.60 " "$12,908.80 " "$1,219.74 " "$12,908.80 " CBL ORTH CBL RD 36IN SS 1.8MM CRLGE STRL 223200128 C1713 SUPPLY/IMPLANTS "$2,292.00 " Outpatient "$1,146.00 " "$1,219.74 " "$1,489.80 " "$1,604.40 " "$1,512.72 " Not Applicable: Bundled with Procedure $802.20 "$1,833.60 " $802.20 "$1,833.60 " CBL ORTH CBL RD PLT 610CM SS 1.8MM GRP STRL 223200318 C1713 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 "$1,219.74 " $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,219.74 " CBL ORTH CBL RD 635CM COCR 1.8MM TROCH CRLGE CRMP 223200418 C1713 SUPPLY/IMPLANTS "$1,993.00 " Outpatient $996.50 "$1,219.74 " "$1,295.45 " "$1,395.10 " "$1,315.38 " Not Applicable: Bundled with Procedure $697.55 "$1,594.40 " $697.55 "$1,594.40 " CBL ORTH CBL RD GT REATT 635MM COCR LNG 1.8MM INTGR CRMP GRP 223200518 C1713 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 "$1,219.74 " $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,219.74 " CBL SLV ORTH 1.6MM DLMLS SET BEAD STRL LF DISP 6704-0-420 C1713 SUPPLY/IMPLANTS "$2,514.00 " Outpatient "$1,257.00 " "$1,219.74 " "$1,634.10 " "$1,759.80 " "$1,659.24 " Not Applicable: Bundled with Procedure $879.90 "$2,011.20 " $879.90 "$2,011.20 " CBL SRG POWEREASE NIM 2344000 C1713 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 "$1,219.74 " "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " CEMENT RESTRICTER REVISION UNIVERSAL 30.0MM B000-0300 C1713 SUPPLY/IMPLANTS $839.00 Outpatient $419.50 "$1,219.74 " $545.35 $587.30 $553.74 Not Applicable: Bundled with Procedure $293.65 $671.20 $293.65 "$1,219.74 " CEMENT BONE RALLY 40 GM HIGH VISCOSITY SPEARMINT GREEN 71271570 C1713 SUPPLY/IMPLANTS "$1,485.00 " Outpatient $742.50 "$1,219.74 " $965.25 "$1,039.50 " $980.10 Not Applicable: Bundled with Procedure $519.75 "$1,188.00 " $519.75 "$1,219.74 " CEMENT BONE HYDROSET XT HA 15 CC INJECTABLE STERILE LATEX FR 897015 C1713 SUPPLY/IMPLANTS "$20,843.00 " Outpatient "$10,421.50 " "$1,219.74 " "$13,547.95 " "$14,590.10 " "$13,756.38 " Not Applicable: Bundled with Procedure "$7,295.05 " "$16,674.40 " "$1,219.74 " "$16,674.40 " CEMENT BONE HYDROSET XT HA 10 CC INJECTABLE STERILE LATEX FR 897010 C1713 SUPPLY/IMPLANTS "$14,527.00 " Outpatient "$7,263.50 " "$1,219.74 " "$9,442.55 " "$10,168.90 " "$9,587.82 " Not Applicable: Bundled with Procedure "$5,084.45 " "$11,621.60 " "$1,219.74 " "$11,621.60 " CEMENT BONE REFOBACIN STERILE LATEX FREE DISPOSABLE 110034355 C1713 SUPPLY/IMPLANTS "$1,441.00 " Outpatient $720.50 "$1,219.74 " $936.65 "$1,008.70 " $951.06 Not Applicable: Bundled with Procedure $504.35 "$1,152.80 " $504.35 "$1,219.74 " CEMENT BONE SIMPLEX P TOBRAMYCIN 6197-9-001 C1713 SUPPLY/IMPLANTS "$1,484.00 " Outpatient $742.00 "$1,219.74 " $964.60 "$1,038.80 " $979.44 Not Applicable: Bundled with Procedure $519.40 "$1,187.20 " $519.40 "$1,219.74 " CEMENT BONE BIOMET 40 GM 110035368 C1713 SUPPLY/IMPLANTS "$1,085.00 " Outpatient $542.50 "$1,219.74 " $705.25 $759.50 $716.10 Not Applicable: Bundled with Procedure $379.75 $868.00 $379.75 "$1,219.74 " CENTRA ANTERIOR CERVICAL PLATING SYSTEM 19-0232 C1713 SUPPLY/IMPLANTS "$4,750.00 " Outpatient "$2,375.00 " "$1,219.74 " "$3,087.50 " "$3,325.00 " "$3,135.00 " Not Applicable: Bundled with Procedure "$1,662.50 " "$3,800.00 " "$1,219.74 " "$3,800.00 " CERAMENT BONE VOID FILLER 5ML AO210-09 C1713 SUPPLY/IMPLANTS "$5,505.00 " Outpatient "$2,752.50 " "$1,219.74 " "$3,578.25 " "$3,853.50 " "$3,633.30 " Not Applicable: Bundled with Procedure "$1,926.75 " "$4,404.00 " "$1,219.74 " "$4,404.00 " "CERVICAL PLATE, 3 LEVEL 51MM 30-0351" C1713 SUPPLY/IMPLANTS "$5,369.00 " Outpatient "$2,684.50 " "$1,219.74 " "$3,489.85 " "$3,758.30 " "$3,543.54 " Not Applicable: Bundled with Procedure "$1,879.15 " "$4,295.20 " "$1,219.74 " "$4,295.20 " CERVICAL PLATE 2 LEVEL 37MM 30-0237 C1713 SUPPLY/IMPLANTS "$6,643.00 " Outpatient "$3,321.50 " "$1,219.74 " "$4,317.95 " "$4,650.10 " "$4,384.38 " Not Applicable: Bundled with Procedure "$2,325.05 " "$5,314.40 " "$1,219.74 " "$5,314.40 " CERVICAL RETAINER PIN 12MM CRP-012-04 C1713 SUPPLY/IMPLANTS $714.00 Outpatient $357.00 "$1,219.74 " $464.10 $499.80 $471.24 Not Applicable: Bundled with Procedure $249.90 $571.20 $249.90 "$1,219.74 " CERVICAL DISC 6 LARGE 17MM X 14MM D X6MM H C1713 SUPPLY/IMPLANTS "$27,398.00 " Outpatient "$13,699.00 " "$1,219.74 " "$17,808.70 " "$19,178.60 " "$18,082.68 " Not Applicable: Bundled with Procedure "$9,589.30 " "$21,918.40 " "$1,219.74 " "$21,918.40 " CHIARI MESH SP-1343 C1713 SUPPLY/IMPLANTS "$9,556.00 " Outpatient "$4,778.00 " "$1,219.74 " "$6,211.40 " "$6,689.20 " "$6,306.96 " Not Applicable: Bundled with Procedure "$3,344.60 " "$7,644.80 " "$1,219.74 " "$7,644.80 " CLAMP BRIDGEPOINT SPINOUS PROCESS DS24001-145 C1713 SUPPLY/IMPLANTS "$68,868.00 " Outpatient "$34,434.00 " "$1,219.74 " "$44,764.20 " "$48,207.60 " "$45,452.88 " Not Applicable: Bundled with Procedure "$24,103.80 " "$55,094.40 " "$1,219.74 " "$55,094.40 " CLAMP EXTERNAL FIXATION HOFFMANN 3 OD11 MM 5 HOLE STRAIGHT P 4922-2-320 C1713 SUPPLY/IMPLANTS "$3,208.00 " Outpatient "$1,604.00 " "$1,219.74 " "$2,085.20 " "$2,245.60 " "$2,117.28 " Not Applicable: Bundled with Procedure "$1,122.80 " "$2,566.40 " "$1,122.80 " "$2,566.40 " CLICKER CMPR/DSTRCT 10CM DNFX TI ADLT C RL NS 6255 C1713 SUPPLY/IMPLANTS "$5,663.00 " Outpatient "$2,831.50 " "$1,219.74 " "$3,680.95 " "$3,964.10 " "$3,737.58 " Not Applicable: Bundled with Procedure "$1,982.05 " "$4,530.40 " "$1,219.74 " "$4,530.40 " CLICKER CMPR/DSTRCT 15CM DNFX TI ADLT C RL NS 6260 C1713 SUPPLY/IMPLANTS "$5,847.00 " Outpatient "$2,923.50 " "$1,219.74 " "$3,800.55 " "$4,092.90 " "$3,859.02 " Not Applicable: Bundled with Procedure "$2,046.45 " "$4,677.60 " "$1,219.74 " "$4,677.60 " CLICKER CMPR/DSTRCT 20CM DNFX TI ADLT C RL NS 6262 C1713 SUPPLY/IMPLANTS "$6,026.00 " Outpatient "$3,013.00 " "$1,219.74 " "$3,916.90 " "$4,218.20 " "$3,977.16 " Not Applicable: Bundled with Procedure "$2,109.10 " "$4,820.80 " "$1,219.74 " "$4,820.80 " CLIP SRG GAMMA3 CLS TUBE STRL 13200125S C1713 SUPPLY/IMPLANTS "$1,334.00 " Outpatient $667.00 "$1,219.74 " $867.10 $933.80 $880.44 Not Applicable: Bundled with Procedure $466.90 "$1,067.20 " $466.90 "$1,219.74 " CLLT PIN 5MM SHANZ SS DSTRCT NS 117903112 C1713 SUPPLY/IMPLANTS "$1,747.00 " Outpatient $873.50 "$1,219.74 " "$1,135.55 " "$1,222.90 " "$1,153.02 " Not Applicable: Bundled with Procedure $611.45 "$1,397.60 " $611.45 "$1,397.60 " CLP BN FRER OPTILOCK SRG SM SS DIST RADL PLT SYS 22894 C1713 SUPPLY/IMPLANTS "$1,066.00 " Outpatient $533.00 "$1,219.74 " $692.90 $746.20 $703.56 Not Applicable: Bundled with Procedure $373.10 $852.80 $373.10 "$1,219.74 " CLP BN SRG NTR NL 249002201 C1713 SUPPLY/IMPLANTS "$4,983.00 " Outpatient "$2,491.50 " "$1,219.74 " "$3,238.95 " "$3,488.10 " "$3,288.78 " Not Applicable: Bundled with Procedure "$1,744.05 " "$3,986.40 " "$1,219.74 " "$3,986.40 " CLP BNHDG LEWIN 10D 17.8CM 25.4MM SRR JAW SS NS LF 315500000 C1713 SUPPLY/IMPLANTS "$1,315.00 " Outpatient $657.50 "$1,219.74 " $854.75 $920.50 $867.90 Not Applicable: Bundled with Procedure $460.25 "$1,052.00 " $460.25 "$1,219.74 " CLP BNHDG LWMN LG 203MM SS NS LF 30.2MM 320500000 C1713 SUPPLY/IMPLANTS "$2,010.00 " Outpatient "$1,005.00 " "$1,219.74 " "$1,306.50 " "$1,407.00 " "$1,326.60 " Not Applicable: Bundled with Procedure $703.50 "$1,608.00 " $703.50 "$1,608.00 " CLP BNHDG LWMN 184MM JAW SS NS LF 25.4MM 320600000 C1713 SUPPLY/IMPLANTS "$2,010.00 " Outpatient "$1,005.00 " "$1,219.74 " "$1,306.50 " "$1,407.00 " "$1,326.60 " Not Applicable: Bundled with Procedure $703.50 "$1,608.00 " $703.50 "$1,608.00 " CLP BNHDG LWMN 102MM SS NS LF 19MM 320700000 C1713 SUPPLY/IMPLANTS "$2,010.00 " Outpatient "$1,005.00 " "$1,219.74 " "$1,306.50 " "$1,407.00 " "$1,326.60 " Not Applicable: Bundled with Procedure $703.50 "$1,608.00 " $703.50 "$1,608.00 " CLP BNHDG LWMN 203MM MOD JAW SS NS LF 28MM 320800000 C1713 SUPPLY/IMPLANTS "$2,630.00 " Outpatient "$1,315.00 " "$1,219.74 " "$1,709.50 " "$1,841.00 " "$1,735.80 " Not Applicable: Bundled with Procedure $920.50 "$2,104.00 " $920.50 "$2,104.00 " CLP BNHDG LWMN 184MM MOD JAW SS NS LF 30MM 320900000 C1713 SUPPLY/IMPLANTS "$2,630.00 " Outpatient "$1,315.00 " "$1,219.74 " "$1,709.50 " "$1,841.00 " "$1,735.80 " Not Applicable: Bundled with Procedure $920.50 "$2,104.00 " $920.50 "$2,104.00 " CLP CRTLG SRG 22.2MM ANG JAW 15D SS 15MM NS 371800000 C1713 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 "$1,219.74 " "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " CLP FEM POLYAX SRG LCK PLT SYS 2141-19-000 C1713 SUPPLY/IMPLANTS "$8,672.00 " Outpatient "$4,336.00 " "$1,219.74 " "$5,636.80 " "$6,070.40 " "$5,723.52 " Not Applicable: Bundled with Procedure "$3,035.20 " "$6,937.60 " "$1,219.74 " "$6,937.60 " CLP FT PERIART SRG LG SS NS 234705800 C1713 SUPPLY/IMPLANTS $621.00 Outpatient $310.50 "$1,219.74 " $403.65 $434.70 $409.86 Not Applicable: Bundled with Procedure $217.35 $496.80 $217.35 "$1,219.74 " CLP RPD RSRB 18MM CRNL FLP TUBE STRL 851.801.01S C1713 SUPPLY/IMPLANTS "$1,910.00 " Outpatient $955.00 "$1,219.74 " "$1,241.50 " "$1,337.00 " "$1,260.60 " Not Applicable: Bundled with Procedure $668.50 "$1,528.00 " $668.50 "$1,528.00 " CLP SRG TWL KWR 2312-20-115 C1713 SUPPLY/IMPLANTS "$3,077.00 " Outpatient "$1,538.50 " "$1,219.74 " "$2,000.05 " "$2,153.90 " "$2,030.82 " Not Applicable: Bundled with Procedure "$1,076.95 " "$2,461.60 " "$1,076.95 " "$2,461.60 " CLP SRG DVR CROSSLOCK MDLR TRY DRT BC C1713 SUPPLY/IMPLANTS "$2,017.00 " Outpatient "$1,008.50 " "$1,219.74 " "$1,311.05 " "$1,411.90 " "$1,331.22 " Not Applicable: Bundled with Procedure $705.95 "$1,613.60 " $705.95 "$1,613.60 " CLP SRG MN FXTR BRDG 7055 C1713 SUPPLY/IMPLANTS "$2,565.00 " Outpatient "$1,282.50 " "$1,219.74 " "$1,667.25 " "$1,795.50 " "$1,692.90 " Not Applicable: Bundled with Procedure $897.75 "$2,052.00 " $897.75 "$2,052.00 " CLP SRG SCR ANGL 15295 C1713 SUPPLY/IMPLANTS "$2,809.00 " Outpatient "$1,404.50 " "$1,219.74 " "$1,825.85 " "$1,966.30 " "$1,853.94 " Not Applicable: Bundled with Procedure $983.15 "$2,247.20 " $983.15 "$2,247.20 " CLP SRG CRV POST REG WHT 21260 C1713 SUPPLY/IMPLANTS "$3,013.00 " Outpatient "$1,506.50 " "$1,219.74 " "$1,958.45 " "$2,109.10 " "$1,988.58 " Not Applicable: Bundled with Procedure "$1,054.55 " "$2,410.40 " "$1,054.55 " "$2,410.40 " CLP SRG 26CM INLN TIP QCK SCR HNDL OFST SS NS 117902801 C1713 SUPPLY/IMPLANTS "$6,610.00 " Outpatient "$3,305.00 " "$1,219.74 " "$4,296.50 " "$4,627.00 " "$4,362.60 " Not Applicable: Bundled with Procedure "$2,313.50 " "$5,288.00 " "$1,219.74 " "$5,288.00 " CLP SRG 3.5CM 29CM QCK SCR HNDL OFST TIP SS NS 117902802 C1713 SUPPLY/IMPLANTS "$6,610.00 " Outpatient "$3,305.00 " "$1,219.74 " "$4,296.50 " "$4,627.00 " "$4,362.60 " Not Applicable: Bundled with Procedure "$2,313.50 " "$5,288.00 " "$1,219.74 " "$5,288.00 " CLP SRG 4.5CM 29CM QCK SCR HNDL OFST TIP SS NS 117902803 C1713 SUPPLY/IMPLANTS "$6,610.00 " Outpatient "$3,305.00 " "$1,219.74 " "$4,296.50 " "$4,627.00 " "$4,362.60 " Not Applicable: Bundled with Procedure "$2,313.50 " "$5,288.00 " "$1,219.74 " "$5,288.00 " CLP TIB POLYAX SRG LCK PLT SYS 2141-20-000 C1713 SUPPLY/IMPLANTS "$8,672.00 " Outpatient "$4,336.00 " "$1,219.74 " "$5,636.80 " "$6,070.40 " "$5,723.52 " Not Applicable: Bundled with Procedure "$3,035.20 " "$6,937.60 " "$1,219.74 " "$6,937.60 " CLP TUBE 13MM CRNL FLP TI NS 460.001 C1713 SUPPLY/IMPLANTS "$2,056.00 " Outpatient "$1,028.00 " "$1,219.74 " "$1,336.40 " "$1,439.20 " "$1,356.96 " Not Applicable: Bundled with Procedure $719.60 "$1,644.80 " $719.60 "$1,644.80 " CLP TUBE 13MM CRNL FLP TI STRL 460.001.01S C1713 SUPPLY/IMPLANTS "$2,257.00 " Outpatient "$1,128.50 " "$1,219.74 " "$1,467.05 " "$1,579.90 " "$1,489.62 " Not Applicable: Bundled with Procedure $789.95 "$1,805.60 " $789.95 "$1,805.60 " CLP TUBE 18MM CLVRLF CRNL FLP TI LOPRFL ANTM FIT SMTH DISK 460.002 C1713 SUPPLY/IMPLANTS "$2,152.00 " Outpatient "$1,076.00 " "$1,219.74 " "$1,398.80 " "$1,506.40 " "$1,420.32 " Not Applicable: Bundled with Procedure $753.20 "$1,721.60 " $753.20 "$1,721.60 " CLP TUBE 18MM CRNL FLP TI STRL 460.002.01S C1713 SUPPLY/IMPLANTS "$2,333.00 " Outpatient "$1,166.50 " "$1,219.74 " "$1,516.45 " "$1,633.10 " "$1,539.78 " Not Applicable: Bundled with Procedure $816.55 "$1,866.40 " $816.55 "$1,866.40 " CLP TUBE 22MM CRNL TI NS 460.003 C1713 SUPPLY/IMPLANTS "$2,257.00 " Outpatient "$1,128.50 " "$1,219.74 " "$1,467.05 " "$1,579.90 " "$1,489.62 " Not Applicable: Bundled with Procedure $789.95 "$1,805.60 " $789.95 "$1,805.60 " CLP TUBE 22MM CRNL FLP TI STRL 460.003.01S C1713 SUPPLY/IMPLANTS "$2,424.00 " Outpatient "$1,212.00 " "$1,219.74 " "$1,575.60 " "$1,696.80 " "$1,599.84 " Not Applicable: Bundled with Procedure $848.40 "$1,939.20 " $848.40 "$1,939.20 " CLP TUBE 13MM CLVRLF CRNL FLP TI LOPRFL ANTM FIT SMTH DISK 460.008 C1713 SUPPLY/IMPLANTS "$2,152.00 " Outpatient "$1,076.00 " "$1,219.74 " "$1,398.80 " "$1,506.40 " "$1,420.32 " Not Applicable: Bundled with Procedure $753.20 "$1,721.60 " $753.20 "$1,721.60 " CLP TUBE 13MM CRNL FLP TI TXTR NS 460.008.01S C1713 SUPPLY/IMPLANTS "$2,333.00 " Outpatient "$1,166.50 " "$1,219.74 " "$1,516.45 " "$1,633.10 " "$1,539.78 " Not Applicable: Bundled with Procedure $816.55 "$1,866.40 " $816.55 "$1,866.40 " CLP TUBE 18MM CLVRLF CRNL FLP TI LOPRFL ANTM FIT SMTH DISK 460.009 C1713 SUPPLY/IMPLANTS "$2,248.00 " Outpatient "$1,124.00 " "$1,219.74 " "$1,461.20 " "$1,573.60 " "$1,483.68 " Not Applicable: Bundled with Procedure $786.80 "$1,798.40 " $786.80 "$1,798.40 " CLP TUBE 18MM CRNL FLP TI TXTR STRL 460.009.01S C1713 SUPPLY/IMPLANTS "$2,424.00 " Outpatient "$1,212.00 " "$1,219.74 " "$1,575.60 " "$1,696.80 " "$1,599.84 " Not Applicable: Bundled with Procedure $848.40 "$1,939.20 " $848.40 "$1,939.20 " CLP TUBE 22MM CLVRLF CRNL FLP TI LOPRFL TXTR NS 460.01 C1713 SUPPLY/IMPLANTS "$2,333.00 " Outpatient "$1,166.50 " "$1,219.74 " "$1,516.45 " "$1,633.10 " "$1,539.78 " Not Applicable: Bundled with Procedure $816.55 "$1,866.40 " $816.55 "$1,866.40 " CLP TUBE 22MM CRNL FLP TI TXTR STRL 460.010.01S C1713 SUPPLY/IMPLANTS "$2,519.00 " Outpatient "$1,259.50 " "$1,219.74 " "$1,637.35 " "$1,763.30 " "$1,662.54 " Not Applicable: Bundled with Procedure $881.65 "$2,015.20 " $881.65 "$2,015.20 " CLP XTRNFX JTX FRDM 10.5-5MM BAR TO PIN MR SF 71064001 C1713 SUPPLY/IMPLANTS "$3,615.00 " Outpatient "$1,807.50 " "$1,219.74 " "$2,349.75 " "$2,530.50 " "$2,385.90 " Not Applicable: Bundled with Procedure "$1,265.25 " "$2,892.00 " "$1,219.74 " "$2,892.00 " CLP XTRNFX JTX 4 HL PIN 71067375 C1713 SUPPLY/IMPLANTS "$3,308.00 " Outpatient "$1,654.00 " "$1,219.74 " "$2,150.20 " "$2,315.60 " "$2,183.28 " Not Applicable: Bundled with Procedure "$1,157.80 " "$2,646.40 " "$1,157.80 " "$2,646.40 " CLP XTRNFX HFMN2 4/5/6 MM PIN 5 HL MRI CLR CD 4921-2-020 C1713 SUPPLY/IMPLANTS "$3,417.00 " Outpatient "$1,708.50 " "$1,219.74 " "$2,221.05 " "$2,391.90 " "$2,255.22 " Not Applicable: Bundled with Procedure "$1,195.95 " "$2,733.60 " "$1,195.95 " "$2,733.60 " CLP XTRNFX HFMN 3 5 HL PIN 4922-2-020 C1713 SUPPLY/IMPLANTS "$4,779.00 " Outpatient "$2,389.50 " "$1,219.74 " "$3,106.35 " "$3,345.30 " "$3,154.14 " Not Applicable: Bundled with Procedure "$1,672.65 " "$3,823.20 " "$1,219.74 " "$3,823.20 " CLP XTRNFX HFMN2 MIC MLPN 4960-2-020 C1713 SUPPLY/IMPLANTS "$3,765.00 " Outpatient "$1,882.50 " "$1,219.74 " "$2,447.25 " "$2,635.50 " "$2,484.90 " Not Applicable: Bundled with Procedure "$1,317.75 " "$3,012.00 " "$1,219.74 " "$3,012.00 " CLP XTRNFX HFMN 3 30D 11MM 5 HL 2 POST PIN 4922-2-240 C1713 SUPPLY/IMPLANTS "$3,414.00 " Outpatient "$1,707.00 " "$1,219.74 " "$2,219.10 " "$2,389.80 " "$2,253.24 " Not Applicable: Bundled with Procedure "$1,194.90 " "$2,731.20 " "$1,194.90 " "$2,731.20 " CLP XTRNFX HFMN 3 11MM 5 HL 2 STRG POST PIN 4922-2-220 C1713 SUPPLY/IMPLANTS "$5,282.00 " Outpatient "$2,641.00 " "$1,219.74 " "$3,433.30 " "$3,697.40 " "$3,486.12 " Not Applicable: Bundled with Procedure "$1,848.70 " "$4,225.60 " "$1,219.74 " "$4,225.60 " CLP XTRNFX SM 2. 5MM KWR SCHNZ SCR CMBN MR CONDITIONAL NS 390.041 C1713 SUPPLY/IMPLANTS "$2,569.00 " Outpatient "$1,284.50 " "$1,219.74 " "$1,669.85 " "$1,798.30 " "$1,695.54 " Not Applicable: Bundled with Procedure $899.15 "$2,055.20 " $899.15 "$2,055.20 " CLP XTRNFX XTRAFIX LG 3D BAR TO PIN BLU 520001002 C1713 SUPPLY/IMPLANTS "$2,977.00 " Outpatient "$1,488.50 " "$1,219.74 " "$1,935.05 " "$2,083.90 " "$1,964.82 " Not Applicable: Bundled with Procedure "$1,041.95 " "$2,381.60 " "$1,041.95 " "$2,381.60 " CLP XTRNFX XTRAFIX 75MM LG 2 BAR PIN LF BLU 520003006 C1713 SUPPLY/IMPLANTS "$7,043.00 " Outpatient "$3,521.50 " "$1,219.74 " "$4,577.95 " "$4,930.10 " "$4,648.38 " Not Applicable: Bundled with Procedure "$2,465.05 " "$5,634.40 " "$1,219.74 " "$5,634.40 " CLP XTRNFX XTRAFIX 45MM LG 2 BAR PIN LF BLU 520003004 C1713 SUPPLY/IMPLANTS "$6,892.00 " Outpatient "$3,446.00 " "$1,219.74 " "$4,479.80 " "$4,824.40 " "$4,548.72 " Not Applicable: Bundled with Procedure "$2,412.20 " "$5,513.60 " "$1,219.74 " "$5,513.60 " CLP XTRNFX XTRAFIX LG 3D BAR TO BAR LF BLU 520001001 C1713 SUPPLY/IMPLANTS "$3,066.00 " Outpatient "$1,533.00 " "$1,219.74 " "$1,992.90 " "$2,146.20 " "$2,023.56 " Not Applicable: Bundled with Procedure "$1,073.10 " "$2,452.80 " "$1,073.10 " "$2,452.80 " CLP XTRNFX XTRAFIX TIB 45MM PIN TRY 520004004 C1713 SUPPLY/IMPLANTS "$2,886.00 " Outpatient "$1,443.00 " "$1,219.74 " "$1,875.90 " "$2,020.20 " "$1,904.76 " Not Applicable: Bundled with Procedure "$1,010.10 " "$2,308.80 " "$1,010.10 " "$2,308.80 " CLP XTRNFX BN STD 4MM SCR 21256 C1713 SUPPLY/IMPLANTS "$1,282.00 " Outpatient $641.00 "$1,219.74 " $833.30 $897.40 $846.12 Not Applicable: Bundled with Procedure $448.70 "$1,025.60 " $448.70 "$1,219.74 " CLP XTRNFX BN STD 6MM SCR 21258 C1713 SUPPLY/IMPLANTS "$1,282.00 " Outpatient $641.00 "$1,219.74 " $833.30 $897.40 $846.12 Not Applicable: Bundled with Procedure $448.70 "$1,025.60 " $448.70 "$1,219.74 " CLP XTRNFX DFS MN STRG LNTHNR 7050 C1713 SUPPLY/IMPLANTS "$2,365.00 " Outpatient "$1,182.50 " "$1,219.74 " "$1,537.25 " "$1,655.50 " "$1,560.90 " Not Applicable: Bundled with Procedure $827.75 "$1,892.00 " $827.75 "$1,892.00 " CLP XTRNFX CONSTRUX 8- CM STRG AL CMPR DSTRCT MECH 1185 C1713 SUPPLY/IMPLANTS "$2,680.00 " Outpatient "$1,340.00 " "$1,219.74 " "$1,742.00 " "$1,876.00 " "$1,768.80 " Not Applicable: Bundled with Procedure $938.00 "$2,144.00 " $938.00 "$2,144.00 " CLP XTRNFX SPL SCR 1500 C1713 SUPPLY/IMPLANTS "$2,451.00 " Outpatient "$1,225.50 " "$1,219.74 " "$1,593.15 " "$1,715.70 " "$1,617.66 " Not Applicable: Bundled with Procedure $857.85 "$1,960.80 " $857.85 "$1,960.80 " CLP XTRNFX DNFX VSN 6 MM SCR 1 LCK RPD 14040 C1713 SUPPLY/IMPLANTS "$2,750.00 " Outpatient "$1,375.00 " "$1,219.74 " "$1,787.50 " "$1,925.00 " "$1,815.00 " Not Applicable: Bundled with Procedure $962.50 "$2,200.00 " $962.50 "$2,200.00 " CLP XTRNFX CONSTRUX 5- CM STRG C TLSCP ARM F CMPR DSTRCT 21180 C1713 SUPPLY/IMPLANTS "$2,755.00 " Outpatient "$1,377.50 " "$1,219.74 " "$1,790.75 " "$1,928.50 " "$1,818.30 " Not Applicable: Bundled with Procedure $964.25 "$2,204.00 " $964.25 "$2,204.00 " CLP XTRNFX DNFX VSN 3 HL 14060 C1713 SUPPLY/IMPLANTS "$2,790.00 " Outpatient "$1,395.00 " "$1,219.74 " "$1,813.50 " "$1,953.00 " "$1,841.40 " Not Applicable: Bundled with Procedure $976.50 "$2,232.00 " $976.50 "$2,232.00 " CLP XTRNFX SCR ANGL 6240 C1713 SUPPLY/IMPLANTS "$2,863.00 " Outpatient "$1,431.50 " "$1,219.74 " "$1,860.95 " "$2,004.10 " "$1,889.58 " Not Applicable: Bundled with Procedure "$1,002.05 " "$2,290.40 " "$1,002.05 " "$2,290.40 " CLP XTRNFX UNV PIN 21415 C1713 SUPPLY/IMPLANTS "$2,891.00 " Outpatient "$1,445.50 " "$1,219.74 " "$1,879.15 " "$2,023.70 " "$1,908.06 " Not Applicable: Bundled with Procedure "$1,011.85 " "$2,312.80 " "$1,011.85 " "$2,312.80 " CLP XTRNFX VSN 5 HL LWR TIER 14090 C1713 SUPPLY/IMPLANTS "$3,141.00 " Outpatient "$1,570.50 " "$1,219.74 " "$2,041.65 " "$2,198.70 " "$2,073.06 " Not Applicable: Bundled with Procedure "$1,099.35 " "$2,512.80 " "$1,099.35 " "$2,512.80 " CLP XTRNFX VSN STRG SLM ROD TO ROD RPD MRI SAFE 14600 C1713 SUPPLY/IMPLANTS "$3,184.00 " Outpatient "$1,592.00 " "$1,219.74 " "$2,069.60 " "$2,228.80 " "$2,101.44 " Not Applicable: Bundled with Procedure "$1,114.40 " "$2,547.20 " "$1,114.40 " "$2,547.20 " CLP XTRNFX XS 6MM RAIL 4445 C1713 SUPPLY/IMPLANTS "$3,375.00 " Outpatient "$1,687.50 " "$1,219.74 " "$2,193.75 " "$2,362.50 " "$2,227.50 " Not Applicable: Bundled with Procedure "$1,181.25 " "$2,700.00 " "$1,181.25 " "$2,700.00 " CLP XTRNFX UNV 2.7-6MM CMPR DSTRCT PIN 21405 C1713 SUPPLY/IMPLANTS "$3,416.00 " Outpatient "$1,708.00 " "$1,219.74 " "$2,220.40 " "$2,391.20 " "$2,254.56 " Not Applicable: Bundled with Procedure "$1,195.60 " "$2,732.80 " "$1,195.60 " "$2,732.80 " CLP XTRNFX XS 4MM RAIL CMPR DSTRCT 4455 C1713 SUPPLY/IMPLANTS "$3,903.00 " Outpatient "$1,951.50 " "$1,219.74 " "$2,536.95 " "$2,732.10 " "$2,575.98 " Not Applicable: Bundled with Procedure "$1,366.05 " "$3,122.40 " "$1,219.74 " "$3,122.40 " CLP XTRNFX VSN 4-6MM SLM PIN TO ROD RPD LWR TIER 14-400070 C1713 SUPPLY/IMPLANTS "$4,031.00 " Outpatient "$2,015.50 " "$1,219.74 " "$2,620.15 " "$2,821.70 " "$2,660.46 " Not Applicable: Bundled with Procedure "$1,410.85 " "$3,224.80 " "$1,219.74 " "$3,224.80 " CLP XTRNFX XS 6MM RAIL CMPR DSTRCT MID LVL 4465 C1713 SUPPLY/IMPLANTS "$4,609.00 " Outpatient "$2,304.50 " "$1,219.74 " "$2,995.85 " "$3,226.30 " "$3,041.94 " Not Applicable: Bundled with Procedure "$1,613.15 " "$3,687.20 " "$1,219.74 " "$3,687.20 " CLP XTRNFX .2CM XS FXTR STRG 2525 C1713 SUPPLY/IMPLANTS "$4,765.00 " Outpatient "$2,382.50 " "$1,219.74 " "$3,097.25 " "$3,335.50 " "$3,144.90 " Not Applicable: Bundled with Procedure "$1,667.75 " "$3,812.00 " "$1,219.74 " "$3,812.00 " CLP XTRNFX 4CM XS MAC TLSCP 2520 C1713 SUPPLY/IMPLANTS "$4,985.00 " Outpatient "$2,492.50 " "$1,219.74 " "$3,240.25 " "$3,489.50 " "$3,290.10 " Not Applicable: Bundled with Procedure "$1,744.75 " "$3,988.00 " "$1,219.74 " "$3,988.00 " CLP XTRNFX TIB PROX ANTM LCK PLT SYS 2142-35-014 C1713 SUPPLY/IMPLANTS "$5,865.00 " Outpatient "$2,932.50 " "$1,219.74 " "$3,812.25 " "$4,105.50 " "$3,870.90 " Not Applicable: Bundled with Procedure "$2,052.75 " "$4,692.00 " "$1,219.74 " "$4,692.00 " CLP XTRNFX STRG SM C RL NS 6570 C1713 SUPPLY/IMPLANTS "$6,026.00 " Outpatient "$3,013.00 " "$1,219.74 " "$3,916.90 " "$4,218.20 " "$3,977.16 " Not Applicable: Bundled with Procedure "$2,109.10 " "$4,820.80 " "$1,219.74 " "$4,820.80 " CLP XTRNFX T XS MAC VAR 2560 C1713 SUPPLY/IMPLANTS "$6,051.00 " Outpatient "$3,025.50 " "$1,219.74 " "$3,933.15 " "$4,235.70 " "$3,993.66 " Not Applicable: Bundled with Procedure "$2,117.85 " "$4,840.80 " "$1,219.74 " "$4,840.80 " CLP XTRNFX CONSTRUX T AL 14-450535 C1713 SUPPLY/IMPLANTS "$6,576.00 " Outpatient "$3,288.00 " "$1,219.74 " "$4,274.40 " "$4,603.20 " "$4,340.16 " Not Applicable: Bundled with Procedure "$2,301.60 " "$5,260.80 " "$1,219.74 " "$5,260.80 " CLP XTRNFX SM C RL BFC LENGTHEN NS 6585 C1713 SUPPLY/IMPLANTS "$6,623.00 " Outpatient "$3,311.50 " "$1,219.74 " "$4,304.95 " "$4,636.10 " "$4,371.18 " Not Applicable: Bundled with Procedure "$2,318.05 " "$5,298.40 " "$1,219.74 " "$5,298.40 " CLP XTRNFX SM C RL UNIPLANAR ADJ 6580 C1713 SUPPLY/IMPLANTS "$7,093.00 " Outpatient "$3,546.50 " "$1,219.74 " "$4,610.45 " "$4,965.10 " "$4,681.38 " Not Applicable: Bundled with Procedure "$2,482.55 " "$5,674.40 " "$1,219.74 " "$5,674.40 " CLP XTRNFX ARCH 20300 C1713 SUPPLY/IMPLANTS "$7,670.00 " Outpatient "$3,835.00 " "$1,219.74 " "$4,985.50 " "$5,369.00 " "$5,062.20 " Not Applicable: Bundled with Procedure "$2,684.50 " "$6,136.00 " "$1,219.74 " "$6,136.00 " CLP XTRNFX DNFX ADLT C RL END ADPR NS 6330 C1713 SUPPLY/IMPLANTS "$8,099.00 " Outpatient "$4,049.50 " "$1,219.74 " "$5,264.35 " "$5,669.30 " "$5,345.34 " Not Applicable: Bundled with Procedure "$2,834.65 " "$6,479.20 " "$1,219.74 " "$6,479.20 " CLP XTRNFX DNFX STRG ADLT C RL NS 6370 C1713 SUPPLY/IMPLANTS "$8,676.00 " Outpatient "$4,338.00 " "$1,219.74 " "$5,639.40 " "$6,073.20 " "$5,726.16 " Not Applicable: Bundled with Procedure "$3,036.60 " "$6,940.80 " "$1,219.74 " "$6,940.80 " CLP XTRNFX DNFX ADLT C RL UNIPLANER ADJ NS 6400 C1713 SUPPLY/IMPLANTS "$9,279.00 " Outpatient "$4,639.50 " "$1,219.74 " "$6,031.35 " "$6,495.30 " "$6,124.14 " Not Applicable: Bundled with Procedure "$3,247.65 " "$7,423.20 " "$1,219.74 " "$7,423.20 " CLP XTRNFX CONSTRUX 8- CM STRG AL 14-450530 C1713 SUPPLY/IMPLANTS "$9,377.00 " Outpatient "$4,688.50 " "$1,219.74 " "$6,095.05 " "$6,563.90 " "$6,188.82 " Not Applicable: Bundled with Procedure "$3,281.95 " "$7,501.60 " "$1,219.74 " "$7,501.60 " CLP XTRNFX SM RAIL GRADUAL ANGL NS 6650 C1713 SUPPLY/IMPLANTS "$9,490.00 " Outpatient "$4,745.00 " "$1,219.74 " "$6,168.50 " "$6,643.00 " "$6,263.40 " Not Applicable: Bundled with Procedure "$3,321.50 " "$7,592.00 " "$1,219.74 " "$7,592.00 " CLP XTRNFX CONSTRUX ANKL AL 14-450510 C1713 SUPPLY/IMPLANTS "$9,588.00 " Outpatient "$4,794.00 " "$1,219.74 " "$6,232.20 " "$6,711.60 " "$6,328.08 " Not Applicable: Bundled with Procedure "$3,355.80 " "$7,670.40 " "$1,219.74 " "$7,670.40 " CLP XTRNFX 5D ADLT C RL SHIM 6380 C1713 SUPPLY/IMPLANTS "$9,636.00 " Outpatient "$4,818.00 " "$1,219.74 " "$6,263.40 " "$6,745.20 " "$6,359.76 " Not Applicable: Bundled with Procedure "$3,372.60 " "$7,708.80 " "$1,219.74 " "$7,708.80 " CLP XTRNFX CONSTRUX ANKL C 14-450520 C1713 SUPPLY/IMPLANTS "$10,004.00 " Outpatient "$5,002.00 " "$1,219.74 " "$6,502.60 " "$7,002.80 " "$6,602.64 " Not Applicable: Bundled with Procedure "$3,501.40 " "$8,003.20 " "$1,219.74 " "$8,003.20 " CLP XTRNFX CONSTRUX ANG AL HNG 14-450540 C1713 SUPPLY/IMPLANTS "$10,008.00 " Outpatient "$5,004.00 " "$1,219.74 " "$6,505.20 " "$7,005.60 " "$6,605.28 " Not Applicable: Bundled with Procedure "$3,502.80 " "$8,006.40 " "$1,219.74 " "$8,006.40 " CLP XTRNFX DNFX ADLT C RL BFC NS 6375 C1713 SUPPLY/IMPLANTS "$10,506.00 " Outpatient "$5,253.00 " "$1,219.74 " "$6,828.90 " "$7,354.20 " "$6,933.96 " Not Applicable: Bundled with Procedure "$3,677.10 " "$8,404.80 " "$1,219.74 " "$8,404.80 " CLP XTRNFX CONSTRUX 5- CM STRG C 14-450515 C1713 SUPPLY/IMPLANTS "$10,707.00 " Outpatient "$5,353.50 " "$1,219.74 " "$6,959.55 " "$7,494.90 " "$7,066.62 " Not Applicable: Bundled with Procedure "$3,747.45 " "$8,565.60 " "$1,219.74 " "$8,565.60 " CLP XTRNFX 15D ADLT C RL SHIM 6390 C1713 SUPPLY/IMPLANTS "$10,722.00 " Outpatient "$5,361.00 " "$1,219.74 " "$6,969.30 " "$7,505.40 " "$7,076.52 " Not Applicable: Bundled with Procedure "$3,752.70 " "$8,577.60 " "$1,219.74 " "$8,577.60 " CLP XTRNFX 20D ADLT C RL SHIM 6395 C1713 SUPPLY/IMPLANTS "$11,388.00 " Outpatient "$5,694.00 " "$1,219.74 " "$7,402.20 " "$7,971.60 " "$7,516.08 " Not Applicable: Bundled with Procedure "$3,985.80 " "$9,110.40 " "$1,219.74 " "$9,110.40 " CLP XTRNFX DNFX ADLT C RL GRADUAL SWVL NS 6350 C1713 SUPPLY/IMPLANTS "$13,275.00 " Outpatient "$6,637.50 " "$1,219.74 " "$8,628.75 " "$9,292.50 " "$8,761.50 " Not Applicable: Bundled with Procedure "$4,646.25 " "$10,620.00 " "$1,219.74 " "$10,620.00 " CLP XTRNFX DNFX ADLT C RL TRANSLATIONAL NS 6360 C1713 SUPPLY/IMPLANTS "$13,275.00 " Outpatient "$6,637.50 " "$1,219.74 " "$8,628.75 " "$9,292.50 " "$8,761.50 " Not Applicable: Bundled with Procedure "$4,646.25 " "$10,620.00 " "$1,219.74 " "$10,620.00 " CLP XTRNFX XTRAFIX TIB 45MM PIN 1-BAR TRY 520002004 C1713 SUPPLY/IMPLANTS "$5,804.00 " Outpatient "$2,902.00 " "$1,219.74 " "$3,772.60 " "$4,062.80 " "$3,830.64 " Not Applicable: Bundled with Procedure "$2,031.40 " "$4,643.20 " "$1,219.74 " "$4,643.20 " CLP XTRNFX XTRAFIX 105MM LG PIN BLU 520004008 C1713 SUPPLY/IMPLANTS "$3,209.00 " Outpatient "$1,604.50 " "$1,219.74 " "$2,085.85 " "$2,246.30 " "$2,117.94 " Not Applicable: Bundled with Procedure "$1,123.15 " "$2,567.20 " "$1,123.15 " "$2,567.20 " CLP XTRNFX UNV TI MTVCTR DSTRCT PIN HLD 487.94 C1713 SUPPLY/IMPLANTS "$4,516.00 " Outpatient "$2,258.00 " "$1,219.74 " "$2,935.40 " "$3,161.20 " "$2,980.56 " Not Applicable: Bundled with Procedure "$1,580.60 " "$3,612.80 " "$1,219.74 " "$3,612.80 " CLP XTRNFX TI BD PIN HLD MULTIVECTOR DSTRCT BLU 487.941 C1713 SUPPLY/IMPLANTS "$4,516.00 " Outpatient "$2,258.00 " "$1,219.74 " "$2,935.40 " "$3,161.20 " "$2,980.56 " Not Applicable: Bundled with Procedure "$1,580.60 " "$3,612.80 " "$1,219.74 " "$3,612.80 " CLP XTRNFX TI RAMUS PIN HLD MULTIVECTOR DSTRCT AU 487.942 C1713 SUPPLY/IMPLANTS "$4,516.00 " Outpatient "$2,258.00 " "$1,219.74 " "$2,935.40 " "$3,161.20 " "$2,980.56 " Not Applicable: Bundled with Procedure "$1,580.60 " "$3,612.80 " "$1,219.74 " "$3,612.80 " CLP XTRNFX JTX 6 HL PIN 71067376 C1713 SUPPLY/IMPLANTS "$3,944.00 " Outpatient "$1,972.00 " "$1,219.74 " "$2,563.60 " "$2,760.80 " "$2,603.04 " Not Applicable: Bundled with Procedure "$1,380.40 " "$3,155.20 " "$1,219.74 " "$3,155.20 " CM ANTIROTATION DRILL 30 249007010 C1713 SUPPLY/IMPLANTS $527.00 Outpatient $263.50 "$1,219.74 " $342.55 $368.90 $347.82 Not Applicable: Bundled with Procedure $184.45 $421.60 $184.45 "$1,219.74 " CM ANTIROTATION PIN 30MMASIA 249032030 C1713 SUPPLY/IMPLANTS $727.00 Outpatient $363.50 "$1,219.74 " $472.55 $508.90 $479.82 Not Applicable: Bundled with Procedure $254.45 $581.60 $254.45 "$1,219.74 " CM EXTRT ADPT CAN TLL M11 THRD 249009051 C1713 SUPPLY/IMPLANTS "$1,747.00 " Outpatient $873.50 "$1,219.74 " "$1,135.55 " "$1,222.90 " "$1,153.02 " Not Applicable: Bundled with Procedure $611.45 "$1,397.60 " $611.45 "$1,397.60 " CMNT BN HYDROSET CA PHOS 5ML INJ BCMPT OSTCNDC STRL 79-43905 C1713 SUPPLY/IMPLANTS "$6,778.00 " Outpatient "$3,389.00 " "$1,219.74 " "$4,405.70 " "$4,744.60 " "$4,473.48 " Not Applicable: Bundled with Procedure "$2,372.30 " "$5,422.40 " "$1,219.74 " "$5,422.40 " CMNT BN PLC LV+GGNTA 40GM GRN 111914001 C1713 SUPPLY/IMPLANTS "$1,747.00 " Outpatient $873.50 "$1,219.74 " "$1,135.55 " "$1,222.90 " "$1,153.02 " Not Applicable: Bundled with Procedure $611.45 "$1,397.60 " $611.45 "$1,397.60 " CMNT BN HYDROSET XT HA 5CC INJ STRL LF DISP 897005 C1713 SUPPLY/IMPLANTS "$7,638.00 " Outpatient "$3,819.00 " "$1,219.74 " "$4,964.70 " "$5,346.60 " "$5,041.08 " Not Applicable: Bundled with Procedure "$2,673.30 " "$6,110.40 " "$1,219.74 " "$6,110.40 " CMPNT DSTRCT 1MM MNDB TI A TY MESH FT CRNMXF DSTRCT SYS NS 04.315.201 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " CMPNT DSTRCT 1MM MNDB MESH FT B TY INTNL CRNMXF DSTRCT SYS 04.315.202 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " CMPNT DSTRCT 1MM MNDB MESH FT C INTNL CRNMXF DSTRCT SYS 04.315.203 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " CMPNT DSTRCT 1.3MM MNDB MESH FT INTNL B TY CRNMXF DSTRCT SYS 04.315.502 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " CMPNT DSTRCT 1.3MM MNDB MESH FT C INTNL CRNMXF DSTRCT SYS 04.315.503 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " CNCT ROD 24MM SPNE OASYS CX PLT 48551073 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " CNCT ROD 53-73MM THORLMBR SPNE XIA 3 TI MA CX 48236053 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " CNCT ROD 37.5MM 5.5MM SPNE ARMADA TI FX CX NS 8450137 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " CNCT ROD 35-44MM THORLMBR SPNE XIA 3 TI MA CX 48236035 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " CNCT ROD 43-54MM THORLMBR SPNE XIA 3 TI MA CX 48236043 C1713 SUPPLY/IMPLANTS "$7,575.00 " Outpatient "$3,787.50 " "$1,219.74 " "$4,923.75 " "$5,302.50 " "$4,999.50 " Not Applicable: Bundled with Procedure "$2,651.25 " "$6,060.00 " "$1,219.74 " "$6,060.00 " CNCT ROD SPNL XLNK LG 7752537 C1713 SUPPLY/IMPLANTS "$6,859.00 " Outpatient "$3,429.50 " "$1,219.74 " "$4,458.35 " "$4,801.30 " "$4,526.94 " Not Applicable: Bundled with Procedure "$2,400.65 " "$5,487.20 " "$1,219.74 " "$5,487.20 " CNCT ROD SPNE XLNK MED 7752536 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " CNCT ROD SPNE XIA 3 ANG OPN PRLL REV 48235010 C1713 SUPPLY/IMPLANTS "$4,579.00 " Outpatient "$2,289.50 " "$1,219.74 " "$2,976.35 " "$3,205.30 " "$3,022.14 " Not Applicable: Bundled with Procedure "$1,602.65 " "$3,663.20 " "$1,219.74 " "$3,663.20 " CNCT ROD SPNE XIA TI 0D LG 3820136 C1713 SUPPLY/IMPLANTS "$3,123.00 " Outpatient "$1,561.50 " "$1,219.74 " "$2,029.95 " "$2,186.10 " "$2,061.18 " Not Applicable: Bundled with Procedure "$1,093.05 " "$2,498.40 " "$1,093.05 " "$2,498.40 " CNCT ROD 25MM 5MM 5.5MM SPNE 124.985 C1713 SUPPLY/IMPLANTS "$8,829.00 " Outpatient "$4,414.50 " "$1,219.74 " "$5,738.85 " "$6,180.30 " "$5,827.14 " Not Applicable: Bundled with Procedure "$3,090.15 " "$7,063.20 " "$1,219.74 " "$7,063.20 " CNCT ROD 60MM SPNE TRNSV 48551071 C1713 SUPPLY/IMPLANTS "$6,451.00 " Outpatient "$3,225.50 " "$1,219.74 " "$4,193.15 " "$4,515.70 " "$4,257.66 " Not Applicable: Bundled with Procedure "$2,257.85 " "$5,160.80 " "$1,219.74 " "$5,160.80 " CNCT ROD 38MM SPNE VUEPOINT II FX CX NS 8976138 C1713 SUPPLY/IMPLANTS "$7,633.00 " Outpatient "$3,816.50 " "$1,219.74 " "$4,961.45 " "$5,343.10 " "$5,037.78 " Not Applicable: Bundled with Procedure "$2,671.55 " "$6,106.40 " "$1,219.74 " "$6,106.40 " CNCT ROD ILSCRL REV ROD TO ROD PRLL 48235011 C1713 SUPPLY/IMPLANTS "$3,123.00 " Outpatient "$1,561.50 " "$1,219.74 " "$2,029.95 " "$2,186.10 " "$2,061.18 " Not Applicable: Bundled with Procedure "$1,093.05 " "$2,498.40 " "$1,093.05 " "$2,498.40 " CNCT ROD 10MM LAT OPN 7756064 C1713 SUPPLY/IMPLANTS "$3,322.00 " Outpatient "$1,661.00 " "$1,219.74 " "$2,159.30 " "$2,325.40 " "$2,192.52 " Not Applicable: Bundled with Procedure "$1,162.70 " "$2,657.60 " "$1,162.70 " "$2,657.60 " CNCT ROD 28-31MM THORLMBR SPNE XIA 3 TI MA CX 48236028 C1713 SUPPLY/IMPLANTS "$7,575.00 " Outpatient "$3,787.50 " "$1,219.74 " "$4,923.75 " "$5,302.50 " "$4,999.50 " Not Applicable: Bundled with Procedure "$2,651.25 " "$6,060.00 " "$1,219.74 " "$6,060.00 " CNCT ROD SPNE XIA TI 0D SM 3820134 C1713 SUPPLY/IMPLANTS "$4,322.00 " Outpatient "$2,161.00 " "$1,219.74 " "$2,809.30 " "$3,025.40 " "$2,852.52 " Not Applicable: Bundled with Procedure "$1,512.70 " "$3,457.60 " "$1,219.74 " "$3,457.60 " CNCT ROD SPNE XIA TI 30D SM 3820135 C1713 SUPPLY/IMPLANTS "$4,322.00 " Outpatient "$2,161.00 " "$1,219.74 " "$2,809.30 " "$3,025.40 " "$2,852.52 " Not Applicable: Bundled with Procedure "$1,512.70 " "$3,457.60 " "$1,219.74 " "$3,457.60 " CNCT ROD SPNE DMN TI CL5.5 OP5.5 CRV AX 779115555 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " CNCT ROD 40MM SPNE CX NS REFORM PDCL SCR SYS 39-CC-0040 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " CNCT ROD SPNE CFBR RING 100231000 C1713 SUPPLY/IMPLANTS $896.00 Outpatient $448.00 "$1,219.74 " $582.40 $627.20 $591.36 Not Applicable: Bundled with Procedure $313.60 $716.80 $313.60 "$1,219.74 " CNCT ROD LG SCR 35-463212 C1713 SUPPLY/IMPLANTS "$1,278.00 " Outpatient $639.00 "$1,219.74 " $830.70 $894.60 $843.48 Not Applicable: Bundled with Procedure $447.30 "$1,022.40 " $447.30 "$1,219.74 " CNCT ROD UNV 21245 C1713 SUPPLY/IMPLANTS "$2,075.00 " Outpatient "$1,037.50 " "$1,219.74 " "$1,348.75 " "$1,452.50 " "$1,369.50 " Not Applicable: Bundled with Procedure $726.25 "$1,660.00 " $726.25 "$1,660.00 " CNCT ROD 15.5MM THORLMBR SNG SS TRNSV 6.35MM ROD 2141 C1713 SUPPLY/IMPLANTS "$3,416.00 " Outpatient "$1,708.00 " "$1,219.74 " "$2,220.40 " "$2,391.20 " "$2,254.56 " Not Applicable: Bundled with Procedure "$1,195.60 " "$2,732.80 " "$1,195.60 " "$2,732.80 " CNCT ROD VHS KNOB VARI ANG HIP SCR SYS 35-463137 C1713 SUPPLY/IMPLANTS "$6,291.00 " Outpatient "$3,145.50 " "$1,219.74 " "$4,089.15 " "$4,403.70 " "$4,152.06 " Not Applicable: Bundled with Procedure "$2,201.85 " "$5,032.80 " "$1,219.74 " "$5,032.80 " CNCT ROD 5.5MM SPNE ARMADA ROD TO ROD NS ASF15T 8452152 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " CNCT ROD SPNE DMN TI CL5.5 SD6.35 CRV OPN CLS SLD 779146555 C1713 SUPPLY/IMPLANTS "$4,888.00 " Outpatient "$2,444.00 " "$1,219.74 " "$3,177.20 " "$3,421.60 " "$3,226.08 " Not Applicable: Bundled with Procedure "$1,710.80 " "$3,910.40 " "$1,219.74 " "$3,910.40 " CNCT ROD 85MM 5.5MM SPNE CNTR 101-65585 C1713 SUPPLY/IMPLANTS "$1,711.00 " Outpatient $855.50 "$1,219.74 " "$1,112.15 " "$1,197.70 " "$1,129.26 " Not Applicable: Bundled with Procedure $598.85 "$1,368.80 " $598.85 "$1,368.80 " CNCT ROD 3.5MM THORLMBR SPNE XBAR TI LG CNTR 50-2013 C1713 SUPPLY/IMPLANTS "$3,910.00 " Outpatient "$1,955.00 " "$1,219.74 " "$2,541.50 " "$2,737.00 " "$2,580.60 " Not Applicable: Bundled with Procedure "$1,368.50 " "$3,128.00 " "$1,219.74 " "$3,128.00 " CNCT ROD SPNE XIA TI 30D LG 3820137 C1713 SUPPLY/IMPLANTS "$3,128.00 " Outpatient "$1,564.00 " "$1,219.74 " "$2,033.20 " "$2,189.60 " "$2,064.48 " Not Applicable: Bundled with Procedure "$1,094.80 " "$2,502.40 " "$1,094.80 " "$2,502.40 " CNCT ROD 16MM SPNE LAT TIGER CLS NS POST OCPTL CRV THOR SYS 35301-16 C1713 SUPPLY/IMPLANTS "$3,814.00 " Outpatient "$1,907.00 " "$1,219.74 " "$2,479.10 " "$2,669.80 " "$2,517.24 " Not Applicable: Bundled with Procedure "$1,334.90 " "$3,051.20 " "$1,219.74 " "$3,051.20 " CNCT ROD 33-39MM SPNE QUARTEX T ROD TO ROD 3.5MM ROD 1149.8102 C1713 SUPPLY/IMPLANTS "$3,907.00 " Outpatient "$1,953.50 " "$1,219.74 " "$2,539.55 " "$2,734.90 " "$2,578.62 " Not Applicable: Bundled with Procedure "$1,367.45 " "$3,125.60 " "$1,219.74 " "$3,125.60 " CNCT ROD 32MM SPNE VUEPOINT II FX CX NS 8976132 C1713 SUPPLY/IMPLANTS "$3,907.00 " Outpatient "$1,953.50 " "$1,219.74 " "$2,539.55 " "$2,734.90 " "$2,578.62 " Not Applicable: Bundled with Procedure "$1,367.45 " "$3,125.60 " "$1,219.74 " "$3,125.60 " CNCT ROD XIA 3 TOP LD OPN CLS 12 MM 22 MM ROD 48235007 C1713 SUPPLY/IMPLANTS "$3,127.00 " Outpatient "$1,563.50 " "$1,219.74 " "$2,032.55 " "$2,188.90 " "$2,063.82 " Not Applicable: Bundled with Procedure "$1,094.45 " "$2,501.60 " "$1,094.45 " "$2,501.60 " CNCT TBG 5MM INSRTR 27996 C1713 SUPPLY/IMPLANTS "$2,579.00 " Outpatient "$1,289.50 " "$1,219.74 " "$1,676.35 " "$1,805.30 " "$1,702.14 " Not Applicable: Bundled with Procedure $902.65 "$2,063.20 " $902.65 "$2,063.20 " COMPRESSION NUT 14-440056 C1713 SUPPLY/IMPLANTS "$2,120.00 " Outpatient "$1,060.00 " "$1,219.74 " "$1,378.00 " "$1,484.00 " "$1,399.20 " Not Applicable: Bundled with Procedure $742.00 "$1,696.00 " $742.00 "$1,696.00 " COMPRESSION HAT 14-440055 C1713 SUPPLY/IMPLANTS "$3,371.00 " Outpatient "$1,685.50 " "$1,219.74 " "$2,191.15 " "$2,359.70 " "$2,224.86 " Not Applicable: Bundled with Procedure "$1,179.85 " "$2,696.80 " "$1,179.85 " "$2,696.80 " CONNECTING SCREW WITH F/LOCKING ATTACHMENT 01.120.606S C1713 SUPPLY/IMPLANTS "$1,570.00 " Outpatient $785.00 "$1,219.74 " "$1,020.50 " "$1,099.00 " "$1,036.20 " Not Applicable: Bundled with Procedure $549.50 "$1,256.00 " $549.50 "$1,256.00 " CONNECTOR ROD L40 MM SPINE TRANSVERSE 48551072 C1713 SUPPLY/IMPLANTS "$3,127.00 " Outpatient "$1,563.50 " "$1,219.74 " "$2,032.55 " "$2,188.90 " "$2,063.82 " Not Applicable: Bundled with Procedure "$1,094.45 " "$2,501.60 " "$1,094.45 " "$2,501.60 " CONNECTOR ROD MEDIUM SPINE ROD TO ROD 3602536 C1713 SUPPLY/IMPLANTS "$3,904.00 " Outpatient "$1,952.00 " "$1,219.74 " "$2,537.60 " "$2,732.80 " "$2,576.64 " Not Applicable: Bundled with Procedure "$1,366.40 " "$3,123.20 " "$1,219.74 " "$3,123.20 " CONNECTOR ROD TIGER OD5.5 MM SIDE BY SIDE CLOSED OPEN NONSTE 55000-14 C1713 SUPPLY/IMPLANTS "$3,123.00 " Outpatient "$1,561.50 " "$1,219.74 " "$2,029.95 " "$2,186.10 " "$2,061.18 " Not Applicable: Bundled with Procedure "$1,093.05 " "$2,498.40 " "$1,093.05 " "$2,498.40 " CONNECTOR ROD ZAVATION OD3.5 MM SPINE INLINE NONSTERILE 3.5 94-31-35-35 C1713 SUPPLY/IMPLANTS "$2,929.00 " Outpatient "$1,464.50 " "$1,219.74 " "$1,903.85 " "$2,050.30 " "$1,933.14 " Not Applicable: Bundled with Procedure "$1,025.15 " "$2,343.20 " "$1,025.15 " "$2,343.20 " CONNECTOR ROD CASPIAN LARGE OD3.5 MM SPINE TRANSVERSE ADJUST 1101-73747M C1713 SUPPLY/IMPLANTS "$2,936.00 " Outpatient "$1,468.00 " "$1,219.74 " "$1,908.40 " "$2,055.20 " "$1,937.76 " Not Applicable: Bundled with Procedure "$1,027.60 " "$2,348.80 " "$1,027.60 " "$2,348.80 " CONNECTOR ROD CASPIAN MEDIUM OD3.5 MM SPINE ADJUSTABLE TRANS 1101-73038M C1713 SUPPLY/IMPLANTS "$2,936.00 " Outpatient "$1,468.00 " "$1,219.74 " "$1,908.40 " "$2,055.20 " "$1,937.76 " Not Applicable: Bundled with Procedure "$1,027.60 " "$2,348.80 " "$1,027.60 " "$2,348.80 " CONNECTOR ROD CROSSLINK MAC L42-51 MM SPINE MULTIAXIAL 4107042 C1713 SUPPLY/IMPLANTS "$2,936.00 " Outpatient "$1,468.00 " "$1,219.74 " "$1,908.40 " "$2,055.20 " "$1,937.76 " Not Applicable: Bundled with Procedure "$1,027.60 " "$2,348.80 " "$1,027.60 " "$2,348.80 " CONNECTOR ROD ILIOSACRAL REVISION 48235008 C1713 SUPPLY/IMPLANTS "$2,936.00 " Outpatient "$1,468.00 " "$1,219.74 " "$1,908.40 " "$2,055.20 " "$1,937.76 " Not Applicable: Bundled with Procedure "$1,027.60 " "$2,348.80 " "$1,027.60 " "$2,348.80 " CONNECTOR ROD RELINE OD5-6 MM NONSTERILE O-H ROTATE 11102255 C1713 SUPPLY/IMPLANTS "$2,936.00 " Outpatient "$1,468.00 " "$1,219.74 " "$1,908.40 " "$2,055.20 " "$1,937.76 " Not Applicable: Bundled with Procedure "$1,027.60 " "$2,348.80 " "$1,027.60 " "$2,348.80 " CONNECTOR ROD CASPIAN SMALL OD3.5 MM SPINE TRANSVERSE NONSTE 1101-72631M C1713 SUPPLY/IMPLANTS "$2,936.00 " Outpatient "$1,468.00 " "$1,219.74 " "$1,908.40 " "$2,055.20 " "$1,937.76 " Not Applicable: Bundled with Procedure "$1,027.60 " "$2,348.80 " "$1,027.60 " "$2,348.80 " CONNECTOR ROD CASPIAN XL OD3.5 MM SPINE TRANSVERSE NONSTERIL 1101-74658M C1713 SUPPLY/IMPLANTS "$2,936.00 " Outpatient "$1,468.00 " "$1,219.74 " "$1,908.40 " "$2,055.20 " "$1,937.76 " Not Applicable: Bundled with Procedure "$1,027.60 " "$2,348.80 " "$1,027.60 " "$2,348.80 " CONNECTOR ROD OASYS OD3.3 MM ODSEC5.5 MM SPINE AXIAL ROD TO 48551085 C1713 SUPPLY/IMPLANTS "$2,936.00 " Outpatient "$1,468.00 " "$1,219.74 " "$1,908.40 " "$2,055.20 " "$1,937.76 " Not Applicable: Bundled with Procedure "$1,027.60 " "$2,348.80 " "$1,027.60 " "$2,348.80 " CONNECTOR ROD YUKON OD3.5-5.5 MM ODSEC6 MM SPINE AXIAL NONST 1101-83560D C1713 SUPPLY/IMPLANTS "$2,936.00 " Outpatient "$1,468.00 " "$1,219.74 " "$1,908.40 " "$2,055.20 " "$1,937.76 " Not Applicable: Bundled with Procedure "$1,027.60 " "$2,348.80 " "$1,027.60 " "$2,348.80 " CONNECTOR ROD RELINE-O OD5-6 MM ODSEC5-6 MM SPINE 2 HOLE INL 11108055 C1713 SUPPLY/IMPLANTS "$2,850.00 " Outpatient "$1,425.00 " "$1,219.74 " "$1,852.50 " "$1,995.00 " "$1,881.00 " Not Applicable: Bundled with Procedure $997.50 "$2,280.00 " $997.50 "$2,280.00 " CONNECTOR ROD PROFICIENT L31-40 MM SPINE CERVICAL POSTERIOR 11-8541 C1713 SUPPLY/IMPLANTS "$2,850.00 " Outpatient "$1,425.00 " "$1,219.74 " "$1,852.50 " "$1,995.00 " "$1,881.00 " Not Applicable: Bundled with Procedure $997.50 "$2,280.00 " $997.50 "$2,280.00 " CONSTRUX FIXR MALEFEMALE ENDS 1801 C1713 SUPPLY/IMPLANTS "$18,925.00 " Outpatient "$9,462.50 " "$1,219.74 " "$12,301.25 " "$13,247.50 " "$12,490.50 " Not Applicable: Bundled with Procedure "$6,623.75 " "$15,140.00 " "$1,219.74 " "$15,140.00 " CONTOUR DUAL COMPRESS PLATE SMALL FRAG SCREW TRAY 480103750 C1713 SUPPLY/IMPLANTS "$2,676.00 " Outpatient "$1,338.00 " "$1,219.74 " "$1,739.40 " "$1,873.20 " "$1,766.16 " Not Applicable: Bundled with Procedure $936.60 "$2,140.80 " $936.60 "$2,140.80 " CONTOUR DUAL COMPRESS PLATE SMALL FRAG PLATE TRAY 480103850 C1713 SUPPLY/IMPLANTS "$3,209.00 " Outpatient "$1,604.50 " "$1,219.74 " "$2,085.85 " "$2,246.30 " "$2,117.94 " Not Applicable: Bundled with Procedure "$1,123.15 " "$2,567.20 " "$1,123.15 " "$2,567.20 " CORE SECURE C 11 X 12 X 7MM 414.107S C1713 SUPPLY/IMPLANTS "$12,230.00 " Outpatient "$6,115.00 " "$1,219.74 " "$7,949.50 " "$8,561.00 " "$8,071.80 " Not Applicable: Bundled with Procedure "$4,280.50 " "$9,784.00 " "$1,219.74 " "$9,784.00 " CORT SCR 120X30MM LNGTH 5MM SHAFT SD5012030 C1713 SUPPLY/IMPLANTS $827.00 Outpatient $413.50 "$1,219.74 " $537.55 $578.90 $545.82 Not Applicable: Bundled with Procedure $289.45 $661.60 $289.45 "$1,219.74 " CORT SCR 8035MM LNGTH 3.33.0 TAPER A33-08035T C1713 SUPPLY/IMPLANTS $862.00 Outpatient $431.00 "$1,219.74 " $560.30 $603.40 $568.92 Not Applicable: Bundled with Procedure $301.70 $689.60 $301.70 "$1,219.74 " CORTICAL-CANCELLOUS BLOCK 6 X 14 X 11MM 245641 C1713 SUPPLY/IMPLANTS "$5,624.00 " Outpatient "$2,812.00 " "$1,219.74 " "$3,655.60 " "$3,936.80 " "$3,711.84 " Not Applicable: Bundled with Procedure "$1,968.40 " "$4,499.20 " "$1,219.74 " "$4,499.20 " CORTICAL TAP 2.7MM DIAMETER 9399-99-386 C1713 SUPPLY/IMPLANTS $815.00 Outpatient $407.50 "$1,219.74 " $529.75 $570.50 $537.90 Not Applicable: Bundled with Procedure $285.25 $652.00 $285.25 "$1,219.74 " CORTICAL CANCELLOUS SPACER 9MM 2504-21409L7 C1713 SUPPLY/IMPLANTS "$4,694.00 " Outpatient "$2,347.00 " "$1,219.74 " "$3,051.10 " "$3,285.80 " "$3,098.04 " Not Applicable: Bundled with Procedure "$1,642.90 " "$3,755.20 " "$1,219.74 " "$3,755.20 " CORTICAL SCREW TITANIUM 4.5MM L.26MM 107-4526 C1713 SUPPLY/IMPLANTS $488.00 Outpatient $244.00 "$1,219.74 " $317.20 $341.60 $322.08 Not Applicable: Bundled with Procedure $170.80 $390.40 $170.80 "$1,219.74 " COUNTERSINK 2.3 60-80123 C1713 SUPPLY/IMPLANTS "$1,226.00 " Outpatient $613.00 "$1,219.74 " $796.90 $858.20 $809.16 Not Applicable: Bundled with Procedure $429.10 $980.80 $429.10 "$1,219.74 " COUNTERBORE 2.5MM 2312-18-014 C1713 SUPPLY/IMPLANTS $780.00 Outpatient $390.00 "$1,219.74 " $507.00 $546.00 $514.80 Not Applicable: Bundled with Procedure $273.00 $624.00 $273.00 "$1,219.74 " COUNTERSINK 2.7MM DIA 9399-99-430 C1713 SUPPLY/IMPLANTS $815.00 Outpatient $407.50 "$1,219.74 " $529.75 $570.50 $537.90 Not Applicable: Bundled with Procedure $285.25 $652.00 $285.25 "$1,219.74 " COUNTERSINK CANN FOR 3.0MM FR3008 C1713 SUPPLY/IMPLANTS "$1,243.00 " Outpatient $621.50 "$1,219.74 " $807.95 $870.10 $820.38 Not Applicable: Bundled with Procedure $435.05 $994.40 $435.05 "$1,219.74 " COUNTERSINK 1.7 60-80117 C1713 SUPPLY/IMPLANTS $940.00 Outpatient $470.00 "$1,219.74 " $611.00 $658.00 $620.40 Not Applicable: Bundled with Procedure $329.00 $752.00 $329.00 "$1,219.74 " COUNTERSINK 320-1009 C1713 SUPPLY/IMPLANTS $878.00 Outpatient $439.00 "$1,219.74 " $570.70 $614.60 $579.48 Not Applicable: Bundled with Procedure $307.30 $702.40 $307.30 "$1,219.74 " COUNTERSINK AO FOR 2.0MM - 2.7MM SCREWS 706200 C1713 SUPPLY/IMPLANTS "$1,119.00 " Outpatient $559.50 "$1,219.74 " $727.35 $783.30 $738.54 Not Applicable: Bundled with Procedure $391.65 $895.20 $391.65 "$1,219.74 " COUPLING ROD TO ROD 49401010 C1713 SUPPLY/IMPLANTS "$3,617.00 " Outpatient "$1,808.50 " "$1,219.74 " "$2,351.05 " "$2,531.90 " "$2,387.22 " Not Applicable: Bundled with Procedure "$1,265.95 " "$2,893.60 " "$1,219.74 " "$2,893.60 " COVER BURR HOLE 20MM DISC NEURO LOW PROFILE W/TAB TANTALUM L 5305520 C1713 SUPPLY/IMPLANTS "$1,453.00 " Outpatient $726.50 "$1,219.74 " $944.45 "$1,017.10 " $958.98 Not Applicable: Bundled with Procedure $508.55 "$1,162.40 " $508.55 "$1,219.74 " COVER BURR HOLE UNIVERSAL NEURO III OD10 MM CRANIOMAXILLOFAC 53-34510 C1713 SUPPLY/IMPLANTS "$1,280.00 " Outpatient $640.00 "$1,219.74 " $832.00 $896.00 $844.80 Not Applicable: Bundled with Procedure $448.00 "$1,024.00 " $448.00 "$1,219.74 " CPLNG XTRNFX 4 5/8MM HFMN2 INVERT PIN TO ROD 4920-1-030 C1713 SUPPLY/IMPLANTS "$2,565.00 " Outpatient "$1,282.50 " "$1,219.74 " "$1,667.25 " "$1,795.50 " "$1,692.90 " Not Applicable: Bundled with Procedure $897.75 "$2,052.00 " $897.75 "$2,052.00 " CPLNG XTRNFX 8MM HFMN2 ROD TO ROD MRI CLR CD TLT SP REPRO 4921-1-010 C1713 SUPPLY/IMPLANTS "$3,116.00 " Outpatient "$1,558.00 " "$1,219.74 " "$2,025.40 " "$2,181.20 " "$2,056.56 " Not Applicable: Bundled with Procedure "$1,090.60 " "$2,492.80 " "$1,090.60 " "$2,492.80 " CPLNG XTRNFX HFMN 3 ROD TO ROD DLT 5/8/11 MM ROD 5 MM APX 4922-1-010 C1713 SUPPLY/IMPLANTS "$3,417.00 " Outpatient "$1,708.50 " "$1,219.74 " "$2,221.05 " "$2,391.90 " "$2,255.22 " Not Applicable: Bundled with Procedure "$1,195.95 " "$2,733.60 " "$1,195.95 " "$2,733.60 " CPLNG XTRNFX HFMN 3 INVERT PIN TO ROD DLT 5/8/11 MM ROD 4922-1-030 C1713 SUPPLY/IMPLANTS "$3,417.00 " Outpatient "$1,708.50 " "$1,219.74 " "$2,221.05 " "$2,391.90 " "$2,255.22 " Not Applicable: Bundled with Procedure "$1,195.95 " "$2,733.60 " "$1,195.95 " "$2,733.60 " CPLNG XTRNFX 3MM 3MM MIC HFMN2 ROD TO ROD HND PLT SYS 4960-1-010 C1713 SUPPLY/IMPLANTS "$3,708.00 " Outpatient "$1,854.00 " "$1,219.74 " "$2,410.20 " "$2,595.60 " "$2,447.28 " Not Applicable: Bundled with Procedure "$1,297.80 " "$2,966.40 " "$1,219.74 " "$2,966.40 " CPLNG XTRNFX HFMN 3 PIN TO ROD DLT 5/8/11 MM ROD 4/5/6 MM 4922-1-020 C1713 SUPPLY/IMPLANTS "$3,251.00 " Outpatient "$1,625.50 " "$1,219.74 " "$2,113.15 " "$2,275.70 " "$2,145.66 " Not Applicable: Bundled with Procedure "$1,137.85 " "$2,600.80 " "$1,137.85 " "$2,600.80 " CPLNG XTRNFX HFMN2 C PIN TO ROD 5 MM ROD POST 3-4 MM PIN MRI 4941-1-020 C1713 SUPPLY/IMPLANTS "$2,188.00 " Outpatient "$1,094.00 " "$1,219.74 " "$1,422.20 " "$1,531.60 " "$1,444.08 " Not Applicable: Bundled with Procedure $765.80 "$1,750.40 " $765.80 "$1,750.40 " CPLNG XTRNFX HFMN2 C ROD TO ROD 5 MM ROD POST MRI 4941-1-010 C1713 SUPPLY/IMPLANTS "$2,188.00 " Outpatient "$1,094.00 " "$1,219.74 " "$1,422.20 " "$1,531.60 " "$1,444.08 " Not Applicable: Bundled with Procedure $765.80 "$1,750.40 " $765.80 "$1,750.40 " CPLNG XTRNFX 5MM 3-4MM CMPCT HFMN2 PIN TO ROD 4940-1-020 C1713 SUPPLY/IMPLANTS "$3,617.00 " Outpatient "$1,808.50 " "$1,219.74 " "$2,351.05 " "$2,531.90 " "$2,387.22 " Not Applicable: Bundled with Procedure "$1,265.95 " "$2,893.60 " "$1,219.74 " "$2,893.60 " CPLNG XTRNFX 5MM 3MM MIC HFMN2 ROD TO ROD HND PLT SYS 4960-1-060 C1713 SUPPLY/IMPLANTS "$3,789.00 " Outpatient "$1,894.50 " "$1,219.74 " "$2,462.85 " "$2,652.30 " "$2,500.74 " Not Applicable: Bundled with Procedure "$1,326.15 " "$3,031.20 " "$1,219.74 " "$3,031.20 " CPLNG XTRNFX HFMN HNG 4933-0-800 C1713 SUPPLY/IMPLANTS "$2,475.00 " Outpatient "$1,237.50 " "$1,219.74 " "$1,608.75 " "$1,732.50 " "$1,633.50 " Not Applicable: Bundled with Procedure $866.25 "$1,980.00 " $866.25 "$1,980.00 " CPLNG XTRNFX 1.5-2MM 3MM MIC HFMN2 PIN TO ROD HND PLT SYS 4960-1-020 C1713 SUPPLY/IMPLANTS "$3,728.00 " Outpatient "$1,864.00 " "$1,219.74 " "$2,423.20 " "$2,609.60 " "$2,460.48 " Not Applicable: Bundled with Procedure "$1,304.80 " "$2,982.40 " "$1,219.74 " "$2,982.40 " CRMPR SRG BMP GRP CBL SLV 498003 C1713 SUPPLY/IMPLANTS "$10,433.00 " Outpatient "$5,216.50 " "$1,219.74 " "$6,781.45 " "$7,303.10 " "$6,885.78 " Not Applicable: Bundled with Procedure "$3,651.55 " "$8,346.40 " "$1,219.74 " "$8,346.40 " CRMPR SRG 11IN CBL RD SS NS 223205007 C1713 SUPPLY/IMPLANTS "$8,771.00 " Outpatient "$4,385.50 " "$1,219.74 " "$5,701.15 " "$6,139.70 " "$5,788.86 " Not Applicable: Bundled with Procedure "$3,069.85 " "$7,016.80 " "$1,219.74 " "$7,016.80 " CROSS LINK 30-37MM TC5530-37 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " CROSS LINK 26 48133226 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " CROSSLINK MEDIUM 56189 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " CROSSLINK MEDIUM TC5537-50 C1713 SUPPLY/IMPLANTS "$4,891.00 " Outpatient "$2,445.50 " "$1,219.74 " "$3,179.15 " "$3,423.70 " "$3,228.06 " Not Applicable: Bundled with Procedure "$1,711.85 " "$3,912.80 " "$1,219.74 " "$3,912.80 " CROSSLINK MED ADJ SCREW SYSTEM 11-XLV-0002 C1713 SUPPLY/IMPLANTS "$2,936.00 " Outpatient "$1,468.00 " "$1,219.74 " "$1,908.40 " "$2,055.20 " "$1,937.76 " Not Applicable: Bundled with Procedure "$1,027.60 " "$2,348.80 " "$1,027.60 " "$2,348.80 " CTR CBL BMP 498010 C1713 SUPPLY/IMPLANTS "$6,364.00 " Outpatient "$3,182.00 " "$1,219.74 " "$4,136.60 " "$4,454.80 " "$4,200.24 " Not Applicable: Bundled with Procedure "$2,227.40 " "$5,091.20 " "$1,219.74 " "$5,091.20 " CTR PIN 3.2MM NS 392500700 C1713 SUPPLY/IMPLANTS "$3,176.00 " Outpatient "$1,588.00 " "$1,219.74 " "$2,064.40 " "$2,223.20 " "$2,096.16 " Not Applicable: Bundled with Procedure "$1,111.60 " "$2,540.80 " "$1,111.60 " "$2,540.80 " CTR PLT MATRIXMIDFACE NS 03.503.039 C1713 SUPPLY/IMPLANTS "$5,514.00 " Outpatient "$2,757.00 " "$1,219.74 " "$3,584.10 " "$3,859.80 " "$3,639.24 " Not Applicable: Bundled with Procedure "$1,929.90 " "$4,411.20 " "$1,219.74 " "$4,411.20 " CTR SRG RECON MESH 03.503.605 C1713 SUPPLY/IMPLANTS "$6,457.00 " Outpatient "$3,228.50 " "$1,219.74 " "$4,197.05 " "$4,519.90 " "$4,261.62 " Not Applicable: Bundled with Procedure "$2,259.95 " "$5,165.60 " "$1,219.74 " "$5,165.60 " CTR SUT REM MNSCL CNCH KNT PSHR 2-0 FBRWR ASCP STRL DISP AR-4515 C1713 SUPPLY/IMPLANTS "$1,020.00 " Outpatient $510.00 "$1,219.74 " $663.00 $714.00 $673.20 Not Applicable: Bundled with Procedure $357.00 $816.00 $357.00 "$1,219.74 " CUP ACTB 48MM 22MM UNV 2 HL HIP 14-103648 C1713 SUPPLY/IMPLANTS "$7,141.00 " Outpatient "$3,570.50 " "$1,219.74 " "$4,641.65 " "$4,998.70 " "$4,713.06 " Not Applicable: Bundled with Procedure "$2,499.35 " "$5,712.80 " "$1,219.74 " "$5,712.80 " CUP ACTB 46MM 22MM MLHD RNL 3 HL HIP NRS 13-104146 C1713 SUPPLY/IMPLANTS "$7,141.00 " Outpatient "$3,570.50 " "$1,219.74 " "$4,641.65 " "$4,998.70 " "$4,713.06 " Not Applicable: Bundled with Procedure "$2,499.35 " "$5,712.80 " "$1,219.74 " "$5,712.80 " CUP ACTB 54MM PNCL 12 HL GRIPTION 1217-30-054 C1713 SUPPLY/IMPLANTS "$14,848.00 " Outpatient "$7,424.00 " "$1,219.74 " "$9,651.20 " "$10,393.60 " "$9,799.68 " Not Applicable: Bundled with Procedure "$5,196.80 " "$11,878.40 " "$1,219.74 " "$11,878.40 " CUP ACTB 44MM 28MM 20D ENDRN HIP STRL ENDRN LF 122344000 C1713 SUPPLY/IMPLANTS "$2,691.00 " Outpatient "$1,345.50 " "$1,219.74 " "$1,749.15 " "$1,883.70 " "$1,776.06 " Not Applicable: Bundled with Procedure $941.85 "$2,152.80 " $941.85 "$2,152.80 " CUP ACTB 42MM 32MM PROSTALAC CMNT HIP ALPLY LF 154142320 C1713 SUPPLY/IMPLANTS "$7,000.00 " Outpatient "$3,500.00 " "$1,219.74 " "$4,550.00 " "$4,900.00 " "$4,620.00 " Not Applicable: Bundled with Procedure "$2,450.00 " "$5,600.00 " "$1,219.74 " "$5,600.00 " CUP ACETABULAR PINNACLE GRIPTION OD58 MM HIP 12 DOME SCREW M 1217-30-058 C1713 SUPPLY/IMPLANTS "$14,872.00 " Outpatient "$7,436.00 " "$1,219.74 " "$9,666.80 " "$10,410.40 " "$9,815.52 " Not Applicable: Bundled with Procedure "$5,205.20 " "$11,897.60 " "$1,219.74 " "$11,897.60 " CUP HUM 32MM THK4MM SHLDR 5570-3204 C1713 SUPPLY/IMPLANTS "$5,067.00 " Outpatient "$2,533.50 " "$1,219.74 " "$3,293.55 " "$3,546.90 " "$3,344.22 " Not Applicable: Bundled with Procedure "$1,773.45 " "$4,053.60 " "$1,219.74 " "$4,053.60 " CUP HUM 4MM 36MM REUNION SHLDR STRL LF 5570-3604 C1713 SUPPLY/IMPLANTS "$12,230.00 " Outpatient "$6,115.00 " "$1,219.74 " "$7,949.50 " "$8,561.00 " "$8,071.80 " Not Applicable: Bundled with Procedure "$4,280.50 " "$9,784.00 " "$1,219.74 " "$9,784.00 " CUP HUM 4MM 40MM SHLDR 5570-4004 C1713 SUPPLY/IMPLANTS "$12,230.00 " Outpatient "$6,115.00 " "$1,219.74 " "$7,949.50 " "$8,561.00 " "$8,071.80 " Not Applicable: Bundled with Procedure "$4,280.50 " "$9,784.00 " "$1,219.74 " "$9,784.00 " CUP HUM 10MM 40MM SHLDR 5570-4010 C1713 SUPPLY/IMPLANTS "$12,230.00 " Outpatient "$6,115.00 " "$1,219.74 " "$7,949.50 " "$8,561.00 " "$8,071.80 " Not Applicable: Bundled with Procedure "$4,280.50 " "$9,784.00 " "$1,219.74 " "$9,784.00 " CUP HUM 42MM DLT XTEND +6MM STD SHLDR PE RVRS SYS STRL LF 130742206 C1713 SUPPLY/IMPLANTS "$7,809.00 " Outpatient "$3,904.50 " "$1,219.74 " "$5,075.85 " "$5,466.30 " "$5,153.94 " Not Applicable: Bundled with Procedure "$2,733.15 " "$6,247.20 " "$1,219.74 " "$6,247.20 " CUP HUM 38MM DLT XTEND +6MM STD SHLDR PE STRL LF 130738206 C1713 SUPPLY/IMPLANTS "$4,283.00 " Outpatient "$2,141.50 " "$1,219.74 " "$2,783.95 " "$2,998.10 " "$2,826.78 " Not Applicable: Bundled with Procedure "$1,499.05 " "$3,426.40 " "$1,219.74 " "$3,426.40 " CUP HUM 38MM DLT XTEND +9MM STD SHLDR PE RVRS SYS STRL LF 130738209 C1713 SUPPLY/IMPLANTS "$4,377.00 " Outpatient "$2,188.50 " "$1,219.74 " "$2,845.05 " "$3,063.90 " "$2,888.82 " Not Applicable: Bundled with Procedure "$1,531.95 " "$3,501.60 " "$1,219.74 " "$3,501.60 " CUP HUM 10MM 32MM SHLDR 5570-3210 C1713 SUPPLY/IMPLANTS "$5,007.00 " Outpatient "$2,503.50 " "$1,219.74 " "$3,254.55 " "$3,504.90 " "$3,304.62 " Not Applicable: Bundled with Procedure "$1,752.45 " "$4,005.60 " "$1,219.74 " "$4,005.60 " CURVED FLAT TRUSS 26 X 9 MM 0 DEGREE 6 MM HEIGHT TSTS-SM0006-26 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED FLAT TRUSS 26 X 9 MM 0 DEGREE 8 MM HEIGHT TSTS-SM0008-26 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED FLAT TRUSS 26 X 9 MM 0 DEGREE 10 MM HEIGHT TSTS-SM0010-26 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED FLAT TRUSS 26 X 9 MM 0 DEGREE 12 MM HEIGHT TSTS-SM0012-26 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED FLAT TRUSS 26 X 9 MM 0 DEGREE 14 MM HEIGHT TSTS-SM0014-26 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED LORDOTIC TRUSS 26 X 9 MM 6 DEGREE 6 MM HEIGHT TSTS-SM0606-26 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED LORDOTIC TRUSS 26 X 9 MM 6 DEGREE 8 MM HEIGHT TSTS-SM0608-26 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED LORDOTIC TRUSS 26 X 9 MM 6 DEGREE 10 MM HEIGHT TSTS-SM0610-26 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED LORDOTIC TRUSS 26 X 9 MM 6 DEGREE 12 MM HEIGHT TSTS-SM0612-26 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED LORDOTIC TRUSS 26 X 9 MM 6 DEGREE 14 MM HEIGHT TSTS-SM0614-26 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED FLAT TRUSS 32 X 9 MM 0 DEGREE 6 MM HEIGHT TSTS-SM0006-32 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED FLAT TRUSS 32 X 9 MM 0 DEGREE 8 MM HEIGHT TSTS-SM0008-32 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED FLAT TRUSS 32 X 9 MM 0 DEGREE 10 MM HEIGHT TSTS-SM0010-32 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED FLAT TRUSS 32 X 9 MM 0 DEGREE 12 MM HEIGHT TSTS-SM0012-32 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED FLAT TRUSS 32 X 9 MM 0 DEGREE 14 MM HEIGHT TSTS-SM0014-32 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED LORDOTIC TRUSS 32 X 9 MM 6 DEGREE 6 MM HEIGHT TSTS-SM0606-32 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED LORDOTIC TRUSS 32 X 9 MM 6 DEGREE 8 MM HEIGHT TSTS-SM0608-32 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED LORDOTIC TRUSS 32 X 9 MM 6 DEGREE 10 MM HEIGHT TSTS-SM0610-32 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED LORDOTIC TRUSS 32 X 9 MM 6 DEGREE 12 MM HEIGHT TSTS-SM0612-32 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED LORDOTIC TRUSS 32 X 9 MM 6 DEGREE 14 MM HEIGHT TSTS-SM0614-32 C1713 SUPPLY/IMPLANTS "$55,027.00 " Outpatient "$27,513.50 " "$1,219.74 " "$35,767.55 " "$38,518.90 " "$36,317.82 " Not Applicable: Bundled with Procedure "$19,259.45 " "$44,021.60 " "$1,219.74 " "$44,021.60 " CURVED GLASS FIBER BAR 210MM 520202021 C1713 SUPPLY/IMPLANTS "$2,563.00 " Outpatient "$1,281.50 " "$1,219.74 " "$1,665.95 " "$1,794.10 " "$1,691.58 " Not Applicable: Bundled with Procedure $897.05 "$2,050.40 " $897.05 "$2,050.40 " CURVED GLASS FIBER BAR 380MM 520202038 C1713 SUPPLY/IMPLANTS "$2,887.00 " Outpatient "$1,443.50 " "$1,219.74 " "$1,876.55 " "$2,020.90 " "$1,905.42 " Not Applicable: Bundled with Procedure "$1,010.45 " "$2,309.60 " "$1,010.45 " "$2,309.60 " CURVED GLASS FIBER BAR 500MM 520202050 C1713 SUPPLY/IMPLANTS "$3,047.00 " Outpatient "$1,523.50 " "$1,219.74 " "$1,980.55 " "$2,132.90 " "$2,011.02 " Not Applicable: Bundled with Procedure "$1,066.45 " "$2,437.60 " "$1,066.45 " "$2,437.60 " CURVED ROD 3.5MM X 30MM 96-C030 C1713 SUPPLY/IMPLANTS "$1,254.00 " Outpatient $627.00 "$1,219.74 " $815.10 $877.80 $827.64 Not Applicable: Bundled with Procedure $438.90 "$1,003.20 " $438.90 "$1,219.74 " CURVED ROD 3.5MM X 60MM 96-C060 C1713 SUPPLY/IMPLANTS "$1,254.00 " Outpatient $627.00 "$1,219.74 " $815.10 $877.80 $827.64 Not Applicable: Bundled with Procedure $438.90 "$1,003.20 " $438.90 "$1,219.74 " CURVED ROD 3.5MM X 70MM 96-C070 C1713 SUPPLY/IMPLANTS "$1,254.00 " Outpatient $627.00 "$1,219.74 " $815.10 $877.80 $827.64 Not Applicable: Bundled with Procedure $438.90 "$1,003.20 " $438.90 "$1,219.74 " "CURVED ROD, CT, TI, 3.5MM X 50MM 11-8654" C1713 SUPPLY/IMPLANTS "$1,108.00 " Outpatient $554.00 "$1,219.74 " $720.20 $775.60 $731.28 Not Applicable: Bundled with Procedure $387.80 $886.40 $387.80 "$1,219.74 " CVR BN SCR 6MM OPTRM KN NS 3320 C1713 SUPPLY/IMPLANTS $531.00 Outpatient $265.50 "$1,219.74 " $345.15 $371.70 $350.46 Not Applicable: Bundled with Procedure $185.85 $424.80 $185.85 "$1,219.74 " CVR BN SCR 3MM SM 3300 C1713 SUPPLY/IMPLANTS $502.00 Outpatient $251.00 "$1,219.74 " $326.30 $351.40 $331.32 Not Applicable: Bundled with Procedure $175.70 $401.60 $175.70 "$1,219.74 " CVR BUR HL CRNMXF .4MM 17MM MATRIXNEURO TI NS BLU 04.503.023 C1713 SUPPLY/IMPLANTS "$1,234.00 " Outpatient $617.00 "$1,219.74 " $802.10 $863.80 $814.44 Not Applicable: Bundled with Procedure $431.90 $987.20 $431.90 "$1,219.74 " CVR BUR HL CRNL LOPRFL SM TI 1.6MM SCR 218-0094 C1713 SUPPLY/IMPLANTS "$1,164.00 " Outpatient $582.00 "$1,219.74 " $756.60 $814.80 $768.24 Not Applicable: Bundled with Procedure $407.40 $931.20 $407.40 "$1,219.74 " CVR BUR HL .4MM 7MM TAB UNV NEURO III NS 5334507 C1713 SUPPLY/IMPLANTS "$1,118.00 " Outpatient $559.00 "$1,219.74 " $726.70 $782.60 $737.88 Not Applicable: Bundled with Procedure $391.30 $894.40 $391.30 "$1,219.74 " CVR BUR HL CRNMXF .4MM 10MM TAB LOPRFL UNV NEURO III NS 5334510 C1713 SUPPLY/IMPLANTS "$1,253.00 " Outpatient $626.50 "$1,219.74 " $814.45 $877.10 $826.98 Not Applicable: Bundled with Procedure $438.55 "$1,002.40 " $438.55 "$1,219.74 " CVR BUR HL 20MM LOPRFL TAB UNV NEURO III 5334520 C1713 SUPPLY/IMPLANTS "$1,231.00 " Outpatient $615.50 "$1,219.74 " $800.15 $861.70 $812.46 Not Applicable: Bundled with Procedure $430.85 $984.80 $430.85 "$1,219.74 " CVR BUR HL LOPRFL TAB SHNT THK20MM STD 5334620 C1713 SUPPLY/IMPLANTS "$1,607.00 " Outpatient $803.50 "$1,219.74 " "$1,044.55 " "$1,124.90 " "$1,060.62 " Not Applicable: Bundled with Procedure $562.45 "$1,285.60 " $562.45 "$1,285.60 " CVR BUR HL CRNMXF .3MM 18.5MM THINFLAP BNT STRL 19-1020B C1713 SUPPLY/IMPLANTS $931.00 Outpatient $465.50 "$1,219.74 " $605.15 $651.70 $614.46 Not Applicable: Bundled with Procedure $325.85 $744.80 $325.85 "$1,219.74 " CVR BUR HL CRNMXF 24MM LOPRFL THINFLAP BNT 19-1021 C1713 SUPPLY/IMPLANTS $931.00 Outpatient $465.50 "$1,219.74 " $605.15 $651.70 $614.46 Not Applicable: Bundled with Procedure $325.85 $744.80 $325.85 "$1,219.74 " CVR BUR HL CRNM 12MM ULT LOPRFL MATRIXNEURO TI NS LGHT GRN 04.502.021 C1713 SUPPLY/IMPLANTS "$1,334.00 " Outpatient $667.00 "$1,219.74 " $867.10 $933.80 $880.44 Not Applicable: Bundled with Procedure $466.90 "$1,067.20 " $466.90 "$1,219.74 " CVR BUR HL CRNM 15MM ULT LOPRFL MATRIXNEURO TI NS LGHT GRN 04.502.022 C1713 SUPPLY/IMPLANTS "$1,334.00 " Outpatient $667.00 "$1,219.74 " $867.10 $933.80 $880.44 Not Applicable: Bundled with Procedure $466.90 "$1,067.20 " $466.90 "$1,219.74 " CVR BUR HL CRNM 17MM ULT LOPRFL MATRIXNEURO TI NS LGHT GRN 04.502.023 C1713 SUPPLY/IMPLANTS "$1,334.00 " Outpatient $667.00 "$1,219.74 " $867.10 $933.80 $880.44 Not Applicable: Bundled with Procedure $466.90 "$1,067.20 " $466.90 "$1,219.74 " CVR BUR HL CRNM 24MM ULT LOPRFL MATRIXNEURO TI NS LGHT GRN 04.502.024 C1713 SUPPLY/IMPLANTS "$1,334.00 " Outpatient $667.00 "$1,219.74 " $867.10 $933.80 $880.44 Not Applicable: Bundled with Procedure $466.90 "$1,067.20 " $466.90 "$1,219.74 " CVR BUR HL CRNM 17MM ULT LOPRFL SHNT MATRIXNEURO TI NS LGHT 04.502.028 C1713 SUPPLY/IMPLANTS "$1,334.00 " Outpatient $667.00 "$1,219.74 " $867.10 $933.80 $880.44 Not Applicable: Bundled with Procedure $466.90 "$1,067.20 " $466.90 "$1,219.74 " CVR BUR HL CRNM 12MM MATRIXNEURO THK.4MM TI NS BLU 04.503.021 C1713 SUPPLY/IMPLANTS "$1,234.00 " Outpatient $617.00 "$1,219.74 " $802.10 $863.80 $814.44 Not Applicable: Bundled with Procedure $431.90 $987.20 $431.90 "$1,219.74 " CVR BUR HL CRNL 24MM MATRIXNEURO TI NS BLU 04.503.024 C1713 SUPPLY/IMPLANTS "$1,234.00 " Outpatient $617.00 "$1,219.74 " $802.10 $863.80 $814.44 Not Applicable: Bundled with Procedure $431.90 $987.20 $431.90 "$1,219.74 " CVR BUR HL CRNMXF 12MM SHNT MATRIXNEURO TI SHNT DRN NS BLU 04.503.026 C1713 SUPPLY/IMPLANTS "$1,234.00 " Outpatient $617.00 "$1,219.74 " $802.10 $863.80 $814.44 Not Applicable: Bundled with Procedure $431.90 $987.20 $431.90 "$1,219.74 " CVR BUR HL CRNMXF 15MM SHNT MATRIXNEURO TI SHNT DRN NS BLU 04.503.027 C1713 SUPPLY/IMPLANTS "$1,234.00 " Outpatient $617.00 "$1,219.74 " $802.10 $863.80 $814.44 Not Applicable: Bundled with Procedure $431.90 $987.20 $431.90 "$1,219.74 " CVR BUR HL 17MM SHNT MATRIXNEURO TI NS BLU 04.503.028 C1713 SUPPLY/IMPLANTS "$1,234.00 " Outpatient $617.00 "$1,219.74 " $802.10 $863.80 $814.44 Not Applicable: Bundled with Procedure $431.90 $987.20 $431.90 "$1,219.74 " CVR BUR HL CRNMXF 24MM MATRIXNEURO TI SHNT DRN NS BLU 04.503.029 C1713 SUPPLY/IMPLANTS "$1,234.00 " Outpatient $617.00 "$1,219.74 " $802.10 $863.80 $814.44 Not Applicable: Bundled with Procedure $431.90 $987.20 $431.90 "$1,219.74 " CVR BUR HL RB 17MM 2.9MM ST LCK MATRIXRIB TI STRL 04.503.134S C1713 SUPPLY/IMPLANTS "$4,216.00 " Outpatient "$2,108.00 " "$1,219.74 " "$2,740.40 " "$2,951.20 " "$2,782.56 " Not Applicable: Bundled with Procedure "$1,475.60 " "$3,372.80 " "$1,219.74 " "$3,372.80 " CVR BUR HL CRNFCL 12MM 6 HL TI 1.3MM SCR NS 421.09 C1713 SUPPLY/IMPLANTS "$1,516.00 " Outpatient $758.00 "$1,219.74 " $985.40 "$1,061.20 " "$1,000.56 " Not Applicable: Bundled with Procedure $530.60 "$1,212.80 " $530.60 "$1,219.74 " CVR BUR HL CRNFCL 17MM 6 HL TI 1.3MM SCR NS 421.091 C1713 SUPPLY/IMPLANTS "$1,516.00 " Outpatient $758.00 "$1,219.74 " $985.40 "$1,061.20 " "$1,000.56 " Not Applicable: Bundled with Procedure $530.60 "$1,212.80 " $530.60 "$1,219.74 " CVR BUR HL CRNFCL .5MM 15MM 6 HL LOPRFL TI NS 421.526 C1713 SUPPLY/IMPLANTS "$1,175.00 " Outpatient $587.50 "$1,219.74 " $763.75 $822.50 $775.50 Not Applicable: Bundled with Procedure $411.25 $940.00 $411.25 "$1,219.74 " CVR BUR HL CRNFCL .5MM 24MM 6 HL LOPRFL TI NS 421.528 C1713 SUPPLY/IMPLANTS "$1,175.00 " Outpatient $587.50 "$1,219.74 " $763.75 $822.50 $775.50 Not Applicable: Bundled with Procedure $411.25 $940.00 $411.25 "$1,219.74 " CVR BUR HL .5MM 24MM 6 HL LOPRFL TI NS 421.553 C1713 SUPPLY/IMPLANTS "$1,175.00 " Outpatient $587.50 "$1,219.74 " $763.75 $822.50 $775.50 Not Applicable: Bundled with Procedure $411.25 $940.00 $411.25 "$1,219.74 " CVR BUR HL CRNMXF .5MM 17MM LOPRFL TI SHNT NS 421.554 C1713 SUPPLY/IMPLANTS "$1,175.00 " Outpatient $587.50 "$1,219.74 " $763.75 $822.50 $775.50 Not Applicable: Bundled with Procedure $411.25 $940.00 $411.25 "$1,219.74 " CVR BUR HL CRNMXF 8 HL RPD RSRB 1.5 MM SCR STRL 851.506.01S C1713 SUPPLY/IMPLANTS "$1,551.00 " Outpatient $775.50 "$1,219.74 " "$1,008.15 " "$1,085.70 " "$1,023.66 " Not Applicable: Bundled with Procedure $542.85 "$1,240.80 " $542.85 "$1,240.80 " CVR BUR HL CRNMXF 10 HL RPD RSRB 1.5 MM SCR STRL 851.508.01S C1713 SUPPLY/IMPLANTS "$1,551.00 " Outpatient $775.50 "$1,219.74 " "$1,008.15 " "$1,085.70 " "$1,023.66 " Not Applicable: Bundled with Procedure $542.85 "$1,240.80 " $542.85 "$1,240.80 " CVR BUR HL 20MM MATRIXNEURO TI SD422.001 C1713 SUPPLY/IMPLANTS "$2,864.00 " Outpatient "$1,432.00 " "$1,219.74 " "$1,861.60 " "$2,004.80 " "$1,890.24 " Not Applicable: Bundled with Procedure "$1,002.40 " "$2,291.20 " "$1,002.40 " "$2,291.20 " CVR BUR HL 17MM MATRIXNEURO TI LG SHNT SD422.002 C1713 SUPPLY/IMPLANTS "$2,875.00 " Outpatient "$1,437.50 " "$1,219.74 " "$1,868.75 " "$2,012.50 " "$1,897.50 " Not Applicable: Bundled with Procedure "$1,006.25 " "$2,300.00 " "$1,006.25 " "$2,300.00 " CVR BUR HL CRNMXF 14MMX.4MM LOPRFL SHNT TAB UNV NEURO III TI 5334614 C1713 SUPPLY/IMPLANTS "$1,547.00 " Outpatient $773.50 "$1,219.74 " "$1,005.55 " "$1,082.90 " "$1,021.02 " Not Applicable: Bundled with Procedure $541.45 "$1,237.60 " $541.45 "$1,237.60 " CVR BUR HL CRNMXF 10MM LOPRFL TAB MED TI 1.5MM SCR NS LF 53-05510 C1713 SUPPLY/IMPLANTS "$1,304.00 " Outpatient $652.00 "$1,219.74 " $847.60 $912.80 $860.64 Not Applicable: Bundled with Procedure $456.40 "$1,043.20 " $456.40 "$1,219.74 " CVR BUR HL 14MM LOPRFL TAB UNV NEURO II THK.05MM NS LF DISP 53-05514 C1713 SUPPLY/IMPLANTS "$1,304.00 " Outpatient $652.00 "$1,219.74 " $847.60 $912.80 $860.64 Not Applicable: Bundled with Procedure $456.40 "$1,043.20 " $456.40 "$1,219.74 " CVR CLP POST 1540 C1713 SUPPLY/IMPLANTS $991.00 Outpatient $495.50 "$1,219.74 " $644.15 $693.70 $654.06 Not Applicable: Bundled with Procedure $346.85 $792.80 $346.85 "$1,219.74 " CVR INST NCB 9 HL FEM PROX PLT MIS PERIPROSTHETIC TRGT DEV 200024390 C1713 SUPPLY/IMPLANTS "$1,206.00 " Outpatient $603.00 "$1,219.74 " $783.90 $844.20 $795.96 Not Applicable: Bundled with Procedure $422.10 $964.80 $422.10 "$1,219.74 " CVR INST NCB 12 HL FEM PROX PLT MIS PERIPROSTHETIC TRGT DEV 200024391 C1713 SUPPLY/IMPLANTS "$1,206.00 " Outpatient $603.00 "$1,219.74 " $783.90 $844.20 $795.96 Not Applicable: Bundled with Procedure $422.10 $964.80 $422.10 "$1,219.74 " CVR INST NCB 15 HL FEM PROX PLT MIS PERIPROSTHETIC TRGT DEV 200024392 C1713 SUPPLY/IMPLANTS "$1,206.00 " Outpatient $603.00 "$1,219.74 " $783.90 $844.20 $795.96 Not Applicable: Bundled with Procedure $422.10 $964.80 $422.10 "$1,219.74 " CVR INST NCB 18 HL FEM PROX PLT MIS PERIPROSTHETIC TRGT DEV 200024393 C1713 SUPPLY/IMPLANTS "$1,206.00 " Outpatient $603.00 "$1,219.74 " $783.90 $844.20 $795.96 Not Applicable: Bundled with Procedure $422.10 $964.80 $422.10 "$1,219.74 " CVR INST NCB 21 HL FEM PROX PLT MIS PERIPROSTHETIC TRGT DEV 200024394 C1713 SUPPLY/IMPLANTS "$1,206.00 " Outpatient $603.00 "$1,219.74 " $783.90 $844.20 $795.96 Not Applicable: Bundled with Procedure $422.10 $964.80 $422.10 "$1,219.74 " CVR INST NCB 9 HL FEM DIST PLT MIS PERIPROSTHETIC TRGT DEV 200024395 C1713 SUPPLY/IMPLANTS "$1,206.00 " Outpatient $603.00 "$1,219.74 " $783.90 $844.20 $795.96 Not Applicable: Bundled with Procedure $422.10 $964.80 $422.10 "$1,219.74 " CVR INST NCB 12 HL FEM DIST PLT MIS PERIPROSTHETIC TRGT DEV 200024396 C1713 SUPPLY/IMPLANTS "$1,206.00 " Outpatient $603.00 "$1,219.74 " $783.90 $844.20 $795.96 Not Applicable: Bundled with Procedure $422.10 $964.80 $422.10 "$1,219.74 " CVR INST NCB 15 HL FEM DIST PLT MIS PERIPROSTHETIC TRGT DEV 200024397 C1713 SUPPLY/IMPLANTS "$1,206.00 " Outpatient $603.00 "$1,219.74 " $783.90 $844.20 $795.96 Not Applicable: Bundled with Procedure $422.10 $964.80 $422.10 "$1,219.74 " CVR INST NCB 18 HL FEM DIST PLT MIS PERIPROSTHETIC TRGT DEV 200024398 C1713 SUPPLY/IMPLANTS "$1,206.00 " Outpatient $603.00 "$1,219.74 " $783.90 $844.20 $795.96 Not Applicable: Bundled with Procedure $422.10 $964.80 $422.10 "$1,219.74 " CVR INST NCB 21 HL FEM DIST PLT MIS PERIPROSTHETIC TRGT DEV 200024399 C1713 SUPPLY/IMPLANTS "$1,206.00 " Outpatient $603.00 "$1,219.74 " $783.90 $844.20 $795.96 Not Applicable: Bundled with Procedure $422.10 $964.80 $422.10 "$1,219.74 " CVR INST GEAR NS 90 D SCRDRVR 03.505.007 C1713 SUPPLY/IMPLANTS $527.00 Outpatient $263.50 "$1,219.74 " $342.55 $368.90 $347.82 Not Applicable: Bundled with Procedure $184.45 $421.60 $184.45 "$1,219.74 " CVR SCR 60MM HBCP WRST TI NS PL-WF60 C1713 SUPPLY/IMPLANTS $599.00 Outpatient $299.50 "$1,219.74 " $389.35 $419.30 $395.34 Not Applicable: Bundled with Procedure $209.65 $479.20 $209.65 "$1,219.74 " CYGNUS 16MMX3.75MM VARIABLE SELF-TAPPING SCREW 7-375V-162 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " CYGNUS 16MMX4.25MM VARIABLE SELF-TAPPING SCREW 7-425V-162 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " CYGNUS 10MM ONE LEVEL ANTERIOR CERVICAL PLATE 7-1-10MT C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " CYGNUS 14MMX3.75MM VARIABLE SELF-TAPPING SCREW 7-375V-142 C1713 SUPPLY/IMPLANTS "$1,142.00 " Outpatient $571.00 "$1,219.74 " $742.30 $799.40 $753.72 Not Applicable: Bundled with Procedure $399.70 $913.60 $399.70 "$1,219.74 " CYGNUS 30MM TWO LEVEL ANTERIOR CERVICAL PLATE 7-2-30MT C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " CYGNUSâ„¢ 35mm TWO LEVEL ANTERIOR CERVICAL PLATE 7-2-35MT C1713 SUPPLY/IMPLANTS "$5,382.00 " Outpatient "$2,691.00 " "$1,219.74 " "$3,498.30 " "$3,767.40 " "$3,552.12 " Not Applicable: Bundled with Procedure "$1,883.70 " "$4,305.60 " "$1,219.74 " "$4,305.60 " CYGNUSâ„¢ 16mm x 3.75mm Variable Self-Drilling Screw 7-375V-161 C1713 SUPPLY/IMPLANTS "$1,142.00 " Outpatient $571.00 "$1,219.74 " $742.30 $799.40 $753.72 Not Applicable: Bundled with Procedure $399.70 $913.60 $399.70 "$1,219.74 " CYGNUSâ„¢ 14mm x 3.75mm Variable Self-Drilling Screw 7-375V-141 C1713 SUPPLY/IMPLANTS "$1,142.00 " Outpatient $571.00 "$1,219.74 " $742.30 $799.40 $753.72 Not Applicable: Bundled with Procedure $399.70 $913.60 $399.70 "$1,219.74 " CYGNUSâ„¢ 14mm x 4.25mm Variable Self-Tapping Screw 7-425V-142 C1713 SUPPLY/IMPLANTS "$1,142.00 " Outpatient $571.00 "$1,219.74 " $742.30 $799.40 $753.72 Not Applicable: Bundled with Procedure $399.70 $913.60 $399.70 "$1,219.74 " CYGNUSâ„¢ 32mm TWO LEVEL ANTERIOR CERVICAL PLATE 7-2-32MT C1713 SUPPLY/IMPLANTS "$5,382.00 " Outpatient "$2,691.00 " "$1,219.74 " "$3,498.30 " "$3,767.40 " "$3,552.12 " Not Applicable: Bundled with Procedure "$1,883.70 " "$4,305.60 " "$1,219.74 " "$4,305.60 " CYGNUSâ„¢ 14mm ONE LEVEL ANTERIOR CERVICAL PLATE 7-1-14MT C1713 SUPPLY/IMPLANTS "$4,404.00 " Outpatient "$2,202.00 " "$1,219.74 " "$2,862.60 " "$3,082.80 " "$2,906.64 " Not Applicable: Bundled with Procedure "$1,541.40 " "$3,523.20 " "$1,219.74 " "$3,523.20 " CYGNUSâ„¢ 12mm x 4.25mm Variable Self-Tapping Screw 7-425V-122 C1713 SUPPLY/IMPLANTS "$1,142.00 " Outpatient $571.00 "$1,219.74 " $742.30 $799.40 $753.72 Not Applicable: Bundled with Procedure $399.70 $913.60 $399.70 "$1,219.74 " CYGNUS 54MM THREE LEVEL ANTERIOR CERVICAL PLATE 7-3-54MT C1713 SUPPLY/IMPLANTS "$5,382.00 " Outpatient "$2,691.00 " "$1,219.74 " "$3,498.30 " "$3,767.40 " "$3,552.12 " Not Applicable: Bundled with Procedure "$1,883.70 " "$4,305.60 " "$1,219.74 " "$4,305.60 " DEPTH GAUGE SLEEVELESS SDG. C1713 SUPPLY/IMPLANTS "$1,875.00 " Outpatient $937.50 "$1,219.74 " "$1,218.75 " "$1,312.50 " "$1,237.50 " Not Applicable: Bundled with Procedure $656.25 "$1,500.00 " $656.25 "$1,500.00 " DEV CLSR 50MM 45D ATRICLIP FLXB SHFT PLNG GRP NTNL TI PLSTR ACH 250 C1713 SUPPLY/IMPLANTS "$6,110.00 " Outpatient "$3,055.00 " "$1,219.74 " "$3,971.50 " "$4,277.00 " "$4,032.60 " Not Applicable: Bundled with Procedure "$2,138.50 " "$4,888.00 " "$1,219.74 " "$4,888.00 " DEV CMPR VERSANAIL TRGT IM NL 8207-05-000 C1713 SUPPLY/IMPLANTS "$10,811.00 " Outpatient "$5,405.50 " "$1,219.74 " "$7,027.15 " "$7,567.70 " "$7,135.26 " Not Applicable: Bundled with Procedure "$3,783.85 " "$8,648.80 " "$1,219.74 " "$8,648.80 " DEV CMPR NTR NL CEPHALOMEDULLARY LG SCR CEPHALOMEDULLARY NL 249000349 C1713 SUPPLY/IMPLANTS $771.00 Outpatient $385.50 "$1,219.74 " $501.15 $539.70 $508.86 Not Applicable: Bundled with Procedure $269.85 $616.80 $269.85 "$1,219.74 " DEV CMPR NTR NL TIB AX 249000549 C1713 SUPPLY/IMPLANTS $771.00 Outpatient $385.50 "$1,219.74 " $501.15 $539.70 $508.86 Not Applicable: Bundled with Procedure $269.85 $616.80 $269.85 "$1,219.74 " DEV FX ANKL ZIPTIGHT ZIPLOOP KNTLS LOPRFL TI STRL DISP 909853 C1713 SUPPLY/IMPLANTS "$3,139.00 " Outpatient "$1,569.50 " "$1,219.74 " "$2,040.35 " "$2,197.30 " "$2,071.74 " Not Applicable: Bundled with Procedure "$1,098.65 " "$2,511.20 " "$1,098.65 " "$2,511.20 " DEV FX HIP TOGGLELOC XL ZIPLOOP TCH INLN 110005090 C1713 SUPPLY/IMPLANTS "$2,372.00 " Outpatient "$1,186.00 " "$1,219.74 " "$1,541.80 " "$1,660.40 " "$1,565.52 " Not Applicable: Bundled with Procedure $830.20 "$1,897.60 " $830.20 "$1,897.60 " DEV MSR DRCT CNN 5 MM SCR NS 03.231.017 C1713 SUPPLY/IMPLANTS "$1,892.00 " Outpatient $946.00 "$1,219.74 " "$1,229.80 " "$1,324.40 " "$1,248.72 " Not Applicable: Bundled with Procedure $662.20 "$1,513.60 " $662.20 "$1,513.60 " DEV MSR NCB-PH SS CNN SCR MIS NS 200024119 C1713 SUPPLY/IMPLANTS "$1,332.00 " Outpatient $666.00 "$1,219.74 " $865.80 $932.40 $879.12 Not Applicable: Bundled with Procedure $466.20 "$1,065.60 " $466.20 "$1,219.74 " DEV STAB 45MM SPNE PLV SPIRE CD HZN 9240100 C1713 SUPPLY/IMPLANTS "$28,071.00 " Outpatient "$14,035.50 " "$1,219.74 " "$18,246.15 " "$19,649.70 " "$18,526.86 " Not Applicable: Bundled with Procedure "$9,824.85 " "$22,456.80 " "$1,219.74 " "$22,456.80 " DEV SUT SPEEDCINCH FBRWR 2-0 PEEK CRV NDL LOPRFL ADJ D STP AR-4502 C1713 SUPPLY/IMPLANTS "$2,764.00 " Outpatient "$1,382.00 " "$1,219.74 " "$1,796.60 " "$1,934.80 " "$1,824.24 " Not Applicable: Bundled with Procedure $967.40 "$2,211.20 " $967.40 "$2,211.20 " DEV THYRPL 9 MONT LRYNG KT SIL F STRL MTF-09 C1713 SUPPLY/IMPLANTS "$2,141.00 " Outpatient "$1,070.50 " "$1,219.74 " "$1,391.65 " "$1,498.70 " "$1,413.06 " Not Applicable: Bundled with Procedure $749.35 "$1,712.80 " $749.35 "$1,712.80 " DEV TRGT UNV WND TIB VERSANAIL 2810-12-016 C1713 SUPPLY/IMPLANTS "$1,484.00 " Outpatient $742.00 "$1,219.74 " $964.60 "$1,038.80 " $979.44 Not Applicable: Bundled with Procedure $519.40 "$1,187.20 " $519.40 "$1,219.74 " DEV TRGT ARM LCK PED NL SYS 24300 C1713 SUPPLY/IMPLANTS "$5,072.00 " Outpatient "$2,536.00 " "$1,219.74 " "$3,296.80 " "$3,550.40 " "$3,347.52 " Not Applicable: Bundled with Procedure "$1,775.20 " "$4,057.60 " "$1,219.74 " "$4,057.60 " DEV TRGT UNV ARM VERSANAIL 2810-13-009 C1713 SUPPLY/IMPLANTS "$12,014.00 " Outpatient "$6,007.00 " "$1,219.74 " "$7,809.10 " "$8,409.80 " "$7,929.24 " Not Applicable: Bundled with Procedure "$4,204.90 " "$9,611.20 " "$1,219.74 " "$9,611.20 " DEV TRGT LOPRFL ARM TIB VERSANAIL 2810-12-009 C1713 SUPPLY/IMPLANTS "$14,773.00 " Outpatient "$7,386.50 " "$1,219.74 " "$9,602.45 " "$10,341.10 " "$9,750.18 " Not Applicable: Bundled with Procedure "$5,170.55 " "$11,818.40 " "$1,219.74 " "$11,818.40 " DEV TRGT RECON PHNX STRL ANTGRD FEM NL SYS 14-442018 C1713 SUPPLY/IMPLANTS "$25,856.00 " Outpatient "$12,928.00 " "$1,219.74 " "$16,806.40 " "$18,099.20 " "$17,064.96 " Not Applicable: Bundled with Procedure "$9,049.60 " "$20,684.80 " "$1,219.74 " "$20,684.80 " DEV TRGT ARM ENTRY PRTL TROCH VERSANAIL 2810-13-010 C1713 SUPPLY/IMPLANTS "$28,879.00 " Outpatient "$14,439.50 " "$1,219.74 " "$18,771.35 " "$20,215.30 " "$19,060.14 " Not Applicable: Bundled with Procedure "$10,107.65 " "$23,103.20 " "$1,219.74 " "$23,103.20 " DEV TRGT JIG ARM PHNX ANKL ARTHDS NL SYS 14-440050 C1713 SUPPLY/IMPLANTS "$50,722.00 " Outpatient "$25,361.00 " "$1,219.74 " "$32,969.30 " "$35,505.40 " "$33,476.52 " Not Applicable: Bundled with Procedure "$17,752.70 " "$40,577.60 " "$1,219.74 " "$40,577.60 " DEV TRGT ARM RTRGD C FEM NL SYS 14-442020 C1713 SUPPLY/IMPLANTS "$54,494.00 " Outpatient "$27,247.00 " "$1,219.74 " "$35,421.10 " "$38,145.80 " "$35,966.04 " Not Applicable: Bundled with Procedure "$19,072.90 " "$43,595.20 " "$1,219.74 " "$43,595.20 " DEV TRGT TIB NL ARM CORELOCK TCH PHNX 41000 C1713 SUPPLY/IMPLANTS "$83,480.00 " Outpatient "$41,740.00 " "$1,219.74 " "$54,262.00 " "$58,436.00 " "$55,096.80 " Not Applicable: Bundled with Procedure "$29,218.00 " "$66,784.00 " "$1,219.74 " "$66,784.00 " DEV TRGT 13CM 13MM PIN RELOCATOR VFX LF 3.2MM GDPN 119900800 C1713 SUPPLY/IMPLANTS "$1,993.00 " Outpatient $996.50 "$1,219.74 " "$1,295.45 " "$1,395.10 " "$1,315.38 " Not Applicable: Bundled with Procedure $697.55 "$1,594.40 " $697.55 "$1,594.40 " DEV TRGT ARM ITST 225805213 C1713 SUPPLY/IMPLANTS "$3,870.00 " Outpatient "$1,935.00 " "$1,219.74 " "$2,515.50 " "$2,709.00 " "$2,554.20 " Not Applicable: Bundled with Procedure "$1,354.50 " "$3,096.00 " "$1,219.74 " "$3,096.00 " DEV TRGT 16CM RTRGD MOD FEM NTR NL 249000416 C1713 SUPPLY/IMPLANTS "$15,058.00 " Outpatient "$7,529.00 " "$1,219.74 " "$9,787.70 " "$10,540.60 " "$9,938.28 " Not Applicable: Bundled with Procedure "$5,270.30 " "$12,046.40 " "$1,219.74 " "$12,046.40 " DEV TRGT 20CM RTRGD MOD FEM NTR NL 249000420 C1713 SUPPLY/IMPLANTS "$16,413.00 " Outpatient "$8,206.50 " "$1,219.74 " "$10,668.45 " "$11,489.10 " "$10,832.58 " Not Applicable: Bundled with Procedure "$5,744.55 " "$13,130.40 " "$1,219.74 " "$13,130.40 " DEV TRGT 24CM RTRGD MOD FEM NTR NL 249000424 C1713 SUPPLY/IMPLANTS "$17,509.00 " Outpatient "$8,754.50 " "$1,219.74 " "$11,380.85 " "$12,256.30 " "$11,555.94 " Not Applicable: Bundled with Procedure "$6,128.15 " "$14,007.20 " "$1,219.74 " "$14,007.20 " DEV TRGT FEM DIST SS NCB NS RT PLT MIS 200024070 C1713 SUPPLY/IMPLANTS "$23,542.00 " Outpatient "$11,771.00 " "$1,219.74 " "$15,302.30 " "$16,479.40 " "$15,537.72 " Not Applicable: Bundled with Procedure "$8,239.70 " "$18,833.60 " "$1,219.74 " "$18,833.60 " DEV TRGT FEM DIST SS NCB NS LT PLT MIS 200024071 C1713 SUPPLY/IMPLANTS "$23,542.00 " Outpatient "$11,771.00 " "$1,219.74 " "$15,302.30 " "$16,479.40 " "$15,537.72 " Not Applicable: Bundled with Procedure "$8,239.70 " "$18,833.60 " "$1,219.74 " "$18,833.60 " DEV TRGT TIB PROX PEEK-OPTM NCB NS RT PLT MIS 200024080 C1713 SUPPLY/IMPLANTS "$21,839.00 " Outpatient "$10,919.50 " "$1,219.74 " "$14,195.35 " "$15,287.30 " "$14,413.74 " Not Applicable: Bundled with Procedure "$7,643.65 " "$17,471.20 " "$1,219.74 " "$17,471.20 " DEV TRGT TIB PROX PEEK-OPTM NCB NS LT PLT MIS 200024081 C1713 SUPPLY/IMPLANTS "$21,839.00 " Outpatient "$10,919.50 " "$1,219.74 " "$14,195.35 " "$15,287.30 " "$14,413.74 " Not Applicable: Bundled with Procedure "$7,643.65 " "$17,471.20 " "$1,219.74 " "$17,471.20 " DEV TRGT STD ANTIROTATION PIN NTR NL 47249003004 C1713 SUPPLY/IMPLANTS $560.00 Outpatient $280.00 "$1,219.74 " $364.00 $392.00 $369.60 Not Applicable: Bundled with Procedure $196.00 $448.00 $196.00 "$1,219.74 " DEV XTRNFX DFS VAR SCR CRRG MID LVL 13080 C1713 SUPPLY/IMPLANTS "$3,600.00 " Outpatient "$1,800.00 " "$1,219.74 " "$2,340.00 " "$2,520.00 " "$2,376.00 " Not Applicable: Bundled with Procedure "$1,260.00 " "$2,880.00 " "$1,219.74 " "$2,880.00 " DEV XTRNFX OPTRM ELB TRGT DISC 9580 C1713 SUPPLY/IMPLANTS "$1,539.00 " Outpatient $769.50 "$1,219.74 " "$1,000.35 " "$1,077.30 " "$1,015.74 " Not Applicable: Bundled with Procedure $538.65 "$1,231.20 " $538.65 "$1,231.20 " DEV XTRNFX A FSHR LID 200801000 C1713 SUPPLY/IMPLANTS "$2,480.00 " Outpatient "$1,240.00 " "$1,219.74 " "$1,612.00 " "$1,736.00 " "$1,636.80 " Not Applicable: Bundled with Procedure $868.00 "$1,984.00 " $868.00 "$1,984.00 " DEV XTRNFX DYN ADLT C RL 6410 C1713 SUPPLY/IMPLANTS "$3,165.00 " Outpatient "$1,582.50 " "$1,219.74 " "$2,057.25 " "$2,215.50 " "$2,088.90 " Not Applicable: Bundled with Procedure "$1,107.75 " "$2,532.00 " "$1,107.75 " "$2,532.00 " DEVICE QUICK CROSS CAPTURE 8MM U108 C1713 SUPPLY/IMPLANTS "$2,691.00 " Outpatient "$1,345.50 " "$1,219.74 " "$1,749.15 " "$1,883.70 " "$1,776.06 " Not Applicable: Bundled with Procedure $941.85 "$2,152.80 " $941.85 "$2,152.80 " DEVICE FUSION RIALTO TITANIUM L50 MM X W12 MM THREAD 74200001250 C1713 SUPPLY/IMPLANTS "$21,473.00 " Outpatient "$10,736.50 " "$1,219.74 " "$13,957.45 " "$15,031.10 " "$14,172.18 " Not Applicable: Bundled with Procedure "$7,515.55 " "$17,178.40 " "$1,219.74 " "$17,178.40 " DEVICE FUSION RIALTO TITANIUM L40 MM X W12 MM THREAD 74200001240 C1713 SUPPLY/IMPLANTS "$21,473.00 " Outpatient "$10,736.50 " "$1,219.74 " "$13,957.45 " "$15,031.10 " "$14,172.18 " Not Applicable: Bundled with Procedure "$7,515.55 " "$17,178.40 " "$1,219.74 " "$17,178.40 " DEVICE FIXATION LSSS POLYESTER L9 CM ACROMIOCLAVICULAR 2 BRA LD090 C1713 SUPPLY/IMPLANTS "$13,333.00 " Outpatient "$6,666.50 " "$1,219.74 " "$8,666.45 " "$9,333.10 " "$8,799.78 " Not Applicable: Bundled with Procedure "$4,666.55 " "$10,666.40 " "$1,219.74 " "$10,666.40 " DEVICE FIXATION EXOSHAPE H30 MM OD10 MM TIBIAL FASTENER 1101-00-1030 C1713 SUPPLY/IMPLANTS "$2,523.00 " Outpatient "$1,261.50 " "$1,219.74 " "$1,639.95 " "$1,766.10 " "$1,665.18 " Not Applicable: Bundled with Procedure $883.05 "$2,018.40 " $883.05 "$2,018.40 " DEVICE FIXATION LOCKDOWN L12 CM ACROMIOCLAVICULAR STERILE LA LD120 C1713 SUPPLY/IMPLANTS "$13,333.00 " Outpatient "$6,666.50 " "$1,219.74 " "$8,666.45 " "$9,333.10 " "$8,799.78 " Not Applicable: Bundled with Procedure "$4,666.55 " "$10,666.40 " "$1,219.74 " "$10,666.40 " DEVICE FIXATION TIGHTROPE BONE TENDON BONE SMALL L10 MM ACL AR-1588BTB-J C1713 SUPPLY/IMPLANTS "$2,539.00 " Outpatient "$1,269.50 " "$1,219.74 " "$1,650.35 " "$1,777.30 " "$1,675.74 " Not Applicable: Bundled with Procedure $888.65 "$2,031.20 " $888.65 "$2,031.20 " DEVICE FIXATION TIGHTROPE FIBERTAG ACL RIGHT DISPOSABLE AR-1588RTT C1713 SUPPLY/IMPLANTS "$2,569.00 " Outpatient "$1,284.50 " "$1,219.74 " "$1,669.85 " "$1,798.30 " "$1,695.54 " Not Applicable: Bundled with Procedure $899.15 "$2,055.20 " $899.15 "$2,055.20 " DEVICE FIXATION TIGHTROPE FIBERTAG ACL ABS DISPOSABLE AR-1588TNT C1713 SUPPLY/IMPLANTS "$1,912.00 " Outpatient $956.00 "$1,219.74 " "$1,242.80 " "$1,338.40 " "$1,261.92 " Not Applicable: Bundled with Procedure $669.20 "$1,529.60 " $669.20 "$1,529.60 " DEVICE FIXATION EXOSHAPE H30 MM OD12 MM TIBIAL FASTENER CART 1101-00-1230 C1713 SUPPLY/IMPLANTS "$2,409.00 " Outpatient "$1,204.50 " "$1,219.74 " "$1,565.85 " "$1,686.30 " "$1,589.94 " Not Applicable: Bundled with Procedure $843.15 "$1,927.20 " $843.15 "$1,927.20 " DISC ARTIFICIAL TITANIUM UHMWPE POLYMER D12.5 MM MEDIUM W15 CDM-625 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " DISC ARTIFICIAL M6-C TITANIUM UHMWPE POLYMER D16 MM LARGE W1 CDL-627 C1713 SUPPLY/IMPLANTS "$25,441.00 " Outpatient "$12,720.50 " "$1,219.74 " "$16,536.65 " "$17,808.70 " "$16,791.06 " Not Applicable: Bundled with Procedure "$8,904.35 " "$20,352.80 " "$1,219.74 " "$20,352.80 " DISC ARTIFICIAL M6-C TITANIUM UHMWPE POLYMER D16 MM LARGE LO CDL-637L C1713 SUPPLY/IMPLANTS "$25,441.00 " Outpatient "$12,720.50 " "$1,219.74 " "$16,536.65 " "$17,808.70 " "$16,791.06 " Not Applicable: Bundled with Procedure "$8,904.35 " "$20,352.80 " "$1,219.74 " "$20,352.80 " DISC ARTIFICIAL M7-C TITANIUM UHMWPE POLYMER D16 MM LARGE LO CDL-737L C1713 SUPPLY/IMPLANTS "$25,441.00 " Outpatient "$12,720.50 " "$1,219.74 " "$16,536.65 " "$17,808.70 " "$16,791.06 " Not Applicable: Bundled with Procedure "$8,904.35 " "$20,352.80 " "$1,219.74 " "$20,352.80 " DISC ARTIFICIAL M6-C TITANIUM UHMWPE POLYMER D15 MM MEDIUM L CDM-635L C1713 SUPPLY/IMPLANTS "$26,600.00 " Outpatient "$13,300.00 " "$1,219.74 " "$17,290.00 " "$18,620.00 " "$17,556.00 " Not Applicable: Bundled with Procedure "$9,310.00 " "$21,280.00 " "$1,219.74 " "$21,280.00 " DISC INTVRTB 6MM PRODISC-C MED DP SPNE CRV COCR TI UHMWPE 09.820.036S C1713 SUPPLY/IMPLANTS "$28,854.00 " Outpatient "$14,427.00 " "$1,219.74 " "$18,755.10 " "$20,197.80 " "$19,043.64 " Not Applicable: Bundled with Procedure "$10,098.90 " "$23,083.20 " "$1,219.74 " "$23,083.20 " DISC INTVRTB 17X5MM MOBI-C 15MM SPNE CRV COCRMO TI UHMWPE HA MB 3575 C1713 SUPPLY/IMPLANTS "$24,700.00 " Outpatient "$12,350.00 " "$1,219.74 " "$16,055.00 " "$17,290.00 " "$16,302.00 " Not Applicable: Bundled with Procedure "$8,645.00 " "$19,760.00 " "$1,219.74 " "$19,760.00 " DISC INTVRTB 15X6MM MOBI-C 15MM SPNE CRV COCRMO TI UHMWPE HA MB 3556 C1713 SUPPLY/IMPLANTS "$46,468.00 " Outpatient "$23,234.00 " "$1,219.74 " "$30,204.20 " "$32,527.60 " "$30,668.88 " Not Applicable: Bundled with Procedure "$16,263.80 " "$37,174.40 " "$1,219.74 " "$37,174.40 " DISC INTVRTB 17X6MM MOBI-C 15MM SPNE CRV COCRMO TI UHMWPE HA MB 3576 C1713 SUPPLY/IMPLANTS "$46,468.00 " Outpatient "$23,234.00 " "$1,219.74 " "$30,204.20 " "$32,527.60 " "$30,668.88 " Not Applicable: Bundled with Procedure "$16,263.80 " "$37,174.40 " "$1,219.74 " "$37,174.40 " DISC INTVRTB 15X5MM MOBI-C 15MM SPNE CRV COCRMO TI UHMWPE HA MB 3555 C1713 SUPPLY/IMPLANTS "$46,468.00 " Outpatient "$23,234.00 " "$1,219.74 " "$30,204.20 " "$32,527.60 " "$30,668.88 " Not Applicable: Bundled with Procedure "$16,263.80 " "$37,174.40 " "$1,219.74 " "$37,174.40 " DISC INTVRTB 15X7MM MOBI-C 13MM SPNE CRV COCRMO TI UHMWPE HA MB 3357 C1713 SUPPLY/IMPLANTS "$35,218.00 " Outpatient "$17,609.00 " "$1,219.74 " "$22,891.70 " "$24,652.60 " "$23,243.88 " Not Applicable: Bundled with Procedure "$12,326.30 " "$28,174.40 " "$1,219.74 " "$28,174.40 " DISC INTVRTB 17X7MM MOBI-C 13MM SPNE CRV COCRMO TI UHMWPE HA MB 3377 C1713 SUPPLY/IMPLANTS "$35,218.00 " Outpatient "$17,609.00 " "$1,219.74 " "$22,891.70 " "$24,652.60 " "$23,243.88 " Not Applicable: Bundled with Procedure "$12,326.30 " "$28,174.40 " "$1,219.74 " "$28,174.40 " DISC INTVRTB 19X6MM MOBI-C 15MM SPNE CRV COCRMO TI UHMWPE HA MB 3596 C1713 SUPPLY/IMPLANTS "$15,848.00 " Outpatient "$7,924.00 " "$1,219.74 " "$10,301.20 " "$11,093.60 " "$10,459.68 " Not Applicable: Bundled with Procedure "$5,546.80 " "$12,678.40 " "$1,219.74 " "$12,678.40 " DISC INTVRTB 19X5MM MOBI-C 15MM SPNE CRV COCRMO TI UHMWPE HA MB 3595 C1713 SUPPLY/IMPLANTS "$15,848.00 " Outpatient "$7,924.00 " "$1,219.74 " "$10,301.20 " "$11,093.60 " "$10,459.68 " Not Applicable: Bundled with Procedure "$5,546.80 " "$12,678.40 " "$1,219.74 " "$12,678.40 " DISC INTVRTB 19X7MM MOBI-C 15MM SPNE CRV COCRMO TI UHMWPE HA MB 3597 C1713 SUPPLY/IMPLANTS "$15,848.00 " Outpatient "$7,924.00 " "$1,219.74 " "$10,301.20 " "$11,093.60 " "$10,459.68 " Not Applicable: Bundled with Procedure "$5,546.80 " "$12,678.40 " "$1,219.74 " "$12,678.40 " DISC INTVRTB 17X7MM MOBI-C 15MM SPNE CRV COCRMO TI UHMWPE HA MB 3577 C1713 SUPPLY/IMPLANTS "$15,848.00 " Outpatient "$7,924.00 " "$1,219.74 " "$10,301.20 " "$11,093.60 " "$10,459.68 " Not Applicable: Bundled with Procedure "$5,546.80 " "$12,678.40 " "$1,219.74 " "$12,678.40 " DISC INTVRTB 14MM 7MM PSTG LP CSPN TI 6972470 C1713 SUPPLY/IMPLANTS "$30,376.00 " Outpatient "$15,188.00 " "$1,219.74 " "$19,744.40 " "$21,263.20 " "$20,048.16 " Not Applicable: Bundled with Procedure "$10,631.60 " "$24,300.80 " "$1,219.74 " "$24,300.80 " DISC INTVRTB 16MM 7MM PSTG LP CSPN TI 6972670 C1713 SUPPLY/IMPLANTS "$30,376.00 " Outpatient "$15,188.00 " "$1,219.74 " "$19,744.40 " "$21,263.20 " "$20,048.16 " Not Applicable: Bundled with Procedure "$10,631.60 " "$24,300.80 " "$1,219.74 " "$24,300.80 " DISC INTVRTB 17X6MM MOBI-C 13MM SPNE CRV COCRMO TI UHMWPE HA MB 3376 C1713 SUPPLY/IMPLANTS "$35,218.00 " Outpatient "$17,609.00 " "$1,219.74 " "$22,891.70 " "$24,652.60 " "$23,243.88 " Not Applicable: Bundled with Procedure "$12,326.30 " "$28,174.40 " "$1,219.74 " "$28,174.40 " DISC INTVRTB 16MM 6MM PSTG LP CSPN TI 6972660 C1713 SUPPLY/IMPLANTS "$30,354.00 " Outpatient "$15,177.00 " "$1,219.74 " "$19,730.10 " "$21,247.80 " "$20,033.64 " Not Applicable: Bundled with Procedure "$10,623.90 " "$24,283.20 " "$1,219.74 " "$24,283.20 " DISC INTVRTB 14MM 6MM PSTG LP SPNE CRV TI STRL LF 6972460 C1713 SUPPLY/IMPLANTS "$27,353.00 " Outpatient "$13,676.50 " "$1,219.74 " "$17,779.45 " "$19,147.10 " "$18,052.98 " Not Applicable: Bundled with Procedure "$9,573.55 " "$21,882.40 " "$1,219.74 " "$21,882.40 " DISC INTERVERTEBRAL MOBI-C D17 MM STANDARD W17 MM X H6 MM ST MB3776 C1713 SUPPLY/IMPLANTS "$25,378.00 " Outpatient "$12,689.00 " "$1,219.74 " "$16,495.70 " "$17,764.60 " "$16,749.48 " Not Applicable: Bundled with Procedure "$8,882.30 " "$20,302.40 " "$1,219.74 " "$20,302.40 " DISC PROSTHESIS MOBI-C 15 X 15 X 7MM MB3557 C1713 SUPPLY/IMPLANTS "$46,468.00 " Outpatient "$23,234.00 " "$1,219.74 " "$30,204.20 " "$32,527.60 " "$30,668.88 " Not Applicable: Bundled with Procedure "$16,263.80 " "$37,174.40 " "$1,219.74 " "$37,174.40 " DIST LAT HUM PLT PROV LT 236002419 C1713 SUPPLY/IMPLANTS "$2,819.00 " Outpatient "$1,409.50 " "$1,219.74 " "$1,832.35 " "$1,973.30 " "$1,860.54 " Not Applicable: Bundled with Procedure $986.65 "$2,255.20 " $986.65 "$2,255.20 " DIST LAT HUM PLT JIG RT 236010501 C1713 SUPPLY/IMPLANTS "$1,391.00 " Outpatient $695.50 "$1,219.74 " $904.15 $973.70 $918.06 Not Applicable: Bundled with Procedure $486.85 "$1,112.80 " $486.85 "$1,219.74 " DIST LAT HUM PLT JIG LT 236010502 C1713 SUPPLY/IMPLANTS "$1,391.00 " Outpatient $695.50 "$1,219.74 " $904.15 $973.70 $918.06 Not Applicable: Bundled with Procedure $486.85 "$1,112.80 " $486.85 "$1,219.74 " DIST MED HUM SHORT PLT PROV 236010707 C1713 SUPPLY/IMPLANTS "$2,595.00 " Outpatient "$1,297.50 " "$1,219.74 " "$1,686.75 " "$1,816.50 " "$1,712.70 " Not Applicable: Bundled with Procedure $908.25 "$2,076.00 " $908.25 "$2,076.00 " DIST POST LAT HUM PLT PROV LT 236000619 C1713 SUPPLY/IMPLANTS "$2,595.00 " Outpatient "$1,297.50 " "$1,219.74 " "$1,686.75 " "$1,816.50 " "$1,712.70 " Not Applicable: Bundled with Procedure $908.25 "$2,076.00 " $908.25 "$2,076.00 " DIST POST LAT HUM PLT JIG RT 236010201 C1713 SUPPLY/IMPLANTS "$2,517.00 " Outpatient "$1,258.50 " "$1,219.74 " "$1,636.05 " "$1,761.90 " "$1,661.22 " Not Applicable: Bundled with Procedure $880.95 "$2,013.60 " $880.95 "$2,013.60 " DIST POST LAT HUM PLT JIG LT 236010202 C1713 SUPPLY/IMPLANTS "$2,517.00 " Outpatient "$1,258.50 " "$1,219.74 " "$1,636.05 " "$1,761.90 " "$1,661.22 " Not Applicable: Bundled with Procedure $880.95 "$2,013.60 " $880.95 "$2,013.60 " DISTAL RADIUS FIXATOR SURGICAL TRAY 5060 C1713 SUPPLY/IMPLANTS "$8,835.00 " Outpatient "$4,417.50 " "$1,219.74 " "$5,742.75 " "$6,184.50 " "$5,831.10 " Not Applicable: Bundled with Procedure "$3,092.25 " "$7,068.00 " "$1,219.74 " "$7,068.00 " DISTAL RADIUS FIXATOR KIT 240MM ROD/SCHANZ SCREW - STERILE 03.390.054S C1713 SUPPLY/IMPLANTS "$15,100.00 " Outpatient "$7,550.00 " "$1,219.74 " "$9,815.00 " "$10,570.00 " "$9,966.00 " Not Applicable: Bundled with Procedure "$5,285.00 " "$12,080.00 " "$1,219.74 " "$12,080.00 " DISTRACTION COMPRESSION DEVICE 214288003 C1713 SUPPLY/IMPLANTS "$3,765.00 " Outpatient "$1,882.50 " "$1,219.74 " "$2,447.25 " "$2,635.50 " "$2,484.90 " Not Applicable: Bundled with Procedure "$1,317.75 " "$3,012.00 " "$1,219.74 " "$3,012.00 " DRCT SRG 4.5MM FEM GRV CNN 1069 C1713 SUPPLY/IMPLANTS "$1,909.00 " Outpatient $954.50 "$1,219.74 " "$1,240.85 " "$1,336.30 " "$1,259.94 " Not Applicable: Bundled with Procedure $668.15 "$1,527.20 " $668.15 "$1,527.20 " DRG 483 MAJOR JOINT SHOULDER DRG 483 C1713 SUPPLY/IMPLANTS "$36,578.00 " Outpatient "$18,289.00 " "$1,219.74 " "$23,775.70 " "$25,604.60 " "$24,141.48 " Not Applicable: Bundled with Procedure "$12,802.30 " "$29,262.40 " "$1,219.74 " "$29,262.40 " DRILL FIXED DEPTH 2.1 X 18MM DS63928-18 C1713 SUPPLY/IMPLANTS "$2,593.00 " Outpatient "$1,296.50 " "$1,219.74 " "$1,685.45 " "$1,815.10 " "$1,711.38 " Not Applicable: Bundled with Procedure $907.55 "$2,074.40 " $907.55 "$2,074.40 " DRILL ADJUSTABLE 1.3MM LONG 76-2010 C1713 SUPPLY/IMPLANTS "$2,483.00 " Outpatient "$1,241.50 " "$1,219.74 " "$1,613.95 " "$1,738.10 " "$1,638.78 " Not Applicable: Bundled with Procedure $869.05 "$1,986.40 " $869.05 "$1,986.40 " DRILL TWIST APTUS L66 MM L10 MM OD1.6 MM STOP AO QUICK COUPL A-3231 C1713 SUPPLY/IMPLANTS $647.00 Outpatient $323.50 "$1,219.74 " $420.55 $452.90 $427.02 Not Applicable: Bundled with Procedure $226.45 $517.60 $226.45 "$1,219.74 " DRILL SURGICAL L9 MM STOP LAMINOPLASTY 95-2209 C1713 SUPPLY/IMPLANTS $782.00 Outpatient $391.00 "$1,219.74 " $508.30 $547.40 $516.12 Not Applicable: Bundled with Procedure $273.70 $625.60 $273.70 "$1,219.74 " DRILL GUIDE 2.7MM INDEP. LAG SCREW 703884 C1713 SUPPLY/IMPLANTS "$1,861.00 " Outpatient $930.50 "$1,219.74 " "$1,209.65 " "$1,302.70 " "$1,228.26 " Not Applicable: Bundled with Procedure $651.35 "$1,488.80 " $651.35 "$1,488.80 " DRL HND 2.4MM HRBRT PILT 115400100 C1713 SUPPLY/IMPLANTS "$1,579.00 " Outpatient $789.50 "$1,219.74 " "$1,026.35 " "$1,105.30 " "$1,042.14 " Not Applicable: Bundled with Procedure $552.65 "$1,263.20 " $552.65 "$1,263.20 " DRL SRG 125MM BIDRV END O+ 3.2MM GRY 58050032 C1713 SUPPLY/IMPLANTS "$1,088.00 " Outpatient $544.00 "$1,219.74 " $707.20 $761.60 $718.08 Not Applicable: Bundled with Procedure $380.80 $870.40 $380.80 "$1,219.74 " DRL SRG LNG ADJ STP 1.3MM 76-9101 C1713 SUPPLY/IMPLANTS $479.00 Outpatient $239.50 "$1,219.74 " $311.35 $335.30 $316.14 Not Applicable: Bundled with Procedure $167.65 $383.20 $167.65 "$1,219.74 " DRL SRG STP SLD LG SCR SLV T2 STRL RECON NL SYS 18063026S C1713 SUPPLY/IMPLANTS "$1,400.00 " Outpatient $700.00 "$1,219.74 " $910.00 $980.00 $924.00 Not Applicable: Bundled with Procedure $490.00 "$1,120.00 " $490.00 "$1,219.74 " DRL SRG SHRT AO CNCT LCK PED 4MM NL SYS 24360 C1713 SUPPLY/IMPLANTS $616.00 Outpatient $308.00 "$1,219.74 " $400.40 $431.20 $406.56 Not Applicable: Bundled with Procedure $215.60 $492.80 $215.60 "$1,219.74 " DRL SRG CNN 5MM 214214002 C1713 SUPPLY/IMPLANTS "$1,004.00 " Outpatient $502.00 "$1,219.74 " $652.60 $702.80 $662.64 Not Applicable: Bundled with Procedure $351.40 $803.20 $351.40 "$1,219.74 " DRL SRG OVR REUN 2.8 MM SCR 450107 C1713 SUPPLY/IMPLANTS "$1,170.00 " Outpatient $585.00 "$1,219.74 " $760.50 $819.00 $772.20 Not Applicable: Bundled with Procedure $409.50 $936.00 $409.50 "$1,219.74 " DRL SRG TWST CROWE PNT END 4MM STRL 471841 C1713 SUPPLY/IMPLANTS "$1,187.00 " Outpatient $593.50 "$1,219.74 " $771.55 $830.90 $783.42 Not Applicable: Bundled with Procedure $415.45 $949.60 $415.45 "$1,219.74 " DRL SRG 200MM CNN ZH 4.8MM STRL DISP 110008408 C1713 SUPPLY/IMPLANTS "$1,311.00 " Outpatient $655.50 "$1,219.74 " $852.15 $917.70 $865.26 Not Applicable: Bundled with Procedure $458.85 "$1,048.80 " $458.85 "$1,219.74 " DRL SRG 41 SHRT DIST SCR GRAD 4.3MM STRL DISP AFFIXUS HIP FX 211201406 C1713 SUPPLY/IMPLANTS "$1,391.00 " Outpatient $695.50 "$1,219.74 " $904.15 $973.70 $918.06 Not Applicable: Bundled with Procedure $486.85 "$1,112.80 " $486.85 "$1,219.74 " DRL SRG SLD AO 2.7MM 24440 C1713 SUPPLY/IMPLANTS "$1,444.00 " Outpatient $722.00 "$1,219.74 " $938.60 "$1,010.80 " $953.04 Not Applicable: Bundled with Procedure $505.40 "$1,155.20 " $505.40 "$1,219.74 " DRL SRG HIPLOC SS CNN CHS SYS STRL DISP 470109S C1713 SUPPLY/IMPLANTS "$1,484.00 " Outpatient $742.00 "$1,219.74 " $964.60 "$1,038.80 " $979.44 Not Applicable: Bundled with Procedure $519.40 "$1,187.20 " $519.40 "$1,219.74 " DRL SRG OVR REUN 3.5 MM SCR 450043 C1713 SUPPLY/IMPLANTS "$1,817.00 " Outpatient $908.50 "$1,219.74 " "$1,181.05 " "$1,271.90 " "$1,199.22 " Not Applicable: Bundled with Procedure $635.95 "$1,453.60 " $635.95 "$1,453.60 " DRL SRG OVR REUN 5 MM SCR 450036 C1713 SUPPLY/IMPLANTS "$1,817.00 " Outpatient $908.50 "$1,219.74 " "$1,181.05 " "$1,271.90 " "$1,199.22 " Not Applicable: Bundled with Procedure $635.95 "$1,453.60 " $635.95 "$1,453.60 " DRL SRG CNN 3MM AO 14-450315 C1713 SUPPLY/IMPLANTS "$2,739.00 " Outpatient "$1,369.50 " "$1,219.74 " "$1,780.35 " "$1,917.30 " "$1,807.74 " Not Applicable: Bundled with Procedure $958.65 "$2,191.20 " $958.65 "$2,191.20 " DRL SRG 4-4.5MM PILT THRD SCR REM 473688 C1713 SUPPLY/IMPLANTS "$5,474.00 " Outpatient "$2,737.00 " "$1,219.74 " "$3,558.10 " "$3,831.80 " "$3,612.84 " Not Applicable: Bundled with Procedure "$1,915.90 " "$4,379.20 " "$1,219.74 " "$4,379.20 " DRL SRG 6-6.5MM PILT THRD SCR REM 473690 C1713 SUPPLY/IMPLANTS "$5,474.00 " Outpatient "$2,737.00 " "$1,219.74 " "$3,558.10 " "$3,831.80 " "$3,612.84 " Not Applicable: Bundled with Procedure "$1,915.90 " "$4,379.20 " "$1,219.74 " "$4,379.20 " DRL SRG CNN MNMGNFX SS 2.7MM 114201127 C1713 SUPPLY/IMPLANTS "$1,127.00 " Outpatient $563.50 "$1,219.74 " $732.55 $788.90 $743.82 Not Applicable: Bundled with Procedure $394.45 $901.60 $394.45 "$1,219.74 " DRL SRG CNN SHFT STP HRBRT/WPL LF 115201300 C1713 SUPPLY/IMPLANTS "$1,240.00 " Outpatient $620.00 "$1,219.74 " $806.00 $868.00 $818.40 Not Applicable: Bundled with Procedure $434.00 $992.00 $434.00 "$1,219.74 " DRL SRG 16.1CM CNN GLD HL HRBRT/WPL SS 3.8MM 1.07MM NS LF 115201700 C1713 SUPPLY/IMPLANTS "$1,372.00 " Outpatient $686.00 "$1,219.74 " $891.80 $960.40 $905.52 Not Applicable: Bundled with Procedure $480.20 "$1,097.60 " $480.20 "$1,219.74 " DRL SRG 2MM HRBRT MAIN HND NS LF 115400200 C1713 SUPPLY/IMPLANTS $994.00 Outpatient $497.00 "$1,219.74 " $646.10 $695.80 $656.04 Not Applicable: Bundled with Procedure $347.90 $795.20 $347.90 "$1,219.74 " DRL SRG PILT PWR HRBRT 3.2MM BN SCR 115407000 C1713 SUPPLY/IMPLANTS $714.00 Outpatient $357.00 "$1,219.74 " $464.10 $499.80 $471.24 Not Applicable: Bundled with Procedure $249.90 $571.20 $249.90 "$1,219.74 " DRL SRG MAIN PWR HRBRT 2MM BN SCR 115407100 C1713 SUPPLY/IMPLANTS $884.00 Outpatient $442.00 "$1,219.74 " $574.60 $618.80 $583.44 Not Applicable: Bundled with Procedure $309.40 $707.20 $309.40 "$1,219.74 " DRL SRG RTRGD TIB DIST MDN SS 3.7MM LF IM NL 225503137 C1713 SUPPLY/IMPLANTS $696.00 Outpatient $348.00 "$1,219.74 " $452.40 $487.20 $459.36 Not Applicable: Bundled with Procedure $243.60 $556.80 $243.60 "$1,219.74 " DRL SRG STD CNN 4.7MM PERIART PROX TIB LCK PLT 236007147 C1713 SUPPLY/IMPLANTS "$1,015.00 " Outpatient $507.50 "$1,219.74 " $659.75 $710.50 $669.90 Not Applicable: Bundled with Procedure $355.25 $812.00 $355.25 "$1,219.74 " DRL SRG STD 1.8MM LF 236015518 C1713 SUPPLY/IMPLANTS "$1,089.00 " Outpatient $544.50 "$1,219.74 " $707.85 $762.30 $718.74 Not Applicable: Bundled with Procedure $381.15 $871.20 $381.15 "$1,219.74 " DRL SRG RTRGD CLBRT CNN FEM 4.9MM LF NTR NL 249003450 C1713 SUPPLY/IMPLANTS "$2,451.00 " Outpatient "$1,225.50 " "$1,219.74 " "$1,593.15 " "$1,715.70 " "$1,617.66 " Not Applicable: Bundled with Procedure $857.85 "$1,960.80 " $857.85 "$1,960.80 " DRL SRG LNG CLBRT 4.9MM LF 249004449 C1713 SUPPLY/IMPLANTS "$1,427.00 " Outpatient $713.50 "$1,219.74 " $927.55 $998.90 $941.82 Not Applicable: Bundled with Procedure $499.45 "$1,141.60 " $499.45 "$1,219.74 " DRL SRG SHRT CNN CLBRT FEM 4.9MM BLK ORNG 6MM SCR NTR NL 249006450 C1713 SUPPLY/IMPLANTS "$1,993.00 " Outpatient $996.50 "$1,219.74 " "$1,295.45 " "$1,395.10 " "$1,315.38 " Not Applicable: Bundled with Procedure $697.55 "$1,594.40 " $697.55 "$1,594.40 " DRL SRG CLBRT CEPHALOMEDULLARY 4.3MM NTR NL 249006643 C1713 SUPPLY/IMPLANTS $527.00 Outpatient $263.50 "$1,219.74 " $342.55 $368.90 $347.82 Not Applicable: Bundled with Procedure $184.45 $421.60 $184.45 "$1,219.74 " DRL SRG FRHD TRGT CLBRT TIB 3.3MM NTR NL 249007233 C1713 SUPPLY/IMPLANTS $958.00 Outpatient $479.00 "$1,219.74 " $622.70 $670.60 $632.28 Not Applicable: Bundled with Procedure $335.30 $766.40 $335.30 "$1,219.74 " DRL SRG 152.5MM FRHD TRGT TIB 3.3MM NTR NL 249007533 C1713 SUPPLY/IMPLANTS $507.00 Outpatient $253.50 "$1,219.74 " $329.55 $354.90 $334.62 Not Applicable: Bundled with Procedure $177.45 $405.60 $177.45 "$1,219.74 " DRL SRG LNG 4MM LF 520704010 C1713 SUPPLY/IMPLANTS $714.00 Outpatient $357.00 "$1,219.74 " $464.10 $499.80 $471.24 Not Applicable: Bundled with Procedure $249.90 $571.20 $249.90 "$1,219.74 " DRL SRG MED XTRAFIX 4MM LF 520704070 C1713 SUPPLY/IMPLANTS $714.00 Outpatient $357.00 "$1,219.74 " $464.10 $499.80 $471.24 Not Applicable: Bundled with Procedure $249.90 $571.20 $249.90 "$1,219.74 " DRL SRG HTO TI SCR AR-13319 C1713 SUPPLY/IMPLANTS $468.00 Outpatient $234.00 "$1,219.74 " $304.20 $327.60 $308.88 Not Applicable: Bundled with Procedure $163.80 $374.40 $163.80 "$1,219.74 " DRL SRG CNN 3.2MM 4MM INST 231201040 C1713 SUPPLY/IMPLANTS "$1,301.00 " Outpatient $650.50 "$1,219.74 " $845.65 $910.70 $858.66 Not Applicable: Bundled with Procedure $455.35 "$1,040.80 " $455.35 "$1,219.74 " DRL SRG XL PRFL DISP 7MM SCR AR-8770-03 C1713 SUPPLY/IMPLANTS "$1,141.00 " Outpatient $570.50 "$1,219.74 " $741.65 $798.70 $753.06 Not Applicable: Bundled with Procedure $399.35 $912.80 $399.35 "$1,219.74 " DRVR 8MM BOLT CNCT SRG PERITROCHANTERIC NL SYS 27947 C1713 SUPPLY/IMPLANTS "$2,314.00 " Outpatient "$1,157.00 " "$1,219.74 " "$1,504.10 " "$1,619.80 " "$1,527.24 " Not Applicable: Bundled with Procedure $809.90 "$1,851.20 " $809.90 "$1,851.20 " DRVR BALL HEX SS MDN RCHT 3.5MM SRG MIS IM NL NS 225503305 C1713 SUPPLY/IMPLANTS "$2,142.00 " Outpatient "$1,071.00 " "$1,219.74 " "$1,392.30 " "$1,499.40 " "$1,413.72 " Not Applicable: Bundled with Procedure $749.70 "$1,713.60 " $749.70 "$1,713.60 " DRVR HMR IMPL SRG TOE 450099 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " DRVR HEX 1 PC 3.5MM SRG 114704935 C1713 SUPPLY/IMPLANTS "$2,531.00 " Outpatient "$1,265.50 " "$1,219.74 " "$1,645.15 " "$1,771.70 " "$1,670.46 " Not Applicable: Bundled with Procedure $885.85 "$2,024.80 " $885.85 "$2,024.80 " DRVR HEX 1 PC 5MM SRG 114704950 C1713 SUPPLY/IMPLANTS "$2,887.00 " Outpatient "$1,443.50 " "$1,219.74 " "$1,876.55 " "$2,020.90 " "$1,905.42 " Not Applicable: Bundled with Procedure "$1,010.45 " "$2,309.60 " "$1,010.45 " "$2,309.60 " DRVR HEX 2.5MM SRG 114706200 C1713 SUPPLY/IMPLANTS "$3,547.00 " Outpatient "$1,773.50 " "$1,219.74 " "$2,305.55 " "$2,482.90 " "$2,341.02 " Not Applicable: Bundled with Procedure "$1,241.45 " "$2,837.60 " "$1,219.74 " "$2,837.60 " DRVR HEX SS CNN TRNKL 5MM SRG MIS NS PERC PERIART 236006850 C1713 SUPPLY/IMPLANTS "$1,409.00 " Outpatient $704.50 "$1,219.74 " $915.85 $986.30 $929.94 Not Applicable: Bundled with Procedure $493.15 "$1,127.20 " $493.15 "$1,219.74 " DRVR LNG AFFIXUS HEX HD 3.5MM SRG ANTIROTATION/DIST SCR HIP 2112-01-504 C1713 SUPPLY/IMPLANTS "$1,544.00 " Outpatient $772.00 "$1,219.74 " "$1,003.60 " "$1,080.80 " "$1,019.04 " Not Applicable: Bundled with Procedure $540.40 "$1,235.20 " $540.40 "$1,235.20 " DRVR LNG SS MDN RCHT 3.5MM SRG IM NL NS 225502200 C1713 SUPPLY/IMPLANTS "$2,461.00 " Outpatient "$1,230.50 " "$1,219.74 " "$1,599.65 " "$1,722.70 " "$1,624.26 " Not Applicable: Bundled with Procedure $861.35 "$1,968.80 " $861.35 "$1,968.80 " DRVR MATRIXRIB SPLNT SRG NS IM 03.501.032 C1713 SUPPLY/IMPLANTS "$4,267.00 " Outpatient "$2,133.50 " "$1,219.74 " "$2,773.55 " "$2,986.90 " "$2,816.22 " Not Applicable: Bundled with Procedure "$1,493.45 " "$3,413.60 " "$1,219.74 " "$3,413.60 " DRVR NUT NTR NL KN FEM CORT RTRGD 249003590 C1713 SUPPLY/IMPLANTS "$1,165.00 " Outpatient $582.50 "$1,219.74 " $757.25 $815.50 $768.90 Not Applicable: Bundled with Procedure $407.75 $932.00 $407.75 "$1,219.74 " DRVR OPTILOCK AO SRG 2 MM SCR PERIART PLT SYS 22842 C1713 SUPPLY/IMPLANTS "$4,310.00 " Outpatient "$2,155.00 " "$1,219.74 " "$2,801.50 " "$3,017.00 " "$2,844.60 " Not Applicable: Bundled with Procedure "$1,508.50 " "$3,448.00 " "$1,219.74 " "$3,448.00 " DRVR PHNX BOLT CNCT FEATURING CORELOCK TCH 7MM SRG ANTGRD 14-442091 C1713 SUPPLY/IMPLANTS "$1,899.00 " Outpatient $949.50 "$1,219.74 " "$1,234.35 " "$1,329.30 " "$1,253.34 " Not Applicable: Bundled with Procedure $664.65 "$1,519.20 " $664.65 "$1,519.20 " DRVR PHNX ANTGRD SRG FEM NL SYS 14-442017 C1713 SUPPLY/IMPLANTS "$20,686.00 " Outpatient "$10,343.00 " "$1,219.74 " "$13,445.90 " "$14,480.20 " "$13,652.76 " Not Applicable: Bundled with Procedure "$7,240.10 " "$16,548.80 " "$1,219.74 " "$16,548.80 " DRVR REUN HD DRCT SRG 450049 C1713 SUPPLY/IMPLANTS $969.00 Outpatient $484.50 "$1,219.74 " $629.85 $678.30 $639.54 Not Applicable: Bundled with Procedure $339.15 $775.20 $339.15 "$1,219.74 " DRVR S3 FST PG AO 4MM SRG FPD40 C1713 SUPPLY/IMPLANTS $457.00 Outpatient $228.50 "$1,219.74 " $297.05 $319.90 $301.62 Not Applicable: Bundled with Procedure $159.95 $365.60 $159.95 "$1,219.74 " DRVR SLV STSCR SRG 27918 C1713 SUPPLY/IMPLANTS $559.00 Outpatient $279.50 "$1,219.74 " $363.35 $391.30 $368.94 Not Applicable: Bundled with Procedure $195.65 $447.20 $195.65 "$1,219.74 " DRVR SHRT AO CNCT HEX 3.5MM SRG 24365 C1713 SUPPLY/IMPLANTS "$2,143.00 " Outpatient "$1,071.50 " "$1,219.74 " "$1,392.95 " "$1,500.10 " "$1,414.38 " Not Applicable: Bundled with Procedure $750.05 "$1,714.40 " $750.05 "$1,714.40 " DRVR SHRT T15 TPR SRG FT 231218021 C1713 SUPPLY/IMPLANTS "$2,314.00 " Outpatient "$1,157.00 " "$1,219.74 " "$1,504.10 " "$1,619.80 " "$1,527.24 " Not Applicable: Bundled with Procedure $809.90 "$1,851.20 " $809.90 "$1,851.20 " DRVR SS CBL RD IMPCT SRG GTR NS 223201100 C1713 SUPPLY/IMPLANTS "$3,836.00 " Outpatient "$1,918.00 " "$1,219.74 " "$2,493.40 " "$2,685.20 " "$2,531.76 " Not Applicable: Bundled with Procedure "$1,342.60 " "$3,068.80 " "$1,219.74 " "$3,068.80 " DRVR SHRT SS MDN RCHT 3.5MM SRG IM NL NS 225502100 C1713 SUPPLY/IMPLANTS "$2,461.00 " Outpatient "$1,230.50 " "$1,219.74 " "$1,599.65 " "$1,722.70 " "$1,624.26 " Not Applicable: Bundled with Procedure $861.35 "$1,968.80 " $861.35 "$1,968.80 " DRVR STD HEX 5MM SRG SWVL HD SCR PERIART 236016550 C1713 SUPPLY/IMPLANTS "$1,540.00 " Outpatient $770.00 "$1,219.74 " "$1,001.00 " "$1,078.00 " "$1,016.40 " Not Applicable: Bundled with Procedure $539.00 "$1,232.00 " $539.00 "$1,232.00 " DRVR TRQ LMT 4.5MM SRG 8162-99-016 C1713 SUPPLY/IMPLANTS "$6,535.00 " Outpatient "$3,267.50 " "$1,219.74 " "$4,247.75 " "$4,574.50 " "$4,313.10 " Not Applicable: Bundled with Procedure "$2,287.25 " "$5,228.00 " "$1,219.74 " "$5,228.00 " DSTRCT ANKL/FT CLS CMPNT SRG 10001467 C1713 SUPPLY/IMPLANTS "$3,322.00 " Outpatient "$1,661.00 " "$1,219.74 " "$2,159.30 " "$2,325.40 " "$2,192.52 " Not Applicable: Bundled with Procedure "$1,162.70 " "$2,657.60 " "$1,162.70 " "$2,657.60 " DSTRCT HIP DEV SRG 1220 C1713 SUPPLY/IMPLANTS "$13,109.00 " Outpatient "$6,554.50 " "$1,219.74 " "$8,520.85 " "$9,176.30 " "$8,651.94 " Not Applicable: Bundled with Procedure "$4,588.15 " "$10,487.20 " "$1,219.74 " "$10,487.20 " DSTRCT PLV RECON TURN KNOB SRG RADEL NS 117903102 C1713 SUPPLY/IMPLANTS "$2,160.00 " Outpatient "$1,080.00 " "$1,219.74 " "$1,404.00 " "$1,512.00 " "$1,425.60 " Not Applicable: Bundled with Procedure $756.00 "$1,728.00 " $756.00 "$1,728.00 " DSTRCT 63.5MM PLV RECON KNOB SLV SRG SS NS 117903108 C1713 SUPPLY/IMPLANTS "$1,183.00 " Outpatient $591.50 "$1,219.74 " $768.95 $828.10 $780.78 Not Applicable: Bundled with Procedure $414.05 $946.40 $414.05 "$1,219.74 " DSTRCT SRG 100MM RDS TI MNDB RT CURVILINEAR MESH FTPLT 1.3MM 04.500.200 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " DSTRCT SRG 100MM RDS TI MNDB LT CURVILINEAR MESH FTPLT 1.3MM 04.500.201 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " DSTRCT SRG STRG TI MNDB MESH FTPLT 1.3MM SCR PED NS 04.500.218 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " DSTRCT SRG 30MM RDS TI MNDB RT CURVILINEAR MESH FTPLT 1.3MM 04.500.230 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " DSTRCT SRG 30MM RDS TI MNDB LT CURVILINEAR MESH FTPLT 1.3MM 04.500.231 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " DSTRCT SRG 40MM RDS STRG TI MNDB RT CURVILINEAR MESH FTPLT 04.500.240 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " DSTRCT SRG 40MM RDS STRG TI MNDB LT CURVILINEAR MESH FTPLT 04.500.241 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " DSTRCT SRG 50MM RDS TI MNDB RT CURVILINEAR MESH FTPLT 1.3MM 04.500.250 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " DSTRCT SRG 50MM RDS TI MNDB LT CURVILINEAR MESH FTPLT 1.3MM 04.500.251 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " DSTRCT SRG 70MM RDS TI MNDB RT CURVILINEAR MESH FTPLT 1.3MM 04.500.270 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " DSTRCT SRG 70MM RDS TI MNDB LT CURVILINEAR MESH FTPLT 1.3MM 04.500.271 C1713 SUPPLY/IMPLANTS "$29,205.00 " Outpatient "$14,602.50 " "$1,219.74 " "$18,983.25 " "$20,443.50 " "$19,275.30 " Not Applicable: Bundled with Procedure "$10,221.75 " "$23,364.00 " "$1,219.74 " "$23,364.00 " DSTRCT BD SRG SS 10MM NS 288.025 C1713 SUPPLY/IMPLANTS "$20,141.00 " Outpatient "$10,070.50 " "$1,219.74 " "$13,091.65 " "$14,098.70 " "$13,293.06 " Not Applicable: Bundled with Procedure "$7,049.35 " "$16,112.80 " "$1,219.74 " "$16,112.80 " DSTRCT BD SRG SS 15MM NS 288.026 C1713 SUPPLY/IMPLANTS "$20,141.00 " Outpatient "$10,070.50 " "$1,219.74 " "$13,091.65 " "$14,098.70 " "$13,293.06 " Not Applicable: Bundled with Procedure "$7,049.35 " "$16,112.80 " "$1,219.74 " "$16,112.80 " DSTRCT 20MM BD SRG SS NS 288.027 C1713 SUPPLY/IMPLANTS "$20,141.00 " Outpatient "$10,070.50 " "$1,219.74 " "$13,091.65 " "$14,098.70 " "$13,293.06 " Not Applicable: Bundled with Procedure "$7,049.35 " "$16,112.80 " "$1,219.74 " "$16,112.80 " DSTRCT BD SRG SS 25MM NS 288.028 C1713 SUPPLY/IMPLANTS "$20,141.00 " Outpatient "$10,070.50 " "$1,219.74 " "$13,091.65 " "$14,098.70 " "$13,293.06 " Not Applicable: Bundled with Procedure "$7,049.35 " "$16,112.80 " "$1,219.74 " "$16,112.80 " DSTRCT MTVCTR MOD SRG NS 304.706 C1713 SUPPLY/IMPLANTS "$5,879.00 " Outpatient "$2,939.50 " "$1,219.74 " "$3,821.35 " "$4,115.30 " "$3,880.14 " Not Applicable: Bundled with Procedure "$2,057.65 " "$4,703.20 " "$1,219.74 " "$4,703.20 " DSTRCT MNDB MTVCTR BD SRG TI NS 487.931 C1713 SUPPLY/IMPLANTS "$21,182.00 " Outpatient "$10,591.00 " "$1,219.74 " "$13,768.30 " "$14,827.40 " "$13,980.12 " Not Applicable: Bundled with Procedure "$7,413.70 " "$16,945.60 " "$1,219.74 " "$16,945.60 " DSTRCT 15MM MNDB MTVCTR ARM SRG TI NS 487.933 C1713 SUPPLY/IMPLANTS "$1,600.00 " Outpatient $800.00 "$1,219.74 " "$1,040.00 " "$1,120.00 " "$1,056.00 " Not Applicable: Bundled with Procedure $560.00 "$1,280.00 " $560.00 "$1,280.00 " DSTRCT 25MM MNDB MTVCTR ARM SRG TI NS 487.934 C1713 SUPPLY/IMPLANTS "$1,600.00 " Outpatient $800.00 "$1,219.74 " "$1,040.00 " "$1,120.00 " "$1,056.00 " Not Applicable: Bundled with Procedure $560.00 "$1,280.00 " $560.00 "$1,280.00 " DSTRCT 35MM MNDB MTVCTR ARM SRG TI NS 487.935 C1713 SUPPLY/IMPLANTS "$1,600.00 " Outpatient $800.00 "$1,219.74 " "$1,040.00 " "$1,120.00 " "$1,056.00 " Not Applicable: Bundled with Procedure $560.00 "$1,280.00 " $560.00 "$1,280.00 " DSTRCT MNDB NUT LNR ACT SRG TI MTVCTR DSTRCT NS 487.937 C1713 SUPPLY/IMPLANTS $597.00 Outpatient $298.50 "$1,219.74 " $388.05 $417.90 $394.02 Not Applicable: Bundled with Procedure $208.95 $477.60 $208.95 "$1,219.74 " DSTRCT MNDB MTVCTR PIN HLD CLP SRG TI NS 487.938 C1713 SUPPLY/IMPLANTS "$4,516.00 " Outpatient "$2,258.00 " "$1,219.74 " "$2,935.40 " "$3,161.20 " "$2,980.56 " Not Applicable: Bundled with Procedure "$1,580.60 " "$3,612.80 " "$1,219.74 " "$3,612.80 " DSTRCT MNDB MTVCTR PIN HLD BD SRG TI NS 487.939 C1713 SUPPLY/IMPLANTS "$4,516.00 " Outpatient "$2,258.00 " "$1,219.74 " "$2,935.40 " "$3,161.20 " "$2,980.56 " Not Applicable: Bundled with Procedure "$1,580.60 " "$3,612.80 " "$1,219.74 " "$3,612.80 " DSTRCT RT MNDB MTVCTR ASMB SRG TI NS 487.966 C1713 SUPPLY/IMPLANTS "$33,965.00 " Outpatient "$16,982.50 " "$1,219.74 " "$22,077.25 " "$23,775.50 " "$22,416.90 " Not Applicable: Bundled with Procedure "$11,887.75 " "$27,172.00 " "$1,219.74 " "$27,172.00 " DSTRCT MNDB LT MTVCTR ASMB SRG TI NS 487.967 C1713 SUPPLY/IMPLANTS "$33,965.00 " Outpatient "$16,982.50 " "$1,219.74 " "$22,077.25 " "$23,775.50 " "$22,416.90 " Not Applicable: Bundled with Procedure "$11,887.75 " "$27,172.00 " "$1,219.74 " "$27,172.00 " DSTRCT 45MM MNDB MTVCTR ARM SRG TI NS 487.971 C1713 SUPPLY/IMPLANTS "$1,600.00 " Outpatient $800.00 "$1,219.74 " "$1,040.00 " "$1,120.00 " "$1,056.00 " Not Applicable: Bundled with Procedure $560.00 "$1,280.00 " $560.00 "$1,280.00 " DSTRCT 55MM MNDB MTVCTR ARM SRG TI NS 487.973 C1713 SUPPLY/IMPLANTS "$1,600.00 " Outpatient $800.00 "$1,219.74 " "$1,040.00 " "$1,120.00 " "$1,056.00 " Not Applicable: Bundled with Procedure $560.00 "$1,280.00 " $560.00 "$1,280.00 " DSTRCT MNDB RT 1 VCTR SRG TI NS 487.974 C1713 SUPPLY/IMPLANTS "$1,384.00 " Outpatient $692.00 "$1,219.74 " $899.60 $968.80 $913.44 Not Applicable: Bundled with Procedure $484.40 "$1,107.20 " $484.40 "$1,219.74 " DSTRCT MNDB LT 1 VCTR SRG TI NS 487.975 C1713 SUPPLY/IMPLANTS "$1,384.00 " Outpatient $692.00 "$1,219.74 " $899.60 $968.80 $913.44 Not Applicable: Bundled with Procedure $484.40 "$1,107.20 " $484.40 "$1,219.74 " DSTRCT 65MM MNDB MTVCTR ARM SRG TI NS 487.976 C1713 SUPPLY/IMPLANTS "$1,600.00 " Outpatient $800.00 "$1,219.74 " "$1,040.00 " "$1,120.00 " "$1,056.00 " Not Applicable: Bundled with Procedure $560.00 "$1,280.00 " $560.00 "$1,280.00 " DSTRCT 75MM MNDB MTVCTR ARM SRG TI NS 487.977 C1713 SUPPLY/IMPLANTS "$1,600.00 " Outpatient $800.00 "$1,219.74 " "$1,040.00 " "$1,120.00 " "$1,056.00 " Not Applicable: Bundled with Procedure $560.00 "$1,280.00 " $560.00 "$1,280.00 " DSTRCT 85MM MNDB MTVCTR ARM SRG TI NS 487.978 C1713 SUPPLY/IMPLANTS "$1,600.00 " Outpatient $800.00 "$1,219.74 " "$1,040.00 " "$1,120.00 " "$1,056.00 " Not Applicable: Bundled with Procedure $560.00 "$1,280.00 " $560.00 "$1,280.00 " DSTRCT 7MM MDFC NUT HEX SRG TI NS 487.98 C1713 SUPPLY/IMPLANTS $698.00 Outpatient $349.00 "$1,219.74 " $453.70 $488.60 $460.68 Not Applicable: Bundled with Procedure $244.30 $558.40 $244.30 "$1,219.74 " DSTRCT 40MM MDFC ASMB SRG TI NS 487.982 C1713 SUPPLY/IMPLANTS "$23,669.00 " Outpatient "$11,834.50 " "$1,219.74 " "$15,384.85 " "$16,568.30 " "$15,621.54 " Not Applicable: Bundled with Procedure "$8,284.15 " "$18,935.20 " "$1,219.74 " "$18,935.20 " DSTRCT 20MM MDFC RGD XTN SRG TI NS 487.992 C1713 SUPPLY/IMPLANTS "$2,512.00 " Outpatient "$1,256.00 " "$1,219.74 " "$1,632.80 " "$1,758.40 " "$1,657.92 " Not Applicable: Bundled with Procedure $879.20 "$2,009.60 " $879.20 "$2,009.60 " DSTRCT JNT XTN 20MM UNV SRG TI 487.993 C1713 SUPPLY/IMPLANTS "$4,313.00 " Outpatient "$2,156.50 " "$1,219.74 " "$2,803.45 " "$3,019.10 " "$2,846.58 " Not Applicable: Bundled with Procedure "$1,509.55 " "$3,450.40 " "$1,219.74 " "$3,450.40 " DSTRCT 40MM MDFC FLXB CBL XTN SRG TI NS 487.994 C1713 SUPPLY/IMPLANTS "$4,313.00 " Outpatient "$2,156.50 " "$1,219.74 " "$2,803.45 " "$3,019.10 " "$2,846.58 " Not Applicable: Bundled with Procedure "$1,509.55 " "$3,450.40 " "$1,219.74 " "$3,450.40 " DSTRCT 8MM ALVEOLAR STRG PLT SRG TI NS 488.074 C1713 SUPPLY/IMPLANTS "$4,469.00 " Outpatient "$2,234.50 " "$1,219.74 " "$2,904.85 " "$3,128.30 " "$2,949.54 " Not Applicable: Bundled with Procedure "$1,564.15 " "$3,575.20 " "$1,219.74 " "$3,575.20 " DVR ANATOMIC NARROW LEFT DVRANL C1713 SUPPLY/IMPLANTS "$3,786.00 " Outpatient "$1,893.00 " "$1,219.74 " "$2,460.90 " "$2,650.20 " "$2,498.76 " Not Applicable: Bundled with Procedure "$1,325.10 " "$3,028.80 " "$1,219.74 " "$3,028.80 " ECLIPSE CAGE SCREW S 30MM AR--9301-01 C1713 SUPPLY/IMPLANTS "$16,244.00 " Outpatient "$8,122.00 " "$1,219.74 " "$10,558.60 " "$11,370.80 " "$10,721.04 " Not Applicable: Bundled with Procedure "$5,685.40 " "$12,995.20 " "$1,219.74 " "$12,995.20 " ELEVR SRG TI PROST 13566 C1713 SUPPLY/IMPLANTS "$1,094.00 " Outpatient $547.00 "$1,219.74 " $711.10 $765.80 $722.04 Not Applicable: Bundled with Procedure $382.90 $875.20 $382.90 "$1,219.74 " ELEVR SRG KY DVR CROSSLOCK PLT SYS 231200112 C1713 SUPPLY/IMPLANTS "$1,226.00 " Outpatient $613.00 "$1,219.74 " $796.90 $858.20 $809.16 Not Applicable: Bundled with Procedure $429.10 $980.80 $429.10 "$1,219.74 " ELEVR SRG 12.5MM ALPS OBB NS 110008333 C1713 SUPPLY/IMPLANTS "$1,484.00 " Outpatient $742.00 "$1,219.74 " $964.60 "$1,038.80 " $979.44 Not Applicable: Bundled with Procedure $519.40 "$1,187.20 " $519.40 "$1,219.74 " ELEVR SRG 20.3CMX7.1MM 41.3MM SS CREGO RTRCTR PROST NS LF 33000000 C1713 SUPPLY/IMPLANTS $602.00 Outpatient $301.00 "$1,219.74 " $391.30 $421.40 $397.32 Not Applicable: Bundled with Procedure $210.70 $481.60 $210.70 "$1,219.74 " ELEVR SRG 20.3CMX7.1MM 17.5MM SS CREGO RTRCTR PROST NS LF 33100000 C1713 SUPPLY/IMPLANTS $602.00 Outpatient $301.00 "$1,219.74 " $391.30 $421.40 $397.32 Not Applicable: Bundled with Procedure $210.70 $481.60 $210.70 "$1,219.74 " ELEVR SRG 20.3CMX14MM 17.5MM SS CREGO RTRCTR PROST NS LF 33200000 C1713 SUPPLY/IMPLANTS $602.00 Outpatient $301.00 "$1,219.74 " $391.30 $421.40 $397.32 Not Applicable: Bundled with Procedure $210.70 $481.60 $210.70 "$1,219.74 " ELEVR SRG 28.6CM 14CMX9.5MM RND 2.5CM ULCT CB HNDL SPNL NS 282200100 C1713 SUPPLY/IMPLANTS "$4,369.00 " Outpatient "$2,184.50 " "$1,219.74 " "$2,839.85 " "$3,058.30 " "$2,883.54 " Not Applicable: Bundled with Procedure "$1,529.15 " "$3,495.20 " "$1,219.74 " "$3,495.20 " ELEVR SRG 28.6CM 14CMX12.7MM RND 2.5CM ULCT CB HNDL SPNL NS 282200200 C1713 SUPPLY/IMPLANTS "$4,369.00 " Outpatient "$2,184.50 " "$1,219.74 " "$2,839.85 " "$3,058.30 " "$2,883.54 " Not Applicable: Bundled with Procedure "$1,529.15 " "$3,495.20 " "$1,219.74 " "$3,495.20 " ELEVR SRG 28.6CM 14CMX19MM RND 2.5CM ULCT CB HNDL SPNL NS LF 282200300 C1713 SUPPLY/IMPLANTS "$4,369.00 " Outpatient "$2,184.50 " "$1,219.74 " "$2,839.85 " "$3,058.30 " "$2,883.54 " Not Applicable: Bundled with Procedure "$1,529.15 " "$3,495.20 " "$1,219.74 " "$3,495.20 " ELEVR SRG 9.5MM REG HEX SS CB HNDL SPNL NS LF 289300100 C1713 SUPPLY/IMPLANTS "$1,015.00 " Outpatient $507.50 "$1,219.74 " $659.75 $710.50 $669.90 Not Applicable: Bundled with Procedure $355.25 $812.00 $355.25 "$1,219.74 " ELEVR SRG 24.1CMX13MM 11.7CM REG HEX SS CB HNDL SPNL NS LF 289300200 C1713 SUPPLY/IMPLANTS "$1,015.00 " Outpatient $507.50 "$1,219.74 " $659.75 $710.50 $669.90 Not Applicable: Bundled with Procedure $355.25 $812.00 $355.25 "$1,219.74 " ELEVR SRG 24.1CMX19MM 11.7CM REG HEX SS CB HNDL SPNL NS LF 289300300 C1713 SUPPLY/IMPLANTS "$1,015.00 " Outpatient $507.50 "$1,219.74 " $659.75 $710.50 $669.90 Not Applicable: Bundled with Procedure $355.25 $812.00 $355.25 "$1,219.74 " ELEVR SRG 24.1CMX9.5MM 12.7CM RND SS CB HVDTY HNDL SPNL NS 289400100 C1713 SUPPLY/IMPLANTS "$1,127.00 " Outpatient $563.50 "$1,219.74 " $732.55 $788.90 $743.82 Not Applicable: Bundled with Procedure $394.45 $901.60 $394.45 "$1,219.74 " ELEVR SRG 24.1CMX13MM 12.7CM RND SS CB HVDTY HNDL SPNL NS LF 289400200 C1713 SUPPLY/IMPLANTS "$1,127.00 " Outpatient $563.50 "$1,219.74 " $732.55 $788.90 $743.82 Not Applicable: Bundled with Procedure $394.45 $901.60 $394.45 "$1,219.74 " ELEVR SRG 24.1CMX19MM 12.7CM RND SS CB HVDTY HNDL SPNE NS LF 289400300 C1713 SUPPLY/IMPLANTS "$1,127.00 " Outpatient $563.50 "$1,219.74 " $732.55 $788.90 $743.82 Not Applicable: Bundled with Procedure $394.45 $901.60 $394.45 "$1,219.74 " ELEVR SRG 16.5X7.9MM SS ADSN CHSL EDG PROST NS LF 290100000 C1713 SUPPLY/IMPLANTS $507.00 Outpatient $253.50 "$1,219.74 " $329.55 $354.90 $334.62 Not Applicable: Bundled with Procedure $177.45 $405.60 $177.45 "$1,219.74 " ELEVR SRG 16.5X6.4MM CRV SS ADSN BLNT EDG PROST NS LF 290200000 C1713 SUPPLY/IMPLANTS $507.00 Outpatient $253.50 "$1,219.74 " $329.55 $354.90 $334.62 Not Applicable: Bundled with Procedure $177.45 $405.60 $177.45 "$1,219.74 " ELEVR SRG 16.5X7.1MM CRV SS ADSN SEMISHARP PROST NS LF 290300000 C1713 SUPPLY/IMPLANTS $507.00 Outpatient $253.50 "$1,219.74 " $329.55 $354.90 $334.62 Not Applicable: Bundled with Procedure $177.45 $405.60 $177.45 "$1,219.74 " ELEVR SRG 220CMX7.9MM 6.4MM SS ALLERDYCE DSCT BLDE NS LF 292400000 C1713 SUPPLY/IMPLANTS $471.00 Outpatient $235.50 "$1,219.74 " $306.15 $329.70 $310.86 Not Applicable: Bundled with Procedure $164.85 $376.80 $164.85 "$1,219.74 " ELEVR SRG 178X13MM 22MM 2.5MM SS CHND BLDE NS LF 297700100 C1713 SUPPLY/IMPLANTS $771.00 Outpatient $385.50 "$1,219.74 " $501.15 $539.70 $508.86 Not Applicable: Bundled with Procedure $269.85 $616.80 $269.85 "$1,219.74 " ELEVR SRG 203X19MM 25MM 6.4MM SS CHND BLDE NS LF 297700200 C1713 SUPPLY/IMPLANTS $771.00 Outpatient $385.50 "$1,219.74 " $501.15 $539.70 $508.86 Not Applicable: Bundled with Procedure $269.85 $616.80 $269.85 "$1,219.74 " ELEVR SRG 229X25MM 29MM 8.7MM SS CHND BLDE NS LF 297700300 C1713 SUPPLY/IMPLANTS $771.00 Outpatient $385.50 "$1,219.74 " $501.15 $539.70 $508.86 Not Applicable: Bundled with Procedure $269.85 $616.80 $269.85 "$1,219.74 " ELEVR SRG 254X30MM 35MM 9.5MM SS CHND BLDE NS LF 297700400 C1713 SUPPLY/IMPLANTS $771.00 Outpatient $385.50 "$1,219.74 " $501.15 $539.70 $508.86 Not Applicable: Bundled with Procedure $269.85 $616.80 $269.85 "$1,219.74 " ELEVR SRG 19.1CM 11.1CMX6.4MM NAR LNGNBK BLDE PRSTM NS LF 365000000 C1713 SUPPLY/IMPLANTS $471.00 Outpatient $235.50 "$1,219.74 " $306.15 $329.70 $310.86 Not Applicable: Bundled with Procedure $164.85 $376.80 $164.85 "$1,219.74 " ELEVR SRG 19.1CM 11.1CMX12.7MM BRD LNGNBK BLDE PRSTM NS LF 365100000 C1713 SUPPLY/IMPLANTS $471.00 Outpatient $235.50 "$1,219.74 " $306.15 $329.70 $310.86 Not Applicable: Bundled with Procedure $164.85 $376.80 $164.85 "$1,219.74 " ELEVR SRG 3MM STRG CRV SS BLDE EDG FT/ANKL PRSTM NS 481400301 C1713 SUPPLY/IMPLANTS $752.00 Outpatient $376.00 "$1,219.74 " $488.80 $526.40 $496.32 Not Applicable: Bundled with Procedure $263.20 $601.60 $263.20 "$1,219.74 " ELEVR SRG 6MM SS CRV BLDE RND EDG PROST NS LF 481400600 C1713 SUPPLY/IMPLANTS $865.00 Outpatient $432.50 "$1,219.74 " $562.25 $605.50 $570.90 Not Applicable: Bundled with Procedure $302.75 $692.00 $302.75 "$1,219.74 " ELEVR SRG 6MM STRG CRV SS BLDE EDG FT/ANKL PRSTM NS 481400601 C1713 SUPPLY/IMPLANTS $865.00 Outpatient $432.50 "$1,219.74 " $562.25 $605.50 $570.90 Not Applicable: Bundled with Procedure $302.75 $692.00 $302.75 "$1,219.74 " ELEVR SRG 14MM RND CRV SS BLDE EDG FT/ANKL PRSTM NS 481401400 C1713 SUPPLY/IMPLANTS $865.00 Outpatient $432.50 "$1,219.74 " $562.25 $605.50 $570.90 Not Applicable: Bundled with Procedure $302.75 $692.00 $302.75 "$1,219.74 " ELEVR SRG 14MM STRG CRV SS BLDE EDG FT/ANKL PRSTM NS 481401402 C1713 SUPPLY/IMPLANTS $865.00 Outpatient $432.50 "$1,219.74 " $562.25 $605.50 $570.90 Not Applicable: Bundled with Procedure $302.75 $692.00 $302.75 "$1,219.74 " ELEVR SRG 200MM 14MM STRG BLDE RND EDG HNDL PRSTM NS 03.100.043 C1713 SUPPLY/IMPLANTS "$2,848.00 " Outpatient "$1,424.00 " "$1,219.74 " "$1,851.20 " "$1,993.60 " "$1,879.68 " Not Applicable: Bundled with Procedure $996.80 "$2,278.40 " $996.80 "$2,278.40 " ELTRD BP 20MM ISLTR 80D LNR PEN MLP1 C1713 SUPPLY/IMPLANTS "$12,230.00 " Outpatient "$6,115.00 " "$1,219.74 " "$7,949.50 " "$8,561.00 " "$8,071.80 " Not Applicable: Bundled with Procedure "$4,280.50 " "$9,784.00 " "$1,219.74 " "$9,784.00 " ELTRD ESURG 6MM 6.1CM ISLTR SNG X CRV V2 EML2 C1713 SUPPLY/IMPLANTS "$14,674.00 " Outpatient "$7,337.00 " "$1,219.74 " "$9,538.10 " "$10,271.80 " "$9,684.84 " Not Applicable: Bundled with Procedure "$5,135.90 " "$11,739.20 " "$1,219.74 " "$11,739.20 " END CAP SPNL 22MM VLIFT 0D NS 48291220 C1713 SUPPLY/IMPLANTS "$2,014.00 " Outpatient "$1,007.00 " "$1,219.74 " "$1,309.10 " "$1,409.80 " "$1,329.24 " Not Applicable: Bundled with Procedure $704.90 "$1,611.20 " $704.90 "$1,611.20 " END CAP SPNL 22MM VLIFT 3D NS 48291223 C1713 SUPPLY/IMPLANTS "$2,180.00 " Outpatient "$1,090.00 " "$1,219.74 " "$1,417.00 " "$1,526.00 " "$1,438.80 " Not Applicable: Bundled with Procedure $763.00 "$1,744.00 " $763.00 "$1,744.00 " END CAP SPNL 18MM VLIFT 0D NS 48291180 C1713 SUPPLY/IMPLANTS $835.00 Outpatient $417.50 "$1,219.74 " $542.75 $584.50 $551.10 Not Applicable: Bundled with Procedure $292.25 $668.00 $292.25 "$1,219.74 " END CAP SPNL 8-14MM TIMBERLINE TI 4 HL CVR LOPRFL LAT MDLR 8606-0400 C1713 SUPPLY/IMPLANTS "$5,890.00 " Outpatient "$2,945.00 " "$1,219.74 " "$3,828.50 " "$4,123.00 " "$3,887.40 " Not Applicable: Bundled with Procedure "$2,061.50 " "$4,712.00 " "$1,219.74 " "$4,712.00 " END CAP SPNL 24-33MM 18MM X-COR 2 TI ATLCK NS 7180033A C1713 SUPPLY/IMPLANTS "$32,865.00 " Outpatient "$16,432.50 " "$1,219.74 " "$21,362.25 " "$23,005.50 " "$21,690.90 " Not Applicable: Bundled with Procedure "$11,502.75 " "$26,292.00 " "$1,219.74 " "$26,292.00 " END CAP SPNL 30MM 18MM X-COR 2 0D TI 18MM NS 6183000 C1713 SUPPLY/IMPLANTS "$8,022.00 " Outpatient "$4,011.00 " "$1,219.74 " "$5,214.30 " "$5,615.40 " "$5,294.52 " Not Applicable: Bundled with Procedure "$2,807.70 " "$6,417.60 " "$1,219.74 " "$6,417.60 " END CAP SPNL X-COR 2 TI LCK SCR NS 7162000 C1713 SUPPLY/IMPLANTS "$1,979.00 " Outpatient $989.50 "$1,219.74 " "$1,286.35 " "$1,385.30 " "$1,306.14 " Not Applicable: Bundled with Procedure $692.65 "$1,583.20 " $692.65 "$1,583.20 " END CAP SPNL 21-27MM 18MM X-COR 2 TI ATLCK NS 7180027A C1713 SUPPLY/IMPLANTS "$31,750.00 " Outpatient "$15,875.00 " "$1,219.74 " "$20,637.50 " "$22,225.00 " "$20,955.00 " Not Applicable: Bundled with Procedure "$11,112.50 " "$25,400.00 " "$1,219.74 " "$25,400.00 " END CAP SPNL 28-41MM 18MM X-COR 2 TI ATLCK NS 7180041A C1713 SUPPLY/IMPLANTS "$31,750.00 " Outpatient "$15,875.00 " "$1,219.74 " "$20,637.50 " "$22,225.00 " "$20,955.00 " Not Applicable: Bundled with Procedure "$11,112.50 " "$25,400.00 " "$1,219.74 " "$25,400.00 " END CAP SPNL 40X22MM 18MM X-COR 2 0D TI NS 6224000 C1713 SUPPLY/IMPLANTS "$2,931.00 " Outpatient "$1,465.50 " "$1,219.74 " "$1,905.15 " "$2,051.70 " "$1,934.46 " Not Applicable: Bundled with Procedure "$1,025.85 " "$2,344.80 " "$1,025.85 " "$2,344.80 " END CAP SPNL 15MM 12MM X-COR MN PRLL TI 12MM NS 5962520 C1713 SUPPLY/IMPLANTS "$2,931.00 " Outpatient "$1,465.50 " "$1,219.74 " "$1,905.15 " "$2,051.70 " "$1,934.46 " Not Applicable: Bundled with Procedure "$1,025.85 " "$2,344.80 " "$1,025.85 " "$2,344.80 " END CAP SPINAL X-CORE 2 TITANIUM 0 D H40 MM H18 MM OD18 MM NONSTERILE 6184000 C1713 SUPPLY/IMPLANTS "$2,929.00 " Outpatient "$1,464.50 " "$1,219.74 " "$1,903.85 " "$2,050.30 " "$1,933.14 " Not Applicable: Bundled with Procedure "$1,025.15 " "$2,343.20 " "$1,025.15 " "$2,343.20 " END CAP SPINAL X-CORE 2 TITANIUM H35-55 MM OD18 MM AUTOLOCK 7180055A C1713 SUPPLY/IMPLANTS "$30,579.00 " Outpatient "$15,289.50 " "$1,219.74 " "$19,876.35 " "$21,405.30 " "$20,182.14 " Not Applicable: Bundled with Procedure "$10,702.65 " "$24,463.20 " "$1,219.74 " "$24,463.20 " END CAP SPINAL OBELISC TITANIUM 0 D H1.5 MM OD24 MM THORACIC CS 2926 00 C1713 SUPPLY/IMPLANTS "$12,765.00 " Outpatient "$6,382.50 " "$1,219.74 " "$8,297.25 " "$8,935.50 " "$8,424.90 " Not Applicable: Bundled with Procedure "$4,467.75 " "$10,212.00 " "$1,219.74 " "$10,212.00 " END CAP SPINAL OBELISC TITANIUM 5 D H1.5 MM OD24 MM THORACIC CS 2926-05 C1713 SUPPLY/IMPLANTS "$14,321.00 " Outpatient "$7,160.50 " "$1,219.74 " "$9,308.65 " "$10,024.70 " "$9,451.86 " Not Applicable: Bundled with Procedure "$5,012.35 " "$11,456.80 " "$1,219.74 " "$11,456.80 " END ROD CUP IMPACTOR 903-0009-02 C1713 SUPPLY/IMPLANTS $674.00 Outpatient $337.00 "$1,219.74 " $438.10 $471.80 $444.84 Not Applicable: Bundled with Procedure $235.90 $539.20 $235.90 "$1,219.74 " ENDPLATE INTERVERTEBRAL DISC ACTIV L PLASMAPORE 0 D SMALL CO SW970K C1713 SUPPLY/IMPLANTS "$21,961.00 " Outpatient "$10,980.50 " "$1,219.74 " "$14,274.65 " "$15,372.70 " "$14,494.26 " Not Applicable: Bundled with Procedure "$7,686.35 " "$17,568.80 " "$1,219.74 " "$17,568.80 " ENDPLATE INTERVERTEBRAL DISC ACTIV L PLASMAPORE 6 D SMALL CO SW971K C1713 SUPPLY/IMPLANTS "$21,961.00 " Outpatient "$10,980.50 " "$1,219.74 " "$14,274.65 " "$15,372.70 " "$14,494.26 " Not Applicable: Bundled with Procedure "$7,686.35 " "$17,568.80 " "$1,219.74 " "$17,568.80 " ENVELOPE ABSORBABLE TYRX POLYARYLATE MINOCYCLINE RIFAMPIN LA NMRM6133 C1713 SUPPLY/IMPLANTS "$4,873.00 " Outpatient "$2,436.50 " "$1,219.74 " "$3,167.45 " "$3,411.10 " "$3,216.18 " Not Applicable: Bundled with Procedure "$1,705.55 " "$3,898.40 " "$1,219.74 " "$3,898.40 " EPLT INTVRTB DISC 12MM SCR-C 6D 11MM LRDTC SPNE CRV ANT 714.106S C1713 SUPPLY/IMPLANTS "$22,011.00 " Outpatient "$11,005.50 " "$1,219.74 " "$14,307.15 " "$15,407.70 " "$14,527.26 " Not Applicable: Bundled with Procedure "$7,703.85 " "$17,608.80 " "$1,219.74 " "$17,608.80 " EPLT SPNL 12X6MM SCR-C 6D 11MM SPHRCL CYL CRV TI COCRMO MLT 714.166S C1713 SUPPLY/IMPLANTS "$34,239.00 " Outpatient "$17,119.50 " "$1,219.74 " "$22,255.35 " "$23,967.30 " "$22,597.74 " Not Applicable: Bundled with Procedure "$11,983.65 " "$27,391.20 " "$1,219.74 " "$27,391.20 " EPLT SPNL 14MM SCR-C 6D 13MM SPHRCL CYL CRV TI COCRMO MLT 714.206S C1713 SUPPLY/IMPLANTS "$22,011.00 " Outpatient "$11,005.50 " "$1,219.74 " "$14,307.15 " "$15,407.70 " "$14,527.26 " Not Applicable: Bundled with Procedure "$7,703.85 " "$17,608.80 " "$1,219.74 " "$17,608.80 " EQUIVABONE 5CC 76-6021 C1713 SUPPLY/IMPLANTS "$11,050.00 " Outpatient "$5,525.00 " "$1,219.74 " "$7,182.50 " "$7,735.00 " "$7,293.00 " Not Applicable: Bundled with Procedure "$3,867.50 " "$8,840.00 " "$1,219.74 " "$8,840.00 " ETEX EQUIVABONE 2.5CC 76-6027 C1713 SUPPLY/IMPLANTS "$7,981.00 " Outpatient "$3,990.50 " "$1,219.74 " "$5,187.65 " "$5,586.70 " "$5,267.46 " Not Applicable: Bundled with Procedure "$2,793.35 " "$6,384.80 " "$1,219.74 " "$6,384.80 " "EUORPA PEDICLE SCREW 6.5MM X 50MM, NON CANNULATED 1-2-6550" C1713 SUPPLY/IMPLANTS "$4,160.00 " Outpatient "$2,080.00 " "$1,219.74 " "$2,704.00 " "$2,912.00 " "$2,745.60 " Not Applicable: Bundled with Procedure "$1,456.00 " "$3,328.00 " "$1,219.74 " "$3,328.00 " "EUROPA PEDICLE SCREW 6.5MM X 40MM, NON-CANNULATED 1-2-6540" C1713 SUPPLY/IMPLANTS "$4,160.00 " Outpatient "$2,080.00 " "$1,219.74 " "$2,704.00 " "$2,912.00 " "$2,745.60 " Not Applicable: Bundled with Procedure "$1,456.00 " "$3,328.00 " "$1,219.74 " "$3,328.00 " EUROPA PEDICLE SCREW 6.5MM X 45MM NON CANNULATED 1-2-6545 C1713 SUPPLY/IMPLANTS "$4,160.00 " Outpatient "$2,080.00 " "$1,219.74 " "$2,704.00 " "$2,912.00 " "$2,745.60 " Not Applicable: Bundled with Procedure "$1,456.00 " "$3,328.00 " "$1,219.74 " "$3,328.00 " EVOLOGICS STRIP EVS-30107 C1713 SUPPLY/IMPLANTS "$3,742.00 " Outpatient "$1,871.00 " "$1,219.74 " "$2,432.30 " "$2,619.40 " "$2,469.72 " Not Applicable: Bundled with Procedure "$1,309.70 " "$2,993.60 " "$1,219.74 " "$2,993.60 " EXOSPHERE SOFT TISSUE FASTNER 11X30 1101-00-1130 C1713 SUPPLY/IMPLANTS "$2,523.00 " Outpatient "$1,261.50 " "$1,219.74 " "$1,639.95 " "$1,766.10 " "$1,665.18 " Not Applicable: Bundled with Procedure $883.05 "$2,018.40 " $883.05 "$2,018.40 " EXTERNAL HEX WRENCH 7MM 5080 C1713 SUPPLY/IMPLANTS "$2,524.00 " Outpatient "$1,262.00 " "$1,219.74 " "$1,640.60 " "$1,766.80 " "$1,665.84 " Not Applicable: Bundled with Procedure $883.40 "$2,019.20 " $883.40 "$2,019.20 " EXTRACTION ROD 14566 C1713 SUPPLY/IMPLANTS $839.00 Outpatient $419.50 "$1,219.74 " $545.35 $587.30 $553.74 Not Applicable: Bundled with Procedure $293.65 $671.20 $293.65 "$1,219.74 " FBR LSR FLEXIVA 200UM FLEXSHIELD HI PWR PLSH OP TIP NTPR GD M0068403910 C1713 SUPPLY/IMPLANTS "$2,519.00 " Outpatient "$1,259.50 " "$1,219.74 " "$1,637.35 " "$1,763.30 " "$1,662.54 " Not Applicable: Bundled with Procedure $881.65 "$2,015.20 " $881.65 "$2,015.20 " FCP 133MM RDC PNT SRG SS W MN FRAG SET 9399-99-445 C1713 SUPPLY/IMPLANTS "$2,263.00 " Outpatient "$1,131.50 " "$1,219.74 " "$1,470.95 " "$1,584.10 " "$1,493.58 " Not Applicable: Bundled with Procedure $792.05 "$1,810.40 " $792.05 "$1,810.40 " FCP 14.6CM JAW MULTIACTION SRG SS STRG 20MM NS 340900000 C1713 SUPPLY/IMPLANTS "$2,425.00 " Outpatient "$1,212.50 " "$1,219.74 " "$1,576.25 " "$1,697.50 " "$1,600.50 " Not Applicable: Bundled with Procedure $848.75 "$1,940.00 " $848.75 "$1,940.00 " FCP 15CM STRG LTUR SS JAW BN CUT 19MM NS LF 344500000 C1713 SUPPLY/IMPLANTS "$1,260.00 " Outpatient $630.00 "$1,219.74 " $819.00 $882.00 $831.60 Not Applicable: Bundled with Procedure $441.00 "$1,008.00 " $441.00 "$1,219.74 " FCP 18CM 50D RSKN LSTN SS JAW BN CUT 25.4MM NS LF 341600000 C1713 SUPPLY/IMPLANTS "$2,517.00 " Outpatient "$1,258.50 " "$1,219.74 " "$1,636.05 " "$1,761.90 " "$1,661.22 " Not Applicable: Bundled with Procedure $880.95 "$2,013.60 " $880.95 "$2,013.60 " FCP 19CM STRG LSTN SS JAW BN CUT 38MM NS LF 340500000 C1713 SUPPLY/IMPLANTS "$1,240.00 " Outpatient $620.00 "$1,219.74 " $806.00 $868.00 $818.40 Not Applicable: Bundled with Procedure $434.00 $992.00 $434.00 "$1,219.74 " FCP 19CM STRG RSKN LSTN SS JAW BN CUT 25.4MM NS LF 341500000 C1713 SUPPLY/IMPLANTS "$2,442.00 " Outpatient "$1,221.00 " "$1,219.74 " "$1,587.30 " "$1,709.40 " "$1,611.72 " Not Applicable: Bundled with Procedure $854.70 "$1,953.60 " $854.70 "$1,953.60 " FCP 5.6IN RDC SRR JAW SRG STRL ANTM LCK PLT SYS SM FRAG 13573 C1713 SUPPLY/IMPLANTS "$2,549.00 " Outpatient "$1,274.50 " "$1,219.74 " "$1,656.85 " "$1,784.30 " "$1,682.34 " Not Applicable: Bundled with Procedure $892.15 "$2,039.20 " $892.15 "$2,039.20 " FCP BIODRIVE BN RDC SRG MIC DISP DA000B C1713 SUPPLY/IMPLANTS "$4,467.00 " Outpatient "$2,233.50 " "$1,219.74 " "$2,903.55 " "$3,126.90 " "$2,948.22 " Not Applicable: Bundled with Procedure "$1,563.45 " "$3,573.60 " "$1,219.74 " "$3,573.60 " FCP BNHDG PLT ANTM LCK PLT SYS 2142-76-000 C1713 SUPPLY/IMPLANTS "$3,459.00 " Outpatient "$1,729.50 " "$1,219.74 " "$2,248.35 " "$2,421.30 " "$2,282.94 " Not Applicable: Bundled with Procedure "$1,210.65 " "$2,767.20 " "$1,210.65 " "$2,767.20 " FCP BNHDG MED ANTM LCK PLT SYS 8163-01-006 C1713 SUPPLY/IMPLANTS "$3,684.00 " Outpatient "$1,842.00 " "$1,219.74 " "$2,394.60 " "$2,578.80 " "$2,431.44 " Not Applicable: Bundled with Procedure "$1,289.40 " "$2,947.20 " "$1,219.74 " "$2,947.20 " FCP CHEEK 2.4MM RTRCTR DIST END QCK CNN INTFC SRG NS BSC 03.506.003 C1713 SUPPLY/IMPLANTS "$5,402.00 " Outpatient "$2,701.00 " "$1,219.74 " "$3,511.30 " "$3,781.40 " "$3,565.32 " Not Applicable: Bundled with Procedure "$1,890.70 " "$4,321.60 " "$1,219.74 " "$4,321.60 " FCP HLD SRG NS 4.5/5.5 MM SCR 114708102 C1713 SUPPLY/IMPLANTS "$2,574.00 " Outpatient "$1,287.00 " "$1,219.74 " "$1,673.10 " "$1,801.80 " "$1,698.84 " Not Applicable: Bundled with Procedure $900.90 "$2,059.20 " $900.90 "$2,059.20 " FCP MATRIXRIB PLT HLD BALL TIP SRG SM NS 03.501.030 C1713 SUPPLY/IMPLANTS "$2,717.00 " Outpatient "$1,358.50 " "$1,219.74 " "$1,766.05 " "$1,901.90 " "$1,793.22 " Not Applicable: Bundled with Procedure $950.95 "$2,173.60 " $950.95 "$2,173.60 " FCP MATRIXRIB PLT HLD BALL TIP SRG LG NS 03.501.031 C1713 SUPPLY/IMPLANTS "$8,528.00 " Outpatient "$4,264.00 " "$1,219.74 " "$5,543.20 " "$5,969.60 " "$5,628.48 " Not Applicable: Bundled with Procedure "$2,984.80 " "$6,822.40 " "$1,219.74 " "$6,822.40 " FCP MNPLT EBI LP 3130 C1713 SUPPLY/IMPLANTS "$7,254.00 " Outpatient "$3,627.00 " "$1,219.74 " "$4,715.10 " "$5,077.80 " "$4,787.64 " Not Applicable: Bundled with Procedure "$2,538.90 " "$5,803.20 " "$1,219.74 " "$5,803.20 " FCP PLT HLD SWVL FT SRG STRL 398.811 C1713 SUPPLY/IMPLANTS "$3,257.00 " Outpatient "$1,628.50 " "$1,219.74 " "$2,117.05 " "$2,279.90 " "$2,149.62 " Not Applicable: Bundled with Procedure "$1,139.95 " "$2,605.60 " "$1,139.95 " "$2,605.60 " FCP PLT HLD SRG 24400 C1713 SUPPLY/IMPLANTS "$9,733.00 " Outpatient "$4,866.50 " "$1,219.74 " "$6,326.45 " "$6,813.10 " "$6,423.78 " Not Applicable: Bundled with Procedure "$3,406.55 " "$7,786.40 " "$1,219.74 " "$7,786.40 " FCP PLVC 200MM RCHT SRG SS NS SCR 481604600 C1713 SUPPLY/IMPLANTS "$3,289.00 " Outpatient "$1,644.50 " "$1,219.74 " "$2,137.85 " "$2,302.30 " "$2,170.74 " Not Applicable: Bundled with Procedure "$1,151.15 " "$2,631.20 " "$1,151.15 " "$2,631.20 " FCP PLVC 260MM RCHT SRG SS NS SCR 481604700 C1713 SUPPLY/IMPLANTS "$3,933.00 " Outpatient "$1,966.50 " "$1,219.74 " "$2,556.45 " "$2,753.10 " "$2,595.78 " Not Applicable: Bundled with Procedure "$1,376.55 " "$3,146.40 " "$1,219.74 " "$3,146.40 " FCP PLVC 345MM SPDLK SRG SS NS SCR 481604800 C1713 SUPPLY/IMPLANTS "$8,401.00 " Outpatient "$4,200.50 " "$1,219.74 " "$5,460.65 " "$5,880.70 " "$5,544.66 " Not Applicable: Bundled with Procedure "$2,940.35 " "$6,720.80 " "$1,219.74 " "$6,720.80 " FCP PLV PNT TIP RDC DISK SRG SS BALL SPK NS 481605000 C1713 SUPPLY/IMPLANTS $789.00 Outpatient $394.50 "$1,219.74 " $512.85 $552.30 $520.74 Not Applicable: Bundled with Procedure $276.15 $631.20 $276.15 "$1,219.74 " FCP RDC PNT SRG STRL ANTM LCK PLT SYS SM FRAG 13576 C1713 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 "$1,219.74 " "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " FCP RDC PNT SRG NS SM FRAG ANTM LCK PLT SYS 2142-13-568 C1713 SUPPLY/IMPLANTS "$2,471.00 " Outpatient "$1,235.50 " "$1,219.74 " "$1,606.15 " "$1,729.70 " "$1,630.86 " Not Applicable: Bundled with Procedure $864.85 "$1,976.80 " $864.85 "$1,976.80 " FCP RDC SRR JAW SRG 8162-99-017 C1713 SUPPLY/IMPLANTS "$2,964.00 " Outpatient "$1,482.00 " "$1,219.74 " "$1,926.60 " "$2,074.80 " "$1,956.24 " Not Applicable: Bundled with Procedure "$1,037.40 " "$2,371.20 " "$1,037.40 " "$2,371.20 " FCP RDC PNT SRG LG STRL ANTM LCK PLT SYS SM FRAG 13577 C1713 SUPPLY/IMPLANTS "$3,116.00 " Outpatient "$1,558.00 " "$1,219.74 " "$2,025.40 " "$2,181.20 " "$2,056.56 " Not Applicable: Bundled with Procedure "$1,090.60 " "$2,492.80 " "$1,090.60 " "$2,492.80 " FCP SCR SRG NS 319.97 C1713 SUPPLY/IMPLANTS $474.00 Outpatient $237.00 "$1,219.74 " $308.10 $331.80 $312.84 Not Applicable: Bundled with Procedure $165.90 $379.20 $165.90 "$1,219.74 " FCP SLFCNTR SRG STRL 13579 C1713 SUPPLY/IMPLANTS "$2,451.00 " Outpatient "$1,225.50 " "$1,219.74 " "$1,593.15 " "$1,715.70 " "$1,617.66 " Not Applicable: Bundled with Procedure $857.85 "$1,960.80 " $857.85 "$1,960.80 " FCP SLF HLD SCR SRG SS NS 10090005 C1713 SUPPLY/IMPLANTS $463.00 Outpatient $231.50 "$1,219.74 " $300.95 $324.10 $305.58 Not Applicable: Bundled with Procedure $162.05 $370.40 $162.05 "$1,219.74 " FCP SRG STD STRG STRL 6218110 C1713 SUPPLY/IMPLANTS $916.00 Outpatient $458.00 "$1,219.74 " $595.40 $641.20 $604.56 Not Applicable: Bundled with Procedure $320.60 $732.80 $320.60 "$1,219.74 " FEMALE TELESCOPING ARM CMPL 5 CM 1820 C1713 SUPPLY/IMPLANTS "$7,512.00 " Outpatient "$3,756.00 " "$1,219.74 " "$4,882.80 " "$5,258.40 " "$4,957.92 " Not Applicable: Bundled with Procedure "$2,629.20 " "$6,009.60 " "$1,219.74 " "$6,009.60 " FEMORAL HEAD C1713 SUPPLY/IMPLANTS "$1,425.00 " Outpatient $712.50 "$1,219.74 " $926.25 $997.50 $940.50 Not Applicable: Bundled with Procedure $498.75 "$1,140.00 " $498.75 "$1,219.74 " FEMORAL JIG BOLT 2810-13-008 C1713 SUPPLY/IMPLANTS $525.00 Outpatient $262.50 "$1,219.74 " $341.25 $367.50 $346.50 Not Applicable: Bundled with Procedure $183.75 $420.00 $183.75 "$1,219.74 " FEMORAL NAIL LATERAL ENTRY 10MM X 380MM RIGHT 04.003.356 C1713 SUPPLY/IMPLANTS "$10,207.00 " Outpatient "$5,103.50 " "$1,219.74 " "$6,634.55 " "$7,144.90 " "$6,736.62 " Not Applicable: Bundled with Procedure "$3,572.45 " "$8,165.60 " "$1,219.74 " "$8,165.60 " FEMORAL COMPONENT POSTERIOR STABILIZED LT SIZE 4 5516F401 C1713 SUPPLY/IMPLANTS "$8,297.00 " Outpatient "$4,148.50 " "$1,219.74 " "$5,393.05 " "$5,807.90 " "$5,476.02 " Not Applicable: Bundled with Procedure "$2,903.95 " "$6,637.60 " "$1,219.74 " "$6,637.60 " FIBULAR SEGMENT 60 1218246-1029 C1713 SUPPLY/IMPLANTS "$5,870.00 " Outpatient "$2,935.00 " "$1,219.74 " "$3,815.50 " "$4,109.00 " "$3,874.20 " Not Applicable: Bundled with Procedure "$2,054.50 " "$4,696.00 " "$1,219.74 " "$4,696.00 " FIL BN VOID 15CC 1.7-10MM CANC ALGRF CHP FRZDR MORSELIZE 400145 C1713 SUPPLY/IMPLANTS "$1,226.00 " Outpatient $613.00 "$1,219.74 " $796.90 $858.20 $809.16 Not Applicable: Bundled with Procedure $429.10 $980.80 $429.10 "$1,219.74 " FIL BN VOID 1CC BIOCARTILAGE ABS-1010-BC C1713 SUPPLY/IMPLANTS "$4,795.00 " Outpatient "$2,397.50 " "$1,219.74 " "$3,116.75 " "$3,356.50 " "$3,164.70 " Not Applicable: Bundled with Procedure "$1,678.25 " "$3,836.00 " "$1,219.74 " "$3,836.00 " FIL BN VOID 14MM CUBE HITCH TTH141414 C1713 SUPPLY/IMPLANTS "$6,173.00 " Outpatient "$3,086.50 " "$1,219.74 " "$4,012.45 " "$4,321.10 " "$4,074.18 " Not Applicable: Bundled with Procedure "$2,160.55 " "$4,938.40 " "$1,219.74 " "$4,938.40 " FIL BN VOID 20X20X4MM DMNR CANC CNFRM FLX MNLTH ALGRF 3 SHT 0WT204 C1713 SUPPLY/IMPLANTS "$3,547.00 " Outpatient "$1,773.50 " "$1,219.74 " "$2,305.55 " "$2,482.90 " "$2,341.02 " Not Applicable: Bundled with Procedure "$1,241.45 " "$2,837.60 " "$1,219.74 " "$2,837.60 " FIL BN VOID 5ML DBM STIMUBLAST GEL RVRS PHS MED ABS-2002-05 C1713 SUPPLY/IMPLANTS "$5,592.00 " Outpatient "$2,796.00 " "$1,219.74 " "$3,634.80 " "$3,914.40 " "$3,690.72 " Not Applicable: Bundled with Procedure "$1,957.20 " "$4,473.60 " "$1,219.74 " "$4,473.60 " FIL BN VOID 35X12MM OSFERION OPTM PORE DIA RGD FX DEV TRM AR-13370-3 C1713 SUPPLY/IMPLANTS "$2,823.00 " Outpatient "$1,411.50 " "$1,219.74 " "$1,834.95 " "$1,976.10 " "$1,863.18 " Not Applicable: Bundled with Procedure $988.05 "$2,258.40 " $988.05 "$2,258.40 " FIL BN VOID 5CC DBM ALLOSYNC GEL ABS-2013-05 C1713 SUPPLY/IMPLANTS "$5,583.00 " Outpatient "$2,791.50 " "$1,219.74 " "$3,628.95 " "$3,908.10 " "$3,684.78 " Not Applicable: Bundled with Procedure "$1,954.05 " "$4,466.40 " "$1,219.74 " "$4,466.40 " FIL BN VOID 1CC DBM ALLOSYNC GEL ABS-2013-01 C1713 SUPPLY/IMPLANTS "$1,141.00 " Outpatient $570.50 "$1,219.74 " $741.65 $798.70 $753.06 Not Applicable: Bundled with Procedure $399.35 $912.80 $399.35 "$1,219.74 " FILLER BONE VOID ALLOSYNC DEMINERALIZED BONE MATRIX 10 CC GE ABS-2013-10 C1713 SUPPLY/IMPLANTS "$5,857.00 " Outpatient "$2,928.50 " "$1,219.74 " "$3,807.05 " "$4,099.90 " "$3,865.62 " Not Applicable: Bundled with Procedure "$2,049.95 " "$4,685.60 " "$1,219.74 " "$4,685.60 " FIXATION PIN 1G008R C1713 SUPPLY/IMPLANTS "$1,654.00 " Outpatient $827.00 "$1,219.74 " "$1,075.10 " "$1,157.80 " "$1,091.64 " Not Applicable: Bundled with Procedure $578.90 "$1,323.20 " $578.90 "$1,323.20 " FIXATION NUT 1G010R C1713 SUPPLY/IMPLANTS $512.00 Outpatient $256.00 "$1,219.74 " $332.80 $358.40 $337.92 Not Applicable: Bundled with Procedure $179.20 $409.60 $179.20 "$1,219.74 " FIXATION PINS ACP-009 C1713 SUPPLY/IMPLANTS "$1,022.00 " Outpatient $511.00 "$1,219.74 " $664.30 $715.40 $674.52 Not Applicable: Bundled with Procedure $357.70 $817.60 $357.70 "$1,219.74 " FIXATION PINS 30-1008 C1713 SUPPLY/IMPLANTS $855.00 Outpatient $427.50 "$1,219.74 " $555.75 $598.50 $564.30 Not Applicable: Bundled with Procedure $299.25 $684.00 $299.25 "$1,219.74 " FLEX GRAFT 9.5 X 230 POSTERIOR TIBIAL TENDON 1722417-1002 C1713 SUPPLY/IMPLANTS "$8,150.00 " Outpatient "$4,075.00 " "$1,219.74 " "$5,297.50 " "$5,705.00 " "$5,379.00 " Not Applicable: Bundled with Procedure "$2,852.50 " "$6,520.00 " "$1,219.74 " "$6,520.00 " FLEXFIT EXPANDER T10 TORX SD-10-ST C1713 SUPPLY/IMPLANTS "$2,823.00 " Outpatient "$1,411.50 " "$1,219.74 " "$1,834.95 " "$1,976.10 " "$1,863.18 " Not Applicable: Bundled with Procedure $988.05 "$2,258.40 " $988.05 "$2,258.40 " FLEXIBLE NAIL PRE-CURVED 1.50x300 mm 0194-1500S C1713 SUPPLY/IMPLANTS $934.00 Outpatient $467.00 "$1,219.74 " $607.10 $653.80 $616.44 Not Applicable: Bundled with Procedure $326.90 $747.20 $326.90 "$1,219.74 " FLEXIBLE NAIL PRE-CURVED 1.75x300 mm 0194-1750S C1713 SUPPLY/IMPLANTS $967.00 Outpatient $483.50 "$1,219.74 " $628.55 $676.90 $638.22 Not Applicable: Bundled with Procedure $338.45 $773.60 $338.45 "$1,219.74 " FLXFIT CAGE AT0911 C1713 SUPPLY/IMPLANTS "$26,883.00 " Outpatient "$13,441.50 " "$1,219.74 " "$17,473.95 " "$18,818.10 " "$17,742.78 " Not Applicable: Bundled with Procedure "$9,409.05 " "$21,506.40 " "$1,219.74 " "$21,506.40 " FOOT FRAME CROSS BAR 8180-04-013 C1713 SUPPLY/IMPLANTS "$6,692.00 " Outpatient "$3,346.00 " "$1,219.74 " "$4,349.80 " "$4,684.40 " "$4,416.72 " Not Applicable: Bundled with Procedure "$2,342.20 " "$5,353.60 " "$1,219.74 " "$5,353.60 " FORCEPS SURGICAL REPOSITIONING 4.5 MM SCREWS 702924 C1713 SUPPLY/IMPLANTS "$5,697.00 " Outpatient "$2,848.50 " "$1,219.74 " "$3,703.05 " "$3,987.90 " "$3,760.02 " Not Applicable: Bundled with Procedure "$1,993.95 " "$4,557.60 " "$1,219.74 " "$4,557.60 " FRM FT LG RDLCNT XBAR ATCH CFBR XTRNFX SYS 8180-04-012 C1713 SUPPLY/IMPLANTS "$11,250.00 " Outpatient "$5,625.00 " "$1,219.74 " "$7,312.50 " "$7,875.00 " "$7,425.00 " Not Applicable: Bundled with Procedure "$3,937.50 " "$9,000.00 " "$1,219.74 " "$9,000.00 " FTPLT BN 40MM TI MXL NS 04.307.001 C1713 SUPPLY/IMPLANTS "$2,562.00 " Outpatient "$1,281.00 " "$1,219.74 " "$1,665.30 " "$1,793.40 " "$1,690.92 " Not Applicable: Bundled with Procedure $896.70 "$2,049.60 " $896.70 "$2,049.60 " FTPLT BN TI MNDB TY B CLVRLF 1MM SCR CRNMXF DSTRCT NS GRN 04.315.211 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN MNDB CLVRLF B TY INTNL 1 MM SCR 04.315.212 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN MNDB MESH C INTNL 1 MM SCR 04.315.213 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB TY A MESH 1.5MM SCR CRNMXF DSTRCT NS PNK 04.315.301 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB B TY MESH CMF DSTRCT NS 04.315.302 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB C MESH CMF DSTRCT NS 04.315.303 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB TY A CLVRLF 1.5MM SCR CRNMXF DSTRCT NS PNK 04.315.311 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB TY B CLVRLF 1.5MM SCR CRNMXF DSTRCT NS PNK 04.315.312 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB TY C CLVRLF 1.5MM SCR CRNMXF DSTRCT NS PNK 04.315.313 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN 5.5MM TI MNDB TY B ELEV MESH OFST 1.5MM SCR CRNMXF 04.315.321 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN 7.5MM TI MNDB TY B ELEV MESH OFST 1.5MM SCR CRNMXF 04.315.322 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB TY C ELEV MESH OFST 1.5MM SCR CRNMXF DSTRCT 04.315.323 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB TY A MESH 2MM SCR CRNMXF DSTRCT NS BLU 04.315.401 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB TY B MESH 2MM SCR CRNMXF DSTRCT NS BLU 04.315.402 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB TY C MESH 2MM SCR CRNMXF DSTRCT NS BLU 04.315.403 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB TY A CLVRLF 2MM SCR CRNMXF DSTRCT NS BLU 04.315.411 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB TY B CLVRLF 2MM SCR CRNMXF DSTRCT NS BLU 04.315.412 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB TY C CLVRLF 2MM SCR CRNMXF DSTRCT NS BLU 04.315.413 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN 5.5MM TI MNDB TY B MESH OFST 2MM SCR CRNMXF DSTRCT 04.315.421 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN 7.5MM TI MNDB TY C MESH OFST 2MM SCR CRNMXF DSTRCT 04.315.422 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB TY C MESH OFST 2MM SCR CRNMXF DSTRCT NS BLU 04.315.423 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB TY A MESH 1.3MM SCR CRNMXF DSTRCT NS YLW 04.315.501 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN TI MNDB TY A CLVRLF 1.3MM SCR CRNMXF DSTRCT NS YLW 04.315.511 C1713 SUPPLY/IMPLANTS "$3,668.00 " Outpatient "$1,834.00 " "$1,219.74 " "$2,384.20 " "$2,567.60 " "$2,420.88 " Not Applicable: Bundled with Procedure "$1,283.80 " "$2,934.40 " "$1,219.74 " "$2,934.40 " FTPLT BN 6MM SS RT ANT MXL SPLNT NS 288.038 C1713 SUPPLY/IMPLANTS "$2,556.00 " Outpatient "$1,278.00 " "$1,219.74 " "$1,661.40 " "$1,789.20 " "$1,686.96 " Not Applicable: Bundled with Procedure $894.60 "$2,044.80 " $894.60 "$2,044.80 " FTPLT BN 10MM SS RT ANT MXL SPLNT NS 288.039 C1713 SUPPLY/IMPLANTS "$2,556.00 " Outpatient "$1,278.00 " "$1,219.74 " "$1,661.40 " "$1,789.20 " "$1,686.96 " Not Applicable: Bundled with Procedure $894.60 "$2,044.80 " $894.60 "$2,044.80 " FTPLT BN 14MM SS RT ANT MXL SPLNT NS 288.04 C1713 SUPPLY/IMPLANTS "$2,556.00 " Outpatient "$1,278.00 " "$1,219.74 " "$1,661.40 " "$1,789.20 " "$1,686.96 " Not Applicable: Bundled with Procedure $894.60 "$2,044.80 " $894.60 "$2,044.80 " FTPLT BN 6MM SS LT ANT MXL SPLNT NS 288.042 C1713 SUPPLY/IMPLANTS "$2,556.00 " Outpatient "$1,278.00 " "$1,219.74 " "$1,661.40 " "$1,789.20 " "$1,686.96 " Not Applicable: Bundled with Procedure $894.60 "$2,044.80 " $894.60 "$2,044.80 " FTPLT BN 10MM SS LT ANT MXL SPLNT NS 288.043 C1713 SUPPLY/IMPLANTS "$2,556.00 " Outpatient "$1,278.00 " "$1,219.74 " "$1,661.40 " "$1,789.20 " "$1,686.96 " Not Applicable: Bundled with Procedure $894.60 "$2,044.80 " $894.60 "$2,044.80 " FTPLT BN 14MM SS LT ANT MXL SPLNT NS 288.044 C1713 SUPPLY/IMPLANTS "$2,556.00 " Outpatient "$1,278.00 " "$1,219.74 " "$1,661.40 " "$1,789.20 " "$1,686.96 " Not Applicable: Bundled with Procedure $894.60 "$2,044.80 " $894.60 "$2,044.80 " FTPLT BN SHRT SS POST MXL OFST 7MM NS 288.052 C1713 SUPPLY/IMPLANTS "$5,085.00 " Outpatient "$2,542.50 " "$1,219.74 " "$3,305.25 " "$3,559.50 " "$3,356.10 " Not Applicable: Bundled with Procedure "$1,779.75 " "$4,068.00 " "$1,219.74 " "$4,068.00 " FTPLT BN SHRT SS POST MXL OFST 12MM NS 288.053 C1713 SUPPLY/IMPLANTS "$5,085.00 " Outpatient "$2,542.50 " "$1,219.74 " "$3,305.25 " "$3,559.50 " "$3,356.10 " Not Applicable: Bundled with Procedure "$1,779.75 " "$4,068.00 " "$1,219.74 " "$4,068.00 " FTPLT BN MED SS POST MXL OFST 7MM NS 288.055 C1713 SUPPLY/IMPLANTS "$5,085.00 " Outpatient "$2,542.50 " "$1,219.74 " "$3,305.25 " "$3,559.50 " "$3,356.10 " Not Applicable: Bundled with Procedure "$1,779.75 " "$4,068.00 " "$1,219.74 " "$4,068.00 " FTPLT BN MED 12MM SS POST MXL OFST NS 288.056 C1713 SUPPLY/IMPLANTS "$5,085.00 " Outpatient "$2,542.50 " "$1,219.74 " "$3,305.25 " "$3,559.50 " "$3,356.10 " Not Applicable: Bundled with Procedure "$1,779.75 " "$4,068.00 " "$1,219.74 " "$4,068.00 " FTPLT BN TLL SS POST MXL OFST 7MM NS 288.058 C1713 SUPPLY/IMPLANTS "$5,085.00 " Outpatient "$2,542.50 " "$1,219.74 " "$3,305.25 " "$3,559.50 " "$3,356.10 " Not Applicable: Bundled with Procedure "$1,779.75 " "$4,068.00 " "$1,219.74 " "$4,068.00 " FTPLT BN TLL SS POST MXL OFST 12MM NS 288.059 C1713 SUPPLY/IMPLANTS "$5,085.00 " Outpatient "$2,542.50 " "$1,219.74 " "$3,305.25 " "$3,559.50 " "$3,356.10 " Not Applicable: Bundled with Procedure "$1,779.75 " "$4,068.00 " "$1,219.74 " "$4,068.00 " FTPLT BN TI ZYG 3 HL NS 447.007 C1713 SUPPLY/IMPLANTS "$1,204.00 " Outpatient $602.00 "$1,219.74 " $782.60 $842.80 $794.64 Not Applicable: Bundled with Procedure $421.40 $963.20 $421.40 "$1,219.74 " FTPLT BN 20MM TI MNDB RT 1 VCTR DSTRCT BD NS 487.962 C1713 SUPPLY/IMPLANTS "$28,641.00 " Outpatient "$14,320.50 " "$1,219.74 " "$18,616.65 " "$20,048.70 " "$18,903.06 " Not Applicable: Bundled with Procedure "$10,024.35 " "$22,912.80 " "$1,219.74 " "$22,912.80 " FTPLT BN 20MM TI MNDB LT 1 VCTR DSTRCT BD NS 487.963 C1713 SUPPLY/IMPLANTS "$28,641.00 " Outpatient "$14,320.50 " "$1,219.74 " "$18,616.65 " "$20,048.70 " "$18,903.06 " Not Applicable: Bundled with Procedure "$10,024.35 " "$22,912.80 " "$1,219.74 " "$22,912.80 " FTPLT BN 30MM TI MNDB RT 1 VCTR DSTRCT BD NS 487.964 C1713 SUPPLY/IMPLANTS "$28,641.00 " Outpatient "$14,320.50 " "$1,219.74 " "$18,616.65 " "$20,048.70 " "$18,903.06 " Not Applicable: Bundled with Procedure "$10,024.35 " "$22,912.80 " "$1,219.74 " "$22,912.80 " FTPLT BN 30MM TI MNDB LT 1 VCTR DSTRCT BD NS 487.965 C1713 SUPPLY/IMPLANTS "$28,641.00 " Outpatient "$14,320.50 " "$1,219.74 " "$18,616.65 " "$20,048.70 " "$18,903.06 " Not Applicable: Bundled with Procedure "$10,024.35 " "$22,912.80 " "$1,219.74 " "$22,912.80 " FTPLT BN TI RT ANT MDFC ELEV MDFC DSTRCT SYS NS 487.984 C1713 SUPPLY/IMPLANTS "$4,222.00 " Outpatient "$2,111.00 " "$1,219.74 " "$2,744.30 " "$2,955.40 " "$2,786.52 " Not Applicable: Bundled with Procedure "$1,477.70 " "$3,377.60 " "$1,219.74 " "$3,377.60 " FTPLT BN TI LT ANT MDFC ELEV MDFC DSTRCT SYS NS 487.985 C1713 SUPPLY/IMPLANTS "$4,222.00 " Outpatient "$2,111.00 " "$1,219.74 " "$2,744.30 " "$2,955.40 " "$2,786.52 " Not Applicable: Bundled with Procedure "$1,477.70 " "$3,377.60 " "$1,219.74 " "$3,377.60 " FTPLT BN TI ANT MDFC LOPRFL SMTR MDFC DSTRCT SYS NS 487.986 C1713 SUPPLY/IMPLANTS "$4,222.00 " Outpatient "$2,111.00 " "$1,219.74 " "$2,744.30 " "$2,955.40 " "$2,786.52 " Not Applicable: Bundled with Procedure "$1,477.70 " "$3,377.60 " "$1,219.74 " "$3,377.60 " FTPLT BN TI ANT MDFC ELEV SMTR MDFC DSTRCT SYS NS 487.987 C1713 SUPPLY/IMPLANTS "$4,222.00 " Outpatient "$2,111.00 " "$1,219.74 " "$2,744.30 " "$2,955.40 " "$2,786.52 " Not Applicable: Bundled with Procedure "$1,477.70 " "$3,377.60 " "$1,219.74 " "$3,377.60 " FTPLT BN TI ANT MDFC MESH MDFC DSTRCT SYS NS 487.988 C1713 SUPPLY/IMPLANTS "$2,656.00 " Outpatient "$1,328.00 " "$1,219.74 " "$1,726.40 " "$1,859.20 " "$1,752.96 " Not Applicable: Bundled with Procedure $929.60 "$2,124.80 " $929.60 "$2,124.80 " FTPLT BN TI ANT MDFC BTRS MDFC DSTRCT SYS NS 487.989 C1713 SUPPLY/IMPLANTS "$2,656.00 " Outpatient "$1,328.00 " "$1,219.74 " "$1,726.40 " "$1,859.20 " "$1,752.96 " Not Applicable: Bundled with Procedure $929.60 "$2,124.80 " $929.60 "$2,124.80 " FTPLT BN TI MDFC POST 1 VCTR DSTRCT SYS NS 487.99 C1713 SUPPLY/IMPLANTS "$4,222.00 " Outpatient "$2,111.00 " "$1,219.74 " "$2,744.30 " "$2,955.40 " "$2,786.52 " Not Applicable: Bundled with Procedure "$1,477.70 " "$3,377.60 " "$1,219.74 " "$3,377.60 " FXTR XTRNFX A FSHR UNV JNT 10740 C1713 SUPPLY/IMPLANTS "$1,544.00 " Outpatient $772.00 "$1,219.74 " "$1,003.60 " "$1,080.80 " "$1,019.04 " Not Applicable: Bundled with Procedure $540.40 "$1,235.20 " $540.40 "$1,235.20 " FXTR XTRNFX 4- CM DFS XS DSTRCT MOD 2545 C1713 SUPPLY/IMPLANTS "$2,709.00 " Outpatient "$1,354.50 " "$1,219.74 " "$1,760.85 " "$1,896.30 " "$1,787.94 " Not Applicable: Bundled with Procedure $948.15 "$2,167.20 " $948.15 "$2,167.20 " FXTR XTRNFX DFS RADL DIST SS REPK KT 04100 4065 C1713 SUPPLY/IMPLANTS "$4,818.00 " Outpatient "$2,409.00 " "$1,219.74 " "$3,131.70 " "$3,372.60 " "$3,179.88 " Not Applicable: Bundled with Procedure "$1,686.30 " "$3,854.40 " "$1,219.74 " "$3,854.40 " FXTR XTRNFX DFS WRST RDS DIST REPK 04102 4170 C1713 SUPPLY/IMPLANTS "$5,253.00 " Outpatient "$2,626.50 " "$1,219.74 " "$3,414.45 " "$3,677.10 " "$3,466.98 " Not Applicable: Bundled with Procedure "$1,838.55 " "$4,202.40 " "$1,219.74 " "$4,202.40 " FXTR XTRNFX CONSTRUX M TLSCP ARM CMPLT 1810 C1713 SUPPLY/IMPLANTS "$7,512.00 " Outpatient "$3,756.00 " "$1,219.74 " "$4,882.80 " "$5,258.40 " "$4,957.92 " Not Applicable: Bundled with Procedure "$2,629.20 " "$6,009.60 " "$1,219.74 " "$6,009.60 " FXTR XTRNFX DFS RADL DIST SS CMPLT 4100 C1713 SUPPLY/IMPLANTS "$13,040.00 " Outpatient "$6,520.00 " "$1,219.74 " "$8,476.00 " "$9,128.00 " "$8,606.40 " Not Applicable: Bundled with Procedure "$4,564.00 " "$10,432.00 " "$1,219.74 " "$10,432.00 " FXTR XTRNFX DFS WRST RDS SS CMPLT DSTRCT MOD SYS NS LF DISP 4102 C1713 SUPPLY/IMPLANTS "$13,911.00 " Outpatient "$6,955.50 " "$1,219.74 " "$9,042.15 " "$9,737.70 " "$9,181.26 " Not Applicable: Bundled with Procedure "$4,868.85 " "$11,128.80 " "$1,219.74 " "$11,128.80 " FXTR XTRNFX CONSTRUX CNTR BD 14450500 C1713 SUPPLY/IMPLANTS "$18,925.00 " Outpatient "$9,462.50 " "$1,219.74 " "$12,301.25 " "$13,247.50 " "$12,490.50 " Not Applicable: Bundled with Procedure "$6,623.75 " "$15,140.00 " "$1,219.74 " "$15,140.00 " FXTR XTRNFX CONSTRUX 1800 C1713 SUPPLY/IMPLANTS "$19,076.00 " Outpatient "$9,538.00 " "$1,219.74 " "$12,399.40 " "$13,353.20 " "$12,590.16 " Not Applicable: Bundled with Procedure "$6,676.60 " "$15,260.80 " "$1,219.74 " "$15,260.80 " FXTR XTRNFX DFS XS CMPLT NS LF DISP 2500 C1713 SUPPLY/IMPLANTS "$20,289.00 " Outpatient "$10,144.50 " "$1,219.74 " "$13,187.85 " "$14,202.30 " "$13,390.74 " Not Applicable: Bundled with Procedure "$7,101.15 " "$16,231.20 " "$1,219.74 " "$16,231.20 " FXTR XTRNFX DFS ANG STD ANT 6150 C1713 SUPPLY/IMPLANTS "$24,945.00 " Outpatient "$12,472.50 " "$1,219.74 " "$16,214.25 " "$17,461.50 " "$16,463.70 " Not Applicable: Bundled with Procedure "$8,730.75 " "$19,956.00 " "$1,219.74 " "$19,956.00 " FXTR XTRNFX ANKL RDLCNT 20380 C1713 SUPPLY/IMPLANTS "$27,567.00 " Outpatient "$13,783.50 " "$1,219.74 " "$17,918.55 " "$19,296.90 " "$18,194.22 " Not Applicable: Bundled with Procedure "$9,648.45 " "$22,053.60 " "$1,219.74 " "$22,053.60 " FXTR XTRNFX VSN ANKL C VAR CMPLT TOP TRY UNLAT NS LF DISP 20390 C1713 SUPPLY/IMPLANTS "$28,585.00 " Outpatient "$14,292.50 " "$1,219.74 " "$18,580.25 " "$20,009.50 " "$18,866.10 " Not Applicable: Bundled with Procedure "$10,004.75 " "$22,868.00 " "$1,219.74 " "$22,868.00 " "FiberStitch Implant, Curved AR-4570" C1713 SUPPLY/IMPLANTS "$2,742.00 " Outpatient "$1,371.00 " "$1,219.74 " "$1,782.30 " "$1,919.40 " "$1,809.72 " Not Applicable: Bundled with Procedure $959.70 "$2,193.60 " $959.70 "$2,193.60 " GA D 100MM PIN KWR 214140000 C1713 SUPPLY/IMPLANTS $839.00 Outpatient $419.50 "$1,219.74 " $545.35 $587.30 $553.74 Not Applicable: Bundled with Procedure $293.65 $671.20 $293.65 "$1,219.74 " GA D 14MM VERSANAIL FEM MSR NL LGTH 2810-01-031 C1713 SUPPLY/IMPLANTS "$2,389.00 " Outpatient "$1,194.50 " "$1,219.74 " "$1,552.85 " "$1,672.30 " "$1,576.74 " Not Applicable: Bundled with Procedure $836.15 "$1,911.20 " $836.15 "$1,911.20 " GA D 1.5-2MM SS SCR 1.5-2MM SCR MN FRAG SET 9399-99-438 C1713 SUPPLY/IMPLANTS "$2,622.00 " Outpatient "$1,311.00 " "$1,219.74 " "$1,704.30 " "$1,835.40 " "$1,730.52 " Not Applicable: Bundled with Procedure $917.70 "$2,097.60 " $917.70 "$2,097.60 " GA D 100MM TIB PROX ANTM LCK PLT SYS 2142-35-008 C1713 SUPPLY/IMPLANTS "$2,691.00 " Outpatient "$1,345.50 " "$1,219.74 " "$1,749.15 " "$1,883.70 " "$1,776.06 " Not Applicable: Bundled with Procedure $941.85 "$2,152.80 " $941.85 "$2,152.80 " GA D 13.5CM HRBRT/WPL FLT SS CNN NS 115200400 C1713 SUPPLY/IMPLANTS "$1,127.00 " Outpatient $563.50 "$1,219.74 " $732.55 $788.90 $743.82 Not Applicable: Bundled with Procedure $394.45 $901.60 $394.45 "$1,219.74 " GA D 15.9CM HRBRT/WPL FR HND 1.09MM SS CNN NS LF 115205500 C1713 SUPPLY/IMPLANTS "$1,765.00 " Outpatient $882.50 "$1,219.74 " "$1,147.25 " "$1,235.50 " "$1,164.90 " Not Applicable: Bundled with Procedure $617.75 "$1,412.00 " $617.75 "$1,412.00 " GA D 150- MM SM SS 2.7/3.5/4MM SCR NS 481000202 C1713 SUPPLY/IMPLANTS "$2,628.00 " Outpatient "$1,314.00 " "$1,219.74 " "$1,708.20 " "$1,839.60 " "$1,734.48 " Not Applicable: Bundled with Procedure $919.80 "$2,102.40 " $919.80 "$2,102.40 " GA D 120MM SS BSC 4.5-6.5MM SCR NS 481000301 C1713 SUPPLY/IMPLANTS "$2,292.00 " Outpatient "$1,146.00 " "$1,219.74 " "$1,489.80 " "$1,604.40 " "$1,512.72 " Not Applicable: Bundled with Procedure $802.20 "$1,833.60 " $802.20 "$1,833.60 " GA D 160MM SS BSC 4.5-6.5MM SCR NS 481000302 C1713 SUPPLY/IMPLANTS "$3,014.00 " Outpatient "$1,507.00 " "$1,219.74 " "$1,959.10 " "$2,109.80 " "$1,989.24 " Not Applicable: Bundled with Procedure "$1,054.90 " "$2,411.20 " "$1,054.90 " "$2,411.20 " GA D 110MM 4-5MM NCB-DF LG HUM SS NS 200024005 C1713 SUPPLY/IMPLANTS "$2,155.00 " Outpatient "$1,077.50 " "$1,219.74 " "$1,400.75 " "$1,508.50 " "$1,422.30 " Not Applicable: Bundled with Procedure $754.25 "$1,724.00 " $754.25 "$1,724.00 " GA D 110MM SM SS 3.5-4MM SCR NS 10090025 C1713 SUPPLY/IMPLANTS "$2,072.00 " Outpatient "$1,036.00 " "$1,219.74 " "$1,346.80 " "$1,450.40 " "$1,367.52 " Not Applicable: Bundled with Procedure $725.20 "$1,657.60 " $725.20 "$1,657.60 " GA D 2MM 2.7MM SCR 26931 C1713 SUPPLY/IMPLANTS "$2,881.00 " Outpatient "$1,440.50 " "$1,219.74 " "$1,872.65 " "$2,016.70 " "$1,901.46 " Not Applicable: Bundled with Procedure "$1,008.35 " "$2,304.80 " "$1,008.35 " "$2,304.80 " GA D 25.4CM 1.7/2.5MM MNMGNFX AL GDPN NS 114201400 C1713 SUPPLY/IMPLANTS $714.00 Outpatient $357.00 "$1,219.74 " $464.10 $499.80 $471.24 Not Applicable: Bundled with Procedure $249.90 $571.20 $249.90 "$1,219.74 " GA D 251MM 12.7MM ECT VFX II LG BRL HIP SS CMPR 4.5-6.5MM 231300500 C1713 SUPPLY/IMPLANTS "$1,501.00 " Outpatient $750.50 "$1,219.74 " $975.65 "$1,050.70 " $990.66 Not Applicable: Bundled with Procedure $525.35 "$1,200.80 " $525.35 "$1,219.74 " GA D 2.7 MM SCR UNV LCK SYS NS 482800201 C1713 SUPPLY/IMPLANTS "$2,531.00 " Outpatient "$1,265.50 " "$1,219.74 " "$1,645.15 " "$1,771.70 " "$1,670.46 " Not Applicable: Bundled with Procedure $885.85 "$2,024.80 " $885.85 "$2,024.80 " GA D 3MM CNTRSNK NS 110008459 C1713 SUPPLY/IMPLANTS "$2,326.00 " Outpatient "$1,163.00 " "$1,219.74 " "$1,511.90 " "$1,628.20 " "$1,535.16 " Not Applicable: Bundled with Procedure $814.10 "$1,860.80 " $814.10 "$1,860.80 " GA D 300-350MM 214214301 C1713 SUPPLY/IMPLANTS "$4,964.00 " Outpatient "$2,482.00 " "$1,219.74 " "$3,226.60 " "$3,474.80 " "$3,276.24 " Not Applicable: Bundled with Procedure "$1,737.40 " "$3,971.20 " "$1,219.74 " "$3,971.20 " GA D 30MM MN SS 1.5-2MM SCR NS 481000101 C1713 SUPPLY/IMPLANTS "$2,029.00 " Outpatient "$1,014.50 " "$1,219.74 " "$1,318.85 " "$1,420.30 " "$1,339.14 " Not Applicable: Bundled with Procedure $710.15 "$1,623.20 " $710.15 "$1,623.20 " GA D 5MM CNTRSNK NS 110008463 C1713 SUPPLY/IMPLANTS "$2,326.00 " Outpatient "$1,163.00 " "$1,219.74 " "$1,511.90 " "$1,628.20 " "$1,535.16 " Not Applicable: Bundled with Procedure $814.10 "$1,860.80 " $814.10 "$1,860.80 " GA D 6IN KWR 8241-98-000 C1713 SUPPLY/IMPLANTS "$1,425.00 " Outpatient $712.50 "$1,219.74 " $926.25 $997.50 $940.50 Not Applicable: Bundled with Procedure $498.75 "$1,140.00 " $498.75 "$1,219.74 " GA D 6.5MM 8MM CNTRSNK NS 110008465 C1713 SUPPLY/IMPLANTS "$2,326.00 " Outpatient "$1,163.00 " "$1,219.74 " "$1,511.90 " "$1,628.20 " "$1,535.16 " Not Applicable: Bundled with Procedure $814.10 "$1,860.80 " $814.10 "$1,860.80 " GA D 60MM MN SS 1.5-2MM SCR NS 481000102 C1713 SUPPLY/IMPLANTS "$2,235.00 " Outpatient "$1,117.50 " "$1,219.74 " "$1,452.75 " "$1,564.50 " "$1,475.10 " Not Applicable: Bundled with Procedure $782.25 "$1,788.00 " $782.25 "$1,788.00 " GA D 60MM SM SS 2.7-4MM SCR NS 10090020 C1713 SUPPLY/IMPLANTS "$2,072.00 " Outpatient "$1,036.00 " "$1,219.74 " "$1,346.80 " "$1,450.40 " "$1,367.52 " Not Applicable: Bundled with Procedure $725.20 "$1,657.60 " $725.20 "$1,657.60 " GA D 8MM NTR NL LNG STD SCR CEPHALOMEDULLARY IM NL 249004580 C1713 SUPPLY/IMPLANTS "$3,161.00 " Outpatient "$1,580.50 " "$1,219.74 " "$2,054.65 " "$2,212.70 " "$2,086.26 " Not Applicable: Bundled with Procedure "$1,106.35 " "$2,528.80 " "$1,106.35 " "$2,528.80 " GA D 8MM NTR NL SHRT TIB TRGT SCR FR HND IM NL 249006580 C1713 SUPPLY/IMPLANTS "$2,466.00 " Outpatient "$1,233.00 " "$1,219.74 " "$1,602.90 " "$1,726.20 " "$1,627.56 " Not Applicable: Bundled with Procedure $863.10 "$1,972.80 " $863.10 "$1,972.80 " GA D 8MM NTR NL RTRGD KN FEM SCR 249006585 C1713 SUPPLY/IMPLANTS "$3,143.00 " Outpatient "$1,571.50 " "$1,219.74 " "$2,042.95 " "$2,200.10 " "$2,074.38 " Not Applicable: Bundled with Procedure "$1,100.05 " "$2,514.40 " "$1,100.05 " "$2,514.40 " GA D 9IN 9.5MM FRLC 3.2MM HIP AL CNN GDPN LG SCR NS LF 118004000 C1713 SUPPLY/IMPLANTS "$1,747.00 " Outpatient $873.50 "$1,219.74 " "$1,135.55 " "$1,222.90 " "$1,153.02 " Not Applicable: Bundled with Procedure $611.45 "$1,397.60 " $611.45 "$1,397.60 " GA D A FSHR FF-10516 C1713 SUPPLY/IMPLANTS $986.00 Outpatient $493.00 "$1,219.74 " $640.90 $690.20 $650.76 Not Applicable: Bundled with Procedure $345.10 $788.80 $345.10 "$1,219.74 " GA D BIODRIVE MIC DISP JA000B C1713 SUPPLY/IMPLANTS "$2,355.00 " Outpatient "$1,177.50 " "$1,219.74 " "$1,530.75 " "$1,648.50 " "$1,554.30 " Not Applicable: Bundled with Procedure $824.25 "$1,884.00 " $824.25 "$1,884.00 " GA D BN INSTR 231200100 C1713 SUPPLY/IMPLANTS "$2,656.00 " Outpatient "$1,328.00 " "$1,219.74 " "$1,726.40 " "$1,859.20 " "$1,752.96 " Not Applicable: Bundled with Procedure $929.60 "$2,124.80 " $929.60 "$2,124.80 " GA D CLPR 110018220 C1713 SUPPLY/IMPLANTS "$2,514.00 " Outpatient "$1,257.00 " "$1,219.74 " "$1,634.10 " "$1,759.80 " "$1,659.24 " Not Applicable: Bundled with Procedure $879.90 "$2,011.20 " $879.90 "$2,011.20 " GA D CNN 3 MM SCR 114702000 C1713 SUPPLY/IMPLANTS "$2,676.00 " Outpatient "$1,338.00 " "$1,219.74 " "$1,739.40 " "$1,873.20 " "$1,766.16 " Not Applicable: Bundled with Procedure $936.60 "$2,140.80 " $936.60 "$2,140.80 " GA D CNN 4-4.5 MM SCR 114702100 C1713 SUPPLY/IMPLANTS "$2,580.00 " Outpatient "$1,290.00 " "$1,219.74 " "$1,677.00 " "$1,806.00 " "$1,702.80 " Not Applicable: Bundled with Procedure $903.00 "$2,064.00 " $903.00 "$2,064.00 " GA D CNN 6.5-7-7.5 MM SCR 114702200 C1713 SUPPLY/IMPLANTS "$2,580.00 " Outpatient "$1,290.00 " "$1,219.74 " "$1,677.00 " "$1,806.00 " "$1,702.80 " Not Applicable: Bundled with Procedure $903.00 "$2,064.00 " $903.00 "$2,064.00 " GA D CNN 4.5/5.5 MM SCR 114702300 C1713 SUPPLY/IMPLANTS "$2,580.00 " Outpatient "$1,290.00 " "$1,219.74 " "$1,677.00 " "$1,806.00 " "$1,702.80 " Not Applicable: Bundled with Procedure $903.00 "$2,064.00 " $903.00 "$2,064.00 " GA D DVR BN FST ANTM VOLR PLT SYS FBDG C1713 SUPPLY/IMPLANTS "$2,036.00 " Outpatient "$1,018.00 " "$1,219.74 " "$1,323.40 " "$1,425.20 " "$1,343.76 " Not Applicable: Bundled with Procedure $712.60 "$1,628.80 " $712.60 "$1,628.80 " GA D DIST DIST SCR AFFIXUS HIP FX NL SYS 2112-01-404 C1713 SUPPLY/IMPLANTS "$2,704.00 " Outpatient "$1,352.00 " "$1,219.74 " "$1,757.60 " "$1,892.80 " "$1,784.64 " Not Applicable: Bundled with Procedure $946.40 "$2,163.20 " $946.40 "$2,163.20 " GA D DNFX VS 14504 C1713 SUPPLY/IMPLANTS "$4,520.00 " Outpatient "$2,260.00 " "$1,219.74 " "$2,938.00 " "$3,164.00 " "$2,983.20 " Not Applicable: Bundled with Procedure "$1,582.00 " "$3,616.00 " "$1,219.74 " "$3,616.00 " GA D ESTMT MDLRY CNL LGTH 14-442075 C1713 SUPPLY/IMPLANTS "$1,361.00 " Outpatient $680.50 "$1,219.74 " $884.65 $952.70 $898.26 Not Applicable: Bundled with Procedure $476.35 "$1,088.80 " $476.35 "$1,219.74 " GA D FRS A5733 C1713 SUPPLY/IMPLANTS "$6,258.00 " Outpatient "$3,129.00 " "$1,219.74 " "$4,067.70 " "$4,380.60 " "$4,130.28 " Not Applicable: Bundled with Procedure "$2,190.30 " "$5,006.40 " "$1,219.74 " "$5,006.40 " GA D INTMD 14-450250 C1713 SUPPLY/IMPLANTS "$4,697.00 " Outpatient "$2,348.50 " "$1,219.74 " "$3,053.05 " "$3,287.90 " "$3,100.02 " Not Applicable: Bundled with Procedure "$1,643.95 " "$3,757.60 " "$1,219.74 " "$3,757.60 " GA D ITST LNG SS CNN IM NL NS 225805701 C1713 SUPPLY/IMPLANTS "$2,676.00 " Outpatient "$1,338.00 " "$1,219.74 " "$1,739.40 " "$1,873.20 " "$1,766.16 " Not Applicable: Bundled with Procedure $936.60 "$2,140.80 " $936.60 "$2,140.80 " GA D KWR MSR CNN SCR SM FRAG PLT SYS 13545 C1713 SUPPLY/IMPLANTS "$1,254.00 " Outpatient $627.00 "$1,219.74 " $815.10 $877.80 $827.64 Not Applicable: Bundled with Procedure $438.90 "$1,003.20 " $438.90 "$1,219.74 " GA D LG 14-450255 C1713 SUPPLY/IMPLANTS "$5,054.00 " Outpatient "$2,527.00 " "$1,219.74 " "$3,285.10 " "$3,537.80 " "$3,335.64 " Not Applicable: Bundled with Procedure "$1,768.90 " "$4,043.20 " "$1,219.74 " "$4,043.20 " GA D LNG CNN SCR 114730000 C1713 SUPPLY/IMPLANTS "$2,466.00 " Outpatient "$1,233.00 " "$1,219.74 " "$1,602.90 " "$1,726.20 " "$1,627.56 " Not Applicable: Bundled with Procedure $863.10 "$1,972.80 " $863.10 "$1,972.80 " GA D MGNFX 50-120MM 3.2MM PERC SS CNN GDPN NS 114600900 C1713 SUPPLY/IMPLANTS "$2,197.00 " Outpatient "$1,098.50 " "$1,219.74 " "$1,428.05 " "$1,537.90 " "$1,450.02 " Not Applicable: Bundled with Procedure $768.95 "$1,757.60 " $768.95 "$1,757.60 " GA D MDN 20-130MM SS TI SCR IM NL NS 223705400 C1713 SUPPLY/IMPLANTS "$2,466.00 " Outpatient "$1,233.00 " "$1,219.74 " "$1,602.90 " "$1,726.20 " "$1,627.56 " Not Applicable: Bundled with Procedure $863.10 "$1,972.80 " $863.10 "$1,972.80 " GA D MDN SCR IM NL 223706300 C1713 SUPPLY/IMPLANTS "$2,791.00 " Outpatient "$1,395.50 " "$1,219.74 " "$1,814.15 " "$1,953.70 " "$1,842.06 " Not Applicable: Bundled with Procedure $976.85 "$2,232.80 " $976.85 "$2,232.80 " GA D MDN IM NL 223706400 C1713 SUPPLY/IMPLANTS "$2,791.00 " Outpatient "$1,395.50 " "$1,219.74 " "$1,814.15 " "$1,953.70 " "$1,842.06 " Not Applicable: Bundled with Procedure $976.85 "$2,232.80 " $976.85 "$2,232.80 " GA D MDN FEM DIST SS SCR MIS IM FX SYS NS 225501800 C1713 SUPPLY/IMPLANTS "$2,142.00 " Outpatient "$1,071.00 " "$1,219.74 " "$1,392.30 " "$1,499.40 " "$1,413.72 " Not Applicable: Bundled with Procedure $749.70 "$1,713.60 " $749.70 "$1,713.60 " GA D MDN SS CNN IM NL NS 225805700 C1713 SUPPLY/IMPLANTS "$1,879.00 " Outpatient $939.50 "$1,219.74 " "$1,221.35 " "$1,315.30 " "$1,240.14 " Not Applicable: Bundled with Procedure $657.65 "$1,503.20 " $657.65 "$1,503.20 " GA D NL AFFIXUS HIP FX NL SYS 2112-01-106 C1713 SUPPLY/IMPLANTS "$2,218.00 " Outpatient "$1,109.00 " "$1,219.74 " "$1,441.70 " "$1,552.60 " "$1,463.88 " Not Applicable: Bundled with Procedure $776.30 "$1,774.40 " $776.30 "$1,774.40 " GA D NTR NL DIA 249000030 C1713 SUPPLY/IMPLANTS $640.00 Outpatient $320.00 "$1,219.74 " $416.00 $448.00 $422.40 Not Applicable: Bundled with Procedure $224.00 $512.00 $224.00 "$1,219.74 " GA D NTR NL LGTH 249000034 C1713 SUPPLY/IMPLANTS "$3,289.00 " Outpatient "$1,644.50 " "$1,219.74 " "$2,137.85 " "$2,302.30 " "$2,170.74 " Not Applicable: Bundled with Procedure "$1,151.15 " "$2,631.20 " "$1,151.15 " "$2,631.20 " GA D NTR NL RTRGD KN FEM 249000422 C1713 SUPPLY/IMPLANTS $564.00 Outpatient $282.00 "$1,219.74 " $366.60 $394.80 $372.24 Not Applicable: Bundled with Procedure $197.40 $451.20 $197.40 "$1,219.74 " GA D NTR NL LNG STD SCR CEPHALOMEDULLARY IM NL 249004780 C1713 SUPPLY/IMPLANTS "$1,579.00 " Outpatient $789.50 "$1,219.74 " "$1,026.35 " "$1,105.30 " "$1,042.14 " Not Applicable: Bundled with Procedure $552.65 "$1,263.20 " $552.65 "$1,263.20 " GA D NTR NL RTRGD KN FEM CNN 249004781 C1713 SUPPLY/IMPLANTS "$1,823.00 " Outpatient $911.50 "$1,219.74 " "$1,184.95 " "$1,276.10 " "$1,203.18 " Not Applicable: Bundled with Procedure $638.05 "$1,458.40 " $638.05 "$1,458.40 " GA D NCB-PH STD 200024214 C1713 SUPPLY/IMPLANTS "$1,902.00 " Outpatient $951.00 "$1,219.74 " "$1,236.30 " "$1,331.40 " "$1,255.32 " Not Applicable: Bundled with Procedure $665.70 "$1,521.60 " $665.70 "$1,521.60 " GA D NCB-PH STD SM 3.5MM SCR 200024216 C1713 SUPPLY/IMPLANTS "$1,902.00 " Outpatient $951.00 "$1,219.74 " "$1,236.30 " "$1,331.40 " "$1,255.32 " Not Applicable: Bundled with Procedure $665.70 "$1,521.60 " $665.70 "$1,521.60 " GA D OPTILOCK 10-110MM PERIART PLT SYS 26930 C1713 SUPPLY/IMPLANTS "$5,058.00 " Outpatient "$2,529.00 " "$1,219.74 " "$3,287.70 " "$3,540.60 " "$3,338.28 " Not Applicable: Bundled with Procedure "$1,770.30 " "$4,046.40 " "$1,219.74 " "$4,046.40 " GA D OPTILOCK 2MM UPR XTRMT PLT SYS 36515 C1713 SUPPLY/IMPLANTS "$7,655.00 " Outpatient "$3,827.50 " "$1,219.74 " "$4,975.75 " "$5,358.50 " "$5,052.30 " Not Applicable: Bundled with Procedure "$2,679.25 " "$6,124.00 " "$1,219.74 " "$6,124.00 " GA D POLYAX UNV LCK PLT SYS 2141-10-100 C1713 SUPPLY/IMPLANTS "$1,932.00 " Outpatient $966.00 "$1,219.74 " "$1,255.80 " "$1,352.40 " "$1,275.12 " Not Applicable: Bundled with Procedure $676.20 "$1,545.60 " $676.20 "$1,545.60 " GA D PERIART 234705500 C1713 SUPPLY/IMPLANTS "$2,442.00 " Outpatient "$1,221.00 " "$1,219.74 " "$1,587.30 " "$1,709.40 " "$1,611.72 " Not Applicable: Bundled with Procedure $854.70 "$1,953.60 " $854.70 "$1,953.60 " GA D PERC 3.5-2.7 MM LCK SCR NS 236004535 C1713 SUPPLY/IMPLANTS "$3,161.00 " Outpatient "$1,580.50 " "$1,219.74 " "$2,054.65 " "$2,212.70 " "$2,086.26 " Not Applicable: Bundled with Procedure "$1,106.35 " "$2,528.80 " "$1,106.35 " "$2,528.80 " GA D PERC CNN 5.5 MM LCK SCR NS 236009055 C1713 SUPPLY/IMPLANTS "$1,183.00 " Outpatient $591.50 "$1,219.74 " $768.95 $828.10 $780.78 Not Applicable: Bundled with Procedure $414.05 $946.40 $414.05 "$1,219.74 " GA D REUN PIN 450034 C1713 SUPPLY/IMPLANTS "$2,788.00 " Outpatient "$1,394.00 " "$1,219.74 " "$1,812.20 " "$1,951.60 " "$1,840.08 " Not Applicable: Bundled with Procedure $975.80 "$2,230.40 " $975.80 "$2,230.40 " GA D REUN LG SCR 450012 C1713 SUPPLY/IMPLANTS "$4,472.00 " Outpatient "$2,236.00 " "$1,219.74 " "$2,906.80 " "$3,130.40 " "$2,951.52 " Not Applicable: Bundled with Procedure "$1,565.20 " "$3,577.60 " "$1,219.74 " "$3,577.60 " GA D REUN SM SCR 450070 C1713 SUPPLY/IMPLANTS "$6,451.00 " Outpatient "$3,225.50 " "$1,219.74 " "$4,193.15 " "$4,515.70 " "$4,257.66 " Not Applicable: Bundled with Procedure "$2,257.85 " "$5,160.80 " "$1,219.74 " "$5,160.80 " GA D SHLDR SBDG C1713 SUPPLY/IMPLANTS "$2,314.00 " Outpatient "$1,157.00 " "$1,219.74 " "$1,504.10 " "$1,619.80 " "$1,527.24 " Not Applicable: Bundled with Procedure $809.90 "$1,851.20 " $809.90 "$1,851.20 " GA D SS 2.7-4 MM SCR SM FRAG SET 9399-99-620 C1713 SUPPLY/IMPLANTS "$2,574.00 " Outpatient "$1,287.00 " "$1,219.74 " "$1,673.10 " "$1,801.80 " "$1,698.84 " Not Applicable: Bundled with Procedure $900.90 "$2,059.20 " $900.90 "$2,059.20 " GA D STRCT 4440 C1713 SUPPLY/IMPLANTS "$3,375.00 " Outpatient "$1,687.50 " "$1,219.74 " "$2,193.75 " "$2,362.50 " "$2,227.50 " Not Applicable: Bundled with Procedure "$1,181.25 " "$2,700.00 " "$1,181.25 " "$2,700.00 " GA D SCR 14-401415 C1713 SUPPLY/IMPLANTS "$3,863.00 " Outpatient "$1,931.50 " "$1,219.74 " "$2,510.95 " "$2,704.10 " "$2,549.58 " Not Applicable: Bundled with Procedure "$1,352.05 " "$3,090.40 " "$1,219.74 " "$3,090.40 " GA D SM MN 14-450245 C1713 SUPPLY/IMPLANTS "$4,697.00 " Outpatient "$2,348.50 " "$1,219.74 " "$3,053.05 " "$3,287.90 " "$3,100.02 " Not Applicable: Bundled with Procedure "$1,643.95 " "$3,757.60 " "$1,219.74 " "$3,757.60 " GA D SCR LNG NOSE 24335 C1713 SUPPLY/IMPLANTS "$5,072.00 " Outpatient "$2,536.00 " "$1,219.74 " "$3,296.80 " "$3,550.40 " "$3,347.52 " Not Applicable: Bundled with Procedure "$1,775.20 " "$4,057.60 " "$1,219.74 " "$4,057.60 " GA D STD PERIART 3.5-2.7MM LCK SCR NS 236004035 C1713 SUPPLY/IMPLANTS "$2,406.00 " Outpatient "$1,203.00 " "$1,219.74 " "$1,563.90 " "$1,684.20 " "$1,587.96 " Not Applicable: Bundled with Procedure $842.10 "$1,924.80 " $842.10 "$1,924.80 " GA D STD PERIART CNN 5.5MM LCK SCR NS 236004155 C1713 SUPPLY/IMPLANTS $941.00 Outpatient $470.50 "$1,219.74 " $611.65 $658.70 $621.06 Not Applicable: Bundled with Procedure $329.35 $752.80 $329.35 "$1,219.74 " GA D STD PERIART 1.8-2.4MM LCK SCR NS 236004224 C1713 SUPPLY/IMPLANTS "$2,442.00 " Outpatient "$1,221.00 " "$1,219.74 " "$1,587.30 " "$1,709.40 " "$1,611.72 " Not Applicable: Bundled with Procedure $854.70 "$1,953.60 " $854.70 "$1,953.60 " GA D SHRT CNN SCR CEPHALOMEDULLARY NL 249003780 C1713 SUPPLY/IMPLANTS "$2,612.00 " Outpatient "$1,306.00 " "$1,219.74 " "$1,697.80 " "$1,828.40 " "$1,723.92 " Not Applicable: Bundled with Procedure $914.20 "$2,089.60 " $914.20 "$2,089.60 " GA D XL 14-450257 C1713 SUPPLY/IMPLANTS "$5,870.00 " Outpatient "$2,935.00 " "$1,219.74 " "$3,815.50 " "$4,109.00 " "$3,874.20 " Not Applicable: Bundled with Procedure "$2,054.50 " "$4,696.00 " "$1,219.74 " "$4,696.00 " GA MSR NL LGTH VERSANAIL CNL PRP 2810-01-009 C1713 SUPPLY/IMPLANTS "$3,037.00 " Outpatient "$1,518.50 " "$1,219.74 " "$1,974.05 " "$2,125.90 " "$2,004.42 " Not Applicable: Bundled with Procedure "$1,062.95 " "$2,429.60 " "$1,062.95 " "$2,429.60 " GA MSR RTRGD PHNX FEM NL SYS 98CM 14-440067 C1713 SUPPLY/IMPLANTS "$18,099.00 " Outpatient "$9,049.50 " "$1,219.74 " "$11,764.35 " "$12,669.30 " "$11,945.34 " Not Applicable: Bundled with Procedure "$6,334.65 " "$14,479.20 " "$1,219.74 " "$14,479.20 " GA MSR DRL KWR 702712 C1713 SUPPLY/IMPLANTS "$1,515.00 " Outpatient $757.50 "$1,219.74 " $984.75 "$1,060.50 " $999.90 Not Applicable: Bundled with Procedure $530.25 "$1,212.00 " $530.25 "$1,219.74 " GD 12 HL TRGT POLYAX SRG FEM LCK PLT SYS 2141-02-012 C1713 SUPPLY/IMPLANTS "$4,895.00 " Outpatient "$2,447.50 " "$1,219.74 " "$3,181.75 " "$3,426.50 " "$3,230.70 " Not Applicable: Bundled with Procedure "$1,713.25 " "$3,916.00 " "$1,219.74 " "$3,916.00 " GD 130D PEAK FX SRG 214201003 C1713 SUPPLY/IMPLANTS "$2,691.00 " Outpatient "$1,345.50 " "$1,219.74 " "$1,749.15 " "$1,883.70 " "$1,776.06 " Not Applicable: Bundled with Procedure $941.85 "$2,152.80 " $941.85 "$2,152.80 " GD 14 HL TRGT POLYAX SRG TIB 2141-45-014 C1713 SUPPLY/IMPLANTS "$5,436.00 " Outpatient "$2,718.00 " "$1,219.74 " "$3,533.40 " "$3,805.20 " "$3,587.76 " Not Applicable: Bundled with Procedure "$1,902.60 " "$4,348.80 " "$1,219.74 " "$4,348.80 " GD 18 HL TRGT POLYAX SRG FEM LCK PLT SYS 2141-02-018 C1713 SUPPLY/IMPLANTS "$5,436.00 " Outpatient "$2,718.00 " "$1,219.74 " "$3,533.40 " "$3,805.20 " "$3,587.76 " Not Applicable: Bundled with Procedure "$1,902.60 " "$4,348.80 " "$1,219.74 " "$4,348.80 " GD 3.2MM SPLT SRG TISS 21462 C1713 SUPPLY/IMPLANTS "$2,701.00 " Outpatient "$1,350.50 " "$1,219.74 " "$1,755.65 " "$1,890.70 " "$1,782.66 " Not Applicable: Bundled with Procedure $945.35 "$2,160.80 " $945.35 "$2,160.80 " GD 3.2MM PIN SRG 14517 C1713 SUPPLY/IMPLANTS "$3,156.00 " Outpatient "$1,578.00 " "$1,219.74 " "$2,051.40 " "$2,209.20 " "$2,082.96 " Not Applicable: Bundled with Procedure "$1,104.60 " "$2,524.80 " "$1,104.60 " "$2,524.80 " GD 3.2MM PIN SRG SS NS MGNFX 114601500 C1713 SUPPLY/IMPLANTS "$2,757.00 " Outpatient "$1,378.50 " "$1,219.74 " "$1,792.05 " "$1,929.90 " "$1,819.62 " Not Applicable: Bundled with Procedure $964.95 "$2,205.60 " $964.95 "$2,205.60 " GD 3.2MM LNK PRLL REPL LOPRFL VFX2 SRG SS HIP NS 119301005 C1713 SUPPLY/IMPLANTS "$1,372.00 " Outpatient $686.00 "$1,219.74 " $891.80 $960.40 $905.52 Not Applicable: Bundled with Procedure $480.20 "$1,097.60 " $480.20 "$1,219.74 " GD 3.5MM 4MM LOPRFL SRG SFT TIS 466146 C1713 SUPPLY/IMPLANTS "$1,613.00 " Outpatient $806.50 "$1,219.74 " "$1,048.45 " "$1,129.10 " "$1,064.58 " Not Applicable: Bundled with Procedure $564.55 "$1,290.40 " $564.55 "$1,290.40 " GD 3MM 2.5MM LOPRFL SRG SFT TIS 466142 C1713 SUPPLY/IMPLANTS "$1,613.00 " Outpatient $806.50 "$1,219.74 " "$1,048.45 " "$1,129.10 " "$1,064.58 " Not Applicable: Bundled with Procedure $564.55 "$1,290.40 " $564.55 "$1,290.40 " GD 4.5CM 4MM 3.2MM ADJ PIN CNN HNDL MGNFX SRG SS NS 114601000 C1713 SUPPLY/IMPLANTS "$4,064.00 " Outpatient "$2,032.00 " "$1,219.74 " "$2,641.60 " "$2,844.80 " "$2,682.24 " Not Applicable: Bundled with Procedure "$1,422.40 " "$3,251.20 " "$1,219.74 " "$3,251.20 " GD 48CM 3.2MM NL DRV SRG 467212 C1713 SUPPLY/IMPLANTS $633.00 Outpatient $316.50 "$1,219.74 " $411.45 $443.10 $417.78 Not Applicable: Bundled with Procedure $221.55 $506.40 $221.55 "$1,219.74 " GD 5.2MM REM ASMB STATAK SRG SS NS 234401900 C1713 SUPPLY/IMPLANTS "$1,353.00 " Outpatient $676.50 "$1,219.74 " $879.45 $947.10 $892.98 Not Applicable: Bundled with Procedure $473.55 "$1,082.40 " $473.55 "$1,219.74 " GD 5MM REM ASMB STATAK SRG SS NS 234401800 C1713 SUPPLY/IMPLANTS "$1,353.00 " Outpatient $676.50 "$1,219.74 " $879.45 $947.10 $892.98 Not Applicable: Bundled with Procedure $473.55 "$1,082.40 " $473.55 "$1,219.74 " GD 80CM 4MM 4 NL DRV SRG SS 467220 C1713 SUPPLY/IMPLANTS $599.00 Outpatient $299.50 "$1,219.74 " $389.35 $419.30 $395.34 Not Applicable: Bundled with Procedure $209.65 $479.20 $209.65 "$1,219.74 " GD 80CM 3.2MM DRV SRG TIB NL SYS 467210 C1713 SUPPLY/IMPLANTS $672.00 Outpatient $336.00 "$1,219.74 " $436.80 $470.40 $443.52 Not Applicable: Bundled with Procedure $235.20 $537.60 $235.20 "$1,219.74 " GD 8MM RECON CNN SRG SS PLV PERC NS 117909980 C1713 SUPPLY/IMPLANTS "$1,260.00 " Outpatient $630.00 "$1,219.74 " $819.00 $882.00 $831.60 Not Applicable: Bundled with Procedure $441.00 "$1,008.00 " $441.00 "$1,219.74 " GD ALGN HUENE HRBRT SRG SS LF NS BN SCR 115401100 C1713 SUPPLY/IMPLANTS "$6,803.00 " Outpatient "$3,401.50 " "$1,219.74 " "$4,421.95 " "$4,762.10 " "$4,489.98 " Not Applicable: Bundled with Procedure "$2,381.05 " "$5,442.40 " "$1,219.74 " "$5,442.40 " GD ASIA BRL ITST SRG MIS 225805212 C1713 SUPPLY/IMPLANTS "$13,348.00 " Outpatient "$6,674.00 " "$1,219.74 " "$8,676.20 " "$9,343.60 " "$8,809.68 " Not Applicable: Bundled with Procedure "$4,671.80 " "$10,678.40 " "$1,219.74 " "$10,678.40 " GD DPL RLV STRT FRNTL SIN GC090RS C1713 SUPPLY/IMPLANTS "$2,388.00 " Outpatient "$1,194.00 " "$1,219.74 " "$1,552.20 " "$1,671.60 " "$1,576.08 " Not Applicable: Bundled with Procedure $835.80 "$1,910.40 " $835.80 "$1,910.40 " GD DRL 4.8MM VSN STRL 3060 C1713 SUPPLY/IMPLANTS "$1,004.00 " Outpatient $502.00 "$1,219.74 " $652.60 $702.80 $662.64 Not Applicable: Bundled with Procedure $351.40 $803.20 $351.40 "$1,219.74 " GD DRL .5MM TOP TRY 466132 C1713 SUPPLY/IMPLANTS "$1,493.00 " Outpatient $746.50 "$1,219.74 " $970.45 "$1,045.10 " $985.38 Not Applicable: Bundled with Procedure $522.55 "$1,194.40 " $522.55 "$1,219.74 " GD DRL 3.5MM TOP TRY 466133 C1713 SUPPLY/IMPLANTS "$1,493.00 " Outpatient $746.50 "$1,219.74 " $970.45 "$1,045.10 " $985.38 Not Applicable: Bundled with Procedure $522.55 "$1,194.40 " $522.55 "$1,219.74 " GD DRL 3MM TOP TRY 466135 C1713 SUPPLY/IMPLANTS "$1,493.00 " Outpatient $746.50 "$1,219.74 " $970.45 "$1,045.10 " $985.38 Not Applicable: Bundled with Procedure $522.55 "$1,194.40 " $522.55 "$1,219.74 " GD DRL FLXB NL 5 466137 C1713 SUPPLY/IMPLANTS "$1,493.00 " Outpatient $746.50 "$1,219.74 " $970.45 "$1,045.10 " $985.38 Not Applicable: Bundled with Procedure $522.55 "$1,194.40 " $522.55 "$1,219.74 " GD DRL REUN SM 450083 C1713 SUPPLY/IMPLANTS "$1,596.00 " Outpatient $798.00 "$1,219.74 " "$1,037.40 " "$1,117.20 " "$1,053.36 " Not Applicable: Bundled with Procedure $558.60 "$1,276.80 " $558.60 "$1,276.80 " GD DRL 3.2MM GRN NTRL END ACP 8242-26-000 C1713 SUPPLY/IMPLANTS "$1,773.00 " Outpatient $886.50 "$1,219.74 " "$1,152.45 " "$1,241.10 " "$1,170.18 " Not Applicable: Bundled with Procedure $620.55 "$1,418.40 " $620.55 "$1,418.40 " GD DRL ACP 2.5MM NS SM FRAG PLT SYS 8241-68-000 C1713 SUPPLY/IMPLANTS "$1,973.00 " Outpatient $986.50 "$1,219.74 " "$1,282.45 " "$1,381.10 " "$1,302.18 " Not Applicable: Bundled with Procedure $690.55 "$1,578.40 " $690.55 "$1,578.40 " GD DRL SCR HNDL REUN LG 450025 C1713 SUPPLY/IMPLANTS "$2,006.00 " Outpatient "$1,003.00 " "$1,219.74 " "$1,303.90 " "$1,404.20 " "$1,323.96 " Not Applicable: Bundled with Procedure $702.10 "$1,604.80 " $702.10 "$1,604.80 " GD DRL ACP SRG 13700 C1713 SUPPLY/IMPLANTS "$2,029.00 " Outpatient "$1,014.50 " "$1,219.74 " "$1,318.85 " "$1,420.30 " "$1,339.14 " Not Applicable: Bundled with Procedure $710.15 "$1,623.20 " $710.15 "$1,623.20 " GD DRL 2.5/3.5MM UNV 8241-96-500 C1713 SUPPLY/IMPLANTS "$2,212.00 " Outpatient "$1,106.00 " "$1,219.74 " "$1,437.80 " "$1,548.40 " "$1,459.92 " Not Applicable: Bundled with Procedure $774.20 "$1,769.60 " $774.20 "$1,769.60 " GD DRL TUBE FX 14-401427 C1713 SUPPLY/IMPLANTS "$2,360.00 " Outpatient "$1,180.00 " "$1,219.74 " "$1,534.00 " "$1,652.00 " "$1,557.60 " Not Applicable: Bundled with Procedure $826.00 "$1,888.00 " $826.00 "$1,888.00 " GD DRL FX 14-401425 C1713 SUPPLY/IMPLANTS "$2,709.00 " Outpatient "$1,354.50 " "$1,219.74 " "$1,760.85 " "$1,896.30 " "$1,787.94 " Not Applicable: Bundled with Procedure $948.15 "$2,167.20 " $948.15 "$2,167.20 " GD DRL 2.5MM 35-463220 C1713 SUPPLY/IMPLANTS "$5,270.00 " Outpatient "$2,635.00 " "$1,219.74 " "$3,425.50 " "$3,689.00 " "$3,478.20 " Not Applicable: Bundled with Procedure "$1,844.50 " "$4,216.00 " "$1,219.74 " "$4,216.00 " GD DRL SP CNDL VHS VARI ANG HIP SCR SYS 35-463151 C1713 SUPPLY/IMPLANTS "$10,311.00 " Outpatient "$5,155.50 " "$1,219.74 " "$6,702.15 " "$7,217.70 " "$6,805.26 " Not Applicable: Bundled with Procedure "$3,608.85 " "$8,248.80 " "$1,219.74 " "$8,248.80 " GD DRL 7.2MM 6.1MM FR HND GDPN CNN MNMGNFX SS 5.3CM NS 114201200 C1713 SUPPLY/IMPLANTS "$1,465.00 " Outpatient $732.50 "$1,219.74 " $952.25 "$1,025.50 " $966.90 Not Applicable: Bundled with Procedure $512.75 "$1,172.00 " $512.75 "$1,219.74 " GD DRL 3.5MM PERIART 2 CMPR SS NS 234803500 C1713 SUPPLY/IMPLANTS "$2,483.00 " Outpatient "$1,241.50 " "$1,219.74 " "$1,613.95 " "$1,738.10 " "$1,638.78 " Not Applicable: Bundled with Procedure $869.05 "$1,986.40 " $869.05 "$1,986.40 " GD DRL 2MM CMPR SS NS 480802005 C1713 SUPPLY/IMPLANTS "$2,537.00 " Outpatient "$1,268.50 " "$1,219.74 " "$1,649.05 " "$1,775.90 " "$1,674.42 " Not Applicable: Bundled with Procedure $887.95 "$2,029.60 " $887.95 "$2,029.60 " GD DRL 3.5MM PERIART CMPR SS NS 480803505 C1713 SUPPLY/IMPLANTS "$1,784.00 " Outpatient $892.00 "$1,219.74 " "$1,159.60 " "$1,248.80 " "$1,177.44 " Not Applicable: Bundled with Procedure $624.40 "$1,427.20 " $624.40 "$1,427.20 " GD DRL 4.5MM FEM PERIART CMPR VFX2 SS NS 480804505 C1713 SUPPLY/IMPLANTS "$2,272.00 " Outpatient "$1,136.00 " "$1,219.74 " "$1,476.80 " "$1,590.40 " "$1,499.52 " Not Applicable: Bundled with Procedure $795.20 "$1,817.60 " $795.20 "$1,817.60 " GD DRL 2.7MM CMPR NS UNV LCK SYS 3.5MM SCR 482803505 C1713 SUPPLY/IMPLANTS "$3,289.00 " Outpatient "$1,644.50 " "$1,219.74 " "$2,137.85 " "$2,302.30 " "$2,170.74 " Not Applicable: Bundled with Procedure "$1,151.15 " "$2,631.20 " "$1,151.15 " "$2,631.20 " GD DRL 3.5MM CMPR SS NS UNV LCK SYS 483603505 C1713 SUPPLY/IMPLANTS "$2,791.00 " Outpatient "$1,395.50 " "$1,219.74 " "$1,814.15 " "$1,953.70 " "$1,842.06 " Not Applicable: Bundled with Procedure $976.85 "$2,232.80 " $976.85 "$2,232.80 " GD DRL 5.2MM .2MM TIB PROX WRE NCB KRSH SS NS LF MIS 200024092 C1713 SUPPLY/IMPLANTS "$1,945.00 " Outpatient $972.50 "$1,219.74 " "$1,264.25 " "$1,361.50 " "$1,283.70 " Not Applicable: Bundled with Procedure $680.75 "$1,556.00 " $680.75 "$1,556.00 " GD DRL 3.3MM TIB HUM NCB SS STD NS LF 4-4.5MM SCR 200024111 C1713 SUPPLY/IMPLANTS "$1,670.00 " Outpatient $835.00 "$1,219.74 " "$1,085.50 " "$1,169.00 " "$1,102.20 " Not Applicable: Bundled with Procedure $584.50 "$1,336.00 " $584.50 "$1,336.00 " GD DRL 2.5MM HUM PROX NCB LF 200024223 C1713 SUPPLY/IMPLANTS "$1,015.00 " Outpatient $507.50 "$1,219.74 " $659.75 $710.50 $669.90 Not Applicable: Bundled with Procedure $355.25 $812.00 $355.25 "$1,219.74 " GD DRL FEM DIST RT NCB 95D 200024234 C1713 SUPPLY/IMPLANTS "$3,338.00 " Outpatient "$1,669.00 " "$1,219.74 " "$2,169.70 " "$2,336.60 " "$2,203.08 " Not Applicable: Bundled with Procedure "$1,168.30 " "$2,670.40 " "$1,168.30 " "$2,670.40 " GD DRL FEM DIST LT NCB 95D 200024235 C1713 SUPPLY/IMPLANTS "$3,338.00 " Outpatient "$1,669.00 " "$1,219.74 " "$2,169.70 " "$2,336.60 " "$2,203.08 " Not Applicable: Bundled with Procedure "$1,168.30 " "$2,670.40 " "$1,168.30 " "$2,670.40 " GD DRL FEM CMPR NCB STD 5MM SCR 200024335 C1713 SUPPLY/IMPLANTS "$3,374.00 " Outpatient "$1,687.00 " "$1,219.74 " "$2,193.10 " "$2,361.80 " "$2,226.84 " Not Applicable: Bundled with Procedure "$1,180.90 " "$2,699.20 " "$1,180.90 " "$2,699.20 " GD DRL FEM CMPR NCB 4 MM SCR 200024336 C1713 SUPPLY/IMPLANTS "$3,464.00 " Outpatient "$1,732.00 " "$1,219.74 " "$2,251.60 " "$2,424.80 " "$2,286.24 " Not Applicable: Bundled with Procedure "$1,212.40 " "$2,771.20 " "$1,212.40 " "$2,771.20 " GD DRL 2.5MM FEM NCB LNG LF 200024343 C1713 SUPPLY/IMPLANTS "$2,091.00 " Outpatient "$1,045.50 " "$1,219.74 " "$1,359.15 " "$1,463.70 " "$1,380.06 " Not Applicable: Bundled with Procedure $731.85 "$1,672.80 " $731.85 "$1,672.80 " GD DRL 3.3MM FEM NCB LNG LF 200024345 C1713 SUPPLY/IMPLANTS "$2,091.00 " Outpatient "$1,045.50 " "$1,219.74 " "$1,359.15 " "$1,463.70 " "$1,380.06 " Not Applicable: Bundled with Procedure $731.85 "$1,672.80 " $731.85 "$1,672.80 " GD DRL 4.3MM FEM NCB LNG LF 200024347 C1713 SUPPLY/IMPLANTS "$2,091.00 " Outpatient "$1,045.50 " "$1,219.74 " "$1,359.15 " "$1,463.70 " "$1,380.06 " Not Applicable: Bundled with Procedure $731.85 "$1,672.80 " $731.85 "$1,672.80 " GD DRL 4MM FEM NCB LNG LF 200024361 C1713 SUPPLY/IMPLANTS "$2,091.00 " Outpatient "$1,045.50 " "$1,219.74 " "$1,359.15 " "$1,463.70 " "$1,380.06 " Not Applicable: Bundled with Procedure $731.85 "$1,672.80 " $731.85 "$1,672.80 " GD DRL 5MM NCB LNG 200024363 C1713 SUPPLY/IMPLANTS "$1,902.00 " Outpatient $951.00 "$1,219.74 " "$1,236.30 " "$1,331.40 " "$1,255.32 " Not Applicable: Bundled with Procedure $665.70 "$1,521.60 " $665.70 "$1,521.60 " GD DRL 2.2MM THRD NS MATRIXRIB LCK PLT 03.501.033 C1713 SUPPLY/IMPLANTS "$2,327.00 " Outpatient "$1,163.50 " "$1,219.74 " "$1,512.55 " "$1,628.90 " "$1,535.82 " Not Applicable: Bundled with Procedure $814.45 "$1,861.60 " $814.45 "$1,861.60 " GD DRL 5.5MM NS MATRIXRIB INTRAMEDULLY SPLNT 03.501.055 C1713 SUPPLY/IMPLANTS "$2,565.00 " Outpatient "$1,282.50 " "$1,219.74 " "$1,667.25 " "$1,795.50 " "$1,692.90 " Not Applicable: Bundled with Procedure $897.75 "$2,052.00 " $897.75 "$2,052.00 " GD DRL 1.25MM BLCK 6MM NS 03.503.134 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " GD DRL 1.25MM BLCK 8MM NS 03.503.138 C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " GD ENTRY VERSANAIL SRG IM NL 8207-09-000 C1713 SUPPLY/IMPLANTS "$1,300.00 " Outpatient $650.00 "$1,219.74 " $845.00 $910.00 $858.00 Not Applicable: Bundled with Procedure $455.00 "$1,040.00 " $455.00 "$1,219.74 " GD FR HND HRBRT SRG SS NS BN SCR 115409200 C1713 SUPPLY/IMPLANTS "$3,451.00 " Outpatient "$1,725.50 " "$1,219.74 " "$2,243.15 " "$2,415.70 " "$2,277.66 " Not Applicable: Bundled with Procedure "$1,207.85 " "$2,760.80 " "$1,207.85 " "$2,760.80 " GD LT INTLK TRGT RT RECON MDN SRG SS PERC NS IM NL 225505001 C1713 SUPPLY/IMPLANTS "$8,673.00 " Outpatient "$4,336.50 " "$1,219.74 " "$5,637.45 " "$6,071.10 " "$5,724.18 " Not Applicable: Bundled with Procedure "$3,035.55 " "$6,938.40 " "$1,219.74 " "$6,938.40 " GD MIC ALGN BIODRIVE SRG NL PLT VA000B C1713 SUPPLY/IMPLANTS "$2,194.00 " Outpatient "$1,097.00 " "$1,219.74 " "$1,426.10 " "$1,535.80 " "$1,448.04 " Not Applicable: Bundled with Procedure $767.90 "$1,755.20 " $767.90 "$1,755.20 " GD MXL RECONSTUCTION FIB GFT HRVT SRG SD900.004 C1713 SUPPLY/IMPLANTS "$17,387.00 " Outpatient "$8,693.50 " "$1,219.74 " "$11,301.55 " "$12,170.90 " "$11,475.42 " Not Applicable: Bundled with Procedure "$6,085.45 " "$13,909.60 " "$1,219.74 " "$13,909.60 " GD NDL 2.7MM FST TCH SHRT FST GD 231218016 C1713 SUPPLY/IMPLANTS $982.00 Outpatient $491.00 "$1,219.74 " $638.30 $687.40 $648.12 Not Applicable: Bundled with Procedure $343.70 $785.60 $343.70 "$1,219.74 " GD NRV 2CM 2MM NRGN PERI CLGN MTRX RSRB BCMPT SEMIPERM TUBE PNG220 C1713 SUPPLY/IMPLANTS "$8,737.00 " Outpatient "$4,368.50 " "$1,219.74 " "$5,679.05 " "$6,115.90 " "$5,766.42 " Not Applicable: Bundled with Procedure "$3,057.95 " "$6,989.60 " "$1,219.74 " "$6,989.60 " GD OBLQ MDN SRG SS TIB PROX NS IM NL 225503300 C1713 SUPPLY/IMPLANTS "$14,461.00 " Outpatient "$7,230.50 " "$1,219.74 " "$9,399.65 " "$10,122.70 " "$9,544.26 " Not Applicable: Bundled with Procedure "$5,061.35 " "$11,568.80 " "$1,219.74 " "$11,568.80 " GD PIN ORTH 343MM 3.2MM BRAD PNT TIP THRD 71674130 C1713 SUPPLY/IMPLANTS "$1,170.00 " Outpatient $585.00 "$1,219.74 " $760.50 $819.00 $772.20 Not Applicable: Bundled with Procedure $409.50 $936.00 $409.50 "$1,219.74 " GD PIN ORTH 9IN 3.2MM STNM 405800 C1713 SUPPLY/IMPLANTS "$1,060.00 " Outpatient $530.00 "$1,219.74 " $689.00 $742.00 $699.60 Not Applicable: Bundled with Procedure $371.00 $848.00 $371.00 "$1,219.74 " GD PIN ORTH .54IN PROSTOP + UNV ARTHROEREISIS AR-4206 C1713 SUPPLY/IMPLANTS $775.00 Outpatient $387.50 "$1,219.74 " $503.75 $542.50 $511.50 Not Applicable: Bundled with Procedure $271.25 $620.00 $271.25 "$1,219.74 " GD PIN ORTH 100MM DECADE SPNE XLIF 7141112 C1713 SUPPLY/IMPLANTS $512.00 Outpatient $256.00 "$1,219.74 " $332.80 $358.40 $337.92 Not Applicable: Bundled with Procedure $179.20 $409.60 $179.20 "$1,219.74 " GD PIN ORTH 14IN 3.2MM ACE ST VERSANAIL TTC SYS NS DISP 14012-14 C1713 SUPPLY/IMPLANTS $331.00 Outpatient $165.50 "$1,219.74 " $215.15 $231.70 $218.46 Not Applicable: Bundled with Procedure $115.85 $264.80 $115.85 "$1,219.74 " GD PIN ORTH 3MM RETRODRILL KN FEM TIB FLXB GFT PLC AR-1250RS C1713 SUPPLY/IMPLANTS "$1,043.00 " Outpatient $521.50 "$1,219.74 " $677.95 $730.10 $688.38 Not Applicable: Bundled with Procedure $365.05 $834.40 $365.05 "$1,219.74 " GD PIN ORTH 2MM TROC LF 9010000515 C1713 SUPPLY/IMPLANTS $913.00 Outpatient $456.50 "$1,219.74 " $593.45 $639.10 $602.58 Not Applicable: Bundled with Procedure $319.55 $730.40 $319.55 "$1,219.74 " GD PIN ORTH 150MM 3.2MM THG 1STP OSTM 6980-6-000 C1713 SUPPLY/IMPLANTS "$1,334.00 " Outpatient $667.00 "$1,219.74 " $867.10 $933.80 $880.44 Not Applicable: Bundled with Procedure $466.90 "$1,067.20 " $466.90 "$1,219.74 " GD PIN ORTH 6IN 1.6MM THRD TIP GD PIN STRL 245020 C1713 SUPPLY/IMPLANTS $580.00 Outpatient $290.00 "$1,219.74 " $377.00 $406.00 $382.80 Not Applicable: Bundled with Procedure $203.00 $464.00 $203.00 "$1,219.74 " GD PIN ORTH 14IN 3.6MM VERSANAIL BALL TIB 281001036 C1713 SUPPLY/IMPLANTS $667.00 Outpatient $333.50 "$1,219.74 " $433.55 $466.90 $440.22 Not Applicable: Bundled with Procedure $233.45 $533.60 $233.45 "$1,219.74 " GD PIN 2MM SHLDR SNPG20 C1713 SUPPLY/IMPLANTS $691.00 Outpatient $345.50 "$1,219.74 " $449.15 $483.70 $456.06 Not Applicable: Bundled with Procedure $241.85 $552.80 $241.85 "$1,219.74 " GD PIN ORTH 17.5IN 3.2MM VERSANAIL THRD ANTM FIT ABL FEM 903003004 C1713 SUPPLY/IMPLANTS $827.00 Outpatient $413.50 "$1,219.74 " $537.55 $578.90 $545.82 Not Applicable: Bundled with Procedure $289.45 $661.60 $289.45 "$1,219.74 " GD PIN ORTH 444MM 3.2MM VERSANAIL HIP THRD STRL 281001175 C1713 SUPPLY/IMPLANTS $827.00 Outpatient $413.50 "$1,219.74 " $537.55 $578.90 $545.82 Not Applicable: Bundled with Procedure $289.45 $661.60 $289.45 "$1,219.74 " GD PIN ORTH 230MM 2.5MM HIPLOC NTHRD CHS SYS STRL DISP 470009S C1713 SUPPLY/IMPLANTS $969.00 Outpatient $484.50 "$1,219.74 " $629.85 $678.30 $639.54 Not Applicable: Bundled with Procedure $339.15 $775.20 $339.15 "$1,219.74 " GD PIN ORTH 3MM LG D GAGE 14115 C1713 SUPPLY/IMPLANTS $991.00 Outpatient $495.50 "$1,219.74 " $644.15 $693.70 $654.06 Not Applicable: Bundled with Procedure $346.85 $792.80 $346.85 "$1,219.74 " GD PIN ORTH 60CM 2.8-3.2MM SET 467265 C1713 SUPPLY/IMPLANTS "$1,375.00 " Outpatient $687.50 "$1,219.74 " $893.75 $962.50 $907.50 Not Applicable: Bundled with Procedure $481.25 "$1,100.00 " $481.25 "$1,219.74 " GD PIN ORTH DNFX SW 14516 C1713 SUPPLY/IMPLANTS "$1,437.00 " Outpatient $718.50 "$1,219.74 " $934.05 "$1,005.90 " $948.42 Not Applicable: Bundled with Procedure $502.95 "$1,149.60 " $502.95 "$1,219.74 " GD PIN ORTH 3.2MM POLYAX LCK PLT SYS 2141-03-000 C1713 SUPPLY/IMPLANTS "$1,613.00 " Outpatient $806.50 "$1,219.74 " "$1,048.45 " "$1,129.10 " "$1,064.58 " Not Applicable: Bundled with Procedure $564.55 "$1,290.40 " $564.55 "$1,290.40 " GD PIN ORTH STD CNTR 14549 C1713 SUPPLY/IMPLANTS "$2,291.00 " Outpatient "$1,145.50 " "$1,219.74 " "$1,489.15 " "$1,603.70 " "$1,512.06 " Not Applicable: Bundled with Procedure $801.85 "$1,832.80 " $801.85 "$1,832.80 " GD PIN ORTH UNV HND GRP TIB NL SYS 469675 C1713 SUPPLY/IMPLANTS "$4,868.00 " Outpatient "$2,434.00 " "$1,219.74 " "$3,164.20 " "$3,407.60 " "$3,212.88 " Not Applicable: Bundled with Procedure "$1,703.80 " "$3,894.40 " "$1,219.74 " "$3,894.40 " GD PIN ORTH VHS JIG 35-463150 C1713 SUPPLY/IMPLANTS "$6,687.00 " Outpatient "$3,343.50 " "$1,219.74 " "$4,346.55 " "$4,680.90 " "$4,413.42 " Not Applicable: Bundled with Procedure "$2,340.45 " "$5,349.60 " "$1,219.74 " "$5,349.60 " GD PIN ORTH 22.9CM 2.4MM SS 2 END DMD PT CLBRT STY 6 NS 18200069 C1713 SUPPLY/IMPLANTS $714.00 Outpatient $357.00 "$1,219.74 " $464.10 $499.80 $471.24 Not Applicable: Bundled with Procedure $249.90 $571.20 $249.90 "$1,219.74 " GD PIN ORTH 230MM 1.6MM HRBRT P/T SS CNN STRL 115501600 C1713 SUPPLY/IMPLANTS $581.00 Outpatient $290.50 "$1,219.74 " $377.65 $406.70 $383.46 Not Applicable: Bundled with Procedure $203.35 $464.80 $203.35 "$1,219.74 " GD PIN ORTH 22.8CM 2MM HRBRT P/T SS CNN STRL 115502600 C1713 SUPPLY/IMPLANTS $602.00 Outpatient $301.00 "$1,219.74 " $391.30 $421.40 $397.32 Not Applicable: Bundled with Procedure $210.70 $481.60 $210.70 "$1,219.74 " GD PIN ORTH 230MM 3.2MM VFX2 FRLC HIP FEM SS TROC PNT STRL 118102000 C1713 SUPPLY/IMPLANTS $507.00 Outpatient $253.50 "$1,219.74 " $329.55 $354.90 $334.62 Not Applicable: Bundled with Procedure $177.45 $405.60 $177.45 "$1,219.74 " GD PIN ORTH 3.2MM MGNFX SS PRLL NS 114601200 C1713 SUPPLY/IMPLANTS "$2,516.00 " Outpatient "$1,258.00 " "$1,219.74 " "$1,635.40 " "$1,761.20 " "$1,660.56 " Not Applicable: Bundled with Procedure $880.60 "$2,012.80 " $880.60 "$2,012.80 " GD PIN ORTH 3.2MM ITST LNG SS THRD IM NL STRL 225806701 C1713 SUPPLY/IMPLANTS $752.00 Outpatient $376.00 "$1,219.74 " $488.80 $526.40 $496.32 Not Applicable: Bundled with Procedure $263.20 $601.60 $263.20 "$1,219.74 " GD RT INTLK TRGT LT RECON MDN SRG SS PERC NS IM NL 225505002 C1713 SUPPLY/IMPLANTS "$8,673.00 " Outpatient "$4,336.50 " "$1,219.74 " "$5,637.45 " "$6,071.10 " "$5,724.18 " Not Applicable: Bundled with Procedure "$3,035.55 " "$6,938.40 " "$1,219.74 " "$6,938.40 " GD RTRGD TRGT MDN SRG SS ULTEM FEM NS IM NL 224100100 C1713 SUPPLY/IMPLANTS "$5,901.00 " Outpatient "$2,950.50 " "$1,219.74 " "$3,835.65 " "$4,130.70 " "$3,894.66 " Not Applicable: Bundled with Procedure "$2,065.35 " "$4,720.80 " "$1,219.74 " "$4,720.80 " GD SM HNDL TRGT SRG TIB NTR NL 249000510 C1713 SUPPLY/IMPLANTS "$23,183.00 " Outpatient "$11,591.50 " "$1,219.74 " "$15,068.95 " "$16,228.10 " "$15,300.78 " Not Applicable: Bundled with Procedure "$8,114.05 " "$18,546.40 " "$1,219.74 " "$18,546.40 " GD STD AIM PLT SRG TI RDS LT DIST VOLR AR-8916-02 C1713 SUPPLY/IMPLANTS "$2,425.00 " Outpatient "$1,212.50 " "$1,219.74 " "$1,576.25 " "$1,697.50 " "$1,600.50 " Not Applicable: Bundled with Procedure $848.75 "$1,940.00 " $848.75 "$1,940.00 " GD SW DNFX VS SRG 14515 C1713 SUPPLY/IMPLANTS "$5,253.00 " Outpatient "$2,626.50 " "$1,219.74 " "$3,414.45 " "$3,677.10 " "$3,466.98 " Not Applicable: Bundled with Procedure "$1,838.55 " "$4,202.40 " "$1,219.74 " "$4,202.40 " GD TLL HNDL TRGT SRG TIB NTR NL 249000513 C1713 SUPPLY/IMPLANTS "$31,050.00 " Outpatient "$15,525.00 " "$1,219.74 " "$20,182.50 " "$21,735.00 " "$20,493.00 " Not Applicable: Bundled with Procedure "$10,867.50 " "$24,840.00 " "$1,219.74 " "$24,840.00 " GD TRGT SM LCK CALCANEUS LT ALPS NS MN INV SRG 110008301 C1713 SUPPLY/IMPLANTS "$7,401.00 " Outpatient "$3,700.50 " "$1,219.74 " "$4,810.65 " "$5,180.70 " "$4,884.66 " Not Applicable: Bundled with Procedure "$2,590.35 " "$5,920.80 " "$1,219.74 " "$5,920.80 " GD TRGT SM LCK CALCANEUS RT ALPS NS MN INV SRG 110008303 C1713 SUPPLY/IMPLANTS "$7,401.00 " Outpatient "$3,700.50 " "$1,219.74 " "$4,810.65 " "$5,180.70 " "$4,884.66 " Not Applicable: Bundled with Procedure "$2,590.35 " "$5,920.80 " "$1,219.74 " "$5,920.80 " GD TRGT LG LCK CALCANEUS LT ALPS NS MN INV SRG 110008305 C1713 SUPPLY/IMPLANTS "$7,924.00 " Outpatient "$3,962.00 " "$1,219.74 " "$5,150.60 " "$5,546.80 " "$5,229.84 " Not Applicable: Bundled with Procedure "$2,773.40 " "$6,339.20 " "$1,219.74 " "$6,339.20 " GD TRGT LG LCK CALCANEUS RT ALPS NS MN INV SRG 110008307 C1713 SUPPLY/IMPLANTS "$7,929.00 " Outpatient "$3,964.50 " "$1,219.74 " "$5,153.85 " "$5,550.30 " "$5,233.14 " Not Applicable: Bundled with Procedure "$2,775.15 " "$6,343.20 " "$1,219.74 " "$6,343.20 " GD TRGT MDN SRG SS FEM PROX NS IM NL 225500200 C1713 SUPPLY/IMPLANTS "$11,786.00 " Outpatient "$5,893.00 " "$1,219.74 " "$7,660.90 " "$8,250.20 " "$7,778.76 " Not Applicable: Bundled with Procedure "$4,125.10 " "$9,428.80 " "$1,219.74 " "$9,428.80 " GD TRGT MDN SRG SS TIB PROX NS IM NL 225500300 C1713 SUPPLY/IMPLANTS "$5,869.00 " Outpatient "$2,934.50 " "$1,219.74 " "$3,814.85 " "$4,108.30 " "$3,873.54 " Not Applicable: Bundled with Procedure "$2,054.15 " "$4,695.20 " "$1,219.74 " "$4,695.20 " GFT BN DBM 10X1.75CM MAGNIFUSE 7509141 C1713 SUPPLY/IMPLANTS "$18,587.00 " Outpatient "$9,293.50 " "$1,219.74 " "$12,081.55 " "$13,010.90 " "$12,267.42 " Not Applicable: Bundled with Procedure "$6,505.45 " "$14,869.60 " "$1,219.74 " "$14,869.60 " GFT BN FIB SEG 60MM FRZDR CHP MTRGRFT 8-15MM FIB6.0 C1713 SUPPLY/IMPLANTS "$2,902.00 " Outpatient "$1,451.00 " "$1,219.74 " "$1,886.30 " "$2,031.40 " "$1,915.32 " Not Applicable: Bundled with Procedure "$1,015.70 " "$2,321.60 " "$1,015.70 " "$2,321.60 " GFT BN PTLR 16-18MM FRZDR PRTRT WDG P00557 C1713 SUPPLY/IMPLANTS "$4,605.00 " Outpatient "$2,302.50 " "$1,219.74 " "$2,993.25 " "$3,223.50 " "$3,039.30 " Not Applicable: Bundled with Procedure "$1,611.75 " "$3,684.00 " "$1,219.74 " "$3,684.00 " GFT BN TRCORT PTLR 25MMX18MM FRZDR WDG VG PAT.WEDGE8 C1713 SUPPLY/IMPLANTS "$5,016.00 " Outpatient "$2,508.00 " "$1,219.74 " "$3,260.40 " "$3,511.20 " "$3,310.56 " Not Applicable: Bundled with Procedure "$1,755.60 " "$4,012.80 " "$1,219.74 " "$4,012.80 " GFT BN ILC CRST TRCORT 14-18X14-21MM ALGRF BLCK FRZDR 400411 C1713 SUPPLY/IMPLANTS "$5,825.00 " Outpatient "$2,912.50 " "$1,219.74 " "$3,786.25 " "$4,077.50 " "$3,844.50 " Not Applicable: Bundled with Procedure "$2,038.75 " "$4,660.00 " "$1,219.74 " "$4,660.00 " GFT BN DBM XPANSE C9 LG T600309 C1713 SUPPLY/IMPLANTS "$2,936.00 " Outpatient "$1,468.00 " "$1,219.74 " "$1,908.40 " "$2,055.20 " "$1,937.76 " Not Applicable: Bundled with Procedure "$1,027.60 " "$2,348.80 " "$1,027.60 " "$2,348.80 " GFT BN DBM XPANSE L LG T600612 C1713 SUPPLY/IMPLANTS "$3,742.00 " Outpatient "$1,871.00 " "$1,219.74 " "$2,432.30 " "$2,619.40 " "$2,469.72 " Not Applicable: Bundled with Procedure "$1,309.70 " "$2,993.60 " "$1,219.74 " "$2,993.60 " GFT BN ILC TRCORT BLCK LG X00220 C1713 SUPPLY/IMPLANTS "$6,189.00 " Outpatient "$3,094.50 " "$1,219.74 " "$4,022.85 " "$4,332.30 " "$4,084.74 " Not Applicable: Bundled with Procedure "$2,166.15 " "$4,951.20 " "$1,219.74 " "$4,951.20 " GFT BN FIB SHFT 100MM FRZN MTRGRFT 8-15MM FFIB 10 C1713 SUPPLY/IMPLANTS "$3,542.00 " Outpatient "$1,771.00 " "$1,219.74 " "$2,302.30 " "$2,479.40 " "$2,337.72 " Not Applicable: Bundled with Procedure "$1,239.70 " "$2,833.60 " "$1,219.74 " "$2,833.60 " GFT BN FIB SEG 40MM FRZDR CHP MTRGRFT 8-15MM FIB 4.0 C1713 SUPPLY/IMPLANTS "$2,001.00 " Outpatient "$1,000.50 " "$1,219.74 " "$1,300.65 " "$1,400.70 " "$1,320.66 " Not Applicable: Bundled with Procedure $700.35 "$1,600.80 " $700.35 "$1,600.80 " GFT BN CLLR BN MTRX 10ML OSTEOCEL + 5013010 C1713 SUPPLY/IMPLANTS "$19,341.00 " Outpatient "$9,670.50 " "$1,219.74 " "$12,571.65 " "$13,538.70 " "$12,765.06 " Not Applicable: Bundled with Procedure "$6,769.35 " "$15,472.80 " "$1,219.74 " "$15,472.80 " GFT BN CANC ALGRF FRZN VIABLE CELL MORSELIZE TRN ELT MED 410002 C1713 SUPPLY/IMPLANTS "$13,030.00 " Outpatient "$6,515.00 " "$1,219.74 " "$8,469.50 " "$9,121.00 " "$8,599.80 " Not Applicable: Bundled with Procedure "$4,560.50 " "$10,424.00 " "$1,219.74 " "$10,424.00 " GFT BN CANC DBM 3CC RVRS PHS MED GEL PST PUROS 84238003 C1713 SUPPLY/IMPLANTS "$2,863.00 " Outpatient "$1,431.50 " "$1,219.74 " "$1,860.95 " "$2,004.10 " "$1,889.58 " Not Applicable: Bundled with Procedure "$1,002.05 " "$2,290.40 " "$1,002.05 " "$2,290.40 " GFT BN CORT CNC 14X11MM ALGRF PUROS 7D THK7MM SPNE 701268021 C1713 SUPPLY/IMPLANTS "$5,870.00 " Outpatient "$2,935.00 " "$1,219.74 " "$3,815.50 " "$4,109.00 " "$3,874.20 " Not Applicable: Bundled with Procedure "$2,054.50 " "$4,696.00 " "$1,219.74 " "$4,696.00 " GFT BN CLLR BN MTRX 10CC OSTEOCEL PRO LG 5016010 C1713 SUPPLY/IMPLANTS "$22,245.00 " Outpatient "$11,122.50 " "$1,219.74 " "$14,459.25 " "$15,571.50 " "$14,681.70 " Not Applicable: Bundled with Procedure "$7,785.75 " "$17,796.00 " "$1,219.74 " "$17,796.00 " GFT BN CANC 5CC ALGRF FRZN VIABLE CELL MORSELIZE TRN EVOL 410105 C1713 SUPPLY/IMPLANTS "$11,568.00 " Outpatient "$5,784.00 " "$1,219.74 " "$7,519.20 " "$8,097.60 " "$7,634.88 " Not Applicable: Bundled with Procedure "$4,048.80 " "$9,254.40 " "$1,219.74 " "$9,254.40 " GFT BN FIB SHFT 180MMX5+ MM ALGRF FRZN 450636 C1713 SUPPLY/IMPLANTS "$4,767.00 " Outpatient "$2,383.50 " "$1,219.74 " "$3,098.55 " "$3,336.90 " "$3,146.22 " Not Applicable: Bundled with Procedure "$1,668.45 " "$3,813.60 " "$1,219.74 " "$3,813.60 " GFT BN CORT 14MM FRZDR RING MACH 26MM 439014 C1713 SUPPLY/IMPLANTS "$18,934.00 " Outpatient "$9,467.00 " "$1,219.74 " "$12,307.10 " "$13,253.80 " "$12,496.44 " Not Applicable: Bundled with Procedure "$6,626.90 " "$15,147.20 " "$1,219.74 " "$15,147.20 " GFT BN DBM 2.5ML PTTY RTU AC CNXS STRL 02-3000-025 C1713 SUPPLY/IMPLANTS "$3,001.00 " Outpatient "$1,500.50 " "$1,219.74 " "$1,950.65 " "$2,100.70 " "$1,980.66 " Not Applicable: Bundled with Procedure "$1,050.35 " "$2,400.80 " "$1,050.35 " "$2,400.80 " GFT BN DBM 10ML PTTY SYR AC CNXS 02-3000-100 C1713 SUPPLY/IMPLANTS "$11,998.00 " Outpatient "$5,999.00 " "$1,219.74 " "$7,798.70 " "$8,398.60 " "$7,918.68 " Not Applicable: Bundled with Procedure "$4,199.30 " "$9,598.40 " "$1,219.74 " "$9,598.40 " GFT BN DBM 1ML PTTY SYR RTU MLBL MLD NTR AC CNXS 02-3000-010 C1713 SUPPLY/IMPLANTS "$1,533.00 " Outpatient $766.50 "$1,219.74 " $996.45 "$1,073.10 " "$1,011.78 " Not Applicable: Bundled with Procedure $536.55 "$1,226.40 " $536.55 "$1,226.40 " GFT BN DBF 1ML PTTY GRFTN T50101 C1713 SUPPLY/IMPLANTS "$2,280.00 " Outpatient "$1,140.00 " "$1,219.74 " "$1,482.00 " "$1,596.00 " "$1,504.80 " Not Applicable: Bundled with Procedure $798.00 "$1,824.00 " $798.00 "$1,824.00 " GFT BN FIB 110X6.5MM ALGRF FRZN STRUT 450656 C1713 SUPPLY/IMPLANTS "$5,459.00 " Outpatient "$2,729.50 " "$1,219.74 " "$3,548.35 " "$3,821.30 " "$3,602.94 " Not Applicable: Bundled with Procedure "$1,910.65 " "$4,367.20 " "$1,219.74 " "$4,367.20 " GFT BN DBM CORT CNC DISK FRZN OPTEFORM 9569 C1713 SUPPLY/IMPLANTS "$3,018.00 " Outpatient "$1,509.00 " "$1,219.74 " "$1,961.70 " "$2,112.60 " "$1,991.88 " Not Applicable: Bundled with Procedure "$1,056.30 " "$2,414.40 " "$1,056.30 " "$2,414.40 " GFT BN FIB SEG 15- CM ALGRF FRZDR ASPT 450047 C1713 SUPPLY/IMPLANTS "$4,193.00 " Outpatient "$2,096.50 " "$1,219.74 " "$2,725.45 " "$2,935.10 " "$2,767.38 " Not Applicable: Bundled with Procedure "$1,467.55 " "$3,354.40 " "$1,219.74 " "$3,354.40 " GFT BN 12MMX11MMX6IN FORTIS LRDTC ACF 37106 C1713 SUPPLY/IMPLANTS "$6,872.00 " Outpatient "$3,436.00 " "$1,219.74 " "$4,466.80 " "$4,810.40 " "$4,535.52 " Not Applicable: Bundled with Procedure "$2,405.20 " "$5,497.60 " "$1,219.74 " "$5,497.60 " GFT BN ZYG SD800.563 C1713 SUPPLY/IMPLANTS "$38,421.00 " Outpatient "$19,210.50 " "$1,219.74 " "$24,973.65 " "$26,894.70 " "$25,357.86 " Not Applicable: Bundled with Procedure "$13,447.35 " "$30,736.80 " "$1,219.74 " "$30,736.80 " GFT BN FIB RECON MNDB NS SD900.001 C1713 SUPPLY/IMPLANTS "$17,387.00 " Outpatient "$8,693.50 " "$1,219.74 " "$11,301.55 " "$12,170.90 " "$11,475.42 " Not Applicable: Bundled with Procedure "$6,085.45 " "$13,909.60 " "$1,219.74 " "$13,909.60 " GFT BN COSTAL CRTLG 4.1-5X1-2CM ALGRF SHT PRFL THK1.8-2.2MM 258225 C1713 SUPPLY/IMPLANTS "$3,007.00 " Outpatient "$1,503.50 " "$1,219.74 " "$1,954.55 " "$2,104.90 " "$1,984.62 " Not Applicable: Bundled with Procedure "$1,052.45 " "$2,405.60 " "$1,052.45 " "$2,405.60 " GFT BN COSTAL CRTLG 2.5-3X1-2CM ALGRF PRFL THK1.8-2.2MM 258223 C1713 SUPPLY/IMPLANTS "$1,098.00 " Outpatient $549.00 "$1,219.74 " $713.70 $768.60 $724.68 Not Applicable: Bundled with Procedure $384.30 $878.40 $384.30 "$1,219.74 " GFT BN FIB SHFT 60MM ALGRF BIO SHFT 8-15MM 77712060 C1713 SUPPLY/IMPLANTS "$3,281.00 " Outpatient "$1,640.50 " "$1,219.74 " "$2,132.65 " "$2,296.70 " "$2,165.46 " Not Applicable: Bundled with Procedure "$1,148.35 " "$2,624.80 " "$1,148.35 " "$2,624.80 " GFT BN VIABLE BN MTRX 2.5CC ALLOGENIC CMPR MLD BIO4 3102-2102 C1713 SUPPLY/IMPLANTS "$7,772.00 " Outpatient "$3,886.00 " "$1,219.74 " "$5,051.80 " "$5,440.40 " "$5,129.52 " Not Applicable: Bundled with Procedure "$2,720.20 " "$6,217.60 " "$1,219.74 " "$6,217.60 " GFT BN FIB SHFT 40MM BIOLOGICS 2504-20040FB C1713 SUPPLY/IMPLANTS "$3,798.00 " Outpatient "$1,899.00 " "$1,219.74 " "$2,468.70 " "$2,658.60 " "$2,506.68 " Not Applicable: Bundled with Procedure "$1,329.30 " "$3,038.40 " "$1,219.74 " "$3,038.40 " GFT BN DBM 5X2.5CM SHRT 653050 C1713 SUPPLY/IMPLANTS "$3,713.00 " Outpatient "$1,856.50 " "$1,219.74 " "$2,413.45 " "$2,599.10 " "$2,450.58 " Not Applicable: Bundled with Procedure "$1,299.55 " "$2,970.40 " "$1,219.74 " "$2,970.40 " GFT BN VIABLE CELL BN MTRX 2.5CC ALGRF BIO4 PS51002 C1713 SUPPLY/IMPLANTS "$7,767.00 " Outpatient "$3,883.50 " "$1,219.74 " "$5,048.55 " "$5,436.90 " "$5,126.22 " Not Applicable: Bundled with Procedure "$2,718.45 " "$6,213.60 " "$1,219.74 " "$6,213.60 " GFT BN CANC 1ML ALGRF VIABLE BIO4 PS51001 C1713 SUPPLY/IMPLANTS "$3,566.00 " Outpatient "$1,783.00 " "$1,219.74 " "$2,317.90 " "$2,496.20 " "$2,353.56 " Not Applicable: Bundled with Procedure "$1,248.10 " "$2,852.80 " "$1,219.74 " "$2,852.80 " GFT BN DMNR CORT FBR 10CC ALGRF CHSV PTTY HI AVG CELL CNT 8137.0010S C1713 SUPPLY/IMPLANTS "$17,095.00 " Outpatient "$8,547.50 " "$1,219.74 " "$11,111.75 " "$11,966.50 " "$11,282.70 " Not Applicable: Bundled with Procedure "$5,983.25 " "$13,676.00 " "$1,219.74 " "$13,676.00 " GFT BN CORT CNC 22X16X7MM ALGRF FRZDR CTTN WDG FLATFOOT 403207 C1713 SUPPLY/IMPLANTS "$4,233.00 " Outpatient "$2,116.50 " "$1,219.74 " "$2,751.45 " "$2,963.10 " "$2,793.78 " Not Applicable: Bundled with Procedure "$1,481.55 " "$3,386.40 " "$1,219.74 " "$3,386.40 " GFT BN DBM PLGLY 5X2.5CM ALGRF RSRB REMODEL REPL MESH BG 7509505 C1713 SUPPLY/IMPLANTS "$15,893.00 " Outpatient "$7,946.50 " "$1,219.74 " "$10,330.45 " "$11,125.10 " "$10,489.38 " Not Applicable: Bundled with Procedure "$5,562.55 " "$12,714.40 " "$1,219.74 " "$12,714.40 " GFT BN DBM PLGLY 10X2.5CM ALGRF RSRB REMODEL REPL MESH BG 7509510 C1713 SUPPLY/IMPLANTS "$23,124.00 " Outpatient "$11,562.00 " "$1,219.74 " "$15,030.60 " "$16,186.80 " "$15,261.84 " Not Applicable: Bundled with Procedure "$8,093.40 " "$18,499.20 " "$1,219.74 " "$18,499.20 " GFT BN 60-80MM FRZN ALGRF PRESUTURE PRESIZE FLEXIGRAFT FGL C1713 SUPPLY/IMPLANTS "$10,933.00 " Outpatient "$5,466.50 " "$1,219.74 " "$7,106.45 " "$7,653.10 " "$7,215.78 " Not Applicable: Bundled with Procedure "$3,826.55 " "$8,746.40 " "$1,219.74 " "$8,746.40 " GFT BN DMNR CORT FBR 5CC ALGRF CHSV PTTY HI AVG CELL CNT 8137.0005S C1713 SUPPLY/IMPLANTS "$8,549.00 " Outpatient "$4,274.50 " "$1,219.74 " "$5,556.85 " "$5,984.30 " "$5,642.34 " Not Applicable: Bundled with Procedure "$2,992.15 " "$6,839.20 " "$1,219.74 " "$6,839.20 " GFT BN DMNR CANC 15X20X6MM STRP BIOLOGICS 4104-K1520DC C1713 SUPPLY/IMPLANTS "$7,633.00 " Outpatient "$3,816.50 " "$1,219.74 " "$4,961.45 " "$5,343.10 " "$5,037.78 " Not Applicable: Bundled with Procedure "$2,671.55 " "$6,106.40 " "$1,219.74 " "$6,106.40 " GFT BN CORT CNC 22X22X10MM ALGRF FRZDR EVANS WDG 5MM 403110 C1713 SUPPLY/IMPLANTS "$5,178.00 " Outpatient "$2,589.00 " "$1,219.74 " "$3,365.70 " "$3,624.60 " "$3,417.48 " Not Applicable: Bundled with Procedure "$1,812.30 " "$4,142.40 " "$1,219.74 " "$4,142.40 " GFT SFT TIS AT 453042 C1713 SUPPLY/IMPLANTS "$15,653.00 " Outpatient "$7,826.50 " "$1,219.74 " "$10,174.45 " "$10,957.10 " "$10,330.98 " Not Applicable: Bundled with Procedure "$5,478.55 " "$12,522.40 " "$1,219.74 " "$12,522.40 " GFT SFT TIS 10X6CM EPIXL XL-5610 C1713 SUPPLY/IMPLANTS "$21,841.00 " Outpatient "$10,920.50 " "$1,219.74 " "$14,196.65 " "$15,288.70 " "$14,415.06 " Not Applicable: Bundled with Procedure "$7,644.35 " "$17,472.80 " "$1,219.74 " "$17,472.80 " GFT SFT TIS 7X4CM XCM BIOLOGIC THK PRCN DERM NONCROSS LNK XM106.0407S C1713 SUPPLY/IMPLANTS "$4,847.00 " Outpatient "$2,423.50 " "$1,219.74 " "$3,150.55 " "$3,392.90 " "$3,199.02 " Not Applicable: Bundled with Procedure "$1,696.45 " "$3,877.60 " "$1,219.74 " "$3,877.60 " GFT SNTH TISS 47X28X3MM PE POR MDPR MDFC RIM LT MALAR STRL 83003 C1713 SUPPLY/IMPLANTS "$2,584.00 " Outpatient "$1,292.00 " "$1,219.74 " "$1,679.60 " "$1,808.80 " "$1,705.44 " Not Applicable: Bundled with Procedure $904.40 "$2,067.20 " $904.40 "$2,067.20 " GOUG SRG 241.3X6.4MM 1.6CM HIBBS STRG HEX SS HNDL BLDE 108MM 288400001 C1713 SUPPLY/IMPLANTS "$1,033.00 " Outpatient $516.50 "$1,219.74 " $671.45 $723.10 $681.78 Not Applicable: Bundled with Procedure $361.55 $826.40 $361.55 "$1,219.74 " GOUG SRG 241.3X13MM 16MM HIBBS STRG HEX SS HNDL BLDE 108MM 288400002 C1713 SUPPLY/IMPLANTS "$1,033.00 " Outpatient $516.50 "$1,219.74 " $671.45 $723.10 $681.78 Not Applicable: Bundled with Procedure $361.55 $826.40 $361.55 "$1,219.74 " GOUG SRG 241.3X19MM 16MM HIBBS STRG HEX SS HNDL BLDE 108MM 288400003 C1713 SUPPLY/IMPLANTS "$1,033.00 " Outpatient $516.50 "$1,219.74 " $671.45 $723.10 $681.78 Not Applicable: Bundled with Procedure $361.55 $826.40 $361.55 "$1,219.74 " GOUG SRG 241.3X25MM 16MM HIBBS STRG HEX SS HNDL BLDE 108MM 288400004 C1713 SUPPLY/IMPLANTS "$1,033.00 " Outpatient $516.50 "$1,219.74 " $671.45 $723.10 $681.78 Not Applicable: Bundled with Procedure $361.55 $826.40 $361.55 "$1,219.74 " GOUG SRG 241.3X32MM 16MM HIBBS STRG HEX SS HNDL BLDE 108MM 288400005 C1713 SUPPLY/IMPLANTS "$1,033.00 " Outpatient $516.50 "$1,219.74 " $671.45 $723.10 $681.78 Not Applicable: Bundled with Procedure $361.55 $826.40 $361.55 "$1,219.74 " GOUG SRG 241.3X9.5MM 16MM HIBBS STRG HEX SS HNDL BLDE 108MM 288400006 C1713 SUPPLY/IMPLANTS "$1,033.00 " Outpatient $516.50 "$1,219.74 " $671.45 $723.10 $681.78 Not Applicable: Bundled with Procedure $361.55 $826.40 $361.55 "$1,219.74 " GOUG SRG 241.3X6.4MM HIBBS CRV SS HNDL BLDE 10.8X1.6CM NS LF 288500001 C1713 SUPPLY/IMPLANTS "$1,053.00 " Outpatient $526.50 "$1,219.74 " $684.45 $737.10 $694.98 Not Applicable: Bundled with Procedure $368.55 $842.40 $368.55 "$1,219.74 " GOUG SRG 241.3X13MM HIBBS CRV SS HNDL BLDE 10.8X1.6CM NS LF 288500002 C1713 SUPPLY/IMPLANTS "$1,053.00 " Outpatient $526.50 "$1,219.74 " $684.45 $737.10 $694.98 Not Applicable: Bundled with Procedure $368.55 $842.40 $368.55 "$1,219.74 " GOUG SRG 241.3X19MM HIBBS CRV SS HNDL BLDE 10.8X1.6CM NS LF 288500003 C1713 SUPPLY/IMPLANTS "$1,053.00 " Outpatient $526.50 "$1,219.74 " $684.45 $737.10 $694.98 Not Applicable: Bundled with Procedure $368.55 $842.40 $368.55 "$1,219.74 " GOUG SRG 241.3X25MM HIBBS CRV SS HNDL BLDE 10.8X1.6CM NS LF 288500004 C1713 SUPPLY/IMPLANTS "$1,053.00 " Outpatient $526.50 "$1,219.74 " $684.45 $737.10 $694.98 Not Applicable: Bundled with Procedure $368.55 $842.40 $368.55 "$1,219.74 " GOUG SRG 241.3X32MM HIBBS CRV SS HNDL BLDE 10.8X1.6CM NS LF 288500005 C1713 SUPPLY/IMPLANTS "$1,053.00 " Outpatient $526.50 "$1,219.74 " $684.45 $737.10 $694.98 Not Applicable: Bundled with Procedure $368.55 $842.40 $368.55 "$1,219.74 " GOUG SRG 241.3X7.9MM CB STRG CRV SPNE SS HVDTY HLW KNURL 289100100 C1713 SUPPLY/IMPLANTS "$1,183.00 " Outpatient $591.50 "$1,219.74 " $768.95 $828.10 $780.78 Not Applicable: Bundled with Procedure $414.05 $946.40 $414.05 "$1,219.74 " GOUG SRG 24.1CMX7.9MM CB MED CRV SPNE SS HVDTY HLW KNURL 289100200 C1713 SUPPLY/IMPLANTS "$1,183.00 " Outpatient $591.50 "$1,219.74 " $768.95 $828.10 $780.78 Not Applicable: Bundled with Procedure $414.05 $946.40 $414.05 "$1,219.74 " GOUG SRG 24.1CMX7.9MM CB SHRP CRV SPNE SS HVDTY HLW KNURL 289100300 C1713 SUPPLY/IMPLANTS "$1,183.00 " Outpatient $591.50 "$1,219.74 " $768.95 $828.10 $780.78 Not Applicable: Bundled with Procedure $414.05 $946.40 $414.05 "$1,219.74 " GOUG SRG 24.1CMX7.9MM CB CRV DN SPNE SS HVDTY HLW KNURL HNDL 289100400 C1713 SUPPLY/IMPLANTS "$1,183.00 " Outpatient $591.50 "$1,219.74 " $768.95 $828.10 $780.78 Not Applicable: Bundled with Procedure $414.05 $946.40 $414.05 "$1,219.74 " GOUG SRG 24.1CMX8MM CB REG STRG HEX SPNE SS HLW HNDL BLDE 289200100 C1713 SUPPLY/IMPLANTS "$1,165.00 " Outpatient $582.50 "$1,219.74 " $757.25 $815.50 $768.90 Not Applicable: Bundled with Procedure $407.75 $932.00 $407.75 "$1,219.74 " GOUG SRG 24.1CMX8MM CB REG HEX MED CRV SPNE SS HLW HNDL BLDE 289200200 C1713 SUPPLY/IMPLANTS "$1,165.00 " Outpatient $582.50 "$1,219.74 " $757.25 $815.50 $768.90 Not Applicable: Bundled with Procedure $407.75 $932.00 $407.75 "$1,219.74 " GOUG SRG 24.1CMX8MM CB REG HEX SHRP CRV SPNE SS HLW HNDL 289200300 C1713 SUPPLY/IMPLANTS "$1,165.00 " Outpatient $582.50 "$1,219.74 " $757.25 $815.50 $768.90 Not Applicable: Bundled with Procedure $407.75 $932.00 $407.75 "$1,219.74 " GOUG SRG 24.1CMX8MM CB REG HEX ANG SPNE SS HLW HNDL BLDE 108 289200400 C1713 SUPPLY/IMPLANTS "$1,165.00 " Outpatient $582.50 "$1,219.74 " $757.25 $815.50 $768.90 Not Applicable: Bundled with Procedure $407.75 $932.00 $407.75 "$1,219.74 " GRAFT DOUBLE STRAND EMITENDONOSIS 0.65X28.0CM 170825-037 C1713 SUPPLY/IMPLANTS "$9,526.00 " Outpatient "$4,763.00 " "$1,219.74 " "$6,191.90 " "$6,668.20 " "$6,287.16 " Not Applicable: Bundled with Procedure "$3,334.10 " "$7,620.80 " "$1,219.74 " "$7,620.80 " GRAFT DOUBLE STRAND SEMITENDINOSIS 0.65X26.0CM 172333-015 C1713 SUPPLY/IMPLANTS "$9,526.00 " Outpatient "$4,763.00 " "$1,219.74 " "$6,191.90 " "$6,668.20 " "$6,287.16 " Not Applicable: Bundled with Procedure "$3,334.10 " "$7,620.80 " "$1,219.74 " "$7,620.80 " GRAFT BONE VERTIGRAFT CANCELLOUS H10 MM PLUG FCPD10 C1713 SUPPLY/IMPLANTS "$2,191.00 " Outpatient "$1,095.50 " "$1,219.74 " "$1,424.15 " "$1,533.70 " "$1,446.06 " Not Applicable: Bundled with Procedure $766.85 "$1,752.80 " $766.85 "$1,752.80 " GRAFT BONE CARTIFORM DISC OD20 MM ALLOGRAFT ABS-1101-20 C1713 SUPPLY/IMPLANTS "$41,482.00 " Outpatient "$20,741.00 " "$1,219.74 " "$26,963.30 " "$29,037.40 " "$27,378.12 " Not Applicable: Bundled with Procedure "$14,518.70 " "$33,185.60 " "$1,219.74 " "$33,185.60 " GRAFT BONE DEMINERALIZED BONE MATRIX 1 CC ALLOGRAFT GEL 3102-1101 C1713 SUPPLY/IMPLANTS "$1,288.00 " Outpatient $644.00 "$1,219.74 " $837.20 $901.60 $850.08 Not Applicable: Bundled with Procedure $450.80 "$1,030.40 " $450.80 "$1,219.74 " GRAFT BONE PRIME HD DBM 2.5 CC ALLOGRAFT LATEX FREE 421025 C1713 SUPPLY/IMPLANTS "$1,685.00 " Outpatient $842.50 "$1,219.74 " "$1,095.25 " "$1,179.50 " "$1,112.10 " Not Applicable: Bundled with Procedure $589.75 "$1,348.00 " $589.75 "$1,348.00 " GRAFT BONE PRIME HD DBM 5 CC ALLOGRAFT LATEX FREE 421050 C1713 SUPPLY/IMPLANTS "$2,929.00 " Outpatient "$1,464.50 " "$1,219.74 " "$1,903.85 " "$2,050.30 " "$1,933.14 " Not Applicable: Bundled with Procedure "$1,025.15 " "$2,343.20 " "$1,025.15 " "$2,343.20 " GRAFT BONE PRIME HD DBM 10 CC ALLOGRAFT LATEX FREE 421100 C1713 SUPPLY/IMPLANTS "$5,369.00 " Outpatient "$2,684.50 " "$1,219.74 " "$3,489.85 " "$3,758.30 " "$3,543.54 " Not Applicable: Bundled with Procedure "$1,879.15 " "$4,295.20 " "$1,219.74 " "$4,295.20 " GRAFT BONE I FACTOR 2.5 CC ALLOGRAFT PUTTY SYRINGE 700-025 C1713 SUPPLY/IMPLANTS "$5,598.00 " Outpatient "$2,799.00 " "$1,219.74 " "$3,638.70 " "$3,918.60 " "$3,694.68 " Not Applicable: Bundled with Procedure "$1,959.30 " "$4,478.40 " "$1,219.74 " "$4,478.40 " GRAFT BONE VERTIGRAFT ILIAC CREST H20 MM FREEZE DRIED WEDGE ICWS C1713 SUPPLY/IMPLANTS "$4,196.00 " Outpatient "$2,098.00 " "$1,219.74 " "$2,727.40 " "$2,937.20 " "$2,769.36 " Not Applicable: Bundled with Procedure "$1,468.60 " "$3,356.80 " "$1,219.74 " "$3,356.80 " GRAFT BONE VERTIGRAFT FEMORAL SHAFT H70 MM OD23-27 MM ODSEC2 VFEMS70 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " GRAFT AMNIOHEAL 25MG TAH2025 C1713 SUPPLY/IMPLANTS "$2,597.00 " Outpatient "$1,298.50 " "$1,219.74 " "$1,688.05 " "$1,817.90 " "$1,714.02 " Not Applicable: Bundled with Procedure $908.95 "$2,077.60 " $908.95 "$2,077.60 " GRAFT BONE VIVIGEN FORMABLE CELLULAR DEMINERALIZE FIBER XL A BL-1600-004 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " GRAFT BONE READIGRAFT CANCELLOUS 1-4 MM 15 ML FREEZE DRIED C CAN15 14BP C1713 SUPPLY/IMPLANTS "$1,359.00 " Outpatient $679.50 "$1,219.74 " $883.35 $951.30 $896.94 Not Applicable: Bundled with Procedure $475.65 "$1,087.20 " $475.65 "$1,219.74 " GRAFT BONE DEMINERALIZED BONE MATRIX 1 CC ALLOGRAFT PUTTY 3102-1001 C1713 SUPPLY/IMPLANTS "$1,029.00 " Outpatient $514.50 "$1,219.74 " $668.85 $720.30 $679.14 Not Applicable: Bundled with Procedure $360.15 $823.20 $360.15 "$1,219.74 " GRAFT BONE DEMINERALIZED BONE MATRIX 10 CC ALLOGRAFT PUTTY P 3102-1210 C1713 SUPPLY/IMPLANTS "$6,943.00 " Outpatient "$3,471.50 " "$1,219.74 " "$4,512.95 " "$4,860.10 " "$4,582.38 " Not Applicable: Bundled with Procedure "$2,430.05 " "$5,554.40 " "$1,219.74 " "$5,554.40 " GRAFT BONE MATRIGRAFT FEMORAL HEAD OD43+ MM ALLOGRAFT FFH C1713 SUPPLY/IMPLANTS "$5,579.00 " Outpatient "$2,789.50 " "$1,219.74 " "$3,626.35 " "$3,905.30 " "$3,682.14 " Not Applicable: Bundled with Procedure "$1,952.65 " "$4,463.20 " "$1,219.74 " "$4,463.20 " GRAFT BONE BIOSURGE III ALLOSYNC ARTHREX ANGEL CANCELLOUS DE ABS-2016-03 C1713 SUPPLY/IMPLANTS "$7,095.00 " Outpatient "$3,547.50 " "$1,219.74 " "$4,611.75 " "$4,966.50 " "$4,682.70 " Not Applicable: Bundled with Procedure "$2,483.25 " "$5,676.00 " "$1,219.74 " "$5,676.00 " GRAFT BONE CANCELLOUS UNICORTICAL L14 MM X W11 MM X H7 MM SP LGAP507 C1713 SUPPLY/IMPLANTS "$4,513.00 " Outpatient "$2,256.50 " "$1,219.74 " "$2,933.45 " "$3,159.10 " "$2,978.58 " Not Applicable: Bundled with Procedure "$1,579.55 " "$3,610.40 " "$1,219.74 " "$3,610.40 " GRAFT BONE LIFEGRAFT CANCELLOUS UNICORTICAL L11 MM X W14 MM LGAP508 C1713 SUPPLY/IMPLANTS "$4,513.00 " Outpatient "$2,256.50 " "$1,219.74 " "$2,933.45 " "$3,159.10 " "$2,978.58 " Not Applicable: Bundled with Procedure "$1,579.55 " "$3,610.40 " "$1,219.74 " "$3,610.40 " GRAFT CAGE LONG BONE STERILE TRUMATCH SD900.501S C1713 SUPPLY/IMPLANTS "$71,250.00 " Outpatient "$35,625.00 " "$1,219.74 " "$46,312.50 " "$49,875.00 " "$47,025.00 " Not Applicable: Bundled with Procedure "$24,937.50 " "$57,000.00 " "$1,219.74 " "$57,000.00 " GRAFT/SPACER SOFAMOR DANEK 12X26MM 399612 C1713 SUPPLY/IMPLANTS "$20,040.00 " Outpatient "$10,020.00 " "$1,219.74 " "$13,026.00 " "$14,028.00 " "$13,226.40 " Not Applicable: Bundled with Procedure "$7,014.00 " "$16,032.00 " "$1,219.74 " "$16,032.00 " GRIP CBL 2MM BMP LG TROCH COCR 120009 C1713 SUPPLY/IMPLANTS "$3,326.00 " Outpatient "$1,663.00 " "$1,219.74 " "$2,161.90 " "$2,328.20 " "$2,195.16 " Not Applicable: Bundled with Procedure "$1,164.10 " "$2,660.80 " "$1,164.10 " "$2,660.80 " GST RELOAD BLACK INTENDED 45MM GST45T C1713 SUPPLY/IMPLANTS $890.00 Outpatient $445.00 "$1,219.74 " $578.50 $623.00 $587.40 Not Applicable: Bundled with Procedure $311.50 $712.00 $311.50 "$1,219.74 " GUIDE PIN TOE MOTION 1.5MM 9P07-1002 C1713 SUPPLY/IMPLANTS $613.00 Outpatient $306.50 "$1,219.74 " $398.45 $429.10 $404.58 Not Applicable: Bundled with Procedure $214.55 $490.40 $214.55 "$1,219.74 " GUIDE PIN 1.4 X 610 TROCAR ROUND 530-0090 C1713 SUPPLY/IMPLANTS $753.00 Outpatient $376.50 "$1,219.74 " $489.45 $527.10 $496.98 Not Applicable: Bundled with Procedure $263.55 $602.40 $263.55 "$1,219.74 " GUIDE PIN ORTHOPEDIC XACTPIN L43.18 CM OD2.4 MM GRAFT PASS C8677S C1713 SUPPLY/IMPLANTS $885.00 Outpatient $442.50 "$1,219.74 " $575.25 $619.50 $584.10 Not Applicable: Bundled with Procedure $309.75 $708.00 $309.75 "$1,219.74 " GUIDE ROD ORTHOPEDIC STAINLESS STEEL L230 MM OD2.5 MM STOP T 03.019.026S C1713 SUPPLY/IMPLANTS $552.00 Outpatient $276.00 "$1,219.74 " $358.80 $386.40 $364.32 Not Applicable: Bundled with Procedure $193.20 $441.60 $193.20 "$1,219.74 " GUIDE DRILL SPEEDGUIDE T8 L30- MM OD2 MM 2.4/2.7 MM SCREW 703888 C1713 SUPPLY/IMPLANTS "$1,659.00 " Outpatient $829.50 "$1,219.74 " "$1,078.35 " "$1,161.30 " "$1,094.94 " Not Applicable: Bundled with Procedure $580.65 "$1,327.20 " $580.65 "$1,327.20 " GUIDEWIRE 9080B-240 C1713 SUPPLY/IMPLANTS $698.00 Outpatient $349.00 "$1,219.74 " $453.70 $488.60 $460.68 Not Applicable: Bundled with Procedure $244.30 $558.40 $244.30 "$1,219.74 " GUIDEWIRE 1.5 X 350MM ML-0301 C1713 SUPPLY/IMPLANTS "$2,565.00 " Outpatient "$1,282.50 " "$1,219.74 " "$1,667.25 " "$1,795.50 " "$1,692.90 " Not Applicable: Bundled with Procedure $897.75 "$2,052.00 " $897.75 "$2,052.00 " GUIDEWIRE ORTHOPEDIC AFFIXUS HUMERAL BALL NOSE STERILE NATUR 110035668 C1713 SUPPLY/IMPLANTS "$2,161.00 " Outpatient "$1,080.50 " "$1,219.74 " "$1,404.65 " "$1,512.70 " "$1,426.26 " Not Applicable: Bundled with Procedure $756.35 "$1,728.80 " $756.35 "$1,728.80 " GW ORTH T2 3MM 1000MM BALL TIP FEM TI STRL FEM NL SYS 1806-0085S C1713 SUPPLY/IMPLANTS "$1,194.00 " Outpatient $597.00 "$1,219.74 " $776.10 $835.80 $788.04 Not Applicable: Bundled with Procedure $417.90 $955.20 $417.90 "$1,219.74 " GW ORTH T2 3MM 800MM BALL TIP TI STRL FEM NL SYS 1806-0080S C1713 SUPPLY/IMPLANTS "$1,636.00 " Outpatient $818.00 "$1,219.74 " "$1,063.40 " "$1,145.20 " "$1,079.76 " Not Applicable: Bundled with Procedure $572.60 "$1,308.80 " $572.60 "$1,308.80 " GW ORTH PHNX 3.2MM 460MM ENTRY TIB DISP NL SYS 27914 C1713 SUPPLY/IMPLANTS $922.00 Outpatient $461.00 "$1,219.74 " $599.30 $645.40 $608.52 Not Applicable: Bundled with Procedure $322.70 $737.60 $322.70 "$1,219.74 " GW ORTH 3MM 98CM BEAD TIP IM DISP RTRGD FEM NL 27922 C1713 SUPPLY/IMPLANTS $623.00 Outpatient $311.50 "$1,219.74 " $404.95 $436.10 $411.18 Not Applicable: Bundled with Procedure $218.05 $498.40 $218.05 "$1,219.74 " GW ORTH 3.2MM 460MM THRD TIP FEM METAPHYSIS DIST COCR DISP 14-441054 C1713 SUPPLY/IMPLANTS $844.00 Outpatient $422.00 "$1,219.74 " $548.60 $590.80 $557.04 Not Applicable: Bundled with Procedure $295.40 $675.20 $295.40 "$1,219.74 " GW ORTH 3.2MM 560MM THRD TIP COCR 14-441053 C1713 SUPPLY/IMPLANTS $844.00 Outpatient $422.00 "$1,219.74 " $548.60 $590.80 $557.04 Not Applicable: Bundled with Procedure $295.40 $675.20 $295.40 "$1,219.74 " GW ORTH ASNS III 2MM 150MM THRD FEM HIP STRL 5MM SCR 702460S C1713 SUPPLY/IMPLANTS $630.00 Outpatient $315.00 "$1,219.74 " $409.50 $441.00 $415.80 Not Applicable: Bundled with Procedure $220.50 $504.00 $220.50 "$1,219.74 " GW ORTH 2.8MM 450MM TROC PNT THRD CLBRT 300MM NS 6.5/7.3 CNN 900.726 C1713 SUPPLY/IMPLANTS $629.00 Outpatient $314.50 "$1,219.74 " $408.85 $440.30 $415.14 Not Applicable: Bundled with Procedure $220.15 $503.20 $220.15 "$1,219.74 " GW ORTH 2.2MM 98CM BEAD TIP DISP 27934 C1713 SUPPLY/IMPLANTS $616.00 Outpatient $308.00 "$1,219.74 " $400.40 $431.20 $406.56 Not Applicable: Bundled with Procedure $215.60 $492.80 $215.60 "$1,219.74 " GW ORTH OPTILOCK 2MM 250MM NTHRD DISP PERIART PLT SYS 27591 C1713 SUPPLY/IMPLANTS $834.00 Outpatient $417.00 "$1,219.74 " $542.10 $583.80 $550.44 Not Applicable: Bundled with Procedure $291.90 $667.20 $291.90 "$1,219.74 " GW ORTH 3MM 120MM GRAD BEAD TIP RND 27921 C1713 SUPPLY/IMPLANTS "$1,106.00 " Outpatient $553.00 "$1,219.74 " $718.90 $774.20 $729.96 Not Applicable: Bundled with Procedure $387.10 $884.80 $387.10 "$1,219.74 " GW ORTH 3MM 98CM BEAD TIP 29222 C1713 SUPPLY/IMPLANTS "$3,416.00 " Outpatient "$1,708.00 " "$1,219.74 " "$2,220.40 " "$2,391.20 " "$2,254.56 " Not Applicable: Bundled with Procedure "$1,195.60 " "$2,732.80 " "$1,195.60 " "$2,732.80 " GW ORTH VFX2 3.2MM 230MM CLBRT FEM FX SYS 119301500 C1713 SUPPLY/IMPLANTS $733.00 Outpatient $366.50 "$1,219.74 " $476.45 $513.10 $483.78 Not Applicable: Bundled with Procedure $256.55 $586.40 $256.55 "$1,219.74 " GW ORTH 3MM 100CM BALL TIP STRL LF NTR NL SYS 47225500801 C1713 SUPPLY/IMPLANTS $640.00 Outpatient $320.00 "$1,219.74 " $416.00 $448.00 $422.40 Not Applicable: Bundled with Procedure $224.00 $512.00 $224.00 "$1,219.74 " GW ORTH 2.4MM 100CM TIB TRDRP STRL NTR NL 47249009701 C1713 SUPPLY/IMPLANTS $884.00 Outpatient $442.00 "$1,219.74 " $574.60 $618.80 $583.44 Not Applicable: Bundled with Procedure $309.40 $707.20 $309.40 "$1,219.74 " GW ORTH 2.4MM 70CM TRDRP TIB STRL NTR NL SYS 47249009801 C1713 SUPPLY/IMPLANTS $771.00 Outpatient $385.50 "$1,219.74 " $501.15 $539.70 $508.86 Not Applicable: Bundled with Procedure $269.85 $616.80 $269.85 "$1,219.74 " H PLATE 6 HOLES 115.102.06 C1713 SUPPLY/IMPLANTS "$2,521.00 " Outpatient "$1,260.50 " "$1,219.74 " "$1,638.65 " "$1,764.70 " "$1,663.86 " Not Applicable: Bundled with Procedure $882.35 "$2,016.80 " $882.35 "$2,016.80 " HALFPLATE CAUDAL 7MM 8409-2107 C1713 SUPPLY/IMPLANTS "$10,291.00 " Outpatient "$5,145.50 " "$1,219.74 " "$6,689.15 " "$7,203.70 " "$6,792.06 " Not Applicable: Bundled with Procedure "$3,601.85 " "$8,232.80 " "$1,219.74 " "$8,232.80 " HANDLE INSERTER AXSOS 4 MM LOCKING PLATE 702778 C1713 SUPPLY/IMPLANTS "$3,647.00 " Outpatient "$1,823.50 " "$1,219.74 " "$2,370.55 " "$2,552.90 " "$2,407.02 " Not Applicable: Bundled with Procedure "$1,276.45 " "$2,917.60 " "$1,219.74 " "$2,917.60 " HEAD CSST 14MM ADDPLUS OM VBR STRG XPD INSRTR DISP CS 2256-14 C1713 SUPPLY/IMPLANTS "$2,574.00 " Outpatient "$1,287.00 " "$1,219.74 " "$1,673.10 " "$1,801.80 " "$1,698.84 " Not Applicable: Bundled with Procedure $900.90 "$2,059.20 " $900.90 "$2,059.20 " HEAD CSST 16MM STRG XPD INSRTR CS 2256-16 C1713 SUPPLY/IMPLANTS "$2,570.00 " Outpatient "$1,285.00 " "$1,219.74 " "$1,670.50 " "$1,799.00 " "$1,696.20 " Not Applicable: Bundled with Procedure $899.50 "$2,056.00 " $899.50 "$2,056.00 " HEAD FEMORAL V40 BIOLOX DELTA -2.7 MM OFFSET TAPER OD28 MM H 6570-0-328 C1713 SUPPLY/IMPLANTS "$2,770.00 " Outpatient "$1,385.00 " "$1,219.74 " "$1,800.50 " "$1,939.00 " "$1,828.20 " Not Applicable: Bundled with Procedure $969.50 "$2,216.00 " $969.50 "$2,216.00 " HEAD RMR 14MM VFX2 HIP FEM SS SHRT TUBE LOPRFL CUT NS 119300300 C1713 SUPPLY/IMPLANTS "$1,841.00 " Outpatient $920.50 "$1,219.74 " "$1,196.65 " "$1,288.70 " "$1,215.06 " Not Applicable: Bundled with Procedure $644.35 "$1,472.80 " $644.35 "$1,472.80 " HEAD RMR FEM IMPCT NTR NL 249003202 C1713 SUPPLY/IMPLANTS "$2,838.00 " Outpatient "$1,419.00 " "$1,219.74 " "$1,844.70 " "$1,986.60 " "$1,873.08 " Not Applicable: Bundled with Procedure $993.30 "$2,270.40 " $993.30 "$2,270.40 " HEAD SCR CLICKX 3D SPNE PDCL TI POST OPN NS 498.571 C1713 SUPPLY/IMPLANTS "$2,920.00 " Outpatient "$1,460.00 " "$1,219.74 " "$1,898.00 " "$2,044.00 " "$1,927.20 " Not Applicable: Bundled with Procedure "$1,022.00 " "$2,336.00 " "$1,022.00 " "$2,336.00 " HEAD SCR TI CNDYL NS 04.449.000 C1713 SUPPLY/IMPLANTS "$13,856.00 " Outpatient "$6,928.00 " "$1,219.74 " "$9,006.40 " "$9,699.20 " "$9,144.96 " Not Applicable: Bundled with Procedure "$4,849.60 " "$11,084.80 " "$1,219.74 " "$11,084.80 " HEADLESS SCREW 2.5 X 20MM AR-8725-20 C1713 SUPPLY/IMPLANTS "$1,998.00 " Outpatient $999.00 "$1,219.74 " "$1,298.70 " "$1,398.60 " "$1,318.68 " Not Applicable: Bundled with Procedure $699.30 "$1,598.40 " $699.30 "$1,598.40 " HERBERT BONE SCREW 22MM 47-1154-022 C1713 SUPPLY/IMPLANTS "$2,046.00 " Outpatient "$1,023.00 " "$1,219.74 " "$1,329.90 " "$1,432.20 " "$1,350.36 " Not Applicable: Bundled with Procedure $716.10 "$1,636.80 " $716.10 "$1,636.80 " HERBERT BONE SCREW 18MM 47-1154-018 C1713 SUPPLY/IMPLANTS "$1,763.00 " Outpatient $881.50 "$1,219.74 " "$1,145.95 " "$1,234.10 " "$1,163.58 " Not Applicable: Bundled with Procedure $617.05 "$1,410.40 " $617.05 "$1,410.40 " HFN AR SCREW 50MM STER 8145-01-050 C1713 SUPPLY/IMPLANTS "$1,562.00 " Outpatient $781.00 "$1,219.74 " "$1,015.30 " "$1,093.40 " "$1,030.92 " Not Applicable: Bundled with Procedure $546.70 "$1,249.60 " $546.70 "$1,249.60 " HFN AR SCREW 55MM STER 8145-01-055 C1713 SUPPLY/IMPLANTS "$1,562.00 " Outpatient $781.00 "$1,219.74 " "$1,015.30 " "$1,093.40 " "$1,030.92 " Not Applicable: Bundled with Procedure $546.70 "$1,249.60 " $546.70 "$1,249.60 " HFN LT 125 DEG 9X260MM STER 8144-09-260 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN LT 125 DEG 9X280MM STER 8144-09-280 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN LT 125 DEG 9X300MM STER 8144-09-300 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN LT 125 DEG 9X360MM STER 8144-09-360 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN LT 125 DEG 9X380MM STER 8144-09-380 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN LT 125 DEG 9X420MM STER 8144-09-420 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN LT 125 DEG 9X440MM STER 8144-09-440 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN LT 125 DEG 9X460MM STER 8144-09-460 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN LT 125 DEG 13X260MM STER 8144-13-260 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN LT 125 DEG 13X280MM STER 8144-13-280 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN LT 125 DEG 13X300MM STER 8144-13-300 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN LT 125 DEG 13X320MM STER 8144-13-320 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN LT 125 DEG 13X340MM STER 8144-13-340 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN LT 125 DEG 13X460MM STER 8144-13-460 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN RT 125 DEG 9X280MM STER 8143-09-280 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN RT 125 DEG 9X300MM STER 8143-09-300 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN RT 125 DEG 9X320MM STER 8143-09-320 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN RT 125 DEG 9X380MM STER 8143-09-380 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN RT 125 DEG 9X440MM STER 8143-09-440 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN RT 125 DEG 13X260MM STER 8143-13-260 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN RT 125 DEG 13X280MM STER 8143-13-280 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN RT 125 DEG 13X300MM STER 8143-13-300 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN RT 125 DEG 13X320MM STER 8143-13-320 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN RT 125 DEG 13X400MM STER 8143-13-400 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HFN RT 125 DEG 13X460MM STER 8143-13-460 C1713 SUPPLY/IMPLANTS "$11,984.00 " Outpatient "$5,992.00 " "$1,219.74 " "$7,789.60 " "$8,388.80 " "$7,909.44 " Not Applicable: Bundled with Procedure "$4,194.40 " "$9,587.20 " "$1,219.74 " "$9,587.20 " HINGE PIN AR-13423-03 C1713 SUPPLY/IMPLANTS "$1,473.00 " Outpatient $736.50 "$1,219.74 " $957.45 "$1,031.10 " $972.18 Not Applicable: Bundled with Procedure $515.55 "$1,178.40 " $515.55 "$1,219.74 " HLDR IMPL A FSHR AL 2 PIN STRL FA-10360 C1713 SUPPLY/IMPLANTS "$2,080.00 " Outpatient "$1,040.00 " "$1,219.74 " "$1,352.00 " "$1,456.00 " "$1,372.80 " Not Applicable: Bundled with Procedure $728.00 "$1,664.00 " $728.00 "$1,664.00 " HLDR IMPL PLT THRD F3 FRAG SYS 2312-07-012 C1713 SUPPLY/IMPLANTS "$2,685.00 " Outpatient "$1,342.50 " "$1,219.74 " "$1,745.25 " "$1,879.50 " "$1,772.10 " Not Applicable: Bundled with Procedure $939.75 "$2,148.00 " $939.75 "$2,148.00 " HLDR IMPL A FSHR 3 PIN FA-10365 C1713 SUPPLY/IMPLANTS "$2,701.00 " Outpatient "$1,350.50 " "$1,219.74 " "$1,755.65 " "$1,890.70 " "$1,782.66 " Not Applicable: Bundled with Procedure $945.35 "$2,160.80 " $945.35 "$2,160.80 " HLDR IMPL MATRIXNEURO SHRT MN PLT NS 03.503.032 C1713 SUPPLY/IMPLANTS "$1,846.00 " Outpatient $923.00 "$1,219.74 " "$1,199.90 " "$1,292.20 " "$1,218.36 " Not Applicable: Bundled with Procedure $646.10 "$1,476.80 " $646.10 "$1,476.80 " HLDR IMPL 40MM CRNL TI MNT PIN NS 390.122 C1713 SUPPLY/IMPLANTS "$1,204.00 " Outpatient $602.00 "$1,219.74 " $782.60 $842.80 $794.64 Not Applicable: Bundled with Procedure $421.40 $963.20 $421.40 "$1,219.74 " HLDR IMPL 40MM MDFC TI MNT PIN 390.126 C1713 SUPPLY/IMPLANTS "$1,358.00 " Outpatient $679.00 "$1,219.74 " $882.70 $950.60 $896.28 Not Applicable: Bundled with Procedure $475.30 "$1,086.40 " $475.30 "$1,219.74 " HLDR PLT LNG NS 03.503.034 C1713 SUPPLY/IMPLANTS "$2,121.00 " Outpatient "$1,060.50 " "$1,219.74 " "$1,378.65 " "$1,484.70 " "$1,399.86 " Not Applicable: Bundled with Procedure $742.35 "$1,696.80 " $742.35 "$1,696.80 " HLDR SCR 95MM NCB HEX SS LCK 3.5MM SCRDRVR NS 200024121 C1713 SUPPLY/IMPLANTS "$2,114.00 " Outpatient "$1,057.00 " "$1,219.74 " "$1,374.10 " "$1,479.80 " "$1,395.24 " Not Applicable: Bundled with Procedure $739.90 "$1,691.20 " $739.90 "$1,691.20 " HLDR WRE VERSANAIL THDL GRPR GW GRPR GN AFFIXUS HIP FX NL 2810-01-002 C1713 SUPPLY/IMPLANTS "$5,601.00 " Outpatient "$2,800.50 " "$1,219.74 " "$3,640.65 " "$3,920.70 " "$3,696.66 " Not Applicable: Bundled with Procedure "$1,960.35 " "$4,480.80 " "$1,219.74 " "$4,480.80 " HLF PN 25X80X20 BR SLFDRL 520402520 C1713 SUPPLY/IMPLANTS $884.00 Outpatient $442.00 "$1,219.74 " $574.60 $618.80 $583.44 Not Applicable: Bundled with Procedure $309.40 $707.20 $309.40 "$1,219.74 " HLF PN 25X120X25 BR SLF DRL 520402525 C1713 SUPPLY/IMPLANTS $884.00 Outpatient $442.00 "$1,219.74 " $574.60 $618.80 $583.44 Not Applicable: Bundled with Procedure $309.40 $707.20 $309.40 "$1,219.74 " HLF PN 3X120X25 BR SLF DRL 520403024 C1713 SUPPLY/IMPLANTS $884.00 Outpatient $442.00 "$1,219.74 " $574.60 $618.80 $583.44 Not Applicable: Bundled with Procedure $309.40 $707.20 $309.40 "$1,219.74 " HLF PN 4X80X20 BR SLF DRL 520404019 C1713 SUPPLY/IMPLANTS $884.00 Outpatient $442.00 "$1,219.74 " $574.60 $618.80 $583.44 Not Applicable: Bundled with Procedure $309.40 $707.20 $309.40 "$1,219.74 " HLF PN 25X80X20 BRN BLNT TIP 521402520 C1713 SUPPLY/IMPLANTS $884.00 Outpatient $442.00 "$1,219.74 " $574.60 $618.80 $583.44 Not Applicable: Bundled with Procedure $309.40 $707.20 $309.40 "$1,219.74 " HLF PN 25X12X25 BRN BLNT TIP 521402525 C1713 SUPPLY/IMPLANTS $884.00 Outpatient $442.00 "$1,219.74 " $574.60 $618.80 $583.44 Not Applicable: Bundled with Procedure $309.40 $707.20 $309.40 "$1,219.74 " HLF PN 30X80X20 BRN BLNT TIP 521403020 C1713 SUPPLY/IMPLANTS $884.00 Outpatient $442.00 "$1,219.74 " $574.60 $618.80 $583.44 Not Applicable: Bundled with Procedure $309.40 $707.20 $309.40 "$1,219.74 " HLF PN 30X120X25 BRN BLNT TIP 521403025 C1713 SUPPLY/IMPLANTS $884.00 Outpatient $442.00 "$1,219.74 " $574.60 $618.80 $583.44 Not Applicable: Bundled with Procedure $309.40 $707.20 $309.40 "$1,219.74 " HLF PN 4X80X120 BLNT TIP 521404020 C1713 SUPPLY/IMPLANTS $884.00 Outpatient $442.00 "$1,219.74 " $574.60 $618.80 $583.44 Not Applicable: Bundled with Procedure $309.40 $707.20 $309.40 "$1,219.74 " HLF PN 25X120X25 BRN BLNT TIP 521404025 C1713 SUPPLY/IMPLANTS $884.00 Outpatient $442.00 "$1,219.74 " $574.60 $618.80 $583.44 Not Applicable: Bundled with Procedure $309.40 $707.20 $309.40 "$1,219.74 " HNG XTRNFX DFS ANG KN LT KT STD FXTR SYS NS LF DISP 90110 C1713 SUPPLY/IMPLANTS "$32,005.00 " Outpatient "$16,002.50 " "$1,219.74 " "$20,803.25 " "$22,403.50 " "$21,123.30 " Not Applicable: Bundled with Procedure "$11,201.75 " "$25,604.00 " "$1,219.74 " "$25,604.00 " HOOK SPNL PEAK FX 214202014 C1713 SUPPLY/IMPLANTS $889.00 Outpatient $444.50 "$1,219.74 " $577.85 $622.30 $586.74 Not Applicable: Bundled with Procedure $311.15 $711.20 $311.15 "$1,219.74 " HOOK SPNL 9.5MM OPN THROATED 5.5MM LMR THORLMBR 2127 C1713 SUPPLY/IMPLANTS "$3,937.00 " Outpatient "$1,968.50 " "$1,219.74 " "$2,559.05 " "$2,755.90 " "$2,598.42 " Not Applicable: Bundled with Procedure "$1,377.95 " "$3,149.60 " "$1,219.74 " "$3,149.60 " HOOK SPNL CLS SNG TI LT OFST 4MM THORLMBR 6.35MM ROD 6250 C1713 SUPPLY/IMPLANTS "$5,492.00 " Outpatient "$2,746.00 " "$1,219.74 " "$3,569.80 " "$3,844.40 " "$3,624.72 " Not Applicable: Bundled with Procedure "$1,922.20 " "$4,393.60 " "$1,219.74 " "$4,393.60 " HUMELOCK K-WIRE 2.0MM L.220MM 451-0017 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " IFIX INTERFERENCE SCR 7X25MM CM1725 C1713 SUPPLY/IMPLANTS $806.00 Outpatient $403.00 "$1,219.74 " $523.90 $564.20 $531.96 Not Applicable: Bundled with Procedure $282.10 $644.80 $282.10 "$1,219.74 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.533 C1713 SUPPLY/IMPLANTS "$52,381.00 " Outpatient "$26,190.50 " "$1,219.74 " "$34,047.65 " "$36,666.70 " "$34,571.46 " Not Applicable: Bundled with Procedure "$18,333.35 " "$41,904.80 " "$1,219.74 " "$41,904.80 " IMPL CRNL TI PTSPC NS SD420.401 C1713 SUPPLY/IMPLANTS "$44,734.00 " Outpatient "$22,367.00 " "$1,219.74 " "$29,077.10 " "$31,313.80 " "$29,524.44 " Not Applicable: Bundled with Procedure "$15,656.90 " "$35,787.20 " "$1,219.74 " "$35,787.20 " IMPL CRNL TI PTSPC NS SD420.402 C1713 SUPPLY/IMPLANTS "$45,260.00 " Outpatient "$22,630.00 " "$1,219.74 " "$29,419.00 " "$31,682.00 " "$29,871.60 " Not Applicable: Bundled with Procedure "$15,841.00 " "$36,208.00 " "$1,219.74 " "$36,208.00 " IMPL CRNL TI PTSPC NS SD420.403 C1713 SUPPLY/IMPLANTS "$45,979.00 " Outpatient "$22,989.50 " "$1,219.74 " "$29,886.35 " "$32,185.30 " "$30,346.14 " Not Applicable: Bundled with Procedure "$16,092.65 " "$36,783.20 " "$1,219.74 " "$36,783.20 " IMPL CRNL TI PTSPC NS SD420.404 C1713 SUPPLY/IMPLANTS "$46,607.00 " Outpatient "$23,303.50 " "$1,219.74 " "$30,294.55 " "$32,624.90 " "$30,760.62 " Not Applicable: Bundled with Procedure "$16,312.45 " "$37,285.60 " "$1,219.74 " "$37,285.60 " IMPL CRNL TI PTSPC NS SD420.405 C1713 SUPPLY/IMPLANTS "$47,314.00 " Outpatient "$23,657.00 " "$1,219.74 " "$30,754.10 " "$33,119.80 " "$31,227.24 " Not Applicable: Bundled with Procedure "$16,559.90 " "$37,851.20 " "$1,219.74 " "$37,851.20 " IMPL CRNL TI PTSPC NS SD420.406 C1713 SUPPLY/IMPLANTS "$48,041.00 " Outpatient "$24,020.50 " "$1,219.74 " "$31,226.65 " "$33,628.70 " "$31,707.06 " Not Applicable: Bundled with Procedure "$16,814.35 " "$38,432.80 " "$1,219.74 " "$38,432.80 " IMPL CRNL TI PTSPC NS SD420.407 C1713 SUPPLY/IMPLANTS "$49,409.00 " Outpatient "$24,704.50 " "$1,219.74 " "$32,115.85 " "$34,586.30 " "$32,609.94 " Not Applicable: Bundled with Procedure "$17,293.15 " "$39,527.20 " "$1,219.74 " "$39,527.20 " IMPL CRNL TI PTSPC NS SD420.408 C1713 SUPPLY/IMPLANTS "$50,232.00 " Outpatient "$25,116.00 " "$1,219.74 " "$32,650.80 " "$35,162.40 " "$33,153.12 " Not Applicable: Bundled with Procedure "$17,581.20 " "$40,185.60 " "$1,219.74 " "$40,185.60 " IMPL CRNL TI PTSPC NS SD420.409 C1713 SUPPLY/IMPLANTS "$51,078.00 " Outpatient "$25,539.00 " "$1,219.74 " "$33,200.70 " "$35,754.60 " "$33,711.48 " Not Applicable: Bundled with Procedure "$17,877.30 " "$40,862.40 " "$1,219.74 " "$40,862.40 " IMPL CRNL TI PTSPC NS SD420.410 C1713 SUPPLY/IMPLANTS "$46,229.00 " Outpatient "$23,114.50 " "$1,219.74 " "$30,048.85 " "$32,360.30 " "$30,511.14 " Not Applicable: Bundled with Procedure "$16,180.15 " "$36,983.20 " "$1,219.74 " "$36,983.20 " IMPL CRNL TI PTSPC NS SD420.411 C1713 SUPPLY/IMPLANTS "$47,399.00 " Outpatient "$23,699.50 " "$1,219.74 " "$30,809.35 " "$33,179.30 " "$31,283.34 " Not Applicable: Bundled with Procedure "$16,589.65 " "$37,919.20 " "$1,219.74 " "$37,919.20 " IMPL CRNL TI PTSPC NS SD420.412 C1713 SUPPLY/IMPLANTS "$48,468.00 " Outpatient "$24,234.00 " "$1,219.74 " "$31,504.20 " "$33,927.60 " "$31,988.88 " Not Applicable: Bundled with Procedure "$16,963.80 " "$38,774.40 " "$1,219.74 " "$38,774.40 " IMPL CRNL TI PTSPC NS SD420.413 C1713 SUPPLY/IMPLANTS "$49,586.00 " Outpatient "$24,793.00 " "$1,219.74 " "$32,230.90 " "$34,710.20 " "$32,726.76 " Not Applicable: Bundled with Procedure "$17,355.10 " "$39,668.80 " "$1,219.74 " "$39,668.80 " IMPL CRNL TI PTSPC NS SD420.414 C1713 SUPPLY/IMPLANTS "$50,786.00 " Outpatient "$25,393.00 " "$1,219.74 " "$33,010.90 " "$35,550.20 " "$33,518.76 " Not Applicable: Bundled with Procedure "$17,775.10 " "$40,628.80 " "$1,219.74 " "$40,628.80 " IMPL CRNL TI PTSPC NS SD420.415 C1713 SUPPLY/IMPLANTS "$52,862.00 " Outpatient "$26,431.00 " "$1,219.74 " "$34,360.30 " "$37,003.40 " "$34,888.92 " Not Applicable: Bundled with Procedure "$18,501.70 " "$42,289.60 " "$1,219.74 " "$42,289.60 " IMPL CRNL TI PTSPC NS SD420.416 C1713 SUPPLY/IMPLANTS "$54,226.00 " Outpatient "$27,113.00 " "$1,219.74 " "$35,246.90 " "$37,958.20 " "$35,789.16 " Not Applicable: Bundled with Procedure "$18,979.10 " "$43,380.80 " "$1,219.74 " "$43,380.80 " IMPL CRNL TI PTSPC NS SD420.417 C1713 SUPPLY/IMPLANTS "$55,612.00 " Outpatient "$27,806.00 " "$1,219.74 " "$36,147.80 " "$38,928.40 " "$36,703.92 " Not Applicable: Bundled with Procedure "$19,464.20 " "$44,489.60 " "$1,219.74 " "$44,489.60 " IMPL CRNL TI PTSPC NS SD420.419 C1713 SUPPLY/IMPLANTS "$48,995.00 " Outpatient "$24,497.50 " "$1,219.74 " "$31,846.75 " "$34,296.50 " "$32,336.70 " Not Applicable: Bundled with Procedure "$17,148.25 " "$39,196.00 " "$1,219.74 " "$39,196.00 " IMPL CRNL TI PTSPC NS SD420.420 C1713 SUPPLY/IMPLANTS "$50,543.00 " Outpatient "$25,271.50 " "$1,219.74 " "$32,852.95 " "$35,380.10 " "$33,358.38 " Not Applicable: Bundled with Procedure "$17,690.05 " "$40,434.40 " "$1,219.74 " "$40,434.40 " IMPL CRNL TI PTSPC NS SD420.421 C1713 SUPPLY/IMPLANTS "$52,160.00 " Outpatient "$26,080.00 " "$1,219.74 " "$33,904.00 " "$36,512.00 " "$34,425.60 " Not Applicable: Bundled with Procedure "$18,256.00 " "$41,728.00 " "$1,219.74 " "$41,728.00 " IMPL CRNL TI PTSPC NS SD420.422 C1713 SUPPLY/IMPLANTS "$53,856.00 " Outpatient "$26,928.00 " "$1,219.74 " "$35,006.40 " "$37,699.20 " "$35,544.96 " Not Applicable: Bundled with Procedure "$18,849.60 " "$43,084.80 " "$1,219.74 " "$43,084.80 " IMPL CRNL TI PTSPC NS SD420.423 C1713 SUPPLY/IMPLANTS "$56,710.00 " Outpatient "$28,355.00 " "$1,219.74 " "$36,861.50 " "$39,697.00 " "$37,428.60 " Not Applicable: Bundled with Procedure "$19,848.50 " "$45,368.00 " "$1,219.74 " "$45,368.00 " IMPL CRNL TI PTSPC NS SD420.424 C1713 SUPPLY/IMPLANTS "$58,643.00 " Outpatient "$29,321.50 " "$1,219.74 " "$38,117.95 " "$41,050.10 " "$38,704.38 " Not Applicable: Bundled with Procedure "$20,525.05 " "$46,914.40 " "$1,219.74 " "$46,914.40 " IMPL CRNL TI PTSPC NS SD420.425 C1713 SUPPLY/IMPLANTS "$60,618.00 " Outpatient "$30,309.00 " "$1,219.74 " "$39,401.70 " "$42,432.60 " "$40,007.88 " Not Applicable: Bundled with Procedure "$21,216.30 " "$48,494.40 " "$1,219.74 " "$48,494.40 " IMPL CRNL TI PTSPC NS SD420.426 C1713 SUPPLY/IMPLANTS "$50,821.00 " Outpatient "$25,410.50 " "$1,219.74 " "$33,033.65 " "$35,574.70 " "$33,541.86 " Not Applicable: Bundled with Procedure "$17,787.35 " "$40,656.80 " "$1,219.74 " "$40,656.80 " IMPL CRNL TI PTSPC NS LF SD420.427 C1713 SUPPLY/IMPLANTS "$52,801.00 " Outpatient "$26,400.50 " "$1,219.74 " "$34,320.65 " "$36,960.70 " "$34,848.66 " Not Applicable: Bundled with Procedure "$18,480.35 " "$42,240.80 " "$1,219.74 " "$42,240.80 " IMPL CRNL TI PTSPC NS SD420.428 C1713 SUPPLY/IMPLANTS "$54,931.00 " Outpatient "$27,465.50 " "$1,219.74 " "$35,705.15 " "$38,451.70 " "$36,254.46 " Not Applicable: Bundled with Procedure "$19,225.85 " "$43,944.80 " "$1,219.74 " "$43,944.80 " IMPL CRNL TI PTSPC NS SD420.429 C1713 SUPPLY/IMPLANTS "$57,206.00 " Outpatient "$28,603.00 " "$1,219.74 " "$37,183.90 " "$40,044.20 " "$37,755.96 " Not Applicable: Bundled with Procedure "$20,022.10 " "$45,764.80 " "$1,219.74 " "$45,764.80 " IMPL CRNL TI PTSPC NS SD420.430 C1713 SUPPLY/IMPLANTS "$60,824.00 " Outpatient "$30,412.00 " "$1,219.74 " "$39,535.60 " "$42,576.80 " "$40,143.84 " Not Applicable: Bundled with Procedure "$21,288.40 " "$48,659.20 " "$1,219.74 " "$48,659.20 " IMPL CRNL TI PTSPC NS SD420.431 C1713 SUPPLY/IMPLANTS "$63,368.00 " Outpatient "$31,684.00 " "$1,219.74 " "$41,189.20 " "$44,357.60 " "$41,822.88 " Not Applicable: Bundled with Procedure "$22,178.80 " "$50,694.40 " "$1,219.74 " "$50,694.40 " IMPL CRNL TI PTSPC NS SD420.432 C1713 SUPPLY/IMPLANTS "$65,964.00 " Outpatient "$32,982.00 " "$1,219.74 " "$42,876.60 " "$46,174.80 " "$43,536.24 " Not Applicable: Bundled with Procedure "$23,087.40 " "$52,771.20 " "$1,219.74 " "$52,771.20 " IMPL CRNL TI PTSPC NS SD420.433 C1713 SUPPLY/IMPLANTS "$55,259.00 " Outpatient "$27,629.50 " "$1,219.74 " "$35,918.35 " "$38,681.30 " "$36,470.94 " Not Applicable: Bundled with Procedure "$19,340.65 " "$44,207.20 " "$1,219.74 " "$44,207.20 " IMPL CRNL TI PTSPC NS SD420.435 C1713 SUPPLY/IMPLANTS "$60,783.00 " Outpatient "$30,391.50 " "$1,219.74 " "$39,508.95 " "$42,548.10 " "$40,116.78 " Not Applicable: Bundled with Procedure "$21,274.05 " "$48,626.40 " "$1,219.74 " "$48,626.40 " IMPL CRNL TI PTSPC NS SD420.436 C1713 SUPPLY/IMPLANTS "$65,194.00 " Outpatient "$32,597.00 " "$1,219.74 " "$42,376.10 " "$45,635.80 " "$43,028.04 " Not Applicable: Bundled with Procedure "$22,817.90 " "$52,155.20 " "$1,219.74 " "$52,155.20 " IMPL CRNL TI PTSPC NS SD420.437 C1713 SUPPLY/IMPLANTS "$68,357.00 " Outpatient "$34,178.50 " "$1,219.74 " "$44,432.05 " "$47,849.90 " "$45,115.62 " Not Applicable: Bundled with Procedure "$23,924.95 " "$54,685.60 " "$1,219.74 " "$54,685.60 " IMPL CRNL TI PTSPC NS SD420.438 C1713 SUPPLY/IMPLANTS "$71,545.00 " Outpatient "$35,772.50 " "$1,219.74 " "$46,504.25 " "$50,081.50 " "$47,219.70 " Not Applicable: Bundled with Procedure "$25,040.75 " "$57,236.00 " "$1,219.74 " "$57,236.00 " IMPL CRNL TI PTSPC NS SD420.439 C1713 SUPPLY/IMPLANTS "$61,108.00 " Outpatient "$30,554.00 " "$1,219.74 " "$39,720.20 " "$42,775.60 " "$40,331.28 " Not Applicable: Bundled with Procedure "$21,387.80 " "$48,886.40 " "$1,219.74 " "$48,886.40 " IMPL CRNL TI PTSPC NS SD420.440 C1713 SUPPLY/IMPLANTS "$64,551.00 " Outpatient "$32,275.50 " "$1,219.74 " "$41,958.15 " "$45,185.70 " "$42,603.66 " Not Applicable: Bundled with Procedure "$22,592.85 " "$51,640.80 " "$1,219.74 " "$51,640.80 " IMPL CRNL TI PTSPC NS SD420.441 C1713 SUPPLY/IMPLANTS "$69,705.00 " Outpatient "$34,852.50 " "$1,219.74 " "$45,308.25 " "$48,793.50 " "$46,005.30 " Not Applicable: Bundled with Procedure "$24,396.75 " "$55,764.00 " "$1,219.74 " "$55,764.00 " IMPL CRNL TI PTSPC NS SD420.442 C1713 SUPPLY/IMPLANTS "$73,479.00 " Outpatient "$36,739.50 " "$1,219.74 " "$47,761.35 " "$51,435.30 " "$48,496.14 " Not Applicable: Bundled with Procedure "$25,717.65 " "$58,783.20 " "$1,219.74 " "$58,783.20 " IMPL CRNL TI PTSPC NS SD420.443 C1713 SUPPLY/IMPLANTS "$77,352.00 " Outpatient "$38,676.00 " "$1,219.74 " "$50,278.80 " "$54,146.40 " "$51,052.32 " Not Applicable: Bundled with Procedure "$27,073.20 " "$61,881.60 " "$1,219.74 " "$61,881.60 " IMPL CRNL TI PTSPC NS SD420.444 C1713 SUPPLY/IMPLANTS "$68,448.00 " Outpatient "$34,224.00 " "$1,219.74 " "$44,491.20 " "$47,913.60 " "$45,175.68 " Not Applicable: Bundled with Procedure "$23,956.80 " "$54,758.40 " "$1,219.74 " "$54,758.40 " IMPL CRNL TI PTSPC NS SD420.445 C1713 SUPPLY/IMPLANTS "$74,318.00 " Outpatient "$37,159.00 " "$1,219.74 " "$48,306.70 " "$52,022.60 " "$49,049.88 " Not Applicable: Bundled with Procedure "$26,011.30 " "$59,454.40 " "$1,219.74 " "$59,454.40 " IMPL CRNL TI PTSPC NS SD420.446 C1713 SUPPLY/IMPLANTS "$78,777.00 " Outpatient "$39,388.50 " "$1,219.74 " "$51,205.05 " "$55,143.90 " "$51,992.82 " Not Applicable: Bundled with Procedure "$27,571.95 " "$63,021.60 " "$1,219.74 " "$63,021.60 " IMPL CRNL TI PTSPC NS SD420.447 C1713 SUPPLY/IMPLANTS "$83,305.00 " Outpatient "$41,652.50 " "$1,219.74 " "$54,148.25 " "$58,313.50 " "$54,981.30 " Not Applicable: Bundled with Procedure "$29,156.75 " "$66,644.00 " "$1,219.74 " "$66,644.00 " IMPL CRNL TI PTSPC NS SD420.448 C1713 SUPPLY/IMPLANTS "$79,129.00 " Outpatient "$39,564.50 " "$1,219.74 " "$51,433.85 " "$55,390.30 " "$52,225.14 " Not Applicable: Bundled with Procedure "$27,695.15 " "$63,303.20 " "$1,219.74 " "$63,303.20 " IMPL CRNL TI PTSPC NS SD420.449 C1713 SUPPLY/IMPLANTS "$84,197.00 " Outpatient "$42,098.50 " "$1,219.74 " "$54,728.05 " "$58,937.90 " "$55,570.02 " Not Applicable: Bundled with Procedure "$29,468.95 " "$67,357.60 " "$1,219.74 " "$67,357.60 " IMPL CRNL TI PTSPC NS SD420.450 C1713 SUPPLY/IMPLANTS "$89,344.00 " Outpatient "$44,672.00 " "$1,219.74 " "$58,073.60 " "$62,540.80 " "$58,967.04 " Not Applicable: Bundled with Procedure "$31,270.40 " "$71,475.20 " "$1,219.74 " "$71,475.20 " IMPL CRNL TI PTSPC NS SD420.451 C1713 SUPPLY/IMPLANTS "$89,715.00 " Outpatient "$44,857.50 " "$1,219.74 " "$58,314.75 " "$62,800.50 " "$59,211.90 " Not Applicable: Bundled with Procedure "$31,400.25 " "$71,772.00 " "$1,219.74 " "$71,772.00 " IMPL CRNL TI PTSPC NS SD420.452 C1713 SUPPLY/IMPLANTS "$95,521.00 " Outpatient "$47,760.50 " "$1,219.74 " "$62,088.65 " "$66,864.70 " "$63,043.86 " Not Applicable: Bundled with Procedure "$33,432.35 " "$76,416.80 " "$1,219.74 " "$76,416.80 " IMPL CRNL TI PTSPC NS SD420.453 C1713 SUPPLY/IMPLANTS "$101,783.00 " Outpatient "$50,891.50 " "$1,219.74 " "$66,158.95 " "$71,248.10 " "$67,176.78 " Not Applicable: Bundled with Procedure "$35,624.05 " "$81,426.40 " "$1,219.74 " "$81,426.40 " IMPL CRNL TI PTSPC NS SD420.501 C1713 SUPPLY/IMPLANTS "$49,960.00 " Outpatient "$24,980.00 " "$1,219.74 " "$32,474.00 " "$34,972.00 " "$32,973.60 " Not Applicable: Bundled with Procedure "$17,486.00 " "$39,968.00 " "$1,219.74 " "$39,968.00 " IMPL CRNL TI PTSPC NS SD420.502 C1713 SUPPLY/IMPLANTS "$50,481.00 " Outpatient "$25,240.50 " "$1,219.74 " "$32,812.65 " "$35,336.70 " "$33,317.46 " Not Applicable: Bundled with Procedure "$17,668.35 " "$40,384.80 " "$1,219.74 " "$40,384.80 " IMPL CRNL TI PTSPC NS SD420.503 C1713 SUPPLY/IMPLANTS "$51,197.00 " Outpatient "$25,598.50 " "$1,219.74 " "$33,278.05 " "$35,837.90 " "$33,790.02 " Not Applicable: Bundled with Procedure "$17,918.95 " "$40,957.60 " "$1,219.74 " "$40,957.60 " IMPL CRNL TI PTSPC NS SD420.504 C1713 SUPPLY/IMPLANTS "$51,829.00 " Outpatient "$25,914.50 " "$1,219.74 " "$33,688.85 " "$36,280.30 " "$34,207.14 " Not Applicable: Bundled with Procedure "$18,140.15 " "$41,463.20 " "$1,219.74 " "$41,463.20 " IMPL CRNL TI PTSPC NS SD420.505 C1713 SUPPLY/IMPLANTS "$52,528.00 " Outpatient "$26,264.00 " "$1,219.74 " "$34,143.20 " "$36,769.60 " "$34,668.48 " Not Applicable: Bundled with Procedure "$18,384.80 " "$42,022.40 " "$1,219.74 " "$42,022.40 " IMPL CRNL TI PTSPC NS SD420.506 C1713 SUPPLY/IMPLANTS "$53,254.00 " Outpatient "$26,627.00 " "$1,219.74 " "$34,615.10 " "$37,277.80 " "$35,147.64 " Not Applicable: Bundled with Procedure "$18,638.90 " "$42,603.20 " "$1,219.74 " "$42,603.20 " IMPL CRNL TI PTSPC NS SD420.507 C1713 SUPPLY/IMPLANTS "$54,626.00 " Outpatient "$27,313.00 " "$1,219.74 " "$35,506.90 " "$38,238.20 " "$36,053.16 " Not Applicable: Bundled with Procedure "$19,119.10 " "$43,700.80 " "$1,219.74 " "$43,700.80 " IMPL CRNL TI PTSPC NS SD420.508 C1713 SUPPLY/IMPLANTS "$55,451.00 " Outpatient "$27,725.50 " "$1,219.74 " "$36,043.15 " "$38,815.70 " "$36,597.66 " Not Applicable: Bundled with Procedure "$19,407.85 " "$44,360.80 " "$1,219.74 " "$44,360.80 " IMPL CRNL TI PTSPC NS SD420.509 C1713 SUPPLY/IMPLANTS "$56,300.00 " Outpatient "$28,150.00 " "$1,219.74 " "$36,595.00 " "$39,410.00 " "$37,158.00 " Not Applicable: Bundled with Procedure "$19,705.00 " "$45,040.00 " "$1,219.74 " "$45,040.00 " IMPL CRNL TI PTSPC NS SD420.510 C1713 SUPPLY/IMPLANTS "$51,445.00 " Outpatient "$25,722.50 " "$1,219.74 " "$33,439.25 " "$36,011.50 " "$33,953.70 " Not Applicable: Bundled with Procedure "$18,005.75 " "$41,156.00 " "$1,219.74 " "$41,156.00 " IMPL CRNL TI PTSPC NS SD420.511 C1713 SUPPLY/IMPLANTS "$52,617.00 " Outpatient "$26,308.50 " "$1,219.74 " "$34,201.05 " "$36,831.90 " "$34,727.22 " Not Applicable: Bundled with Procedure "$18,415.95 " "$42,093.60 " "$1,219.74 " "$42,093.60 " IMPL CRNL TI PTSPC NS SD420.512 C1713 SUPPLY/IMPLANTS "$53,676.00 " Outpatient "$26,838.00 " "$1,219.74 " "$34,889.40 " "$37,573.20 " "$35,426.16 " Not Applicable: Bundled with Procedure "$18,786.60 " "$42,940.80 " "$1,219.74 " "$42,940.80 " IMPL CRNL TI PTSPC NS SD420.513 C1713 SUPPLY/IMPLANTS "$54,793.00 " Outpatient "$27,396.50 " "$1,219.74 " "$35,615.45 " "$38,355.10 " "$36,163.38 " Not Applicable: Bundled with Procedure "$19,177.55 " "$43,834.40 " "$1,219.74 " "$43,834.40 " IMPL CRNL TI PTSPC NS SD420.514 C1713 SUPPLY/IMPLANTS "$55,994.00 " Outpatient "$27,997.00 " "$1,219.74 " "$36,396.10 " "$39,195.80 " "$36,956.04 " Not Applicable: Bundled with Procedure "$19,597.90 " "$44,795.20 " "$1,219.74 " "$44,795.20 " IMPL CRNL TI PTSPC NS SD420.515 C1713 SUPPLY/IMPLANTS "$58,087.00 " Outpatient "$29,043.50 " "$1,219.74 " "$37,756.55 " "$40,660.90 " "$38,337.42 " Not Applicable: Bundled with Procedure "$20,330.45 " "$46,469.60 " "$1,219.74 " "$46,469.60 " IMPL CRNL TI PTSPC NS SD420.516 C1713 SUPPLY/IMPLANTS "$59,451.00 " Outpatient "$29,725.50 " "$1,219.74 " "$38,643.15 " "$41,615.70 " "$39,237.66 " Not Applicable: Bundled with Procedure "$20,807.85 " "$47,560.80 " "$1,219.74 " "$47,560.80 " IMPL CRNL TI PTSPC NS SD420.517 C1713 SUPPLY/IMPLANTS "$60,829.00 " Outpatient "$30,414.50 " "$1,219.74 " "$39,538.85 " "$42,580.30 " "$40,147.14 " Not Applicable: Bundled with Procedure "$21,290.15 " "$48,663.20 " "$1,219.74 " "$48,663.20 " IMPL CRNL TI PTSPC NS SD420.518 C1713 SUPPLY/IMPLANTS "$52,841.00 " Outpatient "$26,420.50 " "$1,219.74 " "$34,346.65 " "$36,988.70 " "$34,875.06 " Not Applicable: Bundled with Procedure "$18,494.35 " "$42,272.80 " "$1,219.74 " "$42,272.80 " IMPL CRNL TI PTSPC NS SD420.519 C1713 SUPPLY/IMPLANTS "$54,208.00 " Outpatient "$27,104.00 " "$1,219.74 " "$35,235.20 " "$37,945.60 " "$35,777.28 " Not Applicable: Bundled with Procedure "$18,972.80 " "$43,366.40 " "$1,219.74 " "$43,366.40 " IMPL CRNL TI PTSPC NS SD420.520 C1713 SUPPLY/IMPLANTS "$55,763.00 " Outpatient "$27,881.50 " "$1,219.74 " "$36,245.95 " "$39,034.10 " "$36,803.58 " Not Applicable: Bundled with Procedure "$19,517.05 " "$44,610.40 " "$1,219.74 " "$44,610.40 " IMPL CRNL TI PTSPC NS SD420.521 C1713 SUPPLY/IMPLANTS "$57,386.00 " Outpatient "$28,693.00 " "$1,219.74 " "$37,300.90 " "$40,170.20 " "$37,874.76 " Not Applicable: Bundled with Procedure "$20,085.10 " "$45,908.80 " "$1,219.74 " "$45,908.80 " IMPL CRNL TI PTSPC NS SD420.522 C1713 SUPPLY/IMPLANTS "$59,081.00 " Outpatient "$29,540.50 " "$1,219.74 " "$38,402.65 " "$41,356.70 " "$38,993.46 " Not Applicable: Bundled with Procedure "$20,678.35 " "$47,264.80 " "$1,219.74 " "$47,264.80 " IMPL CRNL TI PTSPC NS SD420.523 C1713 SUPPLY/IMPLANTS "$61,933.00 " Outpatient "$30,966.50 " "$1,219.74 " "$40,256.45 " "$43,353.10 " "$40,875.78 " Not Applicable: Bundled with Procedure "$21,676.55 " "$49,546.40 " "$1,219.74 " "$49,546.40 " IMPL CRNL TI PTSPC NS SD420.524 C1713 SUPPLY/IMPLANTS "$63,858.00 " Outpatient "$31,929.00 " "$1,219.74 " "$41,507.70 " "$44,700.60 " "$42,146.28 " Not Applicable: Bundled with Procedure "$22,350.30 " "$51,086.40 " "$1,219.74 " "$51,086.40 " IMPL CRNL TI PTSPC NS SD420.525 C1713 SUPPLY/IMPLANTS "$65,834.00 " Outpatient "$32,917.00 " "$1,219.74 " "$42,792.10 " "$46,083.80 " "$43,450.44 " Not Applicable: Bundled with Procedure "$23,041.90 " "$52,667.20 " "$1,219.74 " "$52,667.20 " IMPL CRNL TI PTSPC NS SD420.526 C1713 SUPPLY/IMPLANTS "$56,043.00 " Outpatient "$28,021.50 " "$1,219.74 " "$36,427.95 " "$39,230.10 " "$36,988.38 " Not Applicable: Bundled with Procedure "$19,615.05 " "$44,834.40 " "$1,219.74 " "$44,834.40 " IMPL CRNL TI PTSPC NS SD420.527 C1713 SUPPLY/IMPLANTS "$58,018.00 " Outpatient "$29,009.00 " "$1,219.74 " "$37,711.70 " "$40,612.60 " "$38,291.88 " Not Applicable: Bundled with Procedure "$20,306.30 " "$46,414.40 " "$1,219.74 " "$46,414.40 " IMPL CRNL TI PTSPC NS SD420.528 C1713 SUPPLY/IMPLANTS "$60,152.00 " Outpatient "$30,076.00 " "$1,219.74 " "$39,098.80 " "$42,106.40 " "$39,700.32 " Not Applicable: Bundled with Procedure "$21,053.20 " "$48,121.60 " "$1,219.74 " "$48,121.60 " IMPL CRNL TI PTSPC NS SD420.529 C1713 SUPPLY/IMPLANTS "$62,422.00 " Outpatient "$31,211.00 " "$1,219.74 " "$40,574.30 " "$43,695.40 " "$41,198.52 " Not Applicable: Bundled with Procedure "$21,847.70 " "$49,937.60 " "$1,219.74 " "$49,937.60 " IMPL CRNL TI PTSPC NS SD420.530 C1713 SUPPLY/IMPLANTS "$66,020.00 " Outpatient "$33,010.00 " "$1,219.74 " "$42,913.00 " "$46,214.00 " "$43,573.20 " Not Applicable: Bundled with Procedure "$23,107.00 " "$52,816.00 " "$1,219.74 " "$52,816.00 " IMPL CRNL TI PTSPC NS SD420.531 C1713 SUPPLY/IMPLANTS "$68,580.00 " Outpatient "$34,290.00 " "$1,219.74 " "$44,577.00 " "$48,006.00 " "$45,262.80 " Not Applicable: Bundled with Procedure "$24,003.00 " "$54,864.00 " "$1,219.74 " "$54,864.00 " IMPL CRNL TI PTSPC NS SD420.532 C1713 SUPPLY/IMPLANTS "$71,162.00 " Outpatient "$35,581.00 " "$1,219.74 " "$46,255.30 " "$49,813.40 " "$46,966.92 " Not Applicable: Bundled with Procedure "$24,906.70 " "$56,929.60 " "$1,219.74 " "$56,929.60 " IMPL CRNL TI PTSPC NS SD420.533 C1713 SUPPLY/IMPLANTS "$60,475.00 " Outpatient "$30,237.50 " "$1,219.74 " "$39,308.75 " "$42,332.50 " "$39,913.50 " Not Applicable: Bundled with Procedure "$21,166.25 " "$48,380.00 " "$1,219.74 " "$48,380.00 " IMPL CRNL TI PTSPC NS SD420.534 C1713 SUPPLY/IMPLANTS "$63,183.00 " Outpatient "$31,591.50 " "$1,219.74 " "$41,068.95 " "$44,228.10 " "$41,700.78 " Not Applicable: Bundled with Procedure "$22,114.05 " "$50,546.40 " "$1,219.74 " "$50,546.40 " IMPL CRNL TI PTSPC NS SD420.535 C1713 SUPPLY/IMPLANTS "$65,998.00 " Outpatient "$32,999.00 " "$1,219.74 " "$42,898.70 " "$46,198.60 " "$43,558.68 " Not Applicable: Bundled with Procedure "$23,099.30 " "$52,798.40 " "$1,219.74 " "$52,798.40 " IMPL CRNL TI PTSPC NS SD420.536 C1713 SUPPLY/IMPLANTS "$70,398.00 " Outpatient "$35,199.00 " "$1,219.74 " "$45,758.70 " "$49,278.60 " "$46,462.68 " Not Applicable: Bundled with Procedure "$24,639.30 " "$56,318.40 " "$1,219.74 " "$56,318.40 " IMPL CRNL TI PTSPC NS SD420.537 C1713 SUPPLY/IMPLANTS "$73,568.00 " Outpatient "$36,784.00 " "$1,219.74 " "$47,819.20 " "$51,497.60 " "$48,554.88 " Not Applicable: Bundled with Procedure "$25,748.80 " "$58,854.40 " "$1,219.74 " "$58,854.40 " IMPL CRNL TI PTSPC NS SD420.538 C1713 SUPPLY/IMPLANTS "$76,745.00 " Outpatient "$38,372.50 " "$1,219.74 " "$49,884.25 " "$53,721.50 " "$50,651.70 " Not Applicable: Bundled with Procedure "$26,860.75 " "$61,396.00 " "$1,219.74 " "$61,396.00 " IMPL CRNL TI PTSPC NS SD420.539 C1713 SUPPLY/IMPLANTS "$66,321.00 " Outpatient "$33,160.50 " "$1,219.74 " "$43,108.65 " "$46,424.70 " "$43,771.86 " Not Applicable: Bundled with Procedure "$23,212.35 " "$53,056.80 " "$1,219.74 " "$53,056.80 " IMPL CRNL TI CSTM PTSPC NS SD420.540 C1713 SUPPLY/IMPLANTS "$69,769.00 " Outpatient "$34,884.50 " "$1,219.74 " "$45,349.85 " "$48,838.30 " "$46,047.54 " Not Applicable: Bundled with Procedure "$24,419.15 " "$55,815.20 " "$1,219.74 " "$55,815.20 " IMPL CRNL TI PTSPC NS SD420.541 C1713 SUPPLY/IMPLANTS "$74,921.00 " Outpatient "$37,460.50 " "$1,219.74 " "$48,698.65 " "$52,444.70 " "$49,447.86 " Not Applicable: Bundled with Procedure "$26,222.35 " "$59,936.80 " "$1,219.74 " "$59,936.80 " IMPL CRNL TI PTSPC NS SD420.542 C1713 SUPPLY/IMPLANTS "$78,690.00 " Outpatient "$39,345.00 " "$1,219.74 " "$51,148.50 " "$55,083.00 " "$51,935.40 " Not Applicable: Bundled with Procedure "$27,541.50 " "$62,952.00 " "$1,219.74 " "$62,952.00 " IMPL CRNL TI PTSPC NS SD420.543 C1713 SUPPLY/IMPLANTS "$82,574.00 " Outpatient "$41,287.00 " "$1,219.74 " "$53,673.10 " "$57,801.80 " "$54,498.84 " Not Applicable: Bundled with Procedure "$28,900.90 " "$66,059.20 " "$1,219.74 " "$66,059.20 " IMPL CRNL TI PTSPC NS SD420.544 C1713 SUPPLY/IMPLANTS "$73,659.00 " Outpatient "$36,829.50 " "$1,219.74 " "$47,878.35 " "$51,561.30 " "$48,614.94 " Not Applicable: Bundled with Procedure "$25,780.65 " "$58,927.20 " "$1,219.74 " "$58,927.20 " IMPL CRNL TI PTSPC NS SD420.545 C1713 SUPPLY/IMPLANTS "$79,542.00 " Outpatient "$39,771.00 " "$1,219.74 " "$51,702.30 " "$55,679.40 " "$52,497.72 " Not Applicable: Bundled with Procedure "$27,839.70 " "$63,633.60 " "$1,219.74 " "$63,633.60 " IMPL CRNL TI PTSPC NS SD420.546 C1713 SUPPLY/IMPLANTS "$83,994.00 " Outpatient "$41,997.00 " "$1,219.74 " "$54,596.10 " "$58,795.80 " "$55,436.04 " Not Applicable: Bundled with Procedure "$29,397.90 " "$67,195.20 " "$1,219.74 " "$67,195.20 " IMPL CRNL TI PTSPC NS SD420.547 C1713 SUPPLY/IMPLANTS "$88,526.00 " Outpatient "$44,263.00 " "$1,219.74 " "$57,541.90 " "$61,968.20 " "$58,427.16 " Not Applicable: Bundled with Procedure "$30,984.10 " "$70,820.80 " "$1,219.74 " "$70,820.80 " IMPL CRNL TI PTSPC NS SD420.548 C1713 SUPPLY/IMPLANTS "$84,337.00 " Outpatient "$42,168.50 " "$1,219.74 " "$54,819.05 " "$59,035.90 " "$55,662.42 " Not Applicable: Bundled with Procedure "$29,517.95 " "$67,469.60 " "$1,219.74 " "$67,469.60 " IMPL CRNL TI PTSPC NS SD420.549 C1713 SUPPLY/IMPLANTS "$89,422.00 " Outpatient "$44,711.00 " "$1,219.74 " "$58,124.30 " "$62,595.40 " "$59,018.52 " Not Applicable: Bundled with Procedure "$31,297.70 " "$71,537.60 " "$1,219.74 " "$71,537.60 " IMPL CRNL TI PTSPC NS SD420.550 C1713 SUPPLY/IMPLANTS "$94,565.00 " Outpatient "$47,282.50 " "$1,219.74 " "$61,467.25 " "$66,195.50 " "$62,412.90 " Not Applicable: Bundled with Procedure "$33,097.75 " "$75,652.00 " "$1,219.74 " "$75,652.00 " IMPL CRNL TI PTSPC NS SD420.551 C1713 SUPPLY/IMPLANTS "$94,927.00 " Outpatient "$47,463.50 " "$1,219.74 " "$61,702.55 " "$66,448.90 " "$62,651.82 " Not Applicable: Bundled with Procedure "$33,224.45 " "$75,941.60 " "$1,219.74 " "$75,941.60 " IMPL CRNL TI PTSPC NS SD420.552 C1713 SUPPLY/IMPLANTS "$100,734.00 " Outpatient "$50,367.00 " "$1,219.74 " "$65,477.10 " "$70,513.80 " "$66,484.44 " Not Applicable: Bundled with Procedure "$35,256.90 " "$80,587.20 " "$1,219.74 " "$80,587.20 " IMPL CRNL TI PTSPC NS SD420.553 C1713 SUPPLY/IMPLANTS "$107,005.00 " Outpatient "$53,502.50 " "$1,219.74 " "$69,553.25 " "$74,903.50 " "$70,623.30 " Not Applicable: Bundled with Procedure "$37,451.75 " "$85,604.00 " "$1,219.74 " "$85,604.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.401 C1713 SUPPLY/IMPLANTS "$31,900.00 " Outpatient "$15,950.00 " "$1,219.74 " "$20,735.00 " "$22,330.00 " "$21,054.00 " Not Applicable: Bundled with Procedure "$11,165.00 " "$25,520.00 " "$1,219.74 " "$25,520.00 " IMPL CRNL PEEK PTSPC NS LF SD800.402 C1713 SUPPLY/IMPLANTS "$32,870.00 " Outpatient "$16,435.00 " "$1,219.74 " "$21,365.50 " "$23,009.00 " "$21,694.20 " Not Applicable: Bundled with Procedure "$11,504.50 " "$26,296.00 " "$1,219.74 " "$26,296.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.403 C1713 SUPPLY/IMPLANTS "$33,837.00 " Outpatient "$16,918.50 " "$1,219.74 " "$21,994.05 " "$23,685.90 " "$22,332.42 " Not Applicable: Bundled with Procedure "$11,842.95 " "$27,069.60 " "$1,219.74 " "$27,069.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.404 C1713 SUPPLY/IMPLANTS "$34,796.00 " Outpatient "$17,398.00 " "$1,219.74 " "$22,617.40 " "$24,357.20 " "$22,965.36 " Not Applicable: Bundled with Procedure "$12,178.60 " "$27,836.80 " "$1,219.74 " "$27,836.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.405 C1713 SUPPLY/IMPLANTS "$35,386.00 " Outpatient "$17,693.00 " "$1,219.74 " "$23,000.90 " "$24,770.20 " "$23,354.76 " Not Applicable: Bundled with Procedure "$12,385.10 " "$28,308.80 " "$1,219.74 " "$28,308.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.406 C1713 SUPPLY/IMPLANTS "$35,958.00 " Outpatient "$17,979.00 " "$1,219.74 " "$23,372.70 " "$25,170.60 " "$23,732.28 " Not Applicable: Bundled with Procedure "$12,585.30 " "$28,766.40 " "$1,219.74 " "$28,766.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.407 C1713 SUPPLY/IMPLANTS "$36,538.00 " Outpatient "$18,269.00 " "$1,219.74 " "$23,749.70 " "$25,576.60 " "$24,115.08 " Not Applicable: Bundled with Procedure "$12,788.30 " "$29,230.40 " "$1,219.74 " "$29,230.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.408 C1713 SUPPLY/IMPLANTS "$37,122.00 " Outpatient "$18,561.00 " "$1,219.74 " "$24,129.30 " "$25,985.40 " "$24,500.52 " Not Applicable: Bundled with Procedure "$12,992.70 " "$29,697.60 " "$1,219.74 " "$29,697.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.409 C1713 SUPPLY/IMPLANTS "$37,702.00 " Outpatient "$18,851.00 " "$1,219.74 " "$24,506.30 " "$26,391.40 " "$24,883.32 " Not Applicable: Bundled with Procedure "$13,195.70 " "$30,161.60 " "$1,219.74 " "$30,161.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.411 C1713 SUPPLY/IMPLANTS "$36,538.00 " Outpatient "$18,269.00 " "$1,219.74 " "$23,749.70 " "$25,576.60 " "$24,115.08 " Not Applicable: Bundled with Procedure "$12,788.30 " "$29,230.40 " "$1,219.74 " "$29,230.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.412 C1713 SUPPLY/IMPLANTS "$37,702.00 " Outpatient "$18,851.00 " "$1,219.74 " "$24,506.30 " "$26,391.40 " "$24,883.32 " Not Applicable: Bundled with Procedure "$13,195.70 " "$30,161.60 " "$1,219.74 " "$30,161.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.413 C1713 SUPPLY/IMPLANTS "$38,671.00 " Outpatient "$19,335.50 " "$1,219.74 " "$25,136.15 " "$27,069.70 " "$25,522.86 " Not Applicable: Bundled with Procedure "$13,534.85 " "$30,936.80 " "$1,219.74 " "$30,936.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.414 C1713 SUPPLY/IMPLANTS "$39,634.00 " Outpatient "$19,817.00 " "$1,219.74 " "$25,762.10 " "$27,743.80 " "$26,158.44 " Not Applicable: Bundled with Procedure "$13,871.90 " "$31,707.20 " "$1,219.74 " "$31,707.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.415 C1713 SUPPLY/IMPLANTS "$41,571.00 " Outpatient "$20,785.50 " "$1,219.74 " "$27,021.15 " "$29,099.70 " "$27,436.86 " Not Applicable: Bundled with Procedure "$14,549.85 " "$33,256.80 " "$1,219.74 " "$33,256.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.416 C1713 SUPPLY/IMPLANTS "$42,531.00 " Outpatient "$21,265.50 " "$1,219.74 " "$27,645.15 " "$29,771.70 " "$28,070.46 " Not Applicable: Bundled with Procedure "$14,885.85 " "$34,024.80 " "$1,219.74 " "$34,024.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.417 C1713 SUPPLY/IMPLANTS "$43,494.00 " Outpatient "$21,747.00 " "$1,219.74 " "$28,271.10 " "$30,445.80 " "$28,706.04 " Not Applicable: Bundled with Procedure "$15,222.90 " "$34,795.20 " "$1,219.74 " "$34,795.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.418 C1713 SUPPLY/IMPLANTS "$37,122.00 " Outpatient "$18,561.00 " "$1,219.74 " "$24,129.30 " "$25,985.40 " "$24,500.52 " Not Applicable: Bundled with Procedure "$12,992.70 " "$29,697.60 " "$1,219.74 " "$29,697.60 " IMPL CRNL PEEK-OPTM CSTM PTSPC NS SD800.419 C1713 SUPPLY/IMPLANTS "$38,671.00 " Outpatient "$19,335.50 " "$1,219.74 " "$25,136.15 " "$27,069.70 " "$25,522.86 " Not Applicable: Bundled with Procedure "$13,534.85 " "$30,936.80 " "$1,219.74 " "$30,936.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.420 C1713 SUPPLY/IMPLANTS "$40,594.00 " Outpatient "$20,297.00 " "$1,219.74 " "$26,386.10 " "$28,415.80 " "$26,792.04 " Not Applicable: Bundled with Procedure "$14,207.90 " "$32,475.20 " "$1,219.74 " "$32,475.20 " IMPL CRNL PEEK-OPTM CSTM PTSPC NS SD800.421 C1713 SUPPLY/IMPLANTS "$42,531.00 " Outpatient "$21,265.50 " "$1,219.74 " "$27,645.15 " "$29,771.70 " "$28,070.46 " Not Applicable: Bundled with Procedure "$14,885.85 " "$34,024.80 " "$1,219.74 " "$34,024.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.422 C1713 SUPPLY/IMPLANTS "$44,458.00 " Outpatient "$22,229.00 " "$1,219.74 " "$28,897.70 " "$31,120.60 " "$29,342.28 " Not Applicable: Bundled with Procedure "$15,560.30 " "$35,566.40 " "$1,219.74 " "$35,566.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.423 C1713 SUPPLY/IMPLANTS "$45,433.00 " Outpatient "$22,716.50 " "$1,219.74 " "$29,531.45 " "$31,803.10 " "$29,985.78 " Not Applicable: Bundled with Procedure "$15,901.55 " "$36,346.40 " "$1,219.74 " "$36,346.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.424 C1713 SUPPLY/IMPLANTS "$47,364.00 " Outpatient "$23,682.00 " "$1,219.74 " "$30,786.60 " "$33,154.80 " "$31,260.24 " Not Applicable: Bundled with Procedure "$16,577.40 " "$37,891.20 " "$1,219.74 " "$37,891.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.425 C1713 SUPPLY/IMPLANTS "$49,289.00 " Outpatient "$24,644.50 " "$1,219.74 " "$32,037.85 " "$34,502.30 " "$32,530.74 " Not Applicable: Bundled with Procedure "$17,251.15 " "$39,431.20 " "$1,219.74 " "$39,431.20 " IMPL CRNL PEEK NS LF SD800.426 C1713 SUPPLY/IMPLANTS "$41,571.00 " Outpatient "$20,785.50 " "$1,219.74 " "$27,021.15 " "$29,099.70 " "$27,436.86 " Not Applicable: Bundled with Procedure "$14,549.85 " "$33,256.80 " "$1,219.74 " "$33,256.80 " IMPL CRNL PEEK-OPTM CSTM PTSPC NS SD800.427 C1713 SUPPLY/IMPLANTS "$43,494.00 " Outpatient "$21,747.00 " "$1,219.74 " "$28,271.10 " "$30,445.80 " "$28,706.04 " Not Applicable: Bundled with Procedure "$15,222.90 " "$34,795.20 " "$1,219.74 " "$34,795.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.428 C1713 SUPPLY/IMPLANTS "$45,433.00 " Outpatient "$22,716.50 " "$1,219.74 " "$29,531.45 " "$31,803.10 " "$29,985.78 " Not Applicable: Bundled with Procedure "$15,901.55 " "$36,346.40 " "$1,219.74 " "$36,346.40 " IMPL CRNL PEEK-OPTM CSTM PTSPC NS SD800.429 C1713 SUPPLY/IMPLANTS "$48,337.00 " Outpatient "$24,168.50 " "$1,219.74 " "$31,419.05 " "$33,835.90 " "$31,902.42 " Not Applicable: Bundled with Procedure "$16,917.95 " "$38,669.60 " "$1,219.74 " "$38,669.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.430 C1713 SUPPLY/IMPLANTS "$50,739.00 " Outpatient "$25,369.50 " "$1,219.74 " "$32,980.35 " "$35,517.30 " "$33,487.74 " Not Applicable: Bundled with Procedure "$17,758.65 " "$40,591.20 " "$1,219.74 " "$40,591.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.431 C1713 SUPPLY/IMPLANTS "$53,641.00 " Outpatient "$26,820.50 " "$1,219.74 " "$34,866.65 " "$37,548.70 " "$35,403.06 " Not Applicable: Bundled with Procedure "$18,774.35 " "$42,912.80 " "$1,219.74 " "$42,912.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.432 C1713 SUPPLY/IMPLANTS "$55,087.00 " Outpatient "$27,543.50 " "$1,219.74 " "$35,806.55 " "$38,560.90 " "$36,357.42 " Not Applicable: Bundled with Procedure "$19,280.45 " "$44,069.60 " "$1,219.74 " "$44,069.60 " IMPL CRNL PEEK CSTM PTSPC NS SD800.435 C1713 SUPPLY/IMPLANTS "$52,195.00 " Outpatient "$26,097.50 " "$1,219.74 " "$33,926.75 " "$36,536.50 " "$34,448.70 " Not Applicable: Bundled with Procedure "$18,268.25 " "$41,756.00 " "$1,219.74 " "$41,756.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.437 C1713 SUPPLY/IMPLANTS "$57,411.00 " Outpatient "$28,705.50 " "$1,219.74 " "$37,317.15 " "$40,187.70 " "$37,891.26 " Not Applicable: Bundled with Procedure "$20,093.85 " "$45,928.80 " "$1,219.74 " "$45,928.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.438 C1713 SUPPLY/IMPLANTS "$60,897.00 " Outpatient "$30,448.50 " "$1,219.74 " "$39,583.05 " "$42,627.90 " "$40,192.02 " Not Applicable: Bundled with Procedure "$21,313.95 " "$48,717.60 " "$1,219.74 " "$48,717.60 " IMPL CRNL PEEK-OPTM CSTM PTSPC NS SD800.439 C1713 SUPPLY/IMPLANTS "$53,641.00 " Outpatient "$26,820.50 " "$1,219.74 " "$34,866.65 " "$37,548.70 " "$35,403.06 " Not Applicable: Bundled with Procedure "$18,774.35 " "$42,912.80 " "$1,219.74 " "$42,912.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.440 C1713 SUPPLY/IMPLANTS "$56,248.00 " Outpatient "$28,124.00 " "$1,219.74 " "$36,561.20 " "$39,373.60 " "$37,123.68 " Not Applicable: Bundled with Procedure "$19,686.80 " "$44,998.40 " "$1,219.74 " "$44,998.40 " IMPL CRNL PEEK PTSPC NS SD800.441 C1713 SUPPLY/IMPLANTS "$58,574.00 " Outpatient "$29,287.00 " "$1,219.74 " "$38,073.10 " "$41,001.80 " "$38,658.84 " Not Applicable: Bundled with Procedure "$20,500.90 " "$46,859.20 " "$1,219.74 " "$46,859.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.443 C1713 SUPPLY/IMPLANTS "$66,691.00 " Outpatient "$33,345.50 " "$1,219.74 " "$43,349.15 " "$46,683.70 " "$44,016.06 " Not Applicable: Bundled with Procedure "$23,341.85 " "$53,352.80 " "$1,219.74 " "$53,352.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.444 C1713 SUPPLY/IMPLANTS "$59,731.00 " Outpatient "$29,865.50 " "$1,219.74 " "$38,825.15 " "$41,811.70 " "$39,422.46 " Not Applicable: Bundled with Procedure "$20,905.85 " "$47,784.80 " "$1,219.74 " "$47,784.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.445 C1713 SUPPLY/IMPLANTS "$64,759.00 " Outpatient "$32,379.50 " "$1,219.74 " "$42,093.35 " "$45,331.30 " "$42,740.94 " Not Applicable: Bundled with Procedure "$22,665.65 " "$51,807.20 " "$1,219.74 " "$51,807.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.446 C1713 SUPPLY/IMPLANTS "$68,619.00 " Outpatient "$34,309.50 " "$1,219.74 " "$44,602.35 " "$48,033.30 " "$45,288.54 " Not Applicable: Bundled with Procedure "$24,016.65 " "$54,895.20 " "$1,219.74 " "$54,895.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.447 C1713 SUPPLY/IMPLANTS "$72,485.00 " Outpatient "$36,242.50 " "$1,219.74 " "$47,115.25 " "$50,739.50 " "$47,840.10 " Not Applicable: Bundled with Procedure "$25,369.75 " "$57,988.00 " "$1,219.74 " "$57,988.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.448 C1713 SUPPLY/IMPLANTS "$70,555.00 " Outpatient "$35,277.50 " "$1,219.74 " "$45,860.75 " "$49,388.50 " "$46,566.30 " Not Applicable: Bundled with Procedure "$24,694.25 " "$56,444.00 " "$1,219.74 " "$56,444.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.449 C1713 SUPPLY/IMPLANTS "$75,390.00 " Outpatient "$37,695.00 " "$1,219.74 " "$49,003.50 " "$52,773.00 " "$49,757.40 " Not Applicable: Bundled with Procedure "$26,386.50 " "$60,312.00 " "$1,219.74 " "$60,312.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.450 C1713 SUPPLY/IMPLANTS "$78,283.00 " Outpatient "$39,141.50 " "$1,219.74 " "$50,883.95 " "$54,798.10 " "$51,666.78 " Not Applicable: Bundled with Procedure "$27,399.05 " "$62,626.40 " "$1,219.74 " "$62,626.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.451 C1713 SUPPLY/IMPLANTS "$81,184.00 " Outpatient "$40,592.00 " "$1,219.74 " "$52,769.60 " "$56,828.80 " "$53,581.44 " Not Applicable: Bundled with Procedure "$28,414.40 " "$64,947.20 " "$1,219.74 " "$64,947.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.452 C1713 SUPPLY/IMPLANTS "$84,075.00 " Outpatient "$42,037.50 " "$1,219.74 " "$54,648.75 " "$58,852.50 " "$55,489.50 " Not Applicable: Bundled with Procedure "$29,426.25 " "$67,260.00 " "$1,219.74 " "$67,260.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.453 C1713 SUPPLY/IMPLANTS "$89,882.00 " Outpatient "$44,941.00 " "$1,219.74 " "$58,423.30 " "$62,917.40 " "$59,322.12 " Not Applicable: Bundled with Procedure "$31,458.70 " "$71,905.60 " "$1,219.74 " "$71,905.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.454 C1713 SUPPLY/IMPLANTS "$31,900.00 " Outpatient "$15,950.00 " "$1,219.74 " "$20,735.00 " "$22,330.00 " "$21,054.00 " Not Applicable: Bundled with Procedure "$11,165.00 " "$25,520.00 " "$1,219.74 " "$25,520.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.455 C1713 SUPPLY/IMPLANTS "$32,870.00 " Outpatient "$16,435.00 " "$1,219.74 " "$21,365.50 " "$23,009.00 " "$21,694.20 " Not Applicable: Bundled with Procedure "$11,504.50 " "$26,296.00 " "$1,219.74 " "$26,296.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.456 C1713 SUPPLY/IMPLANTS "$33,837.00 " Outpatient "$16,918.50 " "$1,219.74 " "$21,994.05 " "$23,685.90 " "$22,332.42 " Not Applicable: Bundled with Procedure "$11,842.95 " "$27,069.60 " "$1,219.74 " "$27,069.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.457 C1713 SUPPLY/IMPLANTS "$34,796.00 " Outpatient "$17,398.00 " "$1,219.74 " "$22,617.40 " "$24,357.20 " "$22,965.36 " Not Applicable: Bundled with Procedure "$12,178.60 " "$27,836.80 " "$1,219.74 " "$27,836.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.458 C1713 SUPPLY/IMPLANTS "$35,386.00 " Outpatient "$17,693.00 " "$1,219.74 " "$23,000.90 " "$24,770.20 " "$23,354.76 " Not Applicable: Bundled with Procedure "$12,385.10 " "$28,308.80 " "$1,219.74 " "$28,308.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.459 C1713 SUPPLY/IMPLANTS "$35,958.00 " Outpatient "$17,979.00 " "$1,219.74 " "$23,372.70 " "$25,170.60 " "$23,732.28 " Not Applicable: Bundled with Procedure "$12,585.30 " "$28,766.40 " "$1,219.74 " "$28,766.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.460 C1713 SUPPLY/IMPLANTS "$36,538.00 " Outpatient "$18,269.00 " "$1,219.74 " "$23,749.70 " "$25,576.60 " "$24,115.08 " Not Applicable: Bundled with Procedure "$12,788.30 " "$29,230.40 " "$1,219.74 " "$29,230.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.461 C1713 SUPPLY/IMPLANTS "$37,122.00 " Outpatient "$18,561.00 " "$1,219.74 " "$24,129.30 " "$25,985.40 " "$24,500.52 " Not Applicable: Bundled with Procedure "$12,992.70 " "$29,697.60 " "$1,219.74 " "$29,697.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.462 C1713 SUPPLY/IMPLANTS "$37,702.00 " Outpatient "$18,851.00 " "$1,219.74 " "$24,506.30 " "$26,391.40 " "$24,883.32 " Not Applicable: Bundled with Procedure "$13,195.70 " "$30,161.60 " "$1,219.74 " "$30,161.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.463 C1713 SUPPLY/IMPLANTS "$35,386.00 " Outpatient "$17,693.00 " "$1,219.74 " "$23,000.90 " "$24,770.20 " "$23,354.76 " Not Applicable: Bundled with Procedure "$12,385.10 " "$28,308.80 " "$1,219.74 " "$28,308.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.464 C1713 SUPPLY/IMPLANTS "$36,538.00 " Outpatient "$18,269.00 " "$1,219.74 " "$23,749.70 " "$25,576.60 " "$24,115.08 " Not Applicable: Bundled with Procedure "$12,788.30 " "$29,230.40 " "$1,219.74 " "$29,230.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.465 C1713 SUPPLY/IMPLANTS "$37,702.00 " Outpatient "$18,851.00 " "$1,219.74 " "$24,506.30 " "$26,391.40 " "$24,883.32 " Not Applicable: Bundled with Procedure "$13,195.70 " "$30,161.60 " "$1,219.74 " "$30,161.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.466 C1713 SUPPLY/IMPLANTS "$38,671.00 " Outpatient "$19,335.50 " "$1,219.74 " "$25,136.15 " "$27,069.70 " "$25,522.86 " Not Applicable: Bundled with Procedure "$13,534.85 " "$30,936.80 " "$1,219.74 " "$30,936.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.467 C1713 SUPPLY/IMPLANTS "$39,634.00 " Outpatient "$19,817.00 " "$1,219.74 " "$25,762.10 " "$27,743.80 " "$26,158.44 " Not Applicable: Bundled with Procedure "$13,871.90 " "$31,707.20 " "$1,219.74 " "$31,707.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.468 C1713 SUPPLY/IMPLANTS "$41,571.00 " Outpatient "$20,785.50 " "$1,219.74 " "$27,021.15 " "$29,099.70 " "$27,436.86 " Not Applicable: Bundled with Procedure "$14,549.85 " "$33,256.80 " "$1,219.74 " "$33,256.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.469 C1713 SUPPLY/IMPLANTS "$42,531.00 " Outpatient "$21,265.50 " "$1,219.74 " "$27,645.15 " "$29,771.70 " "$28,070.46 " Not Applicable: Bundled with Procedure "$14,885.85 " "$34,024.80 " "$1,219.74 " "$34,024.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.470 C1713 SUPPLY/IMPLANTS "$43,494.00 " Outpatient "$21,747.00 " "$1,219.74 " "$28,271.10 " "$30,445.80 " "$28,706.04 " Not Applicable: Bundled with Procedure "$15,222.90 " "$34,795.20 " "$1,219.74 " "$34,795.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.502 C1713 SUPPLY/IMPLANTS "$35,906.00 " Outpatient "$17,953.00 " "$1,219.74 " "$23,338.90 " "$25,134.20 " "$23,697.96 " Not Applicable: Bundled with Procedure "$12,567.10 " "$28,724.80 " "$1,219.74 " "$28,724.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.503 C1713 SUPPLY/IMPLANTS "$36,874.00 " Outpatient "$18,437.00 " "$1,219.74 " "$23,968.10 " "$25,811.80 " "$24,336.84 " Not Applicable: Bundled with Procedure "$12,905.90 " "$29,499.20 " "$1,219.74 " "$29,499.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.504 C1713 SUPPLY/IMPLANTS "$37,831.00 " Outpatient "$18,915.50 " "$1,219.74 " "$24,590.15 " "$26,481.70 " "$24,968.46 " Not Applicable: Bundled with Procedure "$13,240.85 " "$30,264.80 " "$1,219.74 " "$30,264.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.505 C1713 SUPPLY/IMPLANTS "$38,421.00 " Outpatient "$19,210.50 " "$1,219.74 " "$24,973.65 " "$26,894.70 " "$25,357.86 " Not Applicable: Bundled with Procedure "$13,447.35 " "$30,736.80 " "$1,219.74 " "$30,736.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.506 C1713 SUPPLY/IMPLANTS "$38,992.00 " Outpatient "$19,496.00 " "$1,219.74 " "$25,344.80 " "$27,294.40 " "$25,734.72 " Not Applicable: Bundled with Procedure "$13,647.20 " "$31,193.60 " "$1,219.74 " "$31,193.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.507 C1713 SUPPLY/IMPLANTS "$39,579.00 " Outpatient "$19,789.50 " "$1,219.74 " "$25,726.35 " "$27,705.30 " "$26,122.14 " Not Applicable: Bundled with Procedure "$13,852.65 " "$31,663.20 " "$1,219.74 " "$31,663.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.508 C1713 SUPPLY/IMPLANTS "$40,156.00 " Outpatient "$20,078.00 " "$1,219.74 " "$26,101.40 " "$28,109.20 " "$26,502.96 " Not Applicable: Bundled with Procedure "$14,054.60 " "$32,124.80 " "$1,219.74 " "$32,124.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.509 C1713 SUPPLY/IMPLANTS "$40,740.00 " Outpatient "$20,370.00 " "$1,219.74 " "$26,481.00 " "$28,518.00 " "$26,888.40 " Not Applicable: Bundled with Procedure "$14,259.00 " "$32,592.00 " "$1,219.74 " "$32,592.00 " IMPL CRNL PEEK-OPTM CSTM PTSPC NS SD800.511 C1713 SUPPLY/IMPLANTS "$39,579.00 " Outpatient "$19,789.50 " "$1,219.74 " "$25,726.35 " "$27,705.30 " "$26,122.14 " Not Applicable: Bundled with Procedure "$13,852.65 " "$31,663.20 " "$1,219.74 " "$31,663.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.512 C1713 SUPPLY/IMPLANTS "$40,740.00 " Outpatient "$20,370.00 " "$1,219.74 " "$26,481.00 " "$28,518.00 " "$26,888.40 " Not Applicable: Bundled with Procedure "$14,259.00 " "$32,592.00 " "$1,219.74 " "$32,592.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.513 C1713 SUPPLY/IMPLANTS "$41,713.00 " Outpatient "$20,856.50 " "$1,219.74 " "$27,113.45 " "$29,199.10 " "$27,530.58 " Not Applicable: Bundled with Procedure "$14,599.55 " "$33,370.40 " "$1,219.74 " "$33,370.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.514 C1713 SUPPLY/IMPLANTS "$42,674.00 " Outpatient "$21,337.00 " "$1,219.74 " "$27,738.10 " "$29,871.80 " "$28,164.84 " Not Applicable: Bundled with Procedure "$14,935.90 " "$34,139.20 " "$1,219.74 " "$34,139.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.515 C1713 SUPPLY/IMPLANTS "$44,609.00 " Outpatient "$22,304.50 " "$1,219.74 " "$28,995.85 " "$31,226.30 " "$29,441.94 " Not Applicable: Bundled with Procedure "$15,613.15 " "$35,687.20 " "$1,219.74 " "$35,687.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.516 C1713 SUPPLY/IMPLANTS "$45,574.00 " Outpatient "$22,787.00 " "$1,219.74 " "$29,623.10 " "$31,901.80 " "$30,078.84 " Not Applicable: Bundled with Procedure "$15,950.90 " "$36,459.20 " "$1,219.74 " "$36,459.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.517 C1713 SUPPLY/IMPLANTS "$46,535.00 " Outpatient "$23,267.50 " "$1,219.74 " "$30,247.75 " "$32,574.50 " "$30,713.10 " Not Applicable: Bundled with Procedure "$16,287.25 " "$37,228.00 " "$1,219.74 " "$37,228.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.518 C1713 SUPPLY/IMPLANTS "$40,156.00 " Outpatient "$20,078.00 " "$1,219.74 " "$26,101.40 " "$28,109.20 " "$26,502.96 " Not Applicable: Bundled with Procedure "$14,054.60 " "$32,124.80 " "$1,219.74 " "$32,124.80 " IMPL CRNL PEEK-OPTM CSTM PTSPC NS SD800.519 C1713 SUPPLY/IMPLANTS "$41,713.00 " Outpatient "$20,856.50 " "$1,219.74 " "$27,113.45 " "$29,199.10 " "$27,530.58 " Not Applicable: Bundled with Procedure "$14,599.55 " "$33,370.40 " "$1,219.74 " "$33,370.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.520 C1713 SUPPLY/IMPLANTS "$43,637.00 " Outpatient "$21,818.50 " "$1,219.74 " "$28,364.05 " "$30,545.90 " "$28,800.42 " Not Applicable: Bundled with Procedure "$15,272.95 " "$34,909.60 " "$1,219.74 " "$34,909.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.521 C1713 SUPPLY/IMPLANTS "$45,574.00 " Outpatient "$22,787.00 " "$1,219.74 " "$29,623.10 " "$31,901.80 " "$30,078.84 " Not Applicable: Bundled with Procedure "$15,950.90 " "$36,459.20 " "$1,219.74 " "$36,459.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.522 C1713 SUPPLY/IMPLANTS "$47,501.00 " Outpatient "$23,750.50 " "$1,219.74 " "$30,875.65 " "$33,250.70 " "$31,350.66 " Not Applicable: Bundled with Procedure "$16,625.35 " "$38,000.80 " "$1,219.74 " "$38,000.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.523 C1713 SUPPLY/IMPLANTS "$48,471.00 " Outpatient "$24,235.50 " "$1,219.74 " "$31,506.15 " "$33,929.70 " "$31,990.86 " Not Applicable: Bundled with Procedure "$16,964.85 " "$38,776.80 " "$1,219.74 " "$38,776.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.524 C1713 SUPPLY/IMPLANTS "$50,408.00 " Outpatient "$25,204.00 " "$1,219.74 " "$32,765.20 " "$35,285.60 " "$33,269.28 " Not Applicable: Bundled with Procedure "$17,642.80 " "$40,326.40 " "$1,219.74 " "$40,326.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.526 C1713 SUPPLY/IMPLANTS "$44,609.00 " Outpatient "$22,304.50 " "$1,219.74 " "$28,995.85 " "$31,226.30 " "$29,441.94 " Not Applicable: Bundled with Procedure "$15,613.15 " "$35,687.20 " "$1,219.74 " "$35,687.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.528 C1713 SUPPLY/IMPLANTS "$48,471.00 " Outpatient "$24,235.50 " "$1,219.74 " "$31,506.15 " "$33,929.70 " "$31,990.86 " Not Applicable: Bundled with Procedure "$16,964.85 " "$38,776.80 " "$1,219.74 " "$38,776.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.529 C1713 SUPPLY/IMPLANTS "$51,376.00 " Outpatient "$25,688.00 " "$1,219.74 " "$33,394.40 " "$35,963.20 " "$33,908.16 " Not Applicable: Bundled with Procedure "$17,981.60 " "$41,100.80 " "$1,219.74 " "$41,100.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.530 C1713 SUPPLY/IMPLANTS "$53,774.00 " Outpatient "$26,887.00 " "$1,219.74 " "$34,953.10 " "$37,641.80 " "$35,490.84 " Not Applicable: Bundled with Procedure "$18,820.90 " "$43,019.20 " "$1,219.74 " "$43,019.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.531 C1713 SUPPLY/IMPLANTS "$56,679.00 " Outpatient "$28,339.50 " "$1,219.74 " "$36,841.35 " "$39,675.30 " "$37,408.14 " Not Applicable: Bundled with Procedure "$19,837.65 " "$45,343.20 " "$1,219.74 " "$45,343.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.532 C1713 SUPPLY/IMPLANTS "$58,131.00 " Outpatient "$29,065.50 " "$1,219.74 " "$37,785.15 " "$40,691.70 " "$38,366.46 " Not Applicable: Bundled with Procedure "$20,345.85 " "$46,504.80 " "$1,219.74 " "$46,504.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.534 C1713 SUPPLY/IMPLANTS "$52,333.00 " Outpatient "$26,166.50 " "$1,219.74 " "$34,016.45 " "$36,633.10 " "$34,539.78 " Not Applicable: Bundled with Procedure "$18,316.55 " "$41,866.40 " "$1,219.74 " "$41,866.40 " IMPL CRNL PEEK-OPTM CSTM PTSPC NS SD800.535 C1713 SUPPLY/IMPLANTS "$55,232.00 " Outpatient "$27,616.00 " "$1,219.74 " "$35,900.80 " "$38,662.40 " "$36,453.12 " Not Applicable: Bundled with Procedure "$19,331.20 " "$44,185.60 " "$1,219.74 " "$44,185.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.537 C1713 SUPPLY/IMPLANTS "$60,449.00 " Outpatient "$30,224.50 " "$1,219.74 " "$39,291.85 " "$42,314.30 " "$39,896.34 " Not Applicable: Bundled with Procedure "$21,157.15 " "$48,359.20 " "$1,219.74 " "$48,359.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.538 C1713 SUPPLY/IMPLANTS "$63,932.00 " Outpatient "$31,966.00 " "$1,219.74 " "$41,555.80 " "$44,752.40 " "$42,195.12 " Not Applicable: Bundled with Procedure "$22,376.20 " "$51,145.60 " "$1,219.74 " "$51,145.60 " IMPL CRNL PEEK-OPTM CSTM PTSPC NS SD800.539 C1713 SUPPLY/IMPLANTS "$56,679.00 " Outpatient "$28,339.50 " "$1,219.74 " "$36,841.35 " "$39,675.30 " "$37,408.14 " Not Applicable: Bundled with Procedure "$19,837.65 " "$45,343.20 " "$1,219.74 " "$45,343.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.540 C1713 SUPPLY/IMPLANTS "$59,292.00 " Outpatient "$29,646.00 " "$1,219.74 " "$38,539.80 " "$41,504.40 " "$39,132.72 " Not Applicable: Bundled with Procedure "$20,752.20 " "$47,433.60 " "$1,219.74 " "$47,433.60 " IMPL CRNL PEEK-OPTM CSTM PTSPC NS SD800.541 C1713 SUPPLY/IMPLANTS "$61,607.00 " Outpatient "$30,803.50 " "$1,219.74 " "$40,044.55 " "$43,124.90 " "$40,660.62 " Not Applicable: Bundled with Procedure "$21,562.45 " "$49,285.60 " "$1,219.74 " "$49,285.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.542 C1713 SUPPLY/IMPLANTS "$65,859.00 " Outpatient "$32,929.50 " "$1,219.74 " "$42,808.35 " "$46,101.30 " "$43,466.94 " Not Applicable: Bundled with Procedure "$23,050.65 " "$52,687.20 " "$1,219.74 " "$52,687.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.543 C1713 SUPPLY/IMPLANTS "$69,726.00 " Outpatient "$34,863.00 " "$1,219.74 " "$45,321.90 " "$48,808.20 " "$46,019.16 " Not Applicable: Bundled with Procedure "$24,404.10 " "$55,780.80 " "$1,219.74 " "$55,780.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.545 C1713 SUPPLY/IMPLANTS "$67,793.00 " Outpatient "$33,896.50 " "$1,219.74 " "$44,065.45 " "$47,455.10 " "$44,743.38 " Not Applicable: Bundled with Procedure "$23,727.55 " "$54,234.40 " "$1,219.74 " "$54,234.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.546 C1713 SUPPLY/IMPLANTS "$71,658.00 " Outpatient "$35,829.00 " "$1,219.74 " "$46,577.70 " "$50,160.60 " "$47,294.28 " Not Applicable: Bundled with Procedure "$25,080.30 " "$57,326.40 " "$1,219.74 " "$57,326.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.547 C1713 SUPPLY/IMPLANTS "$75,522.00 " Outpatient "$37,761.00 " "$1,219.74 " "$49,089.30 " "$52,865.40 " "$49,844.52 " Not Applicable: Bundled with Procedure "$26,432.70 " "$60,417.60 " "$1,219.74 " "$60,417.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.548 C1713 SUPPLY/IMPLANTS "$73,590.00 " Outpatient "$36,795.00 " "$1,219.74 " "$47,833.50 " "$51,513.00 " "$48,569.40 " Not Applicable: Bundled with Procedure "$25,756.50 " "$58,872.00 " "$1,219.74 " "$58,872.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.549 C1713 SUPPLY/IMPLANTS "$78,425.00 " Outpatient "$39,212.50 " "$1,219.74 " "$50,976.25 " "$54,897.50 " "$51,760.50 " Not Applicable: Bundled with Procedure "$27,448.75 " "$62,740.00 " "$1,219.74 " "$62,740.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.550 C1713 SUPPLY/IMPLANTS "$81,322.00 " Outpatient "$40,661.00 " "$1,219.74 " "$52,859.30 " "$56,925.40 " "$53,672.52 " Not Applicable: Bundled with Procedure "$28,462.70 " "$65,057.60 " "$1,219.74 " "$65,057.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.551 C1713 SUPPLY/IMPLANTS "$84,216.00 " Outpatient "$42,108.00 " "$1,219.74 " "$54,740.40 " "$58,951.20 " "$55,582.56 " Not Applicable: Bundled with Procedure "$29,475.60 " "$67,372.80 " "$1,219.74 " "$67,372.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.552 C1713 SUPPLY/IMPLANTS "$87,115.00 " Outpatient "$43,557.50 " "$1,219.74 " "$56,624.75 " "$60,980.50 " "$57,495.90 " Not Applicable: Bundled with Procedure "$30,490.25 " "$69,692.00 " "$1,219.74 " "$69,692.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.553 C1713 SUPPLY/IMPLANTS "$92,916.00 " Outpatient "$46,458.00 " "$1,219.74 " "$60,395.40 " "$65,041.20 " "$61,324.56 " Not Applicable: Bundled with Procedure "$32,520.60 " "$74,332.80 " "$1,219.74 " "$74,332.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.554 C1713 SUPPLY/IMPLANTS "$34,938.00 " Outpatient "$17,469.00 " "$1,219.74 " "$22,709.70 " "$24,456.60 " "$23,059.08 " Not Applicable: Bundled with Procedure "$12,228.30 " "$27,950.40 " "$1,219.74 " "$27,950.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.555 C1713 SUPPLY/IMPLANTS "$35,898.00 " Outpatient "$17,949.00 " "$1,219.74 " "$23,333.70 " "$25,128.60 " "$23,692.68 " Not Applicable: Bundled with Procedure "$12,564.30 " "$28,718.40 " "$1,219.74 " "$28,718.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.556 C1713 SUPPLY/IMPLANTS "$36,874.00 " Outpatient "$18,437.00 " "$1,219.74 " "$23,968.10 " "$25,811.80 " "$24,336.84 " Not Applicable: Bundled with Procedure "$12,905.90 " "$29,499.20 " "$1,219.74 " "$29,499.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.557 C1713 SUPPLY/IMPLANTS "$37,831.00 " Outpatient "$18,915.50 " "$1,219.74 " "$24,590.15 " "$26,481.70 " "$24,968.46 " Not Applicable: Bundled with Procedure "$13,240.85 " "$30,264.80 " "$1,219.74 " "$30,264.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.558 C1713 SUPPLY/IMPLANTS "$38,421.00 " Outpatient "$19,210.50 " "$1,219.74 " "$24,973.65 " "$26,894.70 " "$25,357.86 " Not Applicable: Bundled with Procedure "$13,447.35 " "$30,736.80 " "$1,219.74 " "$30,736.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.559 C1713 SUPPLY/IMPLANTS "$38,992.00 " Outpatient "$19,496.00 " "$1,219.74 " "$25,344.80 " "$27,294.40 " "$25,734.72 " Not Applicable: Bundled with Procedure "$13,647.20 " "$31,193.60 " "$1,219.74 " "$31,193.60 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.560 C1713 SUPPLY/IMPLANTS "$39,579.00 " Outpatient "$19,789.50 " "$1,219.74 " "$25,726.35 " "$27,705.30 " "$26,122.14 " Not Applicable: Bundled with Procedure "$13,852.65 " "$31,663.20 " "$1,219.74 " "$31,663.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.561 C1713 SUPPLY/IMPLANTS "$40,156.00 " Outpatient "$20,078.00 " "$1,219.74 " "$26,101.40 " "$28,109.20 " "$26,502.96 " Not Applicable: Bundled with Procedure "$14,054.60 " "$32,124.80 " "$1,219.74 " "$32,124.80 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.562 C1713 SUPPLY/IMPLANTS "$40,740.00 " Outpatient "$20,370.00 " "$1,219.74 " "$26,481.00 " "$28,518.00 " "$26,888.40 " Not Applicable: Bundled with Procedure "$14,259.00 " "$32,592.00 " "$1,219.74 " "$32,592.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.564 C1713 SUPPLY/IMPLANTS "$39,579.00 " Outpatient "$19,789.50 " "$1,219.74 " "$25,726.35 " "$27,705.30 " "$26,122.14 " Not Applicable: Bundled with Procedure "$13,852.65 " "$31,663.20 " "$1,219.74 " "$31,663.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.565 C1713 SUPPLY/IMPLANTS "$40,740.00 " Outpatient "$20,370.00 " "$1,219.74 " "$26,481.00 " "$28,518.00 " "$26,888.40 " Not Applicable: Bundled with Procedure "$14,259.00 " "$32,592.00 " "$1,219.74 " "$32,592.00 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.566 C1713 SUPPLY/IMPLANTS "$41,713.00 " Outpatient "$20,856.50 " "$1,219.74 " "$27,113.45 " "$29,199.10 " "$27,530.58 " Not Applicable: Bundled with Procedure "$14,599.55 " "$33,370.40 " "$1,219.74 " "$33,370.40 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.567 C1713 SUPPLY/IMPLANTS "$42,674.00 " Outpatient "$21,337.00 " "$1,219.74 " "$27,738.10 " "$29,871.80 " "$28,164.84 " Not Applicable: Bundled with Procedure "$14,935.90 " "$34,139.20 " "$1,219.74 " "$34,139.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.568 C1713 SUPPLY/IMPLANTS "$44,609.00 " Outpatient "$22,304.50 " "$1,219.74 " "$28,995.85 " "$31,226.30 " "$29,441.94 " Not Applicable: Bundled with Procedure "$15,613.15 " "$35,687.20 " "$1,219.74 " "$35,687.20 " IMPL CRNL PEEK-OPTM PTSPC NS SD800.569 C1713 SUPPLY/IMPLANTS "$45,574.00 " Outpatient "$22,787.00 " "$1,219.74 " "$29,623.10 " "$31,901.80 " "$30,078.84 " Not Applicable: Bundled with Procedure "$15,950.90 " "$36,459.20 " "$1,219.74 " "$36,459.20 " IMPL CRNL PEEK-OPTM KT PTSPC BSC RECON MDFC NS SD900.054 C1713 SUPPLY/IMPLANTS "$10,310.00 " Outpatient "$5,155.00 " "$1,219.74 " "$6,701.50 " "$7,217.00 " "$6,804.60 " Not Applicable: Bundled with Procedure "$3,608.50 " "$8,248.00 " "$1,219.74 " "$8,248.00 " IMPL CRNL PEEK-OPTM KT PTSPC BSC RECON MDFC NS SD900.056 C1713 SUPPLY/IMPLANTS "$11,700.00 " Outpatient "$5,850.00 " "$1,219.74 " "$7,605.00 " "$8,190.00 " "$7,722.00 " Not Applicable: Bundled with Procedure "$4,095.00 " "$9,360.00 " "$1,219.74 " "$9,360.00 " IMPL CRNL LG CSTM 7850030 C1713 SUPPLY/IMPLANTS "$78,943.00 " Outpatient "$39,471.50 " "$1,219.74 " "$51,312.95 " "$55,260.10 " "$52,102.38 " Not Applicable: Bundled with Procedure "$27,630.05 " "$63,154.40 " "$1,219.74 " "$63,154.40 " IMPL FX 1 XPN AMRPH BABSR PUL OUT STRTH STRNG BTRNSF 40MM 5 AR-1351B C1713 SUPPLY/IMPLANTS "$2,355.00 " Outpatient "$1,177.50 " "$1,219.74 " "$1,530.75 " "$1,648.50 " "$1,554.30 " Not Applicable: Bundled with Procedure $824.25 "$1,884.00 " $824.25 "$1,884.00 " IMPL FX RECON SCR GRAFTBOLT 8MM TIB STRL AR-5100-08 C1713 SUPPLY/IMPLANTS "$2,764.00 " Outpatient "$1,382.00 " "$1,219.74 " "$1,796.60 " "$1,934.80 " "$1,824.24 " Not Applicable: Bundled with Procedure $967.40 "$2,211.20 " $967.40 "$2,211.20 " IMPL FX SYS SET MATRIXRIB 14MM 04.501.024.01 C1713 SUPPLY/IMPLANTS "$1,088.00 " Outpatient $544.00 "$1,219.74 " $707.20 $761.60 $718.08 Not Applicable: Bundled with Procedure $380.80 $870.40 $380.80 "$1,219.74 " IMPL FX SM TI SPLNT MATRIXRIB 3MM IM NS 04.501.010 C1713 SUPPLY/IMPLANTS "$2,683.00 " Outpatient "$1,341.50 " "$1,219.74 " "$1,743.95 " "$1,878.10 " "$1,770.78 " Not Applicable: Bundled with Procedure $939.05 "$2,146.40 " $939.05 "$2,146.40 " IMPL FX LG TI SPLNT MATRIXRIB 5MM IM NS 04.501.012 C1713 SUPPLY/IMPLANTS "$2,683.00 " Outpatient "$1,341.50 " "$1,219.74 " "$1,743.95 " "$1,878.10 " "$1,770.78 " Not Applicable: Bundled with Procedure $939.05 "$2,146.40 " $939.05 "$2,146.40 " IMPL FX RECON SCR GRAFTBOLT 9MM TIB STRL AR-5100-09 C1713 SUPPLY/IMPLANTS "$2,764.00 " Outpatient "$1,382.00 " "$1,219.74 " "$1,796.60 " "$1,934.80 " "$1,824.24 " Not Applicable: Bundled with Procedure $967.40 "$2,211.20 " $967.40 "$2,211.20 " IMPL FC P.5CM P.4CM MED SIL BNDR SHL BNDR SUBMALAR 4.9X3.3CM CSM-M C1713 SUPPLY/IMPLANTS "$1,997.00 " Outpatient $998.50 "$1,219.74 " "$1,298.05 " "$1,397.90 " "$1,318.02 " Not Applicable: Bundled with Procedure $698.95 "$1,597.60 " $698.95 "$1,597.60 " IMPL FX PEEK-OPTM CNN DRVR APERFIX II 30MM 9MM TIB CM-3009C C1713 SUPPLY/IMPLANTS "$2,262.00 " Outpatient "$1,131.00 " "$1,219.74 " "$1,470.30 " "$1,583.40 " "$1,492.92 " Not Applicable: Bundled with Procedure $791.70 "$1,809.60 " $791.70 "$1,809.60 " IMPL FX INLN TOGGLELOC ZIPLOOP 110005087 C1713 SUPPLY/IMPLANTS "$1,997.00 " Outpatient $998.50 "$1,219.74 " "$1,298.05 " "$1,397.90 " "$1,318.02 " Not Applicable: Bundled with Procedure $698.95 "$1,597.60 " $698.95 "$1,597.60 " IMPL MALAR SPC ZYG NS SD800.510 C1713 SUPPLY/IMPLANTS "$38,421.00 " Outpatient "$19,210.50 " "$1,219.74 " "$24,973.65 " "$26,894.70 " "$25,357.86 " Not Applicable: Bundled with Procedure "$13,447.35 " "$30,736.80 " "$1,219.74 " "$30,736.80 " IMPL ORBT 3D LG MDPR TN CRNMXF LT MTB 81043 C1713 SUPPLY/IMPLANTS "$12,230.00 " Outpatient "$6,115.00 " "$1,219.74 " "$7,949.50 " "$8,561.00 " "$8,071.80 " Not Applicable: Bundled with Procedure "$4,280.50 " "$9,784.00 " "$1,219.74 " "$9,784.00 " IMPL ORBT 3D LG MDPR TN CRNMXF RT MTB 81044 C1713 SUPPLY/IMPLANTS "$10,676.00 " Outpatient "$5,338.00 " "$1,219.74 " "$6,939.40 " "$7,473.20 " "$7,046.16 " Not Applicable: Bundled with Procedure "$3,736.60 " "$8,540.80 " "$1,219.74 " "$8,540.80 " IMPL SNTH TISS STD PLSTR SIL BA TNDN HNTR 24.5CMX4MM STRL TR400000 C1713 SUPPLY/IMPLANTS "$7,707.00 " Outpatient "$3,853.50 " "$1,219.74 " "$5,009.55 " "$5,394.90 " "$5,086.62 " Not Applicable: Bundled with Procedure "$2,697.45 " "$6,165.60 " "$1,219.74 " "$6,165.60 " IMPLANT CLAMPS B24903 C1713 SUPPLY/IMPLANTS "$4,379.00 " Outpatient "$2,189.50 " "$1,219.74 " "$2,846.35 " "$3,065.30 " "$2,890.14 " Not Applicable: Bundled with Procedure "$1,532.65 " "$3,503.20 " "$1,219.74 " "$3,503.20 " IMPLANT CANNULATED TIBIAL PEEK 10MM X 30MM CM3010C C1713 SUPPLY/IMPLANTS "$2,261.00 " Outpatient "$1,130.50 " "$1,219.74 " "$1,469.65 " "$1,582.70 " "$1,492.26 " Not Applicable: Bundled with Procedure $791.35 "$1,808.80 " $791.35 "$1,808.80 " IMPLANT SPEED COMPRESSION 11 X 15 X 13MM SE111513 C1713 SUPPLY/IMPLANTS "$4,767.00 " Outpatient "$2,383.50 " "$1,219.74 " "$3,098.55 " "$3,336.90 " "$3,146.22 " Not Applicable: Bundled with Procedure "$1,668.45 " "$3,813.60 " "$1,219.74 " "$3,813.60 " "IMPLANT SYS. 7.0MM X 45MM IMPLANT, IFUSE-3D 7045M-90" C1713 SUPPLY/IMPLANTS "$20,272.00 " Outpatient "$10,136.00 " "$1,219.74 " "$13,176.80 " "$14,190.40 " "$13,379.52 " Not Applicable: Bundled with Procedure "$7,095.20 " "$16,217.60 " "$1,219.74 " "$16,217.60 " IMPLANT LEFT FRONTAL SPHENOID PARIETAL TEMPORAL PK621116 C1713 SUPPLY/IMPLANTS "$53,682.00 " Outpatient "$26,841.00 " "$1,219.74 " "$34,893.30 " "$37,577.40 " "$35,430.12 " Not Applicable: Bundled with Procedure "$18,788.70 " "$42,945.60 " "$1,219.74 " "$42,945.60 " IMPLANT TOE COMPONENT ARTICULAR 12MM 1.0X1.5MM OFFSET 9122-1015-W C1713 SUPPLY/IMPLANTS "$10,454.00 " Outpatient "$5,227.00 " "$1,219.74 " "$6,795.10 " "$7,317.80 " "$6,899.64 " Not Applicable: Bundled with Procedure "$3,658.90 " "$8,363.20 " "$1,219.74 " "$8,363.20 " IMPLANT SYSTEM ALL RECONSTRUCTION AR-5522 C1713 SUPPLY/IMPLANTS "$5,369.00 " Outpatient "$2,684.50 " "$1,219.74 " "$3,489.85 " "$3,758.30 " "$3,543.54 " Not Applicable: Bundled with Procedure "$1,879.15 " "$4,295.20 " "$1,219.74 " "$4,295.20 " IMPLANT SET 4MM CANNULATED DRILL GUIDEPEN RULER SCREW AR-1677BC-CP C1713 SUPPLY/IMPLANTS "$2,904.00 " Outpatient "$1,452.00 " "$1,219.74 " "$1,887.60 " "$2,032.80 " "$1,916.64 " Not Applicable: Bundled with Procedure "$1,016.40 " "$2,323.20 " "$1,016.40 " "$2,323.20 " IMPLANT CRANIAL PEEK MEDIUM CUSTOMIZE PRIORITY NONSTERILE 78-50020 C1713 SUPPLY/IMPLANTS "$68,108.00 " Outpatient "$34,054.00 " "$1,219.74 " "$44,270.20 " "$47,675.60 " "$44,951.28 " Not Applicable: Bundled with Procedure "$23,837.80 " "$54,486.40 " "$1,219.74 " "$54,486.40 " INS DRVR RAPIDSORB BTR-PWR RSRB TRY NS 305.818 C1713 SUPPLY/IMPLANTS "$1,199.00 " Outpatient $599.50 "$1,219.74 " $779.35 $839.30 $791.34 Not Applicable: Bundled with Procedure $419.65 $959.20 $419.65 "$1,219.74 " INS INST OPTN FRS SCR P1005 C1713 SUPPLY/IMPLANTS "$2,057.00 " Outpatient "$1,028.50 " "$1,219.74 " "$1,337.05 " "$1,439.90 " "$1,357.62 " Not Applicable: Bundled with Procedure $719.95 "$1,645.60 " $719.95 "$1,645.60 " INS INST MDN DIST ULTEM IM NL NS 225501501 C1713 SUPPLY/IMPLANTS $659.00 Outpatient $329.50 "$1,219.74 " $428.35 $461.30 $434.94 Not Applicable: Bundled with Procedure $230.65 $527.20 $230.65 "$1,219.74 " INS INST RAPIDSORB NS RSRB TRY 305.811 C1713 SUPPLY/IMPLANTS "$1,304.00 " Outpatient $652.00 "$1,219.74 " $847.60 $912.80 $860.64 Not Applicable: Bundled with Procedure $456.40 "$1,043.20 " $456.40 "$1,219.74 " INS PLT BNDRG STD CNCV FEM PRS NCB LG FRAG SYS 200024315 C1713 SUPPLY/IMPLANTS "$1,606.00 " Outpatient $803.00 "$1,219.74 " "$1,043.90 " "$1,124.20 " "$1,059.96 " Not Applicable: Bundled with Procedure $562.10 "$1,284.80 " $562.10 "$1,284.80 " INS PLT BNDRG STD CNVX FEM PRS NCB LG FRAG SYS 200024316 C1713 SUPPLY/IMPLANTS "$2,556.00 " Outpatient "$1,278.00 " "$1,219.74 " "$1,661.40 " "$1,789.20 " "$1,686.96 " Not Applicable: Bundled with Procedure $894.60 "$2,044.80 " $894.60 "$2,044.80 " INS PLT ULT LOPRFL MATRIXNEURO MOD NS 306.546 C1713 SUPPLY/IMPLANTS "$2,226.00 " Outpatient "$1,113.00 " "$1,219.74 " "$1,446.90 " "$1,558.20 " "$1,469.16 " Not Applicable: Bundled with Procedure $779.10 "$1,780.80 " $779.10 "$1,780.80 " INS PLT BNDRG LG MESH SD306.512 C1713 SUPPLY/IMPLANTS $518.00 Outpatient $259.00 "$1,219.74 " $336.70 $362.60 $341.88 Not Applicable: Bundled with Procedure $181.30 $414.40 $181.30 "$1,219.74 " INS PLT BNDRG MED MESH SD306.513 C1713 SUPPLY/IMPLANTS $518.00 Outpatient $259.00 "$1,219.74 " $336.70 $362.60 $341.88 Not Applicable: Bundled with Procedure $181.30 $414.40 $181.30 "$1,219.74 " INS SCR HL 8MM NCB FEM DIST TI BLIND HANDTIGHTEN 3.5MM HEX 203150310 C1713 SUPPLY/IMPLANTS $483.00 Outpatient $241.50 "$1,219.74 " $313.95 $338.10 $318.78 Not Applicable: Bundled with Procedure $169.05 $386.40 $169.05 "$1,219.74 " INS SRG SCR HLDR 90 SCRDRVR 1.5/2 MM SCR NS 03.505.011 C1713 SUPPLY/IMPLANTS $643.00 Outpatient $321.50 "$1,219.74 " $417.95 $450.10 $424.38 Not Applicable: Bundled with Procedure $225.05 $514.40 $225.05 "$1,219.74 " INS SRG SCR HLDR 90 SCRDRVR 2.4 MM SCR NS 03.505.012 C1713 SUPPLY/IMPLANTS $643.00 Outpatient $321.50 "$1,219.74 " $417.95 $450.10 $424.38 Not Applicable: Bundled with Procedure $225.05 $514.40 $225.05 "$1,219.74 " INS SRG ADJ PLT MATRIXNEURO MOD NS 306.507 C1713 SUPPLY/IMPLANTS "$2,358.00 " Outpatient "$1,179.00 " "$1,219.74 " "$1,532.70 " "$1,650.60 " "$1,556.28 " Not Applicable: Bundled with Procedure $825.30 "$1,886.40 " $825.30 "$1,886.40 " INS SRG SCR MATRIXNEURO MOD NS 306.512 C1713 SUPPLY/IMPLANTS $888.00 Outpatient $444.00 "$1,219.74 " $577.20 $621.60 $586.08 Not Applicable: Bundled with Procedure $310.80 $710.40 $310.80 "$1,219.74 " INS SRG PLT GNRC MOD 306.64 C1713 SUPPLY/IMPLANTS "$1,976.00 " Outpatient $988.00 "$1,219.74 " "$1,284.40 " "$1,383.20 " "$1,304.16 " Not Applicable: Bundled with Procedure $691.60 "$1,580.80 " $691.60 "$1,580.80 " INS STRL NS 1.5/2 MM SCR TWINBOX 60.503.010 C1713 SUPPLY/IMPLANTS "$2,248.00 " Outpatient "$1,124.00 " "$1,219.74 " "$1,461.20 " "$1,573.60 " "$1,483.68 " Not Applicable: Bundled with Procedure $786.80 "$1,798.40 " $786.80 "$1,798.40 " INS STRL BX NS 1.5 MM SCR BN FX SYS 60.503.020 C1713 SUPPLY/IMPLANTS "$2,248.00 " Outpatient "$1,124.00 " "$1,219.74 " "$1,461.20 " "$1,573.60 " "$1,483.68 " Not Applicable: Bundled with Procedure $786.80 "$1,798.40 " $786.80 "$1,798.40 " INS STRL BX NS 2 MM SCR BN FX SYS 60.503.030 C1713 SUPPLY/IMPLANTS "$2,248.00 " Outpatient "$1,124.00 " "$1,219.74 " "$1,461.20 " "$1,573.60 " "$1,483.68 " Not Applicable: Bundled with Procedure $786.80 "$1,798.40 " $786.80 "$1,798.40 " INS STRL NS 1.3/2 MM SCR TWINBOX 60.503.040 C1713 SUPPLY/IMPLANTS "$2,248.00 " Outpatient "$1,124.00 " "$1,219.74 " "$1,461.20 " "$1,573.60 " "$1,483.68 " Not Applicable: Bundled with Procedure $786.80 "$1,798.40 " $786.80 "$1,798.40 " INS STRL SGTL SPLT PLT MATRIXORTHOGNATHIC 60.511.005 C1713 SUPPLY/IMPLANTS "$1,976.00 " Outpatient $988.00 "$1,219.74 " "$1,284.40 " "$1,383.20 " "$1,304.16 " Not Applicable: Bundled with Procedure $691.60 "$1,580.80 " $691.60 "$1,580.80 " INS STRL SCR DRLBT BLDE RCSS HL MATRIXORTHOGNATHIC 60.511.006 C1713 SUPPLY/IMPLANTS "$1,626.00 " Outpatient $813.00 "$1,219.74 " "$1,056.90 " "$1,138.20 " "$1,073.16 " Not Applicable: Bundled with Procedure $569.10 "$1,300.80 " $569.10 "$1,300.80 " INS STRL CHIN PLT MATRIXORTHOGNATHIC 60.511.010 C1713 SUPPLY/IMPLANTS "$1,976.00 " Outpatient $988.00 "$1,219.74 " "$1,284.40 " "$1,383.20 " "$1,304.16 " Not Applicable: Bundled with Procedure $691.60 "$1,580.80 " $691.60 "$1,580.80 " INS STRL PLT PREBNT MATRIXORTHOGNATHIC 60.511.011 C1713 SUPPLY/IMPLANTS "$1,976.00 " Outpatient $988.00 "$1,219.74 " "$1,284.40 " "$1,383.20 " "$1,304.16 " Not Applicable: Bundled with Procedure $691.60 "$1,580.80 " $691.60 "$1,580.80 " INS STRL OBLQ L PLT 90D MATRIXORTHOGNATHIC 60.511.012 C1713 SUPPLY/IMPLANTS "$1,014.00 " Outpatient $507.00 "$1,219.74 " $659.10 $709.80 $669.24 Not Applicable: Bundled with Procedure $354.90 $811.20 $354.90 "$1,219.74 " INS STRL ANATMOIC L AND ADP PLT MATRIXORTHOGNATHIC 60.511.013 C1713 SUPPLY/IMPLANTS "$1,014.00 " Outpatient $507.00 "$1,219.74 " $659.10 $709.80 $669.24 Not Applicable: Bundled with Procedure $354.90 $811.20 $354.90 "$1,219.74 " INS STRL TROC MATRIXORTHOGNATHIC 60.511.015 C1713 SUPPLY/IMPLANTS "$1,411.00 " Outpatient $705.50 "$1,219.74 " $917.15 $987.70 $931.26 Not Applicable: Bundled with Procedure $493.85 "$1,128.80 " $493.85 "$1,219.74 " INS STRL SCR DRLBT RCSS HL NS MATRIXMIDFACE SYS 60.511.107 C1713 SUPPLY/IMPLANTS "$1,626.00 " Outpatient $813.00 "$1,219.74 " "$1,056.90 " "$1,138.20 " "$1,073.16 " Not Applicable: Bundled with Procedure $569.10 "$1,300.80 " $569.10 "$1,300.80 " INS STRL MED 2MM 2.5MM 2.8MM MATRIXMANDIBLE RECON PLT MOD 60.511.109 C1713 SUPPLY/IMPLANTS "$1,885.00 " Outpatient $942.50 "$1,219.74 " "$1,225.25 " "$1,319.50 " "$1,244.10 " Not Applicable: Bundled with Procedure $659.75 "$1,508.00 " $659.75 "$1,508.00 " INS STRL HLF HT NS .4 MM PLT MATRIXMIDFACE MOD SYS 60.511.113 C1713 SUPPLY/IMPLANTS $974.00 Outpatient $487.00 "$1,219.74 " $633.10 $681.80 $642.84 Not Applicable: Bundled with Procedure $340.90 $779.20 $340.90 "$1,219.74 " INS STRL HLF HT .5 MM/.7 MM PLT MATRIXMIDFACE MOD SYS 60.511.114 C1713 SUPPLY/IMPLANTS $974.00 Outpatient $487.00 "$1,219.74 " $633.10 $681.80 $642.84 Not Applicable: Bundled with Procedure $340.90 $779.20 $340.90 "$1,219.74 " INS STRL HLF HT NS .8 MM PLT MATRIXMIDFACE MOD SYS 60.511.115 C1713 SUPPLY/IMPLANTS $974.00 Outpatient $487.00 "$1,219.74 " $633.10 $681.80 $642.84 Not Applicable: Bundled with Procedure $340.90 $779.20 $340.90 "$1,219.74 " INS STRL SCR DRLBT BLDE NO RCS HL MATRIXORTHOGNATHIC SYS SD305.001 C1713 SUPPLY/IMPLANTS "$1,540.00 " Outpatient $770.00 "$1,219.74 " "$1,001.00 " "$1,078.00 " "$1,016.40 " Not Applicable: Bundled with Procedure $539.00 "$1,232.00 " $539.00 "$1,232.00 " INSERT POLY O0 DEGREE 36MM 623-00-361 C1713 SUPPLY/IMPLANTS "$5,920.00 " Outpatient "$2,960.00 " "$1,219.74 " "$3,848.00 " "$4,144.00 " "$3,907.20 " Not Applicable: Bundled with Procedure "$2,072.00 " "$4,736.00 " "$1,219.74 " "$4,736.00 " "INSERT POLYETHYLENE 10 DEGREE, 32MM 623-10-36D" C1713 SUPPLY/IMPLANTS "$4,397.00 " Outpatient "$2,198.50 " "$1,219.74 " "$2,858.05 " "$3,077.90 " "$2,902.02 " Not Applicable: Bundled with Procedure "$1,538.95 " "$3,517.60 " "$1,219.74 " "$3,517.60 " INSERT TIBIAL ARTICULAR CRUCIATE RETAINING 9MM THICK SIZE 8 5530G809 C1713 SUPPLY/IMPLANTS "$5,369.00 " Outpatient "$2,684.50 " "$1,219.74 " "$3,489.85 " "$3,758.30 " "$3,543.54 " Not Applicable: Bundled with Procedure "$1,879.15 " "$4,295.20 " "$1,219.74 " "$4,295.20 " INSRTR SRG 3.5MM SHRT CNCT SLD PHNX ANTGRD FEM NL SYS 14-441052 C1713 SUPPLY/IMPLANTS "$1,489.00 " Outpatient $744.50 "$1,219.74 " $967.85 "$1,042.30 " $982.74 Not Applicable: Bundled with Procedure $521.15 "$1,191.20 " $521.15 "$1,219.74 " INSRTR SRG PIN A FSHR FF-10504 C1713 SUPPLY/IMPLANTS "$2,218.00 " Outpatient "$1,109.00 " "$1,219.74 " "$1,441.70 " "$1,552.60 " "$1,463.88 " Not Applicable: Bundled with Procedure $776.30 "$1,774.40 " $776.30 "$1,774.40 " INSRTR SRG 5MM BOLT CNCT PHNX TIB NL SYS 41003 C1713 SUPPLY/IMPLANTS "$2,667.00 " Outpatient "$1,333.50 " "$1,219.74 " "$1,733.55 " "$1,866.90 " "$1,760.22 " Not Applicable: Bundled with Procedure $933.45 "$2,133.60 " $933.45 "$2,133.60 " INSRTR SRG PIN REUN 2MM 450006 C1713 SUPPLY/IMPLANTS "$2,455.00 " Outpatient "$1,227.50 " "$1,219.74 " "$1,595.75 " "$1,718.50 " "$1,620.30 " Not Applicable: Bundled with Procedure $859.25 "$1,964.00 " $859.25 "$1,964.00 " INSRTR SRG PIN REUN 2.4MM 450007 C1713 SUPPLY/IMPLANTS "$2,455.00 " Outpatient "$1,227.50 " "$1,219.74 " "$1,595.75 " "$1,718.50 " "$1,620.30 " Not Applicable: Bundled with Procedure $859.25 "$1,964.00 " $859.25 "$1,964.00 " INSRTR SRG LG SCR REUSE 27990 C1713 SUPPLY/IMPLANTS "$2,626.00 " Outpatient "$1,313.00 " "$1,219.74 " "$1,706.90 " "$1,838.20 " "$1,733.16 " Not Applicable: Bundled with Procedure $919.10 "$2,100.80 " $919.10 "$2,100.80 " INSRTR SRG LG SCR 5MM 27997 C1713 SUPPLY/IMPLANTS "$2,994.00 " Outpatient "$1,497.00 " "$1,219.74 " "$1,946.10 " "$2,095.80 " "$1,976.04 " Not Applicable: Bundled with Procedure "$1,047.90 " "$2,395.20 " "$1,047.90 " "$2,395.20 " INSRTR SRG LG SCR CPTR 35-463103 C1713 SUPPLY/IMPLANTS "$3,150.00 " Outpatient "$1,575.00 " "$1,219.74 " "$2,047.50 " "$2,205.00 " "$2,079.00 " Not Applicable: Bundled with Procedure "$1,102.50 " "$2,520.00 " "$1,102.50 " "$2,520.00 " INSRTR SRG 3.5MM SHRT CNCT RTRGD PHNX FEM NL SYS 14-441045 C1713 SUPPLY/IMPLANTS "$3,371.00 " Outpatient "$1,685.50 " "$1,219.74 " "$2,191.15 " "$2,359.70 " "$2,224.86 " Not Applicable: Bundled with Procedure "$1,179.85 " "$2,696.80 " "$1,179.85 " "$2,696.80 " INSRTR SRG LG SF 35-463214 C1713 SUPPLY/IMPLANTS "$3,600.00 " Outpatient "$1,800.00 " "$1,219.74 " "$2,340.00 " "$2,520.00 " "$2,376.00 " Not Applicable: Bundled with Procedure "$1,260.00 " "$2,880.00 " "$1,219.74 " "$2,880.00 " INSRTR SRG LNG CNCT RTRGD PHNX FEM NL SYS 3.5MM 14-441043 C1713 SUPPLY/IMPLANTS "$3,631.00 " Outpatient "$1,815.50 " "$1,219.74 " "$2,360.15 " "$2,541.70 " "$2,396.46 " Not Applicable: Bundled with Procedure "$1,270.85 " "$2,904.80 " "$1,219.74 " "$2,904.80 " INSRTR SRG PLT XTRT 24420 C1713 SUPPLY/IMPLANTS "$4,619.00 " Outpatient "$2,309.50 " "$1,219.74 " "$3,002.35 " "$3,233.30 " "$3,048.54 " Not Applicable: Bundled with Procedure "$1,616.65 " "$3,695.20 " "$1,219.74 " "$3,695.20 " INSRTR SRG CNCT RECON PHNX FEM NL SYS 14-442051 C1713 SUPPLY/IMPLANTS "$5,186.00 " Outpatient "$2,593.00 " "$1,219.74 " "$3,370.90 " "$3,630.20 " "$3,422.76 " Not Applicable: Bundled with Procedure "$1,815.10 " "$4,148.80 " "$1,219.74 " "$4,148.80 " INSRTR SRG LNG CNCT 3.5MM 14-401418 C1713 SUPPLY/IMPLANTS "$9,436.00 " Outpatient "$4,718.00 " "$1,219.74 " "$6,133.40 " "$6,605.20 " "$6,227.76 " Not Applicable: Bundled with Procedure "$3,302.60 " "$7,548.80 " "$1,219.74 " "$7,548.80 " INSRTR SRG LOPRFL LG SCR LNK SS VFX2 HIP 24CM NS 119301200 C1713 SUPPLY/IMPLANTS "$2,451.00 " Outpatient "$1,225.50 " "$1,219.74 " "$1,593.15 " "$1,715.70 " "$1,617.66 " Not Applicable: Bundled with Procedure $857.85 "$1,960.80 " $857.85 "$1,960.80 " INSRTR SRG REPL DRV LNK LOPRFL SS VFX2 HIP NS 119301201 C1713 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 "$1,219.74 " "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " INSRTR SRG NL CAP SS MDN PERC IM NL NS 225505900 C1713 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 "$1,219.74 " "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " INSRTR SRG LCK CAP LNK SS ITST MIS NS 225809201 C1713 SUPPLY/IMPLANTS "$4,804.00 " Outpatient "$2,402.00 " "$1,219.74 " "$3,122.60 " "$3,362.80 " "$3,170.64 " Not Applicable: Bundled with Procedure "$1,681.40 " "$3,843.20 " "$1,219.74 " "$3,843.20 " INSRTR SRG CNN SS 5.5-4.5 MM PERIART LCK PLT SYS NS 236008800 C1713 SUPPLY/IMPLANTS "$2,255.00 " Outpatient "$1,127.50 " "$1,219.74 " "$1,465.75 " "$1,578.50 " "$1,488.30 " Not Applicable: Bundled with Procedure $789.25 "$1,804.00 " $789.25 "$1,804.00 " INSRTR SRG CNCT BOLT NTR NL ZNN IM NL 249003100 C1713 SUPPLY/IMPLANTS "$2,292.00 " Outpatient "$1,146.00 " "$1,219.74 " "$1,489.80 " "$1,604.40 " "$1,512.72 " Not Applicable: Bundled with Procedure $802.20 "$1,833.60 " $802.20 "$1,833.60 " INSRTR SRG CNCT BOLT NTR NL CEPHALOMEDULLARY NL 8MM 249003280 C1713 SUPPLY/IMPLANTS "$2,442.00 " Outpatient "$1,221.00 " "$1,219.74 " "$1,587.30 " "$1,709.40 " "$1,611.72 " Not Applicable: Bundled with Procedure $854.70 "$1,953.60 " $854.70 "$1,953.60 " INSRTR SRG LINR CNSTRN TI MTRX 40MMX.7MM NS 04.511.445 C1713 SUPPLY/IMPLANTS "$2,639.00 " Outpatient "$1,319.50 " "$1,219.74 " "$1,715.35 " "$1,847.30 " "$1,741.74 " Not Applicable: Bundled with Procedure $923.65 "$2,111.20 " $923.65 "$2,111.20 " INST FX RDC SPIN KNOB PLT 236001203 C1713 SUPPLY/IMPLANTS $979.00 Outpatient $489.50 "$1,219.74 " $636.35 $685.30 $646.14 Not Applicable: Bundled with Procedure $342.65 $783.20 $342.65 "$1,219.74 " INST RDC PERIART LCK PLT SLV NS 5.5-4.5 MM SCR 236001202 C1713 SUPPLY/IMPLANTS $994.00 Outpatient $497.00 "$1,219.74 " $646.10 $695.80 $656.04 Not Applicable: Bundled with Procedure $347.90 $795.20 $347.90 "$1,219.74 " INST RDC JSTK NS 6.5 MM SCR 03.211.455 C1713 SUPPLY/IMPLANTS "$2,426.00 " Outpatient "$1,213.00 " "$1,219.74 " "$1,576.90 " "$1,698.20 " "$1,601.16 " Not Applicable: Bundled with Procedure $849.10 "$1,940.80 " $849.10 "$1,940.80 " INSTRUMENTS TRAY 231218103 C1713 SUPPLY/IMPLANTS "$6,066.00 " Outpatient "$3,033.00 " "$1,219.74 " "$3,942.90 " "$4,246.20 " "$4,003.56 " Not Applicable: Bundled with Procedure "$2,123.10 " "$4,852.80 " "$1,219.74 " "$4,852.80 " INTERBODY ALIF COROENT 8027108 C1713 SUPPLY/IMPLANTS "$24,246.00 " Outpatient "$12,123.00 " "$1,219.74 " "$15,759.90 " "$16,972.20 " "$16,002.36 " Not Applicable: Bundled with Procedure "$8,486.10 " "$19,396.80 " "$1,219.74 " "$19,396.80 " INTERMEDIATE VHS DEPTH GAUGE 35-463226 C1713 SUPPLY/IMPLANTS "$3,839.00 " Outpatient "$1,919.50 " "$1,219.74 " "$2,495.35 " "$2,687.30 " "$2,533.74 " Not Applicable: Bundled with Procedure "$1,343.65 " "$3,071.20 " "$1,219.74 " "$3,071.20 " INTRADISCAL SKIN D2701-90060 C1713 SUPPLY/IMPLANTS "$1,140.00 " Outpatient $570.00 "$1,219.74 " $741.00 $798.00 $752.40 Not Applicable: Bundled with Procedure $399.00 $912.00 $399.00 "$1,219.74 " INTRADISCAL SKIN 02701-90060 C1713 SUPPLY/IMPLANTS "$1,140.00 " Outpatient $570.00 "$1,219.74 " $741.00 $798.00 $752.40 Not Applicable: Bundled with Procedure $399.00 $912.00 $399.00 "$1,219.74 " ISOLATER LONG PEN MAX5 C1713 SUPPLY/IMPLANTS "$8,805.00 " Outpatient "$4,402.50 " "$1,219.74 " "$5,723.25 " "$6,163.50 " "$5,811.30 " Not Applicable: Bundled with Procedure "$3,081.75 " "$7,044.00 " "$1,219.74 " "$7,044.00 " JAW BUNDLE F/ORTHOGNATHIC IMPLANT VSPCUST6 C1713 SUPPLY/IMPLANTS "$16,120.00 " Outpatient "$8,060.00 " "$1,219.74 " "$10,478.00 " "$11,284.00 " "$10,639.20 " Not Applicable: Bundled with Procedure "$5,642.00 " "$12,896.00 " "$1,219.74 " "$12,896.00 " JIG PSTN OPTILOCK RL DIST LOPRFL PERIART PLT SYS 27126 C1713 SUPPLY/IMPLANTS "$5,157.00 " Outpatient "$2,578.50 " "$1,219.74 " "$3,352.05 " "$3,609.90 " "$3,403.62 " Not Applicable: Bundled with Procedure "$1,804.95 " "$4,125.60 " "$1,219.74 " "$4,125.60 " JIG PSTN OPTILOCK RL DIST FEM LOPRFL PERIART PLT SYS 27246 C1713 SUPPLY/IMPLANTS "$5,436.00 " Outpatient "$2,718.00 " "$1,219.74 " "$3,533.40 " "$3,805.20 " "$3,587.76 " Not Applicable: Bundled with Procedure "$1,902.60 " "$4,348.80 " "$1,219.74 " "$4,348.80 " JIG PSTN OPTILOCK L/L DIST FEM LOPRFL PERIART PLT SYS 26246 C1713 SUPPLY/IMPLANTS "$5,436.00 " Outpatient "$2,718.00 " "$1,219.74 " "$3,533.40 " "$3,805.20 " "$3,587.76 " Not Applicable: Bundled with Procedure "$1,902.60 " "$4,348.80 " "$1,219.74 " "$4,348.80 " JIG PSTN VERSANAIL UNV BD 2810-17-009 C1713 SUPPLY/IMPLANTS "$8,389.00 " Outpatient "$4,194.50 " "$1,219.74 " "$5,452.85 " "$5,872.30 " "$5,536.74 " Not Applicable: Bundled with Procedure "$2,936.15 " "$6,711.20 " "$1,219.74 " "$6,711.20 " JIG PSTN VERSANAIL TIB XTD CMPLT 2810-12-003 C1713 SUPPLY/IMPLANTS "$13,124.00 " Outpatient "$6,562.00 " "$1,219.74 " "$8,530.60 " "$9,186.80 " "$8,661.84 " Not Applicable: Bundled with Procedure "$4,593.40 " "$10,499.20 " "$1,219.74 " "$10,499.20 " JIG PSTN VERSANAIL LOPRFL TIB SET 2810-12-007 C1713 SUPPLY/IMPLANTS "$17,423.00 " Outpatient "$8,711.50 " "$1,219.74 " "$11,324.95 " "$12,196.10 " "$11,499.18 " Not Applicable: Bundled with Procedure "$6,098.05 " "$13,938.40 " "$1,219.74 " "$13,938.40 " JIG PSTN 125D INS AFFIXUS HIP FX NL SYS 2112-01-200 C1713 SUPPLY/IMPLANTS "$22,049.00 " Outpatient "$11,024.50 " "$1,219.74 " "$14,331.85 " "$15,434.30 " "$14,552.34 " Not Applicable: Bundled with Procedure "$7,717.15 " "$17,639.20 " "$1,219.74 " "$17,639.20 " JIG PSTN 130D INS AFFIXUS HIP FX NL SYS 2112-01-201 C1713 SUPPLY/IMPLANTS "$22,049.00 " Outpatient "$11,024.50 " "$1,219.74 " "$14,331.85 " "$15,434.30 " "$14,552.34 " Not Applicable: Bundled with Procedure "$7,717.15 " "$17,639.20 " "$1,219.74 " "$17,639.20 " JIG PSTN 125D INS FXTR ASMB 2112-01-207 C1713 SUPPLY/IMPLANTS "$33,603.00 " Outpatient "$16,801.50 " "$1,219.74 " "$21,841.95 " "$23,522.10 " "$22,177.98 " Not Applicable: Bundled with Procedure "$11,761.05 " "$26,882.40 " "$1,219.74 " "$26,882.40 " JIG PSTN 130D INS FXTR ASMB 2112-01-208 C1713 SUPPLY/IMPLANTS "$33,603.00 " Outpatient "$16,801.50 " "$1,219.74 " "$21,841.95 " "$23,522.10 " "$22,177.98 " Not Applicable: Bundled with Procedure "$11,761.05 " "$26,882.40 " "$1,219.74 " "$26,882.40 " JIG PSTN MNMGNFX SS PRLL PLC NS 114201300 C1713 SUPPLY/IMPLANTS "$2,936.00 " Outpatient "$1,468.00 " "$1,219.74 " "$1,908.40 " "$2,055.20 " "$1,937.76 " Not Applicable: Bundled with Procedure "$1,027.60 " "$2,348.80 " "$1,027.60 " "$2,348.80 " JIG PSTN PERC PERIART LCK 5.5-4.5 MM SCR 235807000 C1713 SUPPLY/IMPLANTS "$6,917.00 " Outpatient "$3,458.50 " "$1,219.74 " "$4,496.05 " "$4,841.90 " "$4,565.22 " Not Applicable: Bundled with Procedure "$2,420.95 " "$5,533.60 " "$1,219.74 " "$5,533.60 " JIG PSTN FEM RT DIST LAT SS RADEL PERIART LCK PLT SYS NS 236009001 C1713 SUPPLY/IMPLANTS "$2,311.00 " Outpatient "$1,155.50 " "$1,219.74 " "$1,502.15 " "$1,617.70 " "$1,525.26 " Not Applicable: Bundled with Procedure $808.85 "$1,848.80 " $808.85 "$1,848.80 " JIG PSTN FEM LT DIST LAT SS RADEL PERIART LCK PLT SYS NS 236009002 C1713 SUPPLY/IMPLANTS "$2,311.00 " Outpatient "$1,155.50 " "$1,219.74 " "$1,502.15 " "$1,617.70 " "$1,525.26 " Not Applicable: Bundled with Procedure $808.85 "$1,848.80 " $808.85 "$1,848.80 " JIG PSTN PERC SS HNG BOLT MIS PERIART LCK PLT SYS NS 236009011 C1713 SUPPLY/IMPLANTS $696.00 Outpatient $348.00 "$1,219.74 " $452.40 $487.20 $459.36 Not Applicable: Bundled with Procedure $243.60 $556.80 $243.60 "$1,219.74 " JIG PSTN PERC SS THB SCR MIS PERIART LCK PLT SYS NS 236009013 C1713 SUPPLY/IMPLANTS $696.00 Outpatient $348.00 "$1,219.74 " $452.40 $487.20 $459.36 Not Applicable: Bundled with Procedure $243.60 $556.80 $243.60 "$1,219.74 " JIG PSTN BLK FEM RT PERC DIST SS CF PEEK MIS PERIART LCK PLT 236009015 C1713 SUPPLY/IMPLANTS "$40,965.00 " Outpatient "$20,482.50 " "$1,219.74 " "$26,627.25 " "$28,675.50 " "$27,036.90 " Not Applicable: Bundled with Procedure "$14,337.75 " "$32,772.00 " "$1,219.74 " "$32,772.00 " JIG PSTN BLK FEM LT PERC DIST SS CF PEEK MIS PERIART LCK PLT 236009016 C1713 SUPPLY/IMPLANTS "$40,965.00 " Outpatient "$20,482.50 " "$1,219.74 " "$26,627.25 " "$28,675.50 " "$27,036.90 " Not Applicable: Bundled with Procedure "$14,337.75 " "$32,772.00 " "$1,219.74 " "$32,772.00 " JIG PSTN STD TIB RT PROX LAT SS RADEL 5.5MM SCR MIS PERIART 236009101 C1713 SUPPLY/IMPLANTS "$2,029.00 " Outpatient "$1,014.50 " "$1,219.74 " "$1,318.85 " "$1,420.30 " "$1,339.14 " Not Applicable: Bundled with Procedure $710.15 "$1,623.20 " $710.15 "$1,623.20 " JIG PSTN STD TIB LT PROX LAT SS RADEL 5.5MM SCR MIS PERIART 236009102 C1713 SUPPLY/IMPLANTS "$2,029.00 " Outpatient "$1,014.50 " "$1,219.74 " "$1,318.85 " "$1,420.30 " "$1,339.14 " Not Applicable: Bundled with Procedure $710.15 "$1,623.20 " $710.15 "$1,623.20 " JIG PSTN BLK TIB RT PROX LAT SS CF PEEK 5.5MM SCR MIS 236009115 C1713 SUPPLY/IMPLANTS "$12,124.00 " Outpatient "$6,062.00 " "$1,219.74 " "$7,880.60 " "$8,486.80 " "$8,001.84 " Not Applicable: Bundled with Procedure "$4,243.40 " "$9,699.20 " "$1,219.74 " "$9,699.20 " JIG PSTN BLK TIB LT PROX LAT SS CF PEEK 5.5MM SCR MIS 236009116 C1713 SUPPLY/IMPLANTS "$12,124.00 " Outpatient "$6,062.00 " "$1,219.74 " "$7,880.60 " "$8,486.80 " "$8,001.84 " Not Applicable: Bundled with Procedure "$4,243.40 " "$9,699.20 " "$1,219.74 " "$9,699.20 " JIG PSTN STD HUM RT PROX LAT SS RADEL PERIART LCK PLT SYS NS 236009201 C1713 SUPPLY/IMPLANTS "$2,029.00 " Outpatient "$1,014.50 " "$1,219.74 " "$1,318.85 " "$1,420.30 " "$1,339.14 " Not Applicable: Bundled with Procedure $710.15 "$1,623.20 " $710.15 "$1,623.20 " JIG PSTN STD TIB RT PROX LAT SS RADEL 3.5MM SCR PERIART LCK 236009301 C1713 SUPPLY/IMPLANTS "$2,311.00 " Outpatient "$1,155.50 " "$1,219.74 " "$1,502.15 " "$1,617.70 " "$1,525.26 " Not Applicable: Bundled with Procedure $808.85 "$1,848.80 " $808.85 "$1,848.80 " JIG PSTN STD TIB LT PROX LAT SS RADEL 3.5MM SCR PERIART LCK 236009302 C1713 SUPPLY/IMPLANTS "$2,311.00 " Outpatient "$1,155.50 " "$1,219.74 " "$1,502.15 " "$1,617.70 " "$1,525.26 " Not Applicable: Bundled with Procedure $808.85 "$1,848.80 " $808.85 "$1,848.80 " JIG PSTN TIB RT PROX LAT 30% C REINF PEEK SS 3.5 MM SCR MIS 236009305 C1713 SUPPLY/IMPLANTS "$39,289.00 " Outpatient "$19,644.50 " "$1,219.74 " "$25,537.85 " "$27,502.30 " "$25,930.74 " Not Applicable: Bundled with Procedure "$13,751.15 " "$31,431.20 " "$1,219.74 " "$31,431.20 " JIG PSTN TIB LT PROX LAT 30% C REINF PEEK SS 3.5 MM SCR MIS 236009306 C1713 SUPPLY/IMPLANTS "$39,289.00 " Outpatient "$19,644.50 " "$1,219.74 " "$25,537.85 " "$27,502.30 " "$25,930.74 " Not Applicable: Bundled with Procedure "$13,751.15 " "$31,431.20 " "$1,219.74 " "$31,431.20 " JIG PSTN STD TIB RT DIST MDL SS RADEL MIS PERIART LCK PLT 236009401 C1713 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 "$1,219.74 " "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " JIG PSTN STD TIB LT DIST MDL SS RADEL MIS PERIART LCK PLT 236009402 C1713 SUPPLY/IMPLANTS "$1,710.00 " Outpatient $855.00 "$1,219.74 " "$1,111.50 " "$1,197.00 " "$1,128.60 " Not Applicable: Bundled with Procedure $598.50 "$1,368.00 " $598.50 "$1,368.00 " JIG PSTN STD TIB RT DIST MDL SS RADEL PERIART LCK PLT SYS NS 236009501 C1713 SUPPLY/IMPLANTS "$2,311.00 " Outpatient "$1,155.50 " "$1,219.74 " "$1,502.15 " "$1,617.70 " "$1,525.26 " Not Applicable: Bundled with Procedure $808.85 "$1,848.80 " $808.85 "$1,848.80 " JIG PSTN STD TIB LT DIST MDL SS RADEL PERIART LCK PLT SYS NS 236009502 C1713 SUPPLY/IMPLANTS "$2,311.00 " Outpatient "$1,155.50 " "$1,219.74 " "$1,502.15 " "$1,617.70 " "$1,525.26 " Not Applicable: Bundled with Procedure $808.85 "$1,848.80 " $808.85 "$1,848.80 " JIG PSTN STD RDS RT DIST LAT RADEL CLMN PERIART LCK PLT SYS 236009601 C1713 SUPPLY/IMPLANTS "$1,353.00 " Outpatient $676.50 "$1,219.74 " $879.45 $947.10 $892.98 Not Applicable: Bundled with Procedure $473.55 "$1,082.40 " $473.55 "$1,219.74 " JIG PSTN STD RDS LT DIST LAT RADEL CLMN PERIART LCK PLT SYS 236009602 C1713 SUPPLY/IMPLANTS "$1,353.00 " Outpatient $676.50 "$1,219.74 " $879.45 $947.10 $892.98 Not Applicable: Bundled with Procedure $473.55 "$1,082.40 " $473.55 "$1,219.74 " JIG PSTN T STD RDS RT DIST DRSL RADEL PERIART LCK PLT SYS NS 236009801 C1713 SUPPLY/IMPLANTS "$1,353.00 " Outpatient $676.50 "$1,219.74 " $879.45 $947.10 $892.98 Not Applicable: Bundled with Procedure $473.55 "$1,082.40 " $473.55 "$1,219.74 " JIG PSTN T STD RDS LT DIST DRSL RADEL PERIART LCK PLT SYS NS 236009802 C1713 SUPPLY/IMPLANTS "$1,353.00 " Outpatient $676.50 "$1,219.74 " $879.45 $947.10 $892.98 Not Applicable: Bundled with Procedure $473.55 "$1,082.40 " $473.55 "$1,219.74 " JIG PSTN DLT STD RDS RT DIST DRSL RADEL PERIART LCK PLT SYS 236009901 C1713 SUPPLY/IMPLANTS "$1,353.00 " Outpatient $676.50 "$1,219.74 " $879.45 $947.10 $892.98 Not Applicable: Bundled with Procedure $473.55 "$1,082.40 " $473.55 "$1,219.74 " JIG PSTN DLT STD RDS LT DIST DRSL RADEL PERIART LCK PLT SYS 236009902 C1713 SUPPLY/IMPLANTS "$1,353.00 " Outpatient $676.50 "$1,219.74 " $879.45 $947.10 $892.98 Not Applicable: Bundled with Procedure $473.55 "$1,082.40 " $473.55 "$1,219.74 " JIG PSTN FIB LT DIST LAT PERIART LCK NS 236010102 C1713 SUPPLY/IMPLANTS "$1,015.00 " Outpatient $507.50 "$1,219.74 " $659.75 $710.50 $669.90 Not Applicable: Bundled with Procedure $355.25 $812.00 $355.25 "$1,219.74 " JIG PSTN HUM RT DIST MDL PERIART LCK NS 236010301 C1713 SUPPLY/IMPLANTS "$2,517.00 " Outpatient "$1,258.50 " "$1,219.74 " "$1,636.05 " "$1,761.90 " "$1,661.22 " Not Applicable: Bundled with Procedure $880.95 "$2,013.60 " $880.95 "$2,013.60 " JIG PSTN HUM LT DIST MDL PERIART LCK NS 236010302 C1713 SUPPLY/IMPLANTS "$2,517.00 " Outpatient "$1,258.50 " "$1,219.74 " "$1,636.05 " "$1,761.90 " "$1,661.22 " Not Applicable: Bundled with Procedure $880.95 "$2,013.60 " $880.95 "$2,013.60 " JIG PSTN SHRT HUM RT DIST MDL PERIART LCK NS 236010303 C1713 SUPPLY/IMPLANTS "$2,517.00 " Outpatient "$1,258.50 " "$1,219.74 " "$1,636.05 " "$1,761.90 " "$1,661.22 " Not Applicable: Bundled with Procedure $880.95 "$2,013.60 " $880.95 "$2,013.60 " JIG PSTN SHRT HUM LT DIST MDL PERIART LCK NS 236010304 C1713 SUPPLY/IMPLANTS "$2,517.00 " Outpatient "$1,258.50 " "$1,219.74 " "$1,636.05 " "$1,761.90 " "$1,661.22 " Not Applicable: Bundled with Procedure $880.95 "$2,013.60 " $880.95 "$2,013.60 " JIG PSTN ELB ULNA RT PROX PERIART LCK NS 236010401 C1713 SUPPLY/IMPLANTS "$2,517.00 " Outpatient "$1,258.50 " "$1,219.74 " "$1,636.05 " "$1,761.90 " "$1,661.22 " Not Applicable: Bundled with Procedure $880.95 "$2,013.60 " $880.95 "$2,013.60 " JIG PSTN ELB ULNA LT PROX PERIART LCK NS 236010402 C1713 SUPPLY/IMPLANTS "$2,517.00 " Outpatient "$1,258.50 " "$1,219.74 " "$1,636.05 " "$1,761.90 " "$1,661.22 " Not Applicable: Bundled with Procedure $880.95 "$2,013.60 " $880.95 "$2,013.60 " JIG PSTN NCB HUM PROX 3.5 MM LCK SCR 200024220 C1713 SUPPLY/IMPLANTS "$1,967.00 " Outpatient $983.50 "$1,219.74 " "$1,278.55 " "$1,376.90 " "$1,298.22 " Not Applicable: Bundled with Procedure $688.45 "$1,573.60 " $688.45 "$1,573.60 " K WIRE 2.0 703561 C1713 SUPPLY/IMPLANTS $473.00 Outpatient $236.50 "$1,219.74 " $307.45 $331.10 $312.18 Not Applicable: Bundled with Procedure $165.55 $378.40 $165.55 "$1,219.74 " K WIRE TROCAR POINT 1.6MM 929.16 C1713 SUPPLY/IMPLANTS $577.00 Outpatient $288.50 "$1,219.74 " $375.05 $403.90 $380.82 Not Applicable: Bundled with Procedure $201.95 $461.60 $201.95 "$1,219.74 " K WIRE AR-A4016B C1713 SUPPLY/IMPLANTS $586.00 Outpatient $293.00 "$1,219.74 " $380.90 $410.20 $386.76 Not Applicable: Bundled with Procedure $205.10 $468.80 $205.10 "$1,219.74 " K WIRE 10-NBN-0520 C1713 SUPPLY/IMPLANTS $714.00 Outpatient $357.00 "$1,219.74 " $464.10 $499.80 $471.24 Not Applicable: Bundled with Procedure $249.90 $571.20 $249.90 "$1,219.74 " K WIRE 2.5MM X 15MM THREAD TROCOR PINT 200MM 292.76 C1713 SUPPLY/IMPLANTS "$1,323.00 " Outpatient $661.50 "$1,219.74 " $859.95 $926.10 $873.18 Not Applicable: Bundled with Procedure $463.05 "$1,058.40 " $463.05 "$1,219.74 " K-WIRE PACK 3.2MM 1147-92 C1713 SUPPLY/IMPLANTS $718.00 Outpatient $359.00 "$1,219.74 " $466.70 $502.60 $473.88 Not Applicable: Bundled with Procedure $251.30 $574.40 $251.30 "$1,219.74 " K-WIRE 34MM OLIVE 10MM A-6045.40/1 C1713 SUPPLY/IMPLANTS $589.00 Outpatient $294.50 "$1,219.74 " $382.85 $412.30 $388.74 Not Applicable: Bundled with Procedure $206.15 $471.20 $206.15 "$1,219.74 " K-WIRE 13-1035 C1713 SUPPLY/IMPLANTS "$1,155.00 " Outpatient $577.50 "$1,219.74 " $750.75 $808.50 $762.30 Not Applicable: Bundled with Procedure $404.25 $924.00 $404.25 "$1,219.74 " K-WIRE 1.4MM X 305MM 9080-124 C1713 SUPPLY/IMPLANTS "$1,632.00 " Outpatient $816.00 "$1,219.74 " "$1,060.80 " "$1,142.40 " "$1,077.12 " Not Applicable: Bundled with Procedure $571.20 "$1,305.60 " $571.20 "$1,305.60 " KEYED LAG SCREWSTD 105MM STER 8013-00-105 C1713 SUPPLY/IMPLANTS "$1,700.00 " Outpatient $850.00 "$1,219.74 " "$1,105.00 " "$1,190.00 " "$1,122.00 " Not Applicable: Bundled with Procedure $595.00 "$1,360.00 " $595.00 "$1,360.00 " KEYED LAG SCR SUPER STER 60MM 8013-01-060 C1713 SUPPLY/IMPLANTS "$1,802.00 " Outpatient $901.00 "$1,219.74 " "$1,171.30 " "$1,261.40 " "$1,189.32 " Not Applicable: Bundled with Procedure $630.70 "$1,441.60 " $630.70 "$1,441.60 " KEYED LAG SCR SUPER STER 70MM 8013-01-070 C1713 SUPPLY/IMPLANTS "$1,802.00 " Outpatient $901.00 "$1,219.74 " "$1,171.30 " "$1,261.40 " "$1,189.32 " Not Applicable: Bundled with Procedure $630.70 "$1,441.60 " $630.70 "$1,441.60 " KEYLESS LAG SCREWSTD 60MM STER 8013-02-060 C1713 SUPPLY/IMPLANTS "$1,700.00 " Outpatient $850.00 "$1,219.74 " "$1,105.00 " "$1,190.00 " "$1,122.00 " Not Applicable: Bundled with Procedure $595.00 "$1,360.00 " $595.00 "$1,360.00 " KEYLESS LAG SCREWSTD 70MM STER 8013-02-070 C1713 SUPPLY/IMPLANTS "$1,700.00 " Outpatient $850.00 "$1,219.74 " "$1,105.00 " "$1,190.00 " "$1,122.00 " Not Applicable: Bundled with Procedure $595.00 "$1,360.00 " $595.00 "$1,360.00 " KEYLESS LAG SCREWSTD 75MM STER 8013-02-075 C1713 SUPPLY/IMPLANTS "$1,700.00 " Outpatient $850.00 "$1,219.74 " "$1,105.00 " "$1,190.00 " "$1,122.00 " Not Applicable: Bundled with Procedure $595.00 "$1,360.00 " $595.00 "$1,360.00 " KEYLESS LAG SCREWSTD 85MM STER 8013-02-085 C1713 SUPPLY/IMPLANTS "$1,700.00 " Outpatient $850.00 "$1,219.74 " "$1,105.00 " "$1,190.00 " "$1,122.00 " Not Applicable: Bundled with Procedure $595.00 "$1,360.00 " $595.00 "$1,360.00 " KEYLESS LAG SCREWSTD 90MM STER 8013-02-090 C1713 SUPPLY/IMPLANTS "$1,700.00 " Outpatient $850.00 "$1,219.74 " "$1,105.00 " "$1,190.00 " "$1,122.00 " Not Applicable: Bundled with Procedure $595.00 "$1,360.00 " $595.00 "$1,360.00 " KEYLESS LAG SCREWSTD 100MM STER 8013-02-100 C1713 SUPPLY/IMPLANTS "$1,700.00 " Outpatient $850.00 "$1,219.74 " "$1,105.00 " "$1,190.00 " "$1,122.00 " Not Applicable: Bundled with Procedure $595.00 "$1,360.00 " $595.00 "$1,360.00 " KEYLESS PLATE 78.5MM 4 HOLE 200502 C1713 SUPPLY/IMPLANTS "$4,266.00 " Outpatient "$2,133.00 " "$1,219.74 " "$2,772.90 " "$2,986.20 " "$2,815.56 " Not Applicable: Bundled with Procedure "$1,493.10 " "$3,412.80 " "$1,219.74 " "$3,412.80 " KIT ARTHROSCOPIC FIXATION ARTHREX SUTURETAPE STERILE LATEX F AR-8862DS C1713 SUPPLY/IMPLANTS "$7,296.00 " Outpatient "$3,648.00 " "$1,219.74 " "$4,742.40 " "$5,107.20 " "$4,815.36 " Not Applicable: Bundled with Procedure "$2,553.60 " "$5,836.80 " "$1,219.74 " "$5,836.80 " KIT ARTHROSCOPIC BIOSCREW HYPERFLEX NITINOL UNIVERSAL L18.5 8821 C1713 SUPPLY/IMPLANTS $733.00 Outpatient $366.50 "$1,219.74 " $476.45 $513.10 $483.78 Not Applicable: Bundled with Procedure $256.55 $586.40 $256.55 "$1,219.74 " KIT ARTHROSCOPIC FIXATION INTERNALBRACE SWIVELOCK BIOCOMPOSI AR-1788J-CP C1713 SUPPLY/IMPLANTS "$7,315.00 " Outpatient "$3,657.50 " "$1,219.74 " "$4,754.75 " "$5,120.50 " "$4,827.90 " Not Applicable: Bundled with Procedure "$2,560.25 " "$5,852.00 " "$1,219.74 " "$5,852.00 " KIT ASCP FX BTN DRL PIN INSRTR SCR STRL AR-2260 C1713 SUPPLY/IMPLANTS "$5,944.00 " Outpatient "$2,972.00 " "$1,219.74 " "$3,863.60 " "$4,160.80 " "$3,923.04 " Not Applicable: Bundled with Procedure "$2,080.40 " "$4,755.20 " "$1,219.74 " "$4,755.20 " KIT ASCP FX ACL PCL KN 1.2MM RPC DRL GD LF 72202798 C1713 SUPPLY/IMPLANTS "$1,460.00 " Outpatient $730.00 "$1,219.74 " $949.00 "$1,022.00 " $963.60 Not Applicable: Bundled with Procedure $511.00 "$1,168.00 " $511.00 "$1,219.74 " KIT ASCP FX MCL INTERNALBRACE FIBERTAPE SWIVELOCK 2 ANCH 2 AR-5511-CP C1713 SUPPLY/IMPLANTS "$8,354.00 " Outpatient "$4,177.00 " "$1,219.74 " "$5,430.10 " "$5,847.80 " "$5,513.64 " Not Applicable: Bundled with Procedure "$2,923.90 " "$6,683.20 " "$1,219.74 " "$6,683.20 " KIT ASCP FX INTERNALBRACE FIBERTAPE CLGN LGMNT AUG REPR AR-1688-CP C1713 SUPPLY/IMPLANTS "$7,512.00 " Outpatient "$3,756.00 " "$1,219.74 " "$4,882.80 " "$5,258.40 " "$4,957.92 " Not Applicable: Bundled with Procedure "$2,629.20 " "$6,009.60 " "$1,219.74 " "$6,009.60 " KIT ASCP FX SFT TIS 1.4MM JUGGERKNOT SHRT GD DRLBT DISP 912073 C1713 SUPPLY/IMPLANTS "$1,506.00 " Outpatient $753.00 "$1,219.74 " $978.90 "$1,054.20 " $993.96 Not Applicable: Bundled with Procedure $527.10 "$1,204.80 " $527.10 "$1,219.74 " KIT ASCP FX 2.1MM JUGGERKNOT SFT ANCH DISP 110003172 C1713 SUPPLY/IMPLANTS "$1,579.00 " Outpatient $789.50 "$1,219.74 " "$1,026.35 " "$1,105.30 " "$1,042.14 " Not Applicable: Bundled with Procedure $552.65 "$1,263.20 " $552.65 "$1,263.20 " KIT ATSBWL SEP TUBE SYR NDL SET TRNQT 10ML MN GPS III DISP 800-0505A C1713 SUPPLY/IMPLANTS "$1,426.00 " Outpatient $713.00 "$1,219.74 " $926.90 $998.20 $941.16 Not Applicable: Bundled with Procedure $499.10 "$1,140.80 " $499.10 "$1,219.74 " KIT BN CMNT VERTAPLEX HV AUTOPLEX WO NDL DLV SYS STRL 607687000 C1713 SUPPLY/IMPLANTS "$4,076.00 " Outpatient "$2,038.00 " "$1,219.74 " "$2,649.40 " "$2,853.20 " "$2,690.16 " Not Applicable: Bundled with Procedure "$1,426.60 " "$3,260.80 " "$1,219.74 " "$3,260.80 " KIT CNTRF 30ML 1 PLTL CONC DISP GPS III 8001003A C1713 SUPPLY/IMPLANTS "$1,426.00 " Outpatient $713.00 "$1,219.74 " $926.90 $998.20 $941.16 Not Applicable: Bundled with Procedure $499.10 "$1,140.80 " $499.10 "$1,219.74 " KIT DCMPRS SPNE 7.5MM MCBLD SD CTR SHVR IO-MBS7.5SC C1713 SUPPLY/IMPLANTS "$6,819.00 " Outpatient "$3,409.50 " "$1,219.74 " "$4,432.35 " "$4,773.30 " "$4,500.54 " Not Applicable: Bundled with Procedure "$2,386.65 " "$5,455.20 " "$1,219.74 " "$5,455.20 " KIT ESCP INST TGHTRP CNN STRL DISP ANKL SYNDESMOSIS REPR AR-8921CDS C1713 SUPPLY/IMPLANTS "$3,669.00 " Outpatient "$1,834.50 " "$1,219.74 " "$2,384.85 " "$2,568.30 " "$2,421.54 " Not Applicable: Bundled with Procedure "$1,284.15 " "$2,935.20 " "$1,219.74 " "$2,935.20 " KIT ESCP INST TGHTRP CNN STRL SYNDESMOSIS REPR ASCP SS AR-8926SS C1713 SUPPLY/IMPLANTS "$6,153.00 " Outpatient "$3,076.50 " "$1,219.74 " "$3,999.45 " "$4,307.10 " "$4,060.98 " Not Applicable: Bundled with Procedure "$2,153.55 " "$4,922.40 " "$1,219.74 " "$4,922.40 " KIT FX 1.3MM 1.4MM OTHSRB KRSH LCTSRB TPR PIN 110010745 C1713 SUPPLY/IMPLANTS $969.00 Outpatient $484.50 "$1,219.74 " $629.85 $678.30 $639.54 Not Applicable: Bundled with Procedure $339.15 $775.20 $339.15 "$1,219.74 " KIT IM NL .062IN SLT AWL LK DV BNDRG TL CAP SM BN FX SYS SBFS062 C1713 SUPPLY/IMPLANTS "$2,445.00 " Outpatient "$1,222.50 " "$1,219.74 " "$1,589.25 " "$1,711.50 " "$1,613.70 " Not Applicable: Bundled with Procedure $855.75 "$1,956.00 " $855.75 "$1,956.00 " KIT IM NL 360MM 11MM GMA 125D LNG R1.5 FEM LT TI STRL LF 3525-1360S C1713 SUPPLY/IMPLANTS "$12,898.00 " Outpatient "$6,449.00 " "$1,219.74 " "$8,383.70 " "$9,028.60 " "$8,512.68 " Not Applicable: Bundled with Procedure "$4,514.30 " "$10,318.40 " "$1,219.74 " "$10,318.40 " KIT IM NL 400MM 13MM 125D R1.5 LNG RT TI 3425-3400S C1713 SUPPLY/IMPLANTS "$12,898.00 " Outpatient "$6,449.00 " "$1,219.74 " "$8,383.70 " "$9,028.60 " "$8,512.68 " Not Applicable: Bundled with Procedure "$4,514.30 " "$10,318.40 " "$1,219.74 " "$10,318.40 " KIT IM NL 360MM 15MM 125D R1.5 LNG RT TI 3425-5360S C1713 SUPPLY/IMPLANTS "$12,898.00 " Outpatient "$6,449.00 " "$1,219.74 " "$8,383.70 " "$9,028.60 " "$8,512.68 " Not Applicable: Bundled with Procedure "$4,514.30 " "$10,318.40 " "$1,219.74 " "$10,318.40 " KIT IM NL 360MM 13MM 125D R1.5 LNG LT TI 3525-3360S C1713 SUPPLY/IMPLANTS "$12,898.00 " Outpatient "$6,449.00 " "$1,219.74 " "$8,383.70 " "$9,028.60 " "$8,512.68 " Not Applicable: Bundled with Procedure "$4,514.30 " "$10,318.40 " "$1,219.74 " "$10,318.40 " KIT IM NL 360MM 13MM 125D R1.5 LNG RT TI 3425-3360S C1713 SUPPLY/IMPLANTS "$12,898.00 " Outpatient "$6,449.00 " "$1,219.74 " "$8,383.70 " "$9,028.60 " "$8,512.68 " Not Applicable: Bundled with Procedure "$4,514.30 " "$10,318.40 " "$1,219.74 " "$10,318.40 " KIT IM NL 380MM 11MM GMA 125D LNG R1.5 FEM LT TI STRL LF 3525-1380S C1713 SUPPLY/IMPLANTS "$12,898.00 " Outpatient "$6,449.00 " "$1,219.74 " "$8,383.70 " "$9,028.60 " "$8,512.68 " Not Applicable: Bundled with Procedure "$4,514.30 " "$10,318.40 " "$1,219.74 " "$10,318.40 " KIT IM NL 380MM 13MM 130D R1.5 LNG LT TI 3530-3380S C1713 SUPPLY/IMPLANTS "$12,898.00 " Outpatient "$6,449.00 " "$1,219.74 " "$8,383.70 " "$9,028.60 " "$8,512.68 " Not Applicable: Bundled with Procedure "$4,514.30 " "$10,318.40 " "$1,219.74 " "$10,318.40 " KIT IM NL 360MM 11MM 130D R1.5 LNG RT TI 3430-1360S C1713 SUPPLY/IMPLANTS "$12,898.00 " Outpatient "$6,449.00 " "$1,219.74 " "$8,383.70 " "$9,028.60 " "$8,512.68 " Not Applicable: Bundled with Procedure "$4,514.30 " "$10,318.40 " "$1,219.74 " "$10,318.40 " KIT IM NL 420MM 11MM GMA 125D LNG R1.5 FEM RT TI STRL LF 3425-1420S C1713 SUPPLY/IMPLANTS "$12,898.00 " Outpatient "$6,449.00 " "$1,219.74 " "$8,383.70 " "$9,028.60 " "$8,512.68 " Not Applicable: Bundled with Procedure "$4,514.30 " "$10,318.40 " "$1,219.74 " "$10,318.40 " KIT IM NL 380MM 11MM GMA 130D LNG R1.5 FEM LT TI STRL LF 3530-1380S C1713 SUPPLY/IMPLANTS "$12,898.00 " Outpatient "$6,449.00 " "$1,219.74 " "$8,383.70 " "$9,028.60 " "$8,512.68 " Not Applicable: Bundled with Procedure "$4,514.30 " "$10,318.40 " "$1,219.74 " "$10,318.40 " KIT IM NL 360MM 11MM GMA 125D LNG R1.5 FEM RT TI STRL LF 3425-1360S C1713 SUPPLY/IMPLANTS "$12,898.00 " Outpatient "$6,449.00 " "$1,219.74 " "$8,383.70 " "$9,028.60 " "$8,512.68 " Not Applicable: Bundled with Procedure "$4,514.30 " "$10,318.40 " "$1,219.74 " "$10,318.40 " KIT IM NL 420MM 11MM GMA 125D LNG R1.5 FEM LT TI STRL LF 3525-1420S C1713 SUPPLY/IMPLANTS "$12,444.00 " Outpatient "$6,222.00 " "$1,219.74 " "$8,088.60 " "$8,710.80 " "$8,213.04 " Not Applicable: Bundled with Procedure "$4,355.40 " "$9,955.20 " "$1,219.74 " "$9,955.20 " KIT IM NL 400MM 11MM 130D R1.5 LNG LT TI 3530-1400S C1713 SUPPLY/IMPLANTS "$12,436.00 " Outpatient "$6,218.00 " "$1,219.74 " "$8,083.40 " "$8,705.20 " "$8,207.76 " Not Applicable: Bundled with Procedure "$4,352.60 " "$9,948.80 " "$1,219.74 " "$9,948.80 " KIT IM NL 340MM 11MM GMA 125D LNG R1.5 FEM RT TI STRL LF 3425-1340S C1713 SUPPLY/IMPLANTS "$12,891.00 " Outpatient "$6,445.50 " "$1,219.74 " "$8,379.15 " "$9,023.70 " "$8,508.06 " Not Applicable: Bundled with Procedure "$4,511.85 " "$10,312.80 " "$1,219.74 " "$10,312.80 " KIT IM NL 420MM 11MM 130D R1.5 LNG LT TI 3530-1420S C1713 SUPPLY/IMPLANTS "$12,891.00 " Outpatient "$6,445.50 " "$1,219.74 " "$8,379.15 " "$9,023.70 " "$8,508.06 " Not Applicable: Bundled with Procedure "$4,511.85 " "$10,312.80 " "$1,219.74 " "$10,312.80 " KIT IM NL 340MM 13MM 125D R1.5 LNG LT TI 3525-3340S C1713 SUPPLY/IMPLANTS "$12,436.00 " Outpatient "$6,218.00 " "$1,219.74 " "$8,083.40 " "$8,705.20 " "$8,207.76 " Not Applicable: Bundled with Procedure "$4,352.60 " "$9,948.80 " "$1,219.74 " "$9,948.80 " KIT IM NL 360MM 13MM 130D R1.5 LNG RT TI 3430-3360S C1713 SUPPLY/IMPLANTS "$12,436.00 " Outpatient "$6,218.00 " "$1,219.74 " "$8,083.40 " "$8,705.20 " "$8,207.76 " Not Applicable: Bundled with Procedure "$4,352.60 " "$9,948.80 " "$1,219.74 " "$9,948.80 " KIT IM NL 320MM 11MM 125D R1.5 LT TI 3525-1320S C1713 SUPPLY/IMPLANTS "$12,436.00 " Outpatient "$6,218.00 " "$1,219.74 " "$8,083.40 " "$8,705.20 " "$8,207.76 " Not Applicable: Bundled with Procedure "$4,352.60 " "$9,948.80 " "$1,219.74 " "$9,948.80 " KIT IMPL XL CRNL PEEK CSTM 78-10040 C1713 SUPPLY/IMPLANTS "$91,469.00 " Outpatient "$45,734.50 " "$1,219.74 " "$59,454.85 " "$64,028.30 " "$60,369.54 " Not Applicable: Bundled with Procedure "$32,014.15 " "$73,175.20 " "$1,219.74 " "$73,175.20 " KIT IM NL 420MM 13MM 130D R1.5 LNG LT TI 3530-3420S C1713 SUPPLY/IMPLANTS "$12,436.00 " Outpatient "$6,218.00 " "$1,219.74 " "$8,083.40 " "$8,705.20 " "$8,207.76 " Not Applicable: Bundled with Procedure "$4,352.60 " "$9,948.80 " "$1,219.74 " "$9,948.80 " KIT IM NL 340MM 11MM 130D R1.5 LNG LT TI 3530-1340S C1713 SUPPLY/IMPLANTS "$15,305.00 " Outpatient "$7,652.50 " "$1,219.74 " "$9,948.25 " "$10,713.50 " "$10,101.30 " Not Applicable: Bundled with Procedure "$5,356.75 " "$12,244.00 " "$1,219.74 " "$12,244.00 " KIT IM NL 360MM 11MM 130D R1.5 LT TI 3530-1360S C1713 SUPPLY/IMPLANTS "$15,305.00 " Outpatient "$7,652.50 " "$1,219.74 " "$9,948.25 " "$10,713.50 " "$10,101.30 " Not Applicable: Bundled with Procedure "$5,356.75 " "$12,244.00 " "$1,219.74 " "$12,244.00 " KIT IM NL 380MM 11MM 130D R1.5 LNG RT TI 3430-1380S C1713 SUPPLY/IMPLANTS "$15,305.00 " Outpatient "$7,652.50 " "$1,219.74 " "$9,948.25 " "$10,713.50 " "$10,101.30 " Not Applicable: Bundled with Procedure "$5,356.75 " "$12,244.00 " "$1,219.74 " "$12,244.00 " KIT IMPL 18X5.5MM 2.5MM BME ELT 10.4MM 2 LG BRDG MAX CLSR EL-1818S2 C1713 SUPPLY/IMPLANTS "$8,793.00 " Outpatient "$4,396.50 " "$1,219.74 " "$5,715.45 " "$6,155.10 " "$5,803.38 " Not Applicable: Bundled with Procedure "$3,077.55 " "$7,034.40 " "$1,219.74 " "$7,034.40 " KIT IMPL 15X5.5MM 2.5MM BME ELT 9.1MM 2 LG BRDG MAX CLSR EL-1515S2 C1713 SUPPLY/IMPLANTS "$8,793.00 " Outpatient "$4,396.50 " "$1,219.74 " "$5,715.45 " "$6,155.10 " "$5,803.38 " Not Applicable: Bundled with Procedure "$3,077.55 " "$7,034.40 " "$1,219.74 " "$7,034.40 " KIT INST MNDB PTSPC MNDB RECON NONFIBULA GFT SD900.002 C1713 SUPPLY/IMPLANTS "$17,387.00 " Outpatient "$8,693.50 " "$1,219.74 " "$11,301.55 " "$12,170.90 " "$11,475.42 " Not Applicable: Bundled with Procedure "$6,085.45 " "$13,909.60 " "$1,219.74 " "$13,909.60 " KIT INST MNDB BSC RECON FIB GFT CUT GD SD900.003 C1713 SUPPLY/IMPLANTS "$12,422.00 " Outpatient "$6,211.00 " "$1,219.74 " "$8,074.30 " "$8,695.40 " "$8,198.52 " Not Applicable: Bundled with Procedure "$4,347.70 " "$9,937.60 " "$1,219.74 " "$9,937.60 " KIT INST PTSPC MXL RECON NONFIBULA GFT SD900.005 C1713 SUPPLY/IMPLANTS "$17,387.00 " Outpatient "$8,693.50 " "$1,219.74 " "$11,301.55 " "$12,170.90 " "$11,475.42 " Not Applicable: Bundled with Procedure "$6,085.45 " "$13,909.60 " "$1,219.74 " "$13,909.60 " KIT INST PTSPC PLN DSTRCT SD900.006 C1713 SUPPLY/IMPLANTS "$17,387.00 " Outpatient "$8,693.50 " "$1,219.74 " "$11,301.55 " "$12,170.90 " "$11,475.42 " Not Applicable: Bundled with Procedure "$6,085.45 " "$13,909.60 " "$1,219.74 " "$13,909.60 " KIT INST PTSPC LNR DSTRCT SD900.007 C1713 SUPPLY/IMPLANTS "$14,900.00 " Outpatient "$7,450.00 " "$1,219.74 " "$9,685.00 " "$10,430.00 " "$9,834.00 " Not Applicable: Bundled with Procedure "$5,215.00 " "$11,920.00 " "$1,219.74 " "$11,920.00 " KIT INST 2 SPLNT PTSPC OTHGN NS SD900.008 C1713 SUPPLY/IMPLANTS "$12,422.00 " Outpatient "$6,211.00 " "$1,219.74 " "$8,074.30 " "$8,695.40 " "$8,198.52 " Not Applicable: Bundled with Procedure "$4,347.70 " "$9,937.60 " "$1,219.74 " "$9,937.60 " KIT INST CSTM NS SD900.009 C1713 SUPPLY/IMPLANTS "$9,940.00 " Outpatient "$4,970.00 " "$1,219.74 " "$6,461.00 " "$6,958.00 " "$6,560.40 " Not Applicable: Bundled with Procedure "$3,479.00 " "$7,952.00 " "$1,219.74 " "$7,952.00 " KIT INST PTSPC CRNFCL RECON MODL SD900.010 C1713 SUPPLY/IMPLANTS "$17,387.00 " Outpatient "$8,693.50 " "$1,219.74 " "$11,301.55 " "$12,170.90 " "$11,475.42 " Not Applicable: Bundled with Procedure "$6,085.45 " "$13,909.60 " "$1,219.74 " "$13,909.60 " KIT INST CRNFCL PTSPC PLN RECON SD900.011 C1713 SUPPLY/IMPLANTS "$10,929.00 " Outpatient "$5,464.50 " "$1,219.74 " "$7,103.85 " "$7,650.30 " "$7,213.14 " Not Applicable: Bundled with Procedure "$3,825.15 " "$8,743.20 " "$1,219.74 " "$8,743.20 " KIT INST MNDB RECON PTSPC WO MODL SD900.051 C1713 SUPPLY/IMPLANTS "$10,310.00 " Outpatient "$5,155.00 " "$1,219.74 " "$6,701.50 " "$7,217.00 " "$6,804.60 " Not Applicable: Bundled with Procedure "$3,608.50 " "$8,248.00 " "$1,219.74 " "$8,248.00 " KIT INST 1.5MM BN TAMP GD SLV RADIOLUCENCY SUP SHR STRTH AR-4151DS C1713 SUPPLY/IMPLANTS "$1,711.00 " Outpatient $855.50 "$1,219.74 " "$1,112.15 " "$1,197.70 " "$1,129.26 " Not Applicable: Bundled with Procedure $598.85 "$1,368.80 " $598.85 "$1,368.80 " KIT ORTH TIB JIG XTD REPL 2810-12-005 C1713 SUPPLY/IMPLANTS "$6,343.00 " Outpatient "$3,171.50 " "$1,219.74 " "$4,122.95 " "$4,440.10 " "$4,186.38 " Not Applicable: Bundled with Procedure "$2,220.05 " "$5,074.40 " "$1,219.74 " "$5,074.40 " KIT PRC 4 TRTHLN CR DISP FEM 5555-2204 C1713 SUPPLY/IMPLANTS $632.00 Outpatient $316.00 "$1,219.74 " $410.80 $442.40 $417.12 Not Applicable: Bundled with Procedure $221.20 $505.60 $221.20 "$1,219.74 " KIT PRC 5 TRTHLN CR DISP TIB 5555-2325 C1713 SUPPLY/IMPLANTS $791.00 Outpatient $395.50 "$1,219.74 " $514.15 $553.70 $522.06 Not Applicable: Bundled with Procedure $276.85 $632.80 $276.85 "$1,219.74 " KIT PRC 2 TRTHLN CR DISP FEM 5555-2202 C1713 SUPPLY/IMPLANTS $632.00 Outpatient $316.00 "$1,219.74 " $410.80 $442.40 $417.12 Not Applicable: Bundled with Procedure $221.20 $505.60 $221.20 "$1,219.74 " KIT PRC 8 TRTHLN CR DISP TIB 5555-2328 C1713 SUPPLY/IMPLANTS $514.00 Outpatient $257.00 "$1,219.74 " $334.10 $359.80 $339.24 Not Applicable: Bundled with Procedure $179.90 $411.20 $179.90 "$1,219.74 " KIT PRC 7 TRTHLN CR DISP FEM 5555-2207 C1713 SUPPLY/IMPLANTS "$1,108.00 " Outpatient $554.00 "$1,219.74 " $720.20 $775.60 $731.28 Not Applicable: Bundled with Procedure $387.80 $886.40 $387.80 "$1,219.74 " KIT PRC 7 TRTHLN CR DISP TIB 5555-2327 C1713 SUPPLY/IMPLANTS $514.00 Outpatient $257.00 "$1,219.74 " $334.10 $359.80 $339.24 Not Applicable: Bundled with Procedure $179.90 $411.20 $179.90 "$1,219.74 " KIT PRC 6 TRTHLN CR DISP TIB 5555-2326 C1713 SUPPLY/IMPLANTS $514.00 Outpatient $257.00 "$1,219.74 " $334.10 $359.80 $339.24 Not Applicable: Bundled with Procedure $179.90 $411.20 $179.90 "$1,219.74 " KIT PRC 6 TRTHLN CR DISP FEM 5555-2206 C1713 SUPPLY/IMPLANTS $632.00 Outpatient $316.00 "$1,219.74 " $410.80 $442.40 $417.12 Not Applicable: Bundled with Procedure $221.20 $505.60 $221.20 "$1,219.74 " KIT PRC 7 TRTHLN PS DISP FEM 5555-2257 C1713 SUPPLY/IMPLANTS "$1,085.00 " Outpatient $542.50 "$1,219.74 " $705.25 $759.50 $716.10 Not Applicable: Bundled with Procedure $379.75 $868.00 $379.75 "$1,219.74 " KIT SCR 85/80MM 11/7MM HIP TROCH LG CMPR INTGR INTLK 71677085 C1713 SUPPLY/IMPLANTS "$4,775.00 " Outpatient "$2,387.50 " "$1,219.74 " "$3,103.75 " "$3,342.50 " "$3,151.50 " Not Applicable: Bundled with Procedure "$1,671.25 " "$3,820.00 " "$1,219.74 " "$3,820.00 " KIT SCR NEXEL HUM 840009000 C1713 SUPPLY/IMPLANTS "$1,937.00 " Outpatient $968.50 "$1,219.74 " "$1,259.05 " "$1,355.90 " "$1,278.42 " Not Applicable: Bundled with Procedure $677.95 "$1,549.60 " $677.95 "$1,549.60 " KIT SCR MATRIXNEURO 4MM STD SLFDRL CRNL BN FLP FX STRL 04.503.131S C1713 SUPPLY/IMPLANTS "$2,796.00 " Outpatient "$1,398.00 " "$1,219.74 " "$1,817.40 " "$1,957.20 " "$1,845.36 " Not Applicable: Bundled with Procedure $978.60 "$2,236.80 " $978.60 "$2,236.80 " KIT SCR SHLDR RVRS TRQ DEFINE 320-20-00 C1713 SUPPLY/IMPLANTS "$2,006.00 " Outpatient "$1,003.00 " "$1,219.74 " "$1,303.90 " "$1,404.20 " "$1,323.96 " Not Applicable: Bundled with Procedure $702.10 "$1,604.80 " $702.10 "$1,604.80 " KIT SCR 105MM 4.5MM INTERTAN TROCH TI LG CMPR INTGR INTLK 7167-7105 C1713 SUPPLY/IMPLANTS "$4,182.00 " Outpatient "$2,091.00 " "$1,219.74 " "$2,718.30 " "$2,927.40 " "$2,760.12 " Not Applicable: Bundled with Procedure "$1,463.70 " "$3,345.60 " "$1,219.74 " "$3,345.60 " KIT SCR 24MM 3.5MM MOTOBAND CP STRL 1500-3524 C1713 SUPPLY/IMPLANTS "$1,072.00 " Outpatient $536.00 "$1,219.74 " $696.80 $750.40 $707.52 Not Applicable: Bundled with Procedure $375.20 $857.60 $375.20 "$1,219.74 " KIT SPINAL AERO PEEK-OPTIMA TITANIUM ALUMINUM VANADIUM 0 D D 48892090 C1713 SUPPLY/IMPLANTS "$17,179.00 " Outpatient "$8,589.50 " "$1,219.74 " "$11,166.35 " "$12,025.30 " "$11,338.14 " Not Applicable: Bundled with Procedure "$6,012.65 " "$13,743.20 " "$1,219.74 " "$13,743.20 " KIT SPINAL AERO PEEK-OPTIMA TITANIUM ALUMINUM VANADIUM 6 D L 48892096 C1713 SUPPLY/IMPLANTS "$17,179.00 " Outpatient "$8,589.50 " "$1,219.74 " "$11,166.35 " "$12,025.30 " "$11,338.14 " Not Applicable: Bundled with Procedure "$6,012.65 " "$13,743.20 " "$1,219.74 " "$13,743.20 " KIT SUT ACU-SINCH REPR 46-0001-S C1713 SUPPLY/IMPLANTS "$4,081.00 " Outpatient "$2,040.50 " "$1,219.74 " "$2,652.65 " "$2,856.70 " "$2,693.46 " Not Applicable: Bundled with Procedure "$1,428.35 " "$3,264.80 " "$1,219.74 " "$3,264.80 " KIT TRMA FX .045IN SBFS 1.1MM SBFS045 C1713 SUPPLY/IMPLANTS "$1,859.00 " Outpatient $929.50 "$1,219.74 " "$1,208.35 " "$1,301.30 " "$1,226.94 " Not Applicable: Bundled with Procedure $650.65 "$1,487.20 " $650.65 "$1,487.20 " KIT XTRNFX 100MM DFS SS MN FXTR LENGTHEN 7030 C1713 SUPPLY/IMPLANTS "$8,507.00 " Outpatient "$4,253.50 " "$1,219.74 " "$5,529.55 " "$5,954.90 " "$5,614.62 " Not Applicable: Bundled with Procedure "$2,977.45 " "$6,805.60 " "$1,219.74 " "$6,805.60 " KIT XTRNFX 150MM DFS SS MN FXTR LENGTHEN 7035 C1713 SUPPLY/IMPLANTS "$9,031.00 " Outpatient "$4,515.50 " "$1,219.74 " "$5,870.15 " "$6,321.70 " "$5,960.46 " Not Applicable: Bundled with Procedure "$3,160.85 " "$7,224.80 " "$1,219.74 " "$7,224.80 " KIT XTRNFX 200MM DFS SS MN FXTR LENGTHEN 7037 C1713 SUPPLY/IMPLANTS "$9,387.00 " Outpatient "$4,693.50 " "$1,219.74 " "$6,101.55 " "$6,570.90 " "$6,195.42 " Not Applicable: Bundled with Procedure "$3,285.45 " "$7,509.60 " "$1,219.74 " "$7,509.60 " KNF ACTB LGMNT TERES 25.4CMX25.4MM SRG SS SKD NS LF 360100100 C1713 SUPPLY/IMPLANTS "$2,218.00 " Outpatient "$1,109.00 " "$1,219.74 " "$1,441.70 " "$1,552.60 " "$1,463.88 " Not Applicable: Bundled with Procedure $776.30 "$1,774.40 " $776.30 "$1,774.40 " KWIRE BLUNT TIP NITINOL 18 IN SE-73770-18-2 C1713 SUPPLY/IMPLANTS "$1,396.00 " Outpatient $698.00 "$1,219.74 " $907.40 $977.20 $921.36 Not Applicable: