description amout charged cpt code hcpcs ......description amout charged cpt code hcpcs acidophilus...

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Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU PED 0.25ML VAC $112.18 90685 FLU HD 0.5ML VAC(65YRS & UP) $257.50 90662 HEPARIN 5 UNIT/5ML FLUSH $34.90 FEMORAL NERVE BLOCK, SINGLE $560.00 64447 FEMORAL NERVE BLOCK, SINGLE $560.00 64447 VENTILATOR INIT/SUP $1,062.00 94002 PULSE OX OVERNIGHT STUDY $500.00 94762 ECHO, T.E.E. $1,210.00 93312 INTBAT ICU KIT SUP $78.00 CPT TX EVAL/DEMON $206.00 94667 UPDRFT 1ST TREATMENT $433.00 94640 O2 PER HOUR $24.00 SIMPLE SPIOMETRY (PFT) $135.00 94010 PRE/POST SPIRO EVAL (PFT) $478.00 94060 VENTILATOR SUBSEQ DA $754.00 94003 MED BRONCHO-DILATOR $19.00 HEATED MIST PER HR. $10.00 MDI INTIAL TREATMENT $433.00 94640 E.C.G. $154.00 93005 LIVER/SPLEEN SCAN $900.00 78216 SPLEEN SCAN W/WO VSF $811.00 78185 G.I. BLEEDING SCAN $1,152.00 78278 LUNG PERFUSION SCAN $840.00 78580 THYROID SCAN $551.00 78013 THYROID SCAN (123 I) $416.00 78012 THYROID SCN UPT MULT $697.00 78014 THYROID CA WHLE BODY $708.00 78018 BONE SCAN LIMIT AREA $918.00 78300 BONE SCAN WHOLE BODY $1,293.00 78306 BONE MARROW SCAN MLT $532.00 78103 RENAL SCAN W/VASFLOW $637.00 78701 MECKELS SCAN $465.00 78290 GALLIUM SCAN $2,337.00 78802 HEPATOBILIARY SCAN $792.00 78226 GASTRIC EMPTY SCAN $974.00 78264 THALLOUS CHLORI 4MCI $200.00 A9505 CISTERNOGRAPH $1,490.00 78630 MUGA SCAN $1,122.00 78472 MYO PERF TREADMILL $2,637.00 78452 RIBS UNIL INCLD CHST LT 3 V $281.83 71101 XRAY RIBS UNIL INCLD CHEST 3 V $281.83 71101 XRAY SPINE LUMBOSAC BND 2-3 V $149.65 72120 X-RAY HAND 2 VIEWS RT $281.83 73120 BONE SCAN, 3 PHASE $1,771.00 78315 X-RAY HAND 2 VIEWS LT $281.83 73120 GALLIUM SCAN 24HR $2,337.00 78802

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Page 1: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

Description Amout Charged CPT CODE HCPCS

ACIDOPHILUS 2 TABLET $11.00

RHYTHM STRIP ALONE $102.00 93041

DERMOPLAST PAIN SPRAY $29.36

FLU PED 0.25ML VAC $112.18 90685

FLU HD 0.5ML VAC(65YRS & UP) $257.50 90662

HEPARIN 5 UNIT/5ML FLUSH $34.90

FEMORAL NERVE BLOCK, SINGLE $560.00 64447

FEMORAL NERVE BLOCK, SINGLE $560.00 64447

VENTILATOR INIT/SUP $1,062.00 94002

PULSE OX OVERNIGHT STUDY $500.00 94762

ECHO, T.E.E. $1,210.00 93312

INTBAT ICU KIT SUP $78.00

CPT TX EVAL/DEMON $206.00 94667

UPDRFT 1ST TREATMENT $433.00 94640

O2 PER HOUR $24.00

SIMPLE SPIOMETRY (PFT) $135.00 94010

PRE/POST SPIRO EVAL (PFT) $478.00 94060

VENTILATOR SUBSEQ DA $754.00 94003

MED BRONCHO-DILATOR $19.00

HEATED MIST PER HR. $10.00

MDI INTIAL TREATMENT $433.00 94640

E.C.G. $154.00 93005

LIVER/SPLEEN SCAN $900.00 78216

SPLEEN SCAN W/WO VSF $811.00 78185

G.I. BLEEDING SCAN $1,152.00 78278

LUNG PERFUSION SCAN $840.00 78580

THYROID SCAN $551.00 78013

THYROID SCAN (123 I) $416.00 78012

THYROID SCN UPT MULT $697.00 78014

THYROID CA WHLE BODY $708.00 78018

BONE SCAN LIMIT AREA $918.00 78300

BONE SCAN WHOLE BODY $1,293.00 78306

BONE MARROW SCAN MLT $532.00 78103

RENAL SCAN W/VASFLOW $637.00 78701

MECKELS SCAN $465.00 78290

GALLIUM SCAN $2,337.00 78802

HEPATOBILIARY SCAN $792.00 78226

GASTRIC EMPTY SCAN $974.00 78264

THALLOUS CHLORI 4MCI $200.00 A9505

CISTERNOGRAPH $1,490.00 78630

MUGA SCAN $1,122.00 78472

MYO PERF TREADMILL $2,637.00 78452

RIBS UNIL INCLD CHST LT 3 V $281.83 71101

XRAY RIBS UNIL INCLD CHEST 3 V $281.83 71101

XRAY SPINE LUMBOSAC BND 2-3 V $149.65 72120

X-RAY HAND 2 VIEWS RT $281.83 73120

BONE SCAN, 3 PHASE $1,771.00 78315

X-RAY HAND 2 VIEWS LT $281.83 73120

GALLIUM SCAN 24HR $2,337.00 78802

Page 2: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

GALLIUM SCAN 48HR $1,681.00 78804

GALLIUM SCAN 72HR $1,681.00 78804

MAA PER VIAL $82.00 A9540

BONE SPECT $1,164.00 78320

BRAIN SPECT $1,524.00 78607

MYOVIEW PER DOSE $761.00 A9502

CERETEC PER DOSE $1,887.00 A9521

LUNG/VENT/PERF QUANT $533.00 78598

RENOGRAM $921.00 78707

MDP UP TO 30 MCI $330.00 A9503

DTPA PER STUDY DOSE UP 25 MCI $227.00 A9539

SKELTL SRVY MORE 1YR $572.00 77075

SCAPULA, RIGHT $148.00 73010

XRAY CERVICAL SPINE 4 OR 5 V $376.00 72050

RAD EX STERNOCLAV (S) MIN 3 VI $160.00 71130

X-RAY CLAVICLE, RIGHT $175.00 73000

STERNUM MIN 2 VIEWS $189.00 71120

RIBS UNI 2 VIEWS RT $340.00 71100

X-RAY RIBS, BILAT 3 VIEWS $310.00 71110

SHOULDER 1 VIEW RIGHT $193.00 73020

SHOULDER 2 VIEWS, RT $244.00 73030

SHOULDER COMPLETE, RT MIN 2 V $305.00 73030

ELBOW RT 2 VIEWS $191.00 73070

FOREARM RT 2 VIEWS $282.00 73090

FINGER/FINGERS RT MIN 2 VIEWS $151.00 73140

HAND 3 VIEW RT $360.00 73130

HUMERUS 2 VIEW RT $233.00 73060

THORACIC SPINE 3VIEW $347.00 72072

LUMBOSAC SPINE >=4 $291.00 72110

X-RAY PELVIS 1-2 VIEWS $198.00 72170

PELVIS, 3 VIEWS $238.00 72190

LEG, RT 2 VIEWS $208.00 73590

TOE/TOES 2 VIEWS RT $150.00 73660

BONE AGE $172.00 77072

HEEL-OS CALCIS MIN 2 VIEWS RT $176.00 73650

WRIST COMPLETE RT MIN 3 V $257.00 73110

WRIST RT 2 VIEWS $170.00 73100

ANKLE COMPLETE RT MIN 3 V RT $307.00 73610

FEMUR, RT MIN 2 VIEWS $182.00 73552

FOOT COMPLETE MIN 3 VIEWS RT $329.00 73630

HIP 1 VIEW RT $131.00 73501

PROMETHAZINE HCL 50MG CREAM $16.00

HIP 2 - 3 VIEWS RT $182.00 73502

KNEE 1-2 VIEWS RT $140.00 73560

RAD EX KNEE, COM => 4 VIEWS RT $179.00 73564

X-RAY EYE/FOREIGN BODY RT $169.00 70030

RAD EX FACIAL BONES, MIN 3 VI $322.00 70150

MANDIBLE, PARTIAL < 4 VIEWS $126.00 70100

MANDIBLE COMPLETE MIN 4 VIEWS $145.00 70110

MASTOIDS 3 OR MORE $294.00 70130

Page 3: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

RAD EX NASAL BONE, COM MIN 3 V $211.00 70160

SELLA TURCICA $193.00 70240

RAD EX SINUS, PARANASAL < 3 VI $195.00 70210

XRAY SINUSES PARANASAL MIN 3 V $247.00 70220

SKULL < 4 $231.00 70250

RAD EX SKULL, COM MIN 4 VIEWS $292.00 70260

T-M JOINT, BILATERAL $648.00 70330

RAD EXAM, FACIAL < 3 VIEWS $229.00 70140

PYELOGRAM (IVP) $1,279.00 74400

PYELOGRAM RETROGRADE $748.00 74420

ACUTE ABDOMEN SERIES $382.00 74022

ABDOMEN (KUB) 1 VIEW $191.00 74018

ABDOMEN 2 VIEWS $197.00 74019

ESOPHAGRAM $453.00 74220

CHOLANGIOGRAM OPERAT $438.00 74300

FLUOROSCOPY $398.00 76000

CHOLANGIOGRAM T-TUBE $5,871.00 47531

SMALL BOWEL SERIES $317.00 74250

BARIUM ENEMA $418.00 74270

BE COLON W AIR & BARIUM $586.00 74280

UPPER/GI SERIES $552.00 74240

X-RAY CHEST 1 VIEW $183.00 71045

CHEST PA & LAT 2 VIEWS $216.00 71046

INSERT LEADLESS C PM/RPL VENTR $42,895.00 33274

INS TRANSCATH PACEMAKER LEADLE $40,651.00

TOMOGRAMS $351.00 76100

METASTATIC SURVY LMT $196.00 77074

IVP/TOMOS $1,279.00 74400

X-RAY CERVICAL SPINE 2-3 VIEWS $348.00 72040

XRAY THORACIC SPINE AP&L 2 VIE $340.00 72070

LUMBAR SPINE AP&LAT 2 OR 3 V $259.00 72100

HIPS, BILATERAL $175.00 73521

FLUOROSCOPY OVER 60M $398.00 76000

SCANOGRAM $242.00 77073

ASPIRTION/INJCTION MAJOR JOINT $1,159.00

REM, NON-BIO DRUG DEL IMPLANT $767.00

ANOSCOPY W/POLYPECTOMY $5,385.00

X-RAY NECK, SOFT TISSUE $203.00 70360

CT SELLA/EAR/ORB WO $1,402.00 70480

CT CHEST WO CNTRST $930.00 71250

CT CHEST WI CNTRST $1,977.00 71260

CT CERV SPINE WO CNT $1,834.00 72125

CT CERV SPINE WI CNT $5,204.00 72126

CT THORACIC SPINE WI CONTRAST $3,301.00 72129

CT LUMBOSPINE WI CNT $5,204.00 72132

CT PELVIS WI CNTRST $1,784.00 72193

CT UP EXT RT WO/CONT $1,479.00 73200

CT UP EXT RT W/CONTR $1,479.00 73201

CT UP EXT RTW/WO CON $1,833.00 73202

CT LO EXT WO/CONTRAS $1,377.00 73700

Page 4: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CT LO EXT RT W/CONTR $1,734.00 73701

CT LO EXT RTW/WO CON $2,106.00 73702

CT ABDMN WI CNTRST $2,197.00 74160

EXECUTIVE CHEST 2 VIEWS $216.00 71046

CT NECK WI/WO CNTRST $2,431.00 70492

CT NECK WI CNTRST $2,294.00 70491

CT NECK WO CNTRST $1,882.00 70490

CT LIMITED STUDY $622.00 76380

INSRT/REP SGL CHAM PM VENTRICU $15,821.00 33207

CT HEAD WI CONTRAST $1,995.00 70460

CT HEAD WO/WI CNTRST $3,000.00 70470

CT SELL/EAR/ORB WO/W $1,887.00 70482

CT CHEST WO/WI CNTRS $2,886.00 71270

CT PELVIS WO/WI CNTR $1,971.00 72194

CT ABD WO/WI CNTRST $2,494.00 74170

CT HEAD WO CONTRAST $2,000.00 70450

CT PELVIS WO CNTRST $1,778.00 72192

CT THOR SPINE WO CNT $1,957.00 72128

CT LUMBOSPINE WO CNT $1,685.00 72131

CT MAXILLOFACIAL WI $1,730.00 70487

CT MAXILLOFACIAL W/O $1,441.00 70486

CT ABDMN WO CNTRST $1,426.00 74150

VIDEO FLUOR. SWA.STY $362.00 74230

US HEPATIC $472.00 76705

US EXTREMITY RT $193.00 76882

US SCROTUM $618.00 76870

US PELVIS COMPLETE $473.00 76856

US OB COMPLETE $271.00 76805

MAMMO SURG SPECIMEN $564.00 76098

US ABDOMEN $637.00 76700

US GALLBLADDER $472.00 76705

MAMMOGRAM BILATERAL $187.00 77066

CT 3D RENDER W/O WS $268.00 76376

PULSE OX SINGLE DETERMINE $70.00 94760

MAMMO SCRN/INDUSTRY $155.00 77067

MRI BRAIN W/O CONT $2,429.00 70551

MRI ORB/FAC/NECK WO $1,568.00 70540

MRI CERV SPINE WO $2,051.00 72141

MRI THROAC SP WO $2,644.00 72146

MRI LUMB SPINE WO $2,105.00 72148

MRI ABDOMEN WO CONT $1,490.00 74181

MRI CHEST WO CONT $2,200.00 71550

DLCO TEST (PFT) $266.00 94729

VENOUS PH $48.00 83986

O2 PER 24 HRS. $442.00

CPAP INITIAL $318.00 94660

INFER VENCAV GRM S&I $5,838.00 75825

IVC FILTER PLACEMENT $5,548.00 37191

INSRT PM PULSE GEN SNGL LEAD $7,960.00 33212

PERCSTNT REN PLVS RT $5,404.00 50695

Page 5: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PERCCATH REN PLVS RT $4,540.00 50433

MRI UP EXT JNT RT W/O CONTRAST $2,838.00 73221

MRI LO EXT JNT RT WO $2,904.00 73721

OXYGEN SATURATIN SDY $92.00 82810

AMNISURE $245.00 84112

PLSEOX MULTI/CONT DY $102.00 94761

INSRT/REP DUAL CHAM PM ATRL VE $17,012.00 33208

ART. DUPLEX BILAT $1,164.00 93925

ART. UNILAT STUDY RT $674.00 93926

ECHO, 2D/M MODE $1,200.00 93306

US PELVIS TRANS.VAG. $675.00 76830

US RENAL, UNI RT $377.00 76775

US AORTA $377.00 76775

US OB LIMITED 1 + FETUS $233.00 76815

US FTL AGE FLUP Q FS $494.00 76816

US THYROID $530.00 76536

US BABY HEAD $241.00 76506

ULTRASOUND BREAST LIMITED,UNIL $484.00 76642

US CHEST $316.00 76604

MYOCARDIAL BIOPSY $3,024.00 93505

STRESS W/RHYTHM STRP $678.00 93017

GLUCOSE $44.00 82947

GLUCOSE - 2 HR $44.00 82947

GLUCOSE PC /GLUCOLA $51.00 82950

BUN $46.00 84520

SODIUM $47.00 84295

POTASSIUM $40.00 84132

CHLORIDES $61.00 82435

CO 2 $31.00 82374

CALCIUM $47.00 82310

PHOSPHORUS $54.00 84100

URIC ACID $40.00 84550

AMYLASE $60.00 82150

BILIRUBIN (TOTAL) $52.00 82247

BILIRUBIN (DIRECT) $55.00 82248

ALKALINE PHOSPHATASE $75.00 84075

PROTEIN/SERUM $41.00 84155

ALBUMIN / SERUM $39.00 82040

ALPHA-1-ANTITRYPSIN MUT ANA SO $174.00 81332

SGOT $45.00 84450

SGPT $28.00 84460

LDH $43.00 83615

CPK $66.00 82550

CHOLESTEROL $54.00 82465

CREATININE (SERUM) $50.00 82565

EXC TR-EXT B9+MAR 3.1-4 CM LES $374.00 11404

T4 FREE $78.00 84439

IRON $48.00 83540

IRON BINDING (TOTAL) $63.00 83550

TRIGLYCERIDES $38.00 84478

Page 6: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ANTI QGIB AB SO $463.00 83520

MTB COMPLEX PCR SO $818.00 87801

URINE CREAT. CL/24HR $109.00 82575

DIGOXIN (LANOXIN) $106.00 80162

ESLICARBAZEPINE SO $136.00 80299

DILANTIN (PHENYTOIN) $114.00 80185

SO PROTEIN ELECTROPHORETIC FRA $36.00 84165

HDL CHOLESTEROL $28.00 83718

MAGNESIUM $81.00 83735

SO PHENOBARBITAL $102.00 80184

CSF PROTEIN $28.00 84157

SALICYLATE $160.00 80307

BODY FL. CELL COUNT $54.00 89051

THEOPHYLLINE $113.00 80198

GENTAMICIN TROUGH $153.00 80170

SO TOBRAMYCIN TROUGH $123.00 80200

HEPATIC FUNCT. PANEL $129.00 80076

LIPID PROFILE $101.00 80061

CBC/DIFF/PLT $62.00 85025

ELECTROLYTE PROFILE $56.00 80051

CHOLINESTERASE SERUM SO $20.00 82480

BLEEDING TIME $74.00 85002

EOSINOPHIL COUNT/ABS $59.00 85008

EOSINOPHIL SMEAR $45.00 89190

FIBRINOGEN LEVEL $91.00 85384

WBC - STOOL $46.00 89055

PLATELET COUNT $46.00 85049

PROTIME/INR $45.00 85610

PTT $71.00 85730

RETICULOCYTE COUNT $53.00 85046

PH-URINE $51.00 81003

PINWORM SCOTCH TPSMR $36.00 87172

PREGNANCY/URINE HCG $97.00 81025

SEMEN EXAM/POST VAS $39.00 89321

BODY FLUID PH $31.00 84315

SO PARASITE (WET) PREP $40.00 87210

URINALYSIS/MICRO $69.00 81001

GGT $61.00 82977

SO COLD AGGLUTININS $34.00 86156

MONOSCREEN (TEST) $54.00 86308

MLH1 PROMOTER METHYLATION SO $955.00 81288

MIC $66.00 87186

GRAM STAIN-ROUTINSMR $47.00 87205

KOH PREP $29.00 87210

PRBC LEUKORED UNIT $492.00 P9016

FRESH FROZEN PLASMA $194.00 P9017

PLATELETS, EA UNIT $308.00 P9019

CRYOPRECIPITATE/EA. $118.00 P9012

COOMBS-DIRECT $87.00 86880

COOMBS-INDIRECT $60.00 86885

Page 7: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CORD BLD/DIRECT COMB $87.00 86880

TYPE/CROSSMATCH $128.00 86920

RHOGAM/VIAL 300 MCG $297.00 J2790

SO TRAMADOL QUANT URINE $69.55 G0480

OBS UNIT - PRIVATE $709.00

C&S BLOOD $78.00 87040

KETONES BODY (S) QUALITATIVE $54.00 82009

ALCOHOL - ETHANOL $84.00 G0480

TEGRATOL(CARBAMAZ.) $128.00 80156

HEP C GENOTYPE 3NS5A DRG RESIS $567.18 87902

NEUTROPHIL AB FLOW CYTOMETRY $98.53 86021

TULAREMIA $69.00 86668

SED RATE/ESR $53.00 85652

URINE CREAT. 24HOUR $51.00 82570

PREGNANCY/SERUM HCG $97.00 84703

STREP SCREEN $35.00 87880

PLATELET PHERESIS LEUKO RD, EA $1,277.00 P9035

PLATELETS, EA UNIT $308.00 P9019

URINE POTASSIUM/24HR $30.00 84133

BASIC MET. PANEL $101.00 80048

RENAL PANEL $129.00 80069

BODY FLUID CREAT. $51.00 82570

AMMONIA/PLASMA $91.00 82140

BODY FLUID CRYSTALS $54.00 89060

SO URINE PHOSHORUS $38.00 84105

ACETAMINOPHEN $160.00 80307

ANTIGEN TYPING $226.00 86902

AUTOLOGOUS X-MATCH $128.00 86920

HEMATOCRIT/HCT $33.00 85014

CSF GLUCOSE $50.00 82945

SO TOBRAMYCIN PEAK $123.00 80200

QUANT. HCG $117.00 84702

FETAL HGB. STAIN $83.00 85460

CK - MB $78.00 82553

GENTAMICIN PEAK $153.00 80170

BARBITURATES/UR/QUAL $160.00 80307

PHLEBOTOMY $31.00 36415

PH BODY FLUID $48.00 83986

BODY FLUID PROTEIN $28.00 84157

BODY FLUID LDH $43.00 83615

TSH-ULTRA TS HORMONE $90.00 84443

NEONATAL BILIRUBIN $52.00 82247

ARC IRRADIATION -DAY $83.00 86945

GENTAMICIN RANDOM $153.00 80170

C & S CATH TIP $113.00 87070

C&S TISSUE-SPECIFY $113.00 87070

C&S EYE $113.00 87070

BODY FLUID AMYLASE $60.00 82150

BODY FLUID GLUCOSE $50.00 82945

VANCOMYCIN RANDOM $145.00 80202

Page 8: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BCR-ABL 1 STAND (MAJOR/MINOR) $813.00 81479

GLUCOSE/1-HR 50G. $51.00 82950

SO TOBRAMYCIN RANDOM $133.00 80200

UR. CREATININE RAND. $51.00 82570

C&S URINE/C.L. CATCH $70.00 87086

FDA PD-LI $501.00 88360

ANTIBODY ID PANEL $393.00 86870

COLLECT DRUG SCREEN $30.00 99001

TISSEEL THROMBIN 4ML $251.69 C9250

TORADOL 60MG/2ML $44.00 J1885

GAMMAGARD 10 GM VIAL 10% $3,849.00 J1569

OXYTOCIN 20UN/IN NS PER 10 UN $110.24 J2590

KYPROLIS 10 MG VIAL PER 1MG $563.51 J9047

ANES. SPINAL $279.00

DEPAKOTE/VALPROIC $154.00 80164

LITHIUM $80.00 80178

SO FETAL/MATERNAL SCR. $46.00 85461

SO CSF VDRL $47.00 86592

CSF CELL COUNT $54.00 89051

CSF C & S $113.00 87070

TZANCKS STAIN $32.00 87207

URINALYSIS $51.00 81003

C&S BRONCH WASHING $113.00 87070

C&S ORTHOPED-SP. $113.00 87070

C&S UROGENT $113.00 87070

C&S G C $113.00 87070

FZ. SECT. STAINING $104.00 88314TC

TEASED NERVE PREPARATION SO $827.00 88362

ENZYME HISTOCHEMICAL FROZEN SO $174.00 88319

KRAS MUTATION ANALYSIS EX 4 SO $920.00 81276

C&S RESP CULTURE $113.00 87070

C&S WOUND $113.00 87070

C&S BODY FLD-SPECIFY $113.00 87070

C&S OTHER-SPECIFY $113.00 87070

C&S THROAT $113.00 87070

VANCOMYCIN TROUGH $145.00 80202

VANCOMYCIN PEAK $145.00 80202

ORTHO FIT & TRAIN INIT 15 MIN $234.00 97760

C&S EAR $113.00 87070

URINE-MICRO ONLY $24.00 81015

RUBELLA IGG,QUAL. $63.00 86762

US W/POP TX 15 PT $114.00 97035

DRY NEEDLING PHYSICAL THERAPY $83.00 97799

TEST/MEASURE 15 MIN $104.00 97750

ORTHO FIT/TRN 15 OT $234.00 97760

PT SELECT DEB <=20CM $270.00 97597

ELEC STIM PT UNATTEN $106.00 97014

GAIT/TRANS TRAIN 15 $92.00 97116

MASSAGE, LOCAL 15 PT $71.00 97124

TRACTION,MECHANICAL $101.00 97012

Page 9: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ULTRASOUND 15 PT $114.00 97035

ELEC STIM W/US 15 PT $97.00 97032

THERAPUTIC EX 15 PT $110.00 97110

CONTRAST BATH 15 PT $86.00 97034

TENS INIT APPL 15 $97.00 97032

THERAPUTIC ACT 15 PT $95.00 97530

ADL 15 PT $101.00 97535

HEMORRHOID BAND PROC $1,996.00

ECG W/12 LEADS INTER & REPORT $20.50 93010

ER CRITCL C/ADD/30MN $316.00 99292

ER GASTRIC LAVAGE $40.00 43753

EXPL P WND; EXTREMITY $825.00 20103

I & D PILONIDAL CYST $349.00 10080

I * D ONYCHIA/PARONY $212.00 10060

PUNCT.ASPIR.ABSCESS $247.00 10160

LARYNGOSCOPY, INDIRECT, DIAG $114.00 31505

SM REP 2.5 CM OR LESS $275.00 12001

SM2-6-7-5CM BDY &EXT $247.00 12002

SM7-6-12.5CM BDY&EXT $357.00 12004

SM12.6-20.0CM BDY&EX $444.00 12005

SM>2.5CM FC.8R EY/LP $282.00 12011

SM2.6-7.5 FC.8REY/LP $322.00 12013

SM7.6-12.5 FC.8EY/LP $412.00 12015

SM12.6-20 FC.8REY/LP $490.00 12016

IN>2.5CM SCP.TR.EXT. $379.00 12031

IN2.6-7.5 SCP.TR.EXT $527.00 12032

IN7.6-12.5 SCP.TR.EX $524.00 12034

IN12.6-20.0SCP TR EX $492.00 12035

IN>2.5CM NK/HD/GT/FT $420.00 12041

IN2.6-7.5NK/HD/GT/FT $508.00 12042

IN7.6-12.5NK/HD/GT/F $425.00 12044

IN>2.5CM FC/ER/EY/LP $484.00 12051

IN2.6-5.0FC/ER/EY/LP $508.00 12052

IN5.1-7.5F/ER/EY/LP $425.00 12053

IN7.6-12.5F/ER/EY/LP $458.00 12054

DISLOCATN TEMPOROMAN $161.00 21480

INSERT ART LINE $127.00 36620

INSERT FOLEY CATH $207.00 51702

I&D BARTH.GLND ABSCS $255.00 56420

CODE BLUE ICCU $605.00

IONTOPHORESIS 15 PT $132.00 97033

ICCU $1,600.00

NURSERY $368.00

NURSERY - ROOMING IN $270.00

TELEMETRY $296.00

NURSERY LEVEL II $446.00

NURSERY LEVEL III $494.00

COMP<2.5CM RY/NS/L/E $786.00 13151

COMP<2.5CM SCLP.EXT. $509.00 13120

COMP<2.5CM NK/FH/HFG $711.00 13131

Page 10: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

COMP2.6-7.5CME/N/L/E $1,055.00 13152

COMP2.6-7.5CM SCP EX $801.00 13121

COMP2.6-7.5 N/FH/HFG $1,039.00 13132

FORIN BDY EYE CORNEL $113.00 65220

FOREIGN BODY - NOSE $373.00 30300

CAST REMOVAL/REPAIR $142.00 29705

DISLOCATE ELBOW $818.00 24600

DISLOCATION SHOULDER $668.00 23650

RED'NURSE MAID'ELBOW $256.00 24640

DISLOCATION FINGER $596.00 26770

DISLOC. PATELLA $573.00 27560

BURN DRES.DEBRID.SML $150.00 16020

BURN DRES.DEBRID.LRG $378.00 16030

NOSE BLEED ROUTINE $182.00 30901

NOSE BLEED ANT. PACK $292.00 30903

NOSE BLEED POST PACK $291.00 30905

LUMBAR PUNCTURE $216.00 62270

I & D SIMPLE $241.00 10060

I & D COMPLEX $341.00 10061

HEMORRHOID EXCISION $317.00 46320

CARDIOVERSION $1,285.00 92960

CHEST TUBE INSERTION $503.00 32551

EMER. ENDOTR. INTUB $316.00 31500

THORACENTESIS $171.00 32554

FLUID/BLOOD WARMER $172.00

INJ EPIDURAL CERV/THOR W/O IMA $425.00 62320

ACETAMINOPHEN S 120M $8.00

ACETAMINOPHEN SUPP 3 $8.00

INJ EPIDURAL CERV/THOR W/IMAG $425.00 62321

ACETAMINOPHEN S650MU $8.00

ACETAMINOPHEN/COD 10 $6.00

ACETAMINOPHEN/COD 5M $7.00

INJ EPIDURAL LUMB/SAC W/O IMAG $425.00 62322

INJ CNT INF EPD CRV/THR WO IMA $425.00 62324

TETRACYCLINE OINT 1 $33.00

ACI JEL/APP 3OZ $41.00

ACTA CHAR 400ML 30GM $15.00

INJ CNT INF EPD CRV/THOR W/IMA $506.40 62325

ACTIFED SYR 4OZ $16.00

INJ CNT INF EPD LUM/SAC WO IMA $425.00 62326

AD OINT 1.5OZ $14.00

INJ CNT INF EPD LUM/SAC W/IMAG $425.00 62327

ADRENALIN 1MG/1ML $19.00 J0171

ADRIAMYCIN INJ 10MG $282.00 J9000

ADRIAMYCIN INJ 50MG $444.00 J9000

AFRIN NASAL SPR 15ML $27.00

AFRIN NOSE DROP 20ML $15.00

AGGRENOX 200/25MG CA $23.00

ALDACTAZIDE TAB UD $6.00

SPIRONOLACTONE 25MG $6.00

Page 11: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

RABIES IMMUNE GLOB 1500U/10 ML $1,365.45 90376

RABIES IMMUNE GLOB 1500U/5ML $2,094.72 90376

ALDORIL 15 TAB $6.00

ALKA SELTZER FOIL $6.00

ALKERAN TAB 2MG $6.00

ALUPENT INHALER 15ML $70.00

ALUPENT SOL 5DROPR $44.00

ALUPENT SYR $6.00

AMBENYL EXPT 4OZ $37.00

AMERICAINE AERO.67OZ $28.00

AMERICAINE OINT 1 0Z $15.00

DEXAMETHASONE 10 MG ORAL CONC $51.47

AMICAR TAB 500MG $13.00

AMIDATE 25MG/ML 20ML $19.00

AMINOPHYLLIN INJ250M $19.00 J0280

AMINOPHYLLIN INJ500M $19.00 J0280

AMOXIL ORAL SUSP125M $24.00

AMOXIL ORAL SUSP250M $43.00

AMPHOJEL SUSP 12OZ $6.00

ANAPROX TAB $8.00

ANBESOL .31OZ $19.00

SUCCINYLCHOLINE 20MG $39.00 J0330

ANTILIRIUM AMP $39.00

ANTIVENIN POLYVALENT $3,786.00 J0840

ANUSOL HC SUPP $9.00

ANUSOL SUPP $8.00

TUBERCULIN 5TU1 $39.00

APRESAZIDE CAP 25/25 $6.00

HYDRALAZINE AMP 20MG $111.00 J0360

VITAMIN K INJ 10MG $51.00 J3430

VITAMIN K INJ 1MG/0. $39.00 J3430

SEREVENT DISKUS 50MC $98.00

AROMATIC AMMONIA VAP $6.00

ASPIRIN SUPP 600MG $9.00

LORAZEPAM TAB 0.5MG $10.00

LORAZEPAM TAB 1MG UD $10.00

ATROPINE SULF INJ20M $17.00

ATROPINE SULF INJ.4M $19.00 J0461

ATROPINE SULF 0.25MG $44.00 J0461

ATROPINE SULF .5MG $13.00

ATROPINE SULF 1MG AB $39.00 J0461

ANTIPYRINE/BENZ OTIC $17.00

AVEENO BATH REG 16OZ $20.00

GABITRIL 4MG TAB. $19.00

AVITENE FLOUR 1GM. $532.00

AYR NASAL DROPS 20ML $15.00

AYR NASAL MIST 50ML $12.00

AZULFIDINE TAB 5GM $8.00

BACITRACIN 50MU $109.00

SULFAME/TRIMET TAB D $6.00

Page 12: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SULFAMETH/TRIMET I.V $109.00

SULFAMET/TRIMET 5ML $45.00

SULFAME/TRIMET TAB $9.00

BANALG LIQ 2OZ $19.00

DIPHENHYDRAMINE 50MG $19.00 J1200

DIPHENHYDRAMINE CRM1 $27.00

DIPHENHYDRAMINE 12.5 LIQUID PO $6.00

DICYCLOMINE INJ. 10M $150.00 J0500

DICYCLOMINE 20MG CAP $6.00

BETADINE DOUCHE PACK $86.00

BETADINE OINT 1-OZ $13.00

BICILLIN CR 900/300I $197.00 J0558

BICILLIN LA 1,200,000 $260.00 J0561

TELEPAQUE 500MG CAPS $22.00

BLEPHAMIDE SUSP 5ML $421.00

BLISTEX REG. .15-OZ $14.00

BLOCADREN TAB 10MG $6.00

TERBUTALINE AMP 1MG $177.00 J3105

TERBUTALINE 2.5MG $6.00

TERBUTALINE 5MG TAB $6.00

BRETYLOL AMP 500MG/1 $142.00

BREVITAL SOD 500MG $19.00

BSS 15ML $34.00

BUMETANIDE .25MG/ML $39.00

BUMEX TAB 1MG UD $6.00

BUTAZOLIDIN CAP 100M $10.00

BUTABARBITAL TAB 30M $6.00

CALAMINE LOT PLAIN $11.00

CALCIUM CHL INJ 10 percent $19.00

CALCIUM CHL 10 percent 10 ML $39.00

CALCIUM GLUC INJ 10% $19.00 J0610

CAPOTEN TAB 25MG UD $6.00

CARAFATE TAB 1GM UD $6.00

CARDIZEM TAB 30MG $6.00

CARDIZEM TAB 60MG $6.00

CASTOR OIL USP ROX $7.00

CLONIDINE TAB 0.1MG $6.00

CLONIDINE TAB 0.2MG $6.00

CECLOR 250MG. CAP UD $6.00

CECLOR 500MG. CAP UD $16.00

CELESTONE SLSPN 12MG $48.00 J0702

LACTULOSE SYRUP 20GM $23.00

CERUMENEX DROP 6ML $122.00

CETACAINE SPRAY 56GM $195.00

CHLORPHENIRAMINE 12M $6.00

IC Green 25 mg $547.46

CHLORAL HYDRATE SYR $10.00

CHLORASEPTIC LOZ CUD $6.00

CHLOROMYCETIN OPTH $8.00

CITRATE OF MAG.10-OZ $6.00

Page 13: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CLAFORAN 1GM PB $48.00 J0698

CLAFORAN 1GM VL $109.00 J0698

CLINDAMYCIN CAP 150M $6.00

CLINORIL TAB 150MG $6.00

CLINORIL TAB 200MG $7.00

CODEINE TAB 30MG $10.00

CODIMAL DH SYR 1-OZ $6.00

COGENTIN INJ 2MG/2ML $274.00 J0515

COGENTIN TAB 1MG UD $6.00

DOCUSATE SODIUM 10MG $6.00

COLY MYCIN S OTIC 5M $38.00

COMPAZIN INJ 5MG 2ML $58.00 J0780

COMPAZINE SUPP 25MG $27.00

COMPAZINE TAB 10MG U $6.00 Q0164

COMPAZINE TAB 05MG $6.00 Q0164

COPPER TRACE ADD $19.00

CORGARD TAB 40MG UD $6.00

CORTENEMA $68.00

CORTISPORIN OINT.5OZ $33.00

CORTISPORIN OPTH SUS $220.00

CORTISPORIN OTIC SOL $95.00

CORTISPORIN OTIC SUS $225.00

CORTONE SALINE SUSP $10.00

COUMADIN TAB 1MG $6.00

COUMADIN TAB 2.5MG $6.00

COUMADIN TAB 2MG $6.00

COUMADIN TAB 5MG $6.00

COUMADIN TAB 7.5MG $8.00

CYANOCOBALAMIN 100MC $19.00 J3420

ZEBETA 5MG TAB. $6.00

CYTOMEL TAB 25MCG $6.00

DANTRIUM CAP 25MG UD $7.00

DARVOCET N 100 TAB $10.00

PROPOXY 65MG CAP $10.00

DEBROX DROP 15ML $26.00

DECADRON OPTH SOL $82.00

DECADRON TOP CRM .1 percent $26.00

DELESTROGEN 20MG $132.00 J1380

DEPO ESTRADIOL CYP 5 $211.00 J1000

DEPO MEDROL INJ 40M $56.00 J1030

DEPO MEDROL INJ 80M $114.00 J1040

DEPO PROVERA 100MG $86.00 J1050

DESENEX PWD 1.5 OZ $19.00

DESITIN BABY PAD 9OZ $6.00

DIAPER RASH OINTMENT $18.00

NUCALA 200 MG VIARL $4,303.01 J2182

DESYREL TAB 050MG $6.00

CHLORPROPMDE TAB 100 $9.00

CHLORPROMDE TAB 250M $6.00

DILANTIN CAP 100MG $6.00

Page 14: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PHENYTOIN 250MG INJE $39.00

PHENYTOIN 100MG INJE $39.00

DYPHYLLINE 500MG/2ML $10.00 J1180

DIMETAPP ELIX 4-OZ $33.00

DITROPAN TAB UD $6.00

METOLAZONE TAB 10MG $12.00

METOLAZONE 5MG TABLET $20.00

DOLOBID TAB 250MG $6.00

DOLOPHINE 5MG TAB $6.00

DONNATAL ELIX DISCO $6.00

CEFADROXIL CAP 500MG $27.00

DURICEF ORAL SUSP250 $130.00

DYAZIDE CAP UD $6.00

DYCLONE SOL .5 percent 1-OZ $91.00

E E S LIQ 200MG 16OZ $6.00

E E S LIQ 400MG 16OZ $6.00

E E S 400 TAB UD $6.00

EFUDEX CRM 25GM $91.00

ELASE OINT 30GM $105.00

ELASE/CHLOROMYCETIN $54.00

ELIXICON SUSP 8 OZ $39.00

EMETROL 3OZ $33.00

EPHEDRINE AMP 50MG $31.00

EPIFOAM 10GM $128.00

EPIFRIN .5 percent 5ML $165.00

EPINEPHRINE INJ .05M $22.00

EPINEPHRINE IJ/1MG 1 $39.00 J0171

EPINEPHRINE IJ/1MG 3 $109.00 J0171

ERYTHROCIN LACTOB IV $39.00

ERYTHROCIN LACTOB IV $46.00

ERYTHROMYCIN TAB 250 $6.00

ERYTHROMYCIN TAB 500 $6.00

BAVENCIO 200 MG (PER 10MG) $2,330.63 J9023

ETHIODOL $569.00

ETRAFON FORTE TAB $7.00

ETRAFON TAB 2-10 $6.00

ETRAFON TAB 2-25 $6.00

FELDENE CAP 20MG $8.00

FEOSOL SPANSULE $6.00

FIORINAL CAP RNP $17.00

FLAGYL IV RTU VIAFLE $39.00

FLAGYL TAB 250MG $6.00

FLEET PHOSPHO SODA $16.00

CYCLOBENZAPRINE 10MG $6.00

FLUOR I STRIP AT $7.00

FOLIC ACID INJ 5MG/M $10.00

FOLIC ACID TAB 1MG $6.00

FUNGIZONE IV 50MG $150.00

GENTAMICIN 20MG/2ML $33.00

GENTAMICIN OPTH OINT $88.00

Page 15: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

GENTAMICIN OPTH SOL $45.00

GAVISCON LIQ 12-OZ $43.00

GAVISCON TAB FOIL $6.00

GELFOAM SPONGE SZ 12 $52.00

GENTIAN VIOLET SOL 1 $40.00

GEVRABON 1-OZ $6.00

GLYCERIN SUPP ADULT $6.00

GYNE-LOTRIMIN VAGCRM $58.00

HALCION TAB .25MG $19.00

HALOPERIDOL 2MG/ML 1 $43.00

HALOPERIDOL AMP 5MG/ $109.00

HALDOL TAB 0.5MG $6.00

HALOTESTIN TAB 10MG $6.00

HEPARIN 1000U/ML $10.00 J1644

HEPARIN SOD INJ 10MU $39.00 J1644

HEPARIN 5,000U/0.5M $19.00 J1644

DEXAMETHASONE 4MG VL $19.00 J1100

DEXAMETHASONE INJ4MG $16.00

DEXAMETHASONE TAB.75 $6.00

DEXAMETHASONE TAB 4M $9.00

HISTOPLASMIN SK.TEST $127.00 86510

HYDROCORTOSINE CREAM 1% $22.00

HYDROMORPHONE HCL2MG $31.00 J1170

HYDROMORPHONE HCL4MG $31.00 J1170

HYDROXYZINE 50/2ML V $19.00 J3410

HYGROTON TAB 50MG $6.00

IBERET FOLIC 500 TAB $7.00

IMFERON 50MG $176.00 J1750

IMODIUM CAP $6.00

DROPERIDOL 2.5MG/ML $42.00 J1790

PROPRANOLOL INJ 1MG $127.00

INDERAL LA CAP 120MG $12.00

INDERAL LA CAP 80MG $22.00

PROPRANOLOL 10MG TAB $6.00

PROPRANOLOL 20MG TAB $6.00

PROPRANOLOL 40MG TAB $6.00

INDIGO CARMINE AMP 5 $53.00

INDOMETHACIN CAP 25M $6.00

INSULIN HUMULIN NPH $6.00

INSULIN NOVOLIN REG $6.00

INSULIN LENTE U100 $57.00

INSULIN NPH U100 10M $76.00

INSULIN REG U100 10M $113.00

IPECAC SYR 30ML $12.00

ISONIALZID (INH) $6.00

VERAPAMIL 5MG INJ. $19.00

VERAPAMIL TAB 120MG $6.00

VERAPAMIL TAB 80MG $9.00

PILOCARPINE 1% OPTH $60.00

ISOPTO CARPINE 4% $65.00

Page 16: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ISUPREL SOD 1/100 1% $37.00

ISUPREL SOD 1/5000 1 $41.00

KANTREX INJ 1.0GM VL $47.00

KEFLEX 250MG CAP $6.00

KEFLEX 250MG SUSP $100.00

KEFLEX 500MG CAP $9.00

KENALOG CRM .1% 15GM $21.00

TRIAMCINOLONE CRM/OI $31.00

TRIAMCINOLONE IN 5GM $49.00

TRIAMCINOLONE OINT1% $21.00

KETAMINE INJ 50MG/ML $55.00

KWELL SHAMPOO 2OZ $71.00

LACRI LUBE SOP 3.5GM $29.00

LACRIL TEARS 15ML $28.00

LACTINEX GRAN 1GM $6.00

LACTINEX TAB $6.00

LANOXIN 0.1MG/ML *PE $46.00

LANOXIN INJ 0.5MG/2M $19.00 J1160

LANOXIN TAB .125MG $6.00

LANOXIN TAB .25 MG $6.00

DARZALEX 100 MG/5ML VIAL $737.09 J9145

AMOXICILLIN CAP 250M $6.00

AMOXICILLIN CAP 500M $6.00

LASIX ORAL SOL 10MG/ $61.00

ACTOS 45MG TAB $52.00

LEUKERAN TAB 2MG $14.00

LEVOPHED 1MG/ML 4ML $109.00

LIBRAX CAP UD $10.00

LIBRIUM AMP 100MG $148.00 J1990

CHLORDIAZPDE CAP 10M $10.00

CHLORDIAZDE CAP 25MG $10.00

CHLORDIAZDE CAP 05MG $10.00

LIDEX CRM .05% 15GM $60.00

LIDEX CRM .05% 30GM $117.00

LIDOCAINE HCL INJ 2G $38.00

LIDOCAINE HCL 2% 100 $39.00

PREDNISONE SYRUP 5MG $24.00

LOMOTIL LIQUID 5ML $10.00

LOMOTIL TAB UD $10.00

LONITEN TAB 2.5MG $6.00

LOPRESSOR TAB 50MG $6.00

MAALOX PLUS SUSP UD $6.00

MAALOX SUSP UD $6.00

MACRODANTIN CAP 50M $6.00

MAG. SULF. 50% VIAL $19.00 J3475

MAGNESIUM SULF USP16 $13.00

MAGNESIUM SULF 50% $39.00

MANNITOL INJ 25% 50M $39.00

MARCAINE EPI 0.25% 3 $48.00

MEFOXIN 1GM VIAL $109.00 J0694

Page 17: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

MEFOXIN 2GM VIAL $163.00 J0694

MELLARIL TAB 10MG $6.00

MELLARIL TAB 25MG $6.00

MEPERIDINE HCLINJ100 $31.00 J2175

MEPERIDINE INJ 25MG $31.00 J2175

MEPERIDINE HCLINJ 75 $31.00 J2175

MEPERIDINE HCL50MGTB $10.00

MEPERIDINE HCL50MG $31.00 J2175

VITAMIN K TAB 5MG $10.00

MESTINON AMP 10MG $17.00

METAMUCIL INST MIX $6.00

METHADONE HCL TAB 10 $10.00

METHADONE HCL TAB 5M $10.00

METHOTREXATE SOD 50M $39.00 J9260

METHYLENE BLUE INJ $109.00 Q9968

MIDAMOR TAB 5MG $6.00

MIDRIN CAP $10.00

MILK MAGNESIA ROX $6.00

MINERAL OIL LIGHT $16.00

MINERAL OIL USP ROX $6.00

MINIPRESS CAP 1MG UD $6.00

MINIPRESS CAP 5MG UD $6.00

MITHRACIN IV VIAL 25 $261.00 J9270

MODURETIC TAB 5/50 $6.00

MICONAZOLE CRM 2% 1O $27.00

MONISTAT 7 VAG CRM/A $66.00

MONISTAT 7 VAG SUPP $13.00

MORPHINE SOL 10MG/5M $10.00 J2270

MORPHINE INJ 10MG/ML $31.00 J2270

MVI-12 2/5ML VLS $54.00

MYCOSTATIN TOP PWD15 $119.00

MYDRIACYL SOL 1% 15M $132.00

MYLICON DROPS 30ML $49.00

MYLICON 80 TAB UD $6.00

NAPROSYN TAB 250MG U $6.00

NAPROSYN TAB 375MG U $6.00

NARCAN INJ 0.4MG 1ML $39.00 J2310

NAVANE CAP 2MG UD $6.00

NEBCIN 1.2GM AMP $1,046.00

TOBRAMYCIN 80MG/2ML $28.00 J3260

NEO DECADRON OCUMETR $75.00

NEO DECADRON OPTH OI $29.00

NEO SYNEPH OPTH SOL $24.00

PHENYLEPHRINE INJ 1 $19.00

NEO SYNEPHRINE SOL.5 $27.00

NEO SYNEPHRINESOL 1% $29.00

NEO SYNEPHRINESPR.25 $27.00

NEO SYNEPHRINE SPR.5 $27.00

NEOMYCIN SO4 TAB 500 $10.00

NEOSPORIN OINT 1/32 $6.00

Page 18: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NEOSPORIN OINT 1-OZ $47.00

NEOSPORIN OPTH OINT $78.00

NESACAINE-CE HCL UNI $162.00

NEUTRA PHOS CAP $6.00

NIFEREX TAB $6.00

NIFEREX 150 CAP $6.00

NYSTATIN ORAL SUSP. $94.00

NITROPRUSSIDE 50MG V $19.00

NITRO DUR 10CM $13.00

NITROGLYCERIN .6MG $16.00

NITROGLYCERIN 6.5MG $6.00

NITROSTAT 1/150SL (. $54.00

NITROSTAT 1/200SL (0 $54.00

NIZORAL TAB 200MG $24.00

NOLVADEX TAB 10MG $9.00

NORFLEX TAB 100MG $23.00

NORPACE CAP 100MG $6.00

NORPACE CAP 150MG $9.00

NUBAIN 10MG $31.00 J2300

NUPERCAINAL OINT 1OZ $28.00

AMPICILLIN 1GM VIAL $54.00 J0290

AMPICILLIN 125MG VIA $39.00

AMPICILLIN 250MG INJ $39.00

AMPICILLIN 500MG VIA $39.00 J0290

ORINASE TAB .5GM $6.00

ORTHO DIENESTROL CRM $152.00

PARLODEL TAB 2.5MG $21.00

PAPVERINE CAP $6.00

PAVULON AMP 2MG/ML $123.00

PEDIAZOLE SUSP 100ML $82.00

PEN VEE K 250MG ORAL $23.00

PENTOTHAL INJ SYR400 $31.00

PERCONDAN TAB 5MG $15.00

DOCUSATE NA.W/CASANT $6.00

PERIACTIN SYR 2MG $218.00

PERIACTIN TAB 4MG $6.00

PERSANTINE TAB 25MG $6.00

PERSANTINE TAB 50MG $6.00

PERSANTINE TAB 75MG $6.00

PENICILLIN G K 1 MIL $34.00

PENICILLIN G K 5 MIL $109.00

PHENERGAN SUPP 12.5M $30.00

PHENERGAN SUPP 25MG $33.00

PHENERGAN TAB 25MG $6.00

PHENERGAN VC EXP/COD $13.00

PHENOBARB TAB30MGROX $10.00

PHENOBARB TAB60MGROX $10.00

PHENOBARBITAL ELIX20 $10.00

PHENOBARBITAL INJ 60 $28.00

CISPLATIN 50MG/50ML $73.00 J9060

Page 19: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

POLYMIXIN B SULF 500 $56.00

POTASS CHL INJ 20MEQ $19.00 J3480

POTASS CHL INJ 40MEQ $19.00

POTASS CHL LIQ10%PHC $6.00

POTASS PHOS INJ 45MM $19.00

POTASSIUM ACETATE IJ $19.00

PRED FORTE 5ML $110.00

PREMARIN TAB 1.25MG $7.00

PREMARIN VAG.CRM.APP $279.00

PREPARATION H OINT. $26.00

AMPICILLIN CAP 250MG $6.00

AMPICILLIN CAP 500MG $6.00

PRISCOLINE INJECTION $74.00

PROCAN SR TAB 500MG $6.00

NIFEDIPINE 10MG CAP $6.00

PROLIXIN TAB 1MG $6.00

PROMETH. 25MG/ML INJ $10.00 J2550

PROCAINAMIDE IM/IV 5 $19.00

PROPINE OPTH SOL .1% $74.00

PROVENTIL/VENTOLIN M $107.00

PROVERA TAB 10MG $6.00

PYRIDIUM TAB 100MG $6.00

PYRIDIUM TAB 200MG $6.00

QUINAGLUTE DURATAB $7.00

QUINIDEX EXTENTAB UD $6.00

QUINIDINE SULF TAB $6.00

QUINIDINE SULFTB300M $6.00

QUNINE SULF CAP 5GR $6.00

QUNINE SULF CAP 3GR $6.00

REGLAN 10MG/2ML VL $19.00 J2765

REGLAN SYR 16-OZ $6.00

REGLAN TAB 10MG $6.00

RESTORIL CAP 15MGRNP $10.00

D5LR 1000CC $109.00

RHO D IMMUNE GLOBULN $222.00 J2791

RIFAMPIN CAP 300MG $23.00

RIOPAN PLUS SUSP 12O $25.00

RITALIN TAB 5MG $10.00

ROBAXIN INJ 10ML $19.00

ROBAXIN TAB UD $6.00

ROBINUL INJ 0.2MG 1M $19.00

ASPIRIN SUP 300MG $9.00

ROBITUSSIN SYR UD5ML $6.00

ROBITUSSIN SYR 4-OZ $30.00

SILVADENE CRM 400GM $106.00

SILVADENE CRM 50GM $47.00

SILVER NITRATE APPL $6.00

SINEMET TAB 25/100UD $7.00

SINEMET TAB 25/250 $6.00

SINEQUAN CAP 10MG $6.00

Page 20: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SINEQUAN CAP 25MG $6.00

SINEQUAN CAP 50MG $6.00

SODIUM ACETATE 40MEQ $19.00

SODIUM BICARB 4.2% 2 $39.00

SODIUM BICARB 8.4% 1 $23.00

SODIUM CHL INJ4MEQ/M $19.00

SULFACETAMIDE SOL10% $54.00

COMBIVENT 14.7G INHA $295.00

CARISOPRODOL TAB 350 $10.00

SORBITOL SOL USP 70% $6.00

ISOSORBIDE ORAL 5MG $6.00

ISOSORBIDE SA 40MG $6.00

STADOL INJ*2MG/1ML $53.00 J0595

STADOL INJ 1MG/ML $39.00 J0595

STELAZINE TAB 1MG $6.00

STELAZINE TAB 2MG $6.00

STELAZINE TAB 5MG $9.00

STERILE WATER/INJ500 $21.00

STERILE WATER/INJ10M $19.00

FENTANYL INJ .05MG $31.00 J3010

TETRACYCLINE 500MG $6.00

SYMMETREL CAP 100MG $6.00

SYMMETREL SYR 50MG $7.00

SYNTHROID TAB (0.05 $6.00

SYNTHROID TAB .1MG $6.00

SYNTHROID TAB .15MG $6.00

SYNTHROID TAB .2MG $6.00

ACTOS 15MG TABLET $30.00

TALWIN AMP 30MG 1ML $31.00

TALWIN NX TAB UD $10.00

TEGRETOL TAB 100MGUD $6.00

TEGRETOL TAB 200MGUD $6.00

TENSILON AMP 10MG1ML $17.00

MISOPROSTOL 200MCG TABLET $12.68 S0191

TESALON PERLES 100MG $6.00

TETANUS IMM GLOB 250 $407.00 J1670

TETANUS/DIPH TOX AD $147.00 90714

TETRACAINE HCL .5% 1 $31.00

THEO DUR TAB 200MG $6.00

THEO DUR TAB 300MG $6.00

THIAMINE HCL INJ 100 $71.00 J3411

THORAZINE INJ25MG/2M $109.00 J3230

THORAZINE TAB 10MG $6.00

THORAZINE TAB 100MG $6.00

THORAZINE TAB 25MG $6.00

THROMBINAR TOPICAL10 $455.00

TIGAN AMP 200MG 2ML $49.00 J3250

TIGAN CAP 250MG $9.00

TIGAN SUPP 200MG $9.00

TIGAN SUPP PED 100MG $9.00

Page 21: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

TIMOLOL OPHT. SOL. 0 $81.00

IMIPRAMINE 10MG TAB $6.00

IMIPRAMINE 25MG TAB $6.00

DESOXIMETASONE CR. 0.05PER 15g $76.00

TPN ELECTROLYTES ABB $22.00

TRACE METAL ADD 5ML $39.00

TRANSDERM SCOPE PATCH $59.00

TRANXENE CAP 3.75MG $16.00

TRINSICON CAP $6.00

TB SKIN TEST $71.00 86580

TUCKS $6.00

TUSSIONEX SUSP 1-OZ $10.00

TYLENOL DROP CHILD ( $30.00

TYLENOL/COD ELIXIR $7.00

TYLENOL/COD TAB #3 $10.00

NAFCILLIN 1GM VL $58.00

NAFCILLIN 2GM VL $126.00

URISED TAB $6.00

URISPAS 100MG TAB UD $8.00

BETAMTSNE CRM.1%15GM $10.00

BETAMSNE OINT.1%15GM $41.00

BETAMTSNE OINT.1%45G $32.00

VALIUM AMP 10MG 2ML $31.00 J3360

VALIUM TAB 10MG RNP $10.00

VALIUM TAB 2MG RNP $10.00

VALIUM TAB 5MG RNP $10.00

VANCENASE NASAL INHA $297.00

VANCOMYCIN 500MG VL $51.00 J3370

VIBRAMYCIN CAP 100MG $6.00

DOXYCYCLINE HYCLATE 100 MG VIA $110.00

VICKS VAPOR RUB WHTE $16.00

VICODIN TAB $12.00

KEPPRA 500MG TAB. $24.00

HYDROXYZINE CAP 25MG $6.00

HYDROXYZINE CAP 50MG $6.00

HYDROXYZINE PAM.SUSP $61.00

WYTENSIN TAB 4MG $6.00

XANAX TAB 1MG $15.00

XYLOCAINE 5%/GLUC $32.00

XYLOCAINE AMP 2%10ML $19.00

XYLOCAINE OINT 5% 35 $76.00

XYLOCAINE TOP SOL 4% $50.00

LIDOCAINE VISC 2% 20 $7.00

XYLOCAINE VL .5% 50M $39.00

XYLOCAINE/EP VL .5 $39.00

XYLOCAINE/EP VL 1% $39.00

ZANTAC TAB 150MG UD $24.00

ZINC OXIDE OINT NORW $12.00

ZINC TRACE METAL ADD $22.00

FLOXIN 0.3% OTIC SOL $232.00

Page 22: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ZOVIRAX 500MG VIAL PER 5MG $241.00 J0133

ACYCLOVIR 5% OINTMENT 30GM $266.00

ZYLOPRIM TAB 100MG $6.00

ZYLOPRIM TAB 300MG $6.00

ALBUMIN 25% 100ML $861.00 P9047

METYLDOPA 250MG TAB $6.00

ALTERNAGEL 5OZ $57.00

CLINDAMYCIN 900MG/6M $43.00

ACETAZOLAMIDE IV500M $235.00 J1120

ACETAZOLAMIDE 250MG TABLET $6.00

FLORINEF .1MG TAB $6.00

ERYTHROMYCIN OINT 1G $6.00

NICORETTE 2MG GUM $6.00

PREMARIN .625MG UD $6.00

RITALIN 10MG TAB $10.00

SINEMET 10/100 TAB $6.00

SODIUM LACTATE 50MEQ $21.00

SODIUM PHOSPHATE 3MM $19.00

THYROID 1GRAIN ARMOR $6.00

WELLBUTRIN SR 150 TA $26.00

XANAX .5MG $10.00

GENTAMICIN 100MG IN $109.00 J1580

GENTAMICIN 80MG IN $60.00 J1580

Xolair 150 MG $1,626.98 J2357

BETHANECOL TAB 25MG $12.00

FUROSEMIDE 40MG $6.00

GLAUCON 1% 10ML $111.00

DOCUSATE SOD 100MG V $6.00

METHYLPREDNISOLON 40 $26.00 J2920

XANAX 0.25MG TAB UD $10.00

CEFUROXIME 1.5GM VIAL $60.00 J0697

METHYLPREDNISOL 125 $39.00 J2930

POTASS CL TAB 750MG $6.00

MILK MAGN/CASCA 30ML $9.00

MECLIZINE 25MG TAB $6.00

TRIAMCINOLONE CREAM $21.00

PROCAN SR 750MG TAB $6.00

NITROGLYCERIN 9MG SR $6.00

NORMODYNE/TRANDATE 2 $6.00

CORTICAINE CREAM 1OZ $22.00

TIMOLOL OPHT. SOL. 0 $76.00

ACETAMINOPHEN ELIX. $31.00

TETRACYCLINE 125MG/5 $6.00

CASCARA SAGRADA 5ML $6.00

FUROSEMIDE 40MG/4ML $19.00 J1940

FUROSEMIDE 100MG/10M $19.00 J1940

DANTRIUM 20MG VIAL $431.00

PHENOBARBITAL 15MG U $6.00

ATROMID S 500MG $6.00

PREDNISONE 50MG TAB $8.00

Page 23: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

OGEN 1.25MG TABS 100 $6.00

DEPAKENE 250MG CAPS $6.00

FLOVENT 220MG INHALE $34.00

GENTAMICIN OINT 15GM $18.00

ARAVA 20 MG TABLET $46.00

TRENTAL 400MG TAB $6.00

BETADINE SUGAR PASTE $29.00

METHYLPREDNISOLE 1GM $154.00 J2930

NORPACE CR 150 UD $8.00

HYDROXYZINE HCL TABS $6.00

MEDROL TAB 4MG UD $7.00

TRANXENE 7.5MG UD $17.00

BETAMTSNE LOTION60ML $71.00

DILANTIN 50MG CHEW. $6.00

GLUTOSE LIQ. 80GM $23.00

NASALIDE SPRAY 25ML $158.00

DEXAMETHASONE ELIX.0 $36.00

PROMETHAZINE EXPECTO $6.00

HYDRALAZINE 25MG TAB $6.00

THYROID 1/2 GRAIN 30 $6.00

COLYTE PKG. $136.00

AMRINONE 5MG/ML 20ML $197.00

AMITRIPTYLINE TAB 25 $6.00

COMPAZINE SUPP 5MG $8.00

VINCRISTINE 2MG/2ML $132.00 J9370

PERCOCET TAB $16.00

NARDIL 15MG TAB $6.00

RIFAMATE CAPS $25.00

MATERNA 1-60 TAB $6.00

ATIVAN INJ 2MG/ML(DI $31.00 J2060

BACITRA SOL PT $6.00

DICYCLOMINE 10MG CAP $6.00

LOTRISONE CREAM 15GM $112.00

MUCOMYST 20% SOL 30M $98.00

MORPHINE INJ 50MG/50 $186.00 J2270

MEPERIDINE 500MG/50M $186.00 J2175

DEXAMETHASONE TAB.5M $6.00

MYCOSTATIN VAGINAL T $17.00

VEPESID 100MG VIAL $109.00 J9181

CORTROSYN 0.25MG/ML $416.00 J0834

IMURAN 50MG TAB $17.00 J7500

TINACTIN CREAM 15GM $27.00

MEDROL DOSEPAK 4MG $62.00

ZOVIRAX 200MG CAPS U $14.00

ERY TAB 250MG UD $8.00

NORMODYNE 100MG/20ML $39.00

BRETHAIRE INHALER 7. $58.00

MICRONASE 2.5MG TAB $6.00

E E S 400/5ML 100ML $23.00

NORCURON VIAL 10ML $39.00

Page 24: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PROENTIL 4MG TAB $6.00

GLYCERIN SUPP CHILD $6.00

LIMBITROL 10-25 TAB $6.00

NAVANE 5MG UD $6.00

MICARDIS 80MG TAB $9.00

TOBREX OPTH OINT 3.5 $179.00

PHENERGAN SUPP 50MG $40.00

KAYEXALATE $55.00

MUMPS SKIN TEST 0.1M $637.00 86486

MAG. SULFATE 50% INJ $32.00

THORAZINE 25MG SUP $29.00

AQUAPHOR 1LB $72.00

MERCUROCLEAR SOLN. 1 $13.00

DILAUDID SUPP. 3MG $6.00

PHENOBARBITAL 100MG $10.00

BUMEX TAB. 0.5MG $9.00

PROLIXIN DECANOATE I $109.00 J2680

GELFOAM POWDER 1GM $170.00

ALCOHOL DEHYDRATED I $52.00

AMITRIPTYLINE TAB100 $6.00

NYSTATIN TOPICAL CRE $18.00

MUTAMYCIN 5MG INJ. $485.00 J9280

CHLOROPTIC OPTHAL. G $18.00

CEFTAZIDIME 1GM VL. $109.00 J0713

AMITRIPTYLINE TAB 10 $6.00

PAPAVERINE INJ. 60MG $39.00

GLIPIZIDE 5MG TABLET $6.00

ASCRIPTIN AD TAB $6.00

BLENOXANE 15 UNITS I $976.00 J9040

BICNU 100MG INJ $193.00 J9050

DOPRAM INJ. 20ML $583.00

MARCAINE 0.25% INJ. $21.00

NESACAINE-CE 2% INJ. $160.00

REGITINE 5MG INJ. 1M $1,680.00

ROBINUL INJ. 20ML $22.00

MOISTURIN CREAM 16OZ $73.00

EURAX CREAM 60GM $32.00

GYNE-LORTIMIN VAG. T $49.00

HALOTEX 1% CREAM 15G $26.00

KWELL LOTION 1% 60ML $117.00

MONISTAT 3 200MG VAG $160.00

BI-CILLIN L-A 600,00 $171.00 J0561

WYCILLIN 1.2MM UNITS $27.00 J2510

HEP B GAMMAGEE 5ML ( $125.00

PREMARIN IV 25MG/5M $561.00 J1410

D.H.E. 45 AMPULS $261.00 J1110

DEPO-TESTOSTERONE 20 $50.00

TRIAMCINOLONE-40 INJ $64.14 J3301

NEOSTIGMINE INJ. 1/1 $109.00

PROGESTERONE 50MG IN $209.00

Page 25: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PROLIXIN 2.5MG/ML 10 $467.00

PROTAMINE 50MG INJ. $46.00

HYDROCORT 250MG/2ML $47.00 J1720

AVC CREAM W/DIENESTR $43.00

ANUSOL OINT. 1OZ. $30.00

BISACODYL UNISERTS ( $6.00

CELEXA 40MG TAB. $26.00

DYCLONE 1% SOLN. 1OZ $109.00

ATROPISOL 1ML UD $6.00

CORTISPORIN OPTH OIN $156.00

ISOPTO HYOSCINE .25PERC 5 ML $120.00

ISOPTO HOMATROPINE 5 $125.00

ISOPTO CARPINE 3% 15 $25.00

NEOSPORIN OPTH. SOLN $125.00

SULFACETAMIDE SOD OP $39.00

HYDROXYZINE SYRUP 10 $188.00

CHLORPHENIRAM SYRUP $6.00

CIPRO HC OTIC 10ML $294.00

FER-IN-SOL SYRUP $6.00

LOPERAMIDE 2MG/1OML $7.00

B & O SUPP. $27.00

DILAUDID 2MG TAB. $10.00

LIMBITROL 5-12.5 TAB $9.00

MINOCIN 50MG CAP UD $9.00

MYSOLINE 250MG TAB U $6.00

TRIHEXIPHENIDYL 2MG $6.00

NORTRIPTYLINE HCL 25 $6.00

DIPHENHYDRAMINE 50MG $6.00

PROBENICID 0.5GM TAB $6.00

ROBITUSSIN AC SYR 2O $17.00

DYNAPEN 250MG CAP UD $6.00

PROPYLTHIOURACIL 50M $6.00

BETAMTSNE CRM.1% 45G $49.00

SPORANOX 10MG/ML 25M $773.00

COLCHICINE 0.6MG TAB $6.00

METOLAZONE TAB 2.5MG $9.00

ESTRACE 1MG TAB. $6.00

LITHIUM CARBONATE300 $6.00

MYAMBUTOL 400MG TAB. $23.00

DESIPRAMINE 25MG (PE $6.00

PLAQUENIL TAB. $7.00

CANDIDA SKIN TEST 1: $127.00 86485

DEXTROSE INJ 50% 25G $39.00

MYSOLINE 50 MG. TAB $6.00

SENOKOT TAB $6.00

DEXTROSE 25% PED. AB $39.00

D5/.45NS 1000CC $91.00

CORTAID CRM O.5%15GM $9.00

ISOPTO CARPINE 6%15M $42.00

MICRONASE 5 MG UDTAB $6.00

Page 26: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CATAPRES-TTS-2 $147.00

MAXZIDE UD TABLET $6.00

CAPOTEN 12.5 MG TAB $6.00

CATAPRES-TTS-3 $190.00

DANOCRINE 200 MG.CAP $31.00

XYLOCAINE/EPI 1%20ML $19.00

XYLOCAINE 2% 20ML $19.00

XYLOCAINE, 1% 20ML $19.00

HEPARIN LOCK FLUSHPF $19.00 J1642

OXYTOCIN AMP 1CC 10U $19.00 J2590

SODIUM CHL O.9% PF $19.00

MAGNESIUM OXIDE400MG $6.00

BECONASE ORAL INHALE $206.00

RUBELLA VIRUS VACCIN $148.00

AK-PRED OPTH SOL 5CC $17.00

D5/.45NS 500CCPLASTI $60.00

MESTINON 60 MG. TAB $6.00

SUCRETS LOZ. (24) $11.00

LONITEN 10 MG TAB $9.00

ISOSORBIDE ORAL 20MG $6.00

NYSTATIN OINT 15GM $18.00

NITROGLYCERIN IV 50M $109.00

TRIAMCINOLONE CR/OIN $29.00

PREMARIN TAB 0.3MG $7.00

KLONOPIN 0.5MG TAB. $10.00

NEWBORN DRUG KIT $40.00

ISOSORBIDE ORAL 30MG $6.00

ISOSORBIDE ORAL 40MG $6.00

PEN G BENZATHINE1.2M $19.00

COMPOUNDING FEE $20.00

IBUPROFEN TAB400MGUD $6.00

CATAPRES-TTS-1 $94.00

IBUPROFEN TAB 800MG $6.00

VITAMIN D 50,000U $6.00

STELAZINE INJ2MG10ML $109.00

LANOLIN USP 10Z $16.00

BICILLIN LA 2,400,000 $101.00 J0561

CYTOXAN 50 MG TAB. $11.00

BLINX OPHTH 30ML $72.00

THEOPHYLLINE 80MG/15 $6.00

PRIMATENE MIST KIT $67.00

HIBICLENS LIQ. 15ML $6.00 A4248

PROSTIN E2 20MG VAG $2,359.00

THROMBIN TOP. SPRAY $1,097.00

GENTAMICIN 80MG/2ML $19.00 J1580

FIORICET TAB UD $6.00

NEO SYNEP OPTH SOL 2 $29.00

AVC CRM/APPL. 40Z $72.00

SSKI SOLN. DROPS 1OZ $80.00

NORTRIPTYLINE 10 MG $6.00

Page 27: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SYNTHROID INJ 500MCG $153.00

ADSORBONAC 2% 15ML $21.00

ADSORBONAC 5% 15ML $51.00

VERELAN PM 300MG TAB $28.00

STERILE WATER FOR IR $31.00

CORDARONE TAB 200MG $26.00

ED LEVEL I $57.00 99281

ED LEVEL II $105.00 99282

ED LEVEL III $162.00 99283

ED LEVEL IV $300.00 99284

ED LEVEL V $491.00 99285

IP CONSULT, LIMITED 20 MIN $101.00 99251

IP CONSULT,INTERMED $190.00 99252

HEPARIN 25,000 UNITS $41.00 J1644

DEPAKOTE SPR. 125MG $6.00

DEPAKOTE TAB 125MG $6.00

XYLOCAINE 1% 5ML AMP $19.00

NEPHRO-VITE RX $6.00

ADALAT CC 30MG TAB $6.00

CLEOCIN 900MG/50ML D $77.00

ZOSYN 3.375G $131.00 J2543

RED IPJ DISLOCATION $179.00 28660

STRAP SHOULDER $137.00 29240

STRAP ANKLE $92.00 29540

STRAP TOE $79.00 29550

STRAPPING KNEE $115.00 29530

RED METACARP/PHAL $714.00 26700

REDUCE ANKLE DISLOC $745.00 27840

EMER CRICOTHYROIDOMY $433.00 31605

I&D HEMATOMA $256.00 10140

DEBRIDGE <10% $88.00 11000

DEBRID FUL THICK SKN $112.00 97597

DEBRIDE SKIN & SUBCU $121.00 11042

FBR SUBCUTANOUS-SIMP $238.00 10120

I&D FINGER SIMPLE $334.00 26010

AVULSION NAIL $168.00 11730

SUBUNQUAL HEMATOMA $79.00 11740

I&D ABCESS EAR $304.00 69000

FBR EAR $212.00 69200

REMOVAL CERUMEN $92.00 69210

I&D PERINEAL ABSCESS $241.00 56405

VAG. DELIVERY EMER. $2,086.00 59409

BLOCK DIGITAL-DOCTOR $307.00 64450

INJ LIGA/TENDON/GANG $131.00 20550

ASP/INJ BURSA SMALL $114.00 20600

ASP/INJ BURSA MED. $125.00 20605

ASP/INJ BURSA LARGE $138.00 20610

CARDIAC ARREST $521.00 92950

ED CRITICAL CARE DOC $524.00 99291

REPAIR NAIL BED $290.00 11760

Page 28: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SM20.1-30.0 BDY&EXT $480.00 12006

SM 5.1-7.5 EYE/LIP $326.00 12014

BTE THERAP EX 15 OT $88.00 97110

FLUIDOTHERAPY/DRY OT $120.00 97022

THERAPUTIC EXC 15 OT $110.00 97110

ADL EA OT EA 15 MIN $101.00 97535

THERAPUTIC ACT 15 OT $95.00 97530

PARAFFIN BATH OT $57.00 97018

IONTOPHORESIS 15MOT $132.00 97033

E-STIM UNATTENDED SP $102.00 97014

SYNTHROID INJ 200MCG $194.00

BOTOX 200 UNITS $3,756.00 J0585

TAMBOCOR 100MG TAB(F $13.00

MEXILETINE 200MG CAP $6.00

NAROPIN 5MG/ML 30ML $125.00 J2795

VASOTEC TAB 10.0MG $6.00

BROMPTON'S SOLN. $11.00

DESMOPRESSIN AC 4 MC $118.00 J2597

LACRI LUBE OPTH OINT $14.00

NITRO DUR 15CM $12.00

VYTONE 1% CREAM $189.00

NITRO DUR II 20CM $12.00

SECTRAL 200MG CAP. $6.00

MEXILETINE 150MG CAP $6.00

AZMACORT ORAL INHALE $261.00

BLEPHAMIDE SOPO/OINT $166.00

PROMETH. INJ.50MG/ML $25.00 J2550

HYDROCORTISONE TAB. $6.00

DEPO PROVERA 400MG/M $557.00

CEFUROXIME 1.5GM VL $109.00

PRIMAXIN 500MG VL $218.00 J0743

NITROLINGUAL 0.4MG/S $441.00

MEGACE TAB 40MG 100' $6.00

FLUOCINOLONE 0.025% $52.00

VANCOMYCIN CAP 250MG $143.00

M M R VIAL & DILUE $83.00 90707

INTAL INHALER 112M S $188.00

FLUOCINONIDE .05% 15 $57.00

BUSPAR TAB 5MG TAB $6.00

BUSPAR TAB 100MG UD $6.00

HEPARIN FLUSH KIT 10 $10.00

VERAPAMIL 240MG TAB $13.00

NITRO DUR II 30CM $14.00

VASOPRESSIN TANNATE $40.00

ACHROMYCIN OS 1%0.5M $8.00

VASELINE TUBE 30GM $6.00

TETRACYCLINE 1% OPHT $8.00

MYCELEX TROCHE ORAL $10.00

DESIPRAMINE TAB 10MG $8.00

HALOPERIDOL TAB 1MG $6.00

Page 29: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

HALOPERIDOL TAB. 2MG $6.00

HALOPERIDOL TAB 5MG $6.00

MORPHINE 2MG/ML INJ $31.00 J2270

MORPHINE 4MG/ML INJ $31.00 J2270

TOBREX OPHTH SOL .3% $76.00

BETOPTIC 0.5% OPHTH $56.00

ERYPED SUSP. 400MG $6.00

PENICILLIN V K 100ML $6.00

NIZORAL CREAM 2% 15G $80.00

PILOCARPINE 2% 15ML $67.00

PHISOHEX 5 OZ. $88.00

DOXEPIN CONC. 10MG $78.00

PREMARIN TAB 0.9MG $8.00

SKELAXIN 800 MG TAB $16.00

LOZOL TAB 2.5MG UD $6.00

COCAINE TOP SOL 4%4M $139.00

VOSOL 15ML $27.00

PEPCID 20MG TABLET $9.00

CEFAZOLIN 250MG VIAL $21.00 J0690

CEFAZOLIN 500MG VL $39.00 J0690

CEFAZOLIN 500MG PB $25.00 J0690

CEFAZOLIN 1GM VIAL $39.00 J0690

CEFAZOLIN 1GM PB PER 500MG $23.00 J0690

ATROVENT ORAL INHALE $235.00

PILOCARPINE 0.5% 15M $42.00

DEMECLOCYCLINE TAB 3 $31.00

AUGMENTIN SUSP 250MG $100.00

RANITIDINE 50MG 100M $19.00

DOPAMINE HCL 400MG/2 $167.00

LIDOCAINE HCL 2GR500 $143.00

DEPAKOTE TAB 250MG $10.00

DIPROSONE CRM.O.05% $57.00

MYCELEX G VAG 500MG $46.00

POTASSIUM CL 8MEQ $6.00

INDERAL LA CAP 60MG $19.00

AUGMENTIN TAB 500MG $37.00

AUGMENTIN SUSP.125MG $59.00

AUGMENTIN 125MG150ML $45.00

AUGMENTIN 250MG 100S $8.00

AUGMENTIN SUSP.250MG $100.00

AUGMENTIN CHEW 125MG $6.00

NIFEREX ELIXER 8OZ $229.00

HEMABATE(IM ONLY)250 $581.00

SONATA 5MG CAPSULE $41.00

RONDEC DM DROPS 30ML $46.00

HUMALOG MIX 75/25 $6.00

INSULIN PORK REG 10M $68.00

ALBUTEROL SYRUP 2MG $10.00

CEFTRIAXONE 250MG VL $117.00 J0696

HEPARIN LOCK FLUSH $19.00 J1642

Page 30: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PEPCID 20MG/2ML (FAM $24.00

FLAGYL IV 500MG VIAL $113.00

VIROPTIC SOL'N 7.5ML $288.00

ERYTHROMYCIN SOL 2% $32.00

PEPCID 40MG/5ML SUSP $392.00

ACTIVASE 50MG VIAL $5,542.00 J2997

DIPROLENE OINT. 45GM $103.00

PROLIXIN TAB 5MG UD $7.00

VITAMIN E DROPS 12ML $43.00

MEVACOR TAB 20MG. UD $23.00

D5W 25ML BAG $13.00

PROZAC CAP 20MG UD $23.00

HYDROCORTISONE 2.5% $55.00

PANCREASE CAP $6.00

MORPHINE CONTIN 30MG $18.00

PNEUMOVAX 0.5ML (25M $179.00 90732

CARDIZEM TAB 90MG UD $8.00

ERYTHROMYCIN 333MG $6.00

INTERFERON 3 MMU (EA $1,234.00 J9214

INTERFERON 5MMU (EA. $2,251.00 J9214

CIPRO 500 MG TAB $47.00

CYTOXAN 500MG VIAL $151.00 J9070

PROVENTIL REPETAB 4M $6.00

ELOCON CREAM 15GM $143.00

GLIPIZIDE 10MG TABLE $6.00

HYDOCORTISONE 1% 4OZ $71.00

POTASS CL 20MEQ TAB $6.00

VERSED 5MG/1ML VIAL $31.00 J2250

ENLON INJ 15ML $109.00

BRETYLIUM 1GM/20ML $172.00

BUPRENEX 0.3MG/1ML $31.00 J0592

CHARCOAL-AQUA 25G $71.00

CHARCOAL-AQUA 50G 24 $110.00

CHARCOAL-SORBITOL 25 $90.00

CHARCOAL-SORBITOL50G $110.00

LEUCOVORIN 100MG (IM $109.00 J0640

HALICION .125MG UD $10.00

CALCITONIN SALMON INJ 400U/2ML $8,370.57 J0630

ALORA 0.05MG PATCH ( $30.00

DDAVP(0.01% NASAL SO $358.00

HYTRIN TABS 2MG (TER $8.00

MUCOMYST 10% 4ML X 1 $28.00 J0132

AZTREONAM 1GM VL 10' $200.00

CYTARABINE INJ 100MG $72.00 J9100

CYTARABINE INJ 500MG $197.00 J9100

METHOTREXATE SOD 200 $218.00

TENEX TAB 1MG $6.00

OSELTAMIVIR 30 MG TAB $22.69

TRAVASOL 10% $133.30

SWALLOW/FEEDING TX $176.00 92526

Page 31: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DYSPHAGIA EVAL/FLURO $336.00 92611

DYSPHAGIA EVAL $212.00 92610

SPEECH TX, GROUP $39.00 92508

HOME EXER PGM 15 PT $101.00 97535

POLAR GEL WRAP $166.00

ROOM & BOARD SEMI-PRIVATE $647.00

ROOM & BOARD - PVT $677.00

BLOOD ADMINISTRATION $775.00 36430

ROOM & BOARD IMCU $745.00

ASPIRAT/INJ JONT $582.00

SPINAL PUNCTURE, THERAPEUTIC $1,455.00 62272

SPINAL PUNCTURE, DX $1,455.00 62270

BRONCH TOILETING FLX $531.00

IN/OUT CATH RESIDUAL $321.00 51701

INSERT FOLEY CATH SIMPLE $229.00 51702

CHEST TUBE INSERT WT $1,314.00 32551

CLOSED RED FR/DISLOC $307.00

CARDIOPULMONARY RESUSCITATION $914.00 92950

EPI CONTINOUS W/CATH $739.00

PLMT URETERAL STENT PRQ $7,221.00 50694

LUMBAR PUNCTURE,DIAG $520.00

IM/SQ INJ O.P. $95.00 96372

RPLC GTUBE NO REVJ TRC $1,843.00 43762

DIALYSIS, PERITONEAL $450.00 90945

PHLEBOTOMY, THERAPU. $139.00 99195

INTUBATION EMERGENCY $737.00 31500

THORACENTESIS $886.00 32555

THOROCOTOMY $504.00

TRACHEOSTOMY PROC. $2,130.00 31603

ACCU-CHECK $25.00 82962

INSERT ARTERIAL LINE $1,752.00 36620

CARDIOVERSION EXTERN $1,290.00 92960

INSERT CVL CATH >5YR $2,134.00

CRITICAL CARE $1,800.00 99291

ACUITY LEVEL I $200.00 99281

ACUITY LEVEL II $355.00 99282

ACUITY LEVEL III $639.00 99283

ACUITY LEVEL IV $1,100.00 99284

ACUITY LEVEL V $1,500.00 99285

AMNIOINFUSION $1,016.00 59070

DELIVERY, VAGINAL EMERGENCY $3,782.00

FETAL MONITOR LABOR $132.00

IUPC MONITOR $217.00

NON STRESS TEST $454.00 59025

OCT $339.00 59020

CIRCUMCISION W/DEVIC $1,983.00 54150

CODE BLUE/NEONATE $1,250.00 99465

INTUBATION EMERG NEO $589.00 31500

UVC PROC NEONATE $238.00 36510

BETAPACE 80MG TABLET $23.00

Page 32: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ETHMOZINE 200MG TAB. $6.00

HYOSCYAMINE.125MG TB $6.00

LANACAINE CREAM 10Z $28.00

LANACAINE SPRAY 40Z $15.00

CLOTRIMAZOLE 1% CREA $38.00

HYDROCORTIZONE OINT. $55.00

HYDROCORTISONE CREAM .05 PERCE $28.00

KINEVAC 5MCG $333.00

NITROSTAT 0.6(100GR) $54.00

TOLNAFTATE PWDR.45GM $40.00

CYTOXAN 25MG TABLET $23.00

OGEN .75MG TABLET $6.00

CORTEF FEM.ITCH.CRM. $10.00

GELFOAM SPONGE 50 $122.00

LIDEX TOPICAL SOLUTI $119.00

FLUOCINOLONE .25% CM $26.00

NYSTATION CREAM 30GM $27.00

DECADRON TOPICAL CRM $36.00

ANBESOL GEL 7.4G $28.00

ALPHA KERI SH&BD 4OZ $26.00

PROCTO CREAM -HC $176.00

AVC SUPP $101.00

PEROXYL GEL $30.00

STR. WATER/INJ.1000M $60.00

D5W 100ML AD VAN $57.00

ATROPINE SULFATE 1% $18.00

BICILLIN CR 1,200,000 $180.00 J0558

CYCLOGYL 1% 5ML $125.00

METHOTREXATE 250MG I $131.00

QUESTRAN LIGHT PK $25.00

SODIUM CHLORIDE .9% $56.00

PRELONE 10Z $14.00

BACITRACIN OPTH ONIT $32.00

CYTADREN 250MG TAB $6.00

HEMATROPINE 5% 15ML $43.00

HEMATROPINE 2% 15ML $60.00

FLUOROMETHOLONE FML $78.00

RACEPINEPHRINE 2.25 $56.00

SALSITAB 500MG TAB $6.00

SALSITAB 750MG TAB $6.00

SALIVA SUBSTITUTE 4O $31.00

ARGYROL SS 10% 15ML $33.00

RIMACTANE 300MG TAB $13.00

HEPATITIS B VAC.ADUL $301.00 90746

HEPATITIS B VAC PED $169.00 90744

INSULIN NOVOLIN L $6.00

COSOPT OCUMETER PLUS $195.00

ATROPISOL 1% 5ML $45.00

PHENOBARBITAL 65MGIN $31.00

MANUAL THRPY EA15 PT $92.00 97140

Page 33: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NAPHCON OPTH 15ML $44.00

GLUCOTROL XL 5MG $6.00

FERRITIN $112.00 82728

ACCUPRIL 5MG TABLET $6.00

ESTRATAB O.625MG TAB $6.00

DARAPRIM 25MG TABLET $9.00

INSULIN HUMLIN 50/50 $6.00

LEUCOVORIN 5MG TABL $23.00

ZERIT 40MG CAPSULES $23.00

SO CATACHOL/FRAC/U $130.00 82384

XAP SOLUTION $140.00

TOPROL XL 50 MG TAB $6.00

INSERT CATH W/COMPLN $279.00 51703

RPR QUALITATIVE $45.00 86592

BREVIBLOC 2.5G/10ML $428.00

LUVOX 50MG TABLET UD $23.00

SO PLATELET ANTIB'S $147.00 86022

SO CAT SCR.D.ANTIB $68.00 86611

NEURONTIN 100MG CAPS $6.00

MAXZIDE 37.5/TABLET $6.00

HEPARIN LOCK FLUSH S $18.00 J1642

MEGACE 40MG/ML 30 ML $97.00

MRI TM JOINT $2,200.00 70336

MRA UP EXT LT W & WO CONTRAST $1,557.00 C8936

GLUCAGON INJ 1MG $548.00 J1610

MAMMOGRAM SCREENING $155.00 77067

STRESS ECHO $1,023.00 93350

SO CRYOGLOBULIN, QUALITATIVE $18.00 82595

EPOGEN 10000 UNITS $469.00 J0885

OMNIPAQUE LOCM 180 MG/ML $267.26 Q9965

ULTRASOUND 15 OT $114.00 97035

ULTRAM 50MG TAB $6.00

H. PYLORI ANTIBODY $84.00 86677

CEA $140.00 82378

GLUCOPHAGE 500MG TAB $6.00

SO PLATELET AB DIRECT $184.00 86023

DEXRAZOXANE HCI INJ 500MG $698.50 J1190

BODY FLUID ALBUMIN $36.00 82042

BODY FLUID BILIRUBIN $52.00 82247

LESCOL 20MG CAPSULE $13.00

24 HR EVENT RECORDER $520.00 93270

IN-HS SGCHAMBW/REPRO $47.00 93279

IN-HS DLCHAMBW/REPRO $106.00 93280

IN-HS DLCHAMBW/OREPR $99.00 93288

OP DL CHAMB TEL ANL $129.00 93293

IN-HS SGCHAMB W/OREP $99.00 93288

OPTI-RAY 240 50CC RE $159.00 Q9966

SO NON-DOT DRUG SCRN $160.00 80307

SPORONOX 100 MG CAPS $67.00

BIOFEEDBACK $116.00 90901

Page 34: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

COZAAR 50 MG. TABLET $11.00

PLATELETS, PHERES LEUKO,RD EA $1,277.00 P9035

FFP, FROZ W/N 8 HRS, EA P/S $194.00 P9017

PLATELETS, LEUKO RD,IRR,EA $449.00 P9033

PLATELETS, LEUKO,RD,IRR, EA $449.00 P9033

PLATE, PHER, LEUKO, RD, IRR EA $1,673.00 P9037

PLATE, PHER, LEUKO,RD, IRR EA $1,673.00 P9037

RBC, LEUKO, RD IRR EA $697.00 P9040

RBC, LEUKO, RD IRR EA $697.00 P9040

PLAT, PHER, LEUKO RD CMV-IR $1,445.00 P9053

PLAT, PHER, LEUKO RD CMV-IR $1,445.00 P9053

PLAT, LEUKO RD CMV-NEG AP/PH $910.00 P9055

PLAT, LEUKO RD CMV-NEG AP/PH $910.00 P9055

FFP BET 8-24 HRS OF COLL EA $199.00 P9059

C&S BRONCH BRUSHING $113.00 87070

LYMPHOCYTE SUBSET PANEL 5 $83.00 86361

HLA-A-B *5701 TYPING $425.00 81381

C & S ABCESS $113.00 87070

SO EOSINOPHILS SMEAR SPUTUM $47.00 89190

LAMICTAL 25MG TABLET $30.00

BI-PAP INITIAL/MGT $318.00 94660

BI-PAP SUBSEQ DAYS $318.00 94660

IMITREX 25MG TABLET $127.00

FLUDARA 50MG INJECTI $1,185.00 J9185

NYSTATIN 100,000 UNI $6.00

SO FUNGUS CUL $70.00 87102

LAMICTAL 100MG TABLE $33.00

MIACALCIN NASAL SPRA $144.00

PTT/HEPARIN PROTOCOL $71.00 85730

BONE DENSITOMETRY $294.00 77080

SO HERPES SMPLEX TYPE 2 $42.00 86696

LAMISIL CREAM 15 GRA $47.00

FLEBOGAMMA 10% 100ML VIAL $2,897.70 J1572

PURINETHOL 50 MG. TA $34.00

CARDIOVERSION $1,290.00 92960

EPOGEN 4000 UNITS $452.00 J0885

MENINGOCOC. VACC. 0. $663.00 90733

HAEMOPH-B VACC 0.5CC $163.00

DIPRIVAN 10MG/ML 100 $343.00

NAVELBINE INJ 10MG/M $371.00 J9390

SO VAR ZOSTER IGG/M $86.00 86787

FOSAMAX 10MG. TAB $25.00

VERSED 2MG/ML 2ML VI $31.00 J2250

RSV $93.00 87807

CLO TEST $57.00 87081

TRUSOPT 2PERC OPTHALMIC 5 ml $132.00

PYRAZINAMIDE 500MGTB $6.00

NIMBEX 20MG/10MLVIAL $148.00

APPLY HAND/WRST CAST $432.00 29085

ARM, LONG ARM SPLINT $289.00 29105

Page 35: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

FINGER SPLINT STATIC $327.00 29130

ARM, SHORT SPLT STAT $455.00 29125

APPLY LONG LEG SPLIN $313.00 29505

NEURONTIN 300MG CAPS $10.00

CARBOPLATIN 150MG IV $593.00 J9045

CERVIDIL VAG. INSERT $612.00

DTIC/DOME 200MG VIAL $145.00 J9130

IFEX 1GM VIAL $526.00 J9208

PACLITAXEL 1 MG (100 MG VIAL $1,571.00 J9267

FLONASE NASAL SPRAY $258.00

SO LYME PCR $194.00 87801

OCTREOTIDE 0.1MG/ML $130.00 J2354

RSVSC $217.00 87801

IMOVAX RABIES VAC 2. $639.00 90675

NIZORAL SHAMPOO 4OZ. $133.00

VITAMIN E OIL 30ML $48.00

PHYSICIAN TRIAGE $69.00 T1015

PCP ENROLL FEE MCD $30.00

PROTHROMBIN FRAGMENT 1:2 $222.00 83520

THROMBIN-ANTITHROMBIN COMP T $182.00 83520

PLASMINOGEN ACTIV INH ANTEG $146.00 85415

KYTRIL 1MG TABLET $227.00 Q0166

MCD ASSESS AND SCREEN $40.00 T1015

KYTRIL 1MG/ML INJECT $937.00 J1626

GLUCOPHAGE 850 MG. T $6.00

EPIVIR 150MG TABLET $23.00

D5NS 100 ML $109.00

SCOPOLAMINE 0.4MG IN $41.00

SO FACTOR X $244.00 85260

DIPYRIDAMOLE 50MG/10 $492.00 J1245

INTERFERON B1A 30MCG $1,710.00 Q3027

SO IMMUNE COMPLEX ASSAY $88.00 86332

ROMAZICON 0-5 ML $589.00

IABP DAILY CHARGE $2,422.00

CATHETER DIAGNOSTIC $135.00

GUIDEWIRES, CARDIAC $363.00 C1769

MASSAGE,LOCAL 15 OT $71.00 97124

FLUIDOTHERAPY/DRY PT $120.00 97022

CPAP SUBSEQ. DAYS $318.00 94660

SO THYROID ST. IMMO $331.00 84445

IOPIDINE 0.5% 5ML OP $248.00

CATH, BALLOON PUMP $2,806.00

INSERT BALLOON PUMP $1,033.00 33967

DOUBLE ANTIBIOTIC OI $40.00

OPTIRAY 350 25X50ML $90.00 Q9967

OPTIRAY 350 12X100ML $178.00 Q9967

SO LAMOTRIGINE $102.00 80175

AUGMENTIN 400MG/5ML $163.00

HEP B IMMUNE GLO 1ML $517.00 90371

OXYCONTIN CR 10MGTAB $18.00

Page 36: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NOVANTRONE 20MG INJ $4,017.00 J9293

OCUFLOX 0.3% OPHTH. $176.00

IMDUR 30MG TABLET $7.00

SO FETAL LUNG MAT. $473.00 83663

PRECOSE $6.00

EGD/DILATATION $2,654.00

PRE-ALBUMIN $103.00 84134

AUGMENTIN 875MG TABL $55.00

CISPLATIN 10MG INJECTION $145.00 J9060

PACER LD SING INSERT $12,268.00 33216

ROBITUSSIN PED. DROP $30.00

SO COMP.TOT.(CH-100) $87.00 86162

ULTIVA 5MG/10ML INJ. $259.00

CAMPTOSAR 100MG INJE $1,978.00 J9206

LEVAQUIN 500MG TABLE $84.00

ETOMIDATE 20MG. INJ. $109.00

EMLA CREAM 30GM $179.00

ATROVENT .06% NASAL $228.00

BREAST BX NEDLE CORE $1,169.00

MARINOL 2.5MG CAPSLE $46.00 Q0167

REMERON 15MG TABLET $18.00

ZYPREXA 5MG TABLET $57.00

CEREBYX 500MG PE/10M $557.00 Q2009

MESNA 1GM INJECTION $412.00 J9209

CLARITIN D TABLET $9.00

ASCORBIC ACID INJECT $10.00

LO-ESTRIN 1/20 TABS. $89.00

SO PARVO VIRUS ABY $49.00 86747

GEMZAR 1 GM INJECTIO $2,117.00 J9201

Rituxan Hycela- 1400 mg vial $9,485.45 C9467

OPDIVO 240 MG $9,306.43 J9299

White Petrolatum 28 gm tube $13.56

ZYRTEC 5MG TABLET $23.00

CASODEX 50MG TABLET $98.00

ARICEPT 5MG TABLET $39.00

CORTANE-B OTIC 10ML $110.00

SO HEPARIN ANTI-XA $131.00 85520

D-DIMER $100.00 85378

ZITHROMAX 200MG/5ML $189.00

LEVAQUIN INJ 250MG/5 $144.00 J1956

FLUCONAZOLE SUSP 10M $198.00

LOTRIMIN LOTION 30ML $195.00

LEVAQUIN 250MG TAB. $66.00

SO GIARDIA ANTIGEN $55.00 87329

AMARYL 4MG TAB $7.00

ZANAFLEX 4MG TAB. $8.00

SO OSMOLALITY UA-RANDOM $73.00 83935

PERCSTNT REN PLVS LT $5,404.00 50695

DILATION URTR/URT RS&I $2,952.00 74485

SO HISTOPLASMA.AG $73.00 87385

Page 37: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DENAVIR 1% OINTMENT $135.00

ZYPREXA 10 MG TAB $73.00

CYTOSAR-U 2GM INJ $255.00 J9100

MUSTARGEN 10MG INJECTION $382.00 J9230

XYLOCAINE 2%/EPI $22.00

METRO-GEL 0.75% GEL $288.00

PREVACID 30MG CAPSUL $31.00

REHAB - SEMI-PRIVATE $788.00

REHAB - PRIVATE $876.00

FLURO NEEDLE BIOPSY $680.00 77002

FLURO ABSCESS DRAIN $788.00 75989

SO ANTI HISTONE ABY $46.00 83516

SO ANTI. RNP $103.00 86235

GROUP THERAP. PROC $69.00 97150

GROUP OUTING $69.00 97150

ORTHO MANGE/TRAIN INIT EA 15MI $234.00 97760

FAM/PT TRAIN $70.00 97139

GROUP THERAP PROC $69.00 97150

COG TRAIN/VIS PCP 15 $77.00 97127

PT SCHOOL DOCUM 15 $29.00

RHINOCAINE 5ML SOL. $12.00

LEVAQUIN 500MG INJ. $238.00 J1956

FAMVIR 500MG TAB $73.00

TOPAMAX 100MG TABLET $38.00

TOPAMAX 25MG TABLET $12.00

HEMOGLOBIN/HGB $35.00 85018

WBC ONLY $43.00 85048

7 DAY INFUSOR $264.00

ASTELIN 137 MCG NSPR $197.00

TRANSCATH RETRIV F.B $6,127.00 37197

DIOVAN 80MG CAPSULE $12.00

LAMISIL 250 TAB $81.00

SO FACTOR V LEIDEN $799.00 81241

APIXABAN (ELIQUIS) SO $398.00 80299

OT SCHOOL DOCUM 15 $29.00

ST SCHOOL DOCUM 15 $25.00

ZIAC 10MG TAB $6.00

INSULIN HUMALOG VIAL $6.00

ACCOLATE 20MG TABLET $9.00

ERYPED 200MG/5ML 100 $43.00

PHENOBARB 130MG INJE $31.00

FFPL-THAWING $263.00 86927

COMP MET PANEL $129.00 80053

DEMECLOCYCLINE 150MG $79.00

MICROPUNTURE SET MPI $153.00

UNIVASE 15MG TAB. $9.00

BILIRUBIN TOTAL $52.00 82247

CHOLESTEROL FRACTION $168.00 80061

ALPHAGAN 0.2% 5ML $142.00

SYNALAR 0.025% IN VS $96.00

Page 38: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

TEMP PACER LEAD $418.00 C1779

LEVOXYL 175 MCG $6.00

CARDIO/TILT TEST $1,847.50 93660

FLUOROSCOPY, DIAG.EX $398.00 76000

ARIMIDEX 1MG TAB $64.00

SO GLYCATED PROTEIN $66.00 82985

MYCOBACTERIUM AV COMP MIC PAN $52.62 87186

WINDOW CAST $239.00 29730

WEDGE CAST EXCEPT CLUBFOOT $239.00 29740

KNEE STRAPPING $137.00 29530

CAST SHORT ARM $93.00 29075

SHOULDER STRAPPING $137.00 29240

ELBOW/WRIST STRAPPIN $137.00 29260

CAST LONG ARM $110.00 29065

APP SHORT LEG SPLINT $394.00 29515

ANKLE/FOOT STRAPPING $137.00 29540

TOE STRAPPING $137.00 29550

REMOVAL FIXATION DEVICE, DEEP $5,407.00 20680

ZITHROMAX 500MG INJ $198.00 J0456

MAXIPIME 1GM ADD-VAN $143.00 J0692

SARNA LOTION 7.5 02 $47.00

IV FLUID PER BAG $167.00

BURN 1ST DEG INITIAL $1,658.00

CARDIAC OUTPUT $96.00

CARDIOVERSION $1,290.00

CHEST TUBE INSERTION $2,286.00 32551

MUSCLE COMPART MONIT $1,159.00

REMOVAL EAR CERUMEN $630.00 69210

EXTERNAL PACING ER $1,250.00 92953

INSERT ARTERIAL LINE $1,752.00

I & D SIMPLE SKIN $300.00

LAVAGE PERITONEAL $780.00

LUMBAR PUNCTURE DIAG $423.00

CONTROL NASAL BLEED $373.00

PERICARDIOCENTESIS $1,166.00

THORACENTESIS W/TUBE $1,404.00

TRACHEOSTOMY PROC. $1,120.00

CLOSED REDUCTION $53.00

INSERT, ARTERIAL LIN $671.00

TROPONIN $98.00 84484

SO ANTI SS-B $103.00 86235

SO ANTI SS-A $103.00 86235

VAG EXAM W/CURETTAGE $229.00

EPIDURAL STEROID INJ $482.00

TRIGGER PT 1 OR MORE $272.00

NERVE BLOCK $972.00

SCOLIOSIS SURVEY(AP) $182.00 72081

SO RISPERIDONE $90.00 G0480

LIPITOR 10MG TABLET $25.00

ELBOW COMPLETE RT MIN 3 V $216.00 73080

Page 39: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ANKLE 2 VIEWS, RT $232.00 73600

FOOT 2 VIEWS, RT $288.00 73620

SO LASA $73.00 84275

SO GANGLIOSIDE AB $276.00 83520

RAD EXAM CERVICAL SPINE 6 OR M $473.00 72052

CALMOSEPTINE 4 OZ ON $32.00

ESOPHAGEAL MOTILITY $768.00 91010

ACID REFLUX TEST-PH $819.00 91034

SO HYDROX PROGES. 17 $145.00 83498

SO ESTRONE - $151.00 82679

TARKA 2/240 TAB. $15.00

GEMZAR 200MG IV $433.00 J9201

REVIA 50MG TAB. $42.00

PLAVIX 75MG TAB $32.00

REQUIP 0.5MG TAB. $14.00

SO COMPLEMENT;AGTIGEN, EA COM $45.00 86160

SO PANCR POLYPEP PL $221.00 83519

SO TOPIR/TOPAMAX $91.00 80201

SO METANEPH PLASMA $203.00 83835

SO IGE ABY ALLER,EA $25.00 86003

SO PROT C. ACTIV - $164.00 85303

SO OPIATE CONFIRMATION $160.00 G0480

SO STREP ANTIBODIES $26.00 86060

SO HEP C RNA QUANT $159.00 87522

METHADONE 5MG/5ML SL $10.00

RITUXAN 500MG VL 50M $8,256.00 J9310

RITUXAN 100MG VL 10M $1,654.00 J9310

MURO 128 5% OPTH. SL $82.00

MAXIPIME 2GM PIGGYBA $235.00

PREVACID 15MG CAPSUL $36.00

OXYCONTIN 20MG TAB. $41.00

DEPAKOTE ER 500MG TA $25.00

AVAPRO 150MG $11.00

FLOMAX 0.4MG CAP. $15.00

SO CA 27.29 $120.00 86300

SO HOMOCYSTINE/PLAS $178.00 83090

ESTABLISHED PATIENT LEVEL 1 $25.50 99211

COREG 6.25 MG. TAB. $12.00

XALATAN .005% OPHT. $218.00

CARDIAC EX. W/C ECG $250.00 93798

SO GLOM. BASE MEM AB $213.00 83520

HOMOGENIZATION, TISSUE FOR CUL $19.00 87176

REFLUDAN 50MG VIAL $409.00

ZOMIG 5MG TAB. $112.00

EVISTA 60MG TAB $26.00

DETROL 2MG TAB. $12.00

SPINE SINGLE VIEW $147.00 72020

RAD EX ORBITS COMP MIN 4 VIEWS $241.00 70200

SO CRYPT ANTIG BLD $100.00 86403

PROLONG PSY TX SRVS 1ST HR FA- $292.00 99354

Page 40: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PRO. PSY TX SRV EA ADDL 30M $217.25 99355

PRO PSY TX SRV 1ST HR NFC $267.00 99358

INITIAL OBS. CARE LOW 30 MIN $238.25 99218

INITIAL OBS. CARE MOD 50 MIN $325.00 99219

INITIAL OBS.CARE HIGH 70 MIN $444.50 99220

TEMPORARY TRANSCUT PACEMAKER $28.00 92953

IPECACC/OBSERVATION $34.75 99175

FB REM EYE SUP CONJ $113.00 65205

INJ, ANEST. AGENT PARACERVICAL $197.00 64435

AMP FING/THMB ANY JT $1,292.00 26951

ORTHO FIT/TR INITIAL 15 PT $234.00 97760

EFFEXOR XR 37.5MG CP $27.00

UPPER GI/SBFT $836.00 74245

ABD (KUB W/GASTVIEW) $483.00 49465

METHROTREXATE 1GM VIAL $445.00 J9260

SO ORGANIC ACID SC U $152.00 83918

FLOVENT 110MCG INH. $199.00

CELLCEPT 250 CAP. $28.00 J7517

NEORAL 25MG CAP. $8.00

NEORAL 100MG CAP. $22.00

AGGRASTAT 12.5MG/50M $1,643.00 J3246

BAG BALM 10 OZ $27.00

CT MAXILLOFAC WO/WI $2,119.00 70488

CT CERV SPINE WO/WI $3,554.00 72127

CT THOR SPINE WO/WI $3,301.00 72130

CT LUMBOSPINE WO/WI $3,554.00 72133

CT TOMOGM FEMUR RT $622.00 76380

CHEST TUBE PROC. $1,314.00 32551

EFFEXOR XR 75MG CAP. $29.00

SEROQUEL 25MG TAB $13.00

SEROQUEL 100MG TAB $29.00

CYLERT 37.5 MG TAB. $6.00

ZOVIRAX SUSP 1OZ $56.00

CBC $52.00 85027

TRICOR 48MG CAPSULE $23.00

GUIDEWIRES, SPECIALS $361.00 C1769

PHLEBOTOMY ER $31.00 36415

ARTERIO, EXT BIL $4,842.00 75716

THROMBO FOLLOW-UP $891.00 75898

ARTERIOGRM,RENAL RT $6,869.00 36251

REPOSITION CVL CATH $1,152.00 36597

INJCT EXT VENOGRAPHY $325.00 36005

PACEMKR,DUL CH.GN RP $9,132.00

PACER LEAD DUAL INST $12,664.00 33217

RELOCATE POCKET PACEMAKER $2,533.00 33222

PACEMAKR GEN. REMOVE $14,776.00 33233

PACEMAKR,SING.LD REM $5,320.00 33234

PACEMAKR, DUAL LD REM $5,320.00 33235

1ST ODR ABD/PELV EXT $1,807.00 36245

2ND ODR ABD/PELV EXT $1,521.00 36246

Page 41: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

3RD ODR ABD/PELV EXT $1,811.00 36247

INS CATH ABD/L-EXT ART ADDL $1,069.00 36248

1ST ORDER THORACIC $2,385.00 36215

2ND ORDER THORACIC $1,304.00 36216

3RD ORDER THORACIC $2,385.00 36217

SEL CATH ART-BRACH-CEPH,EA ADD $514.00 36218

ADD VESSEL STUDY $1,808.00 75774

PERC. STENT INITIAL $16,855.00

PTA, TIBOPERONEAL $14,147.00 37228

PLMT URETERAL STENT PRQ $7,221.00 50693

HYPRTHYRD THRPY ORAL $736.00 79005

WBC FULLBODY TAG STD $1,919.00 78806

GALACTOSE-1-PHOSPHATE $73.00 82775

SO EBV PCR $212.00 87798

OT SCHOOL IEP 15 $22.00

PT SCHOOL IEP 15" P $22.00

SINGULAIR 10MG TAB $28.00

AUGMENTIN 200MG/5ML $145.00

CELEXA 20MG TAB $25.00

SANTYL OINTMENT 30GM $201.00

MIRAPEX 0.25MG TAB $10.00

ANTIBODY TITER $444.00 86886

T3 FREE $86.00 84481

SO FUNGUS CULT, BLD $76.00 87103

ANZEMET 12.5MG INJ $127.00 J1260

SO MYASTHENIA GR P A $346.00 83519

VERSED 5MG/ML 10ML $106.00 J2250

GLUCOSAMIN SUL 500MG $6.00

MVV $206.00 94200

VITAL CAPACITY TOTAL $220.00 94150

REMICADE 100MG INJEC $1,947.00 J1745

NASONEX 17GM INHALER $223.00

ABELCET 100MG VIAL $742.00 J0287

DEPACON 500MG/5ML IN $124.00

NAROPIN 2MG/ML 20ML $50.00 J2795

TIMOPTIC-XE 0.5% SOL $129.00

SO QUANTITATION OF DRUG , NES $47.00 80299

SO RISTOCETIN COFAC $154.00 85245

HOME EXER PRG 15 OT $101.00 97535

WELLBUTRIN SR 100MG $17.00

SO TESTOSTERONE/TOT $189.00 84403

LIORESAL IT 10MG/20ML $2,877.00 J0475

MIRAPEX 1MG TAB $23.00

US PARACENTESIS DIAG $922.00 49083

US PARACENTESIS THERP $922.00 49083

LIDEX GEL 30GM $100.00

US OB LIMITED $361.00 76815

SPEECH TREAT PER DAY $165.00 92507

TAXOTERE 80MG INJECT $4,203.00 J9171

UROCIT-K 540MG TAB $6.00

Page 42: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ATACAND 16MG TAB $10.00

SO GABAPENTIN $110.00 80171

SOD CHLORID 3% 500ML $109.00

UNNA BOOT UNILATERAL $227.00 29580

SO PARATHYROID HORMONE $280.00 83970

ALLEGRA 60MG CAP $6.00

ALPROSTDIL 500MCG/ML $1,002.00

CELEBRAX 100MG TAB $12.00

PRIMACOR 200MCG/ML 1 $382.00 J2260

NERVE DEST NEUROLTIC $1,843.00

REPAIR LAC F,L,N,E $280.00

AMARYL 2MG TAB $6.00

LYMPHAZURIN 1% 10MG/ $598.00

LYMPHATIC IMAGING $1,069.00 78195

SENTINEL NODE INJ $576.00 38792

SULFUR COLLOID UP TO 20 MCI $449.00 A9541

SO HEP C GENO S $736.00 87902

SO ST LOUIS ENCPH AB $45.00 86653

SO FK506 $181.00 80197

PATANOL 0.1% OPHT. S $259.00

SULAR 10MG TAB $6.00

PRIMAXIN 250MG INJ $139.00 J0743

CERETEC W/WBC DOSE $3,219.00 A9569

SO DHEA SULFATE $65.00 82627

TASMAR 100MG TAB. $25.00

BLADDER SCAN $525.00 51798

ORAMORPH SR 15MG TAB $15.00

AREDIA 90MG VIAL $387.00 J2430

ZITHROMAX 1GM POWDER $162.00

MAVIK 2MG TAB $7.00

PACLITAXEL 1MG (300 MG VIAL) $8,062.00 J9267

HYCAMTIN 4MG VIAL $3,003.00 J9351

DENOREX SHAMP.EX-STR $31.00

SO THC CONFIRMATION $105.00 G0480

MANUAL THRPY EA15 OT $92.00 97140

NEURO REEDUCATION PT EA 15MIN $93.00 97112

NEURO REEDUCATION OT EA 15MIN $93.00 97112

GROUP THERAPY PT $69.00 97150

MCD INDIV TX OT $84.00 97530

MCD GROUP TX OT $84.00 97150

MCD INDIV TX $132.00 92507

MCD GROUP TX $39.00 92508

OT COG SKL/ATN/MEM15 $77.00 G0515

SP COG SKL/ATN/MEM15 $77.00 G0515

SO AMINO ACIDS QUANITATIVE $103.00 82139

PRBC LEUKO EA UNIT PROC/STOR $492.00 P9016

SO ALUMINUM LEVEL $140.00 82108

CHEST (PRE-OP) $216.00 71046

MIRALAX 17G POWDER $10.00

AVANDIA 4MG TAB $27.00

Page 43: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

C&S JOINT ASPIRATE $113.00 87070

IMITRX NASL SPRY 20M $132.00

NB HEARING SCRN EDAE $438.00 92587

VIOXX 12.5MG TAB $24.00

SO YERSINIA ENT. ABY $88.00 86793

CETIRIZINE 5MG/5ML SYRUP $8.00

RIFAMPIN 150MG CAP $11.00

ZOSYN 4.5G VIAL $152.00

SINGULAIR 5MG TAB $28.00

SO CMV QUALITATIVE PCR $191.00 87496

SO HERPES SIMPLEX VIRUS PCR $130.00 87529

SO ANTI THROMBN 3 AG $174.00 85301

BOUDREAUX'S BUTT PAS $29.00

SO KETOSTEROID-17 FRACTIONATIO $297.00 83593

LOVENOX 40MG INJECTI $191.00 J1650

ESTRADIOL ENH $101.00 82670

MCD INDIV TX PTA 15 $88.00 97110

MCD INDIV TX 15" PT $88.00 97110

COLONOSCOPY/BX $2,377.00

EGD/BX $2,623.00

SO VITAMIN K1 $142.00 84597

LUMBAR PUNCTURE,DIAG $520.00

SO HIV-1 RNA QUANT PCR $315.00 87536

HEMODIALYSIS PROC. $877.00 90937

VICOPROFEN 7.5/200MG $19.00

RETROVIR 10MG SYRUP $57.00

RETROVIR 10MG/ML INJ $141.00

GLUCOTROL XL 2.5MG $6.00

DESOWEN 0.05% CREAM $83.00

SO THYROID AB GR. $61.00 86376

FLOVENT 44MCG INHALR $210.00

PRANDIN 2MG TAB $8.00

PSA FREE $77.00 84154

CATH, VASCULAR DILAT $47.00 C1725

CATH IJ DIALYSIS LT $269.00 C1752

CATH IJ DIALYSIS RT $269.00 C1752

CATHETER PICC LINE $382.00 C1751

LEXXEL 5-5MG TAB $6.00

SYNERCID 500MG 10ML $376.00 J2770

INS PICC, AGE 5 YRS/> $1,152.00

MIDLINE CATH >2YRS $1,006.00

DOVONEX 0.005% OINTM $517.00

LIDODERM 5% PATCH $41.00

NEURONTIN 400MG CAP $12.00

SO HEP C RNA/PCR QUAL $130.00 87521

SO FACTOR VIII ACT $121.00 85240

POTASS CHL 20MEG/100 $110.00 J3480

CAROTID DUPLEX SCAN; BILAT $710.00 93880

ART. SEG. PRESSURES $557.00 93923

SO FOOD 13 RAST PN $322.00 86003

Page 44: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

TAMIFLU 75MG CAP $57.00

SIMPLE SIMULATION $336.00 77280

INTERMEDIATE SIMULATION $865.00 77285

COMPLEX SIMULATION $924.00 77290

3-DIMENSION SIMULATN $3,177.00 77295

BASIC DOSE CALC $336.00 77300

SIMPLE ISODOSE PLAN $865.00 77306

COMPLEX ISODOSE PLAN $865.00 77307

SPECIAL THERAPY PLAN $865.00 77321

SPEC DOSIMETRY/TLD $336.00 77331

SIMPLE TX DEVICE $336.00 77332

COMPLEX TX DEVICE $865.00 77334

CONTINUING PHYSICS $336.00 77336

SPEC PHYSICS CONSULT $336.00 77370

DAILY TX-S 6-10 MEV $334.00 77402

DAILY TX-S 11-19 MEV $334.00 77402

DAILY TX-S >20 MEV $334.00 77402

DAILY TX-I >20 MEV $589.00 77407

DAILY TX-C 6-10 MEV $589.00 77412

DAILY TX-C 11-19 MEV $619.00 77412

DAILY TX-C >20 MEV $589.00 77412

PORT FILMS $176.00 77417

SPECIAL TX PROCEDURE $1,398.00 77470

SO THIAMINE B1 $140.00 84425

PLETAL 100MG TAB $11.00

SO HTLV-I/II ABY $92.00 86790

SO ANTI SCL 70 AB $103.00 86235

PRIMAXIN 500MG IM $165.00 J0743

MYOGLOBIN(SERUM) $114.00 83874

URETERAL REFLEX STUDY $1,113.00 78740

NEW ACUITY LEV II 30 $125.00 G0463 T1015

NEW ACUITY LV III 40 $125.00 G0463 T1015

NEW ACUITY LEV IV 60 $125.00 G0463 T1015

EST ACUITY LEV I 15 $125.00 T1015

EST ACUITY LEV II 30 $125.00 G0463 T1015

EST ACUITY LEV III $125.00 G0463 T1015

EST ACUITY LEV IV 60 $125.00 T1015 T1015

SO DIHYDROTESTOSTERONE $92.00 G0480

PLEURODESIS $1,100.00

SO HEPAT E AB IGG $108.00 86790

US ABD LIMITED $472.00 76705

US GUIDED NEEDLE PLACEMENT $567.00 76942

FERRLECIT 62.5MG/5ML $227.00 J2916

ILR REMOVAL $3,056.00 33284

INSJ SUBQ CAR RHYTHM MNTR $13,819.00 33285

ILR ANALYSIS $105.00 93291

INSERT TUNNEL DIALYS $3,269.00 36558

LARYNGOSCOPY, DIAG $421.00 31575

SO CHOR.GON.B-SUB TM $78.00 84702

SO INSUL-LIKE GR. FI $58.00 84305

Page 45: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO NEISSERIA GONORRHOEAE RNA T $125.00 87591

SO QUAL. FECAL FAT $85.00 82705

SO GLIADIN AB $78.00 83516

RHEUMATOID FACTOR $25.00 86431

ACT $60.00 85347

ORG. ID - AEROBIC $99.00 87077

C&S MRSA/VRE/MDRPA $57.00 87081

C&S PATHOGENIC ORG $57.00 87081

TAXOTERE 20MG INJ $1,200.00 J9171

LACTATE $93.00 83605

LIDOCAINE 20% 2GM $7.00

NITROGLYCERIN $56.00

HEPARIN 1000U/500ML $47.00

SUFENTA 50 MCG/ML $22.00

LAVAGE GASTRIC $362.00 43753

LAVAGE GASTRIC $362.00

CELLUVISC EYE DROP $8.00

DOBUTAMN 500MG/250ML $543.00 J1250

AMIODARONE 150MG PER 30MG $11.00 J0282

LIDOCAIN 20% 2GM/10M $41.00

PANCURONIUM 1MG/ML $39.00

NITROGLYCRN 50MG/250 $117.00

SO E COLI 0157 AGN $103.00 87046

EGD $2,445.00

COLONSCOPY $1,807.00

BRONCHOSCOPY $2,018.00

DILATATION $428.00

WASHINGS $81.00

POLYPECTOMY/TRAPS $575.00

FOREIGN BODY REMOVAL $410.00

SIGMOIDOSCOPY,FLEXBL $1,906.00

ANOSCOPY $745.00

ESOPHAGEAL DILATATIN $428.00

SO CONSULTATION,COMP W/REVIEW $197.00 88325

SO HERPES SIMPLEX TYPE 1 $32.00 86695

DRUG TESTING/URINE $160.00 80307

SLEEP STUDY SCHEDULE FEE $25.00

CORVERT 1MG/10ML $1,324.00 J1742

LDL CHOLESTEROL $63.00 83721

ART. UNILAT STDY LT $565.00 93926

SCAN ANLYSIS W/REPRT $196.00 93226

VENOUS DOPPLER UN RT $214.00

ECHO,FOLLOW UP/LIMIT $690.00 93308

GUIDEWIRE,SPORT STR $465.00 C1769

BLOOD ADMIN O.P. $775.00 36430

US GUIDED $165.00 76937

US PICC CATH PLACE $284.00 76499

CT LO EXT LT W/CTS $1,734.00 73701

CT LO EXT LT WO/CTS $1,377.00 73700

CT LO EXT LT W/WO CS $2,106.00 73702

Page 46: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CT TOMOGM FEMUR LT $622.00 76380

CT UP EXT W/CTS LT $1,479.00 73201

CT UP EXT WO/CTS LT $1,479.00 73200

CT UP EXT W/WO CS LT $1,833.00 73202

MRI UP EXT JNT LT WO $2,838.00 73221

MRI LO EXT JT LT WO $2,904.00 73721

ACROMIO-CLAV JNT BIL $189.00 73050

ANKLE COMPLETE MIN 3 V LT $307.00 73610

ANKLE 2 VIEWS, LEFT $232.00 73600

FLUOROSCOPIC GUIDE $680.00 77002

X-RAY CLAVICLE, LEFT $175.00 73000

ELBOW, LEFT 2 VIEWS $239.00 73070

ELBOW COMPLETE, LT MIN 3 V $216.00 73080

X-RAY EYE/FOREIGN BODY, LT $169.00 70030

FEMUR, LEFT MIN 2 VIEW $182.00 73552

JOINT SURVEY SINGLE $242.00 77077

FOOT COMPLETE MIN 3 VIEWS LT $329.00 73630

FOOT 2 VIEWS, LEFT $288.00 73620

FOREARM, LEFT 2 VIEWS $282.00 73090

HAND 3 VIEW LEFT $360.00 73130

HIP 1 VIEW LT $131.00 73501

HIP 2 - 3 VIEWS LT $182.00 73502

HUMERUS 2 VIEW LT $233.00 73060

KNEE, 1 OR 2 VIEWS LT $149.65 73560

RAD EX KNEE COMPLETE =>4 VIEWS $179.00 73564

LEG, LEFT 2 VIEWS $260.00 73590

MASTOIDS 3ORMORVIEWS $294.00 70130

HEEL-OS CALCIS, MIN 2 V LEFT $176.00 73650

RIBS ONE SIDE, 2 VIEWS LEFT $340.00 71100

SCAPULA, LEFT $148.00 73010

SHOULDER 1 VIEW LT $193.00 73020

SHOULDER COMPT. LT MIN 2 V $305.00 73030

US EXTREMITY, LEFT $193.00 76882

US RENAL, LEFT $377.00 76775

WRIST, LEFT 2 VIEWS $170.00 73100

WRIST COMPLETE, LEFT MIN 3 V $257.00 73110

AUTO BLOOD UNIT $303.00 86890

SO CRP, HIGH SENS $45.00 86141

US RENAL BILATERAL LIMITED $472.00 76775

US BREAST UNI $279.00 76642

CT GUIDED PLACEMENT $1,292.00 77012

CVL CATHETER $191.00 C1751

SPECIAL STAINS;GROUP II $147.00 88313

SO CONSULT AND REPORT REFERRED $130.00 88321

LEVEL IV SURGICAL PATHOLOGY $247.00 88305

SO CONSULT & REPORT $444.00 88323

INSERT CVL N-TUN<5YR $312.00 36555

REMOVAL F.B. PHARYNX $274.00 42809

INSERT CATH W/COMPLN $348.00 51703

INC-THROMBOSD HEMORR $272.00 46083

Page 47: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

LONG ARM SPLINT $158.00 29105

APPLCTN SHT ARM SPNT $113.00 29125

APPLCTN LG LEG SPLNT $126.00 29505

APPLCTN SHT LEG SPLT $132.00 29515

CLOSED CLAVICLE $509.00 23500

CLSD PHALNG SHFT/MNP $710.00 26725

OPN PHALNG SHFT/STC $1,147.00

CLSD DSTL PHALNG/MNP $637.00 26755

OPN DSTL PHALANG/STC $921.00 26765

CLSD GREAT TOE MANIP $319.00 28495

CLSD TOE/MANIPULATIN $290.00 28515

PTA, ILIAC $8,093.00 37220

PTA, FEM POP $7,702.00 37224

ARTERGRM,EXTWRNOF LT $4,842.00 75710

ARTERIOGRM, RENAL LT $6,869.00 36251

PULMONARY ANGIO LEFT $5,977.00 75741

PERCCATH REN PLVS LT $4,540.00 50433

MCD GROUP THERAPY $69.00 97150

INTO CATH RENAL PLVS $4,540.00 50432

CHG NEPHROSTOMY TUBE $1,286.00

NEPHROSTOGRAM $770.00 50431

WHEELCHIR MANGE 15PT $76.00 97542

WHEELCHIR MANGE 15OT $76.00 97542

COM/WRK REINTRGT15PT $75.00 97537

COM/WRK REINTRGT15OT $75.00 97537

PROSTHTC TRAIN INIT EA 15 PT $102.00 97761

PROSTHTC TRAIN INIT EA 15 OT $102.00 97761

ORGANISM ID/URINE $78.00 87088

ELEC STIM OT UNATTEN OT $102.00 97014

TRACH TUBE CHANGE $516.00 31502

TRACH TUBE CHANGE $587.00 31502

CHOLOTEC PER DOSE $310.00 A9537

SO HISTOPLASMA AB $84.00 86698

SO KEPPRA $94.00 80177

DEBRIDEMENT, SIMPLE $134.00

US W/POP TX 15 OT $114.00 97035

IVP EACH NEW DRUG $400.00 96374

REVEAL, CARDREC9526 $8,510.00 C1764

STENT, TRBR $2,112.00 C1874

STENT,BIL PALMAZ BAL $2,368.00 C1876

STENT,BILRXHERCLNK14 $3,789.00 C1876

GUIDEWIRE MED ZUMA $220.00 C1769

SO HERE HEMO GENE BL $519.00 81256

STNT,BILSMRTNIT40/60 $3,810.00 C1876

CATH.BALL.DIL.MARSHL $992.00 C1725

CATH POWERFLEX BL/DL $1,080.00 C1725

CATH SPRINTER BALOON $861.00

CATH GUID VERIPATH $220.00 C1887

CATH FLEXIMA DRAIN W $548.00 C1729

BRUSHING $91.00

Page 48: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ORG. ID - ANAEROBIC $73.00 87076

ACUTE HEPATITIS PANEL $391.00 80074

INFLUENZA A/B VIRUS $206.00 87400

TRACH SPEAK VALVE $288.00

CROSSMATCH ANTIGLOBU $153.00 86922

SO TRILEPTAL $81.00 80183

CTA HEAD WO/W SEC $1,482.00 70496

CTA NECK WO/W SEC $1,565.00 70498

GLUCOPHAGE XR 500MG $6.00

VERELAN 100MG CAP $9.00

AORTIC ROOT INJ $495.00 93567

CARDIAC OUTPUT $521.00 93561

PULMONARY ART. INJ $779.00 36014

THROMBOLYSIS INFUSON $7,751.00 37211

DILAT XST TRC NDURLGC PX $4,422.00 50436

INTRO CATH IN AORTA $996.00 36200

TRANSCATH RET.FB INT $5,603.00 37197

INSERT VADEVIC PORT $6,255.00 36561

CATH, MTI PERFUSION $220.00 C1887

AORTOGRAM ABD $3,223.00 75625

ARTERIOGM/ABD/RUNOFF $3,997.00 75630

AORTAGRAM, ARCH $6,869.00 75600

ARTERGRM,EXTWRNOF RT $4,842.00 75710

ARTERIOGRM,RENAL BIL $7,472.00 36252

ARTERIOGRM,MESENTRIC $4,784.00 75726

PULMONARY,ANGIO/BIL $6,869.00 75743

TRANSCATH THRPY/EMBO $1,136.00 75894

HEART CATH, RT $7,500.00 93451

HEART CATH, LT $8,200.00 93458

HEART CATH, GRAFT $7,500.00 93459

HEART CATH, RT & LT $8,200.00 93460

EXELON 2MG/ML 30ML $323.00

CYTOVENE 500MG CAP $48.00

SUPERIOR VENACAVAGRM $1,460.00 75827

VERSED 2MG/ML ORAL $41.00

DUETT CLOSURE DEVICE $1,133.00 C1760

CETAPHIL 8OZ. $35.00

PT REM DEV TIS N-SEL $389.00 97602

OT SELECT DEB<=20 CM $270.00 97597

OT REM DEV TIS N-SEL $389.00 97602

OT COG SKIL/SENSR 15 $91.00 97533

SP COG SKIL/SENSR 15 $91.00 97533

CTA CHEST WO/W SEC $2,321.00 71275

CTA PELVIS WO/W SEC $3,199.00 72191

CTA UPEXT RTWO/WSEC $934.00 73206

CTA UPEXT LTWO/WSEC $934.00 73206

CTA LOEXT RTWO/WSEC $934.00 73706

CTA LOEXT LTWO/WSEC $934.00 73706

CTA ABD WO/W SEC $837.00 74175

MRA HEAD WO CONST $2,142.00 70544

Page 49: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

MRA NECK WO CONST $1,880.00 70547

MRI CHEST W CONST $2,123.00 71551

MRI PELVIS WO CONST $1,617.00 72195

MRI UP EXT RT WO CON $1,691.00 73218

MRI UP EXT LT WO $1,691.00 73218

MRI LO EXTRE JOINT W CONTRAST $2,183.00 73722

MRI LOWER EXT W/CONTRAST RT $2,878.00 73719

MRI LO EXT LTW/O CON $2,168.00 73718

MRI LO EXT RT WO $1,734.00 73718

MRI BREAST C-+ W/CAD UNI $2,284.00 77048

MRA UP EXT RT W & WO CONTRAST $1,557.00 C8936

CT ASPIRATION $2,919.00

CT NEEDLE BIOPSY $1,944.00

CT WIRE PLACEMENT $310.00

CARAFATE SUSP 2OZ $23.00

CARBATROL ER 300MG $12.00

ART SEG (ABI ONLY) $357.00 93922

SO T3 REVERSE SER $59.00 84482

ZYVOX 600MG TAB $297.00

ACTONEL 5MG TAB $24.00

FINGER/FINGERS LT MIN 2 VIEWS $151.00 73140

TOE/TOES LT 2 VIEWS $150.00 73660

MAMMO SCREEN UNI LT $155.00 77067

MAMMO SCREEN UNI/RT $155.00 77067

US GUIDED NEDLE PLCM $567.00 76942

THORACOLUMBAR $203.00 72080

UPR/LXTR ART STUDY 3+ LEVELS $53.80 93923

EEG AWAKE & ASLEEP $586.00 95819

REMINYL 4MG TAB $23.00

LIDO 1.5% / EPI 5ML $24.00

SO ECHOVIRUS AB $149.00 86658

HERCEPTIN 10 MG VIAL $7,226.00 J9355

SO B. PERTUSSIS PCR $257.00 87801

PERICARDIOCNTIS INIT $1,166.00 33010

TRANSHEP STENT INTRO $10,947.00 47534

PTC INJ W/T-TUBE $5,871.00 47531

PTC INJ CHOLANGIO $5,244.00 47532

BILIARY CATH CHANGE $3,022.00 47536

CHOLANGIO PERC SUPER $5,244.00 47532

DRAIN CATH PLACE/SPV $5,244.00 47534

DRAIN PERC BILARY/SP $5,244.00 47533

CHOLANGIO POSTOP SPV $5,871.00 47531

TRNSHP INTR PERC CTH $3,072.00 47533

REM F.B. FOOT SUBCU $366.00 28190

INC/DRAIN PERITONSILLAR ABSCES $830.00

REM FOREIGN BODY EAR $417.00

REM F.B. NOSE $410.00

NAILBED REPAIR $215.00 11760

REM FB FOOT SUBQ $1,422.00

STRAPPING APPLICATIN $103.00

Page 50: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

INS CENT LINE TPL $519.00

RABIES IMMUN GLOBULN $1,133.00 90376

PERICARDIOCNTIS SUBQ $1,681.00 33011

CRIXIVAN 400MG CAP $19.00

VAGIFEM 25MCG TAB $24.00

HAND AP/LAT $297.00 73120

HAND AP/LAT RIGHT $297.00 73120

NPSG $2,378.00 95810

NPSG W/BIPAP OR CPAP $3,129.00 95811

ZOCOR 40MG TAB $33.00

ADVAIR DISKUS 100/50 $294.00

SPECTAZOLE 1% CREAM $163.00

MOBIC 7.5MG TABLET $28.00

HYZAAR 50/12.5 TAB $11.00

PREDNISONE 6DAY PACK $58.00

SO IGE AB MULTI-ALL $25.00 86003

FLURO.GUIDE/LOCALEYA $405.00 77002

EPI INJ SGL DIA/THER $1,318.00

LANT.INSULIN 100U/ML $6.00

PARATHYROID PLANAR IMAGING $640.00 78070

EPI PAIN PUMP TRIAL $657.00

ST SCHOOL IEP 15 P $22.00

RISPERDAL 1MG/ML $509.00 J2794

DDAVP 0.2MG TAB $34.00

GUIDE PLACEMNT MARKR $448.00

ABBI LEFT BREAST $1,522.00

MAMMOTOME LT BREAST $1,815.00

MAMMOTOME RT BREAST $1,815.00

MAMMOTOME, BILATERAL BREAST $865.00

SHEATH BALKIN COOK $55.00

SHEATH ANVINTI INTRO $55.00

VENACAVA FILTER $4,718.00 C1880

GUIDEWIRE, BENTSON $96.00 C1769

BUMETANID 0.25MG 4ML $19.00

TEGRETOL XR 400MG TB $10.00

NEXIUM 40MG CAP $35.00

SO NEURON SPEC ENOL $91.00 86316

SO SUB P, P/S $346.00 83520

SO ANDROSTENEDIO,SER $205.00 82157

NEOSPORIN GU IRR 1ML $54.00

BRONCHOSCOPY W/DILATATI/STENT $1,163.00

BALLOON KIT 6215 $582.00

DELIVERY SYSTEM 6216 $2,291.00

SO NTX-TELOPEP,URI $150.00 82523

TENECTEPLAS 50MG INJ $7,514.00 J3101

XOPENEX .63MG VIALS $21.00

NATRECOR 1.5MG VIAL $1,921.00 J2325

BRONCH W/TRAN NDL BX $1,227.00

EGD W/DILATATION/STENT $8,732.00

COLONOSCOPY W/DILAT/STENT $10,907.00 45389

Page 51: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

AZOPT 1% OPHTH 5ML $149.00

TRAVATAN0.004% 2.5ML $226.00

SO RHEUFACTOR, BFL $59.00 86431

INS/REPL PEG/ENDO $1,851.00

PROTONIX I.V. 40MG $173.00 S0164

SO MYCOBAC TB, AMPGP $641.00 87556

TUMOR SCAN MULTIPLE $773.00 78801

TUMOR SCN WHL BDY 1D $2,337.00 78802

STARLIX 120MG TAB $9.00

COREG 3.125MG TAB $12.00

CODICLEAR DH SYR 5ML $10.00

EPOGEN 40,000U/1ML V $1,648.00 J0885

PROZAC 90MG TAB $150.00

MCD EVAL EA 30 /ST $479.00

MCD EVAL EA 30 /OT $217.00 97165

MCD EVAL EA 30 /PT $231.00 97162

DILAUDID 10MG/50ML P $128.00 J1170

SO FACTOR XII ASSAY $205.00 85280

SO FACTOR XI ASSAY $205.00 85270

SO HEP B VIRAL DNA $236.00 87517

ADVAIR DISKUS 250/50 $294.00

CUTTING BALLOON ULTRA $3,383.00 C1725

NICOTROL INHALOR $6.00

MYOCARDIAL SCAN $2,109.00 78452

SO CFTR GENE COM VARIANTS $896.00 81220

BETAPACE 120MG TAB $25.00

CATHFLO ACTIVASE 2MG $573.00 J2997

UREA CLEARANCE 24HR $100.00 84545

VENOUS DUPLEX READING BILATERA $83.75 93970

VENOUS DUPLEX READING UNILATER $118.00 93970

XOPENEX 1.25MG DOSE $21.00

BACLOFEN 10MG TABLET $6.00

VISICOL TAB $9.00

ZOMETA 4MG IV $2,457.00 J3489

SACRUM AND/OR COCCYX MIN 2 V $247.00 72220

INJ DX/THER LUM/SAC $921.00

IMPLT CATH THEAC/EPI $2,953.00

COMTAN 200MG TAB $15.00

ESTRACE 0.01% VAG CM $269.00

FLUOROSCOPY W/C-ARM $460.00 76000

ABBOTT BALLOON BS $3,000.00

GUIDEWIRE MED $266.00 C1769

SO SSDNA AB $71.00 86226

AUGMENTIN ES - 600 $208.00

XIGRIS 20MG INJ $3,539.00

XIGRIS 5MG INJ $979.00

FEMHRT 1MG/5MCG $8.00

KNEE 3 VIEWS RT $161.00 73562

KNEE 3 VIEWS LT $161.00 73562

KNEE, STANDING BIL $163.00 73565

Page 52: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

APHTHASOL ORL PST 5% $109.00

ACIPHEX 20MG TAB $36.00

PULMICORT 0.5MG/2ML $35.00

UPPER GI/AIR $550.00 74246

SINGULAIR 4MG CHEW $28.00

PROVIGIL 100MG TAB $45.00

CLADRIBINE 10MG VIAL $1,848.00 J9065

RISPERDAL 0.5MG TAB $31.00

PSA DIAG $83.00 84153

PSA SCREEN $115.00 G0103

DETROL LA 2MG CAP $29.00

LESCOL XL 80MG TAB $26.00

GEODON 20MG CAP $38.00

INFNT/CHLD PELVS/HIP 1 VIEW $158.00 73501

INFANT LOW EXT less than 12mon $253.00 73592

REM FB SUBQ SIMPLE $723.00

REM FB MUSCLE SIMPLE $1,815.00

KCL 30MEG 100ML BAG $77.00

CLINDAMYCN LOTN 60ML $173.00

ADENOSCAN 60MG/20ML $552.00 J0153

ADENOSCAN 6MG/2ML $218.00 J0153

ADENOSCAN 90MG/30ML $824.00 J0153

OVRAL TAB $23.00

PROTOPAM CL 1GM 20ML $375.00 J2730

ARIXTRA 2.5MG INJ $165.00 J1652

PLENDIL ER 2.5MG $9.00

SO AMINO ACIDS QUANTITATIVE $238.00 82131

VENOGRAPHY,RENAL BIL $6,869.00 75833

1ST ORD VENOUS CATH $579.00 36011

EPIDURAL INJ BL PTCH $1,424.00 62273

EPIDURAL INJ BL PTCH ER $1,306.00

REFIL/MAINT PAIN PMP $248.00

PROCTOSIGMOIDOSCOPY $1,000.00

INFER VENACAVA GRAM $1,006.00 36010

VANCOCIN ORAL 1GM/6 $173.00

US OB 14WK EA AD FTS $132.00 76810

BURN DRES/DEB SM $208.00

BURN DRES/DEB MED $429.00

BURN DRES/DEB LG $516.00

ERCP SPHINC/PAPILL $1,681.00

LEVSIN 1ML INJ .5MG $152.00 J1980

IMM GLOBIN IV 1000MCG $3,429.00 J2792

CYCLOSPORINE 250MG $170.00 J7516

SO PHOSPHATASE, ALKALINE;ISOEN $91.00 84080

SO ENDOMYSIAL ABY. $141.00 86255

NS 40 KCL 1000ML $119.00

D5 1/2 NS 20 KCL $119.00

D5 1/2 NS 40 KCL $119.00

EXC NAIL/NAIL MATRIX $373.00 11750

LUMIGAN OPTH 0.03PERC 5ml $411.00

Page 53: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

OPTIPRANOLOL 0.3% $108.00

PAMINE 2.5MG $9.00

FARESTON 60MG $25.00

DEPAKOTE 500MG $26.00

THAM 500ML IV $1,051.00

S.I.JOINTS 1-2 VIEWS $249.00 72200

X-RAY S.I.JOINTS 3 OR > VIEWS $286.00 72202

MYELIN-ASSO GLYCOPROTEIN $96.00 83520

NEORAL ORAL SOLUTION $1,114.00

COMBIVIR TABS $87.00

VIRACEPT 250MG TAB $23.00

HIP-OR-RIGHT 1 VIEWS $158.00 73501

HIP-OR-LEFT 1 VIEW $158.00 73501

PROTONIX 40MG TAB $30.00

SO 5.10-MTHF RED BL $233.00 81291

ZYPREXA ZYDIS 5 MG TAB $61.00

VASOPNEUMATIC TX OT $101.00 97016

VASOPNEUMATIC TX PT $101.00 97016

REM VEN ACC DEV $3,041.00 36590

ECG 1-3 LEADS INTRP/REPT $163.00 93040

MMRII INJ $124.00

LUPRON DEPOT 3.75MG $1,760.00 J1950

SO CO PCP CONFIRM,UA $72.00 G0480

ULTRAFOAM 12.7SQCM $47.00

TISSEEL THROMBIN 5ML $2,127.00

TISSEEL THROMBIN 2ML $1,020.00 C9250

LEXAPRO 10MG TAB $24.00

INVANZ 1GRAM INJ $333.00 J1335

PRECEDEX 200MCG INJ $517.00

SO VIT D,1,25-DIHYD $191.00 82652

DEMADEX IV 20MG 2ML $49.00 J3265

SO FACTOR VII ACTIV $199.00 85230

SO FACTOR V ACTIV $173.00 85220

PAXIL CR 12.5MG TAB $27.00

NERVE BLK BRACHIAL $240.00

NERVE BLK AXILLARY $238.00

SO ACTIVATED PROTEIN C (APC) R $51.00 85307

REP EA5CM ADD/SCARLG $193.00 13122

SO AFB SMEAR $56.00 87206

SO AFB CULTURE $50.00 87116

EXPL PENWD ABD/FL/BK $541.00 20102

CLSD TX GRHMTB FX WA $775.00 23655

CLSD TX RD/UL FXW/MN $994.00 25565

EX TM/VASML HD/FG SQ $763.00 26115

CAST ELBOW TO FINGER $178.00 29075

CAST GAUNTLET HD/LOF $189.00 29085

SH LEG CAST WALKING $200.00 29425

BLEPHARTY ABS EYELID $588.00 67700

RM EMBED FB EYELID $443.00 67938

NAROPIN 200MG/100ML $162.00 J2795

Page 54: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

REM FB EYE EXTERNAL $417.00

IM/SQ INJECTION $95.00 96372

ER VACNE/TOXD INJ 1 $63.00 90471

ER IVP EACH NEW DRUG $400.00 96374

REM FB EYE CORN W/SL $425.00

RM FB EYE CORN W/OSL $346.00

BLOOD ADMIN EA ER VS $775.00 36430

SO CADMIUM $99.00 82300

INSERT FOLEY CATH $196.00 51702

NG TUBE INSERT/REPLC $677.00 43752

ENDO AVITENE 5MM $369.00

GELFOAM 100 $136.00

GELFOAM 50 $99.00

GELFOAM 12X7 $36.00

AVITENE $452.00

ULTRAFOAM 50 $125.00

ULTRAFOAM 100 $188.00

ULTRAFOAM 12.5 $47.00

TAMIFLU 12MG/ML SUS $192.00

ZETIA 10MG TAB $26.00

CHEST XRAY SNGLE VIEW FRONT $183.00 71045

SKLTL SRVY LESS 1YR $202.00 77076

MRA ABDOMEN WITHOUT CONTRAST $1,274.00 74185

COMP FCCMN EA 5CM $286.00 13133

DIRECT ADMIT HOSPITAL OBSERV $1,159.00 G0379

LV ATTAIN LEAD 2187 $20,347.00 C1900

INSRT LV LD W/PM/ICD $21,148.00 33225

INSERT ICD GENERATOR $61,070.00 33240

ELTPC EVAL ICD@INSRT $3,500.00 93640

ELTPC EVAL/TEST ICD $3,500.00 93641

FLURO PCKMR INSRT SI $398.00 76000

EX STRNG TYLENOL LIQ $33.00

ZELNORM 6MG TAB $23.00

CORONARY ANGIOGRAM $7,500.00 93454

BVL ATTIN LV LED4193 $6,830.00 C1900

OP VACNE/TOXID INJ 1 $63.00 90471

PERC PLACEMNT G TUBE $1,851.00 49440

GASTRIC OCCULT BLOOD $82.00 82271

NASACORT AQ NASL SPR $264.00

GEODON 20MG/ML INJ $109.00 J3486

DEPO PROVRA 150MG/ML $435.00 J1050

OP HEMODIALYSIS UNSH $835.00 G0257

INSERT LV UPGRADE $23,225.00 33224

PERC PLACE G TUBE $1,851.00 49440

EVAL PROSTHTC DV FIT $270.00 92597

NONSPEECH AUG TX $104.00 92606

SPEECH AUGMENTED TX $251.00 92609

DIFF/MAN $38.00 85007

HYDROCODONE 10/500 $10.00

MULTI DRUG BRON/DILT $34.00

Page 55: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

E STIM INDOLENT WND $102.00 G0281

HAEMOPHILUS B FLU VC $167.00 90648

SO THYROGLOB,ABY,S $101.00 86800

SO RIBOFLAVIN,VIT B2 $174.00 84252

BIOTINIDASE $59.00 82261

CLSD RD TRIAKL FX ML $957.00 27818

REMOVAL FB INTROCULAR $2,529.85 65265

PENCILLIN VK 500MG $6.00

RPLC GTUBE NO REVJ TRC $1,763.00 43762

GOOSENECK SNARE $958.00 C1773

ASH-SPLIT DIAL CATH $1,808.00 C1750

DECLOT FIBRIN SHEATH $4,723.00 36595

DECLT FIBRN SHTH S&I $1,082.00 75901

DECLT INTRALMN MEC $943.00 36596

DECLT INTRLMN MC S&I $381.00 75902

SO VASOPRESSIN (ADH) $102.00 84588

INTRO ART CATH EXT $2,385.00 36140

PACER LV LEAD REPOST $3,377.00 33226

DPNS/ESTM 1-7 15 SP $88.00 97110

DPNS 8-11 OME 15 SP $93.00 97112

HOME EXER Q15 SP $101.00 97535

BONE MARROW BIOPSY $3,407.00 38221

PROLASTIN 10MG $861.00 J0256

DECLOT VAS DEV W/MED $612.00 36593

INSERT FOLEY W/COMP BY DOCTOR $429.00

LITHOTRIPSY PROC $14,847.00

BALLOON RANGER NC $1,595.00 C1725

PCKL CAPSURE SENSE $2,422.00 C1898

DUPLEX SCAN VISCERAL LIMITED $540.00 93976

MINOR PROCEDURE $83.00

DAKINS SOL 0.25% $47.00

ELEC STIM W/US 15 OT $97.00 97032

US OB 1ST TRIMS SNGL $174.00 76801

OB US DETAILED ADDL FETUS $92.00 76812

US TV PREG UTERUS $415.00 76817

US INF HIP W/MANPLTN $370.00 76885

US INF HIP WO/MANPLT $270.00 76886

ESOPHAGOSCOPY $1,372.00

IRR CORP/CAV PRIPSM $214.00 54220

CLOSED FX TX PACU $613.00

LOVENOX 100MG/ML $540.00 J1650

LOVENOX 120MG INJ $602.00 J1650

LOVENOX 80MG INJ $478.00 J1650

LOVENOX 60MG INJ $261.00 J1650

CANCIDAS 70 MG INJ $1,309.00 J0637

CANCIDAS 50 MG INJ $1,309.00 J0637

I 131 TX EA MCI $262.00 A9517

CARDIOLITE PER DOSE $601.00 A9500

I 123 PER DOSE $339.00 A9516

I 131 DX 5 MCI $1,205.00 A9528

Page 56: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

MAG 3 PER DOSE $1,940.00 A9562

MMA PER DOSE $317.00 A9540

ULTRA TAG PER DOSE $391.00 A9560

HDP PER DOSE $160.00 A9561

REM VENOUS ACC DEVCE $861.00

RENOGRAM W/MED $1,124.00 78708

RENOGRAM W/MED MULTI $1,124.00 78709

STENT CORONARY ABBOT 2.75 x 12 $3,607.00 C1876

SO CARNTINE(TOTAL/FREE) $51.00 82379

LUNG/VENT/PERF 1/MLT $1,204.00 78582

IRESSA 250MG TAB $247.00

VELCADE 3.5 MG INJ $3,837.00 J9041

NG TUBE PLACED BY DR $98.00 43752

INJ SI JOINT WO MEDS $319.00

SO PT G20210A GENE MU $458.00 81240

OXALIPLATIN 100MG INJ $2,184.68 J9263

INJ SI JOINT W/MEDS $319.00

GENERAL HEALTH PANEL $281.00 80050

ABILIFY 15MG TAB $82.00

LIPITOR 40 MG TAB $30.00

MASTOIDS LESS 3VIEWS LT $242.00 70120

NS 20 KCL 1000 ML $119.00

ALPHAGAN P 0.15% 5ML $180.00

TEGRETOLXR 200MG TAB $6.00

REMERON SOLTAB 15MG $25.00

TRILEPTAL 300 MG TAB $25.00

PEPCID COMPLETE TABS $6.00

OXANDRIN 2.5 MG TABS $47.00

ACTONEL 35 MG TABLET $117.00

FOSAMAX 70 MG TABLET $113.00

ADVAIR 500/50 DISKUS $474.00

DITROPAN XL 5 MG TAB $28.00

US S TIS HEAD/NECK $424.00 76536

ECG $147.00 93005

GROUP THERAPY OT $69.00 97150

MEFOXIN 1GM/NS 50ML $124.00 J0694

AMPICILLIN 2GM/NS100 $109.00 J0290

ZOSYN 3.375GM/NS50ML $144.00 J2543

ZOSYN 4.5GM/NS 50ML $162.00 J2543

UNASYN 3 GM/NS 100ML $138.00 J0295

VANCOMYCIN 1GM/NS250 $109.00 J3370

MEFOXIN 2GM/NS 50ML $170.00 J0694

AMPICILLIN 1GM/NS50M $56.00 J0290

KEFZOL 1GM/NS 50ML $109.00 J0690

SO PARASITE IDEN $34.00 87169

EVAL/ASES RESP TX 1X $310.00 94664

IV SOL PER BAG $169.00

CPT TX FIRST OF DAY $259.00 94668

CPT TX SUBSEQUENT $259.00 94668

INVANZ 1 GRAM/NS50ML $693.28 J1335

Page 57: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ZINACEF 1.5MG/NS50ML $133.00

FORTAZ 2 GRAM/NS50ML $190.00 J0713

DOXYCYLINE 100MG/NS $56.00

ZITHROMAX 500MG/NS $184.00 J0456

UNASYN 1.5MG/NS50ML $110.00 J0295

VANCOMYCIN 500MG/NS $109.00 J3370

FENTANYL 500MCG/50ML $150.00 J3010

PRIMAXIN250MG/NS100 $146.00 J0743

ROCEPHIN 1 G/NS 50ML $441.00 J0696

PRIMAXIN500MG/NS100M $207.00 J0743

FORTAZ 1 G/ NS 50ML $136.00 J0713

ROCEPHIN 250MG/NS 50 $145.00 J0696

ROCEPHIN500MG/NS50ML $197.00 J0696

HEPARIN 1000U/ML30ML $39.00

PUNCTURE ASPIRATION $590.00 10160

ZOSYN 2.25 G/NS 50ML $130.00 J2543

NAFCILLIN 2G/NS100ML $109.00

NAFCILLIN 1 G/NS50ML $109.00

AMPICILLIN 500M/NS50 $59.00 J0290

ROCEPHIN 2 G/NS50ML $628.00 J0696

AMPHOTEC 50MG INJ $569.00 J0285

KEFZOL 500MG/NS50ML $110.00 J0690

MAXIPIME 1 G/NS50ML $158.00 J0692

CEFOTAN 1 G/NS 50 ML $139.00

CEFOTAN 2 G/NS 50 ML $199.00

AZACTAM 1 G/NS 50 ML $172.00

CEFUROXIME 1.5G/50ML IV $111.00 J0697

CLAFORAN 1 G/NS50ML $127.00 J0698

CLAFORAN 2 G/NS50ML $175.00 J0698

BENICAR 20 MG TAB $10.00

FENT/MARC EPIDRL SYR $109.00

PENICILN 5MMU/NS10OM $186.00 J2540

PENICILN 2.5MMU/50ML $186.00 J2540

CLOSED RED D-RADIUS $1,159.00 25605

I & D PERIRECTAL ABS $974.00 46040

SO PTH RELATED PROTEIN $184.00 83519

DIFLUCAN 100M/50MLNS $415.00

TRIGGER PT NB 1-2MCL $101.00 20552

ARTERIAL THERAPT INJ $117.00 96373

US GUIDANCE INTRAOP $403.00 76998

CONRAY 60 $57.00

SO GAD65 $189.00 86341

INSULIN FREE SO $100.00 83527

BS FILTERWIRE 300CM $4,519.00 C1884

BS FILTER RETR SHETH $350.00

CSD DL SHD W/NKFX WM $1,037.00 23675

NOVOSEVEN RT 2MG VIAL $4,574.00 J7189

TOPROL XL 25MG TAB $6.00

OMNICEF 300MG CAP $36.00

CRESTOR 10MG TABLET $27.00

Page 58: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

EEG 40-60 MINUTES $729.00 95812

EEG GREATER 1 HOUR $882.00 95813

EEG REC AWAKE/DROWSY $515.00 95816

EEG REC COMA/SLP ONY $747.00 95822

EEG CERBRAL DTH EVAL $469.00 95824

EEG OVERNIGHT $1,273.00 95827

TEMODAR 100MG CAP $186.00

SO ESTRIOL (E3) $91.00 82677

NEUROLITE PER DOSE $1,660.00 A9557

OCTREOSCAN PER DOSE $11,359.00 A9572

FASLODEX 250/5ML INJ $3,044.00 J9395 J9395

TUMOR SCAN WB 2DAYS $1,681.00 78804

US PELVIC LIM/FOLLUP $284.00 76857

TRICOR 145 MG TABLET $28.00

BN PEPTIDE (BNP) $109.00 83880

CHEST TUBE PLACEMENT $1,314.00 32551

PACING/DEFIB LEAD REPOSITIONIN $3,852.00 33215

ROOM & BOARD-SWING BED SEMI-PR $647.00

ROOM & BOARD SWING BED-PRIVATE $677.00

MCD LEVEL I $200.00 99281

MCD ED LEVEL II $355.00 99282

MCD LEVEL III $639.00 99283

MCD ED LEVEL IV $1,100.00 99284

MCD ED LEVEL V $1,500.00 99285

APPLICATION LONG ARM SPLINT $327.00 29105

PROGENSA PCA3 SO $676.00 81313

APPLICAT STATIC SHORT ARM SPLI $258.00 29125

ANTI-IBM AB (ANTI-cN-1A)SO $419.00 83520

APPLICAT SHORT ARM SPLINT DYN $258.00 29126

APPLICAT FINGER SPLINT STATIC $136.00 29130

APPLICAT FINGER SPLINT DYN $131.00 29131

STRAPPING SHOULDER $258.00 29240

STRAPPPING ELBOW/WRIST $78.00 29260

STRAPPING HAND/FINGER $78.00 29280

STRAPPING ANKLE/FOOT $327.00 29540

SO JC VIRUS QUANT PCR $194.00 87799

OXALIPLATIN 50MG VIAL $1,028.00 J9263

SO LIPOPROTEIN A $53.00 83695

CL RED FINGER FXW/MN $778.00 26742

OMNICEF 125/5ML SUSP $316.00

ZYVOX 600 MG IV $634.00 J2020

REPLC TUN CVL WO PRT $2,576.00 36581

STENT DRIVER CORONAR $3,075.00 C1874

INSERT ICD W/LEADS $39,107.00 33249

SO CYCLIC CITR PEPAB $87.00 86200

CATH, PRONTO $1,928.00 C1757

FETAL FIBRONECTIN $282.00 82731

NAMENDA 5MG TABLET $24.00

WELBUTRINXL 150MG TA $33.00

PEAK FLOW METER $135.00

Page 59: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

FUROSEMIDE 40MG/5MLO $8.00

GLUCOSE TABLETS $6.00

TUBE JEJUNOSTOMY $151.00

KLONOPIN WAF 0.25MG $10.00

KLONOPIN WAF 0.125MG $17.00

KLONOPIN WAF 0.5MG $18.00

LEVAQUIN 750MG TAB $120.00

LEVAQUIN 750MG IV $452.00 J1956

CIPRODEX OTIC SUSP $140.00

ULTRACET TABLET $7.00

RHINOCORT NAS SP 120 $271.00

NEULASTA 6MG/.6MLSYR $9,348.00 J2505

ELIDEL CREAM 30 GRAM $233.00

ZOFRAN 32MG/50ML BAG $670.00 J2405

MCD GRP THRPY OTA $69.00 97150 97150

MCD GRP THPY PTA $69.00 97150 97150

MCD COTA THERAPY 15 $84.00 97530

PEGASYS 180UG SYRINGE $1,242.00

SO PROINSULIN $45.00 84206

CULTURELE/LACTOB TAB $6.00

LEVABUTEROL 1.25MG/3ML UPDRAF $13.00

ATTAIN DELIVERY SYST $1,945.00 C1766

ANGIO SEAL $580.00 C1760

MLST MULTI LATENCY $2,199.00 95805

SPIRIVA HANDIHALER $144.00

GLYSET 25MG TAB $6.00

FRAGMIN 10,000 UNITS $453.00 J1645

PROAMATINE 2.5 MG $8.00

SO JO 1 AUTOANTIB $103.00 86235

AVASTIN 100MG/4ML VL $1,772.00 J9035

LOTEMAX 0.5OP $167.00

VIDAZA 100 MG VIAL $2,234.00 J9025

REGRANEX .01% GEL $1,216.00

PET LUNG CA DIAGNOS $3,342.00 78815 78815

PET LUNG CA STAGING $3,342.00 78815 78815

PET LUNG CA RESTAGIN $3,342.00 78815 78815

PET COLORECTAL CA DX $3,342.00 78815

PET COLORECTAL CA ST $3,342.00 78815 78815

PET COLORECTAL CA RS $3,342.00 78815 78815

PET MELANOMA DIAGNOSTIC $3,409.00 78816

PET MELANOMA STAGING $3,409.00 78816 78816

PET MELANOMA RESTAGI $3,409.00 78816

PET LYMPHOMA DIAGNOS $3,342.00 78815 78815

PET LYMPHOMA STAGING $3,342.00 78815 78815

PET LYMPHOMA RESTAGI $3,342.00 78815 78815

PET HEAD & NECK DIAG $3,342.00 78815 78815

PET HEAD & NECK STAG $3,600.00 78815 78815

PET HEAD & NECK REST $3,342.00 78815 78815

PET ESOPHAGEAL CA DX $3,342.00 78815

PET ESOPHAGEAL CA ST $3,342.00 78815 78815

Page 60: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PET ESOPHAGEAL CA RS $3,342.00 78815

PET BREAST CA STAGIN $3,342.00 78815 78815

PET BREAST CA RESTAG $3,600.00 78815 78815

PET THYROID CA RESTA $3,342.00 78815 78815

PET FDG PER DOSE $1,311.00 A9552

ASSAY CARBOXY HB QUANT. $98.00 82375

CARDIZEM 100MG/NS100 $163.00

OMNIPAQUE LOCM 240 MG/ML $429.00 Q9966

ARANESP 25 MCG INJ $459.00 J0881

ARANESP 40 MCG INJ $732.00 J0881

ARANESP 100 MCG $1,829.00 J0881

ARANESP 200 MCG INJ $3,652.00 J0881

REMOVAL TUN CV CATH $1,699.00 36589

RIBAVARIN 200MG CAP $60.00

RID SHAMPOO 2 OZ $43.00

FENTANYL 0.1MG/2MLAM $31.00 J3010

D5 1/4 NS 500 ML $60.00

1/2 NS 20 KCL $109.00

ZYPREXA 10 MG VIAL $169.00

PET SOLTARY PULM NOD $3,342.00 78815 78815

BILI STONE EXTR S&I $418.00 47544

STONE EXTR BILI DUCT $2,233.00 47544

LEUCOVORIN 500MG VL $113.00 J0640

OMNIPAQUE 300 MG INJ $209.00 Q9967

REMOVAL SKIN TAGS 15 $131.00 11200

EXC BEN LES 06-1.0 $251.00 11421

MOTRIN 100 MG SOL $6.00

EXELON 1.5MG CAPSULE $27.00

ACETAMIN SOL 160MG $6.00

TRIGEMINAL NERVE BLK $354.00 64400

PET IMAGE W/CT SKULL-THIGH $3,342.00 78815

PREVACID SOLUTAB30MG $22.00

PARAFFIN BATH PT $57.00 97018

EST PT LEVEL I VISIT $125.00 T1015 T1015

EST PT LEVEL II VIST $125.00 T1015 T1015

EST PT LEVEL III VST $125.00 G0463 T1015

EST PT LEVEL IV VIST $125.00 G0463 T1015

EST PT LEVEL V VISIT $125.00 G0463 T1015

EST PT LEVEL I PROC $125.00 G0463 T1015

EST PT LEVEL II PROC $125.00 G0463 T1015

EST PT LEVEL III PRO $125.00 G0463 T1015

EST PT LEVEL IV PROC $125.00 G0463 T1015

EST PT LEVEL V PROC $125.00 G0463 T1015

NEW PT LEVEL I $125.00 G0463 T1015

NEW PT LEVEL II $125.00 G0463 T1015

NEW PT LEVEL III $125.00 G0463 T1015

NEW PT LEVEL IV $125.00 G0463 T1015

NEW PT LEVEL V $125.00 G0463 T1015

NEW PT LEVEL I PROC $125.00 G0463 T1015

NEW PT LEVEL II PROC $125.00 G0463 T1015

Page 61: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NEW PT LEVEL III PRO $125.00 G0463 T1015

NEW PT LEVEL IV PROC $125.00 G0463 T1015

NEW PT LEVEL V PROC $125.00 G0463 T1015

SELECT DEBRID 20CM $270.00 97597

DEBRIDEMENT NON-SELC $403.00 97602

ABI BILATERAL $357.00 93922

ABI UNILATERAL $202.00 93922

SKIN BIOPSY 1 LESION $322.00 11102

SKIN BX EACH ADDITON $318.00 11103

I & D SIMPLE $542.00 10060

TRIM DYSTPH NAILS $163.00 G0127

SILVER NITRATE TX $394.00 17250

APPLY COMPRES WRP LT $165.00 29580

BURN DRES DEBRIDE SM $208.00 16020

BURN DRES DEBRID MED $429.00 16025

BURN DRESS DEBRID LG $516.00 16030

APPLICATION UNNA BOOT $740.00 29580

SO TISSUE TRANSGLUT IGA AB $107.00 83516

LATERAL VIEW $224.00 71045

ACCUZYME SPRAY $190.00

XENADERM OINT 60 GM $247.00

PANAFIL SPRAY $293.00

NEUTROSPEC 20 MCI $4,431.00 A4641

ERBITUX 100 MG INJ $1,545.00 J9055

NASOPHARNGSPY W/ENDO $465.00 92511

TRIGGER PT NERV BLCK $745.00

ABG'S CORD BLOOD $87.00 82800

ACULAR P/FOPTSOL.4ML $29.00

CARDEC DM 1 OZ SYRUP $462.00

EYE WASH $28.00

DONATUSSIN 16OZ $89.00

LANTISEPTIC CR 4 OZ $38.00

LIPITOR 20MG TABLET $27.00

NALOXONE 2 MG $32.00 J2310

PRAVACHOL 20MG TAB $21.00

PULMICORT TURBUHALER $673.00

MIRTAZAPINE(REMERON) 30MG TAB $22.00

TEMAZEPAM 30 MG TAB $17.00

EAR GESIC OTIC DROPS $67.00

VICODIN 10/325 MG $15.00

CYMBALTA 30 MG CAP $23.00

PROGRAM NEUROSTIM 1ST HR $294.00 95972

REMV/REVS NEROELCTRD $2,655.00

SO ANAFRANIL $83.00 G0480

FLURO GUIDANCE CVL $515.00 77001

US PSUDO-ANRYSM COMP $423.00 76936

US GUIDE AMNIOCENTES $275.00 76946

NERVE BLOCK FACIAL $343.00 64402

NERVE BLOCK FACIAL $227.00 64402

REPAIR CVL W/O PT/PM $1,247.00 36575

Page 62: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PROTONIX 20MG TABLET $30.00

TEVETEN 600/12.5MGTA $14.00

E-STIM ATTEND Q15 SP $97.00 97032

SO RAPAMUNE $93.00 80195

OP ALLERGEN INJECTION 1 $66.00 95115

INSJ PICC 5 YR+ W/O IMAGING $1,518.00 36569

TRACH TUBE CHANGE $84.00 31502

SO DEOXYCORTISOL, 11- $96.00 82634

D5 LR 1000 CC $76.00

TRANSCER INTR FLPNTB $4,904.00 58345

TRANSCERV CATH S&I $390.00 74742

SELECT DEBRID 20 CM $127.00 97598

SELECT DEBRID 20CM $127.00 97598

IV PROPHYLAC INF 1HR $450.00 96365

IV PROPHY INF EA HR $230.00 96366 96365

CHEMO IV THRPY 1STHR $555.00 96413

CHEMO ADMIN IV THRY EA HR $170.00 96415

CHEMO ADMIN INJ (IVP) $373.00 96409

CHEMO REFIL PORT IMP $233.00 96522

IV SEQ PROPH 1ST HR $100.00 96367

IV SEQ PROPH EA HR $230.00 96366 96365

OP VAC/TOX INJ 2 $32.00 90472

METRONIDAZDE 500MG TABLET $67.00

ATENOLOL 50 MG TAB $17.00

AMOXIL 200MG/15MLSPS $14.00

DOPAMINE 800MG IV $163.00

HEPARIN FLUSH SYRING $9.00 J1642

POLOCAINE 1.5% 30ML $67.00

NOTUSS SYRUP $15.00

REGONAL AMPS $120.00

DRAIN MOUTH LESION $339.00 40800

D5LR 20 KCL 1000ML $60.00

ZOCOR 20MG TABLET $30.00

NAMENDA 10MG TABLET $15.00

CR EST PT VISIT II $125.00 G0463 T1015

PULMONARY STRESS TES $308.00 94618

CR EST PT VISIT II/W $125.00 G0463

CR NEW PT VISIT II $125.00 G0463 T1015

CLEOCIN 300MG IV $41.00

GEFTIN 250MG TABLET $14.00

SURVANTA 4ML IV $2,059.00

SO APOLIPOPROTEIN, EACH $53.00 82172

HYDROMORPHONE 500MG $671.00

OP FLU VACCINE ADMINISTRATION $38.00 G0008

OP PNEUMO VACCINE ADMIN $63.00 G0009

NYSTATIN 500,000U/5ML $25.00

CELEBREX 200MG CAPSULE $21.00

APPL SKIN SUBSTI GRAFT 25 SQ $3,656.00 15271

BRAVO PH MONITORING $977.00 91035

VALTREX 500MG CAP $49.00

Page 63: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BLADDER IRRIG CONT D $525.00 51700

PERPHENAZINE 2 MG TABLET $12.00

DIFIL G 10ML LIQUID $7.00

ETODOLAC 400 MG TAB $7.00

GI COCKTAIL 30ML LIQ $6.00

ESTROGEN NASAL SPRAY $101.00

TETRACAINE 0.45% LOL $24.00

PROGESTERONE 200MGCP $25.00

D5/40KCL 1000ML $55.00

D5/40KCL 1000ML $55.00

ALFENTA 10ML $153.00

GELIFILM 12.5CM $145.00

BL DRAW IMPLNT VAD $172.00 36591

DEPAKOTE ER 250MG TA $10.00

CEFACLOR 250MG/5MLSU $143.00

FLURO GUIDANCE CVL $515.00 77001

INSERT CVL N-TUN>5YR $292.75 36556

INSERT CVL >5Y $1,927.00

INSERT CVL N-TUN <5Y $975.00

REPLC CVL SM ACCESS $2,266.00 36580

PET CERV DX STA REST $3,342.00 78815 78815

ANZAMET 100 MG VIAL $155.00 J1260

LUNESTA 2 MG $41.00

ZINECARD 250 MG VIAL $794.00 J1190

WOUND VAC LE50 SQ CM $452.00 97605

WOUND VAC >50 SQ CM $601.00 97606 97606

SO LUPUS ANTICOAG DR $91.00 85613

INSERT N-TUNEL DIALY $1,927.00 36556

CLSD RED HIP DISLOCT $835.00 27250

US OF SPINE $1,218.00 76800 76800

APPLY WND VAC<=50SQC $250.00 97605

APPLY WND VAC >50SQC $601.00 97606

HYDROCODONE/APAP 7.5 $10.00

AMIKACIN SULF 500MG V PE 100MG $44.00 J0278

CLR EYES OPTH DRP 15 $19.00

PROPRANOLOL 60MG TAB $6.00

MANNITOL 20% 500ML $205.00

AROMASIN 25 MG TAB $66.00

SILVASORB GEL 1.5 OZ $98.00

SOD CHL .45% 500ML B $59.00

ARGATROBAN SDV 100MG $3,420.00 J0883

ARANESP SYRNGE 60MCG $1,097.00 J0881

WELCHOL 625MG TAB $7.00

ROBITUSSIN AC SYR 5M $10.00

PREDNISONE 5MG 12DAY $25.00

BRMNIDINE TARTRTE DR $130.00

LOVENOX 150MG/ML INJ $695.00 J1650

SO CHROMOGRANIN A $72.00 86316

I&D COMP SKIN ABSCES $554.00

I&D PILONIDAL CYST S $759.00

Page 64: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

I&DHEMA, SERO FLUID $1,944.00

DEBRID PART THK SKIN $552.00

DEBRID FULL TCK SKIN $957.00

DEBRIDE SQ TISSUE $1,000.00

DEBRID SQ TIS/MUSCLE $1,029.00

DEBRID SQ MUSCL/BONE $1,788.00

SKIN TAG REMOVAL1-15 $290.00

EXC BEN LES TRUN/ARM/LEG <.5CM $1,006.00

EXC BLES T/A/L .6-1C $1,132.00

EXC BLESN T/A/L1.1-2 $1,106.00

EXC BENI LESN TR/AR/LE 2.1-3CM $2,196.00

EXC BLESN SNHFG.6-1C $1,146.00

EXC BEN LES F/E/E/N/L <.5CM $1,006.00

EXC BN LESN FAC1.1-2 $1,422.00

DEBRIDE NAILS 1-5 $158.00

AVULSION NAIL PLATE $417.00

EVAC SUBUNGAL HEMATO $135.00

REM NAILBED & MATRIX $417.00

REPAIR NAILBED $1,107.00

REP SCALP ETC 2.5 CM OR LESS $263.00

REP SCALP ETC2.6-7.5 $345.00

REP SCLP ETC7.6-12.5 $410.00

REP SCLP ETC 12.6-20 $535.00

REP SCLP ETC20.1-30C $702.00

REPAIR SCALP ECT >30CM $582.00

REPAIR FACE 2.5CM $267.00

REPAIR FACE 2.6-5CM $280.00

REPAIR FACE 5.1-7.5C $360.00

REPAIR FACE 7.6-12.5 $456.00

REPAIR FACE 20.1-30C $743.00

SMP WND DEHISCEN REP $830.00

SMP WND DEHIS RP W/P $957.00

INT REP S/T/E/ LESS THAN 2.5 $719.00

INT REP S/T/E 2.6-75 $773.00

INT REP S/T/E7.6-125 $703.00

INT REP S/T/E12.6-20 $1,977.00

INT REP S/T/E20.1-30 $2,163.00

INT REP S/T/ETC >30C $5,861.00

INT REP HFNG <2.5CM $840.00

INT REP HFNG 2.6-7.5 $1,119.00

INT REP HFNG7.6-12.5 $1,209.00

INTRMED REP FACE<2.5 $371.00

INTMED REPR FACE 2.6 to 5.0 CM $442.00

INT REPR FACE5.1-7.5 $472.00

INT REP FACE7.6-12.5 $481.00

COMP RP S/A/L1.1-2.5 $1,197.00

COMP RP S/A/L2.6-7.5 $1,345.00

COMP RP S/A/L>7.5Q% $442.00

COMP REP FACE1.1-2.5 $1,219.00

COMP REP FACE2.6-7.5 $1,732.00

Page 65: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

COMP RP FACE>7.5Q% $442.00

COMP RP ENEL 1.1-2.5 $1,639.00

COMP REPEYE,NO,EAR,LIP 2.6-7.5 $1,210.00

INC SQ TISSUE ABSCSS $429.00

INCISION DEEP TISSUE ABSCESS $1,040.00

WOUND EXPL EXTREMITY $1,159.00

INJ 1> TRIGER PT1-2M $417.00

ARTHROCNTS SM JOINT $462.00

ARTHROCNTS INTR JONT $462.00

ARTHROCNT MAJOR JONT $462.00

CLS TX NOSE $1,239.00

REDUCTION JAW $1,351.00

REDUCTION SHOULDER W/O ANESTHE $620.00

CLSD TX HUM SHFT W/M $2,642.00

REDUCTION POST ELBOW $467.00

REDUCTN NURSEMD ELBW $388.00

CLSD TX RAD HD/NCK $2,642.00

CLSD TX COLLES FX WM $2,829.00

I&D SMP FINGER ABSCS $417.00

I&D COMP FINGER ABSC $1,456.00

REP FING EXT TENDON $5,001.00

REDUCTION FINGER MP $417.00

CLSD TX FNG/THMB W/M $1,316.00

CLSD TX ARTCLAR W/MN $2,497.00

REDUCTION FINGER DIS $557.00

REDUCTION HIP TRAUMA $244.00

REDUCTN KNEE PATELLA $388.00

CLSD TX TIB SHFT WM $3,583.00

CLSD TX LAT MALLS WM $856.00

CLOSED TX BIMALL FX W/MANULIP $2,497.00

REDUCTION ANKLE DISC $832.00

CLSD TX OTHER TOE WM $509.00

REDUCTION TOE MP DIS $677.00

REDUCTION TOE IP DIS $417.00

HAND OR FINGER STRAP $137.00

ANTER NASAL PCK COMP $530.00

POST NASAL PACK INTL $856.00

INTRAOSSUEOUS NEEDLE PLACEMEN $884.00 36680

REP LIP > 1/2 VERT H $1,416.00

FB REM MOUTH EMBED S $464.00

I&D PERIRECTAL ABSCE $1,153.00

I&D PERIANAL ABSCESS $2,446.00

I&D THROM HEMORRHOID $449.00

BLADDER IRR/LAV/INST $525.00

CATH IN/OUT RESIDUAL $321.00 51701

I&D VULVA/PERINEUM $1,452.00

I&D BARTHOLIN'S GLND $417.00

REMOVAL IUD $429.00

REM FECA IMPAC W/SED $2,506.00

BLOCK DIGITAL $1,159.00

Page 66: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

FB REM SUBCONJUNCTVL $145.00

FB REM EMBED SUBCNJN $332.00

I&D EAR ABSCESS SMPL $1,106.00

I&D EAR ABSCESS COMP $3,363.00 69005

MOD SED SAME PHYS >5YRS $41.00 99152

HYDROCODONE 5MG APAP $10.00

MNT ASSES/INTV EA 15 $84.00 97802

MNT REASS INTV EA15 $83.00 97803

MNT GROUP INTVT EA30 $26.00 G0271 97804

MNT 2ND REASS/IN Q15 $40.00 G0270 97804

SMOKING CESSTN LESS THAN 10MIN $33.00 99406

SMOKING CESST GREATER THAN 10M $68.00 G0437

AMIODARONE 900MG/18M $524.00 J0282

MEGESTROL ACETATE ORAL SOLU 40 $70.00

LUNESTA 1 MG TAB $41.00

STERILE TALC PWD 5GR $237.00

DEXAMETH ACTAT LA 8M $23.00 J1094

CYTOVENE 500MG VIAL $263.00 J1570

SO ACYLCARNITINES, QUAN $51.00 82017

LOXAPINE 5 MG CAP $6.00

D-FIB EA SC W/O REPR $97.00 93289

D-FIB EA SC W/REPROG $97.00

D-FIB ANALY DC W/O $73.00 93289

D-FIB EA DC W REPROG $95.00 93283

INTRAVAS DOPPLER VELOCITY $1,300.00 93571

INTRAVAS DOP VELOCITY EA ADD V $153.00 93572

INFUMORPH PF 500MG $781.00 J2274

SO DOA SCR MECONIUM $194.00 80307

DOXIL 20MG/10ML VIAL $2,565.00 Q2050

MERREM 1 GRAM VIAL $509.00 J2185

MEROPENEM 500MG VIAL $68.00 J2185

INSERT ARM PORT 5YR $5,374.00 36571

CHEMO INTRA-ART. PUS $676.00 96420

PET LIMITED (BRAIN) $3,008.00 78814 78814

TYGACIL VIAL 50MG $461.00 J3243

SO SUBSTANCE UNK ID $157.00 80307

MIVACRON INJECTION 5 $109.00

LABET HYDRO INJ 20MG $109.00

INFRARED THERPY PT $50.00 97026

APPLY COMPRES WRP RT $165.00 29580

INFRARED THERPY OT $50.00 97026

ABI MULTI LEVEL BIL $589.00

ABI MULTI LEVEL UNI $546.00 93923

THORACENTESIS W/TUBE $886.00 32555

COMMHEALTH HS PSA $115.00 G0103

COMMHEALTH HS EVENT $37.00

ZOLADEX 10.8MG INJ $3,631.00 J9202

VALTREX 1GM TABLET $61.00

FORADIL AEROLIZER $98.00

AMBIEN CR 6.25MG TAB $41.00

Page 67: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PCKG ENRHYTHM DR $18,394.00

PCKL CAPSURE 5076 $2,051.00 C1898

DEXTROSE 5%/.33NS $38.00

BIOPSY;OROPHARYNX $3,248.00

NEOSTIGMINE INJ .5MG $39.00 J2710

CYSTO-CONRAY 250ML $140.00

SO NICOTINE METAB UR $83.00 G0480

LYRICA 50 MG CAPSULE $22.00

LYRICA 100MG CAPSULE $22.00

OCTREOTIDE 30MG IM $8,184.00 J2353

ARC PRETREAT CHEM/DR $142.00 86970

ARC, RBC AG $77.00 86905

ARC INCUBATION XM $184.00 86921

AVODART 0.5MG CAPSUL $26.00

CL TX TIB SHFT FX W MANI $1,151.00 27252

ICDL SPRINT Q RV6947 $16,002.00

LIDOCAINE 1% 10MG/ML $10.00

TICLID 250MG TABLET $10.00

MEPERIDINE 300MG PCA $21.00 J2175

REPLC NONTUNN SAME A $1,655.00 36580

AUGMENTIN XR $38.00

MAXALT MLT 10MG TABLET $8.00

ACETADOTE 200MG/ML V $500.00 J0132

IV THRPY/HYDRA 1STHR $372.00 96360

IV THRPY/HYDRA EAHR $150.00 96361

IV CONCURRENT INFUSION $146.00 96368 96365

IV PROL INFUS > 8HRS $369.00 96365 96365

IVP-SUBSEQUENT EA ADD'L $190.00 96375

ER IV SUQ IVP DIF DR $190.00 96375

CHEM ADMIN IV THRY>8HR W/P $462.00 96416

PORT FLUSH ONLY $201.00 96523 96523

CHEMO ADMIN SQ/IM NON-HORM $460.00 96401

CHEMO ADMIN SQ/IM HORMONAL $198.00 96402

TARCEVA 150MG TAB $435.00

MIRALAX 255GM NF POW $129.00

SO CALCIUM; IONIZED $89.00 82330

MUSCLE COMPART MONIT $1,159.00 20950

US GUID CVL PLACEMEN $132.00 76937

SO PROTEIN S ACTIV $179.00 85306

SO BENZO CONF UA $72.00 G0480

LYRICA 25MG CAPSULE $22.00

COMMHEALTH INS GLUCO $44.00 82947

COMMHEALTH INS HBA1C $94.00 83036

COMMHEALTH INS PSA $115.00 G0103

COMMHEALTH INS CHOLE $54.00 82465

COMMHEALTH HS CHOLES $54.00 82465

COMMHEALTH HS GLUCOS $44.00 82947

COMMHEALTH HS HGBA1C $94.00 83036

MINOR PROCEDURE $3,153.00

DEX 5% LR KCL 40MEQ $60.00

Page 68: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PROGRAF 1 MG CAPSULE $31.00 J7507

PROPARACAINE HCL .5OP $66.00

CAST REM/BIVAL AM/LG $75.00 29705

CARDIOPULMARY RESUST $731.00

VIRAMUNE 200MG TAB $43.00

VIREAD 300MG TABLET $91.00

EPZICOM TABLET $145.00

REMOVAL ICD GENERATO $6,179.00 33241

RELOCATE POCKET FOR DEFIB $1,857.00 33223

MINOR PROCEDURE $2,085.00

RESERPINE 0.1MG TAB $6.00

GRAFT OASIS PER SQ CM $26.70 Q4102

ANGIOMAX VL 250MG $1,442.00 J0583 J0583

XOPENEX HFA IH 45MCG $176.00

RISPERDAL CONSTA2.50 $933.00 J2794 J2794

SOLIFENACIN SUCIN TA $29.00

PENTOSAN POLYS 100MG $25.00

CYCLOSPORINE OPHT.05 $28.00

ENABLEX 7.5MG TABLET $29.00

SO NMO AB IGG $146.00 86256 86256

SO LIV/KID MICRO 1 AB $87.00 86376 86376

POTASSIUM CHOLRIDE 20MEG/D5-NS $50.00 J3480

OASIS ACELLULR APPLY 1ST 100 S $6,026.00 15273 15273

OASIS APP EA AD 100S $627.00 15274 15274

ILEOSCOPY ARTIF OPEN $1,996.00

ABILIFY 10MG TABLET $77.00

ABILIFY 5MG TABLET $66.00

RAZADYNE ER 8MG CAP $35.00

PHENOTYPE $95.00 86906

RISPERAL M-TAB 0.5 $31.00

SYVEK NT PATCH $283.00

SO TULAREMIA AB $63.00 86000

T4 TOTAL $74.00 84436

SO PARIETAL CELL AB $114.00 83516

LIPASE, PLASMA $96.00 83690

DIRECT LARYNGOSCOPY $1,218.00

HALFLYTELY BOWEL PRE $210.00

NOVOSEVEN 2.4 MG VI $12,424.00 J7189

WORK HARDENING 2HRS $163.00 97545

WORK HARDENING EA HR $40.00 97546

MICROALB, URINE 24HR $50.00 82043

SO MICROALBUMIN URINE $44.00 82043

SURGICEL HEMOSTAT $236.00

LIORESAL INTRA 20MG $1,484.00 J0475

FOREIGN BODY SPEC SI $284.00 76499

CYMBALTA 20MG CAPSUL $28.00

UROXATRAL ER 10MG TA $24.00

SO NMP22 TUMOR MARKR $127.00 86316

T3 UPTAKE $107.00 84479

FENTANYL 500MCG/ML40 $645.00

Page 69: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ADEFOVIR 10MG TABLET $120.00

DECLOT VAS DEV W/MED $416.00 36593

CONT INJ CVL/VAS DEV $688.00 36598

BOTOX 100 UNIT INJEC $2,030.00 J0585

IMPLANT STIM. GENERA $1,539.00

IMPLNT CATH SP/EPI $1,539.00

IMPLANT PROG PAIN PU $1,539.00

INJECTION JOINT $462.00

REMOVAL IMPT CATH $1,539.00

REMOVAL STIM GENERAT $1,148.00

EPI SINGLE INJECT $1,912.00

NERVE BLOCK $1,041.00

DISCOGRAM EACH LEVEL $1,621.00

REFILL PAIN PUMP/MD $256.00 95991

TRIGGER POINT 1 OR M $462.00

FACET NERVE INJECTIO $1,676.00

FACET NER INJ EA ADD $2,121.00

PUMP ANALYSIS W/WO $596.00

NERVE DST FAC NERVE LUMBAR $1,191.00

NERVE DST FACET NERV CER/THOR $3,593.00

NERVE DEST FACET ADD CER/THOR $998.00

EPI INJECT EA ADD LE $616.00

NERVE BLOCK OCCIPITA $488.00

ELECTRODE STIM INSER $12,522.00

LEAD KIT SPINE STIM $2,287.00

BOTOX INJECTION $1,191.00

NEUROLYSIS $2,121.00

MORPH/BACLOFEN INTRA $510.00

MORPHINE 50MG INTRAT $227.00

OP VISIT UP TO 30MIN $125.00 G0463 T1015

ROZEREM 8MG TABLET $26.00

CHEMODENRV EXT/TR/MU $1,488.00

INTRATHECAL INJECTIO $594.00

ORENCIA 250MG INJ $1,453.00 J0129

BILARY ENDO PERCUT $5,871.00 47552

SMOKING CESS 10MIN $82.00 99406

ADACEL VACCINE (TDAP) $245.48 90715

BYETTA(EXENATIDE 10MCG/.04) $992.00 C9399

AMINOSYN4.25%/DEXT25 $265.00

RISPERDAL CONSTA 37. $1,412.00 J2794

US BIO PROFILE W/O NON-STRESS $294.00 76819

PCKG ADAPTA ADDR01 $17,559.00 C1785

FEMARA 2.5MG TABLET $54.00

SO TISSUE TRANSGLUT IGG AB $78.00 83516

SO JAK2 V617FMUTA $97.00 81270

SO FENTANYL, URINE $146.00 G0480

SO PREGNENOLONE $116.00 84140

REM TUNNEL CATHETER $2,124.00 36589

FENT/BUPIV.CLON500/2 $685.00

HYDROMORP/BUPIV50/10 $519.00

Page 70: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

OCTAGAM 5% 10GM VIAL $1,700.00 J1568

OCTAGAM 5% 5GM VIAL $1,224.00 J1568

ICD VIRTUOSO D154AWG $35,319.00

DYNACIRC CR 5MG TAB $23.00

BRUSH BIOPSY/URETER $5,538.00 52007

EMEND 40MG TABLET $239.00 J8501

REVATIO 20MG TABLET $90.00

AMPUTATION ANY EXT $1,815.00

SO CULT, FUNGUS VAG $43.00 87102

NEEDLE HOLDR AMPLATZ $191.00

SO CYSTATIN C $108.00 82610

SUTURE VEIN/ARTERY $3,611.00

RANEXA TABLET 500MG $26.00

RAZADYNE ER TAB 8MG $48.00

SO PNEUMOCOCCAL ABYS $514.00 86609

ING BETA INTERFERON SQ 1 MCG $593.00 Q3028

ELECTRONIC XMATCH $303.00 86923

DISCOGRPHY SI LUMBAR $4,660.00 72295

HYDROMORPHONE 10MG $240.00

SWEET-EASE 15ML $6.00

CRITICAL CARE ADD 30 ER $645.00 99292

SO HEP B CORE ABY $61.00 86704 86704

SO HEP B SURFACE ABY $57.00 86317 86317

HEPATITIS C, ABY $94.00 86803 86703

ARSENIC,HAIR/NAIL SO $104.00 82175

SO ENTEROVIRUS PCR $204.00 87498

INVEGA 6MG TABLET $83.00

US BREAST KOMEN $391.00 76642

INSULIN DETEMIR $47.00

NIZATIDINE ORAL SOLU $48.00

INJECTION JOINT $462.00

JANUVIA 100 MG TABLE $48.00

TENS INT APP 15 OT $97.00 97032

VERTBRPLASTY-LUMBAR $2,052.00

VERTBROPLASTY-THORAC $2,052.00

VERTBRPLASTY EA ADD $1,927.00

DISKECTOMY-PERC-LUMB $2,545.00

EXCISION CALLUS 1 LE $627.00 11055 11055

EXCISION CALLUS 2/4L $885.00 11056 11056

EXCISION CALLUS >4 L $1,160.00 11057 11057

HBOT, FULL BODY CHAMBER, 30M $296.00 G0277 99183

EGD/BIOP/DILATATION $3,185.00

COLON W/BIO/POLYP SS $4,754.00

COLON W/BIOP & POLYP $4,754.00

APPLY SHORT LEG RIGID CAST $440.00 29445

PCKG ADAPTA SR MEDTR $12,991.00 C1786

CYTOTEC 25MCG TAB $6.00

SO NMR LIPOPROFILE $108.00 83704

MAGIC MOUTHWASH $31.00

AVULSION NAIL BED SN $627.00 11730

Page 71: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

AVUL NAIL BED EA ADD $362.00 11732

AMITIZA 24MG TABLET $26.00

CAFFEINE CITRATE 60M $238.00 J0706

SILVERHAWK PERI CATH $7,270.00

SHEATH-ATHERECTOMY $283.00

ATHERECTOMY,PER FEM $16,387.00 37225

ATHERECTOMY TIBIAL PERONEAL TR $18,137.00 37229

THROMBECTOMY SECONDA $3,346.00 37186

PTC THROMBECTOMY $3,848.00 92973

BUPIVACAINE 0.75% 10ML $24.60 J3490

Bupivacaine 0.25% 10 ML VIAL $39.00 J3490

SENSORCAINE0.5% 10ML $39.00

NEOSYNCOCAINE DROPS $139.00

INSERT GROSHONG PORT $6,255.00 36561

DOXYSUSP25MG/5ML60ML $116.00

CONTNEBTREAT1HRSUB $102.00 94645

CONTNEBTX1ST HR $183.00 94644

DIASTAT 10 MG RECTAL $432.00

GFR $50.00 82565

ASPERGILLUS AGN SO $113.00 87305

SO COCCIDIOIDES TOTAL AB $111.00 86635

HISTOPLA ABY CSF SO $123.00 86698

SO IRON URINE $111.00 83540

LUNESTA 3 MG TAB $41.00

CELIAC PLEXUS INJ $1,082.00

SO H PYLORI ABY IG $155.00 86677

CT PARENCHYMAL ABLA $599.00 77013

CR NEW PT VISIT III $125.00 G0463 T1015

CR NEW PT VISIT IV $125.00 G0463 T1015

CR NEW PT VISIT V $125.00 G0463 T1015

CR EST PT VISIT III $125.00 G0463 T1015

CR EST PT VISIT IV $125.00 G0463 T1015

CR EST PT LEVEL V $125.00 G0463 T1015

BONIVA 3MG/3ML $1,561.00 J1740

SO LEGIONEL ANTIG, UR $98.00 87449

SO STREP PNEUMO AG, UR $93.00 87899

SO ETHYLENE GLYCOL $90.00 82693

ALPHAGAN PO 1% OPTH $203.00

SP HOME EXERCISE EA 15 MIN $101.00 97535 97535

REFILL PAIN PUMP/RN $676.00 95990

SO INTERLEUKIN 6 $130.00 83520

ABD ARTERIES CTANGIO $1,643.00 75635

T4 BIND PROT ELEC S/ $119.00 82664

FABRAZYME 35MG VIAL $13,519.00 J0180

RECLAST 5MG VIAL $3,389.00 J3489

ABILIFY 9.75MG VIAL $109.00

RAD DOSE PLAN IMRT $3,177.00 77301

RAD TX DELIVERY IMRT-SIMPLE $1,398.00 77385 77385

FABRAZYME 5MG VIAL $1,932.00 J0180

EGD W/POLYPECTOMY $1,688.00

Page 72: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

EGD W/BIO & POLYP $3,373.00

EGD W/BIO & POYLP SS $1,688.00

VENOUS CATH SEL ORGA $1,648.00 36500

SO RIBOSOME P ABY $81.00 83516

INVEGA 3MG TABLET $83.00

THROMBECTOMY PRIMARY $4,955.00 37184

ZADITOR 0.025% OPHTH $66.00

MRI BREAST SNGL DUCT $1,232.00 77053

MRI BREAST MULT DUCT $1,232.00 77054

TIKOSYN 250 MCG CAPS $23.00

ITRACONAZOLE 10MG/ML $498.00

IVP SAME DRUG MORE30 $125.00 96376

ER IVP SAME DRUG 30M $125.00 96376

EGD W/BIO&FOREI BODY $3,373.00

APPLY SPLINT OT $88.00

APPLY SPLINT PT $88.00

STRAPPING APPLICATION $96.00

KEPPRA 500MG/5ML INJ $218.00 J1953

ENBREL 50MG INJ $1,339.00 J1438

PLAVIX 300MG TABLET $107.00

SO MUSK(MUSCLE SP RECP TK) $31.00 83519

DRAINAGE NOSE LESION $1,258.00

BLD DRAW PICC CVL $172.00 36592

REM SGL/DUAL ELECTRO $4,259.00 33244

REP FOOT TENDON $1,976.00

SO PORPHOBILIN UA $112.00 84110

SO PORPHOBILIN DEAM $77.00 82657

BIOPSY BREAST STEROT $1,562.00

ANGIOGRAPHY-PELVIC $4,230.00 75736

FACET NERVE INJ $779.00

FACET NER INJ EA ADD $514.00

REPAIR INC CIRCUMCIS $1,983.00

SO CADASIL(NOTCH3) $4,549.00 81406

KEPPRA 500MG/5ML ORA $24.00

ASMANEX INHALER $313.00

ADVAIR INHAL 115/21 $6.00

ADVAIR INHALER 45/21 $5.00

ADVAIR INHALE 230/21 $7.00

CAFFE SOD BEN 500MG $69.00

OXYTOCIN 10U D5LR $60.00 J2590

PROGRAM SPINAL STIMU $294.00 95972

SO ANTI HIV 2, SERUM $103.00 86702

SO RA QUANITATIVE $40.00 86431

SO HEPARIN-PF4 ANTIB $208.00 86022

CTA COR ART W QUANTI $956.00 75574

REDUCTION KNEE DISLO $724.00 27550

EGD W/PEG & BIOPSY $4,373.00

ENDEAVOR OTW DRUG ST $4,849.00

US OTHER $495.00 76999

TEKTURNA 150MG TAB $23.00

Page 73: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DISCOGRPHY SI CER TH $4,657.00 72285

PHYS PERFORM TEST 15 $104.00 97750

TIKOSYN 125MCG CAPSU $23.00

SO IMMUNE COMP EXPAN PA ASSAY $84.00 86332

CT HEART CORON CALCU $147.00 75571

SO HEP E ANTIBODY IGM $57.00 86790

SO TOTAL INHIBIN $160.00 83520

SO CALPROTECTIN $190.00 83993

BREVIBLOC 2500MG/250 $443.00

TYSABRI 300MG/15ML V $7,174.00 J2323

IDET PROCEDURE SINGL $2,319.00

IDET PROC EA ADD LEV $2,319.00

CT CALCIUM SCORING $264.00 75571

SO FATTY ACID PROFILE $170.00 82726

TENS FOLLOWUP 15MIN $97.00 97032

TENS FOLLOWUP 15MIN $97.00 97032

ANTIZOL 1.5GM $3,518.00 J1451

DISCOGRAM EACH LEVEL $1,884.00

SO N-METHYLHISTAMINE UR $123.00 83789

SO PARVOVIRUS B19 DNA S $134.00 87798

SO AFP CSF $114.00 86316

AMINOSYN 8.5% 500ML $288.00

D5W 100ML GLASS $37.00

D5W 50ML GLASS $27.00

D5W 250ML PLSTC $57.00

D5W 1000ML PLSTC $109.00 J7070

D5W 500ML PLSTC $57.00

NACL 0.9% 500ML PLST $56.00

NACL 0.9%1000ML PLST $48.00

NACL 0.9% IRG.1000ML $65.00

NACL .45% 1000MLPLST $109.00

D10W 1000ML GLASS $25.00

D10W 1000ML PLASTIC $109.00

D10W 500ML $109.00

D30W 500ML $165.00

D5W 250ML GLASS $22.00

D5W 500ML GLASS $22.00

D50W 50ML $106.00

D50W 500ML $196.00

D70W 500ML $128.00

AMINOSYN-RF 5.2% 300 $131.00

D5W 100ML PLASTIC AB $59.00

D5W 50ML PLASTIC AB $59.00

NACL 0.9% 100ML PLST $59.00

NACL 0.9% 50ML PLST $59.00

STREPTASE IV 750MU $1,235.00 J2995

ZANTAC 25MG/ML 2ML V $39.00 J2780

HYDROCORT 100MG/2ML $28.00 J1720

LOPRESSOR 5MG/ML $39.00

METHYLPREDNISOLONE 5 $111.00

Page 74: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DEPO-PROVERA 400MG S $308.00

DOBUTAMINE 250MG/20M $109.00 J1250

CALCIUM DISODIUM VER $488.00 J0600

PREDNISONE 1MG TAB $6.00

DEXAMETHASONE 0.5MG $25.00

PEPTO BISMOL 4OZ $23.00

ACTIGALL CAP 300MG $30.00

REMOVAL EAR CERUMEN $630.00 69210

DEXTROSE 10% 250ML B $109.00

EGD POLYPECTOMY/DILA $3,033.00

SELECT DEBRIDE >20 $127.00 97598

OPTIRAY 350 200ML $169.00 Q9967

VISIPAQUE 320 200ML $350.00 Q9967

VISIPAQUE 320 50ML $140.00 Q9967

LEXISCAN 0.4MG/5ML $783.00 J2785

VAG EXAM $100.00

CARDIAC SCREEN PATIE $68.00

ERAXIS 100MG VIAL $696.00 J0348

EXELON PATCH 4.6MG $45.00

VFEND 50MG TABLET $78.00

EPIRUBICIN 200MG/100 $2,704.00 J9178

SO MAGNESIUM TOT RBC $71.00 83735

REPAIR ICDL SINGLE $6,179.00 33218

PLEURX PERIT CATH KI $1,163.00

RABIES VACCINE IM $691.00 90675

KETONE BODY(S) QUALITATIVE URI $54.00 82009

PLATELET FUNCTION TE $92.00 85576

TORISEL 25MG VIAL $3,714.00 J9330

NEUROMATRIX COLL N C $3,051.00 C9355

EGD W/REMOVAL PEG TU $1,688.00

SO SALMONELLA TOT ANTI $229.00 86768

SO REDUCING SUB FECES $82.00 84376

LACTOFERRIN DECT $111.00 83630

VIABAHN STENT $5,977.00

TENOTOMY TOE SINGLE $1,851.00 28010

SO Drug test(s), presum,” $412.00 80307

VAPRISOL 20MG VIAL $1,942.55

RAMIPRIL 5MG CAPSULE $10.00

PRAVASTATIN 40MG TAB $31.00

IVUS WIRE VOLCANO $1,542.00 C1753

XIENCE DRUG STENT $3,910.00 C1874

INTRAVAS US INT VESS $1,792.00 92978

IVUS EACH ADD VESSEL $1,792.00 92979

I 131 TX EA ADD MCI $50.00 A9517

SO LYME DISEASE SEROLOGY SERUM $57.00 86617

ESOINOPHIL SM OTHER $19.00 89190

MYSTOTOMY W/EXPLOR/DRAINAGE $706.00 19020

EXP REM FOREIGN BODY ARM/WRIST $952.28 25248

EXCISION BEN LESION 1.1 TO 2.0 $278.00 11402

ROOMING IN - WOMENS UNIT $270.00

Page 75: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO MYCOBACTERIUM MIC 12 DRUG & $477.00 87188

DRUG-SCREEN PRESCRIPTION/OTC $52.00 80307

BONE MARROW ASPIRATION $1,078.00

ARTHROSCOPY WRIST $2,693.00

VENTOLIN HFA INHALER $178.00

EXC BEN LES SCALP/HAND/FEET $102.00 11420

SIMPLE REPAIR SCALP/AX/GENIT $578.00 12007

TX SUPERFICIAL WOUND DEHISCENC $351.00 12020

MASTOTOMY W/EXPLORATION/DRAI $711.00 19020

CLOSED TX TIB SHAFT FX $1,228.00 27752

APPLY SHORT ARM SPLINT $62.00 29126

APPLICATION FINGER SPLINT $80.00 29130

REPAIR BLOOD VESSEL $1,437.00

REPAIR LACERATION 2.5CM OR LES $355.00 41250

EGD DIAGNOSTIC/DOCTOR $298.00 43235

EGD W/BIOPSY $337.00 43239

RPLC GTUBE NO REVJ TRC $153.00 43762

OBSERVATION CARE D/C DA MG $173.25 99217

INITAL HOSP CARE DETAIL 30 MIN $241.25 99221

INITAL HOSP CARE COMPLX 50 MIN $326.50 99222

INITIAL HOSPITAL DA E/M HIGH $484.00 99223

SUBSQT HOSP CARE DA 15 MIN $110.00 99231

SUBSQT HOSP CARE DA 25 MIN $173.00 99232

SUBSQT HOSP DA E/M $250.50 99233

OBS INPT HOSP CARE 40 MIN $318.50 99234

OBSER/INPT HOSP CARE 50 MIN $404.50 99235

OBSER/INPT HOSP CARE 55 MIN $521.50 99236

DATE OF HOSP D/C 30MIN OR < $173.25 99238

HOSP D/C DA MGMT >30 MIN $258.00 99239

OFFICE CONSULT NEW/EST LTD 15M $325.00 99241

OFFICE CONSULT LOW 30 MIN $475.00 99242

SNF DISCHARGE < 30 MIN $174.25 99315

SNF D/C > 30MIN $250.75 99316

SIGMOIDOSCOPY WITH POLYPECTOM $2,301.00

CRYOPRECIPITATE EA UNIT $118.00 P9012

SO MMR PROTEIN $524.00 88344

SO INTERLEUKIN 6 $145.00 83520

SO LIPASE RANDOM URINE $67.00 83690

SO BILIRUBIN URINE $31.00 81005

SIGMOIDOSCOPY W/BIOPSY $2,301.00

ALOXI 0.25MG/5ML VIAL $1,977.00 J2469

ONDANSETRON 4MG ODT (TABLET) $117.00

SO HIV TYPE 1 PROVIRAL DNA QUA $190.00 87535

GLUCOSE TOLERANCE 3HR $103.00 82951

GTT ADD SPEC $20.00 82952

CALCIUM 24HR URINE $30.00 82340

VOLUME MEASUREMENT $16.00 81050

SO URIC ACID OTHER SOURCE $23.00 84560

URINE SODIUM $91.00 84300

URINE POTASSIUM $30.00 84133

Page 76: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO MAGNESUM 24HR URINE $32.00 83735

C&S STOOL $127.00 87045

C&S STOOL $34.00 87046

SO NEUT/CYTOPL/ANTI $41.00 86255

TITER, EACH ANTIBODY $46.00 86256

SPLITTING BLOOD/BLOOD PRODUCTS $147.00 86985

SO SUBCLASSES $26.00 82787

URINE PROTEIN $54.00 84156

SO ALBUMIN URINE/OTHER SOURCE $30.00 82042

FIBRIN DEGRA QUANITIATIVE $34.00 85379

PLATELET NEUTRALIZATION $60.00 85597

SO RUSSELL VIPER VENOM DILUATE $20.00 85613

SO REPTILASE TIME W/REFLEX $69.00 85635

THROMBIN TIME TITER $23.00 85675

PTT SUBSTI PLASMA FRACT $22.00 85732

SO CLOTTING FACTOR VIII $136.00 85240

H-PYLORI DRUG ADMINISTRATION $27.00 83014

SO H-PYLORI BREATH TEST $96.00 83013

SO METHSUXIMIDE $50.00 G0480

SO CHROMATOGRAPHY, QUANITITATI $60.00 82542

SO IMMUNFIXATION ELECTRO; SERU $74.00 86334

HEP C; AMPLIFIED PROBE TECH $118.00 87521

HEP C VIRUS $569.00 87902

SO FLOW CYTOMETRY EACH ADD $83.00 88185

SO CHROMOSOME ANALY CONT 15-20 $277.00 88262

SO CYOGENETICS/MOLECULAR CYOGE $78.00 88291

SO CONCENTRATION FOR INFECTIOU $23.00 87015

SO SMEAR, SPECIAL STAIN $20.00 87207

ANTINUCLEAR ANTIBODIES $51.00 86038

SO ANA TITER $37.00 86039

BARBITURATES NOT ELSEWHERE SPE $66.00 G0480

SUGARS/OLIGOSACC MULTI QUALITA $85.00 84377

SO ORGANIC ACIDS QUALITITATIVE $55.00 83919

MOLE CYTOGENE DNA PR $71.00 88271

DIPHTHERIA $52.00 86648

SO TETANUS ANTITOXOID AB $51.00 86774

SO METHADONE DRUG SCREEN $160.00 80307

DRUG CONFIRMATION EACH DRUG $160.00 80307

SO IMMUN ANALUTE MULTIP $95.00 83516

MOLE CYTO ANALYSIS 100-3 $134.00 88275

INEC AGE DET NUC AC $197.00 87798

SO IMMUNFLOUORESCENT STU $444.00 88350

SO IMMUNOASSAY ANALY NO $112.00 83520

SO HEMOGLOBIN UNSTABLE $29.00 83068

SO ELECTROLYTE QN F $118.00 84999

SO CHLORIDE OTHER SOURCE $55.00 82438

SO MYCOB CULTURE DEFINF $37.00 87118

SO CULT TYP IDENT BY NU $67.00 87149

SO PKU BLOOD $19.00 84030

SO TYOSINE $22.00 84510

Page 77: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PART AGGLUTINATIN S $273.00 86403

SO BLASTOMYCES $43.00 86612

SO ISLET CELL ANTIBODY $67.00 86341

SO IMMUN ANALYSIS QUANTITATIVE $30.00 83519

SO WESTERN BLOT INTERP/REPORT $60.00 84182

SPECTROPHOTOMETRY $109.00 84311

SO CHROMATOGRAPHY QUANT $60.00 82542

ELECTROPHORETIC TECH $119.00 82664

IMMUNOHISTOCHEMISTRY $524.00 88342

NEPHELOMETRY $90.00 83883

SO IMMUNOFIXATION ELECT;OTHER $78.00 86335

SO PYRIDOXAL PHOSPHATE (VIT B6 $94.00 84207

SO CHLAMYDIA $40.00 86631

SO CHLAMYDIA,. IgM $43.00 86632

SO COLD AGGLUTININ; TITER $27.00 86157

CYSTINE & HOMOCYSTINE URINE QU $29.00 82615

TISSUE CULTURE SOLID TUMOR $142.00 88239

SO OVA & PARASITES DIRECT SMEA $31.00 87177

SMEAR PRIMARY SOURCE,COMPLEX $61.00 87209

SO PROTEIN;ELECTRO FRACT/QUANT $40.00 84166

SO EPSTEIN-BARR VIRUS, NUCLEA $52.00 86664

SO EPSTEIN-BARR VIRUS,VIRAL CA $61.00 86665

SO VIRUS ISOLATION, TISSUE CUL $87.00 87252

SO VIRUS ISOL. CENTRIFURE ENHA $65.00 87254

SO T CELLS; TOTAL COUNT $126.00 86359

B CELLS, TOTAL COUNT $84.00 86355

NATURAL KILLER CELLS TOTAL COU $84.00 86357

SO T CELLS; ABSOLUTE CD4/CD8 C $134.00 86360

COLUMN CHROMATOGRAPHY/MASS SPE $53.00 82542

SO CORTISOL;FREE $56.00 82530

MASS SPECTROMETRY QUANTITATIVE $60.00 83789

T4-NEONATAL $23.00 84437

SO PKU PROFILE $80.00 84030

MOLE CYTOGENE INTERPHASE IN SI $116.00 88274

TISSUE CULTURE $142.00 88230

SO PHENYTOIN; FREE $82.00 80186

SO CHROMATOGRAPHY, THIN LAYER $112.00 84999

DRUG SCREEN EACH DRUG CLASS $256.00 80307

SO TESTOSTERONE FREE $85.00 84402

SO CHLAMYDIA TRACHOMATIS RNA T $155.00 87491

SO CULTURE CHLAMYDIA ANY SOURC $65.00 87110

SO CLOTTING FACTOR VII $103.00 85230

SO CLOTTING FACTOR XI $103.00 85270

HIV1 & HIV2 SINGLE ASSAY $91.00 86703

VOLATILES $46.00 84600

SO DEOXYRIBONUCLEASE, ANTIBODY $58.00 86215

SO VMA URINE $62.00 84585

KETOGENIC STEROIDS FRACTIONATI $62.00 83582

SO FLOW CYTOMETRY INT 16 OR MO $95.00 G0452

TISSUE CULTURE NON-NEOPLASTIC $170.00 88237

Page 78: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO IMIPRAMINE $47.00 G0480

INFECTIOUS AGENT ANTIGEN DETEC $67.00 87449

SO HISTOPLASMA $43.00 86698

SO SENSORI MONITOR NEUROPATHY $1,812.00 83520

SO THALLIUM SERUM $91.00 83018

EGD WITH REPLACEMENT PEG TUBE $1,788.00

RELENZA 5MG DISKHALER $301.00

3-DAY PHASE 3 $159.19

2-DAY PHASE 3 $108.17

PHASE 3 ASSESSMENT $135.00

SO THYROTROPIN RECEP A/B SERUM $56.00 83519

SO TRYPTASE SERUM $134.00 83520

SO BLASTOMYCES A/B SERUM $122.00 86612

SO LACTIC ACID,CSF $101.00 83605

SO AMIKACIN RANDOM $65.00 80150

SO EBV IGA $61.00 86665

SO INHIBIN A $68.00 86336

SO ROCKY MTN SPOTTED FEVER $129.00 86757

SO TYPHUS FEVER IGG/IGM $129.00 86757

SO MUMPS VIRUS IGG $44.00 86735

SO MUMPS VIRUS IGM $44.00 86735

STRONTIUM-MISC METAL TESTING $109.00 83018

SO CHROMIUM, SERUM $126.00 82495

SO HAIRSTAT $239.00 80307

TEST/MEASURE 15 MIN $123.00 97750

TEST/MEASURE 15MIN $123.00 97750

ALIMTA 500 MG VIAL $13,475.00 J9305

DIRECT COMBS $87.00 86880

SO ITRACONAZOLE $152.00 80299

SO BK VIRUS DNA BY PCR $282.00 87799

TRIPLE AAA STENT GRAFT S&I $4,619.00 75952

ATRIAL NATRIURETIC FACTOR PLAS $185.00 83880

SO ANTIMICRO SUSCEP MIC $125.00 87186

SO ANTIMICRO SUSCEP MIC $125.00 87187

INOTOPHORESIS PT PER 15MIN $132.00 97033

ED-A-HIST SYRUP 5ML $8.00

IONIZED CALCIUM $113.00 82330

CUBICIN 500MG/10ML VIAL $829.00 J0878

HEPARIN COFACTOR II $201.00 85130

PARAFFIN BATH OT $57.00 97018

ANESTHESIA GENERAL 1ST 15 MIN $869.00

ANESTHESIA GENERAL EA ADD 15 M $218.00

ANESTHESIA OTHER 1ST 15 MIN $312.00

ANESTHESIA OTHER EA ADD 15 MIN $79.00

PACU 1ST 30 MIN $885.00

PACU EACH ADD 15 MIN $222.00

PACU PHASE II 1ST 30 MIN $184.00

PACU PHASE II EA ADD 15 MIN $20.00

ZEMPLAR 2MCG/ML VIAL $71.00 J2501

AMOXICILLIN 400MG/5ML 100ML SU $54.00

Page 79: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BYSTOLIC 5 MG TABLET $18.00

INJECT CYSTOGRAM $1,065.00 78740

INJECT HSTEROSAPLIN $296.00

INJECT VENOGRAM $648.00

INJECT ARTHO HIP $363.00

INJECT ARTHO KNEE $363.00

INJECT ARTHO SHOULDER $363.00

INJECT ARTHO WRIST $363.00

THORACENTESIS $886.00 32555

INJECTION LOOP-O-GRAM $542.00

INJ RETRO URTHO CYST $132.00

ASPIRATION PROCEDURE $1,082.00

INJECTION MYELOGRAPHY $247.00

DIAG. INJECTION $227.00

INJECT VCUG $1,082.00

INJECT VENOGRAM $648.00

INJ LOWER EXT $2,048.00

THRMBN INJ PSDANRYAM $1,452.00 36002

SO REFLEX ANA IFA $38.00 86039

SO REFLEX DSDNA $47.00 86225

SO REFLEX RNP $60.00 86235

SO REFLEX SMITH $60.00 86235

SO REFLEX SSA $60.00 86235

SO REFLEX SSB $60.00 86235

SO ANA IGG REFLEX $41.00 86038

GADOLINIUM PER ML $12.00 A9579

PERCUTAN TUBE CHANGE $3,236.00 50435

V STEM MAPPING $1,670.00 93609

SO BETA-2 GLYCOPROTEIN $262.00 86146

MRA ABD W & WO CONTRAST $2,054.00 74185

EOVIST PER ML (10ML VIAL) $170.00 A9581

CHOLANGIOGRAM T-TUBE $5,871.00 47531

HYSTEROSALPINGOGRAM $721.00 74740

VENOGRAM RT $1,091.00 75820

ARTHROGRAM HIP RT $586.00 73525

ARTHROGRAM KNEE RT $908.00 73580

ARTHROGRAM SHOULDER RT $711.00 73040

ARTHROGRAM WRIST RT $923.00 73115

LOOP O GRAM $640.00 74425

RETROGRADE URETHROGRAM $378.00 74450

MAMMO STEROTACTIC GUIDANCE $868.00

US CYST ASPIRATION $453.00 76942

MYELOGRAPHY, CERVICAL $836.00 62302

CYSTOGRAM $525.00 74430

MYELOGRAPHY, 2 LEVELS $1,252.00 62305

MYELOGRAPHY, THORACIC $1,847.00 62303

MYELOGRAPHY, LUMBARSAC $783.00 62304

US NEEDLE BIOPSY $2,032.00

FISTUAL GUIDANCE $643.00 76080

ARTHROGRAM HIP LEFT $586.00 73525

Page 80: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ARTHROGRAM KNEE LEFT $908.00 73580

ARTHROGRAM SHOULDER LEFT $711.00 73040

ARTHROGRAM WRIST LEFT $923.00 73115

VCUG $688.00 74455

VENOGRAM LEFT $1,091.00 75820

ARTERIOGRAM-SURGERY $5,610.00 75710

ARTERIOGRAM-OR-LEFT $5,610.00 75710

VENOUS DUPLEX RIGHT $371.00 93971

VENOUS DUPLEX BILATERAL $1,093.00 93970

DUPLEX EXT VEINS; UNIL/LIMIT $533.00 93971 93971

HOLTER MONITOR 24HR $134.00 93225

US THROMBIN INJECTION $453.00 76942

MRI PELVIS W/CONT $2,695.00 72196

MRI UP EXT RT WO/W CONT $2,807.00 73220

MRI LO EXT RT WO/W CONT $2,878.00 73720

MRI BRAIN WO/W CONTRAST $4,048.00 70553

MRI CERVICAL SPINE WO/W CONT $4,255.00 72156

MRI LUMBAR SPINE WO/W CONT $4,132.00 72158

MRI THORACIC SPINE WO/W CONT $4,388.00 72157

MRA PELVIS W OR WO CONTRAST $1,985.00 72198

MRI LO EXT LT WO/W CONT $2,878.00 73720

MRI UP EXT LT WO/W CONT $2,807.00 73220

MRA HEAD WO/W CONTRAST $3,556.00 70546

MRA NECK WO/W CONTRAST $3,132.00 70549

MRI CHEST WO/W CONTRAST $2,601.00 71552

MRI PELVIS WO/W CONTRAST $3,369.00 72197

MRI UP EXT LT W/CONTRAST $2,807.00 73219

MRI UP EXT JOINT W/CONT $3,768.00 73222

MRI UP EXT JOINT RTWO/W CONT $3,768.00 73223

MRI UP EXT JOINT LT WO/W CONT $3,768.00 73223

MRI LO EXT JOINT LT WO/W CONT $3,211.00 73723

MRI LO EXT JOINT RT WO/W CONT $2,764.00 73723

MRI LO EXT LT W/CONTRAST $2,878.00 73719

MRI ABDOMEN W/CONTRAST $2,483.00 74182

MRI ABDOMEN WO/W CONTRAST $2,483.00 74183

MRI ORB/FAC/NECK W/ CONTRAST $2,613.00 70542

MRI ORB/FAC/NECK WO/W CONTRAST $2,613.00 70543

MRA ABD W & WO CONTRAST $2,054.00 74185

MRA CHEST W OR W/O CONTRAST $2,017.00 71555

MRA LT LOW EX W & WO CONTRAST $2,319.00 73725

MRA RT LOW EX W & WO CONTRAST $2,319.00 73725

MRI LUMBAR SPINE W/CONTRAST $3,494.00 72149

CT RFA LIVER TUMOR $6,042.00

CT RFA KIDNEY TUMOR $6,042.00

CT RFA LUNG TUMOR $6,042.00

ADRENAL ABLATION $4,663.00

INSRT/REP ELECTRD/PM PM CATH S $11,354.00 33210

PERCUTANOUS TUBE CHANGE $426.00 75984

INSERT CVL N-TUNN 5YRS $1,927.00 36556

NEPHROSTOGRAM S&I $640.00 74425

Page 81: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

VENOGRAM RT $2,205.00 75820

VENOGRAM LT $2,205.00 75820

VENOGRAM BILATERAL $1,298.00 75822

RENAL RENIN SAMPLING $5,977.00 75893

V STEM STUDY $10,834.00 93620

COMPL RPLCMT PICC RS&I $1,657.00 36584

SO BORDATELLA PERTUSIS IgG ANT $223.00 86615

SO HEP BSAG CONFIRMATION $36.00 87341

SO HEPATITIS A VIRUS TOTAL $42.00 86708

SO HEPATITIS A ANTIBODY IGM $39.00 86709

REVISE REPLACE NEUROELETRODE $1,617.00

ELECTRONIC ANALYSIS NEUROSTIMU $227.00 95970

SO CELIAC DISEASE PANEL $20.00 82784

SO TRANSGLUTAMINASE AB IgG $42.00 83516

SO GLIADIN PEPTIDE ANTIBODY Ig $40.00 83516

SO GLIADIN PEPTIDE ANTIBODY I $40.00 83516

SO TISSUE TRANSGLUTAMINSE AB I $40.00 83516

SO ENDOMYSIAL AB TITER $53.00 86256

SO BCR/ABL1 GENE MAJOR BP $510.00 81206

US GUIDE PERICARDIOCENTESIS S& $146.00 76930

SO ANTIBODY; FUNGUS NES $66.00 86671

APPLY TOE SPLINT $239.00 29550

IA-2 ANTIBODY $218.00 86341

DIGITAL MAMMO SCREEN W/CAD BIL $297.00 77067 77067

DIGITAL MAMMO DIAG BIL W/CAD $315.00 77066 G0204

DX MAMMO INCL CAD UNI LT $259.00 77065 77065

DIGITAL MAMMO SCREEN BIL $297.00

DIGITAL MAMMO SCR/INDU W/CAD $297.00 77067

CLSD TX PROX TIBIA FX W/WO MAN $1,336.75 27532

SUSCEPTIBILITY STUDIES EA MULT $66.00 87186

SO 17-HYDROXYPROGESTERONE $91.00 83498

SO 17-HYDROXYPREGNENOLONE $77.00 84143

SO PREGNENOLONE SERUM $70.00 84140

SO AEROBIC ORGANISM ID ROUTINE $60.00 87077

Quantitation Therp drug, NOS $448.00 80299

SO ORGANISM IB BY 16s r DNA SE $164.00 87158

SUSCEPITIBILITY, KIRBY BAUER $50.00 87184

SO PHOSPHORUS $18.00 84105

SO CYSTINE $57.00 82131

SO CITRIC ACID $93.00 82507

SO LIPOPROTEIN ELECTROPHORESIS $64.00 83700

ELTPC EVAL/TEST ICD $3,500.00 93642

INJ TENDON ORIGIN/INSERT $136.00 20551

PRIALT 500MCG/20ML VIAL $17,731.00 J2278

ANCOBON 500MG CAP $204.00

AMBISOME 50MG VIAL $948.00 J0289

EFFIENT 10MG TAB $39.00

MULTAQ 400MG TAB $27.00

VIMPAT 100MG TAB $39.00

VIMPAT 200MG/20ML VIAL $165.00

Page 82: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NUCYNTA 75MG TAB $19.00

NUCYNTA 50MG TAB $17.00

AO HANTAVIRUS AB IgG & IgM BY $188.00 86790

SO HERPES SIMPLEX VIRUS TYPE 2 $65.00 86696

SO HERPES SIMPLEX VIRUS TYPE 1 $32.00 86695

SO HEPATITIS Be VIRUS ANTIGEN $40.00 87350

SO LIPOPROTEIN-ASSOC PHOSPHOLI $116.00 83698

OCCULT BLOOD FECES $30.00 82272

SO NEUROKININ A $273.00 83519

SO COXSACKIE B VIRUS AB $134.00 86658

SO COXSACKIE A9 VIRUS AB BY CF $44.00 86658

SO REFLEX TO PTT $22.00 85732

SO INHIBITOR ASSAY PTT $40.00 85730

OMP $156.00 83516

SO ASCA IgG $42.00 86671

SO ANCA $41.00 86255

SO ASCA IgA $42.00 86671

SO APC RESISTANCE PROFILE $52.00 85307

SO TREPONEMA PALLIDUM AB BY TP $45.00 86780

SO TREPONEMA PALLIDUM AB (FTA- $45.00 86780

O2 PER 12 HOURS $222.00

ADVAIR HFA 115 PER DOSE $17.00

IPRA.ALBUTEROL 3ML UD $12.00

SO REFLEX THYROID PEROXIDASE A $49.00 86376

SO REFLEX SCLERODERMA AB $60.00 86235

LABOR ROOM/C-SEC 1ST HR $300.00

LABOR ROOM/C-SEC EA ADD HR $110.00

LABOR/DELIVERY/RECOV 1ST HR $1,235.00

LABOR/DELIV/RECOV EA ADD HR $72.00

IV INFUSION PER HR - MAG $450.00 96365

IV INFUS EA ADD HR - MAG $230.00 96366

PITCON IND 1ST HOUR $68.00

PITCON IND EA ADD HOUR $72.00

GIEMSA STAIN $55.00 87207

SO CONCENTRATION $55.00 87015

ICU OBSERVATION 1ST HOUR $1,084.00 G0378

ICU OBSERVATION EA ADD HR $65.00 G0378

FLOOR OBSERVATION 1ST HOUR $650.00 G0378

FLOOR OBSERVATION EA ADD HR $65.00 G0378

PCU OBSERVATION 1ST HOUR $750.00 G0378

PCU OBSERVATION EA ADD HR $75.00 G0378

LEUKOCYTE HISTAMINE $43.00 86343

SO HISTAMINE $93.00 83088

ANTIBODY IDENTIFICATION $50.00 86021

SO CAMPYLOBACTER JEJUNI ANTIBO $128.00 86625

SO PNEUMOCYSTIS JIROVECI DFA $42.00 87281

SO RESPIRATORY SYNCYTIAL VIRUS $37.00 87280

SO DEAMIDATED GLIADN AB IgG & $238.00 83516

SO INFLUENZA B VIRUS AB IgM $46.00 86710

SO INFLUENZA B VIRUS AB IgG $46.00 86710

Page 83: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO INFLUENZA A VIRUS AB IgM $46.00 86710

SO INFLUENZA A VIRUS AB IgG $46.00 86710

I&D SCROTAL/EPIDID/TESTIS ABSC $335.00 54700

SO PT CIRCULATING ANTICOAG $31.00 85610

SO REFLEX PT 1:1 MIX 1HR $22.00 85611

SO REFLEX PT 1:1 MIX 2HR $22.00 85611

SO PTT CIRCULATING ANTICOAG $40.00 85730

SO REFLEX PTT 1:1 MIX $22.00 85732

SO REFLEX PTT 1:1 MIX 2HR $22.00 85732

COMBIVENT INHALER 1 PUFF $10.00

ATROVENT INHALER 1 PUFF $10.00

AEROBID INHALER 1 PUFF $11.00

FLOVENT 44MCG INH 1 PUFF $11.00

FLOVENT 110MCG INHALER 1 PUFF $13.00

FLOVENT 220MCG INHALER 1 PUFF $16.00

ALBUTEROL HFA 1 PUFF $7.00

REPAIR ICD LEAD DUAL CHAMBER $6,179.00 33220

MUCOMYST 10 percent 2ml $20.00

INTRATHECAL CATHETER CHECK $1,082.00

SHUNTOGRAM S&I $179.00 75809

INFLU VIRUS A & B RAPID CULTUR $67.00 87254

RUFINAMIDE $53.00 82542

SO HEMOGLOBIN URINE $27.00 83069

SO HEPATITIS C VIRUS RNA OUAN $156.00 87522

ALBUTEROL/MUCOMYST U/D $38.00

REMOVAL FB UP ARM/ELBOW DEEP $773.00 24201

SO DNase-B ANTIBODY $42.00 86215

ROOM SEMI PRIVATE ACC $709.00

ROOM SEMI PRIVATE ER $709.00

CLINIMIX E 2.75/5 PERCENT $237.00

SO HELICOBACTER PYLORI ANTIGEN $62.00 87338

SO PROTEIN S FREE ANTIGEN $74.00 85306

SO NICOTINE & METABOLITIES SER $80.00 G0480

SO BILE ACIDS, FRACTINAT & TOT $169.00 83789

SO NEURONAL AB IGG BY IMMUNOBL $157.00 83516

SO NEUROMYELITIS OPTICA (NMO) $393.00 83516

SO ZONISAMIDE $66.00 80203

SO AMIDARONE & METABOLITE $47.00 82542

SO TAMBOCOR (FLECAINIDE) $47.00 80299

THROMBOLYSIS CORONARY ARTERY $2,833.00 92975

ADVAIR 230/21 INHALER $681.00

SO SEROTONIN REL ASSA HEP DEP $338.00 86022

SO JC VIRUS QUAL BY PCR $263.00 87798

SO METHADONE-SERUM $160.00 G0480 83840

SERUM IMMUNOASSAY $160.00 80307

SERUM, GC/FID $160.00 80307

SERUM, GC/ECD $160.00 80307

URINE IMMUNOASSAY $160.00 80307

URINE, GC/MS $160.00 80307

SO TROPHERYMA WHIPPLEI DNA $257.00 87798

Page 84: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO INSULIN LIKE GROWTH FACTOR $107.00 83519

XOPENEX HFA INHALER 1 PUFF $7.00

SO HUMAN PAPILLOMAVIRUS DNA P $117.00 87624

EGD W/PEG PLACEMENT $1,452.00

SO CMV IGM $38.00 86645

SO HSV IGM $32.00 86694

SO RUBELLA IGM $32.00 86762

SO TOXOPLASMA IGM $38.00 86778

SO APT TEST $20.00 83033

SO PROPOXYPHENE $160.00 G0480

SO IMMUKNOW $261.00 86352

INTRON 18MMU/1 ml $1,146.00 J9214

ULTRAFOAM 50 SPONGE $141.00

ULTRAFOAM 8 x 12.5 sheet $179.00

CUROSURF 240MG/3ML $1,684.00

SO HERBICIDES PANEL 1 SCREEN $235.00 80307

SO ATRAZINE $343.00 82542

SO HALOPERIDOL $49.00 80173

SO ACETYLCHOLINE BLOCKING AB $48.00 83519

SO ACETYLCHOLINE MODULATING AB $52.00 83519

SO CLOZAPINE, NORCLOZAPINE $131.00 G0480

SO ALLERGENS, FOOD COMP PROFIL $450.00 86003

COMBIGAN OPHTH. DROPS $225.00

SO DEOXYPRIDINOLINE CROSSLINK $63.00 82523

SO BRUCELLA AB $30.00 86622

SO PANCREASTATIN $273.00 83519

HYDROMORPHONE HCL/PF 50MG/5M $129.00

MYOCARDIAL SPECT SINGLE STUDY $1,231.00 78451

SO THIOCYANATE $40.00 84430

SO TSH RECEPTOR AB $44.00 83520

ARC INCUBATION W/INHIBITORS $184.00 86977

ARC, COLD AGGLUTININ SCREEN $62.00 86156

ARC DIFFERENTIAL/AUTO ADS SERU $119.00 86978

ARC INCUBATION; SERUM & DRUGS $303.00 86975

ARC PRETREATMENT W/ENZYMES $303.00 86971

ARC, AB ID /EA SELECT REAGENT $303.00 86885

SO ARC, AB SCREEN EACH MEDIA $184.00 86850

SO HEPATITIS B VIRUS CORE AB I $40.00 86705

SO CHLAMYDIA PNEUMONIAE $190.00 87486

TOBRAMYCIN (INHOUSE ONLY) $45.00 80200

SO VONWILLEBRAND FACTOR ANT $77.00 85246

SO ARC ELUTION $303.00 86860

SO THYROTROPIN REL HORM $254.00 83519

PONTOCAINE 20MG AMP $82.00

SO CORTISOL SALVIA $55.00 82530

SO IODIDE SERUM $121.00 82542

SO PYRUVIC ACID $37.00 84210

REPAIR ICDL DUAL $2,700.00 33220

SO H-PYLORI AB IGM $49.00 86677

ATRACURIUM 100MG/10ML VIAL $66.00

Page 85: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

OXYCODONE/APAP 7.5MG/325 TAB $14.00

RENVELA 2.4GM PACKET $66.00

MOPATH PROCEDURE LEVEL 2 $252.00 81401

CHECKOUT/ORTH-PROS EA 15M $234.00 97760

ARTERIAL PUNCTURE $207.00 36600

SO COMPLEMENT COMPONENT 1 FUN $145.00 86161

DEB/REM FB/OPN FX/SKIN & SUBQ $1,082.00

DEBRIDEMENT SKIN/SUB/MUSCLE $1,082.00 11011

DEBRIDEMENT SKIN/SUB/MUS/BONE $6,223.00 11012

SO MPO-AB $40.00 83516

APPLY PROFORE COMP WRAP LT $227.00 29581

APPLY PROFORE COMP WRAP BIL $436.00 29581

APPLY PROFORE COMP WRAP RT $227.00 29581

TRIM NONDYSTROPHIC NAILS $55.00 11719

SO NEISSERIA GONORRHOEA AB $70.00 86171

SO AMPHETAMINE SERUM CONFIRM $100.00 G0480 82145

FFP BET 8-24 HRS OF COLL EA $199.00 P9059

SO GIARDIA LAMBLIA AB $84.00 86674

INSERTION PERITONEAL CATH PERM $5,816.00 49421

SO FMR1 GENE DETECTION $240.00 81243

TC99M PERTECHNETATE PER 1 MCI $64.00 A9512

CVP MONITORING 1 PER DAY $32.00 93770

SO REFLEX TREPONEMA PALLIDUM $17.00 86593

SO TREPONEMA PALLIDUM (RPR) $17.00 86592

SENSIPAR 30MG TABLET $86.00

ZONISAMIDE 100MG CAPSULE $20.00

SYMBYAX 6/25 CAPSULE $83.00

EVOXAC CAPSULE $22.00

FEMARA 2.5 MG TABLET $90.00

SO IGM CSF $22.00 82784

NITROGLYCERIN OINT. 1GM $8.00

LIORESAL 50MCG/ML 1ML TEST DOS $396.00 J0476

TOBRAMYCIN 80MG/100ML $96.00 J3260

METHENAMINE HIPPURATE 1GM TAB $21.00

SO FATTY ACIDS, FREE $50.00 82725

SO IGG $54.00 86787

IGM $54.00 86753

DNA PROBE EACH $81.00 88271

INTERPHASE IN SITU HYBRID 100- $152.00 88275

INTERPRETATION & REPORT $78.00 88291

BODY FLUID UREA NITROGEN $46.00 84520

SO METHEMALBUMIN SERUM/PLASM $42.00 83857

SO 17-HYDROXYCORTICOSTEROIDS U $66.00 83491

SO GONADOTROPIN RELEASING HORM $65.00 83727

LHRH $65.00 83727

URINE DRUG SCREEN DIPSTICK $13.00 80305

PHENOL $59.00 84600

SO CREATININE $20.00 82570

SO PCCA SCREEN $47.00 86255

SO PCCA TITER $47.00 86256

Page 86: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO PCCA IMMUNOBLOT $45.00 83516

SO BODY FLUID LIPASE $26.00 83690

SO SOMATOSTATIN $68.00 84307

IVUS NON-CORONARY VES INITAL $1,792.00 37252

IVUS NON-CORONARY S&I $440.00 37252

ABRAXANE 100MG VIAL $2,883.00 J9264

TESTOSTERONE 200MG/1ML VIAL $146.00

SO VARICELLA-ZOSTER VIRUS DFA $34.00 87290

SO HSV 1 $34.00 87274

SO HSV 2 $34.00 87273

SO CULTURE $97.00 87252

SO IP STAIN $76.00 87253

TRIGGER POINT 3 OR MORE MUSCLE $66.00 20553

SO ALKALINE PHOSPHATASE BONE S $55.00 84080

ELAVIL INJ 10MG/ML $55.00 J1320

CIPROFLOXACIN TAB 25 $33.00

MORPHINE SULFATE 5MG/1ML $31.00 J2270

NORFLEX INJ. 60MG $166.00 J2360

LANOXICAPS 0.1MG $6.00

ERYPED DROPS $23.00

EGD W/CAUTERY/FORCEPS $1,688.00

REPL DUODEN/J-TUBE W/FLUOR $1,219.00 49451

CARBAMAZEPINE 100MG $10.00

VOLTAREN TAB 25MG $6.00

VOLTAREN TAB 75MG $6.00

SO PROPHYRINS PROFILE PLASMA $25.00 84311

SO PROPHYRINS FRAC PLASMA(REFL $67.00 82542

CAPSAISIN .025% CREA $50.00

MAXITROL O/S 5ML $46.00

UNASYN 1.5GM VIAL $53.00 J0295

LORCET PLUS $13.00

LISINOPRIL TAB 10MG $6.00

UAC PROCEDURE NEONATE $238.00 36660

BUPIVICAINE 0.5 0/0 W/EPI 10ML $19.00

SO LIPOPROTEIN BLOOD (SUBCLASS $91.00 83701

MICONAZOLE CREAM 30G $22.00

INSULIN SEMILENTE 10 $42.00

LIDEX CRM .5% 60GM $83.00

DIBENZYLINE 10MG CAP $9.00

SO CHOLESTEROL SERUM/WHOLE BL $15.00 82465

SO CONCENTRATION $25.00 87015

STAIN $23.00 87207

SULFACETAMIDE 10%5ML $35.00

MORPHINE SO4 500ML $106.00

BACTROBAN OINT 2% 22 $202.00

EDECRIN TAB 50MG $9.00

INDIUM 111 $3,881.00 A9570

PEDIAPRED LIQ 4OZ(5M $47.00

XYLOCAINE 0.5% W/O P $39.00

CARDIZEM CAP 120MG $6.00

Page 87: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ANSAID 50MG TABLET $6.00

ICCU PRIVATE ROOM $1,600.00

LICE X 4OZ. (RID) $23.00

ICCU STEP DOWN PRIVATE ROOM $1,600.00

INSULIN TOTAL $47.00 83525

SO INSULIN FREE $49.00 83527

DEPAKENE SYRUP 250MG $6.00

ELASE OINTMENT 10GM $50.00

MAXAIR (PIRBUTEROL) $500.00

HYTRIN TABS 5MG (TER $8.00

PARAFON FORTE DSC $6.00

DIGIBIND INJ 40MG $1,957.00 J1162

MORPHINE 150MG/30ML PCA $76.00

LITHIUM 300MG TABLET $6.00

MUTAMYCIN 20MG $1,345.00 J9280

DOXYCYCLINE 100MG TABLET $9.00

LIDOCAINE 2PERCENT JEL 5ML $45.00

DOPAMINE INJ 400MG $39.00

CAPOZIDE TAB 25/15 $6.00

HYDROXYUREA CAP 500M $7.00

DEXAMETHASONE 10MG $21.00 J1100

SO SOLUBLE TRANSFERRIN RECEPTO $135.00 84238

SO OSMOLALITY FECAL $62.00 84999

SO TADALAFIL $67.00 83789

SO VGCC AB $34.00 83519

ELDEPRYL TAB 5MG $23.00

EULEXIN CAP 125MG $23.00

FEMSTAT VAG CRM 28GM $44.00

ROCEPHIN 1GM (CEFTRI $261.00 J0696

CARDENE CAP 20MG $6.00

CARDENE CAP 30MG $11.00

MARCAINE EPI 0.5% 30 $42.00

SUFENTA AMP 2ML $61.00

HYTRIN TABS 1MG (TER $8.00

IBUPROFEN SUSP 100MG $45.00

NIFEDIPINE XL TAB 60 $18.00

RIMSO 50 (DMSO) 50ML $186.00

MERTHIOLATE 1OZ $11.00

AV OPTIMIZATION $97.00 93321

CARBOPLATIN INJECTION 50 MG $1,030.00 J9045

SUPRAX 400MG TAB (CE $41.00

SO TRAMADOL & METABOLITES $160.00 G0480

MAGNESIUM SULF 2GM/50ML $49.00 J3475

BACTITRACIN OINT 1OZ $21.00

SO REFLEX AMPHET CONFIRM/MEC $58.00 G0480

SO REFLEX BARB CONFIRM/MECO $44.00 G0480

SO REFLEX BENZO CONFIRM/MECO $70.00 G0480

CYCLOCORT OINT 0.1% $20.00

SO REFLEX CANNA CONFIRM/MECO $67.00 82542

SO REFLEX COCAINE CONFIRM/MECO $54.00 G0480 82520

Page 88: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO REFLEX METH & META CONF MEC $160.00 G0480

SO REFLEX OPIATES CONF/MEC $160.00 G0480

SO REFLEX PHENC CONFIR/MEC $52.00 G0480

SO REFLEX PROPOX CONFIR/MEC $160.00 G0480

PCE 333 $6.00

VASOTEC TAB 2.5MG $6.00

DIPROLENE CRM/OINT 0 $187.00

SO FLOW CYTOMETRY 1ST MARKER $444.00 88184TC

LIDOCAINE JLY 2%10ML $52.00

SO FLOW CYTOMETRY EA ADD MARKE $88.00 88185TC

FER-IN-SOL GTTS $30.00

ER VAC/TOX INJ EA ADD $32.00 90472

SO CANDIDA ALBICANS AB IGA,IGG $45.00 86628

SO SEX HORMONE BINDING GLOBULI $81.00 84270

AUTOMATED DIFF W/WBC COUNT $27.00 85004

AEROBID INHALER 7G $261.00

INSULIN HUMULIN 70/3 $121.00

MORPHINE SULFATE 30MG TABLET $9.55

CARDIZEM SR CAP 60MG $12.00

SO RENIN DIRECT $79.00 84244

HEPARIN FLUSH KIT2.5 $12.00

SO AQUAPORIN-4 RECEPTOR AB $42.00 83516

SO VEGF PLASMA $47.00 83520

SO EGFR SERUM $131.00 84238

SO PHENOTYPE $52.00 82104

LIDOCAINE VISC2%100M $11.00

VIT. E CRM. 4000IUTO $28.00

CYTP URNE 3-5 PROBES EA SPEC $980.00 88120

SO AARAY-BASED MULT MOLE PROBE $997.00 88399

SUPRAX SUSP100/MG/5L $174.00

ALCOHOL 95% (190 PR) $6.00

PRILOSEC 20MG CAPSUL $30.00

TERAZOL 3 VAG SUPP 3 $78.00

TERAZOL 7 VAG CRM 45 $176.00

TYGACIL 50MG/100ML IV $412.35 J3243

CHANGE CYSTOSTOMY TUBE SIMPLE $374.00

URINALYSIS DIPSTICK $10.00 81002

SO ANABOLIC STEROIDS $142.00 80307

CLINDAMYCIN 900MG AD $122.00

INSERTION SUPRAPUBIC CATHETER $3,704.00 51102

WEDGE EXC SKIN NAIL FOLD $601.00

PRADAXA 150MG CAPSULE $26.20

PIPRACIL 2GM ADD/VAN $110.00

SO ALDOSTERONE $146.00 82088

LACTATED RINGERS 100 $51.00

PIPRACIL 3GM ADD/VAN $71.00

CEFAZOLIN 500MG ADD/ $42.00 J0690

LT HEART W/LV GRAM ONLY $7,500.00 93452

RT HEART W/CORONARY ONLY $7,500.00 93456

RT HEART W/CORO& GRAFTS ONLY $7,500.00 93457

Page 89: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

RT & LT HEART W/LV GRAM ONLY $7,500.00 93453

RT & LT HEART /LV/CORO & GRAFT $7,500.00 93461

CORONARY & GRAFTS ONLY $6,451.00 93455

IV MED INJECT DURING CATH $301.00 93463

STENT ILIAC $19,998.00 37221

PTA ILIAC ADDITIONAL $3,697.00 37222

STENT ILIAC ADDITIONAL $4,196.00 37223

TOBRAMYCIN 80MG $340.00 J3260

STENT FEMORAL-POPITIAL $16,387.00 37226

STENT FEM-POP W/ARTHERECTOMY $28,349.00 37227

PIPRACIL 4GM ADD/VAN $171.00

STENT TIBIAL-PERONEAL $17,775.00 37230

STENT TIB-PERONEAL W/ARTHER $19,588.00 37231

PTA TIBIAL-PERONEAL ADDITIONAL $5,079.00 37232

ROCALTROL 0.25MCGCAP $7.00

RYTHMOL TAB 150MG (P $9.00

PTA TIBIAL-PERONEAL ADD W/ARTH $8,343.00 37233

VERAPAMIL SR 180MG T $8.00

VASOTEC IV 1.25MG/ML $109.00

EPOGEN 1000 UNITS $175.00 J0885

DIPROSONE CR 15GM $73.00

STENT TIBIAL-PERONEAL ADDITION $7,255.00 37234

STENT TIB-PERONEAL ADD W/ARTHE $10,157.00 37235

HEPATAMINE 8% 500ML $361.00

HESPAN 500ML PLASMA $146.00

COUMADIN TAB 10MG $8.00

DEBRIDE SUBCU TIS EA ADD 20 CM $519.00 11045

ALBUMIN 25% 50ML $231.00 P9047

WELLBUTRIN 100MG TAB $6.00

NEUTRA-PHOS(P-250MG) $6.00

AVITENE SHEET 70X35X $400.16

CEFOTETAN 2GM VL.(CE $140.00

CEFOTETAN 2GM PB (CE $151.00

D5/.225NS 1000CC $109.00

BLEPHAROTOMY $616.00

CT ABD/PELVIC W/O CONTRAST $2,600.00 74176

VERAPAMIL 40MG TAB $6.00

METHOTREXATE 2.5MG T $27.00 J8610

CT ABD/PELVIC W/CONTRAST $3,800.00 74177

CT ABD/PELVIC W & W/O CONTRAST $3,355.00 74178

ROWASA (RECTAL SUSP 4.0gram $93.00

REPAIR LIP FULL THICK VERM ONL $1,501.00

P4E1 EYE DROPS 15ML $54.00

SO CARNITINE, TOTAL $64.00 83789

DARVON-N 100MG TAB $6.00

DRAINAGE MOUTH LESION $283.00

HEPARIN ANTI XA $33.00 85520

GAS CHROMATOGRAPHY $55.00 84600

FLUCONAZOLE 200MG/D5 $715.00 J1450

REFRACTOMETER $9.00 81002

Page 90: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO TOXOCARA AB ELISA $46.00 86682

LASIX INJ. 100MG/10M $22.00

SO DNA PROBE-MYCOBACTERIUM AVI $71.00 87149

SO DNA PROBE-MYCOBACTERIUM TUB $71.00 87149

ASPERCREME 1.25OZ TU $17.00

CEFTAZIDIME 2GM ADD/ $167.00 J0713

TORADOL 30MG/1MLIMUS $39.00 J1885

SO DNA SEQUENCING-AFB IDENTIFI $406.00 87153

PREMARTIN TAB. 2.5MG $9.00

SO YEAST IDENTIFICATION $30.00 87106

KLONOPIN 1MG TAB $10.00

TENORETIC 50MG TAB $6.00

SO MOLD IDENTIFICATION $29.00 87107

DIPRIVAN 10MG/ML 20M $109.00

REMOVAL NAILBED/MATRIX $965.00

CANALITH REPOSITIONING PER DAY $112.00 95992

SO MTB COMPLEX SPECIATION $126.00 87150

SO SUSCEPTIBILITY-MYCOBAC TUBE $17.00 87188

SO BLASTOMYCES DERM ANTIGE EIA $33.00 87449

RUTUSS TAB DE $6.00

SO T4 FREE (DIRECT DIALYSIS) $33.00 84439

MEPERGAN FORTIS $10.00

SO TSH $61.00 84443

PROVERA TAB 2.5MG $6.00

SO LACOSAMIDE (VIMPAT) $50.00 80299

HISTUSSIN HC / OZ $9.00

PCE 500MG TAB $23.00

VISKEN 5MG TAB $6.00

CEFTRIAXONE 500MG VL $173.00 J0696

RIFAMPIN I.V. 600MG $293.00

LOPID 600MG TAB UD $6.00

CEFTRIAXONE 2GM ADD/ $315.00 J0696

CODIMAL DM PER OZ. $6.00

VERELAN 120MG SR $13.00

VERELAN 240MG SR $6.00

SO FREE KAPPA/LAMBD LGHT CHAIN $49.00 83883

CARDURA TAB 1MG(DOXA $6.00

PREGABALIN (LYRICA) $53.00 82542

CARDURA TAB 4MG(DOXA $6.00

PSEUDOEPHEDRINE 60MG $10.00

FLEX SIGMOIDOSCOPY W/CAUTERY $1,801.00

REPAIR LAC MOUTH 2.5 OR LESS $216.00

FLOXIN 400MG TAB $19.00

NALEX-A TAB $6.00

CAMPHO PHENIQUE LIQ. $15.00

REQUIP 1MG TABLET $21.00

SO ZIPRASIDONE (GEODON) SERUM $49.00 80299

SKIN PUNCH BIOPSY $640.00

DIAZEPAM ORAL SOLN.1 $6.00

SELECTIVE CATH PLACE 2ND ORDER $33.00 36012

Page 91: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NIACIN SR 500MG TAB $12.00

PROVENTIL SOLN. 20ML $41.00

LEVOTHYROXINE 125MCG $6.00

SO HEXAGONAL PHOSPHOLIDIPD NEU $64.00 85598

BETAGEN 0.5% OPTH.DP $81.00

SO PROLACTIN MACROADENOMA $69.00 84146

SO SP CHLORIDE FLUID $18.00 82438

KERLONE 10MG TAB $6.00

AZULFIDINE EN-TAB500 $6.00

FLOXIN 200MG TAB UD $14.00

REMOVAL G-TUBE $1,436.00

PROSOM(ESTAZOLAM)1MG $10.00

ALORA 0.1MG PATCH (E $31.00

FLOXIN 300MG TAB (FL $17.00

POLY VI SOL DROP 30M $28.00

SURMONTIL 25MG CAP $9.00

FLOOR OBSERVATION HR EA ADDITI $65.00 G0378

LANOXICAPS 0.05MG $6.00

SO BODY FLUID POTASSIUM $19.00 84999

UNASYN 3.0GM VIAL $114.00

CORDRAN SP O.025%CRM $37.00

DYNACIRC CAP 2.5MG $8.00

PROZAC 20MG/5ML 30M $379.00

SO MELATONIN $32.00 83519

NORMODYNE/TRANDATE $6.00

LITHIUM CARBONATE 150 MG CAP $6.00

SO ASCA IgG $44.00 86671

OXYCODONE TAB 5MG $10.00

SO LAM Ag IgG $41.00 83516

SO MAN Ag IgG $41.00 83516

SO CHITO Ag IgA $41.00 83516

OCTREOTIDE 0.05MG/M $60.00 J2354

EPINEPHRINE SOLUTION $116.00

SO TISSUE CULTURE $225.00 88237

CIPRO 400MG/200ML D $178.00 J0744

LOTENSIN 10MG TAB (B $6.00

SO ANALYSIS 20-25 CELLS $439.00 88264

CALADRYL LOTION 6OZ $31.00

NITROGLYCERIN IV 25MG $59.00

AO BRUCELLA Ab $32.00 86622

NARACN 1MG/ML MDV10M $231.00

BUTISOL TAB 15MG $6.00

NASO- OR ORO-GASTRIC TUBE PLAC $542.00 43752

FENTANYL 12MCG PATCH $9.00

NEUPOGEN 480 MCG $1,273.00 J1442

THROMBOECTOMY MECH VENOUS $7,226.00 37187

WELLBUTRIN 75MG TAB $6.00

NYSTATIN-TRIAMCINOLO $31.00

BETOPTIC S 0.25PERC OPT 10 ml $161.00

ALTACE CAP 2.5MG (RA $10.00

Page 92: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CEFADROXIL 500MG/5ML $314.00

MONOPRIL 10MG TAB $8.00

DABIGATRAN 75MG CAPSULE $26.20

CITRUCEL UD PACKETS $6.00

PYRIDOXINE 100MG INJ $10.00

CIPRO ORAL SUSP. 5G/ $333.00

SYMBICORT 160/4.5 INH 1 PUFF $20.96

SODIUM POLYSTYRENE $88.00

XYLOCAINE JELLY 2% 3 $92.00

ROBINUL TAB 1MG. $15.00

BUFFERIN X-STR TAB $6.00

LAC-HYDRIN 12% LOTIO $78.00

SYMBICORT 80/4.5 INH 1 PUFF $19.56

DRUG PRESCR MONITERI URINE SO $722.00 G0480

CARDIZEM 50MG/10ML I $39.00

BIAXIN TAB 500MG (CL $37.00

INTEGRILIN 75MG/100ML $1,472.00 J1327

SO CERULOPLASMIN $38.00 82390

ELIMITE CREAM 60GM $192.00

MAXIDEX OPH SOL 5ML $48.00

PRINIZIDE 12.5 TAB $6.00

SO COPPER $44.00 82525

SO COPPER FREE DIRECT $44.00 82525

SO REFLEX ANNA IgG TITER BY IF $43.00 86256

CYTOTEC 100MCG TAB $7.00

KETOROLAC 10MG TAB $6.00

PLENDIL TAB 5MG (FEL $9.00

NICODERM PATCH 7MG $24.00

CARDIZEM 180MG CD $9.00

CARDIZEM CD 240MG CA $11.00

SO REFLEX PURKINJE CELL CYTO A $43.00 86256

PRAVACHOL TAB 10MG ( $28.00

SO REFLEX ANNA IgG IMMUNOBLOT $41.00 83516

SLOW FE TAB $6.00

SO REFLEX NEURONAL NUCL Ab (AN $41.00 83516

MAZICON INJ. 0.5MG $98.00

SODIUM BICARB 50MEQ/ $39.00

ALBUMIN 5% 250ML $588.00 P9045

ORAJEL $30.00

INSERT PLEURAL CATHETER $5,873.00 32550

SULFAMETH/TRIMETH (1 $81.00

CEFOTETAN 1GM PB (CE $109.00

CARMEX 1/4 OZ $11.00

VERAPAMIL SR 120MG $7.00

NASALCROM 13ML $49.00

SINEMET CR TAB $9.00

PERI COLACE SYRUP OZ $6.00

NIFEREX-150 FORTE $6.00

LIDOCAINE HCL 1%50MG $16.00

MARCAINE PF 0.5% 30M $23.00

Page 93: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO METHADONE URINE $160.00 G0480

FENTANYL 50MCG/H TR. $136.00

ERYTHROMYCIN TAB 500 $9.00

SO CANNABINOID METABOLITES(SYN $64.00 80350

TOBRADEX OPTH SUSP 2.5 ML $161.00

TOBRADX OPTH ONT 3.5 $61.00

MARCAINE SPINAL AMP $39.00

NEUPOGEN 300 MCG $1,161.00 J1442

PERC TRAN AORTIC VALVULOPLASTY $10,397.00 92986

ACCUPRIL TAB 10MG (Q $9.00

ZOLOFT TAB 50MG (SE $26.00

STADOL NS 2.5ML $226.00

DALLERGY TAB $6.00

VICODIN ES TAB $7.00

RELAFEN TAB 500MG (N $11.00

SO AMITRIPTYLINE $63.00 G0480

PREDNISONE 5MG/5ML LIQUID $6.55

ZOCOR TAB 10MG (SIMV $24.00

VANCOMYCIN CAP 125MG $88.00

CALCIUM POLYCARBOPHIL TABLET $5.00

LEVOTHROID TAB 25MCG $6.00

MACROBID CAP. 100MG $23.00

DAPSONE 100MG TAB $8.00

DIPRIVAN 10MG/ML 50M $122.00

SO PORPHYRINS, FECAL $90.00 84126

GLYNASE 3MG PRESTAB $6.00

ISMO TAB 20MG (ISOSO $9.00

ELOCON LOTION 0.1% $42.00

SO FACTOR II, ACT(PROTHROMBIN) $23.00 85210

DILANTIN 100MG/4ML S $10.00 J1165

PRIVATE ROOM 2 EAST PCU $900.00

ZANTAC SYRUP 150MG $53.00

INSULIN HUMULIN U $6.00

CEPHALEXIN 125MG/5ML $56.00

PRIVATE ROOM 4TH FLOOR EAST $750.00

CARDENE SR 30MG CAP $7.00

MIVACURIUM 2MG/ML5ML $465.00

ORAP 2MG TAB $8.00

JEVTANA 60MG/1.5ML $16,000.00 J9043

CARDIZEM CD 300MG CA $25.00

XGEVA 120MG/1.7ML $5,100.00 J0897

LUMBAR PUNCTURE THERAPEUTIC $736.00

SYNTHROID TB 88MCG. $6.00

TREANDA 180MG/2ML $5,400.00 J9033

ARANESP 300MCG $5,190.00 J0881

VERELAN 180MG SR $13.00

COCOA BUTTER 6OZ CRM $21.00

BUPRENORPHINE & METABOLITIES S $69.00 G0480

SO INTERFERON BETA SCREEN $478.00 86352

COCOA BUTTER OZ JAR $41.00

Page 94: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BALM BARR COCOA BUCM $21.00

SO INTERFERON BETA TITER $478.00 86352

TRIMETHOPRIM TAB100M $6.00

IVP CHEMOTHERAPY EA ADD DRUG $208.00 96411

FRAGMIN 5000 IU/0.2M $143.00

CHEMO REFILL PORTABLE PUMP $233.00 96521

ZOVIRAX 800MG TAB. ( $26.00

CIPRO IV 200MG/100ML $116.00 J0744

AZATHIOPRINE 100MG I $539.00 J7501

NASACORT NASAL INHAL $186.00

CHEMO IV SEQ $260.00 96417

ZOCOR TAB 5MG $42.00

FERAHEME 510MG VIAL $714.21 Q0138

CARDIZEM CD 120MG $8.00

NIMOTOP 30MG CAP $45.00

LEVSINEX TIMECAP O.3 $6.00

GASTRIC LAVAGE $84.00 43754

PRED MILD 0.12% OPTH $114.00

SO LAMELLAR BODY COUNTS $67.00 83664

STERILE TALC 4GM/100 $308.00

NORVASC 5MG TAB $11.00

CREON 10 ER CAP $6.00

MAG SULFATE 4G/100ML $49.00

MAG SULFATE 20G/1000 $43.00

ACTIVASE 1OOMG $10,759.00 J2997

CYCLOSPORINE 25MG UD $14.00 J7515

SO CD14 $71.00 86356

IMITREX 6MG/0.5ML (S $565.00 J3030

SO CD15 $71.00 86356

ESKALITH CR 450MG $6.00

HUMIBID LA TAB. $6.00

ESTRATEST H.S. TAB. $16.00

HEMOCYTE TAB. $6.00

FLUCONAZOLE TAB 100M $67.00

SO CD24 $71.00 86356

SO CD33 $71.00 86356

FLAER $60.00 86356

PROSCAR 5MG TAB $25.00

CAMPTOSAR 40MG/2ML VIAL $89.10 J9206

ERBITUX 200MG/100ML VIAL $1,753.92 J9055

ZYVOX 100MG/5ML SUSP 150ML $1,410.90

AREDIA 3OMG/VIAL $902.00 J2430

CEFZIL TAB 250MG (CE $31.00

CEFZIL 250MG/5ML SUS $185.00

CEFZIL 125MG/5ML SUS $108.00

GELFOAM SPONGE 100MM $151.00

ARANESP 500MCG/ML $5,040.00 J0881

AVASTIN 400MG/16ML $4,202.40 J9035

SO IMMUNOASSAY INFECT AGEN AB $53.00 86317

PRED G OPTH SUSP 5ML $111.00

Page 95: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO HEPATITIS B SURFACE ANTIGEN $37.00 87340

SO LISTERIA AB CSF OR SERUM $46.00 86609

ZITHROMAX 250MG $62.00

SO OSMOTIC FRAGILI ERYTHROCYTE $24.00 85555

LUPRON DEPOT 22.50MG $4,391.43 J9217

EPOGEN 3000 UNITS $237.00 J0885

RESP FCN THERAPY/15 MIN $80.00 G0238

RESP FCN/STRENGH 2/> INDIV $80.00 G0239

PERIDEX ORAL RIN16OZ $64.00

NICODERM PATCH 21MG $27.00

PULMONARY REHAB W EXER $174.00 G0424

FLUCONAZOLE 400MG/D5 $608.00

ROMAZICON 1MG/10ML I $510.00

LORCET 10/650 TAB. $7.00

DAYPRO 600MG TAB $6.00

LIDEX E CRM 15G $52.00

MORRHUATE SODIUM50MG $120.00

PREDNISONE DOSEPK 5M $23.00

PREDNISONE DOSEPK10M $43.00

SO BENZENE WHOLE BLOOD $55.00 84600

GENTAMICIN 40MG/ML 2 $116.00 J1580

FENTANYL PATCH 100MC $212.00

SO REPTILASE TIME 1:1 MIX $73.00 85635

CHLORASEPTIC 6 OZ CH $25.00

WESTCORT CRM 0.2% $77.00

PHRENALIN FORTE CAP $6.00

CLARITIN TAB 10MG (L $24.00

SO FACTOR VIII 1-STAGE $63.00 85240

SO FACTOR INHIBITOR TEST $46.00 85335

CLEOCIN PED SUSP 75M $204.00

KONSYL (NON STOCK) $6.00

IXEMPRA 45MG VIAL $5,054.00 J9207

VINORELBINE 50MG/5ML VIAL $162.00 J9390

KETALAR 100MG/ML $106.00

INSERT TUN INTRAPERITONEAL CAT $5,873.00 49418

ELOCON CR 0.1% 45GM. $197.00

PAXIL TAB 20MG (PARO $27.00

OCTREOTIDE LAR 10MG INJ $3,207.75 J2353

INSULIN NOVULIN 70/3 $6.00

VECTIBIX 400MG/20ML VIAL $6,069.80 J9303

REOPRO 10MG/5ML VIAL $1,484.00 J0130

MRI THORACIC SPINE W/CONTRAST $3,510.00 72147

OCTREOTIDE LAR 20MG INJ $4,202.72 J2353

AMBIEN TAB 5MG $15.00

TESTOSTERONE 100MG/M $50.00

BETAGAN OPH. 2ML $72.00

SO CD 59 $71.00 86356

DITROPAN SYRUP/OZ $225.00

SO GLYCOPHORIN $71.00 86356

ZOFRAN 4MG TAB $128.00 Q0162

Page 96: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

LOVENOX 30MG INJ $156.00 J1650

IMODIUM LIQUID 20Z $24.00

BETADINE OINT. 1LB. $84.00

ZOFRAN 8MG TAB $192.00 Q0162

CARDENE SR 45MG. $9.00

GAMMAGARD 5 GRAM LIQUID $1,602.00 J1569

TENORMIN 25MG. TAB $6.00

SO CANDIDA SPECIES DNA PROBE $71.00 87480

PENTAMIDINE 300MG IN $275.00

SO GARDNERELLA VAG DNA PROBE $71.00 87510

SO TRICHOMONAS VAGIN DNA PROBE $71.00 87660

MOPATH PROCEDURE LEVEL 2 $549.00 81401

VERMOX TAB $43.00

SO SMITH-LEMLI-OPITZ SCR PLASM $64.00 82542

ULTRAVATE OINT 15GM $141.00

HALAVEN 1MG/2ML VIAL $1,530.00 J9179

INTEGRILIN 20MG/20ML VIAL $568.32 J1327

CARNITOR LIQ. $90.00

SO QUANTIFERON-TB GOLD IN TUBE $219.00 86480

SO TOTAL PROTEIN $13.00 84156

SO PROTEIN FRACTIONATION $63.00 84166

RENAGEL 403MG CAPSUL $6.00

SO IFE $104.00 86335

ASTRAMORPH/PF 2MG/2M $106.00

DURAMORPH INJ10MG/10 $55.00 J2270

AMOXIL 125MG CHE.TAB $6.00

ADALAT CC 60MG $23.00

SO DNA PROBE-COCCIDIOIDES IMMI $71.00 87149

SO REFLEX CANNABIN CONFIRM S/P $64.00 82542

XARELTO 10MG TABLET $50.85

BREVIBLOC (ESMOLOL)1 $144.00

SO CMV QUANTITATIVE PCR $151.00 87497

RESTORIL 7.5MG CAP $47.00

CARDIZEM 120MG TAB $8.00

TILADE INHALER $266.00

SODIUM BICARB 8.4% 5 $19.00

CLINDAMYCIN 600MG $109.00

SELSUM BLUE $17.00

SO CARDIOLIPIN Ab IgG,IgM & Ig $90.00 86147

SO ALLERGEN RESP PRO REGION 6 $418.00 86003

DYPHYLLINE GG ELIX $6.00

VISINE AC 5OZ $40.00

SO HIV-1 QUALTATIVE PCR $124.00 87535

ALBALON 15CC $41.00

NIVEA CRM 2OZ. TUBE $17.00

ZOSTRIX CR 20G $43.00

SO ALLERGY PANEL GROUP $95.00 86003

ZOFRAN 4MG/2ML $160.00 J2405

FENTANYL PATCH 75MCG $175.00

COCAINE VISCOUS 4% $76.00

Page 97: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

MURO 128*OINT TWN/PK $68.00

BETAGAN O/SOL .25% 5 $73.00

SO ALLERGY FOOD PROFILE $228.00 86003

GOLD BOND POW 4OZ8.3 $17.00

SO DNA SEQ-FUNGAL IDENT $406.00 87153

MECH REMOVAL OBS MAT FROM TUBE $1,199.00 49460

THIORIDAZINE 100MG/M $57.00

LYRICA 75MG CAPSULE $28.60

VENOFER 100MG VIAL $345.60 J1756

ACTEMRA 200MG VIAL $1,992.00 J3262

SO HU,YO & RI AB W/REFLEX $129.00 86255

ASACOL TAB 400MG DR $6.00

SO RELEX HU AB WB $60.00 84181

RISPERDAL 1MG $32.00

SYNTHROID .112MCG $6.00

SO RELEX HU AB TITER $43.00 86256

SO REFLEX YO AB WB $60.00 84181

NYSTATIN-TRIAMC ACET $30.00

SWEEN CREAM TUBE 2OZ $21.00

ALUPENT SOL .6% 2.5M $7.00

SO REFLEX YO AB TITER $60.00 86256

PRAMOSONE CR 1% $178.00

ACETIC ACID USP .25% $18.00

NICODERM PATCH 14MG $24.00

ZOSYN 2.25G $109.00

FENTANYL PATCH 25UG $87.00

ENLON PLUS 15ML VIAL $134.00

HEP-LOCK FLUSH 20U/2 $10.00

TRICHOPHYTON 1.500 $109.00

SO REFLEX RI AB WB $60.00 84181

SO REFLEX RI AB TITER $43.00 86256

EFFEXOR 37.5MG $9.00

ATROVENT INH SOL.02% $8.00

ACTH 80MG CC $122.00

HUMIBID DM $6.00

5FU INJ 500MG/10ML $39.00 J9190

SO ANCA SCREEN W/REF TO TITER $59.00 86021

TUBOCURARINE 3MG 10M $38.00

ZEMURON INJ 10MG/ML $222.00

SO C-ANCA TITER RELEX $59.00 86021

METHERGINE .2MG TAB $6.00

CORTONE B-OTIC 10MG $62.00

SO P-ANCA TITER REFLEX $59.00 86021

SO ATYPICAL P-ANCA TITER REFLX $59.00 86021

MARCAINE 75% AMP $39.00

SO HERPES SIMPLEX NS TYPE TEST $51.00 86694

FLUOROMETHOLONE(FML) 0.1PER 5m $62.00

SO HERPES SIMPLEX TYPE 1 $34.00 86695

ZIAC 2.5MG $6.00

SO HERPES SIMPLEX TYPE 2 $69.00 86696

Page 98: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

FENTANYL .05MG/ML20M $31.00 J3010

SOLU-MEDROL 2GM W/DI $279.00

SINEMET CR 25/100 $6.00

DEPO-TEST. SOL VIAL $48.00

LANOXIN PED ELIX 60M $84.00

TENORETIC 100MG $7.00

FLUOCINOLONE AC CR . $52.00

OCUPRESS 5ML $86.00

SO FLUORESCENT NONINFECT AGT A $43.00 86255

CLEOCIN VAG CREAM40G $107.00

LEUKINE 250 MCG VIAL $1,159.00 J2820

DEMADEX 20MG TAB $6.00

SEREVENT INHAL AEROS $180.00

IMDUR 60MG $7.00

HEPARIN SOD INJ 10MU $19.00 J1642

SO IMMUNOASSAY ANALYTE OTHER $41.00 83516

PROZAC 10MG TAB $23.00

DEMADEX TAB 100MG $30.00

POLYTRIM 10ML $29.00

SO GAMMAGLOBULIN IGA,IGD,IGG,I $21.00 82784

ACETAMINOPEHN W/COD $10.00

METHERGINE 1ML (.2MG $46.00

CAR SEAT/BED TEST 60MIN $127.00 94780

CAR SEAT/BED TEST EA ADD 30MIN $50.00 94781

FERRO-SEQUELS TAB $6.00

CTA ABD/PELVIS W & W/O CONTRAS $1,325.00 74174

HEPATOBILIARY SCAN W/CCK $1,357.00 78227

VOLTAREN OPHTHALMIC $166.00

SO QUETIAPINE (SEOQUEL) $49.00 80299

BLEPH-10 5CC $74.00

SO WNV IGG $51.00 86789

COLLODION FLEX. 4 0Z $33.00

VANCOCIN 1GM IV $56.00 J3370

LIPOSYN 20% 500ML $552.00

SO WNV IGM $60.00 86788

METRO-GEL VAG 75% $140.00

DDAVP INJ 1ML $51.00

SO BACTERIAL ID & SENS NON-UA $29.00 87077

TPN BAS 3000ML EMPTY $137.00

DILOR 400MG TAB $6.00

DILOR 200MG TAB $6.00

SO FASTIDIOUS PATH MIC $21.00 87186

HALDOL DECONATE 100M $594.00 J1631

BIAXIN SUSP 125MG/5M $144.00

ALBUTEROL .083% INH $11.00

SO BACTERIAL ID & SEN UA ISOLA $29.00 87077

DIPROLENE GEL 15GM $158.00

PROTAMINE AMP 25ML $132.00

THROMBOLYSIS CORAONARY BY IV F $445.00

ACULAR .5% $252.00

Page 99: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

LEVSIN DROPS $88.00

CARDENE IV $526.00

FLOXIN IV 200MG/50ML $50.00

FLUPHENAZINE HCL 2.5 $120.00

GUAIFENESIN DM 10ML $6.00

GUAIFENESIN 200MG10C $6.00

REM/REPL PULSE GEN DUAL SYSTEM $33,717.00 33263

APPLY SKIN GRAFT F,S,E,M,N,H,F $3,656.00 15275

APPLY SKIN GRAFT EA ADD 25CM $229.00 15276

PETROLATUM $8.00

APP SKIN GFT F,S, ETC. 100 CM $3,656.00 15277

APP SKIN GFT F,S ETC EA ADD100 $627.00 15278

LTA KIT $30.00

POLOCAINE 2% MPF $28.00

PEDATRIC FLU VACCINE 0.25ML $82.07 90655

ZIAC 5MG $6.00

SO HOMOCYSTEINE $60.00 83090

AMPICILLIN 2GM VIAL $66.00 J0290

ARISTOSPAN 5MG/ML $44.00 J3303

SO CLOTTING INHIBITORS ANTITHR $42.00 85300

SO CLOTTING INHIB ANTITHR III $49.00 85303

SO CLOTTING INHIB ANTITHR III $55.00 85306

SO APC RESISTENCE ASSAY $55.00 85307

SO FIBRINOGEN; ACTIVITY $31.00 85384

SO IMM ANA OTHER;QUANTITATIVE $46.00 83520

SO CHEMILUMINESCENT ASSAY $448.00 82397

SO CRP $19.00 86140

SPIRIVA 18MCG CAPSULE $72.18

MORPHINE 100MG/4ML VIAL $94.58 J2270

SO CREOSOL SERUM $64.00 82542

SO SULONYLUREA HYPOG PANEL SER $64.00 83789

PROLIA 60MG/1ML SYRINGE $2,625.00 J0897

ELECT. ANALYSIS WITH REPRO/REF $461.00

PROGLYCEM 50MG/30ML $644.35

ABILIFY 1MG/ML SOLUTION $28.24 J0400

SO GADOLINIUM RANDOM URINE $78.00 83018

DIABETIC TEACH IND PER 30 MIN $138.00 G0108

DIABETIC TEACH GRP PER 30 MIN $42.00 G0109

BREAST FEEDING EDUCAT PER 15 M $80.00 99401

BREAST FEEDING EDUCAT PER 30 M $158.00 99402

BREAST FEEDING EDUCAT PER 45 M $237.00 99403

BREAST FEEDING EDUCAT PER 60 M $315.00 99404

MRI CARDIAC W/O CONTRAST $932.00 75557

MRI CARDIAC W & W/O CONTRAST $1,470.00 75561

ALIMTA 100MG VIAL $920.11 J9305

SO LC-1 AUTOANTIBODIES $52.00 86376

LISINOPRIL 5 MG TABLET $6.37

CELL SURFACE SO $55.00 88346

SO DESMOGLEIN 1 $41.00 83516

SO DESMOGLEIN 3 $41.00 83516

Page 100: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BIV-ICD GEN CHANGE $35,065.00 33264

DRUG SCREEN PRESCRIPTION/OTC $160.00 80307

INTERPRETATION OF 2-8 MARKERS $436.00 G0452

SO CD3 $72.00 86356

SO CD4 $72.00 86356

SO CD8 $72.00 86356

ICD GEN CHANGE SINGLE CHAMBER $32,368.00 33262

SO CULTURE, TYPING; IDENT BY N $409.00 87153

SO CHROMOSOME KARYOTYPE STUD $89.00 88280

ULTIVA 1MG VIAL $185.03

SO POTASSIUM FECAL $19.00 84311

SO SODIUM FECAL $18.00 84302

SO IMMUNOFIXATION $80.00 86334

INTRAVASCULAR OCT $1,792.00 92978

SO HERPES SIMPLES VIRUS TYPE 1 $304.00 87530

INTRALIPID .20 100ML $163.10

HEAVY METALS $81.00 83018

SO PANCREATIC ELASTASE-1 $43.00 82656

SO CENTROMERE B $45.00 86038

SO REFLEX CHROMATIN $66.00 86235

SO REFLEX SCL-70 $66.00 86235

SO REFLEX JO-1 $66.00 86235

CYTOPATH FL NONGYN SMEARS $77.00 88104

CYTOPATH CONCENTRATE TECH $77.00 88108

CYTOPATH CELL ENHANCE TECH $136.00 88112

CYTOPATH SMEAR OTHER SOURCE $77.00 88161

CYTOPATH SMEAR OTHER SOURCE $70.00 88160

CYTOPATH DX EVAL FNA 1ST EA SI $256.00 88172

CYTOPATH EVAL FNA REPORT $155.00 88173

SURGICAL PATH GROSS $158.08 88300

TISSUE EXAM BY PATHOLOGIST $158.08 88302

TISSUE EXAM BY PATHOLOGIST $247.00 88304

TISSUE EXAM BY PATHOLOGIST $247.00 88305

TISSUE EXAM BY PATHOLOGIST $1,079.39 88307

TISSUE EXAM BY PATHOLOGIST $2,267.46 88309

DECALCIFY TISSUE $15.00 88311

SPECIAL STAINS GROUP 1 $168.00 88312

SPECIAL STAINS GROUP 2 $147.00 88313

MICROSLIDE CONSULTATION $444.00 88323

PATH CONSULT INTRAP 1 BLOC $152.00 88331

PATH CONSULT INTRAOP ADDL $33.00 88332

INTRAOP CYTO PATH CONSULT 1 $936.00 88333

SO IMMUNOHISTOCHEMISTRY $524.00 88342

TUMOR IMMUNOHISTOCHEM/MANUA $524.00 88360

TUMOR IMMUNOHISTOCHEM/COMP $444.00 88361

INSITU HYBRIDIZATION (FISH) $185.00 88365

BARR BODIES $54.00 88130

LAP $31.00 85540

SO FLOW CYTOMETRY 2-8 MARKERS $436.00 G0452

SO FLOW CYTOMETRY 9-15 MARKERS $675.00 G0452

Page 101: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO FLOW CYTOMETRY 16 OR MORE M $84.00 G0452

INT DIFF CROSS MATCH/IRR ANTI $71.00 86077

INVEST OF TRANSFUSION REACTION $444.00 86078

AUTH FOR DEV FROM STD PROC $444.00 86079

SLIDES ONLY, LIMITED $39.00 88321

COMPREHENSIVE $131.00 88325

PAP THIN PREP $54.00 88142

PAP WITH PATH REVIEW $61.00 88141

ASPIRATE INTERP BM $604.00 85097

OR CONSULT (ONLY) $39.00 88329

SO SM/RNP REFLEX $64.00 86235

ENTEREG 12MG CAPSULE $286.65

SO CSF STRET PNEUMONIA ANTIGEN $32.00 87899

INSERT INTER FID MARK, PERC, R $2,623.00

TRAUMA ACTIVATION FEE WRMC $2,011.00 G0390

TRAUMA ACTIVATION FEE SCMC $2,011.00 G0390

FLUOROURACIL 5000MG $41.31 J9190

INFLU VIRUS, MULTIPLE TYPES FI $291.00 87502

SO DETECT AGENT NOS, DNA, AMP $125.00 87798

SO ADENOVIRUS CULTURE $93.00 87252

SO CYTOMEGALOVIRUS CULTURE $70.00 87254

D5NS W/40 MEQ KCL 1000ML BAG $95.02

D5-1/2NS W/30MEQ KCL 1000ML BA $95.02

D5-1/2NS W/10MEQ KCL 500 ML BA $93.06

REPLACE G-TUBE/C-TUBE PERCUTAN $1,196.00 49450

DIAGNOSTIC BLOOD, OCCULT, FECA $66.00 82274

SCREENING COLORECTAL CA; FECAL $66.00 G0328 82270

SO OXALATE SERUM $46.00 83945

MOPATH PROCEDURE LEVEL 2 $982.00 81401

NUCLEAR SCAN $2,109.00

ECHOCARDIOGRAM $1,510.00 93306

FOLLOW-UP ECHOCARDIOGRAM $690.00 93308

ARTERIAL DOPPLER-BILATERAL $954.00 93925

ABI-UNILATERAL $357.00 93922

ABI-BILATERAL $557.00 93923

EKG $147.00 93005

STRESS TEST $542.00 93017

PACER QUICKLOOK $105.00 93288

PACER QUICKLOOK - 1-LEAD $98.00 93279

PACER QUICKLOOK- 2 -LEAD $113.00

ICD OUICKLOOK $105.00 93289

ICD OUICKLOOK 1-LEAD $66.00 93282

ICD OUICKLOOK 2-LEAD $85.00 93284

OPITIVAL THRU CARELINK $105.00 93297

OPITIVAL THRU CARELINK $105.00 93299

CARELINK ICD $105.00 93296

CARELINK ICD $105.00 93295

PACEMAKER CARELINK $105.00 93294

CEFAZOLIN 2GM/50ML PER 500MG $54.06 J0690

NI ART UNILAT/LTD UPPER EXT $266.00 93931

Page 102: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ALFENTA 2ML $37.36

PHENOBARBITAL 15MG TABLET $9.04

SO CYANIDE BLOOD $69.00 82600

SAPHRIS 10MG SL TABLET $74.59

SO CHLORPROMAZINE SERUM $56.00 G0480

CT RENAL CRYOTHERAPY $10,716.00 50593

SO MI-2 AUTOANTIBODIES $64.00 86235

SO SRP AUTOANTIBODY $41.00 83516

TREANDA 45MG/0.5ML VIAL $783.20 J9033

SO DENGUE FEVER AB (IGG,IGM) $46.00 86790

SO TRANSCOBALAMIN-VIT B12 $49.00 82608

EGD W/ESOPHAGEAL BANDING $2,725.00

OFIRMEV 1000MG/100ML VIAL $99.10 J0131

SO ADENOVIRUS CULTURE $93.00 87252

SO CYTOMEGALOVIRUS CULTURE $70.00 87254

SO GENOMIC ALTER POST,OLIGO-SN $1,363.00 81229

EXC,BEN LES TR/AR/LG .6 TO 1. $601.00 11401

SO ADENOSINE DEAMIN, PLEUR FL $24.00 84311

SO MESOMARK $74.00 86316

SO INFLUENZA A H1N1 (2009) PCR $302.00 87502

OBS-INITAL- NURSERY $282.00

OBSERVATION EA ADD HR- NURSERY $36.00

REM PPG/REPL PPG;DUAL LEAD SYS $10,669.00 33228

BROVANA 15MCG/2ML INHALATION $42.98

HYDROMORPHONE 1MG/ML INJECTION $30.00 J1170

YERVOY 200MG/40ML VIAL $43,158.80 J9228

SO ANTI-MULLERIAN HORMONE ASSE $46.00 83520

CLINDAMYCIN 300MG/2ML VIAL $20.07

SO VWF:FACTOR VIII $46.00 83520

SO HYDROXYPROLINE TOT URIN 24H $87.00 83505

SO CYSTICERCUS AB ELISA SERUM $47.00 86682

SO CYSTICERUS AB ELISA CSF $47.00 86682

BRONCHOSCOPY W/WASHING $2,119.00

BRONCHOSCOPY W/BRUSHING $2,018.00

BRONCHOSCOPY W/BIOPSY $2,018.00

ELLENCE 200MG/100ML $806.40 J9178

MAGNETIC RESONANC SPECTROSCOP $841.00 76390

COSMEGEN 0.5MG/3ML VIAL $985.34 J9120

MAMMOGRAM-UNILATERAL KOMEN $147.00 77065

MAMMOGRAM BILATERAL KOMEN $187.00 77066

MAMMOGRAM SCREENING KOMEN $155.00 77067

SO CORTICOSTERONE $83.00 82528

SO TOTAL CORTISOL $114.00 82633

MOPATH PROCEDURE LEVEL 2 $330.00 81401

THORACENTESIS- ER $1,404.00

TISSEEL FROZEN 10ML $1,644.00 C9250

REM PPG/REPL PPG; SNGLE LEAD S $10,243.00 33227

SO HERPES VIRUS 6 DNA QUAN PCR $61.00 87533

SO P2Y12 $154.00 85576

MICRODISSECTION; LASER CAPTURE $238.00 88380

Page 103: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO YERSINIA CULTURE $34.00 87046

SO GALACTOSE QUANTITATIV URINE $29.00 82760

CARDIAC EXERCISE W/EKG /MOD KX $196.00 93798

HUMRIA 40MG/0.8ML SYRINGE $2,839.05 J0135

MOPATH PROCEDURE LEVEL 4 $471.00 81403

EXC BEN LES T/A/L; > 4.0CM $3,273.00

EXC BEN LES T/A/L; > 4.0CM $449.00 11406

SO AROM PRI AMINE EXP URINE $24.00 84311

CANALITH REPOSTITIONAL PER DAY $112.00 95992

APPLY WOUND VAC <=50 SQ $315.00 97605

CHECKOUT/ORTH-PROS EA 15MIN $52.00 97760

HOME EXCER PROGRAM 15 OT $101.00 97535

PROFORE COMPRESSION WRAP UNL $178.00 29581

BIOFEEDBACK $116.00 90901

SPEECH TREATMENT PER DAY $183.00 92507

SPEECH TRATMENT GROUP $53.00 92508

SWALLOW/FEEDING TREATMENT $208.00 92526

EVAL PROSTHTC DEVICE FIT $270.00 92597

SPEECH AUGMENTED TREATMENT $251.00 92609

DYSPHAGIA EVALUATION $340.00 92610

TRACTION MECHANICAL $101.00 97012

ELEC STIM PT UNATTENDED $102.00 G0283

ELEC STIM SP UNATTENDED $102.00 G0283

ELEC STIM OT UNATTENDED $102.00 G0283

VASOPNEUMATIC TREATMENT OT $101.00 97016

VASOPNEUMATIC TREATMENT PT $101.00 97016

PARAFFIN BATH OT $77.00 97018

PARAFFIN BATH PT $77.00 97018

FLUIDOTHERAPY/DRY OT $120.00 97022

FLUIDOTHERAPY/DRY PT $120.00 97022

INFRARED THERAPY PT $50.00 97026

SO THIOPURINE MEATBOLITES $67.00 82542

ELEC STIM W/US 15 OT $114.00 97032

ELEC STIM W/US 15 PT $114.00 97032

ELEC STIM ATTENDED Q15 SP $114.00 97032

TENS INITAL APP 15 OT $114.00 97032

TENS INITAL APP 15 PT $114.00 97032

TENS FOLLOW-UP 15MIN PT $114.00 97032

TENS FOLLOW-UP 15 MIN OT $114.00 97032

IONTOPHORESIS 15MIN OT $132.00 97033

IONTOPHORESIS 15MIN PT $132.00 97033

CONTRAST BATH 15 PT $86.00 97034

ULTRASOUND 15 OT $92.00 97035

ULTRASOUND 15 PT $92.00 97035

US W/POP TX 15 PT $114.00 97035

US W/POP TX 15 OT $114.00 97035

DPNS/ESTM 1-7 15 SP $102.00 97110

BTE THERAPY EX 15 OT $102.00 97110

THERAPUTIC EXC 15 OT $102.00 97110

THERAPUTIC EXC 15 PT $102.00 97110

Page 104: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NEURO REEDUCATION PT $93.00 97112

NEURO REEDUCATION OT $93.00 97112

GAIT/TRANS TRAINING 15 PT $91.00 97116

MASSAGE, LOCAL 15 PT $71.00 97124

MASSAGE LOCAL 15 OT $92.00 97124

MANUAL THERAPY EA 15 OT $92.00 97140

MANUAL THERAP EA 15 PT $92.00 97140

GROUP THERAPY OT $74.00 97150

GROUP THERAPY PT $74.00 97150

THERAPUTIC ACT 15 OT $104.00 97530

THERAPUTIC ACT 15 PT $104.00 97530

COG SKL/ATN/MEM 15 SP $92.00 97127

COG SKL/ATN/MEM 15 OT $92.00 97127

COG SKIL/SENSR 15 OT $91.00 97533

COG SKIL/SENSR 15 SP $91.00 97533

ADL EA OT $101.00 97535

HOME EXER PGM 15 PT $101.00 97535

ADL 15 PT $91.00 97535

HOME EXERCISE SP $101.00 97535

COM/WRK REINTRGT 15 OT $72.00 97537

COM/WRK REINTRGT 15 PT $81.00 97537

WHEELCHAIR MANAGEMENT 15 OT $76.00 97542

WHEELCHAIR MANAGEMENT 15 PT $76.00 97542

SELECT DEB <= 20CM OT $289.00 97597

SELECT DEB <= 20CM PT $289.00 97597

SELECT DEBRIDE > 20CM OT $147.00 97598

SELECT DEBRIDE > 20CM PT $147.00 97598

APPLY WOUND VAC > 50SQ CM $601.00 97606

TEST/MEASURE 15 PT $123.00 97750

ORTHO FIT/TRAIN 15 PT $234.00 97760

ORTHO FIT/TRAIN 15 OT $234.00 97760

PROSTHTC TRAIN 15 OT $102.00 97761

PROSTHTC TRAIN 15 PT $102.00 97761

SO BARTONELLA DNA QUAL REAL-TI $125.00 87471

INFRARED THERAPY OT $50.00 97026

SO OCTREOTIDE/SANDOSTATI SERUM $49.00 80299

SO INSITU HYBRIDIZATION AUTO $624.00 88368TC

SO INSITU HYBRIDIZATION MANUAL $490.00 88367TC

TEST/MEASURE 15MIN OT $123.00 97750

DPNS 8-11 OME 15 SP $93.00 97112

SO CRYOGLOBULIN SERUM $23.00 82595

DALIRESP 500MCG TABLET $46.65

SO MARIJUANA CONF BY GCMS BLD $64.00 82542

LEXISCAN 0.4MG/5ML $783.00 J2785

MYOVIEW $761.00 A9502

SO BLASTOMYCES DERM ID DNA PRO $71.00 87149

VINBLASTINE SULFATE 10MG VIAL $6.50 J9360

EMEND 150MG VIAL $921.60 J1453

ROPINIROLE 2MG TABLET $20.04

SO FUNGAL IDENTIFICATION $29.00 87106

Page 105: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO COENZYME Q 10 $64.00 82542

SO DOXEPIN $55.00 G0480

ROOM(SEMI-PRIVATE) OBSERVATION $709.00

HYDROMET $10.00

SO SLA AUTOANTIBODY $46.00 83520

SO IMMUNOHISTOCHEMISTRY TUMO $234.00 88361TC

SO CHROMOSOME ANALYSIS, 5 $626.00 88261TC

SO CHROMOSOME COUNT, ADD $68.00 88285TC

MORPHINE 15MG IR TABLET $5.00

PRALATREXATE 20MG/ML VIAL $5,625.00 J9307

SO IMMUNOFLUORESCENT STUDY $444.00 88346

ELECTRON MICROSCOPY $1,159.00 88348

ELIGARD 45MG SYRINGE $4,438.80 J9217

AORTOGRAP, THORACIC SERIAL S&I $5,739.00 75605

ANGIOGRAPHY SPINAL SELECTI S&I $5,739.00 75705

KYPROLIS 60MG VIAL $3,084.36 J9047

COLONOSCOPY W/CAUTERY $1,803.00

SO SEZARY PANEL $444.00 88184

SO TRICHINELLA IGG AB, ELISA $45.00 86784

SO CSF ANTINUCLEAR ABS(ANA) $43.00 86038

SO HIV-1 RNA QUALITATIVE CSF $125.00 87535

PROCRIT 20,000 UNITS/1ML $1,808.70 J0885

DRUG OF ABUSE 9 PNL SER/PAIN C $412.00 80307

CREATININE;OTHER SOURCE $51.00 82570

ETHANOL SO $35.00 G0480 80320

AMPHETAMINE URINE SO $103.00 G0480 80324

BENZODIAZEPAMS SO $121.00 G0480 80346

SO OPIATES URINE $160.00 G0480 83925

METHADONE URINE SO $160.00 G0480 80358

DRUG SCREEN EACH DRUG CLASS $192.00 80307 80307

COCAINE/QUNT UA SO $72.00 G0480 80353

SO CULT TYPING;IMMUNOFLUO MET $21.00 87140

PTCA:MAJOR CORONARY OR BRANCH $9,237.00 92920

PTCA:EACH ADDITIONAL BRANCH $9,237.00 C9601

PTCA W/ATHRECTOMY:MAJOR CORON/$18,180.00 92924

PTCA W/ATHRECTOMY:EA ADD BRAN $18,180.00 92925

PTCA W/STENT:MAJOR CORON OR BR $13,159.00 92928

PTCA W/STENT: EA ADD BRANCH $13,159.00 92929

PTCA W/ATHREC &STENT:MAJOR COR $30,443.00 92933

PTCA W/ATHREC & STENT EA ADD B $13,159.00 92934

PTCA W/ATHRE/STENT/DIS PRO THR $13,159.00 92937

PTCA W/ATHR/STENT/DIS PRO EA A $13,159.00 92938

PTCA W/ATHRE/THROM/STENT DURIN $13,159.00 92941

PTCA W/ATHR/STENT OF CTO CORO $13,159.00 92943

PTCA W/ATHR/STENT CTO CORO EA $13,159.00 92944

THROMBOLYSIS OF CORONARY BY IN $476.00 92977

DES STENT MAJOR CORONARY $15,691.00 92928

DES STENT EACH BRANCH $15,691.00 92929

DES STENT/ATHRECTOMY MAJOR COR $15,691.00 C9602

DES STENT/ATHRECTOMY EACH BRAN $15,691.00 C9603

Page 106: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DES STENT BYPASS GRAFT $15,691.00 92937

DES STENT EACH BRANCH THRU BYP $15,691.00 C9605

DES STENT DURING ACUTE MI $15,691.00 92941

DES STENT CTO MAJOR CORONARY $15,691.00 92937

DES STENT CTO EACH BRANCH $15,691.00 C9608

SO INTERLEUKIN-2 RECEPTOR, EIA $134.00 84238

THROMBOLYTIC ART THERAPY $7,751.00 37211

THROMBOLYTIC VENOUS THERAPY $4,842.00 37212

THROMBLYTIC ART/VEN THERAPY $4,101.00 37213

CESSJ THERAPY CATH REMOVAL $4,101.00 37214

SYNAGIS 50MG VIAL $4,398.69 90378

SO BCR/ABL1; MINOR BREAKPOINT $150.00 81207

SO FMR1 GENE ANALYSIS CHARA/AL $98.00 81244

SYNVISC-ONE 48MG SYRINGE $3,400.80 J7325

SO c-KIT MUTATIONS $1,257.00 81404

SO PDGFRA FOR GIST REFLEX $1,257.00 81404

THORACIC AORTA ANGIO $6,105.00 36221

UNI COMM CAROTID ANGIO/EXTRACR $6,105.00 36222

UNI COM CAROTID ANGIO/INTRACRA $6,105.00 36223

UNI INTER CAROTID ANGIO $9,984.00 36224

UNI SUBCLAVIN ANGIO $6,105.00 36225

UNI VERTEBRAL ANGIO $9,984.00 36226

UNI EXTER CAROTID ANGIO $3,053.00 36227

UNI CAR/VERT BRANCH ANGIO $3,053.00 36228

REMOV ENDOVAS VENA CAVA FILTER $6,127.00 37193

SO BACILLUS ANTHRACIS SCREEN $23.00 87081

ROOM Private $709.00

SAMSCA (TOLVAPTAN) 15MG TABLET $550.40

ZOLADEX 3.6MG INJECTION $1,841.96 J9202

SO STREP PNEMONIAE IGG AB (7) $364.00 86317

ROOM SEMI-PRIVATE PRE/POST OP $709.00

SO NOROVIRUS EIA STOOL $31.00 87449

MYCAMINE 100MG VIAL $673.20 J2248

INSERT ART LINE $671.00

CLOSED FX TX PRE/POST CARE $613.00

PRE/POST CARE 1ST 30MIN $930.00

PRE/POST CARE EACH ADD 15MIN $222.00

PRE/POST CARE PHASE II 1ST 30M $194.00

PRE/POST CARE PHASE II EA ADD $21.00

SO ZINC PROTOPORPHYRIN (ZPP) $50.00 84202

DOXORUBICIN 10MG/5ML VIAL $26.06 J9000

ALLEVYN HEEL PADS $31.00

DEWRAP $37.00

FIBROCOL SHEET $37.00

MEPETEL NON-ADHESIVE $20.00

NON STING BARRIER SPRAY $29.00

MEDIPORE 4 INCH $27.00

MEDIPORE 6 INCH $37.00

ZINC PASTE BAND W>=3<5YD UB $39.00 A6456

IODODOSORB GEL $40.00

Page 107: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ALGEDIX AG PASTE $59.00

ALGEDIX PACKING 1/2 $41.00

ALGEDIX PACKING 1/4 $40.00

AQUACEL AG ROPE 403712 $47.00

HYDROFERA BLUE 4X4 $27.00

MULTIDEX GEL/POWDER $44.00 A6248

DERMAGRAN W/ZINC $50.00 A6248

SO PARVOVIRUS B19 DNA QUAN PCR $148.00 87799

VECTIBIX 100MG/5ML VIAL $1,488.55 J9303

SO CYTOGENOMIC CONS MICRO ANA $50.00 81229

INJ OF AIR/CONTRAST PERITONE C $1,050.00 49400

MANIPULATION PERITONEAL CATH $4,293.00 49999

PERITONEOGRAM S & I $483.00 74190

CT VENOGRAM UPPER EXT RT $934.00 73206

CT VENOGRAM UPPER EXT LT $934.00 73206

CT VENOGRAM LOWER EXT RT $934.00 73706

CT VENOGRAM LOWER EXT LT $934.00 73706

CYKLOKAPRON 1000MG/10ML AMP $892.68

NEUPRO 1MG PATCH $35.30

NEUPRO 2 MG PATCH $35.30

NEUPRO 4 MG PATCH $72.50

ORAL PHARYNGOSCOPY W/BIOPSY $3,156.00

I&D HEMATOMA/DEEP ABS LEG/ANKL $4,185.00 27603

LIDOCAINE 2% 5ML VIAL $20.13

SO IMMUNODIFFUSION; GEL DIFFUS $40.00 86331

SO ANTIBODY; ADENOVIRUS $45.00 86603

SO ALK LUNG FISH MANUAL $313.00 88368

SO HEMEFISH MANUAL $313.00 88368

SO HEMEFISH AUTO $304.00 88367

SO ALK/ROS1 FISH MANUAL $313.00 88368

SO ESTROGENS TOTAL $75.00 82672

BRIMONIDINE 0.2% 5ML OPHTH DRO $80.33

SO MATERNAL SERUM AFP $58.00 82105

SO XYLENES PANEL BLOOD $54.00 84600

REPAIR F,E,L,N OR L 12.6/20.0 $621.00

FLUOROURACIL 2.5GM VIAL $109.18 J9190

LEUCOVORIN 350 MG VIAL $102.70 J0640

I & D PERINAL ABSCESS $327.00

SO ANTIBOTIC SENSITIVITY TESTI $24.00 87184

REPAIR ARTERY-DIGIT $8,527.00

MULTIVITAMIN W/IRON 50ML DROP $8.38

SO CANNABINOIDS PANEL SERUM $63.00 82542

YERVOY 50MG VIAL $10,750.74 J9228

SO PROCALCITONIN $93.00 84145

PARTIAL EXCHANGE TRANSFUSION $718.00 36450

SIGMOIDOSCOPY W/DILATATION $1,968.00

SO URINE DHEA 24 HOUR $87.00 82626

SO URINE TESTOSTERONE $87.00 84403

SO METHAMPHETAMI & METABOLITE $54.00 G0480

BILIARY ENDO W/DIL BIL ST W/ST $11,129.00 47556

Page 108: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PERC TRANSHE DIL BIL DUCT STRI $66.00 74363

SO HEMOSIDERIN STAIN URINE $12.00 83070

ARC RBC $210.00 81479

SO MALARIA/BLOOD PARASITE SMEA $21.00 87207

INTUBATION EMERGENCY $737.00 31500

PEGINTRON 120 MCG SYRINGE $2,225.76

SITZMARKS CAPSULE $28.00

SO LIPID PEROXIDES PROFILE $63.00 82542

SO ADMARK APOE GENO ANA & INTE $209.00 81401

SO VIGABATRIN (SABRIL) $63.00 82542

ILIAC ART ANGIO CARD CATH/CORO $2,866.00 G0278

URINE PREGNANCY TEST $46.00 81025

CYTOGENETICS, 10-30 $111.00 88273

SO NONHEMEFISH AUTO-TECH $304.00 88367

PRISTIQ ER 50MG TABLET $8.18

SO PHOSPHOLIPID ANTIBODY $40.00 86148

PET IMAGING WHOLE BODY $3,409.00 78816

TRANEXAMIC ACID 1GM/50ML BAG $633.84

IN111 PENTETATE PER 0.5 MCI/6 $1,535.00 A9548

PROVENGE INJECTION $55,800.00 Q2043

LUPRON 45MG INJECTION $8,783.00 J9217

GLUCAGON SO $50.00 82943

US OB LEVEL 11 SINGLE FETUS $491.00 76811

OB US DETAILED ADDL FETUS $555.00 76812

SO ANAPLASMA PHAG AB IGG&IGM $35.00 86666

CA 15.3 $130.00 86300

HEPATITIS B CORE IGM $61.00 86705

HEPATITIS B SURFACE AG $100.00 87340

ALBUTEROL HFA INHALER 8GM $30.53

SO IGE ANTIBODY (ANTI-IGE IGG) $45.00 83520

SKIN SCRAPING FOR SCABIES $13.00 87220

SO BETA-HYDROXYBUTYRATE $25.00 82010

VIIBRYD 40MG TABLET $7.58

SO CSF ALBUMIN $18.00 82042

SO CSF PROTEIN TOTAL $13.00 84157

SO PROTEIN ELECTROPHORESIS $62.00 84166

SO ALPRAZOLAM (XANAX) $64.00 80346

SO URINE CARNITINE $58.00 82379

SO BENZODIAZEPINES SERUM $64.00 G0480

COLISTIMETHATE 150 MG VIAL $181.90 J0770

PERJETA 420MG VIAL $7,286.68 J9306

VANCOMYCIN CONFIRMATION SO $17.00 87181

SO STACH CHARTA/ATRA IGE $18.00 86003

SO STACH CHARTA/ATRA IGA $43.00 86671

SO STACH CHARTA/ATRA IGG $18.00 86001

SO TBII-THYROTROPIN BINDING IN $31.00 83519

SO TRIGLYCERIDES, PLEURAL FLUI $20.00 84478

SO TISSUE HYBRIDIZATION $185.00 88365

SO PROCOLLAGEN TYPE 1INTACT N $31.00 83519

DEFEROXAMINE 500MG $91.62 J0895

Page 109: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CULTURE VIBRIO SO $34.00 87046

C1 ESTERASE INHIBIT, PROTEI SO $91.00 86160

SO NOREPINEPHRINE PLASMA $63.00 82542

EGD W/FOREIGN BODY REMOVAL $1,715.00

EGD W/BIO & CONTROL BLEEDING $4,264.00

SO OLANZAPINE (ZYPREXA) $48.00 80299

SO EASTERN EQUINE ENCEPHALITIS $92.00 86652

ELIQUIS 5MG TABLET $8.48

SO FLCN GENE SEQUENCING $2,513.00 81229

CLOBAZAM SERUM/PLASMA SO $121.00 G0480

PROGESTRONE LC/MS/MS SO $113.00 84144

MURAMIDASE (LYSOZYME) SO $65.00 85549

ALCOHOL/SUB SCREE INTEV 15-30M $125.00 G0396

ALCOH/SUBS SCREE-INT 30 OR GRE $324.00 G0397

EXT DRAIN, PSEUDO PANCREA PERC $3,077.00 49405

HEMOGLOBIN A2 QUANTITATIVE SO $57.00 83021

CHROMATIN (NUCLEOSOMAL) AB SO $89.00 86235

EXPAREL SUSP 20ML VIA PER 1MG $1,432.13 C9290

SO FACTOR XIII ACTIVITY $57.00 85290

SO HERPES SIMPLEX TYPING $20.00 87140

SPEECH EVALUATION FLUENCY $219.00 92521

EVALUATION SPEECH SOUND PRODUC $180.00 92522

EVAL SPEECH SOUND PRODUCTION $314.00 92523

BEHAVIORAL & QUALITATIVE ANALY $185.00 92524

PHOTOTHERAPY $101.00 96900

SO FACTOR V HR2 DNA MUT ANAL $157.00 81400

SO PARANEOPLAST AUTANTI EVA CS $378.00 86256

BIOPSY STEREOTACTIC RT $1,873.00 19081

BIOPSY STEREOTACTIC LT $1,873.00 19081

BIOPSY STEREOTACTIC EACH ADD $1,873.00 19082

US BREAST BIOPSY RT $1,873.00 19083

US BREAST BIOPSY LT $1,873.00 19083

US BREAST BIOPSY EACH ADD $1,873.00 19084

J-WIRE PLACEMENT RT $1,159.00 19281

J-WIRE PLACEMENT LT $1,159.00 19281

J-WIRE PLACEMENT EACH ADD $263.00 19282

J-WIRE STEREO PLACEMENT RT $1,159.00 19283

J-WIRE STEREO PLACEMENT LT $1,159.00 19283

J-WIRE STEREO PLACEMENT EACH A $263.00 19284

US J-WIRE PLACEMENT RT $1,159.00 19285

US J-WIRE PLACEMENT LT $1,159.00 19285

US J-WIRE PLACEMENT EACH ADD $580.00 19286

5-HIAA PLASMA SO $53.00 82542

URINE CYTOLOGY $136.00 88112

EVALUATION SPEECH FLUENCY $219.00 92521

EVAL SPEECH SOUND PRODUCTION $180.00 92522

EVAL SPEECH PRO W/LANG COMP $370.00 92523

BEHAVIORAL AND QUALITATIVE ANA $185.00 92524

EGD W/BIOPSY & BANDING $4,630.00

SO INFLUENZA A H1N1 PCR $302.00 87502

Page 110: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO PGD2 SERUM OR PLASMA $86.00 84150

SO PGD2 URINE 24HR $86.00 84150

SO NICKEL $84.00 83885

SO INFLUENZA A&B RNA QUAL PCR $302.00 87502

SO COPPER RBC $43.00 82525

SO ZINC RBC $39.00 84630

THROMBECTOMY CELIAC/MESENT ART $8,997.00 34151

SO CASCADING REFLEX STAGE 2 $264.00 86235

SO CLONIDINE URINE $47.00 80299

SO KAPPA/LAMB LT CH FR W/RAT U $94.00 83883

ACYCLOVIR 1 GRAM VIAL $239.22 J0133

SO ASPERGILLUS IGE PANEL $125.70 86003

SO IMMUNOCYTOCHEMISTRY EA ADD $444.00 88344

ATGAM 250 MG / 5ML AMPULE $1,951.90 J7504

SO LEVEL IV TISSUE $120.00 88305

SO SPECIAL STAINS $120.00 88313

SO IMMUNOFLUORESCENT STUDY $444.00 88346

SO ELECTRON MICROSCOPY $996.00 88348

XIFAXAN 550 MG TABLET $35.23

DPTA AEROSOL UP TO 75 MCI $118.00 A9567

TRANSCATH PLACE INTRA STENT, I $25,080.00 37236

SO MORPHINE SERUM $160.00 G0480

SO OXYCOD & METABOLITE QUANTIT $67.00 G0480

SO c-kit MUTA ANALYSIS, CELL-B $969.00 81404

SO ALCOHOL, ETHYL-LEGAL BLOOD $34.00 G0480 82055

SO CULTURE NEISSERIA GONORRHOE $23.00 87081

CLSD TX TRIMALL ANKLE FX W/MA $2,497.00

EPIRUBICIN HCL 2 MG INJ $421.00 J9178

DECITABINE INJ 50 MG VIAL $4,277.50 J0894

XPANSION SKIN GRAFT FIRST 100S $6,218.00 15100

XPANSION SKIN GRAFT EA ADD 100 $2,865.00 15101

XPANSION SKIN GRAFT 1ST 100SQ, $6,218.00 15120

XPANSION SKIN GFT EA ADD 100SQ $2,865.00 15121

PERC DIL BILIARY STRICTURE WO $4,919.00 47555

SO MANNOSE-BINDING LECTIN $45.00 83520

SO TOXIC SHOCK SYNDROME PANEL $132.00 86609

MYRBETRIQ 50MG TABLET $12.13

DIFICID 200MG TABLET $236.62

ATIVAN 20MG/10ML MDV $30.00 J2060

SO VWB FACTOR VIII, MULTI ANAL $79.00 85247

PERCOCET 10/325 MG TABLET $10.00

SO AMINOLEV ACID, RANDOM URINE $57.00 82135

VANCOMYCIN 500MG IV $94.50 J3370

SO BORDE PERT AB IGA,IGG/IGM W $135.00 86615

VASC EMB/OCC TUMOR/ORGAN/INFA $24,318.00 37243

SO CORTISONE SERUM $62.00 83789

SO FLUPHENAZINE SERUM (PROLIXI $54.00 G0480

SO SPUTUM CYTOLOGY $120.00 88112

INTRA-ABD COMPART MONITORING $4,293.00 49999

MYRBETRIQ 25MG TABLET $12.13

Page 111: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

LATUDA 40MG TABLET $32.40

NAMENDA XR 7MG CAPSULE $13.46

NAMENDA XR 28MG CAPSULE $13.46

XARELTO 15MG CAPSULE $14.16

DESIGN MLC DEVICE FOR IMRT $865.00 77338

SO SPECTROPHOTOMETRY $23.00 84311

SO PH; BODY FLUID NOS $13.00 83986

SO PAIN MGT AMPHETAMINE CON UA $53.00 G0480 82145

SO PAIN MGT BARBITURATES CON U $40.00 G0480

SO PAIN MGT BENZODIAZE CON UA $53.00 G0480 82145

SO PAIN MGT COCAINE CONFIR UA $52.00 G0480 82520

SO PAIN MGT MARIJUANA CONFIR U $53.00 82542

SO PAIN MGT METHADONE CONFIR U $160.00 G0480 83840

SO PAIN MGT OPIATES CONFIRM UA $160.00 G0480 83925

SO PAIN MGT OXYCODONE CONF UA $160.00 G0480

SO PAIN MGT PHENCYCLIDINE CON $48.00 G0480

SO PAIN MGT PROPOXYPHENE CON U $160.00 G0480 83925

SODIUM THIOSULFATE 12.5G/50ML $556.80

SO CYP2C19 GENOTYPE $730.00 81225

ABSCESSOGRAM $330.00 49424

REM PP GEN W/REP MULLEADSYSTEM $34,900.00 33229

TELEHEALTH ORGINATING SITE FAC $100.00 Q3014

EXCHANGE PREVIOUS DRAINAGE CAT $3,593.00 49423

BRILINTA 90MG TABLET $6.32

LORTAB ELIXIR 10/300 15ML $11.39

ARTISS FIBRIN SEALANT 2 ML $747.00 C9250

SO GAMMAGLOBULIN; IGE $56.00 82785

ALLERG SP IGE; QUAN OR SEMIQUA $15.00 86003

CHOLECYSTOSTOMY, PERCUTANEOUS $4,917.00 47490

SO INFECT AGENT DRUG PHENOTYPE $445.00 87900

SO GENOTYPE DNA HIV REVERSE T $879.00 87901

SO FUNGAL IDENTIFICATION ONLY $28.00 87106

KETAMINE 200MG/20ML VIAL $123.26

INSTLL RX AGNT INTO RNAL TUB $581.00 50391

SO LSD SCREEN SERUM $160.00 80307

D-DIMER QUALITATIVE $100.00 85378

SO ALCOHOL ETHYL QUAL URINE $248.00 80307

CATH FOR URINE SPECIMAN $8.00 P9612

IMAGE-GUIDED FLUID COLLECTION $1,332.00 10030

INJECTAFER 750 MG $2,343.75 J1439

SO EGG COMPONENT PANEL $36.00 86008

SO MILK COMPONENT PANEL $54.00 86008

SO PEANUT COMPONENT PANEL $54.00 86008

E.C.G $147.00 93005

UPDRAFT 1ST TX DAY $310.00 94640

STENT SUPERA PERIPHERAL SYSTEM $5,900.00 C1876

SO TISSUE CULTURE SOLID TUMOR $216.00 88239

SO BRAF MUTATION ANALYSIS $449.00 81210

SO ARIPIPRAZOLE (ABILIFY) $47.00 80299

SO TRAMADOL URINE $248.00 83789

Page 112: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO FENTANYL URINE $248.00 80307

US RENAL BILATERAL COMPLETE $738.00 76770

ZALTRIP 200MG VIAL $4,750.74 J9400

EMBOLIZATION ART/VEN HEMORRHA $24,318.00 37244

EMBOLECTOMY; RADIAL/ULNAR ARE $8,997.00 34111

SO CULTURE WOUND QUANTITATIVE $33.00 87071

PHLEBOTOMY THERAPEUTIC $139.00 99195

SO PSA ULTRASENSITIVE $63.00 84153

SO AB; ENCEP, CALIFORNIA $45.00 86651

SO AB; ENCEPH WESTERN EQUINE $45.00 86654

SO CHIKUNGUNYA AB (IGG & IGM) $88.00 86790

SO CARBOHYDRATE-DEFICIENT TRAN $62.00 82373

EPOETIN/DIALYSIS 10,000 UNITS/ $236.25 Q4081

EPOETIN/DIALYSIS 2,000 UNITS/M $47.25 Q4081

EPOETIN/DIALYSIS 3,000 UNITS/M $70.89 Q4081

EPOETIN/DIALYSIS 40,000 UNITS/ $970.17 Q4081

EPOETIN/DIALYSIS 4,000 UNITS/M $94.50 Q4081

ARANESP/DIALYSIS 100 MCG $964.80 J0882

ARANESP/DIALYSIS 200 MCG $1,929.60 J0882

ARANESP/DIALYSIS 40 MCG $370.50 J0882

ARANESP/DIALYSIS 60 MCG $578.85 J0882

ARANESP/DIALYSIS 25 MCG $231.57 J0882

MCD EVAL OF SPEECH FLUENCY $219.00 92521

MCD EVAL OF SPEECH SOUND $180.00 92521

MCD EVAL OF SPEECH SOUND/LANG $370.00 92523

MCD EVAL OF SPEECH BEH/QUAL AN $185.00 92524

SO FOSPHENYTOIN BLOOD $46.00 80185

NEEDLE ELECTRO; 1 EXT $213.00 95860

NEEDLE ELECTRO; 2 EXT $300.00 95861

NEEDLE ELECTRO; 3 EXT $372.00 95863

NEEDLE ELECTRO; 4 EXT $419.00 95864

NERVE CONDUCT 1-2 $269.00 95907

NERVE CONDUCT 3-4 $456.00 95908

NERVE CONDUCT 5-6 $456.00 95909

NERVE CONDUCT 7-8 $456.00 95910

NERVE CONDUCT 9-10 $819.00 95911

NERVE CONDUCT 11-12 $819.00 95912

NERVE CONDUCT 13 OR MORE $819.00 95913

NEEDLE ELECTRO EACH EXT WITH $83.00 95885

NEEDLE ELECTRO; COMP 5 OR MORE $129.00 95886

NEW PATIENT ACUITY LEVEL 1 $125.00 99201

NEW PATIENT ACUITY LEVEL 2 $125.00 99202

NEW PATIENT ACUITY LEVEL 3 $125.00 99203

NEW PATIENT ACUITY LEVEL 4 $125.00 99204

NEW PATIENT ACUITY LEVEL 5 $125.00 99205

ESTABLISH PATIENT ACUITY LEVEL $125.00 99211

ESTABLISH PATIENT ACUITY LEVEL $125.00 99212

ESTABLISH PATIENT ACUITY LEVEL $125.00 99213

ESTABLISH PATIENT ACUITY LEVEL $125.00 99214

ESTABLISH PATIENT ACUITY LEVEL $125.00 99215

Page 113: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DEHYDRATED ALCOHOL 5ML VIAL $309.55

LINACLOTIDE 145MG CAPSULE $11.36

NPLATE 10MCG $1,867.35 J2796

SO SERPINA 1 $149.00 81332

PSYCHIATRIC DIAG EVALUATION $351.00 90791

PSYCHIATRIC DIA EVAL W/MED SER $390.00 90792

PSYCHOTHERAPY, 30 MIN $197.00 90832

PSYCHOTHERAPY, 30 MIN W/E&M $203.00 90833

PSYCHOTHERAPY, 45 MIN $262.00 90834

PSYCHOTHERAPY, 45 MIN W/E&M $260.00 90836

PSYCHOTHERAPY, 60 MIN $396.00 90837

PSYCHOTHERAPY, 60MIN W/E&M $343.00 90838

PSYCHOTHERAPY FOR CRISIS, 60 M $317.00 90839

PSYCHOTHERAPY FOR CRISIS EA AD $317.00 90840

FAMILY PSYCHOTHERAPY W/O PATIE $358.00 90846

FAMILY PSYCHOTHERAPY W/PATIENT $358.00 90847

GROUP PSYCHOTHERAPY $192.00 90853

EST PATIENT LEVEL 1 $125.00 99211

EST PATIENT LEVEL 2 $125.00 99212

EST PATIENT LEVEL 3 $125.00 99213

EST PATIENT LEVEL 4 $125.00 99214

EST PATIENT LEVEL 5 $125.00 99215

CBC W/DIFF $63.00 85025

XARELTO 20MG TABLET $15.28

POST-OP NERVE BLOCK $1,843.00

IMAG GUID FLD COLL PERITONEAL $3,365.00 49406

CLOSED TX BIMALL FX W/MANULIP $642.00 27810

TEFLARO 400 MG VIAL $446.10 J0712

MRI BRAIN WITH CONTRAST $3,238.00 70552

SO Y CHROM MICRO DNA ANALYSIS $346.00 81403

SO ACHR/MUSK REFLEX AB TEST $62.00 83519

SO ENTAMOEBA HISTOLYTIC AB IGG $43.00 86753

SO EVEROLIMUS (ZORTRESS) $47.00 80169

SO VARIC-ZOSTER VIR AB IGG CSF $44.00 86787

DAVI PROSTATE OR TIME 60 MIN $3,306.00

DAVI PROSTATE OR TIME EA 15 MI $915.00

REPAIR SUPERF LAC 2.5 OR LESS $250.00 12001

REPAIR SUPER LAC 2.6 TO 7.5 $328.00 12002

SO CARBAMAZEPINE TOTAL $50.00 80156

SO CARPAMAZEPINE FREE $46.00 80157

ELITEK 1.5MG VIAL $949.77 J2783

SO RNA POLYMERASE III AB $45.00 83520

MONSEL'S TOP SOLUTION 8ML BOT $70.88

SO PAIN MGT CARISPRODOL URINE $160.00 G0480

SO PAIN MGT FENTANYL URINE $160.00 G0480

SO PAIN MGT GABAPENTIN URINE $46.00 80171

SO PAIN MGT PREGABALIN URINE $62.00 83789

SO PAIN MGT TAPANTADOL URINE $62.00 83789

SO PAIN MGT TRAMADOL URINE $53.00 82542

SO FLUNITRA & META QUANT URINE $50.00 80346

Page 114: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

MOD SED AGE 5 OR OLDER 30 MIN $87.00 99156

MOD SED 5 OR OLDER EA ADD 15MI $22.00 99157

ASPIRA/INJECT RENAL CYST PERCU $2,085.00 50390

RADIO EXAM RENAL CYST STUDY $2,032.00 74470

PENTAM 300 MG VIAL $620.60 S0080

SO BETA-2 TRANSFERRIN BODY FLU $101.00 86335

SO PHENCYCLIDINE,GC/MS SERUM $48.00 G0480

KADCYLA 160MG VIAL $6,607.31 J9354

KEYTRUDA 100MG VIAL $33,835.14 J9271

SO VORICONAZOLE $47.00 80299

REVISION EYELID $3,282.00

SO BENZODIAZEPINES PANEL BLOOD $64.00 G0480

PROMETHAZINE/CODEINE SYRUP 5M $5.00

SO T-CELL ANTIGEN RECEPT BETA $713.00 81340

SO T-CELL ANTIGEN RECEPT GAMMA $688.00 81342

SO YERSINIA ENTERO AB IGG, IGA $90.00 86793

ROPIVACAINE 0.2 PREC 60ML SYR $65.82

ADULT PSYCH ROOM $1,873.00

SEMI-PRIVATE ADULT PSYCH $1,906.00

SO BENZTROPINE SERUM/PLASMA $47.00 80299

ANAGRELIDE 1 MG CAPSULE $30.82

CEFEPIME 2 GM/ 50ML $142.32 J0692

TRANSCATH PLC STENT INIT VEIN $25,080.00 37238

TRANSCATH PLC STENT EA AD VEIN $12,130.00 37239

INJECTION SINUS TRACT; DIAG $275.00 20501

REMOVAL TUN CV CATH $1,699.00 36589

SO LEPTOSPIRA AB SCREEN W/REF $45.00 86720

CT LIVER CRYOTHERAPY ABLATION $10,790.00 47383

SO ALLER BASOFU HRT PAT BLUE V $464.00 86352

INJECTION WRIST ARTHROGRAM $327.00 25246

INJECTION FOR HIP ARTHOGRAM $275.00 27093

INJECTION SHOULDER ARTHROGRAM $275.00 23350

NJX CNTRST KNE ARTHG/CT/MRI $275.00 27369

ACETYLSTEINE 20PER 4ML $10.08

SO HEAVY METAL (ANTIMONY) QUAT $75.00 83018

SO HEAVY METAL (BISMUTH) QUAT $75.00 83018

SO HEAVY METAL (BERYLLIUM) QUA $75.00 83018

SO HEAVY METAL (BARIUM) QUAT E $75.00 83018

SO ESTRADIOL FREE LC/MS/MS $192.00 82670

SO VALPROLIC ACID FREE $65.50 80164

SO VALPROLIC ACID TOTAL $65.50 80165

IMRT; COMPLEX $1,398.00 77386

PSYCHIATRIC DIAG EVAL W/MED SE $351.00 90791

PSYCHOTHERAPY. 30 MIN W/PT AND $197.00 90832

PSYCHOTHERAPY, 45 MIN W/PT AND $262.00 90834

PSYCHOTHERAPY. 60 MIN W/PT AND $396.00 90837

FAMILY PSYCHOTHERAPY W/O PT $341.00 90846

FAMILY PSYCHOTHERAPY W/PT $341.00 90847

MULTIPLE-FAMILY GRP PSYCHOTHER $183.00 90849

GROUP PSYCHOTHERAPY-OTHER MUL $183.00 90853

Page 115: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ADMISSION HISTORY AND PHYSICIA $215.00 99222

RESULTS EXPLAINED TO FAMILY $197.00 90887

DISCHARGE EVAL LESS THAN 30 MI $115.00 99238

FACE TO FACE WITH PATIENT 15 M $62.00 99231

FACE TO FACE WITH PATIENT 25 M $115.00 99232

FACE TO FACE WITH PATIENT 35 M $164.00 99233

FACE TO FACE WITH PATIENT 30 M $103.00 90832

PSYCHIATRIC DIAG EVAL W/MED SE $225.00 90792

PSYTX PT&/FAMILY 30 MINUTES $103.00 90832

PSYTX PT&/FAMILY 45 MINUTES $138.00 90834

PSYCHOTHERPY 60 MIN W/PT/FAM $205.00 90837

SO INHALENT ALLERGY PANEL $180.00 86003

PROTIME/INR BEDSIDE $45.00 85610

SO MUMPS VIRUS RNA, QUAL PCR $120.00 87798

FAMILY PSYCHOTHERAPY W/O PATIE $165.00 90846

FAMILY PSYCHOTHERAPY W PATIENT $171.00 90847

MULTIPLE-FAMILY GROUP PSYCHOTH $176.00 90849

GROUP PSYCHOTHERAPY-MULT FAM $176.00 90853

INTER OF PSYCHIATRIC RESULTS F $197.00 90887

RENVELA 800MG TABLET $6.18

SO IMMUNOHISTO AB SLIDE $50.00 88342

KCENTRA, PER I.U $2,596.14 C9132

BREATHING CAPACITY TEST $135.00 94010

6 MINUTE WALK TEST $308.00 94618

NEW PATIENT LEVEL 1 $125.00 99201

NEW PATIENT LEVEL 2 $125.00 99202

NEW PATIENT LEVEL 3 $125.00 99203

NEW PATIENT LEVEL 4 $125.00 99204

NEW PATIENT LEVEL 5 $125.00 99205

EST PATIENT LEVEL 1 $125.00 99211

EST PATIENT LEVEL 2 $125.00 99212

EST PATIENT LEVEL 3 $125.00 99213

EST PATIENT LEVEL 4 $125.00 99214

EST PATIENT LEVEL 5 $125.00 99215

SO AMPHIPHYSIN AB $58.00 84181

REMOVAL RENAL TUBE W/FLUORO $1,511.00 50389

SO FISH AUTO-TC (MULTIPLEX PRO $460.00 88374

SO RBC FRAGILITY, INCUBATED $46.00 85557

EEG MONITOR/VIDEO RECORD $2,712.00 95951

EEG DIGITAL ANALYSIS $764.00 95957

VORICONAZOLE 200MG VIAL $457.74 J3465

SO PEPSINOGEN I $31.00 83519

SO PEPSINOGRN II $31.00 83519

BLOXIVERZ 1MG/ML 10ML VIAL $75.80 J2710

SO SYNTH STIM QUANT URINE $62.00 G0480

CYCLOPHOSPHAMIDE 50MG CAPSULE $22.30

SO FISH AUTO-TC(SINGLE PROBE) $460.00 88365

SO FIBRINOGEN ACTIVITY CLAUSS $29.00 85384

SO GALACTITOL QUANTITATIVE URI $28.00 82760

SO ELECTROPHORETIC TECHNIQUE $117.00 82664

Page 116: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO GALACTITOL-1-PHOS URIDYT QU $72.00 82775

SO GALACTITOL-1-PHOS URIDYT ER $40.00 84378

GAZYVA 1000MG/40ML VIAL $7,697.63 J9301

SO M.TUBERCU COMP DIRECT DETEC $120.00 87556

SO INTERLEUKIN-5 (IL-5) PLASMA $45.00 83520

STREPTOMYCIN 1GM VIAL $133.13 J3000

TRANSCATH PLACE STE EA ADD ART $6,494.00 37237

ARTHROGRAM ELBOW $559.00 73085

INJECTION ARTHROGRAM ELBOW $327.00 24220

SO LUNG FISH MANUAL-TC $460.00 88377

SO EGFR MUTATION ANALYSIS $823.00 81235

SO PHENYLALANINE $19.00 84030

SO MDMA/MDA QUAN URINE $53.00 G0480

L-SPINE COMP W/FLEX-EXT $372.00 72114

TRANS CARE MGMT 14 DAY DISCHAR $125.00 99495

SCID $210.00 81479

IMAGE CO-REGISTRATION $336.00 77399

SO JAK2 EXON 12-14 MUTATION AN $346.00 81403

SO MPL MUTATION ANALYSIS $453.00 81402

LUPRON DEPOT 30 MG $7,002.81 J9217

SO ALPHA-1-ANTITRYPSIN (AAT) P $50.00 82104

OPDIVO 100MG VIAL $3,547.74 J9299

OPDIVO 40MG VIAL $1,389.54 J9299

SO RUFINAMIDE $47.00 G0480

URETERAL DILATION $313.00 53899

SO POLIOVIRUS AB NEUTRALIZATIO $174.00 86382

SO MICROSATELLITE INSTABILITY $986.00 81301

VITAMIN D3 BOTTLE $11.55

REM FOREIGN BODY EXT EAR-W/O A $363.00 69200

INSERT HEART PM ATRIAL $14,801.00 33206

ABG'S $192.00 82803

INJ SI JOINT W/MEDS $1,850.00

LACTATION CONSULTS 15 MIN $80.00 99401

LACTATION CONSULTS 30 MIN $158.00 99402

SO TRICHOMONAS VAG RNA QUAL TM $120.00 87661

US SCREENING AAA $253.00 76706

ELIQUIS 2.5 MG TABLET $8.40

SO URINE IODINE 24 HR $62.00 83789

SO CHROMOSOME ANA TISS NO GROW $218.00 88230

SO CLOSTRIDIUM DIFFICILE TOXIN $120.00 87493

ZERBAXA 1.5 GM VIAL $515.50 J0695

ADCETRIS 50MG VIAL $14,105.00 J9042

SO AEROMONAS/PLESIOMONAS CUL $33.00 87046

SO PSILOCYBIN QUAL URINE MUSHR $522.00 G0480

ULORIC 40 MG TABLET $13.79

ARIPIPORAZOLE 2MG TABLET $51.38

PACER QUICKLOOK SINGLE LEAD $97.00 93279

PACER QUICKLOOK MULT LEAD $127.00 93281

SO CSF IMMUNOGLOBULINS $60.00 82784

I&D SCROTAL/EPIDID/TESTIS ABSC $4,985.00

Page 117: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CYRAMZA 100MG/10ML VIAL $1,786.74 J9308

CRYAMZA 500MG/50ML VIAL $9,130.74 J9308

COMP EP EVAL W/RT ATRIAL PACIN $7,506.42 93619

COMP EP EVAL INSERT/REPOST MUL $10,834.00 93620

COMP EP EVAL W/LT ARTIAL PACIN $5,004.28 93621

COMP EP EVAL W/LT VENT PACING $5,004.28 93622

PROGRAMMED STIMULATION & PAC $5,004.28 93623

EP FOLLOW-UP STUDY W/PACING $12,747.00 93624

BUNDLE OF HIS RECORDING $12,747.00 93600

INTRA-ATRIAL RECORDING $12,747.00 93602

RIGHT VENTRICULAR RECORDING $5,460.00 93603

INTRA-ATRIAL PACING $12,747.00 93610

INTRAVENTRICULAR PACING $13,385.00 93612

INTRAVENT AND/OR INTRA-ATRIAL $5,004.28 93609

INTRACARDIAC EP 3 D MAPPING $5,004.28 93613

INTRACARDIAC CATHETER ABLATION $12,639.00 93650

COMP EP EVAL INSERT/REPOST MUL $39,497.00 93653

COMP EP EVAL INSERT/REPOST MUL $39,497.00 93654

INTRACARDIAC CATH ABLATION $16,778.15 93655

INTRACARDIAC ECHO DURING THER/ $3,512.00 93662

LUPRON DEPOT 11.25 MG SYRINGE $6,567.30 J1950

ISOPROTERENOL 1MG/5ML AMPULE $1,132.28

ADMIS/INIT VISIT LOW SEVERITY $159.00 99221

ADMIS/INIT VISIT MOD SEVERITY $215.00 99222

ADMIS/INIT VISIT HIGH SEVERITY $318.00 99223

FOLLOW-UP STABLE/READY FOR DC $62.00 99231

FOLLOW-UP MINOR/INADEQUATE RE $115.00 99232

FOLLOW-UP NEW/DEV SEVERELY UN $164.00 99233

DISCHARGE LESS THAN 30 MIN $115.00 99238

SAME DAY ADMIT/DC LOW SEVERITY $211.00 99234

SAME DAY ADMIT/DC MODERATE SEV $266.00 99235

SAME DAY ADMIT/DC HIGH SEVERIT $343.00 99236

DOC OBS STATUS LOW SEVERITY $158.00 99218

INITIAL OBS CARE PER DAY $214.00 99219

INITIAL OBS CARE $292.00 99220

1ST HR BEYOND THE EM SERVICE $145.00 99356

EACH ADD 30MIN BEYOND 1ST HR $143.00 99357

PLEURAL DRAIN PER W/INT CATH $1,347.00 32557

PRIVATE ROOM-EMU $709.00

BILIRUBIN,TOTAL TRANSCUTANEOUS $18.00 88720

STREP A AMPLIF NA PROBE $138.00 87651

SO MYCOPHENOLIC ACID $62.00 80180

SO ADD TISS CULT BONE MAR/BLD $218.00 88237

ROPIVACAINE 0.5 PER 20ML VIAL $106.14

SYMBICORT 160/4.5MG 1 INHALER $360.00

INS CATH REN ART 2ND+ UNILAT $6,748.00 36253

SO ALPHA MSH $31.00 83519

SO UREA NITROGEN RANDOM URINE $17.00 84540

SO PROTEINASE-3 AB $59.00 86021

SO FABRY DIS FULL GENE ANALYSI $1,322.00 81405

Page 118: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

INITIAL VISIT 15 MIN $134.00 96150

REASSESSMENT $134.00 96151

INTERVENTION (SINGLE) $134.00 96152

SO CONNEXIN 26 DNA SEQ TEST $860.00 81252

FLUZONE QUAD PEDI SYRINGE 30MC $125.00 Q2038

FLUZONE QUAD SYRINGE 60MCG/0.5 $104.51 90686

FLUCELVAX SYRINGE 60MCG/0.5ML $122.47 90674

OCTAGAM 10 PERC VIAL 10MG/100M $4,099.00 J1568

GAMASTAN 10ML VIAL $1,325.00 J1560

EGD W/BIO,DILAT & POLYP $7,577.00

SO TRICH VAG RNA QUAL. TMA MAL $120.00 87661

TRADJENTA 5MG TABLET $17.63

INVOKANA 100MG TABLET $18.29

CARDIAC OUTPUT MON-NICOM CHEET $521.00 93561

SO HDL CHOLESTEROL $28.00 83718

SO FOOD ALLERGY PRO W/REFLEXES $270.00 86003

SO PM-SCL AB $62.00 86235

VALACYCLOVIR 1GM TABLET $20.22

ORBACTIV 400 MG $2,900.00 J2407

FINE NEED ASPIR W/O IMA 1ST LE $832.00 10021

FNA BX W/O IMG EA ADD LESION $544.00 10004

TOBRAMYCIN PEAK $45.00 80200

TOBRAMYCIN TROUGH $45.00 80200

TOBRAMYCIN RANDOM $45.00 80200

Staphylococcus Aureus, amplifi $138.00 87640

MRSA amplified probe technique $138.00 87641

Clostridium difficile/EPI, Amp $105.00 87493

Chlamydia trachomatis,amplifie $118.00 87491

Neisseria gonorrhoeae, amplifi $135.00 87591

SO CALR MUTATION ANALYSIS $498.00 81479

SO BCR/ABL TRANSLO 9:22 MAJOR $558.00 81206

SO BCR/ABL TRANSLO 9:22 MINOR $493.00 81207

SO 17-OHCS $190.00 83491

SO TESTOSTERONE TOTAL $88.00 84403

SO PREGNANETRIOL $65.00 84138

SO PREGNANEDIOL $66.00 84135

SO ETIOCHOLANOLONE $81.00 82696

SO KETOSTEROIDS 17; FRACT $360.00 83593

SO ESTRONE $510.00 82679

SO DEOXYCORTISOL 11 $100.00 82634

SO ESTRIOL UNCONJUGATED $83.00 82677

SO COLUMN CHROMOTOGRAPHY QUAN $62.00 82542

SO ANDROSTERONE $86.00 82160

SO DHEA $86.00 82626

SO ESTRADIOL $96.00 82670

SO VITAMIN B5 $37.00 84591

SOMATULINE DEPO 120MG INJ $16,632.00 J1930

SPIRIVA RESPIMAT PER DOSE $8.42

FLUVIRIN VACCINE 2015-2016 $91.02 Q2037

SO HIV Ag/Ab 4th GEN W/REFLEX $82.00 87389

Page 119: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO HIV-1 $31.00 86701

SO HIV-2 $46.00 86702

SO HIV-1 RNA QUALITATIVE TMA $120.00 87535

SO GLUCOSE TOLERANCE 3HR $44.00 82951

SO GTT ADD SPEC $14.00 82952

SO DIPTHERIA $52.00 86648

SO NMDA RECEPTOR (NR-1) AUTOAN $41.00 86255

SO HU AB SCREEN $42.00 86255

SO STREP PHEMONIA IGG AB 14 SE $52.00 86317

PRAXBIND 2.5GM/50ML VIAL $5,400.00

PCR BLOOD CULTURE $204.00 87150

SO IGG ALLERGEN EACH $18.00 86001

SO DOPAMINE PLASMA $62.00 82542

CRESEMBA 372 MB VIAL $715.50 J1833

COUNSELING VISIT LDCT SCREEN $193.00 G0296

LDCT FOR LUNG CA SCREENING $311.00 G0297

PCN G KCL 5MMU VIAL $146.82 J2540

SO ALCOHOL METHYL, BLOOD $55.00 84600

HIP-OR-LEFT 2-3 VIEWS $158.00 73502

HIP-OR-LEFT 4 VIEWS $227.00 73503

HIP-OR-RIGHT 2-3 VIEWS $182.00 73502

HIP-OR-RIGHT 4 VIEWS $227.00 73503

INFANT-CHILD PELVIS/HIP 2-3 V $182.00 73502

INFANT-CHILD PELVIS/HIP 4 VIEW $227.00 73503

SO GAGS URINE $68.00 83864

SO BCL-1 TRANSLOCATIO T(11:14) $261.00 81401

CREATININE; NOT BLOOD $51.00 82570

C-PEPTIDE $71.00 84681

SO RH FACT SCRE SYNOVIAL FLUID $20.00 86430

SO RH FACT TITE SYNOVIAL FLUID $20.00 86431

SO ANA (FANA) BODY FLUID $42.00 86038

VASC EMBOLIZE/OCCLUDE VENOUS $24,612.00 37241

SO JC VIRUS QUANT. PCR CSF $146.00 87799

CIMZIA 200MG VIAL POWDER $2,843.64 J0717

LIDO 1% W/ EPINEPHRINE 30ML $31.28

INSERT HEPATIC SHUNT (TIPS) $12,628.00

SO ZINC TRANSPORTER 8 AB $68.00 86341

SO N-TELOPEPTIDE SERUM $64.00 82523

MRSA CLEARING NASAL SWAB PCR $138.00 87641

SO URINE BICARBONATE $17.00 82374

ADVAIR 45/21MCG INHALER $493.18

SYMBICORT 80/4.5 MCG INHALER $472.84

SO TITANIUM SERUM/PLASMA $75.00 83018

LEMTRADA 12MG VIAL $29,633.06 J0202

HIP 2-3 VIEWS RT-PELVIS $182.00 73502

HIP 2 VIEW LT-PELVIS $182.00 73502

HIP 1 VIEW RT-PELVIS $131.00 73501

HIP 1 VIEW LT-PELVIS $131.00 73501

SALINE INF SONOHYSTEROGRAPHY $398.00 76831

CATH AND INTRO OF SALINE $1,065.00 58340

Page 120: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DEXAMETHASONE 10MG PRESER FREE $42.56 J1100

SO METHAD SCREEN/CONFIRM URIN $200.00 80307

SO ANTIDEPRE SERO CLASS; 1OR2 $139.00 80332

SO ANTIDEP SERO CLASS 6 OR MOR $139.00 80337

SO ANTIDEPRESSANT NOS $139.00 80338

SO URINE METHADONE BY GC/MS $160.00 80358

DISKECTOMY-PERC-LUMBAR $58.00

SO LANREOTIDE $47.00 80299

SO CLONIDINE SERUM $47.00 80299

SO ESCITALOPRAM SERUM $200.00 80332

SO ENA ANY METHOD $62.00 86235

SO IMMUNOASSAY NONANTIBODY $40.00 83516

BENDEKA(BENDAMUSTINE HCL)1MG $3,496.22 J9034

SO BILIRUBIN TOTAL $18.00 82247

SO GGT $25.00 82977

SO SGPT $19.00 84460

SO ADDIT TISS CULT SOLID TUMOR $218.00 88239

REMOVAL PLEURAL CATHETER $1,247.00 32552

SED RATE MANUAL-MC $13.00 85651

SO LEPTOSPIRA DNA QUAL PCR $120.00 87798

SO CUTANE DIR IMMUNOFLU $524.00 88346

ENTRESTO 49/51 MG TABLET $10.00

ENTRESTO 97/103 MG TABLET $10.00

SO MANGANESE HAIR TEST $84.00 83785

TRANSCATH STENT CCA W/EPS $21,714.00 37215

TRANSCATH STENT CCA W/O EPS $21,714.00 37216

PRESUMPTIVE DRUG CLASS SCREEN $52.00 80305

SO CYTOCHROME P450 2D6 GENOTY $1,128.00 81226

SO MAPLE SYRUP DISE (MSUD) ANA $446.00 81205

OR TIME 1ST 30 MINUTE $3,306.00

OR TIME EACH MINUTE $34.00

SO PLASMINOGEN ACTIVITY $23.00 85420

SO IMMUNOGLOBULIN G SUBCLASS $28.00 82787

SO LEVEL 1 SURG PATH GROSS ANA $72.00 88300

FMT FMP250 $1,236.00 J3590

SO MEASLES AB IGM $44.00 86765

SO F-2 FOUNDATION ONE $11,220.00 81479

SO ANTIBODY; CHLAMYDIA IGM $44.00 86632

SO ANTIBODY; CHLAMYDIA $41.00 86631

SO ANTIBODY; INFLUENZA VIRUS $47.00 86710

SO ANTIBODY; ENTEROVIRUS $45.00 86658

SO CALCULUS QUAL ANALYSIS SCMC $40.00 82355

DISULFIRAM 250 MG TABLET $6.45

DIALYSIS PERITONEAL REPEAT EVA $1,241.00

NEULASTA ONPRO 6 MG $7,734.00 J2505

HYALURONIDASE 150 UNIT VIAL $327.00 J3470

CT PULMONARY VEIN MAP $612.00 75572

NEW PT LEVEL I $125.00 99201

NEW PT LEVEL II $125.00 99202

NEW PT LEVEL III $125.00 99203

Page 121: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NEW PT LEVEL IV $125.00 99204

NEW PT LEVEL V $125.00 99205

EST PT LEVEL I VISIT $125.00 99211

EST PT LEVEL II VIST $125.00 99212

EST PT LEVEL III VST $125.00 99213

EST PT LEVEL IV VIST $125.00 99214

EST PT LEVEL V VISIT $125.00 99215

CHEMO SQ/IM HORMONAL $198.00 96402

CHEMO SQ/IM NON-HORM $460.00 96401

IM OR SQ INJECTION $134.00 96372

IV PROPHYLACYTIC INFUSION 1ST $369.00 96365

IV PROPHYLAC INFU EA ADD HR $88.00 96366

SEQ IV PROPHYLACYTIC EA HR $88.00 96365

SEQ IV PROPHYLACYTIC 1ST HR $88.00 96367

IVP DRUG INITIAL $370.00 96374

IVP SEQUENTIAL-NEW DRUG $183.00 96375

NEW PT LEVEL I $125.00 99201

NEW PT LEVEL II $125.00 99202

NEW PT LEVEL III $125.00 99203

NEW PT LEVEL IV $125.00 99204

NEW PT LEVEL V $125.00 99205

EST PT LEVEL I VISIT $125.00 99211

EST PT LEVEL II VIST $125.00 99212

EST PT LEVEL III VST $125.00 99213

EST PT LEVEL IV VIST $125.00 99214

EST PT LEVEL V VISIT $125.00 99215

CHEMO SQ/IM HORMONAL $198.00 96402

CHEMO SQ/IM NON-HORM $460.00 96401

IM OR SQ INJECTION $134.00 96372

IV PROPHYLACYTIC INFUSION 1ST $369.00 96365

IV PROPHYLAC INFU EA ADD HR $88.00 96366

SEQ IV PROPHYLACYTIC EA HR $88.00 96367

SEQ IV PROPHYLACYTIC 1ST HR $88.00 96365

IVP INITIAL $370.00 96374

ANGEL PASTE TOPICAL $180.00

UA DIPSTICK $10.00 81002

BLOOD OCCULT $57.00 82270

GULCOSE $26.00 82962

PROTIME QW $67.00 85610

HETEROPLHILE QW $56.00 86308

STREPTOCCUS QW $60.00 87880

INFLUENZA QW $41.00 87804

EKG $147.00 93005

PNEUMOVAX ADMIN. $148.00 G0009

TB SKIN TEST $71.00 86580

FECAL OCCULT $30.00 82272

FLU SHOT ADMIN. $91.00 G0008

PSA SCREENING $121.00 G0103

COLORECTAL CANCER SCREENING $57.00 G0328

HEPATITIS B VAC ADMINISTRATION $118.00 G0010

Page 122: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CAPILLARY BLD DRAW $8.00 36416

INJ FOR PER TX EXT PSEUDOANEUR $1,076.00 36002

US GUID NEEDLE PLACE IMAGING $385.00 76942

EIA HIV 1 AND/OR HIV 2 SCREEN $47.00 G0432

HEP SCREEN HIGH RISK/OTHER $49.00 G0472

BENLYSTA 120 MG VIAL $1,503.00 J0490

BENLYSTA 400 MG VIAL $4,088.00 J0490

STELARA 45 MG VIAL $25,432.00 J3357

STELARA 90 MG VIAL $50,714.00 J3357

SIMPONI 50MG VIAL $3,710.00 J1602

KRYSTEXXA 8 MG VIAL $38,514.00 J2507

PHLEBOTOMY $28.00 36415

QCTREOTIDE 500 MCG VIAL $296.00 J2354

PREVNAR 13 VACCINE SYRINGE $746.00 90670

SO RECOMBX MATA AUTOAB TEST $62.00 84182

SO RECOMBX CV2 AB TEST $62.00 84182

SO GQ1B ANTIBODY TEST $45.00 83520

CARDIAC PROCEDURE-UNLISTED $1,247.00 33999

IMMUN ADM; EA ADDTL VACCINE $69.00 90472

IMMUN ADMIN 1 VACCINE $118.00 90471

SMOKING CESS GREAT THAN 10 MIN $68.00 99407

SMOKING CESST LESS THAN 10 MIN $59.00 99406

EKG 12 LEAD, TRACING ONLY $147.00 93005

TB SKIN TEST $71.00 86580

CAPILLARY BLOOD DRAW $8.00 36416

PHLEBOTOMY-VENIPUNCTURE $31.00 36415

CHEMO IV THERAPY 1ST HR $536.00 96413

CHEMO IV THERAPY EA ADD HR $62.00 96415

DICLOFENAC GEL 100 GM $157.00

MOVANTIK 25 MG TABLET $19.00

OP VAC/TOX INJ 2 $69.00

OP VAC/TOX INJ 1 $118.00

SO HEP C VIR RNA NS3 DRUG RESI $877.00 87902

SMOKING CESSATION LESS THAN 10 $59.00

PULMOZYNE 2.5MG/2.5ML INHALA $306.00

SO ZIKA VIRUS RNA QUAL REALTIM $96.00 87798

ENTYVIO 300MG $12,579.00 J3380

MORTON'S NEUROMA NEUROTOMY $462.00

BRIDION 200 MG VIAL $523.00

BRIDION 500 MG VIAL $803.00

MIDODRINE 10 MG TABLET $8.00

UA DIPSTICK $10.00

SO IMMUNOCHISTOCHEMISTR EA ADD $109.00 88341

SO FERRITIN $112.00 82728

SO HCT $33.00 85014

SO HGB $35.00 85018

SO RBC COUNT AUTOMATED $9.00 85041

SO EBV QUANTITATIVE PCR $117.00 87799

EVAL/ASSESS RESP TX 1X $334.00

ABI COMPLETE STUDY $269.00

Page 123: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO STRAT JCV AB W/REFLE TO INH $40.00 86711

SO JC VIRUS AB INHIBITIO ASSAY $40.00 86711

NOREPINEPHRINE 8MG/250 ML BAG $310.00

SO ALLERGY NICKEL $15.00 86003

SO RETICIGG & IGA SCRE W/REL $33.00 86255

SO RETICULIN IGG TITER $33.00 86256

SO RETICULIN IGA TITER $33.00 86256

IMMUNOFLUOR ANTB ADDL STAIN $76.00 88350

ELITEK 7.5 MG VIAL $5,497.00 J2783

KCENTRA 1000 UNIT VIAL $5,088.00 C9132

I & D SIMPLE $300.00

I & D COMPLEX $555.00

I&D HEMATOMA $1,622.00

PUNCTURE ASPIRATION $590.00

DEBRIDE SQ TISSUE $1,000.00

BIOPSY OF SKIN $322.00 11102

REMOVAL SKIN TAGS 15 $290.00

SHAVE SKIN LESION $467.00

EXC BENG LESION T/A/L .5 OR LE $1,006.00

EXC BEN LES T/A/L .6 TO 1CM $1,132.00

EXC BEN LES TR/AR/LE 1.1 / 2CM $1,106.00

EXC BLESN SNHFG.6-1C $1,146.00

EXC BEN LES SC/HA/FEET 1.1-2CM $1,944.00

EXC BEN LES SC/HA/FE 2.1-3 CM $1,944.00

EXC BEN LES SC/HA/FE 3.1-4 CM $2,919.00

EXC BEN LES SC/HAN/FEET > 4 CM $2,919.00

EXC BEN LES F/E/E/N/L <.5CM $1,006.00

EXC BEN LES F/E/E/N/L 0.6-1 CM $993.00

EXC BN LESN FAC1.1-2 CM $1,422.00

EXC BN LESN FAC 2.1 - 3 CM $1,944.00

EXC TR-EXT MLG+MARG 1.1 - 2 CM $993.00

EXC TR-EXT MLG+MARG > 4 CM $2,919.00

EXC H-FNK-SP MLG+MARG 1.1-2 CM $1,944.00

EXC FACE-MM MALIG+MAR 0.6-1 CM $993.00

EXC FACE-MM MALIG+MAR 1.1-2 CM $993.00

EXC FACE-MM MALIG+MAR 2.1-3 CM $1,944.00

EXC FACE-MM MALIG+MAR3.1-4 CM $1,944.00

INJECTION INTO SKIN LESIONS $245.00

INT REP HFNG <2.5CM $840.00

INT REP HFNG 2.6-7.5 $1,119.00

INTRMED REP FACE<2.5 $371.00

COMP2.6-7.5CM TRUNK $886.00

COMP RP S/A/L2.6-7.5 $1,345.00

COMP REP FACE1.1-2.5 $1,219.00

COMP REP FACE2.6-7.5 $1,732.00

COMP2.6-7.5CME/N/L/E $1,210.00

SKIN TISSUE REARRANGEMENT $2,913.00

SKIN TISSUE REARRANGEMENT $2,913.00

SKIN FULL GRAFT EEN & LIPS $2,913.00

DESTRUC PREMALIG LESION FIRST $382.80 17000

Page 124: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DESTRUCTION OF SKIN LESION $886.00

DESTRUCTION B9 LESION 1-14 $245.00

SILVER NITRATE TREATMENT $394.00

DESTRUCTION OF SKIN LESION $467.00

TRIGGER POINT INJECT 1 OR MORE $462.00

EXC TUM ST FAC/SCAL SUBQ < 2CM $1,944.00

EXC TUM ST FAC/SCAL SUBQ > 2CM $2,919.00

REMOVAL EXOSTOSIS MANDIBLE $3,337.00

CLD REDUCTION NOSE FX W/O STAB $3,337.00

EXC TUM ST N/THO SUBFASC 5CM/> $2,919.00

REMOVE LESION, NECK / CHEST $2,919.00

REMOVE LESION ARM/ELBOW $2,919.00

REMOVEAL FOREARM LESION SUBCU $2,919.00

EXC TUM ST H/F SUBC 1.5 OR GRE $2,919.00

DRAINAGE ABSCESS/HEMATOMA $268.00

DRAINAGE NOSE LESION $646.00

INTRANASAL BIOPSY $1,424.00

REMOVAL OF NOSE POLYP(S) $1,424.00

REMOVAL OF INTRANASAL LESION $3,337.00

REM F.B. NOSE $410.00

RELEASE OF NASAL ADHESIONS $646.00

ABLAT INF TURBINATE, SUPERFICI $1,424.00

CONTROL NASAL BLEED $373.00

ANTER NASAL PCK COMP $531.00

NASAL ENDOSCOPY, DIAGNOSTIC $293.00

NASAL/SINUS ENDOSCOPY, SURGIC $2,142.00

LARYNGOSCOPY FOR ASPIRATION $775.00

LARYNGOSCOPY, DIAG $359.00

VISUALIZATION OF WINDPIPE $1,424.00

PHLEBOTOMY $31.00

REMOVAL VAC DEVICE $3,041.00

TEMPORAL ARTERY PROCEDURE $2,919.00

BIOPSY/REMOVAL LYMPH NODES $4,515.00

BIOPSY OF LIP $646.00

PARTIAL EXCISION OF LIP $3,337.00

INCISION OF LIP FOLD $646.00

EXC/REP MOUTH LESIO W/SIMP REP $3,337.00

EXC/REP MOUTH LES W COMP REPAI $3,337.00

EXC OF FRENUM,LABIAL OR BUCCAL $3,337.00

BIOSPY OF TONGUE; ANTERIOR 2/3 $1,424.00

BIOPSY OF FLOOR OF MOUTH $1,944.00

EXC LES OF TONGUE W/O CLOSURE $3,337.00

EXC LESION TONG W/CLOS ANT 2/3 $3,337.00

EXCISION OF LINGUAL FERNUM $1,424.00

DRAIN ABC, CYST, HEM FROM DENT $190.00

DRAINAGE OF TONSIL ABSCESS $646.00

BLADDER IRRIG CONT D $449.00

CATH IN/OUT RESIDUAL $525.00

CHANGE OF BLADDER TUBE $321.00

TREATMENT OF BLADDER LESION $427.00

Page 125: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

COMPLEX CYSTOMETROGRAM $1,083.00

COMP CYSTOMETROGRAM W/VOID $1,083.00

COMP CYSTO W VOID PRESS $1,083.00

COMPLEX UROFLOMETRY $269.00

ELECTROMYOGRAPHY STUDIES $269.00

BLADDER SCAN $525.00

DILA URE STRI BY PASS DILA M $427.00

DEST OF LESIO PENIS,SIMPLE ELE $2,913.00

CIRCUMCISION $1,983.00

INJ OF CORPORA CAVERNOSA $427.00

FORESKIN MANIPULATION $427.00

VASECTOMY, UNI OR BILATERAL $3,109.00

BIO, PROSTATE; NEEDLE OR PUNCH $3,109.00

PLACE OF INTERSTIT DEVICE/RADI $2,119.00

FIT/INSERT PF PESS OR OTH DEVI $291.00

INJ ANESTH; OTHR PERI NRV/BRAN $1,041.00

POST TIB NEUROSTIM SINGLE TX $462.00

EXC EYEL LESW/O CLOSE/SIMP REP $1,438.00

DRAIN EXT EAR, ABS/HEMA; COMPL $3,363.00

EXC ST LESION EXT AUDITORY CAN $2,919.00

REM FB EXT AUD CANA W/O GEN AN $363.00

REM IMPACT EAR WAX INSTRU UNIL $630.00

DEBRIDE MASTOIDEC CAVITY SIMPL $245.00

INCISE INNER EAR $1,424.00

CT HEAD/BRAIN W/O CONTRAST $1,425.00

CT HEAD/BRAIN W & W/O CONTRAST $2,351.00 70470

CT ORB SEL MID-INN EAR W/O CON $1,402.00

CT ORB SEL MID-INNE EAR W&W/O $1,887.00

CT MAXILLOFACIAL W/O CONTRAST $1,441.00

CT SOFT TISSUE NECK W/O CONTRA $1,505.00

CT SOFT TISS NECK W CONTRAST $1,835.00

CT ST NECK WITH & W/O CONTRAST $2,166.00

CT THORAX W/O CONTRAST $930.00

CT THORAX WITH CONTRAST $1,977.00

CT CERVICAL SPINE W/O CONTRAST $1,685.00

CT PELVIS W/O CONTRAST $1,565.00

CT PELVIS WITH CONTRAST $1,784.00

CT UPPER EXT W/O CONTRAST $1,183.00

CT LOWER EXT W/O CONTRAST $1,377.00

CT LOW EXT WITH & W/O CONTRAST $2,106.00

CT ABD W/O CONTRAST $1,426.00

CT ABD WITH CONTRAST $2,197.00

CT ABD WITH & W/O CONTRAST $2,494.00

CT ABD & PELVIS W/O CONTRAST $1,901.00

CT ABD & PELVIS WITH CONTRAST $2,969.00

CT ABD & PELVIS W & W/O CONT $3,355.00

ANGIOGRAPHY EXTREMI UNILATERAL $2,723.00

ULTRASOUND OF HEAD AND NECK $424.00

US OF ABDOMINAL COMPLETE $509.00

ECHO EXAM OF ABDOMEN $377.00

Page 126: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ULTRASOUND, TRANSRECTAL $318.00 76872

US GUIDED NEEDLE PLACEMENT $453.00

UNLISTED ULTRASOUND $495.00

VENOGRAM, UNILATERAL $2,337.00

HEPATIC FUNCTION PANEL $158.00

URINALYSIS BY DIPSTICK W/MICRO $9.00

UA BY DIPSTICK W/O MICRO $10.00

CREATININE; BLOOD $50.00

PSA; TOTAL $83.00

CYTOPATH CELL ENHANCE TESH $136.00

CYTP URNE 3-5 PROBES EA SPEC $980.00

SURGICAL PATH LVL 2 $158.08

TISSUE EXAM BY PATHOLOGI LVL 4 $247.00

SPECIAL STAINS GROUP 2 $147.00

IMMUNOHISTO ANTIBODY SLIDE $524.00

INSITU HYBRIDIZATION MANUAL $490.00

NASOPHARYNGOSCOPY W/ENDOSCOP $465.00

PURE TONE AUDIOMETRY; AIR ONLY $190.00

SP AUDIO THRES WITH SP RECOG $64.00

COMP AUDIOMETRY EVAL&SP RECOG $269.00

TYMPANOMETRY $64.00

EVOKED AUDITORY TEST LIMITED $438.00

UP/LOW EXTREMITY ART 2 LEVELS $357.00

DUP UP EXT ART UNI /LIMIT STUD $266.00

DUPLEX EXT VEINS; BILATERAL $874.00

DUPLEX EXT VEINS;UNILATERAL $533.00

DUPLEX HEMODIALYSIS ACCESS $191.00

ICUT ALLERGY TEST DRUG/BUG $116.00

PRO ALLERGY IMT $66.00 95115

IMMUNOTHERAPY 2+ INJECTIONS $64.00

ANTIGENS-ALLERG IMMUN; SGL/MUL $64.00

UNLISTED ALLER/CLINICA IMMUNOL $27.00

CANALITH REPOSITIONING PROC $112.00

IM/SQ INJECTION $134.00 96372

CHEMO HORMON ANTINEOPL SQ/IM $198.00

SELECTWND DEBRIDE 20 CM OR < $270.00

NEW PATIENT VISIT LEVEL 1 $125.00

NEW PATIENT VISIT LEVEL 2 $125.00

NEW PATIENT VISIT LEVEL 3 $125.00

NEW PATIENT VISIT LEVEL 4 $125.00

NEW PATIENT VISIT LEVEL 5 $125.00

EST. PATIENT VISIT LEVEL 1 $125.00

EST. PATIENT VISIT LEVEL 2 $125.00

EST. PATIENT VISIT LEVEL 3 $125.00

EST. PATIENT VISIT LEVEL 4 $125.00

EST. PATIENT VISIT LEVEL 5 $125.00

SMOKING CESSATION 3-10MIN $59.00

SMOKING CESSATION >10MIN $68.00

PSA SCREENING $121.00

PULMONARY REHAB W/EXER KX $174.00

Page 127: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PNEUMOVAX ADMIN $148.00

TRINTELLIX 10 MG TABLET $17.00

INCISI& REM FB SQ COMPLICATED $2,919.00

EXC BEN LESI T/A/L; 3.1-4.0 CM $1,944.00

FLU SHOT ADMIN $91.00

CAPILLARY BLOOD DRAW $8.00

SIM REP OF SUPER WND 2.5/LESS $245.00

SIM REP OF SUPER WND 2.6 -7.5 $245.00

INTERMEDI REP 2.5 CM OR LESS $467.00

INTERMEDI REP 2.6 CM TO 7.5 $467.00

INCISION & DRAINAGE OF SEROMA $1,944.00

PUNCTURE ASPIRATIO BREAST CYST $993.00

PUNCTURE ASP EA ADD BREA CYST $293.00

NEW PATIENT LEVEL 1 $256.00

EST PATIENT LEVEL 1 $256.00

EST PATIENT LEVEL 2 $125.00 99212

EST PATIENT LEVEL 3 $125.00 99213 G0463

EST PATIENT LEVEL 4 $256.00 99214

EST PATIENT LEVEL 5 $256.00

INSERT PLEURAL CATH (ER) $4,493.00

SO BASOFUNCTION HRT PT BLUE V $371.00 86352

SO SULF HYPO PANEL QUANT URINE $795.00 80377

CRESEMBA 186 MG CAPSULE $118.00

SO HLA-A29 DETERMINATION $149.00 81374

SO MUMPS VIRUS RNA, QUAL PCR $96.00 87798

SO IODINE SERUM $50.00 82542

SO SCHISTOSOMA AB IGG FMI $36.00 86682

SO EPIDERMAL AB W/REFLEX TO TI $66.00 86255

SO INTERCELLULAR SUBSTANCE AB $33.00 86256

SO BASEMENT MEMBRANE ZONE TITE $33.00 86256

SO DESMOGEIN AB (1 & 3) $72.00 83520

SO BULLOUS PEMPHIGOLD BP 230 I $36.00 83520

SO BULL PEMPH ANTIGEN AB $36.00 83520

SO T-SPOT.TB TEST $205.00 86481

I&D COMPLEX $472.00 10061

CALDOLOR 800 MG VIAL $163.00 J1741

EPLERENONE 25 MG TABLET $6.00

SO PROLACTIN TOTAL & MONOMERIC $106.00 84146

INSERT CVL-DOCTOR $205.00 36556

SO BIOTIN (VITAMIN B7) $30.00 84591

SO TIF1 GAMMA (155/140) (EIA) $36.00 83520

EGD W/REM FB & DILATATION $4,369.00

SO IHC QUANT MORPH ANALYSIS $343.00 88360

ENTRESTO 24/26 MG TABLET $11.00

VELTASSA 8.4 GM PACKET $48.00

DEBRIDEMENT BONE 20 SQ CM /< $540.00 11044

PRIALT 100MCG/ML $2,267.00 J2278

AMIODARONE 900 MG/500ML D5W $444.00 J0282

FONDAPARINUX 5MG SYRINGE $633.00 J1652

P2Y12 $59.00 85576

Page 128: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO HLA-A HIGH RESOLUTION $487.00 81380

SO HLA-B HIGH RESOLUTION $487.00 81380

SO HLA-C HIGH RESOLUTION $487.00 81380

METANEB INITAL $334.00 94669

CT GUIDED ABSCESS DRAINAGE $119.00 75989

PT EVAL, LOW COMPLEXITY, 20MIN $168.00 97161

PT eval, moderate comple 30min $168.00 97162

PT eval, High complexity 45min $168.00 97163

PT Re-eval est plan of care $114.00 97164

OT eval, Low comple 30min $162.00 97165

OT EVAL, MOD COMPLEXITY, 45MIN $162.00 97166

OT EVAL, HIGH COMPLEX, 60MIN $178.00 97167

OT Re-eval est plan of care $107.00 97168

RISPERDONE 4MG OD TABLET $21.00

ETOPOSIDE 20MG/ML VIAL $10.00

CPAP/HFT INITIAL DAY $334.00 94660

CLOSED TX WRIST FX /MANIPULATI $2,497.00

METANEB SUBSEQUENT $334.00 94669

PRADAXA 110 MG CAPSULE $10.00

THEOPHYLLINE 300 MG ER TABLET $5.00

FENTANYL 500MCG/50 ML BAG $322.00 J3010

SO ORGANOCHLOR PEST BLOOD TEST $15.00 82441

DIGITAL MAMMO SCREEN W/CAD UN $253.00 77067 G0202

SO DILTIAZEM SERUM $38.00 80299

SO TRYPANSOMA CRUZI AB TOTAL $34.00 86753

SO DRUG ABUSE PANEL 9 $412.00 80307

TECENTRIQ 1200MG VIA PER 10MG $12,937.00 J9022

PROCALCITONIN $74.00 84145

SO PHOSPHATIDYLETHANOLAMINE AB $108.00 83520

REM IMPACT CERUM USE IRRIGATIO $113.00

MOD SED SAME PHYS <5YRS $79.00 99151

COGNITIVE TEST BY HC PRO $242.00 96125

SO SENSITIVITY-AGAR DILUTION / $14.00 87181

SO BC-ANAEROBE ADDITIONAL ID $23.00 87076

ASSESS APHASIS W/ I&R PER HR $226.00 96105

MITOMYCIN 40 MG VIAL $3,597.00 J9280

ARTHROGRAM ANKLE $923.00 73615

INJECT FOR ANKLE ARTHROGRAM $327.00 27648

SO ADENOVIRUS DNA QUAL PCR $97.00 87798

SO RAV IGG & IGM SERUM $72.00 86756

UROGESIC BLUE 0485015130 $7.00

SO CORDSTAT 5 $160.00 80307

SO METHEMOGLOBIN $16.00 83050

SO SULFHEMOGLOBIN $23.00 83060

DIGITAL MAMMO SCREEN W/CAD BIL $297.00 77067 77067

J-WIRE PLACEMENT EACH ADD $263.00

BIOPSY STEREOTACTIC RT $1,873.00

MAMMO UNILATERAL RT $147.00 77065 77065

J-WIRE PLACEMENT LT $1,159.00

MAMMO SURG SPECIMEN $564.00 76098

Page 129: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

J-WIRE STEREO PLACEMENT RT $1,053.00

MAMMOGRAM BILATERAL $187.00 77066 G0204

J-WIRE STEREO PLACEMENT LT $1,053.00

J-WIRE STEREO PLACEMENT EACH A $239.00

MAMMO SCREEN UNI LT $155.00 77067 G0202

DIGITAL MAMMO DIAG BIL W/CAD $315.00 77066 G0204

BIOPSY STEREOTACTIC LT $1,702.00

MAMMO SCRN/INDUSTRY $155.00 77067

MAMMO SCREEN UNI/RT $155.00 77067 G0202

MAMMO UNILATERAL, LT $147.00 77065

BIOPSY STEREOTACTIC EACH ADD $1,702.00

DX MAMMO INCL CAD UNI RT $259.00 77065 G0206

DIGITAL MAMMO SCR/INDU W/CAD $297.00 77067

J-WIRE PLACEMENT RT $1,053.00

DIGITAL MAMMO SCREEN W/CAD UN $253.00 77067

MRI CHEST WO/W CONTRAST $2,601.00 71552

MRI UP EXT JOINT LT WO/W CONT $3,768.00 73223

MRI BRAIN WO/W CONTRAST $3,238.00 70553

MRI THORACIC SPINE W/CONTRAST $3,510.00 72147

MRI LO EXT LTW/O CON $1,734.00 73718

MRI THORACIC SPINE WO/W CONT $3,510.00 72157

MRI ORB/FAC/NECK W/ CONTRAST $2,613.00 70542

MRI LO EXT LT WO/W CONT $2,878.00 73720

MRI UP EXT LT WO/W CONT $2,807.00 73220

MRI LO EXT JOINT LT WO/W CONT $2,764.00 73723

MRI UP EXT LT W/CONTRAST $2,807.00 73219

GADOLINIUM $12.00 A9579

INSERT INTER FID MARK, PERC, R $2,623.00

MRI UP EXT JOINT RTWO/W CONT $3,768.00 73223

MRI BRAIN WITH CONTRAST $3,238.00 70552

MRI ABDOMEN WO CONT $1,490.00 74181

MRI UP EXT RT WO CON $1,691.00 73218

MRI BREAST MULT DUCT $1,232.00 77054

MRI ABDOMEN W/CONTRAST $2,483.00 74182

MRI UP EXT JNT LT WO $2,270.00 73221

MRI LO EXT LT W/CONTRAST $2,878.00 73719

MRI PELVIS WO/W CONTRAST $2,695.00 72197

MRA HEAD WO CONST $2,142.00 70544

MRI CHEST WO CONT $2,200.00 71550

MAGNETIC RESONANC SPECTROSCOP $841.00 76390

EOVIST 10ML VIAL $170.00 A9581

MRI CERVICAL SPINE WO/W CONT $3,404.00 72156

MRI UP EXT LT WO $1,691.00 73218

MRA NECK WO CONST $1,880.00 70547

MRI PELVIS WO CONST $1,617.00 72195

MRI TM JOINT $2,200.00 70336

MRI ABDOMEN WO/W CONTRAST $2,483.00 74183

MRI BREAST SNGL DUCT $1,232.00 77053

MRI LO EXT RT WO $1,734.00 73718

MRI LO EXT JOINT RT WO/W CONT $2,764.00 73723

Page 130: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

MRA ABD W & WO CONTRAST $2,054.00 74185

MRI CERV SPINE WO $2,051.00 72141

MRI THROAC SP WO $2,115.00 72146

MRI LO EXT RT WO/W CONT $2,878.00 73720

MRI LUMBAR SPINE W/CONTRAST $3,494.00 72149

MRI LO EXTRE JOINT W CONTRAST $2,183.00 73722

MRI UP EXT RT WO/W CONT $2,807.00 73220

MRI LOWER EXT W/CONTRAST RT $2,878.00 73719

MRI LUMB SPINE WO $2,105.00 72148

MRI CARDIAC W & W/O CONTRAST $1,470.00 75561

MRI UP EXT JOINT W/CONT $3,768.00 73222

MRI LUMBAR SPINE WO/W CONT $3,494.00 72158

MRI PELVIS W/CONT $2,695.00 72196

MRI LO EXT JT LT WO $2,323.00 73721

MRI ORB/FAC/NECK WO/W CONTRAST $2,613.00 70543

MRI BRAIN W/O CONT $1,943.00 70551

MRI CHEST W CONST $2,123.00 71551

MRI LO EXT JNT RT WO $2,323.00 73721

MRA NECK WO/W CONTRAST $3,132.00 70549

MRI ORB/FAC/NECK WO $1,568.00 70540

MRI UP EXT JNT RT W/O CONTRAST $2,270.00 73221

MRA HEAD WO/W CONTRAST $3,556.00 70546

MRI CARDIAC W/O CONTRAST $932.00 75557

US BREAST BIOPSY LT $1,702.00

US OB COMPLETE $233.00 76805

US J-WIRE PLACEMENT RT $1,053.00

US SCREENING AAA $253.00 76706

US OB LIMITED 1+ FETUS $233.00 76815

US J-WIRE PLACEMENT EACH ADD $526.50

OB US <14 WKS ADDL FETUS $92.00 76802

US OB LEVEL 11 SINGLE FETUS $491.00 76811

US J-WIRE PLACEMENT LT $1,053.00

US HEPATIC $377.00 76705

US BIO PROFILE W/O NON-STRESS $294.00 76819

US OTHER $495.00 76999

US FTL AGE FLUP Q FS $494.00 76816

US PSUDO-ANRYSM COMP $423.00 76936

US CHEST $316.00 76604

US GUIDED NEDLE PLCM $453.00 76942

US GALLBLADDER $377.00 76705

US PELVIS TRANS.VAG. $567.00 76830

US PARACENTESIS DIAG $922.00 49083

US GUIDANCE INTRAOP $403.00 76998

US ABD LIMITED $377.00 76705

US THYROID $424.00 76536

US INF HIP W/MANPLTN $370.00 76885

US OB 14WK EA AD FTS $132.00 76810

US OF SPINE $163.00 76800

US PELVIS COMPLETE $473.00 76856

US GUIDED NEEDLE BX $453.00 76942

Page 131: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

US RENAL, LEFT $377.00 76775

US NEEDLE BIOPSY $1,759.00

US PARACENTESIS THERP $922.00 49083

US THROMBIN INJECTION $453.00 76942

US BABY HEAD $241.00 76506

US CYST ASPIRATION $453.00 76942

US BREAST UNI $279.00 76642

US AORTA $377.00 76775

US S TIS HEAD/NECK $424.00 76536

US BREAST BIOPSY RT $1,702.00

US INF HIP WO/MANPLT $423.00 76886

US BREAST KOMEN $391.00 76642

OB US DETAILED ADDL FETUS $555.00 76812

US EXTREMITY RT $193.00 76882

US RENAL BILATERAL LIMITED $377.00 76775

US PELVIC LIM/FOLLUP $284.00 76857

US TV PREG UTERUS $415.00 76817

US RENAL BILATERAL COMPLETE $738.00 76770

US BREAST BIOPSY EACH ADD $1,702.00

OB US <14 WKS SING FETUS $174.00 76801

US GUIDE AMNIOCENTES $275.00 76946

US ABDOMEN $509.00 76700

US SCROTUM $494.00 76870

US EXTREMITY, LEFT $193.00 76882

Epi Sing inject lumbar/sacral $1,507.00

Epi Inject ea add lumb/sacral $616.00

Facet Ner Inj Parave Facet Lum $2,121.00

Nerv Destruct Facet Ner Lumbar $3,593.00

Facet Nerve Inj =/> 3rd $596.00

Nerv Dest Facet Nerv Lumb ea $998.00

Botox Inject ea add 1-4 muscle $1,191.00

Botox Inject 1 Ext > 5 muscle $1,191.00

Botox Inj 1 Ext ea add > 5 $1,191.00

Botox Inject Trunk Muscle 1-5 $1,191.00

Botox Inject trunk Muscle >6 $1,191.00

Neuroplasty; Nerv of hand/foot $2,121.00

Neuro Maj Peri Nerve AorL open $2,121.00

Neur Maj Perip Nerv Brach Plex $2,121.00

Neuroplasty Ulnar Nerve Elbow $2,121.00

Neuroplasty Ulnar Nerve Wrist $2,121.00

Neuro Med Nerve Carpal Tunnel $2,121.00

Internal Neurolysis $2,121.00

Facet Nerv Inj Para Lum 2 lev $2,121.00

Facet Nerv Inj Lum 3rd or more $596.00

Inj Anesth Agent, Lumbar/Thora $1,312.00

Inj Anesth Agent Celiac Plexus $1,312.00

Chemodenervat Muscle innverted $1,191.00

Destr Neuro ag other peri nerv $1,191.00

SO INSTU HYBRID EA ADD SINGLE $174.00 88364

REMOVAL FB PHARYNX $542.00

Page 132: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO OPIATES URINE $160.00 G0480

CT CHEST WO CNTRST $930.00 71250

CT CHEST WI CNTRST $1,977.00 71260

CT CERV SPINE WO CNT $1,834.00 72125

CT PELVIS WI CNTRST $1,784.00 72193

CT UP EXT RT WO/CONT $1,083.00 73200

CT LO EXT WO/CONTRAS $1,377.00 73700

CT ABDMN WI CNTRST $2,197.00 74160

CT NECK WI/WO CNTRST $1,968.24 70492

CT NECK WI CNTRST $1,668.00 70491

CT NECK WO CNTRST $1,882.00 70490

CT HEAD WO/WI CNTRST $2,136.75 70470

CT CHEST WO/WI CNTRS $2,632.62 71270

CT HEAD WO CONTRAST $2,000.00 70450

CT PELVIS WO CNTRST $1,778.00 72192

CT THOR SPINE WO CNT $1,565.00 72128

CT LUMBOSPINE WO CNT $1,531.00 72131

CT MAXILLOFACIAL WI $1,572.00 70487

CT MAXILLOFACIAL W/O $1,441.00 70486

CT ABDMN WO CNTRST $1,426.00 74150

CT LO EXT LT WO/CTS $1,377.00 73700

CT UP EXT WO/CTS LT $1,183.00 73200

CTA HEAD WO/W SEC $1,482.00 70496

CTA NECK WO/W SEC $1,565.00 70498

CTA CHEST WO/W SEC $2,321.00 71275

CTA ABD WO/W SEC $837.00 74175

CT ABD/PELVIC W/O CONTRAST $2,600.00 74176

CT ABD/PELVIC W/CONTRAST $3,800.00 74177

CT ABD/PELVIC W & W/O CONTRAST $3,355.00 74178

CT UP EXT RT W/CONTR $1,343.75

CT UP EXT RTW/WO CON $1,666.25 73202

CT PELVIS WO/WI CNTR $1,791.72 72194

CT MAXILLOFAC WO/WI $1,925.70 70488

CT LUMBOSPINE WO/WI $3,230.41 72133

ART SEG (ABI ONLY) $357.00 93922

ART. DUPLEX BILAT $866.97 93925

ART. UNILAT STDY LT $513.00 93926

ART. UNILAT STUDY RT $513.00 93926

CAROTID DUPLEX SCAN $645.00 93880

ECHO, 2D/M MODE $714.78 93306

ECHO,FOLLOW UP/LIMIT $627.00 93308

HOLTER MONITOR 24HR $121.04 93225

SCAN ANLYSIS W/REPRT $178.00 93226

VENOUS DUPLEX $484.00 93971

VENOUS DUPLEX BILATERAL $793.76 93970

INSERT NON-TUNNEL CVC > 5 YRS $255.00 36556

INJECT EPIDURAL BLOOD/CLOT $680.00 62273

INJECT ANESTH AGT SUPRA NERVE $425.00 64418

INJECT ANESTH AGT INTERCOSTAL $425.00 64420

INJ ANESTH AGT INTERCOSTAL NER $680.00 64421

Page 133: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

INJ ANESTH AGT ILIOINGUINAL NE $425.00 64425

INJ ANESTH AGT PUDENDAL NERVE $425.00 64430

INJ ANESTH AGT PARACERV UTER N $425.00 64435

INJ ANESTH AGT SCIATIC NERVE $595.00 64445

TAP BLOCK, BILATERAL $425.00 64488

US GUIDE FOR VASCULAR ACCESS $85.00 76937

US GUIDE NEEDLE PLACEMENT $85.00 76942

ENDOTRACH INTUBATION $510.00 31500

INSERT ART LINE $170.00 36620

INSERT NON-TUNNELED CVC <5YRS $255.00 36555

NERVE BLOCK BRACHIAL $680.00 64415

NERVE BLOCK AXILLARY $680.00 64417

INJ ANESTH;OTHER PERIPH NRV/BR $425.00 64450

CT ANGIOGRAPHY ABD ARTERIES $1,314.00 75635

DUPLEX UE ART/BPG; BILATERAL $465.00 93930

EXPAREL SUSP 133MG 10ML VIAL $788.00 C9290

CTA ABD & PELVIS W&W/O CONTRAS $963.00 74174

TEFLARO 600 MG VIAL $539.00 J0712

SPECIAL ANESTH SERV <1 OR >70 $85.00 99100

ANESTHESIA COMPLI ER CONDITION $170.00 99140

NEOSTIGMINE 3MG SYRINGE $188.00 J2710

ROOM (PRIVATE) $709.00

ROOM(SEMI PRIVATE) $709.00

ROOM CHARGE (IMCU) $745.00

PRIVATE RM - RECUP $702.00

IRRIGATION OF CORPORA CAVERNOS $444.00

SEMI-PRIVATE RECUP $750.00

PROCRIT 40,000 UNIT VIAL $1,648.00 J0885

NEULASTA MG/.6MLSYR $9,348.00 J2505

NEUPOGEN 480 MCG $1,273.00 J1442

NEUPOGEN 300 MCG $1,161.00 J1442

ACTIVASE 100MG $10,759.00 J2997

SO IBSDETEX $72.00 83520

SHIGA TOXINS,EIA W/REF TO E $43.20 87427

SO BUPRENORPHINE QUANT URINE $236.00 80348

I & D ABSCESS SIMPLE/SINGLE $151.00 10060

I & D ABSCESS COMPLICATED/MULT $279.00 10061

I & D PILONI CYST, SIM/SINGLE $159.00 10080

I & D PILONIDAL CYST, COM/MULT $263.00 10081

INCISION & REMOVAL OF FB, SUBQ $160.00 10120

INC & REM OF FB, COMPLICATED $289.00 10121

DEB, SUBQ, FIR 20 SQ CM < LESS $146.00 11042

DEBRIDE, SUBQ, EA ADD 20 SQ CM $42.00 11045

DEBRIDE,MUSCLE, FIRST 20 SQ CM $365.00 11043

DEBRIDE MUSCLE EA ADD 20 SQ CM $90.00 11046

DEBRIDE, BONE, FIRST 20 SQ CM $362.00 11044

DEBRIDE, BONE, EA ADD 20 SQ CM $157.00 11047

PARING/CUTTING BEN LES – SIN $27.00 11055

PARING OR CUTTING BEN LES 2-4 $38.00 11056

PARING OR CUTTING BENI LES >4 $49.00 11057

Page 134: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BIOPSY OF SKIN, SINGLE LESION $77.00 11102

BIOPSY, SKIN, EA ADD LESION $40.00 11103

TRIMMING OF NAILS $14.00 11719

AVULSION OF NAIL PLATE $90.00 11730

AVULSION OF NAIL PLATE, EA ADD $30.00 11732

EXC OF NAIL MATRIX, (INGROWN) $178.00 11750

REP SIM, SCA, TRU, EXT <2.5 CM $71.00 12001

REP SIM, SCA, R,EX 2.6-7.5 CM $94.00 12002

REP SIM, S,TR, EX 7.6-12.5 CM $117.00 12004

REP SIM, S, T, E 12.6-20.0 CM $151.00 12005

REP SIM, SCA, TRU, EXT > 30 CM $233.00 12007

REPAIR SIMPLE, FACE, <2.5 $87.00 12011

REPAIR SIMPLE, FACE, 2.6-5.0CM $93.00 12013

REPAIR SIMPLE, FACE, 5.1-7.5CM $119.00 12014

REPAIR SIMPLE, FACE 7.6-12.5CM $150.00 12015

REP SIMPLE, FACE, 12.6-20.0CM $204.00 12016

REP SIMPLE, FACE, 21.0-30.0CM $247.00 12017

REPAIR SIMPLE, FACE, OVER 30CM $280.00 12018

REP INTER SCALP, TRU, EXT <2.5 $238.00 12031

REP IN SCA, TRU, EXT 2.6-7.5CM $303.00 12032

REP INT SCA,TRU,EXT 7.6-12.5CM $323.00 12034

REP INTER SC, T, E 12.6-20.0CM $372.00 12035

REP INT SC,TR,EX 20.1CM-30.0CM $433.00 12036

REP INT SC, TR, EXT > 30.0 CM $510.00 12037

REP INTER NE, HA, FT, GEN <2.5 $235.00 12041

REP INTER N, H,F, G 2.6-7.5 CM $313.00 12042

REP INT N,H,FT, GEN 7.6-12.5CM $336.00 12044

REP INT N,H,FT, G 12.6-20.0CM $418.00 12045

REP INT N,H,FT, G 20.1-30.0CM $475.00 12046

REP INTER N,H,F,G > 30.0 CM $572.00 12047

REPAIR INTERMEDIATE FACE <2.5 $267.00 12051

REPAIR INTER FACE 2.6-5.0CM $318.00 12052

REPAIR INTER FACE 5.1-7.5CM $340.00 12053

REP INTER FACE 7.6-12.5CM $348.00 12054

REPAIR INTER FACE 12.6-20.0CM $476.00 12055

REPAIR INTER FACE 20.1-30.0CM $536.00 12056

REPAIR INTER FACE > 30.0CM $605.00 12057

REPAIR COMP TRUNK, 1.1 – 2.5CM $322.00 13100

REPAIR COMP TRUNK, 2.6-7.5CM $395.00 13101

REP COM TR, EA ADD 5CM OR LESS $117.00 13102

REP S, A, LEGS 1.1- 2.5 CM $368.00 13120

REP COMP, S, A, L 2.6-7.5 CM $418.00 13121

REP , S, A, L EA AD 5CM < LESS $136.00 13122

REP COMP NE, HDS, FT 1.1-2.5 $392.00 13131

REP COM NE, HDS, FT 2.6-7.5CM $494.00 13132

REP CO N, H, F EA A 5 CM< LESS $207.00 13133

REP COMPLEX FACE, 1.1 – 2.5CM $450.00 13151

REP COMPLEX FACE, 2.6 - 7.5CM $546.00 13152

REP COMP FA, EA ADD 5 CM <LESS $224.00 13153

AP SK S, T, A, L, 1 25 SQ CM $202.00 15271

Page 135: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

APP SK SU TO T,A,L EA AD 25 SQ $28.00 15272

APP SK SUB F,S,N,H,F,G 100 SQ $154.00 15275

APP SK S TO F,S,N,H,F,G EA25SQ $41.00 15276

INITIAL TREAT 1ST DEGREE BURNS $74.00 16000

DRESSING/DEBRIDEMENT – SMALL $85.00 16020

DRESSING/DEBRIDEMENT – MED $174.00 16025

DRESSING/DEBRIDEMENT – LARGE $208.00 16030

REMOVAL OF FB – MUSCLE, SIMPLE $227.00 20520

REMOVAL OF FB – DEEP, COMP $383.00 20525

NEG PRE WND , DME, </= 50 SQ C $41.00 97605

NEG PRESS WND DME, > 50 SQ CM $44.00 97606

HBO SUPERVISION PER SESSION $174.00 99183

SMOKE CESSAT COUNS 3-10 MIN $20.00 99406

SMOKE CESSAT COUNS OVER 10 MIN $42.00 99407

I & D HEMATOMA $183.00 10140

EXCISION BENIGN LESION 2.1-3.0 $227.00 11403

TENOTOMY-TOE SINGLE TENDON $328.00 28010

APPLY RIGID TOTAL CONTACT CAST $165.00 29445

APPLY COMPRESSION WRAP $57.00 29580

SELECTIVE DEBRIDE W/O ANESTHES $39.00 97597

ROOM(PRIVATE 3RD) $750.00

ROOM(PRIVATE 4TH) $709.00

SELE DEBRIDE W/O ANES ADD 20CM $19.00 97598

PRIVATE ROOM(J-CAMP) $709.00

ROOM(PRIVATE) $750.00

NON-SELECTIVE DEBRIDE WOUND $29.00 97602

NEW PATIENT LEVEL 2 $81.00 T1015

NEW PATIENT LEVEL 3 $121.00 T1015

NEW PATIENT LEVEL 4 $205.00 T1015

NEW PATIENT LEVEL 5 $267.00 T1015

EST PATIENT LEVEL 1 $16.00 99211

EST PATIENT LEVEL 2 $41.00 T1015

EST PATIENT LEVEL 3 $82.00 99213

SEMI PRIVATE ROOM $709.00

EST PATIENT LEVEL 4 $125.00 T1015

EST PATIENT LEVEL 5 $176.00 T1015

SUBSUQ HOSP VISIT $115.00 99232

IP CONSULT LEVEL 3 $323.00 99253

IP CONSULT LEVEL 4 $465.00 99254

APPLY MULTI LAYER COMP WRAP $21.00 29581

EXCISION LESION BREAST <2.5 CM $422.00 11400

SO D-LACTATE $30.00 83605

SO SICKLE CELL SCREEN $16.00 85660

MORPHINE 0.5MG SYRINGE $46.00 J2270

EPHEDRINE 25 MG/5 ML SYRINGE $163.00

PHENYLEPHRINE 1MG/10 ML SYR $41.00

SUCCINYLCHOLINE 100MG/5ML SYR $128.00

ELEC STIM PT UNATTENDED $102.00 G0283

MANUAL THERAP EA 15 PT $92.00 97140

ORTHO FIT/TRAIN 15 PT $234.00 97760

Page 136: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CANALI REPOSTIT PER DAY $112.00 95992

PT Re-eval est plan of $114.00 97164

NEURO REEDUCATION PT $93.00 97112

MCD INDIV TX 15 PT $88.00 97110

CONTRAST BATH 15 PT $86.00 97034

MASSAGE, LOCAL 15 PT $71.00 97124

VASOPNEUMATIC TREATM PT $101.00 97016

TRACTION MECHANICAL $101.00 97012

TENS INITAL APP 15 PT $114.00 97032

US W/POP TX 15 PT $114.00 97035

CANALITH REPOSI PER DAY $112.00 95992

TENS FOLLOW-UP 15MIN PT $114.00 97032

GAIT/TRANS TRAINI 15 PT $91.00 97116

ELEC STIM W/US 15 PT $114.00 97032

GROUP THERAPY PT $74.00 97150

ULTRASOUND 15 PT $92.00 97035

FLUIDOTHERAPY/DRY PT $120.00 97022

NEURO REEDUCATION PT $93.00 97112

WHEELCHAIR MANAG 15 PT $76.00 97542

CHECKO/ORTH-PROS EA 15M $52.00 97760

THERAPUTIC EXC 15 PT $102.00 97110

PT eval, mod comple 30m $168.00 97162

MCD INDIV TX PTA 15 $88.00 97110

PT eval, High com 45min $168.00 97163

IONTOPHORESIS 15MIN PT $132.00 97033

PT EVAL, LOW COM 20MIN $168.00 97161

SO CLONAZE & 7-AMINO CLONAZ UR $236.00 80346

TEST/MEASURE 15 PT $123.00 97750

INFRARED THERAPY PT $50.00 97026

HOME EXER PGM 15 PT $101.00 97535

THERAPUTIC ACT 15 PT $104.00 97530

PROSTHTC TRAIN 15 PT $102.00 97761

ORTHOTIC MGMT&TRAINJ 1ST ENC $234.00 97760

CONTRAST BATH 15 PT $86.00 97034

IONTOPHORESIS 15 PT $132.00 97033

FLUIDOTHERAPY/DRY PT $120.00 97022

THERAPUTIC EX 15 PT $88.00 97110

PROSTHTC TRAIN 15 PT $102.00 97761

TRACTION,MECHANICAL $101.00 97012

ELEC STIM PT UNATTEN $102.00 97014

MCD GRP THPY PTA 15 $69.00 97150

ULTRASOUND 15 PT $114.00 97035

MCD EVAL EA 30 /PT $231.00 97162

INFRARED THERPY PT $50.00 97026

VASOPNEUMATIC TX PT $101.00 97016

MANUAL THRPY EA15 PT $92.00 97140

THERAPUTIC ACT 15 PT $84.00 97530

GAIT/TRANS TRAIN 15 $92.00 97116

FAM/PT TRAIN 15 PT $70.00 97139

TEST/MEASURE 15 MIN $104.00 97750

Page 137: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

TENS FOLLOWUP 15MIN $97.00 97032

MCD GROUP THERAPY $69.00 97150

ORTHO FIT/TR 15 PT $234.00 97760

TENS INIT APPL 15 $97.00 97032

HOME EXER PGM 15 PT $101.00 97535

US W/POP TX 15 PT $114.00 97035

ELEC STIM W/US 15 PT $97.00 97032

MASSAGE, LOCAL 15 PT $71.00 97124

GROUP THERAPY PT $69.00 97150

CAST LONG LEG $154.00 29345

CAST SHORT LEG $92.00 29405

CLOSED REDUC OF COLLES'RADIUS $615.00

IRIGATE CORPORA CAVER PRIAPISM $615.00

X-RAY EXAM, CHEST, 3 VIEW $216.00 71047

X-RAY EXAM, CHEST, >3 VIEW $324.00 71048

X-RAY EXAM, ABD, >2 VIEW $324.00 74021

CHYMOTRYPSIN STOOL SO $124.00 84311

KADCYLA 100 MG VIAL $4,358.44 J9354

ANTI MERKEL CELL PANEL SO $592.00 86256

ORTHO/PROSTC MGMT SBSQ 15MIN $113.00 97763

ORTH/PRO TRAIN/MANAG UP/LOW EX $113.00 97763

ACETAZOLAMIDE BLOOD SO $188.00 80299

HLA-A,B,C LOW RESOLUTION SO $925.00 81372

US, ELASTOGRAPHY, 1ST LESION $273.00 76982

US, ELASTO, EA LESION $273.00 76983

RMVL PERM LDLS PM $6,408.00 33275

PUNCH BX SKIN SINGLE LESION $428.00 11104

PUNCH BX SKIN EA SEP/ADDL $428.00 11105

INCISION BX SKN SINGLE LES $762.00 11106

INCISION BX SKN EA SEP/ADDL $762.00 11107

FNA BX W/US GDN 1ST LES $1,405.00 10005

FNA BX W/US GDN EA ADDL $1,405.00 10006

FNA BX W/FLUOR GDN 1ST LES $1,405.00 10007

FNA BX W/FLUOR GDN EA ADDL $1,405.00 10008

FNA BX W/CT GDN 1ST LES $1,405.00 10009

FNA BX W/CT GDN EA ADDL $1,405.00 10010

FNA BX W/MR GDN 1ST LES $1,405.00 10011

FNA BX W/MR GDN EA ADDL $1,405.00 10012

RMVL SUBQ CAR RHYTHM MNTR $1,405.00 33286

MRI BREAST C-+ W/CAD BI $2,284.00 77049

MRI BREAST W/O CONTRAST UNL $559.00 77046

MRI BREAST W/O CONTRAST BILAT $559.00 77047

DILTIAZEM 25MG/ 5 ML VIAL $11.86

OCREVUS 300 MG VIAL $24,381.44 J2350

OSTEOCALCIN N-MID SO $54.00 83937

CL TX FX PHALNX/PHALANG WO MAN $500.00

REP LAC MOUTH VES 2.5 OR < $415.00

INSERT NON-TUNNEL CVC >5 YRS $255.00 36556

INJECT EPIDURAL BLOOD/CLOT $680.00 62273

INJ ANES AGT SUPRA NERVE $425.00 64418

Page 138: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

INJ ANES AGT INTERCOSTAL $425.00 64420

INJ ANESTH AGT INTERCOSTAL NER $680.00 64421

INJ ANESTH AGT ILIOING NERV $425.00 64425

INJ ANESTH AGT PUDENDAL NERV $425.00 64430

INJ ANESTH AGT PARACERV UTER N $425.00 64435

INJ ANESTH AGT SCIATIC NER $595.00 64445

TAP BLOCK, BILATERAL $425.00 64488

US GUIDE VASC ACCESS $85.00 76937

US GUIDE NEED PLACE $85.00 76942

ENDOTRACH INTUBATION $501.00 31500

INSERT ART LINE $170.00 36620

INS NON-TUNN CVS < 5YRS $255.00 36555

NERVE BLOCK BRACHIAL $680.00 64415

NERVE BLOCK AXIALLARY $680.00 64417

INJ ANESTH;OTHR PERIP NRV/BRAN $425.00 64450

SPECIAL ANESTH SERV<1OR>70 $85.00 99100

ANESTH COMPLI ER COND $170.00 99140

INJ EPID CER/THOR W/O IMA $425.00 62320

INJ EPI CER/THOR W/IMAG $425.00 62321

INJ EPID LUM/SAC W/O IMAG $425.00 62322

TAP BLOCK UNIL BY INJECT $425.00 64486

INJ CNT INF EPD CRV/THR WO IMA $425.00 62324

INJ CNT INF EPD LUM/SAC WO IMA $425.00 62326

INJ CNT INF EPD LUM/SAC W/IMAG $425.00 62326

ANESTHESIA PRO FEE BILLING $85.00

MIRENA 52 MG IUD $1,877.94 J7298

HLA HIGH RESOLUTION TYPING $400.00 81382

HLA LOW RESOLUTION TYPING $375.00 81376

URINE SULFATE $197.00 84392

BUPRENORPHINE 2 MG SL TAB $6.62

TRICYCLICS ANTIDEP ID & QT SO $182.00 80337

NRAS MUTAT ANAL EXON 4 SO $850.00 81403

TTE W/WO FOLWCON DOPPLER $1,586.00 93306

2D TTE W/WO FOL W/CON FU $1,136.00 C8924

TTE W/WO CONT ECG $1,586.00 C8930

HYDRO/APAP7.5/325MG ORAL SOLU $10.00

MEROPENEM 1GM/50ML IVPB $300.25 J2185

BUDESONIDE EC 3MG CAPSULE $30.16

DUROLANE 3ML SINGLE USE $3,075.00 J3490

2D TEE W/WO FOI W/CONT IN $1,586.00 C8925

DA HOSP MAN EPID/SUBARA CON DR $255.00 1996

CLOSED TREAT OF NAV FX FOOT $546.00 28455

VENIPUNCTURE 3OR OLD NEC PHY $24.00 36410

FORESKIN MANIPULATION $534.00

FORESKIN MANIPULATION $266.00 54450

TAP BLOCK UNIL BY INJECTION $425.00 64486

SO ACTH $164.00 82024

SO ALPHA-1- ANTITRYP $89.00 82103

SO AMIKACIN (PEAK OR TROUGH) $94.00 80150

SO ACE/CSF $83.00 82164

Page 139: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO ANTI-DNA-DS $72.00 86225

SO VITAMIN E $83.00 84446

SO CERULOPLASMIN $89.00 82390

SO COMPLEMENT C'5 $140.00 86160

SO COMPLEMENT C3 $120.00 86160

SO COMPLEMENT C4 $120.00 86160

CORTISOL/SER $83.00 82533

SO C-PEPTIDE/SERM $94.00 84681

SO DHEA SERUM $154.00 82626

SO FECAL FAT QUAN $143.00 82710

FERRITIN $112.00 82728

SO FACTOR IX ASSAY $126.00 85250

SO G-6PD $185.00 82955

SO GASTRIN $131.00 82941

HEMOGLOBIN A1C $94.00 83036

SO HAPTOGLOBIN $105.00 83010

SO HEPATITIS BE ANTIBODY $67.00 86707

17-APLHA HYDROXYPROG $92.00 83498

SO IG A/SERUM $61.00 82784

SO IGM/SERUM $61.00 82784

SO INSULIN ANTIBOD $130.00 86337

SO INTRI FACT BL.AB. $100.00 86340

SO LEUKOCYTE ALK P $102.00 85540

SO METANEPHRINE URINE $215.00 83835

MUCOPOLYSACCHARIDES, ACID;QUAN $88.00 83864

PROGESTERONE $113.00 84144

PROLACTIN $101.00 84146

SO PROSTATIC ACD P $76.00 84066

SO RENIN $174.00 84244

SO SELENIUM S $130.00 84255

SO TRANSFERRIN $83.00 84466

SO VITAMIN B6 $154.00 84207

SO VITAMIN C $74.00 82180

KETONE BODY(S) QUANTITATIVE $23.00 82010

SO ALBUMIN;URINE/OTHER SOURCE $32.00 82042

SO ALBUMIN;SERUM, PLASMA/WHOL $27.00 82040

SO ETHANOL $35.00 G0480

SO ALDOLASE $78.00 82085

SO ALDOSTER/SERUM $277.00 82088

SO AMPHETAMIN.URINE $55.00 G0480

SO ANTI-THROMBN III ACT $93.00 85300

SO ARSENIC/QUANTIT $108.00 82175

SO ASPERGIL.ANTI AB PANEL $162.00 86606

SO BENZODIAZEPAM/S $66.00 G0480

BLOOD TYPING; ABO $105.00 86900

BLOOD RH $55.00 86901

SO CAFFEINE $73.00 80155

SO CALCITONIN SERUM $73.00 82308

SO CALCIUM URINE $30.00 82340

SO STONE ANALYSIS $95.00 82365

Page 140: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO CARBONMONOXIDE $68.00 82375

SO CAROTENE $81.00 82380

SO COCAINE/QUNT UA $72.00 G0480

SO COLD AGGLUTININ $61.00 86157

SO COPPER/SERUM AT $44.00 82525

SO COPPER URINE TEST $42.00 82525

CPK, TOTAL $66.00 82550

SO CREATININE; OTHER SOURCE $19.00 82570

CRP $71.00 86140

SO CRYPTO. AG/CSF $90.00 86403

CULTURE STOOL $127.00 87045

URINE UREA NITROGEN $30.00 84540

SO DNA TISSUE $343.00 88182

SO ETHOSUXIMIDE/ZA $84.00 G0480

SO ANA $46.00 86038

FOLATE/SERUM $116.00 82746

FSH,SERUM $112.00 83001

SO HEP B SUR AG W/CONFIRMATION $62.00 87340

SO HEPATITIS B CORE ANTIBODY T $73.00 86704

SO HVA $143.00 83150

SO HLA-B27 $118.00 86812

SO GROWTH HORMONE $83.00 83003

SO HIAA-5 $53.00 83497

SO IG. PROF (G,A,M) $40.00 82784

SO INFLU/A&B ANTTIT $91.00 86710

SO INSULIN/ASSA $61.00 83525

SO KETOSTER-17 U TOT. $73.00 83586

SO LDH ISOENZYEMS $37.00 83625

SO LEAD/BLD. $68.00 83655

SO LIBRIUM $142.00 G0480

SO LIDOCAINE $65.00 80176

SO MANGANESE $84.00 83785

SO MERCURY $116.00 83825

SO METHYLMALONIC/A $195.00 83921

SO METHOTREXATE SR $114.00 80299

SO MUMPS VR/ANT TIT $87.00 86735

SO MYCOPLASMA ANTI. $89.00 86738

SO MYELIN BASIC PRO $93.00 83873

SO MYOGLOBIN/URINE $78.00 83874

SO OLIGOC.BAN.CSF $103.00 83916

SO OSMOLALITY,SERUM $67.00 83930

SO OXALATES QUAN UA $85.00 83945

SO KETOSTEROID 17-; TOTAL $73.00 83586

SO PHOSPHOLIPID/ATN. $169.00 86147

SO PHOSPHORUS INORGANIC $26.00 84100

SO PORPHYRIN/UA QAT $139.00 84120

SO PRIMIDON-MYSOLIN $78.00 80188

SO PROCAINAMID/NAPA $109.00 80192

SO PROTEIN TOTAL;SERUM,PLASMA/ $26.00 84155

PROTHROMBIN TIME $45.00 85610

Page 141: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO THROMBOPLASTIN TIME, PARTIA $66.00 85730

SO RBC FOLATE $118.00 82747

SO SEROTONIN SR/QNT $87.00 84260

SO SICKLE CELL TST $36.00 85660

SO SPERM COUNT/PV $42.00 89310

T3 TOTAL $95.00 84480

SO THY.MICROS/ANTIB $61.00 86376

SO TOXOPLASMA $74.00 86777

TRIGLYCERIDES $38.00 84478

TSH $141.00 84443

ARC ABO GR $105.00 86900

SO VISCOSITY/SERUM $112.00 85810

SO VITAMIN A $90.00 84590

ARC RH $55.00 86901

B12 VITAMIN $129.00 82607

ARC RH PHENO $95.00 86906

ARC DIRECT COOMBS $87.00 86880

SO ZINC/PLASMA $65.00 84630

SO ZINC URINE TEST $39.00 84630

ARC CROSSMATCH $153.00 86922

CLOST. DIFF. TOXIN $80.00 87324

ARC ID PANEL $393.00 86870

SO NORTRIPTY QNT $160.00 80307

SO CATECHLMINS PLS $130.00 82384

SO ERYTHROPOIETIN $151.00 82668

SO IMMUNOGLOBE E $78.00 82785

LH/SERUM $112.00 83002

CYTOMEGALOVIRUS (CMV) $60.00 86644

HIV $79.00 86701

SO MITOCHONDRIA M2 $136.00 83516

SO CMV $85.00 86644

SO DRUG SCR/PLASMA $200.00 80307

VITAMIN D/TOTAL $113.00 82306

SO CPK ISOENZYEMS $70.00 82552

SO LYMES DIS. CONF. $103.00 86617

SO IGG/SERUM $61.00 82784

HEMOGLOBIN FRACT $57.00 83021

SO CITRATE UA $123.00 82507

SO HGB FRAC & QUANTITATION;ELE $43.00 83020

SO TOXOPLAS 1GM/QNT $108.00 86778

SO ARC AGN SCREEN $226.00 86902

SO AFP - TUMOR MARK $93.00 82105

SO HOMOCYSTINE/U $200.00 83090

SO ROTAZYME $84.00 87425

SO VIP $271.00 84586

SODIUM OTHER SOURCE $122.00 84302

SO FLOW CYTOMETRY $444.00 88184

CA-125 $120.00 86304

SO Q FEVER ANTIB $81.00 86638

SO URINE CHLORIDE $50.00 82436

Page 142: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SO CYCLOSPORIN $147.00 80158

SO CHROMOSOME ANALYSIS;COUNT $362.00 88261

SO CHROMATOGRAPHY, QUALITATIV $58.00 84591

CALCIUM, IONIZED IS $113.00 82330

SO PROTEIN C AG $182.00 85302

SO PROTEIN S, TOTAL $39.00 85305

SO CARDIOLIPIN ANTIBODY $160.00 86147

SO THROMBIN TIME $23.00 85670

SO LUP. ANTI COAG $168.00 85705

SO ACE SERUM $109.00 82164

SO VITAMIN D/25 HYD $102.00 82306

SO HISTAMINE 24HR URINE $174.00 83088

SO NUCLEATIDASE-5 $75.00 83915

SO CA 19-9 $114.00 86301

SO DESIPRAMINE $66.00 G0480

SO HEP-DELTA/ANTIB $86.00 86692

SO MICROGLOB. BETA 2 $92.00 82232

HEPATITIS C ANTI $94.00 86803

SO CRYPTOSPOR. AG/F $62.00 87328

SO EHRLICHIA PANEL $68.00 86666

SO ACETYLCHOL REC AB $346.00 83519

SO STOOL PH $78.00 83986

SO RUBEOLA IGM/IGG $86.00 86765

18-HYDROXYCORTICOSTERONE SO $336.00 82542

SO GRAM-NEG BACILLUS GENE PCR $1,820.00 82542

SO NPM1 MUTATION ANALYSIS $371.00 81310

HERPES VIRUS 8 DNA Q. PCR SO $488.00 87799

MOLRASRAF SO $488.00 87799

SO IMMUNOGLOBIN D $66.00 82784

SO CYTOMEGALOVIRUS (CMV) IgM $90.00 86645

SEMI-PRIVATE ROOM $1,815.00

TRYPSIN RIA NON-ANTIBODY $250.00 83519

SO IMM INF AG AB STREP PNEU $57.00 86317

HAEMOPHILUS INFLUENZE B AB $50.00 86684

CALR MUTATION ANALYSIS $332.00 81219

MITOCHONDRIAL TITER $41.33 86256

COLOVANTAGE (METHY SEPT9) $209.18 81327

MITOCHONDRIAL AB SCREEN $41.33 86255

ACTIVATED PROTEIN C RESISTANCE $140.00 85307

EPST BARR ANTIBODY D AB(IgG) S $32.00 86663

DRUG TEST 1-7 DRUG CLASS(ES) $294.13 G0480

DRUG TEST 15-21 DRUG CLASS(ES) $497.00 80377

SO GROWTH FAC. BETA1 (TGF B1) $105.00 83520

SO TOTAL GLUTATHIONE $61.00 82978

FLU VAC QUAD SPLT 0.5ML IM $98.32 90688

REMOV FECAL IMPACT W SEDATION $531.00 45915

REPAIR LIP, FT, VERM ONLY $835.83 40650

ROOM & BOARD - NURSERY $327.00

MONITOR PRESSURE COMPASS CMPRT $198.00

AR-1934BCFT-2 $340.00 C1713

Page 143: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREWS 3.0 LOCKING HEXALOBE $458.00 C1713

STENT, COR RES ONX2.0MMX22MM $2,710.00 C1874

BALLOON NON COMPLIANT 2.0 X 12 $553.00 C1726

COLONSCPY/POLYPECTMY $2,377.00

PARACENTESIS, ABD $1,688.00

SCREW CORTEX 3.5 X 36 MM $87.00 C1713

PRIM ART M-THR MBC SBSQ VSL $3,924.28 37185

PERIPHERAL ARTER DISEASE REHAB $136.33 93668

SO C4a LEVEL $123.51 86160

CLSD TX NASAL BONE FX W/O MAN $333.30 21310

TX METATRSPHLNGL JT DISL WO AN $402.93 28630

SUPPORT ABD/SACRAL LG $58.00 A4461

SUPPORT ABD/SACRAL MED $58.00

SUPPORT ABD/SACRAL SM $58.00

SUPPORT ABD/SACRAL XLG $33.00

CIRCUIT ANES BRTHG KIT ADLT $23.00

BRACE ANKLE UNIVERSAL $71.00

CREAM FREE UP SOFT TISSUE 16OZ $55.00

RESTRAINT POSEY VEST $36.00

CATH TRAY W/O CATH $29.00

CATH TRAY COMP 16FR $48.00 A4344

CATH TRAY COMP 18FR $48.00

CATH THERMODIL/SWANZ 7FR $154.00

KIT CENTRAL VENOUS CATH 7F $169.00 C1751

BAG CATH CLOSED SYS METER $34.00

CATH FOLEY 12FR/5CC $35.00

CATH FOLEY 14FR/5CC $35.00

CATH FOLEY 16FR/5CC $34.00

CATH FOLEY 18FR/30CC $37.00

CATH FOLEY 22FR/30CC $36.00

CATH FOLEY 24FR/5CC $35.00

CATH FOLEY 10FR/3CC $29.00

CATH FOLEY 8FR/3CC $29.00

CATH SUCTION 6FR $32.00

GUIDEWIRE COBRA CG501 $50.00 C1769

COLLAR CERVICAL LG $30.00 L0120

COLLAR CERVICLE XLG $30.00 L0120

COLLAR CERVICLE MED $30.00 L0120

COLLAR CERVICLE SM $30.00 L0120

STRAP CLAVICLE LG $28.00 L3670

STRAP CAVICLE MED $29.00 L3670

STRAP CAVICLE SM $29.00 L3670

STRAP CAVICLE XLG $29.00 L3670

STRAP CAVICLE XSM $29.00 L3670

CONRAY CYSTOII 250ML $45.00

CUSHION INVALID RING $115.00

TUBING CYSTO IRRIGATION $27.00

IV SOL D5W 100ML $155.00

IV SOL D5W 50ML $155.00

IV SOL NS 0.9% 100ML $155.00

Page 144: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

IV SOL D10 1000ML $155.00

IV SOL D5W 250ML AVIVA BAGS $155.00

IV SOL D10 500ML $155.00

IV SOL D5W 1000ML $155.00

IV SOL D5W 500ML $155.00

IV SOL D5W LR 500ML $155.00

IV SOL D5W LR 1000ML $155.00

IV SOL D5W 0.45 NS 1000ML $155.00

IV SOL D5W 0.45 NS 500ML $155.00

IV SOL D5W 0.9% NS 1000ML $155.00

IV SOL D5W 0.2% NS 1000ML $155.00

DRAIN ROUND 10FR W/TROCAR $32.00

DRAIN ROUND 15FR W/TROCAR $32.00

DRAIN ROUND 19FR W/TROCAR $40.00

DRAPE IOBAN 2 $63.00

SYSTEM WOUND IRRIGATION MAX $35.00

IV SOL EMPTY EVAC 1000ML $155.00

BARIUM ENEMA BARO-KIT $27.00

SOFTJAW INSERT SM $44.00

SOFTJAW INSERT MED $45.00

KIT GASTRIC LAVAGE 34FR $159.00

BLANKET HYPR/HYPO LG 25X64 $50.00

REAGENT WBC B SAPPHIRE $176.00

IV SOL LR 1000ML $155.00

IV SOL LR 500ML $155.00

IV SOL NS 0.9% 50ML $155.00

DRAPE BILAT LIMB SHT $23.00

PACK CYSTO $33.00

PACK OB $164.00

CATH TRIPLE LUM 8.5F AVA $283.00

COLLAR PHILI SM $94.00 L0150

PILLOW SHLDR ABDUCT MED $170.00

PILLOW SHLDR ABDUCT LG $560.00

DRAIN CHEST ATS READY SYS $133.00

BARIUM POLIBAR LIQUID L164 $123.00

SHOE POST OP LG MLE $31.00

SHOE POST OP MED MLE $31.00

SHOE POST OP MED FEMLE $31.00

SHOE POST OP SM MLE $31.00

POUCH CLSTMY DRAIN 4 $42.00

RESERVOIR LG VOL SUCTION $41.00

IMMOBILIZER SHLDR LG $47.00

IMMOBILIZER SHLDR MED $47.00

IMMOBILIZER SHLDR SM $47.00

IMMOBILIZER SHLDR XLG $47.00

IMMOBILIZER SHLDR XSM $50.00

SLING SWATHE UNIVER $44.00

IV SOL NS 0.9% 250ML AVIVA $155.00

IV SOL NS 0.9% 1000ML $155.00

IV SOL NS 0.9% 500ML $155.00

Page 145: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

IV SOL NS 0.45 $155.00

IV SOL NS 0.45% 500ML $155.00

SOLN NS STER 3000ML BG $30.00

TRAY SPINAL ANES 25GA/NO EPHED $67.00

SPLINT COCKUP LG LT $42.00

SPLINT COCKUP LG RT $46.00

SPLINT COCKUP MED LT $42.00

SPLINT COCKUP MED RT $42.00

SPLINT COCKUP SM LT $42.00

SPLINT COCKUP SM RT $42.00

SPLINT COCKUP XLG LT $42.00

SPLINT COCKUP XLG RT $42.00

SPLINT FOREARM LG LT $37.00

SPLINT FOREARM LG RT $30.00

SPLINT FOREARM MD LT $29.00

SPLINT FOREARM MED RT $29.00

SPLINT FOREARM SM LT $37.00

SPLINT FOREARM SM RT $30.00

SPLINT LONG LEG LG $137.00

SPLINT LONG LEG MED $137.00

SPLINT LONG LEG SM $137.00

SPLINT TIBIA MED $108.00

SPLINT TIBIA LG $109.00

SPLINT TIBIA SM $72.00

IV SOL H20 INJ 1000ML BG $155.00

TRANSDUCER PRESSURE MONITORIN $35.00

TRAY AMNIOCENTESIS $50.00

TRAY ARTHROGRAM $47.00

TRAY LUMB PUNCT INFANT $40.00

TRAY LUMB PUNCT 20GA $48.00

TRAY LUMB PUNCT PEDI 22GA $50.00

TRAY PRUDENDAL BLOCK $40.00

TRAY THORACENTHESIS $82.00

TUBE FEEDING FLXFLO 8FR $34.00

DRAIN PENROSE .75 $23.00

TRAY TUR/Y IRRIG SET $41.00

TAPE TWILL .5 $292.00

BALLOON DIL PERIP 3X4 120CM $2,584.00 C1725

TUBE KAM VAC SUCT TIP $43.00

COLLAR CERVICAL PEDI $31.00 L0120

IV SET PCA TUBING $30.00

TEMP STRIP CRYSTALINE $368.00

MITYVAC CUP/TUBE $70.00

PACK GENERAL SURGERY $99.00

TAP FOR CORTEX 2.0MM 311.19 $270.00

DRILL BIT QC 1.5MM $168.00

DRILL BIT QC 2.0MM $218.00

DRILL BIT QC 2.7MM $187.00

DRILL BIT QC 3.2MM $219.00

DRILL BIT QC 3.5MM $218.00

Page 146: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DRILL BIT QC 3.5MM $335.00

PLATE SM T $174.00 C1713

PLATE DCP 2.7MM $295.00 C1713

PLATE DCP 2.7MM $335.00 C1713

PLATE DCP 2.7MM $474.00 C1713

PLATE DCP 2.7MM $528.00 C1713

PLATE MIN T 2.0M $165.00 C1713

PLATE MIN 2.0M ORT $172.00 C1713

PLATE S L2.7M $174.00 C1713

PLATE STRM 2.0M 5H $200.00 C1713

SCREW CANCEL 32MM TL 217.055 $146.00 C1713

SCREW CANCEL 32MM TL 217.060 $123.00 C1713

SCREW CANCEL 6.5MM 216.060 $146.00 C1713

SCREW CANCEL 6.5MM 216.085 $155.00

SCREW CTX 1.5MM 200.807 $77.00 C1713

SCREW CTX 1.5MM 200.808 $74.00 C1713

SCREW CTX 1.5MM 200.810 $77.00 C1713

SCREW CTX 1.5MM 200.812 $88.00 C1713

SCREW CTX 1.5MM 200.816 $77.00 C1713

SCREW CTX 2.0MM 201.806 $78.00 C1713

SCREW CTX 2.0MM 201.808 $91.00 C1713

SCREW CTX 2.0MM 201.810 $73.00 C1713

SCREW CTX 2.0MM 201.812 $78.00 C1713

SCREW CTX 2.0MM 201.814 $78.00 C1713

SCREW CTX 2.0MM 201.816 $73.00 C1713

SCREW CTX 2.0MM 201.818 $78.00 C1713

SCREW CTX 2.0MM 201.820 $78.00 C1713

SCREW CTX 2.7MM 202.806 $85.00 C1713

SCREW CTX 2.7MM 202.810 $85.00 C1713

SCREW CTX 2.7MM 202.812 $78.00 C1713

SCREW CTX 2.7MM 202.814 $78.00 C1713

SCREW CTX 2.7MM 202.816 $78.00 C1713

SCREW CTX 2.7MM 202.818 $91.00 C1713

SCREW CTX 2.7MM 202.820 $93.00 C1713

SCREW CTX 2.7MM 202.822 $85.00 C1713

SCREW CTX 2.7MM 202.824 $93.00 C1713

SCREW CTX 3.5MM 206.010 $63.00 C1713

SCREW CTX 3.5MM 206.012 $66.00 C1713

SCREW CTX 3.5MM 206.014 $78.00 C1713

SCREW CTX 3.5MM 206.016 $76.00 C1713

SCREW CTX 3.5MM 206.018 $78.00 C1713

SCREW CTX 3.5MM 206.020 $78.00 C1713

SCREW CTX 3.5MM 206.022 $78.00 C1713

SCREW CTX 3.5MM 206.024 $71.00 C1713

SCREW CTX 3.5MM 206.026 $71.00 C1713

SCREW CTX 3.5MM 206.040 $78.00 C1713

SCREW CANCLUS 218.035 $146.00

SUTR VICRYL 1 CT-2 27IN $28.00

HEMOCLIP LG WECK $59.00

CATH RADIAL ARTERY SET $34.00

Page 147: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CATH UMBIL VESS 3.5FR $49.00

CATH BRONCHO 35L $163.00

CATH BRONCHO 37L $162.00

CATH BRONCHO 39L $163.00

DRAPE SNAP COVER $113.00

VESSEL CLUDE 120 $54.00

NEEDLE CHIBA ECHO TIP 22-5.0 $77.00

KIT BARD TOUCHLESS 14FR CATH $21.00

NEG 50 MED FROZEN SECTION $80.00

CATH FOLEY 26FR/30CC $31.00

CATH FOLEY 18FR/5CC $34.00

CATH FOLEY 20FR/5CC $35.00

CATH FOLEY 24FR/30CC $37.00

CATH FOLEY 22FR/5CC $35.00

CATH COUDE 24FR/5CC $36.00

CATH COUDE 22FR/5CC $38.00

CATH COUDE 20FR/5CC $38.00

CATH COUDE 18FR/5CC $37.00

CATH COUDE 16FR/5CC $25.00

NEEDLE JMSHDI BNE MRW 8GA $76.00

TRAY BNE MRW ILL/JAM $177.00

VEIN DISTN BONCHEK SYS $56.00

TUBE TRCHSTMY 4LPC $184.00

TUBE TRCHSTMY 6LPC $184.00

TUBE TRCHSTMY 8LPC $184.00

TUBE TRCHSTMY 10LPC $186.00

TUBE TRCHSTMY 8FEN $176.00

TUBE TRCHSTMY 10FEN $182.00

ADAPTOR SWVL FBROPT BRNC $56.00

CATH UMBIL VESS 5FR $49.00

SUTURE BOOT $28.00

CATH SIMMONS T/1 $76.00

CATH SIMMONS T/2 $50.00

CATH RENAL DBL CRV 5FR $42.00

CATH MANI P 5 35 100 P NS MAN $76.00

BLADE GIGLI SAW $515.00

DERMACARRIER 012 $101.00

DERMACARRIER 013 $112.00

SHUNDT CAROTID $829.00

SHUNDT CAROTID $772.00

BARICON $175.00

CATH PEZZER 36FR $67.00

CATH PROGRESS RT 5FR $40.00

TRANSDUCER PX600F CL $31.00

CATH JUDK RT 5FR/4.0 $40.00

CATH JUDK LT 5FR/4.0 $299.00

CATH 5FR 100CM MULTI $41.00

CATH INTRDCR 6FR $111.00

CATH STRT PGTL 5FR/110 $40.00

GUIDEWIRE 3MM J $34.00 C1769

Page 148: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SPLINT SURG NAIL 4R $25.00 C1713

PULLEY SET HOMERANGER $62.00

CATH MULTI A-1 $49.00

SHUNDT CAROTID $772.00

COLLAR PHILI MED $94.00 L0150

COLLAR PHILI LG $94.00 L0150

SHOE CAST MED $22.00

SHOE CAST LG $32.00

MESH DEXON 9 X7 $868.00 C1781

SUCTION FRAZIER 5FR $27.00

BOOT BUCKS UNIVERSAL $83.00

BRACE KNEE HNGD SHRT $284.00 L1810

BRACE KNEE HNGD LNG $284.00 L1810

TRAY CT BPSY W/O NDL $59.00

TRAY CT BPSY W/NDL $101.00

GASTROVIEW 120ML $42.00

METER PEAK FLOW $33.00

SPLINT COCKUP PEDI RT $42.00

SPLINT COCKUP PEDI LT $42.00

SPLINT COCKUP CHLD LT $39.00

PACK SPECIAL CATH PACK $192.00

IV SET BURETROL $26.00

AEROCHAMBER RT $24.00

BAG RESUSC AMBU ADLT $32.00

BAG HYPERINFLATION SYS $28.00

PROBE NEONATE OXYTIP EASY $49.00

ADAPTER AEROSOL T $50.00

BILIMASK PREMI 01A $394.70

TUBE TRCHSTMY 6FEN $176.00

TUBE TRCHSTMY 4FEN $176.00

LAVAGE PERITONEAL KT $115.00

TRAY LACERATION $41.00

STAPLER MULTIDR PDOX WD $31.00

TRAP POLYP $39.00

CATH JUDK LT 5FR/5.0 $40.00

CATH JUDK LT 5FR/6.0 $49.00

CATH JUDK RT 5FR/3.5 $127.00

CATH JUDK RT 5FR/5.0 $49.00

COLLAR PHILI PEDI $93.00 L0150

INFUSER IV PRESS BG 1000CC $73.00

ASPIRATOR MECONIUM $31.00

PADS CPM UNIVERSAL INPAT REHAB $58.00

CATH FOLEY 6FR/1CC $77.00

GUIDEWIRE CATH .025 $30.00 C1769

TUBING BLOOD WRMR LEV1 $147.00

CLSTMY PST-OP STER 1.75 $38.00

CLSTMY PST-OP STER 2.75 $38.00

IMMOBILIZER KNEE SM $61.00 L1830

IMMOBILIZER KNEE MED $62.00 L1830

IMOBILIZER KNEE LG $62.00 L1830

Page 149: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

IMMOBILIZER KNEE XLG $62.00 L1830

PUMP BREAST MAN/ELECT $99.00

CATH JUDK RT 5FR/6.0 $49.00

TRAY UMBILICAL ARTERY $183.00

CATH HEMATURIA 2WY 22FR $81.00

CATH COUNCILL 16FR $49.00

CATH COUNCILL 18FR $49.00

CATH COUNCILL 20FR $49.00

CATH FOLEY 3WY CONTINUOUS 22FR $39.00

CATH FOLEY 3WY CONTINUOUS 24FR $38.00

CATH COUDE 12FR/5CC $36.00

CATH COUDE 14FR/5CC $25.00

CATH IN LINE SUCTION $39.00

CATH URET WDGE 5FR $39.00

STENT DBLJ SIL 6FR/26CM $359.00 C1874

STENT DBLJ SIL 7FR/26CM $359.00 C1874

STENT DBLJ SIL 8FR/26CM $184.00 C1874

IRRIGATOR PULSOVC FN SPRY TP $41.00

IRRIGATOR PULSOVC INTRMDLLRY $43.00

IRRIGATOR PULSOVC HAND CNTRL $81.00

IRRIGATOR PULSOVC SPIKE FLUID $49.00

NEEDLE INFUSION 19G X.75 Y $22.00

INTERCEED 3X4 ADHESIVE BARRIER $694.00 C1765

CHOLANGIOCATH TAUT $140.00

BLANKET BAIR HGGR UPPER $28.00

BLANKET BAIR HGGR LWR $28.00

WAFER DURADHESIVE 2.75 $51.00

WAFER DURAHESIVE 1.75 $51.00

POUCH URSTMY 2.75 $50.00

POUCH URSTMY 1.75 $39.00

REMOVER CLSTMY ADHESIVE $37.00

POUCH CLSTMY DRAIN 1.75 $29.00

POUCH CLSTMY DRAIN 2.75 $29.00

DRAPE ARTHROSCOPY SHEET $45.00

CATH NASAL BALLOON EPISTAX $192.00

NEEDLE KEITH STR TRI 2 7/8 $28.00

STAPLER PREM SKIN 35 $77.00

NEEDLE JMSHDI BNE MRW 16GA $48.00

OPTIRAY 50CC SYRINGE PREFILL $48.00 Q9967

LENS MORGAN DELIVERY ST $147.00

NEEDLE SPINAL 22GA/5.5 $42.00

NEEDLE SPINAL 25GA/4 11/16 $22.00

NEEDLE EPIDURAL 17GA/6 $58.00

CLEANER SPR HDQ NEUT $80.00

SURGICLIP MED $189.00

CATH COUDE 20FR/30CC $42.00

CATH COUDE 22FR/30CC $329.50

SPLINT ANKLE SM MCDAVID $91.00 L1902

SPLINT ANKLE MED MCDAVID $91.00 L1902

SPLINT ANKLE LG MCDAVID $91.00 L1902

Page 150: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

COLD PACK TKTEMP KNEE WRP $126.00

GLIDEWIRE MICROV STRT 038 $145.00 C1769

GLIDEWIRE MICROV ANGL 038 $84.00 C1769

GLIDEWIRE MICROV STRT 035 $84.00 C1769

GLIDEWIRE MICROV ANGL 035 $84.00 C1769

BIOPSY SYS MICROV $132.00

OPTIRAY 320 20X125ML $118.00 Q9967

TUBE LAVACUATOR 36FR $40.00

VICRYL WOVEN MESH $1,548.00 C1781

CATH FOLEY 28FR/5CC $34.00

CATH FOLEY 20FR/30CC $37.00

FILIFORM STRT WOV 3FR 12.5 $110.00

STENT DBLJ 7X24 $359.00 C1874

STENT DBLJ 7X28 $359.00 C1874

BLADE MAC 4 DISP $29.00

BLADE MAC 3 DISP $21.00

CATH ULTRA FLSH 90CM $50.00

COLD PACK TKTEMP SHLDR WRP $67.00

IRRIGATOR ENDOFLO $808.00

CATH HEMATURIA 2WY 20FR $83.00

COAGULATOR ESU SUCT 10FR $34.00

CATH CCO/SV02 744HF75 $628.00

SUTR RETREIVER HEWSON $194.00

BOOT WALKER SM $102.00 L4387

BOOT WALKER MED $102.00 L4387

BOOT WALKER LG $102.00 L4387

TRAY PNEUMOTHORAX $255.00

SCREW R/S KT RDCK SAYE $3,178.00 C1713

NEEDLE COLLAGEN TRNSRTHRL $90.00 L8603

NEEDLE COLLAGEN PERIRTHAL $47.00 L8603

SHEATH 5FR $36.00

SUTR PDS PLUS 0.60IN V PDP991G $28.00

URSTMY POST-OP SYS 1.75 $41.00

URSTMY POST/OP SYS 2.75 $22.00

LOOP SYS CLSTMY 4 $82.00

WAFER DURADHESIVE 4 $48.00

MAGNEVIST 20ML $12.00 A9579

PACK GENERAL ORTHO $92.00

DRAPE HAND $25.00

PACK LITHO DRAPE W/POUCH $40.00

PACK UROVIEW TBL CVR $42.00

STERIS 20 $36.00

KIT GASTRIC LAVAGE 18FR PEDI $154.00

IRRIGATOR CLSTMY VISIFLO $40.00

BARIUM ENEMA KT SPR XL $24.00

KIT NSY/MATERNITY $88.00

BOOT WEE WALKER $141.00 L4386

TRAY MULTILMNEN PEDI 5.5FR $174.00

DRESSING FIBROCOL 4X4 $39.00 A6021

GUIDEWIRE VASC .035 $37.00 C1769

Page 151: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BURR 5.0 PEAR $183.00

CUTTER MENISCUS 5.6 AGGRESS $231.00

ACCUGRID $82.00

CATH BONANO SUPRAPUBIC $1,060.00 C2627

CUTTER MENISCUS 4.0 ANGL AGG $149.00

PENCIL ENDOSTAT $603.00

GAS SUPRANE $455.00

SUTR VICRYL 1 36 CT-1 $28.00

PACEMAKER IPG ADDR01 $11,392.00 C1785

MED PACELD CAPSURE 5076-52 $1,547.00 C1898

SUTURE VICRYL 2-0 36 CT-1 $28.00

SUTR VICRYL 2-0 27 SH $28.00

SUTR VICRYL 2-0 27 $28.00

SUTURE VICRYL 2-0 27 UR-5 $28.00

REGULATOR C02 EASYCAP II $40.00

SUTURE VICRYL 2-0 8-18 CT-1 $28.00

SUTURE VICRYL 3-0 27 SH $28.00

SUTR VICRYL 3-0 36 CT-1 $28.00

SUTURE VICRYL 3-0 16-18 TIES $28.00

SUTR VICRYL 4-0 27 $28.00

SUTR VICRYL 6-0 $28.00

SUTURE SILK 0 30 TIES $28.00

SUTURE SILK 0 30 KS $28.00

SUTR SILK 0 30 FSL $28.00

SUTURE SILK 2-0 30 TIES $28.00

SUTR SILK 3-0 30 SH $28.00

SUTR SILK 3-0 30 SH $42.00

SUTURE SILK 3-0 18 FS-1 $28.00

SUTURE SILK 3-0 18 TIES $28.00

SUTR SILK 3-0 18 PS1 $28.00

SUTR SILK 4-0 8-18 SH $28.00

SUTR SILK 4-0 18 TIES $28.00

SUTURE SILK 4-0 18 FS-2 $28.00

SUTURE SILK 5-0 18 TIES $28.00

SUTURE CHROMIC 1 27 CT-1 $28.00

SUTURE CHROMIC 1 54 REEL $28.00

SUTURE CHROMIC 0 27 CT-1 $28.00

SUTURE CHROMIC 0 27 UR-5 $28.00

SUTURE CHROMIC 2-0 27 UR-5 $28.00

SUTR CHROMIC 2-0 27IN SH $28.00

SUTURE CHROMIC 2-0 27 CT-1 $28.00

SUTURE CHROMIC 2-0 27 CP-1 $28.00

SUTURE CHROMIC 3-0 27 SH $28.00

SUTURE CHROMIC 3-0 36 CT $28.00

SUTURE CHROMIC 4-0 27 RB-1 $28.00

SUTURE CHROMIC 4-0 27 SH $28.00

SUTURE CHROMIC 4-0 27 FS-2 $28.00

SUTURE CHROMIC 4-0 18 PS-4 $28.00

SUTURE CHROMIC 5-0 27 RB-1 $28.00

SUTR PLAIN GUT 0 54 TIES $28.00

Page 152: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SUTURE PROLENE 0 8-18 MO-6 $28.00

SUTURE PROLENE 2 60 TP-1 $28.00

SUTURE PROLENE 1 60 TP-1 $28.00

SUTR PROLENE 2-0 30 CT-2 $28.00

SUTURE PROLENE 3-0 36 SH $28.00

SUTURE PROLENE 4-0 18 PS-2 $28.00

SUTR PROLENE 4-0 36IN $28.00

SUTURE PROLENE 5-0 18 PS-2 $28.00

SUTR PROLENE 7-0 24IN $28.00

SUTURE ETHILON 2-0 18 FS $28.00

SUTURE ETHILON 3-0 18 FS-1 $28.00

SUTURE ETHILON 3-0 30 FSLX $28.00

SUTURE ETHILON 4-0 18 FS-2 $28.00

SUTURE ETHIBOND 2-0 30 SH-2 $28.00

SUTURE ETHIBOND 4-0 30 RB-1 $28.00

SUTURE PDS II 1 36 CTX $28.00

SUTURE PDS II 1 36 CT-1 $28.00

SUTURE PDS II 0 36 CT-1 $28.00

SUTURE PDS II 2-0 27 CT-1 $28.00

SUTURE VICRYL 3-0 8-27 SH $28.00

SUTR VICRYL 1 36IN CTB-1 $28.00

SUTR VICRYL 2-0 27 CTB-1 $28.00

SUTURE PROLENE 1 MO6 D SPECIAL $28.00

SUTURE CHROMIC 5-0 27 C-1 $28.00

STAPLER TA30-3.5 $305.00

RELOAD STPL TA30-3.5 $287.00

STAPLER TA30-4.8 $261.00

RELOAD STPL TA30-4.8 $142.00

STAPLER TA30-V3 $300.00

RELOAD TX LIN STPLR 30MM VAS $161.00

STAPLER TA60-3.5 $262.00

RELOAD STPL TA60-3.5 $160.00

STAPLER TA60-4.8 $270.00

RELOAD STPL TA60-4.8L $160.00

RELOAD STPL TA90-3.5 $169.00

STAPLER TA90-4.8 $277.00

RELOAD STPL TA90-4.8 $169.00

STAPLER ROTIC 55 POLY 200 $1,283.00

STAPLER ARTICUL LINEAR GRN $523.00

STAPLER / CUTTER GIA60-2.5 $301.00

RELOAD STPL / CUTR GIA60-2.5 $162.00

STAPLER / CUTTER GIA60-3.8 $289.00

RELOAD STPL / CUTR GIA60-3.8 $188.00

RELOAD STPL GIA STRT WH 30-2.5 $277.00

RELOAD STPL GIA STRT BL 30-3.5 $269.00

STAPLER / CUTTER GIA80-3.8 $432.00

RELOAD STPL / CUTR GIA80-3.8 $225.00

STAPLER / CUTTER GIA80-4.8 $432.00

RELOAD STPL / CUTR GIA80-4.8 $225.00

STAPLER SKIN APPOSE REGULAR $32.00

Page 153: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STAPLER SKIN APPOSE WIDE $32.00

STAPLER POWERED LDS 15W $458.00

APPLIER MCA MULTI CLIP MED $189.00

APPLIER MCA MULTI CLIP SM $188.00

APPLIER MCA MULTI CLIP LG $191.00

REMOVER VCS CLIP $186.00

TROCAR ENDO BLDLSS 12MM X 150 $127.00

ENDO STITCH $329.00

DISSECTOR BLNT TIP 5MM $68.00

ENDO SUTR CLOSE $90.00

CLAMP ENDOCLINCH II RATCH 5MM $234.00

BAG SPECIMN ENDO CTCH 10MM $416.00

CLAMP BABCOCK 10MM $225.00

STAPLER ROTIC ENDO GRSP 5MM $276.00

CLIP APPLIER ENDO DDRV 10MM $218.00

CLIP APPLIER LG PSTL GRP 10MM $262.00

SCISSOR CRVD LAP DRCT DRV 5MM $161.00

DISSECTOR CRVD W/UNIPOL 5MM $234.00

ENDO RETRACT II 10MM $843.00

TROCAR DIL TIP 5MMX100MM $83.00

THORACOPORT 10.5MM TCR $158.00

THORACOPORT 11.5MM TCR $55.00

PROTECTOR BOOT CRADLE $47.00

TRAY FEM ART LINE 18 GA $185.00

IV SET EPIDURAL PUMP $38.00

TUBING INSUFF DOUBLE $40.00

PORT INFUSION STANDARD TI 8FR $898.00 C1788

TROCAR ENDO BLDLSS 11MM X 100 $127.00

MAMO LOK HOMER 20GAX3CM $108.00

MAMO LOK HOMER 20GAX5CM $112.00

MAMO LOK HOMER 20GAX7.5CM $108.00

MAMO LOK HOMER 20GAX10.0CM $183.00

NEEDLE STIMEX INSUL 22GA/2 1/8 $25.00

INTRODUCER TAUT $54.00

PAD DISP LEG HOLDER STR IMP $53.00

FILTER LASER NS X-LG PLUME $58.00

FILTER LASER PRE NS DISP $23.00

NEEDLE SPINAL WHIT 27G/ 4 11/1 $27.00

PEG KIT 20FR $456.00

SCREW 4.0 CANC $71.00 C1713

DRILL BIT 3.5 $1,128.00

SCREWDRIVER 3.5 314.03 $184.00

SCREW 4.0 CANN 207.610 $514.00 C1713

SCREW 4.0 CANN 207.614 $514.00 C1713

SCREW 4.0 CANN 207.616 $514.00 C1713

SCREW 4.0 CANN 207.618 $514.00 C1713

SCREW 4.0 CANN 207.620 $525.00 C1713

SCREW 4.0 CANN 207.622 $525.00 C1713

SCREW 4.0 CANN 207.624 $525.00 C1713

SCREW 4.0 CANN 207.626 $549.00 C1713

Page 154: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW 4.0 CANN 207.628 $549.00 C1713

SCREW 4.0 CANN 207.630 $549.00 C1713

SCREW 4.0 CANN 207.632 $595.00 C1713

SCREW 4.0 CANN 207.634 $525.00 C1713

SCREW 4.0 CANN 207.636 $525.00 C1713

SCREW 4.0 CANN 207.638 $595.00 C1713

SCREW 4.0 CANN 207.640 $525.00 C1713

SCREW 4.0 CANN 207.642 $595.00 C1713

SCREW 4.0 CANN 207.644 $549.00 C1713

SCREW 4.0 CANN 207.646 $549.00 C1713

SCREW 4.0 CANN 207.648 $549.00 C1713

SCREW 4.0 CANN 207.650 $549.00 C1713

SCREW 4.0 CANN 207.716 $507.00 C1713

SCREW 4.0 CANN 207.718 $507.00 C1713

SCREW 4.0 CANN 207.720 $507.00 C1713

SCREW 4.0 CANN 207.722 $595.00 C1713

SCREW 4.0 CANN 207.724 $549.00 C1713

SCREW 4.0 CANN 207.726 $514.00 C1713

SCREW 4.0 CANN 207.728 $514.00 C1713

SCREW 4.0 CANN 207.730 $514.00 C1713

SCREW 4.0 CANN 207.732 $514.00 C1713

SCREW 4.0 CANN 207.734 $514.00 C1713

SCREW 4.0 CANN 207.736 $595.00 C1713

SCREW 4.0 CANN 207.738 $514.00 C1713

SCREW 4.0 CANN 207.740 $595.00 C1713

SCREW 4.0 CANN 207.742 $549.00 C1713

SCREW 4.0 CANN 207.744 $514.00 C1713

SCREW 4.0 CANN 207.746 $595.00 C1713

SCREW 4.0 CANN 207.748 $514.00 C1713

SCREW 4.0 CANN 207.750 $507.00 C1713

SCREW 4.0 CANN $514.00 C1713

EXTENSION SET MICK LOCK $142.00

DRESSING BURN ADULT VEST $88.00

DRESSING BURN LEG 18X36 $30.00

SUTR VICRYL 1 36IN CT1 $28.00

SUTR VICRYL 0 27IN UR-6 $28.00

SUTR VICRYL 2-0 27 CT-3 $28.00

IRRIGATOR SIMPLSE FEMOR TIP $179.00

TRAY EPIDURAL ARROW $135.00

DRAPE VIDEO CAMERA $38.00

GLIDESCOPE GVL STAT SIZE 2.5 $78.00

DRESSING TIELLE HYDRO 4X4 $26.00

DRESSING TIELLE HYDRO 7X7 $79.00

SOAP MEDICATED LOTION STERIS $27.00

INHALANT ANESTHETIC SEVOFLURAN $528.00

TRAY PARACENTESIS 8FR TURKEL $172.00

SUPPORTER ATHLETIC LARGE $40.00

SUPPORTER ATHLETIC MEDIUM $40.00

CORD ESU DISP MONOPOLAR $80.00

VESEPHENE II SE STERIS $64.00

Page 155: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BLADE MILLER 2 DISPOSABLE $28.00

MONOPOLAR .35MM 24FR $192.00

PACK ARTHROSCOPY FLD SHLDR $67.00

MASK RESPIRATOR SMALL $35.00

APPLIANCE ADL REACHER $41.00

CATH JUDK LT 5FR/3.5 $49.00

CATH AMPLTZ LT 5FR/AL1 $49.00

CATH AMPLTZ LT 5FR/AL2 $49.00

CATH AMPLTZ LT 5FR/AL3 $49.00

CATH AMPLTZ LT 5FR/AL4 $49.00

CATH AMPLTZ RT 5FR/AR-MOD $49.00

CATH AMPLTZ RT 5FR/AR3 $49.00

AEROCHAMBER W/ADLT MASK $50.00

AEROCHAMBER W/ MED MASK $47.00

AEROCHAMBER W/SM MASK $47.00

TENT CARE CUBES $73.00

CIRCUIT VENT PORTABLE $33.00

DRESSING MULTIDEX $105.00

DRESSING TUBE CHEST SZ 7 $67.00

DRESSING TUBE TORSO SZ 12 $103.00

PROBE PULSE-OX DATASCPE DISP $162.00

BIPAP CPAP CIRCUIT $31.00

ALISTRAP 3X30 $34.00

SUPPORT ARTLINE WRIST $33.00

BLADE DERMATOME $139.00

IRRIGATOR STRYKFLO $153.00

DIALATOR RENAL SET $581.00

PAPER ATL-3000 ULTRASOUND $609.00

OPTIRAY 350 25X50ML $45.00 Q9967

GUIDEWIRE STORQ $258.00 C1769

GUIDEWIRE WHOLEY HTF $261.00 C1769

GUIDEWIRE WHOLEY EXC FLOPPY $357.00 C1769

RESTRAINT FINGER CONTROL MITT $56.00

LEAD PACEMAKER VDD $2,261.00 C1898

PAD ADULT HEARTSTART PHILLIPS $82.00

SUTURE ETHILON 18 6-0 P-3 $28.00

SUTR ETHILON 4-0 18IN P3 $28.00

SUTR PROLENE 5-0 18IN PS2 $28.00

SUTURE PROLENE 3-0 18 FS-2 $28.00

PROBE COVER ULTRASOUND $119.00

DRESSING VAC KIT SM ATS $131.00

DRESSING VAC KIT MED ATS $165.00

DRESSING VAC KIT LG ATS $164.00

CANISTER VAC KIT ATS $135.00

CATH TRIPLE LUM 9FR AVA $346.00

SURGICEL NUKNIT HEMSTAT 3X4 $165.00

BAG RESUSC AMBU PEDI $84.00

CATH URINE METER PEDI $47.00

DRAPE MINI C-ARM STERILE $30.00

CAUTERY HIGH TEMP FINE TIP $31.00

Page 156: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BULB FIBEROPTIC WA $47.00

CATH IM 5FR $40.00

IUPC INTRAN PLUS 400 $114.00

NEEDLE CHIBA 22GA $37.00

NEEDLE CHIBA 18GAX15CM $48.00

PACKING POPE EPSTXS W/O 10CM $57.00

CATH DILATOR 5.0 $182.00

CATH DILATOR 6.0 $182.00

CATH DILATOR 8.0 $182.00

CATH BERENSTIN $50.00

SEAL LOCK $60.00

PROTECTOR CROUCH CORNEAL $27.00

PACK HEAD AND NECK $38.00

SLINGSHOT SHOULDER $189.00

CATH COBRA GLIDE 90 $205.00

BLADE MILLER #3 $21.00

GUIDEWIRE NITINOL STIFF $179.00 C1769

CATH WORD BARTHOLIN GLAND $42.00

TROCAR ENDO BLNT SMTH SLV 12MM $100.00

NEEDLE INSUF VERESS 120MM $49.00

CUTTER STPL INTER GIA 12MM $307.00

STAPLER CIRCULAR 21MM $744.00

STAPLER CIRCULAR 25MM $744.00

STAPLER CIRCULAR 28MM $744.00

STAPLER CIRCULAR 31MM $766.00

RELOAD STPL / CUTR GIA60-4.8 $183.00

IMMOBILIZER KNEE PEDI 12 $35.00 L1830

IMMOBILIZER KNEE PEDI $29.00 L1830

TRANSDUCER SINGLE W/VAMP $85.00

CATH TRAY 16FR (LF) $45.00

CATH TRAY 18FR (LF) $46.00

FORCEP RENAL BIOPSY DISP $856.00

DRAPE STCKNTTE SPR LG $39.00

CUTTER 4.0 AGG. PLUS TIP $744.00

CEMENT PLUG UNIVERSAL $264.00 C1713

BURR 4.0 BARRELL 6 FLUTE $174.00

CATH FOLEY 3WY 20FR/30CC $38.00

CANISTER GUARDINE LRG 12,000CC $69.00

INTRODUCER SUPRAPUB 16FR $101.00

CATH FOLEY SHRT TP 18FR/30CC $62.00

CATH GRAHAM 18FR $231.00

TUBE BLOOD MICRO SERUM SEP $81.00

TUBE BLOOD MICRO AMBER $91.00

TUBE BLOOD MICRO PLASMA SEP $81.00

TUBE BLOOD MICRO EDTA $88.00

TUBE BLOOD BL VAC 2.7ML $35.00

TUBE BLOOD PRPL EDTA 3.0ML $27.00

TUBE BLOOD LT GRN PST 3.0ML $68.00

VACUTAINER DROP IT HOLDER $26.00

BLADE CAST SAW STRYKER $157.00

Page 157: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

UNNA BOOT UNILATERAL $38.00 A6545

REFLECTOR NEOGUARD THERMAL $114.00

FEM COMP SERIES 7000 11L $3,573.00

SCREW BIOINTERFERENCE 9X23 $425.00 C1713

SYRINGE COLLAGEN IMPLNT TX $847.00 C1713

BRUSH CYTOLOGY $50.00

CATH FOLEY 3WY 26FR/30CC $33.00

CATH COUNCILL 22 FR $49.00

STENT PERCUFLEX SFT WHT 7X28 $443.00

STENT PERCUFLEX BLUE 6X24 $359.00

STENT PERCUFLEX BLUE 6X28 $359.00 C1874

STENT RETROMAX PLS 7-14FRX26 $625.00 C1874

GUIDEWIRE PTFE MOVBLE CORE $72.00 C1874

SUTR ARTHOSEW DEVICE 8MM $639.00 C1874

SUTR ARTHOSEW SINGLE UNIT $111.00 C1769

CANNULA SHOULDER 7CM $62.00

NEEDLE INTEROSSOUS 18 GA $150.00

TUBE CONNECTING MEDI-TECH $40.00

SUTR DERMABOND $28.00

TRANSDUCER CO-SET INJECTATE $42.00

DRESSING STATLOK VAS CATH $23.00

SUTURE ETHILON 18 6-0 PS-3 $28.00

SUTURE ETHILON 5-0 18 P-3 $28.00

SUTURE ETHILON 5-0 18 PS-2 $28.00

SUTR ETHILON 5-0 FS2 $28.00

SUTURE ETHILON 4-0 18 P-3 $28.00

SUTR ETHILON 4-0 PS2 $28.00

SUTURE ETHILON 4-0 18 FS-1 $28.00

SUTR SILK 0 FSL $28.00

SUTURE PROLENE 5-0 18 P-3 $28.00

SUTR PROLENE 5-0 PS2 $28.00

SUTURE PROLENE 6-0 18 P-1 $28.00

SUTURE PROLENE 6-0 18 P-3 $28.00

SUTR VICRYL 4-0 PC1 $28.00

SUTURE PLAIN GUT 5-0 27 FS-2 $28.00

SUTURE PLAIN GUT 5-0 18 PC-1 $28.00

SUTURE PLAIN GUT 6-0 18 PC-1 $28.00

SUTURE ETHIBOND 3-0 30 RB-1 $28.00

SUTURE CHROMIC 5-0 18 P-3 $28.00

SUTR CHROMIC 3-0 FS2 $28.00

SUTR VICRYL 1 CT $28.00

SUTR VICRYL 3-0 CT1 $28.00

SUTURE VICRYL 3-0 27 RB-1 $28.00

SUTR VICRYL 0 27 CT-2 $28.00

SUTR VICRYL 2 TP-1 $28.00

SUTR VICRYL 3-0 CT1 $28.00

SUTURE SILK 2-0 18 SH $28.00

SUTURE SILK 6-0 18 PS-3 $28.00

SUTR PLAIN GUT 3-0 PS2 27IN $28.00

SUTR PLAIN GUT 4-0 SC1 18IN $28.00

Page 158: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SUTURE PROLENE 0 30 CT-1 $28.00

SUTR PROLENE 3-0 V7 36IN $28.00

SUTR PROLENE 5-0 V5 36IN $28.00

SUTR PROLENE 8-0 24IN $28.00

SUTURE PDS II 3-0 27 RB-1 $28.00

SUTURE MONOCRYL 2-0 27 SH $28.00

SUTURE ETHIBOND EXC 2 30 OS-4 $28.00

SUTURE ETHIBOND 4-0 18 PS-4 $28.00

SUTR VICRYL 5-0 PS3 $28.00

PAD DEFIB MULTI FUNC ADLT $70.00

BARIUM HYPAQUE $435.00

DRAIN CHEST ATS BLOOD BAG $106.00

DRAIN CHEST INFANT/PEDI $136.00 C1786

ASH SPLIT $921.00

CATH TRETOTOLA KIT $1,611.00

CATH PICC KIT 3 FR $202.00 C1757

CATH MIDLINE KIT 4 FR MK02041T $183.00

PAD DEFIB MULTI FUNC PEDI $74.00 C1751

SUTURE MONOCRYL 3-0 KS Y523 $28.00

DRESSING VAC WHITEFOAM TRAC $173.00

TUBE TRCHSTMY 8DCFS $159.00

TUBE TRCHSTMY 6DCFS $159.00

TUBE TRCHSTMY 4DCFS $159.00

NEEDLE QUIKCRE 18G 9CM 10THR $132.00

NEEDLE QUIKCRE 18G 9CM 20THR $132.00

NEEDLE QUIKCRE 18G 6CM 10THR $148.00

NEEDLE QUIKCRE 18G 6CM 20THR $132.00

NEEDLE QUIKCRE 18G 15CM 20TH $132.00

NEEDLE CHIBA 22GA 10CM $48.00

NEEDLE CHIBA 22GA 15CM $48.00

CATH PICC KIT 4 FR SGLE LUM $178.00

CATH PICC KIT 4FR DUAL LUM $223.00

DRESSING STATLOK PICC $49.00

TRANSDUCER TRPL LINE W/VAMP $216.00

TUBE TRACH XLNG SZ 8 $140.00

DRAPE IOBAN 2 23X33 $38.00

BAG IV PRESS INFUSOR 500CC $69.00

CELLSAVER ATF FAST START KIT $346.00

CELLSAVER ATS SUCTION LINE $115.00

ADAPTER CARDIOPLGIA MLE 1/4 $58.00

ADAPTER SET PERF 3/8 X24 $58.00

PADS GROUNDING STRYKER $91.00

IV SOL PLASMALITE PH7.4 1000CC $155.00

GLIDESCOPE GVL STAT SIZE 2 $71.00

PCKG ADAPTA DR $11,110.00 C1785

LIGACLIP MED $33.00

PATCH CV HEMSHLD VELOUR 3X3 $215.00

PATCH CV HEMSHLD VELOUR 1X6 $530.00

SUTURE PROLENE 5-0 RB1 24" $28.00

GRAFT HEMSHLD STR GLD 24X15 $927.00 C1768

Page 159: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

GRAFT HEMSHLD STR GLD 22X15 $665.00 C1768

GRAFT HEMSHLD STR GLD 20X15 $665.00 C1768

GRAFT HEMSHLD STR GLD 18X15 $665.00 C1768

GRAFT HEMSHLD STR GLD 14X15 $665.00 C1768

GRAFT HEMSHLD STR 12X60 $1,404.00 C1768

GRAFT HEMSHLD STR 10X60 $1,194.00 C1768

GRAFT HEMSHLD STR 8X60 $980.00 C1768

GRAFT HEMSHLD STR 6X60 $980.00 C1768

GRAFT HEMSHLD BIFUR 24X12X40 $1,214.00 C1768

GRAFT HEMSHLD BIFUR 22X11X40 $1,645.00 C1768

GRAFT HEMSHLD BIFUR 20X10X40 $1,214.00 C1768

GRAFT HEMSHLD BIFUR 18X9X40 $1,129.00 C1768

GRAFT HEMSHLD BIFUR 16X6X40 $1,998.00 C1768

GRAFT HEMSHLD BIFUR 14X7X40 $1,214.00 C1768

GRAFT HEMSHLD BIFUR 12X7X40 $1,214.00 C1768

GRAFT HEMSHLD AXIL 8X100X60 $1,460.00 C1768

GRAFT CV ACCUSEAL .8X7.5X.8 $529.00 C1768

VALVULOTOME LAMAITRE SHORT $1,902.00

TAPE GLOW AND TELL $155.00

FEM HEAD C-TAPER 26MMO $2,020.00

FEM HEAD C-TAPER 26MM% $2,020.00

FEM HEAD C-TAPER 26MM!0 $2,020.00 C1713

HIP STEM ODC #5 $3,561.00 C1713

HIP STEM ODC #6 $3,561.00 C1713

HIP STEM ODC #7 $3,561.00 C1776

HIP STEM ODC #8 $3,561.00 C1776

HIP STEM ODC #9 $3,561.00 C1776

HIP STEM ODC #10 $3,561.00 C1776

GUIDEWIRE SPORT MS/REX $283.00 C1776

OPTIRAY 300 100ML SYRINGE $93.00 Q9967

TUBE ESPOHAGEL SENGSTAKEN 20 F $891.00

TUBING ATHROSCOPY $179.00

PACK SHLDR ARTHROSCPY CSTM $313.00

CLO TEST $54.00

GRASPER ENDOGRASP RATCH 5MM $225.00

CATH THOR RIGHT ANGLE 16FR $197.00

CATH THOR RIGHT ANGLE 20FR $197.00

CATH THOR RIGHT ANGLE 24FR $197.00

TUBE TRCHSTMY 6 DCFN $169.00

TUBE TRCHSTMY 8 DCFN $162.00

BLADE STERNAL SAW $78.00

BLADE EXT ELECTRODE COATED $22.00

STENT SMART 120CM 6X20 $2,510.00

BALLOON NC RANGER 9/2.5 $962.00

BALLOON NC RANGER 9/3.0 $962.00 C1877

BALLOON NC RANGER 9/3.5 $962.00 C1727

SUTURE ETHICON PDS II Z303H $28.00 C1727

SYRINGE INFLATION $164.00 C1727

PACK ANGIOPLASTY $81.00

VALVE HEMOSTASIS $48.00

Page 160: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

TUBE TRCHSTMY 3.0 NEO $136.00

FAS T 325 VAS $1,385.00

PUSHER COIL 16 $513.00

VORTEX COIL 2MM/4MM $367.00

PTD TREROTOLO OTW $1,545.00

CATH MEDCOMP 14X8 20CM LF IJ $181.00

CATH MEDCOMP 14X6 15CM RT IJ $362.00

CATH MEDCOMP 14X8 20CM FEMOR $85.00

CATH MEDCOMP 14X9.5 24CM LG LI $362.00

ASH SPLINT 14X32 $847.00

CATH GUIDING 6F JL 3.5 $170.00

CATH GUIDING 6F JL 4.0 $170.00 C1887

CATH GUIDING 6F JL 4.0 SH $170.00 C1887

CATH GUIDING 6F JL 4.5 $170.00 C1887

CATH GUIDING 6F JL 5.0 $170.00 C1887

CATH GUIDING 6F EBU 3.5 $170.00 C1887

CATH GUIDING 6F EBU 4.0 $170.00 C1887

CATH GUIDING 6F JR 3.0 $170.00 C1887

CATH GUIDING 6F JR 3.0 SH $170.00 C1887

CATH GUIDING 6F JR 3.5 $170.00 C1887

CATH GUIDING 6F JR 3.5 SH $170.00 C1887

CATH GUIDING 6F JR 4.0 $170.00 C1887

CATH GUIDING 6F JR 4.0 SH $170.00 C1887

CATH GUIDING 6F JR 5.0 $170.00 C1887

CATH GUIDING 6F FR 4.0 $170.00 C1887

CATH GUIDING 6F FR 5.0 $177.85 C1887

CATH GUIDING 6F SR 3.5 $170.00 C1887

CATH GUIDING 6F SR 4.0 $170.00 C1887

CATH GUIDING 6F SCR 3.5 $170.00 C1887

CATH GUIDING 6F SCR 4.0 $170.00 C1887

CATH GUIDING 6F AL 1.0 $170.00 C1887

CATH GUIDING 6F AL 1.5 $170.00 C1887

CATH GUIDING 6F AL 2.0 $170.00 C1887

CATH GUIDING 6F AR 1.0 $170.00 C1887

CATH GUIDING 6F AR 2.0 $170.00 C1887

CATH GUIDING 6F SAR 1.0 $170.00 C1887

CATH GUIDING 6F MB1 $170.00 C1887

CATH GUIDING 6F HS 1 $170.00 C1887

CATH GUIDING 6F ELGAMEL $170.00 C1887

CATH GUIDING 6F MAC 3.0 $170.00 C1887

CATH GUIDING 6F MAC 3.5 $170.00 C1887

CATH GUIDING 8F JL 4.0 $170.00 C1887

CATH GUIDING 8F JL 4.0 SH $170.00 C1887

CATH GUIDING 8F JL 5.0 SH $170.00 C1887

CATH GUIDING 8F EBU 3.5 $170.00 C1887

CATH GUIDING 8F EBU 4.0 $170.00 C1887

CATH GUIDING 8F JR 4.0 $170.00 C1887

CATH GUIDING 6F JL 3.0 $170.00 C1887

CATH GUIDING 6F JL 3.0 SH $170.00 C1887

SHEATH BANANA PEEL 16X15 $164.00 C1887

Page 161: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SHEATH BANANA PEEL 12X15 $164.00 C1887

SHEATH BANANA PEEL 11X15 $164.00

SHEATH BANANA PEEL 9X15 $164.00

CATH BUD 8X30 $731.00

CATH BUD 6X15 $180.00

DRAIN FLEXIMA 10FR $236.00

DRAIN FLEXIMA 8FR $236.00

DRAIN FLEXIMA 12FR $236.00 C1729

CATH VASCULAR DILATOR 10FR $24.00 C1729

CATH VASCULAR DILATOR 14FR $24.00 C1729

EZEFORM SPLINTING MATERIAL $85.00

SPLINT FOOT DROP LG $177.00

SPLINT NIGHT SM $229.00

SPLINT NIGHT MED $229.00

SPLINT NIGHT LG $229.00

SPLINT WRIST MED-RT FUTURO $53.00

SPLINT WRIST SM-RT FUTURO $53.00

SPLINT WRIST LG-RT FUTURO $53.00

SPLINT WRIST MED-LT FUTURO $53.00

CORD CLAMP REMOVER $40.00

PROBE MAMMOTOME 11 G $170.00

MESH PROLENE SYSTEM MED $666.00

MESH PROLENE SYSTEM LG $881.00

MESH PROLENE SYSTEM EXT $754.00 C1781

BIPAP CPAP WHISPER SWIVEL $167.00 C1781

GRAFT HEMASHIELD GOLD MDVS $890.00

DRESSING MEROGEL NASAL $267.00

SUTURE PDS 96" TP-1 $28.00

CATH 3WAY HAEMA 20FR $84.00

CATH 3WAY HAEMA 22FR $116.00

CATH 3WAY HAEMA 24FR $116.00

AMPLATZ RENAL DILATOR SET $566.00

AMPLATZ EX-LONG DILATOR $173.00

VALVE 6248 VAL ADJUST $130.00

URO CART $23.00

SUTURE TICRON 5 30 C-20 HDS14 $28.00

SUTURE TICRON 2 30 T-56 HDS21 $28.00

CANNULA MENISCAL DART $92.00

MENISCAL DART 10MM $315.00

MENISCAL DART 12MM $315.00

MENISCAL DART 14MM $315.00 C1713

GUIDEWIRE THUNDER .014X190 ST $975.00 C1769

STENT BILIARY 1008021-15 $2,843.00 C1769

BALLOON DIL AGILTRAC 6X18 135C $526.00

STENT BILIARY HERC 7X40 55CM $2,742.00 C1874

REAGENT SAPPHIRE HGB $243.00 C1725

SUTURE PDS 11 2-0 27" CT-2 $104.00

SUTURE PLAIN GUT 2-0 27" FN-2 $28.00

SUTURE CHROMIC 2-0 27" UR-6 $28.00

SUTURE ETHIBOND EXT 2-0 36" SH $28.00

Page 162: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SUTURE GORETEX CV-0 PHX-26 36" $28.00

SUTURE MONOCRYL 0 27" UR-6 $28.00

SUTURE PROLENE 2-0 18" CT-2 $28.00

SUTR SILK V-20 3-0 $28.00

SUTURE STEEL #6 CHEST WIRE $28.00

SUTURE TICRON 1 30" T-56 HGS21 $28.00

SUTURE TICRON 1 30" KV-30 $28.00

SUTR VICRYL 0 18 TIES $28.00

SUTURE VICRYL 0 8-27 CT-1 $28.00

SUTR GORETEX 3-0 CV-3 $28.00

SUTURE GORTEX 5-0 CV-5 $28.00

SUTURE GORETEX 6-0 CV-6 $28.00

SUTURE VICRYL 2-0 8-18" CP-2 $28.00

SUTURE VICRYL 2-0 8-18" SH $28.00

SUTURE VICRYL 3-0 8-18" SH-1 $28.00

SUTR VICRYL 18" 3-0 $28.00

SUTURE VICRYL 4-0 27" FS-1 $28.00

DAVINCI ENDOWRIST CLIP APP LG $267.00

KIT DISCECTOMY W PROBE 407-250 $4,353.00

CANNULA RF 100MMX22GAX5MM $58.00

ELECTRODES SELF ADH NEUTRAL PT $58.00

CONTRAST OPTIRAY 350 100ML POW $100.00 Q9967

ADAPTER Y W/DUAL CHECK OPTIST $187.00

SET POWERLOCK SAFETY INFUSION $71.00

CATHETER SELECTSITE GLOBAL $1,283.00

LEAD CATH DELIV 4FR 59CM $1,733.00 C1898

LEAD SPRINT QUATTRO RV/SVC $11,650.00 C1895

VIRTUOSO ICD DR AT 35J $34,346.00 C1721

SPLINT PREFORMED RIGHT LG $97.00 C1895 C1895

SPLINT PREFORMED LEFT MED $97.00

SPLINT PREFORMED LEFT LG $97.00

GARMENT THIGH REGULAR $125.00

PORT MEDTRONIC CATHETER ACCESS $93.00

BALLOON DIL PERIP 6X4 75CM $2,584.00

BALLOON DIL PERIP OPTI 5FR 75C $2,584.00

BALLOON DIL PEROP CONQUEST 5.8 $560.00 C1725

BALLOON DIL PEROP CONQUEST 5.5 $560.00 C1725

BALLOON DIL PERIP ATLAS 6.5FR $2,584.00 C1725

BALLOON DIL PERIP OPTI-PLAST 5 $626.00 C1725

STENT GRAFT FLU 10X60 80CM $4,547.00 C1725

SENSOR THERMOCOUPLES ADULT $409.00 C1874

WIRE LEAD 60" BLACK SNAP CONNE $28.00

VENT TESTING LUNG $359.00

SENDOR BELT RESPIRATORY $757.00

CONNECTOR X-MAS TREE YELLOW $146.00

CATH BARD MALECOT 24FR $78.00

CATHETER BARD MALECOT 32FR $41.00

CATHETER BARD MALECOT 36FR $41.00

MESH PROCEED 10X15 PCDN1 $529.00

MESH COMPOSIX 6X8 EX $1,767.00

Page 163: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PATCH CURASOFT SM 7X6 $949.00 C1781

PATCH CURASOFT LG 11X8 $1,212.00 C1781

MESH SURGISIS GOLD 13X22 $2,915.00 C1781

MESH SURGISIS GOLD 20X20 $3,822.00 C1781

CATH EMBOLECTOMY 2FR $368.00 C1781

CATH EMBOLECTOMY 4FR $229.00 C1781

CATH EMBOLECTOMY 5FR $133.00

CATH EMBOLECTOMY 6FR $133.00

CATH EMBOLECTOMY 7FR $229.00

CATH EMBOLECTOMY 6FR IRR $113.00

CATH EMBOLECTOMY BIL 5FR $184.00

GRAFT VASCULAR ULTRAMAX 16X30 $890.00

SHUNT CAROTID 9FR PRUITT $308.00

SHUNT CAROTID 8FR PRUITT $93.00 C1768

GRAFT PTFE 4-7MM $956.00

GRAFT PTFE 6X45 $907.00

GRAFT PTFE 6X80 $1,112.00 C1768

GRAFT PTFE 8X80 $920.00 C1768

BALLOON DILATATION SPRINTER $170.00 C1768

MASK THERMO UNI-FRAME 12" DISP $409.00 C1768

CATH GUIDING 4.0 Z26RBU40 $170.00 C1725

CPM SET UP/SUPPLY $58.00

STENT GENESIS 6X29X80 $2,980.00 C1887

STENT GRAFT FLU 7X80 80CM $2,584.00

BALLOON DIL PERIP 5.5F 75CM $560.00 C1874

FILTER SYS JUGULAR DIL SHEATH $2,425.00 C1874

BALLOON DIL PERI CONQUEST 5.5F $560.00 C1725

BALLOON FIL PERIP CONQUEST 5.5 $560.00

SCREW SCHANZ 4.0MM 294.771 $384.00 C1727

STENT BILIARY 8X39 80CM PG3980 $3,079.00 C1727

BALLOON DIL CUTTING 2.25X15 $1,904.00 C1713

OPTIRAY 320 20ML VIALS $34.00 Q9967

IONTOPATCH LARGE 80M $161.00

GONIOMETER SMALL JOINT $99.00

GUIDEWIRE TORQUE PILOT 3CM $258.00

SHEATH INTRO 7FR FLEXOR $199.00

INTRODUCER CHECK FLO FLEXOR 8F $198.00 C1769

BALLOON SPRINTER 2X25MM $578.00

STENT TRANS BILIARY 7C18 135CM $2,742.00 C1727

STENT BILIARY PALMAZ 6X39 $3,079.00

STENT BILIARY PALMAZ 7X39 $3,079.00 C1874

STENT TRANS BILIARY 6X30 120CM $2,980.00 C1874

FILTER VENA CAVE OPTEASE 6FR $3,811.00 C1874

GUIDEWIRE STORQ 180 CM ST $195.00 C1769

CATHETER ASPIRATION EXPORT $1,428.00

CATH BALLOON SPRINTER 1.5X6MM $578.00

CATH BALLOON SPRINTER 2MMX 6M $578.00

BALLOON SPRINTER 2.5X6 $578.00

CATH BALLOON SPRINTER 2.5X25 $578.00

CATH BALLOON SPRINTER 2.75X12 $578.00 C1727

Page 164: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BALLOON SPRINTER 2.25 X 15 $578.00

BALLOON SPRINTER 3X6 $578.00

CATH BALLOON SPRINTER 3X25 $578.00 C1727

CATH BALLOON SPRINTER 3.5X12 $578.00 C1727

CATH BALLOON SPRINTER $578.00

CABLE PAT EDWARDS PX1800 $363.00

CATH BALLOON SPRINTER 4X12 $578.00

CATH BALLOON SPRINTER 4X30 $578.00

CATH GUIDING 8FR 091X100 $170.00

BALLOON SPRINTER 3.5X10 $578.00

BALLOON DILAT CORO OTW 1.5X10 $503.00 C1887

BALLOON SPRINTER 2X10 $578.00 C1727

GUIDEWIRE SM PRESSURE XT14/185 $1,428.00 C1727

POSITIONER HEAD REST F $85.00 C1727

BALLOON DIL CONQUEST $654.00 C1769

CONTRAST OPTIRAY 320 100ML $249.00 Q9967

BALLOON OPTIPLAST XT7554 $626.00 C1727

BALLOON OPTIPLAST XT-7564 $626.00

STENT FTL06080 $5,459.00 C1727

SUTR MONOCRYL 27IN Y417H $28.00 C1874

GLOVE RADIATION RESIS 6 1/2 $181.00

GLOVE RADIATION RESIST 8.0 $181.00

BALLOON SPRINTER SPR2510W $578.00

CATH GUIDING 6FR Z26EBU30SH $170.00

CATH GUIDING Z26SR35SH $170.00 C1727

SPICA THUMB HAND BASED MED $70.00 C1887

DRESSING HYDROFERA BLUE $112.00

PERCUSSOR NEONATAL $165.00

NEEDLE AVAMAX TROCAR 11GX12CM $198.00

SUTR VICRYL PLUS 36" VCP947H $28.00

BALLOON DIL OTW 1010004-40 $526.00

SYSTEM VACORA BIOPSY 10GAX140M $667.00

SUTR CHROMIC 1 27IN 48G $35.00 C1727

SUTR MONOFOF 4-0 SN5667G $28.00

KNEE LOCK STANDARD $67.00

TRANSFER PIPETS $28.00

CREAM SKIN 4OZ BARRIER DIMETHI $25.00

HOLDER NEEDLE COOK G14464 $238.00

TUBE SKIN LEVEL G 14FR $292.00

STENT WLGORE VBC070502 $5,017.00

WIRE LEAD WITH SNAP CONNECTOR $32.00 C1874

MASK GEL SMALL $284.00

MASK GEL MEDIUM $284.00

MASK GEL LARGE $284.00

GUIDEWIRE STD FLEX TIP 3CM X 1 $872.00

TOOL ACCESS 6056 PINCH ON FIX $91.00

KIT ACCESS STYLET 65CM $154.00 C1769

BALLOON DILATATION PERI 5FR $626.00

STENT BILIARY 6MMX15MM 80CM $2,742.00

STENT CORONARY XIENCE 2.75MMX1 $4,543.00 C1727

Page 165: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CONTRAST EOVIST VL 10ML $246.00 A9581

DRESSING HYDROFERA BLUE 4X4 $28.00

STENT BILIARY 9MMX59MM 80CM $2,487.00 A9581

STENT BILIARY 6MMX15MM 135CM $2,487.00 A6209

SET SHEATH W/O GUIDEWIRE 7F $198.00 C1874

STENT BILIARY GENESIS 9X79 80 $181.00 C1874

SHEATH SAFESHEATH 7FR 25CM $58.00

STENT GRAFT FLUENCY 7X40 80CM $4,841.00 C1874

INTRODUCER SAFESHEATH 9FR 25CM $312.00

STENT GRAFT 7MMX60MM 117CM $312.00 C1874

STENT GRAFT FL 6MMX80MM 117CM $312.00

STENT GRAFT FLU 6X60 80CM $188.00 C1874

GASTROVIEW 120ML $23.00

STENT CORONARY XIENCE 2.75X23M $4,543.00

CAUTERY CORDLESS LOOP HI TEMP $39.00 C1874

CATH THORACIC RT ANGLED 28FR $197.00

TUBE ARMSTRONG BEVELED VENT $42.00

SPLINT DOYLE NASAL SEPTAL $135.00

BLADE BEAVER 6MM $117.00

BLADE SKIMMER ANGLE 3.5 $789.00

SUTR 2-0 POLYSORB V-20 $28.00

MESH PROLENE 6X6 SOFT $1,785.00

NEEDLE CONCENTRIC SCN SHORT $38.00 C1781

BALLOON DIL OTW 4.0 X 10 $2,584.00

BALLOON DIL OTW 3.0MM X 10MM $4,644.00

BALLOON DIL OTW 2.75MMX10MM $4,440.00 C1727

BALLOON DIL OTW 5MMX40MM $2,584.00 C1727

BALLOON DIL 5F 6MMX40MM $526.00 C1727

OPRIRAY 350 SYRINGE 20X 75 $104.00 Q9967

OPTIRAY 350 20 X 125 $125.00 Q9967

SYRINGE SODIUM CHLOR INJ 125ML $61.00

CATH EPISTAXIS 5.5 ANTERIOR $102.00

CATH EPISTAXIS 7.5 RHINO $115.00

BALLOON DILATATION PERI 5FR $626.00

BALLOON DIL PERI 5FR 6MM $626.00

BALLOON DIL PERO 6.5FR 12MM $898.00 C1727

SENSOR SNORING MICROPHONE $409.00 C1727

SUTURE VICRYL RAPIDE 2-0 VR945 $28.00 C1727

NEEDLE TURKEL 8FR CATH $108.00

TONER PHASER 8560 CYAN $341.00

BALLOON OPTIPLAST XT-12034 $626.00

BALLOON NC MERLIN 2.5X10CM $731.00

VISICOIL MARKERS/FIDUCIAL MARK $564.00 C1727

NEEDLE BRACHYTHERAPY 1.2X3 $183.00 C1727

GONIOMETER PLASTIC 12" $135.00

GLOVE RADIOPAQUE 7 1/2 $181.00

GLOVE RADIOPAQUE SZ 6 $181.00

CLOSURE VASC STARCLOSE SE $623.00

CURTAIN EQUIP DRYER $421.00

TUBE SKIN LEVEL 3.0 $315.00 C1760

Page 166: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SENSOR NEO ADHESIVE LNCS $73.00

PROBE DISCOGRAM $580.00

STRAP CHIN TRIANIM $70.00

NEEDLE ECHOTIP CHIBA 20X5.0 $68.00

NEEDLE CORE TISSUE 14GA X 10 $121.00

BALLOON DIL 6FR 7MMX40MM 80CM $526.00

BALLOON DILATION 6FR AGILTRAC $654.00

BALLOON DILATION 6FR OTW $578.00 C1727

STENT ENDO BIOACTIVE 7FR $5,346.00 C1727

STENT ENDO 7FR 6MMX2.5CM $5,346.00 C1727

STENT CORONARY 2.5X12 $4,543.00 C1874

STENT CORONARY 2.5 X 15 $4,543.00 C1874

STENT CORONARY 2.5X18 $4,337.00 C1874

STENT CORONARY 2.5X23 $4,337.00 C1874

STENT CORONARY 3.0 X 12 $4,337.00 C1874

STENT CORONARY 3.0 X15 $4,543.00 C1874

CATH BALLOON DIL POWERFLEX $550.00 C1874

STENT BILIARY 9X79 $3,870.00 C1874

CURETTE GYNOSAMPLER ENDO $448.00

PAD CADEXOMER IODINE 5GRAM $95.00 A6222

GEL IODOSORB 10GRAM $168.00 A6261

STENT BILIARY HERC 5X15 $2,742.00

PACKING POPE EPISTAXIS MERO $27.00 A6261

SUTURE SILK 3-0 8-18 SH $28.00 C1874

SUTR ETHIBOND X GRN BR 0 MO-6 $28.00

MESH PROLENE 3X6 $448.00

ETH SKIN STAPLER PMW35 $30.00

BURR STRYKER 375-951-100 $174.00

DRAPE EXTREMITY W/ARMBO $28.00

BLADE CLIPPER SENSICLIP 4403A $24.00

GAUZE ALGIDEX AG PACKING 1'2X5 $42.00 A6266

GAUZE ALGIDEX PACKING 1/4X5 $41.00

STENT CORONARY 3.0 X 18 $4,337.00 A6266

STENT CORONARY 3.0 X 23 $4,337.00

STENT CORONARY 3.5X12 $4,337.00 C1874

PRIME WIRE $1,654.00 C1874

BALLOON DIL SPRINTER 2.5X15 $578.00

BALLOON DIL SPRINTER 2X15 $578.00 C1769

CATH ANGIO 5FR 38X100 $884.00 C1885

CATH ANGIO 5F 38X65 $884.00 C1725

COIL FIBERED 18 HELICAL $1,124.00

NEEDLE AMPLATZ INSERTS $191.00

COIL EMBOLIZATION 035 5X30 $1,019.00

CATH GUIDING 6F 071X100 $170.00

CATH ANGIO 6F 038X100 $558.00

GUIDEWIRE COUGAR 014X190 $975.00 C1887

GUIDEWIRE ZINGER 014X180 $975.00

CATH IMAGING EAGLE EYE 3.5FR $1,725.00 C1769

GUIDEWIRE AMPLATZ 35X16 75CM $427.00 C1769

GUIDEWIRE AMPLATZ 35X16 145CM $427.00 C1753 C1769

Page 167: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CAPS ENDO IRRIGATOR EL-400C $403.00 C1769

BURR STRYKER 3.5MM $183.00 C1769

CLAMP ADJUSTING 40MM $2,077.00

BALLOON SPRINTER 1.5 X 12 $381.00

GUIDEWIRE CORONARY 014 X 190 $305.00

HIP STEM 599T106 $1,658.00 C1725

HIP STEM ODC-FX 7 $1,658.00 C1769

K WIRE .062 $28.00 C1776

K WIRE 0.45 $28.00 C1776

PERSONAL THERAPY MANAGER $1,283.00 C1713

SUTURE GORE TEX OUO1 $28.00 C1713

SUTR VICRYL 3/0 27IN VCP423H $28.00

POLAR CARE 300 $324.00

PAD KNEE $146.00

SUTR PROLENE 6-0 8707H $28.00

SUTR PROLENE 6-0 8719H $28.00

K WIRE .045 9 $58.00

SCREW SELF TAPPING 1.5X11MM $190.00 C1713

BIT DRILL CPLNG 1.8MM 317.861 $203.00

SYRINGE SAFETY LOK 3CC 22GX1 $52.00

TRAY DRESSING CHANGE $43.00

SCAPEL HARMONIC CS14C $874.00

SCAPEL HARMONIC CS23C $861.00

SCAPEL HARMONIC ACE36E $1,113.00

NEEDLE COAXIAL BIOP 9.0 $181.00

NEEDLE COAXIAL BIOP 15.0 $177.00

CATH TROCAR 12FR $59.00

CATH TEMP PACING KIT $318.00

WAFER CLSTMY 2.25 $51.00

POUCH CLSTMY DRAIN 2.25 $29.00

POUCH URSTMY 2.25 $50.00

SLEEVE CLSTMY IRRIG 2.25 $55.00

CICA CARE $1,204.00

SOCK AID TERRYCLOTH $38.00

SOCK AID WIDE STYLE $33.00

GRASPER CARTRIDGE 5MM X 38CM $167.00

POUCH ENDOSCOPIC 10MM $213.00

H PYLORI $202.00

BALLOON CRE DILATOR 18-20 $578.00

BALLOON CRE DILATOR 15-18 $578.00

BALLOON CRE DILATOR 12-15 $578.00 C1727

BINDER ABD XXL $46.00

PACK MINI GENERAK CUSTOM $25.00

FIBERWIRE #2 $71.00 C1713

SUTURE ETHIBOND 0 30 CT-1 $28.00

SUTURE ETHIBOND EXT 4-0 36 SH $28.00

SUTURE ETHIBOND EXC 2-0 36 SH $28.00

SUTR ETHBND GRN BR 4-0 30 $170.00

SUTURE ETHIBOND 4-0 30 BB $28.00

SUTURE ETHILON 2 30 LR $28.00

Page 168: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SLEEVE ENDOSCOPIC STPCOCK 11MM $57.00

TROCAR ENDO BLDLSS 5MM X 100MM $98.00

SUTURE PRONOVA 5-0 C-1 24 $28.00

TROCAR ENDO BLDLSS 11MM X 100 $127.00

SUTR VIC UD BR CT 3-0 27 $170.00

SUTURE CHROMIC 4-0 18 P-3 $28.00

ENDOSTITCH POLYSORB 2.0 $161.00

PROTACK 5MM INST $693.00

PASTE ELEFIX EEG $78.00

JURGAN PIN BALL REFILL W062GN $115.00

INTERPULSE HANDPIECE $190.00

TUTOPLAST 6X8 $2,758.00

OMNIPAQUE 300 10ML VIALS $35.00

CATH POLLACK 5FR OPEN END $39.00 C1762

SUTURE CHROMIC 0 60 3T REEL $28.00

TISSUE BUTTON 10MMX5MM $898.00

DRAPE STERILE DOUBLE DISC $157.00

CATH 12.5FR HICKMAN TL $654.00 C1713

DEVICE SUTURE CAPTURE STNDRD $767.00

ELECTRODE HOOK WIRE L $116.00

PAD OR FLOOR ABSORBENT 30X40 $27.00

STENT BILIARY OTW 9X38 80CM $2,584.00

CATH ASPIRATION EXPORT 7F 145C $2,584.00

BALLOON DIL OTW 014IN 2.5MMX10 $2,584.00

BALLOON DILATATION OTW 2.5MM $539.00

SET RANGER FLUID WARMING $39.00 C1727

PBDS GENERAL ABDOMINAL $252.00

PBDS HERNIA $171.00

PBDS LAP CHOLE $709.00

PBDS ABDOMINAL HYST $431.00 A4649

PBDS GYN LAP $309.00

PBDS MINOR LITHOTOMY $186.00

PBDS VAGINAL HYST $310.00

PBDS KNEE ARTHROSCOPY $459.00

PBDS HIP PINNING $171.00

PBDS LOWER EXTREMITY $209.00

PACK OPEN SHOULDER $295.00

PBDS TOTAL HIP $724.00

PBDS TOTAL KNEE $692.00

PACK UPPER EXTEMITY $164.00

PBDS CYSTO $228.00

PBDS TURB/TURP $304.00

PBDS ENT $172.00

PACK MINOR ENT $141.00

PBDS C-SECTION $259.00

DRAPE LAVH $41.00

CATH GUIDING 6FRX3.5 Z26FR35 $170.00

CATH GUIDING 6FR LCB Z26LCB $170.00

CATH BALLOON 2.0X20MM $578.00 C1887

STENT OTW 3.0X24 $2,130.00 C1887

Page 169: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

D STAT $371.00

STENT OTW 4.0X12 $2,130.00 C1874

STENT OTW 3.5X9 S73509W $2,130.00

STENT OTW 3.0X9 $2,130.00 C1874

CATH GUIDING 6F EBU 3.0 $170.00 C1874

SCISSOR TIPS DISPOSIBLE $190.00 C1887

SPARC SLING SYSTEM $2,575.00

TUBE G SKIN LEVEL 14FRX2.0 $312.00

TUBE G SKIN LEVEL 14FRX2.5 $299.00 C1771

TUBE G SKIN LEVEL 16FRX2.0 $299.00

TUBE G SKIN LEVEL 16FRX2.5CM $299.00

TUBE G SKIN LEVEL 18FRX2.0CM $299.00

TUBE G SKIN LEVEL 18FRX2.5 $312.00

TUBE G SKIN LEVEL 20FRX2.5 $312.00

SET BOLUS FEEDING 24 $30.00

SPRAY DUPLOREACH 35 EX $175.00

OPTIRAY 350 PREFILLED SYRINGE $52.00 Q9967

BLADE TOTAL SAGITTAL 25MM $160.00

CATH EMBOLECTOMY 3FR $229.00 C1769

SNARE KIT 4FRX10MM GN1000 $808.00

SNARE KIT 6FRX25MM GN2500 $808.00

STENT AVE 3.5X12 S73512W $2,130.00

CATH GUIDING 4.0SH Z26FR40SH $170.00

DRESSING SILVERLOIN $52.00 C1887

SYRINGE OPTISTAR MRI 60/60 $59.00

SYRINGE OPTISTAR MRI 25ML $36.00

JURGAN PIN BALL W0564 $108.00

OMNIPAQUE 240 20ML VIALS $184.00

SEPRAFILM $616.00

RELOAD STPL GIA STRT WH 45-2.5 $277.00

TUBE G SKIN LEVEL 18X1.5 $299.00

TUBE G SKIN LEVEL 16FRX1.5CM $299.00

TRAY CHOLECYSTECTOMY TNC61 $1,125.00

SCREW CAN 4.5MM 214.560 $503.00

SCREW TI CANN 7.3MM 409.880 $584.00

SUTR PROLENE 7-0 24L M8766 $28.00 C1713

PUTTY DBX 10CC $2,950.00

PELLETS OSTEOSET 10CC $1,244.00

SUTR STEEL #6 18 M654G $28.00 C1713

SUTR MONO/BIO 5-0 Y495G $28.00 C1713

STAPLER PURSTRING 65 020242 $219.00

SUTURE MONOCRYL 3-0 27 UR-6 $28.00

NEEDLE CHIBA 18GAX10CM $77.00

TUBE G SKIN LEVEL 20FRX2.0CM $312.00

MESH PROLENE 2.16X4.92 LGE $575.00

STENT GENESIS 8X29 PG2980BPX $2,980.00

FOAM CONTOUR BLUE $127.00 C1781

FLUID SEMEN DILUTING 100ML $240.00 C1874

TUBE 32FR RT ANGLE CHEST $24.00

TUBE FEEDING 8FR JEJUNAL $333.00

Page 170: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CATH GUID 6FX3.0 SH Z26FR30SH $170.00

FIXATOR STRYKER TRAUMA EXTER $4,380.00

CORETAINERS $82.00 C1887

MESH SM CIRCLE KUGEL $1,239.00

SCREW CORTEX 6.0MM 400-686 $207.00

SCREW CORTEX 1.3MM X 8.0MM $207.00 C1781

DRESSING VAC KIT XLG ATS $325.00

SUTR MONOCRYL 5-0 18IN $28.00

FIBERWIRE SZ5 $138.00

MESH COMPOSIX EX 10X13 $3,610.00

MESH COMPOSIX EX 8X10 $2,810.00 C1713

DRESSING ALLYVEN HEEL PAD $31.00 A6210

SUTR ASSIST ENDO 5.16MM SW100 $28.00 A6210

SUTR ASSIST RELOAD SZ0 6 SW120 $28.00

EZEFORM SPLINT MAT BEIGE 18X24 $500.00

STENT OTW 3.0X12 $2,130.00

BAG PHLEBOTOMY 4500ML $40.00

JURGAN PIN BALL W045-YL $115.00 C1874

JURGAN PIN BALL W332-CR $108.00

TUBE G SKIN LEVEL 14FRX3.0CM $312.00

TUBE G SKIN LEVEL 16FRX3.0 $312.00

TUBE G SKIN LEVEL 18FRX3.0CM $299.00

TUBE G SKIN LEVEL 20FRX3.0 $312.00

TUBE G SKIN LEVEL 16FR $299.00

TUBE G SKIN LEVEL 24FR $299.00

PUMP PAIN 120CC $409.00

STENT OTW 3.5X15 S73515W $2,023.00

CATH GUIDING 6FR IMA $170.00

STENT OTW 3.0X15 $2,130.00 C1874

CATH GUIDING 6FR Z26CHAMP10 $170.00 C1887

CATH GUID 6FX3.5 SH Z26FR35SH $170.00 C1874

CATH BALLOON 3.0X10 D3S3010 $578.00 C1887

STENT OTW 4.0X15 $2,023.00 C1887

CONTROL HR CLOTTRAC $264.00

WRENCH KIT $164.00

LEAD PACE J SHAPE 45CM 457445 $1,488.00

CATH MULTIPACKS 7560-13 $110.00

CATH CARDIAC PIGTAIL 7529-23 $49.00

GUIDEWIRE BENTSON IQ35F150B $43.00

TUBE TRCHSTMY 4.0 NEO $136.00

BOLT TI LOCKING 3.9MM 458.26 $471.00 C1769

BOLT LOCKING 3.9MM X 28MM $471.00

BOLT LOCKING 3.9MM X 40MM $471.00 C1713

RESECTOR 4.0MM DISP $41.00 C1713

CUTR AGG PLUS 5.5MM $183.00 C1713

EZEFORM SPLINT MAT WHITE $173.00

OPTIVAC MIXER $393.00

OPTIVAC DOUBLE MIXER $393.00

CEMENT BONE COBALT $236.00

PBDS MINOR UPPER $113.00

Page 171: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SUTURE MONOCRYL 4-0 27 PS-2 $28.00

MESH COMPOSIX EX 4X6 $896.00

PBDS MINOR LOWER EX $150.00 C1781

ENDOCUTTER ARTICULATING $949.00

SPONGE ENDO PEANUT CHERRY 10M $58.00

UTERINE MANIPULATOR/INJECTOR $229.00

DEVICE ENDO FIX 5MM W 20 NITI $706.00

TROCAR ENDO BLDLSS 12MM X 100 $127.00

STAPLER ENDO PROX HENMOR CIR $1,058.00

CUTTER 45MM LINEAR GREEN LOAD $663.00

STAPLER / CUTTER GIA100-3.8 $545.00

STAPLER TA90-3.5 $332.00

RELOAD STPL GIA STRT GN 45-4.8 $277.00

SURGIDAC 2-0 $28.00

BALOON CUTTING 2.75X10CM $1,971.00

CATHETER GUIDING SR 3.0 $170.00 C1887

SUTR VICRYL 1 36 CTXB JB977 $28.00 C1727

SUTR MONOCRYL 1-0 27 CT-1 Y341 $28.00

SUTURE VICRYL 0 36 CT-1 $28.00

SUTURE SILK 2-0 8-30 SH $28.00

SUTURE 5-0 18 ETHILON FS-2 $28.00

SUTURE ETHILON 4-0 18 PS-4 $28.00

SUTURE VICRYL 5-0 18 P-3 $28.00

SUTURE CHROMIC 4-0 18 P-2 $28.00

SUTURE VICRYL 4-0 18 P-3 $28.00

SUTURE 3-0 18 PROLENE PS-2 $28.00

SUTURE SILK 4-0 12-30 TIES $28.00

SUTURE 3-0 8-18 VICRYL ANTIBA $28.00

SUTURE VICRYL 4-0 27 FS-2 $28.00

SUTURE VICRYL 3-0 36 CT $28.00

SUTURE 3-0 36 PROLENE D/A SH $28.00

SUTURE 7-0 4-24 PROLENE D/ACC $28.00

SUTURE CHROMIC 1 27 CT-2 $28.00

SUTURE 0 36 CHROMIC GUT CT $28.00

SUTURE CHROMIC 3-0 54 REEL $28.00

SUTURE PLAIN GUT 3-0 27 FS-2 $28.00

SUTURE PROLENE 1 30 CTX $28.00

SUTURE PROLENE 3-0 36 MH $28.00

SUTURE MERSILENE 5MM 12 BP-3 $28.00

SUTURE 4-0 18 MERSILENE W D/A $28.00

SUTURE PDS II 1 54 TP-1 $28.00

SUTURE PDS II 0 36 CT $28.00

SUTURE PDS II 0 36 CTX $28.00

SUTURE 3-0 27 MONOCRYL UNRB-1 $28.00

SUTURE VICRYL 0 36 CTB-1 $28.00

SUTURE VICRYL 0 8-18 CT2 $28.00

SUTURE VICRYL 0 36 CT $28.00

SUTURE 2-0 27 VICRYL ANTIBC C $28.00

SUTURE 2-0 36 VICRYL ANTIBC C $28.00

SUTURE 2-0 8 18 VICRYL ANTIBC $28.00

Page 172: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SUTURE VICRYL 2-0 27 CP-1 $28.00

SUTURE VICRYL 3-0 27 FSL $28.00

SUTURE VICRYL 4-0 12-18 TIES $28.00

SUTURE VICRYL 4-0 27 SH $28.00

SUTURE VICRYL 4-0 27 RB-1 $28.00

SUTURE VICRYL 5-0 18 P-1 $28.00

SUTURE VICRYL 5-0 27 RB-1 $28.00

SUTURE VICRYL 7-0 12 TG140-8 $28.00

SUTURE SILK 1 10-30 TIES $28.00

SUTURE SILK 3-0 30 RB-1 $28.00

SUTURE ETHILON 2-0 30 FSLX $28.00

SUTURE 3-0 18 ETHILON PS-1 $28.00

SUTURE 5-0 18 ETHILON P-3 $28.00

SUTURE ETHILON 12 8-10 CS1758 $28.00

SUTR 1 30 ETHIBOND EXCEL G OS $28.00

SUTURE ETHIBOND 3-0 30 V-5 $28.00

SUTURE PDP PLS 4-0 18 PS-2 $28.00

SUTURE SILK 2-0 18 FS $28.00

SUTR 4-0 27 MONOCRYL PS-1 $87.00

SUTR 0 36 VICRYL VIL CT-1 $28.00

SUTR 5-0 18 VICRYL UND PS-2 $28.00

SUTR 6-0 4 30 PROLENE DA CC-1 $40.00

SUTURE SILK 1 30 MH $28.00

SUTURE SILK 0 8-18 CT-1 $28.00

SUTURE PROLENE 2-0 18 FS $28.00

CATH SIDEHOLE 6CM 035 X145CM $539.00

CATH INFUSION MTI 5F 5CMX100CB $315.00

CATH INFUSION MTI 5F 5CMX65CM $315.00

TUBING BR HP INJECTOR 1200PSI $37.00

CONTRAST OPTIRAY 350 100ML $87.00 Q9967

GUIDEWIRE 035 X145CM $43.00

VISIPAQUE 50 ML $129.00

VISIPAQUE 200 ML $359.00

GUIDEWIRE ROSEN CV 035 X145CM $59.00 C1769

GUIDEWIRE ROSEN CRV 035X220CM $76.00 C1769

BALLOON INTRA AORTIC DL 10.5FR $1,547.00 C1769

BALOON AORTIC TRUE 9.5FR 40CCC $1,547.00 C1769

BALOON AORTIC TRUE 9.5FR 34CCC $1,547.00 C1727

GUIDEWIRE SPARTA 014 X300CM $252.00 C1727

CATH GUIDING RDCI 6F 068 X50CM $315.00 C1727

CATH GUIDING RDCI 8F 088 X50CM $315.00 C1769

CATH GUIDING LIMA 6F 068 X50CM $315.00 C1887

CATH GUIDING LIMA 7F 078 X50CM $315.00 C1887

CATH GUIDING LIMA 8F 088 X50CM $315.00 C1887

CATH GUIDING VERIPH 6F 068X50 $315.00 C1887

STENT BILIARY HERC 5MMX12M 80C $2,742.00 C1887

STENT BILIARY HERC 5MX12M 135C $2,742.00 C1887

STENT BILIARY HERC 6MX12M 80CM $2,742.00 C1876

STENT BILIARY HERC 7MX18M 80CM $2,843.00 C1876

CATH PER. DIAL14 5MMX20MM 135C $1,155.00 C1876

Page 173: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CATH PER. DIAL14 6MMX20MM 80CM $1,155.00 C1876

CATH PER. DIAL14 7MMX20MM 135C $1,155.00

CATH PER. DIAL14 7MMX15MM 80CM $1,155.00

BALLOON DIL OTW 035 6X40CM 55C $526.00

BALLOON DIL OTW 035 7X20CM 80C $526.00

BALLOON DIL OTW 035 6X40CM 135 $526.00 C1727

INTRODUCER SET PEELAWAY 9F 30C $170.00 C1727

CATH COPE INTR. CWGE-100 $267.00 C1727

GUIDEQIRE PT 014X300CM CHOICE $481.00

INTRODUCER W S/S 018 40CM21G7C $123.00

FILTER VENA CAVA FEM BIRD 75CM $2,781.00

DILATOR COPE-SADDEKNI SFA ACC $85.00

GUIDEWR FIR ROADRN 035 X145CM $123.00 C1880

INTRODUCER SET MICROOPT S/S 4F $136.00

NEEDLE ECHOTIP 21GAX7CM $35.00 C1769

BALLON OTW NC RANGER 3MMX16M $962.00

BALLOON OTW NC RANGER 4MMX9M $962.00

INTRODUCER ACCUSTICK II SYSTEM $221.00 C1727

INTROD ACCUSTICK II SYS NITIN $233.00 C1727

STENT BIL. ENDO CAREY-COONS SF $445.00

INTRODUCER CHK-FL 40CM RAD 038 $175.00 C1874

INTRODUCER SET 7 FR $177.00

CATH BILIARY 10.2F 40CM 32SH $279.00

CATH BIL MAC-LK 12F 038 40CM $297.00

STENT AMPLATZ URETER 10.2F 22C $452.00

STENT AMPLATZ URETER 10.2F 24C $452.00

STENT AMPLATZ URETER 10.2F 26C $452.00 C1874

INTRODUC MICROPUNCTURE 4.5X9CM $158.00 C1874

INTRODUC MICROPUNCTURE 5.5X9CM $173.00 C1874

INTRODUC PEEL MICRO 6.0FX9CMX7 $158.00

INTROD STIFFENED MICROPUNCTURE $160.00

CATHETER DRAINAGE APD 14FR $236.00

TUBING VENTED PACLITAXEL IV $31.00

BALLOON DIL ALL TER 7MMX4.080C $613.00

INTRODUCER AVANTI 4F 035 X11CM $36.00 C1727

INTRODUCER SHEATH AVAN 5F 23CM $85.00

INTROD SHEATH AVAN 7FX11CM $36.00

INTROD SHEATH AVAN 8FX11CM $36.00

CATH INF CRAG MC 10CMX038X65CM $315.00

CATH INFUS MTI 5F 10CMX018X100 $315.00

BALLOON DIL P3 5F 035X4X2CM110 $550.00

BALLOON DILP3 6F 035X8X4CMX80 $550.00

VALVE PROT MINI TITANIUM VAXCE $1,280.00 C1727

GUIDEWIRE ANGLE 3CMX035X260CM $427.00 C1727

GUIDEWIRE ANGLE 3CMX018X150CM $44.00

DEVICE TORQUE $148.00 C1769

FILTER V CAVA TRAP 6F 55CM 8SH $2,756.00 C1769

DILATOR 4F $182.00

SHEATH ULTIMA 6FR X 23CM $85.00 C1880

AVANTI PLUS 038 6F11CM W/O OBT $36.00

Page 174: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

INTRODUCER AVA 8F 038 X23 $96.00

CATHETER SOFT 5F 035 X100CM $76.00

CATHETER SOFT 5F 035 X100CM $76.00

CATHR ANGIO BENT2 5F 035X100CM $50.00

SEAM GUARD $535.00

CATHR AMR MOTAR CR 5F 035X100 $76.00

CATH ANGIO PER. KA2 5F 038X65C $49.00

GUIDEWIRE EX JAGWR STR 035X260 $642.00

WIRE ATW PTCA 014X300CM FLEX $245.00

GUIDEWIRE RAD ANGL 035X150CM $177.00 C1769

CATH ANGIO SOFT 4F 035X100CM $50.00 C1769

GUIDEWRIE ST SUPER ST 035X150C $80.00 C1769

CATH HOOK PERF 5F 035X100 6SH $92.00

CATH ANGIO PERF 5F 035X65C 6SH $49.00 C1769

CATH PIG JL4 JR4 6F 038X100 $186.00

CATH SOFTOUCH PIG 6F 035X110 $76.00

CATH ANGIO SOFT RBC 5F 038X100 $76.00

CATH ANGIO SOFT LCB 5F 038X100 $76.00

BALLOON CUTTING 2MMX10MM $1,971.00

BALLOON CUTTING 2MMX15MM $1,904.00

BALLOON CUTTING 2.5MMX10MM $1,971.00 C1727

BALLOON CUTTING 3.25MMX10MM $1,971.00 C1727

BALLOON CUTTING 3.25MMX15MM $1,971.00 C1727

BALLOON CUTTING 3.75MMX15MM $1,971.00 C1727

BALLOON CUTTING 4MMX10MM $1,904.00 C1727

BALLOON CUTTING 4MMX15MM $1,971.00 C1727

BALLOON CUTTING 2.25MMX10MM $1,971.00 C1727

BALLOON CUTTING 2.50MMX15MM $1,971.00 C1727

BALLOON CUT OTW ULTR2 3MMX10M $1,904.00 C1727

BALLOON CUT OTW ULTR2 3MMX15M $1,971.00 C1727

BALLOON CUTOTW ULTR2 3.5MX10M $1,971.00 C1727

BALLOON CUTOTW ULTR2 3.5MX15M $1,971.00 C1727

CLAMP CATHETER 7F $178.00 C1727

SHEATH INTRODUCER PERCUTANEOUS $188.00 C1727

BALLOON DIAL STORMER 1.5MMX20 $578.00

STENT ESOPHAGEAL 12CM $4,543.00 C1727

STENT ESOPHAGEAL 15CM $4,543.00

SNARE AMPLATZ 6F 15MMX 120CM $744.00 C1874

SHEATH PEELWAY SIDEPORT 7F 13C $197.00

SHEATH PEELWAY SIDEPORT 9F 13C $48.00

SHEATH PEWAY SIDEPORT 10.5F 13 $217.00

LINE INJECTOR HI PRES 1200 PSI $30.00

GUIDEWIRE EXC JTIP 3MMX035X260 $48.00

GUIDEWIRE INQ BENTSON 035X260 $85.00

GUIDEWIRE NIT ANGLE 018X80CM $503.00 C1769

GUIDEWIRE NIT FLOPPY 018X180CM $299.00 C1769

STENT GENES TRANS BI 8X29X80CM $2,980.00 C1769

STENT GENES OPTA PRO 29MMX9MM $2,980.00 C1769

CATHETER FILTER RECOV. FEMORAL $3,193.00 C1874

STENT CORON S7 OTW 3.0MMX18MM $2,130.00 C1874

Page 175: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STENT CORON S7 OTW 3.0MMX30MM $2,130.00

STENT CORON S7 OTW 3.5MMX18MM $2,130.00 C1876

STENT CORONY S7 OTW 3.5MMX24M $2,130.00 C1876

STENT CORON S7 OTW 3.5MMX30MM $2,130.00 C1876

STENT CORON S7 OTW 4MMX9MM $2,130.00 C1874

STENT CORON S7 OTW 4MMX18MM $2,130.00 C1876

STENT CORON S7 OTW 4MMX24MM $2,130.00 C1874

STENT CORON S7 OTW 4MMX30MM $2,130.00 C1876

SUTURE MONOSOF 0 30 C-16 $28.00 C1876

CATH GLIDE 5 FR .038 X 65 CM $198.00 C1876

CATH GUIDE Z2 IMA 6F 070X100CM $170.00

CATH GUIDE Z2 IMA 6F 070X100CM $170.00

CATH GUI Z2 CHAMP1.5 6F070X100 $170.00 C1887

CATH GUI Z2 EBU3.5SH6F070X100C $170.00 C1887

CATH GUIZ2 EBU4.0SH 6F 070X100 $170.00 C1887

CATH GUIZ2 EBU4.5SH 6F 070X100 $170.00 C1887

CATH GUIZ2 EBU5.0SH 6F 070X100 $170.00 C1887

CATH GUI Z2 FL3.0 6F 070MX100C $170.00 C1887

CATH GUI Z2 FL3.5 6F 070MX100C $170.00 C1887

CATH GUI Z2 FL4.0 6F 070MX100C $170.00 C1887

CATH GUI Z2 FR3.0 6F 070MX100C $170.00 C1887

CATH GUI Z2 HSI SH 6F 070MX100 $189.00 C1887

CATHETER GUIDE 6F IMA 90CM $170.00 C1887

CATH GUIDE 6F IMASH 070X100CM $170.00 C1887

CATH GUIDE 6F IMA SH 070X90CM $170.00

CATH GUIDE LCBSH 6F 070X100CM $170.00 C1887

CATH GUIDE 6F MAC 3.0 SH $170.00 C1887

CATH GUIDE MAC 4.0 6F 070X100C $170.00 C1887

CATH GUIDE Z2 MB2 6F 070X100C $170.00 C1887

CATH GUIDE Z2 RCB 6F 070X90CM $170.00 C1887

CATH GUIDE Z2 RCBSH 6F 070X90C $170.00 C1887

CATH GUIDE SCR3.5SH 6F 070X100 $170.00 C1887

CATH GUIDE 6F SCR4.0 SH $170.00 C1887

CATH GUIDE EBU 3.0 8F 091X100C $170.00 C1887

CATH GUIDE Z2 EBU 3.5 8F SH $170.00 C1887

CATH GUIDE Z2 FR 3.5 8F $170.00 C1887

FORCEPS COLON $31.00

LIGATORS SUPERVIEW BAND $775.00

SNARES POLYP $131.00

BRUSHES CYTOLOGY $50.00

DILATORS 10-12 CRE $578.00

TEST BIOLOGICAL/RAVEN $184.00

MED PACELD CAPSURE 4074-52 $1,488.00

MED PACELD CAPSURE 4575-45 $1,488.00 C1898

MED PACELD CAPSURE 5076-45 $1,547.00 C1898

BLANKET PED FULL ACCESS BAIR $53.00

TOURNIQUET 18 DUAL PORT $100.00

TOURNIQUET 24 DUAL PORT $107.00

TOURNIQUET 34 DUAL PORT $120.00

TOURNIQUET 44 DUAL PORT $133.00

Page 176: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SUTURE 6-0 CHROMIC $28.00

GARMENT STANDARD CALF $68.00

GARMENT LARGE CALF $108.00

GARMENT REGULAR FOOT $106.00 A6549

GARMENT LARGE FOOT $106.00

CATH HEMATURIA 2WY 24FR $102.00

TORQUE VISE $40.00

STENTS POLARIS DUAL 5X24 DURO $451.00

STENTS POLARIS DUAL 5X26 DURO $184.00

STENTS POLARIS DUAL 5X28 DURO $184.00 C2617

STENTS POLARIS DUAL 6X24 DURO $184.00 C2617

STENTS POLARIS DUAL 6X26 DURO $184.00 C2617

STENTS POLARIS DUAL 6X28 DURO $184.00 C2617

STENTS POLARIS DUAL 7X24 DURO $184.00 C2617

STENTS POLARIS DUAL 7X26 DURO $184.00 C2617

STENTS POLARIS DUAL 7X28 DURO $184.00 C2617

STENTS BLUE 8X24 $184.00 C2617

STENTS BLUE 8X28 $184.00 C2617

FIBERS LASER HOLMIUM 200 $1,458.00 C1874

HOLMIUM FIBERS LASER 365 $999.00 C1874

FIBERS LASER HOLMIUM 550 $1,295.00

FIBERS LASER HOLMIUM 1000 $2,054.00

CATH URETERAL 4FR WEDGE $41.00

CATH URETERAL 6FR OPEN END $35.00

FASCIALATA TUTTO PLAST 2CMX7CM $1,244.00

DIALATORS BALL UROMAXII PL 4CM $642.00

DIALATORS BALL UROMAX 20X10CM $599.00 C1762

INFLATOR 10CC LAVEEN $173.00

WIRE 3.0 GEMIMI $588.00

BASKET 4 WIRE 3FR $595.00

BASKET URO STONE 2.2FR 115CM $500.00 C1769

GRASPER URO STONE 3.2FR 115CM $498.00

GRASPIT 3.2 $565.00

LOOP CUTTING 27FR $192.00

LOOP COAG 24FR $422.00

LOOP COAG 27FR $422.00

BALL 24FR $192.00

BALL 27FR $192.00

SUTURE PROLENE SH 3-0 $28.00

SUTURE PROLENE SH 4-0 $28.00

DRAIN 10FR BLAKE $129.00

DRAIN 15FR BLAKE $111.00

DRAIN 19FR BLAKE $148.00

NEEDLE SURGICAL ANCHOR S/S $34.00

NEEDLE SURGICAL ANCHOR S/S 2D $22.00

SHUNT CAROTID $117.00

CABLES PACING $91.00

DRESSING DERMA GRAN WITH ZINC $24.00

ADHESIVE SURGICAL DERMABOND $58.00

STRIP STAPLE LINE ETSFLEX 45 $775.00 A6231

Page 177: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STENT LUMINEXX 80X40 $3,101.00

STENT LUMINEXX 100X40 $3,101.00

STENT LUMINEXX 100X50 $3,101.00 C1874

STENT LUMINEXX 120X40 $3,101.00 C1874

TUBE G SKIN LEVEL 16FRX3.5CM $312.00 C1874

TUBE G SKIN LEVEL 18FRX3.5CM $312.00 C1874

BUTTON MINI 20FR 1.5CM $312.00

BUTTON MINI 20FR 3.5CM $312.00

TUBE 20FR. 4.0CM SKIN LEVEL $299.00

DEVICE STOMA MEASUREING $29.00

TUBE J 8.5FR BENT TIP $227.00

KIT PEG 20FR $440.00

TUBE 14FR. 1.5CM SKIN LEVEL $299.00

FROCEP BRONC BIOPSY RADIAL JAW $642.00

CABLE UMBILICAL $1,270.00

BALLOON THERMACHOICE THERAPY $2,130.00

SUTURE, CAPIO POLYPROYLENE $28.00

LOOP CUTTING ANGLED $81.00 C1727

LOOP CUTTING STRAIGHT $81.00

PIPELLE $23.00

MESH VISILEX 4.5 X6 DAVOL $1,062.00

BOOT WLKER X-LARGE $101.00 L4387

WIRE FILTER EX 300CM $3,603.00 C1781

SHEATH RETREVAL BENT TIP $236.00 L4386

SOLUTION BUFFER PH7.01 $88.00

SOLUTION BUFFER PH 1.07 $88.00

STOCKINETTE COTTON 2 $51.00

PADDING MOLESKIN 6 $114.00

PADDING MOLESKIN 9 $114.00

HOOK SELF ADHESIVE 1 $130.00

THERAPUTTY YELLOW $170.00

THERAPUTTY RED $176.00

TENSO GRIP D $132.00

LOOP 2 VELFOAM 1 $42.00

LOOP 2 VELFOAM 2 $40.00

LOOP VELCRO 2 $88.00

OTOFORM K $40.00

CATALYST $56.00

TUBES, COLON 32 FR $79.00

SUTURE RETENTION BRIDGE $28.00

SUTURE 2-0 VICRYL J839D $28.00

ICD DEVICE VIRTUOSO $28,862.00

SNARE TRIPLE LOOP 45CM $1,071.00

PCKL LEAD 6947M 55 $10,068.00 C1895

ICD PROTECTA D314DRM $35,955.00 C1895

CLIP X-LARGE 3.0MM $250.00

CLIP LARGE 2.0MM $870.00 C1721

CLIP MED 1.4MM $250.00

CLIP SMALL 9MM 40 CLIPS $1,270.00

CONNECTOR Y PORT $30.00

Page 178: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NEEDLE BIOPSY QK CORE 18X15X10 $122.30

BALLOON PTA UNTRA .018 4X10 $585.00

TRACH KIT BLUE RHINO PERC. $542.00 C1725

NETS ROLYP ROTH $268.00

NETS FOREIGN BODY ROTH $236.00

INTRO OPTISEAL GLBL 11FR13M-CM $198.00 C1766

PROBE #7 GOLD $716.00

DISK LAPAROSCOPIC $548.00

NERVE LOCATOR VAR-STIM $168.00

TUBE TRACHEOSTOMY NEONATAL $138.00

KIT INTRODUCER 13FR PEEL-APART $188.00

SYSTEM PERCUTANEOUS 8.5FR $287.00

NEEDLE CONCENTRIC DCN 50 $38.00

PATCH WHITTMAN 20X40CM $3,595.00

NAIL FIXATION 170MM-STERILE $3,049.00

BOLT TI LOCKING 4.9MM 459.40 $532.00

COVER PROBE/PC-0648 $340.00 C1713

SYRINGE INJECTOR WITH STRAW $39.00

5-0 SILK $28.00

TUBE LMA UNIQUE SIZE 1 $89.00

TUBE LMA UNIQUE SIZE 1.5 $41.00

TUBE LMA UNIQUE SIZE 2 $41.00

TUBE LMA UNIQUE SIZE 2.5 $89.00

TUBE LMA UNIQUE SIZE 3 $38.00

TUBE LMA UNIQUE SIZE 4 $38.00

TUBE LMA UNIQUE SIZE 5 $38.00

INJECTOR CENTURY UTERINE MANI $100.00

SCREW CORTEX 3.5MM 204.820 $93.00

SCREW CORTEX 3.5MM 204.822 $93.00

SCREW CORTEX 3.5MM 204.824 $91.00 C1713

SCREW CORTEX 3.5MM 204.826 $93.00 C1713

SCREW CANN 3.5MM 205.020 $522.00 C1713

SCREW CANN 3.5MM 205.022 $564.00 C1713

SCREW CANN 3.5MM 205.042 $564.00 C1713

SCREW CANN 3.5MM 205.044 $522.00 C1713

SCREW CANN 6.5 208.413 $584.00 C1713

SCREW CANN 6.5 208.416 $584.00 C1713

SCREW LK SLF-TPNG 3.5 212.101 $387.00 C1713

SCREW LK SLF-TPNG 3.5 212.102 $387.00 C1713

SCREW LK SLF-TPNG 3.5 212.103 $387.00 C1713

SCREW LK SLF-TPNG 3.5 212.104 $387.00 C1713

SCREW LK SLF-TPNG 3.5 212.105 $387.00 C1713

SCREW LK SLF-TPNG 3.5 212.106 $378.00 C1713

SCREW LK SLF-TPNG 3.5 212.107 $378.00 C1713

SCREW LK SLF-TPNG 3.5 212.108 $378.00 C1713

SCREW LK SLF-TPNG 3.5 212.109 $387.00 C1713

SCREW LK SLF-TPNG 3.5 212.110 $378.00 C1713

SCREW LK SLF-TPNG 3.5 212.111 $387.00 C1713

SCREW LK SLF-TPNG 3.5 212.112 $387.00 C1713

SCREW LK SLF-TPNG 3.5 212.113 $387.00 C1713

Page 179: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW LK SLF-TPNG 3.5 212.115 $378.00 C1713

SCREW LK SLF-TPNG 3.5 212.116 $387.00 C1713

SCREW LK SLF-TPNG 3.5 212.117 $355.00 C1713

SCREW LK SLF-TPNG 3.5 212.119 $329.00 C1713

SCREW LK SLF-TPNG 3.5 212.121 $329.00 C1713

SCREW LK SLF-TPNG 3.5 212.123 $356.00 C1713

SCREW LK SLF-TPNG 3.5 212.124 $356.00 C1713

SCREW CANN 4.5MM $581.00 C1713

SCREW CANN 4.5MM 214.548 $558.00 C1713

SCREW CANN 4.5MM 214.560 $558.00 C1713

SCREW CORTEX 4.5MM 214.824 $91.00 C1713

SCREW CORTEX 4.5MM 214.826 $91.00 C1713

SCREW CORTEX 4.5MM 214.828 $91.00 C1713

SCREW CORTEX 4.5MM 214.830 $77.00 C1713

SCREW CORTEX 4.5MM 214.860 $77.00 C1713

SCREW CORTEX 4.5MM 214.840 $77.00 C1713

SCREW CORTEX 4.5MM 214.844 $77.00 C1713

SCREW CORTEX 4.5MM 214.834 $91.00 C1713

SCREW CORTEX 4.5MM 214.832 $77.00 C1713

SCREW CORTEX 4.5MM 214.836 $83.00 C1713

SCREW CORTEX 4.5MM 214.838 $77.00 C1713

SCREW CORTEX 4.5MM 214.848 $77.00 C1713

SCREW CORTEX 4.5MM 214.850 $83.00 C1713

SCREW CORTEX 4.5MM 214.842 $69.00 C1713

SCREW CAN 6.5MM TL 218.055 $112.00 C1713

WASHER 13.0MM 219.99 $87.00 C1713

PLATE LCP 3.5MM 5H 223.551 $655.00 C1713

PLATE LCP 3.5MM 6H 223.561 $813.00 C1713

PLATE LCP 3.5MM 8H 223.581 $889.00 C1713

PLATE LCP RECON 3.5MM 245.071 $1,175.00 C1713

PLATE QUARTER-TUBE 242.08 $234.00 C1713

PLATE QUARTER-TUBE 242.04 $165.00 C1713

HUMERUS PROX 3.5MM LCP 241.903 $3,518.00 C1713

HUMERUS PROX 3.5MM LCP 241.901 $3,421.00 C1713

PLATE Y CALCANEAL 87MM 241.65 $1,256.00 C1713

PLATE LCP TUB 1-3RD 241.421 $595.00 C1713

PLATE LCP TUB 1-3RD 241.381 $570.00 C1713

ROD REAMING 3.0/950 351.71S $176.00 C1713

WIRE GUIDE 3.2MM 357.399 $284.00 C1713

DRILL BIT 3 FLUT 4.0 357.407 $576.00 C1776

NORIAN SRS BONE VOID FILLER $1,880.00 C1769

NORIAN SRS BONE VOID FILLER $2,987.00

NORIAN SRS BONE VOID FILLER $6,088.00 C1713

CLAMP ADJ WIRE/PIN $1,567.00 C1713

CLAMP ADJ $948.00 C1713

ROD CARBON 11.0 FIBER $572.00

FORCEP REDUCTION W/POINT $1,155.00

NEEDLE SRS DELIVERY $181.00 C1713

NEEDLE SRS DELIVERY 7126 $578.00

SCREW TI CANN 7.3MM 409.875 $584.00

Page 180: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PLATE TI DISTAL FEMUR 422.340 $3,500.00

PLATE TI DISTAL FEMUR 422.344 $3,755.00 C1713

PLATE TI DISTAL FEMUR 422.345 $3,262.00 C1713

PLATE TI DISTAL FEMUR 422.348 $3,500.00 C1713

SCREW TI LOCKING 5.0 422.392 $542.00 C1713

SCREW TI LOCKING 5.0 422.393 $542.00 C1713

SCREW TI LOCKING 5.0 422.394 $625.00 C1713

SCREW TI LOCKING 5.0 422.395 $542.00 C1713

SCREW TI LOCKING 5.0 422.396 $542.00 C1713

SCREW TI LOCKING 5.0 422.397 $577.00 C1713

PLATE TI STRAIGHT 1.5 446.031 $604.00 C1713

DRIVE BATTERY SMALL $1,976.00 C1713

BIT DRILL FLUT 3.2MM 511.414 $618.00 C1713

BOLT TI LOCKING 4.9MM 459.76 $471.00

BOLT TI LOCKING 4.9MM 459.44 $447.00

BOLT TI LOCKING 4.9MM 459.38 $532.00 C1713

BOLT TI LOCKING 4.9MM 459.30 $471.00 C1713

BOLT TI LOCKING 4.9MM 459.34 $510.00 C1713

BOLT TI LOCKING 4.9MM 459.36 $532.00 C1713

BOLT 3.9 LOK TI 30MM 458.30 $471.00 C1713

BOLT 3.9 LOK TI 52MM 458.52 $471.00 C1713

NAIL FIXATION 130 DEG-STERILE $2,942.00 C1713

NAIL FIXATION 130 12MMDEG-STER $3,049.00 C1713

WIRE GUIDE 2.5MM THREADED $176.00 C1713

SCREW CORTEX 1.5MM 400-810.96 $171.00 C1713

SCREW CORTEX 1.5MM 400.812.96 $171.00 C1769

SCREW CORTEX 1.5MM 400.814.96 $190.00 C1713

SCREW CORTEX 2.4MM 401.512.96 $209.00 C1713

SCREW CORTEX 2.4MM 401.514.96 $1,065.00 C1713

SCREW CORTEX 2.4MM 401.516.96 $252.00 C1713

SCREW CORTEX 2.4MM 401.513.96 $209.00 C1713

SCREW CORTEX 2.4MM 401.510.96 $246.00 C1713

SCREW CORTEX 2.4MM 401.528.96 $209.00 C1713

SCREW CORTEX 2.4MM 401.518.96 $204.00 C1713

SCREW CORTEX 2.0MM 401.810.96 $187.00 C1713

SCREW CORTEX 2.0MM 401.809.96 $192.00 C1713

SCREW CORTEX 2.0MM 401.808.96 $192.00 C1713

SCREW CORTEX 2.0MM 401.812.96 $187.00 C1713

SCREW CANN 7.3MM 408.885 $562.00 C1713

SCREW CANN 7.3MM 408.890 $584.00 C1713

SCREW CANN 7.3MM 408.895 $584.00 C1713

PLATE 2.4MM TI LC-DCP $764.00 C1713

SCREW CANN 7.3MM 409.860 $584.00 C1713

PLATE 2.4MM TI LC-DCP $791.00 C1713

PLATE 2.0MM TI LC-DCP $567.00 C1713

BLADE HELICAL TI 11MM 456.302 $1,298.00 C1713

BLADE TI HELICAL 11MM 456.303 $1,369.00 C1713

BLADE TI HELICAL 11MM 456.304 $1,398.00

BLADE TI HELICAL 11MM 456.305 $1,369.00

BLADE TI HELICAL 11MM 456.306 $1,369.00

Page 181: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

VALVE PASSY-MUIR $183.00

LAMP STA HALOGEN 26699 $594.00

SPLINT FT DROP EXPDED HEEL SM $164.00

SPLINT FT DROP EXPDED HEEL MED $87.00

SPLINT FT DROP EXPDED HEEL LG $170.00

SPLINT WHITE EZEFORM 24X36 $486.00

SPLINT BEIGE EZEFORM 24X36 $486.00

GARMENT EX LARGE CALF $140.00

PLATE 3H LCP HEAD 3.5 $747.00

VACCUUM KIWI OMNICUP FLAT DISC $104.00 C1713

K-WIRES .028X4 D-PT $58.00

K-WIRES .035X4 D-PT $58.00

K-WIRES .035X9 D-PT $58.00 C1713

WIRE K DMND PT 2 END 9 .062 $58.00 C1713

K-WIRES .054X4 D-PT $39.00 C1713

SUPPORT ATHLETIC X-LARGE $40.00 C1713

KIT RAPID REFILL 6600 $89.00

PUMP PAIN 270CC LARGE $365.00

ABVISER INTRA-ABD PRESSURE MON $236.00

FORCEP HOT BOX $95.00

BLADES FOR SURGICAL CLIPPERS $36.00

MANIFOLD DRIP REDUCTION $81.00

CATH DRAIN APDL FLEXIMA 6F 25C $236.00

PORT IMPLANTABLE VAS ACC. MINI $1,024.00

RING TRANSJUGULART 16GAX52CM $1,095.00 C1729

INTRODUCER FLX 2 6F 018X038X45 $198.00 C1788

PICC PRO-PICC DUAL CT 5F 55CM $252.00

BALLOON OPTIPLAST 6MX2CMX75CM $626.00

BALLOON OPTIPLAST 7MX4CMX75CM $626.00 C1751

BALLOON OPTIPLAST 10MX2CMX75CM $626.00 C1727

BALLOON OPTIPLAST 10MX2CMX75CM $626.00 C1727

BALLOON OPTIPLAST 9MX2CMX75CM $626.00 C1727

BALLOON OPTIPLAST 5MX2CMX120CM $626.00 C1727

BALLOON OPTIPLAST 9MX4CMX120CM $611.00 C1727

STENT BILIARY 6F 10MX60MX80CM $3,101.00 C1727

STENT GRAFT 9F 035X7MX40MX80CM $4,944.00 C1727

STENT CORONARY ZETA OT 2.75X15 $1,892.00 C1874

STENT CORONARY VISION 3X15 $3,410.00 C1874

STENT CORONARY VISION 3.5X15 $3,410.00 C1874

STENT CORONARY VISION 4X15 $3,410.00 C1874

STENT CORONARY VISION 3X18 $3,410.00 C1874

STENT CORONARY VISION 3.5X18 $3,410.00 C1874

STENT CORONARY VISION 3X23 $3,410.00 C1874

STENT CORONARY VISION 3X28 $2,501.00 C1874

STENT CORONARY VISION 3.5X28 $3,410.00 C1874

STENT CORONARY VISION 4X28 $3,410.00 C1874

STENT CORONARY VISION 3X8 $2,501.00 C1874

STENT CORONARY VISION 3.5X8 $3,410.00 C1874

STENT CORONARY VISION 4X8 $3,410.00 C1874

STENT CORONARY VISION 2.5X23 $2,501.00 C1874

Page 182: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STENT CORONARY VISION $2,720.00 C1874

STENT CORONARY VISION 2.25X8 $3,410.00 C1874

STENT BILIARY RX HR 5.5X15X135 $2,843.00 C1874

BALLOON DIL CORONARY VOY 2.OX8 $731.00 C1874

BALLOON DIL CORONARY VOY 2.5X8 $731.00 C1874

BALLOON DIL CORONARY VOY 3.0X8 $731.00 C1727

BALLOON DIL CORONARY VOY 3.5X8 $744.00 C1727

BALLOON DIL CORONARY VO 1.5X12 $731.00 C1727

BALLOON DIL CORONARY VO 2.5X12 $731.00 C1727

BALLOON DIL CORONARY VO 3.5X12 $731.00 C1727

BALLOON DIL CORONARY VO 1.5X15 $731.00 C1727

BALLOON DIL CORONARY VO 2.0X15 $731.00 C1727

BALLOON DIL CORONARY VO 2.5X15 $731.00 C1727

BALLOON DIL CORONARY VO 3.0X15 $731.00 C1727

BALLOON DIL CORONARY VO 3.5X15 $744.00 C1727

BALLOON DIL CORONARY VO 2.5X20 $731.00 C1727

BALLOON DIL CORONARY VO 4.0X20 $731.00 C1727

INTRODUCER SHEATH 9FX11CM $34.00 C1727

CONTRAST OPTIRAY 350 200ML $154.00 Q9967

CATHETER ASH SPL W CUFF 14FX36 $921.00

CATHETER ANGIO WIRE COBRA 1 5F $50.00 C1769

GUIDEWIRE HYDRO H20 035X150CM $115.00 C1769

GUIDEWIRE HYDRO H20 035X260CM $146.00

CATHETER VENA CAA 5F 65CM $92.00 C1769

CATHETER VESSEL 5F 035X65X6SH $92.00 C1769

CATHETER VSC-2B 5F 035X100 10S $92.00

CATHETER AORTIC 5F 035X100CM $92.00

GUIDEWIRE HYDRO 035X150 ANGLE $115.00

CATHETER DIAGNOSTIC JL5.0 6F $76.00

CATHETER DIAGNOSTIC JL4.5 6F $76.00 C1769

CLOSURE VASCULAR ANGIO PLUS 6F $580.00

CATHETER EXTRACT PRONTO 6F 046 $1,270.00

STATLOCK UNIVERSAL PLUS 12-22F $642.00 C1760

FLOW PLUME-AWAY SES UTLTRA $80.00

SUTURE VICRYL 2-0 27 UR-6 $28.00

BLADE TI HELICAL 11MM 456.307 $1,398.00

BOLT TI LOCKING 4.9MM 459.32 $471.00

DIALATOR CRE FOR EGD 10-12 $608.00

DIALATOR CRE FOR EGD 12-15 $608.00 C1713

DIALATOR CRE FOR EGD 15-18 $608.00

DIALATOR CRE FOR EGD 18-20 $608.00

GTUBE 14FR. 1.0 CM $299.00

DEVICE TRAUMA PELVIC ORTHOTIC $308.00

SEPRAFILM 3X5 SHEETS $3,399.00

TUBE NASO-JEJUNAL $308.00

GRAFT 5MM OATS $1,219.00

GRAFT 6MM OATS $1,219.00

GRAFT 7MM OATS $1,280.00

GRAFT 8MM OATS $1,280.00

GRAFT 9MM OATS $1,280.00

Page 183: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

GRAFT 10MM OATS $1,280.00

KIT MRSA ADULT SINGLE PATIENT $73.00

SCREW CANC BONE 4.0 207.045 $66.00

SUTR VICRYL 1 27 CP $28.00

SUTR VICRYL 2-0 CT-1 J259H $28.00 C1713

SUTR VICRYL 5-0 27 FS-2 $28.00

MARKERS ENDOSCOPIC $77.00

HANDPIECE FOOTCONTROL DISP. $169.00

MESH VENTRALEX SMALL CIRCLE $946.00

MESH VENTRALEX MD CIRCLE $1,133.00

TOURNIQUETS 30X4 $115.00

T SPRAY $256.00 C1781

MESH SM OVAL KUGEL 8CM X 12CM $1,404.00

MESH MD OVAL KUGEL 11CM X 14CM $1,595.00

MESH LG OVAL KUGEL 14CM X 18CM $2,499.00 C1781

PLUG LG PERFIX $526.00 C1781

MESH KEYHOLE LG PRE-SHAPE $375.00 C1781

MESH PROCEED 15CM X 20CM $1,999.00 C1781

DRESSING AQUACEL-AG 3/4 X 18 $49.00 A6196

DRESSING AQUACEL-AG 4X4 $41.00

DRESSING ACTICOAT ROPE 3/4X12 $36.00 A6199

DRESSING ACTICOAT 4X5 ABSORB $40.00

DRESSING ACTICOAT 7 4X5 $70.00

ELECTRODE VAPOR WEDGE 2.3 $519.00

APPLIERS MENISCAL $425.00

IMPLANT MENISCAL 0 STRAIGHT $583.00

IMPLANT MENISCAL 12 RAPID LD $616.00

IMPLANT MENISCAL 27 RAPID LD $583.00 C1713

SPIRALOCK 6.5 W/ ETHIBOND $796.00 C1713

PASTE ALGIUDEX AG $85.00

SUTURE PDS II 4-0 18 P-3 $28.00

BRUSH 5FR BARON SUCTION $29.00

NO STING BARRIER SPRAY $29.00

CAPSULES PH BRAVO $578.00

DRESSING NASAL MEROCEL 8CM $44.00

TROCAR ENDO BLDLSS 5MM X 100MM $27.00

SLEEVE TROCAR EXCEL 11MM $166.00

SLEEVE ENDOSCOPIC STPCOCK 12MM $57.00

ENPOWER FOR NEPTUNE SYSTEM $304.00

APLIGRAF SKIN SUBS PER 1 SQ CM $2,998.00 Q4101

SUTURE VICRYL 2-0 8-27 SH $28.00

DRESSING MEPILEX 6X6 $33.00

CRUTCHES CHILD 28IN-36IN $315.00

SUTURE VICRYL 2-0 CT J357H $28.00

SUTURE VICRYL 2-0 8-18 CT-2 $28.00

LENS MORGAN MEDI-FLOW TUBING $86.00

COLD KNIFE $584.00

ORANDI KNIFE -24 $205.00

DRAPE HIP $59.00

CURCUIT X-LONG BREATHING $32.00

Page 184: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DRESSING MEPITEL 3X4 $22.00

FETAL BLOOD SCREENING KIT $844.00

SUTURE STEEL 7-0 4-18 CCS $28.00

BALLOON DIL. SPRINTER 2MMX12MM $578.00

BALLOON DILA. 2.5MMX20 $578.00

PACEMAKER SPRINT FIDELIS $14,122.00 C1777

PACEMAKER SLEEVE $58.00 C1727

PACEMAKER KAPPA DR $12,474.00 C1777

PACEMAKER SPRINT FIDELIS $11,650.00

PACEMAKER INSYNC MAXIMO $40,232.00 C1785

PACEMAKER IATTAIN $4,409.00 C1777

PACEMAKER INTRODUCER $225.00 C1882

PACEMAKER VALVE $128.00 C1900

PACEMAKER SLITTER $96.00

PACEMAKER ATTAIN $597.00

PACEMAKER ATTAIN $597.00

PACEMAKER BALOON $268.00 C1725

CATH PEZZER 22FR $37.00

CATH PEZZER 26FR $37.00

CATH PEZZER 30FR $37.00

CATH PEZZER 32FR $37.00

COSEAL EXTENDED APPLICATOR $898.00

RETAINER VISCERA SM FISH $77.00

RETAINER VISCERA MED FISH $531.00

RETAINER VISCERA LG FISH $539.00

RETAINER VISCERA X-LG FISH $539.00

DERMACARRIER 6TO1 $101.00

SUCTION FRAZIER 18FR $22.00

DRAIN TRIPLE LUMEN SUMP $121.00

FEMORAL TIP FAN SPRAY $49.00

DRAIN FLAT SUCTION BI $203.00

STAPLER 31MM 111989 $1,187.00

RELOAD STPL / CUTR GIA100-3.8 $353.00

STAPLER 9.0 134046 $165.00

SUTR ENDOLOOP PDSII SZ0 18 $28.00

BLUNT TROCAR OMS-T10BT $191.00

ALLPORT AL326 $414.00

ENDOSTITCH 0 POLY 170050 $161.00

ENDOSTITCH 3-0 POLY 170070 $161.00

RELOAD STPL GIA STRT BL 45-3.5 $277.00

NON ARTICULATING 45MM TSG45 $624.00

CUTTER SCW45 $663.00

RETRACTOR ENDOPADDLE 173046 $345.00

TOURNIQUET 9 DUAL PORT $107.00

TOURNIQUET 12 DUAL PORT $87.00

TOURNIQUET 18 BIER BLOCK $138.00

TOURNIQUET 24 BIER BLOCK $107.00

BRACE HUMERAL FRACTURE SM $311.00

BRACE HUMERAL FRACTURE MED $311.00

BRACE HUMERAL FRACTURE LG $311.00

Page 185: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BRACE HUMERAL FRACTURE X-LG $311.00

BRUSH FEMORAL BONE $43.00

FEMORAL CANAL PRESS W/OUT HUB $326.00

OPTIVAC NOZZLE SLIM $94.00

OPTIVAC NOZZLE REVISION $94.00 C1713

SET 5.0 FEN CATH PAIN PUMP $1,702.00

SET 2.5 FEN CATH PAIN PUMP $1,026.00

BURR 3.5MM RESECTOR $183.00

BURR 4.0 AGGRESSIVE PLUS STRT $149.00

RESECTOR 5.0 $183.00

CANNULA INSTRUMENT ARTHREX $96.00

DRESSING VAC ABDOMINAL $899.00

PORT INFUSION MINI TI 8FR $767.00

PORT INFUSION DUAL IMPL 10FR $1,024.00

PORT DUAL INTRO SET $1,001.00 C1788

TRAY 16G CENTRAL LINE $62.00 C1788

16FR DENVER INTRODUCER $224.00

ASCITES SHUNTDBLE $3,060.00

CONNECTOR NYLON DENVER $82.00

BALLOON SPRINTER 2X15 $578.00

BALLOON SPRINTER 2.5X15 $578.00

MESH MED EXT HERNIA SYSTEM $611.00

MESH LG EXT HERNIA SYSTEM $647.00

MESH PROLENE HERN SYSTEM EXT $647.00 C1781

MESH PROCEED 20X25 $3,118.00 C1781

FECAL MANAGMENT KIT FLEX-SEAL $654.00 C1781

BALLOON SPRINTER 1.5X12MM $578.00

BALLOON SPRINTER 2.75X15 $578.00

BALLOON SPRINTER 3X15MM $578.00 C1727

SUTR VICRYL 0 36 CT-1 $28.00 C1727

SUTURE CHROMIC 5-0 18 PS-4 $28.00 C1727

SUTURE PROLENE 2-0 30 KS $28.00

ENDOSTAT 12FT FIBER OPTIC $863.00

ENDOSTAT FIBER OPTIC X/TIP $4,000.00

SHEET NEPHROSCOPY $90.00

PACK PACEMAKER TRAY $165.00

PACK GENERAL CATH LAB $115.00

PACK CATH LAB $223.00

LASER SHEILDS CO2 ET TUBES 6.5 $459.00

LASER SHEILDS CO2 ET TUBES 7.0 $481.00

LASER SHEILDS CO2 ET TUBES 7.5 $481.00

LASER SHEILDS CO2 ET TUBES 8.0 $481.00

ANGIO KIT SEPERATE CATH LAB $64.00

BALLOON DIL. SPRINTER 2.5X30 $578.00

BALLOON SPRINTER 2.5X12 $578.00

SUTR CARD 6-0 PROBL MONO M8726 $121.00 C1727

CATHETER SET PICC TWIN TURB 4F $239.00 C1727

CATH BALLOON DIL. SPRINTER 3. $578.00

COSEAL 4ML $1,232.00

BALLOON DILA. SPRIN. 3MX30MM $578.00

Page 186: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CIDEX OPA SOLUTION 1 GALLON $97.00 C1765

SCREW SHAFT 3.5MM 204.216 $71.00 C1727

SCREW SHAFT 3.5MM 204.218 $78.00

SCREW SHAFT 3.5MM 204.220 $85.00 C1713

CLEANER SANI-CARE DRC $205.00 C1713

SCREW SHAFT 3.5MM 204.222 $71.00 C1713

SCREW SHAFT 3.5MM 204.224 $78.00

SCREW SHAFT 3.5MM 204.226 $78.00 C1713

SCREW SHAFT 3.5MM 204.228 $78.00 C1713

SCREW SHAFT 3.5MM 204.230 $78.00 C1713

SCREW SHAFT 3.5MM 204.232 $78.00 C1713

SCREW SHAFT 3.5MM 204.234 $78.00 C1713

SCREW SHAFT 3.5MM 204.236 $78.00 C1713

SCREW SHAFT 3.5MM 204.238 $78.00 C1713

SCREW CTX 3.5MM 204.810 $93.00 C1713

SCREW CTX 3.5MM 204.812 $93.00 C1713

SCREW CTX 3.5MM 204.814 $88.00 C1713

SCREW CTX 3.5MM 204.816 $93.00 C1713

SCREW CTX 3.5MM 204.828 $93.00 C1713

SCREW CTX 3.5MM 204.830 $78.00 C1713

SCREW CTX 3.5MM 204.832 $78.00 C1713

SCREW CTX 3.5MM 204.834 $78.00 C1713

SCREW CTX 3.5MM 204.836 $93.00 C1713

SCREW CTX 3.5MM 204.838 $78.00 C1713

SCREW CTX 3.5MM 204.840 $78.00 C1713

SCREW CTX 3.5MM 204.845 $78.00 C1713

SCREW CTX 3.5MM 204.850 $93.00 C1713

SCREW CANCEL 4.0MM 206.030 $71.00 C1713

SCREW CANCEL 4.0MM 206.035 $78.00 C1713

SCREW CANCEL 4.0MM 206.045 $69.00 C1713

SCREW CANCEL 4.0MM 206.050 $78.00 C1713

SCREW CANCEL 4.0MM 206.055 $71.00 C1713

SCREW CANCEL 4.0MM 206.060 $71.00 C1713

SCREW CANCEL 4.0MM 207.010 $71.00 C1713

SCREW CANCEL 4.0MM 207.012 $71.00 C1713

SCREW CANCEL 4.0MM 207.014 $78.00 C1713

SCREW CANCEL 4.0MM 207.016 $78.00 C1713

SCREW CANCEL 4.0MM 207.018 $78.00 C1713

SCREW CANCEL 4.0MM 207.020 $78.00 C1713

SCREW CANCEL 4.0MM 207.022 $78.00 C1713

SCREW CANCEL 4.0MM 207.024 $78.00 C1713

SCREW CANCEL 4.0MM 207.026 $78.00 C1713

SCREW CANCEL 4.0MM 207.028 $78.00 C1713

SCREW CANCEL 4.0MM 207.030 $78.00 C1713

SCREW CANCEL 4.0MM 207.035 $78.00 C1713

SCREW CANCEL 4.0MM 207.040 $78.00 C1713

PATCH STASYS $154.00 C1713

BALLOON SPRINTER 3.5X15 $578.00 C1713

SCREW CANCEL 4.0MM 207.055 $78.00

SCREW CANCEL 4.0MM 207.060 $78.00 C1727

Page 187: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

WASHER 7.0MM 219.98 $98.00 C1713

PLATE QUARTER-TUBE 242.03 $188.00 C1713

PLATE QUARTER-TUBE 242.05 $212.00 C1713

PLATE QUARTER-TUBE 242.06 $234.00 C1713

PLATE QUARTER-TUBE 242.07 $219.00 C1713

WIRE KIRSCHNER 0.6MM 292.06 $236.00 C1713

WIRE KIRSCHNER 1.0MM 292.10 $231.00 C1713

WIRE KIRSCHNER 1.25MM 292.12 $296.00 C1713

WIRE KIRSCHNER 2.0MM 292.20 $252.00 C1713

WIRE KIRSCHNER 2.0MM 292.699 $133.00 C1713

WIRE KIRSCHNER 1.6MM 292.71 $477.00 C1713

WIRE KIRSCHNER 2.5MM 292.75 $564.00 C1713

CAPS KIRSCHNER 2.5MM 392.24 $65.00 C1713

WIRE GUIDE 1.6MM 292.722 $111.00 C1713

CAPS BAR & ROD 4.0MM 394.99 $65.00 C1713

COMPRESSOR OPEN 395.51 $1,506.00 C1769

CLAMP 4.0MM/2.5MM 395.56 $840.00 C1713

CLAMP 4.0MM/4.0MM 395.57 $840.00

NUT SPRING LOADED 395.58 $138.00

ROD CARBON FIBER 4.0MM 395.60 $157.00

ROD CARBON FIBER 4.0MM 395.61 $157.00 C1713

ROD CARBON FIBER 4.0MM 395.62 $157.00 C1713

ROD CARBON FIBER 4.0MM 395.63 $157.00 C1713

ROD CARBON FIBER 4.0MM 395.64 $175.00 C1713

ROD CARBON FIBER 4.0MM 395.65 $175.00 C1713

ROD CARBON FIBER 4.0MM 395.66 $175.00 C1713

ROD CARBON FIBER 4.0MM 395.67 $175.00 C1713

PLATE TI PROXIM TIBIA 422.300 $3,755.00 C1713

PLATE TI PROXIM TIBIA 422.301 $3,262.00 C1713

PLATE TI PROXIM TIBIA 422.305 $3,262.00 C1713

PLATE TI DISTAL FEMUR 422.341 $3,755.00 C1713

WIRE TI KIRSCHNER 1.6MM 492.16 $292.00 C1713

PLATE LCP 3.5MM 9H 223.591 $924.00 C1713

PLATE LCP 3.5MM 10H 223.601 $948.00 C1713

PLATE LCP 3.5MM 12H 223.621 $1,028.00 C1713

PLATE LCP RECON 3.5MM 245.051 $966.00 C1713

PLATE LCP RECON 3.5MM 245.061 $1,200.00 C1713

PLATE LCP RECON 3.5MM 245.121 $1,277.00 C1713

PLATE LCP TUB 1-3RD 241.351 $534.00 C1713

PLATE LCP TUB 1-3RD 241.361 $534.00 C1713

PLATE LCP TUB 1-3RD 241.371 $546.00 C1713

PLATE LCP TUB 1-3RD 241.401 $570.00 C1713

PLATE T LCP 3H 3.5MM 241.031 $919.00 C1713

PLATE T LCP 3H 3.5MM 241.041 $963.00 C1713

PLATE T LCP 3H 3.5MM 241.051 $862.00 C1713

PLATE T LCP 3H 3.5MM 241.071 $1,089.00 C1713

PLATE T LCP 3H 3.5MM 241.931 $850.00 C1713

PLATE T LCP 3H 3.5MM 241.941 $963.00 C1713

PLATE T LCP 3H 3.5MM 241.151 $924.00 C1713

PLATE T LCP 3H 3.5MM 241.171 $1,252.00 C1713

Page 188: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PLATE T LCP 4H 3.5MM 241.141 $840.00 C1713

PLATE T LCP 4H 3.5MM 241.161 $1,079.00 C1713

DRILL BIT QC 2.8MM 310.288 $355.00 C1713

SCREW TI CORTEX 2.4MM 401.756 $210.00 C1713

SCREW TI CORTEX 2.4MM 401.758 $222.00

SCREW TI CORTEX 2.4MM 401.760 $236.00 C1713

SCREW TI CORTEX 2.4MM 401.762 $235.00 C1713

SCREW TI CORTEX 2.4MM 401.764 $248.00 C1713

SCREW TI CORTEX 2.4MM 401.766 $236.00 C1713

SCREW TI CORTEX 2.4MM 401.768 $222.00 C1713

SCREW TI CORTEX 2.4MM 401.770 $236.00 C1713

SCREW TI CORTEX 2.4MM 401.772 $236.00 C1713

SCREW TI CORTEX 2.4MM 401.774 $236.00 C1713

SCREW TI CORTEX 2.4MM 401.776 $236.00 C1713

SCREW TI CORTEX 2.4MM 401.778 $210.00 C1713

SCREW TI CORTEX 2.4MM 401.780 $210.00 C1713

SCREW TI CORTEX 2.7MM 402.870 $160.00 C1713

SCREW TI CORTEX 2.7MM 402.872 $180.00 C1713

SCREW TI CORTEX 2.7MM 402.874 $180.00 C1713

SCREW TI CORTEX 2.7MM 402.876 $180.00 C1713

SCREW TI CORTEX 2.7MM 402.878 $180.00 C1713

SCREW TI CORTEX 2.7MM 402.880 $180.00 C1713

SCREW TI CORTEX 2.7MM 402.882 $180.00 C1713

SCREW TI CORTEX 2.7MM 402.884 $160.00 C1713

SCREW TI CORTEX 2.7MM 402.886 $160.00 C1713

SCREW TI CORTEX 2.7MM 402.888 $160.00 C1713

SCREW TI CORTEX 2.7MM 402.890 $160.00 C1713

SCREW TI LOCKING 2.4MM 412.806 $353.00 C1713

SCREW TI LOCKING 2.4MM 412.808 $314.00 C1713

SCREW TI LOCKING 2.4MM 412.810 $353.00 C1713

SCREW TI LOCKING 2.4MM 412.812 $353.00 C1713

SCREW TI LOCKING 2.4MM 412.814 $346.00 C1713

SCREW TI LOCKING 2.4MM 412.816 $353.00 C1713

SCREW TI LOCKING 2.4MM 412.818 $353.00 C1713

SCREW TI LOCKING 2.4MM 412.820 $353.00 C1713

SCREW TI LOCKING 2.4MM 412.822 $353.00 C1713

SCREW TI LOCKING 2.4MM 412.824 $353.00 C1713

SCREW TI LOCKING 2.4MM 412.826 $353.00 C1713

SCREW TI LOCKING 2.4MM 412.828 $332.00 C1713

PLATE LCP-TM DST 2.4MM 442.479 $1,101.00 C1713

PLATE TI LCP-TM DISTAL 442.491 $1,892.00 C1713

PLATE TI LCP-TM DISTAL 442.502 $1,059.00 C1713

PLATE TI LCP-TM DISTAL 442.508 $1,005.00 C1713

SCREW SHAFT 4.5MM 214.228 $70.00 C1713

SCREW SHAFT 4.5MM 214.230 $70.00 C1713

SCREW SHAFT 4.5MM 214.232 $70.00 C1713

SCREW SHAFT 4.5MM 214.234 $70.00 C1713

SCREW SHAFT 4.5MM 214.236 $70.00 C1713

SCREW SHAFT 4.5MM 214.238 $70.00 C1713

SCREW SHAFT 4.5MM 214.240 $70.00 C1713

Page 189: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW SHAFT 4.5MM 214.242 $82.00 C1713

SCREW SHAFT 4.5MM 214.244 $82.00 C1713

SCREW SHAFT 4.5MM 214.246 $82.00 C1713

SCREW SHAFT 4.5MM 214.248 $82.00 C1713

SCREW SHAFT 4.5MM 214.250 $82.00 C1713

SCREW CORTEX 4.5MM 214.814 $77.00 C1713

SCREW CORTEX 4.5MM 214.816 $77.00 C1713

SCREW CORTEX 4.5MM 214.818 $77.00 C1713

SCREW CORTEX 4.5MM 214.820 $91.00 C1713

SCREW CORTEX 4.5MM 214.822 $91.00 C1713

SCREW CORTEX 4.5MM 214.846 $83.00 C1713

SCREW CORTEX 4.5MM 214.852 $91.00 C1713

SCREW CORTEX 4.5MM 214.854 $91.00 C1713

SCREW CORTEX 4.5MM 214.856 $77.00 C1713

SCREW CORTEX 4.5MM 214.858 $77.00 C1713

SCREW CORTEX 4.5MM 214.862 $77.00 C1713

SCREW CORTEX 4.5MM 214.864 $77.00 C1713

SCREW CORTEX 4.5MM 214.866 $77.00 C1713

SCREW CORTEX 4.5MM 214.868 $77.00 C1713

SCREW CORTEX 4.5MM 214.870 $77.00 C1713

SCREW CANCEL 6.5MM 216.100 $161.00 C1713

SCREW CANCEL 6.5MM 216.105 $161.00 C1713

SCREW CANCEL 6.5MM 216.110 $161.00 C1713

SCREW CANCEL 6.5MM 217.100 $161.00 C1713

SCREW CANCEL 6.5MM 217.105 $124.00 C1713

SCREW CANCEL 6.5MM 217.110 $161.00 C1713

TROCAR ENDO BLDLSS 5MM X 150MM $98.00 C1713

SCREW CANCEL 6.5MM 218.045 $123.00 C1713

SCREW CANCEL 6.5MM 218.050 $146.00

SCREW CANCEL 6.5MM 218.060 $123.00 C1713

SCREW CANCEL 6.5MM 218.065 $146.00 C1713

SCREW CANCEL 6.5MM 218.075 $146.00 C1713

SCREW CANCEL 6.5MM 218.080 $161.00 C1713

SCREW CANCEL 6.5MM 218.085 $161.00 C1713

SCREW CANCEL 6.5MM 218.090 $161.00 C1713

SCREW CANCEL 6.5MM 218.095 $161.00 C1713

SCREW CANCEL 6.5MM 218.100 $161.00 C1713

NUT CORTEX 4.5MM 219.96 $113.00 C1713

SCREW LAG DHS/DCS 280.05 $823.00 C1713

SCREW LAG DHS/DCS 280.10 $823.00 C1713

SCREW LAG DHS/DCS 280.15 $823.00 C1713

SCREW LAG DHS/DCS 280.20 $823.00 C1713

SCREW LAG DHS/DCS 280.25 $823.00 C1713

SCREW LAG DHS/DCS 280.30 $823.00 C1713

SCREW LAG DHS/DCS 280.35 $823.00 C1713

SCREW LAG DHS/DCS 280.40 $823.00 C1713

SCREW LAG DHS/DCS 280.45 $897.00 C1713

SCREW LAG DHS/DCS 280.50 $897.00 C1713

SCREW LAG DHS/DCS 280.55 $823.00 C1713

SCREW LAG DHS/DCS 280.60 $823.00 C1713

Page 190: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW LAG DHS/DCS 280.65 $823.00 C1713

SCREW LAG DHS/DCS 280.70 $823.00 C1713

SCREW LAG DHS/DCS 280.75 $823.00 C1713

SCREW LAG DHS/DCS 280.80 $823.00 C1713

SCREW LAG DHS/DCS 280.85 $823.00 C1713

SCREW LAG DHS/DCS 280.90 $823.00 C1713

SCREW LAG DHS/DCS 280.95 $823.00 C1713

SCREW COMPRES DHS/DCS 280.99 $157.00 C1713

PLATE DHS 135 DEG 281.10 $1,597.00 C1713

PLATE DHS 135 DEG 281.12 $1,261.00 C1713

PLATE DHS 135 DEG 281.14 $1,202.00 C1713

PLATE DHS 135 DEG 281.15 $1,202.00 C1713

PLATE DHS 135 DEG 281.16 $1,202.00 C1713

PLATE DHS 135 DEG 281.18 $1,597.00 C1713

PLATE DHS 140 DEG 281.25 $1,192.00 C1713

PLATE DHS 140 DEG 281.26 $1,202.00 C1713

PLATE DHS 145 DEG 281.35 $1,202.00 C1713

PLATE DHS 145 DEG 281.36 $1,202.00 C1713

PLATE DHS 150 DEG 281.40 $1,597.00 C1713

BIT DRILL QC 1.5MM 310.14 $197.00 C1713

BIT DRILL QC 2.5MM 310.25 $213.00 C1713

BIT DRILL QC 1.8MM 310.510 $428.00

BIT DRILL QC 2.4MM 310.530 $428.00

BIT DRILL CANN 3.2MM 310.65 $1,108.00

BIT DRILL CANN 4.5MM 310.66 $1,108.00

BIT DRILL CANN 3.5MM 310.68 $1,128.00

BIT DRILL CANN 4.5MM 310.69 $956.00

TAP FOR CORTEX 3.5MM 311.32 $362.00

TAP FOR CAN 3.5MM 311.39 $968.00

TAP FOR CAN 4.5MM 311.59 $1,165.00

TAP FOR CANCEL 6.5MM 311.66 $606.00

BIT DRILL QC FLUT 4.5MM 315.23 $420.00

BIT DRILL QC FLUT 2.5MM 315.25 $278.00

BIT DRILL QC FLUT 3.2MM 315.31 $282.00

BIT DRILL QC FLUT 4.0MM 315.40 $443.00

BIT DRILL QC FLUT 3.2MM 356.97 $616.00

BIT DRILL QC FLUT 4.0MM 356.98 $603.00

CAP TI END 458.10 $402.00

BOLT TI LOCKING 3.9MM 458.20 $471.00

BOLT TI LOCKING 3.9MM 458.42 $543.00 C1713

BOLT TI LOCKING 3.9MM 458.56 $543.00 C1713

BOLT TI LOCKING 3.9MM 458.60 $543.00 C1713

BOLT TI LOCKING 3.9MM 458.62 $543.00 C1713

BOLT TI LOCKING 3.9MM 458.64 $543.00 C1713

BOLT TI LOCKING 3.9MM 458.66 $471.00 C1713

BOLT TI LOCKING 3.9MM 458.80 $543.00 C1713

CAP TI END 12MM 459.013 $495.00 C1713

CAP TI END 12MM 459.014 $570.00 C1713

BOLT TI LOCKING 4.9MM 459.26 $471.00 C1713

BOLT TI LOCKING 4.9MM 459.28 $471.00 C1713

Page 191: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BOLT TI LOCKING 4.9MM 459.42 $471.00 C1713

BOLT TI LOCKING 4.9MM 459.46 $559.00 C1713

BOLT TI LOCKING 4.9MM 459.48 $471.00 C1713

BOLT TI LOCKING 4.9MM 459.50 $471.00 C1713

BOLT TI LOCKING 4.9MM 459.52 $471.00 C1713

BOLT TI LOCKING 4.9MM 459.54 $532.00 C1713

BOLT TI LOCKING 4.9MM 459.56 $550.00 C1713

BOLT TI LOCKING 4.9MM 459.58 $550.00 C1713

BOLT TI LOCKING 4.9MM 459.60 $471.00 C1713

BOLT TI LOCKING 4.9MM 459.64 $471.00 C1713

BOLT TI LOCKING 4.9MM 459.68 $471.00 C1713

BOLT TI LOCKING 4.9MM 459.72 $471.00 C1713

BOLT TI LOCKING 4.9MM 459.80 $471.00 C1713

BOLT TI LOCKING 4.9MM 459.85 $471.00 C1713

BOLT TI LOCKING 4.9MM 459.90 $471.00 C1713

BOLT TI LOCKING 4.9MM 459.95 $471.00 C1713

BIT DRILL FLUT 2.0MM 511.411 $537.00 C1713

BIT DRILL FLUT 3.6MM 511.416 $537.00 C1713

BIT DRILL FLUT 4.0MM 511.417 $537.00

BIT DRILL FLUT 4.5MM 511.418 $537.00

BIT DRILL FLUT 3.2MM 511.431 $618.00

BIT DRILL FLUT 4.0MM 511.432 $618.00

SCREW CANN 3.5MM 205.010 $610.00

SCREW CANN 3.5MM 205.012 $610.00

SCREW CANN 3.5MM 205.014 $610.00 C1713

SCREW CANN 3.5MM 205.016 $522.00 C1713

SCREW CANN 3.5MM 205.018 $610.00 C1713

SCREW CANN 3.5MM 205.024 $564.00 C1713

SCREW CANN 3.5MM 205.026 $610.00 C1713

SCREW CANN 3.5MM 205.028 $610.00 C1713

SCREW CANN 3.5MM 205.030 $564.00 C1713

SCREW CANN 3.5MM 205.032 $522.00 C1713

SCREW CANN 3.5MM 205.034 $564.00 C1713

SCREW CANN 3.5MM 205.036 $564.00 C1713

SCREW CANN 3.5MM 205.038 $564.00 C1713

SCREW CANN 3.5MM 205.040 $522.00 C1713

SCREW CANN 3.5MM 205.046 $610.00 C1713

SCREW CANN 3.5MM 205.048 $522.00 C1713

SCREW CANN 3.5MM 205.050 $610.00 C1713

SCREW CANN 3.5MM 205.210 $522.00 C1713

SCREW CANN 3.5MM 205.212 $522.00 C1713

SCREW CANN 3.5MM 205.214 $610.00 C1713

SCREW CANN 3.5MM 205.216 $610.00 C1713

SCREW CANN 3.5MM 205.218 $522.00 C1713

SCREW CANN 3.5MM 205.220 $522.00 C1713

SCREW CANN 3.5MM 205.222 $522.00 C1713

SCREW CANN 3.5MM 205.224 $522.00 C1713

SCREW CANN 3.5MM 205.226 $522.00 C1713

SCREW CANN 3.5MM 205.228 $610.00 C1713

SCREW CANN 3.5MM 205.230 $540.00 C1713

Page 192: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CANN 3.5MM 205.232 $522.00 C1713

SCREW CANN 3.5MM 205.234 $610.00 C1713

SCREW CANN 3.5MM 205.236 $610.00 C1713

SCREW CANN 3.5MM 205.238 $610.00 C1713

SCREW CANN 3.5MM 205.240 $564.00 C1713

SCREW CANN 3.5MM 205.242 $522.00 C1713

SCREW CANN 3.5MM 205.244 $522.00 C1713

SCREW CANN 3.5MM 205.246 $522.00 C1713

SCREW CANN 3.5MM 205.248 $610.00 C1713

SCREW CANN 3.5MM 205.250 $522.00 C1713

SCREW CANN 7.0MM 208.030 $700.00 C1713

SCREW CANN 7.0MM 208.035 $700.00 C1713

SCREW CANN 7.0MM 208.040 $700.00 C1713

SCREW CANN 7.0MM 208.045 $700.00 C1713

SCREW CANN 7.0MM 208.050 $700.00 C1713

SCREW CANN 7.0MM 208.065 $700.00 C1713

SCREW CANN 7.0MM 208.075 $700.00 C1713

SCREW CANN 7.0MM 208.080 $700.00 C1713

SCREW CANN 7.0MM 208.085 $700.00 C1713

SCREW CANN 7.0MM 208.090 $700.00 C1713

SCREW CANN 7.0MM 208.095 $700.00 C1713

SCREW CANN 7.0MM 208.100 $700.00 C1713

SCREW CANN 7.0MM 208.105 $700.00 C1713

SCREW CANN 7.0MM 208.110 $700.00 C1713

SCREW CANN 7.0MM 208.115 $700.00 C1713

SUTURE CHROMIC 3-0 27 RB-1 $28.00 C1713

SCREW CANN 7.0MM 208.120 $700.00 C1713

SCREW CANN 7.0MM 208.125 $700.00

SCREW CANN 7.0MM 208.130 $700.00 C1713

SCREW CANN 7.0MM 209.045 $700.00 C1713

SCREW CANN 7.0MM 209.050 $700.00 C1713

SCREW CANN 7.0MM 209.070 $700.00 C1713

SCREW CANN 7.0MM 209.075 $700.00 C1713

SCREW CANN 7.0MM 209.080 $700.00 C1713

SCREW CANN 7.0MM 209.085 $700.00 C1713

SCREW CANN 7.0MM 209.090 $700.00 C1713

SCREW CANN 7.0MM 209.095 $700.00 C1713

SCREW CANN 7.0MM 209.100 $700.00 C1713

SCREW CANN 7.0MM 209.105 $700.00 C1713

SCREW CANN 7.0MM 209.110 $700.00 C1713

SCREW CANN 7.0MM 209.115 $700.00 C1713

SCREW CANN 7.0MM 209.120 $700.00 C1713

SCREW CANN 7.0MM 209.125 $700.00 C1713

SCREW CANN 4.5MM 214.522 $532.00 C1713

SCREW CANN 4.5MM 214.524 $532.00 C1713

SCREW CANN 4.5MM 214.526 $532.00 C1713

SCREW CANN 4.5MM 214.534 $604.00 C1713

SCREW CANN 4.5MM 214.536 $532.00 C1713

SCREW CANN 4.5MM 214.542 $558.00 C1713

SCREW CANN 4.5MM 214.550 $604.00 C1713

Page 193: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CANN 4.5MM 214.552 $558.00 C1713

SCREW CANN 4.5MM 214.564 $532.00 C1713

SCREW CANN 4.5MM 214.568 $532.00 C1713

SCREW CANN 4.5MM 214.720 $532.00 C1713

SCREW CANN 4.5MM 214.722 $532.00 C1713

SCREW CANN 4.5MM 214.726 $532.00 C1713

SCREW CANN 4.5MM 214.732 $532.00 C1713

SCREW CANN 4.5MM 214.736 $532.00 C1713

SCREW CANN 4.5MM 214.738 $532.00 C1713

SCREW CANN 4.5MM 214.742 $532.00 C1713

SCREW CANN 4.5MM 214.744 $604.00 C1713

SCREW CANN 4.5MM 214.748 $604.00 C1713

SCREW CANN 4.5MM 214.750 $532.00 C1713

SCREW CANN 4.5MM 214.752 $532.00 C1713

SCREW CANN 4.5MM 214.754 $532.00 C1713

SCREW CANN 4.5MM 214.756 $604.00 C1713

SCREW CANN 4.5MM 214.760 $532.00 C1713

SCREW CANN 4.5MM 214.764 $532.00 C1713

SCREW CANN 4.5MM 214.772 $532.00 C1713

WIRE GUIDE 1.25MM 900.722 $112.00 C1713

WIRE GUIDE 2.8MM 292.68 $159.00 C1713

WIRE GUIDE 1.6MM 292.72 $126.00 C1769

SCREW TI CANN 7.3MM 408.830 $682.00 C1769

SCREW TI CANN 7.3MM 408.835 $682.00 C1769

SCREW TI CANN 7.3MM 408.840 $682.00 C1713

SCREW TI CANN 7.3MM 408.845 $682.00 C1713

SCREW TI CANN 7.3MM 408.850 $682.00 C1713

SCREW TI CANN 7.3MM 408.860 $682.00 C1713

SCREW TI CANN 7.3MM 408.870 $584.00 C1713

SCREW TI CANN 7.3MM 408.880 $584.00 C1713

SCREW TI CANN 7.3MM 408.915 $682.00 C1713

SCREW TI CANN 7.3MM 408.920 $584.00 C1713

SCREW TI CANN 7.3MM 408.930 $682.00 C1713

SCREW TI CANN 7.3MM 409.850 $584.00 C1713

SCREW TI CANN 7.3MM 409.865 $682.00 C1713

SUTURE VICRYL 2-0 8-18 CTB-1 $28.00 C1713

SCREW TI CANN 7.3MM 409.895 $584.00 C1713

SCREW TI CANN 7.3MM 409.905 $682.00

SCREW TI CANN 7.3MM 409.910 $584.00 C1713

SCREW TI CANN 7.3MM 409.920 $682.00 C1713

SCREW TI CANN 7.3MM 409.925 $682.00 C1713

BLADE TI HELICAL 11MM 456.301 $1,298.00 C1713

BLADE TI HELICAL 11MM 456.308 $1,257.00 C1713

BLADE TI HELICAL 11MM 456.309 $1,344.00

SCREW CORTEX 3.5MM 204.818 $91.00

BIT DRILL FLUT 2.7MM 315.28 $420.00

CAP TI END EXT 15MM 458.110 $614.00 C1713

SCISSOR SWITCH BLADE DISP $184.00 C1713

SUTURE VICRYL 0 27 UR-5 $28.00

DRESSING SOFSORB 15X18 $27.00

Page 194: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CONNECTOR Y INSTRUMED $125.00

TUBE T BARD 8FR $27.00

TUBE T BARD 10FR $27.00

TUBE T BARD 12FR $27.00

TUBE T BARD 14FR $369.00

TUBE T BARD 16FR $30.00

TUBE T BARD 18FR $27.00

TUBE T BARD 20FR $27.00

GUIDEWIRE PILOT 50 14X300 $258.00

CATH GUIDING 6F 3D RIGHT $170.00

PROBES FOR COMPARTMENTAL PRESS $576.00 C1769

BALLOON SPRINTER 1.5MMX15MM $578.00 C1887

BALLOON SPRINTER 3MMX12MM $578.00

BLADE RADNOID PEDIATRIC 4MM $403.00 C1727

PROBE PRASS STAND PKG $280.00 C1727

KNIFE MYRINGOTOMY $122.00

TUBES PE VENT $37.00

BINDER ABDOMINAL 85-94 XXXL $57.00

PUMP PAIN ON-Q C-BLOC 400ML $833.00

PUMP PAIN ON-Q 270ML 2.5 CATH $503.00

DRESSING ACTICOAT 3 5X5 $49.00

TUBE TRACH BL LN CUF 8.0MM $97.00

TUBE TRACH BL LN DBL CUF 9.0MM $140.00 A6204

BLADE TOTAL SAGITTAL 18MM $160.00

NAIL CANN TIB 12MM 04.004.658S $3,266.00

NAIL CANN TIB 8MM 04.004.231S $3,266.00

NAIL CANN TIB 8MM 04.004.234S $3,266.00 C1713

NAIL CANN TIB 10MM 04.004.446S $2,986.00 C1713

NAIL CANN TIB 10MM 04.004.449S $3,266.00 C1713

NAIL CANN TIB 10MM 04.004.452S $2,986.00 C1713

NAIL CANN TIB 10MM 04.004.455S $3,266.00 C1713

NAIL CANN TIB 10MM 04.004.458S $2,845.00 C1713

NAIL CANN TIB 12MM 04.004.637S $3,266.00 C1713

NAIL CANN TIB 12MM 04.004.640S $2,986.00 C1713

NAIL CANN TIB 12MM 04.004.643S $3,266.00 C1713

NAIL CANN TIB 12MM 04.004.646S $3,266.00 C1713

NAIL CANN TIB 12MM 04.004.649S $3,266.00 C1713

NAIL CANN TIB 12MM 04.004.652S $3,266.00 C1713

NAIL CANN TIB 12MM 04.004.655S $3,266.00 C1713

SUTR CHROMIC 2-0 36IN $28.00 C1713

SUTR CHROMIC 3-0 27IN $28.00 C1713

SUTR CHROMIC 4-0 36IN $28.00

SUTURE STEEL 5-0 8-16 KS $28.00

SUTR CHROMIC 7-0 $28.00

SUTR ETHIBOND EXCEL 2-0 30IN $28.00

SUTR ETHIBOND EXCEL 2-0 27IN $28.00

SUTR ETHILON BLK 4-0 18IN $28.00

SUTR ETHILON BLK 8-0 12IN $28.00

SUTR MERSILENE 4-0 18IN $28.00

SUTR MERSILENE RS21 BP1 12IN $28.00

Page 195: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SUTR MONOCRYL #0 27IN $28.00

SUTR MONOCRYL #0 27IN $28.00

SUTR MONOCRYL #1 27IN $28.00

SUTR MONOCRYL #1 36IN $28.00

SUTR MONOCRYL 2-0 27IN $28.00

SUTR MONOCRYL VLT 2-0 27IN $28.00

SUTR MONOCRYL 3-0 27IN $28.00

SUTR MONOCRYL VLT 3-0 27IN $28.00

SUTR MONOCRYL VLT 3-0 27IN $28.00

SUTR MONOCRYL 3-0 27IN $28.00

SUTURE PDP PLS 3-0 18 PS-2 $28.00

IMMOBILIZER SHLDR XXLG $47.00

IMMOBILIZER SHLDR XXXLG $48.00

CANNULA CURVED RF 150MM X 22M $58.00

SUTURE 3-0 18 NUROLON RB-1 BK $28.00

BALLOON SPRINTER OTW 4MMX15M $578.00

BALLOON SPRINTER OTW 2X30MM $578.00

POTATO POWDER $406.00 C1727

CASSETTE NX $174.00 C1727

INDICATOR CYCLESURE BIOLOGICAL $41.00

SUTR PDS II 4-0 18 PC-3 $28.00

SUTR VICRYL DEXON 3-0 18 SH $28.00

PIN THREADED TROCHAR PNT 2 END $155.00

WIRE K THREADED DIAMOND PNT 2 $100.00

SHAFT REAMER BIX CUT STERILE $468.00 C1713

CONTAINER TISSUE 16 OZ $273.00

TUBING BLOOD Y-TYPE PLT $25.00

CEMENT BONE G COBALT W/ GENT $557.00

SCREW CORTEX 2.0MM 401.811.96 $187.00

PLATE T TI 2.0MM 3H 447.233 $550.00 C1713

4.5 VITAGEL $1,232.00 C1713

CELL PACKER WITH CITRATE $503.00

DISK OPTICAL 9.1GHB CT $170.00

ARTHROSEW SINGLE 8.6MM CANNUL $526.00

COVER PROBE ULTRASOUND W/ GEL $45.00

MAINTEN. KIT PHASER 8500/8550 $421.00

OASIS 3X3.5CM FEN $469.00 Q4102

TAPE SEAL SURE INDIC $33.00

KIT TIGHT ROPE SYNDESMOSIS $1,155.00

SCAPEL HARMONIC ACE23E $942.00

TUBE EMG REINFORCED 7MM $667.00

PUTTY DBX BONE 5CC $1,990.00 C1713

IMMOBILIZER 16 UNIVERS. YOUTH $47.00

SENSOR DUAL FLEX $159.00

NERVE BLOCK SET 20GA X 2IN $105.00

NERVE BLOCK SET 20GA X 1 1/8IN $123.00

NERVE BLOCK SET $98.00

NEEDLE NERVE STIMUPLEX 22GAX1 $40.00

ELECTRODE TC VAPOR $647.00

ELECTRODE VAPOR S90 $397.00

Page 196: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

KIT ACL DISPOSABLE $1,014.00

KIT CROSS PIN RGDFX FEM 3.3 ST $888.00 C1713

CROSS PIN RGDFX FEM 2.7 BTP $888.00 C1713

SCREW INTRFX TAPRD 8-10 X 30MM $544.00 C1713

SCREW INTRFX TAPRD 7-9 X 30MM $516.00 C1713

SCREW INTRFX TAPRD 6-8 X 30MM $566.00 C1713

SHEATH INTRFX TIBIAL 30MM $562.00

SCREW MILAGRO INTRFNNCE 8X23 $744.00 C1713

SCREW MILAGRO INTRFNNCE 9X23 $744.00 C1713

SCREW MILAGRO INTRFNNCE 10X23 $808.00 C1713

ANCHOR BIOKNOTLESS RC PANACRYL $803.00 C1713

ANCHOR MINI QUICK PLUS $798.00 C1713

SPLINT SURG NAIL 10MM 4S $115.00 C1713

SPLINT SURG NAIL 22MM 4W $115.00 C1713

SPIRALOCK 5.0 W/ ORTHOCORD $729.00 C1713

SPIRALOCK 6.5 W/ ORTHOCORD $819.00 C1713

GRASPER SUTURE 45* $521.00

PELLETS OSTEOSET 5CC $1,065.00 C1713

CHIPS CANCELLOUS 4-9.5MM 30CC $1,193.00 C1713

CHIPS CANCELLOUS 4-9.5MM 15CC $731.00 C1713

BLADE TPS LNG MED AGGRESSIVE $116.00

EXTRACTOR CORK SCREW $131.00

FIBERWIRE #2 ANGEL OPEN CUFFS $71.00 C1713

DART CHONDRAL $381.00 C1713

INSTR OSTEOCHONDRAL FLP REPAIR $526.00

CANNULA 5.75X7 $96.00

CANNULA 8.25X $96.00

ARTHRORIVET LACTOSORB $701.00

PLATE ROTATOR CUFF BUTTRS 1.75 $526.00 C1713

RETRIEVER SUTURE SPDPSS DISP $421.00

ANCHOR SUTURE 3MM TI SCREW $680.00 C1713

ANCHOR SUTURE 5MM TI SCREW $706.00 C1713

ANCHOR SUTURE LACTOSCREW 3.5 $680.00 C1713

ANCHOR SUTURE LACTOSCREW 5.5 $706.00 C1713

CATH PEZZER 24FR $37.00

CATH PEZZER 45FR $87.00

CUTTER CURVED CONTOUR $1,163.00

RELOAD CUTTER CURVED CONTOUR $521.00

RELOAD CUTTER CURVED CONTOUR $521.00

SLING SYST LYNX SUPRAUBIC $2,029.00 C1771

SUTUR CATGUT 1/2 CIRC/TAPR 5D $28.00

SUTUR CATGUT 1/2 CIRC/TAPR 6D $28.00

SUTUR CATGUT 1/2 CIRC/TROCR 6D $85.00

SUTUR ABDOMINAL STRGHT CUT 2D $28.00

SUTUR UTERINE 1/2 CIRC/RCUT 7D $28.00

DISK LAPAROSCOPIC LD112 $1,273.00

DISK LAPAROSCOPIC LD1115 $1,206.00

CLIP U REG FLEX REG NEEDLE $264.00

PATCH HEMSHLD 1X6 $574.00 C1781

GRAFT SIZER $350.00

Page 197: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

GRAFT HEMSHLD 24X30 $1,224.00 C1768

GRAFT HEMSHLD 26X30 $1,224.00 C1768

GRAFT HEMSHLD 28X30 $1,224.00 C1768

GRAFT HEMSHLD 30X30 $1,224.00 C1768

GRAFT HEMSHLD 32X30 $1,224.00 C1768

TUBE EMG REINFORCED 6MM $667.00

TUBE EMG REINFORCED 8MM $667.00

TUBE T MODIFIED GOODE VENT $97.00

NAIL CANN TIB 8MM 04.004.237S $3,266.00 C1713

NAIL CANN TIB 8MM 04.004.240S $3,266.00 C1713

NAIL CANN TIB 8MM 04.004.243S $2,986.00 C1713

NAIL CANN TIB 8MM 04.004.246S $3,120.00 C1713

NAIL CANN TIB 8MM 04.004.249S $3,266.00 C1713

NAIL CANN TIB 8MM 04.004.252S $3,266.00 C1713

NAIL CANN TIB 8MM 04.004.255S $3,266.00 C1713

NAIL CANN TIB 8MM 04.004.258S $3,266.00 C1713

NAIL CANN TIB 10MM 04.004.431S $3,266.00 C1713

NAIL CANN TIB 10MM 04.004.434S $3,266.00 C1713

NAIL CANN TIB 10MM 04.004.437S $3,266.00 C1713

NAIL CANN TIB 10MM 04.004.443S $2,986.00 C1713

NAIL CANN TIB 12MM 04.004.631S $3,266.00 C1713

NAIL CANN TROCH 11MM 456.415S $3,913.00 C1713

NAIL CANN TROCH 11MM 456.417S $3,913.00 C1713

NAIL CANN TROCH 11MM 456.421S $3,913.00 C1713

NAIL CANN TROCH 11MM 456.425S $3,913.00 C1713

NAIL CANN TROCH 11MM 456.412S $3,913.00 C1713

NAIL CANN TROCH 11MM 456.414S $3,913.00 C1713

NAIL CANN TROCH 11MM 456.418S $3,838.00 C1713

NAIL CANN TROCH 11MM 456.420S $3,913.00 C1713

NAIL CANN TROCH 11MM 456.422S $3,913.00 C1713

NAIL CANN TROCH 11MM 456.424S $3,913.00 C1713

NAIL SOLID FEMORAL 9MM 464.32 $2,365.00 C1713

NAIL SOLID FEMORAL 9MM 464.34 $2,365.00 C1713

NAIL SOLID FEMORAL 9MM 464.36 $2,365.00 C1713

NAIL SOLID FEMORAL 9MM 464.38 $2,365.00 C1713

NAIL SOLID FEMORAL 9MM 464.40 $2,365.00 C1713

NAIL SOLID FEMORAL 9MM 464.42 $2,365.00 C1713

NAIL SOLID FEMORAL 9MM 464.44 $2,365.00 C1713

NAIL CANN FEMORAL 10MM 474.032 $2,912.00 C1713

NAIL CANN FEMORAL 10MM 474.034 $2,912.00 C1713

NAIL CANN FEMORAL 10MM 474.036 $2,912.00 C1713

NAIL CANN FEMORAL 10MM 474.038 $2,912.00 C1713

NAIL CANN FEMORAL 10MM 474.041 $2,912.00 C1713

NAIL CANN FEMORAL 10MM 474.042 $2,912.00 C1713

NAIL CANN FEMORAL 10MM 474.044 $2,912.00 C1713

NAIL CANN FEMORAL 10MM 474.046 $2,912.00 C1713

NAIL CANN FEMORAL 11MM 474.134 $2,912.00 C1713

NAIL CANN FEMORAL 11MM 474.136 $2,912.00 C1713

NAIL CANN FEMORAL 11MM 474.138 $2,912.00 C1713

NAIL CANN FEMORAL 11MM 474.141 $2,912.00 C1713

Page 198: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NAIL CANN FEMORAL 11MM 474.142 $2,912.00 C1713

NAIL CANN FEMORAL 11MM 474.144 $2,912.00 C1713

NAIL CANN FEMORAL 11MM 474.146 $2,912.00 C1713

NAIL CANN FEMORAL 12MM 474.232 $2,912.00 C1713

NAIL CANN FEMORAL 12MM 474.234 $2,912.00 C1713

NAIL CANN FEMORAL 12MM 474.236 $2,912.00 C1713

NAIL CANN FEMORAL 12MM 474.238 $2,912.00 C1713

NAIL CANN FEMORAL 12MM 474.241 $2,489.00 C1713

NAIL CANN FEMORAL 12MM 474.242 $2,912.00 C1713

NAIL CANN FEMORAL 12MM 474.244 $2,912.00 C1713

NAIL CANN FEMORAL 12MM 474.246 $2,912.00 C1713

NAIL CANN FEMORAL 13MM 474.334 $2,912.00 C1713

NAIL CANN FEMORAL 13MM 474.336 $2,912.00 C1713

NAIL CANN FEMORAL 13MM 474.338 $2,912.00 C1713

NAIL CANN FEMORAL 13MM 474.341 $2,912.00 C1713

NAIL CANN FEMORAL 13MM 474.342 $2,912.00 C1713

NAIL CANN FEMORAL 13MM 474.344 $2,912.00 C1713

NAIL CANN FEMORAL 13MM 474.346 $2,912.00 C1713

NAIL PROX HUMERAL 8MM 462.971 $3,688.00 C1713

NAIL SLD HUMERAL 7.5MM 462.719 $3,717.00 C1713

NAIL SLD HUMERAL 7.5MM 462.720 $3,717.00 C1713

NAIL SLD HUMERAL 7.5MM 462.722 $3,717.00 C1713

NAIL SLD HUMERAL 7.5MM 462.724 $3,717.00 C1713

NAIL SLD HUMERAL 7.5MM 462.725 $3,717.00 C1713

NAIL SLD HUMERAL 7.5MM 462.726 $3,717.00 C1713

NAIL SLD HUMERAL 7.5MM 462.727 $3,717.00 C1713

NAIL SLD HUMERAL 7.5MM 462.728 $3,717.00 C1713

NAIL SLD HUMERAL 7.5MM 462.731 $3,717.00 C1713

NAIL SLD HUMERAL 7.5MM 462.732 $3,717.00 C1713

CABLE BEADED 1.6MM 6704-0-420 $776.00

CABLE BEADED 2MM 6704-0-520 $684.00

CABLE BEADED 1.6MM 3704-0-040 $684.00

CABLE BEADED 2MM 3704-0-050 $684.00

NEEDLE BLOCK 22 GA X 50MM $109.00

CEMENT BONE SIMPLEX P W/ TOBRA $635.00 C1713

TUBE VENT MORETZ TINY TAB $141.00

BLADE SILVER BULLET 4MM $82.00

MIXER KNEE BONE CEMENT EVAC 3 $209.00

MIXER HIP BONE CEMENT $370.00

BLADE TPS LNG $116.00

PATCH SYVEK NT HEMOST 3X3CM $220.00 C1760

SHIELD BLAST MIRROW $590.00

CATH RADIAL ARTERY SET $35.00

TUBE INTRODUCER TRACHEAL COUDE $25.00

TUBE INTRODUCER TRACHEAL STRT $25.00

FORCEP JUMBO 240 CM $82.00

TRAY KYPHOPAK EXPRESS KPE1001 $8,045.00

TRAY KYPHOPAK EXPRESS KPE1003 $7,725.00

TRAY KYPHOPAK EXPRESS KPE1004 $5,253.00

CEMENT BONE KYPHON MIX PK CO1B $534.00 C1713

Page 199: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PAIN CLINIC EPIDURAL TRAY $45.00

REFILL KITS MEDTRONIC PAIN CLI $77.00

BURR 4.0 UNHOODED ROUND $183.00

RETRACTOR DEEP SCROTAL SYSTEM $759.00

STIMUPLEX 22G 1 3/8 NEEDLE $40.00

INJECTOR UTERINE ZUI 2.0 $110.00

STENT CORO DRV OTW 2.25MMX8M $2,261.00 C1876

STENT CORO DRV OTW 2.25MMX12M $2,130.00 C1876

STENT CORO DRV OTW 2.25MMX14M $2,130.00 C1876

STENT CORO DRV OTW 2.25MMX18M $2,130.00 C1876

STENT CORO DRV OTW 2.25MMX24M $2,261.00 C1876

STENT CORO DRV OTW 2.5MMX8MM $2,130.00 C1876

STENT CORO DRV OTW 2.5MMX12M $2,130.00 C1876

STENT CORO DRV OTW 2.5MMX14M $2,130.00 C1876

STENT CORO DRV OTW 2.5MMX18M $2,130.00 C1876

STENT CORO DRV OTW 2.5MMX24M $2,130.00 C1876

STENT CORO DRV OTW 2.75MMX8M $2,130.00 C1876

STENT CORO DRV OTW 2.75MMX12M $2,130.00 C1876

STENT CORO DRV OTW 2.75MMX14M $2,130.00 C1876

STENT CORO DRV OTW 2.75MMX18M $2,130.00 C1876

STENT CORO DRV OTW 2.75MMX24M $2,130.00 C1876

REPLEFORM 5X10 $2,895.00 C1762

DRESSING VERSAFOAM VAC SMALL $40.00 A6550

SHOE POST OP WOOD SM MLE $38.00

SHOE POST OP WOOD MD MLE $38.00

SHOE POST OP WOOD LG MLE $38.00

SHOE POST OP WOOD SM FEMLE $38.00

SHOE POST OP WOOD MD FEMLE $37.00

STRIP STAPLE LINE EC60 4.1 $513.00

STAPLER RELOAD GRN ECHELON 60 $397.00

STAPLER RELOAD WHT ECHELON 60 $397.00

STAPLER ENDOPATH ECHELON 60 $492.00

ELECTRODE PAIRED $308.00

TUBE EMG ENDOTRACH 7.0MM $624.00

CARTRIDGE CURVTEK 12MM LG $151.00

CARTRIDGE CURVTEK 22MM XLG $1,202.00

SCREW CORTEX 2.7MM 202.026 $72.00 C1713

SCREW CORTEX 2.7MM 202.030 $60.00 C1713

SCREW CORTEX 2.7MM 202.032 $72.00 C1713

SCREW CORTEX 2.7MM 202.036 $72.00 C1713

SCREW CORTEX 2.7MM 202.038 $72.00 C1713

SCREW CORTEX 2.7MM 202.040 $60.00 C1713

SCREW CANN 4.5MM 214.746 $532.00 C1713

SCREW CANN 4.5MM 214.768 $532.00 C1713

PLATE CALCANEAL 70MM 241.62 $1,150.00 C1713

WIRE GUIDE 2.0MM 292.65 $151.00 C1769

SCREW SCHANZ 5.0MM 294.56 $261.00 C1713

SCREW SCHANZ 5.0MM 294.785 $435.00 C1713

SCREW SCHANZ 5.0MM 294.786 $435.00 C1713

COUNTERSINK 2.OMM 310.972 $516.00

Page 200: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SHAFT SCRWDRVR 1.5MM 313.993 $1,192.00

SHAFT SCRWDRVR 2.5MM 314.10 $764.00

GUIDE DRILL UNV 3.5MM 323.36 $1,170.00

WIRE GUIDE THR 2.5MM 338.00 $159.00 C1769

CLAMP COMBINATION 393.647 $1,766.00

COMPRESSOR OPEN 393.76 $1,389.00

ROD CARBON FIBER 11.0MM 394.83 $532.00 C1713

ROD CARBON FIBER 11.0MM 394.86 $572.00 C1713

ROD CARBON FIBER 11.0MM 394.87 $626.00 C1713

ROD CARBON FIBER 8.0MM 395.782 $432.00 C1713

ROD CARBON FIBER 8.0MM 395.784 $432.00 C1713

ROD CARBON FIBER 8.0MM 395.786 $504.00 C1713

PLATE TI PROXIM TIBIA 422.304 $3,755.00 C1713

PLATE TI PROXIM TIBIA 422.308 $3,755.00 C1713

PLATE TI PROXIM TIBIA 422.309 $3,262.00 C1713

PLATE TI DISTAL FEMUR 422.349 $3,500.00 C1713

CAP TI END EXT 0MM 456.311 $486.00 C1713

CAP TI END EXT 5MM 456.312 $486.00 C1713

CAP TI END EXT 10MM 456.313 $486.00 C1713

NAIL FIXATION 340MM/R 456.414S $3,551.00 C1713

NAIL FIXATION 340MM/L 456.415S $3,322.00 C1713

NAIL FIXATION 360MM/R 456.416S $3,913.00 C1713

NAIL FIXATION 360MM/L 456.417S $195.00 C1713

NAIL FIXATION 400MM/R 456.420S $3,913.00 C1713

NAIL FIXATION 400MM/L 456.421S $3,322.00 C1713

NAIL FIXATION 420MM/R 456.422S $3,551.00 C1713

NAIL FIXATION 420MM/L 456.423S $3,551.00 C1713

NAIL FIXATION 440MM/R 456.424S $3,913.00 C1713

NAIL FIXATION 440MM/L 456.425S $3,913.00 C1713

PLATE LCP RECON 3.5MM 245.081 $1,220.00 C1713

PLATE LCP RECON 3.5MM 245.101 $1,264.00 C1713

PLATE LCP TUB 1-3RD 241.391 $570.00 C1713

CLAMP MULTI-PIN LG 390.002 $1,659.00

CLAMP OPEN ADJUST 390.008 $1,387.00

CLAMP ADJUST 4.0MM 390.051 $1,606.00

PLATE TI LCP-TM DISTAL 442.492 $1,892.00 C1713

PLATE TI LCP-TM DISTAL 442.493 $1,892.00 C1713

PLATE TI LCP-TM DISTAL 442.494 $2,006.00 C1713

PLATE TI LCP-TM DISTAL 442.501 $968.00 C1713

PLATE TI LCP-TM DISTAL 442.509 $1,182.00 C1713

NEEDLE NORIAN DLS-7123-05S $552.00

SCREW CANN 7.3MM 208.850 $682.00 C1713

SCREW CANN 7.3MM 208.865 $584.00 C1713

SCREW CANN 7.3MM 208.870 $584.00 C1713

SCREW CANN 7.3MM 208.875 $631.00 C1713

SCREW CANN 7.3MM 209.860 $682.00 C1713

SCREW CANN 7.3MM 209.865 $682.00 C1713

SCREW CANN 7.3MM 209.870 $682.00 C1713

SCREW CANN 7.3MM 209.875 $682.00 C1713

SCREW CANN 7.3MM 209.880 $682.00 C1713

Page 201: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CANN 7.3MM 209.885 $682.00 C1713

SCREW CANN 7.3MM 209.890 $631.00 C1713

SCREW MALLEO 4.5MM 215.025 $138.00 C1713

SCREW MALLEO 4.5MM 215.030 $138.00 C1713

SCREW MALLEO 4.5MM 215.035 $138.00 C1713

SCREW MALLEO 4.5MM 215.040 $138.00 C1713

SCREW MALLEO 4.5MM 215.045 $138.00 C1713

SCREW MALLEO 4.5MM 215.050 $138.00 C1713

SCREW MALLEO 4.5MM 215.055 $138.00 C1713

SCREW MALLEO 4.5MM 215.060 $138.00 C1713

SCREW MALLEO 4.5MM 215.065 $138.00 C1713

SCREW MALLEO 4.5MM 215.070 $138.00 C1713

WASHER 10.0MM 219.91 $92.00 C1713

PLATE CALCANEAL 60MM 241.61 $1,126.00 C1713

MOUNT WIRE 4.5MM 281.001S $480.00 C1713

PLATE DHS 150 DEG 281.45 $1,202.00 C1713

PLATE DHS 150 DEG 281.46 $1,202.00 C1713

PLATE DHS 150 DEG 281.48 $1,597.00 C1713

PLATE DHS 140 DEG 281.66 $1,202.00 C1713

PLATE DHS 145 DEG 281.75 $1,202.00 C1713

PLATE DHS 150 DEG 281.84 $1,202.00 C1713

PLATE DHS 150 DEG 281.85 $1,202.00 C1713

PLATE DHS 150 DEG 281.86 $1,202.00 C1713

WIRE SPD-PNT 1.8MM 292.38 $240.00 C1713

WIRE REDUCTION 1.8MM 292.39 $611.00 C1713

WIRE SPD-PNT 2.0MM 292.40 $240.00 C1713

WIRE REDUCTION 2.0MM 292.41 $564.00 C1713

WIRE CALIBRATED 3.2MM 292.69 $338.00 C1769

SCREW SCHANZ 4.0/3.0MM 294.30 $239.00 C1713

SCREW SCHANZ 4.0MM 294.43 $239.00 C1713

SCREW SCHANZ 4.0MM 294.44 $239.00 C1713

SCREW SCHANZ 4.0MM 294.45 $239.00 C1713

SCREW SCHANZ 4.0MM 294.46 $239.00 C1713

SCREW SCHANZ 5.0MM 294.52 $260.00 C1713

SCREW SCHANZ 5.0MM 294.53 $260.00 C1713

SCREW SCHANZ 5.0MM 294.54 $260.00 C1713

SCREW SCHANZ 5.0MM 294.57 $302.00 C1713

SCREW SCHANZ 4.5MM 294.71 $242.00 C1713

SCREW SCHANZ 4.5MM 294.73 $242.00 C1713

SCREW SCHANZ 4.5MM 294.74 $242.00 C1713

SCREW SCHANZ 4.5MM 294.75 $290.00 C1713

SCREW SCHANZ 4.5MM 294.76 $251.00 C1713

SCREW SCHANZ 4.0MM 294.775 $447.00 C1713

SCREW SCHANZ 4.0MM 294.776 $447.00 C1713

SCREW SCHANZ 5.0MM 294.783 $504.00 C1713

SCREW SCHANZ 5.0MM 294.784 $504.00 C1713

BIT DRILL QC 2.5MM 310.23 $283.00

BIT DRILL CANN 5.0MM 310.63 $963.00

BOLT INSERTION 356.542 $462.00 C1713

GUIDE MEDULLARY 356.55 $380.00

Page 202: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CAPS PROT KIRSCHNER 392.18 $105.00 C1713

CLAMP TI TUBE-TUBE 393.361 $1,814.00

CLAMP BODY 2 NUTS 393.44 $1,168.00

CLAMP OPEN 393.69 $660.00

ROD CARBON FIBER 11.0MM 394.80 $616.00 C1713

ROD CARBON FIBER 11.0MM 394.81 $532.00 C1713

ROD CARBON FIBER 11.0MM 394.82 $616.00 C1713

ROD CARBON FIBER 11.0MM 394.88 $724.00 C1713

ROD CARBON FIBER 11.0MM 394.90 $783.00 C1713

ROD CARBON FIBER 11.0MM 394.91 $783.00 C1713

ROD CARBON FIBER 11.0MM 394.92 $783.00 C1713

CAPS 11.0MM TUBE & RODS 394.97 $63.00 C1713

CAP 5.0MM FIX PIN 394.993 $158.00 C1713

BOLT TI LOCKING 3.9MM 458.32 $471.00 C1713

BOLT TI LOCKING 3.9MM 458.34 $543.00 C1713

BOLT TI LOCKING 3.9MM 458.36 $543.00 C1713

BOLT TI LOCKING 3.9MM 458.44 $447.00 C1713

BOLT TI LOCKING 3.9MM 458.76 $471.00 C1713

SCREW SCHANZ 4.0/3.0MM 494.771 $453.00 C1713

PLATE LCP 3.5MM 14H 223.641 $1,458.00 C1713

SCREW CANN 6.5MM 208.431 $631.00 C1713

SCREW CANN 6.5MM 208.432 $631.00 C1713

SCREW CANN 6.5MM 208.433 $631.00 C1713

SCREW CANN 6.5MM 208.435 $682.00 C1713

SCREW CANN 6.5MM 208.436 $584.00 C1713

SCREW CANN 6.5MM 208.439 $584.00 C1713

SCREW CANN 6.5MM 208.440 $584.00 C1713

SCREW CANN 6.5MM 208.441 $584.00 C1713

SCREW CANN 6.5MM 208.442 $584.00 C1713

SCREW CANN 6.5MM 208.443 $584.00 C1713

SCREW CANN 6.5MM 208.444 $631.00 C1713

PIN STEINMANN 5.0MM 293.840 $338.00 C1713

SCREW CANN 6.5MM 208.445 $682.00 C1713

PIN STEINMANN 5.0MM 293.940 $396.00 C1713

SCREW CANN 6.5MM 208.446 $682.00 C1713

SCREW CANN 6.5MM 208.401 $682.00 C1713

SCREW CANN 6.5MM 208.402 $682.00 C1713

SCREW CANN 6.5MM 208.403 $631.00 C1713

SCREW CANN 6.5MM 208.404 $584.00 C1713

SCREW CANN 6.5MM 208.409 $584.00 C1713

CLAMP COMBINATION LG 390.005 $1,460.00

ATTACHMENT ROD CLAMP 390.003 $1,000.00

CAP END TI 0.0MM 04.004.000 $453.00 C1713

BIT DRILL QC 1.8MM 310.509 $474.00

SCREW TI LOCKING 2.4MM 412.830 $314.00 C1713

PLATE LCP DISTAL 2.4MM 442.477 $1,094.00 C1713

PLATE LCP DISTAL 2.4MM 442.478 $1,212.00 C1713

PLATE LCP-TM DST 2.4MM 442.490 $1,094.00 C1713

PLATE LCP-TM DST 2.4MM 442.500 $1,005.00 C1713

PLATE LCP-TM DST 2.4MM 442.512 $1,057.00 C1713

Page 203: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SUTR CAPIO 0 48 CURV 833-137 $143.00

ACCESSORY KIT MEDTRONIC $629.00

SCREW LK TPNG 4.0MM 02.204.014 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.016 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.018 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.022 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.026 $356.00 C1713

SCREW LK TPNG 4.0MM 02.204.030 $414.00 C1713

SCREW LK TPNG 4.0MM 02.204.034 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.038 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.042 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.046 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.050 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.054 $356.00 C1713

SCREW LK TPNG 4.0MM 02.204.058 $384.00 C1713

PLATE LCP NRW 4.5MM 7H 224.571 $1,150.00 C1713

PLATE LCP BRD 4.5MM 6H 226.561 $911.00 C1713

PLATE LCP BRD 4.5MM 7H 226.571 $966.00 C1713

WIRE GUIDE 2.0MM 292.656 $122.00 C1769

BIT DRILL QC 4.5MM 310.44 $190.00

SUTR GORETEX CV-6 24 TT12 $28.00

TUBE EMG ENDOTRACH 8.0MM $606.00

SCREW LK TPNG 4.0MM 02.204.062 $384.00 C1713

PLATE LCP NRW 4.5MM 4H 224.541 $742.00 C1713

PLATE LCP NRW 4.5MM 5H 224.551 $796.00 C1713

PLATE LCP NRW 4.5MM 9H 224.591 $1,273.00 C1713

PLATE LCP NRW 4.5 11H 224.611 $1,385.00 C1713

PLATE LCP NRW 4.5 14H 224.641 $1,433.00 C1713

PLATE LCP BRD 4.5MM 9H 226.591 $1,193.00 C1713

SCREW CANN 7.3MM 208.840 $682.00 C1713

SCREW CANN 7.3MM 208.880 $631.00 C1713

SCREW CANN 7.3MM 208.890 $584.00 C1713

SCREW CANN 7.3MM 208.895 $631.00 C1713

SCREW CANN 7.3MM 209.845 $682.00 C1713

SCREW CANN 7.3MM 209.850 $682.00 C1713

SCREW LK SLF-TPNG 5.0 212.217 $390.00 C1713

PLATE LCP NRW 4.5 16H 224.661 $1,631.00 C1713

PLATE LCP BRD 4.5 16H 226.661 $1,965.00 C1713

SCREW LK SLF-TPNG 5.0 212.218 $362.00 C1713

SCREW LK SLF-TPNG 5.0 212.226 $390.00 C1713

BOLT TI LOCKING 3.9MM 458.22 $471.00 C1713

BOLT TI LOCKING 3.9MM 458.38 $550.00 C1713

BOLT TI LOCKING 3.9MM 458.54 $471.00 C1713

BOLT TI LOCKING 3.9MM 458.68 $550.00 C1713

BOLT TI LOCKING 3.9MM 458.70 $550.00 C1713

BOLT TI LOCKING 3.9MM 458.72 $550.00 C1713

BOLT TI LOCKING 3.9MM 458.74 $550.00 C1713

BOLT TI LOCKING 3.9MM 458.78 $550.00 C1713

MICRO-KOVER 20 X62 FOR OPMI 1 $27.00

SCREW CANN 6.5MM 208.405 $631.00 C1713

Page 204: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CANN 6.5MM 208.406 $631.00 C1713

SCREW CANN 6.5MM 208.407 $584.00 C1713

SCREW LK SLF-TPNG 5.0 212.220 $420.00 C1713

SUTURE VICRYL 3-0 27 FS-2 $28.00

SUTR VICRYL 2 54 TP-1 $28.00

SUTR VICRYL 1 27 CP-1 $28.00

SUTR VICRYL 1 36 CT $28.00

SUTURE VICRYL 1 8-18 CT-1 $28.00

SUTURE VICRYL 0 6-18 TIES $28.00

SUTR VICRYL 2-0 27 CT-2 $28.00

SUTR VICRYL 1 36 CT $28.00

SUTURE VICRYL 2-0 27 FS-1 $28.00

SUTR VICRYL 3-0 27 FS-1 $28.00

TUBE TRACH SINGLE CANNULA 6 $103.00

TUBE TRACH SINGLE CANNULA 8 $123.00

SUTR VICRYL 3-0 8-18 SH-1 $28.00

SUTR VICRYL 3-0 8-27 SH $28.00

SCREW CANN 7.3MM 208.900 $631.00 C1713

SCREW CANN 6.5MM 208.447 $584.00 C1713

SCREW CANN 7.3MM 209.855 $682.00 C1713

SCREW CANN 7.3MM 209.895 $572.00 C1713

SCREW CANN 7.3MM 209.900 $572.00 C1713

BIT DRILL 3FLUT 3.2 03.010.100 $604.00

BIT DRILL 3FLUT 4.2 03.010.101 $564.00

TUBE TRACH PVC UNCUFFED 8.0MM $142.00

TUBE TRACH PVC UNCUFFED 9.0MM $142.00

K-WIRE STNMN TROCR TIP 9 5/64 $46.00 C1713

NEEDLE SPINAL WHITACRE 25GX5 $22.00

BUTTON LIGAMENT HEWSON 19MM $201.00

SUTURE VICRYL 4-0 8-18 SH-1 $28.00

SUTURE VICRYL 5-0 18 PC-1 $28.00

SUTURE VICRYL 5-0 18 PS-3 $28.00

SUTURE VICRYL 6-0 18 P-3 $28.00

SUTURE SILK 0 18 FSL $28.00

SUTURE SILK 2-0 30 FSL $28.00

SUTURE SILK 2-0 30 SH $28.00

SUTURE SILK 4-0 30 RB-1 $28.00

SUTURE SILK 5-0 18 FS-2 $28.00

PLATE STRT TI 2.0MM 6H 447.031 $550.00 C1713

CLIP APPLIER ENDOSCOPIC 5MM $559.00

SCREW CANN CONNECT 03.010.044 $818.00 C1713

SCREW LK DL CR 5.0 04.015.580 $616.00 C1713

SCREW CANN 6.5MM 208.410 $584.00 C1713

GLOVE RADIATION SZ 7 X 1/2 $188.00

SCREW CANN 6.5MM 208.411 $631.00 C1713

SCREW CANN 7.3MM 208.905 $631.00 C1713

SCREW CANN 7.3MM 208.910 $572.00 C1713

SCREW CANN 7.3MM 208.915 $572.00 C1713

SCREW CANN 7.3MM 208.920 $572.00 C1713

SCREW CANN 7.3MM 209.905 $572.00 C1713

Page 205: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DRIVER HEX MDLR TIP 4MM 219219 $563.00

SCREW ADVANTAGE 9X30MM 23013 $500.00 C1713

SCREW BIG ADV 11X25MM 230825 $541.00 C1713

SCREW BIG ADV 11X30MM 230830 $541.00 C1713

SCREW BIG ADV 13X25MM 230925 $541.00 C1713

TRAY VERTEBROPLASTY AVAMAX $1,508.00 C1776

CEMENT BONE VRTBRPLSTY AVA-TEX $552.00 C1713

KIT CEMENT REMX INJTCR AVA-TEX $346.00

KIT NEEDLE INJCTR 13GA AVAMAX $282.00

SUTURE SILK 4-0 30 KS $28.00

SUTURE ETHILON 5-0 18 PS-3 $28.00

K-WIRE STNMN TROCR TIP 9 $46.00 C1713

K-WIRE STNMN TROCR TIP 9 $58.00 C1713

K-WIRE STNMN TROCR TIP 9 $58.00 C1713

KIT HOME MNTR SUPPLY 511 APNEA $65.00

NERVE BLOCK SET 18GA X 2 $104.00

SUTURE STEEL 4 4-18 V-40 $28.00

FILIFORM SPIRAL WOV 3FR 12.5 $110.00

FILIFORM SPIRAL WOV 4FR 12.5 $110.00

FILIFORM SPIRAL WOV 5FR 12.5 $187.00

FILIFORM STRT WOV 4FR 12.5 $187.00

FILIFORM STRT WOV 5FR 12.5 $110.00

FILIFORM STRT WOV 6FR 12.5 $110.00

FILIFORM COUDE WOV 3FR 12.5 $110.00

FILIFORM COUDE WOV 4FR 12.5 $110.00

FILIFORM COUDE WOV 5FR 12.5 $110.00

FILIFORM COUDE WOV 6FR 12.5 $110.00

FOLLOWER PHLP STRT WOV 10FR $166.00

FOLLOWER PHLP STRT WOV 12FR $166.00

FOLLOWER PHLP STRT WOV 14FR $166.00

FOLLOWER PHLP STRT WOV 16FR $166.00

FOLLOWER PHLP STRT WOV 18FR $166.00

FOLLOWER PHLP STRT WOV 20FR $166.00

FOLLOWER PHLP STRT WOV 22FR $166.00

FOLLOWER PHLP STRT WOV 24FR $166.00

SET VITAGEL SPRAY $286.00

FUSER PRNT KT HP8500 C4155A $154.00

CATH PEZZER 28FR $299.00

SCREW LK TPNG 4.0MM 02.204.020 $564.00 C1713

SCREW LK TPNG 4.0MM 02.204.024 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.028 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.032 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.036 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.040 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.044 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.048 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.052 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.056 $384.00 C1713

SCREW LK TPNG 4.0MM 02.204.060 $384.00 C1713

SCREW LK SLF-TPNG 5.0 212.201 $390.00 C1713

Page 206: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW LK SLF-TPNG 5.0 212.202 $390.00 C1713

SCREW LK SLF-TPNG 5.0 212.203 $390.00 C1713

SCREW LK SLF-TPNG 5.0 212.204 $420.00 C1713

SCREW LK SLF-TPNG 5.0 212.205 $390.00 C1713

SCREW LK SLF-TPNG 5.0 212.206 $381.00 C1713

SCREW LK SLF-TPNG 5.0 212.207 $381.00 C1713

SCREW LK SLF-TPNG 5.0 212.208 $381.00 C1713

SCREW LK SLF-TPNG 5.0 212.209 $420.00 C1713

SCREW LK SLF-TPNG 5.0 212.210 $420.00 C1713

SCREW LK SLF-TPNG 5.0 212.211 $420.00 C1713

SCREW LK SLF-TPNG 5.0 212.212 $420.00 C1713

SCREW LK SLF-TPNG 5.0 212.213 $420.00 C1713

SCREW LK SLF-TPNG 5.0 212.214 $440.00 C1713

SCREW LK SLF-TPNG 5.0 212.215 $390.00 C1713

SCREW LK SLF-TPNG 5.0 212.216 $420.00 C1713

SCREW LK SLF-TPNG 5.0 212.219 $390.00 C1713

SCREW LK SLF-TPNG 5.0 212.221 $420.00 C1713

SCREW LK SLF-TPNG 5.0 212.222 $390.00 C1713

SCREW LK SLF-TPNG 5.0 212.223 $390.00 C1713

SCREW LK SLF-TPNG 5.0 212.224 $420.00 C1713

SCREW LK SLF-TPNG 5.0 212.225 $390.00 C1713

SCREW LK SLF-TPNG 5.0 212.227 $381.00 C1713

PAD ARM LAMINECTOMY $45.00

SPLINT WRIST D-RING 8 L-XS $51.00

SPLINT WRIST D-RING 8 R-XS $51.00

SPLINT WRIST D-RING 8 L-SM $51.00

SPLINT WRIST D-RING 8 R-SM $49.00

SPLINT WRIST D-RING 8 L-MD $51.00

SPLINT WRIST D-RING 8 R-MD $51.00

SPLINT WRIST D-RING 8 L-LG $51.00

SPLINT WRIST D-RING 8 R-LG $51.00

SPLINT WRIST D-RING 8 L-XL $51.00

SPLINT WRIST D-RING 8 R-XL $51.00

SPLINT WRIST & THUMB L-XS $66.00

SPLINT WRIST & THUMB R-XS $66.00

SPLINT WRIST & THUMB L-SM $66.00

SPLINT WRIST & THUMB R-SM $66.00

SPLINT WRIST & THUMB L-MD $66.00

SPLINT WRIST & THUMB R-MD $66.00

SPLINT WRIST & THUMB L-LG $66.00

SPLINT WRIST & THUMB R-LG $66.00

SPLINT WRIST & THUMB L-XL $66.00

SPLINT WRIST & THUMB R-XL $66.00

SPLINT THUMB THERMO 6 L-XS $40.00

SPLINT THUMB THERMO 6 R-XS $40.00

SPLINT THUMB THERMO 6 L-SM $40.00

SPLINT THUMB THERMO 6 R-SM $40.00

SPLINT THUMB THERMO 6 L-MD $40.00

SPLINT THUMB THERMO 6 R-MD $40.00

SPLINT THUMB THERMO 6 L-LG $40.00

Page 207: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SPLINT THUMB THERMO 6 R-LG $40.00

SPLINT THUMB THERMO 6 L-XL $40.00

SPLINT THUMB THERMO 6 R-XL $40.00

SPLINT WRIST ELBOW UNIV SM $67.00

SPLINT WRIST ELBOW UNIV MD $67.00

SPLINT WRIST ELBOW UNIV LG $67.00

SPLINT WRIST ELBOW UNIV XL $67.00

SPLINT ELBOW RANGER MD $161.00

SPLINT ELBOW RANGER LG $224.00

DILATOR NEPHROMAX 30FR 210-118 $591.00

SPACER ARTELON CMC LG 21004 $4,337.00 C1713

SPACER ARTELON CMC-1 $3,719.00 C1713

CHIPS CANCELLOUS 15CC 1.7-10MM $635.00 C1713

CHIPS CANCELLOUS 30CC 1.7-10MM $1,039.00 C1713

CHIPS CANCELLOUS 15CC 3-6MM $661.00 C1713

CHIPS CANCELLOUS 30CC 3-6MM $1,074.00 C1713

SUTURE VICRYL 2-0 27 CP-2 $28.00

CATH PRUITT AORTIC OCCLUSION $563.00

PLATE LCP BRD 4.5 12H 226.622 $1,684.00 C1713

PLATE LCP BRD 4.5 13H 226.632 $1,643.00 C1713

PLATE LCP BRD 4.5 14H 226.642 $569.00 C1713

PLATE LCP BRD 4.5 15H 226.652 $1,917.00 C1713

PLATE LCP BRD 4.5 16H 226.662 $1,969.00 C1713

PLATE LCP BRD 4.5 17H 226.672 $2,250.00 C1713

PLATE LCP BRD 4.5 18H 226.682 $2,262.00 C1713

SCREW LOCKING 5MM 02.221.508 $619.00 C1713

SCREW LOCKING 5MM 02.221.510 $619.00 C1713

SCREW LOCKING 5MM 02.221.512 $619.00 C1713

CABLE / CRMP 1.7MM 298.801.01S $1,204.00 C1713

CABLE / COCR 1.7MM 611.105.01S $1,204.00

PIN CERCLAGE POS 298.803S $495.00 C1713

TROCHANTERIC REATTACH 498.806S $4,158.00

CARBO JET $465.00

POUCH LOOP OSTOMY 2.75 $61.00

KIT PORT LAP BAND ACCESS 9.75 $1,416.00

KIT TUBING LAP BAND REPAIR $393.00

MARKER COR MARK BREAST BIOPSY $268.00

NAIL CANN TIB 11MM 04.004.531S $3,266.00 C1713

NAIL CANN TIB 11MM 04.004.534S $3,266.00 C1713

NAIL CANN TIB 11MM $3,266.00 C1713

NAIL CANN TIB 11MM 04.004.540S $3,266.00 C1713

NAIL CANN TIB 11MM 04.004.543S $3,266.00 C1713

NAIL CANN TIB 11MM 04.004.546S $3,120.00 C1713

NAIL CANN TIB 11MM 04.004.549S $3,266.00 C1713

NAIL CANN TIB 11MM 04.004.552S $3,120.00 C1713

NAIL CANN TIB 11MM 04.004.555S $3,266.00 C1713

NAIL CANN TIB 11MM 04.004.558S $3,266.00 C1713

DRESSING VERSAFOAM VAC LARGE $51.00

TISSUE MEND SKIN SUB $5,853.00 Q4100

DISC EPI TEMPANOPLASTY $409.00

Page 208: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PLATE LCP-TM DST 2.4MM 442.503 $1,057.00 C1713

PLATE LCP-TM DST 2.4MM 442.504 $1,005.00 C1713

PLATE LCP-TM DST 2.4MM 442.505 $1,057.00 C1713

PLATE LCP-TM DST 2.4MM 442.506 $1,005.00 C1713

PLATE LCP VOLAR DST 442.459TM $1,796.00 C1713

PLATE LCP VOLAR DST 442.462TM $1,796.00 C1713

PLATE LCP VOLAR DST 442.465TM $1,796.00 C1713

PLATE LCP VOLAR DST 442.468TM $1,796.00 C1713

SCREW BIO-TENODESIS AR-1547B $731.00 C1713

SCREW BIO-TENODESIS AR-1555B $680.00 C1713

SCREW BIO-TENODESIS AR-1562B $731.00 C1713

SCREW BIO-TENODESIS AR-1670B $731.00 C1713

SCREW BIO-TENODESIS AR-1570B $731.00 C1713

SCREW BIO-TENODESIS AR-1680B $731.00 C1713

SCREW BIO-TENODESIS AR-1580B $731.00 C1713

SCREW BIO-TENODESIS AR-1590B $731.00 C1713

KIT DIS BIO-TENODESIS AR1676DS $550.00 C1713

STENT CORONARY VISION 2.25X12 $2,090.00 C1874

STENT CORONARY VISION 2.25X28 $3,410.00 C1874

STENT CORONARY VISION 2.25X15 $2,090.00 C1874

STENT CORONARY VISION 2.5X12 $2,501.00 C1874

STENT CORONARY VISION 2.5X15 $3,410.00 C1874

STENT CORONARY VISION 2.5X28 $3,410.00 C1874

STENT CORONARY VISION 3.5X12 $3,410.00 C1874

STENT CORONARY VISION 4X12 $3,410.00 C1874

STENT CORONARY VISION 3X12 $3,410.00 C1874

PLATE LCP VOLAR DST 442.461TM $1,693.00 C1713

PLATE LCP VOLAR DST 442.464TM $1,892.00 C1713

PLATE LCP VOLAR DST 442.458TM $1,892.00 C1713

SCREW CANN 6.5MM 208.408 $584.00 C1713

SCREW CANN 6.5MM 208.412 $631.00 C1713

CANISTER SUC RGD HOLDER 3000CC $53.00

SUTURE CATGUT 1/2 CIRC/TAPR 3D $28.00

NAIL SLD HUMERAL 7.5MM 462.725 $3,777.00 C1713

PLATE LCP VOLAR DST 442.467TM $1,693.00 C1713

SCREW CANN 6.5MM 208.414 $572.00 C1713

SCREW CANN 6.5MM 208.415 $587.00 C1713

SCREW CANN 6.5MM 208.417 $572.00 C1713

SCREW CANN 6.5MM 208.418 $572.00 C1713

SCREW CANN 6.5MM 208.419 $572.00 C1713

SCREW CANN 6.5MM 208.420 $572.00 C1713

SCREW CANN 6.5MM 208.434 $572.00 C1713

SCREW CANN 6.5MM 208.437 $584.00 C1713

SCREW CANN 6.5MM 208.438 $572.00 C1713

K WIRE INSERT 1.25MM 324.084 $491.00 C1713

SCREW CANN 7.3MM 208.845 $572.00 C1713

SCREW CANN 7.3MM 208.855 $572.00 C1713

SCREW CANN 7.3MM 208.860 $572.00 C1713

SCREW CANN 7.3MM 208.885 $631.00 C1713

SCREW CANN 7.3MM 209.910 $631.00 C1713

Page 209: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CANN 7.3MM 209.915 $572.00 C1713

SCREW CANN 7.3MM 209.920 $631.00 C1713

SEAM GUARD CIRCULAR 1BSGC25 $731.00

ELECTRODE VAPOR S50 $809.00

BAND LAP APS SMALL $6,901.00

BAND LAP APL LARGE $6,901.00

REGULATOR C02 PEDICAP $39.00

BOOT PODUS HEEL PROTECT UNIV $83.00

BOOT LINER PODUS DISPOSABLE $42.00

PARAFILM 4IN X 125FT $55.00

NEEDLE INJCTR STRYKER 13GA $29.00

ELECTRODE SQUARE LOOP 5X5 $55.00

MOP DUST TRPR LOOPED END 48X5 $122.00

SPLINT PREFORMED POSITION SM $97.00

SPLINT PREFORMED POSITION MD $97.00

SENSOR FORHEAD ADH MAX FAST $81.00

PLATE TIBIA PROX 4.5MM 240.036 $2,835.00 C1713

PLATE TIBIA PROX 4.5MM 240.037 $3,011.00 C1713

PLATE TIBIA PROX 4.5MM 240.038 $3,045.00 C1713

PLATE TIBIA PROX 4.5MM 240.039 $3,237.00 C1713

BIT DRILL 4.3MM 310.431 $374.00

ROD REAMING BAL 2.5MM 351.707S $350.00 C1776

TUBE TRACH UNCUFFED XLT 8.0 $349.00

CAP END TI 5MM 04.004.001 $530.00 C1713

PLATE STRAIGHT 2.4MM 449.906 $594.00 C1713

SCREW CORTEX 1.5MM 400.808.96 $171.00 C1713

BIT DRILL QC 2.0MM 310.21 $213.00

SCREW CORTEX 2.4MM 401.508.96 $251.00 C1713

SCREW CORTEX 2.4MM 401.509.96 $246.00 C1713

SCREW CORTEX 2.4MM 401.511.96 $252.00 C1713

DRILL BIT J-LTCH 1.1MM 310.113 $180.00

DRILL BIT CPLNG 1.5MM 310.141 $212.00

DRILL BIT J-LTCH 1.5MM 310.143 $212.00

DRILL BIT CPLNG 2.4MM 317.871 $207.00

PLATE Y-PLATE TI 1.5MM 446.612 $522.00 C1713

GRAFT GORTEX RINGED 6X80 $2,817.00 C1768

REAMER RIA TUBE 520MM 314.746S $1,054.00

REAMER HEAD RIA 12MM 352.250S $702.00

REAMER HEAD RIA 12.5 352.251S $825.00

REAMER HEAD RIA 13MM 352.252S $825.00

REAMER HEAD RIA 13.5 352.253S $825.00

REAMER HEAD RIA 14MM 352.254S $825.00

REAMER HEAD RIA 14.5 352.255S $702.00

REAMER HEAD RIA 15MM 352.256S $825.00

REAMER HEAD RIA 15.5 352.257S $825.00

REAMER HEAD RIA 16MM 352.258S $825.00

REAMER HEAD RIA 16.5 352.259S $825.00

TROCAR ENDO BLADE 12MM X 100M $106.00

SEAL DRIVE SHAFT RIA 351.718S $80.00

BIT DRILL 3FLUT 4.2 03.010.061 $569.00

Page 210: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BIT DRILL 3FLUT 3.2 03.010.060 $569.00

SCREW TI LOK 5.0MM 04.005.518 $586.00 C1713

SCREW TI LOK 5.0MM 04.005.520 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.522 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.526 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.530 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.532 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.534 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.536 $586.00 C1713

SCREW TI LOK 5.0MM 04.005.538 $586.00 C1713

DRESSING VAC KIT SILVER SM $184.00

DRESSING VAC KIT SILVER MD $188.00

DRESSING VAC KIT SILVER LG $228.00

SLING SYST PREFYX PPS $2,586.00 C1771

DEVICE SUTURE CAPTURE OPEN $767.00

SUTURE ETHIBOND 1 30 OS-4 $28.00

TUBE TRACH DBL CUF 10.0MM $140.00

FILIFORM SPIRAL WOV 6FR 12.5 $110.00

TUBE JEJUNOSTOMY FEEDING 7FR $121.00

TENDON ANTERIOR TIBIALIS $3,410.00 C1762

WIRE TI KIRSCHNER 1.25 492.12 $41.00 C1713

PLATE CONDYLAR 1.5MM 446.64.96 $705.00 C1713

DRILL BIT CANN 17MM 357.394 $1,625.00

DRILL BIT CANN TP 11MM 357.404 $1,239.00

OPTIRAY 320 20X100ML $95.00 Q9967

SLING SYST OBTRYX CURVED $2,429.00 C1771

VALVULOTOME EXPANDABLE LEG $4,388.00

BIT DRILL GAMMA 4.2X300MM $562.00

TROCAR ENDO BLDLSS 8MM X 100 $113.00

CLIP FILSHIE $215.00

GUIDE DRILL THRD 1.8MM 323.035 $332.00

SCREW TI LOK 5.0MM 04.005.524 $586.00 C1713

PLATE LCP NRW 4.5MM 8H 224.581 $1,101.00 C1713

BLADE KIT OXFORD KNEE $312.00

BIT DRILL QC 2.0MM 310.201 $207.00

PLATE TI STRT 12H 1.5 446.032 $569.00 C1713

SCREW CORTEX 1.5MM 400.809.96 $190.00 C1713

STENTS POLARIS DUAL 5X30 DURO $192.00 C1874

STENTS POLARIS DUAL 6X30 DURO $192.00 C1874

STENTS POLARIS DUAL 7X30 DURO $192.00 C1874

STENTS POLARIS DUAL 8X30 DURO $448.00 C1874

STENT DES ENDEAVOR OTW 2.5X8 $4,790.00 C1874

STENT DES ENDEAVOR OTW 2.5X12 $4,790.00 C1874

STENT DES ENDEAVOR OTW 2.5X14 $4,790.00 C1874

STENT DES ENDEAVOR OTW 2.5X18 $4,790.00 C1874

STENT DES ENDEAVOR OTW 2.5X24 $4,045.00 C1874

STENT DES ENDEAVOR OTW 2.5X30 $4,790.00 C1874

STENT DES ENDEAVOR OTW 3.0X9 $4,790.00 C1874

STENT DES ENDEAVOR OTW 3.0X12 $4,790.00 C1874

STENT DES ENDEAVOR OTW 3.0X15 $4,790.00 C1874

Page 211: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STENT DES ENDEAVOR OTW 3.0X18 $4,790.00 C1874

STENT DES ENDEAVOR OTW 3.0X24 $4,045.00 C1874

STENT DES ENDEAVOR OTW 3.0X30 $4,045.00 C1874

STENT DES ENDEAVOR OTW 3.5X9 $4,790.00 C1874

STENT DES ENDEAVOR OTW 3.5X12 $4,790.00 C1874

STENT DES ENDEAVOR OTW 3.5X15 $4,790.00 C1874

STENT DES ENDEAVOR OTW 3.5X18 $4,790.00 C1874

STENT DES ENDEAVOR OTW 3.5X24 $4,790.00 C1874

STENT DES ENDEAVOR OTW 3.5X30 $4,045.00 C1874

STENTS POLARIS DUAL 5X14 DURO $184.00 C1874

STENTS POLARIS DUAL 5X18 DURO $184.00 C1874

BLADE SINUS STRT SERRATED 4.8 $532.00

BLADE SINUS STRT SERRATED 4.0 $350.00

BLADE SINUS CURV 15 DEG 4.0 $356.00

BLADE SINUS SERR CONVEX 4.0 $356.00

HANDPIECE IRRIG SUCTION TUBING $66.00

CORD DIEGO REPOSABLE $555.00

CAP END TI 10MM 04.004.002 $616.00 C1713

SCREW LK DL CR 5.0 04.015.550 $616.00 C1713

SCREW TI LOK 5.0MM 04.005.540 $586.00 C1713

SCREW TI LOK 5.0MM 04.005.542 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.544 $586.00 C1713

SCREW TI LOK 5.0MM 04.005.546 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.548 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.550 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.552 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.554 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.558 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.560 $552.00 C1713

BLOCK TIBIAL AUG MAXIM MODULAR $2,175.00 C1713

STEM EXT KNEE FEMORAL 16X80MM $2,915.00 C1713

MESH VENTRALEX LARGE CIRCLE $1,331.00 C1781

FILTER SYSTEM REDI FLOW FINE $166.00

BASKET ESCAPE STONE RETRIEVAL $638.00

STONE CONE RETRIEVAL COIL 3FR $559.00

BIT DRILL QC 1.1MM (310.111) $180.00

SCREW CORTEX TI 2.0MM 401.814 $171.00 C1713

NAIL ELASTIC TI 2.OMM 475.920 $606.00 C1713

BIT DRILL QC FLUT 3.2MM 315.29 $393.00

BIT DRILL QC FLUT 4.5MM 315.48 $393.00

TRITIS BIO 8X30 $1,155.00 C1713

TRITIS BIO 9X30 $1,630.00 C1713

TRITIS BIO 10X30 $1,844.00 C1713

TRITIS BIO 11X30 $1,155.00 C1713

TRITIS BIO 12X30 $1,155.00 C1713

REAMER BARREL 8MM $949.00

REAMER BARREL 9MM $949.00

REAMER BARREL 10MM $949.00

STYLUS INSERTER 30MM $252.00

STYLUS INSERTER 38MM $252.00

Page 212: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

KIT ACL STRAT PACK $962.00

STRATIS BIO 8X25 $2,575.00 C1713

STRATIS BIO 9X25 $1,155.00 C1713

STRATIS BIO 10X25 $1,155.00 C1713

DRILL TRANSVERSE $680.00

REAMER ACORN 8MM $949.00

REAMER ACORN 9MM $949.00

REAMER ACORN 10MM $949.00

WIRE GUIDE DRILL TIPPED $299.00 C1769

WIRE GUIDE NITINOL $299.00 C1769

SUTURE DEXON VICRYL 0 27" CT-1 $28.00

SUTURE PROLENE O MO-6 8418H $27.00

SUTURE PDS PLUS 0 27" CT-2 $28.00

SUTURE PROLENE 30" 8690H $27.00

SUTURE CHROMIC 6-0 18IN PS-6 $28.00

BIT DRILL CANN 7.3MM 310.495 $1,047.00

SCREW CTX 3.5MM 204.855 $85.00 C1713

VERSALOK ANCHOR W/ORTHOCORD $911.00 C1713

FIBERWIRE #2 10 LOOPS 7MM $173.00 C1713

EXPRESSEW II SUTURE NEEDLE $108.00

5.5 HEALIX BR ANCHOR $735.00 C1713

LOCK BIO-PUSHLOCK 3MM $873.00 C1713

KIT DISPOSABLE PUSHLOCK 3.5MM $550.00 C1713

LASSO SUTURELASSO SD 30DEG STR $440.00 C1713

LASSO SUTURELASSO SD 25 TC LFT $560.00 C1713

LASSO SUTURELASSO SD 25 TC RGT $560.00 C1713

FIBERWIRE #2 50" ONE END STIF $177.00 C1713

TIGERWIRE #2 50" ONE END STIF $186.00 C1769

LARGE NEEDLE DRIVER DaVinci $565.00

Cadiere Forceps DaVinci $544.00

ProGrasp Forcep $565.00

DAVINCI ENDOWRIST FRCP MARYLND $694.00

Hot Shears DaVinci supply $821.00

Mega Needle Driver DaVinci $694.00

Fenestrated BiPolar Forceps $694.00

DAVINCI ENDOWRIST FRCP TENACLM $565.00

Suture Cut Needle DR DaVinci $616.00

Hem-o-lok Clip Applier $55.00

DAVINCI ENDOWRIST RETRACTOR DB $816.00

8MM BLADELESS OBTURATOR $96.00

CAMERA ARM DRAPE $114.00

SCREW CORTEX 1.5MM 400.816.96 $190.00 C1713

SCREW CORTEX 1.5MM 400.820.96 $171.00 C1713

PLATE TI T-PLATE 1.5 446.233 $522.00 C1713

HOUSE IV ULTRADRESSING PEDI SM $25.00

HOUSE IV ULTRADRESSING PEDI MD $25.00

HOUSE IV ULTRADRESSING PEDI LG $25.00

HOUSE IV ULTRADRESSING PED ARM $29.00

CAP END TI 15MM 04.004.003 $616.00 C1713

SCREW TI LOK 4.0MM 04.005.416 $516.00 C1713

Page 213: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW TI LOK 4.0MM 04.005.418 $549.00 C1713

SCREW TI LOK 4.0MM 04.005.420 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.422 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.424 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.426 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.428 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.430 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.432 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.434 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.436 $549.00 C1713

SCREW TI LOK 4.0MM 04.005.438 $549.00 C1713

SCREW TI LOK 4.0MM 04.005.440 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.442 $549.00 C1713

SCREW TI LOK 4.0MM 04.005.444 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.446 $549.00 C1713

SCREW TI LOK 4.0MM 04.005.448 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.450 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.452 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.454 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.456 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.458 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.460 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.462 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.464 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.466 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.468 $516.00 C1713

SCREW TI LOK 4.0MM 04.005.470 $516.00 C1713

SCREW TI LOK 5.0MM 04.005.516 $586.00 C1713

SCREW TI LOK 5.0MM 04.005.528 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.556 $586.00 C1713

SCREW TI LOK 5.0MM 04.005.562 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.564 $586.00 C1713

SCREW TI LOK 5.0MM 04.005.566 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.568 $552.00 C1713

SCREW TI LOK 5.0MM 04.005.570 $586.00 C1713

SCREW LK DL CR 5.0 04.015.520 $586.00 C1713

SCREW LK DL CR 5.0 04.015.525 $616.00 C1713

SCREW LK DL CR 5.0 04.015.530 $586.00 C1713

SCREW LK DL CR 5.0 04.015.535 $616.00 C1713

SCREW LK DL CR 5.0 04.015.540 $616.00 C1713

SCREW LK DL CR 5.0 04.015.545 $616.00 C1713

SCREW LK DL CR 5.0 04.015.555 $616.00 C1713

SCREW LK DL CR 5.0 04.015.560 $616.00 C1713

SCREW LK DL CR 5.0 04.015.565 $616.00 C1713

SCREW LK DL CR 5.0 04.015.570 $616.00 C1713

SCREW LK DL CR 5.0 04.015.575 $616.00 C1713

PLATE LCP 3.5MM 7H 223.571 $847.00 C1713

PLATE T LCP 16H 3.5MM 241.017 $2,893.00 C1713

PLATE LCP-TM DST 2.4MM 442.507 $1,182.00 C1713

PLATE LCP-TM DST 2.4MM 442.511 $1,059.00 C1713

Page 214: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW SHAFT 3.5MM 204.240 $85.00 C1713

SCREW CTX 3.5MM 204.860 $93.00 C1713

BLADE PRECISION CARTRIDGE SYS6 $553.00

RELOAD STPL GIA ROTC BL 30-3.5 $430.00

RELOAD STPL GIA ROTC WH 30-2.5 $430.00

RELOAD STPL GIA ROTC WH 45-2.5 $492.00

RELOAD STPL GIA ROTC GN 45-4.8 $516.00

RELOAD GIA 60S 030412 WHITE $415.00

RELOAD STPL GIA STRT BL 60-3.5 $415.00

RELOAD STPL GIA STRT GN 60-4.8 $415.00

RELOAD STPL GIA ROTC WH 60-2.5 $564.00

RELOAD STPL GIA ROTC BL 60-3.5 $549.00

RELOAD STPL GIA ROTC GN 60-4.8 $1,047.00

Hem-o-lok Clips $154.00

RELOAD STPL GIA ROTC BL 45-3.5 $478.00

STAPLER / CUTTER GIA100-4.8 $566.00

RELOAD STPL / CUTR GIA100-4.8 $343.00

STAPLER / CUTTER GIA60-4.8 $289.00

CLIP APPLIER LARGE 13" $165.00

SCREW TI CONICAL 3.5MM 412.428 $384.00 C1713

PK Dissecting Forcep $630.00

PK BiPolar Cord $693.00

PLUG MESS ULTRAPRO SM $486.00 C1781

PLUG MESS ULTRAPRO MD $491.00 C1781

PLUG MESS ULTRAPRO LG $496.00 C1781

SCREW CORTEX 1.5MM 400.806.96 $171.00 C1713

PLATE LCP DISTAL 3.5MM 238.707 $3,413.00 C1713

PUTTY DBX BONE 2.5CC $1,170.00 C1713

BALLOON DIL PERIPH 6.5FR 14X40 $898.00 C1727

BALLOON DIL PERIPH 6.5FR 16X40 $975.00 C1727

BALLOON DIL PERIPH 7FR 18X40 $975.00 C1727

BALLOON DIL PERIPH 7FR 20X40 $1,052.00 C1727

BALLOON DIL PERIPH 10FR 22X40 $1,219.00 C1727

BALLOON DIL PERIPH 10FR 24X40 $1,359.00 C1727

BALLOON DIL PERIPH 12FR 26X40 $1,359.00 C1727

STENT BILIARY BALLOON 4X10MM $3,276.00 C1874

DAVINCI WIRE LUNDERQUIST 260CM $293.00

DAVINCI BALLOON CODA 10FR $246.00

VCare Standard DaVinci supply $249.00

VCare Large DaVinci supply $249.00

PLATE TI LC-DCP 2.0MM 449.936 $702.00 C1713

SCREW CORTEX 2.0MM 401.810 $187.00 C1713

SCREW CORTEX 2.0MM 401.808 $187.00 C1713

SCREW CORTEX 2.0MM 401.812 $187.00 C1713

DRESSING OASIS 7X20CM MESHED $5,730.00

STAPLER SKIN PREM WIDE 35W $265.00

STAPLER GIA UNIVERSAL 12MM $670.00

STAPLER ROTICULATOR 55 4.8 GRN $598.00

DAVINCI TIP BLUE UTERINE MANIP $164.00

PACK VERTEBROPLASTY OR CUST $156.00

Page 215: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PACK DISCECTOMY OR CUST $148.00

DAVINCI ELECTROLUBE ANTI-STICK $89.00

NEUROGEN 2MMX3CM INTEGRA $4,352.00 C9352

NEUROGRN 3MMX3CM INTEGRA $2,897.00 C9352

NEUROGEN 4MMX3CM INTEGRA $2,897.00 C9352

NEUROGEN 5MMX3CM INTEGRA $2,897.00 C9352

NEUROGEN 6MMX3CM INTEGRA $2,897.00 C9352

NEURAWRAP 3MMX4CM INTEGRA $3,119.00 C9353

NEURAWRAP 5MMX4CM INTEGRA $3,119.00 C9353

NEURAWRAP 7MMX4CM INTEGRA $3,119.00 C9353

NEURAWRAP 10MMX4CM INTEGRA $3,119.00 C9353

PROBE NEO PURELIGHT $58.00

SEAMGUARD GRN 45 $475.00 C1784

SEAMGUARD GRN 60 $513.00 C1781

STRIP STAPLE LINE BLUE 45 3.5 $475.00

STRIPE STAPLE LINE BLUE 60 2.5 $513.00

STAPLER EEA 21MM X 3.5MM $977.00

HANDPIECE LORAD PETITE 9GX12CM $642.00

HANDPIECE LORAD STNDRD 9GX12CM $642.00

GUIDE NEEDLE LORAD 9G $42.00

ADAPTER FILTER TISSUE LORAD $58.00

IDENTIFIER TRIMARK 9G $236.00

EXPLOR 18X28 IMPLANT HEAD $236.00 C1713

TRAY BREAST BIOPSY $75.00

KIT STAGE DRAPING $43.00

KIT MULTICARE DRAPING $75.00

ATTACHMENT SMOKE EVAC BOVIE $41.00

DISTAL BICEPS REP IMPLANT SYST $2,023.00 C1713

STAPLER EEA ORVIL 21MM $605.00

SUTURE MONOCRYL 3-0 PS-2 27" $28.00

SUTURE VICRYL 7-0 BV-1 $113.00

SUTURE MONOCRYL 2/0 YB257 $28.00

CABLE GRIP SYSTEM - SMALL $3,748.00

CABLE GRIP SYSTEM-LARGE $3,748.00

Lapra-ty Clips DaVinci $446.00

SUTURE MONOCRYL 3-0 27" R-1 $28.00

SPONGE ENDO PEANUT $106.00

GUIDE NEEDLE LORAD 20-22G $46.00

POST OP SHOE FEMALE LG $36.00 A9270

IMMOBILIZER KNEE 16" X-LGE $80.00 L1830

IMMOBILIZER KNEE 16" LGE $80.00 L1830

IMMOBILIZER KNEE 16" MED $80.00 L1830

IMMOBILIZER KNEE 16" S 7002-01 $80.00 L1830

IMMOBILIZER KNEE 20" SM $91.00 L1830

IMMOBILIZER KNEE 20" MED $91.00 L1830

IMMOBILIZER KNEE 20" LGE $91.00 L1830

SPLINT WRIST/FOREARM LT MED 10 $28.00

SPLINT WRIST/FOREARM LT SM 10" $28.00

SPLINT WRIST/FOREARM LT LGE 10 $28.00

SPLINT WRIST/FOREARM RT SM 10" $28.00

Page 216: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SPLINT WRIST/FOREARM RT MED 10 $28.00

SPLINT WRIST/FOREARM RT LGE 10 $28.00

COLLAR C STIFF NECK $54.00 L0120

COLLAR STIFF NECK C PEDI $54.00 L0120

SUTURE 4-0 VICRYL RA VR494 $28.00

5-0 VICRYL RAPIDE $28.00

SUTURE 4-0 ETH P-3 699H $28.00

SUTURE 5-0 ETHILON P-1 695G $28.00

SUTURE 3-0 SILK 8665G $28.00

SUTURE 4-0 NYLON FS-1 ET1629H $28.00

SUTURE 4-0 PROLENE 8699G $28.00

SUTURE 3-0 VICRYL J327H $28.00

SUTURE 6-0 ETHILON 697G $28.00

MAXORB DRESSING $34.00

TRAY LACERATION $49.00

NORMAL SALINE 250CC $119.00

DOUBLE UNDERWATER DRAINAGE $312.00

DERMABOND DHV-12 $90.00

ANTERIOR DEVICE 4.5CM $97.00

ANTERIOR DEVICE 5.5 CM $102.00

POSTERIOR/ANTERIOR DEVICE $107.00

NON-INFLATABLE DEVICE $92.00

ELASTIC NET SIZE 1 $39.00

ELASTIC NET SIZE 2 $39.00

CATH THORACIC 10 FR $99.00

CATH THORACIC 16 FR $99.00

TUBE 28FR RT ANGLE CHEST $53.00

TUBE 36FR RT ANGLE CHEST $23.00

TUBE 40FR RT ANGLE CHEST $56.00

TWIN CATH 20/22 $37.00

BRACE ANKLE PNEUMATIC LT $64.00 L4350

BRACE ANKLE PNEUMATIC RT $64.00 L4350

NASAL POST PACK $167.00

CATHETER EPISTAT NASAL $160.00

SPLINT UNIVERSAL RT $45.00

SPLINT UNIVERSAL LEFT $45.00

EXUDERM 4 X 4 $27.00

EXUDERM 6 X6 $42.00

SILVASORB 4 X 8" $77.00

SILVERSORB 4 X 4 $39.00

EXUDERM SACRAL $46.00

EMERGENCY CRICOTHYROTOMY CATH $524.00

TUBE ENDO UNCUFFED 6 $184.00

TUBE ENDO UNCUFFED 7 $184.00

CO-FLEX AFD 4" $24.00

NEEDLE INTRAOSSEOUS 15G $337.00

SUTURE 3-0 VICRYL J442H $28.00

SUTURE 3-0 VICRYL J774D $28.00

BAGS NS 3000CC $28.00

KNIFE LIGHT $308.00

Page 217: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SUTURE 3-0 VICRYL J606H $28.00

SUTURE 0 VICRYL J340H $28.00

SUTURE 4-0 VICRYL VR845 $28.00

SUTURE 1 VICRYL J468H $28.00

SUTURE 2-0 VICRYL J339H $28.00

SUTURE 4-0 VICRYL J392H $28.00

LAVAGE $184.00

ARTHROSCOPIC IRRIGATION SET $27.00

IOBAN 2 M6619 $93.00

PLATE DVRAN-L $1,897.00 C1713

PLATE DVRAN-R $1,897.00 C1713

PLATE DVRA-L $1,999.00 C1713

PLATE DVRA-R $1,897.00 C1713

PLATE DVRAS-L $1,999.00 C1713

PLATE DVRAS-R $1,897.00 C1713

PLATE DVRAX-L $1,897.00 C1713

PLATE DVRAX-R $1,897.00 C1713

PLATE-DNP ANATOMIC LEFT $1,999.00 C1713

PLATE DNPA-R $1,904.00 C1713

WIRES-K KW062SS $77.00 C1713

DRILL BITS DB3.3 $346.00

BIT DRILL FDB2.0 $315.00

BIT DRILL DB2.5 $315.00

PLATE DVRAW-R $1,897.00 C1713

PLATE DVRAW-L $1,897.00 C1713

PEG 14MM FP14 $1,733.00

PEG 16MM FP16 $252.00 C1713

PEG 18MM FP18 $252.00 C1713

PEG 20MM FP20 $252.00 C1713

PEG 22MM FP22 $252.00 C1713

PEG FULLY THRD 26MM FP26 $252.00 C1713

PEG NON-LOCKING 12MM SP12000 $283.00 C1713

PEG NON LOCKING 14MM SP14000 $283.00 C1713

PEG NON LOCKING 16MM SP16000 $252.00 C1713

PEG NON LOCKING 18MM SP18000 $283.00 C1713

PEG NON LOCKING 20MM SP20000 $283.00 C1713

PEG NON LOCKING 22MM SP22000 $252.00 C1713

PEG NON LOCKING 24MM SP24000 $283.00 C1713

PEG NON LOCKING 26MM SP26000 $283.00 C1713

PEG NON LOCKING 28MM SP28000 $252.00 C1713

PEG SCREW 30MM SP30000 $252.00 C1713

SCREW CORTICAL 10MM Cq20000 $283.00 C1713

SCREW CORTICAL 12 MM $283.00 C1713

SCREW CORTICAL Cq24000 $283.00 C1713

SCREW CORTICAL 16MM Cq26000 $283.00 C1713

SCREW CORTICAL 18MM Cq28000 $252.00 C1713

SCREW CORTICAL 20MM CS20000 $283.00 C1713

SCREW UNICORTICAL DNP ANATOMIC $346.00 C1713

PEGS THREADED 10MM TP10000 $252.00 C1713

PEGS THREADED 12MM TP12000 $252.00 C1713

Page 218: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PEG THREADED 14MM TP14000 $252.00 C1713

PEG THREADED 16MM TP16000 $252.00 C1713

PEG THREADED 18MM TP18000 $252.00 C1713

PEG THREADED 20MM TP20000 $252.00 C1713

PEG THREADED 22MM TP22000 $283.00 C1713

PEG THREADED 24MM TP24000 $252.00 C1713

PEG THREADED 26MM TP26000 $252.00 C1713

PEG THREADED 28MM TP28000 $252.00 C1713

PEG THREADED 30MM TP30000 $283.00 C1713

PEG LOCKING 10MM P10000 $252.00 C1713

PEG LOCKING 12MM P12000 $252.00 C1713

PEG LOCKING 14MM P14000 $252.00 C1713

PEG LOCKING 16MM P16000 $283.00 C1713

PEG LOCKING 18MM P18000 $283.00 C1713

PEG LOCKING 20MM P20000 $283.00 C1713

PEG LOCKING 22MM P22000 $283.00 C1713

PEG LOCKING 24MM P24000 $283.00 C1713

PEG LOCKING 26MM P26000 $283.00 C1713

PEG LOCKING 28MM P28000 $283.00 C1713

PEG LOCKING 30MM P30000 $283.00 C1713

PEG MULTI DIR 28MM 1312-11-128 $465.00 C1713

PLATE MINI FRAG 242.340 $169.00 C1713

PLATE MINI FRAG 243.140 $187.00 C1713

PLATE-T MINI FRAG 243.150 $200.00 C1713

PLATE 3 HOLE 243.130 $169.00 C1713

PLATE 242.030 $200.00 C1713

BIT DRILL 310.200 $184.00

SCREW CANC. 6.5 30MM 216.030 $143.00 C1713

PLATE 12 HOLE LC-DCP 224.620 $521.00 C1713

PLATE 7-Hole LC-DCP 224.570 $485.00 C1713

WASHERS 219.99 $92.00 C1713

COUPLING MODULAR HAND 316.396 $163.00

COUPLING MODULAR HAND 316.402 $163.00

COUNTERSINK 310.971 $426.00

SCREWDRIVER SHAFT 314.467 $707.00 C1713

BENDING PIN 329.922 $399.00 C1713

PLATE 3.5MM 241.951 $844.00 C1713

PLATE 3.5MM 241.971 $919.00 C1713

PLATE 6 HOLE 241.919 $3,445.00 C1713

PLATE 3.5MM 241.331 $452.00 C1713

PLATE 3.5MM 241.341 $482.00 C1713

BIT DRILL 311.340 $355.00

BIT DRILL MODULAR HAND 316.286 $446.00

BIT DRILL MODULAR HAND 316.288 $446.00

BIT DRILL 316.294 $446.00

BIT DRILL MODULAR HAND 316.290 $446.00

BIT DRILL 316.292 $446.00

BIT DRILL 316.294 $446.00

CLAMPS 393.750 $1,656.00

NUT SPRING LOADED 393.43 $161.00 C1713

Page 219: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

WIRE GUIDE 1.25 292.600 $171.00 C1769

ROD STEEL 393.540 $529.00 C1713

ROD STEEL 393.550 $529.00 C1713

ROD STEEL 393.560 $529.00 C1713

PINS STEIMEN 293.440 $228.00 C1713

PINS STEIMAN 293.500 $228.00 C1713

SCREW 294.640 $494.00 C1713

COUNTERSINK 310.860 $905.00

TAP 311.630 $1,131.00

WIRE-K 2.0 492.200 $184.00 C1713

BIT DRILL 310.320 $184.00

PLATE-T 240.140 $676.00 C1713

BIT DRILL 310.450 $184.00

TAP 1.5 311.150 $265.00

TAP 2.7 311.260 $314.00

TAP 4.5 311.460 $352.00

COUNTERSINK 310.870 $497.00

COUNTERSINK 310.880 $461.00

PLATE 442.530 $2,242.00 C1713

PLATE SHORT BEND 442.520 $2,201.00 C1713

PLATE SHORT BEND 224.520 $2,411.00 C1713

PLATE STANDARD 442.510 $2,201.00 C1713

SCREW 2.7 12MM 402.812 $191.00 C1713

SCREW 3.5 12MM 404.812 $96.00 C1713

PLATE 1.7MM 57-05290 $417.00 C1713

PLATE 1.7MM 57-05292 $417.00 C1713

SCREW 1.7 24MM 59-17024 $214.00 C1713

DRILL BIT 1.4 60-14126 $346.00

SCREW 3.2 14MM 58-30414 $527.00 C1713

PINS THREADED .035 3/16 $26.00 C1713

PINS SMOOTH 1/8 $24.00 C1713

PINS SMOOTH 3/16 $24.00 C1713

PLATE BUTTESSS 240.54 $820.00 C1713

PLATE BUTTESSS 240.44 $820.00 C1713

BIT DRILL MS-DC35 $170.00

DRILL BITS MS-DC28 $170.00

SCREWS AT-1125-S $847.00 C1713

SCREWS AT-1150-S $847.00 C1713

SCREWS AT-1175-S $847.00 C1713

SCREWS AT-1200-S $847.00 C1713

SCREWS AT-1275-S $847.00 C1713

SCREWS AT-1300-S $847.00 C1713

PLATE PL-CL6SR $1,773.00 C1713

BIT DRILL AT2M-1813 $588.00

BIT DRILL AT2M-L1813 $537.00

K-WIRES WS-1106ST $56.00 C1713

SCREW STANDARD BONE AT2-q26-S $962.00 C1713

SCREW STANDARD BONE AT2-q28-S $962.00 C1713

SCREW STANDARD BONE AT2-S20-S $962.00 C1713

SCREW STANDARD BONE ATS-S22-S $962.00 C1713

Page 220: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW STANDARD BONE AT2-S24-S $962.00 C1713

SCREW STANDARD BONE AT2-S26-S $962.00 C1713

SCREW STANDARD BONE AT2-S28-S $962.00 C1713

SCREW STANDARD BONE AT2-S30-S $962.00 C1713

DRILL AT2-L2515 $537.00

SCREW CORTICAL LOCKING CO-3160 $189.00 C1713

WIRE-K WS-0906ST $42.00 C1713

SCREW MINI BONE AT2-M26-S $962.00 C1713

SCREW MINI BONE AT2-M22-S $962.00 C1713

SCREW LOCKING CORTICAL CO-3140 $268.00 C1713

WIRE GUIDE WS-2020 $170.00 C1769

ROD HR-L1115-S $3,410.00 C1713

SCREW LOCKING HCA5350-S $472.00 C1713

SCREW CORTICAL HCO3225-S $443.00 C1713

SCREW LOCKING HCA5300-S $472.00 C1713

WIRE-K 1.0 292.10 $41.00 C1713

WIRE-K 0.8 292.08 $41.00 C1713

SCREW CORTICAL HCO3200-S $472.00 C1713

PLATE 2.0 LCP 247.362 $1,032.00 C1713

PLATE 2.0 LCP 247.36 $608.00 C1713

PLATE 2.0 LCP 247.348 $608.00 C1713

PLATE 2.0 LCP 247.347 $608.00 C1713

PLATE 2.0 LCP 247.346 $608.00 C1713

PLATE 2.0 LCP 247.345 $608.00 C1713

PLATE 2.0 LCP 247.344 $608.00 C1713

PLATE 2.0 LCP 247.351 $1,078.00 C1713

PLATE 2.0 LCP 247.35 $1,078.00 C1713

PLATE 2.4 LCP 247.366 $1,071.00 C1713

PLATE 2.4 LCP 247.364 $921.00 C1713

PLATE 2.4 LCP 249.678 $977.00 C1713

PLATE 2.4 LCP 247.377 $921.00 C1713

PLATE 2.4 LCP 249.676 $977.00 C1713

PLATE 2.4 LCP 247.375 $921.00 C1713

PLATE 2.4 LCP 249.674 $977.00 C1713

PLATE 2.4 LCP 249.615 $1,571.00 C1713

PLATE 2.4 LCP 249.679 $1,284.00 C1713

SCREW2.7 LOCKING 12MM 202.212 $331.00 C1713

SCREW 2.7 CORTEX 10MM 202.87 $82.00 C1713

BIT DRILL 2.0 323.062 $523.00

TAP 311.63 $516.00

BIT DRILL 4.0 315.400 $423.00

WIRE GUIDE 3.2MM 357.399 $263.00 C1769

BIT DRILL 4.5MM 315.48 $414.00

BIT DRILL 3.2MM 315.29 $393.00

BIT DRILL 2.7MM 315.28 $365.00

NAIL ELASTIC 1.5MM 475.915 $613.00 C1713

NAIL ELASTIC 2.0MM 475.920 $606.00 C1713

NAIL ELASTIC 2.5MM 475.925 $702.00 C1713

NAIL ELASTIC 3.0MM 475.930 $745.00 C1713

NAIL ELASTIC 3.5MM 475.935 $789.00 C1713

Page 221: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NAIL ELASTIC 4.0MM 475.940 $847.00 C1713

PLATE 11 HOLE 226.610 $702.00 C1713

PLATE 8 HOLE 226.580 $661.00 C1713

PLATE 4 HOLE 226.540 $528.00 C1713

PLATE 10 HOLE 4.5 BROAD 226.60 $661.00 C1713

PLATE 7 HOLE SEMI-TUB 222.070 $232.00 C1713

PLATE 6 HOLE SEMI TUB 222.060 $215.00 C1713

PLATE 5 HOLE SEMI-TUB 222.050 $203.00 C1713

PLATE 4 HOLE SEMI-TUB 222.040 $192.00 C1713

WIRE-K 06 292.460 $32.00 C1713

WIRE-K 08 292.480 $32.00 C1713

WIRE-K 1.0 292.500 $36.00 C1713

ROD CARBON 120 395.780 $190.00 C1713

ROD 200 STEEL 395.770 $127.00 C1713

ROD 180 STEEL 395.760 $127.00 C1713

ROD 160 STEEL 395.750 $127.00 C1713

ROD 140 STEEL 395.740 $127.00 C1713

ROD 120 STEEL 395.730 $127.00 C1713

ROD 100 STEEL 395.720 $127.00 C1713

ROD 80 STEEL 395.710 $127.00 C1713

ROD 60 STEEL 395.700 $127.00 C1713

PLATE 10-Hole LC-DCP 224.600 $521.00 C1713

BARB STAPLES $169.00

PLATE 10 HOLE TIBIA 239.913 $3,348.00 C1713

PLATE 8 HOLE TIBIA 239.908 $3,317.00 C1713

PLATE TIBIA 239.909 $3,317.00 C1713

PLATE 6 HOLE TIBIA 239.905 $3,288.00 C1713

PLATE 6 HOLE TIBIA 239.904 $3,288.00 C1713

PLATE 10 HOLE TIBIA 239.912 $3,348.00 C1713

PLATE CLOVERLEAF 241.840 $803.00 C1713

PLATE CLOVERLEAF 241.830 $750.00 C1713

PLATE CALCANEAL 241.623 $1,586.00 C1713

PLATE CALCANEAL 241.622 $1,586.00 C1713

NAIL FIXATION 456.34S $3,838.00 C1713

NAIL FIXATION 456.36S $3,838.00 C1713

NAIL FIXATION 456.38S $3,838.00 C1713

NAIL FIXATION 456.40S $3,838.00 C1713

CAP TITANIUM END 459.014S $559.00 C1713

CAP TITANIUM END 459.013S $559.00 C1713

CAP TITANIUM CAP 459.014S $559.00 C1713

NAIL CANNULATED FEM 474.036S $2,502.00 C1713

NAIL CANNULATED FEM 474.034S $2,502.00 C1713

NAIL CANNULATED FEM 474.032S $2,502.00 C1713

NAIL CANNULATED FEM 464.40S $2,000.00 C1713

NAIL CANNULATED FEM 464.38S $2,000.00 C1713

NAIL CANNULATED FEM 464.36S $2,000.00 C1713

NAIL CANNULATED FEM 464.34S $2,000.00 C1713

NAIL CANNULATED FEM 464.32S $2,000.00 C1713

CAP TITANIUM END 458.110S $673.00 C1713

NAIL TITANIUM TIBIAL 478.28S $2,398.00 C1713

Page 222: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NAIL TITANIUM TIBIAL 478.30S $2,398.00 C1713

NAIL TITANIUM TIBIAL 478.33S $2,398.00 C1713

NAIL TITANIUM TIBIAL 478.34S $2,398.00 C1713

NAIL TITANIUM TIBIAL 478.36S $2,398.00 C1713

NAIL TITANIUM 485.027S $2,427.00 C1713

NAIL TITANIUM 485.028S $2,427.00 C1713

NAIL TITANIUM 485.030S $2,427.00 C1713

NAIL TITANIUM 485.034S $2,427.00 C1713

NAIL TITANIUM 485.036S $2,427.00 C1713

NAIL TITANIUM 485.038S $2,427.00 C1713

NAIL TITANIUM 485.040S $2,965.00 C1713

NAIL SOLID TIBIAL 479.28S $2,398.00 C1713

NAIL SOLID TIBIAL 479.30S $2,398.00 C1713

NAIL SOLID TIBIAL 479.31S $2,398.00 C1713

NAIL SOLID TIBIAL 479.33S $2,398.00 C1713

NAIL SOLID TIBIAL 479.34S $2,398.00 C1713

NAIL SOLID TIBIAL 479.36S $2,398.00 C1713

NAIL SOLID TIBIAL 479.42S $2,398.00 C1713

NAIL SOLID TIBIAL 479.30S $2,398.00 C1713

NAIL SOLID TIBIAL 479.38S $2,398.00 C1713

NAIL SOLID TIBIAL 479.40S $2,398.00 C1713

BRACE KNEE KB3001-00 $245.00

Meniscus Stapler Handler $205.00

Meniscus Stapler $425.00

Meniscal repair needle $34.00

PLATE DORSAL 2480-01 $1,250.00 C1713

PLATE DORSAL 2480-02 $1,250.00 C1713

PLATE DORSAL 2480-03 $1,250.00 C1713

PLATE DORSAL 2480-04 $1,250.00 C1713

SCREW HERBERT #22 47-1154-22 $697.00 C1713

SCREW HERBERT #18 47-1154-18 $697.00 C1713

SCREW HERBERT # 20 47-1154-20 $697.00 C1713

SCREW HERBERT#24 47-1154-24 $697.00 C1713

SCREW HERBERT#26 47-1124-26 $697.00 C1713

SCREW HERBERT #28 47-1154-28 $697.00 C1713

SET CABLE 6704-0-0510 $697.00

PLATE ADAPTION 12 HOLE 247.370 $1,209.00 C1713

PLATE 2.7 LCP 247.372 $970.00 C1713

NAIL TROCH 456.414S $3,838.00 C1713

NAIL TROCH 456.415S $3,838.00 C1713

NAIL TROCH 456.419S $3,913.00 C1713

NAIL TROCH 456.418S $3,838.00 C1713

NAIL TROCH 456.411S $3,838.00 C1713

NAIL TROCH 456.410S $3,838.00 C1713

NAIL TROCH 456.322S $2,992.00 C1713

NAIL TROCH 456.318S $2,887.00 C1713

NAIL TROCH 456.323S $2,887.00 C1713

NAIL TROCH 456.316S $2,887.00 C1713

NAIL TROCH 456.321S $2,887.00 C1713

NAIL TROCH 456.314S $2,887.00 C1713

Page 223: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NAIL TROCH 456.315S $2,887.00 C1713

BOLT LOCKING 458.25 $532.00 C1713

SCREW 24MM AT-S24-S $962.00 C1713

WIRE GUIDE WS-1407ST $43.00 C1769

GUIDE WIRE 1.25MM 292.62 $106.00 C1769

SCREW AT-1225-S $962.00 C1713

SCREW AT-1250-S $962.00 C1713

BIT DRILL 2.7 310.28 $229.00

DRILL GUIDE 2.0 323.061 $1,197.00

GUIDE DRILL 323.029 $820.00

SUTURE 3-0 ETHIBOND X976H $28.00

SUTURE 3-0 EHTILON 669H $28.00

SUTURE 5-0 ETHIBOND MB46G $28.00

SUTURE 6-0 ETHILON 697H $28.00

SUTURE 0 PROLENE 8434H $28.00

DEVICE STATAK SOFT TISSUE $597.00

SUTURETAK MICRO KIT $550.00

CURVTEK 12MM NEEDLES $29.00

ARTHROSCOPY PUMP TUBING $179.00

SUTURE O ETHIBOND EXCEL CX45D $28.00

COUNTERSINK 310.972 $461.00

SUTURE ANCHOR 6.5 902580 $28.00 C1713

SUTURE 2-O ETHIBOND MPX17 $28.00

SUTURE 2-0 VICRYL J417H $28.00

SUTURE 2-0 VICRYL J635H $28.00

SUTURE 4-0 VICRYL J109T $28.00

SUTURE 9-0 ETHILON 2809G $28.00

SUTURE 8-0 ETHILON 2808G $28.00

SUTURE 10 ETHILON 2810G $28.00

SUTURE 1 ETH EXC X425H $28.00

SUTURE ETHIBOND EXC X964H $28.00

SUTURE 2-0 ETHIBOND EX X185H $28.00

SUTURE 2 ETHIBOND X406T $28.00

SUTURE 4-0 ETHIBOND X975H $28.00

SUTURE 0 VICRYL J479H $27.00

SUTURE 0 VICRYL J467H $28.00

SUTURE 2-0 VICRYL J266H $28.00

SUTURE 3-0 PROLENE 8926H $28.00

SUTURE 4-0 PROLENE 8871H $28.00

SUTURE 4-0 PROLENE 8925H $28.00

SUTURE 5-0 PROLENE 8661G $28.00

SUTURE 5-0 PROLENE 8870H $28.00

SUTURE 6-0 PROLENE 8860H $28.00

SUTURE 6-0 PROLENE 8889H $28.00

SUTURE 4-0 VICRYL J845G $28.00

SUTURE 5-0 VICRYL VR844 $28.00

VICRYL 4-0 J422H $27.00

SUTURE 3-0 VICRYL J868H $28.00

FIBERWIRE 3-0 AR-7227-01 $75.00 C1713

SUTURE 8-0 PROLENE 8741H $28.00

Page 224: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BIT DRILL 2.4 310.53 $399.00

PLATE-L 2.0 243.33 $188.00 C1713

SCREW 4.0 45MM 206.045 $71.00 C1713

SCREW 2.7MM 18MM 402.818 $191.00 C1713

SCREW 4.OMM PT 50MM 207.050 $78.00 C1713

SCREW 2.7 S-T 14MM 402.814 $172.00 C1713

SCREW 2.7MM 16MM 402.816 $172.00 C1713

SCREW 4.5 CORTEX 214.014 $68.00 C1713

SCREW4.5 CORTEX 30MM 214.03 $68.00 C1713

SCREW4.5 CORTEX 32MM 214.032 $68.00 C1713

SCREW 4.5 CORTEX 34 MM 214.034 $68.00 C1713

SCREW 4.5 CORTEX 36 MM 214.036 $68.00 C1713

SCREW 4.5 CORTEX 38MM 214.038 $68.00 C1713

SCREW 4.5 CORTEX 40 MM 214.04 $68.00 C1713

SCREW4.5 CORTEX 44 MM 214.044 $68.00 C1713

SCREW 4.5 CORTEX 46 MM 214.046 $68.00 C1713

SCREW 4.5 CORTEX 48MM 214.048 $68.00 C1713

SCREW 4.5 CORTEX 50MM 214.05 $68.00 C1713

SCREW 4.5 CORTEX 52MM 214.052 $68.00 C1713

SCREW 4.5 CORTEX 54 MM 214.054 $68.00 C1713

SCREW 4.5 CORTEX 56MM 214.056 $68.00 C1713

SUTURE CHRONIC GUT 915H $28.00

SUTURE CHRONIC GUT 922H $28.00

TRIPLE LUMEN ADULT $148.00

TRAY PEDI CENTRAL LINE $33.00

TRAY THORACENTESIS $99.00

NEEDLE PEEL-AWAY PN-04015 $50.00

GAUZE TUBE 2 5/8" $95.00

PRONET-SIZE 2 $40.00

ELASTIC NET SIZE 8 $83.00

ELASTIC NET SIZE 11 $158.00

TEST DART NB215 $28.00

OIL INSTRUMENT $141.00

SCREW 2.7 LOCKING 16MM 202.216 $331.00 C1713

SCREW 2.7 LOCKING 18MM 202.218 $365.00 C1713

CUFF DISP. BLOOD PRESSURE $62.00

SUTURE ETHIBOND X976H $28.00

SURETRANS PVC DRAIN $439.00

ESMARK-4X9 $45.00

ESMARK 6X12 $64.00

BLADES AGG PLUS - 3.5 $163.00

BLADE AGG PLUS - 5.5 $163.00

BLADE BUR PEAR 5.0 $163.00

BLADE AGG PLUS 4.0 $163.00

BLADE PEAR BUR 6.0 $163.00

BLADE CARPAL TUNNEL $183.00

BLADE DERMATONE $139.00

BLADES DUAL SAGITTAL $160.00

BLADES LONG NARROW 2296-33-414 $119.00

BLADES NARROW 2296-22-115 $119.00

Page 225: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BLADE KNEE K-2000-01 $71.00

BLADE SAGITTAL 6113-89-90 $165.00

BLADE RECIPROCATING 277-96-325 $156.00

BUR EGG 4.0MM 1607-2-35 $196.00

BLADE BUR 3.2MM 1608-2-11 $190.00

BLADE BUR RND 2.3MM 1607-2-101 $33.00

BLADE RECIPROCATING 227-96-251 $144.00

BLADES BNT CRS OF 2296-033-234 $140.00

STAPLER SKIN REG PXR-35 $142.00

COVER C-ARM $32.00

CEMENT MIXING BOWLS $319.00

CEMENT BONE $371.00 C1713

CEMENT RESTRICTOR $331.00

CURVTEK MED $1,244.00

MAJOR OR PACK $148.00

MINOR OR PACK $123.00

SHEET SPLIT 29433 $31.00

PUTTY 1CC $566.00 C1713

SUTURE ANCHOR 5MM $28.00 C1713

Super Turbovac 90 w/cable $616.00

ARTHROWAND 3.5 90 D $601.00

ARTHROWAND 3.0MM 45D $616.00

ARTHROWAND 2.5MM 30D $494.00

PROBLOCK $34.00

SCREW LOCKING 2.7 X 10MM $433.00 C1713

SCREW 2.7 LOCKING 14MM 202.214 $365.00 C1713

SCREW 2.7 LOCKING 20MM 202.22 $365.00 C1713

SCREW 2.7 LOCKING 22MM 202.222 $331.00 C1713

SCREW 2.7 LOCKING 24MM 202.224 $331.00 C1713

SCREW 2.7 CORTEX 12MM 202.872 $124.00 C1713

SCREW 2.7 CORTEX 14MM 202.874 $124.00 C1713

SCREW 2.7 CORTEX 16MM 202.876 $124.00 C1713

SCREW 2.7 CORTEX 18MM 202.878 $124.00 C1713

SCREW 2.7 CORTEX 20MM 202.88 $124.00 C1713

SCREW 2.7 CORTEX 22MM 202.882 $124.00 C1713

SCREW 2.7 CORTEX 24MM 202.884 $124.00 C1713

SCREW 2.7 CORTEX 26MM 202.886 $124.00 C1713

SCREW 2.7 CORTEX 28MM 202.888 $124.00 C1713

SCREW 2.7 CORTEX 30MM 202.89 $124.00 C1713

SCREW 2.7 CORTEX 32 MM 202.892 $124.00 C1713

SCREW 2.4 CORTEX 7MM 201.757 $186.00 C1713

SCREW 2.4 CORTEX 8MM 201.758 $186.00 C1713

SCREW 2.4 CORTEX 9MM 201.759 $186.00 C1713

SCREW 2.4 CORTEX 10MM 201.76 $186.00 C1713

SCREW 2.4 CORTEX 11MM 201.761 $186.00 C1713

SCREW 2.4 CORTEX 12MM 201.762 $186.00 C1713

SCREW 2.4 CORTEX 13MM 201.763 $186.00 C1713

SCREW 2.4 CORTEX 14MM 201.764 $186.00 C1713

SCREW 2.4 CORTEX 16MM 201.766 $186.00 C1713

SCREW 2.4 CORTEX 18MM 201.768 $186.00 C1713

Page 226: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW 2.4 CORTEX 20MM 201.77 $186.00 C1713

SCREW 2.4 CORTEX 22MM 201.772 $186.00 C1713

SCREW 2.4 CORTEX 6MM 201.756 $186.00 C1713

SCREW 2.4 LOCKING 6MM 212.806 $325.00 C1713

SCREW 2.4 LOCKING 7MM 212.807 $325.00 C1713

SCREW 2.4 LOCKING 8MM 212.808 $325.00 C1713

SCREW 2.4 LOCKING 9MM 212.809 $325.00 C1713

SCREW 2.4 LOCKING 10MM 212.81 $325.00 C1713

SCREW 2.4 LOCKING 11MM 212.811 $325.00 C1713

SCREW 2.4 LOCKING 12MM 212.812 $325.00 C1713

SCREW 2.4 LOCKING 13MM 212.813 $325.00 C1713

SCREW 2.4 LOCKING 14MM 212.814 $325.00 C1713

SCREW 2.4 LOCKING 16MM 212.816 $325.00 C1713

SCREW 2.4 LOCKING 18MM 212.818 $325.00 C1713

SCREW 2.4 LOCKING 20MM 212.82 $325.00 C1713

SCREW 2.4 LOCKING 22MM 212.822 $325.00 C1713

PLATE 2.7 LCP 10 HOLE 247.374 $970.00 C1713

PLATE 2.7 LCP 5 HOLE 249.681 $1,243.00 C1713

PLATE 2.7 LCP 7 HOLE 249.683 $970.00 C1713

PLATE 2.7 LCP CONDYLAR 249.684 $1,401.00 C1713

PLATE-L 2.7 249.686 $924.00 C1713

PLATE-L 2.7 249.687 $924.00 C1713

PLATE-L 2.7 249.688 $924.00 C1713

PLATE-L 2.7 249.689 $1,001.00 C1713

NAIL FEMORAL 10MM 474.038S $2,705.00 C1713

NAIL FEMORAL 10MM 474.041S $2,705.00 C1713

NAIL TIBIAL 8MM 478.38S $2,591.00 C1713

NAIL TIBIAL 8MM 478.40S $2,591.00 C1713

NAIL TIBIAL 10MM 476.31S $2,591.00 C1713

SCREW 3.5 50MM FRAG 204.85 $93.00 C1713

NERVE GUIDE PNG630 $3,011.00 C9352

NERVE GUIDE PNG730 $2,895.00 C9352

SCREW CANCEL 6.5MM 216.045 $143.00 C1713

SCREW CANCEL 6.5MM 216.065 $143.00 C1713

SCREW CANCEL 6.5MM 216.070 $143.00 C1713

IMMOBILIZER SLING LG 9023-03 $25.00

FORCEP RADIAL JAW EGD BIOPSY 2 $25.00

SPLINT WRIST 6" LT/LG $23.00

SPLINT WRIST 6" LT/MED $25.00

SPLINT WRIST 6" LT/SM $25.00

SPLINT WRIST 6" RT/SM $25.00

SPLINT WRIST 6" RT/MED $25.00

SPLINT WRIST 6" RT/LG $25.00

WIRE SS SUTURE SIZE 4 $144.00 C1713

WIRE SS SUTURE 18 GA $144.00 C1713

WIRE SS SUTURE GA $116.00 C1713

STEINMANN PINS 5/32 $38.00 C1713

STEINMANN PINS 9/64 $38.00 C1713

STEINMANN PINS 1/8 $44.00 C1713

STEINMANN PINS 7/64 $31.00 C1713

Page 227: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STEINMANN PINS 3/32 $38.00 C1713

STEINMANN PINS 5/64 $41.00 C1713

JURGAN BALLS MICRO PINK $108.00 C1713

JURGAN BALLS MICRO BLUE $108.00 C1713

JURGAN BALLS MICRO WHITE $108.00 C1713

JURGAN BALLS MED. WHITE $108.00 C1713

SCREW CTX 2.7MM 202.806 $93.00 C1713

SCREW CTX 2.7MM 202.808 $93.00 C1713

K-WIRE 1.6 MM 292.16 $265.00 C1713

SCREW CORTEX 1.5 200.808 $93.00 C1713

SCREW CORTEX 200.809 $92.00 C1713

SCREW CTX 1.5MM 200.814 $92.00 C1713

TOURNIQUET 18" $110.00

TOURNIQUET 12" $98.00

TOURNIQUET 8" $87.00

TOURNIQUET 30" $202.00

SCREW CANCEL 6.5MM 217.105 $161.00 C1713

SCREW CANCEL 6.5MM 217.100 $161.00 C1713

COUNTER SINK 310.89 $507.00

PLATE 10 HOLE LC-DCP 224.60 $521.00 C1713

PLATE 11 HOLE LC-DCP 224.61 $521.00 C1713

PLATE 12 HOLE LC-DCP 224.62 $521.00 C1713

PLATE 9 HOLE LC-DCP 224.59 $485.00 C1713

PLATE 8 HOLE LC-DCP 224.58 $485.00 C1713

PLATE 7 HOLE LC-DCP 224.57 $485.00 C1713

PLATE 6 HOLE LC-DCP 224.56 $485.00 C1713

PLATE 5 HOLE LC-DCP 224.55 $429.00 C1713

PLATE 4 HOLE LC-DCP 224.54 $429.00 C1713

PEG DRIVER 2.0 MM FDP20 $280.00

SCREW 3.5MM 404.814 $96.00 C1713

SCREW 3.5MM 404.816 $105.00 C1713

SCREW 3.5MM 404.818 $105.00 C1713

SCREW 3.5MM 404.820 $105.00 C1713

SCREW 3.5MM 404.822 $96.00 C1713

SCREW 3.5MM 404.824 $105.00 C1713

SCREW 3.5MM 404.826 $96.00 C1713

SCREW 3.5MM 404.828 $96.00 C1713

SCREW 1.7MM SIZE 16 59-17016 $214.00 C1713

SCREW 1.7MM SIZE 18 59-17018 $214.00 C1713

SCREW 1.7MM SIZE 12 59-17012 $214.00 C1713

PEG MULTIDIR 30MM 1312-11-130 $465.00 C1713

PEG MULTIDIR 16MM 1312-11-116 $465.00 C1713

PEG MULTIDIR 18MM 1312-11-118 $465.00 C1713

PEG MULTIDIR 20MM 1312-11-120 $465.00 C1713

PEG MULTIDIR 22MM 1312-11-122 $465.00 C1713

PEG MULTIDIR 24MM 1312-11-124 $465.00 C1713

SCREW 3.2 14MM 5830414 $672.00 C1713

SCREW T-FIX 3.2 16MM 5830416 $672.00 C1713

SCREW T-FIX 3.2 18MM 5830418 $672.00 C1713

SCREW TWIN FIX 3.2 22MM $672.00 C1713

Page 228: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW TWIN FIX 3.2 24MM $672.00 C1713

SCREW TWIN FIX 3.2 26MM $672.00 C1713

SCREW TWIN FIX 3.2 28MM $672.00 C1713

SCREW TWIN FIX 3.2 30MM $672.00 C1713

SCREW TWIN FIX 3.2 32 MM $672.00 C1713

SCREW TWIN FIX 3.2 34 MM $672.00 C1713

STAPLERS REG PXR35 $142.00

SUTURE VICRYL RPD 3-0 VR935 $28.00

SUTURE VICRYL RPD 4-0 VR426 $28.00

SUTURE VICRYL RPD 4-0 VR494 $28.00

SUTURE VICRYL RPD 3-0 VR493 $28.00

MANIFOLD 4 PORT NEPTUNE 2 $68.00

K-WIRE 2.0X228MM #56010228 WM $96.00 C1713

SCREW 5.5X45MM #5601554 WMT $3,070.00 C1713

PKS CUTTING FORCEPS W/9-PIN $1,271.00

SHEATH UROPASS ACCESS 38CM $344.00

SHEATH UROPASS ACCESS 54CM $353.00

INJECTOR HARRIS UTERINE $75.00

STEM EXPLORE IMPL 7X26MM $3,272.00 C1713

HEAD EXPLOR IMPL 10X20MM $2,810.00 C1713

KNIFE ORANDI - 27 $205.00

BLADE CURVED IRRIG 40 DEG $356.00

SCREW MINI BONE AT2-M24-S $898.00 C1713

SCREW MINI BONE 20MM AT2-M20-S $898.00 C1713

BVL ATTAIN STARFIX LD MEDTRONI $5,645.00 C1900

MESH HERNIA ULTRAPRO LG $861.00 C1781

SUTURE GORETEX CV-7 30" TTC12 $28.00

PISTON RICHARDS 4.75 X 0.6MM $444.00

SCREW 7.3MM 16MM CANN 208.83 $572.00 C1713

SCREW 7.3MM 16MM THREADED 20 $572.00 C1713

SCREW 7.3MM 125MM CANN. 209.92 $572.00 C1713

SCREW 7.3MM 130MM CANN. 209.93 $572.00 C1713

PLATE 3.5MM LCP 4 HOLE 57MM 24 $704.00 C1713

PLATE 3.5MM LCP 6 HOLE 77MM 24 $909.00 C1713

WIRE GUIDE 1.25 292.62 $452.00 C1769

SCREW 2.7MM SELF TAP 20MM 402. $172.00 C1713

SCREW 2.7MM SELF TAP 22MM 402. $176.00 C1713

SCREW 2.7MM SELF TAP 24MM 402. $172.00 C1713

PLATE 2.4MM LC-DCP 8 HOLE 449. $839.00 C1713

K-WIRE .035 D-ENDED 00-0186-04 $28.00 C1713

BLADE CRESCENTRIC 2296-31-417 $306.00

BLADE LONG NARROW 2296-33-115 $116.00

SCREW CORTEX 2.4 401.506.96 $204.00 C1713

SCREW CORTEX 2.4 401.507.96 $204.00 C1713

SCREW HERBERT BONE 47-1154-30 $697.00 C1713

DRILL BIT AT2-1509 $550.00

DRILL BIT AT2-2515 $539.00

SCREW 10 MICRO BONE AT2-C10-S $962.00 C1713

SCREW 11 MICRO BONE AT2-C11-S $962.00 C1713

SCREW 12MM MICR BONE AT2-C12-S $962.00 C1713

Page 229: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW 14MM MICRO BONE AT2-C14 $962.00 C1713

SCREW 8MM MICRO BONE AT2-C8-S $962.00 C1713

SCREW 9MM MICRO BONE AT2-C9-S $962.00 C1713

SCREW 16MM MINI BONE AT2-M16-S $962.00 C1713

SCREW 18MM MINI AT2-M18-S $962.00 C1713

SCREW MINI BONE 28MM AT2-M28-S $962.00 C1713

SCREW MINI BONE AT2-M30-S $962.00 C1713

SCREW 13MM MICRO AT2-C13-S $962.00 C1713

PLATE LT SH NARW DVRANS-L $1,999.00 C1713

PLATE RT SH NARW DVRANS-R $1,999.00 C1713

PLATE EXT LT DVRAXX-L $1,897.00 C1713

PLATE EXT RT DVRAXX-R $1,897.00 C1713

SCREW NON LOCKING 10MM SP1000 $252.00 C1713

BIT DRILL 3FLUT 4.2 03.010.104 $484.00

WIRE GUIDE 1.25MM 292.62 $121.00 C1769

HANDLE BUCKET RICHARDS 4.5X0.4 $334.00

HANDLE BUCKET RICHARDS 4.5X0.6 $334.00

HANDLE BUCKET RICHARDS 4.0X0.4 $334.00

HANDLE BUCKET RICHARDS 4.0X0.6 $334.00

HANDLE BUCKET RICHARDS 5.0X0.4 $334.00

HANDLE BUCKET RICHARDS 5.0X0.6 $334.00

HANDLE BUCKET RICHARDS 3.5X0.6 $334.00

PISTON RICHARDS 3.5X0.6 $444.00

PISTON RICHARDS 3.75X0.6 $444.00

PISTON RICHARDS $444.00

PISTON RICHARDS 4.5X0.6 $444.00

PISTON RICHARDS 5.0X0.6 $444.00

BUTTON SEPTAL 1524105 $491.00

SCREW TI LOK 5.0MM 04.005.575 $586.00 C1713

SCREW TI LOK 5.0MM 04.005.580 $586.00 C1713

SCREW TI LOK 5.0MM 04.005.585 $586.00 C1713

SCREW TI LOK 5.0MM 04.005.590 $586.00 C1713

BEARING KNEE OXFORD L 6MM $1,904.00 C1713

BEARING KNEE OXFORD L 7MM $1,904.00 C1713

KNEE FEMORAL OXFORD PARTIAL MD $5,643.00 C1776

TRAY KNEE TIBIAL OXFORD PART $3,649.00 C1776

CEMENT BONE COBALT HV 40G $236.00 C1713

STEM HIP FEMORAL 10X130MM $3,515.00 C1776

HEAD MODULAR COMP 28MM $1,333.00 C1713

CUP RING LOC BI-POL ACETB 28MM $1,942.00 C1713

SLEEVE FEMORAL CENTERING 10MM $544.00

SCREW / WASHERLOC BONE MULCH $1,338.00 C1713

FIXATION EZLOC FEM LNG 9-10MM $1,424.00 C1713

KIT EZLOCK / WASHERLOC DISP KI $1,338.00 C1713

FIXATION WASHERLOC TISSUE $1,216.00 C1713

SCREW WASHERLOC CANCELLOUS $557.00 C1713

SUTURE LACERATION SET $28.00

SCREW TI CORTEX 2.7MM 402.812 $172.00 C1713

KNIFE SAFEGUARD CARPAL TUNNEL $428.00

STEM KNEE SPLINED 141660 $3,045.00 C1776

Page 230: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BAR TIBIA MOD LOCKING 141205 $516.00 C1713

HOOD OXYGEN BABY LRG $47.00

SECURA DR DEFIB GEN #D224DRG $35,505.00 C1721

CONTRACEPTIVE PARAGARD T 380A $226.00

SCREW 7.3 CANC. 125MM 208.925 $682.00 C1713

SCREW 7.3 CANC. 130MM 208.930 $682.00 C1713

SCREW CANC 6.5 32 THR 70MM 217 $146.00 C1713

PLATE NARW 6 HOLE 226.56 $540.00 C1713

PLATE NARW 7 HOLE 226.57 $540.00 C1713

PLATE NARW 9 HOLE 226.59 $675.00 C1713

PLATE NARW 12 HOLE 226.62 $717.00 C1713

PLATE NARW 14 HOLE 226.64 $717.00 C1713

SCREW SCHANZ 4.0MM 294.777 $447.00 C1713

DRILL BIT 4.5MM 310.45 $187.00

ROD STEEL TUBE 200 393.53 $580.00 C1713

CLAMP TRANSVERSE 393.66 $1,730.00

JOINT UNIVERSAL 393.71 $1,883.00 C1713

SCREW 2.7MM S-TAP 10MM 402.810 $175.00 C1713

CAP END 459.012S $540.00 C1713

NAIL FEMORAL 474.031S $2,972.00 C1713

NAIL FEMORAL 474.444S $2,972.00 C1713

NAIL TIBIAL 10X330MM 476.33S $2,843.00 C1713

NAIL TIBIAL 8MMX255 478.25S $2,843.00 C1713

NAIL TIBIAL 8MMX 315 478.31S $2,843.00 C1713

SCREW CORT 3.5X13MM Cq23000 $302.00 C1713

SCREW CORT 3.5X15MM Cq25000 $302.00 C1713

PEG FULL THRD 10MM FP10 $302.00 C1713

PEG FULL THRD 12MM FP12 $302.00 C1713

PEG FULL THRD 24MM FP24 $302.00 C1713

PEG FULL THRD 28MM FP28 $302.00 C1713

PEG FULL THRD 30MM FP30 $302.00 C1713

PEG MDTP 2.5X26MM 1312-11-126 $466.00 C1713

PEG MDTP 2.5X30MM 1312-11-130 $466.00 C1713

CATH SPINE INTRADISCAL 8 PIN $2,380.00

CATH SPINE INTRADISCAL XL 8PIN $2,380.00

NEEDLE INTRODUCER XL GEN II $173.00

NEEDLE INTRODUCER GEN II $146.00

REAMER SHAFT 8.0X448 $621.00

CANNULATED COMPRESSION SCREW $516.00 C1713

T2 ANKLE NAIL 11X200 $5,542.00 C1713

LOCKING SCREW 5.0 $544.00 C1713

CATH BALLOON #611765 $1,219.00 C1725

CATH BALLOON #611761 $1,219.00 C1725

CATH BALLOON #611757 $1,219.00 C1725

CATH BALLOON #611753 $1,219.00 C1725

TENDON TIBIALIS SHRT <200MM $2,059.00 C1762

HARMONIC FOCUS 9CM COAG SHEARS $1,154.00

HARMONIC BLUE HANDPIECE CORD $36.00

PUNCH BONE BIOPSY AVAMAX 11G $315.00

PUNCH BONE BIOPSY AVAMAX 13G $486.00

Page 231: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PROBE LITHOCLAST ULTRA 1X497MM $589.00

PROBE LITHOCLAST ULTRA 3.8X330 $1,259.00

COSEAL APPLICATOR TIP $340.00

FORCEP CUTTING GYRUS 5MMX33CM $1,024.00

BLADE SPIRAL RETRO 04.013.046 $1,289.00

NAIL CANN RETR/ANT 04.013.552S $3,682.00 C1713

WIRE GUIDE BALL TIP 3X800 $744.00 C1769

ANCHOR MICRO CORKSCREW FT $1,026.00 C1713

PLATE 4 HOLE 57-15301 $629.00 C1713

SCREW 2.3X 9MM 53-23009E $268.00 C1713

SCREW 2.3 X 10MM 53-23010E $268.00 C1713

SCREW 3.2 20MM 58-30420 $970.00 C1713

SCREW 3.2 21MM 58-30421 $970.00 C1713

SCREW 3.2 23MM 58-30423 $970.00 C1713

SCREW 3.2 25MM 58-30425 $970.00 C1713

SCREW 1.7 8MM 59-17008 $258.00 C1713

SCREW 1.7 9MM 59-17009 $258.00 C1713

SCREW 1.7 10MM 59-17010 $258.00 C1713

SCREW 1.7 11MM 59-17011 $258.00 C1713

SCREW 1.7 14MM 59-17014 $258.00 C1713

PLATE 1.7 4 HOLE 57-0522 $629.00 C1713

PLATE 1.7MM 4 HOLE 57-05201 $629.00 C1713

NAIL TIBIAL 10MM 315MM 485.031 $2,825.00 C1713

BIT DRILL 4.0 356.982 $586.00

ROD REAMING 3.0 SMOOTH 355.041 $464.00 C1776

BIT DRILL 3.2MM 03.010.103 $488.00

NAIL TIBIAL 10MM 330MM 485.033 $2,825.00 C1713

SCREW 6MM LOCKING 201.876 $343.00 C1713

SCREW 7MM LOCKING 201.877 $343.00 C1713

SCREW 8MM LOCKING 201.878 $343.00 C1713

SCREW 9MM LOCKING 201.879 $343.00 C1713

SCREW 10MM LOCKING 201.880 $343.00 C1713

SCREW 11MM LOCKING 201.881 $343.00 C1713

SCREW 12MM LOCKING 201.882 $343.00 C1713

SCREW 13MM LOCKING 201.883 $343.00 C1713

SCREW 14MM LOCKING 201.884 $350.00 C1713

SCREW 16MM LOCKING 201.886 $343.00 C1713

BIT DRILL 1.5MM QC/96MM 310.50 $565.00

PIN THREADED BENDING 329.921 $567.00 C1713

CLAMP TUBE TO TUBE 393.36 $1,730.00

PLATE 4 HOLE 249.680 $970.00 C1713

FIBERTAPE 7" 2MM $189.00 C1713

TIGERWIRE 7" 2MM $189.00 C1769

TENOGLIDE 5X5CM $3,003.00 C9356

BILAYER MATRIX 10X12.5CM $4,720.00 Q4108

BILAYER MATRIX 10X25CM $6,960.00 Q4104

GUIDEWIRE BALL TIP 3X800MM $552.00 C1769

KIT CENTRAL VEN CATH 7FR 16CML $172.00

SET BURETTE US3121M $32.00

PUSHLOCK MINI AR-8825P $1,180.00

Page 232: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

FIBERWIRE 2-0 AR-7220 $112.00 C1713

DEVICE IBD EZ LACTORRERIN $932.00

CONSULTA CRT-D D224TRK $37,515.00 C1882

NAIL GAMMA3 11x180 120DEG $3,502.00 C1713

NAIL GAMMA3 11X180 125DEG $3,502.00 C1713

NAIL GAMMA3 11X180 130DEG $3,597.00 C1713

CAP END GAMMA3 SCREW 8X17.5 $539.00 C1713

CAP END GAMMA3 STANDARD 0 $578.00 C1713

END CAP GAMMA 3 $539.00 C1713

CAP END GAMMA3 !0 $577.00 C1713

SCREW LAG GAMMA3 10.5X70 $1,202.00 C1713

SCREW LAG GAMMA3 10.5X75 $1,392.00 C1713

SCREW LAG GAMMA3 10.5X80 $1,392.00 C1713

SCREW LAG GAMMA3 10.5X85 $1,392.00 C1713

SCREW LAG GAMMA3 10.5X90 $1,544.00 C1713

SCREW LAG GAMMA3 10.5X95 $1,545.00 C1713

SCREW LAG GAMMA3 10.5X100 $1,392.00 C1713

SCREW LAG GAMMA3 10.5X105 $1,392.00 C1713

SCREW LAG GAMMA3 10.5X110 $1,392.00 C1713

SCREW LAG GAMMA3 10.5X115 $1,544.00 C1713

SCREW LAG GAMMA3 10.5X120 $1,392.00 C1713

SCREW LOCK GAMMA3 5X25 $544.00 C1713

SCREW LOCK GAMMA3 5X27.5 $544.00 C1713

SCREW LOCK GAMMA3 5X30 $544.00 C1713

SCREW LOCK GAMMA3 5X32.5 $544.00 C1713

SCREW LOCK GAMMA3 5X35 $544.00 C1713

SCREW LOCK GAMMA3 5X37.5 $582.00 C1713

SCREW LOCK GAMMA3 5X40 $582.00 C1713

SCREW LOCK GAMMA3 5X42.5 $544.00 C1713

SCREW LOCK GAMMA3 5X45 $583.00 C1713

SCREW LOCK GAMMA3 5X47.5 $544.00 C1713

SCREW LOCK GAMMA3 5X50 $583.00 C1713

SCREW LOCK GAMMA3 5X52.5 $544.00 C1713

SCREW LOCK GAMMA3 5X55 $544.00 C1713

SCREW LOCK GAMMA3 5X57.5 $544.00 C1713

SCREW LOCK GAMMA3 5X60 $544.00 C1713

SCREW LOCK GAMMA3 5X65 $544.00 C1713

SCREW LOCK GAMMA3 5X70 $544.00 C1713

SCREW LOCK GAMMA3 5X75 $544.00 C1713

SCREW LOCK GAMMA3 5X80 $544.00 C1713

SCREW LOCK GAMMA3 5X85 $544.00 C1713

SCREW LOCK GAMMA3 5X90 $544.00 C1713

SCREW LOCK GAMMA3 5X95 $544.00 C1713

SCREW LOCK GAMMA3 5X100 $544.00 C1713

DRILL 4 SM 2X300 $526.00

SHAFT REAMER BIXCUT 8X448 $665.00

WIRE K-WIRE GAMMA 3.2X450 $472.00 C1713

MARKER ULTRACLIP II 17G X 10CM $236.00

TITAN ASSEMBLY KIT $1,155.00

TITAN BIOFLEX RESERVOIR $3,039.00 C1813

Page 233: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

TITAN OTR SCROTAL BIOFLEX CYLI $13,916.00 C1813

TUBE TRACH UNCUFF PVC 3.5 PED $138.00

TUBE TRACH UNCUFF PVC FEN 7.0 $88.00

TUBE TRACH CUFF STL 6.0 $544.00

TUBE TRACH CUFF STL 7.0 $544.00

TUBE TRACH CUFF STL 8.0 $544.00

TUBE TRACH CUFF STL 9.0 $544.00

ANCHOR BIO SWVL LCK 4.75X24.5 $975.00 C1713

BLADE LONG MED 2296-33-125 $116.00

TROCAR ENDO BLDLSS 15MM X 100 $172.00

CREAM SECURA EXTRA PROT 7.75OZ $35.00 A6250

MOD TAPERLOC FMRL 5X130MM 103 $9,845.00 C1776

MOD TAPERLOC FMRL 6X132MM 103 $9,845.00 C1776

MOD TAPERLOC FMRL 7.5X135MM 1 $9,845.00 C1776

MOD TAPERLOC FMRL 9.0X137MM 1 $9,845.00 C1776

MOD TAPERLOC FMRL 10X140MM 10 $9,845.00 C1776

MOD TAPERLOC FMRL 11X142MM 10 $9,845.00 C1776

MOD TAPERLOC FMRL 12.5X145MM 1 $9,845.00 C1776

MOD TAPERLOC FMRL 13.5X147MM 1 $9,845.00 C1776

MOD TAPERLOC FMRL 15 X150MM 1 $9,845.00 C1776

MOD TAPERLOC FMRL 17.5X155MM 1 $9,845.00 C1776

MOD TAPERLOC FMRL 20X160MM 10 $9,845.00 C1776

MOD TAPERLOC FMRL 25X170MM 10 $9,845.00 C1776

BONE PLUG LG 130613 $594.00 C1727

STEM HIP FMRL FRACT. 8X120MM 1 $3,515.00 C1776

STEM HIP FMRL FRACT 12X140MM 1 $3,515.00 C1776

STEM HIP FMRL FRACT 14X150MM 1 $3,515.00 C1776

STEM HIP FMRL FRACT 16X160MM 1 $3,515.00 C1776

28MM MOD HEAD 6 NECK 163638 $1,333.00 C1776

28MM MOD HEAD 163660 $1,333.00 C1776

28MM MOD HEAD 163661 $1,333.00 C1776

28MM MOD HEAD ST NECK 163662 $1,333.00 C1776

28MM MOD HEAD 3 NECK 163663 $1,333.00 C1776

28MM MOD HEAD 9 NECK 163665 $1,333.00 C1776

28MM MOD HEAD 12 NECK 163666 $1,333.00 C1776

OPTIVAC KIT 80GR 417200 $613.00

SPACER OMNIFIX DISTAL 12MM 106 $409.00 C1713

SPACER OMNIFIX DISTAL 13MM 106 $409.00 C1713

RINGLOC BI-POLAR 28X41MM 11-16 $1,942.00 C1776

RINGLOC BI-POLAR 28X42MM 11-16 $1,942.00 C1776

RINGLOC BI-POLAR 28X43MM 11-16 $1,942.00 C1776

RINGLOC BI-POLAR 28X44MM 11-16 $1,942.00 C1776

RINGLOC BI-POLAR 28X45MM 11-16 $1,942.00 C1776

RINGLOC BI-POLAR 28X46MM 11-16 $1,942.00 C1776

RINGLOC BI-POLAR 28X48MM 11-16 $1,942.00 C1776

RINGLOC BI-POLAR 28X49MM 11-16 $1,942.00 C1776

RINGLOC BI-POLAR 28X50MM 11-16 $1,942.00 C1776

RINGLOC BI-POLAR 28X51MM 11-16 $1,942.00 C1776

RINGLOC BI-POLAR 28X52MM 11-16 $1,942.00 C1776

RINGLOC BI-POLAR 28X53MM 11-16 $1,942.00 C1776

Page 234: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

RINGLOC BI-POLAR 28X54MM 11-16 $1,942.00 C1776

RINGLOC BI-POLAR 28X55MM 11-16 $1,942.00 C1776

RINGLOC BI-POLAR 28X58MM 11-16 $1,942.00 C1713

STEM HIP 132 SECUR-FIX MAX 605 $10,749.00 C1776

STEM HIP 132 SECUR-FIX MAX 605 $8,280.00 C1776

STEM HIP 132 SECUR-FIX MAX 605 $10,749.00 C1776

STEM HIP 132 SECUR-FIX MAX 605 $10,749.00 C1776

STEM HIP 132 SECUR-FIX MAX 605 $10,749.00 C1776

STEM HIP 132 SECUR-FIX MAX 605 $10,749.00 C1776

STEM HIP 132 SECUR-FIX MAX 605 $10,749.00 C1776

STEM HIP 132 SECUR-FIX MAX 605 $10,749.00 C1776

ODC-FX CEMENTED HIP #8 6072-08 $1,657.00 C1776

ODC-FX CEMENTED HIP #9 6072-09 $1,657.00 C1776

ODC-FX CEMENTED HIP #10 6072-1 $1,657.00 C1776

UNITRAX C-TAPER SLEEVE 6942-7- $1,093.00 C1776

UNITRAX C-TAPER SLEEVE 6942-7- $1,093.00 C1776

UNITRAX C-TAPER SLEEVE 6942-7- $1,093.00 C1776

UNITRAX MOD. ENDO HEAD 40MM 6 $4,944.00 C1776

UNITRAX MOD. ENDO HEAD 41MM 6 $1,093.00 C1776

UNITRAX MOD. ENDO HEAD 42MM 6 $1,093.00 C1776

UNITRAX MOD. ENDO HEAD 43MM 6 $1,093.00 C1776

UNITRAX MOD. ENDO HEAD 44MM 6 $1,093.00 C1776

UNITRAX MOD. ENDO HEAD 46MM 6 $1,093.00 C1776

UNITRAX MOD. ENDO HEAD 47MM 6 $1,093.00 C1776

UNITRAX MOD. ENDO HEAD 48MM 6 $1,093.00 C1776

UNITRAX MOD. ENDO HEAD 51MM 6 $1,093.00 C1776

UNITRAX MOD. ENDO HEAD 52MM 6 $1,093.00 C1776

UNITRAX MOD. ENDO HEAD 53MM 6 $1,093.00 C1776

UNITRAX MOD. ENDO HEAD 54MM 6 $1,093.00 C1776

UNITRAX MOD. ENDO HEAD 55MM 6 $1,093.00 C1776

UNITRAX MOD. ENDO HEAD 56MM 6 $1,093.00 C1776

UNITRAX MOD. ENDO HEAD 58MM 6 $1,093.00 C1776

SCREW 5.0 CANC. 20MM HCA5200-S $443.00 C1713

SCREW 5.0 CANC. 25MM HCA5250-S $443.00 C1713

SCREW 5.0 CANC. 40MM HCA5400-S $443.00 C1713

SCREW 5.0 CANC. 45MM HCA5450-S $443.00 C1713

SCREW 5.0 CANC. 50MM HCA5500-S $443.00 C1713

SCREW 5.0 CANC. 55MM HCA5550-S $443.00 C1713

SCREW 5.3 CANC. 25MM HCA-L5325 $472.00 C1713

SCREW 5.3 CANC. 30MM HCA-L5330 $472.00 C1713

SCREW 5.3 CANC. 35MM HCA-L5335 $472.00 C1713

SCREW 5.3 CANC. 40MM HCA-L5340 $472.00 C1713

SCREW 5.3 CANC. 45MM HCA-L5345 $472.00 C1713

SCREW 3.5 CORT. 17MM HCO3175-S $443.00 C1713

SCREW 3.5 CORT. 25MM HCO3250-S $443.00 C1713

SCREW 3.5 CORT. 27.5MM HCO3275 $443.00 C1713

SCREW 3.5 CORT. 30MM HCO3300-S $443.00 C1713

SCREW 3.5 CORT. 32.5MM HCO3325 $443.00 C1713

SCREW 3.5 CORT. 35MM HCO3350-S $443.00 C1713

SCREW 3.5 CORT. 40MM HCO3400-S $443.00 C1713

Page 235: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW 3.5 CORT. 45MM HCO3450-S $443.00 C1713

SCREW 3.5 CORT. 50MM HCO3500-S $443.00 C1713

SCREW 3.5 CORT. 55MM HCO3550-S $443.00 C1713

SCREW 3.5 CORT. 60MM HCO3600-S $443.00 C1713

ROD HUM. 8X 220MM HR-0820-S $3,410.00 C1713

ROD HUM. 8X220MM HR-0822-S $3,410.00 C1776

ROD HUM. 8X240MM HR-0824-S $3,410.00 C1776

ROD HUM. 8X260MM HR-0826-S $3,410.00 C1776

ROD HUM. 8X280MM HR-0828-S $3,410.00 C1776

UHR BIOPOLAR 41MM UH1-41-26 $2,591.00 C1776

UHR BIOPOLAR 43MM UH1-43-26 $2,591.00 C1776

UHR BIOPOLAR 44MM UH1-44-26 $2,591.00 C1776

UHR BIOPOLAR 45MM UH1-45-26 $2,591.00 C1776

UHR BIOPOLAR 46MM UH1-46-26 $2,003.00 C1776

UHR BIOPOLAR 47MM UH1-47-26 $2,591.00 C1776

UHR BIOPOLAR 48MM UH1-48-26 $2,591.00 C1776

UHR BIOPOLAR 49MM UH1-49-26 $2,591.00 C1776

UHR BIOPOLAR 50MM UH1-50-26 $2,591.00 C1776

UHR BIOPOLAR 51MM UH1-51-26 $2,591.00 C1776

UHR BIOPOLAR 52MM UH1-52-26 $2,591.00 C1776

UHR BIOPOLAR 53MM UH1-53-26 $2,591.00 C1776

UHR BIOPOLAR 54MM UH1-54-26 $2,591.00 C1776

UHR BIOPOLAR 55MM UH1-55-26 $2,591.00 C1776

UHR BIOPOLAR 56MM UH1-56-26 $2,591.00 C1776

UHR BIOPOLAR 57MM UH1-57-26 $2,591.00 C1776

UHR BIOPOLAR 58MM UH1-58-26 $2,591.00 C1776

UHR BIOPOLAR 61MM UH1-61-26 $2,591.00 C1776

UHR BIOPOLAR 42MM UH1-42-26 $2,084.00 C1713

TRAY CVL BUNDLE CUSTOM $118.00

BINDER ABDOMINAL LG $40.00

BINDER ABDOMINAL XLG $40.00

FORCEP CUTTING GYRUS 10MMX15CM $1,024.00

TROCAR ENDO BALLOON 12X100 $191.00

CONTAINER FORMALIN PREF 480ML $25.00

POUCH LAP TISSUE $183.00

CATH UMBILICAL 2.5FR 12" $59.00

OVAL DOME PATELLA 3-PEG $2,380.00 C1713

XLK CURVED PLUS INSERT $4,955.00 C1713

SP2 PAT PLANER BLDE/CTR DRL SM $503.00

PEEK INTRALINE ANCHOR 5.5MM $658.00 C1713

PLATE VA 2 COLUMN RIGHT $2,349.00 C1713

VA TI LOCKING SCREW 16MM $443.00 C1713

VA TI LOCKING SCREW 18MM $443.00 C1713

VA TI LOCKING SCREW 20MM $443.00 C1713

VA TI LOCKING SCREW 22MM $443.00 C1713

MESH PROCEED OVAL 26X34CM $4,644.00 C1781

SUTURE VICRYL 2-0 27" $28.00

SUTURE VICRYL 3-0 36" VCPB944H $28.00

SUTURE VICRYL 2 27" VCPB417H $28.00

STAPLER CIRCULAR 33MM $766.00

Page 236: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

TROCAR ENDO FIXATION 5MMX100 $120.00

SLEEVE ENDO FIXATION 5MMX100 $27.00

STRATTICE MESH 10X16 1016002 $9,384.00 C1781

STRATTICE MESH 16X20 1620002 $18,450.00 C1781

SOLYX SLING SYSTEM $2,858.00 C1771

BLADE SHAVER ENT 3.5MM $286.00

LEAD TRIAL 50CM $1,428.00 C1778

LEAD TRIAL 70CM $1,428.00 C1778

KIT TRIAL PATIENT $312.00

KIT LEAD ST PERM 50CM $2,946.00 C1778

KIT PROGRAMMER PATIENT $2,142.00 C1787

SYSTEM IPG CHARGING $26,714.00 C1820

STENT CORONARY DES 3.5X18 $4,337.00 C1874

CATH BILIARY DRAIN 8.5FR $261.00

STENT CORONARY COBALT 3X12 $2,130.00 C1876

STENT CORONARY COBALT 3X15 $2,130.00 C1876

BALLOON SPRINTER NC 3.5X12 $427.00 C1727

TRIAL** STENT URETRL SFT 24X7 $256.00 C1874

TRIAL** STENT URETRL SFT 26X7 $256.00 C1874

TRIAL** STENT URETRL SFT 28X7 $256.00 C1874

TRIAL** EXTRACTOR STONE NITINL $554.00

SUTURE GORETEX CV-7 $98.00

PICC DUAL CT 5F - BEDSIDE $551.00 C1751

CATH OCCLUSION PRUITT AORTIC $588.00

MORCELLATOR GYNECARE $1,559.00

GUN EZ-IO 9058V $758.00

NEEDLE PD 15MM 9018V $312.00

NEEDLE LD 45MM 9079V $362.00

STENT URETERAL FIRM 6X24 $256.00 C1874

STENT URETERAL FIRM 6X26 $256.00 C1874

STENT URETERAL FIRM 6X28 $256.00 C1874

BALLOON URETERAL DIA 9X29 $283.00 C1727

BALLOON URETERAL DIA 7X29 $283.00 C1727

GRAFTJACKET 86UM-4X07 $7,365.00 Q4107

ADAPTER TAPER M2A MAGNUM $929.00 C1713

KNEE FEMORAL OXFORD PARTIAL SM $5,643.00 C1776

KNEE FEMORAL OXFORD PARITIAL L $5,643.00 C1776

TIBIAL RT MEDIAL SZ TRAY $3,649.00 C1713

TIBIAL RT MEDIAL TRAY 154725 $3,649.00 C1713

HEAD MOD M2A MAGNUM $3,018.00 C1713

M2A MAGNUM PF CUP US157852 $6,321.00 C1776

BEARING ANATOMIC LEFT SMALL $1,904.00 C1776

BEARING ANATOMIC RT MED SZ $1,904.00 C1776

BEARING ANATOMIC RT LARGE SZ $1,904.00 C1776

BEARING ANATOMIC RT LARGE $1,904.00 C1776

RESECTION OXFORD 3/PK 506124 $1,121.00

FEM FIXATION EZLOC 9-10MM $1,423.00 C1713

TISSUE FIX WASHLOC 16MM $1,217.00 C1713

SCREW CANC 40MM 6MM $557.00 C1713

COMP FEM TRIATHLON CR $5,320.00 C1776

Page 237: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BASEPLATE TIB TRIATHLON $3,394.00 C1713

TIBIALIS POSTERIOR GRAFT $4,265.00 C1762

FIBERWIRE SIZE 4 $75.00 C1713

STEM TAPERLOCK POR EMRL 10X140 $9,845.00 C1713

SILAPT 5MM $1,175.00

TROCAR GELPOINT KIT $1,364.00

o2A MAGNUM 42-50 TPR ADPT $929.00 C1776

o2A MAGNUM 52-60 TPR INSRT $929.00 C1776

MOD HD SZ 48MM MAGNUM $3,018.00 C1776

MOD HD SZ 54MM MAGNUM $3,018.00 C1776

MAGNUM o2A PF CUP $6,321.00 C1713

MAGNUM o2A PF CUP $6,321.00 C1713

SPACER UNIV. DISTAL OSTEONICS $312.00 C1713

SCREW BONE 6.5MM 25MM $331.00 C1713

ANCHOR PEEKZIP SUTURE 5.5 $215.00 C1713

HEMI CLUSTER HOLE CUP TRITANIU $3,269.00 C1713

HEMI CLUSTER HOLE SHELL $3,269.00

TRIATHLON CR FEM COMP $5,320.00 C1776

FEM CR TRITHLON COMP $5,320.00 C1713

BASEPLATE TIB PRIM TRIATHLON $3,394.00 C1713

TRIATHLON CS INS SZ 6 13MM $3,559.00 C1776

TRIATHLON CS INS SZ 4 13MM $3,559.00 C1776

PATELLA TRIATHLON ASYMMETRIC $1,547.00 C1776

PATELLA TRIATHLON ASYMMETRIC $1,945.00 C1776

OMNIFIT EON 132 $5,359.00 C1776

INSERT TRIDENT 36MM $3,171.00 C1776

CEMENT RESTRICTOR MED $366.00

HEAD C-TAPER COCR LFIT $2,011.00 C1713

CATH VISIONS PV 0.018 $1,725.00

CATH VISIONS PV 8.2 $2,142.00

SCREW CANN LOCK 5.0 X 30 $619.00 C1713

SCREW CANN LOCK 5.0 X 35 $619.00 C1713

SCREW CANN LOCK 5.0 X 55 $619.00 C1713

SCREW CANN LOCK 5.0 X 65 $618.00 C1713

SCREW CANN LOCK 5.0 X 70 $619.00 C1713

GUIDE WIRE 2.0 X 230 $148.00 C1769

GUIDE WIRE 2.5 X 200 $206.00 C1769

TIBIAL NAIL STANDARD #1822-103 $4,042.00 C1713

DRILL, AO STERILE 1806-4260S $583.00

END CAP 1822-0005S $583.00 C1713

PROBE LITHOCLAST ULTRA 3.8X403 $1,259.00

PROBE LITHOCLAST PNEUMA 1X570 $589.00

ADVANCED MALE SLING 7200-88-01 $9,946.00 C1771

END CAP 1822-0003S STRYKER $582.00 C1713

TIBIAL NAIL 1882-0931S STRYKER $4,042.00 C1713

HUMERAL CUP $2,826.00 C1776

HUMERAL STEM 130710100 $8,280.00 C1776

GLENOID HEAD 130760038 $4,923.00 C1713

LOCKING SCREW 30MM 130770030 $476.00 C1713

LOCKING SCREW 24MM 130770024 $476.00 C1713

Page 238: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

METAGLENE CENTRAL GUIDE PIN $249.00 C1713

2.5MM DRILL BIT $249.00

3.0MM DRILL BIT $201.00

3.2MM FIXATION PIN $503.00 C1713

CEMENTLESS METAGLENE $3,548.00 C1713

LOCKING SCREW 3600 13790036 $655.00 C1713

LOCKING SCREW 30MM 1307900300 $655.00 C1713

LEAD KIT 60CM LENGTH $4,028.00 C1778

CHARGING SYSTEM $2,154.00

PATIENT PROGRAMMER $2,261.00 C1787

CINCH ANCHOR $189.00

IPG 16 CHANNEL RECHARGEABLE $24,782.00 C1820

800 R ACCESSORY KIT 720066-01 $2,654.00

800 TM CONTROL PUMP WITH IZ 72 $11,640.00 C1815 C1815

PRESS REG BALLOON 72400024 $5,690.00 C1815

S.T. CUFF WITH IZ 72404130 $7,732.00

LOCKING BOLT 3.9 50MM #458.50 $518.00 C1713

TI SPIRAL BLADE FOR HUMERAL NA $1,355.00

TI END CAP FOR SPIRAL BLADE 46 $570.00

2.4MM VA/LCP 6 HOLE DISTAL RAD $2,308.00 C1713

K-WIRE W/TROCAR POINT 285MM 29 $44.00 C1713

K-WIRE $491.00 C1713

WIRE BALL $577.00 C1713

DRILL $577.00

WIRE SMOOTH $577.00 C1713

NAIL HUMERAL $4,106.00 C1713

SCREW COMPRESSION $572.00 C1713

END CAP $572.00 C1713

SCREW 1896-4026S $572.00 C1713

SCREW 1891-4045S $572.00 C1713

LOCKING SCREW 04.210.112 $443.00 C1713

LOCKING SCREW 04.210.114 $443.00 C1713

M2A-MAGNUM MODULAR HEAD 50M $3,018.00 C1776

M2A-MAGNUM PF CUP 56ODX501D $6,321.00 C1776

IPG 16 CHANNEL $23,933.00 C1820

HUMERAL OFFSET HEAD 5352-4521 $3,734.00 C1776

HUMERAL COMPONENT 14MM $6,981.00 C1776

PEGGED GLENOID COMPONENT 5361 $3,459.00 C1713

SCREW MILAGNA INTER 12X30 $744.00 C1713

SCREW MILAGNA INTER 11X30 $744.00 C1713

SCREW MILAGNA INTER 10x30 $744.00 C1713

SCREW MILAGNA INTER 9x30 $744.00 C1713

SCREW MILAGNA INTER 8x30 $744.00 C1713

SUTURE ANCHOR MIN HARPOON $816.00 C1713

SUTURE MONOFILAMENT STEEL $31.00

ANCHOR MINI LOCK PLUS #2 $575.00 C1713

BLADE BUR ROUND 3.2 TPS $166.00

BLADE BUR ROUND 4.8 TPS $166.00

BLADE BUR ROUND 6.3 TPS $161.00

BLADE BUR EGG 5.0 TPS $147.00

Page 239: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

MEDI-DUCT OCULAR FLUID $45.00

END-CAP TITAN 458.120 $446.00 C1713

TRIATHLON CR FEM COMP $5,320.00 C1776

TIB BASEPLASTE PRIM TRI $3,393.00 C1776

TRITHLON CS INS SZ5 11M $3,559.00 C1713

ENDO SMART CAP-OLYMPUS $58.00

ENDO GATOR-IRRIGATION $61.00

SLING SUPRIS SUPRAPUBC $1,904.00 C1771

PLATE 12HOLE DCS 281.92 $2,633.00 C1713

WRAP & COLD PACK SHOULDER $151.00

INTERSPACE KNEE #SPK0121 $6,665.00 C1713

TROCAR SILS 5.12MM $1,231.00

HEAD HIP 26MM $1,486.00 C1776

HEAD HIP LFIT 36MM $2,942.00 C1776

HEAD HIP LFIT 40MM $2,942.00 C1776

HEAD HIP LFIT 40MM $2,942.00 C1776

CENTRALIZER HIP CEMENT $312.00

HEAD HIP CERAMIC 36MM $3,051.00 C1776

CUP HIP TRITDENT PSL PRIM $3,270.00 C1713

STEM HIP SECUR-FIT PLS MX $8,467.00 C1776

LINER HIP X3 40MM $3,218.00 C1713

LINER HIP CERAMIC 36MM $3,504.00 C1713

SLEEVE HIP UNITRAX $430.00 C1713

FEMUR KNEE CR TRIATH $5,320.00 C1776

FEMUR KNEE PS TRIATH $3,968.00 C1776

INSERT KNEE X3 CS TRIATH $3,559.00 C1776

INSERT KNEE CA TRIATH $3,559.00 C1776

INSERT KNEE X3 PS TRIATH $3,717.00 C1776

INSERT KNEE PS TRIATH $2,820.00 C1776

PATELLA KNEE ASYM X3 TRIATH $1,945.00 C1776

COMPONENT KNEE FEMUR PKR $5,047.00 C1776

COMPONENT KNEE TIBIAL PKR $3,115.00 C1776

INSERT KNEE POLY TRIATH $2,113.00 C1776

HEAD SHOULDER SOLAR 22MM $2,058.00 C1776

COMPONENT SHOULDER SOLAR BIPL $3,980.00 C1776

HEAD SHOULDER HUMERAL SOLAR $3,339.00 C1776

STEM SHOULDER HUMERAL SOLAR $6,981.00 C1776

STEM SHLDR HUMERAL REUNION FX $7,194.00 C1776

BONE PLUG SHOULDER $312.00

SCREW HERBERT #16 $666.00 C1713

FEMUR KNEE CR TRATH $5,320.00 C1713

PATELL KNEE ASYM X3 TRIATH $1,547.00 C1776

INSERT KNEE CS TRIATH SZ 5 13M $2,932.00 C1776

OXFORD UNICOMP KNEE MEN BEARIN $1,904.00 C1776

OXFORD PART KNEE MEN BEAR $1,904.00 C1776

BIOCOMPOSITE INTER SCREW 7MM $899.00 C1713

INTERERENCE SCREW FULLY THREAD $899.00 C1713

LOW PROFILE REAMER 10MM $706.00

GRAFT HARVESTING KIT $478.00

TRANSTIBIAL ACL DISP KIT $732.00

Page 240: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BONE PLUG 12.5MM STRYKER $312.00

HUMERAL STEM REUNION #9 STRYKE $7,194.00 C1776

TIGHTROPE SYNDESMOSIS REP KIT $1,155.00 C1713

PLATE 6 HOLE DISTAL HUMERUS SY $3,082.00 C1713

PASSER CATH 38CM $308.00

FIBERLOOP #2 AR-7234 $173.00 C1713

WIRE SUTURE PASSING $236.00

MENISCAL CINCH AR-4500 $732.00

KNOT PUSHER/SUTURE 2-O FIBERWI $393.00 C1713

LOW PROFILE REAMER 8MM AR-1408 $706.00

CANNULA AORTIC ARCH STR 7.0 $181.00

FEMORAL NAIL 12X400 STRYKER $4,088.00 C1713

SCREW CANCELLOUS 8MMX46MM W $500.00 C1713

GAMMA NAIL TI R 011X360MMX125 $5,095.00 C1713

PICC SINGLE CT 4F $551.00 C1751

NEEDLE VARIJECT CONTRAST THERA $230.00

CATH THORACIC 8 FR $43.00

STENT CORONARY VISION 2.25x15 $2,089.00 C1874

SCREW CENTRAL 6.5MM $472.00 C1713

GLENOSPHERE COMP SHOULDER REV $3,362.00 C1713

BASEPLATE GLENOSPHERE SHLDER R $3,498.00 C1713

SCREW FIX LK 4.75X15MM $475.00 C1713

SCREW FIX LK 4.75X20MM $475.00 C1713

SCREW FIX LK 4.75X35MM $475.00 C1713

SCREW FIX LK 4.75X30MM $475.00 C1713

TRAY REV HUMERAL SHLDR 44MM RI $3,834.00 C1713

STEM SHOULDER MIN LENGTH $9,071.00 C1776

SYSTEM SHOULDER VERSA-DIAL $569.00 C1713

BEARING HUMERAL SHOULDER REV $2,458.00 C1713

HUMERAL HEAD 40/12 $3,339.00 C1776

HUMERAL STEM 10MM $6,981.00 C1776

MENISCAL BEARING SM RT 4MM OXF $1,904.00 C1776

MEDIAL TIBIAL TRAY OXFORD SZ A $3,649.00 C1776

CEMENT BONE SPEEDSET $468.00 C1713

SCREW CANCELLOUS 60 X 6 $557.00 C1713

DAVINCI MANIP UTERINE VCARE SM $249.00

MILD LUMBAR DECOMP KIT $6,500.00

TRIATHLON TIBIAL BASEPLATE #7 $3,393.00 C1776

TRIATHLON CRU RETAIN FEM #7 $5,320.00 C1776

TRIATHLON PATELLA SZ A38 $1,945.00 C1776

TRIATHLON TIB BEARING SZ 7 $3,559.00 C1776

SUTURE PROLENE 2-0 SH8533H $27.00

RIM INSERT ELEVATED $3,006.00 C1776

SERCU-FIT NECK ANGEL STEM $8,467.00 C1776

C-TAPER FEMORAL HEAD $2,011.00 C1713

SCREW CANCELLOUS BONE $287.00 C1713

HEMISPHERICAL CLUSTER SHELL $3,270.00 C1776

POLYETHYLENE INSERT $3,006.00 C1713

OMNIFIT HEAD/NECK HIP STEM $5,799.00 C1776

TIBIAL NAIL 8X360 $4,042.00 C1713

Page 241: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW LOCKING 4.0X45 $582.00 C1713

END CAP #1822-0010S $582.00 C1713

SMOOTH TIP GUIDE 3.0X800 $603.00 C1713

TEFLON TUBE 1806-0073S $760.00

DRILL BIT AO 1.9 X 87 $399.00

K-WIRE OLIVE STOP #56-40281 $112.00 C1713

SCREW BONE 2.7 X 12 $393.00 C1713

SCREW BONE 2.7 X 16 $393.00 C1713

SCREW BONE 2.3 X 14 $456.00 C1713

LOCKING SCREW 2.3 X 16 $456.00 C1713

VOLAR PLATE RIDE UNIV $2,011.00 C1713

HUMERAL HEAD 40 X 18 $3,734.00 C1776

MESH PERMACOL BIOLGC 10X10X1.0 $4,440.00 C9364

ROTICULATING DISSECTOR $284.00

TRIDENT POLY INSERT #623-00-40 $3,218.00 C1776

SCREW BONE CANC #2030-6535-1 $304.00 C1713

HEMI CLUSTER HOLE SHELL $3,270.00 C1713

SECUR-FIT HIP STEM $8,467.00 C1776

C-TAPER FEMORAL HEAD $2,942.00 C1713

2.4 LOCK SCREW 20MM 04.210.120 $443.00 C1713

2.4 VA VOLAR PLATE 7H 04.111.7 $2,308.00 C1713

4.5MM LCP PROX FEMUR PLATE $3,422.00 C1713

5.0 CANNULATED LOCKING SCREW $618.00 C1713

7.3 CANNULATED CONICAL SCREW $668.00 C1713

73. CAN LOCK SCREW 02.207.090 $746.00 C1713

7.3 CAN LOCK SCREW 02.207.095 $746.00 C1713

STENT ESOPHAGEAL COVER 95CM $4,543.00 C1874

STENT ESOPH POLYFLEX 90CM $4,543.00 C1874

STENT ESOPH POLYFLEX 90MM $4,543.00 C1874

STENT TRANSBRONCHIAL NC 100CM $4,244.00 C1876

STENT TRANSBRONCHIAL NC 100CM $4,244.00 C1876

STENT TRANSBRONCHIAL NC 100CM $4,244.00 C1876

STENT TRANSBRONCHIAL COV 100CM $4,244.00 C1874

STENT TRANSBRONCHIAL COV 100CM $4,244.00 C1874

STENT TRANSBRONCHIAL COV 100CM $4,244.00 C1874

RADIESSE VOICE GEL $758.00 C1878

TRIATHLON CEMENTED STEM $2,313.00 C1776

TRIATHLON CRUCIATE RETAIN FEMO $5,320.00 C1776

TRIATHLON UNIV TIBIAL BASEPLAT $5,180.00 C1776

TRIATHLON TIBIAL BEARING INSER $3,559.00 C1776

SCREW CANCELLOUS BONE $287.00 C1713

HEMISPERICAL CLUSTER HOLE SHEL $3,270.00 C1776

TRIATHLON TIBIAL BEARING $3,559.00 C1776

TRIATHLON CRUC RETAIN FEMORAL $5,320.00 C1776

TRIATHLON ASYM PATELLA $2,084.00 C1776

TRIATHLON TIBIAL BEAR INSERT $3,559.00 C1776

LOCKING INSERT 4.0 #370002 $183.00 C1713

PLATE HUM PROX AXSOS 8 HOLE $3,758.00 C1713

SCREW LOCKING 4.0 X 24 $453.00 C1713

SCREW LOCKING 4.0 X 42 $453.00 C1713

Page 242: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW LOCKING 4.0 X 30 $453.00 C1713

SCREW LOCKING 4.0 X 40 $453.00 C1713

SCREW CORTICAL 3.5 X 26 $96.00 C1713

SCREW LOCKING 4.0 X 22 $453.00 C1713

SCREW CORTICAL 3.5 X 22 $96.00 C1713

K-WIRE 2.0 X 150 #390192 $38.00 C1713

SCREW LOCKING 4.0 X 35 $582.00 C1713

TIBIAL NAIL 8.0 X 300 T2 $4,042.00 C1713

SCREW CANULATED 8.0 X 85 $770.00 C1713

SCREW CANNULATED 8.5 X 90 $770.00 C1713

AO END DRILL 2.5 X 125 $450.00

AO DRILL BIT 3.1 X 204 $412.00

BEARING KNEE MENISCAL MD 7MM $1,904.00 C1713

PERITONEAL PLEUREX CATH KIT $1,221.00 C1729

TUBE RECTAL / COLON 18FR 20" $103.00

PICC 5FR INTRO BEDSIDE $112.00 C1751

SCREW CORTEX 2.7 #402.022 $179.00 C1713

SCREW CORTEX 2.7 #402.024 $179.00 C1713

SCREW CORTEX 2.7 #402.016 $179.00 C1713

SCREW CORTEX 2.7 #402.012 $179.00 C1713

SCREW CORTEX 2.7 #402.026 $179.00 C1713

SCREW CORTEX 2.7 #402.018 $179.00 C1713

SCREW CORTEX 2.7 #402.020 $179.00 C1713

MENISCAL BEARING LG BIOMET $3,649.00 C1776

MENISCAL BEARING MD BIOMET $1,904.00 C1776

MENISCAL BEARING SM BIOMET $1,904.00 C1776

SCREW BIO-CORKSCREW ANCHOR $847.00 C1713

PLATE LCP 4.5MM 8H $3,634.00 C1713

SCREW CANN CONICAL 5.0 02.205. $570.00 C1713

SCREW CANN CONICAL 5.0 02.205. $570.00 C1713

BEARING INSERT KNEE TIB TRIATH $3,559.00 C1713

NAIL GANNA LONG 11 X 380 $5,095.00 C1713

PROSTATE ICE-ROD CRYO-NEEDLE K $8,560.00 C2618

PROSTATE ICE-SEED CRYO-NEEDLE $8,560.00 C2618

RENAL ICE-ROD CRYO-NEEDLE KIT $10,620.00 C2618

TRIA TIBIAL INSERT 5531-G-609 $3,559.00 C1776

TRIA PATELLA COMP 5551-G-350 $1,945.00 C1776

ABSORBATACK 5MM #ABSTACK20 $1,426.00 C1713

TRIATHLON FEMUR KNEE PS #3 $5,371.00 C1776

TRIATHLON KNEE INSERT PS #3 $3,717.00 C1776

TRIATHLON FEMUR KNEE TIB #2 $4,518.00 C1776

TRIATHLON KNEE INSERT #4 $3,559.00 C1776

HYDROSET CEMENT 5CC $4,003.00 C1713

HYDROSET CEMENT 10CC $6,232.00 C1713

GRAFT VASCULAR ULTRAMAX 8X100 $1,226.00 C1768

BIOMET OX PART KNEE ANA BEAR $1,904.00 C1713

BIOMET ORTHO, CUT BLADES $1,361.00

OPTIVAC FUSION KIT BIOMET $424.00

SCREW LOCKING CAN 5.0 $530.00 C1713

SCREW CANN LOCK 5.0 X 85 $550.00 C1713

Page 243: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CANN LK 7.3 X 85 $794.00 C1713

DRILL BIT CANN 5.0 $901.00

T PLATE 2.7 #249.685 $1,784.00 C1713

SCREW NON-LOCKING LG 18 $476.00 C1713

HEAD GLENOID 38MM $4,414.00 C1776

STEM SZ 1/DIA 12 $8,280.00 C1776

CEMENT PLUG SIZED $312.00 C1713

TENDON SEMITENDINOSUS SHORT $2,058.00 C1762

CUP HUMERAL STAND PE $2,743.00 C1713

DISTAL CLAVICLE PLATE 12 HOLE $2,035.00 C1713

SCREW CORTICAL 3.5 X 12 MM $235.00 C1713

SCREW CORTICAL 3.5 X 14 MM $189.00 C1713

SCREW CORTICAL 3.5 X 18 MM $189.00 C1713

SCREW CORTICAL 3.5 X 20 MM $189.00 C1713

SCREW LOCKING 3.5 X 12 MM $277.00 C1713

SCREW LOCKING 3.5 X 14 MM $277.00 C1713

SCREW LOCKING 3.5 X 18 MM $360.00 C1713

HUMERAL STAND PE CUP $2,826.00 C1776

SCREW LOCKING 4.5 X 24 $655.00 C1713

LEAD TRIAL ELECTRODE 60 CM $1,428.00 C1778

SPIKED WASHER 13.5 MM X 5.5 MM $393.00

SPIKED WASHER 13.5 MM X 4.0 MM $401.00

RETRACTOR WILSON IMPLANT KIT $693.00

HEAD MAGNUM M2A MOD 52MM $3,018.00 C1713

MAGNUM PF CUP M2A 58 MM X 52M $6,321.00 C1713

SCREW CANCELLOUS BONE 6.5 $304.00 C1713

POLYETHYLENE INSERT $3,006.00 C1713

SECUR-FIT HIP STEM $8,467.00 C1776

CERAMIC C-TAPER FEMORAL HEAD $3,324.00 C1713

HEMASHIELD PLAT FIN CARDIO PAT $320.00 C1768

K-WIRE 9" 5/64 3811-1-090 $65.00 C1713

K-WIRE 9" 5/32 3596-6-090 $119.00 C1713

REABSORBABLE SLEEVE $539.00 C1713

SCREW LOCKING 5.0MM TI T25 50M $555.00 C1713

SCREW LOCKING 5.0MM TI T25 34M $555.00 C1713

END CAP 0 MM $518.00 C1713

SCREW LOCKING 5.0 EXT 32MM $603.00 C1713

SCREW LOCKING 5.0 EXT 44MM $603.00 C1713

DRILL BILL CALIBRATED 4.2 $587.00

DRILL BIT 3.9/4.2 $586.00

SCREW LOCKING 36MM $635.00 C1713

LEAD PERMANENT 70CM $2,860.00 C1778

COUDE NEEDLE SC-4210 $221.00

HUMERAL STEM TI 10/125MM $7,339.00 C1713

ECCENTER TI #5413-20/5 $1,268.00 C1713

COCR HEAD 46 MM / 17.25 MM $4,954.00 C1713

NEEDLE CABLE W/CLAMP 1.0 MM TI $1,289.00

IPG 16-CHANNEL RECHARG 3716 $22,465.00 C1820

CHARGING SYSTEM RECHARG 3701 $1,548.00

SPLINT FOOT DROP X-LG $171.00

Page 244: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STENT XIENCE DRUG 100953908 $3,910.00 C1874

TIBIAL NAIL TI 10MM X 315MM $3,348.00 C1713

SCREW LOCKING 28 MM $603.00 C1713

SCREW LOCKING 36 MM $603.00 C1713

END CAP 0 MM $518.00 C1713

FIBERWIRE AR-7201 $134.00 C1713

SCORPION NEEDLE AR-1399ON $440.00

BIO SWIVELOCK 4.75 $975.00 C1713

SUTURE BRIDGE ACHILLES PACK $2,792.00 C1713

STENT VIABAHN 5 X 15 $7,430.00 C1874

STENT VIABAHN 6 X 15 $7,500.00 C1874

SCREW CORTICAL 3.5 X 36 $96.00 C1713

SCREW CORTICAL 3.5 X 38 $96.00 C1713

SCREW CORTICAL 3.5 X 40 $96.00 C1713

SCREW CORTICAL 3.5 X 30 $96.00 C1713

SCREW LOCKING 4.0 X 28 $478.00 C1713

SCREW LOCKING 4.0 X 32 $478.00 C1713

SCREW LOCKING 4.0 X 60 $478.00 C1713

SCREW LOCKING 4.0 X 38 $478.00 C1713

SCREW LOCKING 4.0 X 48 $478.00 C1713

PLATE TIBIAL DIS MED 6HOLE $3,628.00 C1713

K-WIRE 1.5 X 150 #390164 $33.00 C1713

DRILL BIT AO 3.5 X 180 $575.00

POST OP SHOE MALE XL IS $40.00

POST OP SHOE FEMALE XL IS $40.00 A9270

GUIDEWIRE .045 X 4 D-PT $85.00 C1769

LEAD KIT 30CM #3183 $4,028.00 C1778

TIBIAL BEARING INSERT TI $3,559.00 C1776

SCREW CANCELLOUS 6.5 X 16 $287.00 C1713

ELEVATED RIM INSERT $3,006.00 C1713

NECK ANGLE HIP STEM $8,467.00 C1713

C-TAPER FEMORAL HEAD $2,011.00 C1713

SCREW LOCKING 4.0 X 40 $582.00 C1713

TIBIAL BASEPLATE PRIMARY TI $3,393.00 C1776

SUTURE PDS II 7-0 24" Z155H $28.00

TUBING HEATED INSUFFLATION $147.00

CANCELLOUS-CRUSHED GRAFT 30 CC $1,155.00 C1713

TIBIAL BEARING INSERT TI $3,559.00 C1776

SYMMETRIC PATELLA TI $1,545.00 C1776

TIBIAL BEARING INSERT TI $3,559.00 C1776

SCREW LOCKING 2.3 X 12 $456.00 C1713

SCREW LOCKING 2.3 X 18 $456.00 C1713

SCREW LOCKING 2.3 X 22 $456.00 C1713

SCREW BONE 2.3 X 12 53-23212E $312.00 C1713

VOLAR RADIUS PLATE, NARROW $2,440.00 C1713

PASSPORT BUTTON CANNULA $123.00

GRAFTJACKET PER 1 SQ CM $6,210.00 Q4107

PERMACOL MESH 5 X 5 X 1 $1,224.00 C9364

PERMACOL MESH 3 X 8 X 1 $1,399.00 C9364

PERMACOL MESH 5 X 10 X 1 $2,440.00 C9364

Page 245: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PERMACOL MESH 10 X 15 X 1.5 $6,679.00 C9364

PERMACOL MESH 15 X 20 X 1.5 $13,038.00 C9364

TIBIAL RT MEDIAL TRAY $3,649.00 C1713

MESICAL PARTIAL BEARING KNEE 4 $1,904.00 C1713

FEMORAL CRUT RETAIN TI $5,371.00 C1713

TIBIAL BEARING INSERT TI $3,164.00 C1776

SCREW MILAGRO INTERFE 10 X 30 $929.00 C1713

IMPLANT SPINAL FUSION STIM $13,576.00

MINI IGNITE POWER MIX 4CC $3,894.00 C1713

SCREW CORTEX 1.3MM X 7MM $255.00 C1713

SCREW CORTEX 1.3MM X 9MM $255.00 C1713

SCREW CORTEX 1.3MM X 10MM $255.00 C1713

SCREW CORTEX 1.3MM X 11MM $255.00 C1713

SCREW CORTEX 1.3 X 13MM $255.00 C1713

FEMORAL NAIL T2 SYS 1825-1140S $4,152.00 C1713

FILTER MILLIPORE STERIVEX $23.00

BEARING TIBIAL INSERT SCORPIO- $4,088.00 C1713

SECURA VR DEFI D224VRC $29,809.00 C1722

ASSEMBLY PROBOSCIS/PISTON $872.00

PLATE DISTAL FEMORAL 10 HOLE $4,972.00 C1713

SCREW CANC PT 6.5 X 80 $175.00 C1713

SCREW CORTICAL 4.5 X 50 $123.00 C1713

SCREW LOCKING 5.0 X 95 $568.00 C1713

SCREW LOCKING 5.0 X 85 $568.00 C1713

ABDOMEN WOUND VAC KCI $42.00

TIBIAL INSERT TRIATHLON $2,113.00 C1713

TIBIAL BEARING INSERT TRIATHLO $3,717.00 C1776

FEMORAL STABILIZED POST TRIA $5,371.00 C1713

SHAFT SCREW DRVER T6 $1,229.00

PLATE COMPRESS 6HOLE $1,145.00 C1713

SCREW CORTEX 2.0 T6 $146.00 C1713

SCREW CORTEX 2.0 T6 $133.00 C1713

SCREW CORTEX 2.0 T6 $137.00 C1713

SCREW CORTEX 2.0 T6 $133.00 C1713

SCREW CORTEX 2.0 T6 $137.00 C1713

SCREW CORTEX 2.0 X 6 $137.00 C1713

SCREW CORTEX 2.0 T6 $137.00 C1713

SCREW CORTEX 2.0 T6 $133.00 C1713

SCREW CORTEX 2.0 T6 $133.00 C1713

SCREW CORTEX 2.0 T6 $149.00 C1713

ESSURE BIRTH CONTROL $2,930.00 A4649

PLATE CLAVICLE 7HOLE $1,488.00 C1713

PATIENT PROGRAMMER #3037 $2,771.00 C1787

NEUROSTIMULATOR #3058 $20,879.00 C1767

LEAD SNS #3093 $6,582.00 C1897

LEAD INTRODUCER KIT #3550-18 $718.00 C1894

ANTENNA # 37092 $252.00

TIBIAL BASEPLATE #2 $3,393.00 C1776

ANCHOR BIO-CORKSCREW $847.00 C1713

PLATE VARIAX ELBOW MED $2,701.00 C1713

Page 246: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW LOCKING 2.7 X 22 $607.00 C1713

SCREW LOCKING 2.7 X 26 $607.00 C1713

SCREW LOCKING 2.7 X 24 $607.00 C1713

SCREW LOCKING 2.7 X 16 $607.00 C1713

SCREW LOCKING 2.7 X 16 $607.00 C1713

SCREW LOCKING 2.7 X 20 $607.00 C1713

SCREW ASNIS III $782.00 C1713

MATRIX HEMOSTAT FLOSEAL $849.00

NAIL RECON T2 9X340 $5,122.00

HUMERAL ST PE CUP $2,826.00 C1776

BONE CEMENT CMW 2, 20GM $315.00 C1713

ANCHOR ABSORBATACK 10 $850.00 C1713

PLATE LEFT VOLAR RADIUS $2,440.00 C1713

SCREW LOCKING TI 14MM $347.00 C1713

SCREW LOCKING TI 18MM $347.00 C1713

SCREW LOCKING TI 20MM $347.00 C1713

SCREW BONE TI 16MM $293.00 C1713

K-WIRE 3.2 #702627 $221.00 C1713

DRILL BIT 4.9 #702601 $1,250.00

SCREW LOCKING 5.0 ANGULAR 38MM $555.00 C1713

SCREW LOCKING 5.0 ANGULAR 32MM $555.00 C1713

SCREW LOCKING 5.0 ANGULAR 42MM $555.00 C1713

SCREW LOCKING 5.0 ANGULAR 46MM $555.00 C1713

END CAP 15MM STANDARD $545.00 C1713

GLENOID COMP SOLAR PEGGED $3,459.00 C1713

HUMERAL OFFSET HEAD SOLAR $3,734.00 C1776

HUMERAL COMPONENT SOLAR $6,981.00 C1776

GUIDE WIRE ASNIS III $184.00 C1769

DRILL BIT AO 2.0 END $544.00

TIBIAL BEARING INSERT $2,932.00 C1776

PEGGED GLENOID COMPONENT $3,459.00 C1713

HUMERAL OFFSET HEAD $3,549.00 C1776

SCREW #611095 $770.00 C1713

SCREW #611105 $770.00 C1713

SCREW #611110 $770.00 C1713

DRILL BIT 2.0 AO SHAFT END $252.00

PLATE VOLAR STD UNIVERSAL $1,525.00 C1713

SCREW LOCKING 2.3 X 18 $347.00 C1713

SCREW LOCKING 2.3 X 14 $347.00 C1713

SCREW LOCKING 2.3 X 12 $347.00 C1713

SCREW LOCKING 2.3 X 10 $347.00 C1713

SCREW LOCKING 2.7 X 12 $347.00 C1713

PLATE ULNAR COLUMN $1,688.00 C1713

K-WIRE 1.1 X 160 $112.00 C1713

SCREW LOCKING 3.5 $404.00 C1713

LEAD KIT MEDTRONIC $5,243.00 C1778

PATIENT PROGRAMMER MEDTRONIC $2,771.00 C1787

RESTORE PRIME STIM NON-CHARG $26,544.00 C1767

TRIATHLON CR RET FEMORAL $5,320.00 C1776

TRIAT TIBIAL BEAR INSERT $3,559.00 C1776

Page 247: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CORTEX 2.0 SELF TAP $196.00 C1713

INTRATHECAL CATH INDURA $1,571.00 C1755

SYNCHROMED II PUMP MEDTRONIC $21,909.00 C1772

ACCESSORY KIT MEDTRONIC $299.00

PLATE 2.0 LCP 7 HOLE $1,952.00 C1713

GUIDE DRILL THRD 1.5 $322.00

MESH STRATTICE 6 X 16 $5,590.00 C1781

PLATE UNIV DISTAL RADIUS $2,011.00 C1713

SCREW LOCKING 2.7 52-27610 $347.00 C1713

SCREW LOCKING 2.7 52-27616 $347.00 C1713

SCREW BONE 2.7 52.27012 $293.00 C1713

APPLIED TROCAR SLEEVE $27.00

BILAYER MATRIX WND PER SQ CM $5,296.00 Q4108

STEM HIP SECURE-FIT MAX $8,467.00 C1776

STONE CATCHER W/TUBING $244.00

TIBIAL TRAY LT MEDI OXFORD $3,649.00 C1713

BEARING MENISCAL SM LT 3MM $1,904.00 C1713

MESH POUCH 8590-1 MEDTRONIC $267.00

AMS 700 ACCESSORY KIT $1,224.00

AMS 700 RESERVIOR $3,367.00 C1813

AMS 700 CX, MS PUMP $14,532.00 C1813

PLATE LT DISTAL RADIUS $2,396.00 C1713

SCREW CORTEX 2.7 X 14 $183.00 C1713

SCREW CORTEX 2.7 X 22 $183.00 C1713

SCREW CORTEX 2.7 X 12 $183.00 C1713

SCREW CANN CON 5.0 X 95MM $570.00 C1713

PLATE PROX FEMUR 6 HOLE $3,421.00 C1713

SCREW LOCK CANNUL 7.3 65MM $783.00 C1713

PLATE DISTAL RADIUS LT $2,476.00 C1713

R/H MALLORY/HEAD MODULAR $6,005.00 C1713

M2A MAGNUM TAPER ADAPTER $929.00 C1776

STEEL CABLE STAINLESS $780.00 C1713

2.0 STAIN STEEL CABLE SYSTEM $546.00 C1713

MODULAR REACH METAPHYSEAL $12,902.00 C1713

DILATOR BALLOON URET 5FR 65CM $609.00

T2 RECON NAIL 9 X 340 $5,276.00 C1713

PS FEMUR SIZE 4 $5,371.00 C1776

PS INSERT SIZE 5/22MM $2,820.00 C1776

MODULAR PEGS $841.00

DRILL BIT AO 2.7 X 102 $425.00

PLATE FIBULA VARIAX 3 HOLE $1,514.00 C1713

SCREW BONE 3.5 X 22 $236.00 C1713

SCREW BONE 3.5 X 14 $236.00 C1713

SCREW BONE 3.5 X 16 $236.00 C1713

SCREW BONE 3.5 X 10 $236.00 C1713

SCREW BONE 3.5 X 20 $236.00 C1713

SCREW BONE 3.5 X 18 $236.00 C1713

DRILL BIT AO 3.5 X 122 $425.00

NAIL TIBIA 10 X 375 $4,042.00 C1713

SCREW BONE 3.5 X 12 $236.00 C1713

Page 248: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

WIRE GUIDE 3 X 1000 $629.00 C1769

BEARING KNEE UNICOM MD 9MM $1,904.00 C1713

BEARING KNEE MEN MD 5MM $1,904.00 C1713

PLATE FIBULA VARIAX 7 HOLE $1,647.00 C1713

SCREW BONE 2.7MM TI $293.00 C1713

SCREW LOCKING 2.3MM TI $347.00 C1713

GUIDE NEEDLE PICC 21G $74.00

STIMULATOR IMPLANT SPF-XL $12,846.00

POWERLINK SYS W/INTUITRACK $6,283.00 C1874

POWERLINK SYS W/INTUITRACK $22,149.00 C1874

SNARE TRIPLE LOOP $770.00

TEAR AWAY SHEATH $299.00 C1892

DUAL LUMEN CATHETER $577.00 C1751

WIRE STIFF AORTIC 4804 $503.00

BASEPLATE TIBIAL TRI UNIV $4,518.00 C1713

BASEPLATE TIBIAL TRI $4,518.00 C1713

FEMORAL RETAINING CRUCIATE TI $5,320.00 C1713

BEARING TIBIAL INSERT TRI $3,559.00 C1713

BEARING TIBIAL INSERT $3,559.00 C1713

NAIL LONG GAMMA $4,946.00 C1713

SCREW BONE TI 18MM $293.00 C1713

BASEPLATE TIBIAL TRI UNI $5,180.00 C1713

CLUSTER HOLE SCHELL TRIT HEMIS $4,312.00 C1713

MEDTRONIC WRENCH $156.00

FEMORAL HEAD C-TAPER 40MM $2,942.00 C1713

SCREW PLATE GAP REST 6.5MM $314.00 C1713

PLATE CLAVICAL DISTAL LT 9 HOL $2,035.00 C1713

SCREW CORTICAL 2.7MM X 22MM $189.00 C1713

SCREW CORTICAL 3.5MM X 10MM $189.00 C1713

SCREW LOCK CORT 3.5MM X 10MM $277.00 C1713

SCREW LOCK CORT 3.5MM X 16MM $277.00 C1713

DRILL BIT 2MM X 5 QUICK RELEAS $177.00

BEARING INSERT TIBIAL TRIATH $2,932.00 C1713

FEMORAL RETAIN CRUCIATE TRIATH $5,320.00 C1713

BEARING INSERT TIBIAL TRIATH $2,932.00 C1713

BASEPLATE TIBIAL TRIATHLON $3,393.00 C1713

CATHETER BALL DILA DORADO PTA $718.00 C1727

GUIDEWIRE HYDROPHILIC $192.00 C1769

PLATE 1/3 TUBULAR 8 HOLE $236.00 C1713

SCREW CORTICAL 3.5 X 12 $96.00 C1713

SCREW CORTICAL 3.5 X 14 $96.00 C1713

SCREW CORTICAL 3.5 X 16 $96.00 C1713

SCREW CORTICAL 3.5 X 18 $96.00 C1713

SCREW CORTICAL 3.5 X 20 $96.00 C1713

SCREW CANCELLOUS 4.0 X 36 $96.00 C1713

DRILL BIT 3.5 X 125 $450.00

PLATE VOLAR LCP 2.4 $2,396.00 C1713

SCREW ANSIS 6.5 X 85 $821.00 C1713

SCREW ANSIS 6.5 X 95 $821.00 C1713

BEARING TIBIAL KNEE INSERT $3,559.00 C1713

Page 249: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CLAMP 5HOLE MULTI PIN $1,833.00 C1713

STRAIGHT POST #4921-2-120 $528.00 C1713

90 DEG ANGLED POST $629.00 C1713

ROD TO ROD COUPLING $1,744.00 C1713

CONNECTING ROD MRI 350MM $1,032.00 C1713

CONNECTING ROD MRI 300MM $1,032.00 C1713

APEX PIN 5X150MM $506.00 C1713

TRANSIXING PIN 4/5X250MM $366.00 C1713

PLATE TIBIA PROX 12 HOLE $3,323.00 C1713

SCREW CANCELLOUS 4.0 X 65 $96.00 C1713

SCREW LOCKING 4.0 X 80 $478.00 C1713

SCREW LOCKING 4.0 X 75 $478.00 C1713

SCREW LOCKING 4.0 X 70 $478.00 C1713

SCREW LOCKING 4.0 X 26 $478.00 C1713

AO DRILL BIT 3.1 X 285 $644.00

AO DRILL BIT 2.5 X 285 $644.00

HEAD HIP LFIT 26MM $2,582.00 C1776

PLATE DIST RAD LCP $2,396.00 C1713

BURR OPHTHALMIC 1MM $37.00

2.0 x 450MM WIRE $267.00 C1713

RING POST LONG $995.00

RING CLAMPS $1,278.00

OPEN RING 180 MM $1,680.00

GRAFT GORTEX RINGED 8 X 100 $3,797.00 C1768

SCREW LOCK 2.7 $347.00 C1713

BEARING TIBIAL TRIATH INSERT $3,559.00 C1713

SECUR-FIT HIP STEM $8,467.00 C1776

SCREW CORTEX 2.7 X 14 $179.00 C1713

SCREW CORTEX 2.4 X 20 $266.00 C1713

SCREW CORTEX 2.4 X 24 $266.00 C1713

K-WIRE .062X4 $85.00 C1713

NAIL SUPRACONDYLAR 14X320 $5,256.00 C1713

SECUR-FIT PLUX HIP STEM $8,467.00 C1776

SPLINT WRIST COCKUP RAD BAR SM $36.00

SPLINT WRIST COCKUP RAD BAR MD $38.00

SPLINT WRIST COCKUP RAD BAR LG $42.00

NAIL, GAMMA LONG KIT TI $6,193.00 C1713

SCREW CANNULATED ASNIS 602880S $821.00 C1713

SCREW CANNULATED ASNIS 602890S $821.00 C1713

SCREW CANNULATED ASNIS 602650S $821.00 C1713

SCREW CANNULATED ASNIS 602690S $821.00 C1713

CLAMP VESSEL DISP $246.00

SCREW CANN 4.5 $560.00 C1713

SLING MALE VIRTUE $9,476.00 C1771

END CAP #1826-0003S $593.00 C1713

SCREW, ASNIS #602680 $821.00 C1713

SCREW, ASNIS #602700 $821.00 C1713

BEARING TIBIAL INSERT TRIA $3,559.00 C1713

BASEPLATEM TUBUAK TRIA $3,115.00 C1713

FEMORAL COMPONENT TRIATHLON $5,047.00 C1713

Page 250: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

TIBIAL INSERT TRIATHLON $2,113.00 C1713

RECIPROCATING BLADE $187.00

SCREW LOCKING 130790042 $655.00 C1713

BASKET URO STONE GEMINI 3X90 $588.00

BONE GROWTH STIMULATOR $13,910.00

WIRE LEAD 60" GOLD $47.00

DRILL BIT 2.0 $399.00

BLADE INSTRUMENT 5301-020-061 $140.00

FEMORAL DIST AUGE RT TRIATH $2,537.00 C1713

BEARING TIBIAL INSERT TRIA $3,717.00 C1713

TRIATHLON FLUTED STEM 5565-G-5 $2,522.00 C1776

FEMORAL COMPNOENT STABILIZER T $11,491.00 C1713

GUIDEWIRE BEAD TIP 2.6 X 80CM $305.00 C1769

R/H/MALLORY/HEAD MODULAR $5,344.00 C1713

M2A MAGNUM TAPER ADAPTER $929.00 C1776

RENAL STENT EXP 4X15X90 $2,410.00 C1876

RENAL STEN EXP 4X19X90 $2,410.00 C1876

RENAL STENT EXP 5X15X90 $2,410.00 C1876

RENAL STENT EXP 5X19X90 $2,410.00 C1876

RENAL STENT EXP 6X14X90 $2,410.00 C1876

RENAL STENT EXP 6X18X90 $2,410.00 C1876

EZLOC FEMORAL FIXATION 7-8MM $1,537.00 C1713

SCREW CANCELL WASHERLOCK $601.00 C1713

BONE MULCH SCREW/WASHERLOC D $1,445.00

BEARING KNEE TIB INSERT TRIA $3,559.00 C1713

SLING PINNACLE UPHOLD $3,583.00 C1771

CATH FOLEY 3WY CONT 26FR $39.00

CATH FOLEY SHORT TP 2WY 16FR $61.00

CATH FOLEY SHRT TP 2WY 20FR $61.00

CUP HIP TRIDENT PSL PRIM $3,270.00 C1713

SCREW ASNIS CANN 8.0 X 75 $770.00 C1713

BLADE RADENOID 4MM $442.00

SCREW LOCKING 2.7X12 $456.00 C1713

SCREW LOCKING 2.7X14 $456.00 C1713

SCREW LOCKING 2.7X16 $456.00 C1713

SCREW LOCKING 2.7X18 $456.00 C1713

SCREW LOCKING 2.7X20 $456.00 C1713

SCREW BINE 2.7X14 $393.00 C1713

C-TAPER HEAD 06-2605 $1,486.00 C1713

UNIVERSAL DRAPE PACK $88.00

HEMISPHERICAL CLUS HOLE SHELL $3,270.00 C1776

TRIDENT POLYETHYLENE INSERT $3,218.00 C1776

SECUR-FIT PLUS MAX HIP STEM $8,467.00 C1776

C-TAPER FEMORAL HEAD $2,942.00 C1713

ENDOCATCH BAG 15MM $335.00

ADAPTER URETER GOLD 14FR $84.00

PLATE TUBULAR 6HOLE 1/3 $3,052.00 C1713

GUIDE WIRE 2,8 $255.00 C1769

PATELLA TRIATHLON SYMMETRIC $1,547.00 C1776

ADVANCE DURAMER TIBIAL INSERT $3,408.00 C1713

Page 251: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CATH GRAHAM 16FR $147.00

PLATE LOCKING COMPRESSION 8 HO $667.00 C1713

DRILL BIT 4.3 AO END $525.00

DRILL BIT 3.2 AO END $575.00

DRILL BIT 4.5 AO END $575.00

LOCKING INSERT 5.0 370003 $236.00 C1713

SCREW CORTICAL 4.5 X 30 $103.00 C1713

SCREW CORTICAL 4.5 X 28 $103.00 C1713

SCREW LOCKING 5.0 X 30 $512.00 C1713

SCREW LOCKING 5.0 X 28 $512.00 C1713

SCREW LOCKING 5.0 X 24 $512.00 C1713

SCREW LOCKING 5.0 X 20 $512.00 C1713

OMNIFIT HIP STEM HEAD/NECK $5,799.00 C1713

TROCHANTERIC GRIP W/CABLES DAL $3,919.00 C1713

SCREW NONLOCKING 2.7 X 20 $293.00 C1713

SCREW LOCKING 2.7 X 20 $347.00 C1713

SCREW LOCKING 2.7 X 22 $347.00 C1713

SCREW LOCKING 2.7 X 24 $347.00 C1713

NAIL HUMERAL T2 PROXIMAL 8 X 2 $4,928.00 C1713

END CAP T2 1832-0004 $572.00 C1713

C-TAPER DELTA HEAD $2,960.00 C1713

INSERT BEARING TIBIAL TRIA $3,559.00 C1776

FEMORAL CRUT RETAIN TRIA $5,320.00 C1713

INSERT TIBIAL TRIA 5630-G-509 $2,113.00 C1776

BASEPLATE TIBIAL TRIATH $3,115.00 C1713

HEMISPHERICAL CLUSTER HOLE SHE $4,738.00 C1776

SECUR-FIT NECK ANGLE HIP STEM $8,467.00 C1776

C-TAPER FEMORAL HEAD $2,942.00 C1713

SCREW LOCKING 3.5 X 14 FOOT $512.00 C1713

SCREW LOCKING 3.5 X 16 FOOT $512.00 C1713

SCREW LOCKING 3.5 X 18 FOOT $512.00 C1713

PLATE 5HOLE FOOT SYSTEM $1,514.00 C1713

SCREW NONLOCKING 3.5 X 26 FOOT $236.00 C1713

PLATE FOOT SOLUTION STRYKER $1,514.00 C1713

SCREW CANN 4.5MM $560.00 C1713

HUMERAL PE CUP STANDARD $2,826.00 C1776

SCREW LOCKING 3.5 X 10 $512.00 C1713

SCREW LOCKING 3.5 X 12 $512.00 C1713

SCREW LOCKING 3.5 X 20 $512.00 C1713

DRILL BITT 2.6MM AO $287.00

SCREW CANN 4.5 X 38 $560.00 C1713

SCREW CANCELLOUS 6 X 58 $583.00 C1713

AIRTRAQ INTUB SIZE 3 REG $249.00

AIRTRAQ INTUB SIZE 1 PEDI $249.00

AIRTRAQ INTUB SIZE 2 SMALL $249.00

AIRTRAQ INTUB SIZE 0 INFANT $249.00

GUIDE WIRE BALL TIP HUMERAL 2. $519.00 C1769

GRAFTING INST IMPACT SLEEVE $629.00

QUICK-VAC MIX SYS BONE CEMENT $409.00

TOTAL ELB INTER HUMER ASSEM SM $10,449.00 C1776

Page 252: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

TOTAL ELB INTER ULNAR ASSEM SM $10,045.00 C1776

TOT ELB CEMENT REST W/NOZZLE $873.00

MENISCAL BEARING SM 5MM $1,904.00 C1776

M2A MAGNUM TAPER ADD 52-60MM $929.00 C1776

SCREW INTERFERENCE 10 X 30 $1,095.00 C1713

MENISCAL BEARING KNEE PHASE 3 $1,904.00 C1776

TIBIAL MEDIAL TRAY UNICOM SZ E $3,649.00 C1713

VAPR LD SUCTION ELECTRODE $488.00

SEMI-TENDINOSIS TENDON $3,307.00 C1762

HIP STEM 127 NECK ANGLE $8,467.00 C1776

POYLETHYLENE INSERT 10 $3,006.00 C1713

SECUR-FIT HIP STEM $8,467.00 C1776

PLATE CLAVICLE LCP 7 HOLE $2,291.00 C1713

PLATE MEDIAL DISTAL TIBIA $3,428.00 C1713

SCREW CANNULATED 3.7 X 34MM $618.00 C1713

SCREW CANNULATED 3.7 X 36MM $618.00 C1713

SCREW CANNULATED 3.7 X 44MM $618.00 C1713

SCREW CANNULATED 3.7 X 46MM $618.00 C1713

SCREW CANNULATED 3.7 X 48MM $618.00 C1713

GUIDEWIRE 1.6 900.601 $169.00 C1769

SCREW LOCK TI 24MM $443.00 C1713

PARAGARD IUD $1,006.00 J7300

STENT ICAST ATRIUM 6 X 38 X 80 $5,624.00 C1874

STENT ICAST ATRIUM 6 X 59 X 80 $6,036.00 C1874

STENT ICAST ATRIUM 8 X 38 X 80 $5,624.00 C1874

STENT ICAST ATRIUM 8 X 59 X 80 $6,036.00 C1874

BEARING INSERT TIBIAL 5 X 9MM $2,932.00 C1713

BEARING INSERT TIBIAL 5 X 11MM $2,932.00 C1713

CATH PEZZER 38FR $67.00

CATH PEZZER 40FR $67.00

PATELLA ASYMM TRIA $1,945.00 C1776

FEMORAL RETAIN CRUCIATE TRIA $5,320.00 C1713

STEM CEMENTED TRIATHLON $2,179.00 C1713

SCREW CANNULATED 7.3 TI $717.00 C1713

MESH PROLITE 6 X 6 $125.00 C1781

PLATE ANGL LOCK R 5H $2,326.00 C1713

PLATE ANGL LOCK L 5H $2,326.00 C1713

PLATE ANGL LCK R 5H $2,480.00 C1713

PLATE ANGL LCK L 4H $2,480.00 C1713

PLATE ANGL LCK R 4H $2,326.00 C1713

PLATE ANGL LCK L 4H $2,326.00 C1713

PLATE ANGL LCK R 4H $2,480.00 C1713

PLATE ANGL LCK L 4H $2,480.00 C1713

SCREW LOCK ANGLE TIT 2.4 X 8 $443.00 C1713

SCREW LOCK ANGLE TIT 2.4 X 10 $443.00 C1713

SCREW LOCK ANGLE TIT 2.4 X 26 $443.00 C1713

SCREW LOCK ANGLE TIT 2.4 X 28 $443.00 C1713

SCREW LOCK ANGLE TIT 2.4 X 30 $443.00 C1713

PLATE VA-LCP TI 6HOLE 49MM $2,308.00 C1713

PLATE VA-LCP TI 6HOLE 58MM $2,396.00 C1713

Page 253: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PLATE VA-LCP TI 6HOLE 70MM RT $2,476.00 C1713

PLATE VA-LCP TI 6HOLE 70MM LT $2,476.00 C1713

PLATE VA-LCP TI 7HOLE 49MM $2,308.00 C1713

PLATE VA-LCP TI 7HOLE 70MM $2,476.00 C1713

PIN BUTTRESS 1.8 400.190 $360.00 C1713

PIN BUTTRESS 1.8 400.191 $360.00 C1713

PIN BUTTRESS 1.8 400.192 $996.00 C1713

PIN BUTTRESS 1.8 400.193 $360.00 C1713

PIN BUTTRESS 1.8 400.194 $360.00 C1713

PIN BUTTRESS 1.8 400.195 $360.00 C1713

PIN BUTTRESS 1.8 400.196 $360.00 C1713

PIN BUTTRESS 1.8 400.197 $360.00 C1713

PIN BUTTRESS 1.8 400.198 $360.00 C1713

PIN BUTTRESS 1.8 400.199 $360.00 C1713

PLATE LCP RADIUS 3H 48MM RT $1,983.00 C1713

PLATE LCP RADIUS 5H 66MM RT $1,983.00 C1713

PLATE LCP RADIUS 3H 48MM LT $1,983.00 C1713

PLATE LCP RADIUS 5H 66MM LT $1,983.00 C1713

PLATE LCP RADUS 3H 47MM RT $1,983.00 C1713

PLATE LCP RADIUS 5H 65MM RT $1,983.00 C1713

PLATE LCP RADIUS 3H 47MM LT $1,983.00 C1713

PLATE LCP RADIUS 5H 65MM LT $1,983.00 C1713

PLATE LCP VOLAR 8H 04.110.430 $2,011.00 C1713

PLATE LCP VOLAR 8H 04.110.431 $2,011.00 C1713

PLATE LCP VOLAR 8H 04.110.440 $2,076.00 C1713

PLATE LCP VOLAR 4H 04.110.441 $2,076.00 C1713

PLATE LCP VOLAR 8H 04.110.450 $2,136.00 C1713

PLATE LCP VOLAR 8H 04.110.451 $2,136.00 C1713

PLATE LCP VOLAR 9H 04.110.330 $2,011.00 C1713

PLATE LCP VOLAR 9H 04.110.331 $2,011.00 C1713

PLATE LCP VOLAR 9H 04.110.340 $2,076.00 C1713

PLATE LCP VOLAR 9H 04.110.341 $2,076.00 C1713

PLATE LCP VOLAR 9H 04.110.350 $2,136.00 C1713

PLATE LCP VOLAR 9H 04.110.351 $2,136.00 C1713

PLATE DIA-META 5H 04.110.005 $3,484.00 C1713

PLATE DIA-META 7H 04.110.007 $3,561.00 C1713

PLATE DIA-META 9H 04.110.009 $3,637.00 C1713

PLATE DIA META 11H 04.110.011 $3,712.00 C1713

PLATE DIA-META 5H 04.110.105 $3,484.00 C1713

PLATE DIA-META 7H 04.110.107 $3,561.00 C1713

PLATE DIA-META 9H 04.110.109 $3,637.00 C1713

PLATE DIA-META 11H 04.110.111 $3,712.00 C1713

PLATE DIA-META 13H 04.110.013S $3,862.00 C1713

PLATE DIA-META 15H 04.110.015S $3,958.00 C1713

PLATE DIA-META 13H 04.110.113S $3,862.00 C1713

PLATE DIA-META 15H 04.110.115S $3,958.00 C1713

K-WIRE TI 04.11.300 1.8MM 150M $338.00 C1713

ULTRA VENT SYSTEM $160.00

AVON PATELLO FEMORA PROSTHESIS $6,430.00 C1776

BALON DILAT CORN VOY RX 2.5X12 $539.00

Page 254: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BALOON DILAT PERIP VIATRAC 14 $1,155.00

STENT CORONARY VISION 4X12 $2,089.00 C1876

STENT VISION ABBOTT 4 X 8 $2,089.00 C1876

SCREW LOCKING 5.0 X 50 $339.00 C1713

MED PACELD CAPSURE 4574-53 $1,357.00 C1898

MED PACELD CAPSURE 5076-58 $1,492.00 C1898

IVAS KYPHO KIT 0705-115-000 $3,255.00

AUTOPLEX W/ HV 0605-887-000 $1,904.00

ACCESSORY KIT SPINE STIM 3550- $174.00

ACCESSORY KIT SPINE STIM 3550- $236.00

SUTURELESS PUMP CONNEC REV KIT $472.00

STENT CORONARY COBALT 3.5 X 12 $1,617.00 C1876

SCREW CANNULATED 4.0 X 38 $96.00 C1713

NAIL LONG KIT GAMMA 3325-0340S $5,095.00 C1713

CEMENT PLUG SIZE 4 X 15.5MM $312.00 C1713

FEMORAL STAB TRIA 5515-F-501 $5,371.00 C1713

TIBIAL BEAR INSERT TI 5532.G-5 $3,717.00 C1776

TIBIAL BEAR INSERT TI 5531-G-7 $3,559.00 C1776

PLATE SMALL FRAG #4270085 $541.00 C1713

HUMERAL PE CUP STAN 38X6 $2,826.00 C1776

CATH UMBILICAL DUAL 3.5FR 15" $120.00

CATH UMBILICAL DUAL 5FR 15" $120.00

STAPLE FIXATION BARBED 11 X 23 $646.00

2-0 PROLENE MH 48" $28.00

ACCESSORY KIT # 3550-14 $173.00

NAIL TROCHANTERIC KIT $4,722.00 C1713

HIP STEM OMNIFIT CEMENTED $5,359.00 C1776

EXTENSION NEURO STIM KIT $1,270.00 C1883

PLATE DIST RAD L-PLATE 242.500 $1,153.00 C1713

PLATE DIST RAD L-PLATE 242.502 $1,153.00 C1713

PLATE DIST RAD L-PLATE 242.511 $1,153.00 C1713

PLATE DIST RAD L-PLATE 242.508 $1,153.00 C1713

PLATE DIST RAD L-PLATE 242.506 $1,153.00 C1713

PLATE DIST RAD L-PLATE 242.504 $1,153.00 C1713

PLATE DIST RAD T-PLATE 242.477 $1,191.00 C1713

PLATE DIST RAD T-PLATE 242.478 $1,245.00 C1713

PLATE DIST RAD STRAIGHT 242.47 $1,131.00 C1713

PLATE DIST RAD STRAIGHT 242.49 $1,191.00 C1713

RUSH PIN HOWMEDICA $1,173.00 C1713

NEUROSTIM INTERSTIM $18,610.00 C1767

PLATE ANATOMIC VOLAR $2,440.00 C1713

SCREW NON-LOCKING 2.7 X 24 $293.00 C1713

SCREW LOCKING 2.7 X 26 $347.00 C1713

SCREW LOCKING 2.7 X 22 $347.00 C1713

PLATE NARROW ANATO VOLAR $2,440.00 C1713

SCREW CANN ASNIS III $441.00 C1713

BEARING KNEE MENISCAL R 3MM $1,904.00 C1713

VNS DEMIPULSE GENERATOR 21934 $34,292.00 C1767

VNS LEAD PERENNIADURA 303 $11,654.00 C1778

VNS THERAPY TUNNELER 402 $968.00

Page 255: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NEEDLE TROCAR KYPHON $1,026.00

SYRINGE INFLATION KYPHON $348.00

BALLOON 15/2 KYPHON $2,781.00 C1727

BONE FILLER DEVICE KYPHON $347.00

MASK BIPAP CPAP LG $50.00

K-WIRE .035X4 $82.00

SCREW GENTLE THREADS INTER $1,203.00 C1713

SCREW INTERFER 905262 $1,095.00 C1713

TRIMIT DRILLPIN 2.0 X 100MM $560.00 C1713

SOLAR SHOULDER HUMERAL $6,981.00 C1776

SOLAR HUMERAL HEAD $3,339.00 C1776

SCREW LOCKING 4.0 X 34 371 $478.00 C1713

PLATE PROX/LATERAL TIB $3,323.00 C1713

ROD 400 X 8.0 MM 5028-8-400 $1,059.00 C1713

REUNION HUMERAL COMP $7,194.00 C1776

SOLAR HUMERAL HEAD 5350-4021 $3,339.00 C1776

NAIL TIBIAL STD 1822-1030S $4,042.00 C1713

PLATE PROX TIB 14HOLE $3,323.00 C1713

SCREW LOCK 4.0 X 30 370530 $453.00 C1713

SCREW LOCK 4.0 X 32 370532 $453.00 C1713

SCREW LOCK 4.0 X 38 370538 $453.00 C1713

SCREW LOCK 4.0 X 40 370540 $453.00 C1713

SCREW LOCK 4.0 X 60 370560 $453.00 C1713

SCREW LOCK 4.0 X 70 370570 $453.00 C1713

DRILL BIT 2.5 X 230 700355 $575.00

NAIL ELASTIC TI 2.5MM 475.925 $751.00 C1713

PLATE DHS 4H 140 DEG 281.24 $1,261.00 C1713

PLATE LOCK COMPR 6 HOLE $588.00 C1713

STENT COLON 10FR 25 X 120 $5,665.00 C1876

TROCAR ENDO HERNIA 10MM $324.00

ESOPHAGEAL STENT G48031 $3,568.00 C1876

ESOPHAGEAL STENT G48033 $3,568.00 C1876

KIT REPAIR PAIN PUMP SYCH $299.00

PLATE DEDICATED MC5 5HOLE $1,709.00 C1713

SCREW BONE 2.3 X 10 $270.00 C1713

SCREW BONE 2.3 X 8 $270.00 C1713

SCREW BONE 2.3 X 12 $270.00 C1713

SCREW BONE 2.3 X 11 $270.00 C1713

SCREW BONE 2.3 X 9 $270.00 C1713

DRILL BIT 1.9 X 27 $384.00

PRO OSTEON BONE GRAFT 5RG15 $2,113.00 C9399

SCREW CANN FT 36MM $560.00 C1713

SCREW CANN FT 38MM $560.00 C1713

SCREW CANN FT 52MM $560.00 C1713

SCREW LOCK TI ANG 5.0 X 36MM $555.00 C1713

SCREW LOCK TI ANG 5.0 X 40MM $555.00 C1713

END CAP 10MM GRAY $545.00 C1713

CANNULA CURVED LUMBAR 17G 6" $1,402.00

INSERT KNEE BEARING TIB TI $2,932.00 C1776

CATH 5 X 70FR ACCU-VU SIZING $525.00

Page 256: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CATH 5 X 100FR ACCU-VU SIZING $608.00

CATH 5 X 100FR SOFT RADIOPAQUE $229.00

CATH BALLOON DIAL OTW 9X4X80 $718.00

CATHBALLOON DIAL OTW 8X4X80 $718.00

CATH BALLOON DIAL OTW 7X4X80 $718.00

INTRODUCER VASC 5 FR 10CM $184.00

SHEATH INTRODUCER VASC 16 FR $377.00

SHEATH DILATOR LEAD 16 FR $957.00

CATH BALLOON DIATION 80 CML $1,250.00

CATH BALLOON DILATION 110 CML $1,250.00

SNARE KIT 6FR 5MM GN500 $846.00

TUBING INJECTION HI PRES 150CM $50.00

RAPID REFILL INJECTION SET $89.00

POWERLINK SYS 25-13-120BL $22,921.00 C1874

POWERLINK SYS 25-25-115RL $7,313.00 C1874

POWERLINK SYS 34-34-120RLE $9,579.00 C1874

POWERLINK SYS 28-16-120BL $22,149.00 C1874

POWERLINK SYS 20-13-70FL $6,180.00 C1874

HEMOSTASIS VAL ADAPT HVA-100 $41.00

PRECISION HEX WRENCH $221.00

OR CABLE & EXTENSION $732.00

TENDON TIBIALIS POSTER 240X9 $4,337.00 C1762

SCREW CANN 4.5 MM $543.00 C1713

NAIL TI LAT ENTRY FEM REC 11MM $3,697.00 C1713

END CAP 0MM 04.003.000 $518.00 C1713

ACL TIGHTROPE AR-1588T $811.00 C1713

SCREW INTERFERENCE 10X28 $827.00 C1713

CUTTER 10MM AR-1204F-100 $1,047.00

MESH PERMACOL 20X30X1.50 $26,455.00 C9364

POWERLINK SYS 22-16-100BL $22,149.00 C1784

POWERLINK SYS 28-28-115RL $7,313.00 C1874

WIRE SUREPASS AF ENDO-035 $503.00 C1713

WIRE SURPASS ACCESS ENDO-014 $551.00 C1713

SCREW CANN 4.5 X 48 214.648 $560.00 C1713

SCREW CANN 4.5 X 40 214.640 $560.00 C1713

SCREW CANN 4.5 X 44 214.644 $560.00 C1713

HIP STEM HEAD/NECK $5,799.00 C1776

PLATE VOLAR ANA 54-25387 $2,440.00 C1713

SCREW BONE 2.7X26 52.27026E $293.00 C1713

KIT MANIFOLD ACIST S/U $56.00

KIT HAND CONTROLLER ACIST S/U $67.00

BEARING UNI KNEE PHASE 3 MEN $1,904.00 C1713

BEARING PART KNEE SYS ANA ACRO $1,904.00 C1713

DRILL BIT 1/8 QUICK RELEASE $315.00

C-TAPER HEAD #06-2610 $2,003.00 C1713

FEMORAL COMP TRIATHLON $5,047.00 C1713

INSERT TIBIAL TRIATHLON $2,113.00 C1776

SCREW CORT 2.7 #202.034 $76.00 C1713

GUIDEWIRE CANN 6.5/7.3 $326.00 C1769

PLATE CLAVICLE 6HOLE $2,233.00 C1713

Page 257: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PLATE CLAVICLE 6H 02.112.080 $2,233.00 C1713

SUTURE VLOC 3-0 CV23 6" $73.00

SUTURE VLOC 3-0 CV23 12" $84.00

SUTURE VLOC 0 GS21 12" $84.00

SUTURE VLOC 3-0 P12 12" $84.00

MARTIN UTERINE SUTURE 1/2 CIRC $28.00

LEAD KIT #3776-60 $5,243.00 C1778

ACCESSORY KIT #3550-28 $174.00

RESTORE STIM #37711 $30,576.00 C1820

CHARGING SYSTEM #37752 $5,243.00

SCREW CAN ASNIS III 611075S $808.00 C1713

DRILL BIT ASNIS 702611 $1,314.00

DRILL BIT ASNIS 702626 $566.00

PLATE TIBIA PROX 4.5MM $500.00 C1713

SCREW CANCELLOUS 6.5 $153.00 C1713

DRILL BIT STRAIGHT 1.5 $133.00

DRILL BIT STRAIGHT 2.0MM $133.00

DRILL BIT STRAIGHT 2.5MM $133.00

DRILL BIT STRAIGHT 2.7MM $133.00

DRILL BIT 3.5MM 00-2318-035-06 $133.00

DRILL BIT STRAIGHT 4.5 MM $133.00

COOLING BLANKET AD 25X64 $43.00

DRAIN T-TUBE DEAVER 14FR $27.00

PIN TO ROD COUPLINGS $1,186.00 C1713

PIN APEX 5.0 X 150 $544.00 C1713

BURR ARTHRO EGG 5.5MM 6FLUTE $183.00

PLATE LCP 3.5 POST/LAT DIS HUM $2,511.00 C1713

PLATE LCP 3.5 MRD DIS HUM 5HOL $2,511.00 C1713

SCREW LOCKING 3.5 14MM $404.00 C1713

SCREW LOCKING 3.5 22MM $404.00 C1713

SCREW LOCKING 2.7 32MM $384.00 C1713

SCREW LOCKING 3.5 20MM $404.00 C1713

SCREW BONE HERBERT 2.5MMX10M $1,028.00 C1713

SCREW BONE HERBERT 2.5MMX12M $1,028.00 C1713

SCREW BONE HERBERT 2.5MMX14M $1,028.00 C1713

SCREW BONE HERBERT 2.5MMX16M $1,028.00 C1713

SCREW BONE HERBERT 2.5MMX18M $1,028.00 C1713

SCREW BONE HEBERT 2.5MMX20MM $1,028.00 C1713

SCREW BONE HERBERT 2.5MMX22M $1,028.00 C1713

SCREW BONE HEBERT 2.5MMX24MM $1,028.00 C1713

VERSAJET HNDPC EXCT 45DEG 14MM $1,233.00

PERFORATOR CRANIAL DISPOS 14MM $525.00

SCREW LOCKING 2.4 X 24MM $325.00 C1713

SCREW LOCKING 2.4 X 26MM $325.00 C1713

SCREW CORTEX 2.4 X 24MM $171.00 C1713

SCREW CORTEX 2.4 X 26MM $229.00 C1713

CLUSTER ACETABULAR SHELL $3,270.00 C1713

FLIXENE VASCULAR GRAFT $1,931.00 C1768

PIN STEINMAN 3811-4-090 $77.00 C1713

SCREW 6.5 # 602670 $823.00 C1713

Page 258: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW BONE 2.3 X 16MM $318.00 C1713

PLATE CLAVICLE 8H MD LEFT $2,035.00 C1713

SCREW CORTICAL 2.7 X 18 MM $189.00 C1713

SCREW CORTICAL 2.7 X 20 MM $189.00 C1713

NAIL TIBIAL TI EX 10MM $3,348.00 C1713

REMOVAL TOOL 351.783 $536.00

SHAFT FLEX 5.0 MM 352.040 $5,504.00 C1713

REAMER HEAD MED 8.5MM $796.00

REAMER HEAD MED 9.0MM $796.00

REAMER HEAD MED 9.5MM $796.00

REAMER HEAD MED 10.0MM $796.00

PLATE ANATOMIC FIBULA 8HOLE $1,895.00 C1713

NEEDLE SCLEROTHRPY 23G 4MM $153.00

GLIDESCOPE SIZE 3 $53.00

GLIDESCOPE SIZE 5-4 $60.00

ADAPTER MAGNUM M2A 42-50MM $929.00

TROCAR FRST ENTRY THRD 11 X 10 $150.00

BLADE FLEMING GL1966 $84.00

CATH HICKMAN DUAL 9FR $570.00

QUINTON DIALYSIS CATHETER 42CM $261.00 C1750

NOZZLE CEMENT FEM REVI $59.00

DRAIN T-TUBE WHELAN 12 X 18 FR $31.00

DRAIN T-TUBE WHELAN 16 X 20 FR $31.00

ELECTRODE BALL 22FR 3MM $474.00

LOOP CUTTING STRAIGHT $432.00

SCREW CANCELLOUS 6.5 X 75 $169.00 C1713

SCREW CANCELLOUS 6.5 X 70 $169.00 C1713

SCREW CANCELLOUS 6.5 X 60 $169.00 C1713

SCREW LOCKING 5.0 X 60 $522.00 C1713

DRILL BIT 4.3 703541 $711.00

DRILL BIT 3.2 703542 $685.00

LEAD TRIAL STANDARD 45CM $1,428.00 C1897

LEAD TRIAL STANDARD 60CM $1,428.00 C1897

LEAD TRIAL COMPACT 45CM $1,428.00 C1897

LEAD TRIAL COMPACT 60CM $1,428.00 C1897

LEAD TRIAL SUBCOMPACT 45CM $1,428.00 C1897

LEAD TRIAL SUBCOMPACT 60CM $1,428.00 C1897

PERICARDIOCENTESIS KIT $330.00

SCREW ASNIS 8.0 X 80 611280 $823.00 C1713

SCREW ASNIS 8.0 X 85 611285 $823.00 C1713

STENT ILIAC EXP LD 7X27X75 $2,410.00 C1876

STENT ILIAC EXP LD 7X37X75 $2,410.00 C1876

STENT ILIAC EXP LD 8X27X75 $2,410.00 C1876

STENT ILIAC EXP LD 8X37X75 $2,410.00 C1876

STENT ILIAC EXPRESS LD10X25X75 $2,410.00 C1876

STENT ILIAC EXPRESS 10 X 37 X $2,410.00 C1876

SCREW ASNIS 6.5 X 75 $823.00 C1713

SCREW ASNIS 6.5 X 80 $823.00 C1713

SCREW ASNIS 6.5 X 85 $823.00 C1713

SCREW ASNIS 6.5 X 95 $823.00 C1713

Page 259: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

C-TAPER HEAD 18-3675 $3,324.00 C1713

SCREW CANNULATED 4.0 X 44 $575.00 C1713

SCREW CANNULATED 4.0 X 40 $575.00 C1713

SCREW CANNULATED 4.0 X 22 $575.00 C1713

DRILL BIT 4.0 702449 $1,028.00

GUIDE WIRE 702459 $167.00 C1769

LEAD PERM 50CM $2,946.00 C1778

STEM HIP HEAD/NECK 6050-0935 $5,799.00 C1776

HEAD REAMER MDLRY 10.5 $772.00 C1713

HEAD REAMER MDLRY 11.0 $772.00 C1713

HEAD REAMER MDLRY 11.5 $772.00 C1713

HEAD REAMER MDLRY 12.0 $772.00 C1713

HEAD REAMER MDLRY 12.5 $772.00 C1713

INSERT KNEE TIB TRIA PS SZ3 $4,610.00 C1776

ACCESSORY KIT INTERSTIM $472.00

SCREW BONE 2.7 X 22 52-27022E $318.00 C1713

SCREW CANN 4.5 X 32 $560.00 C1713

SCREW CANN 4.5 X 40 $560.00 C1713

ACCESSORY KIT SCS #1701 $667.00

SWIFT LOCK ANCHOR #1192 $315.00 C1713

NAIL FEMORAL T2 1825-1038S $4,277.00 C1713

GLIDESHEATH INTRO 5FR $173.00

GLIDESHEATH INTR 6FR $173.00 C1766

GLIDESHEATH INTR 6FR 0.035GW $154.00

TR BAND STANDARD W/INFLATOR $154.00 C1760

TR BAND LONG W/INFLATOR $154.00 C1760

OPTITORQUE 5FR RADIAL TIG 4.0 $143.00

OPTITORQUE 5FR RADIAL TIG 4.5 $143.00

OPTITORQUE 5FR JACKY RADIAL $143.00

OPTITORQUE 5FR SARAH RADIAL $143.00

MESH STRATTICE 20 X 25 $26,716.00 Q4100JD

TIP FEMORAL CANAL 210-8 $41.00

PLATE DISTAL RAD L $1,177.00 C1713

PLATE DISTAL RAD L $1,214.00 C1713

PLATE DISTAL RAD L $1,214.00 C1713

PLATE DISTAL RAD L $1,182.00 C1713

NEEDLE AVAMAX KYPHO CRVD 11G $834.00

KATALYST RADIAL STEM/SHAFT $5,492.00 C1776

KATALYST RADIAL HEAD ASSEMBLY $5,492.00 C1776

SYNCHROMED PAIN PUMP 8637-20 $20,920.00 C1772

HUMERAL STEM 130712200 $8,758.00 C1776

GLENOSPHERE STD 130760142 $4,660.00 C1713

ELECTRODE S90 ARTHX VAPOR $412.00

HEAD REAMER MDLRY 13.0 $772.00 C1713

HEAD REAMER MDLRY 13.5 $772.00 C1713

HEAD REAMER MDLRY 14.0 $772.00 C1713

HEAD REAMER MDLRY 14.5 $772.00 C1713

HEAD REAMER MDLRY 15.0 $772.00 C1713

HEAD REAMER MDLRY 15.5 $772.00 C1713

HEAD REAMER MDLRY 16.0 $772.00 C1713

Page 260: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

HEAD REAMER MDLRY 16.5 $772.00 C1713

HEAD REAMER MDLRY 17.0 $772.00 C1713

BRUSH 3.6MM 352.041 $212.00

ROD REAMING 2.5 MM $350.00 C1776

ROD REAMING EXT 2.5 $401.00 C1776

C-TAPER HEAD DELTA BILOX 28MM $2,960.00 C1713

RESTORATION ADM CUP WITH HA LT $7,381.00 C1776

RESTORATION ADM X3 INSERT $4,102.00 C1776

SCREW CANN 4.0 X 50 $575.00 C1713

CYLINDER PUMP CX 72404231 $14,532.00 C1813

RESTORE ULTRA STIM 37712 $29,417.00 C1820

INSERT KNEE BEARING TIB TRIAT $3,455.00 C1776

INSERT KNEE CS TRIA SZ5 16MM $2,846.00 C1776

TUBE TRACH CUFF 8.0 XLT $199.00

PLATE DISTAL RAD 2.4 VOLAR $2,622.00 C1713

SMARTMIX 5401-98-000 $468.00

CTA HEAD 52 X 21 130752021 $5,463.00 C1776

CTA HEAD 48 X 21 130748021 $5,463.00 C1776

HUMERAL STEM 1 X 8 130708100 $8,040.00 C1776

IONTOPATCH SMALL SP $25.00

TRAY PARA/THORA $177.00

TIBIAL LT MEDIAL TRAY $3,542.00 C1713

OXFORD RESECTION 3/PK BLADES $1,322.00

SCREW CANN 8.0 X 115 $784.00 C1713

PREVENA DRESSING ORTHO $1,233.00

SCREW 240 ROD & SCHANZ KIT $5,749.00 C1713

INJECTABLE GRAFT 5CC $4,410.00 C1713

PLATE DHS 140 DEG 281.210 $1,728.00 C1713

PLATE HUME DIS SHORT POSTERIOR $2,716.00 C1713

SCREW LOCKING 3.5 X 10 #614610 $500.00 C1713

SCREW LOCKING 3.5 X 12 #614612 $508.00 C1713

SCREW LOCKING 3.5 X 14 $508.00 C1713

SCREW LOCKING 3.5 X 16 #614616 $508.00 C1713

SCREW LOCKING 3.5 X 18 #614618 $508.00 C1713

SCREW LOCKING 3.5 X 20 #614620 $508.00 C1713

SCREW LOCKING 3.5 X 22 #614622 $508.00 C1713

SCREW LOCKING 3.5 X 24 #614624 $508.00 C1713

SCREW LOCKING 3.5 X 26 #614626 $508.00 C1713

SCREW LOCKING 3.5 X 28 #614628 $508.00 C1713

SCREW LOCKING 3.5 X 30 #614630 $508.00 C1713

SCREW LOCKING 3.5 X 46 #614646 $508.00 C1713

SCREW LOCKING 3.5 X 60 #614660 $508.00 C1713

DRILL 26MM #703702 $561.00

SCREW INTERFERENCE 9 X 30MM $969.00 C1713

PLATE CLAVICLE DIS 2.3MM 16H $2,171.00 C1713

SCREW CORTICAL LOCK 2.3 X 14MM $317.00 C1713

DRILL SURGIBIT QUK COUP 2.0MM $268.00

MENISCAL REPAIR DEVICE 2-0 SZ5 $874.00 C1713

NEEDLE INJECT DURASPHERE $67.00

BEARING KNEE MEN R 7MM $2,880.00 C1713

Page 261: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SUTURE PDS II 4-0 18" $70.00

SCREW ASNIS 6.5 X 95 $799.00 C1713

SCREW ASNIS 6.5 X 100 $799.00 C1713

ACCESSORY KIT 355531 $610.00 C1778

ENHANCED STYLET KIT SC-4395-50 $534.00

SUTURE VLOC 180 P14 18" $97.00

BEARING TIBIAL INSERT TRIATHLO $3,608.00 C1713

FEMORAL STAB POST TRIA 5515-F $5,214.00 C1713

MESH PERMACOL 2 X 4 X 1 $537.00 C9364

PEG BALLOON GASTRO 18FR 20CC $152.00

RIM INSERT ELEVATED $2,918.00 C1776

NAIL FEMORAL A/R T2 SYS $4,152.00 C1713

BEARING TIBIAL INS 5531-G-213 $3,455.00 C1713

BEARING TIBIAL INS 5531-G-716 $3,455.00 C1713

BEARING TIBIAL INS 5531-G-713 $3,455.00 C1713

PLATE LCP 2.7 249.680 $1,145.00 C1713

PLATE LCP 2.7 247.372 $1,145.00 C1713

PLATE LCP 2.7 249.683 $1,145.00 C1713

SCREW CORTEX 2.7 202.870 $150.00 C1713

GUIDE WIRE .014 4103 $534.00 C1769

POWERLINK SYSTEM 28-16-100BL $21,503.00 C1874

POWERLINK SYSTEM 34-34-100RLE $8,700.00 C1874

KIT PROGRAMMER PATIENT $2,079.00 C1787

IPG PRESCISION SC-1110-02 $27,060.00 C1820

HUMERAL STEM 12MM R5351-4512 $6,984.00 C1776

HUMERAL STEM 21MM R5350-4521 $3,241.00 C1776

PLATE PROX TIBIAL 437302 $3,372.00 C1713

SCREW LOCKING 370575 $479.00 C1713

KIT PUMP REVISION SEGMENT $996.00

COMP FEMORAL TRIATH $4,900.00 C1776

PATELLA SYMP TRIATHLON $1,550.00 C1776

HEMI CLUSTER HOLE SHELL $3,174.00 C1713

PLATE CLAVICLE ANTERIOR 10H $1,975.00 C1713

PLATE RIB UNIVERSAL MATRIX $2,229.00 C1713

SCREW LOCKING 8 X 29MM $546.00 C1713

DRILL BIT 2.2MM 03.501.038 $506.00

LONG TUNNELING TOOL SC-4254 $710.00

INTRODUCER 9FR 11CM AAA $32.00

PLATE, TIBIAL BASE TRIATHLON $5,180.00 C1713

BEARING INSERT TIBIAL TRIATHLO $3,455.00 C1713

CHARGING SYSTEM SC-6412-2 $4,710.00

SCREW LOCKING 42 1307-90-042 $635.00 C1713

GUIDE PIN 1.5 X 300 $260.00 C1713

SCREW TROCH FIX 11 MM $1,410.00 C1713

REUNION HA FX STEM HUMBERAL CO $6,984.00 C1776

TRIDENT HIP INSERT 623-00-36F $2,918.00 C1776

DRILL BIT POLARUS 2.8 $156.00

PLATE ADAPTATION 2.7 12HOLE $1,171.00 C1713

BEARING TIBIAL INSERT TRIA 553 $3,608.00 C1713

TIBIAL BEAR INSERT TRI 5531-G $3,455.00 C1776

Page 262: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

EZLOCK FEMORAL FIXATION 7-8MM $1,492.00 C1713

SCREW INTERFERENCE 8 X 30MM $969.00 C1713

SCREW INTERERENCE 9 X 30MM $1,063.00 C1713

SCREW LOCKING 4.0 X 65 $479.00 C1713

SCREW CORTICAL 3.5 X 34 $100.00 C1713

SCREW CORTICAL 3.5 X 50 $100.00 C1713

SCREW CORTICAL 3.5 X 60 $100.00 C1713

K-WIRE .062 9" 3713-3-090 $89.00 C1713

BEARING MENISC KNEE PART SM $2,880.00 C1713

BLOCK HALF AUGMENT TRIATH $1,962.00 C1776

CABLE & SLEEVE SET 1.6MM $676.00

GRAFT VASC PTFE 4-7MM X 45CM $2,375.00 C1768

KIT-EXPLORATION BILE DUCT $1,492.00

APPLICATOR FLEXTIP ARISTA $54.00

CALIBRATOR TBI/DBI DC167 $189.00

POWERLINK INTUITRACK SYSTEM $21,503.00 C1874

SCREW LOCK 3.5 X 13 $419.00 C1713

TIBIAL INSERT TRIA 5531-G-816 $3,455.00 C1713

SCREW FIXATION 2.7 X 30 $553.00 C1713

FEMORAL STAB POST TRIA SZ 6 $5,214.00 C1713

TIBIAL BEAR INSERT TRIA SZ 6 $2,737.00 C1776

TIBIAL BEAR INS TRI SZ 6 13MM $2,737.00 C1776

FEMORAL STAB POST TRIA SZ 7 $5,214.00 C1713

ACETABULAR CUP ANA DUL MOBILIT $6,052.00 C1776

CUP ADM RESTORATION INSERT X3 $3,385.00 C1776

C-TAPER HEAD 06-2810 $1,442.00 C1713

CEMENT PLUG SZ 1 $302.00 C1713

SOLAR HUMERAL HEAD 5350-4015 $3,241.00 C1776

HUMERAL REUNION COMPONENT $6,986.00 C1776

END CAP 1822-0015S $600.00 C1713

TIBIAL NAIL 8 X 270 $4,142.00 C1713

TIBIAL NAIL 8 X 285 $4,142.00 C1713

BONE PUTTY W/CHUNKS 10CC $3,300.00 C9359

KIT LEAD TRIAL 50 CM 3-4 $2,860.00 C1778

TITAN OTR SCRO CYLINDER/PUMP $14,038.00 C1813

TITAN BIOFLEX RESERVIOR $3,260.00 C1813

BONE CEMENT GENT $517.00 C1713

STENT TRACHEOBRONCHIAL ULTRAFL $5,668.00 C1874

STENT TRACHEOBRONCHIAL ULTRAFL $5,668.00 C1874

PULMONARY BRONCHIA BALL DIALAT $859.00

PLATE DISTAL FEMUR 8H AXSOS $4,194.00 C1713

SCREW LOCKING 5.0 X 28 $506.00 C1713

SCREW LOCKING 5.0 X 26 $506.00 C1713

SCREW LOCKING 5.0 X 70 $506.00 C1713

SCREW LOCKING 5.0 X 85 $506.00 C1713

SCREW CORTICAL 4.5 X 32 $115.00 C1713

SCREW CORTICAL 4.5 X 34 $115.00 C1713

SCREW CORTICAL 4.5 X 36 $115.00 C1713

SCREW CORTICAL 4.5 X 38 $115.00 C1713

SCREW CORTICAL 4.5 X 46 $115.00 C1713

Page 263: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CANCELLOUS 6.5 X 65 $126.00 C1713

C-TAPER FEMORAL HEAD $1,952.00 C1713

INSERT BEARING TIBIAL TRIA $3,608.00 C1776

STENT URINARY SUBCU 8FR 80CML $267.00 C1874

STENT URINARY SUBCU 7FR 80CML $267.00 C1874

CEMENT SPACER 1067-0011 $302.00

OMNIFIT CEMENT HIP STEM $5,202.00 C1776

SCREW CORTEX 1.5MM $164.00 C1713

PLATE 1.5MM TI-T $648.00 C1713

FEMORAL STAB POST TRIA SZ 3 $5,214.00 C1713

BEARING INSERT TIBIAL 3 X 11MM $3,608.00 C1713

SCREW LAG 12.7 X 100 $892.00 C1713

IPG CHARGE SYSTEM $24,135.00

POWERLINK ENDOGRAFT 22X13X120 $22,253.00 C1874

BACK UP MEIER GUIDEWIRE $220.00 C1769

BALLOON DIL CATH $906.00 C1726

HUMERAL HEAD SHOULDER 1128-52 $3,649.00 C1776

GLENOID APG 52MM $4,140.00 C1713

HUMERLA STEM 12MM 1137-12-050 $7,132.00 C1713

POWERLINK ENDOGRAFT 28X95X28 $6,500.00 C1874

PLATE SHORT DISTAL MEDIAL $3,588.00 C1713

SCREW LOCKING 4.0 X 28 $479.00 C1713

SCREW LOCKING 40. X 36 $479.00 C1713

RESTORATION ADM ACETA CUP $7,166.00 C1776

C-TAPER HEAD LFIT 28MM $1,442.00 C1713

RESTORATION ADM W/INSERT CUP $3,982.00 C1776

PORT INFUSION PWR INJ 8F $745.00 C1788

BLOCK HALF AUGMENT TRIATH $2,009.00 C1776

PLATE OLECRANON 6H 3.5 $2,402.00 C1713

STABILIZER FEMORAL COMP $14,319.00 C1776

STEM-FLUTED 5566-S-016 $3,486.00 C1776

FEMORAL POSTERIOR AUGMENT $2,959.00 C1776

OFFSET ADAPTER 5570-S-020 $2,976.00

INSERT STABILIZER TIBIAL $5,806.00 C1776

KIT LEAD PAIN 1X8 $872.00 C1778

MESH POUCH ACCESSORY $259.00

PACEMAKER REVOMRI SURESCAN $11,070.00 C1785

MED PACELD CAPSURE FIX MRI 45 $2,141.00 C1898

MED PACELD CAPSURE FIX MRI 52 $2,141.00 C1898

MED PACELD CAPSURE FIX MRI 58 $2,141.00 C1898

SCREW CANN LOCK 3.5 X 70 $526.00 C1713

SCREW CANN LOCK 3.5 X 60 $526.00 C1713

PLATE PROX TIB 02.120.704S $2,458.00 C1713

PLATE PROX TIB 239.984S $3,564.00 C1713

PLATE LCP NARR 4.5 #224.561 $1,083.00 C1713

INSERT HIP TRIDENT 623-00-36G $2,694.00 C1776

SCREW SELF-TAPPING 3.5 $495.00 C1713

TROCAR 5MM BALLOON CFR03 $96.00

SLEEVE 5 X 100 BALLOON CFS02 $26.00

TROCAR ENDO FIX 5 X 150 $96.00

Page 264: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

TROCAR ENDO FIX 11 X 100 $125.00

SLEEVE TROCAR ENDO FIX 11 X 10 $56.00

TROCAR ENDO FIX 12 X 100 $125.00

STEM HIP ANGLE NECK $7,420.00 C1776

SCREW CORTICAL 4.5 X 44 $115.00 C1713

SCREW CORTICAL 4.5 X 40 $115.00 C1713

SCREW CORTICAL 4.5 X 55 $115.00 C1713

SCREW CANNCELLOUS 6.5 X 80 $164.00 C1713

SCREW LOCKING 5.0 X 38 $506.00 C1713

SCREW LOCKING 5.0 X40 $506.00 C1713

SCREW LOCKING 5.0 X 65 $506.00 C1713

SCREW LOCKING 5.0 X 75 $506.00 C1713

SCREW LOCKING 5.0 X 55 $506.00 C1713

SCREW LOCKING 5.0 X 44 $506.00 C1713

BASEPLATE TIBIAL TRIATHLON $3,294.00 C1713

RETAINING FEMORAL CRUCIAT TRIA $5,165.00 C1713

INSERT TIBIAL BEARING TRI SZ 1 $3,455.00 C1776

INSERT KNEE BEARING TIB TRIA $3,455.00 C1776

CTA HEAD 44 X 18 MM $4,461.00 C1776

HUMERAL HEAD 8 X 133 $7,036.00 C1776

BASKET RETRIEVAL AIRWAY 12 X 1 $620.00

PLATE CLAVICLE 7H 02.112.083 $2,376.00 C1713

NEEDLE INSERTION 6.5" $336.00

BEARING KNEE PRT MENISC SM 9MM $1,848.00 C1713

SCREW CANN ASNIS 6.5 X 65 $799.00 C1713

NET ROTH RETRIEVER PED 1.7 MM $305.00

STENT TRACH ENDOPROSTHESIS 9 F $3,578.00 C1876

SCREW CORTEX 2.7 X 14 $132.00 C1713

SCREW CORTEX 2.7 X 12 $132.00 C1713

SCREW CANN 4.5 MM $581.00 C1713

INSERT KNEE TIB TRIATH SZ6 $3,608.00 C1776

INSERT HIP POLY 623-10-36G $2,694.00 C1776

INSERT BEARING KNEE TIB TRIATH $3,455.00 C1776

SCREW CORTEX 2.7 X 18MM $132.00 C1713

SCREW CORTEX 2.7 X 16MM $132.00 C1713

SCREW CORTEX 2.7 X 20MM $132.00 C1713

TACK BB-TAK #AR-13226 $112.00 C1713

SCREW QUICKFIX 3 X 13 $630.00 C1713

SCREW QUICKFIX 3 X 15 $630.00 C1713

SCREW LOW PROFILE TI 3 X 24 $366.00 C1713

SCREW LOW PROFILE TI 3 X 12 $298.00 C1713

SCREW LOW PROFILE TI 3 X 14 $298.00 C1713

SCREW LOW PROFILE TI 3 X 16 $298.00 C1713

GUIDEWIRE W/TROCAR TIP .062" $28.00 C1769

PLATE MTP LOW PROFILE TI $2,125.00 C1713

DRILL BIT CANNULATED AR-8933- $366.00

DRILL BIT 2.0MM AR-8944-22 $241.00

SPIKED WASHER 13.5 X 4.0 $416.00 C1713

SPIKED WASHER 8.0 X 3.2 $234.00 C1713

VNS GENERATOR 102 $29,801.00 C1767

Page 265: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

VNS LEAD 304-20 $11,644.00 C1778

SCREW NON LOCKING 2.3 X 14 $308.00 C1713

SCREW NON LOCKING 2.3 X 22 $308.00 C1713

SCREW NON LOCKING 2.3 X 12 $308.00 C1713

SCREW NON LOCKING 2.3 X 20 $308.00 C1713

SCREW NON LOCKING 2.3 X 18 $308.00 C1713

SCREW NON LOCKING 2.3 X 24 $308.00 C1713

TITAN OTR SCROTAL CLYIN W/PUMP $14,038.00 C1813

TITAN BIOFLEX RESERVIOR 90-910 $3,260.00 C1813

GAMMA NAIL LONG $6,356.00 C1713

SCREW LOCKING 2.7 X 24 $568.00 C1713

SCREW ASNIS 6.5 X 45 $842.00 C1713

SCREW ASNIS 6.5 X 50 $842.00 C1713

PLATE PROX HUMERAL 5 HOLE $3,992.00 C1713

SCREW LOCKING 4.0 X 20 $534.00 C1713

PLATE OLECRANON LCP 3.5 $2,540.00 C1713

PLATE FUBULA LAT 2.7/3.5 4HOLE $1,594.00 C1713

INSERT KNEE BEARING TIB SZ6 $2,737.00 C1776

OLECRANON SLEDS NEUT 50MM $1,836.00 C1713

K-WIRE 0.9MM X 100MM $40.00 C1713

OLECRANON SLED WASHER $623.00 C1713

SCREW CORTICAL HEX 28MM $229.00 C1713

DRILLS TWIST NON-CANNULATED $336.00

TUBE U-TUBE EAR TYMPANOSTOMY $82.00

MESH CQUR TACSHIELD 8X10 $2,704.00 C1781

MESH CQUR TACSHIELD 6X8 $1,688.00 C1781

MESH SKIRTED TACSHLD CQUR 4X6 $1,125.00 C1781

MESH CQUR LITE FX 3X6 $287.00 C1781

RESTORATION ADM ACETULAR CUP $5,504.00 C1776

RESTORATION ADM CUP INSERT $3,093.00 C1776

MCP DISTAL COMPONENT 40D $3,356.00 C1776

MCP PROXIMAL COMPONENT 40P $4,840.00 C1776

WRAP & COLD PK KNEE 4HR $137.00

INSERT BEARING KNEE TRIATH $3,455.00 C1776

RESTORATION HIP STEM $9,131.00 C1776

SPHY ANE HH CHILD BP CUFF $52.00

BOWL MIXER 5401-76-501 $275.00

ANCHOR PEG GLENOID 1136-41-026 $4,140.00 C1713

SHOULDER HUMERAL HEAD 1128-44- $3,285.00 C1776

BREAK AWAY GUIDE PIN 2.5MM $503.00 C1713

LEAD TRIAL PERCUTANEOUS 3778-7 $1,245.00 C1778

HUMERAL HEAD DUAL RADIUS R5350 $3,241.00 C1776

REUNION HUMERAL COMPONENT R5 $6,984.00 C1776

SCREW ASNIS III 8.0 X 70MM $824.00 C1713

SCREW ASNIS III 8.0 X 100MM $824.00 C1713

END CAP 15 MM 462.965 $586.00 C1713

DRILL BIT 3.2 315.330 $562.00

NAIL CANN HUMERAL 7MM $4,407.00 C1713

PLATE DHS SHORT BARREL 4HOLE $1,300.00 C1713

NAIL LONG GAMMA 3425.0380S $6,356.00 C1713

Page 266: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW LOCKING FT 1896-5052S $595.00 C1713

FEMUR KNEE PS TRIATH #6 $5,592.00 C1776

Z-MED II BALL DIL CATH PDZ653 $1,235.00

Z-MED II BALL DIL PDZ657 $1,235.00

Z-MED II BALL DIL CATH PDZ661 $1,235.00

Z-MED II BALL DIL CATH PDZ765 $1,235.00

C-TAPER HEAD DELTA 28MM $2,873.00 C1713

SCREW LOCKING TI 5.0 #422.391 $578.00 C1713

FEMORAL DISTAL AUGMENT 5540-A- $2,959.00 C1776

STEM FLUTED TRIA 5566-S-014 $3,486.00 C1776

STEM FLUTED TRIA 5566-S-015 $3,486.00 C1776

FEMORAL POST AUG 5543-A-500 $2,959.00 C1776

STABILIZER TIBIAL INSERT TOTAL $5,796.00 C1776

NAIL GAMMA LONG 3225-0420S $5,226.00 C1713

SCREW CANN TI 7.3 X 10 $746.00 C1713

FEMORAL STAB POST TRIA SZ 7 PS $3,994.00 C1713

TIBIAL BEAR INSERT PS SZ 7 $3,792.00 C1776

GUIDEWIRE 2.0 $177.00 C1769

ELECTRODE ARGON COAGULATOR $275.00

STEM HUMER PRESS-FIT 12/130 $7,785.00 C1776

PLATE-T 1.3MM TI 3HOLE $622.00 C1713

SCREW CORTEX 1.5MM X 9MM $164.00 C1713

SCREW CORTEX 2.4 X 18MM $182.00 C1713

SCREW CORTEX 2.4 20MM $182.00 C1713

SCREW LOCK 2.7 28MM $398.00 C1713

PLATE HUMREUS DIST 3.5 LCP SZ5 $2,875.00 C1713

DRILL GUIDE THREADED 2.0 $1,417.00

SCREW CANNULATED 7.3 X 85 $746.00 C1713

SCREW CANNULATED 7.3 X 90 $746.00 C1713

PLATE LCP FIBULA 4 HOLE $1,594.00 C1713

ANCHOR PEEK ZIP 5.5MM $635.00 C1713

LEAD KIT PERM 1X8 STANDARD $5,090.00 C1778

SCREW QUICKFIX 3 X 17 $630.00 C1713

SCREW LOCKING 3X18 $299.00 C1713

SCREW PART THREAD 3 X 28 $366.00 C1713

SCREW BIOSTEON 9X28 $588.00 C1713

SCREW BIOSTEON 8X28 $588.00 C1713

BTB KIT $965.00

PIN VERSA $669.00 C1713

TIBIAL BEARING INSERT $2,860.00 C1776

TIBIAL BEARING TRIATHLON INSER $3,608.00 C1776

TENDON ACHILLES BONE BLOCK $4,710.00 C1762

TENDON QUAD BONE BLOCK $3,380.00 C1762

REUNION DUAL RADIUS HUMERAL HE $4,280.00 C1776

REUNION DUAL RADIUS HUMER HEAD $4,280.00 C1776

NAIL TIBIAL STANDARD $4,142.00 C1713

SCREW CORTEX 2.7 X 34MM $143.00 C1713

GUIDE NEEDLE LORAD 12G $46.00

SCREW CORTEX 2.7 X 30MM $143.00 C1713

SCREW BIOSTEON 9X23 $588.00 C1713

Page 267: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

END CAP 5 $578.00 C1713

NEURAWRAP NERVE PROT 10X4CM $3,572.00 C9353

FEMORAL NAIL 13 X 380MM $4,152.00 C1713

TIBIAL NAIL 10 X 330MM $4,142.00 C1713

ARCOM XL RINGLOC ACTEBULAR LIN $4,734.00 C1776

MODULAR HEAD 36MM $3,142.00 C1776

RINGLOC LTD SHL SIZE 50 $5,586.00 C1776

DRESSING WOUND VAC VIA 7DAY $1,672.00

INSERT KNEE BEARING TIB TRIATH $2,948.00 C1776

SCREW SET U-BLADE LAG 10.5MM $2,312.00 C1713

ACCESSORY KIT WRENCH & SCREWS $183.00

IMPLANT KNEE TOTAL $9,375.00 C1776

IMPLANT HIP TOTAL $9,910.00

IMPLANT HIP TOTAL ADM (SCMC) $11,310.00

IMPLANT KNEE PARTIAL UNI $8,710.00 C1776

IMPLANT HIP PARTIAL ENDO $4,910.00

IMPLANT SHOULDER ENDO/TOTAL $9,710.00

SCREW CANN ASNIS 6.5 X 85 $837.00 C1713

SCREW CORTEX 2.7 X 28 $143.00 C1713

BEARING MENISC UNI OXFORD 7MM $1,848.00 C1713

SCREW LOCKING 4.0 X 50 $479.00 C1713

SCREW LOCKING 4.0 X 80 $479.00 C1713

PICC SAPIENS 4FR SINGLE $610.00 C1751

PICC SAPIENS 5FR DUAL $610.00 C1751

GUIDE WIRE $418.00 C1769

PLATE 10 HOLE $1,619.00 C1713

TITAN RESERVOIR CL $3,910.00 C1813

MODULAR HIP SYSTEM 120 $6,312.00 C1776

CONICAL DISTAL STEM $6,978.00 C1776

MODULAR HIP SYSTEM 325 $8,221.00 C1776

MODULAR HIP SYSTEM 327 $8,221.00 C1776

V40 FEMORAL HEAD $1,952.00 C1776

DALL-MILES CABLE 2.0 $547.00 C1776

SCREW ASNIS 8.0 $799.00 C1713

PLATE STABLIZATION LOCK TROCH $1,665.00 C1713

RELOAD STPL PRPL GIA 60-3.0-4. $658.00

SCREW LOCKING 2.7 X 34 $372.00 C1713

PLATE HUMERUS 3.5 $2,650.00 C1713

PLATE RADIAL COLUMN $1,689.00 C1713

PLATE BARREL 145DEG 12H $1,728.00 C1713

PLATE BARREL 150DEG 12H $1,728.00 C1713

PLATE BARREL 135DEG 14H $2,297.00 C1713

PLATE BARREL 140DEG 14H $2,297.00 C1713

PLATE BARREL 145DEG 14H $2,297.00 C1713

PLATE BARREL 150DEG 14H $2,297.00 C1713

PLATE BARREL 135DEG 16H $2,297.00 C1713

PLATE BARREL 140DEG 16H $2,297.00 C1713

PLATE BARREL 145DEG 16H $2,297.00 C1713

PLATE BARREL 150DEG 16H $2,297.00 C1713

PLATE BARREL 145DEG 4H $1,300.00 C1713

Page 268: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PLATE BARREL 150DEG 4H $1,300.00 C1713

PLATE BARREL 145DEG 8H $1,728.00 C1713

PLATE BARREL 140DEG 8H $1,728.00 C1713

PLATE BARREL 145DEG 10H $1,728.00 C1713

PLATE BARREL 135DEG 12H $1,728.00 C1713

PLATE BARREL 140DEG 12H $1,728.00 C1713

INSERTION NEEDLE 4" $336.00

IPG PORT PLUG $214.00

MESH GRFT VASCULA 4-7MM X 45CM $2,553.00 C1781

CARBON FIBER RODS 11.0 $720.00 C1713

TROCAR POINT BLUNTED $331.00

INTRATHECAL PAIN PUMP CATHETER $1,525.00

TUBE TRACH 9.0 CUFFLESS $159.00

PLATE DORSAL 10 HOLE $2,470.00 C1713

NAIL GAMMA LONG KIT 10X400MM $6,356.00 C1713

SCREW CANN 3.7 X 26 $526.00 C1713

SCREW CANN 3.7 X 38 $526.00 C1713

PLATE LONG ANATOMIC VOLAR $2,470.00 C1713

SCROTAL CYLINDER SET /PUMP $17,890.00 C1815

BLADE BUR ROUND 6.3X21.8 $166.00

DRESSING DERMANET AG 4 X 4.75 $66.00

DRESSING DERMANET AG 4X8 $143.00

DRESSING DERMANET AG 4 X14 $273.00

AC GRAFTROPE $1,846.00 C1713

SCREW TENOD BIOCOMP 5.5 X 15MM $784.00 C1713

SCREW CORTEX 1.5 X 13 $164.00 C1713

U-BLADE SET 3065-0090S $2,454.00

SCREW LOCKING 2.7 X 22 $476.00 C1713

SCREW LOCKING 2.7 X 24 $476.00 C1713

GUIDEWIRE WALLSTENT .035 $393.00 C1769

PLATE LAT ANA DISTAL HUMERAL $2,838.00 C1713

SCREW LOCKING 14 X 2.7 $528.00 C1713

SCREW LOCKING 32 X 2.7 $528.00 C1713

SCREW LOCKING 36 X 2.7 $528.00 C1713

SCREW LOCKING 42 X 2.7 $528.00 C1713

PROTECTA XT CRT-D D314TRG $40,091.00 C1882

NAIL TIBIAL STANDARD 10X36 $4,334.00 C1713

TUBE PEG GASTRO 18 FR 20ML $67.00 B4088

BEARING KNEE MENISCAL R 6MM $1,848.00 C1713

NAIL KIT GAMMA LONG $5,572.00 C1713

PLATE LOCKING 2.7 4 HOLE $1,145.00 C1713

SCREW LOCKING 2.7 X 14 $398.00 C1713

SCREW LOCKING 2.7 X 12 $398.00 C1713

K-WIRE 1.4 X 100 $89.00 C1713

PLATE FIBULA 4 HOLE 2.7/3.5X86 $1,594.00 C1713

TIBIAL BEARING INSERT SZ 5X9MM $3,608.00 C1776

SCREW CORTICAL 2.7 X 28MM $108.00 C1713

SCREW CORTICAL 2.7 X 24MM $108.00 C1713

SCREW CORTICAL 2.7 X 26MM $108.00 C1713

TIGER LOOP #2 $167.00

Page 269: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

FLIP CUTTER II 9.5MM $809.00

SCREW BIOCOMPSOITE INTER 7X23 $560.00 C1713

SCREW BIO INT W/DISP 8 X 23 $560.00 C1713

JUGGERKNOT 2 ANCHOR 2.9MM $984.00 C1713

MICROMAX DISPOSABLE INST SET $916.00

PLATE 6 HOLE $915.00 C1713

PLATE 8 HOLE $1,236.00 C1713

SCREW LOCKING 2.7 X 26 $390.00 C1713

SCREW LOCKING 2.7 X 30 $390.00 C1713

SCREW CANC 6.5 X 95 $170.00 C1713

ROD STEEL $170.00 C1713

PIN STEINMANN 4.5 X 5 X 150MM $424.00 C1713

PIN STEINMAN 4.5 X 5X 180MM $424.00 C1713

SCREW CANN 4.0 X 10MM $559.00 C1713

SCREW CANN 4.0 X 12MM $559.00 C1713

DRILL BIT 6.0 $1,562.00

SCREW SCHANZ 4/3 X 100MM $476.00 C1713

CLAMP 4 X 2.5 $959.00

CLAMP 4 X 4 $959.00

NAIL FEMORAL 465.40S $2,496.00 C1713

PLATE 1.7MM 4 HOLE $610.00 C1713

SYSTEM FIXATION MENISCAL STRT $800.00 C1713

SYSTEM FIXATION MENISCAL CRVD $800.00 C1713

PUSHER/SUTURE CUTTER $371.00

SUTURE TICRON 2-0 10"NDL 30"L $28.00

NAIL SUPRACONDYLAR $5,746.00 C1713

DRILL BIT CANN 8.0 ASNIS $1,474.00

TRIATHLON TIBIAL AUG HALF BLOC $2,272.00 C1776

BEARING TIBIAL INSERT PS TRIAT $2,860.00 C1713

PLATE DISTAL FIB 5 H2.7/3.5X99 $1,617.00 C1713

BLOCK HALF AUGMENT TIB $2,325.00 C1713

K-WIRE $293.00 C1713

SCREW LOCKING 5.0 X 38MM $567.00 C1713

SCREW LOCKING 5.0 X 40MM $567.00 C1713

SCREW LOCKING 5.0 X 60MM $567.00 C1713

SCREW LOCKING 5.0 X 70MM $567.00 C1713

SCREW CORTICAL 4.5 X 42MM $123.00 C1713

SCREW CORTICAL 4.5 X 85MM $109.00 C1713

SCREW CORTICAL 4.5 X 90MM $123.00 C1713

SUTURE LASSO 90 DEGREE $427.00

SUTURETAK KIT $488.00

CANNULA 8.25 $93.00

BIOCOMPOSITE SUTURE TAK 3.0 $1,086.00

BONE PUTTY W/DBM/CAN BONE CHI $2,340.00 C9359

SHOULDER STABILIZATION KIT $187.00

TENDON SEMI TENODESIS $2,109.00 C1762

ACL KIT $645.00

MEDIAL PATELLOFEMORAL LIGAMEN $3,068.00 C1762

SUTURE ANCHOR VENTED #2 $809.00 C1713

PROTECTA DR D334DRG $34,220.00 C1721 C1721

Page 270: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PROTECTA XT DR D314DRG $32,760.00 C1721

PROTECTA CRT-D D334TRG $37,515.00 C1882

HUMERAL NAIL TI 7.5 $4,123.00 C1776

SCREW LOCKING TI 3.9 X 24 $605.00 C1713

SCREW LOCKING TI 3.9 X 46 $605.00 C1713

SCREW LOCKING TI 3.9 X 48 $605.00 C1713

ENDOCAP 0 MM $705.00 C1713

JUGGERKNOT 2.9MM $916.00 C1713

STENT GRAFT MAIN BODY ENDOLOGI $22,253.00 C1874

PROXIMAL EXTENTSION ENDOLOGIX $7,500.00 C1874

AFX INTRODUCER SHEATH $809.00

COIL DETACHABLE 8 X 14CM $1,386.00 C1770

COIL DETACHABLE 10 X 21.5CM $2,079.00 C1770

GUIDE WIRE .014 $534.00 C1769

STENT GRAFT MAIN BODY ENDOLOGI $22,253.00 C1875

LIMB EXTENSION $6,900.00 C1875

PLATE STANDARD MTP LEFT $2,125.00 C1713

SCREW QUICK FIX 3 X 19 $635.00 C1713

SCREW LOCKING 3 X 20 $299.00 C1713

GUIDE WIRE .045 X 5.910 $32.00 C1769

INDURA CATHETER 5.64 $1,305.00 C1755

STENT GRAFT MAIN BODY ENDOLOGI $22,253.00 C1875

GRAFT PROXIMAL EXTENSION $9,300.00 C1874

PLATE TI LC-DCP 8H 2.0X48 $1,053.00 C1713

PORT GELPORT (ONLY) $1,213.00

IMPLANT KINGER MCP SZ 40 $2,702.00 C1776

SUTURE FIBER FORCE 1 X 38" $78.00

BLOCK HALF AUGMENT TRIA TIBIAL $2,272.00 C1776

BLOCK HALF AUG TRIA TIB SZ 4 5 $2,272.00 C1776

PT HYBRID GLENOID POST $595.00 C1776

HYBRID GLENOID BASE 4MM MED $3,750.00 C1776

COMPREHESIVE SHOULDER SYS 14 X $9,500.00 C1776

VERA-DIAL SHOULDER SYS 50 X 24 $4,038.00 C1776

CLOSURE VASCULAR ANGIO PLUS 8F $580.00

JUGGERKNOT 1.4 MM SHORT $336.00 C1713

JUGGERKNOT 1.4MM SHORT W/NEED $934.00 C1713

EXTENSION KIT $1,605.00 C1883

PLATE VOLAR DIST 7H $3,870.00 C1713

IMMOBLIZIER SLINGSHOT SHLDER L $163.00

DRILL BIT CANN 2.4MM $1,058.00

SCREW CANN 3.2 X 18MM $1,148.00 C1713

STENT ESOPH WALLFLEX 23 X 10 $5,260.00 C1874

LONG MED AGGRESSIVE BLADE $116.00

LONG MED BLADE $116.00

SHORT TAPERED RECIP BLADE $198.00

CRESCENTIC BLADE LONG $288.00

CRESCENTIC BLADE SHORT $288.00

BLADE EGG BURR 5.0MM $185.00

PATELLA SYMMETRIC TRIATH $2,316.00 C1776

SHEATH UROPASS ACCESS 24CM $344.00

Page 271: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

TIBIAL NAIL STANDARD 9 X 300 $4,334.00 C1713

TIBIAL NAIL STANDARD 9 X 330 $4,334.00 C1713

PLATE DISTAL LATERAL FEMUR $5,108.00 C1713

SCREW LOCKING 5.0 X 90 $567.00 C1713

STRAW TUNNELING TOOL 28CM $710.00

ANCHOR CLIK $934.00 C1713

HEX WRENCH 7.6CM $214.00

PLATE AXSOS PROX TIBIA $3,986.00 C1713

SCREW LOCKING 4.0 X 24 $503.00 C1713

SCREW LOCKING 4.0 X 26 $503.00 C1713

SCREW LOCKING 4.0 X 34 $503.00 C1713

SCREW CORTICAL 3.5 X 28 $108.00 C1713

SCREW LOCKING 3.5 X 40 $567.00 C1713

SCREW CANN 32MM $581.00 C1713

SCREW CANCEL 4.45 X 40 $108.00 C1713

ANCHOR SUTURE SWIVELCK 4.75 X $996.00 C1713

SCREW BONE 3.5 X 28 $250.00 C1713

SCREW BONE 3.5 X 32 $250.00 C1713

SCREW BONE 3.5 X 34 $250.00 C1713

SCREW BONE 3.5 X 36 $250.00 C1713

SCREW BONE 3.5 X 38 $250.00 C1713

SCREW BONE 3.5 X 46 $250.00 C1713

SCREW BONE 3.5 X 48 $250.00 C1713

PLATE MESH VARIAX CALCANEAL #4 $2,334.00 C1713

NAIL GAMMA 3 LONG 10 X 380 X 1 $6,780.00 C1713

PLATE PROXIMAL HUMERUS $3,992.00 C1713

SCREW LOCKING 4.0 X 18 $534.00 C1713

SCREW LOCKING 4.0 X 44 $534.00 C1713

TOGGLELOC/WASHERLOC DISP KIT $1,767.00 C1713

SCREW CANCELLOUS WASHERLOC $583.00 C1713

PIN STEINMANN SMOOTH 2.5X100 $171.00 C1713

STENT INTEGRITY 4.0 X 12W $1,502.00 C1876

STENT INTEGRITY 4.0 X 12UX $1,502.00 C1876

MICROFIX QUICKANCHOR PLUS SUT $954.00 C1713

MICRO QUICKANCHOR PLUS SUTURE $931.00 C1713

MINILOR QA 2/0 OCCORD $954.00 C1713

CATH ATHRECTOMY TURBO HAWK $7,310.00 C1714

SCREW LOCKING FULLY THREADED $608.00 C1713

SCREW LOCKING PART THREADED $625.00 C1713

INSERT BEARING TIB TRIATHLON $3,422.00 C1776

BLOCK HALF AUG TIB SZ3 10MM $2,473.00 C1713

PLATE AXSOS FEMUR DISTAL $4,972.00 C1713

SCREW LOCKING 5.0 X 80 $567.00 C1713

SCREW CANC PT 6.5 X 65 $175.00 C1713

SCREW CORTICAL 4.5 X 60 $123.00 C1713

SCREW CANC PT 6.5 X 65 $175.00 C1713

SCREW SELF-LOCKING 3.5 X 28 $439.00 C1713

PLATE DISTAL TIB 6 HOLE $3,555.00 C1713

HALF BLOCK AUGMENT TIB $2,272.00 C1713

SCREW LOCKING 4.0 X 36MM $534.00 C1713

Page 272: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CANC FT 4.0 X 38MM $108.00 C1713

SCREW CORTICAL 3.5 X 22MM $108.00 C1713

SCREW CORTICAL 3.5 X 24MM $108.00 C1713

SUTURE 3-0 SUPRAMID EXTRA II $30.00

SUTURE 4-0 SUPRAMID EXTRA II $30.00

SCREW ASNIS 6.5 X 90 $842.00 C1713

SCREW ASNIS 8.0 X 85 $832.00 C1713

SCREW ASNIS 8.0 X 90 $832.00 C1713

SCREW CANN ASNIS SS 4.0 X 26 M $474.00 C1713

BIT DRILL CANN 4.5 X 102 $1,059.00

CAP END TI HUMER NAIL 0MM $533.00 C1713

BLADE SPIRAL TI 38MM $1,541.00

SCREW LOCK 4.0 X 24 $505.00 C1713

WASHER TITANIUM 13.0 $120.00 C1713

SCREW TROCH FIX 11 X 110 $1,499.00 C1713

CATH PREDATOR 1.25 $7,100.00 C1724

CATH PREDATOR 1.50 $7,100.00 C1724

GUIDE WIRE 0.014 $519.00 C1769

VIPERSLIDE LUBRICANT $244.00

PLATE PROX TIBIA RT 6H 4.5 X 1 $3,749.00 C1713

PLATE L DISTAL RAD LCP 2.4 $1,214.00 C1713

SCREW 6.5 X 30 MM $503.00 C1713

PIN STEINMANN 9 IN $537.00 C1713

GLENSPHERE COMP RVRS SHLD 36MM $3,552.00 C1776

BEARING SHLD REV 44- 36 XTD # $2,590.00 C1776

SCREW LOCKING 4.75 FIXED 25MM $506.00 C1713

STEM SHOULDER 9MM MINI $9,500.00 C1776

CYLINDER TITAN SCROTAL OTR $14,038.00 C1813

SCREW BONE T10 3.5 X 24 $250.00 C1713

WASHER ASNIS 4.0 $98.00 C1713

INSERT BEARING KNEE TIB TRIATH $3,949.00 C1776

AUGMENT HALF BLOCK TIB SIZ 8 $2,272.00 C1713

STEM CEMENTED KNEE $2,313.00 C1776

INSERT HIP TRIDENT $3,476.00 C1776

HEAD HIP FEMOR V40 $3,118.00 C1776

HEAD HIP FEMOR V40 $3,118.00 C1776

SCREW ASNIS CANN 4 X 14 $555.00 C1713

SCREW ASNIS CANN 4 X 16 $555.00 C1713

SCREW ASNIS CANN 4 X 18 $555.00 C1713

SCREW ASNIS CANN 4 X 20 $555.00 C1713

SCREW ASNIS CANN 4 X 22 $555.00 C1713

SCREW ASNIS CANN 4 X 24 $555.00 C1713

SCREW ASNIS CANN 4 X 28 $555.00 C1713

SCREW ASNIS CANN 4 X 30 $474.00 C1713

SCREW ASNIS CANN 4 X 32 $555.00 C1713

SCREW ASNIS CANN 4 X 34 $555.00 C1713

SCREW ASNIS CANN 4 X 36 $555.00 C1713

SCREW ASNIS CANN 4 X 38 $474.00 C1713

SCREW ASNIS CANN 4 X 40 $474.00 C1713

SCREW ASNIS CANN 4 X 42 $555.00 C1713

Page 273: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW ASNIS CANN 4 X 44 $555.00 C1713

SCREW ASNIS CANN 4 X 46 $555.00 C1713

SCREW ASNIS CANN 4 X 48 $555.00 C1713

SCREW ASNIS CANN 4 X 50 $555.00 C1713

SCREW ASNIS CANN 4 X 55 $555.00 C1713

SCREW ASNIS CANN 4 X 60 $555.00 C1713

SCREW ASNIS CANN 4 X 65 $555.00 C1713

SCREW ASNIS CANN 4 X 70 $555.00 C1713

SCREW CANN LOCK 3.7 X 30 $550.00 C1713

PLATE DORSAL VARIAX $2,578.00 C1713

PLATE DISTAL TIB 6H 3.5 X135 $3,555.00 C1713

NAIL FEMORAL 9 X 260 $4,346.00 C1713

CATH KIT OCT DRAGONFLY C7 $1,617.00

WIRE PRESSUREWIRE OCT AERIS $1,386.00 C1769

RESTORE SENSOR STIMULATOR 3771 $28,260.00 C1820

STENT WALLSTENT 14 X 60 AAA $2,348.00 C1874

WALLSTENT ENDOPROSTHESIS 16X60 $2,348.00 C1874

WALLSTENT ENDOPROSTHESIS 16X40 $2,348.00 C1874

SNARE POLYP LOOP 2.3 X 240 $86.00

JUGGERKNOT 1.0 MM $984.00 C1713

CATH AMPLTZ 5FR 100CM $38.00

SHEATH INTRODUCER 12FR 12CM $34.00

CANNULA PASSPORT BUTTON 10X3 $138.00

SWIVELOCK SPEEDBRIDGE IMPLANT $4,128.00 C1713

FORCEP BRONCHO BX 1.7 X 100 $179.00

U-BLADE SET, TI $2,454.00

NAIL LONG KIT GAMMA $5,572.00 C1713

SPACER SHOULDER TEMP W/CEMENT $6,310.00 C1713

SCREW NAIL FIX TROCH 11 X 90 $1,499.00 C1713

BURR ROUND 6.3MM $171.00

CHARGING SYSTEM KIT SC-6412-3 $3,210.00

ACL TIGHT ROPE RT $979.00 C1713

SCREW BIOINTERFERENCE 9X23 $802.00 C1713

3.5 FLOCUTTER $198.00

SCREW 10 X 23 $802.00 C1713

SCREW INTERFERENCE 7 X 25 $1,063.00 C1713

PIN PARTIAL THREADED 100MM $842.00 C1713

PIN PARTIAL THREAD 105MM $842.00 C1713

SCREW LOCKING 4.0 X 20 $108.00 C1713

SCREW LOCKING 4.0 X 28 $108.00 C1713

SCREW LOCKING 4.0 X 34 $108.00 C1713

SCREW LOCKING 4.0 X 55 $108.00 C1713

SCREW LOCKING 3.5 X 42 $108.00 C1713

SCREW LOCKING 3.5 X 65 $108.00 C1713

SCREW CANCEL 4.0 $108.00 C1713

NAIL ANKLE ARTHRODESIS $6,294.00 C1713

SCREW LOCKNG PT 5 X 60 $625.00 C1713

DRILL, AO, STERILE $613.00

FIBERLINK #2 $218.00

PUSHLOCK COMPOSITE 3.5 $1,088.00

Page 274: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SUTURE LASSO 25 DEGREE $491.00

PUSHLOCK KIT $600.00

TRANSBRONCHIAL ASPIR NEEDLE $271.00

NAIL KIT LONG GAMMA 3 SYS $5,572.00 C1713

DRILL BIT 4.2 $650.00

TIBIAL NAIL STANDARD $4,334.00 C1713

DRILL, AO, STERILE 04,2 X 180M $545.00

SCREW CANCELLOUS WASHERLO 6X4 $500.00 C1713

ZIPLOOP EXT TOGG ART FIX DEVIC $1,342.00 C1713

PLATE DHS 135DEG 4HOLE $1,468.00 C1713

PLATE DISTAL RADIUS 2.7 $4,132.00 C1713

DRILL BIT 2.0 $494.00

ANCHOR PEEK ZIP W/NEEDLE 6.5 $901.00 C1713

COAGULATOR SUCTION 8FR 6" $28.00

FLIP CUTTER II 9MM $931.00

DRILL PIN II RETRO $503.00

BOLT GRAFT 9MM $1,130.00 C1713

SCREW COMPOSITE 8 X 23 $1,121.00 C1713

SCREW COMPOSITE 6.25 X 15 $1,121.00 C1713

REAMER CANNULATED 8MM $1,173.00

STEM 8MM X 4MM $4,128.00 C1713

HEAD LEFT 22MM $6,580.00 C1713

KIT STYLET STIFF 70CM $534.00

SCREW CANC 4.0 X 18MM $98.00 C1713

SCREW CORT 2.7 X 18MM $108.00 C1713

SCREW ASNIS III $598.00 C1713

SCREW NON LOCKING 3.5 X 30 MM $250.00 C1713

SCREW NON LOCKING 3.5 X 40 MM $250.00 C1713

WASHER 3.5 $265.00 C1713

WASHER 4.0 $120.00 C1713

SCREW LOCK 4 X 30 MM $608.00 C1713

SCREW CANN 6.5 X 60MM $842.00 C1713

SCREW CANN 6.5 X 70MM $842.00 C1713

HEAD SHOULDER ECCENTRIC ADV $3,649.00 C1776

LEAD TRIAL SUB COMPACT 60CM $1,245.00 C1778

TENODESIS KIT SM DIAM $677.00 C1713

SCREW TENODESIS COMPOSITE 7 X $1,121.00 C1713

DRILL PIN 2.4 $119.00

SCREW COMPRESSION WICHITA $3,356.00 C1713

FEMORAL COMPONENT WICHITA $6,432.00 C1776

NAIL FUSION WICHITA $4,638.00 C1713

SCREW SELF-TAPPING WICHITA $531.00 C1713

SCREW SELF-TAPPING FT WICHITA $531.00 C1713

SCREW SELF-TAPPING FT WICHITA $531.00 C1713

SNARE POLYLOOP 30 X 2.8 X 230 $271.00

PLATE DCP 2.7MM X 10 $693.00 C1713

PLATE DCP 2.7MM X 12 $779.00 C1713

PLATE VOLAR DIST RAD 6H 2.4 $2,464.00 C1713

TIBIAL BEARING INSERT $6,534.00 C1776

SCREW CANCELLOUS 4 X 50 $108.00 C1713

Page 275: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

WASHER 390019 $167.00 C1713

PUSHLOCK COMPOSITE 4.5 $1,254.00 C1713

CORKSCREW COMPSITE 5.5 $986.00 C1713

SCREW CANCEL 4.0 $108.00 C1713

NAIL GAMMA 3S 10 X 360 X 125 $6,780.00 C1713

STENT ESOPHAGEAL POLY 14X21 $4,470.00 C1874

PLATE VOLAR WIDE SHORT $2,160.00 C1713

PLATE VOLAR WIDE LONG $2,160.00 C1713

CLIP HEMOSTASIS ESOPH 2.8X235 $543.00

CEMENT PLUG B006-0185 $397.00 C1713

MODULAR CENTERED EPIPHYSIS $7,693.00 C1776

HUMERAL STEM CEMENTLESS MOD $4,162.00 C1776

BINDER PELVIC $535.00

SCREW CORT 3.5 X 10 $108.00 C1713

SCREW CORT 3.5 X 55 $108.00 C1713

DRILL BIT 2.7 $549.00

STENT GRAFT MAIN BODY $9,300.00 C1874

LIMB EXTENSION RIGHT $6,300.00 C1875

CAP END PROX HUMER STANDARD $608.00 C1713

MESH HERNIA 7X9 $2,310.00 C1781

DRESSING FOAM MEPILEX AG 4X8 $63.00

KIT LEAD 3776-75 $3,900.00 C1778

SCREW CANCELLOUS 4.0 X 36 $108.00 C1713

SCREW LOCKING 4.0 X 46 $534.00 C1713

STENT URETER SFT 7FR 24CM $184.00 C2625

PLATE 1/3 4 HOLE $250.00 C1713

NAIL GAMMA 10 X 400 X 125 $6,780.00 C1713

SUTURE SURGIDAC 0 7" GRN $78.00

PLATE TIBIA DIST W/O TAB 3.5 $3,587.00 C1713

STENT URETER SFT 7FR 26CM $184.00 C2625

STENT URETER SFT 7FR 28CM $184.00 C2625

STENT URETER SFT 8FR 24CM $184.00 C2625

STENT URETER SFT 8FR 26CM $184.00 C2625

STENT URETER SFT 8FR 28CM $184.00 C2625

BLADE CUTTER AGG 2.5 $94.00

CALIBRATOR CKI/MBI $108.00

CANNULA PASSPORT BUTTON 8 X 30 $119.00

PLATE PROX HUMERAL ANATOMICAL $3,992.00 C1713

SCREW CANCELLOUS 4.0 X 45 $108.00 C1713

HEAD SHOULDER ECCENTRIC 52X21 $3,649.00 C1776

PLATE LOCKIN CALCANEAL LONG-RT $1,924.00 C1713

PLATE LOCKIN CALCANEAL LONG-LT $1,924.00 C1713

SCREW ASNIS 6.5 X 45MM $842.00 C1713

SCREW CANCELLOUS 4.0 X 32 $108.00 C1713

LOOP KNOTILUS 25MM $610.00

PLATE DCS 90DEG 8H 146MM $2,397.00 C1713

STEM HUMER MONOBLOCK 1 X 14 $8,038.00 C1776

CATH MONITOR SWANZ 5FR $413.00

STENT CORON DE RESOLUTE 3X18 $3,310.00 C1874

STENT CORON DE RESOLUTE 2.5 X $3,310.00 C1874

Page 276: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STENT CORON DE RESOLUTE 2.75X1 $3,310.00 C1874

STENT CORON DE RESOLUTE 4.0 X $3,310.00 C1874

STENT CORON DE RESOLUTE 2.5X14 $3,310.00 C1874

STENT CORON BM INTEGR 3.0X12 $1,502.00 C1874

BALLOON CORON SPRINTER 2.0 X 2 $503.00 C1725

BRACE LUMBAR SUPPORT CHRBK 8" $3,078.00

PLATE L-PLATE DIST RAD 90 2.4 $1,240.00 C1713

AC TIGHTROPE REPAIR KIT $1,485.00 C1713

BUTTON INSERTER $610.00

HEAD COCR 42MM $5,506.00 C1776

HUMERAL STEM 8/120MM $8,268.00 C1776

FLIP CUTTER 10MM $931.00

GRAFT BOLT 10MM $1,130.00 C1713

PLATE VOLAR NARROW LONG $2,160.00 C1713

PENCIL BOVIE W/SMOKE EVAC $89.00

SCREW LOW PROFILE TI 3X30 $366.00 C1713

SCREW LOCKING LOW PRO 3X10 $299.00 C1713

PLATE 6-HOLE AXSOS PROX TIBIA $3,986.00 C1713

SCREW LOCKING 4.0 X 50 $534.00 C1713

SCREW CORTICAL 3.5 X 70 $108.00 C1713

PLATE DISTAL POST LAT HUMERUS $3,566.00 C1713

DRILL BIT 3.5 $598.00

SCREW BONE 3.5 X 16 $320.00 C1713

SCREW BONE 3.5 X 20 $320.00 C1713

SCREW BONE 3.5 X 22 $320.00 C1713

SCREW NAIL FIX TORCH 11X100 $1,562.00 C1713

HEAD HUMERAL ADVANTAGE $3,285.00 C1776

END CAP TI 10MM $638.00 C1713

CHOLANGIOGRAM KUMAR CATH 76CM $120.00

CYLINDER TITAN SCROTAL OTR $14,720.00 C1813

SCREW ASNIS CANN 6.5 X 60 $842.00 C1713

SUTURE NYLON FS-1-2-0 $28.00

SUTURE FISHHOOK LASSO $482.00

PICC TRIPLE LUMEN $699.00 C1751

SCREW CANCEL 4.0 X 28 $108.00 C1713

SCREW ASNIS CANN 6.5 X 70 $842.00 C1713

SCREW CANN 6.5 X 75 $842.00 C1713

STEM SZ2 - 14 $8,038.00 C1776

METAGLENE $3,444.00 C1776

GRAFT VASC PERIPH 6MM X 50CM $2,222.00 C1765

TOURNIQUET TACTICAL BLACK $147.00

GUIDE PIN 3.2 $537.00 C1713

PLATE PROX TIBIA 4.5 $3,824.00 C1713

PLATE PROX TIBIA 4.5 $3,824.00 C1713

SCREW NON LOCK 3.5 X 22 $235.00 C1713

SCREW NON LOCK 3.5 X 24 $235.00 C1713

SCREW NON LOCK 3.5 X 26 $235.00 C1713

SCREW LOCKING CORT 3.5 X 20 $360.00 C1713

SCREW LOCKING CORT 3.5 X 32 $360.00 C1713

DRILL BIT QUICK RELEASE 3.5 $229.00

Page 277: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DRILL BIT QUICK RELEASE 2.0 $229.00

SUTURE CAPROSYN 3/0 ABSORBABLE $28.00

SUTURE CAPROSYN 3.0 UNDYED ABS $28.00

PLATE ANATOMIC LONG $2,578.00 C1713

SCREW LOCKING 2.7 X 18 $381.00 C1713

SCREW LOCKING 4.0 $528.00 C1713

ANCHOR PEG GLENOID 48MM $4,140.00 C1713

HUMERAL HEAD ADVANTAGE $3,285.00 C1776

PLATE DISTEL FEMUR AXSOS 6HOLE $5,108.00 C1713

SCREW CANC FT 6.5 X 85 $175.00 C1713

SCREW CANC FT 6.5 X 90 $175.00 C1713

SCREW LOCKING 5.0 X 36 $567.00 C1713

SCREW LOCKING 5 X 75 $567.00 C1713

SCREW ACUTRAK II 4.7 X 45MM $1,222.00 C1713

PLATE RT LATERAL 10 HOLE $2,522.00 C1713

SCREW HEXALOBE 3.5 X 30 $278.00 C1713

SCREW HEXALOBE 3.5 X 60 $363.00 C1713

SCREW HEXALOBE 3.5 X 22 $433.00 C1713

SCREW HEXALOBE 3.5 X 20 $430.00 C1713

SCREW HEXALOBE 3.5 X 26 $430.00 C1713

SCREW ACUTRAK II 4.7 X 35 $1,222.00 C1713

GUIDEWIRE ACUTRAK 4.7 $941.00 C1769

DRILL ACUTRAK 4.7 30MM $67.00

DRILL BIT 2.8MM $369.00

PLATE LCP POST DSTHUMERUS 7HOL $3,151.00 C1713

SCREW LOCKING SLF-TPN T8 50MM $407.00 C1713

SCREW LOCKING SLF-TPN T8 55MM $407.00 C1713

CABLE WITH CRIMP 1 X 750 $1,244.00

SCREW LOCKING 2.3 X 18 $317.00 C1713

SCREW LOCKING 2.3 X 20 $317.00 C1713

SCREW LOCKING 2.3 X 16 $320.00 C1713

SCREW LOCKING 2.3 X 26 $317.00 C1713

PLATE DISTAL CLAVICLE 2.3 13 H $2,554.00 C1713

STENT CORO DES INT RX 2.25 X 3 $3,310.00 C1874

STENT CORO DES INT RX 2.75 X 1 $3,310.00 C1874

STENT CORO DES INT RX 3.0 X 22 $3,310.00 C1874

STENT CORO DES INT RX 2.75 X 1 $1,502.00 C1874

STENT CORO DES INT RX 2.75 X 8 $1,502.00 C1874

BALLOON DILAT SPRINT RX 2.5 X $427.00 C1727

BALLOON DILAT CORO RX 2.5 X 25 $503.00 C1727

BALLOON DILAT CORO RX 2.25 X 6 $503.00 C1727

BALLOON DILAT CORO RX 2.25 X 1 $503.00 C1726

CATH GUIDE CORO EBU 3.5 FR 081 $167.00 C1887

PLATE OLECRANON LCP 8HOLE $2,706.00 C1713

PLATE 1/3 TUBULAR 6HOLE $250.00 C1713

SCREW CANCELLOUS 4.0 X 14 $108.00 C1713

KATALYST RADIAL STEM/SHAFT $6,120.00 C1776

ANCHOR PEEK ZIP 5.5MM $511.00 C1713

SCREW CANC FT 4.0 X 30 $108.00 C1713

SCREW CANC FT 4.0 X 50 $108.00 C1713

Page 278: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ANGIOJET SOL OMNI 6FR 120C OTW $3,750.00

PLATE HUMERAL AXSOS 14H $3,750.00 C1713

SCREW CANN PT 4.5 $632.00 C1713

PLATE DISTAL CLAVICLE LT 13HOL $2,554.00 C1713

SCREW LOCKING CORTICAL 2.0X10 $329.00 C1713

SCREW LOCKING CORTICAL 2.3X12 $317.00 C1713

SCREW LOCKING CORTICAL 3.5X8 $360.00 C1713

PLATE LATERAL RADIAL SHORT $1,774.00 C1713

INTRAOSSEOUS NEEDLE 45MM 15G $364.00

PLATE CLAVICLE HOOK 3.5 LCP 4H $2,118.00 C1713

SCREW CORTEX 2.7 X 10 $132.00 C1713

PLATE DCP 2.7MM X 80 10HOLE $519.00 C1713

SCREW NON-LOCKING 2.3 X 28 $381.00 C1713

PLATE DISTAL FEMUR AXSOS 8H $4,972.00 C1713

SCREW CORTICAL 4.5 X 70 $123.00 C1713

SCREW LOCKING 5.0 X 34 $567.00 C1713

SCREW LOCKING 5.0 X 46 $567.00 C1713

SCREW LOCKING 5.0 X 55 $567.00 C1713

NAIL FEMORAL, A/R 11 X 360 $4,346.00 C1713

STENT GRAFT MAIN BODY ENDOLOGI $22,253.00 C1874

GRAFT PROXIMAL EXTENSION $7,500.00 C1874

REAMER SHAFT AO FITTING $1,018.00

FEMORAL NAIL A/R R1500 $4,984.00 C1713

SCREW LOCKING ST 5.0 X 18 $414.00 C1713

SUTURE 1 MONOCRYL REF Y335H $28.00

BEARING MENISCAL ARCOM ANATOM $1,848.00 C1713

OXFORD PART KNEE SYSTEM SZ AA $3,542.00 C1776

STENT WALLFLEX ESOPHAGEAL 18X1 $5,260.00 C1874

NAIL HUMERAL PROX LONG RT 08 X $5,198.00 C1713

SCREW LOCKING FULLY THREAD 04 $608.00 C1713

DRILL, AO STERILE 33.5 X 30MM $623.00

SCREW LOCKING 22 X 92 $350.00 C1713

DRILL BIT QC 1.1 60 MM $255.00

DRILL BIT QC 3.2 195MM $407.00

CATH VNUS (DR. JEFFREY) 60CM $2,050.00

STENT GRAFT MAIN BODY ENDOLOGI $22,253.00 C1874

LIMB EXTENSION ENDOLOGIX $6,900.00 C1875

EPIPHYSIS CEMENTLESS MOD SZ 1 $7,693.00 C1776

4-0 MONOCRYL SUTURE Y494G $28.00

NEEDLE EPIDURAL 6" $186.00

CATH VNUS (DR. JEFFREY) 100CM $2,050.00

TIGHT ROPE BTB $934.00 C1713

10.5MM FLIP CUTTER II $809.00

DRESSING BIOBRANE 5 X 15 $640.00

TRIMANO BEACH CHAIR KIT $329.00

PLATE CUP CLAVICLE LCP 3.5 8H $2,470.00 C1713

NAIL LONG PROXIMAL HUMERAL $5,198.00 C1713

SCREW LOCKING FULLY THREADED $608.00 C1713

STAPLE W/SPIKES 5-16 X 7.9MM $737.00 C1713

STAPLE W/O SPIKES LG 9/16X14.3 $737.00 C1713

Page 279: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PLATE POSTERIOR MEDIAL 8H $3,396.00 C1713

SCREW BONE 3.5 X 24 $320.00 C1713

C-TAPER LFIT HEAD LOW FRIC 28M $2,662.00 C1713

SPEEDBRIDGE IMPLANT SYSTEM $3,710.00

SUTURE ANCHOR 5.5 SWIVELOCK $946.00 C1713

ESOPHAGEAL STENT 20 MM X 8CM $3,464.00 C1874

ESOPHAGEAL STENT 20MM X 10CM $3,464.00 C1874

ESOPHAGEAL STENT 20MM X 12.5CM $3,464.00 C1876

ESOPHAGEAL STENT 20MM X 12CM $3,464.00 C1874

SCREW INTERFERENCE FT BIO-COMP $560.00 C1713

SCREW DRILL BIT 2.7MM $583.00

SCREW DRILL BIT 3.2MM $558.00

BASEPLATE COMP REV SLD GLEN 25 $4,548.00 C1713

SCREW NON-LOCKING 4.75 X 15MM $537.00 C1713

SCREW FIXED LOCKING 4.75 X 25M $537.00 C1713

STEM SLD PRIM MIN 10MM X 83MM $10,006.00 C1776

HUMERAL TRAY COMP REV SLD $4,264.00 C1776

STENT CORO BM INTEGRA-BULK $1,386.00 C1874

STENT CORO DES INT RX 2.50 X 1 $3,110.00 C1874

SCREW CORTEX ST 2.0 X 18 $152.00 C1713

GUIDEWIRE CATH ANGIO 5FR 65CM $128.00

NAIL HUMERAL T2 SYSTEM 8X260 $4,326.00 C1713

END CAP T2 SYSTEM $608.00 C1713

SEAMGUARD 60 $520.00

10G VERTEPORT #0306-410-000 $184.00

STABILIZER FEMORAL COMP $12,147.00 C1776

STEM FLUTED #5565-S-014 $2,642.00 C1776

AUGMENT POSTERIOR FEMORAL $2,662.00 C1776

AUGMENT DISTAL FEMORAL $2,549.00 C1776

AUGMENT DISTAL FEMORAL #5541-A $2,662.00 C1776

STEM FLUTED #5565-S-012 $2,406.00 C1776

AUGMENT HALF BLOCK TIBIAL $2,406.00 C1776

OFFSET ADAPTER 6MM $2,338.00 C1776

STABILIZER TIBIAL INSERT $5,036.00 C1776

EZLOCK FEMORAL FIXATION 9-10MM $1,568.00 C1713

NAIL KIT TROCHANTERIC TI GAMMA $5,160.00 C1713

PC HYBRID GLENOID POST $732.00 C1713

HYBRID GLENOID BASE $394.00 C1713

MODULAR HEAD W/VARIABLE OFFSET $4,244.00 C1776

PRIMARY MINI LENGTH SHLDR STEM $10,006.00 C1776

PEG TUBE DECLOGGER 12-16FR $22.00

PEG TUBE DECLOGGER 18-24FR $22.00

PICO DRESSING 4 X 12 $548.00

PICO DRESSING 6 X 12 $548.00

NAIL KIT LG GAMMA 3 10X320X125 $6,780.00 C1776

BLADE BUR CARBID CROSS-CUT 2.1 $56.00

CABLE GRIP SYSTEM $2,815.00

TWIN PEG CEMENTED FEMORAL LARG $9,498.00 C1713

MENISCAL BEARING LARGE LT 3MM $1,848.00 C1713

PLATE ULNA SHORTENING $2,079.00 C1713

Page 280: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SEAMGUARD 60 #12BSGEC60A $557.00

WRENCH TORQUE #1101 $93.00

DRILL BIT 2.0MM AR-4160-20 $241.00

NAIL LONG KIT GAMMA 3 SYSTEM $5,572.00 C1713

PLATE CLAV ANT 8HOLE $2,554.00 C1713

SCREW CORTICAL 3.5 X 30 $235.00 C1713

SCREW CORTICAL 3.5 X 28 $235.00 C1713

SCREW LOCKING 3.5 X 26 $360.00 C1713

OXFORD PART KNEE SYSTEM $9,498.00 C1776

ANCHOR PEEK 3.5MM TWINLOOP $710.00 C1713

HYBRID GLENOID BASE $3,940.00 C1776

VERSA-DIAL SLD SYSTEM MOD HEAD $4,244.00 C1776

COMP SLD SYSTEM 11MM X 83 MM $10,006.00 C1776

PLATE LCP CLV HOOK 7H 3.5 X15M $2,366.00 C1713

NAIL LONG KIT GAMMA 3 SYS $5,572.00 C1713

IMPLANT SHLDER REV CAP EXACTEC $15,100.00

SCREW ASNIS CANN 6.5 X 105 $706.00 C1713

BACK BRACE $2,159.00 L0460

STENT CORO DES RX 3.5 X 15 $3,310.00 C1874

STENT CORO DES RX RX 3.5 X 23 $3,310.00 C1874

STENT BILIARY HERC 5X12 135 $2,742.00 C1876

STENT BILARY HERC 5X18X135 $2,910.00 C1874

STENT BILARY HERC 5.5X15X135 $2,910.00 C1874

STENT, HERCULINK RX 6 X 15X135 $2,910.00 C1874

STENT BILARY HERC 6 X 18 X 135 $2,910.00 C1874

BALLOON DILAT PTA 5 X 40 X 130 $458.00 C1727

BALLOON DILAT PTA 5 X 80 X 130 $458.00 C1727

BALLOON DILAT PTA 5 X 120 X 13 $458.00 C1727

BALLOON DILAT PTA 5.0X150X130 $535.00 C1727

CATH BALLOON OTW 5F 035 X 5 X $458.00 C1727

BALLOON DILAT PTA 6 X 80 X 130 $458.00 C1727

BALLOON DILAT PTA 6 X 120 X 13 $458.00 C1727

BALLOON DILAT PTA 7 X 40 X 130 $458.00 C1727

BALLOON DILAT PTA 7 X 80 X 130 $458.00 C1727

BALLOON DILAT PTA 8.0 X 40 X 1 $458.00 C1727

BALLOON DILAT PTA 8 X 80 X 130 $458.00 C1727

BALLOON DILAT PTA 9 X 40 X 80 $458.00 C1727

BALLOON DILAT PTA 9 X 80 X 80 $458.00 C1727

BALLOON DILAT PTA 10 X 40 X 80 $458.00 C1727

BALLOON DILAT PTA 12 X 40 X 80 $458.00 C1727

BALLOON DILAT PTA 6 X 40 X 130 $458.00 C1727

BALLOON DILAT PERIPH OTW 2 X 4 $896.00 C1727

BALLOON DILAT PERIPH OTW 2 X 1 $896.00 C1727

BALLOON DILAT PERIPH OTW 3 X 4 $896.00 C1727

BALLOON DILAT PERIPH OTW 3 X 1 $896.00 C1727

BALLOON DILAT PERIPH OTW 4 X 4 $896.00 C1727

BALLOON DILAT PERIPH OTW 4 X 1 $896.00 C1727

STENT CORO DES SPRNT RX 2.5 X $3,310.00 C1874

STENT CORO DES SPRNT RX 3 X 18 $3,310.00 C1874

STENT CORO BMS INT RC 2.25 X 8 $1,502.00 C1874

Page 281: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STENT CORO BMS INT RX 2.28 X 1 $1,502.00 C1874

STENT CORO BMS INT RX 2.25 X 1 $1,502.00 C1874

STENT CORO BMS INT RX 2.25 X 1 $1,502.00 C1874

STENT CORO BMS INT OTW 2.25 X $1,502.00 C1874

STENT CORO BMS INT RX 2.50 X 8 $1,502.00 C1874

STENT CORO BMS INT RX 2.50 X 1 $1,502.00 C1874

STENT CORO BMS INT RX 2.50 X 1 $1,502.00 C1874

STENT CORO BMS INT RX 2.50 X 1 $1,502.00 C1874

STENT CORO BMS INT RX 2.50 X 2 $1,502.00 C1874

STENT CORO BMS INT RX 2.75 X 1 $1,502.00 C1876

STENT CORO BMS INT FX 2.75 X 1 $1,502.00 C1874

STENT CORO BMS INT OTW 2.75 X $1,502.00 C1874

STENT CORO BMS INT RX 2.75 X 2 $1,502.00 C1874

STENT CORO BMS INT OTW 2.75 X $1,502.00 C1874

STENT CORO BMS INT RX 3.00 X 9 $1,502.00 C1876

STENT CORO BMS INT RX 3.0 X 15 $1,502.00 C1876

STENT CORO BMS INT RX 3.00 X 1 $1,502.00 C1874

STENT COR BMS INT OTW 3.0 X 22 $1,271.00 C1874

STENT CORO BMS INT OTW 3.00 X $1,502.00 C1874

STENT CORO BMS INT RX 3.00 X 2 $1,502.00 C1874

STENT CORO BMS INT RX 3.00 X 3 $1,502.00 C1874

STENT CORO BMS INT RX 3.50 X 9 $1,502.00 C1874

STENT CORO BMS INT RX 3.50 X 1 $1,502.00 C1874

STENT CORO BMS INT RX 3.50 X 1 $1,502.00 C1876

STENT CORO BMS INT RX 3.50 X 2 $1,502.00 C1874

STENT CORO BMS INT OTW 3.50 X $1,502.00 C1874

STENT CORO BMS INT RX 3.50 X 2 $1,502.00 C1874

STENT CORO BMS INT OTW 3.50 X $1,502.00 C1874

STENT CORO BMS INT RX 3.50 X 3 $1,502.00 C1874

STENT CORO BMS INT RX 4.00 X 9 $1,502.00 C1874

STENT CORO BMS INT RX 4.00 X 1 $1,502.00 C1874

STENT CORO BMS INT RX 4.00 X 1 $1,502.00 C1874

STENT CORO BMS INT OTW 4.00 X $1,502.00 C1874

STENT CORO BMS INT RX 4.00 X 2 $1,502.00 C1874

STENT CORO BMS INT OTW 4.00 X $1,502.00 C1874

STENT CORO BMS INT RX 4.00 X 3 $1,502.00 C1874

CATH GUID PERIPH MPH 6F 071 X $167.00 C1887

CATH GUID PERIPH PK1 6F 071 X $167.00 C1887

CATH GUID PERIPH RDC 6F 071 X $167.00 C1887

CATH GUID PERIPH MPH 7F 081 X $167.00 C1887

CATH GUID PERIPH PK1 7F 081 X $167.00 C1887

CATH GUID PERIPH RDC 7F 081 X $167.00 C1887

CATH GUID PERIPH MPH 8F 090 X $167.00 C1887

CATH GUID PERIPH PK1 8F 090 X $167.00 C1887

CATH GUID PERIPH RDC 8F 090 X $167.00 C1887

BALLOON DILAT SPRNT RX 2.5 X 1 $427.00 C1727

BALLOON DILAT SPRNT RX 3 X 12 $427.00 C1727

BALLOON DILAT SPRNT RX 3 X 15 $427.00 C1727

BALLOON DILAT SPRNT RX 3.5 X 9 $427.00 C1727

BALLOON DILAT SPRNT RX 3.5 X 1 $427.00 C1726

Page 282: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BALLOON DILAT SPRNT RX 4 X 9 $427.00 C1727

BALLOON DILAT SPRNT RX 4 X 12 $427.00 C1727

BALLOON DILAT SPRNT RX 4 X 15 $427.00 C1727

BALLOON DILAT PTA 5 X 80 $548.00 C1726

BALLOON DILAT PTA 6 X 80 $548.00 C1726

BALLOON DILAT PTA 6F 7 X 20 $548.00 C1727

BALLOON DILAT PTA 6F 7 X 80 $548.00 C1727

BALLOON DILAT PTA 8 X 80 $548.00 C1727

BALLOON DILAT PTA 5F 5 X 20 $548.00 C1727

BALLOON DILAT PTA 5F 5 X 40 $548.00 C1727

BALLOON DILAT PTA 5F 6 X 40 $548.00 C1727

BALLOON DILAT PTA 5F 7 X 40 $548.00 C1727

BALLOON DILAT PTA 6F 8 X 20 $548.00 C1727

BALLOON DILAT PTA 6F 8 X 40 $548.00 C1727

STENT CORO DES INT RX 2.25 X 8 $3,310.00 C1874

STENT CORO DES INT OTW 2.25 X $3,310.00 C1874

STENT CORO DES INT RX 2.25 X 1 $3,310.00 C1874

STENT CORO DES INT OTW 2.25 X $3,310.00 C1874

STENT CORO DES INT RX 2.25 X 1 $3,310.00 C1874

STENT CORO DES INT OTW 2.25 X $3,310.00 C1874

STENT CORO DES INT RX 2.25 X 1 $3,310.00 C1874

STENT CORO DES INT OTW 2.25 X $3,310.00 C1874

STENT CORO DES INT RX 2.25 X 2 $3,310.00 C1874

STENT CORO DES INT OTW 2.25 X $3,310.00 C1874

STENT CORO DES INT RX 2.25 X 2 $3,310.00 C1874

STENT CORO DES INT OTW 2.25 X $3,310.00 C1874

STENT CORO DES INT OTW 2.25 X $3,310.00 C1874

STENT CORO DES INT OTW 2.50 X $3,310.00 C1874

STENT CORO DES INT OTW 2.50 X $3,310.00 C1874

STENT CORO DES INT RX 2.50 X 1 $3,310.00 C1874

STENT CORO DES INT RX 2.50 X 1 $3,310.00 C1874

STENT CORO DES INT OTW 2.50 X $3,310.00 C1874

STENT CORO DES INT RX 2.50 X 2 $3,310.00 C1874

STENT CORO DES INT OTW 2.50 X $3,310.00 C1874

STENT CORO DES INT OTW 2.50 X $3,310.00 C1874

STENT CORO DES INT RX 2.50 X 3 $3,310.00 C1874

STENT CORN DES INT OTW 2.5X30 $3,310.00 C1874

STENT CORO DES INT RX 2.75 X 8 $3,310.00 C1874

STENT CORO DES INT OTW 2.75 X $3,310.00 C1874

STENT CORO DES INT RX 2.75 X 1 $3,310.00 C1874

STENT CORO DES INT OTW 2.75 X $3,310.00 C1874

STENT CORO DES INT RX 2.75 X 1 $3,310.00 C1874

STENT CORO DES INT OTW 2.75 X $3,310.00 C1874

STENT CORO DES INT RX 2.75 X 2 $3,310.00 C1874

STENT CORO DES INT OTW 2.75 X $3,310.00 C1874

STENT CORO DES INT RX 2.75 X 2 $3,310.00 C1874

STENT CORO DES INT OTW 2.75 X $3,310.00 C1874

STENT CORO DES INT RX 2.75 X 3 $3,310.00 C1874

STENT CORO DES INT OTW 2.75 X $3,310.00 C1874

STENT CORO DES INT RX 3.00 X 9 $3,310.00 C1874

Page 283: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STENT CORO DES INT OTW 3.00 X $3,310.00 C1874

STENT CORO DES INT RX 3.00 X 1 $3,310.00 C1874

STENT CORO DES INT OTW 3.00 X $3,310.00 C1874

STENT CORO DES INT RX 3.00 X 1 $3,310.00 C1874

STENT CORO DES INT OTW 3.00 X $3,310.00 C1874

STENT CORO DES INT OTW 3.0 X 1 $3,310.00 C1874

STENT CORO DES INT OTW 3.0 X 2 $3,310.00 C1874

STENT CORO DES INT RX 3.00 X 2 $3,310.00 C1874

STENT CORO DES INT OTW 3.00 X $3,310.00 C1874

STENT CORO DES INT RX 3.00 X 3 $3,310.00 C1874

STENT CORO DES INT OTW 3.00 X $3,310.00 C1874

STENT CORO DES INT RX 3.50 X 9 $3,310.00 C1874

STENT CORO DES INT OTW 3.50 X $3,310.00 C1874

STENT CORO DES INT RX 3.50 X 1 $3,310.00 C1874

STENT CORO DES INT OTW 3.50 X $3,310.00 C1874

STENT CORO DES INT RX 3.50 X 1 $3,310.00 C1874

STENT CORO DES INT OTW 3.50 X $3,310.00 C1874

STENT CORO DES INT RX 3.50 X 1 $3,310.00 C1874

STENT CORO DES INT OTW 3.50 X $3,310.00 C1874

STENT CORO DES INT RX 3.50 X 2 $3,310.00 C1874

STENT CORO DES INT OTW 3.50 X $3,310.00 C1874

STENT CORO DES INT RX 3.50 X 2 $3,310.00 C1874

STENT CORO DES INT OTW 3.50 X $3,310.00 C1874

STENT CORO DES INT RX 3.50 X 3 $3,310.00 C1874

STENT CORO DES INT OTW 3.50 X $3,310.00 C1874

STENT CORO DES INT RX 4.00 X 9 $3,310.00 C1874

STENT CORO DES INT OTW 4.0 X 9 $3,310.00 C1874

STENT CORO DES INT RX 4.00 X 1 $3,310.00 C1874

STENT CORO DES INT RX 4.00 X 1 $3,310.00 C1874

STENT CORO DES INT OTW 4.0 X 1 $3,310.00 C1874

STENT CORO DES INT RX 4.00 X 1 $3,310.00 C1874

STENT CORO DES INT OTW 4.0 X 1 $3,310.00 C1874

STENT CORO DES INT RX 4.00 X 2 $3,310.00 C1874

STENT CORO DES OTW 4.0 X 22 $3,310.00 C1874

STENT CORO DES RX 4.00 X 26 $3,310.00 C1874

STENT CORO DES OTW 4.0 X 26 $3,310.00 C1874

STENT CORO DES INT RX 4.00 X 3 $3,310.00 C1874

STENT CORO DES OTW 4.0 X 30 $3,310.00 C1874

STENT COMPL 10 X 40 X 80 $2,510.00 C1874

STENT COMPL 10 X 60 X 80 $2,510.00 C1874

STENT BILIARY COMP 5 X 120 X 1 $2,510.00 C1874

STENT BILIARY COMP OTW 5X40X13 $2,510.00 C1874

STENT BILIARY COMP OTE 5X80X13 $2,510.00 C1874

STENT BILIARY COMP 6X120X130 $2,510.00 C1874

STENT BILIARY COMP 6X150X130 $2,510.00 C1874

STENT BILIARY COMP 6X40X130 $2,510.00 C1874

STENT COMPL 6X80X130 $2,510.00 C1874

STENT BILIARY COMP 7X120X130 $2,510.00 C1874

STENT DILIARY COMP 7X150X130 $2,510.00 C1874

STENT COMPL 6X7X40X80 $2,510.00 C1874

Page 284: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STENT COMPL 7X80X130 $2,510.00 C1874

STENT COMPL OTW 8X40X130 $2,510.00 C1874

STENT DILIARY COMP 8X80X130 $2,510.00 C1874

STENT COMPL 9X60X80 $2,510.00 C1874

BALLOON DILAT CORO OTW 1.25X6 $503.00 C1726

BALLOON DILAT CORO OTW 1.25X10 $503.00 C1727

BALLOON DILAT CORO RX 1.25 X 1 $503.00 C1726

BALLOON DILAT CORO RX 1.25 X 1 $503.00 C1726

BALLOON DILAT CORO OTW 1.25 X $503.00 C1726

BALLOON DILAT CORO RX 1.25 X 1 $503.00 C1726

BALLOON DILAT CORO RX 1.5 X 6 $503.00 C1726

BALLOON DILAT CORO RX 2 X 30 $503.00 C1726

BALLOON DILAT CORO RX 2.25 X 1 $503.00 C1726

BALLOON DILAT CORO RX 2.5 X 6 $503.00 C1726

BALLOON DILAT CORO RX 2.5 X 10 $503.00 C1726

BALLOON DILAT CORO RX 2.5 X 20 $503.00 C1726

BALLOON DILAT CORO RX 2.5 X 25 $503.00 C1726

BALLOON DILAT CORO RX 2.5 X 30 $503.00 C1726

BALLOON DILAT CORO RX 2.75 X6 $503.00 C1726

BALLOON DILAT CORO RX 2.75 X 1 $503.00 C1726

BALLOON DILAT CORO RX 2.75 X 1 $503.00 C1726

BALLOON DILAT CORO RX 3 X 6 $503.00 C1726

BALLOON DILAT CORO RX 3 X10 $503.00 C1726

BALLOON DILAT CORO RX 3 X 20 $503.00 C1726

BALLOON DILAT CORO RX 3 X 25 $503.00 C1726

BALLOON DILAT CORO RX 3 X 30 $503.00 C1726

BALLOON DILAT CORO RX 3.5 X 6 $503.00 C1726

BALLOON DILAT CORO RX 3.5 X 15 $503.00 C1726

BALLOON DILAT CORO RX 4 X 6 $503.00 C1726

BALLOON DILAT CORO RX 4 X 10 $503.00 C1726

BALLOON DILAT CORO RX 4 X 12 $503.00 C1726

BALLOON DILAT CORO RX 4 X 15 $503.00 C1726

BALLOON DILAT CORO RX 4 X 30 $503.00 C1726

STENT VIABAHN 8F 8X2.5X120 $6,300.00 C1874

DISPOSABLE 2.9 KIT AR-1923DS $500.00

RT SUTURE PASSER AR-4068-45R $427.00

2.9 PUSHLOCK AR-1923BC $1,088.00

EPIPHYS MODULAR SIZE 1 $7,693.00 C1776

HUMERAL STEM $4,162.00 C1776

ANGIOJET SPIROFLEX $4,450.00

ANGJOJET SOLENT PROXI $3,950.00 C1757

PLATE AXSOS TIBIA PROXIMAL $3,986.00 C1713

SCREW CORTICAL 3.5 X 44 $108.00 C1713

SCREW CANCELLOUS 4.0 X 70 $108.00 C1713

ANCHOR BIO SWVL LCK 4.75X24.5 $941.00 C1713

PUSHLOCK DISP KIT 3.5 $305.00

SCREW ASNIS CANNUL 6.5 X 110MM $842.00 C1713

REVEAL XT MONITOR 9529 $8,510.00 C1764

SHOULDER STANDARD/ENDO CAP $9,110.00

OXFORD KNEE SYS TWIN PEG FEMOR $5,478.00 C1713

Page 285: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW LOCKING PT 5 X 55 $604.00 C1713

ROD HUNTER TENDON 4 X 24.5 $3,434.00 C1713

SCREW CANN 4.5 $632.00 C1713

PLATE DISTAL FEMORAL AXSOS $2,541.00 C1713

SCREW CORTICAL 4.5 X 52 $98.00 C1713

SCREW LOCKING 5.0 X 46 $441.00 C1713

SCREW LOCKING 5.0 X 50 $441.00 C1713

SCREW LOCKING 5.0 X 90 $441.00 C1713

SCREW LOCKING 5.0 X 80 $441.00 C1713

VENA CAVA LP GUNTH TUL REMOVER $698.00

TOTAL SHOULDER CAPITATED $11,510.00

SCREW BONE 3.5 X 60 $208.00 C1713

SLING RESTORELLE Y 24 X 4 $2,298.00 C1771

RADIAL HEAD SM 11 MM $6,535.00 C1713

MATRIX DX REINFORECEMENT 5X5 $4,106.00 C1762

CATHETER INTRATHECAL ASCENDA $2,079.00 C1755

PLATE CLAVICLE ANTERIOR 6HOLE $2,560.00 C1713

SCREW BONE 2.7 X 12 $263.00 C1713

SCREW BONE 2.7 X 14 $263.00 C1713

SCREW BONE 2.7 X 16 $263.00 C1713

SCREW BONE 2.7 X 18 $263.00 C1713

PLATE LEFT 5 HOLE $1,841.00 C1713

PLATE 6HOLE RIGHT $1,841.00 C1713

NAIL HUMERAL T2 SYS $3,535.00 C1713

KATALYST HEAD 21 MM $6,120.00 C1776

INTERSPACE SHLD KIT SPS0021K $7,646.00 C1776

COLPO-PNEUMO OCCLUDERS, STERIL $171.00

TUBE PEG 20FR X 2.0CM $415.00 B4087

PLATE SHORT DORSAL $2,079.00 C1713

BIT DRILL 2.0 #60-20485 $383.00

PLATE FIB DIST LAT 2.7/3.5 6HO $1,712.00 C1713

EXTENSION LEAD IPG 35CM $2,430.00 C1883

NAIL HUMERAL 27 X 230 $3,535.00 C1713

SCREW LOCKING FT 4 X 38 $599.00 C1713

SCREW LOCKING FT 4 X 36 $599.00 C1713

NAIL HUMERAL 8 X 250 $3,535.00 C1713

PICO DRESSING 6 X 6 $548.00

PLATE STD 80-0695 $2,590.00 C1713

SCREW NON LOCKING 3.5 X 12 $278.00 C1713

SCREW NON LOCKING 3.5 X 14 $278.00 C1713

SCREW LOCKING 3.5 X 12 $430.00 C1713

PEGS LOCKING SMOOTH 2.3 X 22 $317.00 C1713

DRILL BIT 80-0724 $533.00

SCREW NON-LOCKING 4.75 X 30 $537.00 C1713

COMP REV SLD HUMERAL TRAY $4,264.00 C1776

COMP REV SLD HUMERAL BEARING/S $2,590.00 C1776

PLATE AXSOS 6 HOLE $3,409.00 C1713

SCREW CORTICAL 3.5 X 30 $112.00 C1713

GRAFT VASC ADVANTA 5 X 80 $1,176.00 C1768

STENT GRAFT SYS ENDURANT $20,260.00 C1874

Page 286: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STENT GRAFT SYS ENDURANT $10,260.00 C1874

JUGGARKNOT 1.0MM MINI 3-0 $941.00 C1713

GRAFT AFX MAIN BODY $22,680.00 C1874

EXTENSION AORTIC AFX $8,090.00 C1874

PLATE LCP NRW 10H 4.5MM $1,520.00 C1713

SCREW BIO-COMPRESSION $1,245.00 C1713

GUIDEWIRE FOR BIO-SCREW $28.00 C1769

NASAL SPLINT SMALL $186.00

NASAL SPLINT MEDIUM $186.00

NASAL SPLINT LARGE $186.00

SCREW CANNULATED 8.0 X 105MM $698.00 C1713

SCREW CANNULATED 8.0 X 110MM $698.00 C1713

SCREW CANNULATED 8.0 X 115 MM $698.00 C1713

OXFORD PART KNEE SYS SMALL $5,478.00 C1776

SUTURE LASSO 45 DEG LFT $427.00

PLATE STANDARD CLAVICLE 6H LFT $2,335.00 C1713

SCREW BONE 3.5 X 12 $263.00 C1713

SCREW BONE 3.5 X 14 $263.00 C1713

NAIL TIBIA 8 X 330 T2 SYSTEM $3,510.00 C1713

TUBE JEJUNAL FEEDING 8.5 FR $595.00

MESH BIO XENMA TRIX 19 X 28 $24,935.00 C1781

HIP MATRIX DX REIN 6 X 8 $4,450.00 C1762

STENT GRAFT MAIN BODY ENDOLOGI $22,680.00 C1874

STAPLER ENDO 35MM $644.00

STENT PREMOUNTED 7FR $2,410.00 C1876

SCREW ASNIS III 6.5 X 40MM $706.00 C1713

TRACHEOSTOMY TUBE $586.00

TRACHEOSTOMY TUBE $586.00

PLATE MIDSHAFT CLAVICLE 7H $2,560.00 C1713

SCREW BONE 3.5 X 18 $263.00 C1713

SCREW BONE 3.5 X 26 $263.00 C1713

RECHARGEABLE BATTERY RESTORE $20,310.00 C1820

SCREW CANC 6.5 X 60 $140.00 C1713

SCREW CANC 6.5 X 75 $140.00 C1713

SCREW CANC 6.5 X 80 $140.00 C1713

SCREW LOCKING 5.0 X 65 $469.00 C1713

NAIL FIXATION TROCH CANN 11MM $3,572.00 C1713

LATERAL TRACTION SLEEVE $179.00

PLATE ACU-LOCIL STANDARD SIZE $2,678.00 C1713

SCREW LOCKING 2.3 X 22 $317.00 C1713

SCREW LOCKING 3.5 X 14 $430.00 C1713

SCREW LOCKING 3.5 X 16 $430.00 C1713

PLATE 6HOLE 239.987 $3,782.00 C1713

SCREW 5.0 X 45 $590.00 C1713

SCREW 5.0 X 50 $590.00 C1713

PACEMAKER MRI ADVISA DR $12,042.00 C1785

SCREW CANN 4.5 X 72 $632.00 C1713

PLATE TIBIA #437322 $3,316.00 C1713

SCREW CANC 4.0 X 75 $98.00 C1713

SCREW CANC 4.0 X 80 $98.00 C1713

Page 287: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CANC 4.0 X 85 $98.00 C1713

MODULAR HEAD W/VAR 50 X 21 X 5 $3,692.00 C1776

QUICK CONNECT DRILL BIT 4 MM $565.00

QUICK CONNECT DRILL BIT 15/64 $588.00

CYLINDER SET W/OTR PUMP $15,150.00 C1813

SCREW LOCKING 2.7 X 8MM $433.00 C1713

PLATE FIBULA LATERAL 2.7/3.5MM $1,705.00 C1713

RELIEVA SPIN BALLOON SINUPLAST $3,660.00 C1726

RELIEVA SINUS BALLOON INFLATIO $227.00

RELIEVA SPION SINUS GUIDE CATH $797.00 C1887

SHOULDER STANDARD STEM 8 X 122 $9,134.00 C1713

GLIDESCOPE GVL STAT SZ 1 $85.00

NAIL GAMMA 300MM LONG $5,334.00 C1713

TIBIAL BEAR INSERT 5 X 16 $2,848.00 C1713

SCREW LOCKING 4.0 X 42 $416.00 C1713

SCREW LOCKING 4.0 X 46 $416.00 C1713

NAIL HUMERUS T2 SYSTEM 8 X 240 $3,535.00 C1713

SCREW LAG U-BLADE 10.5 X 80 $1,989.00 C1713

NAIL GAMMA RT 10 X 320 X 125 $5,334.00 C1713

NAIL TIBIAL T2 SYS 9 X 375 $3,510.00 C1713

PLATE PROX HUMERUS 3 HOLE $2,988.00 C1713

SCREW LOCKING 4.0 X 44 $416.00 C1713

ACCESSORY KIT MEDTRONIC 8785 $610.00

SCREW CANNULATED 6.5 X 65 $706.00 C1713

TRIATH TK TIBIAL BASEPLATE SZ7 $5,374.00 C1776

STENT ESOPH WALL 23 X 10 $5,130.00 C1874

FIBERWIRE SNARE #2 $162.00 C1713

PLATE SUPER LATERAL 3H RT $2,560.00 C1713

SCREW BONE 2.7 X 24 $263.00 C1713

BIT DRILL ACUTRAK II CANNULATE $727.00

WIRE DBL ENDED .045 ACUTRAK II $67.00 C1713

SCREW ACUTRAK II 26MM $859.00 C1713

NAIL TIBIAL STD 8 X 135 T2 SYS $3,510.00 C1713

BIT DRILL 2.5 MM $594.00

MIC-KEY LOW PROFILE GASTROSTOM $300.00

CLOSURE VASCULAR EXOSEAL 6F $458.00 C1760

SCREW LOCKING 2.3 X 20 $412.00 C1713

PLATE LCP T-ADAPTION 2.4 7H $2,144.00 C1713

SCREW CORTEX 2.0 X 36MM $169.00 C1713

SCREW CORTEX 2.7 X 24 $155.00 C1713

PLATE PROX LAT TIB AXSOS 6H $3,316.00 C1713

SCREW LOCKING 4.0 X 65 MM $441.00 C1713

STENT WALLFLEX ESOPH 23 X 125 $5,130.00 C1874

JAGWIRE GUIDEWIRE STRAIGHT TIP $348.00 C1769

PROTECTA XT D314VRG $28,652.00 C1722

ENDURANT II STENT ETBF3616C166 $20,260.00

RELIANT STENT GRAFT REL46 $1,108.00

GUIDEWIRE SENSH1228W $458.00 C1769

GUIDEWIRE SENSH1628W $610.00 C1769

ENDURANT II STENT ETBF2813C145 $20,260.00

Page 288: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ENDURANT II STENT ETLW1610C199 $13,300.00

ENDURANT II STENT ETLW1628C93E $10,160.00

GUIDEWIRE SENSH1428W $610.00 C1769

POST ANGLED 30 DEGREE $334.00

CARBON MRI ROD 450 MM $870.00

SCREW ASNIS CANN 6.5 X 75 $706.00 C1713

SCREW ASNIS CANN 6.5 X 55 $706.00 C1713

SCREW ASNIS CANN 6.5 X 115 $706.00 C1713

SCREW CORTEX 2.0 X20 $169.00 C1713

SCREW CORTEX 2.0 X 22 $169.00 C1713

SCREW CORTEX 2.0 X 24 $169.00 C1713

SCREW CORTEX 2.0 X 26 $176.00 C1713

SCREW CORTEX 2.0 X 28 $169.00 C1713

PLATE DIST HUMER 10H 3.5 X 230 $4,226.00 C1713

SCREW HEADLESS 2.4 X 17 LG THR $1,118.00 C1713

DRILL BIT 310.221 $1,252.00

URETERAL CATH STEN ILL 5FR $500.00 C1758

SCREW ASNIS CANN 3.0 X 34 $517.00 C1713

SCREW ASNIS CANN 3.0 X 30 $517.00 C1713

K-WIRE 1.2MM 45-30015 $93.00 C1713

DRILL BIT CANNULATED 2.1 MM $598.00

PLATE OBLIQUE 2.4 X 42 2H $1,183.00 C1713

PLATE PROX HUMERUS 4 HOLE $3,382.00 C1713

SCREW CANN 4.0 X 40 $549.00 C1713

SCREW LOCKING 3.5 X 50 $597.00 C1713

SCREW LOCKING 3.5 X 8 $597.00 C1713

SCREW BONE 3.5 X 34 $297.00 C1713

SCREW BONE 3.5 X 55 $297.00 C1713

TWISTER PLUS RETRIEVAL 22MM $232.00

TWISTER PLUS RETRIEVAL 26MM $232.00

PLATE LCP Y 2.4 X 60MM 3H $2,144.00 C1713

MCP FINGER IMPLANT SIZE 60 $2,990.00 C1713

MCP FINGER IMPLANT SIZE 50 $2,990.00 C1713

PLATE DISTAL FIBULA 6 H $1,523.00 C1713

SCREW LOCKING 3.5 X 22 $469.00 C1713

PLATE METACARPAL 5TH $1,214.00 C1713

SCREW LOCKING 2.3 X 12 $320.00 C1713

SCREW LOCKING 2.3 X 14 $320.00 C1713

PLATE PROX HUMERUS 3 HOLE $3,120.00 C1713

SCREW LOCKING 4.0 X 55 $485.00 C1713

SCREW CANCELLOUS 4.0 X 26 $109.00 C1713

SPINAL CORD STIM #97712 $22,860.00 C1820

LEAD KIT MEDTRONIC $4,510.00 C1778

PATIENT PROGRAMMER MEDTRONIC $2,067.00 C1787

CHARGING SYSTEM MEDTRONIC $3,900.00

PLATE MEDIAL 8 HOLE $2,522.00 C1713

SCREW NON-LOCK HEX 3.5 X 65 $363.00 C1713

SCREW NON-LOCK HEX 3.5 X 40 $278.00 C1713

SCREW NON-LOCK HEX 3.5 X 45 $278.00 C1713

SCREW NON-LOCK HEX 3.5 X 34 $278.00 C1713

Page 289: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW NON-LOCK HEX 3.5 X 36 $278.00 C1713

SCREW NON-LOCK HEX 3.5 X 18 $278.00 C1713

SCREW NON-LOCK HEX 3.5 X 28 $278.00 C1713

SCREW LOCKING 3.5 X 28 $433.00 C1713

SCREW ACUTRAK 2 7.5 X 55 $1,319.00 C1713

GUIDE WIRE 2.0 X 9 $86.00 C1769

GUIDE WIRE 0.94 $67.00 C1769

PROF DRILL $941.00

LONG PROF DRILL $941.00

PLATE TAP 3.5 $727.00

GUIDEWIRE 1.1MM X 22 $147.00 C1769

SCREW HEADLESS 20MM $1,200.00 C1713

NAIL LING KIT TI GAMMA 3 SYS $5,584.00 C1713

BAG REINFUSION AUTOTRANS 1L $82.00

STENT GRAFT SYSTEM, ENDURANT I $13,110.00 C1874

CABLE DALL-MILES TROCH GRIP W/ $3,182.00 C1713

CABLE DALL-MILES TROCH GRIP W/ $3,182.00 C1713

FLIP CUTTER II 8MM $931.00

GRAFTBOLT TIBIAL 8MM $1,130.00 C1713

SCREW ACUTRAK AT2-C16 16MM $859.00 C1713

SCREW ACUTRAK AT2-C18 18MM $859.00 C1713

SCREW ACUTAK AT2-C20 20MM $859.00 C1713

SCREW ACUTRAK AT2-C22 22MM $859.00 C1713

SCREW ACUTRAK AT2-C24 24MM $859.00 C1713

SCREW ACUTRAK AT2-C28 28MM $859.00 C1713

SCREW ACUTRAK AT-2C30 30MM $1,220.00 C1713

DEPTH GAUGE $123.00

GUIDE WIRE LONG 80-1524 $56.00 C1769

NAIL RECONST TI 1843-1340S $5,007.00 C1713

SCREW LAG RECON 1897-6085a $684.00 C1713

SCREW SET RECON 1847-0001S $521.00 C1713

K-WIRE COCR RECON 3.2 X 400 $519.00 C1769

TRIATHLON TOT STAB FEMORAL COM $12,904.00 C1776

TRIATHLON TOT KNEE CEMENT STEM $2,540.00 C1776

TRIATHLON TOT STAB TIBIAL INSE $5,186.00 C1776

NEUROSTIM NON-RECHAR MRI $23,310.00 C1767

PATIENT PROGRAMMER MY STIM $2,079.00 C1787

PLATE 1/3 RECON 6H $1,240.00 C1713

PLATE 1/3 RECON 4 H $1,188.00 C1713

PLATE LAT DR 54-25401 $1,646.00 C1713

SCREW LOCKING 2.3 X 10 $400.00 C1713

SCREW LOCKING 2.3 X 24 $400.00 C1713

OXFORD PARTIAL KNEE SYSTE SZ E $3,542.00 C1776

TUBE INSUFFLATION VNUS $56.00

SCREW CORTEX 2.7 X 40 $179.00 C1713

BEARING KNEE MESCL LG RT 3MM $1,848.00 C1713

DRILL ICONIX 2.3 #3910-500-569 $566.00

ANCHOR ICONIX 2.3 W/FORCE FIBE $904.00 C1713

SCREW CANN INT W/DISP SHEATH $503.00 C1713

RIB FIXATION SYSTEM TITANIUM $24,720.00 C1713

Page 290: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CEMEX PREPKIT (BONE PLUG) $610.00

BONE PLUG TPA-8 $244.00

BONE PLUG TPA-13 $244.00

BONE BLUG TPA-18 $305.00

BONE PLUG TPA-24 $305.00

OXFORD PART KNEE SYS SM LT 6MM $1,848.00 C1776

K-WIRE 2.0 X 285 MM $380.00 C1713

PLATE FEMUR HOOK 12H $5,306.00 C1713

SCREW CANN 5.0 X 95MM $652.00 C1713

TENDON GRACILIS 3-10MMX20-38CM $2,903.00 C1762

NAIL GAMMA LONG TI 3 SYSTEM $5,584.00 C1713

SCREW CORTICAL 3.5 X 46 $108.00 C1713

PLATE PROX TIBIA 4 HOLE $4,100.00 C1713

SCREW LOCKING CANN 3.7 X 65 $635.00 C1713

SCREW LOCKING CANN 3.7 X 75 $635.00 C1713

DRILL BIT 2.8 X 200 $575.00

STOCKING TED HIGHT 2XL REG $30.00

CATH FOLEY TEMP SENSING 16FR $105.00

STENT WALLFLEX ESOPH 23 X 120 $5,388.00 C1874

BONE CEMENT SIMPLEX P HV 6194- $213.00 C1713

SCREW LOCKING 5.0 X 26 $517.00 C1713

SCREW LOCKING 5.0 X 42 $517.00 C1713

BIT DRILL ICONIX 1.4 $566.00

ANCHOR SUTURE ICONIX 25 $904.00 C1713

ANCHOR SUTURE ICONIX 1 $904.00 C1713

ANCHOR SUTURE ICONIX 3 $904.00 C1713

NAIL TIBIAL STANDARD 10 X 345 $3,733.00 C1713

SCREW LOCKING 4 X 55 $514.00 C1713

CONCEAL RESERVIOR IZ $4,048.00 C1813

MS PUMP LGX 15CMX12MM $15,956.00 C1813

SCREW LOCK CANN 5.0 $652.00 C1713

PLATE DORSAL MEDIAL $1,646.00 C1713

SENSOR FLOW VENT $65.00

FILTER VENT AIR INTAKE $21.00

K-WIRE .035MM X 9IN DIAMOND PO $126.00 C1769

K-WIRE .045MM X 9IN DIAMOND PO $126.00 C1769

PLATE VOLAR 8 HOLE 100 MM XXL $3,460.00 C1713

PLATE VOLAR 11 HOLE 145MM XXL $3,910.00 C1713

SCREW NL MOD MINI FRAG 2.0 $467.00 C1713

SCREW NL MOD MINI FRAG 2.0 X $467.00 C1713

SCREW LCP MOD MINI FRAG 2.4 X $229.00 C1713

SCREW LCP MOD MINI FRAG 2.4 X $229.00 C1713

SCREW LCP MOD MINI FRAG 2.4 X $229.00 C1713

SCREW BONE 6.5 X 35MM $578.00 C1713

RINGLOC CONSTRAINED LINER 36MM $6,132.00 C1776

FREEDM CONSTRAINED MOD HEAD 3 $3,874.00 C1776

DRILL BIT RINGLOC/QUIK3.2X30MM $357.00

GUIDE WIRE .054 MM $56.00 C1769

SCREW CORTEX ST 2.4 X 8 $188.00 C1713

SCREW CORTEX ST 2.4 X 10 $188.00 C1713

Page 291: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CORTEX ST 2.4 X 12 $188.00 C1713

SCREW CORTEX ST 2.4 X 14 $188.00 C1713

SCREW CORTEX ST 2.4 X 16 $188.00 C1713

SCREW CORTEX ST 2.4 X 18 $188.00 C1713

SCREW CORTEX ST 2.4 X 20 $188.00 C1713

SCREW CORTEX ST 2.4 X 22 $188.00 C1713

SCREW CORTEX ST 2.4 X 24 $188.00 C1713

SCREW CORTEX ST 2.4 X 26 $188.00 C1713

SCREW CORTEX ST 2.4 X 28 $188.00 C1713

SCREW CORTEX ST 2.4 X 30 $188.00 C1713

SCREW CORTEX ST 2.4 X 32 $188.00 C1713

SCREW CORTEX ST 2.4 X 34 $188.00 C1713

SCREW CORTEX ST 2.4 X 36 $188.00 C1713

SCREW CORTEX ST 2.4 X 38 $188.00 C1713

SCREW CORTEX ST 2.4 X 40 $188.00 C1713

SCREW CORTEX ST 2.0 X 20 $188.00 C1713

SCREW CORTEX ST 2.0 X 22 $188.00 C1713

SCREW CORTEX ST 2.0 X 24 $166.00 C1713

SCREW CORTEX ST 2.0 X 26 $166.00 C1713

SCREW CORTEX ST 2.0 X 28 $166.00 C1713

SCREW CORTEX ST 2.0 X 30 $166.00 C1713

SCREW CORTEX ST 2.0 X 32 $166.00 C1713

SCREW CORTEX ST 2.0 X 34 $166.00 C1713

SCREW CORTEX ST 2.0 X 36 $166.00 C1713

SCREW CORTEX ST 2.0 X 38 $166.00 C1713

SCREW CORTEX ST 2.0 X 40 $166.00 C1713

DRILL BIT/QC 1.5 X 110 MM $284.00

DRILL BIT/QC 1.8 X 125 MM $503.00

DRILL BIT/QC 2.4 X 100 MM $503.00

MODULAR FOOT MODULE 2.0 X 2.4 $2,492.00 C1713

SCREW BI-CORTICAL $436.00 C1713

SPIKED WASHER $436.00

DRILL BIT BONE HIGH PERFORMANC $423.00

PLATE CURVED 5 HOLE $1,660.00 C1713

DRILL BIT 2.0MM $244.00

REAMER CONCAVE 18MM - 218 $1,476.00

REAMER CONCAVE 18MM - 318 $1,476.00

REAMER BARRELL 18MM - 418 $2,070.00

SCREW BONE 2.7 X 18 $217.00 C1713

SCREW BONE 2.7 X 16 $174.00 C1713

SCREW LOCKING 2.7 X 16 $425.00 C1713

SCREW LOCKING 2.7 X 18 $531.00 C1713

PLATE OLECRANON 3.5 MM $2,752.00 C1713

STEM RADIAL CURVED 9MM $5,126.00 C1713

RADIAL HEAD 24 MM $5,126.00 C1713

PLATE FIB 6 H RT 2.7/3.5 X 112 $1,973.00 C1713

MPFL IMPLANT SYSTEM BIOCOMP $3,284.00 C1713

SCREW LOCKING FIXED 4.75 X 15M $567.00 C1713

SCREW LOCKING FIXED 4.75 X 25M $567.00 C1713

SCREW LOCKING FIXED 4.75 X 30M $567.00 C1713

Page 292: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

COMP REV SHLD HUME TRAY 44 X 5 $4,402.00 C1776

SCREW CENTRAL CRS 6.5 X 25 $561.00 C1713

SET FILTERLINE CO2 ADLT/PEDI $31.00

MINI TIGHT ROPE 1.1MM $1,635.00 C1713

STEM SHOULDER MINI 7MM $10,366.00 C1776

PLATE STRAIGHT FIBULA VARIAX $1,165.00 C1713

PLATE DISTAL HUMBER LLP 3H 3.5 $2,774.00 C1713

SCREW 40MM X 2.7 $482.00 C1713

SCREW 36MM X 2.4 $229.00 C1713

SCREW 38MM X 2.7 $482.00 C1713

SCREW 36MM X 2.7 $482.00 C1713

PLATE DIST HUM POSTEROLATERAL $3,392.00 C1713

PLATE BROAD LCP 11H 4.5 X 206 $2,074.00 C1713

SCREW CORTICAL 4.5 $137.00 C1713

PLATE LCP POSTEROLATERAL 3H 2. $1,950.00 C1713

PLATE LCP POSTEROLATERAL 6H 2. $2,040.00 C1713

PIN 5 X 120 MM 5018-5-120 $492.00 C1713

PIN 4 X 250 MM 5030-4-250 $458.00 C1713

DRAWTEX WOUND DRESSING $32.00

SCREW SHAFT T2 5 X 50MM $549.00 C1713

SCREW CORTEX TI 1 X 6 $297.00 C1713

SCREW CORTEX TI 1 X 7 $297.00 C1713

SCREW CORTEX TI 1 X 11 $297.00 C1713

SCREW CORTEX TI 1 X 13 $297.00 C1713

SCREW CORTEX TI 1 X 14 $297.00 C1713

SCREW CORTEX TI 2 X 14 $172.00 C1713

SCREW CORTEX TI 2 X 16 $172.00 C1713

SCREW CORTEX TI 2 X 20 $172.00 C1713

SCREW CORTEX TI 1.3 X 12 $311.00 C1713

SCREW CORTEX TI 1.3 X 14 $311.00 C1713

POST BI-CORTICAL 4.5 X 40 $305.00 C1713

WASHER SPIKED $305.00 C1713

SCREW BIOCOMPOSITE INTER $560.00 C1713

LEAD INTERSTIM 3889 SNS 33 CM $6,880.00 C1778

SCREW TI EMERGENCY 1.0 X 14 $305.00 C1713

NAIL SUPRACONDYLAR 014 X 200MM $4,849.00 C1713

BONE FILLER HYDROSET 15CC $7,762.00 C9359

TIBIAL BEARING INSERT SCORPIO- $4,239.00 C1713

SCREW TI CORTEX 1.3 X 16 MM $311.00 C1713

DRILL BIT CANNULATED $727.00

PUSHLOCK 4.5MM PUNCH DISP $229.00

SCREW CANNULATED 4.0 X 60 $592.00 C1713

SCREW CORTEX LCP MOD MINI 2.4 $183.00 C1713

SCREW CORTEX LCP MOD MINI 2.4 $183.00 C1713

SCREW CORTEX LCP MOD MINI 2.4 $183.00 C1713

SCREW CANNULATED 4.0 X 65 $592.00 C1713

SCREW CORTEX SLF-TP 2.4 X 38 $183.00 C1713

SCREW LOCK SELF TAP 2 X 6 $381.00 C1713

SCREW LOCK SLF TP 2.0 X 10 $381.00 C1713

SCREW LOCKING SLF TP 2 X 12 $381.00 C1713

Page 293: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW LOCK SELF TAP 2. X 16 $381.00 C1713

SCREW LOCK ST T6 2.0 X 18 MM $381.00 C1713

SCREW LOCK 2.7 X 12 MM $394.00 C1713

SCREW CORTEX 2.7 X 12 $152.00 C1713

SCREW CORTEX SLF TP 2.7 X 14 $152.00 C1713

SCREW CORTEX SLF TAP 2.7 X 60 $152.00 C1713

SCREW CORTEX 3.5 X 30 $86.00 C1713

INSERT TIBIAL BEARING SZ2 $4,610.00 C1713

SCREW BIOCOMP INTER 11 X 28MM $802.00 C1713

SCREW LOCK MOD MIN FRAG 2.4 X $381.00 C1713

SCREW LOCK MOD MINI FRAG 2.4 X $381.00 C1713

SCREW SHAFT 4.5 X 5.0 $77.00 C1713

SCREW CORTEX SLF TP4.5 X 6.2 $87.00 C1713

PLATE VARIAX STRAIGHT 10 HOLE $1,210.00 C1713

PLATE BROAD 8H 4.5 X 152 $1,374.00 C1713

NAIL PROXMIA HUMERUS LONG RT 2 $5,198.00 C1713

SCREW CANNULATED 4.0 X 38 $592.00 C1713

COMPRESSION THERAPY SLEEVES LG $37.00

GRAFT OSETOCHON CONDYLE LT $21,735.00 C1762

LEAD TRIAL MRI 1 X 8 60 CML $1,245.00 C1897

BIO CARTILAGE UMTB 1850 $1,779.00 C1763

MIXING KIT ABS-1000 $540.00

FUNNEL ABS-1003 $119.00

PRP SYRINGE ABS-10010S $458.00

EDURANT II STENT GRAFT SYSTEM $10,010.00

PLATE BROAD STRAIGHT $1,473.00 C1713

K-WIRE .8MM $140.00 C1769

SCREW CANNULATED 3.0 X 32 $548.00 C1713

CATH INTRODUCER 7FR $110.00

PLATE LCP 2.0 MM 4 HOLE $667.00 C1713

PLATE LCP 6 H 2 X 45 $667.00 C1713

PLATE LCP 7H 2.0 X 52 $667.00 C1713

PLATE T 3H/7H 2.0 $1,181.00 C1713

DRESSING AQUACEL AG 3.5 X 12 $135.00

PLATE HIGH STRENGTH LEFT $1,841.00 C1713

PLATE HIGH STRENGTH STRAIGHT $1,841.00 C1713

PLATE HIGH STRENGTH Y 8 HOLE $1,841.00 C1713

PLATE HIGH FLEX LEFT $1,841.00 C1713

PLATE HIGH FLEX STRAIGHT $1,841.00 C1713

PLATE HIGH FLEX Y $1,841.00 C1713

PLATE T SHAPE LOCKING 1.5 MM $1,351.00 C1713

SCREW LOCKING 1.5 X 11 $302.00 C1713

SCREW LOCKING 1.5 X 10 $302.00 C1713

SCREW LOCKING 1.5 X 15 $302.00 C1713

SCREW LOCKING 1.5 X 12 $302.00 C1713

DRILL BIT 1.1 MM W/MINI-QUICK $183.00

447.232 $646.00 C1713

K-WIRE 6" TROCAR POINT .045 OD $56.00 C1769

PLATE Y 3H/8H 2 X 48 $703.00 C1713

PLATE T 2H/8H 2.4 X 54 $724.00 C1713

Page 294: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PLATE DISTAL HUME 8H 3.5 X 194 $3,455.00 C1713

PLATE VARIABLE ANGLE 16H 4.5MM $4,502.00 C1713

SCREW LOCK CANN 3.7 X 22 $521.00 C1713

SCREW LOCKING CANN 3.7 X 32 $521.00 C1713

SCREW LOCK CANN 3.7 X 40 $521.00 C1713

SCREW CANN LOCK 3.7 X 42 MM $521.00 C1713

SCREW CANN LOCK 3.7 X 44MM $521.00 C1713

SCREW CANN LOCK 3.7 X 50 $521.00 C1713

SCREW ST VAR ANGLE LOCK 5.0 X $588.00 C1713

SCREW ST VAR ANGLE LOCK 5.0 X $588.00 C1713

SCREW ST VAR ANGLE LOCK 5.0 X $588.00 C1713

SCREW LOCK CANN 3.7 X 70 $521.00 C1713

SCREW LOCK CANNULATED 3.7 X 80 $521.00 C1713

CANNULATED SCREW LOCK 3.7 X 85 $521.00 C1713

SCREW ST VAR ANGLE LOCK 5.0 X $588.00 C1713

SCREW CTX 2.0 X 8 $144.00 C1713

SCREW CORTEX SLF TP 2 X 16 $144.00 C1713

SCREW CORTEX SELF TAP 2 X 18 $144.00 C1713

SCREW CORTEX ST T6 2.0 X 20 MM $144.00 C1713

SCREW CORTEX ST T6 2.0 X 24 MM $144.00 C1713

SCREW SELF TAP 2 X 38 $144.00 C1713

DRILL BIT CARBIDE 6.0 $868.00

BIT DRILL J-LATCH 1.0 $428.00

TRIAL PROTECTOR ORTHO ALEXIS $519.00

STENT GRAFT AAA 25X13X80X40 $22,680.00 C1874

SCREW CORTEX SLF TP 2.4 X 7 $267.00 C1713

SCREW CORTEX SLF TP 2.4 X 10 $267.00 C1713

SCREW CORTEX SLF TAP 2.4 X 16 $267.00 C1713

SCREW CORTEX SLF TAP 2.4 X 20 $267.00 C1713

SCREW CORTEX SLF TAP 2.4 X 22 $267.00 C1713

SCREW CORTEX SLF TP 2.4 X 26 $267.00 C1713

DRESSING WND VAC SILVER 4 X 5 $130.00

DRESSING WND VAC SILVER 10 X 1 $244.00

BEARING TIBIAL INSERT $4,844.00 C1713

PLATE ACU-LOC STD SZ RIGHT $2,678.00 C1713

SCREW CORTIC PEG LOCK 2.3 X 16 $317.00 C1713

SCREW CORTIC PEG LOCK 2.3X18 $317.00 C1713

SCREW CORTIC PEG LOCK 2.3X22 $320.00 C1713

SCREW NON-LOCKING 3.5 X 16 $278.00 C1713

PLATE VARIAX STRAIGHT 5H $1,165.00 C1713

SCREW BONE T10 2.7 X 20 $297.00 C1713

SCREW BONE T10 2.7 X 48 $297.00 C1713

SCREW BONE T10 2.7 X 38 $297.00 C1713

SCREW BONE T10 2.7 X 34 $297.00 C1713

SCREW BONE 2.7 X 30 $297.00 C1713

SCREW BONE T10 2.7 X 26 $297.00 C1713

SCREW BONE T10 2.7 X 10 $297.00 C1713

PLATE OLECRANON 6H RT $2,595.00 C1713

PLATE TUB 1/3 5H $210.00 C1713

STEM HIP RESTORATION SIZE 10 $12,158.00 C1776

Page 295: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

HEMISHPERICAL SHELL 509-02-56E $6,667.00 C1776

PLATE VARIAX STRAIGHT 2 HOLE $1,165.00 C1713

SCREW BONE 3.5 X 44 $240.00 C1713

SCREW BONE 3.5 X 55 $240.00 C1713

SCREW CANNULATED 4.0 $592.00 C1713

SCREW FULL THREAD 4.0 X 50 $592.00 C1713

OVERTUBE ESOPHA 25X19.5X16.7 $567.00

SCREW LOCK 5.0 X 34 $588.00 C1713

SCREW LOCK 5.0 X 60 $588.00 C1713

SCREW LOCK 5.0 X 80 $588.00 C1713

SCREW LOCK 5.0 X 85 $588.00 C1713

SCREW LOCK 5.0 X 44 $588.00 C1713

SCREW LOCK 5.0 X 48 $588.00 C1713

SCREW LOCK 5.0 X 42 $588.00 C1713

SCREW LOCK 5.0 X 38 $588.00 C1713

SCREW LOCK 5.0 X 14 $673.00 C1713

SCREW LOCK CANN 5.0 X 80 $652.00 C1713

SCREW LOCK CANN 5.0 X 75 $652.00 C1713

PLATE LCP DIA-META 5 HOLE $3,642.00 C1713

PLATE LCP FOREFOOT/MIDFOOT $2,693.00 C1713

WIRE COMP LCP FOREFOOT 1.6 X 1 $180.00 C1713

SCREW ANG LOCK 2.4 X 10 $438.00 C1713

SCREW ANG LOCK 2.4 X 12 $438.00 C1713

SCREW ANG LOCK 2.4 X 14 $438.00 C1713

BEARING MEN ANA AR SM LT 5MM T $1,848.00 C1713

PLATE VA CONDYLAR 12H 4.5 X 26 $4,164.00 C1713

WIRE GUIDE DRILL TIP 2.5 X 300 $229.00

DRILL BIT PERCU 3.2 X 300 $510.00

DRILL BIT PERCU 4.3 X 300 $510.00

STEM CURVED RADIAL 8MM $4,135.00 C1713

HEAD RADIAL 28MM $4,135.00 C1713

PLATE 4H VARIAX FIBULA STRAIG $1,165.00 C1713

NAIL GAMMA LONG LEFT $5,584.00 C1713

SCREW CANN THREAD 4.5 X 30 $563.00 C1713

MINI IGNITE POWER MIX 20CC 876 $6,600.00 C1713

SCREW CANNULATED 4.0 X 48 $592.00 C1713

ASH SPLIT CATH 14 FR $735.00 C1750

DRILL BIT 2.7 MM $561.00

K-WIRE OLIVE $128.00 C1769

PLATE CLAV VARIAX ANA SUPER 6 $2,457.00 C1713

PLATE MEDIAL PROX TIBIA 4 HOL $3,515.00 C1713

RADIAL HEAD 26 X 2 MM $4,135.00 C1713

STEM STRAIGHT RADIAL 7 MM $4,135.00 C1713

SUTURE LASSO 25 DEG TIGHT CUR $427.00

SUTURE LASSO 25 DEG TIGHT CUR $427.00

CANNULA TWIST-IN 8.25MM X 9CM $93.00

TIGERLINK WIRE AR-7235T $175.00 C1713

SCREW LOCK 4.0 X 48 $432.00 C1713

PLATE PROX HUMERUS 5 HOLE $3,121.00 C1713

PLATE RADIAL 2 HOLE $1,545.00 C1713

Page 296: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

WASHER- 390016 $134.00 C1713

AUGMENT HALF BLOCK TIB SZ 5 $2,488.00 C1713

SCREW CORTEX 2.4 X 32MM $267.00 C1713

SCREW LOCK FULLY THREAD 4 X 32 $514.00 C1713

NAIL HUMERUS 7 X 190 $3,762.00 C1713

C-TAPER HEAD LFIT 22 10 $1,823.00 C1713

LINER TRIDENT CONSTRAINED 22 M $6,486.00 C1713

DRESSING AQUACEL 4 X 4 $105.00

NAIL FEMORAL T2 9 X 340 MM $3,777.00 C1713

SCREW CORTEX 3.5 X 80 MM $112.00 C1713

NEEDLE DELIVERY 12 GA X 7.5 $187.00

KIT MICRO AUTOGRAFTING XPANSIO $1,361.00

HEAD COCR 44MM X 16MM $5,221.00 C1776

PACEMAKER CONSULTA CRT-P MUL L $14,510.00 C2621

NEEDLE FAST-FIX 360 CURVED $1,125.00

ADVANCED PRIME NON-CHARG GEN $22,560.00 C1767

PLATE TIB DIS MED RT 6 HOLE $3,436.00 C1713

SCREW CORTEX LOW PRO 3.5 X 46 $149.00 C1713

SCREW CORTEX LOW PRO 3.5 X 32 $141.00 C1713

SCREW LOCKING 2.7 X 16 MM $482.00 C1713

SCREW LOCKING 2.7 X 12 MM $459.00 C1713

SCREW LOCKING 2.7 X 20 MM $459.00 C1713

SCREW LOCKING 2.7 X 40 MM $459.00 C1713

SCREW LOCKING 2.7 X 18 MM $482.00 C1713

TOTAL KNEE IMPL SYS INPATIENT $8,310.00

ICDL SPRTQ RV LD 6944 $9,082.00 C1895

DRAIN 24F BLAKE $44.00

INSERT TIBIAL BEARING 5531-P-4 $4,037.00 C1713

PLATE TIB MED DISTAL 10 HOLE $3,534.00 C1713

SCREW CORTICAL 4.5 X 95 MM $137.00 C1713

DRILL BIT WIRLY BIRD 4.3 MM $1,726.00

SCREW CANN ASNIS TI 4.0 X 70MM $592.00 C1713

PIN APEX 5.0 X 200 MM $492.00 C1713

PLATE HUMERUS PROX LT 10 HOLE $4,213.00 C1713

NET FOREIGN BODY ROTH MAXI $336.00

CATH BILIARY DRAIN 40 CML 14FR $215.00 C1729

SCREW CANN W/DISP SHEATH $503.00 C1713

PEG LOCK RADIUS 2.0 X 26 $446.00 C1713

PEG LOCK RADIUS 2.0 X 18 $446.00 C1713

PLATE TIBIA POSTEROMEDIAL 3.5 $2,411.00 C1713

PLATE DISTAL LEFT 5 HOLE $1,594.00 C1713

NAIL HUMERUS 08 X 270 MM $3,762.00 C1713

END CAP T2 6 MM $514.00 C1776

SCREW RESTORATION GAP 6.5 X 40 $408.00 C1713

SCREW RESTORATION GAP 6.5 X 20 $408.00 C1713

SCREW RESTORATION GAP 6.5 X 25 $408.00 C1713

SHELL TI HEMSPERICAL 54 MM $6,667.00 C1776

GUIDEWIRE VASC ASAHI 190CM $412.00 C1769

GUIDEWIRE VASC 0.014X180 $305.00 C1769

GUIDEWIRE VASC 0.014 X 300 $305.00 C1769

Page 297: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

GUIDEWIRE VASC 0.014 X 180 $305.00 C1769

GUIDEWIRE VASC 0.014 X 300 $305.00 C1769

GUIDEWIRE VASC 0.0009 X 180 $412.00 C1769

GUIDEWIRE VASC 0.014 X 300 $412.00 C1769

GUIDEWIRE VASC 0.014 X 180 $419.00 C1769

CATH ANGIOGRAPHY 5F 100CM $36.00 C1885

PIN STEINMANN 3.2 X 9 ACCESS $546.00 C1713

SHOULDER SYSTEM VERA-DIAL $4,384.00 C1776

SCREW LOCK 2.3 $446.00 C1713

GUIDE LINER 6 FR 20 CM $1,118.00

PLATE RIGHT 9 HOLE $2,410.00 C1713

SCREW LOCKING 3.5 X 28 $387.00 C1713

SCREW LOCKING 3.5 X 36 $387.00 C1713

SCREW CORT 3.5 X 38 $238.00 C1713

SCREW LOCKING 3.5 X 34 $387.00 C1713

PLATE RIGHT COMB 8 HOLE $2,410.00 C1713

SCREW CORT 3.5 X 40 $238.00 C1713

SCREW LOCKING 3.5 X 34 $238.00 C1713

SCREW LOCKING 3.5 X 38 $387.00 C1713

SCREW CORT 3.5 X 36 $238.00 C1713

GUIDE WIRE .062 X 6 $56.00 C1769

SCREW BONE 2.7 X 22 $297.00 C1713

PLATE CLAVICLE SUP 7 HOLE $2,457.00 C1713

PEG SMOOTH 2.3 X 24 $320.00 C1713

PEG SMOOTH 2.3 X 26 $320.00 C1713

PLATE RT ACU-LOC DORSAL WRIST $2,213.00 C1713

CATH GUDING 6F Z26EBU375 $156.00 C1887

BALLOON DIL SPRINTER 2 X 12 $381.00 C1725

BALLOON DILAT PRINT RX 2.5 X 9 $427.00 C1727

BALLOON DILAT SPRNT RX 3.0X21 $427.00 C1727

DRESSING WND VAC SILVER 5 X 12 $214.00

SUTURE ANCHOR 2.9 L-15 $1,210.00 C1713

JUGGERKNOT SINGLE SZ 1 LOADED $986.00 C1713

SUTURE BUTTON 12 MM $436.00 C1713

SCREW TAP 3.5 AO 70MM $430.00 C1713

WAFER CONVEX CUT TO FIT $31.00

PLATE VARIAK STRAIGHT 8H $1,165.00 C1713

SCREW LOCKING 5.0 X 16 $517.00 C1713

SCREW LOCKING 5.0 X 22 $517.00 C1713

SCREW CORTICAL 4.5 X 18 $137.00 C1713

SCREW CORTICAL 4.5 X 22 $137.00 C1713

SCREW CORTICAL 4.5 X 16 $137.00 C1713

VENA CAVA FILTER $3,300.00 C1880

BALLOON DILAT CORO OTW $381.00 C1727

SHEATH GUIDING RSR04 $436.00

GUIDING SHEATH 6FR 45CM $436.00 C1766

SHEATH GUIDING 5FR 45 X 35 $436.00

SCREW NON-LOCKING 3.5 X 10 $265.00 C1713

GUIDE FRONTAL SINUS RSM110C $797.00

PLATE FIBULA STRAIGHT 6 HOLE $1,165.00 C1713

Page 298: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CATH GUIDE CORO AMPLATZ 6FR $164.00 C1887

PLATE TROCHANETER STABIL 138MM $1,520.00 C1713

STENT GRAFT SYS ENDUR II BIF $20,260.00 C1874

STENT GRT SYS CONT LIM END II $10,160.00 C1874

BLADE MINI EDGE ENT STERL #65 $30.00

CATH GUID PERIPH PK1 6FR 100 $156.00 C1887

CATH BALLOON OTW 5F $400.00 C1727

STENT CORO DES INT RX 3.50X38 $2,810.00 C1874

BALLOON DILAT SPRNT RX $427.00 C1727

BALLOON DILAT SPRINT RX 32515X $427.00 C1727

BALLOON DIL SPRINTER 2.5 X 12 $381.00 C1727

BALLOON DIL SPRINTER 3.0 X 12 $397.00 C1727

BALLOON DIL SPRINTER 1.5 X 10 $397.00 C1727

BALLOON DIL SPRINTER 1.5 X 20 $381.00 C1727

PLATE BARREL 135 DEG 3H 62MM $1,427.00 C1713

TIGHTROP ABS BUTTON 8 X 12 MM $436.00 C1713

TIGHTROPE ABS, IMPLANT $561.00 C1713

TOTAL KNEE SYSTEM N2VAC $7,310.00

T-HANDLE REAMER 3.0MM $1,418.00

T-HANDLE REAMER 3.8 $1,197.00

SCREW TAP & DRILL 3.8 MM $839.00

DRILL STEP 3.8 MM $640.00

NAIL 90 MM X 3.8 MM $2,740.00 C1713

SCREW BONE 3.5 X 50 MM $192.00 C1713

SCREW LOCKING 2.3 X 30 MM $357.00 C1713

SCREW LOCKING 2.3 X 38 MM $357.00 C1713

STENT GRAFT END II BIF SYSTEM $20,260.00 C1874

STENT GRAFT END II CONTRAL SYS $9,260.00 C1874

STENT GRAFT END II CONT SYSTEM $10,160.00 C1874

STENT GRAFT END II BIFUR SYSTE $20,260.00 C1874

STENT GRAFT END II CONT LIMB S $13,110.00 C1874

STENT GRAFT END II CONTRAL LIM $10,160.00 C1874

NAIL LONG 10X440MM 125 DEG TI $4,529.00 C1713

VASCULAR CLOSURE DEVICE $595.00 C1760

INSERT KNEE TIB SCORPIO $2,165.00 C1776

INSERT KNEE BEARING TIB $4,610.00 C1776

CYLINDER PUMP CXR 72404261 $17,094.00 C1813

NAIL LOCKING PROXIMAL 3 LT $4,606.00 C1713

SCREW LOW PROF HEX 4.3 X 50 $473.00 C1713

SCREW LOW PROF HEX 4.3 X 34 $473.00 C1713

SCREW LOW PROF HEX 4.3 X 32 $473.00 C1713

SCREW LOW PROF HEX 4.3 X 40 $473.00 C1713

SCREW LOW PROF HEX 4.3 X 28 $473.00 C1713

SCREW LOW PROF HEX 4.3 X 30 $473.00 C1713

SCREW LOW PROF HEX 4.3 X 20 $473.00 C1713

DRILL BIT LONG $442.00

WIRE BLUNT 20" $357.00

WIRE TROCAR 20" $339.00

NAIL PROX LOCK 150 MM RT POLAR $4,606.00 C1713

SCREW HEX LOW PRO 4.3 X 24 $473.00 C1713

Page 299: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW HEX LOW PRO 4.3 X 44 $473.00 C1713

PLATE ANT CLAVICLE MED 6 H $2,642.00 C1713

SCREW CANN LOCKING 5.0 X 100 $550.00 C1713

SCREW CANN LOCKING 7.3 X 100 $813.00 C1713

PLATE LCP 2-CLMN 6 H HD/3H SHA $2,427.00 C1713

SCREW LOCKING STARDRIVE 2.4 X $438.00 C1713

SCREW LOCKING STARDRIVE 2.4 X $438.00 C1713

SCREW LOCKING STARDRIVE 2.4 X $438.00 C1713

ICD DR EVERA XT $32,460.00 C1721

PLATE 6 HOLE $1,748.00 C1713

BLADE SAW HUB STYLE L OSTEOTOM $241.00

BLADE SAW HUB STYLE S OSTEOTOM $241.00

SCREW CANN INTERFE 9 X 20 $503.00 C1713

SUTUR STRATAFIX 2-0 CT-1 20 CM $94.00

CANNULA RF 150MM 20G 15MM $58.00

PROBE PRESSURE MONITOR QUICK $194.00

PROBE PRESSURE MONITOR INDWEL $178.00

SCREW BONE 2.3 X 30 MM $357.00 C1713

PLATE ANTERIOR LAT 7H $3,013.00 C1713

CLOSURE VASCULAR MYNX $534.00 C1760

DRILL BIT 1.9 MM $252.00

NAIL FEMORAL 11 X 320 $3,083.00 C1713

TIBIAL BERRING INSERT-PS $4,610.00 C1713

DRILL BIT 2.8 MM $461.00

PLATE POSTERIOR R 4 HOLE $3,208.00 C1713

SCREW HX LO PRO 4.3 X 26 $473.00 C1713

SCREW HEX LO PRO 4.3 X 36 $473.00 C1713

NAIL FIX CANN TROCH 12 X 360 $4,206.00 C1713

TISSUE FIBULAR STRUT 8M X 110M $2,670.00 C1713

DRILL BIT 2.8 MM $381.00

SCREW LOCKING 3.5 X 18 MM $433.00 C1713

COBAN COMPRESSION SLEEVE 2 LAY $44.00

COBAN LITE COMP SYSTEM 2794 $44.00 A6545

TOTAL STAB FEM COMPONENT $10,967.00 C1776

PLATE TIBIA 4.5 $3,634.00 C1713

BONE BIOPSY NEEDLE F07A $305.00

DRILL BIT 3.2 $918.00

3" CASTING SYSTEM W/2 REG BOOT $331.00 Q4038

4" CASTING SYSTEM W/2LG BOOTS $331.00

4" CASTING W/2 LG BOOT $346.00

WIRE FILTER 0.042 190CM $3,300.00 C1769

PLATE CLAVICLE MIDSHAFT SUP 7H $2,743.00 C1713

SCREW CENTRAL 6.5 X 30 MM $580.00 C1713

STEM HEAD/NECK HIP SZ 9 X160MM $6,848.00 C1713

SCREW ASNIS PART THREAD 40MM $604.00 C1713

SCREW CORTICAL 4.5 X 75 $109.00 C1713

SCREW CORTICAL 4.5 X 80 $109.00 C1713

SCREW ASNIS PART THREA STER 4O $604.00 C1713

STENT GRAFT AAA BIFURATED $22,680.00 C1874

TROCAR SIZE 2 T34B $996.00

Page 300: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PLATE MIDSHAFT ANTERIOR 8 HOLE $3,013.00 C1713

BIOLOX CERA FEMO HEAD 7.5 X 36 $3,747.00 C1776

CORING REAMER CONN AR-1224S $510.00

SUTURE ANCHOR 2.4 X 12 $916.00 C1713

TENDON LATERAL ANKLE $2,840.00 C1762

HIP STEM RESTORATION S-2652-09 $8,015.00 C1776

SUTURE NYLON 3-0 18" SH-2 WHT $48.00

CATH CHOCOLATE BALLOON $1,964.00 C1725

CATH CUTR TURBOHAWK 6FR $6,700.00 C1724

TIBIAL FIX TUNNELOC DEVICE $1,476.00 C1713

SPLINT THUMB SPICA LT S/M $43.00 L3807

SPLINT THUMB SPICA RT S/M $43.00 L3807

SPLINT THUMB SPICA LT L/XL $43.00 L3807

SPLINT THUMB SPICA RT L/XL $43.00 L3807

STENT CORO RI DRUG-EL 2.50 X 8 $2,810.00 C1874

STENT CORO RI DRUG-ELUT 3 X 34 $2,810.00 C1874

STENT CORO RT DRUG-ELU 3 X 38 $2,810.00 C1874

STENT CORO RT DRUG-EL 3.5 X 34 $2,810.00 C1874

STENT CORO RI DRUG-EL 4 X 34 $2,810.00 C1874

STENT CORO RI DRUG-EL 4 X 38 $2,810.00 C1874

STENT CORO RI DRUG-EL OTW 3X38 $2,810.00 C1874

STENT CORO RT DRUG OTW 3.5X34 $2,810.00 C1874

STENT CORO RI DRUG OTW 4 X 34 $2,810.00 C1874

STENT CORO RT DRUG OTW 4 X 38 $2,810.00 C1874

BALLOON DILAT SPRINT RX 9X2.75 $427.00 C1727

PLATE FIB STRAIGHT 7 HOLE $932.00 C1713

DRILL BIT 2.3 MM $252.00

EXTENSION PIECE 50MM $5,884.00 C1776

STRAIGHT CEMENTED STEM $5,458.00 C1776

DISTAL FEMORAL COMPONENT $13,478.00 C1776

TIBIAL ROTATING COMPONENT $5,889.00 C1776

KNEE TIBIAL BASEPLATE $6,304.00 C1776

ROTATING HINGE KNEE $2,183.00 C1776

TRIATHLON ASYMMETRIC PATELLA $1,799.00 C1776

BRUSHING SLEEVE $3,291.00 C1776

TIB INSERT 20 MM $2,418.00 C1776

KNEE TIB INSERT $2,418.00 C1776

PRESS FIT EXTENDER $1,971.00 C1776

SUTURE ANCHOR 3.5 X 19.5 MM $896.00 C1713

PLATE MED DISTAL HUMERUS 6H $2,111.00 C1713

SCREW LOCKING 2.7 X 30MM $458.00 C1713

SCREW BONE 2.7 X 60MM $238.00 C1713

ENDOLOGIX MAIN BODY BA28-100/1 $27,803.00

PLATE PRO LAT CLAVI 4 HOLE $3,013.00 C1713

SCREW LOCKING 2.7 X 10 MM $458.00 C1713

SCREW LOCKING 2.7 X 12 MM $458.00 C1713

KIT KNEE CARTILAGE BIOPSY $1,233.00

HIP STEM RESTORATION SZ 10 $12,633.00 C1776

K-WIRE 1.6 $130.00 C1769

MEDTRONIC PINCH ON TOOL $93.00

Page 301: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STYLET 6054-52 GLBL $149.00

STENT CORO DES PREM MR 2.50 X $3,010.00 C1874

STENT CORO DES PREM MR 2.50 X $3,010.00 C1874

STENT CORO DES PREM MR 2.75 X $3,010.00 C1874

STENT CORO DES PREM MR 3.00 X $3,010.00 C1874

STENT CORO DES PREM MR 3.50 X $3,010.00 C1874

STENT CORO DES PREM MR 4.00 X $3,010.00 C1874

STENT CORO DES PREM MR 2.25 X $3,010.00 C1874

STENT CORO DES PREM MR 2.50 X $3,010.00 C1874

STENT CORO DES PREM MR 2.75 X $3,010.00 C1874

STENT CORO DES PREM MR 3.00 X $3,010.00 C1874

STENT CORO DES PREM MR 3.50 X $3,010.00 C1874

STENT CORO DES PREM MR 4.00 X $3,010.00 C1874

STENT CORO DES PREM MR 2.25 X $3,010.00 C1874

STENT CORO DES PREM MR 2.50 X $3,010.00 C1874

STENT CORO DES PREM MR 2.75 X $3,010.00 C1874

STENT CORO DES PREM MR 3.00 X $3,010.00 C1874

STENT CORO DES PREM MR 3.50 X $3,010.00 C1874

STENT CORO DES PREM MR 4.00 X $3,010.00 C1874

STENT CORO DES PREM MR 2.25 X $3,010.00 C1874

STENT CORO DES PREM MR 2.50 X $3,010.00 C1874

STENT CORO DES PREM MR 2.75 X $3,010.00 C1874

STENT CORO DES PREM MR 3.00 X $3,010.00 C1874

STENT CORO DES PREM MR 3.50 X $3,010.00 C1874

STENT CORO DES PREM MR 4.00 X $3,010.00 C1874

STENT CORO DES PREM MR 2.25 X $3,010.00 C1874

STENT CORO DES PREM MR 2.50 X $3,010.00 C1874

STENT CORO DES PREM MR 2.75 X $3,010.00 C1874

STENT CORO DES PREM MR 3.00 X $3,010.00 C1874

STENT CORO DES PREM MR 3.50 X $3,010.00 C1874

STENT CORO DES PREM MR 4.00 X $3,010.00 C1874

STENT CORO DES PREM MR 2.25 X $3,010.00 C1874

STENT CORO DES PREM MR 2.50 X $3,010.00 C1874

STENT CORO DES PREM MR 2.75 X $3,010.00 C1874

STENT CORO DES PREM MR 3.00 X $3,010.00 C1874

STENT CORO DES PREM MR 3.50 X $3,010.00 C1874

STENT CORO DES PREM MR 4.00 X $3,010.00 C1874

STENT CORO DES PREM MR 2.25 X $3,010.00 C1874

STENT CORO DES PREM MR 2.50 X $3,010.00 C1874

STENT CORO DES PREM MR 2.75 X $3,010.00 C1874

STENT CORO DES PREM MR 3.00 X $3,010.00 C1874

STENT CORO DES PREM MR 3.50 X $3,010.00 C1874

STENT CORO DES PREM MR 4.00 X $3,010.00 C1874

STENT CORO DES PREM MR 2.50 X $3,010.00 C1874

STENT CORO DES PREM MR 2.75 X $3,010.00 C1874

STENT CORO DES PREM MR 3.00 X $3,010.00 C1874

STENT CORO DES PREM MR 3.50 X $3,010.00 C1874

STENT CORO DES PREM MR 4.00 X $3,010.00 C1874

REAMER LOW PROFILE 9.5 MM $595.00

PLATE LATERAL CLAVICLE 4 H $3,013.00 C1713

Page 302: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

KIT LEAD MEDTRONIC 977A290 $4,400.00 C1778

ANCHOR BI-WING NEURTOSTIM PAIN $685.00

BIT DRILL 4.2 X 250 $421.00

PLATE AXSOS DIAT LAT FEMUR 10H $4,059.00 C1713

SCREW PERIPROSTH 5.0 X 12 MM $529.00 C1713

SCREW LOCK 5.0 X 14 MM $414.00 C1713

SCREW LOCKING VA 5.0 X 40 $588.00 C1713

SCREW CANNULATED 5.0 X 85 $652.00 C1713

BIT DRILL CANNULATED 4.3 $955.00

PLATE VA LCP CURVE COND 6H 4.5 $3,848.00 C1713

SCREW LOCK 5.0 X 12 MM $414.00 C1713

ICD EVERA XT $26,835.00 C1721

ICD-DR EVERA XT DDBB1D1 MEDTRO $26,835.00 C1721

SUTURE NONABSORABLE NYLON STE $48.00

PLEURX PERITONEAL CATH KIT $1,901.00 C1729

STEM SLD PRIMARY MINI 12 X 83M $10,668.00 C1776

SCREW NON-LOCK3.5 HEX 4.75X 30 $586.00 C1713

SCREW NON-LOCK3.5 HEX 4.75X35 $586.00 C1713

SCREW CANN FULL THREAD AR-1400 $290.00 C1713

SCREW BONE 2.7 X 10 MM $357.00 C1713

PLATE LCP HOOK 3.5 3 HOLE $1,447.00 C1713

KIT DISP TUBRICLE OSTEOTOMY $1,324.00

SCREW LOCKING 2.7 X 32 $134.00 C1713

SCREW LOCKING 2.7 X 36 $134.00 C1713

SCREW LOCKING 2.7 X 50 $134.00 C1713

GRAFT VASCULAR HEMAGARD 12X40 $1,170.00 C1768

FIBREWIRE 2-0 MENIS REP NEEDLE $198.00

SUTURE BUTTON AR-8920 $290.00 C1713

GLENOSPHERE 38 MM $6,238.00 C1776

STEM HIP 35 MM $15,522.00 C1776

HEAD FEMORAL CERAMIC V40 $5,598.00 C1776

NAIL HUMERAL 1830-0727S $2,731.00 C1713

PLATE LCP LAT DIST FIB 7H 2.7X $1,641.00 C1713

GRAFT MENISCUS RT LATERAL $9,810.00 C9399

KIT BIO-SUTURETAK 2.4MM $500.00

SCREW LOCK FIX 3.5 HEX 4.75X20 $586.00 C1713

SCREW CENTRAL 6.5 X 20 MM $580.00 C1713

STENT SINUS PROPEL 23MM $1,605.00 C1874

SCREW CANN ASNIS 3.0 X 24/6 $538.00 C1713

PLATE CURVED LFT 5 HOLE $1,328.00 C1713

SCREW BONE 2.7 X 16 MM $174.00 C1713

SCREW LOCKING 2.7 X 14 MM $425.00 C1713

SCREW LOCK STARDRIVE 2.4 X 8 $438.00 C1713

SCREW LOCK STARDRIVE 2.4 X 16 $438.00 C1713

SCREW LOCK STARDRIVE 2.4 X 30 $438.00 C1713

PEG EXT CAGE 10MM $5,123.00 C1713

SCREW 4.5 X 18 MM $428.00 C1713

HUMERAL ADAPTER TRAY $4,556.00

SCREW 4.5 X 38 MM $428.00 C1713

SCREW FIXED ANGLE TORQUE KIT $746.00 C1713

Page 303: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW 4.5 X 30MM $428.00 C1713

SCREW LOCKING $419.00 C1713

STEM LONG 8 MM X 175 MM $8,725.00 C1713

SCREW 4.5 X 22 MM $428.00 C1713

HUMERAL LINER CONSTRAINED 42 M $2,153.00 C1776

GLENOSPHERE 42 MM $3,572.00 C1713

SCREW CORTICAL 3.5 X 85 $100.00 C1713

SCREW CORTICAL 3.4 X 75 $100.00 C1713

SCREW LOCKING 4.0 X 85 $388.00 C1713

SCREW LOCK 4.0 X 90 $388.00 C1713

PLATE WIDE DORSAL RT 54-25292 $1,802.00 C1713

STEM HIP 132 DEGREE 6720-0330 $15,524.00 C1776

INSERT TIB BEAR SCOR-FLEX 12MM $4,239.00 C1713

SCREW CANNULATED 4.5 X 50 $546.00 C1713

HEAD RADIAL COCR 12.5 X 22 $4,135.00 C1776

RETRACTOR LAP ALEXIS $305.00

KIT ESSENTIALS CARTICEL $560.00

PLAT TIB PROX LAT LFT 14H 251M $2,811.00 C1713

STEM HIP NECK ANGLE 6720-0435 $10,199.00 C1776

PLATE AXSOS PROX LAT 12 HOLE $2,811.00 C1713

RESORBABLE BILAYER COLL MEMBRA $1,108.00

STENT WALLSTENT 12 X 90 $3,769.00 C1874

AUGMENT HALF BLOCK TIBIAL $2,597.00

SCREW CENTRAL 6.5 X 35MM $580.00 C1713

TALON GRASPING DEVICE $415.00

SINUS IRRIGATION CATHETER $473.00 C1729

BALLOON SPIN SYSTEM RELIEVA $3,660.00 C1726

STENT SINUS INTERSECT 60011 $1,608.00 S1090

HUMERAL LINER 42MM +2.5 $2,153.00 C1776

EXTENDER PENILE NARROW BASE $747.00

CYLINDER PENILE W/PUMP $16,710.00 C1813

RETRACTOR PENILE TCL-5042-M $685.00

INSERT TIBIAL BEARING 16MM SZ7 $2,849.00 C1713

SCREW CANNULATED 4.0 X 46MM $474.00 C1713

SCREW LOCKING 3.5 X 22 $387.00 C1713

BIO-COM ACHILLES SPEED BRIDGE $3,790.00 C1713

WIRE PRESSURE FFR 175CM $1,386.00 C1769

SCREW RETRO BIO-COMPOSITE $585.00 C1713

DRILL PIN, TIGHTROPE $381.00 C1713

NAIL LONG KIT, LT 010 X 440MM $4,529.00 C1713

SCREW CANN 6.5 X 70 X 16MM $143.00 C1713

SCREW CANN 6.5 X 70 MM $143.00 C1713

SCREW CANN 6.5 X 70 X 32 MM $123.00 C1713

SCREW CORTEX 3.5X95 TAPPING $86.00 C1713

SCREW 3.5 02.200.150 $340.00 C1713

DRILL BIT 2.5 T-FLUTED $508.00

CYLINDER W/PUMP SCROTAL $16,710.00 C1815

PATELLA SYMMETRIC TRIATH $3,590.00 C1776

NAIL FEMORAL T2 10 X 280 $3,083.00 C1713

GRANULE BONE GRAFT 1.4-2.8/5CC $967.00 C1713

Page 304: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CANN ASNIC MICR 3.0 X 40 $538.00 C1713

SCREW HEXALOBE 4.3 X 38 $473.00 C1713

PLATE COND CUR LCP VA 4.5 6 RT $3,848.00 C1713

SCREW LOCK SLF-TP 5.0 X 40 $588.00 C1713

RAPTOR MINI GRASPER $336.00

SCREW CANNULATED 4.0 X 44 MM $474.00 C1713

SCREW CANNULATED 4.0 X 46 MM $474.00 C1713

STEM CEMENTED HIP 6058-0335D $9,840.00 C1776

STEM CEMENTED HIP 6058-4035D $9,840.00 C1776

FEMORAL HEAD 6570-0-136 $5,598.00 C1776

SCREW BONE 2.7 X 26 $174.00 C1713

SCREW BONE 3.5 X 42 $192.00 C1713

KIT SUBCHONDROPLASTY KNEE $6,900.00 C1776

MIXING SYSTEM-SUBCHONDROPLSTY $560.00

CANNULA SUBCHONDROPLASTY $1,058.00

CATH GUIDE SINUS FRNT RELIEVA $797.00

BALLOON SINUS RELIEVA 5 X 16 $3,660.00 C1726

SCREW CANNULATED LOCK 5.0 X 25 $535.00 C1713

SCREW CANNULATED LOCK 5.0 X 60 $535.00 C1713

SCREW CORTICAL 4.5 X 65 $109.00 C1713

SCREW LOCKING PERI 5.0 X 10 $529.00 C1713

SCREW LOCKING PERI 5.0 X 18 $529.00 C1713

LEAD MRI 1 X 8 SURESCAN $4,400.00 C1778

K-WIRE WS-1505ST $56.00 C1769

COMPONENT PROX FINGER IMPLANT $5,214.00 L8630

COMPONENT DISTAL FINGER IMPLAN $3,450.00 L8631

PACK DISP ASCENSION MCP STRYKE $1,033.00

DRILL, AO STERILE $415.00

SCREW BIO-COMPRESSION $1,130.00 C1713

PLATE MED LISFRANC $2,714.00 C1713

PLATE LAPIDIS $2,849.00 C1713

SCREW LOCKING 3.0 X 18 MM $348.00 C1713

SCREW LOCKING 3.0 X 16 MM $348.00 C1713

SCREW NONLOCKING 3.0 X 16 MM $359.00 C1713

SCREW NONLOCKING 3.0 X 30 MM $359.00 C1713

SCREW LOCKING 3.5 X 16 MM $522.00 C1713

SCREW LOCKING 3.5 X 18 MM $522.00 C1713

SCREW LOCKING 3.5 X 22 MM $522.00 C1713

SCREW NONLOCKING 3.5 X 30 $359.00 C1713

DRILL BIT 2.8 $418.00

DRILL BIT 2.5 $418.00

SCREW 2.5 X 30 SV30 $781.00 C1713

SCREW 2.5 X 26 SV26 $781.00 C1713

GUIDEWIRE AGK09070M $93.00 C1769

MIC SKIN LEVEL PEG TUBE 20X4.5 $270.00

NAIL PROX HUMERAL CANNULATED $4,188.00 C1713

SCREW BONE 2.7 X 40 $238.00 C1713

SCREW BONE 3.5 X 50 $238.00 C1713

BIT DRILL AO SM 5 X 340 $447.00

K-WIRE 1.8 X 310 $281.00 C1769

Page 305: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NAIL SUPRACONDYLAR 10 X 200 $3,941.00 C1713

SCREW CONDYLE T2 5 X 80 $553.00 C1713

NUT FOR CONDYLE SCREW T2 $553.00 C1713

SCREW CONDYLKE T2 5 X 60 $553.00 C1713

ICD VIVA XT CRT-D $33,525.00 C1882

TENDON SPEEDGRAFT PRE-SUTR $4,910.00 C1762

DEVICE FIXATION 5MM TITANIUM $745.00 C1713

NAIL PROX HUMERAL T2 $4,188.00 C1713

INSERT TIBIAL STBLZR SZ 4 22MM $5,381.00 C1713

PLATE LCP CLAVICLE HOOK 4H 15M $1,922.00 C1713

INSERT ARTICULAR SZ 3-4 18MM $4,960.00 C1713

INSERT ARTIC POST SZ 3-4 18MM $4,045.00 C1776

PLATE R CALC 8 HOLE $2,410.00 C1713

SCREW LOCK 3.5MM X 24 MM $433.00 C1713

SCREW LOCK 3.5 MM X 30 MM $433.00 C1713

SCREW LOCK 3.5 MM X 32 MM $433.00 C1713

SCREW LOCK 3.5 MM X 34 MM $433.00 C1713

BEAR MENISCAL OXFORD RT SM 3M $1,848.00 C1713

DEVICE FIXATION TUB TUNLC 10MM $1,550.00 C1713

K-WIRE 12 MM $99.00 C1769

SCREW CANN FULLTHREAD 4.0 X 42 $474.00 C1713

SCREW NON-LOCKING 3.5 X 22 $359.00 C1713

SCREW LOCKING 3.5 X 14 $522.00 C1713

SCREW LOCKING 3.5 X 24 $522.00 C1713

SCREW LOCKING 3.5 X 28 $522.00 C1713

SCREW LOCKING 3.5 X 30 $522.00 C1713

SCREW LOCKING 3.5 X 40 $522.00 C1713

SCREW HEX LO PRO 4.3 X 42 $473.00 C1713

SCREW HEX LO PRO 4.3 X 22 $473.00 C1713

NAIL FEMORAL T2 10 X 420 $3,083.00 C1713

PLATE LCP RT VOLAR 7H 2.4 $2,347.00 C1713

SCREW LOCKING SLF TP 2.9 X 10 $540.00 C1713

DRILL BIT T2 2.2 $500.00

PIN STEMMER 35-003 ACMED $134.00 C1713

PLAT LISFRANC SMALL RIGHT $2,714.00 C1713

PLATE LAPIDUS PLP20341 $2,714.00 C1713

SCREW NON-LOCKING 5.0 X 28 $359.00 C1713

SCREW NON-LOCKING 3.5 X 32 $359.00 C1713

SCREW NON-LOCKING 3.5 X 38 $359.00 C1713

SCREW NON-LOCKING 3.5 X 16 $359.00 C1713

SCREW NON-LOCKING 3.5 X 24 $359.00 C1713

SCREW NON-LOCKING 3.5 X 20 $359.00 C1713

SCREW NON-LOCKING 3.5 X 26 $359.00 C1713

CUP HIP TRIDENT 58MM $6,922.00 C1776

SCREW LOCKING 3.5 X 12MM $387.00 C1713

SCREW LOCKING 3.5 X 14MM $387.00 C1713

PLATE LISFRANC LEFT LARGE $2,714.00 C1713

SCREW LOCKING 3.0 X 12 $522.00 C1713

SCREW LOCKING 3.0 X 14 $522.00 C1713

BOOT LARGE TCC21114 $247.00

Page 306: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BOOT X-LARGE TCC21124 $259.00 Q4037

SCREW CORTEX 3.5 X 28 $141.00 C1713

SCREW CORTEX 3.5 X 36 $141.00 C1713

PLATE LCP PERI PROX HUM 3 H $3,696.00 C1713

PLATE DIS LAT FEMUR RT 4H $3,365.00 C1713

SCREW CORTICAL 2.7 X 20 $94.00 C1713

PLATE DISTAL MED TIBIA 10 HOLE $2,889.00 C1713

SCREW LOCKING 4.0 X 24 $87.00 C1713

SCREW LOCKING 4.0 X 32 $87.00 C1713

PLATE DISTAL FIBULA 10 HOLE $1,616.00 C1713

IMPLANT KNEE TTL SYS LESS REV $7,792.00

IMPLANT HIP TTL SYS LESS REV $8,138.00

BASEPLATE TTL KNEE SZ 3 REV $4,733.00

STEM CMNT TTL KNEE 12 X 50 REV $2,740.00

BASEPLATE TTL KNEE SZ4 REV $5,747.00

BLOCK HLF AUB TIB SZ4 REV $2,597.00

BLOCK HLF AUG TIB SZ4 REV $2,597.00

HUMERAL LINER 320-38-03 $1,958.00 C1713

KIT SCREW DRIVE SQ TORQUE DEFI $677.00

STAY ELASTIC $28.00

PLATE STRAIGHT 12 HOLE $1,265.00 C1713

SCREW BONE 2.7 X 28 MM $174.00 C1713

MESH BILAYER 8 X 10 $22,400.00 Q4104

MESH BILAYER 4 X 10 $14,632.00 Q4104

STEM PRIM MINI SHLD 17X 83MM $10,668.00 C1776

SCREW CENTRAL 6.5 X 25 MM $580.00 C1713

MESH WOUND MATRIX 4 X 5 THIN $7,650.00 Q4104

K-WIRE 1.4 #702495 $1,235.00 C1713

SCREW CANNULATED 4.0 X 55 MM $474.00 C1713

SCREW LOCK SLF TP 2.0 X 16 $381.00 C1713

SCREW LOCK SLF TP 2.0 X 18 $381.00 C1713

SCREW LOCK SLF TP 2.0 X 20 $381.00 C1713

SCREW LOCKING 5.0 X 32 MM $414.00 C1713

BURR DISC DIAMOND MD $387.00

BURR RASP HELICOIDAL MD $418.00

PLATE DIST LAT FEMUR 6H RT $3,365.00 C1713

DRESSING ACTICOAT 3" 4X8 $39.00 A6204

SCREW CORTEX SLF-TP T8 2.4X34 $183.00 C1713

NAIL TIBIAL STANDAR 1822-0936S $3,048.00 C1713

GRAFT STRUT CRT FM 20X200MM $1,184.00 C1762

PLATE SHRT BRL 2H 135DEG 46MM $1,310.00 C1713

PLATE REV SLD POST AUG GLENOID $5,123.00 C1713

SCREW REV SHLD COMP 4.5 X 26MM $428.00 C1713

LINER REV SHLD HUMERAL 2.5X42 $2,153.00 C1713

GLENOSPHE REV SHLD OFFSET 4X38 $4,859.00 C1713

DRILL BIT REV SHLD 2.0 X 3.2 $870.00

PLATE GLENOID REV SHLD $3,836.00 C1713

SCREW LOCKING 5.0 X 44 MM $414.00 C1713

PUSHER KNOT STRAIGHT SUTR $424.00 C1713

SCREW LOCKING CANN VAR ANG 5.0 $652.00 C1713

Page 307: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PLATE CONY VA LCP CURV 4.5 10H $4,084.00 C1713

SCREW LOCKING SLF-TP CAR ANG 5 $588.00 C1713

CATHETER ATHERECTOMY SC $6,710.00 C1724

CATHETER ATHERECTOMY XC $6,710.00 C1724

BALLOON COYOTE PTA 4FR 3.00 X $1,207.00 C1725

BALLOON COYOTE PTA 4FR 4.00 X $1,207.00 C1725

CATHETER CROSSING RUBICON 14 4 $509.00 C1887

MESH BILAYER WND 4 X 5 $9,288.00 Q4104

FILTER VAPOR-CLEAN ANESTHESIA $304.00

CATH SOLID ATHER 2.00 DIAMONDB $7,100.00 C1724

CATH MICRO ATHER 1.25 DIAMONDB $7,100.00 C1724

SCREW NON-LOCKING 3.0 X 18 $359.00 C1713

SCREW NON-LOCKING 3.0 X 24 $359.00 C1713

SCREW NON-LOCKING 3.0 X 26 $359.00 C1713

TENDON PATELLAR MACHINED 11MM $6,510.00 C1762

SUTURE ABSO 3-0 18INL MONOFILA $112.00

SCREW NON LOCKING 3.0 X 20MM $359.00 C1713

CASTING 3" NO BOOTS $316.00

CASTING 4" NO BOOTS $316.00

NAIL FEMORAL LEFT 9 X 340 MM $3,905.00 C1713

NAIL HUMERAL 7 X 300 MM $3,071.00 C1713

FLIP CUTTER II 11.0 MM $809.00

REAMER LOW PROFILE 11MM $595.00

TIGHTROPE BUTTON EXTENDER $560.00 C1713

SCREW BIOCOMPOSIT FT 12 X 28MM $585.00 C1713

SCREW ASNIS 6.5 X 55MM $604.00 C1713

WASHER 619904 $127.00 C1713

END CAP 1850-0002S $489.00 C1713

CATH OPT INTRO 1000093002 $198.00

AAA SYS ENDOLOGIX CAPITATED $26,303.00

K-WIRE GLENOID $185.00 C1769

LINER CONSTRAINED HUMERAL 38MM $2,153.00 C1713

SCREW 4.5 X 34 MM $428.00 C1713

CATH CLASSIC ATHER 1.5 DIAMOND $7,100.00 C1724

CATH CLASSIC ATHER 2.0 DIAMOND $7,100.00 C1724

CATH CLASSIC CORONARY DIAMOND $7,900.00 C1724

WIRE VIPERAIRE ADV CORO .014 $595.00 C1769

WIRE ASAHI TREASURE 12 X 300 $458.00 C1769

WIRE ASAHI ASTATO 30 300 $458.00 C1769

WIRE ASAHI TREASURE FLPY 300CM $458.00 C1769

WIRE ASAHI REGALIA 300CM $458.00 C1769

WIRE ASAHI ASTATO XS 20 X 300 $458.00 C1769

GRAFT GORE-TEX STRE VAS 12X30 $1,277.00 C1768

GRAFT GORE-TEX STRE VAS 14X30 $1,277.00 C1768

GRAFT GORE-TEX STRE VAS 16X30 $1,277.00 C1768

SCREW BI-CORT POST 4.5 X 32.5M $436.00 C1713

SCREW BI-CORT POST 4.5 X 37.5M $436.00 C1713

DRILL BIT CANNULATED 9.5 MM $595.00

CATH FFR NAVVUS 014667 $700.00

TIBIAL BEARING INSERT $4,037.00 C1776

Page 308: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW LOCKING 3.5 X 10 $433.00 C1713

PLATE CLAVICLE LARGE 8 HOLE $2,642.00 C1713

HEAD SHOULDER W/VARI OFFSET $3,310.00 C1776

NAIL FEMORAL 1828-1140S $3,461.00 C1713

PLATE TIBIAL PROX LCP 3.5X 76 $3,523.00 C1713

SCREW CANN CONICAL 3.7 X 60 $557.00 C1713

INTRODUCER FOR INFUSION PORT $144.00

GLIDWIRE ANGLED .38 $84.00 C1769

K-WIRE 1.6MM AGK16100 $99.00 C1769

PLATE VARIAX FOOT $1,491.00 C1713

SCREW LOCKING 3.0 X 22 MM $522.00 C1713

SCREW LOCKING 3.0 X 24 MM $522.00 C1713

SCREW LOCKING 3.5 X 20 MM $522.00 C1713

SCREW LOCKING 2.7 X 12 MM $425.00 C1713

SCREW LOCKING 2.7 X 24 MM $425.00 C1713

SCREW BONE 2.7 X 22 MM $174.00 C1713

SCREW BONE 2.7 X 14 MM $174.00 C1713

PLATE UTILITY PLP40340 $2,313.00 C1713

SCREW LOCKING F-T 4 X 22 $503.00 C1713

ROD CONNECTING MRI 8 X 250 $680.00 C1713

PIN TRANSFIX APEX 4 X 300 $366.00 C1713

PIN TRANSFIX APEX 5 X 300 $324.00 C1713

PLATE RADIAL STYLOID 70-0331 $1,975.00 C1713

SCREW NON-TOGG CORT 2.3 X 18 $320.00 C1713

SCREW NON-TOGG CORT 2.3 X 30 $320.00 C1713

SCREW NON-TOGG CORT 2.3 X 26 $320.00 C1713

SCREW NON-TOGG CORT 2.3 X 16 $320.00 C1713

PEG LOCKING CORT 2.3 X 20 $320.00 C1713

SCREW NON-TOGG CORT 2.3 X 24 $320.00 C1713

PLATE DORSAL LUNATE 70-0337 $1,975.00 C1713

CATH PLEURX (ONLY) PLEURAL $1,213.00 C1729

ANCHOR BUMPY NEUROSTIM PAIN $685.00

DRESSING SORBACT PADS 4 X 4 $22.00

DRESSING SORBACT GEL SHEET 3 X $24.00

DRESSING SORBACT RIBBON 2 X 79 $33.00

GRAFT AMNIOEXCEL 1.5 X 1.5 $1,469.00 Q4137

GRAFT AMNIOEXCEL 2 X 3 $2,044.00 Q4137

GRAFT AMNIOEXCEL 4. X 4 $2,271.00 Q4137

DRESSING PRISMA 4.34 X 4.34 $37.00 A6022

DRESSING HEMO QUICKCLOT 4 X 4 $72.00 A6209

DRESSING HEMO QUICKCLOT Z-FOLD $175.00 A6209

DRILL BIT 2.7 MM $462.00

SCREW CANNULATED 4.0 X 42 $474.00 C1713

BONE GROWTH STIMULATOR $18,050.00

SCREW LOCKING 3.5 X 44 MM $478.00 C1713

SCREW CANN MICR ASNIS 2.0 X 24 $538.00 C1713

SCREW CANN MICR ASNIS 2.0 X 28 $538.00 C1713

BIT DRILL CANNULATED 2.0 X 1.7 $547.00

CYLINDER W/PUMP SCROTAL $17,890.00 C1815

PLATE DISTAL MEDIAL TIBIAL 4 H $2,889.00 C1713

Page 309: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW LOCKING 3.5 X 24 MM $432.00 C1713

BIT DRILL QUICK COUPLER 1.7 $534.00

STENT URETERAL POLARIS 8FR $184.00 C2617

SCREW BONE 2.4 X 34 $357.00 C1713

SCREW CANCELLOUS FT 6.5 X 95 $123.00 C1713

TIGHTROPE SYNDESMOSIS REP KIT $2,033.00 C1713

PLATE DISTAL FIBULA 9 HOLE $1,429.00 C1713

WIRE WHISPER VIEW EDS .014X190 $427.00 C1769

CATHETER UNIDIRECT 6FR CS-F CU $1,349.00 C1730

SCREW COMPRESSION 32.3 $220.00 C1713

SCREW LAG OMEGA 90 MM $717.00 C1713

PLATE BARREL HIP OMEGA 4 HOLE $1,306.00 C1713

PIN GUIDE 2.8 X 230 MM $140.00 C1713

SCREW LAG OMEGA PLS 95 MM $717.00 C1713

DRILL BIT 3.2 MM $387.00

PLATE DIST LAT FEMUR 10H RT $3,365.00 C1713

SCREW CORTICAL 4.5 X 24 MM $109.00 C1713

PLATE DIST POST MED 4H LEFT $2,111.00 C1713

PLATE DIST LAT HUM 4 HOLE LEFT $2,111.00 C1713

SCREW LOCKING 4.0 X 14 MM $388.00 C1713

PLATE VA-LCP OLECR 4H 2.7X3.5 $2,508.00 C1713

SCREW VA LOCK SLF-TP 2.7 X 22 $482.00 C1713

SCREW VA LOCK SLF-TP 2.7 X 26 $459.00 C1713

SCREW VA LOCK SLF-TP 2.7 X 36 $459.00 C1713

SCREW METAPHY SLF-TP 2.7 X 16 $180.00 C1713

RADIAL HEAD COCR 24 X 19 MM $4,135.00 C1776

RADIAL STEM TI CURVED 7 X 42 $4,135.00 C1776

PCKG ALLURE QUADRA BIV $39,578.00 C2621

PCKL LEAD TENRIL STS 2088TC/52 $1,742.00 C1898

PCKL LEAD TENDRIL 2088TC/58 $1,233.00 C1898

PCKL LV LEAD 1458-92Q $19,160.00 C1900

SHEATH SAFE II 6FR 13CM $305.00

PCK FINAL CPS 7 FR 47CM $1,199.00

LEAD QUARTER V PR $19,160.00 C1900

BONE FILLER HYDROSET 3CC $1,946.00 C9359

SCREW NON-TOGGING 2.3 X 20 $320.00 C1713

PELLETS OSTEOSET RBK 25CC $2,600.00 C1713

PLATE DIST MED TIBIA 14 HOLE $2,889.00 C1713

SCREW CORTICAL 3.5 X 16 $388.00 C1713

NAIL FEMORAL $3,825.00 C1713

NAIL METACARPAL STD 4.0 $1,767.00 C1713

CONNECTOR 2 MM X 15.0 $934.00 C1713

NAIL DISTAL RADIUS LONG $1,767.00 C1713

SCREW SEL 3.0 X 2.0 $317.00 C1713

SCREW UNICORTICAL 2.8 X 7.0 $381.00 C1713

SCREW UNICORTICAL 2.8 X 8.0 $381.00 C1713

K-WIRE STANDARD TIP 1.5 X 127 $108.00 C1713

DRILL BIT UNICORTICAL 3 X 41 $381.00

SCREW HEADLESS COMPRESS 3.5 X $1,271.00 C1713

K-WIRE HCS 1.4 X 165 $108.00 C1713

Page 310: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DRILL QUICK CONNECT 2.7 CANNUL $560.00

PLATE CLAVICLE SUPER 5HOLE $3,013.00 C1713

SCREW BONE 3.5 X 10 MM $238.00 C1713

PLATE BARREL HIP 12 HOLE $1,306.00 C1713

SCREW OMEGA LAG 100 MM $717.00 C1713

SCREW CENTRAL 6.5 X 20 MM $305.00 C1713

PLATE-T WIDE 8 HOLE $1,008.00 C1713

SCREW LOCKING 2.3 X 16 $275.00 C1713

SCREW LOCKING 2.3 X 20 $275.00 C1713

SCREW LOCKING 2.3 X 26 $275.00 C1713

SCREW BONE 2.3 X 26 $238.00 C1713

SUTURE STRATAFIX 3-0 30CM PS-1 $75.00

SCREW CORTICAL 3.5 X 48 MM $100.00 C1713

CROSSER CTO 14S OTW 146CM $3,810.00 C1714

CROSSER CTO 14P OTW 146CM $3,810.00 C1714

CROSSER CTO NO WIRE S6 154CM $3,810.00 C1714

SCREW LOCKING CANN 3.7 X 52 $521.00 C1713

SCREW LOCK NAIL POLARUS 3 260 $4,606.00 C1713

PLATE COMPRESSION 7 HOLE $412.00 C1713

AMNIOEXCEL DISKS 12 MM X 1 CM $658.00 Q4137

AMNIOEXCEL DISKS 15MM X 2 CM $717.00 Q4137

CATH SIDEKICK SUPPORT ST 110CM $685.00 C1887

CATH SIDEKICK SUPPORT AN 110CM $685.00 C1887

CATH USHER SUPPORT TAPERED 130 $685.00 C1887

CATH USHER SUPP ANG-TAPER 130 $685.00 C1887

FLOWMATE PROCEDURAL KITS $93.00

GUIDEWIRE PORTER 9G $381.00 C1769

CATH SEEKER CROSS/SUP 014/150C $366.00 C1714

CATH SEEKER CROSS/SUP 018/150C $366.00 C1714

CATH SEEKER CROSS/SUP 035/90CM $366.00 C1714

CATH SEEKER CROSS/SUP 035/150C $366.00 C1714

SCREW LAG OMEGA 80MM $717.00 C1713

PLATE OMEGA BARREL HIP 2H 130D $1,306.00 C1713

PLATE CP LAPIDUS PLP27372 $2,849.00 C1713

SCREW BONE 3.5 X 14 MM $359.00 C1713

SCREW BONE 3.5 X 18 MM $359.00 C1713

CATH ATHERECTOMY JETSTREAM 1.8 $6,710.00 C1724

CATH ATHEREC JETSTREAM 2.4/3.4 $6,710.00 C1724

TIBIAL INSERT SIZE 7 11MM $4,610.00 C1713

STENT GRAFTMASTER 2.8 X 16 $5,100.00 C1874

STENT GRAFTMASTER 2.8 X 19 $5,100.00 C1874

PLATE RT ANT DIST TIB 14 HOLE $3,172.00 C1713

SCREW CANNULATED 4.0 X 36 $474.00 C1713

PLATE ROTATION 5 HOLE $1,008.00 C1713

SCREW BONE 2.3 X 14 $238.00 C1713

SHEATH EP 8FR 63 CM $554.00 C1893

INTRODUCER EP HEMOST TRIO .038 $125.00 C1894

CATH EP DECAPOLAR 6FR 115CM $1,276.00 C1730

CATH EP DUO-DECA 7FR 95CM $1,276.00 C1731

CABLE EP BLACK DECA 150CM $319.00

Page 311: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CATH EP JSN QUAD 5FR $436.00 C1730

CATH EP CRD 2 QUAD 5FR $436.00 C1730

CABLE EP BLACK QUAD 150 CM $268.00

CABLE EP BLUE QUAD 150 $268.00

CABLE EP GREY QUAD 150 $268.00

CABLE EP RED QUAD 150 $268.00

PATCH EP CARDIA MAPPING NAVX $2,510.00

CATH EP ABLATION BI-D 8MM TIP $2,620.00 C1733

CABLE EP ABLATION 250 CM $587.00

CATH EP ABLATION M CRL 4MM TIP $1,842.00 C1733

CABLE EP CATH EXT 300 CM $587.00

THERAPY EP MD BI-D 4 MM TIP $1,652.00 C1733

CABLE EP THERAPY IBI-1500T $587.00

SCREW CANN 8.0 X 65 MM $598.00 C1713

SYS DEFIB ICD DC EVERA S $30,960.00 C1721

COMPONENT KNEE LEGION SIZE 5 $10,346.00 C1776

COMPONENT TIB BASE SIZE 4 $4,359.00 C1713

COMPONENT PAT KNEE 32MM $2,064.00 C1776

INSERT TIB KNEE SIZE 3-4 $4,711.00 C1776

NAIL FEMORAL 10 X 340 $3,461.00 C1713

GRAFT VASCULAR HEMAGARD 14MM $1,170.00 C1768

GRAFT VASCULAR HEMASHIELD 14X3 $1,212.00 C1768

GRAFT VASCULAR HEMASHIELD 16X3 $1,212.00 C1768

GRAFT VASCULAR HEMASHIELD 24X3 $1,256.00 C1768

GRAFT VASCULAR HEMASHIELD 28X3 $1,305.00 C1768

ICD DEFIB QUADRA ASSURA OTHER $35,010.00 C1882

ICD LEAD DEFIB BIPOLAR 7FR 65C $8,560.00 C1895

PACEMAKER SHEATH INTRODUCER $180.00 C1766

GUIDE CATH CPS LUMINARY XLG CL $1,980.00 C1887

SLITTER LEAD DELIVERY UNIV $67.00

PACEMAKER DUAL CHAMBER PM224 $8,976.00 C1785

PCKL LEAD TENDRIL STS 1 2088TC $1,233.00 C1898

BASKET STONE CAPTURA G32756 $482.00

SCREW CANN ASNIS 8 X 80 $604.00

CATH CARDIO ATTAIN COMMAND $2,160.00 C1887

PCKL ATTAIN ABILITY STRAIGHT $3,870.00 C1900

NEURAGEN NERVE GUIDE 2MM X 2CM $3,680.00 C9352

DCB LUTONIX 035 130CM 6 X 60MM $3,110.00 C2623

DCB LUTONIX 035 130CM 5 X 60MM $3,110.00 C2623

DCB LUTONIX 035 130CM 4 X 60MM $3,110.00 C2623

DCB LUTONIX 035 130CM 5 X 100M $3,110.00 C2623

DCB LUTONIX 035 130CM 6 X 100M $3,110.00 C2623

DCB LUTONIX 035 130CM 4 X 100M $3,110.00 C2623

SCREW ASNIS 6.5/8.0 110 $604.00 C1713

K-WIRE 1.25 X 150 SS $26.00 C1713

NAIL HUMERAL PROX CANN LT $4,188.00 C1713

END CAP HUMER PROX T2 $509.00 C1713

PLATE PROX LAT HUMERUS 12HOLE $3,146.00 C1713

PLATE COMPRESSION 10 HOLE $458.00 C1713

SCREW CANCEL PT 4.0 X 40 MM $87.00 C1713

Page 312: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CORTICAL TI 3.5 X 65 $192.00 C1713

PLATE EXT MED DIST HUMERUS $2,111.00 C1713

PLATE POST LAT DIST HUMERUS $2,111.00 C1713

DRILL BIT 700352 $418.00

SCREW STANDARD LAG 85 MM $717.00 C1713

ICD VIVA CRT-D QUAD S $30,660.00 C1882

ICD-LEAD ATTAIN PERFORMA 4298 $4,310.00 C1900

ICD-LEAD ATTAIN PERFORMA 4598 $4,310.00 C1900

CATHETER ATTAIN GLOBAL 6227DEF $549.00 C1887

PLATE TIB ANT DIS 4.0 RT AXSOS $2,813.00 C1713

SCREW CANN MICRO 2.0 X 22 MM $538.00 C1713

GUIDEWIRE URO MVBL CORE .038" $72.00 C1769

NGAGE NITI STONE EXT 2.2FRX115 $572.00

SENSOR NICOM CHEETAH CMS25 $458.00

SCREW COMPRESSION 2.5 X 24MM $781.00 C1713

SCREW COMPRESSION 2.5 X 28MM $781.00 C1713

TCC EZ CAST BOOT TCC2116 $284.00

INSERT HIP TRIDENT POLY $2,930.00 C1776

SCREW DISTAL RADIUS FIX 220M $6,445.00 C1713

SCREW CORTICAL BONE TAP 3.5MM $302.00 C1713

SCREW STANDARD LAG 105 MM $717.00 C1713

BALLOON RELIEVA SINUS ADULT KI $4,210.00 C1726

BALLOON RELIEVA SINUS KIT PEDI $4,210.00 C1726

PLATE TROCH GRIP W/2 CABLES $3,865.00 C1776

SCREW CANNULATED 4.0 X 28 $474.00 C1713

SCREW CANNULATED 4.0 X 30MM $474.00 C1713

DRILL BIT CANNULATED 4MM $595.00

STEM RHEAD CPTL SZ 4 $4,788.00 C1776

HEAD RHEAD RAD RHA-H4 $2,850.00 C1776

BOOT CAST TCC21126 $299.00

BIT DRILL CANNULATED 2.0 $525.00

SCREW FIXOS COMP 2.5 X 22 MM $828.00 C1713

MODULAR HIP SYSTEM RESTORATION $5,664.00 C1776

MODULAR HIP SYS REST 23 MM $7,782.00 C1776

FEMORAL HEAD LFIT ANATOMIC V40 $2,849.00 C1776

FEMORAL HEAD LFIT ANAT V40-36 $2,849.00 C1776

CATH PERIPH OCELOT 6F 110 CM $6,300.00 C1751

CATH PERIPH OCELOT 5 FR 135 CM $6,300.00 C1751

SYS MONITOR REVEAL LINQSYS $10,900.00 C1764

PLATE TI MATRIX RIB 6&7 17HOLE $3,756.00 C1713

PLATE TI MAT RIB 8&9 18HOLE $3,756.00 C1713

LIGAMENT INTERNAL BRACE REPAIR $2,252.00 C1713

NAIL FEMORAL R1500 10X360 $3,461.00 C1713

BIT DRILL CANN TWIST 4.0 X 2.6 $611.00

FEMORAL HEAD 6570-0-232 $5,714.00 C1776

SCREW CANNULATED 5.0 X 40 MM $520.00 C1713

WASHER 5.0 390017 $109.00

DRILL BIT CANNULATED 10.5MM $595.00

SINGLE USE OATS SEAT 10 MM $1,201.00

PLATE CLAV ANT LAT 8 HOLE $3,013.00 C1713

Page 313: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SUTURE COVIDINE VLOC0316 $105.00

SCREW BONE T7 2.7 X 38 $174.00 C1713

PLATE L-PLATE RIGHT 40-15092 $947.00 C1713

SCREW BONE T7 2.7 X 12 $174.00 C1713

SCREW LOCKING 2.7 X 10 $425.00 C1713

K-WIRE 2.0 MM $563.00 C1713

DRILL BIT CANNULATED 3.5 MM $227.00

SCREW CANNULAT ASNIS 5.0 X 44 $520.00 C1713

SCREW CANCELLOUS PT 4.0 X 45 M $87.00 C1713

MAGGOTS DISINFECTED 250-500 ML $458.00

DRESSING LEFLAP MAGGOT 3X3 $67.00

LESOC 4 X 6 SOCK LA46 $48.00 99070

LEGLU ADHESIVE 1OZ LG $48.00 99070

CRYONEEDLE ICE-ROD PROSTATE $8,310.00

TRIAL CASSETTE VAC VERAFLO $159.00

TRIAL DRESSING VERAFLO MEDIUM $1,262.00

CATH ASCENDA REVISION-INTRASPI $1,245.00 C1755

SCREW CANNULATED 3.0 X 22 MM $538.00 C1713

BEARING SHLD XL-115367 RVRS $1,617.00 C1776

STENT BILIARY EPIC 8X120 120CM $2,710.00 C1876

STENT VASC EPIC 6F 6X100 120CM $2,710.00 C1876

STENT VASC EPIC 6F 6X120 120CM $2,710.00 C1876

STENT VASC EPIC 6F 6X40 120CM $2,710.00 C1876

STENT VASC EPIC 6F 6X60 120CM $2,710.00 C1876

STENT VASC EPIC 6F 6X80 120CM $2,710.00 C1876

STENT VASC EPIC 6F 7X100 120CM $2,710.00 C1876

STENT VASC EPIC 6F 7X118 120CM $2,710.00 C1876

STENT VASC EPIC 6F 7X40 120CM $2,710.00 C1876

STENT VASC EPIC 6F 7X60 120CM $2,710.00 C1876

STENT VASC EPIC 6F 7X80 120CM $2,710.00 C1876

STENT VASC EPIC 6F 8X100 120CM $2,710.00 C1876

STENT VASC EPIC 6F 8X40 120CM $2,710.00 C1876

STENT VASC EPIC 6F 8X61 120CM $2,710.00 C1876

STENT VASC EPIC 6F 8X82 120CM $2,710.00 C1876

STENT VASC EPIC 6F 9X99 120CM $2,710.00 C1876

STENT VASC EPIC 6F 9X40 120CM $2,710.00 C1876

STENT VASC EPIC 6F 9X60 120CM $2,710.00 C1876

STENT VASC EPIC 6F 9X80 120CM $2,710.00 C1876

STENT VASC EPIC 6F 10X30 120CM $2,710.00 C1876

STENT VASC EPIC 6F 10X40 120CM $2,710.00 C1876

STENT VASC EPIC 6F 12X32 120CM $2,710.00 C1876

STENT VASC EPIC 6F 12X40 120CM $2,710.00 C1876

STENT BILIARY EXPR SD 4X15 150 $2,410.00 C1876

STENT BILIARY EXPR SD 5X15 150 $2,410.00 C1876

STENT BILIARY EXPR SD 6X14 150 $2,410.00 C1876

STENT BILIARY EXPR SD 7X15 150 $2,410.00 C1876

STENT BILIARY EXPR SD 4X19 150 $2,410.00 C1876

STENT BILIARY EXPR SD 5X19 150 $2,410.00 C1876

STENT BILIARY EXPR SD 6X18 150 $2,410.00 C1876

STENT BILIARY EXPR SD 7X19 150 $2,410.00 C1876

Page 314: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STENT BILIARY EXP LD 10X25 135 $2,410.00 C1876

STENT BILIARY EXP LD 10X57 135 $2,410.00 C1876

STENT BILIARY EXPR LD 6X27 135 $2,410.00 C1876

STENT BILIARY EXPR LD 6X37 135 $2,410.00 C1876

STENT BILIARY EXPR LD 6X57 135 $2,410.00 C1876

STENT BILIARY EXPR LD 7X27 135 $2,410.00 C1876

STENT BILIARY EXPR LD 7X37 135 $2,410.00 C1876

STENT BILIARY EXPR LD 7X57 135 $2,410.00 C1876

STENT BILIARY EXPR LD 8X27 135 $2,410.00 C1876

STENT BILIARY EXPR LD 8X37 135 $2,410.00 C1876

STENT BILIARY EXPR LD 8X57 135 $2,410.00 C1876

STENT BILIARY EXPR LD 9X25 135 $2,410.00 C1876

STENT BILIARY EXPR LD 9X37 135 $2,410.00 C1876

STENT BILIARY EXPR LD 9X57 135 $2,410.00 C1876

STENT VASC LIFESTENT 5X60 130 $2,810.00 C1876

STENT VASC LIFESTENT 5X100 130 $2,810.00 C1876

STENT VASC LIFESTENT 5X150 130 $2,810.00 C1876

STENT VASC LIFESTENT 5X170 130 $2,810.00 C1876

STENT VASC LIFESTENT 6X60 130 $2,810.00 C1876

STENT VASC LIFESTENT 6X100 130 $2,810.00 C1876

STENT VASC LIFESTENT 6X150 130 $2,810.00 C1876

STENT VASC LIFESTENT 6X200 135 $2,810.00 C1876

STENT VASC LIFESTENT 7X100 130 $2,810.00 C1876

STENT BILIARY LIFEST 7X150 130 $2,810.00 C1876

STENT VASC LIFESTENT 7X200 135 $2,810.00 C1876

STENT BILIARY LIFESTR 8X40 135 $1,502.00 C1876

STENT BILIARY LIFESTR 8X60 135 $1,502.00 C1876

STENT BILIARY LIFESTR 8X80 135 $1,502.00 C1876

STENT BILIARY LIFESTR 9X40 135 $1,502.00 C1876

STENT BILIARY LIFESTR 9X60 135 $1,502.00 C1876

STENT BILIARY LIFESTR 9X80 135 $1,502.00 C1876

STENT BILIARY LIFEST 10X40 135 $1,502.00 C1876

BALLOON PERIPH CON 5.5F 035 50 $560.00 C1725

BALLOON PERIPH CON 5.5F 035 50 $560.00 C1725

BALLOON PERIPH CON 5.5F 035 50 $560.00 C1725

BALLOON PERIPH CON 5.5F 035 50 $560.00 C1725

BALLOON PERIPH CON 5.5F 035 50 $560.00 C1725

BALLOON PERIPH CON 5.5F 035 50 $560.00 C1725

BALLOON PERIPH CON 5.5F 035 50 $560.00 C1725

BALLOON PERIPH CON 5.5F 035 50 $560.00 C1725

BALLOON PERIPH CON 5.8F 035 75 $560.00 C1725

BALLOON PERIPH CON 6.5F 035 75 $560.00 C1725

BALLOON PERIPH CON 6.5F 035 75 $560.00 C1725

BALLOON PERIPH CON 5.8F 035 75 $560.00 C1725

BALLOON PTA ULTRVS 035 6F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 7F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 7F 130 $351.00 C1725

Page 315: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BALLOON PTA ULTRVS 035 7F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 7F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 7F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 7F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 7F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 7F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 5F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 75 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 75 $351.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

Page 316: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 5F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 5F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 5F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 5F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 5F 150 $585.00 C1725

BALLOON PTA ULTRVS 014 5F 150 $585.00 C1725

BALLOON PTA ULTRVS 018 4F 150 $585.00 C1725

BALLOON PTA VASTR 014 1.8F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 1.8F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 1.8F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 5F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 1.8F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 1.8F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 1.8F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 1.8F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 5F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 1.8F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 1.8F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 1.8F 140 $1,502.00 C1725

BALLOON PTA VASTR 014 1.8F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 1.8F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 1.8F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 1.8F 140 $1,502.00 C1725

Page 317: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BALLOON PTA VASTR 018 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 2.5F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 1.8F 140 $1,502.00 C1725

BALLOON PTA VASTR 018 2.5F 140 $1,502.00 C1725

BALLOON PTA ULTRVS 035 7F 130 $351.00 C1725

BALLOON PTA ULTRVS 014 4F 150 $585.00 C1725

BIT DRILL VARIAX HAND 1.4 MM $252.00

SCREW LOCK CRS PIN 1.7 X 14 $275.00 C1713

SCREW LOCK CRS PIN 1.7 X 16 $275.00 C1713

SCREW LOCK CRS PIN 1.7 X 13 $275.00 C1713

SCREW LOCK CRS PIN 1.7 X 10 $275.00 C1713

SCREW LOCK CRS PIN 1.7 X 8 $275.00 C1713

PLATE T-PLATE HAND LOCK 7H 1.7 $1,008.00 C1713

SCREW BONE CRS PIN 1.7 X 14 $238.00 C1713

PLATE HIP BARREL 3H $1,306.00 C1713

PLATE OLECRANON 4 HOLE $2,111.00 C1713

SCREW LOCKING 3.5 X 60 $432.00 C1713

NAIL ANKLE ARTHRODESIS LEFT $4,269.00 C1713

SCREW LOCKING 2.3 X 22 MM $275.00 C1713

PLATE COMP BROAD STRAIGHT 7 H $941.00 C1713

PLATE COMP NARROW STRAIGHT 6H $941.00 C1713

SCREW BONE 2.3 X 22 MM $238.00 C1713

SCREW BONE 2.3 X 16 $238.00 C1713

PIN APEX 120 MM $324.00 C1713

PLATE DISTAL ANTE LAT TIBIA 4H $2,984.00 C1713

LEAD BLANK SC-4350 $229.00

FORCEP BIOPSY 3.3 FR 115 $751.00

NAIL SUPRACONDYLAR 14 X 380 $3,941.00 C1713

GUIDEWIRE 0.3 MM X 300MM $132.00 C1769

NAIL TIBIAL 11 X 375 $3,048.00 C1713

SHLD REV REVISION IN-PT ONLY $26,689.00

BIT DRILL AO STERILE 4.2 X 260 $415.00

SCREW LOCK FIXED 4.75X35 $305.00 C1713

ICD EVERA S IS1/DF4 DU CHAMBER $24,585.00 C1721

DRILL BIT 1.0 X D22 MM $252.00

SCREW BONE 1.2 X 8 MM $238.00 C1713

SCREW BONE 1.2 X 7 MM $238.00 C1713

TAP 1.2 $297.00

ICD EVERA XT VR DF4 SC $25,710.00 C1722

TUBE JEJUNOSTOMY 12 FR X 68 CM $465.00 B4087

TUBE PEG 24 FR $343.00 B4087

SUTURE VLOC 9" 1/2 CIRCLE TPR $101.00

GRASPIT STONE EXT NGAGE 2.2FR $572.00

PLATE COMPRESSION LOCKING 10 H $525.00 C1713

NAIL FEMORAL 10 X 380 $3,461.00 C1713

SCREW BONE CRS OIN 1.7 X 24 $238.00 C1713

STEM RHEAD LAT COLLAR SZ3 6MM $4,808.00 C1713

Page 318: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

HEAD RADIAL LAT SIZE 3 $3,074.00 C1713

HEAD RADIAL LATERAL SIZE 4 $3,350.00 C1713

SCREW LAG 110MM 3362-5-110 $717.00 C1713

CATH HEMATURIA 2 WAY 16R $63.00

CATH HEMATURIA 2 WAY 18FR $63.00

WASHER 3.0MM $216.00

STENT SUPERA PERI 5.5X150X120 $3,210.00 C1876

STENT SUPRA PERI 5.5X120X120 $3,210.00 C1876

STENT SUPRA PERI 5.5X100X120 $3,010.00 C1876

STENT LUTONIX DRUG 6X120X130 $3,410.00 C2623

STENT LUTONIX DRUG 5X120X130 $3,410.00 C2623

PLATE OLECRANON 4 HOLE $2,111.00 C1713

SCREW BONE 3.5 X 40 MM $238.00 C1713

SCREW BONE 3.5 X 30 MM $238.00 C1713

ABLATION DEVICE NOVASURE $2,298.00

SCREW CANNULATED 3.0 X 18 $538.00 C1713

SCREW LOCKING 4 X 25 MM $503.00 C1713

SCREW BONE 2.3 X 24 MM $238.00 C1713

DRILL BIT 2.5 MM $252.00

PLATE PROX MED TIB AXSOS 8 H $3,366.00 C1713

PLATE PROX LAT TIB AXSOS 4 H $3,378.00 C1713

SCREW CORTICAL 3.5 X 40 $87.00 C1713

SCREW CORTICAL 3.5 X 42 MM $87.00 C1713

SCREW CORTICAL 3.5 X 46 MM $87.00 C1713

SCREW CORTICAL 3.5 X 48 MM $87.00 C1713

SCREW CORTICAL 3.5 X 50MM $87.00 C1713

BALLOON DRUG LUTONIX 5X150X130 $3,710.00 C2623

BALLOON DRUG LUTONIX 6X150X130 $3,710.00 C2623

ICD FORTY ASSURA DR $28,410.00 C1721

SCREW CORTICAL 3.5 X 55 MM $87.00 C1713

SCREW CORTICAL 3.5 X 60 MM $87.00 C1713

SCREW CORTICAL 3.5 X 70MM $87.00 C1713

SCREW CORTICAL 3.5 X 75MM $87.00 C1713

SCREW CORTICAL 3.5 X 90MM $87.00 C1713

SCREW LOCKING 4.0 X 30 MM $447.00 C1713

SCREW LOCKING 4.0 X 36 MM $447.00 C1713

SCREW LOCKING 4.0 X 40 MM $447.00 C1713

SCREW LOCKING 4.0 X 50 MM $447.00 C1713

SCREW LOCKING 4.0 X 70 MM $447.00 C1713

SCREW LOCKING 4.0 X 85 MM $447.00 C1713

SCREW LOCKING 4.0 X 90 MM $447.00 C1713

DRILL BIT 3.1 X 216 MM $575.00

DRILL BIT 2.5 X 216 MM $639.00

PLATE RT SUPER MIDSHAFT CLAVIC $3,283.00 C1713

PLATE PROX MEDIAL TIBIA $2,707.00 C1713

SCREW CORTEX 3.5 X 14 $87.00 C1713

SCREW CORTEX 3.5 X 38 $87.00 C1713

SCREW CORTEX 3.5 X 80 $87.00 C1713

SCREW LOCKING 3.5 X 20 $447.00 C1713

SCREW CORTEX 3.5 X 36 $87.00 C1713

Page 319: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW LOCKING 4.0 X 16 $447.00 C1713

SCREW NON-LOCKING 2.7 X 16 $265.00 C1713

SCREW NON-LOCKING 2.7 X 14 $265.00 C1713

SCREW LOCKING 2.7 X 12 $433.00 C1713

SCREW LOCKING 2.7 X 16 $433.00 C1713

SCREW LOCKING 2.7 X 14 $433.00 C1713

PLATE LATERAL FIBULA 5 HOLE $2,174.00 C1713

SCREW CANNULATED 4.0 X 42 $500.00 C1713

GUIDE WIRE .062 X 6 $56.00 C1769

DRILL BIT 2.0 $482.00

DRILL BIT 2.8 $482.00

DRILL BIT 2.7 $482.00

GUIDE WIRE $482.00 C1769

WAND ELECTRO COBLATOR $564.00

TENO 7MM W/FORK EYELET $1,008.00 C1713

PLATE OLECRANON 7 HOLE $2,904.00 C1713

SCREW LOCKING 2.7 X 18 $433.00 C1713

SCREW NON-LOCKING 3.5 X 26 $265.00 C1713

COMPONENT KNEE LEGION LT $9,069.00 C1776

BASEPLATE KNEE NON-POROUS LT $4,544.00 C1776

INSERT KNEE DISHED ARTICU 18MM $3,572.00 C1776

RETRACTOR TRAXI PANNICULUS $207.00

EXTENDER RETRACTOR TRAXI PANNI $149.00

BLADE ELECTRODE COATED ENT $149.00

PLATE MINI FRAG 2.3 MM T-PLATE $1,008.00 C1713

SCREW BONE 2.3 X 20 MM $238.00 C1713

PLATE FIBULA STRAIGHT 14 HOLE $1,297.00 C1713

PLATE TIBIA MEDIAL DIST 8 HOLE $2,889.00 C1713

TRACH CUFFLESS DISTAL 6.0 $196.00

TRACH CUFFLESS PROXIMAL 6.0 $196.00

PLATE NARROW T-PLATE 6 HOLE $747.00 C1713

SCREW LOCKING 2.3 X 18 $275.00 C1713

COMP SHLD SYSTEM MODULAR HEAD $3,310.00 C1776

SCREW LAG STANDARD 120 MM $717.00 C1713

KWIRE 1.4 X 150 MM $447.00 C1713

PLATE 7 HOLE NARROW T-PLATE $1,008.00 C1713

SUTURE MAXON ABSORABLE GS-26 $101.00

MESH PVPM VENTRAL PATCH $1,295.00 C1781

PLATE HOOK $1,488.00 C1713

SCREW NON-LOCKING 2.7 X 10 $275.00 C1713

SCREW NON-LOCKING 2.7 X 12 $275.00 C1713

SCREW NON-LOCKING 2.7 X 24 $275.00 C1713

SCREW NON-LOCKING 2.7 X 34 $275.00 C1713

SCREW BONE 3.5 X 28 MM $238.00 C1713

SCREW BONE 3.5 X 70 MM $238.00 C1713

PLATE CLAVICLE LT SUPER LATERA $3,013.00 C1713

GRAFT 8 MM OATS $1,201.00

STENT GRAFT AAA BIFURATED $22,680.00 C1874

GRAFT AMNIOEXCEL 5 X 5 CM $2,519.00 Q4137

MESH BIO-A 20 X 30 $9,828.00 C1781

Page 320: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

HEAD FEM V40 26MM X 4MM $1,542.00 C1713

SCREW LOCKING 3.5 X 70 $478.00 C1713

PLATE PROX LAT TIBIA 4 HOLE $3,378.00 C1713

PLATE PROX MED TIBIA 6 HOLE $3,378.00 C1713

SCREW CORTICAL 3.5 X 26 MM $87.00 C1713

SCREW CORTICAL 3.5 X 32 MM $87.00 C1713

SCREW CORTICAL 3.5 X 44 MM $87.00 C1713

SCREW LOCKING 4.0 X 14 MM $447.00 C1713

SCREW LOCKING 4.0 X 24 MM $447.00 C1713

SCREW LOCKING 4.0 X 32 MM $447.00 C1713

SCREW LOCKING 4.0 X 65 MM $447.00 C1713

SCREW LOCKING 4.0 X 80 MM $447.00 C1713

SCREW LOCKING 4.0 X 18 MM $447.00 C1713

PLATE STANDARD BARREL HIP $1,303.00 C1713

BLADED ACCESS SYSTEM, 11X100 $106.00

BLADED ACCESS SYSTEM, 5 X 100 $106.00

SUCTION COAGULATOR FTSW 12 FR $40.00

PLATE PROX MED TIBIA 6 HOLE $3,276.00 C1713

GRAFT FEMORAL HEMI COND LAT RT $21,735.00 C1768

SCREW LOCKING 2.3 X 8 MM $275.00 C1713

PLATE NARROW COMPRESSION 4 H $710.00 C1713

BOOT TCC-EZ REGULAR $207.00

PLATE 140 DEGREE 2 HOLE $1,306.00 C1713

CATH TROCAR 8 FR $40.00

SCREW LOCKING 2.7 X 8 MM $458.00 C1713

SCREW LOCKING 2.7 X 38 MM $476.00 C1713

CATH ABLATION BI-D 4H D-F CURV $3,610.00 C1733

CATH ABLATION ELC BI-D DF CURV $1,885.00 C1730

HIP BARREL STNDRD KYD 130 3 H $1,306.00 C1766

SCREW BONE 2.7 X 24 MM $247.00 C1713

HUMERAL LINER 320-38-00 $2,300.00 C1776

NERVE PROTECTOR 10 X 40 $4,300.00 C1763

PLATE SYNDESMO BUT T-RP $2,360.00 C1713

K-WIRE 1.2 X 100 MM $519.00 C1769

SCREW CANN MIC ASNIS 3.0 X 26 $538.00 C1713

PLATE 3D 2 X 2 2 HOLE $784.00 C1713

PLATE MTP CP RIGHT $2,849.00 C1713

SMART TOE 15MM/0 ANGLE $1,897.00 C1713

KIT CANNULA PONTO MIPS 4MM $1,305.00

KIT CANNULA PONTO BACK UP 3MM $698.00

PROCESSOR PONTO RT BLK $7,802.00 L8690

IMPLANT PONTO BHX 3MM $7,416.00 L8690

ICD CRT-D VIVA QUAD XT $44,393.00 C1882

PLATE PROX LAT TIBIA 2 HOLE $3,378.00 C1713

SCREW CANCELLOU FT 4.0 X 70 MM $123.00 C1713

SCREW CORTEX 3.5 X 20 MM $87.00 C1713

SCREW LOCKING 4.0 X 75 MM $447.00 C1713

SCREW CANNULATED 3.0 X 30MM $538.00 C1713

WAND TURBINATOR COBLATOR $610.00

BLADE HELICAL TFNA 85 MM $2,091.00

Page 321: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NAIL TICAN TFNA 11 X 380 X 130 $5,621.00 C1713

SCREW LOCKING 2.3 X 13 MM $275.00 C1713

PEGS SMOOTH LOCKING 2.3 X 14 $329.00 C1713

SCREW NON-TOGGLING TH 2.3 X 14 $329.00 C1713

SCREW NON-TOGGLING TH 2.3 X 20 $329.00 C1713

DECELLULARIZED DERMIS 40 X 70 $4,794.00 Q4122

STENT URETREAL FIRM 7 X 30 $184.00 C2617

MESH PHYSIOMESH 10 x 10CM $1,065.00 C1781

MESH PHYSIOMESH 12 x 15CM $1,540.00 C1781

MESH PHYSIOMESH 15 x 20CM $2,756.00 C1781

MESH PHYSIOMESH 15 x 25CM $4,321.00 C1781

BIO-A TISSUE REINFORCE 7 X 10 $1,435.00 C1781

BALLOON RAIL CUTTING 3.5 X 142 $1,848.00 C1725

BALLOON EUPHORA NC 3.5 X 15 $381.00 C1726

BALLOON EUPHORA NC 3.75 X 12 $381.00 C1726

BALLOON EUPHORA NC 3 X 15 $381.00 C1726

BALLOON EUPHORA RX 3.5 X 20 $428.00 C1726

CATH EP P-TYPE CRV 6FR X 60CM $916.00 C1730

GUIDEWIRE VASC. 0.035 X 260 $549.00 C1769

SHOULDER REV COMPR 6.5 X 40 $305.00 C1766

KIT NEEDLE CURVED KYPHO $2,079.00

INSERT TIBIA SZ 2 THK 2 X 17MM $4,336.00 C1713

K-WIRE 1.0 $26.00 C1769

SCREW LOCKING 2.7 X 28 $458.00 C1713

SCREW LOCKING 2.7 X 40 $478.00 C1713

SCREW LOCKING 2.7 X 46 $478.00 C1713

SCREW LOCKING 2.7 X 50 $478.00 C1713

MESH 8.0 X 13.7 $482.00 C1781

PLATE COMPRESSION 12 HOLE $458.00 C1713

VASCULAR GRAFT 8 MM X 60 $3,190.00 C1768

VASCULAR GRAFT 6 MM X 80 $4,790.00 C1768

PLATE OLECRANON 8 HOLE $2,642.00 C1713

PLATE OLECRANON 8 HOLE $2,642.00 C1713

SLITTER 6230UNI UNIVERSAL 6230 $135.00

PACEMAKER ICD CONCERTO C154DWK $38,316.00 C1882

SCREW BONE 3.5 X 32 MM $238.00 C1713

SCREW BONE 3.5 X 36 MM $238.00 C1713

SCREW LOCKING 3.5 X 32 MM $478.00 C1713

PLATE 2.3 MM 4X2 3D $1,008.00 C1713

PLATE LISFRANC LEFT SMALL $2,714.00 C1713

SCREW LOCKING 3.5 X 10 MM $522.00 C1713

SCREW LOCKING 4.0 X 38 $447.00 C1713

SCREW LOCKING 4.0 X 42 $447.00 C1713

SCREW LOCKING 4.0 X 46 $447.00 C1713

DRILL BIT 3.1 $284.00

PLATE CLAVICLE SUPER MIDSHAFT $3,013.00 C1713

OX PART KNEE SYSTEM $3,110.00 C1776

PLATE LT ANTERIOR LATER 4 HOLE $3,477.00 C1713

CLOSESURE PRO KIT W/SUT PASSER $329.00

PLATE CLAVICLE SUPER MIDSHAFT $3,013.00 C1713

Page 322: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CANNULATED PT 4.0 X 34 $474.00 C1713

SCREW CANNULATED FT 4.0 X 28 $474.00 C1713

SCREW CANNULATED FT 4.0 X 30 $474.00 C1713

SCREW CANNULATED FT 4.0 X 38 $474.00 C1713

SCREW CANNULATED FT 4.0 X 40 $474.00 C1713

VASCULAR GRAFT 8 MM X 40 $2,710.00 C1768

VASCULAR GRAFT 6 MM X 40 $2,710.00 C1768

VASCULAR GRAFT 6 MM X 60 $3,190.00 C1768

CATH EMBOLECTOMY LEMAITRE 38 $186.00 C1757

CATH EMBOLECTOMY LEMAITRE 48 $186.00 C1757

FILSHIE CLIP $312.00 A4264

SCREW CANNULATED 5.0 X 38 MM $520.00 C1713

KIT AC ACUTE REPAIR $2,560.00 C1713

SCREW CANNULATED 5.0 X 50 MM $520.00 C1713

SCREW ASNIS CANNULAT 6.5 X 60 $604.00 C1713

SCREW ASNIS CANNULAT 6.5 X 75 $604.00 C1713

SHEATH 6 FR 25 CM $71.00

SHEATH 7 FR 25 CM $71.00

SHEATH 9 FR 25 CM $71.00

GLIDEWIRE ADV .035 X 180 CM $549.00 C1769

GLIDEWIRE ADV. .014 X 300 CM $549.00 C1769

GUIDEWIRE,C-TIP .035 X 260 CM $303.00 C1769

CATH ANGIOJET SOLENT DISTA $4,960.00 C1757

GUIDEWIRE, LUNDERQUIST 260 CM $1,245.00 C1769

GUIDEWIRE, ROADRUNNER .035X180 $168.00 C1769

GUIDEWIRE, ROADRUNNER .035X260 $168.00 C1769

CATH-INFUSION 5 X 100 X 30 $483.00 C1752

CATH-INFUSION 5 X 135 X 20 $317.00 C1752

VASCULAR CLOSURE MYNX $534.00 C1760

CATHETER, MOD HOOK 4FR 65 CM $92.00

CATHETER, MOD HOOK 4 F 100 CM $92.00

STENT, I-CAST 8 X 38 X 120 CM $5,460.00 C1874

STENT, I-CAST 8 X 59 X 120 CM $5,860.00 C1874

STENT, I-CAST 9 X 38 X 120 CM $5,460.00 C1874

STENT, I-CAST 9 X 59 X 120 CM $5,860.00 C1874

STENT, I-CAST 10 X 38 X 120 CM $5,460.00 C1874

VEIN SAPHENOUS 61 - 71 CML $13,966.00 C1768

GRAFT MENISCUS LEFT MEDIAL $9,810.00 C1762

GRAFT VASC HEM EPTFE 6 X 80 $1,844.00 C1768

PLATE DISTAL FEMUR RT 10 HOLE $4,059.00 C1713

SCREW CORTEX 4.5 X 32 $100.00 C1713

SCREW CORTEX 4.5 X 80 $100.00 C1713

SCREW LOCKING 5.0 X 24 $474.00 C1713

SCREW LOCKING 5.0 X 32 $474.00 C1713

SCREW LOCKING 5.0 X 38 $474.00 C1713

SCREW LOCKING 5.0 X 40 $474.00 C1713

SCREW LOCKING 5.0 X 80 $474.00 C1713

SCREW LOCKING 5.0 X 85 $474.00 C1713

SCREW LOCKING 5.0 X 36 $474.00 C1713

PATCH VASCULAR XENOSURE 0.8X8 $534.00 C1768

Page 323: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PATCH VASCULAR XENOSURE 2X9 $697.00 C1768

TROCAR BLADE SHLD 5 X 150 $69.00

MESH PHASIX $5,670.00 C1781

MESH VENTRALIGHT ST. $2,590.00 C1781

PLATE RT AXSOS PROX LAT HUMERU $3,146.00 C1713

ALLOGRAFT FREST FEMORAL TROCH $22,448.00 C1762

TIBIAL TRAY LT MED OXFOR SZ AA $3,110.00 C1713

TROCAR BLD SHLD 12 X 100 $106.00

TROCAR BLD SHLD 12 X 150 $106.00

TROCAR BLD SHLD 11 X 150 $106.00

CATH CHOLANGIOGRAPHY C1002 $174.00

PCK ASSURITY PM1240 $10,923.00 C1786

PLATE FIBULA POSTEROLATERAL 4H $2,174.00 C1713

PLATE HOOK 7007-0602 $1,411.00 C1713

PLATE HOOK LOCKING PEG $1,488.00 C1713

PEG LOCKING 2.3 X 36 MM $329.00 C1713

SCREW LOCKING 2.7 X 24 $458.00 C1713

SCREW LOCKING 2.7 X 34 $458.00 C1713

SCREW NON-LOCKING 2.7 X 22 $275.00 C1713

SCREW NON-LOCKING 2.7 X 26 $275.00 C1713

SCREW NON-LOCKING 3.5 X 24 $275.00 C1713

DRILL BIT 3.5 $497.00

STEM HUMERAL PRIMARY PRESS-FIT $4,585.00 C1713

PLATE DISTAL LATERAL FEMUR $4,059.00 C1713

SCREW CORTICAL 4.5 X 32 $100.00 C1713

SCREW CORTICAL 4.5 X 36 $100.00 C1713

SCREW CORTICAL 4.5 X 50 $100.00 C1713

SCREW CORTICAL 4.5 X 65 $100.00 C1713

SCREW LOCKING 5.0 X 30 $474.00 C1713

SCREW LOCKING 5.0 X 55 $474.00 C1713

SCREW LOCKING 5.0 X 60 $474.00 C1713

DRILL BIT 3.0 $939.00

DRILL BIT 4.3 $1,051.00

PLATE COMPRESSION 4 HOLE $320.00 C1713

NAIL ANKLE RIGHT 1819-1015S $4,269.00 C1713

SCREW LOCKING 5 X 45 MM $538.00 C1713

PLATE SUPERIOR LATERAL 5 HOLE $3,013.00 C1713

MESH HERNIA BIOABSORB 9 X 15 $2,095.00 C1781

MESH HERNIA BIOABSORB 20 X 20 $6,638.00

SCREW NON-LOCK 4.75 X 20X 3.5 $305.00 C1713

SCREW NON-LOCK 4.75 X 20X 15 H $305.00 C1713

SCREW CANNULATED 3.0 X 20 $538.00 C1713

SCREW CANNULATED 3.0 X 28 $538.00 C1713

TOE SMART 15MM/O ANGLE $1,897.00 C1713

PLATE STRAIGHT 16 HOLE $1,008.00 C1713

BALLOON DILATION 6FR $578.00 C1727

PLATE 2 X 2 2 HOLE 3D $1,008.00 C1713

PLATE 3 X 2 3 D $1,008.00 C1713

SUTURE PROLENE 8805H $38.00

SUTURE PROLENE 8557H $28.00

Page 324: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STEM RHEAD LATERAL SZ 4 $4,808.00 C1713

SCREW BONE 1.2 MM x 4 $238.00 C1713

SCREW BONE 1.2 MM x 5 $238.00 C1713

SCREW BONE 1.7 MM x 5 $238.00 C1713

SCREW BONE 2.3 MM x 13 $238.00 C1713

PLATE DISTAL LATERAL 14 HOLE $4,059.00 C1713

SCREW CORTICAL 4.5 X 28 $100.00 C1713

SCREW CORTICAL 4.5 X 30 $100.00 C1713

SCREW CORTICAL 4.5 X 40 $100.00 C1713

SCREW CORTICAL 4.5 X 75 $100.00 C1713

SCREW LOCKING 5.0 X 34 $474.00 C1713

SCREW LOCKING 5.0 X 50 $474.00 C1713

SCREW LOCKING 5.0 X 75 $474.00 C1713

NEEDLE NEURO TRACE INSULATE $51.00

PLATE 3D 1.7 X 4 X 2 $784.00 C1713

SCREW NON LOCKING 1.7 X 7 $238.00 C1713

SCREW NON LOCKING 1.7 X 8 $238.00 C1713

SCREW NON LOCKING 1.7 X 10 $238.00 C1713

SCREW NON LOCKING 1.7 X 13 $238.00 C1713

MODULAR HIP SYSTEM 6276-7-017 $5,664.00 C1776

MODULAR HIP SYSTEM 6276-1-021 $7,782.00 C1776

FEMORAL HEAD 6260-9-426 $1,542.00 C1776

STABILIZER TIBIAL TRAY TOTAL $4,892.00 C1776

TIBIAL AUGMENT HALF BLOCK $2,242.00 C1776

GUIDEWIRE VASC 014 3X300 $305.00 C1769

GUIDEWIRE VASC 014 3X190 $305.00 C1769

GUIDEWIRE VASC 014 11X300 $412.00 C1769

GUIDEWIRE VASC 014 2X300 $305.00 C1769

STENT PERIPH SUP 6F 4.5X40 $3,010.00 C1876

STENT PERIPH SUP 6F 4.5X60 $3,010.00 C1876

STENT PERIPH SUP 6F 4.5X80 $3,010.00 C1876

STENT PERIPH SUP 6F 4.5X100 $3,010.00 C1876

STENT PERIPH SUP 6F 4.5X120 $3,010.00 C1876

STENT PERIPH SUP 6F 5.5X40 $3,010.00 C1876

STENT PERIPH SUP 6F 5.5X60 $3,010.00 C1876

STENT PERIPH SUP 6F 5.5X80 $3,010.00 C1876

STENT PERIPH SUP 6F 6.5X40 $3,010.00 C1876

STENT PERIPH SUP 6F 6.5X80 $3,010.00 C1876

STENT PERIPH SUP 6F 6.5X100 $3,010.00 C1876

STENT PERIPH SUP 6F 6.5X120 $3,210.00 C1786

STENT PERIPH SUP 6F 6.5X150 $3,210.00 C1786

CATH ANGIOGRAPH SFT 5F 130CM $567.00 C1725

CATH ANGIOGRAPH BRD 5F 130CM $372.00 C1725

CATH DIALYSIS PWR TRPL LUM 13F $610.00 C1750

STENT LIFESTENT 7X60X130 $2,810.00 C1876

BALLOON DRUG LUTONIX 4X120X130 $3,110.00 C2623

BALLOON DRUG LUTONIX 4X150X130 $3,110.00 C2623

BALLOON ULTRVRS 035 5X20X75 $351.00 C1725

BALLOON ULTRVRS 035 5X40X75 $351.00 C1725

BALLOON ULTRVRS 035 6X60X75 $351.00 C1725

Page 325: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BALLOON ULTRVRS 014 2X15X150 $585.00 C1725

BALLOON ULTRVRS 014 2X4X150 $585.00 C1725

BALLOON ULTRVRS 014 2.5X22X150 $585.00 C1725

BALLOON ULTRVRS 014 2.5X4X150 $585.00 C1725

BALLOON ULTRVRS 014 3X15X150 $585.00 C1725

BALLOON ULTRVRS 014 3X22X150 $585.00 C1725

BALLOON ULTRVRS 014 3X4X150 $585.00 C1725

BALLOON ULTRVRS 014 3X8X150 $585.00 C1725

BALLOON ULTRVRS 014 4X4X150 $585.00 C1725

BALLOON ULTRVRS 014 4X8X150 $585.00 C1725

CATH SUPPORT RUBICON 018 150CM $509.00

CATH SUPPORT RUBICON 018 135CM $509.00

CATH EXTEN GUIDEZILLA 6F 1.45 $934.00 C1769

GUIDEWIRE VASC 014 2X185 $253.00 C1769

GUIDEWIRE VASC 014 185CM $261.00 C1769

GUIDEWIRE VASC KINETIX 014 185 $295.00 C1769

BALLOON CUT FLEXTOME 2X15 $1,848.00 C1725

BALLOON CUT FLEXTOME 3.75X10 $1,848.00 C1725

COIL EMBOLIZ CONICAL 3-7X67 $235.00 C1770

GUIDEWIRE VASC AMPLA 035 7X260 $161.00 C1769

PARTICLE EMBOLIZ MCRSPH 45-150 $480.00 C1884

STABILIZER FEMORAL RT TOTAL $9,831.00 C1776

SUTURE PROLENE BL 3-0 30" CRCL $28.00

SUTURE PROLENE BL 3-0 PS-2 $28.00

SUTURE VICRYL 3-0 27" TPR PNT $28.00

SUTURE VICRYL 5-0 18" PS-2 $28.00

SUTURE VICRYL 5-0 18" PS-2 $28.00

DILATOR VESSEL 038 7F 20CM $27.00

DILATOR VESSEL 038 12F 20CM $27.00

DILATOR VESSEL 038 14F 20CM $27.00

DILATOR VESSEL 038 16F 20CM $27.00

DILATOR VESSEL 038 18F 20CM $27.00

DILATOR VESSEL 038 20F 20CM $50.00

DILATOR VESSEL 038 22F 20CM $50.00

DILATOR VESSEL 038 24F 20CM $50.00

SET CATH DRAIN THAL-QUICK 20F $349.00 C1729

SET CATH DRAIN THAL-QUICK 24F $349.00 C1729

SET INTRODUCER SHEATH 40CM $160.00 C1766

FILTER WIRE SPIDER 5X320 $3,510.00 C1884

FILTER WIRE SPIDER 6X320 $3,510.00 C1884

FILTER WIRE SPIDER 7X320 $3,510.00 C1884

CATH THERMO SWAN-GANZ 7F 110CM $148.00

STATLOCK AORTIC BLN CATH $72.00

BALLOON DIL EUPHORA RX 2x6 $381.00 C1725

BALLOON DIL EUPHORA RX 2X10 $381.00 C1725

BALLOON DIL EUPHORA RX 2.25x10 $381.00 C1725

BALLOON DIL EUPHORA RX 2.25x20 $381.00 C1725

BALLOON DIL EUPHORA RX 2.25x25 $381.00 C1725

BALLOON DIL EUPHORA RX 2.75X10 $381.00 C1725

BALLOON DIL EUPHORA RX 2.75X20 $381.00 C1725

Page 326: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BALLOON DIL EUPHORA RX 3X15 $381.00 C1725

BALLOON DIL EUPHORA RX 3.25X6 $381.00 C1725

BALLOON DIL EUPHORA RX 3.25X10 $381.00 C1725

BALLOON DIL EUPHORA RX 3.25X12 $381.00 C1725

BALLOON DIL EUPHORA RX 3.25X15 $381.00 C1725

BALLOON DIL EUPHORA RX 3.25X25 $381.00 C1725

BALLOON DIL EUPHORA RX 3.25X25 $381.00 C1725

BALLOON DIL EUPHORA RX 3.5X20 $381.00 C1725

BALLOON DIL EUPHORA RX 3.5X10 $381.00 C1725

BALLOON DIL EUPHORA RX 3.5X12 $381.00 C1725

BALLOON DIL EUPHORA RX 3.5X25 $381.00 C1725

BALLOON DIL EUPHORA RX 3.75X6 $381.00 C1725

BALLOON DIL EUPHORA RX 3.75X10 $381.00 C1725

BALLOON DIL EUPHORA RX 3.75x12 $381.00 C1725

BALLOON DIL EUPHORA RX 3.75X15 $381.00 C1725

BALLOON DIL EUPHORA RX 3.75X20 $381.00 C1725

BALLOON DIL EUPHORA RX 3.75X25 $381.00 C1725

BALLOON DIL EUPHORA RX 4X20 $381.00 C1725

BALLOON DIL EUPHORA RX 4X25 $381.00 C1725

STENT CORO BMS INT RX 2.25X22 $1,271.00 C1876

STENT CORO BMS INT OTW 2.25X22 $1,271.00 C1876

STENT CORO BMS INT RX 2.25X26 $1,271.00 C1876

STENT CORO BMS INT RX 2.5X22 $1,271.00 C1876

STENT CORO BMS INT OTW 2.5X26 $1,271.00 C1876

STENT CORO BMS INT RX 2.75X22 $1,271.00 C1876

STENT CORO BMS INT RX 3.0X22 $1,271.00 C1876

STENT CORO BMS INT RX 4.0X22 $1,271.00 C1876

CATH GUIDE CORO IMA 6F 100CM $164.00 C1769

CATH GUIDE CORO IMA 6F 90CM $164.00 C1769

CATH GUIDE CORO JL3.0 6F 100CM $164.00 C1769

CATH GUIDE CORO JR3.0 6F 100CM $164.00 C1769

CATH GUIDE COR SCR4.0 6F 100CM $164.00 C1769

GUIDEWIRE VASC NITREX 14X260 $219.00 C1769

BALLOON DIL EUPHORA NC 2X8 $381.00 C1725

BALLOON DIL EUPHORA NC 2X12 $381.00 C1725

BALLOON DIL EUPHORA NC 2X15 $381.00 C1725

BALLOON DIL EUPHORA NC 2X20 $381.00 C1725

BALLOON DIL EUPHORA NC 2.25X12 $381.00 C1725

BALLOON DIL EUPHORA NC 2.25X15 $381.00 C1725

BALLOON DIL EUPHORA NC 2.25X20 $381.00 C1725

BALLOON DIL EUPHORA NC 2.5X6 $381.00 C1725

BALLOON DIL EUPHORA NC 2.5X20 $381.00 C1725

BALLOON DIL EUPHORA NC 2.75X6 $381.00 C1725

BALLOON DIL EUPHORA NC 2.75X15 $381.00 C1725

BALLOON DIL EUPHORA NC 2.75X20 $381.00 C1725

BALLOON DIL EUPHORA NC 2.75X27 $381.00 C1725

BALLOON DIL EUPHORA NC 3X6 $381.00 C1725

BALLOON DIL EUPHORA NC 3X8 $381.00 C1725

BALLOON DIL EUPHORA NC 3X20 $381.00 C1725

BALLOON DIL EUPHORA NC 3.25X12 $381.00 C1725

Page 327: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BALLOON DIL EUPHORA NC 3.5X6 $381.00 C1725

BALLOON DIL EUPHORA NC 3.5X20 $381.00 C1725

BALLOON DIL EUPHORA NC 3.75X8 $381.00 C1725

BLOCK FEMORAL DISTAL AUMENTAT $2,080.00 C1776

BALLOON DIL EUPHORA NC 4X6 $381.00 C1725

BALLOON DIL EUPHORA NC 4.5X15 $381.00 C1725

BALLOON DIL EUPHORA NC 5X15 $381.00 C1725

CATH ANGIO SPRINTER 1.25X6MM $427.00 C1725

CATH ANGIO SPRINTER 3X15MM $427.00 C1725

CATH GUIDE CORO 5F 058 100CM $164.00 C1769

CATH GUIDE CORO 5F 058 100CM $164.00 C1769

CATH ANGIOGRAPHIC BRD 4F 100CM $48.00 C1885

GUIDEWIRE VASC HYDRO 035 150CM $115.00 C1769

GUIDEWIRE VASC FXD-CR 035 260C $146.00 C1769

GUIDEWIRE VASC FX-CR 035 150CM $34.00 C1769

CATH INFUS 5FR 50X135CM $275.00 C1752

GUIDEWIRE VASC LRT 035 150CM $96.00 C1769

GUIDEWIRE VASC LRT 035 260CM $107.00 C1769

GUIDEWIRE VASC LRT 035 150CM $96.00 C1769

GUIDEWIRE VASC LRT 035 260CM $107.00 C1769

VALVE ANGIO HEMOSTAT 7.2FR $77.00

SHEATH PRELUDE 035 6F 11CM $69.00 C1894

SHEATH PRELUDE 035 6F 23CM $111.00 C1894

SHEATH PRELUDE 038 6F 4CM $63.00

PARTICLE EMBOLIZ MCRSP 100-300 $154.00 C1884

SYRING EMBOLIZ MCRSP 300-500MI $615.00

CATH PACING 5FR 1X110CM $345.00 C1756

INTRODUCER SHEATH 035 10F 12CM $34.00 C1766

INTRODUCER STRBLE 8.5F 71CM $2,195.00 C1766

PLUG VASC EMBOLIZ 4X10 $2,195.00

PLUG VASC EMBOLIZ 6X11 $2,195.00

PLUG VASC EMBOLIZ 8X13.5 $2,195.00

GUIDEWIRE PERIPH ADV 018 1X300 $784.00 C1769

CATH SUPPORT NAVICROS 4F 150CM $568.00

CATH SUPPORT NAVICROS 4F 90CM $568.00

SHEATH GUIDE PINNACLE 6F 65CM $470.00

SHEATH GUIDE PINNACLE 7F 65CM $470.00

STENT VIABAHN 7F 6X10X120 $6,500.00 C1876

STENT VIABAHN 9F 9X5X120 $6,500.00 C1876

STEM COBALT CHROME $1,737.00 C1776

ADAPTOR TOTAL STABILIZ OFFSET $2,015.00 C1776

STABILIZER TIBIAL INSERT TOTAL $3,051.00 C1776

STENT CAROTID PRECISE 7 X 30 $3,190.00 C1876

ANGIOGUARD 6MM-GUIDEWIRE $2,670.00 C1769

AVIATOR PTA 6 X 20 $560.00 C1725

GUIDEWIRE VASC 014 3 X 180 $129.00 C1769

DRILL HAND 10G 7.75 $185.00

CANNULA ACCESS IVS 10 G $169.00

KIT BIOPSY BONE IVS 10 G $244.00

CURRETTE IVAS 10G $1,156.00

Page 328: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

NEEDLE CURVED 10G $1,128.00

KIT KYPHO IVAS 11G 15MM $2,598.00

DRILL HAND 11 G 7.75 $185.00

CANNULA CEMENT VERTEPORT 11G $154.00

CANNULA ACCESS IVAS 11 G $169.00

KIT BIOPSY BONE IVAS 11 G $244.00

CURETTE KYPHO 11 G $1,156.00

STEM PRIM STD LEN SHLD 6 X 122 $8,222.00 C1776

STEM PRIM STD LEN SHLD 7 X 122 $8,222.00 C1776

NAIL LONG KIT 13 X 420 MM $4,529.00 C1713

LOCKING CLIP STERILE FOR RIA $227.00

GRAFT FILTER FOR RIA STERILE $836.00

U-BLADE SET 3065-0110S $1,702.00

TIGHTROPE CMC MINI 1.1 MM $2,067.00 C1713

PLATE 3 TI PROX LAT TIBIA 2H $2,067.00 C1713

SCREW CORTEX 3.5 X 24 MM $87.00 C1713

SCREW LOCKING 4.0 X 55 MM $447.00 C1713

SCREW CANNCE FT 6.0 X 70 MM $147.00 C1713

SCREW CANNCE FT 6.0 X 75 MM $147.00 C1713

SCREW CANNCE FT 6.0 X 80 MM $147.00 C1713

SCREW CANNCE PT 6.0 X 55 MM 16 $147.00 C1713

SCREW CANNCE PT 6.0 X 60 MM 16 $147.00 C1713

SCREW CANNCE PT 6.0 X 65 MM 16 $147.00 C1713

SCREW CANNCE PT 6.0 X 80 MM 16 $147.00 C1713

SCREW CANNCE PT 6.0 X 88 MM 32 $147.00 C1713

DRILL BIT 3.1 X 238 $513.00

MESH BILAYER WND 2 X 2 $5,692.00 Q4104

MESH 3D MAX LIGHT $538.00 C1781

MESH 3D MAX LIGHT LEFT LARGE $538.00 C1781

SHEATH GUIDING 7 FR 45 CM $250.00

CATH GUIDING 5 FR 100 CM $155.00 C1887

MESH VENTALIGHT 4 X 6 $909.00 C1781

MESH VENTRALIGHT 7 X 9 $2,310.00 C1781

PLATE VAR CLAV HOOK 7H 16MM LT $2,470.00 C1713

MESH PVPS VENTRAL SMALL $1,379.00 C1781

PLATE STRAIGHT 10 HOLE 1.3 MM $1,215.00 C1713

DRILL QR SURGIBIT 2.0 X 3.5 $400.00

SCREW MULTI HEXALOBE 2.3 X 12 $329.00 C1713

SCREW MULTI HEXALOBE 2.3 X 13 $329.00 C1713

SCREW MULTI HEXALOBE 2.3 X 14 $329.00 C1713

SCREW MULTI HEXALOBE 2.3 X 16 $329.00 C1713

NEEDLE FAST-FIX ST DEL SYS 360 $1,182.00

“SUTURE VCRL 3-0 27" V-20 $28.00

ICD VR EVERA S DVBC3D1 SG CHAM $22,710.00 C1722

PLATE RT SUPER MIDSHAFT 6 H $3,283.00 C1713

DRILL BIT 2.6 $401.00

PLATE AXSOS 16 HOLE 437536 $3,365.00 C1713

SYS PACEMAKER ADAPTA SNGL CHMB $6,940.00 C1786

SCREW BONE 1.7 X 11 MM $238.00 C1713

BALLOON CR APE FX OTW 1.50 X 8 $366.00 C1725

Page 329: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BALLOON CR APE FX OTW 2.00 X 8 $366.00 C1725

BALLOON CR APE FX OTW 2.25 X 8 $366.00 C1725

BALLOON CR APE FX OTW 2.50 X 8 $366.00 C1725

BALLOON CR APE FX OTW 2.75 X 8 $366.00 C1725

BALLOON CR APE FX OTW 3.00 X 8 $366.00 C1725

BALLOON CR FX OTW 3.50 X 8 $366.00 C1725

BALLOON CR APE FX OTW 4.00 X 8 $366.00 C1725

BALLOON CR FX OTW 1.50 X 12 $366.00 C1725

BALLOON CR FX OTW 2.00 X 12 $366.00 C1725

BALLOON CR FX OTW 2.25 X 12 $366.00 C1725

BALLOON CR FX OTW 2.50 X 12 $366.00 C1725

BALLOON CR FX OTW 2.75 X 12 $366.00 C1725

BALLOON CR FX OTW 3.00 X 12 $366.00 C1725

BALLOON CR FX OTW 3.50 X 12 $366.00 C1725

BALLOON CR FX OTW 4.00 X 12 $366.00 C1725

BALLOON CR FX OTW 1.50 X 15 $366.00 C1725

BALLOON CR FX OTW 2.00 X 15 $366.00 C1725

BALLOON CR FX OTW 2.25 X 15 $366.00 C1725

BALLOON CR FX OTW 2.50 X 15 $366.00 C1725

BALLOON CR FX OTW 2.75 X 15 $366.00 C1725

BALLOON CR FX OTW 3.00 X 15 $366.00 C1725

BALLOON CR FX OTW 3.50 X 15 $366.00 C1725

BALLOON CR FX OTW 4.00 X 15 $366.00 C1725

BALLOON CR APEX FX RX 1.50 X 8 $366.00 C1725

BALLOON CR APEX FX RX 2.00 X 8 $366.00 C1725

BALLOON CR APEX FX RX 2.50 X 8 $366.00 C1725

BALLOON CR APEX FX RX 2.75 X 8 $366.00 C1725

BALLOON CR APEX FX RX 3.00 X 8 $366.00 C1725

BALLOON CR APEX FX RX 3.50 X 8 $366.00 C1725

BALLOON CR APEX FX RX 4.00 X 8 $366.00 C1725

BALLOON CR APE FX RX 1.50 X 12 $366.00 C1725

BALLOON CR APE FX RX 2.00 X 12 $366.00 C1725

BALLOON CR APE FX RX 2.50 X 12 $366.00 C1725

BALLOON CR APE FX RX 2.75 X 12 $366.00 C1725

BALLOON CR APE FX RX 3.00 X 12 $366.00 C1725

BALLOON CR APE FX RX 3.50 X 12 $366.00 C1725

BALLOON CR APE FX RX 4.00 X 12 $366.00 C1725

BALLOON CR APE FX RX 4.50 X 12 $366.00 C1725

BALLOON CR APE FX RX 5.00 X 12 $366.00 C1725

BALLOON CR APE FX RX 1.50 X 15 $366.00 C1725

BALLOON CR APE FX RX 2.00 X 15 $366.00 C1725

BALLOON CR APE FX RX 2.50 X 15 $366.00 C1725

BALLOON CR APE FX RX 2.75 X 15 $366.00 C1725

BALLOON CR APE FX RX 3.00 X 15 $366.00 C1725

BALLOON CR APE FX RX 3.50 X 15 $366.00 C1725

BALLOON CR APE FX RX 4.00 X 15 $366.00 C1725

BALLOON CR APE FX RX 1.50 X 20 $366.00 C1725

BALLOON CR APE FX RX 2.00 X 20 $366.00 C1725

BALLOON CR APE FX RX 2.50 X 20 $366.00 C1725

BALLOON CR APE FX RX 2.75 X 20 $366.00 C1725

Page 330: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BALLOON CR APE FX RX 3.00 X 20 $366.00 C1725

BALLOON CR APE FX RX 3.50 X 20 $366.00 C1725

BALLOON CR APE FX RX 4.00 X 20 $366.00 C1725

BALLOON APE NC MONORL 2.00 X 6 $366.00 C1726

BALLOON APE NC MONORL 2.25 X 6 $366.00 C1726

BALLOON APE NC MONORL 2.50 X 6 $366.00 C1726

BALLOON APE NC MONORL 2.75 X 6 $366.00 C1726

BALLOON APE NC MONORL 3.00 X 6 $366.00 C1726

BALLOON APE NC MONORL 3.25 X 6 $366.00 C1725

BALLOON APE NC MONORL 3.50 X 6 $366.00 C1726

BALLOON APE NC MONORL 3.75 X 6 $366.00 C1726

BALLOON APE NC MONORL 4.00 X 6 $366.00 C1726

BALLOON APE NC MONORL 2.00 X 8 $366.00 C1726

BALLOON APE NC MONORL 2.25 X 8 $366.00 C1726

BALLOON APE NC MONORL 2.50 X 8 $366.00 C1726

BALLOON APE NC MONORL 2.75 X 8 $366.00 C1726

BALLOON APE NC MONORL 3.00 X 8 $366.00 C1726

BALLOON APE NC MONORL 3.25 X 8 $366.00 C1726

BALLOON APE NC MONORL 3.50 X 8 $366.00 C1726

BALLOON APE NC MONORL 3.75 X 8 $366.00 C1726

BALLOON APE NC MONORL 4.00 X 8 $366.00 C1726

BALLOON APEX NC MONO 2.00 X 12 $366.00 C1726

BALLOON APEX NC MONO 2.25 X 12 $366.00 C1726

BALLOON APEX NC MONO 2.50 X 12 $366.00 C1726

BALLOON APEX NC MONO 2.75 X 12 $366.00 C1726

BALLOON APEX NC MONO 3.00 X 12 $366.00 C1725

BALLOON APEX NC MONO 3.25 X 12 $366.00 C1725

BALLOON APEX NC MONO 3.50 X 12 $366.00 C1725

BALLOON APEX NC MONO 3.75 X 12 $366.00 C1725

BALLOON APEX NC MONO 4.00 X 12 $366.00 C1725

BALLOON APEX NC MONO 2.50 X 15 $366.00 C1726

BALLOON APEX NC MONO 2.75 X 15 $366.00 C1726

BALLOON APEX NC MONO 3.00 X 15 $366.00 C1725

BALLOON APEX NC MONO 3.25 X 15 $366.00 C1725

BALLOON APEX NC MONO 3.50 X 15 $366.00 C1725

BALLOON APEX NC MONO 3.75 X 15 $366.00 C1725

BALLOON APEX NC MONO 4.00 X 15 $366.00 C1725

MESH VENTRALIGHT ST 6" $1,328.00 C1781

MESH ABSORB PHASIX 7 X 10 $3,160.00 C1781

BALLOON BAKR UTRN 24 FR 500 ML $565.00

PLATE WRIST DORSAL LT $2,280.00 C1713

SCREW LOCK 2.3 X 24 $329.00 C1713

SCREW BIO-COMPRESSION 3. X 16 $1,130.00 C1713

CATH ATHERECTOMY PANTHERIS 8 F $6,300.00 C1714

CATH ATHERECTOMY PANTHERIS 7 F $6,300.00 C1714

SCREW CANCELLOUS 4.0 X 34 MM $123.00 C1713

SCREW LOCKING 4.0 X 28 MM $447.00 C1713

PLATE PRO MEDICAL TI 3 6HOLE $3,276.00 C1713

DRILL BIT 7.5 $595.00

PLATE UNIV VOLAR STD X LONG $1,663.00 C1713

Page 331: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW NON LOCKING 2.3 X 26 $357.00 C1713

PLATE COMP NARROW STRAIGHT 7 H $941.00 C1713

PLATE MEDIA DIST TIB LCP 8 H $3,503.00 C1713

SCREW LOCKING 2.7 X 34 $459.00 C1713

SCREW LOCK VRBL ANGLE 3.5 X 28 $486.00 C1713

SCREW LOCK VRBL ANGLE 3.5 X 34 $486.00 C1713

SCREW CORTEX LO PRO 3.5 X 30 $141.00 C1713

SCREW CORTEX LO PRO 3.5 X 38 $141.00 C1713

SCREW CORTEX LO PRO 3.5 X 24 $141.00 C1713

PLATE COMP STRAIGHT 4 HOLE LG $672.00 C1713

PLATE COMP STRAIGHT 4 HOLE M $672.00 C1713

SCREW CANNULATE ASNIS 2.0 X 28 $474.00 C1713

WASHER 2.7 MM $178.00 C1713

NAIL HUMERAL 1830-0721S $3,071.00 C1713

SCREW CANNULATED 2.0 X 20 $538.00 C1713

SCREW CANNULATED 2.0 X 16 $538.00 C1713

IMPLANT PONTO BHX 4 MM $7,416.00 L8690

SCREW BONE 2.7 X 12 $174.00 C1713

GLIDE CATH 4FR 150CM NONTA ANG $154.00 C1887

GLIDE CATH 4FR 100CM NONTA ANG $154.00 C1887

GLIDEWIRE ADVAN .035 X 260 CM $171.00 C1769

SHEATH SHUTTLE 5 FR 90 CM $305.00 C1894

SHEATH SHUTTLE 6 FR 90 CM $305.00 C1894

INSERT ADV II MEDIA PIVOT SZ 4 $4,336.00 C1776

PATELADV INLAT ALL-POLY SZ 35 $2,310.00 C1776

PLATE COMPRESS BROAD CURVED 9H $1,282.00 C1713

MESH 3D LIGHT MD 3 X 5 $482.00 C1781

MESH 3D LEFT LG 4 X 6 $525.00 C1781

MESH 3D RIGHT LG 4 X 6 $525.00 C1781

BAG ENDOSCOPIC RETR 12/15MM $305.00

PLATE LEFT 7 HOLE $2,287.00 C1713

CATH FOGARTY EMBOLC 12TLW403F $275.00 C1757

CATH FOGARTY EMBOLC 12TLW404F $275.00 C1757

CATH FOGARTY EMBOL 2TLW405F35 $275.00 C1757

SCREW NON LOCKING 2.7 X 16 $357.00 C1713

BALLOON PTA ULTRVS 035 7F 130 $351.00 C1725

BALLOON PTA ULTRVS 035 6F 130 $351.00 C1725

PLATE DIS LAT FEMUR 8 HOLE $4,005.00 C1713

SCREW CORTEX 4.5 X 44 $100.00 C1713

SCREW LOCKING 5.0 X 65 $474.00 C1713

SCREW LOCKING 5.0 X 70 $474.00 C1713

PLATE OLECRANON LEFT 3 HOLE $2,736.00 C1713

PLATE DIS LAT HUMERUS LT 10 H $2,610.00 C1713

SCREW NONLOC HEXALOBE 3.5 X 20 $275.00 C1713

SCREW NONLOC HEXALOBE 3.5 X 22 $275.00 C1713

SCREW LOCKIN HEXALOBE 2.7 X 20 $458.00 C1713

PLATE TACK PL-PTACK $156.00 C1713

DRILL BIT SHORT 4.3 MM $525.00

INSERT TIBIAL BEARING $1,868.00 C1713

VAC ULTA VERATRAC $217.00

Page 332: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PLATE LAT FIBULA LT 6 HOLE $2,250.00 C1713

SCREW HEXALOBE CANCEL 4.0 X 30 $268.00 C1713

SCREW HEXALOBE CANCEL 4.0 X 35 $268.00 C1713

CATH REBOA ER $4,300.00

BONE GRAFT SYNTHETIC $6,075.00 C1763

PIN APEX 180 MM $340.00 C1713

ROD 8 X 150 MM $663.00 C1713

ROD 8 X 100 MM $663.00 C1713

REAMER CORING 9MM W/COLL PIN $510.00

BUTTON CANNULA PASSPORT $119.00

BIO-GLIDE 40 X 50 $1,233.00 C1763

SUTURE SL TEN BIO-COMP 7X19.5 $1,083.00 C1713

OPTFIX ABSORB FIXATION SYSTEM $1,783.00

PLATE PROX HUMERUS 5 HOLE $3,561.00 C1713

SCREW CORTEX 2.5 X 24 MM $87.00 C1713

SCREW CORTEX 2.5 X 28 MM $87.00 C1713

SCREW CANCELLOUS 4.0 X 46 MM $123.00 C1713

SCREW CANCELLOUS 4.0 X 55 MM $123.00 C1713

PLATE-T 40-15081 $947.00 C1713

SCREW NON-LOCKING 2.7 X 30 $174.00 C1713

BALLOON EUPHORA 3.75 X 15 $381.00 C1725

CABLE INSERTS $192.00 C1713

PLATE COMP LOCK 13 H $624.00 C1713

POST OP SHOE DARCO SM FEMALE $35.00

POST OP SHOE DARCO MD MALE $35.00

POST OP SHOE DARCO LG FEMALE $35.00

POST OP SHOE DARCO XLG MALE $35.00 L3260

POST OP SHOE DARCO SM MALE $35.00

POST OP SHOE DARCO MD FEMALE $35.00

POST OP SHOE DARCO LG MALE $35.00

SCREW BONE CANCELLOUS 6.5 MM $304.00 C1713

INSERT OMNIFIT CROSS 10 SER II $2,468.00 C1713

C-TAPER LFIT HEAD LOW FRIC TX $1,542.00 C1713

RING OSTOMY HYDROFER BLUE FOAM $22.00

SUTURE ANC MIN CORKSCREW FT $710.00 C1713

SCREW BONE 1.7 X 12 $238.00 C1713

VITOSS 5CC BONE GRAFT $3,399.00

PLATE WRIST FUSION $3,160.00

SCREW CTX 3.5 X 18 $293.00

SCREW CTX 3.5 X 22 $293.00

SCREW CTX 2.7 X 12 $284.00

SCREW CTX 2.7 X 16 $284.00

SCREW CTX 2.7 X 20 $284.00

SCREW CTX 2.7 X 24 $284.00

SCREW CTX 2.4 X 14 $284.00

DRILL BIT 2.6 $404.00

DRILL BIT 2.0 $404.00

SCREW 80 MM X 95 MM $604.00

SPHINCTER CUFF URETH 4.5 CM $12,074.00 C1815 C1815

SHELL HEMISPERICA TRIDEN TI 60 $5,689.00 C1776

Page 333: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW PLATE REST GAP 6.5 X 3.5 $269.00 C1713

PLATE BROAD STRAIGH COMP 8HOLE $1,282.00 C1713

PLATE STRAIGHT NARROW COMP 9H $1,282.00 C1713

CATH MIDLINE 10CM $177.00

SCREW LOCKING CANN VA 5.0 X 50 $652.00 C1713

SCREW LOCKING CANN VA 5.0 X 65 $652.00 C1713

PEGS CORTICAL LOCKING 2.3 X 28 $329.00

PLATE VDR ACU-LOC 2 WIDE RT $2,844.00

BALLOON DIL EUPHORA 2.75 X 25 $381.00

BALLOON DIL EUPHORA 3.5 X 30 $381.00

BALLOON DIL EUPHORA 2 X 6 $381.00

STENT RX CORONARY INT $1,271.00

SCREW BONE T7 2.7 X 20 $247.00

PLATE COMPRESSION 4-HOLE $672.00

PICC ANTIMIC 5.5 X 40 $597.00

PICC ANTIMIC 5.5 X 50 $597.00

PICC ANTIMIC 5.5 X 55 $597.00

PICC ANTIMIC 4.5 X 55 $597.00

PICC ANTIMIC 3.0 X 55 $305.00

SCREW LOCKING 3.5 X 30 $432.00

SCREW LOCKING 3.5 X 32 $432.00

SCREW LOCKING 3.5 X 34 $432.00

SCREW LOCKING 3.5 X 38 $432.00

SCREW LOCKING 2.7 X 28 $238.00

PLATE RT POST LATERAL 3 HOLE $2,111.00

SURGICAL NUKNIT HEMOSTAT 3 X 9 $314.00

DEVICE ENERGY FUSION 5 $872.00

DEVICE ENERGY FUSION FN $872.00

PLATE STRAIGHT BROAD 6 HOLE $941.00

PLATE STRAIGHT BROAD 5 HOLE $941.00

PNEUMOTHORAX TRAY $560.00

SHEATH STEERABLE MED CURL $2,195.00

SHEATH STEERABLE 6F MED CURL $1,121.00

CABLE 1920-SA 85954 $458.00

LIVEWIRE CSL 6 FR $1,790.00

INQ STEE QUAD 5F FOR POINT/POI $996.00

CABLE 1904-SA 85953 $412.00

CATH BI-DIRECTIONA 6F MED CURL $1,374.00

FASTENER STAYFIX 5-14FR $36.00

BLADE LARYNGOSCOPE SZ 4 $60.00

BLADE LARYNGOSCOPE SZ 3 $40.00

SCREW CORTICAL 4.0 X 26 MM $87.00

PNEUMOTHORAX TRAY WAYNE 10 FR $559.00

DRESSING PURAPLY AM 2 X 2 $1,368.00 Q4172

BUTTON DOG BONE AR-2270 $872.00

PLATE NARROW T 1.7 6 HOLE $747.00

SCREW BONE 1.7 X 9 $238.00

SCREW LOCKING 1.7 X 6 $275.00

DRILL BIT CANNULATED 2.7 $804.00

SCREW NON-LOCK HEXA 3.5 X 44 $275.00

Page 334: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW CANNULATED 4.0 X 36 $500.00

PLATE 1/3 TUBULAR 3 HOLE $271.00

SCREW BIO-COMP 10 X 28 $585.00

SCREW BIO-COMPRESSION 2.7 X 20 $984.00

NEEDLE 19 GA $623.00

NEEDLE 21 GA $314.00

NEEDLE 22 GA $217.00

BIOPSY FORCEPS $78.00

PLATE LOCKING COMPRESSION 7H $525.00

SCREW CORTICAL 4.5 X 26 $109.00

LEAD INTRODUCER 9 FR 50 CM $834.00

LEAD INTRODUCER JUMBO 9FR 50CM $834.00

LEAD INTRODUCE TELSC 7FR 62 CM $1,000.00

CLOSURE SYSTEM-MED PROGLIDE $645.00

STEM HIP ANGLE $8,084.00

STENT WALLSTENT 14 X 40 $2,348.00

CATH VASC 65 CM 4 FR $797.00

PLUG VASC 12 MM CLOSURE DEVICE $2,195.00

PLUG VASC 14 MM CLOSURE DEVICE $2,195.00

COIL AZUR 18D SYSTEM 4 X 5 $1,728.00

COIL AZUR 18D SYSTEM 3 X 5 $1,728.00

COIL AZUR 18D SYSTEM 5 X 16 $1,733.00

NAIL LOCKING POLARUS 3 240MM $4,658.00

SCREW 2.0 X 18 MM $538.00

EMBOLECTOMY CATH 3 FR $156.00

EMBOLECTOMY CATH 4 FR $156.00

EMBOLECTOMY CATH 5 FR $156.00

EMBOLECTOMY CATH 6 FR $156.00

EMBOLECTOMY CATH 7 FR $156.00

PACEMAKER SYSTEM QUADRA ALLURE $25,932.00 C2621

CATH LEAD 9 FR 51 CM $1,199.00

ADAPTER CATH LAB 13.5X25X65 $2,298.00

UNIT RF MERLIN @ HOME EX1150 $872.00

PCK QUADRA ALLURE $42,578.00 C2621 C2621

STENT THORACIC 30 MM $29,528.00

GUIDEWIRE AAA 18F $610.00

SCREW CANCELLOUS 4.0 X 65 $123.00

SCREW CANN ASNIS PT 4.0 X 38 $474.00

ICD EVERA MRI XT DR $28,485.00 C1721

ICD EVERA MRI XT DR SYSTEM $34,478.00 C1721

ICD EVERA MRI S DR DDMC3D4 $26,235.00 C1721

ICD EVERA MRI S DR SYSTEM $32,610.00 C1721

CATH GUIDE NON TPR 5FR 65 CM $154.00

PRESSURE LUMBAR PUNCTR COMPAS $183.00

KIT KNEE SUBCHONDROPLASTY $7,860.00 C1713

SCREW BONE 2.7 X 24 MM $174.00

SCREW LOCKING 4.0 X 26 $447.00

SCREW LOCKING 4.0 X 44 $447.00

PLATE PROX HUM 3 10 H $4,248.00

SCREW NON-LOCKING 2.7 X 30 MM $275.00

Page 335: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW NON-LOCKING 2.7 X 38 MM $275.00

SCREW CANNCELLO PT 4.0 X 60 MM $123.00

SCREW CANNCELLO PT 4.0 X 65 MM $123.00

SCREW CORTEX 3.5 X 65 MM $87.00

PLATE COMPRESSION 5.0 MM 7H $560.00

NAIL SUPRACONDYLAR $3,941.00

SUTR ANCH, BIO COMP S-TAK $809.00

ALLOGRAFT DERMIS DECELL 40X70 $7,699.00 Q4122

PROBE AR SCOPE MEASUR 220MM 6 $610.00

PLATE HOOK VARIAX CLAVICLE 5H $2,621.00

PLATE DCP 10 HOLE $328.00

BIT DRILL 2.0 $188.00

SCREW CORTICAL 2.7 X 12 $156.00

SCREW CORTICAL 2.7 X 14 $156.00

BLADE KOBY GARD $527.00

SCREW BONE 1.7 X 18 $238.00

GRAFT VASCULAR LEFENE PTFE $2,873.00

CATH THROMBE INF 5 FR 30 X 135 $488.00

CATH THROMBE INF 5 FR 35 X 40 $483.00

CATH THROMBE INF 5 FR 50 X 135 $483.00

PLATE COMPRESSION NARRO 7H 2.3 $672.00

SCREW EMERGENCY 2.5 X 10 MM $238.00

DISP KIT FOR DX SWIVELOCK $685.00

DX SWIVELOCK SL W/FORKED EYELE $1,058.00

K-WIRE 1.6 X 150 MM $117.00

PIN TEN HOLE $1,670.00

POST 20 DEGREE ANGLED $300.00

BLADE XL WIDE 2299-3-108 $118.00

SCREW BIO-COMPRESSION 3 X 18MM $984.00

MESH, PHASIX 10 X 12 $20,535.00

NAIL TIBIAL 10 X 290 MM $3,048.00

MESH 3D MAX LIGHT MED 3.1X5.3 $588.00

PLATE 5H LEFT BLADE $784.00

PLATE 5H RIGHT BLADE $784.00

SCREW BONE 1.7 X 6 MM $238.00

SCREW NON-LOCKING 2.7 X 22 $247.00

WAFFLE HEEL ELEVATOR $98.00

SUTURE PROLENE 6/0 4X18 BLU $156.00

SCREW CANCELLOUS TI 4 X 60 $123.00

SCREW CORTICAL 4.5 X 48 $100.00

PLATE MEDICAL 16 HOLE $2,918.00

SCREW NON-LOCKING 3.0 X 24 $275.00

SCREW LOCKING 3.5 X 38 $275.00

SCREW LOCKING 3.5 X 55 $357.00

DRILL BIT 2.0 MM $403.00

DRILL BIT 3.2 MM $1,383.00

K-WIRE 2.0 X 235 MM $153.00

MESH 3D MAX LIGHT RT 3X5 $588.00

IMPLANT SHOULDER REVERSE STRYK $14,910.00

PLATE 3D 4 X 2 $1,008.00

Page 336: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW LOCING 1.7 X 11 $275.00

SCREW LOCING 1.7 X 12 $275.00

CRUCIATE RETAINING TIBIAL INSE $1,744.00

MODULAR HIP SYSTEM 6276-7-014 $5,664.00

MODULAR HIP SYSTEM 6276-7-015 $5,664.00

MODULAR HIP SYSTEM 6276-7-016 $5,664.00

PLATE DISTAL POSTERIOR LAT 12H $2,642.00

PLATE 4 HOLE $2,134.00

SCREW LOCKING 2.7 X 25 $458.00

SCREW NON-LOCKING 3.5 X 55 $275.00

SCREW TH NON-TOGGLING 2.3 X 12 $329.00

SUTURE 2 ETHILON 20 IN $28.00

SUTURE 0 ETHILON TP-1 $28.00

SCREW LOCKING 2.7 X 10 MM $320.00

SCREW LOCKING 2.7 X 26 MM $320.00

HEMISPHERICAL SHELF $5,689.00

PLATE SCREW 2080-0030 $346.00

PLATE NARROW Z 13 HOLE $1,008.00

PLATE COMPRESSION 6H 2.7 MM $260.00

SCREW CANNULATED 3.0 X 36 MM $538.00

SCREW BIO-COM INTER TAPER TIP $585.00

SCREW LOCKING FT 4 X 34 MM $503.00

SCREW BONE 2.7 X 8 MM $174.00

SCREW PART THREAD 3.5 X 30 MM $94.00

SCREW LOCKING 2.3 X 20 $320.00

SCREW MICRO CANNU 3.0 X 36 MM $538.00

PLATE LAPIDUS CP $2,849.00

PLATE DISTAL MEDIAL TIBIA 14 H $3,364.00

SCREW NON-LOCKING 3.5 X 34 MM $598.00

SCREW NON-LOCKING 3.5 X 28MM $598.00

SCREW LOCKING 3.5 X 26 MM $710.00

SCREW LOCKING 3.5 X 34 MM $710.00

DRILL BIT 3.1 MM $313.00

K-WIRE 2.0 MM $28.00

PLATE COMPRESSION AXSOS 8H 5.0 $525.00

SCREW CANNULATED 3.0 X 34 MM $538.00

PLATE VARIAX CLAVICLE HOOK 5H $2,470.00

PURAPLY 2 X 4 $2,070.00 Q4172

PURAPLY 5 X 5 $5,910.00 Q4172

SCREW LOCKING 4.0 X 34 MM $447.00

SCREW LOCKING 4.0 X 48 MM $447.00

PLARE PROXI LATERAL HUMERUS 6H $3,882.00

BIOPSY VALVE MAJ-1414 $27.00

PLATE SM CALCANEUS MESH $1,635.00

PLATE PROX LAT HUMERUS 6H $3,882.00

SCREW LOCKING 4.0 X 22 MM $447.00

PASTA REPAIR KIT $2,680.00

CATHETER BALLOON BCL2645 $1,490.00

STEM NECK ANGLE HIP $8,317.00

PLATE OLECRANON LEFT 6 HOLE $2,111.00

Page 337: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PLATE OLECRANON RT 3 HOLE $2,736.00

PLATE POSTEROLATERAL RT 5H $2,712.00

SCREW NONLOCK HEXALOBE 3.5X50 $357.00

SCREW LOCKING HEXALOBE 2.7X18 $458.00

SCREW LOCKIN GHEXALOBE 2.7X22 $458.00

SCREW LOCKING HEXALOBE 2.7X26 $458.00

DRIVER TIP 1.5 MM $540.00

NEEDLE TRU-CUT BIOPSY $378.00

PLATE ROLANDO FX HOOK 1.3 $1,215.00

SCREWS MULTI HEXALOBE 2.3X18 $329.00

SCREW MULTI HEXALOBE 2.3X20 $329.00

DRILL MINI AO 2.0 X 3.5 $400.00

PLATE SM ACP 2.7 8 HOLE $289.00

SCREW CORTICAL 2.7 X 16 $181.00

SUTURE 2-0 PROLENE CT-1 NEEDLE $28.00

SCREW LK 4.0 X 48 NON-LOCKING $123.00

SCREW LOCKING 2.7 X 26 MM $320.00

SCREW LOCKING 2.7 X 28 MM $320.00

NEEDLE TUOHY 220 X 5 $40.00

SCREW CANNULATED 4.0 x 75 $520.00

SCREW CANNULATED 4.0 x 80 $520.00

METANEB SUPPLY $259.00

ROD 8 X 200 $680.00

SCREW CORTEX TI 3.5x22 $87.00 C1713

POST CORTICAL BI 4.5 X 60 $305.00

FORCEP STONE GRASP 3.2F 115CM $543.00

WIRE PILOT 5901-1119 $108.00

DRILL BIT 3.1 MM $236.00

PLATE BASE GLENOID $3,228.00

AUGMENT FEMUR POST SZ3 5MM $2,364.00

AUGMENT HALF BLOCK TIB SZ3 5MM $2,128.00

INSERT TIB TTL STBLZ SZ 3 13MM $4,436.00

ADAPTER OFFSET 4MM $2,338.00

SHEATH DRYSEAL GORE DSL1828 $842.00

SHEATH DRYSEAL GORE DSL1228 $702.00

BALLOON STENT GORE Q50-65P $1,238.00

NEEDLE ASP EDUS $181.00

PROTECTOR NERVE 7 X 40 MM $4,660.00

SHEATH BRITE TIP 4FR 11 CM $47.00

SHEATH BRITE TIP 5FR 11 CM $47.00

SHEATH BRITE TIP 6FR 11 CM $47.00

SHEATH BRITE TIP 7FR 23 CM $83.00

PLATE DIS LAT FEMUR 6H $4,059.00

SCREW CORTEX 4.5 X 42 $100.00

SCREW CORTEX 4.5 X 55 $100.00

SCREW CORTEX 4.5 X 60 $100.00

CORTEX SCREW 4.5 X 70 $100.00

SUTURE 2-0 VICRYL M0-6 CR $64.00

SUTURE 2-0 VICRYL TIES 12 X 18 $30.00

SCREW CANNULATED 4.0 X 36 $474.00

Page 338: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW NON-LOCKING 4.75X25X3.5 $305.00

SHEATH MICROPUNCTURE 4F $184.00

SCREW BONE CRS PN 1.7 X 16 $238.00

SCREW CANN INT FT 8 X 20 $415.00

SCREW LOCKING 2.3 X 11 $275.00

DRILL TWIST CANN 8.0 MM $623.00

SCREW CANNULATED 8.0 X 95 $598.00

SCREW CANNULATED 8.0 X 100 $598.00

IMPLANT UCL INTERNAL BRACE $2,668.00

SUTURE PASSER TRANSOSSEOUS $198.00

TENDON SINGLE STRAND SEMI $2,510.00

PLATE XXL VOLAR DR NARROW 2.7 $2,830.00

PLATE 7 HOLE $275.00

PLATE COMPRESSION 9 HOLE $557.00

SCREW CORTEX 4.5 X 20 $109.00

SCREW AUTO COMP MOD T7 DR 2.0X $523.00

GUIDEWIRE SS 0.91 X 80MM $36.00

WIRE GUIDE ASNIS III 3.2 X 300 $296.00

DRIL BIT DENTAL 1.4 $252.00

CATH GROSH CENT VEN 7F 90CM $560.00

CATH GROSH CENT VEN 9.5F 90CM $560.00

CONNECTOR REPLACE GROSH 7F $67.00

CONNECTOR REPLACE GROSH 9.5F $67.00

SCREW NON-LOCKING 3.5 X 22 $275.00

SCREW NON-LOCKING 3.5 X 24 $275.00

SCREW CANCELLOUS 6.0 X 70 T32 $147.00

SCREW CANCELLOUS 6.0 X 75 T16 $147.00

SCREW CANCELLOUS 6.0 X 65 FT $147.00

HYPERINFLATION SYSTEM W/MASK $53.00

PLATE PROX LAT HUMERUS 3HOLE $3,406.00

MESH PHASIX 8 X 10 $13,880.00

DEVICE DEBRIDE DEBRISOFT $58.00

AUGUMENT FEMORAL DISTAL $2,258.00

PLATE STRAIGHT WITH BAR 4H $747.00

FIBERLOOP 13" 2-0 64.8 MM $186.00

BLADE CRESCENTRIC 18X0.51X30MM $408.00

DEVICE SONICBEAT 35CM $647.00

SCREW REDDICK SAYNE RETRACTOR $4,134.00

MESH PHASIX 4 X 6 $4,480.00

SCREW BONE NON-LOCKING 2.7X10 $247.00

PLATE ACU-LOC2 VDR PRO WIDE RT $2,844.00

PLATE ACU-LOC2 VDR EXT PLT NEU $1,878.00

PLATE ACU-LOC2 VDR EXT LINK SC $515.00

PLATE ACU-LOC2 VDU LG RIGHT $2,342.00

LABRALTAPE WHITE 1.5 MM 36" $214.00

PLATE MIDSHAFT RT SUPERIOR 6H $2,941.00

LIGAMENT CMC RECONSTRUCTION $1,374.00

SCREW TENODESIS BIOCOMP 4 X 10 $859.00

MESH ABSORB PHASIX 4 X 6 $5,910.00

PLATE TI VARIAX HOOK 5H 16MM L $2,470.00

Page 339: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW LOCKING 5.0 X 16 $474.00

SCREW BONE 3.5 x 8 x 1 $238.00

SCREW U-BLADE LAG 85 MM $1,702.00

SCREW LAG U-BLADE 95 MM $1,702.00

SCREW CORTEX 2.7 X 10 MM $94.00

GUIDE WIRE $340.00 C1769

NEEDLE SPINAL 18GA X 6" $22.00

PLATE PROX MEDIAL TIBIA 5H $3,096.00

SCREW CANCELLOUS PT 70X4.0MM $123.00

FLIP CUTTER II 8.5MM $809.00

SCREW 1.5 X 6MM SK1510-06 $158.00

SCREW BIOCOMP TENO 4X10 $959.00 C1713

SMART TOE II 16MM 10DEG ANGLE $1,721.00

PLATE 1/3 TUBULAR 6H SM FRAG $332.00 C1713

DRILL BIT COUNTERSINK 45-80040 $287.00

SCREW CAMMULATED 3.0 X 38 $538.00

PLATE FEMUR LEFT 16 HOLE $4,059.00

SCREW CORTEX 4.5 X 38 $100.00

SCREW CANCELLOUS 6.0 X 85 MM $147.00

SCREW PERIPROSTECTIC 5.0 X 10 $562.00

SCREW LOCKING 5.0 X 16 $474.00

SCREW LOCKING 5.0 X 18 $474.00

SCREW CANCELLOUS HEXA 4.0 X 12 $268.00

SCREW CANCELLOUS HEXA 4.0 X 14 $268.00

PLATE ACU-LOC VDU LEFT $2,342.00

SCREW HEXALOBE LOCKING 3.5 X 8 $458.00

SCREW BONE PT 2.7 X 22 MM $357.00

HUMERAL ADAPTER TRAY $5,171.00

GLENOSPHERE $5,517.00

FUNNEL FISTULA KCI $244.00

MESH SOFT 12 X 12 $412.00 C1781

PLATE MTP CP LEFT $2,364.00 C1713

PLATE VAR CLAVICLE HOOK RT 5H $2,470.00 C1713

MESH PRIMATRIX 6 X 6 $4,581.00 Q4110

EBUS ULTRASOUND BALLOON $96.00

NAIL FEMORAL 14 X 32 $3,952.00 C1713

CPAP DEVICE O-TWO $186.00

DRILL BIT 1.9 MM $252.00

SCREW LOCKING 2.3 X 6 MM $275.00 C1713

ROD SEMI-CIRCULAR CARBON $647.00 C1713

PIN APEX 180 MM 5018-8-180 $393.00 C1713

PIN APEX 180 MM 5018-3-120 $393.00 C1713

END CAPS 4MM 5027-1-040 $147.00 C1713

SCREW LOCKING ANCHORAGE 3 X 20 $507.00 C1713

PIN ANCHORAGE FIXATION $290.00

REAMER ANCHORAGE CP $945.00

REAMER CONCEX XFR004222 $1,046.00

REAMER CONCAVE XFR004222 $1,046.00

PIN TRANSFIXING 250 MM $366.00 C1713

GRAFT ARTHROFLEX 35 X 35 MM $4,076.00 Q4122

Page 340: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

XEROGEL XG-102 $458.00

AUTO PLEX SYSTEM 0605-687-015 $4,113.00

CURETTE 10 G 0306-620-000 $1,210.00

CANNULA 10 G 0306-410-000 $154.00

PLATE DR NARROW LT VOLAR LONG $2,079.00 C1713

NAIL FEMORAL A/R R1500 011X340 $3,461.00 C1713

PEC REJPAIR KIT $3,610.00 C1713

AIRLESS SPRAY ACCESSORY $81.00

PLATE POLYAXIAL LOCKING $2,287.00 C1713

PLATE TROCHANTERIC GRIP-2CABLE $2,430.00 C1713

SCREW CORTEX 4.5 X 14 MM $109.00 C1713

PIN STEINMANN THREADED TIP $186.00 C1713

UPTAKE CALVER LQ-T $282.00

SCREW BIO-COMP INTER W/DISP SH $585.00 C1713

SYSTEM EUSTACHIAN DILATION AER $3,663.00 C1726

PLATE CALCANUS SMALL $1,635.00 C1713

PLATE VARIAX CLAVICLE HOOK 7H $2,470.00 C1713

SCREW CANNULATED 3.0 x 17 mm $538.00 C1713

SCREW CANNULAT COUNTERSINK 5.0 $470.00 C1713

NAIL TIBIAL 1822-0928S $3,048.00 C1713

SCREW NON LOCKING 1.7 X 20 $238.00 C1713

SCREW NON LOCKING 1.7 X 22 $238.00 C1713

PLATE COMPRESSION T 6 HOLE $672.00 C1713

SCREW NON LOCKING 2.3 X 18 $238.00 C1713

PLATE DISTAL THIRD LEFT $1,271.00 C1713

SCREW LOCKING -2.7 X 14 $351.00 C1713

SCREW LOCKING -2.7 X 16 $351.00 C1713

SCREW NON-LOCKING -3.5 X 16 $130.00 C1713

SCREW NON-LOCKING -3.5 X 18 $130.00 C1713

SCREW LOCKING -3.5 X 16 $259.00 C1713

K-WIRE -0.062 AR-2663 $74.00 C1713

DRILL BIT -2.5 MM AR-8943-13 $259.00

DRILL BIT -2 MM AR-8943-16 $290.00

SCREW CORTEX 4.5 X 85 MM $100.00 C1713

SCREW LOCKING 5.0 X 42 MM $474.00 C1713

BUTTON DIST CLAV PLATE $872.00 C1713

PLATE CLAV HOOK VARIAN 5H $2,470.00 C1713

SUTURE ANCHOR DBL 4.75MM $1,038.00 C1713

CANNULA TRIPLEDAM AR-6530TD $119.00

PLATE L 6 HOLE $747.00 C1713

SCREW CANNULATED 4.0 X 32 MM $474.00 C1713

SCREW CANNULATED 2.0 X 13 MM $538.00 C1713

SCREW CANNULATED 2.0 X 14 MM $538.00 C1713

SCREW CANNULATED 2.0 X 12 MM $538.00 C1713

SCREW CANNULATED 2.0 X 15 MM $538.00 C1713

SINGLE USE OATS SET 6MM $1,201.00

STENT SINUS PROBLL CONTOUR 8MM $1,605.00 C2625

PLATE DM LG VITA GRIP 2.0 MM $2,430.00 C1713

PLATE DM LG VITA GRIP 200MM $3,865.00 C1713

VERSAJET EXACT HANDPIECE 45-14 $1,663.00

Page 341: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW HEXALOBE 1.5 X 9 $329.00 C1713

DRILL BIT 1.1MM X 3.5 QR $461.00

SCREW CANNULATED 5.0 X 65 $520.00 C1713

SCREW CANNULATED 5.0 X 60 $520.00

SCREW CANNULATED 5.0 X 55 $520.00 C1713

SCREW CORTEX 2.0 X 14 MM $172.00 C1713

SCREW CORTEX 2.0 X 16 MM $172.00 C1713

SCREW CORTEX 2.0 X 18 MM $172.00 C1713

SCREW CORTEX 2.0 X 20 MM $173.00 C1713

PLATE BOLAR DR NARROW 11 HOLE $3,190.00 C1713

DRILL BIT 2.5 M $580.00

PLATE T NARROW 6 HOLE $560.00 C1713

SCREW NON-LOCKING 2.3 X 6 $238.00 C1713

PLATE LEFT LATERAL FIBULA 6H $2,211.00 C1713

INTERNAL BRACE LIGAMENT $2,460.00 C1713

SCREW HEXALOBE -1.5 $329.00 C1713

SCREW MULTI -2.3 X 10 $329.00 C1713

PLATE WRIST FUSION NEUTRAL $2,750.00 C1713

SCREW HEXALOBE LOCKING 2.7 X 8 $458.00 C1713

SCREW CANNULATED 6.5 X 90 $604.00 C1713

SCREW CANNULATED 6.5 X 100 $604.00 C1713

SNAREMASTER 2.8MMX230XCMX15M $39.00

SCREW BONE 2.3 X 15 $238.00 C1713

NAIL FEMORAL A/R R1500 012X360 $3,461.00 C1713

PLATE DORSAL STANDARD LEFT $2,280.00 C1713

PEGS CORTICAL LOCK -2.3 10 MM $329.00 C1713

PLATE NARROW Z 9HOLE $1,008.00 C1713

SCREW LOCKING 1.7 X 5 $275.00 C1713

SCREW LOCKING 1.7 X 7 $275.00 C1713

SCREW LOCKING 1.7 X 9 $275.00 C1713

POUCH FIST/WND EAKIN 6.9X4.3 $223.00

POUCH FIST/WND EAKIN 9.7X6X3 $181.00

CAVA FILTER DINALI JUGULAR $2,021.00 C1880

SCREW ASNIS 6.5 X 8.0 MM $604.00 C1713

DEVICE OPEN 20CM VOYANT $872.00

SCREW CANNULATED 2.0 X 26 $538.00 C1713

SCREW CANCELLOUS 4.0 X 50 $123.00 C1713

SCREW LOCKING 4.0 X 60 $447.00 C1713

DRILL BIT CANNULATED 2.6 MM $406.00

GUIDEWIRE ZIPWIRE 0.35 X 180CM $622.00 C1769

PCKMR ASSURITY MRI SGL CHAMBER $9,415.00 C1786

PLATE NARROW RT DORSAL WRIST $2,280.00 C1713

KIT STERILE 3.0MM PACKED INST $1,101.00

MODULAR HIP SYSTEM 6276-7-215 $6,294.00 C1776

MODULAR HIP SYSTEM 6276-1-019 $7,782.00 C1776

HEAD FEMORAL CERAMIC V40 $3,218.00 C1776

BONE PUTTY 2102-2102 $1,846.00 C9359

BONE DRILL 5085-2-032 $278.00

ADAPTOR HUMERAL CUP TRIAL $607.00 C1776

SCREW HEXALOBE LAG 1.5 X 12 MM $329.00 C1713

Page 342: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW HEXALOBE LAG 1.5 X 13 MM $329.00 C1713

PLATE 5 HOLE PG-2725-05 $251.00 C1713

BLADE SAW STERNAL $119.00

BIT DRILL 1.4 $252.00

HEAD FEMORAL LFIT V40 $1,542.00 C1776

STEM CEMENTED HIP 132 $5,552.00 C1776

NAIL HUMERAL $3,071.00 C1713

PLATE STANDARD BARREL HIP $1,306.00 C1713

PLATE SUPER CLAVICL BRIDGE 6 H $3,283.00 C1713

INSERT TOTAL STAB TIBIAL $4,436.00 C1713

SCREW HEADLESS COMPRESS 2.0X30 $523.00 C1713

IMPLANT INTRA ARTHRO SMART TOE $1,721.00 C1713

SCREW CORTEX $419.00 C1713

SCREW PERIPHERAL 5572-4516 $419.00 C1713

SCREW PERIPHERAL 5572-4524 $419.00 C1713

SCREW PERIPHERAL 5572-4532 $419.00 C1713

GLENOSPHERE CONCENTRIC 5573- $3,060.00 C1776

HUMERAL CUP 5570-3210 $3,060.00 C1776

INSERT HUMERAL 5571-C-326 $2,510.00 C1776

PLATE CLAVICLE 10 HOLE $3,013.00 C1713

STEM LONG HUMERAL FRACTURE $10,365.00 C1713

PLATE 1.7, 3X2 HOLE $1,008.00 C1713

INSERT ARTICULAR SZ3-4 RT 15MM $4,667.00 C1713

INSERT ART RT SZ3-4 15MM AP48M $6,810.00 C1713

NAIL TIBIAL 8 X 345MM $3,048.00 C1713

SCREW CORTEX 5573-6532 $419.00 C1713

SCREW PERIPHERAL 5572-4528 $419.00 C1713

GLENOSPHERE ECCEN 5573-2E-3606 $3,060.00 C1776

STEM MODUL HUMERAL 5569-P-201 $7,569.00 C1776

CUP HUMERAL 5570-3604 $3,060.00 C1776

INSERT HUMERAL 5571-S-3608 $2,510.00 C1776

GLENOSPHERE CONCE 5573-C-3202 $3,060.00 C1776

HUMERAL CUP 5570-3204 $3,060.00 C1776

INSERT HUMERAL 5571-C-3208 $2,510.00 C1776

SCREW CORTEX 5573-6528 $419.00 C1713

SUTURE ANC SWVKL PEEK TENO 8MM $1,008.00 C1713

SCREW CANCELLOUS BONE $304.00 C1713

RIMFIT CUP 6309-3-654 $3,829.00 C1776

HEAD FEMORAL LFIT V40 $1,542.00 C1776

SCREW COMP HEADLESS 2.5 X 30 $523.00 C1713

SCREW COMP HEADLESS 2.5 X 26 $522.00 C1713

STEM HIP CEMENTED 132 $5,552.00 C1776

SCREW PERIPHERAL 5572-4540 $419.00 C1713

STEM MOD HUMERAL SZ 13 $7,569.00 C1776

SCREW PERIPHERAL 5572-4536 $419.00 C1713

STEM MOD HUMERAL SZ 11 $7,569.00 C1776

INSERT HUMERAL X3 $2,510.00 C1776

STEM HUMERAL FRACTURE $9,395.00 C1776

STEM HIP NECK ANGLE 127 $8,678.00 C1776

INSERT HUMERAL $2,510.00 C1776

Page 343: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

PLATE COMPRESSION 7H 5.0 $555.00 C1713

ACHILLES SYS W/JUMP $4,300.00 C1713

STEM HIP CEMENTED 6058-0537D $5,552.00 C1776

DRILL BIT 3.2 #700356 $418.00

DRILL BIT 5.0 CANNULA #702447 $684.00

NEEDLES FOR RF PROBE $163.00

DRILL BIT 2.0 MM $476.00

SCREW ACUTRAK 2 7.5 X 65 $1,331.00 C1713

SCREW ACUTRAK 2 7.5 X 70 $1,331.00 C1713

TRAY PNEUMOTHORAX/COOK $527.00

FEMORAL HEAD 6570-0-536 $3,218.00 C1776

SCREW CANNULTED 6.5 X 100 $604.00 C1713

PLATE COMPRESSION -0.8MM 6H $969.00 C1713

SCREW HEXALOBE MULTI -2.3 X11M $329.00 C1713

SCREW HEXALOBE LAG -2.3X11MM $329.00 C1713

SCREW HEXALOBE LAG -2.3X12MM $329.00 C1713

SCREW HEXALOBE LAG -2.3X13MM $329.00 C1713

270 $301.00

NEURAGEN NERVE GUIDE 3MMX3CM $4,352.00 C9352

SCREW LAG STANDARD 3362-5-125 $717.00 C1713

PLATE COMPRESSION 1.3 MM 6 H $1,215.00 C1713

ANGEL BMC KIT ABS-10062 $2,264.00

SYRINGE 14CC MIXING $458.00

NEEDLE BONE MARROW ASPIRATION $610.00

PLATE PROX LAT HUMERUS 14 HOLE $4,283.00 C1713

SCREW CORTEX 3.5 X 30 MM $87.00 C1713

TUNNELLER E32791 $299.00

CAP KIT CS2406 $93.00

PLATE COMPRES BROAD CURVED 12H $1,525.00 C1713

SCREW COMPRESSION 2.0 X 25 $523.00 C1713

DRILL BIT CAMMULATED 1.9 $436.00

PLATE CURVED 4 HOLE $1,221.00 C1713

STENT WALLFELX COLONIC W/ANCH $5,481.00 C1876

PLATE MED CALCANEUS MESH $1,635.00 C1713

PLATE KNEE TIBIAL BASE LGE-2 $5,374.00 C1713

INSERT KNEE TIBIAL 16MM $2,166.00 C1713

STEM CEMENTED 100 MM $2,179.00 C1713

KNEE FEMORAL COMPONENT LGE $8,652.00 C1776

KNEE FEMORAL DISTAL BLOCK LGE $1,320.00 C1776

STEM CEMENTED 150 MM $2,179.00 C1713

214.556 $573.00 C1713

40-27032 $174.00 C1713

420-27040 $174.00 C1713

5572-4520 $419.00 C1713

5569-C-2007 $7,422.00 C1776

INTRACARDIAC ECHO CATH VIEWFLE $4,910.00 C1759

G407211 $548.00

G407208 $548.00

Sheath Transeptall SLD $503.00 C1893

629324 $2,111.00 C1713

Page 344: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

5568-0007 $5,887.00 C1776

5901-6053 $566.00 C1713

627208 $4,126.00 C1713

661148 $474.00 C1713

661790 $100.00 C1713

340654 $109.00 C1713

1822-104S $3,267.00 C1713

AR-7324-PSL $1,083.00 C1713

AR-1934BCFT-2 $847.00 C1713

5573-6540 $419.00 C1713

5570-3610 $3,060.00 C1776

5571-C-3610 $2,510.00 C1776

CATH MIDLINE BASCI 20GA 10CM $177.00

MICRA LEADLESS PACEMAKER $21,435.00 C1786

MICRA INTRO/SHEATH GUIDING $1,386.00 C1894

627434 $3,364.00 C1713

681428 $87.00 C1713

SCREW CORTEX 3.5X30MM $87.00 C1713

681434 $87.00 C1713

681436 $87.00 C1713

5573-6536 $419.00 C1713

5569-92012 $7,569.00 C1776

661114 $474.00 C1713

61120 $474.00 C1713

661126 $474.00 C1713

661738 $100.00 C1713

6720-0937 $8,618.00 C1776

STENT LIFESTRM COV 8X37X135 $5,110.00 C1713

STENT LIFESTM COV 8X58X135 $5,300.00 C1874

STENT LIFESTRM COV 9X38X135 $5,110.00 C1874

STENT, LIFESTRM COV 9X58X135 $5,300.00 C1874

STENT LIFESTRM COV 10X38X135 $5,110.00 C1874

2102-2101 $1,162.00 C1763

57-10170 $560.00 C1713

5571-C-3604 $2,510.00 C1713

661110 $562.00 C1713

5571-S-3206 $2,510.00 C1776

6570-0-132 $3,218.00 C1713

407358 $503.00 C1776

627444S $3,364.00 C1776

6570-0-436 $3,218.00 C1776

TR-H240R-S $6,954.00 C1713

614708 $238.00 C1713

ABS-10011 $534.00

30-0355 $275.00 C1713

3013-27038 $482.00 C1713

30-0295 $458.00 C1713

30-0349 $275.00 C1713

SCREWS NONLOCK HEX 3.0MMX14M $275.00 C1713

1202025 $17,030.00 C1781

Page 345: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

5569-P-2014 $7,569.00 C1776

5568-0010 $8,638.00 C1776

1067-0009 $322.00 C1713

CX01B MEDTRONIC $834.00 C1713

CC02A MEDTRONIC $305.00

6720-0635 $8,678.00 C1776

5542-P-0048 $4,434.00 C1713

5552-E-5220 $3,509.00 C1776

7007-0104L ACUMED $2,134.00 C1713

AR-1204AS-90 ARTHREX $809.00

597004S STRYKER $1,306.00 C1713

502-03-48C $4,312.00 C1713

623-00-32C $2,930.00 C1713

53-27226E $247.00 C1713

7007-0204L $2,174.00 C1713

3013-27040 $482.00 C1713

30-0286 $458.00 C1713

5568-0009 $8,638.00 C1776

5569-P-2009 $7,569.00 C1776

AR-8737-01 $56.00 C1769

AR-8737-09 $534.00

AR8740-40PTS $503.00 C1713

AR-8935-24 $183.00 C1713

AR-8935-28 $183.00 C1713

AR-8935-32 $183.00 C1713

AR-8935-35 $183.00 C1713

AR-8935-44 $183.00 C1713

AR-8935L-34 $259.00 C1713

AR-8943-42 $259.00

AR-8954-01 $747.00 C1713

AR-8954YR-L $2,500.00 C1713

AR-13226T $259.00

ADAPTER TUBING MALE $21.00

ADAPTER TUBING FEMALE $21.00

608060 STRYKER $147.00 C1713

661190 STRYKER $474.00 C1713

AR-1204AS-80 MEDITECH $809.00

320-02-038 EXACTECH $5,882.00 C1776

5570-4010 STRYKER $3,060.00 C1776

5571-S4004 STRYKER $2,510.00 C1713

5573-2E-4006 $3,060.00 C1776

703706 STRYKER $435.00

1192540 BARD $28,313.00 C1781

57-10101 STRYKER $595.00 C1713

6720-0230 STRYKER $8,678.00 C1776

PM2272 ST JUDE $12,716.00 C2619

614732 STRYKER $238.00 C1713

5568-0006 Stryker $9,395.00 C1776

GRASPER LONG BIPOLAR $722.00

DISSECTOR CURVED BIPOLAR $672.00

Page 346: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DRIVER LARGE NEEDLE $548.00

FORCEPS CADIERE $523.00

FORCEPS DEBAKEY $610.00

HOOK PERM MONOP CAUTERY $610.00

SPATULA PERM MONOP CAUTERY $610.00

APPLIER LARGE CLIP $52.00

APPLIER MED-LG CLIP $52.00

480322 INTUTIVE SURG $1,374.00

IRRIGATOR SUCTION 8MM $660.00

470380 INTUTIVE SURG $74.00

OBTURATOR OPTICAL 12MM $130.00

AR-1204AS-85 $809.00

AR-8935L-40 $259.00 C1713

AR8935-40 $183.00 C1713

AR-8935-42 $183.00 C1713

AR-8935-36 $183.00 C1713

40-27050 STRYKER $174.00 C1713

40-35626 STRYKER $432.00 C1713

40-35628 STRYKER $432.00 C1713

496H222 Wright Medical $3,460.00 C1776

496S075 WRIGHT MEDICAL $4,580.00 C1776

SP1052 INHEALTH TECH $685.00 L8047

0117011 CR BARD $604.00 C1781

470361 DA VINC $67.00

470357 DA VINCI $93.00

SHEATH STAPLER $74.00

REDUCER 12-8 MM $93.00

POLYETHLENE 32 MM INSERT $2,930.00 C1776

SCREW CANCELLOUS 6.0 X8.5 MM $6,356.30 50694

1202530 BARD $23,925.00 C1781

623-00-32E STRYKER $2,930.00 C1713

627642 STRYKER $4,059.00 C1713

608085 STRYKER $147.00 C1713

FOLEY CATH 18FR 5CC LATEX FREE $31.00

FOLEY CATH 20FR 5CC LATEX FREE $31.00

5537-G516 STRYKET $4,436.00 C1776

2030-6560-1 STRYKER $318.00 C1713

40-27036 STRYKER $174.00 C1713

40-30228 STRYKER $538.00 C1713

40-30226 STRYKER $538.00 C1713

AR-1322BCNF ARTHREX $198.00 C1713

326285 STRYKER $604.00 C1713

AR-8956-01 ARTHREX $2,137.00 C1713

AR-8724V-20 ARTHREX $427.00 C1713

AR-8724V-12 ARTHREX $427.00 C1713

AR-8724-14 ARTHREX $336.00 C1713

AR-8724V-16 ARTHREX $427.00 C1713

AR-8724-24 ARTHREX $336.00 C1713

AR-8724-16 ARTHREX $336.00 C1713

AR-8724-12 ARTHREX $336.00 C1713

Page 347: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

AR-8916 14 ARTHREX $241.00

627440 STRYKER $3,364.00 C1713

45-751324 THERUMO $2,494.00 C2628

45-751019 THERUMO $2,494.00 C2628

6293505 STRYKER $2,642.00 C1713

57-15390 STRYKER $1,008.00 C1713

5568-0008 STRYKER $8,638.00 C1776

6721-0435 STRYKER $8,678.00 C1776

6570-0-236 STRYKER $3,218.00 C1776

58-12006E STRYKER $238.00 C1713

60-10122 STRYKER $244.00

58-12009E STRYKER $238.00 C1713

627454 STRYKER $3,477.00 C1713

627438 STRYKER $3,364.00 C1713

607455 STRYKER $123.00 C1713

15-724B BOSTON SCIENTIFIC $43.00 C1894

RELOAD ENDOWRIST STAPLR 45 WH $549.00

RELOAD ENDOWRIST STAPLR 45 BLU $549.00

RELOAD ENDOWRIST STAPLR 45 GRE $549.00

FORCEPS DVINCI FENEST BIPOLAR $672.00

3362-5-115 STRYKER $717.00 C1713

HV GENERATOR ICD CD3357-40Q $34,035.00 C1882

40-27620 STRYKER $531.00 C1713

40-27630 STRYKER $531.00 C1713

325655S STRYKER $520.00 C1713

0705-310-000 STRYKER $2,598.00

AR-8724V-10 ARTHREX $427.00 C1713

AR-9055-45PT ARTHREX $1,836.00 C1713

PEG PULL KIT 20 FR $510.00

SCREW T7 LOCKING 2.7 X 22 $247.00 C1713

Bone Screw 2.3mm T7 $365.00 C1713

DRESSING FOAM 4X4 BACTERIOSTAT $25.00

RADIAL HEAD 496H024 $3,460.00 C1776

RADIAL HEAD STEM 496S065 $4,580.00 C1776

TIBIAL BEARING INSERT SIZE 1 $3,949.00 C1776

POST STAB FEMORAL SIZE 1 $5,592.00 C1776

HUMERAL STEM 12MM $8,638.00 C1713

HUMERAL INSERT 12MM X 30MM $2,510.00 C1713

BAG ENDOSCOPIC 5MM $156.00

Stryker Interpulse Irrigation $37.00

ADAPTER, UROLOCK II SCOPE $88.00

HIP STEM NECK ANGLE SIZE 2 $8,557.00 C1713

TENDON GRACILIS .35X23 CM $2,510.00 C1762

RELOAD ENDOWRIST STAPLER 45 GR $896.00

ARTHOFLEX TENDON GRAFT 50x90M $7,762.00 Q4125

TIBIAL BEARING INSERT SIZE 3 $4,147.00 C1713

HUMERAL INSERT 32MM X 4MM $2,510.00 C1713

SCREW CANNULATED 5.0X48 $520.00 C1713

SGL STRD SEMITENDINOSUS .55X24 $2,510.00 C1762

DAVINCI CLIP HEM-O-LOCK MED $185.00

Page 348: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SOLARA QUAD CRTP MRI PACEMAKER $12,910.00 C2621

NEEDLE TUOHY 20GA X 3.5 $48.00

726214S $4,283.00 C1713

1828-1142S $3,461.00 C1713

AR-1204D $351.00

AR-1934BCT $847.00

AR-7000-01 $381.00

AR-7000-14 $872.00

AR-7000-34FT $610.00 C1713

AR-7000-36FT $610.00 C1713

AR-8941-6 $149.00 C1769

AR-8941-7 $149.00 C1769

AR-8956C-35PD $534.00

AR-8956K-01 $93.00 C1769

AR-9055-50PT $1,836.00 C1713

5542-P-0044 $4,434.00 C1713

5552-E-4416 $3,509.00 C1776

5545-A-701 $2,128.00 C1713

5545-A-702 $2,128.00 C1713

ENDOWRIST STAPLER 45 INST $427.00

PLATE FIBULA 6 HOLE LEFT PL $2,250.00 C1713

SCREW HEXALOBE VA 2.7X14MM $482.00 C1713

PEP VALVE FOR COPD $27.00 A4617

0601138 DUPLOTIP APPLIC. 318MM $180.00

EASYSPRAY SETS $165.00

STRYKER VERTEBRAL BALLOON TRAY $5,810.00

3011-43046 ACUMED 4.3 SCREW $512.00 C1713

SUTURE STRATAFIX SPIRAL PDS $87.00

#113034 BIO SHOULDER MOD HEAD $3,110.00 C1776

ANATO HIP STEM SIZE 2 $9,438.00 C1776

ANATO HIP STEM SIZE 3 $9,438.00 C1776

14 HOLE COMPRESSION PLATE $1,321.00 C1713

12 HOLE RT PROX LAT HUM PLATE $4,041.00 C1713

6 HOLE HOOK PLATE $2,470.00 C1713

FOLEY CATH 16FR SCC LATEX FREE $31.00

BIOMET OXFORD UNI KNEE V001213 $9,310.00 C1776

SUTRE STRATAFIX SPIRAL 0.22 CM $165.00

3.5MM CRTX SCREW/LO PRO $149.00 C1713

2.7MM VA-LCP LAT DIS FIB PLATE $2,477.00 C1713

3.5MM CRTX SCREW/LO PRO $149.00 C1713

2.7MM VA LOCK SCREW SLF TP $482.00 C1713

3.5MM CRTX SCREW/LO PRO $149.00 C1713

3.5MM CRTX SCREW/LO PRO $149.00 C1713

2.0 DRILL BIT FOR SMART TOE $198.00

ICEROD I-THAW PROSTATE KIT/VL $9,310.00

AFX2 BIFURCATED ENDOGRAFT SYS $26,309.00 C1768

CATH CARD CRYOABLATION 23MM $9,310.00 C1733

CATH CARD CRYOABLATION 28MM $9,310.00 C1733

Catheter Mapping $1,848.00 C1730

SHEATH STEERABLE FLEXCATH 12FR $2,510.00 C1766

Page 349: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

COAXIAL UMBILICAL $290.00

ELECTRICAL UMBILICAL $564.00

CATHETER CONNECTION CABLE $535.00

PROX HUMERUS PLATE 5 HOLE $3,406.00 C1713

4.0MM X 42 CANCELLOUS SCREW $123.00 C1713

DISTAL TIBIA PLATE $1,878.00 C1713

3.5MM NON-LOCKING HEX SCREW $275.00 C1713

2.7MM NON-LOCKING HEX SCREW $275.00 C1713

2.7MM NON-LOCKING HEX SCREW $275.00 C1713

4.0MM PT CANCELLOUS HEX SCREW $268.00 C1713

IPG WIDRO AZURE XT DR MRI $8,960.00 C1785

13 HOLE LOCKING RECON PLATE $3,004.00 C1713

3.0 X 10MM LOCKING SCREW $605.00 C1713

3.0 X 14MM LOCKING SCREW $605.00 C1713

MESH ABSORB PHASIX 6X10 $12,470.00 C1781

1.7 X 15MM BONE SCREW $238.00 C1713

IPG A3JRO1 ADVISA SR MRI $8,226.00 C1786

AAA SYS OVATION TX CAPITATED $35,309.00

AUTO INJECTOR O PRIME PNA $623.00 C1874

PLATE 1.3MM T-PLATE $329.00 C1713

SCREW, LAG HEXALOBE 2.3X16MM $1,217.00 C1713

ENDOVASCULAR AUTO INJECTOR $623.00

ARTHREX FLIPCUTTER 9.5MM $809.00

ARTHREX CANN DRILL 3MM ACL $979.00

POST STAB FEMORAL SIZE 8 $5,592.00 C1713

TIBIAL BEARING INSERT SIZE 8 $3,949.00 C1713

SCREW, CANN 6.5 X 120MM STRYKE $604.00 C1713

NECK ANGLE HIP STEM SIZE 8 $8,678.00 C1776

STENT, COR RES ONX2.0MMX08MM $2,710.00 C1874

STENT, COR RES ONX2.0MMX12MM $2,710.00 C1874

STENT, COR RES ONX2.0MMX18MM $2,710.00 C1874

STENT, COR RES ONX2.0MMX15MM $2,710.00 C1874

STENT,COR RES ONYX 2.OOMMX22M $2,710.00 C1874

STENT, COR RES ONX2.0MMX26MM $2,710.00 C1874

STENT, COR RES ONX2.0MMX30MM $2,710.00 C1874

STENT, COR RES 2.25MM X 34MM $2,560.00 C1874

STENT, COR RES ONX 2.25MMX38MM $2,560.00 C1874

STENT, COR RES ONX 2.50MMX34MM $2,560.00 C1874

STENT, COR RES ONX 2.50MMX38MM $2,560.00 C1784

STENT, COR RES ONX 2.75MMX34MM $2,560.00 C1874

STENT, COR RES ONX 2.75MMX38MM $2,560.00 C1874

STENT, COR RES ONX 4.5MMX12MM $2,710.00 C1874

STENT, COR RES ONX 4.5MMX15MM $2,710.00 C1874

STENT, COR RES ONX 4.5MMX18MM $2,710.00 C1874

STENT, COR RES ONX 4.5MMX22MM $2,710.00 C1874

STENT, COR RES ONX 4.5MMX26MM $2,710.00 C1874

STENT, COR RES ONX 4.5MMX30MM $2,710.00 C1874

STENT, COR RES ONX 5.0MMX12MM $2,710.00 C1874

STENT, COR RES ONX 5.0MMX15MM $2,710.00 C1874

STENT, COR RES ONX 5.0MMX22MM $2,710.00 C1874

Page 350: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

STENT, COR RES ONX 5.0MMX26MM $2,710.00 C1874

STENT, COR RES ONX 5.0MMX30MM $2,710.00 C1874

STENT,CORO RES ONYX 5.0MMX18M $2,710.00 C1874

PLATE, BONE 7 HOLE NARROW Y $560.00 C1713

GRAFT, VAS 8X40 ADVANTA $1,203.00 C1768

CURVED VERT BALL SYS 11G X 15M $5,710.00

CURCIATE RET TIB INS SIZE 7 $1,744.00 C1713

MOD HIP SYS 155MM X 18MM $5,664.00 C1776

MOD HIP SYS 21MM $7,782.00 C1776

HIP STEM SIZE 1 ANGLE 132 $8,678.00 C1776

DEV DETACH CONTROLLER AZUR $510.00

COIL EMBOL DETACH AZU 3X8MM $1,733.00

COIL EMBOL DETACH AZUR 4X13MM $1,733.00

COIL EMBO DETACH 7X24MM $1,733.00

COIL EMBO DETACH AZUR 8MMX28CM $1,733.00

COIL EMBO DETACH 10MMX32CM $1,733.00

COIL EMBO DETAC AZUR 12MMX38CM $1,733.00

COIL EMBO DETA AZUR 14MMX34CM $1,733.00

COIL EMBO DETA AZUR 16MMX39CM $1,733.00

PLATE SCREW 6.5 X 15 GAP STRY $346.00 C1713

FEMORAL PROSTHESIS STAB SIZE 2 $5,592.00 C1776

CANNULATED SCREW 80 X 6.5MM $604.00 C1713

FISTULA PLUG SET .4CM $2,463.00 C1763

FISTULA PLUG SET .7CM $2,463.00 C1763

1O HOLE X PLATE $2,686.00 C1713

10 HOLE H PLATE $2,686.00 C1713

3.0 X 16MM LOCKING SCREW $605.00 C1713

3 X 12 MM LOCKING SCREW $605.00 C1713

3.0 X 18MM LOCKING SCREW $605.00 C1713

LOCKING SCREW 5.0 X 44 $474.00 C1713

CANCELLOUS SCREW 6.0 X 50 $110.00 C1713

FLOSEAL 5 ML $512.00 A6250

GLENOID SIZE 40 SELF-PRES $4,434.00 C1776

HUMERAL HEAD SZ 44 SIG RAD $3,509.00 C1776

RING TO ROD $2,547.00

FT 205MM RINGS $1,732.00

PT CORTEX SCREW 4.5 X 34 $105.00 C1713

NEEDLE BIOPSY CHBA 22 GA $74.00

FEMUR PLATE 14 HOLE LEFT $4,059.00 C1713

LOCK SCREW 5.0MM/L4MM $473.00 C1713

CANNULA INNER 6.0 XLT $196.00

LT DISTAL FEMUR PLATE 6HOLE $4,058.00 C1713

AFFILN AMNI DRESS 2.5CMX2.5CM $2,298.00 Q4159

PREVENA NEG PRESS DRESS $1,233.00 A6550

TUB TRCHSTMY SZ 10 DCFN $117.00

TUBE TRCHSTMY SZ 4 DCFN $117.00

TUBE TRCHSTMY SZ 10 DCFS $113.00

TUB TRACH KIT SOF SEAL 8.0MM $144.00

FEMORAL PROSTHESIS $7,910.00 C1776

FEMORAL JOINT PATELLA COMP $1,969.00 C1776

Page 351: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

FIBER HOLMIUM 200 MICRON $560.00

FIBER HOLMIUM 273 MICRON $560.00

FIBER HOLMIUM 365 MICRON $560.00

FIBER HOLMIUM 910 MICRON $685.00

FIBER HOLMIUM 550 MICRON $560.00

2.3MM HEXALOB MULTISCREW 8MM $329.00 C1713

2.3MM HEXALOB LAG SCREW 8MM $329.00 C1713

2.3MM HEXALOBE LAG SCREW 9MM $329.00 C1713

2.3MM HEXALOB LAG SCREW 10MM $329.00 C1713

T6 STICK FIT DRIVER TIP $916.00 C1713

.040 PLATE TACK $299.00 C1713

3.7MM CANN LOCKING SCREW $547.00 C1713

3.5MM LCP PROXIMAL TIBIA PLATE $3,725.00 C1713

CHRONOS GRANULES-MEDIUM $1,818.00 C1713

NEEDLE BIOPSY KIT & MARK 14GA $2,508.00

NEEDLE BIOPSY KIT MARKER 12 GA $2,508.00

INFLATOR ENCORE BALLOON $173.00 C1726

NECK ANGLE HIP STEM SIZE 7 $8,678.00 C1776

PLATE LOCKING 1.7 8 HOLE $1,008.00 C1713

TAP 1.7 MM $305.00

KIT DISP, FIBERTAK STRAIGHT $534.00

FIBERTAK W #2 TIGERTAIL $809.00

SCREW CANNULATED 5.0 X 42 $520.00 C1713

HUMERAL STEM MODULAR SIZE 8 $7,569.00 C1776

APEX PIN 200MM $340.00 C1713

CUFF BP BARIATRIC-REUSABLE $49.00

CRYO 2.1cx 90 DEGREE NEEDLE $2,710.00

STENT URETERAL METAL $2,003.00 C2625

2.7X8MM SCREW $181.00 C1713

2.7X10MM SCREW $181.00 C1713

2.7X11MM SCREW $181.00 C1713

2.0MM DRILL BIT $174.00

2.7MM DRILL BIT $174.00

7HOLE 2.7MM PLATE $295.00 C1713

NECK ANGLE HIP STEM SIZE 4 $8,678.00 C1776

SCORPION NEEDLE, KNEE $595.00

CORNING REAMER $510.00

SHOULDER SYSTEM/COMPREHENSIVE $6,110.00 C1776

BIOPSY STARTER KIT $290.00

LARYNGOSCOPE, HANDLE, REUSABLE $194.00

LARYNGOSCOPE, HANDLE, REUSABLE $194.00

MEDIAL TIBIA PLATE 8 HOLE $3,096.00 C1713

LARYNGOSCOPY, HANDLE, REUSABLE $194.00

OPTITWIST VACUUM MIXING BOWEL $437.00

TRANSFIXING PIN 5MM $366.00 C1713

SHOLE PIN CLAMP $1,301.00 C1713

ROD TO PIN COUPLING $1,181.00 C1713

FIBERLINK, BLUE AR-7258 $198.00

FEMORAL NAIL 11 X 380MM $3,461.00 C1773

BONE SCREW T10 2.7 X 36 MM $238.00 C1713

Page 352: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

CARBON ROD 08 X 500 $757.00 C1713

CANNULATED SCREW 4.0 X 10MM $474.00 C1713

CANNULATED SCREW 4.0X12MM $474.00 C1713

CANN SCREW 4X10MM TI ASNIS III $474.00 C1713

WAND,50DEG, ASP ABLA MULTIPORT $427.00

NEEDLE SPIN QUIN 22 GA $44.00

NECK ANGLE HIP STEM S 8 $8,678.00 C1776

LOCKING CORTICAL PEGS 2.3MM $354.00 C1713

PUSHER KNOT CURVED SUTURE $445.00

PLATE COMPRESSION 9 HOLE $3,736.00 C1713

SCREW, LOCKING 5.0 X 22 MM $473.00 C1713

SCREW, CORTEX 4.5 X 22MM $100.00 C1713

SCREW, CORTEX 4.5 X 24MM $100.00 C1713

SCREW, CORTEX 4.5 X 26MM $100.00 C1713

SCREW, CORTEX 3.5 X 24MM $94.00 C1713

DRILL BIT 4.2 X 230 MM $447.00

ENDOSCOPIC APPLICATOR $197.00

ANGLE HIP STEM SIZE 5 $8,678.00 C1776

DRUG SCREEN TEST KIT 11 PANEL $55.00

IMPLANT SYS BICEPS TENDO $1,617.00 C1713

FIBERTAK 2.6 SOFT ANCH W/1.3MM $921.00 C1713

NEEDLE, SCORPION MULTIFIRE $1,733.00

CANNULA, TWIST IN ARTHREX $93.00

CATH INLINE SUCT 72HR TRACH $737.00

MCK CONSUMABLE KIT (ORTHO) $1,245.00

PF CONSUMABLE KIT (ORTHO) $1,245.00

TOTAL KNEE CONSUM KIT (ORTHO) $1,245.00

TOTAL HIP CONSUM KIT (ORTHO) $1,245.00

HEX IMPACTION $305.00

SCREW, CORTICAL $615.00 C1713

SCREW, ANGLE CORTICAL $615.00 C1713

SURGICAL BLADE $458.00

NECK ANGLE HIP STEM SIZE 10 $8,557.00 C1776

NECK ANGLE HIP STEM SIZE 11 $8,557.00 C1776

BONE SCREW 2.3 X 10MM $247.00 C1713

BONE SCREW 2.3 X 20MM $247.00 C1713

GUIDEWIRE STIFF .035 X 450 CM $568.00 C1769

VALVE KIT FUJI 2 PIECE (DISP) $52.00

MOBILE AIR TRANS SYSTEM $259.00 E0705

LAG SCREW STAND 130MM $717.00 C1713

PLATE,PROFY HAND LOCK ROTATION $1,008.00 C1713

CORTEX SCREW 3.5 X 85MM $87.00 C1713

TIBIAL BEARING INSERT SZ 3 $2,974.00 C1776

DRILL BIT 2.8MM LONG $916.00

NEEDLE, FAST FIX 360, REVERSE $1,187.00

HIP STEM NEUTRAL NECK ANG SZ 6 $8,678.00 C1776

NEEDLE, ISESPHERE $3,710.00

ACETABULAR INSERT $5,536.00 C1776

C TAPER LFIT HEAD $1,542.00 C1776

TIBIAL BEARING INSERT $2,974.00 C1776

Page 353: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

EXTRACTOR 12MM/15MM $606.00

POLY TIBIAL COMPONENT $4,733.00 C1776

HIP STEM $8,678.00 C1776

PENILE IMPLANT TITAN RESERVOIR $4,478.00

TIBIAL BEARING INSERT SIZE 7 $3,464.00 C1776

TIBIAL BEARING INSERT SIZE 4 $2,974.00 C1776

STRYKER 2.0 CUTTER/SET $458.00

TIBIAL COMPONENT ALL POLY $4,733.00 C1776

CANISTER 45ML PREVENA $361.00

TIBIAL BEARING INSERT SIZE 5 $2,974.00 C1776

DEFINITY PERFLUTREN 1.5ML $369.00 Q9957

ACU-LOK 2 VDR PLATES $2,612.00 C1713

LAPIDUS CP PLATE $2,775.00 C1713

SCREW, NONLOCK 3.5 X 12MM $348.00 C1713

DRESSING PREVENA PLUS $1,502.00

MOD HIP SYSTEM 155MM X 20MM $5,664.00 C1776

ACU-LOC 2 VDR PLATES $2,612.00 C1713

BLADE, MAKO SURG NARROW $458.00

TIBIAL BEAR INSERT SZ 7 $2,974.00 C1776

TIBIAL BEAR INSERT SZ 5 $2,974.00 C1776

IDEAL SUTURE GRASPER 30 $926.00

IDEAL SUTURE GRASPER 60 $926.00

IDEAL SUTURE SHUTTLE 45 L $697.00

IDEAL SUTURE SHUTTLE 45 R $697.00

HEALIX 3.4 BR ANCHOR $1,204.00 C1713

HEALIX ADV 4.5 DOUBLE ANCHOR $1,218.00 C1713

HEALIX ADV 5.5 ANCHOR $1,218.00 C1713

HEALIX ADV 5.5 TRIPLE ANCHOR $1,199.00 C1713

HEALIX ADV 6.5 DOUBLE ANCHOR $1,218.00 C1713

HEALIX ADV 6.5 TRIPLE ANCHOR $1,199.00 C1713

GRYPHON P BR SINGLE ANCHOR $1,111.00 C1713

GRYPHON P BR DOUBLE ANCHOR $1,135.00 C1713

MED DISTAL FEMUR PLATE 4 HOLES $4,706.00 C1713

CORTEX SCREW SELFTAP 28MM $167.00 C1713

CORTEX SCREW SELFTAP 64MM $167.00 C1713

BONE CUTTER 4.0MM X 13CM $149.00

DISSECTOR 4.0MMX13CM $149.00

EXCALIBUR 4.0MM X 13CM $149.00

BURR OVAL 8 FLUTE 4.0MMX13CM $149.00

FEMORAL NAIL 10X300MM $3,461.00 C1713

CORTEX SCREW 4.5MMX24MM $105.00 C1713

CORTEX SCREW 4.5MM X 30MM $105.00 C1713

CORTEX SELF TAPPING SCREW $94.00 C1713

CONNECT PIN-DIST LAT FEMUR $541.00 C1713

4.0 TORPEDO ARTHREX $308.00

POWERPICK ARTHREX $308.00

BURR, ARTHOSCOPIC 5.0 $308.00

POWER RASP 4.0 ARTHREX $308.00

APOLLO RF HOOK PROBE $397.00

PRINTER PAPER/RIBBON ARTHREX $607.00

Page 354: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

5.0 OVAL BURR $149.00

TUBING INSUFFLATION/ARTHREX $56.00

TUBING HEATED INSUFFL/ARTHREX $179.00

BLADE, PLASMABLADE TNA $647.00

SCREW,HEXALOBE LAX 1.5 X 8MM $329.00 C1713

SCREW, HEXALOBE LAG 1.5 X 9MMM $329.00 C1713

SCREW HEXALOBE LAG 1.5 X 10MM $329.00 C1713

SCREW, HEXALOBE LAG 1.5 X 11MM $329.00 C1713

SCREW HEXALOBE LAG 1.5 X 14MM $329.00 C1713

SCREW HEXALOBE LAG 1.5 X 16MM $329.00 C1713

SCREW, HEXALOBE LAG 1.5 X 18MM $329.00 C1713

SCREW HEXALOBE LAG 1.5 X 20MM $329.00 C1713

EXTERNAL NEUROSTIMULATOR $996.00

NEUROSTIMULATOR KIT $244.00 C1897

NEUROSTIMULATOR LEAD TEMPORARY $149.00

VERTEBRAL BALLON TRAY $3,010.00

TUBING 4 SPIKE GRAVITY IRR $106.00

TIBIAL INSERT SZ 2 MAKO UNI OL $1,735.00 C1776

FEMORAL-RM-LL SZ 3 MCK $4,190.00 C1776

TIBIAL BASEPLATE-RM/LL SZ 2 MC $2,604.00 C1776

SUTR ANCH, PEEK CRKSCRW FT $747.00 C1713

SUTR ANCH, PEEK, CS FT, 4.75MM $784.00 C1713

LOW PROFILE CANNULA $93.00

RIO DRAPE KIT, 1 PIECE W/POC $93.00

TRACKING KIT, KNEE VIZADISC $366.00

TRACKING KIT, HIP VIZADISC $366.00

PIN, BONE 3.2 X 80MM $130.00 C1713

PIN, BONE 3.2 X 110MM $130.00 C1713

PIN, BONE 3.2 X 140MM $130.00 C1713

PIN, BONE 4 X 80MM $130.00 C1713

PIN, BONE 4 X 110MM $130.00 C1713

PIN, BONE 4 X 140MM $130.00 C1713

PIN, BONE 4 X 170MM $130.00 C1713

KIT CHECKPOINT FEM/TIB $186.00

KIT CHECKPOINT TIBIAL $93.00

KIT CHECKPOINT FEMORAL $93.00

WRAP, POSITIONER STYRK LEG $74.00

CORD SILICONE RETRACTOR $45.00

CHECKPOINT 3.5MM X 15MM $229.00

ANSPACH 8MM FLUTED BALL BURR $229.00

IRRIGATION CLIP ANSPACH $130.00

TUBE IRRIGATION ANSPACH HF $130.00

WRAP LEG DEMAYO $74.00

TUBE ARMSTRONG BEVELED $37.00

BONE CUTTER, HL 4.2MMX19CM $149.00

HIP ARTHOSCOPY MSTR DIS KITW/B $1,121.00

HIP ARTHROSCOPY SET $450.00

HIP ARTHROSCOPE INST SET $872.00

SUTR ANCH, PEEK 4.75 X 19.1MM $934.00 C1713

SCREW ASNIS 3.0 X 38 $538.00 C1713

Page 355: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

TIBIAL INSERT MAKO ONLAY $1,763.00 C1713

TIBIAL BASE PLATE MAKO ONLAY $2,641.00 C1713

FEMORAL COMP MAKO SZ 3 $4,253.00 C1713

ACU-L=LOK 2 VDR PLATES $2,612.00 C1713

SCREW, CANN BONE TAP 4.5MM $534.00 C1713

SCREW, LO-PRO PT THD TI 4.5X50 $1,836.00 C1713

PLATE, PROX HUMERUS 3H RIGHT $3,406.00 C1713

SCREW PEEK INTERF 2/DISP SHTH $623.00 C1713

SUTURE ANCHOR, PEEK SWIVELOCK $934.00 C1713

SUTURE, FIBERTAK ANCHOR $809.00 C1713

INTSCREW RD DELTATPR W/DISP $623.00 C1713

IMP SYS INTBRACE KNEE LIG AUG $2,700.00 C1713

PLATE 6 HOLE RT 16MM $2,470.00 C1713

SCREW, EMER CROSS PIN 1.9X5MM $238.00 C1713

SCREW, EMERG CROSS PIN 1.9X8MM $238.00 C1713

SCREW CORTICAL 2.0 ST L6 $172.00 C1713

SCREW, BONE 2.7 X 34MM $174.00 C1713

DISPS KIT 3.0MM HIP S-TAK $534.00

SUTURE, ANC, PEEK STURTAK $635.00 C1713

SCREW, BONE 2.7 X 14MM $357.00 C1713

TIBIAL BEARING INSERT SZ 7 $3,164.00 C1776

TIBIAL BASEPLATE SZ5 MAKO $2,641.00 C1776

FEMORAL COMP SZ 5 MAKO $4,253.00 C1776

TIBIAL INSERT SZ5 MAKO ONLAY $1,176.00 C1776

TIBIAL BASEPLATE SZ 3 MAKO $2,641.00 C1776

FEMORAL COMP SZ 4 MAKO $4,253.00 C1776

TIBAIL INSERT SZ 3 MAKO $1,763.00 C1776

PLATE, TIB PROX LAT 12 HOLE $3,378.00 C1713

HIP STEM CEMENT, SIZE 2 $3,112.00 C1776

TUBE ENDOTRAC RAE 5.0 CUFF $10.00

TUBE ENDOTRAC RAE 5.5 CUFF $10.00

TUBE ENDOTRAC RAE 6.0 CUFF $10.00

HUMERUS NAIL LG LT 8X260MM PRO $3,668.00 C1776

SCREW 2.7 X 30MM LOCKING $320.00 C1713

DRILL PIN, FLEX TIGHTROPE $595.00

REAMER ARTHREX FLEX 10MM $872.00

NEEDLE SCORP CAPS CLOSE $610.00

DISP KIT 2.4MM PUSHLOCK $685.00

SUTURE ANC 2.4MM HIP PEEK PL $946.00 C1713

BURR, ROUND HL 8 FL 4MMX19CM $149.00

EXCALIBUR HL 4.2MM X 19CM $149.00

NAIL SCN 10X 360 $3,941.00 C1713

NAIL, SCN 11 X 300 $3,941.00 C1713

SCREW, LOCKING 2.7 X 28MM $424.00 C1713

SCREW, LOCKIN 2.7 X 22MM $424.00 C1713

SCREW,CANN 5.0 X 42 MM $520.00 C1713

TIBIAL BEARING INSERT SZ 1 $3,782.00 C1776

DRESSING VAC VERAFLO CLEANSE $400.00

KNEE COMP KIT ZIMMER 414.503 $8,700.00 C1776

SCREW INTS, 12X28MM $623.00 C1713

Page 356: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

DISPOSABLES KIT, 2.4MM PUSHLOC $685.00

GRAFT, VASCULAR HEMA 10X85 $3,135.00 C1768

NAIL,HUMERAL, LONG LT 8X24MM $3,668.00 C1713

SHOUDER TOTAL, REVERSE $16,710.00 C1776

SUTURE ANCHOR,PEEK PUSHLOCK $896.00 C1713

PLATE TIBIA RT 4 HOLE $3,096.00 C1713

PLATE 4/3 HOLE TI-T PLATE $412.00 C1713

SCREW CANCELLOUS TI 4MM $123.00 C1713

SCREW, CAN MICRO 2.0 X 26MM $538.00 C1713

SCREW CAN MICRO 2.0 X 24MM $538.00 C1713

SUTURE ANCHOR, PEEK CORKSCREW $710.00 C1713

DISP KIT, FOR FIBERTAK SUT ANC $595.00

DRILL 1.7MM FOR FIBERTAK $320.00

90 DEG CURVE RT $427.00

CANNULA, PARTIALL THREAD $93.00

RT TIBIA PLATE 10 HOLE $3,378.00 C1713

ULNA PLATE 6 HOLE $1,970.00 C1713

FEMORAL POST STABIL SZ 1 $5,090.00 C1713

DAVINCI STAPLER 20 RELOAD $521.00

DAVINCI STAPLER 20 CURVED TIP $439.00

TIBIAL BASEPLATE MAKO ONLAY $2,641.00 C1776

TIBIAL INSERT MAKO ONLAY $1,763.00 C1776

MAKO PATELLOFEMORAL COM SZ5 $6,637.00 C1776

HIP STEM NEUT 130 NECK ANG SZ5 $7,881.00 C1776

PLATE 4 HOLE STRAIGHT $595.00 C1713

CATH SING LUMEN 9.6 FR $684.00

DAVINCI CLIP HEM-O-LOK LG/MD $99.00

PLATE 5H COMP NARROW, STRAIGHT $941.00 C1713

BLADE SHAVER AGRS 2.3MM $149.00

SCREW LAG 2.3 X 14MM $299.00 C1713

AMNISURE ROM TEST $186.00

AMNISURE CONTROL KIT $214.00

MAKO TIBIAL BEARING SZ 6 $3,164.00 C1776

OBTURATOR OPTICAL 12MM $238.00

NAIL FEMORAL LT 10X380MM $3,905.00 C1713

PLATE, HUMERUS 4 HOLE PROX $3,406.00 C1713

HIP STEM CEMENTED ACCOLADE $5,052.00 C1776

SCREW, TENO, PEEK VENT $784.00 C1713

FIBERWIRE, BRADIDED PB 2-0 SU $78.00

RADIAL/HUMERAL HEAD SZ 40 $2,246.00 C1776

PLATE ANCH OPN WED OMM $2,644.00 C1713

SCREW ANCHORAGE LOCK 3MM X 10 $507.00 C1713

DRAPE 3 STR SHEET $226.00

ENDOTRAC TUBE 2.5 CUFFED $68.00

INTRATHE CATH PINAL SEG REV KI $747.00 C1755

SCREW HEXA 4.O MM PT SZ 28 $244.00 C1713

SCREW HEXA 4.0MM PT SZ 30 $244.00 C1713

SCREW HEXA 4.0MM PT SZ 30 $244.00 C1713

PLATE FIBULA LAT 9 HOLE LT $2,079.00 C1713

GASTRIC FEEDING TUBE $112.00

Page 357: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

ACCUCATH 20 GA X 1.25 $24.00

SCREWDRIVER T/O $547.00

SUTURETAPE 1.3MM W/NEEDLE W/B $130.00

ARTHRE DEV PANTH 7 FR $6,300.00 C1714

DAVINCI CORD MONOPOLAR $672.00

DAVINCI CORD BIPOLAR $672.00

CIRCUIT LOW FLOW DIS PT $278.00

SUTURE, FIBERTAK DOU LOAD FW C $847.00 C1713

ENDO SUTURE CLOSER EFX SYS $108.00

DAVINCI ENDOWRIST 12MM BLDLESS $238.00

OLECRANON PLATE LT 5 HOLE $2,516.00 C1713

SCREW, HEXALOBE LOCKING 3.5MM $418.00 C1713

SCROTAL 0DEG ANG CYL SET W/PUM $19,288.00 C1813

BICEPS TENODESIS KIT PROX $1,559.00 C1713

TSA HUMKERAL STEM SZ 15 $5,422.00 C1776

CIRCUITS VEN EMV EAGLE 2 $56.00

GUIDEWIRE PRESSURE FFR COMET $1,478.00 C1769

CATHETER OPTICROSS IVUS $1,478.00 C1753

CIRCUIT INFANT EMV AEV EAGII $50.00

PLATE VARIAX CLAVICLE HOOK $2,470.00 C1713

LEVER BONE 230 X 19MM $637.00

ZYGOMA HOOK 21CM $275.00

PLATE 8 HOLE LOCK RECON $1,186.00 C1713

DEPTH GAUGE FOR LOCK SCREW $954.00

SCREW, LOCKING 2.7MM X 55MM $478.00 C1713

SCREW, LOCKING 2.7MM X 65MM $478.00 C1713

DAVINCI FORCEP TENACULUM X1 $548.00

PLATE LOCK COMP NAR 8 HOLE $3,604.00 C1713

PLATE LOCK COMP NAR 10 HOLE $3,604.00 C1713

PLATE LOCK COMP BROAD 8 HOLE $3,604.00 C1713

PLATE VARIAX COMP 7 HOLE $947.00 C1713

PLATE VAR COMP NAR,ST8,8HOLES $1,282.00 C1713

PLATE VAR COMP 7 HOLE $941.00 C1713

T2 SUPRACONDYLAR NAIL 10X32OMM $3,940.00 C1713

T2 SUPRACONDYLAR NAIL 10X400MM $3,940.00 C1713

T2 SUPRACONDYLAR 11X320MM $3,940.00 C1713

TRANSMITTER BAG STERILE $112.00

T2 SUPRACONDYLAR NAIL 11X360MM $3,940.00 C1713

T2 SUPRACONDYLAR NAIL 11X420MM $3,940.00 C1713

T2 SUPRACONDYLAR NAIL 12X300MM $3,940.00 C1713

T2 SUPRACONDYLAR NAIL 12X360MM $3,940.00 C1713

T2 SUPRACONDYLAR NAIL 12X420MM $3,940.00 C1713

T2 SUPRACONDYLAR NAIL 11X200MM $3,940.00 C1713

T2 SUPRACONDYLAR NAIL 10X170MM $3,940.00 C1713

T2 SUPRACONDYLAR NAIL 14X170MM $3,940.00 C1713

FEMORAL COMPONENT DISTAL $11,447.00 C1776

STRAIGHT FLUTED PRESS-FIT STEM $7,426.00 C1776

TITANIUM FLUTED STEM $2,037.00 C1776

RADIAL HEAD 8MM MORSE TAPER L $5,072.00 C1776

RADIAL HEAD 22.OMM ANATOMIC $7,420.00 C1776

Page 358: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

SCREW 6.5MM LOW PRO HEX 25MM $291.00 C1713

SCREW 6.5MM LOW PRO HEX 35MM $291.00 C1713

DISTAL MEDIAL PLATE 12 HOLE $2,642.00 C1713

SCREW HEX 6.5MM X 30MM $291.00 C1713

CLUSTERHOLE 52E TRIDENT TITAN $4,040.00 C1776

CONFORM BAND 6CM X 5M $21.00 A6442

CONFORM BAND 8CM X 5M $27.00 A6443

CONFORM BAND 10CM X 5M $32.00 A6443

CONFORM BAND 12CM X 5M $38.00 A6443

PAD FOR COM BAND 10CMX2.5MX0.3 $25.00 S8430

PAD FOR BAND 10CMX2.5MX0.4 $21.00 S8430

PAD FOR BAND 12CMX2.5CMX0.4 $23.00 S8430

PAD FOR BAND 15CMX2.5MX0.4 $46.00 S8430

PAD BAND 15CM X 5M ISOBAND $38.00 A6450

TUBULAR DRESS D5 XSM 6CM X 20M $51.00 A6457

TUBULAR DRESS SM 8CM X 20M $55.00 A6457

TUBULAR DRESS 10CM X 20M $66.00 A6457

TUBULAR DRESS MLG 12CM X 20M $73.00 A6457

CONFORM BAND 6CM X 4M $31.00 A6446

GRAY FOAM $70.00

ELITE THERA BATH WASH 8OZ $36.00

LYMPHO BATH SOLUTION 8OZ $42.00

CITRONELLA LOTION 8 OZ $61.00

EUCERIN LOTION 16 OZ $69.00

JOBST IT STAYS ADHESIVE 2 OZ $38.00

ALPS FITTING LOTION 4 OZ $75.00

TIBIAL BEARING INSERT SZ 3 $3,164.00 C1713

TIBIAL BEARING INSERT SZ 6 $3,164.00 C1713

ICD EMBLEM SUBQ SYSTEM $42,323.00 C1722

SCREW, 2.3 MM X 18MM HEX LAG $299.00 C1713

SCREW, 2.3MM X 20MM HEX LAG $299.00 C1713

LEAD, ICD EMBLEM SQ $8,310.00 C1896

ADAPTER LATTUDE CELL USB $623.00

PLATE 7H R VARIAX CLAV 12MM $2,470.00 C1713

SCREW 3.0 ASNIS SZ 19 $538.00 C1713

INTRO T151 1STEP TRO & DIA $2,580.00

TOOLKIT VPT02A VP NEE SET CUR $1,340.00

CEM GUN AND BONE FILLER SZ 3 $1,233.00

BALLOON NONCOMPL 2.0 X12MM $553.00 C1726

BALLOON NONCOMP 2.5 X12MM $553.00 C1726

BALLOON SEMICOMP 1.5MM X 6MM $829.00 C1726

BALLOON SEMICOMP 1.5 X 12MM $829.00 C1726

BALLOON SEMICOMP 1.5 X 15MM $829.00 C1726

BALLOON SEMI COMPLIN 2.0 X12MM $553.00 C1726

BALLOON SEMI COMP 2.0 X 15MM $553.00 C1726

BALLOON SEMICOMP 2.0 X 20MM $553.00 C1726

BALLOON SEMICOMP $553.00 C1726

BALLOON SEMICOMP 2.5 X 15MM $553.00 C1726

BALLOON SEMICOMP 2.5 X 20MM $553.00 C1726

SCREW BONE 2.3X20MM $247.00 C1713

Page 359: Description Amout Charged CPT CODE HCPCS ......Description Amout Charged CPT CODE HCPCS ACIDOPHILUS 2 TABLET $11.00 RHYTHM STRIP ALONE $102.00 93041 DERMOPLAST PAIN SPRAY $29.36 FLU

BONE SCREW 2.3 X 22MM $247.00 C1713

SCREW BONE 2.3X24MM $247.00 C1713

BONE SCREW 2.3 X 26MM $247.00 C1713

BONE CEMENT BIOMET $214.00 C1713

GLENOID VAULTLOCK ARTHREX UNIV $3,060.00 C1776

SUTURE KIT ARTH UNIVERS APEX $869.00

HUMERAL STEM ARTHREX UNIVERS $7,606.00 C1776

HUMERAL HEAD ARTH UNIVERS II $3,366.00 C1776

NERVE CONNECTOR 2 X 10MM AXOGU $2,760.00 C9353

NERVE CONNECTOR 3X10MM AXOGUA $2,760.00 C9353

PLATE MODULE LID FOR DELUXE $369.00 C1776

PLATE DIS FIB MOD LID FOR VARI $479.00 C1776

HEAD, RADIAL 20MM PROLINE $4,080.00 C1776

K WIRE 1.1 MM $160.00 C1713

DRILL 2.0 MM $767.00

K WIRE 1.6 MM $160.00 C1713

SCREW W/DISP SHTH 7 X 23MM $623.00 C1713

GUIDE, DRILL 1.4/2.7 $441.00

SCREW, CORTEX SHAFT 3.5 $94.00 C1713

SLINGSHOT 70 DEF UP STRYKER $739.00

TRI CUL BLOOD STERIPATH $78.00

TRI CUL BLOOD STERIPATH 21g NE $78.00

TRI CUL BLOOD STERIPATH 23G NE $78.00

ABD PARACENTESIS W/IMAGING $1,749.48 49083

ALLEVYEN HEEL PADS $31.00