mpin |
claim |
dos |
descript |
item |
qty |
unit |
total |
invoice |
contract |
|
|
|
123 |
11/15/2011 |
60MM ACE SHELL, HEMI, HOLED |
1706-0-0060 |
1 |
$3,450.00 |
$3,450.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
123 |
11/15/2011 |
20MM, 6.5 CANCELLOUS BONE SCREW |
0013-1-6520 |
1 |
$250.00 |
$250.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
123 |
11/15/2011 |
LOCKING NUT, TI, 30MM |
3449-03000-0 |
1 |
$350.00 |
$350.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
123 |
11/15/2011 |
26 X 30, PROX BODY, HA/PLASMA |
3461-5260-A |
1 |
$4,950.00 |
$4,950.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
123 |
11/15/2011 |
10CC DBM PUTTY |
DBM510 |
2 |
$2,950.00 |
$5,900.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
123 |
11/15/2011 |
.5ML BIODFACTOR HUMAN AMNION ALLOGRAFT |
BD50 |
1 |
$4,000.00 |
$4,000.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
123 |
11/15/2011 |
30CC CRUSHED CANCELLOUS |
CC30 |
1 |
$1,200.00 |
$1,200.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
123 |
11/15/2011 |
4X6CM HUMAN AMNION PATCH |
HA460 |
1 |
$5,000.00 |
$5,000.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
123 |
11/15/2011 |
15MM, 6.5 CANCELLOUS BONE SCRW |
0013-1-6515 |
1 |
$250.00 |
$250.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
123 |
11/15/2011 |
36X60 XLINK ACE INSERT 10 HOOD |
1008-0-3660 |
1 |
$3,150.00 |
$3,150.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
123 |
11/15/2011 |
NECK, STANDARD 36MM X 34MM |
3441-13634-A |
1 |
$4,795.00 |
$4,795.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
123 |
11/15/2011 |
STEM, 18X160 FLUTED, STRAIGHT |
3422-11816-0 |
1 |
$3,795.00 |
$3,795.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
123 |
11/15/2011 |
NEU, 36MM BIOLOX DELTA FEM HD |
0005-0-3602 |
1 |
$2,895.00 |
$2,895.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
899 |
11/20/2011 |
VeriFLEX (MR) US 4.5 x 16mm |
|
1 |
$560.00 |
$560.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
899 |
11/20/2011 |
VeriFLEX (MR) US 3.5 x 12mm |
|
1 |
$560.00 |
$560.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
980 |
11/29/2011 |
|
|
|
|
$0.00 |
|
Implant Pass-through: PPR Tied to Invoice |
|
400 |
11/29/2011 |
FG,Promus Element Plus, MR,US 3.5x28 |
14714363 |
1 |
$1,485.00 |
$1,485.00 |
|
Implant Pass-through: PPR Tied to Invoice |