Xtant Medical (XTNT) 10-Q 14 Aug 15 2015 Q2 Quarterly report Financial data

Document And Entity Information

Document And Entity Information - shares	6 Months Ended
	Jun. 30, 2015	Aug. 06, 2015
Document Information [Line Items]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Jun. 30, 2015
Document Fiscal Year Focus	2,015
Document Fiscal Period Focus	Q2
Entity Registrant Name	Xtant Medical Holdings, Inc.
Entity Central Index Key	1,453,593
Current Fiscal Year End Date	--12-31
Entity Filer Category	Smaller Reporting Company
Trading Symbol	BONE
Entity Common Stock, Shares Outstanding		11,746,051

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($)	Jun. 30, 2015	Dec. 31, 2014
Current Assets:
Cash and cash equivalents	$ 2,026,108	$ 4,468,208
Trade accounts receivable, net of allowance for doubtful accounts of $1,322,569 and $1,392,989, respectively	5,574,285	4,427,081
Inventories, net	9,392,150	9,558,648
Prepaid and other current assets	1,033,605	654,140
Total current assets	18,026,148	19,108,077
Non-current inventories	1,839,971	1,934,258
Property and equipment, net	4,430,038	4,654,527
Intangible assets, net	609,348	655,490
Other assets	1,446,515	1,598,539
Total Assets	26,352,020	27,950,891
Current Liabilities:
Accounts payable	4,577,488	3,876,760
Accounts payable - related party	293,565	250,629
Accrued liabilities	2,399,599	1,921,301
Warrant derivative liability	1,796,660	1,320,371
Current portion of capital lease obligations	42,761	61,970
Current portion of royalty liability	1,169,500	1,000,750
Current portion of long-term debt	52,374	50,671
Total current liabilities	10,331,947	8,482,452
Long-term Liabilities:
Capital lease obligation, less current portion	37,496	11,808
Long-term royalty liability, less current portion	6,139,374	6,361,216
Long-term debt, less current portion	21,691,674	20,870,330
Total Liabilities	$ 38,200,491	$ 35,725,806
Commitments and Contingencies
Stockholders' (Deficit) Equity
Preferred stock, $0.000001 par value; 5,000,000 shares authorized; no shares issued and outstanding	$ 0	$ 0
Common stock, $0.000001 par value; 95,000,000 shares authorized; 7,464,085 shares issued and outstanding as of June 30, 2015 and 6,679,646 shares issued and outstanding as of December 31, 2014	7	7
Additional paid-in capital	66,091,741	63,091,620
Accumulated deficit	(77,940,219)	(70,866,542)
Total Stockholders’ Deficit	(11,848,471)	(7,774,915)
Total Liabilities & Stockholders’ Deficit	$ 26,352,020	$ 27,950,891

CONDENSED CONSOLIDATED BALANCE3

CONDENSED CONSOLIDATED BALANCE SHEETS [Parenthetical] - USD ($)	Jun. 30, 2015	Dec. 31, 2014
Trade accounts receivable, allowance for doubtful accounts (in dollars)	$ 1,322,569	$ 1,392,989
Preferred stock, par value (in dollars per share)	$ 0.000001	$ 0.000001
Preferred stock, shares authorized	5,000,000	5,000,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value (in dollars per share)	$ 0.000001	$ 0.000001
Common stock, shares authorized	95,000,000	95,000,000
Common stock, shares issued	7,464,085	6,679,646
Common Stock, shares outstanding	7,464,085	6,679,646

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014	Jun. 30, 2015	Jun. 30, 2014
Revenue
Tissue sales	$ 9,732,909	$ 8,714,915	$ 19,009,956	$ 17,466,260
Royalties and other	159,706	169,017	385,773	330,642
Total Revenue	9,892,615	8,883,932	19,395,729	17,796,902
Cost of sales	3,375,288	3,290,512	6,847,766	6,701,218
Gross Profit	6,517,327	5,593,420	12,547,963	11,095,684
Operating Expenses
General and administrative	2,399,133	2,093,792	4,824,300	4,382,595
Sales and marketing	5,035,577	4,405,227	9,749,249	8,460,431
Research and development	291,171	322,277	724,732	576,860
Depreciation and amortization	100,663	82,432	224,774	157,580
Non-cash consulting expense	74,074	21,701	140,869	42,228
Total Operating Expenses	7,900,618	6,925,429	15,663,924	13,619,694
Loss from Operations	(1,383,291)	(1,332,009)	(3,115,961)	(2,524,010)
Other Income (Expense)
Interest expense	(1,383,642)	(1,441,989)	(2,819,220)	(2,717,601)
Change in warrant derivative liability	(14,081)	870,494	(476,289)	(615,235)
Non-cash consideration associated stock agreement	0	0	(558,185)	0
Other income (expense)	(114,963)	3,074	(103,126)	(183,839)
Total Other Income (Expense)	(1,512,686)	(568,421)	(3,956,820)	(3,516,675)
Net Loss from Operations	$ (2,895,977)	$ (1,900,430)	$ (7,072,781)	$ (6,040,685)
Net loss per share:
Basic	$ (0.41)	$ (0.35)	$ (1.02)	$ (1.11)
Dilutive	$ (0.41)	$ (0.35)	$ (1.02)	$ (1.11)
Shares used in the computation:
Basic	7,137,391	5,514,694	6,914,698	5,447,204
Dilutive	7,137,391	5,514,694	6,914,698	5,447,204

CONDENSED CONSOLIDATED STATEME5

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)	6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014
Operating activities:
Net loss	$ (7,072,781)	$ (6,040,685)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	446,799	345,580
Non-cash interest	363,375	0
Non-cash consideration associated with stock purchase agreement	558,185	0
Gain on sale of fixed assets	(17,215)	(13,285)
Amortization of debt discount	848,773	739,127
Non-cash consulting expense/stock option expense	444,395	668,876
Provision for losses on accounts receivable and inventory	(19,394)	338,720
Change in derivative warrant liability	476,289	615,235
Changes in operating assets and liabilities:
Accounts receivable	(1,076,784)	(220,453)
Inventories	209,760	306,863
Prepaid and other assets	(352,704)	(274,825)
Accounts payable	742,767	1,040,469
Accrued liabilities	358,298	(1,376,180)
Net cash used in operating activities	(4,090,237)	(3,870,558)
Investing activities:
Purchases of property and equipment and intangible assets	(70,441)	(115,202)
Proceeds from sale of fixed assets	16,415	36,071
Net cash used in investing activities	(54,026)	(79,131)
Financing activities:
Proceeds from issuance of debt	0	4,000,000
Payments on long-term debt	(25,727)	(24,242)
Payments on capital leases	(64,442)	(82,987)
Payment on royalty obligation	(325,228)	0
Net proceeds from issuance of stock	2,117,560	0
Net cash provided by financing activities	1,702,163	3,892,771
Net change in cash and cash equivalents	(2,442,100)	(56,918)
Cash and cash equivalents at beginning of period	4,468,208	3,046,340
Cash and cash equivalents at end of period	$ 2,026,108	$ 2,989,422

Business Description and Summar

Business Description and Summary of Significant Accounting Policies	6 Months Ended
	Jun. 30, 2015
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business Description and Summary of Significant Accounting Policies	The accompanying consolidated financial statements include the accounts of Xtant Medical Holdings, Inc. (“Xtant”) formerly known as Bacterin International Holdings, Inc., a Delaware corporation, and its wholly owned subsidiary, Bacterin International, Inc., (“Bacterin”) a Nevada corporation (Xtant and Bacterin are jointly referred to herein as, the “Company”). All intercompany balances and transactions have been eliminated in consolidation. Bacterin develops, manufactures and markets biologic products to domestic and international markets. Bacterin’s proprietary methods are used to process human derived allografts into scaffolds that promote bone and other tissue growth. These products are used in a variety of applications including enhancing fusion in spine surgery, relief of back pain with a facet joint stabilization, promotion of bone growth in foot and ankle surgery, promotion of skull healing following neurosurgery and regeneration in knee and other joint surgeries. Bacterin also previously developed and licensed coatings for various medical device applications. As of December 31, 2014, Bacterin made a strategic decision to discontinue the medical device coatings business which resulted in an impairment of related assets. (See Note 4, “Impairment of Assets”). An operating segment is a component of an enterprise whose operating results are regularly reviewed by the enterprise’s chief operating decision maker to make decisions about resources to be allocated to the segment and assess its performance. The primary performance measure used by management is net income or loss. Up until December 31, 2014, the Company operated two distinct lines of business consisting of the biologics and the device divisions; however, due to immaterial revenue from the device division, the Company has reported as one segment. On July 31, 2015, Xtant acquired all of the outstanding capital stock of X-spine Systems, Inc. (“X-spine”) for approximately $ 60 13 4.24 The markets in which the Company competes are highly competitive and rapidly changing. Significant technological advances, changes in customer requirements, or the emergence of competitive products with new capabilities or technologies could adversely affect the Company's operating results. The Company's business could be harmed by a decline in demand for, or in the prices of, its products or as a result of, among other factors, any change in pricing or distribution methods, increased price competition, changes in government regulations or a failure by the Company to keep up with technological change. Further, a decline in available tissue donors could have an adverse impact on our business. The accompanying interim condensed consolidated financial statements of the Company for the six months ended June 30, 2015 and 2014 are unaudited and are prepared in accordance with accounting principles generally accepted in the United States of America. They do not include all disclosures required by generally accepted accounting principles for annual financial statements, but in the opinion of management, include all adjustments, consisting only of normal recurring items, necessary for a fair presentation. Interim results are not necessarily indicative of results which may be achieved in the future for the full year ending December 31, 2015. These financial statements should be read in conjunction with the financial statements and notes thereto which are included in our Annual Report on Form 10-K for the year ended December 31, 2014. The accounting policies set forth in those annual financial statements are the same as the accounting policies utilized in the preparation of these financial statements, except as modified for appropriate interim financial statement presentation. Xtant completed a In August 2014, Xtant offered 1,143,000 5.70 571,500 7.12 6.5 5.9 We entered into a Common Stock Purchase Agreement on March 16, 2015, as amended and restated on April 17, 2015 (the “Purchase Agreement”), with Aspire Capital Fund, LLC (“Aspire Capital”), which provides that, upon the terms and subject to the conditions and limitations set forth therein, Aspire Capital is committed to purchase up to an aggregate of $ 10.0 207,182 750,000 154,189 3.62 558,185 417,000 1,387,439 The Company’s accounts receivable are due from a variety of health care organizations and distributors throughout the world. Approximately 97 98 Six Months Ended 2015 2014 United States $ 18,831,197 $ 17,509,988 Rest of World 564,532 286,914 $ 19,395,729 $ 17,796,902 The preparation of the financial statements requires management of the Company to make a number of estimates and assumptions relating to the reported amount of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the period. Significant estimates include the carrying amount of property and equipment and intangible assets; valuation allowances for trade receivables and deferred income tax assets; valuation of the warrant derivative liability; inventory reserve; royalty liability; and estimates for the fair value of stock options grants and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates. Long-lived assets, including intangible assets, are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to future net cash flows expected to be generated by the asset. If such assets are considered to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount of the assets exceeds the estimated fair value of the assets. See Note 4, “Impairment of Assets”. Revenue is recognized when all of the following criteria are met: a) the Company has entered into a legally binding agreement with the customer; b) the products or services have been delivered; c) the Company's fee for providing the products and services is fixed or determinable; and d) collection of the Company’s fee is probable. The Company’s policy is to record revenue net of any applicable sales, use, or excise taxes. If an arrangement includes a right of acceptance or a right to cancel, revenue is recognized when acceptance is received or the right to cancel has expired. The Company ships to certain customers under consignment arrangements whereby the Company’s product is stored by the customer. The customer is required to report the use to the Company and upon such notice, the Company invoices the customer and revenue is recognized when above criteria have been met. The Company also receives royalty revenue from third parties related to licensing agreements. The Company has royalty agreements with RyMed and Bard Access Systems. Revenue under these agreements represented less than 0.5% of total revenue for the six months ended June 30, 2015 and 2014. The Company expenses advertising costs as incurred. The Company had advertising expense of $ 3,688 27,914 Research and development costs, which are principally related to internal costs for the development of new allograft technologies and processes are expensed as incurred. Basic net income (loss) per share is computed by dividing net income (loss) by the weighted average number of common shares outstanding. Shares issued during the period and shares reacquired during the period are weighted for the portion of the period that they were outstanding. Diluted net income (loss) per share is computed in a manner consistent with that of basic earnings per share while giving effect to all potentially dilutive common shares outstanding during the period, which include the assumed exercise of stock options and warrants using the treasury stock method. Diluted net loss per share was the same as basic net loss per share for the three and six months ended June 30, 2015 and 2014, as shares issuable upon the exercise of stock options and warrants were anti-dilutive as a result of the net losses incurred for those periods. Dilutive earnings per share are not reported as their effects of including 2,142,257 1,784,107 The carrying values of financial instruments, including trade accounts receivable, accounts payable, other accrued expenses and long-term debt, approximate their fair values based on terms and related interest rates. The Company follows a framework for measuring fair value. The framework provides a fair value hierarchy that prioritizes the inputs to valuation techniques used to measure fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (Level 1) and the lowest priority to unobservable inputs (Level 3). The three levels of the fair value hierarchy are described below: Level 1: Inputs to the valuation methodology are unadjusted quoted prices for identical assets or liabilities in active markets. Level 2: Inputs to the valuation methodology include quoted prices for similar assets and liabilities in active markets, and inputs that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the financial instrument. Level 3: Inputs to the valuation methodology are unobservable and significant to the fair value measurement. A financial instrument's level within the fair value hierarchy is based on the lowest level of any input that is significant to the fair value measurement. During the three and six months ended June 30, 2015 and 2014, there was no reclassification in financial assets or liabilities between Level 1, 2 or 3 categories. The following table sets forth by level, within the fair value hierarchy, our liabilities as of June 30, 2015 and December 31, 2014 that are measured at fair value on a recurring basis: As of As of Level 1 - - Level 2 - - Level 3 $ 1,796,660 $ 1,320,371 The valuation technique used to measure fair value of the warrant liability is based on a valuation model and significant assumptions and inputs determined by us (See Note 10, “Warrants” below). Level 3 Changes Warrant derivative liability Balance at January 1, 2015 $ 1,320,371 Loss recognized in earnings in first quarter of 2015 462,208 Balance at March 31, 2015 1,782,579 Loss recognized in earnings in second quarter of 2015 14,081 Balance at June 30, 2015 $ 1,796,660 During the first six months ended June 30, 2015, the Company did not change any of the valuation techniques used to measure its liabilities at fair value. In November 2014, FASB issued ASU No. 2014-08, Presentation of Financial Statements (Topic 201) and Property, Plant and Equipment (Topic 360) - Reporting Discontinued Operations and Disclosures of Disposals of Components of an Entity. The amendments in this Update are effective for the annual period ending after December 15, 2014, and interim periods within those years. Early adoption is permitted only for disposals (or classifications as held for sale) that have not been reported in financial statements previously issued or available for issuance. ASU 2014-08 is not expected to have a material impact on our consolidated financial position, results of operations, or cash flows. In April 2015, the FASB issued ASU 2015-3, to simplify the presentation of debt issuance costs. This update requires that debt issuance costs be presented in the balance sheet as a direct deduction from the carrying amount of the associated debt liability, consistent with the required presentation for debt discounts. This update is effective for interim and annual periods beginning after December 15, 2015. ASU 2015-3 is not expected to have a material impact.

Equity

Equity	6 Months Ended
	Jun. 30, 2015
Equity [Abstract]
Equity	(2) Equity During the first quarter of 2014, the Company issued 150,000 4 In August 2014, the Company offered 1,143,000 5.70 571,500 7.12 6.5 5.9 We entered into a Purchase Agreement on March 16, 2015, as amended and restated April 17, 2015, with Aspire Capital which provides that, upon the terms and subject to the conditions and limitations set forth therein, Aspire Capital is committed to purchase up to an aggregate of $ 10.0 207,182 750,000 154,189 417,000 1,387,439 Under the Purchase Agreement, we have the right, at our sole discretion, to present Aspire Capital with purchase notices, directing Aspire Capital (as principal) to purchase up to 50,000 500,000 • the lowest sale price of our common stock on the purchase date; or • the arithmetic average of the three lowest closing sale prices for our common stock during the ten consecutive trading days ending on the trading day immediately preceding the purchase date. In addition, we also have the right to present Aspire Capital with volume-weighted average price purchase notices directing Aspire Capital to purchase an amount of our common stock equal to up to 30 The Purchase Agreement may be terminated by us at any time, at our discretion, without any penalty or cost to us. The Purchase Agreement also provides for customary events of default, upon the occurrence of which Aspire Capital may terminate the Purchase Agreement. Aspire Capital has agreed that neither it nor any of its agents, representatives or affiliates shall engage in any direct or indirect short-selling or hedging of our common stock during any time prior to the termination of the Purchase Agreement. Any proceeds we receive under the Purchase Agreement are expected to be used for working capital and general corporate purposes.

Inventories

Inventories	6 Months Ended
	Jun. 30, 2015
Inventory Disclosure [Abstract]
Inventories	(3) Inventories June 30, December 31, 2015 2014 Current inventories Raw materials $ 4,219,024 $ 3,836,635 Work in process 2,407,919 2,484,635 Finished goods 5,131,354 5,163,458 11,758,297 11,484,728 Reserve for obsolescence (2,366,147) (1,926,080) Current inventories, total 9,392,150 9,558,648 Non-current inventories Finished goods 2,376,919 2,860,248 Reserve for obsolescence (536,948) (925,990) Non-current inventories, total 1,839,971 1,934,258 Total inventories $ 11,232,121 $ 11,492,906

Impairment of Assets

Impairment of Assets	6 Months Ended
	Jun. 30, 2015
Impairment or Disposal of Tangible Assets Disclosure [Abstract]
Impairment of Assets	(4) Impairment of Assets During the fourth quarter of 2014, management decided to dispose of a group of components because of a shift in strategy for the Company. The component groups are the inventory and fixed assets associated with the Device Coatings and Cranial Maxillofacial Fixation (CMF) lines of business. Sales for these product lines represented less than 1 1 Total assets associated with the two lines at December 31, 2014 included $ 80,042 832,507 912,549 0 The sale of the CMF inventory occurred during the first quarter of 2015 and did not result in any tangible payment to the Company. The sale of the Device Coatings line of business occurred subsequent to June 30, 2015. (See Note 15, “Subsequent Event” below). The terms of the sale call for an initial payment to the Company of approximately $ 250,000

Property and Equipment, Net

Property and Equipment, Net	6 Months Ended
	Jun. 30, 2015
Property, Plant and Equipment [Abstract]
Property and Equipment, Net	(5) Property and Equipment, Net June 30, December 31, 2015 2014 Buildings $ 1,657,579 $ 1,657,579 Equipment 4,800,284 4,724,608 Computer equipment 225,009 225,009 Computer software 360,171 345,039 Furniture and fixtures 153,834 153,834 Leasehold improvements 2,381,413 2,380,617 Vehicles 10,000 41,099 Total cost 9,588,290 9,527,785 Less: accumulated depreciation (5,158,252) (4,873,258) $ 4,430,038 $ 4,654,527 The Company leases certain equipment under capital leases. For financial reporting purposes, minimum lease payments relating to the assets have been capitalized. As of June 30, 2015, the Company has recorded $ 537,480 212,568 Maintenance and repairs expense for the six months of 2015 and 2014 was $173,443 and $ 140,504 336,913 307,747

Intangible Assets

Intangible Assets	6 Months Ended
	Jun. 30, 2015
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	(6) Intangible Assets Bacterin has applied for various patents with regards to processes for its products. June 30, December 31, Intellectual Property Gross carrying value $ 1,032,724 $ 1,036,580 Accumulated amortization (423,376) (381,090) Net carrying value $ 609,348 $ 655,490 Aggregate amortization expense: $ 75,860 $ 77,022 Remainder of 2015 $ 45,093 2016 59,343 2017 59,343 2018 59,154 2019 55,565 Thereafter 330,850 Total $ 609,348

Accrued Liabilities

Accrued Liabilities	6 Months Ended
	Jun. 30, 2015
Payables and Accruals [Abstract]
Accrued Liabilities	June 30, December 31, 2015 2014 Accrued stock compensation $ 120,000 $ - Wages/commissions payable 1,565,827 1,434,743 Other accrued expenses 713,772 486,558 $ 2,399,599 $ 1,921,301

Long-term Debt

Long-term Debt	6 Months Ended
	Jun. 30, 2015
Debt Disclosure [Abstract]
Long-term Debt	(8) Long-term Debt On March 6, 2014, we entered into a Sixth Amendment to our Credit Agreement with ROS whereby we borrowed an additional $ 4.0 150,000 June 30, December 31, Loan payable to ROS Acquisition Offshore, LIBOR plus 12.13% maturing August 2019 $ 24,000,000 $ 24,000,000 Adjustment fee payable to ROS Acquisition Offshore, due in August 2019 700,000 700,000 6.00% loan payable to Valley Bank of Belgrade, $10,746 monthly payments including interest, maturing December 24, 2030; secured by building 1,300,087 1,325,814 26,000,087 26,025,814 Less: current portion (52,374) (50,671) Debt discount (4,256,039) (5,104,813) Long-term debt $ 21,691,674 $ 20,870,330 Remainder of 2015 $ 24,882 2016 2,112,064 2017 8,290,378 2018 8,293,897 2019 6,239,295 Thereafter 1,039,571 Total $ 26,000,087 2015 $ 525,000 2016 1,229,250 2017 1,360,250 2018 1,462,750 2019 1,575,250 Thereafter 5,626,325 Total $ 11,778,825 Subsequent to June 30, 2015, the Company issued $ 65

Stock-Based Compensation

Stock-Based Compensation	6 Months Ended
	Jun. 30, 2015
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Stock-Based Compensation	(9) Stock-Based Compensation The Second Amended and Restated Bacterin International Equity Incentive Plan ("The Plan") which was approved at the annual stockholder meeting on June 24, 2015 provides for stock awards, including options and performance stock awards, to be granted to employees, consultants, independent contractors, officers and directors. The purpose of the Plan is to enable us to attract, retain and motivate key employees, directors and, on occasion, independent consultants, by providing them with stock options and restricted stock grants. Stock options granted under the Plan may be either incentive stock options to employees, as defined in Section 422A of the Internal Revenue Code of 1986, or non-qualified stock options. The Plan is administered by the compensation committee of our Board of Directors. Stock options granted under the Plan are generally not transferable, vest in installments over the requisite service period and are exercisable during the stated contractual term of the option only by such optionee. The exercise price of all incentive stock options granted under the Plan must be at least equal to the fair market value of the shares of common stock on the date of the grant. 1,400,000 580,000 Stock compensation expense recognized in the statement of operations for the six months ended June 30, 2015 and 2014 is based on awards ultimately expected to vest and reflects an estimate of awards that will be forfeited. ASC 718 requires forfeitures to be estimated at the time of grant and revised, if necessary, in subsequent periods if actual forfeitures differ from those estimates. Six Months Ended Six Months Ended June 30, 2015 June 30, 2014 Risk-free interest rate 1.75 % 1.76 % Expected volatility 80 % 63 % Expected term 6.3 Years 5.51 Years Expected forfeiture rate 20 % 20 % Dividend yield 0 % 0 % In July 2014, the Company granted our President an option to purchase 55,000 200,000 2015 2014 Weighted Weighted Weighted Average Weighted Average Average Value at Average Value at Shares Price Date Shares Price Date Outstanding at January 1 695,336 $ 11.09 $ 5.35 758,328 $ 14.90 $ 8.60 Granted 45,000 4.00 2.81 15,200 7.10 5.00 Exercised - - - (6,666) 1.00 - Cancelled or expired (28,480) 12.86 5.67 (66,576) 18.30 9.20 Outstanding at June 30 711,857 $ 10.57 $ 5.31 700,286 $ 14.60 $ 7.10 Exercisable at June 30 340,189 $ 14.41 $ 6.80 331,498 $ 17.90 $ 6.50 The aggregate intrinsic value of options outstanding as of June 30, 2015 was approximately $ 28,750 28,750 371,668 3.94 903,096 From time to time we may grant stock options and stock grants to consultants. We account for consultant stock options in accordance with ASC 505-50. Consulting expense for the grant of stock options to consultants is determined based on the estimated fair value of the stock options at the measurement date as defined in ASC 505-50 and is recognized over the vesting period. The Company recognized non-cash consulting expense for the six months ended June 30, 2015 and 2014 as $ 140,869 42,228 Total share based compensation recognized for employees, directors and consultants was $ 444,352 688,876 On November 10, 2014, the company issued 39,312 4.07 160,000

Warrants

Warrants	6 Months Ended
	Jun. 30, 2015
Warrants and Rights Note Disclosure [Abstract]
Warrants	(10) Warrants Weighted Average Exercise Shares Price Outstanding as of January 1, 2014 1,087,820 $ 16.20 Issued 571,500 7.12 Expired (4,000) 20.00 Outstanding at January 1, 2015 1,655,320 $ 13.06 Issued - - Expired (224,920) 18.52 Outstanding at June 30, 2015 1,430,400 $ 12.20 We utilize a valuation model to determine the fair market value of the warrants accounted for as liabilities. The valuation model accommodates the probability of exercise price adjustment features as outlined in the warrant agreements. We recorded an unrealized loss of $ 14,081 Six Months ended June 30, 2015 2014 Value of underlying common stock (per share) $ 3.50 $ 6.80 Risk free interest rate 1.60 % 1.76 % Expected term 4.50 years 5.51 years Volatility 80 % 63 % Dividend yield 0 % 0 % 2015 2014 Balance at January 1, 1,171,692 600,192 Derivative warrants issued - - Derivative warrants exercised - - Balance at June 30, 1,171,692 600,192

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2015
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	(11) Commitments and Contingencies Operating Leases We lease two office facilities under non-cancelable operating lease agreements with expiration dates in 2019 and 2023. We have the option to extend both the leases for another ten year term and for one facility, we have the right of first refusal on any sale. We lease additional office space under a month-to-month arrangement. Remainder of 2015 $ 193,900 2016 347,498 2017 280,527 2018 286,754 2019 166,940 Thereafter 559,000 Total $ 1,834,619 Rent expense was $ 182,739 158,066 Indemnifications Our arrangements generally include limited warranties and certain provisions for indemnifying customers against liabilities if our products or services infringe a third-party's intellectual property rights. To date, we have not incurred any material costs as a result of such warranties or indemnification provisions and have not accrued any liabilities related to such obligations in the accompanying financial statements. We have also agreed to indemnify our directors and executive officers for costs associated with any fees, expenses, judgments, fines and settlement amounts incurred by any of these persons in any action or proceeding to which any of those persons is, or is threatened to be, made a party by reason of the person's service as a director or officer, including any action by us, arising out of that person's services as our director or officer or that person's services provided to any other company or enterprise at our request. Pending and Threatened Litigation On March 17, 2014, a complaint was served on the Company in the following state court action in the District Court for the County of Arapahoe, State of Colorado: Robert Taggart v. Guy Cook, Bacterin International, Inc., a Nevada Corporation and Bacterin International Holdings, Inc., a Delaware corporation, Civil Action No. 14CV30401. The complaint involves claims under an employment agreement between plaintiff and the Company seeking commissions on Company sales, a commission on funds obtained by the Company as a result of a reverse merger and vesting of certain stock options. Plaintiff seeks damages in excess of $ 5

Income Taxes

Income Taxes	6 Months Ended
	Jun. 30, 2015
Income Tax Disclosure [Abstract]
Income Taxes	(12) Income Taxes In evaluating the realizability of the net deferred tax assets, we take into account a number of factors, primarily relating to the ability to generate taxable income. Where it is determined that it is likely that we will be unable to realize deferred tax assets, a valuation allowance is established against the portion of the deferred tax asset. Because it cannot be accurately determined when or if we will become profitable, a valuation allowance was provided against the entire deferred income tax asset balance. The 2011 through 2014 tax years remain open to examination by the Internal Revenue Service and the 2009 to 2014 tax years remain open to the Montana Department of Revenue. These taxing authorities have the authority to examine those tax years until the applicable statute of limitations expire. The Company did not recognize any interest or penalties related to income taxes for the six months ended June 30, 2015 and 2014.

Supplemental Disclosure of Cash

Supplemental Disclosure of Cash Flow Information	6 Months Ended
	Jun. 30, 2015
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow Information	(13) Supplemental Disclosure of Cash Flow Information Six months Ended June 30, 2015 2014 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 1,610,291 $ 1,730,188 Non-cash activities: Issuance of shares related to debt issuance $ - $ 1,094,999 Issuance of capital leases $ 70,020 $ -

Related Party Transactions

Related Party Transactions	6 Months Ended
	Jun. 30, 2015
Related Party Transactions [Abstract]
Related Party Transactions	(14) Related Party Transactions Darrel Holmes, our Chief Operating Officer, and Mitchell Godfrey, a former director, serve on the board of American Donor Services Inc. (“ADS”), and Mr. Godfrey also serves as secretary and treasurer for ADS. Mssrs. Godfrey and Holmes each receive $ 5,000 827,797 1,897,489 Unless delegated to the Compensation Committee by the Board of Directors, the Audit Committee or the disinterested members of the full Board of Directors reviews and approves all related party transactions.

Subsequent Events

Subsequent Events	6 Months Ended
	Jun. 30, 2015
Subsequent Events [Abstract]
Subsequent Events	(15) Subsequent Events In July 2015, the Company sold its coatings and device business to Harland Medical Systems, Inc. for $ 350,000 5 250,000 100,000 On July 31, 2015 the Company acquired all of the outstanding capital stock of X-spine for approximately $ 60 13 4.24 The stock purchase agreement contains customary representations and warranties by each of the parties, as well as indemnification for breaches of the warranties and covenants by X-spine and the selling shareholders. To secure the indemnification obligations, $ 6 Pursuant to the stock purchase agreement, X-spine’s president, David Kirschman, was appointed as a Class II member of Xtant’s Board of Directors. The X-spine acquisition is considered the acquisition of a business and was accounted for under the purchase method of accounting. At the date of purchase of all identifiable tangible and intangible assets and liabilities purchased in the acquisition have been recognized at their estimated fair value. following reflects the allocation of the consideration to the net tangible and identifiable intangible assets of the Seller, based upon their estimated fair values: Assets and Liabilities at Fair Value Assets Intangible assets Tradename $ 4,543,300 Technology 28,698,700 Non-Compete Agreement 40,500 Customer Relationship 9,911,000 Total intangible assets 43,193,500 Goodwill 22,816,088 Cash 3,000 Accounts Receivable 6,972,764 Inventory 12,861,550 Prepaid Expenses 204,167 Property, Plant & Equipment 7,533,106 Total Assets Acquired 93,584,175 Liabilities Accounts Payable 3,703,097 Accrued Liabilities 2,164,179 Revolving Line of Credit Total liabilities 5,867,276 Consideration Cash Consideration 72,867,606 Stock Consideration 14,849,293 Total Consideration $ 87,716,899 As noted above in the table, we acquired accounts receivables as part of the asset acquisition of X-Spine. As of the date of the acquisition, the estimated fair value and the contractual value of the receivables were the same. As of the date of the acquisition we did not determine that any of the receivables would ultimately become uncollectible. After the specific identification of net tangible and identifiable intangible assets of the sellers and allocation of the acquisition cost, the Company is expected to recognize approximately $ 23 Convertible Notes Concurrent with the acquisition of X-spine, the Company completed an offering of $ 65.0 6.00 52.0 9.75 3 The Notes bear interest at a rate equal to 6.00 July 15, 2021 At any time prior to the close of business on the second business day immediately preceding the maturity date, holders may convert their Notes into shares of Xtant common stock (together with cash in lieu of fractional shares) at an initial conversion rate of 257.5163 1,000 3.88 100 The Notes are Xtant’s senior, unsecured obligations, rank equal in right of payment with its existing and future unsecured indebtedness that is not junior to the Notes, are senior in right of payment to any of its existing and future indebtedness that is expressly subordinated to the Notes, and are effectively subordinated to its existing and future secured indebtedness to the extent of the value of the collateral securing such indebtedness. The Notes are structurally subordinated to all existing and future indebtedness and other liabilities, including trade payables, and (to the extent Xtant is not a holder thereof) preferred equity, if any, of its subsidiaries. Amended and Restated Credit Agreement On July 31, 2015, Bacterin refinanced approximately $ 24 18 The accounting treatment for the Notes and for the New Facility with ROS have been done in accordance with ASC Subtopic 470-50, Debt Modifications and Extinguishments, and ASC Subtopic 470-60, Troubled Debt Restructurings by Debtors. Approximately $ 4.8 2.2 2.6 After payment of the consideration and expenses related to the acquisition and the related financing transactions, our cash on hand increased by approximately $ 5.6 Name Change Following the closing of the acquisition, on July 31, 2015, Bacterin International Holdings, Inc. changed its name to Xtant Medical Holdings, Inc. New Subsidiary On August 6, 2015 Xtant formed a new wholly owned subsidiary, Xtant Medical, Inc., a Delaware corporation.

Business Description and Summ21

Business Description and Summary of Significant Accounting Policies (Policies)	6 Months Ended
	Jun. 30, 2015
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Business Description	Business Description The accompanying consolidated financial statements include the accounts of Xtant Medical Holdings, Inc. (“Xtant”) formerly known as Bacterin International Holdings, Inc., a Delaware corporation, and its wholly owned subsidiary, Bacterin International, Inc., (“Bacterin”) a Nevada corporation (Xtant and Bacterin are jointly referred to herein as, the “Company”). All intercompany balances and transactions have been eliminated in consolidation. Bacterin develops, manufactures and markets biologic products to domestic and international markets. Bacterin’s proprietary methods are used to process human derived allografts into scaffolds that promote bone and other tissue growth. These products are used in a variety of applications including enhancing fusion in spine surgery, relief of back pain with a facet joint stabilization, promotion of bone growth in foot and ankle surgery, promotion of skull healing following neurosurgery and regeneration in knee and other joint surgeries. Bacterin also previously developed and licensed coatings for various medical device applications. As of December 31, 2014, Bacterin made a strategic decision to discontinue the medical device coatings business which resulted in an impairment of related assets. (See Note 4, “Impairment of Assets”). An operating segment is a component of an enterprise whose operating results are regularly reviewed by the enterprise’s chief operating decision maker to make decisions about resources to be allocated to the segment and assess its performance. The primary performance measure used by management is net income or loss. Up until December 31, 2014, the Company operated two distinct lines of business consisting of the biologics and the device divisions; however, due to immaterial revenue from the device division, the Company has reported as one segment. On July 31, 2015, Xtant acquired all of the outstanding capital stock of X-spine Systems, Inc. (“X-spine”) for approximately $ 60 13 4.24 The markets in which the Company competes are highly competitive and rapidly changing. Significant technological advances, changes in customer requirements, or the emergence of competitive products with new capabilities or technologies could adversely affect the Company's operating results. The Company's business could be harmed by a decline in demand for, or in the prices of, its products or as a result of, among other factors, any change in pricing or distribution methods, increased price competition, changes in government regulations or a failure by the Company to keep up with technological change. Further, a decline in available tissue donors could have an adverse impact on our business. The accompanying interim condensed consolidated financial statements of the Company for the six months ended June 30, 2015 and 2014 are unaudited and are prepared in accordance with accounting principles generally accepted in the United States of America. They do not include all disclosures required by generally accepted accounting principles for annual financial statements, but in the opinion of management, include all adjustments, consisting only of normal recurring items, necessary for a fair presentation. Interim results are not necessarily indicative of results which may be achieved in the future for the full year ending December 31, 2015. These financial statements should be read in conjunction with the financial statements and notes thereto which are included in our Annual Report on Form 10-K for the year ended December 31, 2014. The accounting policies set forth in those annual financial statements are the same as the accounting policies utilized in the preparation of these financial statements, except as modified for appropriate interim financial statement presentation.
Reverse Stock Split	Reverse Stock Split Xtant completed a
Public Offering	Public Offering In August 2014, Xtant offered 1,143,000 5.70 571,500 7.12 6.5 5.9
Aspire Capital Transaction	Aspire Capital Transaction We entered into a Common Stock Purchase Agreement on March 16, 2015, as amended and restated on April 17, 2015 (the “Purchase Agreement”), with Aspire Capital Fund, LLC (“Aspire Capital”), which provides that, upon the terms and subject to the conditions and limitations set forth therein, Aspire Capital is committed to purchase up to an aggregate of $ 10.0 207,182 750,000 154,189 3.62 558,185 417,000 1,387,439
Concentrations and Credit Risk	Concentrations and Credit Risk The Company’s accounts receivable are due from a variety of health care organizations and distributors throughout the world. Approximately 97 98 Six Months Ended 2015 2014 United States $ 18,831,197 $ 17,509,988 Rest of World 564,532 286,914 $ 19,395,729 $ 17,796,902
Use of Estimates	Use of Estimates The preparation of the financial statements requires management of the Company to make a number of estimates and assumptions relating to the reported amount of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenue and expenses during the period. Significant estimates include the carrying amount of property and equipment and intangible assets; valuation allowances for trade receivables and deferred income tax assets; valuation of the warrant derivative liability; inventory reserve; royalty liability; and estimates for the fair value of stock options grants and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates.
Long-Lived Assets	Long-Lived Assets Long-lived assets, including intangible assets, are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to future net cash flows expected to be generated by the asset. If such assets are considered to be impaired, the impairment to be recognized is measured by the amount by which the carrying amount of the assets exceeds the estimated fair value of the assets. See Note 4, “Impairment of Assets”.
Revenue Recognition	Revenue Recognition Revenue is recognized when all of the following criteria are met: a) the Company has entered into a legally binding agreement with the customer; b) the products or services have been delivered; c) the Company's fee for providing the products and services is fixed or determinable; and d) collection of the Company’s fee is probable. The Company’s policy is to record revenue net of any applicable sales, use, or excise taxes. If an arrangement includes a right of acceptance or a right to cancel, revenue is recognized when acceptance is received or the right to cancel has expired. The Company ships to certain customers under consignment arrangements whereby the Company’s product is stored by the customer. The customer is required to report the use to the Company and upon such notice, the Company invoices the customer and revenue is recognized when above criteria have been met. The Company also receives royalty revenue from third parties related to licensing agreements. The Company has royalty agreements with RyMed and Bard Access Systems. Revenue under these agreements represented less than 0.5% of total revenue for the six months ended June 30, 2015 and 2014.
Advertising Costs	Advertising Costs The Company expenses advertising costs as incurred. The Company had advertising expense of $ 3,688 27,914
Research and Development	Research and Development Research and development costs, which are principally related to internal costs for the development of new allograft technologies and processes are expensed as incurred.
Net Loss Per Share	Basic net income (loss) per share is computed by dividing net income (loss) by the weighted average number of common shares outstanding. Shares issued during the period and shares reacquired during the period are weighted for the portion of the period that they were outstanding. Diluted net income (loss) per share is computed in a manner consistent with that of basic earnings per share while giving effect to all potentially dilutive common shares outstanding during the period, which include the assumed exercise of stock options and warrants using the treasury stock method. Diluted net loss per share was the same as basic net loss per share for the three and six months ended June 30, 2015 and 2014, as shares issuable upon the exercise of stock options and warrants were anti-dilutive as a result of the net losses incurred for those periods. Dilutive earnings per share are not reported as their effects of including 2,142,257 1,784,107
Fair Value of Financial Instruments	Fair Value of Financial Instruments The carrying values of financial instruments, including trade accounts receivable, accounts payable, other accrued expenses and long-term debt, approximate their fair values based on terms and related interest rates. The Company follows a framework for measuring fair value. The framework provides a fair value hierarchy that prioritizes the inputs to valuation techniques used to measure fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (Level 1) and the lowest priority to unobservable inputs (Level 3). The three levels of the fair value hierarchy are described below: Level 1: Inputs to the valuation methodology are unadjusted quoted prices for identical assets or liabilities in active markets. Level 2: Inputs to the valuation methodology include quoted prices for similar assets and liabilities in active markets, and inputs that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the financial instrument. Level 3: Inputs to the valuation methodology are unobservable and significant to the fair value measurement. A financial instrument's level within the fair value hierarchy is based on the lowest level of any input that is significant to the fair value measurement. During the three and six months ended June 30, 2015 and 2014, there was no reclassification in financial assets or liabilities between Level 1, 2 or 3 categories. The following table sets forth by level, within the fair value hierarchy, our liabilities as of June 30, 2015 and December 31, 2014 that are measured at fair value on a recurring basis: As of As of Level 1 - - Level 2 - - Level 3 $ 1,796,660 $ 1,320,371 The valuation technique used to measure fair value of the warrant liability is based on a valuation model and significant assumptions and inputs determined by us (See Note 10, “Warrants” below). Level 3 Changes Warrant derivative liability Balance at January 1, 2015 $ 1,320,371 Loss recognized in earnings in first quarter of 2015 462,208 Balance at March 31, 2015 1,782,579 Loss recognized in earnings in second quarter of 2015 14,081 Balance at June 30, 2015 $ 1,796,660 During the first six months ended June 30, 2015, the Company did not change any of the valuation techniques used to measure its liabilities at fair value.
Recent Accounting Pronouncements	In November 2014, FASB issued ASU No. 2014-08, Presentation of Financial Statements (Topic 201) and Property, Plant and Equipment (Topic 360) - Reporting Discontinued Operations and Disclosures of Disposals of Components of an Entity. The amendments in this Update are effective for the annual period ending after December 15, 2014, and interim periods within those years. Early adoption is permitted only for disposals (or classifications as held for sale) that have not been reported in financial statements previously issued or available for issuance. ASU 2014-08 is not expected to have a material impact on our consolidated financial position, results of operations, or cash flows. In April 2015, the FASB issued ASU 2015-3, to simplify the presentation of debt issuance costs. This update requires that debt issuance costs be presented in the balance sheet as a direct deduction from the carrying amount of the associated debt liability, consistent with the required presentation for debt discounts. This update is effective for interim and annual periods beginning after December 15, 2015. ASU 2015-3 is not expected to have a material impact.

Business Description and Summ22

Business Description and Summary of Significant Accounting Policies (Tables)	6 Months Ended
	Jun. 30, 2015
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Revenues by Geographic Region	Revenue by geographical region is as follows: Six Months Ended 2015 2014 United States $ 18,831,197 $ 17,509,988 Rest of World 564,532 286,914 $ 19,395,729 $ 17,796,902
Schedule of Assets and Liabilities Measured on Recurring Basis	Warrant derivative liability As of As of Level 1 - - Level 2 - - Level 3 $ 1,796,660 $ 1,320,371
Schedule of Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation	The following is a reconciliation of the beginning and ending balances for liabilities measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the six months ended June 30, 2015: Warrant derivative liability Balance at January 1, 2015 $ 1,320,371 Loss recognized in earnings in first quarter of 2015 462,208 Balance at March 31, 2015 1,782,579 Loss recognized in earnings in second quarter of 2015 14,081 Balance at June 30, 2015 $ 1,796,660

Inventories (Tables)

Inventories (Tables)	6 Months Ended
	Jun. 30, 2015
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories consist of the following: June 30, December 31, 2015 2014 Current inventories Raw materials $ 4,219,024 $ 3,836,635 Work in process 2,407,919 2,484,635 Finished goods 5,131,354 5,163,458 11,758,297 11,484,728 Reserve for obsolescence (2,366,147) (1,926,080) Current inventories, total 9,392,150 9,558,648 Non-current inventories Finished goods 2,376,919 2,860,248 Reserve for obsolescence (536,948) (925,990) Non-current inventories, total 1,839,971 1,934,258 Total inventories $ 11,232,121 $ 11,492,906

Property and Equipment, Net (Ta

Property and Equipment, Net (Tables)	6 Months Ended
	Jun. 30, 2015
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment, Net	Property and equipment, net are as follows: June 30, December 31, 2015 2014 Buildings $ 1,657,579 $ 1,657,579 Equipment 4,800,284 4,724,608 Computer equipment 225,009 225,009 Computer software 360,171 345,039 Furniture and fixtures 153,834 153,834 Leasehold improvements 2,381,413 2,380,617 Vehicles 10,000 41,099 Total cost 9,588,290 9,527,785 Less: accumulated depreciation (5,158,252) (4,873,258) $ 4,430,038 $ 4,654,527

Intangible Assets (Tables)

Intangible Assets (Tables)	6 Months Ended
	Jun. 30, 2015
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets	The following table sets forth information regarding intangible assets: June 30, December 31, Intellectual Property Gross carrying value $ 1,032,724 $ 1,036,580 Accumulated amortization (423,376) (381,090) Net carrying value $ 609,348 $ 655,490 Aggregate amortization expense: $ 75,860 $ 77,022
Schedule of Estimated Amortization Expense for Intangible Assets	The following is a summary of estimated future amortization expense for intangible assets as of June 30, 2015: Remainder of 2015 $ 45,093 2016 59,343 2017 59,343 2018 59,154 2019 55,565 Thereafter 330,850 Total $ 609,348

Accrued Liabilities (Tables)

Accrued Liabilities (Tables)	6 Months Ended
	Jun. 30, 2015
Payables and Accruals [Abstract]
Schedule of Accrued Liabilities	Accrued liabilities consist of the following: June 30, December 31, 2015 2014 Accrued stock compensation $ 120,000 $ - Wages/commissions payable 1,565,827 1,434,743 Other accrued expenses 713,772 486,558 $ 2,399,599 $ 1,921,301

Long-term Debt (Tables)

Long-term Debt (Tables)	6 Months Ended
	Jun. 30, 2015
Debt Disclosure [Abstract]
Schedule of Long-term Debt	Long-term debt consists of the following: June 30, December 31, Loan payable to ROS Acquisition Offshore, LIBOR plus 12.13% maturing August 2019 $ 24,000,000 $ 24,000,000 Adjustment fee payable to ROS Acquisition Offshore, due in August 2019 700,000 700,000 6.00% loan payable to Valley Bank of Belgrade, $10,746 monthly payments including interest, maturing December 24, 2030; secured by building 1,300,087 1,325,814 26,000,087 26,025,814 Less: current portion (52,374) (50,671) Debt discount (4,256,039) (5,104,813) Long-term debt $ 21,691,674 $ 20,870,330
Schedule of Maturities of Long-term Debt	The following is a summary of maturities due on the debt as of June 30, 2015: Remainder of 2015 $ 24,882 2016 2,112,064 2017 8,290,378 2018 8,293,897 2019 6,239,295 Thereafter 1,039,571 Total $ 26,000,087
Schedule of Royalty Payments	The following is a summary of estimated future royalty payments as of June 30, 2015: 2015 $ 525,000 2016 1,229,250 2017 1,360,250 2018 1,462,750 2019 1,575,250 Thereafter 5,626,325 Total $ 11,778,825

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	6 Months Ended
	Jun. 30, 2015
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions	Key assumptions used to estimate the fair value of stock awards are as follows: Six Months Ended Six Months Ended June 30, 2015 June 30, 2014 Risk-free interest rate 1.75 % 1.76 % Expected volatility 80 % 63 % Expected term 6.3 Years 5.51 Years Expected forfeiture rate 20 % 20 % Dividend yield 0 % 0 %
Schedule of Share-based Compensation, Stock Options, Activity	Stock option activity, including options granted under the Plan and the Non-Plan Grants, was as follows: 2015 2014 Weighted Weighted Weighted Average Weighted Average Average Value at Average Value at Shares Price Date Shares Price Date Outstanding at January 1 695,336 $ 11.09 $ 5.35 758,328 $ 14.90 $ 8.60 Granted 45,000 4.00 2.81 15,200 7.10 5.00 Exercised - - - (6,666) 1.00 - Cancelled or expired (28,480) 12.86 5.67 (66,576) 18.30 9.20 Outstanding at June 30 711,857 $ 10.57 $ 5.31 700,286 $ 14.60 $ 7.10 Exercisable at June 30 340,189 $ 14.41 $ 6.80 331,498 $ 17.90 $ 6.50

Warrants (Tables)

Warrants (Tables)	6 Months Ended
	Jun. 30, 2015
Warrants and Rights Note Disclosure [Abstract]
Schedule of Warrant Activity	The following table summarizes our warrant activities for the period ended June 30, 2015: Weighted Average Exercise Shares Price Outstanding as of January 1, 2014 1,087,820 $ 16.20 Issued 571,500 7.12 Expired (4,000) 20.00 Outstanding at January 1, 2015 1,655,320 $ 13.06 Issued - - Expired (224,920) 18.52 Outstanding at June 30, 2015 1,430,400 $ 12.20
Schedule of Warrant Valuation Assumptions	The estimated fair value was derived using the valuation model with the following weighted-average assumptions: Six Months ended June 30, 2015 2014 Value of underlying common stock (per share) $ 3.50 $ 6.80 Risk free interest rate 1.60 % 1.76 % Expected term 4.50 years 5.51 years Volatility 80 % 63 % Dividend yield 0 % 0 %
Schedule of Warrants Activities Used In Derivative Liability	The following table summarizes our activities related to warrants accounted for as a derivative liability for the six months ended June 30, 2015 and 2014: 2015 2014 Balance at January 1, 1,171,692 600,192 Derivative warrants issued - - Derivative warrants exercised - - Balance at June 30, 1,171,692 600,192

Commitments and Contingencies (

Commitments and Contingencies (Tables)	6 Months Ended
	Jun. 30, 2015
Commitments and Contingencies Disclosure [Abstract]
Schedule of Future Minimum Rental Payments for Operating Leases	Future minimum payments for the next five years and thereafter as of June 30, 2015, under these leases, are as follows: Remainder of 2015 $ 193,900 2016 347,498 2017 280,527 2018 286,754 2019 166,940 Thereafter 559,000 Total $ 1,834,619

Supplemental Disclosure of Ca31

Supplemental Disclosure of Cash Flow Information (Tables)	6 Months Ended
	Jun. 30, 2015
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow Information	Supplemental cash flow information is as follows: Six months Ended June 30, 2015 2014 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 1,610,291 $ 1,730,188 Non-cash activities: Issuance of shares related to debt issuance $ - $ 1,094,999 Issuance of capital leases $ 70,020 $ -

Subsequent Events (Tables)

Subsequent Events (Tables)	6 Months Ended
	Jun. 30, 2015
Subsequent Events [Abstract]
Consideration to net tangible and identifiable intangible assets on estimated fair values	following reflects the allocation of the consideration to the net tangible and identifiable intangible assets of the Seller, based upon their estimated fair values: Assets and Liabilities at Fair Value Assets Intangible assets Tradename $ 4,543,300 Technology 28,698,700 Non-Compete Agreement 40,500 Customer Relationship 9,911,000 Total intangible assets 43,193,500 Goodwill 22,816,088 Cash 3,000 Accounts Receivable 6,972,764 Inventory 12,861,550 Prepaid Expenses 204,167 Property, Plant & Equipment 7,533,106 Total Assets Acquired 93,584,175 Liabilities Accounts Payable 3,703,097 Accrued Liabilities 2,164,179 Revolving Line of Credit Total liabilities 5,867,276 Consideration Cash Consideration 72,867,606 Stock Consideration 14,849,293 Total Consideration $ 87,716,899

Business Description and Summ33

Business Description and Summary of Significant Accounting Policies (Details) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014	Jun. 30, 2015	Jun. 30, 2014
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total Revenues	$ 9,892,615	$ 8,883,932	$ 19,395,729	$ 17,796,902
US [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total Revenues			18,831,197	17,509,988
Rest Of World [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total Revenues			$ 564,532	$ 286,914

Business Description and Summ34

Business Description and Summary of Significant Accounting Policies (Details 1) - USD ($)	Jun. 30, 2015	Dec. 31, 2014
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Warrant derivative liability	$ 1,796,660	$ 1,320,371
Fair Value, Inputs, Level 1 [Member] | Fair Value, Measurements, Recurring [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Warrant derivative liability	0	0
Fair Value, Inputs, Level 2 [Member] | Fair Value, Measurements, Recurring [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Warrant derivative liability	0	0
Fair Value, Inputs, Level 3 [Member] | Fair Value, Measurements, Recurring [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Warrant derivative liability	$ 1,796,660	$ 1,320,371

Business Description and Summ35

Business Description and Summary of Significant Accounting Policies (Details 2) - Warrant [Member] - Derivative [Member] - USD ($)	3 Months Ended	6 Months Ended
	Mar. 31, 2015	Jun. 30, 2015
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Balance at January 1, 2015	$ 1,320,371	$ 1,320,371
Loss recognized in earnings	462,208	14,081
Balance at June 30, 2015	$ 1,782,579	$ 1,796,660

Business Description and Summ36

Business Description and Summary of Significant Accounting Policies (Details Textual) - USD ($)

Aug. 06, 2014

Jul. 28, 2014

Jul. 31, 2015

Jun. 30, 2015

Mar. 31, 2015

Jun. 30, 2014

Mar. 31, 2014

Jun. 30, 2015

Jun. 30, 2014

Mar. 16, 2015

Dec. 31, 2014

Dec. 31, 2013

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Advertising Expense

$ 3,688

$ 27,914

Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount

2,142,257

1,784,107

Royalty Revenue Description

The Company also receives royalty revenue from third parties related to licensing agreements. The Company has royalty agreements with RyMed and Bard Access Systems. Revenue under these agreements represented less than 0.5% of total revenue for the six months ended June 30, 2015 and 2014.

The Company also receives royalty revenue from third parties related to licensing agreements. The Company has royalty agreements with RyMed and Bard Access Systems. Revenue under these agreements represented less than 0.5% of total revenue for the six months ended June 30, 2015 and 2014.

Proceeds From Issuance Or Sale Of Equity Gross

$ 6,500,000

Stock Issued During Period, Shares, New Issues

150,000

Class of Warrant or Right, Exercise Price of Warrants or Rights

$ 12.2

$ 12.2

$ 13.06

$ 16.2

Proceeds from Issuance or Sale of Equity, Total

$ 5,900,000

Class Of Warrant Or Right Term

5 years

Stockholders' Equity, Reverse Stock Split

1:10 reverse split

Other Non Cash Expense Associated With Stock Purchase Agreement

$ 0

$ 0

$ 558,185

$ 0

Business Combination, Consideration Transferred

$ 87,716,899

Subsequent Event [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Business Combination, Consideration Transferred

$ 60,000,000

Debt [Member] | Subsequent Event [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Other Payments to Acquire Businesses

$ 13,000,000

Aspire Capital Fund LLC [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Stock Issued During Period, Shares, New Issues

417,000

207,182

Common Stock To Be Issued For Commitment Fee

154,189

Common Stock, Shares Subscribed but Unissued

10,000,000

Stock Issued During Period, Value, New Issues

$ 1,387,439

$ 750,000

Share Price

$ 3.62

Other Non Cash Expense Associated With Stock Purchase Agreement

$ 558,185

Common Stock [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Stock Issued During Period, Shares, New Issues

1,143,000

Shares Issued, Price Per Share

$ 5.70

Common Stock [Member] | Subsequent Event [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Business Acquisition Number Of Shares Acquired

4,240,000

August 2014 Warrants [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Class of Warrant or Right, Number of Securities Called by Warrants or Rights

571,500

Class of Warrant or Right, Exercise Price of Warrants or Rights

$ 7.12

Class Of Warrant Or Right Term

5 years

Geographic Concentration Risk [Member] | Sales Revenue, Net [Member] | US [Member]

Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]

Concentration Risk, Percentage

97.00%

98.00%

Equity (Details Textual)

Equity (Details Textual) - USD ($)	Aug. 06, 2014	Mar. 16, 2015	Jun. 30, 2015	Mar. 31, 2015	Mar. 31, 2014	Dec. 31, 2014	Dec. 31, 2013
Schedule of Equity Method Investments [Line Items]
Stock issued (in shares)					150,000
Proceeds from Issuance or Sale of Equity, Total	$ 5,900,000
Proceeds From Issuance Or Sale Of Equity Gross	$ 6,500,000
Proceeds from Lines of Credit					$ 4,000,000
Class of Warrant or Right, Exercise Price of Warrants or Rights			$ 12.2			$ 13.06	$ 16.2
Class Of Warrant Or Right Term	5 years
Common Stock [Member]
Schedule of Equity Method Investments [Line Items]
Stock issued (in shares)	1,143,000
Shares Issued, Price Per Share	$ 5.70
August 2014 Warrants [Member]
Schedule of Equity Method Investments [Line Items]
Class of Warrant or Right, Number of Securities Called by Warrants or Rights	571,500
Class of Warrant or Right, Exercise Price of Warrants or Rights	$ 7.12
Class Of Warrant Or Right Term	5 years
Aspire Capital Fund LLC [Member]
Schedule of Equity Method Investments [Line Items]
Stock issued (in shares)			417,000	207,182
Common Stock, Shares Subscribed but Unissued		10,000,000
Stock Issued During Period, Value, New Issues			$ 1,387,439	$ 750,000
Common Stock To Be Issued For Commitment Fee				154,189
Maximum Common Stock To Be Issued Per Trading Day		50,000
Maximum Common Stock Value To Be Issued Per Trading Day		$ 500,000
Maximum Percentage Of Common Stock Weighted Average Price		0.00%

Inventories (Details)

Inventories (Details) - USD ($)	Jun. 30, 2015	Dec. 31, 2014
Current inventories
Raw materials	$ 4,219,024	$ 3,836,635
Work in process	2,407,919	2,484,635
Finished goods	5,131,354	5,163,458
Inventory, Gross	11,758,297	11,484,728
Reserve for obsolescence	(2,366,147)	(1,926,080)
Current inventories, total	9,392,150	9,558,648
Non-current inventories
Finished goods	2,376,919	2,860,248
Reserve for obsolescence	(536,948)	(925,990)
Non-current inventories, total	1,839,971	1,934,258
Total inventories	$ 11,232,121	$ 11,492,906

Impairment of Assets (Details T

Impairment of Assets (Details Textual) - USD ($)	6 Months Ended		12 Months Ended
	Jun. 30, 2015	Jun. 30, 2014	Dec. 31, 2014
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Disposal Group, Including Discontinued Operation, Property, Plant and Equipment			$ 80,042
Disposal Group, Including Discontinued Operation, Inventory			832,507
Disposal Group, Including Discontinued Operation, Assets			0
Asset Impairment Charges			$ 912,549
Payments to Acquire Businesses, Gross	$ 250,000
Contingent Payment	$ 100,000
Gross Profit [Member] | Maximum [Member]
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Concentration Risk, Percentage	1.00%	1.00%
Sales Revenue, Net [Member] | Maximum [Member]
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Concentration Risk, Percentage	1.00%	1.00%

Property and Equipment, Net (De

Property and Equipment, Net (Details) - USD ($)	Jun. 30, 2015	Dec. 31, 2014
Property, Plant and Equipment [Line Items]
Total cost	$ 9,588,290	$ 9,527,785
Less: accumulated depreciation	(5,158,252)	(4,873,258)
Property and equipment, net	4,430,038	4,654,527
Building [Member]
Property, Plant and Equipment [Line Items]
Total cost	1,657,579	1,657,579
Equipment [Member]
Property, Plant and Equipment [Line Items]
Total cost	4,800,284	4,724,608
Computer equipment [Member]
Property, Plant and Equipment [Line Items]
Total cost	225,009	225,009
Computer software[Member]
Property, Plant and Equipment [Line Items]
Total cost	360,171	345,039
Furniture and fixtures [Member]
Property, Plant and Equipment [Line Items]
Total cost	153,834	153,834
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Total cost	2,381,413	2,380,617
Vehicles [Member]
Property, Plant and Equipment [Line Items]
Total cost	$ 10,000	$ 41,099

Property and Equipment, Net (41

Property and Equipment, Net (Details Textual) - USD ($)	6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014
Property, Plant and Equipment [Line Items]
Capital Leased Assets, Gross	$ 537,480
Capital Leases, Lessee Balance Sheet, Assets by Major Class, Accumulated Depreciation	212,568
Cost of Property Repairs and Maintenance	173,443	$ 140,504
Depreciation	$ 336,913	$ 307,747

Intangible Assets (Details)

Intangible Assets (Details) - USD ($)	6 Months Ended	12 Months Ended
	Jun. 30, 2015	Dec. 31, 2014
Intellectual Property
Gross carrying value	$ 1,032,724	$ 1,036,580
Accumulated amortization	(423,376)	(381,090)
Net carrying value	609,348	655,490
Aggregate amortization expense:	$ 75,860	$ 77,022

Intangible Assets (Details 1)

Intangible Assets (Details 1)	Jun. 30, 2015USD ($)
Estimated amortization expense:
Remainder of 2015	$ 45,093
2,016	59,343
2,017	59,343
2,018	59,154
2,019	55,565
Thereafter	330,850
Total	$ 609,348

Accrued Liabilities (Details)

Accrued Liabilities (Details) - USD ($)	Jun. 30, 2015	Dec. 31, 2014
Accrued Liabilities [Line Items]
Accrued stock compensation	$ 120,000	$ 0
Wages/commissions payable	1,565,827	1,434,743
Other accrued expenses	713,772	486,558
Accrued Liabilities Current	$ 2,399,599	$ 1,921,301

Long-term Debt (Details)

Long-term Debt (Details) - USD ($)	Jun. 30, 2015	Dec. 31, 2014
Debt Instrument [Line Items]
Loan Payable	$ 26,000,087	$ 26,025,814
Less: current portion	(52,374)	(50,671)
Debt discount	(4,256,039)	(5,104,813)
Long-term debt	21,691,674	20,870,330
Ros Acquisition Offshore [Member]
Debt Instrument [Line Items]
Loan Payable	24,000,000	24,000,000
Adjustment fee payable to ROS Acquisition Offshore, due in August 2019	700,000	700,000
Valley Bank Of Belgrade [Member]
Debt Instrument [Line Items]
Loan Payable	$ 1,300,087	$ 1,325,814

Long-term Debt (Details 1)

Long-term Debt (Details 1)	Jun. 30, 2015USD ($)
Schedule of maturities due on debt [Line Items]
Remainder of 2015	$ 24,882
2,016	2,112,064
2,017	8,290,378
2,018	8,293,897
2,019	6,239,295
Thereafter	1,039,571
Total	$ 26,000,087

Long-term Debt (Details 2)

Long-term Debt (Details 2)	Jun. 30, 2015USD ($)
Estimated future royalty payments [Line Items]
2,015	$ 525,000
2,016	1,229,250
2,017	1,360,250
2,018	1,462,750
2,019	1,575,250
Thereafter	5,626,325
Total	$ 11,778,825

Long-term Debt (Details Textual

Long-term Debt (Details Textual) - USD ($)	Mar. 06, 2014	Mar. 31, 2014	Jun. 30, 2015
Debt Instrument [Line Items]
Proceeds from Lines of Credit		$ 4,000,000
Convertible Notes Payable [Member]
Debt Instrument [Line Items]
Proceeds from Lines of Credit			$ 65,000,000
Valley Bank Of Belgrade [Member]
Debt Instrument [Line Items]
Debt Instrument, Interest Rate, Effective Percentage			6.00%
Debt Instrument, Periodic Payment			$ 10,746
Debt Instrument, Description of Variable Rate Basis			December 24, 2030
Ros Acquisition Offshore [Member]
Debt Instrument [Line Items]
Line of Credit Facility, Description			LIBOR plus 12.13% maturing August 2019
Debt Conversion, Converted Instrument, Shares Issued	150,000
Proceeds from Lines of Credit	$ 4,000,000

Stock-Based Compensation (Detai

Stock-Based Compensation (Details)	6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014
Risk-free interest rate	1.75%	1.76%
Expected volatility	80.00%	63.00%
Expected term	6 years 3 months 18 days	5 years 6 months 4 days
Expected forfeiture rate	20.00%	20.00%
Dividend yield	0.00%	0.00%

Stock-Based Compensation (Det50

Stock-Based Compensation (Details 1) - Stock Option - $ / shares	6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014
Schedule of activity under stock option plans [Line Items]
Outstanding at January 1, 2015 Shares	695,336	758,328
Granted, Shares	45,000	15,200
Exercised, Shares	0	(6,666)
Cancelled or expired, Shares	(28,480)	(66,576)
Outstanding at June 30, 2015 Shares	711,857	700,286
Exercisable at June 30, 2015 Shares	340,189	331,498
Outstanding at January 1, 2015 Weighted Average Exercise Price	$ 11.09	$ 14.9
Granted, Weighted Average Exercise Price	4	7.1
Exercised, Weighted Average Exercise Price	0	1
Cancelled or expired, Weighted Average Exercise Price	12.86	18.3
Outstanding at June 30, 2015 Weighted Average Exercise Price	10.57	14.6
Exercisable at June 30, 2015 Weighted Average Exercise Price	14.41	17.90
Outstanding at January 1, 2015 Weighted Average Fair Value At Grant Date	5.35	8.6
Granted, Weighted Average Fair Value At Grant Date	2.81	5
Exercised, Weighted Average Fair Value At Grant Date	0	0
Cancelled or expired, Weighted Average Fair Value At Grant Date	5.67	9.2
Outstanding at June 30, 2015 Weighted Average Fair Value At Grant Date	5.31	7.1
Exercisable at June 30, 2015 Weighted Average Fair Value At Grant Date	$ 6.80	$ 6.50

Stock-Based Compensation (Det51

Stock-Based Compensation (Details Textual) - USD ($)	Nov. 10, 2014	Jul. 31, 2014	Aug. 31, 2013	Jun. 30, 2015	Jun. 30, 2014
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Shares authorized under the Plan				1,400,000
Aggregate intrinsic value of options outstanding				580,000
Allocated Share-based Compensation Expense				$ 444,352	$ 688,876
Chief Executive Officer [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Options granted			200,000
President [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Options granted		55,000
Employee Stock Option [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Share-based Compensation Arrangement by Share-based Payment Award, Options, Outstanding, Intrinsic Value				28,750
Share-based Compensation Arrangement by Share-based Payment Award, Options, Exercisable, Intrinsic Value				28,750
Employee Service Share-based Compensation, Nonvested Awards, Total Compensation Cost Not yet Recognized, Stock Options				$ 903,096
Number of Unvested options				371,668
Weighted average grant date fair value of unvested options				$ 3.94
Restricted Stock [Member]
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items]
Allocated Share-based Compensation Expense				$ 140,869	$ 42,228
Share-Based Compensation Arrangement By Share-Based Payment Award, Equity Instruments Other Than Options, Grants In Period	39,312
Employee Service Share-based Compensation, Nonvested Awards, Compensation Not yet Recognized, Share-based Awards Other than Options	$ 160,000
Share Based Compensation Arrangement By Share Based Payment Award Equity Instruments Other Than Options Issue Price On Grand Date	$ 4.07

Warrants (Details)

Warrants (Details) - $ / shares	6 Months Ended	12 Months Ended
	Jun. 30, 2015	Dec. 31, 2014
Warrant activity [Line Items]
Outstanding	1,655,320	1,087,820
Issued, Shares	0	571,500
Expired, Shares	(224,920)	(4,000)
Outstanding	1,430,400	1,655,320
Outstanding Weighted Average Exercise Price	$ 13.06	$ 16.2
Issued, Weighted Average Exercise Price	0	7.12
Expired, Weighted Average Exercise Price	18.52	20
Outstanding Weighted Average Exercise Price	$ 12.2	$ 13.06

Warrants (Details 1)

Warrants (Details 1) - Warrant [Member] - $ / shares	6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Value of underlying common stock (per share)	$ 3.5	$ 6.8
Risk free interest rate	1.60%	1.76%
Expected term	4 years 6 months	5 years 6 months 4 days
Volatility	80.00%	63.00%
Dividend yield	0.00%	0.00%

Warrants (Details 2)

Warrants (Details 2) - shares	6 Months Ended		12 Months Ended
	Jun. 30, 2015	Jun. 30, 2014	Dec. 31, 2014
Class of Warrant or Right [Line Items]
Outstanding	1,655,320	1,087,820	1,087,820
Derivative warrants issued	0		571,500
Outstanding	1,430,400		1,655,320
Warrant [Member]
Class of Warrant or Right [Line Items]
Outstanding	1,171,692	600,192	600,192
Derivative warrants issued	0	0
Derivative warrants exercised	0	0
Outstanding	1,171,692	600,192	1,171,692

Warrants (Details Textual)

Warrants (Details Textual)	6 Months Ended
	Jun. 30, 2015USD ($)
Class of Warrant or Right [Line Items]
Unrealized Loss On Warranty Derivative Liability	$ 14,081

Commitments and Contingencies56

Commitments and Contingencies (Details)	Jun. 30, 2015USD ($)
Schedule of future minimum payments by operating lease [Line Items]
Remainder of 2015	$ 193,900
2,016	347,498
2,017	280,527
2,018	286,754
2,019	166,940
Thereafter	559,000
Total	$ 1,834,619

Commitments and Contingencies57

Commitments and Contingencies (Details Textual) - USD ($)	1 Months Ended	6 Months Ended
	Mar. 17, 2014	Jun. 30, 2015	Jun. 30, 2014
Schedule of commitment and contingencies [Line Items]
Operating Leases, Rent Expense, Net		$ 182,739	$ 158,066
Maximum [Member]
Schedule of commitment and contingencies [Line Items]
Lease Expiration Date		Dec. 31, 2023
Minimum [Member]
Schedule of commitment and contingencies [Line Items]
Lease Expiration Date		Dec. 31, 2019
Robert Taggart V Guy Cook Bacterin International Inc [Member]
Schedule of commitment and contingencies [Line Items]
Loss Contingency, Damages Sought, Value	$ 5,000,000

Supplemental Disclosure of Ca58

Supplemental Disclosure of Cash Flow Information (Details) - USD ($)	6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014
Cash paid during the period for:
Interest	$ 1,610,291	$ 1,730,188
Non-cash activities:
Issuance of shares related to debt issuance	0	1,094,999
Issuance of capital leases	$ 70,020	$ 0

Related Party Transactions (Det

Related Party Transactions (Details Textual) - USD ($)	6 Months Ended
	Jun. 30, 2015	Jun. 30, 2014
Chief Operating Officer [Member]
Related Party Transaction [Line Items]
Amount of related party transaction	$ 5,000
American Donor Services [Member]
Related Party Transaction [Line Items]
Amount of related party transaction	$ 827,797	$ 1,897,489

Subsequent Events (Details)

Subsequent Events (Details) - Jun. 30, 2015 - USD ($)	Total
Business Acquisition [Line Items]
Total intangible assets	$ 43,193,500
Goodwill	22,816,088
Cash	3,000
Accounts Receivable	6,972,764
Inventory	12,861,550
Prepaid Expenses	204,167
Property, Plant & Equipment	7,533,106
Total Assets Acquired	93,584,175
Accounts Payable	3,703,097
Accrued Liabilities	$ 2,164,179
Revolving Line of Credit
Total liabilities	$ 5,867,276
Cash Consideration	72,867,606
Stock Consideration	14,849,293
Total Consideration	87,716,899
Trade Names [Member]
Business Acquisition [Line Items]
Total intangible assets	4,543,300
Technology [Member]
Business Acquisition [Line Items]
Total intangible assets	28,698,700
Non Compete Agreement [Member]
Business Acquisition [Line Items]
Total intangible assets	40,500
Customer Relationships [Member]
Business Acquisition [Line Items]
Total intangible assets	$ 9,911,000

Subsequent Events (Details Text

Subsequent Events (Details Textual) - USD ($)	Aug. 10, 2015	Jul. 31, 2015	Jun. 30, 2015
Subsequent Event [Line Items]
Payments to Acquire Businesses, Gross			$ 250,000
Total Consideration			$ 87,716,899
Subsequent Event [Member]
Subsequent Event [Line Items]
Payments to Acquire Businesses, Gross		$ 350,000
Business Acquisition, Percentage of Voting Interests Acquired		100.00%
Debt Instrument, Face Amount		$ 65,000,000
Debt Instrument, Maturity Date		Jul. 15, 2021
Total Consideration		$ 60,000,000
Business Combination Conjunction Related Expenses		4,800,000
Business Combination Expenses Related To Future Acquisition		2,600,000
Business Combination Increase In Cash		5,600,000
Payments of Debt Issuance Costs		$ 2,200,000
Debt Instrument, Interest Rate During Period		6.00%
Subsequent Event [Member] | Term Loan [Member]
Subsequent Event [Line Items]
Line of Credit Facility, Maximum Borrowing Capacity		$ 24,000,000
Subsequent Event [Member] | Convertible Notes Payable [Member]
Subsequent Event [Line Items]
Debt Instrument, Face Amount		$ 52,000,000
Debt Instrument, Interest Rate During Period		6.00%
Conversion of Stock, Shares Converted		257.5163
Debt Instrument, Convertible, Conversion Price		$ 3.88
Line of Credit Facility, Maximum Borrowing Capacity		$ 9,750,000
Conversion of Stock, Amount Converted		1,000
Debt Instrument Purchase Of Additonal Notes	$ 3,000,000
Subsequent Event [Member] | Debt [Member]
Subsequent Event [Line Items]
Other Payments to Acquire Businesses		13,000,000
Subsequent Event [Member] | Promissory Note One [Member]
Subsequent Event [Line Items]
Payments to Acquire Businesses, Gross		250,000
Subsequent Event [Member] | Promissory Note Two [Member]
Subsequent Event [Line Items]
Payments to Acquire Businesses, Gross		$ 100,000
Debt Instrument, Term		3 years
Subsequent Event [Member] | Cash Pay [Member]
Subsequent Event [Line Items]
Total Consideration		$ 60,000,000
Subsequent Event [Member] | New Facility [Member]
Subsequent Event [Line Items]
Debt Instrument, Maturity Date		Jul. 15, 2020
Line of Credit Facility, Current Borrowing Capacity		$ 18,000,000
Debt Instrument, Interest Rate Terms		(a) 9% per annum, which portion of interest will be payable in cash, plus (b) additional interest (“PIK Interest”) in an amount equal to (i) the sum of 14% per annum, plus the higher of (x) LIBOR and (y) 1% per annum, minus (ii) 9% per annum, which portion of interest will be payable “in kind.” During the portion of the First Period before December 31, 2015 (the ‘‘Optional PIK Period’’)
Line of Credit Facility, Interest Rate Description		New Facility to accrue during the Optional PIK Period at a rate equal to the sum of 14% per annum, plus the higher of (x) LIBOR and (y) 1% per annum, which portion of interest will be payable ‘‘in kind.’’ On or after June 30, 2018 until the New Facility is repaid in full (the “Second Period”), interest on loans outstanding under the New Facility will accrue at a rate equal to the sum of (a) 12% per annum, which portion of interest will be payable in cash, plus (b) PIK Interest in an amount equal to the difference of (i) the sum of 14% per annum, plus the higher of (x) LIBOR and (y) 1% per annum, minus (ii) 12% per annum, which portion of interest will be payable “in kind.” In both the First Period and the Second Period, the portion of accrued interest constituting PIK Interest will not be payable in cash but will instead be added to the principal amount outstanding under the New Facility. However, at the Borrower’s option, it may choose to make any “payment-in-kind” interest payment in cash. Until the third anniversary of the closing date of the New Facility, the Borrower will not be allowed to voluntarily prepay the New Facility. Whenever loans outstanding under the New Facility are prepaid or paid, whether voluntarily, involuntarily or on the Maturity Date, a fee of 7.5% on the amount paid will be due and payable.
Subsequent Event [Member] | Common Stock [Member]
Subsequent Event [Line Items]
Business Acquisition Number Of Shares Acquired		4,240,000
Business Acquisitions Contingent Consideration At Fair Value Current		$ 6,000,000
Harland Medical Systems Inc [Member] | Subsequent Event [Member]
Subsequent Event [Line Items]
Debt Instrument, Interest Rate, Stated Percentage		5.00%
Xspine [Member]
Subsequent Event [Line Items]
Description For Stock Purchase Agreement Representations And Warranties			Indemnity for breaches of representations and warranties is generally subject to a $100,000 deductible basket and a cap of $6 million for basic representations, the full escrow amount for intermediate representations, and the full purchase price for fundamental representations.
Goodwill			$ 23,000,000