Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

LORETTO HOSPITAL

Chicago, IL · CCN 140083 · Rates published

4,077 distinct procedures filed
27 distinct payers
109,611 rate rows
2026-05-06 last MRF observed
Data quality

108,594 of 109,611 rate rows are consumer-grade (99.1%)

1,017 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
template filing: same amount across many unrelated codes — excluded 999
placeholder amount (≤ $0.02) — excluded from medians 18
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.lorettohospital.org/documents/362200248_LorettoHospital_StandardCharges.csv
Found on page https://www.lorettohospital.org/patients-visitors/financial-assistance/price-transparency/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-22
Content fingerprint 0217521e27aa890c… · 5,605,148 bytes · first seen 2026-05-05

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
36000193
OTHER 		Impl Sling Urin Rpr Cat 10 27 $55.00 $3,750.00 $100.00 nat. median
$1,788
outlier · 0.1×
36000196
OTHER 		Impl Sling Urin Rpr Cat 13 27 $55.00 $9,375.00 $100.00 nat. median
$820
outlier · 0.1×
36000191
OTHER 		Impl Sling Urin Rpr Cat 8 18 $55.00 $100.00 $100.00 nat. median
$482
outlier · 0.2×
36000192
OTHER 		Impl Sling Urin Rpr Cat 9 27 $55.00 $2,812.50 $100.00 nat. median
$817
outlier · 0.1×
36000194
OTHER 		Impl Sling Urin Rpr Cat 11 27 $55.00 $5,625.00 $100.00 nat. median
$2,387
outlier · 0.0×
36000195
OTHER 		Impl Sling Urin Rpr Cat 12 27 $55.00 $7,500.00 $100.00 nat. median
$2,034
outlier · 0.0×
36000174
OTHER 		Misc Supply Cat 11 27 $55.00 $5,625.00 $100.00 nat. median
$3,124
outlier · 0.0×
36000190
OTHER 		Impl Sling Urin Rpr Cat 7 27 $55.00 $937.50 $100.00 nat. median
$6,670
outlier · 0.0×
36000168
OTHER 		Misc Supply Cat 5 27 $55.00 $375.00 $100.00 nat. median
$664
outlier · 0.2×
36000173
OTHER 		Misc Supply Cat 10 27 $55.00 $3,750.00 $100.00 nat. median
$720
outlier · 0.1×
36000189
OTHER 		Impl Sling Urin Rpr Cat 6 27 $55.00 $656.25 $100.00 nat. median
$4,320
outlier · 0.0×
36000183
OTHER 		Bone/tissue Cat 9 27 $55.00 $2,812.50 $100.00 nat. median
$100
1.0× median
36000160
OTHER 		Impl General Cat 11 27 $55.00 $5,625.00 $100.00 nat. median
$5,752
outlier · 0.0×
36000188
OTHER 		Impl Sling Urin Rpr Cat 5 27 $55.00 $375.00 $100.00 nat. median
$3,145
outlier · 0.0×
36000163
OTHER 		Impl General Cat 14 27 $55.00 $14,062.50 $100.00 nat. median
$11,068
outlier · 0.0×
358500039
OTHER 		Prq Revasc Byp Graft 1 Vsl 27 $55.00 $20,357.51 $100.00 nat. median
$100
1.0× median
36000008
OTHER 		O.r. Level 3 Ea. Add'l 15 Min 27 $55.00 $1,425.00 $100.00 nat. median
$100
1.0× median
36000007
OTHER 		O.r. Level 2 Ea. Add'l 15 Min 27 $55.00 $1,056.75 $100.00 nat. median
$100
1.0× median
36000162
OTHER 		Impl General Cat 13 27 $55.00 $9,375.00 $100.00 nat. median
$152
0.7× median
36000167
OTHER 		Misc Supply Cat 4 27 $55.00 $187.50 $100.00 nat. median
$658
outlier · 0.2×
36000170
OTHER 		Misc Supply Cat 7 27 $55.00 $937.50 $100.00 nat. median
$922
outlier · 0.1×
36000172
OTHER 		Misc Supply Cat 9 27 $55.00 $2,812.50 $100.00 nat. median
$1,573
outlier · 0.1×
36000178
OTHER 		Bone/tissue Cat 4 27 $55.00 $187.50 $100.00 nat. median
$4,116
outlier · 0.0×
36000184
OTHER 		Bone/tissue Cat 10 27 $55.00 $3,750.00 $100.00 nat. median
$897
outlier · 0.1×
36000179
OTHER 		Bone/tissue Cat 5 27 $55.00 $375.00 $100.00 nat. median
$1,750
outlier · 0.1×
36000182
OTHER 		Bone/tissue Cat 8 18 $55.00 $100.00 $100.00 nat. median
$6,289
outlier · 0.0×
36000138
OTHER 		Impl Spinal Cat 12 27 $55.00 $7,500.00 $100.00 nat. median
$146
0.7× median
36000146
OTHER 		Lead Icd Single Cat 5 27 $55.00 $375.00 $100.00 nat. median
$2,686
outlier · 0.0×
36000159
OTHER 		Impl General Cat 10 27 $55.00 $3,750.00 $100.00 nat. median
$1,905
outlier · 0.1×
36000187
OTHER 		Impl Sling Urin Rpr Cat 4 27 $55.00 $187.50 $100.00 nat. median
$1,028
outlier · 0.1×
358500040
OTHER 		Prq Revasc Byp Graft 1 Vsl 27 $55.00 $9,266.25 $100.00 nat. median
$100
1.0× median
36000009
OTHER 		O.r. Level 4 Ea. Add'l 15 Min 27 $55.00 $1,920.00 $100.00 nat. median
$75
1.3× median
358500023
OTHER 		Open/perq Place Stent 1st 27 $55.00 $20,357.51 $100.00 nat. median
$100
1.0× median
358500037
OTHER 		Prq Card Stent W/angio Addl 27 $55.00 $8,364.00 $100.00 nat. median
$100
1.0× median
358500051
OTHER 		L Hrt Artery/ventricle Angio 27 $55.00 $5,673.59 $100.00 nat. median
$100
1.0× median
3585003624
OTHER 		Place Cath Abd/pel/lwr Ext 1st 27 $55.00 $2,529.00 $100.00 nat. median
$100
1.0× median
35851898
OTHER 		Solia S 45 (Right Atrium Lead 27 $55.00 $1,338.75 $100.00 nat. median
$100
1.0× median
36000006
OTHER 		O.r. Level 1 Ea. Add'l 15 Min 27 $55.00 $722.25 $100.00 nat. median
$480
outlier · 0.2×
36000025
OTHER 		Applicator Category 1 27 $55.00 $320.25 $100.00 nat. median
$57
1.8× median
36000044
OTHER 		Cannula Category 1 27 $55.00 $213.75 $100.00 nat. median
$4,459
outlier · 0.0×
36000041
OTHER 		Blade Category 1 27 $55.00 $213.75 $100.00 nat. median
$1,519
outlier · 0.1×
36000040
OTHER 		Biopsy Forcepts Category 6 27 $55.00 $1,281.00 $100.00 nat. median
$1,484
outlier · 0.1×
36000072
OTHER 		Cath Suprapubic/cysto Cat 5 27 $55.00 $375.00 $100.00 nat. median
$4,316
outlier · 0.0×
36000169
OTHER 		Misc Supply Cat 6 27 $55.00 $656.25 $100.00 nat. median
$152
0.7× median
36000064
OTHER 		Impl Port Indwelling Cat 7 27 $55.00 $937.50 $100.00 nat. median
$4,316
outlier · 0.0×
36000171
OTHER 		Misc Supply Cat 8 18 $55.00 $100.00 $100.00 nat. median
$100
1.0× median
36000080
OTHER 		Impl Prosthesis Breast Cat 8 18 $55.00 $100.00 $100.00 nat. median
$100
1.0× median
36000161
OTHER 		Impl General Cat 12 27 $55.00 $7,500.00 $100.00 nat. median
$7,875
outlier · 0.0×
36000164
OTHER 		Impl General Cat 15 27 $55.00 $18,750.00 $100.00 nat. median
$1,828
outlier · 0.1×
36000131
OTHER 		Impl Spinal Cat 5 27 $55.00 $375.00 $100.00 nat. median
$1,289
outlier · 0.1×

Other procedures at this hospital

Browse this hospital's 4,077 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
078000001 OTHER Psych Diagnostic Evaluation 27 27 $372.55 $372.55 $55.00 $279.41 $100.00 2026-05-06
078000002 OTHER Psych Diag Eval W/med Srvs 27 27 $372.55 $372.55 $55.00 $279.41 $100.00 2026-05-06
078000003 OTHER Psytx Pt&/family 30 Minutes 27 27 $372.55 $372.55 $55.00 $279.41 $100.00 2026-05-06
078000005 OTHER Psytx Pt&family 45 Minutes 27 27 $372.55 $372.55 $55.00 $279.41 $100.00 2026-05-06
078000007 OTHER Psytx Pt&family 60 Min 27 27 $372.55 $372.55 $55.00 $279.41 $100.00 2026-05-06
078000009 OTHER Psytx Crisis Initial 60 Min 27 27 $372.55 $372.55 $55.00 $279.41 $100.00 2026-05-06
078000011 OTHER Psychoanalysis 27 27 $372.55 $372.55 $55.00 $279.41 $100.00 2026-05-06
078000012 OTHER Family Psytx Without Patient 27 27 $372.55 $372.55 $55.00 $279.41 $100.00 2026-05-06
078000013 OTHER Family Psytx W/patient 27 27 $372.55 $372.55 $55.00 $279.41 $100.00 2026-05-06
1003003 OTHER **med/surg 5 West-semi 9 9 $1,495.00 $1,495.00 $100.00 $100.00 $100.00 2026-05-06
1003004 OTHER **med/surg 5 West-priv 9 9 $1,505.00 $1,505.00 $100.00 $100.00 $100.00 2026-05-06
1003005 OTHER **med/surg 5 West-isolation 9 9 $2,380.00 $2,380.00 $100.00 $100.00 $100.00 2026-05-06
1003006 OTHER **med/surg 5 West-telemetry 9 9 $2,155.00 $2,155.00 $100.00 $100.00 $100.00 2026-05-06
1003011 OTHER **psych 3 East-isolation 9 9 $2,380.00 $2,380.00 $100.00 $100.00 $100.00 2026-05-06
1003012 OTHER **psych 3 East-ICU 9 9 $1,950.00 $1,950.00 $100.00 $100.00 $100.00 2026-05-06
1003029 OTHER **med/surg 5 East-semi 9 9 $1,495.00 $1,495.00 $100.00 $100.00 $100.00 2026-05-06
1003030 OTHER **med/surg 5 East-priv 9 9 $1,505.00 $1,505.00 $100.00 $100.00 $100.00 2026-05-06
1003031 OTHER **med/surg 5 East-isolation 9 9 $2,380.00 $2,380.00 $100.00 $100.00 $100.00 2026-05-06
1003032 OTHER **med/surg 5 East-telemetry 9 9 $2,155.00 $2,155.00 $100.00 $100.00 $100.00 2026-05-06
1003040 OTHER Observation-direct Place Mcr 27 27 $160.00 $160.00 $55.00 $120.00 $100.00 2026-05-06
1003045 OTHER **psych 6 West-semi 9 9 $1,610.00 $1,610.00 $100.00 $100.00 $100.00 2026-05-06
1003046 OTHER **psych 6 West-priv 9 9 $1,775.00 $1,775.00 $100.00 $100.00 $100.00 2026-05-06
1003047 OTHER **psych 6 West-isolation 9 9 $2,380.00 $2,380.00 $100.00 $100.00 $100.00 2026-05-06
1003048 OTHER **psych 6 West-intensive Care 9 9 $1,950.00 $1,950.00 $100.00 $100.00 $100.00 2026-05-06
1003051 OTHER Observation-direct Admit Mco 27 27 $1,401.53 $1,401.53 $55.00 $1,051.15 $100.00 2026-05-06
1003409 OTHER **psych 3 East-semi 9 9 $1,610.00 $1,610.00 $100.00 $100.00 $100.00 2026-05-06
1003410 OTHER **psych 3 East-priv 9 9 $1,775.00 $1,775.00 $100.00 $100.00 $100.00 2026-05-06
1003417 OTHER **psych 3 West-semi 9 9 $1,610.00 $1,610.00 $100.00 $100.00 $100.00 2026-05-06
1003418 OTHER **psych 3 West-priv 9 9 $1,775.00 $1,775.00 $100.00 $100.00 $100.00 2026-05-06
1003419 OTHER **psych 3 West-isolation 9 9 $2,380.00 $2,380.00 $100.00 $100.00 $100.00 2026-05-06
1003420 OTHER **psych 3 West-intensive Care 9 9 $1,950.00 $1,950.00 $100.00 $100.00 $100.00 2026-05-06
1003425 OTHER **addiction-semi 9 9 $1,495.00 $1,495.00 $100.00 $100.00 $100.00 2026-05-06
1003426 OTHER **addiction-priv 9 9 $2,235.00 $2,235.00 $100.00 $100.00 $100.00 2026-05-06
1003427 OTHER **addiction-isolation 9 9 $2,380.00 $2,380.00 $100.00 $100.00 $100.00 2026-05-06
1003516 OTHER **intensive Care 9 9 $3,050.00 $3,050.00 $100.00 $100.00 $100.00 2026-05-06
1003517 OTHER **intensive Care-isolation 9 9 $3,280.00 $3,280.00 $100.00 $100.00 $100.00 2026-05-06
1003524 OTHER **residential Rehabit 9 9 $550.00 $550.00 $100.00 $100.00 $100.00 2026-05-06
13300730 OTHER Viscoat/provisc 0.5ml 27 27 $280.50 $280.50 $55.00 $210.38 $100.00 2026-05-06
13300990 OTHER Tolvaptan 30mg Tablet 27 27 $560.50 $560.50 $55.00 $420.38 $100.00 2026-05-06
13310119 OTHER Haloperidol Dec 100mg/ml 27 27 $309.00 $309.00 $55.00 $231.75 $100.00 2026-05-06
13310120 OTHER Haloperidol Dec 50mg/ml 27 27 $154.50 $154.50 $55.00 $115.88 $100.00 2026-05-06
13310166 OTHER Hyalgan 10mg/ml Syringe 27 27 $215.35 $215.35 $55.00 $161.51 $100.00 2026-05-06
13370071 OTHER Dificid (Fidaxomicin) 200mg Or 27 27 $5,370.24 $5,370.24 $55.00 $4,027.68 $100.00 2026-05-06
13370072 OTHER Dextrose-water 5% 100ml Mb+ 27 27 $269.95 $269.95 $55.00 $202.46 $100.00 2026-05-06
13370073 OTHER Dextrosed-water 5% 50ml Mb+ 27 27 $269.95 $269.95 $55.00 $202.46 $100.00 2026-05-06
13370075 OTHER Sodium Chloride 0.9% 50ml Mb+ 27 27 $269.95 $269.95 $55.00 $202.46 $100.00 2026-05-06
13370076 OTHER Sodium Chloride 0.9% 100 Ml Mb 27 27 $269.00 $269.00 $55.00 $201.75 $100.00 2026-05-06
13370080 OTHER Ethamolin Oleate 5% Amp 27 27 $5,484.00 $5,484.00 $55.00 $4,113.00 $100.00 2026-05-06
13370090 OTHER Botox 100U/Vial 27 27 $746.40 $746.40 $55.00 $559.80 $100.00 2026-05-06
13410170 OTHER Tetanus Immune Globulin 27 27 $941.28 $941.28 $55.00 $705.96 $100.00 2026-05-06
13650100 OTHER Convalescent Ff Plasma 27 27 $252.00 $252.00 $55.00 $189.00 $100.00 2026-05-06
20000033 OTHER Endometrial Pipelle Bx 27 27 $455.48 $455.48 $55.00 $341.61 $100.00 2026-05-06
24182309 OTHER Staple, Ta 90 3.5 27 27 $436.76 $436.76 $55.00 $327.57 $100.00 2026-05-06
24182517 OTHER Dissector,curved 5mm,lap Chole 27 27 $413.04 $413.04 $55.00 $309.78 $100.00 2026-05-06
2510300261 OTHER Rituximab 100mg/ml Ml 27 27 $2,046.25 $2,046.25 $55.00 $1,534.69 $100.00 2026-05-06
2590300202 OTHER Octreotide Acetate 20mg/kit Ml 27 27 $436.30 $436.30 $55.00 $327.23 $100.00 2026-05-06
260000001 OTHER IV Infusion, 1st Hour 27 27 $528.20 $528.20 $55.00 $396.15 $100.00 2026-05-06
260000003 OTHER IV Infusion, Seq (new Drug) 27 27 $172.53 $172.53 $55.00 $129.40 $100.00 2026-05-06
260000004 OTHER IV Push, Initial Drug <15 Min 27 27 $528.20 $528.20 $55.00 $396.15 $100.00 2026-05-06
260000007 OTHER IV Infusion Hydration, 1st Hr 27 27 $528.20 $528.20 $55.00 $396.15 $100.00 2026-05-06
260000009 OTHER Injection, Im/sq 27 27 $172.53 $172.53 $55.00 $129.40 $100.00 2026-05-06
3000000001 OTHER Abo Group 27 27 $296.90 $296.90 $55.00 $222.68 $100.00 2026-05-06
3010000003 OTHER B-type Natriuretic Peptide 27 27 $162.00 $162.00 $55.00 $121.50 $100.00 2026-05-06
3100032408 OTHER Pf US Core Bx Lung/mediastinum 27 27 $407.90 $407.90 $55.00 $305.93 $100.00 2026-05-06
3201020 OTHER Flouroscopy <1 Hour Phys/qhp 27 27 $597.10 $597.10 $55.00 $447.82 $100.00 2026-05-06
3201650 OTHER Lumbar Spine-ap And Lat 27 27 $273.30 $273.30 $55.00 $204.97 $100.00 2026-05-06
3202501 OTHER Skull-ap And Lat 27 27 $273.30 $273.30 $55.00 $204.97 $100.00 2026-05-06
32900002 OTHER Pt Eval Mod Complex 30 Min 27 27 $564.78 $564.78 $55.00 $423.58 $100.00 2026-05-06
32900003 OTHER Pt Eval High Complex 45 Min 27 27 $756.00 $756.00 $55.00 $567.00 $100.00 2026-05-06
32900039 OTHER Ot Eval Mod Complex 45 Min 27 27 $252.00 $252.00 $55.00 $189.00 $100.00 2026-05-06
32900040 OTHER Ot Eval High Complex 60 Min 27 27 $302.00 $302.00 $55.00 $226.50 $100.00 2026-05-06
3400290 OTHER Nm Meckle's Divericulum 27 27 $993.85 $993.85 $55.00 $745.39 $100.00 2026-05-06
3400320 OTHER Nm Cardiolite-r-spect 27 27 $3,393.83 $3,393.83 $55.00 $2,545.37 $100.00 2026-05-06
3400322 OTHER Nm Whole Body Imaging 2+days 27 27 $3,393.83 $3,393.83 $55.00 $2,545.37 $100.00 2026-05-06
3400423 OTHER Nm Persantine Without Spect 27 27 $3,393.83 $3,393.83 $55.00 $2,545.37 $100.00 2026-05-06
3400424 OTHER Radiopharmaceutical Therapy 27 27 $638.55 $638.55 $55.00 $478.91 $100.00 2026-05-06
3400470 OTHER Nm Renal Scan With Lasix 27 27 $1,290.00 $1,290.00 $55.00 $967.50 $100.00 2026-05-06
343A9516 OTHER L-123 Capsule (200uCi) 27 27 $168.00 $168.00 $55.00 $126.00 $100.00 2026-05-06
3500036905 OTHER Thrombect Dialy Circuit W/baln 27 27 $26,538.28 $26,538.28 $55.00 $19,903.71 $100.00 2026-05-06
3500036906 OTHER Thrombect Dialy Circ W/stnt An 27 27 $42,944.00 $42,944.00 $55.00 $32,208.00 $100.00 2026-05-06
3500036907 OTHER Angioplasty Balln Dialys Circ 27 27 $6,361.14 $6,361.14 $55.00 $4,770.85 $100.00 2026-05-06
3500036908 OTHER Place Stent Dialys Circ W/angi 27 27 $7,096.50 $7,096.50 $55.00 $5,322.38 $100.00 2026-05-06
3500036909 OTHER Embolization/occlu Dialys Circ 27 27 $7,618.00 $7,618.00 $55.00 $5,713.50 $100.00 2026-05-06
3500441 OTHER CT Orb/temp Bones Without Cont 27 27 $273.30 $273.30 $55.00 $204.97 $100.00 2026-05-06
3500442 OTHER CT Orb/temp Bones W/cont 27 27 $461.13 $461.13 $55.00 $345.85 $100.00 2026-05-06
3500443 OTHER CT Orb/temp Bones W/wo Cont 27 27 $461.13 $461.13 $55.00 $345.85 $100.00 2026-05-06
3500571 OTHER CT Thoracic Spine W/wo Cont 27 27 $461.13 $461.13 $55.00 $345.85 $100.00 2026-05-06
3500611 OTHER CT Calcium Scoring 27 27 $222.15 $222.15 $55.00 $166.61 $100.00 2026-05-06
3500613 OTHER Swallow Study 27 27 $461.13 $461.13 $55.00 $345.85 $100.00 2026-05-06
3500614 OTHER CT Angiography Of Heart 27 27 $461.13 $461.13 $55.00 $345.85 $100.00 2026-05-06
355025696 OTHER Erythromycin 500 Mg Vial 27 27 $208.93 $208.93 $55.00 $156.70 $100.00 2026-05-06
355025740 OTHER Fluphenazine 25 mg/mL Decanoat 27 27 $162.00 $162.00 $55.00 $121.50 $100.00 2026-05-06
355025867 OTHER Leuprolide 3.75 Mg Kit 27 27 $2,578.90 $2,578.90 $55.00 $1,934.17 $100.00 2026-05-06
355025929 OTHER Menactra (im) Vial 27 27 $674.00 $674.00 $55.00 $505.50 $100.00 2026-05-06
355026076 OTHER Pegfilgrastim 6 Mg Syringe 27 27 $10,293.08 $10,293.08 $55.00 $7,719.81 $100.00 2026-05-06
355026194 OTHER Rabies Immune Globulin 27 27 $332.82 $332.82 $55.00 $249.62 $100.00 2026-05-06
355026195 OTHER Rabies Vaccine 27 27 $293.59 $293.59 $55.00 $220.19 $100.00 2026-05-06
355026433 OTHER Multivitamin 15 Ml Liquid 18 18 $0.03 $0.03 $55.00 $100.00 $100.00 2026-05-06
355026439 OTHER Ziprasidone Hcl 60 Mg Capsule 27 27 $157.65 $157.65 $55.00 $118.24 $100.00 2026-05-06
355026442 OTHER Zostavax Vaccine 27 27 $223.12 $223.12 $55.00 $167.34 $100.00 2026-05-06
355026445 OTHER Vitamin B Complex 18 18 $0.03 $0.03 $55.00 $100.00 $100.00 2026-05-06
355026452 OTHER Haldol Dec For Opmh 27 27 $154.50 $154.50 $55.00 $115.88 $100.00 2026-05-06
355026501 OTHER Filgrastim 480mcg/0.8ml Syring 27 27 $1,457.00 $1,457.00 $55.00 $1,092.75 $100.00 2026-05-06
355026506 OTHER Phentolamine Mesylate5mg/mlinj 27 27 $316.90 $316.90 $55.00 $237.68 $100.00 2026-05-06
355026514 OTHER Filgrastim 480mcg/0.8ml 27 27 $236.75 $236.75 $55.00 $177.56 $100.00 2026-05-06
358500003 OTHER Insert Electrd/pm Cath Sngl 27 27 $20,872.20 $20,872.20 $55.00 $15,654.15 $100.00 2026-05-06
358500004 OTHER Insert I-aort Percut Device 27 27 $3,150.00 $3,150.00 $55.00 $2,362.50 $100.00 2026-05-06
358500005 OTHER Place Catheter In Vein 27 27 $1,574.00 $1,574.00 $55.00 $1,180.50 $100.00 2026-05-06
358500006 OTHER Intro Ndl Icath Upr/lxtr Art 27 27 $1,595.00 $1,595.00 $55.00 $1,196.25 $100.00 2026-05-06
358500007 OTHER Place Catheter In Aorta 27 27 $1,878.00 $1,878.00 $55.00 $1,408.50 $100.00 2026-05-06
358500008 OTHER Place Catheter In Artery 27 27 $2,119.00 $2,119.00 $55.00 $1,589.25 $100.00 2026-05-06
358500009 OTHER Place Catheter In Artery 27 27 $2,160.00 $2,160.00 $55.00 $1,620.00 $100.00 2026-05-06
358500010 OTHER Ins Cath Ren Art 1st Bilat 27 27 $7,617.23 $7,617.23 $55.00 $5,712.92 $100.00 2026-05-06
358500011 OTHER Insert Non-tunnel Cv Cath<5 27 27 $7,617.23 $7,617.23 $55.00 $5,712.92 $100.00 2026-05-06
358500012 OTHER Insert Non-tunnel Cv Cath5+ 27 27 $7,617.23 $7,617.23 $55.00 $5,712.92 $100.00 2026-05-06
358500013 OTHER Ins Intravascular Vena Cava 27 27 $13,142.38 $13,142.38 $55.00 $9,856.78 $100.00 2026-05-06
358500014 OTHER Remove Intrvas Foreign Body 27 27 $7,617.23 $7,617.23 $55.00 $5,712.92 $100.00 2026-05-06
358500016 OTHER Thromblytic Art/ven Therapy 27 27 $7,617.23 $7,617.23 $55.00 $5,712.92 $100.00 2026-05-06
358500017 OTHER Transcath Stent Cca W/eps 27 27 $8,495.00 $8,495.00 $55.00 $6,371.25 $100.00 2026-05-06
358500018 OTHER Iliac Revasc W/stent 27 27 $27,143.35 $27,143.35 $55.00 $20,357.51 $100.00 2026-05-06
358500019 OTHER Fem/popl Revas W/tla 27 27 $13,335.78 $13,335.78 $55.00 $10,001.83 $100.00 2026-05-06
358500020 OTHER Fem/popl Revas W/ather 27 27 $27,143.35 $27,143.35 $55.00 $20,357.51 $100.00 2026-05-06
358500021 OTHER Fem/popl Revasc W/stent 27 27 $27,143.35 $27,143.35 $55.00 $20,357.51 $100.00 2026-05-06
358500022 OTHER Tib/per Revasc W/ather 27 27 $43,923.13 $43,923.13 $55.00 $32,942.35 $100.00 2026-05-06
358500023 OTHER Open/perq Place Stent 1st 27 27 $27,143.35 $27,143.35 $55.00 $20,357.51 $100.00 2026-05-06
358500024 OTHER Vasc Embolize/occlude Venous 27 27 $27,143.35 $27,143.35 $55.00 $20,357.51 $100.00 2026-05-06
358500025 OTHER Chest X-ray 3 Views 27 27 $222.15 $222.15 $55.00 $166.61 $100.00 2026-05-06
358500026 OTHER Contrast Exam Abdominl Aorta 27 27 $7,617.23 $7,617.23 $55.00 $5,712.92 $100.00 2026-05-06
358500027 OTHER X-ray Aorta Leg Arteries 27 27 $7,617.23 $7,617.23 $55.00 $5,712.92 $100.00 2026-05-06
358500028 OTHER Artery X-rays Arm/leg Uni 27 27 $7,617.23 $7,617.23 $55.00 $5,712.92 $100.00 2026-05-06
358500029 OTHER Artery X-rays Arms/legs 27 27 $7,617.23 $7,617.23 $55.00 $5,712.92 $100.00 2026-05-06
358500030 OTHER Vein X-ray Trunk 27 27 $7,617.23 $7,617.23 $55.00 $5,712.92 $100.00 2026-05-06
358500032 OTHER Prq Cardiac Angioplast 1 Art 27 27 $13,335.78 $13,335.78 $55.00 $10,001.83 $100.00 2026-05-06
358500033 OTHER Prq Cardiac Angio Addl Art 27 27 $8,095.00 $8,095.00 $55.00 $6,071.25 $100.00 2026-05-06
358500034 OTHER Prq Card Angio/athrect 1 Art 27 27 $27,143.35 $27,143.35 $55.00 $20,357.51 $100.00 2026-05-06
358500035 OTHER Prq Card Angio/athrect Addl 27 27 $12,304.00 $12,304.00 $55.00 $9,228.00 $100.00 2026-05-06
358500036 OTHER Prq Card Stent W/angio 1 Vsl 27 27 $27,143.35 $27,143.35 $55.00 $20,357.51 $100.00 2026-05-06
358500037 OTHER Prq Card Stent W/angio Addl 27 27 $11,152.00 $11,152.00 $55.00 $8,364.00 $100.00 2026-05-06
358500039 OTHER Prq Revasc Byp Graft 1 Vsl 27 27 $27,143.35 $27,143.35 $55.00 $20,357.51 $100.00 2026-05-06
358500040 OTHER Prq Revasc Byp Graft 1 Vsl 27 27 $12,355.00 $12,355.00 $55.00 $9,266.25 $100.00 2026-05-06
358500041 OTHER Prq Card Revasc Chronic 1vsl 27 27 $27,143.35 $27,143.35 $55.00 $20,357.51 $100.00 2026-05-06
358500042 OTHER Prq Card Revasc Chronic Addl 27 27 $11,314.00 $11,314.00 $55.00 $8,485.50 $100.00 2026-05-06
358500043 OTHER Prq Coronary Mech Thrombect 27 27 $4,992.00 $4,992.00 $55.00 $3,744.00 $100.00 2026-05-06
358500044 OTHER Edoluminal Imaginge Add On 27 27 $3,801.00 $3,801.00 $55.00 $2,850.75 $100.00 2026-05-06
358500045 OTHER Endoluminal Imaging Add On 27 27 $2,396.00 $2,396.00 $55.00 $1,797.00 $100.00 2026-05-06
358500046 OTHER Right Heart Cath 27 27 $7,564.78 $7,564.78 $55.00 $5,673.59 $100.00 2026-05-06
358500047 OTHER Left Hrt Cath W/ventrclgrphy 27 27 $7,564.78 $7,564.78 $55.00 $5,673.59 $100.00 2026-05-06
358500048 OTHER Cr&l Hrt Cath W/ventriclgrphy 27 27 $7,564.78 $7,564.78 $55.00 $5,673.59 $100.00 2026-05-06
358500049 OTHER Coronary Artery Angio S&i 27 27 $7,564.78 $7,564.78 $55.00 $5,673.59 $100.00 2026-05-06
358500050 OTHER Coronary Art/grft Angio S&i 27 27 $7,564.78 $7,564.78 $55.00 $5,673.59 $100.00 2026-05-06
358500051 OTHER L Hrt Artery/ventricle Angio 27 27 $7,564.78 $7,564.78 $55.00 $5,673.59 $100.00 2026-05-06
358500052 OTHER Insert/place Heart Catheter 27 27 $3,804.43 $3,804.43 $55.00 $2,853.32 $100.00 2026-05-06
358500053 OTHER Biopsy Of Heart Lining 27 27 $7,617.23 $7,617.23 $55.00 $5,712.92 $100.00 2026-05-06
358500054 OTHER Inject Pulm Art Hrt Cath 27 27 $1,676.00 $1,676.00 $55.00 $1,257.00 $100.00 2026-05-06
358500055 OTHER Heart Flow Reserve Measure 27 27 $2,825.00 $2,825.00 $55.00 $2,118.75 $100.00 2026-05-06
358500056 OTHER Heart Flow Reserve Measure 27 27 $1,415.00 $1,415.00 $55.00 $1,061.25 $100.00 2026-05-06
358500057 OTHER Vasc Embolize/occlude Artery 27 27 $27,143.35 $27,143.35 $55.00 $20,357.51 $100.00 2026-05-06
358500058 OTHER Vasc Embolize/occlude Organ 27 27 $27,143.35 $27,143.35 $55.00 $20,357.51 $100.00 2026-05-06
358500059 OTHER Vasc Embolize/occlude Bleed 27 27 $27,143.35 $27,143.35 $55.00 $20,357.51 $100.00 2026-05-06
358500103 OTHER Angio Extremity Bil 27 27 $7,617.23 $7,617.23 $55.00 $5,712.92 $100.00 2026-05-06
3585003624 OTHER Place Cath Abd/pel/lwr Ext 1st 27 27 $3,372.00 $3,372.00 $55.00 $2,529.00 $100.00 2026-05-06
3585036246 OTHER Place Cath Abd/pel/lwr Ext 2nd 27 27 $3,320.00 $3,320.00 $55.00 $2,490.00 $100.00 2026-05-06
3585036247 OTHER Place Cath Abd/pel/lwr Ext 3rd 27 27 $4,078.00 $4,078.00 $55.00 $3,058.50 $100.00 2026-05-06
35851721 OTHER Generator: Rivacor 7 Dr_t Df4 27 27 $64,262.50 $64,262.50 $55.00 $48,196.88 $100.00 2026-05-06
35851777 OTHER Leads: Plexa ProMRI S 60Right 27 27 $9,600.00 $9,600.00 $55.00 $7,200.00 $100.00 2026-05-06
35851898 OTHER Solia S 45 (Right Atrium Lead 27 27 $1,785.00 $1,785.00 $55.00 $1,338.75 $100.00 2026-05-06
36000001 OTHER O.r. Level 1 First 30 Minutes 27 27 $3,577.00 $3,577.00 $55.00 $2,682.75 $100.00 2026-05-06
36000002 OTHER O.r. Level 2 First 30 Minutes 27 27 $5,504.00 $5,504.00 $55.00 $4,128.00 $100.00 2026-05-06
36000003 OTHER O.r. Level 3 First 30 Minutes 27 27 $7,772.00 $7,772.00 $55.00 $5,829.00 $100.00 2026-05-06
36000004 OTHER O.r. Level 4 First 30 Minutes 27 27 $8,768.00 $8,768.00 $55.00 $6,576.00 $100.00 2026-05-06
36000005 OTHER O.r. Level 5 First 30 Minutes 27 27 $9,500.00 $9,500.00 $55.00 $7,125.00 $100.00 2026-05-06
36000006 OTHER O.r. Level 1 Ea. Add'l 15 Min 27 27 $963.00 $963.00 $55.00 $722.25 $100.00 2026-05-06
36000007 OTHER O.r. Level 2 Ea. Add'l 15 Min 27 27 $1,409.00 $1,409.00 $55.00 $1,056.75 $100.00 2026-05-06
36000008 OTHER O.r. Level 3 Ea. Add'l 15 Min 27 27 $1,900.00 $1,900.00 $55.00 $1,425.00 $100.00 2026-05-06
36000009 OTHER O.r. Level 4 Ea. Add'l 15 Min 27 27 $2,560.00 $2,560.00 $55.00 $1,920.00 $100.00 2026-05-06
36000010 OTHER O.r. Level 5 Ea. Add'l 15 Min 27 27 $2,693.00 $2,693.00 $55.00 $2,019.75 $100.00 2026-05-06
36000014 OTHER Cath Infus Picc Cent Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000015 OTHER Cath Infus Picc Cent Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000016 OTHER Cath Infus Picc Cent Cat 6 27 27 $875.00 $875.00 $55.00 $656.25 $100.00 2026-05-06
36000017 OTHER Cath Infus Picc Cent Cat 7 27 27 $1,250.00 $1,250.00 $55.00 $937.50 $100.00 2026-05-06
36000018 OTHER Cath Infus Picc Cent Cat 8 18 18 $2,500.00 $2,500.00 $55.00 $100.00 $100.00 2026-05-06
36000022 OTHER Cath Balloon Nonvasc Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000023 OTHER Cath Balloon Nonvasc Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000025 OTHER Applicator Category 1 27 27 $427.00 $427.00 $55.00 $320.25 $100.00 2026-05-06
36000028 OTHER Cath Drainage Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000029 OTHER Cath Drainage Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000033 OTHER Cath Dialysis Long Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000034 OTHER Cath Dialysis Long Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000035 OTHER Biopsy Forceps Category 1 27 27 $285.00 $285.00 $55.00 $213.75 $100.00 2026-05-06
36000036 OTHER Cath Dialysis Long Cat 6 27 27 $875.00 $875.00 $55.00 $656.25 $100.00 2026-05-06
36000037 OTHER Biopsy Forceps Category 3 27 27 $854.00 $854.00 $55.00 $640.50 $100.00 2026-05-06
36000038 OTHER Cath Dialysis Long Cat 7 27 27 $1,250.00 $1,250.00 $55.00 $937.50 $100.00 2026-05-06
36000039 OTHER Cath Dialysis Long Cat 8 18 18 $2,500.00 $2,500.00 $55.00 $100.00 $100.00 2026-05-06
36000040 OTHER Biopsy Forcepts Category 6 27 27 $1,708.00 $1,708.00 $55.00 $1,281.00 $100.00 2026-05-06
36000041 OTHER Blade Category 1 27 27 $285.00 $285.00 $55.00 $213.75 $100.00 2026-05-06
36000044 OTHER Cannula Category 1 27 27 $285.00 $285.00 $55.00 $213.75 $100.00 2026-05-06
36000046 OTHER Catheter Category 1 27 27 $285.00 $285.00 $55.00 $213.75 $100.00 2026-05-06
36000047 OTHER Cath Dialysis Short Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000048 OTHER Cath Dialysis Short Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000049 OTHER Cath Dialysis Short Cat 6 27 27 $875.00 $875.00 $55.00 $656.25 $100.00 2026-05-06
36000050 OTHER Cath Dialysis Short Cat 7 27 27 $1,250.00 $1,250.00 $55.00 $937.50 $100.00 2026-05-06
36000051 OTHER Cath Dialysis Short Cat 8 18 18 $2,500.00 $2,500.00 $55.00 $100.00 $100.00 2026-05-06
36000055 OTHER Cath Embolectomy Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000056 OTHER Cath Embolectomy Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000057 OTHER Cath Embolectomy Cat 6 27 27 $875.00 $875.00 $55.00 $656.25 $100.00 2026-05-06
36000061 OTHER Impl Port Indwelling Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000062 OTHER Impl Port Indwelling Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000063 OTHER Impl Port Indwelling Cat 6 27 27 $875.00 $875.00 $55.00 $656.25 $100.00 2026-05-06
36000064 OTHER Impl Port Indwelling Cat 7 27 27 $1,250.00 $1,250.00 $55.00 $937.50 $100.00 2026-05-06
36000065 OTHER Impl Port Indwelling Cat 8 18 18 $2,500.00 $2,500.00 $55.00 $100.00 $100.00 2026-05-06
36000066 OTHER Impl Port Indwelling Cat 9 27 27 $3,750.00 $3,750.00 $55.00 $2,812.50 $100.00 2026-05-06
36000067 OTHER Impl Port Indwelling Cat 10 27 27 $10,000.00 $10,000.00 $55.00 $7,500.00 $100.00 2026-05-06
36000071 OTHER Cath Suprapubic/cysto Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000072 OTHER Cath Suprapubic/cysto Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000076 OTHER Impl Prosthesis Breast Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000077 OTHER Impl Prosthesis Breast Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000078 OTHER Impl Prosthesis Breast Cat 6 27 27 $875.00 $875.00 $55.00 $656.25 $100.00 2026-05-06
36000079 OTHER Impl Prosthesis Breast Cat 7 27 27 $1,250.00 $1,250.00 $55.00 $937.50 $100.00 2026-05-06
36000080 OTHER Impl Prosthesis Breast Cat 8 18 18 $2,500.00 $2,500.00 $55.00 $100.00 $100.00 2026-05-06
36000081 OTHER Impl Prosthesis Breast Cat 9 27 27 $3,750.00 $3,750.00 $55.00 $2,812.50 $100.00 2026-05-06
36000082 OTHER Impl Prosthesis Breast Cat 10 27 27 $5,000.00 $5,000.00 $55.00 $3,750.00 $100.00 2026-05-06
36000086 OTHER Cath Ureteral Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000087 OTHER Cath Ureteral Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000091 OTHER Impl Metatarsal Joint Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000092 OTHER Impl Metatarsal Joint Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000093 OTHER Impl Metatarsal Joint Cat 6 27 27 $875.00 $875.00 $55.00 $656.25 $100.00 2026-05-06
36000094 OTHER Impl Metatarsal Joint Cat 7 27 27 $1,250.00 $1,250.00 $55.00 $937.50 $100.00 2026-05-06
36000095 OTHER Impl Metatarsal Joint Cat 8 18 18 $2,500.00 $2,500.00 $55.00 $100.00 $100.00 2026-05-06
36000096 OTHER Impl Metatarsal Joint Cat 9 27 27 $3,750.00 $3,750.00 $55.00 $2,812.50 $100.00 2026-05-06
36000097 OTHER Impl Metatarsal Joint Cat 10 27 27 $5,000.00 $5,000.00 $55.00 $3,750.00 $100.00 2026-05-06
36000098 OTHER Impl Metatarsal Joint Cat 11 27 27 $7,500.00 $7,500.00 $55.00 $5,625.00 $100.00 2026-05-06
36000099 OTHER Impl Metatarsal Joint Cat 12 27 27 $10,000.00 $10,000.00 $55.00 $7,500.00 $100.00 2026-05-06
36000105 OTHER Mosaic Mesh 15cm X 15cm 27 27 $1,315.05 $1,315.05 $55.00 $986.29 $100.00 2026-05-06
36000108 OTHER Impl Mesh Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000109 OTHER Impl Mesh Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000110 OTHER Impl Mesh Cat 6 27 27 $875.00 $875.00 $55.00 $656.25 $100.00 2026-05-06
36000111 OTHER Impl Mesh Cat 7 27 27 $1,250.00 $1,250.00 $55.00 $937.50 $100.00 2026-05-06
36000112 OTHER Impl Mesh Cat 8 18 18 $2,500.00 $2,500.00 $55.00 $100.00 $100.00 2026-05-06
36000113 OTHER Impl Mesh Cat 9 27 27 $3,750.00 $3,750.00 $55.00 $2,812.50 $100.00 2026-05-06
36000118 OTHER Impl Pin/plt/screw Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000119 OTHER Impl Pin/plt/screw Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000120 OTHER Impl Pin/plt/screw Cat 6 27 27 $875.00 $875.00 $55.00 $656.25 $100.00 2026-05-06
36000121 OTHER Impl Pin/plt/screw Cat 7 27 27 $1,250.00 $1,250.00 $55.00 $937.50 $100.00 2026-05-06
36000122 OTHER Impl Pin/plt/screw Cat 8 18 18 $2,500.00 $2,500.00 $55.00 $100.00 $100.00 2026-05-06
36000126 OTHER Impl Skin Substitute Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000130 OTHER Impl Spinal Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000131 OTHER Impl Spinal Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000132 OTHER Impl Spinal Cat 6 27 27 $875.00 $875.00 $55.00 $656.25 $100.00 2026-05-06
36000133 OTHER Impl Spinal Cat 7 27 27 $1,250.00 $1,250.00 $55.00 $937.50 $100.00 2026-05-06
36000134 OTHER Impl Spinal Cat 8 18 18 $2,500.00 $2,500.00 $55.00 $100.00 $100.00 2026-05-06
36000135 OTHER Impl Spinal Cat 9 27 27 $3,750.00 $3,750.00 $55.00 $2,812.50 $100.00 2026-05-06
36000136 OTHER Impl Spinal Cat 10 27 27 $5,000.00 $5,000.00 $55.00 $3,750.00 $100.00 2026-05-06
36000137 OTHER Impl Spinal Cat 11 27 27 $7,500.00 $7,500.00 $55.00 $5,625.00 $100.00 2026-05-06
36000138 OTHER Impl Spinal Cat 12 27 27 $10,000.00 $10,000.00 $55.00 $7,500.00 $100.00 2026-05-06
36000139 OTHER Impl Spinal Cat 13 27 27 $12,500.00 $12,500.00 $55.00 $9,375.00 $100.00 2026-05-06
36000140 OTHER Impl Spinal Cat 14 27 27 $18,750.00 $18,750.00 $55.00 $14,062.50 $100.00 2026-05-06
36000141 OTHER Impl Spinal Cat 15 27 27 $25,000.00 $25,000.00 $55.00 $18,750.00 $100.00 2026-05-06
36000145 OTHER Lead Icd Single Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000146 OTHER Lead Icd Single Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000147 OTHER Lead Icd Single Cat 6 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000148 OTHER Lead Icd Single Cat 7 27 27 $1,250.00 $1,250.00 $55.00 $937.50 $100.00 2026-05-06
36000149 OTHER Lead Icd Single Cat 8 18 18 $2,500.00 $2,500.00 $55.00 $100.00 $100.00 2026-05-06
36000153 OTHER Impl General Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000154 OTHER Impl General Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000155 OTHER Impl General Cat 6 27 27 $825.00 $825.00 $55.00 $618.75 $100.00 2026-05-06
36000156 OTHER Impl General Cat 7 27 27 $1,250.00 $1,250.00 $55.00 $937.50 $100.00 2026-05-06
36000157 OTHER Impl General Cat 8 18 18 $2,500.00 $2,500.00 $55.00 $100.00 $100.00 2026-05-06
36000158 OTHER Impl General Cat 9 27 27 $3,750.00 $3,750.00 $55.00 $2,812.50 $100.00 2026-05-06
36000159 OTHER Impl General Cat 10 27 27 $5,000.00 $5,000.00 $55.00 $3,750.00 $100.00 2026-05-06
36000160 OTHER Impl General Cat 11 27 27 $7,500.00 $7,500.00 $55.00 $5,625.00 $100.00 2026-05-06
36000161 OTHER Impl General Cat 12 27 27 $10,000.00 $10,000.00 $55.00 $7,500.00 $100.00 2026-05-06
36000162 OTHER Impl General Cat 13 27 27 $12,500.00 $12,500.00 $55.00 $9,375.00 $100.00 2026-05-06
36000163 OTHER Impl General Cat 14 27 27 $18,750.00 $18,750.00 $55.00 $14,062.50 $100.00 2026-05-06
36000164 OTHER Impl General Cat 15 27 27 $25,000.00 $25,000.00 $55.00 $18,750.00 $100.00 2026-05-06
36000167 OTHER Misc Supply Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000168 OTHER Misc Supply Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000169 OTHER Misc Supply Cat 6 27 27 $875.00 $875.00 $55.00 $656.25 $100.00 2026-05-06
36000170 OTHER Misc Supply Cat 7 27 27 $1,250.00 $1,250.00 $55.00 $937.50 $100.00 2026-05-06
36000171 OTHER Misc Supply Cat 8 18 18 $2,500.00 $2,500.00 $55.00 $100.00 $100.00 2026-05-06
36000172 OTHER Misc Supply Cat 9 27 27 $3,750.00 $3,750.00 $55.00 $2,812.50 $100.00 2026-05-06
36000173 OTHER Misc Supply Cat 10 27 27 $5,000.00 $5,000.00 $55.00 $3,750.00 $100.00 2026-05-06
36000174 OTHER Misc Supply Cat 11 27 27 $7,500.00 $7,500.00 $55.00 $5,625.00 $100.00 2026-05-06
36000178 OTHER Bone/tissue Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000179 OTHER Bone/tissue Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000180 OTHER Bone/tissue Cat 6 27 27 $875.00 $875.00 $55.00 $656.25 $100.00 2026-05-06
36000181 OTHER Bone/tissue Cat 7 27 27 $1,250.00 $1,250.00 $55.00 $937.50 $100.00 2026-05-06
36000182 OTHER Bone/tissue Cat 8 18 18 $2,500.00 $2,500.00 $55.00 $100.00 $100.00 2026-05-06
36000183 OTHER Bone/tissue Cat 9 27 27 $3,750.00 $3,750.00 $55.00 $2,812.50 $100.00 2026-05-06
36000184 OTHER Bone/tissue Cat 10 27 27 $5,000.00 $5,000.00 $55.00 $3,750.00 $100.00 2026-05-06
36000187 OTHER Impl Sling Urin Rpr Cat 4 27 27 $250.00 $250.00 $55.00 $187.50 $100.00 2026-05-06
36000188 OTHER Impl Sling Urin Rpr Cat 5 27 27 $500.00 $500.00 $55.00 $375.00 $100.00 2026-05-06
36000189 OTHER Impl Sling Urin Rpr Cat 6 27 27 $875.00 $875.00 $55.00 $656.25 $100.00 2026-05-06
36000190 OTHER Impl Sling Urin Rpr Cat 7 27 27 $1,250.00 $1,250.00 $55.00 $937.50 $100.00 2026-05-06
36000191 OTHER Impl Sling Urin Rpr Cat 8 18 18 $2,500.00 $2,500.00 $55.00 $100.00 $100.00 2026-05-06
36000192 OTHER Impl Sling Urin Rpr Cat 9 27 27 $3,750.00 $3,750.00 $55.00 $2,812.50 $100.00 2026-05-06
36000193 OTHER Impl Sling Urin Rpr Cat 10 27 27 $5,000.00 $5,000.00 $55.00 $3,750.00 $100.00 2026-05-06
36000194 OTHER Impl Sling Urin Rpr Cat 11 27 27 $7,500.00 $7,500.00 $55.00 $5,625.00 $100.00 2026-05-06
36000195 OTHER Impl Sling Urin Rpr Cat 12 27 27 $10,000.00 $10,000.00 $55.00 $7,500.00 $100.00 2026-05-06
36000196 OTHER Impl Sling Urin Rpr Cat 13 27 27 $12,500.00 $12,500.00 $55.00 $9,375.00 $100.00 2026-05-06
36000197 OTHER Impl Sling Urin Rpr Cat 14 27 27 $18,750.00 $18,750.00 $55.00 $14,062.50 $100.00 2026-05-06
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