Hospital

Franklin Memorial Hospital

Farmington, ME · CCN 200037 · Rates published

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This facility hasn’t published a payer-negotiated rate for this exact code. See its full rate list below.

10,569 distinct procedures filed

8 distinct payers

240,539 rate rows

2025-09-09 last MRF observed · ⚠ 13 mo old

Data quality

84,064 of 240,539 rate rows are consumer-grade (34.9%)

156,475 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 — reason	Rows
professional (physician) fee — not the facility price	156,295
placeholder amount (≤ $0.02) — excluded from medians	88
per-diem day rate — not a per-procedure price	36
exceeds 10× this hospital's gross charge — excluded from medians	30
percent-of-charges filed in the dollar field — excluded from medians	24
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	2

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 13 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://sthpiprd.blob.core.windows.net/machine-readable-files/7978/010238552-1922791417_mainehealth_standardcharges.csv
Found on page	https://www.mainehealth.org/cms-hpt.txt
Discovered via	Discovered by HANK (automated)
Last fetch	not_modified · 2026-10-11
Content fingerprint	650a42f262ddf7e6… · 70,999,436 bytes · first seen 2026-05-15

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
J1411 HCPCS	Inj, Hemgenix, Per Tx Dose	2	$0.03	$3,570,000.00	$3,570,000.00	nat. median $3,685,267 1.0× median
J1413 HCPCS	Inj Delandistrogene Mox Rokl	2	$0.03	$3,264,000.00	$3,264,000.00	nat. median $3,325,455 1.0× median
J3399 HCPCS	Inj Onase Abepar-xioi Treat	2	$0.03	$2,146,250.00	$2,146,250.00	nat. median $2,455,111 0.9× median
Q2057 HCPCS	Afamitresgene Autoleucel	1	$849,762.67	$849,762.67	$849,762.67	nat. median $813,967 1.0× median
J9355 HCPCS	Trastuzumab 150 Mg IV Solr\|discarded Drug Not Administe	8	$80.05	$673,655.26	$570,799.97	nat. median $191 outlier · 2994.8×
Q2042 HCPCS	Tisagenlecleucel Car-pos T	2	$518,240.68	$637,718.51	$518,240.68	nat. median $621,313 0.8× median
Q2056 HCPCS	Ciltacabtagene Car-pos T	2	$507,495.55	$610,210.84	$507,495.55	nat. median $599,737 0.8× median
Q2055 HCPCS	Idecabtagene Vicleucel Car	2	$484,690.30	$596,847.89	$484,690.30	nat. median $574,037 0.8× median
Q2054 HCPCS	Lisocabtagene Mara Car Pos T	2	$474,060.62	$597,261.64	$474,060.62	nat. median $579,571 0.8× median
Q2041 HCPCS	Axicabtagene Ciloleucel Car+	2	$459,381.45	$587,823.43	$459,381.45	nat. median $562,501 0.8× median
Q2053 HCPCS	Brexucabtagene Car Pos T	2	$449,440.00	$540,014.24	$449,440.00	nat. median $513,770 0.9× median
Q2058 HCPCS	Obecbtge Autol Up To 400 Mil	1	$298,142.51	$298,142.51	$298,142.51	nat. median $286,598 1.0× median
38240 CPT	Transplt Allo Hct/donor	1	$256,761.64	$256,761.64	$256,761.64	nat. median $28,331 outlier · 9.1×
Q0480 HCPCS	Driver Pneumatic Vad, Rep	1	$142,841.00	$142,841.00	$142,841.00	nat. median $108,243 1.3× median
0915T CPT	Insj Perm Ccm-d Sys Pg&eltrd	1	$139,192.75	$139,192.75	$139,192.75	nat. median $35,266 outlier · 3.9×
0674T CPT	Laps Insj Nw/rpcmt Prm Isdss	1	$132,298.61	$132,298.61	$132,298.61	nat. median $29,815 outlier · 4.4×
K1007 HCPCS	Bil Hkaf Pc S/d Micro Sensor	1	$123,348.02	$123,348.02	$123,348.02	nat. median $95,583 1.3× median
0916T CPT	Insj Perm Ccm-d Sys Pg Only	1	$97,448.32	$97,448.32	$97,448.32	nat. median $31,744 outlier · 3.1×
0923T CPT	Rmvl&rplcmt Perm Ccm-d Pg	1	$97,448.32	$97,448.32	$97,448.32	nat. median $32,259 outlier · 3.0×
0680T CPT	Insj/rplcmt Pg Only Isdss	1	$93,099.07	$93,099.07	$93,099.07	nat. median $20,981 outlier · 4.4×
L8702 HCPCS	Ewhf S/d Uprt Micro Sensor	1	$89,256.06	$89,256.06	$89,256.06	nat. median $68,802 1.3× median
23472 CPT	Reconstruct Shoulder Joint	1	$79,838.89	$79,838.89	$79,838.89	nat. median $16,735 outlier · 4.8×
27702 CPT	Reconstruct Ankle Joint	1	$79,838.89	$79,838.89	$79,838.89	nat. median $14,000 outlier · 5.7×
C8003 HCPCS	Imp Extar Knee Shck Absrb	1	$79,838.89	$79,838.89	$79,838.89	nat. median $18,782 outlier · 4.3×
0632T CPT	Perq Tcat US Abltj Nrv P-art	1	$77,957.64	$77,957.64	$77,957.64	nat. median $16,985 outlier · 4.6×
C9797 HCPCS	Vasc Emb/occ W/prs Cath	1	$77,957.64	$77,957.64	$77,957.64	nat. median $19,596 outlier · 4.0×
0981T CPT	Tcat Impl Wrls Ivc Snr	1	$77,957.64	$77,957.64	$77,957.64	nat. median $18,811 outlier · 4.1×
0645T CPT	Tcat Impltj C Sins Rdctj Dev	1	$77,957.64	$77,957.64	$77,957.64	nat. median $17,360 outlier · 4.5×
J3357 HCPCS	Ustekinumab 90 Mg/ml Sc Sosy	8	$152.57	$83,341.58	$74,435.56	nat. median $20,264 outlier · 3.7×
66683 CPT	Implantation Iris Prosthesis	1	$71,270.65	$71,270.65	$71,270.65	nat. median $16,543 outlier · 4.3×
L7181 HCPCS	Electronic Elbo Simultaneous	1	$63,531.52	$63,531.52	$63,531.52	nat. median $48,410 1.3× median
J9029 HCPCS	Instill Adstiladrin, Tx Dose	2	$63,505.40	$192,561.72	$63,505.40	nat. median $66,211 1.0× median
A9543 HCPCS	Y90 Ibritumomab, Rx	2	$63,005.77	$198,557.73	$63,005.77	nat. median $65,477 1.0× median
L7180 HCPCS	Electronic Elbow Sequential	1	$57,646.84	$57,646.84	$57,646.84	nat. median $42,745 1.3× median
55882 CPT	Ablt Trurl Prst8 Tis Trnsdcr	1	$56,405.55	$56,405.55	$56,405.55	nat. median $13,479 outlier · 4.2×
27441 CPT	Revision Of Knee Joint	1	$55,860.25	$55,860.25	$55,860.25	nat. median $11,593 outlier · 4.8×
27440 CPT	Revision Of Knee Joint	1	$55,860.25	$55,860.25	$55,860.25	nat. median $11,814 outlier · 4.7×
27443 CPT	Revision Of Knee Joint	1	$55,860.25	$55,860.25	$55,860.25	nat. median $11,000 outlier · 5.1×
27447 CPT	Total Knee Arthroplasty	1	$55,860.25	$55,860.25	$55,860.25	nat. median $12,374 outlier · 4.5×
0737T CPT	Xenograft Impltj Artclr Surf	1	$55,860.25	$55,860.25	$55,860.25	nat. median $11,814 outlier · 4.7×
23473 CPT	Revis Reconst Shoulder Joint	1	$55,860.25	$55,860.25	$55,860.25	nat. median $12,689 outlier · 4.4×
23470 CPT	Reconstruct Shoulder Joint	1	$55,860.25	$55,860.25	$55,860.25	nat. median $12,505 outlier · 4.5×
27130 CPT	Total Hip Arthroplasty	1	$55,860.25	$55,860.25	$55,860.25	nat. median $12,734 outlier · 4.4×
27442 CPT	Revision Of Knee Joint	1	$55,860.25	$55,860.25	$55,860.25	nat. median $12,162 outlier · 4.6×
27438 CPT	Revise Kneecap With Implant	1	$55,860.25	$55,860.25	$55,860.25	nat. median $11,428 outlier · 4.9×
27446 CPT	Revision Of Knee Joint	1	$55,860.25	$55,860.25	$55,860.25	nat. median $12,905 outlier · 4.3×
Q2043 HCPCS	Sipuleucel-t Auto Cd54+	2	$55,453.57	$61,691.62	$55,453.57	nat. median $63,499 0.9× median
0675T CPT	Laps Insj Nw/rpcmt Isdss 1ld	1	$54,138.85	$54,138.85	$54,138.85	nat. median $12,050 outlier · 4.5×
61715 CPT	Mrgfus Strtctc Ablt Trgt Icr	1	$54,138.85	$54,138.85	$54,138.85	nat. median $12,009 outlier · 4.5×
J2350 HCPCS	Ocrelizumab 300 Mg/10ml IV Soln	8	$58.76	$59,010.77	$52,704.79	nat. median $133 outlier · 396.4×

Other procedures at this hospital

Browse this hospital's 10,569 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

J1411	HCPCS	Inj, Hemgenix, Per Tx Dose	3	2	—	—	$0.03	$3,570,000.00	$3,570,000.00	2025-09-09
J1413	HCPCS	Inj Delandistrogene Mox Rokl	3	2	—	—	$0.03	$3,264,000.00	$3,264,000.00	2025-09-09
J3399	HCPCS	Inj Onase Abepar-xioi Treat	3	2	—	—	$0.03	$2,146,250.00	$2,146,250.00	2025-09-09
Q2057	HCPCS	Afamitresgene Autoleucel	1	1	—	—	$849,762.67	$849,762.67	$849,762.67	2025-09-09
J9355	HCPCS	Trastuzumab 150 Mg IV Solr\|discarded Drug Not Administe	34	8	$710,966.80	$710,966.80	$80.05	$673,655.26	$570,799.97	2025-09-09
Q2042	HCPCS	Tisagenlecleucel Car-pos T	3	2	—	—	$518,240.68	$637,718.51	$518,240.68	2025-09-09
Q2056	HCPCS	Ciltacabtagene Car-pos T	3	2	—	—	$507,495.55	$610,210.84	$507,495.55	2025-09-09
Q2055	HCPCS	Idecabtagene Vicleucel Car	3	2	—	—	$484,690.30	$596,847.89	$484,690.30	2025-09-09
Q2054	HCPCS	Lisocabtagene Mara Car Pos T	3	2	—	—	$474,060.62	$597,261.64	$474,060.62	2025-09-09
Q2041	HCPCS	Axicabtagene Ciloleucel Car+	3	2	—	—	$459,381.45	$587,823.43	$459,381.45	2025-09-09
Q2053	HCPCS	Brexucabtagene Car Pos T	3	2	—	—	$449,440.00	$540,014.24	$449,440.00	2025-09-09
Q2058	HCPCS	Obecbtge Autol Up To 400 Mil	1	1	—	—	$298,142.51	$298,142.51	$298,142.51	2025-09-09
38240	CPT	Transplt Allo Hct/donor	1	1	—	—	$256,761.64	$256,761.64	$256,761.64	2025-09-09
Q0480	HCPCS	Driver Pneumatic Vad, Rep	1	1	—	—	$142,841.00	$142,841.00	$142,841.00	2025-09-09
0915T	CPT	Insj Perm Ccm-d Sys Pg&eltrd	1	1	—	—	$139,192.75	$139,192.75	$139,192.75	2025-09-09
0674T	CPT	Laps Insj Nw/rpcmt Prm Isdss	1	1	—	—	$132,298.61	$132,298.61	$132,298.61	2025-09-09
K1007	HCPCS	Bil Hkaf Pc S/d Micro Sensor	1	1	—	—	$123,348.02	$123,348.02	$123,348.02	2025-09-09
0916T	CPT	Insj Perm Ccm-d Sys Pg Only	1	1	—	—	$97,448.32	$97,448.32	$97,448.32	2025-09-09
0923T	CPT	Rmvl&rplcmt Perm Ccm-d Pg	1	1	—	—	$97,448.32	$97,448.32	$97,448.32	2025-09-09
0680T	CPT	Insj/rplcmt Pg Only Isdss	1	1	—	—	$93,099.07	$93,099.07	$93,099.07	2025-09-09
L8702	HCPCS	Ewhf S/d Uprt Micro Sensor	1	1	—	—	$89,256.06	$89,256.06	$89,256.06	2025-09-09
27702	CPT	Reconstruct Ankle Joint	1	1	—	—	$79,838.89	$79,838.89	$79,838.89	2025-09-09
C8003	HCPCS	Imp Extar Knee Shck Absrb	1	1	—	—	$79,838.89	$79,838.89	$79,838.89	2025-09-09
23472	CPT	Reconstruct Shoulder Joint	1	1	—	—	$79,838.89	$79,838.89	$79,838.89	2025-09-09
C9797	HCPCS	Vasc Emb/occ W/prs Cath	1	1	—	—	$77,957.64	$77,957.64	$77,957.64	2025-09-09
0645T	CPT	Tcat Impltj C Sins Rdctj Dev	1	1	—	—	$77,957.64	$77,957.64	$77,957.64	2025-09-09
0632T	CPT	Perq Tcat US Abltj Nrv P-art	1	1	—	—	$77,957.64	$77,957.64	$77,957.64	2025-09-09
0981T	CPT	Tcat Impl Wrls Ivc Snr	1	1	—	—	$77,957.64	$77,957.64	$77,957.64	2025-09-09
J3357	HCPCS	Ustekinumab 90 Mg/ml Sc Sosy	22	8	$88,661.26	$88,661.26	$152.57	$83,341.58	$74,435.56	2025-09-09
66683	CPT	Implantation Iris Prosthesis	1	1	—	—	$71,270.65	$71,270.65	$71,270.65	2025-09-09
L7181	HCPCS	Electronic Elbo Simultaneous	1	1	—	—	$63,531.52	$63,531.52	$63,531.52	2025-09-09
J9029	HCPCS	Instill Adstiladrin, Tx Dose	3	2	—	—	$63,505.40	$192,561.72	$63,505.40	2025-09-09
A9543	HCPCS	Y90 Ibritumomab, Rx	3	2	—	—	$63,005.77	$198,557.73	$63,005.77	2025-09-09
L7180	HCPCS	Electronic Elbow Sequential	1	1	—	—	$57,646.84	$57,646.84	$57,646.84	2025-09-09
55882	CPT	Ablt Trurl Prst8 Tis Trnsdcr	1	1	—	—	$56,405.55	$56,405.55	$56,405.55	2025-09-09
0737T	CPT	Xenograft Impltj Artclr Surf	1	1	—	—	$55,860.25	$55,860.25	$55,860.25	2025-09-09
23470	CPT	Reconstruct Shoulder Joint	1	1	—	—	$55,860.25	$55,860.25	$55,860.25	2025-09-09
27441	CPT	Revision Of Knee Joint	1	1	—	—	$55,860.25	$55,860.25	$55,860.25	2025-09-09
27447	CPT	Total Knee Arthroplasty	1	1	—	—	$55,860.25	$55,860.25	$55,860.25	2025-09-09
27446	CPT	Revision Of Knee Joint	1	1	—	—	$55,860.25	$55,860.25	$55,860.25	2025-09-09
27442	CPT	Revision Of Knee Joint	1	1	—	—	$55,860.25	$55,860.25	$55,860.25	2025-09-09
27443	CPT	Revision Of Knee Joint	1	1	—	—	$55,860.25	$55,860.25	$55,860.25	2025-09-09
27440	CPT	Revision Of Knee Joint	1	1	—	—	$55,860.25	$55,860.25	$55,860.25	2025-09-09
27438	CPT	Revise Kneecap With Implant	1	1	—	—	$55,860.25	$55,860.25	$55,860.25	2025-09-09
27130	CPT	Total Hip Arthroplasty	1	1	—	—	$55,860.25	$55,860.25	$55,860.25	2025-09-09
23473	CPT	Revis Reconst Shoulder Joint	1	1	—	—	$55,860.25	$55,860.25	$55,860.25	2025-09-09
Q2043	HCPCS	Sipuleucel-t Auto Cd54+	3	2	—	—	$55,453.57	$61,691.62	$55,453.57	2025-09-09
61715	CPT	Mrgfus Strtctc Ablt Trgt Icr	1	1	—	—	$54,138.85	$54,138.85	$54,138.85	2025-09-09
0675T	CPT	Laps Insj Nw/rpcmt Isdss 1ld	1	1	—	—	$54,138.85	$54,138.85	$54,138.85	2025-09-09
J2350	HCPCS	Ocrelizumab 300 Mg/10ml IV Soln	22	8	$62,777.42	$62,777.42	$58.76	$59,010.77	$52,704.79	2025-09-09
C8004	HCPCS	Sim Ang W/prs Cath Rad Emb	1	1	—	—	$49,234.15	$49,234.15	$49,234.15	2025-09-09
90288	CPT	Botulism Ig IV	2	1	—	—	$48,705.00	$48,705.00	$48,705.00	2025-09-09
L8701	HCPCS	Ewh S/d Uprt Micro Sensor	1	1	—	—	$45,366.54	$45,366.54	$45,366.54	2025-09-09
C9901	HCPCS	Endo Defect Closure Gi Tract	1	1	—	—	$45,199.47	$45,199.47	$45,199.47	2025-09-09
0679T	CPT	Laps Rmvl Lead Isdss	1	1	—	—	$45,199.47	$45,199.47	$45,199.47	2025-09-09
0677T	CPT	Laps Repos Lead Isdss 1st Ld	1	1	—	—	$45,199.47	$45,199.47	$45,199.47	2025-09-09
J9226	HCPCS	Supprelin La Implant	3	2	—	—	$44,578.75	$133,909.89	$44,578.75	2025-09-09
53865	CPT	Cysto Insj Dev Ischmc Rmdlg	1	1	—	—	$40,145.74	$40,145.74	$40,145.74	2025-09-09
0950T	CPT	Abltj B9 Prst8 Tissue Hifu	1	1	—	—	$40,145.74	$40,145.74	$40,145.74	2025-09-09
L6700	HCPCS	Ue Add Ext Power Myoel	1	1	—	—	$38,283.40	$38,283.40	$38,283.40	2025-09-09
L5856	HCPCS	Elec Knee-shin Swing/stance	1	1	—	—	$38,118.52	$38,118.52	$38,118.52	2025-09-09
L6880	HCPCS	Elec Hand Ind Art Digits	1	1	—	—	$37,893.15	$37,893.15	$37,893.15	2025-09-09
0918T	CPT	Insj Perm Ccm-d Sys Dual Ld	1	1	—	—	$35,929.50	$35,929.50	$35,929.50	2025-09-09
0917T	CPT	Insj Perm Ccm-d Sys 1 Lead	1	1	—	—	$35,929.50	$35,929.50	$35,929.50	2025-09-09
J9306	HCPCS	Pertuzumab 420 Mg/14ml IV Soln	22	8	$41,487.69	$41,487.69	$15.42	$38,998.43	$34,830.99	2025-09-09
J7330	HCPCS	Cultured Chondrocytes Implnt	2	1	—	—	$31,905.54	$31,905.54	$31,905.54	2025-09-09
L8614	HCPCS	Cochlear Device	1	1	—	—	$30,669.00	$30,669.00	$30,669.00	2025-09-09
Q0483	HCPCS	Monitor Elec Vad, Rep	1	1	—	—	$29,736.40	$29,736.40	$29,736.40	2025-09-09
L5858	HCPCS	Stance Phase Only	1	1	—	—	$29,468.51	$29,468.51	$29,468.51	2025-09-09
J9022	HCPCS	Atezolizumab 1200 Mg/20ml IV Soln	22	8	$34,221.29	$34,221.29	$83.94	$32,168.01	$28,730.49	2025-09-09
L6975	HCPCS	Interscap-thor Myoelectronic	1	1	—	—	$28,200.32	$28,200.32	$28,200.32	2025-09-09
0315U	CPT	Onc Cutan Sq Cll Ca Mrna 40	1	1	—	—	$28,118.85	$28,118.85	$28,118.85	2025-09-09
L5973	HCPCS	Ank-foot Sys Dors-plant Flex	1	1	—	—	$27,669.90	$27,669.90	$27,669.90	2025-09-09
0886T	CPT	Sgmdsc Flx 1st Tndsc Dilat	1	1	—	—	$25,843.63	$25,843.63	$25,843.63	2025-09-09
0885T	CPT	Colsc Flx 1st Tndsc Dilat	1	1	—	—	$25,843.63	$25,843.63	$25,843.63	2025-09-09
0884T	CPT	Esphgsc Flx 1st Tndsc Dilat	1	1	—	—	$25,843.63	$25,843.63	$25,843.63	2025-09-09
J9266	HCPCS	Pegaspargase Injection	3	2	—	—	$25,781.46	$81,922.56	$25,781.46	2025-09-09
Q0489	HCPCS	Pwr Pck Base Combo Vad, Rep	1	1	—	—	$25,779.85	$25,779.85	$25,779.85	2025-09-09
L6970	HCPCS	Interscapular-thor Switch CT	1	1	—	—	$25,737.67	$25,737.67	$25,737.67	2025-09-09
81552	CPT	Onc Uveal Mlnma Mrna 15 Gene	1	1	—	—	$25,723.79	$25,723.79	$25,723.79	2025-09-09
21366	CPT	Opn Tx Complx Malar W/grft	1	1	—	—	$25,682.35	$25,682.35	$25,682.35	2025-09-09
21141	CPT	Rcnstj Midface Lefort I 1pc	1	1	—	—	$25,682.35	$25,682.35	$25,682.35	2025-09-09
21143	CPT	Rcnstj Mdface Lefort I 3/>pc	1	1	—	—	$25,682.35	$25,682.35	$25,682.35	2025-09-09
21255	CPT	Reconstruct Lower Jaw Bone	1	1	—	—	$25,682.35	$25,682.35	$25,682.35	2025-09-09
21194	CPT	Reconst Lwr Jaw W/graft	1	1	—	—	$25,682.35	$25,682.35	$25,682.35	2025-09-09
21347	CPT	Opn Tx Nasomax Fx Multple	1	1	—	—	$25,682.35	$25,682.35	$25,682.35	2025-09-09
21422	CPT	Optx Palatal/max Fracture	1	1	—	—	$25,682.35	$25,682.35	$25,682.35	2025-09-09
J9203	HCPCS	Gemtuzumab Ozogamicin 4.5 Mg IV Solr	22	8	$30,550.87	$30,550.87	$226.28	$28,717.82	$25,648.99	2025-09-09
43659	CPT	Unlisted Laps Px Stomach	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
50949	CPT	Unlisted Laps Px Ureter	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
50549	CPT	Unlisted Laps Px Renal	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
49329	CPT	Unlstd Laps Px Abd Pertm&omn	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
44979	CPT	Unlisted Laps Px Appendix	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
51999	CPT	Unlisted Laps Px Bladder	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
58578	CPT	Unlisted Laps Px Uterus	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
43289	CPT	Unlisted Laps Px Esoph	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
49659	CPT	Unlstd Laps Px Hrnap Hrnrphy	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
45499	CPT	Laparoscope Proc Rectum	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
54699	CPT	Unlisted Laps Px Testis	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
55559	CPT	Unlstd Laps Px Sprmatic Cord	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
38589	CPT	Unlisted Laps Px Lymphtc Sys	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
59898	CPT	Unlstd Laps Px Mat Care&dlvr	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
58679	CPT	Unlisted Laps Px Ovidct Ovry	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
44238	CPT	Unlisted Laps Px Intestine	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
38129	CPT	Unlisted Laps Px Spleen	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
47379	CPT	Unlisted Laps Px Liver	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
60699	CPT	Unlisted Px Endocrine System	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
47579	CPT	Unlisted Laps Px Biliary Trc	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
60659	CPT	Unlisted Laps Px Endoc Sys	1	1	—	—	$25,329.42	$25,329.42	$25,329.42	2025-09-09
L6965	HCPCS	Shldr Disartic Myoelectronic	1	1	—	—	$25,010.09	$25,010.09	$25,010.09	2025-09-09
0913T	CPT	Prq Tcat Ther Rx Ntrac Balo1	1	1	—	—	$24,752.69	$24,752.69	$24,752.69	2025-09-09
J1930	HCPCS	Lanreotide Acetate 120 Mg/0.5ml Sc Soln	22	8	$29,081.87	$29,081.87	$48.00	$27,336.96	$24,415.68	2025-09-09
J3380	HCPCS	Vedolizumab 300 Mg IV Solr	22	8	$28,467.24	$28,467.24	$21.85	$26,759.21	$23,899.67	2025-09-09
81529	CPT	Onc Cutan Mlnma Mrna 31 Gene	1	1	—	—	$23,795.16	$23,795.16	$23,795.16	2025-09-09
J9600	HCPCS	Porfimer Sodium Injection	3	2	—	—	$23,091.78	$71,315.79	$23,091.78	2025-09-09
L5859	HCPCS	Knee-shin Pro Flex/ext Cont	1	1	—	—	$23,088.51	$23,088.51	$23,088.51	2025-09-09
Q0481	HCPCS	Microprcsr Cu Elec Vad, Rep	1	1	—	—	$23,045.75	$23,045.75	$23,045.75	2025-09-09
J9228	HCPCS	Ipilimumab 5 Mg/ml IV Soln (combined)	22	8	$26,999.12	$26,999.12	$172.71	$25,379.17	$22,667.11	2025-09-09
0267U	CPT	Rare Do Id Opt Gen Mapg&seq	1	1	—	—	$22,294.38	$22,294.38	$22,294.38	2025-09-09
0867T	CPT	Tpla B9 Prst8 Hyprplsa>=50ml	1	1	—	—	$22,070.14	$22,070.14	$22,070.14	2025-09-09
J9301	HCPCS	Obinutuzumab 1000 Mg/40ml IV Soln	22	8	$26,194.73	$26,194.73	$70.22	$24,623.05	$21,991.79	2025-09-09
J2323	HCPCS	Natalizumab 300 Mg/15ml IV Conc	22	8	$25,966.61	$25,966.61	$24.23	$24,408.61	$21,800.26	2025-09-09
L6960	HCPCS	Shldr Disartic Switch Contro	1	1	—	—	$21,257.18	$21,257.18	$21,257.18	2025-09-09
L6955	HCPCS	Above Elbow Myoelectronic CT	1	1	—	—	$21,076.45	$21,076.45	$21,076.45	2025-09-09
69930	CPT	Implant Cochlear Device	3	2	—	—	$20,779.05	$138,091.08	$20,779.05	2025-09-09
Q0224	HCPCS	Inj, Pemivibart, 4500 Mg	1	1	—	—	$19,964.46	$19,964.46	$19,964.46	2025-09-09
33231	CPT	Insrt Pulse Gen W/mult Leads	3	2	—	—	$19,926.65	$139,192.75	$19,926.65	2025-09-09
G0448	HCPCS	Place Perm Pacing Cardiovert	2	1	—	—	$19,926.65	$19,926.65	$19,926.65	2025-09-09
33249	CPT	Insj/rplcmt Defib W/lead(s)	3	2	—	—	$19,926.65	$139,192.75	$19,926.65	2025-09-09
33270	CPT	Ins/rep Subq Defibrillator	3	2	—	—	$19,926.65	$139,192.75	$19,926.65	2025-09-09
33264	CPT	Rmvl & Rplcmt Dfb Gen Mlt Ld	3	2	—	—	$19,926.65	$139,192.75	$19,926.65	2025-09-09
33289	CPT	Tcat Impl Wrls P-art Prs Snr	3	2	—	—	$19,071.47	$123,419.28	$19,071.47	2025-09-09
Q0479	HCPCS	Power Module Combo Vad, Rep	1	1	—	—	$19,006.53	$19,006.53	$19,006.53	2025-09-09
0313U	CPT	Hc Onc Pancreatic Fluid Ngs Analys Dna&mrna Seq 74	22	8	$22,464.00	$22,464.00	$3,600.00	$21,116.16	$18,859.65	2025-09-09
64583	CPT	Rev/rplct Hpglsl Nstm Ary Pg	3	2	—	—	$18,707.16	$54,138.85	$18,707.16	2025-09-09
J9303	HCPCS	Panitumumab 400 Mg/20ml IV Soln	22	8	$22,039.81	$22,039.81	$151.24	$20,717.42	$18,503.52	2025-09-09
J2427	HCPCS	Paliperidone Palmitate ER 546 Mg/1.75ml IM Susy	22	8	$21,710.95	$21,710.95	$12.19	$20,408.29	$18,227.43	2025-09-09
0265U	CPT	Rar Do Whl Gn&mtcdrl DNA Als	1	1	—	—	$18,114.49	$18,114.49	$18,114.49	2025-09-09
0212U	CPT	Rare Ds Gen DNA Alys Proband	1	1	—	—	$18,112.51	$18,112.51	$18,112.51	2025-09-09
64582	CPT	Opn Mpltj Hpglsl Nstm Ary Pg	3	2	—	—	$18,038.09	$132,298.61	$18,038.09	2025-09-09
81554	CPT	Pulm Ds Ipf Mrna 190 Gen Alg	1	1	—	—	$18,012.60	$18,012.60	$18,012.60	2025-09-09
L6945	HCPCS	Elbow Disart Myoelectronic C	1	1	—	—	$18,012.43	$18,012.43	$18,012.43	2025-09-09
63685	CPT	Ins/rplc Spi Npg/rcvr Pocket	3	2	—	—	$18,003.60	$132,298.61	$18,003.60	2025-09-09
0817T	CPT	Opn Insj/rplcmt Ins Ptn Subf	3	2	—	—	$18,003.60	$93,099.07	$18,003.60	2025-09-09
64568	CPT	Opn Impltj Crnl Nrv Nea&pg	3	2	—	—	$18,003.60	$132,298.61	$18,003.60	2025-09-09
61886	CPT	Implant Neurostim Arrays	3	2	—	—	$18,003.60	$132,298.61	$18,003.60	2025-09-09
0816T	CPT	Opn Insj/rplcmt Ins Ptn Subq	3	2	—	—	$18,003.60	$93,099.07	$18,003.60	2025-09-09
61891	CPT	Rev/rplcmt Sk-mnt Crnl Nstm	3	2	—	—	$18,003.60	$93,099.07	$18,003.60	2025-09-09
27664	CPT	Hc Repair Exten Leg Tendn,prim,each	22	8	$21,190.80	$21,190.80	$5,129.63	$31,013.93	$17,917.35	2025-09-09
C9760	HCPCS	Non-blind Interatrial Shunt	2	1	—	—	$17,875.33	$17,875.33	$17,875.33	2025-09-09
L6950	HCPCS	Above Elbow Switch Control	1	1	—	—	$17,598.38	$17,598.38	$17,598.38	2025-09-09
C9782	HCPCS	Blind Myocar Trpl Bon Marrow	2	1	—	—	$17,500.50	$17,500.50	$17,500.50	2025-09-09
0621T	CPT	Trabeculostomy Interno Laser	1	1	—	—	$17,464.92	$17,464.92	$17,464.92	2025-09-09
0661T	CPT	Rmvl&rimpltj Ant Sgm Implt	1	1	—	—	$17,464.92	$17,464.92	$17,464.92	2025-09-09
0660T	CPT	Implt Ant Sgm Io Nbio Rx Sys	1	1	—	—	$17,464.92	$17,464.92	$17,464.92	2025-09-09
93653	CPT	Compre Ep Eval Tx Svt	3	2	—	—	$17,292.37	$106,505.00	$17,292.37	2025-09-09
93654	CPT	Compre Ep Eval Tx Vt	3	2	—	—	$17,292.37	$106,505.00	$17,292.37	2025-09-09
93656	CPT	Compre Ep Eval Abltj Atr Fib	3	2	—	—	$17,292.37	$106,505.00	$17,292.37	2025-09-09
0214U	CPT	Rare Ds Xom DNA Alys Proband	1	1	—	—	$17,283.50	$17,283.50	$17,283.50	2025-09-09
C2616	HCPCS	Brachytx, Non-str,yttrium-90	3	2	—	—	$17,177.01	$75,910.17	$17,177.01	2025-09-09
63650	CPT	Hc Stim Trial Epid Perc Imp	22	8	$20,264.90	$20,264.90	$5,381.58	$28,492.30	$17,134.48	2025-09-09
J7310	HCPCS	Hphc Fee Schedule	2	1	—	—	$16,960.00	$16,960.00	$16,960.00	2025-09-09
0784T	CPT	Ins/rplmt Eltrd Ra Spi Nstim	3	2	—	—	$16,836.44	$54,138.85	$16,836.44	2025-09-09
0786T	CPT	Insj/rplcmt Prq Ra Sac Nstim	2	1	—	—	$16,836.44	$16,836.44	$16,836.44	2025-09-09
64596	CPT	Ins/rplcmt Prq Eltrd Ra Pn 1	3	2	—	—	$16,836.44	$54,138.85	$16,836.44	2025-09-09
33288	CPT	Rmv&rplcmt Phrnc Nrv Stim Ld	3	2	—	—	$16,836.44	$54,138.85	$16,836.44	2025-09-09
0971T	CPT	Ablt Mal Brst Tum Pq Lsr Uni	1	1	—	—	$16,624.52	$16,624.52	$16,624.52	2025-09-09
0970T	CPT	Ablt B9 Brst Tum Perq Lsr Ea	1	1	—	—	$16,624.52	$16,624.52	$16,624.52	2025-09-09
A9604	HCPCS	Sm 153 Lexidronam	3	2	—	—	$16,608.54	$52,340.50	$16,608.54	2025-09-09
J2506	HCPCS	Pegfilgrastim 6 Mg/0.6ml Sc Sosy	22	8	$19,519.68	$19,519.68	$109.75	$18,348.50	$16,387.74	2025-09-09
53451	CPT	Tprnl Balo Cntnc Dev Bi	3	2	—	—	$16,319.55	$56,405.55	$16,319.55	2025-09-09
L7191	HCPCS	Elbow Child Myoelectronic CT	1	1	—	—	$16,311.04	$16,311.04	$16,311.04	2025-09-09
62350	CPT	Hc Epidural/it Catheter Placement	22	8	$18,960.10	$18,960.10	$4,109.45	$27,802.76	$16,031.24	2025-09-09
0796T	CPT	Tcat Ins 2chmbr Ldls Pm Ra	3	2	—	—	$15,911.11	$82,795.91	$15,911.11	2025-09-09
0823T	CPT	Tcat Ins 1chmbr Ldls Pm Ra	3	2	—	—	$15,911.11	$82,795.91	$15,911.11	2025-09-09
0797T	CPT	Tcat Ins 2chmbr Ldls Pm Rv	3	2	—	—	$15,911.11	$82,795.91	$15,911.11	2025-09-09
0825T	CPT	Tcat Rmv&rpl1chmb Ldls Pm Ra	3	2	—	—	$15,911.11	$82,795.91	$15,911.11	2025-09-09
0802T	CPT	Tcat Rmv&rpl2chmb Ldls Pm Ra	3	2	—	—	$15,911.11	$82,795.91	$15,911.11	2025-09-09
0795T	CPT	Tcat Ins 2chmbr Ldls Pm Cmpl	3	2	—	—	$15,911.11	$82,795.91	$15,911.11	2025-09-09
0801T	CPT	Tcat Rmv&rpl 2chmbr Ldls Pm	3	2	—	—	$15,911.11	$82,795.91	$15,911.11	2025-09-09
0803T	CPT	Tcat Rmv&rpl2chmb Ldls Pm Rv	3	2	—	—	$15,911.11	$82,795.91	$15,911.11	2025-09-09
0717T	CPT	Adrc Ther Prtl Rc Tear	1	1	—	—	$15,893.79	$15,893.79	$15,893.79	2025-09-09
0718T	CPT	Adrc Ther Prtl Rc Tear Njx	1	1	—	—	$15,893.79	$15,893.79	$15,893.79	2025-09-09
0919T	CPT	Rmvl Perm Ccm-d Sys Pg Only	1	1	—	—	$15,799.72	$15,799.72	$15,799.72	2025-09-09
0920T	CPT	Rmvl Perm Ccm-d Sys 1 Pac Ld	1	1	—	—	$15,799.72	$15,799.72	$15,799.72	2025-09-09
0921T	CPT	Rmvl Perm Ccm-d Sys 1 Dfb Ld	1	1	—	—	$15,799.72	$15,799.72	$15,799.72	2025-09-09
0922T	CPT	Rmvl Perm Ccm-d Sys Dual Ld	1	1	—	—	$15,799.72	$15,799.72	$15,799.72	2025-09-09
L7186	HCPCS	Electron Elbow Child Switch	1	1	—	—	$15,609.53	$15,609.53	$15,609.53	2025-09-09
L6940	HCPCS	Elbow Disarticulation Switch	1	1	—	—	$15,482.79	$15,482.79	$15,482.79	2025-09-09
20694	CPT	Rmvl Ext Fixj Sys Under Anes	3	2	—	—	$6,948.07	$15,402.46	$15,402.46	2025-09-09
L5991	HCPCS	Low Pros Ext Osseo Connector	1	1	—	—	$15,249.75	$15,249.75	$15,249.75	2025-09-09
J9271	HCPCS	Pembrolizumab 100 Mg/4ml IV Soln	22	8	$17,937.33	$17,937.33	$57.31	$16,861.09	$15,059.29	2025-09-09
0681T	CPT	Rlcj Pulse Gen Only Isdss	1	1	—	—	$14,930.17	$14,930.17	$14,930.17	2025-09-09
0682T	CPT	Removal Pulse Gen Only Isdss	1	1	—	—	$14,930.17	$14,930.17	$14,930.17	2025-09-09
0473U	CPT	Onc Sld Tum Bld/slv 648 Gene	1	1	—	—	$14,886.45	$14,886.45	$14,886.45	2025-09-09
33210	CPT	Hc Ins. Temp. Pacer 1 Chamber	22	8	$17,353.10	$17,353.10	$4,812.67	$35,929.50	$14,672.48	2025-09-09
J9041	HCPCS	Bortezomib 3.5 Mg Ij Solr	22	8	$17,063.78	$17,063.78	$2.07	$16,039.95	$14,325.90	2025-09-09
21453	CPT	Hc Clx Rd Mandible Fx+dental Fix	22	8	$16,932.90	$16,932.90	$3,981.81	$25,682.35	$14,317.19	2025-09-09
33230	CPT	Insrt Pulse Gen W/dual Leads	3	2	—	—	$14,297.70	$97,448.32	$14,297.70	2025-09-09
0515T	CPT	Insj Wcs Lv Compl Sys	3	2	—	—	$14,297.70	$97,448.32	$14,297.70	2025-09-09
0571T	CPT	Insj/rplcmt Icds Ss Eltrd	3	2	—	—	$14,297.70	$139,192.75	$14,297.70	2025-09-09
33262	CPT	Rmvl& Replc Pulse Gen 1 Lead	3	2	—	—	$14,297.70	$97,448.32	$14,297.70	2025-09-09
33240	CPT	Insrt Pulse Gen W/singl Lead	3	2	—	—	$14,297.70	$97,448.32	$14,297.70	2025-09-09
0520T	CPT	Rmv&rplcmt Pg Wcs Lv Battery	3	2	—	—	$14,297.70	$45,434.38	$14,297.70	2025-09-09
0614T	CPT	Rmvl&rplcmt Ss Impl Dfb Pg	3	2	—	—	$14,297.70	$97,448.32	$14,297.70	2025-09-09
33263	CPT	Rmvl & Rplcmt Dfb Gen 2 Lead	3	2	—	—	$14,297.70	$97,448.32	$14,297.70	2025-09-09
0408T	CPT	Insj/rplc Cardiac Modulj Sys	3	2	—	—	$14,297.70	$139,192.75	$14,297.70	2025-09-09
0414T	CPT	Rmvl & Rpl Car Modulj Pls Gn	3	2	—	—	$14,297.70	$97,448.32	$14,297.70	2025-09-09
0409T	CPT	Insj/rplc Car Modulj Pls Gn	3	2	—	—	$14,297.70	$97,448.32	$14,297.70	2025-09-09
0869T	CPT	Njx B1 Sub Mtrl Hw Fixj Aug	1	1	—	—	$14,086.21	$14,086.21	$14,086.21	2025-09-09
0958T	CPT	Rmv S-sclp Eltr Ra Rcvr&tlmt	1	1	—	—	$14,086.21	$14,086.21	$14,086.21	2025-09-09
25448	CPT	Arthrp Ntrcrpl/crp/mtcrp Ssp	1	1	—	—	$14,086.21	$14,086.21	$14,086.21	2025-09-09
0964T	CPT	I&cust Prep Jaw Xpnsj 1arch	1	1	—	—	$14,079.52	$14,079.52	$14,079.52	2025-09-09
0966T	CPT	I&cst Prp Jw Xpn Dl Arch Fxd	1	1	—	—	$14,079.52	$14,079.52	$14,079.52	2025-09-09
G0330	HCPCS	Facility Svs Dental Rehab	1	1	—	—	$14,079.52	$14,079.52	$14,079.52	2025-09-09
0965T	CPT	I&cst Prp Jw Xpn Dl Arch Non	1	1	—	—	$14,079.52	$14,079.52	$14,079.52	2025-09-09
0933T	CPT	Tcat Impl Wrls L Atr Prs Snr	1	1	—	—	$13,963.81	$13,963.81	$13,963.81	2025-09-09
28705	CPT	Arthrodesis Pantalar	3	2	—	—	$13,862.21	$79,838.89	$13,862.21	2025-09-09
22869	CPT	Insj Stablj Dev Without Dcmprn	3	2	—	—	$13,862.21	$55,860.25	$13,862.21	2025-09-09
22867	CPT	Insj Stablj Dev W/dcmprn	3	2	—	—	$13,862.21	$79,838.89	$13,862.21	2025-09-09
23616	CPT	Optx Prx Hmrl Fx Fix Rpr Rpl	3	2	—	—	$13,862.21	$79,838.89	$13,862.21	2025-09-09
22862	CPT	Rev Rplcm Rthrp 1ntrspc Lmbr	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
27279	CPT	Arthrd Si Jt Plmt Tartclr Dv	3	2	—	—	$13,862.21	$79,838.89	$13,862.21	2025-09-09
27278	CPT	Arthrd Si Jt Plmt Iartic Dev	3	2	—	—	$13,862.21	$79,838.89	$13,862.21	2025-09-09
22856	CPT	Tot Disc Arthrp 1ntrspc Crv	3	2	—	—	$13,862.21	$79,838.89	$13,862.21	2025-09-09
22849	CPT	Reinsert Spinal Fixation	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
21243	CPT	Reconstruction Of Jaw Joint	3	2	—	—	$13,862.21	$79,838.89	$13,862.21	2025-09-09
25442	CPT	Arthrp W/prostc Dstl Ulna	3	2	—	—	$13,862.21	$79,838.89	$13,862.21	2025-09-09
22861	CPT	Rev Rplcm Arthrp 1ntrspc Crv	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
25446	CPT	Arthrp W/prostc Dst Rds&crps	3	2	—	—	$13,862.21	$79,838.89	$13,862.21	2025-09-09
22857	CPT	Tot Disc Arthrp 1ntrspc Lmbr	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
22630	CPT	Arthrd Pst Tq 1ntrspc Lum	3	2	—	—	$13,862.21	$79,838.89	$13,862.21	2025-09-09
22610	CPT	Arthrd Pst Tq 1ntrspc Thrc	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
22590	CPT	Arthrd Pst Tq Craniocervical	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
22595	CPT	Arthrd Pst Tq Atlas-axis	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
22600	CPT	Arthrd Pst Tq 1ntrspc Crv	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
22556	CPT	Arthrd Ant Ntrbd Min Dsc Thc	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
22558	CPT	Arthrd Ant Ntrbd Min Dsc Lum	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
24546	CPT	Optx Hum Fx W/ntrcndylr Xtn	3	2	—	—	$13,862.21	$55,860.25	$13,862.21	2025-09-09
22586	CPT	Arthrd Pre-sac Ntrbdy L5-s1	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
22532	CPT	Arthrd Lat Xtrcvtry Tq Thrc	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
22533	CPT	Arthrd Lat Xtrcvtry Tq Lmbr	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
24371	CPT	Revise Reconst Elbow Joint	3	2	—	—	$13,862.21	$79,838.89	$13,862.21	2025-09-09
22534	CPT	Arthrd Lat Xtrcvtry Tq Ea Ad	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
24363	CPT	Replace Elbow Joint	3	2	—	—	$13,862.21	$79,838.89	$13,862.21	2025-09-09
22633	CPT	Arthrd Cmbn 1ntrspc Lumbar	3	2	—	—	$13,862.21	$79,838.89	$13,862.21	2025-09-09
24361	CPT	Reconstruct Elbow Joint	3	2	—	—	$13,862.21	$79,838.89	$13,862.21	2025-09-09
22548	CPT	Arthrd Ant Toral/xoral C1-c2	2	1	—	—	$13,862.21	$13,862.21	$13,862.21	2025-09-09
L6935	HCPCS	Below Elbow Myoelectronic CT	1	1	—	—	$13,850.87	$13,850.87	$13,850.87	2025-09-09
0300U	CPT	Onc Pan Tum Whl Gen Seq&opt	1	1	—	—	$13,838.21	$13,838.21	$13,838.21	2025-09-09
37229	CPT	Commercial Fee Schedule	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
37230	CPT	Commercial Fee Schedule	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
37227	CPT	Commercial Fee Schedule	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
0238T	CPT	Trluml Perip Athrc Iliac Art	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
37231	CPT	Commercial Fee Schedule	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
C9775	HCPCS	Revasc Lith-sten-ath Tib/per	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
36837	CPT	Prq Av Fstl Crt Uxtr Sep Acs	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
C9607	HCPCS	Perc D-e Cor Revasc Chro Sin	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
C9602	HCPCS	Perc D-e Cor Stent Ather S	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
C9773	HCPCS	Revasc Lithotr-stent Tib/per	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
33274	CPT	Tcat Insj/rpl Perm Ldls Pm	3	2	—	—	$13,819.05	$82,795.91	$13,819.05	2025-09-09
C9767	HCPCS	Revasc Lithotrip-stent-ather	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
93591	CPT	Perq Transcath Cls Aortic	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
0793T	CPT	Prq Tcat Thrm Ablt Nrv P-art	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
0620T	CPT	Evasc Ven Artlz Tibl/prnl Vn	2	1	—	—	$13,819.05	$13,819.05	$13,819.05	2025-09-09
33902	CPT	Perq P-art Revsc 1 Abnor Uni	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
93590	CPT	Perq Transcath Cls Mitral	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
92933	CPT	Prq Trlml C Athrc St Angiop1	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
93580	CPT	Transcath Closure Of Asd	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
36836	CPT	Prq Av Fstl Crtj Uxtr 1 Acs	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
93581	CPT	Transcath Closure Of Vsd	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
36906	CPT	Thrmbc/nfs Dialysis Circuit	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
93582	CPT	Perq Transcath Closure Pda	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
C9774	HCPCS	Revasc Lithotr-ather Tib/per	3	2	—	—	$13,819.05	$77,957.64	$13,819.05	2025-09-09
J9026	HCPCS	Tarlatamab-dlle 10 Mg IV Solr	56	8	$45,621.00	$45,621.00	$1,368.63	$42,918.05	$13,691.77	2025-09-09
L6925	HCPCS	Wrist Disart Myoelectronic C	1	1	—	—	$13,596.35	$13,596.35	$13,596.35	2025-09-09
L5857	HCPCS	Elec Knee-shin Swing Only	1	1	—	—	$13,561.43	$13,561.43	$13,561.43	2025-09-09
L8679	HCPCS	Imp Neurosti Pls Gn Any Type	1	1	—	—	$13,383.37	$13,383.37	$13,383.37	2025-09-09
L7190	HCPCS	Elbow Adolescent Myoelectron	1	1	—	—	$13,331.17	$13,331.17	$13,331.17	2025-09-09
L8619	HCPCS	Coch Imp Ext Proc/contr Rplc	1	1	—	—	$13,164.33	$13,164.33	$13,164.33	2025-09-09
41016	CPT	Hc Xtroral I&d Absc Cst/hmtma Floor Mouth Subment	22	8	$15,342.35	$15,342.35	$3,981.81	$25,682.35	$12,972.34	2025-09-09
0306U	CPT	Onc Mrd Nxt-gnrj Alys 1st	1	1	—	—	$12,830.30	$12,830.30	$12,830.30	2025-09-09
0497U	CPT	Onc Prst8 Mrna Rt-pcr 6genes	1	1	—	—	$12,812.27	$12,812.27	$12,812.27	2025-09-09
81542	CPT	Onc Prostate Mrna 22 Cnt Gen	1	1	—	—	$12,812.27	$12,812.27	$12,812.27	2025-09-09
J1162	HCPCS	Digoxin Immune Fab 40 Mg/4ml IV (wet Solr Vial)	22	8	$15,127.93	$15,127.93	$4,538.38	$14,487.59	$12,791.04	2025-09-09
0398T	CPT	Commercial Fee Schedule	2	1	—	—	$12,500.50	$12,500.50	$12,500.50	2025-09-09
C9790	HCPCS	Hphc Fee Schedule	2	1	—	—	$12,500.50	$12,500.50	$12,500.50	2025-09-09
0686T	CPT	Histotripsy Mal Hepatcel Tis	2	1	—	—	$12,500.50	$12,500.50	$12,500.50	2025-09-09
C9758	HCPCS	Blind Interatrial Shunt Ide	2	1	—	—	$12,500.50	$12,500.50	$12,500.50	2025-09-09
63655	CPT	Implant Neuroelectrodes	3	2	—	—	$12,159.65	$93,099.07	$12,159.65	2025-09-09
63664	CPT	Revise Spine Eltrd Plate	3	2	—	—	$12,159.65	$54,138.85	$12,159.65	2025-09-09
61885	CPT	Insrt/redo Neurostim 1 Array	3	2	—	—	$12,159.65	$93,099.07	$12,159.65	2025-09-09
33287	CPT	Rmv&rplcmt Phrnc Nrv Stim Pg	3	2	—	—	$12,159.65	$132,298.61	$12,159.65	2025-09-09
0268T	CPT	Commercial Fee Schedule	3	2	—	—	$12,159.65	$132,298.61	$12,159.65	2025-09-09
0266T	CPT	Commercial Fee Schedule	2	1	—	—	$12,159.65	$12,159.65	$12,159.65	2025-09-09
64590	CPT	Ins/rpl Prph Sac/gstr Npg/r	3	2	—	—	$12,159.65	$93,099.07	$12,159.65	2025-09-09
64580	CPT	Opn Impltj Nea Neuromuscular	3	2	—	—	$12,159.65	$93,099.07	$12,159.65	2025-09-09
64575	CPT	Opn Impltj Nea Perph Nerve	3	2	—	—	$12,159.65	$54,138.85	$12,159.65	2025-09-09
0019U	CPT	Onc RNA Tiss Predict Alg	1	1	—	—	$12,157.27	$12,157.27	$12,157.27	2025-09-09
81416	CPT	Exome Sequence Analysis	3	2	—	—	$12,000.00	$39,697.20	$12,000.00	2025-09-09

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