Price Transparency 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

Franklin Memorial Hospital

Farmington, ME · CCN 200037 · Rates published

10,569 distinct procedures filed
8 distinct payers
481,078 rate rows
2025-09-09 last MRF observed
Data quality

168,132 of 481,078 rate rows are consumer-grade (34.9%)

312,946 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
professional (physician) fee — not the facility price 312,590
placeholder amount (≤ $0.02) — excluded from medians 176
per-diem day rate — not a per-procedure price 72
exceeds 10× this hospital's gross charge — excluded from medians 60
percent-of-charges filed in the dollar field — excluded from medians 48
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 viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-05-19
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
$3,710,000
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
$2,469,189
0.9× median
Q2057
HCPCS 		Afamitresgene Autoleucel 1 $849,762.67 $849,762.67 $849,762.67 nat. median
$824,563
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
$989
outlier · 577.3×
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 2 $518,240.68 $637,718.51 $518,240.68 nat. median
$754,974
0.7× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 2 $507,495.55 $610,210.84 $507,495.55 nat. median
$675,122
0.8× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 2 $484,690.30 $596,847.89 $484,690.30 nat. median
$625,184
0.8× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 2 $474,060.62 $597,261.64 $474,060.62 nat. median
$674,188
0.7× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 2 $459,381.45 $587,823.43 $459,381.45 nat. median
$634,511
0.7× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 2 $449,440.00 $540,014.24 $449,440.00 nat. median
$620,080
0.7× median
Q2058
HCPCS 		Obecbtge Autol Up To 400 Mil 1 $298,142.51 $298,142.51 $298,142.51 nat. median
$324,450
0.9× median
38240
CPT 		Transplt Allo Hct/donor 1 $256,761.64 $256,761.64 $256,761.64 nat. median
$15,912
outlier · 16.1×
Q0480
HCPCS 		Driver Pneumatic Vad, Rep 1 $142,841.00 $142,841.00 $142,841.00 nat. median
$111,989
1.3× median
0915T
CPT 		Insj Perm Ccm-d Sys Pg&eltrd 1 $139,192.75 $139,192.75 $139,192.75 nat. median
$32,560
outlier · 4.3×
0674T
CPT 		Laps Insj Nw/rpcmt Prm Isdss 1 $132,298.61 $132,298.61 $132,298.61 nat. median
$25,200
outlier · 5.2×
K1007
HCPCS 		Bil Hkaf Pc S/d Micro Sensor 1 $123,348.02 $123,348.02 $123,348.02 nat. median
$96,983
1.3× median
0916T
CPT 		Insj Perm Ccm-d Sys Pg Only 1 $97,448.32 $97,448.32 $97,448.32 nat. median
$23,439
outlier · 4.2×
0923T
CPT 		Rmvl&rplcmt Perm Ccm-d Pg 1 $97,448.32 $97,448.32 $97,448.32 nat. median
$22,482
outlier · 4.3×
0680T
CPT 		Insj/rplcmt Pg Only Isdss 1 $93,099.07 $93,099.07 $93,099.07 nat. median
$19,911
outlier · 4.7×
L8702
HCPCS 		Ewhf S/d Uprt Micro Sensor 1 $89,256.06 $89,256.06 $89,256.06 nat. median
$70,825
1.3× median
23472
CPT 		Reconstruct Shoulder Joint 1 $79,838.89 $79,838.89 $79,838.89 nat. median
$16,400
outlier · 4.9×
27702
CPT 		Reconstruct Ankle Joint 1 $79,838.89 $79,838.89 $79,838.89 nat. median
$15,707
outlier · 5.1×
C8003
HCPCS 		Imp Extar Knee Shck Absrb 1 $79,838.89 $79,838.89 $79,838.89 nat. median
$18,997
outlier · 4.2×
0632T
CPT 		Perq Tcat US Abltj Nrv P-art 1 $77,957.64 $77,957.64 $77,957.64 nat. median
$16,936
outlier · 4.6×
C9797
HCPCS 		Vasc Emb/occ W/prs Cath 1 $77,957.64 $77,957.64 $77,957.64 nat. median
$18,589
outlier · 4.2×
0981T
CPT 		Tcat Impl Wrls Ivc Snr 1 $77,957.64 $77,957.64 $77,957.64 nat. median
$18,746
outlier · 4.2×
0645T
CPT 		Tcat Impltj C Sins Rdctj Dev 1 $77,957.64 $77,957.64 $77,957.64 nat. median
$17,897
outlier · 4.4×
J3357
HCPCS 		Ustekinumab 90 Mg/ml Sc Sosy 8 $152.57 $83,341.58 $74,435.56 nat. median
$14,306
outlier · 5.2×
66683
CPT 		Implantation Iris Prosthesis 1 $71,270.65 $71,270.65 $71,270.65 nat. median
$16,443
outlier · 4.3×
L7181
HCPCS 		Electronic Elbo Simultaneous 1 $63,531.52 $63,531.52 $63,531.52 nat. median
$50,598
1.3× median
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 2 $63,505.40 $192,561.72 $63,505.40 nat. median
$69,774
0.9× median
A9543
HCPCS 		Y90 Ibritumomab, Rx 2 $63,005.77 $198,557.73 $63,005.77 nat. median
$62,507
1.0× median
L7180
HCPCS 		Electronic Elbow Sequential 1 $57,646.84 $57,646.84 $57,646.84 nat. median
$49,027
1.2× median
55882
CPT 		Ablt Trurl Prst8 Tis Trnsdcr 1 $56,405.55 $56,405.55 $56,405.55 nat. median
$13,392
outlier · 4.2×
27441
CPT 		Revision Of Knee Joint 1 $55,860.25 $55,860.25 $55,860.25 nat. median
$11,718
outlier · 4.8×
27440
CPT 		Revision Of Knee Joint 1 $55,860.25 $55,860.25 $55,860.25 nat. median
$11,954
outlier · 4.7×
27443
CPT 		Revision Of Knee Joint 1 $55,860.25 $55,860.25 $55,860.25 nat. median
$11,588
outlier · 4.8×
27447
CPT 		Total Knee Arthroplasty 1 $55,860.25 $55,860.25 $55,860.25 nat. median
$12,648
outlier · 4.4×
0737T
CPT 		Xenograft Impltj Artclr Surf 1 $55,860.25 $55,860.25 $55,860.25 nat. median
$12,867
outlier · 4.3×
23473
CPT 		Revis Reconst Shoulder Joint 1 $55,860.25 $55,860.25 $55,860.25 nat. median
$12,789
outlier · 4.4×
23470
CPT 		Reconstruct Shoulder Joint 1 $55,860.25 $55,860.25 $55,860.25 nat. median
$12,607
outlier · 4.4×
27130
CPT 		Total Hip Arthroplasty 1 $55,860.25 $55,860.25 $55,860.25 nat. median
$13,091
outlier · 4.3×
27442
CPT 		Revision Of Knee Joint 1 $55,860.25 $55,860.25 $55,860.25 nat. median
$11,338
outlier · 4.9×
27438
CPT 		Revise Kneecap With Implant 1 $55,860.25 $55,860.25 $55,860.25 nat. median
$11,774
outlier · 4.7×
27446
CPT 		Revision Of Knee Joint 1 $55,860.25 $55,860.25 $55,860.25 nat. median
$12,481
outlier · 4.5×
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 2 $55,453.57 $61,691.62 $55,453.57 nat. median
$66,682
0.8× median
0675T
CPT 		Laps Insj Nw/rpcmt Isdss 1ld 1 $54,138.85 $54,138.85 $54,138.85 nat. median
$12,131
outlier · 4.5×
61715
CPT 		Mrgfus Strtctc Ablt Trgt Icr 1 $54,138.85 $54,138.85 $54,138.85 nat. median
$13,466
outlier · 4.0×
J2350
HCPCS 		Ocrelizumab 300 Mg/10ml IV Soln 8 $58.76 $59,010.77 $52,704.79 nat. median
$712
outlier · 74.0×

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.

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
             
J9355 HCPCS Trastuzumab 150 Mg IV Solr|discarded Drug Not Administe 68 8 $710,966.80 $710,966.80 $80.05 $673,655.26 $570,799.97 2025-09-09
J3357 HCPCS Ustekinumab 90 Mg/ml Sc Sosy 44 8 $88,661.26 $88,661.26 $152.57 $83,341.58 $74,435.56 2025-09-09
J2350 HCPCS Ocrelizumab 300 Mg/10ml IV Soln 44 8 $62,777.42 $62,777.42 $58.76 $59,010.77 $52,704.79 2025-09-09
J9306 HCPCS Pertuzumab 420 Mg/14ml IV Soln 44 8 $41,487.69 $41,487.69 $15.42 $38,998.43 $34,830.99 2025-09-09
J9022 HCPCS Atezolizumab 1200 Mg/20ml IV Soln 44 8 $34,221.29 $34,221.29 $83.94 $32,168.01 $28,730.49 2025-09-09
J9203 HCPCS Gemtuzumab Ozogamicin 4.5 Mg IV Solr 44 8 $30,550.87 $30,550.87 $226.28 $28,717.82 $25,648.99 2025-09-09
J1930 HCPCS Lanreotide Acetate 120 Mg/0.5ml Sc Soln 44 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 44 8 $28,467.24 $28,467.24 $21.85 $26,759.21 $23,899.67 2025-09-09
J9228 HCPCS Ipilimumab 5 Mg/ml IV Soln (combined) 44 8 $26,999.12 $26,999.12 $172.71 $25,379.17 $22,667.11 2025-09-09
J9301 HCPCS Obinutuzumab 1000 Mg/40ml IV Soln 44 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 44 8 $25,966.61 $25,966.61 $24.23 $24,408.61 $21,800.26 2025-09-09
0313U CPT Hc Onc Pancreatic Fluid Ngs Analys Dna&mrna Seq 74 44 8 $22,464.00 $22,464.00 $3,600.00 $21,116.16 $18,859.65 2025-09-09
J9303 HCPCS Panitumumab 400 Mg/20ml IV Soln 44 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 44 8 $21,710.95 $21,710.95 $12.19 $20,408.29 $18,227.43 2025-09-09
27664 CPT Hc Repair Exten Leg Tendn,prim,each 44 8 $21,190.80 $21,190.80 $5,129.63 $31,013.93 $17,917.35 2025-09-09
63650 CPT Hc Stim Trial Epid Perc Imp 44 8 $20,264.90 $20,264.90 $5,381.58 $28,492.30 $17,134.48 2025-09-09
J2506 HCPCS Pegfilgrastim 6 Mg/0.6ml Sc Sosy 44 8 $19,519.68 $19,519.68 $109.75 $18,348.50 $16,387.74 2025-09-09
62350 CPT Hc Epidural/it Catheter Placement 44 8 $18,960.10 $18,960.10 $4,109.45 $27,802.76 $16,031.24 2025-09-09
J9271 HCPCS Pembrolizumab 100 Mg/4ml IV Soln 44 8 $17,937.33 $17,937.33 $57.31 $16,861.09 $15,059.29 2025-09-09
33210 CPT Hc Ins. Temp. Pacer 1 Chamber 44 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 44 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 44 8 $16,932.90 $16,932.90 $3,981.81 $25,682.35 $14,317.19 2025-09-09
J9026 HCPCS Tarlatamab-dlle 10 Mg IV Solr 112 8 $45,621.00 $45,621.00 $1,368.63 $42,918.05 $13,691.77 2025-09-09
41016 CPT Hc Xtroral I&d Absc Cst/hmtma Floor Mouth Subment 44 8 $15,342.35 $15,342.35 $3,981.81 $25,682.35 $12,972.34 2025-09-09
J1162 HCPCS Digoxin Immune Fab 40 Mg/4ml IV (wet Solr Vial) 44 8 $15,127.93 $15,127.93 $4,538.38 $14,487.59 $12,791.04 2025-09-09
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 6 2 — — $0.03 $3,570,000.00 $3,570,000.00 2025-09-09
J1413 HCPCS Inj Delandistrogene Mox Rokl 6 2 — — $0.03 $3,264,000.00 $3,264,000.00 2025-09-09
J3399 HCPCS Inj Onase Abepar-xioi Treat 6 2 — — $0.03 $2,146,250.00 $2,146,250.00 2025-09-09
Q2042 HCPCS Tisagenlecleucel Car-pos T 6 2 — — $518,240.68 $637,718.51 $518,240.68 2025-09-09
Q2056 HCPCS Ciltacabtagene Car-pos T 6 2 — — $507,495.55 $610,210.84 $507,495.55 2025-09-09
Q2055 HCPCS Idecabtagene Vicleucel Car 6 2 — — $484,690.30 $596,847.89 $484,690.30 2025-09-09
Q2054 HCPCS Lisocabtagene Mara Car Pos T 6 2 — — $474,060.62 $597,261.64 $474,060.62 2025-09-09
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 6 2 — — $459,381.45 $587,823.43 $459,381.45 2025-09-09
Q2053 HCPCS Brexucabtagene Car Pos T 6 2 — — $449,440.00 $540,014.24 $449,440.00 2025-09-09
J9029 HCPCS Instill Adstiladrin, Tx Dose 6 2 — — $63,505.40 $192,561.72 $63,505.40 2025-09-09
A9543 HCPCS Y90 Ibritumomab, Rx 6 2 — — $63,005.77 $198,557.73 $63,005.77 2025-09-09
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 6 2 — — $55,453.57 $61,691.62 $55,453.57 2025-09-09
J9226 HCPCS Supprelin La Implant 6 2 — — $44,578.75 $133,909.89 $44,578.75 2025-09-09
J9266 HCPCS Pegaspargase Injection 6 2 — — $25,781.46 $81,922.56 $25,781.46 2025-09-09
J9600 HCPCS Porfimer Sodium Injection 6 2 — — $23,091.78 $71,315.79 $23,091.78 2025-09-09
69930 CPT Implant Cochlear Device 6 2 — — $20,779.05 $138,091.08 $20,779.05 2025-09-09
33231 CPT Insrt Pulse Gen W/mult Leads 6 2 — — $19,926.65 $139,192.75 $19,926.65 2025-09-09
33249 CPT Insj/rplcmt Defib W/lead(s) 6 2 — — $19,926.65 $139,192.75 $19,926.65 2025-09-09
33270 CPT Ins/rep Subq Defibrillator 6 2 — — $19,926.65 $139,192.75 $19,926.65 2025-09-09
33264 CPT Rmvl & Rplcmt Dfb Gen Mlt Ld 6 2 — — $19,926.65 $139,192.75 $19,926.65 2025-09-09
33289 CPT Tcat Impl Wrls P-art Prs Snr 6 2 — — $19,071.47 $123,419.28 $19,071.47 2025-09-09
64583 CPT Rev/rplct Hpglsl Nstm Ary Pg 6 2 — — $18,707.16 $54,138.85 $18,707.16 2025-09-09
64582 CPT Opn Mpltj Hpglsl Nstm Ary Pg 6 2 — — $18,038.09 $132,298.61 $18,038.09 2025-09-09
63685 CPT Ins/rplc Spi Npg/rcvr Pocket 6 2 — — $18,003.60 $132,298.61 $18,003.60 2025-09-09
0817T CPT Opn Insj/rplcmt Ins Ptn Subf 6 2 — — $18,003.60 $93,099.07 $18,003.60 2025-09-09
64568 CPT Opn Impltj Crnl Nrv Nea&pg 6 2 — — $18,003.60 $132,298.61 $18,003.60 2025-09-09
61886 CPT Implant Neurostim Arrays 6 2 — — $18,003.60 $132,298.61 $18,003.60 2025-09-09
0816T CPT Opn Insj/rplcmt Ins Ptn Subq 6 2 — — $18,003.60 $93,099.07 $18,003.60 2025-09-09
61891 CPT Rev/rplcmt Sk-mnt Crnl Nstm 6 2 — — $18,003.60 $93,099.07 $18,003.60 2025-09-09
93653 CPT Compre Ep Eval Tx Svt 6 2 — — $17,292.37 $106,505.00 $17,292.37 2025-09-09
93654 CPT Compre Ep Eval Tx Vt 6 2 — — $17,292.37 $106,505.00 $17,292.37 2025-09-09
93656 CPT Compre Ep Eval Abltj Atr Fib 6 2 — — $17,292.37 $106,505.00 $17,292.37 2025-09-09
C2616 HCPCS Brachytx, Non-str,yttrium-90 6 2 — — $17,177.01 $75,910.17 $17,177.01 2025-09-09
0784T CPT Ins/rplmt Eltrd Ra Spi Nstim 6 2 — — $16,836.44 $54,138.85 $16,836.44 2025-09-09
64596 CPT Ins/rplcmt Prq Eltrd Ra Pn 1 6 2 — — $16,836.44 $54,138.85 $16,836.44 2025-09-09
33288 CPT Rmv&rplcmt Phrnc Nrv Stim Ld 6 2 — — $16,836.44 $54,138.85 $16,836.44 2025-09-09
A9604 HCPCS Sm 153 Lexidronam 6 2 — — $16,608.54 $52,340.50 $16,608.54 2025-09-09
53451 CPT Tprnl Balo Cntnc Dev Bi 6 2 — — $16,319.55 $56,405.55 $16,319.55 2025-09-09
0796T CPT Tcat Ins 2chmbr Ldls Pm Ra 6 2 — — $15,911.11 $82,795.91 $15,911.11 2025-09-09
0823T CPT Tcat Ins 1chmbr Ldls Pm Ra 6 2 — — $15,911.11 $82,795.91 $15,911.11 2025-09-09
0797T CPT Tcat Ins 2chmbr Ldls Pm Rv 6 2 — — $15,911.11 $82,795.91 $15,911.11 2025-09-09
0825T CPT Tcat Rmv&rpl1chmb Ldls Pm Ra 6 2 — — $15,911.11 $82,795.91 $15,911.11 2025-09-09
0802T CPT Tcat Rmv&rpl2chmb Ldls Pm Ra 6 2 — — $15,911.11 $82,795.91 $15,911.11 2025-09-09
0795T CPT Tcat Ins 2chmbr Ldls Pm Cmpl 6 2 — — $15,911.11 $82,795.91 $15,911.11 2025-09-09
0801T CPT Tcat Rmv&rpl 2chmbr Ldls Pm 6 2 — — $15,911.11 $82,795.91 $15,911.11 2025-09-09
0803T CPT Tcat Rmv&rpl2chmb Ldls Pm Rv 6 2 — — $15,911.11 $82,795.91 $15,911.11 2025-09-09
20694 CPT Rmvl Ext Fixj Sys Under Anes 6 2 — — $6,948.07 $15,402.46 $15,402.46 2025-09-09
33230 CPT Insrt Pulse Gen W/dual Leads 6 2 — — $14,297.70 $97,448.32 $14,297.70 2025-09-09
0515T CPT Insj Wcs Lv Compl Sys 6 2 — — $14,297.70 $97,448.32 $14,297.70 2025-09-09
0571T CPT Insj/rplcmt Icds Ss Eltrd 6 2 — — $14,297.70 $139,192.75 $14,297.70 2025-09-09
33262 CPT Rmvl& Replc Pulse Gen 1 Lead 6 2 — — $14,297.70 $97,448.32 $14,297.70 2025-09-09
33240 CPT Insrt Pulse Gen W/singl Lead 6 2 — — $14,297.70 $97,448.32 $14,297.70 2025-09-09
0520T CPT Rmv&rplcmt Pg Wcs Lv Battery 6 2 — — $14,297.70 $45,434.38 $14,297.70 2025-09-09
0614T CPT Rmvl&rplcmt Ss Impl Dfb Pg 6 2 — — $14,297.70 $97,448.32 $14,297.70 2025-09-09
33263 CPT Rmvl & Rplcmt Dfb Gen 2 Lead 6 2 — — $14,297.70 $97,448.32 $14,297.70 2025-09-09
0408T CPT Insj/rplc Cardiac Modulj Sys 6 2 — — $14,297.70 $139,192.75 $14,297.70 2025-09-09
0414T CPT Rmvl & Rpl Car Modulj Pls Gn 6 2 — — $14,297.70 $97,448.32 $14,297.70 2025-09-09
0409T CPT Insj/rplc Car Modulj Pls Gn 6 2 — — $14,297.70 $97,448.32 $14,297.70 2025-09-09
28705 CPT Arthrodesis Pantalar 6 2 — — $13,862.21 $79,838.89 $13,862.21 2025-09-09
22869 CPT Insj Stablj Dev Without Dcmprn 6 2 — — $13,862.21 $55,860.25 $13,862.21 2025-09-09
22867 CPT Insj Stablj Dev W/dcmprn 6 2 — — $13,862.21 $79,838.89 $13,862.21 2025-09-09
23616 CPT Optx Prx Hmrl Fx Fix Rpr Rpl 6 2 — — $13,862.21 $79,838.89 $13,862.21 2025-09-09
27279 CPT Arthrd Si Jt Plmt Tartclr Dv 6 2 — — $13,862.21 $79,838.89 $13,862.21 2025-09-09
27278 CPT Arthrd Si Jt Plmt Iartic Dev 6 2 — — $13,862.21 $79,838.89 $13,862.21 2025-09-09
22856 CPT Tot Disc Arthrp 1ntrspc Crv 6 2 — — $13,862.21 $79,838.89 $13,862.21 2025-09-09
21243 CPT Reconstruction Of Jaw Joint 6 2 — — $13,862.21 $79,838.89 $13,862.21 2025-09-09
25442 CPT Arthrp W/prostc Dstl Ulna 6 2 — — $13,862.21 $79,838.89 $13,862.21 2025-09-09
25446 CPT Arthrp W/prostc Dst Rds&crps 6 2 — — $13,862.21 $79,838.89 $13,862.21 2025-09-09
22630 CPT Arthrd Pst Tq 1ntrspc Lum 6 2 — — $13,862.21 $79,838.89 $13,862.21 2025-09-09
24546 CPT Optx Hum Fx W/ntrcndylr Xtn 6 2 — — $13,862.21 $55,860.25 $13,862.21 2025-09-09
24371 CPT Revise Reconst Elbow Joint 6 2 — — $13,862.21 $79,838.89 $13,862.21 2025-09-09
24363 CPT Replace Elbow Joint 6 2 — — $13,862.21 $79,838.89 $13,862.21 2025-09-09
22633 CPT Arthrd Cmbn 1ntrspc Lumbar 6 2 — — $13,862.21 $79,838.89 $13,862.21 2025-09-09
24361 CPT Reconstruct Elbow Joint 6 2 — — $13,862.21 $79,838.89 $13,862.21 2025-09-09
37229 CPT Commercial Fee Schedule 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
37230 CPT Commercial Fee Schedule 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
37227 CPT Commercial Fee Schedule 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
0238T CPT Trluml Perip Athrc Iliac Art 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
37231 CPT Commercial Fee Schedule 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
C9775 HCPCS Revasc Lith-sten-ath Tib/per 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
36837 CPT Prq Av Fstl Crt Uxtr Sep Acs 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
C9607 HCPCS Perc D-e Cor Revasc Chro Sin 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
C9602 HCPCS Perc D-e Cor Stent Ather S 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
C9773 HCPCS Revasc Lithotr-stent Tib/per 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
33274 CPT Tcat Insj/rpl Perm Ldls Pm 6 2 — — $13,819.05 $82,795.91 $13,819.05 2025-09-09
C9767 HCPCS Revasc Lithotrip-stent-ather 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
93591 CPT Perq Transcath Cls Aortic 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
0793T CPT Prq Tcat Thrm Ablt Nrv P-art 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
33902 CPT Perq P-art Revsc 1 Abnor Uni 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
93590 CPT Perq Transcath Cls Mitral 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
92933 CPT Prq Trlml C Athrc St Angiop1 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
93580 CPT Transcath Closure Of Asd 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
36836 CPT Prq Av Fstl Crtj Uxtr 1 Acs 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
93581 CPT Transcath Closure Of Vsd 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
36906 CPT Thrmbc/nfs Dialysis Circuit 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
93582 CPT Perq Transcath Closure Pda 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
C9774 HCPCS Revasc Lithotr-ather Tib/per 6 2 — — $13,819.05 $77,957.64 $13,819.05 2025-09-09
63655 CPT Implant Neuroelectrodes 6 2 — — $12,159.65 $93,099.07 $12,159.65 2025-09-09
63664 CPT Revise Spine Eltrd Plate 6 2 — — $12,159.65 $54,138.85 $12,159.65 2025-09-09
61885 CPT Insrt/redo Neurostim 1 Array 6 2 — — $12,159.65 $93,099.07 $12,159.65 2025-09-09
33287 CPT Rmv&rplcmt Phrnc Nrv Stim Pg 6 2 — — $12,159.65 $132,298.61 $12,159.65 2025-09-09
0268T CPT Commercial Fee Schedule 6 2 — — $12,159.65 $132,298.61 $12,159.65 2025-09-09
64590 CPT Ins/rpl Prph Sac/gstr Npg/r 6 2 — — $12,159.65 $93,099.07 $12,159.65 2025-09-09
64580 CPT Opn Impltj Nea Neuromuscular 6 2 — — $12,159.65 $93,099.07 $12,159.65 2025-09-09
64575 CPT Opn Impltj Nea Perph Nerve 6 2 — — $12,159.65 $54,138.85 $12,159.65 2025-09-09
81416 CPT Exome Sequence Analysis 6 2 — — $12,000.00 $39,697.20 $12,000.00 2025-09-09
Q2057 HCPCS Afamitresgene Autoleucel 2 1 — — $849,762.67 $849,762.67 $849,762.67 2025-09-09
Q2058 HCPCS Obecbtge Autol Up To 400 Mil 2 1 — — $298,142.51 $298,142.51 $298,142.51 2025-09-09
38240 CPT Transplt Allo Hct/donor 2 1 — — $256,761.64 $256,761.64 $256,761.64 2025-09-09
Q0480 HCPCS Driver Pneumatic Vad, Rep 2 1 — — $142,841.00 $142,841.00 $142,841.00 2025-09-09
0915T CPT Insj Perm Ccm-d Sys Pg&eltrd 2 1 — — $139,192.75 $139,192.75 $139,192.75 2025-09-09
0674T CPT Laps Insj Nw/rpcmt Prm Isdss 2 1 — — $132,298.61 $132,298.61 $132,298.61 2025-09-09
K1007 HCPCS Bil Hkaf Pc S/d Micro Sensor 2 1 — — $123,348.02 $123,348.02 $123,348.02 2025-09-09
0916T CPT Insj Perm Ccm-d Sys Pg Only 2 1 — — $97,448.32 $97,448.32 $97,448.32 2025-09-09
0923T CPT Rmvl&rplcmt Perm Ccm-d Pg 2 1 — — $97,448.32 $97,448.32 $97,448.32 2025-09-09
0680T CPT Insj/rplcmt Pg Only Isdss 2 1 — — $93,099.07 $93,099.07 $93,099.07 2025-09-09
L8702 HCPCS Ewhf S/d Uprt Micro Sensor 2 1 — — $89,256.06 $89,256.06 $89,256.06 2025-09-09
27702 CPT Reconstruct Ankle Joint 2 1 — — $79,838.89 $79,838.89 $79,838.89 2025-09-09
C8003 HCPCS Imp Extar Knee Shck Absrb 2 1 — — $79,838.89 $79,838.89 $79,838.89 2025-09-09
23472 CPT Reconstruct Shoulder Joint 2 1 — — $79,838.89 $79,838.89 $79,838.89 2025-09-09
C9797 HCPCS Vasc Emb/occ W/prs Cath 2 1 — — $77,957.64 $77,957.64 $77,957.64 2025-09-09
0645T CPT Tcat Impltj C Sins Rdctj Dev 2 1 — — $77,957.64 $77,957.64 $77,957.64 2025-09-09
0632T CPT Perq Tcat US Abltj Nrv P-art 2 1 — — $77,957.64 $77,957.64 $77,957.64 2025-09-09
0981T CPT Tcat Impl Wrls Ivc Snr 2 1 — — $77,957.64 $77,957.64 $77,957.64 2025-09-09
66683 CPT Implantation Iris Prosthesis 2 1 — — $71,270.65 $71,270.65 $71,270.65 2025-09-09
L7181 HCPCS Electronic Elbo Simultaneous 2 1 — — $63,531.52 $63,531.52 $63,531.52 2025-09-09
L7180 HCPCS Electronic Elbow Sequential 2 1 — — $57,646.84 $57,646.84 $57,646.84 2025-09-09
55882 CPT Ablt Trurl Prst8 Tis Trnsdcr 2 1 — — $56,405.55 $56,405.55 $56,405.55 2025-09-09
0737T CPT Xenograft Impltj Artclr Surf 2 1 — — $55,860.25 $55,860.25 $55,860.25 2025-09-09
23470 CPT Reconstruct Shoulder Joint 2 1 — — $55,860.25 $55,860.25 $55,860.25 2025-09-09
27441 CPT Revision Of Knee Joint 2 1 — — $55,860.25 $55,860.25 $55,860.25 2025-09-09
27447 CPT Total Knee Arthroplasty 2 1 — — $55,860.25 $55,860.25 $55,860.25 2025-09-09
27446 CPT Revision Of Knee Joint 2 1 — — $55,860.25 $55,860.25 $55,860.25 2025-09-09
27442 CPT Revision Of Knee Joint 2 1 — — $55,860.25 $55,860.25 $55,860.25 2025-09-09
27443 CPT Revision Of Knee Joint 2 1 — — $55,860.25 $55,860.25 $55,860.25 2025-09-09
27440 CPT Revision Of Knee Joint 2 1 — — $55,860.25 $55,860.25 $55,860.25 2025-09-09
27438 CPT Revise Kneecap With Implant 2 1 — — $55,860.25 $55,860.25 $55,860.25 2025-09-09
27130 CPT Total Hip Arthroplasty 2 1 — — $55,860.25 $55,860.25 $55,860.25 2025-09-09
23473 CPT Revis Reconst Shoulder Joint 2 1 — — $55,860.25 $55,860.25 $55,860.25 2025-09-09
61715 CPT Mrgfus Strtctc Ablt Trgt Icr 2 1 — — $54,138.85 $54,138.85 $54,138.85 2025-09-09
0675T CPT Laps Insj Nw/rpcmt Isdss 1ld 2 1 — — $54,138.85 $54,138.85 $54,138.85 2025-09-09
C8004 HCPCS Sim Ang W/prs Cath Rad Emb 2 1 — — $49,234.15 $49,234.15 $49,234.15 2025-09-09
90288 CPT Botulism Ig IV 4 1 — — $48,705.00 $48,705.00 $48,705.00 2025-09-09
L8701 HCPCS Ewh S/d Uprt Micro Sensor 2 1 — — $45,366.54 $45,366.54 $45,366.54 2025-09-09
C9901 HCPCS Endo Defect Closure Gi Tract 2 1 — — $45,199.47 $45,199.47 $45,199.47 2025-09-09
0679T CPT Laps Rmvl Lead Isdss 2 1 — — $45,199.47 $45,199.47 $45,199.47 2025-09-09
0677T CPT Laps Repos Lead Isdss 1st Ld 2 1 — — $45,199.47 $45,199.47 $45,199.47 2025-09-09
53865 CPT Cysto Insj Dev Ischmc Rmdlg 2 1 — — $40,145.74 $40,145.74 $40,145.74 2025-09-09
0950T CPT Abltj B9 Prst8 Tissue Hifu 2 1 — — $40,145.74 $40,145.74 $40,145.74 2025-09-09
L6700 HCPCS Ue Add Ext Power Myoel 2 1 — — $38,283.40 $38,283.40 $38,283.40 2025-09-09
L5856 HCPCS Elec Knee-shin Swing/stance 2 1 — — $38,118.52 $38,118.52 $38,118.52 2025-09-09
L6880 HCPCS Elec Hand Ind Art Digits 2 1 — — $37,893.15 $37,893.15 $37,893.15 2025-09-09
0918T CPT Insj Perm Ccm-d Sys Dual Ld 2 1 — — $35,929.50 $35,929.50 $35,929.50 2025-09-09
0917T CPT Insj Perm Ccm-d Sys 1 Lead 2 1 — — $35,929.50 $35,929.50 $35,929.50 2025-09-09
J7330 HCPCS Cultured Chondrocytes Implnt 4 1 — — $31,905.54 $31,905.54 $31,905.54 2025-09-09
L8614 HCPCS Cochlear Device 2 1 — — $30,669.00 $30,669.00 $30,669.00 2025-09-09
Q0483 HCPCS Monitor Elec Vad, Rep 2 1 — — $29,736.40 $29,736.40 $29,736.40 2025-09-09
L5858 HCPCS Stance Phase Only 2 1 — — $29,468.51 $29,468.51 $29,468.51 2025-09-09
L6975 HCPCS Interscap-thor Myoelectronic 2 1 — — $28,200.32 $28,200.32 $28,200.32 2025-09-09
0315U CPT Onc Cutan Sq Cll Ca Mrna 40 2 1 — — $28,118.85 $28,118.85 $28,118.85 2025-09-09
L5973 HCPCS Ank-foot Sys Dors-plant Flex 2 1 — — $27,669.90 $27,669.90 $27,669.90 2025-09-09
0886T CPT Sgmdsc Flx 1st Tndsc Dilat 2 1 — — $25,843.63 $25,843.63 $25,843.63 2025-09-09
0885T CPT Colsc Flx 1st Tndsc Dilat 2 1 — — $25,843.63 $25,843.63 $25,843.63 2025-09-09
0884T CPT Esphgsc Flx 1st Tndsc Dilat 2 1 — — $25,843.63 $25,843.63 $25,843.63 2025-09-09
Q0489 HCPCS Pwr Pck Base Combo Vad, Rep 2 1 — — $25,779.85 $25,779.85 $25,779.85 2025-09-09
L6970 HCPCS Interscapular-thor Switch CT 2 1 — — $25,737.67 $25,737.67 $25,737.67 2025-09-09
81552 CPT Onc Uveal Mlnma Mrna 15 Gene 2 1 — — $25,723.79 $25,723.79 $25,723.79 2025-09-09
21366 CPT Opn Tx Complx Malar W/grft 2 1 — — $25,682.35 $25,682.35 $25,682.35 2025-09-09
21141 CPT Rcnstj Midface Lefort I 1pc 2 1 — — $25,682.35 $25,682.35 $25,682.35 2025-09-09
21143 CPT Rcnstj Mdface Lefort I 3/>pc 2 1 — — $25,682.35 $25,682.35 $25,682.35 2025-09-09
21255 CPT Reconstruct Lower Jaw Bone 2 1 — — $25,682.35 $25,682.35 $25,682.35 2025-09-09
21194 CPT Reconst Lwr Jaw W/graft 2 1 — — $25,682.35 $25,682.35 $25,682.35 2025-09-09
21347 CPT Opn Tx Nasomax Fx Multple 2 1 — — $25,682.35 $25,682.35 $25,682.35 2025-09-09
21422 CPT Optx Palatal/max Fracture 2 1 — — $25,682.35 $25,682.35 $25,682.35 2025-09-09
43659 CPT Unlisted Laps Px Stomach 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
50949 CPT Unlisted Laps Px Ureter 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
50549 CPT Unlisted Laps Px Renal 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
49329 CPT Unlstd Laps Px Abd Pertm&omn 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
44979 CPT Unlisted Laps Px Appendix 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
51999 CPT Unlisted Laps Px Bladder 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
58578 CPT Unlisted Laps Px Uterus 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
43289 CPT Unlisted Laps Px Esoph 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
49659 CPT Unlstd Laps Px Hrnap Hrnrphy 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
45499 CPT Laparoscope Proc Rectum 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
54699 CPT Unlisted Laps Px Testis 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
55559 CPT Unlstd Laps Px Sprmatic Cord 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
38589 CPT Unlisted Laps Px Lymphtc Sys 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
59898 CPT Unlstd Laps Px Mat Care&dlvr 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
58679 CPT Unlisted Laps Px Ovidct Ovry 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
44238 CPT Unlisted Laps Px Intestine 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
38129 CPT Unlisted Laps Px Spleen 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
47379 CPT Unlisted Laps Px Liver 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
60699 CPT Unlisted Px Endocrine System 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
47579 CPT Unlisted Laps Px Biliary Trc 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
60659 CPT Unlisted Laps Px Endoc Sys 2 1 — — $25,329.42 $25,329.42 $25,329.42 2025-09-09
L6965 HCPCS Shldr Disartic Myoelectronic 2 1 — — $25,010.09 $25,010.09 $25,010.09 2025-09-09
0913T CPT Prq Tcat Ther Rx Ntrac Balo1 2 1 — — $24,752.69 $24,752.69 $24,752.69 2025-09-09
81529 CPT Onc Cutan Mlnma Mrna 31 Gene 2 1 — — $23,795.16 $23,795.16 $23,795.16 2025-09-09
L5859 HCPCS Knee-shin Pro Flex/ext Cont 2 1 — — $23,088.51 $23,088.51 $23,088.51 2025-09-09
Q0481 HCPCS Microprcsr Cu Elec Vad, Rep 2 1 — — $23,045.75 $23,045.75 $23,045.75 2025-09-09
0267U CPT Rare Do Id Opt Gen Mapg&seq 2 1 — — $22,294.38 $22,294.38 $22,294.38 2025-09-09
0867T CPT Tpla B9 Prst8 Hyprplsa>=50ml 2 1 — — $22,070.14 $22,070.14 $22,070.14 2025-09-09
L6960 HCPCS Shldr Disartic Switch Contro 2 1 — — $21,257.18 $21,257.18 $21,257.18 2025-09-09
L6955 HCPCS Above Elbow Myoelectronic CT 2 1 — — $21,076.45 $21,076.45 $21,076.45 2025-09-09
Q0224 HCPCS Inj, Pemivibart, 4500 Mg 2 1 — — $19,964.46 $19,964.46 $19,964.46 2025-09-09
G0448 HCPCS Place Perm Pacing Cardiovert 4 1 — — $19,926.65 $19,926.65 $19,926.65 2025-09-09
Q0479 HCPCS Power Module Combo Vad, Rep 2 1 — — $19,006.53 $19,006.53 $19,006.53 2025-09-09
0265U CPT Rar Do Whl Gn&mtcdrl DNA Als 2 1 — — $18,114.49 $18,114.49 $18,114.49 2025-09-09
0212U CPT Rare Ds Gen DNA Alys Proband 2 1 — — $18,112.51 $18,112.51 $18,112.51 2025-09-09
81554 CPT Pulm Ds Ipf Mrna 190 Gen Alg 2 1 — — $18,012.60 $18,012.60 $18,012.60 2025-09-09
L6945 HCPCS Elbow Disart Myoelectronic C 2 1 — — $18,012.43 $18,012.43 $18,012.43 2025-09-09
C9760 HCPCS Non-blind Interatrial Shunt 4 1 — — $17,875.33 $17,875.33 $17,875.33 2025-09-09
L6950 HCPCS Above Elbow Switch Control 2 1 — — $17,598.38 $17,598.38 $17,598.38 2025-09-09
C9782 HCPCS Blind Myocar Trpl Bon Marrow 4 1 — — $17,500.50 $17,500.50 $17,500.50 2025-09-09
0621T CPT Trabeculostomy Interno Laser 2 1 — — $17,464.92 $17,464.92 $17,464.92 2025-09-09
0661T CPT Rmvl&rimpltj Ant Sgm Implt 2 1 — — $17,464.92 $17,464.92 $17,464.92 2025-09-09
0660T CPT Implt Ant Sgm Io Nbio Rx Sys 2 1 — — $17,464.92 $17,464.92 $17,464.92 2025-09-09
0214U CPT Rare Ds Xom DNA Alys Proband 2 1 — — $17,283.50 $17,283.50 $17,283.50 2025-09-09
J7310 HCPCS Hphc Fee Schedule 4 1 — — $16,960.00 $16,960.00 $16,960.00 2025-09-09
0786T CPT Insj/rplcmt Prq Ra Sac Nstim 4 1 — — $16,836.44 $16,836.44 $16,836.44 2025-09-09
0971T CPT Ablt Mal Brst Tum Pq Lsr Uni 2 1 — — $16,624.52 $16,624.52 $16,624.52 2025-09-09
0970T CPT Ablt B9 Brst Tum Perq Lsr Ea 2 1 — — $16,624.52 $16,624.52 $16,624.52 2025-09-09
L7191 HCPCS Elbow Child Myoelectronic CT 2 1 — — $16,311.04 $16,311.04 $16,311.04 2025-09-09
0717T CPT Adrc Ther Prtl Rc Tear 2 1 — — $15,893.79 $15,893.79 $15,893.79 2025-09-09
0718T CPT Adrc Ther Prtl Rc Tear Njx 2 1 — — $15,893.79 $15,893.79 $15,893.79 2025-09-09
0919T CPT Rmvl Perm Ccm-d Sys Pg Only 2 1 — — $15,799.72 $15,799.72 $15,799.72 2025-09-09
0920T CPT Rmvl Perm Ccm-d Sys 1 Pac Ld 2 1 — — $15,799.72 $15,799.72 $15,799.72 2025-09-09
0921T CPT Rmvl Perm Ccm-d Sys 1 Dfb Ld 2 1 — — $15,799.72 $15,799.72 $15,799.72 2025-09-09
0922T CPT Rmvl Perm Ccm-d Sys Dual Ld 2 1 — — $15,799.72 $15,799.72 $15,799.72 2025-09-09
L7186 HCPCS Electron Elbow Child Switch 2 1 — — $15,609.53 $15,609.53 $15,609.53 2025-09-09
L6940 HCPCS Elbow Disarticulation Switch 2 1 — — $15,482.79 $15,482.79 $15,482.79 2025-09-09
L5991 HCPCS Low Pros Ext Osseo Connector 2 1 — — $15,249.75 $15,249.75 $15,249.75 2025-09-09
0681T CPT Rlcj Pulse Gen Only Isdss 2 1 — — $14,930.17 $14,930.17 $14,930.17 2025-09-09
0682T CPT Removal Pulse Gen Only Isdss 2 1 — — $14,930.17 $14,930.17 $14,930.17 2025-09-09
0473U CPT Onc Sld Tum Bld/slv 648 Gene 2 1 — — $14,886.45 $14,886.45 $14,886.45 2025-09-09
0869T CPT Njx B1 Sub Mtrl Hw Fixj Aug 2 1 — — $14,086.21 $14,086.21 $14,086.21 2025-09-09
0958T CPT Rmv S-sclp Eltr Ra Rcvr&tlmt 2 1 — — $14,086.21 $14,086.21 $14,086.21 2025-09-09
25448 CPT Arthrp Ntrcrpl/crp/mtcrp Ssp 2 1 — — $14,086.21 $14,086.21 $14,086.21 2025-09-09
0964T CPT I&cust Prep Jaw Xpnsj 1arch 2 1 — — $14,079.52 $14,079.52 $14,079.52 2025-09-09
0966T CPT I&cst Prp Jw Xpn Dl Arch Fxd 2 1 — — $14,079.52 $14,079.52 $14,079.52 2025-09-09
G0330 HCPCS Facility Svs Dental Rehab 2 1 — — $14,079.52 $14,079.52 $14,079.52 2025-09-09
0965T CPT I&cst Prp Jw Xpn Dl Arch Non 2 1 — — $14,079.52 $14,079.52 $14,079.52 2025-09-09
0933T CPT Tcat Impl Wrls L Atr Prs Snr 2 1 — — $13,963.81 $13,963.81 $13,963.81 2025-09-09
22862 CPT Rev Rplcm Rthrp 1ntrspc Lmbr 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
22849 CPT Reinsert Spinal Fixation 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
22861 CPT Rev Rplcm Arthrp 1ntrspc Crv 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
22857 CPT Tot Disc Arthrp 1ntrspc Lmbr 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
22610 CPT Arthrd Pst Tq 1ntrspc Thrc 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
22590 CPT Arthrd Pst Tq Craniocervical 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
22595 CPT Arthrd Pst Tq Atlas-axis 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
22600 CPT Arthrd Pst Tq 1ntrspc Crv 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
22556 CPT Arthrd Ant Ntrbd Min Dsc Thc 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
22558 CPT Arthrd Ant Ntrbd Min Dsc Lum 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
22586 CPT Arthrd Pre-sac Ntrbdy L5-s1 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
22532 CPT Arthrd Lat Xtrcvtry Tq Thrc 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
22533 CPT Arthrd Lat Xtrcvtry Tq Lmbr 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
22534 CPT Arthrd Lat Xtrcvtry Tq Ea Ad 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
22548 CPT Arthrd Ant Toral/xoral C1-c2 4 1 — — $13,862.21 $13,862.21 $13,862.21 2025-09-09
L6935 HCPCS Below Elbow Myoelectronic CT 2 1 — — $13,850.87 $13,850.87 $13,850.87 2025-09-09
0300U CPT Onc Pan Tum Whl Gen Seq&opt 2 1 — — $13,838.21 $13,838.21 $13,838.21 2025-09-09
0620T CPT Evasc Ven Artlz Tibl/prnl Vn 4 1 — — $13,819.05 $13,819.05 $13,819.05 2025-09-09
L6925 HCPCS Wrist Disart Myoelectronic C 2 1 — — $13,596.35 $13,596.35 $13,596.35 2025-09-09
L5857 HCPCS Elec Knee-shin Swing Only 2 1 — — $13,561.43 $13,561.43 $13,561.43 2025-09-09
L8679 HCPCS Imp Neurosti Pls Gn Any Type 2 1 — — $13,383.37 $13,383.37 $13,383.37 2025-09-09
L7190 HCPCS Elbow Adolescent Myoelectron 2 1 — — $13,331.17 $13,331.17 $13,331.17 2025-09-09
L8619 HCPCS Coch Imp Ext Proc/contr Rplc 2 1 — — $13,164.33 $13,164.33 $13,164.33 2025-09-09
0306U CPT Onc Mrd Nxt-gnrj Alys 1st 2 1 — — $12,830.30 $12,830.30 $12,830.30 2025-09-09
0497U CPT Onc Prst8 Mrna Rt-pcr 6genes 2 1 — — $12,812.27 $12,812.27 $12,812.27 2025-09-09
81542 CPT Onc Prostate Mrna 22 Cnt Gen 2 1 — — $12,812.27 $12,812.27 $12,812.27 2025-09-09
0398T CPT Commercial Fee Schedule 4 1 — — $12,500.50 $12,500.50 $12,500.50 2025-09-09
C9790 HCPCS Hphc Fee Schedule 4 1 — — $12,500.50 $12,500.50 $12,500.50 2025-09-09
0686T CPT Histotripsy Mal Hepatcel Tis 4 1 — — $12,500.50 $12,500.50 $12,500.50 2025-09-09
C9758 HCPCS Blind Interatrial Shunt Ide 4 1 — — $12,500.50 $12,500.50 $12,500.50 2025-09-09
0266T CPT Commercial Fee Schedule 4 1 — — $12,159.65 $12,159.65 $12,159.65 2025-09-09
0019U CPT Onc RNA Tiss Predict Alg 2 1 — — $12,157.27 $12,157.27 $12,157.27 2025-09-09
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