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

LINCOLNHEALTH

Damariscotta, ME · CCN 201302 · Rates published

8,717 distinct procedures filed
9 distinct payers
244,316 rate rows
2025-09-09 last MRF observed
Data quality

82,155 of 244,316 rate rows are consumer-grade (33.6%)

162,161 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 161,917
exceeds 10× this hospital's gross charge — excluded from medians 91
placeholder amount (≤ $0.02) — excluded from medians 76
percent-of-charges filed in the dollar field — excluded from medians 39
per-diem day rate — not a per-procedure price 37
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/7981/010238552-1912094806_mainehealth_standardcharges.csv
Found on page https://www.mainehealth.org/cms-hpt.txt
Discovered viaDiscovered by HANK (automated)
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-05-18
Content fingerprint 8cd977ca5f7cc04b… · 92,237,885 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
J9355
HCPCS 		Trastuzumab 150 Mg IV Solr|discarded Drug Not Administe 9 $236.78 $583,701.71 $550,118.78 nat. median
$989
outlier · 556.4×
38240
CPT 		Transplt Allo Hct/donor 1 $353,730.41 $353,730.41 $353,730.41 nat. median
$15,912
outlier · 22.2×
A9543
HCPCS 		Y90 Ibritumomab, Rx 1 $198,557.73 $198,557.73 $198,557.73 nat. median
$62,507
outlier · 3.2×
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 1 $192,561.72 $192,561.72 $192,561.72 nat. median
$69,774
outlier · 2.8×
33249
CPT 		Insj/rplcmt Defib W/lead(s) 1 $191,760.38 $191,760.38 $191,760.38 nat. median
$31,833
outlier · 6.0×
0408T
CPT 		Insj/rplc Cardiac Modulj Sys 1 $191,760.38 $191,760.38 $191,760.38 nat. median
$32,221
outlier · 6.0×
33264
CPT 		Rmvl & Rplcmt Dfb Gen Mlt Ld 1 $191,760.38 $191,760.38 $191,760.38 nat. median
$31,873
outlier · 6.0×
0915T
CPT 		Insj Perm Ccm-d Sys Pg&eltrd 1 $191,760.38 $191,760.38 $191,760.38 nat. median
$32,560
outlier · 5.9×
0571T
CPT 		Insj/rplcmt Icds Ss Eltrd 1 $191,760.38 $191,760.38 $191,760.38 nat. median
$32,221
outlier · 6.0×
33231
CPT 		Insrt Pulse Gen W/mult Leads 1 $191,760.38 $191,760.38 $191,760.38 nat. median
$30,121
outlier · 6.4×
33270
CPT 		Ins/rep Subq Defibrillator 1 $191,760.38 $191,760.38 $191,760.38 nat. median
$32,221
outlier · 6.0×
69930
CPT 		Implant Cochlear Device 1 $190,242.66 $190,242.66 $190,242.66 nat. median
$29,663
outlier · 6.4×
61886
CPT 		Implant Neurostim Arrays 1 $182,262.59 $182,262.59 $182,262.59 nat. median
$27,077
outlier · 6.7×
0674T
CPT 		Laps Insj Nw/rpcmt Prm Isdss 1 $182,262.59 $182,262.59 $182,262.59 nat. median
$25,200
outlier · 7.2×
64568
CPT 		Opn Impltj Crnl Nrv Nea&pg 1 $182,262.59 $182,262.59 $182,262.59 nat. median
$27,541
outlier · 6.6×
64582
CPT 		Opn Mpltj Hpglsl Nstm Ary Pg 1 $182,262.59 $182,262.59 $182,262.59 nat. median
$28,316
outlier · 6.4×
33287
CPT 		Rmv&rplcmt Phrnc Nrv Stim Pg 1 $182,262.59 $182,262.59 $182,262.59 nat. median
$29,718
outlier · 6.1×
0268T
CPT 		Commercial Fee Schedule 1 $182,262.59 $182,262.59 $182,262.59 nat. median
$30,333
outlier · 6.0×
63685
CPT 		Ins/rplc Spi Npg/rcvr Pocket 1 $182,262.59 $182,262.59 $182,262.59 nat. median
$21,347
outlier · 8.5×
33289
CPT 		Tcat Impl Wrls P-art Prs Snr 1 $170,029.88 $170,029.88 $170,029.88 nat. median
$28,318
outlier · 6.0×
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 1 $168,342.51 $168,342.51 $168,342.51 nat. median
$66,682
outlier · 2.5×
93653
CPT 		Compre Ep Eval Tx Svt 1 $146,727.75 $146,727.75 $146,727.75 nat. median
$26,156
outlier · 5.6×
93656
CPT 		Compre Ep Eval Abltj Atr Fib 1 $146,727.75 $146,727.75 $146,727.75 nat. median
$26,811
outlier · 5.5×
93654
CPT 		Compre Ep Eval Tx Vt 1 $146,727.75 $146,727.75 $146,727.75 nat. median
$26,704
outlier · 5.5×
J9043
HCPCS 		Cabazitaxel 60 Mg/6ml IV Soln 9 $653.50 $142,275.70 $135,162.67 nat. median
$739
outlier · 183.0×
33262
CPT 		Rmvl& Replc Pulse Gen 1 Lead 1 $134,250.72 $134,250.72 $134,250.72 nat. median
$23,398
outlier · 5.7×
0916T
CPT 		Insj Perm Ccm-d Sys Pg Only 1 $134,250.72 $134,250.72 $134,250.72 nat. median
$23,439
outlier · 5.7×
0923T
CPT 		Rmvl&rplcmt Perm Ccm-d Pg 1 $134,250.72 $134,250.72 $134,250.72 nat. median
$22,482
outlier · 6.0×
0614T
CPT 		Rmvl&rplcmt Ss Impl Dfb Pg 1 $134,250.72 $134,250.72 $134,250.72 nat. median
$23,514
outlier · 5.7×
0515T
CPT 		Insj Wcs Lv Compl Sys 1 $134,250.72 $134,250.72 $134,250.72 nat. median
$22,512
outlier · 6.0×
0414T
CPT 		Rmvl & Rpl Car Modulj Pls Gn 1 $134,250.72 $134,250.72 $134,250.72 nat. median
$22,718
outlier · 5.9×
33240
CPT 		Insrt Pulse Gen W/singl Lead 1 $134,250.72 $134,250.72 $134,250.72 nat. median
$22,134
outlier · 6.1×
33263
CPT 		Rmvl & Rplcmt Dfb Gen 2 Lead 1 $134,250.72 $134,250.72 $134,250.72 nat. median
$23,504
outlier · 5.7×
0409T
CPT 		Insj/rplc Car Modulj Pls Gn 1 $134,250.72 $134,250.72 $134,250.72 nat. median
$22,946
outlier · 5.9×
33230
CPT 		Insrt Pulse Gen W/dual Leads 1 $134,250.72 $134,250.72 $134,250.72 nat. median
$22,359
outlier · 6.0×
J9226
HCPCS 		Supprelin La Implant 1 $133,909.89 $133,909.89 $133,909.89 nat. median
$60,368
outlier · 2.2×
61891
CPT 		Rev/rplcmt Sk-mnt Crnl Nstm 1 $128,258.93 $128,258.93 $128,258.93 nat. median
$20,874
outlier · 6.1×
0816T
CPT 		Opn Insj/rplcmt Ins Ptn Subq 1 $128,258.93 $128,258.93 $128,258.93 nat. median
$21,683
outlier · 5.9×
61885
CPT 		Insrt/redo Neurostim 1 Array 1 $128,258.93 $128,258.93 $128,258.93 nat. median
$20,011
outlier · 6.4×
0817T
CPT 		Opn Insj/rplcmt Ins Ptn Subf 1 $128,258.93 $128,258.93 $128,258.93 nat. median
$21,444
outlier · 6.0×
63655
CPT 		Implant Neuroelectrodes 1 $128,258.93 $128,258.93 $128,258.93 nat. median
$19,078
outlier · 6.7×
64590
CPT 		Ins/rpl Prph Sac/gstr Npg/r 1 $128,258.93 $128,258.93 $128,258.93 nat. median
$18,332
outlier · 7.0×
64580
CPT 		Opn Impltj Nea Neuromuscular 1 $128,258.93 $128,258.93 $128,258.93 nat. median
$18,977
outlier · 6.8×
0680T
CPT 		Insj/rplcmt Pg Only Isdss 1 $128,258.93 $128,258.93 $128,258.93 nat. median
$19,911
outlier · 6.4×
54411
CPT 		Remov/replc Penis Pros Comp 1 $120,388.99 $120,388.99 $120,388.99 nat. median
$18,696
outlier · 6.4×
54416
CPT 		Remv/repl Penis Contain Pros 1 $120,388.99 $120,388.99 $120,388.99 nat. median
$18,797
outlier · 6.4×
54410
CPT 		Remove/replace Penis Prosth 1 $120,388.99 $120,388.99 $120,388.99 nat. median
$18,616
outlier · 6.5×
53444
CPT 		Insert Tandem Cuff 1 $120,388.99 $120,388.99 $120,388.99 nat. median
$14,070
outlier · 8.6×
53445
CPT 		Insert Uro/ves Nck Sphincter 1 $120,388.99 $120,388.99 $120,388.99 nat. median
$16,382
outlier · 7.3×
53447
CPT 		Remove/replace Ur Sphincter 1 $120,388.99 $120,388.99 $120,388.99 nat. median
$15,897
outlier · 7.6×

Other procedures at this hospital

Browse this hospital's 8,717 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 34 9 $615,310.98 $615,310.98 $236.78 $583,701.71 $550,118.78 2025-09-09
38240 CPT Transplt Allo Hct/donor 1 1 — — $353,730.41 $353,730.41 $353,730.41 2025-09-09
A9543 HCPCS Y90 Ibritumomab, Rx 1 1 — — $198,557.73 $198,557.73 $198,557.73 2025-09-09
J9029 HCPCS Instill Adstiladrin, Tx Dose 1 1 — — $192,561.72 $192,561.72 $192,561.72 2025-09-09
0571T CPT Insj/rplcmt Icds Ss Eltrd 1 1 — — $191,760.38 $191,760.38 $191,760.38 2025-09-09
33264 CPT Rmvl & Rplcmt Dfb Gen Mlt Ld 1 1 — — $191,760.38 $191,760.38 $191,760.38 2025-09-09
0408T CPT Insj/rplc Cardiac Modulj Sys 1 1 — — $191,760.38 $191,760.38 $191,760.38 2025-09-09
33249 CPT Insj/rplcmt Defib W/lead(s) 1 1 — — $191,760.38 $191,760.38 $191,760.38 2025-09-09
33270 CPT Ins/rep Subq Defibrillator 1 1 — — $191,760.38 $191,760.38 $191,760.38 2025-09-09
33231 CPT Insrt Pulse Gen W/mult Leads 1 1 — — $191,760.38 $191,760.38 $191,760.38 2025-09-09
0915T CPT Insj Perm Ccm-d Sys Pg&eltrd 1 1 — — $191,760.38 $191,760.38 $191,760.38 2025-09-09
69930 CPT Implant Cochlear Device 1 1 — — $190,242.66 $190,242.66 $190,242.66 2025-09-09
64568 CPT Opn Impltj Crnl Nrv Nea&pg 1 1 — — $182,262.59 $182,262.59 $182,262.59 2025-09-09
0674T CPT Laps Insj Nw/rpcmt Prm Isdss 1 1 — — $182,262.59 $182,262.59 $182,262.59 2025-09-09
61886 CPT Implant Neurostim Arrays 1 1 — — $182,262.59 $182,262.59 $182,262.59 2025-09-09
33287 CPT Rmv&rplcmt Phrnc Nrv Stim Pg 1 1 — — $182,262.59 $182,262.59 $182,262.59 2025-09-09
0268T CPT Commercial Fee Schedule 1 1 — — $182,262.59 $182,262.59 $182,262.59 2025-09-09
63685 CPT Ins/rplc Spi Npg/rcvr Pocket 1 1 — — $182,262.59 $182,262.59 $182,262.59 2025-09-09
64582 CPT Opn Mpltj Hpglsl Nstm Ary Pg 1 1 — — $182,262.59 $182,262.59 $182,262.59 2025-09-09
33289 CPT Tcat Impl Wrls P-art Prs Snr 1 1 — — $170,029.88 $170,029.88 $170,029.88 2025-09-09
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 1 1 — — $168,342.51 $168,342.51 $168,342.51 2025-09-09
93654 CPT Compre Ep Eval Tx Vt 1 1 — — $146,727.75 $146,727.75 $146,727.75 2025-09-09
93656 CPT Compre Ep Eval Abltj Atr Fib 1 1 — — $146,727.75 $146,727.75 $146,727.75 2025-09-09
93653 CPT Compre Ep Eval Tx Svt 1 1 — — $146,727.75 $146,727.75 $146,727.75 2025-09-09
J9043 HCPCS Cabazitaxel 60 Mg/6ml IV Soln 21 9 $151,180.21 $151,180.21 $653.50 $142,275.70 $135,162.67 2025-09-09
0614T CPT Rmvl&rplcmt Ss Impl Dfb Pg 1 1 — — $134,250.72 $134,250.72 $134,250.72 2025-09-09
33230 CPT Insrt Pulse Gen W/dual Leads 1 1 — — $134,250.72 $134,250.72 $134,250.72 2025-09-09
0515T CPT Insj Wcs Lv Compl Sys 1 1 — — $134,250.72 $134,250.72 $134,250.72 2025-09-09
0916T CPT Insj Perm Ccm-d Sys Pg Only 1 1 — — $134,250.72 $134,250.72 $134,250.72 2025-09-09
0923T CPT Rmvl&rplcmt Perm Ccm-d Pg 1 1 — — $134,250.72 $134,250.72 $134,250.72 2025-09-09
33240 CPT Insrt Pulse Gen W/singl Lead 1 1 — — $134,250.72 $134,250.72 $134,250.72 2025-09-09
0414T CPT Rmvl & Rpl Car Modulj Pls Gn 1 1 — — $134,250.72 $134,250.72 $134,250.72 2025-09-09
33262 CPT Rmvl& Replc Pulse Gen 1 Lead 1 1 — — $134,250.72 $134,250.72 $134,250.72 2025-09-09
33263 CPT Rmvl & Rplcmt Dfb Gen 2 Lead 1 1 — — $134,250.72 $134,250.72 $134,250.72 2025-09-09
0409T CPT Insj/rplc Car Modulj Pls Gn 1 1 — — $134,250.72 $134,250.72 $134,250.72 2025-09-09
J9226 HCPCS Supprelin La Implant 1 1 — — $133,909.89 $133,909.89 $133,909.89 2025-09-09
63655 CPT Implant Neuroelectrodes 1 1 — — $128,258.93 $128,258.93 $128,258.93 2025-09-09
0816T CPT Opn Insj/rplcmt Ins Ptn Subq 1 1 — — $128,258.93 $128,258.93 $128,258.93 2025-09-09
64580 CPT Opn Impltj Nea Neuromuscular 1 1 — — $128,258.93 $128,258.93 $128,258.93 2025-09-09
64590 CPT Ins/rpl Prph Sac/gstr Npg/r 1 1 — — $128,258.93 $128,258.93 $128,258.93 2025-09-09
0680T CPT Insj/rplcmt Pg Only Isdss 1 1 — — $128,258.93 $128,258.93 $128,258.93 2025-09-09
61885 CPT Insrt/redo Neurostim 1 Array 1 1 — — $128,258.93 $128,258.93 $128,258.93 2025-09-09
61891 CPT Rev/rplcmt Sk-mnt Crnl Nstm 1 1 — — $128,258.93 $128,258.93 $128,258.93 2025-09-09
0817T CPT Opn Insj/rplcmt Ins Ptn Subf 1 1 — — $128,258.93 $128,258.93 $128,258.93 2025-09-09
54401 CPT Insert Self-contd Prosthesis 1 1 — — $120,388.99 $120,388.99 $120,388.99 2025-09-09
54416 CPT Remv/repl Penis Contain Pros 1 1 — — $120,388.99 $120,388.99 $120,388.99 2025-09-09
54410 CPT Remove/replace Penis Prosth 1 1 — — $120,388.99 $120,388.99 $120,388.99 2025-09-09
54411 CPT Remov/replc Penis Pros Comp 1 1 — — $120,388.99 $120,388.99 $120,388.99 2025-09-09
53447 CPT Remove/replace Ur Sphincter 1 1 — — $120,388.99 $120,388.99 $120,388.99 2025-09-09
54405 CPT Insert Multi-comp Penis Pros 1 1 — — $120,388.99 $120,388.99 $120,388.99 2025-09-09
53445 CPT Insert Uro/ves Nck Sphincter 1 1 — — $120,388.99 $120,388.99 $120,388.99 2025-09-09
53444 CPT Insert Tandem Cuff 1 1 — — $120,388.99 $120,388.99 $120,388.99 2025-09-09
0796T CPT Tcat Ins 2chmbr Ldls Pm Ra 1 1 — — $114,064.67 $114,064.67 $114,064.67 2025-09-09
0803T CPT Tcat Rmv&rpl2chmb Ldls Pm Rv 1 1 — — $114,064.67 $114,064.67 $114,064.67 2025-09-09
0797T CPT Tcat Ins 2chmbr Ldls Pm Rv 1 1 — — $114,064.67 $114,064.67 $114,064.67 2025-09-09
0823T CPT Tcat Ins 1chmbr Ldls Pm Ra 1 1 — — $114,064.67 $114,064.67 $114,064.67 2025-09-09
0801T CPT Tcat Rmv&rpl 2chmbr Ldls Pm 1 1 — — $114,064.67 $114,064.67 $114,064.67 2025-09-09
33274 CPT Tcat Insj/rpl Perm Ldls Pm 1 1 — — $114,064.67 $114,064.67 $114,064.67 2025-09-09
0802T CPT Tcat Rmv&rpl2chmb Ldls Pm Ra 1 1 — — $114,064.67 $114,064.67 $114,064.67 2025-09-09
0525T CPT Insj/rplcmt Compl Iims 1 1 — — $114,064.67 $114,064.67 $114,064.67 2025-09-09
33221 CPT Insert Pulse Gen Mult Leads 1 1 — — $114,064.67 $114,064.67 $114,064.67 2025-09-09
0795T CPT Tcat Ins 2chmbr Ldls Pm Cmpl 1 1 — — $114,064.67 $114,064.67 $114,064.67 2025-09-09
0825T CPT Tcat Rmv&rpl1chmb Ldls Pm Ra 1 1 — — $114,064.67 $114,064.67 $114,064.67 2025-09-09
33229 CPT Remv&replc Pm Gen Mult Leads 1 1 — — $114,064.67 $114,064.67 $114,064.67 2025-09-09
22867 CPT Insj Stablj Dev W/dcmprn 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
C8003 HCPCS Imp Extar Knee Shck Absrb 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
20696 CPT App Mltpln Uni Xtrnl Fix 1st 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
22612 CPT Arthrd Pst Tq 1ntrspc Lumbar 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
24363 CPT Replace Elbow Joint 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
24371 CPT Revise Reconst Elbow Joint 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
23472 CPT Reconstruct Shoulder Joint 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
25446 CPT Arthrp W/prostc Dst Rds&crps 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
22633 CPT Arthrd Cmbn 1ntrspc Lumbar 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
23616 CPT Optx Prx Hmrl Fx Fix Rpr Rpl 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
24361 CPT Reconstruct Elbow Joint 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
28705 CPT Arthrodesis Pantalar 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
25442 CPT Arthrp W/prostc Dstl Ulna 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
27279 CPT Arthrd Si Jt Plmt Tartclr Dv 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
21243 CPT Reconstruction Of Jaw Joint 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
27702 CPT Reconstruct Ankle Joint 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
22630 CPT Arthrd Pst Tq 1ntrspc Lum 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
27278 CPT Arthrd Si Jt Plmt Iartic Dev 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
22856 CPT Tot Disc Arthrp 1ntrspc Crv 1 1 — — $109,990.90 $109,990.90 $109,990.90 2025-09-09
93591 CPT Perq Transcath Cls Aortic 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
C9767 HCPCS Revasc Lithotrip-stent-ather 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
C9602 HCPCS Perc D-e Cor Stent Ather S 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
C9607 HCPCS Perc D-e Cor Revasc Chro Sin 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
36837 CPT Prq Av Fstl Crt Uxtr Sep Acs 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
93580 CPT Transcath Closure Of Asd 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
93581 CPT Transcath Closure Of Vsd 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
93590 CPT Perq Transcath Cls Mitral 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
0238T CPT Trluml Perip Athrc Iliac Art 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
C9765 HCPCS Revasc Intra Lithotrip-stent 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
C9775 HCPCS Revasc Lith-sten-ath Tib/per 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
C9774 HCPCS Revasc Lithotr-ather Tib/per 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
37242 CPT Vasc Embolize/occlude Artery 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
92933 CPT Prq Trlml C Athrc St Angiop1 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
37231 CPT Commercial Fee Schedule 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
37230 CPT Commercial Fee Schedule 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
37227 CPT Commercial Fee Schedule 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
37225 CPT Commercial Fee Schedule 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
37229 CPT Commercial Fee Schedule 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
37184 CPT Prim Art M-thrmbc 1st Vsl 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
36906 CPT Thrmbc/nfs Dialysis Circuit 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
33902 CPT Perq P-art Revsc 1 Abnor Uni 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
36836 CPT Prq Av Fstl Crtj Uxtr 1 Acs 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
C9773 HCPCS Revasc Lithotr-stent Tib/per 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
C9797 HCPCS Vasc Emb/occ W/prs Cath 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
C9766 HCPCS Revasc Intra Lithotrip-ather 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
0645T CPT Tcat Impltj C Sins Rdctj Dev 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
0981T CPT Tcat Impl Wrls Ivc Snr 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
93582 CPT Perq Transcath Closure Pda 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
0632T CPT Perq Tcat US Abltj Nrv P-art 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
0793T CPT Prq Tcat Thrm Ablt Nrv P-art 1 1 — — $107,399.18 $107,399.18 $107,399.18 2025-09-09
62361 CPT Implant Spine Infusion Pump 1 1 — — $105,708.93 $105,708.93 $105,708.93 2025-09-09
62362 CPT Implant Spine Infusion Pump 1 1 — — $105,708.93 $105,708.93 $105,708.93 2025-09-09
62360 CPT Insert Spine Infusion Device 1 1 — — $105,708.93 $105,708.93 $105,708.93 2025-09-09
C2616 HCPCS Brachytx, Non-str,yttrium-90 1 1 — — $104,578.45 $104,578.45 $104,578.45 2025-09-09
19357 CPT Tiss Xpndr Plmt Brst Rcnstj 1 1 — — $104,059.59 $104,059.59 $104,059.59 2025-09-09
66683 CPT Implantation Iris Prosthesis 1 1 — — $98,186.77 $98,186.77 $98,186.77 2025-09-09
0308T CPT Insj Ocular Telescope Prosth 1 1 — — $98,186.77 $98,186.77 $98,186.77 2025-09-09
J9347 HCPCS Tremelimumab-actl 300 Mg/15ml IV Soln 21 9 $106,803.10 $106,803.10 $411.09 $100,512.40 $95,487.32 2025-09-09
67027 CPT Implant Eye Drug System 1 1 — — $91,897.06 $91,897.06 $91,897.06 2025-09-09
65770 CPT Keratoprosthesis 1 1 — — $85,464.37 $85,464.37 $85,464.37 2025-09-09
J9266 HCPCS Pegaspargase Injection 1 1 — — $81,922.56 $81,922.56 $81,922.56 2025-09-09
53451 CPT Tprnl Balo Cntnc Dev Bi 1 1 — — $77,707.71 $77,707.71 $77,707.71 2025-09-09
55882 CPT Ablt Trurl Prst8 Tis Trnsdcr 1 1 — — $77,707.71 $77,707.71 $77,707.71 2025-09-09
54417 CPT Remv/replc Penis Pros Compl 1 1 — — $77,707.71 $77,707.71 $77,707.71 2025-09-09
54400 CPT Insert Semi-rigid Prosthesis 1 1 — — $77,707.71 $77,707.71 $77,707.71 2025-09-09
53440 CPT Male Sling Procedure 1 1 — — $77,707.71 $77,707.71 $77,707.71 2025-09-09
24362 CPT Reconstruct Elbow Joint 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
29889 CPT Arthrs Aid Pcl Rpr/agmntj 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
28725 CPT Arthrodesis Subtalar 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27130 CPT Total Hip Arthroplasty 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
22551 CPT Arthrd Ant Ntrbdy Cervical 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
28297 CPT Cor Hlx Vlgs Jt Arthrd 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27871 CPT Fusion Of Tibiofibular Joint 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24346 CPT Reconstruct Elbow Med Ligmnt 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27428 CPT Reconstruction Knee 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24666 CPT Optx Radial Head/nck Fx Rplc 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
23680 CPT Optx Sho Dislc Neck Fx Fixj 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24365 CPT Reconstruct Head Of Radius 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24410 CPT Mlt Osteot Rlgnm Imed Rd Hum 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27438 CPT Revise Kneecap With Implant 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
0629T CPT Perq Njx Algc CT Lmbr 1st 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
23615 CPT Optx Prox Humrl Fx W/int Fix 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24516 CPT Tx Humrl Shaft Fx Imed Implt 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
20692 CPT Appl Mltpln Uni Ext Fixj Sys 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24366 CPT Reconstruct Head Of Radius 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
25810 CPT Arthrd Wrst Iliac/oth Agrft 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
23802 CPT Arthrd Glenohumeral Jt W/grf 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
C9734 HCPCS U/s Trtmt, Not Leiomyomata 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
20982 CPT Ablate Bone Tumor(s) Perq 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
C9757 HCPCS Spine Device Implant Surgery 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27758 CPT Treatment Of Tibia Fracture 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27415 CPT Osteochondral Knee Allograft 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24545 CPT Optx Hum Fx Wo Ntrcndylr Xtn 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
23485 CPT Revision Of Collar Bone 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24587 CPT Optx Partclr Fx&/dslc Elbw W 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
C9781 HCPCS Arthro/shoul Surg; W/spacer 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
0737T CPT Xenograft Impltj Artclr Surf 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
69730 CPT Rplc Oi Implt Sk Tc Esp>=100 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
25491 CPT Prophylactic Tx Ulna 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
23491 CPT Reinforce Shoulder Bones 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24575 CPT Optx Humeral Epcndylr Fx 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24370 CPT Revise Reconst Elbow Joint 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
25444 CPT Arthrp W/prostc Lunate 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
23473 CPT Revis Reconst Shoulder Joint 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
22554 CPT Arthrd Ant Ntrbd Min Dsc Crv 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24586 CPT Optx Partclr Fx&/dislc Elbow 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24579 CPT Optx Humrl Cndylr Fracture 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24546 CPT Optx Hum Fx W/ntrcndylr Xtn 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
69716 CPT Impl Oi Implt Sk Tc Esp<100 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24430 CPT Rpr Non/mal Humerus Wo Graft 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27356 CPT Remove Femur Lesion/graft 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
25391 CPT Lengthen Radius Or Ulna 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
25365 CPT Revise Radius & Ulna 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
0627T CPT Perq Njx Algc Fluor Lmbr 1st 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
69719 CPT Rplcm Oi Implt Sk Tc Esp<100 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24802 CPT Arthrd Elbow Jt Autog Graft 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24498 CPT Proph Tx W/wo Mthylmthcrylt 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
23470 CPT Reconstruct Shoulder Joint 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
69714 CPT Impl Oi Implt Skull Perq Esp 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27443 CPT Revision Of Knee Joint 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24435 CPT Rpr Non/mal Hum With Agrft 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
29907 CPT Subtalar Arthro W/fusion 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
29856 CPT Tibial Arthroscopy/surgery 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
29867 CPT Allgrft Implnt Knee W/scope 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27440 CPT Revision Of Knee Joint 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
28730 CPT Fusion Of Foot Bones 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
28715 CPT Arthrodesis Triple 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
28735 CPT Fusion Of Foot Bones 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
22869 CPT Insj Stablj Dev Without Dcmprn 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
28320 CPT Repair Of Foot Bones 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
28420 CPT Optx Calcaneal Fx W/bone Grf 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
28737 CPT Revision Of Foot Bones 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27759 CPT Treatment Of Tibia Fracture 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27709 CPT Osteotomy Tibia & Fibula 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27827 CPT Treat Lower Leg Fracture 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27446 CPT Revision Of Knee Joint 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27447 CPT Total Knee Arthroplasty 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27828 CPT Treat Lower Leg Fracture 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
69729 CPT Impl Oi Implt Sk Tc Esp>=100 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27441 CPT Revision Of Knee Joint 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27429 CPT Reconstruction Knee 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27870 CPT Fusion Of Ankle Joint Open 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
24515 CPT Optx Humrl Shft Fx Plate/scr 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
25441 CPT Arthrp W/prostc Dstl Rds 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
27442 CPT Revision Of Knee Joint 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
64628 CPT Trml Dstrj Ios Bvn 1st 2 L/s 1 1 — — $76,956.48 $76,956.48 $76,956.48 2025-09-09
61715 CPT Mrgfus Strtctc Ablt Trgt Icr 1 1 — — $74,584.96 $74,584.96 $74,584.96 2025-09-09
61888 CPT Revise/remove Neuroreceiver 1 1 — — $74,584.96 $74,584.96 $74,584.96 2025-09-09
64575 CPT Opn Impltj Nea Perph Nerve 1 1 — — $74,584.96 $74,584.96 $74,584.96 2025-09-09
64553 CPT Implant Neuroelectrodes 1 1 — — $74,584.96 $74,584.96 $74,584.96 2025-09-09
63664 CPT Revise Spine Eltrd Plate 1 1 — — $74,584.96 $74,584.96 $74,584.96 2025-09-09
64569 CPT Revise/repl Vagus N Eltrd 1 1 — — $74,584.96 $74,584.96 $74,584.96 2025-09-09
64583 CPT Rev/rplct Hpglsl Nstm Ary Pg 1 1 — — $74,584.96 $74,584.96 $74,584.96 2025-09-09
64596 CPT Ins/rplcmt Prq Eltrd Ra Pn 1 1 1 — — $74,584.96 $74,584.96 $74,584.96 2025-09-09
43647 CPT Lap Impl Electrode Antrum 1 1 — — $74,584.96 $74,584.96 $74,584.96 2025-09-09
0675T CPT Laps Insj Nw/rpcmt Isdss 1ld 1 1 — — $74,584.96 $74,584.96 $74,584.96 2025-09-09
33288 CPT Rmv&rplcmt Phrnc Nrv Stim Ld 1 1 — — $74,584.96 $74,584.96 $74,584.96 2025-09-09
0784T CPT Ins/rplmt Eltrd Ra Spi Nstim 1 1 — — $74,584.96 $74,584.96 $74,584.96 2025-09-09
J9600 HCPCS Porfimer Sodium Injection 1 1 — — $71,315.79 $71,315.79 $71,315.79 2025-09-09
J3357 HCPCS Ustekinumab 90 Mg/ml Sc Sosy 21 9 $76,732.48 $76,732.48 $479.62 $72,212.94 $68,602.68 2025-09-09
61626 CPT Tcat Perm Occls/embol Noncns 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
61623 CPT Evasc Temp Balo Artl Occ H/n 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
92937 CPT Prq Trluml Revsc Cab Grf 1 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
0237T CPT Trluml Perip Athrc Brchiocph 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
0236T CPT Trluml Perip Athrc Abd Aorta 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
0234T CPT Trluml Perip Athrc Renal Art 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
C8004 HCPCS Sim Ang W/prs Cath Rad Emb 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
92924 CPT Prq Trluml C Athrc 1 Art&/br 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
92990 CPT Revision Of Pulmonary Valve 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
92997 CPT Pul Art Balloon Repr Percut 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
92943 CPT Prq Trluml Revsc Ch Occ Ant 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
C9600 HCPCS Perc Drug-el Cor Stent Sing 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
92928 CPT Prq Tcat Plmt Ntrac St 1 Les 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
C9604 HCPCS Perc D-e Cor Revasc T Cabg S 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
C9783 HCPCS Blind Cor Sinus Reducer Impl 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
37243 CPT Vasc Embolize/occlude Organ 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
37241 CPT Vasc Embolize/occlude Venous 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
37244 CPT Vasc Embolize/occlude Bleed 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
37228 CPT Commercial Fee Schedule 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
37236 CPT Open/perq Place Stent 1st 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
37221 CPT Commercial Fee Schedule 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
37187 CPT Venous Mech Thrombectomy 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
37226 CPT Commercial Fee Schedule 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
36905 CPT Thrmbc/nfs Dialysis Circuit 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
37238 CPT Open/perq Place Stent Same 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
92987 CPT Revision Of Mitral Valve 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
33901 CPT Perq P-art Revsc 1 Nm Nt Bi 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
0505T CPT Ev Fempop Artl Revsc 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
33900 CPT Perq P-art Revsc 1 Nm Nt Uni 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
33903 CPT Perq P-art Revsc 1 Abnor Bi 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
C9764 HCPCS Revasc Intravasc Lithotripsy 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
C9772 HCPCS Revasc Lithotrip Tibi/perone 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
36903 CPT Intro Cath Dialysis Circuit 1 1 — — $67,827.96 $67,827.96 $67,827.96 2025-09-09
81416 CPT Exome Sequence Analysis 1 1 — — $66,163.20 $66,163.20 $66,163.20 2025-09-09
0519T CPT Rmv&rplcmt Pg Wcs Lv Both 1 1 — — $62,593.16 $62,593.16 $62,593.16 2025-09-09
0520T CPT Rmv&rplcmt Pg Wcs Lv Battery 1 1 — — $62,593.16 $62,593.16 $62,593.16 2025-09-09
0517T CPT Insj Wcs Lv Both Compnt Pg 1 1 — — $62,593.16 $62,593.16 $62,593.16 2025-09-09
0516T CPT Insj Wcs Lv Eltrd Only 1 1 — — $62,593.16 $62,593.16 $62,593.16 2025-09-09
33228 CPT Remv&replc Pm Gen Dual Lead 1 1 — — $62,593.16 $62,593.16 $62,593.16 2025-09-09
33224 CPT Insert Pacing Lead & Connect 1 1 — — $62,593.16 $62,593.16 $62,593.16 2025-09-09
33213 CPT Insert Pulse Gen Dual Leads 1 1 — — $62,593.16 $62,593.16 $62,593.16 2025-09-09
33214 CPT Upgrade Of Pacemaker System 1 1 — — $62,593.16 $62,593.16 $62,593.16 2025-09-09
33206 CPT Insert Heart Pm Atrial 1 1 — — $62,593.16 $62,593.16 $62,593.16 2025-09-09
33207 CPT Insert Heart Pm Ventricular 1 1 — — $62,593.16 $62,593.16 $62,593.16 2025-09-09
33208 CPT Insrt Heart Pm Atrial & Vent 1 1 — — $62,593.16 $62,593.16 $62,593.16 2025-09-09
0601T CPT Abltj Ire 1+tumors Open 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
58674 CPT Laps Abltj Uterine Fibroids 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
58673 CPT Laparoscopy Salpingostomy 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
58570 CPT Tlh Uterus 250 G Or Less 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
58554 CPT Laparo-vag Hyst W/t/o Compl 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
58571 CPT Tlh W/t/o 250 G Or Less 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
58552 CPT Laparo-vag Hyst Incl T/o 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
58553 CPT Laparo-vag Hyst Complex 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
58572 CPT Tlh Uterus Over 250 G 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
58546 CPT Laparo-myomectomy Complex 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
58573 CPT Tlh W/t/o Uterus Over 250 G 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
58543 CPT Lsh Uterus Above 250 G 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
58541 CPT Lsh Uterus 250 G Or Less 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
58542 CPT Lsh W/t/o Ut 250 G Or Less 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
57423 CPT Repair Paravag Defect Lap 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
57425 CPT Laparoscopy Surg Colpopexy 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
58544 CPT Lsh W/t/o Uterus Above 250 G 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
55866 CPT Laps Surg Prst8ect Rpbic Rad 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
55867 CPT Laps Surg Prst8ect Smpl Stot 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
50947 CPT Laparo New Ureter/bladder 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
50593 CPT Perc Cryo Ablate Renal Tum 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
50948 CPT Laparo New Ureter/bladder 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
50543 CPT Laparo Partial Nephrectomy 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
50544 CPT Laparoscopy Pyeloplasty 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
50542 CPT Laparo Ablate Renal Mass 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
50541 CPT Laparo Ablate Renal Cyst 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
47564 CPT Laparo Cholecystectomy/explr 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
43770 CPT Lap Place Gastr Adj Device 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
43648 CPT Lap Revise/remv Eltrd Antrum 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
47370 CPT Laparo Ablate Liver Tumor Rf 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
43281 CPT Lap Paraesophag Hern Repair 1 1 — — $62,269.54 $62,269.54 $62,269.54 2025-09-09
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