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

MEMORIAL HOSPITAL, THE

North Conway, NH · CCN 301307 · Rates published

6,841 distinct procedures filed
9 distinct payers
498,848 rate rows
2025-09-09 last MRF observed
Data quality

167,684 of 498,848 rate rows are consumer-grade (33.6%)

331,164 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 330,780
placeholder amount (≤ $0.02) — excluded from medians 156
per-diem day rate — not a per-procedure price 84
percent-of-charges filed in the dollar field — excluded from medians 82
exceeds 10× this hospital's gross charge — excluded from medians 62
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/7979/020222156-1760436216_mainehealth_standardcharges.csv
Found on page https://search.hospitalpriceindex.com/hpi2/machineReadable/mainehealthmemorialhospital/7979
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 5a65a4a73d47eb04… · 112,039,040 bytes · first seen 2026-05-08

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 9 $233.90 $1,577,054.07 $780,977.31 nat. median
$989
outlier · 789.9×
38240
CPT 		Transplt Allo Hct/donor 1 $200,304.85 $200,304.85 $200,304.85 nat. median
$15,979
outlier · 12.5×
33231
CPT 		Insrt Pulse Gen W/mult Leads 1 $108,587.03 $108,587.03 $108,587.03 nat. median
$30,121
outlier · 3.6×
0915T
CPT 		Insj Perm Ccm-d Sys Pg&eltrd 1 $108,587.03 $108,587.03 $108,587.03 nat. median
$32,560
outlier · 3.3×
33249
CPT 		Insj/rplcmt Defib W/lead(s) 1 $108,587.03 $108,587.03 $108,587.03 nat. median
$31,833
outlier · 3.4×
33270
CPT 		Ins/rep Subq Defibrillator 1 $108,587.03 $108,587.03 $108,587.03 nat. median
$32,221
outlier · 3.4×
0571T
CPT 		Insj/rplcmt Icds Ss Eltrd 1 $108,587.03 $108,587.03 $108,587.03 nat. median
$32,221
outlier · 3.4×
33264
CPT 		Rmvl & Rplcmt Dfb Gen Mlt Ld 1 $108,587.03 $108,587.03 $108,587.03 nat. median
$31,873
outlier · 3.4×
0408T
CPT 		Insj/rplc Cardiac Modulj Sys 1 $108,587.03 $108,587.03 $108,587.03 nat. median
$32,221
outlier · 3.4×
69930
CPT 		Implant Cochlear Device 1 $107,727.60 $107,727.60 $107,727.60 nat. median
$29,690
outlier · 3.6×
61886
CPT 		Implant Neurostim Arrays 1 $103,208.77 $103,208.77 $103,208.77 nat. median
$27,109
outlier · 3.8×
63685
CPT 		Ins/rplc Spi Npg/rcvr Pocket 1 $103,208.77 $103,208.77 $103,208.77 nat. median
$21,357
outlier · 4.8×
0268T
CPT 		Commercial Fee Schedule 1 $103,208.77 $103,208.77 $103,208.77 nat. median
$30,333
outlier · 3.4×
33287
CPT 		Rmv&rplcmt Phrnc Nrv Stim Pg 1 $103,208.77 $103,208.77 $103,208.77 nat. median
$29,698
outlier · 3.5×
64568
CPT 		Opn Impltj Crnl Nrv Nea&pg 1 $103,208.77 $103,208.77 $103,208.77 nat. median
$27,591
outlier · 3.7×
0674T
CPT 		Laps Insj Nw/rpcmt Prm Isdss 1 $103,208.77 $103,208.77 $103,208.77 nat. median
$25,200
outlier · 4.1×
64582
CPT 		Opn Mpltj Hpglsl Nstm Ary Pg 1 $103,208.77 $103,208.77 $103,208.77 nat. median
$28,316
outlier · 3.6×
33289
CPT 		Tcat Impl Wrls P-art Prs Snr 1 $96,281.83 $96,281.83 $96,281.83 nat. median
$28,318
outlier · 3.4×
93653
CPT 		Compre Ep Eval Tx Svt 1 $83,086.66 $83,086.66 $83,086.66 nat. median
$26,156
outlier · 3.2×
93656
CPT 		Compre Ep Eval Abltj Atr Fib 1 $83,086.66 $83,086.66 $83,086.66 nat. median
$26,811
outlier · 3.1×
93654
CPT 		Compre Ep Eval Tx Vt 1 $83,086.66 $83,086.66 $83,086.66 nat. median
$26,704
outlier · 3.1×
0916T
CPT 		Insj Perm Ccm-d Sys Pg Only 1 $76,021.37 $76,021.37 $76,021.37 nat. median
$23,439
outlier · 3.2×
0515T
CPT 		Insj Wcs Lv Compl Sys 1 $76,021.37 $76,021.37 $76,021.37 nat. median
$22,512
outlier · 3.4×
33263
CPT 		Rmvl & Rplcmt Dfb Gen 2 Lead 1 $76,021.37 $76,021.37 $76,021.37 nat. median
$23,504
outlier · 3.2×
0614T
CPT 		Rmvl&rplcmt Ss Impl Dfb Pg 1 $76,021.37 $76,021.37 $76,021.37 nat. median
$23,537
outlier · 3.2×
0409T
CPT 		Insj/rplc Car Modulj Pls Gn 1 $76,021.37 $76,021.37 $76,021.37 nat. median
$22,946
outlier · 3.3×
0923T
CPT 		Rmvl&rplcmt Perm Ccm-d Pg 1 $76,021.37 $76,021.37 $76,021.37 nat. median
$22,482
outlier · 3.4×
33240
CPT 		Insrt Pulse Gen W/singl Lead 1 $76,021.37 $76,021.37 $76,021.37 nat. median
$22,137
outlier · 3.4×
33262
CPT 		Rmvl& Replc Pulse Gen 1 Lead 1 $76,021.37 $76,021.37 $76,021.37 nat. median
$23,398
outlier · 3.2×
33230
CPT 		Insrt Pulse Gen W/dual Leads 1 $76,021.37 $76,021.37 $76,021.37 nat. median
$22,360
outlier · 3.4×
0414T
CPT 		Rmvl & Rpl Car Modulj Pls Gn 1 $76,021.37 $76,021.37 $76,021.37 nat. median
$22,718
outlier · 3.3×
61885
CPT 		Insrt/redo Neurostim 1 Array 1 $72,628.43 $72,628.43 $72,628.43 nat. median
$20,011
outlier · 3.6×
61891
CPT 		Rev/rplcmt Sk-mnt Crnl Nstm 1 $72,628.43 $72,628.43 $72,628.43 nat. median
$20,874
outlier · 3.5×
63655
CPT 		Implant Neuroelectrodes 1 $72,628.43 $72,628.43 $72,628.43 nat. median
$19,095
outlier · 3.8×
64580
CPT 		Opn Impltj Nea Neuromuscular 1 $72,628.43 $72,628.43 $72,628.43 nat. median
$18,978
outlier · 3.8×
64590
CPT 		Ins/rpl Prph Sac/gstr Npg/r 1 $72,628.43 $72,628.43 $72,628.43 nat. median
$18,334
outlier · 4.0×
0680T
CPT 		Insj/rplcmt Pg Only Isdss 1 $72,628.43 $72,628.43 $72,628.43 nat. median
$19,911
outlier · 3.6×
0816T
CPT 		Opn Insj/rplcmt Ins Ptn Subq 1 $72,628.43 $72,628.43 $72,628.43 nat. median
$21,683
outlier · 3.3×
0817T
CPT 		Opn Insj/rplcmt Ins Ptn Subf 1 $72,628.43 $72,628.43 $72,628.43 nat. median
$21,444
outlier · 3.4×
54416
CPT 		Remv/repl Penis Contain Pros 1 $68,171.97 $68,171.97 $68,171.97 nat. median
$18,813
outlier · 3.6×
54411
CPT 		Remov/replc Penis Pros Comp 1 $68,171.97 $68,171.97 $68,171.97 nat. median
$18,732
outlier · 3.6×
54410
CPT 		Remove/replace Penis Prosth 1 $68,171.97 $68,171.97 $68,171.97 nat. median
$18,645
outlier · 3.7×
54405
CPT 		Insert Multi-comp Penis Pros 1 $68,171.97 $68,171.97 $68,171.97 nat. median
$18,902
outlier · 3.6×
53447
CPT 		Remove/replace Ur Sphincter 1 $68,171.97 $68,171.97 $68,171.97 nat. median
$15,897
outlier · 4.3×
53445
CPT 		Insert Uro/ves Nck Sphincter 1 $68,171.97 $68,171.97 $68,171.97 nat. median
$16,382
outlier · 4.2×
53444
CPT 		Insert Tandem Cuff 1 $68,171.97 $68,171.97 $68,171.97 nat. median
$14,071
outlier · 4.8×
54401
CPT 		Insert Self-contd Prosthesis 1 $68,171.97 $68,171.97 $68,171.97 nat. median
$18,813
outlier · 3.6×
0823T
CPT 		Tcat Ins 1chmbr Ldls Pm Ra 1 $64,590.73 $64,590.73 $64,590.73 nat. median
$21,351
outlier · 3.0×
0825T
CPT 		Tcat Rmv&rpl1chmb Ldls Pm Ra 1 $64,590.73 $64,590.73 $64,590.73 nat. median
$19,264
outlier · 3.4×
0525T
CPT 		Insj/rplcmt Compl Iims 1 $64,590.73 $64,590.73 $64,590.73 nat. median
$17,680
outlier · 3.7×

Other procedures at this hospital

Browse this hospital's 6,841 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 82 9 $845,569.40 $845,569.40 $233.90 $1,577,054.07 $780,977.31 2025-09-09
38240 CPT Transplt Allo Hct/donor 2 1 — — $200,304.85 $200,304.85 $200,304.85 2025-09-09
33264 CPT Rmvl & Rplcmt Dfb Gen Mlt Ld 2 1 — — $108,587.03 $108,587.03 $108,587.03 2025-09-09
33231 CPT Insrt Pulse Gen W/mult Leads 2 1 — — $108,587.03 $108,587.03 $108,587.03 2025-09-09
0408T CPT Insj/rplc Cardiac Modulj Sys 2 1 — — $108,587.03 $108,587.03 $108,587.03 2025-09-09
0571T CPT Insj/rplcmt Icds Ss Eltrd 2 1 — — $108,587.03 $108,587.03 $108,587.03 2025-09-09
0915T CPT Insj Perm Ccm-d Sys Pg&eltrd 2 1 — — $108,587.03 $108,587.03 $108,587.03 2025-09-09
33249 CPT Insj/rplcmt Defib W/lead(s) 2 1 — — $108,587.03 $108,587.03 $108,587.03 2025-09-09
33270 CPT Ins/rep Subq Defibrillator 2 1 — — $108,587.03 $108,587.03 $108,587.03 2025-09-09
69930 CPT Implant Cochlear Device 2 1 — — $107,727.60 $107,727.60 $107,727.60 2025-09-09
0268T CPT Commercial Fee Schedule 2 1 — — $103,208.77 $103,208.77 $103,208.77 2025-09-09
33287 CPT Rmv&rplcmt Phrnc Nrv Stim Pg 2 1 — — $103,208.77 $103,208.77 $103,208.77 2025-09-09
63685 CPT Ins/rplc Spi Npg/rcvr Pocket 2 1 — — $103,208.77 $103,208.77 $103,208.77 2025-09-09
61886 CPT Implant Neurostim Arrays 2 1 — — $103,208.77 $103,208.77 $103,208.77 2025-09-09
64582 CPT Opn Mpltj Hpglsl Nstm Ary Pg 2 1 — — $103,208.77 $103,208.77 $103,208.77 2025-09-09
64568 CPT Opn Impltj Crnl Nrv Nea&pg 2 1 — — $103,208.77 $103,208.77 $103,208.77 2025-09-09
0674T CPT Laps Insj Nw/rpcmt Prm Isdss 2 1 — — $103,208.77 $103,208.77 $103,208.77 2025-09-09
33289 CPT Tcat Impl Wrls P-art Prs Snr 2 1 — — $96,281.83 $96,281.83 $96,281.83 2025-09-09
93656 CPT Compre Ep Eval Abltj Atr Fib 2 1 — — $83,086.66 $83,086.66 $83,086.66 2025-09-09
93653 CPT Compre Ep Eval Tx Svt 2 1 — — $83,086.66 $83,086.66 $83,086.66 2025-09-09
93654 CPT Compre Ep Eval Tx Vt 2 1 — — $83,086.66 $83,086.66 $83,086.66 2025-09-09
0515T CPT Insj Wcs Lv Compl Sys 2 1 — — $76,021.37 $76,021.37 $76,021.37 2025-09-09
0916T CPT Insj Perm Ccm-d Sys Pg Only 2 1 — — $76,021.37 $76,021.37 $76,021.37 2025-09-09
33230 CPT Insrt Pulse Gen W/dual Leads 2 1 — — $76,021.37 $76,021.37 $76,021.37 2025-09-09
33262 CPT Rmvl& Replc Pulse Gen 1 Lead 2 1 — — $76,021.37 $76,021.37 $76,021.37 2025-09-09
0923T CPT Rmvl&rplcmt Perm Ccm-d Pg 2 1 — — $76,021.37 $76,021.37 $76,021.37 2025-09-09
0409T CPT Insj/rplc Car Modulj Pls Gn 2 1 — — $76,021.37 $76,021.37 $76,021.37 2025-09-09
33240 CPT Insrt Pulse Gen W/singl Lead 2 1 — — $76,021.37 $76,021.37 $76,021.37 2025-09-09
0614T CPT Rmvl&rplcmt Ss Impl Dfb Pg 2 1 — — $76,021.37 $76,021.37 $76,021.37 2025-09-09
0414T CPT Rmvl & Rpl Car Modulj Pls Gn 2 1 — — $76,021.37 $76,021.37 $76,021.37 2025-09-09
33263 CPT Rmvl & Rplcmt Dfb Gen 2 Lead 2 1 — — $76,021.37 $76,021.37 $76,021.37 2025-09-09
61885 CPT Insrt/redo Neurostim 1 Array 2 1 — — $72,628.43 $72,628.43 $72,628.43 2025-09-09
61891 CPT Rev/rplcmt Sk-mnt Crnl Nstm 2 1 — — $72,628.43 $72,628.43 $72,628.43 2025-09-09
0816T CPT Opn Insj/rplcmt Ins Ptn Subq 2 1 — — $72,628.43 $72,628.43 $72,628.43 2025-09-09
0817T CPT Opn Insj/rplcmt Ins Ptn Subf 2 1 — — $72,628.43 $72,628.43 $72,628.43 2025-09-09
63655 CPT Implant Neuroelectrodes 2 1 — — $72,628.43 $72,628.43 $72,628.43 2025-09-09
64590 CPT Ins/rpl Prph Sac/gstr Npg/r 2 1 — — $72,628.43 $72,628.43 $72,628.43 2025-09-09
0680T CPT Insj/rplcmt Pg Only Isdss 2 1 — — $72,628.43 $72,628.43 $72,628.43 2025-09-09
64580 CPT Opn Impltj Nea Neuromuscular 2 1 — — $72,628.43 $72,628.43 $72,628.43 2025-09-09
53445 CPT Insert Uro/ves Nck Sphincter 2 1 — — $68,171.97 $68,171.97 $68,171.97 2025-09-09
54416 CPT Remv/repl Penis Contain Pros 2 1 — — $68,171.97 $68,171.97 $68,171.97 2025-09-09
54401 CPT Insert Self-contd Prosthesis 2 1 — — $68,171.97 $68,171.97 $68,171.97 2025-09-09
53447 CPT Remove/replace Ur Sphincter 2 1 — — $68,171.97 $68,171.97 $68,171.97 2025-09-09
54411 CPT Remov/replc Penis Pros Comp 2 1 — — $68,171.97 $68,171.97 $68,171.97 2025-09-09
54405 CPT Insert Multi-comp Penis Pros 2 1 — — $68,171.97 $68,171.97 $68,171.97 2025-09-09
53444 CPT Insert Tandem Cuff 2 1 — — $68,171.97 $68,171.97 $68,171.97 2025-09-09
54410 CPT Remove/replace Penis Prosth 2 1 — — $68,171.97 $68,171.97 $68,171.97 2025-09-09
0525T CPT Insj/rplcmt Compl Iims 2 1 — — $64,590.73 $64,590.73 $64,590.73 2025-09-09
0802T CPT Tcat Rmv&rpl2chmb Ldls Pm Ra 2 1 — — $64,590.73 $64,590.73 $64,590.73 2025-09-09
0803T CPT Tcat Rmv&rpl2chmb Ldls Pm Rv 2 1 — — $64,590.73 $64,590.73 $64,590.73 2025-09-09
0801T CPT Tcat Rmv&rpl 2chmbr Ldls Pm 2 1 — — $64,590.73 $64,590.73 $64,590.73 2025-09-09
0795T CPT Tcat Ins 2chmbr Ldls Pm Cmpl 2 1 — — $64,590.73 $64,590.73 $64,590.73 2025-09-09
33229 CPT Remv&replc Pm Gen Mult Leads 2 1 — — $64,590.73 $64,590.73 $64,590.73 2025-09-09
33221 CPT Insert Pulse Gen Mult Leads 2 1 — — $64,590.73 $64,590.73 $64,590.73 2025-09-09
0823T CPT Tcat Ins 1chmbr Ldls Pm Ra 2 1 — — $64,590.73 $64,590.73 $64,590.73 2025-09-09
33274 CPT Tcat Insj/rpl Perm Ldls Pm 2 1 — — $64,590.73 $64,590.73 $64,590.73 2025-09-09
0825T CPT Tcat Rmv&rpl1chmb Ldls Pm Ra 2 1 — — $64,590.73 $64,590.73 $64,590.73 2025-09-09
0797T CPT Tcat Ins 2chmbr Ldls Pm Rv 2 1 — — $64,590.73 $64,590.73 $64,590.73 2025-09-09
0796T CPT Tcat Ins 2chmbr Ldls Pm Ra 2 1 — — $64,590.73 $64,590.73 $64,590.73 2025-09-09
22867 CPT Insj Stablj Dev W/dcmprn 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
C8003 HCPCS Imp Extar Knee Shck Absrb 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
24361 CPT Reconstruct Elbow Joint 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
24363 CPT Replace Elbow Joint 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
20696 CPT App Mltpln Uni Xtrnl Fix 1st 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
28705 CPT Arthrodesis Pantalar 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
22630 CPT Arthrd Pst Tq 1ntrspc Lum 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
25442 CPT Arthrp W/prostc Dstl Ulna 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
22612 CPT Arthrd Pst Tq 1ntrspc Lumbar 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
21243 CPT Reconstruction Of Jaw Joint 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
27702 CPT Reconstruct Ankle Joint 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
22633 CPT Arthrd Cmbn 1ntrspc Lumbar 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
23616 CPT Optx Prx Hmrl Fx Fix Rpr Rpl 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
24371 CPT Revise Reconst Elbow Joint 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
27278 CPT Arthrd Si Jt Plmt Iartic Dev 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
22856 CPT Tot Disc Arthrp 1ntrspc Crv 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
25446 CPT Arthrp W/prostc Dst Rds&crps 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
27279 CPT Arthrd Si Jt Plmt Tartclr Dv 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
23472 CPT Reconstruct Shoulder Joint 2 1 — — $62,283.91 $62,283.91 $62,283.91 2025-09-09
0238T CPT Trluml Perip Athrc Iliac Art 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
0793T CPT Prq Tcat Thrm Ablt Nrv P-art 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
C9602 HCPCS Perc D-e Cor Stent Ather S 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
C9775 HCPCS Revasc Lith-sten-ath Tib/per 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
93582 CPT Perq Transcath Closure Pda 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
93591 CPT Perq Transcath Cls Aortic 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
92933 CPT Prq Trlml C Athrc St Angiop1 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
C9607 HCPCS Perc D-e Cor Revasc Chro Sin 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
C9766 HCPCS Revasc Intra Lithotrip-ather 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
0981T CPT Tcat Impl Wrls Ivc Snr 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
C9797 HCPCS Vasc Emb/occ W/prs Cath 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
37231 CPT Commercial Fee Schedule 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
37230 CPT Commercial Fee Schedule 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
37227 CPT Commercial Fee Schedule 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
37242 CPT Vasc Embolize/occlude Artery 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
37184 CPT Prim Art M-thrmbc 1st Vsl 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
37225 CPT Commercial Fee Schedule 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
0645T CPT Tcat Impltj C Sins Rdctj Dev 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
93580 CPT Transcath Closure Of Asd 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
36836 CPT Prq Av Fstl Crtj Uxtr 1 Acs 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
33902 CPT Perq P-art Revsc 1 Abnor Uni 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
0632T CPT Perq Tcat US Abltj Nrv P-art 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
36906 CPT Thrmbc/nfs Dialysis Circuit 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
C9773 HCPCS Revasc Lithotr-stent Tib/per 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
37229 CPT Commercial Fee Schedule 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
C9774 HCPCS Revasc Lithotr-ather Tib/per 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
36837 CPT Prq Av Fstl Crt Uxtr Sep Acs 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
C9767 HCPCS Revasc Lithotrip-stent-ather 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
C9765 HCPCS Revasc Intra Lithotrip-stent 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
93590 CPT Perq Transcath Cls Mitral 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
93581 CPT Transcath Closure Of Vsd 2 1 — — $60,816.31 $60,816.31 $60,816.31 2025-09-09
62360 CPT Insert Spine Infusion Device 2 1 — — $59,859.18 $59,859.18 $59,859.18 2025-09-09
62361 CPT Implant Spine Infusion Pump 2 1 — — $59,859.18 $59,859.18 $59,859.18 2025-09-09
62362 CPT Implant Spine Infusion Pump 2 1 — — $59,859.18 $59,859.18 $59,859.18 2025-09-09
C2616 HCPCS Brachytx, Non-str,yttrium-90 2 1 — — $59,219.03 $59,219.03 $59,219.03 2025-09-09
19357 CPT Tiss Xpndr Plmt Brst Rcnstj 2 1 — — $58,925.21 $58,925.21 $58,925.21 2025-09-09
J9309 HCPCS Polatuzumab Vedotin-piiq 140 Mg/7ml IV (wet Solr Vial) 42 9 $66,787.05 $66,787.05 $389.31 $62,779.83 $57,817.55 2025-09-09
66683 CPT Implantation Iris Prosthesis 2 1 — — $55,599.65 $55,599.65 $55,599.65 2025-09-09
0308T CPT Insj Ocular Telescope Prosth 2 1 — — $55,599.65 $55,599.65 $55,599.65 2025-09-09
67027 CPT Implant Eye Drug System 2 1 — — $52,038.01 $52,038.01 $52,038.01 2025-09-09
65770 CPT Keratoprosthesis 2 1 — — $48,395.41 $48,395.41 $48,395.41 2025-09-09
55882 CPT Ablt Trurl Prst8 Tis Trnsdcr 2 1 — — $44,003.09 $44,003.09 $44,003.09 2025-09-09
54417 CPT Remv/replc Penis Pros Compl 2 1 — — $44,003.09 $44,003.09 $44,003.09 2025-09-09
53451 CPT Tprnl Balo Cntnc Dev Bi 2 1 — — $44,003.09 $44,003.09 $44,003.09 2025-09-09
54400 CPT Insert Semi-rigid Prosthesis 2 1 — — $44,003.09 $44,003.09 $44,003.09 2025-09-09
53440 CPT Male Sling Procedure 2 1 — — $44,003.09 $44,003.09 $44,003.09 2025-09-09
27130 CPT Total Hip Arthroplasty 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24435 CPT Rpr Non/mal Hum With Agrft 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27827 CPT Treat Lower Leg Fracture 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27709 CPT Osteotomy Tibia & Fibula 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24410 CPT Mlt Osteot Rlgnm Imed Rd Hum 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
22869 CPT Insj Stablj Dev Without Dcmprn 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27870 CPT Fusion Of Ankle Joint Open 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
23470 CPT Reconstruct Shoulder Joint 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24365 CPT Reconstruct Head Of Radius 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
28730 CPT Fusion Of Foot Bones 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
23473 CPT Revis Reconst Shoulder Joint 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
28735 CPT Fusion Of Foot Bones 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
28737 CPT Revision Of Foot Bones 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24587 CPT Optx Partclr Fx&/dslc Elbw W 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
C9734 HCPCS U/s Trtmt, Not Leiomyomata 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
23680 CPT Optx Sho Dislc Neck Fx Fixj 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
23802 CPT Arthrd Glenohumeral Jt W/grf 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24666 CPT Optx Radial Head/nck Fx Rplc 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
C9757 HCPCS Spine Device Implant Surgery 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24498 CPT Proph Tx W/wo Mthylmthcrylt 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
0737T CPT Xenograft Impltj Artclr Surf 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24545 CPT Optx Hum Fx Wo Ntrcndylr Xtn 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24802 CPT Arthrd Elbow Jt Autog Graft 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24366 CPT Reconstruct Head Of Radius 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
C9781 HCPCS Arthro/shoul Surg; W/spacer 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24516 CPT Tx Humrl Shaft Fx Imed Implt 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
25491 CPT Prophylactic Tx Ulna 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24370 CPT Revise Reconst Elbow Joint 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24579 CPT Optx Humrl Cndylr Fracture 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
25441 CPT Arthrp W/prostc Dstl Rds 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
20982 CPT Ablate Bone Tumor(s) Perq 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
25810 CPT Arthrd Wrst Iliac/oth Agrft 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
25444 CPT Arthrp W/prostc Lunate 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
23615 CPT Optx Prox Humrl Fx W/int Fix 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24586 CPT Optx Partclr Fx&/dislc Elbow 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
23491 CPT Reinforce Shoulder Bones 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27356 CPT Remove Femur Lesion/graft 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
69730 CPT Rplc Oi Implt Sk Tc Esp>=100 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
0629T CPT Perq Njx Algc CT Lmbr 1st 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
0627T CPT Perq Njx Algc Fluor Lmbr 1st 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
23485 CPT Revision Of Collar Bone 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
20692 CPT Appl Mltpln Uni Ext Fixj Sys 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
69719 CPT Rplcm Oi Implt Sk Tc Esp<100 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24362 CPT Reconstruct Elbow Joint 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
69729 CPT Impl Oi Implt Sk Tc Esp>=100 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
22551 CPT Arthrd Ant Ntrbdy Cervical 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27440 CPT Revision Of Knee Joint 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
22554 CPT Arthrd Ant Ntrbd Min Dsc Crv 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27428 CPT Reconstruction Knee 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
69716 CPT Impl Oi Implt Sk Tc Esp<100 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24546 CPT Optx Hum Fx W/ntrcndylr Xtn 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24515 CPT Optx Humrl Shft Fx Plate/scr 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24346 CPT Reconstruct Elbow Med Ligmnt 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
25365 CPT Revise Radius & Ulna 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
64628 CPT Trml Dstrj Ios Bvn 1st 2 L/s 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
29907 CPT Subtalar Arthro W/fusion 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27415 CPT Osteochondral Knee Allograft 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
29856 CPT Tibial Arthroscopy/surgery 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
29867 CPT Allgrft Implnt Knee W/scope 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
29889 CPT Arthrs Aid Pcl Rpr/agmntj 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
28715 CPT Arthrodesis Triple 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
25391 CPT Lengthen Radius Or Ulna 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
28725 CPT Arthrodesis Subtalar 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
69714 CPT Impl Oi Implt Skull Perq Esp 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24430 CPT Rpr Non/mal Humerus Wo Graft 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27871 CPT Fusion Of Tibiofibular Joint 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27828 CPT Treat Lower Leg Fracture 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
28297 CPT Cor Hlx Vlgs Jt Arthrd 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27758 CPT Treatment Of Tibia Fracture 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27759 CPT Treatment Of Tibia Fracture 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
28320 CPT Repair Of Foot Bones 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
28420 CPT Optx Calcaneal Fx W/bone Grf 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27443 CPT Revision Of Knee Joint 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27442 CPT Revision Of Knee Joint 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27446 CPT Revision Of Knee Joint 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27429 CPT Reconstruction Knee 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27438 CPT Revise Kneecap With Implant 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27447 CPT Total Knee Arthroplasty 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
27441 CPT Revision Of Knee Joint 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
24575 CPT Optx Humeral Epcndylr Fx 2 1 — — $43,577.69 $43,577.69 $43,577.69 2025-09-09
J9306 HCPCS Pertuzumab 420 Mg/14ml IV Soln 42 9 $48,950.70 $48,950.70 $47.78 $46,013.66 $42,376.62 2025-09-09
61888 CPT Revise/remove Neuroreceiver 2 1 — — $42,234.79 $42,234.79 $42,234.79 2025-09-09
61715 CPT Mrgfus Strtctc Ablt Trgt Icr 2 1 — — $42,234.79 $42,234.79 $42,234.79 2025-09-09
64583 CPT Rev/rplct Hpglsl Nstm Ary Pg 2 1 — — $42,234.79 $42,234.79 $42,234.79 2025-09-09
64575 CPT Opn Impltj Nea Perph Nerve 2 1 — — $42,234.79 $42,234.79 $42,234.79 2025-09-09
64569 CPT Revise/repl Vagus N Eltrd 2 1 — — $42,234.79 $42,234.79 $42,234.79 2025-09-09
63664 CPT Revise Spine Eltrd Plate 2 1 — — $42,234.79 $42,234.79 $42,234.79 2025-09-09
64553 CPT Implant Neuroelectrodes 2 1 — — $42,234.79 $42,234.79 $42,234.79 2025-09-09
0784T CPT Ins/rplmt Eltrd Ra Spi Nstim 2 1 — — $42,234.79 $42,234.79 $42,234.79 2025-09-09
64596 CPT Ins/rplcmt Prq Eltrd Ra Pn 1 2 1 — — $42,234.79 $42,234.79 $42,234.79 2025-09-09
43647 CPT Lap Impl Electrode Antrum 2 1 — — $42,234.79 $42,234.79 $42,234.79 2025-09-09
0675T CPT Laps Insj Nw/rpcmt Isdss 1ld 2 1 — — $42,234.79 $42,234.79 $42,234.79 2025-09-09
33288 CPT Rmv&rplcmt Phrnc Nrv Stim Ld 2 1 — — $42,234.79 $42,234.79 $42,234.79 2025-09-09
0236T CPT Trluml Perip Athrc Abd Aorta 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
61626 CPT Tcat Perm Occls/embol Noncns 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
61623 CPT Evasc Temp Balo Artl Occ H/n 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
92937 CPT Prq Trluml Revsc Cab Grf 1 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
0234T CPT Trluml Perip Athrc Renal Art 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
92943 CPT Prq Trluml Revsc Ch Occ Ant 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
C9604 HCPCS Perc D-e Cor Revasc T Cabg S 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
C8004 HCPCS Sim Ang W/prs Cath Rad Emb 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
C9600 HCPCS Perc Drug-el Cor Stent Sing 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
92987 CPT Revision Of Mitral Valve 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
C9764 HCPCS Revasc Intravasc Lithotripsy 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
0505T CPT Ev Fempop Artl Revsc 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
C9783 HCPCS Blind Cor Sinus Reducer Impl 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
37244 CPT Vasc Embolize/occlude Bleed 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
37243 CPT Vasc Embolize/occlude Organ 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
37236 CPT Open/perq Place Stent 1st 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
37238 CPT Open/perq Place Stent Same 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
37241 CPT Vasc Embolize/occlude Venous 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
92997 CPT Pul Art Balloon Repr Percut 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
37228 CPT Commercial Fee Schedule 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
37187 CPT Venous Mech Thrombectomy 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
36905 CPT Thrmbc/nfs Dialysis Circuit 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
37221 CPT Commercial Fee Schedule 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
36903 CPT Intro Cath Dialysis Circuit 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
33903 CPT Perq P-art Revsc 1 Abnor Bi 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
33900 CPT Perq P-art Revsc 1 Nm Nt Uni 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
33901 CPT Perq P-art Revsc 1 Nm Nt Bi 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
37226 CPT Commercial Fee Schedule 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
92924 CPT Prq Trluml C Athrc 1 Art&/br 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
92928 CPT Prq Tcat Plmt Ntrac St 1 Les 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
92990 CPT Revision Of Pulmonary Valve 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
0237T CPT Trluml Perip Athrc Brchiocph 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
C9772 HCPCS Revasc Lithotrip Tibi/perone 2 1 — — $38,408.54 $38,408.54 $38,408.54 2025-09-09
0520T CPT Rmv&rplcmt Pg Wcs Lv Battery 2 1 — — $35,444.26 $35,444.26 $35,444.26 2025-09-09
0519T CPT Rmv&rplcmt Pg Wcs Lv Both 2 1 — — $35,444.26 $35,444.26 $35,444.26 2025-09-09
0517T CPT Insj Wcs Lv Both Compnt Pg 2 1 — — $35,444.26 $35,444.26 $35,444.26 2025-09-09
0516T CPT Insj Wcs Lv Eltrd Only 2 1 — — $35,444.26 $35,444.26 $35,444.26 2025-09-09
33228 CPT Remv&replc Pm Gen Dual Lead 2 1 — — $35,444.26 $35,444.26 $35,444.26 2025-09-09
33224 CPT Insert Pacing Lead & Connect 2 1 — — $35,444.26 $35,444.26 $35,444.26 2025-09-09
33214 CPT Upgrade Of Pacemaker System 2 1 — — $35,444.26 $35,444.26 $35,444.26 2025-09-09
33207 CPT Insert Heart Pm Ventricular 2 1 — — $35,444.26 $35,444.26 $35,444.26 2025-09-09
33208 CPT Insrt Heart Pm Atrial & Vent 2 1 — — $35,444.26 $35,444.26 $35,444.26 2025-09-09
33206 CPT Insert Heart Pm Atrial 2 1 — — $35,444.26 $35,444.26 $35,444.26 2025-09-09
33213 CPT Insert Pulse Gen Dual Leads 2 1 — — $35,444.26 $35,444.26 $35,444.26 2025-09-09
58673 CPT Laparoscopy Salpingostomy 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
58674 CPT Laps Abltj Uterine Fibroids 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
58573 CPT Tlh W/t/o Uterus Over 250 G 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
58572 CPT Tlh Uterus Over 250 G 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
58554 CPT Laparo-vag Hyst W/t/o Compl 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
58570 CPT Tlh Uterus 250 G Or Less 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
58571 CPT Tlh W/t/o 250 G Or Less 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
58544 CPT Lsh W/t/o Uterus Above 250 G 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
58542 CPT Lsh W/t/o Ut 250 G Or Less 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
58543 CPT Lsh Uterus Above 250 G 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
58546 CPT Laparo-myomectomy Complex 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
58552 CPT Laparo-vag Hyst Incl T/o 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
58541 CPT Lsh Uterus 250 G Or Less 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
57423 CPT Repair Paravag Defect Lap 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
58553 CPT Laparo-vag Hyst Complex 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
57425 CPT Laparoscopy Surg Colpopexy 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
55866 CPT Laps Surg Prst8ect Rpbic Rad 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
55867 CPT Laps Surg Prst8ect Smpl Stot 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
50948 CPT Laparo New Ureter/bladder 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
50593 CPT Perc Cryo Ablate Renal Tum 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
50947 CPT Laparo New Ureter/bladder 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
50541 CPT Laparo Ablate Renal Cyst 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
50542 CPT Laparo Ablate Renal Mass 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
50543 CPT Laparo Partial Nephrectomy 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
50544 CPT Laparoscopy Pyeloplasty 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
47554 CPT Biliary Endoscopy Thru Skin 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
47383 CPT Perq Abltj Lvr Cryoablation 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
47556 CPT Biliary Endoscopy Thru Skin 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
47371 CPT Laparo Ablate Liver Cryosurg 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
47564 CPT Laparo Cholecystectomy/explr 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
43281 CPT Lap Paraesophag Hern Repair 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
43280 CPT Laparoscopy Fundoplasty 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
43282 CPT Lap Paraesoph Her Rpr W/mesh 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
38573 CPT Laps Pelvic Lymphadec 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
43210 CPT Egd Esophagogastrc Fndoplsty 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
43284 CPT Laps Esophgl Sphnctr Agmntj 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
38571 CPT Laparoscopy Lymphadenectomy 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
38572 CPT Laparoscopy Lymphadenectomy 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
38120 CPT Laparoscopy Splenectomy 2 1 — — $35,261.01 $35,261.01 $35,261.01 2025-09-09
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