Hospital

MEMORIAL HOSPITAL, THE

North Conway, NH · CCN 301307 · Rates published

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6,841 distinct procedures filed

9 distinct payers

498,848 rate rows

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

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 — reason	Rows
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

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 13 months old.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

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

Source MRF file	https://sthpiprd.blob.core.windows.net/machine-readable-files/7979/020222156-1760436216_mainehealth_standardcharges.csv
Found on page	https://search.hospitalpriceindex.com/hpi2/machineReadable/mainehealthmemorialhospital/7979
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-09-21
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 $191 outlier · 4097.5×
38240 CPT	Transplt Allo Hct/donor	1	$200,304.85	$200,304.85	$200,304.85	nat. median $28,331 outlier · 7.1×
33231 CPT	Insrt Pulse Gen W/mult Leads	1	$108,587.03	$108,587.03	$108,587.03	nat. median $31,377 outlier · 3.5×
0915T CPT	Insj Perm Ccm-d Sys Pg&eltrd	1	$108,587.03	$108,587.03	$108,587.03	nat. median $35,266 outlier · 3.1×
33249 CPT	Insj/rplcmt Defib W/lead(s)	1	$108,587.03	$108,587.03	$108,587.03	nat. median $32,069 outlier · 3.4×
33270 CPT	Ins/rep Subq Defibrillator	1	$108,587.03	$108,587.03	$108,587.03	nat. median $32,475 outlier · 3.3×
0571T CPT	Insj/rplcmt Icds Ss Eltrd	1	$108,587.03	$108,587.03	$108,587.03	nat. median $32,945 outlier · 3.3×
33264 CPT	Rmvl & Rplcmt Dfb Gen Mlt Ld	1	$108,587.03	$108,587.03	$108,587.03	nat. median $32,779 outlier · 3.3×
0408T CPT	Insj/rplc Cardiac Modulj Sys	1	$108,587.03	$108,587.03	$108,587.03	nat. median $31,369 outlier · 3.5×
69930 CPT	Implant Cochlear Device	1	$107,727.60	$107,727.60	$107,727.60	nat. median $23,645 outlier · 4.6×
61886 CPT	Implant Neurostim Arrays	1	$103,208.77	$103,208.77	$103,208.77	nat. median $23,007 outlier · 4.5×
63685 CPT	Ins/rplc Spi Npg/rcvr Pocket	1	$103,208.77	$103,208.77	$103,208.77	nat. median $21,812 outlier · 4.7×
0268T CPT	Commercial Fee Schedule	1	$103,208.77	$103,208.77	$103,208.77	nat. median $30,474 outlier · 3.4×
33287 CPT	Rmv&rplcmt Phrnc Nrv Stim Pg	1	$103,208.77	$103,208.77	$103,208.77	nat. median $27,599 outlier · 3.7×
64568 CPT	Opn Impltj Crnl Nrv Nea&pg	1	$103,208.77	$103,208.77	$103,208.77	nat. median $27,905 outlier · 3.7×
0674T CPT	Laps Insj Nw/rpcmt Prm Isdss	1	$103,208.77	$103,208.77	$103,208.77	nat. median $29,815 outlier · 3.5×
64582 CPT	Opn Mpltj Hpglsl Nstm Ary Pg	1	$103,208.77	$103,208.77	$103,208.77	nat. median $29,815 outlier · 3.5×
33289 CPT	Tcat Impl Wrls P-art Prs Snr	1	$96,281.83	$96,281.83	$96,281.83	nat. median $28,889 outlier · 3.3×
93653 CPT	Compre Ep Eval Tx Svt	1	$83,086.66	$83,086.66	$83,086.66	nat. median $25,502 outlier · 3.3×
93656 CPT	Compre Ep Eval Abltj Atr Fib	1	$83,086.66	$83,086.66	$83,086.66	nat. median $26,469 outlier · 3.1×
93654 CPT	Compre Ep Eval Tx Vt	1	$83,086.66	$83,086.66	$83,086.66	nat. median $26,477 outlier · 3.1×
0916T CPT	Insj Perm Ccm-d Sys Pg Only	1	$76,021.37	$76,021.37	$76,021.37	nat. median $31,744 outlier · 2.4×
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 $23,924 outlier · 3.2×
0614T CPT	Rmvl&rplcmt Ss Impl Dfb Pg	1	$76,021.37	$76,021.37	$76,021.37	nat. median $24,111 outlier · 3.2×
0409T CPT	Insj/rplc Car Modulj Pls Gn	1	$76,021.37	$76,021.37	$76,021.37	nat. median $24,700 outlier · 3.1×
0923T CPT	Rmvl&rplcmt Perm Ccm-d Pg	1	$76,021.37	$76,021.37	$76,021.37	nat. median $32,259 outlier · 2.4×
33240 CPT	Insrt Pulse Gen W/singl Lead	1	$76,021.37	$76,021.37	$76,021.37	nat. median $23,398 outlier · 3.2×
33262 CPT	Rmvl& Replc Pulse Gen 1 Lead	1	$76,021.37	$76,021.37	$76,021.37	nat. median $23,514 outlier · 3.2×
33230 CPT	Insrt Pulse Gen W/dual Leads	1	$76,021.37	$76,021.37	$76,021.37	nat. median $23,060 outlier · 3.3×
0414T CPT	Rmvl & Rpl Car Modulj Pls Gn	1	$76,021.37	$76,021.37	$76,021.37	nat. median $24,700 outlier · 3.1×
61885 CPT	Insrt/redo Neurostim 1 Array	1	$72,628.43	$72,628.43	$72,628.43	nat. median $18,802 outlier · 3.9×
61891 CPT	Rev/rplcmt Sk-mnt Crnl Nstm	1	$72,628.43	$72,628.43	$72,628.43	nat. median $20,209 outlier · 3.6×
63655 CPT	Implant Neuroelectrodes	1	$72,628.43	$72,628.43	$72,628.43	nat. median $18,350 outlier · 4.0×
64580 CPT	Opn Impltj Nea Neuromuscular	1	$72,628.43	$72,628.43	$72,628.43	nat. median $17,811 outlier · 4.1×
64590 CPT	Ins/rpl Prph Sac/gstr Npg/r	1	$72,628.43	$72,628.43	$72,628.43	nat. median $18,089 outlier · 4.0×
0680T CPT	Insj/rplcmt Pg Only Isdss	1	$72,628.43	$72,628.43	$72,628.43	nat. median $20,981 outlier · 3.5×
0816T CPT	Opn Insj/rplcmt Ins Ptn Subq	1	$72,628.43	$72,628.43	$72,628.43	nat. median $21,090 outlier · 3.4×
0817T CPT	Opn Insj/rplcmt Ins Ptn Subf	1	$72,628.43	$72,628.43	$72,628.43	nat. median $20,981 outlier · 3.5×
54416 CPT	Remv/repl Penis Contain Pros	1	$68,171.97	$68,171.97	$68,171.97	nat. median $19,496 outlier · 3.5×
54411 CPT	Remov/replc Penis Pros Comp	1	$68,171.97	$68,171.97	$68,171.97	nat. median $13,959 outlier · 4.9×
54410 CPT	Remove/replace Penis Prosth	1	$68,171.97	$68,171.97	$68,171.97	nat. median $12,124 outlier · 5.6×
54405 CPT	Insert Multi-comp Penis Pros	1	$68,171.97	$68,171.97	$68,171.97	nat. median $17,094 outlier · 4.0×
53447 CPT	Remove/replace Ur Sphincter	1	$68,171.97	$68,171.97	$68,171.97	nat. median $11,516 outlier · 5.9×
53445 CPT	Insert Uro/ves Nck Sphincter	1	$68,171.97	$68,171.97	$68,171.97	nat. median $14,204 outlier · 4.8×
53444 CPT	Insert Tandem Cuff	1	$68,171.97	$68,171.97	$68,171.97	nat. median $12,622 outlier · 5.4×
54401 CPT	Insert Self-contd Prosthesis	1	$68,171.97	$68,171.97	$68,171.97	nat. median $18,598 outlier · 3.7×
0823T CPT	Tcat Ins 1chmbr Ldls Pm Ra	1	$64,590.73	$64,590.73	$64,590.73	nat. median $20,485 outlier · 3.2×
0825T CPT	Tcat Rmv&rpl1chmb Ldls Pm Ra	1	$64,590.73	$64,590.73	$64,590.73	nat. median $20,485 outlier · 3.2×
0525T CPT	Insj/rplcmt Compl Iims	1	$64,590.73	$64,590.73	$64,590.73	nat. median $12,136 outlier · 5.3×

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.

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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