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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

OKLAHOMA CENTER FOR ORTHOPAEDIC & MULTI-SP

Oklahoma City, OK · CCN 370212 · Rates published

10,884 distinct procedures filed
6 distinct payers
140,363 rate rows
2026-04-14 last MRF observed
Data quality

101,460 of 140,363 rate rows are consumer-grade (72.3%)

38,903 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 28,417
template filing: same amount across many unrelated codes — excluded 9,758
exceeds 10× this hospital's gross charge — excluded from medians 353
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 313
per-diem day rate — not a per-procedure price 62
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://mrfs.hyvehealthcare.com/USPI/731623669_oklahoma-center-for-orthopedic-&-multi-specialty-surgery_standardcharges.json
Found on page https://ocomhospital.com/cms-hpt.txt
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-11
Content fingerprint 7aa3ec8d0307afbf… · 31,686,735 bytes · first seen 2026-05-17

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
77371
CPT 		Srs Multisource 2 $5,454.00 $41,468.00 $38,250.00 nat. median
$7,491
outlier · 5.1×
221
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$35,297
0.9× median
225
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$2,024
outlier · 16.5×
228
MS_DRG 		Other Cardiothoracic Procedures With Mcc 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$35,725
0.9× median
232
MS_DRG 		Coronary Bypass With Ptca Without Mcc 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$43,803
0.8× median
222
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$2,024
outlier · 16.5×
215
MS_DRG 		Other Heart Assist System Implant 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$73,023
outlier · 0.5×
217
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$47,458
0.7× median
216
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$69,822
outlier · 0.5×
229
MS_DRG 		Other Cardiothoracic Procedures Without Mcc 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$22,934
1.5× median
227
MS_DRG 		Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$2,024
outlier · 16.5×
231
MS_DRG 		Coronary Bypass With Ptca With Mcc 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$60,505
0.6× median
224
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$2,024
outlier · 16.5×
218
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$45,446
0.7× median
226
MS_DRG 		Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$2,024
outlier · 16.5×
223
MS_DRG 		Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$2,024
outlier · 16.5×
220
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$38,832
0.9× median
219
MS_DRG 		Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 $33,325.00 $33,325.00 $33,325.00 nat. median
$55,923
0.6× median
77372
CPT 		Srs Linear Based 3 $1,237.38 $41,468.00 $21,852.00 nat. median
$7,667
outlier · 2.9×
248
MS_DRG 		Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4… 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$2,024
outlier · 7.2×
242
MS_DRG 		Permanent Cardiac Pacemaker Implant With Mcc 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$23,970
0.6× median
243
MS_DRG 		Permanent Cardiac Pacemaker Implant With Cc 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$16,535
0.9× median
247
MS_DRG 		Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$2,024
outlier · 7.2×
249
MS_DRG 		Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent Without Mcc 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$2,024
outlier · 7.2×
253
MS_DRG 		Other Vascular Procedures With Cc 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$19,118
0.8× median
246
MS_DRG 		Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$2,024
outlier · 7.2×
254
MS_DRG 		Other Vascular Procedures Without Cc/mcc 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$13,169
1.1× median
244
MS_DRG 		Permanent Cardiac Pacemaker Implant Without Cc/mcc 1 $14,485.00 $14,485.00 $14,485.00 nat. median
$13,640
1.1× median
C9770
HCPCS 		Vitrec/mech Pars, Subret Inj 1 $13,461.00 $13,461.00 $13,461.00 nat. median
$6,582
outlier · 2.0×
C9771
HCPCS 		Nsl/sins Cryo Post Nasal Tis 1 $13,461.00 $13,461.00 $13,461.00 nat. median
$5,608
outlier · 2.4×
788
MS_DRG 		Cesarean Section Without Sterilization Without Cc/mcc 1 $12,053.00 $12,053.00 $12,053.00 nat. median
$6,949
1.7× median
786
MS_DRG 		Cesarean Section Without Sterilization With Mcc 1 $12,053.00 $12,053.00 $12,053.00 nat. median
$11,737
1.0× median
787
MS_DRG 		Cesarean Section Without Sterilization With Cc 1 $12,053.00 $12,053.00 $12,053.00 nat. median
$8,114
1.5× median
785
MS_DRG 		Cesarean Section With Sterilization Without Cc/mcc 1 $12,053.00 $12,053.00 $12,053.00 nat. median
$6,801
1.8× median
783
MS_DRG 		Cesarean Section With Sterilization With Mcc 1 $12,053.00 $12,053.00 $12,053.00 nat. median
$13,196
0.9× median
784
MS_DRG 		Cesarean Section With Sterilization With Cc 1 $12,053.00 $12,053.00 $12,053.00 nat. median
$7,818
1.5× median
418
MS_DRG 		Laparoscopic Cholecystectomy Without C.d.e. With Cc 1 $10,715.00 $10,715.00 $10,715.00 nat. median
$12,668
0.8× median
419
MS_DRG 		Laparoscopic Cholecystectomy Without C.d.e. Without Cc/mcc 1 $10,715.00 $10,715.00 $10,715.00 nat. median
$10,316
1.0× median
417
MS_DRG 		Laparoscopic Cholecystectomy Without C.d.e. With Mcc 1 $10,715.00 $10,715.00 $10,715.00 nat. median
$17,369
0.6× median
287
MS_DRG 		Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc 1 $8,385.00 $8,385.00 $8,385.00 nat. median
$8,225
1.0× median
286
MS_DRG 		Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc 1 $8,385.00 $8,385.00 $8,385.00 nat. median
$16,072
0.5× median
81416
CPT 		Exome Sequence Analysis 2 $5,454.00 $10,800.00 $8,127.00 nat. median
$12,000
0.7× median
C7562
HCPCS 		Catheter Placement In Coronary Artery(s) For Coronary Angiography, Including Int… 1 $6,016.00 $9,621.00 $7,818.50 nat. median
$2,182
outlier · 3.6×
915T
OTHER 		Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 1 $5,511.00 $8,814.00 $7,162.50 nat. median
$48,103
outlier · 0.1×
933T
OTHER 		Transcatheter Implantation Of Wireless Left Atrial Pressure Sensor For Long-term… 1 $5,511.00 $8,814.00 $7,162.50 nat. median
$6,850
1.0× median
C8005
HCPCS 		Bronchoscopy, Rigid Or Flexible, Non-thermal Transbronchial Ablation Of Lesion(s… 1 $5,511.00 $8,814.00 $7,162.50 nat. median
$17,552
outlier · 0.4×
C7564
HCPCS 		Percutaneous Transluminal Mechanical Thrombectomy, Vein(s), Including Intraproce… 1 $5,511.00 $8,814.00 $7,162.50 nat. median
$4,176
1.7× median
C7563
HCPCS 		Transluminal Balloon Angioplasty (except Lower Extremity Artery(ies) For Occlusi… 1 $5,511.00 $8,814.00 $7,162.50 nat. median
$3,188
outlier · 2.2×
913T
OTHER 		Percutaneous Transcatheter Therapeutic Drug Delivery By Intracoronary Drug-deliv… 1 $5,511.00 $8,814.00 $7,162.50 nat. median
$17,691
outlier · 0.4×
36837
CPT 		Prq Av Fstl Crt Uxtr Sep Acs 3 $5,454.00 $8,814.00 $6,905.50 nat. median
$17,943
outlier · 0.4×

Other procedures at this hospital

Browse this hospital's 10,884 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
             
15013 CPT Preparation Of Skin Cell Suspension Autograft, Requiring Enzymatic Processing, M… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
15014 CPT Preparation Of Skin Cell Suspension Autograft, Requiring Enzymatic Processing, M… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
15171 CPT Acellular Dermal Replacement Trunk 100 Sq/cm Or Less 15170 1 1 $2,069.00 $558.63 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
15175 CPT Acellular Dermal Replacement Facial/genitalia/hands/feet 15175 1 1 $2,069.00 $558.63 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
15850 CPT Removal Of Sutures Under Anesthesia By Same Surgeon 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
19324 CPT Breast Enlargement Without A Prosthesis 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
19366 CPT Plastic Surgery To Reconstruct Breast With Other Technique 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
20926 CPT Tissue Grafts-other (eg. Paratenon/ Fat/dermis) 20926 1 1 $3,711.00 $1,001.97 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
215 MS_DRG Other Heart Assist System Implant 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
216 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
217 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
218 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheteriza… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
219 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
220 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
221 MS_DRG Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheter… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
222 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
223 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
224 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
225 MS_DRG Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Sh… 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
226 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
227 MS_DRG Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
228 MS_DRG Other Cardiothoracic Procedures With Mcc 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
22851 CPT Application Interverteral Device 22851 1 1 $8,637.00 $2,331.99 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
231 MS_DRG Coronary Bypass With Ptca With Mcc 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
232 MS_DRG Coronary Bypass With Ptca Without Mcc 1 1 — — $33,325.00 $33,325.00 $33,325.00 2026-04-14
242 MS_DRG Permanent Cardiac Pacemaker Implant With Mcc 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
243 MS_DRG Permanent Cardiac Pacemaker Implant With Cc 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
244 MS_DRG Permanent Cardiac Pacemaker Implant Without Cc/mcc 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
246 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent With Mcc Or 4+ Ar… 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
247 MS_DRG Percutaneous Cardiovascular Procedures With Drug-eluting Stent Without Mcc 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
248 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent With Mcc Or 4… 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
249 MS_DRG Percutaneous Cardiovascular Procedures With Non-drug-eluting Stent Without Mcc 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
253 MS_DRG Other Vascular Procedures With Cc 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
254 MS_DRG Other Vascular Procedures Without Cc/mcc 1 1 — — $14,485.00 $14,485.00 $14,485.00 2026-04-14
286 MS_DRG Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc 1 1 — — $8,385.00 $8,385.00 $8,385.00 2026-04-14
287 MS_DRG Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc 1 1 — — $8,385.00 $8,385.00 $8,385.00 2026-04-14
36836 CPT Prq Av Fstl Crtj Uxtr 1 Acs 4 3 — — $5,454.00 $8,814.00 $6,905.50 2026-04-14
36837 CPT Prq Av Fstl Crt Uxtr Sep Acs 4 3 — — $5,454.00 $8,814.00 $6,905.50 2026-04-14
417 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Mcc 1 1 — — $10,715.00 $10,715.00 $10,715.00 2026-04-14
418 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Cc 1 1 — — $10,715.00 $10,715.00 $10,715.00 2026-04-14
419 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. Without Cc/mcc 1 1 — — $10,715.00 $10,715.00 $10,715.00 2026-04-14
49190 CPT Excision Or Destruction, Open, Intra-abdominal (ie, Peritoneal, Mesenteric, Retr… 3 2 — — $3,683.00 $5,946.00 $5,454.00 2026-04-14
49561 CPT Repair Of Trapped Incisional Or Abdominal Hernia 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49565 CPT Repair Of Incisional Or Abdominal Hernia, Recurrent Of Secondary, Not Trapped 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49566 CPT Repair Of Trapped Recurrent Incisional Or Abdominal Hernia 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49568 CPT Placement Of Mesh To Repair Incisional Or Abdominal Hernia, Open Procedure 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49570 CPT Repair Of Not Trapped Incisional Or Abdominal Hernia, In The Upper Stomach Area 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49572 CPT Repair Of Trapped Incisional Or Abdominal Hernia In The Upper Stomach Area 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49580 CPT Repair Of Hernia At Navel Patient Younger Than Age 5 Years 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49585 CPT Repair Of Hernia At Navel Patient Age 5 Years Or Older 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49587 CPT Repair Of Trapped Hernia At Navel Patient Age 5 Years Or Older 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49590 CPT Repair Of Hernia Between Abdominal Muscles 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49652 CPT Repair Of Hernia Using An Endoscope 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49653 CPT Repair Of Trapped Hernia Using An Endoscope 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49654 CPT Repair Of Incisional Hernia Using An Endoscope, Initial Or Primary 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49655 CPT Repair Of Trapped Incisional Hernia Using An Endoscope, Primary 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49656 CPT Repair Of Incisional Hernia Using An Endoscope, Recurrent Of Secondary 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
49657 CPT Repair Of Trapped Incisional Hernia Using An Endoscope, Secondary 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
53865 CPT Cystourethroscopy With Insertion Of Temporary Device For Ischemic Remodeling (ie… 3 2 — — $3,683.00 $5,946.00 $5,454.00 2026-04-14
55707 CPT Biopsy Prostate Transrectal U/s Guided 55707 1 1 $4,300.00 $1,161.00 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
55708 CPT Biopsy Prostate; Transrectal Us/mri Guidance First Lesion 55708 1 1 $4,300.00 $1,161.00 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
55711 CPT Biopsy Prostate; Transrectal Mri/us Guided; 1st Targeted Lesion 55711 1 1 $4,529.00 $1,222.83 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
55882 CPT Ablation Of Prostate Tissue, Transurethral, Using Thermal Ultrasound, Including … 3 2 — — $3,683.00 $5,946.00 $5,454.00 2026-04-14
57112 CPT Complete Removal Of Vaginal Wall And Surrounding Tissue With Removal Of Lymph No… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
58293 CPT Vaginal Removal Of Uterus (Greater Than 250 Grams) With Repair For Stress Incont… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59135 CPT Removal Impregnated Ovum Outside The Uterus And Entire Uterus 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59425 CPT Antepartum Care Only 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59426 CPT Antepartum Care Only 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59510 CPT Cesarean Delivery 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59515 CPT Cesarean Delivery 3 2 — — $4,728.00 $7,411.00 $5,454.00 2026-04-14
59610 CPT Vbac Delivery 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59614 CPT Vbac Care After Delivery 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59618 CPT Attempted Vbac Delivery 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
59622 CPT Attempted Vbac After Care 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
61715 CPT Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS), Ster… 3 2 — — $3,683.00 $5,946.00 $5,454.00 2026-04-14
61870 CPT Implantation Of Brain Neurostimulator Electrodes 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
62163 CPT Removal Of Foreign Material In Brain Using An Endoscope 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
62330 CPT Decomp. Perc. Incl. Laminotomy; Epidurography And Imaging; Bilat 1 Interspace Lu… 1 1 $8,637.00 $2,331.99 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
62331 CPT Decomp. Perc. Incl. Laminotomy; Epidurography And Imaging; Bilat Addtl; Interspa… 1 1 $8,637.00 $2,331.99 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
63180 CPT Removal Of Upper Spine Bone With Removal Of Ligaments, 1 Or 2 Segments 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
63182 CPT Removal Of Upper Spine Bone With Removal Of Ligaments, More Than 2 Segments 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
63194 CPT Removal Of Spine Bone With Incision Of One Upper Spinal Cord Tract 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
63195 CPT Removal Of Spine Bone With Incision Of One Middle Spinal Cord Tract 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
63196 CPT Removal Of Spine Bone With Incision Of Both Upper Spinal Cord Tracts 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
63198 CPT Removal Of Spine Bone With Incision Of Upper Spinal Cord, 2 Stages Within 14 Day… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
63199 CPT Removal Of Spine Bone With Incision Of Middle Spinal Cord, 2 Stages Within 14 Da… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
64626 CPT Cervical Or Throacic Facet Radiofrequency/1st Level 64626 1 1 $5,181.00 $1,398.87 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
64627 CPT Cervical Or Throacic Facet Radiofrequency/additional Level 64627 1 1 $2,458.00 $663.66 73% off $5,454.00 $5,454.00 $5,454.00 2026-04-14
66683 CPT Implantation Of Iris Prosthesis, Including Suture Fixation And Repair Or Removal… 3 2 — — $4,728.00 $7,411.00 $5,454.00 2026-04-14
69605 CPT Revision Of Previous Mastoid Surgery, With Removal Of A Portion Of The Temporal … 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
69715 CPT Removal Of Mastoid Bone With Implantation Of Cochlear Stimulating System, Access… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
69718 CPT Removal Of Mastoid Bone With Removal And Replacement (Accessed Through The Skin)… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77293 CPT Respirator Motion Mgmt Simul 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77306 CPT Telethx Isodose Plan Simple 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77307 CPT Telethx Isodose Plan Cplx 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77316 CPT Brachytx Isodose Plan Simple 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77317 CPT Brachytx Isodose Intermed 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77318 CPT Brachytx Isodose Complex 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77371 CPT Srs Multisource 3 2 — — $5,454.00 $41,468.00 $38,250.00 2026-04-14
77372 CPT Srs Linear Based 4 3 — — $1,237.38 $41,468.00 $21,852.00 2026-04-14
77387 CPT Guidance For Radj Tx Dlvr 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77399 CPT Unlisted Px Med Radj Physics 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77424 CPT Io Rad Tx Delivery By X-ray 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77425 CPT Io Rad Tx Deliver By Elctrns 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77469 CPT Io Radiation Tx Management 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77499 CPT Unlisted Px Ther Rad Tx Mgmt 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77520 CPT Proton Trmt Simple Without Comp 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77522 CPT Proton Trmt Simple W/comp 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77523 CPT Proton Trmt Intermediate 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77525 CPT Proton Treatment Complex 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77770 CPT Hdr Rdncl Ntrstl/icav Brchtx 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77771 CPT Hdr Rdncl Ntrstl/icav Brchtx 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
77772 CPT Hdr Rdncl Ntrstl/icav Brchtx 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
783 MS_DRG Cesarean Section With Sterilization With Mcc 1 1 — — $12,053.00 $12,053.00 $12,053.00 2026-04-14
784 MS_DRG Cesarean Section With Sterilization With Cc 1 1 — — $12,053.00 $12,053.00 $12,053.00 2026-04-14
785 MS_DRG Cesarean Section With Sterilization Without Cc/mcc 1 1 — — $12,053.00 $12,053.00 $12,053.00 2026-04-14
786 MS_DRG Cesarean Section Without Sterilization With Mcc 1 1 — — $12,053.00 $12,053.00 $12,053.00 2026-04-14
787 MS_DRG Cesarean Section Without Sterilization With Cc 1 1 — — $12,053.00 $12,053.00 $12,053.00 2026-04-14
788 MS_DRG Cesarean Section Without Sterilization Without Cc/mcc 1 1 — — $12,053.00 $12,053.00 $12,053.00 2026-04-14
796 MS_DRG Vaginal Delivery With Sterilization And/or D&c With Mcc 1 1 — — $6,721.00 $6,721.00 $6,721.00 2026-04-14
797 MS_DRG Vaginal Delivery With Sterilization And/or D&c With Cc 1 1 — — $6,721.00 $6,721.00 $6,721.00 2026-04-14
798 MS_DRG Vaginal Delivery With Sterilization And/or D&c Without Cc/mcc 1 1 — — $6,721.00 $6,721.00 $6,721.00 2026-04-14
80320 CPT Drug Screen Quantalcohols 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80321 CPT Alcohols Biomarkers 1or 2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80322 CPT Alcohols Biomarkers 3/more 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80323 CPT Alkaloids Nos 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80324 CPT Drug Screen Amphetamines 1/2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80325 CPT Amphetamines 3or 4 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80326 CPT Amphetamines 5 Or More 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80327 CPT Anabolic Steroid 1 Or 2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80328 CPT Anabolic Steroid 3 Or More 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80329 CPT Analgesics Non-opioid 1 Or 2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80330 CPT Analgesics Non-opioid 3-5 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80331 CPT Analgesics Non-opioid 6/more 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80332 CPT Antidepressants Class 1 Or 2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80333 CPT Antidepressants Class 3-5 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80334 CPT Antidepressants Class 6/more 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80335 CPT Antidepressant Tricyclic 1/2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80336 CPT Antidepressant Tricyclic 3-5 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80337 CPT Tricyclic & Cyclicals 6/more 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80338 CPT Antidepressant Not Specified 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80339 CPT Antiepileptics Nos 1-3 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80340 CPT Antiepileptics Nos 4-6 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80341 CPT Antiepileptics Nos 7/more 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80342 CPT Antipsychotics Nos 1-3 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80343 CPT Antipsychotics Nos 4-6 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80344 CPT Antipsychotics Nos 7/more 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80345 CPT Drug Screening Barbiturates 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80346 CPT Benzodiazepines1-12 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80347 CPT Benzodiazepines 13 Or More 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80348 CPT Drug Screening Buprenorphine 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80349 CPT Cannabinoids Natural 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80350 CPT Cannabinoids Synthetic 1-3 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80351 CPT Cannabinoids Synthetic 4-6 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80353 CPT Drug Screening Cocaine 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80354 CPT Drug Screening Fentanyl 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80355 CPT Gabapentin Non-blood 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80358 CPT Drug Screening Methadone 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80359 CPT Methylenedioxyamphetamines 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80362 CPT Opioids & Opiate Analogs 1/2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80364 CPT Opioid &opiate Analog 5/more 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80367 CPT Drug Screening Propoxyphene 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80368 CPT Sedative Hypnotics 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80369 CPT Skeletal Muscle Relaxant 1/2 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80371 CPT Stimulants Synthetic 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80373 CPT Drug Screening Tramadol 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80375 CPT Drug/substance Nos 1-3 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
805 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Mcc 1 1 — — $6,721.00 $6,721.00 $6,721.00 2026-04-14
80500 CPT Clinical Pathology Consultation 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
80502 CPT Comprehensive, Clinical Pathology Consultation 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
806 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Cc 1 1 — — $6,721.00 $6,721.00 $6,721.00 2026-04-14
807 MS_DRG Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc 1 1 — — $6,721.00 $6,721.00 $6,721.00 2026-04-14
81195 CPT Cytogenomic (genome-wide) Analysis, Hematologic Malignancy, Structural Variants … 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81416 CPT Exome Sequence Analysis 2 2 — — $5,454.00 $10,800.00 $8,127.00 2026-04-14
81441 CPT Ibmfs Seq Alys Pnl 30 Genes 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81449 CPT So Neo Gsap 5-50 RNA Alys 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81451 CPT Hl Neo Gsap 5-50 RNA Alys 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81457 CPT So Neo Gsap DNA Mcrstl Ins 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81458 CPT So Gsap DNA Cpy Nmbr&mcrstl 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81459 CPT So Neo Gsap Dna/dna&rna 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81479 CPT Unlisted Molecular Pathology 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81517 CPT Liver Ds Alys 3 Bmrk Srm Alg 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81529 CPT Onc Cutan Mlnma Mrna 31 Gene 2 2 — — $5,454.00 $6,473.70 $5,963.85 2026-04-14
81552 CPT Onc Uveal Mlnma Mrna 15 Gene 2 2 — — $5,454.00 $6,998.40 $6,226.20 2026-04-14
81558 CPT Transplantation Medicine (allograft Rejection, Kidney), Mrna, Gene Expression Pr… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
81599 CPT Unlisted Maaa 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
82166 CPT Assay Anti-mullerian Horm 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
82233 CPT Beta-amyloid; 1-40 (Abeta 40) 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
83884 CPT Neurofilament Light Chain (NfL) 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
84393 CPT Tau, Phosphorylated (eg, pTau 181, pTau 217), Each 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
84394 CPT Tau, Total (tTau) 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
84433 CPT Asy Thiopurin S-mthyltrnsfrs 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
84999 CPT Unlisted Chemistry Procedure 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
85999 CPT Unlisted Hematology&coagj Px 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
86041 CPT Acetylcholn Rcptr Bndng Antb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
86042 CPT Acetylcholn Rcptr Blckg Antb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
86043 CPT Acetylcholn Rcptr Modlg Antb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
86153 CPT Cell Enumeration Phys Interp 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
86366 CPT Muscle-specific Kinase Antb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
86581 CPT Streptococcus Pneumoniae Antibody (IgG), Serotypes, Multiplex Immunoassay, Quant… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
86849 CPT Immunology Procedure 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87450 CPT Immunologic Analysis For Detection Of Organism By Immunoassay Technique, Single … 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87467 CPT Hepatitis B Surface Ag Quan 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87468 CPT Anaplsma Phgcytophlm Amp Prb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87469 CPT Babesia Microti Amp Prb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87478 CPT Borrelia Miyamotoi Amp Prb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87484 CPT Ehrlicha Chaffeensis Amp Prb 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87513 CPT Infectious Agent Detection By Nucleic Acid (dna Or Rna); Helicobacter Pylori (h.… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87523 CPT Hepatitis D Quantification 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87564 CPT Infectious Agent Detection By Nucleic Acid (dna Or Rna); Mycobacterium Tuberculo… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87593 CPT Orthopoxvirus Amp Prb Each 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87594 CPT Infectious Agent Detection By Nucleic Acid (dna Or Rna); Pneumocystis Jirovecii,… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
87626 CPT Infectious Agent Detection By Nucleic Acid (dna Or Rna); Human Papillomavirus (h… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
88099 CPT Unlisted Necropsy (autopsy) 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
88749 CPT Unlisted In Vivo Lab Service 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
888T OTHER Histotripsy (ie, Non-thermal Ablation Via Acoustic Energy Delivery) Of Malignant… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
90281 CPT Human Ig IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90284 CPT Human Ig Sc 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90287 CPT Botulinum Antitoxin 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90288 CPT Botulism Ig IV 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90291 CPT Cmv Ig IV 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90296 CPT Diphtheria Antitoxin 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90371 CPT Hep B Ig IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90375 CPT Rabies Ig Im/sc 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90376 CPT Rabies Ig Heat Treated 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90377 CPT Rabies Ig Ht&sol Human Im/sc 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90378 CPT Rsv Mab IM 50mg 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90382 CPT Respiratory Syncytial Virus, Monoclonal Antibody, Seasonal Dose, 0.7 Ml, For Int… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90384 CPT Rh Ig Full-dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90471 CPT Immunization Admin 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90472 CPT Immunization Admin Each Add 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90476 CPT Adenovirus Vaccine Type 4 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90477 CPT Adenovirus Vaccine Type 7 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90480 CPT Admn Sarscov2 Vacc 1 Dose 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90581 CPT Anthrax Vaccine Sc Or IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90585 CPT Bcg Vaccine Percut 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90586 CPT Bcg Vaccine Intravesical 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90587 CPT Dengue Vacc Quad 3 Dose Subq 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90589 CPT Chikungunya Vaccine Live IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90593 CPT Chikungunya Virus Vaccine, Recombinant, For Intramuscular Use 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90611 CPT Smallpox&monkeypox Vac 0.5ml 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90612 CPT Influenza Virus Vaccine, Trivalent, And Severe Acute Respiratory Syndrome Corona… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90613 CPT Influenza Virus Vaccine, Quadrivalent, And Severe Acute Respiratory Syndrome Cor… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90619 CPT Menacwy-tt Vaccine IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90620 CPT Menb-4c Vacc 2 Dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90621 CPT Menb-fhbp Vacc 2/3 Dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90622 CPT Vaccinia Vrs Vac 0.3 Ml Perq 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90623 CPT Menacwy-tt Menb-fhbp Vacc IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90624 CPT Meningococcal Pentavalent Vaccine, Men B-4c Recombinant Proteins And Outer Membr… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90625 CPT Cholera Vaccine Live Oral 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90626 CPT Tic-brn Enceph Vac 0.25ml IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90627 CPT Tic-brn Enceph Vac 0.5ml IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90630 CPT Flu Vacc Iiv4 No Preserv Id 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90631 CPT Influenza Virus Vaccine (iiv), H5, Pandemic Formulation, Split Virus, Adjuvanted… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90632 CPT Hepa Vaccine Adult IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90633 CPT Hepa Vacc Ped/adol 2 Dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90634 CPT Hepa Vacc Ped/adol 3 Dose 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90635 CPT Influenza Virus Vaccine, H5n1, Derived From Cell Cultures, Adjuvanted, For Intra… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90636 CPT Hep A/hep B Vacc Adult IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90637 CPT Influenza Virus Vaccine, Quadrivalent (qIRV), Mrna; 30 Mcg/0.5 Ml Dosage, For In… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90638 CPT Influenza Virus Vaccine, Quadrivalent (qIRV), Mrna; 60 Mcg/0.5 Ml Dosage, For In… 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90644 CPT Hib-mency Vacc 6wk-18m0 IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90647 CPT Hib Prp-omp Vacc 3 Dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90648 CPT Hib Prp-t Vaccine 4 Dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90649 CPT 4vhpv Vaccine 3 Dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90650 CPT 2vhpv Vaccine 3 Dose IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90654 CPT Flu Vacc Iiv3 No Preserv Id 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90655 CPT Iiv3 Vacc No Prsv 0.25 Ml IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90656 CPT Iiv3 Vacc No Prsv 0.5 Ml IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
90658 CPT Iiv3 Vaccine Splt 0.5 Ml IM 1 1 — — $5,454.00 $5,454.00 $5,454.00 2026-04-14
913T OTHER Percutaneous Transcatheter Therapeutic Drug Delivery By Intracoronary Drug-deliv… 2 1 — — $5,511.00 $8,814.00 $7,162.50 2026-04-14
915T OTHER Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 2 1 — — $5,511.00 $8,814.00 $7,162.50 2026-04-14
917T OTHER Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
918T OTHER Insertion Of Permanent Cardiac Contractility Modulation-defibrillation System Co… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
919T OTHER Removal Of A Permanent Cardiac Contractility Modulation-defibrillation System Co… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
920T OTHER Removal Of A Permanent Cardiac Contractility Modulation-defibrillation System Co… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
921T OTHER Removal Of A Permanent Cardiac Contractility Modulation-defibrillation System Co… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
922T OTHER Removal Of A Permanent Cardiac Contractility Modulation-defibrillation System Co… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
933T OTHER Transcatheter Implantation Of Wireless Left Atrial Pressure Sensor For Long-term… 2 1 — — $5,511.00 $8,814.00 $7,162.50 2026-04-14
93530 CPT Insertion Of Catheter Into Right Upper Heart Chamber For Evaluation Of Congenita… 2 2 — — $5,454.00 $7,786.00 $6,620.00 2026-04-14
93531 CPT Insertion Of Catheter Into Right And Left Heart Chambers For Evaluation Of Conge… 2 2 — — $5,454.00 $7,786.00 $6,620.00 2026-04-14
93532 CPT Insertion Of Catheter Into Right And Left Heart Chambers Through Intact Septum F… 2 2 — — $5,454.00 $7,786.00 $6,620.00 2026-04-14
93533 CPT Insertion Of Catheter Into Right And Left Heart Chambers Through Existing Septal… 2 2 — — $5,454.00 $7,786.00 $6,620.00 2026-04-14
93600 CPT Bundle Of His Recording 8 3 — — $0.50 $8,814.00 $5,482.50 2026-04-14
93618 CPT Heart Rhythm Pacing 8 3 — — $0.50 $8,814.00 $5,482.50 2026-04-14
93619 CPT Electrophysiology Evaluation 6 3 — — $0.50 $8,814.00 $5,666.00 2026-04-14
93620 CPT Electrophysiology Evaluation 6 3 — — $0.50 $8,814.00 $5,666.00 2026-04-14
93624 CPT Electrophysiologic Study 5 3 — — $3,683.00 $6,631.00 $5,821.00 2026-04-14
981T OTHER Transcatheter Implantation Of Wireless Inferior Vena Cava Sensor For Long-term H… 2 1 — — $4,928.00 $7,879.00 $6,403.50 2026-04-14
C7562 HCPCS Catheter Placement In Coronary Artery(s) For Coronary Angiography, Including Int… 2 1 — — $6,016.00 $9,621.00 $7,818.50 2026-04-14
C7563 HCPCS Transluminal Balloon Angioplasty (except Lower Extremity Artery(ies) For Occlusi… 2 1 — — $5,511.00 $8,814.00 $7,162.50 2026-04-14
C7564 HCPCS Percutaneous Transluminal Mechanical Thrombectomy, Vein(s), Including Intraproce… 2 1 — — $5,511.00 $8,814.00 $7,162.50 2026-04-14
C7565 HCPCS Repair Of Anterior Abdominal Hernia(s) (ie, Epigastric, Incisional, Ventral, Umb… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
C8003 HCPCS Implantation Of Medial Knee Extraarticular Implantable Shock Absorber Spanning T… 2 1 — — $4,192.00 $6,768.00 $5,480.00 2026-04-14
C8005 HCPCS Bronchoscopy, Rigid Or Flexible, Non-thermal Transbronchial Ablation Of Lesion(s… 2 1 — — $5,511.00 $8,814.00 $7,162.50 2026-04-14
C9770 HCPCS Vitrec/mech Pars, Subret Inj 1 1 — — $13,461.00 $13,461.00 $13,461.00 2026-04-14
C9771 HCPCS Nsl/sins Cryo Post Nasal Tis 1 1 — — $13,461.00 $13,461.00 $13,461.00 2026-04-14
C9790 HCPCS Kidney Histotripsy W/image 3 2 — — $4,192.00 $13,250.53 $6,768.00 2026-04-14
C9901 HCPCS Endoscopic Defect Closure Within The Entire Gastrointestinal Tract, Including Up… 3 2 — — $3,683.00 $8,300.00 $5,946.00 2026-04-14
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