Hospital

EASTERN OKLAHOMA MEDICAL CENTER

Poteau, OK · CCN 371337 · Rates published

1,660 distinct procedures filed

1 distinct payers

1,962 rate rows

2026-05-23 last MRF observed

Data quality

1,962 of 1,962 rate rows are consumer-grade (100.0%)

Every filed rate row passes our consumer-grade checks — none are excluded from the medians.

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

Source MRF file	https://eomchospital.com/wp-content/uploads/2026/03/736060835_eastern-oklahoma-medical-center_standardcharges.csv
Found on page	https://eomchospital.com/price-transparency/
Discovered via	CMS hospital list
Last fetch	success · 2026-11-03
Content fingerprint	f1cadfba7b1a5c63… · 3,565,758 bytes · first seen 2026-11-03

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
112 OTHER		1	$11,840.00	$11,840.00	$11,840.00	nat. median $2,676 outlier · 4.4×
121 OTHER		1	$11,840.00	$11,840.00	$11,840.00	nat. median $10,120 1.2× median
36589 CPT	Removal Tunneled Cv Cath	1	$365.75	$365.75	$365.75	nat. median $927 outlier · 0.4×
45338 CPT	Sigmoidoscopy W/tumr Remove	1	$365.75	$365.75	$365.75	nat. median $1,498 outlier · 0.2×
28899 CPT	Unlisted Px Foot/toes	1	$365.75	$365.75	$365.75	nat. median $572 0.6× median
28124 CPT	Partial Removal Of Toe	1	$365.75	$365.75	$365.75	nat. median $3,324 outlier · 0.1×
49591 CPT	Rpr Aa Hrn 1st < 3 Cm Rdc	1	$365.75	$365.75	$365.75	nat. median $3,851 outlier · 0.1×
49593 CPT	Rpr Aa Hrn 1st 3-10 Rdc	1	$365.75	$365.75	$365.75	nat. median $5,973 outlier · 0.1×
360 OTHER		1	$365.75	$365.75	$365.75	nat. median $3,247 outlier · 0.1×
45385 CPT	Colonoscopy W/lesion Removal	1	$365.00	$365.75	$365.75	nat. median $1,672 outlier · 0.2×
28298 CPT	Cor Hlx Vlgs Prx Phlx Osteot	1	$365.75	$365.75	$365.75	nat. median $6,632 outlier · 0.1×
45330 CPT	Diagnostic Sigmoidoscopy	1	$365.75	$365.75	$365.75	nat. median $1,081 outlier · 0.3×
23071 CPT	Exc Shoulder Les Sc 3 Cm/>	1	$365.75	$365.75	$365.75	nat. median $1,913 outlier · 0.2×
27324 CPT	Biopsy Thigh Soft Tissues	1	$365.75	$365.75	$365.75	nat. median $2,997 outlier · 0.1×
23066 CPT	Biopsy Shoulder Tissues	1	$365.75	$365.75	$365.75	nat. median $2,940 outlier · 0.1×
11103 CPT	Tangntl Bx Skin Ea Sep/addl	1	$365.75	$365.75	$365.75	nat. median $143 outlier · 2.6×
11107 CPT	Incal Bx Skn Ea Sep/addl	1	$365.75	$365.75	$365.75	nat. median $219 1.7× median
23065 CPT	Biopsy Shoulder Tissues	1	$365.75	$365.75	$365.75	nat. median $1,687 outlier · 0.2×
27323 CPT	Biopsy Thigh Soft Tissues	1	$365.75	$365.75	$365.75	nat. median $1,728 outlier · 0.2×
11105 CPT	Punch Bx Skin Ea Sep/addl	1	$365.75	$365.75	$365.75	nat. median $167 outlier · 2.2×
11104 CPT	Punch Bx Skin Single Lesion	1	$365.75	$365.75	$365.75	nat. median $402 0.9× median
11102 CPT	Tangntl Bx Skin Single Les	1	$365.75	$365.75	$365.75	nat. median $278 1.3× median
28750 CPT	Fusion Of Big Toe Joint	1	$365.75	$365.75	$365.75	nat. median $7,000 outlier · 0.1×
45378 CPT	Diagnostic Colonoscopy	1	$365.00	$365.75	$365.75	nat. median $1,342 outlier · 0.3×
23075 CPT	Exc Shoulder Les Sc < 3 Cm	1	$365.75	$365.75	$365.75	nat. median $1,727 outlier · 0.2×
45388 CPT	Colonoscopy W/ablation	1	$365.00	$365.75	$365.75	nat. median $1,879 outlier · 0.2×
58600 CPT	Division Of Fallopian Tube	1	$365.75	$365.75	$365.75	nat. median $3,232 outlier · 0.1×
11603 CPT	Exc Tr-ext Mal+marg 2.1-3 Cm	1	$365.75	$365.75	$365.75	nat. median $794 outlier · 0.5×
11606 CPT	Exc Tr-ext Mal+marg >4 Cm	1	$365.75	$365.75	$365.75	nat. median $1,805 outlier · 0.2×
11106 CPT	Incal Bx Skn Single Les	1	$365.75	$365.75	$365.75	nat. median $639 0.6× median
11602 CPT	Exc Tr-ext Mal+marg 1.1-2 Cm	1	$365.75	$365.75	$365.75	nat. median $499 0.7× median
11444 CPT	Exc Face-mm B9+marg 3.1-4 Cm	1	$365.75	$365.75	$365.75	nat. median $1,625 outlier · 0.2×
11600 CPT	Exc Tr-ext Mal+marg 0.5 Cm/<	1	$365.75	$365.75	$365.75	nat. median $727 0.5× median
45380 CPT	Colonoscopy And Biopsy	1	$365.00	$365.75	$365.75	nat. median $1,565 outlier · 0.2×
11446 CPT	Exc Face-mm B9+marg >4 Cm	1	$365.75	$365.75	$365.75	nat. median $2,812 outlier · 0.1×
11601 CPT	Exc Tr-ext Mal+marg 0.6-1 Cm	1	$365.75	$365.75	$365.75	nat. median $717 0.5× median
28285 CPT	Repair Of Hammertoe	1	$365.75	$365.75	$365.75	nat. median $3,601 outlier · 0.1×
11604 CPT	Exc Tr-ext Mal+marg 3.1-4 Cm	1	$365.75	$365.75	$365.75	nat. median $862 outlier · 0.4×
28289 CPT	Corrj Halux Rigdus Without Implt	1	$365.75	$365.75	$365.75	nat. median $3,524 outlier · 0.1×
28470 CPT	Cltx Metatarsal Fx Wo Mnp Ea	1	$365.75	$365.75	$365.75	nat. median $378 1.0× median
28080 CPT	Removal Of Foot Lesion	1	$365.75	$365.75	$365.75	nat. median $2,058 outlier · 0.2×
11400 CPT	Exc Tr-ext B9+marg 0.5 Cm<	1	$365.75	$365.75	$365.75	nat. median $711 0.5× median
20816 CPT	Replantation Digit Complete	1	$365.75	$365.75	$365.75	nat. median $3,784 outlier · 0.1×
23076 CPT	Exc Shoulder Tum Deep < 5 Cm	1	$365.75	$365.75	$365.75	nat. median $2,903 outlier · 0.1×
G0463 HCPCS	Hospital Outpatient Clinic Visit	1	$365.00	$365.75	$365.38	nat. median $170 outlier · 2.1×
99308 CPT	Sbsq Nf Care Low Mdm 20	1	$365.00	$365.75	$365.38	nat. median $96 outlier · 3.8×
99315 CPT	Nf Dschrg Mgmt 30 Min/less	1	$365.00	$365.75	$365.38	nat. median $115 outlier · 3.2×
99255 CPT	Ip/obs Consltj New/est Hi 80	1	$365.00	$365.75	$365.38	nat. median $320 1.1× median
99418 CPT	Prolng Ip/obs E/m Ea 15 Min	1	$365.00	$365.75	$365.38	nat. median $101 outlier · 3.6×
97803 CPT	Med Nutrition Indiv Subseq	1	$365.00	$365.75	$365.38	nat. median $43 outlier · 8.5×

Other procedures at this hospital

Browse this hospital's 1,660 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

10061	CPT	I&d Abscess Comp/multiple	1	1	$135.56	$135.56	$365.00	$365.00	$365.00	2026-05-23
10081	CPT	I&d Pilonidal Cyst Comp	1	1	$235.38	$235.38	$365.00	$365.00	$365.00	2026-05-23
10120	CPT	Inc&rmvl Fb Subq Tiss Smpl	2	1	$667.08	$667.08	$365.00	$365.75	$365.38	2026-05-23
10121	CPT	Inc&rmvl Fb Subq Tiss Comp	1	1	$460.95	$460.95	$365.00	$365.00	$365.00	2026-05-23
10160	CPT	Pnxr Aspir Absc Hmtma Bulla	1	1	$59.46	$59.46	$365.00	$365.00	$365.00	2026-05-23
11000	CPT	Dbrdmt Ecz/infected Skin<10%	1	1	$87.24	$87.24	$365.00	$365.00	$365.00	2026-05-23
11010	CPT	Debride Skin At Fx Site	1	1	$598.97	$598.97	$365.00	$365.00	$365.00	2026-05-23
11011	CPT	Debride Skin Musc At Fx Site	1	1	$1,052.52	$1,052.52	$365.00	$365.00	$365.00	2026-05-23
11012	CPT	Deb Skin Bone At Fx Site	1	1	$1,508.75	$1,508.75	$365.00	$365.00	$365.00	2026-05-23
11042	CPT	Dbrdmt Subq Tis 1st 20sqcm/<	1	1	$547.55	$547.55	$365.00	$365.00	$365.00	2026-05-23
11043	CPT	Dbrdmt Musc&/fsca 1st 20/<	1	1	$762.76	$762.76	$365.00	$365.00	$365.00	2026-05-23
11102	CPT	Tangntl Bx Skin Single Les	1	1	$596.10	$596.10	$365.75	$365.75	$365.75	2026-05-23
11103	CPT	Tangntl Bx Skin Ea Sep/addl	1	1	$600.00	$600.00	$365.75	$365.75	$365.75	2026-05-23
11104	CPT	Punch Bx Skin Single Lesion	1	1	$1,198.59	$1,198.59	$365.75	$365.75	$365.75	2026-05-23
11105	CPT	Punch Bx Skin Ea Sep/addl	1	1	$378.00	$378.00	$365.75	$365.75	$365.75	2026-05-23
11106	CPT	Incal Bx Skn Single Les	1	1	$1,591.54	$1,591.54	$365.75	$365.75	$365.75	2026-05-23
11107	CPT	Incal Bx Skn Ea Sep/addl	1	1	$2,000.00	$2,000.00	$365.75	$365.75	$365.75	2026-05-23
112	OTHER	—	1	1	$1,789.00	$1,789.00	$11,840.00	$11,840.00	$11,840.00	2026-05-23
11200	CPT	Rmvl Skin Tags Up To&inc 15	1	1	$154.01	$154.01	$365.00	$365.00	$365.00	2026-05-23
11300	CPT	Shave Skin Lesion 0.5 Cm/<	1	1	$1,198.59	$1,198.59	$365.00	$365.00	$365.00	2026-05-23
11400	CPT	Exc Tr-ext B9+marg 0.5 Cm<	1	1	$1,829.33	$1,829.33	$365.75	$365.75	$365.75	2026-05-23
11401	CPT	Exc Tr-ext B9+marg 0.6-1 Cm	2	1	$911.64	$911.64	$365.00	$365.75	$365.38	2026-05-23
11402	CPT	Exc Tr-ext B9+marg 1.1-2 Cm	2	1	$758.02	$758.02	$365.00	$365.75	$365.38	2026-05-23
11403	CPT	Exc Tr-ext B9+marg 2.1-3cm	2	1	$913.63	$913.63	$365.00	$365.75	$365.38	2026-05-23
11404	CPT	Exc Tr-ext B9+marg 3.1-4 Cm	2	1	$1,014.90	$1,014.90	$365.00	$365.75	$365.38	2026-05-23
11406	CPT	Exc Tr-ext B9+marg >4.0 Cm	2	1	$1,970.05	$1,970.05	$365.00	$365.75	$365.38	2026-05-23
11423	CPT	Exc H-f-nk-sp B9+marg 2.1-3	1	1	$1,050.05	$1,050.05	$365.00	$365.00	$365.00	2026-05-23
11444	CPT	Exc Face-mm B9+marg 3.1-4 Cm	1	1	$3,089.50	$3,089.50	$365.75	$365.75	$365.75	2026-05-23
11446	CPT	Exc Face-mm B9+marg >4 Cm	1	1	$5,414.70	$5,414.70	$365.75	$365.75	$365.75	2026-05-23
11600	CPT	Exc Tr-ext Mal+marg 0.5 Cm/<	1	1	$1,407.18	$1,407.18	$365.75	$365.75	$365.75	2026-05-23
11601	CPT	Exc Tr-ext Mal+marg 0.6-1 Cm	1	1	$1,407.18	$1,407.18	$365.75	$365.75	$365.75	2026-05-23
11602	CPT	Exc Tr-ext Mal+marg 1.1-2 Cm	1	1	$1,198.59	$1,198.59	$365.75	$365.75	$365.75	2026-05-23
11603	CPT	Exc Tr-ext Mal+marg 2.1-3 Cm	1	1	$1,407.18	$1,407.18	$365.75	$365.75	$365.75	2026-05-23
11604	CPT	Exc Tr-ext Mal+marg 3.1-4 Cm	1	1	$1,407.18	$1,407.18	$365.75	$365.75	$365.75	2026-05-23
11606	CPT	Exc Tr-ext Mal+marg >4 Cm	1	1	$3,240.48	$3,240.48	$365.75	$365.75	$365.75	2026-05-23
11641	CPT	Exc F/e/e/n/l Mal+mrg 0.6-1	1	1	$1,309.68	$1,309.68	$365.00	$365.00	$365.00	2026-05-23
11730	CPT	Avulsion Nail Plate Simple 1	1	1	$84.44	$84.44	$365.00	$365.00	$365.00	2026-05-23
11732	CPT	Avlsn Nail Plate Simple Each	1	1	$124.07	$124.07	$365.00	$365.00	$365.00	2026-05-23
11740	CPT	Evacuation Subungual Hmtma	1	1	$39.25	$39.25	$365.00	$365.00	$365.00	2026-05-23
11750	CPT	Excision Nail&nail Matrix	1	1	$553.10	$553.10	$365.00	$365.00	$365.00	2026-05-23
11760	CPT	Repair Of Nail Bed	1	1	$123.81	$123.81	$365.00	$365.00	$365.00	2026-05-23
11765	CPT	Wedge Excision Skn Nail Fold	1	1	$223.22	$223.22	$365.00	$365.00	$365.00	2026-05-23
11976	CPT	Remove Contraceptive Capsule	1	1	$675.36	$675.36	$365.00	$365.00	$365.00	2026-05-23
12001	CPT	Rpr S/n/ax/gen/trnk 2.5cm/<	1	1	$197.11	$197.11	$365.00	$365.00	$365.00	2026-05-23
12002	CPT	Rpr S/n/ax/gen/trnk2.6-7.5cm	1	1	$225.76	$225.76	$365.00	$365.00	$365.00	2026-05-23
12004	CPT	Rpr S/n/ax/gen/trk7.6-12.5cm	1	1	$141.51	$141.51	$365.00	$365.00	$365.00	2026-05-23
12005	CPT	Rpr S/n/a/gen/trk12.6-20.0cm	1	1	$141.51	$141.51	$365.00	$365.00	$365.00	2026-05-23
12006	CPT	Rpr S/n/a/gen/trk20.1-30.0cm	1	1	$141.51	$141.51	$365.00	$365.00	$365.00	2026-05-23
12007	CPT	Rpr S/n/ax/gen/trnk >30.0 Cm	1	1	$123.81	$123.81	$365.00	$365.00	$365.00	2026-05-23
12011	CPT	Rpr F/e/e/n/l/m 2.5 Cm/<	1	1	$198.43	$198.43	$365.00	$365.00	$365.00	2026-05-23
12013	CPT	Rpr F/e/e/n/l/m 2.6-5.0 Cm	1	1	$222.87	$222.87	$365.00	$365.00	$365.00	2026-05-23
12014	CPT	Rpr F/e/e/n/l/m 5.1-7.5 Cm	1	1	$141.51	$141.51	$365.00	$365.00	$365.00	2026-05-23
12015	CPT	Rpr F/e/e/n/l/m 7.6-12.5 Cm	1	1	$141.51	$141.51	$365.00	$365.00	$365.00	2026-05-23
12016	CPT	Rpr Fe/e/en/l/m 12.6-20.0 Cm	1	1	$141.51	$141.51	$365.00	$365.00	$365.00	2026-05-23
12017	CPT	Rpr Fe/e/en/l/m 20.1-30.0 Cm	1	1	$123.81	$123.81	$365.00	$365.00	$365.00	2026-05-23
12018	CPT	Rpr F/e/e/n/l/m >30.0 Cm	1	1	$123.81	$123.81	$365.00	$365.00	$365.00	2026-05-23
12020	CPT	Tx Supfc Wnd Dehsn Smpl Clsr	1	1	$692.29	$692.29	$365.00	$365.00	$365.00	2026-05-23
12036	CPT	Intmd Rpr S/a/t/ext 20.1-30	1	1	$141.51	$141.51	$365.00	$365.00	$365.00	2026-05-23
12037	CPT	Intmd Rpr S/tr/ext >30.0 Cm	1	1	$688.83	$688.83	$365.00	$365.00	$365.00	2026-05-23
12041	CPT	Intmd Rpr N-hf/genit 2.5cm/<	1	1	$202.81	$202.81	$365.00	$365.00	$365.00	2026-05-23
12042	CPT	Intmd Rpr N-hf/genit2.6-7.5	1	1	$141.51	$141.51	$365.00	$365.00	$365.00	2026-05-23
12044	CPT	Intmd Rpr N-hf/genit7.6-12.5	1	1	$123.81	$123.81	$365.00	$365.00	$365.00	2026-05-23
12045	CPT	Intmd Rpr N-hf/genit12.6-20	1	1	$442.47	$442.47	$365.00	$365.00	$365.00	2026-05-23
12046	CPT	Intmd Rpr N-hf/genit20.1-30	1	1	$123.81	$123.81	$365.00	$365.00	$365.00	2026-05-23
12047	CPT	Intmd Rpr N-hf/genit >30.0cm	1	1	$688.83	$688.83	$365.00	$365.00	$365.00	2026-05-23
12051	CPT	Intmd Rpr Face/mm 2.5 Cm/<	1	1	$142.71	$142.71	$365.00	$365.00	$365.00	2026-05-23
12052	CPT	Intmd Rpr Face/mm 2.6-5.0 Cm	1	1	$141.51	$141.51	$365.00	$365.00	$365.00	2026-05-23
12053	CPT	Intmd Rpr Face/mm 5.1-7.5 Cm	1	1	$123.81	$123.81	$365.00	$365.00	$365.00	2026-05-23
12054	CPT	Intmd Rpr Face/mm 7.6-12.5cm	1	1	$141.51	$141.51	$365.00	$365.00	$365.00	2026-05-23
12055	CPT	Intmd Rpr Face/mm 12.6-20 Cm	1	1	$123.81	$123.81	$365.00	$365.00	$365.00	2026-05-23
12056	CPT	Intmd Rpr Face/mm 20.1-30.0	1	1	$123.81	$123.81	$365.00	$365.00	$365.00	2026-05-23
12057	CPT	Intmd Rpr Face/mm >30.0 Cm	1	1	$688.83	$688.83	$365.00	$365.00	$365.00	2026-05-23
121	OTHER	—	1	1	$1,590.00	$1,590.00	$11,840.00	$11,840.00	$11,840.00	2026-05-23
13100	CPT	Cmplx Rpr Trunk 1.1-2.5 Cm	1	1	$185.21	$185.21	$365.00	$365.00	$365.00	2026-05-23
13101	CPT	Cmplx Rpr Trunk 2.6-7.5 Cm	1	1	$185.21	$185.21	$365.00	$365.00	$365.00	2026-05-23
13102	CPT	Cmplx Rpr Trunk Addl 5cm/<	1	1	$653.12	$653.12	$365.00	$365.00	$365.00	2026-05-23
13120	CPT	Cmplx Rpr S/a/l 1.1-2.5 Cm	1	1	$211.68	$211.68	$365.00	$365.00	$365.00	2026-05-23
13121	CPT	Cmplx Rpr S/a/l 2.6-7.5 Cm	1	1	$211.68	$211.68	$365.00	$365.00	$365.00	2026-05-23
13122	CPT	Cmplx Rpr S/a/l Addl 5 Cm/>	1	1	$319.03	$319.03	$365.00	$365.00	$365.00	2026-05-23
13131	CPT	Cmplx Rpr F/c/c/m/n/ax/g/h/f	1	1	$185.21	$185.21	$365.00	$365.00	$365.00	2026-05-23
13132	CPT	Cmplx Rpr F/c/c/m/n/ax/g/h/f	1	1	$211.68	$211.68	$365.00	$365.00	$365.00	2026-05-23
13133	CPT	Cmplx Rpr F/c/c/m/n/ax/g/h/f	1	1	$498.02	$498.02	$365.00	$365.00	$365.00	2026-05-23
13151	CPT	Cmplx Rpr E/n/e/l 1.1-2.5 Cm	1	1	$185.21	$185.21	$365.00	$365.00	$365.00	2026-05-23
13152	CPT	Cmplx Rpr E/n/e/l 2.6-7.5 Cm	1	1	$185.21	$185.21	$365.00	$365.00	$365.00	2026-05-23
13160	CPT	Sec Clsr Surg Wnd/dehsn Xtn	1	1	$3,090.54	$3,090.54	$365.00	$365.00	$365.00	2026-05-23
16000	CPT	Initial Treatment Of Burn(s)	1	1	$85.15	$85.15	$365.00	$365.00	$365.00	2026-05-23
16020	CPT	Dress/debrid P-thick Burn S	1	1	$306.25	$306.25	$365.00	$365.00	$365.00	2026-05-23
16025	CPT	Dress/debrid P-thick Burn M	1	1	$73.88	$73.88	$365.00	$365.00	$365.00	2026-05-23
16030	CPT	Dress/debrid P-thick Burn L	1	1	$129.62	$129.62	$365.00	$365.00	$365.00	2026-05-23
16035	CPT	Escharotomy 1st Incision	1	1	$434.52	$434.52	$365.00	$365.00	$365.00	2026-05-23
17250	CPT	Chem Caut Of Granltj Tissue	1	1	$223.22	$223.22	$365.00	$365.00	$365.00	2026-05-23
20101	CPT	Expl Pentrg Wound Chest	1	1	$1,879.09	$1,879.09	$365.00	$365.00	$365.00	2026-05-23
20102	CPT	Expl Pentrg Wnd Abd/flnk/bk	1	1	$3,090.54	$3,090.54	$365.00	$365.00	$365.00	2026-05-23
20103	CPT	Expl Pentrg Wound Extremity	1	1	$1,069.99	$1,069.99	$365.00	$365.00	$365.00	2026-05-23
20520	CPT	Rmvl Fb Musc/tdn Simple	1	1	$229.96	$229.96	$365.00	$365.00	$365.00	2026-05-23
20525	CPT	Rmvl Fb Musc/tdn Deep/comp	1	1	$759.59	$759.59	$365.00	$365.00	$365.00	2026-05-23
20550	CPT	Njx 1 Tendon Sheath/ligament	1	1	$659.31	$659.31	$365.00	$365.00	$365.00	2026-05-23
20552	CPT	Njx 1/mlt Trigger Point 1/2	1	1	$483.01	$483.01	$365.00	$365.00	$365.00	2026-05-23
20553	CPT	Njx 1/mlt Trigger Points 3/>	1	1	$483.17	$483.17	$365.00	$365.00	$365.00	2026-05-23
20600	CPT	Drain/inj Joint/bursa Without US	1	1	$122.79	$122.79	$365.00	$365.00	$365.00	2026-05-23
20605	CPT	Drain/inj Joint/bursa Without US	1	1	$140.32	$140.32	$365.00	$365.00	$365.00	2026-05-23
20610	CPT	Drain/inj Joint/bursa Without US	1	1	$409.20	$409.20	$365.00	$365.00	$365.00	2026-05-23
20611	CPT	Drain/inj Joint/bursa W/us	1	1	$511.72	$511.72	$365.00	$365.00	$365.00	2026-05-23
20816	CPT	Replantation Digit Complete	1	1	$4,877.93	$4,877.93	$365.75	$365.75	$365.75	2026-05-23
21480	CPT	Cltx Tmprmand Dislc 1st/sbsq	1	1	$137.29	$137.29	$365.00	$365.00	$365.00	2026-05-23
21485	CPT	Cltx Tmprmand Dislc Comp	1	1	$2,336.66	$2,336.66	$365.00	$365.00	$365.00	2026-05-23
23065	CPT	Biopsy Shoulder Tissues	1	1	$3,240.48	$3,240.48	$365.75	$365.75	$365.75	2026-05-23
23066	CPT	Biopsy Shoulder Tissues	1	1	$3,240.48	$3,240.48	$365.75	$365.75	$365.75	2026-05-23
23071	CPT	Exc Shoulder Les Sc 3 Cm/>	1	1	$3,240.48	$3,240.48	$365.75	$365.75	$365.75	2026-05-23
23075	CPT	Exc Shoulder Les Sc < 3 Cm	1	1	$3,240.48	$3,240.48	$365.75	$365.75	$365.75	2026-05-23
23076	CPT	Exc Shoulder Tum Deep < 5 Cm	1	1	$5,724.10	$5,724.10	$365.75	$365.75	$365.75	2026-05-23
23500	CPT	Cltx Clavicular Fx Without Mnpj	1	1	$220.60	$220.60	$365.00	$365.00	$365.00	2026-05-23
23540	CPT	Cltx Acromclav Dislc Wo Mnpj	1	1	$442.91	$442.91	$365.00	$365.00	$365.00	2026-05-23
23600	CPT	Cltx Prox Humrl Fx Without Mnpj	1	1	$697.03	$697.03	$365.00	$365.00	$365.00	2026-05-23
23650	CPT	Cltx Sho Dslc W/mnpj Wo Anes	1	1	$252.11	$252.11	$365.00	$365.00	$365.00	2026-05-23
23655	CPT	Cltx Sho Dslc W/mnpj W/anes	1	1	$2,796.05	$2,796.05	$365.00	$365.00	$365.00	2026-05-23
24500	CPT	Cltx Humrl Shft Fx Without Mnpj	1	1	$138.40	$138.40	$365.00	$365.00	$365.00	2026-05-23
24505	CPT	Cltx Humrl Shft Fx W/mnpj	1	1	$513.46	$513.46	$365.00	$365.00	$365.00	2026-05-23
24650	CPT	Cltx Rdl Head/nck Fx Wo Mnpj	1	1	$499.08	$499.08	$365.00	$365.00	$365.00	2026-05-23
24670	CPT	Cltx Ulnar Fx Prox Without Mnpj	1	1	$138.40	$138.40	$365.00	$365.00	$365.00	2026-05-23
25248	CPT	Remove Forearm Foreign Body	1	1	$836.76	$836.76	$365.00	$365.00	$365.00	2026-05-23
25500	CPT	Cltx Rdl Shft Fx Without Mnpj	1	1	$486.59	$486.59	$365.00	$365.00	$365.00	2026-05-23
25505	CPT	Cltx Rdl Shft Fx W/mnpj	1	1	$1,273.96	$1,273.96	$365.00	$365.00	$365.00	2026-05-23
25530	CPT	Cltx Ulnar Shft Fx Without Mnpj	1	1	$138.40	$138.40	$365.00	$365.00	$365.00	2026-05-23
25560	CPT	Cltx Rdl&uln Shft Fx Wo Mnpj	1	1	$593.88	$593.88	$365.00	$365.00	$365.00	2026-05-23
25565	CPT	Cltx Rdl&uln Shft Fx W/mnpj	1	1	$935.13	$935.13	$365.00	$365.00	$365.00	2026-05-23
25600	CPT	Cltx Dst Rdl Fx/ephys Sep Wo	1	1	$575.47	$575.47	$365.00	$365.00	$365.00	2026-05-23
25605	CPT	Cltx Dst Rdl Fx/ephys Sep With	1	1	$1,267.36	$1,267.36	$365.00	$365.00	$365.00	2026-05-23
25622	CPT	Cltx Carpl Scphd Fx Without Mnpj	1	1	$558.97	$558.97	$365.00	$365.00	$365.00	2026-05-23
25630	CPT	Cltx Carpl Fx Without Mnpj Ea B1	1	1	$261.09	$261.09	$365.00	$365.00	$365.00	2026-05-23
25650	CPT	Cltx Ulnar Styloid Fracture	1	1	$586.89	$586.89	$365.00	$365.00	$365.00	2026-05-23
25675	CPT	Cltx Dstl Rad/uln Dislc Mnpj	1	1	$866.98	$866.98	$365.00	$365.00	$365.00	2026-05-23
26010	CPT	Drainage Of Finger Abscess	1	1	$135.56	$135.56	$365.00	$365.00	$365.00	2026-05-23
26011	CPT	Drainage Of Finger Abscess	1	1	$735.31	$735.31	$365.00	$365.00	$365.00	2026-05-23
26075	CPT	Explore/treat Finger Joint	1	1	$2,384.43	$2,384.43	$365.00	$365.00	$365.00	2026-05-23
26410	CPT	Repair Hand Tendon	1	1	$637.85	$637.85	$365.00	$365.00	$365.00	2026-05-23
26600	CPT	Treat Metacarpal Fracture	1	1	$499.08	$499.08	$365.00	$365.00	$365.00	2026-05-23
26605	CPT	Treat Metacarpal Fracture	1	1	$547.24	$547.24	$365.00	$365.00	$365.00	2026-05-23
26641	CPT	Treat Thumb Dislocation	1	1	$690.07	$690.07	$365.00	$365.00	$365.00	2026-05-23
26645	CPT	Treat Thumb Fracture	1	1	$886.54	$886.54	$365.00	$365.00	$365.00	2026-05-23
26700	CPT	Treat Knuckle Dislocation	1	1	$220.60	$220.60	$365.00	$365.00	$365.00	2026-05-23
26720	CPT	Treat Finger Fracture Each	1	1	$220.60	$220.60	$365.00	$365.00	$365.00	2026-05-23
26725	CPT	Treat Finger Fracture Each	1	1	$79.68	$79.68	$365.00	$365.00	$365.00	2026-05-23
26740	CPT	Treat Finger Fracture Each	1	1	$513.46	$513.46	$365.00	$365.00	$365.00	2026-05-23
26750	CPT	Treat Finger Fracture Each	1	1	$252.11	$252.11	$365.00	$365.00	$365.00	2026-05-23
26755	CPT	Treat Finger Fracture Each	1	1	$554.31	$554.31	$365.00	$365.00	$365.00	2026-05-23
26770	CPT	Treat Finger Dislocation	1	1	$252.11	$252.11	$365.00	$365.00	$365.00	2026-05-23
26775	CPT	Treat Finger Dislocation	1	1	$533.82	$533.82	$365.00	$365.00	$365.00	2026-05-23
26951	CPT	Amputation Of Finger/thumb	1	1	$2,289.13	$2,289.13	$365.00	$365.00	$365.00	2026-05-23
27043	CPT	Exc Hip Pelvis Les Sc 3 Cm/>	1	1	$1,300.23	$1,300.23	$365.00	$365.00	$365.00	2026-05-23
27200	CPT	Treat Tail Bone Fracture	1	1	$383.84	$383.84	$365.00	$365.00	$365.00	2026-05-23
27230	CPT	Treat Thigh Fracture	1	1	$513.46	$513.46	$365.00	$365.00	$365.00	2026-05-23
27250	CPT	Treat Hip Dislocation	1	1	$158.16	$158.16	$365.00	$365.00	$365.00	2026-05-23
27252	CPT	Treat Hip Dislocation	1	1	$3,981.46	$3,981.46	$365.00	$365.00	$365.00	2026-05-23
27265	CPT	Treat Hip Dislocation	1	1	$298.39	$298.39	$365.00	$365.00	$365.00	2026-05-23
27323	CPT	Biopsy Thigh Soft Tissues	1	1	$5,724.10	$5,724.10	$365.75	$365.75	$365.75	2026-05-23
27324	CPT	Biopsy Thigh Soft Tissues	1	1	$5,724.10	$5,724.10	$365.75	$365.75	$365.75	2026-05-23
27372	CPT	Removal Of Foreign Body	1	1	$61.12	$61.12	$365.00	$365.00	$365.00	2026-05-23
27500	CPT	Treatment Of Thigh Fracture	1	1	$570.30	$570.30	$365.00	$365.00	$365.00	2026-05-23
27502	CPT	Treatment Of Thigh Fracture	1	1	$2,207.14	$2,207.14	$365.00	$365.00	$365.00	2026-05-23
27503	CPT	Treatment Of Thigh Fracture	1	1	$1,543.46	$1,543.46	$365.00	$365.00	$365.00	2026-05-23
27520	CPT	Treat Kneecap Fracture	1	1	$634.84	$634.84	$365.00	$365.00	$365.00	2026-05-23
27530	CPT	Treat Knee Fracture	1	1	$836.76	$836.76	$365.00	$365.00	$365.00	2026-05-23
27550	CPT	Treat Knee Dislocation	1	1	$138.40	$138.40	$365.00	$365.00	$365.00	2026-05-23
27560	CPT	Treat Kneecap Dislocation	1	1	$138.39	$138.39	$365.00	$365.00	$365.00	2026-05-23
27562	CPT	Treat Kneecap Dislocation	1	1	$2,258.34	$2,258.34	$365.00	$365.00	$365.00	2026-05-23
27580	CPT	Fusion Of Knee	1	1	$2,789.31	$2,789.31	$365.00	$365.00	$365.00	2026-05-23
27750	CPT	Treatment Of Tibia Fracture	1	1	$261.09	$261.09	$365.00	$365.00	$365.00	2026-05-23
27760	CPT	Cltx Medial Ankle Fx	1	1	$138.40	$138.40	$365.00	$365.00	$365.00	2026-05-23
27767	CPT	Cltx Post Ankle Fx	1	1	$575.13	$575.13	$365.00	$365.00	$365.00	2026-05-23
27780	CPT	Treatment Of Fibula Fracture	1	1	$655.66	$655.66	$365.00	$365.00	$365.00	2026-05-23
27786	CPT	Treatment Of Ankle Fracture	1	1	$158.16	$158.16	$365.00	$365.00	$365.00	2026-05-23
27788	CPT	Treatment Of Ankle Fracture	1	1	$158.16	$158.16	$365.00	$365.00	$365.00	2026-05-23
27808	CPT	Treatment Of Ankle Fracture	1	1	$158.16	$158.16	$365.00	$365.00	$365.00	2026-05-23
27810	CPT	Treatment Of Ankle Fracture	1	1	$1,307.09	$1,307.09	$365.00	$365.00	$365.00	2026-05-23
27816	CPT	Treatment Of Ankle Fracture	1	1	$513.46	$513.46	$365.00	$365.00	$365.00	2026-05-23
27818	CPT	Treatment Of Ankle Fracture	1	1	$1,152.03	$1,152.03	$365.00	$365.00	$365.00	2026-05-23
27824	CPT	Treat Lower Leg Fracture	1	1	$261.09	$261.09	$365.00	$365.00	$365.00	2026-05-23
27840	CPT	Treat Ankle Dislocation	1	1	$151.16	$151.16	$365.00	$365.00	$365.00	2026-05-23
28080	CPT	Removal Of Foot Lesion	1	1	$3,200.82	$3,200.82	$365.75	$365.75	$365.75	2026-05-23
28124	CPT	Partial Removal Of Toe	1	1	$6,489.22	$6,489.22	$365.75	$365.75	$365.75	2026-05-23
28190	CPT	Removal Of Foot Foreign Body	1	1	$229.96	$229.96	$365.00	$365.00	$365.00	2026-05-23
28285	CPT	Repair Of Hammertoe	1	1	$3,406.68	$3,406.68	$365.75	$365.75	$365.75	2026-05-23
28289	CPT	Corrj Halux Rigdus Without Implt	1	1	$5,224.66	$5,224.66	$365.75	$365.75	$365.75	2026-05-23
28298	CPT	Cor Hlx Vlgs Prx Phlx Osteot	1	1	$3,534.54	$3,534.54	$365.75	$365.75	$365.75	2026-05-23
28400	CPT	Cltx Calcaneal Fx Without Mnpj	1	1	$261.09	$261.09	$365.00	$365.00	$365.00	2026-05-23
28430	CPT	Cltx Talus Fracture Without Mnpj	1	1	$506.35	$506.35	$365.00	$365.00	$365.00	2026-05-23
28450	CPT	Tx Tarsal B1 Fx Without Mnpj Ea	1	1	$407.98	$407.98	$365.00	$365.00	$365.00	2026-05-23
28470	CPT	Cltx Metatarsal Fx Wo Mnp Ea	1	1	$531.00	$531.00	$365.75	$365.75	$365.75	2026-05-23
28490	CPT	Treat Big Toe Fracture	1	1	$138.40	$138.40	$365.00	$365.00	$365.00	2026-05-23
28510	CPT	Treatment Of Toe Fracture	1	1	$220.60	$220.60	$365.00	$365.00	$365.00	2026-05-23
28515	CPT	Treatment Of Toe Fracture	1	1	$220.60	$220.60	$365.00	$365.00	$365.00	2026-05-23
28630	CPT	Treat Toe Dislocation	1	1	$138.40	$138.40	$365.00	$365.00	$365.00	2026-05-23
28660	CPT	Treat Toe Dislocation	1	1	$278.87	$278.87	$365.00	$365.00	$365.00	2026-05-23
28750	CPT	Fusion Of Big Toe Joint	1	1	$5,306.32	$5,306.32	$365.75	$365.75	$365.75	2026-05-23
28899	CPT	Unlisted Px Foot/toes	1	1	$621.03	$621.03	$365.75	$365.75	$365.75	2026-05-23
29065	CPT	Appl Cst Sho To Hand Lng Arm	1	1	$162.16	$162.16	$365.00	$365.00	$365.00	2026-05-23
29075	CPT	Appl Cst Elbw Fngr Short Arm	1	1	$100.42	$100.42	$365.00	$365.00	$365.00	2026-05-23
29105	CPT	Application Long Arm Splint	1	1	$117.42	$117.42	$365.00	$365.00	$365.00	2026-05-23
29125	CPT	Appl Short Arm Splint Static	1	1	$110.81	$110.81	$365.00	$365.00	$365.00	2026-05-23
29130	CPT	Appl Finger Splint Static	1	1	$116.19	$116.19	$365.00	$365.00	$365.00	2026-05-23
29200	CPT	Strapping Thorax	1	1	$156.39	$156.39	$365.00	$365.00	$365.00	2026-05-23
29240	CPT	Strapping Of Shoulder	1	1	$91.29	$91.29	$365.00	$365.00	$365.00	2026-05-23
29260	CPT	Strapping Of Elbow Or Wrist	1	1	$118.92	$118.92	$365.00	$365.00	$365.00	2026-05-23
29280	CPT	Strapping Of Hand Or Finger	1	1	$63.38	$63.38	$365.00	$365.00	$365.00	2026-05-23
29345	CPT	Application Of Long Leg Cast	1	1	$156.08	$156.08	$365.00	$365.00	$365.00	2026-05-23
29358	CPT	Appl Long Leg Cast Brace	1	1	$350.49	$350.49	$365.00	$365.00	$365.00	2026-05-23
29405	CPT	Appl Short Leg Cast	1	1	$141.90	$141.90	$365.00	$365.00	$365.00	2026-05-23
29425	CPT	Appl Short Leg Cast Walking	1	1	$85.20	$85.20	$365.00	$365.00	$365.00	2026-05-23
29505	CPT	Application Long Leg Splint	1	1	$137.94	$137.94	$365.00	$365.00	$365.00	2026-05-23
29515	CPT	Application Short Leg Splint	1	1	$132.50	$132.50	$365.00	$365.00	$365.00	2026-05-23
29530	CPT	Strapping Of Knee	1	1	$111.75	$111.75	$365.00	$365.00	$365.00	2026-05-23
29540	CPT	Strapping Ankle &/foot	1	1	$111.96	$111.96	$365.00	$365.00	$365.00	2026-05-23
29550	CPT	Strapping Of Toes	1	1	$53.63	$53.63	$365.00	$365.00	$365.00	2026-05-23
29581	CPT	Appl Multlayer Cmprn Sys Leg	1	1	$227.01	$227.01	$365.00	$365.00	$365.00	2026-05-23
29584	CPT	Appl Mltlay Cmprn Sys Up Arm	1	1	$122.66	$122.66	$365.00	$365.00	$365.00	2026-05-23
29700	CPT	Rmvl/bivlv Gauntlet Boot/cst	1	1	$53.63	$53.63	$365.00	$365.00	$365.00	2026-05-23
29740	CPT	Wedging Of Cast	1	1	$100.61	$100.61	$365.00	$365.00	$365.00	2026-05-23
30300	CPT	Remove Nasal Foreign Body	1	1	$45.79	$45.79	$365.00	$365.00	$365.00	2026-05-23
30901	CPT	Control Of Nosebleed	1	1	$161.50	$161.50	$365.00	$365.00	$365.00	2026-05-23
30903	CPT	Control Of Nosebleed	1	1	$130.81	$130.81	$365.00	$365.00	$365.00	2026-05-23
30905	CPT	Control Of Nosebleed	1	1	$100.62	$100.62	$365.00	$365.00	$365.00	2026-05-23
30906	CPT	Repeat Control Of Nosebleed	1	1	$88.04	$88.04	$365.00	$365.00	$365.00	2026-05-23
31500	CPT	Insert Emergency Airway	1	1	$352.18	$352.18	$365.00	$365.00	$365.00	2026-05-23
31502	CPT	Change Of Windpipe Airway	1	1	$144.69	$144.69	$365.00	$365.00	$365.00	2026-05-23
31505	CPT	Diagnostic Laryngoscopy	1	1	$51.23	$51.23	$365.00	$365.00	$365.00	2026-05-23
31515	CPT	Laryngoscopy For Aspiration	1	1	$1,196.23	$1,196.23	$365.00	$365.00	$365.00	2026-05-23
31530	CPT	Laryngoscopy W/fb Removal	1	1	$731.58	$731.58	$365.00	$365.00	$365.00	2026-05-23
32550	CPT	Insert Pleural Cath	1	1	$6,105.89	$6,105.89	$365.00	$365.00	$365.00	2026-05-23
32551	CPT	Insertion Of Chest Tube	1	1	$557.90	$557.90	$365.00	$365.00	$365.00	2026-05-23
32555	CPT	Aspirate Pleura With Imaging	1	1	$1,944.72	$250.00 87% off	$365.00	$365.00	$365.00	2026-05-23
33016	CPT	Pericardiocentesis W/imaging	1	1	$220.46	$220.46	$365.00	$365.00	$365.00	2026-05-23
33210	CPT	Insert Electrd/pm Cath Sngl	1	1	$1,594.43	$1,594.43	$365.00	$365.00	$365.00	2026-05-23
35207	CPT	Rpr Bld Vsl Dir Hand Finger	1	1	$1,284.73	$1,284.73	$365.00	$365.00	$365.00	2026-05-23
360	OTHER	—	1	1	$1,673.01	$1,673.01	$365.75	$365.75	$365.75	2026-05-23
36000	CPT	Place Needle In Vein	1	1	$48.89	$48.89	$365.00	$365.00	$365.00	2026-05-23
36100	CPT	Establish Access To Artery	1	1	$1,104.87	$1,104.87	$365.00	$365.00	$365.00	2026-05-23
36140	CPT	Intro Ndl Icath Upr/lxtr Art	1	1	$1,005.57	$1,005.57	$365.00	$365.00	$365.00	2026-05-23
36420	CPT	Venipuncture Cutdown < 1 Yr	1	1	$5.10	$5.10	$365.00	$365.00	$365.00	2026-05-23
36430	CPT	Transfusion Bld/bld Compnt	1	1	$307.81	$307.81	$365.00	$365.00	$365.00	2026-05-23
36513	CPT	Apheresis Platelets	1	1	$187.78	$187.78	$365.00	$365.00	$365.00	2026-05-23
36589	CPT	Removal Tunneled Cv Cath	1	1	$3,100.05	$3,100.05	$365.75	$365.75	$365.75	2026-05-23
38222	CPT	Dx Bone Marrow Bx & Aspir	1	1	$1,407.82	$1,407.82	$365.00	$365.00	$365.00	2026-05-23
40804	CPT	Removal Foreign Body Mouth	1	1	$316.36	$316.36	$365.00	$365.00	$365.00	2026-05-23
40810	CPT	Excision Of Mouth Lesion	1	1	$845.87	$845.87	$365.00	$365.00	$365.00	2026-05-23
40830	CPT	Repair Mouth Laceration	1	1	$101.65	$101.65	$365.00	$365.00	$365.00	2026-05-23
40831	CPT	Repair Mouth Laceration	1	1	$456.22	$456.22	$365.00	$365.00	$365.00	2026-05-23
41250	CPT	Repair Tongue Laceration	1	1	$116.17	$116.17	$365.00	$365.00	$365.00	2026-05-23
41252	CPT	Repair Tongue Laceration	1	1	$1,196.26	$1,196.26	$365.00	$365.00	$365.00	2026-05-23
41800	CPT	Drainage Of Gum Lesion	1	1	$222.45	$222.45	$365.00	$365.00	$365.00	2026-05-23
42809	CPT	Remove Pharynx Foreign Body	1	1	$36.59	$36.59	$365.00	$365.00	$365.00	2026-05-23
42960	CPT	Control Throat Bleeding	1	1	$404.78	$404.78	$365.00	$365.00	$365.00	2026-05-23
43235	CPT	Egd Diagnostic Brush Wash	2	1	$876.94	$876.94	$365.00	$365.75	$365.38	2026-05-23
43239	CPT	Egd Biopsy Single/multiple	2	1	$1,020.91	$1,020.91	$365.00	$365.75	$365.38	2026-05-23
43249	CPT	Esoph Egd Dilation <30 Mm	2	1	$1,134.89	$1,134.89	$365.00	$365.75	$365.38	2026-05-23
43251	CPT	Egd Remove Lesion Snare	1	1	$534.93	$534.93	$365.00	$365.00	$365.00	2026-05-23
43752	CPT	Nasal/orogastric W/tube Plmt	1	1	$79.56	$79.56	$365.00	$365.00	$365.00	2026-05-23
43753	CPT	Tx Gastro Intub W/asp	1	1	$173.58	$173.58	$365.00	$365.00	$365.00	2026-05-23
43754	CPT	Dx Gastr Intub W/asp Spec	1	1	$100.91	$100.91	$365.00	$365.00	$365.00	2026-05-23
43761	CPT	Reposition Gastrostomy Tube	1	1	$1,182.26	$1,182.26	$365.00	$365.00	$365.00	2026-05-23
43763	CPT	Rplc Gtube Revj Gstrst Trc	1	1	$432.04	$432.04	$365.00	$365.00	$365.00	2026-05-23
45330	CPT	Diagnostic Sigmoidoscopy	1	1	$2,484.11	$2,484.11	$365.75	$365.75	$365.75	2026-05-23
45333	CPT	Sigmoidoscopy & Polypectomy	1	1	$352.20	$352.20	$365.00	$365.00	$365.00	2026-05-23
45338	CPT	Sigmoidoscopy W/tumr Remove	1	1	$2,919.29	$2,919.29	$365.75	$365.75	$365.75	2026-05-23
45378	CPT	Diagnostic Colonoscopy	3	1	$2,608.32	$2,608.32	$365.00	$365.75	$365.75	2026-05-23
45379	CPT	Colonoscopy W/fb Removal	2	1	$1,641.84	$1,641.84	$365.00	$365.75	$365.38	2026-05-23
45380	CPT	Colonoscopy And Biopsy	3	1	$1.00	$1.00	$365.00	$365.75	$365.75	2026-05-23
45381	CPT	Colonoscopy Submucous Njx	2	1	$1,587.68	$1,587.68	$365.00	$365.75	$365.38	2026-05-23
45384	CPT	Colonoscopy W/lesion Removal	2	1	$1,678.89	$1,678.89	$365.00	$365.75	$365.38	2026-05-23
45385	CPT	Colonoscopy W/lesion Removal	3	1	$2,165.82	$2,165.82	$365.00	$365.75	$365.75	2026-05-23
45388	CPT	Colonoscopy W/ablation	3	1	$2,608.32	$2,608.32	$365.00	$365.75	$365.75	2026-05-23
46040	CPT	I&d Ischiorct&/perirct Absc	1	1	$253.39	$253.39	$365.00	$365.00	$365.00	2026-05-23
46050	CPT	I&d Perianal Abscess Supfc	1	1	$115.26	$115.26	$365.00	$365.00	$365.00	2026-05-23
46083	CPT	Inc Thrombosed Hroid Xtrnl	1	1	$115.26	$115.26	$365.00	$365.00	$365.00	2026-05-23
46320	CPT	Removal Of Hemorrhoid Clot	2	1	$1,442.45	$1,442.45	$365.00	$365.75	$365.38	2026-05-23
47562	CPT	Laparoscopic Cholecystectomy	2	1	$1,272.61	$1,272.61	$365.00	$365.75	$365.38	2026-05-23
49591	CPT	Rpr Aa Hrn 1st < 3 Cm Rdc	1	1	$7,058.12	$7,058.12	$365.75	$365.75	$365.75	2026-05-23
49593	CPT	Rpr Aa Hrn 1st 3-10 Rdc	1	1	$12,479.50	$12,479.50	$365.75	$365.75	$365.75	2026-05-23
55250	CPT	Removal Of Sperm Duct(s)	2	1	$907.31	$907.31	$365.00	$365.75	$365.38	2026-05-23
58600	CPT	Division Of Fallopian Tube	1	1	$1,191.52	$1,191.52	$365.75	$365.75	$365.75	2026-05-23
58661	CPT	Laparoscopy Remove Adnexa	2	1	$6,385.06	$6,385.06	$365.00	$365.75	$365.38	2026-05-23
92613	CPT	Endoscopy Swallow (fees) I&r	2	1	$102.56	$102.56	$365.00	$365.75	$365.38	2026-05-23
97802	CPT	Medical Nutrition Indiv In	2	1	$110.48	$110.48	$365.00	$365.75	$365.38	2026-05-23
97803	CPT	Med Nutrition Indiv Subseq	2	1	$105.92	$105.92	$365.00	$365.75	$365.38	2026-05-23
99199	CPT	Unlisted Special Svc Px/rprt	2	1	$181.07	$181.07	$365.00	$365.75	$365.38	2026-05-23
99211	CPT	Off/op Est May X Req Phy/qhp	2	1	$669.50	$669.50	$365.00	$365.75	$365.38	2026-05-23
99255	CPT	Ip/obs Consltj New/est Hi 80	2	1	$575.61	$575.61	$365.00	$365.75	$365.38	2026-05-23
99304	CPT	1st Nf Care Sf/low Mdm 25	2	1	$169.46	$169.46	$365.00	$365.75	$365.38	2026-05-23
99305	CPT	1st Nf Care Moderate Mdm 35	2	1	$214.00	$214.00	$365.00	$365.75	$365.38	2026-05-23
99306	CPT	1st Nf Care High Mdm 50	2	1	$471.12	$471.12	$365.00	$365.75	$365.38	2026-05-23
99307	CPT	Sbsq Nf Care Sf Mdm 10	2	1	$150.84	$150.84	$365.00	$365.75	$365.38	2026-05-23
99308	CPT	Sbsq Nf Care Low Mdm 20	2	1	$260.56	$260.56	$365.00	$365.75	$365.38	2026-05-23
99309	CPT	Sbsq Nf Care Moderate Mdm 30	2	1	$343.68	$343.68	$365.00	$365.75	$365.38	2026-05-23
99310	CPT	Sbsq Nf Care High Mdm 45	2	1	$380.64	$380.64	$365.00	$365.75	$365.38	2026-05-23
99315	CPT	Nf Dschrg Mgmt 30 Min/less	2	1	$274.72	$274.72	$365.00	$365.75	$365.38	2026-05-23
99316	CPT	Nf Dschrg Mgmt 30 Min+	2	1	$394.44	$394.44	$365.00	$365.75	$365.38	2026-05-23
99418	CPT	Prolng Ip/obs E/m Ea 15 Min	2	1	$344.96	$344.96	$365.00	$365.75	$365.38	2026-05-23
G0105	HCPCS	Prof Fee Colonoscopy High Risk	2	1	$1,565.27	$1,565.27	$365.00	$365.75	$365.38	2026-05-23
G0121	HCPCS	Prof Fee Colonoscopy Not High Risk	2	1	$1,565.27	$1,565.27	$365.00	$365.75	$365.38	2026-05-23
G0463	HCPCS	Hospital Outpatient Clinic Visit	2	1	$220.12	$220.12	$365.00	$365.75	$365.38	2026-05-23

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