Hospital

GLEN ROSE MEDICAL CENTER

Glen Rose, TX · CCN 450451 · Rates published

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You selected 93306 (CPT)

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This hospital’s price: $1,401 across 8 payers · range $921-$1,902

Source: https://secure.claraprice.net/price-transparency/NUH2773072790/machine-readable/463085950_glen-rose-medical-center_standardcharges.json · observed 2025-08-22

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

4,319 distinct procedures filed

9 distinct payers

52,355 rate rows

2026-07-31 last MRF observed

Data quality

50,733 of 52,355 rate rows are consumer-grade (96.9%)

1,622 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	1,622

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

Source MRF file	https://secure.claraprice.net/price-transparency/NUH2773072790/machine-readable/463085950_glen-rose-medical-center_standardcharges.json
Found on page	https://secure.claraprice.net/price-transparency/glen-rose
Discovered via	Discovered by HANK
Last fetch	success · 2026-09-25
Content fingerprint	9d507f7798a1bbbf… · 253,267 bytes · first seen 2026-05-18

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
L8687 HCPCS	Implantable Nero Pgen 2ar Recharge +Ext	8	$82,355.00	$170,080.00	$125,322.00	nat. median $14,605 outlier · 8.6×
L8679 HCPCS	Implantable Nero Pulse Generator	8	$82,355.00	$170,080.00	$125,322.00	nat. median $10,964 outlier · 11.4×
L8686 HCPCS	Implantable Nero Pgen 1array No-recharge	8	$82,355.00	$170,080.00	$125,322.00	nat. median $7,230 outlier · 17.3×
L8688 HCPCS	Implantable Nero Pgen 2ar No-recharge+ex	8	$82,355.00	$170,080.00	$125,322.00	nat. median $12,140 outlier · 10.3×
38240 CPT	Bone Marrrow/blood Derive	8	$65,298.00	$134,855.00	$99,367.00	nat. median $12,855 outlier · 7.7×
49560 CPT	Rep Init Inc/ven Hernia W/52 Modifier	8	$5,172.00	$295,841.00	$76,965.50	nat. median $3,041 outlier · 25.3×
63685 CPT	Ins/rep Spinal Neurostim	8	$47,849.00	$98,819.00	$72,814.00	nat. median $21,040 outlier · 3.5×
27279 CPT	Arthrodesis Sacroiliac Jt Perq/min Nvas	8	$34,853.00	$71,979.00	$53,037.00	nat. median $17,324 outlier · 3.1×
64590 CPT	Ins/plce Perip/gast Neuro Replacement	8	$33,284.00	$68,739.00	$50,650.00	nat. median $17,881 outlier · 2.8×
63655 CPT	Laminectomy For Implant Neuro Electrodes	8	$33,173.00	$68,510.00	$50,481.00	nat. median $18,228 outlier · 2.8×
44150 CPT	Colectomy Total Abdominal Without Proctectom	8	$32,164.00	$66,426.00	$48,945.00	nat. median $3,333 outlier · 14.7×
64575 CPT	Inc For Implant Of Neurostim	8	$31,332.00	$64,706.00	$47,678.00	nat. median $11,873 outlier · 4.0×
54401 CPT	Insert Penile Prosth Infl	8	$29,688.00	$61,312.00	$45,177.00	nat. median $18,545 outlier · 2.4×
54410 CPT	Penile Pros Replacement	8	$29,688.00	$61,312.00	$45,177.00	nat. median $17,694 outlier · 2.6×
54405 CPT	Insert Penile Prosth Mult	8	$29,688.00	$61,312.00	$45,177.00	nat. median $18,590 outlier · 2.4×
23470 CPT	Arthroplasty Glenohumeral	8	$20,044.00	$41,394.00	$30,501.00	nat. median $12,420 outlier · 2.5×
24579 CPT	Opn Tx Humeral Condyl Fx	8	$20,044.00	$41,394.00	$30,501.00	nat. median $11,086 outlier · 2.8×
23472 CPT	Reconstruct Shoulder, Total Ip Only	8	$20,044.00	$41,394.00	$30,501.00	nat. median $16,677 1.8× median
24515 CPT	Opn Tx Humeral Shaft Fx W	8	$20,044.00	$41,394.00	$30,501.00	nat. median $11,494 outlier · 2.7×
24666 CPT	Opn Tx Radial Head/neck Fracture	8	$20,044.00	$41,394.00	$30,501.00	nat. median $10,791 outlier · 2.8×
29867 CPT	Arthrscpy Knee Ostechnd A	8	$20,044.00	$41,394.00	$30,501.00	nat. median $12,102 outlier · 2.5×
20692 CPT	Apply Bone Fixation Devic	8	$20,044.00	$41,394.00	$30,501.00	nat. median $8,566 outlier · 3.6×
28735 CPT	Midtarsal Fusion	8	$20,044.00	$41,394.00	$30,501.00	nat. median $11,242 outlier · 2.7×
28725 CPT	Subtalar Fusion	8	$20,044.00	$41,394.00	$30,501.00	nat. median $10,564 outlier · 2.9×
28737 CPT	Arthrodesis W/tendon	8	$20,044.00	$41,394.00	$30,501.00	nat. median $11,274 outlier · 2.7×
29889 CPT	Knee Arthroscopy- Posterior Cruciate Lig	8	$20,044.00	$41,394.00	$30,501.00	nat. median $11,552 outlier · 2.6×
28715 CPT	Triple Arthrodesis	8	$20,044.00	$41,394.00	$30,501.00	nat. median $11,408 outlier · 2.7×
23615 CPT	Orif Proximal Humeral Fx Left	8	$20,043.00	$41,394.00	$30,501.00	nat. median $11,353 outlier · 2.7×
27759 CPT	Tibial Shaft Fract W/wo R	8	$20,044.00	$41,394.00	$30,501.00	nat. median $10,667 outlier · 2.9×
27415 CPT	Osteochon Allograft With Rt Modifier	8	$20,044.00	$41,394.00	$30,501.00	nat. median $11,847 outlier · 2.6×
27429 CPT	Intr&extr-artclr Lig Rcns	8	$20,044.00	$41,394.00	$30,501.00	nat. median $11,277 outlier · 2.7×
24516 CPT	Tx Humeral Shaft Fx W/imp	8	$20,044.00	$41,394.00	$30,501.00	nat. median $11,344 outlier · 2.7×
24586 CPT	Treatment Of Fracture	8	$20,044.00	$41,394.00	$30,501.00	nat. median $11,251 outlier · 2.7×
27428 CPT	Reconstruction Kneelt	8	$20,044.00	$41,394.00	$30,501.00	nat. median $11,589 outlier · 2.6×
27446 CPT	Arthro Knee Condyle & Pla	8	$20,044.00	$41,394.00	$30,501.00	nat. median $12,418 outlier · 2.5×
27447 CPT	Total Knee Replacmnt	8	$20,044.00	$41,394.00	$30,501.00	nat. median $12,739 outlier · 2.4×
27827 CPT	Opn Tx Of Fx Wt Bear Tibi	8	$20,044.00	$41,394.00	$30,501.00	nat. median $11,028 outlier · 2.8×
27870 CPT	Arthrodesis	8	$20,044.00	$41,394.00	$30,501.00	nat. median $10,917 outlier · 2.8×
24430 CPT	Nonunion Of Fracture	8	$20,044.00	$41,394.00	$30,501.00	nat. median $11,512 outlier · 2.6×
27130 CPT	Total Hip Replacement	8	$20,044.00	$41,394.00	$30,501.00	nat. median $13,091 outlier · 2.3×
28730 CPT	Arthrd Midtarsl/tarsomettrsl Mult Rt	8	$20,044.00	$41,394.00	$30,501.00	nat. median $10,638 outlier · 2.9×
C1820 HCPCS	Eterna System	8	$19,734.00	$40,755.00	$30,030.00	nat. median $22,969 1.3× median
60212 CPT	Partial Thyroid W/contra	8	$19,340.00	$39,942.00	$29,431.00	nat. median $6,009 outlier · 4.9×
54400 CPT	Insert Penile Prosth Non-	8	$18,670.00	$38,557.00	$28,410.00	nat. median $12,369 outlier · 2.3×
33228 CPT	Rmvl Perm Pm Pls Gen W Repl Dual Chamber	8	$16,902.00	$34,906.00	$25,720.00	nat. median $11,450 outlier · 2.2×
33208 CPT	Dual Chamber Pacemaker Insertion	8	$16,902.00	$34,906.00	$25,720.00	nat. median $11,862 outlier · 2.2×
33207 CPT	Dual Chamber Pacemaker Insertion	8	$16,856.00	$34,811.00	$25,650.00	nat. median $11,506 outlier · 2.2×
J2997 HCPCS	Activase (t-pa) 100 Mg	8	$16,808.00	$34,712.00	$25,577.00	nat. median $500 outlier · 51.2×
37244 CPT	Vasc Embolize/occlude Bleed	8	$16,327.00	$33,719.00	$24,846.00	nat. median $12,394 outlier · 2.0×
19325 CPT	Breast Augment W/implant	8	$14,494.00	$29,933.00	$22,056.00	nat. median $8,839 outlier · 2.5×

Other procedures at this hospital

Browse this hospital's 4,319 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

L8688	HCPCS	Implantable Nero Pgen 2ar No-recharge+ex	14	8	$179,032.00	$179,032.00	$82,355.00	$170,080.00	$125,322.00	2025-08-22
L8686	HCPCS	Implantable Nero Pgen 1array No-recharge	14	8	$179,032.00	$179,032.00	$82,355.00	$170,080.00	$125,322.00	2025-08-22
L8687	HCPCS	Implantable Nero Pgen 2ar Recharge +Ext	14	8	$179,032.00	$179,032.00	$82,355.00	$170,080.00	$125,322.00	2025-08-22
L8679	HCPCS	Implantable Nero Pulse Generator	14	8	$179,032.00	$179,032.00	$82,355.00	$170,080.00	$125,322.00	2025-08-22
38240	CPT	Bone Marrrow/blood Derive	14	8	$141,953.00	$141,953.00	$65,298.00	$134,855.00	$99,367.00	2025-08-22
49560	CPT	Rep Init Inc/ven Hernia W/52 Modifier	28	8	$161,327.50	$161,327.50	$5,172.00	$295,841.00	$76,965.50	2025-08-22
63685	CPT	Ins/rep Spinal Neurostim	14	8	$104,020.00	$104,020.00	$47,849.00	$98,819.00	$72,814.00	2025-08-22
27279	CPT	Arthrodesis Sacroiliac Jt Perq/min Nvas	14	8	$75,767.00	$75,767.00	$34,853.00	$71,979.00	$53,037.00	2025-08-22
64590	CPT	Ins/plce Perip/gast Neuro Replacement	14	8	$72,357.00	$72,357.00	$33,284.00	$68,739.00	$50,650.00	2025-08-22
63655	CPT	Laminectomy For Implant Neuro Electrodes	14	8	$72,116.00	$72,116.00	$33,173.00	$68,510.00	$50,481.00	2025-08-22
44150	CPT	Colectomy Total Abdominal Without Proctectom	14	8	$69,922.00	$69,922.00	$32,164.00	$66,426.00	$48,945.00	2025-08-22
64575	CPT	Inc For Implant Of Neurostim	14	8	$68,112.00	$68,112.00	$31,332.00	$64,706.00	$47,678.00	2025-08-22
54410	CPT	Penile Pros Replacement	14	8	$64,539.00	$64,539.00	$29,688.00	$61,312.00	$45,177.00	2025-08-22
54401	CPT	Insert Penile Prosth Infl	14	8	$64,539.00	$64,539.00	$29,688.00	$61,312.00	$45,177.00	2025-08-22
54405	CPT	Insert Penile Prosth Mult	14	8	$64,539.00	$64,539.00	$29,688.00	$61,312.00	$45,177.00	2025-08-22
29889	CPT	Knee Arthroscopy- Posterior Cruciate Lig	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
23470	CPT	Arthroplasty Glenohumeral	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
24515	CPT	Opn Tx Humeral Shaft Fx W	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
27827	CPT	Opn Tx Of Fx Wt Bear Tibi	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
27429	CPT	Intr&extr-artclr Lig Rcns	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
27759	CPT	Tibial Shaft Fract W/wo R	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
27130	CPT	Total Hip Replacement	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
29867	CPT	Arthrscpy Knee Ostechnd A	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
27428	CPT	Reconstruction Kneelt	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
28730	CPT	Arthrd Midtarsl/tarsomettrsl Mult Rt	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
24579	CPT	Opn Tx Humeral Condyl Fx	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
20692	CPT	Apply Bone Fixation Devic	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
28735	CPT	Midtarsal Fusion	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
28725	CPT	Subtalar Fusion	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
28737	CPT	Arthrodesis W/tendon	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
27415	CPT	Osteochon Allograft With Rt Modifier	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
27446	CPT	Arthro Knee Condyle & Pla	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
24666	CPT	Opn Tx Radial Head/neck Fracture	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
27870	CPT	Arthrodesis	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
24430	CPT	Nonunion Of Fracture	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
23472	CPT	Reconstruct Shoulder, Total Ip Only	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
24586	CPT	Treatment Of Fracture	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
27447	CPT	Total Knee Replacmnt	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
28715	CPT	Triple Arthrodesis	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
23615	CPT	Orif Proximal Humeral Fx Left	24	8	$43,573.00	$43,573.00	$20,043.00	$41,394.00	$30,501.00	2025-08-22
24516	CPT	Tx Humeral Shaft Fx W/imp	14	8	$43,573.00	$43,573.00	$20,044.00	$41,394.00	$30,501.00	2025-08-22
C1820	HCPCS	Eterna System	14	8	$42,900.00	$42,900.00	$19,734.00	$40,755.00	$30,030.00	2025-08-22
60212	CPT	Partial Thyroid W/contra	14	8	$42,044.00	$42,044.00	$19,340.00	$39,942.00	$29,431.00	2025-08-22
54400	CPT	Insert Penile Prosth Non-	14	8	$40,586.00	$40,586.00	$18,670.00	$38,557.00	$28,410.00	2025-08-22
33228	CPT	Rmvl Perm Pm Pls Gen W Repl Dual Chamber	14	8	$36,743.00	$36,743.00	$16,902.00	$34,906.00	$25,720.00	2025-08-22
33208	CPT	Dual Chamber Pacemaker Insertion	14	8	$36,743.00	$36,743.00	$16,902.00	$34,906.00	$25,720.00	2025-08-22
33207	CPT	Dual Chamber Pacemaker Insertion	14	8	$36,643.00	$36,643.00	$16,856.00	$34,811.00	$25,650.00	2025-08-22
J2997	HCPCS	Activase (t-pa) 100 Mg	14	8	$36,539.00	$36,539.00	$16,808.00	$34,712.00	$25,577.00	2025-08-22
37244	CPT	Vasc Embolize/occlude Bleed	14	8	$35,494.00	$35,494.00	$16,327.00	$33,719.00	$24,846.00	2025-08-22
19325	CPT	Breast Augment W/implant	14	8	$31,508.00	$31,508.00	$14,494.00	$29,933.00	$22,056.00	2025-08-22
55866	CPT	Surgical Removal Of Prostate And Surrounding Lymph Nodes Using An Endoscope	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
49655	CPT	Lap Inc Hernia Repair Comp	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
58573	CPT	Lap Tot Hyst W/t/o Ut>250g	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
57425	CPT	Laparoscopy Copopexy (Vag Susp)	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
58554	CPT	Lavh W/removal Tube(s)/ov	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
58572	CPT	Lap Tot Hyst Uterus>250g	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
58571	CPT	Lap Totalhyst 250g/less W/tube/ov Remov	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
58552	CPT	Lavh;w/rem Tube & Or Ovar	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
49656	CPT	Lap Inc Hernia Repair Recur	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
49657	CPT	Incarcerated Or Strangula	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
38571	CPT	Laparoscopy Lymphadenectomy	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
50543	CPT	Laparoscopy Partial Nephrectomy	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
49654	CPT	Lap Inc Hernia Repair	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
58570	CPT	Lap Total Hyst 250g Or Less	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
43280	CPT	Laparoscopy Fundoplasty	14	8	$31,474.00	$31,474.00	$14,478.00	$29,900.00	$22,032.00	2025-08-22
58546	CPT	Laparo-myomectomy Complex	14	8	$31,442.00	$31,442.00	$14,463.00	$29,870.00	$22,009.00	2025-08-22
58542	CPT	Lsh W/t/o Ut 250 G Or Less	14	8	$31,442.00	$31,442.00	$14,463.00	$29,870.00	$22,009.00	2025-08-22
50080	CPT	Removal Kidney Stone	14	8	$29,164.00	$29,164.00	$13,415.00	$27,706.00	$20,415.00	2025-08-22
33285	CPT	Insert Subcutaneous Cardiac Rhythm Moni	14	8	$28,830.00	$28,830.00	$13,262.00	$27,389.00	$20,181.00	2025-08-22
33282	CPT	Implantation Cardiac	14	8	$28,134.00	$28,134.00	$12,942.00	$26,727.00	$19,694.00	2025-08-22
57285	CPT	Repair Paravag Defect Vag	14	8	$23,989.00	$23,989.00	$11,035.00	$22,790.00	$16,792.00	2025-08-22
58290	CPT	Vag Hyst Uterus /250grams	14	8	$23,989.00	$23,989.00	$11,035.00	$22,790.00	$16,792.00	2025-08-22
57426	CPT	Revision W/removal Of Prosth Vag Graft	14	8	$23,989.00	$23,989.00	$11,035.00	$22,790.00	$16,792.00	2025-08-22
58920	CPT	Partial Removal Of Ovary(s)	14	8	$23,989.00	$23,989.00	$11,035.00	$22,790.00	$16,792.00	2025-08-22
57282	CPT	Rep Of Vaginal Prolapse	14	8	$23,989.00	$23,989.00	$11,035.00	$22,790.00	$16,792.00	2025-08-22
29888	CPT	Arthroscopy-acl Reconstru Rt	28	8	$23,625.00	$23,625.00	$10,182.00	$23,860.00	$16,463.00	2025-08-22
22513	CPT	Percut/verteb/augmentatio Thoracic	14	8	$22,887.00	$22,887.00	$10,528.00	$21,743.00	$16,021.00	2025-08-22
22514	CPT	Percut/verteb/augmentatio Lumbar	14	8	$22,887.00	$22,887.00	$10,528.00	$21,743.00	$16,021.00	2025-08-22
27524	CPT	Opn Tx Patellar Fx W/inte Left	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
25628	CPT	Opn Tx Carpal Scaphoid Fx	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
24685	CPT	Opn Tx Ulnar Fx Proximal W/mod Rt	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
20902	CPT	Bone Graft Major Or Large	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
25608	CPT	Orif Dstl Rad Fx Intraart 2 Frags 50 Mod	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
25575	CPT	Opn Tx Radial & Ulnar Sha	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
23405	CPT	Tenotomy, Shoulder Area, Single Tendon	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
28299	CPT	Osteotomy Double	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27422	CPT	Patella Stabilization	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
23515	CPT	Opn Tx Clavicular Fx W/wo	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
25263	CPT	Rep Forearm Tendon/muscle	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
25607	CPT	Opn Repair Radius/ulna W/rt Modifier	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
25440	CPT	Rep Nonunion Carpal Bone	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
23670	CPT	Opn Tx Shldr Disloc/w Fx	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
29887	CPT	Drill Osteochon Intern Fix	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
25390	CPT	Osteoplasty Radius Or Uln	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
23410	CPT	Rep Ruptured Rotator Cuff W/mod Lt & 73	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
24538	CPT	Clsd Supracondylar Hum Fx With Perc Fix	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
28297	CPT	Hallux Valgus Rep Lapidus	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
20900	CPT	Rem Of Bone For Graft	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
28300	CPT	Incision Of Heel Bone	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27400	CPT	Trnsfr Tendn/musc Hamstri	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
28306	CPT	Osteotomy W/wo Correction	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27405	CPT	Repair Prim Torn Ligamnt Knee W/mod Lt	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
23412	CPT	Rep Of Rotator Cuff Opn Lt	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
25609	CPT	Orif Dstl Radius Fx =>3 Frags	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27427	CPT	Ligamentous Reconst;knee	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27829	CPT	Open Trmt Distal Tibiofib	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
23455	CPT	Capsulorrhapy W/labral Re	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
28238	CPT	Recon Tibial Tendon W/lt Mod	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
25545	CPT	Opn Red Fx Rad/ulna W/int W/mod Lt	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27350	CPT	Patellectomy/orhemipatell	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
28485	CPT	Opn Tx Metatarsal Fx W/wo With Rt Modifier	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
26352	CPT	Rep Or Advance Flexor Tendon W/free Graf	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27822	CPT	Opn Tx Trimalleolar Ankle	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27823	CPT	Open Reduction W/fixation	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
28465	CPT	Opn Tx Tarsal Bone Fx W/w	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
23430	CPT	Tenodesis Of Long Tendon W/mod Lt	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
28298	CPT	Hallus Valqus (Bunion), By Phalanx Osteo	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
23660	CPT	Open Red Disloc Shlder	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
28305	CPT	Osteotomy W/autograft	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
20982	CPT	Ablation Bone Tumor Radio	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
28304	CPT	Incision Of Mid Foot Bone	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27766	CPT	Opn Tx Fx Med Malleolus W/mod Rt	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27792	CPT	Treatment Of Ankle Fractu	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
28750	CPT	Arthrodesis Great Toe	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
23420	CPT	Rep Shoulder Cuff Avulsio	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27814	CPT	Open Tx/ankle Fx W/mod Lt	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
26531	CPT	Arthroplasty Metacarp W/i	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
25515	CPT	Treat Fracture Of Radius	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
29828	CPT	Arthroscopy Shoulder Debridement Lmtd Rt	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
25400	CPT	Rep Nonunion/malunion Rad	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
28202	CPT	Rep Flexor Tendon Foot With Free Graft	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27696	CPT	Repair Colateral Lig	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
23550	CPT	Opn Tx Acromioclavicular	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27235	CPT	Percutaneous Tx Of Femoral Fractu Rt	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
25652	CPT	Opn Tx Ulnar Styloid Fxrt	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27698	CPT	Sut Sec Rep Torn Rupt Sev	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
28740	CPT	Arthrodesis Midtarsal/tar	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27418	CPT	Repair Degenerated Kneecap W/mod Rt	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27691	CPT	Repair Deep Tendon	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
29806	CPT	Arthro Shldr Surg Capsulo	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
29807	CPT	Arthro Shldr Rpr Slap Les	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
20690	CPT	Appl Uniplane Uni Ext Fix	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
29820	CPT	Arthoscopy Shoulder-lt Synovectomy, Part	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
24342	CPT	Repair Rupt Bicep/tricep W/wo Grft W/lt	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27654	CPT	Repair Achilles Tendon/gr	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
23415	CPT	Coracoacromial Lig Releas	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27650	CPT	Prim Repr Achilles Tendon	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
28415	CPT	Open Trmt Fracture/wfix	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
24665	CPT	Orif Radial Head/neck Fx W/mod Lt	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27695	CPT	Prim Repr Collatral Lig A	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27380	CPT	Suture Infrapatellar Tendon Left	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
29827	CPT	Shoulder Arthroscopy/surg-rt	14	8	$22,134.00	$22,134.00	$10,182.00	$21,027.00	$15,494.00	2025-08-22
27596	CPT	Reamputation Femur/knee W/mod Lt	14	8	$22,133.00	$22,133.00	$10,181.00	$21,026.00	$15,493.00	2025-08-22
27236	CPT	Open Tx Of Femoral Fractu	14	8	$22,133.00	$22,133.00	$10,181.00	$21,026.00	$15,493.00	2025-08-22
63663	CPT	Rev Incl Repl Spinal Neurostim	14	8	$21,859.00	$21,859.00	$10,055.00	$20,766.00	$15,301.00	2025-08-22
64581	CPT	Sacral Nerve (Transforaminal Placement)	14	8	$21,859.00	$21,859.00	$10,055.00	$20,766.00	$15,301.00	2025-08-22
63650	CPT	Perc Implantation Of Neurostim Epid	14	8	$21,859.00	$21,859.00	$10,055.00	$20,766.00	$15,301.00	2025-08-22
64561	CPT	Sacral Nerve (Transforaminal)test	14	8	$21,859.00	$21,859.00	$10,055.00	$20,766.00	$15,301.00	2025-08-22
31287	CPT	Nasal/sinsus Endo W/sphen W/50	14	8	$20,578.00	$20,578.00	$9,466.00	$19,549.00	$14,405.00	2025-08-22
31297	CPT	Sinus Endo W/balloon Dil W/50 59 Mod	14	8	$20,578.00	$20,578.00	$9,466.00	$19,549.00	$14,405.00	2025-08-22
31288	CPT	Nasal/sinus Endosur Rt	14	8	$20,578.00	$20,578.00	$9,466.00	$19,549.00	$14,405.00	2025-08-22
31267	CPT	Nasal/sinus Endoscopy	14	8	$20,578.00	$20,578.00	$9,466.00	$19,549.00	$14,405.00	2025-08-22
31276	CPT	Nasal/sinus Endoscopy	14	8	$20,578.00	$20,578.00	$9,466.00	$19,549.00	$14,405.00	2025-08-22
31254	CPT	Nasal/sinus Endoscopy	14	8	$20,578.00	$20,578.00	$9,466.00	$19,549.00	$14,405.00	2025-08-22
31253	CPT	A/p Totl Nasal W/expl/tiss Remv W/mod Rt	14	8	$20,578.00	$20,578.00	$9,466.00	$19,549.00	$14,405.00	2025-08-22
31255	CPT	Nasal/sinus Endo Complete Left	14	8	$20,578.00	$20,578.00	$9,466.00	$19,549.00	$14,405.00	2025-08-22
62365	CPT	Rem Of Subcutaneous Reser	14	8	$20,151.00	$20,151.00	$9,269.00	$19,143.00	$14,106.00	2025-08-22
C1767	HCPCS	Interstim Neurostimulator 3058 Replace	14	8	$19,694.00	$19,694.00	$9,059.00	$18,709.00	$13,786.00	2025-08-22
19380	CPT	Revise Breast Reconstruct	14	8	$19,556.00	$19,556.00	$8,996.00	$18,578.00	$13,689.00	2025-08-22
19318	CPT	Reduction Mammaplasty	14	8	$19,556.00	$19,556.00	$8,996.00	$18,578.00	$13,689.00	2025-08-22
19316	CPT	Suspension Of Breast	14	8	$19,556.00	$19,556.00	$8,996.00	$18,578.00	$13,689.00	2025-08-22
19307	CPT	Mast Mod/rad Excl Pect Ma	14	8	$19,556.00	$19,556.00	$8,996.00	$18,578.00	$13,689.00	2025-08-22
19303	CPT	Mastectomy Simple Complet	14	8	$19,556.00	$19,556.00	$8,996.00	$18,578.00	$13,689.00	2025-08-22
19302	CPT	Mast/w Axil/lymphadenecto	14	8	$19,556.00	$19,556.00	$8,996.00	$18,578.00	$13,689.00	2025-08-22
15830	CPT	Exc Excess Skin & Sq;abd	14	8	$19,556.00	$19,556.00	$8,996.00	$18,578.00	$13,689.00	2025-08-22
44238	CPT	Unlisted Laparoscopy, Intestine Exc Rect	14	8	$19,022.00	$19,022.00	$8,750.00	$18,071.00	$13,315.00	2025-08-22
J3101	HCPCS	Tnkase (Tenecteplase) Vial 50mg	14	8	$18,674.00	$18,674.00	$8,590.00	$17,740.00	$13,072.00	2025-08-22
49594	CPT	Rpr Aa Hernia 1st 3-10 Ncr/strn	14	8	$18,034.00	$18,034.00	$8,296.00	$17,132.00	$12,624.00	2025-08-22
49592	CPT	Repair Ant Abd Hernia 1st W/prost <3 Cm	14	8	$18,034.00	$18,034.00	$8,296.00	$17,132.00	$12,624.00	2025-08-22
30420	CPT	Rhinoplasty Primary;incl	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
21365	CPT	Opn Red Of Malar & Zygoma	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
42425	CPT	Tot En Bloc Rem W/sacrifi	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
42420	CPT	Exc Parotid Tumor/gland	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
69631	CPT	Repair Eardrum Structures	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
69641	CPT	Tmpanoplasty W/mastoidect	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
21210	CPT	Graft Bone;nasal Maxillar	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
60502	CPT	Re-expl Of Parathroids	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
60500	CPT	Parathyroidectomy Explora	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
31032	CPT	Sinusotomy Axil;rad Rem P	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
31050	CPT	Sinustomy Sphenoid W/wo B	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
30450	CPT	Rhinoplasty Major Rev(nas	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
42890	CPT	Partial Removal Of Pharynx	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
31051	CPT	Sinus/sphenoid W/mucos St	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
30580	CPT	Repair Fistula Oromaxilla	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
42825	CPT	Tonsilectmy;prim/sec<12yr	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
30600	CPT	Repair Fistula, Oronasal	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
42842	CPT	Extensive Surgery Of Throat	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
42440	CPT	Exc Submaxillary Gland	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
42415	CPT	Exc Parotid Gland/lesion	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
42815	CPT	Excision Of Neck Cyst	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
42145	CPT	Palatopharyngoplasty	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
42410	CPT	Exc Parotid Tumor Gland;l	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
42820	CPT	Removal Of Tonsils And Adenoid Glands, Patient Younger Than Age 12	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
42844	CPT	Extensive Surgery Of Throat	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
31090	CPT	Exploration Of Sinuses	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
40527	CPT	Exc Of Lip Full Thick Rec	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
30400	CPT	Rhinoplasty	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
41120	CPT	Partial Removal Of Tongue	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
30410	CPT	Rhinoplasty Complete	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
42870	CPT	Excision Of Lingual Tonsil	14	8	$17,972.00	$17,972.00	$8,267.00	$17,073.00	$12,580.00	2025-08-22
60210	CPT	Prtl Thyroid Lobectomy Rt	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
32607	CPT	Thoracbscopy W/bx Infiltrate	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
49659	CPT	Unlisted Lap Hernioplasty	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
49653	CPT	Hernia-umbilical-incarcerated	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
49651	CPT	Lap Inguinal Hernia Recurrent	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
49652	CPT	Lap Repr Hernia Ingun	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
32601	CPT	Thoracbscopy Diagnostic	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
60200	CPT	Exc Of Cyst/adenoma Thyro	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
60225	CPT	Tot Thyroid Lobectomy	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
58671	CPT	Lap W/occlusion Ovidct De	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
58679	CPT	Unlisted Lap Oviduct/ovar	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
58670	CPT	Laparoscopy W Fulguration	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
49650	CPT	Lap Inguinal Hernia Initial	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
58578	CPT	Laparoscopiclysis Of Peri	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
58660	CPT	Lap-surg-w/lysis/adhesion	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
49565	CPT	Rep Rec Incis/ventral Her	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
58661	CPT	Lap Unilat Salpingo-ooph	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
58662	CPT	Lap W/fulguration Or Exc	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
60240	CPT	Thyroidectomy Total Or Co	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
49566	CPT	Rep Rec Inc/ventrl Hernia	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
49320	CPT	Lap/abd/perit/omen Diagns	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
49321	CPT	Lap Abd Peritoneum & Omen	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
58545	CPT	Laparoscopy Excision	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
49322	CPT	Lap W/aspir Of Cavity Or Cyst	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
49329	CPT	Unlisted Lap Procedure Abd, Peritoneum	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
51990	CPT	Lap Surg;urethral Suspens	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
58550	CPT	Laporscopy Hysterectomy	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
60220	CPT	Tot Thyroid Lobectomy Uni	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
32608	CPT	Thoracbscopy W/bx Nodule	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
60281	CPT	Recurrent Thyroglossal	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
47562	CPT	Removal Of Gallbladder Using An Endoscope	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
47379	CPT	Clsd Percutane/ndl Bx Liv	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
47563	CPT	Lap Chole W/graphy	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
44979	CPT	Unlisted Laparoscopy Proc. Appendec	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
60280	CPT	Exc Thyroglossal Duct Cys	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
44180	CPT	Lap Enterolysis W/mod 74	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
47564	CPT	Lap Choly W/expl Of Common Duct	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
47579	CPT	Lap Procedure Of Biliary Trc Unlisted	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
38589	CPT	Unlisted Laparoscopy Lymphatic System	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
38745	CPT	Rad Exc Of Axillary Lymph	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
38570	CPT	Laparoscopy Lymp Node Bio	14	8	$17,880.00	$17,880.00	$8,225.00	$16,986.00	$12,516.00	2025-08-22
44970	CPT	Laparoscopy Surg Appendec	28	8	$17,407.00	$17,407.00	$7,790.00	$16,986.00	$12,439.00	2025-08-22
21390	CPT	Opn Tx Orbital Fx	14	8	$17,140.00	$17,140.00	$7,884.00	$16,283.00	$11,998.00	2025-08-22
L8680	HCPCS	Implantable Nero Electrode, Each	14	8	$16,965.00	$16,965.00	$7,804.00	$16,117.00	$11,876.00	2025-08-22
29826	CPT	Shaving Of Shoulder Bone Using Endoscope	14	8	$16,439.00	$16,439.00	$7,562.00	$15,617.00	$11,507.00	2025-08-22
43116	CPT	Partial Removal Of Esophagus	14	8	$16,416.00	$16,416.00	$7,551.00	$15,595.00	$11,491.00	2025-08-22
43450	CPT	Dilate Esophagus	28	8	$22,451.50	$22,451.50	$1,315.00	$39,942.00	$11,028.00	2025-08-22
50957	CPT	Endo/w/fulguration	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
50961	CPT	Endo/w/removal Fb	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
51050	CPT	Cystolithotomy Cysto W/re	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
54660	CPT	Testicular Prosthesis	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
51860	CPT	Cystorrhaphy Suture Of Bladder	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
52325	CPT	Cystourethroscopy W Frag	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
52240	CPT	Transureth Exc Lg Bladd T	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
52647	CPT	Turp Non Contact Laser Co	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
52648	CPT	Laser Vaporization	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
52649	CPT	Enucleation W/morcellatio	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
52630	CPT	Transurethral Resection	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
52601	CPT	Prostatectomy (Turp)	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
53446	CPT	Remove Uro Sphincter	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
52353	CPT	Cysto W/lithotripsy	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
52356	CPT	Cysto W/uretero W/lithotripsy -mod Lt	14	8	$15,590.00	$15,590.00	$7,171.00	$14,811.00	$10,913.00	2025-08-22
57288	CPT	Repair Bladder Defect	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
57120	CPT	Colpocleisis	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
57268	CPT	Rep Enterocele Vag Approa	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
57265	CPT	Comb Antero Colpo W/enter	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
57220	CPT	Plastic Op On Uretheral S	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
57240	CPT	Repair Bladder And Vigina	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
58925	CPT	Ovarian Cysts,uni/bilateral	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
58561	CPT	Hsc Removal Of Myoma	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
58563	CPT	Hysteroscopy/endometrial	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
58356	CPT	Endometrial Cryo W/us	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
58350	CPT	Chromotubation Of Oviduct	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
58353	CPT	Endo Ablation Therm Without H	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
57250	CPT	Repair Of Rectum & Vagina	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
57530	CPT	Removal Of Cervix	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
57260	CPT	Repair Of Vagina	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
58291	CPT	Vag Hyst W/rem Tube/ovary 250 Gm/	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
58262	CPT	Vag Hyst Uterus 250g<w/re	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
58260	CPT	Vag Hyst Uterus 250g Or <	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
58270	CPT	Hysterectomy W Repair 250 Gm/	14	8	$15,582.00	$15,582.00	$7,168.00	$14,803.00	$10,907.00	2025-08-22
27486	CPT	Rev Of Tot Knee Arthropla	14	8	$15,074.00	$15,074.00	$6,934.00	$14,320.00	$10,552.00	2025-08-22
50553	CPT	Kidney Endoscopy With 50 Modifier	14	8	$14,950.00	$14,950.00	$6,877.00	$14,203.00	$10,465.00	2025-08-22
43123	CPT	Partial Removal Of Esophagus	14	8	$14,886.00	$14,886.00	$6,848.00	$14,142.00	$10,420.00	2025-08-22
64636	CPT	Dest By Neuro Ag Para Facet Jt Nerv Addi	28	8	$16,659.00	$16,659.00	$5,109.00	$21,101.00	$10,384.50	2025-08-22
43108	CPT	Removal Of Esophagus	14	8	$14,687.00	$14,687.00	$6,756.00	$13,953.00	$10,281.00	2025-08-22
43113	CPT	Removal Of Esophagus	14	8	$14,361.00	$14,361.00	$6,606.00	$13,643.00	$10,053.00	2025-08-22
67036	CPT	Vitrectomy Mechanical Par	14	8	$13,839.00	$13,839.00	$6,366.00	$13,147.00	$9,687.00	2025-08-22
42830	CPT	Rem Adenoids Prim Yngr/12	14	8	$13,759.00	$13,759.00	$6,329.00	$13,071.00	$9,631.00	2025-08-22
J0840	HCPCS	Antivenin (Wyeth) (Crofab) Ea 1ea	14	8	$13,623.00	$13,623.00	$6,267.00	$12,942.00	$9,536.00	2025-08-22

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