Hospital

United Memorial Medical Center

Houston, TX · CCN 450803 · Rates published

Your selected procedure

You selected 29806 (CPT)

Arthroscopy Shldr Capsulorrhaphy 1st

This hospital’s price: $9,341 across 2 payers · range $1,232-$17,450

Source: https://secure.claraprice.net/price-transparency/UUDI-1739314437513/machine-readable/832329088_independence-heights-hospital_standardcharges.json · observed 2025-03-24

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.

3,508 distinct procedures filed

3 distinct payers

24,561 rate rows

2025-03-24 last MRF observed · ⚠ 20 mo old

Data quality

20,288 of 24,561 rate rows are consumer-grade (82.6%)

4,273 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
template filing: same amount across many unrelated codes — excluded	4,152
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	111
exceeds 10× this hospital's gross charge — excluded from medians	10

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

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

Source MRF file	https://secure.claraprice.net/price-transparency/UUDI-1739314437513/machine-readable/832329088_independence-heights-hospital_standardcharges.json
Found on page	https://bmchospitals.care/cms-hpt.txt
Discovered via	Discovered by HANK (automated)
Last fetch	success · 2026-11-03
Content fingerprint	fb1733ab986c4852… · 6,664,507 bytes · first seen 2026-07-31

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
CP17428480127449384 CDM	Spinal Fusion Except Cervical Without Mcc	1	$98,535.00	$98,535.00	$98,535.00	nat. median $98,535 1.0× median
CP17428480127449881 CDM	Cervical Spinal Fusion Without Cc Or Mcc	1	$91,972.00	$91,972.00	$91,972.00	nat. median $91,972 1.0× median
36593 CPT	Declotting By Thrombolytic Agent Of Impl	2	$924.00	$177,250.00	$89,087.00	nat. median $425 outlier · 209.7×
CP17428480127432116 CDM	Cardiac Valve Or Cardiothoracic Procedure With Cardiac Catheterization With Mcc	1	$79,558.00	$79,558.00	$79,558.00	nat. median $79,558 1.0× median
C1822 HCPCS	Nevro Blue Lead Kit	1	$4,000.00	$94,300.00	$79,000.00	nat. median $31,450 outlier · 2.5×
CP17428480127440289 CDM	Major Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	1	$78,554.00	$78,554.00	$78,554.00	nat. median $78,554 1.0× median
C1816 HCPCS	Receiver And/or Transmitter, Neurostimul	1	$76,000.00	$76,000.00	$76,000.00	nat. median $10,174 outlier · 7.5×
C1820 HCPCS	B.s Spectra Wavewrtier Generator	1	$6,800.00	$82,000.00	$76,000.00	nat. median $22,950 outlier · 3.3×
74246 CPT	Xr Gastrointestinal Tract	1	$56,295.00	$56,295.00	$56,295.00	nat. median $323 outlier · 174.4×
12202992 CDM	New Or Level 6 1st 30 Mins	1	$54,450.00	$54,450.00	$54,450.00	nat. median $54,450 1.0× median
0505T CPT	Endovenous Femoral-popliteal Arterial Re	1	$52,000.00	$52,000.00	$52,000.00	nat. median $12,894 outlier · 4.0×
12202990 CDM	New Or Level 5 1st 30 Mins	1	$49,502.00	$49,502.00	$49,502.00	nat. median $49,502 1.0× median
12202984 CDM	New Or Level 4 1st 30 Mins	1	$45,861.00	$45,861.00	$45,861.00	nat. median $45,861 1.0× median
75733 CPT	Angiography Adrenal Bil Slct Rad Sup&int	1	$43,527.00	$43,527.00	$43,527.00	nat. median $3,163 outlier · 13.8×
75600 CPT	Aorto Thor Without Serialography Rad Sup&int	1	$43,527.00	$43,527.00	$43,527.00	nat. median $3,037 outlier · 14.3×
75833 CPT	Veno Renal Bil Selective	1	$43,527.00	$43,527.00	$43,527.00	nat. median $3,197 outlier · 13.6×
75810 CPT	Splenoportography Rad Sup&int	1	$43,527.00	$43,527.00	$43,527.00	nat. median $3,153 outlier · 13.8×
75885 CPT	Percutaneous Transhepatic Portography	1	$43,527.00	$43,527.00	$43,527.00	nat. median $3,098 outlier · 14.1×
75658 CPT	Angiography Brach Retrograde Rad Sup&int	1	$43,527.00	$43,527.00	$43,527.00	nat. median $793 outlier · 54.9×
75731 CPT	Angiography Adrenal Uni Slct Rad Sup&int	1	$43,527.00	$43,527.00	$43,527.00	nat. median $2,918 outlier · 14.9×
75840 CPT	Veno Adrenal Uni Selective	1	$43,527.00	$43,527.00	$43,527.00	nat. median $3,025 outlier · 14.4×
75842 CPT	Venography Adrenal Bilateral	1	$43,527.00	$43,527.00	$43,527.00	nat. median $3,596 outlier · 12.1×
75743 CPT	Angiography Pulm Bil Slct Rad Sup&int	1	$43,527.00	$43,527.00	$43,527.00	nat. median $3,226 outlier · 13.5×
75741 CPT	Angiography Pulm Uni Slct Rad Sup&int	1	$43,527.00	$43,527.00	$43,527.00	nat. median $3,148 outlier · 13.8×
C1772 HCPCS	Infusion Pump, Programmable (Implantable	1	$40,400.00	$40,400.00	$40,400.00	nat. median $10,928 outlier · 3.7×
12202982 CDM	New Or Level 3 1st 30 Mins	1	$37,015.00	$37,015.00	$37,015.00	nat. median $37,015 1.0× median
75891 CPT	Hepatic Venography Wedged	1	$35,416.00	$35,416.00	$35,416.00	nat. median $3,064 outlier · 11.6×
75831 CPT	Venography Renal Unilateral	1	$33,358.00	$33,358.00	$33,358.00	nat. median $3,137 outlier · 10.6×
36903 CPT	Introduction Of Needle(s) And/or Cathete	2	$2,196.00	$63,714.00	$32,955.00	nat. median $12,642 outlier · 2.6×
77372 CPT	Srs Linear Based	1	$32,032.00	$32,032.00	$32,032.00	nat. median $9,177 outlier · 3.5×
63052 CPT	Laminectomy, Facetectomy, Or Foraminotom	2	$924.00	$60,000.00	$30,462.00	nat. median $2,359 outlier · 12.9×
75889 CPT	Hepatic Venography Wedged	1	$29,532.00	$29,532.00	$29,532.00	nat. median $3,170 outlier · 9.3×
75630 CPT	Aorto Abd+bil Iliofemoral Serialography	1	$29,532.00	$29,532.00	$29,532.00	nat. median $3,309 outlier · 8.9×
77371 CPT	Srs Multisource	1	$28,834.00	$28,834.00	$28,834.00	nat. median $9,357 outlier · 3.1×
C1874 HCPCS	Stent, Coated/covered, With Delivery Sys	1	$28,000.00	$28,000.00	$28,000.00	nat. median $4,810 outlier · 5.8×
37607 CPT	Ligation Or Banding Of Angioaccess Arter	2	$1,232.00	$54,450.00	$27,841.00	nat. median $3,652 outlier · 7.6×
75726 CPT	Angio Visc Selective Or Supra Selective	1	$25,810.00	$25,810.00	$25,810.00	nat. median $5,123 outlier · 5.0×
36821 CPT	Arteriovenous Anastomosis, Open; Direct,	2	$1,232.00	$49,722.00	$25,477.00	nat. median $3,652 outlier · 7.0×
75605 CPT	Aorto/ Serialography Thor Rad Sup&int	1	$25,352.00	$25,352.00	$25,352.00	nat. median $5,122 outlier · 4.9×
50593 CPT	Ablation, Renal Tumor(s), Unilateral, Pe	2	$2,948.00	$47,078.00	$25,013.00	nat. median $10,411 outlier · 2.4×
2202994 CDM	Or Level 7 1st 15min	1	$24,862.00	$24,862.00	$24,862.00	nat. median $24,862 1.0× median
27769 CPT	Optx Post Ankle Fx	2	$1,232.00	$45,861.00	$23,546.50	nat. median $6,872 outlier · 3.4×
75705 CPT	Angiography Spinal Slct Rad Sup&int	1	$23,153.00	$23,153.00	$23,153.00	nat. median $5,145 outlier · 4.5×
78816 CPT	PET Body Skull To Feet	1	$21,866.00	$21,866.00	$21,866.00	nat. median $2,784 outlier · 7.9×
78815 CPT	PET Body Skull To Thigh	2	$950.00	$21,866.00	$21,866.00	nat. median $2,810 outlier · 7.8×
36906 CPT	Thrombolysis With Stent	2	$2,196.00	$41,225.00	$21,710.50	nat. median $18,590 1.2× median
CP17428480127443755 CDM	Uterine And Adnexa Procedures For Non-malignancy Without Cc Or Mcc	1	$21,337.00	$21,337.00	$21,337.00	nat. median $21,337 1.0× median
37228 CPT	Revascularization, Endovascular, Open Or	2	$1,508.00	$40,386.00	$20,947.00	nat. median $11,095 1.9× median
35011 CPT	Direct Repair Of Aneurysm, Pseudoaneurys	1	$20,944.00	$20,944.00	$20,944.00	nat. median $5,811 outlier · 3.6×
74485 CPT	Dilation Nephrostomy Ureters Or Urethra	1	$20,858.00	$20,858.00	$20,858.00	nat. median $1,933 outlier · 10.8×

Other procedures at this hospital

Browse this hospital's 3,508 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

CP17428480127449384	CDM	Spinal Fusion Except Cervical Without Mcc	2	1	$123,169.00	$123,169.00	$98,535.00	$98,535.00	$98,535.00	2025-03-24
CP17428480127449881	CDM	Cervical Spinal Fusion Without Cc Or Mcc	2	1	$114,965.00	$114,965.00	$91,972.00	$91,972.00	$91,972.00	2025-03-24
36593	CPT	Declotting By Thrombolytic Agent Of Impl	6	2	$221,562.00	$221,562.00	$924.00	$177,250.00	$89,087.00	2025-03-24
CP17428480127432116	CDM	Cardiac Valve Or Cardiothoracic Procedure With Cardiac Catheterization With Mcc	2	1	$99,448.00	$99,448.00	$79,558.00	$79,558.00	$79,558.00	2025-03-24
C1822	HCPCS	Nevro Blue Lead Kit	15	1	$98,750.00	$98,750.00	$4,000.00	$94,300.00	$79,000.00	2025-03-24
CP17428480127440289	CDM	Major Joint Replacement Or Reattachment Of Lower Extremity Without Mcc	2	1	$98,193.00	$98,193.00	$78,554.00	$78,554.00	$78,554.00	2025-03-24
C1816	HCPCS	Receiver And/or Transmitter, Neurostimul	3	1	$95,000.00	$95,000.00	$76,000.00	$76,000.00	$76,000.00	2025-03-24
C1820	HCPCS	B.s Spectra Wavewrtier Generator	9	1	$95,000.00	$95,000.00	$6,800.00	$82,000.00	$76,000.00	2025-03-24
74246	CPT	Xr Gastrointestinal Tract	3	1	$70,369.00	$70,369.00	$56,295.00	$56,295.00	$56,295.00	2025-03-24
12202992	CDM	New Or Level 6 1st 30 Mins	3	1	$68,063.00	$68,063.00	$54,450.00	$54,450.00	$54,450.00	2025-03-24
0505T	CPT	Endovenous Femoral-popliteal Arterial Re	3	1	$65,000.00	$65,000.00	$52,000.00	$52,000.00	$52,000.00	2025-03-24
12202990	CDM	New Or Level 5 1st 30 Mins	3	1	$61,878.00	$61,878.00	$49,502.00	$49,502.00	$49,502.00	2025-03-24
12202984	CDM	New Or Level 4 1st 30 Mins	3	1	$57,326.00	$57,326.00	$45,861.00	$45,861.00	$45,861.00	2025-03-24
75733	CPT	Angiography Adrenal Bil Slct Rad Sup&int	3	1	$54,409.00	$54,409.00	$43,527.00	$43,527.00	$43,527.00	2025-03-24
75600	CPT	Aorto Thor Without Serialography Rad Sup&int	3	1	$54,409.00	$54,409.00	$43,527.00	$43,527.00	$43,527.00	2025-03-24
75833	CPT	Veno Renal Bil Selective	3	1	$54,409.00	$54,409.00	$43,527.00	$43,527.00	$43,527.00	2025-03-24
75810	CPT	Splenoportography Rad Sup&int	3	1	$54,409.00	$54,409.00	$43,527.00	$43,527.00	$43,527.00	2025-03-24
75885	CPT	Percutaneous Transhepatic Portography	3	1	$54,409.00	$54,409.00	$43,527.00	$43,527.00	$43,527.00	2025-03-24
75658	CPT	Angiography Brach Retrograde Rad Sup&int	3	1	$54,409.00	$54,409.00	$43,527.00	$43,527.00	$43,527.00	2025-03-24
75731	CPT	Angiography Adrenal Uni Slct Rad Sup&int	3	1	$54,409.00	$54,409.00	$43,527.00	$43,527.00	$43,527.00	2025-03-24
75840	CPT	Veno Adrenal Uni Selective	3	1	$54,409.00	$54,409.00	$43,527.00	$43,527.00	$43,527.00	2025-03-24
75842	CPT	Venography Adrenal Bilateral	3	1	$54,409.00	$54,409.00	$43,527.00	$43,527.00	$43,527.00	2025-03-24
75743	CPT	Angiography Pulm Bil Slct Rad Sup&int	3	1	$54,409.00	$54,409.00	$43,527.00	$43,527.00	$43,527.00	2025-03-24
75741	CPT	Angiography Pulm Uni Slct Rad Sup&int	3	1	$54,409.00	$54,409.00	$43,527.00	$43,527.00	$43,527.00	2025-03-24
C1772	HCPCS	Infusion Pump, Programmable (Implantable	3	1	$50,500.00	$50,500.00	$40,400.00	$40,400.00	$40,400.00	2025-03-24
12202982	CDM	New Or Level 3 1st 30 Mins	3	1	$46,269.00	$46,269.00	$37,015.00	$37,015.00	$37,015.00	2025-03-24
75891	CPT	Hepatic Venography Wedged	3	1	$44,270.00	$44,270.00	$35,416.00	$35,416.00	$35,416.00	2025-03-24
75831	CPT	Venography Renal Unilateral	3	1	$41,698.00	$41,698.00	$33,358.00	$33,358.00	$33,358.00	2025-03-24
36903	CPT	Introduction Of Needle(s) And/or Cathete	6	2	$79,642.00	$79,642.00	$2,196.00	$63,714.00	$32,955.00	2025-03-24
77372	CPT	Srs Linear Based	3	1	$40,040.00	$40,040.00	$32,032.00	$32,032.00	$32,032.00	2025-03-24
63052	CPT	Laminectomy, Facetectomy, Or Foraminotom	6	2	$75,000.00	$75,000.00	$924.00	$60,000.00	$30,462.00	2025-03-24
75889	CPT	Hepatic Venography Wedged	3	1	$36,915.00	$36,915.00	$29,532.00	$29,532.00	$29,532.00	2025-03-24
75630	CPT	Aorto Abd+bil Iliofemoral Serialography	3	1	$36,915.00	$36,915.00	$29,532.00	$29,532.00	$29,532.00	2025-03-24
77371	CPT	Srs Multisource	3	1	$36,043.00	$36,043.00	$28,834.00	$28,834.00	$28,834.00	2025-03-24
C1874	HCPCS	Stent, Coated/covered, With Delivery Sys	3	1	$35,000.00	$35,000.00	$28,000.00	$28,000.00	$28,000.00	2025-03-24
37607	CPT	Ligation Or Banding Of Angioaccess Arter	6	2	$68,063.00	$68,063.00	$1,232.00	$54,450.00	$27,841.00	2025-03-24
75726	CPT	Angio Visc Selective Or Supra Selective	3	1	$32,262.00	$32,262.00	$25,810.00	$25,810.00	$25,810.00	2025-03-24
36821	CPT	Arteriovenous Anastomosis, Open; Direct,	6	2	$62,153.00	$62,153.00	$1,232.00	$49,722.00	$25,477.00	2025-03-24
75605	CPT	Aorto/ Serialography Thor Rad Sup&int	3	1	$31,690.00	$31,690.00	$25,352.00	$25,352.00	$25,352.00	2025-03-24
50593	CPT	Ablation, Renal Tumor(s), Unilateral, Pe	6	2	$58,847.00	$58,847.00	$2,948.00	$47,078.00	$25,013.00	2025-03-24
2202994	CDM	Or Level 7 1st 15min	3	1	$31,077.00	$31,077.00	$24,862.00	$24,862.00	$24,862.00	2025-03-24
27769	CPT	Optx Post Ankle Fx	6	2	$57,326.00	$57,326.00	$1,232.00	$45,861.00	$23,546.50	2025-03-24
75705	CPT	Angiography Spinal Slct Rad Sup&int	3	1	$28,941.00	$28,941.00	$23,153.00	$23,153.00	$23,153.00	2025-03-24
78816	CPT	PET Body Skull To Feet	3	1	$27,332.00	$27,332.00	$21,866.00	$21,866.00	$21,866.00	2025-03-24
78815	CPT	PET Body Skull To Thigh	4	2	$27,332.00	$27,332.00	$950.00	$21,866.00	$21,866.00	2025-03-24
36906	CPT	Thrombolysis With Stent	6	2	$51,531.00	$51,531.00	$2,196.00	$41,225.00	$21,710.50	2025-03-24
CP17428480127443755	CDM	Uterine And Adnexa Procedures For Non-malignancy Without Cc Or Mcc	2	1	$26,671.00	$26,671.00	$21,337.00	$21,337.00	$21,337.00	2025-03-24
37228	CPT	Revascularization, Endovascular, Open Or	6	2	$50,482.00	$50,482.00	$1,508.00	$40,386.00	$20,947.00	2025-03-24
35011	CPT	Direct Repair Of Aneurysm, Pseudoaneurys	3	1	$26,180.00	$26,180.00	$20,944.00	$20,944.00	$20,944.00	2025-03-24
74485	CPT	Dilation Nephrostomy Ureters Or Urethra	3	1	$26,073.00	$26,073.00	$20,858.00	$20,858.00	$20,858.00	2025-03-24
74480	CPT	Intro Ureteral Cath Or Stent Into Ureter	3	1	$26,073.00	$26,073.00	$20,858.00	$20,858.00	$20,858.00	2025-03-24
74475	CPT	Intro Cath Into Renal Pelvis For Drainag	3	1	$26,073.00	$26,073.00	$20,858.00	$20,858.00	$20,858.00	2025-03-24
0275T	CPT	Perq Lamot/lam Lumbar	3	1	$25,897.00	$25,897.00	$20,718.00	$20,718.00	$20,718.00	2025-03-24
2202992	CDM	Or Level 6 1st 15min	3	1	$25,897.00	$25,897.00	$20,718.00	$20,718.00	$20,718.00	2025-03-24
22585	CPT	Arthrodesis Anterior Interbody Tech 1st	3	1	$25,897.00	$25,897.00	$20,718.00	$20,718.00	$20,718.00	2025-03-24
63051	CPT	C-laminoplasty W/graft/plate	3	1	$25,897.00	$25,897.00	$20,718.00	$20,718.00	$20,718.00	2025-03-24
37242	CPT	Vascular Embolization Or Occlusion, Incl	6	2	$50,122.00	$50,122.00	$1,232.00	$40,098.00	$20,665.00	2025-03-24
36830	CPT	Creation Of Arteriovenous Fistula By Oth	6	2	$47,123.00	$47,123.00	$1,508.00	$37,698.00	$19,603.00	2025-03-24
77373	CPT	Sbrt Delivery	3	1	$24,376.00	$24,376.00	$19,501.00	$19,501.00	$19,501.00	2025-03-24
36819	CPT	Arteriovenous Anastomosis, Open; By Uppe	6	2	$47,123.00	$47,123.00	$1,232.00	$37,698.00	$19,465.00	2025-03-24
75563	CPT	Card MRI W/stress Img & Dye	3	1	$24,236.00	$24,236.00	$19,389.00	$19,389.00	$19,389.00	2025-03-24
36571	CPT	Insert Picvad Cath	6	2	$46,269.00	$46,269.00	$1,232.00	$37,015.00	$19,123.50	2025-03-24
25290	CPT	Incise Wrist/forearm Tendon	6	2	$46,269.00	$46,269.00	$1,232.00	$37,015.00	$19,123.50	2025-03-24
2202990	CDM	Or Level 5 1st 15min	3	1	$23,544.00	$23,544.00	$18,835.00	$18,835.00	$18,835.00	2025-03-24
63081	CPT	Remove Vert Body Dcmprn Crvl	3	1	$23,544.00	$23,544.00	$18,835.00	$18,835.00	$18,835.00	2025-03-24
75710	CPT	Angiography Ext Uni Rad Sup&int	3	1	$23,495.00	$23,495.00	$18,796.00	$18,796.00	$18,796.00	2025-03-24
75893	CPT	Venous Sampling Throu Cath W/wo Angio	3	1	$23,005.00	$23,005.00	$18,404.00	$18,404.00	$18,404.00	2025-03-24
43633	CPT	Removal Of Stomach Partial	3	1	$21,812.00	$21,812.00	$17,450.00	$17,450.00	$17,450.00	2025-03-24
49653	CPT	Lap Vent/abd Hern Proc Comp	3	1	$21,812.00	$21,812.00	$17,450.00	$17,450.00	$17,450.00	2025-03-24
43621	CPT	Removal Of Stomach	3	1	$21,812.00	$21,812.00	$17,450.00	$17,450.00	$17,450.00	2025-03-24
63709	CPT	Repair Spinal Fluid Leakage	3	1	$21,812.00	$21,812.00	$17,450.00	$17,450.00	$17,450.00	2025-03-24
49568	CPT	Mesh Implant Incis/ventral Hernia Rep	3	1	$21,812.00	$21,812.00	$17,450.00	$17,450.00	$17,450.00	2025-03-24
2202984	CDM	Or Level 4 1st 15min	3	1	$21,812.00	$21,812.00	$17,450.00	$17,450.00	$17,450.00	2025-03-24
29826	CPT	Shaving Of Shoulder Bone Using Endoscope	9	2	$28,812.00	$28,812.00	$1,232.00	$23,050.00	$17,450.00	2025-03-24
61615	CPT	Resect/excise Lesion Skull	3	1	$21,812.00	$21,812.00	$17,450.00	$17,450.00	$17,450.00	2025-03-24
49654	CPT	Lap Inc Hernia Repair	3	1	$21,812.00	$21,812.00	$17,450.00	$17,450.00	$17,450.00	2025-03-24
43775	CPT	Lap Sleeve Gastrectomy	3	1	$21,812.00	$21,812.00	$17,450.00	$17,450.00	$17,450.00	2025-03-24
34718	CPT	Endovascular Repair The Iliac Artery	3	1	$21,812.00	$21,812.00	$17,450.00	$17,450.00	$17,450.00	2025-03-24
66984	CPT	Removal Of Cataract With Insertion Of Lens	9	2	$32,812.00	$32,812.00	$1,665.00	$26,250.00	$17,450.00	2025-03-24
43632	CPT	Removal Of Stomach Partial	3	1	$21,812.00	$21,812.00	$17,450.00	$17,450.00	$17,450.00	2025-03-24
75716	CPT	Angiography Ext Bil Rad Sup&int	3	1	$19,648.00	$19,648.00	$15,718.00	$15,718.00	$15,718.00	2025-03-24
12202986	CDM	New Or Level 2 1st 30 Mins	3	1	$18,846.00	$18,846.00	$15,077.00	$15,077.00	$15,077.00	2025-03-24
75825	CPT	Venography Caval Infer W/serialography	3	1	$18,770.00	$18,770.00	$15,016.00	$15,016.00	$15,016.00	2025-03-24
75736	CPT	Angio Pelvic Slct/supraslct Rad Sup&int	3	1	$18,426.00	$18,426.00	$14,741.00	$14,741.00	$14,741.00	2025-03-24
35903	CPT	Excision Of Infected Graft; Extremity	3	1	$18,222.00	$18,222.00	$14,578.00	$14,578.00	$14,578.00	2025-03-24
C1604	HCPCS	Graft, Transmural Transvenous Arterial B	3	1	$18,000.00	$18,000.00	$14,400.00	$14,400.00	$14,400.00	2025-03-24
54430	CPT	Revision Of Penis	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
0627T	CPT	Perc Lumbar Intravertebral Disc Inj Proc	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
0249T	CPT	Liga Hemorrhoid Vas Bund Includ US Guid	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
43644	CPT	Lap Gastric Bypass/roux-en-y	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
49652	CPT	Lap Vent/abd Hernia Repair	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
27694	CPT	Decompression Fasciotomy W/debridement	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
44120	CPT	Removal Of Small Intestine	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
44139	CPT	Takedown Splenic Flexure W Colectomy	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
27886	CPT	Amp Leg Through Tibia&fibula Re-amp 1st	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
42820	CPT	Removal Of Tonsils And Adenoid Glands, Patient Younger Than Age 12	9	2	$37,605.00	$37,605.00	$1,232.00	$30,084.00	$14,084.00	2025-03-24
63706	CPT	Repair Of Spinal Herniation	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
43122	CPT	Partial Removal Of Esophagus	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
11005	CPT	Debride Abdom Wall	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
51530	CPT	Cystotomy For Excision Bladder Tumor	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
0232T	CPT	Inj Platelet Rich Plasma Any Site	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
27880	CPT	Amputation Leg Through Tibia & Fibula 1	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
29881	CPT	Removal Of One Knee Cartilage Using An Endoscope	9	2	$27,605.00	$27,605.00	$1,508.00	$22,084.00	$14,084.00	2025-03-24
58950	CPT	Resect Ovarian Malignancy	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
49572	CPT	Rpr Epigastric Hern Blocked	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
19324	CPT	Enlarge Breast	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
49561	CPT	Rpr Ventral Hern Init Block	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
49565	CPT	Rerepair Ventrl Hern Reduce	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
49655	CPT	Lap Inc Hern Repair Comp	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
49657	CPT	Lap Inc Hern Recur Comp	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
27598	CPT	Disarticulation At Knee	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
49560	CPT	Rpr Ventral Hern Init Reduc	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
49656	CPT	Lap Inc Hernia Repair Recur	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
49587	CPT	Rpr Umbil Hern Block > 5 Yr	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
49505	CPT	Repair Of Groin Hernia Patient Age 5 Years Or Older	9	2	$57,605.00	$57,605.00	$1,508.00	$46,084.00	$14,084.00	2025-03-24
49585	CPT	Rpr Umbil Hern Reduc > 5 Yr	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
49060	CPT	Drainage Retroperitoneal Abscess Open	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
44146	CPT	Partial Removal Of Colon	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
44620	CPT	Closure Enterostomy Lg/sm Intest	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
2202982	CDM	Or Level 3 1st 15 Min	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
C9749	HCPCS	Repair Nasal Stenosis With Implant	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
44143	CPT	Partial Removal Of Colon	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
47562	CPT	Removal Of Gallbladder Using An Endoscope	9	2	$87,605.00	$87,605.00	$1,665.00	$70,084.00	$14,084.00	2025-03-24
43843	CPT	Gastroplasty Without V-band	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
44140	CPT	Colectomy Partial With Anastomosis	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
20102	CPT	Explore Wound Abdomen	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
44205	CPT	Lap Colectomy Part W/ileum	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
44238	CPT	Laparoscope Proc Intestine	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
44160	CPT	Removal Of Colon	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
43279	CPT	Lap Myotomy Heller	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
44207	CPT	L Colectomy/coloproctostomy	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
22522	CPT	Percutaneous Vertebroplasty 1st	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
58146	CPT	Myomectomy Abdom Complex	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
44955	CPT	Appendectomy	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
31040	CPT	Pterygomaxillary Fossa Any Approach	3	1	$17,605.00	$17,605.00	$14,084.00	$14,084.00	$14,084.00	2025-03-24
75887	CPT	Percutaneous Transhepatic Portography	3	1	$17,585.00	$17,585.00	$14,068.00	$14,068.00	$14,068.00	2025-03-24
75872	CPT	Venography Epidural	3	1	$17,585.00	$17,585.00	$14,068.00	$14,068.00	$14,068.00	2025-03-24
75860	CPT	Venography Venous Sinus	3	1	$17,585.00	$17,585.00	$14,068.00	$14,068.00	$14,068.00	2025-03-24
75880	CPT	Venography Orbital	3	1	$17,585.00	$17,585.00	$14,068.00	$14,068.00	$14,068.00	2025-03-24
75756	CPT	Angiography Int Mammary Rad Sup&int	3	1	$17,585.00	$17,585.00	$14,068.00	$14,068.00	$14,068.00	2025-03-24
75827	CPT	Venography Caval Sup With Serialography	3	1	$17,585.00	$17,585.00	$14,068.00	$14,068.00	$14,068.00	2025-03-24
75746	CPT	Angio Pulm Nonslct Cath/ven Inj Rad	3	1	$17,585.00	$17,585.00	$14,068.00	$14,068.00	$14,068.00	2025-03-24
37187	CPT	Percutaneous Transluminal Mechanical Thr	6	2	$31,445.00	$31,445.00	$2,948.00	$25,156.00	$14,052.00	2025-03-24
49325	CPT	Laparoscopy, Surgical; With Revision Of	6	2	$32,986.00	$32,986.00	$1,508.00	$26,389.00	$13,948.50	2025-03-24
75803	CPT	Lymphangiography Extremity Only Bil Rad	3	1	$17,281.00	$17,281.00	$13,825.00	$13,825.00	$13,825.00	2025-03-24
75805	CPT	Lymphangiography Pel/abd Unilateral Rad	3	1	$17,281.00	$17,281.00	$13,825.00	$13,825.00	$13,825.00	2025-03-24
75807	CPT	Lymphangiography Pelvic/abd Bilat Rad	3	1	$17,281.00	$17,281.00	$13,825.00	$13,825.00	$13,825.00	2025-03-24
75822	CPT	Venography Extremity B/l	3	1	$17,281.00	$17,281.00	$13,825.00	$13,825.00	$13,825.00	2025-03-24
36905	CPT	Thrmbc/nfs Dialysis Circuit	6	2	$31,445.00	$31,445.00	$2,196.00	$25,156.00	$13,676.00	2025-03-24
36902	CPT	Dialysis Of Av Fistula	6	2	$30,630.00	$30,630.00	$2,196.00	$24,504.00	$13,350.00	2025-03-24
36833	CPT	Revision, Open, Arteriovenous Fistula; W	6	2	$31,416.00	$31,416.00	$1,508.00	$25,133.00	$13,320.50	2025-03-24
12202988	CDM	New Or Level 1 1st 30 Mins	3	1	$16,197.00	$16,197.00	$12,958.00	$12,958.00	$12,958.00	2025-03-24
78452	CPT	Mycardiol Perfusion Imaging Tomographic	4	2	$15,927.00	$15,927.00	$950.00	$12,742.00	$12,742.00	2025-03-24
78814	CPT	PET Limited Study	3	1	$15,819.00	$15,819.00	$12,655.00	$12,655.00	$12,655.00	2025-03-24
78608	CPT	PET Brain Imaging	3	1	$15,671.00	$15,671.00	$12,537.00	$12,537.00	$12,537.00	2025-03-24
93452	CPT	Insertion Of Catheter Into Left Heart For Diagnosis	6	2	$28,105.00	$28,105.00	$2,196.00	$22,484.00	$12,340.00	2025-03-24
C1889	HCPCS	8mm Barricaid (Annular Closure Device)	9	1	$15,000.00	$15,000.00	$11,980.00	$24,600.00	$12,000.00	2025-03-24
C1760	HCPCS	Closure Device, Vascular (Implantable/in	3	1	$15,000.00	$15,000.00	$12,000.00	$12,000.00	$12,000.00	2025-03-24
50592	CPT	Ablation, 1 Or More Renal Tumor(s), Perc	6	2	$27,488.00	$27,488.00	$1,508.00	$21,990.00	$11,749.00	2025-03-24
62380	CPT	Endoscopic Decompression Of Spinal Cord,	6	2	$27,265.00	$27,265.00	$1,665.00	$21,812.00	$11,738.50	2025-03-24
36904	CPT	Percutaneous Transluminal Mechanical Thr	6	2	$27,229.00	$27,229.00	$1,665.00	$21,783.00	$11,724.00	2025-03-24
77424	CPT	Io Rad Tx Delivery By Xr	3	1	$14,591.00	$14,591.00	$11,673.00	$11,673.00	$11,673.00	2025-03-24
S2068	HCPCS	Breast Diep Or Siea Flap	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
19305	CPT	Mast Radical	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
19361	CPT	Breast Reconstr W/lat Flap	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
51585	CPT	Removal Of Bladder & Nodes	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
19260	CPT	Exc Chest Wall Tumor Including Ribs 1st	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
19120	CPT	Removal Of One Or More Breast Growth, Open Procedure	9	2	$24,342.00	$24,342.00	$1,232.00	$19,474.00	$11,474.00	2025-03-24
19083	CPT	Biopsy Breast W Plcmnt Brst Local Dvc 1s	9	2	$14,342.00	$14,342.00	$1,058.00	$14,396.00	$11,474.00	2025-03-24
42971	CPT	Control Nose/throat Bleeding	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
38525	CPT	Biopsy/removal Lymph Nodes	9	2	$20,996.00	$20,996.00	$1,058.00	$16,797.00	$11,474.00	2025-03-24
11310	CPT	Shave Skin Lesion 0.5 Cm/<	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
C9728	HCPCS	Place Device/marker Non Pro	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
63707	CPT	Repair Spinal Fluid Leakage	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
15420	CPT	Xenograft Skin Dermal/temp Wound Close	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
2202986	CDM	Or Level 2 1st 15min	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
49203	CPT	Exc Abd Tum 5 Cm Or Less	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
31299	CPT	Procedure Accessory Sinuses	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
49020	CPT	Drainage Abdom Abscess Open	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
47122	CPT	Extensive Removal Of Liver	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
45562	CPT	Exploration/repair Of Rectum	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
44960	CPT	Appendectomy	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
20974	CPT	Electrical Bone Stimulation	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
20926	CPT	Tiss Grafts Oth Eg Paratenon Fat Dermis	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
44322	CPT	Colostomy With Biopsies	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
44604	CPT	Suture Large Intestine	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
44204	CPT	Laparo Partial Colectomy	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
69105	CPT	Biopsy External Auditory Canal	3	1	$14,342.00	$14,342.00	$11,474.00	$11,474.00	$11,474.00	2025-03-24
22861	CPT	Revise Cerv Artific Disc 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
63655	CPT	Implant Neuroelectrodes 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
27138	CPT	Revise Hip Joint Replacement 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22551	CPT	Neck Spine Fuse&remov Bel C2 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22855	CPT	Removal Anterior Instrumentation 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22856	CPT	Cerv Artific Diskectomy 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
27130	CPT	Total Hip Arthroplasty 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22857	CPT	Lumbar Artif Diskectomy 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
27134	CPT	Revise Hip Joint Replacement 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22558	CPT	Lumbar Spine Fusion 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22849	CPT	Reinsertion Spinal Fixation Device 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22556	CPT	Thorax Spine Fusion 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22633	CPT	Lumbar Spine Fusion Combined 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22600	CPT	Neck Spine Fusion 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22802	CPT	Post Fusion 7-12 Vert Seg 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
63056	CPT	Decompress Spinal Cord Lmbr 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22850	CPT	Remove Spine Fixation Device 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22610	CPT	Thorax Spine Fusion 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22612	CPT	Lumbar Spine Fusion 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22630	CPT	Lumbar Spine Fusion 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
27280	CPT	Fusion Of Sacroiliac Joint 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22532	CPT	Lat Thorax Spine Fusion 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
22554	CPT	Neck Spine Fusion 1st	6	2	$25,897.00	$25,897.00	$1,868.00	$20,718.00	$11,293.00	2025-03-24
63042	CPT	Laminotomy Single Lumbar 1st	6	2	$25,897.00	$25,897.00	$1,665.00	$20,718.00	$11,191.50	2025-03-24
63040	CPT	Laminotomy Single Cervical 1st	6	2	$25,897.00	$25,897.00	$1,665.00	$20,718.00	$11,191.50	2025-03-24
63035	CPT	Laminotomy Single Cervical/lumbar 1st	6	2	$25,897.00	$25,897.00	$1,665.00	$20,718.00	$11,191.50	2025-03-24
63048	CPT	Laminectomy Facetectomy And Foraminotomy	6	2	$25,897.00	$25,897.00	$1,665.00	$20,718.00	$11,191.50	2025-03-24
63012	CPT	Remove Lamina/facets Lumbar 1st	6	2	$25,897.00	$25,897.00	$1,665.00	$20,718.00	$11,191.50	2025-03-24
63030	CPT	Low Back Disk Surgery 1st	6	2	$25,897.00	$25,897.00	$1,665.00	$20,718.00	$11,191.50	2025-03-24
63267	CPT	Excise Intrspinl Lesion Lmbr 1st	6	2	$25,897.00	$25,897.00	$1,665.00	$20,718.00	$11,191.50	2025-03-24
22514	CPT	Perq Vertebral Augmentation Lu 1st	6	2	$25,897.00	$25,897.00	$1,665.00	$20,718.00	$11,191.50	2025-03-24
63046	CPT	Remove Spine Lamina 1 Thrc 1st	6	2	$25,897.00	$25,897.00	$1,665.00	$20,718.00	$11,191.50	2025-03-24
22513	CPT	Perq Vertebral Augmentation Th 1st	6	2	$25,897.00	$25,897.00	$1,665.00	$20,718.00	$11,191.50	2025-03-24
63045	CPT	Remove Spine Lamina 1 Crvl 1st	6	2	$25,897.00	$25,897.00	$1,665.00	$20,718.00	$11,191.50	2025-03-24
63047	CPT	Lamin/facet&foramin Sgl Vrtbrl Sgmt Lumb	6	2	$25,897.00	$25,897.00	$1,665.00	$20,718.00	$11,191.50	2025-03-24
27279	CPT	Arthrodesis Sacroiliac Joint 1st	6	2	$25,897.00	$25,897.00	$1,665.00	$20,718.00	$11,191.50	2025-03-24
22830	CPT	Exploration Spinal Fusion 1st	6	2	$25,897.00	$25,897.00	$1,508.00	$20,718.00	$11,113.00	2025-03-24
22511	CPT	Perq Lumbosacral Injection 1st	6	2	$25,897.00	$25,897.00	$1,508.00	$20,718.00	$11,113.00	2025-03-24
78492	CPT	Myocrd Img PET Mlt Rst&strs	3	1	$13,726.00	$13,726.00	$10,981.00	$10,981.00	$10,981.00	2025-03-24
63020	CPT	Neck Spine Disk Surgery 1st	6	2	$25,897.00	$25,897.00	$1,232.00	$20,718.00	$10,975.00	2025-03-24
64561	CPT	Implant Neuroelectrodes 1st	6	2	$25,897.00	$25,897.00	$1,232.00	$20,718.00	$10,975.00	2025-03-24
63650	CPT	Implant Neuroelectrodes 1st	6	2	$25,897.00	$25,897.00	$1,058.00	$20,718.00	$10,888.00	2025-03-24
63663	CPT	Revise Spine Eltrd Perq Aray 1st	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
63664	CPT	Revise Spine Eltrd Plate 1st	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
63662	CPT	Remove Spine Eltrd Plate 1st	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
63043	CPT	Laminotomy Single Ea Add Cervical 1st	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
63688	CPT	Revise/remove Neuroreceiver 1st	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22858	CPT	Tot Disc Arthroplasty Anterior Approach	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22854	CPT	Ins Intervertebral Miomechanical Device	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22552	CPT	Arthrodesis Anterior Interbody Disc 1st	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22534	CPT	Arthrodesis Lat Extracavitary Technique	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22853	CPT	Insertion Interbody Biomechanical Device	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22846	CPT	Ant Instrument 4-7 Vertebral Seg 1st 15	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22847	CPT	Ant Instrument =>8 Vertebral Seg 1st 15	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22848	CPT	Pelvic Fixation Attachment Caudal End 1	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22845	CPT	Ant Instrument 2-3 Vertebral Seg 1st 15	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22840	CPT	Post Nonsegmental Instr Eg Harrington 1s	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
63057	CPT	Transped Appr W Decompression Spinal Cr	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
63044	CPT	Laminotomy Single Ea Add Lumbar 1st	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22634	CPT	Arthrodesis Combined Posterior Tech 1st	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22632	CPT	Arthrodesis Posterior Interbody Techniqu	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22842	CPT	Posterior Segmental Instrumentation 1st	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22614	CPT	Arthrodesis Post Or Posterolat Tech 1st	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22512	CPT	Perc Vertebroplasty Bone Biopsy 1st	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
22844	CPT	Posterior Segmental Instrumentation 1st	6	2	$25,897.00	$25,897.00	$924.00	$20,718.00	$10,821.00	2025-03-24
70010	CPT	Myelography Posterior Fossa Rad Sup&int	3	1	$13,053.00	$13,053.00	$10,442.00	$10,442.00	$10,442.00	2025-03-24
70015	CPT	Cistern Positive Contrast Rad Sup&int	3	1	$13,053.00	$13,053.00	$10,442.00	$10,442.00	$10,442.00	2025-03-24
72270	CPT	Myelography Two Or More Regions	3	1	$13,053.00	$13,053.00	$10,442.00	$10,442.00	$10,442.00	2025-03-24
72240	CPT	Myelography Cervical Rad Sup&int	3	1	$13,053.00	$13,053.00	$10,442.00	$10,442.00	$10,442.00	2025-03-24
27447	CPT	Total Knee Arthroplasty 1st	6	2	$23,544.00	$23,544.00	$1,868.00	$18,835.00	$10,351.50	2025-03-24
23472	CPT	Reconstruct Shoulder Joint 1st	6	2	$23,544.00	$23,544.00	$1,665.00	$18,835.00	$10,250.00	2025-03-24
78491	CPT	Myocrd Img PET 1std Rst/strs	3	1	$12,581.00	$12,581.00	$10,065.00	$10,065.00	$10,065.00	2025-03-24
45391	CPT	Ultrasound Examination Of Lower Large Bowel Using An Endoscope	6	2	$23,345.00	$23,345.00	$1,058.00	$18,676.00	$9,867.00	2025-03-24
51840	CPT	Ant Vesicoure/urethropexy Smp 1st 15 Min	6	2	$21,812.00	$21,812.00	$2,196.00	$17,450.00	$9,823.00	2025-03-24
49651	CPT	Lap Ing Hernia Repair Recur 1st	6	2	$21,812.00	$21,812.00	$2,196.00	$17,450.00	$9,823.00	2025-03-24
58554	CPT	Laparo-vag Hyst W/t/o Compl 1st	6	2	$21,812.00	$21,812.00	$2,196.00	$17,450.00	$9,823.00	2025-03-24
58553	CPT	Laparo-vag Hyst Complex 1st	6	2	$21,812.00	$21,812.00	$2,196.00	$17,450.00	$9,823.00	2025-03-24
23412	CPT	Repair Rotator Cuff Chronic 1st	6	2	$21,812.00	$21,812.00	$2,196.00	$17,450.00	$9,823.00	2025-03-24
58180	CPT	Partial Hysterectomy 1st	6	2	$21,812.00	$21,812.00	$2,196.00	$17,450.00	$9,823.00	2025-03-24
58150	CPT	Total Hysterectomy 1st	6	2	$21,812.00	$21,812.00	$2,196.00	$17,450.00	$9,823.00	2025-03-24
26727	CPT	Treat Finger Fracture Each 1st	6	2	$21,812.00	$21,812.00	$2,196.00	$17,450.00	$9,823.00	2025-03-24
30465	CPT	Repair Nasal Stenosis 1st	6	2	$21,812.00	$21,812.00	$2,196.00	$17,450.00	$9,823.00	2025-03-24
26531	CPT	Revise Knuckle With Implant 1st	6	2	$21,812.00	$21,812.00	$2,196.00	$17,450.00	$9,823.00	2025-03-24
37248	CPT	Transluminal Balloon Angioplasty (Except	6	2	$21,784.00	$21,784.00	$2,196.00	$17,427.00	$9,811.50	2025-03-24
C1776	HCPCS	Attune Tibial Insert Rotating Platform 1	36	1	$12,246.00	$12,246.00	$231.00	$36,616.00	$9,797.00	2025-03-24
72158	CPT	Mr Lumbar Spine Wwo	3	1	$12,204.00	$12,204.00	$9,763.00	$9,763.00	$9,763.00	2025-03-24
75894	CPT	Transcath Ther Embolization Any Method	3	1	$12,123.00	$12,123.00	$9,698.00	$9,698.00	$9,698.00	2025-03-24
22852	CPT	Remove Spine Fixation Device 1st	6	2	$21,812.00	$21,812.00	$1,868.00	$17,450.00	$9,659.00	2025-03-24
47612	CPT	Removal Of Gallbladder 1st	6	2	$21,812.00	$21,812.00	$1,868.00	$17,450.00	$9,659.00	2025-03-24
27486	CPT	Revise/replace Knee Joint 1st	6	2	$21,812.00	$21,812.00	$1,868.00	$17,450.00	$9,659.00	2025-03-24
58550	CPT	Laparo-asst Vag Hysterectomy 1st	6	2	$21,812.00	$21,812.00	$1,868.00	$17,450.00	$9,659.00	2025-03-24
23470	CPT	Reconstruct Shoulder Joint 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
29827	CPT	Arthroscopy Shldr W/rot Cuff Repair 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
52320	CPT	Cystoscopy And Treatment 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
29824	CPT	Shoulder Arthroscopy/surgery 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
52647	CPT	Laser Surgery Of Prostate 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
22207	CPT	Incis Spine 3 Column Lumbar 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
15823	CPT	Revision Of Upper Eyelid 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
58720	CPT	Removal Of Ovary/tube(s) 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
22206	CPT	Incis Spine 3 Column Thorac 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
25447	CPT	Repair Wrist Joints 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
58260	CPT	Vaginal Hysterectomy 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
31257	CPT	Nsl/sins Ndsc Tot W/sphendt 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
58290	CPT	Vag Hyst Complex 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
23630	CPT	Treat Humerus Fracture 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
31253	CPT	Nsl/sins Ndsc Total 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
31259	CPT	Nsl/sins Ndsc Sphn Tiss Rmvl 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
57287	CPT	Revise/remove Sling Repair 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
57288	CPT	Repair Bladder Defect 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
66982	CPT	Xcapsl Ctrc Rmvl Cplx Wo Ecp 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
26535	CPT	Arthroplasty Ipj Each Joint 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24
28299	CPT	Correction Hallux Valgus 1st	6	2	$21,812.00	$21,812.00	$1,665.00	$17,450.00	$9,557.50	2025-03-24

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