Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

ALTUS BAYTOWN HOSPITAL

Baytown, TX · CCN 670109 · Rates published

3,517 distinct procedures filed
3 distinct payers
24,568 rate rows
2026-04-01 last MRF observed
Data quality

24,447 of 24,568 rate rows are consumer-grade (99.5%)

121 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
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
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://secure.claraprice.net/price-transparency/VXMZ-1739314201791/machine-readable/832329088_baytown-medical-center_standardcharges.json
Found on page https://secure.claraprice.net/price-transparency/baytown-medical-center-tx
Discovered viaDiscovered by HANK
Last fetch success · 2026-09-25
Content fingerprint ed54414eaaa1783e… · 6,665,513 bytes · first seen 2026-06-16

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
CP17428476722283252
CDM 		Spinal Fusion Except Cervical Without Mcc 1 $98,535.00 $98,535.00 $98,535.00 —
CP17428476722286257
CDM 		Cervical Spinal Fusion Without Cc Or Mcc 1 $91,972.00 $91,972.00 $91,972.00 —
36593
CPT 		Declotting By Thrombolytic Agent Of Impl 2 $924.00 $177,250.00 $89,087.00 nat. median
$425
outlier · 209.7×
CP17428476722284545
CDM 		Cardiac Valve Or Cardiothoracic Procedure With Cardiac Catheterization With Mcc 1 $79,558.00 $79,558.00 $79,558.00 —
CP17428476722285366
CDM 		Major Joint Replacement Or Reattachment Of Lower Extremity Without Mcc 1 $78,554.00 $78,554.00 $78,554.00 —
C1816
HCPCS 		Receiver And/or Transmitter, Neurostimul 1 $76,000.00 $76,000.00 $76,000.00 nat. median
$9,555
outlier · 8.0×
74246
CPT 		Xr Gastrointestinal Tract 1 $56,295.00 $56,295.00 $56,295.00 nat. median
$225
outlier · 249.8×
C1822
HCPCS 		Nevro Trial Lead Kit 1 $4,000.00 $94,300.00 $54,996.00 nat. median
$30,046
1.8× median
C1820
HCPCS 		Medtronic Recharger 1 $6,800.00 $82,000.00 $54,933.33 nat. median
$21,100
outlier · 2.6×
12202992
CDM 		New Or Level 6 1st 30 Mins 1 $54,450.00 $54,450.00 $54,450.00 —
0505T
CPT 		Endovenous Femoral-popliteal Arterial Re 1 $52,000.00 $52,000.00 $52,000.00 nat. median
$11,927
outlier · 4.4×
12202990
CDM 		New Or Level 5 1st 30 Mins 1 $49,502.00 $49,502.00 $49,502.00 —
12202984
CDM 		New Or Level 4 1st 30 Mins 1 $45,861.00 $45,861.00 $45,861.00 —
75743
CPT 		Angiography Pulm Bil Slct Rad Sup&int 1 $43,527.00 $43,527.00 $43,527.00 nat. median
$3,197
outlier · 13.6×
75600
CPT 		Aorto Thor Without Serialography Rad Sup&int 1 $43,527.00 $43,527.00 $43,527.00 nat. median
$3,134
outlier · 13.9×
75658
CPT 		Angiography Brach Retrograde Rad Sup&int 1 $43,527.00 $43,527.00 $43,527.00 nat. median
$1,226
outlier · 35.5×
75810
CPT 		Splenoportography Rad Sup&int 1 $43,527.00 $43,527.00 $43,527.00 nat. median
$3,176
outlier · 13.7×
75842
CPT 		Venography Adrenal Bilateral 1 $43,527.00 $43,527.00 $43,527.00 nat. median
$4,760
outlier · 9.1×
75733
CPT 		Angiography Adrenal Bil Slct Rad Sup&int 1 $43,527.00 $43,527.00 $43,527.00 nat. median
$3,115
outlier · 14.0×
75840
CPT 		Veno Adrenal Uni Selective 1 $43,527.00 $43,527.00 $43,527.00 nat. median
$3,156
outlier · 13.8×
75741
CPT 		Angiography Pulm Uni Slct Rad Sup&int 1 $43,527.00 $43,527.00 $43,527.00 nat. median
$3,197
outlier · 13.6×
75731
CPT 		Angiography Adrenal Uni Slct Rad Sup&int 1 $43,527.00 $43,527.00 $43,527.00 nat. median
$3,077
outlier · 14.1×
75885
CPT 		Percutaneous Transhepatic Portography 1 $43,527.00 $43,527.00 $43,527.00 nat. median
$3,120
outlier · 14.0×
75833
CPT 		Veno Renal Bil Selective 1 $43,527.00 $43,527.00 $43,527.00 nat. median
$3,174
outlier · 13.7×
C1772
HCPCS 		Infusion Pump, Programmable (Implantable 1 $40,400.00 $40,400.00 $40,400.00 nat. median
$18,271
outlier · 2.2×
12202982
CDM 		New Or Level 3 1st 30 Mins 1 $37,015.00 $37,015.00 $37,015.00 —
75891
CPT 		Hepatic Venography Wedged 1 $35,416.00 $35,416.00 $35,416.00 nat. median
$3,146
outlier · 11.3×
75831
CPT 		Venography Renal Unilateral 1 $33,358.00 $33,358.00 $33,358.00 nat. median
$3,184
outlier · 10.5×
36903
CPT 		Introduction Of Needle(s) And/or Cathete 2 $2,196.00 $63,714.00 $32,955.00 nat. median
$12,181
outlier · 2.7×
77372
CPT 		Srs Linear Based 1 $32,032.00 $32,032.00 $32,032.00 nat. median
$7,667
outlier · 4.2×
63052
CPT 		Laminectomy, Facetectomy, Or Foraminotom 2 $924.00 $60,000.00 $30,462.00 nat. median
$3,327
outlier · 9.2×
75630
CPT 		Aorto Abd+bil Iliofemoral Serialography 1 $29,532.00 $29,532.00 $29,532.00 nat. median
$3,228
outlier · 9.1×
75889
CPT 		Hepatic Venography Wedged 1 $29,532.00 $29,532.00 $29,532.00 nat. median
$3,197
outlier · 9.2×
77371
CPT 		Srs Multisource 1 $28,834.00 $28,834.00 $28,834.00 nat. median
$7,491
outlier · 3.8×
C1874
HCPCS 		Stent, Coated/covered, With Delivery Sys 1 $28,000.00 $28,000.00 $28,000.00 nat. median
$5,596
outlier · 5.0×
37607
CPT 		Ligation Or Banding Of Angioaccess Arter 2 $1,232.00 $54,450.00 $27,841.00 nat. median
$3,612
outlier · 7.7×
75726
CPT 		Angio Visc Selective Or Supra Selective 1 $25,810.00 $25,810.00 $25,810.00 nat. median
$5,454
outlier · 4.7×
36821
CPT 		Arteriovenous Anastomosis, Open; Direct, 2 $1,232.00 $49,722.00 $25,477.00 nat. median
$3,984
outlier · 6.4×
75605
CPT 		Aorto/ Serialography Thor Rad Sup&int 1 $25,352.00 $25,352.00 $25,352.00 nat. median
$5,493
outlier · 4.6×
50593
CPT 		Ablation, Renal Tumor(s), Unilateral, Pe 2 $2,948.00 $47,078.00 $25,013.00 nat. median
$10,473
outlier · 2.4×
2202994
CDM 		Or Level 7 1st 15min 1 $24,862.00 $24,862.00 $24,862.00 —
27769
CPT 		Optx Post Ankle Fx 2 $1,232.00 $45,861.00 $23,546.50 nat. median
$6,897
outlier · 3.4×
75705
CPT 		Angiography Spinal Slct Rad Sup&int 1 $23,153.00 $23,153.00 $23,153.00 nat. median
$5,352
outlier · 4.3×
78816
CPT 		PET Body Skull To Feet 1 $21,866.00 $21,866.00 $21,866.00 nat. median
$1,696
outlier · 12.9×
36906
CPT 		Thrombolysis With Stent 2 $2,196.00 $41,225.00 $21,710.50 nat. median
$18,501
1.2× median
47562
CPT 		Removal Of Gallbladder Using An Endoscope 2 $176.00 $70,084.00 $21,502.25 nat. median
$6,043
outlier · 3.6×
CP17428476722288338
CDM 		Uterine And Adnexa Procedures For Non-malignancy Without Cc Or Mcc 1 $21,337.00 $21,337.00 $21,337.00 —
37228
CPT 		Revascularization, Endovascular, Open Or 2 $1,508.00 $40,386.00 $20,947.00 nat. median
$12,087
1.7× median
35011
CPT 		Direct Repair Of Aneurysm, Pseudoaneurys 1 $20,944.00 $20,944.00 $20,944.00 nat. median
$5,429
outlier · 3.9×
74480
CPT 		Intro Ureteral Cath Or Stent Into Ureter 1 $20,858.00 $20,858.00 $20,858.00 nat. median
$1,404
outlier · 14.9×

Other procedures at this hospital

Browse this hospital's 3,517 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
             
CP17428476722283252 CDM Spinal Fusion Except Cervical Without Mcc 3 1 $123,169.00 $123,169.00 $98,535.00 $98,535.00 $98,535.00 2026-04-01
CP17428476722286257 CDM Cervical Spinal Fusion Without Cc Or Mcc 3 1 $114,965.00 $114,965.00 $91,972.00 $91,972.00 $91,972.00 2026-04-01
36593 CPT Declotting By Thrombolytic Agent Of Impl 6 2 $221,562.00 $221,562.00 $924.00 $177,250.00 $89,087.00 2026-04-01
CP17428476722284545 CDM Cardiac Valve Or Cardiothoracic Procedure With Cardiac Catheterization With Mcc 3 1 $99,448.00 $99,448.00 $79,558.00 $79,558.00 $79,558.00 2026-04-01
CP17428476722285366 CDM Major Joint Replacement Or Reattachment Of Lower Extremity Without Mcc 3 1 $98,193.00 $98,193.00 $78,554.00 $78,554.00 $78,554.00 2026-04-01
C1816 HCPCS Receiver And/or Transmitter, Neurostimul 3 1 $95,000.00 $95,000.00 $76,000.00 $76,000.00 $76,000.00 2026-04-01
74246 CPT Xr Gastrointestinal Tract 3 1 $70,369.00 $70,369.00 $56,295.00 $56,295.00 $56,295.00 2026-04-01
C1822 HCPCS Nevro Trial Lead Kit 15 1 $117,875.00 $117,875.00 $4,000.00 $94,300.00 $54,996.00 2026-04-01
C1820 HCPCS Medtronic Recharger 9 1 $102,500.00 $102,500.00 $6,800.00 $82,000.00 $54,933.33 2026-04-01
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 2026-04-01
0505T CPT Endovenous Femoral-popliteal Arterial Re 3 1 $65,000.00 $65,000.00 $52,000.00 $52,000.00 $52,000.00 2026-04-01
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 2026-04-01
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 2026-04-01
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 2026-04-01
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 2026-04-01
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 2026-04-01
75810 CPT Splenoportography Rad Sup&int 3 1 $54,409.00 $54,409.00 $43,527.00 $43,527.00 $43,527.00 2026-04-01
75842 CPT Venography Adrenal Bilateral 3 1 $54,409.00 $54,409.00 $43,527.00 $43,527.00 $43,527.00 2026-04-01
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 2026-04-01
75840 CPT Veno Adrenal Uni Selective 3 1 $54,409.00 $54,409.00 $43,527.00 $43,527.00 $43,527.00 2026-04-01
75833 CPT Veno Renal Bil Selective 3 1 $54,409.00 $54,409.00 $43,527.00 $43,527.00 $43,527.00 2026-04-01
75885 CPT Percutaneous Transhepatic Portography 3 1 $54,409.00 $54,409.00 $43,527.00 $43,527.00 $43,527.00 2026-04-01
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 2026-04-01
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 2026-04-01
C1772 HCPCS Infusion Pump, Programmable (Implantable 3 1 $50,500.00 $50,500.00 $40,400.00 $40,400.00 $40,400.00 2026-04-01
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 2026-04-01
75891 CPT Hepatic Venography Wedged 3 1 $44,270.00 $44,270.00 $35,416.00 $35,416.00 $35,416.00 2026-04-01
75831 CPT Venography Renal Unilateral 3 1 $41,698.00 $41,698.00 $33,358.00 $33,358.00 $33,358.00 2026-04-01
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 2026-04-01
77372 CPT Srs Linear Based 3 1 $40,040.00 $40,040.00 $32,032.00 $32,032.00 $32,032.00 2026-04-01
63052 CPT Laminectomy, Facetectomy, Or Foraminotom 6 2 $75,000.00 $75,000.00 $924.00 $60,000.00 $30,462.00 2026-04-01
75889 CPT Hepatic Venography Wedged 3 1 $36,915.00 $36,915.00 $29,532.00 $29,532.00 $29,532.00 2026-04-01
75630 CPT Aorto Abd+bil Iliofemoral Serialography 3 1 $36,915.00 $36,915.00 $29,532.00 $29,532.00 $29,532.00 2026-04-01
77371 CPT Srs Multisource 3 1 $36,043.00 $36,043.00 $28,834.00 $28,834.00 $28,834.00 2026-04-01
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 2026-04-01
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 2026-04-01
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 2026-04-01
36821 CPT Arteriovenous Anastomosis, Open; Direct, 6 2 $62,153.00 $62,153.00 $1,232.00 $49,722.00 $25,477.00 2026-04-01
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 2026-04-01
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 2026-04-01
2202994 CDM Or Level 7 1st 15min 3 1 $31,077.00 $31,077.00 $24,862.00 $24,862.00 $24,862.00 2026-04-01
27769 CPT Optx Post Ankle Fx 6 2 $57,326.00 $57,326.00 $1,232.00 $45,861.00 $23,546.50 2026-04-01
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 2026-04-01
78816 CPT PET Body Skull To Feet 3 1 $27,332.00 $27,332.00 $21,866.00 $21,866.00 $21,866.00 2026-04-01
36906 CPT Thrombolysis With Stent 6 2 $51,531.00 $51,531.00 $2,196.00 $41,225.00 $21,710.50 2026-04-01
47562 CPT Removal Of Gallbladder Using An Endoscope 12 2 $87,605.00 $87,605.00 $176.00 $70,084.00 $21,502.25 2026-04-01
CP17428476722288338 CDM Uterine And Adnexa Procedures For Non-malignancy Without Cc Or Mcc 3 1 $26,671.00 $26,671.00 $21,337.00 $21,337.00 $21,337.00 2026-04-01
37228 CPT Revascularization, Endovascular, Open Or 6 2 $50,482.00 $50,482.00 $1,508.00 $40,386.00 $20,947.00 2026-04-01
35011 CPT Direct Repair Of Aneurysm, Pseudoaneurys 3 1 $26,180.00 $26,180.00 $20,944.00 $20,944.00 $20,944.00 2026-04-01
74485 CPT Dilation Nephrostomy Ureters Or Urethra 3 1 $26,073.00 $26,073.00 $20,858.00 $20,858.00 $20,858.00 2026-04-01
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 2026-04-01
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 2026-04-01
2202992 CDM Or Level 6 1st 15min 3 1 $25,897.00 $25,897.00 $20,718.00 $20,718.00 $20,718.00 2026-04-01
37242 CPT Vascular Embolization Or Occlusion, Incl 6 2 $50,122.00 $50,122.00 $1,232.00 $40,098.00 $20,665.00 2026-04-01
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 2026-04-01
77373 CPT Sbrt Delivery 3 1 $24,376.00 $24,376.00 $19,501.00 $19,501.00 $19,501.00 2026-04-01
36819 CPT Arteriovenous Anastomosis, Open; By Uppe 6 2 $47,123.00 $47,123.00 $1,232.00 $37,698.00 $19,465.00 2026-04-01
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 2026-04-01
36571 CPT Insert Picvad Cath 6 2 $46,269.00 $46,269.00 $1,232.00 $37,015.00 $19,123.50 2026-04-01
25290 CPT Incise Wrist/forearm Tendon 6 2 $46,269.00 $46,269.00 $1,232.00 $37,015.00 $19,123.50 2026-04-01
2202990 CDM Or Level 5 1st 15min 3 1 $23,544.00 $23,544.00 $18,835.00 $18,835.00 $18,835.00 2026-04-01
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 2026-04-01
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 2026-04-01
2202984 CDM Or Level 4 1st 15min 3 1 $21,812.00 $21,812.00 $17,450.00 $17,450.00 $17,450.00 2026-04-01
78815 CPT PET Body Skull To Thigh 4 2 $27,332.00 $27,332.00 $950.00 $21,866.00 $16,637.00 2026-04-01
C1889 HCPCS Mild Kit - 9 1 $30,750.00 $30,750.00 $11,980.00 $24,600.00 $16,193.33 2026-04-01
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 2026-04-01
49505 CPT Repair Of Groin Hernia Patient Age 5 Years Or Older 12 2 $57,605.00 $57,605.00 $176.00 $46,084.00 $15,463.00 2026-04-01
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 2026-04-01
75825 CPT Venography Caval Infer W/serialography 3 1 $18,770.00 $18,770.00 $15,016.00 $15,016.00 $15,016.00 2026-04-01
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 2026-04-01
35903 CPT Excision Of Infected Graft; Extremity 3 1 $18,222.00 $18,222.00 $14,578.00 $14,578.00 $14,578.00 2026-04-01
C1604 HCPCS Graft, Transmural Transvenous Arterial B 3 1 $18,000.00 $18,000.00 $14,400.00 $14,400.00 $14,400.00 2026-04-01
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 2026-04-01
75827 CPT Venography Caval Sup With Serialography 3 1 $17,585.00 $17,585.00 $14,068.00 $14,068.00 $14,068.00 2026-04-01
75880 CPT Venography Orbital 3 1 $17,585.00 $17,585.00 $14,068.00 $14,068.00 $14,068.00 2026-04-01
75872 CPT Venography Epidural 3 1 $17,585.00 $17,585.00 $14,068.00 $14,068.00 $14,068.00 2026-04-01
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 2026-04-01
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 2026-04-01
75860 CPT Venography Venous Sinus 3 1 $17,585.00 $17,585.00 $14,068.00 $14,068.00 $14,068.00 2026-04-01
75887 CPT Percutaneous Transhepatic Portography 3 1 $17,585.00 $17,585.00 $14,068.00 $14,068.00 $14,068.00 2026-04-01
37187 CPT Percutaneous Transluminal Mechanical Thr 6 2 $31,445.00 $31,445.00 $2,948.00 $25,156.00 $14,052.00 2026-04-01
49325 CPT Laparoscopy, Surgical; With Revision Of 6 2 $32,986.00 $32,986.00 $1,508.00 $26,389.00 $13,948.50 2026-04-01
75807 CPT Lymphangiography Pelvic/abd Bilat Rad 3 1 $17,281.00 $17,281.00 $13,825.00 $13,825.00 $13,825.00 2026-04-01
75805 CPT Lymphangiography Pel/abd Unilateral Rad 3 1 $17,281.00 $17,281.00 $13,825.00 $13,825.00 $13,825.00 2026-04-01
75822 CPT Venography Extremity B/l 3 1 $17,281.00 $17,281.00 $13,825.00 $13,825.00 $13,825.00 2026-04-01
75803 CPT Lymphangiography Extremity Only Bil Rad 3 1 $17,281.00 $17,281.00 $13,825.00 $13,825.00 $13,825.00 2026-04-01
36905 CPT Thrmbc/nfs Dialysis Circuit 6 2 $31,445.00 $31,445.00 $2,196.00 $25,156.00 $13,676.00 2026-04-01
36902 CPT Dialysis Of Av Fistula 6 2 $30,630.00 $30,630.00 $2,196.00 $24,504.00 $13,350.00 2026-04-01
36833 CPT Revision, Open, Arteriovenous Fistula; W 6 2 $31,416.00 $31,416.00 $1,508.00 $25,133.00 $13,320.50 2026-04-01
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 2026-04-01
78814 CPT PET Limited Study 3 1 $15,819.00 $15,819.00 $12,655.00 $12,655.00 $12,655.00 2026-04-01
26477 CPT Tendon Shortening 9 2 $46,269.00 $46,269.00 $6.00 $37,015.00 $12,648.33 2026-04-01
C1776 HCPCS Zimmer Prolong Highly Crosslinked Polyet 36 1 $45,770.00 $45,770.00 $231.00 $36,616.00 $12,631.17 2026-04-01
78608 CPT PET Brain Imaging 3 1 $15,671.00 $15,671.00 $12,537.00 $12,537.00 $12,537.00 2026-04-01
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 2026-04-01
C1760 HCPCS Closure Device, Vascular (Implantable/in 3 1 $15,000.00 $15,000.00 $12,000.00 $12,000.00 $12,000.00 2026-04-01
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 2026-04-01
62380 CPT Endoscopic Decompression Of Spinal Cord, 6 2 $27,265.00 $27,265.00 $1,665.00 $21,812.00 $11,738.50 2026-04-01
36904 CPT Percutaneous Transluminal Mechanical Thr 6 2 $27,229.00 $27,229.00 $1,665.00 $21,783.00 $11,724.00 2026-04-01
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 2026-04-01
2202986 CDM Or Level 2 1st 15min 3 1 $14,342.00 $14,342.00 $11,474.00 $11,474.00 $11,474.00 2026-04-01
42820 CPT Removal Of Tonsils And Adenoid Glands, Patient Younger Than Age 12 12 2 $37,605.00 $37,605.00 $176.00 $30,084.00 $11,394.00 2026-04-01
66984 CPT Removal Of Cataract With Insertion Of Lens 12 2 $32,812.00 $32,812.00 $208.00 $26,250.00 $11,393.25 2026-04-01
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 2026-04-01
93458 CPT Catheter Placement In Coronary Artery(s) 9 2 $27,943.00 $27,943.00 $2,196.00 $22,354.00 $10,550.00 2026-04-01
0275T CPT Perq Lamot/lam Lumbar 1st 6 1 $25,897.00 $25,897.00 $350.00 $20,718.00 $10,534.00 2026-04-01
22585 CPT Arthrodesis Anterior Interbody Techn 6 1 $25,897.00 $25,897.00 $350.00 $20,718.00 $10,534.00 2026-04-01
63051 CPT C-laminoplasty W/graft/plate 1st 6 1 $25,897.00 $25,897.00 $350.00 $20,718.00 $10,534.00 2026-04-01
29826 CPT Shaving Of Shoulder Bone Using Endoscope 12 2 $28,812.00 $28,812.00 $208.00 $23,050.00 $10,485.00 2026-04-01
72270 CPT Myelography Two Or More Regions 3 1 $13,053.00 $13,053.00 $10,442.00 $10,442.00 $10,442.00 2026-04-01
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 2026-04-01
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 2026-04-01
72240 CPT Myelography Cervical Rad Sup&int 3 1 $13,053.00 $13,053.00 $10,442.00 $10,442.00 $10,442.00 2026-04-01
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 2026-04-01
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 2026-04-01
2202988 CDM Or Level 1 1st 15min 3 1 $12,326.00 $12,326.00 $9,861.00 $9,861.00 $9,861.00 2026-04-01
37248 CPT Transluminal Balloon Angioplasty (Except 6 2 $21,784.00 $21,784.00 $2,196.00 $17,427.00 $9,811.50 2026-04-01
78452 CPT Mycardiol Perfusion Imaging Tomographic 4 2 $15,927.00 $15,927.00 $950.00 $12,742.00 $9,794.00 2026-04-01
72158 CPT Mr Lumbar Spine Wwo 3 1 $12,204.00 $12,204.00 $9,763.00 $9,763.00 $9,763.00 2026-04-01
75894 CPT Transcath Ther Embolization Any Method 3 1 $12,123.00 $12,123.00 $9,698.00 $9,698.00 $9,698.00 2026-04-01
63090 CPT Remove Vert Body Dcmprn Lmbr 1st 6 1 $23,544.00 $23,544.00 $270.00 $18,835.00 $9,552.50 2026-04-01
63101 CPT Remove Vert Body Dcmprn Thrc 1st 6 1 $23,544.00 $23,544.00 $270.00 $18,835.00 $9,552.50 2026-04-01
63082 CPT Vertebral Corpectomy Vertebral Body Res 6 1 $23,544.00 $23,544.00 $270.00 $18,835.00 $9,552.50 2026-04-01
63088 CPT Vertebr Corpectomy Vertebral Body Resect 6 1 $23,544.00 $23,544.00 $270.00 $18,835.00 $9,552.50 2026-04-01
63277 CPT Bx/exc Xdrl Spine Lesn Lmbr 1st 6 1 $23,544.00 $23,544.00 $270.00 $18,835.00 $9,552.50 2026-04-01
63081 CPT Remove Vert Body Dcmprn Crvl 1st 6 1 $23,544.00 $23,544.00 $270.00 $18,835.00 $9,552.50 2026-04-01
49566 CPT Rerepair Ventrl Hern Block 1st 6 1 $23,544.00 $23,544.00 $270.00 $18,835.00 $9,552.50 2026-04-01
0163T CPT Total Disc Arthroplasty Anterior Approac 6 1 $23,544.00 $23,544.00 $270.00 $18,835.00 $9,552.50 2026-04-01
22523 CPT Perq Vertebral Augmentation Th 1st 6 1 $23,544.00 $23,544.00 $270.00 $18,835.00 $9,552.50 2026-04-01
63050 CPT Cervical Laminoplsty 2/> Seg 1st 6 1 $23,544.00 $23,544.00 $270.00 $18,835.00 $9,552.50 2026-04-01
63103 CPT Vertebral Corpectomy Vertebral Body Rese 6 1 $23,544.00 $23,544.00 $270.00 $18,835.00 $9,552.50 2026-04-01
48550 CPT Donor Pancreatectomy Inc Cold Preserv 1s 6 1 $23,544.00 $23,544.00 $270.00 $18,835.00 $9,552.50 2026-04-01
63087 CPT Remov Vertbr Dcmprn Thrclmbr 1st 6 1 $23,544.00 $23,544.00 $270.00 $18,835.00 $9,552.50 2026-04-01
29881 CPT Removal Of One Knee Cartilage Using An Endoscope 12 2 $27,605.00 $27,605.00 $176.00 $22,084.00 $9,463.00 2026-04-01
C1763 HCPCS Spinal Graft Technologies Allograft 8x11 12 1 $21,975.00 $21,975.00 $2,184.00 $17,580.00 $9,436.00 2026-04-01
C9362 HCPCS Stryker 2.5cc Bio Viable Bone Matrix 6 1 $13,500.00 $13,500.00 $7,650.00 $10,800.00 $9,225.00 2026-04-01
55700 CPT Biopsy Of Prostate Gland 12 2 $32,326.00 $32,326.00 $115.00 $25,861.00 $9,223.75 2026-04-01
12202993 CDM New Or Level 6 Addl 15 Mins 3 1 $11,519.00 $11,519.00 $9,215.00 $9,215.00 $9,215.00 2026-04-01
75820 CPT Veno Extremity Unilateral 3 1 $11,282.00 $11,282.00 $9,026.00 $9,026.00 $9,026.00 2026-04-01
34718 CPT Endovascular Repair The Iliac Artery 1st 6 1 $21,812.00 $21,812.00 $208.00 $17,450.00 $8,829.00 2026-04-01
61615 CPT Resect/excise Lesion Skull 1st 6 1 $21,812.00 $21,812.00 $208.00 $17,450.00 $8,829.00 2026-04-01
49654 CPT Lap Inc Hernia Repair 1st 6 1 $21,812.00 $21,812.00 $208.00 $17,450.00 $8,829.00 2026-04-01
49568 CPT Mesh Implant Incis/ventral Hernia Rep 1s 6 1 $21,812.00 $21,812.00 $208.00 $17,450.00 $8,829.00 2026-04-01
43632 CPT Removal Of Stomach Partial 1st 6 1 $21,812.00 $21,812.00 $208.00 $17,450.00 $8,829.00 2026-04-01
43621 CPT Removal Of Stomach 1st 6 1 $21,812.00 $21,812.00 $208.00 $17,450.00 $8,829.00 2026-04-01
49653 CPT Lap Vent/abd Hern Proc Comp 1st 6 1 $21,812.00 $21,812.00 $208.00 $17,450.00 $8,829.00 2026-04-01
43633 CPT Removal Of Stomach Partial 1st 6 1 $21,812.00 $21,812.00 $208.00 $17,450.00 $8,829.00 2026-04-01
63709 CPT Repair Spinal Fluid Leakage 1st 6 1 $21,812.00 $21,812.00 $208.00 $17,450.00 $8,829.00 2026-04-01
43775 CPT Lap Sleeve Gastrectomy 1st 6 1 $21,812.00 $21,812.00 $208.00 $17,450.00 $8,829.00 2026-04-01
49615 CPT Rpr Aa Hrn Rcr 3-10 Rdc 6 2 $19,778.00 $19,778.00 $1,508.00 $15,822.00 $8,665.00 2026-04-01
49402 CPT Removal Of Peritoneal Foreign Body From 6 2 $19,778.00 $19,778.00 $1,058.00 $15,822.00 $8,440.00 2026-04-01
71552 CPT Mr Chest Wwo 3 1 $10,383.00 $10,383.00 $8,306.00 $8,306.00 $8,306.00 2026-04-01
74174 CPT CT Angio Abd/pel With And Without IV 3 1 $10,369.00 $10,369.00 $8,295.00 $8,295.00 $8,295.00 2026-04-01
28055 CPT Neurectomy Foot 6 2 $18,846.00 $18,846.00 $1,508.00 $15,077.00 $8,292.50 2026-04-01
73723 CPT Mr Joint Low Extr Wwo Rt 6 1 $10,266.00 $10,266.00 $8,212.00 $8,213.00 $8,212.50 2026-04-01
73720 CPT Mr Non-joint Low Extr Wwo Rt 6 1 $10,266.00 $10,266.00 $8,212.00 $8,213.00 $8,212.50 2026-04-01
73223 CPT Mr Joint Upper Extr Wwo Rt 6 1 $10,266.00 $10,266.00 $8,212.00 $8,213.00 $8,212.50 2026-04-01
73220 CPT Mr Non-joint Upper Extr Wwo Rt 6 1 $10,266.00 $10,266.00 $8,212.00 $8,213.00 $8,212.50 2026-04-01
70559 CPT MRI Open Intracranial Proc W/wo Dye 3 1 $10,265.00 $10,265.00 $8,212.00 $8,212.00 $8,212.00 2026-04-01
72156 CPT Mr Cervical Spine Wwo 3 1 $10,265.00 $10,265.00 $8,212.00 $8,212.00 $8,212.00 2026-04-01
70549 CPT Mr Angiograph Neck W/wo Dye 3 1 $10,265.00 $10,265.00 $8,212.00 $8,212.00 $8,212.00 2026-04-01
70543 CPT Mr Orbs/face/neck Wwo 3 1 $10,265.00 $10,265.00 $8,212.00 $8,212.00 $8,212.00 2026-04-01
70546 CPT Mr Angiograph Head W/wo Dye 3 1 $10,265.00 $10,265.00 $8,212.00 $8,212.00 $8,212.00 2026-04-01
72197 CPT Mr Pelvis Wwo 3 1 $10,265.00 $10,265.00 $8,212.00 $8,212.00 $8,212.00 2026-04-01
75561 CPT Cardiac MRI For Morph With Contrast 3 1 $10,265.00 $10,265.00 $8,212.00 $8,212.00 $8,212.00 2026-04-01
72157 CPT MRI Thoracic Spine Wwo 3 1 $10,265.00 $10,265.00 $8,212.00 $8,212.00 $8,212.00 2026-04-01
74183 CPT Mr Abd Wwo 3 1 $10,265.00 $10,265.00 $8,212.00 $8,212.00 $8,212.00 2026-04-01
70553 CPT MRI Scan 3 1 $10,265.00 $10,265.00 $8,212.00 $8,212.00 $8,212.00 2026-04-01
45385 CPT Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope 9 2 $23,345.00 $23,345.00 $1,058.00 $18,676.00 $8,210.67 2026-04-01
45380 CPT Biopsy Exam Of Large Bowel Using An Endoscope 9 2 $23,345.00 $23,345.00 $1,058.00 $18,676.00 $8,210.67 2026-04-01
19120 CPT Removal Of One Or More Breast Growth, Open Procedure 12 2 $24,342.00 $24,342.00 $138.00 $19,474.00 $8,079.50 2026-04-01
27047 CPT Exc Hip/pelvis Les Sc < 3 Cm 6 2 $18,846.00 $18,846.00 $1,058.00 $15,077.00 $8,067.50 2026-04-01
45398 CPT Colonoscopy Flexible W/band Ligations 6 2 $18,564.00 $18,564.00 $1,058.00 $14,851.00 $7,954.50 2026-04-01
36582 CPT Replacement, Complete, Of A Tunneled Cen 6 2 $18,222.00 $18,222.00 $1,232.00 $14,578.00 $7,905.00 2026-04-01
36475 CPT Endovenous Rf 1st Vein 6 2 $18,140.00 $18,140.00 $1,232.00 $14,512.00 $7,872.00 2026-04-01
52353 CPT Cystouretero W/lithotripsy 7 3 $19,940.00 $19,940.00 $1,508.00 $15,952.00 $7,797.14 2026-04-01
C1778 HCPCS Trial Lead Kit 70b 9 1 $10,750.00 $10,750.00 $6,000.00 $8,600.00 $7,729.33 2026-04-01
77022 CPT Magnetic Resonance Guidance 3 1 $9,652.00 $9,652.00 $7,722.00 $7,722.00 $7,722.00 2026-04-01
22612 CPT Lumbar Spine Fusion 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22633 CPT Lumbar Spine Fusion Combined 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22849 CPT Reinsertion Spinal Fixation Device 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22855 CPT Removal Anterior Instrumentation 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22554 CPT Neck Spine Fusion 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22802 CPT Post Fusion 7-12 Vert Seg 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22857 CPT Lumbar Artif Diskectomy 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22600 CPT Neck Spine Fusion 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22610 CPT Thorax Spine Fusion 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
27280 CPT Fusion Of Sacroiliac Joint 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
27138 CPT Revise Hip Joint Replacement 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22551 CPT Neck Spine Fuse&remov Bel C2 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
27134 CPT Revise Hip Joint Replacement 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
27130 CPT Total Hip Arthroplasty 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22861 CPT Revise Cerv Artific Disc 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22556 CPT Thorax Spine Fusion 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22630 CPT Lumbar Spine Fusion 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22856 CPT Cerv Artific Diskectomy 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22558 CPT Lumbar Spine Fusion 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22850 CPT Remove Spine Fixation Device 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
22532 CPT Lat Thorax Spine Fusion 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
63056 CPT Decompress Spinal Cord Lmbr 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
63655 CPT Implant Neuroelectrodes 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,645.33 2026-04-01
74178 CPT CT Abdomen Pelvis With And Without IV 6 1 $12,555.00 $12,555.00 $5,214.00 $10,044.00 $7,629.00 2026-04-01
63012 CPT Remove Lamina/facets Lumbar 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,577.67 2026-04-01
63047 CPT Lamin/facet&foramin Sgl Vrtbrl Sgmt Lumb 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,577.67 2026-04-01
63030 CPT Low Back Disk Surgery 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,577.67 2026-04-01
63040 CPT Laminotomy Single Cervical 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,577.67 2026-04-01
63035 CPT Laminotomy Single Cervical/lumbar 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,577.67 2026-04-01
63048 CPT Laminectomy Facetectomy And Foraminotomy 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,577.67 2026-04-01
27279 CPT Arthrodesis Sacroiliac Joint Add 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,577.67 2026-04-01
63045 CPT Remove Spine Lamina 1 Crvl 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,577.67 2026-04-01
22513 CPT Perq Vertebral Augmentation Th 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,577.67 2026-04-01
22514 CPT Perq Vertebral Augmentation Lu 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,577.67 2026-04-01
63046 CPT Remove Spine Lamina 1 Thrc 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,577.67 2026-04-01
63267 CPT Excise Intrspinl Lesion Lmbr 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,577.67 2026-04-01
63042 CPT Laminotomy Single Lumbar 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,577.67 2026-04-01
74176 CPT CT Abdomen Pelvis Without IV 6 1 $10,697.00 $10,697.00 $6,527.00 $8,558.00 $7,542.50 2026-04-01
22830 CPT Exploration Spinal Fusion 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,525.33 2026-04-01
22511 CPT Perq Lumbosacral Injection 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,525.33 2026-04-01
77048 CPT MRI Breast C-+ W/cad Uni 3 1 $9,328.00 $9,328.00 $7,462.00 $7,462.00 $7,462.00 2026-04-01
C8905 HCPCS MRI Without Fol W/cont Brst Unilat 3 1 $9,328.00 $9,328.00 $7,462.00 $7,462.00 $7,462.00 2026-04-01
63020 CPT Neck Spine Disk Surgery 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,433.33 2026-04-01
64561 CPT Implant Neuroelectrodes 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,433.33 2026-04-01
63650 CPT Implant Neuroelectrodes 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,375.33 2026-04-01
38525 CPT Biopsy/removal Lymph Nodes 12 2 $20,996.00 $20,996.00 $138.00 $16,797.00 $7,366.75 2026-04-01
73219 CPT Mr Non-joint Upper Extr W Lt 3 1 $9,188.00 $9,188.00 $7,350.00 $7,350.00 $7,350.00 2026-04-01
22845 CPT Ant Instrument 2-3 Vertebral Seg Add 1 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22846 CPT Ant Instrument 4-7 Vertebral Seg Add 1 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22842 CPT Posterior Segmental Instrumentation 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22854 CPT Ins Intervertebral Miomechanical Device 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22848 CPT Pelvic Fixation Attachment Caudal End 1 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22847 CPT Ant Instrument =>8 Vertebral Seg Add 1 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
63057 CPT Transped Appr W Decompression Spinal Cr 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22534 CPT Arthrodesis Lat Extracavitary Technique 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22634 CPT Arthrodesis Combined Posterior Tech 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22614 CPT Arthrodesis Post Or Posterolat Tech 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22844 CPT Posterior Segmental Instrumentation 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
63044 CPT Laminotomy Single Ea Add Lumbar 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22552 CPT Arthrodesis Anterior Interbody Disc 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
63688 CPT Revise/remove Neuroreceiver 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
63664 CPT Revise Spine Eltrd Plate 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22632 CPT Arthrodesis Posterior Interbody Techniqu 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
63663 CPT Revise Spine Eltrd Perq Aray 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22512 CPT Perc Vertebroplasty Bone Biopsy 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22840 CPT Post Nonsegmental Instr Eg Harrington 1s 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22858 CPT Tot Disc Arthroplasty Anterior Approach 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
63043 CPT Laminotomy Single Ea Add Cervical 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
63662 CPT Remove Spine Eltrd Plate 1st 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
22853 CPT Insertion Interbody Biomechanical Device 9 2 $25,897.00 $25,897.00 $350.00 $20,718.00 $7,330.67 2026-04-01
37220 CPT Revascularization, Endovascular, Open Or 6 2 $16,338.00 $16,338.00 $1,508.00 $13,070.00 $7,289.00 2026-04-01
73722 CPT Mr Joint Low Extr W Lt 3 1 $9,075.00 $9,075.00 $7,260.00 $7,260.00 $7,260.00 2026-04-01
72142 CPT Mr Cervical Spine W 3 1 $9,075.00 $9,075.00 $7,260.00 $7,260.00 $7,260.00 2026-04-01
72147 CPT MRI Thoracic Spine W 3 1 $9,075.00 $9,075.00 $7,260.00 $7,260.00 $7,260.00 2026-04-01
72149 CPT Mr Lumbar Spine W 3 1 $9,075.00 $9,075.00 $7,260.00 $7,260.00 $7,260.00 2026-04-01
70558 CPT MRI Open Intracranial Proc With Contrast 3 1 $9,075.00 $9,075.00 $7,260.00 $7,260.00 $7,260.00 2026-04-01
71551 CPT Mr Chest W 3 1 $9,075.00 $9,075.00 $7,260.00 $7,260.00 $7,260.00 2026-04-01
73719 CPT Mr Non-joint Low Extr W Lt 3 1 $9,075.00 $9,075.00 $7,260.00 $7,260.00 $7,260.00 2026-04-01
70548 CPT Mr Angiography Neck With Contrast 3 1 $9,075.00 $9,075.00 $7,260.00 $7,260.00 $7,260.00 2026-04-01
70545 CPT Mr Angiography Head With Contrast 3 1 $9,075.00 $9,075.00 $7,260.00 $7,260.00 $7,260.00 2026-04-01
70552 CPT Mr Brain W 3 1 $9,075.00 $9,075.00 $7,260.00 $7,260.00 $7,260.00 2026-04-01
72196 CPT Mr Pelvis W 3 1 $9,075.00 $9,075.00 $7,260.00 $7,260.00 $7,260.00 2026-04-01
74182 CPT Mr Abd W 3 1 $9,075.00 $9,075.00 $7,260.00 $7,260.00 $7,260.00 2026-04-01
73222 CPT Mr Joint Upper Extr W Lt 3 1 $9,075.00 $9,075.00 $7,260.00 $7,260.00 $7,260.00 2026-04-01
70542 CPT Mr Orbs/face/neck W 3 1 $9,075.00 $9,075.00 $7,260.00 $7,260.00 $7,260.00 2026-04-01
50590 CPT Lithotripsy Extracorporeal Shock Wave 7 3 $16,471.00 $16,471.00 $2,200.00 $13,177.00 $7,225.00 2026-04-01
74177 CPT CT Scan Of Abdomen And Pelvis With Contrast 6 1 $11,827.00 $11,827.00 $4,882.00 $9,462.00 $7,172.00 2026-04-01
49657 CPT Lap Inc Hern Recur Comp 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
49656 CPT Lap Inc Hernia Repair Recur 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
19324 CPT Enlarge Breast 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
49655 CPT Lap Inc Hern Repair Comp 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
58146 CPT Myomectomy Abdom Complex 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
0249T CPT Liga Hemorrhoid Vas Bund Inc US Guid 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
27694 CPT Decompression Fasciotomy W/debridement 1 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
51530 CPT Cystotomy For Excision Bladder Tumor 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
27598 CPT Disarticulation At Knee 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
27880 CPT Amputation Leg Through Tibia & Fibula A 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
44238 CPT Laparoscope Proc Intestine 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
44620 CPT Closure Enterostomy Lg/sm Intest 1st 32 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
44207 CPT L Colectomy/coloproctostomy 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
27886 CPT Amp Leg Through Tibia&fibula Re-amp Add 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
0232T CPT Inj Platelet Rich Plasma Any Site 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
44955 CPT Appendectomy 1st 15 Min 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
54430 CPT Revision Of Penis 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
31040 CPT Pterygomaxillary Fossa Any Approach 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
49587 CPT Rpr Umbil Hern Block > 5 Yr 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
44146 CPT Partial Removal Of Colon 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
44160 CPT Removal Of Colon 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
49572 CPT Rpr Epigastric Hern Blocked 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
49652 CPT Lap Vent/abd Hernia Repair 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
49585 CPT Rpr Umbil Hern Reduc > 5 Yr 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
44139 CPT Takedown Splenic Flexure W Colectomy 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
44120 CPT Removal Of Small Intestine 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
44143 CPT Partial Removal Of Colon 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
44140 CPT Colectomy Partial With Anastomosis 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
43843 CPT Gastroplasty Without V-band 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
43644 CPT Lap Gastric Bypass/roux-en-y 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
49560 CPT Rpr Ventral Hern Init Reduc 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
63706 CPT Repair Of Spinal Herniation 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
49561 CPT Rpr Ventral Hern Init Block 1st 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
0627T CPT Perc Lumbar Intravertebral Disc Inj Proc 6 1 $17,605.00 $17,605.00 $176.00 $14,084.00 $7,130.00 2026-04-01
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