Hospital

ALTUS HOUSTON HOSPITAL, LP

Houston, TX · CCN 670135 · Rates published

Your selected procedure

You selected 45378 (CPT)

Diagnostic exam of large bowel using an endoscope

This hospital’s price: $8,802 across 2 payers · range $1,058-$15,082

Source: https://secure.claraprice.net/price-transparency/ZWAM-1739310256610/machine-readable/474624853_west-chase-houston-hospital_standardcharges.json · observed 2026-04-01

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.

3,192 distinct procedures filed

3 distinct payers

22,930 rate rows

2026-04-01 last MRF observed

Data quality

20,034 of 22,930 rate rows are consumer-grade (87.4%)

2,896 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	2,880
exceeds 10× this hospital's gross charge — excluded from medians	10
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	6

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

Source MRF file	https://secure.claraprice.net/price-transparency/ZWAM-1739310256610/machine-readable/474624853_west-chase-houston-hospital_standardcharges.json
Found on page	https://wchh.care/cms-hpt.txt
Discovered via	CMS hospital list
Last fetch	success · 2026-09-25
Content fingerprint	dfc8d8d07a83a1df… · 10,227,683 bytes · first seen 2026-09-25

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
CP17428471194763655 CDM	Spinal Fusion Except Cervical Without Mcc	1	$98,535.00	$98,535.00	$98,535.00	nat. median $98,535 1.0× median
CP17428471194766026 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
CP17428471194764672 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
CP17428471194763579 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
C1820 HCPCS	Bs Precision Charging System Kit	1	$3,200.00	$109,720.00	$70,600.00	nat. median $21,100 outlier · 3.3×
2203406 CDM	Or Level 7 1st 30min	1	$65,341.00	$65,341.00	$65,341.00	nat. median $65,341 1.0× median
2203404 CDM	Or Level 5 1st 30min	1	$49,502.00	$49,502.00	$49,502.00	nat. median $49,502 1.0× median
C1767 HCPCS	Medtronic Interstim Ii	1	$46,720.00	$46,720.00	$46,720.00	nat. median $25,172 1.9× median
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×
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×
75810 CPT	Splenoportography Rad Sup&int	1	$43,527.00	$43,527.00	$43,527.00	nat. median $3,176 outlier · 13.7×
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×
75885 CPT	Percutaneous Transhepatic Portography	1	$43,527.00	$43,527.00	$43,527.00	nat. median $3,120 outlier · 14.0×
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×
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×
75833 CPT	Veno Renal Bil Selective	1	$43,527.00	$43,527.00	$43,527.00	nat. median $3,174 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×
75978 CPT	Transluminal Balloon Angioplasty Venous	1	$42,520.00	$42,520.00	$42,520.00	nat. median $876 outlier · 48.5×
C1772 HCPCS	Medtronic Handset Kit	1	$5,044.00	$49,796.00	$40,400.00	nat. median $18,271 outlier · 2.2×
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×
77372 CPT	Srs Linear Based	1	$32,032.00	$32,032.00	$32,032.00	nat. median $7,667 outlier · 4.2×
C1813 HCPCS	Ams 700 Cx, Ms Pump Iz 12 Cm X 12 Mm	1	$3,384.00	$57,032.00	$31,845.00	nat. median $10,938 outlier · 2.9×
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×
63081 CPT	Remove Vert Body Dcmprn Crvl	1	$7,090.00	$49,502.00	$28,296.00	nat. median $4,440 outlier · 6.4×
63082 CPT	Vertebral Corpectomy Vertebral Body Res	1	$7,090.00	$49,502.00	$28,296.00	nat. median $2,143 outlier · 13.2×
63087 CPT	Remov Vertbr Dcmprn Thrclmbr	1	$7,090.00	$49,502.00	$28,296.00	nat. median $4,821 outlier · 5.9×
22523 CPT	Perq Vertebral Augmentation Th	1	$7,090.00	$49,502.00	$28,296.00	nat. median $8,255 outlier · 3.4×
49566 CPT	Rerepair Ventrl Hern Block	1	$7,090.00	$49,502.00	$28,296.00	nat. median $3,259 outlier · 8.7×
63088 CPT	Vertebr Corpectomy Vertebral Body Resect	1	$7,090.00	$49,502.00	$28,296.00	nat. median $2,545 outlier · 11.1×
0163T CPT	Total Disc Arthroplasty Anterior Approac	1	$7,090.00	$49,502.00	$28,296.00	nat. median $6,890 outlier · 4.1×
63101 CPT	Remove Vert Body Dcmprn Thrc	1	$7,090.00	$49,502.00	$28,296.00	nat. median $5,164 outlier · 5.5×
63050 CPT	Cervical Laminoplsty 2/> Seg	1	$7,090.00	$49,502.00	$28,296.00	nat. median $3,123 outlier · 9.1×
63277 CPT	Bx/exc Xdrl Spine Lesn Lmbr	1	$7,090.00	$49,502.00	$28,296.00	nat. median $6,140 outlier · 4.6×
63090 CPT	Remove Vert Body Dcmprn Lmbr	1	$7,090.00	$49,502.00	$28,296.00	nat. median $4,950 outlier · 5.7×
48550 CPT	Donor Pancreatectomy Inc Cold Preserv	1	$7,090.00	$49,502.00	$28,296.00	nat. median $2,846 outlier · 9.9×
63103 CPT	Vertebral Corpectomy Vertebral Body Rese	1	$7,090.00	$49,502.00	$28,296.00	nat. median $3,950 outlier · 7.2×
C1889 HCPCS	Bard Ventralight Mesh 6 X 8	1	$11,786.00	$26,800.00	$26,000.00	nat. median $1,642 outlier · 15.8×
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×
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×
C1815 HCPCS	Ams 800 Contol Pump	1	$5,022.00	$25,020.00	$24,102.00	nat. median $8,336 outlier · 2.9×
C1776 HCPCS	Biomet Partial Femur Cemented Size 4	1	$5,040.00	$57,080.00	$24,000.00	nat. median $3,543 outlier · 6.8×
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 CT Full Body Skull To Feet	1	$21,866.00	$21,866.00	$21,866.00	nat. median $1,696 outlier · 12.9×
78815 CPT	PET CT Skull Base To Mid Thigh	1	$21,866.00	$21,866.00	$21,866.00	nat. median $1,679 outlier · 13.0×
CP17428471194764652 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

Other procedures at this hospital

Browse this hospital's 3,192 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

CP17428471194763655	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
CP17428471194766026	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
CP17428471194764672	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
CP17428471194763579	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
C1820	HCPCS	Bs Precision Charging System Kit	36	1	$88,250.00	$88,250.00	$3,200.00	$109,720.00	$70,600.00	2026-04-01
2203406	CDM	Or Level 7 1st 30min	3	1	$81,676.00	$81,676.00	$65,341.00	$65,341.00	$65,341.00	2026-04-01
2203404	CDM	Or Level 5 1st 30min	3	1	$61,878.00	$61,878.00	$49,502.00	$49,502.00	$49,502.00	2026-04-01
C1767	HCPCS	Medtronic Interstim Ii	3	1	$58,400.00	$58,400.00	$46,720.00	$46,720.00	$46,720.00	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
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
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
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
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
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
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
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
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
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
75978	CPT	Transluminal Balloon Angioplasty Venous	3	1	$53,150.00	$53,150.00	$42,520.00	$42,520.00	$42,520.00	2026-04-01
C1772	HCPCS	Medtronic Handset Kit	9	1	$50,500.00	$50,500.00	$5,044.00	$49,796.00	$40,400.00	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
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
C1813	HCPCS	Ams 700 Cx, Ms Pump Iz 12 Cm X 12 Mm	24	1	$39,806.50	$39,806.50	$3,384.00	$57,032.00	$31,845.00	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
48550	CPT	Donor Pancreatectomy Inc Cold Preserv	6	1	$35,370.00	$35,370.00	$7,090.00	$49,502.00	$28,296.00	2026-04-01
63090	CPT	Remove Vert Body Dcmprn Lmbr	6	1	$35,370.00	$35,370.00	$7,090.00	$49,502.00	$28,296.00	2026-04-01
63050	CPT	Cervical Laminoplsty 2/> Seg	6	1	$35,370.00	$35,370.00	$7,090.00	$49,502.00	$28,296.00	2026-04-01
49566	CPT	Rerepair Ventrl Hern Block	6	1	$35,370.00	$35,370.00	$7,090.00	$49,502.00	$28,296.00	2026-04-01
63103	CPT	Vertebral Corpectomy Vertebral Body Rese	6	1	$35,370.00	$35,370.00	$7,090.00	$49,502.00	$28,296.00	2026-04-01
63088	CPT	Vertebr Corpectomy Vertebral Body Resect	6	1	$35,370.00	$35,370.00	$7,090.00	$49,502.00	$28,296.00	2026-04-01
22523	CPT	Perq Vertebral Augmentation Th	6	1	$35,370.00	$35,370.00	$7,090.00	$49,502.00	$28,296.00	2026-04-01
63087	CPT	Remov Vertbr Dcmprn Thrclmbr	6	1	$35,370.00	$35,370.00	$7,090.00	$49,502.00	$28,296.00	2026-04-01
63277	CPT	Bx/exc Xdrl Spine Lesn Lmbr	6	1	$35,370.00	$35,370.00	$7,090.00	$49,502.00	$28,296.00	2026-04-01
63081	CPT	Remove Vert Body Dcmprn Crvl	6	1	$35,370.00	$35,370.00	$7,090.00	$49,502.00	$28,296.00	2026-04-01
63101	CPT	Remove Vert Body Dcmprn Thrc	6	1	$35,370.00	$35,370.00	$7,090.00	$49,502.00	$28,296.00	2026-04-01
0163T	CPT	Total Disc Arthroplasty Anterior Approac	6	1	$35,370.00	$35,370.00	$7,090.00	$49,502.00	$28,296.00	2026-04-01
63082	CPT	Vertebral Corpectomy Vertebral Body Res	6	1	$35,370.00	$35,370.00	$7,090.00	$49,502.00	$28,296.00	2026-04-01
C1889	HCPCS	Bard Ventralight Mesh 6 X 8	9	1	$32,500.00	$32,500.00	$11,786.00	$26,800.00	$26,000.00	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
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
C1815	HCPCS	Ams 800 Contol Pump	9	1	$30,128.00	$30,128.00	$5,022.00	$25,020.00	$24,102.00	2026-04-01
C1776	HCPCS	Biomet Partial Femur Cemented Size 4	39	1	$30,000.00	$30,000.00	$5,040.00	$57,080.00	$24,000.00	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
78815	CPT	PET CT Skull Base To Mid Thigh	3	1	$27,332.00	$27,332.00	$21,866.00	$21,866.00	$21,866.00	2026-04-01
78816	CPT	PET CT Full Body Skull To Feet	3	1	$27,332.00	$27,332.00	$21,866.00	$21,866.00	$21,866.00	2026-04-01
CP17428471194764652	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
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
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
21600	CPT	Excision Rib Partial	6	2	$49,351.00	$49,351.00	$1,058.00	$39,481.00	$20,269.50	2026-04-01
49594	CPT	Repair Of Anterior Abdominal Hernia(s)	6	2	$46,908.00	$46,908.00	$1,508.00	$37,526.00	$19,517.00	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
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
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
C1778	HCPCS	3660 Ploclaim 5 Elite	51	1	$21,000.00	$21,000.00	$400.00	$84,000.00	$16,800.00	2026-04-01
Q4125	HCPCS	Lifenet Decellularized Dermis 2.5 X3.5mm	3	1	$19,735.00	$19,735.00	$15,788.00	$15,788.00	$15,788.00	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
2802657	CDM	Artisan 50cm 2x8 Surgical Lead Kit	3	1	$19,000.00	$19,000.00	$15,200.00	$15,200.00	$15,200.00	2026-04-01
L8680	HCPCS	Abbott Octrode External Pulse Generator	9	1	$19,000.00	$19,000.00	$8,800.00	$31,860.00	$15,200.00	2026-04-01
2203394	CDM	Or 2 1st 30 Min	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
77525	CPT	Proton Treatment Delivery Complex	3	1	$18,150.00	$18,150.00	$14,520.00	$14,520.00	$14,520.00	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
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
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
75872	CPT	Venography Epidural	3	1	$17,585.00	$17,585.00	$14,068.00	$14,068.00	$14,068.00	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
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
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
74320	CPT	Cholangiography Perc Transhepatic 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
77523	CPT	Proton Treatment Delivery Intermediate	3	1	$17,089.00	$17,089.00	$13,671.00	$13,671.00	$13,671.00	2026-04-01
Q4107	HCPCS	Graft Jacket	12	1	$16,282.50	$16,282.50	$6,059.00	$16,780.00	$13,026.00	2026-04-01
78609	CPT	Brain Imag Positron Emission Tomography	3	1	$16,013.00	$16,013.00	$12,810.00	$12,810.00	$12,810.00	2026-04-01
78814	CPT	PET CT Limited Study	3	1	$15,819.00	$15,819.00	$12,655.00	$12,655.00	$12,655.00	2026-04-01
78608	CPT	Brain Imaging (Pet)	3	1	$15,671.00	$15,671.00	$12,537.00	$12,537.00	$12,537.00	2026-04-01
Q4138	HCPCS	Med Usa Biod Dryflex	3	1	$15,500.00	$15,500.00	$12,400.00	$12,400.00	$12,400.00	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
78813	CPT	PET Image Full Body	3	1	$15,305.00	$15,305.00	$12,244.00	$12,244.00	$12,244.00	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
2203407	CDM	Or Level 7 Each Add 15	3	1	$13,823.00	$13,823.00	$11,058.00	$11,058.00	$11,058.00	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
75966	CPT	Transluminal Balloon Angioplasty Renal	3	1	$13,449.00	$13,449.00	$10,759.00	$10,759.00	$10,759.00	2026-04-01
L8642	HCPCS	Arthrosurface Hemi Implant 15mm 2.5mmx4.	3	1	$13,180.00	$13,180.00	$10,544.00	$10,544.00	$10,544.00	2026-04-01
78812	CPT	PET Image Skull-thigh	3	1	$13,113.00	$13,113.00	$10,490.00	$10,490.00	$10,490.00	2026-04-01
77522	CPT	Proton Trmt Simple W/comp	3	1	$13,064.00	$13,064.00	$10,451.00	$10,451.00	$10,451.00	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
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
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
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
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
74178	CPT	CT Abdomen Pelvis Wwo	3	1	$12,555.00	$12,555.00	$10,044.00	$10,044.00	$10,044.00	2026-04-01
C1765	HCPCS	Sky Biologics Active Wound Barrier	3	1	$12,475.00	$12,475.00	$9,980.00	$9,980.00	$9,980.00	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
72158	CPT	MRI Lumbar Spine Wwo	3	1	$12,204.00	$12,204.00	$9,763.00	$9,763.00	$9,763.00	2026-04-01
87507	CPT	Inf Agent Det By DNA Or RNA Gi Pathogen	3	1	$12,149.00	$12,149.00	$9,719.00	$9,719.00	$9,719.00	2026-04-01
87492	CPT	Inf Agent Det Chlamydia Trachomatis	3	1	$12,149.00	$12,149.00	$9,719.00	$9,719.00	$9,719.00	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
78811	CPT	PET Image Ltd Area	3	1	$12,000.00	$12,000.00	$9,600.00	$9,600.00	$9,600.00	2026-04-01
74177	CPT	CT Scan Of Abdomen And Pelvis With Contrast	3	1	$11,827.00	$11,827.00	$9,462.00	$9,462.00	$9,462.00	2026-04-01
78459	CPT	Myocrd Img PET Single Study	3	1	$11,594.00	$11,594.00	$9,275.00	$9,275.00	$9,275.00	2026-04-01
0275T	CPT	Perq Lamot/lam Lumbar	3	1	$11,519.00	$11,519.00	$9,215.00	$9,215.00	$9,215.00	2026-04-01
2203399	CDM	Or 6 Each Add 15 Min	3	1	$11,519.00	$11,519.00	$9,215.00	$9,215.00	$9,215.00	2026-04-01
63051	CPT	C-laminoplasty W/graft/plate	3	1	$11,519.00	$11,519.00	$9,215.00	$9,215.00	$9,215.00	2026-04-01
22585	CPT	Arthrodesis Anterior Interbody Tech 1st	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
20926	CPT	Tiss Grafts Oth Eg Paratenon Fat Dermis	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
20100	CPT	Explore Wound Neck	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
19305	CPT	Mast Radical	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
49203	CPT	Exc Abd Tum 5 Cm Or Less	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
69105	CPT	Biopsy External Auditory Canal	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
19260	CPT	Exc Chest Wall Tumor Including Ribs 1st	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
19120	CPT	Removal Of One Or More Breast Growth, Open Procedure	12	2	$21,594.00	$21,594.00	$1,232.00	$19,474.00	$8,801.50	2026-04-01
19361	CPT	Breast Reconstr W/lat Flap	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
43239	CPT	Biopsy Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope	12	2	$18,888.00	$18,888.00	$1,058.00	$15,144.00	$8,801.50	2026-04-01
11310	CPT	Shave Skin Lesion 0.5 Cm/<	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
20974	CPT	Electrical Bone Stimulation	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
31299	CPT	Procedure Accessory Sinuses	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
63707	CPT	Repair Spinal Fluid Leakage	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
42971	CPT	Control Nose/throat Bleeding	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
15420	CPT	Xenograft Skin Dermal/temp Wound Close	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
49020	CPT	Drainage Abdom Abscess Open	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
38525	CPT	Biop/exc Lymph Nodes Open Deep Axil Nd	12	2	$19,921.50	$19,921.50	$1,058.00	$16,798.00	$8,801.50	2026-04-01
45562	CPT	Exploration/repair Of Rectum	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
45380	CPT	Biopsy Exam Of Large Bowel Using An Endoscope	12	2	$21,095.50	$21,095.50	$1,058.00	$18,676.00	$8,801.50	2026-04-01
51585	CPT	Removal Of Bladder & Nodes	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
45378	CPT	Diagnostic Exam Of Large Bowel Using An Endoscope	12	2	$18,849.00	$18,849.00	$1,058.00	$15,082.00	$8,801.50	2026-04-01
44204	CPT	Laparo Partial Colectomy	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
44960	CPT	Appendectomy	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
45385	CPT	Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope	12	2	$21,095.50	$21,095.50	$1,058.00	$18,676.00	$8,801.50	2026-04-01
44604	CPT	Suture Large Intestine	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
47122	CPT	Extensive Removal Of Liver	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
C9728	HCPCS	Place Device/marker Non Pro	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
44322	CPT	Colostomy With Biopsies	6	1	$11,002.00	$11,002.00	$2,526.00	$15,077.00	$8,801.50	2026-04-01
74176	CPT	CT Abdomen Pelvis Wo	3	1	$10,697.00	$10,697.00	$8,558.00	$8,558.00	$8,558.00	2026-04-01
S2083	HCPCS	Lap-band Ap With Rapidport Ez	6	2	$19,975.00	$19,975.00	$924.00	$15,980.00	$8,452.00	2026-04-01
C9362	HCPCS	Fortis Dbm Strips 10cc (Per 5cc)	9	1	$10,500.00	$10,500.00	$7,650.00	$16,800.00	$8,400.00	2026-04-01
71552	CPT	MRI Chest Wwo	3	1	$10,383.00	$10,383.00	$8,306.00	$8,306.00	$8,306.00	2026-04-01
74174	CPT	CTA Abdomen Pelvis Wwo	3	1	$10,369.00	$10,369.00	$8,295.00	$8,295.00	$8,295.00	2026-04-01
77520	CPT	Proton Trmt Simple Without Comp	3	1	$10,345.00	$10,345.00	$8,276.00	$8,276.00	$8,276.00	2026-04-01
74183	CPT	MRI Abdomen Wwo	3	1	$10,265.00	$10,265.00	$8,212.00	$8,212.00	$8,212.00	2026-04-01
72156	CPT	MRI Cervical Spine Wwo	3	1	$10,265.00	$10,265.00	$8,212.00	$8,212.00	$8,212.00	2026-04-01
73720	CPT	MRI Low Ext Nonjoint Wwo Lt	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
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
73723	CPT	MRI Low Ext Joint Wwo Lt	3	1	$10,265.00	$10,265.00	$8,212.00	$8,212.00	$8,212.00	2026-04-01
73220	CPT	MRI Up Ext Nonjoint Wwo Lt	3	1	$10,265.00	$10,265.00	$8,212.00	$8,212.00	$8,212.00	2026-04-01
73223	CPT	MRI Up Ext Joint Wwo Lt	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
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	MRI Pelvis Wwo	3	1	$10,265.00	$10,265.00	$8,212.00	$8,212.00	$8,212.00	2026-04-01
70543	CPT	MRI Orbit/face/neck 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
70553	CPT	MRI Scan	3	1	$10,265.00	$10,265.00	$8,212.00	$8,212.00	$8,212.00	2026-04-01
C1763	HCPCS	Aesculap Arradius 2.5x3.5x14	57	1	$10,250.00	$10,250.00	$1,828.00	$29,000.00	$8,200.00	2026-04-01
93610	CPT	Intraatrial Pacing	4	2	$10,013.00	$10,013.00	$275.00	$8,010.00	$8,010.00	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
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
77778	CPT	Apply Interstit Radiat Compl	3	1	$9,657.00	$9,657.00	$7,726.00	$7,726.00	$7,726.00	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
36902	CPT	Introduction Of Needle(s) And/or Cathete	6	2	$16,338.00	$16,338.00	$2,196.00	$13,070.00	$7,633.00	2026-04-01
Q4139	HCPCS	Hybrid Amniotic Membrane Tissue 1.25ml	12	1	$9,369.00	$9,369.00	$4,000.00	$17,000.00	$7,495.00	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
77048	CPT	MRI Breast With Cad Wwo Unilat	3	1	$9,328.00	$9,328.00	$7,462.00	$7,462.00	$7,462.00	2026-04-01
43235	CPT	Diagnostic Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope	12	2	$17,119.50	$17,119.50	$924.00	$15,077.00	$7,420.00	2026-04-01
74182	CPT	MRI Abdomen 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	MRI Lumbar Spine W	3	1	$9,075.00	$9,075.00	$7,260.00	$7,260.00	$7,260.00	2026-04-01
72142	CPT	MRI Cervical 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
73722	CPT	MRI Low Ext Joint W Lt	3	1	$9,075.00	$9,075.00	$7,260.00	$7,260.00	$7,260.00	2026-04-01
73219	CPT	MRI Up Ext Nonjoint W Lt	3	1	$9,075.00	$9,075.00	$7,260.00	$7,260.00	$7,260.00	2026-04-01
73222	CPT	MRI Up Ext Joint W Lt	3	1	$9,075.00	$9,075.00	$7,260.00	$7,260.00	$7,260.00	2026-04-01
70552	CPT	MRI Brain W	3	1	$9,075.00	$9,075.00	$7,260.00	$7,260.00	$7,260.00	2026-04-01
72196	CPT	MRI Pelvis W	3	1	$9,075.00	$9,075.00	$7,260.00	$7,260.00	$7,260.00	2026-04-01
70542	CPT	MRI Orbit/face/neck W	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
71551	CPT	MRI Chest W	3	1	$9,075.00	$9,075.00	$7,260.00	$7,260.00	$7,260.00	2026-04-01
76825	CPT	Echo Exam Of Fetal Heart	3	1	$8,983.00	$8,983.00	$7,186.00	$7,186.00	$7,186.00	2026-04-01
S2068	HCPCS	Breast Diep Or Siea Flap 1st	3	1	$8,959.00	$8,959.00	$7,167.00	$7,167.00	$7,167.00	2026-04-01
54400	CPT	Insert Self-contd Prosthesis 1st	9	2	$61,878.00	$61,878.00	$1,232.00	$49,502.00	$7,090.00	2026-04-01
23473	CPT	Revis Reconst Shoulder Joint 1st	9	2	$61,878.00	$61,878.00	$1,665.00	$49,502.00	$7,090.00	2026-04-01
49320	CPT	Diag Laparo Separate Proc 1st	9	2	$61,878.00	$61,878.00	$1,232.00	$49,502.00	$7,090.00	2026-04-01
23472	CPT	Reconstruct Shoulder Joint 1st	9	2	$61,878.00	$61,878.00	$1,665.00	$49,502.00	$7,090.00	2026-04-01
2203405	CDM	Or Level 5 Each Add 15 Min	3	1	$8,862.00	$8,862.00	$7,090.00	$7,090.00	$7,090.00	2026-04-01
24342	CPT	Repair Of Ruptured Tendon 1st	9	2	$61,878.00	$61,878.00	$1,232.00	$49,502.00	$7,090.00	2026-04-01
64555	CPT	Implant Neuroelectrodes 1st	9	2	$61,878.00	$61,878.00	$924.00	$49,502.00	$7,090.00	2026-04-01
27702	CPT	Arthroplasty Ankle W/implant 1st 30	9	2	$61,878.00	$61,878.00	$1,868.00	$49,502.00	$7,090.00	2026-04-01
63661	CPT	Remove Spine Eltrd Perq Aray 1st	9	2	$61,878.00	$61,878.00	$924.00	$49,502.00	$7,090.00	2026-04-01
22515	CPT	Perq Vertebral Augmentation Ea Add Th 1s	9	2	$61,878.00	$61,878.00	$924.00	$49,502.00	$7,090.00	2026-04-01
27487	CPT	Revise/replace Knee Joint 1st	9	2	$61,878.00	$61,878.00	$1,868.00	$49,502.00	$7,090.00	2026-04-01
27447	CPT	Total Knee Arthroplasty 1st	9	2	$61,878.00	$61,878.00	$1,868.00	$49,502.00	$7,090.00	2026-04-01
27446	CPT	Revision Of Knee Joint 1st	9	2	$61,878.00	$61,878.00	$1,665.00	$49,502.00	$7,090.00	2026-04-01
62287	CPT	Percutaneous Diskectomy 1st	9	2	$61,878.00	$61,878.00	$1,665.00	$49,502.00	$7,090.00	2026-04-01
62350	CPT	Implant Spinal Canal Cath 1st	9	2	$61,878.00	$61,878.00	$1,058.00	$49,502.00	$7,090.00	2026-04-01
27132	CPT	Total Hip Arthroplasty 1st	9	2	$61,878.00	$61,878.00	$1,868.00	$49,502.00	$7,090.00	2026-04-01
27125	CPT	Partial Hip Replacement 1st	9	2	$61,878.00	$61,878.00	$1,868.00	$49,502.00	$7,090.00	2026-04-01
64722	CPT	Decompression Unspecified Nerves Specify	9	2	$61,878.00	$61,878.00	$924.00	$49,502.00	$7,090.00	2026-04-01
62355	CPT	Remove Spinal Canal Catheter 1st	9	2	$61,878.00	$61,878.00	$1,058.00	$49,502.00	$7,090.00	2026-04-01
23420	CPT	Repair Of Shoulder 1st	9	2	$61,878.00	$61,878.00	$2,196.00	$49,502.00	$7,090.00	2026-04-01
74470	CPT	Xr Renal Cyst Study	3	1	$8,855.00	$8,855.00	$7,084.00	$7,084.00	$7,084.00	2026-04-01
36832	CPT	Revision, Open, Arteriovenous Fistula; W	6	2	$15,708.00	$15,708.00	$1,508.00	$12,566.00	$7,037.00	2026-04-01
72141	CPT	MRI Cervical Spine Wo	3	1	$8,786.00	$8,786.00	$7,029.00	$7,029.00	$7,029.00	2026-04-01
72146	CPT	MRI Thoracic Spine Wo	3	1	$8,695.00	$8,695.00	$6,956.00	$6,956.00	$6,956.00	2026-04-01
75896	CPT	Transcatheter Therapy Infusion	3	1	$8,680.00	$8,680.00	$6,944.00	$6,944.00	$6,944.00	2026-04-01
87633	CPT	Inf Agent Det By DNA Or RNA Resp Virus	3	1	$8,576.00	$8,576.00	$6,861.00	$6,861.00	$6,861.00	2026-04-01
C1762	HCPCS	Alliance Bonebank Allograft	120	1	$8,437.50	$8,437.50	$600.00	$40,000.00	$6,750.00	2026-04-01
72148	CPT	MRI Scan Of Lower Spinal Canal	3	1	$8,385.00	$8,385.00	$6,708.00	$6,708.00	$6,708.00	2026-04-01
Q4100	HCPCS	Human Allograft Tissue Per Cc	18	1	$8,297.50	$8,297.50	$2,828.00	$24,000.00	$6,638.00	2026-04-01
78804	CPT	Rp Loclzj Tum Whbdy 2+d Img	3	1	$8,235.00	$8,235.00	$6,588.00	$6,588.00	$6,588.00	2026-04-01
15772	CPT	Each Add'l 50cc Injectate 1st	9	2	$18,846.00	$18,846.00	$924.00	$15,077.00	$6,526.00	2026-04-01
15771	CPT	Grfg Autol Fat Lipo 50 Cc/< 1st	9	2	$18,846.00	$18,846.00	$1,508.00	$15,077.00	$6,526.00	2026-04-01
72195	CPT	MRI Pelvis Wo	3	1	$8,080.00	$8,080.00	$6,464.00	$6,464.00	$6,464.00	2026-04-01
72125	CPT	CT Cervical Spine Wo	3	1	$8,000.00	$8,000.00	$6,400.00	$6,400.00	$6,400.00	2026-04-01
L8689	HCPCS	Nevro Charger Kit	6	1	$7,867.50	$7,867.50	$4,000.00	$8,588.00	$6,294.00	2026-04-01
75970	CPT	Transcatheter Biopsy Rad Sup&int	3	1	$7,844.00	$7,844.00	$6,275.00	$6,275.00	$6,275.00	2026-04-01
75625	CPT	Aorto/serialography Abd Rad Sup&int	3	1	$7,812.00	$7,812.00	$6,250.00	$6,250.00	$6,250.00	2026-04-01
73225	CPT	MRA Up Ext Wwo Lt	3	1	$7,709.00	$7,709.00	$6,167.00	$6,167.00	$6,167.00	2026-04-01
70555	CPT	MRI Brain By Phys/psych	3	1	$7,549.00	$7,549.00	$6,039.00	$6,039.00	$6,039.00	2026-04-01
73719	CPT	MRI Low Ext Nonjoint W Lt	3	1	$7,490.00	$7,490.00	$5,992.00	$5,992.00	$5,992.00	2026-04-01
73218	CPT	MRI Up Ext Nonjoint Wo Lt	3	1	$7,490.00	$7,490.00	$5,992.00	$5,992.00	$5,992.00	2026-04-01
A4264	HCPCS	Permanent Birth Control	6	1	$7,375.00	$7,375.00	$5,800.00	$6,000.00	$5,900.00	2026-04-01
72133	CPT	CT Lumbar Spine Wwo	3	1	$7,366.00	$7,366.00	$5,893.00	$5,893.00	$5,893.00	2026-04-01
74170	CPT	CT Abdomen Wwo	3	1	$7,262.00	$7,262.00	$5,810.00	$5,810.00	$5,810.00	2026-04-01
72295	CPT	Discography Lumbar Rad Sup&int	3	1	$7,212.00	$7,212.00	$5,770.00	$5,770.00	$5,770.00	2026-04-01
72285	CPT	Discography Cerv Or Thoracic Rad Sup&int	3	1	$7,212.00	$7,212.00	$5,770.00	$5,770.00	$5,770.00	2026-04-01
70332	CPT	Temporomandibular Jt Arthro Rad Sup&int	3	1	$7,196.00	$7,196.00	$5,757.00	$5,757.00	$5,757.00	2026-04-01
72265	CPT	Myelography Lumbosacral Rad Sup&int	3	1	$7,196.00	$7,196.00	$5,757.00	$5,757.00	$5,757.00	2026-04-01
74305	CPT	Cholangio/ Pancreatography With Cath	3	1	$7,162.00	$7,162.00	$5,730.00	$5,730.00	$5,730.00	2026-04-01
74190	CPT	Peritoneogram	3	1	$7,162.00	$7,162.00	$5,730.00	$5,730.00	$5,730.00	2026-04-01
74740	CPT	Hysterosalpingography Rad Sup&int	3	1	$7,162.00	$7,162.00	$5,730.00	$5,730.00	$5,730.00	2026-04-01
70390	CPT	Sialography Rad Sup&int	3	1	$7,162.00	$7,162.00	$5,730.00	$5,730.00	$5,730.00	2026-04-01
70170	CPT	Dacryocysto Nasolac Duct Rad Sup&int	3	1	$7,162.00	$7,162.00	$5,730.00	$5,730.00	$5,730.00	2026-04-01
76102	CPT	Xr Complex Motion	3	1	$7,162.00	$7,162.00	$5,730.00	$5,730.00	$5,730.00	2026-04-01
76098	CPT	Xrination Specimen	3	1	$7,162.00	$7,162.00	$5,730.00	$5,730.00	$5,730.00	2026-04-01
77053	CPT	Mammary Ductogram Or Galactogram	3	1	$7,162.00	$7,162.00	$5,730.00	$5,730.00	$5,730.00	2026-04-01
77054	CPT	Mammary Ductogram/galactogram Mult Ducts	3	1	$7,162.00	$7,162.00	$5,730.00	$5,730.00	$5,730.00	2026-04-01
76101	CPT	Xr Complex Motion	3	1	$7,162.00	$7,162.00	$5,730.00	$5,730.00	$5,730.00	2026-04-01
75870	CPT	Venography Sup Sag Sinus	3	1	$7,162.00	$7,162.00	$5,730.00	$5,730.00	$5,730.00	2026-04-01
75801	CPT	Lymphangiography Extremity Uni Rad	3	1	$7,162.00	$7,162.00	$5,730.00	$5,730.00	$5,730.00	2026-04-01
C1768	HCPCS	Checkpoint Guardian	6	1	$7,140.00	$7,140.00	$2,644.00	$8,780.00	$5,712.00	2026-04-01
73206	CPT	CTA Up Ext Rt Wwo	3	1	$7,115.00	$7,115.00	$5,692.00	$5,692.00	$5,692.00	2026-04-01
76826	CPT	Echo Exam Of Fetal Heart	3	1	$7,099.00	$7,099.00	$5,679.00	$5,679.00	$5,679.00	2026-04-01
70554	CPT	MRI Brain By Tech	3	1	$7,091.00	$7,091.00	$5,673.00	$5,673.00	$5,673.00	2026-04-01
74247	CPT	Xr Gastrointestinal Tract	3	1	$7,069.00	$7,069.00	$5,655.00	$5,655.00	$5,655.00	2026-04-01
78472	CPT	Gated Heart Planar Single	3	1	$7,069.00	$7,069.00	$5,655.00	$5,655.00	$5,655.00	2026-04-01
75635	CPT	CTA Abdominal Arteries	3	1	$7,069.00	$7,069.00	$5,655.00	$5,655.00	$5,655.00	2026-04-01
78305	CPT	Bone And/or Joint Imaging Multiple Areas	3	1	$7,069.00	$7,069.00	$5,655.00	$5,655.00	$5,655.00	2026-04-01
78226	CPT	Hepatobiliary System Imaging	3	1	$7,069.00	$7,069.00	$5,655.00	$5,655.00	$5,655.00	2026-04-01
78278	CPT	Acute Gi Blood Loss Imaging	3	1	$7,069.00	$7,069.00	$5,655.00	$5,655.00	$5,655.00	2026-04-01
78227	CPT	Hepatobil Syst Image W/drug	3	1	$7,069.00	$7,069.00	$5,655.00	$5,655.00	$5,655.00	2026-04-01
78290	CPT	Meckels Divert Exam	3	1	$7,069.00	$7,069.00	$5,655.00	$5,655.00	$5,655.00	2026-04-01
78195	CPT	Lymphatics And Lymph Nodes Imaging	3	1	$7,069.00	$7,069.00	$5,655.00	$5,655.00	$5,655.00	2026-04-01
74400	CPT	Urography Pyelography IV W/wo Kub/tomo	3	1	$7,069.00	$7,069.00	$5,655.00	$5,655.00	$5,655.00	2026-04-01
78300	CPT	Bone And/or Joint Imaging Limited Area	3	1	$7,069.00	$7,069.00	$5,655.00	$5,655.00	$5,655.00	2026-04-01
78070	CPT	Parathyroid Imaging	3	1	$7,069.00	$7,069.00	$5,655.00	$5,655.00	$5,655.00	2026-04-01
2802661	CDM	J&j 2.7 Lcp Condylar Plate 7hole Shaft	3	1	$7,030.00	$7,030.00	$5,624.00	$5,624.00	$5,624.00	2026-04-01
70498	CPT	CTA Neck	3	1	$7,010.00	$7,010.00	$5,608.00	$5,608.00	$5,608.00	2026-04-01
76936	CPT	US Guide Compression Rep Pseudoaneurysm	3	1	$7,008.00	$7,008.00	$5,606.00	$5,606.00	$5,606.00	2026-04-01
70496	CPT	CTA Head Brain	3	1	$7,000.00	$7,000.00	$5,600.00	$5,600.00	$5,600.00	2026-04-01
66821	CPT	Removal Of Recurring Cataract In Lens Capsule Using Laser	6	2	$12,554.00	$12,554.00	$1,058.00	$10,043.00	$5,550.50	2026-04-01
22861	CPT	Revise Cerv Artific Disc 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22857	CPT	Lumbar Artif Diskectomy 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22856	CPT	Cerv Artific Diskectomy 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22855	CPT	Removal Anterior Instrumentation 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22849	CPT	Reinsertion Spinal Fixation Device 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22850	CPT	Remove Spine Fixation Device 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
63056	CPT	Decompress Spinal Cord Lmbr 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22802	CPT	Post Fusion 7-12 Vert Seg 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22633	CPT	Lumbar Spine Fusion Combined 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22630	CPT	Lumbar Spine Fusion 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
63655	CPT	Implant Neuroelectrodes 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22600	CPT	Neck Spine Fusion 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22610	CPT	Thorax Spine Fusion 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
27280	CPT	Fusion Of Sacroiliac Joint 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
27130	CPT	Total Hip Arthroplasty 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
27134	CPT	Revise Hip Joint Replacement 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22554	CPT	Neck Spine Fusion 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22551	CPT	Neck Spine Fuse&remov Bel C2 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22556	CPT	Thorax Spine Fusion 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22558	CPT	Lumbar Spine Fusion 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
27138	CPT	Revise Hip Joint Replacement 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22612	CPT	Lumbar Spine Fusion 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
22532	CPT	Lat Thorax Spine Fusion 1st	6	2	$39,791.00	$39,791.00	$1,868.00	$9,215.00	$5,541.50	2026-04-01
73718	CPT	MRI Low Ext Nonjoint Wo Lt	3	1	$6,916.00	$6,916.00	$5,533.00	$5,533.00	$5,533.00	2026-04-01
49568	CPT	Mesh Implant Incis/ventral Hernia Rep	3	1	$6,836.00	$6,836.00	$5,469.00	$5,469.00	$5,469.00	2026-04-01
29826	CPT	Shaving Of Shoulder Bone Using Endoscope	9	2	$28,812.00	$28,812.00	$1,232.00	$23,050.00	$5,469.00	2026-04-01
19366	CPT	Breast Reconstruction W/other Tech 1st	3	1	$6,836.00	$6,836.00	$5,469.00	$5,469.00	$5,469.00	2026-04-01
43775	CPT	Lap Sleeve Gastrectomy	3	1	$6,836.00	$6,836.00	$5,469.00	$5,469.00	$5,469.00	2026-04-01
2203401	CDM	Or 4 Each Add 15 Min	3	1	$6,836.00	$6,836.00	$5,469.00	$5,469.00	$5,469.00	2026-04-01

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