| Code | Description | Price | Price Type | Last Updated |
|---|---|---|---|---|
| 99211 | OP VISIT LEVEL 1 EST | $424 [source] | gross_charge | 1 month ago |
| 99212 | OP VISIT LEVEL 2 EST | $767 [source] | gross_charge | 1 month ago |
| 99213 | OP VISIT LEVEL 3 EST | $1,069 [source] | gross_charge | 1 month ago |
| 99214 | OP VISIT LEVEL 4 EST | $1,374 [source] | gross_charge | 1 month ago |
| C1713 | KT SCTM CRNL DFCT RPR | $27,548 [source] | gross_charge | 1 month ago |
| C1725 | CATH ULTSND IVL 7X60MM | $20,873 [source] | gross_charge | 1 month ago |
| C1776 | CMPNT SHLD INTSEG 30MM | $22,560 [source] | gross_charge | 1 month ago |
| C1821 | IMPLNT SPN 10MM | $11,200 [source] | gross_charge | 1 month ago |
| C1874 | GRAFT STNT 34MM 200MM | $38,990 [source] | gross_charge | 1 month ago |
| C1876 | SYSTEM EVAS 6MM 150CM | $5,590 [source] | gross_charge | 1 month ago |