Hospital

KEEFE MEMORIAL HOSPITAL

Cheyenne Wells, CO · CCN 061343 · Rates published

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You selected 93306 (HCPCS)

US ECHOCARDIOGRAPHY

This hospital’s price: $1,186 across 8 payers · range $1,186-$1,834

Source: https://keefemh.org/wp-content/uploads/2025/07/472340447_keefe-memorial-health-service-district_standardcharges.csv · observed 2026-07-15

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.

1,691 distinct procedures filed

8 distinct payers

31,334 rate rows

2026-07-15 last MRF observed

Data quality

28,619 of 31,334 rate rows are consumer-grade (91.3%)

2,715 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
placeholder amount (≤ $0.02) — excluded from medians	2,614
exceeds 10× this hospital's gross charge — excluded from medians	49
percent-of-charges filed in the dollar field — excluded from medians	44
per-diem day rate — not a per-procedure price	8

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

Source MRF file	https://keefemh.org/wp-content/uploads/2025/07/472340447_keefe-memorial-health-service-district_standardcharges.csv
Found on page	https://keefemh.org/patient-resources/pricing-transparency/
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-10-20
Content fingerprint	b8d89ba277ad11ef… · 12,212,567 bytes · first seen 2026-05-08

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
J3101 HCPCS	Tenecteplase (tnkase) Inj [50 Mg]	8	$9,931.26	$9,931.26	$9,931.26	nat. median $3,787 outlier · 2.6×
J2997 HCPCS	Alteplase [activase] Inj 100mg	8	$291.86	$11,228.16	$5,148.22	nat. median $500 outlier · 10.3×
J2505 HCPCS	Pegfilgrastim-cbqv [udenyca] 0.6ml	8	$4,551.42	$4,730.61	$4,641.01	nat. median $6,279 0.7× median
J0840 HCPCS	Crotalidae Immune Fab [crofab] Inj/vial	8	$4,070.82	$4,070.82	$4,070.82	nat. median $3,452 1.2× median
60220 HCPCS	Total Thyroid Lobectomy	8	$3,647.50	$3,647.50	$3,647.50	nat. median $5,943 0.6× median
74178 HCPCS	CT Abd & Pelvis W Without	8	$2,829.50	$4,944.60	$2,829.50	nat. median $1,027 outlier · 2.8×
26765 HCPCS	Fx Phalanx Open	8	$642.50	$4,639.00	$2,640.75	nat. median $3,497 0.8× median
81162 HCPCS	Brca Panel (brca1, Brca2)	8	$2,477.00	$2,477.00	$2,477.00	nat. median $1,825 1.4× median
74177 HCPCS	CT Abd & Pelvis W	8	$2,425.00	$4,238.10	$2,425.00	nat. median $976 outlier · 2.5×
74176 HCPCS	CT Abd & Pelvis Wo	8	$2,182.50	$3,814.20	$2,182.50	nat. median $694 outlier · 3.1×
78452 HCPCS	Nm Spect Mult Rest Stress	8	$2,147.00	$4,450.81	$2,147.00	nat. median $1,822 1.2× median
72158 HCPCS	MRI Spine Lumbar Wwo	8	$2,126.50	$2,126.50	$2,126.50	nat. median $1,097 1.9× median
78451 HCPCS	Nm Spect Sing Rest Stress	8	$2,064.00	$2,064.00	$2,064.00	nat. median $1,550 1.3× median
70553 HCPCS	MRI Brain W Wo	8	$2,053.00	$3,587.40	$2,053.00	nat. median $1,136 1.8× median
71275 HCPCS	CT Angiography Chest W	8	$2,040.00	$3,618.45	$2,040.00	nat. median $759 outlier · 2.7×
72159 HCPCS	MRA Spinal Canal Wwo	8	$2,017.50	$2,017.50	$2,017.50	nat. median $1,092 1.8× median
21556 HCPCS	Exc Tumor Dp Subfas IM	8	$2,005.00	$2,005.00	$2,005.00	nat. median $2,936 0.7× median
71552 HCPCS	MRI Chest W Wo	8	$1,956.50	$1,956.50	$1,956.50	nat. median $1,103 1.8× median
71555 HCPCS	MRA Chest W Wo	8	$1,956.50	$1,956.50	$1,956.50	nat. median $1,151 1.7× median
95811 HCPCS	Polysomnography 6+ W Positive Airway Pre	8	$1,944.50	$3,500.10	$1,944.50	nat. median $1,894 1.0× median
72156 HCPCS	MRI Spine Cerv Wwo	8	$1,941.50	$3,494.70	$1,941.50	nat. median $1,110 1.7× median
72142 HCPCS	MRI Spine Cerv W	8	$1,863.50	$1,863.50	$1,863.50	nat. median $978 1.9× median
73723LT OTHER	MRI Ext Low Lt Jt Wwo	8	$1,834.50	$1,834.50	$1,834.50	nat. median $1,834 1.0× median
73723RT OTHER	MRI Ext Low Rt Jt Wwo	8	$1,834.50	$1,834.50	$1,834.50	nat. median $1,834 1.0× median
74174 HCPCS	CT Angio Abd & Pelvis W	8	$1,799.50	$2,939.92	$1,799.50	nat. median $998 1.8× median
74175 HCPCS	CT Angoabdomen W	8	$1,799.50	$1,799.50	$1,799.50	nat. median $718 outlier · 2.5×
72149 HCPCS	MRI Spine Lumbar W	8	$1,788.00	$1,788.00	$1,788.00	nat. median $979 1.8× median
71550 HCPCS	MRI Chest Wo	8	$1,767.50	$1,767.50	$1,767.50	nat. median $820 outlier · 2.2×
71551 HCPCS	MRI Chest W	8	$1,767.50	$1,767.50	$1,767.50	nat. median $1,156 1.5× median
72197 HCPCS	MRI Pelvis W Wo	8	$1,722.00	$1,722.00	$1,722.00	nat. median $1,074 1.6× median
72141 HCPCS	MRI Spine Cerv Wo	8	$1,718.50	$3,003.30	$1,718.50	nat. median $785 outlier · 2.2×
12037 HCPCS	Rep Interm >30cm	8	$623.50	$2,811.50	$1,717.50	nat. median $1,950 0.9× median
70546 HCPCS	MRA Head W Wo	8	$1,710.50	$1,710.50	$1,710.50	nat. median $1,073 1.6× median
74185 HCPCS	MRA Abdomen W Wo	8	$1,709.00	$1,709.00	$1,709.00	nat. median $1,253 1.4× median
74183 HCPCS	MRI Abdomen W Wo	8	$1,709.00	$1,709.00	$1,709.00	nat. median $1,105 1.5× median
72198 HCPCS	MRA Pelvis W Or Wo	8	$1,702.00	$1,702.00	$1,702.00	nat. median $1,136 1.5× median
72196 HCPCS	MRI Pelvis W	8	$1,702.00	$1,702.00	$1,702.00	nat. median $953 1.8× median
95810 HCPCS	Polysomnography 6+	8	$1,697.00	$1,697.00	$1,697.00	nat. median $1,827 0.9× median
71270 HCPCS	CT Chest/thorax W Wo	8	$1,696.00	$1,696.00	$1,696.00	nat. median $684 outlier · 2.5×
71271 HCPCS	CT Low Dose Lung Ca Screen	8	$1,696.00	$2,963.70	$1,696.00	nat. median $215 outlier · 7.9×
36245 HCPCS	Cath Placement Abd/l Ext	8	$1,694.50	$1,694.50	$1,694.50	nat. median $1,743 1.0× median
72157 HCPCS	MRI Spine Thorac Wwo	8	$1,678.00	$1,678.00	$1,678.00	nat. median $1,114 1.5× median
78454 HCPCS	Nm Thall Mult Rest Stress	8	$1,673.00	$1,673.00	$1,673.00	nat. median $1,383 1.2× median
75557 HCPCS	MRI Cardiac Wo	8	$1,672.00	$1,672.00	$1,672.00	nat. median $538 outlier · 3.1×
75561 HCPCS	MRI Cardiac W	8	$1,672.00	$1,672.00	$1,672.00	nat. median $766 outlier · 2.2×
73220RT OTHER	MRI Ext Upp Rt Wwo	8	$1,672.00	$1,672.00	$1,672.00	nat. median $1,672 1.0× median
73223LT OTHER	MRI Ext Upp Lt Jt Wwo	8	$1,672.00	$1,672.00	$1,672.00	nat. median $1,507 1.1× median
73225LT OTHER	MRA Ext Upp Lt Wwo	8	$1,672.00	$1,672.00	$1,672.00	nat. median $1,000 1.7× median
73220LT OTHER	MRI Ext Upp Lt Wwo	8	$1,672.00	$1,672.00	$1,672.00	nat. median $1,672 1.0× median
73223RT OTHER	MRI Ext Upp Rt Jt Wwo	8	$1,672.00	$1,672.00	$1,672.00	nat. median $1,672 1.0× median

Other procedures at this hospital

Browse this hospital's 1,691 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

J3101	HCPCS	Tenecteplase (tnkase) Inj [50 Mg]	12	8	$19,862.53	$9,931.26 50% off	$9,931.26	$9,931.26	$9,931.26	2026-07-15
J2997	HCPCS	Alteplase [activase] Inj 100mg	36	8	$10,296.43	$5,148.21 50% off	$291.86	$11,228.16	$5,148.22	2026-07-15
J2505	HCPCS	Pegfilgrastim-cbqv [udenyca] 0.6ml	24	8	$9,282.03	$4,641.01 50% off	$4,551.42	$4,730.61	$4,641.01	2026-07-15
J0840	HCPCS	Crotalidae Immune Fab [crofab] Inj/vial	12	8	$8,141.64	$4,070.82 50% off	$4,070.82	$4,070.82	$4,070.82	2026-07-15
60220	HCPCS	Total Thyroid Lobectomy	12	8	$7,295.00	$4,377.00 40% off	$3,647.50	$3,647.50	$3,647.50	2026-07-15
74178	HCPCS	CT Abd & Pelvis W Without	12	8	$5,659.00	$3,395.40 40% off	$2,829.50	$4,944.60	$2,829.50	2026-07-15
26765	HCPCS	Fx Phalanx Open	24	8	$5,281.50	$2,833.50 46% off	$642.50	$4,639.00	$2,640.75	2026-07-15
81162	HCPCS	Brca Panel (brca1, Brca2)	12	8	$4,954.00	$3,467.80 30% off	$2,477.00	$2,477.00	$2,477.00	2026-07-15
74177	HCPCS	CT Abd & Pelvis W	12	8	$4,850.00	$3,395.00 30% off	$2,425.00	$4,238.10	$2,425.00	2026-07-15
74176	HCPCS	CT Abd & Pelvis Wo	12	8	$4,365.00	$3,055.50 30% off	$2,182.50	$3,814.20	$2,182.50	2026-07-15
78452	HCPCS	Nm Spect Mult Rest Stress	12	8	$4,294.00	$3,005.80 30% off	$2,147.00	$4,450.81	$2,147.00	2026-07-15
72158	HCPCS	MRI Spine Lumbar Wwo	12	8	$4,253.00	$2,977.10 30% off	$2,126.50	$2,126.50	$2,126.50	2026-07-15
78451	HCPCS	Nm Spect Sing Rest Stress	12	8	$4,128.00	$2,889.60 30% off	$2,064.00	$2,064.00	$2,064.00	2026-07-15
70553	HCPCS	MRI Brain W Wo	12	8	$4,106.00	$2,874.20 30% off	$2,053.00	$3,587.40	$2,053.00	2026-07-15
71275	HCPCS	CT Angiography Chest W	12	8	$4,080.00	$2,856.00 30% off	$2,040.00	$3,618.45	$2,040.00	2026-07-15
72159	HCPCS	MRA Spinal Canal Wwo	12	8	$4,035.00	$2,824.50 30% off	$2,017.50	$2,017.50	$2,017.50	2026-07-15
21556	HCPCS	Exc Tumor Dp Subfas IM	12	8	$4,010.00	$2,807.00 30% off	$2,005.00	$2,005.00	$2,005.00	2026-07-15
71555	HCPCS	MRA Chest W Wo	12	8	$3,913.00	$2,739.10 30% off	$1,956.50	$1,956.50	$1,956.50	2026-07-15
71552	HCPCS	MRI Chest W Wo	12	8	$3,913.00	$2,739.10 30% off	$1,956.50	$1,956.50	$1,956.50	2026-07-15
95811	HCPCS	Polysomnography 6+ W Positive Airway Pre	12	8	$3,889.00	$2,722.30 30% off	$1,944.50	$3,500.10	$1,944.50	2026-07-15
72156	HCPCS	MRI Spine Cerv Wwo	12	8	$3,883.00	$2,718.10 30% off	$1,941.50	$3,494.70	$1,941.50	2026-07-15
72142	HCPCS	MRI Spine Cerv W	12	8	$3,727.00	$2,608.90 30% off	$1,863.50	$1,863.50	$1,863.50	2026-07-15
73723LT	OTHER	MRI Ext Low Lt Jt Wwo	12	8	$3,669.00	$2,568.30 30% off	$1,834.50	$1,834.50	$1,834.50	2026-07-15
73723RT	OTHER	MRI Ext Low Rt Jt Wwo	12	8	$3,669.00	$2,568.30 30% off	$1,834.50	$1,834.50	$1,834.50	2026-07-15
74174	HCPCS	CT Angio Abd & Pelvis W	12	8	$3,599.00	$2,519.30 30% off	$1,799.50	$2,939.92	$1,799.50	2026-07-15
74175	HCPCS	CT Angoabdomen W	12	8	$3,599.00	$2,519.30 30% off	$1,799.50	$1,799.50	$1,799.50	2026-07-15
72149	HCPCS	MRI Spine Lumbar W	12	8	$3,576.00	$2,503.20 30% off	$1,788.00	$1,788.00	$1,788.00	2026-07-15
71550	HCPCS	MRI Chest Wo	12	8	$3,535.00	$2,474.50 30% off	$1,767.50	$1,767.50	$1,767.50	2026-07-15
71551	HCPCS	MRI Chest W	12	8	$3,535.00	$2,474.50 30% off	$1,767.50	$1,767.50	$1,767.50	2026-07-15
72197	HCPCS	MRI Pelvis W Wo	12	8	$3,444.00	$2,410.80 30% off	$1,722.00	$1,722.00	$1,722.00	2026-07-15
72141	HCPCS	MRI Spine Cerv Wo	12	8	$3,437.00	$2,405.90 30% off	$1,718.50	$3,003.30	$1,718.50	2026-07-15
12037	HCPCS	Rep Interm >30cm	24	8	$3,435.00	$2,185.70 36% off	$623.50	$2,811.50	$1,717.50	2026-07-15
70546	HCPCS	MRA Head W Wo	12	8	$3,421.00	$2,394.70 30% off	$1,710.50	$1,710.50	$1,710.50	2026-07-15
74185	HCPCS	MRA Abdomen W Wo	12	8	$3,418.00	$2,392.60 30% off	$1,709.00	$1,709.00	$1,709.00	2026-07-15
74183	HCPCS	MRI Abdomen W Wo	12	8	$3,418.00	$2,392.60 30% off	$1,709.00	$1,709.00	$1,709.00	2026-07-15
72196	HCPCS	MRI Pelvis W	12	8	$3,404.00	$2,382.80 30% off	$1,702.00	$1,702.00	$1,702.00	2026-07-15
72198	HCPCS	MRA Pelvis W Or Wo	12	8	$3,404.00	$2,382.80 30% off	$1,702.00	$1,702.00	$1,702.00	2026-07-15
95810	HCPCS	Polysomnography 6+	12	8	$3,394.00	$2,375.80 30% off	$1,697.00	$1,697.00	$1,697.00	2026-07-15
71271	HCPCS	CT Low Dose Lung Ca Screen	12	8	$3,392.00	$2,374.40 30% off	$1,696.00	$2,963.70	$1,696.00	2026-07-15
71270	HCPCS	CT Chest/thorax W Wo	12	8	$3,392.00	$2,374.40 30% off	$1,696.00	$1,696.00	$1,696.00	2026-07-15
36245	HCPCS	Cath Placement Abd/l Ext	12	8	$3,389.00	$2,372.30 30% off	$1,694.50	$1,694.50	$1,694.50	2026-07-15
72157	HCPCS	MRI Spine Thorac Wwo	12	8	$3,356.00	$2,349.20 30% off	$1,678.00	$1,678.00	$1,678.00	2026-07-15
78454	HCPCS	Nm Thall Mult Rest Stress	12	8	$3,346.00	$2,342.20 30% off	$1,673.00	$1,673.00	$1,673.00	2026-07-15
73223RT	OTHER	MRI Ext Upp Rt Jt Wwo	12	8	$3,344.00	$2,340.80 30% off	$1,672.00	$1,672.00	$1,672.00	2026-07-15
73725LT	OTHER	MRA Ext Low Lt Wwo	12	8	$3,344.00	$2,340.80 30% off	$1,672.00	$1,672.00	$1,672.00	2026-07-15
73223LT	OTHER	MRI Ext Upp Lt Jt Wwo	12	8	$3,344.00	$2,340.80 30% off	$1,672.00	$1,672.00	$1,672.00	2026-07-15
73220RT	OTHER	MRI Ext Upp Rt Wwo	12	8	$3,344.00	$2,340.80 30% off	$1,672.00	$1,672.00	$1,672.00	2026-07-15
73720RT	OTHER	MRI Ext Low Rt Wwo	12	8	$3,344.00	$2,340.80 30% off	$1,672.00	$1,672.00	$1,672.00	2026-07-15
73725RT	OTHER	MRA Ext Low Rt Wwo	12	8	$3,344.00	$2,340.80 30% off	$1,672.00	$1,672.00	$1,672.00	2026-07-15
73720LT	OTHER	MRI Ext Low Lt Wwo	12	8	$3,344.00	$2,340.80 30% off	$1,672.00	$1,672.00	$1,672.00	2026-07-15
73225RT	OTHER	MRA Ext Upp Rt Wwo	12	8	$3,344.00	$2,340.80 30% off	$1,672.00	$1,672.00	$1,672.00	2026-07-15
75557	HCPCS	MRI Cardiac Wo	12	8	$3,344.00	$2,340.80 30% off	$1,672.00	$1,672.00	$1,672.00	2026-07-15
75561	HCPCS	MRI Cardiac W	12	8	$3,344.00	$2,340.80 30% off	$1,672.00	$1,672.00	$1,672.00	2026-07-15
73225LT	OTHER	MRA Ext Upp Lt Wwo	12	8	$3,344.00	$2,340.80 30% off	$1,672.00	$1,672.00	$1,672.00	2026-07-15
73220LT	OTHER	MRI Ext Upp Lt Wwo	12	8	$3,344.00	$2,340.80 30% off	$1,672.00	$1,672.00	$1,672.00	2026-07-15
93350	HCPCS	US Stress Echo	12	8	$3,291.00	$2,303.70 30% off	$1,645.50	$1,645.50	$1,645.50	2026-07-15
72147	HCPCS	MRI Spine Thorac W	12	8	$3,258.00	$2,280.60 30% off	$1,629.00	$1,629.00	$1,629.00	2026-07-15
70552	HCPCS	MRI Brain W	12	8	$3,254.00	$2,277.80 30% off	$1,627.00	$1,627.00	$1,627.00	2026-07-15
78453	HCPCS	Nm Thall Sing Rest Stress	12	8	$3,196.00	$2,237.20 30% off	$1,598.00	$1,598.00	$1,598.00	2026-07-15
72148	HCPCS	MRI Spine Lumbar Wo	12	8	$3,186.00	$2,230.20 30% off	$1,593.00	$2,495.02	$1,593.00	2026-07-15
40812	HCPCS	Exc Les Mouth W Simp Rep	12	8	$3,164.00	$2,214.80 30% off	$1,582.00	$1,582.00	$1,582.00	2026-07-15
72194	HCPCS	CT Pelvis Wwo	12	8	$3,119.00	$2,183.30 30% off	$1,559.50	$1,559.50	$1,559.50	2026-07-15
74170	HCPCS	CT Abdomen W Wo	12	8	$3,119.00	$2,183.30 30% off	$1,559.50	$1,559.50	$1,559.50	2026-07-15
73219LT	OTHER	MRI Ext Upp Lt W	12	8	$3,084.00	$2,158.80 30% off	$1,542.00	$1,542.00	$1,542.00	2026-07-15
73219RT	OTHER	MRI Ext Upper W Rt	12	8	$3,084.00	$2,158.80 30% off	$1,542.00	$1,542.00	$1,542.00	2026-07-15
74182	HCPCS	MRI Abdomen W	12	8	$3,050.00	$2,135.00 30% off	$1,525.00	$1,525.00	$1,525.00	2026-07-15
70549	HCPCS	MRA Neck W Wo	12	8	$3,041.00	$2,128.70 30% off	$1,520.50	$1,520.50	$1,520.50	2026-07-15
J7298	HCPCS	Mirena IUD	12	8	$3,036.58	$2,125.60 30% off	$1,518.29	$1,518.29	$1,518.29	2026-07-15
70543	HCPCS	MRI Orb Face Neck Wwo	12	8	$3,031.00	$2,121.70 30% off	$1,515.50	$1,515.50	$1,515.50	2026-07-15
70336	HCPCS	MRI Tempromandib Jt	12	8	$3,013.00	$2,109.10 30% off	$1,506.50	$1,506.50	$1,506.50	2026-07-15
70548	HCPCS	MRA Neck W	12	8	$3,007.00	$2,104.90 30% off	$1,503.50	$1,503.50	$1,503.50	2026-07-15
70544	HCPCS	MRA Head Wo	12	8	$3,007.00	$2,104.90 30% off	$1,503.50	$1,503.50	$1,503.50	2026-07-15
74181	HCPCS	MRI Abdomen Wo	12	8	$2,983.00	$2,088.10 30% off	$1,491.50	$1,491.50	$1,491.50	2026-07-15
25605	HCPCS	Fx Distal Radius W/manip	24	8	$2,977.50	$2,153.80 28% off	$695.50	$2,282.00	$1,488.75	2026-07-15
70551	HCPCS	MRI Brain Wo	12	8	$2,974.00	$2,081.80 30% off	$1,487.00	$1,487.00	$1,487.00	2026-07-15
25565	HCPCS	Fx Rad/ulnar Shaft W/mani	24	8	$2,952.00	$2,133.40 28% off	$670.00	$2,282.00	$1,476.00	2026-07-15
73218RT	OTHER	MRI Ext Upper Wo Rt	12	8	$2,946.00	$2,062.20 30% off	$1,473.00	$1,473.00	$1,473.00	2026-07-15
73218LT	OTHER	MRI Ext Upp Lt Wo	12	8	$2,946.00	$2,062.20 30% off	$1,473.00	$1,473.00	$1,473.00	2026-07-15
38500	HCPCS	Biopsy Lymph Node Super	24	8	$2,938.50	$2,156.10 27% off	$991.50	$1,947.00	$1,469.25	2026-07-15
72146	HCPCS	MRI Spine Thorac Wo	12	8	$2,909.00	$2,036.30 30% off	$1,454.50	$1,454.50	$1,454.50	2026-07-15
77084	HCPCS	MRI Bone Marr Blood Stdy	12	8	$2,897.00	$2,027.90 30% off	$1,448.50	$1,448.50	$1,448.50	2026-07-15
24605	HCPCS	Dislocation Elbow W Anes	24	8	$2,896.00	$2,088.60 28% off	$614.00	$2,282.00	$1,448.00	2026-07-15
73221LT	OTHER	MRI Ext Upp Lt Jt Wo	12	8	$2,858.00	$2,000.60 30% off	$1,429.00	$1,429.00	$1,429.00	2026-07-15
73221RT	OTHER	MRI Ext Upp Rt Jt Wo	12	8	$2,858.00	$2,000.60 30% off	$1,429.00	$1,429.00	$1,429.00	2026-07-15
72195	HCPCS	MRI Pelvis Wo	12	8	$2,857.00	$1,999.90 30% off	$1,428.50	$2,496.60	$1,428.50	2026-07-15
73718RT	OTHER	MRI Ext Lower Wo Rt	12	8	$2,831.00	$1,981.70 30% off	$1,415.50	$1,415.50	$1,415.50	2026-07-15
23655	HCPCS	Disloca Shoulder W/anes	24	8	$2,808.00	$2,018.20 28% off	$526.00	$2,282.00	$1,404.00	2026-07-15
75635	HCPCS	CT Angio Aorta W Runoff	12	8	$2,796.00	$1,957.20 30% off	$1,398.00	$1,398.00	$1,398.00	2026-07-15
55250	HCPCS	Vasectomy	12	8	$2,779.00	$1,945.30 30% off	$1,389.50	$1,389.50	$1,389.50	2026-07-15
73718LT	OTHER	MRI Ext Low Lt Wo	12	8	$2,765.00	$1,935.50 30% off	$1,382.50	$1,382.50	$1,382.50	2026-07-15
73722RT	OTHER	MRI Ext Low Rt Jt W	12	8	$2,742.00	$1,919.40 30% off	$1,371.00	$1,371.00	$1,371.00	2026-07-15
73222RT	OTHER	MRI Ext Upp Rt Jt W	12	8	$2,742.00	$1,919.40 30% off	$1,371.00	$1,371.00	$1,371.00	2026-07-15
73722LT	OTHER	MRI Ext Low Lt Jt W	12	8	$2,742.00	$1,919.40 30% off	$1,371.00	$1,371.00	$1,371.00	2026-07-15
73222LT	OTHER	MRI Ext Upp Lt Jt W	12	8	$2,742.00	$1,919.40 30% off	$1,371.00	$1,371.00	$1,371.00	2026-07-15
73719LT	OTHER	MRI Ext Lower W Lt	12	8	$2,740.00	$1,918.00 30% off	$1,370.00	$1,370.00	$1,370.00	2026-07-15
73719RT	OTHER	MRI Ext Lower W Rt	12	8	$2,740.00	$1,918.00 30% off	$1,370.00	$1,370.00	$1,370.00	2026-07-15
73206	HCPCS	CT Angio Upper Extremity	12	8	$2,732.00	$1,912.40 30% off	$1,366.00	$1,366.00	$1,366.00	2026-07-15
70542	HCPCS	MRI Orb Face Neck W	12	8	$2,720.00	$1,904.00 30% off	$1,360.00	$1,360.00	$1,360.00	2026-07-15
72193	HCPCS	CT Pelvis W	12	8	$2,718.00	$1,902.60 30% off	$1,359.00	$1,359.00	$1,359.00	2026-07-15
70470	HCPCS	CT Head Wwo	12	8	$2,702.00	$1,891.40 30% off	$1,351.00	$1,351.00	$1,351.00	2026-07-15
J7296	HCPCS	Kyleena IUD	24	8	$2,694.29	$1,886.00 30% off	$1,338.04	$1,356.25	$1,347.14	2026-07-15
70492	HCPCS	CT Soft Tiss Neck Wwo	12	8	$2,686.00	$1,880.20 30% off	$1,343.00	$1,343.00	$1,343.00	2026-07-15
70540	HCPCS	MRI Orb Face Neck Wo	12	8	$2,683.00	$1,878.10 30% off	$1,341.50	$1,341.50	$1,341.50	2026-07-15
70482	HCPCS	CT Orb Sella Ear Wwo	12	8	$2,681.00	$1,876.70 30% off	$1,340.50	$1,340.50	$1,340.50	2026-07-15
71260	HCPCS	CT Chest/thorax W	12	8	$2,678.00	$1,874.60 30% off	$1,339.00	$1,339.00	$1,339.00	2026-07-15
70547	HCPCS	MRA Neck Wo	12	8	$2,669.00	$1,868.30 30% off	$1,334.50	$1,334.50	$1,334.50	2026-07-15
45384	HCPCS	Colonoscopy W Cautery	12	8	$2,657.00	$1,859.90 30% off	$1,328.50	$1,328.50	$1,328.50	2026-07-15
49082	HCPCS	Paracentesis Abdominal	12	8	$2,654.00	$1,857.80 30% off	$1,327.00	$1,327.00	$1,327.00	2026-07-15
10121	HCPCS	Incision Removal Fb Comp	24	8	$2,647.50	$1,955.70 26% off	$341.50	$2,306.00	$1,323.75	2026-07-15
72126	HCPCS	CT Spine Cervical W	12	8	$2,633.00	$1,843.10 30% off	$1,316.50	$1,316.50	$1,316.50	2026-07-15
G0390	HCPCS	Trauma Team Activation	11	8	$2,622.00	$1,835.40 30% off	$1,311.00	$1,311.00	$1,311.00	2026-07-15
73721LT	OTHER	MRI Ext Low Lt Jt Wo	12	8	$2,620.00	$1,834.00 30% off	$1,310.00	$1,310.00	$1,310.00	2026-07-15
73721RT	OTHER	MRI Ext Low Rt Jt Wo	12	8	$2,620.00	$1,834.00 30% off	$1,310.00	$1,310.00	$1,310.00	2026-07-15
74160	HCPCS	CT Abdomen W	12	8	$2,598.00	$1,818.60 30% off	$1,299.00	$2,338.20	$1,299.00	2026-07-15
J9217	HCPCS	Leuprolide Acetate [lupron] 22.5mg Inj	22	8	$2,559.89	$1,899.39 26% off	$1,074.80	$1,485.09	$1,279.94	2026-07-15
70491	HCPCS	CT Soft Tiss Neck W	12	8	$2,550.00	$1,785.00 30% off	$1,275.00	$1,275.00	$1,275.00	2026-07-15
45385	HCPCS	Colonoscopy By Snare	24	8	$2,549.50	$1,906.75 25% off	$1,221.00	$1,328.50	$1,274.75	2026-07-15
45380	HCPCS	Colonoscopy W Biopsy	24	8	$2,549.50	$1,906.75 25% off	$1,221.00	$1,328.50	$1,274.75	2026-07-15
72125	HCPCS	CT Spine Cervical Wo	12	8	$2,539.00	$1,777.30 30% off	$1,269.50	$1,929.64	$1,269.50	2026-07-15
70545	HCPCS	MRA Head W	12	8	$2,491.00	$1,992.80 20% off	$1,245.50	$1,245.50	$1,245.50	2026-07-15
73202LT	OTHER	CT Ext Upp Lt Wwo	12	8	$2,475.00	$1,980.00 20% off	$1,237.50	$1,237.50	$1,237.50	2026-07-15
73202RT	OTHER	CT Ext Upp Rt Wwo	12	8	$2,475.00	$1,980.00 20% off	$1,237.50	$1,237.50	$1,237.50	2026-07-15
60500	HCPCS	Parathyroidectomy	12	8	$2,470.00	$1,976.00 20% off	$1,235.00	$1,235.00	$1,235.00	2026-07-15
43239	HCPCS	Gi Endo W Biopsy	12	8	$2,451.00	$1,960.80 20% off	$1,225.50	$1,225.50	$1,225.50	2026-07-15
70460	HCPCS	CT Head Or Brain W	12	8	$2,419.00	$1,935.20 20% off	$1,209.50	$1,209.50	$1,209.50	2026-07-15
21315	HCPCS	Fx Nasal Bone Wo Manip	24	8	$2,414.00	$1,748.90 28% off	$197.00	$2,217.00	$1,207.00	2026-07-15
70496	HCPCS	CT Angio Head W	12	8	$2,407.00	$1,925.60 20% off	$1,203.50	$1,203.50	$1,203.50	2026-07-15
70498	HCPCS	CT Angio Neck W	12	8	$2,407.00	$1,925.60 20% off	$1,203.50	$1,203.50	$1,203.50	2026-07-15
71250	HCPCS	CT Chest/thorax Wo	12	8	$2,397.00	$1,917.60 20% off	$1,198.50	$1,198.50	$1,198.50	2026-07-15
78473	HCPCS	Nm Card Bld Mult Image	12	8	$2,381.00	$1,904.80 20% off	$1,190.50	$1,190.50	$1,190.50	2026-07-15
93306	HCPCS	US Echocardiography	12	8	$2,371.00	$1,896.80 20% off	$1,185.50	$1,834.40	$1,185.50	2026-07-15
45378	HCPCS	Colonoscopy	24	8	$2,337.50	$1,870.00 20% off	$1,123.00	$1,214.50	$1,168.75	2026-07-15
74150	HCPCS	CT Abdomen Wo	12	8	$2,313.00	$1,850.40	$1,156.50	$2,021.40	$1,156.50	2026-07-15
78227	HCPCS	Nm Liver Bili Img W Gb	12	8	$2,292.00	$1,833.60 20% off	$1,146.00	$2,062.80	$1,146.00	2026-07-15
G0105	HCPCS	Screening Colonoscopy	12	8	$2,246.00	$1,796.80 20% off	$1,123.00	$1,123.00	$1,123.00	2026-07-15
70481	HCPCS	CT Orb Sella Ear W	12	8	$2,196.00	$1,756.80 20% off	$1,098.00	$1,098.00	$1,098.00	2026-07-15
73201LT	OTHER	CT Ext Upp Lt W	12	8	$2,185.00	$1,748.00 20% off	$1,092.50	$1,092.50	$1,092.50	2026-07-15
73201RT	OTHER	CT Ext Upp Rt W	12	8	$2,185.00	$1,748.00 20% off	$1,092.50	$1,092.50	$1,092.50	2026-07-15
73701RT	OTHER	CT Ext Low Rt W	12	8	$2,168.00	$1,734.40	$1,084.00	$1,084.00	$1,084.00	2026-07-15
73701LT	OTHER	CT Ext Low Lt W	12	8	$2,168.00	$1,734.40	$1,084.00	$1,084.00	$1,084.00	2026-07-15
72131	HCPCS	CT Spine Lumbar Wo	12	8	$2,154.00	$1,723.20 20% off	$1,077.00	$1,589.16	$1,077.00	2026-07-15
78320	HCPCS	Nm Bone Scan Spect	12	8	$2,142.00	$1,713.60 20% off	$1,071.00	$1,071.00	$1,071.00	2026-07-15
72192	HCPCS	CT Pelvis Wo	12	8	$2,142.00	$1,713.60 20% off	$1,071.00	$1,604.36	$1,071.00	2026-07-15
0120	RC	—	8	8	$2,137.25	$1,709.80 20% off	$1,068.62	$1,068.62	$1,068.62	2026-07-15
72128	HCPCS	CT Spine Thoracic Wo	12	8	$2,127.00	$1,701.60 20% off	$1,063.50	$1,569.40	$1,063.50	2026-07-15
70488	HCPCS	CT Maxillofacial W Wo	12	8	$2,105.00	$1,684.00 20% off	$1,052.50	$1,052.50	$1,052.50	2026-07-15
40500	HCPCS	Vermilionectomy Lip Shave	24	8	$2,095.50	$1,531.95 27% off	$651.00	$1,444.50	$1,047.75	2026-07-15
62270	HCPCS	Spinal Puncture Lumbar Dx	12	8	$2,081.00	$1,664.80 20% off	$1,040.50	$1,040.50	$1,040.50	2026-07-15
9929125	OTHER	Critical Care	12	8	$2,076.00	$1,660.80 20% off	$1,038.00	$1,038.00	$1,038.00	2026-07-15
43235	HCPCS	Gi Endo	12	8	$2,040.00	$1,632.00 20% off	$1,020.00	$1,020.00	$1,020.00	2026-07-15
14060	HCPCS	Adj Tissue Trans 10sqcm <	12	8	$2,038.00	$1,630.40	$1,019.00	$1,019.00	$1,019.00	2026-07-15
73702RT	OTHER	CT Ext Low Rt Wwo	12	8	$2,003.00	$1,602.40	$1,001.50	$1,001.50	$1,001.50	2026-07-15
73702LT	OTHER	CT Ext Low Lt Wwo	12	8	$2,003.00	$1,602.40	$1,001.50	$1,001.50	$1,001.50	2026-07-15
13160	HCPCS	Secondary Clos Wound Ext	12	8	$2,002.00	$1,601.60 20% off	$1,001.00	$1,001.00	$1,001.00	2026-07-15
38510	HCPCS	Ex Lymph Node Open Deep	12	8	$1,983.00	$1,586.40	$991.50	$991.50	$991.50	2026-07-15
70480	HCPCS	CT Orb Sella Ear Wo	12	8	$1,964.00	$1,571.20 20% off	$982.00	$982.00	$982.00	2026-07-15
78315	HCPCS	Nm Bone Scan 3 Phase	12	8	$1,964.00	$1,571.20 20% off	$982.00	$982.00	$982.00	2026-07-15
73200RT	OTHER	CT Ext Upp Rt Wo	12	8	$1,929.00	$1,543.20 20% off	$964.50	$964.50	$964.50	2026-07-15
73200LT	OTHER	CT Ext Upp Lt Wo	12	8	$1,929.00	$1,543.20 20% off	$964.50	$964.50	$964.50	2026-07-15
70487	HCPCS	CT Maxillofacial W	12	8	$1,916.00	$1,532.80 20% off	$958.00	$958.00	$958.00	2026-07-15
78264	HCPCS	Nm Gastric Emptying Study	12	8	$1,916.00	$1,532.80 20% off	$958.00	$958.00	$958.00	2026-07-15
42820	HCPCS	Tonsillec Adenoid >age 12	12	8	$1,906.00	$1,524.80 20% off	$953.00	$953.00	$953.00	2026-07-15
42825	HCPCS	Tonsillectomy <age 12	12	8	$1,906.00	$1,524.80 20% off	$953.00	$953.00	$953.00	2026-07-15
42821	HCPCS	Tonsillec Adenoid Age 12<	12	8	$1,906.00	$1,524.80 20% off	$953.00	$953.00	$953.00	2026-07-15
42826	HCPCS	Tonsillectomy Age 12<	12	8	$1,906.00	$1,524.80 20% off	$953.00	$953.00	$953.00	2026-07-15
81404	HCPCS	Ttr DNA Sequence Testing	12	8	$1,878.00	$1,502.40	$939.00	$939.00	$939.00	2026-07-15
31612	HCPCS	Transtracheal Procedure	12	8	$1,872.00	$1,497.60 20% off	$936.00	$936.00	$936.00	2026-07-15
9296059	OTHER	Cardioversion	12	8	$1,843.00	$1,474.40	$921.50	$921.50	$921.50	2026-07-15
73700RT	OTHER	CT Ext Low Rt Wo	12	8	$1,838.00	$1,470.40	$919.00	$919.00	$919.00	2026-07-15
73700LT	OTHER	CT Ext Low Lt Wo	12	8	$1,838.00	$1,470.40	$919.00	$919.00	$919.00	2026-07-15
26951	HCPCS	Amputation Finger/thumb	12	8	$1,834.00	$1,467.20 20% off	$917.00	$917.00	$917.00	2026-07-15
70490	HCPCS	CT Soft Tiss Neck Wo	12	8	$1,795.00	$1,436.00 20% off	$897.50	$1,568.70	$897.50	2026-07-15
86366	HCPCS	MuSK Antibody Test	12	8	$1,785.00	$1,428.00 20% off	$892.50	$892.50	$892.50	2026-07-15
78306	HCPCS	Nm Bone Scan Body Whole	12	8	$1,749.00	$1,399.20 20% off	$874.50	$874.50	$874.50	2026-07-15
78481	HCPCS	Nm Card Bld Sin Planar	12	8	$1,718.00	$1,374.40	$859.00	$859.00	$859.00	2026-07-15
J0248	HCPCS	Remdesivir 100 Mg Inj	12	8	$1,714.44	$1,371.55 20% off	$857.22	$857.22	$857.22	2026-07-15
70486	HCPCS	CT Maxillofacial Wo	12	8	$1,672.00	$1,337.60 20% off	$836.00	$836.00	$836.00	2026-07-15
A9567	HCPCS	Nm Tc99m Mma & Dtpa	12	8	$1,669.00	$1,335.20 20% off	$834.50	$834.50	$834.50	2026-07-15
78607	HCPCS	Nm Brain Spect Imaging	12	8	$1,664.00	$1,331.20 20% off	$832.00	$832.00	$832.00	2026-07-15
78202	HCPCS	Nm Liver Vasc Flow	12	8	$1,658.00	$1,326.40	$829.00	$829.00	$829.00	2026-07-15
78220	HCPCS	Nm Liver Function Study	12	8	$1,658.00	$1,326.40	$829.00	$829.00	$829.00	2026-07-15
78216	HCPCS	Nm Liver Spleen W Vasc	12	8	$1,658.00	$1,326.40	$829.00	$829.00	$829.00	2026-07-15
J7307	HCPCS	Nexplanon [etonogestrel] 68 Mg Implant	12	8	$1,638.03	$1,310.42 20% off	$819.02	$819.02	$819.02	2026-07-15
78472	HCPCS	Nm Card Bld Sin Image	12	8	$1,625.00	$1,300.00 20% off	$812.50	$812.50	$812.50	2026-07-15
94002	HCPCS	Ventassist Initial Day	12	8	$1,602.00	$1,281.60 20% off	$801.00	$801.00	$801.00	2026-07-15
81407	HCPCS	Molecular Path Level 8	12	8	$1,582.00	$1,265.60 20% off	$791.00	$791.00	$791.00	2026-07-15
78710	HCPCS	Nm Kidney Spect	12	8	$1,569.00	$1,255.20 20% off	$784.50	$784.50	$784.50	2026-07-15
78195	HCPCS	Nm Lymphatics&lymph Node	12	8	$1,554.00	$1,243.20 20% off	$777.00	$777.00	$777.00	2026-07-15
P9034	HCPCS	Bb Platelet Pheresis	12	8	$1,537.00	$1,229.60 20% off	$768.50	$768.50	$768.50	2026-07-15
93880	HCPCS	US Duplex Bilat Carotid	12	8	$1,530.00	$1,224.00 20% off	$765.00	$765.00	$765.00	2026-07-15
13152	HCPCS	Rep Comp 2.6-7.5	24	8	$1,523.50	$1,218.80	$642.00	$881.50	$761.75	2026-07-15
12046	HCPCS	Rep Inter 20.1cm-30.0cm	24	8	$1,511.00	$1,208.80	$651.50	$859.50	$755.50	2026-07-15
59426	HCPCS	Antepartum Care 7 Or More Visits	12	8	$1,497.00	$1,197.60 20% off	$748.50	$748.50	$748.50	2026-07-15
93970	HCPCS	US Noninvas Vascular Stdy	13	8	$1,482.00	$1,185.60 20% off	$741.00	$1,230.06	$741.00	2026-07-15
78707	HCPCS	Nm Kidney Img Wo Pharm	12	8	$1,473.00	$1,178.40	$736.50	$736.50	$736.50	2026-07-15
13132	HCPCS	Rep Comp 2.6-7.5	24	8	$1,471.00	$1,176.80 20% off	$611.50	$859.50	$735.50	2026-07-15
78708	HCPCS	Nm Kidney Img Sin Pharm	12	8	$1,470.00	$1,176.00 20% off	$735.00	$735.00	$735.00	2026-07-15
78801	HCPCS	Nm Radiop Mult Tumor Loca	12	8	$1,470.00	$1,176.00 20% off	$735.00	$735.00	$735.00	2026-07-15
70450	HCPCS	CT Head Or Brain Wo	12	8	$1,450.00	$1,160.00 20% off	$725.00	$1,305.00	$725.00	2026-07-15
11443	HCPCS	Exc Les Benign 2.1-3.0cm	24	8	$1,430.00	$1,202.80	$294.00	$1,136.00	$715.00	2026-07-15
42408	HCPCS	Exc Subling Salivary Cyst	12	8	$1,428.00	$1,142.40	$714.00	$714.00	$714.00	2026-07-15
12036	HCPCS	Rep Interm 20.1cm-30.0cm	24	8	$1,419.50	$1,135.60 20% off	$560.00	$859.50	$709.75	2026-07-15
78704	HCPCS	Nm Kidney Img W Fx Stdy	12	8	$1,402.00	$1,121.60 20% off	$701.00	$701.00	$701.00	2026-07-15
78709	HCPCS	Nm Kidney Wwo Mult Pharm	12	8	$1,398.00	$1,118.40	$699.00	$699.00	$699.00	2026-07-15
27752	HCPCS	Fx Tibia W/manipulation	12	8	$1,376.00	$1,100.80 20% off	$688.00	$688.00	$688.00	2026-07-15
78201	HCPCS	Nm Liver Static Only	12	8	$1,368.00	$1,094.40	$684.00	$684.00	$684.00	2026-07-15
78205	HCPCS	Nm Liver Spect	12	8	$1,368.00	$1,094.40	$684.00	$684.00	$684.00	2026-07-15
10080	HCPCS	I&d Pilonidal Cyst-simple	24	8	$1,358.50	$1,154.60	$339.00	$1,019.50	$679.25	2026-07-15
12044	HCPCS	Rep Intermed 7.6-12.5cm	24	8	$1,355.50	$1,183.60	$496.00	$859.50	$677.75	2026-07-15
93307	HCPCS	US Echo T Thorac Comp	12	8	$1,331.00	$1,064.80 20% off	$665.50	$665.50	$665.50	2026-07-15
78466	HCPCS	Nm Myocard Img Qual Quant	12	8	$1,319.00	$1,055.20	$659.50	$659.50	$659.50	2026-07-15
25505	HCPCS	Fx Radial Shaft W/manipu	12	8	$1,305.00	$1,044.00 20% off	$652.50	$652.50	$652.50	2026-07-15
40810	HCPCS	Exc Les Mucosa Wo Repair	12	8	$1,302.00	$1,041.60 20% off	$651.00	$651.00	$651.00	2026-07-15
78580	HCPCS	Nm Pulm Perf Img Particlt	12	8	$1,285.00	$1,028.00 20% off	$642.50	$642.50	$642.50	2026-07-15
78587	HCPCS	Nm Pulm Vent Multiple	12	8	$1,285.00	$1,028.00 20% off	$642.50	$642.50	$642.50	2026-07-15
78588	HCPCS	Nm Pulm Perf W Vent Img	12	8	$1,285.00	$1,028.00 20% off	$642.50	$642.50	$642.50	2026-07-15
A9540	HCPCS	Nm Tc99m Mma	12	8	$1,283.00	$1,026.40	$641.50	$641.50	$641.50	2026-07-15
25535	HCPCS	Fx Ulnar Shaft W/manip	12	8	$1,281.00	$1,024.80 20% off	$640.50	$640.50	$640.50	2026-07-15
A9500	HCPCS	Nm Tec Tc99m Sest To40mci	12	8	$1,280.00	$1,024.00 20% off	$640.00	$1,326.95	$640.00	2026-07-15
78701	HCPCS	Nm Kidney Img W Vasc Flow	12	8	$1,267.00	$1,013.60 20% off	$633.50	$633.50	$633.50	2026-07-15
43250	HCPCS	Gi Endo W Biopsy Cautery	12	8	$1,258.00	$1,006.40 20% off	$629.00	$629.00	$629.00	2026-07-15
93925	HCPCS	US Arterial Dup Low Ext Bila	12	8	$1,255.00	$1,004.00 20% off	$627.50	$627.50	$627.50	2026-07-15
42100	HCPCS	Biopsy Of Palate,uvula	12	8	$1,250.00	$1,000.00 20% off	$625.00	$625.00	$625.00	2026-07-15
40510	HCPCS	Excision Of Lip Transverse Wedge	12	8	$1,246.00	$996.80 20% off	$623.00	$623.00	$623.00	2026-07-15
Q5106	HCPCS	Epoetin Alfa-epbx Inj 40000u/ml	12	8	$1,244.28	$995.42 20% off	$622.14	$622.14	$622.14	2026-07-15
87901	HCPCS	Infec Ag Geno By Nuc Acid	12	8	$1,228.00	$982.40 20% off	$614.00	$614.00	$614.00	2026-07-15
78740	HCPCS	Nm Ureteral Reflux Study	12	8	$1,216.00	$972.80 20% off	$608.00	$608.00	$608.00	2026-07-15
13121	HCPCS	Rep Comp 2.6-7.5	24	8	$1,194.00	$955.20 20% off	$553.00	$641.00	$597.00	2026-07-15
93930	HCPCS	US Arterial Dup Upp Ext Bila	12	8	$1,190.00	$952.00 20% off	$595.00	$595.00	$595.00	2026-07-15
28024	HCPCS	Arthrotomy Ip Joint	12	8	$1,172.00	$937.60 20% off	$586.00	$586.00	$586.00	2026-07-15
36430	HCPCS	Bb Transfusion Blood Product	12	8	$1,165.00	$932.00 20% off	$582.50	$582.50	$582.50	2026-07-15
94003	HCPCS	Ventilation Assist Subseq	12	8	$1,165.00	$932.00 20% off	$582.50	$582.50	$582.50	2026-07-15
78290	HCPCS	Nm Bowel Img Meckels	12	8	$1,163.00	$930.40 20% off	$581.50	$581.50	$581.50	2026-07-15
78800	HCPCS	Nm Radiop Ltd Tumor Local	12	8	$1,144.00	$915.20	$572.00	$572.00	$572.00	2026-07-15
11606	HCPCS	Exc Malign Les Over 4.0cm	12	8	$1,143.00	$914.40 20% off	$571.50	$571.50	$571.50	2026-07-15
78278	HCPCS	Nm Gastrointest Bleed	12	8	$1,142.00	$913.60 20% off	$571.00	$571.00	$571.00	2026-07-15
78215	HCPCS	Nm Liver Spleen Static	12	8	$1,138.00	$910.40 20% off	$569.00	$569.00	$569.00	2026-07-15
78300	HCPCS	Nm Bone Scan Ltd Area	12	8	$1,135.00	$908.00 20% off	$567.50	$567.50	$567.50	2026-07-15
78761	HCPCS	Nm Testicul W Vasc Flo	12	8	$1,135.00	$908.00 20% off	$567.50	$567.50	$567.50	2026-07-15
93882	HCPCS	US Duplex Extracran Ltd	12	8	$1,131.00	$904.80 20% off	$565.50	$565.50	$565.50	2026-07-15
90675	HCPCS	Vac- Rabavert [rabies] Chick - Emb	12	8	$1,125.09	$900.07 20% off	$562.54	$562.54	$562.54	2026-07-15
26645	HCPCS	Fx Thumb W/manip	12	8	$1,123.00	$898.40 20% off	$561.50	$561.50	$561.50	2026-07-15
J0885	HCPCS	Epoetin Alfa [procrit] Inj 10000unt/ml	36	8	$1,119.84	$955.40	$477.70	$770.31	$559.92	2026-07-15
0346U	OTHER	Quest Ad-detect Beta-amyloid 42/40 Rati	12	8	$1,105.00	$884.00 20% off	$552.50	$552.50	$552.50	2026-07-15
26641	HCPCS	Dislocation Thumb W/manip	12	8	$1,089.00	$871.20	$544.50	$544.50	$544.50	2026-07-15
93017	HCPCS	Nm Treadmill Tracing Only	12	8	$1,087.00	$869.60 20% off	$543.50	$1,126.41	$543.50	2026-07-15
A9510	HCPCS	Nm Tc 99m Hepatolite	12	8	$1,086.00	$868.80 20% off	$543.00	$543.00	$543.00	2026-07-15
12035	HCPCS	Rep Intermed 12.6-20.0cm	24	8	$1,071.50	$857.20	$504.50	$567.00	$535.75	2026-07-15
13131	HCPCS	Rep Complex 1.1-2.5 Cm	24	8	$1,071.00	$856.80 20% off	$504.00	$567.00	$535.50	2026-07-15
93931	HCPCS	US Dup Ext Upp Unilat Artery	12	8	$1,071.00	$856.80 20% off	$535.50	$535.50	$535.50	2026-07-15
93931LT	OTHER	US Arterial Dup Upper Ext Lt	12	8	$1,071.00	$856.80 20% off	$535.50	$535.50	$535.50	2026-07-15
93931RT	OTHER	US Arterial Dup Upper Ext Rt	12	8	$1,071.00	$856.80 20% off	$535.50	$535.50	$535.50	2026-07-15
78305	HCPCS	Nm Bone Scan Mult Area	12	8	$1,070.00	$856.00 20% off	$535.00	$535.00	$535.00	2026-07-15
12054	HCPCS	Rep Intermed 7.6-12.5cm	24	8	$1,068.00	$854.40	$501.00	$567.00	$534.00	2026-07-15
93923	HCPCS	US Ankle Brachial Index Bilateral	24	8	$1,050.00	$924.50	$422.50	$627.50	$525.00	2026-07-15
0110	RC	—	15	8	$2,219.65	$1,775.72 20% off	$239.25	$1,109.82	$522.21	2026-07-15
12053	HCPCS	Rep Intermed 5.1-7.5cm	24	8	$1,042.00	$928.60	$475.00	$567.00	$521.00	2026-07-15
11626	HCPCS	Exc Malign Les Over 4.0cm	12	8	$1,041.00	$832.80 20% off	$520.50	$520.50	$520.50	2026-07-15
P9016BL	OTHER	Leukocyte Reduced Rbc	12	8	$1,030.00	$824.00 20% off	$515.00	$515.00	$515.00	2026-07-15
32551	HCPCS	Thoracostomy Tube Plcment	24	8	$1,021.00	$855.40	$193.00	$828.00	$510.50	2026-07-15
26775	HCPCS	Disloca Intermed W/anes	12	8	$1,021.00	$816.80 20% off	$510.50	$510.50	$510.50	2026-07-15
78700	HCPCS	Nm Kidney Img Static	12	8	$1,017.00	$813.60 20% off	$508.50	$508.50	$508.50	2026-07-15
59425	HCPCS	Antepartum Care 4-6 Visits	12	8	$1,007.00	$805.60 20% off	$503.50	$503.50	$503.50	2026-07-15
27500	HCPCS	Fx Femoral Shaft Wo Manip	24	8	$1,006.50	$872.90	$338.50	$668.00	$503.25	2026-07-15
93922LT	OTHER	US Ankle Brachial Index Left	12	8	$1,004.00	$803.20	$502.00	$502.00	$502.00	2026-07-15
93926RT	OTHER	US Arterial Dup Low Ext Rt	12	8	$1,004.00	$803.20	$502.00	$502.00	$502.00	2026-07-15
93922RT	OTHER	US Ankle Brachial Index Right	12	8	$1,004.00	$803.20	$502.00	$502.00	$502.00	2026-07-15
93926LT	OTHER	US Arterial Dup Low Ext Lt	12	8	$1,004.00	$803.20	$502.00	$502.00	$502.00	2026-07-15
11644	HCPCS	Exc Malign Face 3.1-4cm	12	8	$996.00	$996.00	$498.00	$498.00	$498.00	2026-07-15
27842	HCPCS	Fx Disloc Ankle W/anes	24	8	$991.50	$864.80	$358.00	$633.50	$495.75	2026-07-15
10061	HCPCS	I&d Abscess Comp/multiple	24	8	$989.00	$845.70	$272.50	$716.50	$494.50	2026-07-15
93978	HCPCS	US Dup Aorta Inf Vc Comp	12	8	$983.00	$983.00	$491.50	$491.50	$491.50	2026-07-15
99285	HCPCS	ER Level V	24	8	$982.50	$829.50	$217.50	$765.00	$491.25	2026-07-15
81406	HCPCS	Molecular Path Level 7	12	8	$982.00	$982.00	$491.00	$491.00	$491.00	2026-07-15
27840	HCPCS	Dislocation Ankle-closed	12	8	$980.00	$980.00	$490.00	$490.00	$490.00	2026-07-15
12052	HCPCS	Rep Intermed 2.6-5.0cm	24	8	$977.50	$864.10	$410.50	$567.00	$488.75	2026-07-15
81405	HCPCS	Molecular Path Level 6	12	8	$977.00	$977.00	$488.50	$488.50	$488.50	2026-07-15
88262	HCPCS	Chromosome Analysis 15-20	12	8	$974.00	$974.00	$487.00	$487.00	$487.00	2026-07-15
12042	HCPCS	Rep Intermed 2.6-7.5cm	24	8	$971.00	$857.60	$404.00	$567.00	$485.50	2026-07-15
24600	HCPCS	Dislocation Elbow Wo Anes	12	8	$965.00	$965.00	$482.50	$482.50	$482.50	2026-07-15
21012	HCPCS	Excision,tumor Face >2cm	12	8	$962.00	$962.00	$481.00	$481.00	$481.00	2026-07-15
12032	HCPCS	Rep Intermed 2.6-7.5cm	24	8	$961.00	$847.60	$394.00	$567.00	$480.50	2026-07-15
87902	HCPCS	Hepatitis C Viral Rna, Genotype, LiPA	12	8	$958.00	$958.00	$479.00	$479.00	$479.00	2026-07-15
10022	HCPCS	Aspiration Needle W/guide	24	8	$957.50	$840.30	$371.50	$586.00	$478.75	2026-07-15
G0480	HCPCS	Dihydrotestosterone	22	8	$950.00	$950.00	$18.50	$855.00	$475.00	2026-07-15
20670	HCPCS	Removal Implaint Superfic	12	8	$950.00	$950.00	$475.00	$475.00	$475.00	2026-07-15
93971LT	OTHER	US Duplex Low Ext Veins Lt D	12	8	$939.00	$939.00	$469.50	$469.50	$469.50	2026-07-15
81317	HCPCS	Pms2 Gene Analysis	12	8	$939.00	$939.00	$469.50	$469.50	$469.50	2026-07-15
93971RT	OTHER	US Duplex Low Ext Veins Rt D	12	8	$939.00	$939.00	$469.50	$469.50	$469.50	2026-07-15
41000	HCPCS	I&d Tongue Mouth;lingual	24	8	$938.50	$790.20	$197.00	$741.50	$469.25	2026-07-15
12051	HCPCS	Rep Intermed 2.5cm Or <	24	8	$938.00	$824.60	$371.00	$567.00	$469.00	2026-07-15
76700	HCPCS	US Abdomen Complete	12	8	$935.00	$935.00	$467.50	$817.20	$467.50	2026-07-15
45333	HCPCS	Sigmoid W Removal Cautery	12	8	$931.00	$931.00	$465.50	$465.50	$465.50	2026-07-15
74420	HCPCS	Ivp Retrogr W/wo Kub	12	8	$930.00	$930.00	$465.00	$465.00	$465.00	2026-07-15
13120	HCPCS	Rep Comp 1.1-2.5cm	12	8	$926.00	$926.00	$463.00	$463.00	$463.00	2026-07-15
76805	HCPCS	US OB >1st Trimester	12	8	$922.00	$922.00	$461.00	$461.00	$461.00	2026-07-15
J0561	HCPCS	Penicillin G Benz[bicillin La] Inj 1.2mm	12	8	$917.69	$917.69	$458.84	$825.92	$458.84	2026-07-15
24576	HCPCS	Fx Humerus Wo Manip	12	8	$917.00	$917.00	$458.50	$458.50	$458.50	2026-07-15
78006	HCPCS	Nm Thyr Img Sin Uptake	12	8	$915.00	$915.00	$457.50	$457.50	$457.50	2026-07-15
12041	HCPCS	Rep Intermed 2.5cm Or <	24	8	$913.50	$800.10	$346.50	$567.00	$456.75	2026-07-15

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