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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

MIDWEST MEDICAL CENTER

Galena, IL · CCN 141302 · Rates published

3,324 distinct procedures filed
10 distinct payers
69,506 rate rows
2026-05-06 last MRF observed
Data quality

69,021 of 69,506 rate rows are consumer-grade (99.3%)

485 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 466
per-diem day rate — not a per-procedure price 19
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.midwestmedicalcenter.org/content/pdfs/204560540_midwest-medical-center_standardcharges.csv
Found on page https://www.midwestmedicalcenter.org/patients-visitors/standard-charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 32b1bbca1d4926df… · 8,278,558 bytes · first seen 2026-05-05

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
17027870
OTHER 		17027870 Fusion Of Ankle Joint Open Ed Charge 10 $19,643.15 $20,388.47 $20,388.47 nat. median
$20,388
1.0× median
15000971
OTHER 		Equinoxe Platform Fracture Humeral Stem Cemented Left 8.5mm 304-21-09 10 $7,473.33 $7,473.33 $7,473.33 nat. median
$7,473
1.0× median
24070012
OTHER 		Radiology Request 10 $4,865.25 $6,863.15 $6,863.15 nat. median
$6,863
1.0× median
15000935
OTHER 		Itotal Ps Ipoly Implant Kit Right Tps1111111 10 $6,735.63 $6,735.63 $6,735.63 nat. median
$6,736
1.0× median
15000842
OTHER 		Itotal Ps Ipoly Implant Kit Left Tps1111111 10 $6,735.63 $6,735.63 $6,735.63 nat. median
$6,736
1.0× median
15000595
OTHER 		Tm Reverse Stem 14mm X 130mm 00-4349-014-13 10 $6,174.35 $6,174.35 $6,174.35 nat. median
$6,174
1.0× median
17026350
OTHER 		17026350 Repair Finger/hand Tendon Ed Charge 10 $6,089.60 $6,089.60 $6,089.60 nat. median
$6,090
1.0× median
15000695
OTHER 		Tm Reverse Stem 12mmx130mm 00-4349-012-13 10 $6,053.22 $6,053.22 $6,053.22 nat. median
$6,053
1.0× median
15000472
OTHER 		Equinoxe Humeral Stem Primary Press Fit 300-01-13 10 $5,813.97 $5,813.97 $5,813.97 nat. median
$5,814
1.0× median
15000490
OTHER 		Equinoxe Humeral Stem Primary Press Fit 9mm 300-01-09 10 $5,813.97 $5,813.97 $5,813.97 nat. median
$5,814
1.0× median
17026727
OTHER 		17026727 Treat Finger Fracture, Each Ed Charge 10 $5,646.96 $5,646.96 $5,646.96 nat. median
$5,647
1.0× median
17045108
OTHER 		17045108 Removal Of Anorectal Lesion Ed Charge 10 $5,448.81 $5,448.81 $5,448.81 nat. median
$5,449
1.0× median
18045108
OTHER 		18045108 Pf Removal Anorectal Lesion Ed Charge 10 $5,448.81 $5,448.81 $5,448.81 nat. median
$5,449
1.0× median
10021365
OTHER 		21365 Opn Tx Complx Malar Fx 6 $5,178.15 $5,178.15 $5,178.15 nat. median
$5,178
1.0× median
15000943
OTHER 		G7 Osseoti Multihole 54mm F 110010265 10 $4,974.27 $4,974.27 $4,974.27 nat. median
$4,974
1.0× median
15000473
OTHER 		Equinoxe Reverse Shoulder Humeral Adapter Tray 320-10-00 10 $4,957.94 $4,957.94 $4,957.94 nat. median
$4,958
1.0× median
10030420
OTHER 		30420 Reconstruction Of Nose 6 $4,933.53 $4,933.53 $4,933.53 nat. median
$4,934
1.0× median
17020650
OTHER 		17020650 Insert And Remove Bone Pin Ed Charge 10 $4,822.06 $4,822.06 $4,822.06 nat. median
$744
outlier · 6.5×
18020650
OTHER 		18020650 Pf Insert And Remove Bone Pin Ed Charge 10 $4,822.06 $4,822.06 $4,822.06 nat. median
$1,264
outlier · 3.8×
10014301
OTHER 		Adjacent Tissue Transfer Or Rearrangement, Any Area; Defect 30.1 Sq Cm To 60.0 S… 6 $4,754.23 $4,754.23 $4,754.23 nat. median
$4,754
1.0× median
17031515
OTHER 		17031515 Laryngoscopy For Aspiration Ed Charge 10 $4,456.73 $4,677.68 $4,677.68 nat. median
$4,678
1.0× median
18031515
OTHER 		18031515 Pf Laryngoscopy For Aspiration Ed Charge 10 $4,456.73 $4,677.68 $4,677.68 nat. median
$4,678
1.0× median
18023931
OTHER 		18023931 Remove Shoulder Fb Ed Charge 10 $4,675.70 $4,675.70 $4,675.70 nat. median
$4,676
1.0× median
17023931
OTHER 		17023931 Drainage Of Arm Bursa Ed Charge 10 $4,675.70 $4,675.70 $4,675.70 nat. median
$4,676
1.0× median
15000266
OTHER 		Arhtrex Univers Apex Humeral Stem 9mm Ar-9100-09s 10 $4,594.98 $4,594.98 $4,594.98 nat. median
$4,595
1.0× median
24074113
OTHER 		CT Abdomen +Pelvis With + Without Cont 10 $4,234.44 $4,543.02 $4,543.02 nat. median
$4,543
1.0× median
15000391
OTHER 		Comp Primary Stem 11mm Mini 113631 10 $4,490.40 $4,490.40 $4,490.40 nat. median
$4,490
1.0× median
10030410
OTHER 		30410 Reconstruction Of Nose 6 $4,480.70 $4,480.70 $4,480.70 nat. median
$4,481
1.0× median
17027301
OTHER 		17027301 Drain Thigh/knee Lesion Ed Charge 10 $4,240.36 $4,240.36 $4,240.36 nat. median
$4,240
1.0× median
18027301
OTHER 		18027301 Drain Thigh/knee Lesion Ed Charge 10 $4,240.36 $4,240.36 $4,240.36 nat. median
$4,240
1.0× median
15000464
OTHER 		Equinoxe Reverse Shoulder Genoid Plate 320-15-01 10 $4,226.16 $4,226.16 $4,226.16 nat. median
$4,226
1.0× median
15000714
OTHER 		G7 Osseoti 4 Hole Shell 58mm G 110010247 10 $4,117.63 $4,117.63 $4,117.63 nat. median
$4,118
1.0× median
15000940
OTHER 		G7 Osseoti 3 Hole Shell 52mm E 110010244 10 $4,117.63 $4,117.63 $4,117.63 nat. median
$4,118
1.0× median
15000949
OTHER 		G7 Osseoti 4 Hole Shell 56mm F 110010246 10 $4,117.63 $4,117.63 $4,117.63 nat. median
$4,118
1.0× median
15000679
OTHER 		G7 Osseoti 3 Hole Shell 48mm C 110010242 10 $4,117.63 $4,117.63 $4,117.63 nat. median
$4,118
1.0× median
10042145
OTHER 		42145 Repair Palate Pharynx/uvula 6 $4,102.26 $4,102.26 $4,102.26 nat. median
$4,102
1.0× median
10021390
OTHER 		21390 Open Treatment Orbit Periorbital Floor Blowout Fracture 6 $4,030.73 $4,030.73 $4,030.73 nat. median
$4,031
1.0× median
15000470
OTHER 		Equinoxe Reverse Shoulder Glenosphere 320-01-38 10 $3,962.08 $3,962.08 $3,962.08 nat. median
$3,962
1.0× median
15000818
OTHER 		3.5mm Lcp Proximal Humerus Plate Long 10h Shaft 232mm 241.923 10 $3,945.99 $3,945.99 $3,945.99 nat. median
$3,946
1.0× median
24070010
OTHER 		Radiology Request 10 $3,016.04 $3,894.86 $3,894.86 nat. median
$3,895
1.0× median
10042440
OTHER 		42440 Excise Submaxillary Gland 6 $3,888.35 $3,888.35 $3,888.35 nat. median
$3,888
1.0× median
17046320
OTHER 		17046320 Removal Of Hemorrhoid Clot Ed Charge 10 $3,676.03 $3,769.32 $3,769.32 nat. median
$3,769
1.0× median
15000928
OTHER 		G7 Osseoti 3 Hole Shell 50mm D 110010243 10 $3,743.27 $3,743.27 $3,743.27 nat. median
$3,743
1.0× median
10015260
OTHER 		Full Thick Gft Nose/lips; 20 S 6 $3,735.72 $3,735.72 $3,735.72 nat. median
$1,804
outlier · 2.1×
10014061
OTHER 		Adjacent Tissue Xfer/rearrangement,eyelids,nose,ears Or Lips Defect 10.1cm-30cm… 6 $3,732.61 $3,732.61 $3,732.61 nat. median
$3,733
1.0× median
24074111
OTHER 		CT Abdomen +Pelvis With Cont 10 $3,477.07 $3,730.46 $3,730.46 nat. median
$3,730
1.0× median
18042104
OTHER 		18042104 ER Pf Excision Lesion Mouth Roof Ed Charge 10 $3,653.80 $3,653.80 $3,653.80 nat. median
$3,654
1.0× median
17042104
OTHER 		17042104 Excision Lesion Mouth Roof Ed Charge 10 $3,653.80 $3,653.80 $3,653.80 nat. median
$3,654
1.0× median
62095805
OTHER 		Sleep Study First 10 $3,648.18 $3,648.18 $3,648.18 nat. median
$3,648
1.0× median
10014041
OTHER 		Adj Tissue Xfer/rearrangement,forehead,cheek,chin,mouth,hands/ft 10.1cm-30.0cm T… 6 $3,587.58 $3,587.58 $3,587.58 nat. median
$3,588
1.0× median

Other procedures at this hospital

Browse this hospital's 3,324 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
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
             
17027870 OTHER 17027870 Fusion Of Ankle Joint Open Ed Charge 23 10 $26,844.60 $24,428.59 $19,643.15 $20,388.47 $20,388.47 2026-05-06
15000971 OTHER Equinoxe Platform Fracture Humeral Stem Cemented Left 8.5mm 304-21-09 22 10 $9,839.80 $8,954.22 $7,473.33 $7,473.33 $7,473.33 2026-05-06
10021365 OTHER 21365 Opn Tx Complx Malar Fx 12 6 $8,903.90 $8,102.55 $5,178.15 $5,178.15 $5,178.15 2026-05-06
15000842 OTHER Itotal Ps Ipoly Implant Kit Left Tps1111111 22 10 $8,868.50 $8,070.34 $6,735.63 $6,735.63 $6,735.63 2026-05-06
15000935 OTHER Itotal Ps Ipoly Implant Kit Right Tps1111111 22 10 $8,868.50 $8,070.34 $6,735.63 $6,735.63 $6,735.63 2026-05-06
24070012 OTHER Radiology Request 23 10 $8,632.90 $7,855.94 $4,865.25 $6,863.15 $6,863.15 2026-05-06
15000595 OTHER Tm Reverse Stem 14mm X 130mm 00-4349-014-13 22 10 $8,129.50 $7,397.85 $6,174.35 $6,174.35 $6,174.35 2026-05-06
10014301 OTHER Adjacent Tissue Transfer Or Rearrangement, Any Area; Defect 30.1 Sq Cm To 60.0 S… 12 6 $8,029.50 $7,306.85 $4,754.23 $4,754.23 $4,754.23 2026-05-06
17026350 OTHER 17026350 Repair Finger/hand Tendon Ed Charge 23 10 $8,017.90 $7,296.29 $6,089.60 $6,089.60 $6,089.60 2026-05-06
15000695 OTHER Tm Reverse Stem 12mmx130mm 00-4349-012-13 22 10 $7,970.00 $7,252.70 $6,053.22 $6,053.22 $6,053.22 2026-05-06
10030420 OTHER 30420 Reconstruction Of Nose 12 6 $7,719.50 $7,024.74 $4,933.53 $4,933.53 $4,933.53 2026-05-06
15000490 OTHER Equinoxe Humeral Stem Primary Press Fit 9mm 300-01-09 22 10 $7,655.00 $6,966.05 $5,813.97 $5,813.97 $5,813.97 2026-05-06
15000472 OTHER Equinoxe Humeral Stem Primary Press Fit 300-01-13 22 10 $7,655.00 $6,966.05 $5,813.97 $5,813.97 $5,813.97 2026-05-06
17026727 OTHER 17026727 Treat Finger Fracture, Each Ed Charge 23 10 $7,435.10 $6,765.94 $5,646.96 $5,646.96 $5,646.96 2026-05-06
10042440 OTHER 42440 Excise Submaxillary Gland 12 6 $7,432.10 $6,763.21 $3,888.35 $3,888.35 $3,888.35 2026-05-06
10042145 OTHER 42145 Repair Palate Pharynx/uvula 12 6 $7,370.40 $6,707.06 $4,102.26 $4,102.26 $4,102.26 2026-05-06
18045108 OTHER 18045108 Pf Removal Anorectal Lesion Ed Charge 23 10 $7,174.20 $6,528.52 $5,448.81 $5,448.81 $5,448.81 2026-05-06
17045108 OTHER 17045108 Removal Of Anorectal Lesion Ed Charge 23 10 $7,174.20 $6,528.52 $5,448.81 $5,448.81 $5,448.81 2026-05-06
10021390 OTHER 21390 Open Treatment Orbit Periorbital Floor Blowout Fracture 12 6 $7,014.90 $6,383.56 $4,030.73 $4,030.73 $4,030.73 2026-05-06
10030410 OTHER 30410 Reconstruction Of Nose 12 6 $6,814.20 $6,200.92 $4,480.70 $4,480.70 $4,480.70 2026-05-06
10069145 OTHER 69145 Excision Soft Tissue Lesion, External Auditory Canal 12 6 $6,777.30 $6,167.34 $3,580.32 $3,580.32 $3,580.32 2026-05-06
15000943 OTHER G7 Osseoti Multihole 54mm F 110010265 22 10 $6,549.40 $5,959.95 $4,974.27 $4,974.27 $4,974.27 2026-05-06
15000473 OTHER Equinoxe Reverse Shoulder Humeral Adapter Tray 320-10-00 22 10 $6,527.90 $5,940.39 $4,957.94 $4,957.94 $4,957.94 2026-05-06
18020650 OTHER 18020650 Pf Insert And Remove Bone Pin Ed Charge 23 10 $6,349.00 $5,777.59 $4,822.06 $4,822.06 $4,822.06 2026-05-06
17020650 OTHER 17020650 Insert And Remove Bone Pin Ed Charge 23 10 $6,349.00 $5,777.59 $4,822.06 $4,822.06 $4,822.06 2026-05-06
17031515 OTHER 17031515 Laryngoscopy For Aspiration Ed Charge 23 10 $6,158.90 $5,604.60 $4,456.73 $4,677.68 $4,677.68 2026-05-06
18031515 OTHER 18031515 Pf Laryngoscopy For Aspiration Ed Charge 23 10 $6,158.90 $5,604.60 $4,456.73 $4,677.68 $4,677.68 2026-05-06
18023931 OTHER 18023931 Remove Shoulder Fb Ed Charge 23 10 $6,156.30 $5,602.23 $4,675.70 $4,675.70 $4,675.70 2026-05-06
17023931 OTHER 17023931 Drainage Of Arm Bursa Ed Charge 23 10 $6,156.30 $5,602.23 $4,675.70 $4,675.70 $4,675.70 2026-05-06
15000266 OTHER Arhtrex Univers Apex Humeral Stem 9mm Ar-9100-09s 22 10 $6,050.00 $5,505.50 $4,594.98 $4,594.98 $4,594.98 2026-05-06
10014061 OTHER Adjacent Tissue Xfer/rearrangement,eyelids,nose,ears Or Lips Defect 10.1cm-30cm … 12 6 $6,042.20 $5,498.40 $3,732.61 $3,732.61 $3,732.61 2026-05-06
10015260 OTHER Full Thick Gft Nose/lips; 20 S 12 6 $6,036.50 $5,493.22 $3,735.72 $3,735.72 $3,735.72 2026-05-06
10041825 OTHER 41825 Excision Of Lesion Or Tumor (except Listed Above), Dentoalveolar Structure… 12 6 $5,974.60 $5,436.89 $3,033.34 $3,033.34 $3,033.34 2026-05-06
15000391 OTHER Comp Primary Stem 11mm Mini 113631 22 10 $5,912.30 $5,380.19 $4,490.40 $4,490.40 $4,490.40 2026-05-06
10014041 OTHER Adj Tissue Xfer/rearrangement,forehead,cheek,chin,mouth,hands/ft 10.1cm-30.0cm T… 12 6 $5,866.20 $5,338.24 $3,587.58 $3,587.58 $3,587.58 2026-05-06
10015240 OTHER Full Thick Gft Chin/ax/ft; 20 12 6 $5,843.80 $5,317.86 $3,583.19 $3,583.19 $3,583.19 2026-05-06
24074113 OTHER CT Abdomen +Pelvis With + Without Cont 23 10 $5,714.50 $5,200.19 $4,234.44 $4,543.02 $4,543.02 2026-05-06
10014021 OTHER Adj Tissue Xfer/rearrangement,scalp,arms Or Legs Defect 10.1cm-30.0cm Tech Chg 12 6 $5,685.50 $5,173.81 $3,449.82 $3,449.82 $3,449.82 2026-05-06
10021360 OTHER 21360 Opn Tx Dprsd Malar Fracture 12 6 $5,595.20 $5,091.63 $3,105.65 $3,105.65 $3,105.65 2026-05-06
18027301 OTHER 18027301 Drain Thigh/knee Lesion Ed Charge 23 10 $5,583.10 $5,080.62 $4,240.36 $4,240.36 $4,240.36 2026-05-06
17027301 OTHER 17027301 Drain Thigh/knee Lesion Ed Charge 23 10 $5,583.10 $5,080.62 $4,240.36 $4,240.36 $4,240.36 2026-05-06
15000464 OTHER Equinoxe Reverse Shoulder Genoid Plate 320-15-01 22 10 $5,564.40 $5,063.60 $4,226.16 $4,226.16 $4,226.16 2026-05-06
10014060 OTHER Adj Tissue Xfer/rearrangement,eyelids,nose,ears Or Lips Defect <10cm Tech Chg 12 6 $5,459.30 $4,967.96 $3,260.15 $3,260.15 $3,260.15 2026-05-06
15000949 OTHER G7 Osseoti 4 Hole Shell 56mm F 110010246 22 10 $5,421.50 $4,933.56 $4,117.63 $4,117.63 $4,117.63 2026-05-06
15000714 OTHER G7 Osseoti 4 Hole Shell 58mm G 110010247 22 10 $5,421.50 $4,933.56 $4,117.63 $4,117.63 $4,117.63 2026-05-06
15000940 OTHER G7 Osseoti 3 Hole Shell 52mm E 110010244 22 10 $5,421.50 $4,933.56 $4,117.63 $4,117.63 $4,117.63 2026-05-06
15000679 OTHER G7 Osseoti 3 Hole Shell 48mm C 110010242 22 10 $5,421.50 $4,933.56 $4,117.63 $4,117.63 $4,117.63 2026-05-06
10014040 OTHER Adjacent Tissue Transfer Or Rearrangement Forehead Cheeks Chin Mouth Ect Defe… 12 6 $5,416.90 $4,929.38 $3,230.95 $3,230.95 $3,230.95 2026-05-06
10043220 OTHER 43220 Esophagoscopy Balloon <30mm 12 6 $5,379.00 $4,894.89 $3,441.66 $3,441.66 $3,441.66 2026-05-06
10014020 OTHER Adj Tissue Xfer/rearrangement,scalp,arms Or Legs Defect <10cm Tech Chg 12 6 $5,246.30 $4,774.13 $3,098.11 $3,098.11 $3,098.11 2026-05-06
15000470 OTHER Equinoxe Reverse Shoulder Glenosphere 320-01-38 22 10 $5,216.70 $4,747.20 $3,962.08 $3,962.08 $3,962.08 2026-05-06
15000818 OTHER 3.5mm Lcp Proximal Humerus Plate Long 10h Shaft 232mm 241.923 22 10 $5,195.50 $4,727.90 $3,945.99 $3,945.99 $3,945.99 2026-05-06
17046320 OTHER 17046320 Removal Of Hemorrhoid Clot Ed Charge 23 10 $4,962.90 $4,516.24 $3,676.03 $3,769.32 $3,769.32 2026-05-06
15000928 OTHER G7 Osseoti 3 Hole Shell 50mm D 110010243 22 10 $4,928.60 $4,485.03 $3,743.27 $3,743.27 $3,743.27 2026-05-06
10031541 OTHER 31541 Larynscop W/tumr Exc Scope 12 6 $4,913.10 $4,470.92 $2,559.68 $2,559.68 $2,559.68 2026-05-06
24070010 OTHER Radiology Request 23 10 $4,899.20 $4,458.27 $3,016.04 $3,894.86 $3,894.86 2026-05-06
10041112 OTHER 41112 Excision Of Tongue Lesion 12 6 $4,891.00 $4,450.81 $2,621.24 $2,621.24 $2,621.24 2026-05-06
17042104 OTHER 17042104 Excision Lesion Mouth Roof Ed Charge 23 10 $4,810.80 $4,377.83 $3,653.80 $3,653.80 $3,653.80 2026-05-06
18042104 OTHER 18042104 ER Pf Excision Lesion Mouth Roof Ed Charge 23 10 $4,810.80 $4,377.83 $3,653.80 $3,653.80 $3,653.80 2026-05-06
62095805 OTHER Sleep Study First 22 10 $4,803.40 $4,371.09 $3,648.18 $3,648.18 $3,648.18 2026-05-06
10040812 OTHER 40812 Excise/repair Mouth Lesion . 12 6 $4,774.90 $4,345.16 $2,522.48 $2,522.48 $2,522.48 2026-05-06
10012037 OTHER Repair Intermediate Wounds Of Scalp Axillae Trunk And/or Extremities Over 3… 12 6 $4,714.60 $4,290.29 $2,662.18 $2,662.18 $2,662.18 2026-05-06
24074111 OTHER CT Abdomen +Pelvis With Cont 23 10 $4,692.40 $4,270.08 $3,477.07 $3,730.46 $3,730.46 2026-05-06
10030117 OTHER 30117 Excision Or Destruction (eg, Laser), Intranasal Lesion; Internal Approach 12 6 $4,681.30 $4,259.98 $3,082.09 $3,082.09 $3,082.09 2026-05-06
15000443 OTHER Cartiva Synthetic Cartilage Osteochondral Implant 8mm Car-08-US 22 10 $4,642.80 $4,224.95 $3,526.20 $3,526.20 $3,526.20 2026-05-06
18027257 OTHER 18027257 ER Prof Treat Hip Dislocation Ed Charge 23 10 $4,619.60 $4,203.84 $3,508.59 $3,508.59 $3,508.59 2026-05-06
17027257 OTHER 17027257 Treatment Of Hip Dislocation Ed Charge 23 10 $4,619.60 $4,203.84 $3,508.59 $3,508.59 $3,508.59 2026-05-06
17027552 OTHER 17027552 Treat Knee Dislocation Ed Charge 23 10 $4,582.70 $4,170.26 $3,480.56 $3,480.56 $3,480.56 2026-05-06
18027552 OTHER 18027552 ER Prof Treat Knee Dislocation Ed Charge 23 10 $4,582.70 $4,170.26 $3,480.56 $3,480.56 $3,480.56 2026-05-06
10069610 OTHER 69610 Repair Of Eardrum 12 6 $4,524.90 $4,117.66 $2,481.11 $2,481.11 $2,481.11 2026-05-06
10011446 OTHER Remove Other Benign Lesion w/Margins , Face/Ears/Eyelids/Nose/Lips; Diam 4.0+ Cm… 12 6 $4,515.20 $4,108.83 $2,484.34 $2,484.34 $2,484.34 2026-05-06
62511044 OTHER 11044 Wc Debridement, Bone; First 20 Sq Cm Or Less 12 6 $4,507.20 $4,101.55 $2,411.43 $2,411.43 $2,411.43 2026-05-06
10030520 OTHER 30520 Repair Of Nasal Septum 12 6 $4,437.60 $4,038.22 $2,692.86 $2,692.86 $2,692.86 2026-05-06
10015002 OTHER 15002 Surgical Prep/creation Of Recipient Site By Excision Of Open Wounds, First… 12 6 $4,393.60 $3,998.18 $2,393.88 $2,393.88 $2,393.88 2026-05-06
10021335 OTHER 21335 Open Treatment Of Nasal Fracture 12 6 $4,385.80 $3,991.08 $2,708.99 $2,708.99 $2,708.99 2026-05-06
10027337 OTHER 27337 - Exc Thigh/Knee Greater Than 3 Cm 12 6 $4,359.10 $3,966.78 $2,430.18 $2,430.18 $2,430.18 2026-05-06
10031536 OTHER 31536 Laryngoscopy W/bx 12 6 $4,328.20 $3,938.66 $2,236.20 $2,236.20 $2,236.20 2026-05-06
15000461 OTHER Augment Injectable K30003010 22 10 $4,327.70 $3,938.21 $3,286.89 $3,286.89 $3,286.89 2026-05-06
17013160 OTHER 13160 Secondary Closure Surg Wound/dehsn Extsv/complic 23 10 $4,256.50 $3,873.41 $3,232.82 $3,429.30 $3,232.82 2026-05-06
10011426 OTHER Remove Lesion, Scalp/Neck/Hand/Foot >4.0 Cm Charge 12 6 $4,130.30 $3,758.57 $2,254.89 $2,254.89 $2,254.89 2026-05-06
24074174 OTHER CT Angio Abdomen +Pelvis With Cont 23 10 $4,065.60 $3,699.70 $3,012.61 $3,232.15 $3,232.15 2026-05-06
24070013 OTHER CT Chest Thin Section Ild Request 23 10 $3,941.50 $3,586.76 $2,446.41 $3,133.49 $3,133.49 2026-05-06
17026765 OTHER 26765 Open Tx Distal Phalangeal Fracture, Each 23 10 $3,927.40 $3,573.93 $2,982.86 $5,003.07 $2,982.86 2026-05-06
10021325 OTHER 21325 Open Tx Nose Fx Uncomplicatd 12 6 $3,844.00 $3,498.04 $2,214.38 $2,214.38 $2,214.38 2026-05-06
18020103 OTHER 18020103 Pf Explore Wound Extremity Ed Charge 23 10 $3,834.70 $3,489.58 $2,258.44 $2,912.45 $2,912.45 2026-05-06
17020103 OTHER 17020103 Explore Wound Extremity Ed Charge 23 10 $3,834.70 $3,489.58 $2,258.44 $2,912.45 $2,912.45 2026-05-06
15000717 OTHER Artelon Tissue Reinforcement 31054 22 10 $3,818.40 $3,474.74 $2,900.07 $2,900.07 $2,900.07 2026-05-06
17028575 OTHER Treat Foot Dislocation 23 10 $3,786.70 $3,445.90 $1,973.17 $2,875.99 $2,875.99 2026-05-06
17027502 OTHER 17027502 Closed Treatment Of Femoral Shaft Fracture With Manipulation Ed Charge 23 10 $3,779.20 $3,439.07 $1,969.61 $2,870.30 $2,870.30 2026-05-06
10001787 OTHER Rabies Immune Globulin, Heat-treated (rig-ht) 8 3 $3,741.40 $3,404.67 $3,180.19 $3,180.19 $3,180.19 2026-05-06
24074112 OTHER CT Abdomen +Pelvis Without Cont 23 10 $3,740.80 $3,404.13 $2,771.93 $2,973.93 $2,973.93 2026-05-06
15048007 OTHER Triathlon Cr Fem Component - Cemented 5510-f-402 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048002 OTHER Triathlon Cr Fem Component - Cemented 5510-f-201 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048000 OTHER Triathlon Cr Fem Component - Cemented 5510-f-101 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048012 OTHER Triathlon Cr Fem Component - Cemented 5510-f-701 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048004 OTHER Triathlon Cr Fem Component - Cemented 5510-f-301 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048009 OTHER Triathlon Cr Fem Component - Cemented 5510-f-502 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048003 OTHER Triathlon Cr Fem Component - Cemented 5510-f-202 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048010 OTHER Triathlon Cr Fem Component - Cemented 5510-f-601 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048001 OTHER Triathlon Cr Fem Component - Cemented 5510-f-102 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048011 OTHER Triathlon Cr Fem Component - Cemented 5510-f-602 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048005 OTHER Triathlon Cr Fem Component - Cemented 5510-f-302 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048014 OTHER Triathlon Cr Fem Component - Cemented 5510-f-801 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048013 OTHER Triathlon Cr Fem Component - Cemented 5510-f-702 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048015 OTHER Triathlon Cr Fem Component - Cemented 5510-f-802 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048008 OTHER Triathlon Cr Fem Component - Cemented 5510-f-501 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15048006 OTHER Triathlon Cr Fem Component - Cemented 5510-f-401 22 10 $3,736.20 $3,399.94 $2,837.64 $2,837.64 $2,837.64 2026-05-06
15000947 OTHER M/l Taper 13.5 Ext 00-7711-013-20 22 10 $3,695.20 $3,362.63 $2,806.51 $2,806.51 $2,806.51 2026-05-06
15000568 OTHER M/l Taper 12.5 Ext Reduced Neck Length 00-7711-012-40 22 10 $3,695.20 $3,362.63 $2,806.51 $2,806.51 $2,806.51 2026-05-06
15000958 OTHER M/l Taper 10 Ext 00-7711-010-20 22 10 $3,695.20 $3,362.63 $2,806.51 $2,806.51 $2,806.51 2026-05-06
15000961 OTHER M/l Taper 16.25 Ext 00-7711-016-20 22 10 $3,695.20 $3,362.63 $2,806.51 $2,806.51 $2,806.51 2026-05-06
15000957 OTHER M/l Taper 9 Std Reduced Neck Length 00-7711-009-10 22 10 $3,695.20 $3,362.63 $2,806.51 $2,806.51 $2,806.51 2026-05-06
15000950 OTHER M/l Taper 10 Ext Reduced Neck Length 00-7711-010-40 22 10 $3,695.20 $3,362.63 $2,806.51 $2,806.51 $2,806.51 2026-05-06
15000676 OTHER M/l Taper 7.5 Ext 00-7711-007-20 22 10 $3,695.20 $3,362.63 $2,806.51 $2,806.51 $2,806.51 2026-05-06
15000422 OTHER Istent Inject Trabecular Micro Bypass System G2-m-is 22 10 $3,669.20 $3,338.97 $2,786.76 $2,786.76 $2,786.76 2026-05-06
15000934 OTHER Graftlink Allograft Fgl 22 10 $3,624.30 $3,298.11 $2,752.66 $2,752.66 $2,752.66 2026-05-06
10019083 OTHER 19083 Bx Breast. 1st. Lesion US Imag 12 6 $3,606.20 $3,281.64 $2,211.72 $2,211.72 $2,211.72 2026-05-06
62095811 OTHER Sleep Study W/cpap 22 10 $3,595.20 $3,271.63 $2,730.55 $2,730.55 $2,730.55 2026-05-06
15000979 OTHER Cer Bioloxd Option Hd 36mm 650-1057 22 10 $3,581.90 $3,259.53 $2,720.45 $2,720.45 $2,720.45 2026-05-06
15000632 OTHER Tm Rvs Base Plt 15mm Pos 00-4349-015-00 22 10 $3,577.00 $3,255.07 $2,716.73 $2,716.73 $2,716.73 2026-05-06
15000932 OTHER M/l Taper 9 Std 00-7711-009-00 22 10 $3,547.40 $3,228.13 $2,694.25 $2,694.25 $2,694.25 2026-05-06
34072159 OTHER MRA Spinal Canal +Contents 23 10 $3,544.90 $3,225.86 $2,626.78 $2,818.20 $2,818.20 2026-05-06
34072158 OTHER MRI Spine Lumbar With + Without Cont 23 10 $3,544.90 $3,225.86 $2,803.16 $2,818.20 $2,818.20 2026-05-06
34072156 OTHER MRI Spine Cervical With + Without Cont 23 10 $3,539.90 $3,221.31 $2,723.54 $2,814.22 $2,814.22 2026-05-06
34072157 OTHER MRI Spine Thoracic With + Without Cont 23 10 $3,519.90 $3,203.11 $2,650.97 $2,798.32 $2,798.32 2026-05-06
15000716 OTHER Actishield Amniotic Barrier Membrane Am20-4x04 22 10 $3,518.50 $3,201.84 $2,672.30 $2,672.30 $2,672.30 2026-05-06
24076666 OTHER CT Angio Chest Pe With Cont 23 10 $3,498.80 $3,183.91 $2,555.01 $2,781.55 $2,781.55 2026-05-06
24070496 OTHER CT Angio Head 23 10 $3,498.80 $3,183.91 $2,549.59 $2,781.55 $2,781.55 2026-05-06
24075635 OTHER CT Angio Abdomen Aorta +Iliofemoral 23 10 $3,498.80 $3,183.91 $2,525.93 $2,781.55 $2,781.55 2026-05-06
24070498 OTHER CT Angio Neck 23 10 $3,498.80 $3,183.91 $2,441.00 $2,781.55 $2,781.55 2026-05-06
24071275 OTHER CT Angio Chest 23 10 $3,498.80 $3,183.91 $2,555.01 $2,781.55 $2,781.55 2026-05-06
34070553 OTHER MRI Brain With + Without Cont 23 10 $3,479.30 $3,166.16 $2,711.29 $2,766.05 $2,766.05 2026-05-06
34071555 OTHER MRA Chest With Cont 23 10 $3,466.70 $3,154.70 $2,568.82 $2,756.03 $2,756.03 2026-05-06
34077555 OTHER MRA Chest Without Cont 23 10 $3,466.70 $3,154.70 $2,568.82 $2,756.03 $2,756.03 2026-05-06
34071552 OTHER MRI Chest With + Without Cont 23 10 $3,466.70 $3,154.70 $2,568.82 $2,756.03 $2,756.03 2026-05-06
15000092 OTHER Cer Bioloxd Option Hd 32mm 650-1056 22 10 $3,455.80 $3,144.78 $2,624.68 $2,624.68 $2,624.68 2026-05-06
15000722 OTHER Plate Fibula Lateral 5888403r 22 10 $3,412.90 $3,105.74 $2,592.10 $2,592.10 $2,592.10 2026-05-06
34074185 OTHER MRA Abdomen With Cont 23 10 $3,336.80 $3,036.49 $2,347.45 $2,652.76 $2,652.76 2026-05-06
34074183 OTHER MRI Abdomen With + Without Cont 23 10 $3,336.80 $3,036.49 $2,562.17 $2,652.76 $2,652.76 2026-05-06
24074185 OTHER MRA Abdomen Without Cont 23 10 $3,336.80 $3,036.49 $2,347.45 $2,652.76 $2,652.76 2026-05-06
17027842 OTHER 17027842 Closed Treatment Of Ankle Dislocaiton, Requiriing Anesthesia Ed Charge 23 10 $3,313.90 $3,015.65 $2,516.91 $2,516.91 $2,516.91 2026-05-06
34076005 OTHER MRI Soft Tissue Neck With + Without Cont 23 10 $3,312.00 $3,013.92 $2,583.10 $2,633.04 $2,633.04 2026-05-06
34076004 OTHER MRI Face Neck Orbit With + Without Cont 23 10 $3,312.00 $3,013.92 $2,583.10 $2,633.04 $2,633.04 2026-05-06
34072197 OTHER MRI Pelvis With + Without Cont 23 10 $3,296.40 $2,999.72 $2,399.67 $2,620.64 $2,620.64 2026-05-06
34072198 OTHER MRA Pelvis With Cont 23 10 $3,296.40 $2,999.72 $2,442.63 $2,620.64 $2,620.64 2026-05-06
34077198 OTHER MRA Pelvis Without Cont 23 10 $3,296.40 $2,999.72 $2,442.63 $2,620.64 $2,620.64 2026-05-06
15000841 OTHER Subtalar Mba Implant 10mm 22 10 $3,279.70 $2,984.53 $2,490.93 $2,490.93 $2,490.93 2026-05-06
34076051 OTHER MRA Finger With + Without Cont Lt 23 10 $3,270.30 $2,975.97 $2,423.29 $2,599.89 $2,599.89 2026-05-06
34077049 OTHER MRA Shoulder Without Cont Lt 23 10 $3,270.30 $2,975.97 $2,423.29 $2,599.89 $2,599.89 2026-05-06
34076050 OTHER MRA Finger With + Without Cont Rt 23 10 $3,270.30 $2,975.97 $2,423.29 $2,599.89 $2,599.89 2026-05-06
34076044 OTHER MRI Elbow With + Without Cont Rt 23 10 $3,270.30 $2,975.97 $2,437.62 $2,599.89 $2,599.89 2026-05-06
34076052 OTHER MRA Elbow With Cont Rt 23 10 $3,270.30 $2,975.97 $2,423.29 $2,599.89 $2,599.89 2026-05-06
34077055 OTHER MRA Wrist Without Cont Lt 23 10 $3,270.30 $2,975.97 $2,423.29 $2,599.89 $2,599.89 2026-05-06
34076042 OTHER MRI Fingers With + Without Cont Rt 23 10 $3,270.30 $2,975.97 $2,437.62 $2,599.89 $2,599.89 2026-05-06
34077052 OTHER MRA Elbow Without Cont Rt 23 10 $3,270.30 $2,975.97 $2,423.29 $2,599.89 $2,599.89 2026-05-06
34076045 OTHER MRI Elbow With + Without Cont Lt 23 10 $3,270.30 $2,975.97 $2,437.62 $2,599.89 $2,599.89 2026-05-06
34076049 OTHER MRA Shoulder With Cont Lt 23 10 $3,270.30 $2,975.97 $2,423.29 $2,599.89 $2,599.89 2026-05-06
34076041 OTHER MRI Shoulder With + Without Cont Lt 23 10 $3,270.30 $2,975.97 $2,437.62 $2,599.89 $2,599.89 2026-05-06
34076043 OTHER MRI Fingers With + Without Cont Lt 23 10 $3,270.30 $2,975.97 $2,437.62 $2,599.89 $2,599.89 2026-05-06
34076040 OTHER MRI Shoulder With + Without Cont Rt 23 10 $3,270.30 $2,975.97 $2,437.62 $2,599.89 $2,599.89 2026-05-06
34076054 OTHER MRA Wrist With Cont Rt 23 10 $3,270.30 $2,975.97 $2,423.29 $2,599.89 $2,599.89 2026-05-06
34077056 OTHER MRA Wrist Without Cont Rt 23 10 $3,270.30 $2,975.97 $2,423.29 $2,599.89 $2,599.89 2026-05-06
34076053 OTHER MRA Elbow With Cont Lt 23 10 $3,270.30 $2,975.97 $2,423.29 $2,599.89 $2,599.89 2026-05-06
34076055 OTHER MRA Wrist With Cont Lt 23 10 $3,270.30 $2,975.97 $2,423.29 $2,599.89 $2,599.89 2026-05-06
34076047 OTHER MRI Wrist With + Without Cont Lt 23 10 $3,270.30 $2,975.97 $2,437.62 $2,599.89 $2,599.89 2026-05-06
34076048 OTHER MRA Shoulder With Cont Rt 23 10 $3,270.30 $2,975.97 $2,423.29 $2,599.89 $2,599.89 2026-05-06
34076046 OTHER MRI Wrist With + Without Cont Rt 23 10 $3,270.30 $2,975.97 $2,437.62 $2,599.89 $2,599.89 2026-05-06
34077048 OTHER MRA Shoulder Without Cont Rt 23 10 $3,270.30 $2,975.97 $2,423.29 $2,599.89 $2,599.89 2026-05-06
34077053 OTHER MRA Elbow Without Cont Lt 23 10 $3,270.30 $2,975.97 $2,423.29 $2,599.89 $2,599.89 2026-05-06
15000645 OTHER Straight Staple Assembly 8mmx8mm P71-008-0808-s 22 10 $3,269.10 $2,974.88 $2,482.88 $2,482.88 $2,482.88 2026-05-06
15000746 OTHER Psn Fem Cr Cmt Ccr Std Sz11 R 42-5026-070-02 22 10 $3,244.30 $2,952.31 $2,464.05 $2,464.05 $2,464.05 2026-05-06
15000245 OTHER Psn Fem Cr Cmt Ccr Nrw Sz9 L 42-5020-066-01 22 10 $3,244.30 $2,952.31 $2,464.05 $2,464.05 $2,464.05 2026-05-06
15000710 OTHER Psn Fem Cr Cmt Ccr Nrw Sz 10 R 42-5020-068-02 22 10 $3,244.30 $2,952.31 $2,464.05 $2,464.05 $2,464.05 2026-05-06
15000224 OTHER Psn Fem Cr Cmt Ccr Std Sz6 L 42-5026-060-01 22 10 $3,244.30 $2,952.31 $2,464.05 $2,464.05 $2,464.05 2026-05-06
15000237 OTHER Psn Fem Cr Cmt Ccr Nrw Sz 10 L 42-5020-068-01 22 10 $3,244.30 $2,952.31 $2,464.05 $2,464.05 $2,464.05 2026-05-06
15000242 OTHER Psn Fem Cr Cmt Ccr Std Sz 12 L 42-5026-074-01 22 10 $3,244.30 $2,952.31 $2,464.05 $2,464.05 $2,464.05 2026-05-06
17024620 OTHER 17024620 Treat Elbow Fracture Ed Charge 23 10 $3,242.00 $2,950.22 $1,714.44 $2,462.30 $2,462.30 2026-05-06
18024620 OTHER 18024620 Pf Treat Elbow Fracture Ed Charge 23 10 $3,242.00 $2,950.22 $1,714.44 $2,462.30 $2,462.30 2026-05-06
34076096 OTHER MRI Hip With + Without Cont Rt 23 10 $3,236.50 $2,945.22 $2,573.02 $2,573.02 $2,573.02 2026-05-06
34076095 OTHER MRI Ankle With + Without Cont Lt 23 10 $3,236.50 $2,945.22 $2,573.02 $2,573.02 $2,573.02 2026-05-06
34076090 OTHER MRI Toes With + Without Cont Rt 23 10 $3,236.50 $2,945.22 $2,573.02 $2,573.02 $2,573.02 2026-05-06
34076094 OTHER MRI Ankle With + Without Cont Rt 23 10 $3,236.50 $2,945.22 $2,573.02 $2,573.02 $2,573.02 2026-05-06
34076092 OTHER MRI Knee With + Without Cont Rt 23 10 $3,236.50 $2,945.22 $2,573.02 $2,573.02 $2,573.02 2026-05-06
34076091 OTHER MRI Fingers Without Cont Lt 23 10 $3,236.50 $2,945.22 $2,573.02 $2,573.02 $2,573.02 2026-05-06
34076093 OTHER MRI Knee With + Without Cont Lt 23 10 $3,236.50 $2,945.22 $2,573.02 $2,573.02 $2,573.02 2026-05-06
34076097 OTHER MRI Hip With + Without Cont Lt 23 10 $3,236.50 $2,945.22 $2,573.02 $2,573.02 $2,573.02 2026-05-06
15000226 OTHER Echo Por Fmrl Nc 10x130mm 192010 22 10 $3,235.90 $2,944.67 $2,457.67 $2,457.67 $2,457.67 2026-05-06
15000248 OTHER Echo Por Fmrl Nc 8x120mm 192008 22 10 $3,235.90 $2,944.67 $2,457.67 $2,457.67 $2,457.67 2026-05-06
15000992 OTHER Echo Por Fmrl Nc 12x140mm 192012 22 10 $3,235.90 $2,944.67 $2,457.67 $2,457.67 $2,457.67 2026-05-06
15000951 OTHER G7 Neu +5mm E1 Liner 36mm F 110017220 22 10 $3,160.30 $2,875.87 $2,400.24 $2,400.24 $2,400.24 2026-05-06
15001005 OTHER Psn Fem Cr Cmt Ccr Std Sz 12 R 42-5026-074-02 22 10 $3,149.80 $2,866.32 $2,392.28 $2,392.28 $2,392.28 2026-05-06
15000082 OTHER Psn Fem Cr Cmt Ccr Std Sz 10 L 42-5026-068-01 22 10 $3,149.80 $2,866.32 $2,392.28 $2,392.28 $2,392.28 2026-05-06
15000015 OTHER Psn Fem Cr Cmt Ccr Nrw Sz9 R 42-5020-066-02 22 10 $3,149.80 $2,866.32 $2,392.28 $2,392.28 $2,392.28 2026-05-06
15000980 OTHER Psn Fem Cr Cmt Ccr Std Sz6 R 42-5026-060-02 22 10 $3,149.80 $2,866.32 $2,392.28 $2,392.28 $2,392.28 2026-05-06
15001009 OTHER Psn Fem Cr Cmt Ccr Std Sz10 R 42-5026-068-02 22 10 $3,149.80 $2,866.32 $2,392.28 $2,392.28 $2,392.28 2026-05-06
15000044 OTHER Echo Por Fmrl Lat Fpp Nc 10x130mm 192110 22 10 $3,141.60 $2,858.86 $2,386.05 $2,386.05 $2,386.05 2026-05-06
15001010 OTHER Echo Por Fmrl Fpp Nc 9x125mm 192009 22 10 $3,141.60 $2,858.86 $2,386.05 $2,386.05 $2,386.05 2026-05-06
15000091 OTHER Echo Por Fmrl Fpp Nc 11x135mm 192011 22 10 $3,141.60 $2,858.86 $2,386.05 $2,386.05 $2,386.05 2026-05-06
17036556 OTHER Collection Of Blood Specimen From An Implantable Venous Access Devicecharge 23 10 $3,140.60 $2,857.95 $2,385.28 $2,385.28 $2,385.28 2026-05-06
34076073 OTHER MRI Tibia/Fibula With + Without Cont Lt 23 10 $3,137.10 $2,854.76 $2,344.43 $2,493.99 $2,493.99 2026-05-06
34076071 OTHER MRI Femur With + Without Cont Lt 23 10 $3,137.10 $2,854.76 $2,344.43 $2,493.99 $2,493.99 2026-05-06
34076068 OTHER MRI Foot With + Without Cont Rt 23 10 $3,137.10 $2,854.76 $2,344.43 $2,493.99 $2,493.99 2026-05-06
34076069 OTHER MRI Foot With + Without Cont Lt 23 10 $3,137.10 $2,854.76 $2,344.43 $2,493.99 $2,493.99 2026-05-06
34076070 OTHER MRI Femur With + Without Cont Rt 23 10 $3,137.10 $2,854.76 $2,344.43 $2,493.99 $2,493.99 2026-05-06
34073720 OTHER MRI Tibia/Fibula With + Without Cont Rt 23 10 $3,137.10 $2,854.76 $2,344.43 $2,493.99 $2,493.99 2026-05-06
34076030 OTHER MRI Forearm With + Without Cont Rt 23 10 $3,134.60 $2,852.49 $2,399.38 $2,492.01 $2,492.01 2026-05-06
34076027 OTHER MRI Humerus With + Without Cont Lt 23 10 $3,134.60 $2,852.49 $2,399.38 $2,492.01 $2,492.01 2026-05-06
34076031 OTHER MRI Forearm With + Without Cont Lt 23 10 $3,134.60 $2,852.49 $2,399.38 $2,492.01 $2,492.01 2026-05-06
34076029 OTHER MRI Hand With + Without Cont Lt 23 10 $3,134.60 $2,852.49 $2,399.38 $2,492.01 $2,492.01 2026-05-06
34076028 OTHER MRI Hand With + Without Cont Rt 23 10 $3,134.60 $2,852.49 $2,399.38 $2,492.01 $2,492.01 2026-05-06
34076026 OTHER MRI Humerus With + Without Cont Rt 23 10 $3,134.60 $2,852.49 $2,399.38 $2,492.01 $2,492.01 2026-05-06
34070549 OTHER MRA Neck With + Without Cont 23 10 $3,117.20 $2,836.65 $2,478.18 $2,478.18 $2,478.18 2026-05-06
15000678 OTHER G7 10 Deg E1 Liner 32mm C 010000886 22 10 $3,103.90 $2,824.55 $2,357.41 $2,357.41 $2,357.41 2026-05-06
15000946 OTHER G7 Neutral E1 Liner 36mm F 010000858 22 10 $3,103.90 $2,824.55 $2,357.41 $2,357.41 $2,357.41 2026-05-06
15000713 OTHER G7 10 Deg E1 Liner 36mm G 010000898 22 10 $3,103.90 $2,824.55 $2,357.41 $2,357.41 $2,357.41 2026-05-06
15000939 OTHER G7 Neutral E1 Liner 36mm E 010000857 22 10 $3,103.90 $2,824.55 $2,357.41 $2,357.41 $2,357.41 2026-05-06
15000960 OTHER G7 Neutral E1 Liner 36mm G 010000859 22 10 $3,103.90 $2,824.55 $2,357.41 $2,357.41 $2,357.41 2026-05-06
34070546 OTHER MRA Head With + Without Cont 23 10 $3,070.00 $2,793.70 $2,274.87 $2,440.65 $2,440.65 2026-05-06
15000489 OTHER Equinoxe Reverse 38mm Humeral Liner +2.5 320-38-03 22 10 $3,038.80 $2,765.31 $2,307.97 $2,307.97 $2,307.97 2026-05-06
15000474 OTHER Equinoxe Reverse Shoulder 38mm Humeral Liner 320-38-00 22 10 $3,038.80 $2,765.31 $2,307.97 $2,307.97 $2,307.97 2026-05-06
15000927 OTHER G7 Neutral E1 Liner 32mm D 010000848 22 10 $2,956.20 $2,690.14 $2,245.24 $2,245.24 $2,245.24 2026-05-06
15000592 OTHER Implant Hemi Medium 03-6000-17 22 10 $2,935.40 $2,671.21 $2,229.43 $2,229.43 $2,229.43 2026-05-06
15000569 OTHER 36mm Vit E Liner +3mm 00-4350-036-03 22 10 $2,926.60 $2,663.21 $2,222.76 $2,222.76 $2,222.76 2026-05-06
22093306 OTHER US Echo 2d Comp With Color Flow Doppler 22 10 $2,926.60 $2,663.21 $2,222.76 $2,222.76 $2,222.76 2026-05-06
62095810 OTHER Sleep Study / 4+ Request 22 10 $2,921.80 $2,658.84 $2,219.11 $2,219.11 $2,219.11 2026-05-06
24071270 OTHER CT Chest With + Without Cont 23 10 $2,918.60 $2,655.93 $2,150.96 $2,320.28 $2,320.28 2026-05-06
15048078 OTHER X3 Triathlon Cs Ins Size8 22mm 5531-g-822 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048033 OTHER X3 Triathlon Cs Ins Size2 13mm 5531-g-213 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048044 OTHER X3 Triathlon Cs Ins Size3 25mm 5531-g-325 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048079 OTHER X3 Triathlon Cs Ins Size8 25mm 5531-g-825 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048024 OTHER X3 Triathlon Cs Ins Size1 9mm 5531-g-109 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048061 OTHER X3 Triathlon Cs Ins Size6 13mm 5531-g-613 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048054 OTHER X3 Triathlon Cs Ins Size5 13mm 5531-g-513 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048034 OTHER X3 Triathlon Cs Ins Size2 16mm 5531-g-216 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048055 OTHER X3 Triathlon Cs Ins Size5 16mm 5531-g-516 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048046 OTHER X3 Triathlon Cs Ins Size4 11mm 5531-g-411 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048025 OTHER X3 Triathlon Cs Ins Size1 11mm 5531-g-111 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048037 OTHER X3 Triathlon Cs Ins Size2 25mm 5531-g-225 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048039 OTHER X3 Triathlon Cs Ins Size3 11mm 5531-g-311 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048074 OTHER X3 Triathlon Cs Ins Size8 11mm 5531-g-811 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048056 OTHER X3 Triathlon Cs Ins Size5 19mm 5531-g-519 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048057 OTHER X3 Triathlon Cs Ins Size5 22mm 5531-g-522 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048060 OTHER X3 Triathlon Cs Ins Size6 11mm 5531-g-611 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048068 OTHER X3 Triathlon Cs Ins Size7 13mm 5531-g-713 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048077 OTHER X3 Triathlon Cs Ins Size8 19mm 5531-g-819 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048063 OTHER X3 Triathlon Cs Ins Size6 19mm 5531-g-619 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048028 OTHER X3 Triathlon Cs Ins Size1 19mm 5531-g-119 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048053 OTHER X3 Triathlon Cs Ins Size5 11mm 5531-g-511 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048064 OTHER X3 Triathlon Cs Ins Size6 22mm 5531-g-622 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048076 OTHER X3 Triathlon Cs Ins Size8 5531-g-816 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048035 OTHER X3 Triathlon Cs Ins Size2 19mm 5531-g-219 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048040 OTHER X3 Triathlon Cs Ins Size3 13mm 5531-g-313 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048066 OTHER X3 Triathlon Cs Ins Size7 9mm 5531-g-709 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048031 OTHER X3 Triathlon Cs Ins Size2 9mm 5531-g-209 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048073 OTHER X3 Triathlon Cs Ins Size8 9mm 5531-g-809 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048036 OTHER X3 Triathlon Cs Ins Size2 22mm 5531-g-222 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048070 OTHER X3 Triathlon Cs Ins Size7 19mm 5531-g-719 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048069 OTHER X3 Triathlon Cs Ins Size7 16mm 5531-g-716 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048062 OTHER X3 Triathlon Cs Ins Size6 16mm 5531-g-616 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048043 OTHER X3 Triathlon Cs Ins Size3 22mm 5531-g-322 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048065 OTHER X3 Triathlon Cs Ins Size6 25mm 5531-g-625 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048029 OTHER X3 Triathlon Cs Ins Size1 22mm 5531-g-122 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048059 OTHER X3 Triathlon Cs Ins Size6 9mm 5531-g-609 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048038 OTHER X3 Triathlon Cs Ins Size3 9mm 5531-g-309 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048049 OTHER X3 Triathlon Cs Ins Size4 19mm 5531-g-419 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048052 OTHER X3 Triathlon Cs Ins Size5 9mm 5531-g-509 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048047 OTHER X3 Triathlon Cs Ins Size4 13mm 5531-g-413 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048071 OTHER X3 Triathlon Cs Ins Size7 22mm 5531-g-722 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048050 OTHER X3 Triathlon Cs Ins Size4 22mm 5531-g-422 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048026 OTHER X3 Triathlon Cs Ins Size1 13mm 5531-g-113 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048030 OTHER X3 Triathlon Cs Ins Size1 25mm 5531-g-125 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048051 OTHER X3 Triathlon Cs Ins Size4 25mm 5531-g-425 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048067 OTHER X3 Triathlon Cs Ins Size7 11mm 5531-g-711 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048027 OTHER X3 Triathlon Cs Ins Size1 16mm 5531-g-116 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048072 OTHER X3 Triathlon Cs Ins Size7 25mm 5531-g-725 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048032 OTHER X3 Triathlon Cs Ins Size2 11mm 5531-g-211 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048045 OTHER X3 Triathlon Cs Ins Size4 9mm 5531-g-409 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048041 OTHER X3 Triathlon Cs Ins Size3 16mm 5531-g-316 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048042 OTHER X3 Triathlon Cs Ins Size3 19mm 5531-g-319 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048058 OTHER X3 Triathlon Cs Ins Size5 25mm 5531-g-525 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048075 OTHER X3 Triathlon Cs Ins Size8 13mm 5531-g-813 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
15048048 OTHER X3 Triathlon Cs Ins Size4 16mm 5531-g-416 22 10 $2,917.20 $2,654.65 $2,215.61 $2,215.61 $2,215.61 2026-05-06
24070492 OTHER CT Soft Tissue Neck With + Without Cont 23 10 $2,896.40 $2,635.72 $2,234.77 $2,302.64 $2,302.64 2026-05-06
24074170 OTHER CT Abdomen With + Without Cont 23 10 $2,896.40 $2,635.72 $2,154.91 $2,302.64 $2,302.64 2026-05-06
15000696 OTHER 36mm Vit E Liner +0mm 00-4350-036-00 22 10 $2,869.30 $2,611.06 $2,179.24 $2,179.24 $2,179.24 2026-05-06
24072194 OTHER CT Pelvis With + Without Cont 23 10 $2,818.60 $2,564.93 $2,039.46 $2,240.78 $2,240.78 2026-05-06
34070548 OTHER MRA Neck With Cont 23 10 $2,812.20 $2,559.10 $2,083.84 $2,235.70 $2,235.70 2026-05-06
1000897 OTHER J0897 Prolia (Denosumab) 60 Mg/ml Subcutaneous 8 3 $2,772.20 $2,522.70 $2,356.37 $2,356.37 $2,356.37 2026-05-06
34072149 OTHER MRI Spine Lumbar With Cont 23 10 $2,768.70 $2,519.52 $2,051.61 $2,201.11 $2,201.11 2026-05-06
34076003 OTHER MRI Soft Tissue Neck With Cont 23 10 $2,767.10 $2,518.06 $2,050.26 $2,199.84 $2,199.84 2026-05-06
34070542 OTHER MRI Face Neck Orbit With Cont 23 10 $2,767.10 $2,518.06 $2,050.26 $2,199.84 $2,199.84 2026-05-06
34076063 OTHER MRI Foot With Cont Lt 23 10 $2,750.40 $2,502.86 $1,907.04 $2,186.57 $2,186.57 2026-05-06
34076064 OTHER MRI Femur With Cont Rt 23 10 $2,750.40 $2,502.86 $1,907.04 $2,186.57 $2,186.57 2026-05-06
34076062 OTHER MRI Foot With Cont Rt 23 10 $2,750.40 $2,502.86 $1,907.04 $2,186.57 $2,186.57 2026-05-06
34076067 OTHER MRI Tibia/Fibula With Cont Lt 23 10 $2,750.40 $2,502.86 $1,907.04 $2,186.57 $2,186.57 2026-05-06
34076065 OTHER MRI Femur With Cont Lt 23 10 $2,750.40 $2,502.86 $1,907.04 $2,186.57 $2,186.57 2026-05-06
24070482 OTHER CT Orbit Sella Etc. Or Iac With + Without Cont 23 10 $2,740.10 $2,493.49 $2,019.04 $2,178.38 $2,178.38 2026-05-06
24070470 OTHER CT Head Or Brain With + Without Cont 23 10 $2,740.10 $2,493.49 $1,943.54 $2,178.38 $2,178.38 2026-05-06
34070552 OTHER MRI Brain With Cont 23 10 $2,734.10 $2,488.03 $2,112.80 $2,173.61 $2,173.61 2026-05-06
40044442 OTHER Room/bed: Acute Ii 17 8 $2,519.60 $2,292.84 $2,211.68 $2,211.68 $2,211.68 2026-05-06
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