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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

HAMILTON MEMORIAL HOSPITAL

Mcleansboro, IL · CCN 141326 · Rates published

2,160 distinct procedures filed
79 distinct payers
622,080 rate rows
2024-12-20 last MRF observed · ⚠ 18 mo old
Data quality

622,080 of 622,080 rate rows are consumer-grade (100.0%)

Every filed rate row passes our consumer-grade checks — none are excluded from the medians.

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 18 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/100285/376019589-1447257258_hamilton-memorial-hospital-district_standardcharges.csv
Found on page https://search.hospitalpriceindex.com/hpi2/machineReadable/HamiltonMemorialHospital/100285
Discovered viaCMS hospital list
Last fetch success · 2026-06-22

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
J1290
HCPCS 		Ecallantide 10 Mg/ml Sc Soln 79 $33,919.85 $33,919.85 $33,919.85 nat. median
$896
outlier · 37.8×
C1734
HCPCS 		Kit Bngf 3Cc Aug Inj 79 $11,810.63 $11,810.63 $11,810.63 nat. median
$2,408
outlier · 4.9×
J3101
HCPCS 		Tenecteplase 50 Mg IV Kit 79 $11,190.59 $11,190.59 $11,190.59 nat. median
$5,949
1.9× median
Q4130
HCPCS 		Tiss Strattice Recon Perf 10 X 16 Firm 79 $10,569.75 $10,569.75 $10,569.75 nat. median
$405
outlier · 26.1×
SUP-462363
CDM 		Ndl Biopsy Kt Asp Bn Mrw 79 $7,675.50 $7,675.50 $7,675.50 nat. median
$7,676
1.0× median
81162
CPT 		Brca 1/2 Gene Full Seq Dup/Del 79 $7,092.40 $7,092.40 $7,092.40 nat. median
$1,825
outlier · 3.9×
PX-SUP108683
CDM 		Staple Nitinoli Fuseforce 8x8mm 79 $4,924.90 $4,924.90 $4,924.90 nat. median
$4,925
1.0× median
49329
CPT 		Unlisted Lap Abd Perit Omentum 79 $4,137.98 $4,137.98 $4,137.98 nat. median
$6,428
0.6× median
SUP-D1030000
CDM 		Pack Dart-fire Edge Inst 3.0mm Headed Aff 79 $4,072.35 $4,072.35 $4,072.35 nat. median
$4,072
1.0× median
78452
CPT 		Nm Myocard Perfusion Spect Stress And Rest 79 $4,067.12 $4,067.12 $4,067.12 nat. median
$1,765
outlier · 2.3×
PX-811386
CDM 		Or Surgery Level 4 79 $3,792.70 $3,792.70 $3,792.70 nat. median
$3,793
1.0× median
95811
CPT 		Polysomn W/Cpap >=6yrs 79 $3,767.24 $3,767.24 $3,767.24 nat. median
$2,026
1.9× median
Q4175
HCPCS 		Wound Matrix Biologic MiroDerm 3cm X 7cm Aff 79 $3,598.56 $3,598.56 $3,598.56 nat. median
$129
outlier · 27.8×
PX-811385
CDM 		Or Surgery Level 3 79 $3,591.25 $3,591.25 $3,591.25 nat. median
$3,591
1.0× median
20822
CPT 		Replantation Digit Distal Complt 79 $3,579.82 $3,579.82 $3,579.82 nat. median
$2,377
1.5× median
J1451
HCPCS 		Fomepizole 1 Gm/ml IV Soln 79 $3,545.26 $3,545.26 $3,545.26 nat. median
$1,050
outlier · 3.4×
95810
CPT 		Polysomn 4 Or More >=6yrs 79 $3,516.45 $3,516.45 $3,516.45 nat. median
$1,870
1.9× median
74178
CPT 		CT Abdomen Pelvis Wwo Contrast 79 $3,458.44 $3,458.44 $3,458.44 nat. median
$977
outlier · 3.5×
49020
CPT 		Drain Peritoneal Abscess Open 79 $3,449.71 $3,449.71 $3,449.71 nat. median
$2,803
1.2× median
PX-811384
CDM 		Or Surgery Level 2 79 $3,444.20 $3,444.20 $3,444.20 nat. median
$3,444
1.0× median
C1889
HCPCS 		Mesh Micro 6 X 8 Pc 79 $3,427.20 $3,427.20 $3,427.20 nat. median
$2,393
1.4× median
27329
CPT 		Resect Tumor Thigh Knee < 5 Cm 79 $3,365.60 $3,365.60 $3,365.60 nat. median
$3,253
1.0× median
27364
CPT 		Resect Tumor Thigh Knee > 5cm 79 $3,365.60 $3,365.60 $3,365.60 nat. median
$3,366
1.0× median
70546
CPT 		MRA Angio Head With And Without Contrast 79 $3,358.47 $3,358.47 $3,358.47 nat. median
$1,043
outlier · 3.2×
Q4100
HCPCS 		Wound Matrix Miro3D 2cm X 2cm X 2cm Aff 79 $3,302.25 $3,302.25 $3,302.25 nat. median
$1,878
1.8× median
74177
CPT 		CT Abdomen Pelvis W Contrast 79 $3,112.15 $3,112.15 $3,112.15 nat. median
$928
outlier · 3.4×
72197
CPT 		MRI Pelvis With And Without Contrast 79 $3,022.64 $3,022.64 $3,022.64 nat. median
$1,064
outlier · 2.8×
27059
CPT 		Resect Tumr Radical Soft Tiss Pelv >=5cm 79 $2,894.70 $2,894.70 $2,894.70 nat. median
$3,321
0.9× median
27049
CPT 		Resect Tumor Rad Soft Tiss Pelvic < 5 Cm 79 $2,894.70 $2,894.70 $2,894.70 nat. median
$3,125
0.9× median
15100
CPT 		Split Autograft Trunk Ext 100 Sqcm 79 $2,760.12 $2,760.12 $2,760.12 nat. median
$2,324
1.2× median
49520
CPT 		Rpr Hernia Ing Recur Reducible 79 $2,753.28 $2,753.28 $2,753.28 nat. median
$3,817
0.7× median
27616
CPT 		Resect Tumor Lower Extremity > 5cm 79 $2,726.63 $2,726.63 $2,726.63 nat. median
$3,319
0.8× median
49525
CPT 		Repair Hernia Inguinal Sliding Any Age 79 $2,725.01 $2,725.01 $2,725.01 nat. median
$3,761
0.7× median
C1713
HCPCS 		Dart Fire In Pk Edge Headed 3.0mm 79 $2,714.90 $2,714.90 $2,714.90 nat. median
$836
outlier · 3.2×
59409
CPT 		Delivery Vaginal 79 $2,637.82 $2,637.82 $2,637.82 nat. median
$3,185
0.8× median
72157
CPT 		MRI Spine Thoracic With And Wo Contrast 79 $2,568.45 $2,568.45 $2,568.45 nat. median
$1,093
outlier · 2.4×
71552
CPT 		MRI Chest With And Without Contrast 79 $2,554.25 $2,554.25 $2,554.25 nat. median
$1,093
outlier · 2.3×
C1781
HCPCS 		Mesh Srg Ventralight St Sepra Echo 6x4In 79 $2,535.72 $2,535.72 $2,535.72 nat. median
$1,362
1.9× median
81229
CPT 		Cytogen Micrarray Copy Nmbr+Snp 79 $2,465.00 $2,465.00 $2,465.00 nat. median
$1,330
1.9× median
74176
CPT 		CT Abdomen Pelvis Wo Contrast 79 $2,440.99 $2,440.99 $2,440.99 nat. median
$685
outlier · 3.6×
23077
CPT 		Resect Shoulder Tum < 5 Cm 79 $2,440.26 $2,440.26 $2,440.26 nat. median
$3,122
0.8× median
23078
CPT 		Resect Shoulder Tum >= 5 Cm 79 $2,440.26 $2,440.26 $2,440.26 nat. median
$3,321
0.7× median
SUP-366899
CDM 		Slr/Divr Lapscp 18Cm 13.5Mm Ligasure 79 $2,406.05 $2,406.05 $2,406.05 nat. median
$2,406
1.0× median
70543
CPT 		MRI Orbit Face Neck With And Wo Contrast 79 $2,404.68 $2,404.68 $2,404.68 nat. median
$1,077
outlier · 2.2×
72156
CPT 		MRI Spine Cervical With And Wo Contrast 79 $2,404.66 $2,404.66 $2,404.66 nat. median
$1,092
outlier · 2.2×
C8900
HCPCS 		MRA Abd W/Contrast 79 $2,392.80 $2,392.80 $2,392.80 nat. median
$870
outlier · 2.7×
C8901
HCPCS 		MRI MRA Abd Without Contrst 79 $2,392.80 $2,392.80 $2,392.80 nat. median
$703
outlier · 3.4×
C8902
HCPCS 		MRI MRA Abd Without Fol W/Contrast 79 $2,392.80 $2,392.80 $2,392.80 nat. median
$986
outlier · 2.4×
49650
CPT 		Lap Rpr Hernia Ing Init 79 $2,352.12 $2,352.12 $2,352.12 nat. median
$5,743
outlier · 0.4×
72127
CPT 		CT Cervical Spine With And Wo Contrast 79 $2,293.30 $2,293.30 $2,293.30 nat. median
$595
outlier · 3.9×

Other procedures at this hospital

Browse this hospital's 2,160 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
             
J1290 HCPCS Ecallantide 10 Mg/ml Sc Soln 288 79 $39,905.70 $39,905.70 $33,919.85 $33,919.85 $33,919.85 2024-12-20
C1734 HCPCS Kit Bngf 3Cc Aug Inj 288 79 $13,894.86 $13,894.86 $11,810.63 $11,810.63 $11,810.63 2024-12-20
J3101 HCPCS Tenecteplase 50 Mg IV Kit 288 79 $13,165.40 $13,165.40 $11,190.59 $11,190.59 $11,190.59 2024-12-20
Q4130 HCPCS Tiss Strattice Recon Perf 10 X 16 Firm 288 79 $12,435.00 $12,435.00 $10,569.75 $10,569.75 $10,569.75 2024-12-20
SUP-462363 CDM Ndl Biopsy Kt Asp Bn Mrw 288 79 $9,030.00 $9,030.00 $7,675.50 $7,675.50 $7,675.50 2024-12-20
81162 CPT Brca 1/2 Gene Full Seq Dup/Del 288 79 $8,344.00 $8,344.00 $7,092.40 $7,092.40 $7,092.40 2024-12-20
PX-SUP108683 CDM Staple Nitinoli Fuseforce 8x8mm 288 79 $5,794.00 $5,794.00 $4,924.90 $4,924.90 $4,924.90 2024-12-20
49329 CPT Unlisted Lap Abd Perit Omentum 288 79 $4,868.22 $4,868.22 $4,137.98 $4,137.98 $4,137.98 2024-12-20
SUP-D1030000 CDM Pack Dart-fire Edge Inst 3.0mm Headed Aff 288 79 $4,791.00 $4,791.00 $4,072.35 $4,072.35 $4,072.35 2024-12-20
78452 CPT Nm Myocard Perfusion Spect Stress And Rest 288 79 $4,784.85 $4,784.85 $4,067.12 $4,067.12 $4,067.12 2024-12-20
PX-811386 CDM Or Surgery Level 4 288 79 $4,462.00 $4,462.00 $3,792.70 $3,792.70 $3,792.70 2024-12-20
95811 CPT Polysomn W/Cpap >=6yrs 288 79 $4,432.05 $4,432.05 $3,767.24 $3,767.24 $3,767.24 2024-12-20
Q4175 HCPCS Wound Matrix Biologic MiroDerm 3cm X 7cm Aff 288 79 $4,233.60 $4,233.60 $3,598.56 $3,598.56 $3,598.56 2024-12-20
PX-811385 CDM Or Surgery Level 3 288 79 $4,225.00 $4,225.00 $3,591.25 $3,591.25 $3,591.25 2024-12-20
20822 CPT Replantation Digit Distal Complt 288 79 $4,211.55 $4,211.55 $3,579.82 $3,579.82 $3,579.82 2024-12-20
J1451 HCPCS Fomepizole 1 Gm/ml IV Soln 288 79 $4,170.90 $4,170.90 $3,545.26 $3,545.26 $3,545.26 2024-12-20
95810 CPT Polysomn 4 Or More >=6yrs 288 79 $4,137.00 $4,137.00 $3,516.45 $3,516.45 $3,516.45 2024-12-20
74178 CPT CT Abdomen Pelvis Wwo Contrast 288 79 $4,068.75 $4,068.75 $3,458.44 $3,458.44 $3,458.44 2024-12-20
49020 CPT Drain Peritoneal Abscess Open 288 79 $4,058.48 $4,058.48 $3,449.71 $3,449.71 $3,449.71 2024-12-20
PX-811384 CDM Or Surgery Level 2 288 79 $4,052.00 $4,052.00 $3,444.20 $3,444.20 $3,444.20 2024-12-20
C1889 HCPCS Mesh Micro 6 X 8 Pc 288 79 $4,032.00 $4,032.00 $3,427.20 $3,427.20 $3,427.20 2024-12-20
27364 CPT Resect Tumor Thigh Knee > 5cm 288 79 $3,959.53 $3,959.53 $3,365.60 $3,365.60 $3,365.60 2024-12-20
27329 CPT Resect Tumor Thigh Knee < 5 Cm 288 79 $3,959.53 $3,959.53 $3,365.60 $3,365.60 $3,365.60 2024-12-20
70546 CPT MRA Angio Head With And Without Contrast 288 79 $3,951.15 $3,951.15 $3,358.47 $3,358.47 $3,358.47 2024-12-20
Q4100 HCPCS Wound Matrix Miro3D 2cm X 2cm X 2cm Aff 288 79 $3,885.00 $3,885.00 $3,302.25 $3,302.25 $3,302.25 2024-12-20
74177 CPT CT Abdomen Pelvis W Contrast 288 79 $3,661.35 $3,661.35 $3,112.15 $3,112.15 $3,112.15 2024-12-20
72197 CPT MRI Pelvis With And Without Contrast 288 79 $3,556.04 $3,556.04 $3,022.64 $3,022.64 $3,022.64 2024-12-20
27059 CPT Resect Tumr Radical Soft Tiss Pelv >=5cm 288 79 $3,405.53 $3,405.53 $2,894.70 $2,894.70 $2,894.70 2024-12-20
27049 CPT Resect Tumor Rad Soft Tiss Pelvic < 5 Cm 288 79 $3,405.53 $3,405.53 $2,894.70 $2,894.70 $2,894.70 2024-12-20
15100 CPT Split Autograft Trunk Ext 100 Sqcm 288 79 $3,247.20 $3,247.20 $2,760.12 $2,760.12 $2,760.12 2024-12-20
49520 CPT Rpr Hernia Ing Recur Reducible 288 79 $3,239.15 $3,239.15 $2,753.28 $2,753.28 $2,753.28 2024-12-20
27616 CPT Resect Tumor Lower Extremity > 5cm 288 79 $3,207.80 $3,207.80 $2,726.63 $2,726.63 $2,726.63 2024-12-20
49525 CPT Repair Hernia Inguinal Sliding Any Age 288 79 $3,205.90 $3,205.90 $2,725.01 $2,725.01 $2,725.01 2024-12-20
C1713 HCPCS Dart Fire In Pk Edge Headed 3.0mm 288 79 $3,194.00 $3,194.00 $2,714.90 $2,714.90 $2,714.90 2024-12-20
59409 CPT Delivery Vaginal 288 79 $3,103.32 $3,103.32 $2,637.82 $2,637.82 $2,637.82 2024-12-20
72157 CPT MRI Spine Thoracic With And Wo Contrast 288 79 $3,021.70 $3,021.70 $2,568.45 $2,568.45 $2,568.45 2024-12-20
71552 CPT MRI Chest With And Without Contrast 288 79 $3,005.00 $3,005.00 $2,554.25 $2,554.25 $2,554.25 2024-12-20
C1781 HCPCS Mesh Srg Ventralight St Sepra Echo 6x4In 288 79 $2,983.20 $2,983.20 $2,535.72 $2,535.72 $2,535.72 2024-12-20
81229 CPT Cytogen Micrarray Copy Nmbr+Snp 288 79 $2,900.00 $2,900.00 $2,465.00 $2,465.00 $2,465.00 2024-12-20
74176 CPT CT Abdomen Pelvis Wo Contrast 288 79 $2,871.75 $2,871.75 $2,440.99 $2,440.99 $2,440.99 2024-12-20
23077 CPT Resect Shoulder Tum < 5 Cm 288 79 $2,870.90 $2,870.90 $2,440.26 $2,440.26 $2,440.26 2024-12-20
23078 CPT Resect Shoulder Tum >= 5 Cm 288 79 $2,870.90 $2,870.90 $2,440.26 $2,440.26 $2,440.26 2024-12-20
SUP-366899 CDM Slr/Divr Lapscp 18Cm 13.5Mm Ligasure 288 79 $2,830.65 $2,830.65 $2,406.05 $2,406.05 $2,406.05 2024-12-20
70543 CPT MRI Orbit Face Neck With And Wo Contrast 288 79 $2,829.03 $2,829.03 $2,404.68 $2,404.68 $2,404.68 2024-12-20
72156 CPT MRI Spine Cervical With And Wo Contrast 288 79 $2,829.02 $2,829.02 $2,404.66 $2,404.66 $2,404.66 2024-12-20
C8902 HCPCS MRI MRA Abd Without Fol W/Contrast 288 79 $2,815.05 $2,815.05 $2,392.80 $2,392.80 $2,392.80 2024-12-20
C8900 HCPCS MRA Abd W/Contrast 288 79 $2,815.05 $2,815.05 $2,392.80 $2,392.80 $2,392.80 2024-12-20
C8901 HCPCS MRI MRA Abd Without Contrst 288 79 $2,815.05 $2,815.05 $2,392.80 $2,392.80 $2,392.80 2024-12-20
49650 CPT Lap Rpr Hernia Ing Init 288 79 $2,767.20 $2,767.20 $2,352.12 $2,352.12 $2,352.12 2024-12-20
72127 CPT CT Cervical Spine With And Wo Contrast 288 79 $2,698.00 $2,698.00 $2,293.30 $2,293.30 $2,293.30 2024-12-20
72130 CPT CT Thoracic Spine With And Wo Contrast 288 79 $2,698.00 $2,698.00 $2,293.30 $2,293.30 $2,293.30 2024-12-20
47600 CPT Removal Gallbladder 288 79 $2,694.25 $2,694.25 $2,290.11 $2,290.11 $2,290.11 2024-12-20
72133 CPT CT Lumbar Spine With And Without Contrast 288 79 $2,670.15 $2,670.15 $2,269.63 $2,269.63 $2,269.63 2024-12-20
74170 CPT CT Abdomen With And Without IV Contrast 288 79 $2,670.15 $2,670.15 $2,269.63 $2,269.63 $2,269.63 2024-12-20
22905 CPT Resect Abd Tum > 5 Cm 288 79 $2,668.20 $2,668.20 $2,267.97 $2,267.97 $2,267.97 2024-12-20
22904 CPT Resect Abd Tum < 5 Cm 288 79 $2,668.20 $2,668.20 $2,267.97 $2,267.97 $2,267.97 2024-12-20
73223 CPT MRI Upper Ext Any Jnt W And Wo Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
70336 CPT MRI Temporomandibular Joints 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
73718 CPT MRI Lower Ext Non Joint Non Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
C8914 HCPCS MRA Lwr Ext Without Fol W/Contras 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
C8912 HCPCS MRA Lwr Ext W/Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
70547 CPT MRA Angio Neck Non Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
73720 CPT MRI Lower Ext Non Jnt W And Wo Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
72141 CPT MRI C Spine Limited 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
72148 CPT MRI Spine Lumbar Non Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
71550 CPT MRI Chest Limited 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
74181 CPT MRI Abdomen Non Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
70540 CPT MRI Orbit Face Neck Non Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
74183 CPT MRI Abdomen With And Without Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
70544 CPT MRA Angio Head Non Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
73218 CPT MRI Upper Ext Non Joint Non Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
72149 CPT MRI Spine Lumbar With Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
72146 CPT MRI Spine Thoracic Non Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
70551 CPT MRI Brain Limited 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
73722 CPT MRI Lower Ext Any Joint With Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
74182 CPT MRI Abdomen With Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
73721 CPT MRI Lower Ext Any Joint Non Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
73221 CPT MRI Upper Ext Any Joint Non Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
73220 CPT MRI Upper Ext Non Jnt W And Wo Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
72195 CPT MRI Pelvis Non Contrast Limited 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
72196 CPT MRI Pelvis With Contrast 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
C8913 HCPCS MRA Lwr Ext Without Contrst 288 79 $2,638.65 $2,638.65 $2,242.86 $2,242.86 $2,242.86 2024-12-20
24079 CPT Resect Upper Arm Tumor < 5cm 288 79 $2,616.30 $2,616.30 $2,223.86 $2,223.86 $2,223.86 2024-12-20
24077 CPT Resect Arm/Elbow Tum < 5 Cm 288 79 $2,616.30 $2,616.30 $2,223.86 $2,223.86 $2,223.86 2024-12-20
21935 CPT Resect Back Tumor < 5cm 288 79 $2,587.15 $2,587.15 $2,199.08 $2,199.08 $2,199.08 2024-12-20
21936 CPT Resect Tumor Radical Back Flank >= 5cm 288 79 $2,587.15 $2,587.15 $2,199.08 $2,199.08 $2,199.08 2024-12-20
J0885 HCPCS Epoetin Alfa 40000 Unit/ml Ij Soln 288 79 $2,580.60 $2,580.60 $2,193.51 $2,193.51 $2,193.51 2024-12-20
49592 CPT Rpr Hernia Ant Abd Init <3cm Incr Strng 288 79 $2,451.70 $2,451.70 $2,083.95 $2,083.95 $2,083.95 2024-12-20
49507 CPT Rpr Hernia Ing Init Incarc >= 5yrs 288 79 $2,443.00 $2,443.00 $2,076.55 $2,076.55 $2,076.55 2024-12-20
49553 CPT Repair Femoral Hernia Strang 288 79 $2,441.93 $2,441.93 $2,075.64 $2,075.64 $2,075.64 2024-12-20
SUP-374361 CDM Slr/Divr Lapscp 44Cm Ligasure 350d 18.5 288 79 $2,439.96 $2,439.96 $2,073.97 $2,073.97 $2,073.97 2024-12-20
SUP-344466 CDM Sys Fx 37Cm Cpsr Str Ss Peek Perm Hndl 288 79 $2,430.00 $2,430.00 $2,065.50 $2,065.50 $2,065.50 2024-12-20
74160 CPT CT Abdomen With IV Contrast 288 79 $2,416.05 $2,416.05 $2,053.64 $2,053.64 $2,053.64 2024-12-20
72194 CPT CT Pelvis With And Without IV Contrast 288 79 $2,416.05 $2,416.05 $2,053.64 $2,053.64 $2,053.64 2024-12-20
21558 CPT Resect Soft Tissues Of Neck Chest 5cm> 288 79 $2,414.05 $2,414.05 $2,051.95 $2,051.95 $2,051.95 2024-12-20
21557 CPT Resect Neck Thorax Tumor < 5cm 288 79 $2,414.05 $2,414.05 $2,051.95 $2,051.95 $2,051.95 2024-12-20
70470 CPT CT Head With And Without Contrast 288 79 $2,406.60 $2,406.60 $2,045.61 $2,045.61 $2,045.61 2024-12-20
70488 CPT CT Maxillofacial W & Wo Contrast 288 79 $2,406.60 $2,406.60 $2,045.61 $2,045.61 $2,045.61 2024-12-20
71270 CPT CT Chest With And Without Contrast 288 79 $2,406.60 $2,406.60 $2,045.61 $2,045.61 $2,045.61 2024-12-20
75635 CPT CT Angio Abd Aorta Bil Low Ext W/wo 288 79 $2,370.90 $2,370.90 $2,015.27 $2,015.27 $2,015.27 2024-12-20
73206 CPT CT Angio Upper Extrem W And Wo Contrast 288 79 $2,370.00 $2,370.00 $2,014.50 $2,014.50 $2,014.50 2024-12-20
72126 CPT CT Cervical Spine With Contrast 288 79 $2,323.00 $2,323.00 $1,974.55 $1,974.55 $1,974.55 2024-12-20
SUP-379273 CDM Dsct 21Cm Ligasure Exact 40d 2Mm 19.8Mm 288 79 $2,322.84 $2,322.84 $1,974.41 $1,974.41 $1,974.41 2024-12-20
SUP-249738 CDM Stplr 25Mmx4.8Mm Dst Eea Lnr Ctr Sqz 288 79 $2,314.77 $2,314.77 $1,967.56 $1,967.56 $1,967.56 2024-12-20
94003 CPT Vent Mgmt IP/Obsv Subseq Days 288 79 $2,300.00 $2,300.00 $1,955.00 $1,955.00 $1,955.00 2024-12-20
27842 CPT Tx Ankle Disl W Ans 288 79 $2,280.60 $2,280.60 $1,938.51 $1,938.51 $1,938.51 2024-12-20
27552 CPT Tx Knee Disl W Ans 288 79 $2,280.60 $2,280.60 $1,938.51 $1,938.51 $1,938.51 2024-12-20
SUP-368841 CDM Bit Drl 2.7Mm Fixos Cann 288 79 $2,259.00 $2,259.00 $1,920.15 $1,920.15 $1,920.15 2024-12-20
72132 CPT CT Lumbar Spine With Contrast 288 79 $2,244.90 $2,244.90 $1,908.16 $1,908.16 $1,908.16 2024-12-20
25077 CPT Resect Forearm/Wrist Tum < 3 Cm 288 79 $2,236.38 $2,236.38 $1,900.92 $1,900.92 $1,900.92 2024-12-20
25078 CPT Resect Tumor Radical Frarm Wrist >=3cm 288 79 $2,236.38 $2,236.38 $1,900.92 $1,900.92 $1,900.92 2024-12-20
49651 CPT Rpr Recur Hernia Inguinal Laprascopic 288 79 $2,169.95 $2,169.95 $1,844.45 $1,844.45 $1,844.45 2024-12-20
28750 CPT Arthrodesis Great Toe Mtp Joint 288 79 $2,165.88 $2,165.88 $1,841.00 $1,841.00 $1,841.00 2024-12-20
72193 CPT CT Pelvis With IV Contrast 288 79 $2,161.95 $2,161.95 $1,837.66 $1,837.66 $1,837.66 2024-12-20
70492 CPT CT Soft Tissue Neck With And Wo Contrast 288 79 $2,150.40 $2,150.40 $1,827.84 $1,827.84 $1,827.84 2024-12-20
70460 CPT CT Head With Contrast 288 79 $2,150.40 $2,150.40 $1,827.84 $1,827.84 $1,827.84 2024-12-20
71260 CPT CT Chest With Contrast 288 79 $2,150.40 $2,150.40 $1,827.84 $1,827.84 $1,827.84 2024-12-20
38760 CPT Lymphadenectomy Inguinofem Supericial 288 79 $2,128.63 $2,128.63 $1,809.34 $1,809.34 $1,809.34 2024-12-20
78451 CPT Nm Myocard Perfusion Spect 288 79 $2,111.55 $2,111.55 $1,794.82 $1,794.82 $1,794.82 2024-12-20
81490 CPT Autoimmune Rheumatoid Arthritis 288 79 $2,101.63 $2,101.63 $1,786.38 $1,786.38 $1,786.38 2024-12-20
70553 CPT MRI Brain With And Without Contrast 288 79 $2,074.90 $2,074.90 $1,763.66 $1,763.66 $1,763.66 2024-12-20
72158 CPT MRI Spine Lumbar With And Without Contrast 288 79 $2,074.35 $2,074.35 $1,763.20 $1,763.20 $1,763.20 2024-12-20
19301 CPT Partial Mastectomy 288 79 $2,050.00 $2,050.00 $1,742.50 $1,742.50 $1,742.50 2024-12-20
SUP-382920 CDM Cntrsnk Drl 3.8Mm Ao Cplng Cann 3Mm Asns 288 79 $2,025.00 $2,025.00 $1,721.25 $1,721.25 $1,721.25 2024-12-20
70482 CPT CT Orbit Post Fossa Ear With & Without Contrast 288 79 $1,976.10 $1,976.10 $1,679.68 $1,679.68 $1,679.68 2024-12-20
72131 CPT CT Lumbar Spine Non Contrast 288 79 $1,976.10 $1,976.10 $1,679.68 $1,679.68 $1,679.68 2024-12-20
70481 CPT CT Orbit Post Fossa Ear With Contrast 288 79 $1,976.10 $1,976.10 $1,679.68 $1,679.68 $1,679.68 2024-12-20
36573 CPT Insert Picc Wo Sq Pt >=5yrs W Img 288 79 $1,970.85 $1,970.85 $1,675.22 $1,675.22 $1,675.22 2024-12-20
73723 CPT MRI Lower Ext Any Jnt W And Wo Contrast 288 79 $1,964.25 $1,964.25 $1,669.61 $1,669.61 $1,669.61 2024-12-20
49000 CPT Exploratory Laparotomy Celiotomy 288 79 $1,958.03 $1,958.03 $1,664.33 $1,664.33 $1,664.33 2024-12-20
SUP-364587 CDM Troc 5Mm Cnn Blnt Tip Ovl Dsct Balln 288 79 $1,951.08 $1,951.08 $1,658.42 $1,658.42 $1,658.42 2024-12-20
74150 CPT CT Abdomen Non IV Contrast 288 79 $1,922.55 $1,922.55 $1,634.17 $1,634.17 $1,634.17 2024-12-20
72128 CPT CT Thoracic Spine Non Contrast 288 79 $1,915.20 $1,915.20 $1,627.92 $1,627.92 $1,627.92 2024-12-20
73719 CPT MRI Lower Ext Non Joint With Contrast 288 79 $1,900.00 $1,900.00 $1,615.00 $1,615.00 $1,615.00 2024-12-20
73222 CPT MRI Upper Ext Any Joint With Contrast 288 79 $1,900.00 $1,900.00 $1,615.00 $1,615.00 $1,615.00 2024-12-20
72142 CPT MRI C Spine Limited Post Contrast 288 79 $1,900.00 $1,900.00 $1,615.00 $1,615.00 $1,615.00 2024-12-20
72147 CPT MRI T Spine Limited Post Contrast 288 79 $1,900.00 $1,900.00 $1,615.00 $1,615.00 $1,615.00 2024-12-20
70498 CPT CT Angio Neck 288 79 $1,898.45 $1,898.45 $1,613.68 $1,613.68 $1,613.68 2024-12-20
73201 CPT CT Upper Extremity With Contrast 288 79 $1,896.30 $1,896.30 $1,611.86 $1,611.86 $1,611.86 2024-12-20
70491 CPT CT Soft Tissue Neck With Contrast 288 79 $1,896.30 $1,896.30 $1,611.86 $1,611.86 $1,611.86 2024-12-20
49594 CPT Rpr Hernia Ant Abd Init 3-10cm Incr Strn 288 79 $1,893.08 $1,893.08 $1,609.12 $1,609.12 $1,609.12 2024-12-20
21933 CPT Excise Tumor Back Flank Subfasc >=5cm 288 79 $1,883.68 $1,883.68 $1,601.13 $1,601.13 $1,601.13 2024-12-20
27045 CPT Exc Tum Hip Pelv Deep 5 Cm Or Greater 288 79 $1,867.25 $1,867.25 $1,587.16 $1,587.16 $1,587.16 2024-12-20
26118 CPT Rad Resect Hand Tumor > 3cm 288 79 $1,862.08 $1,862.08 $1,582.77 $1,582.77 $1,582.77 2024-12-20
26117 CPT Rad Resect Tumr Tiss Hand/Finger < 3 Cm 288 79 $1,862.08 $1,862.08 $1,582.77 $1,582.77 $1,582.77 2024-12-20
45171 CPT Exc Rectaltumor Transanal Approach 288 79 $1,854.00 $1,854.00 $1,575.90 $1,575.90 $1,575.90 2024-12-20
70480 CPT CT Orbit Post Fossa Ear Non Contrast 288 79 $1,852.20 $1,852.20 $1,574.37 $1,574.37 $1,574.37 2024-12-20
72125 CPT CT Cervical Spine Non Contrast 288 79 $1,852.20 $1,852.20 $1,574.37 $1,574.37 $1,574.37 2024-12-20
49521 CPT Repair Recurr Inguin Hern Strang 288 79 $1,844.63 $1,844.63 $1,567.93 $1,567.93 $1,567.93 2024-12-20
32556 CPT Ed Drain Pleura W Cath Wo Imaging 288 79 $1,842.05 $1,842.05 $1,565.74 $1,565.74 $1,565.74 2024-12-20
28820 CPT Amputation Toe Metatarsophal Jnt 288 79 $1,815.50 $1,815.50 $1,543.17 $1,543.17 $1,543.17 2024-12-20
24605 CPT Tx Fx Elbow Disl Clsd W Ans 288 79 $1,799.67 $1,799.67 $1,529.72 $1,529.72 $1,529.72 2024-12-20
28047 CPT Resect Tumor Foot Toe >=3 Cm 288 79 $1,769.98 $1,769.98 $1,504.48 $1,504.48 $1,504.48 2024-12-20
28046 CPT Resect Tumor Radical Foot < 3 Cm 288 79 $1,769.98 $1,769.98 $1,504.48 $1,504.48 $1,504.48 2024-12-20
65235 CPT Remv Fb Anterior Chamber Lens 288 79 $1,765.90 $1,765.90 $1,501.02 $1,501.02 $1,501.02 2024-12-20
85597 CPT Platelet Neutralization 288 79 $1,760.00 $1,760.00 $1,496.00 $1,496.00 $1,496.00 2024-12-20
SUP-469235 CDM Bit Drl 1.6Mm 2.4Mm Screw 288 79 $1,756.00 $1,756.00 $1,492.60 $1,492.60 $1,492.60 2024-12-20
PX-8104575 CDM Rb Swing Bed Isolation 288 79 $1,754.25 $1,754.25 $1,491.11 $1,491.11 $1,491.11 2024-12-20
PX-812669 CDM Med/Surg Unit Isolation 288 79 $1,754.25 $1,754.25 $1,491.11 $1,491.11 $1,491.11 2024-12-20
21016 CPT Rad Resct Tumor Sft Tiss Face Or Scalp >2cm 288 79 $1,743.98 $1,743.98 $1,482.38 $1,482.38 $1,482.38 2024-12-20
21015 CPT Exc Tumor Face Or Scalp < 2 Cm 288 79 $1,743.98 $1,743.98 $1,482.38 $1,482.38 $1,482.38 2024-12-20
SUP-RELTACK4XDPTSW CDM Reload Stplr Reliatack Artc Hrn Repr 288 79 $1,738.50 $1,738.50 $1,477.72 $1,477.72 $1,477.72 2024-12-20
27634 CPT Exicsion Tumr Leg Ankle Subfasc >= 5 Cm 288 79 $1,705.40 $1,705.40 $1,449.59 $1,449.59 $1,449.59 2024-12-20
27615 CPT Resect Leg/Ankle Tum < 5 Cm 288 79 $1,705.40 $1,705.40 $1,449.59 $1,449.59 $1,449.59 2024-12-20
SUP-337841 CDM Bit Drl 2.5Mm 32Mm Fixos Cann Ao Drv 288 79 $1,704.00 $1,704.00 $1,448.40 $1,448.40 $1,448.40 2024-12-20
77012 CPT CT Guided Needle Placement 288 79 $1,688.40 $1,688.40 $1,435.14 $1,435.14 $1,435.14 2024-12-20
21932 CPT Exc Back Tum Deep < 5 Cm 288 79 $1,680.75 $1,680.75 $1,428.64 $1,428.64 $1,428.64 2024-12-20
72192 CPT CT Pelvis Wo Contrast 288 79 $1,666.35 $1,666.35 $1,416.39 $1,416.39 $1,416.39 2024-12-20
L8610 HCPCS Impl Orbt Rnd Mdpr Pe 18Mm Crnmxf Orbt 288 79 $1,661.52 $1,661.52 $1,412.29 $1,412.29 $1,412.29 2024-12-20
70450 CPT CT Head Non Contrast 288 79 $1,660.05 $1,660.05 $1,411.05 $1,411.05 $1,411.05 2024-12-20
70486 CPT CT Sinus Facial Bones Non Contrast 288 79 $1,660.05 $1,660.05 $1,411.05 $1,411.05 $1,411.05 2024-12-20
71250 CPT CT Chest Non Contrast 288 79 $1,660.05 $1,660.05 $1,411.05 $1,411.05 $1,411.05 2024-12-20
20103 CPT Explore Wound Extremity 288 79 $1,653.75 $1,653.75 $1,405.69 $1,405.69 $1,405.69 2024-12-20
25565 CPT Tx Fx Radial Ulnar Shft Clsd With Manip 288 79 $1,628.55 $1,628.55 $1,384.27 $1,384.27 $1,384.27 2024-12-20
SUP-267528 CDM Rod Orth 2Mm Easyclip Ft/Ankl Pstn 288 79 $1,600.00 $1,600.00 $1,360.00 $1,360.00 $1,360.00 2024-12-20
21554 CPT Excise Tumor Neck Ant Thor Subfasc >=5cm 288 79 $1,599.15 $1,599.15 $1,359.28 $1,359.28 $1,359.28 2024-12-20
78071 CPT Parathyroid Planar W Spect 288 79 $1,599.15 $1,599.15 $1,359.28 $1,359.28 $1,359.28 2024-12-20
27337 CPT Excision Tumor Thigh Knee Subq >=3cm 288 79 $1,597.28 $1,597.28 $1,357.69 $1,357.69 $1,357.69 2024-12-20
C1769 HCPCS Gw Orth 150Mm 1.4Mm Unthread 288 79 $1,596.00 $1,596.00 $1,356.60 $1,356.60 $1,356.60 2024-12-20
74174 CPT CT Angio Abdomen Pelvis W Wo Con 288 79 $1,594.49 $1,594.49 $1,355.32 $1,355.32 $1,355.32 2024-12-20
74175 CPT CT Angio Abdomen W/wo Contrast 288 79 $1,590.00 $1,590.00 $1,351.50 $1,351.50 $1,351.50 2024-12-20
27339 CPT Excision Tumor Thigh Knee Subfasc >=5cm 288 79 $1,576.70 $1,576.70 $1,340.19 $1,340.19 $1,340.19 2024-12-20
27328 CPT Excision Tumor Thigh Knee Subfasc <5cm 288 79 $1,576.70 $1,576.70 $1,340.19 $1,340.19 $1,340.19 2024-12-20
14040 CPT Adj Tiss Tran Face Hnd<=10sqcm 288 79 $1,564.18 $1,564.18 $1,329.56 $1,329.56 $1,329.56 2024-12-20
P9034 HCPCS Lchg Platelet Pheresis 288 79 $1,561.35 $1,561.35 $1,327.14 $1,327.14 $1,327.14 2024-12-20
PX-811383 CDM Or Surgery Level 1 288 79 $1,560.00 $1,560.00 $1,326.00 $1,326.00 $1,326.00 2024-12-20
27048 CPT Excise Tumor Pelvis Hip Subfascial <5cm 288 79 $1,549.38 $1,549.38 $1,316.97 $1,316.97 $1,316.97 2024-12-20
27788 CPT Tx Fx Fibula Distal Clsd With Manip 288 79 $1,546.12 $1,546.12 $1,314.20 $1,314.20 $1,314.20 2024-12-20
23655 CPT Tx Disloc Shldr Clsd W Manip W Anes 288 79 $1,539.83 $1,539.83 $1,308.86 $1,308.86 $1,308.86 2024-12-20
20102 CPT Explore Wound Penedtrating Abd Back 288 79 $1,537.98 $1,537.98 $1,307.29 $1,307.29 $1,307.29 2024-12-20
70487 CPT CT Maxillofacial W Contrast 288 79 $1,523.55 $1,523.55 $1,295.02 $1,295.02 $1,295.02 2024-12-20
71275 CPT CT Angio Chest W Contrast 288 79 $1,495.00 $1,495.00 $1,270.75 $1,270.75 $1,270.75 2024-12-20
J0248 HCPCS Remdesivir 100 Mg IV Solr 288 79 $1,453.80 $1,453.80 $1,235.73 $1,235.73 $1,235.73 2024-12-20
SUP-353410 CDM Bit Drl 2Mm 135Mm Ao Fit Scl F/1113759 288 79 $1,436.00 $1,436.00 $1,220.60 $1,220.60 $1,220.60 2024-12-20
22901 CPT Excise Tumor Abd Wall Subfascl >=5cm 288 79 $1,434.60 $1,434.60 $1,219.41 $1,219.41 $1,219.41 2024-12-20
22900 CPT Excise Tumor Abd Wall Subfasc <5cm 288 79 $1,434.60 $1,434.60 $1,219.41 $1,219.41 $1,219.41 2024-12-20
70490 CPT CT Soft Tissue Neck Non Contrast 288 79 $1,402.80 $1,402.80 $1,192.38 $1,192.38 $1,192.38 2024-12-20
73702 CPT CT Lower Extremity W And Wo Contrast 288 79 $1,395.15 $1,395.15 $1,185.88 $1,185.88 $1,185.88 2024-12-20
49083 CPT Paracentesis Abd W Guidance 288 79 $1,389.92 $1,389.92 $1,181.43 $1,181.43 $1,181.43 2024-12-20
26607 CPT Tx Fx Metcarp Clsd W Manip Fix Ea 288 79 $1,389.00 $1,389.00 $1,180.65 $1,180.65 $1,180.65 2024-12-20
12036 CPT Wnd Rpr Intermed Sc Ax Tk Xt 20.1-30cm 288 79 $1,389.00 $1,389.00 $1,180.65 $1,180.65 $1,180.65 2024-12-20
76937 CPT US Guide Vascular Access 288 79 $1,383.90 $1,383.90 $1,176.32 $1,176.32 $1,176.32 2024-12-20
24076 CPT Excision Tumor Up Arm Elbow Subfasc <5cm 288 79 $1,379.13 $1,379.13 $1,172.26 $1,172.26 $1,172.26 2024-12-20
24073 CPT Ex Tumor Upper Arm Deep 5cm Or More 288 79 $1,379.13 $1,379.13 $1,172.26 $1,172.26 $1,172.26 2024-12-20
47562 CPT Laparoscopic Cholecystectomy 288 79 $1,375.56 $1,375.56 $1,169.22 $1,169.22 $1,169.22 2024-12-20
28308 CPT Osteotomy Metatarsal 288 79 $1,373.15 $1,373.15 $1,167.18 $1,167.18 $1,167.18 2024-12-20
SUP-324570 CDM Wire K 1.2Mm 65Mm Smth Troc Tip Fx Olv 288 79 $1,372.00 $1,372.00 $1,166.20 $1,166.20 $1,166.20 2024-12-20
12057 CPT Ed Wnd Rpr Intermed Face >30cm 288 79 $1,370.25 $1,370.25 $1,164.71 $1,164.71 $1,164.71 2024-12-20
23076 CPT Excision Tumor Shoulder Subfasc <5cm 288 79 $1,370.20 $1,370.20 $1,164.67 $1,164.67 $1,164.67 2024-12-20
23073 CPT Exc Shoulder Lesion Deep 5cm Or More 288 79 $1,370.20 $1,370.20 $1,164.67 $1,164.67 $1,164.67 2024-12-20
22903 CPT Excise Tumor Abd Wall Subq >=3cm 288 79 $1,365.00 $1,365.00 $1,160.25 $1,160.25 $1,160.25 2024-12-20
21556 CPT Excise Tumor Neck IM < 5cm 288 79 $1,351.65 $1,351.65 $1,148.90 $1,148.90 $1,148.90 2024-12-20
67961 CPT Revision Of Eyelid Up To 1/4 Lid 288 79 $1,350.00 $1,350.00 $1,147.50 $1,147.50 $1,147.50 2024-12-20
26115 CPT Excision Tumor Hand Finger Subq <1.5cm 288 79 $1,339.60 $1,339.60 $1,138.66 $1,138.66 $1,138.66 2024-12-20
26111 CPT Excision Tumor Hand Finger Subq >=1.5cm 288 79 $1,339.60 $1,339.60 $1,138.66 $1,138.66 $1,138.66 2024-12-20
78803 CPT Rp Localzn Tmr Spect 1 Area 1 Day 288 79 $1,336.00 $1,336.00 $1,135.60 $1,135.60 $1,135.60 2024-12-20
C1726 HCPCS Dil Escp Cre 240Cm 5.5Cm 7.5Fr 15-18mm 288 79 $1,328.48 $1,328.48 $1,129.21 $1,129.21 $1,129.21 2024-12-20
21013 CPT Exc Tumor Sft Tiss Face Or Scalp <2cm 288 79 $1,319.08 $1,319.08 $1,121.22 $1,121.22 $1,121.22 2024-12-20
26116 CPT Excision Tumor Hand Fing Subfasc <1.5cm 288 79 $1,316.83 $1,316.83 $1,119.31 $1,119.31 $1,119.31 2024-12-20
26113 CPT Excision Tumor Hand Fing Subfasc >=1.5cm 288 79 $1,316.83 $1,316.83 $1,119.31 $1,119.31 $1,119.31 2024-12-20
21014 CPT Exc Tumor Sft Tiss Face Or Scalp >2cm 288 79 $1,307.48 $1,307.48 $1,111.36 $1,111.36 $1,111.36 2024-12-20
24075 CPT Excision Tumor Up Arm Elbow Subq <3cm 288 79 $1,304.98 $1,304.98 $1,109.23 $1,109.23 $1,109.23 2024-12-20
24071 CPT Exc Arm/Elbow Lesion Subq 3cm Or More 288 79 $1,304.98 $1,304.98 $1,109.23 $1,109.23 $1,109.23 2024-12-20
25076 CPT Excision Tumor Frarm Wrist Subfasc <3cm 288 79 $1,303.40 $1,303.40 $1,107.89 $1,107.89 $1,107.89 2024-12-20
25073 CPT Excision Tumor Frarm Wrist Subfasc >=3cm 288 79 $1,303.40 $1,303.40 $1,107.89 $1,107.89 $1,107.89 2024-12-20
70496 CPT CT Angio Head With And Without Contrast 288 79 $1,302.60 $1,302.60 $1,107.21 $1,107.21 $1,107.21 2024-12-20
28285 CPT Hammertoe Repair Unilat 288 79 $1,296.28 $1,296.28 $1,101.84 $1,101.84 $1,101.84 2024-12-20
19120 CPT Excise Breast Lesion Open >=1 288 79 $1,279.32 $1,279.32 $1,087.42 $1,087.42 $1,087.42 2024-12-20
93243 CPT EKG >48hrs To 7 Days Cont Scan Anly 288 79 $1,274.13 $1,274.13 $1,083.01 $1,083.01 $1,083.01 2024-12-20
19300 CPT Mastectomy For Gynecomastia 288 79 $1,272.72 $1,272.72 $1,081.81 $1,081.81 $1,081.81 2024-12-20
Q9957 HCPCS Perflutren Lipid Microsphere 6.52 Mg/ml IV Susp 288 79 $1,268.30 $1,268.30 $1,078.06 $1,078.06 $1,078.06 2024-12-20
25075 CPT Excision Tumor Frarm Wrist Subq <3cm 288 79 $1,268.08 $1,268.08 $1,077.87 $1,077.87 $1,077.87 2024-12-20
25071 CPT Excision Tumor Frarm Wrist Subq >=3cm 288 79 $1,268.08 $1,268.08 $1,077.87 $1,077.87 $1,077.87 2024-12-20
23075 CPT Excise Tumor Shoulder Subcut <3cm 288 79 $1,261.18 $1,261.18 $1,072.01 $1,072.01 $1,072.01 2024-12-20
23071 CPT Exc Shoulder Les Subq 3cm Or More 288 79 $1,261.18 $1,261.18 $1,072.01 $1,072.01 $1,072.01 2024-12-20
PX-814038 CDM Med/Surg Telemetry Daily 288 79 $1,256.25 $1,256.25 $1,067.82 $1,067.82 $1,067.82 2024-12-20
19020 CPT Mastotomy W/Expl/Drainage Abscess Deep 288 79 $1,250.84 $1,250.84 $1,063.21 $1,063.21 $1,063.21 2024-12-20
26765 CPT Tx Fx Phalanx Distal Open Ea 288 79 $1,250.10 $1,250.10 $1,062.59 $1,062.59 $1,062.59 2024-12-20
21930 CPT Excision Tumor Back Flank Subq <3cm 288 79 $1,241.35 $1,241.35 $1,055.15 $1,055.15 $1,055.15 2024-12-20
45385 CPT Colonoscopy Flex W Remv Les Snare 288 79 $1,238.12 $1,238.12 $1,052.40 $1,052.40 $1,052.40 2024-12-20
55250 CPT Vasectomy Unilat Or Bilat 288 79 $1,237.20 $1,237.20 $1,051.62 $1,051.62 $1,051.62 2024-12-20
G0121 HCPCS Colon Ca Scrn Not Hi Rsk Ind 288 79 $1,232.33 $1,232.33 $1,047.48 $1,047.48 $1,047.48 2024-12-20
78227 CPT Hepatobil Syst Image W/Drug 288 79 $1,231.65 $1,231.65 $1,046.90 $1,046.90 $1,046.90 2024-12-20
94002 CPT Vent Mgmt IP/Obsv Initial Day 288 79 $1,225.00 $1,225.00 $1,041.25 $1,041.25 $1,041.25 2024-12-20
81207 CPT Bcr-abl1 Gene Minor Bp 288 79 $1,224.30 $1,224.30 $1,040.65 $1,040.65 $1,040.65 2024-12-20
92950 CPT Cardiopulmonary Resuscitation 288 79 $1,224.30 $1,224.30 $1,040.65 $1,040.65 $1,040.65 2024-12-20
27818 CPT Fx Ankle Trimall Clsd Tx & Manip 288 79 $1,223.15 $1,223.15 $1,039.68 $1,039.68 $1,039.68 2024-12-20
27047 CPT Exc Tumor Hip Pelv Subq Less Thn 3cm 288 79 $1,222.68 $1,222.68 $1,039.28 $1,039.28 $1,039.28 2024-12-20
27603 CPT I&d Abscess Hematoma Ankle 288 79 $1,221.15 $1,221.15 $1,037.97 $1,037.97 $1,037.97 2024-12-20
46060 CPT Id Abscess Ischrectl Submusc W Fistultmy 288 79 $1,216.83 $1,216.83 $1,034.31 $1,034.31 $1,034.31 2024-12-20
78579 CPT Lung Ventilation Imaging 288 79 $1,206.45 $1,206.45 $1,025.48 $1,025.48 $1,025.48 2024-12-20
93306 CPT Tte 2d Wo Con W Doppler And Color Cmpl 288 79 $1,205.40 $1,205.40 $1,024.59 $1,024.59 $1,024.59 2024-12-20
27752 CPT Tx Fx Tibia Shft Clsd W Manip 288 79 $1,204.83 $1,204.83 $1,024.11 $1,024.11 $1,024.11 2024-12-20
78708 CPT Nm Renogram W Pharm Single 288 79 $1,197.00 $1,197.00 $1,017.45 $1,017.45 $1,017.45 2024-12-20
78315 CPT Nm Bone Scan 3 Phase 288 79 $1,197.00 $1,197.00 $1,017.45 $1,017.45 $1,017.45 2024-12-20
21931 CPT Excise Tumor Back Flank Subcut >=3cm 288 79 $1,194.03 $1,194.03 $1,014.92 $1,014.92 $1,014.92 2024-12-20
27043 CPT Excise Hip Pelvis Les Sc > 3 Cm 288 79 $1,190.05 $1,190.05 $1,011.54 $1,011.54 $1,011.54 2024-12-20
11406 CPT Exc Skin Benign Trunk/Arm/Leg >4cm 288 79 $1,188.56 $1,188.56 $1,010.27 $1,010.27 $1,010.27 2024-12-20
27632 CPT Excise Tumor Leg Ankle Sc >=3cm 288 79 $1,188.48 $1,188.48 $1,010.21 $1,010.21 $1,010.21 2024-12-20
27619 CPT Excision Tumor Leg Ankle Subfasc <5cm 288 79 $1,188.48 $1,188.48 $1,010.21 $1,010.21 $1,010.21 2024-12-20
27618 CPT Excise Tumor Leg Or Ankle Subcutn 288 79 $1,188.48 $1,188.48 $1,010.21 $1,010.21 $1,010.21 2024-12-20
31603 CPT Tracheostomy Emerg Xtrach 288 79 $1,180.20 $1,180.20 $1,003.17 $1,003.17 $1,003.17 2024-12-20
28045 CPT Excision Tumor Foot Toe Subfasc <1.5cm 288 79 $1,164.43 $1,164.43 $989.76 $989.76 $989.76 2024-12-20
28041 CPT Excision Tumor Foot Toe Subfasc >=1.5cm 288 79 $1,164.43 $1,164.43 $989.76 $989.76 $989.76 2024-12-20
22902 CPT Exc Abd Les Sc < 3 Cm 288 79 $1,163.60 $1,163.60 $989.06 $989.06 $989.06 2024-12-20
C1762 HCPCS Graft Tissue Ttpl Ioptch Sclr .8X.5Cm 288 79 $1,160.00 $1,160.00 $986.00 $986.00 $986.00 2024-12-20
SUP-271144 CDM Slr/Divr Lapscp 18.8Cm Ligasure 28d 14.7 288 79 $1,140.00 $1,140.00 $969.00 $969.00 $969.00 2024-12-20
SUP-200137 CDM Clip Hmst Radopq Preld Strl Disp Rsl 235 288 79 $1,135.16 $1,135.16 $964.88 $964.88 $964.88 2024-12-20
70552 CPT MRI Brain With Contrast 288 79 $1,135.08 $1,135.08 $964.82 $964.82 $964.82 2024-12-20
11426 CPT Rmvl Lesn Bngn Sc/Nk/H/F >4cm 288 79 $1,129.16 $1,129.16 $959.78 $959.78 $959.78 2024-12-20
78306 CPT Nm Bone Scan Whole Body 288 79 $1,125.60 $1,125.60 $956.76 $956.76 $956.76 2024-12-20
78707 CPT Nm Renogram W Flow And Function 288 79 $1,125.60 $1,125.60 $956.76 $956.76 $956.76 2024-12-20
Q9968 HCPCS Methylene Blue (antidote) 50 Mg/10ml IV Soln 288 79 $1,125.10 $1,125.10 $956.34 $956.34 $956.34 2024-12-20
M0243 HCPCS Inf Or Inj Casirvimab And Imdevimab Admin 288 79 $1,125.00 $1,125.00 $956.25 $956.25 $956.25 2024-12-20
46948 CPT Hemorrhoidecmy By Dartlzj Intrnl 2+ W US 288 79 $1,120.08 $1,120.08 $952.07 $952.07 $952.07 2024-12-20
78014 CPT Nm Thyroid Uptake And Scan 288 79 $1,114.05 $1,114.05 $946.95 $946.95 $946.95 2024-12-20
PX-SUP106249 CDM Glidescope Bflex 5.0 288 79 $1,110.00 $1,110.00 $943.50 $943.50 $943.50 2024-12-20
C1788 HCPCS Port Implinfn Powerport MRI Argd Chrnflx 288 79 $1,100.00 $1,100.00 $935.00 $935.00 $935.00 2024-12-20
78290 CPT Nm Meckels 288 79 $1,097.25 $1,097.25 $932.66 $932.66 $932.66 2024-12-20
12056 CPT Wnd Rpr Intermed Face 20.1-30cm 288 79 $1,097.25 $1,097.25 $932.66 $932.66 $932.66 2024-12-20
37799 CPT Unlisted Vascular Procedure 288 79 $1,095.50 $1,095.50 $931.17 $931.17 $931.17 2024-12-20
78278 CPT Nm Gi Blood Loss 288 79 $1,092.00 $1,092.00 $928.20 $928.20 $928.20 2024-12-20
78226 CPT Hepatobiliary System Imaging 288 79 $1,092.00 $1,092.00 $928.20 $928.20 $928.20 2024-12-20
49505 CPT Rpr Hernia Ing Init Reducible >=5yrs 288 79 $1,083.66 $1,083.66 $921.11 $921.11 $921.11 2024-12-20
25605 CPT Fx Radius Distal Clsd Tx & Manip 288 79 $1,082.40 $1,082.40 $920.04 $920.04 $920.04 2024-12-20
73701 CPT CT Lower Extremity With Contrast 288 79 $1,080.86 $1,080.86 $918.73 $918.73 $918.73 2024-12-20
21555 CPT Excise Tumor Neck Subcutaneous <3cm 288 79 $1,066.43 $1,066.43 $906.47 $906.47 $906.47 2024-12-20
21552 CPT Excise Tumor Neck Sc >= 3cm 288 79 $1,066.43 $1,066.43 $906.47 $906.47 $906.47 2024-12-20
25505 CPT Tx Fx Radial Shft Clsd W Manip 288 79 $1,061.55 $1,061.55 $902.32 $902.32 $902.32 2024-12-20
19110 CPT Hp Nipple Exploration 288 79 $1,059.96 $1,059.96 $900.97 $900.97 $900.97 2024-12-20
SUP-249806 CDM Hmst Absb Bionert Arista Ah Mph Plnt 288 79 $1,052.52 $1,052.52 $894.64 $894.64 $894.64 2024-12-20
78264 CPT Nm Gastric Emptying 288 79 $1,052.10 $1,052.10 $894.28 $894.28 $894.28 2024-12-20
44388 CPT Colonoscopy Thru Stoma 288 79 $1,051.60 $1,051.60 $893.86 $893.86 $893.86 2024-12-20
45331 CPT Sigmoidoscopy Flex W Bx 288 79 $1,050.00 $1,050.00 $892.50 $892.50 $892.50 2024-12-20
0202U CPT Biofire Respiratory Panel 2.1 288 79 $1,041.95 $1,041.95 $885.66 $885.66 $885.66 2024-12-20
93017 CPT Card Stress Test Routine 288 79 $1,035.30 $1,035.30 $880.00 $880.00 $880.00 2024-12-20
SUP-EEA31 CDM Stplr 31Mmx4.8Mm Eea Lnr Ctr Sqz Hndl Lg 288 79 $1,028.76 $1,028.76 $874.45 $874.45 $874.45 2024-12-20
13152 CPT Wnd Rpr Cmp Eyld Ns ER Lp 2.6-7.5cm 288 79 $1,026.90 $1,026.90 $872.87 $872.87 $872.87 2024-12-20
13132 CPT Rpr Face/Nk/Hd/Ft Cmplx 2.6-7.5 Cm 288 79 $1,026.90 $1,026.90 $872.87 $872.87 $872.87 2024-12-20
13121 CPT Rpr Sclp Extrm Cmplx 2.6-7.5 Cm 288 79 $1,026.90 $1,026.90 $872.87 $872.87 $872.87 2024-12-20
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