Price Transparencybeta Hospital negotiated rates

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

WABASH GENERAL HOSPITAL 1

Mount Carmel, IL · CCN 141327 · Rates published

4,369 distinct procedures filed
58 distinct payers
205,898 rate rows
2026-08-01 last MRF observed
Data quality

200,721 of 205,898 rate rows are consumer-grade (97.5%)

5,177 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
per-diem day rate — not a per-procedure price 4,473
exceeds 10× this hospital's gross charge — excluded from medians 432
percent-of-charges filed in the dollar field — excluded from medians 228
placeholder amount (≤ $0.02) — excluded from medians 40
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 4
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbWGHMOUNTCARMELIL&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/Wabash_General_Hospital.aspx
Discovered viaCMS hospital list
Last fetch not_modified · 2026-08-14
Content fingerprint 193b9322ca4c0eb5… · 31,792,478 bytes · first seen 2026-05-13

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
PX-3600006
CDM 		Surgery, 1st 30 Minutes Level Vi 5 $14,060.00 $18,077.00 $17,072.00 nat. median
$2,729
outlier · 6.3×
3600006
CDM 		Operating Room Services - General Classification 20 $6,092.62 $18,619.20 $16,550.40 nat. median
$3,863
outlier · 4.3×
PX-3600005
CDM 		Surgery, 1st 30 Minutes Level V 5 $11,250.00 $14,465.00 $13,661.00 nat. median
$2,921
outlier · 4.7×
3600005
CDM 		Operating Room Services - General Classification 20 $4,875.15 $14,898.60 $13,243.20 nat. median
$2,744
outlier · 4.8×
6360001
OTHER 		Adalimumab-aaty 40 Mg/0.4ml Sc Ajkt 18 $429.00 $38,640.00 $10,497.50 nat. median
$98
outlier · 106.8×
PX-3600004
CDM 		Surgery, 1st 30 Minutes Level IV 5 $7,816.00 $10,049.00 $9,490.00 nat. median
$3,409
outlier · 2.8×
3600004
CDM 		Operating Room Services - General Classification 20 $3,386.75 $10,350.00 $9,200.00 nat. median
$3,318
outlier · 2.8×
15829
HCPCS 		Removal Of Wrinkles And Extra Skin With Grafting Of Cheeks, Chin, And Neck 13 $2,271.73 $8,250.00 $7,012.50 nat. median
$4,332
1.6× median
PX-3600015
CDM 		Surgery, Ea Add'l 30 Min Level Vi 5 $5,047.00 $6,489.00 $6,129.00 nat. median
$8,915
0.7× median
3600015
CDM 		Operating Room Services - General Classification 20 $2,186.96 $6,683.40 $5,940.80 nat. median
$166
outlier · 35.7×
15828
HCPCS 		Removal Of Wrinkles And Extra Skin Of Cheeks, Chin, And Neck 13 $2,032.36 $6,600.00 $5,610.00 nat. median
$4,113
1.4× median
74178
CPT 		CT Abd & Plvs W & Wo Cont 1 Body Regn 5 $4,609.00 $5,926.00 $5,597.00 nat. median
$1,024
outlier · 5.5×
74174
CPT 		CT Angiography Abd/Pelvis W Contrast 5 $4,606.00 $5,923.00 $5,594.00 nat. median
$982
outlier · 5.7×
PX-3600003
CDM 		Surgery, 1st 30 Minutes Level Iii 5 $4,185.00 $5,380.00 $5,081.00 nat. median
$65
outlier · 77.7×
74178
HCPCS 		CT Scan Of Abdomen And Pelvis Before And After Contrast 24 $734.28 $5,925.95 $4,938.29 nat. median
$1,024
outlier · 4.8×
74174
HCPCS 		CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 24 $897.16 $5,922.60 $4,935.50 nat. median
$982
outlier · 5.0×
3600003
CDM 		Operating Room Services - General Classification 20 $1,813.24 $5,541.30 $4,925.60 nat. median
$1,101
outlier · 4.5×
72157
CPT 		MRI Thorac Spine Wo/w Contrast 5 $3,976.00 $5,112.00 $4,828.00 nat. median
$1,116
outlier · 4.3×
72156
CPT 		MRI Cerv Spine Wo/w Contrast 5 $3,976.00 $5,112.00 $4,828.00 nat. median
$1,111
outlier · 4.3×
73723
CPT 		MRI Low Extrem, Joint, Wo/w Contrast-lt 5 $3,976.00 $5,112.00 $4,828.00 nat. median
$1,210
outlier · 4.0×
70553
CPT 		MRI Brain Without With Contrast 5 $3,976.00 $5,112.00 $4,828.00 nat. median
$1,137
outlier · 4.2×
72158
CPT 		MRI Lumbar Spine Wo/w Contrast 5 $3,976.00 $5,112.00 $4,828.00 nat. median
$1,103
outlier · 4.4×
27134
HCPCS 		Revision Of Thigh Bone And Hip Joint Prosthesis 24 $193.75 $22,917.50 $4,637.81 nat. median
$9,285
outlier · 0.5×
26765
CPT 		Open Tx, Dist Phal Fx, Fing/Thmb, Ea 5 $3,740.00 $4,808.00 $4,541.00 nat. median
$3,497
1.3× median
95811
CPT 		Polysomnograph With Cpap 5 $3,721.00 $4,784.00 $4,518.00 nat. median
$1,923
outlier · 2.3×
26765
HCPCS 		Treatment Of Broken End Of Finger Or Thumb 24 $900.00 $12,742.22 $4,402.22 nat. median
$3,497
1.3× median
PX-3600012
CDM 		Surgery, Ea Add'l 30 Min Level V 5 $3,599.00 $4,628.00 $4,370.00 nat. median
$4,370
1.0× median
73223
CPT 		MRI Up Extrem, Any Joint, Wo/w Contr-lt 5 $3,565.00 $4,583.00 $4,329.00 nat. median
$1,177
outlier · 3.7×
70546
CPT 		MRA Head Wo/w Contrast 5 $3,532.00 $4,541.00 $4,289.00 nat. median
$1,051
outlier · 4.1×
3600012
CDM 		Operating Room Services - General Classification 20 $1,559.67 $4,766.40 $4,236.80 nat. median
$1,467
outlier · 2.9×
72142
CPT 		MRI Cervical Spine W/Contrast 5 $3,482.00 $4,476.00 $4,228.00 nat. median
$973
outlier · 4.3×
72147
CPT 		MRI Thoracic Spine With Contrast 5 $3,482.00 $4,476.00 $4,228.00 nat. median
$976
outlier · 4.3×
70552
CPT 		MRI Brain With Contrast 5 $3,439.00 $4,421.00 $4,175.00 nat. median
$970
outlier · 4.3×
72149
CPT 		MRI Lumbar Spine With Contrast 5 $3,439.00 $4,421.00 $4,175.00 nat. median
$979
outlier · 4.3×
72157
HCPCS 		MRI Scan Of Middle Spinal Canal Before And After Contrast 24 $950.00 $5,111.78 $4,117.82 nat. median
$1,116
outlier · 3.7×
70553
HCPCS 		MRI Scan Of Brain Before And After Contrast 24 $950.00 $5,111.78 $4,117.82 nat. median
$1,137
outlier · 3.6×
73723
HCPCS 		MRI Scan Of Leg Joint Before And After Contrast 24 $950.00 $5,111.68 $4,117.74 nat. median
$1,210
outlier · 3.4×
72158
HCPCS 		MRI Scan Of Lower Spinal Canal Before And After Contrast 24 $950.00 $5,111.68 $4,117.74 nat. median
$1,103
outlier · 3.7×
72156
HCPCS 		MRI Scan Of Upper Spinal Canal Before And After Contrast 24 $950.00 $5,111.68 $4,117.74 nat. median
$1,111
outlier · 3.7×
73725
CPT 		MRA Lower Extremity With Contrast Lt 5 $3,384.00 $4,351.00 $4,109.00 nat. median
$1,273
outlier · 3.2×
73720
CPT 		MRI Low Ext, Non Joint, Wo/w Contrast Lt 5 $3,384.00 $4,351.00 $4,109.00 nat. median
$1,142
outlier · 3.6×
95811
HCPCS 		Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 24 $1,612.47 $4,927.75 $4,106.46 nat. median
$1,923
outlier · 2.1×
74176
CPT 		CT,Abd And Pelvis, Without Contrast 5 $3,312.00 $4,258.00 $4,021.00 nat. median
$697
outlier · 5.8×
75635
CPT 		CTA Abd Aorta Bilat Iliofemoral W/wo 5 $3,240.00 $4,165.00 $3,934.00 nat. median
$719
outlier · 5.5×
38525
CPT 		Biopsy/Excis Lymph, Opn, Deep Axil Node-lt 5 $3,178.00 $4,086.00 $3,859.00 nat. median
$3,992
1.0× median
73225
CPT 		MRA Upper Extrem W Or Without Contrast-lt 5 $3,177.00 $4,085.00 $3,858.00 nat. median
$1,215
outlier · 3.2×
73220
CPT 		MRI Up Extr, Non Joint, Wo/w Contr-lt 5 $3,177.00 $4,085.00 $3,858.00 nat. median
$1,147
outlier · 3.4×
72146
CPT 		MRI Thoracic Spine Without Contrast 5 $3,166.00 $4,071.00 $3,845.00 nat. median
$791
outlier · 4.9×
PC9820107
CDM 		Pro Morpheus8 Burst Deep Large Area 8x11in, Pkg 3 6 $2,790.00 $3,825.00 $3,825.00 nat. median
$3,825
1.0× median
81445
CPT 		So Misc Targeted Genomic Seq Anlsys 81445 5 $3,142.00 $4,040.00 $3,816.00 nat. median
$1,092
outlier · 3.5×

Other procedures at this hospital

Browse this hospital's 4,369 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
             
6360001 OTHER Adalimumab-aaty 40 Mg/0.4ml Sc Ajkt 72 18 $15,718.50 $15,718.50 $429.00 $38,640.00 $10,497.50 2025-03-11
26951 CPT Amputation Of Finger Or Thumb 16 5 $3,147.00 $3,147.00 $2,203.00 $2,833.00 $2,675.00 2025-03-11
26951 HCPCS Amputation Of Finger Or Thumb With Direct Closure 24 24 $3,241.86 $3,241.86 $900.00 $3,151.34 $2,593.49 2026-03-25
L4631 HCPCS Ankle Foot Orthosis, Walking Boot Type, Varus/valgus Correction, Rocker Bottom, … 20 20 $4,392.05 $4,392.05 $1,293.46 $3,952.85 $3,403.84 2026-03-25
15275 CPT App High Cost Skin Sub Face,Hand,Feet,Genital 1st 25 Sq Cm 16 5 $2,606.00 $2,606.00 $1,824.00 $2,346.00 $2,215.00 2025-03-11
15276 CPT App High Cost Skin Sub Face,Hand,Feet,Genital Ea Addtl 25 Sq Cm 16 5 $2,606.00 $2,606.00 $1,824.00 $2,346.00 $2,215.00 2025-03-11
15272 CPT App High Cost Skin Sub Trunk,Arms,Legs Ea Addtl 25 Sqcm 16 5 $2,606.00 $2,606.00 $1,824.00 $2,346.00 $2,215.00 2025-03-11
15271 CPT App High Cost Skin Sub Trunk,Arms,Legs First 25 Sq Cm 16 5 $2,606.00 $2,606.00 $1,824.00 $2,346.00 $2,215.00 2025-03-11
140119_ERX CDM Aquasol A 100,000 Unit/2 Ml Vl 20 20 $3,390.67 $3,390.67 $998.55 $3,051.60 $2,712.53 2026-03-25
38222 HCPCS Biopsy And Aspiration Of Bone Marrow Sample For Diagnosis 24 24 $3,384.19 $3,384.19 $996.64 $4,001.66 $2,707.35 2026-03-25
25065 HCPCS Biopsy Of Surface Tissue Of Forearm Or Wrist 48 24 $3,748.88 $3,748.88 $1,104.05 $4,104.01 $2,999.10 2026-03-25
38510 HCPCS Biopsy Or Removal Of Deep Lymph Nodes Of Neck 24 24 $4,539.74 $4,539.74 $1,336.95 $7,676.35 $3,631.79 2026-03-25
38525 HCPCS Biopsy Or Removal Of Deep Lymph Nodes Of Underarm 72 24 $4,540.00 $4,540.00 $1,337.03 $7,676.35 $3,632.00 2026-03-25
25065 CPT Biopsy Soft Tissue Forearm/Wrist Rt 16 5 $3,749.00 $3,749.00 $2,624.00 $3,374.00 $3,187.00 2025-03-11
38525 CPT Biopsy/Excis Lymph, Opn, Deep Axil Node-lt 16 5 $4,540.00 $4,540.00 $3,178.00 $4,086.00 $3,859.00 2025-03-11
28270 CPT Capsulotomy; Metatarsophal Jt, W Or Without Tenorrhaphy, Ea Joint 16 5 $2,977.00 $2,977.00 $2,084.00 $2,679.00 $2,530.00 2025-03-11
360 OTHER Chest Tube Insertion 9,020 10 $4,099.11 — $45.39 $40,726.49 $3,348.60 2026-08-01
23505 HCPCS Closed Treatment Of Broken Collar Bone With Manipulation 88 24 $3,804.71 $3,804.71 $900.00 $3,424.24 $2,853.53 2026-03-25
27532 HCPCS Closed Treatment Of Broken Shin Bone With Traction 24 24 $3,157.94 $3,157.94 $900.00 $2,842.15 $2,368.46 2026-03-25
27502 HCPCS Closed Treatment Of Broken Thigh Bone At Midportion With Manipulation 48 24 $3,804.71 $3,804.71 $900.00 $3,424.24 $2,853.53 2026-03-25
27842 HCPCS Closed Treatment Of Dislocated Ankle Under Anesthesia 72 24 $3,804.71 $3,804.71 $900.00 $3,424.24 $2,853.53 2026-03-25
27266 HCPCS Closed Treatment Of Dislocated Hip Prosthesis Under Anesthesia 48 24 $3,804.71 $3,804.71 $900.00 $3,424.24 $2,853.53 2026-03-25
27252 HCPCS Closed Treatment Of Dislocated Hip Under Anesthesia 48 24 $3,804.71 $3,804.71 $900.00 $3,424.24 $2,853.53 2026-03-25
23665 HCPCS Closed Treatment Of Dislocated Shoulder And Broken Upper Arm Bone At Shoulder Jo… 48 24 $3,804.71 $3,804.71 $900.00 $3,424.24 $2,853.53 2026-03-25
23655 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia 48 24 $3,804.71 $3,804.71 $900.00 $3,424.24 $2,853.53 2026-03-25
27252 CPT Closed Tx Hip Disloc Trauma With Anes - Rt 16 5 $3,694.00 $3,694.00 $2,586.00 $3,325.00 $3,140.00 2025-03-11
27842 CPT Clsd Tx Ankle Dislocation W/Anes 16 5 $3,694.00 $3,694.00 $2,586.00 $3,325.00 $3,140.00 2025-03-11
27266 CPT Clsd Tx Post Hip Arth Dis With Anes Rt 16 5 $3,694.00 $3,694.00 $2,586.00 $3,325.00 $3,140.00 2025-03-11
23655 CPT Clsd Tx Shldr Disloc W Manip W Anes-rt 16 5 $3,694.00 $3,694.00 $2,586.00 $3,325.00 $3,140.00 2025-03-11
23505 CPT Clsd Tx, Clavical Fx W/manip-rt 32 5 $3,640.00 $3,640.00 $2,510.00 $3,325.00 $3,084.00 2025-03-11
27502 CPT Clsd Tx,Femoral Shaft Fx,With Manip Rt 16 5 $3,694.00 $3,694.00 $2,586.00 $3,325.00 $3,140.00 2025-03-11
23665 CPT Clsd Tx,Shl Dsl,W/Fx Grtubr,W/Man Rt 16 5 $3,694.00 $3,694.00 $2,586.00 $3,325.00 $3,140.00 2025-03-11
74178 CPT CT Abd & Plvs W & Wo Cont 1 Body Regn 16 5 $6,584.00 $6,584.00 $4,609.00 $5,926.00 $5,597.00 2025-03-11
74160 CPT CT Abdomen With Contrast 16 5 $2,752.00 $2,752.00 $1,927.00 $2,477.00 $2,339.00 2025-03-11
74170 CPT CT Abdomen Wo/w Con 16 5 $3,333.00 $3,333.00 $2,333.00 $3,000.00 $2,833.00 2025-03-11
74175 CPT CT Angio Abdomen Wo/w Contrast With Img Pp 16 5 $3,174.00 $3,174.00 $2,222.00 $2,857.00 $2,698.00 2025-03-11
70498 CPT CT Angio Neck Wo/w Contrast With Image Pp 16 5 $2,784.00 $2,784.00 $1,949.00 $2,505.00 $2,366.00 2025-03-11
72191 CPT CT Angio Pelvis, Wo/w Contrast With Img Pp 16 5 $3,096.00 $3,096.00 $2,167.00 $2,786.00 $2,631.00 2025-03-11
73206 CPT CT Angio Up Extrem Wo/w Contr With Pp-rt 16 5 $2,774.00 $2,774.00 $1,942.00 $2,496.00 $2,358.00 2025-03-11
73706 CPT CT Angio, Low Ext Wo/w Contrast With Pp Rt 16 5 $2,955.00 $2,955.00 $2,068.00 $2,659.00 $2,512.00 2025-03-11
74174 CPT CT Angiography Abd/Pelvis W Contrast 16 5 $6,581.00 $6,581.00 $4,606.00 $5,923.00 $5,594.00 2025-03-11
72126 CPT CT Cervical Spine With Contrast 16 5 $2,802.00 $2,802.00 $1,961.00 $2,522.00 $2,382.00 2025-03-11
72125 CPT CT Cervical Spine Without Contrast 16 5 $3,270.00 $3,270.00 $2,289.00 $2,943.00 $2,780.00 2025-03-11
72127 CPT CT Cervical Spine Wo/w Contrast 16 5 $3,386.00 $3,386.00 $2,370.00 $3,048.00 $2,878.00 2025-03-11
70488 CPT CT Facial Bones W/wo Contrast 16 5 $2,899.00 $2,899.00 $2,030.00 $2,609.00 $2,464.00 2025-03-11
70470 CPT CT Head Or Brain Wo/w Contrast 16 5 $2,892.00 $2,892.00 $2,024.00 $2,603.00 $2,458.00 2025-03-11
70482 CPT CT Intracranial Wo/w Contrast 16 5 $2,907.00 $2,907.00 $2,035.00 $2,616.00 $2,471.00 2025-03-11
73702 CPT CT Lower Extrem Wo/w Contrast Rt 16 5 $2,912.00 $2,912.00 $2,039.00 $2,621.00 $2,476.00 2025-03-11
72132 CPT CT Lumbar Spine W/Contrast 16 5 $2,802.00 $2,802.00 $1,961.00 $2,522.00 $2,382.00 2025-03-11
72131 CPT CT Lumbar Spine Without Contrast 16 5 $2,470.00 $2,470.00 $1,729.00 $2,223.00 $2,100.00 2025-03-11
72133 CPT CT Lumbar Spine Wo/w Contrast 16 5 $3,389.00 $3,389.00 $2,373.00 $3,050.00 $2,881.00 2025-03-11
350 OTHER CT Needle Biopsy 10 10 $2,769.39 — $1,827.80 $2,492.45 $2,215.51 2026-08-01
72193 CPT CT Pelvis With Contrast 16 5 $2,705.00 $2,705.00 $1,893.00 $2,434.00 $2,299.00 2025-03-11
72194 CPT CT Pelvis Wo/w Contrast 16 5 $3,250.00 $3,250.00 $2,275.00 $2,925.00 $2,763.00 2025-03-11
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 24 24 $6,584.39 $6,584.39 $734.28 $5,925.95 $4,938.29 2026-03-25
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 24 24 $4,154.57 $4,154.57 $734.28 $3,739.11 $3,115.93 2026-03-25
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 24 24 $4,731.07 $4,731.07 $734.28 $4,257.96 $3,548.30 2026-03-25
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 24 24 $3,332.83 $3,332.83 $734.28 $2,999.55 $2,499.62 2026-03-25
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 24 24 $4,627.89 $4,627.89 $897.16 $4,165.10 $3,470.92 2026-03-25
73202 HCPCS CT Scan Of Arm Before And After Contrast 72 24 $3,102.61 $3,102.61 $734.28 $2,792.35 $2,326.96 2026-03-25
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 24 24 $6,580.67 $6,580.67 $897.16 $5,922.60 $4,935.50 2026-03-25
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 24 24 $3,174.13 $3,174.13 $897.16 $2,856.72 $2,380.60 2026-03-25
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 24 24 $3,270.37 $3,270.37 $897.16 $2,943.33 $2,452.78 2026-03-25
73706 HCPCS CT Scan Of Blood Vessels Of Lower Leg With Contrast 72 24 $2,954.85 $2,954.85 $870.20 $2,659.37 $2,216.14 2026-03-25
72191 HCPCS CT Scan Of Blood Vessels Of Pelvis With Contrast 24 24 $3,095.64 $3,095.64 $897.16 $2,786.08 $2,321.73 2026-03-25
71270 HCPCS CT Scan Of Chest Before And After Contrast 24 24 $3,433.90 $3,433.90 $734.28 $3,090.51 $2,575.43 2026-03-25
71260 HCPCS CT Scan Of Chest With Contrast 24 24 $2,811.42 $2,811.42 $734.28 $2,530.28 $2,108.57 2026-03-25
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 24 24 $2,906.59 $2,906.59 $734.28 $2,615.93 $2,179.94 2026-03-25
70488 HCPCS CT Scan Of Face Before And After Contrast 24 24 $2,899.31 $2,899.31 $734.28 $2,609.38 $2,174.48 2026-03-25
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 24 24 $2,891.80 $2,891.80 $734.28 $2,602.62 $2,168.85 2026-03-25
73702 HCPCS CT Scan Of Leg Before And After Contrast 72 24 $2,912.46 $2,912.46 $734.28 $2,621.21 $2,184.35 2026-03-25
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 24 24 $3,389.36 $3,389.36 $734.28 $3,050.42 $2,542.02 2026-03-25
72132 HCPCS CT Scan Of Lower Spine With Contrast 24 24 $2,801.93 $2,801.93 $734.28 $2,521.74 $2,101.45 2026-03-25
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 24 24 $3,386.42 $3,386.42 $734.28 $3,047.78 $2,539.82 2026-03-25
72129 HCPCS CT Scan Of Middle Spine With Contrast 24 24 $2,801.93 $2,801.93 $734.28 $2,521.74 $2,101.45 2026-03-25
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 24 24 $3,250.44 $3,250.44 $734.28 $2,925.40 $2,437.83 2026-03-25
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 24 24 $2,922.99 $2,922.99 $734.28 $2,630.69 $2,192.24 2026-03-25
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 24 24 $3,386.42 $3,386.42 $734.28 $3,047.78 $2,539.82 2026-03-25
72126 HCPCS CT Scan Of Upper Spine With Contrast 24 24 $2,801.93 $2,801.93 $734.28 $2,521.74 $2,101.45 2026-03-25
72125 HCPCS CT Scan Of Upper Spine Without Contrast 24 24 $3,270.37 $3,270.37 $257.77 $2,943.33 $2,452.78 2026-03-25
70492 CPT CT Soft Tissue Neck Wo/w Contrast 16 5 $2,923.00 $2,923.00 $2,046.00 $2,631.00 $2,485.00 2025-03-11
72129 CPT CT Thoracic Spine With Contrast 16 5 $2,802.00 $2,802.00 $1,961.00 $2,522.00 $2,382.00 2025-03-11
72130 CPT CT Thoracic Spine Wo/w Contrast 16 5 $3,386.00 $3,386.00 $2,370.00 $3,048.00 $2,878.00 2025-03-11
71260 CPT CT Thorax Diagnostic W/Contrast 16 5 $2,811.00 $2,811.00 $1,968.00 $2,530.00 $2,390.00 2025-03-11
71270 CPT CT Thorax Diagnostic Wo/w Contrast 16 5 $3,434.00 $3,434.00 $2,404.00 $3,091.00 $2,919.00 2025-03-11
73202 CPT CT Upper Extremity Wo/w Contrast-rt 16 5 $3,103.00 $3,103.00 $2,172.00 $2,792.00 $2,637.00 2025-03-11
74177 CPT CT,Abd And Pelvis, With Contrast 16 5 $4,155.00 $4,155.00 $2,908.00 $3,739.00 $3,531.00 2025-03-11
74176 CPT CT,Abd And Pelvis, Without Contrast 16 5 $4,731.00 $4,731.00 $3,312.00 $4,258.00 $4,021.00 2025-03-11
71275 CPT CT-angio Chst,Ncrny Wo/w Cont With Img Pp 16 5 $3,270.00 $3,270.00 $2,289.00 $2,943.00 $2,780.00 2025-03-11
75635 CPT CTA Abd Aorta Bilat Iliofemoral W/wo 16 5 $4,628.00 $4,628.00 $3,240.00 $4,165.00 $3,934.00 2025-03-11
70496 CPT CTA Head Wo/w Contrast 16 5 $2,754.00 $2,754.00 $1,928.00 $2,479.00 $2,341.00 2025-03-11
11012 CPT Debride W/fb Rem Skin/Sq,Mus/Bone 16 5 $2,661.00 $2,661.00 $1,863.00 $2,395.00 $2,262.00 2025-03-11
38222 CPT Diag Bone Marrow Biopsy & Aspiration 16 5 $3,384.00 $3,384.00 $2,369.00 $3,046.00 $2,877.00 2025-03-11
27301 CPT Drain Abscess Knee/Thigh Rt 16 5 $2,583.00 $2,583.00 $1,808.00 $2,325.00 $2,196.00 2025-03-11
49020 HCPCS Drainage Of Abdominal Abscess Or Infection 24 24 $4,254.98 $4,254.98 $193.75 $8,829.20 $3,403.98 2026-03-25
55100 HCPCS Drainage Of Abscess Of Scrotum 24 24 $2,765.70 $2,765.70 $814.50 $5,715.67 $2,212.56 2026-03-25
28002 HCPCS Drainage Of Fluid Filled Sac Below Connective Tissue In Foot Joint 48 24 $3,062.66 $3,062.66 $901.95 $5,162.32 $2,450.13 2026-03-25
23931 HCPCS Drainage Of Fluid Filled Sac In Elbow Joint 48 24 $4,054.45 $4,054.45 $900.00 $4,322.57 $3,243.56 2026-03-25
55100 CPT Drainage Of Scrotal Wall Abscess 16 5 $2,685.00 $2,685.00 $1,880.00 $2,417.00 $2,282.00 2025-03-11
31603 CPT Emergency Incision Of Windpipe 16 5 $3,574.00 $3,574.00 $2,502.00 $3,217.00 $3,038.00 2025-03-11
31603 HCPCS Emergent Incision Of Windpipe Through Neck For Insertion Of Breathing Tube 24 24 $3,681.69 $3,681.69 $900.00 $4,965.96 $2,945.35 2026-03-25
11446 CPT Exc Benign Lesion F/e/e/n/l/m; Diam > 4.0cm 16 5 $2,583.00 $2,583.00 $1,808.00 $2,325.00 $2,196.00 2025-03-11
11426 CPT Exc Benign Lesion S/n/h/f/g; Diam > 4.0cm 16 5 $2,583.00 $2,583.00 $1,808.00 $2,325.00 $2,196.00 2025-03-11
11646 CPT Exc Malignant Lesion F/e/e/n/l; >4.0 Cm 16 5 $2,583.00 $2,583.00 $1,808.00 $2,325.00 $2,196.00 2025-03-11
11626 CPT Exc Malignant Lesion S/n/h/f/g; >4.0 Cm 16 5 $2,583.00 $2,583.00 $1,808.00 $2,325.00 $2,196.00 2025-03-11
21552 CPT Exc Tumor Sft Tiss Nck/Chest 3.0 Cm Or More 16 5 $3,384.00 $3,384.00 $2,369.00 $3,046.00 $2,877.00 2025-03-11
20102 HCPCS Exploration Of Wound Of Abdomen, Back, Or Flank 24 24 $2,856.85 $2,856.85 $841.34 $2,571.17 $2,285.48 2026-03-25
20101 HCPCS Exploration Of Wound Of Chest 24 24 $2,856.85 $2,856.85 $841.34 $2,571.17 $2,285.48 2026-03-25
20102 CPT Explore Penetrating Wound Abd/Flnk/Back 16 5 $2,774.00 $2,774.00 $1,942.00 $2,496.00 $2,358.00 2025-03-11
20101 CPT Explore Penetrating Wound Chest 16 5 $2,774.00 $2,774.00 $1,942.00 $2,496.00 $2,358.00 2025-03-11
28008 CPT Fasciotomy Foot And/or Toe 16 5 $2,977.00 $2,977.00 $2,084.00 $2,679.00 $2,530.00 2025-03-11
81229 HCPCS Genome-wide Microarray Analysis For Copy Number And Single Nucleotide Polymorphi… 24 24 $2,704.00 $2,704.00 $46.80 $4,563.69 $2,163.20 2026-03-25
81445 HCPCS Genomic Sequence Analysis Panel Of DNA Or Combined DNA And RNA Of 5-50 Genes Ass… 24 24 $4,488.83 $4,488.83 $46.80 $4,039.95 $3,366.62 2026-03-25
23931 CPT Inc/DRN, Upper Arm/Elbow, Bursa Rt 16 5 $3,936.00 $3,936.00 $2,755.00 $3,543.00 $3,346.00 2025-03-11
28270 HCPCS Incision Of Joint Capsule Of Foot And Toe 24 24 $2,976.66 $2,976.66 $876.63 $5,162.32 $2,381.33 2026-03-25
15826 HCPCS Incision, Stretching, And Suture Of Skin Between Eyebrows 13 13 $4,400.00 $4,400.00 $777.05 $4,400.00 $3,740.00 2026-03-25
36556 CPT Insert Central Line >5yrs 16 5 $2,477.00 $2,477.00 $1,734.00 $2,229.00 $2,105.00 2025-03-11
36569 HCPCS Insertion Of Tube For Infusion (5 Years Or Older) 44 24 $3,831.00 $3,831.00 $900.00 $3,551.54 $2,959.62 2026-03-25
36568 HCPCS Insertion Of Tube For Infusion (younger Than 5 Years) 24 24 $2,678.00 $2,678.00 $788.67 $2,650.37 $2,142.40 2026-03-25
36573 HCPCS Insertion Of Tube For Infusion With Imaging Guidance And Review By Radiologist, … 24 24 $3,698.00 $3,698.00 $1,089.06 $3,328.20 $2,773.50 2026-03-25
2000001 CDM Intensive Care Unit - General Classification 12 12 $2,543.00 $2,543.00 $1,678.38 $2,288.70 $2,097.98 2026-03-25
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 44 24 $2,950.65 $2,950.65 $769.84 $2,655.59 $2,286.08 2026-03-25
616 OTHER MRA Abd With Contrast 18 10 $3,615.10 — $950.00 $3,828.73 $3,167.88 2026-08-01
618 OTHER MRA Abdomen Without Contrast 34 10 $3,646.94 — $950.00 $3,594.61 $2,965.59 2026-08-01
74185 CPT MRA Angiography Abdomen W/Contrast 48 5 $4,108.00 $4,108.00 $2,708.00 $3,797.00 $3,486.50 2025-03-11
71555 CPT MRA Chest Without Contrast 16 5 $4,145.00 $4,145.00 $2,901.00 $3,730.00 $3,523.00 2025-03-11
615 OTHER MRA Head W Dye 34 10 $3,317.22 — $950.00 $3,995.75 $2,833.29 2026-08-01
70545 CPT MRA Head With Contrast 16 5 $3,770.00 $3,770.00 $2,639.00 $3,393.00 $3,204.00 2025-03-11
70544 CPT MRA Head Without Contrast 16 5 $3,474.00 $3,474.00 $2,432.00 $3,127.00 $2,953.00 2025-03-11
70546 CPT MRA Head Wo/w Contrast 16 5 $5,045.00 $5,045.00 $3,532.00 $4,541.00 $4,289.00 2025-03-11
73725 CPT MRA Lower Extremity With Contrast Lt 16 5 $4,835.00 $4,835.00 $3,384.00 $4,351.00 $4,109.00 2025-03-11
70548 CPT MRA Neck With Contrast 16 5 $3,770.00 $3,770.00 $2,639.00 $3,393.00 $3,204.00 2025-03-11
70547 CPT MRA Neck Without Con 16 5 $3,474.00 $3,474.00 $2,432.00 $3,127.00 $2,953.00 2025-03-11
70549 CPT MRA Neck Wo/w Contrast 16 5 $4,213.00 $4,213.00 $2,949.00 $3,792.00 $3,581.00 2025-03-11
72198 CPT MRA Pelvis Without Follow With Contrast 16 5 $4,145.00 $4,145.00 $2,901.00 $3,730.00 $3,523.00 2025-03-11
73225 CPT MRA Upper Extrem W Or Without Contrast-lt 16 5 $4,539.00 $4,539.00 $3,177.00 $4,085.00 $3,858.00 2025-03-11
619 OTHER MRI Abdomen W Dye 138 10 $3,830.95 — $950.00 $4,497.98 $3,076.12 2026-08-01
74182 CPT MRI Abdomen With Contrast 16 5 $3,701.00 $3,701.00 $2,591.00 $3,331.00 $3,146.00 2025-03-11
74181 CPT MRI Abdomen Without Contrast 16 5 $3,405.00 $3,405.00 $2,384.00 $3,065.00 $2,895.00 2025-03-11
74183 CPT MRI Abdomen Wo/w Contrast 16 5 $4,145.00 $4,145.00 $2,901.00 $3,730.00 $3,523.00 2025-03-11
70551 CPT MRI Brain Inc Stem Without Contrast 16 5 $4,095.00 $4,095.00 $2,867.00 $3,686.00 $3,481.00 2025-03-11
611 OTHER MRI Brain W 28 10 $4,322.46 — $950.00 $4,498.07 $3,270.99 2026-08-01
70552 CPT MRI Brain With Contrast 16 5 $4,912.00 $4,912.00 $3,439.00 $4,421.00 $4,175.00 2025-03-11
70553 CPT MRI Brain Without With Contrast 16 5 $5,680.00 $5,680.00 $3,976.00 $5,112.00 $4,828.00 2025-03-11
72156 CPT MRI Cerv Spine Wo/w Contrast 16 5 $5,680.00 $5,680.00 $3,976.00 $5,112.00 $4,828.00 2025-03-11
72142 CPT MRI Cervical Spine W/Contrast 16 5 $4,974.00 $4,974.00 $3,482.00 $4,476.00 $4,228.00 2025-03-11
72141 CPT MRI Cervical Spine Without Contrast 16 5 $4,145.00 $4,145.00 $2,901.00 $3,730.00 $3,523.00 2025-03-11
612 OTHER MRI Cervical Spine W/wo 56 8 $4,322.46 — $2,406.98 $4,498.07 $3,457.97 2026-08-01
71551 CPT MRI Chest With Contrast 16 5 $3,701.00 $3,701.00 $2,591.00 $3,331.00 $3,146.00 2025-03-11
71550 CPT MRI Chest Without Contrast 16 5 $3,405.00 $3,405.00 $2,384.00 $3,065.00 $2,895.00 2025-03-11
71552 CPT MRI Chest Wo/w Contrast 16 5 $4,145.00 $4,145.00 $2,901.00 $3,730.00 $3,523.00 2025-03-11
73720 CPT MRI Low Ext, Non Joint, Wo/w Contrast Lt 16 5 $4,835.00 $4,835.00 $3,384.00 $4,351.00 $4,109.00 2025-03-11
73719 CPT MRI Low Extm, Non Joint, With Contrast Lt 16 5 $4,391.00 $4,391.00 $3,074.00 $3,952.00 $3,732.00 2025-03-11
73722 CPT MRI Low Extrem, Joint, With Contrast-lt 16 5 $4,354.00 $4,354.00 $3,048.00 $3,918.00 $3,701.00 2025-03-11
73721 CPT MRI Low Extrem, Joint, Without Contrast - Lt 16 5 $4,069.00 $4,069.00 $2,848.00 $3,662.00 $3,459.00 2025-03-11
73723 CPT MRI Low Extrem, Joint, Wo/w Contrast-lt 16 5 $5,680.00 $5,680.00 $3,976.00 $5,112.00 $4,828.00 2025-03-11
73718 CPT MRI Low Extrem, Non Joint, Without Contrast - Lt 16 5 $4,095.00 $4,095.00 $2,867.00 $3,686.00 $3,481.00 2025-03-11
72149 CPT MRI Lumbar Spine With Contrast 16 5 $4,912.00 $4,912.00 $3,439.00 $4,421.00 $4,175.00 2025-03-11
72148 CPT MRI Lumbar Spine Without Contrast 16 5 $4,474.00 $4,474.00 $3,132.00 $4,027.00 $3,803.00 2025-03-11
72158 CPT MRI Lumbar Spine Wo/w Contrast 16 5 $5,680.00 $5,680.00 $3,976.00 $5,112.00 $4,828.00 2025-03-11
70542 CPT MRI Orbit/Face/Neck With Contrast 16 5 $4,391.00 $4,391.00 $3,074.00 $3,952.00 $3,732.00 2025-03-11
70540 CPT MRI Orbit/Face/Neck Without Contrast 16 5 $4,095.00 $4,095.00 $2,867.00 $3,686.00 $3,481.00 2025-03-11
70543 CPT MRI Orbit/Face/Neck Wo/w Contrast 16 5 $4,469.00 $4,469.00 $3,128.00 $4,022.00 $3,798.00 2025-03-11
72196 CPT MRI Pelvis With Contrast 16 5 $3,701.00 $3,701.00 $2,591.00 $3,331.00 $3,146.00 2025-03-11
72195 CPT MRI Pelvis Without Contrast 16 5 $3,405.00 $3,405.00 $2,384.00 $3,065.00 $2,895.00 2025-03-11
72197 CPT MRI Pelvis Wo/w Con 16 5 $4,145.00 $4,145.00 $2,901.00 $3,730.00 $3,523.00 2025-03-11
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 24 24 $4,144.51 $4,144.51 $950.00 $3,730.06 $3,004.77 2026-03-25
74182 HCPCS MRI Scan Of Abdomen With Contrast 24 24 $3,700.99 $3,700.99 $950.00 $3,330.89 $2,683.22 2026-03-25
74181 HCPCS MRI Scan Of Abdomen Without Contrast 24 24 $3,405.38 $3,405.38 $582.84 $3,064.84 $2,468.90 2026-03-25
73220 HCPCS MRI Scan Of Arm Before And After Contrast 72 24 $4,538.93 $4,538.93 $950.00 $4,085.04 $3,290.72 2026-03-25
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 72 24 $5,092.75 $5,092.75 $950.00 $4,583.48 $3,692.24 2026-03-25
73222 HCPCS MRI Scan Of Arm Joint With Contrast 72 24 $4,353.63 $4,353.63 $950.00 $3,918.27 $3,156.38 2026-03-25
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 96 24 $4,057.99 $4,057.99 $193.75 $3,652.19 $2,868.79 2026-03-25
73219 HCPCS MRI Scan Of Arm With Contrast 72 24 $3,799.85 $3,799.85 $950.00 $3,419.87 $2,754.89 2026-03-25
73218 HCPCS MRI Scan Of Arm Without Contrast 72 24 $3,799.85 $3,799.85 $582.84 $3,419.87 $2,754.89 2026-03-25
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 60 24 $4,108.32 $4,108.32 $950.00 $3,796.97 $3,087.89 2026-03-25
73225 HCPCS MRI Scan Of Blood Vessels Of Arm 48 24 $4,538.93 $4,538.93 $950.00 $4,085.04 $3,290.72 2026-03-25
71555 HCPCS MRI Scan Of Blood Vessels Of Chest 24 24 $4,144.51 $4,144.51 $950.00 $3,730.06 $3,004.77 2026-03-25
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 24 24 $5,045.46 $5,045.46 $950.00 $4,540.91 $3,657.96 2026-03-25
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 24 24 $3,769.81 $3,769.81 $950.00 $3,392.83 $2,733.11 2026-03-25
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 24 24 $3,474.16 $3,474.16 $950.00 $3,126.74 $2,518.76 2026-03-25
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 126 24 $4,834.52 $4,834.52 $950.00 $4,351.10 $3,625.90 2026-03-25
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 24 24 $4,213.29 $4,213.29 $950.00 $3,791.96 $3,054.64 2026-03-25
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 24 24 $3,769.81 $3,769.81 $950.00 $3,392.83 $2,733.11 2026-03-25
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 24 24 $3,474.16 $3,474.16 $950.00 $3,126.74 $2,518.76 2026-03-25
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 24 24 $4,144.51 $4,144.51 $950.00 $3,730.06 $3,004.77 2026-03-25
77084 HCPCS MRI Scan Of Bone Marrow 24 24 $4,144.51 $4,144.51 $582.84 $3,730.06 $3,004.77 2026-03-25
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 24 24 $4,468.53 $4,468.53 $950.00 $4,021.68 $3,239.68 2026-03-25
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 24 24 $4,391.08 $4,391.08 $950.00 $3,951.97 $3,183.53 2026-03-25
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 24 24 $4,095.42 $4,095.42 $582.84 $3,685.88 $2,969.18 2026-03-25
70553 HCPCS MRI Scan Of Brain Before And After Contrast 24 24 $5,679.75 $5,679.75 $950.00 $5,111.78 $4,117.82 2026-03-25
70552 HCPCS MRI Scan Of Brain With Contrast 24 24 $4,912.20 $4,912.20 $950.00 $4,420.98 $3,561.35 2026-03-25
70551 HCPCS MRI Scan Of Brain Without Contrast 24 24 $4,095.42 $4,095.42 $582.84 $3,685.88 $2,969.18 2026-03-25
71552 HCPCS MRI Scan Of Chest Before And After Contrast 24 24 $4,144.51 $4,144.51 $950.00 $3,730.06 $3,004.77 2026-03-25
71551 HCPCS MRI Scan Of Chest With Contrast 24 24 $3,700.99 $3,700.99 $950.00 $3,330.89 $2,683.22 2026-03-25
71550 HCPCS MRI Scan Of Chest Without Contrast 24 24 $3,405.38 $3,405.38 $582.84 $3,064.84 $2,468.90 2026-03-25
70336 HCPCS MRI Scan Of Jaw Joint 48 24 $4,057.99 $4,057.99 $582.84 $3,652.19 $2,942.04 2026-03-25
73720 HCPCS MRI Scan Of Leg Before And After Contrast 72 24 $4,834.56 $4,834.56 $950.00 $4,351.10 $3,505.06 2026-03-25
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 72 24 $5,679.64 $5,679.64 $950.00 $5,111.68 $4,117.74 2026-03-25
73722 HCPCS MRI Scan Of Leg Joint With Contrast 72 24 $4,353.63 $4,353.63 $950.00 $3,918.27 $3,156.38 2026-03-25
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 72 24 $4,069.05 $4,069.05 $582.84 $3,662.15 $2,950.07 2026-03-25
73719 HCPCS MRI Scan Of Leg With Contrast 48 24 $4,391.08 $4,391.08 $950.00 $3,951.97 $3,183.53 2026-03-25
73718 HCPCS MRI Scan Of Leg Without Contrast 48 24 $4,095.42 $4,095.42 $582.84 $3,685.88 $2,969.18 2026-03-25
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 24 24 $5,679.64 $5,679.64 $950.00 $5,111.68 $4,117.74 2026-03-25
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 24 24 $4,912.20 $4,912.20 $950.00 $4,420.98 $3,561.35 2026-03-25
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 48 24 $4,474.09 $4,474.09 $582.84 $4,026.68 $3,243.72 2026-03-25
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 24 24 $5,679.75 $5,679.75 $950.00 $5,111.78 $4,117.82 2026-03-25
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 24 24 $4,973.73 $4,973.73 $950.00 $4,476.36 $3,605.95 2026-03-25
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 48 24 $4,523.02 $4,523.02 $582.84 $4,070.72 $3,279.19 2026-03-25
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 24 24 $4,144.51 $4,144.51 $950.00 $3,730.06 $3,004.77 2026-03-25
72196 HCPCS MRI Scan Of Pelvis With Contrast 24 24 $3,700.99 $3,700.99 $950.00 $3,330.89 $2,683.22 2026-03-25
72195 HCPCS MRI Scan Of Pelvis Without Contrast 24 24 $3,405.38 $3,405.38 $582.84 $3,064.84 $2,468.90 2026-03-25
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 24 24 $5,679.64 $5,679.64 $950.00 $5,111.68 $4,117.74 2026-03-25
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 24 24 $4,973.73 $4,973.73 $950.00 $4,476.36 $3,605.95 2026-03-25
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 48 24 $4,144.51 $4,144.51 $582.84 $3,730.06 $3,004.77 2026-03-25
610 OTHER MRI Shoulder Rt Wo 19 10 $3,570.81 — $950.00 $4,033.21 $3,106.60 2026-08-01
72157 CPT MRI Thorac Spine Wo/w Contrast 16 5 $5,680.00 $5,680.00 $3,976.00 $5,112.00 $4,828.00 2025-03-11
72147 CPT MRI Thoracic Spine With Contrast 16 5 $4,974.00 $4,974.00 $3,482.00 $4,476.00 $4,228.00 2025-03-11
72146 CPT MRI Thoracic Spine Without Contrast 16 5 $4,523.00 $4,523.00 $3,166.00 $4,071.00 $3,845.00 2025-03-11
70336 CPT MRI Tmj Joint(S) 16 5 $4,058.00 $4,058.00 $2,841.00 $3,652.00 $3,449.00 2025-03-11
73219 CPT MRI Up Extr Non Joint W Contrast-lt 16 5 $3,800.00 $3,800.00 $2,660.00 $3,420.00 $3,230.00 2025-03-11
73218 CPT MRI Up Extr Non Joint Without Contrast-lt 16 5 $3,800.00 $3,800.00 $2,660.00 $3,420.00 $3,230.00 2025-03-11
73220 CPT MRI Up Extr, Non Joint, Wo/w Contr-lt 16 5 $4,539.00 $4,539.00 $3,177.00 $4,085.00 $3,858.00 2025-03-11
73222 CPT MRI Up Extrem, Any Joint, W/contrast-lt 16 5 $4,354.00 $4,354.00 $3,048.00 $3,918.00 $3,701.00 2025-03-11
73221 CPT MRI Up Extrem, Any Joint, Without Contrast - Lt 16 5 $4,058.00 $4,058.00 $2,841.00 $3,652.00 $3,449.00 2025-03-11
73223 CPT MRI Up Extrem, Any Joint, Wo/w Contr-lt 16 5 $5,093.00 $5,093.00 $3,565.00 $4,583.00 $4,329.00 2025-03-11
77084 CPT MRI-bone Marrow Blood Supply 16 5 $4,145.00 $4,145.00 $2,901.00 $3,730.00 $3,523.00 2025-03-11
81229 CPT Msh6 Gene Known Variants 16 5 $2,704.00 $2,704.00 $1,893.00 $2,434.00 $2,298.00 2025-03-11
72265 CPT Myelography Lumbar 16 5 $2,578.00 $2,578.00 $1,805.00 $2,320.00 $2,191.00 2025-03-11
78709 CPT Nm Kidney, With Vasc Flow, Mult, Wo/w Phar 16 5 $3,390.00 $3,390.00 $2,373.00 $3,051.00 $2,881.00 2025-03-11
78472 CPT Nm Muga Single Study, Single 16 5 $3,494.00 $3,494.00 $2,446.00 $3,145.00 $2,970.00 2025-03-11
78452 CPT Nm Myocardial Perfus,Spect,Mltp Stdy R/e 16 5 $2,637.00 $2,637.00 $1,846.00 $2,373.00 $2,241.00 2025-03-11
78452 HCPCS Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 24 24 $2,636.84 $2,636.84 $776.55 $2,373.16 $2,109.47 2026-03-25
78709 HCPCS Nuclear Medicine Studies Of Kidney, Blood Flow, And Function 24 24 $3,389.62 $3,389.62 $887.62 $3,050.66 $2,542.22 2026-03-25
78472 HCPCS Nuclear Medicine Study Of Heart Pumping Function By Labeling Red Blood Cells Wit… 24 24 $3,494.21 $3,494.21 $887.62 $3,144.79 $2,620.66 2026-03-25
26785 CPT Open Phalanx Fx With Or Without Manip 16 5 $3,147.00 $3,147.00 $2,203.00 $2,833.00 $2,675.00 2025-03-11
26765 CPT Open Tx, Dist Phal Fx, Fing/Thmb, Ea 16 5 $5,343.00 $5,343.00 $3,740.00 $4,808.00 $4,541.00 2025-03-11
3600006 CDM Operating Room Services - General Classification 20 20 $20,688.00 $20,688.00 $6,092.62 $18,619.20 $16,550.40 2026-03-25
3600005 CDM Operating Room Services - General Classification 20 20 $16,554.00 $16,554.00 $4,875.15 $14,898.60 $13,243.20 2026-03-25
3600004 CDM Operating Room Services - General Classification 20 20 $11,500.00 $11,500.00 $3,386.75 $10,350.00 $9,200.00 2026-03-25
3600015 CDM Operating Room Services - General Classification 20 20 $7,426.00 $7,426.00 $2,186.96 $6,683.40 $5,940.80 2026-03-25
3600003 CDM Operating Room Services - General Classification 20 20 $6,157.00 $6,157.00 $1,813.24 $5,541.30 $4,925.60 2026-03-25
3600012 CDM Operating Room Services - General Classification 20 20 $5,296.00 $5,296.00 $1,559.67 $4,766.40 $4,236.80 2026-03-25
3600002 CDM Operating Room Services - General Classification 20 20 $3,796.00 $3,796.00 $1,117.92 $3,416.40 $3,036.80 2026-03-25
22510 CPT Perq Vertebroplasty, Cervicothoracic Injection 16 5 $2,977.00 $2,977.00 $2,084.00 $2,679.00 $2,530.00 2025-03-11
36568 CPT Picc Line Insert < 5yrs Without Imaging 16 5 $2,678.00 $2,678.00 $1,875.00 $2,410.00 $2,276.00 2025-03-11
36573 CPT Picc Line Insert >5 Yrs /With Imaging 16 5 $3,698.00 $3,698.00 $2,589.00 $3,328.00 $3,143.00 2025-03-11
36569 CPT Picc Line Insert>5yrs Without Imaging 24 5 $3,831.00 $3,831.00 $2,682.00 $3,448.00 $3,256.50 2025-03-11
95782 CPT Polysom <6 Yrs 4/> Paramtrs Attended 32 5 $4,170.50 $4,170.50 $2,876.00 $3,809.00 $3,533.50 2025-03-11
95811 CPT Polysomnograph With Cpap 16 5 $5,316.00 $5,316.00 $3,721.00 $4,784.00 $4,518.00 2025-03-11
95810 CPT Polysomnography, 4 Or > Param 16 5 $4,232.00 $4,232.00 $2,962.00 $3,809.00 $3,597.00 2025-03-11
PC9820083 CDM Pro Bbl Heroic Body Back, 5 Tx 6 6 $4,000.00 $4,000.00 $2,480.00 $3,400.00 $3,400.00 2026-03-25
PC9820085 CDM Pro Bbl Heroic Body Full Legs, 5 Tx 6 6 $4,000.00 $4,000.00 $2,480.00 $3,400.00 $3,400.00 2026-03-25
PC9820047 CDM Pro Contour Trl Deep Resurface Full Face 6 6 $3,500.00 $3,500.00 $2,170.00 $2,975.00 $2,975.00 2026-03-25
PC9820107 CDM Pro Morpheus8 Burst Deep Large Area 8x11in, Pkg 3 6 6 $4,500.00 $4,500.00 $2,790.00 $3,825.00 $3,825.00 2026-03-25
PC9820106 CDM Pro Morpheus8 Burst Deep Small Area 4x10in, Pkg 3 6 6 $3,500.00 $3,500.00 $2,170.00 $2,975.00 $2,975.00 2026-03-25
PC9820088 CDM Pro Morpheus8 Burst Face & Neck, 3 Tx 6 6 $3,500.00 $3,500.00 $2,170.00 $2,975.00 $2,975.00 2026-03-25
PC9820086 CDM Pro Morpheus8 Burst Full Face, 3 Tx 6 6 $3,000.00 $3,000.00 $1,860.00 $2,550.00 $2,550.00 2026-03-25
PC9820094 CDM Pro Morpheus8 Burst Resurface Face & Neck, 3 Tx 6 6 $2,700.00 $2,700.00 $1,674.00 $2,295.00 $2,295.00 2026-03-25
28192 HCPCS Removal Of Foreign Body Of Foot Tissue, Deep 72 24 $3,977.19 $3,977.19 $193.75 $4,322.57 $2,982.89 2026-03-25
11012 HCPCS Removal Of Foreign Material From Skin, Tissue, Muscle, And Bone At Open Broken A… 24 24 $2,740.57 $2,740.57 $807.10 $2,466.51 $2,192.46 2026-03-25
21552 HCPCS Removal Of Growth Of Soft Tissue Under Skin Of Neck Or Front Of Chest, 3.0 Cm Or… 24 24 $3,384.19 $3,384.19 $996.64 $5,592.86 $2,707.35 2026-03-25
27632 HCPCS Removal Of Growth Under Skin Of Leg Or Ankle, 3.0 Cm Or More 24 24 $4,293.08 $4,293.08 $1,264.31 $7,556.31 $3,434.46 2026-03-25
28119 HCPCS Removal Of Heel Bone Spur 72 24 $3,855.04 $3,855.04 $1,135.31 $5,162.32 $3,084.03 2026-03-25
28119 CPT Removal Of Heel Spur Lt 16 5 $3,855.00 $3,855.00 $2,699.00 $3,470.00 $3,277.00 2025-03-11
15828 HCPCS Removal Of Wrinkles And Extra Skin Of Cheeks, Chin, And Neck 13 13 $6,600.00 $6,600.00 $2,032.36 $6,600.00 $5,610.00 2026-03-25
15825 HCPCS Removal Of Wrinkles And Extra Skin Of Neck 13 13 $4,400.00 $4,400.00 $1,075.99 $4,400.00 $3,740.00 2026-03-25
15829 HCPCS Removal Of Wrinkles And Extra Skin With Grafting Of Cheeks, Chin, And Neck 13 13 $8,250.00 $8,250.00 $2,271.73 $8,250.00 $7,012.50 2026-03-25
28192 CPT Remove Fb Foot, Deep Rt 16 5 $3,861.00 $3,861.00 $2,703.00 $3,475.00 $3,282.00 2025-03-11
11770 CPT Remove Pilonidal Cyst Simple 16 5 $3,385.00 $3,385.00 $2,370.00 $3,047.00 $2,877.00 2025-03-11
29806 HCPCS Repair Of Shoulder Joint Capsule Using An Endoscope 24 24 $4,174.92 $4,174.92 $193.75 $13,030.86 $3,339.94 2026-03-25
26418 HCPCS Repair Of Tendon On Top Side Of Finger 24 24 $3,693.89 $3,693.89 $900.00 $3,324.50 $2,955.11 2026-03-25
27446 HCPCS Replacement Of Knee Joint On Side Of Knee 24 24 $4,437.11 $4,437.11 $193.75 $22,917.50 $3,549.69 2026-03-25
26418 CPT Repr,Exten Tendon,Fing Without Fr Graft, Ea 16 5 $3,694.00 $3,694.00 $2,586.00 $3,325.00 $3,140.00 2025-03-11
27134 HCPCS Revision Of Thigh Bone And Hip Joint Prosthesis 24 24 $5,797.26 $5,797.26 $193.75 $22,917.50 $4,637.81 2026-03-25
1200003 CDM Room & Board - Semi-private (two Beds) - General Classification 12 12 $2,543.00 $2,543.00 $1,678.38 $2,288.70 $2,097.98 2026-03-25
PX-2000001 CDM Room & Care Intensive Care 16 5 $2,469.00 $2,469.00 $1,728.00 $2,222.00 $2,099.00 2025-03-11
PX-1200003 CDM Room & Care Semi-private Intermediate 16 5 $2,469.00 $2,469.00 $1,728.00 $2,222.00 $2,099.00 2025-03-11
PX-1210001 CDM Room & Care Semi-private Telemetry 16 5 $2,469.00 $2,469.00 $1,728.00 $2,222.00 $2,099.00 2025-03-11
11770 HCPCS Simple Removal Of Cyst Of Tailbone 24 24 $3,385.00 $3,385.00 $996.88 $3,046.50 $2,708.00 2026-03-25
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 24 24 $4,358.90 $4,358.90 $1,283.70 $3,923.01 $3,269.18 2026-03-25
95782 HCPCS Sleep Study In Sleep Lab (younger Than 6 Years) 24 24 $4,358.90 $4,358.90 $1,283.70 $3,923.01 $3,269.18 2026-03-25
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 24 24 $5,475.28 $5,475.28 $1,612.47 $4,927.75 $4,106.46 2026-03-25
81445 CPT So Misc Targeted Genomic Seq Anlsys 81445 16 5 $4,489.00 $4,489.00 $3,142.00 $4,040.00 $3,816.00 2025-03-11
22510 HCPCS Stabilization Of Upper Spine Bone 24 24 $2,976.66 $2,976.66 $876.63 $11,919.65 $2,381.33 2026-03-25
2780001 CDM Supply Shell Code From Trans 20 20 $4,696.32 $4,696.32 $1,383.07 $4,226.69 $3,639.65 2026-03-25
PX-3600002 CDM Surgery, 1st 30 Minutes Level Ii 16 5 $3,685.00 $3,685.00 $2,580.00 $3,317.00 $3,133.00 2025-03-11
PX-3600003 CDM Surgery, 1st 30 Minutes Level Iii 16 5 $5,978.00 $5,978.00 $4,185.00 $5,380.00 $5,081.00 2025-03-11
PX-3600004 CDM Surgery, 1st 30 Minutes Level IV 16 5 $11,165.00 $11,165.00 $7,816.00 $10,049.00 $9,490.00 2025-03-11
PX-3600005 CDM Surgery, 1st 30 Minutes Level V 16 5 $16,072.00 $16,072.00 $11,250.00 $14,465.00 $13,661.00 2025-03-11
PX-3600006 CDM Surgery, 1st 30 Minutes Level Vi 16 5 $20,085.00 $20,085.00 $14,060.00 $18,077.00 $17,072.00 2025-03-11
PX-3600012 CDM Surgery, Ea Add'l 30 Min Level V 16 5 $5,142.00 $5,142.00 $3,599.00 $4,628.00 $4,370.00 2025-03-11
PX-3600015 CDM Surgery, Ea Add'l 30 Min Level Vi 16 5 $7,210.00 $7,210.00 $5,047.00 $6,489.00 $6,129.00 2025-03-11
23605 CPT Treat Humerus Fracture-rt 16 5 $3,586.00 $3,586.00 $2,510.00 $3,228.00 $3,048.00 2025-03-11
27532 CPT Treat Knee Fracture-right 16 5 $3,066.00 $3,066.00 $2,146.00 $2,759.00 $2,606.00 2025-03-11
26765 HCPCS Treatment Of Broken End Of Finger Or Thumb 24 24 $5,502.78 $5,502.78 $900.00 $12,742.22 $4,402.22 2026-03-25
26785 HCPCS Treatment Of Dislocated Finger Joint 24 24 $3,241.86 $3,241.86 $900.00 $12,742.22 $2,593.49 2026-03-25
28002 CPT Treatment Of Foot Infection-lt 16 5 $3,063.00 $3,063.00 $2,144.00 $2,756.00 $2,603.00 2025-03-11
J3590 HCPCS Unclassified Biologics 20 20 $3,674.30 $3,674.30 $1,082.08 $3,306.87 $2,939.44 2026-03-25
Q4309 HCPCS Via Matrix, Per Square Centimeter 44 20 $3,034.00 $3,034.00 $193.75 $2,730.60 $2,351.35 2026-03-25
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