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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

PANA COMMUNITY HOSPITAL

Pana, IL · CCN 141341 · Rates published

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You selected 27447 (CPT)

This facility hasn’t published a payer-negotiated rate for this exact code. See its full rate list below.

636 distinct procedures filed
29 distinct payers
4,261 rate rows
2025-11-03 last MRF observed
Data quality

4,077 of 4,261 rate rows are consumer-grade (95.7%)

184 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
professional (physician) fee — not the facility price 176
exceeds 10× this hospital's gross charge — excluded from medians 6
placeholder amount (≤ $0.02) — excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://machine-readable-files.com/pana-community-hospital/370602326_Pana-Community-Hospital-Association_standardcharges.csv
Found on page https://panahospital.com/cms-hpt.txt
Discovered viaCMS hospital list
Last fetch not_modified · 2026-07-19
Content fingerprint 23476375322f0800… · 2,320,397 bytes · first seen 2026-05-14

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
72156
CPT 		MRI Spine Cervical With + Without Contrast 3 $858.60 $4,474.58 $4,474.58 nat. median
$1,111
outlier · 4.0×
72133
CPT 		CT Spine Lumbar With + Without Contrast 1 $3,315.25 $3,315.25 $3,315.25 nat. median
$637
outlier · 5.2×
72146
CPT 		MRI Spine Thoracic Without Contrast 3 $849.75 $2,685.98 $2,685.98 nat. median
$791
outlier · 3.4×
74178
CPT 		74178 CT Abdomen And Pelvis With + Without Contrast 8 $640.61 $7,463.50 $2,172.52 nat. median
$1,024
outlier · 2.1×
19083
CPT 		US Breast Biopsy With US Guide Left 2 $1,012.15 $3,316.06 $2,164.11 nat. median
$2,151
1.0× median
27266
CPT 		27266 Closed Treatment Of Post Hip Arthroplasty Dislocation; Requiring Regional… 1 $2,033.98 $2,033.98 $2,033.98 nat. median
$2,048
1.0× median
78452
CPT 		Nm Myocardial Spect Rest And Stress Eo 14 $1,739.84 $6,309.38 $1,932.36 nat. median
$1,777
1.1× median
73723
CPT 		MRI Ankle With + Without Contrast Left 2 $1,035.47 $2,598.54 $1,817.01 nat. median
$1,210
1.5× median
J9217
HCPCS 		Leuprolide 22.5 Mg/3 Months Kit [pana] 1 $1,811.84 $1,811.84 $1,811.84 nat. median
$1,518
1.2× median
95811
CPT 		95811 Polysomnography W/cpap > 4 Parameters Charge 9 $1,446.52 $5,045.04 $1,667.07 nat. median
$1,923
0.9× median
95810
CPT 		95810 Polysomnography > 4 Parameters Observati Charge 2 $1,667.07 $1,667.07 $1,667.07 nat. median
$1,777
0.9× median
73720
CPT 		MRI Femur With + Without Contrast Left 4 $858.60 $2,698.22 $1,662.58 nat. median
$1,142
1.5× median
74177
CPT 		74177 CT Abdomen And Pelvis With Contrast 20 $641.11 $5,360.30 $1,639.80 nat. median
$968
1.7× median
36556
CPT 		36556 Insertion Of Non-tunneled Centrally Inserted Central Venous 4 $860.71 $2,314.08 $1,590.36 nat. median
$2,458
0.6× median
92950
CPT 		92950 Initial Cpr Charge 3 $462.18 $1,482.29 $1,481.15 nat. median
$589
outlier · 2.5×
74176
CPT 		74176 CT Abdomen And Pelvis Without Contrast 19 $641.11 $4,648.60 $1,418.88 nat. median
$697
outlier · 2.0×
72157
CPT 		MRI Spine Thoracic With + Without Contrast 3 $1,365.76 $4,261.40 $1,417.26 nat. median
$1,116
1.3× median
70553
CPT 		MRI Brain With + Without Contrastt - Bce 11 $858.60 $4,474.58 $1,395.26 nat. median
$1,137
1.2× median
64445
CPT 		64445 Sciatic Nerve Block Tech Fee 2 $349.46 $2,371.80 $1,360.63 nat. median
$1,014
1.3× median
76776
CPT 		76776 US Kidney Transplant With Doppler 1 $1,320.00 $1,320.00 $1,320.00 nat. median
$248
outlier · 5.3×
74185
CPT 		MRA Abdomen With + Without Contrast 1 $1,239.71 $1,239.71 $1,239.71 nat. median
$1,279
1.0× median
72197
CPT 		MRI Pelvis With + Without Contrast 5 $858.60 $3,891.14 $1,231.02 nat. median
$1,074
1.1× median
75635
CPT 		CT Angio Abdomen Aorta + Iliofemoral 2 $1,221.24 $1,234.98 $1,228.11 nat. median
$719
1.7× median
72191
CPT 		CT Angio Abdomen And Pelvis 1 $1,134.77 $1,134.77 $1,134.77 nat. median
$642
1.8× median
70496
CPT 		CT Angio Brain/Head 5 $783.33 $2,999.92 $1,134.77 nat. median
$760
1.5× median
71270
CPT 		71270 CT Chest With + Without Contrast 2 $1,084.88 $1,163.74 $1,124.31 nat. median
$681
1.7× median
74174
CPT 		74174 CT Angio Abdomen And Pelvis 2 $1,111.00 $1,111.00 $1,111.00 nat. median
$982
1.1× median
72148
CPT 		MRI Spine Lumbar Without Contrast 15 $508.89 $3,633.96 $1,109.19 nat. median
$797
1.4× median
72141
CPT 		MRI Spine Cervical Without Contrast 8 $508.50 $3,633.96 $1,105.39 nat. median
$785
1.4× median
70551
CPT 		MRI Brain Without Contrast 11 $508.89 $3,633.96 $1,099.67 nat. median
$791
1.4× median
74183
CPT 		MRI Abdomen With + Without Contrast 10 $858.60 $3,307.26 $991.87 nat. median
$1,106
0.9× median
27550
CPT 		27550 Closed Tx Knee Dislocation Without Anesthesia TechFee 1 $969.32 $969.32 $969.32 nat. median
$524
1.8× median
73221
CPT 		MRI Elbow Without Contrast Left 14 $508.50 $3,149.30 $961.25 nat. median
$843
1.1× median
73721
CPT 		MRI Ankle Without Contrast Left 12 $508.89 $3,149.30 $952.24 nat. median
$866
1.1× median
73718
CPT 		MRI Calcaneus Without Contrast Left 3 $508.89 $3,043.04 $922.80 nat. median
$886
1.0× median
70498
CPT 		70498 CT Angio Neck 1 $916.05 $916.05 $916.05 nat. median
$747
1.2× median
C8929
HCPCS 		US Echo 2d Complete With Contrast Eo 14 $846.09 $2,910.60 $913.27 nat. median
$1,361
0.7× median
93350
CPT 		US Stress Echo Eo 2 $912.57 $913.27 $912.92 nat. median
$822
1.1× median
71260
CPT 		71260 CT Chest With Contrast 13 $641.11 $2,924.46 $892.63 nat. median
$650
1.4× median
74170
CPT 		CT Abdomen With + Without Contrast 4 $641.11 $1,139.13 $886.22 nat. median
$720
1.2× median
71275
CPT 		71275 CT Angio Chest 12 $782.72 $2,999.92 $873.98 nat. median
$754
1.2× median
72158
CPT 		MRI Spine Lumbar With + Without Contrast 3 $857.94 $1,365.76 $858.60 nat. median
$1,103
0.8× median
73223
CPT 		MRI Elbow With + Without Contrast Left 1 $858.60 $858.60 $858.60 nat. median
$1,177
0.7× median
73220
CPT 		MRI Brachial Plexus With + Without Contrast Lt 1 $858.60 $858.60 $858.60 nat. median
$1,147
0.7× median
73222
CPT 		MRI Elbow With Contrast Left 4 $857.94 $3,182.30 $858.27 nat. median
$1,287
0.7× median
73722
CPT 		MRI Ankle With Contrast Left 3 $857.94 $3,030.72 $857.94 nat. median
$1,284
0.7× median
87799
CPT 		Bk Quant Pcr (Urine) Lc 1 $855.14 $855.14 $855.14 nat. median
$174
outlier · 4.9×
U0002
HCPCS 		Respiratory Panel 2.1 (BioFire) Covid Only 5 $18.02 $1,011.12 $828.43 nat. median
$58
outlier · 14.3×
70450
CPT 		CT Brain/Head Stroke Protocol 21 $641.11 $2,710.62 $827.36 nat. median
$456
1.8× median
36569
CPT 		Picc Placement Initial Tech Fee 3 $802.75 $2,314.08 $825.34 nat. median
$1,713
outlier · 0.5×

Other procedures at this hospital

Browse this hospital's 636 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
             
72156 CPT MRI Spine Cervical With + Without Contrast 3 3 $5,084.75 $5,084.75 $858.60 $4,474.58 $4,474.58 2025-11-03
72133 CPT CT Spine Lumbar With + Without Contrast 1 1 $3,481.25 $3,481.25 $3,315.25 $3,315.25 $3,315.25 2025-11-03
72146 CPT MRI Spine Thoracic Without Contrast 3 3 $3,052.25 $3,052.25 $849.75 $2,685.98 $2,685.98 2025-11-03
74178 CPT 74178 CT Abdomen And Pelvis With + Without Contrast 8 8 $8,481.25 $8,481.25 $640.61 $7,463.50 $2,172.52 2025-11-03
19083 CPT US Breast Biopsy With US Guide Left 2 2 $3,956.75 $3,956.75 $1,012.15 $3,316.06 $2,164.11 2025-11-03
27266 CPT 27266 Closed Treatment Of Post Hip Arthroplasty Dislocation; Requiring Regional … 1 1 $6,470.00 $6,470.00 $2,033.98 $2,033.98 $2,033.98 2025-11-03
78452 CPT Nm Myocardial Spect Rest And Stress Eo 14 14 $7,169.75 $7,169.75 $1,739.84 $6,309.38 $1,932.36 2025-11-03
73723 CPT MRI Ankle With + Without Contrast Left 2 2 $3,758.25 $3,758.25 $1,035.47 $2,598.54 $1,817.01 2025-11-03
J9217 HCPCS Leuprolide 22.5 Mg/3 Months Kit [pana] 1 1 $21,248.30 $21,248.30 $1,811.84 $1,811.84 $1,811.84 2025-11-03
95811 CPT 95811 Polysomnography W/cpap > 4 Parameters Charge 9 9 $5,733.00 $5,733.00 $1,446.52 $5,045.04 $1,667.07 2025-11-03
95810 CPT 95810 Polysomnography > 4 Parameters Observati Charge 2 2 $5,512.50 $5,512.50 $1,667.07 $1,667.07 $1,667.07 2025-11-03
73720 CPT MRI Femur With + Without Contrast Left 4 4 $3,459.25 $3,459.25 $858.60 $2,698.22 $1,662.58 2025-11-03
74177 CPT 74177 CT Abdomen And Pelvis With Contrast 20 20 $6,091.25 $6,091.25 $641.11 $5,360.30 $1,639.80 2025-11-03
36556 CPT 36556 Insertion Of Non-tunneled Centrally Inserted Central Venous 4 4 $3,226.50 $3,226.50 $860.71 $2,314.08 $1,590.36 2025-11-03
92950 CPT 92950 Initial Cpr Charge 3 3 $1,697.75 $1,697.75 $462.18 $1,482.29 $1,481.15 2025-11-03
74176 CPT 74176 CT Abdomen And Pelvis Without Contrast 19 19 $5,282.50 $5,282.50 $641.11 $4,648.60 $1,418.88 2025-11-03
72157 CPT MRI Spine Thoracic With + Without Contrast 3 3 $5,084.75 $5,084.75 $1,365.76 $4,261.40 $1,417.26 2025-11-03
70553 CPT MRI Brain With + Without Contrastt - Bce 11 11 $5,084.75 $5,084.75 $858.60 $4,474.58 $1,395.26 2025-11-03
64445 CPT 64445 Sciatic Nerve Block Tech Fee 2 2 $3,235.75 $3,235.75 $349.46 $2,371.80 $1,360.63 2025-11-03
76776 CPT 76776 US Kidney Transplant With Doppler 1 1 $1,500.00 $1,500.00 $1,320.00 $1,320.00 $1,320.00 2025-11-03
74185 CPT MRA Abdomen With + Without Contrast 1 1 $4,647.25 $4,647.25 $1,239.71 $1,239.71 $1,239.71 2025-11-03
72197 CPT MRI Pelvis With + Without Contrast 5 5 $4,421.75 $4,421.75 $858.60 $3,891.14 $1,231.02 2025-11-03
75635 CPT CT Angio Abdomen Aorta + Iliofemoral 2 2 $4,436.00 $4,436.00 $1,221.24 $1,234.98 $1,228.11 2025-11-03
70496 CPT CT Angio Brain/Head 5 5 $3,409.00 $3,409.00 $783.33 $2,999.92 $1,134.77 2025-11-03
72191 CPT CT Angio Abdomen And Pelvis 1 1 $4,436.00 $4,436.00 $1,134.77 $1,134.77 $1,134.77 2025-11-03
71270 CPT 71270 CT Chest With + Without Contrast 2 2 $4,241.00 $4,241.00 $1,084.88 $1,163.74 $1,124.31 2025-11-03
74174 CPT 74174 CT Angio Abdomen And Pelvis 2 2 $4,136.25 $4,136.25 $1,111.00 $1,111.00 $1,111.00 2025-11-03
72148 CPT MRI Spine Lumbar Without Contrast 15 15 $4,129.50 $4,129.50 $508.89 $3,633.96 $1,109.19 2025-11-03
72141 CPT MRI Spine Cervical Without Contrast 8 8 $4,129.50 $4,129.50 $508.50 $3,633.96 $1,105.39 2025-11-03
70551 CPT MRI Brain Without Contrast 11 11 $4,129.50 $4,129.50 $508.89 $3,633.96 $1,099.67 2025-11-03
74183 CPT MRI Abdomen With + Without Contrast 10 10 $3,758.25 $3,758.25 $858.60 $3,307.26 $991.87 2025-11-03
27550 CPT 27550 Closed Tx Knee Dislocation Without Anesthesia TechFee 1 1 $975.00 $975.00 $969.32 $969.32 $969.32 2025-11-03
73221 CPT MRI Elbow Without Contrast Left 14 14 $3,578.75 $3,578.75 $508.50 $3,149.30 $961.25 2025-11-03
73721 CPT MRI Ankle Without Contrast Left 12 12 $3,578.75 $3,578.75 $508.89 $3,149.30 $952.24 2025-11-03
73718 CPT MRI Calcaneus Without Contrast Left 3 3 $3,458.00 $3,458.00 $508.89 $3,043.04 $922.80 2025-11-03
70498 CPT 70498 CT Angio Neck 1 1 $3,409.00 $3,409.00 $916.05 $916.05 $916.05 2025-11-03
C8929 HCPCS US Echo 2d Complete With Contrast Eo 14 14 $3,307.50 $3,307.50 $846.09 $2,910.60 $913.27 2025-11-03
93350 CPT US Stress Echo Eo 2 2 $3,032.00 $3,032.00 $912.57 $913.27 $912.92 2025-11-03
71260 CPT 71260 CT Chest With Contrast 13 13 $3,323.25 $3,323.25 $641.11 $2,924.46 $892.63 2025-11-03
74170 CPT CT Abdomen With + Without Contrast 4 4 $4,241.00 $4,241.00 $641.11 $1,139.13 $886.22 2025-11-03
71275 CPT 71275 CT Angio Chest 16 12 $3,409.00 $3,409.00 $782.72 $2,999.92 $873.98 2025-11-03
73223 CPT MRI Elbow With + Without Contrast Left 1 1 $3,758.25 $3,758.25 $858.60 $858.60 $858.60 2025-11-03
73220 CPT MRI Brachial Plexus With + Without Contrast Lt 1 1 $3,009.75 $3,009.75 $858.60 $858.60 $858.60 2025-11-03
72158 CPT MRI Spine Lumbar With + Without Contrast 3 3 $5,084.75 $5,084.75 $857.94 $1,365.76 $858.60 2025-11-03
73222 CPT MRI Elbow With Contrast Left 4 4 $3,616.25 $3,616.25 $857.94 $3,182.30 $858.27 2025-11-03
73722 CPT MRI Ankle With Contrast Left 3 3 $3,616.25 $3,616.25 $857.94 $3,030.72 $857.94 2025-11-03
87799 CPT Bk Quant Pcr (Urine) Lc 1 1 $779.00 $779.00 $855.14 $855.14 $855.14 2025-11-03
U0002 HCPCS Respiratory Panel 2.1 (BioFire) Covid Only 5 5 $218.75 $218.75 $18.02 $1,011.12 $828.43 2025-11-03
70450 CPT CT Brain/Head Stroke Protocol 21 21 $3,080.25 $3,080.25 $641.11 $2,710.62 $827.36 2025-11-03
36569 CPT Picc Placement Initial Tech Fee 3 3 $3,009.25 $3,009.25 $802.75 $2,314.08 $825.34 2025-11-03
72125 CPT CT Spine Cervical Without Contrast 15 15 $2,939.75 $2,939.75 $225.06 $2,586.98 $789.61 2025-11-03
78226 CPT Nm Hepatobiliary Imaging 1 1 $1,507.50 $1,507.50 $775.00 $775.00 $775.00 2025-11-03
78227 CPT Nm Hepatobiliary Imaging With Drug 4 4 $2,376.75 $2,376.75 $631.29 $2,091.54 $774.40 2025-11-03
74181 CPT MRI Abdomen Without Contrast 1 1 $3,009.75 $3,009.75 $773.36 $773.36 $773.36 2025-11-03
36584 CPT Picc Placement Repair/replace Tech Fee 1 1 $3,009.25 $3,009.25 $769.74 $769.74 $769.74 2025-11-03
93306 CPT US Echocardiogram 2d + M-mode 12 12 $2,756.25 $2,756.25 $735.26 $2,425.50 $767.34 2025-11-03
72195 CPT MRI Pelvis Without Contrast 1 1 $3,009.75 $3,009.75 $766.89 $766.89 $766.89 2025-11-03
72131 CPT CT Spine Lumbar Without Contrast 11 11 $2,939.75 $2,939.75 $225.06 $2,586.98 $752.34 2025-11-03
8163853 CDM Room/bed: Isolation 5 5 $2,159.00 $2,159.00 $535.45 $10,760.64 $746.93 2025-11-03
8078890 CDM Room/bed: Semi-private 5 5 $1,395.00 $1,395.00 $535.45 $10,760.64 $746.93 2025-11-03
2120847 CDM Room/bed: Telemetry 5 5 $2,159.00 $2,159.00 $535.45 $10,760.64 $746.93 2025-11-03
8404420 CDM Room/bed: Monitored Bed 5 5 $2,159.00 $2,159.00 $535.45 $10,760.64 $746.93 2025-11-03
2120840 CDM Room/bed: Inpatient 5 5 $1,395.00 $1,395.00 $535.45 $10,760.64 $746.93 2025-11-03
8163846 CDM Room/bed: Respite 5 5 $1,395.00 $1,395.00 $535.45 $10,760.64 $746.93 2025-11-03
73218 CPT MRI Forearm Without Contrast Left 2 2 $3,009.75 $3,009.75 $508.89 $956.97 $732.93 2025-11-03
74160 CPT 74160 CT Abdomen With Contrast 2 2 $2,888.00 $2,888.00 $641.11 $775.72 $708.41 2025-11-03
74150 CPT 74150 CT Chest Without Contrast 4 4 $2,610.25 $2,610.25 $696.32 $2,187.46 $702.59 2025-11-03
70486 CPT CT Maxillofacial Without Contrast 11 11 $2,610.25 $2,610.25 $224.89 $2,297.02 $701.12 2025-11-03
73700 CPT CT Ankle With Contrast Right 7 7 $2,610.25 $2,610.25 $225.06 $2,187.46 $701.12 2025-11-03
95816 CPT EEG Pro Fee 4 4 $251.75 $251.75 $698.81 $925.54 $698.81 2025-11-03
8078891 CDM Room/bed: Swingbed 4 4 $1,019.00 $1,019.00 $535.45 $998.82 $692.50 2025-11-03
27369 CPT 27369 Arthrography Knee Injection Procedure 1 1 $1,285.75 $1,285.75 $690.79 $690.79 $690.79 2025-11-03
23350 CPT 23350 Arthrography Shoulder Injection Proc 4 4 $1,283.25 $1,283.25 $690.25 $1,129.26 $690.52 2025-11-03
27093 CPT 27093 Arthrography Hip Injection Procedure 3 3 $1,285.75 $1,285.75 $690.25 $1,077.56 $690.25 2025-11-03
71250 CPT 71250 CT Abdomen Without Contrast 16 16 $2,435.50 $2,435.50 $224.89 $2,297.02 $687.18 2025-11-03
76641 CPT US Breast Complete Left 2 2 $1,285.75 $1,285.75 $230.34 $1,130.91 $680.62 2025-11-03
P9035 HCPCS E5030 Aph Plt Acda Lr Bm 1 1 $2,505.50 $2,505.50 $672.98 $672.98 $672.98 2025-11-03
73551 CPT Xr Femur 1 View Right 1 1 $440.00 $440.00 $672.54 $672.54 $672.54 2025-11-03
70544 CPT MRA Brain/Head Without Contrast 1 1 $2,559.75 $2,559.75 $654.78 $654.78 $654.78 2025-11-03
70491 CPT CT Neck Soft Tissue With Contrast 7 7 $2,888.00 $2,888.00 $640.61 $779.22 $651.83 2025-11-03
64447 CPT Adductor Canal Block Tech Fee 2 2 $1,123.50 $1,123.50 $301.78 $988.68 $645.23 2025-11-03
70487 CPT CT Maxillofacial With Contrast 2 2 $2,763.25 $2,763.25 $641.11 $641.11 $641.11 2025-11-03
70470 CPT CT Brain/Head With + Without Contrast 1 1 $3,690.00 $3,690.00 $641.11 $641.11 $641.11 2025-11-03
73701 CPT CT Ankle With Contrast Left 4 4 $2,509.25 $2,509.25 $641.11 $2,208.14 $641.11 2025-11-03
20611 CPT US Guided Joint Inj/Asp Hip Lt Eo 6 6 $1,033.50 $1,033.50 $264.37 $967.65 $627.32 2025-11-03
0202U OTHER Respiratory Panel 2.1 (BioFire) 11 11 $1,149.00 $1,149.00 $289.54 $1,011.12 $614.60 2025-11-03
77002 CPT 77002 Fluoroscopic Guidance For Needle Placeme 7 7 $2,324.00 $2,324.00 $426.02 $2,045.12 $585.63 2025-11-03
49083 CPT US Paracentesis 1 1 $2,516.00 $2,516.00 $554.13 $554.13 $554.13 2025-11-03
72128 CPT CT Spine Thoracic Without Contrast 5 5 $1,928.75 $1,928.75 $518.06 $1,697.30 $536.96 2025-11-03
76817 CPT 76817 US OB Transvaginal 3 3 $774.25 $774.25 $106.09 $681.34 $535.24 2025-11-03
99285 CPT 99285 Ed Visit E M Patient, Lev 5, Req Med Approp Hstry/exam/high Mdm, Cc 23 23 $1,463.25 $1,463.25 $90.00 $1,436.48 $518.33 2025-11-03
73200 CPT CT Finger(s) Without Contrast Left 5 5 $1,836.75 $1,836.75 $225.06 $1,749.25 $518.06 2025-11-03
76801 CPT 76801 US OB < 14 Weeks Single 2 2 $883.00 $883.00 $212.18 $777.04 $494.61 2025-11-03
12051 CPT 12051 Repair Intermediate F/e/e/n/l&/muc 2.5 Cm/< TechFee 1 1 $547.00 $547.00 $481.36 $481.36 $481.36 2025-11-03
92522 CPT Speech Sound Production Eval Charge 1 1 $512.75 $512.75 $480.42 $480.42 $480.42 2025-11-03
92610 CPT Eval Of Oral And Pharyngeal Swallowing Fx Chg 2 2 $1,097.75 $1,097.75 $480.42 $480.42 $480.42 2025-11-03
92523 CPT Speech Sound Prod With Language Charge 5 5 $512.75 $512.75 $137.72 $480.42 $480.04 2025-11-03
72192 CPT CT Pelvis Without Contrast 4 4 $2,610.25 $2,610.25 $225.06 $701.12 $463.09 2025-11-03
99284 CPT 99284 Ed Visit E&m Patient, Lev 4, Req Med Approp Hstry/exam/moderate Mdm, Cc 22 22 $901.75 $901.75 $90.00 $886.21 $460.57 2025-11-03
12032 CPT 12032 Repair Intermediate S/a/t/e 2.6-7.5 Cm TechFee 1 1 $547.00 $547.00 $458.26 $458.26 $458.26 2025-11-03
94002 CPT 94002 Ventilator First Day Charge 1 1 $1,670.00 $1,670.00 $450.58 $450.58 $450.58 2025-11-03
23650 CPT 23650 Clsd Tx Shoulder Dislc W/manipulation Without Anes TechFee 2 2 $470.00 $470.00 $413.60 $460.60 $437.10 2025-11-03
78264 CPT Nm Gastric Emptying Study 1 1 $1,600.75 $1,600.75 $432.20 $432.20 $432.20 2025-11-03
92507 CPT Tx Of Speech/Lang/Voice/Comm/Auditory Chg 5 5 $425.75 $425.75 $114.35 $425.75 $425.75 2025-11-03
70328 CPT Xr Tmj Open And Closed Left 1 1 $505.75 $505.75 $423.72 $423.72 $423.72 2025-11-03
70250 CPT Xr Skull < 4 Views 1 1 $481.25 $481.25 $423.50 $423.50 $423.50 2025-11-03
73040 CPT 73040 Arthrography Shoulder Radiologic Exam 1 1 $466.00 $466.00 $410.08 $410.08 $410.08 2025-11-03
78306 CPT 78306 Nm Bone Imaging Whole Body 1 1 $1,502.50 $1,502.50 $403.58 $403.58 $403.58 2025-11-03
93970 CPT US Upper Ext Venous Duplex Bilateral 8 8 $998.50 $998.50 $354.89 $663.98 $382.51 2025-11-03
Q3014 HCPCS Q3014 Ed Telehealth Facility Fee TechFee 5 5 $1,400.00 $1,400.00 $30.51 $1,400.00 $376.20 2025-11-03
93880 CPT US Carotid Duplex Bilateral 13 13 $1,364.00 $1,364.00 $354.89 $1,200.32 $366.37 2025-11-03
93017 CPT Stress Test 14 14 $1,339.75 $1,339.75 $144.69 $1,178.98 $359.85 2025-11-03
76856 CPT 76856 US Pelvic Complete 10 10 $982.75 $982.75 $252.48 $864.82 $355.16 2025-11-03
76770 CPT US Retroperitoneal Complete 11 11 $1,500.00 $1,500.00 $265.78 $870.76 $355.16 2025-11-03
93975 CPT US Renal Artery Duplex Bilateral 3 3 $1,760.50 $1,760.50 $354.89 $490.12 $355.16 2025-11-03
93925 CPT US Lower Ext Arterial Duplex Bilateral 3 3 $1,448.00 $1,448.00 $355.16 $388.93 $355.16 2025-11-03
93923 CPT US Segmental Pressures Le 3+ Lvls Bilat 3 3 $472.50 $472.50 $127.58 $415.80 $349.29 2025-11-03
87507 CPT Gi Profile, Stool, Pcr Lc 2 2 $1,098.25 $1,098.25 $348.53 $348.80 $348.66 2025-11-03
10060 CPT 10060 Incision & Drainage Abscess Simple/single TechFee 3 2 $572.75 $572.75 $148.92 $348.20 $348.20 2025-11-03
10120 CPT 10120 Incision & Removal Foreign Body Subq Tiss Simple TechFee 3 3 $670.50 $670.50 $348.20 $348.20 $348.20 2025-11-03
20610 CPT 20610 Injection And Or Aspiration Major Joint 5 5 $1,278.75 $1,278.75 $328.72 $986.60 $344.02 2025-11-03
76700 CPT US Abdomen Complete 6 6 $1,191.50 $1,191.50 $301.96 $355.16 $337.47 2025-11-03
70160 CPT Xr Nasal Bones 3+ Views 1 1 $485.25 $485.25 $335.41 $335.41 $335.41 2025-11-03
99283 CPT 99283 Ed Visit E&m Patient, Lev 3, Req Med Approp Hstry/exam/low Mdm, Cc 24 23 $577.50 $577.50 $90.00 $568.26 $333.50 2025-11-03
12013 CPT 12013 Simple Repair F/e/e/n/l/m 2.6cm-5.0 Cm TechFee 1 1 $376.25 $376.25 $331.10 $331.10 $331.10 2025-11-03
78803 CPT 78803 1 1 $1,220.00 $1,220.00 $327.69 $327.69 $327.69 2025-11-03
95806 CPT Sleep Study Unatt Resp Efft Charge 10 10 $1,227.25 $1,227.25 $309.25 $1,079.98 $324.98 2025-11-03
70030 CPT Xr Foreign Body Localization Eye 1 1 $376.25 $376.25 $315.26 $315.26 $315.26 2025-11-03
87497 CPT Cmv Quant DNA Pcr (Plasma) Lc 2 2 $628.50 $628.50 $73.30 $553.08 $313.19 2025-11-03
96360 CPT 96360 IV Fluids Initial Charges 20 18 $402.50 $402.50 $101.42 $394.45 $310.63 2025-11-03
94010 CPT Tidal Volume W Vital Capacity 2 2 $349.75 $349.75 $307.78 $307.78 $307.78 2025-11-03
87902 CPT 87902 Component 1 1 $533.50 $533.50 $304.43 $304.43 $304.43 2025-11-03
36430 CPT 36430 Blood Administration Charge 6 6 $1,100.50 $1,100.50 $281.49 $922.24 $295.60 2025-11-03
96368 CPT 96368- Ed IV Tx, Concurrent Infusion 1 1 $291.00 $291.00 $286.34 $286.34 $286.34 2025-11-03
81402 CPT 81402 Component 1 1 $958.50 $958.50 $281.71 $281.71 $281.71 2025-11-03
92611 CPT 92611 Eval - Vf Swallow 5 5 $1,097.75 $1,097.75 $124.70 $966.02 $280.76 2025-11-03
93225 CPT 9322552 Holter Monitor Less Than 12 Hours Charge 10 10 $541.25 $541.25 $130.25 $950.84 $276.21 2025-11-03
93226 CPT Holter Monitor Scanning 9 9 $1,025.50 $1,025.50 $65.13 $902.44 $275.45 2025-11-03
76775 CPT US Aorta 3 3 $1,006.25 $1,006.25 $230.51 $885.50 $271.69 2025-11-03
99282 CPT 99282 Ed Visit E&m Patient, Lev 2, Req Med Approp Hstry/exam/mdm, Cc 18 18 $410.75 $410.75 $105.02 $385.58 $271.26 2025-11-03
94726 CPT Plethysmography 12 12 $853.50 $853.50 $216.81 $774.23 $269.19 2025-11-03
76706 CPT US Aaa Screening Medicare 3 3 $1,006.25 $1,006.25 $266.26 $276.11 $268.43 2025-11-03
93971 CPT US Lower Ext Venous Duplex Left 11 11 $998.50 $998.50 $230.51 $878.68 $268.20 2025-11-03
29580 CPT 29580 Strapping Unna Boot TechFee 1 1 $300.00 $300.00 $264.00 $264.00 $264.00 2025-11-03
P9016 HCPCS E0181 Rbc Cpd 500 Lr 5 5 $970.25 $970.25 $248.19 $406.98 $260.61 2025-11-03
C1781 HCPCS Prolene Polypropylene Mesh 3x6 3 3 $244.48 $244.48 $163.73 $365.32 $255.99 2025-11-03
74221 CPT Xr Esophagus With Air Contrast 5 5 $571.50 $571.50 $153.51 $502.92 $253.42 2025-11-03
76705 CPT US Soft Tissue Abd/Pel 9 9 $774.25 $774.25 $230.51 $823.68 $251.41 2025-11-03
29105 CPT 29105 Application Long Arm Splint (shoulder To Hand) 1 1 $300.00 $300.00 $251.24 $251.24 $251.24 2025-11-03
99281 CPT 99281 Ed Visit For E&m Patient, Lev 1, May Not Req Presence Of Physician Or Othe… 2 2 $387.50 $387.50 $104.09 $387.50 $245.79 2025-11-03
J2760 HCPCS Phentolamine 5 Mg Inj [pana] 1 1 $1,471.20 $1,471.20 $244.30 $244.30 $244.30 2025-11-03
J1610 HCPCS Glucagon 1 Mg Inj [pana] 3 3 $924.00 $924.00 $122.15 $248.19 $244.11 2025-11-03
74300 CPT Xr Cholangiogram In Or 1 1 $950.75 $950.75 $243.15 $243.15 $243.15 2025-11-03
74246 CPT Xr Upper Gi With Air Contrast 4 4 $843.50 $843.50 $212.85 $742.28 $238.59 2025-11-03
76857 CPT US Bladder Scan 2 2 $448.50 $448.50 $230.51 $230.51 $230.51 2025-11-03
76830 CPT 76830 US Transvaginal Non-OB 9 9 $774.25 $774.25 $208.90 $681.34 $230.51 2025-11-03
76642 CPT US Breast Limited Left 15 15 $686.00 $686.00 $174.27 $1,119.36 $230.51 2025-11-03
76536 CPT US Head/Neck Soft Tissue 15 15 $613.50 $613.50 $156.93 $539.88 $230.51 2025-11-03
76870 CPT US Scrotum (Contents) With Doppler If Ind 5 5 $849.75 $849.75 $228.24 $747.78 $230.51 2025-11-03
76882 CPT US Axilla Left 6 6 $739.25 $739.25 $199.60 $619.52 $230.43 2025-11-03
82672 CPT Estrogens, Total Lc 6 6 $302.25 $302.25 $11.28 $265.98 $226.84 2025-11-03
82131 CPT 82131 24 Hr 1 1 $75.00 $75.00 $226.38 $226.38 $226.38 2025-11-03
70490 CPT CT Neck Soft Tissue Without Contrast 1 1 $2,610.25 $2,610.25 $225.06 $225.06 $225.06 2025-11-03
70480 CPT CT Iac Without Contrast 3 3 $2,610.25 $2,610.25 $225.06 $225.06 $225.06 2025-11-03
71271 CPT CT Lung Cancer Screening 10 10 $702.50 $702.50 $177.02 $618.20 $225.06 2025-11-03
97164 CPT Pt ReEval Units 5 5 $252.00 $252.00 $64.46 $252.00 $221.76 2025-11-03
94070 CPT Bronchospasm Evaluation 1 1 $1,705.25 $1,705.25 $217.64 $217.64 $217.64 2025-11-03
29260 CPT 29260 Strapping Elbow/wrist TechFee 2 2 $300.00 $300.00 $159.51 $264.00 $211.75 2025-11-03
81207 CPT 81207 Component 2 2 $578.75 $578.75 $140.85 $281.71 $211.28 2025-11-03
89321 CPT Semen Analysis Post Vas 2 2 $233.75 $233.75 $182.33 $233.75 $208.04 2025-11-03
71101 CPT Xr Ribs With Pa Chest Left 3 3 $801.50 $801.50 $118.44 $224.71 $205.01 2025-11-03
96365 CPT 96365 Ivpb Initial And Up To 1 Hour Charge 31 20 $752.75 $752.75 $44.10 $737.69 $202.19 2025-11-03
12011 CPT 12011 Simple Repair F/e/e/n/l/m 2.5cm/< TechFee 3 3 $376.25 $376.25 $101.06 $331.10 $202.13 2025-11-03
77080 CPT Bd Bone Density Dexa Axial Skeleton 10 10 $755.25 $755.25 $166.30 $664.62 $200.66 2025-11-03
87635 CPT Sars-cov-2/rsv (spotfire)-87635 1 1 $157.50 $157.50 $198.25 $198.25 $198.25 2025-11-03
93931 CPT US Upper Ext Arterial Duplex Left 1 1 $732.25 $732.25 $196.68 $196.68 $196.68 2025-11-03
93926 CPT US Lower Ext Arterial Duplex Left 1 1 $727.00 $727.00 $195.27 $195.27 $195.27 2025-11-03
76604 CPT US Chest 4 4 $564.75 $564.75 $144.44 $496.98 $193.87 2025-11-03
94618 CPT 94618 6 Minute Walk Test Charge 7 7 $713.25 $713.25 $181.20 $627.66 $191.58 2025-11-03
94060 CPT Bronchodilation Responsiveness 11 11 $698.25 $698.25 $108.82 $614.46 $187.55 2025-11-03
86617 CPT 86617 Component 1 1 $105.75 $105.75 $186.12 $186.12 $186.12 2025-11-03
31500 CPT 31500 Intubation Endotracheal Emergency Procedure ProFee 2 2 $327.50 $327.50 $86.21 $281.16 $183.69 2025-11-03
71111 CPT Xr Ribs With Pa Chest Bilateral 3 3 $720.25 $720.25 $118.44 $603.46 $182.19 2025-11-03
84305 CPT Igf-1 Lc 4 4 $361.00 $361.00 $22.57 $317.68 $180.07 2025-11-03
93668 CPT 93668 Set Pad Subsequent Visit Charge 2 2 $285.00 $285.00 $79.34 $266.32 $172.83 2025-11-03
72050 CPT Xr Spine Cervical 4 Or 5 Views 4 4 $871.50 $871.50 $118.44 $231.21 $170.69 2025-11-03
70110 CPT Xr Mandible Complete 4+ Views 2 2 $797.50 $797.50 $118.44 $215.33 $166.88 2025-11-03
70220 CPT Xr Sinuses Paranasal Complete 7 7 $646.50 $646.50 $118.35 $504.27 $164.20 2025-11-03
82705 CPT Fecal Fat, Qualitative Lc 1 1 $185.25 $185.25 $163.02 $163.02 $163.02 2025-11-03
73560 CPT Xr Knee 1 Or 2 Views Left 4 4 $324.00 $324.00 $82.87 $285.12 $161.18 2025-11-03
96413 CPT 96413 IV Chemo Single Initial Up To 1 Hour Charge 3 3 $603.50 $603.50 $154.38 $593.84 $161.00 2025-11-03
72040 CPT Xr Spine Cervical 2 Or 3 Views 12 12 $628.50 $628.50 $118.44 $553.08 $160.76 2025-11-03
29515 CPT 29515 Application Short Leg Splint Calf Foot TechFee 1 1 $508.50 $508.50 $159.63 $159.63 $159.63 2025-11-03
73080 CPT Xr Elbow Complete 3+ Views Left 11 11 $589.25 $589.25 $118.44 $518.54 $158.27 2025-11-03
86304 CPT Ca 125 In The Presence Of Hama Lc 2 2 $337.25 $337.25 $19.69 $296.78 $158.23 2025-11-03
72072 CPT Xr Spine Thoracic 3 Views 5 5 $605.25 $605.25 $59.22 $162.57 $154.78 2025-11-03
83993 CPT Calprotectin, Fecal Lc 4 4 $389.00 $389.00 $20.45 $293.18 $154.62 2025-11-03
Q5108 HCPCS Pegfilgrastim Jmdb 6 Mg/0.6 Ml Sol [pana] 1 1 $6,888.75 $6,888.75 $154.19 $154.19 $154.19 2025-11-03
71100 CPT Xr Ribs 2 Views Left 6 6 $588.75 $588.75 $118.44 $493.24 $153.38 2025-11-03
70150 CPT Xr Zygomatic Arches 2 2 $359.00 $359.00 $118.44 $188.14 $153.29 2025-11-03
87071 CPT Throat Culture 13 13 $221.75 $221.75 $18.02 $195.14 $153.19 2025-11-03
74240 CPT Xr Upper Gi 1 1 $565.25 $565.25 $152.62 $152.62 $152.62 2025-11-03
80299 CPT Clobazam (onfi) Lc 3 3 $308.00 $308.00 $20.75 $271.04 $152.18 2025-11-03
74230 CPT Xr Swallowing Function With Speech 5 5 $567.00 $567.00 $124.80 $498.96 $150.53 2025-11-03
29125 CPT 29125 Application Short Arm Splint Forearm-hand Static TechFee 4 4 $300.00 $300.00 $80.58 $264.00 $148.95 2025-11-03
12001 CPT 12001 Simple Repair Scalp/neck/ax/genit/trunk 2.5cm/< TechFee 8 8 $376.25 $376.25 $21.39 $331.10 $148.47 2025-11-03
77066 CPT 77066 Mg Mammo Digital Diagnostic Bilat 15 15 $533.50 $533.50 $100.64 $469.48 $146.99 2025-11-03
73564 CPT Xr Knee Complete 4+ Views Left 16 16 $531.00 $531.00 $88.76 $804.25 $145.60 2025-11-03
72100 CPT Xr Spine Lumbosacral 2 Or 3 Views 13 13 $538.25 $538.25 $118.44 $473.66 $143.59 2025-11-03
73610 CPT Xr Ankle Complete 3+ Views Left 14 14 $518.00 $518.00 $88.76 $455.84 $140.95 2025-11-03
99195 CPT 99195 Therapeutic Phlebotomy Charge 2 2 $483.00 $483.00 $123.56 $158.30 $140.93 2025-11-03
73522 CPT Xr Hips 3-4 Views W/ap Pelvis Bilat 4 4 $638.50 $638.50 $118.44 $175.21 $140.88 2025-11-03
81206 CPT 81206 Component 3 3 $578.75 $578.75 $140.74 $140.85 $140.85 2025-11-03
73630 CPT Xr Foot Complete 3+ Views Left 18 18 $518.00 $518.00 $88.83 $455.84 $139.50 2025-11-03
73130 CPT Xr Hand Complete 3+ Views Left 17 17 $509.75 $509.75 $88.83 $448.58 $136.92 2025-11-03
80143 CPT Acetaminophen Level 3 3 $162.75 $162.75 $41.01 $143.22 $136.40 2025-11-03
73502 CPT Xr Hip 2-3 Views Left 16 16 $445.25 $445.25 $59.22 $495.63 $135.84 2025-11-03
73000 CPT Xr Clavicle Left 6 6 $501.50 $501.50 $118.44 $441.32 $135.14 2025-11-03
72190 CPT Xr Pelvis Complete 3+ Views 1 1 $523.00 $523.00 $133.76 $133.76 $133.76 2025-11-03
89051 CPT Cell Count And Diff Body Fluid Smh 1 1 $49.50 $49.50 $131.56 $131.56 $131.56 2025-11-03
73562 CPT Xr Knee 3 Views Left 14 14 $484.50 $484.50 $88.76 $474.44 $131.54 2025-11-03
72114 CPT Xr Spine Lumbosacral With Bending 6+ Views 2 2 $740.75 $740.75 $59.22 $198.96 $129.09 2025-11-03
73521 CPT Xr Hips 2 Views Bilat 8 8 $517.00 $517.00 $59.17 $159.11 $129.01 2025-11-03
74022 CPT Xr Abdomen Series + Chest 1 View 4 4 $480.25 $480.25 $118.44 $352.02 $129.00 2025-11-03
80158 CPT Cyclosporine, Blood Lc-ms/ms Lc 1 1 $145.75 $145.75 $128.26 $128.26 $128.26 2025-11-03
72220 CPT Xr Sacrum/Coccyx 2+ Views 5 5 $501.50 $501.50 $59.22 $135.41 $128.26 2025-11-03
73070 CPT Xr Elbow 2 Views Left 6 6 $485.25 $485.25 $118.44 $427.02 $127.22 2025-11-03
94640 CPT 94640 Nebulizer 1 Charge 16 16 $191.75 $191.75 $49.02 $487.25 $124.91 2025-11-03
73590 CPT Xr Tibia/Fibula Left 9 9 $465.00 $465.00 $118.35 $442.75 $123.64 2025-11-03
73090 CPT Xr Forearm 2 Views Left 8 8 $469.75 $469.75 $59.22 $460.35 $123.15 2025-11-03
73030 CPT Xr Shoulder Complete 2+ Views Left 20 20 $448.50 $448.50 $88.83 $441.32 $122.58 2025-11-03
94729 CPT Diffusion Capacity 11 11 $320.75 $320.75 $81.44 $282.26 $121.47 2025-11-03
84144 CPT Progesterone Lc 6 6 $302.25 $302.25 $22.57 $265.98 $120.25 2025-11-03
74019 CPT Xr Abdomen 2 Views 5 5 $450.00 $450.00 $118.35 $121.42 $119.67 2025-11-03
73110 CPT Xr Wrist Complete 3+ Views Left 14 14 $453.00 $453.00 $44.42 $398.64 $119.45 2025-11-03
82679 CPT Estrone, Serum Lc 1 1 $135.50 $135.50 $119.24 $119.24 $119.24 2025-11-03
73060 CPT Xr Humerus Left 9 9 $466.00 $466.00 $118.35 $458.54 $119.19 2025-11-03
73552 CPT Xr Femur 2 Views Left 9 9 $440.00 $440.00 $106.76 $343.20 $118.44 2025-11-03
73503 CPT Xr Hip 4+ Views Left 3 3 $517.00 $517.00 $59.22 $143.93 $118.44 2025-11-03
73140 CPT Fingers Minimum Of 2 Views 6 6 $320.75 $320.75 $59.17 $282.26 $118.44 2025-11-03
73092 CPT Xr Upper Extremity Infant (0-1yr) Left 1 1 $368.25 $368.25 $118.44 $118.44 $118.44 2025-11-03
77072 CPT Xr Bone Age Studies 1 1 $460.00 $460.00 $118.44 $118.44 $118.44 2025-11-03
70330 CPT Xr Tmj Open And Closed Bilateral 1 1 $596.50 $596.50 $118.44 $118.44 $118.44 2025-11-03
72110 CPT Xr Spine Lumbosacral 4plus Views 7 7 $674.25 $674.25 $118.35 $674.25 $118.44 2025-11-03
72081 CPT Xr Spine Scoliosis 1 View 6 6 $565.25 $565.25 $59.22 $497.42 $118.44 2025-11-03
72052 CPT Xr Spine Cervical 6+ Views 1 1 $968.50 $968.50 $118.44 $118.44 $118.44 2025-11-03
74018 CPT Xr Abdomen Kub 1 View 12 12 $423.75 $423.75 $108.38 $372.90 $118.44 2025-11-03
73650 CPT Xr Calcaneus Left 3 3 $410.50 $410.50 $109.51 $118.44 $118.44 2025-11-03
73620 CPT Xr Foot 2 Views Left 6 6 $414.50 $414.50 $106.03 $364.76 $118.44 2025-11-03
71110 CPT Xr Ribs 3 Views Bilateral 1 1 $759.25 $759.25 $118.44 $118.44 $118.44 2025-11-03
73660 CPT Xr Toe(s) 2+ Views Left 4 4 $320.75 $320.75 $85.17 $118.44 $118.39 2025-11-03
76010 CPT Xr Foreign Body Localization Child 1 Vw 1 1 $345.00 $345.00 $118.35 $118.35 $118.35 2025-11-03
71120 CPT Xr Sternum 2+ Views 1 1 $410.50 $410.50 $118.35 $118.35 $118.35 2025-11-03
71046 CPT Xr Chest 2 Views 21 21 $423.75 $423.75 $102.81 $372.90 $114.33 2025-11-03
73120 CPT Xr Hand 2 Views Left 5 5 $423.75 $423.75 $97.19 $372.90 $113.82 2025-11-03
72170 CPT Xr Pelvis 1 Or 2 Views 9 9 $423.75 $423.75 $108.38 $372.90 $113.82 2025-11-03
77073 CPT Xr Bone Length Studies Scanograms 4 4 $396.75 $396.75 $106.56 $349.14 $113.61 2025-11-03
77067 CPT 77067 Mg Mammo Digital Screening Left 18 18 $175.50 $175.50 $80.23 $400.18 $110.52 2025-11-03
73600 CPT Xr Ankle 2 Views Left 2 2 $346.50 $346.50 $59.22 $161.63 $110.42 2025-11-03
94760 CPT Pulse Ox 9 9 $109.50 $109.50 $29.54 $168.01 $109.50 2025-11-03
73100 CPT Xr Wrist 2 Views Right 7 7 $302.25 $302.25 $81.19 $356.62 $109.34 2025-11-03
97161 CPT Pt Low Complex Units 21 21 $396.75 $396.75 $99.96 $396.75 $108.87 2025-11-03
94375 CPT Methacholine Challenge Pana 1 1 $245.00 $245.00 $108.82 $108.82 $108.82 2025-11-03
96374 CPT 96374 IV Push Meds Single With Initial Substan Charge 30 20 $402.50 $402.50 $97.61 $394.45 $108.14 2025-11-03
97165 CPT Ot Low Complex Units 12 12 $396.75 $396.75 $100.77 $359.75 $107.91 2025-11-03
51702 CPT 51702 Insj Temp Ndwellg Bladder Catheter Simple TechFee 8 7 $389.00 $389.00 $69.37 $381.22 $104.86 2025-11-03
87631 CPT Respiratory Panel Mini (SpotFire) 20 20 $378.00 $378.00 $95.26 $354.24 $103.69 2025-11-03
93922 CPT US Ankle Brachial Index 4 4 $405.25 $405.25 $102.91 $230.51 $103.61 2025-11-03
12004 CPT 12004 Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Geni… 1 1 $376.25 $376.25 $103.24 $103.24 $103.24 2025-11-03
97162 CPT Pt Moderate Complex Units 2 2 $396.75 $396.75 $101.46 $104.98 $103.22 2025-11-03
84466 CPT Transferrin Lc 1 1 $117.25 $117.25 $103.18 $103.18 $103.18 2025-11-03
82642 CPT Dihydrotestosterone Lc 1 1 $117.25 $117.25 $103.18 $103.18 $103.18 2025-11-03
51701 CPT 51701 Insj Non-ndwellg Bladder Catheter TechFee 3 3 $369.50 $369.50 $94.48 $102.87 $102.87 2025-11-03
73050 CPT Xr Ac Joints Bilateral 1 1 $363.50 $363.50 $101.20 $101.20 $101.20 2025-11-03
12002 CPT 12002 Smpl Repair Scalp/neck/ax/genit/trunk 2.6-7.5cm TechFee 3 3 $376.25 $376.25 $96.23 $214.22 $101.06 2025-11-03
77065 CPT 77065 Mg Mammo Digital Diagnostic Left 14 14 $328.25 $328.25 $82.70 $299.53 $100.72 2025-11-03
93005 CPT 93005 Ekg, Tracing Only 26 26 $180.00 $180.00 $54.22 $328.46 $100.26 2025-11-03
31720 CPT 31720 Suction Charge 1 1 $352.50 $352.50 $98.14 $98.14 $98.14 2025-11-03
87536 CPT Rna, Real Time Pcr (non-graph) Lc 2 2 $438.25 $438.25 $73.30 $122.34 $97.82 2025-11-03
94762 CPT 94762 Pulse Oximeter Recording Charge 2 2 $264.50 $264.50 $73.64 $121.47 $97.56 2025-11-03
84244 CPT 84244 Component 3 3 $329.00 $329.00 $22.55 $321.20 $96.58 2025-11-03
J3410 HCPCS hydrOXYzine Hydrochloride 50 mg/mL 1 Ml Inj [pana] 1 1 $111.24 $111.24 $93.78 $93.78 $93.78 2025-11-03
96375 CPT 96375-IV Injection, Add New Drug 27 20 $347.50 $347.50 $22.50 $611.60 $93.34 2025-11-03
80053 CPT Comprehensive Metabolic Panel 28 28 $344.50 $344.50 $15.45 $337.61 $92.57 2025-11-03
71045 CPT Xr Chest 1 View 16 16 $342.50 $342.50 $86.26 $301.40 $92.00 2025-11-03
97760 CPT Orthotic Mgmt And Training Charges 6 6 $150.25 $150.25 $38.02 $132.22 $89.92 2025-11-03
82088 CPT 82088 Component 3 3 $329.00 $329.00 $59.78 $298.54 $89.77 2025-11-03
96376 CPT 96376- Ed IV Injection, Add Same Drug 15 12 $330.50 $330.50 $48.81 $323.89 $88.78 2025-11-03
80179 CPT Salicylate Level 3 3 $105.75 $105.75 $26.60 $93.06 $88.44 2025-11-03
80307 CPT Methadone Screen, Urine Lc 5 5 $41.75 $41.75 $13.23 $119.35 $88.25 2025-11-03
96402 CPT Highly Complex Hormonal Sq/im Inj Charge 2 2 $314.75 $314.75 $87.63 $87.63 $87.63 2025-11-03
87101 CPT Fungus (Mycology) Culture Lc 2 2 $177.50 $177.50 $18.01 $156.20 $87.11 2025-11-03
82803 CPT 82803 Arterial Blood Gas 10 10 $327.25 $327.25 $48.13 $311.50 $86.59 2025-11-03
86870 CPT Antibody Screen Lc 2 2 $114.25 $114.25 $82.60 $86.76 $84.68 2025-11-03
80197 CPT Tacrolimus (fk506), Blood Lc/ms Lc 3 3 $331.50 $331.50 $20.75 $291.72 $83.49 2025-11-03
88311 CPT Decalcification 1 1 $47.25 $47.25 $83.16 $83.16 $83.16 2025-11-03
84145 CPT Procalcitonin 10 10 $220.50 $220.50 $22.55 $220.50 $83.01 2025-11-03
96372 CPT 96372 Ed Subq/IM Injection 28 20 $210.25 $210.25 $48.55 $401.72 $82.99 2025-11-03
86698 CPT Histoplasma Abs, Qn, Did Lc 1 1 $174.75 $174.75 $82.80 $82.80 $82.80 2025-11-03
83498 CPT 17-oh Progesterone Lcms Lc 2 2 $210.00 $210.00 $11.27 $153.93 $82.60 2025-11-03
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