Hospital

SPARTA COMMUNITY HOSPITAL

Sparta, IL · CCN 141349 · Rates published

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You selected 93306 (CPT)

US ECHO W/DOPPLER/ COLORFLOW (ROUTINE)

This hospital’s price: $1,602 across 10 payers · range $732-$3,940

Source: https://hospitalpricelists.org/export/376014817_SpartaCommunityHospitalDistrict_standardcharges.csv · observed 2026-01-08

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

1,434 distinct procedures filed

49 distinct payers

52,393 rate rows

2026-07-16 last MRF observed

Data quality

52,164 of 52,393 rate rows are consumer-grade (99.6%)

229 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reason	Rows
professional (physician) fee — not the facility price	223
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	6

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

Source MRF file	https://hospitalpricelists.org/export/376014817_SpartaCommunityHospitalDistrict_standardcharges.csv
Found on page	https://www.hospitalpricelists.org/Sparta-Community-Hospital
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-10-20
Content fingerprint	2ad4f05283602b2d… · 1,600,895 bytes · first seen 2026-05-08

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code	Description	Payers	Min $	Max $	Avg median	vs national
J3380 HCPCS	Entyvio (vedolizumab) 300mg Vial	22	$1,422.94	$13,517.93	$9,391.41	nat. median $162 outlier · 58.0×
J0517 HCPCS	Fasenra Subcutaneous Solution 30mg/1ml	22	$1,247.43	$11,850.59	$8,233.04	nat. median $919 outlier · 9.0×
J2353 HCPCS	Sandostatin Lar Depot : 20mg	22	$1,119.30	$10,633.35	$7,387.38	nat. median $5,573 1.3× median
G0495 HCPCS	Hh/rn Teaching Visit	21	$42.00	$23,351.00	$5,653.40	nat. median $207 outlier · 27.3×
J2182 HCPCS	Nucala 100 Mg: Vial	22	$730.44	$7,368.39	$5,041.53	nat. median $2,791 1.8× median
623 OTHER	Graft Connext Matrix .030oz	22	$718.50	$6,825.75	$4,742.10	nat. median $17,488 outlier · 0.3×
95811 OTHER	Sleep Study/cpap >= 6 Hrs Of Recording	22	$509.75	$7,262.99	$3,695.69	nat. median $921 outlier · 4.0×
23655 OTHER	Ubdisl Tx Shoulder Closed W/man W/anes	22	$546.53	$5,191.99	$3,607.06	nat. median $1,340 outlier · 2.7×
#NAME? OTHER	Colonoscopy W/egd	22	$546.50	$5,191.75	$3,606.90	nat. median $3,607 1.0× median
78452 OTHER	Nm Mpi R & S Multi Spect W/wall & Eject	22	$530.78	$5,042.36	$3,503.11	nat. median $1,346 outlier · 2.6×
73720 CPT	MRI Upper Leg Left W/wo Contrast	1	$3,370.77	$3,370.77	$3,370.77	nat. median $1,129 outlier · 3.0×
78071 OTHER	Nm Parathyroid Planar Spect W/subtractio	22	$508.45	$4,830.28	$3,355.77	nat. median $506 outlier · 6.6×
Q4184 HCPCS	Graft Cellesta 3x3cm	22	$398.75	$11,150.63	$3,190.00	nat. median $210 outlier · 15.2×
J3111 HCPCS	Evenity Sc Inj 210mg (2 Syringe 105mg)	22	$479.07	$4,551.12	$3,161.83	nat. median $681 outlier · 4.6×
74178 OTHER	CT Abd & Pelvis W/wo Contrast	22	$710.50	$6,749.75	$3,142.54	nat. median $550 outlier · 5.7×
J1602 HCPCS	Simponi Aria 50mg/4ml Sdv	24	$23.77	$4,532.64	$3,101.28	nat. median $273 outlier · 11.4×
J2507 HCPCS	Krystexxa (pegloticase) : 8mg/ml IV	1	$3,027.84	$3,027.84	$3,027.84	nat. median $9,200 outlier · 0.3×
25565 OTHER	Ub-clsed Tx Radial&ulnar Shaft Fx W/manj	22	$456.55	$4,337.23	$3,013.23	nat. median $1,336 outlier · 2.3×
25560 OTHER	Ubfx Tx Radius/ulnar Shaft Closed W/oman	22	$456.55	$4,337.23	$3,013.23	nat. median $273 outlier · 11.0×
56420 OTHER	Ub-i & D Bartholins Gland Abscess	22	$456.33	$4,335.09	$3,011.74	nat. median $208 outlier · 14.5×
65222 OTHER	Ub-remove Fb-cornea,w/sl	22	$456.33	$4,335.09	$3,011.74	nat. median $142 outlier · 21.2×
70487 CPT	CT Facial W/enhancement	3	$513.65	$3,748.40	$2,989.71	nat. median $605 outlier · 4.9×
12013 OTHER	Ub-repair, Smpl, Face, 2.6-5.0	22	$395.68	$5,186.76	$2,868.64	nat. median $212 outlier · 13.6×
95811 CPT	Sleep Study/cpap >= 6 Hrs Of Recording	12	$1,289.29	$5,120.00	$2,849.62	nat. median $1,894 1.5× median
J0490 HCPCS	Benlysta 400mg Sdv	22	$430.38	$4,088.61	$2,840.51	nat. median $1,026 outlier · 2.8×
32551 OTHER	Ub-tube Thoracostomy W Or Without Wtr Seal	22	$428.13	$4,067.19	$2,825.62	nat. median $845 outlier · 3.3×
30901 OTHER	Ub-control Nosebleed Ant, Simple	22	$428.13	$4,067.19	$2,825.62	nat. median $157 outlier · 18.0×
78582 OTHER	Nm Lung Perf/vent Aerosol,1+ Projections	22	$421.45	$4,003.78	$2,781.57	nat. median $629 outlier · 4.4×
99285 OTHER	Emergency Room Level 5	22	$375.68	$4,291.86	$2,723.64	nat. median $639 outlier · 4.3×
73706 OTHER	CT Venogram Le/right	22	$593.00	$5,633.50	$2,651.25	nat. median $371 outlier · 7.2×
74175 OTHER	CTA Abdomen	22	$591.63	$5,620.44	$2,646.78	nat. median $530 outlier · 5.0×
74174 OTHER	CTA Abd & Pelvis W/contrast	22	$591.63	$5,620.44	$2,646.78	nat. median $521 outlier · 5.1×
74170 OTHER	CT Abdomen W/wo Enhancement	22	$568.43	$5,400.04	$2,571.38	nat. median $359 outlier · 7.2×
99284 OTHER	Emergency Room Level 4	22	$329.70	$4,282.36	$2,543.92	nat. median $434 outlier · 5.9×
74177 OTHER	CT Abd & Pelvis W/contrast	22	$556.13	$5,283.19	$2,531.40	nat. median $521 outlier · 4.9×
93350 CPT	US Stress Echo W/contrast,dop And Color	1	$2,521.21	$2,521.21	$2,521.21	nat. median $802 outlier · 3.1×
25600 OTHER	Ub-fx Tx Dist Radius Closed Without Man	22	$378.08	$3,591.71	$2,495.30	nat. median $323 outlier · 7.7×
J9217 HCPCS	Lupron Depot 22.5mg : Prefilled Syringe	25	$272.71	$9,978.14	$2,489.94	nat. median $1,575 1.6× median
70482 OTHER	CT Orbits W/wo Enhancement	22	$536.65	$5,098.18	$2,468.11	nat. median $363 outlier · 6.8×
78709 OTHER	Nm Kidney Fl/fun W/wo Pharm I	22	$369.73	$3,512.39	$2,440.18	nat. median $786 outlier · 3.1×
23650 OTHER	Ubdisl Tx Shoulder Closed W/man Without Anes	22	$339.53	$3,622.11	$2,427.48	nat. median $325 outlier · 7.5×
70549 OTHER	MRA Neck W/wo Contrast	22	$546.53	$5,191.99	$2,425.20	nat. median $549 outlier · 4.4×
70546 OTHER	MRA Head W/wo Contrast	22	$545.98	$5,186.76	$2,423.42	nat. median $739 outlier · 3.3×
99281 OTHER	Emergency Room Level 1	22	$323.35	$4,275.95	$2,415.78	nat. median $90 outlier · 26.9×
Q4110 HCPCS	Graft Primatrix 8x8 Cm	22	$301.80	$8,728.60	$2,414.40	nat. median $156 outlier · 15.5×
99291 OTHER	Emergency Room Critical	22	$305.83	$3,599.08	$2,408.03	nat. median $824 outlier · 2.9×
25530 OTHER	Ub-fx Tx Ulnar Shaft Closed Without Man	22	$363.40	$3,452.30	$2,398.44	nat. median $264 outlier · 9.1×
78598 OTHER	Nm Vent/perfusion Dif Study	22	$363.23	$3,450.64	$2,397.28	nat. median $651 outlier · 3.7×
G0416 HCPCS	Path Prstat (gross/micro) Tc	26	$517.65	$4,917.68	$2,385.32	nat. median $412 outlier · 5.8×
78195 OTHER	Nm Lymphatics/lymph Gland	22	$354.65	$3,369.18	$2,340.69	nat. median $585 outlier · 4.0×

Other procedures at this hospital

Browse this hospital's 1,434 published procedures. Use the slice to choose what to show, then sort or filter any column.

Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code	Type	Description	Rate rows	Payers	Gross	Cash	Min $	Max $	Avg median	Last observed

J3380	HCPCS	Entyvio (vedolizumab) 300mg Vial	22	22	$14,229.40	$14,229.40	$1,422.94	$13,517.93	$9,391.41	2026-07-16
J0517	HCPCS	Fasenra Subcutaneous Solution 30mg/1ml	22	22	$12,474.30	$12,474.30	$1,247.43	$11,850.59	$8,233.04	2026-07-16
J2353	HCPCS	Sandostatin Lar Depot : 20mg	22	22	$11,193.00	$11,193.00	$1,119.30	$10,633.35	$7,387.38	2026-07-16
G0495	HCPCS	Hh/rn Teaching Visit	21	21	$24,580.00	$24,580.00	$42.00	$23,351.00	$5,653.40	2026-07-16
J2182	HCPCS	Nucala 100 Mg: Vial	44	22	$7,530.27	$7,530.27	$730.44	$7,368.39	$5,041.53	2026-07-16
623	OTHER	Graft Connext Matrix .030oz	22	22	$7,185.00	$7,185.00	$718.50	$6,825.75	$4,742.10	2026-07-16
95811	OTHER	Sleep Study/cpap >= 6 Hrs Of Recording	44	22	$6,371.38	$6,371.38	$509.75	$7,262.99	$3,695.69	2026-07-16
23655	OTHER	Ubdisl Tx Shoulder Closed W/man W/anes	22	22	$5,465.25	$5,465.25	$546.53	$5,191.99	$3,607.06	2026-07-16
#NAME?	OTHER	Colonoscopy W/egd	22	22	$5,465.00	$5,465.00	$546.50	$5,191.75	$3,606.90	2026-07-16
78452	OTHER	Nm Mpi R & S Multi Spect W/wall & Eject	22	22	$5,307.75	$5,307.75	$530.78	$5,042.36	$3,503.11	2026-07-16
73720	CPT	MRI Upper Leg Left W/wo Contrast	1	1	$5,282.75	$5,282.75	$3,370.77	$3,370.77	$3,370.77	2026-01-08
78071	OTHER	Nm Parathyroid Planar Spect W/subtractio	22	22	$5,084.50	$5,084.50	$508.45	$4,830.28	$3,355.77	2026-07-16
Q4184	HCPCS	Graft Cellesta 3x3cm	66	22	$6,237.50	$6,237.50	$398.75	$11,150.63	$3,190.00	2026-07-16
J3111	HCPCS	Evenity Sc Inj 210mg (2 Syringe 105mg)	22	22	$4,790.65	$4,790.65	$479.07	$4,551.12	$3,161.83	2026-07-16
74178	OTHER	CT Abd & Pelvis W/wo Contrast	22	22	$7,105.00	$7,105.00	$710.50	$6,749.75	$3,142.54	2026-07-16
J1602	HCPCS	Simponi Aria 50mg/4ml Sdv	24	24	$4,771.20	$4,771.20	$23.77	$4,532.64	$3,101.28	2026-07-16
J2507	HCPCS	Krystexxa (pegloticase) : 8mg/ml IV	1	1	$76,961.85	$76,961.85	$3,027.84	$3,027.84	$3,027.84	2026-01-08
25565	OTHER	Ub-clsed Tx Radial&ulnar Shaft Fx W/manj	22	22	$4,565.50	$4,565.50	$456.55	$4,337.23	$3,013.23	2026-07-16
25560	OTHER	Ubfx Tx Radius/ulnar Shaft Closed W/oman	22	22	$4,565.50	$4,565.50	$456.55	$4,337.23	$3,013.23	2026-07-16
56420	OTHER	Ub-i & D Bartholins Gland Abscess	22	22	$4,563.25	$4,563.25	$456.33	$4,335.09	$3,011.74	2026-07-16
65222	OTHER	Ub-remove Fb-cornea,w/sl	22	22	$4,563.25	$4,563.25	$456.33	$4,335.09	$3,011.74	2026-07-16
70487	CPT	CT Facial W/enhancement	3	3	$4,685.50	$4,685.50	$513.65	$3,748.40	$2,989.71	2026-01-08
12013	OTHER	Ub-repair, Smpl, Face, 2.6-5.0	44	22	$4,708.25	$4,708.25	$395.68	$5,186.76	$2,868.64	2026-07-16
95811	CPT	Sleep Study/cpap >= 6 Hrs Of Recording	12	12	$6,400.00	$6,400.00	$1,289.29	$5,120.00	$2,849.62	2026-01-08
J0490	HCPCS	Benlysta 400mg Sdv	22	22	$4,303.80	$4,303.80	$430.38	$4,088.61	$2,840.51	2026-07-16
32551	OTHER	Ub-tube Thoracostomy W Or Without Wtr Seal	22	22	$4,281.25	$4,281.25	$428.13	$4,067.19	$2,825.62	2026-07-16
30901	OTHER	Ub-control Nosebleed Ant, Simple	22	22	$4,281.25	$4,281.25	$428.13	$4,067.19	$2,825.62	2026-07-16
78582	OTHER	Nm Lung Perf/vent Aerosol,1+ Projections	22	22	$4,214.50	$4,214.50	$421.45	$4,003.78	$2,781.57	2026-07-16
99285	OTHER	Emergency Room Level 5	44	22	$4,137.25	$4,137.25	$375.68	$4,291.86	$2,723.64	2026-07-16
73706	OTHER	CT Venogram Le/right	22	22	$5,930.00	$5,930.00	$593.00	$5,633.50	$2,651.25	2026-07-16
74174	OTHER	CTA Abd & Pelvis W/contrast	22	22	$5,916.25	$5,916.25	$591.63	$5,620.44	$2,646.78	2026-07-16
74175	OTHER	CTA Abdomen	22	22	$5,916.25	$5,916.25	$591.63	$5,620.44	$2,646.78	2026-07-16
74170	OTHER	CT Abdomen W/wo Enhancement	22	22	$5,684.25	$5,684.25	$568.43	$5,400.04	$2,571.38	2026-07-16
99284	OTHER	Emergency Room Level 4	88	22	$3,989.75	$3,989.75	$329.70	$4,282.36	$2,543.92	2026-07-16
74177	OTHER	CT Abd & Pelvis W/contrast	22	22	$5,561.25	$5,561.25	$556.13	$5,283.19	$2,531.40	2026-07-16
93350	CPT	US Stress Echo W/contrast,dop And Color	1	1	$3,763.00	$3,763.00	$2,521.21	$2,521.21	$2,521.21	2026-01-08
25600	OTHER	Ub-fx Tx Dist Radius Closed Without Man	22	22	$3,780.75	$3,780.75	$378.08	$3,591.71	$2,495.30	2026-07-16
J9217	HCPCS	Lupron Depot 22.5mg : Prefilled Syringe	47	25	$10,503.30	$10,503.30	$272.71	$9,978.14	$2,489.94	2026-07-16
70482	OTHER	CT Orbits W/wo Enhancement	22	22	$5,366.50	$5,366.50	$536.65	$5,098.18	$2,468.11	2026-07-16
78709	OTHER	Nm Kidney Fl/fun W/wo Pharm I	22	22	$3,697.25	$3,697.25	$369.73	$3,512.39	$2,440.18	2026-07-16
23650	OTHER	Ubdisl Tx Shoulder Closed W/man Without Anes	44	22	$3,604.00	$3,604.00	$339.53	$3,622.11	$2,427.48	2026-07-16
70549	OTHER	MRA Neck W/wo Contrast	22	22	$5,465.25	$5,465.25	$546.53	$5,191.99	$2,425.20	2026-07-16
70546	OTHER	MRA Head W/wo Contrast	22	22	$5,459.75	$5,459.75	$545.98	$5,186.76	$2,423.42	2026-07-16
99281	OTHER	Emergency Room Level 1	88	22	$3,808.00	$3,808.00	$323.35	$4,275.95	$2,415.78	2026-07-16
Q4110	HCPCS	Graft Primatrix 8x8 Cm	66	22	$7,255.92	$7,255.92	$301.80	$8,728.60	$2,414.40	2026-07-16
99291	OTHER	Emergency Room Critical	88	22	$3,650.00	$3,650.00	$305.83	$3,599.08	$2,408.03	2026-07-16
25530	OTHER	Ub-fx Tx Ulnar Shaft Closed Without Man	22	22	$3,634.00	$3,634.00	$363.40	$3,452.30	$2,398.44	2026-07-16
78598	OTHER	Nm Vent/perfusion Dif Study	22	22	$3,632.25	$3,632.25	$363.23	$3,450.64	$2,397.28	2026-07-16
G0416	HCPCS	Path Prstat (gross/micro) Tc	26	26	$5,176.50	$5,176.50	$517.65	$4,917.68	$2,385.32	2026-07-16
78195	OTHER	Nm Lymphatics/lymph Gland	22	22	$3,546.50	$3,546.50	$354.65	$3,369.18	$2,340.69	2026-07-16
Q4105	HCPCS	Graft Omnigraft 4cm X4cm	22	22	$3,540.00	$3,540.00	$354.00	$3,363.00	$2,336.40	2026-07-16
73702	OTHER	CT Ext Lower W/wo Contrast	22	22	$4,955.50	$4,955.50	$495.55	$4,707.73	$2,334.54	2026-07-16
70488	OTHER	CT Sinuses W/wo Contrast	22	22	$4,936.75	$4,936.75	$493.68	$4,689.91	$2,328.44	2026-07-16
12011	OTHER	Ub-repair, Smpl, Face, < 2.5	44	22	$3,449.75	$3,449.75	$325.03	$3,466.79	$2,323.60	2026-07-16
29105	OTHER	Ub-splint, Long Arm	44	22	$3,930.25	$3,930.25	$316.83	$4,457.64	$2,296.99	2026-07-16
71270	OTHER	CT Thorax W/wo Enh	22	22	$4,829.50	$4,829.50	$482.95	$4,588.03	$2,293.59	2026-07-16
70492	OTHER	CT Neck S.t. W/wo Enhancement	22	22	$4,812.50	$4,812.50	$481.25	$4,571.88	$2,288.07	2026-07-16
72194	OTHER	CT Pelvis W/wo Enhancement	22	22	$4,784.00	$4,784.00	$478.40	$4,544.80	$2,278.80	2026-07-16
78315	OTHER	Nm Bone Three Phase Study	22	22	$3,449.25	$3,449.25	$344.93	$3,276.79	$2,276.51	2026-07-16
23665	OTHER	Ub-fx Clsd Tx Shoulder W/man	22	22	$3,395.25	$3,395.25	$339.53	$3,225.49	$2,240.86	2026-07-16
20610	OTHER	Ub-arthrocentesis, Maj Jt Inj Without US	22	22	$3,395.25	$3,395.25	$339.53	$3,225.49	$2,240.86	2026-07-16
20605	OTHER	Ub-arthrocentesis, Intermed Jt Without US	22	22	$3,395.25	$3,395.25	$339.53	$3,225.49	$2,240.86	2026-07-16
24600	OTHER	Ub-disl Tx Elbow Closed Without Anes	22	22	$3,395.25	$3,395.25	$339.53	$3,225.49	$2,240.86	2026-07-16
24640	OTHER	Ub-disl Tx Nursemaids Elbow Closed W/man	22	22	$3,395.25	$3,395.25	$339.53	$3,225.49	$2,240.86	2026-07-16
78227	OTHER	Nm Hepatobiliary Gallbladder	22	22	$3,327.50	$3,327.50	$332.75	$3,161.13	$2,196.15	2026-07-16
36680	OTHER	Ub-intraossedus Needle Placem	22	22	$3,320.50	$3,320.50	$332.05	$3,154.48	$2,191.53	2026-07-16
46040	OTHER	Ub-i & D Perirectal &/or Ischiorectal Ab	22	22	$3,320.50	$3,320.50	$332.05	$3,154.48	$2,191.53	2026-07-16
51701	OTHER	Insert Urin Cath Nonindwelling(er)	22	22	$3,320.50	$3,320.50	$332.05	$3,154.48	$2,191.53	2026-07-16
36555	OTHER	Ub-cent Ven Cath, Perc, < 2 Yr	22	22	$3,320.50	$3,320.50	$332.05	$3,154.48	$2,191.53	2026-07-16
46083	OTHER	Ub-inc Thromb Hemorrhoid, Ext	22	22	$3,320.50	$3,320.50	$332.05	$3,154.48	$2,191.53	2026-07-16
36556	OTHER	Ub-cent Ven Cath, Perc, > 2 Yr	22	22	$3,320.50	$3,320.50	$332.05	$3,154.48	$2,191.53	2026-07-16
71552	OTHER	MRI Chest W/wo Contrast	22	22	$4,692.25	$4,692.25	$469.23	$4,457.64	$2,173.98	2026-07-16
12004	OTHER	Ub-repair, Smpl, Scalp, 7.6-12.5	44	22	$3,319.88	$3,319.88	$299.05	$3,466.79	$2,168.11	2026-07-16
74183	OTHER	MRI Abdomen W/wo Contrast	22	22	$4,596.00	$4,596.00	$459.60	$4,366.20	$2,142.70	2026-07-16
72197	OTHER	MRI Pelvis W/wo Contrast	22	22	$4,590.00	$4,590.00	$459.00	$4,360.50	$2,140.75	2026-07-16
92950	OTHER	Ub-cpr	22	22	$3,233.50	$3,233.50	$323.35	$3,071.83	$2,134.11	2026-07-16
99151	OTHER	Cons Sed By Same MD,AGE<5y/o,1st 15min	22	22	$3,233.50	$3,233.50	$323.35	$3,071.83	$2,134.11	2026-07-16
99153	OTHER	Cons Sed By Same Md, Ea Addl 15	22	22	$3,233.50	$3,233.50	$323.35	$3,071.83	$2,134.11	2026-07-16
99152	OTHER	Cons Sed By Same MD,AGE>=5y/o,1st 15min	22	22	$3,233.50	$3,233.50	$323.35	$3,071.83	$2,134.11	2026-07-16
69210	OTHER	Ub-remove Impac Cerumen Unilat	22	22	$3,233.50	$3,233.50	$323.35	$3,071.83	$2,134.11	2026-07-16
70553	OTHER	MRI Brain W/wo Contrast	22	22	$4,517.75	$4,517.75	$451.78	$4,291.86	$2,117.27	2026-07-16
70543	OTHER	MRI Orbit,face,&/or Neck W/wo Contrast	22	22	$4,507.75	$4,507.75	$450.78	$4,282.36	$2,114.02	2026-07-16
72156	OTHER	MRI Cervical W/wo Contrast	22	22	$4,501.00	$4,501.00	$450.10	$4,275.95	$2,111.82	2026-07-16
74160	OTHER	CT Abdomen W/enhancement	22	22	$4,247.00	$4,247.00	$424.70	$4,034.65	$2,104.28	2026-07-16
88374	CPT	Path Morph Anl Situ Comp Mplx	1	1	$2,750.00	$2,750.00	$2,095.20	$2,095.20	$2,095.20	2026-01-08
72133	OTHER	CT Lumbar Spine W/wo Contrast	22	22	$4,208.75	$4,208.75	$420.88	$3,998.31	$2,091.85	2026-07-16
29130	OTHER	Ub-splint, Finger	22	22	$3,168.25	$3,168.25	$316.83	$3,009.84	$2,091.05	2026-07-16
26725	OTHER	Ub-reduction Phalangeal Fx (mod F8)	22	22	$3,168.25	$3,168.25	$316.83	$3,009.84	$2,091.05	2026-07-16
26770	OTHER	Ub-disloc Tx Ipj Closed Without Anes	22	22	$3,168.25	$3,168.25	$316.83	$3,009.84	$2,091.05	2026-07-16
72158	OTHER	MRI Lumbosacral W/wo Contrast	22	22	$4,435.25	$4,435.25	$443.53	$4,213.49	$2,090.45	2026-07-16
Q4106	HCPCS	Graft Dermagraft 38 Sq Cm	22	22	$3,125.00	$3,125.00	$312.50	$2,968.75	$2,062.50	2026-07-16
29125	OTHER	Ub-splint, Short Arm	44	22	$3,074.62	$3,074.62	$298.10	$3,009.84	$2,059.36	2026-07-16
71260	OTHER	CT Thorax W/enh	22	22	$4,089.50	$4,089.50	$408.95	$3,885.03	$2,053.09	2026-07-16
70480	OTHER	CT Orbits	22	22	$4,071.75	$4,071.75	$407.18	$3,868.16	$2,047.32	2026-07-16
SC	CDM	Special Care Unit	5	5	$925.00	$925.00	$294.20	$4,725.00	$2,042.41	2026-01-08
SP	CDM	Semi Private Med Surg	5	5	$945.00	$945.00	$294.20	$4,725.00	$2,042.41	2026-01-08
70487	OTHER	CT Facial W/enhancement	22	22	$4,047.25	$4,047.25	$404.73	$3,844.89	$2,039.36	2026-07-16
74176	OTHER	CT Abd & Pelvis Without Contrast	22	22	$4,036.50	$4,036.50	$403.65	$3,834.68	$2,035.87	2026-07-16
73723	OTHER	MRI Hip Right W/wo Contrast	22	22	$4,265.75	$4,265.75	$426.58	$4,052.46	$2,035.37	2026-07-16
70491	OTHER	CT Neck S.t. W/enhancement	22	22	$3,954.75	$3,954.75	$395.48	$3,757.01	$2,009.30	2026-07-16
72157	OTHER	MRI Thoracic W/wo Contrast	22	22	$4,178.25	$4,178.25	$417.83	$3,969.34	$2,006.93	2026-07-16
70470	OTHER	CT Brain W/wo Enhancement	22	22	$3,893.00	$3,893.00	$389.30	$3,698.35	$1,989.22	2026-07-16
72132	OTHER	CT Lumbar Spine W/contrast	22	22	$3,889.25	$3,889.25	$388.93	$3,694.79	$1,988.01	2026-07-16
73701	OTHER	CT Ext Lower W/contrast	22	22	$3,839.50	$3,839.50	$383.95	$3,647.53	$1,971.84	2026-07-16
73201	OTHER	CT Ext Upper W/enhancement	22	22	$3,815.25	$3,815.25	$381.53	$3,624.49	$1,963.95	2026-07-16
511	OTHER	Pain Mgmt/time (rev Code 511)	22	22	$2,959.00	$2,959.00	$295.90	$2,811.05	$1,952.94	2026-07-16
12034	OTHER	Ub-repair,int,scalp...,7.6-12.5	22	22	$2,959.00	$2,959.00	$295.90	$2,811.05	$1,952.94	2026-07-16
71275	OTHER	CTA Chest, Non-coronary	22	22	$3,768.25	$3,768.25	$376.83	$3,579.84	$1,948.68	2026-07-16
75635	OTHER	CTA Aa W/runoffs W/lower Extremities	22	22	$3,604.25	$3,604.25	$360.43	$3,424.04	$1,895.38	2026-07-16
93975	OTHER	US Renal Duplex Complete Study	22	22	$2,861.75	$2,861.75	$286.18	$2,718.66	$1,888.76	2026-07-16
70548	OTHER	MRA Neck W/contrast	22	22	$3,812.75	$3,812.75	$381.28	$3,622.11	$1,888.14	2026-07-16
72142	OTHER	MRI Cervical W/contrast	22	22	$3,788.50	$3,788.50	$378.85	$3,599.08	$1,880.27	2026-07-16
78264	OTHER	Nm Gastric Emptying Study	22	22	$2,847.50	$2,847.50	$284.75	$2,705.13	$1,879.36	2026-07-16
71550	OTHER	MRI Chest Without Contrast	22	22	$3,780.75	$3,780.75	$378.08	$3,591.71	$1,877.74	2026-07-16
70552	OTHER	MRI Brain W/contrast	22	22	$3,756.75	$3,756.75	$375.68	$3,568.91	$1,869.94	2026-07-16
72148	OTHER	MRI Lumbosacral Without Contrast	22	22	$3,747.75	$3,747.75	$374.78	$3,560.36	$1,867.02	2026-07-16
Q0138	HCPCS	Ferumoxytol Inj : 30mg/ml 17ml Vial	22	22	$2,812.50	$2,812.50	$281.25	$2,671.88	$1,856.26	2026-07-16
70551	OTHER	MRI Brain Without Contrast	22	22	$3,713.75	$3,713.75	$371.38	$3,528.06	$1,855.97	2026-07-16
70545	OTHER	MRA Brain W/contrast	22	22	$3,649.25	$3,649.25	$364.93	$3,466.79	$1,835.01	2026-07-16
70544	OTHER	MRA Brain Without Contrast	22	22	$3,649.25	$3,649.25	$364.93	$3,466.79	$1,835.01	2026-07-16
70547	OTHER	MRA Neck Without Contrast	22	22	$3,634.00	$3,634.00	$363.40	$3,452.30	$1,830.05	2026-07-16
72125	OTHER	CT Cervical Spine	22	22	$3,387.00	$3,387.00	$338.70	$3,217.65	$1,824.78	2026-07-16
71250	OTHER	CT Thorax	22	22	$3,382.75	$3,382.75	$338.28	$3,213.61	$1,823.39	2026-07-16
70486	OTHER	CT Sinuses	22	22	$3,329.75	$3,329.75	$332.98	$3,163.26	$1,806.17	2026-07-16
97760	OTHER	Ot/orthotics Fitting 15 Min	22	22	$2,736.25	$2,736.25	$273.63	$2,599.44	$1,805.92	2026-07-16
72141	OTHER	MRI Cervical Without Contrast	22	22	$3,552.25	$3,552.25	$355.23	$3,374.64	$1,803.48	2026-07-16
73722	CPT	MRI Low Ext Jt W/contrast	2	2	$3,980.00	$3,980.00	$915.40	$2,666.60	$1,791.00	2026-01-08
70490	OTHER	CT Neck S.t. Without	22	22	$3,268.50	$3,268.50	$326.85	$3,105.08	$1,786.27	2026-07-16
72128	OTHER	CT Thoracic Spine	22	22	$3,228.50	$3,228.50	$322.85	$3,067.08	$1,773.27	2026-07-16
72131	OTHER	CT Lumbar Spine	22	22	$3,215.25	$3,215.25	$321.53	$3,054.49	$1,768.95	2026-07-16
73722	OTHER	MRI Low Ext Jt W/contrast	22	22	$3,437.75	$3,437.75	$343.78	$3,265.86	$1,766.27	2026-07-16
70498	OTHER	CTA Neck	22	22	$3,191.00	$3,191.00	$319.10	$3,031.45	$1,761.08	2026-07-16
73700	OTHER	CT Ext Lower	22	22	$3,154.50	$3,154.50	$315.45	$2,996.78	$1,749.21	2026-07-16
72195	OTHER	MRI Pelvis Without Contrast	22	22	$3,384.75	$3,384.75	$338.48	$3,215.51	$1,749.05	2026-07-16
73200	OTHER	CT Ext Upper	22	22	$3,147.00	$3,147.00	$314.70	$2,989.65	$1,746.78	2026-07-16
73218	CPT	MRI Upper Arm Right Without Contrast	2	2	$3,930.75	$3,930.75	$858.76	$2,633.60	$1,746.18	2026-01-08
74150	OTHER	CT Abdomen Without Contrast	22	22	$3,083.00	$3,083.00	$308.30	$2,928.85	$1,725.97	2026-07-16
70540	OTHER	MRI Orbit,face,&/or Neck Without Contrast	22	22	$3,297.00	$3,297.00	$329.70	$3,132.15	$1,720.53	2026-07-16
72192	OTHER	CT Pelvis Without Contrast	22	22	$3,028.75	$3,028.75	$302.88	$2,877.31	$1,708.35	2026-07-16
70496	OTHER	CTA Head	22	22	$2,936.00	$2,936.00	$293.60	$2,789.20	$1,678.20	2026-07-16
78451	OTHER	Nm Mpi R Or S Sngl Spect W/wall&eject	22	22	$2,501.75	$2,501.75	$250.18	$2,376.66	$1,651.16	2026-07-16
78306	OTHER	Nm Bone/or Jt Whole Body	22	22	$2,501.75	$2,501.75	$250.18	$2,376.66	$1,651.16	2026-07-16
72146	OTHER	MRI Thoracic Without Contrast	22	22	$3,058.25	$3,058.25	$305.83	$2,905.34	$1,642.93	2026-07-16
72193	OTHER	CT Pelvis W/enhancement	22	22	$2,819.00	$2,819.00	$281.90	$2,678.05	$1,640.17	2026-07-16
74181	OTHER	MRI Abdomen Without	22	22	$2,981.00	$2,981.00	$298.10	$2,831.95	$1,617.83	2026-07-16
93306	CPT	US Echo W/doppler/ Colorflow (routine)	10	10	$4,925.00	$4,925.00	$731.71	$3,940.00	$1,602.33	2026-01-08
J3262	HCPCS	Actemra : 200mg/10ml (20mg/ml)	44	22	$3,586.39	$3,586.39	$219.20	$4,731.76	$1,589.19	2026-07-16
70450	OTHER	CT Brain Without Contrast	22	22	$2,566.00	$2,566.00	$256.60	$2,437.70	$1,557.95	2026-07-16
Q4196	HCPCS	Graft Puraply Am 2x2	88	22	$4,250.00	$4,250.00	$187.50	$11,400.00	$1,551.88	2026-07-16
93970	OTHER	US Venous Mapping Bilateral	22	22	$2,351.25	$2,351.25	$235.13	$2,233.69	$1,551.82	2026-07-16
78803	OTHER	Nm Bone Tomo Spect	44	22	$2,283.62	$2,283.62	$220.30	$2,246.04	$1,536.76	2026-07-16
74175	CPT	CTA Abdomen	3	3	$6,849.00	$6,849.00	$1,500.23	$4,370.24	$1,530.24	2026-01-08
74174	CPT	CTA Abd & Pelvis W/contrast	16	16	$6,849.00	$6,849.00	$627.47	$5,218.20	$1,530.24	2026-01-08
93880	OTHER	US Carotid Dop Bil W/dup	22	22	$2,267.75	$2,267.75	$226.78	$2,154.36	$1,496.72	2026-07-16
70549	CPT	MRA Neck W/wo Contrast	1	1	$6,327.25	$6,327.25	$1,413.64	$1,413.64	$1,413.64	2026-01-08
73220	OTHER	MRI Lower Arm Right W/wo Contrast	22	22	$2,351.25	$2,351.25	$235.13	$2,233.69	$1,413.15	2026-07-16
70546	CPT	MRA Head W/wo Contrast	1	1	$6,320.50	$6,320.50	$1,412.17	$1,412.17	$1,412.17	2026-01-08
78580	OTHER	Nm Lung Perfusion	22	22	$2,113.75	$2,113.75	$211.38	$2,008.06	$1,395.08	2026-07-16
97018	OTHER	Ot/paraffin Bath	22	22	$2,106.50	$2,106.50	$210.65	$2,001.18	$1,390.30	2026-07-16
29126	OTHER	Ot/application Short Arm Splint;dynamic	22	22	$2,106.50	$2,106.50	$210.65	$2,001.18	$1,390.30	2026-07-16
97014	OTHER	Ot/electrical Stim (unattended)	22	22	$2,106.50	$2,106.50	$210.65	$2,001.18	$1,390.30	2026-07-16
36569	OTHER	Picc Insertion Age >=5 Yr W/supplies	22	22	$2,105.25	$2,105.25	$210.53	$1,999.99	$1,389.47	2026-07-16
94760	OTHER	Pulse Oximeter,single	22	22	$2,105.25	$2,105.25	$210.53	$1,999.99	$1,389.47	2026-07-16
J1439	HCPCS	Injectafer : 50mg/ml 15ml Sdv	22	22	$2,095.40	$2,095.40	$209.54	$1,990.63	$1,382.97	2026-07-16
95810	CPT	Sleep Study/psg >= 6 Hrs Of Recording	9	9	$5,901.50	$5,901.50	$1,266.81	$4,496.20	$1,335.64	2026-01-08
74280	OTHER	Be With Air Routine	22	22	$2,019.75	$2,019.75	$201.98	$1,918.76	$1,333.03	2026-07-16
360	OTHER	Cataract Extraction W/lens Insertion	132	22	$3,143.12	$3,143.12	$9.75	$5,858.41	$1,321.22	2026-07-16
A9520	HCPCS	Nm Tc99 Tilmanocept Diag 0.5mci	22	22	$1,999.25	$1,999.25	$199.93	$1,899.29	$1,319.51	2026-07-16
78454	OTHER	Nm Mpi R & S Multi Planar W/wall&eject	22	22	$1,943.75	$1,943.75	$194.38	$1,846.56	$1,282.88	2026-07-16
90471	OTHER	Fluzone 0.5ml Administration	44	22	$12,319.38	$12,319.38	$5.88	$23,351.00	$1,256.90	2026-07-16
J1561	HCPCS	Gamunex C Infus 10% : 20gm (200ml)sdv	89	23	$4,289.25	$4,289.25	$33.20	$9,127.60	$1,249.04	2026-07-16
72197	CPT	MRI Pelvis W/wo Contrast	7	7	$5,313.75	$5,313.75	$687.90	$3,795.38	$1,222.16	2026-01-08
78201	OTHER	Nm Liver Static Only	22	22	$1,829.00	$1,829.00	$182.90	$1,737.55	$1,207.14	2026-07-16
23655	CPT	Ubdisl Tx Shoulder Closed W/man W/anes	2	2	$3,168.00	$3,168.00	$693.91	$1,630.88	$1,162.39	2026-01-08
73220	CPT	MRI Hand Right W/wo Contrast	1	1	$5,285.50	$5,285.50	$1,154.74	$1,154.74	$1,154.74	2026-01-08
78708	OTHER	Nm Kidney Morph W Fl/fun With Pharm	22	22	$1,745.75	$1,745.75	$174.58	$1,658.46	$1,152.20	2026-07-16
J2357	HCPCS	Xolair 150mg/1mL Syringe	66	22	$2,684.00	$2,684.00	$142.36	$2,704.89	$1,138.88	2026-07-16
73219	OTHER	MRI Up Ext Non Jt W/contrast	22	22	$1,719.00	$1,719.00	$171.90	$1,633.05	$1,134.54	2026-07-16
73223	CPT	MRI Elbow Right W/wo Contrast	5	5	$4,956.50	$4,956.50	$687.90	$1,162.79	$1,082.83	2026-01-08
65220	OTHER	Ub-remove Fb-corneal,without Sl	44	22	$2,943.12	$2,943.12	$132.30	$4,335.09	$1,058.40	2026-07-16
97598	CPT	Debride,derm &/or EPID/ea Addl 20cm	1	1	$1,323.00	$1,323.00	$1,058.40	$1,058.40	$1,058.40	2026-01-08
92960	OTHER	Cardioversion ER Facility (450)	44	22	$3,086.50	$3,086.50	$132.30	$4,607.50	$1,058.40	2026-07-16
69200	OTHER	Ub-remove Fb-ext Aud Canal	44	22	$2,943.12	$2,943.12	$132.30	$4,335.09	$1,058.40	2026-07-16
78070	OTHER	Nm Parathyroid Planar Imaging W/subtract	22	22	$1,559.25	$1,559.25	$155.93	$1,481.29	$1,029.11	2026-07-16
93971	OTHER	US Venous Mapping Unilateral	22	22	$1,543.50	$1,543.50	$154.35	$1,466.33	$1,018.72	2026-07-16
99282	OTHER	Emergency Room Level 2	44	22	$2,794.38	$2,794.38	$132.30	$4,052.46	$1,000.74	2026-07-16
93923	OTHER	US Art Up Ext Bilat	44	22	$1,547.62	$1,547.62	$137.63	$1,633.05	$997.79	2026-07-16
93882	OTHER	US Carotid Dop Uni W/dup	22	22	$1,511.75	$1,511.75	$151.18	$1,436.16	$997.75	2026-07-16
72148	CPT	MRI Lumbosacral Without Contrast	19	19	$4,338.75	$4,338.75	$370.65	$3,471.00	$984.95	2026-01-08
62270	OTHER	* Lumbar Puncture & Kit	44	22	$4,033.12	$4,033.12	$122.20	$6,502.04	$977.60	2026-07-16
71275	CPT	CTA Chest, Non-coronary	23	23	$4,362.25	$4,362.25	$570.42	$3,115.88	$974.65	2026-01-08
74270	OTHER	Be Without Air	22	22	$1,460.50	$1,460.50	$146.05	$1,387.48	$963.93	2026-07-16
81220	OTHER	Cystic Fibrosis Cfvantage Screen	22	22	$1,481.25	$1,481.25	$35.00	$1,407.19	$962.81	2026-07-16
J0881	HCPCS	Aranesp 0.06mg/0.3mL Singleject	66	22	$3,404.05	$3,404.05	$117.03	$3,705.00	$936.24	2026-07-16
75635	CPT	CTA Aa W/runoffs W/lower Extremities	3	3	$4,172.50	$4,172.50	$856.75	$957.18	$932.24	2026-01-08
J1740	HCPCS	Boniva Injection 3mg/3ml (ibandronate)	22	22	$1,384.45	$1,384.45	$138.45	$1,315.23	$913.74	2026-07-16
C9399	HCPCS	Remdesivir 100mg/VIAL (veklury)	22	22	$1,365.00	$1,365.00	$136.50	$1,296.75	$900.90	2026-07-16
93308	CPT	US Heart Limited M Mode	1	1	$1,193.00	$1,193.00	$894.75	$894.75	$894.75	2026-01-08
J1442	HCPCS	Neupogen Singleject : 480mcg/0.8ml	22	22	$1,354.35	$1,354.35	$135.44	$1,286.63	$893.87	2026-07-16
73218	OTHER	MRI Upper Arm Right Without Contrast	102	22	$1,511.75	$1,511.75	$110.83	$2,154.36	$886.60	2026-07-16
97597	CPT	Debride,dermis &/or EPID,1st 20cm	3	3	$1,323.00	$1,323.00	$310.38	$1,058.40	$886.41	2026-01-08
73718	CPT	MRI Upper Leg Left Without Contrast	7	7	$3,844.25	$3,844.25	$407.72	$3,075.40	$881.87	2026-01-08
12002	OTHER	Ub-repair, Smpl, Scalp, 2.6-7.5	44	22	$2,686.38	$2,686.38	$109.15	$4,067.19	$873.20	2026-07-16
29580	OTHER	Application Of Unna Boot/right	22	22	$1,323.00	$1,323.00	$132.30	$1,256.85	$873.18	2026-07-16
94761	OTHER	Pulse Oximeter,multiple	22	22	$1,323.00	$1,323.00	$132.30	$1,256.85	$873.18	2026-07-16
11045	OTHER	DEBRIDE,subq Tissue,ea Addl 20cm 1-4unit	22	22	$1,323.00	$1,323.00	$132.30	$1,256.85	$873.18	2026-07-16
11042	OTHER	DEBRIDE,subq Tissue,first 20cm	22	22	$1,323.00	$1,323.00	$132.30	$1,256.85	$873.18	2026-07-16
11043	OTHER	DEBRIDE,MUSCLE/FASCIA,first 20cm	22	22	$1,323.00	$1,323.00	$132.30	$1,256.85	$873.18	2026-07-16
97598	OTHER	Debride,derm &/or EPID/ea Addl 20cm	22	22	$1,323.00	$1,323.00	$132.30	$1,256.85	$873.18	2026-07-16
93306	OTHER	US Echo W/doppler & Colorflow (routine)	22	22	$1,323.00	$1,323.00	$132.30	$1,256.85	$873.18	2026-07-16
94726	OTHER	Plethysmography Determine Lung Volumes	22	22	$1,323.00	$1,323.00	$132.30	$1,256.85	$873.18	2026-07-16
94762	OTHER	Pulse Ox, Continuous Overnight	22	22	$1,323.00	$1,323.00	$132.30	$1,256.85	$873.18	2026-07-16
97602	OTHER	Active Wound Mgmt/non-sel Debridement	22	22	$1,323.00	$1,323.00	$132.30	$1,256.85	$873.18	2026-07-16
94729	OTHER	Dlco	22	22	$1,323.00	$1,323.00	$132.30	$1,256.85	$873.18	2026-07-16
97597	OTHER	Debride,dermis &/or EPID,1st 20cm	22	22	$1,323.00	$1,323.00	$132.30	$1,256.85	$873.18	2026-07-16
70498	CPT	CTA Neck	11	11	$3,694.25	$3,694.25	$424.84	$3,694.25	$866.67	2026-01-08
88319	CPT	Path Special Stn Group 3 I&r	1	1	$2,728.00	$2,728.00	$848.34	$848.34	$848.34	2026-01-08
76380	OTHER	CT Clavicle	22	22	$1,259.25	$1,259.25	$125.93	$1,448.00	$831.11	2026-07-16
G0283	HCPCS	Electrical Stim (unattended)	22	22	$1,244.75	$1,244.75	$124.48	$1,182.51	$821.54	2026-07-16
420	OTHER	Body Mechanics Evaluation	22	22	$1,244.75	$1,244.75	$124.48	$1,182.51	$821.54	2026-07-16
93922	OTHER	US Abi (ankle,brachial Indexes)	44	22	$1,242.25	$1,242.25	$110.83	$1,307.44	$803.49	2026-07-16
J1745	HCPCS	Remicade 100mg Sdv	25	25	$1,220.70	$1,220.70	$28.16	$1,159.67	$793.46	2026-07-16
74246	OTHER	Ugi W/air Routine	22	22	$1,197.50	$1,197.50	$119.75	$1,137.63	$790.36	2026-07-16
81270	OTHER	Jak2 V617f Mutation Analysis	22	22	$1,211.50	$1,211.50	$35.00	$1,150.93	$787.48	2026-07-16
73525	OTHER	Hip Arthrogram (l) W Assc Inj Chg	22	22	$1,154.00	$1,154.00	$115.40	$1,096.30	$761.64	2026-07-16
70496	CPT	CTA Head	12	12	$3,399.25	$3,399.25	$627.60	$3,399.25	$761.57	2026-01-08
73040	OTHER	Shoulder Arthrogram (r)	22	22	$1,151.00	$1,151.00	$115.10	$1,093.45	$759.66	2026-07-16
73580	OTHER	Knee Arthrogram (r)	22	22	$1,145.00	$1,145.00	$114.50	$1,087.75	$755.70	2026-07-16
81596	OTHER	Liver Fibrosis, Fibrotest-actitest	22	22	$1,161.75	$1,161.75	$35.00	$1,103.66	$755.14	2026-07-16
G0399	HCPCS	Home Sleep Test/type 3 Porta	14	14	$1,178.25	$1,178.25	$256.52	$942.60	$751.74	2026-01-08
15271	CPT	App Skin Grf Tk/a/l To 100 Sqcm 1st 25sq	1	1	$3,233.00	$3,233.00	$741.65	$741.65	$741.65	2026-01-08
78014	OTHER	Nm Thy Uptake Single/multi Quan Measure	22	22	$1,115.50	$1,115.50	$111.55	$1,059.73	$736.24	2026-07-16
29505	OTHER	Ub-splint, Long Leg	66	22	$3,168.25	$3,168.25	$16.78	$4,366.20	$735.99	2026-07-16
84238	OTHER	Myesthenia Gravis Panel	22	22	$1,098.00	$1,098.00	$35.00	$1,043.10	$713.70	2026-07-16
93017	CPT	Stress EKG	6	6	$1,616.50	$1,616.50	$280.06	$1,031.47	$701.63	2026-01-08
73219	CPT	MRI Up Ext Non Jt W/contrast	1	1	$4,207.00	$4,207.00	$687.90	$687.90	$687.90	2026-01-08
74240	OTHER	Ugi	22	22	$1,031.75	$1,031.75	$103.18	$980.16	$680.95	2026-07-16
10080	OTHER	Ub-i & D Pilonidal Cyst, Simple	44	22	$2,112.38	$2,112.38	$84.00	$3,215.51	$672.00	2026-07-16
81256	OTHER	Hereditary Hemochromatosis DNA Mutation	22	22	$1,023.25	$1,023.25	$35.00	$972.09	$665.11	2026-07-16
74250	OTHER	Small Bowel Without Fluoro	22	22	$1,005.25	$1,005.25	$100.53	$954.99	$663.46	2026-07-16
76000	OTHER	Fluoroscopy	22	22	$988.50	$988.50	$98.85	$939.08	$652.41	2026-07-16
361	OTHER	Minor Or/colonoscopy	66	22	$2,658.00	$2,658.00	$67.93	$4,039.16	$623.57	2026-07-16
97164	OTHER	Re Evaluation - Ep	22	22	$894.00	$894.00	$89.40	$849.30	$590.04	2026-07-16
370	OTHER	Forane Anes Gas (minutes)	44	22	$1,070.88	$1,070.88	$80.83	$1,266.83	$585.99	2026-07-16
88120	OTHER	Fish, Vysis,urovysion, Bladder Cancer	22	22	$890.50	$890.50	$35.00	$845.98	$578.83	2026-07-16
85247	OTHER	Von Willebrand Ag Multinumeric Analysis	22	22	$879.50	$879.50	$35.00	$835.53	$571.68	2026-07-16
80074	OTHER	Hepatitis Panel Acute	22	22	$877.50	$877.50	$35.00	$833.63	$570.38	2026-07-16
343	OTHER	Nm Indium In-111 Auto Wbc	44	22	$5,163.12	$5,163.12	$11.83	$9,697.60	$566.57	2026-07-16
74230	OTHER	Barium Swallow Modified	22	22	$853.25	$853.25	$85.33	$810.59	$563.14	2026-07-16
74300	OTHER	C Arm Cholangiogram	22	22	$847.00	$847.00	$84.70	$804.65	$559.02	2026-07-16
74220	OTHER	Ba Swallow	22	22	$841.75	$841.75	$84.18	$799.66	$555.56	2026-07-16
P9016	HCPCS	*bb Prbc Per Unit	31	31	$2,384.00	$2,384.00	$52.91	$2,264.80	$548.32	2026-07-16
761	OTHER	Pain Mgmt/time (rev Code 761/swb)	44	22	$1,819.12	$1,819.12	$67.93	$2,811.05	$543.40	2026-07-16
402	OTHER	US Guidance Needle Bx, Asb, Inj	22	22	$817.50	$817.50	$81.75	$776.63	$539.56	2026-07-16
87498	OTHER	Enterovirus RNA Csf,ql Real Time Pcr	22	22	$793.75	$793.75	$35.00	$754.06	$515.94	2026-07-16
74430	OTHER	Cystogram	22	22	$779.00	$779.00	$77.90	$740.05	$514.14	2026-07-16
76882	OTHER	US Extremity Single Site	44	22	$1,218.25	$1,218.25	$68.20	$1,666.78	$494.45	2026-07-16
G0496	HCPCS	Hh/lpn Teach Visit	21	21	$2,115.25	$2,115.25	$42.00	$2,009.49	$486.51	2026-07-16
G0151	HCPCS	Hh/physical Therapy	38	21	$1,244.75	$1,244.75	$42.00	$2,001.18	$484.50	2026-07-16
83727	OTHER	Gonadotropin Releasing Hormone	22	22	$745.25	$745.25	$35.00	$707.99	$484.41	2026-07-16
87801	OTHER	Inf Agnt Nuc Acid Mlt Org Amp Probe Tq	22	22	$742.25	$742.25	$35.00	$705.14	$482.46	2026-07-16
81332	OTHER	Alpha-1 Antitrypsin Phenotype Mutation A	22	22	$738.75	$738.75	$35.00	$701.81	$480.19	2026-07-16
90384	OTHER	*bb Rhogam Full Dose, 1m	22	22	$721.50	$721.50	$72.15	$685.43	$476.20	2026-07-16
83921	OTHER	Organic Acid Urine, Qual	43	22	$1,098.25	$1,098.25	$35.00	$1,043.34	$475.13	2026-07-16
87902	OTHER	Hep C Genotype	64	22	$1,129.75	$1,129.75	$35.00	$2,063.40	$475.00	2026-07-16
87497	OTHER	Cytomegalovirus DNA Qn Pcr Real Time	22	22	$714.75	$714.75	$35.00	$679.01	$464.59	2026-07-16
80050	OTHER	General Health Screen	22	22	$714.50	$714.50	$35.00	$678.78	$464.43	2026-07-16
87496	OTHER	Cytomegalovirus Ql DNA Pcr Real Time	43	22	$638.25	$638.25	$35.00	$680.44	$446.78	2026-07-16
10060	OTHER	Ub-i & D Abscess, Simple	44	22	$2,460.62	$2,460.62	$48.60	$4,213.49	$443.53	2026-07-16
72114	OTHER	Ls Spine Comp W/flex Ext	22	22	$663.00	$663.00	$66.30	$629.85	$437.58	2026-07-16
92950	CPT	Ub-cpr	5	5	$682.50	$682.50	$149.50	$668.85	$435.50	2026-01-08
93226	OTHER	*holter Monitor/analysis W/report	22	22	$659.25	$659.25	$65.93	$626.29	$435.11	2026-07-16
10120	OTHER	Fb Removal Simple(456) Dpa	44	22	$2,509.50	$2,509.50	$42.90	$4,360.50	$433.27	2026-07-16
77074	OTHER	Metastatic Bone Series	22	22	$653.75	$653.75	$65.38	$621.06	$431.48	2026-07-16
73223	OTHER	MRI Elbow Right W/wo Contrast	42	22	$149.75	$149.75	$14.98	$4,067.19	$428.13	2026-07-16
81512	OTHER	Penta Screen	22	22	$655.25	$655.25	$35.00	$622.49	$425.91	2026-07-16
77002	OTHER	Fluoro Guidance-biopsy/aspr/injection	22	22	$632.25	$632.25	$63.23	$600.64	$417.28	2026-07-16
87522	OTHER	$$cpthep C Viral Quant Pcr/rfx To Geno	43	22	$593.75	$593.75	$35.00	$949.29	$415.63	2026-07-16
88307	OTHER	Path Level 5 (gross/micro) Tc	22	22	$627.75	$627.75	$35.00	$596.36	$408.04	2026-07-16
77073	OTHER	Bone Length Studies	22	22	$617.00	$617.00	$61.70	$586.15	$407.22	2026-07-16
87799	OTHER	Bk Virus Dna, Qn Pcr Plasma	43	22	$625.25	$625.25	$35.00	$593.99	$406.41	2026-07-16
51798	OTHER	US Bladder-measure Vol/port Unit(450)	44	22	$2,466.12	$2,466.12	$36.90	$4,335.09	$403.44	2026-07-16
72052	OTHER	C Spine 6 Or More Views	22	22	$605.50	$605.50	$60.55	$575.23	$399.63	2026-07-16
31500	OTHER	Intubation Endotracheal	44	22	$2,334.12	$2,334.12	$38.70	$4,067.19	$397.89	2026-07-16
93225	OTHER	Holter Monitor/recording	22	22	$596.00	$596.00	$59.60	$566.20	$393.36	2026-07-16
81288	CPT	Path Mlh1 Gene Anl Prom Methy	1	1	$1,745.25	$1,745.25	$389.91	$389.91	$389.91	2026-01-08
97016	OTHER	Vasopneumatic DEVICES/1x Per Day Only	22	22	$589.50	$589.50	$58.95	$560.03	$389.08	2026-07-16
81401	CPT	$$cpthuntington Disease Mutation	1	1	$254.50	$254.50	$378.14	$378.14	$378.14	2026-01-08
86341	OTHER	Islet Cell Ab Screen With Reflex	22	22	$579.00	$579.00	$35.00	$550.05	$376.35	2026-07-16
87250	OTHER	Culture Viral Body Fluid	22	22	$578.75	$578.75	$35.00	$549.81	$376.19	2026-07-16
82024	OTHER	Adrenocorticotropic Hormone	22	22	$578.75	$578.75	$35.00	$549.81	$376.19	2026-07-16
76700	OTHER	US Abdominal Complete	22	22	$568.50	$568.50	$56.85	$540.08	$375.21	2026-07-16
87902	CPT	Hep C Genotype	6	6	$1,308.00	$1,308.00	$154.44	$996.40	$374.75	2026-01-08
J2785	HCPCS	Lexiscan 0.4mg/5ml IV (regadenoson)	22	22	$564.50	$564.50	$56.45	$536.28	$372.58	2026-07-16
87517	OTHER	Hep B Virus DNA Rt Pcr	22	22	$572.75	$572.75	$35.00	$544.11	$372.29	2026-07-16
81291	OTHER	Mthfr	22	22	$571.50	$571.50	$35.00	$542.93	$371.48	2026-07-16
87536	OTHER	HIV-1 RNA Qnt Ultra V1.5	22	22	$568.75	$568.75	$35.00	$540.31	$369.69	2026-07-16
77080	OTHER	Dexa/axial - Hip, Spine	22	22	$557.50	$557.50	$55.75	$529.63	$367.95	2026-07-16
A9562	HCPCS	Nm Tc99m Mag3/mertiatide Ud	22	22	$555.50	$555.50	$55.55	$527.73	$366.63	2026-07-16
99283	OTHER	Emergency Room Level 3	66	22	$546.00	$546.00	$33.95	$4,052.46	$360.36	2026-07-16

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