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

FLOYD VALLEY HEALTHCARE

Le Mars, IA · CCN 161368 · Rates published

1,324 distinct procedures filed
5 distinct payers
22,031 rate rows
2026-07-15 last MRF observed
Data quality

21,876 of 22,031 rate rows are consumer-grade (99.3%)

155 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
percent-of-charges filed in the dollar field — excluded from medians 79
exceeds 10× this hospital's gross charge — excluded from medians 50
placeholder amount (≤ $0.02) — excluded from medians 18
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 8
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.avera.org/app/files/public/718846f0-2571-438d-8c93-43650e7cefb8/420928451_floyd-valley-healthcare_standardcharges.csv
Found on page https://www.avera.org/patients-visitors/price-transparency/
Discovered viaDiscovered by HANK (automated)
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-10-10
Content fingerprint 5475ab0ef3a452f5… · 5,662,802 bytes · first seen 2026-06-08

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
327
MS_DRG 		Ms-DRG 327 1 $36,911.13 $36,911.13 $36,911.13 nat. median
$18,223
outlier · 2.0×
806
MS_DRG 		Ms-DRG 806 1 $22,717.19 $22,717.19 $22,717.19 nat. median
$5,473
outlier · 4.2×
805
MS_DRG 		Ms-DRG 805 1 $22,162.88 $22,162.88 $22,162.88 nat. median
$7,517
outlier · 2.9×
J2350
HCPCS 		Ocrelizumab 300 Mg/10 Ml 5 $6.09 $32,782.29 $19,841.91 nat. median
$133
outlier · 149.2×
787
APR_DRG 		Apr-DRG 787 1 $13,594.89 $13,594.89 $13,594.89 —
787
MS_DRG 		Ms-DRG 787 1 $13,594.89 $13,594.89 $13,594.89 nat. median
$8,114
1.7× median
807
MS_DRG 		Ms-DRG 807 1 $9,896.83 $9,896.83 $9,896.83 nat. median
$4,880
outlier · 2.0×
690
MS_DRG 		Ms-DRG 690 1 $9,595.59 $9,595.59 $9,595.59 nat. median
$6,107
1.6× median
J3380
HCPCS 		Vedolizumab 300 Mg Vial 5 $21.16 $14,998.77 $9,078.20 nat. median
$59
outlier · 154.4×
J3101
HCPCS 		Tenecteplase 50 Mg/10 Ml Syrng 5 $0.41 $11,627.68 $7,037.81 nat. median
$498
outlier · 14.1×
793
MS_DRG 		Ms-DRG 793 1 $5,906.52 $5,906.52 $5,906.52 nat. median
$15,882
outlier · 0.4×
J0717
HCPCS 		Certolizumab Pegol 400 Mg Kit 5 $3.42 $9,522.40 $5,763.56 nat. median
$29
outlier · 198.6×
794
MS_DRG 		Ms-DRG 794 1 $5,427.04 $5,427.04 $5,427.04 nat. median
$5,568
1.0× median
J0517
HCPCS 		Benralizumab 30 Mg/ml Syringe 5 $3.10 $8,366.52 $5,063.94 nat. median
$404
outlier · 12.5×
795
MS_DRG 		Ms-DRG 795 1 $4,066.55 $4,066.55 $4,066.55 nat. median
$2,086
1.9× median
J0565
HCPCS 		Bezlotoxumab 1,000 Mg/40 Ml Vl 5 $39.87 $6,324.54 $3,828.01 nat. median
$121
outlier · 31.7×
J1944
HCPCS 		Aripiprazole Lauroxil 1064 Mg 5 $3.26 $4,831.49 $3,202.73 nat. median
$894
outlier · 3.6×
90375
HCPCS 		Rabies Ig (Human) 300 U/Ml 5Ml 5 $146.90 $5,143.35 $3,113.08 nat. median
$789
outlier · 3.9×
871
MS_DRG 		Ms-DRG 871 1 $2,901.98 $2,901.98 $2,901.98 nat. median
$14,442
outlier · 0.2×
Q5115
HCPCS 		Rituximab-abbs 500Mg/50Ml Vial 5 $34.76 $4,118.87 $2,861.53 nat. median
$368
outlier · 7.8×
J9034
HCPCS 		Bendamustine 100 Mg/4 Ml Vial 5 $14.86 $4,616.73 $2,794.34 nat. median
$36
outlier · 77.5×
636
OTHER 		Inclisiran 284mg/1.5mL 5 $2,066.50 $3,926.35 $2,748.45 nat. median
$6,011
outlier · 0.5×
J9202
HCPCS 		Goserelin 10.8 Mg Implant 5 $77.08 $4,425.86 $2,678.81 nat. median
$1,728
1.6× median
73720
CPT 		MRI Le Wwo Dye Lt 5 $175.17 $4,531.50 $2,385.00 nat. median
$754
outlier · 3.2×
73220
CPT 		MRI Ue Wwo Dye Rt 5 $175.17 $4,531.50 $2,385.00 nat. median
$737
outlier · 3.2×
73223
CPT 		MRI Joint Ue Wwo Dye Rt 5 $175.17 $4,474.50 $2,355.00 nat. median
$757
outlier · 3.1×
73723
CPT 		MRI Joint Le Wwo Dye Lt 5 $175.17 $4,465.00 $2,350.00 nat. median
$756
outlier · 3.1×
J0401
HCPCS 		Aripiprazole 400 Mg Vial 5 $0.77 $3,752.26 $2,271.11 nat. median
$22
outlier · 101.1×
95811
CPT 		Polysomnogram W CPap 5 $1,580.00 $3,002.00 $2,270.46 nat. median
$1,412
1.6× median
Q5108
HCPCS 		Pegfilgrastim-jmdb 6 Mg/0.6 Ml 5 $112.90 $5,330.25 $2,036.92 nat. median
$418
outlier · 4.9×
Q5122
HCPCS 		Pegfilgrastim 6 Mg/0.6 Ml Syr 5 $134.25 $3,939.75 $2,036.24 nat. median
$487
outlier · 4.2×
94002
CPT 		Vent Assist & Mgmt First Day 5 $1,503.00 $2,855.70 $1,998.99 nat. median
$783
outlier · 2.6×
Q5111
HCPCS 		Pegfilgrastim-cbqv 6 Mg/0.6 Ml 5 $163.60 $3,256.13 $1,970.82 nat. median
$665
outlier · 3.0×
J1602
HCPCS 		Golimumab 50 Mg/4 Ml Vial 5 $10.77 $3,243.70 $1,963.29 nat. median
$55
outlier · 36.0×
J0897
HCPCS 		Denosumab 60 Mg/ml Syringe 5 $9.69 $4,985.07 $1,893.41 nat. median
$86
outlier · 22.0×
J3032
HCPCS 		Eptinezumab-jjmr 100Mg/Ml Vial 5 $19.32 $3,078.18 $1,863.11 nat. median
$35
outlier · 53.2×
95810
CPT 		Polysomnogram 5 $1,386.00 $2,633.40 $1,843.38 nat. median
$1,446
1.3× median
112
OTHER 		Room Womens Ctr 5 $1,302.00 $2,473.80 $1,718.64 nat. median
$2,874
0.6× median
111
OTHER 		Room Medical Unit Priv 5 $1,302.00 $2,473.80 $1,718.64 nat. median
$9,983
outlier · 0.2×
Q4133
HCPCS 		Allograft Stravix Pl 8SqCm 5 $1,282.50 $2,436.75 $1,705.72 nat. median
$456
outlier · 3.7×
73721
CPT 		MRI Joint Le Wo Dye Lt 5 $110.25 $2,280.00 $1,560.00 nat. median
$509
outlier · 3.1×
J1569
HCPCS 		Immune Glob Gammagard 5gr/50ml 5 $21.77 $5,142.60 $1,538.69 nat. median
$946
1.6× median
19083
CPT 		Biopsy Breast 1st Lesion Lt 5 $268.60 $2,077.65 $1,443.42 nat. median
$1,957
0.7× median
J0129
HCPCS 		Abatacept 250 Mg Vial 5 $43.38 $2,375.61 $1,437.87 nat. median
$122
outlier · 11.8×
73222
CPT 		MRI Joint Ue W Dye Lt 5 $132.25 $2,631.50 $1,385.00 nat. median
$1,026
1.4× median
73221
CPT 		MRI Joint Ue Wo Dye Lt 5 $110.25 $2,270.50 $1,374.25 nat. median
$547
outlier · 2.5×
C1768
HCPCS 		Graft Vasc Propaten 4x7mm 5 $1,029.50 $1,956.53 $1,364.42 nat. median
$2,193
0.6× median
360
OTHER 		Biopsy Prostate 5 $300.00 $11,400.00 $1,350.00 nat. median
$16,601
outlier · 0.1×
C1889
HCPCS 		Device Ut Nvsr V5 Cmb Kt US 5 $951.00 $1,807.38 $1,260.41 nat. median
$1,642
0.8× median
73218
CPT 		MRI Ue Wo Dye Lt 5 $79.39 $2,318.00 $1,220.00 nat. median
$553
outlier · 2.2×

Other procedures at this hospital

Browse this hospital's 1,324 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
327 MS_DRG Ms-DRG 327 1 1 — — $36,911.13 $36,911.13 $36,911.13 2026-07-15
806 MS_DRG Ms-DRG 806 1 1 — — $22,717.19 $22,717.19 $22,717.19 2026-07-15
805 MS_DRG Ms-DRG 805 1 1 — — $22,162.88 $22,162.88 $22,162.88 2026-07-15
J2350 HCPCS Ocrelizumab 300 Mg/10 Ml 12 5 $34,507.00 $34,507.67 $6.09 $32,782.29 $19,841.91 2026-07-15
787 MS_DRG Ms-DRG 787 1 1 — — $13,594.89 $13,594.89 $13,594.89 2026-07-15
787 APR_DRG Apr-DRG 787 1 1 — — $13,594.89 $13,594.89 $13,594.89 2026-07-15
807 MS_DRG Ms-DRG 807 1 1 — — $9,896.83 $9,896.83 $9,896.83 2026-07-15
690 MS_DRG Ms-DRG 690 1 1 — — $9,595.59 $9,595.59 $9,595.59 2026-07-15
J3380 HCPCS Vedolizumab 300 Mg Vial 12 5 $15,788.00 $15,788.18 $21.16 $14,998.77 $9,078.20 2026-07-15
J3101 HCPCS Tenecteplase 50 Mg/10 Ml Syrng 12 5 $12,239.00 $12,239.66 $0.41 $11,627.68 $7,037.81 2026-07-15
793 MS_DRG Ms-DRG 793 1 1 — — $5,906.52 $5,906.52 $5,906.52 2026-07-15
J0717 HCPCS Certolizumab Pegol 400 Mg Kit 12 5 $10,023.00 $10,023.58 $3.42 $9,522.40 $5,763.56 2026-07-15
794 MS_DRG Ms-DRG 794 1 1 — — $5,427.04 $5,427.04 $5,427.04 2026-07-15
J0517 HCPCS Benralizumab 30 Mg/ml Syringe 12 5 $8,806.00 $8,806.86 $3.10 $8,366.52 $5,063.94 2026-07-15
795 MS_DRG Ms-DRG 795 1 1 — — $4,066.55 $4,066.55 $4,066.55 2026-07-15
J0565 HCPCS Bezlotoxumab 1,000 Mg/40 Ml Vl 12 5 $6,657.00 $6,657.41 $39.87 $6,324.54 $3,828.01 2026-07-15
J1944 HCPCS Aripiprazole Lauroxil 1064 Mg 12 5 $5,085.00 $5,085.78 $3.26 $4,831.49 $3,202.73 2026-07-15
90375 HCPCS Rabies Ig (Human) 300 U/Ml 5Ml 12 5 $5,414.00 $5,414.05 $146.90 $5,143.35 $3,113.08 2026-07-15
871 MS_DRG Ms-DRG 871 1 1 — — $2,901.98 $2,901.98 $2,901.98 2026-07-15
Q5115 HCPCS Rituximab-abbs 500Mg/50Ml Vial 12 5 $4,335.00 $4,335.65 $34.76 $4,118.87 $2,861.53 2026-07-15
J9034 HCPCS Bendamustine 100 Mg/4 Ml Vial 12 5 $4,859.00 $4,859.72 $14.86 $4,616.73 $2,794.34 2026-07-15
636 OTHER Inclisiran 284mg/1.5mL 9 5 $4,133.00 $4,133.00 $2,066.50 $3,926.35 $2,748.45 2026-07-15
J9202 HCPCS Goserelin 10.8 Mg Implant 12 5 $4,658.00 $4,658.80 $77.08 $4,425.86 $2,678.81 2026-07-15
73220 CPT MRI Ue Wwo Dye Rt 25 5 $4,770.00 $4,770.00 $175.17 $4,531.50 $2,385.00 2026-07-15
73720 CPT MRI Le Wwo Dye Lt 25 5 $4,770.00 $4,770.00 $175.17 $4,531.50 $2,385.00 2026-07-15
73223 CPT MRI Joint Ue Wwo Dye Rt 25 5 $4,710.00 $4,710.00 $175.17 $4,474.50 $2,355.00 2026-07-15
73723 CPT MRI Joint Le Wwo Dye Lt 25 5 $4,700.00 $4,700.00 $175.17 $4,465.00 $2,350.00 2026-07-15
J0401 HCPCS Aripiprazole 400 Mg Vial 12 5 $3,949.00 $3,949.75 $0.77 $3,752.26 $2,271.11 2026-07-15
95811 CPT Polysomnogram W CPap 10 5 $3,160.00 $3,160.00 $1,580.00 $3,002.00 $2,270.46 2026-07-15
Q5108 HCPCS Pegfilgrastim-jmdb 6 Mg/0.6 Ml 12 5 $3,086.00 $3,086.25 $112.90 $5,330.25 $2,036.92 2026-07-15
Q5122 HCPCS Pegfilgrastim 6 Mg/0.6 Ml Syr 12 5 $3,085.00 $3,085.21 $134.25 $3,939.75 $2,036.24 2026-07-15
94002 CPT Vent Assist & Mgmt First Day 9 5 $3,006.00 $3,006.00 $1,503.00 $2,855.70 $1,998.99 2026-07-15
Q5111 HCPCS Pegfilgrastim-cbqv 6 Mg/0.6 Ml 12 5 $3,427.00 $3,427.50 $163.60 $3,256.13 $1,970.82 2026-07-15
J1602 HCPCS Golimumab 50 Mg/4 Ml Vial 12 5 $3,414.00 $3,414.42 $10.77 $3,243.70 $1,963.29 2026-07-15
J0897 HCPCS Denosumab 60 Mg/ml Syringe 27 5 $2,912.00 $2,912.94 $9.69 $4,985.07 $1,893.41 2026-07-15
J3032 HCPCS Eptinezumab-jjmr 100Mg/Ml Vial 12 5 $3,240.00 $3,240.19 $19.32 $3,078.18 $1,863.11 2026-07-15
95810 CPT Polysomnogram 9 5 $2,772.00 $2,772.00 $1,386.00 $2,633.40 $1,843.38 2026-07-15
111 OTHER Room Medical Unit Priv 7 5 $2,604.00 $2,604.00 $1,302.00 $2,473.80 $1,718.64 2026-07-15
112 OTHER Room Womens Ctr 7 5 $2,604.00 $2,604.00 $1,302.00 $2,473.80 $1,718.64 2026-07-15
Q4133 HCPCS Allograft Stravix Pl 8SqCm 9 5 $2,565.00 $2,565.00 $1,282.50 $2,436.75 $1,705.72 2026-07-15
73721 CPT MRI Joint Le Wo Dye Lt 27 5 $2,400.00 $2,400.00 $110.25 $2,280.00 $1,560.00 2026-07-15
J1569 HCPCS Immune Glob Gammagard 5gr/50ml 36 5 $1,893.00 $1,893.77 $21.77 $5,142.60 $1,538.69 2026-07-15
19083 CPT Biopsy Breast 1st Lesion Lt 25 5 $2,187.00 $2,187.00 $268.60 $2,077.65 $1,443.42 2026-07-15
J0129 HCPCS Abatacept 250 Mg Vial 12 5 $2,500.00 $2,500.64 $43.38 $2,375.61 $1,437.87 2026-07-15
73222 CPT MRI Joint Ue W Dye Lt 25 5 $2,770.00 $2,770.00 $132.25 $2,631.50 $1,385.00 2026-07-15
73221 CPT MRI Joint Ue Wo Dye Lt 26 5 $2,390.00 $2,390.00 $110.25 $2,270.50 $1,374.25 2026-07-15
C1768 HCPCS Graft Vasc Propaten 4x7mm 10 5 $2,059.00 $2,059.50 $1,029.50 $1,956.53 $1,364.42 2026-07-15
360 OTHER Biopsy Prostate 81 5 $2,000.00 $2,000.00 $300.00 $11,400.00 $1,350.00 2026-07-15
C1889 HCPCS Device Ut Nvsr V5 Cmb Kt US 10 5 $1,902.00 $1,902.50 $951.00 $1,807.38 $1,260.41 2026-07-15
73218 CPT MRI Ue Wo Dye Lt 25 5 $2,440.00 $2,440.00 $79.39 $2,318.00 $1,220.00 2026-07-15
73718 CPT MRI Le Wo Dye Lt 25 5 $2,420.00 $2,420.00 $56.38 $2,299.00 $1,210.00 2026-07-15
72194 CPT CT Pelvis Wwo Dye 9 5 $1,810.00 $1,810.00 $719.64 $1,719.50 $1,194.60 2026-07-15
93975 CPT Vascular Study 9 5 $1,777.00 $1,777.00 $888.50 $1,688.15 $1,181.70 2026-07-15
J7296 HCPCS Levonorgestrel 17.5Mcg24Hr IUD 20 5 $1,851.00 $1,851.17 $2.49 $1,758.61 $1,180.22 2026-07-15
99285 CPT Emergency Room Visit Level 5 18 5 $2,047.00 $2,047.00 $267.73 $1,944.65 $1,177.03 2026-07-15
19084 CPT Biopsy Breast Addl Lesion Lt 25 5 $1,762.00 $1,762.00 $135.20 $2,077.65 $1,171.73 2026-07-15
25605 CPT Fx Distal Radius W Man 7 5 $1,229.00 $1,229.00 $1,022.30 $1,409.30 $1,113.65 2026-07-15
J1301 HCPCS Edaravone 30 Mg/100 Ml Bag 12 5 $1,925.00 $1,925.50 $20.41 $1,829.22 $1,107.16 2026-07-15
78071 CPT Parathyroid Planar Img W Spect 9 5 $1,560.00 $1,560.00 $780.00 $1,482.00 $1,037.40 2026-07-15
24605 CPT Dislocation Elbow W Anes 7 5 $832.00 $832.00 $950.40 $1,308.72 $1,037.29 2026-07-15
93306 CPT Tte W Doppler Complete 10 5 $1,400.00 $1,400.00 $700.00 $1,330.00 $1,005.90 2026-07-15
C1776 HCPCS Baseplate Tib Gns2 3 Rt Kn Npr 252 5 $1,414.00 $1,414.72 $135.00 $4,061.25 $1,002.62 2026-07-15
71275 CPT CTA Chest Wwo Contrast 15 5 $2,000.00 $2,000.00 $147.65 $1,900.00 $1,000.00 2026-07-15
Q5119 HCPCS Rituximab-pvvr 100Mg/10Ml Vial 20 5 $847.00 $847.06 $24.94 $4,014.00 $958.56 2026-07-15
J1439 HCPCS Ferric Carboxymalt 750mg/15ml 12 5 $1,629.00 $1,629.30 $1.13 $1,547.84 $936.85 2026-07-15
710 OTHER Recovery Phase 1 Per 15 Min 72 5 $1,428.50 $1,428.50 $112.00 $2,356.00 $904.38 2026-07-15
J1561 HCPCS Immune Glob Gamunex 20gr/200ml 28 5 $1,563.00 $1,563.59 $3.60 $2,571.67 $899.06 2026-07-15
23655 CPT Dislocation Shoulder W Anes Lt 7 5 $952.00 $952.00 $814.40 $1,118.12 $889.75 2026-07-15
93880 CPT Extracranial Bilat Study 17 5 $1,364.00 $1,364.00 $57.48 $1,295.80 $886.60 2026-07-15
23665 CPT Tx Should Disloc W Fx W Man Lt 14 5 $1,050.00 $1,050.00 $806.00 $1,095.50 $881.26 2026-07-15
93970 CPT Venous Duplex 17 5 $1,316.00 $1,316.00 $49.31 $1,250.20 $855.40 2026-07-15
G0399 HCPCS Sleep Study Type Iii Portable 11 5 $1,248.00 $1,248.00 $624.00 $1,185.60 $829.92 2026-07-15
C1788 HCPCS Port-a-cath/power Port 20 5 $1,217.50 $1,218.01 $605.00 $1,163.96 $808.65 2026-07-15
P9037 HCPCS Platelet Pheresis Leuk Red Irr 9 5 $1,202.00 $1,202.00 $601.00 $1,141.90 $799.33 2026-07-15
J1459 HCPCS Immune Glob Privigen 5gr/50ml 20 5 $968.00 $968.44 $0.28 $3,514.34 $786.86 2026-07-15
24600 CPT Dislocation Elbow Wo Anes 7 5 $803.00 $803.00 $691.80 $926.91 $751.74 2026-07-15
J3262 HCPCS Tocilizumab 200 Mg/10 Ml Vial 20 5 $2,280.00 $2,280.74 $2.71 $2,166.70 $742.46 2026-07-15
70553 CPT MRI Brain Wwo Contrast 17 5 $4,790.00 $4,790.00 $185.99 $4,550.50 $729.76 2026-07-15
60100 CPT Biopsy Thyroid 16 5 $1,257.00 $1,257.00 $142.50 $1,194.15 $722.77 2026-07-15
20103 CPT Explore Puncture Wound Ext Lt 14 5 $828.00 $828.00 $668.70 $950.21 $717.20 2026-07-15
74160 CPT CT Abdomen W Dye 16 5 $1,490.00 $1,490.00 $103.19 $1,415.50 $706.77 2026-07-15
129 OTHER Room Swing Bed Skilled 7 5 $1,068.00 $1,068.00 $534.00 $1,014.60 $704.88 2026-07-15
72195 CPT MRI Pelvis Wo Dye 14 5 $1,308.50 $1,308.50 $118.72 $2,308.50 $697.70 2026-07-15
26160 CPT Excision Cyst Hand/Finger 7 5 $952.00 $952.00 $631.50 $873.26 $695.02 2026-07-15
C8930 HCPCS Stress Echo W Contrast 10 5 $943.00 $943.00 $471.50 $895.85 $677.55 2026-07-15
74150 CPT CT Abdomen Wo Dye 16 5 $1,170.00 $1,170.00 $96.49 $1,111.50 $672.75 2026-07-15
23650 CPT Dislocation Shoulder Wo Anes 21 5 $666.00 $666.00 $610.30 $802.00 $667.22 2026-07-15
70549 CPT MRA Neck Wwo Contrast 16 5 $4,600.00 $4,600.00 $146.02 $4,370.00 $666.91 2026-07-15
93320 CPT Cardiac Doppler 9 5 $1,000.00 $1,000.00 $500.00 $950.00 $665.00 2026-07-15
C8929 HCPCS Echo M Mode 2d W Contrast 9 5 $998.00 $998.00 $499.00 $948.10 $663.67 2026-07-15
J1745 HCPCS Infliximab 100 Mg Vial 20 5 $1,995.00 $1,995.34 $1.46 $1,895.57 $660.09 2026-07-15
78226 CPT Hepatobiliary Scan Without Ef 16 5 $1,146.00 $1,146.00 $58.80 $1,088.70 $658.95 2026-07-15
78227 CPT Hida With Ef w/Pharm 16 5 $1,146.00 $1,146.00 $71.40 $1,088.70 $658.95 2026-07-15
Q5103 HCPCS Infliximab-dyyb 100 Mg Vial 12 5 $995.00 $995.90 $40.50 $3,013.05 $657.29 2026-07-15
74174 CPT CTA Abd&Pelv Wwo Dye 14 5 $1,218.50 $1,218.50 $177.75 $2,052.00 $657.05 2026-07-15
73201 CPT CT Ue W Dye Lt 25 5 $1,300.00 $1,300.00 $90.44 $1,235.00 $650.00 2026-07-15
73701 CPT CT Le W Dye Lt 25 5 $1,300.00 $1,300.00 $94.13 $1,235.00 $650.00 2026-07-15
90675 CPT Rabies Vax Pcec/Pf 2.5Unit Vl 20 5 $980.00 $980.93 $125.23 $1,027.57 $647.41 2026-07-15
92950 CPT Heart/Lung Resuscitation Cpr 9 5 $970.00 $970.00 $485.00 $921.50 $645.05 2026-07-15
78306 CPT Bone Scan Whole Body 16 5 $1,121.00 $1,121.00 $67.90 $1,064.95 $644.58 2026-07-15
90375 CPT Rabies Imm Glob (Human) 300u/m 12 5 $1,101.00 $1,101.80 $146.90 $1,046.71 $633.53 2026-07-15
73700 CPT CT Le Wo Dye Lt 26 5 $1,080.00 $1,080.00 $76.65 $1,026.00 $621.00 2026-07-15
74183 CPT MRI Abdomen Wwo Dye 16 5 $4,780.00 $4,780.00 $178.70 $4,541.00 $619.08 2026-07-15
72197 CPT MRI Pelvis Wwo Dye 16 5 $4,770.00 $4,770.00 $178.70 $4,531.50 $618.16 2026-07-15
72125 CPT CT Cervical Spine Wo Contrast 19 5 $1,230.00 $1,230.00 $80.96 $1,168.50 $615.00 2026-07-15
26755 CPT Fx Phalange W Manipulation 7 5 $655.00 $655.00 $560.20 $756.95 $613.62 2026-07-15
J0248 HCPCS Remdesivir 100 Mg Vial 12 5 $1,064.00 $1,064.09 $6.35 $1,010.89 $611.85 2026-07-15
99284 CPT Emergency Room Visit Level 4 18 5 $1,040.00 $1,040.00 $184.86 $988.00 $598.00 2026-07-15
93351 CPT Stress Tte Complete 10 5 $832.00 $832.00 $416.00 $790.40 $597.79 2026-07-15
72192 CPT CT Pelvis Wo Dye 16 5 $1,210.00 $1,210.00 $88.24 $1,149.50 $597.01 2026-07-15
72193 CPT CT Pelvis W Dye 16 5 $1,430.00 $1,430.00 $94.13 $1,358.50 $593.33 2026-07-15
75635 CPT CTA Abdominal Arteries 16 5 $1,290.00 $1,290.00 $191.88 $1,225.50 $592.68 2026-07-15
170 OTHER Baby Assessment And Monitoring 7 5 $896.00 $896.00 $448.00 $851.20 $591.36 2026-07-15
26770 CPT Dislocation Finger Wo Anes 7 5 $624.00 $624.00 $536.50 $710.47 $586.61 2026-07-15
A9562 HCPCS Radiophar Tc99M Mertiatide 9 5 $877.00 $877.00 $438.50 $833.15 $583.21 2026-07-15
78708 CPT Renal Imaging Func Pharm Inter 16 5 $1,011.00 $1,011.00 $94.80 $960.45 $581.33 2026-07-15
76811 CPT OB US Detailed Single Fetus 9 5 $841.00 $841.00 $420.50 $798.95 $559.26 2026-07-15
C8924 HCPCS Tte 2d W Contrast Limited 10 5 $776.00 $776.00 $388.00 $737.20 $557.56 2026-07-15
78070 CPT Parathyroid Nuclear Imaging 16 5 $964.00 $964.00 $63.90 $915.80 $554.30 2026-07-15
Q5121 HCPCS Infliximab-axxq 100 Mg Vial 12 5 $838.00 $838.66 $35.88 $4,302.82 $553.52 2026-07-15
0202U CPT Respir Path 22 Targets Biofire 9 5 $828.00 $828.00 $414.00 $786.60 $550.62 2026-07-15
74181 CPT MRI Abdomen Wo Dye 16 5 $2,340.00 $2,340.00 $118.13 $2,223.00 $544.29 2026-07-15
73200 CPT CT Ue Wo Dye Lt 25 5 $1,080.00 $1,080.00 $70.19 $1,026.00 $540.00 2026-07-15
72157 CPT MRI Chest Spine Wwo Dye 16 5 $4,680.00 $4,680.00 $186.58 $4,446.00 $535.35 2026-07-15
C9809 HCPCS Tip Crysg G2 Iovera 2190 1x90 10 5 $803.00 $803.50 $401.50 $763.33 $532.32 2026-07-15
93922 CPT Ankle Arm Screen 10 5 $695.00 $695.00 $347.50 $660.25 $499.36 2026-07-15
76870 CPT Ultrasound Scrotum 16 5 $866.00 $866.00 $51.89 $822.70 $497.95 2026-07-15
86362 CPT Mog Antibody Ref 9 5 $739.00 $739.00 $369.50 $702.05 $491.44 2026-07-15
70450 CPT CT Head/Brain Wo Contrast 15 5 $970.00 $970.00 $69.18 $921.50 $485.00 2026-07-15
74178 CPT CT Abd & Pelv Wwo Contrast 16 5 $2,530.00 $2,530.00 $162.95 $2,403.50 $479.88 2026-07-15
36593 CPT Declot/Thrombo Impl Vad 9 5 $710.00 $710.00 $355.00 $674.50 $472.15 2026-07-15
64448 CPT Inj Femoral Nerve Inf Cath Lt 18 5 $702.00 $702.00 $351.00 $666.90 $466.83 2026-07-15
20220 CPT Biopsy Bone Trocar Superficial 16 5 $800.00 $800.00 $166.20 $760.00 $460.00 2026-07-15
70547 CPT MRA Neck Wo Contrast 16 5 $2,520.00 $2,520.00 $97.66 $2,394.00 $456.87 2026-07-15
87507 CPT Gi Path Panel 12-25 9 5 $686.00 $686.00 $343.00 $651.70 $456.19 2026-07-15
70551 CPT MRI Brain Wo Contrast 16 5 $2,450.00 $2,450.00 $119.89 $2,327.50 $447.03 2026-07-15
Q5104 HCPCS Infliximab-abda 100 Mg Vial 12 5 $676.00 $676.53 $27.85 $5,119.19 $446.51 2026-07-15
87632 CPT Respiratory Virus Pcr Ref 9 5 $649.00 $649.00 $324.50 $616.55 $431.58 2026-07-15
12052 CPT Repair Lac Interm 2.6-5.0 Cm 7 5 $490.00 $490.00 $356.90 $559.61 $426.80 2026-07-15
90380 CPT Rsv .5mL IM 11 5 $500.00 $500.00 $250.00 $2,714.34 $426.50 2026-07-15
J0666 HCPCS Bupivac Liposome 1.3% Pf 20 Ml 13 5 $644.00 $644.93 $1.42 $1,713.62 $425.65 2026-07-15
70492 CPT CT Soft Tissue Neck Wwo Cont 16 5 $1,580.00 $1,580.00 $131.08 $1,501.00 $422.85 2026-07-15
94060 CPT Pft Pre & Post Screen Spirome 10 5 $584.00 $584.00 $292.00 $554.80 $419.61 2026-07-15
94660 CPT CPap/BiPap First Day 20 5 $652.00 $652.00 $208.00 $843.60 $419.60 2026-07-15
93985 CPT US Vessel Map Preop Hd Bi 9 5 $624.00 $624.00 $312.00 $592.80 $414.96 2026-07-15
12032 CPT Repair Lac Interm 2.6-7.5 Cm 7 5 $471.00 $471.00 $340.90 $534.49 $410.41 2026-07-15
70544 CPT MRA Head Wo Contrast 16 5 $2,520.00 $2,520.00 $97.07 $2,394.00 $408.12 2026-07-15
55250 CPT Removal Sperm Duct(s) 16 5 $448.00 $448.00 $224.00 $636.97 $403.87 2026-07-15
73706 CPT CTA Le Wwo Dye Rt 25 5 $790.00 $790.00 $71.13 $750.50 $395.00 2026-07-15
72146 CPT MRI Chest Spine Wo Dye 16 5 $2,560.00 $2,560.00 $120.48 $2,432.00 $390.63 2026-07-15
73722 CPT MRI Joint Le W Dye Rt 16 5 $2,780.00 $2,780.00 $132.25 $2,641.00 $388.80 2026-07-15
93926 CPT Arterial Duplex Le Rt 19 5 $580.00 $580.00 $290.00 $551.00 $385.70 2026-07-15
38505 CPT Needle Biopsy Lymph Nodes Lt 25 5 $580.00 $580.00 $160.80 $551.00 $382.80 2026-07-15
93930 CPT Duplex Arterial Ue Complete 9 5 $575.00 $575.00 $287.50 $546.25 $382.38 2026-07-15
Q5101 HCPCS Filgrastim-sndz 480 Mcg/0.8ml 12 5 $573.00 $573.01 $0.33 $2,902.39 $378.19 2026-07-15
99291 CPT Critical Care 1st 30-74 Min 7 5 $535.00 $535.00 $329.00 $444.51 $374.70 2026-07-15
93308 CPT Echo Limited 9 5 $563.00 $563.00 $281.50 $534.85 $374.39 2026-07-15
A9537 HCPCS Radiophar Tc99M Mebrofenin 9 5 $561.00 $561.00 $280.50 $532.95 $373.06 2026-07-15
G0390 HCPCS Trauma Team Level 4 9 5 $546.00 $546.00 $273.00 $518.70 $363.09 2026-07-15
C1781 HCPCS Mesh Srg 15x10cm 2.4mm 121 5 $502.00 $502.02 $29.00 $2,720.75 $358.70 2026-07-15
C1713 HCPCS Anchor Bio CrkScrw FibWr 5.5mm 318 5 $477.00 $477.00 $27.50 $5,343.75 $358.69 2026-07-15
70491 CPT CT Soft Tissue Neck W Cont 16 5 $1,260.00 $1,260.00 $112.02 $1,197.00 $357.52 2026-07-15
76805 CPT OB US >14 Wk Tvta Single Fetus 17 5 $550.00 $550.00 $81.54 $522.50 $357.50 2026-07-15
70540 CPT MRI Orbit Face Neck Wo Cont 16 5 $2,420.00 $2,420.00 $109.07 $2,299.00 $350.14 2026-07-15
72158 CPT MRI Lumbar Spine Wwo Dye 16 5 $4,770.00 $4,770.00 $186.58 $4,531.50 $340.96 2026-07-15
72156 CPT MRI Neck Spine Wwo Dye 16 5 $4,770.00 $4,770.00 $186.58 $4,531.50 $340.05 2026-07-15
70543 CPT MRI Orbit Face Neck Wwo Cont 16 5 $4,760.00 $4,760.00 $174.58 $4,522.00 $335.44 2026-07-15
93017 CPT Cardiovascular Stress Test 9 5 $500.00 $500.00 $250.00 $475.00 $332.50 2026-07-15
C7901 HCPCS Individual Psychotherapy 45min 9 5 $500.00 $500.00 $250.00 $475.00 $332.50 2026-07-15
59025 CPT Fetal Non Stress 10 5 $456.00 $456.00 $228.00 $433.20 $327.63 2026-07-15
87483 CPT Csf Meningitis Pcr 9 5 $492.00 $492.00 $246.00 $467.40 $327.18 2026-07-15
62272 CPT Lumbar Puncture Therap Without Gde 10 5 $453.00 $453.00 $226.50 $430.35 $325.49 2026-07-15
99306 CPT Nf Initial Visit High 7 5 $298.00 $298.00 $256.50 $387.63 $322.45 2026-07-15
70488 CPT CT Maxillofac Wwo Contrast 16 5 $1,600.00 $1,600.00 $102.60 $1,520.00 $319.79 2026-07-15
32555 CPT Aspirate Pleura W Imaging Lt 32 5 $500.00 $500.00 $197.80 $475.00 $319.12 2026-07-15
99205 CPT New Patient Level 5 High Comp 7 5 $194.00 $194.00 $257.00 $382.02 $316.98 2026-07-15
A9585 HCPCS Gadobutrol Inj 10 Mm/10 Ml Vl 11 5 $480.00 $480.00 $2.69 $456.00 $316.80 2026-07-15
72148 CPT MRI Lumbar Spine Wo Dye 17 5 $2,560.00 $2,560.00 $120.48 $2,432.00 $315.18 2026-07-15
87637 CPT Influ/RSV/CoV2 Pcr Ceph 10 5 $437.00 $437.00 $218.50 $415.15 $313.99 2026-07-15
J1455 HCPCS Foscarnet 6000 Mg/250 Ml Bot 12 5 $545.00 $545.13 $21.63 $517.87 $313.44 2026-07-15
72132 CPT CT Lumbar Spine W Contrast 16 5 $1,490.00 $1,490.00 $98.84 $1,415.50 $313.35 2026-07-15
90834 CPT Psychotherapy 45 Minutes 9 5 $470.00 $470.00 $235.00 $446.50 $312.55 2026-07-15
99223 CPT IP/Obs Initial High Comp 7 5 $517.00 $517.00 $270.04 $389.40 $303.59 2026-07-15
10005 CPT Fna Biopsy W US 1st Lesion 17 5 $465.00 $465.00 $128.70 $441.75 $302.25 2026-07-15
76700 CPT Ultrasound Abdomen Complete 16 5 $524.00 $524.00 $65.65 $497.80 $301.30 2026-07-15
76770 CPT Ultrasound Abdo Back Wall Comp 16 5 $524.00 $524.00 $59.76 $497.80 $301.30 2026-07-15
76801 CPT OB US < 14 Wks Single Fetus 16 5 $524.00 $524.00 $80.96 $497.80 $301.30 2026-07-15
81596 CPT Fibrotest-atitest 9 5 $450.00 $450.00 $225.00 $427.50 $299.25 2026-07-15
90684 CPT Pneumo Conjugate Vaccine 21 Va 12 5 $350.00 $350.00 $175.00 $474.00 $298.55 2026-07-15
29581 CPT Appl Multi Layer Ven Wnd Compr 9 5 $448.00 $448.00 $224.00 $425.60 $297.92 2026-07-15
49083 CPT Abd Paracentesis W Imaging 16 5 $452.00 $452.00 $202.20 $429.40 $296.06 2026-07-15
27093 CPT Arthrogram Hip Rt 17 5 $452.00 $452.00 $130.30 $429.40 $293.80 2026-07-15
36569 CPT Insert Picc Catheter 16 5 $488.00 $488.00 $182.79 $463.60 $290.79 2026-07-15
P9040 HCPCS Rbc Packed Leuko-reduc Irrad 9 5 $437.00 $437.00 $218.50 $415.15 $290.61 2026-07-15
87636 CPT Influ & CoV2 Pcr Ceph 9 5 $437.00 $437.00 $218.50 $415.15 $290.61 2026-07-15
P9016 HCPCS Red Blood Cells Lekoreduced 9 5 $437.00 $437.00 $218.50 $415.15 $290.61 2026-07-15
76882 CPT US Extremity Nonvasc Limit Lt 26 5 $440.00 $440.00 $45.24 $418.00 $290.40 2026-07-15
12007 CPT Repair Lac Simple >30.0 Cm 7 5 $310.00 $310.00 $256.70 $392.95 $287.55 2026-07-15
43236 CPT Egd Diagnostic W Submuc Inj 7 5 $509.00 $509.00 $263.10 $385.95 $287.15 2026-07-15
31500 CPT Intubation 16 5 $409.00 $409.00 $204.50 $390.88 $286.24 2026-07-15
76830 CPT Ultrasound Transvaginal 17 5 $440.00 $440.00 $56.60 $418.00 $286.00 2026-07-15
76856 CPT Ultrasound Pelvic Complete 17 5 $440.00 $440.00 $56.01 $418.00 $286.00 2026-07-15
C7900 HCPCS Individual Psychotherpy Remote 9 5 $430.00 $430.00 $215.00 $408.50 $285.95 2026-07-15
90832 CPT Psychotherapy 30 Minutes 9 5 $430.00 $430.00 $215.00 $408.50 $285.95 2026-07-15
20520 CPT Remove Fb Muscle Simple 9 5 $427.00 $427.00 $213.50 $405.65 $283.95 2026-07-15
90677 CPT Pneumo Conjugate Vaccine 20 Va 12 5 $312.00 $312.00 $156.00 $380.34 $281.27 2026-07-15
99235 CPT Admit/Discharge Same Day Mod 7 5 $323.00 $323.00 $247.05 $334.65 $279.26 2026-07-15
70498 CPT CT Angiography Neck W Cont 16 5 $1,220.00 $1,220.00 $141.90 $1,159.00 $278.38 2026-07-15
64479 CPT Inj Foramen Epidural C/t Bi 21 5 $479.00 $479.00 $251.60 $366.91 $278.10 2026-07-15
88309 CPT Surg Path L6 9 5 $418.00 $418.00 $209.00 $397.10 $277.97 2026-07-15
88307 CPT Surg Path L5 9 5 $418.00 $418.00 $209.00 $397.10 $277.97 2026-07-15
70490 CPT CT Soft Tissue Neck Wo Cont 16 5 $1,050.00 $1,050.00 $104.36 $997.50 $277.47 2026-07-15
64445 CPT Inj Sciatic Single N Block Lt 9 5 $416.00 $416.00 $208.00 $395.20 $276.64 2026-07-15
93925 CPT Arterial Duplex Le Bi 10 5 $383.00 $383.00 $191.50 $363.85 $275.19 2026-07-15
64999 CPT Facial Nerve Injection Lt 14 5 $416.00 $416.00 $208.00 $395.20 $274.56 2026-07-15
51700 CPT Irrigation Bladder 9 5 $409.00 $409.00 $204.50 $388.55 $271.99 2026-07-15
92960 CPT Cardioversion 9 5 $409.00 $409.00 $204.50 $388.55 $271.99 2026-07-15
77066 CPT Mammo Dx Digit Impl Bi 17 5 $415.00 $415.00 $80.96 $394.25 $269.75 2026-07-15
36573 CPT Insert Picc >5 Yrs W Img Gde 16 5 $464.00 $464.00 $163.62 $440.80 $268.52 2026-07-15
70487 CPT CT Maxillofacial W Contrast 16 5 $1,290.00 $1,290.00 $91.78 $1,225.50 $268.29 2026-07-15
88185 CPT Flow Cytometry Ea Addit Marker 9 5 $401.00 $401.00 $200.50 $380.95 $266.67 2026-07-15
99283 CPT Emergency Room Visit Level 3 21 5 $533.00 $533.00 $88.54 $506.35 $266.50 2026-07-15
J0561 HCPCS Pen G Benzathine 1200000Un/2ML 12 5 $416.00 $416.18 $26.98 $395.37 $265.64 2026-07-15
30300 CPT Remove Foreign Body Nose 7 5 $312.00 $312.00 $225.50 $318.08 $263.47 2026-07-15
G0438 HCPCS Annual Wellness Visit Initial 7 5 $286.00 $286.00 $184.13 $358.02 $262.69 2026-07-15
11600 CPT Exc Mal Lesion <0.5 Trunk Limb 7 5 $275.00 $275.00 $218.80 $336.22 $262.09 2026-07-15
76000 CPT Fluoroscope Examination 17 5 $403.00 $403.00 $25.40 $753.11 $261.95 2026-07-15
G0481 HCPCS Drug Test Def 8-14 Classes 10 5 $364.00 $364.00 $182.00 $345.80 $261.53 2026-07-15
96125 CPT Cognitive Performance Test St 9 5 $389.00 $389.00 $194.50 $369.55 $258.69 2026-07-15
96105 CPT Aphasia Evaluation Per Hour 9 5 $389.00 $389.00 $194.50 $369.55 $258.69 2026-07-15
62328 CPT Spinal Puncture, Diagnostic 16 5 $415.00 $415.00 $162.40 $394.25 $258.07 2026-07-15
J0885 HCPCS Epoetin Alfa 10000 Unit/ML Vl 28 5 $408.00 $408.31 $0.06 $949.94 $256.79 2026-07-15
76705 CPT Ultrasound Abdomen Limited 37 5 $390.00 $390.00 $47.77 $376.20 $256.75 2026-07-15
64640 CPT Destruct Peripheral Nerve Lt 14 5 $416.00 $416.00 $232.30 $330.06 $256.21 2026-07-15
97605 CPT Neg Pressure Wound Dme <50 Cm 9 5 $385.00 $385.00 $192.50 $365.75 $256.02 2026-07-15
74240 CPT X-ray Upper Gi Delay Without Air 30 5 $390.00 $390.00 $65.10 $627.00 $255.45 2026-07-15
76775 CPT Ultrasound Aorta 17 5 $390.00 $390.00 $47.18 $370.50 $253.50 2026-07-15
G0416 HCPCS Prostate Sat Biopsy 9 5 $381.00 $381.00 $190.50 $361.95 $253.37 2026-07-15
97607 CPT Neg Pressure Wound Disp <50 Cm 10 5 $382.00 $382.00 $191.00 $362.90 $253.07 2026-07-15
23350 CPT Arthrogram Shoulder Lt 25 5 $383.00 $383.00 $95.00 $363.85 $252.78 2026-07-15
93931 CPT Arterial Duplex Ue Rt 9 5 $380.00 $380.00 $190.00 $361.00 $252.70 2026-07-15
77012 CPT CT Scan For Needle Biopsy 9 5 $380.00 $380.00 $96.05 $361.00 $250.80 2026-07-15
110 OTHER Room Custodial Care 7 5 $380.00 $380.00 $190.00 $361.00 $250.80 2026-07-15
115 OTHER Room Hospice Respite Care 7 5 $380.00 $380.00 $190.00 $361.00 $250.80 2026-07-15
70496 CPT CT Angiography Head W Cont 16 5 $1,200.00 $1,200.00 $141.90 $1,140.00 $246.84 2026-07-15
20611 CPT Asp/Inj Large Joint W US Lt 32 5 $423.00 $423.00 $113.60 $401.85 $243.22 2026-07-15
93246 CPT Ext ECG >7 Days Hook Up 10 5 $338.00 $338.00 $169.00 $321.10 $242.86 2026-07-15
93225 CPT Holter Monitor Hook Up <48 Hrs 10 5 $338.00 $338.00 $169.00 $321.10 $242.86 2026-07-15
84145 CPT Procalcitonin 10 5 $336.00 $336.00 $168.00 $319.20 $241.41 2026-07-15
70470 CPT CT Head/Brain Wwo Contrast 16 5 $1,480.00 $1,480.00 $103.19 $1,406.00 $241.32 2026-07-15
64615 CPT Chemodenerv Muscle Migraine 7 5 $425.00 $425.00 $230.72 $321.69 $240.95 2026-07-15
720 OTHER Delivery Charge 27 5 $312.00 $312.00 $130.00 $838.85 $240.86 2026-07-15
Q0138 HCPCS Ferumoxy 510mg/17ml (non-esrd) 12 5 $415.00 $415.50 $0.33 $394.73 $238.91 2026-07-15
86361 CPT Cd4 Absolute Count 9 5 $359.00 $359.00 $179.50 $341.05 $238.74 2026-07-15
62273 CPT Epidural Blood Patch 16 5 $344.00 $344.00 $172.00 $326.80 $238.68 2026-07-15
76536 CPT Ultrasound Head And Neck 16 5 $415.00 $415.00 $46.00 $394.25 $238.62 2026-07-15
76506 CPT Echo Head 16 5 $415.00 $415.00 $51.52 $394.25 $238.62 2026-07-15
64483 CPT Inj Foramen Epidural L/s Bi 21 5 $416.00 $416.00 $213.70 $312.87 $237.30 2026-07-15
77067 CPT Mammo Screen Implant Bi 54 5 $355.00 $355.00 $62.12 $349.60 $236.69 2026-07-15
99305 CPT Nf Initial Visit Mod 7 5 $232.00 $232.00 $187.90 $284.10 $236.06 2026-07-15
76642 CPT Ultrasound Breast Limited Bi 35 5 $305.00 $305.00 $55.64 $482.60 $235.46 2026-07-15
72131 CPT CT Lumbar Spine Wo Contrast 17 5 $1,230.00 $1,230.00 $80.96 $1,168.50 $234.87 2026-07-15
11760 CPT Repair Nailbed 7 5 $322.00 $322.00 $195.60 $319.03 $234.49 2026-07-15
72141 CPT MRI Neck Spine Wo Dye 16 5 $2,360.00 $2,360.00 $120.48 $2,242.00 $233.96 2026-07-15
56420 CPT Drainage Gland Abscess 7 5 $222.00 $222.00 $209.30 $284.14 $233.15 2026-07-15
96413 CPT Chemotherapy Inf Initial 9 5 $350.00 $350.00 $175.00 $332.50 $232.75 2026-07-15
76815 CPT OB US Limited Fetus(s) 25 5 $348.00 $348.00 $53.06 $347.70 $231.42 2026-07-15
92611 CPT Swallow Evaluation Video 11 5 $347.00 $347.00 $173.50 $329.65 $230.75 2026-07-15
86341 CPT Gad65 Ab Csf 9 5 $345.00 $345.00 $172.50 $327.75 $229.43 2026-07-15
99222 CPT Inpatient Initial/Obs Mod Comp 7 5 $348.00 $348.00 $202.33 $274.01 $228.15 2026-07-15
74177 CPT CT Abd & Pelv W Contrast 17 5 $1,940.00 $1,940.00 $148.23 $1,843.00 $227.52 2026-07-15
62321 CPT Inj Epidural C/t W Guide 7 5 $510.00 $510.00 $206.00 $300.75 $227.17 2026-07-15
12031 CPT Repair Lac Intermed <2.5 Cm 17 5 $266.00 $266.00 $133.00 $423.98 $226.90 2026-07-15
77065 CPT Mammography Dx Digital Lt 26 5 $343.00 $343.00 $65.65 $325.85 $226.38 2026-07-15
11603 CPT Exc Mal Lesion 2.1-3.0 Trunk 16 5 $251.00 $251.00 $125.50 $539.39 $226.27 2026-07-15
74280 CPT Contrast X-ray Colon 16 5 $683.00 $683.00 $101.10 $648.85 $225.69 2026-07-15
93242 CPT Ext ECG 48 Hrs -7days Hook Up 11 5 $338.00 $338.00 $169.00 $321.10 $224.77 2026-07-15
77075 CPT X-rays Bone Survey Complete 16 5 $390.00 $390.00 $44.82 $370.50 $224.25 2026-07-15
76817 CPT Transvaginal US Obstetrical 16 5 $390.00 $390.00 $61.31 $370.50 $224.25 2026-07-15
76819 CPT Fetal Biophys Profil Wo Nst 16 5 $390.00 $390.00 $62.85 $370.50 $224.25 2026-07-15
64490 CPT Inj Paravert F Jnt C/t 1st Bi 7 5 $957.00 $957.00 $202.80 $295.71 $224.19 2026-07-15
76816 CPT OB US Follow-up Per Fetus 17 5 $342.00 $342.00 $69.91 $324.90 $222.30 2026-07-15
93798 CPT Cardiac Rehab Ii Monitored 10 5 $306.00 $306.00 $153.00 $290.70 $219.86 2026-07-15
90853 CPT Group Psychotherapy 9 5 $330.00 $330.00 $165.00 $313.50 $219.45 2026-07-15
C7903 HCPCS Group Therapy, Remote 9 5 $330.00 $330.00 $165.00 $313.50 $219.45 2026-07-15
G0410 HCPCS Group Psychotherapy Iop 45-50 9 5 $330.00 $330.00 $165.00 $313.50 $219.45 2026-07-15
76641 CPT Ultrasound Breast Complete Bi 34 5 $305.00 $305.00 $59.76 $534.85 $219.14 2026-07-15
87154 CPT Culture Id By Amp Prb 6 Or 6+ 10 5 $328.00 $328.00 $164.00 $311.60 $217.30 2026-07-15
30905 CPT Control Posterior Hemorrhage 7 5 $242.00 $242.00 $196.60 $288.51 $216.10 2026-07-15
64415 CPT Inj Brachial Plexus N Block Lt 32 5 $375.00 $375.00 $133.50 $356.25 $215.62 2026-07-15
90750 CPT Zoster (hzv) IM 11 5 $260.00 $260.00 $130.00 $247.00 $215.51 2026-07-15
99215 CPT Est Patient Level 5 High Comp 27 5 $161.00 $161.00 $51.00 $356.25 $215.01 2026-07-15
93971 CPT Extremity Study Lt 28 5 $274.00 $274.00 $31.92 $833.15 $214.00 2026-07-15
80280 CPT Vedolizumab 9 5 $320.00 $320.00 $160.00 $304.00 $212.80 2026-07-15
73040 CPT Contrast X-ray Shoulder Lt 25 5 $383.00 $383.00 $45.70 $363.85 $210.04 2026-07-15
62323 CPT Inj Epidural L/s W Guide 7 5 $468.00 $468.00 $190.60 $277.51 $210.01 2026-07-15
64417 CPT Inj Axillary Nerve Lt 32 5 $364.00 $364.00 $123.90 $345.80 $209.30 2026-07-15
10160 CPT Punc Asp Abscess Hematoma Cyst 32 5 $213.50 $213.50 $66.00 $428.45 $208.55 2026-07-15
88365 CPT Ish Stain Init Pr Spec 9 5 $312.00 $312.00 $156.00 $296.40 $207.48 2026-07-15
G0439 HCPCS Annual Wellness Visit Subs 7 5 $224.00 $224.00 $145.13 $282.26 $206.95 2026-07-15
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