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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

MEADE DISTRICT HOSPITAL

Meade, KS · CCN 171321 · Rates published

1,335 distinct procedures filed
7 distinct payers
9,347 rate rows
2024-12-31 last MRF observed · ⚠ 18 mo old
Data quality

4,600 of 9,347 rate rows are consumer-grade (49.2%)

4,747 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 4,118
placeholder amount (≤ $0.02) — excluded from medians 620
per-diem day rate — not a per-procedure price 9

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 18 months old.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

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://a9a4b96f-06fd-48d5-afab-60ad79a55e97.filesusr.com/ugd/3293c1_b634e2c6081e4736bc6956dddef01d94.json?dn=480966086_Meade%20District%20Hospital_standardcharges%20(3).json
Found on page https://www.avhealthsystem.com/pricing-information
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 1696e10f03dc48ff… · 6,005,167 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
470
MS_DRG 		Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without… 6 $19,388.28 $29,074.55 $19,388.28 nat. median
$20,059
1.0× median
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc 6 $15,247.07 $24,820.14 $15,247.07 nat. median
$16,235
0.9× median
33228
CPT 		Pacemaker Battery Exchange 7 $14,932.63 $23,441.03 $14,932.63 nat. median
$11,435
1.3× median
2744750
CPT 		Arthroplasty Knee Bilateral 7 $12,076.93 $20,688.86 $12,076.93 —
27446
CPT 		Arthroplast Knee Condyle Plateau 7 $12,038.14 $20,688.86 $12,038.14 nat. median
$12,481
1.0× median
27447
CPT 		Arthroplasty Knee 7 $11,773.29 $20,688.86 $11,773.29 nat. median
$12,648
0.9× median
23472
CPT 		Total Shoulder Arthroplasty 7 $11,394.43 $20,688.86 $11,394.43 nat. median
$16,400
0.7× median
27130
CPT 		Arthroplasty Hip 7 $11,219.43 $20,688.86 $11,219.43 nat. median
$13,091
0.9× median
58262
CPT 		Vaginal Hyst With Rmvl Tubes/overay 7 $7,937.84 $9,502.02 $9,502.02 nat. median
$5,512
1.7× median
58150
CPT 		Total Hysterectomy 7 $8,786.08 $8,786.08 $8,786.08 nat. median
$3,280
outlier · 2.7×
292
MS_DRG 		Heart Failure And Shock With Cc 6 $8,294.38 $9,509.26 $8,294.38 nat. median
$9,636
0.9× median
194
MS_DRG 		Simple Pneumonia And Pleurisy With Cc 6 $7,560.84 $11,690.98 $7,560.84 nat. median
$9,125
0.8× median
58260
CPT 		Vaginal Hysterectomy 7 $6,288.76 $7,528.38 $7,528.38 nat. median
$5,272
1.4× median
195
MS_DRG 		Simple Pneumonia And Pleurisy Without Cc/mcc 6 $6,906.88 $8,934.24 $6,906.88 nat. median
$7,339
0.9× median
23430
CPT 		Tenodesis Of Long Tendon Biceps 7 $6,462.84 $10,475.68 $6,462.84 nat. median
$6,990
0.9× median
24516
CPT 		IM Nailing Of Humerus 7 $6,446.62 $10,119.82 $6,446.62 nat. median
$11,435
0.6× median
603
MS_DRG 		Cellulitis Without Mcc 6 $6,403.27 $10,216.55 $6,403.27 nat. median
$9,571
0.7× median
29827
CPT 		Arthroscopy Shoulder With Rotator Cup Rpr 7 $6,371.99 $10,433.98 $6,371.99 nat. median
$7,155
0.9× median
192
MS_DRG 		Chronic Obstructive Pulmonary Disease Without Cc/mcc 6 $6,240.41 $9,481.32 $6,240.41 nat. median
$7,581
0.8× median
690
MS_DRG 		Kidney And Urinary Tract Infections Without Mcc 6 $6,112.97 $9,556.13 $6,112.97 nat. median
$8,979
0.7× median
641
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 6 $5,775.74 $8,996.49 $5,775.74 nat. median
$8,665
0.7× median
58353
CPT 		Endometr Ablate Thermal 7 $5,401.35 $7,345.05 $5,401.35 nat. median
$5,021
1.1× median
58600
CPT 		Division Of Fallopian Tube 7 $4,503.15 $5,389.52 $5,389.52 nat. median
$3,265
1.7× median
47562
CPT 		Laparoscopy Cholecystectomy 7 $5,290.55 $8,554.25 $5,290.55 nat. median
$5,956
0.9× median
J1162
HCPCS 		Digifab Inj 40mg 7 $4,079.01 $6,145.65 $4,079.01 nat. median
$7,316
0.6× median
52630
CPT 		Transurethral Resect; Residual Regrowth 7 $4,045.44 $7,455.83 $4,045.44 nat. median
$5,155
0.8× median
38510
CPT 		Biopsy Or Excision Deep Cervical Nodes 7 $3,310.30 $5,196.45 $3,310.30 nat. median
$3,856
0.9× median
23120
CPT 		Claviculectomy; Partial 7 $3,246.53 $5,093.05 $3,246.53 nat. median
$3,601
0.9× median
29877
CPT 		Arthroscopy Knee Debrid/shave Art Carti 7 $3,209.80 $5,038.70 $3,209.80 nat. median
$3,961
0.8× median
49505
CPT 		Bilat Hernia Repr; Reducible Age > 5 7 $3,187.00 $5,002.91 $3,187.00 nat. median
$3,829
0.8× median
52234
CPT 		Cysto With Fulberation Tumor .5 To 2.0 Cm 7 $2,808.40 $4,391.80 $2,808.40 nat. median
$3,489
0.8× median
55040
CPT 		Excision Hydrocele; Unilateral 7 $2,655.06 $2,655.06 $2,655.06 nat. median
$3,652
0.7× median
33285
CPT 		Implantation Cardiac Event Monitor 7 $2,513.02 $2,513.02 $2,513.02 nat. median
$8,842
outlier · 0.3×
29893
CPT 		Endoscopic Plantar Fasciotomy 7 $2,507.07 $3,929.15 $2,507.07 nat. median
$3,475
0.7× median
2984850
CPT 		Carpal Tunnel Bilateral 7 $2,500.00 $3,551.35 $2,500.00 —
J0840
HCPCS 		Crofab Per Vial 7 $2,404.75 $2,436.16 $2,404.75 nat. median
$3,427
0.7× median
46260
CPT 		Hemorrhoidectomy; Intrnal/ext 2 Or More 7 $2,399.12 $3,766.10 $2,399.12 nat. median
$3,137
0.8× median
29848
CPT 		Carpal Tunnel Unilateral 7 $2,388.18 $3,551.35 $2,388.18 nat. median
$2,297
1.0× median
49203
CPT 		Excis Or Destr Open Intra Abd Tumors 7 $2,300.68 $3,551.35 $2,300.68 nat. median
$3,342
0.7× median
95811
CPT 		Sleep Stgng 4 Pra W Cpap/bipap(abn)95811 7 $1,386.60 $2,045.62 $2,045.62 nat. median
$2,026
1.0× median
90375
CPT 		Kedrab (rabies Immune) Inj 10ml 7 $398.51 $2,041.51 $2,041.51 nat. median
$1,039
2.0× median
26842
CPT 		Fusion Of Joint(s); Fingers Or Hand 7 $2,000.00 $2,000.00 $2,000.00 nat. median
$6,887
outlier · 0.3×
49585
CPT 		Umbilical Hernia 7 $1,929.38 $1,929.38 $1,929.38 nat. median
$3,235
0.6× median
70549
CPT 		MRA Of Neck W &without Cont (abn)(babn)70549 7 $1,900.59 $1,900.59 $1,900.59 nat. median
$1,050
1.8× median
36563
CPT 		Insert Tunnel Centrl Venous Access Devic 7 $1,733.92 $1,888.64 $1,888.64 nat. median
$5,439
outlier · 0.3×
J2353
HCPCS 		SandoSTAT Lar (octreotide) Inj 30mg 7 $259.42 $1,877.89 $1,877.89 nat. median
$5,975
outlier · 0.3×
72158
CPT 		MRI L-spine With & Without Contrast 7 $1,830.33 $1,830.33 $1,830.33 nat. median
$1,080
1.7× median
72141
CPT 		MRI C-spine With & Without Contrast 7 $1,830.33 $1,830.33 $1,830.33 nat. median
$765
outlier · 2.4×
70553
CPT 		MRI Brain With & Without Contrast 7 $1,830.33 $1,830.33 $1,830.33 nat. median
$1,122
1.6× median
25000
CPT 		Incision Flexor Tendon Sheath Wrist 7 $1,810.53 $2,842.14 $1,810.53 nat. median
$2,120
0.9× median

Other procedures at this hospital

Browse this hospital's 1,335 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
             
10060 CPT I&d Abscess;simple Or Single 7 7 $940.00 $940.00 $285.76 $565.88 $565.88 2024-12-31
10140 CPT I&d Hematoma 7 7 $1,425.00 $1,425.00 $1,028.18 $1,557.61 $1,028.18 2024-12-31
11760 CPT Repair Of Nail Bed 7 7 $475.00 $475.00 $327.04 $487.83 $327.04 2024-12-31
11982 CPT Rmvl Drug Delivery Implant Non-biodegra 7 7 $1,440.00 $1,440.00 $900.00 $900.00 $900.00 2024-12-31
12001 CPT Simple Repair Sclp Nck 2.5 7 7 $338.00 $338.00 $310.36 $502.41 $310.36 2024-12-31
12002 CPT Suture Wound 2.6 7 7 $550.00 $550.00 $396.50 $600.51 $396.50 2024-12-31
12011 CPT Simp Repair <2.5cm Face 7 7 $488.90 $488.90 $397.74 $624.37 $397.74 2024-12-31
12013 CPT Suture Superficial Wound 2.6 7 7 $488.90 $488.90 $397.74 $624.37 $397.74 2024-12-31
12031 CPT Intermed Suture 2.5 Cm Or Less 7 7 $1,500.00 $1,500.00 $592.16 $937.50 $937.50 2024-12-31
12032 CPT Intermed Suture Wound 2.6-7.5cm 7 7 $1,600.00 $1,600.00 $592.16 $1,000.00 $1,000.00 2024-12-31
12041 CPT Intermed Suture Wound 2.5 Cm Or Less 7 7 $547.03 $547.03 $445.03 $698.60 $445.03 2024-12-31
12042 CPT Repair Intermediate; 2.6 7 7 $750.00 $750.00 $595.22 $927.94 $595.22 2024-12-31
12051 CPT Repair Intermediate; 2.5 Or Less 7 7 $950.00 $950.00 $635.52 $938.54 $635.52 2024-12-31
12052 CPT Repair Intermediate; 2.6 7 7 $1,050.00 $1,050.00 $592.16 $656.25 $656.25 2024-12-31
12053 CPT Interm Closure Face 5.1-7.5 Cm 7 7 $655.50 $655.50 $753.66 $1,277.90 $753.66 2024-12-31
13121 CPT Repr Scalparmsleg Complx 2.6cm 7 7 $665.00 $665.00 $470.31 $470.31 $470.31 2024-12-31
177 MS_DRG Respiratory Infections And Inflammations With Mcc 6 6 $16,211.00 $16,211.00 $15,247.07 $24,820.14 $15,247.07 2024-12-31
192 MS_DRG Chronic Obstructive Pulmonary Disease Without Cc/mcc 6 6 $8,570.00 $8,570.00 $6,240.41 $9,481.32 $6,240.41 2024-12-31
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 6 6 $9,802.00 $9,802.00 $7,560.84 $11,690.98 $7,560.84 2024-12-31
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/mcc 6 6 $11,051.00 $11,051.00 $6,906.88 $8,934.24 $6,906.88 2024-12-31
20552 CPT Inj Trigger Pnt 1 Or 2 Muscles 7 7 $200.00 $200.00 $251.91 $433.82 $251.91 2024-12-31
20553 CPT Inj Trigger Pnt 3 Or More Muscles 7 7 $215.00 $215.00 $254.53 $433.82 $254.53 2024-12-31
20604 CPT Sm Joint Or Bursa Inj With US Guidance 7 7 $475.40 $475.40 $386.76 $607.14 $386.76 2024-12-31
20610 CPT Major Joint Or Bursa Injection 7 7 $820.00 $820.00 $433.82 $512.50 $512.50 2024-12-31
20611 CPT Major Joint Or Bursa Injection 7 7 $820.00 $820.00 $433.82 $512.50 $512.50 2024-12-31
23071 CPT Excise Tumor Shoulder >3cm 7 7 $1,989.85 $1,989.85 $1,618.84 $2,541.22 $1,618.84 2024-12-31
23120 CPT Claviculectomy; Partial 7 7 $4,000.00 $4,000.00 $3,246.53 $5,093.05 $3,246.53 2024-12-31
23430 CPT Tenodesis Of Long Tendon Biceps 7 7 $7,000.00 $7,000.00 $6,462.84 $10,475.68 $6,462.84 2024-12-31
23472 CPT Total Shoulder Arthroplasty 7 7 $6,000.00 $6,000.00 $11,394.43 $20,688.86 $11,394.43 2024-12-31
23655 CPT ER Tx Shoulder W/anesthesia 7 7 $962.00 $962.00 $699.26 $1,061.83 $699.26 2024-12-31
24516 CPT IM Nailing Of Humerus 7 7 $7,924.09 $7,924.09 $6,446.62 $10,119.82 $6,446.62 2024-12-31
25000 CPT Incision Flexor Tendon Sheath Wrist 7 7 $2,225.47 $2,225.47 $1,810.53 $2,842.14 $1,810.53 2024-12-31
25605 CPT Closed Tx Of Radial Fracture 7 7 $1,728.00 $1,728.00 $1,243.60 $1,882.39 $1,243.60 2024-12-31
26055 CPT Incision Of Tendon Trig Finger Release 7 7 $1,528.97 $1,528.97 $1,243.89 $1,952.65 $1,243.89 2024-12-31
26842 CPT Fusion Of Joint(s); Fingers Or Hand 7 7 $3,200.00 $3,200.00 $2,000.00 $2,000.00 $2,000.00 2024-12-31
27096 CPT Sacroiliac Injection 7 7 $900.00 $900.00 $600.92 $886.84 $600.92 2024-12-31
27130 CPT Arthroplasty Hip 7 7 $5,000.00 $5,000.00 $11,219.43 $20,688.86 $11,219.43 2024-12-31
27380 CPT Suture Infrapatellar Tendon; Primary 7 7 $1,975.00 $1,975.00 $1,234.38 $1,234.38 $1,234.38 2024-12-31
27446 CPT Arthroplast Knee Condyle Plateau 7 7 $9,678.31 $9,678.31 $12,038.14 $20,688.86 $12,038.14 2024-12-31
27447 CPT Arthroplasty Knee 7 7 $8,164.91 $8,164.91 $11,773.29 $20,688.86 $11,773.29 2024-12-31
2744750 CPT Arthroplasty Knee Bilateral 7 7 $9,900.00 $9,900.00 $12,076.93 $20,688.86 $12,076.93 2024-12-31
29065 CPT Long Arm Cast Application 7 7 $273.00 $273.00 $331.46 $567.37 $331.46 2024-12-31
29075 CPT Application Short Arm Cast; Elbow-finger 7 7 $500.00 $500.00 $371.19 $567.37 $371.19 2024-12-31
29085 CPT Casting Hand & Lower Forearm (gauntlet) 7 7 $535.00 $535.00 $377.31 $567.37 $377.31 2024-12-31
29105 CPT Application Of Long Arm Splint 7 7 $285.00 $285.00 $201.00 $302.24 $201.00 2024-12-31
29125 CPT Application Of Short Arm Splint 7 7 $285.00 $285.00 $201.00 $302.24 $201.00 2024-12-31
29130 CPT Application Of Finger Splint; Static 7 7 $236.66 $236.66 $192.53 $302.24 $192.53 2024-12-31
292 MS_DRG Heart Failure And Shock With Cc 6 6 $13,271.00 $13,271.00 $8,294.38 $9,509.26 $8,294.38 2024-12-31
29240 CPT Splint/strapping Of Shoulder 7 7 $330.00 $330.00 $240.03 $364.55 $240.03 2024-12-31
29505 CPT Application Long Leg Splint Thigh To Ank 7 7 $315.00 $315.00 $206.25 $302.24 $206.25 2024-12-31
29515 CPT Application Short Leg Splint 7 7 $274.00 $274.00 $199.07 $302.24 $199.07 2024-12-31
29540 CPT Strapping; Ankle Or Foot 7 7 $358.00 $358.00 $244.93 $364.55 $244.93 2024-12-31
29827 CPT Arthroscopy Shoulder With Rotator Cup Rpr 7 7 $6,600.00 $6,600.00 $6,371.99 $10,433.98 $6,371.99 2024-12-31
29848 CPT Carpal Tunnel Unilateral 7 7 $3,500.00 $3,500.00 $2,388.18 $3,551.35 $2,388.18 2024-12-31
2984850 CPT Carpal Tunnel Bilateral 7 7 $4,000.00 $4,000.00 $2,500.00 $3,551.35 $2,500.00 2024-12-31
29877 CPT Arthroscopy Knee Debrid/shave Art Carti 7 7 $3,945.44 $3,945.44 $3,209.80 $5,038.70 $3,209.80 2024-12-31
29893 CPT Endoscopic Plantar Fasciotomy 7 7 $3,100.00 $3,100.00 $2,507.07 $3,929.15 $2,507.07 2024-12-31
30901 CPT Control Nasal Hemor Anterior Simple 7 7 $502.39 $502.39 $408.72 $641.60 $408.72 2024-12-31
30906 CPT Control Nasal Hemor Posterior Initial 7 7 $457.00 $457.00 $275.73 $285.62 $285.62 2024-12-31
31500 CPT Intubation Endotracheal 7 7 $538.00 $538.00 $336.25 $336.25 $336.25 2024-12-31
31505 CPT Laryngoscopy Indirect; Diagnostic 7 7 $750.00 $750.00 $468.75 $468.75 $468.75 2024-12-31
31720 CPT Suctioning 7 7 $712.07 $712.07 $579.30 $909.38 $579.30 2024-12-31
33228 CPT Pacemaker Battery Exchange 7 7 $18,354.95 $18,354.95 $14,932.63 $23,441.03 $14,932.63 2024-12-31
33285 CPT Implantation Cardiac Event Monitor 7 7 $5,112.27 $5,112.27 $2,513.02 $2,513.02 $2,513.02 2024-12-31
33286 CPT Remove Implanted Cardiac Event Monitor 7 7 $400.02 $400.02 $250.01 $250.01 $250.01 2024-12-31
36430 CPT Blood Adm 1-16 Hours 7 7 $650.00 $650.00 $452.17 $676.84 $452.17 2024-12-31
36563 CPT Insert Tunnel Centrl Venous Access Devic 7 7 $3,021.83 $3,021.83 $1,733.92 $1,888.64 $1,888.64 2024-12-31
38510 CPT Biopsy Or Excision Deep Cervical Nodes 7 7 $4,068.96 $4,068.96 $3,310.30 $5,196.45 $3,310.30 2024-12-31
43235 CPT Egd 7 7 $704.50 $704.50 $801.34 $1,356.11 $801.34 2024-12-31
43239 CPT Egd With Biopsy Single Or Multiple 7 7 $1,750.00 $1,750.00 $1,093.75 $1,513.86 $1,093.75 2024-12-31
43249 CPT Egd W Balloon Dilation <30mm 7 7 $2,000.00 $2,000.00 $1,378.02 $2,056.04 $1,378.02 2024-12-31
43251 CPT Egd With Polypectomy-secondary 7 7 $874.50 $874.50 $1,041.20 $1,776.34 $1,041.20 2024-12-31
43752 CPT N/g Tube Placement With Flouro Guidance 7 7 $501.82 $501.82 $313.64 $313.64 $313.64 2024-12-31
45378 CPT Colonoscopy 7 7 $899.50 $899.50 $1,024.37 $1,733.92 $1,024.37 2024-12-31
45380 CPT Colonoscopy With Biopsy 7 7 $1,750.00 $1,750.00 $1,201.05 $1,789.59 $1,201.05 2024-12-31
45384 CPT Colonoscopy With Biopsy; Hot Biopsy Forcep 7 7 $1,750.00 $1,750.00 $1,173.21 $1,733.92 $1,173.21 2024-12-31
45385 CPT Colonoscopy With Biopsy Snare Technique 7 7 $1,750.00 $1,750.00 $1,281.91 $1,951.32 $1,281.91 2024-12-31
45398 CPT Colonoscopy With Hemorrhoid Banding 7 7 $1,750.00 $1,750.00 $1,261.37 $1,910.23 $1,261.37 2024-12-31
46260 CPT Hemorrhoidectomy; Intrnal/ext 2 Or More 7 7 $2,948.96 $2,948.96 $2,399.12 $3,766.10 $2,399.12 2024-12-31
470 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without … 6 6 $27,720.00 $27,720.00 $19,388.28 $29,074.55 $19,388.28 2024-12-31
47562 CPT Laparoscopy Cholecystectomy 7 7 $5,791.00 $5,791.00 $5,290.55 $8,554.25 $5,290.55 2024-12-31
49203 CPT Excis Or Destr Open Intra Abd Tumors 7 7 $3,000.00 $3,000.00 $2,300.68 $3,551.35 $2,300.68 2024-12-31
49505 CPT Bilat Hernia Repr; Reducible Age > 5 7 7 $3,917.41 $3,917.41 $3,187.00 $5,002.91 $3,187.00 2024-12-31
49585 CPT Umbilical Hernia 7 7 $3,087.01 $3,087.01 $1,929.38 $1,929.38 $1,929.38 2024-12-31
51700 CPT Bladder Irrigation; Simple 7 7 $159.78 $159.78 $232.82 $409.72 $232.82 2024-12-31
52000 CPT Cystourethroscopy 7 7 $1,339.00 $1,339.00 $836.88 $994.03 $836.88 2024-12-31
52234 CPT Cysto With Fulberation Tumor .5 To 2.0 Cm 7 7 $3,500.00 $3,500.00 $2,808.40 $4,391.80 $2,808.40 2024-12-31
52630 CPT Transurethral Resect; Residual Regrowth 7 7 $1,814.42 $1,814.42 $4,045.44 $7,455.83 $4,045.44 2024-12-31
55040 CPT Excision Hydrocele; Unilateral 7 7 $4,248.10 $4,248.10 $2,655.06 $2,655.06 $2,655.06 2024-12-31
58150 CPT Total Hysterectomy 7 7 $14,078.00 $14,078.00 $8,786.08 $8,786.08 $8,786.08 2024-12-31
58260 CPT Vaginal Hysterectomy 7 7 $12,045.00 $12,045.00 $6,288.76 $7,528.38 $7,528.38 2024-12-31
58262 CPT Vaginal Hyst With Rmvl Tubes/overay 7 7 $15,203.00 $15,203.00 $7,937.84 $9,502.02 $9,502.02 2024-12-31
58353 CPT Endometr Ablate Thermal 7 7 $8,642.00 $8,642.00 $5,401.35 $7,345.05 $5,401.35 2024-12-31
58600 CPT Division Of Fallopian Tube 7 7 $8,623.00 $8,623.00 $4,503.15 $5,389.52 $5,389.52 2024-12-31
603 MS_DRG Cellulitis Without Mcc 6 6 $7,400.00 $7,400.00 $6,403.27 $10,216.55 $6,403.27 2024-12-31
62270 CPT Spinal Puncture Lumbar Diagnostic 7 7 $550.00 $550.00 $380.60 $568.69 $380.60 2024-12-31
62320 CPT Epidural; Lumbar/sacral Without Image Guide 7 7 $945.00 $945.00 $590.62 $772.84 $590.62 2024-12-31
62321 CPT Epidural; C Or T Spine With Imaging Guide 7 7 $1,419.00 $1,419.00 $997.63 $1,498.61 $997.63 2024-12-31
62323 CPT Epidural; Lumbar With Imaging Guidance 7 7 $1,419.00 $1,419.00 $997.63 $1,498.61 $997.63 2024-12-31
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 6 6 $7,300.00 $7,300.00 $5,775.74 $8,996.49 $5,775.74 2024-12-31
6440550 CPT Nerve Block Bilateral Greater Occipital 7 7 $551.00 $551.00 $344.38 $418.90 $344.38 2024-12-31
64421 CPT Nerve Block Intercostal Nerves Multiple 7 7 $778.50 $778.50 $633.35 $994.22 $633.35 2024-12-31
6449350 CPT Facet Joint Injection Bilateral 7 7 $695.00 $695.00 $575.77 $908.29 $575.77 2024-12-31
64494 CPT Facet Joint Injection Bilateral 7 7 $852.20 $852.20 $795.33 $1,292.39 $795.33 2024-12-31
65205 CPT Rmvl Fb Ext Eye 7 7 $375.00 $375.00 $269.11 $406.97 $269.11 2024-12-31
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 6 6 $7,628.00 $7,628.00 $6,112.97 $9,556.13 $6,112.97 2024-12-31
69200 CPT Rmvl Foreign Body Without Anes 7 7 $310.00 $310.00 $212.66 $316.82 $212.66 2024-12-31
70150 CPT Facial Bones 7 7 $305.00 $305.00 $190.62 $190.62 $190.62 2024-12-31
70160 CPT Nasal Bones Pa & Lat 7 7 $237.25 $237.25 $148.28 $148.28 $148.28 2024-12-31
70220 CPT Sinuses Complete 7 7 $311.85 $311.85 $194.91 $194.91 $194.91 2024-12-31
70250 CPT Skull 1-3 Views 7 7 $229.79 $229.79 $143.62 $143.62 $143.62 2024-12-31
70260 CPT Skull Series 4 Views 7 7 $338.71 $338.71 $211.69 $211.69 $211.69 2024-12-31
70360 CPT Neck Soft Tissue/fb 7 7 $207.41 $207.41 $129.62 $129.62 $129.62 2024-12-31
70450 CPT CT Head Without Contrast 7 7 $1,100.00 $1,100.00 $687.50 $687.50 $687.50 2024-12-31
70460 CPT CT Head W/contrast 7 7 $1,375.00 $1,375.00 $859.38 $859.38 $859.38 2024-12-31
70470 CPT CT Head W/of/u W/contrast 7 7 $2,475.00 $2,475.00 $1,414.01 $1,414.01 $1,414.01 2024-12-31
70480 CPT CT Mastoids Without Contrast 7 7 $1,100.00 $1,100.00 $687.50 $687.50 $687.50 2024-12-31
70486 CPT CT Facial Or Sinus Without Contrast 7 7 $1,100.00 $1,100.00 $687.50 $687.50 $687.50 2024-12-31
70490 CPT CT Neck Soft Tissue Wo Contrast 7 7 $1,100.00 $1,100.00 $687.50 $687.50 $687.50 2024-12-31
70491 CPT CT Neck Soft Tissue W/contrast 7 7 $1,375.00 $1,375.00 $859.38 $859.38 $859.38 2024-12-31
70492 CPT CT Neck Soft Tissue Without Fu With 7 7 $2,475.00 $2,475.00 $1,414.01 $1,414.01 $1,414.01 2024-12-31
70544 CPT MRA Of Head Without Contrast(abn)(babn)70544 7 7 $1,770.00 $1,770.00 $1,106.25 $1,106.25 $1,106.25 2024-12-31
70549 CPT MRA Of Neck W &without Cont (abn)(babn)70549 7 7 $3,300.00 $3,300.00 $1,900.59 $1,900.59 $1,900.59 2024-12-31
70551 CPT MRI Brain Without Contrast (abn) 7 7 $1,770.00 $1,770.00 $1,106.25 $1,106.25 $1,106.25 2024-12-31
70553 CPT MRI Brain With & Without Contrast 7 7 $3,300.00 $3,300.00 $1,830.33 $1,830.33 $1,830.33 2024-12-31
71046 CPT Chest Pa & Lat 7 7 $189.29 $189.29 $132.07 $132.07 $132.07 2024-12-31
71101 CPT Ribs 3v 7 7 $256.65 $256.65 $176.02 $176.02 $176.02 2024-12-31
71120 CPT Sternum 7 7 $232.77 $232.77 $145.48 $145.48 $145.48 2024-12-31
71250 CPT CT Chest Without Contr(babn)71250 7 7 $1,100.00 $1,100.00 $687.50 $687.50 $687.50 2024-12-31
71260 CPT CT Chest With Contr 7 7 $1,375.00 $1,375.00 $859.38 $859.38 $859.38 2024-12-31
71270 CPT CT Chest W/of/u W/contrast 7 7 $2,475.00 $2,475.00 $1,414.01 $1,414.01 $1,414.01 2024-12-31
71275 CPT CT Angiography Chest 7 7 $1,375.00 $1,375.00 $991.27 $991.27 $991.27 2024-12-31
72020 CPT C-spine Lat 7 7 $373.92 $373.92 $233.70 $233.70 $233.70 2024-12-31
72040 CPT C-spine Ap & Lat 7 7 $205.32 $205.32 $140.81 $140.81 $140.81 2024-12-31
72050 CPT C-spine Aplat With Obliques 7 7 $677.83 $677.83 $423.64 $423.64 $423.64 2024-12-31
72052 CPT C-spine W/obliques Flex/ext 7 7 $435.70 $435.70 $272.31 $272.31 $272.31 2024-12-31
72070 CPT Thoracic Spine Xray 2 Views 7 7 $219.00 $219.00 $136.88 $136.88 $136.88 2024-12-31
72100 CPT Lumbar Spine Ap/lat 7 7 $224.42 $224.42 $153.91 $153.91 $153.91 2024-12-31
72110 CPT Lumbar Sp Ap Lat W/obliques 7 7 $318.72 $318.72 $218.59 $218.59 $218.59 2024-12-31
72125 CPT CT C-spine Without Contrast 7 7 $1,100.00 $1,100.00 $687.50 $687.50 $687.50 2024-12-31
72128 CPT CT Thoracic Without Contrast 7 7 $1,100.00 $1,100.00 $687.50 $687.50 $687.50 2024-12-31
72131 CPT CT Lumbar Spine Without Contrast 7 7 $1,100.00 $1,100.00 $687.50 $687.50 $687.50 2024-12-31
72141 CPT MRI C-spine With & Without Contrast 7 7 $3,300.00 $3,300.00 $1,830.33 $1,830.33 $1,830.33 2024-12-31
72146 CPT MRI T-spine Without Contrast 7 7 $1,770.00 $1,770.00 $1,106.25 $1,106.25 $1,106.25 2024-12-31
72148 CPT MRI L-spine Without Contrast 7 7 $1,770.00 $1,770.00 $1,106.25 $1,106.25 $1,106.25 2024-12-31
72158 CPT MRI L-spine With & Without Contrast 7 7 $3,300.00 $3,300.00 $1,830.33 $1,830.33 $1,830.33 2024-12-31
72170 CPT Pelvis Ap Only 7 7 $202.93 $202.93 $126.83 $126.83 $126.83 2024-12-31
72190 CPT Pelvis W/lat Hips 7 7 $265.00 $265.00 $165.62 $165.62 $165.62 2024-12-31
72192 CPT CT Pelvis Without Contrast 7 7 $1,100.00 $1,100.00 $687.50 $687.50 $687.50 2024-12-31
72193 CPT CT Pelvis W/contrast 7 7 $1,375.00 $1,375.00 $859.38 $859.38 $859.38 2024-12-31
72195 CPT MRI Pelvis Without Contrast 7 7 $1,770.00 $1,770.00 $690.65 $1,106.25 $1,106.25 2024-12-31
72220 CPT Sacrum And Coccyx 7 7 $229.79 $229.79 $143.62 $143.62 $143.62 2024-12-31
73030 CPT Shoulder Rt 2-4 Views 7 7 $225.31 $225.31 $140.82 $140.82 $140.82 2024-12-31
73060 CPT Humerus Rt Side 7 7 $220.83 $220.83 $138.02 $138.02 $138.02 2024-12-31
73110 CPT Wrist 3 Views Rt Side 7 7 $229.79 $229.79 $143.62 $143.62 $143.62 2024-12-31
73130 CPT Hand Rt Side 7 7 $219.34 $219.34 $137.09 $137.09 $137.09 2024-12-31
73200 CPT CT Upper Extremities Rt Side 7 7 $1,100.00 $1,100.00 $687.50 $687.50 $687.50 2024-12-31
73218 CPT MRI Upper Extremities Without Contrast Rt 7 7 $1,770.00 $1,770.00 $1,106.25 $1,106.25 $1,106.25 2024-12-31
73221 CPT MRI Upper Ext Joint Without Contrast Rt Side 7 7 $1,770.00 $1,770.00 $1,106.25 $1,106.25 $1,106.25 2024-12-31
73222 CPT MRI Upper Extrem Joint W/contrast Lt Sid 7 7 $2,200.00 $2,200.00 $1,335.33 $1,335.33 $1,335.33 2024-12-31
73502 CPT Hip 2v Lt (includes Ap Pelvis) 7 7 $247.00 $247.00 $156.92 $156.92 $156.92 2024-12-31
73552 CPT Femur Rt Side 7 7 $528.21 $528.21 $330.13 $330.13 $330.13 2024-12-31
73562 CPT Knee 3 Views Rt Side 7 7 $240.23 $240.23 $150.15 $150.15 $150.15 2024-12-31
73564 CPT Zz 7 7 $347.67 $347.67 $217.29 $217.29 $217.29 2024-12-31
73590 CPT Tib/fib Rt Side 2 Views 7 7 $228.30 $228.30 $142.69 $142.69 $142.69 2024-12-31
73610 CPT Ankle Rt Side With Or Without Stress 7 7 $223.82 $223.82 $139.89 $139.89 $139.89 2024-12-31
73630 CPT Foot Rt Side 7 7 $216.36 $216.36 $135.22 $135.22 $135.22 2024-12-31
73700 CPT CT Lower Ext Rt Side Without Contrast 7 7 $1,100.00 $1,100.00 $687.50 $687.50 $687.50 2024-12-31
73718 CPT MRI Low Ext Non Joint Without Contrast Rt 7 7 $1,770.00 $1,770.00 $1,106.25 $1,106.25 $1,106.25 2024-12-31
73721 CPT MRI Low Extremity Jt Wo Contrast Rt Side 7 7 $1,770.00 $1,770.00 $1,106.25 $1,106.25 $1,106.25 2024-12-31
74018 CPT Kub 7 7 $216.36 $216.36 $135.22 $135.22 $135.22 2024-12-31
74019 CPT Abdomen Flat And Upright 7 7 $219.00 $219.00 $136.88 $136.88 $136.88 2024-12-31
74150 CPT CT Upper Abd Only Without Contrast 7 7 $1,100.00 $1,100.00 $687.50 $687.50 $687.50 2024-12-31
74160 CPT CT Upper Abd Only With Contrast 7 7 $1,375.00 $1,375.00 $859.38 $859.38 $859.38 2024-12-31
74174 CPT CT Angiography Abdomen And Pelvis 7 7 $2,736.56 $2,736.56 $1,710.35 $1,710.35 $1,710.35 2024-12-31
74176 CPT CT Abd & Pelvis Without Contrast 7 7 $1,100.00 $1,100.00 $687.50 $687.50 $687.50 2024-12-31
74177 CPT CT Abd & Pelvis With Contrast 7 7 $1,650.00 $1,650.00 $1,031.25 $1,031.25 $1,031.25 2024-12-31
74178 CPT CT Abd & Pelvis Without Fu With Contrast 7 7 $2,475.00 $2,475.00 $1,414.01 $1,414.01 $1,414.01 2024-12-31
76000 CPT Fluro Assist Up To 1st Hr 7 7 $376.02 $376.02 $235.01 $235.01 $235.01 2024-12-31
76536 CPT US Head/neck 7 7 $772.01 $772.01 $482.50 $482.50 $482.50 2024-12-31
76705 CPT US Abd Limited 7 7 $422.00 $422.00 $263.75 $263.75 $263.75 2024-12-31
76706 CPT US Abd Aorta 7 7 $422.00 $422.00 $263.75 $263.75 $263.75 2024-12-31
76770 CPT US Renal/bladder Complete 7 7 $412.00 $412.00 $257.50 $257.50 $257.50 2024-12-31
76775 CPT US Renal 7 7 $375.00 $375.00 $234.38 $234.38 $234.38 2024-12-31
76830 CPT US Transvaginal Non OB 7 7 $461.00 $461.00 $161.73 $288.12 $288.12 2024-12-31
76870 CPT US Testicular 7 7 $265.00 $265.00 $165.62 $165.62 $165.62 2024-12-31
76882 CPT Zzus Xtr Non Vasc Limited (not Covered) 7 7 $210.00 $210.00 $131.25 $131.25 $131.25 2024-12-31
77075 CPT Metastatic Bone Survey 7 7 $813.21 $813.21 $508.25 $508.25 $508.25 2024-12-31
77080 CPT Osteogram 7 7 $266.50 $266.50 $176.54 $176.54 $176.54 2024-12-31
78071 CPT Parathyroid Planar Imaging W Spect 7 7 $1,250.00 $1,250.00 $781.25 $781.25 $781.25 2024-12-31
78227 CPT Hepatobiliary Ductal System Imaging 7 7 $1,770.00 $1,770.00 $1,106.25 $1,106.25 $1,106.25 2024-12-31
78264 CPT Gastric Emptying Study 7 7 $812.00 $812.00 $507.50 $507.50 $507.50 2024-12-31
78306 CPT Nm Total Body Bone Scan 7 7 $1,100.00 $1,100.00 $687.50 $687.50 $687.50 2024-12-31
78315 CPT Three Phase Bone Scan 7 7 $803.00 $803.00 $501.88 $501.88 $501.88 2024-12-31
78452 CPT Stress & Rest W/wo Ejection Frac(abn) 7 7 $2,000.00 $2,000.00 $1,313.43 $1,313.43 $1,313.43 2024-12-31
80074 CPT Hepatitis Panel Acute(abn) 7 7 $221.58 $221.58 $138.49 $138.49 $138.49 2024-12-31
80197 CPT Prograf (tacrolimus) 7 7 $223.00 $223.00 $139.38 $139.38 $139.38 2024-12-31
80307 CPT Drug Profile 9 Serum (abn) 7 7 $240.99 $240.99 $150.62 $150.62 $150.62 2024-12-31
80375 CPT Guanfacine (intuniv) Level 7 7 $300.00 $300.00 $172.35 $172.35 $172.35 2024-12-31
81240 CPT Prothrombin Factor Ii DNA (babn)81240 7 7 $305.40 $305.40 $190.88 $190.88 $190.88 2024-12-31
81241 CPT Factor 5 Leiden (abn)(babn)81241 7 7 $281.25 $281.25 $175.78 $175.78 $175.78 2024-12-31
81270 CPT Jak 2 Mutation (v617f) (abn) 7 7 $500.00 $500.00 $312.50 $312.50 $312.50 2024-12-31
81291 CPT Methylenetetrahydrofolate DNA(get Auth) 7 7 $310.00 $310.00 $193.75 $193.75 $193.75 2024-12-31
82024 CPT Acth Plasma 7 7 $235.00 $235.00 $146.88 $146.88 $146.88 2024-12-31
82306 CPT Vit D Hydroxy(d2d3)(abn)(babn) 7 7 $350.76 $350.76 $219.23 $219.23 $219.23 2024-12-31
82379 CPT Carnitine 7 7 $311.16 $311.16 $194.47 $194.47 $194.47 2024-12-31
82542 CPT Co Q 10 7 7 $312.00 $312.00 $195.00 $195.00 $195.00 2024-12-31
82679 CPT Estrone 7 7 $206.00 $206.00 $128.75 $128.75 $128.75 2024-12-31
83013 CPT H Pylori Analysis Unrease 7 7 $441.41 $441.41 $275.88 $275.88 $275.88 2024-12-31
83014 CPT H Pylori Adm And Collection 7 7 $347.45 $347.45 $217.16 $217.16 $217.16 2024-12-31
83090 CPT Homocysteine(babn)83090 7 7 $283.55 $283.55 $177.22 $177.22 $177.22 2024-12-31
83519 CPT Thyrotropin-binding (tbii) 7 7 $230.00 $230.00 $127.44 $127.44 $127.44 2024-12-31
83520 CPT Immunoassay For Analyte Quant 7 7 $289.00 $289.00 $153.99 $153.99 $153.99 2024-12-31
83835 CPT Metanephrines Plasma 7 7 $285.00 $285.00 $171.41 $171.41 $171.41 2024-12-31
83880 CPT Bnp (triage) 7 7 $252.00 $252.00 $157.50 $157.50 $157.50 2024-12-31
83970 CPT Parathyroid Hormone (intact) 7 7 $248.93 $248.93 $155.57 $155.57 $155.57 2024-12-31
84207 CPT Vitamin B6 7 7 $225.65 $225.65 $141.03 $141.03 $141.03 2024-12-31
84270 CPT Sex Hormone Binding Globulin 7 7 $206.92 $206.92 $129.32 $129.32 $129.32 2024-12-31
84305 CPT Insulin-like Growth Factor Bp3 7 7 $228.00 $228.00 $142.50 $142.50 $142.50 2024-12-31
84445 CPT Thyroid Stimulating Immunoglobulins 7 7 $754.51 $754.51 $471.57 $471.57 $471.57 2024-12-31
84481 CPT T3 Free 7 7 $285.00 $285.00 $178.12 $178.12 $178.12 2024-12-31
84597 CPT Vitamin K 7 7 $225.00 $225.00 $136.91 $136.91 $136.91 2024-12-31
86256 CPT Anti Neutrophilic Cyto Ab 7 7 $209.00 $209.00 $130.62 $130.62 $130.62 2024-12-31
86480 CPT Quantiferon (r)-TB Gold 7 7 $213.57 $213.57 $133.48 $133.48 $133.48 2024-12-31
86920 CPT Blood Crossmatch 7 7 $248.00 $248.00 $142.00 $142.00 $142.00 2024-12-31
87471 CPT Bartonella DNA Qualitative Pcr 7 7 $263.00 $263.00 $164.38 $164.38 $164.38 2024-12-31
87497 CPT Cmv DNA Quant Pcr 7 7 $350.00 $350.00 $217.82 $217.82 $217.82 2024-12-31
87529 CPT Hsv I/ii DNA By Pcr(babn)87529 7 7 $350.00 $350.00 $206.93 $206.93 $206.93 2024-12-31
87902 CPT Hep C Genotype(babn)83912 7 7 $887.10 $887.10 $554.44 $554.44 $554.44 2024-12-31
88184 CPT Flow Cytometry Lymes Cd57 Cd3 Cd8 7 7 $280.21 $280.21 $175.13 $175.13 $175.13 2024-12-31
88230 CPT Tissue Culture Lymphocyte(abn) 7 7 $945.23 $945.23 $590.77 $590.77 $590.77 2024-12-31
88262 CPT Chromosome Analysis 7 7 $842.32 $842.32 $526.45 $526.45 $526.45 2024-12-31
88271 CPT Molecular Cytogenics DNA Probe(abn) 7 7 $236.91 $236.91 $148.07 $148.07 $148.07 2024-12-31
88275 CPT Interphase Hybridaztion(abn) 7 7 $236.91 $236.91 $148.07 $193.63 $148.07 2024-12-31
88289 CPT Chromosome Study Additional(abn) 7 7 $679.71 $679.71 $424.82 $555.55 $424.82 2024-12-31
88291 CPT Cyto/molecular Report 7 7 $269.00 $269.00 $168.12 $168.12 $168.12 2024-12-31
90375 CPT Kedrab (rabies Immune) Inj 10ml 7 7 $4,093.89 $4,093.89 $398.51 $2,041.51 $2,041.51 2024-12-31
90675 CPT Rabies Vaccine (rabavert) Inj Kit 7 7 $616.60 $616.60 $447.68 $676.59 $447.68 2024-12-31
90746 CPT Hepatitis B Vaccine 7 7 $236.69 $236.69 $95.25 $147.93 $147.93 2024-12-31
92950 CPT Cardiopulmonary Resuscitation 8 7 $970.50 $970.50 $310.62 $606.56 $606.56 2024-12-31
92960 CPT Cardioversion Elective 7 7 $758.85 $758.85 $474.28 $474.28 $474.28 2024-12-31
92977 CPT Thrombolysis Coronary; By IV Infusion 7 7 $1,192.08 $1,192.08 $745.05 $974.33 $745.05 2024-12-31
93005 CPT ECG 12 Leads-tracing Only 7 7 $123.00 $123.00 $129.47 $215.88 $129.47 2024-12-31
93017 CPT ECG Stress Test Tracing Only(abn) 7 7 $572.26 $572.26 $357.67 $467.74 $357.67 2024-12-31
93225 CPT ECG Holter Mntr-hook Up 24 Hr(abn) 7 7 $302.33 $302.33 $188.96 $247.10 $188.96 2024-12-31
93270 CPT Evnt Mntr Hu& Rcrding Dt(abn)(babn)93270 7 7 $299.00 $299.00 $157.40 $186.88 $186.88 2024-12-31
93304 CPT US Echo Limited Or Follow Up 7 7 $930.96 $930.96 $581.85 $760.91 $581.85 2024-12-31
93306 CPT US Echocardiogram Complete 7 7 $2,460.38 $2,460.38 $1,537.74 $2,010.97 $1,537.74 2024-12-31
93321 CPT US Echo F/u Lmted(abn) 7 7 $772.01 $772.01 $482.50 $631.00 $482.50 2024-12-31
93880 CPT US Carotid (abn) 7 7 $772.01 $772.01 $482.50 $631.00 $482.50 2024-12-31
93922 CPT US A/b Index (abn) 7 7 $772.01 $772.01 $482.50 $631.00 $482.50 2024-12-31
93923 CPT US Noin Studies Lwr Or Upr Ext (abn) Rt 7 7 $772.01 $772.01 $482.50 $631.00 $482.50 2024-12-31
93924 CPT US Noin Lt Lower Ext Arteries Comp(abn) 7 7 $772.01 $772.01 $482.50 $631.00 $482.50 2024-12-31
93925 CPT US Dup Scan Low Ext Arterial Bil(abn) 7 7 $772.01 $772.01 $482.50 $631.00 $482.50 2024-12-31
93926 CPT US Dup Scan Arter Lwr Ext Unltl Lmt(abn) 7 7 $772.01 $772.01 $482.50 $631.00 $482.50 2024-12-31
93931 CPT US Upper Ext Unilat Arterial Dup(abn) 7 7 $772.01 $772.01 $482.50 $631.00 $482.50 2024-12-31
93970 CPT US Dup Scan Ven Comp Bil(abn)(babn)93970 7 7 $772.01 $772.01 $482.50 $631.00 $482.50 2024-12-31
93971 CPT US Dup Scan Venous Unilt(abn)(babn)93971 7 7 $772.01 $772.01 $482.50 $631.00 $482.50 2024-12-31
94002 CPT Vent Assist; Initial Day 7 7 $850.00 $850.00 $531.25 $531.25 $531.25 2024-12-31
94003 CPT Vent Assist; Subsequent Day 7 7 $735.03 $735.03 $459.39 $459.39 $459.39 2024-12-31
94060 CPT Pft Comp Brochospams Eval Spirometry As 7 7 $245.00 $245.00 $237.99 $237.99 $237.99 2024-12-31
94660 CPT Cpap / Bipap 7 7 $434.44 $434.44 $271.52 $355.08 $271.52 2024-12-31
94664 CPT Demo/eval Of Pt Aerosolnebmdiippb 7 7 $58.00 $58.00 $148.73 $277.16 $148.73 2024-12-31
94762 CPT Overnight Cnt Pls Ox Noninvas(babn)94762 7 7 $215.00 $215.00 $85.52 $134.38 $134.38 2024-12-31
95810 CPT Sleep Ltncy Stdy Psg 1(abn)(babn)95810 7 7 $2,783.00 $2,783.00 $1,386.60 $1,739.38 $1,739.38 2024-12-31
95811 CPT Sleep Stgng 4 Pra W Cpap/bipap(abn)95811 7 7 $3,273.00 $3,273.00 $1,386.60 $2,045.62 $2,045.62 2024-12-31
95816 CPT Electroencephalogram Including Awake And 7 7 $500.07 $500.07 $312.55 $408.73 $312.55 2024-12-31
96360 CPT IV Infusion Hydration Initial 31-60mins 7 7 $214.09 $214.09 $188.28 $301.64 $188.28 2024-12-31
96361 CPT IV Infusion Hydration First/addtl Hrs 7 7 $214.09 $214.09 $133.81 $174.98 $133.81 2024-12-31
96366 CPT IV Infusion Ther Addtl/frst Hr Same Drug 7 7 $214.09 $214.09 $133.81 $174.98 $133.81 2024-12-31
96367 CPT Infusion Seq New Drug Up To 1 Hr 7 7 $214.09 $214.09 $133.81 $174.98 $133.81 2024-12-31
96374 CPT IV Push Single Or Initial Inclu Inf <16 7 7 $69.74 $69.74 $163.03 $301.64 $163.03 2024-12-31
97602 CPT Debridment(abn) 7 7 $254.32 $254.32 $175.88 $262.76 $175.88 2024-12-31
99218 CPT Op Observation Low 7 7 $225.50 $225.50 $140.94 $140.94 $140.94 2024-12-31
99281 CPT ER Mse/clinic Level 0 8 7 $273.48 $273.48 $170.93 $223.53 $170.93 2024-12-31
99282 CPT ER Level 2 7 7 $426.03 $426.03 $266.27 $348.22 $266.27 2024-12-31
99283 CPT ER Level 3 7 7 $654.83 $654.83 $409.27 $535.22 $409.27 2024-12-31
99284 CPT ER Level 4 7 7 $1,116.43 $1,116.43 $697.77 $912.50 $697.77 2024-12-31
99285 CPT ER Level 5 7 7 $1,735.15 $1,735.15 $1,084.46 $1,418.21 $1,084.46 2024-12-31
99291 CPT Critical Care First Hour 7 7 $767.50 $767.50 $804.87 $1,341.10 $804.87 2024-12-31
A9577 HCPCS Multihance (gadobenate Dimglmn)inj 15ml 7 7 $322.54 $322.54 $17.40 $153.84 $153.84 2024-12-31
J0490 HCPCS Benlysta Inj 120mg 7 7 $756.76 $756.76 $69.59 $375.33 $375.33 2024-12-31
J0558 HCPCS Bicillin Cr(pcn G B&p)900/300inj 1.2 Mun 7 7 $407.83 $407.83 $26.55 $196.80 $196.80 2024-12-31
J0561 HCPCS Bicillin La (pcn G Benzat) Inj 1.2 Mmu 7 7 $558.98 $558.98 $32.82 $267.95 $267.95 2024-12-31
J0630 HCPCS Miacalcin (calcitonin) Inj 400 Iu/2ml 7 7 $2,750.19 $2,750.19 $1,417.27 $1,718.87 $1,718.87 2024-12-31
J0834 HCPCS Cortrosyn (cosyntropin) Inj 0.25mg 7 7 $304.49 $304.49 $36.78 $155.41 $155.41 2024-12-31
J0840 HCPCS Crofab Per Vial 7 7 $3,847.60 $3,847.60 $2,404.75 $2,436.16 $2,404.75 2024-12-31
J1162 HCPCS Digifab Inj 40mg 7 7 $5,749.60 $5,749.60 $4,079.01 $6,145.65 $4,079.01 2024-12-31
J1610 HCPCS Glucagen Inj 1mg/1ml 7 7 $514.00 $514.00 $244.75 $321.25 $321.25 2024-12-31
J2353 HCPCS SandoSTAT Lar (octreotide) Inj 30mg 7 7 $3,884.84 $3,884.84 $259.42 $1,877.89 $1,877.89 2024-12-31
J2506 HCPCS Neulasta (pegfilgrastim) Inj 6mg 1 1 $7,487.27 $7,487.27 $135.05 $135.05 $135.05 2024-12-31
J2730 HCPCS Protopam (pralidoxime) Inj 1gm 7 7 $328.36 $328.36 $107.66 $201.59 $201.59 2024-12-31
J2997 HCPCS Cathflo Activase (alteplase) IV 2 Mg/2ml 7 7 $433.24 $433.24 $112.88 $251.40 $251.40 2024-12-31
J3101 HCPCS Tnkase (tenecteplase) Inj Kit 50mg 1 1 $9,129.53 $9,129.53 $196.97 $196.97 $196.97 2024-12-31
J3240 HCPCS Thyrogen (thyrotropin Alfa) Inj 0.9mg 7 7 $1,385.80 $1,385.80 $1,540.83 $2,596.62 $1,540.83 2024-12-31
J7298 HCPCS Levonorgestrel-releasing IUD (mirena) 52 7 7 $1,322.04 $1,322.04 $1,057.31 $1,651.90 $1,057.31 2024-12-31
J9217 HCPCS Lupron Depot Inj 7.5 Mg 7 7 $1,410.57 $1,410.57 $238.83 $754.17 $754.17 2024-12-31
J9280 HCPCS mitoMYcin 40mg Inj 7 7 $1,425.64 $1,425.64 $86.23 $684.65 $684.65 2024-12-31
P9046 HCPCS Albumin Ivpb: 25gm/100ml 7 7 $351.94 $351.94 $27.69 $172.22 $172.22 2024-12-31
Q5111 HCPCS Udenyca (pegfilgrastim-cbqv) Inj 6mg 1 1 $5,020.00 $5,020.00 $174.29 $174.29 $174.29 2024-12-31
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