Price Transparency 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

SHERIDAN COUNTY HOSPITAL

Hoxie, KS · CCN 171347 · Rates published

1,434 distinct procedures filed
3 distinct payers
6,650 rate rows
2026-05-13 last MRF observed
Data quality

6,646 of 6,650 rate rows are consumer-grade (99.9%)

4 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
exceeds 10× this hospital's gross charge — excluded from medians 2
placeholder amount (≤ $0.02) — excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://ambermed.com/480579744_sheridan-county-hospital_standardcharges.csv
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-05-18
Content fingerprint 703c9423ab7430c1… · 823,767 bytes · first seen 2026-05-13

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
J3380
CPT 		Entyvio 300mg IV 20mL Sdv 3 $7,812.00 $17,274.80 $11,001.32 nat. median
$288
outlier · 38.2×
Q5115
CPT 		Truxima 500mg (rituximab-abbs) IV Sdv 3 $6,698.56 $11,072.00 $10,518.40 nat. median
$885
outlier · 11.9×
J3101
CPT 		Tenecteplase (TNKase) Kit 50mg 3 $8,073.72 $12,677.75 $10,447.50 nat. median
$5,949
1.8× median
J2506
CPT 		Pegfligrastim (Neulasta)6mg Inj Syr 3 $147.54 $16,001.80 $10,190.62 nat. median
$2,076
outlier · 4.9×
58670
CPT 		Laparoscopy Fulg Of Oviducts 3 $5,684.58 $10,046.04 $8,926.20 nat. median
$5,656
1.6× median
Q5119
CPT 		Ruxience (rituximab) 500 Mg Inj Sdv 50mL 3 $5,269.55 $8,710.00 $8,274.50 nat. median
$934
outlier · 8.9×
J9217
CPT 		Eligard 225mg(3mo)/pfs 3 $1,935.40 $28,793.55 $7,345.00 nat. median
$1,523
outlier · 4.8×
Q5111
CPT 		Udenyca (pegfilgrastim-cbqv) 6mg/06mL 3 $1,262.76 $10,732.15 $6,834.68 nat. median
$2,111
outlier · 3.2×
Q5108
CPT 		Fulphila (pegfilgrastim) 6mg/06ml Syr 3 $909.30 $10,087.10 $6,423.89 nat. median
$1,258
outlier · 5.1×
15275
CPT 		Epi Fix/cord Skn Subs Fce Sclp Eyeld Mth 3 $5,108.62 $8,021.80 $6,175.87 nat. median
$1,737
outlier · 3.6×
J2997
CPT 		Alteplase (Activase) Inj 100mg Vial 3 $235.00 $19,301.15 $6,087.32 nat. median
$545
outlier · 11.2×
J0739
CPT 		Apretude 600mg IM Kit 3ml 3 $5,322.00 $8,902.45 $5,669.46 nat. median
$14
outlier · 420.0×
J2356
CPT 		Tezspire 210mg/191mL Syringe 3 $4,809.00 $8,852.10 $5,637.39 nat. median
$66
outlier · 85.1×
Q4278
CPT 		EpiEffect 1x2 Cm 3 $1,102.07 $14,601.50 $5,533.20 nat. median
$357
outlier · 15.5×
28825
CPT 		Amputation Toe/interphalangeal Joint 3 $4,701.46 $7,382.45 $5,459.36 nat. median
$3,319
1.6× median
J2182
CPT 		Nucala (mepolizumab) 100mg/ml Syringe 3 $3,895.00 $8,473.05 $5,396.00 nat. median
$3,098
1.7× median
J0840
CPT 		Antivenin ovine(CroFab) Vial IV 3 $2,189.78 $8,228.90 $5,240.51 nat. median
$3,427
1.5× median
Q4145
CPT 		EpiFix Micronized 100mg 3 $3,114.54 $8,521.50 $5,158.73 nat. median
$88
outlier · 58.7×
J1306
CPT 		Leqvio 284 Mg Syringe 15mL 3 $4,407.68 $7,695.00 $4,900.50 nat. median
$57
outlier · 86.7×
15271
CPT 		Epi Fix/cord Skn Grft Sub Trnk Arms Legs 3 $3,430.96 $5,387.45 $4,152.96 nat. median
$1,748
outlier · 2.4×
J0875
CPT 		Dalvance (dalbavancin) 500mg Inj Sdv 3 $2,599.08 $4,296.00 $4,081.20 nat. median
$1,069
outlier · 3.8×
12035
CPT 		Wound Int Rep 126 Cm To 20 Cm S A T E 3 $2,512.64 $6,183.55 $3,937.94 nat. median
$661
outlier · 6.0×
J3262
CPT 		Actemra 400mg/20mL Sdv 3 $2,896.00 $6,138.90 $3,909.51 nat. median
$1,425
outlier · 2.7×
J0881
CPT 		Darbepoetin (aranesp)non-esrd 150mcg Inj 3 $3.82 $8,603.20 $3,810.29 nat. median
$751
outlier · 5.1×
J3111
CPT 		Evenity 210mg (2X105mg) Inj Syringe 3 $3,103.80 $5,843.45 $3,721.36 nat. median
$1,003
outlier · 3.7×
Q4186
CPT 		EpiFix 4cm X 4cm Patch 3 $260.17 $18,450.90 $3,705.02 nat. median
$398
outlier · 9.3×
Q5130
CPT 		Fylnetra 6mg/06mL Inj Syringe 3 $1,267.02 $5,779.80 $3,680.82 nat. median
$336
outlier · 11.0×
J0129
CPT 		Orencia 250mg Sdv 3 $2,159.85 $3,570.00 $3,391.50 nat. median
$1,082
outlier · 3.1×
81408
CPT 		Rl Full Gene Sequence (81408) 3 $2,093.90 $3,461.00 $3,287.95 nat. median
$938
outlier · 3.5×
43249
CPT 		Egd W Dilation Less Than 30 Mm 3 $1,995.29 $3,266.38 $3,133.10 nat. median
$2,133
1.5× median
28286
CPT 		Correction, Cock-up Fifth Toe, With Plas 3 $1,967.46 $5,586.81 $3,089.40 nat. median
$3,510
0.9× median
26607
CPT 		Clsd Trt Met Carp Fra W Manip W Ext Fix 3 $2,220.96 $3,487.45 $3,066.37 nat. median
$3,135
1.0× median
J1745
CPT 		Remicade (inFLIXimab) 100mg Vial Sdv 3 $1,925.72 $3,183.00 $3,023.85 nat. median
$451
outlier · 6.7×
J0897
CPT 		Denosumab (Prolia) 60mg/ml Syringe 3 $1,749.06 $4,746.20 $3,022.58 nat. median
$2,506
1.2× median
28124
CPT 		Partial Excision Bone Phalanx Toe 3 $2,537.98 $3,985.25 $2,971.76 nat. median
$3,310
0.9× median
J1602
CPT 		Simponi Aria 50mg/4ml Sdv 3 $663.00 $4,628.40 $2,947.56 nat. median
$496
outlier · 5.9×
22902
CPT 		Excision Tmr Sft Tiss Abdom Subcu >3 Cm 3 $1,441.72 $3,661.30 $2,788.76 nat. median
$1,960
1.4× median
21315
CPT 		Clsd Trt Of Nasal Bone Fracture Wo Man 3 $1,706.10 $2,693.51 $2,679.00 nat. median
$1,733
1.5× median
36590
CPT 		Removal Of Cent Line W/subcut 3 $1,782.33 $2,798.70 $2,674.83 nat. median
$1,781
1.5× median
J3240
CPT 		Thyrogen 09mg Inj Sdv 3 $2,667.12 $4,196.15 $2,672.28 nat. median
$2,976
0.9× median
36573
CPT 		Picc Line Insertion With Image Guidance 3 $1,635.92 $2,674.83 $2,568.80 nat. median
$2,044
1.3× median
J1568
CPT 		Octagam 5% (10grams In 200ml) Ivig 3 $630.20 $3,984.30 $2,537.37 nat. median
$848
outlier · 3.0×
J1459
CPT 		Privigen (igg) 10gm (10%) IV Sdv 3 $309.80 $12,877.25 $2,474.61 nat. median
$1,228
outlier · 2.0×
12051
CPT 		Wound Int Rep 25 Cm Or Less F E E N L 3 $985.02 $3,819.95 $2,432.70 nat. median
$523
outlier · 4.7×
J9395
CPT 		fulvestrant(Faslodex) 250mg Inj Syr 3 $1,646.20 $2,721.00 $2,401.22 nat. median
$241
outlier · 10.0×
J7168
CPT 		KCENTRA(prothrombin Complex Conc):500un 3 $3.62 $3,757.25 $2,392.78 nat. median
$18
outlier · 135.3×
74174
CPT 		CTA Abdomen/pelvis With 3 $1,671.01 $2,623.90 $2,347.47 nat. median
$958
outlier · 2.5×
46221
CPT 		Hemorrhoidectomy Internal Rub Band Ligat 3 $1,601.44 $2,514.65 $2,248.30 nat. median
$1,056
outlier · 2.1×
43237
CPT 		Esophagogastroduodenoscopy 3 $1,418.72 $3,266.38 $2,227.75 nat. median
$2,261
1.0× median
43246
CPT 		Egd W Peg 3 $1,418.72 $3,266.38 $2,227.75 nat. median
$2,133
1.0× median

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.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
J3380 CPT Entyvio 300mg IV 20mL Sdv 3 3 $18,184.00 $18,184.00 $7,812.00 $17,274.80 $11,001.32 2026-05-13
Q5115 CPT Truxima 500mg (rituximab-abbs) IV Sdv 3 3 $11,072.00 $11,072.00 $6,698.56 $11,072.00 $10,518.40 2026-05-13
J3101 CPT Tenecteplase (TNKase) Kit 50mg 3 3 $13,345.00 $13,345.00 $8,073.72 $12,677.75 $10,447.50 2026-05-13
J2506 CPT Pegfligrastim (Neulasta)6mg Inj Syr 3 3 $16,844.00 $16,844.00 $147.54 $16,001.80 $10,190.62 2026-05-13
58670 CPT Laparoscopy Fulg Of Oviducts 3 3 $9,396.00 $9,396.00 $5,684.58 $10,046.04 $8,926.20 2026-05-13
Q5119 CPT Ruxience (rituximab) 500 Mg Inj Sdv 50mL 3 3 $8,710.00 $8,710.00 $5,269.55 $8,710.00 $8,274.50 2026-05-13
J9217 CPT Eligard 225mg(3mo)/pfs 15 3 $13,504.00 $13,504.00 $1,935.40 $28,793.55 $7,345.00 2026-05-13
Q5111 CPT Udenyca (pegfilgrastim-cbqv) 6mg/06mL 3 3 $11,297.00 $11,297.00 $1,262.76 $10,732.15 $6,834.68 2026-05-13
Q5108 CPT Fulphila (pegfilgrastim) 6mg/06ml Syr 5 3 $10,618.00 $10,618.00 $909.30 $10,087.10 $6,423.89 2026-05-13
15275 CPT Epi Fix/cord Skn Subs Fce Sclp Eyeld Mth 3 3 $8,444.00 $8,444.00 $5,108.62 $8,021.80 $6,175.87 2026-05-13
J2997 CPT Alteplase (Activase) Inj 100mg Vial 6 3 $10,382.00 $10,382.00 $235.00 $19,301.15 $6,087.32 2026-05-13
J0739 CPT Apretude 600mg IM Kit 3ml 3 3 $9,371.00 $9,371.00 $5,322.00 $8,902.45 $5,669.46 2026-05-13
J2356 CPT Tezspire 210mg/191mL Syringe 3 3 $9,318.00 $9,318.00 $4,809.00 $8,852.10 $5,637.39 2026-05-13
Q4278 CPT EpiEffect 1x2 Cm 9 3 $6,148.00 $6,148.00 $1,102.07 $14,601.50 $5,533.20 2026-05-13
28825 CPT Amputation Toe/interphalangeal Joint 3 3 $7,771.00 $7,771.00 $4,701.46 $7,382.45 $5,459.36 2026-05-13
J2182 CPT Nucala (mepolizumab) 100mg/ml Syringe 3 3 $8,919.00 $8,919.00 $3,895.00 $8,473.05 $5,396.00 2026-05-13
J0840 CPT Antivenin ovine(CroFab) Vial IV 3 3 $8,662.00 $8,662.00 $2,189.78 $8,228.90 $5,240.51 2026-05-13
Q4145 CPT EpiFix Micronized 100mg 6 3 $7,059.00 $7,059.00 $3,114.54 $8,521.50 $5,158.73 2026-05-13
J1306 CPT Leqvio 284 Mg Syringe 15mL 3 3 $8,100.00 $8,100.00 $4,407.68 $7,695.00 $4,900.50 2026-05-13
15271 CPT Epi Fix/cord Skn Grft Sub Trnk Arms Legs 3 3 $5,671.00 $5,671.00 $3,430.96 $5,387.45 $4,152.96 2026-05-13
J0875 CPT Dalvance (dalbavancin) 500mg Inj Sdv 3 3 $4,296.00 $4,296.00 $2,599.08 $4,296.00 $4,081.20 2026-05-13
12035 CPT Wound Int Rep 126 Cm To 20 Cm S A T E 3 3 $6,509.00 $6,509.00 $2,512.64 $6,183.55 $3,937.94 2026-05-13
J3262 CPT Actemra 400mg/20mL Sdv 3 3 $6,462.00 $6,462.00 $2,896.00 $6,138.90 $3,909.51 2026-05-13
J0881 CPT Darbepoetin (aranesp)non-esrd 150mcg Inj 11 3 $6,298.00 $6,298.00 $3.82 $8,603.20 $3,810.29 2026-05-13
J3111 CPT Evenity 210mg (2X105mg) Inj Syringe 3 3 $6,151.00 $6,151.00 $3,103.80 $5,843.45 $3,721.36 2026-05-13
Q4186 CPT EpiFix 4cm X 4cm Patch 13 3 $6,124.00 $6,124.00 $260.17 $18,450.90 $3,705.02 2026-05-13
Q5130 CPT Fylnetra 6mg/06mL Inj Syringe 3 3 $6,084.00 $6,084.00 $1,267.02 $5,779.80 $3,680.82 2026-05-13
J0129 CPT Orencia 250mg Sdv 3 3 $3,570.00 $3,570.00 $2,159.85 $3,570.00 $3,391.50 2026-05-13
81408 CPT Rl Full Gene Sequence (81408) 3 3 $3,461.00 $3,461.00 $2,093.90 $3,461.00 $3,287.95 2026-05-13
43249 CPT Egd W Dilation Less Than 30 Mm 3 3 $3,298.00 $3,298.00 $1,995.29 $3,266.38 $3,133.10 2026-05-13
28286 CPT Correction, Cock-up Fifth Toe, With Plas 3 3 $3,252.00 $3,252.00 $1,967.46 $5,586.81 $3,089.40 2026-05-13
26607 CPT Clsd Trt Met Carp Fra W Manip W Ext Fix 3 3 $3,671.00 $3,671.00 $2,220.96 $3,487.45 $3,066.37 2026-05-13
J1745 CPT Remicade (inFLIXimab) 100mg Vial Sdv 3 3 $3,183.00 $3,183.00 $1,925.72 $3,183.00 $3,023.85 2026-05-13
J0897 CPT Denosumab (Prolia) 60mg/ml Syringe 7 3 $4,417.00 $4,417.00 $1,749.06 $4,746.20 $3,022.58 2026-05-13
28124 CPT Partial Excision Bone Phalanx Toe 3 3 $4,195.00 $4,195.00 $2,537.98 $3,985.25 $2,971.76 2026-05-13
J1602 CPT Simponi Aria 50mg/4ml Sdv 3 3 $4,872.00 $4,872.00 $663.00 $4,628.40 $2,947.56 2026-05-13
22902 CPT Excision Tmr Sft Tiss Abdom Subcu >3 Cm 4 3 $3,854.00 $3,854.00 $1,441.72 $3,661.30 $2,788.76 2026-05-13
21315 CPT Clsd Trt Of Nasal Bone Fracture Wo Man 3 3 $2,820.00 $2,820.00 $1,706.10 $2,693.51 $2,679.00 2026-05-13
36590 CPT Removal Of Cent Line W/subcut 3 3 $2,946.00 $2,946.00 $1,782.33 $2,798.70 $2,674.83 2026-05-13
J3240 CPT Thyrogen 09mg Inj Sdv 3 3 $4,417.00 $4,417.00 $2,667.12 $4,196.15 $2,672.28 2026-05-13
36573 CPT Picc Line Insertion With Image Guidance 3 3 $2,704.00 $2,704.00 $1,635.92 $2,674.83 $2,568.80 2026-05-13
J1568 CPT Octagam 5% (10grams In 200ml) Ivig 3 3 $4,194.00 $4,194.00 $630.20 $3,984.30 $2,537.37 2026-05-13
J1459 CPT Privigen (igg) 10gm (10%) IV Sdv 12 3 $5,430.50 $5,430.50 $309.80 $12,877.25 $2,474.61 2026-05-13
12051 CPT Wound Int Rep 25 Cm Or Less F E E N L 3 3 $4,021.00 $4,021.00 $985.02 $3,819.95 $2,432.70 2026-05-13
J9395 CPT fulvestrant(Faslodex) 250mg Inj Syr 4 3 $2,721.00 $2,721.00 $1,646.20 $2,721.00 $2,401.22 2026-05-13
J7168 CPT KCENTRA(prothrombin Complex Conc):500un 3 3 $3,955.00 $3,955.00 $3.62 $3,757.25 $2,392.78 2026-05-13
74174 CPT CTA Abdomen/pelvis With 3 3 $2,762.00 $2,762.00 $1,671.01 $2,623.90 $2,347.47 2026-05-13
46221 CPT Hemorrhoidectomy Internal Rub Band Ligat 3 3 $2,647.00 $2,647.00 $1,601.44 $2,514.65 $2,248.30 2026-05-13
43246 CPT Egd W Peg 3 3 $2,345.00 $2,345.00 $1,418.72 $3,266.38 $2,227.75 2026-05-13
43237 CPT Esophagogastroduodenoscopy 3 3 $2,345.00 $2,345.00 $1,418.72 $3,266.38 $2,227.75 2026-05-13
45378 CPT Colonoscopy Dx W Specimen 3 3 $3,671.00 $3,671.00 $1,819.79 $3,487.45 $2,220.96 2026-05-13
25605 CPT Clsd Trt Dist Rad Frac Epiphys Sep W Man 3 3 $2,336.00 $2,336.00 $1,413.28 $2,755.70 $2,219.20 2026-05-13
Q5103 CPT Inflectra (infliximab-dyyb) 100mg Vial 3 3 $2,252.00 $2,252.00 $1,362.46 $2,252.00 $2,139.40 2026-05-13
27500 CPT Closed Treat Femoral Shaft & Fract W/out 3 3 $2,370.00 $2,370.00 $1,433.85 $2,251.50 $2,133.00 2026-05-13
12034 CPT Repair Intermediate S/a/t/e 76-125 Cm 3 3 $2,394.00 $2,394.00 $1,448.37 $2,274.30 $2,132.82 2026-05-13
12017 CPT Wound Repair 201 Cm To 30 Cm F E E N L 3 3 $3,068.00 $3,068.00 $1,856.14 $2,914.60 $2,118.91 2026-05-13
12007 CPT Wound Repair Over 30 Cm S N A Eg 3 3 $3,068.00 $3,068.00 $1,856.14 $2,914.60 $2,118.91 2026-05-13
12018 CPT Wound Repair Over 30 Cm F E E N L 3 3 $3,068.00 $3,068.00 $1,856.14 $2,914.60 $2,118.91 2026-05-13
12006 CPT Wound Repair 201 Cm To 30 Cm S N A Eg 3 3 $3,068.00 $3,068.00 $1,856.14 $2,914.60 $2,118.91 2026-05-13
25565 CPT Clsd Trt Rad & Uln Shaft Frac Sep W Man 3 3 $2,225.00 $2,225.00 $1,346.12 $2,755.70 $2,113.75 2026-05-13
93306 CPT Card Echocardiogram Without 3 3 $3,056.00 $3,056.00 $1,848.88 $2,903.20 $2,110.56 2026-05-13
C8929 CPT Card Echocardiogram With 3 3 $3,198.00 $3,198.00 $1,934.79 $3,038.10 $2,110.56 2026-05-13
45388 CPT Colonoscopy W Ablation (dx) 3 3 $2,902.00 $2,902.00 $1,755.71 $2,756.90 $2,030.23 2026-05-13
45384 CPT Colonoscopy W Hot Biopsy (sn-dx) 3 3 $2,637.00 $2,637.00 $1,595.38 $2,505.15 $2,030.23 2026-05-13
45380 CPT Colonoscopy Sn-dx W Biopsy 3 3 $2,637.00 $2,637.00 $1,595.38 $2,505.15 $2,030.23 2026-05-13
45381 CPT Colonscpy W Submucosal Inj (add On Chrg) 3 3 $2,637.00 $2,637.00 $1,595.38 $2,505.15 $2,030.23 2026-05-13
45385 CPT Colonoscopy W Snare (sn-dx) 5 3 $3,391.00 $3,391.00 $1,598.41 $3,221.45 $2,030.23 2026-05-13
78452 CPT Nuc Myocardial Spect Multi Ef Wm 3 3 $2,730.00 $2,730.00 $1,651.65 $2,593.50 $2,022.28 2026-05-13
28470 CPT Closed Treatment Of Metatarsal Fract Wo 3 3 $2,818.00 $2,818.00 $1,704.89 $2,677.10 $2,003.44 2026-05-13
27786 CPT Clsd Treat Dist Fib Frac Lat Mall W/out 3 3 $2,370.00 $2,370.00 $1,433.85 $2,251.50 $2,003.44 2026-05-13
27760 CPT Applications Fiber Glass Splint Splint 3 3 $2,437.00 $2,437.00 $1,474.38 $2,315.15 $2,003.44 2026-05-13
J0882 CPT Darbepoetin (Aranesp)ESRD*150mcg Inj Syr 3 3 $3,166.00 $3,166.00 $3.82 $3,007.70 $1,915.43 2026-05-13
28190 CPT Foreign Body Rem Foot-subcuta 5 3 $352.00 $352.00 $212.96 $2,961.15 $1,885.78 2026-05-13
J0885 CPT epoetin(Procrit)10,000unit/1ml*SPEC Ord* 9 3 $2,917.00 $2,917.00 $892.98 $3,038.00 $1,837.99 2026-05-13
J1439 CPT Injectafer 750mg Inj 15ml Sdv 3 3 $3,019.00 $3,019.00 $1,087.50 $2,868.05 $1,826.50 2026-05-13
36575 CPT Picc Line Repair 3 3 $2,456.00 $2,456.00 $1,485.88 $2,333.20 $1,819.79 2026-05-13
Q0138 CPT Feraheme (ferumoxytol) 510mg Sdv 17mL 5 3 $2,921.00 $2,921.00 $214.20 $2,774.95 $1,767.20 2026-05-13
Q4187 CPT EpiCord 3cm X 5cm Patch 7 3 $2,649.00 $2,649.00 $260.17 $6,269.05 $1,763.20 2026-05-13
95810 CPT Polysomnograpyy 6or Older Sleep Staging 3 3 $2,085.00 $2,085.00 $1,261.42 $1,980.75 $1,751.82 2026-05-13
95811 CPT Polysomnography Age 6or Older 4+add Para 3 3 $2,318.00 $2,318.00 $1,402.39 $2,202.10 $1,751.82 2026-05-13
75635 CPT CTA Abdomen/pelvis With Runoffs 3 3 $2,028.00 $2,028.00 $1,226.94 $1,926.60 $1,721.56 2026-05-13
26055 CPT Trigger Finger Release 3 3 $1,774.00 $1,774.00 $1,073.27 $2,755.70 $1,685.30 2026-05-13
11403 CPT Removal Of Lesion 21 To 30cm 3 3 $2,745.00 $2,745.00 $1,211.50 $2,607.75 $1,660.72 2026-05-13
36569 CPT Picc Line Insertion W/out Image Guidance 3 3 $2,704.00 $2,704.00 $1,066.14 $2,568.80 $1,635.92 2026-05-13
43235 CPT Egd/gastroscope 3 3 $2,345.00 $2,345.00 $1,418.72 $2,227.75 $1,614.36 2026-05-13
43239 CPT Gastroscope W/biopsy 3 3 $2,345.00 $2,345.00 $1,418.72 $2,227.75 $1,614.36 2026-05-13
J2357 CPT Xolair (omalizumab) 150mg/1mL Sub-q Syr 6 3 $2,230.00 $2,230.00 $801.62 $3,135.00 $1,610.84 2026-05-13
70471 CPT CTA Head/neck With 3 3 $2,348.00 $2,348.00 $1,420.54 $2,230.60 $1,597.40 2026-05-13
70498 CPT CTA Neck With 3 3 $1,881.00 $1,881.00 $1,138.00 $1,786.95 $1,597.40 2026-05-13
70496 CPT CTA Head With 3 3 $1,821.00 $1,821.00 $1,101.70 $1,729.95 $1,596.12 2026-05-13
71275 CPT CTA Chest With 5 3 $1,856.00 $1,856.00 $1,122.88 $1,786.00 $1,575.65 2026-05-13
G0121 CPT Colonoscopy Screening 3 3 $2,011.00 $2,011.00 $1,216.66 $1,910.45 $1,569.85 2026-05-13
45333 CPT Sigmoidscopy Flex W Removal 3 3 $1,672.00 $1,672.00 $1,011.56 $1,588.40 $1,569.85 2026-05-13
45330 CPT Sigmoidscopy Diag W Spec By Brush 3 3 $1,661.00 $1,661.00 $1,004.90 $1,577.95 $1,569.85 2026-05-13
G0105 CPT Colonoscopy Screen High Risk 3 3 $2,011.00 $2,011.00 $1,216.66 $1,910.45 $1,569.85 2026-05-13
26725 CPT Cltx Phlngl Fx Prox/mid PX/F/T,Surgical Care Only 3 3 $1,787.00 $1,787.00 $1,081.14 $1,697.65 $1,566.58 2026-05-13
32551 CPT Chest Tube Insertion 3 3 $1,642.00 $1,642.00 $993.41 $2,674.83 $1,559.90 2026-05-13
24605 CPT Clsd Elbow Disloc With Anesthes 3 3 $1,986.00 $1,986.00 $1,201.53 $1,886.70 $1,538.75 2026-05-13
G0104 CPT Sigmoidoscopy Colorect Scrn Flexible 3 3 $1,617.00 $1,617.00 $978.28 $1,569.85 $1,536.15 2026-05-13
64495 CPT Injec Para Vert W Img Guid Lv 3 5 3 $1,999.00 $1,999.00 $376.92 $1,899.05 $1,532.96 2026-05-13
74175 CPT CTA Abdomen With 3 3 $1,592.00 $1,592.00 $963.16 $1,592.00 $1,512.40 2026-05-13
99285 CPT Emergency Room - Critical Care 6 3 $2,073.50 $2,073.50 $1,174.30 $2,095.70 $1,488.44 2026-05-13
27552 CPT Closed Tx Knee Disloc W Anesthesia 3 3 $1,746.00 $1,746.00 $1,056.33 $1,658.70 $1,484.49 2026-05-13
27842 CPT Closed Treat Ankle Disloc W Anesthesia 3 3 $1,747.00 $1,747.00 $1,056.94 $1,659.65 $1,484.49 2026-05-13
10120 CPT Incisn & Removal/foreign Body 3 3 $1,774.00 $1,774.00 $1,073.27 $1,685.30 $1,481.71 2026-05-13
20670 CPT Removal Of Implant Superficial 3 3 $1,544.00 $1,544.00 $934.12 $2,789.85 $1,466.80 2026-05-13
360 CPT Pleural Drainage Procedure 3 3 $1,603.00 $1,603.00 $969.82 $1,522.85 $1,442.70 2026-05-13
12032 CPT Repair Interm Wound Scalp Axillae Trunk 3 3 $2,347.00 $2,347.00 $621.49 $2,229.65 $1,419.94 2026-05-13
99291 CPT ER Critical CARE,Emergency Services 3 3 $2,206.00 $2,206.00 $1,334.63 $2,095.70 $1,407.52 2026-05-13
78451 CPT Nuc Myocardial Spect Single 3 3 $1,878.00 $1,878.00 $1,136.19 $1,784.10 $1,391.28 2026-05-13
55100 CPT Drainage Scrotal Wall Abscessabcess 3 3 $1,444.00 $1,444.00 $873.62 $2,789.85 $1,371.80 2026-05-13
25600 CPT Immobilization Of L Lower Arm Using 3 3 $2,241.00 $2,241.00 $413.04 $2,128.95 $1,355.80 2026-05-13
10080 CPT Inc Drain Pilonidal Cyst Simple 3 3 $1,558.00 $1,558.00 $942.59 $1,480.10 $1,353.71 2026-05-13
12053 CPT Wound Int Rep 51cm To 75cm S N A Eg 3 3 $1,448.00 $1,448.00 $876.04 $1,375.60 $1,341.19 2026-05-13
43213 CPT Dilation Of Esophagus 3 3 $1,586.00 $1,586.00 $959.53 $1,506.70 $1,327.28 2026-05-13
J1569 CPT Gammagard (igg) 25gm/25ml Inj Sdv 12 3 $4,897.00 $4,897.00 $145.12 $11,701.15 $1,319.12 2026-05-13
12031 CPT Suture Int Rep 25 Cm Or Less S A T E 5 3 $2,167.00 $2,167.00 $621.49 $2,058.65 $1,311.04 2026-05-13
10160 CPT Pncture Aspir Abcess Hematoma Bulla Cyst 5 3 $1,978.00 $1,978.00 $894.19 $1,879.10 $1,305.02 2026-05-13
64484 CPT Njx Aa&/strd Tfrml Epi Lumbar/sacral Ea 5 3 $1,437.00 $1,437.00 $316.42 $1,365.15 $1,296.67 2026-05-13
30300 CPT Removal Of Foreign Body Intranasal 3 3 $1,510.00 $1,510.00 $913.55 $1,434.50 $1,292.49 2026-05-13
87507 CPT Gastrointestinal Panel Torch 3 3 $1,475.00 $1,475.00 $892.38 $1,401.25 $1,252.79 2026-05-13
23650 CPT Clsd Tx Shoulder Dis W/manip Without Aneseth 3 3 $1,410.00 $1,410.00 $853.05 $1,339.50 $1,236.84 2026-05-13
69000 CPT Drainage Ext Ear Abscess Hematoma Simple 3 3 $1,320.00 $1,320.00 $798.60 $1,254.00 $1,211.50 2026-05-13
26700 CPT Clsdmetacarp Dislocation, Single W Man W 3 3 $1,986.00 $1,986.00 $1,114.41 $1,886.70 $1,201.53 2026-05-13
32555 CPT US Thoracentesis With Guidance 3 3 $1,825.00 $1,825.00 $1,104.12 $1,733.75 $1,188.15 2026-05-13
64450 CPT Peripheral Nerve Block W Ultrasound 5 3 $1,426.00 $1,426.00 $316.42 $1,354.70 $1,183.98 2026-05-13
J2760 CPT Phentolamine Mesylate 5 Mg/ml Vial 3 3 $1,237.00 $1,237.00 $748.38 $1,237.00 $1,175.15 2026-05-13
43450 CPT Esophageal Dillitation 3 3 $1,234.00 $1,234.00 $746.57 $1,614.36 $1,172.30 2026-05-13
J2770 CPT quinupristin/dalfopr(Synercid)500mg 3 3 $1,232.00 $1,232.00 $745.36 $1,232.00 $1,170.40 2026-05-13
64491 CPT Injec Paravert Facet W Image Guid Lv 2,Bilateral Procedure 7 3 $1,222.00 $1,222.00 $268.02 $1,532.96 $1,160.90 2026-05-13
78708 CPT Nuc Renal Flow & Function Single W Lasix 3 3 $1,343.00 $1,343.00 $812.52 $1,275.85 $1,157.10 2026-05-13
49083 CPT US Paracentesis W Guidance 3 3 $1,204.00 $1,204.00 $728.42 $1,614.36 $1,143.80 2026-05-13
94003 CPT Rt Vent Ast Mng Init Pres Vol Preset Sub 3 3 $1,299.00 $1,299.00 $785.90 $1,234.05 $1,138.34 2026-05-13
64492 CPT Injec Paravert Facet Cerv /thor Level 3 4 3 $948.50 $948.50 $263.18 $1,532.96 $1,136.70 2026-05-13
P9053 CPT Bb Platelets Pher Leukred Irradiated 3 3 $1,260.00 $1,260.00 $762.30 $1,197.00 $1,134.00 2026-05-13
49082 CPT Abdominal Parancentesis Without Guidance 3 3 $1,180.00 $1,180.00 $713.90 $1,614.36 $1,121.00 2026-05-13
28660 CPT Clsd Trt Of Interphalangeal Jnt Wo Anes 3 3 $1,249.00 $1,249.00 $755.64 $1,186.55 $1,114.41 2026-05-13
27840 CPT Clsd Treat Of Ankel Disloc Without Anesthes 3 3 $1,328.00 $1,328.00 $803.44 $1,261.60 $1,114.41 2026-05-13
27560 CPT Closed Treat Patellar Dislocation W/out 3 3 $1,280.00 $1,280.00 $774.40 $1,216.00 $1,114.41 2026-05-13
27550 CPT Clsd Tx Knee Disloc Without Anesthes 3 3 $1,314.00 $1,314.00 $794.97 $1,248.30 $1,114.41 2026-05-13
26770 CPT Clsd Trt Interphalang Joint Dis Sgl W/ma 3 3 $1,310.00 $1,310.00 $792.55 $1,244.50 $1,114.41 2026-05-13
26605 CPT Clsd Trt Met Carp Fra W Manip Ea 3 3 $1,443.00 $1,443.00 $873.02 $1,370.85 $1,114.41 2026-05-13
25675 CPT Clsd Treat Distalradioulnar Disloc W Man 3 3 $1,323.00 $1,323.00 $800.42 $1,256.85 $1,114.41 2026-05-13
12016 CPT Wound Repair 126 Cm To 20 Cm F E E N L 3 3 $1,615.00 $1,615.00 $977.08 $1,534.25 $1,114.41 2026-05-13
12015 CPT Wound Repair 76 Cm To 125cm F E E N L 3 3 $1,615.00 $1,615.00 $977.08 $1,534.25 $1,114.41 2026-05-13
24640 CPT Dislocation Of Elbow Treatment Nursemaid 3 3 $1,615.00 $1,615.00 $977.08 $1,534.25 $1,114.41 2026-05-13
24600 CPT Dislocation Of Elbow Treatment 3 3 $1,615.00 $1,615.00 $977.08 $1,534.25 $1,114.41 2026-05-13
12005 CPT Wound Repair 126 Cm To 20 Cm S N A Eg 3 3 $1,615.00 $1,615.00 $977.08 $1,534.25 $1,114.41 2026-05-13
37609 CPT Ligation Or Biopsy Temporal Artery 3 3 $1,444.00 $1,444.00 $873.62 $1,371.80 $1,103.38 2026-05-13
64494 CPT Injection Para Vertebral W Img Guid Lv2 4 3 $1,405.00 $1,405.00 $255.92 $1,532.96 $1,092.38 2026-05-13
13131 CPT Repair Cmplx 11 To 25 Cm 3 3 $1,237.00 $1,237.00 $748.38 $1,175.15 $1,085.19 2026-05-13
P9037 CPT Bb Platelets Pheresis Leukoreduce 3 3 $1,159.00 $1,159.00 $701.20 $1,101.05 $1,043.10 2026-05-13
36010 CPT Central Line Insertion 3 3 $1,693.00 $1,693.00 $908.50 $1,608.35 $1,024.26 2026-05-13
32554 CPT Thoracentesis Procedure Without Guidance 3 3 $1,482.00 $1,482.00 $896.61 $1,407.90 $1,022.59 2026-05-13
41800 CPT Drainage Abscess/cyst/hematoma Dentoalv 3 3 $1,681.00 $1,681.00 $221.96 $1,596.95 $1,017.00 2026-05-13
28010 CPT Tenotomy, Percutaneous, Toe; Single Tend 3 3 $1,658.00 $1,658.00 $218.20 $1,575.10 $1,003.09 2026-05-13
64510 CPT Stellate Ganglion Block Under Fluoro 3 3 $1,204.00 $1,204.00 $728.42 $1,143.80 $985.02 2026-05-13
17110 CPT Destruction Benign Lesion <=14 Less 3 3 $1,622.00 $1,622.00 $342.14 $1,540.90 $981.31 2026-05-13
73206 CPT CTA Upper Extremity Bilateral With 3 3 $1,616.00 $1,616.00 $306.54 $1,535.20 $977.68 2026-05-13
73706 CPT CTA Lower Extremity With Left 3 3 $1,616.00 $1,616.00 $306.54 $1,535.20 $977.68 2026-05-13
12042 CPT Wound Int Repair 26 To 75cm N H F Ext 3 3 $1,080.00 $1,080.00 $653.40 $1,026.00 $973.89 2026-05-13
62323 CPT Lumbar Epidur Steroid Inj W/fluoro 5 3 $1,603.00 $1,603.00 $521.51 $1,572.83 $969.82 2026-05-13
J0248 CPT Remdesivir (Veklury) 100mg Inj Sdv 3 3 $1,600.00 $1,600.00 $818.00 $1,520.00 $968.00 2026-05-13
99284 CPT ER - Level 4 3 3 $1,292.00 $1,292.00 $781.66 $1,227.40 $957.69 2026-05-13
31720 CPT Catheter Aspiration Nasotracheal (spx) 5 3 $1,404.00 $1,404.00 $659.45 $1,333.80 $954.41 2026-05-13
11765 CPT Wedge Excision Skin Nail Fold 3 3 $1,113.00 $1,113.00 $673.36 $1,057.35 $954.41 2026-05-13
78227 CPT Nuc Hepatoductal System (gb) 3 3 $1,004.00 $1,004.00 $607.42 $953.80 $940.61 2026-05-13
90940 CPT US Post Av Fistula Evaluation 3 3 $1,043.00 $1,043.00 $631.02 $990.85 $938.70 2026-05-13
20680 CPT Removal Of Implant Deep 3 3 $987.00 $987.00 $597.14 $4,928.09 $937.65 2026-05-13
72191 CPT CTA Pelvis With 3 3 $1,534.00 $1,534.00 $306.54 $1,457.30 $928.07 2026-05-13
27096 CPT Sacroiliac Joint Injection W Fluoro 5 3 $1,128.00 $1,128.00 $559.02 $1,071.60 $924.00 2026-05-13
36680 CPT Intraosseous Injection 3 3 $1,521.00 $1,521.00 $687.10 $1,444.95 $920.20 2026-05-13
70549 CPT MRA Neck With/without 3 3 $1,265.00 $1,265.00 $765.32 $1,201.75 $915.94 2026-05-13
70546 CPT MRA Head With/without 3 3 $1,265.00 $1,265.00 $765.32 $1,201.75 $915.94 2026-05-13
72198 CPT MRA Pelvis With/without 3 3 $1,265.00 $1,265.00 $765.32 $1,201.75 $915.94 2026-05-13
70545 CPT MRA Head With 3 3 $1,265.00 $1,265.00 $765.32 $1,201.75 $915.94 2026-05-13
74185 CPT MRA Abdomen With/without 3 3 $1,265.00 $1,265.00 $765.32 $1,201.75 $915.94 2026-05-13
70544 CPT MRA Head Without 3 3 $1,265.00 $1,265.00 $765.32 $1,201.75 $915.94 2026-05-13
11400 CPT Removal Of Lesion 05 Cm Or Less 3 3 $960.00 $960.00 $580.80 $1,211.50 $912.00 2026-05-13
13160 CPT Secondary Closure Of Wound 3 3 $956.00 $956.00 $578.38 $2,807.59 $908.20 2026-05-13
19000 CPT Aspiration Of Cyst Of Breast 3 3 $956.00 $956.00 $578.38 $1,211.50 $908.20 2026-05-13
64493 CPT Injec Paravert Facet W Image Guid Lev 1,Bilateral Procedure 9 3 $988.00 $988.00 $443.46 $1,532.96 $885.12 2026-05-13
62321 CPT Thoracic Epid Ster Inj W/fluoroscopy 7 3 $877.00 $877.00 $530.58 $1,572.83 $877.00 2026-05-13
20103 CPT Exploration Of Penetrating Wound 3 3 $1,444.00 $1,444.00 $427.12 $1,371.80 $873.62 2026-05-13
64483 CPT Lumbar Transforaminal Inj With Fluoro 7 3 $956.00 $956.00 $552.36 $1,532.96 $867.35 2026-05-13
12052 CPT Repair Intermed F/e/e/n/l&/muc 26-50cm 3 3 $1,386.00 $1,386.00 $621.49 $1,316.70 $838.53 2026-05-13
87632 CPT Pneumonia Virus Panel (87632) 3 3 $1,126.00 $1,126.00 $681.23 $1,069.70 $833.99 2026-05-13
62322 CPT Injection Single-non Ind Cath 3 3 $1,176.00 $1,176.00 $711.48 $1,117.20 $811.11 2026-05-13
88230 CPT Rl Chromosome Blood Culture 3 3 $908.00 $908.00 $549.34 $862.60 $810.84 2026-05-13
C8924 CPT Card Echocardiogram Limited With 3 3 $1,333.00 $1,333.00 $798.59 $1,266.35 $806.46 2026-05-13
94002 CPT Respir Ventilation Less 24 Consec Hrs 6 3 $1,059.00 $1,059.00 $495.50 $1,234.05 $802.45 2026-05-13
93350 CPT Card Dobutamine Stress Echocardiogram 3 3 $1,158.00 $1,158.00 $700.59 $1,100.10 $798.59 2026-05-13
64479 CPT Thoracic Transforaminal Inj W Fluoro 4 3 $1,027.00 $1,027.00 $263.18 $1,532.96 $798.50 2026-05-13
12004 CPT Wound Repair 76 Cm To 125 Cm S N A Eg 3 3 $858.00 $858.00 $519.09 $815.10 $795.81 2026-05-13
93308 CPT Card Echocardiogram Limited Without 3 3 $1,149.00 $1,149.00 $695.14 $1,091.55 $793.03 2026-05-13
64454 CPT Inj Aa&/strd Genic Nrv Brnch W Img Guide 3 3 $833.00 $833.00 $503.96 $1,134.55 $791.35 2026-05-13
10021 CPT Fn Needle Asp Biop Without Img Guid1stlesion 3 3 $1,305.00 $1,305.00 $687.94 $1,239.75 $789.52 2026-05-13
69209 CPT Rem Impacted Earwax By Irrigation/lavage 3 3 $831.00 $831.00 $502.76 $807.89 $789.45 2026-05-13
11104 CPT Punch Biop Skin Sngl Lesion Simple Close 3 3 $1,291.00 $1,291.00 $687.94 $1,226.45 $781.06 2026-05-13
74181 CPT MRI Abdomen Without 5 3 $1,049.00 $1,049.00 $516.67 $996.55 $761.10 2026-05-13
70540 CPT MRI Orbits Without 3 3 $1,049.00 $1,049.00 $634.64 $996.55 $761.10 2026-05-13
73223 CPT MRI Elbow With/without Left 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-05-13
71552 CPT MRI Chest With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-05-13
73222 CPT MRI Elbow With Left 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-05-13
72142 CPT MRI Cervical Spine With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-05-13
73218 CPT MRI Forearm Without Left 3 3 $1,049.00 $1,049.00 $634.64 $996.55 $761.10 2026-05-13
73221 CPT MRI Elbow Without Left 5 3 $1,049.00 $1,049.00 $516.67 $996.55 $761.10 2026-05-13
72148 CPT MRI Lumbar Spine Without 3 3 $854.00 $854.00 $516.67 $811.30 $761.10 2026-05-13
70543 CPT MRI Orbits With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-05-13
72141 CPT MRI Cervical Spine Without 3 3 $854.00 $854.00 $516.67 $811.30 $761.10 2026-05-13
72195 CPT MRI Pelvis Without 3 3 $1,049.00 $1,049.00 $634.64 $996.55 $761.10 2026-05-13
72196 CPT MRI Pelvis With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-05-13
72147 CPT MRI Thoracic Spine With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-05-13
72158 CPT MRI Lumbar Spine With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-05-13
73723 CPT MRI Ankle With/without Left 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-05-13
73722 CPT MRI Ankle With Left 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-05-13
72149 CPT MRI Lumbar Spine With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-05-13
73720 CPT MRI Femur With/without Left 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-05-13
73721 CPT MRI Ankle Without Left 3 3 $1,049.00 $1,049.00 $634.64 $996.55 $761.10 2026-05-13
73220 CPT MRI Forearm With/without Left 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-05-13
72197 CPT MRI Pelvis With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-05-13
73718 CPT MRI Femur Without Left 3 3 $1,049.00 $1,049.00 $634.64 $996.55 $761.10 2026-05-13
70542 CPT MRI Orbits With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-05-13
74182 CPT MRI Abdomen With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-05-13
74183 CPT MRI Abdomen With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-05-13
71551 CPT MRI Chest With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-05-13
71550 CPT MRI Chest Without 3 3 $1,049.00 $1,049.00 $634.64 $996.55 $761.10 2026-05-13
73719 CPT MRI Femur With Left 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-05-13
72156 CPT MRI Cervical Spine With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-05-13
73219 CPT MRI Forearm With Left 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-05-13
72157 CPT MRI Thoracic Spine With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-05-13
70553 CPT MRI Brain (head) With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-05-13
70552 CPT MRI Brain (head) With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-05-13
70551 CPT MRI Brain (head) Without 3 3 $854.00 $854.00 $516.67 $811.30 $761.10 2026-05-13
72146 CPT MRI Thoracic Spine Without 3 3 $1,049.00 $1,049.00 $634.64 $996.55 $761.10 2026-05-13
26755 CPT Treat Finger Fracture W/manip 3 3 $1,246.00 $1,246.00 $745.72 $1,183.70 $753.83 2026-05-13
81219 CPT Rl Calreticulin (calr) Mutation Analysis 3 3 $1,236.00 $1,236.00 $345.71 $1,174.20 $747.78 2026-05-13
65220 CPT Removal Foreign Body Ext Eye, Corneal 3 3 $864.00 $864.00 $522.72 $820.80 $745.72 2026-05-13
27250 CPT Clsd Hip Disloc Traumatic Without Anesthes 3 3 $833.00 $833.00 $503.96 $791.35 $745.72 2026-05-13
13121 CPT Wound Repair 26 Cm To 75 Cm S A L 3 3 $907.00 $907.00 $548.74 $861.65 $742.94 2026-05-13
P9016 CPT Bb Red Blood Cells Per Unit 3 3 $835.00 $835.00 $505.18 $793.25 $736.05 2026-05-13
12041 CPT Repair Intermed N/h/f/xtrn Gent 25 Cm/< 3 3 $817.00 $817.00 $494.28 $776.15 $733.20 2026-05-13
82139 CPT Rl Amino Acids Quant, Plasma 3 3 $1,060.00 $1,060.00 $641.30 $1,007.00 $731.08 2026-05-13
S8037 CPT MRI Cholangiopancreatography 3 3 $854.00 $854.00 $516.67 $811.30 $724.85 2026-05-13
88262 CPT Rl Chromosome Analysis Blood 3 3 $810.00 $810.00 $490.05 $769.50 $722.55 2026-05-13
46500 CPT Injection Into Hemorrhoids 3 3 $799.00 $799.00 $483.40 $759.05 $719.10 2026-05-13
36430 CPT Blood Administration 3 3 $812.00 $812.00 $491.26 $771.40 $710.36 2026-05-13
78472 CPT Nuc Muga Scan 3 3 $975.00 $975.00 $589.88 $926.25 $698.86 2026-05-13
77075 CPT Xr Skeletal Survey >12 Months 3 3 $941.00 $941.00 $569.30 $893.95 $697.58 2026-05-13
78306 CPT Nuc Bone Scan Total Body 3 3 $878.00 $878.00 $531.19 $834.10 $691.90 2026-05-13
78264 CPT Nuc Gastric Emptying Study 3 3 $789.00 $789.00 $477.34 $749.55 $691.90 2026-05-13
11750 CPT Excision Nail Matrix Permanent Removal 3 3 $958.00 $958.00 $579.59 $910.10 $687.94 2026-05-13
10061 CPT Incision & Drainage Of Abcess Comp Or Mu 5 3 $620.00 $620.00 $375.10 $2,914.60 $687.94 2026-05-13
78013 CPT Nuc Thyroid Imaging 3 3 $712.00 $712.00 $430.76 $691.90 $676.40 2026-05-13
74178 CPT CT Abdomen/pelvis With/without 3 3 $1,115.00 $1,115.00 $661.76 $1,059.25 $674.58 2026-05-13
30901 CPT Nose Bleedltd Cautery And Packing 3 3 $754.00 $754.00 $456.17 $716.30 $673.38 2026-05-13
78315 CPT Nuc 3-phase Bone Scan 3 3 $708.00 $708.00 $428.34 $691.90 $672.60 2026-05-13
78278 CPT Nuc Gastrointestinal Bleed 3 3 $702.00 $702.00 $424.71 $691.90 $666.90 2026-05-13
92960 CPT Cardioversion External 3 3 $1,068.00 $1,068.00 $646.14 $1,014.60 $663.86 2026-05-13
74400 CPT Xr Intravenous Pyelogram 3 3 $894.00 $894.00 $540.87 $849.30 $663.03 2026-05-13
93922 CPT US Ankle Brachial Index 3 3 $782.00 $782.00 $473.11 $742.90 $662.25 2026-05-13
93990 CPT US Av Fistula Mapping 3 3 $782.00 $782.00 $473.11 $742.90 $662.25 2026-05-13
93975 CPT US Renal Doppler 3 3 $958.00 $958.00 $579.59 $910.10 $662.25 2026-05-13
93925 CPT US Arterial Lower Extremity Bilateral 3 3 $782.00 $782.00 $473.11 $742.90 $662.25 2026-05-13
93931 CPT US Arterial Upper Extremity LEFT,Left Side 6 3 $958.00 $958.00 $579.59 $910.10 $662.25 2026-05-13
76536 CPT US Neck Soft Tissue 3 3 $782.00 $782.00 $473.11 $742.90 $662.25 2026-05-13
93979 CPT US Aorta-iliac Bypass Unilateral 3 3 $958.00 $958.00 $579.59 $910.10 $662.25 2026-05-13
93930 CPT US Arterial Upper Extremity Bilateral 3 3 $1,028.00 $1,028.00 $621.94 $976.60 $662.25 2026-05-13
93970 CPT US Venous Upper Extremity Bilateral 5 3 $958.00 $958.00 $533.00 $910.10 $662.25 2026-05-13
93882 CPT US Carotid Doppler Unilateral Right 3 3 $782.00 $782.00 $473.11 $742.90 $662.25 2026-05-13
93926 CPT US Arterial Lower Extremity LEFT,Left Side 6 3 $958.00 $958.00 $579.59 $910.10 $662.25 2026-05-13
93978 CPT US Aorta-iliac Bypass Bilateral 3 3 $1,028.00 $1,028.00 $621.94 $976.60 $662.25 2026-05-13
93976 CPT US Ovarian Doppler 3 3 $958.00 $958.00 $579.59 $910.10 $662.25 2026-05-13
93880 CPT US Carotid Doppler 3 3 $782.00 $782.00 $473.11 $742.90 $662.25 2026-05-13
93971 CPT US Venous Lower Extremity LEFT,Left Side 10 3 $752.00 $752.00 $454.96 $910.10 $662.25 2026-05-13
70492 CPT CT Neck (soft Tissue) With/without 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
70491 CPT CT Neck (soft Tissue) With 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
70490 CPT CT Neck (soft Tissue) Without 3 3 $914.00 $914.00 $552.97 $868.30 $661.76 2026-05-13
70488 CPT CT Sinus With/without 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
70487 CPT CT Sinus With 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
70486 CPT CT Mandible Without 3 3 $914.00 $914.00 $552.97 $868.30 $661.76 2026-05-13
70482 CPT CT Iac With/without 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
70481 CPT CT Iac With 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
70480 CPT CT Iac Without 3 3 $914.00 $914.00 $552.97 $868.30 $661.76 2026-05-13
70470 CPT CT Head (brain) With/without 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
70460 CPT CT Head (brain) With 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
70450 CPT CT Head (brain) Without 3 3 $758.00 $758.00 $458.59 $720.10 $661.76 2026-05-13
73200 CPT CT Elbow Without Left 3 3 $914.00 $914.00 $552.97 $868.30 $661.76 2026-05-13
73701 CPT CT Ankle With Left 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
73202 CPT CT Elbow With/without Left 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
73702 CPT CT Ankle With/without Left 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
72192 CPT CT Pelvis Without 3 3 $914.00 $914.00 $552.97 $868.30 $661.76 2026-05-13
72132 CPT CT Lumbar Spine With 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
73201 CPT CT Elbow With Left 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
73700 CPT CT Ankle Without Left 3 3 $914.00 $914.00 $552.97 $868.30 $661.76 2026-05-13
72130 CPT CT Thoracic Spine With/without 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
72133 CPT CT Lumbar Spine With/without 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
72194 CPT CT Pelvis With/without 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-05-13
120 OTHER Acute Semi-private Room Charge 2 2 $1,569.00 $1,569.00 $180.69 $1,490.55 $835.62 2026-05-13
120 CPT Swing Bed Room Charge 2 2 $1,348.00 $1,348.00 $174.06 $1,280.60 $727.33 2026-05-13
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