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

LADY OF THE SEA GENERAL HOSPITAL

Cut Off, LA · CCN 191325 · Rates published

1,613 distinct procedures filed
21 distinct payers
44,694 rate rows
2026-09-15 last MRF observed
Data quality

36,836 of 44,694 rate rows are consumer-grade (82.4%)

7,858 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
professional (physician) fee — not the facility price 6,117
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 1,697
placeholder amount (≤ $0.02) — excluded from medians 44
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.losgh.org/financial%20policies/726012041_lafourche-parish-hospital-service-district-no-1_standardcharges.csv
Found on page https://www.losgh.org/price-transparency.php
Discovered viaCMS hospital list
Last fetch success · 2026-10-05
Content fingerprint e5f6e290df8a2136… · 14,201,496 bytes · first seen 2026-10-05

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
J3380
HCPCS 		Vedolizumab (entyvio) 300mg Vial 15 $20.98 $23,508.80 $14,105.28 nat. median
$59
outlier · 239.9×
J2997
HCPCS 		Alteplase (activase) 100mg Kit 15 $95.09 $29,569.19 $8,870.77 nat. median
$428
outlier · 20.7×
33210
HCPCS 		Ed-pacemaker Temp Insertion 15 $292.70 $7,921.77 $6,976.19 nat. median
$8,372
0.8× median
J0840
HCPCS 		Crotalidae (crofab) Immune Fab 1gm Vial 15 $1,841.02 $10,745.28 $6,447.17 nat. median
$3,496
1.8× median
81443
HCPCS 		.genetic Testing Inherited Conditions 15 $1,028.40 $7,676.23 $5,551.70 nat. median
$2,449
outlier · 2.3×
81408
HCPCS 		Col1a DNA 15 $840.00 $6,270.00 $5,436.86 nat. median
$2,000
outlier · 2.7×
13160
HCPCS 		Ed-secondary Close Of Surgical Wound; Co 15 $868.42 $5,880.22 $4,326.00 nat. median
$2,668
1.6× median
25260
HCPCS 		Ed-rep Tendon/muscle-flexor/4arm Wrist-p 15 $1,283.95 $5,547.00 $4,001.55 nat. median
$3,426
1.2× median
59409
HCPCS 		Ed-vaginal Delivery Only 15 $1,133.55 $4,978.53 $3,965.50 nat. median
$3,106
1.3× median
J0897
HCPCS 		Denosumab (prolia) 60mg/ml Syringe 15 $24.08 $6,490.47 $3,894.28 nat. median
$86
outlier · 45.3×
10121
HCPCS 		Ed-fb Rem; Subq Tissue Complex 15 $291.73 $5,356.20 $3,893.40 nat. median
$1,652
outlier · 2.4×
36557
HCPCS 		Ed-tunneled Central Venous Cath Under 5 15 $1,609.15 $4,923.53 $3,694.40 nat. median
$5,811
0.6× median
36558
HCPCS 		Ed-central Line Insertion >5 Years 15 $1,584.55 $4,923.53 $3,694.40 nat. median
$3,467
1.1× median
81162
HCPCS 		Brcassure Comprehensive Panel 15 $1,044.06 $7,793.16 $3,639.87 nat. median
$1,880
1.9× median
49405
HCPCS 		Sur Sur Fld Drain Guidance Visceral Orga 15 $1,429.68 $4,763.34 $3,442.78 nat. median
$2,114
1.6× median
49406
HCPCS 		Sur Sur Fld Drain Guidance Retro Peri 15 $1,429.11 $4,763.34 $3,442.78 nat. median
$1,917
1.8× median
J1439
HCPCS 		Ferric Carboxymaltose 750mg/15ml Vial 15 $1.10 $5,727.82 $3,436.69 nat. median
$5
outlier · 683.9×
20525
HCPCS 		Ed-fb Rem; Muscle/tendon Deep 15 $750.92 $4,535.45 $3,280.55 nat. median
$2,969
1.1× median
20102
HCPCS 		Ed-expl Penetrat Wnd Abd/flank Bk-sep Pr 15 $681.40 $4,216.58 $3,064.25 nat. median
$2,172
1.4× median
20101
HCPCS 		Ed-expl Penetrating Wound Chest Sep Proc 15 $550.51 $4,216.58 $3,064.25 nat. median
$2,155
1.4× median
67715
HCPCS 		Ed-canthotomy 15 $485.35 $4,175.74 $3,028.20 nat. median
$2,397
1.3× median
0110
RC 		15 $400.00 $3,373.49 $2,965.00 nat. median
$855
outlier · 3.5×
J3111
HCPCS 		Evenity 105mg/1.17ml Inj Syringe 15 $10.40 $4,637.43 $2,782.46 nat. median
$19
outlier · 146.4×
69005
HCPCS 		Ed-drain Ext Ear Abscess Or Hematoma Com 15 $220.11 $3,776.21 $2,739.80 nat. median
$1,740
1.6× median
69145
HCPCS 		Ed-ex Soft Tissue Lesion Ext Auditory Ca 15 $361.10 $3,475.68 $2,523.50 nat. median
$2,749
0.9× median
27266
HCPCS 		Ed-clsd Tx Hip Dislocation Without Anesthesi 15 $884.07 $3,323.41 $2,415.35 nat. median
$1,864
1.3× median
24605
HCPCS 		Ed-reduction Of Elbow W/anesthesia 15 $679.77 $3,323.41 $2,415.35 nat. median
$1,758
1.4× median
36005
HCPCS 		Sur Venogram 15 $514.98 $3,302.41 $2,397.33 nat. median
$412
outlier · 5.8×
Q0138
HCPCS 		Ferumoxytol (feraheme) 510mg/17ml Vial 15 $0.23 $3,893.75 $2,336.25 nat. median
$6
outlier · 416.4×
81229
HCPCS 		Snp Microarray - Pediatric Reveal 15 $143.24 $3,784.17 $2,270.50 nat. median
$1,230
1.8× median
G0288
HCPCS 		Sur Reconstruct Of Aorta Vasc Surg 15 $331.18 $3,100.30 $2,258.79 nat. median
$173
outlier · 13.0×
93503
HCPCS 		Ed-insertion Of Swan Ganz 15 $167.59 $2,601.59 $2,180.16 nat. median
$2,001
1.1× median
74178
HCPCS 		CT Abd And Pelv Wwo 1 Or Both Regions 15 $390.64 $2,902.03 $2,114.34 nat. median
$539
outlier · 3.9×
74174
HCPCS 		CT Angio Abd Pelv Wwo W Post Proc 15 $508.46 $2,811.90 $2,048.67 nat. median
$549
outlier · 3.7×
J0630
HCPCS 		Calcitonin (miacalcin) 400unit/2ml Vial 15 $800.00 $3,360.00 $2,016.00 nat. median
$1,663
1.2× median
33016
HCPCS 		Ed-pericardiocentesis Including Imaging 15 $432.93 $2,691.36 $1,946.70 nat. median
$1,860
1.0× median
36620
HCPCS 		Arterial Cath Percutaneous 15 $90.42 $2,580.78 $1,874.60 nat. median
$308
outlier · 6.1×
70549
HCPCS 		MRA Neck W And Wo Contrast 15 $786.53 $2,458.61 $1,791.28 nat. median
$606
outlier · 3.0×
70546
HCPCS 		MRA Head W And Wo Contrast 15 $786.53 $2,447.80 $1,783.39 nat. median
$625
outlier · 2.9×
81404
HCPCS 		.beta Thalassemia 15 $115.43 $3,078.67 $1,713.10 nat. median
$322
outlier · 5.3×
32408
HCPCS 		Sur Needle Biopsy Lung 15 $1,016.61 $2,321.55 $1,694.35 nat. median
$1,917
0.9× median
74177
HCPCS 		CT Abd And Pelvis W 15 $309.09 $2,307.20 $1,680.96 nat. median
$501
outlier · 3.4×
11044
HCPCS 		Ed-debride Bone; 1st 20sq Cm 15 $354.44 $2,272.58 $1,658.30 nat. median
$1,716
1.0× median
10005
HCPCS 		Sur Fine Needle Asp W Image Guide LT,Left Side 15 $159.74 $2,255.95 $1,658.30 nat. median
$880
1.9× median
350
OTHER 		CTA Neck W & Without Contrast 1 $1,650.00 $1,650.00 $1,650.00 nat. median
$278
outlier · 5.9×
J1561
HCPCS 		Immune Glob (gamunex-c) 1 Gm/10ml Vial 15 $49.01 $5,487.58 $1,646.27 nat. median
$994
1.7× median
36569
HCPCS 		Ep-insert Picc Line_er_w/o Port/pump Without 13 $976.81 $1,628.02 $1,628.02 nat. median
$1,664
1.0× median
36556
HCPCS 		Ed-inst Non-tunnel Central Ven Cath >5yr 15 $502.34 $1,907.48 $1,628.02 nat. median
$2,885
0.6× median
71552
HCPCS 		MRI Chest W And Wo Contrast 15 $885.73 $2,226.45 $1,622.12 nat. median
$691
outlier · 2.3×
49440
HCPCS 		Obs-percutaneous Placement Of Gastro Tub 15 $962.54 $2,193.31 $1,604.23 nat. median
$2,040
0.8× median

Other procedures at this hospital

Browse this hospital's 1,613 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
             
J3380 HCPCS Vedolizumab (entyvio) 300mg Vial 19 15 $33,584.00 $33,584.00 $20.98 $23,508.80 $14,105.28 2026-09-15
J2997 HCPCS Alteplase (activase) 100mg Kit 49 15 $21,120.88 $21,120.88 $95.09 $29,569.19 $8,870.77 2026-09-15
33210 HCPCS Ed-pacemaker Temp Insertion 18 15 $10,192.64 $10,192.64 $292.70 $7,921.77 $6,976.19 2026-09-15
J0840 HCPCS Crotalidae (crofab) Immune Fab 1gm Vial 19 15 $15,350.40 $15,350.40 $1,841.02 $10,745.28 $6,447.17 2026-09-15
81443 HCPCS .genetic Testing Inherited Conditions 18 15 $7,931.00 $7,931.00 $1,028.40 $7,676.23 $5,551.70 2026-09-15
81408 HCPCS Col1a DNA 18 15 $7,825.32 $7,825.32 $840.00 $6,270.00 $5,436.86 2026-09-15
13160 HCPCS Ed-secondary Close Of Surgical Wound; Co 18 15 $6,180.00 $6,180.00 $868.42 $5,880.22 $4,326.00 2026-09-15
25260 HCPCS Ed-rep Tendon/muscle-flexor/4arm Wrist-p 18 15 $5,716.50 $5,716.50 $1,283.95 $5,547.00 $4,001.55 2026-09-15
59409 HCPCS Ed-vaginal Delivery Only 18 15 $5,665.00 $5,665.00 $1,133.55 $4,978.53 $3,965.50 2026-09-15
J0897 HCPCS Denosumab (prolia) 60mg/ml Syringe 19 15 $9,272.10 $9,272.10 $24.08 $6,490.47 $3,894.28 2026-09-15
10121 HCPCS Ed-fb Rem; Subq Tissue Complex 18 15 $5,562.00 $5,562.00 $291.73 $5,356.20 $3,893.40 2026-09-15
36557 HCPCS Ed-tunneled Central Venous Cath Under 5 18 15 $5,277.72 $5,277.72 $1,609.15 $4,923.53 $3,694.40 2026-09-15
36558 HCPCS Ed-central Line Insertion >5 Years 18 15 $5,277.72 $5,277.72 $1,584.55 $4,923.53 $3,694.40 2026-09-15
81162 HCPCS Brcassure Comprehensive Panel 18 15 $8,666.36 $8,666.36 $1,044.06 $7,793.16 $3,639.87 2026-09-15
49406 HCPCS Sur Sur Fld Drain Guidance Retro Peri 18 15 $4,918.25 $4,918.25 $1,429.11 $4,763.34 $3,442.78 2026-09-15
49405 HCPCS Sur Sur Fld Drain Guidance Visceral Orga 18 15 $4,918.25 $4,918.25 $1,429.68 $4,763.34 $3,442.78 2026-09-15
J1439 HCPCS Ferric Carboxymaltose 750mg/15ml Vial 19 15 $8,182.60 $8,182.60 $1.10 $5,727.82 $3,436.69 2026-09-15
20525 HCPCS Ed-fb Rem; Muscle/tendon Deep 18 15 $4,686.50 $4,686.50 $750.92 $4,535.45 $3,280.55 2026-09-15
20102 HCPCS Ed-expl Penetrat Wnd Abd/flank Bk-sep Pr 18 15 $4,377.50 $4,377.50 $681.40 $4,216.58 $3,064.25 2026-09-15
20101 HCPCS Ed-expl Penetrating Wound Chest Sep Proc 18 15 $4,377.50 $4,377.50 $550.51 $4,216.58 $3,064.25 2026-09-15
67715 HCPCS Ed-canthotomy 18 15 $4,326.00 $4,326.00 $485.35 $4,175.74 $3,028.20 2026-09-15
0110 RC — 31 15 $1,133.00 $1,133.00 $400.00 $3,373.49 $2,965.00 2026-09-15
J3111 HCPCS Evenity 105mg/1.17ml Inj Syringe 19 15 $6,624.90 $6,624.90 $10.40 $4,637.43 $2,782.46 2026-09-15
69005 HCPCS Ed-drain Ext Ear Abscess Or Hematoma Com 18 15 $3,914.00 $3,914.00 $220.11 $3,776.21 $2,739.80 2026-09-15
69145 HCPCS Ed-ex Soft Tissue Lesion Ext Auditory Ca 18 15 $3,605.00 $3,605.00 $361.10 $3,475.68 $2,523.50 2026-09-15
24605 HCPCS Ed-reduction Of Elbow W/anesthesia 18 15 $3,450.50 $3,450.50 $679.77 $3,323.41 $2,415.35 2026-09-15
27266 HCPCS Ed-clsd Tx Hip Dislocation Without Anesthesi 18 15 $3,450.50 $3,450.50 $884.07 $3,323.41 $2,415.35 2026-09-15
36005 HCPCS Sur Venogram 18 15 $3,424.75 $3,424.75 $514.98 $3,302.41 $2,397.33 2026-09-15
Q0138 HCPCS Ferumoxytol (feraheme) 510mg/17ml Vial 19 15 $5,562.50 $5,562.50 $0.23 $3,893.75 $2,336.25 2026-09-15
81229 HCPCS Snp Microarray - Pediatric Reveal 18 15 $5,405.96 $5,405.96 $143.24 $3,784.17 $2,270.50 2026-09-15
G0288 HCPCS Sur Reconstruct Of Aorta Vasc Surg 18 15 $4,429.00 $4,429.00 $331.18 $3,100.30 $2,258.79 2026-09-15
93503 HCPCS Ed-insertion Of Swan Ganz 18 15 $3,716.56 $3,716.56 $167.59 $2,601.59 $2,180.16 2026-09-15
74178 HCPCS CT Abd And Pelv Wwo 1 Or Both Regions 18 15 $4,145.75 $4,145.75 $390.64 $2,902.03 $2,114.34 2026-09-15
74174 HCPCS CT Angio Abd Pelv Wwo W Post Proc 18 15 $4,017.00 $4,017.00 $508.46 $2,811.90 $2,048.67 2026-09-15
J0630 HCPCS Calcitonin (miacalcin) 400unit/2ml Vial 19 15 $4,800.00 $4,800.00 $800.00 $3,360.00 $2,016.00 2026-09-15
33016 HCPCS Ed-pericardiocentesis Including Imaging 18 15 $2,781.00 $2,781.00 $432.93 $2,691.36 $1,946.70 2026-09-15
36620 HCPCS Arterial Cath Percutaneous 18 15 $2,678.00 $2,678.00 $90.42 $2,580.78 $1,874.60 2026-09-15
70549 HCPCS MRA Neck W And Wo Contrast 18 15 $3,512.30 $3,512.30 $786.53 $2,458.61 $1,791.28 2026-09-15
70546 HCPCS MRA Head W And Wo Contrast 18 15 $3,496.85 $3,496.85 $786.53 $2,447.80 $1,783.39 2026-09-15
81404 HCPCS .beta Thalassemia 48 15 $2,734.07 $2,734.07 $115.43 $3,078.67 $1,713.10 2026-09-15
32408 HCPCS Sur Needle Biopsy Lung 18 15 $2,420.50 $2,420.50 $1,016.61 $2,321.55 $1,694.35 2026-09-15
74177 HCPCS CT Abd And Pelvis W 18 15 $3,296.00 $3,296.00 $309.09 $2,307.20 $1,680.96 2026-09-15
10005 HCPCS Sur Fine Needle Asp W Image Guide LT,Left Side 36 15 $2,369.00 $2,369.00 $159.74 $2,255.95 $1,658.30 2026-09-15
11044 HCPCS Ed-debride Bone; 1st 20sq Cm 18 15 $2,369.00 $2,369.00 $354.44 $2,272.58 $1,658.30 2026-09-15
350 OTHER CTA Neck W & Without Contrast 1 1 $2,200.00 $2,200.00 $1,650.00 $1,650.00 $1,650.00 2026-07-18
J1561 HCPCS Immune Glob (gamunex-c) 1 Gm/10ml Vial 49 15 $3,919.70 $3,919.70 $49.01 $5,487.58 $1,646.27 2026-09-15
36569 HCPCS Ep-insert Picc Line_er_w/o Port/pump Without 15 13 $2,325.74 $2,325.74 $976.81 $1,628.02 $1,628.02 2026-09-15
36556 HCPCS Ed-inst Non-tunnel Central Ven Cath >5yr 18 15 $2,325.74 $2,325.74 $502.34 $1,907.48 $1,628.02 2026-09-15
71552 HCPCS MRI Chest W And Wo Contrast 18 15 $3,180.64 $3,180.64 $885.73 $2,226.45 $1,622.12 2026-09-15
49440 HCPCS Obs-percutaneous Placement Of Gastro Tub 18 15 $2,291.75 $2,291.75 $962.54 $2,193.31 $1,604.23 2026-09-15
81223 HCPCS .cftr Sequencing 18 15 $2,734.07 $2,734.07 $209.58 $1,913.85 $1,602.40 2026-09-15
75635 HCPCS CT Angio Abd Aorta Bilat Fem Lower W And 18 15 $3,115.75 $3,115.75 $590.31 $2,181.03 $1,589.03 2026-09-15
81329 HCPCS .smn1 18 15 $3,084.13 $3,084.13 $57.54 $2,158.89 $1,572.90 2026-09-15
81406 HCPCS .galactosemia Galt 18 15 $2,862.37 $2,862.37 $118.81 $2,003.66 $1,459.81 2026-09-15
70548 HCPCS MRA Neck W Contrast 18 15 $2,830.44 $2,830.44 $417.44 $1,981.31 $1,443.52 2026-09-15
41252 HCPCS Ed-lac Tongue Flr Of Mouth Over 2.6cm 18 15 $2,060.00 $2,060.00 $422.19 $1,952.96 $1,442.00 2026-09-15
70545 HCPCS MRA Head W Contrast 18 15 $2,776.88 $2,776.88 $417.44 $1,943.82 $1,416.21 2026-09-15
73720 HCPCS MRI Lower Lt Extremity W And Wo Contrast 18 15 $2,723.32 $2,723.32 $887.15 $1,906.32 $1,388.89 2026-09-15
36589 HCPCS Ed-removal Of Picc Line 18 15 $1,982.75 $1,982.75 $291.94 $1,907.48 $1,387.93 2026-09-15
74183 HCPCS MRI Abdomen W And Wo Contrast 18 15 $2,703.75 $2,703.75 $894.99 $1,892.63 $1,378.91 2026-09-15
73220 HCPCS MRI Upper Lt Extremity W And Wo Contrast 18 15 $2,694.48 $2,694.48 $887.45 $1,886.14 $1,374.18 2026-09-15
72197 HCPCS MRI Pelvis W And Wo Contrast 18 15 $2,694.48 $2,694.48 $894.99 $1,886.14 $1,374.18 2026-09-15
31605 HCPCS Ed-cricothyrotomy; Emergency 18 15 $1,957.00 $1,957.00 $350.63 $1,877.85 $1,369.90 2026-09-15
31603 HCPCS Ed-tracheostomy; Emergency 18 15 $1,957.00 $1,957.00 $425.83 $1,877.85 $1,369.90 2026-09-15
74176 HCPCS CT Abd And Pelvis Wo 18 15 $2,678.00 $2,678.00 $198.03 $1,874.60 $1,365.78 2026-09-15
70482 HCPCS CT Ear In Mid Out W And Wo Contrast 33 15 $2,266.00 $2,266.00 $293.97 $1,586.20 $1,359.60 2026-09-15
70543 HCPCS MRI Orbits Face Neck W And Wo Contrast 18 15 $2,638.86 $2,638.86 $887.45 $1,847.20 $1,345.82 2026-09-15
81263 HCPCS Igvh Somatic Hypermutation 18 15 $2,541.01 $2,541.01 $168.75 $1,778.71 $1,332.25 2026-09-15
81220 HCPCS Cystic Fibrosis Full Gene Carrier Scr 27 15 $3,170.34 $3,170.34 $224.01 $2,219.24 $1,331.54 2026-09-15
74175 HCPCS CT Angio Abdomen W And Wo Contrast 18 15 $2,600.75 $2,600.75 $465.73 $1,820.53 $1,326.38 2026-09-15
71275 HCPCS CT Angio Chest W And Wo Contr 18 15 $2,600.75 $2,600.75 $478.03 $1,820.53 $1,326.38 2026-09-15
70553 HCPCS MRI Brain W And Wo Contrast 18 15 $2,584.27 $2,584.27 $914.47 $1,808.99 $1,317.97 2026-09-15
70552 HCPCS MRI Brain W Contrast 18 15 $2,580.15 $2,580.15 $516.17 $1,806.11 $1,315.88 2026-09-15
71551 HCPCS MRI Chest W Contrast 18 15 $2,580.15 $2,580.15 $507.02 $1,806.11 $1,315.88 2026-09-15
72196 HCPCS MRI Pelvis W Contrast 18 15 $2,559.55 $2,559.55 $507.02 $1,791.69 $1,305.37 2026-09-15
73219 HCPCS MRI Upper Lt Extremity W Contrast 18 15 $2,559.55 $2,559.55 $500.24 $1,791.69 $1,305.37 2026-09-15
72156 HCPCS MRI C Spine W And Wo Contrast 18 15 $2,522.47 $2,522.47 $923.75 $1,765.73 $1,295.57 2026-09-15
72158 HCPCS MRI L Spine W And Wo Contrast 18 15 $2,513.20 $2,513.20 $914.47 $1,759.24 $1,292.79 2026-09-15
73719 HCPCS MRI Lower Lt Extremity W Contrast 18 15 $2,532.77 $2,532.77 $499.94 $1,772.94 $1,291.71 2026-09-15
73723 HCPCS MRI Lower Lt Ext Jnt Ankle W And Wo Con 18 15 $2,508.05 $2,508.05 $887.45 $1,755.64 $1,291.24 2026-09-15
73223 HCPCS MRI Upper Lt Extremity Joint W And Wo Co 18 15 $2,496.72 $2,496.72 $887.45 $1,747.70 $1,287.84 2026-09-15
74182 HCPCS MRI Abdomen W Contrast 18 15 $2,505.99 $2,505.99 $507.02 $1,754.19 $1,278.05 2026-09-15
75774 HCPCS Sp Angio Select Ea Addl Vessel Studied 18 15 $2,494.66 $2,494.66 $265.14 $1,746.26 $1,272.28 2026-09-15
J1670 HCPCS Tetanus Immune Globulin 250unit/ml Syr 19 15 $3,025.25 $3,025.25 $558.12 $2,117.68 $1,270.61 2026-09-15
70542 HCPCS MRI Orbits Face Neck W Contrast 18 15 $2,489.51 $2,489.51 $499.94 $1,742.66 $1,269.65 2026-09-15
73206 HCPCS CT Angio Upper Extrem Lt W And WO,Left Side 36 15 $2,472.00 $2,472.00 $429.31 $1,730.40 $1,260.72 2026-09-15
73706 HCPCS CT Angio Lower Extrem Lt W And WO,Left Side 36 15 $2,472.00 $2,472.00 $433.13 $1,730.40 $1,260.72 2026-09-15
72191 HCPCS CT Angio Pelvis W And Wo Contrast 18 15 $2,472.00 $2,472.00 $462.22 $1,730.40 $1,260.72 2026-09-15
19083 HCPCS US Guid Bx Brst W Loc Dev 1st Les BI,Bilateral Procedure 54 15 $2,000.26 $2,000.26 $828.68 $2,100.27 $1,260.16 2026-09-15
72157 HCPCS MRI T Spine W And Wo Contrast 18 15 $2,302.05 $2,302.05 $923.45 $1,611.44 $1,229.44 2026-09-15
43761 HCPCS Ed-gastrostomy Tube Repositioning 18 15 $1,725.25 $1,725.25 $197.19 $1,667.24 $1,207.68 2026-09-15
70547 HCPCS MRA Neck Wo Contrast 18 15 $2,315.44 $2,315.44 $417.44 $1,620.81 $1,180.87 2026-09-15
70481 HCPCS CT Ear Inner Middle Outer W Contras 33 15 $1,957.00 $1,957.00 $245.14 $1,369.90 $1,174.20 2026-09-15
74185 HCPCS MRA Abdomen Wo Contrast 33 15 $1,676.84 $1,676.84 $444.01 $1,534.29 $1,173.79 2026-09-15
32555 HCPCS Ed-thoracentesis W/tube Insertion 18 15 $1,673.75 $1,673.75 $702.98 $1,605.85 $1,171.63 2026-09-15
20225 HCPCS Sur Sur Needle Biopsy Bone 18 15 $1,673.75 $1,673.75 $702.98 $1,608.50 $1,171.63 2026-09-15
93306 HCPCS Echo 2d-mm With Doppler & Color Flow 18 15 $1,666.95 $1,666.95 $317.37 $1,352.34 $1,165.35 2026-09-15
72142 HCPCS MRI C Spine W Contrast 18 15 $2,284.54 $2,284.54 $522.60 $1,599.18 $1,165.12 2026-09-15
72147 HCPCS MRI T Spine W Contrast 18 15 $2,272.18 $2,272.18 $522.29 $1,590.53 $1,158.82 2026-09-15
72149 HCPCS MRI L Spine W Contrast 18 15 $2,270.12 $2,270.12 $516.48 $1,589.08 $1,157.76 2026-09-15
74170 HCPCS CT Abdomen W And Wo Contrast 18 15 $2,266.00 $2,266.00 $337.34 $1,586.20 $1,155.66 2026-09-15
73702 HCPCS CT Lower Lt Extremity W And Wo CONTRAST,Left Side 36 15 $2,266.00 $2,266.00 $295.18 $1,586.20 $1,155.66 2026-09-15
73202 HCPCS CT Upper Lt Extremity W And Wo CONTR,Left Side 36 15 $2,266.00 $2,266.00 $295.18 $1,586.20 $1,155.66 2026-09-15
71270 HCPCS CT Chest W And Wo Contrast 18 15 $2,266.00 $2,266.00 $348.82 $1,586.20 $1,155.66 2026-09-15
70470 HCPCS CT Head W And Wo Contrast 18 15 $2,266.00 $2,266.00 $286.35 $1,586.20 $1,155.66 2026-09-15
70496 HCPCS CTA Head W And Wo Contrast 18 15 $2,266.00 $2,266.00 $423.12 $1,586.20 $1,155.66 2026-09-15
72127 HCPCS CT C Spine W And Wo Contrast 18 15 $2,266.00 $2,266.00 $344.36 $1,586.20 $1,155.66 2026-09-15
72194 HCPCS CT Pelvis W And Wo Contrast 18 15 $2,266.00 $2,266.00 $329.32 $1,586.20 $1,155.66 2026-09-15
70498 HCPCS CTA Neck W And Wo Contrast 18 15 $2,266.00 $2,266.00 $423.12 $1,586.20 $1,155.66 2026-09-15
72130 HCPCS CT T Spine W And Wo Contrast 18 15 $2,266.00 $2,266.00 $344.36 $1,586.20 $1,155.66 2026-09-15
72133 HCPCS CT L Spine W And Wo Contrast 18 15 $2,266.00 $2,266.00 $344.36 $1,586.20 $1,155.66 2026-09-15
70544 HCPCS MRA Head Wo Contrast 18 15 $2,261.88 $2,261.88 $417.74 $1,583.32 $1,153.56 2026-09-15
13101 HCPCS Ed-lac Complex-trunk-2.6<7.5cm 18 15 $1,622.25 $1,622.25 $392.88 $1,531.83 $1,135.58 2026-09-15
13152 HCPCS Ed-lac Complex-lids Nose Ears Lip-2 6-7 18 15 $1,622.25 $1,622.25 $569.47 $1,531.83 $1,135.58 2026-09-15
J1742 HCPCS Ibutilide (corvert) 1mg/10ml Vial 19 15 $2,687.20 $2,687.20 $298.30 $1,881.04 $1,128.62 2026-09-15
12020 HCPCS Ed-simple Close; Superficial Wound 18 15 $1,596.50 $1,596.50 $300.25 $1,531.83 $1,117.55 2026-09-15
13132 HCPCS Ed-lac Complex-forehead/cheek/chn-2.6<7. 18 15 $1,596.50 $1,596.50 $542.24 $1,531.83 $1,117.55 2026-09-15
99291 HCPCS Ed-critical Care 36 15 $1,596.50 $1,596.50 $309.70 $1,497.69 $1,117.55 2026-09-15
13100 HCPCS Ed-lac Complex-trunk-1.1<2.5cm 18 15 $1,596.50 $1,596.50 $330.71 $1,531.83 $1,117.55 2026-09-15
13151 HCPCS Ed-lac Complex-lids Nose Ear Lip-1 1<2 5 18 15 $1,596.50 $1,596.50 $425.72 $1,531.83 $1,117.55 2026-09-15
24535 HCPCS Ed-clsd Tx Humeral Fx W/wo Ext W/manipul 18 15 $2,178.45 $2,178.45 $686.06 $1,524.92 $1,115.18 2026-09-15
70492 HCPCS CT Neck Soft Tiss W And Wo Contrast 18 15 $2,163.00 $2,163.00 $293.67 $1,514.10 $1,103.13 2026-09-15
70488 HCPCS CT Maxillo Facial Sinus W And Wo Contras 18 15 $2,163.00 $2,163.00 $292.40 $1,514.10 $1,103.13 2026-09-15
49083 HCPCS Sur Paracentesis Abd W Image Guide 18 15 $1,570.75 $1,570.75 $527.39 $1,501.22 $1,099.53 2026-09-15
49082 HCPCS Sur Paracentesis Abd Wo Image Guide 18 15 $1,570.75 $1,570.75 $280.46 $1,501.22 $1,099.53 2026-09-15
49084 HCPCS Sur Peritoneal Lavage W Image Guide 18 15 $1,570.75 $1,570.75 $173.96 $1,501.22 $1,099.53 2026-09-15
81219 HCPCS Calr Mutation Analysis 18 15 $2,141.37 $2,141.37 $69.59 $1,498.96 $1,092.10 2026-09-15
81403 HCPCS Molecular Pathology Procedure Level 4 18 15 $2,141.37 $2,141.37 $77.78 $1,498.96 $1,092.10 2026-09-15
81402 HCPCS Mpl Mutation Analysis 18 15 $2,141.37 $2,141.37 $63.14 $1,498.96 $1,092.10 2026-09-15
73722 HCPCS MRI Lower Lt Ext Jnt Ankle W Contrast 18 15 $2,113.56 $2,113.56 $499.94 $1,479.49 $1,077.92 2026-09-15
75630 HCPCS Sp Angiogram Abdominal W Runoff 18 15 $2,104.29 $2,104.29 $300.78 $1,473.00 $1,073.18 2026-09-15
90675 HCPCS Rabies Vaccine (rabavert) 1ml Kit 18 15 $2,086.15 $2,086.15 $383.38 $1,460.31 $1,063.93 2026-09-15
72146 HCPCS MRI T Spine Wo Contrast 33 15 $1,757.18 $1,757.18 $475.38 $1,230.03 $1,054.31 2026-09-15
70551 HCPCS MRI Brain Wo Contrast 18 15 $2,065.15 $2,065.15 $430.27 $1,445.61 $1,053.22 2026-09-15
71550 HCPCS MRI Chest Wo Contrast 18 15 $2,065.15 $2,065.15 $423.54 $1,445.61 $1,053.22 2026-09-15
50390 HCPCS Sur Asp Inj Renal Pelvis Cyst Ndl 18 15 $1,493.50 $1,493.50 $118.28 $1,446.87 $1,045.45 2026-09-15
50200 HCPCS Sur Needle Biopsy Renal 18 15 $1,493.50 $1,493.50 $176.46 $1,446.87 $1,045.45 2026-09-15
49180 HCPCS Sur Sur Needle Biopsy Retro Peritoneal 18 15 $1,493.50 $1,493.50 $288.74 $1,446.87 $1,045.45 2026-09-15
48102 HCPCS Sur Needle Biopsy Pancreas 18 15 $1,493.50 $1,493.50 $627.27 $1,446.87 $1,045.45 2026-09-15
47000 HCPCS Sur Needle Biopsy Liver 18 15 $1,493.50 $1,493.50 $298.71 $1,446.87 $1,045.45 2026-09-15
73222 HCPCS MRI Upper Lt Extremity Joint W Contrast 18 15 $2,044.55 $2,044.55 $499.94 $1,431.19 $1,042.72 2026-09-15
73218 HCPCS MRI Upper Lt Extremity Wo Contrast 18 15 $2,044.55 $2,044.55 $416.47 $1,431.19 $1,042.72 2026-09-15
72195 HCPCS MRI Pelvis Without Contrast 18 15 $2,044.55 $2,044.55 $423.54 $1,431.19 $1,042.72 2026-09-15
73718 HCPCS MRI Lower Lt Extremity Wo Contrast 18 15 $2,017.77 $2,017.77 $416.47 $1,412.44 $1,029.06 2026-09-15
81226 HCPCS Cytochrome P450 2d6 Genotyping 18 15 $1,467.75 $1,467.75 $189.67 $1,413.60 $1,027.43 2026-09-15
75600 HCPCS Sp Angiogram Thoracic 18 15 $1,998.61 $1,998.61 $432.59 $1,399.03 $1,019.30 2026-09-15
73721 HCPCS MRI Lower Lt Ext Jnt Ankle Wo Contras 18 15 $1,985.84 $1,985.84 $416.47 $1,390.09 $1,012.77 2026-09-15
32400 HCPCS Sur Needle Biopsy Pleura 18 15 $1,442.00 $1,442.00 $263.91 $1,391.21 $1,009.40 2026-09-15
70540 HCPCS MRI Orbits Face Neck Wo Contrast 18 15 $1,974.51 $1,974.51 $416.47 $1,382.16 $1,007.00 2026-09-15
72132 HCPCS CT L Spine W Contrast 18 15 $1,957.00 $1,957.00 $283.74 $1,369.90 $998.07 2026-09-15
70460 HCPCS CT Head W Contrast 18 15 $1,957.00 $1,957.00 $234.26 $1,369.90 $998.07 2026-09-15
73201 HCPCS CT Upper Lt Extremity W CONTRAST,Left Side 36 15 $1,957.00 $1,957.00 $243.53 $1,369.90 $998.07 2026-09-15
73701 HCPCS CT Lower Lt Extremity W CONTRAST,Left Side 36 15 $1,957.00 $1,957.00 $243.53 $1,369.90 $998.07 2026-09-15
72126 HCPCS CT C Spine W Contrast 18 15 $1,957.00 $1,957.00 $283.74 $1,369.90 $998.07 2026-09-15
71260 HCPCS CT Chest W Contrast 18 15 $1,957.00 $1,957.00 $284.69 $1,369.90 $998.07 2026-09-15
72193 HCPCS CT Pelvis W Contrast 18 15 $1,957.00 $1,957.00 $273.80 $1,369.90 $998.07 2026-09-15
72129 HCPCS CT T Spine W Contrast 18 15 $1,957.00 $1,957.00 $283.74 $1,369.90 $998.07 2026-09-15
81479 HCPCS .crtc Sequencing 47 14 $1,640.79 $1,640.79 $90.82 $1,913.85 $984.47 2026-09-15
73221 HCPCS MRI Upper Lt Extremity Joint Wo Contras 18 15 $1,930.22 $1,930.22 $416.47 $1,351.15 $984.41 2026-09-15
12021 HCPCS Ed-simple Close; Superficial Wound W/pac 18 15 $1,648.00 $1,648.00 $175.48 $1,153.60 $984.03 2026-09-15
27825 HCPCS Ed-clsd Tx/fx Distal Tibia W/wo Anes W/t 18 15 $1,928.16 $1,928.16 $686.06 $1,349.71 $983.37 2026-09-15
90371 HCPCS Hep B Immune Glob 220units/ml Vial 5ml 18 15 $1,920.60 $1,920.60 $149.47 $1,344.42 $979.50 2026-09-15
36245 HCPCS Sur Angio Arch 18 15 $1,390.50 $1,390.50 $584.01 $2,210.74 $973.35 2026-09-15
36216 HCPCS Sur Angio Carotid Cereb 18 15 $1,390.50 $1,390.50 $584.01 $2,070.12 $973.35 2026-09-15
36215 HCPCS Sur Angio Carotids 18 15 $1,390.50 $1,390.50 $584.01 $1,908.93 $973.35 2026-09-15
J1745 HCPCS inFLIXimab (remicade) 100mg Vial 19 15 $2,280.00 $2,280.00 $31.04 $1,596.00 $957.60 2026-09-15
70491 HCPCS CT Neck Soft Tiss W Contrast 18 15 $1,854.00 $1,854.00 $245.14 $1,297.80 $945.54 2026-09-15
70487 HCPCS CT Maxillo Facial Sinus W Contrast 18 15 $1,854.00 $1,854.00 $241.95 $1,297.80 $945.54 2026-09-15
74160 HCPCS CT Abdomen W Contrast 18 15 $1,854.00 $1,854.00 $278.95 $1,297.80 $945.54 2026-09-15
90684 HCPCS Pneumococcal Vacc (pcv21) 0.5ml Syringe 18 15 $1,450.10 $1,450.10 $362.37 $1,015.07 $942.57 2026-09-15
32551 HCPCS Ed-thoracostomy Tube W Or Without Water Seal 18 15 $1,339.00 $1,339.00 $305.75 $1,290.32 $937.30 2026-09-15
92960 HCPCS Ed-cardioversion External 18 15 $1,339.00 $1,339.00 $367.73 $1,274.34 $937.30 2026-09-15
25505 HCPCS Ed-clsd Tx Radial Shaft Fx W/manipulatio 18 15 $1,744.82 $1,744.82 $686.06 $1,221.37 $922.04 2026-09-15
74181 HCPCS MRI Abdomen Wo Contrast 18 15 $1,768.51 $1,768.51 $423.54 $1,237.96 $901.94 2026-09-15
72148 HCPCS MRI L Spine Wo Contrast 18 15 $1,755.12 $1,755.12 $470.29 $1,228.58 $895.11 2026-09-15
72141 HCPCS MRI C Spine Wo Contrast 18 15 $1,755.12 $1,755.12 $435.35 $1,228.58 $895.11 2026-09-15
12037 HCPCS Ed-lac Interm-scalp/axillae/trnk-over 30 18 15 $1,287.50 $1,287.50 $510.71 $979.26 $872.00 2026-09-15
70480 HCPCS CT Ear Inner Mid Outer Wo Contrast 33 15 $1,442.00 $1,442.00 $210.12 $1,009.40 $865.20 2026-09-15
20100 HCPCS Ed-expl Penetrating Wound Neck Sep Proce 18 15 $1,236.00 $1,236.00 $519.12 $1,104.49 $865.20 2026-09-15
70336 HCPCS MRI Tmj 18 15 $1,675.81 $1,675.81 $430.27 $1,173.07 $854.66 2026-09-15
12036 HCPCS Ed-lac Interm-scalp/axillae/trnk-20.1<30 18 15 $1,236.00 $1,236.00 $453.30 $979.26 $853.98 2026-09-15
J2760 HCPCS Phentolamine 5mg Vial 19 15 $2,015.05 $2,015.05 $257.45 $1,410.54 $846.32 2026-09-15
81243 HCPCS .fragile X Chromosome 18 15 $1,640.79 $1,640.79 $23.96 $1,148.55 $836.80 2026-09-15
12057 HCPCS Ed-lac Interim-face/ear/nos/lip-over 30. 18 15 $1,184.50 $1,184.50 $497.49 $979.26 $829.15 2026-09-15
12035 HCPCS Ed-lac Interm-scalp/axillae/trnk-12.6<20 18 15 $1,184.50 $1,184.50 $400.91 $979.26 $829.15 2026-09-15
611 OTHER MRI-brain Without Contrast 8 5 $2,005.00 $2,005.00 $427.73 $1,485.96 $825.82 2026-07-18
12056 HCPCS Ed-lac Interim-face/ear/nos/lip-20.1<30. 18 15 $1,158.75 $1,158.75 $486.68 $979.26 $811.13 2026-09-15
610 OTHER MRI-lower Lt Ext Jnt-ankle- Without Contras 4 3 $1,901.00 $1,901.00 $588.25 $1,040.48 $808.59 2026-07-18
12055 HCPCS Ed-lac Interim-face/ear/nos/lip-12.6<20. 18 15 $1,133.00 $1,133.00 $418.67 $979.26 $793.10 2026-09-15
99292 HCPCS Ed-critical Care; Ea Add'l 30 Min 36 15 $1,133.00 $1,133.00 $138.26 $1,029.75 $793.10 2026-09-15
12047 HCPCS Ed-lac Interm-neck/hands/feet-over 30.0c 18 15 $1,133.00 $1,133.00 $475.86 $979.26 $793.10 2026-09-15
72192 HCPCS CT Cystogram 33 15 $1,133.00 $1,133.00 $240.67 $1,009.40 $793.10 2026-09-15
12034 HCPCS Ed-lac Interm-scalp/axillae/trnk-7.6<12. 18 15 $1,133.00 $1,133.00 $284.06 $979.26 $793.10 2026-09-15
12046 HCPCS Ed-lac Interm-neck/hands/feet-20.1<30.0c 18 15 $1,107.25 $1,107.25 $465.05 $979.26 $775.08 2026-09-15
93224 HCPCS Holter Monitor Rec/scan/analysis/terp 18 15 $1,106.96 $1,106.96 $186.99 $919.88 $774.87 2026-09-15
38505 HCPCS Sur Needle Bx Lymph Node Superficial 18 15 $1,143.30 $1,143.30 $229.32 $830.40 $757.47 2026-09-15
12032 HCPCS Ed-lac Interm-scalp/axillae/trunk-2.6<7. 18 15 $1,081.50 $1,081.50 $286.67 $979.26 $757.05 2026-09-15
13121 HCPCS Ed-lac Complex-scalp Arms Legs-2 6<7 5cm 18 15 $1,081.50 $1,081.50 $419.15 $979.26 $757.05 2026-09-15
12053 HCPCS Ed-lac Interim-face/ears/nose/lip-5.1<7. 18 15 $1,081.50 $1,081.50 $294.23 $979.26 $757.05 2026-09-15
12045 HCPCS Ed-lac Interm-neck/hands/feet-12.6<20.0c 18 15 $1,081.50 $1,081.50 $414.55 $979.26 $757.05 2026-09-15
12052 HCPCS Ed-lac Interim-face/ears/nose/lips-2.5<5 18 15 $1,055.75 $1,055.75 $274.19 $979.26 $739.03 2026-09-15
12044 HCPCS Ed-lac Interm-neck/hands/feet-7.6<12.5cm 18 15 $1,055.75 $1,055.75 $296.03 $979.26 $739.03 2026-09-15
77012 HCPCS CT Guided For Needle Placement 18 15 $1,442.00 $1,442.00 $193.84 $1,009.40 $735.42 2026-09-15
70450 HCPCS CT Head Wo Contrast 18 15 $1,442.00 $1,442.00 $191.23 $1,009.40 $735.42 2026-09-15
73200 HCPCS CT Upper Lt Extremity Wo CONTRAST,Left Side 36 15 $1,442.00 $1,442.00 $209.10 $1,009.40 $735.42 2026-09-15
72131 HCPCS CT L Spine Trauma Reformatted From Abdom 18 15 $1,442.00 $1,442.00 $243.53 $1,009.40 $735.42 2026-09-15
72128 HCPCS CT T Spine Trauma Reformatted From Chest 18 15 $1,442.00 $1,442.00 $243.53 $1,009.40 $735.42 2026-09-15
72125 HCPCS CT C Spine Wo Contrast 18 15 $1,442.00 $1,442.00 $243.53 $1,009.40 $735.42 2026-09-15
71271 HCPCS CT Low Dose Lung Screening Wo Contrast 18 15 $1,442.00 $1,442.00 $135.84 $1,009.40 $735.42 2026-09-15
71250 HCPCS CT Chest Wo Contrast 18 15 $1,442.00 $1,442.00 $243.53 $1,009.40 $735.42 2026-09-15
73700 HCPCS CT Lower Lt Extremity Wo CONTRAST,Left Side 36 15 $1,442.00 $1,442.00 $209.10 $1,009.40 $735.42 2026-09-15
90677 HCPCS Pneumococcal Vacc (pcv20) 0.5ml Syringe 18 15 $1,436.50 $1,436.50 $312.09 $1,005.55 $732.62 2026-09-15
19285 HCPCS Sur US Guide Brst Loc Dev 1st Lesion BI,Bilateral Procedure 54 15 $1,159.78 $1,159.78 $329.26 $1,217.05 $730.23 2026-09-15
81257 HCPCS .alpha Thalassemia DNA Mutation Analysis 18 15 $1,427.58 $1,427.58 $42.95 $999.31 $728.07 2026-09-15
12031 HCPCS Ed-lac Interm-scalp/axillae/trunk-<2.5cm 18 15 $1,030.00 $1,030.00 $205.55 $979.26 $721.00 2026-09-15
13153 HCPCS Ed-lac Complex-lid Nose Ear Lip-ea Addl 18 15 $1,030.00 $1,030.00 $204.76 $979.26 $721.00 2026-09-15
13133 HCPCS Ed-lac Complex-forehd/cheek/chn-ea Addl 18 15 $1,030.00 $1,030.00 $180.80 $979.26 $721.00 2026-09-15
11750 HCPCS Ed-excision Of Nail Part/complete Perman 18 15 $1,030.00 $1,030.00 $189.92 $961.27 $721.00 2026-09-15
13131 HCPCS Ed-lac Complex-forehead/cheek/chn-1.1<2. 18 15 $1,030.00 $1,030.00 $374.06 $979.26 $721.00 2026-09-15
12018 HCPCS Ed-lac Simple-face/ears/nose/lip-over 30 18 15 $1,030.00 $1,030.00 $383.10 $979.26 $721.00 2026-09-15
13120 HCPCS Ed-lac Complex-scalp Arms Legs-1 1<2 5cm 18 15 $1,030.00 $1,030.00 $342.77 $979.26 $721.00 2026-09-15
13102 HCPCS Ed-lac Complex-trunk-ea Add'l 5cm Or Les 18 15 $1,030.00 $1,030.00 $113.81 $979.26 $721.00 2026-09-15
12051 HCPCS Ed-lac Interm-face/ears/nose/lips-<2.5cm 18 15 $1,030.00 $1,030.00 $264.32 $979.26 $721.00 2026-09-15
12042 HCPCS Ed-lac Interm-neck/hands/feet-2.5<7.5cm 18 15 $1,030.00 $1,030.00 $274.54 $979.26 $721.00 2026-09-15
20520 HCPCS Ed-fb Removal-muscle/tendon Sheath-simpl 33 15 $1,708.77 $1,708.77 $285.88 $1,196.14 $717.68 2026-09-15
28190 HCPCS Ed-fb Removal-foot Subcutaneous 18 15 $1,004.25 $1,004.25 $319.74 $961.27 $702.98 2026-09-15
24200 HCPCS Ed-fb Rem; Upper Arm/elbow Subq 18 15 $1,004.25 $1,004.25 $307.69 $961.27 $702.98 2026-09-15
615 OTHER MRA-head Without Contrast 1 1 $2,196.00 $2,196.00 $702.72 $702.72 $702.72 2026-07-18
70490 HCPCS CT Neck Soft Tiss Wo Contrast 18 15 $1,339.00 $1,339.00 $210.12 $937.30 $682.89 2026-09-15
70486 HCPCS CT Maxillo Facial Sinus Wo Contrast 18 15 $1,339.00 $1,339.00 $203.70 $937.30 $682.89 2026-09-15
74150 HCPCS CT Abd Wo Contrast 18 15 $1,339.00 $1,339.00 $236.80 $937.30 $682.89 2026-09-15
612 OTHER MRI-c-spine Without Contrast 10 3 $1,704.00 $1,704.00 $430.70 $1,010.38 $668.63 2026-07-18
43762 HCPCS Ed-change Gastrostomy Tube Percu Without Ima 18 15 $952.75 $952.75 $363.79 $901.15 $666.93 2026-09-15
10061 HCPCS Ed-i&d-abcess-complicated Or Multiple 18 15 $927.00 $927.00 $202.03 $888.89 $648.90 2026-09-15
10120 HCPCS Ed-fb Rem Subq Tissue Simple 18 15 $927.00 $927.00 $155.80 $878.30 $648.90 2026-09-15
11043 HCPCS Ed-debride Muscle &/or Fascia; 1st 20sq 18 15 $927.00 $927.00 $271.50 $816.37 $648.90 2026-09-15
86152 HCPCS .circulating Tumor Cells Breast 18 15 $1,250.42 $1,250.42 $34.29 $875.29 $637.71 2026-09-15
81170 HCPCS .bcr-abl1 Kinase Domain Mutation 18 15 $2,005.41 $2,005.41 $138.39 $1,403.79 $636.44 2026-09-15
J1442 HCPCS Filgrastim (neupogen) 300mcg/ml Vial 19 15 $1,511.20 $1,511.20 $0.30 $1,057.84 $634.70 2026-09-15
352 OTHER CT Abd & Pelvis Without 47 6 $1,900.00 $1,900.00 $168.39 $2,850.94 $631.28 2026-07-18
36440 HCPCS Ed-transfusion; Blood <2yrs 18 15 $901.25 $901.25 $88.73 $843.94 $630.88 2026-09-15
19084 HCPCS Sur Guide Bx Brst W Loc Dev Addt Lesion 18 15 $1,000.13 $1,000.13 $1.42 $700.09 $629.51 2026-09-15
351 OTHER CT Head Without Contrast 19 6 $1,400.00 $1,400.00 $191.22 $1,350.00 $624.00 2026-07-18
11042 HCPCS Ed-debride Skin &subq Tissue; 1st 20 Sq 18 15 $875.50 $875.50 $99.74 $816.37 $612.85 2026-09-15
29345 HCPCS Ed-appl; Cast-long Leg 18 15 $875.50 $875.50 $197.60 $736.51 $612.85 2026-09-15
M0239 HCPCS Op- IV Infusion Bamlanivimab-xxxx 17 14 $875.50 $875.50 $367.71 $612.85 $612.85 2026-09-15
11045 HCPCS Ed-debridement Subq; Ea Add'l 20 Sq Cm 18 15 $875.50 $875.50 $40.76 $816.37 $612.85 2026-09-15
20206 HCPCS Sur Needle Biopsy Muscle 18 15 $875.50 $875.50 $367.71 $830.40 $612.85 2026-09-15
36430 HCPCS Ed-transfusion Blood Or Blood Components 18 15 $875.50 $875.50 $64.00 $843.94 $612.85 2026-09-15
99285 HCPCS Ed-acuity Level V 36 15 $875.50 $875.50 $186.15 $704.68 $609.65 2026-09-15
27830 HCPCS Ed-prox Tibiofib Joint Disloc Close Without 18 15 $1,175.23 $1,175.23 $343.03 $822.66 $604.99 2026-09-15
Q4101 HCPCS Apligraf 19 15 $1,387.20 $1,387.20 $33.56 $971.04 $582.62 2026-09-15
29405 HCPCS Ed-appl; Cast-short Leg 18 15 $824.00 $824.00 $128.24 $736.51 $576.80 2026-09-15
29065 HCPCS Ed-appl; Cast-long Arm 18 15 $824.00 $824.00 $135.65 $736.51 $576.80 2026-09-15
62322 HCPCS Ed-injection(s) Lumbar Or Sacral 18 15 $824.00 $824.00 $245.71 $797.15 $576.80 2026-09-15
28899 HCPCS Sur Biopsy Foot Ndl Core W Imaging LT,Left Side 17 14 $824.00 $824.00 $346.08 $797.18 $576.80 2026-09-15
28475 HCPCS Ed-closed Fx/tx-metatarsal W/manip Each 18 15 $824.00 $824.00 $346.08 $797.18 $576.80 2026-09-15
93307 HCPCS Echo 2d-mm (bubble) Without Doppler & Clr Fl 18 15 $901.77 $901.77 $230.81 $631.24 $566.80 2026-09-15
12054 HCPCS Ed-lac Interim-face/ear/nose/lip-7.6<12. 18 15 $1,107.25 $1,107.25 $287.37 $775.08 $564.70 2026-09-15
J3101 HCPCS Tenecteplase (TNKase) 25mg Kit (mg) 34 15 $1,593.07 $1,593.07 $158.26 $1,115.15 $557.59 2026-09-15
76377 HCPCS CT 3d Render With Image Post Process 33 15 $927.00 $927.00 $96.29 $648.90 $556.20 2026-09-15
84393 HCPCS Ptau-181, Plasma 35 15 $783.11 $783.11 $54.15 $593.82 $548.18 2026-09-15
87902 HCPCS Hcv Genotyping Non Reflex 18 15 $1,460.54 $1,460.54 $151.07 $1,022.38 $547.64 2026-09-15
19281 HCPCS Sur Mammo Guide Brst Loc Dev 1st Les BI,Bilateral Procedure 54 15 $866.23 $866.23 $302.21 $909.90 $545.94 2026-09-15
29075 HCPCS Ed-appl; Cast-short Arm 18 15 $772.50 $772.50 $124.47 $736.51 $540.75 2026-09-15
93930 HCPCS Pr US Upper Extremity Bilateral Art 15 13 $772.50 $772.50 $324.45 $540.75 $540.75 2026-09-15
Q5106 HCPCS Epoetin Alfa-epbx 10,000unit/ml Vial 48 15 $1,058.90 $1,058.90 $7.88 $1,518.90 $540.04 2026-09-15
81270 HCPCS Jak2 Mutation Analysis Qual 18 15 $1,034.12 $1,034.12 $52.53 $723.88 $527.40 2026-09-15
M0222 HCPCS Op- IV Push Bebtelovimab 17 14 $875.50 $875.50 $30.34 $612.85 $525.30 2026-09-15
M0247 HCPCS Op- IV Infusion Sotrovimab 17 14 $875.50 $875.50 $310.75 $612.85 $525.30 2026-09-15
M0243 HCPCS Op- IV Infusion Casirivimab And Imdevima 17 14 $875.50 $875.50 $310.75 $612.85 $525.30 2026-09-15
M0245 HCPCS Op- IV Infusion Bamlanivimab And Etesevi 17 14 $875.50 $875.50 $310.75 $612.85 $525.30 2026-09-15
99284 HCPCS Ed-acuity Level IV 36 15 $746.75 $746.75 $118.75 $704.68 $522.73 2026-09-15
89322 HCPCS Semen Analysis 18 15 $1,024.94 $1,024.94 $12.99 $717.46 $522.72 2026-09-15
J1740 HCPCS Ibandronate (boniva) 3mg/3ml Syringe 19 15 $1,200.00 $1,200.00 $9.06 $840.00 $504.00 2026-09-15
92950 HCPCS Cpr 36 15 $721.00 $721.00 $302.82 $569.65 $497.47 2026-09-15
J0561 HCPCS Penicillin G Benzathine 0.6mu/ml IM Susp 34 15 $698.60 $698.60 $18.40 $1,365.00 $489.02 2026-09-15
83884 HCPCS Neurofilament Light Chain, Plasma 18 15 $752.23 $752.23 $48.82 $526.56 $488.95 2026-09-15
92614 HCPCS St Sensory Testing Endoscopy STUDY,Service Was Delivered Under An Outpatient Spe… 18 15 $695.25 $695.25 $138.11 $620.24 $486.68 2026-09-15
88248 HCPCS .chromosome Analysis Fragile X 18 15 $1,460.54 $1,460.54 $145.18 $1,022.38 $484.33 2026-09-15
93970 HCPCS Pr US Legs Bilateral VENOUS,Professional Component 18 15 $772.50 $772.50 $232.15 $540.75 $470.02 2026-09-15
93925 HCPCS Pr US Lower Extremity Bilat ARTERIAL,Professional Component 18 15 $772.50 $772.50 $279.78 $540.75 $470.02 2026-09-15
P9035 HCPCS .bb Platelets Pheresis Leuko REDUCED,Special Acquisition Of Blood And Blood Prod… 32 14 $1,110.34 $1,110.34 $54.08 $1,530.79 $466.34 2026-09-15
88374 HCPCS .insitu Hybridization Multi Plex Probe 18 15 $1,435.27 $1,435.27 $124.30 $1,004.69 $463.43 2026-09-15
87507 HCPCS Gi Profile Pcr Stool 18 15 $1,084.59 $1,084.59 $238.22 $759.21 $455.53 2026-09-15
94002 HCPCS Ed-vent Assist/manage 1st Day 33 15 $643.75 $643.75 $83.01 $540.75 $450.63 2026-09-15
93975 HCPCS Pr US Visceral Doppler STUDIES,Professional Component 18 15 $695.25 $695.25 $292.01 $486.68 $446.85 2026-09-15
76998 HCPCS US Guidance Intraoperative 18 15 $875.50 $875.50 $138.65 $612.85 $446.50 2026-09-15
87799 HCPCS .bk Virus DNA Pcr Urine 36 15 $1,249.53 $1,249.53 $13.55 $946.48 $443.37 2026-09-15
88237 HCPCS .bm Culture For Neoplastic Disorders 27 15 $1,052.66 $1,052.66 $53.57 $1,081.50 $442.12 2026-09-15
62270 HCPCS Ed-spinal Puncture Lumbar Diagnostic 18 15 $775.59 $775.59 $231.17 $542.91 $440.58 2026-09-15
93880 HCPCS Pr US Carotid Complete And BILATERAL,Professional Component 18 15 $669.50 $669.50 $237.00 $476.55 $439.38 2026-09-15
87517 HCPCS Hbv DNA Realtime Pcr 18 15 $1,882.66 $1,882.66 $25.14 $1,317.86 $436.36 2026-09-15
88189 HCPCS .flowcytometry Interp 16+ Markers 18 15 $852.84 $852.84 $67.11 $596.99 $434.94 2026-09-15
94003 HCPCS Vent Daily 18 15 $747.78 $747.78 $60.45 $523.45 $433.38 2026-09-15
92953 HCPCS Ed-temp Transcutaneous Pacing 18 15 $618.00 $618.00 $14.14 $569.65 $432.60 2026-09-15
72265 HCPCS Sp Myelogram L S 18 15 $838.01 $838.01 $160.70 $586.61 $427.38 2026-09-15
93976 HCPCS Pr US Portal Vein Lmt Doppler Visc ORG,Professional Component 18 15 $618.00 $618.00 $214.50 $476.55 $421.36 2026-09-15
76376 HCPCS CT 3d Render No Image Post Process 18 15 $824.00 $824.00 $106.29 $576.80 $420.24 2026-09-15
77078 HCPCS CT Spine Density 18 15 $824.00 $824.00 $117.72 $576.80 $420.24 2026-09-15
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