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

NORTH SHORE HEALTH

Grand Marais, MN · CCN 241317 · Rates published

4,381 distinct procedures filed
8 distinct payers
84,708 rate rows
2026-05-08 last MRF observed
Data quality

83,900 of 84,708 rate rows are consumer-grade (99.0%)

808 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 720
per-diem day rate — not a per-procedure price 49
exceeds 10× this hospital's gross charge — excluded from medians 39
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.northshorehealthgm.org/Data/Sites/43/media/patients-and-visitors/41647880_north-shore-health_standardcharges.csv
Found on page https://www.northshorehealthgm.org/pricing-transparency
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-20
Content fingerprint 7d41eb2dac233a40… · 8,068,451 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
6363007
OTHER 		Neulasta 6mg 8 $3,769.83 $3,769.83 $3,769.83 nat. median
$3,770
1.0× median
6361000
OTHER 		Rituxan Per 100 Mg 8 $3,325.28 $3,325.28 $3,325.28 nat. median
$147
outlier · 22.6×
3009957
OTHER 		Paraneoplastic Neoencephalitis 8 $3,288.51 $3,288.51 $3,288.51 nat. median
$4
outlier · 903.4×
1220001
OTHER 		Birthing/labor Room 8 $1,044.73 $4,137.57 $2,591.15 nat. median
$2,591
1.0× median
4505053
OTHER 		Central Line Placement 8 $2,558.18 $2,558.18 $2,558.18 nat. median
$2,558
1.0× median
1200000
OTHER 		Ip R&b Semiprivate 8 $929.16 $4,106.48 $2,517.82 nat. median
$929
outlier · 2.7×
7501045
OTHER 		Colonoscopy W/snare Polypectom 8 $2,515.22 $2,515.22 $2,515.22 nat. median
$2,515
1.0× median
5405014
OTHER 		Specialty Rn/dr Diag/hosp 8 $2,511.68 $2,511.68 $2,511.68 nat. median
$2,512
1.0× median
6102006
OTHER 		Mr Chest W & W/out Contrast 8 $2,170.47 $2,170.47 $2,170.47 nat. median
$2,170
1.0× median
3519862
OTHER 		CTA Abd/pel W/wo Contrast 8 $2,159.93 $2,159.93 $2,159.93 nat. median
$2,160
1.0× median
6102028
OTHER 		MRA Neck/carotids W & W/out 8 $2,148.70 $2,148.70 $2,148.70 nat. median
$2,149
1.0× median
6101009
OTHER 		MRA Neck W & Without Contrast 8 $2,148.70 $2,148.70 $2,148.70 nat. median
$2,149
1.0× median
3514789
OTHER 		CTA Low Ext With Contrast 8 $2,028.11 $2,028.11 $2,028.11 nat. median
$2,028
1.0× median
7501025
OTHER 		Colonoscopy W/control Bleeding 8 $2,019.72 $2,019.72 $2,019.72 nat. median
$2,020
1.0× median
3504174
OTHER 		CTA Abd/pel W Contrast 8 $2,011.12 $2,011.12 $2,011.12 nat. median
$2,011
1.0× median
4506120
OTHER 		Late Closure Of Wound 8 $2,011.06 $2,011.06 $2,011.06 nat. median
$2,011
1.0× median
7501020
OTHER 		Colonoscopy W/submucosal Inj 8 $1,986.15 $1,986.15 $1,986.15 nat. median
$1,986
1.0× median
3104150
OTHER 		Mds Syndrome Panel 8 $1,954.85 $1,954.85 $1,954.85 nat. median
$1,955
1.0× median
5405060
OTHER 		Als 2 Hosp/hosp 8 $1,953.54 $1,953.54 $1,953.54 nat. median
$1,954
1.0× median
5405055
OTHER 		Als 2 Res/hosp 8 $1,953.54 $1,953.54 $1,953.54 nat. median
$1,954
1.0× median
5405050
OTHER 		Als 2 Scene/hosp 8 $1,953.54 $1,953.54 $1,953.54 nat. median
$1,954
1.0× median
4505220
OTHER 		Thoracotomy, Traum Hemm 8 $1,952.22 $1,952.22 $1,952.22 nat. median
$1,168
1.7× median
7501015
OTHER 		Colonoscopy With Biopsy 8 $1,948.71 $1,948.71 $1,948.71 nat. median
$1,949
1.0× median
6101036
OTHER 		Mr Up Ext Nonjoint Lt W&w/out 8 $1,911.76 $1,911.76 $1,911.76 nat. median
$1,912
1.0× median
6101035
OTHER 		Mr Up Ext Nonjoint Rt W&w/out 8 $1,911.76 $1,911.76 $1,911.76 nat. median
$1,912
1.0× median
6102012
OTHER 		Mr Abdomen W & W/out 8 $1,885.14 $1,885.14 $1,885.14 nat. median
$1,885
1.0× median
6102036
OTHER 		Mr Abd/renal With Abd/kidney 8 $1,885.14 $1,885.14 $1,885.14 nat. median
$1,885
1.0× median
6102021
OTHER 		Mr Abdomen/mrcp W & W/out 8 $1,885.14 $1,885.14 $1,885.14 nat. median
$1,885
1.0× median
6102024
OTHER 		Mr Pelvis W & W/out Contrast 8 $1,881.13 $1,881.13 $1,881.13 nat. median
$1,881
1.0× median
6101047
OTHER 		Mr Low Ext Nonjoint Rt W&w/out 8 $1,878.41 $1,878.41 $1,878.41 nat. median
$1,878
1.0× median
6101048
OTHER 		Mr Low Ext Nonjoint Lt W&w/ou 8 $1,878.41 $1,878.41 $1,878.41 nat. median
$1,878
1.0× median
4509500
OTHER 		Delivery-vaginal 8 $1,876.95 $1,876.95 $1,876.95 nat. median
$1,877
1.0× median
6102009
OTHER 		Mr Brachial Plexus W & W/out 8 $1,854.42 $1,854.42 $1,854.42 nat. median
$1,854
1.0× median
6101014
OTHER 		Mr Orbits/face/neck W&w/out 8 $1,854.42 $1,854.42 $1,854.42 nat. median
$1,854
1.0× median
6101019
OTHER 		Mr Cervical Spine W & W/out 8 $1,834.64 $1,834.64 $1,834.64 nat. median
$1,835
1.0× median
6101005
OTHER 		Mr Brain W&w/0 Cont & MRA 8 $1,834.64 $1,834.64 $1,834.64 nat. median
$1,835
1.0× median
6101001
OTHER 		Mr Brain W & Without Contrast 8 $1,834.64 $1,834.64 $1,834.64 nat. median
$1,506
1.2× median
6101016
OTHER 		Mr Neck & Brain 8 $1,834.64 $1,834.64 $1,834.64 nat. median
$1,835
1.0× median
6101011
OTHER 		Mr Iac W & W/out Contrast 8 $1,834.64 $1,834.64 $1,834.64 nat. median
$1,835
1.0× median
7501000
OTHER 		Colonoscopy 8 $1,831.03 $1,831.03 $1,831.03 nat. median
$1,831
1.0× median
3528210
OTHER 		Abdomen/pelvis W & Without Contras 8 $1,829.14 $1,829.14 $1,829.14 nat. median
$1,829
1.0× median
6101029
OTHER 		Mr Upper Ext Joint Rt W&w/out 8 $1,814.51 $1,814.51 $1,814.51 nat. median
$1,815
1.0× median
6101030
OTHER 		Mr Upper Ext Joint Lt W&w/out 8 $1,814.51 $1,814.51 $1,814.51 nat. median
$1,815
1.0× median
6101041
OTHER 		Mr Low Ext Joint Rt W&w/out 8 $1,810.66 $1,810.66 $1,810.66 nat. median
$1,811
1.0× median
6101042
OTHER 		Mr Low Ext Joint Lt W&w/out 8 $1,810.66 $1,810.66 $1,810.66 nat. median
$1,811
1.0× median
6101025
OTHER 		Mr Lumber Spine/sacrum W & Without 8 $1,807.92 $1,807.92 $1,807.92 nat. median
$1,808
1.0× median
4507500
OTHER 		Secondary Closure Of Wound Ex 8 $1,773.94 $1,773.94 $1,773.94 nat. median
$1,774
1.0× median
7501010
OTHER 		Colonoscopy W/rem Foreign Body 8 $1,773.38 $1,773.38 $1,773.38 nat. median
$1,773
1.0× median
3517812
OTHER 		CTA Head/brain W/wo Contrast 8 $1,748.98 $1,748.98 $1,748.98 nat. median
$1,749
1.0× median
6101022
OTHER 		Mr Thoracic Spine W & W/out 8 $1,735.13 $1,735.13 $1,735.13 nat. median
$1,735
1.0× median

Other procedures at this hospital

Browse this hospital's 4,381 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
             
1200000 OTHER Ip R&b Semiprivate 20 8 $1,415.00 $1,301.80 $929.16 $4,106.48 $2,517.82 2026-05-08
1200100 OTHER R&b Swing Bed 10 3 $930.00 $855.60 $610.68 $610.68 $610.68 2026-05-08
1220001 OTHER Birthing/labor Room 20 8 $1,591.00 $1,463.72 $1,044.73 $4,137.57 $2,591.15 2026-05-08
1700005 OTHER Nursery 10 3 $1,018.00 $936.56 $668.47 $668.47 $668.47 2026-05-08
2060000 OTHER Monitored Bed 20 8 $1,789.00 $1,645.88 $1,174.74 $1,174.74 $1,174.74 2026-05-08
2100001 OTHER Ccu/icu 20 8 $1,763.00 $1,621.96 $1,157.67 $1,157.67 $1,157.67 2026-05-08
2503010 OTHER Pamidronate 60 Mg 20 8 $1,039.25 $956.11 $682.42 $682.42 $682.42 2026-05-08
2601941 OTHER Monocloncal IV Bam/ete 20 8 $1,217.00 $1,119.64 $799.14 $799.14 $799.14 2026-05-08
2604512 OTHER Monoclonal IV Cas/imd 20 8 $1,217.00 $1,119.64 $799.14 $799.14 $799.14 2026-05-08
2604563 OTHER Sotrovimab Admin 20 8 $1,217.00 $1,119.64 $799.14 $799.14 $799.14 2026-05-08
2605005 OTHER IV Therapy 8+ Hrs 20 8 $1,067.50 $982.10 $700.98 $700.98 $700.98 2026-05-08
2745102 OTHER Breg Fusion Xt Knee Brace 20 8 $874.00 $804.08 $573.91 $573.91 $573.91 2026-05-08
3000361 OTHER Neurofilament Light Chain 20 8 $2,112.00 $1,943.04 $1,386.85 $1,386.85 $1,386.85 2026-05-08
3001054 OTHER Tpmt Genotype 20 8 $1,434.00 $1,319.28 $941.63 $941.63 $941.63 2026-05-08
3001090 OTHER Thrombophilia Screen Inerited 20 8 $1,450.00 $1,334.00 $952.14 $952.14 $952.14 2026-05-08
3001106 OTHER Myasthenia Gravis Panel 2 20 8 $907.00 $834.44 $595.58 $595.58 $595.58 2026-05-08
3001169 OTHER Myasthenia Gravis Panel 3 20 8 $1,111.00 $1,022.12 $729.54 $729.54 $729.54 2026-05-08
3001181 OTHER Paraneoplastic Syndrome Ab 20 8 $1,133.00 $1,042.36 $743.99 $743.99 $743.99 2026-05-08
3001184 OTHER Stone Risk Profile 20 8 $1,485.00 $1,366.20 $975.12 $975.12 $975.12 2026-05-08
3001201 OTHER 22q11 20 8 $1,010.00 $929.20 $663.22 $663.22 $663.22 2026-05-08
3001206 OTHER Fish 20 8 $1,010.00 $929.20 $663.22 $663.22 $663.22 2026-05-08
3001245 OTHER Thrombophilia Profile 20 8 $2,282.00 $2,099.44 $1,498.47 $1,498.47 $1,498.47 2026-05-08
3001317 OTHER Brgyp Pms2 Full Gene 20 8 $1,691.00 $1,555.72 $1,110.39 $1,110.39 $1,110.39 2026-05-08
3001401 OTHER Translocation 8;21 20 8 $2,167.00 $1,993.64 $1,422.96 $1,422.96 $1,422.96 2026-05-08
3001432 OTHER Brgyp Breast Cancer Hereditary 20 8 $2,312.00 $2,127.04 $1,518.17 $1,518.17 $1,518.17 2026-05-08
3001499 OTHER Stratify Jc Virus Antibody 20 8 $2,003.00 $1,842.76 $1,315.27 $1,315.27 $1,315.27 2026-05-08
3001699 OTHER Beta 2 Transferrin 20 8 $1,104.00 $1,015.68 $724.94 $724.94 $724.94 2026-05-08
3004232 OTHER Coag Consult Thrombosis/hyperc 20 8 $1,165.00 $1,071.80 $765.00 $765.00 $765.00 2026-05-08
3005178 OTHER Factor Viii Inhibit 20 8 $1,137.00 $1,046.04 $746.61 $746.61 $746.61 2026-05-08
3005500 OTHER Whipples Dna, Pcr 20 8 $1,199.00 $1,103.08 $787.33 $787.33 $787.33 2026-05-08
3007641 OTHER Mrsa Pcr Nasal 20 8 $935.00 $860.20 $613.97 $613.97 $613.97 2026-05-08
3008993 OTHER Uroca Fish 20 8 $1,346.00 $1,238.32 $718.38 $718.38 $718.38 2026-05-08
3009153 OTHER Musk Autoantibody 20 8 $1,110.00 $1,021.20 $728.88 $728.88 $728.88 2026-05-08
3009502 OTHER Factor V (leiden) 20 8 $915.00 $841.80 $600.84 $600.84 $600.84 2026-05-08
3009606 OTHER Chromosome Analysis Blood 20 8 $933.00 $858.36 $612.65 $612.65 $612.65 2026-05-08
3009770 OTHER Hep C Viral RNA Pcr Quest 20 8 $895.00 $823.40 $587.70 $587.70 $587.70 2026-05-08
3009800 OTHER Emp Health Fair Panel B 20 8 $1,232.00 $1,133.44 $809.00 $809.00 $809.00 2026-05-08
3009899 OTHER Hep C Viral Rna,genotype Lipa 20 8 $898.00 $826.16 $589.67 $589.67 $589.67 2026-05-08
3009957 OTHER Paraneoplastic Neoencephalitis 20 8 $5,008.00 $4,607.36 $3,288.51 $3,288.51 $3,288.51 2026-05-08
3009958 OTHER Chromosome Analysis Ii 20 8 $1,194.00 $1,098.48 $784.04 $784.04 $784.04 2026-05-08
3009960 OTHER Chrom Analysis Tissue 20 8 $1,600.00 $1,472.00 $1,050.64 $1,050.64 $1,050.64 2026-05-08
3009974 OTHER Bcr/abli Translocation 20 8 $1,435.00 $1,320.20 $942.29 $942.29 $942.29 2026-05-08
3065123 OTHER Gi Pathogens Panel 20 8 $1,120.00 $1,030.40 $735.45 $735.45 $735.45 2026-05-08
3091545 OTHER Pms2 Full Seq Analysis 20 8 $884.00 $813.28 $580.48 $580.48 $580.48 2026-05-08
3100430 OTHER Malabsorption Panel 20 8 $1,117.00 $1,027.64 $733.48 $733.48 $733.48 2026-05-08
3101162 OTHER Brca1-brca2 20 8 $2,535.00 $2,332.20 $1,664.61 $1,664.61 $1,664.61 2026-05-08
3101318 OTHER Pms2 Gene Full Seq 20 8 $1,035.00 $952.20 $679.63 $679.63 $679.63 2026-05-08
3101401 OTHER Molecular Path Runx1 20 8 $1,050.00 $966.00 $689.48 $689.48 $689.48 2026-05-08
3102795 OTHER Adenomatous Polyposis Coli 20 8 $1,385.00 $1,274.20 $909.46 $909.46 $909.46 2026-05-08
3104150 OTHER Mds Syndrome Panel 20 8 $2,977.00 $2,738.84 $1,954.85 $1,954.85 $1,954.85 2026-05-08
3107027 OTHER Sma Diagnostic Test 20 8 $1,346.00 $1,238.32 $883.85 $883.85 $883.85 2026-05-08
3208205 OTHER Abdomen / Pelvis With Contrast 20 8 $2,150.00 $1,978.00 $1,180.63 $1,180.63 $1,180.63 2026-05-08
3504174 OTHER CTA Abd/pel W Contrast 20 8 $3,800.00 $3,496.00 $2,011.12 $2,011.12 $2,011.12 2026-05-08
3514789 OTHER CTA Low Ext With Contrast 20 8 $3,894.00 $3,582.48 $2,028.11 $2,028.11 $2,028.11 2026-05-08
3517556 OTHER CTA Upper Ext W/wo 20 8 $3,115.00 $2,865.80 $1,641.57 $1,641.57 $1,641.57 2026-05-08
3517812 OTHER CTA Head/brain W/wo Contrast 20 8 $3,360.00 $3,091.20 $1,748.98 $1,748.98 $1,748.98 2026-05-08
3518000 OTHER Head Without Contrast 20 8 $1,778.00 $1,635.76 $906.00 $906.00 $906.00 2026-05-08
3518005 OTHER Head W/contrast 20 8 $2,025.00 $1,863.00 $1,045.11 $1,045.11 $1,045.11 2026-05-08
3518010 OTHER Head W & Without Contrast 20 8 $2,494.00 $2,294.48 $1,282.52 $1,282.52 $1,282.52 2026-05-08
3518015 OTHER Fossa/ear Without Contrast 20 8 $1,778.00 $1,635.76 $931.72 $931.72 $931.72 2026-05-08
3518020 OTHER Fossa/ear W/contrast 20 8 $2,025.00 $1,863.00 $1,060.79 $1,060.79 $1,060.79 2026-05-08
3518025 OTHER Fossa/ear W & Without Contras 20 8 $2,494.00 $2,294.48 $1,300.46 $1,300.46 $1,300.46 2026-05-08
3518030 OTHER Maxillofacial Without Cont 20 8 $1,778.00 $1,635.76 $916.51 $916.51 $916.51 2026-05-08
3518035 OTHER Maxillofacial W/contrast 20 8 $2,025.00 $1,863.00 $1,046.88 $1,046.88 $1,046.88 2026-05-08
3518040 OTHER Maxillofacial W & Without 20 8 $2,494.00 $2,294.48 $1,287.69 $1,287.69 $1,287.69 2026-05-08
3518045 OTHER CT Neck Without Contrast 20 8 $1,778.00 $1,635.76 $927.35 $927.35 $927.35 2026-05-08
3518050 OTHER CT Neck W/contrast 20 8 $2,025.00 $1,863.00 $1,062.57 $1,062.57 $1,062.57 2026-05-08
3518055 OTHER CT Neck W & Without 20 8 $2,494.00 $2,294.48 $1,305.81 $1,305.81 $1,305.81 2026-05-08
3518057 OTHER CTA Neck W/wo Contrast 20 8 $2,940.00 $2,704.80 $1,547.21 $1,547.21 $1,547.21 2026-05-08
3518931 OTHER CTA Pelvis W Contrast 20 8 $2,678.00 $2,463.76 $1,435.37 $1,435.37 $1,435.37 2026-05-08
3518954 OTHER CTA Chest W/wo Noncoronary 20 8 $3,173.00 $2,919.16 $1,661.97 $1,661.97 $1,661.97 2026-05-08
3518964 OTHER CTA Abdomen W/wo 20 8 $2,867.00 $2,637.64 $1,503.77 $1,503.77 $1,503.77 2026-05-08
3519862 OTHER CTA Abd/pel W/wo Contrast 20 8 $4,110.00 $3,781.20 $2,159.93 $2,159.93 $2,159.93 2026-05-08
3528060 OTHER Thorax Without Contrast 20 8 $1,778.00 $1,635.76 $918.94 $918.94 $918.94 2026-05-08
3528065 OTHER Thorax W/contrast 20 8 $2,025.00 $1,863.00 $1,054.16 $1,054.16 $1,054.16 2026-05-08
3528070 OTHER Thorax W & Without Contrast 20 8 $2,494.00 $2,294.48 $1,293.67 $1,293.67 $1,293.67 2026-05-08
3528075 OTHER C-spine Without Contrast 20 8 $1,778.00 $1,635.76 $917.49 $917.49 $917.49 2026-05-08
3528080 OTHER C-spine W/contrast 20 8 $2,025.00 $1,863.00 $1,054.97 $1,054.97 $1,054.97 2026-05-08
3528085 OTHER C-spine W & W/0 Contrast 20 8 $2,494.00 $2,294.48 $1,293.84 $1,293.84 $1,293.84 2026-05-08
3528090 OTHER T-spine Without Contrast 20 8 $1,778.00 $1,635.76 $917.33 $917.33 $917.33 2026-05-08
3528095 OTHER T-spine W/contrast 20 8 $2,025.00 $1,863.00 $1,055.78 $1,055.78 $1,055.78 2026-05-08
3528100 OTHER T-spine W & Without Contrast 20 8 $2,494.00 $2,294.48 $1,294.97 $1,294.97 $1,294.97 2026-05-08
3528105 OTHER L-spine Without Contrast 20 8 $1,778.00 $1,635.76 $917.16 $917.16 $917.16 2026-05-08
3528110 OTHER L-spine W/contrast 20 8 $2,025.00 $1,863.00 $1,055.29 $1,055.29 $1,055.29 2026-05-08
3528115 OTHER L-spine W & Without Contrast 20 8 $2,494.00 $2,294.48 $1,294.00 $1,294.00 $1,294.00 2026-05-08
3528120 OTHER Pelvis Without Contrast 20 8 $1,778.00 $1,635.76 $918.94 $918.94 $918.94 2026-05-08
3528125 OTHER Pelvis W/contrast 20 8 $2,025.00 $1,863.00 $1,083.60 $1,083.60 $1,083.60 2026-05-08
3528130 OTHER Pelvis W & Without Contrast 20 8 $2,494.00 $2,294.48 $1,320.36 $1,320.36 $1,320.36 2026-05-08
3528135 OTHER Upper Extr Without Contrast 20 8 $1,778.00 $1,635.76 $932.52 $932.52 $932.52 2026-05-08
3528140 OTHER Upper Extr W/contrast 20 8 $2,025.00 $1,863.00 $1,070.34 $1,070.34 $1,070.34 2026-05-08
3528145 OTHER Upper Extr W & Without Contra 20 8 $2,494.00 $2,294.48 $1,318.26 $1,318.26 $1,318.26 2026-05-08
3528150 OTHER Lower Extr Without Contrast 20 8 $1,778.00 $1,635.76 $917.33 $917.33 $917.33 2026-05-08
3528155 OTHER Lower Extr W/contrast 20 8 $2,025.00 $1,863.00 $1,054.00 $1,054.00 $1,054.00 2026-05-08
3528160 OTHER Lower Extr W & Without Contra 20 8 $2,494.00 $2,294.48 $1,293.19 $1,293.19 $1,293.19 2026-05-08
3528165 OTHER Abdomen Without Contrast 20 8 $1,778.00 $1,635.76 $920.56 $920.56 $920.56 2026-05-08
3528170 OTHER Abdomen W/contrast 20 8 $2,025.00 $1,863.00 $1,085.54 $1,085.54 $1,085.54 2026-05-08
3528175 OTHER Abdomen W & Without Contrast 20 8 $2,494.00 $2,294.48 $1,324.72 $1,324.72 $1,324.72 2026-05-08
3528180 OTHER Abd/pelvis With And W/out 20 8 $1,950.00 $1,794.00 $1,026.41 $1,026.41 $1,026.41 2026-05-08
3528200 OTHER Abdomen / Pelvis Without Contrast 20 8 $2,413.00 $2,219.96 $1,248.65 $1,248.65 $1,248.65 2026-05-08
3528205 OTHER Abdomen/pelvis W/contrast 20 8 $2,661.00 $2,448.12 $1,425.91 $1,425.91 $1,425.91 2026-05-08
3528210 OTHER Abdomen/pelvis W & Without Contras 20 8 $3,464.00 $3,186.88 $1,829.14 $1,829.14 $1,829.14 2026-05-08
3903014 OTHER Platelet Pheresis Leukoreduced 20 8 $887.00 $816.04 $582.45 $582.45 $582.45 2026-05-08
4021709 OTHER Ultrasound-carotid Neck 20 8 $1,231.00 $1,132.52 $681.77 $681.77 $681.77 2026-05-08
4021721 OTHER Ultrasound-vascular,unilateral 20 8 $1,069.00 $983.48 $570.38 $570.38 $570.38 2026-05-08
4025123 OTHER Ultrasound Vascular Bilateral 20 8 $1,107.00 $1,018.44 $620.80 $620.80 $620.80 2026-05-08
4500001 OTHER Crit Care Facitlity 30-74 Min 20 8 $1,957.00 $1,800.44 $1,042.22 $1,042.22 $1,042.22 2026-05-08
4500009 OTHER ER Base Rate Level 4 20 8 $1,083.00 $996.36 $578.07 $578.07 $578.07 2026-05-08
4500555 OTHER Cardioversion 20 8 $1,362.00 $1,253.04 $705.67 $705.67 $705.67 2026-05-08
4501005 OTHER ER Base Rate Level 5 20 8 $1,412.00 $1,299.04 $762.18 $762.18 $762.18 2026-05-08
4501008 OTHER Crit Care Initial 30-74 Facili 20 8 $1,530.00 $1,407.60 $837.26 $837.26 $837.26 2026-05-08
4502496 OTHER Debridement Bone > 20 Cm 20 8 $942.00 $866.64 $561.00 $561.00 $561.00 2026-05-08
4505053 OTHER Central Line Placement 20 8 $4,998.00 $4,598.16 $2,558.18 $2,558.18 $2,558.18 2026-05-08
4505123 OTHER Lac-inter,12.6-20 Cm I 20 8 $1,264.00 $1,162.88 $724.78 $724.78 $724.78 2026-05-08
4505124 OTHER Lac-intermed,20.1-30 Cm I 20 8 $1,264.00 $1,162.88 $744.84 $744.84 $744.84 2026-05-08
4505125 OTHER Lac-intermed, >30 Cm I 20 8 $1,264.00 $1,162.88 $766.67 $766.67 $766.67 2026-05-08
4505131 OTHER Lac-inter, >30 Cm Ii 20 8 $1,264.00 $1,162.88 $779.45 $779.45 $779.45 2026-05-08
4505220 OTHER Thoracotomy, Traum Hemm 20 8 $2,973.00 $2,735.16 $1,952.22 $1,952.22 $1,952.22 2026-05-08
4505221 OTHER Tracheostomy Cricothyroid 20 8 $1,682.00 $1,547.44 $966.99 $966.99 $966.99 2026-05-08
4505222 OTHER Tracheostomy Transtacheal 20 8 $1,682.00 $1,547.44 $961.17 $961.17 $961.17 2026-05-08
4506050 OTHER Fx Proximal Humeral Facility 20 8 $1,568.00 $1,442.56 $915.02 $915.02 $915.02 2026-05-08
4506102 OTHER I/r Fb Complex 20 8 $2,826.00 $2,599.92 $1,446.24 $1,446.24 $1,446.24 2026-05-08
4506111 OTHER Cmplx Rpr Trunk 1.1-2.5 Cm 20 8 $1,264.00 $1,162.88 $704.40 $704.40 $704.40 2026-05-08
4506115 OTHER Cmplx Rpr S/a/l 2.6-7.5 Cm 20 8 $1,264.00 $1,162.88 $732.07 $732.07 $732.07 2026-05-08
4506117 OTHER Cmplx Rpr F/c/c 2.6 - 7.5 Cm 20 8 $1,264.00 $1,162.88 $753.25 $753.25 $753.25 2026-05-08
4506120 OTHER Late Closure Of Wound 20 8 $3,377.00 $3,106.84 $2,011.06 $2,011.06 $2,011.06 2026-05-08
4506122 OTHER Reduce Nasal Fx 20 8 $3,001.00 $2,760.92 $1,589.76 $1,589.76 $1,589.76 2026-05-08
4506155 OTHER Reduce Fx Tibia Manip 20 8 $3,084.00 $2,837.28 $1,726.15 $1,726.15 $1,726.15 2026-05-08
4506161 OTHER Reduce Fx Tib/fib 20 8 $3,084.00 $2,837.28 $1,728.26 $1,728.26 $1,728.26 2026-05-08
4506162 OTHER I/r Fb Foot Subq 20 8 $1,977.00 $1,818.84 $1,013.98 $1,013.98 $1,013.98 2026-05-08
4506163 OTHER I/r Fb Foot Deep 20 8 $2,826.00 $2,599.92 $1,510.12 $1,510.12 $1,510.12 2026-05-08
4506164 OTHER I/r Fb Foot Complex 20 8 $1,977.00 $1,818.84 $1,128.48 $1,128.48 $1,128.48 2026-05-08
4506189 OTHER Thoracostomy 20 8 $1,498.00 $1,378.16 $793.60 $793.60 $793.60 2026-05-08
4506190 OTHER Thoracentesis 20 8 $1,498.00 $1,378.16 $761.25 $761.25 $761.25 2026-05-08
4506205 OTHER Fx Reduc Of Dist Radius W/mani 20 8 $1,721.00 $1,583.32 $1,083.72 $1,083.72 $1,083.72 2026-05-08
4506209 OTHER Fracture Reduction, Ankle 20 8 $2,155.00 $1,982.60 $1,256.62 $1,256.62 $1,256.62 2026-05-08
4506240 OTHER Fx Distal Fibular W/man 20 8 $884.00 $813.28 $580.48 $580.48 $580.48 2026-05-08
4506250 OTHER Fx Bimalleolar Ankl W/man Faci 20 8 $1,568.00 $1,442.56 $968.72 $968.72 $968.72 2026-05-08
4507195 OTHER Fx Femoral Dist End W/man 20 8 $2,388.00 $2,196.96 $1,483.45 $1,483.45 $1,483.45 2026-05-08
4507500 OTHER Secondary Closure Of Wound Ex 20 8 $2,883.00 $2,652.36 $1,773.94 $1,773.94 $1,773.94 2026-05-08
4509465 OTHER Nb Resuscitation 20 8 $1,175.00 $1,081.00 $631.76 $631.76 $631.76 2026-05-08
4509500 OTHER Delivery-vaginal 20 8 $3,102.00 $2,853.84 $1,876.95 $1,876.95 $1,876.95 2026-05-08
5400000 OTHER Bls Base Scene/hos 20 8 $1,275.00 $1,173.00 $837.23 $837.23 $837.23 2026-05-08
5400003 OTHER Ambulance Base 2 Scene/hosp 20 8 $1,375.00 $1,265.00 $902.89 $902.89 $902.89 2026-05-08
5400004 OTHER Ambulance Base 3 Scene/hosp 20 8 $1,225.00 $1,127.00 $804.39 $804.39 $804.39 2026-05-08
5400005 OTHER Bls 1 (ma)scene/hos 20 8 $1,275.00 $1,173.00 $837.23 $837.23 $837.23 2026-05-08
5400006 OTHER Ambulance Base 2 (ma)scene/hos 20 8 $1,375.00 $1,265.00 $902.89 $902.89 $902.89 2026-05-08
5400007 OTHER Ambulance Base 3(ma)scene/hosp 20 8 $1,225.00 $1,127.00 $804.39 $804.39 $804.39 2026-05-08
5400010 OTHER Bls Base Res/hosp 20 8 $1,275.00 $1,173.00 $837.23 $837.23 $837.23 2026-05-08
5400013 OTHER Ambulance Base 2(mc) Res/hosp 20 8 $1,375.00 $1,265.00 $902.89 $902.89 $902.89 2026-05-08
5400014 OTHER Ambulance Base 3(mc)res/hosp 20 8 $1,225.00 $1,127.00 $804.39 $804.39 $804.39 2026-05-08
5400015 OTHER Ambulance Base Non-ER Hosp/res 20 8 $956.00 $879.52 $627.75 $627.75 $627.75 2026-05-08
5400016 OTHER Scheduled Base Hosp/res 20 8 $897.00 $825.24 $589.01 $589.01 $589.01 2026-05-08
5400025 OTHER Bls 1 (ma)res/hosp 20 8 $1,275.00 $1,173.00 $837.23 $837.23 $837.23 2026-05-08
5400026 OTHER Ambulance Base 2 (ma)res/hosp 20 8 $1,375.00 $1,265.00 $902.89 $902.89 $902.89 2026-05-08
5400027 OTHER Ambulance Base 3(ma) Res/hosp 20 8 $1,225.00 $1,127.00 $804.39 $804.39 $804.39 2026-05-08
5400040 OTHER Bls Base Hosp To Home 20 8 $1,077.00 $990.84 $707.21 $707.21 $707.21 2026-05-08
5405001 OTHER Bls Base Hosp\hosp 20 8 $1,275.00 $1,173.00 $837.23 $837.23 $837.23 2026-05-08
5405002 OTHER Ambulance Base 2 Hosp/hosp 20 8 $1,375.00 $1,265.00 $902.89 $902.89 $902.89 2026-05-08
5405003 OTHER Ambulance Base 3 Hosp/hosp 20 8 $1,225.00 $1,127.00 $804.39 $804.39 $804.39 2026-05-08
5405011 OTHER Ambulance Base 1(ma) Diag/hosp 20 8 $1,275.00 $1,173.00 $837.23 $837.23 $837.23 2026-05-08
5405012 OTHER Ambulance Base 2 (ma)diag/hosp 20 8 $1,375.00 $1,265.00 $902.89 $902.89 $902.89 2026-05-08
5405013 OTHER Ambulance Base 3(ma)diag/hosp 20 8 $1,225.00 $1,127.00 $804.39 $804.39 $804.39 2026-05-08
5405014 OTHER Specialty Rn/dr Diag/hosp 20 8 $3,825.00 $3,519.00 $2,511.68 $2,511.68 $2,511.68 2026-05-08
5405015 OTHER Amb Base 3 Ma Rn/dr Diag/hosp 20 8 $1,225.00 $1,127.00 $804.39 $804.39 $804.39 2026-05-08
5405030 OTHER Als 1 Scene/hosp 20 8 $2,125.00 $1,955.00 $1,395.38 $1,395.38 $1,395.38 2026-05-08
5405031 OTHER Als 1 Ma Scene/hos 20 8 $2,125.00 $1,955.00 $1,395.38 $1,395.38 $1,395.38 2026-05-08
5405035 OTHER Als 1 Res/hosp 20 8 $2,125.00 $1,955.00 $1,395.38 $1,395.38 $1,395.38 2026-05-08
5405036 OTHER Als 1 Ma Res/hosp 20 8 $1,794.00 $1,650.48 $1,178.03 $1,178.03 $1,178.03 2026-05-08
5405040 OTHER Als 1 Hosp/hosp 20 8 $2,125.00 $1,955.00 $1,395.38 $1,395.38 $1,395.38 2026-05-08
5405041 OTHER Als 1 Ma Hosp/hosp 20 8 $2,125.00 $1,955.00 $1,395.38 $1,395.38 $1,395.38 2026-05-08
5405045 OTHER Als Base Type 1 Diag/hosp 20 8 $1,794.00 $1,650.48 $1,178.03 $1,178.03 $1,178.03 2026-05-08
5405046 OTHER Als 1 Ma Diag/hosp 20 8 $1,794.00 $1,650.48 $1,178.03 $1,178.03 $1,178.03 2026-05-08
5405050 OTHER Als 2 Scene/hosp 20 8 $2,975.00 $2,737.00 $1,953.54 $1,953.54 $1,953.54 2026-05-08
5405051 OTHER Als 2 Ma Scene/hos 20 8 $2,331.00 $2,144.52 $1,530.65 $1,530.65 $1,530.65 2026-05-08
5405055 OTHER Als 2 Res/hosp 20 8 $2,975.00 $2,737.00 $1,953.54 $1,953.54 $1,953.54 2026-05-08
5405056 OTHER Specialty Ma Res/hosp 20 8 $2,331.00 $2,144.52 $1,530.65 $1,530.65 $1,530.65 2026-05-08
5405060 OTHER Als 2 Hosp/hosp 20 8 $2,975.00 $2,737.00 $1,953.54 $1,953.54 $1,953.54 2026-05-08
5405061 OTHER Als 2 Ma Hosp/hosp 20 8 $2,331.00 $2,144.52 $1,530.65 $1,530.65 $1,530.65 2026-05-08
5405065 OTHER Als Base Type 2 Diag/hosp 20 8 $2,331.00 $2,144.52 $1,530.65 $1,530.65 $1,530.65 2026-05-08
5405066 OTHER Als 2 Ma Diag/hosp 20 8 $2,331.00 $2,144.52 $1,530.65 $1,530.65 $1,530.65 2026-05-08
6051045 OTHER Mr Low Ext Non-joint Rt W/out 20 8 $2,445.00 $2,249.40 $1,283.10 $1,283.10 $1,283.10 2026-05-08
6101000 OTHER Mr Brain Without Contrast 20 8 $2,491.00 $2,291.72 $1,292.39 $1,292.39 $1,292.39 2026-05-08
6101001 OTHER Mr Brain W & Without Contrast 20 8 $3,495.00 $3,215.40 $1,834.64 $1,834.64 $1,834.64 2026-05-08
6101002 OTHER Mr Brain W Contrast 20 8 $2,782.00 $2,559.44 $1,468.63 $1,468.63 $1,468.63 2026-05-08
6101003 OTHER Mr Brain Without Contrast & MRA 20 8 $2,491.00 $2,291.72 $1,292.39 $1,292.39 $1,292.39 2026-05-08
6101004 OTHER Mr Head/circle Of Willis 20 8 $2,635.00 $2,424.20 $1,370.89 $1,370.89 $1,370.89 2026-05-08
6101005 OTHER Mr Brain W&w/0 Cont & MRA 20 8 $3,495.00 $3,215.40 $1,834.64 $1,834.64 $1,834.64 2026-05-08
6101006 OTHER Mr Brain W&without Circle Of Will 20 8 $2,635.00 $2,424.20 $1,370.89 $1,370.89 $1,370.89 2026-05-08
6101008 OTHER MRA Brain Without Contrast 20 8 $2,635.00 $2,424.20 $1,370.89 $1,370.89 $1,370.89 2026-05-08
6101009 OTHER MRA Neck W & Without Contrast 20 8 $4,122.00 $3,792.24 $2,148.70 $2,148.70 $2,148.70 2026-05-08
6101010 OTHER Mr Iac Without Contrast 20 8 $2,491.00 $2,291.72 $1,292.39 $1,292.39 $1,292.39 2026-05-08
6101011 OTHER Mr Iac W & W/out Contrast 20 8 $3,495.00 $3,215.40 $1,834.64 $1,834.64 $1,834.64 2026-05-08
6101012 OTHER Mr Iac W/contrast 20 8 $2,782.00 $2,559.44 $1,468.63 $1,468.63 $1,468.63 2026-05-08
6101013 OTHER Mr Orbits/face/neck W/out Cont 20 8 $2,409.00 $2,216.28 $1,267.43 $1,267.43 $1,267.43 2026-05-08
6101014 OTHER Mr Orbits/face/neck W&w/out 20 8 $3,516.00 $3,234.72 $1,854.42 $1,854.42 $1,854.42 2026-05-08
6101015 OTHER Mr Orbits/face/neck W Contrast 20 8 $2,694.00 $2,478.48 $1,424.61 $1,424.61 $1,424.61 2026-05-08
6101016 OTHER Mr Neck & Brain 20 8 $3,495.00 $3,215.40 $1,834.64 $1,834.64 $1,834.64 2026-05-08
6101017 OTHER Mr Tmj W/out Contrast 20 8 $2,175.00 $2,001.00 $1,172.90 $1,172.90 $1,172.90 2026-05-08
6101018 OTHER Mr Cervical Spine W/out Contra 20 8 $2,250.00 $2,070.00 $1,173.81 $1,173.81 $1,173.81 2026-05-08
6101019 OTHER Mr Cervical Spine W & W/out 20 8 $3,494.00 $3,214.48 $1,834.64 $1,834.64 $1,834.64 2026-05-08
6101020 OTHER Mr Cervical Spine 2/contrast 20 8 $2,812.00 $2,587.04 $1,485.29 $1,485.29 $1,485.29 2026-05-08
6101021 OTHER Mr Thoracic Spine W/out Cont 20 8 $2,283.00 $2,100.36 $1,189.81 $1,189.81 $1,189.81 2026-05-08
6101022 OTHER Mr Thoracic Spine W & W/out 20 8 $3,286.00 $3,023.12 $1,735.13 $1,735.13 $1,735.13 2026-05-08
6101023 OTHER Mr Thoracic Spine W/contrast 20 8 $2,538.00 $2,334.96 $1,352.32 $1,352.32 $1,352.32 2026-05-08
6101024 OTHER Mr Lumbar Spine/sacrum W/out 20 8 $2,252.00 $2,071.84 $1,175.09 $1,175.09 $1,175.09 2026-05-08
6101025 OTHER Mr Lumber Spine/sacrum W & Without 20 8 $3,439.00 $3,163.88 $1,807.92 $1,807.92 $1,807.92 2026-05-08
6101026 OTHER Mr Lumbar Spine/sacrum W/cont 20 8 $2,769.00 $2,547.48 $1,462.22 $1,462.22 $1,462.22 2026-05-08
6101027 OTHER Mr Upper Ext Joint Rt W/out 20 8 $2,351.00 $2,162.92 $1,228.76 $1,228.76 $1,228.76 2026-05-08
6101028 OTHER Mr Upper Ext Joint Lt W/out 20 8 $2,351.00 $2,162.92 $1,228.76 $1,228.76 $1,228.76 2026-05-08
6101029 OTHER Mr Upper Ext Joint Rt W&w/out 20 8 $3,386.00 $3,115.12 $1,814.51 $1,814.51 $1,814.51 2026-05-08
6101030 OTHER Mr Upper Ext Joint Lt W&w/out 20 8 $3,386.00 $3,115.12 $1,814.51 $1,814.51 $1,814.51 2026-05-08
6101031 OTHER Mr Upper Ext Joint Rt W/cont 20 8 $2,562.00 $2,357.04 $1,382.60 $1,382.60 $1,382.60 2026-05-08
6101032 OTHER Mr Upper Ext Joint Lt W/cont 20 8 $2,562.00 $2,357.04 $1,382.60 $1,382.60 $1,382.60 2026-05-08
6101033 OTHER Mr Up Ext Nonjointrt W/out 20 8 $2,493.00 $2,293.56 $1,344.79 $1,344.79 $1,344.79 2026-05-08
6101034 OTHER Mr Up Ext Nonjoint Lt W/out 20 8 $2,493.00 $2,293.56 $1,344.79 $1,344.79 $1,344.79 2026-05-08
6101035 OTHER Mr Up Ext Nonjoint Rt W&w/out 20 8 $3,564.00 $3,278.88 $1,911.76 $1,911.76 $1,911.76 2026-05-08
6101036 OTHER Mr Up Ext Nonjoint Lt W&w/out 20 8 $3,564.00 $3,278.88 $1,911.76 $1,911.76 $1,911.76 2026-05-08
6101037 OTHER Mr Up Ext Non-joint Rt W/cont 20 8 $2,698.00 $2,482.16 $1,457.26 $1,457.26 $1,457.26 2026-05-08
6101038 OTHER Mr Up Ext Non-joint Lt W/cont 20 8 $2,698.00 $2,482.16 $1,457.26 $1,457.26 $1,457.26 2026-05-08
6101039 OTHER Mr Low Ext Joint Rt W/out 20 8 $2,398.00 $2,206.16 $1,251.15 $1,251.15 $1,251.15 2026-05-08
6101040 OTHER Mr Low Ext Joint Lt W/out 20 8 $2,398.00 $2,206.16 $1,251.15 $1,251.15 $1,251.15 2026-05-08
6101041 OTHER Mr Low Ext Joint Rt W&w/out 20 8 $3,379.00 $3,108.68 $1,810.66 $1,810.66 $1,810.66 2026-05-08
6101042 OTHER Mr Low Ext Joint Lt W&w/out 20 8 $3,379.00 $3,108.68 $1,810.66 $1,810.66 $1,810.66 2026-05-08
6101043 OTHER Mr Low Ext Joint Rt W/cont 20 8 $2,604.00 $2,395.68 $1,402.76 $1,402.76 $1,402.76 2026-05-08
6101044 OTHER Mr Low Ext Joint Lt W/contrast 20 8 $2,604.00 $2,395.68 $1,402.76 $1,402.76 $1,402.76 2026-05-08
6101045 OTHER Mr Low Ext Non-joint Rt W/out 20 8 $2,445.00 $2,249.40 $1,283.10 $1,283.10 $1,283.10 2026-05-08
6101046 OTHER Mr Low Ext Non-joint Lt W/out 20 8 $2,445.00 $2,249.40 $1,283.10 $1,283.10 $1,283.10 2026-05-08
6101047 OTHER Mr Low Ext Nonjoint Rt W&w/out 20 8 $3,568.00 $3,282.56 $1,878.41 $1,878.41 $1,878.41 2026-05-08
6101048 OTHER Mr Low Ext Nonjoint Lt W&w/ou 20 8 $3,568.00 $3,282.56 $1,878.41 $1,878.41 $1,878.41 2026-05-08
6101049 OTHER Mr Low Ext Non-joint Rt W/cont 20 8 $2,692.00 $2,476.64 $1,421.38 $1,421.38 $1,421.38 2026-05-08
6101050 OTHER Mr Low Ext Non-joint Lt W/cont 20 8 $2,692.00 $2,476.64 $1,421.38 $1,421.38 $1,421.38 2026-05-08
6101051 OTHER Mr Wrist Rt W/out Contrast 20 8 $1,807.50 $1,662.90 $967.88 $967.88 $967.88 2026-05-08
6101052 OTHER Mr Wrist Lt W/out Cont 20 8 $1,807.50 $1,662.90 $967.88 $967.88 $967.88 2026-05-08
6101053 OTHER Mr Wrist Rt W & W/out Cont 20 8 $2,604.00 $2,395.68 $1,439.14 $1,439.14 $1,439.14 2026-05-08
6101080 OTHER MRA Head Without Contrast 20 8 $2,491.00 $2,291.72 $1,301.78 $1,301.78 $1,301.78 2026-05-08
6102005 OTHER Mr Chest W/out Contrast 20 8 $2,722.00 $2,504.24 $1,471.37 $1,471.37 $1,471.37 2026-05-08
6102006 OTHER Mr Chest W & W/out Contrast 20 8 $4,041.00 $3,717.72 $2,170.47 $2,170.47 $2,170.47 2026-05-08
6102007 OTHER Mr Chest W/contrast 20 8 $3,070.00 $2,824.40 $1,657.16 $1,657.16 $1,657.16 2026-05-08
6102008 OTHER Mr Brachial Plexus W/out Cont 20 8 $2,409.00 $2,216.28 $1,267.43 $1,267.43 $1,267.43 2026-05-08
6102009 OTHER Mr Brachial Plexus W & W/out 20 8 $3,516.00 $3,234.72 $1,854.42 $1,854.42 $1,854.42 2026-05-08
6102010 OTHER Mr Brachial Plexus W/contrast 20 8 $2,694.00 $2,478.48 $1,424.61 $1,424.61 $1,424.61 2026-05-08
6102011 OTHER Mr Abdomen W/out 20 8 $2,219.00 $2,041.48 $1,161.35 $1,161.35 $1,161.35 2026-05-08
6102012 OTHER Mr Abdomen W & W/out 20 8 $3,581.00 $3,294.52 $1,885.14 $1,885.14 $1,885.14 2026-05-08
6102013 OTHER Mr Abdomen W/contrast 20 8 $2,999.00 $2,759.08 $1,588.15 $1,588.15 $1,588.15 2026-05-08
6102014 OTHER Mr Abdomen/kidneys W/out 20 8 $1,706.25 $1,569.75 $915.23 $915.23 $915.23 2026-05-08
6102015 OTHER Mr Abdomen/kidneys W & W/out 20 8 $2,756.50 $2,535.98 $1,489.38 $1,489.38 $1,489.38 2026-05-08
6102016 OTHER Mr Abdomen/kidneys W/contrast 20 8 $2,307.50 $2,122.90 $1,256.23 $1,256.23 $1,256.23 2026-05-08
6102017 OTHER Mr Abdomen-adrenals W/out 20 8 $1,706.50 $1,569.98 $915.35 $915.35 $915.35 2026-05-08
6102018 OTHER Mr Abdomen/adrenals W&w/out 20 8 $2,756.50 $2,535.98 $1,489.38 $1,489.38 $1,489.38 2026-05-08
6102019 OTHER Mr Abdomen/adrenals W/contrast 20 8 $2,307.50 $2,122.90 $1,256.23 $1,256.23 $1,256.23 2026-05-08
6102020 OTHER Mr Abdomen / Mrcp W/out 20 8 $1,706.50 $1,569.98 $915.35 $915.35 $915.35 2026-05-08
6102021 OTHER Mr Abdomen/mrcp W & W/out 20 8 $3,581.00 $3,294.52 $1,885.14 $1,885.14 $1,885.14 2026-05-08
6102022 OTHER Mr Abdomen/mrcp W/contrast 20 8 $2,999.00 $2,759.08 $1,588.15 $1,588.15 $1,588.15 2026-05-08
6102023 OTHER Mr Pelvis W/out Contrast 20 8 $2,478.00 $2,279.76 $1,301.68 $1,301.68 $1,301.68 2026-05-08
6102024 OTHER Mr Pelvis W & W/out Contrast 20 8 $3,574.00 $3,288.08 $1,881.13 $1,881.13 $1,881.13 2026-05-08
6102025 OTHER Mr Pelvis W/contrast 20 8 $2,744.00 $2,524.48 $1,449.26 $1,449.26 $1,449.26 2026-05-08
6102026 OTHER MRA Head/circle Of Willis 20 8 $2,635.00 $2,424.20 $1,370.89 $1,370.89 $1,370.89 2026-05-08
6102027 OTHER Mrs Neck/carotids W/out 20 8 $2,631.00 $2,420.52 $1,369.30 $1,369.30 $1,369.30 2026-05-08
6102028 OTHER MRA Neck/carotids W & W/out 20 8 $4,122.00 $3,792.24 $2,148.70 $2,148.70 $2,148.70 2026-05-08
6102029 OTHER MRA Neck/carotids W/contrast 20 8 $2,761.00 $2,540.12 $1,446.58 $1,446.58 $1,446.58 2026-05-08
6102031 OTHER MRA Pelvis 20 8 $2,661.00 $2,448.12 $1,443.87 $1,443.87 $1,443.87 2026-05-08
6102032 OTHER MRA Upper Extremity 20 8 $2,908.00 $2,675.36 $1,556.12 $1,556.12 $1,556.12 2026-05-08
6102033 OTHER MRA Lower Extremity 20 8 $2,667.00 $2,453.64 $1,445.93 $1,445.93 $1,445.93 2026-05-08
6102034 OTHER MRA Spine 20 8 $2,953.00 $2,716.76 $1,585.32 $1,585.32 $1,585.32 2026-05-08
6102035 OTHER Mr Abdomen / Renal 20 8 $2,658.00 $2,445.36 $1,441.62 $1,441.62 $1,441.62 2026-05-08
6102036 OTHER Mr Abd/renal With Abd/kidney 20 8 $3,581.00 $3,294.52 $1,885.14 $1,885.14 $1,885.14 2026-05-08
6361000 OTHER Rituxan Per 100 Mg 20 8 $5,064.00 $4,658.88 $3,325.28 $3,325.28 $3,325.28 2026-05-08
6363007 OTHER Neulasta 6mg 20 8 $5,741.00 $5,281.72 $3,769.83 $3,769.83 $3,769.83 2026-05-08
7210005 OTHER Delivery Charge 20 8 $2,121.00 $1,951.32 $1,392.76 $1,392.76 $1,392.76 2026-05-08
7501000 OTHER Colonoscopy 20 8 $3,630.00 $3,339.60 $1,831.03 $1,831.03 $1,831.03 2026-05-08
7501010 OTHER Colonoscopy W/rem Foreign Body 20 8 $3,457.00 $3,180.44 $1,773.38 $1,773.38 $1,773.38 2026-05-08
7501015 OTHER Colonoscopy With Biopsy 20 8 $3,859.00 $3,550.28 $1,948.71 $1,948.71 $1,948.71 2026-05-08
7501020 OTHER Colonoscopy W/submucosal Inj 20 8 $3,937.00 $3,622.04 $1,986.15 $1,986.15 $1,986.15 2026-05-08
7501025 OTHER Colonoscopy W/control Bleeding 20 8 $3,950.00 $3,634.00 $2,019.72 $2,019.72 $2,019.72 2026-05-08
7501030 OTHER Colonscopy W/ablation Lesions 20 8 $2,503.00 $2,302.76 $1,330.66 $1,330.66 $1,330.66 2026-05-08
7501045 OTHER Colonoscopy W/snare Polypectom 20 8 $4,987.00 $4,588.04 $2,515.22 $2,515.22 $2,515.22 2026-05-08
7501060 OTHER Flex Sigmoid W/snare Polypecto 20 8 $1,225.00 $1,127.00 $645.90 $645.90 $645.90 2026-05-08
7612211 OTHER Thoracentesis Outpatient 20 8 $1,467.00 $1,349.64 $746.37 $746.37 $746.37 2026-05-08
9211713 OTHER US Arterial Abd/pel Complete 20 8 $1,002.00 $921.84 $607.27 $607.27 $607.27 2026-05-08
9811010 OTHER Chest Tube Insertion 9 2 $2,151.00 $1,978.92 $718.74 $1,545.29 $754.68 2026-05-08
9815053 OTHER Insertion Central Venous Acces 9 2 $1,064.00 $978.88 $899.88 $1,934.74 $944.87 2026-05-08
9815131 OTHER Lac-inter, >30 Cm Ii Phys 9 2 $1,584.00 $1,457.28 $533.07 $1,146.10 $559.72 2026-05-08
9815137 OTHER Lac-inter, 20.1-30 Cm Iii Phys 9 2 $1,683.00 $1,548.36 $562.18 $1,208.69 $590.29 2026-05-08
9815138 OTHER Lac-inter, >30 Cm Iii 9 2 $1,715.00 $1,577.80 $586.44 $1,260.85 $615.76 2026-05-08
98151555 OTHER Dermal Autograft 9 2 $1,718.00 $1,580.56 $848.77 $1,824.86 $891.21 2026-05-08
9815157 OTHER Dermal Autograft 9 2 $2,581.00 $2,374.52 $848.77 $1,824.86 $891.21 2026-05-08
9815237 OTHER Catheterization Intraperitonea 9 2 $3,898.00 $3,586.16 $912.17 $1,961.17 $957.78 2026-05-08
9815520 OTHER Dislocate Knee W/anesth Phys 9 2 $917.00 $843.64 $633.34 $1,361.69 $665.01 2026-05-08
9816015 OTHER Fx Mandibular-closed,phys 9 2 $1,925.00 $1,771.00 $572.86 $1,231.64 $601.50 2026-05-08
9816045 OTHER Fx Scapular - Open, Phys 9 2 $2,935.00 $2,700.20 $961.66 $2,067.57 $1,009.74 2026-05-08
9816075 OTHER Fx Epicondylar W/man,phys 9 2 $1,608.00 $1,479.36 $548.60 $1,179.48 $576.03 2026-05-08
9816115 OTHER Fx Distal Rad Clsd W/man,phys 9 2 $1,655.00 $1,522.60 $546.33 $1,174.61 $573.65 2026-05-08
9816120 OTHER Fx Distal Rad-open,phys 9 2 $1,991.00 $1,831.72 $669.25 $1,438.89 $702.71 2026-05-08
9816140 OTHER Fx Wrist-clsd W/man,phys 9 2 $1,426.00 $1,311.92 $535.33 $1,150.97 $562.10 2026-05-08
9816161 OTHER Reduction Of Distal Tib Fx 9 2 $1,347.00 $1,239.24 $551.18 $1,185.05 $578.74 2026-05-08
9816185 OTHER Fx Femoral Shaft W/man,phys 9 2 $2,304.00 $2,119.68 $744.94 $1,601.62 $782.19 2026-05-08
9816195 OTHER Fx Femoral Dist End W/man,phys 9 2 $2,052.00 $1,887.84 $674.42 $1,450.01 $708.15 2026-05-08
9816215 OTHER Fx Tib/fib Shaft W/man,phys 9 2 $1,623.00 $1,493.16 $538.57 $1,157.92 $565.50 2026-05-08
9816281 OTHER Fx Gr Toe, Phalanges Open 9 2 $2,063.00 $1,897.96 $632.05 $1,358.91 $663.65 2026-05-08
9817500 OTHER Secondary Closure Dehiscence 9 2 $2,388.00 $2,196.96 $780.20 $1,677.42 $819.21 2026-05-08
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