Hospital

APPLETON AREA HEALTH

Appleton, MN · CCN 241341 · Rates published

Your selected procedure

You selected 93306 (HCPCS)

Ultrasound of heart with color-depicted blood flow, rate, direction and valve function

This hospital’s price: $1,192 across 3 payers · range $1,052-$2,105

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbAAHSAPPLETONMN&type=CDMWithoutLabel&fileType=CSV · observed 2026-01-22

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

2,115 distinct procedures filed

3 distinct payers

14,628 rate rows

2026-01-22 last MRF observed

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbAAHSAPPLETONMN&type=CDMWithoutLabel&fileType=CSV
Discovered via	Discovered by HANK (automated)
Last fetch	not_modified · 2026-10-22
Content fingerprint	d0cef81be8af053c… · 2,521,296 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
25002291 CDM	Operating Room Services - General Classification	3	$6,139.82	$12,327.46	$10,561.84	nat. median $10,170 1.0× median
25002326 CDM	Operating Room Services - General Classification	3	$5,527.01	$11,097.07	$9,507.67	nat. median $5,223 1.8× median
25007348 CDM	Operating Room Services - General Classification	3	$5,109.53	$10,258.86	$8,789.52	nat. median $8,716 1.0× median
25019340 CDM	Operating Room Services - General Classification	3	$4,574.36	$9,184.35	$7,868.91	nat. median $6,277 1.3× median
25010170 CDM	Operating Room Services - General Classification	3	$4,338.05	$8,709.89	$7,462.40	nat. median $8,870 0.8× median
25000063 CDM	Operating Room Services - General Classification	3	$4,324.80	$8,683.29	$7,439.61	nat. median $27 outlier · 270.8×
25009475 CDM	Operating Room Services - General Classification	3	$4,245.62	$8,524.31	$7,303.40	nat. median $4,816 1.5× median
25024281 CDM	Operating Room Services - General Classification	3	$4,114.98	$8,262.02	$7,078.68	nat. median $2,072 outlier · 3.4×
25009452 CDM	Operating Room Services - General Classification	3	$4,108.21	$8,248.41	$7,067.02	nat. median $7,067 1.0× median
25007480 CDM	Operating Room Services - General Classification	3	$3,703.36	$7,435.57	$6,370.60	nat. median $5,469 1.2× median
25007784 CDM	Operating Room Services - General Classification	3	$3,703.36	$7,435.57	$6,370.60	nat. median $3,703 1.7× median
25001746 CDM	Operating Room Services - General Classification	3	$3,703.36	$7,435.57	$6,370.60	nat. median $2,462 outlier · 2.6×
25001029 CDM	Operating Room Services - General Classification	3	$3,703.36	$7,435.57	$6,370.60	nat. median $4,179 1.5× median
25001312 CDM	Operating Room Services - General Classification	3	$3,703.36	$7,435.57	$6,370.60	nat. median $5,381 1.2× median
25002250 CDM	Operating Room Services - General Classification	3	$3,503.10	$7,033.48	$6,026.10	nat. median $6,003 1.0× median
25004697 CDM	Operating Room Services - General Classification	3	$3,402.35	$6,831.20	$5,852.79	nat. median $6,831 0.9× median
25002283 CDM	Operating Room Services - General Classification	3	$3,402.04	$6,830.58	$5,852.26	nat. median $7,124 0.8× median
25001153 CDM	Operating Room Services - General Classification	3	$3,389.10	$6,804.60	$5,830.00	nat. median $2,467 outlier · 2.4×
25003326 CDM	Operating Room Services - General Classification	3	$3,344.12	$6,714.28	$5,752.62	nat. median $4,818 1.2× median
25003064 CDM	Operating Room Services - General Classification	3	$3,338.88	$6,703.77	$5,743.61	nat. median $4,532 1.3× median
25005431 CDM	Operating Room Services - General Classification	3	$3,338.88	$6,703.77	$5,743.61	nat. median $3,691 1.6× median
25011014 CDM	Operating Room Services - General Classification	3	$3,338.88	$6,703.77	$5,743.61	nat. median $2,337 outlier · 2.5×
25002307 CDM	Operating Room Services - General Classification	3	$3,331.18	$6,688.30	$5,730.36	nat. median $6,688 0.9× median
25011858 CDM	Operating Room Services - General Classification	3	$3,290.51	$6,606.65	$5,660.40	nat. median $5,351 1.1× median
25002412 CDM	Operating Room Services - General Classification	3	$3,288.66	$6,602.94	$5,657.22	nat. median $3,792 1.5× median
25002965 CDM	Operating Room Services - General Classification	3	$3,288.66	$6,602.94	$5,657.22	nat. median $8,388 0.7× median
25002279 CDM	Operating Room Services - General Classification	3	$3,288.66	$6,602.94	$5,657.22	nat. median $6,674 0.8× median
25001196 CDM	Operating Room Services - General Classification	3	$3,283.42	$6,592.42	$5,648.21	nat. median $9 outlier · 655.2×
25000004 CDM	Operating Room Services - General Classification	3	$3,257.85	$6,541.08	$5,604.22	nat. median $41 outlier · 138.0×
25009570 CDM	Operating Room Services - General Classification	3	$3,257.85	$6,541.08	$5,604.22	nat. median $5,554 1.0× median
25014119 CDM	Operating Room Services - General Classification	3	$3,240.60	$6,506.43	$5,574.54	nat. median $1,270 outlier · 4.4×
25000403 CDM	Operating Room Services - General Classification	3	$3,235.05	$6,495.30	$5,565.00	nat. median $1,598 outlier · 3.5×
25003027 CDM	Operating Room Services - General Classification	3	$3,150.01	$6,324.57	$5,418.72	nat. median $1,215 outlier · 4.5×
25011588 CDM	Operating Room Services - General Classification	3	$3,108.73	$6,241.67	$5,347.70	nat. median $8 outlier · 713.0×
25001727 CDM	Operating Room Services - General Classification	3	$3,083.16	$6,190.33	$5,303.71	nat. median $5,223 1.0× median
25019498 CDM	Operating Room Services - General Classification	3	$3,069.29	$6,162.49	$5,279.86	nat. median $5,280 1.0× median
25002587 CDM	Operating Room Services - General Classification	3	$2,914.93	$5,852.57	$5,014.33	nat. median $5,071 1.0× median
25007261 CDM	Operating Room Services - General Classification	3	$2,910.31	$5,843.30	$5,006.38	nat. median $5,006 1.0× median
25007663 CDM	Operating Room Services - General Classification	3	$2,743.32	$5,508.01	$4,719.12	nat. median $3,994 1.2× median
25001882 CDM	Operating Room Services - General Classification	3	$2,693.41	$5,407.80	$4,633.26	nat. median $5,212 0.9× median
25001714 CDM	Operating Room Services - General Classification	3	$2,674.62	$5,370.07	$4,600.93	nat. median $5,750 0.8× median
25012229 CDM	Operating Room Services - General Classification	3	$2,674.62	$5,370.07	$4,600.93	nat. median $6,130 0.8× median
25007420 CDM	Operating Room Services - General Classification	3	$2,671.54	$5,363.88	$4,595.63	nat. median $31 outlier · 147.6×
25000908 CDM	Operating Room Services - General Classification	3	$2,657.67	$5,336.04	$4,571.78	nat. median $3,271 1.4× median
25003247 CDM	Operating Room Services - General Classification	3	$2,657.67	$5,336.04	$4,571.78	nat. median $5,359 0.9× median
25001851 CDM	Operating Room Services - General Classification	3	$2,657.67	$5,336.04	$4,571.78	nat. median $3,994 1.1× median
25004513 CDM	Operating Room Services - General Classification	3	$2,657.67	$5,336.04	$4,571.78	nat. median $5,223 0.9× median
25007463 CDM	Operating Room Services - General Classification	3	$2,657.67	$5,336.04	$4,571.78	nat. median $2,652 1.7× median
25001792 CDM	Operating Room Services - General Classification	3	$2,657.67	$5,336.04	$4,571.78	nat. median $5,595 0.8× median
25001823 CDM	Operating Room Services - General Classification	3	$2,657.67	$5,336.04	$4,571.78	nat. median $2,761 1.7× median

Other procedures at this hospital

Browse this hospital's 2,115 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

25002291	CDM	Operating Room Services - General Classification	6	3	$19,928.00	$16,938.80	$6,139.82	$12,327.46	$10,561.84	2026-01-22
25002326	CDM	Operating Room Services - General Classification	6	3	$17,939.00	$15,248.15	$5,527.01	$11,097.07	$9,507.67	2026-01-22
25007348	CDM	Operating Room Services - General Classification	6	3	$16,584.00	$14,096.40	$5,109.53	$10,258.86	$8,789.52	2026-01-22
25019340	CDM	Operating Room Services - General Classification	6	3	$14,847.00	$12,619.95	$4,574.36	$9,184.35	$7,868.91	2026-01-22
25010170	CDM	Operating Room Services - General Classification	6	3	$14,080.00	$11,968.00	$4,338.05	$8,709.89	$7,462.40	2026-01-22
25000063	CDM	Operating Room Services - General Classification	6	3	$14,037.00	$11,931.45	$4,324.80	$8,683.29	$7,439.61	2026-01-22
25009475	CDM	Operating Room Services - General Classification	6	3	$13,780.00	$11,713.00	$4,245.62	$8,524.31	$7,303.40	2026-01-22
25024281	CDM	Operating Room Services - General Classification	6	3	$13,356.00	$11,352.60	$4,114.98	$8,262.02	$7,078.68	2026-01-22
25009452	CDM	Operating Room Services - General Classification	6	3	$13,334.00	$11,333.90	$4,108.21	$8,248.41	$7,067.02	2026-01-22
25001746	CDM	Operating Room Services - General Classification	6	3	$12,020.00	$10,217.00	$3,703.36	$7,435.57	$6,370.60	2026-01-22
25007480	CDM	Operating Room Services - General Classification	6	3	$12,020.00	$10,217.00	$3,703.36	$7,435.57	$6,370.60	2026-01-22
25001029	CDM	Operating Room Services - General Classification	6	3	$12,020.00	$10,217.00	$3,703.36	$7,435.57	$6,370.60	2026-01-22
25001312	CDM	Operating Room Services - General Classification	6	3	$12,020.00	$10,217.00	$3,703.36	$7,435.57	$6,370.60	2026-01-22
25007784	CDM	Operating Room Services - General Classification	6	3	$12,020.00	$10,217.00	$3,703.36	$7,435.57	$6,370.60	2026-01-22
25002250	CDM	Operating Room Services - General Classification	6	3	$11,370.00	$9,664.50	$3,503.10	$7,033.48	$6,026.10	2026-01-22
25004697	CDM	Operating Room Services - General Classification	6	3	$11,043.00	$9,386.55	$3,402.35	$6,831.20	$5,852.79	2026-01-22
25002283	CDM	Operating Room Services - General Classification	6	3	$11,042.00	$9,385.70	$3,402.04	$6,830.58	$5,852.26	2026-01-22
25001153	CDM	Operating Room Services - General Classification	6	3	$11,000.00	$9,350.00	$3,389.10	$6,804.60	$5,830.00	2026-01-22
25003326	CDM	Operating Room Services - General Classification	6	3	$10,854.00	$9,225.90	$3,344.12	$6,714.28	$5,752.62	2026-01-22
25005431	CDM	Operating Room Services - General Classification	6	3	$10,837.00	$9,211.45	$3,338.88	$6,703.77	$5,743.61	2026-01-22
25011014	CDM	Operating Room Services - General Classification	6	3	$10,837.00	$9,211.45	$3,338.88	$6,703.77	$5,743.61	2026-01-22
25003064	CDM	Operating Room Services - General Classification	6	3	$10,837.00	$9,211.45	$3,338.88	$6,703.77	$5,743.61	2026-01-22
25002307	CDM	Operating Room Services - General Classification	6	3	$10,812.00	$9,190.20	$3,331.18	$6,688.30	$5,730.36	2026-01-22
25011858	CDM	Operating Room Services - General Classification	6	3	$10,680.00	$9,078.00	$3,290.51	$6,606.65	$5,660.40	2026-01-22
25002279	CDM	Operating Room Services - General Classification	6	3	$10,674.00	$9,072.90	$3,288.66	$6,602.94	$5,657.22	2026-01-22
25002965	CDM	Operating Room Services - General Classification	6	3	$10,674.00	$9,072.90	$3,288.66	$6,602.94	$5,657.22	2026-01-22
25002412	CDM	Operating Room Services - General Classification	6	3	$10,674.00	$9,072.90	$3,288.66	$6,602.94	$5,657.22	2026-01-22
25001196	CDM	Operating Room Services - General Classification	6	3	$10,657.00	$9,058.45	$3,283.42	$6,592.42	$5,648.21	2026-01-22
25000004	CDM	Operating Room Services - General Classification	6	3	$10,574.00	$8,987.90	$3,257.85	$6,541.08	$5,604.22	2026-01-22
25009570	CDM	Operating Room Services - General Classification	6	3	$10,574.00	$8,987.90	$3,257.85	$6,541.08	$5,604.22	2026-01-22
25014119	CDM	Operating Room Services - General Classification	6	3	$10,518.00	$8,940.30	$3,240.60	$6,506.43	$5,574.54	2026-01-22
25000403	CDM	Operating Room Services - General Classification	6	3	$10,500.00	$8,925.00	$3,235.05	$6,495.30	$5,565.00	2026-01-22
25003027	CDM	Operating Room Services - General Classification	6	3	$10,224.00	$8,690.40	$3,150.01	$6,324.57	$5,418.72	2026-01-22
25011588	CDM	Operating Room Services - General Classification	6	3	$10,090.00	$8,576.50	$3,108.73	$6,241.67	$5,347.70	2026-01-22
25001727	CDM	Operating Room Services - General Classification	6	3	$10,007.00	$8,505.95	$3,083.16	$6,190.33	$5,303.71	2026-01-22
25019498	CDM	Operating Room Services - General Classification	6	3	$9,962.00	$8,467.70	$3,069.29	$6,162.49	$5,279.86	2026-01-22
25002587	CDM	Operating Room Services - General Classification	6	3	$9,461.00	$8,041.85	$2,914.93	$5,852.57	$5,014.33	2026-01-22
25007261	CDM	Operating Room Services - General Classification	6	3	$9,446.00	$8,029.10	$2,910.31	$5,843.30	$5,006.38	2026-01-22
25007663	CDM	Operating Room Services - General Classification	6	3	$8,904.00	$7,568.40	$2,743.32	$5,508.01	$4,719.12	2026-01-22
25001882	CDM	Operating Room Services - General Classification	6	3	$8,742.00	$7,430.70	$2,693.41	$5,407.80	$4,633.26	2026-01-22
25001714	CDM	Operating Room Services - General Classification	6	3	$8,681.00	$7,378.85	$2,674.62	$5,370.07	$4,600.93	2026-01-22
25012229	CDM	Operating Room Services - General Classification	6	3	$8,681.00	$7,378.85	$2,674.62	$5,370.07	$4,600.93	2026-01-22
25007420	CDM	Operating Room Services - General Classification	6	3	$8,671.00	$7,370.35	$2,671.54	$5,363.88	$4,595.63	2026-01-22
25001792	CDM	Operating Room Services - General Classification	6	3	$8,626.00	$7,332.10	$2,657.67	$5,336.04	$4,571.78	2026-01-22
25000908	CDM	Operating Room Services - General Classification	6	3	$8,626.00	$7,332.10	$2,657.67	$5,336.04	$4,571.78	2026-01-22
25009135	CDM	Operating Room Services - General Classification	6	3	$8,626.00	$7,332.10	$2,657.67	$5,336.04	$4,571.78	2026-01-22
25001851	CDM	Operating Room Services - General Classification	6	3	$8,626.00	$7,332.10	$2,657.67	$5,336.04	$4,571.78	2026-01-22
25003247	CDM	Operating Room Services - General Classification	6	3	$8,626.00	$7,332.10	$2,657.67	$5,336.04	$4,571.78	2026-01-22
25001345	CDM	Operating Room Services - General Classification	6	3	$8,626.00	$7,332.10	$2,657.67	$5,336.04	$4,571.78	2026-01-22
25001844	CDM	Operating Room Services - General Classification	6	3	$8,626.00	$7,332.10	$2,657.67	$5,336.04	$4,571.78	2026-01-22
25007463	CDM	Operating Room Services - General Classification	6	3	$8,626.00	$7,332.10	$2,657.67	$5,336.04	$4,571.78	2026-01-22
25004513	CDM	Operating Room Services - General Classification	6	3	$8,626.00	$7,332.10	$2,657.67	$5,336.04	$4,571.78	2026-01-22
25001823	CDM	Operating Room Services - General Classification	6	3	$8,626.00	$7,332.10	$2,657.67	$5,336.04	$4,571.78	2026-01-22
25000692	CDM	Operating Room Services - General Classification	6	3	$8,348.00	$7,095.80	$2,572.02	$5,164.07	$4,424.44	2026-01-22
25000700	CDM	Operating Room Services - General Classification	6	3	$8,348.00	$7,095.80	$2,572.02	$5,164.07	$4,424.44	2026-01-22
25009227	CDM	Operating Room Services - General Classification	6	3	$8,348.00	$7,095.80	$2,572.02	$5,164.07	$4,424.44	2026-01-22
25005405	CDM	Operating Room Services - General Classification	6	3	$8,348.00	$7,095.80	$2,572.02	$5,164.07	$4,424.44	2026-01-22
25005235	CDM	Operating Room Services - General Classification	6	3	$8,014.00	$6,811.90	$2,469.11	$4,957.46	$4,247.42	2026-01-22
25010533	CDM	Operating Room Services - General Classification	6	3	$7,746.00	$6,584.10	$2,386.54	$4,791.68	$4,105.38	2026-01-22
25010018	CDM	Operating Room Services - General Classification	6	3	$7,680.00	$6,528.00	$2,366.21	$4,750.85	$4,070.40	2026-01-22
25001246	CDM	Operating Room Services - General Classification	6	3	$7,680.00	$6,528.00	$2,366.21	$4,750.85	$4,070.40	2026-01-22
25001202	CDM	Operating Room Services - General Classification	6	3	$7,632.00	$6,487.20	$2,351.42	$4,721.16	$4,044.96	2026-01-22
25000117	CDM	Operating Room Services - General Classification	6	3	$7,568.00	$6,432.80	$2,331.70	$4,681.56	$4,011.04	2026-01-22
25010051	CDM	Operating Room Services - General Classification	6	3	$7,513.00	$6,386.05	$2,314.76	$4,647.54	$3,981.89	2026-01-22
25006849	CDM	Operating Room Services - General Classification	6	3	$7,235.00	$6,149.75	$2,229.10	$4,475.57	$3,834.55	2026-01-22
25004031	CDM	Operating Room Services - General Classification	6	3	$7,079.00	$6,017.15	$2,181.04	$4,379.07	$3,751.87	2026-01-22
11458	CDM	Sodium Bicarb 650 Mg Tablet	6	3	$7,000.00	$5,950.00	$2,156.70	$4,330.20	$3,710.00	2026-01-22
81432	HCPCS	Test For Detecting Genes Associated With Inherited Breast Cancer-related Disorde…	6	3	$6,371.00	$5,415.35	$1,962.91	$3,941.10	$3,376.63	2026-01-22
25000543	CDM	Operating Room Services - General Classification	6	3	$5,904.00	$5,018.40	$1,819.02	$3,652.21	$3,129.12	2026-01-22
25000080	CDM	Operating Room Services - General Classification	6	3	$5,788.00	$4,919.80	$1,783.28	$3,580.46	$3,067.64	2026-01-22
25022732	CDM	Operating Room Services - General Classification	6	3	$5,738.00	$4,877.30	$1,767.88	$3,549.53	$3,041.14	2026-01-22
25003195	CDM	Operating Room Services - General Classification	6	3	$5,676.00	$4,824.60	$1,748.78	$3,511.17	$3,008.28	2026-01-22
25003187	CDM	Operating Room Services - General Classification	6	3	$5,676.00	$4,824.60	$1,748.78	$3,511.17	$3,008.28	2026-01-22
25000520	CDM	Operating Room Services - General Classification	6	3	$5,676.00	$4,824.60	$1,748.78	$3,511.17	$3,008.28	2026-01-22
143387{2}	CDM	Nirmatrelvir-ritonavir 300 Mg (150 Mg X 2)-100 Mg Oral Dspk	6	3	$5,664.95	$4,815.21	$1,745.37	$3,504.34	$3,002.42	2026-01-22
143387	CDM	Paxlovid 300-100 Mg Dose Pack	6	3	$5,664.95	$4,815.21	$1,745.37	$3,504.34	$3,002.42	2026-01-22
25009974	CDM	Operating Room Services - General Classification	6	3	$5,616.00	$4,773.60	$1,730.29	$3,474.06	$2,976.48	2026-01-22
55700	HCPCS	Biopsy Of Prostate Gland	6	3	$5,616.00	$4,773.60	$1,730.29	$3,474.06	$2,976.48	2026-01-22
25005812	CDM	Operating Room Services - General Classification	6	3	$5,616.00	$4,773.60	$1,730.29	$3,474.06	$2,976.48	2026-01-22
31510	HCPCS	Biopsy Of Voice Box Using An Endoscope With Mirror	6	3	$5,565.00	$4,730.25	$1,714.58	$3,442.51	$2,949.45	2026-01-22
25000328	CDM	Operating Room Services - General Classification	6	3	$5,565.00	$4,730.25	$1,714.58	$3,442.51	$2,949.45	2026-01-22
31536	HCPCS	Biopsy Of Voice Box Using An Endoscope With Operating Microscope Or Telescope	6	3	$5,565.00	$4,730.25	$1,714.58	$3,442.51	$2,949.45	2026-01-22
31535	HCPCS	Biopsy Of Voice Box Using An Endoscope	6	3	$5,565.00	$4,730.25	$1,714.58	$3,442.51	$2,949.45	2026-01-22
19120	HCPCS	Removal Of Growth And Tissue Of Breast, Duct, Or Nipple	6	3	$5,464.00	$4,644.40	$1,683.46	$3,380.03	$2,895.92	2026-01-22
25017205	CDM	Operating Room Services - General Classification	6	3	$5,443.00	$4,626.55	$1,676.99	$3,367.04	$2,884.79	2026-01-22
15273	HCPCS	Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.…	6	3	$5,435.00	$4,619.75	$1,674.52	$3,362.09	$2,880.55	2026-01-22
25003812	CDM	Operating Room Services - General Classification	6	3	$5,426.00	$4,612.10	$1,671.75	$3,356.52	$2,875.78	2026-01-22
25004257	CDM	Operating Room Services - General Classification	6	3	$5,426.00	$4,612.10	$1,671.75	$3,356.52	$2,875.78	2026-01-22
25003275	CDM	Operating Room Services - General Classification	6	3	$5,417.00	$4,604.45	$1,668.98	$3,350.96	$2,871.01	2026-01-22
25001995	CDM	Operating Room Services - General Classification	6	3	$5,342.00	$4,540.70	$1,645.87	$3,304.56	$2,831.26	2026-01-22
25009953	CDM	Operating Room Services - General Classification	6	3	$5,281.00	$4,488.85	$1,627.08	$3,266.83	$2,798.93	2026-01-22
25005784	CDM	Operating Room Services - General Classification	6	3	$5,243.00	$4,456.55	$1,615.37	$3,243.32	$2,778.79	2026-01-22
25001657	CDM	Operating Room Services - General Classification	6	3	$5,231.00	$4,446.35	$1,611.67	$3,235.90	$2,772.43	2026-01-22
25003704	CDM	Operating Room Services - General Classification	6	3	$5,204.00	$4,423.40	$1,603.35	$3,219.19	$2,758.12	2026-01-22
75635	HCPCS	CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast	6	3	$5,176.00	$4,399.60	$1,594.73	$3,201.87	$2,743.28	2026-01-22
25009406	CDM	Operating Room Services - General Classification	6	3	$5,120.00	$4,352.00	$1,577.47	$3,167.23	$2,713.60	2026-01-22
78452	HCPCS	Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect	6	3	$4,712.00	$4,005.20	$2,497.36	$5,417.00	$2,708.50	2026-01-22
78815	HCPCS	Nuclear Medicine Study From Skull Base To Mid-thigh With CT Scan	12	3	$5,065.00	$4,305.25	$1,560.53	$3,133.21	$2,684.45	2026-01-22
78816	HCPCS	Nuclear Medicine Study Whole Body With CT Scan	12	3	$5,065.00	$4,305.25	$1,560.53	$3,133.21	$2,684.45	2026-01-22
95811	HCPCS	Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older)	6	3	$5,052.00	$4,294.20	$1,556.52	$3,125.17	$2,677.56	2026-01-22
25000219	CDM	Operating Room Services - General Classification	6	3	$5,009.00	$4,257.65	$1,543.27	$3,098.57	$2,654.77	2026-01-22
25024997	CDM	Operating Room Services - General Classification	6	3	$5,009.00	$4,257.65	$1,543.27	$3,098.57	$2,654.77	2026-01-22
25015539	CDM	Operating Room Services - General Classification	6	3	$5,009.00	$4,257.65	$1,543.27	$3,098.57	$2,654.77	2026-01-22
25003360	CDM	Operating Room Services - General Classification	6	3	$5,009.00	$4,257.65	$1,543.27	$3,098.57	$2,654.77	2026-01-22
25000381	CDM	Operating Room Services - General Classification	6	3	$4,990.00	$4,241.50	$1,537.42	$3,086.81	$2,644.70	2026-01-22
25003051	CDM	Operating Room Services - General Classification	6	3	$4,982.00	$4,234.70	$1,534.95	$3,081.87	$2,640.46	2026-01-22
25019682	CDM	Operating Room Services - General Classification	6	3	$4,969.00	$4,223.65	$1,530.95	$3,073.82	$2,633.57	2026-01-22
25003009	CDM	Operating Room Services - General Classification	6	3	$4,904.00	$4,168.40	$1,510.92	$3,033.61	$2,599.12	2026-01-22
25019809	CDM	Operating Room Services - General Classification	6	3	$4,904.00	$4,168.40	$1,510.92	$3,033.61	$2,599.12	2026-01-22
28124	HCPCS	Partial Removal Of Toe Bone	6	3	$4,904.00	$4,168.40	$1,510.92	$3,033.61	$2,599.12	2026-01-22
25010235	CDM	Operating Room Services - General Classification	6	3	$4,830.00	$4,105.50	$1,488.12	$2,987.84	$2,559.90	2026-01-22
25011096	CDM	Operating Room Services - General Classification	6	3	$4,828.00	$4,103.80	$1,487.51	$2,986.60	$2,558.84	2026-01-22
25006873	CDM	Operating Room Services - General Classification	6	3	$4,828.00	$4,103.80	$1,487.51	$2,986.60	$2,558.84	2026-01-22
25006471	CDM	Operating Room Services - General Classification	6	3	$4,825.00	$4,101.25	$1,486.58	$2,984.75	$2,557.25	2026-01-22
25004712	CDM	Operating Room Services - General Classification	6	3	$4,808.00	$4,086.80	$1,481.34	$2,974.23	$2,548.24	2026-01-22
25003986	CDM	Operating Room Services - General Classification	6	3	$4,786.00	$4,068.10	$1,474.57	$2,960.62	$2,536.58	2026-01-22
25000252	CDM	Operating Room Services - General Classification	6	3	$4,786.00	$4,068.10	$1,474.57	$2,960.62	$2,536.58	2026-01-22
25000021	CDM	Operating Room Services - General Classification	6	3	$4,786.00	$4,068.10	$1,474.57	$2,960.62	$2,536.58	2026-01-22
25004167	CDM	Operating Room Services - General Classification	6	3	$4,750.00	$4,037.50	$1,463.48	$2,938.35	$2,517.50	2026-01-22
25002348	CDM	Operating Room Services - General Classification	6	3	$4,732.00	$4,022.20	$1,457.93	$2,927.22	$2,507.96	2026-01-22
25010899	CDM	Operating Room Services - General Classification	6	3	$4,720.00	$4,012.00	$1,454.23	$2,919.79	$2,501.60	2026-01-22
25012615	CDM	Operating Room Services - General Classification	6	3	$4,720.00	$4,012.00	$1,454.23	$2,919.79	$2,501.60	2026-01-22
25013827	CDM	Operating Room Services - General Classification	6	3	$4,614.00	$3,921.90	$1,421.57	$2,854.22	$2,445.42	2026-01-22
25001958	CDM	Operating Room Services - General Classification	6	3	$4,586.00	$3,898.10	$1,412.95	$2,836.90	$2,430.58	2026-01-22
95810	HCPCS	Sleep Study In Sleep Lab (6 Years Or Older)	6	3	$4,503.00	$3,827.55	$1,387.37	$2,785.56	$2,386.59	2026-01-22
25009672	CDM	Operating Room Services - General Classification	6	3	$4,464.00	$3,794.40	$1,375.36	$2,761.43	$2,365.92	2026-01-22
25002430	CDM	Operating Room Services - General Classification	6	3	$4,456.00	$3,787.60	$1,372.89	$2,756.48	$2,361.68	2026-01-22
25003388	CDM	Operating Room Services - General Classification	6	3	$4,375.00	$3,718.75	$1,347.94	$2,706.38	$2,318.75	2026-01-22
25006386	CDM	Operating Room Services - General Classification	6	3	$4,335.00	$3,684.75	$1,335.61	$2,681.63	$2,297.55	2026-01-22
25006501	CDM	Operating Room Services - General Classification	6	3	$4,305.00	$3,659.25	$1,326.37	$2,663.07	$2,281.65	2026-01-22
5380	CDM	Olanzapine 5 Mg Tablet	6	3	$4,295.20	$3,650.92	$1,323.35	$2,657.01	$2,276.46	2026-01-22
25010104	CDM	Operating Room Services - General Classification	6	3	$4,250.00	$3,612.50	$1,309.43	$2,629.05	$2,252.50	2026-01-22
25002937	CDM	Operating Room Services - General Classification	6	3	$4,174.00	$3,547.90	$1,286.01	$2,582.04	$2,212.22	2026-01-22
25006753	CDM	Operating Room Services - General Classification	6	3	$4,165.00	$3,540.25	$1,283.24	$2,576.47	$2,207.45	2026-01-22
25011081	CDM	Operating Room Services - General Classification	6	3	$4,163.00	$3,538.55	$1,282.62	$2,575.23	$2,206.39	2026-01-22
25000557	CDM	Operating Room Services - General Classification	6	3	$4,146.00	$3,524.10	$1,277.38	$2,564.72	$2,197.38	2026-01-22
25002791	CDM	Operating Room Services - General Classification	6	3	$4,118.00	$3,500.30	$1,268.76	$2,547.39	$2,182.54	2026-01-22
25007950	CDM	Operating Room Services - General Classification	6	3	$4,041.00	$3,434.85	$1,245.03	$2,499.76	$2,141.73	2026-01-22
25011918	CDM	Operating Room Services - General Classification	6	3	$4,041.00	$3,434.85	$1,245.03	$2,499.76	$2,141.73	2026-01-22
25010999	CDM	Operating Room Services - General Classification	6	3	$4,041.00	$3,434.85	$1,245.03	$2,499.76	$2,141.73	2026-01-22
25002988	CDM	Operating Room Services - General Classification	6	3	$3,926.00	$3,337.10	$1,209.60	$2,428.62	$2,080.78	2026-01-22
25004409	CDM	Operating Room Services - General Classification	6	3	$3,885.00	$3,302.25	$1,196.97	$2,403.26	$2,059.05	2026-01-22
25000039	CDM	Operating Room Services - General Classification	6	3	$3,885.00	$3,302.25	$1,196.97	$2,403.26	$2,059.05	2026-01-22
105310	CDM	Eliquis 2.5 Mg Tablet	6	3	$3,863.93	$3,284.34	$1,190.48	$2,390.23	$2,047.88	2026-01-22
25007989	CDM	Operating Room Services - General Classification	6	3	$3,732.00	$3,172.20	$1,149.83	$2,308.62	$1,977.96	2026-01-22
25004760	CDM	Operating Room Services - General Classification	6	3	$3,710.00	$3,153.50	$1,143.05	$2,295.01	$1,966.30	2026-01-22
25004611	CDM	Operating Room Services - General Classification	6	3	$3,673.00	$3,122.05	$1,131.65	$2,272.12	$1,946.69	2026-01-22
J7307	HCPCS	Etonogestrel (contraceptive) Implant System, Including Implant And Supplies	6	3	$3,643.89	$3,097.31	$1,238.93	$2,477.86	$1,931.26	2026-01-22
73222	HCPCS	MRI Scan Of Arm Joint With Contrast	12	3	$3,274.00	$2,782.90	$1,735.22	$3,818.00	$1,909.00	2026-01-22
73722	HCPCS	MRI Scan Of Leg Joint With Contrast	12	3	$3,274.00	$2,782.90	$1,735.22	$3,818.00	$1,909.00	2026-01-22
25023231	CDM	Operating Room Services - General Classification	6	3	$3,596.00	$3,056.60	$1,107.93	$2,224.49	$1,905.88	2026-01-22
25004103	CDM	Operating Room Services - General Classification	6	3	$3,541.00	$3,009.85	$1,090.98	$2,190.46	$1,876.73	2026-01-22
J7298	HCPCS	Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg	6	3	$3,470.37	$2,949.81	$1,238.93	$2,477.86	$1,839.30	2026-01-22
J7296	HCPCS	Levonorgestrel-releasing Intrauterine Contraceptive System, (kyleena), 19.5 Mg	6	3	$3,470.37	$2,949.81	$1,238.93	$2,477.86	$1,839.30	2026-01-22
74178	HCPCS	CT Scan Of Abdomen And Pelvis Before And After Contrast	6	3	$5,864.00	$4,984.40	$917.00	$3,107.92	$1,834.00	2026-01-22
73220	HCPCS	MRI Scan Of Arm Before And After Contrast	12	3	$4,388.00	$3,729.80	$917.00	$2,325.64	$1,834.00	2026-01-22
72158	HCPCS	MRI Scan Of Lower Spinal Canal Before And After Contrast	6	3	$4,333.00	$3,683.05	$917.00	$2,296.49	$1,834.00	2026-01-22
70553	HCPCS	MRI Scan Of Brain Before And After Contrast	6	3	$4,526.00	$3,847.10	$917.00	$2,398.78	$1,834.00	2026-01-22
74174	HCPCS	CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast	6	3	$4,563.00	$3,878.55	$917.00	$2,418.39	$1,834.00	2026-01-22
74177	HCPCS	CT Scan Of Abdomen And Pelvis With Contrast	6	3	$3,968.00	$3,372.80	$917.00	$2,103.04	$1,834.00	2026-01-22
25000833	CDM	Operating Room Services - General Classification	6	3	$3,433.00	$2,918.05	$1,057.71	$2,123.65	$1,819.49	2026-01-22
25003900	CDM	Operating Room Services - General Classification	6	3	$3,400.00	$2,890.00	$1,047.54	$2,103.24	$1,802.00	2026-01-22
74183	HCPCS	MRI Scan Of Abdomen Before And After Contrast	8	3	$4,965.00	$4,220.25	$917.00	$2,631.45	$1,784.61	2026-01-22
73223	HCPCS	MRI Scan Of Arm Joint Before And After Contrast	12	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
73219	HCPCS	MRI Scan Of Arm With Contrast	12	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
72197	HCPCS	MRI Scan Of Pelvis Before And After Contrast	6	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
72196	HCPCS	MRI Scan Of Pelvis With Contrast	6	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
72157	HCPCS	MRI Scan Of Middle Spinal Canal Before And After Contrast	6	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
72156	HCPCS	MRI Scan Of Upper Spinal Canal Before And After Contrast	6	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
72149	HCPCS	MRI Scan Of Lower Spinal Canal With Contrast	6	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
72147	HCPCS	MRI Scan Of Middle Spinal Canal With Contrast	6	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
72142	HCPCS	MRI Scan Of Upper Spinal Canal With Contrast	6	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
70552	HCPCS	MRI Scan Of Brain With Contrast	6	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
70549	HCPCS	MRI Scan Of Blood Vessels Of Neck Before And After Contrast	6	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
70548	HCPCS	MRI Scan Of Blood Vessels Of Neck With Contrast	6	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
70546	HCPCS	MRI Scan Of Blood Vessels Of Head Before And After Contrast	6	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
70543	HCPCS	MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast	6	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
70542	HCPCS	MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast	6	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
73723	HCPCS	MRI Scan Of Leg Joint Before And After Contrast	12	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
73720	HCPCS	MRI Scan Of Leg Before And After Contrast	12	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
73719	HCPCS	MRI Scan Of Leg With Contrast	12	3	$3,274.00	$2,782.90	$917.00	$1,834.00	$1,735.22	2026-01-22
25005552	CDM	Operating Room Services - General Classification	6	3	$3,250.00	$2,762.50	$1,001.33	$2,010.45	$1,722.50	2026-01-22
25000670	CDM	Operating Room Services - General Classification	6	3	$3,228.00	$2,743.80	$994.55	$1,996.84	$1,710.84	2026-01-22
58002822	CDM	Gastro - Intestinal (gi) Services - General Classification	6	3	$3,223.00	$2,739.55	$993.01	$1,993.75	$1,708.19	2026-01-22
25017739	CDM	Operating Room Services - General Classification	6	3	$3,217.00	$2,734.45	$991.16	$1,990.04	$1,705.01	2026-01-22
25014539	CDM	Operating Room Services - General Classification	6	3	$3,217.00	$2,734.45	$991.16	$1,990.04	$1,705.01	2026-01-22
25011970	CDM	Operating Room Services - General Classification	6	3	$3,217.00	$2,734.45	$991.16	$1,990.04	$1,705.01	2026-01-22
25015450	CDM	Operating Room Services - General Classification	6	3	$3,180.00	$2,703.00	$979.76	$1,967.15	$1,685.40	2026-01-22
25005059	CDM	Operating Room Services - General Classification	6	3	$3,116.00	$2,648.60	$960.04	$1,927.56	$1,651.48	2026-01-22
25003093	CDM	Operating Room Services - General Classification	6	3	$3,116.00	$2,648.60	$960.04	$1,927.56	$1,651.48	2026-01-22
99291	HCPCS	Critical Care, First 30-74 Minutes	6	3	$3,099.00	$2,634.15	$954.80	$1,917.04	$1,642.47	2026-01-22
25005328	CDM	Operating Room Services - General Classification	6	3	$3,095.00	$2,630.75	$953.57	$1,914.57	$1,640.35	2026-01-22
25004153	CDM	Operating Room Services - General Classification	6	3	$3,039.00	$2,583.15	$936.32	$1,879.93	$1,610.67	2026-01-22
25017756	CDM	Operating Room Services - General Classification	6	3	$3,039.00	$2,583.15	$936.32	$1,879.93	$1,610.67	2026-01-22
25011903	CDM	Operating Room Services - General Classification	6	3	$3,001.00	$2,550.85	$924.61	$1,856.42	$1,590.53	2026-01-22
25003881	CDM	Operating Room Services - General Classification	6	3	$2,968.00	$2,522.80	$914.44	$1,836.00	$1,573.04	2026-01-22
25002030	CDM	Operating Room Services - General Classification	6	3	$2,948.00	$2,505.80	$908.28	$1,823.63	$1,562.44	2026-01-22
58001972	CDM	Ambulatory Surgical Care - General Classification	6	3	$2,932.00	$2,492.20	$903.35	$1,813.74	$1,553.96	2026-01-22
25011863	CDM	Operating Room Services - General Classification	6	3	$2,921.00	$2,482.85	$899.96	$1,806.93	$1,548.13	2026-01-22
58002836	CDM	Gastro - Intestinal (gi) Services - General Classification	6	3	$2,914.00	$2,476.90	$897.80	$1,802.60	$1,544.42	2026-01-22
J7301	HCPCS	Levonorgestrel-releasing Intrauterine Contraceptive System (skyla), 13.5 Mg	6	3	$2,889.66	$2,456.21	$1,031.61	$2,063.22	$1,531.52	2026-01-22
25003624	CDM	Operating Room Services - General Classification	6	3	$2,881.00	$2,448.85	$887.64	$1,782.19	$1,526.93	2026-01-22
25025331	CDM	Operating Room Services - General Classification	6	3	$2,881.00	$2,448.85	$887.64	$1,782.19	$1,526.93	2026-01-22
15275	HCPCS	Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne…	6	3	$2,866.00	$2,436.10	$883.01	$1,772.91	$1,518.98	2026-01-22
J7300	HCPCS	Intrauterine Copper Contraceptive	6	3	$2,813.00	$2,391.05	$1,161.78	$2,323.56	$1,490.89	2026-01-22
25012599	CDM	Operating Room Services - General Classification	6	3	$2,762.00	$2,347.70	$850.97	$1,708.57	$1,463.86	2026-01-22
25011938	CDM	Operating Room Services - General Classification	6	3	$2,760.00	$2,346.00	$850.36	$1,707.34	$1,462.80	2026-01-22
25004494	CDM	Operating Room Services - General Classification	6	3	$2,760.00	$2,346.00	$850.36	$1,707.34	$1,462.80	2026-01-22
25003850	CDM	Operating Room Services - General Classification	6	3	$2,759.00	$2,345.15	$850.05	$1,706.72	$1,462.27	2026-01-22
15271	HCPCS	Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C…	6	3	$2,756.00	$2,342.60	$849.12	$1,704.86	$1,460.68	2026-01-22
25007286	CDM	Operating Room Services - General Classification	6	3	$2,722.00	$2,313.70	$838.65	$1,683.83	$1,442.66	2026-01-22
36568	HCPCS	Insertion Of Tube For Infusion (younger Than 5 Years)	6	3	$2,672.00	$2,271.20	$823.24	$1,652.90	$1,416.16	2026-01-22
25001474	CDM	Operating Room Services - General Classification	6	3	$2,672.00	$2,271.20	$823.24	$1,652.90	$1,416.16	2026-01-22
25006328	CDM	Operating Room Services - General Classification	6	3	$2,672.00	$2,271.20	$823.24	$1,652.90	$1,416.16	2026-01-22
36572	HCPCS	Insertion Of Tube For Infusion With Imaging Guidance And Review By Radiologist, …	6	3	$2,672.00	$2,271.20	$823.24	$1,652.90	$1,416.16	2026-01-22
25000586	CDM	Operating Room Services - General Classification	6	3	$2,671.00	$2,270.35	$822.94	$1,652.28	$1,415.63	2026-01-22
25005507	CDM	Operating Room Services - General Classification	6	3	$2,621.00	$2,227.85	$807.53	$1,621.35	$1,389.13	2026-01-22
3517	CDM	Pacerone 200 Mg Tablet	6	3	$2,581.80	$2,194.53	$795.45	$1,597.10	$1,368.35	2026-01-22
25004396	CDM	Operating Room Services - General Classification	6	3	$2,572.00	$2,186.20	$792.43	$1,591.04	$1,363.16	2026-01-22
25003012	CDM	Operating Room Services - General Classification	6	3	$2,560.00	$2,176.00	$788.74	$1,583.62	$1,356.80	2026-01-22
25005883	CDM	Operating Room Services - General Classification	6	3	$2,555.00	$2,171.75	$787.20	$1,580.52	$1,354.15	2026-01-22
11044	HCPCS	Removal Of Bone, 20.0 Sq Cm Or Less	6	3	$2,542.00	$2,160.70	$783.19	$1,572.48	$1,347.26	2026-01-22
25000270	CDM	Operating Room Services - General Classification	6	3	$2,528.00	$2,148.80	$778.88	$1,563.82	$1,339.84	2026-01-22
26000018	CDM	General Anesthesia Charge	6	3	$2,505.00	$2,129.25	$771.79	$1,549.59	$1,327.65	2026-01-22
72132	HCPCS	CT Scan Of Lower Spine With Contrast	6	3	$2,473.00	$2,102.05	$917.00	$1,834.00	$1,310.69	2026-01-22
72126	HCPCS	CT Scan Of Upper Spine With Contrast	6	3	$2,473.00	$2,102.05	$917.00	$1,834.00	$1,310.69	2026-01-22
71271	HCPCS	Low Dose CT Scan Of Chest For Lung Cancer Screening	6	3	$2,473.00	$2,102.05	$761.93	$1,529.80	$1,310.69	2026-01-22
38898	CDM	Pregabalin 200 Mg Capsule	6	3	$2,464.90	$2,095.17	$759.44	$1,524.79	$1,306.40	2026-01-22
25002654	CDM	Operating Room Services - General Classification	6	3	$2,449.00	$2,081.65	$754.54	$1,514.95	$1,297.97	2026-01-22
25015199	CDM	Operating Room Services - General Classification	6	3	$2,435.00	$2,069.75	$750.22	$1,506.29	$1,290.55	2026-01-22
25012903	CDM	Operating Room Services - General Classification	6	3	$2,435.00	$2,069.75	$750.22	$1,506.29	$1,290.55	2026-01-22
A0427	HCPCS	Ambulance Service, Advanced Life Support, Emergency Transport, Level 1 (als 1 - …	6	3	$2,407.00	$2,045.95	$741.60	$1,488.97	$1,275.71	2026-01-22
25014759	CDM	Operating Room Services - General Classification	6	3	$2,399.00	$2,039.15	$739.13	$1,484.02	$1,271.47	2026-01-22
25004130	CDM	Operating Room Services - General Classification	6	3	$2,395.00	$2,035.75	$737.90	$1,481.55	$1,269.35	2026-01-22
25015781	CDM	Operating Room Services - General Classification	6	3	$2,393.00	$2,034.05	$737.28	$1,480.31	$1,268.29	2026-01-22
25009946	CDM	Operating Room Services - General Classification	6	3	$2,385.00	$2,027.25	$734.82	$1,475.36	$1,264.05	2026-01-22
112533	CDM	Jardiance 10 Mg Tablet	6	3	$2,383.29	$2,025.80	$734.29	$1,474.30	$1,263.14	2026-01-22
25023666	CDM	Operating Room Services - General Classification	6	3	$2,374.00	$2,017.90	$731.43	$1,468.56	$1,258.22	2026-01-22
40819	HCPCS	Removal Of Tissue At Dental Edge And Cheek	6	3	$2,318.00	$1,970.30	$714.18	$1,433.91	$1,228.54	2026-01-22
42800	HCPCS	Biopsy Of Back Of Throat	6	3	$2,315.00	$1,967.75	$713.25	$1,432.06	$1,226.95	2026-01-22
25002670	CDM	Operating Room Services - General Classification	6	3	$2,293.00	$1,949.05	$706.47	$1,418.45	$1,215.29	2026-01-22
A0433	HCPCS	Advanced Life Support, Level 2 (als 2)	6	3	$2,287.00	$1,943.95	$704.62	$1,414.74	$1,212.11	2026-01-22
25002681	CDM	Operating Room Services - General Classification	6	3	$2,287.00	$1,943.95	$704.62	$1,414.74	$1,212.11	2026-01-22
93306	HCPCS	Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu…	6	3	$2,250.00	$1,912.50	$1,052.50	$2,105.00	$1,192.50	2026-01-22
68211	CDM	Januvia 50 Mg Tablet	6	3	$2,234.70	$1,899.50	$688.51	$1,382.39	$1,184.39	2026-01-22
78803	HCPCS	Nuclear Medicine Study, Spect Imaging, 1 Area Or Single Acquisition, Single Day …	6	3	$2,226.00	$1,892.10	$685.83	$1,377.00	$1,179.78	2026-01-22
78831	HCPCS	Nuclear Medicine Study, Spect Imaging, At Least 2 Areas Or Separate Acquisitions…	6	3	$2,226.00	$1,892.10	$685.83	$1,377.00	$1,179.78	2026-01-22
97000	CDM	Xarelto 10 Mg Tablet	6	3	$2,221.34	$1,888.14	$684.39	$1,374.12	$1,177.31	2026-01-22
98942	CDM	Xarelto 15 Mg Tablet	6	3	$2,221.34	$1,888.14	$684.39	$1,374.12	$1,177.31	2026-01-22
25001134	CDM	Operating Room Services - General Classification	6	3	$2,215.00	$1,882.75	$682.44	$1,370.20	$1,173.95	2026-01-22
73225	HCPCS	MRI Scan Of Blood Vessels Of Arm	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
73221	HCPCS	MRI Scan Of Arm Joint Without Contrast	12	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
73218	HCPCS	MRI Scan Of Arm Without Contrast	12	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
72198	HCPCS	MRI Scan Of Blood Vessels Of Pelvis	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
72195	HCPCS	MRI Scan Of Pelvis Without Contrast	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
72148	HCPCS	MRI Scan Of Lower Spinal Canal Without Contrast	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
72146	HCPCS	MRI Scan Of Middle Spinal Canal Without Contrast	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
72141	HCPCS	MRI Scan Of Upper Spinal Canal Without Contrast	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
71550	HCPCS	MRI Scan Of Chest Without Contrast	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
70551	HCPCS	MRI Scan Of Brain Without Contrast	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
70547	HCPCS	MRI Scan Of Blood Vessels Of Neck Without Contrast	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
70544	HCPCS	MRI Scan Of Blood Vessels Of Head Without Contrast	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
70540	HCPCS	MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
70336	HCPCS	MRI Scan Of Jaw Joint	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
74185	HCPCS	MRI Scan Of Blood Vessels Of Abdomen	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
74181	HCPCS	MRI Scan Of Abdomen Without Contrast	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
74176	HCPCS	CT Scan Of Abdomen And Pelvis Without Contrast	6	3	$3,709.00	$3,152.65	$584.50	$1,965.77	$1,169.00	2026-01-22
73725	HCPCS	MRI Scan Of Blood Vessels Of Leg	6	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
73721	HCPCS	MRI Scan Of Leg Joint Without Contrast	12	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
73718	HCPCS	MRI Scan Of Leg Without Contrast	12	3	$3,274.00	$2,782.90	$584.50	$1,735.22	$1,169.00	2026-01-22
J8597	HCPCS	Antiemetic Drug, Oral, Not Otherwise Specified	6	3	$2,172.59	$1,846.70	$669.38	$1,343.96	$1,151.47	2026-01-22
A0426	HCPCS	Ambulance Service, Advanced Life Support, Non-emergency Transport, Level 1 (als …	6	3	$2,167.00	$1,841.95	$667.65	$1,340.51	$1,148.51	2026-01-22
25010672	CDM	Operating Room Services - General Classification	6	3	$2,119.00	$1,801.15	$652.86	$1,310.81	$1,123.07	2026-01-22
72320028	CDM	Room & Board - Semi-private (two Beds) - General Classification	4	2	$2,356.00	$2,002.60	$725.88	$1,457.42	$1,091.65	2026-01-22
96182	CDM	Tradjenta 5 Mg Tablet	6	3	$2,047.79	$1,740.62	$630.92	$1,266.76	$1,085.33	2026-01-22
8132	CDM	Vancomycin Hcl 125 Mg Capsule	6	3	$2,034.89	$1,729.66	$626.95	$1,258.78	$1,078.49	2026-01-22
25002593	CDM	Operating Room Services - General Classification	6	3	$2,031.00	$1,726.35	$625.75	$1,256.38	$1,076.43	2026-01-22
73201	HCPCS	CT Scan Of Arm With Contrast	6	3	$2,024.00	$1,720.40	$917.00	$1,834.00	$1,072.72	2026-01-22
93930	HCPCS	Ultrasound Of Arm Arteries Or Artery Grafts	6	3	$2,003.00	$1,702.55	$617.12	$1,239.06	$1,061.59	2026-01-22
25004172	CDM	Operating Room Services - General Classification	6	3	$1,986.00	$1,688.10	$611.89	$1,228.54	$1,052.58	2026-01-22
52204	HCPCS	Biopsy Of Bladder Using An Endoscope	6	3	$1,983.00	$1,685.55	$610.96	$1,226.68	$1,050.99	2026-01-22
25009481	CDM	Operating Room Services - General Classification	6	3	$1,983.00	$1,685.55	$610.96	$1,226.68	$1,050.99	2026-01-22
17853	CDM	Colchicine 0.6 Mg Tablet	6	3	$1,970.28	$1,674.74	$607.04	$1,218.82	$1,044.25	2026-01-22
99285	HCPCS	Emergency Department Visit With High Level Of Medical Decision Making	6	3	$1,957.00	$1,663.45	$602.95	$1,210.60	$1,037.21	2026-01-22
57461	HCPCS	Cone Biopsy Of Cervix And Vagina Using An Endoscope With Loop Electrode	12	3	$2,861.00	$2,431.85	$308.72	$2,919.79	$1,037.04	2026-01-22
25007872	CDM	Operating Room Services - General Classification	6	3	$1,948.00	$1,655.80	$600.18	$1,205.03	$1,032.44	2026-01-22
57460	HCPCS	Biopsy Of Cervix Using An Endoscope With Loop Electrode	12	3	$2,830.50	$2,405.93	$289.92	$2,919.79	$1,018.16	2026-01-22
81319	HCPCS	Gene Analysis (postmeiotic Segregation Increased 2 [s Cerevisiae]) Duplication O…	6	3	$1,910.00	$1,623.50	$588.47	$1,181.53	$1,012.30	2026-01-22
81420	HCPCS	Test For Detecting Genes Associated With Fetal Disease, Aneuploidy Genomic Seque…	6	3	$1,882.00	$1,599.70	$579.84	$1,164.21	$997.46	2026-01-22
86366	HCPCS	Test For Muscle-specific Kinase Antibody	6	3	$1,873.00	$1,592.05	$577.07	$1,158.64	$992.69	2026-01-22
25024971	CDM	Operating Room Services - General Classification	6	3	$1,870.00	$1,589.50	$576.15	$1,156.78	$991.10	2026-01-22
52000	HCPCS	Diagnostic Exam Of Bladder And Urethra Using An Endoscope	6	3	$1,860.00	$1,581.00	$573.07	$1,150.60	$985.80	2026-01-22
25000465	CDM	Operating Room Services - General Classification	6	3	$1,860.00	$1,581.00	$573.07	$1,150.60	$985.80	2026-01-22
78306	HCPCS	Nuclear Medicine Study Of Bone And/or Joint Whole Body	6	3	$1,835.00	$1,559.75	$565.36	$1,135.13	$972.55	2026-01-22
25012430	CDM	Operating Room Services - General Classification	6	3	$1,829.00	$1,554.65	$563.51	$1,131.42	$969.37	2026-01-22
25001429	CDM	Operating Room Services - General Classification	6	3	$1,787.00	$1,518.95	$550.57	$1,105.44	$947.11	2026-01-22
C8929	HCPCS	Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi…	6	3	$1,781.00	$1,513.85	$548.73	$1,101.73	$943.93	2026-01-22
78451	HCPCS	Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect	6	3	$1,771.00	$1,505.35	$545.65	$1,095.54	$938.63	2026-01-22
25014093	CDM	Operating Room Services - General Classification	6	3	$1,767.00	$1,501.95	$544.41	$1,093.07	$936.51	2026-01-22
64483	HCPCS	Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I…	6	3	$1,764.00	$1,499.40	$543.49	$1,091.21	$934.92	2026-01-22

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