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Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

ROOSEVELT MEDICAL CENTER

Culbertson, MT · CCN 271308 · Rates published

1,697 distinct procedures filed
12 distinct payers
31,370 rate rows
2026-04-01 last MRF observed
Data quality

31,278 of 31,370 rate rows are consumer-grade (99.7%)

92 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
percent-of-charges filed in the dollar field — excluded from medians 88
exceeds 10× this hospital's gross charge — excluded from medians 4
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://rooseveltmedical.org/wp-content/uploads/2026/07/810373589_roosevelt-medical-center_standardcharges.csv
Found on page https://rooseveltmedical.org/services/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-11-02
Content fingerprint ba79318f7dcb622e… · 4,680,318 bytes · first seen 2026-08-03

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
G0378
HCPCS 		Observation 10 Hr 12 $161.16 $13,183.68 $6,460.06 nat. median
$113
outlier · 57.3×
0120
RC 		12 $3,868.20 $6,592.00 $5,934.88 nat. median
$984
outlier · 6.0×
74174
HCPCS 		CTA Abdomen And Pelvis 10 $4,763.70 $5,293.00 $5,187.14 nat. median
$988
outlier · 5.2×
74174
CPT 		CTA Abdomen And Pelvis 8 $3,769.20 $4,188.00 $4,104.24 nat. median
$988
outlier · 4.2×
70471
HCPCS 		CTA Head And Neck 10 $3,222.00 $3,580.00 $3,508.40 nat. median
$835
outlier · 4.2×
71552
HCPCS 		MRI Chest (clavicle) Without &w Contrast 10 $3,098.70 $3,443.00 $3,374.14 nat. median
$1,097
outlier · 3.1×
71552
CPT 		MRI Chest (clavicle) Without &w Contrast 8 $3,098.70 $3,443.00 $3,374.14 nat. median
$1,097
outlier · 3.1×
74178
CPT 		CT Abdomen And Pelvis With And Without Contrast 8 $3,002.40 $3,336.00 $3,269.28 nat. median
$1,024
outlier · 3.2×
74178
HCPCS 		CT Abdomen And Pelvis With And Without Contrast 10 $3,002.40 $3,336.00 $3,269.28 nat. median
$1,024
outlier · 3.2×
73220
HCPCS 		MRI Upper Extremity, Non-joint Without & With Contrast 10 $2,693.70 $2,993.00 $2,933.14 nat. median
$1,128
outlier · 2.6×
73220
CPT 		MRI Upper Extremity, Non-joint Without & With Contrast 8 $2,693.70 $2,993.00 $2,933.14 nat. median
$1,128
outlier · 2.6×
72126
HCPCS 		CT Cervical Spine With Contrast 10 $2,587.50 $2,875.00 $2,817.50 nat. median
$755
outlier · 3.7×
72126
CPT 		CT Cervical Spine With Contrast 8 $2,587.50 $2,875.00 $2,817.50 nat. median
$755
outlier · 3.7×
74170
CPT 		CT Abdomen With And Without Contrast 8 $2,574.90 $2,861.00 $2,803.78 nat. median
$710
outlier · 3.9×
74170
HCPCS 		CT Abdomen With And Without Contrast 10 $2,574.90 $2,861.00 $2,803.78 nat. median
$710
outlier · 3.9×
59409
CPT 		Vaginal Delivery Of Baby 8 $2,556.90 $2,841.00 $2,784.18 nat. median
$3,155
0.9× median
59414
CPT 		Delivery Of Placenta 8 $2,556.00 $2,840.00 $2,783.20 nat. median
$2,865
1.0× median
75630
CPT 		CTA Abdominal Aorta & Bilateral Iliofemoral Lower Ext. Runoff 8 $2,555.10 $2,839.00 $2,782.22 nat. median
$3,321
0.8× median
75635
HCPCS 		CTA Abdominal Aorta & Bilateral Iliofemoral Lower Ext. Runoff 10 $2,555.10 $2,839.00 $2,782.22 nat. median
$719
outlier · 3.9×
73223
HCPCS 		MRI Upper Extremity, Joint Without & With Contrast 10 $2,544.30 $2,827.00 $2,770.46 nat. median
$1,158
outlier · 2.4×
73223
CPT 		MRI Upper Extremity, Joint Without & With Contrast 8 $2,544.30 $2,827.00 $2,770.46 nat. median
$1,158
outlier · 2.4×
71275
CPT 		CTA Chest 8 $2,538.00 $2,820.00 $2,763.60 nat. median
$753
outlier · 3.7×
71275
HCPCS 		CTA Chest 10 $2,538.00 $2,820.00 $2,763.60 nat. median
$753
outlier · 3.7×
73723
HCPCS 		MRI Lower Extremity, Joint Without & With Contrast 10 $2,534.40 $2,816.00 $2,759.68 nat. median
$1,191
outlier · 2.3×
73723
CPT 		MRI Lower Extremity, Joint Without & With Contrast 8 $2,534.40 $2,816.00 $2,759.68 nat. median
$1,191
outlier · 2.3×
70553
HCPCS 		MRI Brain Without & With Contrast 10 $2,503.80 $2,782.00 $2,726.36 nat. median
$1,132
outlier · 2.4×
71270
HCPCS 		CT Chest With And Without Contrast 10 $2,492.10 $2,769.00 $2,713.62 nat. median
$672
outlier · 4.0×
74183
HCPCS 		MRI Abdomen Without & W Contrast 10 $2,472.30 $2,747.00 $2,692.06 nat. median
$1,099
outlier · 2.4×
72197
HCPCS 		MRI Pelvis Without & W Contrast 10 $2,463.30 $2,737.00 $2,682.26 nat. median
$1,063
outlier · 2.5×
71270
CPT 		CT Chest With And Without Contrast 8 $2,455.20 $2,728.00 $2,673.44 nat. median
$672
outlier · 4.0×
70496
CPT 		CTA Head 8 $2,322.00 $2,580.00 $2,528.40 nat. median
$746
outlier · 3.4×
70496
HCPCS 		CTA Head 10 $2,322.00 $2,580.00 $2,528.40 nat. median
$746
outlier · 3.4×
70498
CPT 		CTA Neck 8 $2,320.20 $2,578.00 $2,526.44 nat. median
$736
outlier · 3.4×
70498
HCPCS 		CTA Neck 10 $2,320.20 $2,578.00 $2,526.44 nat. median
$736
outlier · 3.4×
71550
CPT 		MRI Chest (clavicle) Without Contrast 8 $2,309.40 $2,566.00 $2,514.68 nat. median
$820
outlier · 3.1×
71550
HCPCS 		MRI Chest (clavicle) Without Contrast 10 $2,309.40 $2,566.00 $2,514.68 nat. median
$820
outlier · 3.1×
74177
HCPCS 		CT Abdomen And Pelvis With Contrast 10 $2,234.70 $2,483.00 $2,433.34 nat. median
$972
outlier · 2.5×
74177
CPT 		CT Abdomen And Pelvis With Contrast 8 $2,234.70 $2,483.00 $2,433.34 nat. median
$972
outlier · 2.5×
70543
CPT 		MRI Orbit, Face, & Neck Without & With Contrast 8 $2,228.40 $2,476.00 $2,426.48 nat. median
$1,083
outlier · 2.2×
70543
HCPCS 		MRI Orbit, Face, & Neck Without & With Contrast 10 $2,228.40 $2,476.00 $2,426.48 nat. median
$1,083
outlier · 2.2×
74183
CPT 		MRI Abdomen Without & W Contrast 8 $2,221.20 $2,468.00 $2,418.64 nat. median
$1,099
outlier · 2.2×
73720
HCPCS 		MRI Lower Extremity, Non-joint Without & W Contrast 10 $2,214.90 $2,461.00 $2,411.78 nat. median
$1,125
outlier · 2.1×
73720
CPT 		MRI Lower Extremity, Non-joint Without & W Contrast 8 $2,214.90 $2,461.00 $2,411.78 nat. median
$1,125
outlier · 2.1×
72197
CPT 		MRI Pelvis Without & W Contrast 8 $2,212.20 $2,458.00 $2,408.84 nat. median
$1,063
outlier · 2.3×
72157
HCPCS 		MRI Thoracic Spine Without & W Contrast 10 $2,174.40 $2,416.00 $2,367.68 nat. median
$1,103
outlier · 2.1×
72158
HCPCS 		MRI Lumbar Spine Without & W Contrast 10 $2,174.40 $2,416.00 $2,367.68 nat. median
$1,090
outlier · 2.2×
72156
HCPCS 		MRI Cervical Spine Without & With Contrast 10 $2,174.40 $2,416.00 $2,367.68 nat. median
$1,103
outlier · 2.1×
72193
CPT 		CT Pelvis With Contrast 8 $2,151.90 $2,391.00 $2,343.18 nat. median
$637
outlier · 3.7×
72193
HCPCS 		CT Pelvis With Contrast 10 $2,151.90 $2,391.00 $2,343.18 nat. median
$637
outlier · 3.7×
72157
CPT 		MRI Thoracic Spine Without & W Contrast 8 $2,106.00 $2,340.00 $2,293.20 nat. median
$1,103
outlier · 2.1×

Other procedures at this hospital

Browse this hospital's 1,697 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
             
G0378 HCPCS Observation 10 Hr 1,234 12 $6,591.86 $6,591.86 $161.16 $13,183.68 $6,460.06 2026-04-01
0120 RC — 36 12 $6,056.00 $6,056.00 $3,868.20 $6,592.00 $5,934.88 2026-04-01
74174 HCPCS CTA Abdomen And Pelvis 12 10 $5,293.00 $5,293.00 $4,763.70 $5,293.00 $5,187.14 2026-04-01
74174 CPT CTA Abdomen And Pelvis 12 8 $4,188.00 $4,188.00 $3,769.20 $4,188.00 $4,104.24 2024-11-30
70471 HCPCS CTA Head And Neck 12 10 $3,580.00 $3,580.00 $3,222.00 $3,580.00 $3,508.40 2026-04-01
71552 HCPCS MRI Chest (clavicle) Without &w Contrast 12 10 $3,443.00 $3,443.00 $3,098.70 $3,443.00 $3,374.14 2026-04-01
71552 CPT MRI Chest (clavicle) Without &w Contrast 12 8 $3,443.00 $3,443.00 $3,098.70 $3,443.00 $3,374.14 2024-11-30
74178 CPT CT Abdomen And Pelvis With And Without Contrast 12 8 $3,336.00 $3,336.00 $3,002.40 $3,336.00 $3,269.28 2024-11-30
74178 HCPCS CT Abdomen And Pelvis With And Without Contrast 12 10 $3,336.00 $3,336.00 $3,002.40 $3,336.00 $3,269.28 2026-04-01
73220 HCPCS MRI Upper Extremity, Non-joint Without & With Contrast 12 10 $2,993.00 $2,993.00 $2,693.70 $2,993.00 $2,933.14 2026-04-01
73220 CPT MRI Upper Extremity, Non-joint Without & With Contrast 12 8 $2,993.00 $2,993.00 $2,693.70 $2,993.00 $2,933.14 2024-11-30
72126 HCPCS CT Cervical Spine With Contrast 12 10 $2,875.00 $2,875.00 $2,587.50 $2,875.00 $2,817.50 2026-04-01
72126 CPT CT Cervical Spine With Contrast 12 8 $2,875.00 $2,875.00 $2,587.50 $2,875.00 $2,817.50 2024-11-30
74170 CPT CT Abdomen With And Without Contrast 12 8 $2,861.00 $2,861.00 $2,574.90 $2,861.00 $2,803.78 2024-11-30
74170 HCPCS CT Abdomen With And Without Contrast 12 10 $2,861.00 $2,861.00 $2,574.90 $2,861.00 $2,803.78 2026-04-01
59409 CPT Vaginal Delivery Of Baby 12 8 $2,841.00 $2,841.00 $2,556.90 $2,841.00 $2,784.18 2024-11-30
59414 CPT Delivery Of Placenta 12 8 $2,840.00 $2,840.00 $2,556.00 $2,840.00 $2,783.20 2024-11-30
75630 CPT CTA Abdominal Aorta & Bilateral Iliofemoral Lower Ext. Runoff 12 8 $2,839.00 $2,839.00 $2,555.10 $2,839.00 $2,782.22 2024-11-30
75635 HCPCS CTA Abdominal Aorta & Bilateral Iliofemoral Lower Ext. Runoff 12 10 $2,839.00 $2,839.00 $2,555.10 $2,839.00 $2,782.22 2026-04-01
73223 HCPCS MRI Upper Extremity, Joint Without & With Contrast 12 10 $2,827.00 $2,827.00 $2,544.30 $2,827.00 $2,770.46 2026-04-01
73223 CPT MRI Upper Extremity, Joint Without & With Contrast 12 8 $2,827.00 $2,827.00 $2,544.30 $2,827.00 $2,770.46 2024-11-30
71275 CPT CTA Chest 12 8 $2,820.00 $2,820.00 $2,538.00 $2,820.00 $2,763.60 2024-11-30
71275 HCPCS CTA Chest 12 10 $2,820.00 $2,820.00 $2,538.00 $2,820.00 $2,763.60 2026-04-01
73723 HCPCS MRI Lower Extremity, Joint Without & With Contrast 12 10 $2,816.00 $2,816.00 $2,534.40 $2,816.00 $2,759.68 2026-04-01
73723 CPT MRI Lower Extremity, Joint Without & With Contrast 12 8 $2,816.00 $2,816.00 $2,534.40 $2,816.00 $2,759.68 2024-11-30
70553 HCPCS MRI Brain Without & With Contrast 12 10 $2,782.00 $2,782.00 $2,503.80 $2,782.00 $2,726.36 2026-04-01
71270 HCPCS CT Chest With And Without Contrast 12 10 $2,769.00 $2,769.00 $2,492.10 $2,769.00 $2,713.62 2026-04-01
74183 HCPCS MRI Abdomen Without & W Contrast 12 10 $2,747.00 $2,747.00 $2,472.30 $2,747.00 $2,692.06 2026-04-01
72197 HCPCS MRI Pelvis Without & W Contrast 12 10 $2,737.00 $2,737.00 $2,463.30 $2,737.00 $2,682.26 2026-04-01
71270 CPT CT Chest With And Without Contrast 12 8 $2,728.00 $2,728.00 $2,455.20 $2,728.00 $2,673.44 2024-11-30
70496 CPT CTA Head 12 8 $2,580.00 $2,580.00 $2,322.00 $2,580.00 $2,528.40 2024-11-30
70496 HCPCS CTA Head 12 10 $2,580.00 $2,580.00 $2,322.00 $2,580.00 $2,528.40 2026-04-01
70498 CPT CTA Neck 12 8 $2,578.00 $2,578.00 $2,320.20 $2,578.00 $2,526.44 2024-11-30
70498 HCPCS CTA Neck 12 10 $2,578.00 $2,578.00 $2,320.20 $2,578.00 $2,526.44 2026-04-01
71550 CPT MRI Chest (clavicle) Without Contrast 12 8 $2,566.00 $2,566.00 $2,309.40 $2,566.00 $2,514.68 2024-11-30
71550 HCPCS MRI Chest (clavicle) Without Contrast 12 10 $2,566.00 $2,566.00 $2,309.40 $2,566.00 $2,514.68 2026-04-01
74177 HCPCS CT Abdomen And Pelvis With Contrast 12 10 $2,483.00 $2,483.00 $2,234.70 $2,483.00 $2,433.34 2026-04-01
74177 CPT CT Abdomen And Pelvis With Contrast 12 8 $2,483.00 $2,483.00 $2,234.70 $2,483.00 $2,433.34 2024-11-30
70543 CPT MRI Orbit, Face, & Neck Without & With Contrast 12 8 $2,476.00 $2,476.00 $2,228.40 $2,476.00 $2,426.48 2024-11-30
70543 HCPCS MRI Orbit, Face, & Neck Without & With Contrast 12 10 $2,476.00 $2,476.00 $2,228.40 $2,476.00 $2,426.48 2026-04-01
74183 CPT MRI Abdomen Without & W Contrast 12 8 $2,468.00 $2,468.00 $2,221.20 $2,468.00 $2,418.64 2024-11-30
73720 HCPCS MRI Lower Extremity, Non-joint Without & W Contrast 12 10 $2,461.00 $2,461.00 $2,214.90 $2,461.00 $2,411.78 2026-04-01
73720 CPT MRI Lower Extremity, Non-joint Without & W Contrast 12 8 $2,461.00 $2,461.00 $2,214.90 $2,461.00 $2,411.78 2024-11-30
72197 CPT MRI Pelvis Without & W Contrast 12 8 $2,458.00 $2,458.00 $2,212.20 $2,458.00 $2,408.84 2024-11-30
72157 HCPCS MRI Thoracic Spine Without & W Contrast 12 10 $2,416.00 $2,416.00 $2,174.40 $2,416.00 $2,367.68 2026-04-01
72158 HCPCS MRI Lumbar Spine Without & W Contrast 12 10 $2,416.00 $2,416.00 $2,174.40 $2,416.00 $2,367.68 2026-04-01
72156 HCPCS MRI Cervical Spine Without & With Contrast 12 10 $2,416.00 $2,416.00 $2,174.40 $2,416.00 $2,367.68 2026-04-01
72193 CPT CT Pelvis With Contrast 12 8 $2,391.00 $2,391.00 $2,151.90 $2,391.00 $2,343.18 2024-11-30
72193 HCPCS CT Pelvis With Contrast 12 10 $2,391.00 $2,391.00 $2,151.90 $2,391.00 $2,343.18 2026-04-01
72157 CPT MRI Thoracic Spine Without & W Contrast 12 8 $2,340.00 $2,340.00 $2,106.00 $2,340.00 $2,293.20 2024-11-30
72156 CPT MRI Cervical Spine Without & With Contrast 12 8 $2,335.00 $2,335.00 $2,101.50 $2,335.00 $2,288.30 2024-11-30
72158 CPT MRI Lumbar Spine Without & W Contrast 12 8 $2,331.00 $2,331.00 $2,097.90 $2,331.00 $2,284.38 2024-11-30
70553 CPT MRI Brain Without & With Contrast 12 8 $2,324.00 $2,324.00 $2,091.60 $2,324.00 $2,277.52 2024-11-30
71260 HCPCS CT Chest With Contrast 12 10 $2,313.00 $2,313.00 $2,081.70 $2,313.00 $2,266.74 2026-04-01
70492 HCPCS CT Soft Tissue Neck, With And Without Contrast 12 10 $2,300.00 $2,300.00 $2,070.00 $2,300.00 $2,254.00 2026-04-01
73722 CPT MRI Lower Extremity, Joint With Contrast 12 8 $2,290.00 $2,290.00 $2,061.00 $2,290.00 $2,244.20 2024-11-30
73722 HCPCS MRI Lower Extremity, Joint With Contrast 12 10 $2,290.00 $2,290.00 $2,061.00 $2,290.00 $2,244.20 2026-04-01
71260 CPT CT Chest With Contrast 12 8 $2,289.00 $2,289.00 $2,060.10 $2,289.00 $2,243.22 2024-11-30
73222 CPT MRI Upper Extremity, Joint With Contrast 12 8 $2,288.00 $2,288.00 $2,059.20 $2,288.00 $2,242.24 2024-11-30
73222 HCPCS MRI Upper Extremity, Joint With Contrast 12 10 $2,288.00 $2,288.00 $2,059.20 $2,288.00 $2,242.24 2026-04-01
59409 HCPCS Delivery: Vaginal Only 24 10 $2,380.00 $2,380.00 $1,118.93 $2,841.00 $2,218.76 2026-04-01
70488 CPT CT Maxillofacial With And Without Contrast 12 8 $2,261.00 $2,261.00 $2,034.90 $2,261.00 $2,215.78 2024-11-30
70488 HCPCS CT Maxillofacial With And Without Contrast 12 10 $2,261.00 $2,261.00 $2,034.90 $2,261.00 $2,215.78 2026-04-01
73218 CPT MRI Upper Extremity, Non-joint Without Contrast 12 8 $2,217.00 $2,217.00 $1,995.30 $2,217.00 $2,172.66 2024-11-30
73218 HCPCS MRI Upper Extremity, Non-joint Without Contrast 12 10 $2,217.00 $2,217.00 $1,995.30 $2,217.00 $2,172.66 2026-04-01
74176 HCPCS CT Abdomen And Pelvis Without Contrast 12 10 $2,184.00 $2,184.00 $1,965.60 $2,184.00 $2,140.32 2026-04-01
74176 CPT CT Abdomen And Pelvis Without Contrast 12 8 $2,184.00 $2,184.00 $1,965.60 $2,184.00 $2,140.32 2024-11-30
99291 CPT Critical Care First 30-74 Minutes 36 8 $2,166.00 $2,166.00 $347.05 $2,389.00 $2,122.68 2024-11-30
74182 HCPCS MRI Abdomen With Contrast 12 10 $2,108.00 $2,108.00 $1,897.20 $2,108.00 $2,065.84 2026-04-01
G0390 HCPCS Trauma Team With Critical Care 24 12 $2,100.00 $2,100.00 $1,890.00 $2,100.00 $2,058.00 2026-04-01
N/a OTHER Trauma Team Activation In-house 12 10 $2,100.00 $2,100.00 $1,890.00 $2,100.00 $2,058.00 2026-04-01
73701 HCPCS CT Lower Extremity With Contrast 12 10 $2,077.00 $2,077.00 $1,869.30 $2,077.00 $2,035.46 2026-04-01
73701 CPT CT Lower Extremity With Contrast 12 8 $2,077.00 $2,077.00 $1,869.30 $2,077.00 $2,035.46 2024-11-30
93306 HCPCS Complete Transthoracic Echocardiogram 12 10 $2,065.00 $2,065.00 $1,858.50 $2,065.00 $2,023.70 2026-04-01
74160 HCPCS CT Abdomen With Contrast 12 10 $2,056.00 $2,056.00 $1,850.40 $2,056.00 $2,014.88 2026-04-01
74160 CPT CT Abdomen With Contrast 12 8 $2,056.00 $2,056.00 $1,850.40 $2,056.00 $2,014.88 2024-11-30
87632 CPT Respiratory Virus Panel, Pcr Q 12 8 $2,047.54 $2,047.54 $1,842.79 $2,047.54 $2,006.59 2024-11-30
87632 HCPCS Respiratory Virus Panel, Pcr Q 12 10 $2,047.54 $2,047.54 $599.67 $2,047.54 $2,006.59 2026-04-01
70491 CPT CT Neck Soft Tissue With Contrast 12 8 $2,017.00 $2,017.00 $1,815.30 $2,017.00 $1,976.66 2024-11-30
70491 HCPCS CT Neck Soft Tissue With Contrast 12 10 $2,017.00 $2,017.00 $1,815.30 $2,017.00 $1,976.66 2026-04-01
72132 HCPCS CT Lumbar With Contrast 12 10 $1,973.00 $1,973.00 $1,775.70 $1,973.00 $1,933.54 2026-04-01
71250 HCPCS CT Chest Without Contrast 24 10 $2,053.00 $2,053.00 $1,496.70 $2,443.00 $1,930.85 2026-04-01
71250 CPT CT Chest Without Contrast 24 8 $2,053.00 $2,053.00 $1,496.70 $2,443.00 $1,930.85 2024-11-30
73206 HCPCS CTA Upper Extremity 12 10 $1,969.00 $1,969.00 $1,772.10 $1,969.00 $1,929.62 2026-04-01
73206 CPT CTA Upper Extremity 12 8 $1,969.00 $1,969.00 $1,772.10 $1,969.00 $1,929.62 2024-11-30
72129 CPT CT Thoracic Spine With Contrast 12 8 $1,968.00 $1,968.00 $1,771.20 $1,968.00 $1,928.64 2024-11-30
72129 HCPCS CT Thoracic Spine With Contrast 12 10 $1,968.00 $1,968.00 $1,771.20 $1,968.00 $1,928.64 2026-04-01
72142 CPT MRI Cervical Spine With Contrast 12 8 $1,937.00 $1,937.00 $1,743.30 $1,937.00 $1,898.26 2024-11-30
72142 HCPCS MRI Cervical Spine With Contrast 12 10 $1,937.00 $1,937.00 $1,743.30 $1,937.00 $1,898.26 2026-04-01
70336 HCPCS MRI Tmj 12 10 $1,928.00 $1,928.00 $1,735.20 $1,928.00 $1,889.44 2026-04-01
70336 CPT MRI Tmj 12 8 $1,928.00 $1,928.00 $1,735.20 $1,928.00 $1,889.44 2024-11-30
72132 CPT CT Lumbar With Contrast 12 8 $1,921.00 $1,921.00 $1,728.90 $1,921.00 $1,882.58 2024-11-30
J2357 HCPCS Xolair 150 Mg/1.2 Ml Powder Vl 150 Mg, 1 Each 24 12 $1,909.00 $1,909.00 $1,718.10 $1,909.00 $1,870.82 2026-04-01
86711 CPT Jc Virus Ab With Reflex Inhibition Assay - Q 12 8 $1,888.85 $1,888.85 $1,699.97 $1,888.85 $1,851.07 2024-11-30
86711 HCPCS Jc Virus Ab With Reflex Inhibition Assay - Q 12 10 $1,888.85 $1,888.85 $46.45 $1,888.85 $1,851.07 2026-04-01
C9399 HCPCS Paxlovid 150-100 Mg Dose Pack Per Course 12 10 $1,870.00 $1,870.00 $1,683.00 $1,870.00 $1,832.60 2026-04-01
70470 HCPCS CT Head/brain With & Without Contrast 12 10 $1,859.00 $1,859.00 $1,673.10 $1,859.00 $1,821.82 2026-04-01
70470 CPT CT Head/brain With & Without Contrast 12 8 $1,859.00 $1,859.00 $1,673.10 $1,859.00 $1,821.82 2024-11-30
70490 CPT CT Neck Soft Tissue Without Contrast 12 8 $1,841.00 $1,841.00 $1,656.90 $1,841.00 $1,804.18 2024-11-30
70490 HCPCS CT Neck Soft Tissue Without Contrast 12 10 $1,841.00 $1,841.00 $1,656.90 $1,841.00 $1,804.18 2026-04-01
J1745 HCPCS Remicade 100 Mg Vial 100 Mg, 1 Each 24 12 $1,825.00 $1,825.00 $1,642.50 $1,825.00 $1,788.50 2026-04-01
74150 HCPCS CT Abdomen Without Contrast 12 10 $1,779.00 $1,779.00 $1,601.10 $1,779.00 $1,743.42 2026-04-01
74150 CPT CT Abdomen Without Contrast 12 8 $1,779.00 $1,779.00 $1,601.10 $1,779.00 $1,743.42 2024-11-30
73200 CPT CT Upper Extermity Without Contrast 12 8 $1,775.00 $1,775.00 $1,597.50 $1,775.00 $1,739.50 2024-11-30
73200 HCPCS CT Upper Extermity Without Contrast 12 10 $1,775.00 $1,775.00 $1,597.50 $1,775.00 $1,739.50 2026-04-01
72125 CPT CT Cervical Spine Without Contrast 12 8 $1,768.00 $1,768.00 $1,591.20 $1,768.00 $1,732.64 2024-11-30
72125 HCPCS CT Cervical Spine Without Contrast 12 10 $1,768.00 $1,768.00 $1,591.20 $1,768.00 $1,732.64 2026-04-01
73700 HCPCS CT Lower Extremity Without Contrast 12 10 $1,767.00 $1,767.00 $1,590.30 $1,767.00 $1,731.66 2026-04-01
72131 HCPCS CT Lumbar Spine Without Contrast 12 10 $1,765.00 $1,765.00 $1,588.50 $1,765.00 $1,729.70 2026-04-01
73700 CPT CT Lower Extremity Without Contrast 12 8 $1,761.00 $1,761.00 $1,584.90 $1,761.00 $1,725.78 2024-11-30
70460 HCPCS CT Head/brain With Contrast 12 10 $1,760.00 $1,760.00 $1,584.00 $1,760.00 $1,724.80 2026-04-01
70460 CPT CT Head/brain With Contrast 12 8 $1,760.00 $1,760.00 $1,584.00 $1,760.00 $1,724.80 2024-11-30
72128 HCPCS CT Thoracic Spine Without Contrast 12 10 $1,759.00 $1,759.00 $1,583.10 $1,759.00 $1,723.82 2026-04-01
72131 CPT CT Lumbar Spine Without Contrast 12 8 $1,759.00 $1,759.00 $1,583.10 $1,759.00 $1,723.82 2024-11-30
93925 HCPCS Duplex Scan Of Lower Extremity Arteries Or Arterial Bypass Graft; Complete Bilat… 12 10 $1,757.00 $1,757.00 $1,581.30 $1,757.00 $1,721.86 2026-04-01
72128 CPT CT Thoracic Spine Without Contrast 12 8 $1,753.00 $1,753.00 $1,577.70 $1,753.00 $1,717.94 2024-11-30
73221 HCPCS MRI Upper Extremity, Joint Without Contrast 12 10 $1,676.00 $1,676.00 $1,508.40 $1,676.00 $1,642.48 2026-04-01
72195 CPT MRI Pelvis Without Contrast 12 8 $1,673.00 $1,673.00 $1,505.70 $1,673.00 $1,639.54 2024-11-30
72195 HCPCS MRI Pelvis Without Contrast 12 10 $1,673.00 $1,673.00 $1,505.70 $1,673.00 $1,639.54 2026-04-01
71271 HCPCS CT Low Dose For Lung Cancer Screening, Without Contrast 12 10 $1,663.00 $1,663.00 $1,496.70 $1,663.00 $1,629.74 2026-04-01
71271 CPT CT Low Dose For Lung Cancer Screening, Without Contrast 12 8 $1,663.00 $1,663.00 $1,496.70 $1,663.00 $1,629.74 2024-11-30
70540 CPT MRI Orbit, Face, & Neck Without Contrast 12 8 $1,652.00 $1,652.00 $1,486.80 $1,652.00 $1,618.96 2024-11-30
70540 HCPCS MRI Orbit, Face, & Neck Without Contrast 12 10 $1,652.00 $1,652.00 $1,486.80 $1,652.00 $1,618.96 2026-04-01
70487 HCPCS CT Maxillofacial With Contrast 12 10 $1,650.00 $1,650.00 $1,485.00 $1,650.00 $1,617.00 2026-04-01
70487 CPT CT Maxillofacial With Contrast 12 8 $1,650.00 $1,650.00 $1,485.00 $1,650.00 $1,617.00 2024-11-30
73721 HCPCS MRI Lower Extremity, Joint Without Contrast 12 10 $1,641.00 $1,641.00 $1,476.90 $1,641.00 $1,608.18 2026-04-01
73718 CPT MRI Lower Extremity, Non-joint Without Contrast 12 8 $1,630.00 $1,630.00 $1,467.00 $1,630.00 $1,597.40 2024-11-30
73718 HCPCS MRI Lower Extremity, Non-joint Without Contrast 12 10 $1,630.00 $1,630.00 $1,467.00 $1,630.00 $1,597.40 2026-04-01
72192 CPT CT Pelvis Without Contrast 12 8 $1,625.00 $1,625.00 $1,462.50 $1,625.00 $1,592.50 2024-11-30
72192 HCPCS CT Pelvis Without Contrast 12 10 $1,625.00 $1,625.00 $1,462.50 $1,625.00 $1,592.50 2026-04-01
77049 HCPCS MRI Breast 12 10 $1,597.00 $1,597.00 $1,437.30 $1,597.00 $1,565.06 2026-04-01
77049 CPT MRI Breast 12 8 $1,597.00 $1,597.00 $1,437.30 $1,597.00 $1,565.06 2024-11-30
A0427 HCPCS Ambulance Als Emergency 12 10 $1,571.00 $1,571.00 $1,413.90 $1,571.00 $1,539.58 2026-04-01
70551 HCPCS MRI Brain Without Contrast 12 10 $1,510.00 $1,510.00 $1,359.00 $1,510.00 $1,479.80 2026-04-01
72141 HCPCS MRI Cervical Spine Without Contrast 12 10 $1,500.00 $1,500.00 $1,350.00 $1,500.00 $1,470.00 2026-04-01
72146 HCPCS MRI Thoracic Spine Without Contrast 12 10 $1,500.00 $1,500.00 $1,350.00 $1,500.00 $1,470.00 2026-04-01
72148 HCPCS MRI Lumbar Spine Without Contrast 12 10 $1,500.00 $1,500.00 $1,350.00 $1,500.00 $1,470.00 2026-04-01
70480 HCPCS CT Orbit, Sella Or Posterior Fossa Or Outer, Middle Or Inner Ear Without Contrast 12 10 $1,486.00 $1,486.00 $1,337.40 $1,486.00 $1,456.28 2026-04-01
70450 HCPCS CT Head/brain Without Contrast 12 10 $1,486.00 $1,486.00 $1,337.40 $1,486.00 $1,456.28 2026-04-01
70450 CPT CT Head/brain Without Contrast 12 8 $1,483.00 $1,483.00 $1,334.70 $1,483.00 $1,453.34 2024-11-30
73221 CPT MRI Upper Extremity, Joint Without Contrast 12 8 $1,481.00 $1,481.00 $1,332.90 $1,481.00 $1,451.38 2024-11-30
70480 CPT CT Orbit, Sella Or Posterior Fossa Or Outer, Middle Or Inner Ear Without Contrast 12 8 $1,481.00 $1,481.00 $1,332.90 $1,481.00 $1,451.38 2024-11-30
A0427,QN OTHER Ambulance Als Emergency 12 8 $1,480.00 $1,480.00 $1,332.00 $1,480.00 $1,450.40 2024-11-30
73721 CPT MRI Lower Extremity, Joint Without Contrast 12 8 $1,479.00 $1,479.00 $1,331.10 $1,479.00 $1,449.42 2024-11-30
P9035 HCPCS Plateletpherisis, Leuko Reduced 24 12 $1,455.00 $1,455.00 $1,309.50 $1,455.00 $1,425.90 2026-04-01
70551 CPT MRI Brain Without Contrast 12 8 $1,431.00 $1,431.00 $1,287.90 $1,431.00 $1,402.38 2024-11-30
74181 HCPCS MRI Abdomen Without Contrast 12 10 $1,429.00 $1,429.00 $1,286.10 $1,429.00 $1,400.42 2026-04-01
74181 CPT MRI Abdomen Without Contrast 12 8 $1,429.00 $1,429.00 $1,286.10 $1,429.00 $1,400.42 2024-11-30
59414 HCPCS Delivery Of Placenta 24 10 $1,527.50 $1,527.50 $39.27 $2,840.00 $1,383.35 2026-04-01
72148 CPT MRI Lumbar Spine Without Contrast 12 8 $1,396.00 $1,396.00 $1,256.40 $1,396.00 $1,368.08 2024-11-30
72141 CPT MRI Cervical Spine Without Contrast 12 8 $1,391.00 $1,391.00 $1,251.90 $1,391.00 $1,363.18 2024-11-30
72146 CPT MRI Thoracic Spine Without Contrast 12 8 $1,389.00 $1,389.00 $1,250.10 $1,389.00 $1,361.22 2024-11-30
99291 HCPCS Critical Care First 30-74 Minutes 24 10 $1,472.00 $1,472.00 $252.05 $2,389.00 $1,360.05 2026-04-01
93930 HCPCS Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts Complete Bilat… 12 10 $1,367.00 $1,367.00 $1,230.30 $1,367.00 $1,339.66 2026-04-01
93970 HCPCS Ext. Venous Doppler Bilateral US 12 10 $1,311.00 $1,311.00 $1,179.90 $1,311.00 $1,284.78 2026-04-01
70486 HCPCS CT Maxillofacial Area Without Contrast 12 10 $1,304.00 $1,304.00 $1,173.60 $1,304.00 $1,277.92 2026-04-01
70486 CPT CT Maxillofacial Area Without Contrast 12 8 $1,274.00 $1,274.00 $1,146.60 $1,274.00 $1,248.52 2024-11-30
93880 HCPCS Carotid Complete US 12 10 $1,242.00 $1,242.00 $1,117.80 $1,242.00 $1,217.16 2026-04-01
J0885 HCPCS Aranesp 100mcg 24 12 $1,210.00 $1,210.00 $1,089.00 $1,210.00 $1,185.80 2026-04-01
J0881 HCPCS Aranesp 100 Mcg/0.5 Ml Syringe 100 Mcg, 0.5 Ml 24 12 $1,161.00 $1,161.00 $1,044.90 $1,161.00 $1,137.78 2026-04-01
A0433 HCPCS Ambulance Als Level Ii 12 10 $1,144.00 $1,144.00 $1,029.60 $1,144.00 $1,121.12 2026-04-01
A0433,QN OTHER Ambulance Als Level Ii 12 8 $1,144.00 $1,144.00 $1,029.60 $1,144.00 $1,121.12 2024-11-30
36430 HCPCS Blood Transfusion 12 10 $1,126.00 $1,126.00 $1,013.40 $1,126.00 $1,103.48 2026-04-01
93971 HCPCS Ext. Venous Doppler Unilateral US 12 10 $1,105.00 $1,105.00 $994.50 $1,105.00 $1,082.90 2026-04-01
25605 CPT Closed Treatment Distal Radial Or Ulnar Styloid Fracture With Manipulation 36 8 $1,096.00 $1,096.00 $920.70 $1,381.00 $1,074.08 2024-11-30
49083 HCPCS Abdominal Paracentesis With Imaging 24 10 $1,147.00 $1,147.00 $145.40 $1,692.00 $1,056.38 2026-04-01
36430 CPT Blood Transfusion 12 8 $1,061.00 $1,061.00 $954.90 $1,061.00 $1,039.78 2024-11-30
25565 CPT Closed Treatment Radial And Ulnar Shaft Fracture With Manipulation 36 8 $1,045.00 $1,045.00 $880.20 $1,336.00 $1,024.10 2024-11-30
23650 HCPCS Closed Tx Of Shoulder Dislocation W/manipulation; Without Anesth 36 10 $1,042.00 $1,042.00 $113.05 $1,400.00 $1,021.16 2026-04-01
A0428 HCPCS Ambulance Bls Non-emergency 24 12 $1,047.00 $1,047.00 $915.30 $1,077.00 $1,012.38 2026-04-01
25605 HCPCS Closed Treatment Distal Radial Or Ulnar Styloid Fracture With Manipulation 36 10 $1,096.00 $1,096.00 $163.03 $1,381.00 $1,007.65 2026-04-01
27265 HCPCS Closed Treatment Of Post Hip Arthroplasty Dislocation; Without Anethesia 24 10 $1,052.00 $1,052.00 $48.20 $1,256.00 $1,004.61 2026-04-01
93308 HCPCS Limited Transthoracic Echocardiogram 12 10 $1,021.00 $1,021.00 $918.90 $1,021.00 $1,000.58 2026-04-01
A0429 HCPCS Ambulance Bls Emergency 12 10 $1,015.00 $1,015.00 $913.50 $1,015.00 $994.70 2026-04-01
A0429,QN OTHER Ambulance Bls Emergency 12 8 $1,015.00 $1,015.00 $913.50 $1,015.00 $994.70 2024-11-30
31500 HCPCS Intubation, Endotracheal, Emergency Procedure 12 10 $1,002.00 $1,002.00 $901.80 $1,002.00 $981.96 2026-04-01
93931 HCPCS Duplex Scan Of Upper Extremity Arteries Or Arterial Bypass Grafts; Unilateral Or… 12 10 $996.00 $996.00 $896.40 $996.00 $976.08 2026-04-01
99285 HCPCS Emergency Room Level 5 24 10 $971.50 $971.50 $207.71 $1,571.00 $972.32 2026-04-01
25565 HCPCS Closed Treatment Radial And Ulnar Shaft Fracture With Manipulation 36 10 $1,045.00 $1,045.00 $45.82 $1,336.00 $963.33 2026-04-01
93922 HCPCS Us, Ankle Brachial Index 12 10 $956.00 $956.00 $860.40 $956.00 $936.88 2026-04-01
11642 HCPCS Excision Malignant Lesion Face, Ears,eyelids, Nose Lips 1.1 Cm To 2.0cm 12 10 $956.00 $956.00 $860.40 $956.00 $936.88 2026-04-01
11642 CPT Excision Malignant Lesion Face, Ears,eyelids, Nose Lips 1.1 Cm To 2.0cm 12 8 $956.00 $956.00 $860.40 $956.00 $936.88 2024-11-30
28192 CPT Removal Foreign Body Foot: Deep 12 8 $950.00 $950.00 $855.00 $950.00 $931.00 2024-11-30
76700 HCPCS Abdominal Complete US 12 10 $922.00 $922.00 $829.80 $922.00 $903.56 2026-04-01
24605 CPT Treatment Of Closed Elbow Dislocation; Requiring Anesthesia 21 8 $959.00 $959.00 $697.53 $959.00 $901.46 2024-11-30
24605 HCPCS Treatment Of Closed Elbow Dislocation; Requiring Anesthesia 21 10 $959.00 $959.00 $102.94 $959.00 $901.46 2026-04-01
93926 HCPCS Duplex Scan Of Lower Extremity Arteries Or Arterial Bypass Grafts; Unilateral Or… 12 10 $908.00 $908.00 $817.20 $908.00 $889.84 2026-04-01
99285 CPT Emergency Room Level 5 24 8 $948.50 $948.50 $246.08 $1,525.00 $868.53 2024-11-30
49083 CPT Abdominal Paracentesis With Imaging 24 8 $901.50 $901.50 $541.80 $1,201.00 $841.45 2024-11-30
27562 HCPCS Closed Treatment Of Petellar Dislocation With Anesthesia Without E/m 24 10 $787.00 $787.00 $93.42 $860.00 $808.40 2026-04-01
99284 HCPCS Emergency Room Level 4 24 10 $708.50 $708.50 $143.40 $1,164.00 $791.55 2026-04-01
26725 CPT Closed Treatment Phalangeal Shaft Fracture: With Manipulation, With Or Without Traction:… 24 8 $829.00 $829.00 $617.40 $972.00 $780.40 2024-11-30
26725 HCPCS Closed Treatment Phalangeal Shaft Fracture: With Manipulation, With Or Without Traction:… 24 10 $829.00 $829.00 $126.74 $972.00 $773.54 2026-04-01
76942 HCPCS Guided Needle Plcmt US 12 10 $786.00 $786.00 $707.40 $786.00 $770.28 2026-04-01
76942 CPT Guided Needle Plcmt US 12 8 $786.00 $786.00 $707.40 $786.00 $770.28 2024-11-30
P9040 HCPCS Irradiation With P.c. Per Unit 24 12 $782.00 $782.00 $703.80 $782.00 $766.36 2026-04-01
26775 CPT Closed Treatment Interphalangeal Dislocation: SINGLE:with MANIPULATION;with Anesthe… 12 8 $777.00 $777.00 $699.30 $777.00 $761.46 2024-11-30
92950 HCPCS Cardiopulmonary Resuscitation 24 10 $755.00 $755.00 $251.52 $866.00 $744.32 2026-04-01
32551 CPT Tube Thoracostomy (insertion Chest Tube) Includes Connection And Drainage 24 8 $803.50 $803.50 $340.20 $1,229.00 $742.05 2024-11-30
76705 HCPCS Abdominal Limted US 12 10 $756.00 $756.00 $680.40 $756.00 $740.88 2026-04-01
27560 CPT Closed Treatment Patellar Dislocation: Without Anesthesia 12 8 $755.00 $755.00 $679.50 $755.00 $739.90 2024-11-30
32551 HCPCS Tube Thoracostomy (insertion Chest Tube) Includes Connection And Drainage 24 10 $803.50 $803.50 $82.11 $1,229.00 $738.27 2026-04-01
27788 HCPCS Closed Treatment Of Distal Fibular Fracture With Manipulation 24 10 $762.50 $762.50 $30.35 $769.30 $721.68 2026-04-01
27257 CPT Closed Treatment Of Hip Dislocation, Spontaneou:by Abduction, Splint Or Traction… 24 8 $725.50 $725.50 $645.30 $734.00 $709.83 2024-11-30
92950 CPT Cardiopulmonary Resuscitation 24 8 $755.00 $755.00 $295.90 $866.00 $705.26 2024-11-30
24600 HCPCS Closed Tx Elbow Dislocation; Without Manipulation 24 10 $737.50 $737.50 $67.24 $735.00 $700.73 2026-04-01
76536 HCPCS Soft Tissue Head & Neck, Thyroid, Parathyroid US 12 10 $706.00 $706.00 $635.40 $706.00 $691.88 2026-04-01
P9016 HCPCS Packed Cells - Leuko-reduced 24 12 $706.00 $706.00 $635.40 $706.00 $691.88 2026-04-01
27750 CPT Closed Treatment Tibial Shaft Fracture, Proximal: Without Manipulation 12 8 $697.00 $697.00 $627.30 $697.00 $683.06 2024-11-30
24600 CPT Closed Tx Elbow Dislocation; Without Manipulation 24 8 $737.50 $737.50 $557.45 $735.00 $681.50 2024-11-30
62270 HCPCS Spinal Puncture, Lumbar, Diagnostic 12 10 $690.00 $690.00 $621.00 $690.00 $676.20 2026-04-01
62270 CPT Spinal Puncture, Lumbar, Diagnostic 12 8 $690.00 $690.00 $621.00 $690.00 $676.20 2024-11-30
27257 HCPCS Closed Treatment Of Hip Dislocation, Spontaneou:by Abduction, Splint Or Traction… 24 10 $725.50 $725.50 $452.80 $719.32 $673.98 2026-04-01
12004 HCPCS Laceration Repair Superficial 7.6 To 12.5 Cm:scalp, Neck, Axillae, External Geni… 36 10 $678.00 $678.00 $57.12 $1,029.00 $664.44 2026-04-01
12015 CPT Pf Laceration Repair Superficial 7.6 To 12.5 Cm: Face, Ears, Eyelids, Nose, Lip… 24 8 $719.00 $719.00 $154.00 $1,055.00 $662.42 2024-11-30
12015 HCPCS Pf Laceration Repair Superficial 7.6 To 12.5 Cm: Face, Ears, Eyelids, Nose, Lip… 24 10 $719.00 $719.00 $130.90 $1,055.00 $662.42 2026-04-01
31500 CPT Intubation, Endotracheal, Emergency Procedure 24 8 $708.50 $708.50 $399.60 $973.00 $659.85 2024-11-30
73523 CPT Bil Hips With Pelvis Min 5 Views 12 8 $673.00 $673.00 $605.70 $673.00 $659.54 2024-11-30
73523 HCPCS Bil Hips With Pelvis Min 5 Views 12 10 $673.00 $673.00 $605.70 $673.00 $659.54 2026-04-01
27808 CPT Closed Treatment Bimalleolar Ankle Fracture 12 8 $673.00 $673.00 $605.70 $673.00 $659.54 2024-11-30
27760 CPT Closed Treatment Medial Malleolus Fracture: Without Manipulation 12 8 $672.00 $672.00 $604.80 $672.00 $658.56 2024-11-30
76856 HCPCS Pelvic Complete Us, Non OB 12 10 $671.00 $671.00 $603.90 $671.00 $657.58 2026-04-01
12032 CPT Intermediate Lac Scalp, Neck, Trunk, Extm; 2.6-7.5cm 24 8 $697.00 $697.00 $310.20 $790.00 $651.46 2024-11-30
12032 HCPCS Intermediate Lac Scalp, Neck, Trunk, Extm; 2.6-7.5cm 24 10 $697.00 $697.00 $86.87 $790.00 $651.46 2026-04-01
76870 HCPCS Scrotum US 12 10 $662.00 $662.00 $595.80 $662.00 $648.76 2026-04-01
27520 CPT Closed Treatment Of Patellar Fracture: Without Manipulation 12 8 $651.00 $651.00 $585.90 $651.00 $637.98 2024-11-30
76770 HCPCS US Retroperitoneal Complete 12 10 $651.00 $651.00 $585.90 $651.00 $637.98 2026-04-01
84182 HCPCS Systemic Sclerosis Ab Panel 2 Q 2 Of 2 12 10 $649.00 $649.00 $80.33 $649.00 $636.02 2026-04-01
99283 HCPCS Emergency Room Level 3 24 10 $442.00 $442.00 $84.28 $750.00 $634.70 2026-04-01
99284 CPT Emergency Room Level 4 24 8 $691.50 $691.50 $169.88 $1,130.00 $632.47 2024-11-30
72052 HCPCS C-spine 6 Or More Views/flex/ext 12 10 $637.00 $637.00 $573.30 $637.00 $624.26 2026-04-01
72052 CPT C-spine 6 Or More Views/flex/ext 12 8 $637.00 $637.00 $573.30 $637.00 $624.26 2024-11-30
24500 CPT Pf Closed Treatment Humeral Shaft Fracture Without Manipulation 12 8 $723.00 $723.00 $538.52 $708.54 $623.56 2024-11-30
13121 CPT Complex Laceration 2.6-7.5 Cm 36 8 $861.00 $861.00 $415.80 $1,010.00 $617.54 2024-11-30
93882 HCPCS Carotid Unilateral US 12 10 $630.00 $630.00 $567.00 $630.00 $617.40 2026-04-01
12002 HCPCS Simple Lac Scalp, Neck, Trunk, Extm; 2.6-7.5cm 37 10 $626.00 $626.00 $81.81 $948.00 $613.48 2026-04-01
32555 CPT Thoracentesis; Aspiration Of Pleural Space With Imaging; Needle Or Cath 12 8 $622.00 $622.00 $559.80 $622.00 $609.56 2024-11-30
27780 CPT Closed Treatment Proximal Fibula Or Shaft Fracture: Without Manipulation 12 8 $619.00 $619.00 $557.10 $619.00 $606.62 2024-11-30
27530 CPT Closed Treatment Tibial Fracture, Proximal: Without Manipulation 12 8 $612.00 $612.00 $550.80 $612.00 $599.76 2024-11-30
24500 HCPCS Pf Closed Treatment Humeral Shaft Fracture Without Manipulation 12 10 $723.00 $723.00 $480.59 $708.54 $599.52 2026-04-01
23600 CPT Closed Tx Of Proximal Humeral Fracture; Without Manipulation 24 8 $637.50 $637.50 $494.51 $651.70 $597.44 2024-11-30
10040 HCPCS Acne Surgery 24 10 $558.50 $558.50 $72.00 $898.00 $597.18 2026-04-01
27560 HCPCS Closed Treatment Patellar Dislocation: Without Anesthesia 12 10 $755.00 $755.00 $487.31 $739.90 $591.50 2026-04-01
26605 CPT Closed Treatment Metacarpal Fracture: Single With Manipulation: Each Bone 24 8 $619.00 $619.00 $523.80 $656.00 $586.20 2024-11-30
23600 HCPCS Closed Tx Of Proximal Humeral Fracture; Without Manipulation 24 10 $637.50 $637.50 $104.72 $651.70 $584.97 2026-04-01
13121 HCPCS Complex Laceration 2.6-7.5 Cm 36 10 $861.00 $861.00 $23.21 $1,010.00 $583.11 2026-04-01
27750 HCPCS Closed Treatment Tibial Shaft Fracture, Proximal: Without Manipulation 12 10 $697.00 $697.00 $463.76 $907.97 $581.42 2026-04-01
12034 HCPCS Lac. Inter.scalp,trunk,ext 7.6-12.5 24 10 $626.50 $626.50 $74.38 $849.00 $580.01 2026-04-01
24670 CPT Closed Treatment Ulnar Fracture Proximal End Without Manipulation 12 8 $588.00 $588.00 $529.20 $588.00 $576.24 2024-11-30
26775 HCPCS Closed Treatment Interphalangeal Dislocation: SINGLE:with MANIPULATION;with Anesthe… 12 10 $777.00 $777.00 $97.58 $761.46 $573.77 2026-04-01
27767 CPT Closed Treatment Posterior Malleolus Fracture: Without Manipulation 24 8 $582.50 $582.50 $521.10 $586.00 $573.21 2024-11-30
12002 CPT Simple Lac Scalp, Neck, Trunk, Extm; 2.6-7.5cm 48 8 $590.50 $590.50 $96.25 $948.00 $571.52 2024-11-30
23650 CPT Closed Tx Of Shoulder Dislocation W/manipulation; Without Anesth 36 8 $766.00 $766.00 $493.09 $814.00 $568.67 2024-11-30
12011 HCPCS Simple Lac Face, Ears, Eyelids, Nose, Lips; 2.5cm Or Less 37 10 $577.00 $577.00 $63.67 $886.00 $565.46 2026-04-01
12031 HCPCS Laceration Intermediate Repair Up To 2.5 Cm: Scalp, Neck, Axillae, External Geni… 24 10 $602.50 $602.50 $55.93 $701.00 $562.41 2026-04-01
25560 CPT Closed Treatment Radial And Ulnar Shaft Fracture Without Manipulation 12 8 $573.00 $573.00 $515.70 $573.00 $561.54 2024-11-30
12013 HCPCS Pf Laceration Repair Superficial 2.6 To 5 Cm: Face, Ears, Eyelids, Nose, Lips, M… 36 10 $573.00 $573.00 $80.62 $739.00 $561.54 2026-04-01
12013 CPT Pf Laceration Repair Superficial 2.6 To 5 Cm: Face, Ears, Eyelids, Nose, Lips, M… 36 8 $573.00 $573.00 $95.70 $739.00 $561.54 2024-11-30
76775 HCPCS Retroperitoneal Limited US 12 10 $569.00 $569.00 $512.10 $569.00 $557.62 2026-04-01
27760 HCPCS Closed Treatment Medial Malleolus Fracture: Without Manipulation 12 10 $672.00 $672.00 $439.92 $658.56 $556.97 2026-04-01
27808 HCPCS Closed Treatment Bimalleolar Ankle Fracture 12 10 $673.00 $673.00 $439.45 $659.54 $556.64 2026-04-01
26605 HCPCS Closed Treatment Metacarpal Fracture: Single With Manipulation: Each Bone 24 10 $619.00 $619.00 $127.33 $642.88 $551.40 2026-04-01
27767 HCPCS Closed Treatment Posterior Malleolus Fracture: Without Manipulation 24 10 $582.50 $582.50 $417.01 $978.78 $550.84 2026-04-01
26600 CPT Closed Treatment Metacarpal Fracture: Single Without Manipulation 24 8 $574.00 $574.00 $495.00 $598.00 $550.00 2024-11-30
12052 HCPCS Laceration Intermediate Repair 2.6 To 5.0 Cm: Face, Ears, Eyelids, Nose, Lips Or… 24 10 $593.50 $593.50 $53.55 $795.00 $549.83 2026-04-01
25500 CPT Closed Treatment Radial Shaft Fracture Without Manipulation 12 8 $561.00 $561.00 $504.90 $561.00 $549.78 2024-11-30
76706 HCPCS Aorta US 12 10 $560.00 $560.00 $504.00 $560.00 $548.80 2026-04-01
12001 HCPCS Simple Lac Scalp, Neck, Trunk, Extm; 2.5cm Or Less Without Em 37 10 $541.00 $541.00 $62.45 $867.00 $530.18 2026-04-01
26600 HCPCS Closed Treatment Metacarpal Fracture: Single Without Manipulation 24 10 $574.00 $574.00 $99.37 $586.04 $529.65 2026-04-01
26770 CPT Closed Treatment Interphalangeal Dislocation: SINGLE:with MANIPULATION;without Anesth… 24 8 $547.50 $547.50 $474.30 $568.00 $527.00 2024-11-30
12011 CPT Simple Lac Face, Ears, Eyelids, Nose, Lips; 2.5cm Or Less 48 8 $544.00 $544.00 $90.20 $886.00 $526.40 2024-11-30
72084 HCPCS Thorocolumbar Standing Min 6 Views 12 10 $534.00 $534.00 $480.60 $534.00 $523.32 2026-04-01
72084 CPT Thorocolumbar Standing Min 6 Views 12 8 $534.00 $534.00 $480.60 $534.00 $523.32 2024-11-30
27780 HCPCS Closed Treatment Proximal Fibula Or Shaft Fracture: Without Manipulation 12 10 $619.00 $619.00 $410.00 $606.62 $519.14 2026-04-01
25530 CPT Closed Treatment Ulnar Shaft Fracture Without Manipulation 12 8 $529.00 $529.00 $476.10 $529.00 $518.42 2024-11-30
12014 HCPCS Pf Laceration Repair Superficial 5.1 To 7.5 Cm: Face, Ears, Eyelids, Nose, Lips,… 24 10 $562.50 $562.50 $86.67 $844.00 $517.49 2026-04-01
12014 CPT Pf Laceration Repair Superficial 5.1 To 7.5 Cm: Face, Ears, Eyelids, Nose, Lips,… 24 8 $562.50 $562.50 $122.10 $844.00 $517.49 2024-11-30
26770 HCPCS Closed Treatment Interphalangeal Dislocation: SINGLE:with MANIPULATION;without Anesth… 24 10 $547.50 $547.50 $377.27 $556.64 $516.46 2026-04-01
10040 CPT Acne Surgery 24 8 $558.50 $558.50 $84.70 $898.00 $511.41 2024-11-30
12034 CPT Lac. Inter.scalp,trunk,ext 7.6-12.5 12 8 $520.00 $520.00 $468.00 $520.00 $509.60 2024-11-30
73522 CPT Bil Hips With Pelvis 3-4 Views 12 8 $511.00 $511.00 $459.90 $511.00 $500.78 2024-11-30
73522 HCPCS Bil Hips With Pelvis 3-4 Views 12 10 $511.00 $511.00 $459.90 $511.00 $500.78 2026-04-01
27520 HCPCS Closed Treatment Of Patellar Fracture: Without Manipulation 12 10 $651.00 $651.00 $41.65 $637.98 $493.81 2026-04-01
12001 CPT Laceration Repair Superficial To 2.5 Cm:scalp, Neck, Axillae, External Genitalia… 48 8 $510.00 $510.00 $73.70 $867.00 $493.50 2024-11-30
12006 HCPCS Laceration Repair Simple Scalp, Neck, Axillae,external Genitalia, Trunk And/or E… 24 10 $537.00 $537.00 $67.24 $847.00 $492.38 2026-04-01
24670 HCPCS Closed Treatment Ulnar Fracture Proximal End Without Manipulation 12 10 $588.00 $588.00 $386.16 $621.18 $490.63 2026-04-01
92523,GN OTHER Sp Evaluation Of Language Comprehension 12 8 $499.00 $499.00 $449.10 $499.00 $489.02 2024-11-30
10080 HCPCS Incision And Drainage Of Pilonidal Cyst; Simple 36 10 $495.00 $495.00 $68.43 $853.00 $485.10 2026-04-01
74022 HCPCS Abdomen Acute Series 12 10 $492.00 $492.00 $442.80 $492.00 $482.16 2026-04-01
74022 CPT Abdomen Acute Series 12 8 $492.00 $492.00 $442.80 $492.00 $482.16 2024-11-30
81256 HCPCS Hemochromatosis DNA Analysis Q 12 10 $491.00 $491.00 $179.74 $491.00 $481.18 2026-04-01
81256 CPT Hemochromatosis DNA Analysis Q 12 8 $491.00 $491.00 $441.90 $491.00 $481.18 2024-11-30
72080 HCPCS Spine, Thoracolumbar Junction 2 View 12 10 $490.00 $490.00 $441.00 $490.00 $480.20 2026-04-01
72080 CPT Spine, Thoracolumbar Junction 2 View 12 8 $490.00 $490.00 $441.00 $490.00 $480.20 2024-11-30
76881 HCPCS US Extremity, Nonvascular, Complete 12 10 $488.00 $488.00 $439.20 $488.00 $478.24 2026-04-01
28192 HCPCS Removal Foreign Body Foot: Deep 12 10 $950.00 $950.00 $102.34 $931.00 $477.73 2026-04-01
25560 HCPCS Closed Treatment Radial And Ulnar Shaft Fracture Without Manipulation 12 10 $573.00 $573.00 $373.53 $853.83 $476.66 2026-04-01
27530 HCPCS Closed Treatment Tibial Fracture, Proximal: Without Manipulation 12 10 $612.00 $612.00 $205.87 $599.76 $476.56 2026-04-01
25500 HCPCS Closed Treatment Radial Shaft Fracture Without Manipulation 12 10 $561.00 $561.00 $371.20 $716.38 $475.49 2026-04-01
28430 CPT Closed Treatment Talus Fracture: Without Manipulation 12 8 $482.00 $482.00 $433.80 $482.00 $472.36 2024-11-30
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