Hospital

MEMORIAL HOSPITAL

Aurora, NE · CCN 281320 · Rates published

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You selected 93306 (CPT)

ECHOCARDIOGRAM M-MODE

This hospital’s price: $2,112 across 12 payers · range $968-$2,231

Source: https://sthpiprd.blob.core.windows.net/machine-readable-files/7911/470461859_memorial-community-health%2C-inc_standardcharges.csv · observed 2025-05-01

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.

1,503 distinct procedures filed

12 distinct payers

80,491 rate rows

2025-05-01 last MRF observed · ⚠ 17 mo old

Data quality

80,173 of 80,491 rate rows are consumer-grade (99.6%)

318 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 — reason	Rows
percent-of-charges filed in the dollar field — excluded from medians	291
per-diem day rate — not a per-procedure price	18
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	9

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 17 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

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

Source MRF file	https://sthpiprd.blob.core.windows.net/machine-readable-files/7911/470461859_memorial-community-health%2C-inc_standardcharges.csv
Found on page	https://search.hospitalpriceindex.com/hpi2/machineReadable/MemorialCommunityHealth/7911
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-10-21
Content fingerprint	744ab99eb76afdf5… · 58,715,869 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
J3245 HCPCS	Tildrakizumab 100 mg/mL Inj [mchi]	12	$10,401.58	$22,930.76	$22,694.36	nat. median $256 outlier · 88.6×
J3101 HCPCS	Tenecteplase 50 Mg IV Inj [mchi]	12	$4,268.62	$9,410.38	$9,313.36	nat. median $3,820 outlier · 2.4×
J0741 HCPCS	Cabotegravir-rilpivirine 200 Mg-300 mg/mL ER X2 Of 3 Ml Inj [mchi]	12	$4,077.22	$8,988.41	$8,895.74	nat. median $70 outlier · 126.8×
J9217 HCPCS	Leuprolide 45 Mg/6 Months Depot Inj [mchi]	12	$3,817.86	$15,538.69	$8,329.87	nat. median $1,575 outlier · 5.3×
J0517 HCPCS	Benralizumab 30 mg/mL Inj [mchi]	12	$3,565.87	$7,861.12	$7,780.08	nat. median $919 outlier · 8.5×
J2796 HCPCS	romiPLOStim 500 Mcg Inj [mchi]	12	$3,437.79	$7,578.76	$7,500.62	nat. median $1,463 outlier · 5.1×
J9312 HCPCS	riTUXimab 10 mg/mL Inj 50 Ml [mchi]	12	$3,224.43	$7,108.41	$7,035.13	nat. median $1,071 outlier · 6.6×
78816 CPT	PET Whole Body	12	$3,102.00	$6,838.50	$6,768.00	nat. median $2,788 outlier · 2.4×
J2353 HCPCS	Octreotide 30 Mg IM Inj [mchi]	12	$3,009.93	$9,663.51	$6,567.11	nat. median $5,573 1.2× median
Q5115 HCPCS	riTUXimab Abbs 500 Mg/50 Ml Inj [mchi]	12	$2,901.93	$6,397.43	$6,331.48	nat. median $840 outlier · 7.5×
Q5111 HCPCS	Pegfilgrastim Cbqv 6 Mg/0.6 Ml Inj [mchi]	12	$2,865.72	$6,317.61	$6,252.48	nat. median $1,982 outlier · 3.2×
78815 CPT	PET Skull - Mid Thigh	12	$2,805.00	$6,183.75	$6,120.00	nat. median $2,820 outlier · 2.2×
J2356 HCPCS	Tezepelumab 210 Mg/1.91 Ml Inj [mchi]	12	$2,685.51	$5,920.34	$5,859.30	nat. median $81 outlier · 72.1×
J0896 HCPCS	Luspatercept 25 Mg Inj [mchi]	12	$2,543.72	$14,419.90	$5,549.94	nat. median $4,583 1.2× median
74178 CPT	CT Abd Pelvis Wwo Cont	12	$2,406.80	$5,305.90	$5,251.20	nat. median $1,024 outlier · 5.1×
J1306 HCPCS	Inclisiran 284 Mg/1.5 Ml Sol [mchi]	12	$2,402.40	$5,296.20	$5,241.60	nat. median $44 outlier · 118.7×
78492 CPT	PET Perfusion Evaluation Multiple	12	$2,354.00	$5,189.50	$5,136.00	nat. median $1,839 outlier · 2.8×
78491 CPT	PET Perfusion Evaluation Single	12	$2,354.00	$5,189.50	$5,136.00	nat. median $1,785 outlier · 2.9×
78459 CPT	PET Metabolic Evaluation	12	$2,354.00	$5,189.50	$5,136.00	nat. median $1,880 outlier · 2.7×
78608 CPT	PET Brain Imaging	12	$2,354.00	$5,189.50	$5,136.00	nat. median $2,450 outlier · 2.1×
36475 CPT	Endovenous Rf Ablation	12	$2,288.00	$5,044.00	$4,992.00	nat. median $4,061 1.2× median
59510 CPT	Cesarean Delivery Only, Following Attempted Vaginal Delivery	12	$2,112.00	$4,656.00	$4,608.00	nat. median $3,648 1.3× median
74177 CPT	CT abd/Pelvis W Contrast	12	$2,079.00	$4,583.25	$4,536.00	nat. median $974 outlier · 4.7×
74174 CPT	CTA Abd Pelvis W/wo	12	$2,079.00	$5,286.50	$4,536.00	nat. median $988 outlier · 4.6×
J0630 HCPCS	Calcitonin 200 units/mL Inj 2 Ml [mchi]	12	$1,998.11	$5,104.07	$4,359.50	nat. median $1,894 outlier · 2.3×
59400 CPT	Routine OB Care, Antepartum/Vaginal Delivery/Postpartum Charge	12	$1,892.00	$4,171.00	$4,128.00	nat. median $3,137 1.3× median
J0717 HCPCS	Certolizumab 200 Mg Inj Kit [mchi]	12	$1,884.84	$4,155.22	$4,112.38	nat. median $1,598 outlier · 2.6×
74176 CPT	CT Abd/Pelvis Without Contrast	12	$1,793.00	$3,952.75	$3,912.00	nat. median $694 outlier · 5.6×
J1602 HCPCS	Golimumab 50 Mg/4 Ml Inj [mchi]	12	$1,688.92	$3,723.30	$3,684.91	nat. median $273 outlier · 13.5×
74175 CPT	CT Angiography Abdomen With + Without Contrast	12	$1,555.40	$3,428.95	$3,393.60	nat. median $714 outlier · 4.8×
Q0222 HCPCS	Bebtelovimab 175 Mg/2 Ml Inj [mchi]	12	$1,552.32	$3,422.16	$3,386.88	nat. median $2,564 1.3× median
Q5108 HCPCS	Pegfilgrastim Jmdb 6 Mg/0.6 Ml Inj [mchi]	12	$1,543.08	$6,317.61	$3,366.72	nat. median $1,244 outlier · 2.7×
75635 CPT	CT Angio Abd Aorta + Iliofemoral Le Runo	12	$1,540.00	$3,395.00	$3,360.00	nat. median $722 outlier · 4.7×
71275 CPT	CTA Chest	12	$1,513.60	$3,336.80	$3,302.40	nat. median $754 outlier · 4.4×
J0875 HCPCS	Dalbavancin 500 Mg Inj [mchi]	12	$1,459.23	$3,216.94	$3,183.77	nat. median $390 outlier · 8.2×
73206 CPT	CT Angiography Upper Extremity Bilat	12	$1,430.00	$3,152.50	$3,120.00	nat. median $689 outlier · 4.5×
J7327 HCPCS	Hyaluronan 88 Mg/4 Ml Inj [mchi]	12	$1,425.60	$3,142.80	$3,110.40	nat. median $888 outlier · 3.5×
73702 CPT	CT Lw Ext Rt W/wo Cont	12	$1,408.00	$3,104.00	$3,072.00	nat. median $703 outlier · 4.4×
J0897 HCPCS	Denosumab 60 mg/mL Inj [mchi]	12	$1,403.89	$4,427.87	$3,063.03	nat. median $1,972 1.6× median
74170 CPT	CT Abd Wwo Contrast	12	$1,386.00	$3,055.50	$3,024.00	nat. median $710 outlier · 4.3×
70496 CPT	CTA Head W/wo	12	$1,375.00	$3,031.25	$3,000.00	nat. median $747 outlier · 4.0×
72132 CPT	CT L Spine W Contrast	12	$1,375.00	$3,031.25	$3,000.00	nat. median $766 outlier · 3.9×
70498 CPT	CT Angiography Neck With + Without Contrast	12	$1,357.40	$2,992.45	$2,961.60	nat. median $739 outlier · 4.0×
95811 CPT	Polysonogram W/cpap	12	$1,342.00	$2,958.50	$2,928.00	nat. median $1,894 1.5× median
J0881 HCPCS	Darbepoetin Alfa 500 mcg/mL Inj [mchi]	12	$843.74	$6,306.55	$2,925.72	nat. median $752 outlier · 3.9×
73202 CPT	CT Up Ext Lt W/wo Cont	12	$1,331.00	$2,934.25	$2,904.00	nat. median $711 outlier · 4.1×
71270 CPT	CT Thorax W/wo Contrast	12	$1,331.00	$2,934.25	$2,904.00	nat. median $672 outlier · 4.3×
70482 CPT	CT Orbs W/wo Contrast	12	$1,309.00	$2,885.75	$2,856.00	nat. median $656 outlier · 4.4×
27752 CPT	27752 Ed Pf/tech Closed Treatment Of Tibial Shaft Fracture (	12	$1,287.88	$2,839.19	$2,809.92	nat. median $1,773 1.6× median
72133 CPT	CT L Spine Wwo Contrast	12	$1,287.00	$2,837.25	$2,808.00	nat. median $633 outlier · 4.4×

Other procedures at this hospital

Browse this hospital's 1,503 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

J3245	HCPCS	Tildrakizumab 100 mg/mL Inj [mchi]	28	12	$23,639.96	$22,694.37	$10,401.58	$22,930.76	$22,694.36	2025-05-01
J3101	HCPCS	Tenecteplase 50 Mg IV Inj [mchi]	28	12	$9,701.42	$9,313.37	$4,268.62	$9,410.38	$9,313.36	2025-05-01
J0741	HCPCS	Cabotegravir-rilpivirine 200 Mg-300 mg/mL ER X2 Of 3 Ml Inj [mchi]	28	12	$9,266.40	$8,895.75	$4,077.22	$8,988.41	$8,895.74	2025-05-01
J9217	HCPCS	Leuprolide 45 Mg/6 Months Depot Inj [mchi]	47	12	$16,019.27	$15,378.50	$3,817.86	$15,538.69	$8,329.87	2025-05-01
J0517	HCPCS	Benralizumab 30 mg/mL Inj [mchi]	28	12	$8,104.25	$7,780.08	$3,565.87	$7,861.12	$7,780.08	2025-05-01
J2796	HCPCS	romiPLOStim 500 Mcg Inj [mchi]	28	12	$7,813.15	$7,500.63	$3,437.79	$7,578.76	$7,500.62	2025-05-01
J9312	HCPCS	riTUXimab 10 mg/mL Inj 50 Ml [mchi]	28	12	$7,328.26	$7,035.13	$3,224.43	$7,108.41	$7,035.13	2025-05-01
78816	CPT	PET Whole Body	29	12	$7,050.00	$6,768.00	$3,102.00	$6,838.50	$6,768.00	2025-05-01
J2353	HCPCS	Octreotide 30 Mg IM Inj [mchi]	66	12	$7,508.07	$7,207.75	$3,009.93	$9,663.51	$6,567.11	2025-05-01
Q5115	HCPCS	riTUXimab Abbs 500 Mg/50 Ml Inj [mchi]	28	12	$6,595.29	$6,331.48	$2,901.93	$6,397.43	$6,331.48	2025-05-01
Q5111	HCPCS	Pegfilgrastim Cbqv 6 Mg/0.6 Ml Inj [mchi]	28	12	$6,513.00	$6,252.48	$2,865.72	$6,317.61	$6,252.48	2025-05-01
78815	CPT	PET Skull - Mid Thigh	28	12	$6,375.00	$6,120.00	$2,805.00	$6,183.75	$6,120.00	2025-05-01
J2356	HCPCS	Tezepelumab 210 Mg/1.91 Ml Inj [mchi]	28	12	$6,103.44	$5,859.31	$2,685.51	$5,920.34	$5,859.30	2025-05-01
J0896	HCPCS	Luspatercept 25 Mg Inj [mchi]	47	12	$5,781.19	$5,549.95	$2,543.72	$14,419.90	$5,549.94	2025-05-01
74178	CPT	CT Abd Pelvis Wwo Cont	31	12	$5,470.00	$5,251.20	$2,406.80	$5,305.90	$5,251.20	2025-05-01
J1306	HCPCS	Inclisiran 284 Mg/1.5 Ml Sol [mchi]	28	12	$5,460.00	$5,241.60	$2,402.40	$5,296.20	$5,241.60	2025-05-01
78491	CPT	PET Perfusion Evaluation Single	28	12	$5,350.00	$5,136.00	$2,354.00	$5,189.50	$5,136.00	2025-05-01
78459	CPT	PET Metabolic Evaluation	28	12	$5,350.00	$5,136.00	$2,354.00	$5,189.50	$5,136.00	2025-05-01
78492	CPT	PET Perfusion Evaluation Multiple	28	12	$5,350.00	$5,136.00	$2,354.00	$5,189.50	$5,136.00	2025-05-01
78608	CPT	PET Brain Imaging	28	12	$5,350.00	$5,136.00	$2,354.00	$5,189.50	$5,136.00	2025-05-01
36475	CPT	Endovenous Rf Ablation	28	12	$5,200.00	$4,992.00	$2,288.00	$5,044.00	$4,992.00	2025-05-01
59510	CPT	Cesarean Delivery Only, Following Attempted Vaginal Delivery	28	12	$4,800.00	$4,608.00	$2,112.00	$4,656.00	$4,608.00	2025-05-01
74177	CPT	CT abd/Pelvis W Contrast	34	12	$4,725.00	$4,536.00	$2,079.00	$4,583.25	$4,536.00	2025-05-01
74174	CPT	CTA Abd Pelvis W/wo	49	12	$5,450.00	$5,232.00	$2,079.00	$5,286.50	$4,536.00	2025-05-01
J0630	HCPCS	Calcitonin 200 units/mL Inj 2 Ml [mchi]	47	12	$4,541.15	$4,359.51	$1,998.11	$5,104.07	$4,359.50	2025-05-01
59400	CPT	Routine OB Care, Antepartum/Vaginal Delivery/Postpartum Charge	28	12	$4,300.00	$4,128.00	$1,892.00	$4,171.00	$4,128.00	2025-05-01
J0717	HCPCS	Certolizumab 200 Mg Inj Kit [mchi]	28	12	$4,283.73	$4,112.39	$1,884.84	$4,155.22	$4,112.38	2025-05-01
74176	CPT	CT Abd/Pelvis Without Contrast	32	12	$4,075.00	$3,912.00	$1,793.00	$3,952.75	$3,912.00	2025-05-01
J1602	HCPCS	Golimumab 50 Mg/4 Ml Inj [mchi]	28	12	$3,838.45	$3,684.92	$1,688.92	$3,723.30	$3,684.91	2025-05-01
74175	CPT	CT Angiography Abdomen With + Without Contrast	28	12	$3,535.00	$3,393.60	$1,555.40	$3,428.95	$3,393.60	2025-05-01
Q0222	HCPCS	Bebtelovimab 175 Mg/2 Ml Inj [mchi]	28	12	$3,528.00	$3,386.88	$1,552.32	$3,422.16	$3,386.88	2025-05-01
Q5108	HCPCS	Pegfilgrastim Jmdb 6 Mg/0.6 Ml Inj [mchi]	47	12	$6,513.00	$6,252.48	$1,543.08	$6,317.61	$3,366.72	2025-05-01
75635	CPT	CT Angio Abd Aorta + Iliofemoral Le Runo	28	12	$3,500.00	$3,360.00	$1,540.00	$3,395.00	$3,360.00	2025-05-01
71275	CPT	CTA Chest	31	12	$3,440.00	$3,302.40	$1,513.60	$3,336.80	$3,302.40	2025-05-01
J0875	HCPCS	Dalbavancin 500 Mg Inj [mchi]	28	12	$3,316.43	$3,183.78	$1,459.23	$3,216.94	$3,183.77	2025-05-01
73206	CPT	CT Angiography Upper Extremity Bilat	28	12	$3,250.00	$3,120.00	$1,430.00	$3,152.50	$3,120.00	2025-05-01
J7327	HCPCS	Hyaluronan 88 Mg/4 Ml Inj [mchi]	28	12	$3,240.00	$3,110.40	$1,425.60	$3,142.80	$3,110.40	2025-05-01
73702	CPT	CT Lw Ext Rt W/wo Cont	28	12	$3,200.00	$3,072.00	$1,408.00	$3,104.00	$3,072.00	2025-05-01
J0897	HCPCS	Denosumab 60 mg/mL Inj [mchi]	66	12	$3,429.34	$3,292.17	$1,403.89	$4,427.87	$3,063.03	2025-05-01
74170	CPT	CT Abd Wwo Contrast	30	12	$3,150.00	$3,024.00	$1,386.00	$3,055.50	$3,024.00	2025-05-01
72132	CPT	CT L Spine W Contrast	29	12	$3,125.00	$3,000.00	$1,375.00	$3,031.25	$3,000.00	2025-05-01
70496	CPT	CTA Head W/wo	30	12	$3,125.00	$3,000.00	$1,375.00	$3,031.25	$3,000.00	2025-05-01
70498	CPT	CT Angiography Neck With + Without Contrast	31	12	$3,085.00	$2,961.60	$1,357.40	$2,992.45	$2,961.60	2025-05-01
95811	CPT	Polysonogram W/cpap	31	12	$3,050.00	$2,928.00	$1,342.00	$2,958.50	$2,928.00	2025-05-01
J0881	HCPCS	Darbepoetin Alfa 500 mcg/mL Inj [mchi]	47	12	$6,501.60	$6,241.54	$843.74	$6,306.55	$2,925.72	2025-05-01
73202	CPT	CT Up Ext Lt W/wo Cont	28	12	$3,025.00	$2,904.00	$1,331.00	$2,934.25	$2,904.00	2025-05-01
71270	CPT	CT Thorax W/wo Contrast	29	12	$3,025.00	$2,904.00	$1,331.00	$2,934.25	$2,904.00	2025-05-01
70482	CPT	CT Orbs W/wo Contrast	28	12	$2,975.00	$2,856.00	$1,309.00	$2,885.75	$2,856.00	2025-05-01
27752	CPT	27752 Ed Pf/tech Closed Treatment Of Tibial Shaft Fracture (	28	12	$2,927.00	$2,809.92	$1,287.88	$2,839.19	$2,809.92	2025-05-01
72133	CPT	CT L Spine Wwo Contrast	28	12	$2,925.00	$2,808.00	$1,287.00	$2,837.25	$2,808.00	2025-05-01
J3111	HCPCS	Romosozumab 105 Mg/1.17 Ml Inj [mchi]	28	12	$2,921.23	$2,804.39	$1,285.34	$2,833.59	$2,804.38	2025-05-01
72126	CPT	CT C Spine W Contrast	28	12	$2,900.00	$2,784.00	$1,276.00	$2,813.00	$2,784.00	2025-05-01
93312	CPT	Tee	29	12	$2,900.00	$2,784.00	$1,276.00	$2,813.00	$2,784.00	2025-05-01
19083	CPT	US Biopsy Breast Right	29	12	$2,900.00	$2,784.00	$1,276.00	$2,813.00	$2,784.00	2025-05-01
64635	CPT	Xr Nerve Root Ablation Lumbar Or Sacral	28	12	$2,900.00	$2,784.00	$1,276.00	$2,813.00	$2,784.00	2025-05-01
95810	CPT	Polysonogram	30	12	$2,900.00	$2,784.00	$1,276.00	$2,813.00	$2,784.00	2025-05-01
72127	CPT	CT C Spine W/wo Contrast	28	12	$2,900.00	$2,784.00	$1,276.00	$2,813.00	$2,784.00	2025-05-01
64633	CPT	Xr Nerve Root Ablation Cerv Or Thora	28	12	$2,900.00	$2,784.00	$1,276.00	$2,813.00	$2,784.00	2025-05-01
0360	RC	Podiatry Procedure	2,023	12	$3,945.00	$3,787.20	$99.00	$17,023.50	$2,761.00	2025-05-01
70492	CPT	CT Neck W/wo Contrast	28	12	$2,850.00	$2,736.00	$1,254.00	$2,764.50	$2,736.00	2025-05-01
72194	CPT	CT Pelvis Wwo Contrast	28	12	$2,840.00	$2,726.40	$1,249.60	$2,754.80	$2,726.40	2025-05-01
J1745	HCPCS	inFLIXimab 100 Mg Inj [mchi]	28	12	$2,802.76	$2,690.65	$1,233.21	$2,718.68	$2,690.65	2025-05-01
70470	CPT	CT Head W/wo Contrast	29	12	$2,760.00	$2,649.60	$1,214.40	$2,677.20	$2,649.60	2025-05-01
72130	CPT	CT T Spine W/wo Contrast	28	12	$2,750.00	$2,640.00	$1,210.00	$2,667.50	$2,640.00	2025-05-01
72129	CPT	CT T Spine W Contrast	28	12	$2,750.00	$2,640.00	$1,210.00	$2,667.50	$2,640.00	2025-05-01
74160	CPT	CT Abdomen With Contrast	30	12	$2,750.00	$2,640.00	$1,210.00	$2,667.50	$2,640.00	2025-05-01
J9280	HCPCS	mitoMYcin 40 Mg Inj [mchi]	66	12	$2,730.15	$2,620.95	$1,201.24	$2,868.94	$2,620.90	2025-05-01
93318	CPT	Tee With Cardioversion	28	12	$2,700.00	$2,592.00	$1,188.00	$2,619.00	$2,592.00	2025-05-01
72193	CPT	CT Pelvis W Contrast	28	12	$2,700.00	$2,592.00	$1,188.00	$2,619.00	$2,592.00	2025-05-01
71260	CPT	CT Chest With Contrast	32	12	$2,680.00	$2,572.80	$1,179.20	$2,599.60	$2,572.80	2025-05-01
70481	CPT	CT Orbs W Contrast	28	12	$2,675.00	$2,568.00	$1,177.00	$2,594.75	$2,568.00	2025-05-01
J7296	HCPCS	Levonorgestrel 19.5 Mg Iu Device [mchi]	28	12	$2,644.08	$2,538.32	$1,163.40	$2,564.76	$2,538.32	2025-05-01
C8929	HCPCS	US Echo Doppler Complete With Contrast	31	12	$2,600.00	$2,496.00	$1,144.00	$2,522.00	$2,496.00	2025-05-01
78452	CPT	Nuclear Med, Myo Perf Spect Mult	32	12	$2,600.00	$2,496.00	$1,144.00	$2,522.00	$2,496.00	2025-05-01
70488	CPT	CT Max-fac W/wo Contrast	28	12	$2,575.00	$2,472.00	$1,133.00	$2,497.75	$2,472.00	2025-05-01
74185	CPT	MRA Abdomen W/wo Contrast	28	12	$2,550.00	$2,448.00	$1,122.00	$2,473.50	$2,448.00	2025-05-01
70549	CPT	MRA Neck W/wo Contrast	28	12	$2,550.00	$2,448.00	$1,122.00	$2,473.50	$2,448.00	2025-05-01
70546	CPT	MRA Head With Wo Cont	28	12	$2,550.00	$2,448.00	$1,122.00	$2,473.50	$2,448.00	2025-05-01
J0129	HCPCS	Abatacept 250 Mg Inj [mchi]	47	12	$2,511.00	$2,410.56	$1,104.84	$3,064.19	$2,410.56	2025-05-01
73701	CPT	CT Lw Ext Lt W/cont	28	12	$2,510.00	$2,409.60	$1,104.40	$2,434.70	$2,409.60	2025-05-01
70491	CPT	CT Soft Tissue Neck With Contrast	29	12	$2,510.00	$2,409.60	$1,104.40	$2,434.70	$2,409.60	2025-05-01
72131	CPT	CT L Spine Without Contrast	29	12	$2,500.00	$2,400.00	$1,100.00	$2,425.00	$2,400.00	2025-05-01
72125	CPT	CT C Spine Without Contrast	32	12	$2,500.00	$2,400.00	$1,100.00	$2,425.00	$2,400.00	2025-05-01
72128	CPT	CT T Spine Without Contrast	29	12	$2,490.00	$2,390.40	$1,095.60	$2,415.30	$2,390.40	2025-05-01
74150	CPT	CT Abdomen Without Contrast	28	12	$2,485.00	$2,385.60	$1,093.40	$2,410.45	$2,385.60	2025-05-01
70545	CPT	MRA Head With Cont	28	12	$2,450.00	$2,352.00	$1,078.00	$2,376.50	$2,352.00	2025-05-01
70548	CPT	MRA With Contrast	28	12	$2,450.00	$2,352.00	$1,078.00	$2,376.50	$2,352.00	2025-05-01
J7318	HCPCS	Sodium Hyaluronate 60 Mg/3 Ml Inj [mchi]	28	12	$2,410.20	$2,313.80	$1,060.49	$2,337.89	$2,313.79	2025-05-01
71250	CPT	CT Thorax Without Contrast	31	12	$2,410.00	$2,313.60	$1,060.40	$2,337.70	$2,313.60	2025-05-01
30310	CPT	Ed Pf/tech Remov Fb Intranasal; Req Gen A	28	12	$2,402.00	$2,305.92	$1,056.88	$2,329.94	$2,305.92	2025-05-01
59515	CPT	Cesarean Section Only With Postpartum	28	12	$2,400.00	$2,304.00	$1,056.00	$2,328.00	$2,304.00	2025-05-01
71555	CPT	MRA Chest W Or Without	28	12	$2,375.00	$2,280.00	$1,045.00	$2,303.75	$2,280.00	2025-05-01
70547	CPT	MRA Neck Without Contrast	28	12	$2,375.00	$2,280.00	$1,045.00	$2,303.75	$2,280.00	2025-05-01
72159	CPT	MRA Spinal Canal W Or Wo	28	12	$2,375.00	$2,280.00	$1,045.00	$2,303.75	$2,280.00	2025-05-01
73201	CPT	CT Upper Extremity With Contrast Left	28	12	$2,375.00	$2,280.00	$1,045.00	$2,303.75	$2,280.00	2025-05-01
70544	CPT	MRA Head Without Cont	28	12	$2,375.00	$2,280.00	$1,045.00	$2,303.75	$2,280.00	2025-05-01
72192	CPT	CT Pelvis Without Contrast	28	12	$2,375.00	$2,280.00	$1,045.00	$2,303.75	$2,280.00	2025-05-01
70460	CPT	CT Head Or Brain With Contrast	28	12	$2,360.00	$2,265.60	$1,038.40	$2,289.20	$2,265.60	2025-05-01
J0485	HCPCS	Belatacept 250 Mg Inj [mchi]	28	12	$2,320.92	$2,228.09	$1,021.20	$2,251.29	$2,228.08	2025-05-01
27096	CPT	Xr Si Joint Inj	29	12	$2,300.00	$2,208.00	$1,012.00	$2,231.00	$2,208.00	2025-05-01
64479	CPT	Xr Spine Trans Inj Cerv Or Thor Sngl Lvl	29	12	$2,300.00	$2,208.00	$1,012.00	$2,231.00	$2,208.00	2025-05-01
64483	CPT	CT Spine Trans Inj Lumb Or Sac Sngl Lvl	30	12	$2,300.00	$2,208.00	$1,012.00	$2,231.00	$2,208.00	2025-05-01
70487	CPT	CT Max-fac W Contrast	28	12	$2,275.00	$2,184.00	$1,001.00	$2,206.75	$2,184.00	2025-05-01
Q5103	HCPCS	inFLIXimab Dyyb 100 Mg Inj [mchi]	28	12	$2,271.08	$2,180.24	$999.28	$2,202.95	$2,180.24	2025-05-01
73700	CPT	CT Lw Ext Lt Without Cont	29	12	$2,260.00	$2,169.60	$994.40	$2,192.20	$2,169.60	2025-05-01
70480	CPT	CT Orbit Sella Etc. Without Contrast	28	12	$2,240.00	$2,150.40	$985.60	$2,172.80	$2,150.40	2025-05-01
70490	CPT	CT Soft Tissue Neck Without Contrast	28	12	$2,215.00	$2,126.40	$974.60	$2,148.55	$2,126.40	2025-05-01
72197	CPT	MRI Pelvis W/wo Contrast	28	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
71552	CPT	MRI Chest W/wo Contrast	28	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
78582	CPT	Pulmonary Ventilation Perfusion Imaging	28	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
70543	CPT	MRI Neck W/wo Contrast	28	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
78315	CPT	Bone Imaging-three Phase Study	28	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
73223	CPT	MRI Upper Joint W/wo Cont	28	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
78451	CPT	Nm, Myo Perf Spect Single	28	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
73723	CPT	MRI Le Joint With + Without Contrast Right	28	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
72146	CPT	MRI Spine Thoracic Without Contrast	31	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
64493	CPT	Fluoro Guided Medial Branch Block, 1st Level	29	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
93306	CPT	Echocardiogram M-mode	57	12	$2,300.00	$2,208.00	$968.00	$2,231.00	$2,112.00	2025-05-01
72158	CPT	MRI Lumbar W/wo Contrast	29	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
74183	CPT	MRI Abdomen With + Without Contrast	29	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
73720	CPT	MRI Lower Ext W/wo	28	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
38505	CPT	US Guided Biopsy Lymph Node	28	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
73220	CPT	MRI Upper Ext. W/wo Cont	29	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
72156	CPT	MRI Cervical W/wo Contras	29	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
62323	CPT	Xr Spine Lumbar Epidural Steroid Injecti	28	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
62321	CPT	Xr Spine C-t Epidural Steroid Injection	28	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
72157	CPT	MRI Thoracic W/wo Contras	28	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
64454	CPT	Xr Genicular Nerve Branch Inj	28	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
70553	CPT	MRI Brain W/wo Contrast	31	12	$2,200.00	$2,112.00	$968.00	$2,134.00	$2,112.00	2025-05-01
Q0138	HCPCS	Ferumoxytol 30 mg/mL Inj 17 Ml [mchi]	49	12	$2,172.84	$2,085.93	$956.05	$2,697.80	$2,085.93	2025-05-01
73200	CPT	CT Up Ext Lt Without Cont	31	12	$2,150.00	$2,064.00	$946.00	$2,085.50	$2,064.00	2025-05-01
72148	CPT	MRI Lumbar Without Contrast	32	12	$2,125.00	$2,040.00	$935.00	$2,061.25	$2,040.00	2025-05-01
70450	CPT	CT Head Without Contrast	33	12	$2,100.00	$2,016.00	$924.00	$2,037.00	$2,016.00	2025-05-01
73221	CPT	MRI Ue Joint Without Contrast Left	32	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
73219	CPT	MRI Upper Extremity	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
77049	CPT	MRI Breast Bilateral	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
71551	CPT	MRI Chest	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
71550	CPT	MRI Chest Without Contrast	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
70552	CPT	MRI Brain	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
70551	CPT	MRI Brain Without Contrast	31	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
77048	CPT	MRI Breast Unilateral	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
70542	CPT	MRI Face Neck Orbit With Contrast	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
70540	CPT	MRI Face/neck Without Cont	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
70336	CPT	MRI Temporom Joint(s)	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
74182	CPT	MRI Abdomen	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
73722	CPT	MRI Lower Joint	29	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
73718	CPT	MRI Lower Extremity Non Joint Without Contrast	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
74181	CPT	MRI Abdomen Without Cont	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
73721	CPT	MRI Le Joint Without Contrast Right	57	12	$2,600.00	$2,496.00	$902.00	$2,522.00	$1,968.00	2025-05-01
73222	CPT	MRI Upper Joint	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
73719	CPT	MRI Lower Extremity	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
73218	CPT	MRI Upper Extemity Without	29	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
78598	CPT	Pulmonary Vent/perf Quantification Imaging	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
72196	CPT	MRI Pelvis With Contrast	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
72195	CPT	MRI Pelvis Without Contrast	29	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
72149	CPT	MRI Spine Lumbar With Contrast	29	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
72147	CPT	MRI Spine Thoracic With Contrast	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
72142	CPT	MRI Spinal Canal	28	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
72141	CPT	MRI Spine Cervical Without Contrast	32	12	$2,050.00	$1,968.00	$902.00	$1,988.50	$1,968.00	2025-05-01
G0390	HCPCS	Trauma Response Team	28	12	$2,000.00	$1,920.00	$880.00	$1,940.00	$1,920.00	2025-05-01
19084	CPT	US Biopsy Breast Left Addl Lesion	28	12	$2,000.00	$1,920.00	$880.00	$1,940.00	$1,920.00	2025-05-01
57240	CPT	Hosp Pf 57240 Anterior Coloporrhaphy	28	12	$2,000.00	$1,920.00	$880.00	$1,940.00	$1,920.00	2025-05-01
35201	CPT	Hosp Pf Repair Blood Vessel Direct; Neck	28	12	$2,000.00	$1,920.00	$880.00	$1,940.00	$1,920.00	2025-05-01
64634	CPT	Mch Xr Rfn/rfa C-t Spine Addl Joint	28	12	$2,000.00	$1,920.00	$880.00	$1,940.00	$1,920.00	2025-05-01
78264	CPT	Gastric Emptying Study	28	12	$2,000.00	$1,920.00	$880.00	$1,940.00	$1,920.00	2025-05-01
65235	CPT	Ed Pf/tech 65235 Removal Of Foreign Body Intraocular Fron An	47	12	$4,225.00	$4,056.00	$704.00	$4,098.25	$1,901.25	2025-05-01
78803	CPT	Bone Imaging, Tomographic (spect Charge)	28	12	$1,975.00	$1,896.00	$869.00	$1,915.75	$1,896.00	2025-05-01
70486	CPT	CT Maxillofacial Without Contrast	30	12	$1,950.00	$1,872.00	$858.00	$1,891.50	$1,872.00	2025-05-01
78306	CPT	Bone Imaging, Whole Body	28	12	$1,925.00	$1,848.00	$847.00	$1,867.25	$1,848.00	2025-05-01
59410	CPT	Delivery Vaginal-only With Postpartum Care Charge	28	12	$1,900.00	$1,824.00	$836.00	$1,843.00	$1,824.00	2025-05-01
J9155	HCPCS	Degarelix 120 Mg Inj Kit [mchi]	28	12	$1,889.02	$1,813.46	$831.17	$1,832.35	$1,813.46	2025-05-01
32556	CPT	32556 Ed Pf/tech Pleural Drainage, Percutaneous, With Insert	28	12	$1,885.00	$1,809.60	$829.40	$1,828.45	$1,809.60	2025-05-01
78226	CPT	Hepatobiliary System Imaging	28	12	$1,875.00	$1,800.00	$825.00	$1,818.75	$1,800.00	2025-05-01
78227	CPT	Hepatobiliary System Imaging W/drug	30	12	$1,875.00	$1,800.00	$825.00	$1,818.75	$1,800.00	2025-05-01
44110	CPT	Hosp Pf Excision Of 1+ Lesions Sm/lg Intestine Not Requiring Anastomosis Exterio…	28	12	$1,850.00	$1,776.00	$814.00	$1,794.50	$1,776.00	2025-05-01
93307	CPT	Echo Limited Study	30	12	$1,825.00	$1,752.00	$803.00	$1,770.25	$1,752.00	2025-05-01
20610	CPT	Xr Arthro Asp And/or Inj Major Joint	32	12	$1,800.00	$1,728.00	$792.00	$1,746.00	$1,728.00	2025-05-01
35226	CPT	Tech Repair Blood Vessel Direct; Lower Extremity Charge	28	12	$1,800.00	$1,728.00	$792.00	$1,746.00	$1,728.00	2025-05-01
99468	CPT	Initial Inpatient Neonatal Critical Care, Per Day, Critically Ill Neonate, >28 D	28	12	$1,785.00	$1,713.60	$785.40	$1,731.45	$1,713.60	2025-05-01
27786	CPT	Ed Pf/tech Closed Trtmt Of Distal Fibular Fx (Lateral Malleo	28	12	$1,726.00	$1,656.96	$759.44	$1,674.22	$1,656.96	2025-05-01
J2357	HCPCS	Omalizumab 150 mg/mL Syr [mchi]	47	12	$2,930.76	$2,813.53	$757.66	$2,842.84	$1,653.08	2025-05-01
58290	CPT	Tech Vaginal Hysterectomy Complex (assist)	28	12	$1,703.00	$1,634.88	$749.32	$1,651.91	$1,634.88	2025-05-01
P9035	HCPCS	Aph Plt Acda Lr 2	28	12	$1,675.00	$1,608.00	$737.00	$1,624.75	$1,608.00	2025-05-01
93350	CPT	US Echo 2d Complete-stress	28	12	$1,675.00	$1,608.00	$737.00	$1,624.75	$1,608.00	2025-05-01
C8928	HCPCS	US Echo 2d Complete Stress With Contrast	28	12	$1,675.00	$1,608.00	$737.00	$1,624.75	$1,608.00	2025-05-01
78708	CPT	Renal Funct/flow W/drug	28	12	$1,665.00	$1,598.40	$732.60	$1,615.05	$1,598.40	2025-05-01
57260	CPT	Hosp Pf 57260 Anterioposterior Coporrhaphy	28	12	$1,650.00	$1,584.00	$726.00	$1,600.50	$1,584.00	2025-05-01
C8923	HCPCS	Echo Limited	28	12	$1,625.00	$1,560.00	$715.00	$1,576.25	$1,560.00	2025-05-01
C8924	HCPCS	Echo Limited With Contrast	28	12	$1,625.00	$1,560.00	$715.00	$1,576.25	$1,560.00	2025-05-01
P9037	HCPCS	Aph Plt Acda Lr Irr	28	12	$1,625.00	$1,560.00	$715.00	$1,576.25	$1,560.00	2025-05-01
86832	CPT	Post-transplant Donor Specific Ab Rps	28	12	$1,600.00	$1,536.00	$704.00	$1,552.00	$1,536.00	2025-05-01
44900	CPT	Tech Incision And Drainage Of Appendiceal Abscess; Open	28	12	$1,600.00	$1,536.00	$704.00	$1,552.00	$1,536.00	2025-05-01
64494	CPT	Fluoro Guided Medial Branch Block, 2nd Level	28	12	$1,600.00	$1,536.00	$704.00	$1,552.00	$1,536.00	2025-05-01
86711	CPT	Jcv Antibody Qst	47	12	$3,384.00	$3,248.64	$0.44	$3,282.48	$1,522.80	2025-05-01
J0490	HCPCS	Belimumab 120 Mg Inj [mchi]	47	12	$1,531.44	$1,470.19	$673.83	$3,805.94	$1,470.18	2025-05-01
94002	CPT	Ventilator Services Initial	28	12	$1,500.00	$1,440.00	$660.00	$1,455.00	$1,440.00	2025-05-01
93303	CPT	US Echo Congenital Complete Peds	31	12	$1,500.00	$1,440.00	$660.00	$1,455.00	$1,440.00	2025-05-01
J1301	HCPCS	Edaravone 30 Mg/100 Ml Pmx IV Bag [mchi]	28	12	$1,498.84	$1,438.89	$659.49	$1,453.87	$1,438.88	2025-05-01
59409	CPT	Tech 59409 Vaginal Delivery Surgical Assist	47	12	$2,152.00	$2,065.92	$653.40	$2,087.44	$1,425.60	2025-05-01
93880	CPT	US Carotid Doppler Bilateral	32	12	$1,485.00	$1,425.60	$653.40	$1,440.45	$1,425.60	2025-05-01
78707	CPT	Renal With Vasc Flow/function Without Drug	28	12	$1,475.00	$1,416.00	$649.00	$1,430.75	$1,416.00	2025-05-01
0610	RC	Aph Plt Acda Irr 2	28	12	$1,470.00	$1,411.20	$646.80	$1,425.90	$1,411.20	2025-05-01
0110	RC	Inpatient Room (self Pay)	20	10	$1,462.50	$1,404.00	$902.50	$1,915.75	$1,398.88	2025-05-01
93970	CPT	US Le Venous Doppler Bilateral	30	12	$1,450.00	$1,392.00	$638.00	$1,406.50	$1,392.00	2025-05-01
J2597	HCPCS	Desmopressin 40 Mcg/10 Ml Inj [mchi]	47	12	$1,448.48	$1,390.55	$636.45	$1,405.03	$1,388.62	2025-05-01
10005	CPT	US Guided Fna Biopsy, 1st Lesion	29	12	$1,400.00	$1,344.00	$616.00	$1,358.00	$1,344.00	2025-05-01
J1670	HCPCS	Tetanus Immune Globulin 250 units/mL Inj [mchi]	28	12	$1,395.36	$1,339.55	$613.96	$1,353.50	$1,339.55	2025-05-01
J7325	HCPCS	Hylan G-f 48 Mg/6 Ml Inj [mchi]	47	12	$2,958.37	$2,840.04	$483.81	$2,869.62	$1,331.27	2025-05-01
J3262	HCPCS	Tocilizumab 200 Mg/10 Ml Inj [mchi]	47	12	$2,946.82	$2,828.95	$545.05	$2,858.42	$1,326.07	2025-05-01
64491	CPT	Cervical/thoracic Mmb Or Facet Injection, Second Lvl	28	12	$1,350.00	$1,296.00	$594.00	$1,309.50	$1,296.00	2025-05-01
71271	CPT	CT Low Dose Lung Screening	32	12	$1,339.00	$1,285.44	$589.16	$1,298.83	$1,285.44	2025-05-01
78300	CPT	Bone Imaging, Limited Area	28	12	$1,315.00	$1,262.40	$578.60	$1,275.55	$1,262.40	2025-05-01
J0248	HCPCS	Remdesivir 100 Mg Inj [mchi]	28	12	$1,308.00	$1,255.68	$575.52	$1,268.76	$1,255.68	2025-05-01
44340	CPT	Tech Revision Of Colostomy; Simple (Release Of Superficial Scar)	47	12	$1,300.00	$1,248.00	$572.00	$3,329.04	$1,248.00	2025-05-01
J1096	HCPCS	Dexamethasone Opth 0.4 Mg Insert [mchi]	28	12	$1,293.20	$1,241.48	$569.01	$1,254.40	$1,241.47	2025-05-01
57250	CPT	Posterior Colporrhaphy; Repair Rectocele With Or Without Perineorrhaphy Charge	28	12	$1,280.00	$1,228.80	$563.20	$1,241.60	$1,228.80	2025-05-01
93886	CPT	US Transcranial Doppler Complete	28	12	$1,260.00	$1,209.60	$554.40	$1,222.20	$1,209.60	2025-05-01
J7298	HCPCS	Levonorgestrel 52 Mcg Iu Device [mchi]	28	12	$1,259.09	$1,208.73	$554.00	$1,221.32	$1,208.73	2025-05-01
93975	CPT	Mch US Art/Vein Abd/Pelvis/Scrotal Complete	31	12	$1,250.00	$1,200.00	$550.00	$1,212.50	$1,200.00	2025-05-01
93304	CPT	US Echo Congenital Limited Peds	28	12	$1,250.00	$1,200.00	$550.00	$1,212.50	$1,200.00	2025-05-01
78305	CPT	Bone Imaging, Multiple Areas	28	12	$1,240.00	$1,190.40	$545.60	$1,202.80	$1,190.40	2025-05-01
93925	CPT	US Le Arterial Duplex Bilateral	30	12	$1,225.00	$1,176.00	$539.00	$1,188.25	$1,176.00	2025-05-01
77001	CPT	Xr Fluoro Central Venous Catheter Plcmnt	28	12	$1,200.00	$1,152.00	$528.00	$1,164.00	$1,152.00	2025-05-01
32555	CPT	US Guided Thoracentesis	28	12	$1,200.00	$1,152.00	$528.00	$1,164.00	$1,152.00	2025-05-01
J7307	HCPCS	Etonogestrel 68 Mg Subdermal Implant [mchi]	47	12	$1,200.00	$1,152.00	$528.00	$1,199.67	$1,152.00	2025-05-01
49083	CPT	US Paracentesis With Imaging Guidance	28	12	$1,200.00	$1,152.00	$528.00	$1,164.00	$1,152.00	2025-05-01
46040	CPT	Tech Id Of Ischiorectal And/or Perirectal AbscessCharge	28	12	$1,180.00	$1,132.80	$519.20	$1,144.60	$1,132.80	2025-05-01
93017	CPT	Stress Test	33	12	$1,175.00	$1,128.00	$517.00	$1,139.75	$1,128.00	2025-05-01
93930	CPT	US Ue Arterial Duplex Bilateral	29	12	$1,160.00	$1,113.60	$510.40	$1,125.20	$1,113.60	2025-05-01
41250	CPT	41250 Ed Pf/tech Repair Of Laceration 2.5cm Or Less; Floor O	28	12	$1,150.00	$1,104.00	$506.00	$1,115.50	$1,104.00	2025-05-01
J0586	HCPCS	abobotulinumtoxinA 300 Units Inj [mchi]	28	12	$1,144.73	$1,098.95	$503.68	$1,110.39	$1,098.94	2025-05-01
36471	CPT	Mch US Injection Varicose Vein Multiple	28	12	$1,100.00	$1,056.00	$484.00	$1,067.00	$1,056.00	2025-05-01
10006	CPT	US Guided Fna Biopsy, Addl Lesions	28	12	$1,100.00	$1,056.00	$484.00	$1,067.00	$1,056.00	2025-05-01
93229	CPT	Mobile Cardiac Telemetry (mct)	28	12	$1,100.00	$1,056.00	$484.00	$1,067.00	$1,056.00	2025-05-01
64484	CPT	Mch CT Spine Trans Inj Lumb Or Sac Addl Lvl	28	12	$1,100.00	$1,056.00	$484.00	$1,067.00	$1,056.00	2025-05-01
64480	CPT	Mch CT Spine Trans Inj Cerv Or Thor Addl Lvl	28	12	$1,100.00	$1,056.00	$484.00	$1,067.00	$1,056.00	2025-05-01
93971	CPT	US Le Venous Doppler Right	34	12	$1,075.00	$1,032.00	$473.00	$1,042.75	$1,032.00	2025-05-01
59899	CPT	Unlisted Maternity Procedure	28	12	$1,050.00	$1,008.00	$462.00	$1,018.50	$1,008.00	2025-05-01
J7301	HCPCS	Levonorgestrel 13.5 Mg Iu Device [mchi]	28	12	$1,048.40	$1,006.47	$461.30	$1,016.95	$1,006.46	2025-05-01
58152	CPT	Tech Total Abd. Hysterectomy With Or Without Removal Of Tube(s) Or Ovary(s); W/colpo-u…	47	12	$2,215.00	$2,126.40	$228.80	$2,148.55	$996.75	2025-05-01
88275	CPT	Interphase Fish 100-300 Cells	28	12	$1,028.00	$986.88	$452.32	$997.16	$986.88	2025-05-01
93978	CPT	Abd Vessels Duplex Scan, Complete	28	12	$1,025.00	$984.00	$451.00	$994.25	$984.00	2025-05-01
36430	CPT	Blood Administration Daily	29	12	$1,000.00	$960.00	$440.00	$970.00	$960.00	2025-05-01
94003	CPT	Rt Ventilator Services - Subsequent Charge	28	12	$1,000.00	$960.00	$440.00	$970.00	$960.00	2025-05-01
64495	CPT	Fluoro Guided Medial Branch Block, 3rd Level	28	12	$1,000.00	$960.00	$440.00	$970.00	$960.00	2025-05-01
94726	CPT	Rt Plethysmography Tr Only Charge	31	12	$990.00	$950.40	$435.60	$960.30	$950.40	2025-05-01
94681	CPT	Nitrogen Washout Testing	28	12	$990.00	$950.40	$435.60	$960.30	$950.40	2025-05-01
55250	CPT	Hosp Pf Vasectomy Unilateral Or Bilateral (Separate Procedure) w/Postoperative S…	28	12	$985.00	$945.60	$433.40	$955.45	$945.60	2025-05-01
93924	CPT	US Abi With Exercise	28	12	$965.00	$926.40	$424.60	$936.05	$926.40	2025-05-01
93931	CPT	Arterial Duplex Scan, Limited Upper Extremity	49	12	$960.00	$921.60	$422.40	$936.05	$921.60	2025-05-01
93926	CPT	US Le Arterial Duplex Left	28	12	$960.00	$921.60	$422.40	$931.20	$921.60	2025-05-01
92950	CPT	Ed Pf/tech Cpr	28	12	$950.00	$912.00	$418.00	$921.50	$912.00	2025-05-01
G0378	HCPCS	Observation Room (self Pay)	30	12	$950.00	$912.00	$418.00	$921.50	$912.00	2025-05-01
90675	HCPCS	Rabies Vaccine 2.5 Inter units/mL Inj [mchi]	47	12	$944.96	$907.17	$415.78	$925.59	$907.16	2025-05-01
J7326	HCPCS	Sodium Hyaluronate 30 Mg/3 Ml Inj [mchi]	28	12	$940.00	$902.40	$413.60	$911.80	$902.40	2025-05-01
93976	CPT	Ultrasound Art/vein Abd/pelvis/scrotal Ltd	47	12	$930.00	$892.80	$409.20	$916.65	$892.80	2025-05-01
77002	CPT	Mch Xr Fluoro Guidance Needle Placement	28	12	$925.00	$888.00	$407.00	$897.25	$888.00	2025-05-01
76700	CPT	US Abdomen Complete	33	12	$915.00	$878.40	$402.60	$887.55	$878.40	2025-05-01
59426	CPT	Antepartum Care 7+ Visits (single Visit)	47	12	$1,950.00	$1,872.00	$88.00	$1,891.50	$877.50	2025-05-01
81270	CPT	Jak2 V617f, Ql, Leumeta w/Refl Exons 12 13 Qst	28	12	$914.00	$877.44	$402.16	$886.58	$877.44	2025-05-01
J7323	HCPCS	Sodium Hyaluronate 20 Mg/2 Ml Inj [mchi]	28	12	$900.29	$864.28	$396.13	$873.28	$864.28	2025-05-01
0202U	OTHER	Respiratory Panel 2.1 (BioFire)	29	12	$900.00	$864.00	$396.00	$873.00	$864.00	2025-05-01
93308	CPT	Echocardiogram Without Dopp Limited	28	12	$900.00	$864.00	$396.00	$873.00	$864.00	2025-05-01
64992	CPT	Cervical/thoracic Mmb Or Facet Injection, Third Lvl	28	12	$900.00	$864.00	$396.00	$873.00	$864.00	2025-05-01
93882	CPT	Carotid Duplex Scan, Limited	28	12	$900.00	$864.00	$396.00	$873.00	$864.00	2025-05-01
93990	CPT	Fistula Hemodialysis Doppler	28	12	$895.00	$859.20	$393.80	$868.15	$859.20	2025-05-01
77075	CPT	X-ray Skeletal Survey	28	12	$885.00	$849.60	$389.40	$858.45	$849.60	2025-05-01
P9016	HCPCS	Aph Rbc Cp2d As3 Lr 2	29	12	$865.00	$830.40	$380.60	$839.05	$830.40	2025-05-01
G0416	HCPCS	Prostate Needle Biopsy	28	12	$850.00	$816.00	$374.00	$824.50	$816.00	2025-05-01
87632	CPT	Resp Virus Panel Fa	28	12	$845.00	$811.20	$371.80	$819.65	$811.20	2025-05-01
73040	CPT	X-ray Shoulder Arth Lt	28	12	$840.00	$806.40	$369.60	$814.80	$806.40	2025-05-01
27842	CPT	Tech Ankle Dislocation Reduction	66	12	$1,075.00	$1,032.00	$368.28	$2,718.91	$803.52	2025-05-01
76856	CPT	Ultrasound Pelvis	32	12	$835.00	$801.60	$367.40	$809.95	$801.60	2025-05-01
P9040	HCPCS	Aph Rbc Cp2d As3 Lr Irr	28	12	$835.00	$801.60	$367.40	$809.95	$801.60	2025-05-01
46050	CPT	Ed Pf/tech Id Perianal Abscess Superficial Charge	28	12	$827.00	$793.92	$363.88	$802.19	$793.92	2025-05-01
88271	CPT	Fish,b Cell Lymphocytic Leukemia Panel Qst	28	12	$826.00	$792.96	$363.44	$801.22	$792.96	2025-05-01
J7300	HCPCS	Copper 1 Unit Iu Device [mchi]	28	12	$826.00	$792.96	$363.44	$801.22	$792.96	2025-05-01
93979	CPT	US Aorta Ivc Iliac Duplex Limited	28	12	$825.00	$792.00	$363.00	$800.25	$792.00	2025-05-01
A9562	HCPCS	Mag-3 0-15 Mci	28	12	$825.00	$792.00	$363.00	$800.25	$792.00	2025-05-01
76770	CPT	Ultrasound Kidney	32	12	$825.00	$792.00	$363.00	$800.25	$792.00	2025-05-01
J0666	HCPCS	Bupivacaine Liposome 1.3% (13.3 mg/mL) Inj [mchi]	28	12	$822.00	$789.12	$361.68	$797.34	$789.12	2025-05-01
J1442	HCPCS	Filgrastim 300 Mcg/0.5 Ml Inj Syringe [mchi]	47	12	$1,661.76	$1,595.29	$358.86	$1,611.91	$782.98	2025-05-01
31500	CPT	Ed Pf/tech Intubation Endotracheal (emergency)	29	12	$807.00	$774.72	$355.08	$782.79	$774.72	2025-05-01
76937	CPT	US Guide For Cva	28	12	$800.00	$768.00	$352.00	$776.00	$768.00	2025-05-01
76776	CPT	Ultrasound Transplanted Kidney	29	12	$785.00	$753.60	$345.40	$761.45	$753.60	2025-05-01
59514	CPT	Hosp Pf Cesarean Delivery Only	47	12	$1,665.00	$1,598.40	$248.60	$1,615.05	$749.25	2025-05-01
66821	CPT	Tech Yag-opthalmology Charge	28	12	$780.00	$748.80	$343.20	$756.60	$748.80	2025-05-01
77003	CPT	C Arm, More Than An Hour	47	12	$777.00	$745.92	$341.88	$823.53	$745.92	2025-05-01
99469	CPT	99469 Subsequent Inpatient NICU Per Day	28	12	$775.00	$744.00	$341.00	$751.75	$744.00	2025-05-01
81313	CPT	Progensa Pca3 Qst	28	12	$771.00	$740.16	$339.24	$747.87	$740.16	2025-05-01
76805	CPT	Ultrasound Obstetric Fetalmat	28	12	$760.00	$729.60	$334.40	$737.20	$729.60	2025-05-01
30906	CPT	Hosp Pf Control Nasal Hemmorhage Posterior With Posterior Nasal Packs And Or Cau…	28	12	$760.00	$729.60	$334.40	$737.20	$729.60	2025-05-01
27750	CPT	Tech Closed Trtmt Of Tibial Shaft Fx (With Or Without Fibular Fx); Without Manipulation …	28	12	$760.00	$729.60	$334.40	$737.20	$729.60	2025-05-01
88237	CPT	Chromosome Analysis, Hematologic Maligna	28	12	$750.00	$720.00	$330.00	$727.50	$720.00	2025-05-01
58605	CPT	Tech Tubal Ligation	47	12	$1,197.00	$1,149.12	$323.40	$1,161.09	$705.60	2025-05-01
27760	CPT	Tech Closed Treatment Of Medial Malleolus Fracture; Without Manipulation	28	12	$730.00	$700.80	$321.20	$708.10	$700.80	2025-05-01
37785	CPT	Tech Vein Ligation/suture	28	12	$730.00	$700.80	$321.20	$708.10	$700.80	2025-05-01
30905	CPT	Tech Control Nasal Hemorrhage Posterior With Posterior Nasal Packs And/or Cauter…	49	12	$725.00	$696.00	$319.00	$1,054.39	$696.00	2025-05-01
86790	CPT	Zika Virus IgM	28	12	$710.00	$681.60	$312.40	$688.70	$681.60	2025-05-01
41252	CPT	Hosp Pf Repair Of Laceration Of Tounge/Floor Of Mouth > 2.6cm Or Com	28	12	$705.00	$676.80	$310.20	$683.85	$676.80	2025-05-01

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