Price Transparencybeta Hospital negotiated rates

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

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Hospital

ST FRANCIS MEMORIAL HOSPITAL

West Point, NE · CCN 281322 · Rates published

1,536 distinct procedures filed
12 distinct payers
164,201 rate rows
2026-03-18 last MRF observed
Data quality

86,021 of 164,201 rate rows are consumer-grade (52.4%)

78,180 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
professional (physician) fee — not the facility price 77,960
percent-of-charges filed in the dollar field — excluded from medians 157
per-diem day rate — not a per-procedure price 38
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 25
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/7971/470486026_franciscan-care-services_standardcharges.csv
Found on page https://search.hospitalpriceindex.com/hpi2/machineReadable/FranciscanHealthcare/7971
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 84c96fb2480cc160… · 72,592,033 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
C1822
HCPCS 		Hfx Spinal Cord Stimulator Charger Kit Hfx-d 11 $11,510.20 $29,078.40 $22,111.70 nat. median
$31,540
0.7× median
J2350
HCPCS 		Ocrelizumab 300 Mg/10 Ml Soln[FRAN] 11 $11,246.72 $28,412.76 $21,605.54 nat. median
$683
outlier · 31.6×
C1820
HCPCS 		Spectra Wavewriter Ipg Kit & Precision Charging System 11 $9,880.00 $24,960.00 $18,980.00 nat. median
$22,013
0.9× median
Q4361
HCPCS 		Epixpress 2x3 Cm Ef-5230 11 $6,840.00 $17,280.00 $13,140.00 nat. median
$1,030
outlier · 12.8×
J2327
HCPCS 		Risankizumab Rzaa 60 mg/mL Sol 11 $5,777.76 $14,596.44 $11,099.38 nat. median
$2,241
outlier · 5.0×
J3380
HCPCS 		Vedolizumab 300mg Powder-inj [fran] 11 $4,949.45 $12,503.88 $9,508.16 nat. median
$280
outlier · 33.9×
J9299
HCPCS 		Nivolumab 10 mg/mL Sol 11 $4,718.16 $11,919.55 $9,063.83 nat. median
$2,944
outlier · 3.1×
J3101
HCPCS 		Tenecteplase 50 Mg IV Inj [fran] 11 $3,996.77 $10,097.10 $7,678.01 nat. median
$5,957
1.3× median
78814
CPT 		PET Ltd Area With CT Scan 11 $3,883.22 $9,810.24 $7,459.87 nat. median
$2,306
outlier · 3.2×
78811
CPT 		PET Ltd Area 11 $3,883.22 $9,810.24 $7,459.87 nat. median
$1,668
outlier · 4.5×
Q5120
HCPCS 		Pegfilgrastim Bmez 6 Mg/0.6 Ml Sol 11 $3,878.43 $9,798.13 $7,450.66 nat. median
$361
outlier · 20.6×
Q5122
HCPCS 		Pegfilgrastim Apgf 6 Mg/0.6 Ml Sol 11 $3,877.90 $9,796.80 $7,449.65 nat. median
$439
outlier · 17.0×
J2506
HCPCS 		Pegfilgrastim 6 Mg/0.6 Ml SubQ Inj [fran] 11 $3,804.58 $9,611.58 $7,308.81 nat. median
$2,076
outlier · 3.5×
78815
CPT 		PET Skull Base To Midthigh With CT Scan 11 $3,775.30 $9,537.60 $7,252.55 nat. median
$2,793
outlier · 2.6×
Q0224
HCPCS 		Pemivibart 4,500 Mg/36 Ml Sol 11 $3,773.66 $9,533.46 $7,249.40 nat. median
$7,346
1.0× median
78816
CPT 		PET Whole Body With CT Scan 11 $3,595.56 $9,083.52 $6,907.26 nat. median
$2,707
outlier · 2.6×
C1889
HCPCS 		Via Disc Np 100mg Vcad-00100 Kit: Includes Vcad-kit-01 11 $3,230.00 $8,160.00 $6,205.00 nat. median
$2,392
outlier · 2.6×
J2406
HCPCS 		Oritavancin 1200 Mg Pow 11 $3,163.71 $7,992.52 $6,077.65 nat. median
$63
outlier · 96.6×
74178
CPT 		CT Abdomen +Pelvis With + Without Cont 11 $3,044.64 $7,879.68 $5,991.84 nat. median
$979
outlier · 6.1×
78608
CPT 		PET Brain Metabolic Eval 11 $2,983.38 $7,536.96 $5,731.23 nat. median
$2,352
outlier · 2.4×
78452
CPT 		Nm Myocard Perf Spect Mult Rest+Stress Famc 11 $2,359.65 $7,444.80 $5,661.15 nat. median
$1,767
outlier · 3.2×
J0717
HCPCS 		Certolizumab 200 Mg Kit[FRAN] 11 $2,864.16 $8,565.06 $5,502.21 nat. median
$1,372
outlier · 4.0×
74177
CPT 		CT Abdomen +Pelvis With Cont 11 $2,721.05 $6,998.40 $5,321.70 nat. median
$928
outlier · 5.7×
72156
CPT 		MRI Spine Cervical With + Without Cont 11 $2,721.56 $6,875.52 $5,228.26 nat. median
$1,092
outlier · 4.8×
72157
CPT 		MRI Spine Thoracic With + Without Cont 11 $2,721.56 $6,875.52 $5,228.26 nat. median
$1,094
outlier · 4.8×
74174
CPT 		CT Angio Abdomen +Pelvis With + Without Cont 11 $2,713.96 $6,856.32 $5,213.66 nat. median
$959
outlier · 5.4×
72158
CPT 		MRI Spine Lumbar With + Without Cont 11 $2,670.26 $6,745.92 $5,129.71 nat. median
$1,081
outlier · 4.7×
70553
CPT 		MRI Brain With + Without Cont 11 $2,657.34 $6,713.28 $5,104.89 nat. median
$1,122
outlier · 4.6×
J3590
HCPCS 		Benralizumab 30 mg/mL Sol[FRAN] 11 $2,606.04 $6,583.68 $5,006.34 nat. median
$683
outlier · 7.3×
72147
CPT 		MRI Spine Thoracic With Cont 11 $2,568.80 $6,489.60 $4,934.80 nat. median
$965
outlier · 5.1×
J2356
HCPCS 		Tezepelumab-ekko 210 Mg Soln 11 $2,562.59 $6,473.90 $4,922.86 nat. median
$66
outlier · 74.8×
70552
CPT 		MRI Brain With Cont 11 $2,553.98 $6,452.16 $4,906.33 nat. median
$960
outlier · 5.1×
70543
CPT 		MRI Face Neck Orbit With + Without Cont 11 $2,546.76 $6,433.92 $4,892.46 nat. median
$1,079
outlier · 4.5×
J1952
HCPCS 		Leuprolide 42 Mg/6 Months Emu 11 $2,531.29 $6,394.85 $4,862.75 nat. median
$79
outlier · 61.6×
22511
CPT 		CT Guide Perc Vertebroplasty 11 $2,520.92 $6,368.64 $4,842.82 nat. median
$4,208
1.2× median
95811
CPT 		.overnight Sleep Study With Cpap 11 $2,513.70 $6,350.40 $4,828.95 nat. median
$2,026
outlier · 2.4×
74176
CPT 		CT Abdomen +Pelvis Without Cont 11 $2,217.82 $6,347.52 $4,826.76 nat. median
$685
outlier · 7.0×
72142
CPT 		MRI Spine Cervical With Cont 11 $2,497.36 $6,309.12 $4,797.56 nat. median
$959
outlier · 5.0×
Q5111
HCPCS 		Pegfilgrastim Cbqv 6 Mg/0.6 Ml Sol 11 $2,474.94 $6,252.48 $4,754.49 nat. median
$2,102
outlier · 2.3×
72146
CPT 		MRI Spine Thoracic Without Cont 11 $2,438.46 $6,160.32 $4,684.41 nat. median
$772
outlier · 6.1×
J0565
HCPCS 		Bezlotoxumab 25 mg/mL Sol 11 $2,435.42 $6,152.64 $4,678.57 nat. median
$144
outlier · 32.5×
72149
CPT 		MRI Spine Lumbar With Cont 11 $2,397.04 $6,055.68 $4,604.84 nat. median
$970
outlier · 4.7×
72141
CPT 		MRI Spine Cervical Without Cont 11 $2,394.00 $6,048.00 $4,599.00 nat. median
$766
outlier · 6.0×
78451
CPT 		Nm Myocard Perf Single Rest Or Stress 11 $2,386.78 $6,029.76 $4,585.13 nat. median
$1,534
outlier · 3.0×
32550
CPT 		Fran Insert Pleural Cath 11 $2,381.46 $6,016.32 $4,574.91 nat. median
$4,089
1.1× median
76498
CPT 		MRI Whole Body 11 $2,352.96 $5,944.32 $4,520.16 nat. median
$300
outlier · 15.1×
74183
CPT 		MRI Abdomen With + Without Cont 11 $2,341.18 $5,914.56 $4,497.53 nat. median
$1,102
outlier · 4.1×
95810
CPT 		.overnight Sleep Study 11 $2,339.28 $5,909.76 $4,493.88 nat. median
$1,870
outlier · 2.4×
77049
CPT 		MRI Breast With + Without Cont Bil. 11 $2,326.36 $5,877.12 $4,469.06 nat. median
$957
outlier · 4.7×
Q5119
HCPCS 		riTUXimab Pvvr 10 mg/mL Sol 11 $2,297.63 $5,804.54 $4,413.87 nat. median
$933
outlier · 4.7×

Other procedures at this hospital

Browse this hospital's 1,536 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
             
C1822 HCPCS Hfx Spinal Cord Stimulator Charger Kit Hfx-d 28 11 $30,290.00 $30,290.00 $11,510.20 $29,078.40 $22,111.70 2026-03-18
J2350 HCPCS Ocrelizumab 300 Mg/10 Ml Soln[FRAN] 28 11 $29,596.63 $29,596.63 $11,246.72 $28,412.76 $21,605.54 2026-03-18
C1820 HCPCS Spectra Wavewriter Ipg Kit & Precision Charging System 28 11 $26,000.00 $26,000.00 $9,880.00 $24,960.00 $18,980.00 2026-03-18
Q4361 HCPCS Epixpress 2x3 Cm Ef-5230 28 11 $18,000.00 $18,000.00 $6,840.00 $17,280.00 $13,140.00 2026-03-18
J2327 HCPCS Risankizumab Rzaa 60 mg/mL Sol 28 11 $15,204.63 $15,204.63 $5,777.76 $14,596.44 $11,099.38 2026-03-18
J3380 HCPCS Vedolizumab 300mg Powder-inj [fran] 28 11 $13,024.88 $13,024.88 $4,949.45 $12,503.88 $9,508.16 2026-03-18
J9299 HCPCS Nivolumab 10 mg/mL Sol 28 11 $12,416.20 $12,416.20 $4,718.16 $11,919.55 $9,063.83 2026-03-18
J3101 HCPCS Tenecteplase 50 Mg IV Inj [fran] 28 11 $10,517.81 $10,517.81 $3,996.77 $10,097.10 $7,678.01 2026-03-18
78814 CPT PET Ltd Area With CT Scan 28 11 $10,219.00 $10,219.00 $3,883.22 $9,810.24 $7,459.87 2026-03-18
78811 CPT PET Ltd Area 28 11 $10,219.00 $10,219.00 $3,883.22 $9,810.24 $7,459.87 2026-03-18
Q5120 HCPCS Pegfilgrastim Bmez 6 Mg/0.6 Ml Sol 28 11 $10,206.39 $10,206.39 $3,878.43 $9,798.13 $7,450.66 2026-03-18
Q5122 HCPCS Pegfilgrastim Apgf 6 Mg/0.6 Ml Sol 28 11 $10,205.00 $10,205.00 $3,877.90 $9,796.80 $7,449.65 2026-03-18
J2506 HCPCS Pegfilgrastim 6 Mg/0.6 Ml SubQ Inj [fran] 28 11 $10,012.06 $10,012.06 $3,804.58 $9,611.58 $7,308.81 2026-03-18
78815 CPT PET Skull Base To Midthigh With CT Scan 28 11 $9,935.00 $9,935.00 $3,775.30 $9,537.60 $7,252.55 2026-03-18
Q0224 HCPCS Pemivibart 4,500 Mg/36 Ml Sol 29 11 $9,930.69 $9,930.69 $3,773.66 $9,533.46 $7,249.40 2026-03-18
J9217 HCPCS Leuprolide 45 Mg/6 Months Pwd 96 11 $9,566.34 $9,566.34 $1,398.16 $17,661.24 $4,372.01 2026-03-18
78816 CPT PET Whole Body With CT Scan 28 11 $9,462.00 $9,462.00 $3,595.56 $9,083.52 $6,907.26 2026-03-18
C1889 HCPCS Via Disc Np 100mg Vcad-00100 Kit: Includes Vcad-kit-01 29 11 $8,500.00 $8,500.00 $3,230.00 $8,160.00 $6,205.00 2026-03-18
J2406 HCPCS Oritavancin 1200 Mg Pow 28 11 $8,325.54 $8,325.54 $3,163.71 $7,992.52 $6,077.65 2026-03-18
74178 CPT CT Abdomen +Pelvis With + Without Cont 29 11 $8,208.00 $8,208.00 $3,044.64 $7,879.68 $5,991.84 2026-03-18
Q4278 HCPCS Epieffect 2cm X 2cm Sheet Le-5220 96 11 $8,000.00 $8,000.00 $546.16 $20,954.64 $3,127.50 2026-03-18
78608 CPT PET Brain Metabolic Eval 28 11 $7,851.00 $7,851.00 $2,983.38 $7,536.96 $5,731.23 2026-03-18
78452 CPT Nm Myocard Perf Spect Mult Rest+Stress Famc 29 11 $7,755.00 $7,755.00 $2,359.65 $7,444.80 $5,661.15 2026-03-18
J0717 HCPCS Certolizumab 200 Mg Kit[FRAN] 45 11 $7,537.27 $7,537.27 $2,864.16 $8,565.06 $5,502.21 2026-03-18
74177 CPT CT Abdomen +Pelvis With Cont 30 11 $7,290.00 $7,290.00 $2,721.05 $6,998.40 $5,321.70 2026-03-18
72157 CPT MRI Spine Thoracic With + Without Cont 29 11 $7,162.00 $7,162.00 $2,721.56 $6,875.52 $5,228.26 2026-03-18
72156 CPT MRI Spine Cervical With + Without Cont 29 11 $7,162.00 $7,162.00 $2,721.56 $6,875.52 $5,228.26 2026-03-18
74174 CPT CT Angio Abdomen +Pelvis With + Without Cont 28 11 $7,142.00 $7,142.00 $2,713.96 $6,856.32 $5,213.66 2026-03-18
72158 CPT MRI Spine Lumbar With + Without Cont 30 11 $7,027.00 $7,027.00 $2,670.26 $6,745.92 $5,129.71 2026-03-18
70553 CPT MRI Brain With + Without Cont 30 11 $6,993.00 $6,993.00 $2,657.34 $6,713.28 $5,104.89 2026-03-18
J3590 HCPCS Benralizumab 30 mg/mL Sol[FRAN] 28 11 $6,858.00 $6,858.00 $2,606.04 $6,583.68 $5,006.34 2026-03-18
72147 CPT MRI Spine Thoracic With Cont 28 11 $6,760.00 $6,760.00 $2,568.80 $6,489.60 $4,934.80 2026-03-18
J2356 HCPCS Tezepelumab-ekko 210 Mg Soln 28 11 $6,743.65 $6,743.65 $2,562.59 $6,473.90 $4,922.86 2026-03-18
70552 CPT MRI Brain With Cont 28 11 $6,721.00 $6,721.00 $2,553.98 $6,452.16 $4,906.33 2026-03-18
70543 CPT MRI Face Neck Orbit With + Without Cont 28 11 $6,702.00 $6,702.00 $2,546.76 $6,433.92 $4,892.46 2026-03-18
J1952 HCPCS Leuprolide 42 Mg/6 Months Emu 28 11 $6,661.30 $6,661.30 $2,531.29 $6,394.85 $4,862.75 2026-03-18
22511 CPT CT Guide Perc Vertebroplasty 28 11 $6,634.00 $6,634.00 $2,520.92 $6,368.64 $4,842.82 2026-03-18
95811 CPT .overnight Sleep Study With Cpap 28 11 $6,615.00 $6,615.00 $2,513.70 $6,350.40 $4,828.95 2026-03-18
74176 CPT CT Abdomen +Pelvis Without Cont 30 11 $6,612.00 $6,612.00 $2,217.82 $6,347.52 $4,826.76 2026-03-18
72142 CPT MRI Spine Cervical With Cont 28 11 $6,572.00 $6,572.00 $2,497.36 $6,309.12 $4,797.56 2026-03-18
Q5111 HCPCS Pegfilgrastim Cbqv 6 Mg/0.6 Ml Sol 28 11 $6,513.00 $6,513.00 $2,474.94 $6,252.48 $4,754.49 2026-03-18
Q5108 HCPCS Pegfilgrastim Jmdb 6 Mg/0.6 Ml Sol [fran] 45 11 $6,513.00 $6,513.00 $1,332.66 $6,252.48 $3,256.50 2026-03-18
72146 CPT MRI Spine Thoracic Without Cont 29 11 $6,417.00 $6,417.00 $2,438.46 $6,160.32 $4,684.41 2026-03-18
J0565 HCPCS Bezlotoxumab 25 mg/mL Sol 28 11 $6,409.00 $6,409.00 $2,435.42 $6,152.64 $4,678.57 2026-03-18
72149 CPT MRI Spine Lumbar With Cont 28 11 $6,308.00 $6,308.00 $2,397.04 $6,055.68 $4,604.84 2026-03-18
72141 CPT MRI Spine Cervical Without Cont 30 11 $6,300.00 $6,300.00 $2,394.00 $6,048.00 $4,599.00 2026-03-18
78451 CPT Nm Myocard Perf Single Rest Or Stress 28 11 $6,281.00 $6,281.00 $2,386.78 $6,029.76 $4,585.13 2026-03-18
32550 CPT Fran Insert Pleural Cath 24 11 $6,267.00 $6,267.00 $2,381.46 $6,016.32 $4,574.91 2026-03-18
76498 CPT MRI Whole Body 28 11 $6,192.00 $6,192.00 $2,352.96 $5,944.32 $4,520.16 2026-03-18
74183 CPT MRI Abdomen With + Without Cont 30 11 $6,161.00 $6,161.00 $2,341.18 $5,914.56 $4,497.53 2026-03-18
95810 CPT .overnight Sleep Study 28 11 $6,156.00 $6,156.00 $2,339.28 $5,909.76 $4,493.88 2026-03-18
77049 CPT MRI Breast With + Without Cont Bil. 29 11 $6,122.00 $6,122.00 $2,326.36 $5,877.12 $4,469.06 2026-03-18
Q5119 HCPCS riTUXimab Pvvr 10 mg/mL Sol 28 11 $6,046.40 $6,046.40 $2,297.63 $5,804.54 $4,413.87 2026-03-18
70540 CPT MRI Face Neck Orbit Without Cont 28 11 $6,002.00 $6,002.00 $2,280.76 $5,761.92 $4,381.46 2026-03-18
75635 CPT CT Angio Abdomen + Pelvis w/Runoff 47 11 $5,998.00 $5,998.00 $1,942.18 $5,758.08 $4,378.54 2026-03-18
70546 CPT MRA Head With + Without Cont 28 11 $5,925.00 $5,925.00 $2,251.50 $5,688.00 $4,325.25 2026-03-18
72148 CPT MRI Spine Lumbar Without Cont 31 11 $5,871.00 $5,871.00 $1,954.12 $5,636.16 $4,285.83 2026-03-18
J1162 HCPCS Digoxin Immune Fab 40mg Powder-inj [fran] 28 11 $5,796.95 $5,796.95 $2,202.84 $5,565.07 $4,231.77 2026-03-18
J2182 HCPCS Mepolizumab 100 Mg Pow 28 11 $5,731.73 $5,731.73 $2,178.06 $5,502.46 $4,184.16 2026-03-18
74170 CPT CT Abdomen With + Without Cont 28 11 $5,709.00 $5,709.00 $2,169.42 $5,480.64 $4,167.57 2026-03-18
J1306 HCPCS Inclisiran 284 Mg/1.5 Ml Sol 28 11 $5,667.33 $5,667.33 $2,153.59 $5,440.64 $4,137.15 2026-03-18
70551 CPT MRI Brain Without Cont 29 11 $5,639.00 $5,639.00 $2,142.82 $5,413.44 $4,116.47 2026-03-18
72197 CPT MRI Pelvis Without & With Contrast 30 11 $5,605.00 $5,605.00 $2,129.90 $5,380.80 $4,091.65 2026-03-18
70545 CPT MRA Head With Cont 28 11 $5,529.00 $5,529.00 $2,101.02 $5,307.84 $4,036.17 2026-03-18
A9572 HCPCS Fran Rp Octreoscan Ud 28 11 $5,463.00 $5,463.00 $2,075.94 $5,244.48 $3,987.99 2026-03-18
J1437 HCPCS Ferric Derisomaltose 100 mg/mL Sol 28 11 $5,454.54 $5,454.54 $2,072.73 $5,236.36 $3,981.82 2026-03-18
71552 CPT MRI Chest With + Without Cont 28 11 $5,436.00 $5,436.00 $2,065.68 $5,218.56 $3,968.28 2026-03-18
70549 CPT MRA Neck With + Without Cont 29 11 $5,392.00 $5,392.00 $2,048.96 $5,176.32 $3,936.16 2026-03-18
78598 CPT Nm Pulm Perf +Vent Quantitative 28 11 $5,377.00 $5,377.00 $2,043.26 $5,161.92 $3,925.21 2026-03-18
72196 CPT MRI Prostate With Cont 28 11 $5,348.00 $5,348.00 $2,032.24 $5,134.08 $3,904.04 2026-03-18
74185 CPT MRA Abdomen With + Without Cont 28 11 $5,322.00 $5,322.00 $2,022.36 $5,109.12 $3,885.06 2026-03-18
A9570 HCPCS Fran Rp Auto Wbc Ud 28 11 $5,272.00 $5,272.00 $2,003.36 $5,061.12 $3,848.56 2026-03-18
99395 CPT MRI Chest Without Cont 17 11 $5,272.00 $5,272.00 $2,003.36 $5,061.12 $2,435.66 2026-03-18
74175 CPT CT Angio Abdomen With + Without Cont 28 11 $5,228.00 $5,228.00 $1,986.64 $5,018.88 $3,816.44 2026-03-18
71555 CPT MRA Chest With + Without Cont 29 11 $5,175.00 $5,175.00 $1,966.50 $4,968.00 $3,777.75 2026-03-18
70544 CPT MRA Head Without Cont 29 11 $5,094.00 $5,094.00 $1,935.72 $4,890.24 $3,718.62 2026-03-18
70336 CPT MRI Tmj 28 11 $5,019.00 $5,019.00 $1,907.22 $4,818.24 $3,663.87 2026-03-18
77048 CPT MRI Breast C-+ W/cad Uni 28 11 $5,014.00 $5,014.00 $1,905.32 $4,813.44 $3,660.22 2026-03-18
73220 CPT MRI Uppr Extremity W/O&with Contrast 28 11 $5,010.00 $5,010.00 $1,903.80 $4,809.60 $3,657.30 2026-03-18
70548 CPT MRA Neck With Cont 28 11 $4,965.00 $4,965.00 $1,886.70 $4,766.40 $3,624.45 2026-03-18
73720 CPT MRI Lwr Extremity W/O&with Contrast 30 11 $4,890.00 $4,890.00 $1,858.20 $4,694.40 $3,569.70 2026-03-18
72195 CPT MRI Prostate Without Cont 29 11 $4,760.00 $4,760.00 $1,808.80 $4,569.60 $3,474.80 2026-03-18
22512 CPT Fran 22512 CT Guided Vertebroplasty, Ea Addl Inj 28 11 $4,754.00 $4,754.00 $1,806.52 $4,563.84 $3,470.42 2026-03-18
73723 CPT MRI Joint Lwr Extr W/O&with Contrast 45 11 $4,690.00 $4,690.00 $1,782.20 $4,728.00 $3,423.70 2026-03-18
71275 CPT CT Angio Chest 30 11 $4,673.00 $4,673.00 $1,775.74 $4,486.08 $3,411.29 2026-03-18
78803 CPT Nm Bone Whole Body +Spect 28 11 $4,673.00 $4,673.00 $1,775.74 $4,486.08 $3,411.29 2026-03-18
70470 CPT CT Head Or Brain With + Without Cont 29 11 $4,548.00 $4,548.00 $1,728.24 $4,366.08 $3,320.04 2026-03-18
74160 CPT CT Abdomen With Cont 28 11 $4,532.00 $4,532.00 $1,722.16 $4,350.72 $3,308.36 2026-03-18
72130 CPT CT Spine Thoracic With + Without Cont 28 11 $4,513.00 $4,513.00 $1,714.94 $4,332.48 $3,294.49 2026-03-18
C1776 HCPCS Fixed Cruciate Tubial Plate - Cemented 1,073 11 $4,485.00 $4,485.00 $0.95 $18,864.00 $2,627.70 2026-03-18
73719 CPT MRI Lower Extremity With Contrast 45 11 $4,449.00 $4,449.00 $1,690.62 $4,484.16 $3,247.77 2026-03-18
73223 CPT MRI Joint Upr Extr W/O&with Contrast 28 11 $4,448.00 $4,448.00 $1,690.24 $4,270.08 $3,247.04 2026-03-18
C1778 HCPCS Infinion Cx Lead Kit 50cm 16 Lead 28 11 $4,400.00 $4,400.00 $1,672.00 $4,224.00 $3,212.00 2026-03-18
19081 CPT Ma Stereotactic Biopsy Lt 30 11 $4,365.00 $4,365.00 $1,658.70 $4,190.40 $3,186.45 2026-03-18
72194 CPT CT Pelvis With + Without Cont 28 11 $4,358.00 $4,358.00 $1,656.04 $4,183.68 $3,181.34 2026-03-18
70547 CPT MRA Neck Without Cont 28 11 $4,355.00 $4,355.00 $1,654.90 $4,180.80 $3,179.15 2026-03-18
72193 CPT CT Pelvis With Cont 28 11 $4,316.00 $4,316.00 $1,640.08 $4,143.36 $3,150.68 2026-03-18
73219 CPT MRI Upper Extremity With Contrast 28 11 $4,243.00 $4,243.00 $1,612.34 $4,073.28 $3,097.39 2026-03-18
70482 CPT CT Orbit Sella Etc. With + Without Cont 28 11 $4,230.00 $4,230.00 $1,607.40 $4,060.80 $3,087.90 2026-03-18
73722 CPT MRI Joint Of Lwr Extr With Contrast 49 11 $4,212.00 $4,212.00 $1,600.56 $4,246.08 $3,074.76 2026-03-18
72133 CPT CT Spine Lumbar With + Without Cont 28 11 $4,212.00 $4,212.00 $1,600.56 $4,043.52 $3,074.76 2026-03-18
J3111 HCPCS Romosozumab 105 Mg/1.17 Ml Sol 45 11 $4,206.29 $4,206.29 $1,554.47 $4,038.04 $3,070.59 2026-03-18
71270 CPT CT Chest With + Without Cont 28 11 $4,193.00 $4,193.00 $1,593.34 $4,025.28 $3,060.89 2026-03-18
71260 CPT CT Chest With Cont 30 11 $4,168.00 $4,168.00 $1,476.09 $4,001.28 $3,042.64 2026-03-18
72192 CPT CT Pelvis Without Cont 30 11 $4,150.00 $4,150.00 $1,577.00 $3,984.00 $3,029.50 2026-03-18
73718 CPT MRI Lower Extremity Without Contrast 30 11 $4,139.00 $4,139.00 $1,572.82 $3,973.44 $3,021.47 2026-03-18
73725 CPT MRA Le With And/or Without Cont 28 11 $4,133.00 $4,133.00 $1,570.54 $3,967.68 $3,017.09 2026-03-18
73225 CPT Mr Angio Upr Extr W/O&with Contrast 28 11 $4,127.00 $4,127.00 $1,568.26 $3,961.92 $3,012.71 2026-03-18
73222 CPT MRI Joint Upr Extrem With Contrast 30 11 $4,082.00 $4,082.00 $1,551.16 $3,918.72 $2,979.86 2026-03-18
74181 CPT MRI Abdomen Without Cont 28 11 $4,079.00 $4,079.00 $1,550.02 $3,915.84 $2,977.67 2026-03-18
A9557 HCPCS Fran Rp Neurolite Ud 28 11 $4,078.00 $4,078.00 $1,549.64 $3,914.88 $2,976.94 2026-03-18
26055 CPT Fran Finger Tendon Sheath Incision 26 11 $4,077.00 $4,077.00 $1,549.26 $3,913.92 $2,976.21 2026-03-18
70492 CPT CT Soft Tissue Neck With + Without Cont 29 11 $4,073.00 $4,073.00 $1,547.74 $3,910.08 $2,973.29 2026-03-18
74150 CPT CT Abdomen Without Cont 28 11 $4,067.00 $4,067.00 $1,545.46 $3,904.32 $2,968.91 2026-03-18
73221 CPT MRI Elbow Without Cont Lt 30 11 $4,053.00 $4,053.00 $1,540.14 $3,890.88 $2,958.69 2026-03-18
Q4125 HCPCS Arthroflex 25mm X 30mm X 2.0mm Aflex202 28 11 $4,039.25 $4,039.25 $1,534.92 $3,877.68 $2,948.66 2026-03-18
71250 CPT CT Chest Without Cont 31 11 $4,028.00 $4,028.00 $1,530.64 $3,866.88 $2,940.44 2026-03-18
78579 CPT Nm Pulm Vent 28 11 $3,990.00 $3,990.00 $1,516.20 $3,830.40 $2,912.70 2026-03-18
72129 CPT CT Spine Thoracic With Cont 28 11 $3,973.00 $3,973.00 $1,509.74 $3,814.08 $2,900.29 2026-03-18
70481 CPT CT Orbit Sella Etc. With Cont 28 11 $3,959.00 $3,959.00 $1,504.42 $3,800.64 $2,890.07 2026-03-18
73721 CPT MRI Jnt Of Lwr Extre Without Contrast 48 11 $3,931.00 $3,931.00 $1,484.50 $3,962.88 $2,869.63 2026-03-18
70498 CPT CT Angio Neck 29 11 $3,904.00 $3,904.00 $1,483.52 $3,747.84 $2,849.92 2026-03-18
95805 CPT .multiple Sleep Latency Test 28 11 $3,901.00 $3,901.00 $1,482.38 $3,744.96 $2,847.73 2026-03-18
70491 CPT CT Soft Tissue Neck With Cont 30 11 $3,900.00 $3,900.00 $1,482.00 $3,744.00 $2,847.00 2026-03-18
36573 CPT 36573 Insertion Of Picc Without Subcutaneous Port Or Pump, Includes All Imaging 29 11 $3,888.00 $3,888.00 $1,477.44 $3,732.48 $2,838.24 2026-03-18
72132 CPT CT Spine Lumbar With Cont 28 11 $3,875.00 $3,875.00 $1,472.50 $3,720.00 $2,828.75 2026-03-18
72128 CPT CT Spine Thoracic Without Cont 29 11 $3,861.00 $3,861.00 $1,467.18 $3,706.56 $2,818.53 2026-03-18
78582 CPT Nm Pulm Perf With Vent 28 11 $3,839.00 $3,839.00 $1,458.82 $3,685.44 $2,802.47 2026-03-18
73206 CPT CT Angio Upr Extrm W/O&with Contrast 28 11 $3,839.00 $3,839.00 $1,458.82 $3,685.44 $2,802.47 2026-03-18
78710 CPT Nm Kidney Spect 28 11 $3,836.00 $3,836.00 $1,457.68 $3,682.56 $2,800.28 2026-03-18
78802 CPT Nm Tumor Loc Whole Body 28 11 $3,827.00 $3,827.00 $1,454.26 $3,673.92 $2,793.71 2026-03-18
78315 CPT Nm Bone 3 Phase Study 28 11 $3,822.00 $3,822.00 $1,452.36 $3,669.12 $2,790.06 2026-03-18
72131 CPT CT Spine Lumbar Without Cont 30 11 $3,792.00 $3,792.00 $1,440.96 $3,640.32 $2,768.16 2026-03-18
A9569 HCPCS Fran Rp Tc-99 Labeled Wbc Ud 28 11 $3,791.00 $3,791.00 $1,440.58 $3,639.36 $2,767.43 2026-03-18
73218 CPT MRI Upper Extremity Without Contrast 28 11 $3,776.00 $3,776.00 $1,434.88 $3,624.96 $2,756.48 2026-03-18
73702 CPT CT Lwr Extremity W/O&with Contrast 28 11 $3,765.00 $3,765.00 $1,430.70 $3,614.40 $2,748.45 2026-03-18
72126 CPT CT Spine Cervical With Cont 28 11 $3,757.00 $3,757.00 $1,427.66 $3,606.72 $2,742.61 2026-03-18
70460 CPT CT Head Or Brain With Cont 28 11 $3,731.00 $3,731.00 $1,417.78 $3,581.76 $2,723.63 2026-03-18
70488 CPT CT Maxillofacial Without & With Contrast 28 11 $3,705.00 $3,705.00 $1,407.90 $3,556.80 $2,704.65 2026-03-18
J7187 HCPCS Antihemophilic Factor-von Willebrand Factor - Pow 28 11 $3,687.13 $3,687.13 $1,401.11 $3,539.64 $2,691.61 2026-03-18
19083 CPT US Breast Biopsy Rt 30 11 $3,628.00 $3,628.00 $1,378.64 $3,482.88 $2,648.44 2026-03-18
J1602 HCPCS Golimumab 50 Mg/4 Ml Sol 28 11 $3,623.54 $3,623.54 $1,376.95 $3,478.60 $2,645.18 2026-03-18
90375 CPT Rabies Immune Globulin, Human 300 Intl units/mL Sol 45 11 $3,620.39 $3,620.39 $582.86 $3,475.57 $1,592.97 2026-03-18
70490 CPT CT Soft Tissue Neck Without Contrast 28 11 $3,607.00 $3,607.00 $1,370.66 $3,462.72 $2,633.11 2026-03-18
78806 CPT Nm Wbc Tagged 28 11 $3,602.00 $3,602.00 $1,368.76 $3,457.92 $2,629.46 2026-03-18
72125 CPT CT Spine Cervical Without Cont 29 11 $3,600.00 $3,600.00 $1,368.00 $3,456.00 $2,628.00 2026-03-18
77084 CPT MRI Bone Marrow Blood Supply 28 11 $3,595.00 $3,595.00 $1,366.10 $3,451.20 $2,624.35 2026-03-18
70480 CPT CT Orbit Sella Etc. Without Cont 28 11 $3,591.00 $3,591.00 $1,364.58 $3,447.36 $2,621.43 2026-03-18
J0219 HCPCS Avalglucosidase Alfa Ngpt 100 Mg Inj 29 11 $3,530.32 $3,530.32 $1,341.52 $3,389.11 $2,577.14 2026-03-18
58353 CPT Thermal Endometrial Ablation 28 11 $3,519.00 $3,519.00 $1,337.22 $3,378.24 $2,568.87 2026-03-18
73202 CPT CT Uppr Extremity W/O&with Contrast 45 11 $3,497.00 $3,497.00 $1,328.86 $3,525.12 $2,552.81 2026-03-18
77012 CPT CT Scan For Needle Biopsy 29 11 $3,473.00 $3,473.00 $1,319.74 $3,334.08 $2,535.29 2026-03-18
32408 CPT CT Lung Biopsy 62 11 $3,473.00 $3,473.00 $938.98 $5,347.20 $2,411.48 2026-03-18
70450 CPT CT Head/brain Without Contrast 29 11 $3,465.00 $3,465.00 $1,316.70 $3,326.40 $2,529.45 2026-03-18
78264 CPT Nm Gastric Emptying Study 28 11 $3,455.00 $3,455.00 $1,312.90 $3,316.80 $2,522.15 2026-03-18
70496 CPT CT Angio Head 29 11 $3,443.00 $3,443.00 $1,308.34 $3,305.28 $2,513.39 2026-03-18
78206 CPT Nm Liver Spect With Vascular Flow 28 11 $3,437.00 $3,437.00 $1,306.06 $3,299.52 $2,509.01 2026-03-18
78709 CPT Nm Kidney With Flow With + Without Pharm 28 11 $3,437.00 $3,437.00 $1,306.06 $3,299.52 $2,509.01 2026-03-18
78472 CPT Gated Heart Planar Single 28 11 $3,434.00 $3,434.00 $1,304.92 $3,296.64 $2,506.82 2026-03-18
C1762 HCPCS Tibialis Tendon - Anterior Fz 29 11 $3,421.25 $3,421.25 $1,300.08 $3,284.40 $2,497.51 2026-03-18
78306 CPT Nm Bone Whole Body 28 11 $3,415.00 $3,415.00 $1,297.70 $3,278.40 $2,492.95 2026-03-18
78227 CPT Nm Hepa Duct System With Pharm 30 11 $3,407.00 $3,407.00 $1,294.66 $3,270.72 $2,487.11 2026-03-18
J1459 HCPCS Immune Globulin 10% IV Sol 50ml [fran] 79 11 $3,389.04 $3,389.04 $729.77 $11,278.72 $2,403.96 2026-03-18
70487 CPT CT Maxillofacial With Contrast 28 11 $3,338.00 $3,338.00 $1,268.44 $3,204.48 $2,436.74 2026-03-18
49083 CPT Fran Abd Paracentesis With Imaging 24 11 $3,337.00 $3,337.00 $1,268.06 $3,203.52 $2,436.01 2026-03-18
73701 CPT CT Lower Extremity With Contrast 47 11 $3,319.00 $3,319.00 $1,261.22 $3,345.60 $2,422.87 2026-03-18
A9521 HCPCS Fran Rp Ceretec Ud 28 11 $3,282.00 $3,282.00 $1,247.16 $3,150.72 $2,395.86 2026-03-18
99291 CPT 99291 - Fac Ed Critical Care 23 11 $3,250.00 $3,250.00 $1,235.00 $3,120.00 $2,372.50 2026-03-18
73700 CPT CT Lower Extremity Without Contrast 30 11 $3,239.00 $3,239.00 $1,230.82 $3,109.44 $2,364.47 2026-03-18
J0875 HCPCS Dalbavancin 500 Mg Pow 28 11 $3,227.43 $3,227.43 $1,226.42 $3,098.33 $2,356.03 2026-03-18
J0897 HCPCS Denosumab 120 Mg/1.7 Ml Sol [fran] 45 11 $3,215.01 $3,215.01 $1,221.70 $5,298.80 $2,346.96 2026-03-18
78195 CPT Nm Lymphatics +Lymph Nodes 28 11 $3,215.00 $3,215.00 $1,221.70 $3,086.40 $2,346.95 2026-03-18
62305 CPT Xr Spine Myelography 2 Or More Regions 28 11 $3,195.00 $3,195.00 $1,214.10 $3,067.20 $2,332.35 2026-03-18
Q4259 HCPCS Celera 2cm X 2cm Sheet Cel-26222 28 11 $3,194.50 $3,194.50 $1,213.91 $3,066.72 $2,331.99 2026-03-18
J2315 HCPCS Naltrexone 380 Mg Pwd 28 11 $3,175.93 $3,175.93 $1,206.85 $3,048.89 $2,318.43 2026-03-18
79005 CPT Nm Radiopharm Ther Hyperthyroidism Int 28 11 $3,172.00 $3,172.00 $1,205.36 $3,045.12 $2,315.56 2026-03-18
C1783 HCPCS Istent Inject Trabecular Micro-bypass System 29 11 $3,165.00 $3,165.00 $1,202.70 $3,038.40 $2,310.45 2026-03-18
75989 CPT US Guided Pleural Cath Insert With Fluoro 28 11 $3,152.00 $3,152.00 $1,197.76 $3,025.92 $2,300.96 2026-03-18
78708 CPT Nm Kidney With Flow With Pharm 28 11 $3,144.00 $3,144.00 $1,194.72 $3,018.24 $2,295.12 2026-03-18
93306 CPT .echo W/doppler/color Flow 30 11 $3,132.00 $3,132.00 $1,190.16 $3,006.72 $2,286.36 2026-03-18
70486 CPT CT Maxillofacial Without Contrast 30 11 $3,131.00 $3,131.00 $1,189.78 $3,005.76 $2,285.63 2026-03-18
50200 CPT CT Renal Biopsy 28 11 $3,131.00 $3,131.00 $1,189.78 $3,005.76 $2,285.63 2026-03-18
J1950 HCPCS Leuprolide 3.75 Mg/month Pwd 28 11 $3,112.62 $3,112.62 $1,182.80 $2,988.12 $2,272.22 2026-03-18
J1439 HCPCS Ferric Carboxymaltose (as Elemental Iron) 50 mg/mL Soln [fran] 28 11 $3,092.43 $3,092.43 $1,175.12 $2,968.73 $2,257.47 2026-03-18
C1897 HCPCS Trial System Trialsys-60-2-evk 28 11 $3,000.00 $3,000.00 $1,140.00 $2,880.00 $2,190.00 2026-03-18
73201 CPT CT Upper Extremity With Contrast 28 11 $2,977.00 $2,977.00 $1,131.26 $2,857.92 $2,173.21 2026-03-18
78216 CPT Nm Liver +Spleen With Vascular Flow 28 11 $2,945.00 $2,945.00 $1,119.10 $2,827.20 $2,149.85 2026-03-18
73200 CPT CT Ue Without Cont Rt 30 11 $2,942.00 $2,942.00 $1,117.96 $2,824.32 $2,147.66 2026-03-18
J3032 HCPCS Eptinezumab Jjmr 100 mg/mL Sol 28 11 $2,895.40 $2,895.40 $1,100.25 $2,779.58 $2,113.64 2026-03-18
Q4186 HCPCS Epifix Graft 18mm Disc 96 11 $2,858.00 $2,858.00 $356.44 $3,557.28 $1,270.38 2026-03-18
78226 CPT Nm Hepa Duct System Without Pharm 28 11 $2,721.00 $2,721.00 $1,033.98 $2,612.16 $1,986.33 2026-03-18
78278 CPT Nm Gi Blood Loss 28 11 $2,710.00 $2,710.00 $1,029.80 $2,601.60 $1,978.30 2026-03-18
78215 CPT Nm Liver +Spleen Static Only 28 11 $2,707.00 $2,707.00 $1,028.66 $2,598.72 $1,976.11 2026-03-18
78707 CPT Nm Kidney With Funct 28 11 $2,680.00 $2,680.00 $1,018.40 $2,572.80 $1,956.40 2026-03-18
J2357 HCPCS Omalizumab 150mg/mL 1mL Soln [fran] 28 11 $2,659.12 $2,659.12 $1,010.47 $2,552.76 $1,941.16 2026-03-18
93350 CPT Stress Tte Only 47 11 $2,658.00 $2,658.00 $726.56 $2,551.68 $1,816.40 2026-03-18
76080 CPT Xr Fistula Or Sinus Tract Abscess Study 28 11 $2,653.00 $2,653.00 $1,008.14 $2,546.88 $1,936.69 2026-03-18
J7325 HCPCS Hylan G-f 20 48mg/6mL Soln [fran] 28 11 $2,629.63 $2,629.63 $999.26 $2,524.44 $1,919.63 2026-03-18
10030 CPT US Guide Incision +Drain Fluid 28 11 $2,625.00 $2,625.00 $997.50 $2,520.00 $1,916.25 2026-03-18
19281 CPT Ma Breast Ndl Loc Placement Rt. 28 11 $2,576.00 $2,576.00 $978.88 $2,472.96 $1,880.48 2026-03-18
78305 CPT Nm Bone Mult Areas 28 11 $2,549.00 $2,549.00 $968.62 $2,447.04 $1,860.77 2026-03-18
93880 CPT US Carotid Doppler Bil 29 11 $2,481.00 $2,481.00 $942.78 $2,381.76 $1,811.13 2026-03-18
23675 CPT 23675 Cltx Shoulder Dislc W/surg/antmcl Neck Fx W/manj 24 11 $2,464.00 $2,464.00 $936.32 $2,365.44 $1,798.72 2026-03-18
49180 CPT Biopsy Of Abd/Retroperitoneal Mass 29 11 $2,456.00 $2,456.00 $933.28 $2,357.76 $1,792.88 2026-03-18
47000 CPT Biopsy Of Liver By Needle 28 11 $2,456.00 $2,456.00 $933.28 $2,357.76 $1,792.88 2026-03-18
36598 CPT Xr Venography Caval Superior 28 11 $2,428.00 $2,428.00 $922.64 $2,330.88 $1,772.44 2026-03-18
78014 CPT Nm Thyroid Uptake And Scan 28 11 $2,398.00 $2,398.00 $911.24 $2,302.08 $1,750.54 2026-03-18
78701 CPT Nm Kidney Morph With Vascular Flow 28 11 $2,393.00 $2,393.00 $909.34 $2,297.28 $1,746.89 2026-03-18
78290 CPT Nm Meckel's Scan 28 11 $2,384.00 $2,384.00 $905.92 $2,288.64 $1,740.32 2026-03-18
78597 CPT Nm Pulm Perf Quantitative 28 11 $2,349.00 $2,349.00 $892.62 $2,255.04 $1,714.77 2026-03-18
J7326 HCPCS Sodium Hyaluronate 30mg/3mL 3mL Soln [fran] 28 11 $2,346.00 $2,346.00 $891.48 $2,252.16 $1,712.58 2026-03-18
93351 CPT Stress/Dobutamine Echo 28 11 $2,322.00 $2,322.00 $882.36 $2,229.12 $1,695.06 2026-03-18
93970 CPT US Le Veins Duplex Bil 28 11 $2,300.00 $2,300.00 $874.00 $2,208.00 $1,679.00 2026-03-18
J7318 HCPCS Sodium Hyaluronate 20 mg/mL Sol [fran] 29 11 $2,274.60 $2,274.60 $864.35 $2,183.62 $1,660.46 2026-03-18
78580 CPT Nm Pulm Perf 28 11 $2,220.00 $2,220.00 $843.60 $2,131.20 $1,620.60 2026-03-18
27752 CPT 27752 Cltx Tibial Shaft Fx W/manj W/wo Skel Tracj TechFee 24 11 $2,205.00 $2,205.00 $837.90 $2,116.80 $1,609.65 2026-03-18
27252 CPT 27252 Closed Treatment Of Hip Dislocation, Traumatic, Requiring Anesthesia 24 11 $2,205.00 $2,205.00 $837.90 $2,116.80 $1,609.65 2026-03-18
92960 CPT Cardioversion 28 11 $2,159.00 $2,159.00 $820.42 $2,072.64 $1,576.07 2026-03-18
78801 CPT Nm Tumor Loc Mult Areas 28 11 $2,153.00 $2,153.00 $818.14 $2,066.88 $1,571.69 2026-03-18
38505 CPT 38505 Biopsy Of Lymph Node By Needle 47 11 $2,096.00 $2,096.00 $796.48 $3,563.52 $1,530.08 2026-03-18
93930 CPT US Ue Art Duplex Bil 28 11 $2,091.00 $2,091.00 $794.58 $2,007.36 $1,526.43 2026-03-18
94002 CPT Ventilator Services Initial 28 11 $2,040.00 $2,040.00 $775.20 $1,958.40 $1,489.20 2026-03-18
J9202 HCPCS Goserelin 3.6 Mg Imp[FRAN] 28 11 $2,025.35 $2,025.35 $769.63 $1,944.34 $1,478.51 2026-03-18
31237 CPT Nasal Endoscopy/Polypectomy 28 11 $2,024.00 $2,024.00 $769.12 $1,943.04 $1,477.52 2026-03-18
93307 CPT .echocardiogram 28 11 $2,000.00 $2,000.00 $760.00 $1,920.00 $1,460.00 2026-03-18
20103 CPT 20103 Exploration Penetrating Wound Spx Extremity TechFee 26 11 $2,000.00 $2,000.00 $760.00 $1,920.00 $1,460.00 2026-03-18
99285 CPT 99285 - Fac Ed Level 5 - Room Charge 30 11 $1,990.00 $1,990.00 $756.20 $1,910.40 $1,452.70 2026-03-18
25605 CPT Treat Fracture Radius/ulna. 28 11 $1,985.00 $1,985.00 $754.30 $1,905.60 $1,449.05 2026-03-18
23665 CPT 23665 Cltx Shoulder Dislc W/fx Humeral Tubrst W/manj 24 11 $1,985.00 $1,985.00 $754.30 $1,905.60 $1,449.05 2026-03-18
23655 CPT Treat Shoulder Dislocation 24 11 $1,985.00 $1,985.00 $754.30 $1,905.60 $1,449.05 2026-03-18
93925 CPT US Le Art Duplex Bil 29 11 $1,946.00 $1,946.00 $739.48 $1,868.16 $1,420.58 2026-03-18
78070 CPT Nm Parathyroid 28 11 $1,943.00 $1,943.00 $738.34 $1,865.28 $1,418.39 2026-03-18
76380 CPT CT Limited Study 28 11 $1,928.00 $1,928.00 $732.64 $1,850.88 $1,407.44 2026-03-18
71048 CPT Xr Chest Comp Min 4 Views 28 11 $1,928.00 $1,928.00 $732.64 $1,850.88 $1,407.44 2026-03-18
78071 CPT Nm Parathyroid With Tomography Famc 28 11 $1,916.00 $1,916.00 $728.08 $1,839.36 $1,398.68 2026-03-18
93017 CPT Cardiac Stress Testing. 30 11 $1,895.00 $1,895.00 $720.10 $1,819.20 $1,383.35 2026-03-18
62323 CPT Inj Epidural, Lumbar Or Caudal, W/imaging Charge 29 11 $1,876.00 $1,876.00 $712.88 $1,800.96 $1,369.48 2026-03-18
78650 CPT Nm Cerebrospinal Fluid Leakage Detection 28 11 $1,867.00 $1,867.00 $709.46 $1,792.32 $1,362.91 2026-03-18
78606 CPT Nm Brain Min 4 Views With Vascular Flow 28 11 $1,867.00 $1,867.00 $709.46 $1,792.32 $1,362.91 2026-03-18
46621 CPT Hemorrhoidectomy, Internal, Rubber Band 28 11 $1,865.00 $1,865.00 $708.70 $1,790.40 $1,361.45 2026-03-18
P9037 HCPCS Aph Plt Acda Lr Irr <3 X Log 11 28 11 $1,854.00 $1,854.00 $704.52 $1,779.84 $1,353.42 2026-03-18
64479 CPT 6447950 Inj Transfor Cervical/thoracic, Bilateral 28 11 $1,852.00 $1,852.00 $703.76 $1,777.92 $1,351.96 2026-03-18
G0260 HCPCS Inj Sacroiliac Joint With Fluoro, Bil 45 11 $1,852.00 $1,852.00 $684.38 $1,777.92 $1,351.96 2026-03-18
78300 CPT Nm Bone Ltd 28 11 $1,846.00 $1,846.00 $701.48 $1,772.16 $1,347.58 2026-03-18
J7327 HCPCS Hyaluronan 88 Mg/4 Ml Sol [fran] 28 11 $1,845.90 $1,845.90 $701.44 $1,772.06 $1,347.51 2026-03-18
A9551 HCPCS Fran Rp Succimer Dmsa Ud 28 11 $1,842.00 $1,842.00 $699.96 $1,768.32 $1,344.66 2026-03-18
32555 CPT US Guide Thoracentesis 28 11 $1,838.00 $1,838.00 $698.44 $1,764.48 $1,341.74 2026-03-18
10009 CPT 10009 Fine Needle Aspiration Biopsy, Including CT Guidance; First Lesion 45 11 $1,806.00 $1,806.00 $686.28 $1,820.16 $1,318.38 2026-03-18
A9552 HCPCS Fran Rp Fdg 28 11 $1,800.00 $1,800.00 $684.00 $1,728.00 $1,314.00 2026-03-18
J7168 HCPCS Prothrombin Complex - Pow [fran] 45 11 $1,792.74 $1,792.74 $681.24 $4,822.08 $1,631.39 2026-03-18
62321 CPT Inj Epidural, Cerv Or Thor, W/imaging 28 11 $1,787.00 $1,787.00 $679.06 $1,715.52 $1,304.51 2026-03-18
78761 CPT Nm Testicular With Vascular Flow 28 11 $1,772.00 $1,772.00 $673.36 $1,701.12 $1,293.56 2026-03-18
93924 CPT US Segmental Pressures w/Stress 29 11 $1,771.00 $1,771.00 $672.98 $1,700.16 $1,292.83 2026-03-18
G0390 HCPCS G03901 Trauma Team Activation Without Critical Care 28 11 $1,769.00 $1,769.00 $672.22 $1,698.24 $1,291.37 2026-03-18
64493 CPT Inj Facet Jt/medial Branch, Lumb/sacr, Single Lev, Bil 49 11 $1,764.00 $1,764.00 $635.74 $1,693.44 $1,287.72 2026-03-18
93931 CPT US Ue Art Duplex Rt 28 11 $1,733.00 $1,733.00 $658.54 $1,663.68 $1,265.09 2026-03-18
J7999 HCPCS Gemcitabine 1 Gm Powder-recon 28 11 $1,726.20 $1,726.20 $655.96 $1,657.15 $1,260.12 2026-03-18
74249 CPT Xr Ugi With Air Cont With Sb 28 11 $1,682.00 $1,682.00 $639.16 $1,614.72 $1,227.86 2026-03-18
93926 CPT Lower Extremity Study 28 11 $1,681.00 $1,681.00 $638.78 $1,613.76 $1,227.13 2026-03-18
64490 CPT Inj Facet Jt/medial Branch, Cerv/thor, Single Level 47 11 $1,673.00 $1,673.00 $635.74 $1,777.92 $1,221.29 2026-03-18
A9548 HCPCS Fran Rp In111 Dtpa Per 0.5 Mci 28 11 $1,663.00 $1,663.00 $631.94 $1,596.48 $1,213.99 2026-03-18
24655 CPT 24655 Closed Tx Radial Head/neck Fx W/manipulation TechFee 24 11 $1,654.00 $1,654.00 $628.52 $1,587.84 $1,207.42 2026-03-18
32551 CPT 32551 Tube Thoracostomy Includes Water Seal 24 11 $1,654.00 $1,654.00 $628.52 $1,587.84 $1,207.42 2026-03-18
13133 CPT 13133 Repair Complex F/c/c/m/n/ax/g/h/f Ea Addl 5 Cm 28 11 $1,654.00 $1,654.00 $628.52 $1,587.84 $1,207.42 2026-03-18
Q5104 HCPCS inFLIXimab Abda 100 Mg Pow 28 11 $1,652.33 $1,652.33 $627.89 $1,586.24 $1,206.20 2026-03-18
27266 CPT 27266 Cltx Post Hip Arthrp Dislc Req Anes TechFee 28 11 $1,645.00 $1,645.00 $625.10 $1,579.20 $1,200.85 2026-03-18
74280 CPT X-ray Xm Colon 2cntrst Std 29 11 $1,632.00 $1,632.00 $620.16 $1,566.72 $1,191.36 2026-03-18
40650 CPT 40650 Repair Lip, Full Thickness, Vermillion Only 24 11 $1,625.00 $1,625.00 $617.50 $1,560.00 $1,186.25 2026-03-18
62302 CPT Xr Spine Cerv Myelography 28 11 $1,618.00 $1,618.00 $614.84 $1,553.28 $1,181.14 2026-03-18
62328 CPT Xr Spine Puncture Lumbar Diag 28 11 $1,615.00 $1,615.00 $613.70 $1,550.40 $1,178.95 2026-03-18
77002 CPT Xr Fluoro Ankle Joint Inj Asp Lt 28 11 $1,615.00 $1,615.00 $613.70 $1,550.40 $1,178.95 2026-03-18
92950 CPT Cpr By Nursing 45 11 $1,608.00 $1,608.00 $611.04 $1,620.48 $1,173.84 2026-03-18
36569 CPT Picc Line Insertion Charges 45 11 $1,600.00 $1,600.00 $608.00 $1,782.72 $1,168.00 2026-03-18
64483 CPT Inj Transf, Lumb/sacr, Single Level, Bil 51 11 $1,597.00 $1,597.00 $606.86 $1,777.92 $1,165.81 2026-03-18
78605 CPT Nm Brain Min 4 Views 28 11 $1,594.00 $1,594.00 $605.72 $1,530.24 $1,163.62 2026-03-18
74245 CPT Xr Ugi With Sb 28 11 $1,582.00 $1,582.00 $601.16 $1,518.72 $1,154.86 2026-03-18
62273 CPT 62273 Inject Epidural Patch 28 11 $1,579.00 $1,579.00 $600.02 $1,515.84 $1,152.67 2026-03-18
J1212 HCPCS Dimethyl Sulfoxide 50% Sol [fran] 28 11 $1,576.22 $1,576.22 $598.96 $1,513.17 $1,150.64 2026-03-18
27762 CPT 27762 Cltx Medial Malls Fx W/manj W/wo Skn/skel Tracj TechFee 24 11 $1,575.00 $1,575.00 $598.50 $1,512.00 $1,149.75 2026-03-18
27510 CPT 27510 Ed Treatment Of Thigh Fracture 25 11 $1,575.00 $1,575.00 $598.50 $1,512.00 $1,149.75 2026-03-18
25505 CPT 25505 Closed Tx Radial Shaft Fracture W/manipulation TechFee 28 11 $1,575.00 $1,575.00 $598.50 $1,512.00 $1,149.75 2026-03-18
24565 CPT 24565 Cltx Humeral Epicondylar Fx Medial/lat W/manj TechFee 28 11 $1,575.00 $1,575.00 $598.50 $1,512.00 $1,149.75 2026-03-18
94003 CPT Rt Ventilator Services - Subs Charge 28 11 $1,574.00 $1,574.00 $598.12 $1,511.04 $1,149.02 2026-03-18
94070 CPT Methacholine 28 11 $1,547.00 $1,547.00 $587.86 $1,485.12 $1,129.31 2026-03-18
26605 CPT 26605 Cltx Metacarpal Fx Without Manipulation Each Bone 28 11 $1,544.00 $1,544.00 $586.72 $1,482.24 $1,127.12 2026-03-18
62304 CPT Xr Spine Lumbosacral Myelography 28 11 $1,541.00 $1,541.00 $585.58 $1,479.36 $1,124.93 2026-03-18
19285 CPT US Breast Wire Placement Lt 28 11 $1,536.00 $1,536.00 $583.68 $1,474.56 $1,121.28 2026-03-18
77075 CPT Xr Bone Survey Comp 28 11 $1,528.00 $1,528.00 $580.64 $1,466.88 $1,115.44 2026-03-18
10007 CPT 10007 Fine Needle Aspiration Biopsy, Including Fluoroscopic Guidance; First Lesi… 28 11 $1,525.00 $1,525.00 $579.50 $1,464.00 $1,113.25 2026-03-18
L8699 HCPCS Urolift 2 Implant Cartridge 45 11 $1,525.00 $1,525.00 $551.00 $1,464.00 $1,113.25 2026-03-18
94726 CPT Raw & Tgv/pleth 29 11 $1,523.00 $1,523.00 $578.74 $1,462.08 $1,111.79 2026-03-18
P9035 HCPCS Aph Plt Acda Lr <3 X Log 11 1 28 11 $1,520.00 $1,520.00 $577.60 $1,459.20 $1,109.60 2026-03-18
93923 CPT US Segmental Pressures 29 11 $1,517.00 $1,517.00 $576.46 $1,456.32 $1,107.41 2026-03-18
93971 CPT Extremity Study 31 11 $1,515.00 $1,515.00 $575.70 $1,454.40 $1,105.95 2026-03-18
0120 RC Room/bed: Swing Bed 18 5 $1,470.00 $1,470.00 $500.50 $1,845.12 $1,411.20 2026-03-18
0170 RC Room/bed: Nursery 6 5 $1,339.00 $1,339.00 $1,218.49 $1,285.44 $1,285.44 2026-03-18
M0241 HCPCS Outpatient Carveouts 1 1 — — $1,207.46 $1,207.46 $1,207.46 2026-03-18
M0248 HCPCS Outpatient Carveouts 1 1 — — $1,207.46 $1,207.46 $1,207.46 2026-03-18
M0244 HCPCS Outpatient Carveouts 1 1 — — $1,207.46 $1,207.46 $1,207.46 2026-03-18
M0246 HCPCS Outpatient Carveouts 1 1 — — $1,207.46 $1,207.46 $1,207.46 2026-03-18
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