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

BUTLER COUNTY HEALTH

David City, NE · CCN 281332 · Rates published

2,041 distinct procedures filed
12 distinct payers
39,456 rate rows
2025-07-02 last MRF observed · ⚠ 15 mo old
Data quality

39,441 of 39,456 rate rows are consumer-grade (100.0%)

15 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
per-diem day rate — not a per-procedure price 12
exceeds 10× this hospital's gross charge — excluded from medians 3

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 15 months old.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://secure.claraprice.net/price-transparency/XJEN-1744822433611/machine-readable/470551144_butler-county-health_standardcharges.json
Found on page https://secure.claraprice.net/price-transparency/butler-county-health-ne
Discovered viaDiscovered by HANK
Last fetch success · 2026-09-25
Content fingerprint 6535e28ace5aa9dc… · 185,528 bytes · first seen 2026-05-18

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
23472
CPT 		Prosthetic Repair Of Shoulder Joint, Total Shoulder 12 $34,971.00 $70,789.00 $57,727.00 nat. median
$16,677
outlier · 3.5×
CP17490754486558310
CDM 		Major Joint Replacement Or Reattachment Of Lower Extremity Without Mcc 10 $51,763.00 $53,397.00 $52,798.00 nat. median
$52,798
1.0× median
27447
CPT 		Replacement Of Knee Joint, Both Sides Of Knee 12 $32,597.00 $61,821.00 $52,368.00 nat. median
$12,739
outlier · 4.1×
CP17679997033716101
CDM 		Major Joint Replacement Or Reattachment Of Lower Extremity Without Mcc 10 $50,765.00 $52,368.00 $51,780.00 nat. median
$51,780
1.0× median
C1826
HCPCS 		Impl Inceptiv Ins 12 $13,047.00 $34,362.00 $33,310.00 nat. median
$28,776
1.2× median
29826
CPT 		Shaving Of Shoulder Bone Using Endoscope 12 $17,122.00 $38,613.00 $29,677.50 nat. median
$3,122
outlier · 9.5×
29827
CPT 		Repair Of Shoulder Rotator Cuff Using An Endoscope 12 $16,637.00 $40,448.00 $28,837.00 nat. median
$7,187
outlier · 4.0×
CP17679997033716088
CDM 		Cesarean Section With Sterilization Without Cc/mcc 10 $22,649.00 $23,364.00 $23,102.00 nat. median
$23,102
1.0× median
CP17679997033715104
CDM 		Cesarean Section Without Sterilization Without Cc/mcc 10 $22,649.00 $23,364.00 $23,102.00 nat. median
$23,102
1.0× median
CP17679997033714246
CDM 		Cesarean Section Without Sterilization With Cc 10 $22,649.00 $23,364.00 $23,102.00 nat. median
$23,102
1.0× median
CP17490754486555634
CDM 		Cesarean Section With Sterilization Without Cc/mcc 10 $22,366.00 $23,072.00 $22,813.00 nat. median
$22,813
1.0× median
CP17490754486552414
CDM 		Cesarean Section Without Sterilization With Cc 10 $19,727.00 $20,350.00 $20,121.00 nat. median
$20,121
1.0× median
47562
CPT 		Removal Of Gallbladder Using An Endoscope 12 $12,144.00 $23,359.00 $19,535.00 nat. median
$5,988
outlier · 3.3×
CP17490754486556236
CDM 		Cesarean Section Without Sterilization Without Cc/mcc 10 $18,869.00 $19,465.00 $19,246.00 nat. median
$19,246
1.0× median
11684193
CDM 		Impl Lapiplasty System 4 Sk39 12 $6,067.00 $15,978.00 $15,489.00 nat. median
$15,489
1.0× median
11684196
CDM 		Impl Lapiplasty System 2 Sk14 12 $5,950.00 $15,669.00 $15,190.00 nat. median
$15,190
1.0× median
49505
CPT 		Repair Of Groin Hernia Patient Age 5 Years Or Older 12 $8,797.00 $16,974.00 $14,173.00 nat. median
$3,855
outlier · 3.7×
29881
CPT 		Removal Of One Knee Cartilage Using An Endoscope 12 $7,888.00 $17,680.00 $13,672.00 nat. median
$3,838
outlier · 3.6×
63650
CPT 		Fac Fee, Implant Neuroelectrodes 12 $4,582.00 $13,973.00 $11,816.00 nat. median
$7,298
1.6× median
42820
CPT 		Removal Of Tonsils And Adenoid Glands, Patient Younger Than Age 12 12 $7,136.00 $14,202.00 $11,677.50 nat. median
$5,545
outlier · 2.1×
C1778
HCPCS 		Impl Lead 5mm 1x8 MRI 12 $553.00 $24,255.00 $10,973.00 nat. median
$4,400
outlier · 2.5×
63685
CPT 		Fac Fee, Ins/rplc Spi Npg/rcvr Pocket 12 $4,104.00 $12,515.00 $10,583.50 nat. median
$21,040
0.5× median
CP17679997033711069
CDM 		Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc 10 $9,172.00 $9,462.00 $9,356.00 nat. median
$9,356
1.0× median
Q4197
HCPCS 		Puraply Am Xt Ef (4.91x4.91) 24.1sq Cm 12 $3,602.00 $8,637.00 $8,456.00 nat. median
$211
outlier · 40.1×
94617
CPT 		94617 Exercise Test For Bronchospasm Charge 12 $2,965.00 $9,040.00 $7,645.50 nat. median
$182
outlier · 42.0×
70546
CPT 		MRA Brain/head With + Without Contrast 12 $2,700.00 $8,100.00 $6,962.00 nat. median
$1,073
outlier · 6.5×
CP17490754486554362
CDM 		Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc 10 $6,720.00 $6,933.00 $6,855.00 nat. median
$6,855
1.0× median
Q4159
HCPCS 		Affinity (2.5x2.5) 6.25sq Cm 12 $2,593.00 $6,218.00 $6,088.00 nat. median
$643
outlier · 9.5×
70471
CPT 		CT Angio Head/neck 12 $2,326.00 $6,977.00 $5,997.00 nat. median
$815
outlier · 7.4×
43239
CPT 		Biopsy Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 12 $3,468.00 $7,640.00 $5,984.50 nat. median
$1,379
outlier · 4.3×
43235
CPT 		Diagnostic Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 12 $3,468.00 $7,640.00 $5,984.50 nat. median
$1,316
outlier · 4.5×
C9359
HCPCS 		Bone Matrix Cellular V92 2.5cc 12 $2,317.00 $6,103.00 $5,917.00 nat. median
$1,472
outlier · 4.0×
70545
CPT 		MRA Brain/head With Contrast 12 $2,228.00 $7,474.00 $5,868.00 nat. median
$893
outlier · 6.6×
74178
CPT 		CT Abdomen And Pelvis With + Without Contrast 12 $2,210.00 $7,561.00 $5,821.00 nat. median
$1,027
outlier · 5.7×
64635
CPT 		Fac Fee, Destruction By Neurolytic Agent Lum 12 $2,195.00 $6,694.00 $5,661.00 nat. median
$2,392
outlier · 2.4×
64633
CPT 		Fac Fee, Destruction By Neurolytic Agent Cer 12 $2,184.00 $6,660.00 $5,632.50 nat. median
$2,325
outlier · 2.4×
C1767
HCPCS 		Interstim, Neurostimulatorfull Implant 12 $781.00 $23,995.00 $5,584.50 nat. median
$23,881
outlier · 0.2×
95811
CPT 		95811 Psg/split Charge 12 $2,094.00 $6,384.00 $5,399.50 nat. median
$1,894
outlier · 2.9×
Q4186
HCPCS 		Epifix 2cm X 2cm 12 $1,209.00 $22,141.00 $5,384.00 nat. median
$448
outlier · 12.0×
74174
CPT 		CT Angio Abdomen And Pelvis 12 $2,009.00 $6,999.00 $5,292.00 nat. median
$998
outlier · 5.3×
74177
CPT 		CT Scan Of Abdomen And Pelvis With Contrast 12 $2,009.00 $6,520.00 $5,292.00 nat. median
$976
outlier · 5.4×
45385
CPT 		Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope 12 $2,933.00 $6,806.00 $5,083.50 nat. median
$1,663
outlier · 3.1×
74185
CPT 		MRA Abdomen With + Without Contrast 12 $1,924.00 $6,452.00 $5,067.00 nat. median
$1,253
outlier · 4.0×
72156
CPT 		MRI Spine Cervical With + Without Contrast 12 $1,935.00 $5,806.00 $5,056.00 nat. median
$1,110
outlier · 4.6×
78452
CPT 		Rt Stress Test Myoview Charge 12 $1,904.00 $5,839.00 $5,016.00 nat. median
$1,822
outlier · 2.8×
71551
CPT 		MRI Chest With Contrast 12 $1,857.00 $6,228.00 $4,890.00 nat. median
$1,156
outlier · 4.2×
72157
CPT 		MRI Spine Thoracic With + Without Contrast 12 $1,857.00 $5,789.00 $4,890.00 nat. median
$1,114
outlier · 4.4×
L8699
HCPCS 		Impl Zim Scp Foot & Ankle Kit 12 $1,903.00 $5,013.00 $4,859.00 nat. median
$2,008
outlier · 2.4×
45380
CPT 		Biopsy Exam Of Large Bowel Using An Endoscope 12 $2,795.00 $6,511.00 $4,844.50 nat. median
$1,565
outlier · 3.1×
70553
CPT 		MRI Scan 12 $1,828.00 $5,484.00 $4,815.00 nat. median
$1,136
outlier · 4.2×

Other procedures at this hospital

Browse this hospital's 2,041 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
             
23472 CPT Prosthetic Repair Of Shoulder Joint, Total Shoulder 28 12 $59,860.50 $59,860.50 $34,971.00 $70,789.00 $57,727.00 2025-07-02
CP17490754486558310 CDM Major Joint Replacement Or Reattachment Of Lower Extremity Without Mcc 11 10 $54,487.00 $54,487.00 $51,763.00 $53,397.00 $52,798.00 2025-07-02
27447 CPT Replacement Of Knee Joint, Both Sides Of Knee 28 12 $53,962.00 $53,962.00 $32,597.00 $61,821.00 $52,368.00 2025-07-02
CP17679997033716101 CDM Major Joint Replacement Or Reattachment Of Lower Extremity Without Mcc 11 10 $53,437.00 $53,437.00 $50,765.00 $52,368.00 $51,780.00 2025-07-02
C1826 HCPCS Impl Inceptiv Ins 15 12 $35,063.00 $35,063.00 $13,047.00 $34,362.00 $33,310.00 2025-07-02
29826 CPT Shaving Of Shoulder Bone Using Endoscope 28 12 $31,050.50 $31,050.50 $17,122.00 $38,613.00 $29,677.50 2025-07-02
29827 CPT Repair Of Shoulder Rotator Cuff Using An Endoscope 28 12 $31,462.00 $31,462.00 $16,637.00 $40,448.00 $28,837.00 2025-07-02
CP17679997033716088 CDM Cesarean Section With Sterilization Without Cc/mcc 11 10 $23,841.00 $23,841.00 $22,649.00 $23,364.00 $23,102.00 2025-07-02
CP17679997033714246 CDM Cesarean Section Without Sterilization With Cc 11 10 $23,841.00 $23,841.00 $22,649.00 $23,364.00 $23,102.00 2025-07-02
CP17679997033715104 CDM Cesarean Section Without Sterilization Without Cc/mcc 11 10 $23,841.00 $23,841.00 $22,649.00 $23,364.00 $23,102.00 2025-07-02
CP17490754486555634 CDM Cesarean Section With Sterilization Without Cc/mcc 11 10 $23,543.00 $23,543.00 $22,366.00 $23,072.00 $22,813.00 2025-07-02
CP17490754486552414 CDM Cesarean Section Without Sterilization With Cc 11 10 $20,765.00 $20,765.00 $19,727.00 $20,350.00 $20,121.00 2025-07-02
47562 CPT Removal Of Gallbladder Using An Endoscope 28 12 $20,248.50 $20,248.50 $12,144.00 $23,359.00 $19,535.00 2025-07-02
CP17490754486556236 CDM Cesarean Section Without Sterilization Without Cc/mcc 11 10 $19,862.00 $19,862.00 $18,869.00 $19,465.00 $19,246.00 2025-07-02
11684193 CDM Impl Lapiplasty System 4 Sk39 15 12 $16,304.00 $16,304.00 $6,067.00 $15,978.00 $15,489.00 2025-07-02
11684196 CDM Impl Lapiplasty System 2 Sk14 15 12 $15,989.00 $15,989.00 $5,950.00 $15,669.00 $15,190.00 2025-07-02
49505 CPT Repair Of Groin Hernia Patient Age 5 Years Or Older 28 12 $14,691.00 $14,691.00 $8,797.00 $16,974.00 $14,173.00 2025-07-02
29881 CPT Removal Of One Knee Cartilage Using An Endoscope 28 12 $14,257.00 $14,257.00 $7,888.00 $17,680.00 $13,672.00 2025-07-02
63650 CPT Fac Fee, Implant Neuroelectrodes 16 12 $12,315.00 $12,315.00 $4,582.00 $13,973.00 $11,816.00 2025-07-02
42820 CPT Removal Of Tonsils And Adenoid Glands, Patient Younger Than Age 12 28 12 $12,107.50 $12,107.50 $7,136.00 $14,202.00 $11,677.50 2025-07-02
C1778 HCPCS Impl Lead 5mm 1x8 MRI 75 12 $11,550.00 $11,550.00 $553.00 $24,255.00 $10,973.00 2025-07-02
63685 CPT Fac Fee, Ins/rplc Spi Npg/rcvr Pocket 16 12 $11,030.00 $11,030.00 $4,104.00 $12,515.00 $10,583.50 2025-07-02
CP17679997033711069 CDM Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc 11 10 $9,655.00 $9,655.00 $9,172.00 $9,462.00 $9,356.00 2025-07-02
Q4197 HCPCS Puraply Am Xt Ef (4.91x4.91) 24.1sq Cm 14 12 $8,813.00 $8,813.00 $3,602.00 $8,637.00 $8,456.00 2025-07-02
94617 CPT 94617 Exercise Test For Bronchospasm Charge 16 12 $7,968.00 $7,968.00 $2,965.00 $9,040.00 $7,645.50 2025-07-02
70546 CPT MRA Brain/head With + Without Contrast 16 12 $7,256.00 $7,256.00 $2,700.00 $8,100.00 $6,962.00 2025-07-02
CP17490754486554362 CDM Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc 11 10 $7,074.00 $7,074.00 $6,720.00 $6,933.00 $6,855.00 2025-07-02
Q4159 HCPCS Affinity (2.5x2.5) 6.25sq Cm 14 12 $6,345.00 $6,345.00 $2,593.00 $6,218.00 $6,088.00 2025-07-02
70471 CPT CT Angio Head/neck 16 12 $6,250.00 $6,250.00 $2,326.00 $6,977.00 $5,997.00 2025-07-02
43235 CPT Diagnostic Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 28 12 $6,210.00 $6,210.00 $3,468.00 $7,640.00 $5,984.50 2025-07-02
43239 CPT Biopsy Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 28 12 $6,210.00 $6,210.00 $3,468.00 $7,640.00 $5,984.50 2025-07-02
C9359 HCPCS Bone Matrix Cellular V92 2.5cc 15 12 $6,228.00 $6,228.00 $2,317.00 $6,103.00 $5,917.00 2025-07-02
70545 CPT MRA Brain/head With Contrast 31 12 $6,695.00 $6,695.00 $2,228.00 $7,474.00 $5,868.00 2025-07-02
74178 CPT CT Abdomen And Pelvis With + Without Contrast 31 12 $6,773.00 $6,773.00 $2,210.00 $7,561.00 $5,821.00 2025-07-02
64635 CPT Fac Fee, Destruction By Neurolytic Agent Lum 16 12 $5,900.00 $5,900.00 $2,195.00 $6,694.00 $5,661.00 2025-07-02
64633 CPT Fac Fee, Destruction By Neurolytic Agent Cer 16 12 $5,870.00 $5,870.00 $2,184.00 $6,660.00 $5,632.50 2025-07-02
C1767 HCPCS Interstim, Neurostimulatorfull Implant 30 12 $13,292.50 $13,292.50 $781.00 $23,995.00 $5,584.50 2025-07-02
95811 CPT 95811 Psg/split Charge 16 12 $5,627.00 $5,627.00 $2,094.00 $6,384.00 $5,399.50 2025-07-02
Q4186 HCPCS Epifix 2cm X 2cm 84 12 $6,266.50 $6,266.50 $1,209.00 $22,141.00 $5,384.00 2025-07-02
74174 CPT CT Angio Abdomen And Pelvis 31 12 $6,270.00 $6,270.00 $2,009.00 $6,999.00 $5,292.00 2025-07-02
74177 CPT CT Scan Of Abdomen And Pelvis With Contrast 31 12 $5,841.00 $5,841.00 $2,009.00 $6,520.00 $5,292.00 2025-07-02
45385 CPT Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope 28 12 $5,403.50 $5,403.50 $2,933.00 $6,806.00 $5,083.50 2025-07-02
74185 CPT MRA Abdomen With + Without Contrast 31 12 $5,780.00 $5,780.00 $1,924.00 $6,452.00 $5,067.00 2025-07-02
72156 CPT MRI Spine Cervical With + Without Contrast 31 12 $5,201.00 $5,201.00 $1,935.00 $5,806.00 $5,056.00 2025-07-02
78452 CPT Rt Stress Test Myoview Charge 31 12 $5,118.00 $5,118.00 $1,904.00 $5,839.00 $5,016.00 2025-07-02
72157 CPT MRI Spine Thoracic With + Without Contrast 31 12 $5,186.00 $5,186.00 $1,857.00 $5,789.00 $4,890.00 2025-07-02
71551 CPT MRI Chest With Contrast 31 12 $5,579.00 $5,579.00 $1,857.00 $6,228.00 $4,890.00 2025-07-02
L8699 HCPCS Impl Zim Scp Foot & Ankle Kit 15 12 $5,115.00 $5,115.00 $1,903.00 $5,013.00 $4,859.00 2025-07-02
45380 CPT Biopsy Exam Of Large Bowel Using An Endoscope 28 12 $5,160.50 $5,160.50 $2,795.00 $6,511.00 $4,844.50 2025-07-02
70553 CPT MRI Scan 31 12 $4,913.00 $4,913.00 $1,828.00 $5,484.00 $4,815.00 2025-07-02
70542 CPT MRI Face Neck Orbit With Contrast 31 12 $5,487.00 $5,487.00 $1,826.00 $6,125.00 $4,810.00 2025-07-02
72158 CPT MRI Spine Lumbar With + Without Contrast 31 12 $5,057.00 $5,057.00 $1,857.00 $5,645.00 $4,804.00 2025-07-02
95810 CPT Sleep Study 16 12 $4,946.00 $4,946.00 $1,840.00 $5,612.00 $4,746.00 2025-07-02
70549 CPT MRA Neck With + Without Contrast 31 12 $4,941.00 $4,941.00 $1,826.00 $5,516.00 $4,694.00 2025-07-02
74183 CPT MRI Abdomen With + Without Contrast 31 12 $5,125.00 $5,125.00 $1,768.00 $5,721.00 $4,657.00 2025-07-02
70552 CPT MRI Brain With Contrast 31 12 $4,691.00 $4,691.00 $1,746.00 $5,237.00 $4,597.00 2025-07-02
76498 CPT Mr Unlisted Procedure 31 12 $5,206.00 $5,206.00 $1,733.00 $5,811.00 $4,564.00 2025-07-02
70543 CPT MRI Face Neck Orbit With + Without Contrast 31 12 $4,648.00 $4,648.00 $1,730.00 $5,189.00 $4,555.00 2025-07-02
72197 CPT MRI Pelvis With + Without Contrast 31 12 $5,123.00 $5,123.00 $1,729.00 $5,719.00 $4,553.00 2025-07-02
72147 CPT MRI Spine Thoracic With Contrast 31 12 $5,194.00 $5,194.00 $1,729.00 $5,798.00 $4,553.00 2025-07-02
72149 CPT MRI Spine Lumbar With Contrast 31 12 $5,475.00 $5,475.00 $1,729.00 $6,112.00 $4,553.00 2025-07-02
74176 CPT CT Abdomen And Pelvis Without Contrast 31 12 $5,088.00 $5,088.00 $1,728.00 $5,680.00 $4,551.00 2025-07-02
71552 CPT MRI Chest With + Without Contrast 31 12 $4,557.00 $4,557.00 $1,696.00 $5,216.00 $4,466.00 2025-07-02
72142 CPT MRI Spine Cervical With Contrast 31 12 $4,505.00 $4,505.00 $1,676.00 $5,029.00 $4,414.00 2025-07-02
73223 CPT MRI Ue Joint With + Without Contrast Left 31 12 $4,524.00 $4,524.00 $1,683.00 $5,050.00 $4,342.00 2025-07-02
71550 CPT MRI Chest Without Contrast 31 12 $4,398.00 $4,398.00 $1,636.00 $4,909.00 $4,298.00 2025-07-02
70551 CPT MRI Brain Without Contrast 31 12 $4,324.00 $4,324.00 $1,609.00 $4,827.00 $4,238.00 2025-07-02
72146 CPT MRI Spine Thoracic Without Contrast 31 12 $4,304.00 $4,304.00 $1,602.00 $4,805.00 $4,164.00 2025-07-02
72141 CPT MRI Spine Cervical Without Contrast 31 12 $4,277.00 $4,277.00 $1,591.00 $4,774.00 $4,164.00 2025-07-02
78451 CPT Nm PET Myocardial Perf Single Study 31 12 $4,837.00 $4,837.00 $1,562.00 $5,400.00 $4,113.00 2025-07-02
72148 CPT MRI Scan Of Lower Spinal Canal 31 12 $4,141.00 $4,141.00 $1,541.00 $4,623.00 $4,058.00 2025-07-02
70544 CPT MRA Brain/head Without Contrast 31 12 $4,129.00 $4,129.00 $1,536.00 $4,810.00 $4,046.00 2025-07-02
73220 CPT MRI Upper Extremity With + Without Cnt Left 30 12 $4,187.00 $4,187.00 $1,527.00 $4,185.00 $4,022.00 2025-07-02
73723 CPT MRI Le Joint With + Without Contrast Left 15 12 $4,163.00 $4,163.00 $1,549.00 $4,080.00 $3,955.00 2025-07-02
72196 CPT MRI Pelvis With Contrast 31 12 $4,468.00 $4,468.00 $1,487.00 $4,988.00 $3,916.00 2025-07-02
59899 CPT Jada System 16 12 $4,060.00 $4,060.00 $1,511.00 $4,606.00 $3,895.50 2025-07-02
45378 CPT Diagnostic Exam Of Large Bowel Using An Endoscope 28 12 $4,163.00 $4,163.00 $2,228.00 $5,302.00 $3,862.50 2025-07-02
73720 CPT MRI Lower Extremity With + Without Cnt Left 30 12 $4,051.50 $4,051.50 $1,505.00 $3,978.00 $3,856.00 2025-07-02
74181 CPT MRI Abdomen Without Contrast 31 12 $3,922.00 $3,922.00 $1,459.00 $4,553.00 $3,844.00 2025-07-02
70540 CPT MRI Face Neck Orbit Without Contrast 31 12 $3,922.00 $3,922.00 $1,459.00 $4,378.00 $3,844.00 2025-07-02
73702 CPT CT Lower Extremity W/+without Contrast Left 30 12 $3,965.00 $3,965.00 $1,424.00 $4,022.00 $3,749.00 2025-07-02
36571 CPT 36571 Picc Line Insertion 16 12 $3,886.00 $3,886.00 $1,446.00 $4,409.00 $3,729.00 2025-07-02
64479 CPT Fac Fee, Njx Aa&/strd Tfrm Epi C/t 1 16 12 $3,880.00 $3,880.00 $1,444.00 $4,402.00 $3,723.00 2025-07-02
74175 CPT CT Angio Abdomen 31 12 $4,098.00 $4,098.00 $1,407.00 $4,575.00 $3,704.00 2025-07-02
71275 CPT CT Angio Chest 31 12 $4,180.00 $4,180.00 $1,407.00 $4,666.00 $3,704.00 2025-07-02
70548 CPT MRA Neck With Contrast 31 12 $3,771.00 $3,771.00 $1,403.00 $4,553.00 $3,696.00 2025-07-02
72195 CPT MRI Pelvis Without Contrast 31 12 $3,768.00 $3,768.00 $1,402.00 $4,206.00 $3,693.00 2025-07-02
70547 CPT MRA Neck Without Contrast 31 12 $3,720.00 $3,720.00 $1,384.00 $4,295.00 $3,646.00 2025-07-02
75635 CPT CT Angio Abdomen Aorta + Iliofemoral 31 12 $4,395.00 $4,395.00 $1,382.00 $4,906.00 $3,639.00 2025-07-02
70336 CPT MRI Tmj 31 12 $4,090.00 $4,090.00 $1,362.00 $4,566.00 $3,586.00 2025-07-02
74170 CPT CT Abdomen With + Without Contrast 31 12 $3,775.00 $3,775.00 $1,378.00 $4,214.00 $3,586.00 2025-07-02
CP17679997033711435 CDM Normal Newborn 11 10 $3,625.00 $3,625.00 $3,444.00 $3,553.00 $3,513.00 2025-07-02
Q4101 HCPCS Apligraf 14 12 $3,626.00 $3,626.00 $1,482.00 $3,553.00 $3,479.50 2025-07-02
8290746 CDM Bchc Labor And Delivery Charges 15 12 $3,650.00 $3,650.00 $1,358.00 $3,577.00 $3,468.00 2025-07-02
8290744 CDM Birthing Service Charge 15 12 $3,650.00 $3,650.00 $1,358.00 $3,577.00 $3,468.00 2025-07-02
CP17490754486559182 CDM Normal Newborn 11 10 $3,570.00 $3,570.00 $3,392.00 $3,499.00 $3,459.00 2025-07-02
11684192 CDM Impl Meteric Superstaple 21401 15 12 $3,630.00 $3,630.00 $1,351.00 $3,557.00 $3,449.00 2025-07-02
70496 CPT CT Angio Brain/head 31 12 $3,814.00 $3,814.00 $1,306.00 $4,258.00 $3,440.00 2025-07-02
C1787 HCPCS Patient Programmer 30 12 $4,452.50 $4,452.50 $1,302.00 $5,297.00 $3,430.00 2025-07-02
73218 CPT MRI Upper Extremity Without Contrast Left 30 12 $3,607.00 $3,607.00 $1,298.00 $3,651.00 $3,418.00 2025-07-02
64483 CPT Injection(s) Of Anesthetic Into Lower Spine Using Imaging Guidance 56 12 $3,482.00 $3,482.00 $190.00 $4,313.00 $3,374.00 2025-07-02
73202 CPT CT Upper Extremity W/+without Contrast Left 30 12 $3,583.00 $3,583.00 $1,260.00 $3,704.00 $3,318.00 2025-07-02
72194 CPT CT Pelvis With + Without Contrast 31 12 $3,649.00 $3,649.00 $1,243.00 $4,073.00 $3,274.00 2025-07-02
70498 CPT CT Angio Neck 31 12 $3,810.00 $3,810.00 $1,238.00 $4,253.00 $3,259.00 2025-07-02
73706 CPT CT Angio Lower Extremity Left 30 12 $3,723.50 $3,723.50 $1,238.00 $4,039.00 $3,259.00 2025-07-02
99291 CPT 99291 Facility Level Critical Care Ill/injured Patient Init 30-74 Min 16 12 $3,385.00 $3,385.00 $1,260.00 $3,841.00 $3,248.00 2025-07-02
71270 CPT CT Chest With + Without Contrast 31 12 $3,819.00 $3,819.00 $1,228.00 $4,263.00 $3,235.00 2025-07-02
64615 CPT Fac Fee, Chemodenerv Musc Migraine 16 12 $3,360.00 $3,360.00 $1,250.00 $3,812.00 $3,224.00 2025-07-02
73718 CPT MRI Lower Extremity Without Contrast Left 30 12 $3,406.00 $3,406.00 $1,186.00 $3,553.00 $3,122.00 2025-07-02
72130 CPT CT Spine Thoracic With + Without Contrast 16 12 $3,250.00 $3,250.00 $1,209.00 $3,628.00 $3,118.50 2025-07-02
72133 CPT CT Spine Lumbar With + Without Contrast 31 12 $3,180.00 $3,180.00 $1,183.00 $3,550.00 $3,116.00 2025-07-02
74160 CPT CT Abdomen With Contrast 31 12 $3,279.00 $3,279.00 $1,198.00 $3,660.00 $3,115.00 2025-07-02
70492 CPT CT Neck Soft Tissue With + Without Contrast 31 12 $3,445.00 $3,445.00 $1,171.00 $3,846.00 $3,085.00 2025-07-02
64490 CPT Fac Fee, Inj Paravert F Jnt C/t 1 Lev 16 12 $3,195.00 $3,195.00 $1,189.00 $3,625.00 $3,065.50 2025-07-02
73721 CPT MRI Scan Of Leg Joint 33 12 $3,118.00 $3,118.00 $1,160.00 $3,481.00 $3,056.00 2025-07-02
C1776 HCPCS Impl Aesculap Obturator Screw 705 12 $3,617.00 $3,617.00 $4.00 $37,037.00 $3,042.00 2025-07-02
72126 CPT CT Spine Cervical With Contrast 31 12 $3,711.00 $3,711.00 $1,154.00 $4,143.00 $3,038.00 2025-07-02
72193 CPT CT Scan Of Pelvis With Contrast 31 12 $3,346.00 $3,346.00 $1,154.00 $3,735.00 $3,038.00 2025-07-02
72132 CPT CT Spine Lumbar With Contrast 31 12 $3,304.00 $3,304.00 $1,154.00 $3,688.00 $3,038.00 2025-07-02
62322 CPT Injection(s) Of Therapeutic Substance 42 12 $3,164.00 $3,164.00 $146.00 $4,121.00 $3,036.00 2025-07-02
71260 CPT CT Chest With Contrast 31 12 $3,152.00 $3,152.00 $1,154.00 $3,519.00 $2,994.00 2025-07-02
70482 CPT CT Orbits Sella With + Without Contrast 33 12 $3,100.00 $3,100.00 $1,117.00 $3,461.00 $2,943.00 2025-07-02
10659305 CDM Impl Synth Speed Implant 11x8x8 (se-1108) 15 12 $3,067.00 $3,067.00 $1,141.00 $3,006.00 $2,914.00 2025-07-02
10659304 CDM Impl Synth Speed Implant 11x10x10 (se-1110) 15 12 $3,067.00 $3,067.00 $1,141.00 $3,006.00 $2,914.00 2025-07-02
72129 CPT CT Spine Thoracic With Contrast 31 12 $2,960.00 $2,960.00 $1,101.00 $3,304.00 $2,901.00 2025-07-02
86711 CPT Jcv Ab, Stratify Unmc 16 12 $3,027.00 $3,027.00 $1,237.00 $2,966.00 $2,876.00 2025-07-02
70481 CPT CT Iac With Contrast 31 12 $3,355.00 $3,355.00 $1,078.00 $3,745.00 $2,840.00 2025-07-02
70470 CPT CT Brain/head With + Without Contrast 31 12 $3,275.00 $3,275.00 $1,078.00 $3,656.00 $2,840.00 2025-07-02
72125 CPT CT Spine Cervical Without Contrast 31 12 $2,995.00 $2,995.00 $1,078.00 $3,343.00 $2,840.00 2025-07-02
72128 CPT CT Spine Thoracic Without Contrast 31 12 $2,995.00 $2,995.00 $1,078.00 $3,343.00 $2,840.00 2025-07-02
70491 CPT CT Neck Soft Tissue With Contrast 31 12 $3,012.00 $3,012.00 $1,078.00 $3,362.00 $2,840.00 2025-07-02
62321 CPT Fac Fee, Njx Interlaminar Crv/thrc W/image Guidance 16 12 $2,950.00 $2,950.00 $1,098.00 $3,347.00 $2,831.00 2025-07-02
73221 CPT MRI Ue Joint Without Contrast Lt 30 12 $2,970.00 $2,970.00 $1,065.00 $3,016.00 $2,805.00 2025-07-02
70488 CPT CT Maxillofacial With + Without Contrast 31 12 $3,190.00 $3,190.00 $1,065.00 $3,561.00 $2,805.00 2025-07-02
Q4196 HCPCS Puraply Am 1.6 Sq Cm Disc 56 12 $3,273.00 $3,273.00 $552.00 $6,334.00 $2,793.00 2025-07-02
72131 CPT CT Spine Lumbar Without Contrast 31 12 $2,908.00 $2,908.00 $1,078.00 $3,246.00 $2,763.00 2025-07-02
71250 CPT CT Chest Without Contrast 31 12 $2,902.00 $2,902.00 $1,078.00 $3,240.00 $2,757.00 2025-07-02
64493 CPT Fac Fee, Inj Paravert F Jnt L/s 1 Lev 16 12 $2,870.00 $2,870.00 $1,068.00 $3,256.00 $2,754.00 2025-07-02
0561T CPT Trumatch Custom Block 30 12 $2,995.00 $2,995.00 $1,028.00 $3,162.00 $2,708.00 2025-07-02
74150 CPT CT Abdomen Without Contrast 31 12 $2,990.00 $2,990.00 $1,018.00 $3,338.00 $2,682.00 2025-07-02
62323 CPT Injection(s) Of Therapeutic Substance 56 12 $2,947.00 $2,947.00 $179.00 $4,121.00 $2,675.00 2025-07-02
8081565 CDM Room/bed: Private 15 12 $2,730.00 $2,730.00 $1,665.00 $5,391.00 $2,675.00 2025-07-02
78803 CPT Nm Bone Spect 31 12 $2,827.00 $2,827.00 $1,016.00 $3,156.00 $2,675.00 2025-07-02
73701 CPT CT Lower Extremity With Contrast Left 30 12 $2,926.00 $2,926.00 $1,004.00 $3,091.00 $2,644.00 2025-07-02
70480 CPT CT Orbits Sella Without Contrast 33 12 $2,698.00 $2,698.00 $1,004.00 $3,328.00 $2,644.00 2025-07-02
70460 CPT CT Brain/head With Contrast 31 12 $2,873.00 $2,873.00 $1,004.00 $3,207.00 $2,644.00 2025-07-02
73201 CPT CT Upper Extremity With Contrast Left 30 12 $2,790.50 $2,790.50 $1,004.00 $2,825.00 $2,644.00 2025-07-02
72192 CPT CT Pelvis Without Contrast 31 12 $2,940.00 $2,940.00 $1,004.00 $3,282.00 $2,644.00 2025-07-02
C1729 HCPCS Cathpleurx Peritoneal Starter Kit 30 12 $2,733.50 $2,733.50 $1,002.00 $2,718.00 $2,634.00 2025-07-02
93306 CPT 93306 2d Echo Complete Tech Fee 16 12 $2,710.00 $2,710.00 $1,008.00 $3,075.00 $2,600.50 2025-07-02
70490 CPT CT Neck Soft Tissue Without Contrast 31 12 $2,625.00 $2,625.00 $977.00 $2,930.00 $2,563.00 2025-07-02
78290 CPT Nm Intestine Imaging Meckels 31 12 $2,835.00 $2,835.00 $966.00 $3,165.00 $2,544.00 2025-07-02
78305 CPT Nm Bone Imaging Multiple Areas 31 12 $2,768.00 $2,768.00 $943.00 $3,090.00 $2,484.00 2025-07-02
78315 CPT Nm Bone Three Phase Study 31 12 $2,750.00 $2,750.00 $937.00 $3,070.00 $2,468.00 2025-07-02
73700 CPT CT Lower Extremity Without Contrast Left 30 12 $2,651.00 $2,651.00 $929.00 $2,750.00 $2,446.00 2025-07-02
70487 CPT CT Maxillofacial With Contrast 31 12 $2,814.00 $2,814.00 $929.00 $3,141.00 $2,446.00 2025-07-02
73200 CPT CT Upper Extremity Without Contrast Left 30 12 $2,560.50 $2,560.50 $929.00 $2,573.00 $2,446.00 2025-07-02
70450 CPT CT Scan 31 12 $2,542.00 $2,542.00 $929.00 $2,838.00 $2,415.00 2025-07-02
11684197 CDM Guided Release Inst Sn20 15 12 $2,538.00 $2,538.00 $944.00 $2,487.00 $2,411.00 2025-07-02
11684198 CDM Triple Edge Relase Inst Sn21 15 12 $2,538.00 $2,538.00 $944.00 $2,487.00 $2,411.00 2025-07-02
78226 CPT Nm Hepatobiliary Imaging 31 12 $2,428.00 $2,428.00 $903.00 $2,815.00 $2,379.00 2025-07-02
78216 CPT Nm Liver/spleen Imaging With Vascular Flow 31 12 $2,619.00 $2,619.00 $892.00 $2,924.00 $2,350.00 2025-07-02
78278 CPT Nm Gastrointestinal Blood Loss Imaging 31 12 $2,619.00 $2,619.00 $892.00 $2,924.00 $2,350.00 2025-07-02
10905299 CDM Impl Tissuetak Tendon Anchor 15 12 $2,407.00 $2,407.00 $896.00 $2,359.00 $2,287.00 2025-07-02
27096 CPT Fac Fee, Inject Sacroiliac Joint W/image Guidance 16 12 $2,380.00 $2,380.00 $886.00 $2,700.00 $2,283.50 2025-07-02
9763579 CDM Picasso I2400/2400 Iic 15 12 $2,398.00 $2,398.00 $892.00 $2,350.00 $2,278.00 2025-07-02
Q4160 HCPCS Nushield 1.6 Sq Cm Disc 42 12 $2,385.00 $2,385.00 $484.00 $3,842.00 $2,266.00 2025-07-02
70486 CPT CT Maxillofacial Without Contrast 31 12 $2,374.00 $2,374.00 $854.00 $2,650.00 $2,250.00 2025-07-02
9488111 CDM Ea153 Aph Plts Acda>pasc Irrlr Bm>=36h 1 15 12 $2,365.00 $2,365.00 $880.00 $2,318.00 $2,247.00 2025-07-02
P9037 HCPCS E3046 Aph Plt Acda Lr Irr 15 12 $2,365.00 $2,365.00 $880.00 $2,318.00 $2,247.00 2025-07-02
9488113 CDM Ea155 Aph Plts Acda>pasc Irrlr Bm>=36h 3 15 12 $2,365.00 $2,365.00 $880.00 $2,318.00 $2,247.00 2025-07-02
9488112 CDM Ea154 Aph Plts Acda>pasc Irrlr Bm>=36h 2 15 12 $2,365.00 $2,365.00 $880.00 $2,318.00 $2,247.00 2025-07-02
78227 CPT Nm Hepatobiliary Imaging With Drug 31 12 $2,292.00 $2,292.00 $853.00 $2,815.00 $2,246.00 2025-07-02
78707 CPT Nm Kidney Imaging Single Without Pharm 31 12 $2,466.00 $2,466.00 $841.00 $2,753.00 $2,214.00 2025-07-02
55700 CPT Biopsy Of Prostate Gland 55 12 $3,413.00 $3,413.00 $716.00 $5,228.00 $2,206.00 2025-07-02
78472 CPT Nm Cardiac Muga 31 12 $2,452.00 $2,452.00 $835.00 $2,737.00 $2,200.00 2025-07-02
9763670 CDM Muse Iq I2400 Rechargeable 15 12 $2,238.00 $2,238.00 $833.00 $2,193.00 $2,126.00 2025-07-02
78306 CPT Nm Bone Imaging Whole Body 16 12 $2,197.00 $2,197.00 $818.00 $2,453.00 $2,108.00 2025-07-02
64454 CPT Fac Fee, Njx Aa&/strd Gnclr Nrv Brnch 16 12 $2,185.00 $2,185.00 $813.00 $2,479.00 $2,096.50 2025-07-02
9763578 CDM Picasso I2400/2400 Cic 15 12 $2,198.00 $2,198.00 $818.00 $2,154.00 $2,088.00 2025-07-02
9763577 CDM Picasso I2400 Custom 15 12 $2,198.00 $2,198.00 $818.00 $2,154.00 $2,088.00 2025-07-02
78709 CPT Nm Kidney Imaging Multiple W/+without Pharm 31 12 $2,292.00 $2,292.00 $781.00 $2,559.00 $2,057.00 2025-07-02
78264 CPT Nm Gastric Emptying Study 31 12 $2,376.00 $2,376.00 $775.00 $2,652.00 $2,041.00 2025-07-02
78215 CPT Nm Liver/spleen Imaging 31 12 $2,274.00 $2,274.00 $775.00 $2,538.00 $2,041.00 2025-07-02
9763576 CDM Livio 2400 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
9595385 CDM Lnx Quattro 9 Non-rechargable Custom 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
12747746 CDM Genesis Ai 24 Itc R 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
10924758 CDM Oticon Real 1 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
12231787 CDM Phonak Audeo L90-rt 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
9589743 CDM One 9 Non-rechargeable 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
9763561 CDM Livio Edge Ai 2400 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
11270741 CDM Genesis Ai24 Ric Rt 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
11924069 CDM Phonak Lumity 90 Slims 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
9763560 CDM Livio Edge Ai 2400 Standard Rechargeable 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
10301484 CDM Audeo P90-r 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
13217093 CDM Audeo Infinio Sphere I90 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
10375018 CDM Moment 440 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
11912287 CDM Genesis Ai 24 Cic Nw 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
9763575 CDM Livio 2400 Rechargable 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
13356164 CDM Audeo Infinio I90 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
9763574 CDM Livio 2400 Custom Chargeable 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
10375019 CDM Moment 440 Mric R D 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
12108946 CDM Intent 1 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
10301485 CDM More 1 Minirite/minibte-r 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
10314693 CDM Opn Play 1 Minirite,minirite-t, Btepp 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
10900010 CDM Phonak L90-rl 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
9590754 CDM Moment Mric R 312 D 440 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
10374414 CDM More 1 Minirite/minibte-t 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
9590755 CDM Moment 440 (All Other Forms) 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
10625979 CDM Enolv Al 2400 Standard R Wireless 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
9595390 CDM Enzo 3d 9 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
9763559 CDM Livio Edge Ai 2400 Custom Rechargeable 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
12090573 CDM Widex Smart Ric 440 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
12411464 CDM Resound Nexia 9 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
9589742 CDM One 9 Rechargeable 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
12231786 CDM Phonak Naida L90-sp 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
12562979 CDM Starkey Signature Series 24 Cic R Nw 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
9595413 CDM Linx 3d 9 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
12914782 CDM Vivia 9 Rechargeable 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
10327569 CDM Lumity 90-r Ric 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
10625980 CDM Omnia 9 Rechargeable 15 12 $2,100.00 $2,100.00 $781.00 $2,058.00 $1,995.00 2025-07-02
78708 CPT Nm Kidney Imaging Single With Pharm 31 12 $2,027.00 $2,027.00 $754.00 $2,475.00 $1,986.00 2025-07-02
78195 CPT Nm Lymphoscintigraphy 31 12 $2,246.00 $2,246.00 $736.00 $2,507.00 $1,939.00 2025-07-02
9763688 CDM Picasso I2000/2000 Cic 15 12 $1,998.00 $1,998.00 $743.00 $1,958.00 $1,898.00 2025-07-02
9763687 CDM Picasso I2000 15 12 $1,998.00 $1,998.00 $743.00 $1,958.00 $1,898.00 2025-07-02
9763689 CDM Picasso 2000 Iic 15 12 $1,998.00 $1,998.00 $743.00 $1,958.00 $1,898.00 2025-07-02
8293236 CDM Treatment Rm/t6 Charge 15 12 $1,985.00 $1,985.00 $739.00 $1,945.00 $1,886.00 2025-07-02
Q4125 HCPCS Impl Arth Arthoflex Biowasher 10x14x2.0 45 12 $1,980.00 $1,980.00 $367.00 $3,265.00 $1,881.00 2025-07-02
8290745 CDM Labor Service Only Charge 15 12 $1,950.00 $1,950.00 $726.00 $1,911.00 $1,853.00 2025-07-02
9763582 CDM Halo Iq I2400 15 12 $1,938.00 $1,938.00 $721.00 $1,899.00 $1,841.00 2025-07-02
9763672 CDM Muse Iq I2400 Custom 15 12 $1,938.00 $1,938.00 $721.00 $1,899.00 $1,841.00 2025-07-02
9763676 CDM Muse I2400 Standard 15 12 $1,938.00 $1,938.00 $721.00 $1,899.00 $1,841.00 2025-07-02
9763671 CDM Muse Iq I2400 Cic 15 12 $1,938.00 $1,938.00 $721.00 $1,899.00 $1,841.00 2025-07-02
9764149 CDM Muse Iq I2000 Rechargable 15 12 $1,938.00 $1,938.00 $721.00 $1,899.00 $1,841.00 2025-07-02
9763673 CDM Muse Iq I2400 Standard 15 12 $1,938.00 $1,938.00 $721.00 $1,899.00 $1,841.00 2025-07-02
84182 CPT Amphiphysin Wb, Ser Unmc 16 12 $1,933.00 $1,933.00 $790.00 $1,894.00 $1,836.00 2025-07-02
92960 CPT 92960 Cardioversion Charge 16 12 $1,911.00 $1,911.00 $711.00 $2,168.00 $1,833.50 2025-07-02
8612016 CDM Room/bed: Skilled Nursing Care 15 12 $1,845.00 $1,845.00 $1,125.00 $5,391.00 $1,808.00 2025-07-02
4232582 CDM Room/bed: Snf 15 12 $1,845.00 $1,845.00 $1,125.00 $5,391.00 $1,808.00 2025-07-02
9763677 CDM Z Series I110 Cic 15 12 $1,898.00 $1,898.00 $706.00 $1,860.00 $1,803.00 2025-07-02
9763669 CDM Halo I 110 15 12 $1,898.00 $1,898.00 $706.00 $1,860.00 $1,803.00 2025-07-02
9763674 CDM Muse I2400 Cic 15 12 $1,898.00 $1,898.00 $706.00 $1,860.00 $1,803.00 2025-07-02
9763583 CDM Halo 2 I2400 15 12 $1,898.00 $1,898.00 $706.00 $1,860.00 $1,803.00 2025-07-02
9763675 CDM Muse I2400 Custom 15 12 $1,898.00 $1,898.00 $706.00 $1,860.00 $1,803.00 2025-07-02
94002 CPT 94002 Ventilator Mgmt Initial Day 16 12 $1,858.00 $1,858.00 $691.00 $2,108.00 $1,782.50 2025-07-02
10905092 CDM Graft Spreader 15 12 $1,875.00 $1,875.00 $698.00 $1,838.00 $1,781.00 2025-07-02
8862350 CDM Encephalopathy, Csf Unmc 15 12 $1,866.00 $1,866.00 $763.00 $1,829.00 $1,773.00 2025-07-02
93970 CPT 93970 Bilateral Venous Duplex Charge 16 12 $1,822.00 $1,822.00 $678.00 $2,067.00 $1,748.50 2025-07-02
9607586 CDM D Moxi Jump R T 9 15 12 $1,838.00 $1,838.00 $684.00 $1,801.00 $1,746.00 2025-07-02
9607584 CDM Dx Moxi Stride P R 9 15 12 $1,838.00 $1,838.00 $684.00 $1,801.00 $1,746.00 2025-07-02
9607592 CDM T Moxi Fit Now Pro 15 12 $1,838.00 $1,838.00 $684.00 $1,801.00 $1,746.00 2025-07-02
9607587 CDM D Stride P R 9 15 12 $1,838.00 $1,838.00 $684.00 $1,801.00 $1,746.00 2025-07-02
9607582 CDM Dx Moxi Fit 9 15 12 $1,838.00 $1,838.00 $684.00 $1,801.00 $1,746.00 2025-07-02
9607588 CDM D Moxi Fit 9 Xs Xm Xp 15 12 $1,838.00 $1,838.00 $684.00 $1,801.00 $1,746.00 2025-07-02
9607535 CDM Dx Moxi Jump R T 9 15 12 $1,838.00 $1,838.00 $684.00 $1,801.00 $1,746.00 2025-07-02
9607590 CDM D Moxi Jump R 9 Xs Xm Xp 15 12 $1,838.00 $1,838.00 $684.00 $1,801.00 $1,746.00 2025-07-02
9607591 CDM D Moxi Jump R 9 Xup 15 12 $1,838.00 $1,838.00 $684.00 $1,801.00 $1,746.00 2025-07-02
9607593 CDM T Stride M P P Dura Pro 15 12 $1,838.00 $1,838.00 $684.00 $1,801.00 $1,746.00 2025-07-02
9607585 CDM Dx Stride M9 15 12 $1,838.00 $1,838.00 $684.00 $1,801.00 $1,746.00 2025-07-02
9607589 CDM D Moxi Fit 9 Xup 15 12 $1,838.00 $1,838.00 $684.00 $1,801.00 $1,746.00 2025-07-02
9607583 CDM Dx Moxi Move R 9 15 12 $1,838.00 $1,838.00 $684.00 $1,801.00 $1,746.00 2025-07-02
A0427 HCPCS A0427 Als1-emergency Techfee 15 12 $1,825.00 $1,825.00 $679.00 $1,789.00 $1,734.00 2025-07-02
A0433 HCPCS A0433 Als 2 Techfee 15 12 $1,825.00 $1,825.00 $679.00 $1,789.00 $1,734.00 2025-07-02
9566541 CDM E8340 Aph Plt Acda>pasc Lr Psoralen 15 12 $1,815.00 $1,815.00 $675.00 $1,779.00 $1,724.00 2025-07-02
P9035 HCPCS E3077 Aph Plt Acda Lr 15 12 $1,815.00 $1,815.00 $675.00 $1,779.00 $1,724.00 2025-07-02
99285 CPT 99285 Ed Visit E M Patient, Lev 5, Req Med Approp Hstry/exam/high Mdm, Cc 16 12 $1,790.00 $1,790.00 $666.00 $2,031.00 $1,718.00 2025-07-02
87150 CPT 87150 Blood Path Panel Pcr Unmc 16 12 $1,799.00 $1,799.00 $735.00 $1,763.00 $1,709.00 2025-07-02
9763678 CDM Z Series I110 Custom 15 12 $1,798.00 $1,798.00 $669.00 $1,762.00 $1,708.00 2025-07-02
9763679 CDM Z Series I110 Standard 15 12 $1,798.00 $1,798.00 $669.00 $1,762.00 $1,708.00 2025-07-02
11684194 CDM Impl Locking Screw 2.7mm Sd22 15 12 $1,754.00 $1,754.00 $653.00 $1,719.00 $1,666.00 2025-07-02
93880 CPT 93880 Bilateral Carotid Duplex Charge 16 12 $1,725.00 $1,725.00 $642.00 $1,957.00 $1,655.50 2025-07-02
99292 CPT Critical Care Ill/injured Patient Addl 30 Min 99292 16 12 $1,725.00 $1,725.00 $642.00 $1,957.00 $1,655.50 2025-07-02
9764150 CDM Muse Iq I2000 Cic 15 12 $1,738.00 $1,738.00 $647.00 $1,703.00 $1,651.00 2025-07-02
9763692 CDM Halo Iq I2000 15 12 $1,738.00 $1,738.00 $647.00 $1,703.00 $1,651.00 2025-07-02
9804008 CDM Picasso 1600 Iic 13 12 $1,698.00 $1,698.00 $1,036.00 $1,664.00 $1,645.00 2025-07-02
9803592 CDM Picasso I 1600/1600 Cic 13 12 $1,698.00 $1,698.00 $1,036.00 $1,664.00 $1,645.00 2025-07-02
9803591 CDM Picasso I 1600 13 12 $1,698.00 $1,698.00 $1,036.00 $1,664.00 $1,645.00 2025-07-02
12878920 CDM Impl Maxtack 15 12 $1,712.00 $1,712.00 $637.00 $1,678.00 $1,626.00 2025-07-02
19281 CPT Mg Device Plcmnt With Mammo Guide Left 30 12 $1,853.50 $1,853.50 $614.00 $2,016.00 $1,617.00 2025-07-02
8293235 CDM Treatment Rm/t5 Charge 15 12 $1,701.00 $1,701.00 $633.00 $1,667.00 $1,616.00 2025-07-02
9764153 CDM Muse I2000 Cic 15 12 $1,698.00 $1,698.00 $632.00 $1,664.00 $1,613.00 2025-07-02
9764156 CDM Z Series I90 Cic 15 12 $1,698.00 $1,698.00 $632.00 $1,664.00 $1,613.00 2025-07-02
9763693 CDM Halo 2 I2000 15 12 $1,698.00 $1,698.00 $632.00 $1,664.00 $1,613.00 2025-07-02
9764148 CDM Halo I90 15 12 $1,698.00 $1,698.00 $632.00 $1,664.00 $1,613.00 2025-07-02
C2631 HCPCS Capio Slim Suture Capturing Device 15 12 $1,667.00 $1,667.00 $620.00 $1,634.00 $1,584.00 2025-07-02
49083 CPT 49083 Paracentesis W/guidance Charge 17 12 $1,608.00 $1,608.00 $598.00 $1,824.00 $1,558.00 2025-07-02
9764152 CDM Muse Iq I2000 Standard 15 12 $1,638.00 $1,638.00 $609.00 $1,605.00 $1,556.00 2025-07-02
9764151 CDM Muse Iq I2000 Custom 15 12 $1,638.00 $1,638.00 $609.00 $1,605.00 $1,556.00 2025-07-02
8307334 CDM Room/bed: Nursery 14 12 $1,580.00 $1,580.00 $964.00 $5,391.00 $1,539.50 2025-07-02
10005 CPT US Fine Needle Aspiration With Guidance 16 12 $1,589.00 $1,589.00 $591.00 $1,803.00 $1,525.00 2025-07-02
9763562 CDM Livio Ai 2000 Custom Rechargeable 15 12 $1,600.00 $1,600.00 $595.00 $1,568.00 $1,520.00 2025-07-02
9595391 CDM Enzo 3d 7 15 12 $1,600.00 $1,600.00 $595.00 $1,568.00 $1,520.00 2025-07-02
9595387 CDM Lnx Quattro 7 Non-rechargable Custom 15 12 $1,600.00 $1,600.00 $595.00 $1,568.00 $1,520.00 2025-07-02
13356166 CDM Infinio Virto I70 15 12 $1,600.00 $1,600.00 $595.00 $1,568.00 $1,520.00 2025-07-02
13217095 CDM Widex Allure Ric R D 330 15 12 $1,600.00 $1,600.00 $595.00 $1,568.00 $1,520.00 2025-07-02
9589744 CDM One 7 Rechargeable 15 12 $1,600.00 $1,600.00 $595.00 $1,568.00 $1,520.00 2025-07-02
9590757 CDM Moment 330 (All Other Forms) 15 12 $1,600.00 $1,600.00 $595.00 $1,568.00 $1,520.00 2025-07-02
11080722 CDM Real 2 15 12 $1,600.00 $1,600.00 $595.00 $1,568.00 $1,520.00 2025-07-02
9590756 CDM Moment Mric R 312 D 330 15 12 $1,600.00 $1,600.00 $595.00 $1,568.00 $1,520.00 2025-07-02
12316240 CDM Smartric 330 15 12 $1,600.00 $1,600.00 $595.00 $1,568.00 $1,520.00 2025-07-02
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