Hospital

BUTLER COUNTY HEALTH

David City, NE · CCN 281332 · Rates published

Your selected procedure

You selected 93306 (CPT)

93306 2d Echo Complete Tech Fee

This hospital’s price: $2,600 across 12 payers · range $1,008-$3,075

Source: https://secure.claraprice.net/price-transparency/XJEN-1744822433611/machine-readable/470551144_butler-county-health_standardcharges.json · observed 2025-07-02

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

2,041 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 — reason	Rows
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⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 15 months old.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 via	Discovered 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.

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

See an error in this hospital's data? Submit a correction