Hospital

CALLAWAY DISTRICT HOSPITAL

Callaway, NE · CCN 281335 · Rates published

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You selected 93306 (CPT)

Us Echo 2d Complete

This hospital’s price: $1,190 across 8 payers · range $1,134-$2,364

Source: https://secure.claraprice.net/price-transparency/IHDY-1698614401401/machine-readable/470533576_callaway-district-hospital_standardcharges.json · observed 2026-06-30

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

1,578 distinct procedures filed

8 distinct payers

18,023 rate rows

2026-06-30 last MRF observed

Data quality

18,023 of 18,023 rate rows are consumer-grade (100.0%)

Every filed rate row passes our consumer-grade checks — none are excluded from the medians.

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

Source MRF file	https://www.callawayhospital.org/wp-content/uploads/2019/07/01-2019_Charge_Master.csv
Found on page	https://www.callawayhospital.org/
Discovered via	Discovered by HANK
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-10-22
Content fingerprint	a2212a3572291c1a… · 169,931 bytes · first seen 2026-05-04

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
4000309 CDM	Risankizumab Rzaa 60 Mg/ml Sol [Cdh]	8	$13,492.00	$28,132.00	$14,166.00	nat. median $1,176 outlier · 12.0×
4000368 CDM	Pegfilgrastim Cbqv 6 Mg/0.6 Ml Sol	8	$9,026.00	$18,821.00	$9,478.00	nat. median $488 outlier · 19.4×
4001726 CDM	Tenecteplase 50 Mg IV Inj[cdh]	8	$8,987.00	$18,739.00	$9,436.00	nat. median $9,436 1.0× median
4000188 CDM	Cygnus Dual 4x6cm 24 Units	8	$8,601.00	$17,934.00	$9,031.00	nat. median $306 outlier · 29.5×
4000073 CDM	Leuprolide 22.5 Mg/3 Months Intramuscular Kit	8	$7,215.00	$15,045.00	$7,576.00	nat. median $72 outlier · 104.9×
4002223 CDM	Certolizumab 200 Mg Subcutaneous Kit [Cdh]	8	$6,247.00	$13,025.00	$6,559.00	nat. median $46 outlier · 144.2×
4001385 CDM	Pegfilgrastim 6 Mg/0.6 Ml Subq Inj[cdh]	8	$6,154.00	$12,831.00	$6,461.00	nat. median $1,181 outlier · 5.5×
4000187 CDM	Cyngus 4x4cm 16 Units	8	$6,000.00	$12,511.00	$6,300.00	nat. median $202 outlier · 31.2×
4000008 CDM	Immune Globulin 10% IV Sol 400 Ml[cdh]	8	$5,759.00	$12,009.00	$6,047.00	nat. median $59 outlier · 102.3×
4000293 CDM	Eflapegrastim Xnst 13.2 Mg/0.6 Ml Sol [Cdh]	8	$4,568.00	$9,526.00	$4,797.00	nat. median $458 outlier · 10.5×
4000569 CDM	Antivenin (Crotalidae) Polyvalentpow[cdh]	8	$4,329.00	$9,026.00	$4,545.00	nat. median $213 outlier · 21.4×
4000348 CDM	Inclisiran 284 Mg/1.5 Ml Sol[cdh]	8	$3,788.00	$7,898.00	$3,977.00	nat. median $1,858 outlier · 2.1×
73725 CPT	MRA Lower Extremity With + Without Cnt Bilat	8	$2,844.00	$7,414.00	$3,733.00	nat. median $1,252 outlier · 3.0×
4000053 CDM	Tocilizumab 20 Mg/ml Sol [Cdh]	8	$3,424.00	$7,139.00	$3,595.00	nat. median $132 outlier · 27.2×
4000294 CDM	Via Matrix 2 X 3 2/3 Cm Film	8	$3,177.00	$6,625.00	$3,336.00	nat. median $749 outlier · 4.5×
4001851 CDM	Denosumab 120 Mg/1.7 Ml[cdh]	8	$3,065.00	$6,391.00	$3,218.00	nat. median $127 outlier · 25.4×
71555 CPT	MRA Chest With + Without Contrast	8	$2,847.00	$5,936.00	$2,989.00	nat. median $1,151 outlier · 2.6×
72157 CPT	MRI Spine Thoracic With + Without Contrast	8	$2,828.00	$5,898.00	$2,970.00	nat. median $1,114 outlier · 2.7×
74174 CPT	CT Angio Abdomen And Pelvis	8	$2,802.00	$5,842.00	$2,942.00	nat. median $998 outlier · 2.9×
74178 CPT	CT Abdomen And Pelvis With + Without Contrast	8	$2,659.00	$5,544.00	$2,792.00	nat. median $1,027 outlier · 2.7×
73223 CPT	MRI Ue Joint With + Without Contrast Bilat	8	$2,027.00	$5,282.00	$2,660.00	nat. median $1,158 outlier · 2.3×
4000186 CDM	Cygnus Dual 2x3cm 6 Units	8	$2,435.00	$5,076.00	$2,556.00	nat. median $240 outlier · 10.7×
4000057 CDM	Dupilumab 300 Mg/2 Ml Subcutaneous Solution 2 Ml	8	$2,386.00	$4,975.00	$2,505.00	nat. median $30 outlier · 82.4×
73720 CPT	MRI Lower Extremity With + Without Cnt Bilat	8	$1,678.00	$4,899.00	$2,467.00	nat. median $1,135 outlier · 2.2×
74177 CPT	CT Scan Of Abdomen And Pelvis With Contrast	8	$2,306.00	$4,809.00	$2,422.00	nat. median $976 outlier · 2.5×
74183 CPT	MRI Abdomen With + Without Contrast	8	$2,281.00	$4,756.00	$2,395.00	nat. median $1,105 outlier · 2.2×
72158 CPT	MRI Spine Lumbar With + Without Contrast	8	$2,184.00	$4,553.00	$2,293.00	nat. median $1,097 outlier · 2.1×
74175 CPT	CT Angio Abdomen	8	$2,160.00	$4,503.00	$2,268.00	nat. median $718 outlier · 3.2×
72149 CPT	MRI Spine Lumbar With Contrast	8	$2,135.00	$4,452.00	$2,242.00	nat. median $979 outlier · 2.3×
73220 CPT	MRI Upper Extremity With + Without Cnt Bilat	8	$1,525.00	$4,452.00	$2,242.00	nat. median $1,136 2.0× median
70553 CPT	MRI Scan	8	$2,118.00	$4,416.00	$2,224.00	nat. median $1,136 2.0× median
72156 CPT	MRI Spine Cervical With + Without Contrast	8	$2,097.00	$4,373.00	$2,202.00	nat. median $1,110 2.0× median
73718 CPT	MRI Lower Extremity Without Contrast Bilat	8	$1,495.00	$4,364.00	$2,198.00	nat. median $870 outlier · 2.5×
72198 CPT	MRA Pelvis With + Without Contrast	8	$2,044.00	$4,263.00	$2,147.00	nat. median $1,136 1.9× median
4001949 CDM	Denosumab 60 Mg/ml Sol[cdh]	8	$2,015.00	$4,201.00	$2,116.00	nat. median $2,116 1.0× median
73218 CPT	MRI Upper Extremity Without Contrast Bilat	8	$1,424.00	$4,156.00	$2,093.00	nat. median $866 outlier · 2.4×
74176 CPT	CT Abdomen And Pelvis Without Contrast	8	$1,981.00	$4,131.00	$2,080.00	nat. median $694 outlier · 3.0×
71551 CPT	MRI Chest With Contrast	8	$1,981.00	$4,130.00	$2,080.00	nat. median $1,156 1.8× median
73700 CPT	CT Lower Extremity Without Contrast Bilat	8	$1,126.00	$4,077.00	$2,053.00	nat. median $505 outlier · 4.1×
73702 CPT	CT Lower Extremity W/+without Contrast Bilat	8	$1,375.00	$4,013.00	$2,021.00	nat. median $708 outlier · 2.9×
73723 CPT	MRI Le Joint With + Without Contrast Bilat	8	$1,673.00	$3,917.00	$1,973.00	nat. median $1,199 1.6× median
73721 CPT	MRI Scan Of Leg Joint	8	$1,342.00	$3,917.00	$1,973.00	nat. median $856 outlier · 2.3×
4000166 CDM	Puraply Xt 4.91 Cm X 4.91 Cm 24.11 Each	8	$1,859.00	$3,876.00	$1,952.00	nat. median $721 outlier · 2.7×
73221 CPT	MRI Ue Joint Without Contrast Bilat	8	$1,326.00	$3,872.00	$1,950.00	nat. median $844 outlier · 2.3×
72146 CPT	MRI Spine Thoracic Without Contrast	8	$1,857.00	$3,873.00	$1,950.00	nat. median $800 outlier · 2.4×
4000050 CDM	Romosozumab-aqqg 105 Mg/1.17 Ml Subcut Soln 1.17 Ml [Cdh]	8	$1,836.00	$3,828.00	$1,928.00	nat. median $80 outlier · 24.3×
71550 CPT	MRI Chest Without Contrast	8	$1,805.00	$3,764.00	$1,896.00	nat. median $820 outlier · 2.3×
74185 CPT	MRA Abdomen With + Without Contrast	8	$1,805.00	$3,763.00	$1,895.00	nat. median $1,253 1.5× median
70551 CPT	MRI Brain Without Contrast	8	$1,793.00	$3,738.00	$1,882.00	nat. median $787 outlier · 2.4×
71552 CPT	MRI Chest With + Without Contrast	8	$1,779.00	$3,710.00	$1,868.00	nat. median $1,103 1.7× median

Other procedures at this hospital

Browse this hospital's 1,578 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

4000309	CDM	Risankizumab Rzaa 60 Mg/ml Sol [Cdh]	11	8	$28,706.00	$25,835.00	$13,492.00	$28,132.00	$14,166.00	2026-06-30
4000368	CDM	Pegfilgrastim Cbqv 6 Mg/0.6 Ml Sol	11	8	$19,205.00	$17,285.00	$9,026.00	$18,821.00	$9,478.00	2026-06-30
4001726	CDM	Tenecteplase 50 Mg IV Inj[cdh]	11	8	$19,121.00	$17,209.00	$8,987.00	$18,739.00	$9,436.00	2026-06-30
4000188	CDM	Cygnus Dual 4x6cm 24 Units	11	8	$18,300.00	$16,470.00	$8,601.00	$17,934.00	$9,031.00	2026-06-30
4000073	CDM	Leuprolide 22.5 Mg/3 Months Intramuscular Kit	11	8	$15,352.00	$13,817.00	$7,215.00	$15,045.00	$7,576.00	2026-06-30
4002223	CDM	Certolizumab 200 Mg Subcutaneous Kit [Cdh]	11	8	$13,291.00	$11,962.00	$6,247.00	$13,025.00	$6,559.00	2026-06-30
4001385	CDM	Pegfilgrastim 6 Mg/0.6 Ml Subq Inj[cdh]	11	8	$13,093.00	$11,784.00	$6,154.00	$12,831.00	$6,461.00	2026-06-30
4000187	CDM	Cyngus 4x4cm 16 Units	11	8	$12,766.00	$11,489.00	$6,000.00	$12,511.00	$6,300.00	2026-06-30
4000008	CDM	Immune Globulin 10% IV Sol 400 Ml[cdh]	11	8	$12,254.00	$11,029.00	$5,759.00	$12,009.00	$6,047.00	2026-06-30
4000293	CDM	Eflapegrastim Xnst 13.2 Mg/0.6 Ml Sol [Cdh]	11	8	$9,720.00	$8,748.00	$4,568.00	$9,526.00	$4,797.00	2026-06-30
4000569	CDM	Antivenin (Crotalidae) Polyvalentpow[cdh]	11	8	$9,210.00	$8,289.00	$4,329.00	$9,026.00	$4,545.00	2026-06-30
4000348	CDM	Inclisiran 284 Mg/1.5 Ml Sol[cdh]	11	8	$8,059.00	$7,253.00	$3,788.00	$7,898.00	$3,977.00	2026-06-30
73725	CPT	MRA Lower Extremity With + Without Cnt Bilat	22	8	$6,808.50	$6,128.00	$2,844.00	$7,414.00	$3,733.00	2026-06-30
4000053	CDM	Tocilizumab 20 Mg/ml Sol [Cdh]	11	8	$7,285.00	$6,557.00	$3,424.00	$7,139.00	$3,595.00	2026-06-30
4000294	CDM	Via Matrix 2 X 3 2/3 Cm Film	11	8	$6,760.00	$6,084.00	$3,177.00	$6,625.00	$3,336.00	2026-06-30
4001851	CDM	Denosumab 120 Mg/1.7 Ml[cdh]	11	8	$6,521.00	$5,869.00	$3,065.00	$6,391.00	$3,218.00	2026-06-30
71555	CPT	MRA Chest With + Without Contrast	11	8	$6,057.00	$5,451.00	$2,847.00	$5,936.00	$2,989.00	2026-06-30
72157	CPT	MRI Spine Thoracic With + Without Contrast	11	8	$6,018.00	$5,416.00	$2,828.00	$5,898.00	$2,970.00	2026-06-30
74174	CPT	CT Angio Abdomen And Pelvis	11	8	$5,961.00	$5,365.00	$2,802.00	$5,842.00	$2,942.00	2026-06-30
74178	CPT	CT Abdomen And Pelvis With + Without Contrast	11	8	$5,657.00	$5,091.00	$2,659.00	$5,544.00	$2,792.00	2026-06-30
73223	CPT	MRI Ue Joint With + Without Contrast Bilat	22	8	$4,851.00	$4,366.00	$2,027.00	$5,282.00	$2,660.00	2026-06-30
4000186	CDM	Cygnus Dual 2x3cm 6 Units	11	8	$5,180.00	$4,662.00	$2,435.00	$5,076.00	$2,556.00	2026-06-30
4000057	CDM	Dupilumab 300 Mg/2 Ml Subcutaneous Solution 2 Ml	11	8	$5,077.00	$4,569.00	$2,386.00	$4,975.00	$2,505.00	2026-06-30
73720	CPT	MRI Lower Extremity With + Without Cnt Bilat	22	8	$4,285.00	$3,856.50	$1,678.00	$4,899.00	$2,467.00	2026-06-30
74177	CPT	CT Scan Of Abdomen And Pelvis With Contrast	11	8	$4,907.00	$4,416.00	$2,306.00	$4,809.00	$2,422.00	2026-06-30
74183	CPT	MRI Abdomen With + Without Contrast	11	8	$4,853.00	$4,368.00	$2,281.00	$4,756.00	$2,395.00	2026-06-30
72158	CPT	MRI Spine Lumbar With + Without Contrast	11	8	$4,646.00	$4,181.00	$2,184.00	$4,553.00	$2,293.00	2026-06-30
74175	CPT	CT Angio Abdomen	11	8	$4,595.00	$4,136.00	$2,160.00	$4,503.00	$2,268.00	2026-06-30
72149	CPT	MRI Spine Lumbar With Contrast	11	8	$4,543.00	$4,089.00	$2,135.00	$4,452.00	$2,242.00	2026-06-30
73220	CPT	MRI Upper Extremity With + Without Cnt Bilat	22	8	$3,894.00	$3,505.00	$1,525.00	$4,452.00	$2,242.00	2026-06-30
70553	CPT	MRI Scan	11	8	$4,506.00	$4,055.00	$2,118.00	$4,416.00	$2,224.00	2026-06-30
72156	CPT	MRI Spine Cervical With + Without Contrast	11	8	$4,462.00	$4,016.00	$2,097.00	$4,373.00	$2,202.00	2026-06-30
73718	CPT	MRI Lower Extremity Without Contrast Bilat	22	8	$3,817.00	$3,435.50	$1,495.00	$4,364.00	$2,198.00	2026-06-30
72198	CPT	MRA Pelvis With + Without Contrast	11	8	$4,350.00	$3,915.00	$2,044.00	$4,263.00	$2,147.00	2026-06-30
4001949	CDM	Denosumab 60 Mg/ml Sol[cdh]	11	8	$4,287.00	$3,858.00	$2,015.00	$4,201.00	$2,116.00	2026-06-30
73218	CPT	MRI Upper Extremity Without Contrast Bilat	22	8	$3,635.00	$3,271.50	$1,424.00	$4,156.00	$2,093.00	2026-06-30
74176	CPT	CT Abdomen And Pelvis Without Contrast	11	8	$4,215.00	$3,794.00	$1,981.00	$4,131.00	$2,080.00	2026-06-30
71551	CPT	MRI Chest With Contrast	11	8	$4,214.00	$3,793.00	$1,981.00	$4,130.00	$2,080.00	2026-06-30
73700	CPT	CT Lower Extremity Without Contrast Bilat	22	8	$3,277.50	$2,950.00	$1,126.00	$4,077.00	$2,053.00	2026-06-30
73702	CPT	CT Lower Extremity W/+without Contrast Bilat	22	8	$3,510.00	$3,159.50	$1,375.00	$4,013.00	$2,021.00	2026-06-30
73721	CPT	MRI Scan Of Leg Joint	22	8	$3,426.00	$3,083.50	$1,342.00	$3,917.00	$1,973.00	2026-06-30
73723	CPT	MRI Le Joint With + Without Contrast Bilat	22	8	$3,778.00	$3,400.00	$1,673.00	$3,917.00	$1,973.00	2026-06-30
4000166	CDM	Puraply Xt 4.91 Cm X 4.91 Cm 24.11 Each	11	8	$3,955.00	$3,560.00	$1,859.00	$3,876.00	$1,952.00	2026-06-30
72146	CPT	MRI Spine Thoracic Without Contrast	11	8	$3,952.00	$3,557.00	$1,857.00	$3,873.00	$1,950.00	2026-06-30
73221	CPT	MRI Ue Joint Without Contrast Bilat	22	8	$3,386.50	$3,048.00	$1,326.00	$3,872.00	$1,950.00	2026-06-30
4000050	CDM	Romosozumab-aqqg 105 Mg/1.17 Ml Subcut Soln 1.17 Ml [Cdh]	11	8	$3,906.00	$3,515.00	$1,836.00	$3,828.00	$1,928.00	2026-06-30
71550	CPT	MRI Chest Without Contrast	11	8	$3,841.00	$3,457.00	$1,805.00	$3,764.00	$1,896.00	2026-06-30
74185	CPT	MRA Abdomen With + Without Contrast	11	8	$3,840.00	$3,456.00	$1,805.00	$3,763.00	$1,895.00	2026-06-30
70551	CPT	MRI Brain Without Contrast	11	8	$3,814.00	$3,433.00	$1,793.00	$3,738.00	$1,882.00	2026-06-30
71552	CPT	MRI Chest With + Without Contrast	11	8	$3,786.00	$3,407.00	$1,779.00	$3,710.00	$1,868.00	2026-06-30
400026	CDM	Infliximab 100 Mg IV Inj[cdh]	11	8	$3,784.00	$3,406.00	$1,778.00	$3,708.00	$1,867.00	2026-06-30
75635	CPT	CT Angio Abdominal Aorta With Runoff	11	8	$3,769.00	$3,392.00	$1,771.00	$3,694.00	$1,860.00	2026-06-30
72148	CPT	MRI Scan Of Lower Spinal Canal	11	8	$3,735.00	$3,362.00	$1,755.00	$3,660.00	$1,843.00	2026-06-30
72141	CPT	MRI Spine Cervical Without Contrast	11	8	$3,728.00	$3,355.00	$1,752.00	$3,653.00	$1,840.00	2026-06-30
74182	CPT	MRI Abdomen With Contrast	11	8	$3,716.00	$3,344.00	$1,747.00	$3,642.00	$1,834.00	2026-06-30
71275	CPT	CT Angio Chest Pe Protocol	11	8	$3,645.00	$3,281.00	$1,713.00	$3,572.00	$1,799.00	2026-06-30
70492	CPT	CT Neck Soft Tissue With + Without Contrast	11	8	$3,576.00	$3,218.00	$1,681.00	$3,504.00	$1,765.00	2026-06-30
70544	CPT	MRA Brain/head Without Contrast	11	8	$3,574.00	$3,217.00	$1,680.00	$3,503.00	$1,764.00	2026-06-30
70540	CPT	MRI Face Neck Orbit Without Contrast	11	8	$3,572.00	$3,215.00	$1,679.00	$3,501.00	$1,763.00	2026-06-30
72197	CPT	MRI Pelvis With + Without Contrast	11	8	$3,546.00	$3,191.00	$1,667.00	$3,475.00	$1,750.00	2026-06-30
4001944	CDM	Zoledronic Acid 5 Mg/100 Ml Sol	11	8	$3,512.00	$3,161.00	$1,651.00	$3,442.00	$1,733.00	2026-06-30
70471	CPT	CT Angio Head/neck	11	8	$3,500.00	$3,150.00	$1,645.00	$3,430.00	$1,727.00	2026-06-30
70543	CPT	MRI Face Neck Orbit With + Without Contrast	11	8	$3,488.00	$3,139.00	$1,639.00	$3,418.00	$1,721.00	2026-06-30
4001499	CDM	Epoetin Alfa 40,000 Units/ml Preservative-free[cdh]	11	8	$3,464.00	$3,118.00	$1,628.00	$3,395.00	$1,709.00	2026-06-30
74181	CPT	MRI Abdomen Without Contrast	11	8	$3,461.00	$3,115.00	$1,627.00	$3,392.00	$1,708.00	2026-06-30
72195	CPT	MRI Pelvis Without Contrast	11	8	$3,410.00	$3,069.00	$1,603.00	$3,342.00	$1,683.00	2026-06-30
70549	CPT	MRA Neck With + Without Contrast	11	8	$3,375.00	$3,038.00	$1,586.00	$3,308.00	$1,666.00	2026-06-30
72196	CPT	MRI Pelvis With Contrast	11	8	$3,375.00	$3,038.00	$1,586.00	$3,308.00	$1,666.00	2026-06-30
73701	CPT	CT Lower Extremity With Contrast Bilat	22	8	$2,888.50	$2,599.50	$1,131.00	$3,303.00	$1,663.00	2026-06-30
73202	CPT	CT Upper Extremity W/+without Contrast Bilat	22	8	$3,010.00	$2,709.00	$1,246.00	$3,303.00	$1,663.00	2026-06-30
70496	CPT	CT Angio Brain/head	11	8	$3,344.00	$3,010.00	$1,572.00	$3,277.00	$1,650.00	2026-06-30
70498	CPT	CT Angio Neck	11	8	$3,333.00	$3,000.00	$1,567.00	$3,266.00	$1,645.00	2026-06-30
72126	CPT	CT Spine Cervical With Contrast	11	8	$3,318.00	$2,986.00	$1,559.00	$3,252.00	$1,637.00	2026-06-30
73200	CPT	CT Upper Extremity Without Contrast Bilat	22	8	$2,779.00	$2,501.00	$1,089.00	$3,177.00	$1,600.00	2026-06-30
73201	CPT	CT Upper Extremity With Contrast Bilat	22	8	$2,824.50	$2,542.00	$1,131.00	$3,177.00	$1,600.00	2026-06-30
74170	CPT	CT Abdomen With + Without Contrast	11	8	$3,224.00	$2,902.00	$1,515.00	$3,160.00	$1,591.00	2026-06-30
71270	CPT	CT Chest With + Without Contrast	11	8	$3,184.00	$2,866.00	$1,496.00	$3,120.00	$1,571.00	2026-06-30
46255	CPT	46255 Hemorrhoidectomy Internal And External, Single Column/group	11	8	$3,152.00	$2,837.00	$1,481.00	$3,089.00	$1,556.00	2026-06-30
72132	CPT	CT Spine Lumbar With Contrast	11	8	$3,135.00	$2,822.00	$1,473.00	$3,072.00	$1,547.00	2026-06-30
72130	CPT	CT Spine Thoracic With + Without Contrast	11	8	$2,975.00	$2,678.00	$1,398.00	$2,916.00	$1,468.00	2026-06-30
70470	CPT	CT Brain/head With + Without Contrast	11	8	$2,973.00	$2,676.00	$1,397.00	$2,914.00	$1,467.00	2026-06-30
72194	CPT	CT Pelvis With + Without Contrast	11	8	$2,921.00	$2,629.00	$1,373.00	$2,863.00	$1,442.00	2026-06-30
4000170	CDM	Affinity 2.5 X 2.5 Cm [Cdh]	11	8	$2,880.00	$2,592.00	$1,354.00	$2,822.00	$1,421.00	2026-06-30
G0105	HCPCS	G0105 Colorectal Ca Screen High Risk	11	8	$2,878.00	$2,590.00	$1,353.00	$2,820.00	$1,420.00	2026-06-30
72133	CPT	CT Spine Lumbar With + Without Contrast	11	8	$2,877.00	$2,589.00	$1,352.00	$2,819.00	$1,420.00	2026-06-30
71260	CPT	CT Chest With Contrast	11	8	$2,853.00	$2,568.00	$1,341.00	$2,796.00	$1,408.00	2026-06-30
72193	CPT	CT Scan Of Pelvis With Contrast	11	8	$2,815.00	$2,534.00	$1,323.00	$2,759.00	$1,389.00	2026-06-30
72191	CPT	CT Angio Pelvis	11	8	$2,813.00	$2,532.00	$1,322.00	$2,757.00	$1,388.00	2026-06-30
70481	CPT	CT Orbits Sella With Contrast	11	8	$2,805.00	$2,525.00	$1,318.00	$2,749.00	$1,384.00	2026-06-30
28285	CPT	28285 Correction Hammertoe	11	8	$2,800.00	$2,520.00	$1,316.00	$2,744.00	$1,382.00	2026-06-30
4000109	CDM	Rabies Immune Globulin, Human 150 Intl Units/ml Intramuscular Solution 2 Ml	11	8	$2,793.00	$2,514.00	$1,313.00	$2,737.00	$1,378.00	2026-06-30
72127	CPT	CT Spine Cervical With + Without Contrast	11	8	$2,756.00	$2,480.00	$1,295.00	$2,701.00	$1,360.00	2026-06-30
74160	CPT	CT Abdomen With Contrast	11	8	$2,737.00	$2,463.00	$1,286.00	$2,682.00	$1,351.00	2026-06-30
43239	CPT	Biopsy Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope	11	8	$2,704.00	$2,434.00	$1,271.00	$2,650.00	$1,334.00	2026-06-30
70547	CPT	MRA Neck Without Contrast	11	8	$2,704.00	$2,434.00	$1,271.00	$2,650.00	$1,334.00	2026-06-30
93312	CPT	93312 Transesophageal Echo Charges	11	8	$2,704.00	$2,434.00	$1,271.00	$2,650.00	$1,334.00	2026-06-30
4000287	CDM	Apligraf 44 Units Topical [Cdh]	11	8	$2,690.00	$2,421.00	$1,264.00	$2,636.00	$1,328.00	2026-06-30
70491	CPT	CT Neck Soft Tissue With Contrast	11	8	$2,653.00	$2,388.00	$1,247.00	$2,600.00	$1,309.00	2026-06-30
4000011	CDM	Etonogestrel 68 Mg Subcut Implant [Cdh]	11	8	$2,622.00	$2,360.00	$1,232.00	$2,570.00	$1,294.00	2026-06-30
72125	CPT	CT Spine Cervical Without Contrast	11	8	$2,578.00	$2,320.00	$1,212.00	$2,526.00	$1,272.00	2026-06-30
72128	CPT	CT Spine Thoracic Without Contrast	11	8	$2,570.00	$2,313.00	$1,208.00	$2,519.00	$1,268.00	2026-06-30
72131	CPT	CT Spine Lumbar Without Contrast	11	8	$2,568.00	$2,311.00	$1,207.00	$2,517.00	$1,267.00	2026-06-30
71250	CPT	CT Chest Without Contrast	11	8	$2,566.00	$2,309.00	$1,206.00	$2,515.00	$1,266.00	2026-06-30
4001558	CDM	Rabies Immune Globulin, Human 300 Intl Units/ml Sol	11	8	$2,556.00	$2,300.00	$1,201.00	$2,505.00	$1,261.00	2026-06-30
70460	CPT	CT Brain/head With Contrast	11	8	$2,534.00	$2,281.00	$1,191.00	$2,483.00	$1,251.00	2026-06-30
4000283	CDM	Atovaquone 750 Mg/5 Ml Sus[cdh]	11	8	$2,523.00	$2,271.00	$1,186.00	$2,473.00	$1,245.00	2026-06-30
70487	CPT	CT Maxillofacial With Contrast	11	8	$2,507.00	$2,256.00	$1,178.00	$2,457.00	$1,237.00	2026-06-30
72192	CPT	CT Pelvis Without Contrast	11	8	$2,505.00	$2,255.00	$1,177.00	$2,455.00	$1,236.00	2026-06-30
74150	CPT	CT Abdomen Without Contrast	11	8	$2,482.00	$2,234.00	$1,167.00	$2,432.00	$1,225.00	2026-06-30
70482	CPT	CT Orbits Sella With + Without Contrast	11	8	$2,447.00	$2,202.00	$1,150.00	$2,398.00	$1,208.00	2026-06-30
93306	CPT	US Echo 2d Complete	11	8	$2,412.00	$2,171.00	$1,134.00	$2,364.00	$1,190.00	2026-06-30
45384	CPT	45384 Colonoscopy W/lesion Removal	11	8	$2,407.00	$2,166.00	$1,131.00	$2,359.00	$1,188.00	2026-06-30
G0121	HCPCS	G0121 Colonoscopy Screening	11	8	$2,340.00	$2,106.00	$1,100.00	$2,293.00	$1,155.00	2026-06-30
72129	CPT	CT Spine Thoracic With Contrast	11	8	$2,324.00	$2,092.00	$1,092.00	$2,278.00	$1,147.00	2026-06-30
70488	CPT	CT Maxillofacial With + Without Contrast	11	8	$2,306.00	$2,075.00	$1,084.00	$2,260.00	$1,138.00	2026-06-30
4000169	CDM	Affinity 1.5 X 1.5 Cm [Cdh]	11	8	$2,295.00	$2,066.00	$1,079.00	$2,249.00	$1,133.00	2026-06-30
45380	CPT	Biopsy Exam Of Large Bowel Using An Endoscope	11	8	$2,272.00	$2,045.00	$1,068.00	$2,227.00	$1,121.00	2026-06-30
70450	CPT	CT Scan	11	8	$2,247.00	$2,022.00	$1,056.00	$2,202.00	$1,109.00	2026-06-30
70490	CPT	CT Neck Soft Tissue Without Contrast	11	8	$2,237.00	$2,013.00	$1,051.00	$2,192.00	$1,104.00	2026-06-30
73706	CPT	CT Angio Lower Extremity Bilateral	11	8	$2,166.00	$1,949.00	$1,018.00	$2,123.00	$1,069.00	2026-06-30
73206	CPT	CT Angio Upper Extremity Left	11	8	$2,166.00	$1,949.00	$1,018.00	$2,123.00	$1,069.00	2026-06-30
43250	CPT	43250 Esophagogastroduodenoscopy, Flexible, Transoral; With Removal Of Tumor(s),…	11	8	$2,164.00	$1,948.00	$1,017.00	$2,121.00	$1,068.00	2026-06-30
70480	CPT	CT Orbits Sella Without Contrast	11	8	$2,082.00	$1,874.00	$979.00	$2,040.00	$1,027.00	2026-06-30
99291	CPT	99291 Trauma Critical Care E&m First 30-74 Techfee	11	8	$2,075.00	$1,868.00	$975.00	$2,034.00	$1,024.00	2026-06-30
70486	CPT	CT Maxillofacial Without Contrast	11	8	$2,033.00	$1,830.00	$956.00	$1,992.00	$1,003.00	2026-06-30
71271	CPT	CT Low Dose Lung Scan	11	8	$1,897.00	$1,707.00	$892.00	$1,859.00	$936.00	2026-06-30
25605	CPT	25605 Closed Treatment Of Distal Radial Fracture	11	8	$1,895.00	$1,706.00	$891.00	$1,857.00	$935.00	2026-06-30
13160	CPT	13160 Secondary Closure Of Surgical Wound Or Dehiscence, Extensive Or Complicate…	11	8	$1,890.00	$1,701.00	$888.00	$1,852.00	$933.00	2026-06-30
43255	CPT	43255 Esophagogastroduodenoscopy, Flexible, Transoral; With Control Of Bleeding;…	11	8	$1,839.00	$1,655.00	$864.00	$1,802.00	$908.00	2026-06-30
43235	CPT	Diagnostic Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope	11	8	$1,839.00	$1,655.00	$864.00	$1,802.00	$908.00	2026-06-30
45378	CPT	Diagnostic Exam Of Large Bowel Using An Endoscope	11	8	$1,839.00	$1,655.00	$864.00	$1,802.00	$908.00	2026-06-30
CP17825079737594440	CDM	Room/bed: Monitored	11	8	$1,827.00	$1,644.00	$859.00	$1,790.00	$902.00	2026-06-30
4000167	CDM	Puraply Am 2 Cm X 4 Cm [Cdh]	11	8	$1,785.00	$1,607.00	$839.00	$1,749.00	$881.00	2026-06-30
4000063	CDM	Remdesivir 100 Mg Inj [Cdh]	11	8	$1,768.00	$1,591.00	$831.00	$1,733.00	$873.00	2026-06-30
25535	CPT	25535 Closed Treatment Of Ulnar Shaft Fracture; With Manual Manipulation Pc Prof…	11	8	$1,711.00	$1,540.00	$804.00	$1,677.00	$844.00	2026-06-30
45385	CPT	Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope	11	8	$1,623.00	$1,461.00	$763.00	$1,591.00	$801.00	2026-06-30
43251	CPT	43251 Esophagogastroduodenoscopy, Flexible, Transoral; With Removal Of Tumor(s),…	11	8	$1,623.00	$1,461.00	$763.00	$1,591.00	$801.00	2026-06-30
45331	CPT	45331 Sigmoidoscopy, Flexible With Biopsy, Single Or Multiple	11	8	$1,623.00	$1,461.00	$763.00	$1,591.00	$801.00	2026-06-30
4000171	CDM	Infliximab 100 Mg Pow [Cdh]	11	8	$1,617.00	$1,455.00	$760.00	$1,585.00	$798.00	2026-06-30
CP17825079737410354	CDM	Obstetrical Delivery	11	8	$1,607.00	$1,446.00	$755.00	$1,575.00	$793.00	2026-06-30
25635	CPT	25635 Cltx Carpal Bone Fx W/manj Each Bone Profee	11	8	$1,595.00	$1,436.00	$750.00	$1,563.00	$787.00	2026-06-30
93880	CPT	93880 Carotid Duplex Bil Charge John	11	8	$1,583.00	$1,425.00	$744.00	$1,551.00	$781.00	2026-06-30
93970	CPT	93970 Venous Duplex Bilateral Charge John	11	8	$1,578.00	$1,420.00	$742.00	$1,546.00	$779.00	2026-06-30
4000590	CDM	Daptomycin 500 Mg IV Inj[cdh]	11	8	$1,518.00	$1,366.00	$713.00	$1,488.00	$749.00	2026-06-30
40000240	CDM	Epoetin Alfa Epbx 40,000 Units/ml Preservative-free Sol [Cdh]	11	8	$1,503.00	$1,353.00	$706.00	$1,473.00	$742.00	2026-06-30
93350	CPT	US Stress Echo Treadmill	11	8	$1,492.00	$1,343.00	$701.00	$1,462.00	$736.00	2026-06-30
4000149	CDM	Pneumococcal 15-valent Conjugate Vaccinesus	11	8	$1,472.00	$1,325.00	$692.00	$1,443.00	$726.00	2026-06-30
CP17825079737598391	CDM	Room/bed: Inpatient	11	8	$1,461.00	$1,315.00	$687.00	$1,432.00	$721.00	2026-06-30
26641	CPT	26641 Cltx Carpo/metacarpal Dislocation Thumb W/manj Profee	11	8	$1,444.00	$1,300.00	$679.00	$1,415.00	$713.00	2026-06-30
27301	CPT	27301 Incision And Drainage Of Deep Abscess Of Knee Region	11	8	$1,426.00	$1,283.00	$670.00	$1,397.00	$704.00	2026-06-30
12056	CPT	12056 Intermed Repair Of Wounds; Face, Ears, Eyelids, Nose, Lips, Mucous Membra;…	11	8	$1,394.00	$1,255.00	$655.00	$1,366.00	$688.00	2026-06-30
20103	CPT	20103 Clinic Exploration Of Penetrating Wound; Extremity	11	8	$1,363.00	$1,227.00	$641.00	$1,336.00	$673.00	2026-06-30
4000971	CDM	Eptifibatide 0.75 Mg/ml IV Sol[cdh]	11	8	$1,334.00	$1,201.00	$627.00	$1,307.00	$658.00	2026-06-30
93925	CPT	93925 Bil Art Graft Scan/abi Charge John	11	8	$1,310.00	$1,179.00	$616.00	$1,284.00	$646.00	2026-06-30
99285	CPT	99285 Emergency Dept Visit High Severity&threat Funcj Tech Fee	11	8	$1,298.00	$1,168.00	$610.00	$1,272.00	$641.00	2026-06-30
46040	CPT	46040 I&d Of Ischiorectal And/or Perirectal Abscess	11	8	$1,284.00	$1,156.00	$603.00	$1,258.00	$634.00	2026-06-30
27560	CPT	27560 Closed Tx Patellar Dislocation Without Anesthesia Profee	11	8	$1,277.00	$1,149.00	$600.00	$1,251.00	$630.00	2026-06-30
26742	CPT	26742 Cltx Artclr Fx Invg Mtcarphlngl/iphal Jt W/manj Profee	11	8	$1,264.00	$1,138.00	$594.00	$1,239.00	$624.00	2026-06-30
99292	CPT	99292 Trauma Critical Care Each Add 30 Mins Techfee	11	8	$1,244.00	$1,120.00	$585.00	$1,219.00	$614.00	2026-06-30
CP17825079737599615	CDM	Room/bed: Swing Bed	11	8	$1,242.00	$1,118.00	$584.00	$1,217.00	$613.00	2026-06-30
13152	CPT	13152 Repair Complex Eyelid/nose/ear/lip 2.6-7.5 Cm	11	8	$1,224.00	$1,102.00	$575.00	$1,200.00	$604.00	2026-06-30
12055	CPT	12055 Intermed Repair Of Wounds; Face, Ears, Eyelids, Nose, Lips, Mucous Membra;…	11	8	$1,220.00	$1,098.00	$573.00	$1,196.00	$602.00	2026-06-30
11646	CPT	11646 Excision, Malignant Lesion Including Margins, Face, Ears, Eyelids, Nose, L…	11	8	$1,213.00	$1,092.00	$570.00	$1,189.00	$599.00	2026-06-30
36589	CPT	36589 Op Removal Tunneled Cv Catheter	11	8	$1,208.00	$1,087.00	$568.00	$1,184.00	$596.00	2026-06-30
21930	CPT	21930 Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; Less Than 3 C…	11	8	$1,199.00	$1,079.00	$564.00	$1,175.00	$592.00	2026-06-30
93975	CPT	93975 Abdominal Organ Vascular Scan Complete Charge John	11	8	$1,196.00	$1,076.00	$562.00	$1,172.00	$590.00	2026-06-30
26670	CPT	26670 Cltx Carpo/metacarpl Dislc Thmb Manj Ea Without Anes Profee	11	8	$1,187.00	$1,068.00	$558.00	$1,163.00	$586.00	2026-06-30
26700	CPT	26700 Cltx Metacarpophalangeal Dislc W/manj Without Anes Profee	11	8	$1,184.00	$1,066.00	$556.00	$1,160.00	$584.00	2026-06-30
93307	CPT	93307 Echocardiogram Charge	11	8	$1,184.00	$1,066.00	$556.00	$1,160.00	$584.00	2026-06-30
93971	CPT	93971 Venous Duplex Limited Charge John	11	8	$1,166.00	$1,049.00	$548.00	$1,143.00	$575.00	2026-06-30
36430	CPT	Bill Only Blood Administration, 17-23 Hrs	11	8	$1,160.00	$1,044.00	$545.00	$1,137.00	$572.00	2026-06-30
49083	CPT	49083 Op Abdominal Paracentesis With Imaging Guidance	11	8	$1,157.00	$1,041.00	$544.00	$1,134.00	$571.00	2026-06-30
40650	CPT	40650 Repair Lip, Full Thickness; Vermilion Only	11	8	$1,157.00	$1,041.00	$544.00	$1,134.00	$571.00	2026-06-30
C7901	HCPCS	C7901 Psychotherapy, Group, Remote Services	22	8	$955.00	$860.00	$355.00	$1,132.00	$570.00	2026-06-30
26725	CPT	26725 Cltx Phlngl Fx Prox/middle Px/f/t W/manj Ea Profee	11	8	$1,156.00	$1,040.00	$543.00	$1,133.00	$570.00	2026-06-30
13132	CPT	13132 Repair, Complex, Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, …	11	8	$1,147.00	$1,032.00	$539.00	$1,124.00	$566.00	2026-06-30
26605	CPT	26605 Cltx Metacarpal Fx W/manipulation Each Bone Profee	11	8	$1,134.00	$1,021.00	$533.00	$1,111.00	$560.00	2026-06-30
23650	CPT	23650 Clsd Tx Shoulder Dislc W/manipulation Without Anes Profee	11	8	$1,135.00	$1,022.00	$533.00	$1,112.00	$560.00	2026-06-30
93926	CPT	93926 Lim Art Graft Scan/abi Charge John	11	8	$1,114.00	$1,003.00	$524.00	$1,092.00	$550.00	2026-06-30
93978	CPT	93978 Duplex Scan / Aorta/complete Study Charge John	11	8	$1,114.00	$1,003.00	$524.00	$1,092.00	$550.00	2026-06-30
11606	CPT	11606 Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; >4.0cm	11	8	$1,071.00	$964.00	$503.00	$1,050.00	$529.00	2026-06-30
45330	CPT	45330 Sigmoidoscopy, Flexible; Diagnostic, Including Collection Of Specimen(s) B…	11	8	$1,043.00	$939.00	$490.00	$1,022.00	$515.00	2026-06-30
P9033	HCPCS	Bill Only P9033 Platelets Leuko Reduced, Irradiated	11	8	$1,035.00	$932.00	$486.00	$1,014.00	$511.00	2026-06-30
13121	CPT	13121 Repair, Complex, Scalp, Arms, And/or Legs; 2.6 Cm To 7.5 Cm	11	8	$1,036.00	$932.00	$487.00	$1,015.00	$511.00	2026-06-30
13151	CPT	13151 Repair, Complex, Eyelids, Nose, Ears And/or Lips; 1.1 Cm To 2.5 Cm	11	8	$1,029.00	$926.00	$484.00	$1,008.00	$508.00	2026-06-30
45333	CPT	45333 Sigmoidoscopy, Flexible; With Removal Of Tumor(s), Polyp(s), Or Other Lesi…	11	8	$1,028.00	$925.00	$483.00	$1,007.00	$507.00	2026-06-30
93924	CPT	US Segmental Pressures (Abi) With Exercise	11	8	$1,024.00	$922.00	$481.00	$1,004.00	$505.00	2026-06-30
93271	CPT	93271 ECG Event Monitor Charge	11	8	$1,009.00	$908.00	$474.00	$989.00	$498.00	2026-06-30
26770	CPT	26770 Cltx Iphal Jt Dislc W/manj Without Anes Profee	11	8	$998.00	$898.00	$469.00	$978.00	$493.00	2026-06-30
P9031	HCPCS	Bill Only P9031 Platelets Leuko Reduced	11	8	$983.00	$885.00	$462.00	$963.00	$485.00	2026-06-30
11626	CPT	11626 Excision, Malignant Lesion Including Margins, Scalp, Neck, Hands, Feet, Ge…	11	8	$975.00	$878.00	$458.00	$956.00	$481.00	2026-06-30
13101	CPT	13101 Repair, Complex, Trunk; 2.6 Cm To 7.5 Cm	11	8	$967.00	$870.00	$454.00	$948.00	$477.00	2026-06-30
76700	CPT	Ultrasound Of Abdomen	11	8	$944.00	$850.00	$444.00	$925.00	$466.00	2026-06-30
13131	CPT	13131 Repair, Complex, Forehead, Cheeks, Chin, Mouth, Neck, Axillae, Genitalia, …	11	8	$944.00	$850.00	$444.00	$925.00	$466.00	2026-06-30
93308	CPT	US Echo 2d Limited	11	8	$941.00	$847.00	$442.00	$922.00	$464.00	2026-06-30
11644	CPT	11644 Excision, Malignant Lesion Including Margins, Face, Ears, Eyelids, Nose, L…	11	8	$937.00	$843.00	$440.00	$918.00	$462.00	2026-06-30
12035	CPT	12035 Repair, Intermediate; Wounds Of Scalp, Axillae, Trunk, Extremities; 12.6-2…	11	8	$934.00	$841.00	$439.00	$915.00	$461.00	2026-06-30
77076	CPT	Xr Osseous Survey Infant	11	8	$931.00	$838.00	$438.00	$912.00	$459.00	2026-06-30
77075	CPT	Xr Bone Survey Complete	11	8	$931.00	$838.00	$438.00	$912.00	$459.00	2026-06-30
12044	CPT	12044 Repair, Intermediate, Wounds Of Neck, Hands, Feet And/or External Genitali…	11	8	$924.00	$832.00	$434.00	$906.00	$456.00	2026-06-30
93923	CPT	US Segmental Pressures Le 3+ Lvls Bilat	11	8	$908.00	$817.00	$427.00	$890.00	$448.00	2026-06-30
4000165	CDM	Puraply Am 1.6 Cm Disc [Cdh]	11	8	$900.00	$810.00	$423.00	$882.00	$444.00	2026-06-30
76641	CPT	US Breast Complete Bilat	22	8	$743.50	$669.00	$276.00	$882.00	$444.00	2026-06-30
12053	CPT	12053 Intermed Repair Of Wounds; Face, Ears, Eyelids, Nose, Lips, Mucous Membra;…	11	8	$884.00	$796.00	$415.00	$866.00	$436.00	2026-06-30
76856	CPT	US Pelvic Complete	11	8	$880.00	$792.00	$414.00	$862.00	$434.00	2026-06-30
20670	CPT	20670 Removal Of Implant; Superficial (Buried Wire, Pin Or Rod)	11	8	$880.00	$792.00	$414.00	$862.00	$434.00	2026-06-30
4000313	CDM	Amphotericin B Liposomal 50 Mg Pow	11	8	$877.00	$789.00	$412.00	$859.00	$433.00	2026-06-30
11010	CPT	11010 Debride Incl Remvl Foreign Matl At Site Of Open Fx/open Disloc; Skn/subq T…	11	8	$872.00	$785.00	$410.00	$855.00	$430.00	2026-06-30
4900352	CDM	Human Papillomavirus Vaccine 9-valent Intramuscular Suspension 0.5 Ml	11	8	$871.00	$784.00	$409.00	$854.00	$430.00	2026-06-30
86922	CPT	Ahg Crossmatch X4	11	8	$869.00	$782.00	$408.00	$852.00	$429.00	2026-06-30
76770	CPT	US Aorta	11	8	$869.00	$782.00	$408.00	$852.00	$429.00	2026-06-30
46606	CPT	46606 Anoscopy With Biopsy; Single Or Multiple	11	8	$866.00	$779.00	$407.00	$849.00	$427.00	2026-06-30
13120	CPT	13120 Repair, Complex, Scalp, Arms, And/or Legs; 1.1 Cm To 2.5 Cm	11	8	$864.00	$778.00	$406.00	$847.00	$426.00	2026-06-30
23930	CPT	23930 Incision And Drainage, Upper Arm Or Elbow Area; Deep Abscess Or Hematoma	11	8	$863.00	$777.00	$406.00	$846.00	$426.00	2026-06-30
3300122	CDM	Regadenoson 0.4 Mg/5 Ml Intravenous Solution 5 Ml	11	8	$862.00	$776.00	$405.00	$845.00	$425.00	2026-06-30
27345	CPT	27345 Excision Of Synovial Cyst Of Popliteal Space (Eg, Baker's Cyst) Techfee	11	8	$855.00	$770.00	$402.00	$838.00	$422.00	2026-06-30
45300	CPT	45300â Proctosigmoidoscopy, Rigid; Diagnostic, With Or Without Collection Of Spe…	11	8	$853.00	$768.00	$401.00	$836.00	$421.00	2026-06-30
30905	CPT	30905 Control Nasal Hemorrhage, Posterior W/posterior Nasal Packs And/or Cautery…	11	8	$853.00	$768.00	$401.00	$836.00	$421.00	2026-06-30
93882	CPT	93882 Carotid Duplex Limit Charge John	11	8	$849.00	$764.00	$399.00	$832.00	$419.00	2026-06-30
90847	CPT	Family Psychotherapy, Including Patient, 50 Min	11	8	$845.00	$761.00	$397.00	$828.00	$417.00	2026-06-30
74400	CPT	Xr Ivp	11	8	$845.00	$761.00	$397.00	$828.00	$417.00	2026-06-30
99284	CPT	99284 Trauma Evaluation Techfee	11	8	$833.00	$750.00	$392.00	$816.00	$411.00	2026-06-30
13100	CPT	13100 Repair, Complex, Trunk; 1.1 Cm To 2.5 Cm	11	8	$829.00	$746.00	$390.00	$812.00	$409.00	2026-06-30
15271	CPT	15271 Op App Skin Sub With Puraply Mz	11	8	$825.00	$743.00	$388.00	$809.00	$407.00	2026-06-30
11624	CPT	11624 Excision, Malignant Lesion Including Margins, Scalp, Neck, Hands, Feet, Ge…	11	8	$814.00	$733.00	$383.00	$798.00	$402.00	2026-06-30
12034	CPT	12034 Repair, Intermediate; Wounds Of Scalp, Axillae, Trunk, Extremities; 7.6-12…	11	8	$810.00	$729.00	$381.00	$794.00	$400.00	2026-06-30
90846	CPT	Family Psychotherapy, Not Including Patient, 50 Min	11	8	$805.00	$725.00	$378.00	$789.00	$397.00	2026-06-30
11426	CPT	11426 Excision, Benign Lesion Including Margins; Scalp, Neck, Hands, Feet, Genit…	11	8	$792.00	$713.00	$372.00	$776.00	$391.00	2026-06-30
93979	CPT	93979 Dup-scan Arta Ivc Ilic Vasc/bpgs Uni/lmt Charge John	11	8	$790.00	$711.00	$371.00	$774.00	$390.00	2026-06-30
4000364	CDM	Hylan G-f 20 48 Mg/6 Ml Sol	11	8	$788.00	$709.00	$370.00	$772.00	$389.00	2026-06-30
25111	CPT	25111 Excision Of Ganglion, Wrist (Dorsal Or Volar); Primary	11	8	$787.00	$708.00	$370.00	$771.00	$388.00	2026-06-30
90677	CPT	90677 Prevnar 20 Pneumococcal 20 Valent	11	8	$776.00	$698.00	$365.00	$760.00	$383.00	2026-06-30
90837	CPT	Psychotherapy, 60 Min	11	8	$770.00	$693.00	$362.00	$755.00	$380.00	2026-06-30
12052	CPT	12052 Intermed Repair Of Wounds; Face, Ears, Eyelids, Nose, Lips, Mucous Membra;…	11	8	$768.00	$691.00	$361.00	$753.00	$379.00	2026-06-30
4000866	CDM	Glucagon Recombinant 1 Mg Inj [Cdh]	11	8	$766.00	$689.00	$360.00	$751.00	$378.00	2026-06-30
11643	CPT	11643 Excision, Malignant Lesion Including Margins, Face, Ears, Eyelids, Nose, L…	11	8	$762.00	$686.00	$358.00	$747.00	$376.00	2026-06-30
11406	CPT	11406 Excision, Benign Lesion Including Margins, Except Skin Tag (Unless Listed …	11	8	$760.00	$684.00	$357.00	$745.00	$375.00	2026-06-30
94060	CPT	94060 Pft Complete Charge	11	8	$760.00	$684.00	$357.00	$745.00	$375.00	2026-06-30
4000902	CDM	Heparin 100 Units/ml-nacl 0.45% Sol	11	8	$757.00	$681.00	$356.00	$742.00	$374.00	2026-06-30
93930	CPT	93930 Arterial Duplex Bil Upper Charge John	11	8	$758.00	$682.00	$356.00	$743.00	$374.00	2026-06-30
41252	CPT	41252 Tongue Laceration Ed Tech Fee	11	8	$757.00	$681.00	$356.00	$742.00	$374.00	2026-06-30
90834	CPT	Psychotherapy, 45 Min	11	8	$755.00	$680.00	$355.00	$740.00	$373.00	2026-06-30
76830	CPT	Ultrasound Pelvis Through Vagina	11	8	$755.00	$680.00	$355.00	$740.00	$373.00	2026-06-30
76705	CPT	US Abdomen Limited	11	8	$753.00	$678.00	$354.00	$738.00	$372.00	2026-06-30
46230	CPT	46230 Excision Of Multiple External Papillae Or Tags, Anus	11	8	$754.00	$679.00	$354.00	$739.00	$372.00	2026-06-30
12042	CPT	12042 Repair, Intermediate, Wounds Of Neck, Hands, Feet And/or External Genitali…	11	8	$754.00	$679.00	$354.00	$739.00	$372.00	2026-06-30
M0243	HCPCS	M0243 Intravenous Infusion Or Subq Injection Casirivimab And Imdevimab	11	8	$754.00	$679.00	$354.00	$739.00	$372.00	2026-06-30
M0247	HCPCS	M0247 Intravenous Infusion Sotrovimab, Infusion And Post Admin Monitoring	11	8	$754.00	$679.00	$354.00	$739.00	$372.00	2026-06-30
M0245	HCPCS	M0245 Intravenous Infusion Bamlanivimab/etesevimab-includes Infusion And Post Ad…	11	8	$754.00	$679.00	$354.00	$739.00	$372.00	2026-06-30
11604	CPT	11604 Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; 3.1-4.…	11	8	$752.00	$677.00	$353.00	$737.00	$371.00	2026-06-30
77074	CPT	Xr Bone Survery (Metastatic)	11	8	$749.00	$674.00	$352.00	$734.00	$370.00	2026-06-30
4000601	CDM	Darbepoetin Alfa 40 Mcg/ml Inj Sol[cdh]	11	8	$743.00	$669.00	$349.00	$728.00	$367.00	2026-06-30
62270	CPT	62270 Lumbar Puncture	11	8	$741.00	$667.00	$348.00	$726.00	$366.00	2026-06-30
12032	CPT	12032 Repair, Intermediate; Wounds Of Scalp, Axillae, Trunk, Extremities; 2.6-7.…	11	8	$739.00	$665.00	$347.00	$724.00	$365.00	2026-06-30
90853	CPT	Group Psychotherapy	11	8	$735.00	$662.00	$345.00	$720.00	$363.00	2026-06-30
C7903	HCPCS	Psychothrpy Group	11	8	$735.00	$662.00	$345.00	$720.00	$363.00	2026-06-30
G0410	HCPCS	Iop Psychothrpy Group; 45-50 Min	11	8	$735.00	$662.00	$345.00	$720.00	$363.00	2026-06-30
23931	CPT	23931 Incision And Drainage, Upper Arm Or Elbow Area; Bursa	11	8	$734.00	$661.00	$345.00	$719.00	$362.00	2026-06-30
76870	CPT	US Scrotum (Contents)	11	8	$731.00	$658.00	$344.00	$716.00	$361.00	2026-06-30
93226	CPT	Holter Scanning Analysis With Report 12-48 Hrsekg Chargesekg	11	8	$723.00	$651.00	$340.00	$709.00	$357.00	2026-06-30
11623	CPT	11623 Excision, Malignant Lesion Including Margins, Scalp, Neck, Hands, Feet, Ge…	11	8	$717.00	$645.00	$337.00	$703.00	$354.00	2026-06-30
45398	CPT	45398 Colonoscopy, Flexible; With Band Ligation(s)	11	8	$716.00	$644.00	$337.00	$702.00	$353.00	2026-06-30
87507	CPT	Gi Pathogen Panel, Pcr Pspc	11	8	$713.00	$642.00	$335.00	$699.00	$352.00	2026-06-30
74220	CPT	Xr Esophagus	11	8	$706.00	$635.00	$332.00	$692.00	$348.00	2026-06-30
46221	CPT	46221 Hemorrhoidectomy, Internal, By Rubber Band Ligation	11	8	$704.00	$634.00	$331.00	$690.00	$347.00	2026-06-30
46945	CPT	46945 Hemorrhoidectomy, Internal, By Ligation Other Than Rubber Band; Single Hem…	11	8	$698.00	$628.00	$328.00	$684.00	$344.00	2026-06-30
72083	CPT	Xr Spine Scoliosis 4-5 Views	11	8	$694.00	$625.00	$326.00	$680.00	$342.00	2026-06-30
12051	CPT	12051 Intermed Repair Of Wounds; Face, Ears, Eyelids, Nose, Lips, Mucous Membra;…	11	8	$689.00	$620.00	$324.00	$675.00	$340.00	2026-06-30
76536	CPT	US Thyroid	11	8	$685.00	$617.00	$322.00	$671.00	$338.00	2026-06-30
11603	CPT	11603 Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; 2.1-3.…	11	8	$676.00	$608.00	$318.00	$662.00	$334.00	2026-06-30
CP17825079737443300	CDM	43762 Replacement Of Gastrostomy Tube	11	8	$670.00	$603.00	$315.00	$657.00	$331.00	2026-06-30
10121	CPT	10121 I & Removal Foreign Body Subq Tissu Complicated	11	8	$671.00	$604.00	$315.00	$658.00	$331.00	2026-06-30
4001700	CDM	Tetanus Immune Globulin 250 Units/ml[cdh]	11	8	$668.00	$601.00	$314.00	$655.00	$330.00	2026-06-30
92950	CPT	92950 Pf/tech Cpr	11	8	$664.00	$598.00	$312.00	$651.00	$328.00	2026-06-30
76706	CPT	US Aaa Screening	11	8	$665.00	$599.00	$313.00	$652.00	$328.00	2026-06-30
72052	CPT	Xr Spine Cervical 6+ Views	11	8	$663.00	$597.00	$312.00	$650.00	$327.00	2026-06-30
76775	CPT	US Retroperitoneal Limited	11	8	$656.00	$590.00	$308.00	$643.00	$324.00	2026-06-30
72114	CPT	Xr Spine Lumbosacral With Bending 6+ Views	11	8	$656.00	$590.00	$308.00	$643.00	$324.00	2026-06-30
4000223	CDM	Acetylcysteine 20% IV Sol 30 Ml[cdh]	11	8	$653.00	$588.00	$307.00	$640.00	$322.00	2026-06-30
G0176	HCPCS	Iop Psychothrpy; Activity; 45 Min	11	8	$650.00	$585.00	$306.00	$637.00	$321.00	2026-06-30
G0177	HCPCS	Iop Psychothrpy; Train/educate 45	11	8	$650.00	$585.00	$306.00	$637.00	$321.00	2026-06-30
11642	CPT	11642 Excision, Malignant Lesion Including Margins, Face, Ears, Eyelids, Nose, L…	11	8	$650.00	$585.00	$306.00	$637.00	$321.00	2026-06-30
93931	CPT	US Upper Ext Arterial Duplex Left	11	8	$649.00	$584.00	$305.00	$636.00	$320.00	2026-06-30
90675	CPT	Medication Charge	11	8	$648.00	$583.00	$305.00	$635.00	$320.00	2026-06-30
12041	CPT	12041 Repair, Intermediate, Wounds Of Neck, Hands, Feet And/or External Genitali…	11	8	$642.00	$578.00	$302.00	$629.00	$317.00	2026-06-30
12031	CPT	12031 Repair, Intermediate; Wounds Of Scalp, Axillae, Trunk, Extremities; <2.5cm	11	8	$640.00	$576.00	$301.00	$627.00	$316.00	2026-06-30
4000251	CDM	Zoledronic Acid 4 Mg/100 Ml Soln [Cdh]	11	8	$626.00	$563.00	$294.00	$613.00	$309.00	2026-06-30
71110	CPT	Xr Ribs 3 Views Bilateral	11	8	$625.00	$563.00	$294.00	$613.00	$308.00	2026-06-30
CP17825079737567571	CDM	Type And Cross Immediate Spin X2 Cdh	11	8	$624.00	$562.00	$293.00	$612.00	$308.00	2026-06-30
73522	CPT	Xr Hips 3-4 Views W/ap Pelvis Bilat	11	8	$621.00	$559.00	$292.00	$609.00	$306.00	2026-06-30
CP17825079737140879	CDM	Immediate Spin Crossmatch X4	11	8	$620.00	$558.00	$291.00	$608.00	$306.00	2026-06-30
4001876	CDM	Budesonide-formoterol 160 Mcg-4.5 Mcg/inh Inh Aer W/adapter[cdh]	11	8	$618.00	$556.00	$290.00	$606.00	$305.00	2026-06-30
87798	CPT	Measles Virus, Molecular Detection, Pcr, Random Urine (Mayo	11	8	$615.00	$554.00	$289.00	$603.00	$304.00	2026-06-30
11622	CPT	11622 Excision, Malignant Lesion Including Margins, Scalp, Neck, Hands, Feet, Ge…	11	8	$614.00	$553.00	$289.00	$602.00	$303.00	2026-06-30
93922	CPT	93922 Ankle Arm Index Charge John	11	8	$614.00	$553.00	$289.00	$602.00	$303.00	2026-06-30
28190	CPT	28190 Removal Of Foreign Body, Foot; Subcutaneous	11	8	$613.00	$552.00	$288.00	$601.00	$303.00	2026-06-30
C7900	HCPCS	C7900 Psychotherapy, Individual, Remote Services	22	8	$502.50	$452.50	$186.00	$598.00	$301.00	2026-06-30
10080	CPT	10080 Clinic Incision & Drainage Of Polonidal Cyst	11	8	$610.00	$549.00	$287.00	$598.00	$301.00	2026-06-30
90832	CPT	Psychotherapy, 30 Min	11	8	$610.00	$549.00	$287.00	$598.00	$301.00	2026-06-30
26070	CPT	26070 Arthrotomy W/explor, Drain/rem Of Loose Or Fb Carpometacarpal Jnt	11	8	$608.00	$547.00	$286.00	$596.00	$300.00	2026-06-30

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