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

VALLEY COUNTY HEALTH SYSTEM

Ord, NE · CCN 281353 · Rates published

Your selected procedure

You selected 93306 (CPT)

ECHO COMPLETE (2D M-MODE

This hospital’s price: $1,231 across 11 payers · range $469-$2,298

Source: https://sthpiprd.blob.core.windows.net/machine-readable-files/10190/470485275_valley-county-hospital_standardcharges.csv · observed 2026-06-15

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.

1,781 distinct procedures filed
11 distinct payers
234,258 rate rows
2026-06-15 last MRF observed
Data quality

77,199 of 234,258 rate rows are consumer-grade (33.0%)

157,059 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
professional (physician) fee — not the facility price 156,787
percent-of-charges filed in the dollar field — excluded from medians 159
per-diem day rate — not a per-procedure price 59
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 32
exceeds 10× this hospital's gross charge — excluded from medians 21
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/10190/470485275_valley-county-hospital_standardcharges.csv
Found on page https://search.hospitalpriceindex.com/hpi2/machineReadable/ValleyCountyHealthSystem/10190
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-08-01
Content fingerprint eaf76e5c13413051… · 59,019,900 bytes · first seen 2026-07-31

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
C1820
HCPCS 		Wavewriter Alpha Prime Ki 11 $9,753.00 $53,376.68 $37,166.22 nat. median
$22,986
1.6× median
J3357
HCPCS 		Ustekinumab 45mg/0.5ml Subq 11 $3,961.00 $19,408.90 $18,715.72 nat. median
$14,744
1.3× median
C1767
HCPCS 		Interstim-neurostimulator 11 $3,849.00 $18,860.10 $18,186.53 nat. median
$23,896
0.8× median
C1772
HCPCS 		Pump Implant Medtronic 86 11 $3,688.60 $18,074.14 $17,428.63 nat. median
$10,870
1.6× median
J3380
HCPCS 		Vedolizumab 300 Mg / 20 Ml Sdv (entyvio) 11 $3,642.00 $17,845.80 $17,208.45 nat. median
$162
outlier · 106.2×
C1897
HCPCS 		Coveredge 32 Surgical Lea 11 $3,246.40 $15,907.36 $15,339.24 nat. median
$1,177
outlier · 13.0×
J3101
HCPCS 		Tenecteplase 50 Mg Inj 11 $2,987.20 $14,637.28 $14,114.52 nat. median
$3,820
outlier · 3.7×
J9217
HCPCS 		Leuprolide 22.5 Mg (3 Mo) Depot Syr Kit 11 $2,434.00 $11,926.60 $11,500.65 nat. median
$1,575
outlier · 7.3×
J1096
HCPCS 		Dextenza 0.4 Mg Ophthalmic Insert 11 $2,304.00 $11,289.60 $10,886.40 nat. median
$169
outlier · 64.5×
J0517
HCPCS 		Benralizumab 30 Mg Subq Inj Pfs 11 $2,168.20 $10,624.18 $10,244.75 nat. median
$919
outlier · 11.2×
J0491
HCPCS 		Saphnelo 300 Mg / 2 Ml Sdv 11 $1,988.20 $9,742.18 $9,394.25 nat. median
$65
outlier · 145.3×
78816
CPT 		PET Image W/ct Full Body 11 $1,895.20 $9,286.48 $8,954.82 nat. median
$2,788
outlier · 3.2×
J1449
HCPCS 		Rolvedon 13.2 Mg Subq Syrg 11 $1,620.00 $7,938.00 $7,654.50 nat. median
$30
outlier · 252.9×
J2506
HCPCS 		Neulasta Onpro 6 Mg Kit 11 $1,611.60 $7,896.84 $7,614.81 nat. median
$1,646
outlier · 4.6×
J2997
HCPCS 		Alteplase (stroke) 100 Mg Inj Vial 11 $77.80 $15,524.18 $7,603.68 nat. median
$500
outlier · 15.2×
Q5111
HCPCS 		Udenyca 6 Mg / 0.6 Ml Syrg 11 $1,503.00 $7,364.70 $7,101.68 nat. median
$1,982
outlier · 3.6×
78815
CPT 		PET Image W/ct Skull-thigh 11 $1,453.20 $7,120.68 $6,866.37 nat. median
$2,820
outlier · 2.4×
J1568
HCPCS 		Octagam 20 Gm / 200 Ml Vial 11 $1,398.60 $6,853.14 $6,608.39 nat. median
$710
outlier · 9.3×
J1306
HCPCS 		Leqvio 284 Mg / 1.5 Ml Subq Syrg 11 $1,291.60 $6,328.84 $6,102.81 nat. median
$44
outlier · 138.2×
Q5119
HCPCS 		Ruxience 500 Mg / 50 Ml Sdv 11 $1,290.40 $6,322.96 $6,097.14 nat. median
$826
outlier · 7.4×
C1763
HCPCS 		Matriderm Acellular Derma 11 $1,270.00 $6,223.00 $6,000.75 nat. median
$2,299
outlier · 2.6×
74178
CPT 		CT Abd&plv Wo Cntr Flwd Cntr 11 $1,158.20 $5,675.18 $5,472.49 nat. median
$1,024
outlier · 5.3×
J0840
HCPCS 		Crotalidae Polyval Immune Fab Inj 11 $1,151.40 $5,641.86 $5,440.36 nat. median
$3,445
1.6× median
74177
CPT 		CT Abd & Pelvis W/contrast 11 $1,089.60 $5,339.04 $5,148.36 nat. median
$974
outlier · 5.3×
C1783
HCPCS 		Vantage Istent Msc0957 11 $1,079.80 $5,291.02 $5,102.06 nat. median
$2,321
outlier · 2.2×
J3315
HCPCS 		Triptorelin Pamoate 11.25 Mg Inj Vial 11 $1,036.20 $10,154.76 $4,896.05 nat. median
$933
outlier · 5.2×
78452
CPT 		Ht Muscle Image Spect Mult 11 $1,019.20 $4,994.08 $4,815.72 nat. median
$1,816
outlier · 2.7×
74176
CPT 		CT Abd & Pelvis Without Contrast 11 $1,004.80 $4,923.52 $4,747.68 nat. median
$694
outlier · 6.8×
95811
CPT 		Polysom 6/>yrs Cpap 4/> Parm 11 $986.20 $4,832.38 $4,659.80 nat. median
$1,894
outlier · 2.5×
74183
CPT 		MRI Abd Without Cntr Flwd Cntr 11 $974.00 $4,772.60 $4,602.15 nat. median
$1,100
outlier · 4.2×
J3111
HCPCS 		Romosozumab-aqqg 210mg Dose 2 Syr 11 $946.60 $4,638.34 $4,472.69 nat. median
$681
outlier · 6.6×
70553
CPT 		MRI Brain Stem Without & With Contrast 11 $929.40 $4,554.06 $4,391.41 nat. median
$1,133
outlier · 3.9×
70543
CPT 		MRI Orbt/fac/nck Without &with Contrast 11 $929.40 $4,554.06 $4,391.41 nat. median
$1,083
outlier · 4.1×
71552
CPT 		MRI Chest Without & With Contrast 11 $902.40 $4,421.76 $4,263.84 nat. median
$1,097
outlier · 3.9×
C1776
HCPCS 		Tibia Insert 11 $508.40 $73,725.40 $4,243.98 nat. median
$3,394
1.3× median
72156
CPT 		MRI Neck Spine Without & With Contrast 11 $884.60 $4,334.54 $4,179.73 nat. median
$1,103
outlier · 3.8×
74181
CPT 		MRI Abdomen Without Contrast 11 $884.60 $4,334.54 $4,179.73 nat. median
$820
outlier · 5.1×
72158
CPT 		MRI Lumbar Spine Without & With Contrast 11 $884.60 $4,334.54 $4,179.73 nat. median
$1,093
outlier · 3.8×
70549
CPT 		Mr Angiograph Neck W/O&with Contrast 11 $884.60 $4,334.54 $4,179.73 nat. median
$1,055
outlier · 4.0×
72157
CPT 		MRI Chest Spine Without & With Contrast 11 $884.60 $4,334.54 $4,179.73 nat. median
$1,105
outlier · 3.8×
95810
CPT 		Polysom 6/> Yrs 4/> Param 11 $858.00 $4,204.20 $4,054.05 nat. median
$1,825
outlier · 2.2×
72197
CPT 		MRI Pelvis Without & With Contrast 11 $851.00 $4,169.90 $4,020.97 nat. median
$1,063
outlier · 3.8×
70552
CPT 		MRI Brain Stem With Contrast 11 $851.00 $4,169.90 $4,020.97 nat. median
$962
outlier · 4.2×
74185
CPT 		MRA Abd W Or Without Cntrst 11 $851.00 $4,169.90 $4,020.97 nat. median
$1,241
outlier · 3.2×
71551
CPT 		MRI Chest With Contrast 11 $851.00 $4,169.90 $4,020.97 nat. median
$1,158
outlier · 3.5×
74174
CPT 		CTA Abd&plvs W/contrast 11 $839.60 $4,114.04 $3,967.11 nat. median
$988
outlier · 4.0×
70551
CPT 		MRI Brain Stem Without Contrast 11 $839.60 $4,114.04 $3,967.11 nat. median
$784
outlier · 5.1×
70544
CPT 		Mr Angiography Head Without Contrast 11 $839.60 $4,114.04 $3,967.11 nat. median
$826
outlier · 4.8×
Q4177
HCPCS 		Floweramnioflo Per .1cc 11 $835.20 $4,092.48 $3,946.32 nat. median
$346
outlier · 11.4×
Q4159
HCPCS 		Affinity Amniotic Membran 11 $826.40 $4,049.36 $3,904.74 nat. median
$642
outlier · 6.1×

Other procedures at this hospital

Browse this hospital's 1,781 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
             
C1820 HCPCS Wavewriter Alpha Prime Ki 44 11 $54,466.00 $49,019.40 $9,753.00 $53,376.68 $37,166.22 2026-06-15
J3357 HCPCS Ustekinumab 45mg/0.5ml Subq 28 11 $19,805.00 $17,824.50 $3,961.00 $19,408.90 $18,715.72 2026-06-15
C1767 HCPCS Interstim-neurostimulator 28 11 $19,245.00 $17,320.50 $3,849.00 $18,860.10 $18,186.53 2026-06-15
C1772 HCPCS Pump Implant Medtronic 86 28 11 $18,443.00 $16,598.70 $3,688.60 $18,074.14 $17,428.63 2026-06-15
J3380 HCPCS Vedolizumab 300 Mg / 20 Ml Sdv (entyvio) 28 11 $18,210.00 $16,389.00 $3,642.00 $17,845.80 $17,208.45 2026-06-15
C1897 HCPCS Coveredge 32 Surgical Lea 28 11 $16,232.00 $14,608.80 $3,246.40 $15,907.36 $15,339.24 2026-06-15
J3101 HCPCS Tenecteplase 50 Mg Inj 28 11 $14,936.00 $13,442.40 $2,987.20 $14,637.28 $14,114.52 2026-06-15
J9217 HCPCS Leuprolide 22.5 Mg (3 Mo) Depot Syr Kit 28 11 $12,170.00 $10,953.00 $2,434.00 $11,926.60 $11,500.65 2026-06-15
J1096 HCPCS Dextenza 0.4 Mg Ophthalmic Insert 28 11 $11,520.00 $10,368.00 $2,304.00 $11,289.60 $10,886.40 2026-06-15
J0517 HCPCS Benralizumab 30 Mg Subq Inj Pfs 28 11 $10,841.00 $9,756.90 $2,168.20 $10,624.18 $10,244.75 2026-06-15
J0491 HCPCS Saphnelo 300 Mg / 2 Ml Sdv 28 11 $9,941.00 $8,946.90 $1,988.20 $9,742.18 $9,394.25 2026-06-15
78816 CPT PET Image W/ct Full Body 28 11 $9,476.00 $8,528.40 $1,895.20 $9,286.48 $8,954.82 2026-06-15
J1449 HCPCS Rolvedon 13.2 Mg Subq Syrg 28 11 $8,100.00 $7,290.00 $1,620.00 $7,938.00 $7,654.50 2026-06-15
J2506 HCPCS Neulasta Onpro 6 Mg Kit 28 11 $8,058.00 $7,252.20 $1,611.60 $7,896.84 $7,614.81 2026-06-15
J2997 HCPCS Alteplase (stroke) 100 Mg Inj Vial 44 11 $15,841.00 $14,256.90 $77.80 $15,524.18 $7,603.68 2026-06-15
Q5111 HCPCS Udenyca 6 Mg / 0.6 Ml Syrg 28 11 $7,515.00 $6,763.50 $1,503.00 $7,364.70 $7,101.68 2026-06-15
78815 CPT PET Image W/ct Skull-thigh 28 11 $7,266.00 $6,539.40 $1,453.20 $7,120.68 $6,866.37 2026-06-15
J1568 HCPCS Octagam 20 Gm / 200 Ml Vial 28 11 $6,993.00 $6,293.70 $1,398.60 $6,853.14 $6,608.39 2026-06-15
J1306 HCPCS Leqvio 284 Mg / 1.5 Ml Subq Syrg 28 11 $6,458.00 $5,812.20 $1,291.60 $6,328.84 $6,102.81 2026-06-15
Q5119 HCPCS Ruxience 500 Mg / 50 Ml Sdv 29 11 $6,452.00 $5,806.80 $1,290.40 $6,322.96 $6,097.14 2026-06-15
C1763 HCPCS Matriderm Acellular Derma 28 11 $6,350.00 $5,715.00 $1,270.00 $6,223.00 $6,000.75 2026-06-15
74178 CPT CT Abd&plv Wo Cntr Flwd Cntr 29 11 $5,791.00 $5,211.90 $1,158.20 $5,675.18 $5,472.49 2026-06-15
J0840 HCPCS Crotalidae Polyval Immune Fab Inj 28 11 $5,757.00 $5,181.30 $1,151.40 $5,641.86 $5,440.36 2026-06-15
74177 CPT CT Abd & Pelvis W/contrast 29 11 $5,448.00 $4,903.20 $1,089.60 $5,339.04 $5,148.36 2026-06-15
C1783 HCPCS Vantage Istent Msc0957 28 11 $5,399.00 $4,859.10 $1,079.80 $5,291.02 $5,102.06 2026-06-15
J3315 HCPCS Triptorelin Pamoate 11.25 Mg Inj Vial 44 11 $5,181.00 $4,662.90 $1,036.20 $10,154.76 $4,896.05 2026-06-15
78452 CPT Ht Muscle Image Spect Mult 29 11 $5,096.00 $4,586.40 $1,019.20 $4,994.08 $4,815.72 2026-06-15
74176 CPT CT Abd & Pelvis Without Contrast 29 11 $5,024.00 $4,521.60 $1,004.80 $4,923.52 $4,747.68 2026-06-15
95811 CPT Polysom 6/>yrs Cpap 4/> Parm 28 11 $4,931.00 $4,437.90 $986.20 $4,832.38 $4,659.80 2026-06-15
74183 CPT MRI Abd Without Cntr Flwd Cntr 29 11 $4,870.00 $4,383.00 $974.00 $4,772.60 $4,602.15 2026-06-15
J3111 HCPCS Romosozumab-aqqg 210mg Dose 2 Syr 28 11 $4,733.00 $4,259.70 $946.60 $4,638.34 $4,472.69 2026-06-15
70553 CPT MRI Brain Stem Without & With Contrast 29 11 $4,647.00 $4,182.30 $929.40 $4,554.06 $4,391.41 2026-06-15
70543 CPT MRI Orbt/fac/nck Without &with Contrast 29 11 $4,647.00 $4,182.30 $929.40 $4,554.06 $4,391.41 2026-06-15
71552 CPT MRI Chest Without & With Contrast 28 11 $4,512.00 $4,060.80 $902.40 $4,421.76 $4,263.84 2026-06-15
C1776 HCPCS Tibia Insert 108 11 $6,641.00 $5,976.90 $508.40 $73,725.40 $4,243.98 2026-06-15
70549 CPT Mr Angiograph Neck W/O&with Contrast 28 11 $4,423.00 $3,980.70 $884.60 $4,334.54 $4,179.73 2026-06-15
72156 CPT MRI Neck Spine Without & With Contrast 29 11 $4,423.00 $3,980.70 $884.60 $4,334.54 $4,179.73 2026-06-15
72157 CPT MRI Chest Spine Without & With Contrast 28 11 $4,423.00 $3,980.70 $884.60 $4,334.54 $4,179.73 2026-06-15
72158 CPT MRI Lumbar Spine Without & With Contrast 29 11 $4,423.00 $3,980.70 $884.60 $4,334.54 $4,179.73 2026-06-15
74181 CPT MRI Abdomen Without Contrast 28 11 $4,423.00 $3,980.70 $884.60 $4,334.54 $4,179.73 2026-06-15
95810 CPT Polysom 6/> Yrs 4/> Param 28 11 $4,290.00 $3,861.00 $858.00 $4,204.20 $4,054.05 2026-06-15
74185 CPT MRA Abd W Or Without Cntrst 28 11 $4,255.00 $3,829.50 $851.00 $4,169.90 $4,020.97 2026-06-15
71551 CPT MRI Chest With Contrast 28 11 $4,255.00 $3,829.50 $851.00 $4,169.90 $4,020.97 2026-06-15
70552 CPT MRI Brain Stem With Contrast 28 11 $4,255.00 $3,829.50 $851.00 $4,169.90 $4,020.97 2026-06-15
72197 CPT MRI Pelvis Without & With Contrast 28 11 $4,255.00 $3,829.50 $851.00 $4,169.90 $4,020.97 2026-06-15
70551 CPT MRI Brain Stem Without Contrast 29 11 $4,198.00 $3,778.20 $839.60 $4,114.04 $3,967.11 2026-06-15
70544 CPT Mr Angiography Head Without Contrast 28 11 $4,198.00 $3,778.20 $839.60 $4,114.04 $3,967.11 2026-06-15
74174 CPT CTA Abd&plvs W/contrast 28 11 $4,198.00 $3,778.20 $839.60 $4,114.04 $3,967.11 2026-06-15
Q4177 HCPCS Floweramnioflo Per .1cc 28 11 $4,176.00 $3,758.40 $835.20 $4,092.48 $3,946.32 2026-06-15
Q4159 HCPCS Affinity Amniotic Membran 28 11 $4,132.00 $3,718.80 $826.40 $4,049.36 $3,904.74 2026-06-15
74182 CPT MRI Abdomen W/contrast 28 11 $4,088.00 $3,679.20 $817.60 $4,006.24 $3,863.16 2026-06-15
73722 CPT MRI Joint Of Lwr Extr With Contrast 28 11 $4,072.00 $3,664.80 $814.40 $3,990.56 $3,848.04 2026-06-15
72147 CPT MRI Chest Spine With Contrast 28 11 $4,002.00 $3,601.80 $800.40 $3,921.96 $3,781.89 2026-06-15
71550 CPT MRI Chest Without Contrast 28 11 $4,002.00 $3,601.80 $800.40 $3,921.96 $3,781.89 2026-06-15
72149 CPT MRI Lumbar Spine With Contrast 28 11 $4,002.00 $3,601.80 $800.40 $3,921.96 $3,781.89 2026-06-15
72142 CPT MRI Neck Spine With Contrast 28 11 $4,002.00 $3,601.80 $800.40 $3,921.96 $3,781.89 2026-06-15
72196 CPT MRI Pelvis With Contrast 28 11 $4,002.00 $3,601.80 $800.40 $3,921.96 $3,781.89 2026-06-15
72148 CPT MRI Lumbar Spine Without Contrast 29 11 $3,971.00 $3,573.90 $794.20 $3,891.58 $3,752.59 2026-06-15
72146 CPT MRI Chest Spine Without Contrast 28 11 $3,971.00 $3,573.90 $794.20 $3,891.58 $3,752.59 2026-06-15
72141 CPT MRI Neck Spine Without Contrast 29 11 $3,971.00 $3,573.90 $794.20 $3,891.58 $3,752.59 2026-06-15
71275 CPT CT Angiography Chest 29 11 $3,835.00 $3,451.50 $767.00 $3,758.30 $3,624.07 2026-06-15
74175 CPT CTA Abdomen W/contrast 28 11 $3,819.00 $3,437.10 $763.80 $3,742.62 $3,608.95 2026-06-15
70498 CPT CT Angiography Neck 29 11 $3,768.00 $3,391.20 $753.60 $3,692.64 $3,560.76 2026-06-15
Q5108 HCPCS Pegfilgrastim-jmdb 6 Mg Inj 28 11 $3,758.00 $3,382.20 $751.60 $3,682.84 $3,551.31 2026-06-15
75635 CPT CT Angio Abdominal Arteries 28 11 $3,749.00 $3,374.10 $749.80 $3,674.02 $3,542.80 2026-06-15
73220 CPT MRI Uppr Extremity W/O&with Contrast 28 11 $3,749.00 $3,374.10 $749.80 $3,674.02 $3,542.80 2026-06-15
73723 CPT MRI Joint Lwr Extr W/O&with Contrast 28 11 $3,749.00 $3,374.10 $749.80 $3,674.02 $3,542.80 2026-06-15
73223 CPT MRI Joint Upr Extr W/O&with Contrast 29 11 $3,749.00 $3,374.10 $749.80 $3,674.02 $3,542.80 2026-06-15
70540 CPT MRI Orbit/face/neck Without Contrast 29 11 $3,747.00 $3,372.30 $749.40 $3,672.06 $3,540.91 2026-06-15
72195 CPT MRI Pelvis Without Contrast 28 11 $3,747.00 $3,372.30 $749.40 $3,672.06 $3,540.91 2026-06-15
J7296 HCPCS Levonorgestrel Implant 19.2 Mg (kyleena) 28 11 $3,644.00 $3,279.60 $728.80 $3,571.12 $3,443.58 2026-06-15
73206 CPT CT Angio Upr Extrm W/O&with Contrast 28 11 $3,614.00 $3,252.60 $722.80 $3,541.72 $3,415.23 2026-06-15
78451 CPT Ht Muscle Image Spect Sing 28 11 $3,599.00 $3,239.10 $719.80 $3,527.02 $3,401.05 2026-06-15
J1602 HCPCS Simponi Aria 50 Mg / 4 Ml Sdv 28 11 $3,599.00 $3,239.10 $719.80 $3,527.02 $3,401.05 2026-06-15
J7300 HCPCS Paragard IUD Copper 28 11 $3,560.00 $3,204.00 $712.00 $3,488.80 $3,364.20 2026-06-15
L1831 HCPCS Leg Training Brace Adult 28 11 $3,541.00 $3,186.90 $708.20 $3,470.18 $3,346.24 2026-06-15
70496 CPT CT Angiography Head 29 11 $3,518.00 $3,166.20 $703.60 $3,447.64 $3,324.51 2026-06-15
70547 CPT Mr Angiography Neck Without Contrast 28 11 $3,437.00 $3,093.30 $687.40 $3,368.26 $3,247.97 2026-06-15
72130 CPT CT Chest Spine Without & With Contrast 28 11 $3,419.00 $3,077.10 $683.80 $3,350.62 $3,230.95 2026-06-15
74170 CPT CT Abd Wo Cntrst Flwd Cntrst 29 11 $3,408.00 $3,067.20 $681.60 $3,339.84 $3,220.56 2026-06-15
J0897 HCPCS Prolia 60 Mg / 1 Ml Syringe 44 11 $3,376.00 $3,038.40 $675.20 $6,268.08 $3,190.32 2026-06-15
73218 CPT MRI Upper Extremity Without Contrast 28 11 $3,300.00 $2,970.00 $660.00 $3,234.00 $3,118.50 2026-06-15
73221 CPT MRI Joint Upr Extrem Without Contrast 29 11 $3,300.00 $2,970.00 $660.00 $3,234.00 $3,118.50 2026-06-15
73718 CPT MRI Lower Extremity Without Contrast 28 11 $3,300.00 $2,970.00 $660.00 $3,234.00 $3,118.50 2026-06-15
73721 CPT MRI Jnt Of Lwr Extre Without Contrast 29 11 $3,300.00 $2,970.00 $660.00 $3,234.00 $3,118.50 2026-06-15
71270 CPT CT Thorax Dx C-/c+ 28 11 $3,263.00 $2,936.70 $652.60 $3,197.74 $3,083.53 2026-06-15
72133 CPT CT Lumbar Spine Without & With Contrast 28 11 $3,250.00 $2,925.00 $650.00 $3,185.00 $3,071.25 2026-06-15
73720 CPT MRI Lwr Extremity W/O&with Contrast 29 11 $3,238.00 $2,914.20 $647.60 $3,173.24 $3,059.91 2026-06-15
72194 CPT CT Pelvis Without & With Contrast 28 11 $3,225.00 $2,902.50 $645.00 $3,160.50 $3,047.62 2026-06-15
J0875 HCPCS Dalvance 500 Mg Vial 28 11 $3,203.00 $2,882.70 $640.60 $3,138.94 $3,026.84 2026-06-15
74160 CPT CT Abdomen W/contrast 29 11 $3,189.00 $2,870.10 $637.80 $3,125.22 $3,013.61 2026-06-15
72132 CPT CT Lumbar Spine With Contrast 28 11 $3,158.00 $2,842.20 $631.60 $3,094.84 $2,984.31 2026-06-15
49083 CPT Abdominal Paracentesis Ul 28 11 $3,081.00 $2,772.90 $616.20 $3,019.38 $2,911.55 2026-06-15
71260 CPT CT Thorax Dx C+ 29 11 $3,075.00 $2,767.50 $615.00 $3,013.50 $2,905.88 2026-06-15
72193 CPT CT Pelvis With Contrast 28 11 $3,038.00 $2,734.20 $607.60 $2,977.24 $2,870.91 2026-06-15
J7168 HCPCS Hum Prothrombin Cplx 400-620 U (kcentra 28 11 $2,986.00 $2,687.40 $597.20 $2,926.28 $2,821.77 2026-06-15
70488 CPT CT Maxillofacial Without & With Contrast 28 11 $2,985.00 $2,686.50 $597.00 $2,925.30 $2,820.82 2026-06-15
73702 CPT CT Lwr Extremity W/O&with Contrast 28 11 $2,969.00 $2,672.10 $593.80 $2,909.62 $2,805.70 2026-06-15
G0390 HCPCS Trauma Team Activation (f 28 11 $2,900.00 $2,610.00 $580.00 $2,842.00 $2,740.50 2026-06-15
J1439 HCPCS Injectafer 750 Mg / 15 Ml Sdv 28 11 $2,900.00 $2,610.00 $580.00 $2,842.00 $2,740.50 2026-06-15
70470 CPT CT Head/brain Without & With Contrast 29 11 $2,890.00 $2,601.00 $578.00 $2,832.20 $2,731.05 2026-06-15
86711 CPT Antibody Jc(john Cunningh 28 11 $2,890.00 $2,601.00 $578.00 $2,832.20 $2,731.05 2026-06-15
72131 CPT CT Lumbar Spine Without Contrast 29 11 $2,890.00 $2,601.00 $578.00 $2,832.20 $2,731.05 2026-06-15
72125 CPT CT Neck Spine Without Contrast 29 11 $2,890.00 $2,601.00 $578.00 $2,832.20 $2,731.05 2026-06-15
71250 CPT CT Thorax Dx C- 29 11 $2,890.00 $2,601.00 $578.00 $2,832.20 $2,731.05 2026-06-15
72128 CPT CT Chest Spine Without Contrast 29 11 $2,890.00 $2,601.00 $578.00 $2,832.20 $2,731.05 2026-06-15
73706 CPT CT Angio Lwr Extr W/O&with Contrast 28 11 $2,875.00 $2,587.50 $575.00 $2,817.50 $2,716.88 2026-06-15
70492 CPT CT Sft Tsue Nck Without & With Contrast 28 11 $2,856.00 $2,570.40 $571.20 $2,798.88 $2,698.92 2026-06-15
70482 CPT CT Orbit/ear/fossa W/O&with Contrast 28 11 $2,856.00 $2,570.40 $571.20 $2,798.88 $2,698.92 2026-06-15
70481 CPT CT Orbit/ear/fossa With Contrast 28 11 $2,853.00 $2,567.70 $570.60 $2,795.94 $2,696.09 2026-06-15
72126 CPT CT Neck Spine With Contrast 28 11 $2,833.00 $2,549.70 $566.60 $2,776.34 $2,677.18 2026-06-15
27810 CPT Closed Tx Ankle Fx With Man 28 11 $2,815.00 $2,533.50 $563.00 $2,758.70 $2,660.18 2026-06-15
J0881 HCPCS Darbepoetin Alfa 200 Mcg / 0.4 Ml 28 11 $2,787.00 $2,508.30 $557.40 $2,731.26 $2,633.72 2026-06-15
J1459 HCPCS Privigen 10% 10 Gm / 100 Ml Sdv 44 11 $3,558.00 $3,202.20 $711.60 $3,577.00 $2,622.64 2026-06-15
70336 CPT Magnetic Image Jaw Joint 28 11 $2,726.00 $2,453.40 $545.20 $2,671.48 $2,576.07 2026-06-15
74150 CPT CT Abdomen Without Contrast 28 11 $2,707.00 $2,436.30 $541.40 $2,652.86 $2,558.11 2026-06-15
72129 CPT CT Chest Spine With Contrast 28 11 $2,705.00 $2,434.50 $541.00 $2,650.90 $2,556.22 2026-06-15
70491 CPT CT Soft Tissue Neck With Contrast 29 11 $2,701.00 $2,430.90 $540.20 $2,646.98 $2,552.45 2026-06-15
J7327 HCPCS Hyaluronate Sod 88mg/4ml Syr Monovisc 28 11 $2,700.00 $2,430.00 $540.00 $2,646.00 $2,551.50 2026-06-15
70487 CPT CT Maxillofacial With Contrast 29 11 $2,690.00 $2,421.00 $538.00 $2,636.20 $2,542.05 2026-06-15
J2357 HCPCS Omalizumab 150 Mg / Ml Syringe 28 11 $2,651.00 $2,385.90 $530.20 $2,597.98 $2,505.20 2026-06-15
95805 CPT Multiple Sleep Latency Test 28 11 $2,595.00 $2,335.50 $519.00 $2,543.10 $2,452.28 2026-06-15
72192 CPT CT Pelvis Without Contrast 28 11 $2,589.00 $2,330.10 $517.80 $2,537.22 $2,446.61 2026-06-15
49082 CPT Abdominal Paracentesis 28 11 $2,536.00 $2,282.40 $507.20 $2,485.28 $2,396.52 2026-06-15
73200 CPT CT Upper Extremity Without Contrast 29 11 $2,518.00 $2,266.20 $503.60 $2,467.64 $2,379.51 2026-06-15
73700 CPT CT Lower Extremity Without Contrast 29 11 $2,518.00 $2,266.20 $503.60 $2,467.64 $2,379.51 2026-06-15
81443 CPT Severe Congenital & Cycli 28 11 $2,500.00 $2,250.00 $500.00 $2,450.00 $2,362.50 2026-06-15
59426 CPT Anteptartum Care 7+ Visit 29 11 $2,495.00 $2,245.50 $499.00 $2,445.10 $2,357.78 2026-06-15
77047 CPT MRI Breast C- Bilateral 28 11 $2,472.00 $2,224.80 $494.40 $2,422.56 $2,336.04 2026-06-15
J7325 HCPCS Synvisc-one 48 Mg / 6 Ml Syr 28 11 $2,466.00 $2,219.40 $493.20 $2,416.68 $2,330.37 2026-06-15
70490 CPT CT Soft Tissue Neck Without Contrast 29 11 $2,428.00 $2,185.20 $485.60 $2,379.44 $2,294.46 2026-06-15
73201 CPT CT Upper Extremity With Contrast 28 11 $2,428.00 $2,185.20 $485.60 $2,379.44 $2,294.46 2026-06-15
73701 CPT CT Lower Extremity With Contrast 28 11 $2,428.00 $2,185.20 $485.60 $2,379.44 $2,294.46 2026-06-15
70460 CPT CT Head/brain With Contrast 28 11 $2,428.00 $2,185.20 $485.60 $2,379.44 $2,294.46 2026-06-15
70450 CPT CT Head/brain Without Contrast 29 11 $2,415.00 $2,173.50 $483.00 $2,366.70 $2,282.18 2026-06-15
70480 CPT CT Orbit/ear/fossa Without Contrast 28 11 $2,364.00 $2,127.60 $472.80 $2,316.72 $2,233.98 2026-06-15
93306 CPT Tte W/doppler Complete 29 11 $2,345.00 $2,110.50 $469.00 $2,298.10 $2,216.03 2026-06-15
C1787 HCPCS Interstim-patient Program 44 11 $2,892.00 $2,602.80 $578.40 $3,026.24 $2,165.06 2026-06-15
78803 CPT Rp Loclzj Tum Spect 1 Area 28 11 $2,280.00 $2,052.00 $456.00 $2,234.40 $2,154.60 2026-06-15
L3765 HCPCS Ewhfo Rigid Without Joints Cf 28 11 $2,276.00 $2,048.40 $455.20 $2,230.48 $2,150.82 2026-06-15
J7307 HCPCS Amb Nexplanon 44 11 $2,493.00 $2,243.70 $498.60 $3,600.52 $2,144.66 2026-06-15
78315 CPT Bone Imaging 3 Phase 28 11 $2,260.00 $2,034.00 $452.00 $2,214.80 $2,135.70 2026-06-15
78227 CPT Hepatobil Syst Image W/drug 29 11 $2,220.00 $1,998.00 $444.00 $2,175.60 $2,097.90 2026-06-15
J2426 HCPCS Invega Sustenna 78 Mg IM Syrg 28 11 $2,193.00 $1,973.70 $438.60 $2,149.14 $2,072.39 2026-06-15
78306 CPT Bone Imaging Whole Body 28 11 $2,179.00 $1,961.10 $435.80 $2,135.42 $2,059.16 2026-06-15
C1755 HCPCS Ascenda Intrathecal 8780 28 11 $2,159.00 $1,943.10 $431.80 $2,115.82 $2,040.26 2026-06-15
Q0138 HCPCS Feraheme 510 Mg / 17 Ml Sdv Inj 28 11 $2,149.00 $1,934.10 $429.80 $2,106.02 $2,030.81 2026-06-15
70486 CPT CT Maxillofacial Without Contrast 29 11 $2,142.00 $1,927.80 $428.40 $2,099.16 $2,024.19 2026-06-15
90375 CPT Hyperrab 1,500 Unit / 5 Ml 60 11 $3,749.00 $3,374.10 $291.60 $6,002.50 $2,007.40 2026-06-15
78226 CPT Hepatobiliary System Imaging 28 11 $2,102.00 $1,891.80 $420.40 $2,059.96 $1,986.39 2026-06-15
78472 CPT Gated Heart Planar Single 28 11 $2,102.00 $1,891.80 $420.40 $2,059.96 $1,986.39 2026-06-15
93660 CPT Tilt Table Evaluation 28 11 $2,071.00 $1,863.90 $414.20 $2,029.58 $1,957.10 2026-06-15
J7326 HCPCS Hyaluronate Sod. X-linked 30 Mg Inj 28 11 $2,070.00 $1,863.00 $414.00 $2,028.60 $1,956.15 2026-06-15
92960 CPT Cardioversion 46 11 $2,092.00 $1,882.80 $395.00 $2,050.16 $1,846.62 2026-06-15
C1762 HCPCS Podiatry Nerve Protector 124 11 $3,794.00 $3,414.60 $32.40 $7,816.48 $1,835.04 2026-06-15
78278 CPT Acute Gi Blood Loss Imaging 28 11 $1,906.00 $1,715.40 $381.20 $1,867.88 $1,801.17 2026-06-15
78264 CPT Gastric Emptying Img Study 28 11 $1,893.00 $1,703.70 $378.60 $1,855.14 $1,788.88 2026-06-15
27266 CPT Closed Tx Post Hip Artho 28 11 $1,885.00 $1,696.50 $377.00 $1,847.30 $1,781.33 2026-06-15
78215 CPT Lvr&spleen Img Static Only 28 11 $1,869.00 $1,682.10 $373.80 $1,831.62 $1,766.20 2026-06-15
78582 CPT Lung Ventilat&perfus Imaging 28 11 $1,847.00 $1,662.30 $369.40 $1,810.06 $1,745.41 2026-06-15
27842 CPT Closed Treatment Of Ankle 45 11 $3,166.00 $2,849.40 $364.40 $3,102.68 $1,728.32 2026-06-15
A4649 HCPCS Derma Close 28 11 $1,801.00 $1,620.90 $360.20 $1,764.98 $1,701.94 2026-06-15
78761 CPT Testicular Imaging W/flow 28 11 $1,796.00 $1,616.40 $359.20 $1,760.08 $1,697.22 2026-06-15
Q5135 HCPCS Tyenne 200 Mg / 10 Ml Sdv 44 11 $1,763.00 $1,586.70 $352.60 $3,455.48 $1,666.04 2026-06-15
78709 CPT K Flow/funct Image Multiple 28 11 $1,743.00 $1,568.70 $348.60 $1,708.14 $1,647.13 2026-06-15
78071 CPT Parathyrd Planar W/wo Subtrj 28 11 $1,737.00 $1,563.30 $347.40 $1,702.26 $1,641.46 2026-06-15
93247 CPT Zio ECG > 7days Up To 15 29 11 $1,719.00 $1,547.10 $343.80 $1,684.62 $1,624.45 2026-06-15
Q5103 HCPCS Infliximab-dyyb 100 Mg Sdv (inflectra) 29 11 $1,704.00 $1,533.60 $340.80 $1,669.92 $1,610.28 2026-06-15
59409 CPT Vaginal Delivery Only 28 11 $1,690.00 $1,521.00 $338.00 $1,656.20 $1,597.05 2026-06-15
93880 CPT Extracranial Bilat Study 28 11 $1,637.00 $1,473.30 $327.40 $1,604.26 $1,546.96 2026-06-15
27750 CPT Closed Reduction Of Tibia 28 11 $1,636.00 $1,472.40 $327.20 $1,603.28 $1,546.02 2026-06-15
25565 CPT Closed Trtmt Radial/ulnar 45 11 $2,733.00 $2,459.70 $390.20 $2,678.34 $1,503.15 2026-06-15
78014 CPT Thyroid Imaging W/blood Flow 28 11 $1,545.00 $1,390.50 $309.00 $1,514.10 $1,460.03 2026-06-15
78707 CPT K Flow/funct Image Without Drug 28 11 $1,523.00 $1,370.70 $304.60 $1,492.54 $1,439.23 2026-06-15
93970 CPT Extremity Study 29 11 $1,509.00 $1,358.10 $301.80 $1,478.82 $1,426.01 2026-06-15
78070 CPT Parathyroid Planar Imaging 28 11 $1,506.00 $1,355.40 $301.20 $1,475.88 $1,423.17 2026-06-15
P9037 HCPCS Plt [heresis Leuko Reduce 28 11 $1,490.00 $1,341.00 $298.00 $1,460.20 $1,408.05 2026-06-15
78290 CPT Intestine Imaging 28 11 $1,488.00 $1,339.20 $297.60 $1,458.24 $1,406.16 2026-06-15
78305 CPT Bone Imaging Multiple Areas 28 11 $1,455.00 $1,309.50 $291.00 $1,425.90 $1,374.97 2026-06-15
V2632 HCPCS Intraocular Lens 28 11 $1,447.00 $1,302.30 $289.40 $1,418.06 $1,367.41 2026-06-15
74415 CPT Urography Nfs Drip&/bls W/nf 28 11 $1,388.00 $1,249.20 $277.60 $1,360.24 $1,311.66 2026-06-15
J0248 HCPCS Remdesivir 100 Mg Vial 28 11 $1,367.00 $1,230.30 $273.40 $1,339.66 $1,291.82 2026-06-15
59425 CPT Anteptartum Care 4-6 Visi 29 11 $1,366.00 $1,229.40 $273.20 $1,338.68 $1,290.87 2026-06-15
93017 CPT Cardiovascular Stress Tes 29 11 $1,365.00 $1,228.50 $273.00 $1,337.70 $1,289.92 2026-06-15
12047 CPT Int Rpr N/h/hxtrnl >30.0 29 11 $1,364.00 $1,227.60 $272.80 $1,336.72 $1,288.98 2026-06-15
78580 CPT Lung Perfusion Imaging 28 11 $1,353.00 $1,217.70 $270.60 $1,325.94 $1,278.59 2026-06-15
0278 RC Modular Cemented Stem 604 11 $3,168.00 $2,851.20 $41.20 $16,595.32 $1,278.40 2026-06-15
25605 CPT Closed Tx Of Distal Radia 29 11 $1,352.00 $1,216.80 $270.40 $1,324.96 $1,277.64 2026-06-15
47563 CPT Cholecystectomy With Chola 28 11 $1,342.00 $1,207.80 $268.40 $1,315.16 $1,268.19 2026-06-15
93930 CPT Upper Extremity Study 28 11 $1,335.00 $1,201.50 $267.00 $1,308.30 $1,261.58 2026-06-15
93925 CPT Lower Extremity Study 28 11 $1,322.00 $1,189.80 $264.40 $1,295.56 $1,249.29 2026-06-15
58262 CPT Vag Hyster Tech 46 11 $1,342.00 $1,207.80 $268.40 $1,746.36 $1,244.70 2026-06-15
92977 CPT Thrombolytic Infusion 28 11 $1,306.00 $1,175.40 $261.20 $1,279.88 $1,234.17 2026-06-15
P9035 HCPCS Platelets Pheresis Leukoc 28 11 $1,289.00 $1,160.10 $257.80 $1,263.22 $1,218.11 2026-06-15
76380 CPT Cat Scan Follow-up Study 28 11 $1,286.00 $1,157.40 $257.20 $1,260.28 $1,215.27 2026-06-15
12055 CPT Int Repair F/e/e/n/l 12.6 29 11 $1,282.00 $1,153.80 $256.40 $1,256.36 $1,211.49 2026-06-15
11646 CPT Exc Mal Les F/e/e/n/l >4. 29 11 $1,274.00 $1,146.60 $254.80 $1,248.52 $1,203.93 2026-06-15
11000 CPT Debride Infected Skin 28 11 $1,270.00 $1,143.00 $254.00 $1,244.60 $1,200.15 2026-06-15
13152 CPT Cmplx Rpr E/e/n/l 2.6-7.5 29 11 $1,268.00 $1,141.20 $253.60 $1,242.64 $1,198.26 2026-06-15
12046 CPT Int Rpr N/h/hxtrnl 20.1-3 29 11 $1,250.00 $1,125.00 $250.00 $1,225.00 $1,181.25 2026-06-15
47562 CPT Lap Chole Tech Fee 28 11 $1,232.00 $1,108.80 $246.40 $1,207.36 $1,164.24 2026-06-15
12037 CPT Int Rpr S/a/t/e >30 Cm 29 11 $1,213.00 $1,091.70 $242.60 $1,188.74 $1,146.29 2026-06-15
13132 CPT Cmplx Rpr F/c/c/m/n/ax/g/ 29 11 $1,206.00 $1,085.40 $241.20 $1,181.88 $1,139.67 2026-06-15
93882 CPT Extracranial Uni/ltd Study 28 11 $1,200.00 $1,080.00 $240.00 $1,176.00 $1,134.00 2026-06-15
C1788 HCPCS Port 8fr Powerport Implan 28 11 $1,197.00 $1,077.30 $239.40 $1,173.06 $1,131.16 2026-06-15
0450 RC Thoracentesis 28 11 $1,197.00 $1,077.30 $239.40 $1,173.06 $1,131.16 2026-06-15
77002 CPT Needle Localization By Xray 28 11 $1,187.00 $1,068.30 $237.40 $1,163.26 $1,121.71 2026-06-15
93978 CPT Vascular Study 28 11 $1,183.00 $1,064.70 $236.60 $1,159.34 $1,117.93 2026-06-15
93975 CPT Vascular Study 28 11 $1,181.00 $1,062.90 $236.20 $1,157.38 $1,116.05 2026-06-15
P9053 HCPCS Plt Pheresis Leuko Reduce 28 11 $1,175.00 $1,057.50 $235.00 $1,151.50 $1,110.38 2026-06-15
11043 CPT Debride Muscle And/or Fas 45 11 $2,286.00 $2,057.40 $117.20 $2,240.28 $1,097.28 2026-06-15
27818 CPT Closed Tx Ankle With Mani 45 11 $1,259.00 $1,133.10 $251.80 $1,806.14 $1,087.37 2026-06-15
93243 CPT Zio ECG > 48 Hr Upto 7 Da 29 11 $1,147.00 $1,032.30 $229.40 $1,124.06 $1,083.91 2026-06-15
A9552 HCPCS Fdg/f-19 Up To 45mci 28 11 $1,142.00 $1,027.80 $228.40 $1,119.16 $1,079.19 2026-06-15
97607 CPT Wound Vac Prevena Disposa 28 11 $1,138.00 $1,024.20 $227.60 $1,115.24 $1,075.41 2026-06-15
93971 CPT Extremity Study 31 11 $1,129.00 $1,016.10 $225.80 $1,106.42 $1,066.90 2026-06-15
11606 CPT Exc Mal Les T/a/l >4.0 Cm 29 11 $1,125.00 $1,012.50 $225.00 $1,102.50 $1,063.12 2026-06-15
24605 CPT Tx Closed Elbow Disloc With 45 11 $1,419.00 $1,277.10 $283.80 $1,742.44 $1,049.02 2026-06-15
25505 CPT Closed Trtmt Radial Shaft 45 11 $1,133.00 $1,019.70 $226.60 $1,867.88 $1,048.30 2026-06-15
74280 CPT X-ray Xm Colon 2cntrst Std 28 11 $1,088.00 $979.20 $217.60 $1,066.24 $1,028.16 2026-06-15
92950 CPT Cardiopulmonary Resucitat 28 11 $1,085.00 $976.50 $217.00 $1,063.30 $1,025.33 2026-06-15
12036 CPT Int Rpr S/a/t/e 20.1-30 C 29 11 $1,084.00 $975.60 $216.80 $1,062.32 $1,024.38 2026-06-15
94070 CPT Evaluation Of Wheezing 28 11 $1,082.00 $973.80 $216.40 $1,060.36 $1,022.49 2026-06-15
13151 CPT Cmplx Rpr E/e/n/l 1.1-2.5 29 11 $1,081.00 $972.90 $216.20 $1,059.38 $1,021.54 2026-06-15
99291 CPT Critical Care ER 30-74 Mi 47 11 $2,110.00 $1,899.00 $141.00 $2,067.80 $1,012.80 2026-06-15
93246 CPT Zio ECG > 7days Up To 15 29 11 $1,063.00 $956.70 $212.60 $1,041.74 $1,004.53 2026-06-15
93924 CPT Lwr Xtr Vasc Stdy Bilat 28 11 $1,061.00 $954.90 $212.20 $1,039.78 $1,002.64 2026-06-15
0360 RC Or Chg Up To 15 Min Sched 476 11 $2,996.00 $2,696.40 $46.40 $6,209.28 $994.92 2026-06-15
77001 CPT Fluoroguide For Vein Device 28 11 $1,050.00 $945.00 $210.00 $1,029.00 $992.25 2026-06-15
12045 CPT Int Rpr N/h/hxtrnl 12.6-2 29 11 $1,047.00 $942.30 $209.40 $1,026.06 $989.41 2026-06-15
C8957 HCPCS Synchromed Ii Intrathecal 28 11 $1,042.00 $937.80 $208.40 $1,021.16 $984.69 2026-06-15
76805 CPT Uls Preg Uterus >or=14wks 29 11 $1,040.00 $936.00 $208.00 $1,019.20 $982.80 2026-06-15
36430 CPT Blood Administration 29 11 $1,038.00 $934.20 $207.60 $1,017.24 $980.91 2026-06-15
94002 CPT Ventilation Assisted Mgmt 28 11 $1,037.00 $933.30 $207.40 $1,016.26 $979.97 2026-06-15
77075 CPT Radex Osseous Survey Compl 28 11 $1,032.00 $928.80 $206.40 $1,011.36 $975.24 2026-06-15
11626 CPT Exc Mal Les S/n/h/fg >4.0 29 11 $1,024.00 $921.60 $204.80 $1,003.52 $967.68 2026-06-15
88237 CPT Tissue Culture Neoplastic 28 11 $1,017.00 $915.30 $203.40 $996.66 $961.07 2026-06-15
13101 CPT Cmplx Rpr Trunk 2.6-7.5 C 29 11 $1,016.00 $914.40 $203.20 $995.68 $960.12 2026-06-15
93926 CPT Lower Extremity Study 28 11 $1,010.00 $909.00 $202.00 $989.80 $954.45 2026-06-15
13120 CPT Complex Repair Arm 1.1-2. 45 11 $1,974.00 $1,776.60 $181.60 $1,934.52 $947.52 2026-06-15
23600 CPT Clsd Tx Of Proximal Humer 28 11 $997.00 $897.30 $199.40 $977.06 $942.16 2026-06-15
13131 CPT Cmplx Rpr F/c/c/m/n/ax/g/ 29 11 $993.00 $893.70 $198.60 $973.14 $938.38 2026-06-15
93931 CPT Upper Extremity Study 28 11 $990.00 $891.00 $198.00 $970.20 $935.55 2026-06-15
78300 CPT Bone Imaging Limited Area 28 11 $989.00 $890.10 $197.80 $969.22 $934.61 2026-06-15
11644 CPT Exc Mal Les F/e/e/n/l 3.1 29 11 $985.00 $886.50 $197.00 $965.30 $930.83 2026-06-15
12054 CPT Int Repair F/e/e/n/l 7.6- 29 11 $978.00 $880.20 $195.60 $958.44 $924.21 2026-06-15
11446 CPT Exc B9les Mgn Xcp Sktg F/ 29 11 $974.00 $876.60 $194.80 $954.52 $920.43 2026-06-15
12044 CPT Int Rpr N/h/hxtrnl 7.6-12 29 11 $973.00 $875.70 $194.60 $953.54 $919.49 2026-06-15
L0456 HCPCS Back Brace 44 11 $1,174.00 $1,056.60 $234.80 $1,336.72 $909.27 2026-06-15
93923 CPT Upr/lxtr Art Stdy 3+ Lvls 28 11 $958.00 $862.20 $191.60 $938.84 $905.31 2026-06-15
L1843 HCPCS Unloader One X Right Medi 28 11 $958.00 $862.20 $191.60 $938.84 $905.31 2026-06-15
76776 CPT US Exam K Transpl W/doppler 28 11 $954.00 $858.60 $190.80 $934.92 $901.53 2026-06-15
10121 CPT Remove Foreign Body Compl 45 11 $1,876.00 $1,688.40 $134.20 $1,838.48 $900.48 2026-06-15
30906 CPT Control Nasal Hemorrhage 29 11 $952.00 $856.80 $190.40 $932.96 $899.64 2026-06-15
76700 CPT US Exam Abdom Complete 29 11 $952.00 $856.80 $190.40 $932.96 $899.64 2026-06-15
94660 CPT Cpap Initial 28 11 $951.00 $855.90 $190.20 $931.98 $898.70 2026-06-15
Q5106 HCPCS Retacrit 40,000 U / 1 Ml Sdv 28 11 $950.00 $855.00 $190.00 $931.00 $897.75 2026-06-15
74400 CPT Urography IV +-kub Tomog 28 11 $944.00 $849.60 $188.80 $925.12 $892.08 2026-06-15
81206 CPT Bcr/abli Major Breakpoin 28 11 $942.00 $847.80 $188.40 $923.16 $890.19 2026-06-15
81207 CPT Bcr/abli Minor Breakpoin 28 11 $942.00 $847.80 $188.40 $923.16 $890.19 2026-06-15
95819 CPT EEG Awake And Asleep 28 11 $941.00 $846.90 $188.20 $922.18 $889.25 2026-06-15
88261 CPT Chromosome Analysis Count 28 11 $936.00 $842.40 $187.20 $917.28 $884.52 2026-06-15
81382 CPT Hla Class Ii Typing 28 11 $933.00 $839.70 $186.60 $914.34 $881.68 2026-06-15
93308 CPT Tte F-up Or Lmtd 28 11 $932.00 $838.80 $186.40 $913.36 $880.74 2026-06-15
12053 CPT Int Repair F/e/e/n/l 5.1- 29 11 $930.00 $837.00 $186.00 $911.40 $878.85 2026-06-15
L3671 HCPCS So-custom-inc Fit/adj 28 11 $925.00 $832.50 $185.00 $906.50 $874.12 2026-06-15
76942 CPT Echo Guide For Biopsy 28 11 $915.00 $823.50 $183.00 $896.70 $864.67 2026-06-15
76856 CPT US Exam Pelvic Complete 29 11 $910.00 $819.00 $182.00 $891.80 $859.95 2026-06-15
76770 CPT US Exam Abdo Back Wall Comp 29 11 $904.00 $813.60 $180.80 $885.92 $854.28 2026-06-15
L0464 HCPCS Tlso Aspen Vista 464 Back 28 11 $897.00 $807.30 $179.40 $879.06 $847.66 2026-06-15
88360 CPT Tumor Immunohistochem/manual 28 11 $888.00 $799.20 $177.60 $870.24 $839.16 2026-06-15
81401 CPT Apolipoprotein E(apoe) Mu 28 11 $886.00 $797.40 $177.20 $868.28 $837.27 2026-06-15
13121 CPT Complex Repair Arm 2.6-7. 45 11 $1,519.00 $1,367.10 $217.60 $1,488.62 $835.45 2026-06-15
86978 CPT Ptx Of Rbc By Using Rbc 28 11 $884.00 $795.60 $176.80 $866.32 $835.38 2026-06-15
10081 CPT Amb Inc & DRG Of Pilondia 29 11 $883.00 $794.70 $176.60 $865.34 $834.43 2026-06-15
0099U CPT Respiratory Pathogen Pane 28 11 $882.00 $793.80 $176.40 $864.36 $833.49 2026-06-15
J2760 HCPCS Phentolamine 5 Mg Vial 28 11 $882.00 $793.80 $176.40 $864.36 $833.49 2026-06-15
J0666 HCPCS Bupivicaine Liposome Pf 266 Mg / 20 Ml 28 11 $880.00 $792.00 $176.00 $862.40 $831.60 2026-06-15
Q4282 HCPCS Cygnus Dual Amniotic Allo 28 11 $878.00 $790.20 $175.60 $860.44 $829.71 2026-06-15
95816 CPT EEG Awake And Drowsy 28 11 $877.00 $789.30 $175.40 $859.46 $828.76 2026-06-15
13100 CPT Cmplx Rpr Trunk 1.1-2.5 C 29 11 $871.00 $783.90 $174.20 $853.58 $823.10 2026-06-15
93979 CPT Vascular Study 28 11 $869.00 $782.10 $173.80 $851.62 $821.21 2026-06-15
76998 CPT US Guide Intraop 28 11 $860.00 $774.00 $172.00 $842.80 $812.70 2026-06-15
76870 CPT US Exam Scrotum 29 11 $858.00 $772.20 $171.60 $840.84 $810.81 2026-06-15
0170 RC Nursery Room Rate 4 3 $841.00 $756.90 $765.31 $824.18 $807.36 2026-06-15
81403 CPT Molecular Path Proc Leve 28 11 $840.00 $756.00 $168.00 $823.20 $793.80 2026-06-15
11426 CPT Exc B9les Mgn Xcp Sktg S/ 30 11 $836.00 $752.40 $167.20 $819.28 $790.02 2026-06-15
76872 CPT US Transrectal 28 11 $819.00 $737.10 $163.80 $802.62 $773.96 2026-06-15
J7328 HCPCS Gelsyn-3 Intraartic Syringe 28 11 $815.00 $733.50 $163.00 $798.70 $770.17 2026-06-15
76801 CPT Uls Preg Uterus <14wks Si 29 11 $808.00 $727.20 $161.60 $791.84 $763.56 2026-06-15
11643 CPT Exc Mal Les F/e/e/n/l 2.1 29 11 $801.00 $720.90 $160.20 $784.98 $756.95 2026-06-15
11406 CPT Exc B9les Mrgn Xcp Sk Tg 29 11 $800.00 $720.00 $160.00 $784.00 $756.00 2026-06-15
75809 CPT Nonvascular Shunt X-ray 28 11 $795.00 $715.50 $159.00 $779.10 $751.27 2026-06-15
12042 CPT Int Rpr N/h/hxtrnl 2.6-7. 29 11 $793.00 $713.70 $158.60 $777.14 $749.38 2026-06-15
76937 CPT US Guide Vascular Access 28 11 $792.00 $712.80 $158.40 $776.16 $748.44 2026-06-15
11604 CPT Exc Mal Les T/a/l 3.1-4.0 29 11 $791.00 $711.90 $158.20 $775.18 $747.50 2026-06-15
81219 CPT Calr Gene Com Variants 28 11 $787.00 $708.30 $157.40 $771.26 $743.72 2026-06-15
C9088 HCPCS Bupivacaine-meloxicam 400-12 Mg / 14 Ml 28 11 $781.00 $702.90 $156.20 $765.38 $738.04 2026-06-15
L0457 HCPCS Tlso Aspen Horizon 456 Ba 28 11 $778.00 $700.20 $155.60 $762.44 $735.21 2026-06-15
74270 CPT X-ray Xm Colon 1cntrst Std 28 11 $774.00 $696.60 $154.80 $758.52 $731.43 2026-06-15
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