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 →

Export CSV
Hospital

JENNIE M MELHAM MEMORIAL MEDICAL CENTER

Broken Bow, NE · CCN 281365 · Rates published

Your selected procedure

You selected 93306 (CPT)

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography

This hospital’s price: $1,438 across 2 payers · range $519-$2,358

Source: https://irp.cdn-website.com/a8c802d4/files/uploaded/470426530_melham-medical-center_standardcharges.csv · observed 2026-07-24

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.

1,159 distinct procedures filed
28 distinct payers
44,828 rate rows
2026-07-24 last MRF observed
Data quality

3,291 of 44,828 rate rows are consumer-grade (7.3%)

41,537 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 41,537
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://irp.cdn-website.com/a8c802d4/files/uploaded/470426530_melham-medical-center_standardcharges.csv
Found on page https://www.melham.org/jmmmmc-price-transparency
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-08-03
Content fingerprint f4c43eec1a7ada47… · 20,086,661 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
J9271
HCPCS 		Injection, Pembrolizumab, 1 Mg 2 $12,917.91 $63,323.70 $38,120.80 nat. median
$276
outlier · 138.3×
J9144
HCPCS 		Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj 1 $29,524.35 $29,524.35 $29,524.35 nat. median
$211
outlier · 139.6×
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 1 $24,360.66 $24,360.66 $24,360.66 nat. median
$162
outlier · 150.4×
J0896
HCPCS 		Injection, Luspatercept-aamt, 0.25 Mg 1 $4,625.30 $41,557.05 $23,091.17 nat. median
$4,583
outlier · 5.0×
0948
RC 		1 $14,948.14 $14,948.14 $14,948.14 nat. median
$166
outlier · 90.0×
0101
RC 		1 $13,904.44 $13,904.44 $13,904.44 nat. median
$863
outlier · 16.1×
27447
CPT 		Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compartments With Or… 2 $2,755.00 $13,925.00 $13,775.00 nat. median
$12,734
1.1× median
J0875
HCPCS 		Injection, Dalbavancin, 5 Mg 1 $13,150.06 $13,150.06 $13,150.06 nat. median
$390
outlier · 33.7×
J0129
HCPCS 		Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 1 $11,976.65 $11,976.65 $11,976.65 nat. median
$902
outlier · 13.3×
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 1 $11,029.74 $11,029.74 $11,029.74 nat. median
$1,646
outlier · 6.7×
Q5113
HCPCS 		Injection, Trastuzumab-pkrb, Biosimilar, (herzuma), 10 Mg 1 $6,994.84 $14,211.46 $10,603.15 nat. median
$225
outlier · 47.1×
J1459
HCPCS 		Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 1 $5,890.50 $9,799.50 $7,845.00 nat. median
$1,388
outlier · 5.7×
J9312
HCPCS 		Injection, Rituximab, 10 Mg 1 $3,071.25 $12,204.20 $7,637.73 nat. median
$1,071
outlier · 7.1×
0390
RC 		1 $7,474.07 $7,474.07 $7,474.07 nat. median
$288
outlier · 26.0×
47562
CPT 		Laparoscopy, Surgical; Cholecystectomy 1 $6,650.00 $6,650.00 $6,650.00 nat. median
$5,993
1.1× median
J9035
HCPCS 		Injection, Bevacizumab, 10 Mg 2 $1,304.15 $19,184.95 $6,107.46 nat. median
$722
outlier · 8.5×
J1602
HCPCS 		Injection, Golimumab, 1 Mg, For Intravenous Use 2 $856.27 $27,680.65 $5,961.57 nat. median
$273
outlier · 21.9×
J3247
HCPCS 		Injection, Secukinumab, Intravenous, 1 Mg 1 $4,727.00 $7,077.05 $5,902.02 nat. median
$49
outlier · 119.7×
Q3027
HCPCS 		Injection, Interferon Beta-1a, 1 Mcg For Intramuscular Use 1 $5,835.05 $5,835.05 $5,835.05 nat. median
$130
outlier · 44.8×
J1306
HCPCS 		Injection, Inclisiran, 1 Mg 2 $1,906.73 $9,508.52 $5,707.62 nat. median
$44
outlier · 129.2×
29880
CPT 		Arthroscopy, Knee, Surgical; With Meniscectomy (medial And Lateral, Including An… 1 $5,350.00 $5,350.00 $5,350.00 nat. median
$3,840
1.4× median
29881
CPT 		Arthroscopy, Knee, Surgical; With Meniscectomy (medial Or Lateral, Including Any… 1 $5,177.50 $5,177.50 $5,177.50 nat. median
$3,830
1.4× median
J0897
HCPCS 		Injection, Denosumab, 1 Mg 2 $1,013.65 $9,197.05 $4,941.55 nat. median
$1,972
outlier · 2.5×
57250
CPT 		Posterior Colporrhaphy, Repair Of Rectocele With Or Without Perineorrhaphy 1 $4,700.00 $4,700.00 $4,700.00 nat. median
$4,890
1.0× median
J3111
HCPCS 		Injection, Romosozumab-aqqg, 1 Mg 2 $1,584.31 $7,385.40 $4,484.85 nat. median
$681
outlier · 6.6×
64718
CPT 		Neuroplasty And/or Transposition; Ulnar Nerve At Elbow 1 $4,480.00 $4,480.00 $4,480.00 nat. median
$2,505
1.8× median
64721
CPT 		Neuroplasty And/or Transposition; Median Nerve At Carpal Tunnel 1 $4,480.00 $4,480.00 $4,480.00 nat. median
$2,395
1.9× median
58262
CPT 		Vaginal Hysterectomy, For Uterus 250 G Or Less; With Removal Of Tube(s), And/or… 1 $4,465.00 $4,465.00 $4,465.00 nat. median
$5,362
0.8× median
72156
CPT 		Magnetic Resonance (eg, Proton) Imaging, Spinal Canal And Contents, Without Cont… 1 $4,444.71 $4,444.71 $4,444.71 nat. median
$1,103
outlier · 4.0×
J1745
HCPCS 		Injection, Infliximab, Excludes Biosimilar, 10 Mg 1 $4,305.63 $4,305.63 $4,305.63 nat. median
$398
outlier · 10.8×
74178
CPT 		Computed Tomography, Abdomen And Pelvis; Without Contrast Material In One Or Bot… 2 $3,198.70 $5,411.50 $4,305.10 nat. median
$1,024
outlier · 4.2×
28820
CPT 		Amputation, Toe; Metatarsophalangeal Joint 1 $4,180.00 $4,180.00 $4,180.00 nat. median
$3,395
1.2× median
72157
CPT 		Magnetic Resonance (eg, Proton) Imaging, Spinal Canal And Contents, Without Cont… 1 $4,144.14 $4,144.14 $4,144.14 nat. median
$1,105
outlier · 3.7×
27654
CPT 		Repair, Secondary, Achilles Tendon, With Or Without Graft 1 $4,085.00 $4,085.00 $4,085.00 nat. median
$6,823
0.6× median
49505
CPT 		Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible 2 $780.00 $3,925.00 $3,801.88 nat. median
$3,856
1.0× median
G0390
HCPCS 		Trauma Response Team Associated With Hospital Critical Care Service 1 $3,800.00 $3,800.00 $3,800.00 nat. median
$3,197
1.2× median
74177
CPT 		Computed Tomography, Abdomen And Pelvis; With Contrast Material(s) 2 $2,858.73 $4,653.88 $3,756.31 nat. median
$974
outlier · 3.9×
66991
CPT 		Extracapsular Cataract Removal With Insertion Of Intraocular Lens Prosthesis (1… 1 $3,750.00 $3,750.00 $3,750.00 nat. median
$5,639
0.7× median
66984
CPT 		Extracapsular Cataract Removal With Insertion Of Intraocular Lens Prosthesis (1… 2 $1,517.00 $3,750.00 $3,700.00 nat. median
$2,919
1.3× median
70551
CPT 		Magnetic Resonance (eg, Proton) Imaging, Brain (including Brain Stem); Without C… 2 $2,370.30 $3,699.10 $3,645.23 nat. median
$784
outlier · 4.7×
29848
CPT 		Endoscopy, Wrist, Surgical, With Release Of Transverse Carpal Ligament 2 $1,886.00 $4,480.00 $3,611.00 nat. median
$2,344
1.5× median
73723
CPT 		Magnetic Resonance (eg, Proton) Imaging, Any Joint Of Lower Extremity; Without C… 1 $3,591.14 $3,591.14 $3,591.14 nat. median
$1,192
outlier · 3.0×
70544
CPT 		Magnetic Resonance Angiography, Head; Without Contrast Material(s) 1 $3,569.71 $3,569.71 $3,569.71 nat. median
$826
outlier · 4.3×
74175
CPT 		Computed Tomographic Angiography, Abdomen, With Contrast Material(s), Including… 1 $3,540.37 $3,540.37 $3,540.37 nat. median
$714
outlier · 5.0×
72146
CPT 		Magnetic Resonance (eg, Proton) Imaging, Spinal Canal And Contents, Thoracic; Wi… 1 $3,539.98 $3,539.98 $3,539.98 nat. median
$797
outlier · 4.4×
52332
CPT 		Cystourethroscopy, With Insertion Of Indwelling Ureteral Stent (eg, Gibbons Or D… 1 $3,525.00 $3,525.00 $3,525.00 nat. median
$3,667
1.0× median
73220
CPT 		Magnetic Resonance (eg, Proton) Imaging, Upper Extremity, Other Than Joint; With… 1 $3,524.65 $3,524.65 $3,524.65 nat. median
$1,130
outlier · 3.1×
78452
CPT 		Myocardial Perfusion Imaging, Tomographic (spect) (including Attenuation Correct… 2 $2,479.05 $4,487.72 $3,483.39 nat. median
$1,816
1.9× median
75635
CPT 		Computed Tomographic Angiography, Abdominal Aorta And Bilateral Iliofemoral Lowe… 1 $3,468.09 $3,468.09 $3,468.09 nat. median
$722
outlier · 4.8×
72158
CPT 		Magnetic Resonance (eg, Proton) Imaging, Spinal Canal And Contents, Without Cont… 2 $2,507.41 $4,233.69 $3,370.55 nat. median
$1,093
outlier · 3.1×

Other procedures at this hospital

Browse this hospital's 1,159 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
             
J9271 HCPCS Injection, Pembrolizumab, 1 Mg 2 2 — — $12,917.91 $63,323.70 $38,120.80 2026-07-24
J9144 HCPCS Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj 1 1 — — $29,524.35 $29,524.35 $29,524.35 2026-07-24
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 1 1 — — $24,360.66 $24,360.66 $24,360.66 2026-07-24
J0896 HCPCS Injection, Luspatercept-aamt, 0.25 Mg 4 1 — — $4,625.30 $41,557.05 $23,091.17 2026-07-24
0948 RC — 1 1 — — $14,948.14 $14,948.14 $14,948.14 2026-07-24
0101 RC — 1 1 — — $13,904.44 $13,904.44 $13,904.44 2026-07-24
27447 CPT Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compartments With Or… 3 2 — — $2,755.00 $13,925.00 $13,775.00 2026-07-24
J0875 HCPCS Injection, Dalbavancin, 5 Mg 2 1 — — $13,150.06 $13,150.06 $13,150.06 2026-07-24
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 1 1 — — $11,976.65 $11,976.65 $11,976.65 2026-07-24
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 1 1 — — $11,029.74 $11,029.74 $11,029.74 2026-07-24
Q5113 HCPCS Injection, Trastuzumab-pkrb, Biosimilar, (herzuma), 10 Mg 4 1 — — $6,994.84 $14,211.46 $10,603.15 2026-07-24
J1459 HCPCS Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 2 1 — — $5,890.50 $9,799.50 $7,845.00 2026-07-24
J9312 HCPCS Injection, Rituximab, 10 Mg 4 1 — — $3,071.25 $12,204.20 $7,637.73 2026-07-24
0390 RC — 1 1 — — $7,474.07 $7,474.07 $7,474.07 2026-07-24
47562 CPT Laparoscopy, Surgical; Cholecystectomy 1 1 — — $6,650.00 $6,650.00 $6,650.00 2026-07-24
J9035 HCPCS Injection, Bevacizumab, 10 Mg 6 2 — — $1,304.15 $19,184.95 $6,107.46 2026-07-24
J1602 HCPCS Injection, Golimumab, 1 Mg, For Intravenous Use 16 2 — — $856.27 $27,680.65 $5,961.57 2026-07-24
J3247 HCPCS Injection, Secukinumab, Intravenous, 1 Mg 4 1 — — $4,727.00 $7,077.05 $5,902.02 2026-07-24
Q3027 HCPCS Injection, Interferon Beta-1a, 1 Mcg For Intramuscular Use 1 1 — — $5,835.05 $5,835.05 $5,835.05 2026-07-24
J1306 HCPCS Injection, Inclisiran, 1 Mg 2 2 — — $1,906.73 $9,508.52 $5,707.62 2026-07-24
29880 CPT Arthroscopy, Knee, Surgical; With Meniscectomy (medial And Lateral, Including An… 1 1 — — $5,350.00 $5,350.00 $5,350.00 2026-07-24
29881 CPT Arthroscopy, Knee, Surgical; With Meniscectomy (medial Or Lateral, Including Any… 1 1 — — $5,177.50 $5,177.50 $5,177.50 2026-07-24
J0897 HCPCS Injection, Denosumab, 1 Mg 4 2 — — $1,013.65 $9,197.05 $4,941.55 2026-07-24
57250 CPT Posterior Colporrhaphy, Repair Of Rectocele With Or Without Perineorrhaphy 1 1 — — $4,700.00 $4,700.00 $4,700.00 2026-07-24
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 2 2 — — $1,584.31 $7,385.40 $4,484.85 2026-07-24
64721 CPT Neuroplasty And/or Transposition; Median Nerve At Carpal Tunnel 1 1 — — $4,480.00 $4,480.00 $4,480.00 2026-07-24
64718 CPT Neuroplasty And/or Transposition; Ulnar Nerve At Elbow 1 1 — — $4,480.00 $4,480.00 $4,480.00 2026-07-24
58262 CPT Vaginal Hysterectomy, For Uterus 250 G Or Less; With Removal Of Tube(s), And/or … 1 1 — — $4,465.00 $4,465.00 $4,465.00 2026-07-24
72156 CPT Magnetic Resonance (eg, Proton) Imaging, Spinal Canal And Contents, Without Cont… 2 1 — — $4,444.71 $4,444.71 $4,444.71 2026-07-24
J1745 HCPCS Injection, Infliximab, Excludes Biosimilar, 10 Mg 1 1 — — $4,305.63 $4,305.63 $4,305.63 2026-07-24
74178 CPT Computed Tomography, Abdomen And Pelvis; Without Contrast Material In One Or Bot… 4 2 — — $3,198.70 $5,411.50 $4,305.10 2026-07-24
28820 CPT Amputation, Toe; Metatarsophalangeal Joint 1 1 — — $4,180.00 $4,180.00 $4,180.00 2026-07-24
72157 CPT Magnetic Resonance (eg, Proton) Imaging, Spinal Canal And Contents, Without Cont… 2 1 — — $4,144.14 $4,144.14 $4,144.14 2026-07-24
27654 CPT Repair, Secondary, Achilles Tendon, With Or Without Graft 1 1 — — $4,085.00 $4,085.00 $4,085.00 2026-07-24
49505 CPT Repair Initial Inguinal Hernia, Age 5 Years Or Older; Reducible 4 2 — — $780.00 $3,925.00 $3,801.88 2026-07-24
G0390 HCPCS Trauma Response Team Associated With Hospital Critical Care Service 1 1 — — $3,800.00 $3,800.00 $3,800.00 2026-07-24
74177 CPT Computed Tomography, Abdomen And Pelvis; With Contrast Material(s) 4 2 — — $2,858.73 $4,653.88 $3,756.31 2026-07-24
66991 CPT Extracapsular Cataract Removal With Insertion Of Intraocular Lens Prosthesis (1 … 1 1 — — $3,750.00 $3,750.00 $3,750.00 2026-07-24
66984 CPT Extracapsular Cataract Removal With Insertion Of Intraocular Lens Prosthesis (1 … 3 2 — — $1,517.00 $3,750.00 $3,700.00 2026-07-24
70551 CPT Magnetic Resonance (eg, Proton) Imaging, Brain (including Brain Stem); Without C… 6 2 — — $2,370.30 $3,699.10 $3,645.23 2026-07-24
29848 CPT Endoscopy, Wrist, Surgical, With Release Of Transverse Carpal Ligament 3 2 — — $1,886.00 $4,480.00 $3,611.00 2026-07-24
73723 CPT Magnetic Resonance (eg, Proton) Imaging, Any Joint Of Lower Extremity; Without C… 2 1 — — $3,591.14 $3,591.14 $3,591.14 2026-07-24
70544 CPT Magnetic Resonance Angiography, Head; Without Contrast Material(s) 2 1 — — $3,569.71 $3,569.71 $3,569.71 2026-07-24
74175 CPT Computed Tomographic Angiography, Abdomen, With Contrast Material(s), Including … 2 1 — — $3,540.37 $3,540.37 $3,540.37 2026-07-24
72146 CPT Magnetic Resonance (eg, Proton) Imaging, Spinal Canal And Contents, Thoracic; Wi… 2 1 — — $3,539.98 $3,539.98 $3,539.98 2026-07-24
52332 CPT Cystourethroscopy, With Insertion Of Indwelling Ureteral Stent (eg, Gibbons Or D… 1 1 — — $3,525.00 $3,525.00 $3,525.00 2026-07-24
73220 CPT Magnetic Resonance (eg, Proton) Imaging, Upper Extremity, Other Than Joint; With… 2 1 — — $3,524.65 $3,524.65 $3,524.65 2026-07-24
78452 CPT Myocardial Perfusion Imaging, Tomographic (spect) (including Attenuation Correct… 4 2 — — $2,479.05 $4,487.72 $3,483.39 2026-07-24
75635 CPT Computed Tomographic Angiography, Abdominal Aorta And Bilateral Iliofemoral Lowe… 2 1 — — $3,468.09 $3,468.09 $3,468.09 2026-07-24
72158 CPT Magnetic Resonance (eg, Proton) Imaging, Spinal Canal And Contents, Without Cont… 4 2 — — $2,507.41 $4,233.69 $3,370.55 2026-07-24
74170 CPT Computed Tomography, Abdomen; Without Contrast Material, Followed By Contrast Ma… 4 2 — — $3,112.43 $3,317.20 $3,214.81 2026-07-24
J0717 HCPCS Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm… 3 2 — — $1,600.67 $16,073.38 $3,190.50 2026-07-24
74174 CPT Computed Tomographic Angiography, Abdomen And Pelvis, With Contrast Material(s),… 2 1 — — $3,163.61 $3,163.61 $3,163.61 2026-07-24
71552 CPT Magnetic Resonance (eg, Proton) Imaging, Chest (eg, For Evaluation Of Hilar And … 2 1 — — $3,116.00 $3,116.00 $3,116.00 2026-07-24
74176 CPT Computed Tomography, Abdomen And Pelvis; Without Contrast Material 4 2 — — $2,330.05 $3,899.20 $3,114.62 2026-07-24
19120 CPT Excision Of Cyst, Fibroadenoma, Or Other Benign Or Malignant Tumor, Aberrant Bre… 1 1 — — $3,025.00 $3,025.00 $3,025.00 2026-07-24
45100 CPT Biopsy Of Anorectal Wall, Anal Approach (eg, Congenital Megacolon) 1 1 — — $3,025.00 $3,025.00 $3,025.00 2026-07-24
70498 CPT Computed Tomographic Angiography, Neck, With Contrast Material(s), Including Non… 6 2 — — $606.96 $3,034.82 $2,883.08 2026-07-24
70496 CPT Computed Tomographic Angiography, Head, With Contrast Material(s), Including Non… 8 2 — — $590.66 $3,041.90 $2,879.47 2026-07-24
27337 CPT Excision, Tumor, Soft Tissue Of Thigh Or Knee Area, Subcutaneous; 3 Cm Or Greate… 1 1 — — $2,873.75 $2,873.75 $2,873.75 2026-07-24
42830 CPT Adenoidectomy, Primary; Younger Than Age 12 1 1 — — $2,826.25 $2,826.25 $2,826.25 2026-07-24
95811 CPT Polysomnography; Age 6 Years Or Older, Sleep Staging With 4 Or More Additional P… 4 2 — — $931.04 $4,655.18 $2,793.11 2026-07-24
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 10 2 — — $568.72 $3,317.73 $2,755.33 2026-07-24
72148 CPT Magnetic Resonance (eg, Proton) Imaging, Spinal Canal And Contents, Lumbar; With… 4 2 — — $2,053.00 $3,374.95 $2,713.97 2026-07-24
45331 CPT Sigmoidoscopy, Flexible; With Biopsy, Single Or Multiple 1 1 — — $2,700.00 $2,700.00 $2,700.00 2026-07-24
26055 CPT Tendon Sheath Incision (eg, For Trigger Finger) 4 2 — — $896.00 $4,600.00 $2,700.00 2026-07-24
73221 CPT Magnetic Resonance (eg, Proton) Imaging, Any Joint Of Upper Extremity; Without C… 6 2 — — $1,537.13 $2,726.74 $2,673.28 2026-07-24
G0121 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual Not Meeting Criteria For … 3 2 — — $2,517.50 $2,700.00 $2,650.00 2026-07-24
72141 CPT Magnetic Resonance (eg, Proton) Imaging, Spinal Canal And Contents, Cervical; Wi… 4 2 — — $1,920.13 $3,339.35 $2,629.74 2026-07-24
74160 CPT Computed Tomography, Abdomen; With Contrast Material(s) 2 1 — — $2,621.78 $2,621.78 $2,621.78 2026-07-24
45378 CPT Colonoscopy, Flexible; Diagnostic, Including Collection Of Specimen(s) By Brushi… 1 1 — — $2,517.50 $2,517.50 $2,517.50 2026-07-24
G0105 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual At High Risk 3 2 — — $1,643.00 $2,700.00 $2,517.50 2026-07-24
45330 CPT Sigmoidoscopy, Flexible; Diagnostic, Including Collection Of Specimen(s) By Brus… 1 1 — — $2,517.50 $2,517.50 $2,517.50 2026-07-24
70553 CPT Magnetic Resonance (eg, Proton) Imaging, Brain (including Brain Stem); Without C… 4 2 — — $828.52 $4,142.61 $2,485.56 2026-07-24
70491 CPT Computed Tomography, Soft Tissue Neck; With Contrast Material(s) 6 2 — — $511.60 $2,520.76 $2,483.50 2026-07-24
95810 CPT Polysomnography; Age 6 Years Or Older, Sleep Staging With 4 Or More Additional P… 4 2 — — $822.65 $4,113.26 $2,467.95 2026-07-24
71275 CPT Computed Tomographic Angiography, Chest (noncoronary), With Contrast Material(s)… 8 2 — — $696.21 $3,463.82 $2,429.84 2026-07-24
73201 CPT Computed Tomography, Upper Extremity; With Contrast Material(s) 2 1 — — $2,423.44 $2,423.44 $2,423.44 2026-07-24
45385 CPT Colonoscopy, Flexible; With Removal Of Tumor(s), Polyp(s), Or Other Lesion(s) By… 2 2 — — $2,095.75 $2,650.00 $2,372.88 2026-07-24
73701 CPT Computed Tomography, Lower Extremity; With Contrast Material(s) 2 1 — — $2,352.46 $2,352.46 $2,352.46 2026-07-24
43247 CPT Esophagogastroduodenoscopy, Flexible, Transoral; With Removal Of Foreign Body(s) 1 1 — — $2,325.00 $2,325.00 $2,325.00 2026-07-24
43235 CPT Esophagogastroduodenoscopy, Flexible, Transoral; Diagnostic, Including Collectio… 1 1 — — $2,325.00 $2,325.00 $2,325.00 2026-07-24
43245 CPT Esophagogastroduodenoscopy, Flexible, Transoral; With Dilation Of Gastric/duoden… 1 1 — — $2,325.00 $2,325.00 $2,325.00 2026-07-24
72193 CPT Computed Tomography, Pelvis; With Contrast Material(s) 2 1 — — $2,279.86 $2,279.86 $2,279.86 2026-07-24
66982 CPT Extracapsular Cataract Removal With Insertion Of Intraocular Lens Prosthesis (1-… 2 2 — — $740.00 $3,750.00 $2,245.00 2026-07-24
70480 CPT Computed Tomography, Orbit, Sella, Or Posterior Fossa Or Outer, Middle, Or Inner… 2 1 — — $2,207.76 $2,207.76 $2,207.76 2026-07-24
70470 CPT Computed Tomography, Head Or Brain; Without Contrast Material, Followed By Contr… 4 2 — — $1,824.51 $2,569.86 $2,197.18 2026-07-24
70487 CPT Computed Tomography, Maxillofacial Area; With Contrast Material(s) 2 1 — — $2,160.95 $2,160.95 $2,160.95 2026-07-24
71260 CPT Computed Tomography, Thorax, Diagnostic; With Contrast Material(s) 4 2 — — $1,550.78 $2,735.46 $2,143.12 2026-07-24
73721 CPT Magnetic Resonance (eg, Proton) Imaging, Any Joint Of Lower Extremity; Without C… 4 2 — — $1,559.62 $2,716.56 $2,138.09 2026-07-24
70450 CPT Computed Tomography, Head Or Brain; Without Contrast Material 8 2 — — $1,440.40 $2,166.62 $2,134.76 2026-07-24
78227 CPT Hepatobiliary System Imaging, Including Gallbladder When Present; With Pharmacol… 4 2 — — $2,061.51 $2,170.01 $2,115.76 2026-07-24
45380 CPT Colonoscopy, Flexible; With Biopsy, Single Or Multiple 6 2 — — $165.29 $2,700.00 $2,095.75 2026-07-24
72126 CPT Computed Tomography, Cervical Spine; With Contrast Material 2 1 — — $2,079.55 $2,079.55 $2,079.55 2026-07-24
43239 CPT Esophagogastroduodenoscopy, Flexible, Transoral; With Biopsy, Single Or Multiple 2 2 — — $1,776.75 $2,350.00 $2,063.38 2026-07-24
73200 CPT Computed Tomography, Upper Extremity; Without Contrast Material 6 2 — — $2,027.83 $2,134.56 $2,047.10 2026-07-24
C1776 HCPCS Joint Device (implantable) 3 2 — — $900.00 $4,500.00 $2,025.65 2026-07-24
72128 CPT Computed Tomography, Thoracic Spine; Without Contrast Material 4 2 — — $1,562.82 $2,441.90 $2,002.36 2026-07-24
78306 CPT Bone And/or Joint Imaging; Whole Body 2 1 — — $1,957.24 $1,957.24 $1,957.24 2026-07-24
72125 CPT Computed Tomography, Cervical Spine; Without Contrast Material 8 2 — — $481.55 $2,443.86 $1,955.86 2026-07-24
70486 CPT Computed Tomography, Maxillofacial Area; Without Contrast Material 8 2 — — $810.88 $2,022.30 $1,914.32 2026-07-24
G0378 HCPCS Hospital Observation Service, Per Hour 46 2 — — $93.81 $4,678.52 $1,876.11 2026-07-24
J7325 HCPCS Hyaluronan Or Derivative, Synvisc Or Synvisc-one, For Intra-articular Injection,… 2 2 — — $1,149.03 $2,419.00 $1,784.01 2026-07-24
J3262 HCPCS Injection, Tocilizumab, 1 Mg 22 2 — — $217.44 $12,838.20 $1,772.46 2026-07-24
64483 CPT Injection(s), Anesthetic Agent(s) And/or Steroid; Transforaminal Epidural, With … 4 1 — — $151.05 $1,800.00 $1,762.50 2026-07-24
52234 CPT Cystourethroscopy, With Fulguration (including Cryosurgery Or Laser Surgery) And… 1 1 — — $1,475.00 $1,475.00 $1,475.00 2026-07-24
11443 CPT Excision, Other Benign Lesion Including Margins, Except Skin Tag (unless Listed … 3 2 — — $80.70 $1,575.00 $1,472.50 2026-07-24
94002 CPT Ventilation Assist And Management, Initiation Of Pressure Or Volume Preset Venti… 1 1 — — $1,438.67 $1,438.67 $1,438.67 2026-07-24
93306 CPT Echocardiography, Transthoracic, Real-time With Image Documentation (2d), Includ… 4 2 — — $518.80 $2,358.16 $1,438.48 2026-07-24
93970 CPT Duplex Scan Of Extremity Veins Including Responses To Compression And Other Mane… 6 2 — — $1,364.64 $1,508.29 $1,436.46 2026-07-24
72192 CPT Computed Tomography, Pelvis; Without Contrast Material 4 2 — — $440.18 $2,200.88 $1,320.53 2026-07-24
71250 CPT Computed Tomography, Thorax, Diagnostic; Without Contrast Material 4 2 — — $450.09 $2,184.89 $1,317.49 2026-07-24
88341 CPT Immunohistochemistry Or Immunocytochemistry, Per Specimen; Each Additional Singl… 8 2 — — $833.78 $2,632.98 $1,316.49 2026-07-24
73700 CPT Computed Tomography, Lower Extremity; Without Contrast Material 6 2 — — $1,166.19 $2,028.16 $1,307.76 2026-07-24
93925 CPT Duplex Scan Of Lower Extremity Arteries Or Arterial Bypass Grafts; Complete Bila… 2 1 — — $1,300.15 $1,300.15 $1,300.15 2026-07-24
88305 CPT Level IV - Surgical Pathology, Gross And Microscopic Examination Abortion - Spon… 24 2 — — $321.40 $2,866.01 $1,197.59 2026-07-24
93971 CPT Duplex Scan Of Extremity Veins Including Responses To Compression And Other Mane… 6 2 — — $777.02 $1,289.14 $1,177.30 2026-07-24
93975 CPT Duplex Scan Of Arterial Inflow And Venous Outflow Of Abdominal, Pelvic, Scrotal … 2 1 — — $1,149.89 $1,149.89 $1,149.89 2026-07-24
78709 CPT Kidney Imaging Morphology; With Vascular Flow And Function, Multiple Studies, Wi… 2 1 — — $1,114.00 $1,114.00 $1,114.00 2026-07-24
P9016 HCPCS Red Blood Cells, Leukocytes Reduced, Each Unit 6 2 — — $85.00 $1,683.96 $1,073.42 2026-07-24
64493 CPT Injection(s), Diagnostic Or Therapeutic Agent, Paravertebral Facet (zygapophysea… 4 2 — — $122.82 $1,800.00 $1,050.00 2026-07-24
93926 CPT Duplex Scan Of Lower Extremity Arteries Or Arterial Bypass Grafts; Unilateral Or… 4 2 — — $1,003.50 $1,048.66 $1,026.08 2026-07-24
93880 CPT Duplex Scan Of Extracranial Arteries; Complete Bilateral Study 8 2 — — $405.85 $1,632.71 $1,025.11 2026-07-24
36430 CPT Transfusion, Blood Or Blood Components 4 2 — — $609.04 $1,086.45 $1,018.56 2026-07-24
93308 CPT Echocardiography, Transthoracic, Real-time With Image Documentation (2d), Includ… 4 2 — — $997.49 $1,018.68 $1,008.09 2026-07-24
Q5106 HCPCS Injection, Epoetin Alfa-epbx, Biosimilar, (retacrit) (for Non-esrd Use), 1000 Un… 6 2 — — $494.71 $1,552.42 $985.62 2026-07-24
Q5101 HCPCS Injection, Filgrastim-sndz, Biosimilar, (zarxio), 1 Microgram 2 2 — — $718.30 $1,209.70 $964.00 2026-07-24
94660 CPT Continuous Positive Airway Pressure Ventilation (cpap), Initiation And Managemen… 2 2 — — $948.02 $977.96 $962.99 2026-07-24
11646 CPT Excision, Malignant Lesion Including Margins, Face, Ears, Eyelids, Nose, Lips; E… 2 1 — — $343.33 $1,575.00 $959.16 2026-07-24
93978 CPT Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; C… 2 1 — — $946.30 $946.30 $946.30 2026-07-24
93017 CPT Cardiovascular Stress Test Using Maximal Or Submaximal Treadmill Or Bicycle Exer… 3 2 — — $300.93 $1,331.55 $932.88 2026-07-24
74183 CPT Magnetic Resonance (eg, Proton) Imaging, Abdomen; Without Contrast Material(s), … 2 1 — — $929.98 $929.98 $929.98 2026-07-24
82787 CPT Gammaglobulin (immunoglobulin); Immunoglobulin Subclasses (eg, IgG1, 2, 3, Or 4)… 1 1 — — $912.22 $912.22 $912.22 2026-07-24
96413 CPT Chemotherapy Administration, Intravenous Infusion Technique; Up To 1 Hour, Singl… 2 2 — — $881.55 $927.95 $904.75 2026-07-24
52000 CPT Cystourethroscopy (separate Procedure) 2 2 — — $295.00 $1,425.00 $860.00 2026-07-24
87507 CPT Infectious Agent Detection By Nucleic Acid (dna Or Rna); Gastrointestinal Pathog… 1 1 — — $826.64 $826.64 $826.64 2026-07-24
76700 CPT Ultrasound, Abdominal, Real Time With Image Documentation; Complete 4 2 — — $728.69 $911.14 $819.91 2026-07-24
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 3 2 — — $161.94 $1,610.60 $809.70 2026-07-24
76856 CPT Ultrasound, Pelvic (nonobstetric), Real Time With Image Documentation; Complete 2 1 — — $803.23 $803.23 $803.23 2026-07-24
99292 CPT Critical Care, Evaluation And Management Of The Critically Ill Or Critically Inj… 12 2 — — $80.37 $9,295.00 $796.53 2026-07-24
87150 CPT Culture, Typing; Identification By Nucleic Acid (dna Or Rna) Probe, Amplified Pr… 1 1 — — $773.30 $773.30 $773.30 2026-07-24
70546 CPT Magnetic Resonance Angiography, Head; Without Contrast Material(s), Followed By … 2 1 — — $760.97 $760.97 $760.97 2026-07-24
93924 CPT Noninvasive Physiologic Studies Of Lower Extremity Arteries, At Rest And Followi… 2 1 — — $736.00 $736.00 $736.00 2026-07-24
94060 CPT Bronchodilation Responsiveness, Spirometry As In 94010, Pre- And Post-bronchodil… 10 2 — — $146.75 $777.79 $733.76 2026-07-24
71271 CPT Computed Tomography, Thorax, Low Dose For Lung Cancer Screening, Without Contras… 4 2 — — $579.15 $877.50 $728.33 2026-07-24
76770 CPT Ultrasound, Retroperitoneal (eg, Renal, Aorta, Nodes), Real Time With Image Docu… 4 2 — — $547.91 $883.73 $715.82 2026-07-24
80329 CPT Analgesics, Non-opioid; 1 Or 2 1 1 — — $714.91 $714.91 $714.91 2026-07-24
73720 CPT Magnetic Resonance (eg, Proton) Imaging, Lower Extremity Other Than Joint; Witho… 2 1 — — $709.70 $709.70 $709.70 2026-07-24
76705 CPT Ultrasound, Abdominal, Real Time With Image Documentation; Limited (eg, Single O… 6 2 — — $669.53 $719.75 $704.77 2026-07-24
76942 CPT Ultrasonic Guidance For Needle Placement (eg, Biopsy, Aspiration, Injection, Loc… 4 2 — — $664.45 $699.42 $681.93 2026-07-24
76830 CPT Ultrasound, Transvaginal 2 1 — — $651.99 $651.99 $651.99 2026-07-24
76536 CPT Ultrasound, Soft Tissues Of Head And Neck (eg, Thyroid, Parathyroid, Parotid), R… 4 2 — — $624.41 $657.27 $640.84 2026-07-24
93979 CPT Duplex Scan Of Aorta, Inferior Vena Cava, Iliac Vasculature, Or Bypass Grafts; U… 4 1 — — $612.50 $644.74 $628.62 2026-07-24
0202U CPT Infectious Disease (bacterial Or Viral Respiratory Tract Infection), Pathogen-sp… 1 1 — — $624.40 $624.40 $624.40 2026-07-24
46260 CPT Hemorrhoidectomy, Internal And External, 2 Or More Columns/groups 1 1 — — $615.00 $615.00 $615.00 2026-07-24
76870 CPT Ultrasound, Scrotum And Contents 4 2 — — $476.92 $740.67 $608.79 2026-07-24
71111 CPT Radiologic Examination, Ribs, Bilateral; Including Posteroanterior Chest, Minimu… 4 1 — — $574.88 $586.38 $580.63 2026-07-24
70492 CPT Computed Tomography, Soft Tissue Neck; Without Contrast Material Followed By Con… 2 1 — — $578.02 $578.02 $578.02 2026-07-24
87040 CPT Culture, Bacterial; Blood, Aerobic, With Isolation And Presumptive Identificatio… 6 2 — — $337.71 $953.46 $577.65 2026-07-24
88307 CPT Level V - Surgical Pathology, Gross And Microscopic Examination Adrenal, Resecti… 2 1 — — $570.50 $570.50 $570.50 2026-07-24
76882 CPT Ultrasound, Limited, Joint Or Focal Evaluation Of Other Nonvascular Extremity St… 4 2 — — $550.67 $565.51 $558.09 2026-07-24
87154 CPT Culture, Typing; Identification Of Blood Pathogen And Resistance Typing, When Pe… 3 2 — — $407.82 $1,096.30 $548.15 2026-07-24
96365 CPT Intravenous Infusion, For Therapy, Prophylaxis, Or Diagnosis (specify Substance … 3 2 — — $300.05 $576.45 $528.85 2026-07-24
77080 CPT Dual-energy X-ray Absorptiometry (dxa), Bone Density Study, 1 Or More Sites; Axi… 6 2 — — $487.74 $539.08 $513.41 2026-07-24
93225 CPT External Electrocardiographic Recording Up To 48 Hours By Continuous Rhythm Reco… 5 2 — — $112.84 $550.76 $510.47 2026-07-24
96360 CPT Intravenous Infusion, Hydration; Initial, 31 Minutes To 1 Hour 3 2 — — $446.01 $504.69 $499.17 2026-07-24
93005 CPT Electrocardiogram, Routine ECG With At Least 12 Leads; Tracing Only, Without Int… 7 2 — — $176.60 $990.75 $495.38 2026-07-24
72131 CPT Computed Tomography, Lumbar Spine; Without Contrast Material 6 2 — — $487.41 $2,437.07 $494.73 2026-07-24
72072 CPT Radiologic Examination, Spine; Thoracic, 3 Views 2 1 — — $486.98 $486.98 $486.98 2026-07-24
A9562 HCPCS Technetium Tc-99m Mertiatide, Diagnostic, Per Study Dose, Up To 15 Millicuries 1 1 — — $483.32 $483.32 $483.32 2026-07-24
93226 CPT External Electrocardiographic Recording Up To 48 Hours By Continuous Rhythm Reco… 4 2 — — $174.29 $726.22 $482.21 2026-07-24
0420 RC — 6 1 — — $313.74 $2,436.76 $476.04 2026-07-24
73522 CPT Radiologic Examination, Hips, Bilateral, With Pelvis When Performed; 3-4 Views 2 1 — — $475.00 $475.00 $475.00 2026-07-24
72050 CPT Radiologic Examination, Spine, Cervical; 4 Or 5 Views 8 2 — — $110.15 $542.72 $453.39 2026-07-24
96415 CPT Chemotherapy Administration, Intravenous Infusion Technique; Each Additional Hou… 2 1 — — $302.00 $604.00 $453.00 2026-07-24
73523 CPT Radiologic Examination, Hips, Bilateral, With Pelvis When Performed; Minimum Of … 4 2 — — $346.70 $525.30 $436.00 2026-07-24
93246 CPT External Electrocardiographic Recording For More Than 7 Days Up To 15 Days By Co… 4 2 — — $91.00 $455.00 $430.71 2026-07-24
87497 CPT Infectious Agent Detection By Nucleic Acid (dna Or Rna); Cytomegalovirus, Quanti… 2 1 — — $407.79 $448.57 $428.18 2026-07-24
83993 CPT Calprotectin, Fecal 1 1 — — $425.23 $425.23 $425.23 2026-07-24
76642 CPT Ultrasound, Breast, Unilateral, Real Time With Image Documentation, Including Ax… 10 2 — — $103.11 $447.88 $419.71 2026-07-24
96402 CPT Chemotherapy Administration, Subcutaneous Or Intramuscular; Hormonal Anti-neopla… 3 2 — — $87.66 $438.32 $417.45 2026-07-24
71101 CPT Radiologic Examination, Ribs, Unilateral; Including Posteroanterior Chest, Minim… 6 2 — — $405.77 $427.13 $416.71 2026-07-24
87633 CPT Infectious Agent Detection By Nucleic Acid (dna Or Rna); Respiratory Virus (eg, … 2 2 — — $403.75 $425.00 $414.38 2026-07-24
86255 CPT Fluorescent Noninfectious Agent Antibody; Screen, Each Antibody 1 1 — — $405.00 $405.00 $405.00 2026-07-24
72100 CPT Radiologic Examination, Spine, Lumbosacral; 2 Or 3 Views 4 2 — — $359.11 $449.31 $404.21 2026-07-24
72190 CPT Radiologic Examination, Pelvis; Complete, Minimum Of 3 Views 2 1 — — $400.00 $400.00 $400.00 2026-07-24
73564 CPT Radiologic Examination, Knee; Complete, 4 Or More Views 10 2 — — $92.06 $415.17 $399.20 2026-07-24
74019 CPT Radiologic Examination, Abdomen; 2 Views 10 2 — — $79.47 $619.83 $397.33 2026-07-24
87385 CPT Infectious Agent Antigen Detection By Immunoassay Technique (eg, Enzyme Immunoas… 2 1 — — $263.06 $526.11 $394.59 2026-07-24
92523 CPT Evaluation Of Speech Sound Production (eg, Articulation, Phonological Process, A… 2 1 — — $389.84 $389.84 $389.84 2026-07-24
86922 CPT Compatibility Test Each Unit; Antiglobulin Technique 6 2 — — $67.87 $678.70 $388.71 2026-07-24
36593 CPT Declotting By Thrombolytic Agent Of Implanted Vascular Access Device Or Catheter 4 2 — — $90.44 $437.50 $382.81 2026-07-24
97535 CPT Self-care/home Management Training (eg, Activities Of Daily Living (adl) And Com… 15 2 — — $96.39 $694.61 $378.02 2026-07-24
70160 CPT Radiologic Examination, Nasal Bones, Complete, Minimum Of 3 Views 2 1 — — $377.10 $377.10 $377.10 2026-07-24
72110 CPT Radiologic Examination, Spine, Lumbosacral; Minimum Of 4 Views 8 2 — — $109.81 $541.08 $375.82 2026-07-24
88342 CPT Immunohistochemistry Or Immunocytochemistry, Per Specimen; Initial Single Antibo… 4 2 — — $360.59 $379.57 $370.08 2026-07-24
72070 CPT Radiologic Examination, Spine; Thoracic, 2 Views 6 2 — — $362.75 $381.84 $368.10 2026-07-24
96361 CPT Intravenous Infusion, Hydration; Each Additional Hour (List Separately In Additi… 4 2 — — $182.94 $486.76 $360.27 2026-07-24
95806 CPT Sleep Study, Unattended, Simultaneous Recording Of, Heart Rate, Oxygen Saturatio… 8 2 — — $313.50 $407.55 $354.75 2026-07-24
94667 CPT Manipulation Chest Wall, Such As Cupping, Percussing, And Vibration To Facilitat… 2 1 — — $236.00 $472.00 $354.00 2026-07-24
73130 CPT Radiologic Examination, Hand; Minimum Of 3 Views 12 2 — — $207.82 $729.89 $353.12 2026-07-24
73030 CPT Radiologic Examination, Shoulder; Complete, Minimum Of 2 Views 12 2 — — $72.29 $368.69 $352.42 2026-07-24
82803 CPT Gases, Blood, Any Combination Of Ph, Pco2, Po2, Co2, Hco3 (including Calculated … 6 2 — — $252.18 $530.90 $351.73 2026-07-24
73630 CPT Radiologic Examination, Foot; Complete, Minimum Of 3 Views 6 2 — — $267.90 $370.00 $350.71 2026-07-24
62323 CPT Injection(s), Of Diagnostic Or Therapeutic Substance(s) (eg, Anesthetic, Antispa… 9 2 — — $17.91 $1,800.00 $350.00 2026-07-24
94621 CPT Cardiopulmonary Exercise Testing, Including Measurements Of Minute Ventilation, … 2 1 — — $348.36 $348.36 $348.36 2026-07-24
93922 CPT Limited Bilateral Noninvasive Physiologic Studies Of Upper Or Lower Extremity Ar… 4 2 — — $131.45 $565.02 $348.24 2026-07-24
77065 CPT Diagnostic Mammography, Including Computer-aided Detection (cad) When Performed;… 6 2 — — $293.02 $364.85 $346.61 2026-07-24
73610 CPT Radiologic Examination, Ankle; Complete, Minimum Of 3 Views 8 2 — — $257.19 $352.30 $342.13 2026-07-24
96401 CPT Chemotherapy Administration, Subcutaneous Or Intramuscular; Non-hormonal Anti-ne… 2 2 — — $330.49 $347.88 $339.19 2026-07-24
72220 CPT Radiologic Examination, Sacrum And Coccyx, Minimum Of 2 Views 2 1 — — $337.46 $337.46 $337.46 2026-07-24
80050 CPT General Health Panel This Panel Must Include The Following: Comprehensive Metabo… 3 1 — — $279.68 $336.11 $336.10 2026-07-24
96374 CPT Therapeutic, Prophylactic, Or Diagnostic Injection (specify Substance Or Drug); … 3 2 — — $229.02 $350.91 $335.80 2026-07-24
83520 CPT Immunoassay For Analyte Other Than Infectious Agent Antibody Or Infectious Agent… 1 1 — — $331.18 $331.18 $331.18 2026-07-24
96366 CPT Intravenous Infusion, For Therapy, Prophylaxis, Or Diagnosis (specify Substance … 7 2 — — $66.23 $993.45 $331.15 2026-07-24
73562 CPT Radiologic Examination, Knee; 3 Views 4 2 — — $275.40 $383.95 $329.67 2026-07-24
73590 CPT Radiologic Examination; Tibia And Fibula, 2 Views 8 2 — — $262.16 $343.67 $323.44 2026-07-24
73110 CPT Radiologic Examination, Wrist; Complete, Minimum Of 3 Views 8 2 — — $216.21 $348.73 $321.64 2026-07-24
97110 CPT Therapeutic Procedure, 1 Or More Areas, Each 15 Minutes; Therapeutic Exercises T… 18 2 — — $75.06 $548.26 $321.58 2026-07-24
71100 CPT Radiologic Examination, Ribs, Unilateral; 2 Views 4 1 — — $316.19 $325.67 $320.93 2026-07-24
77066 CPT Diagnostic Mammography, Including Computer-aided Detection (cad) When Performed;… 4 2 — — $199.66 $442.17 $320.92 2026-07-24
73090 CPT Radiologic Examination; Forearm, 2 Views 6 2 — — $304.17 $336.18 $319.38 2026-07-24
96375 CPT Therapeutic, Prophylactic, Or Diagnostic Injection (specify Substance Or Drug); … 5 2 — — $62.19 $332.66 $312.54 2026-07-24
74018 CPT Radiologic Examination, Abdomen; 1 View 6 2 — — $65.36 $326.79 $310.45 2026-07-24
92522 CPT Evaluation Of Speech Sound Production (eg, Articulation, Phonological Process, A… 2 1 — — $309.44 $309.44 $309.44 2026-07-24
87522 CPT Infectious Agent Detection By Nucleic Acid (dna Or Rna); Hepatitis C, Quantifica… 1 1 — — $307.41 $307.41 $307.41 2026-07-24
94644 CPT Continuous Inhalation Treatment With Aerosol Medication For Acute Airway Obstruc… 3 2 — — $122.50 $581.89 $306.26 2026-07-24
92507 CPT Treatment Of Speech, Language, Voice, Communication, And/or Auditory Processing … 2 1 — — $305.24 $305.24 $305.24 2026-07-24
73560 CPT Radiologic Examination, Knee; 1 Or 2 Views 8 2 — — $73.24 $379.00 $304.55 2026-07-24
94618 CPT Pulmonary Stress Testing (eg, 6-minute Walk Test), Including Measurement Of Hear… 4 2 — — $183.38 $423.50 $303.44 2026-07-24
80074 CPT Acute Hepatitis Panel This Panel Must Include The Following: Hepatitis A Antibod… 2 2 — — $286.72 $301.81 $294.26 2026-07-24
71045 CPT Radiologic Examination, Chest; Single View 8 2 — — $59.35 $845.74 $289.34 2026-07-24
73600 CPT Radiologic Examination, Ankle; 2 Views 2 1 — — $278.70 $278.70 $278.70 2026-07-24
83880 CPT Natriuretic Peptide 3 2 — — $231.69 $289.43 $274.96 2026-07-24
73070 CPT Radiologic Examination, Elbow; 2 Views 2 1 — — $274.55 $274.55 $274.55 2026-07-24
94640 CPT Pressurized Or Nonpressurized Inhalation Treatment For Acute Airway Obstruction … 8 2 — — $135.80 $339.50 $273.68 2026-07-24
73620 CPT Radiologic Examination, Foot; 2 Views 2 1 — — $272.18 $272.18 $272.18 2026-07-24
64490 CPT Injection(s), Diagnostic Or Therapeutic Agent, Paravertebral Facet (zygapophysea… 2 1 — — $194.28 $350.00 $272.14 2026-07-24
80377 CPT Drug(s) Or Substance(s), Definitive, Qualitative Or Quantitative, Not Otherwise … 1 1 — — $268.19 $268.19 $268.19 2026-07-24
A9500 HCPCS Technetium Tc-99m Sestamibi, Diagnostic, Per Study Dose 2 2 — — $89.25 $446.23 $267.74 2026-07-24
87493 CPT Infectious Agent Detection By Nucleic Acid (dna Or Rna); Clostridium Difficile, … 3 2 — — $248.75 $281.09 $267.04 2026-07-24
73100 CPT Radiologic Examination, Wrist; 2 Views 4 2 — — $251.56 $278.03 $264.79 2026-07-24
73502 CPT Radiologic Examination, Hip, Unilateral, With Pelvis When Performed; 2-3 Views 8 2 — — $68.11 $340.53 $264.68 2026-07-24
96376 CPT Therapeutic, Prophylactic, Or Diagnostic Injection (specify Substance Or Drug); … 1 1 — — $264.09 $264.09 $264.09 2026-07-24
73020 CPT Radiologic Examination, Shoulder; 1 View 2 1 — — $256.91 $256.91 $256.91 2026-07-24
88313 CPT Special Stain Including Interpretation And Report; Group Ii, All Other (eg, Iron… 6 2 — — $91.49 $260.90 $247.86 2026-07-24
72170 CPT Radiologic Examination, Pelvis; 1 Or 2 Views 8 2 — — $70.19 $350.91 $246.25 2026-07-24
84145 CPT Procalcitonin (pct) 4 2 — — $155.29 $256.73 $244.21 2026-07-24
73140 CPT Radiologic Examination, Finger(s), Minimum Of 2 Views 6 2 — — $147.56 $256.18 $243.37 2026-07-24
71046 CPT Radiologic Examination, Chest; 2 Views 4 2 — — $136.73 $347.85 $242.29 2026-07-24
73660 CPT Radiologic Examination; Toe(s), Minimum Of 2 Views 4 2 — — $241.14 $241.74 $241.44 2026-07-24
99195 CPT Phlebotomy, Therapeutic (separate Procedure) 3 2 — — $148.65 $279.51 $241.40 2026-07-24
83521 CPT Immunoglobulin Light Chains (ie, Kappa, Lambda), Free, Each 1 1 — — $240.00 $240.00 $240.00 2026-07-24
87901 CPT Infectious Agent Genotype Analysis By Nucleic Acid (dna Or Rna); HIV-1, Reverse … 1 1 — — $237.50 $237.50 $237.50 2026-07-24
87906 CPT Infectious Agent Genotype Analysis By Nucleic Acid (dna Or Rna); HIV-1, Other Re… 1 1 — — $237.50 $237.50 $237.50 2026-07-24
87900 CPT Infectious Agent Drug Susceptibility Phenotype Prediction Using Regularly Update… 1 1 — — $237.50 $237.50 $237.50 2026-07-24
87186 CPT Susceptibility Studies, Antimicrobial Agent; Microdilution Or Agar Dilution (min… 9 2 — — $100.06 $480.48 $237.35 2026-07-24
97140 CPT Manual Therapy Techniques (eg, Mobilization/ Manipulation, Manual Lymphatic Drai… 12 2 — — $71.80 $544.02 $236.53 2026-07-24
73551 CPT Radiologic Examination, Femur; 1 View 4 1 — — $192.00 $259.20 $225.60 2026-07-24
99291 CPT Critical Care, Evaluation And Management Of The Critically Ill Or Critically Inj… 9 2 — — $38.40 $2,313.70 $220.81 2026-07-24
92610 CPT Evaluation Of Oral And Pharyngeal Swallowing Function 4 2 — — $69.50 $371.81 $220.66 2026-07-24
86042 CPT Acetylcholine Receptor (AChR); Blocking Antibody 1 1 — — $217.70 $217.70 $217.70 2026-07-24
86041 CPT Acetylcholine Receptor (AChR); Binding Antibody 1 1 — — $217.70 $217.70 $217.70 2026-07-24
72040 CPT Radiologic Examination, Spine, Cervical; 2 Or 3 Views 4 2 — — $74.68 $355.64 $215.16 2026-07-24
83970 CPT Parathormone (parathyroid Hormone) 2 2 — — $190.18 $234.86 $212.52 2026-07-24
73650 CPT Radiologic Examination; Calcaneus, Minimum Of 2 Views 6 2 — — $173.18 $266.71 $211.84 2026-07-24
73080 CPT Radiologic Examination, Elbow; Complete, Minimum Of 3 Views 14 2 — — $71.83 $369.92 $211.63 2026-07-24
80320 CPT Alcohols 1 1 — — $210.94 $210.94 $210.94 2026-07-24
88360 CPT Morphometric Analysis, Tumor Immunohistochemistry (eg, Her-2/neu, Estrogen Recep… 4 2 — — $204.25 $215.00 $209.62 2026-07-24
73552 CPT Radiologic Examination, Femur; Minimum 2 Views 8 2 — — $72.12 $378.62 $209.14 2026-07-24
93798 CPT Physician Or Other Qualified Health Care Professional Services For Outpatient Ca… 2 2 — — $69.67 $348.36 $209.01 2026-07-24
88304 CPT Level Iii - Surgical Pathology, Gross And Microscopic Examination Abortion, Indu… 6 2 — — $196.99 $228.10 $207.36 2026-07-24
97167 CPT Occupational Therapy Evaluation, High Complexity, Requiring These Components: An… 2 1 — — $205.00 $205.00 $205.00 2026-07-24
83090 CPT Homocysteine 1 1 — — $204.17 $204.17 $204.17 2026-07-24
73060 CPT Radiologic Examination; Humerus, Minimum Of 2 Views 4 2 — — $66.38 $331.91 $199.15 2026-07-24
86334 CPT Immunofixation Electrophoresis; Serum 2 1 — — $189.95 $199.45 $194.70 2026-07-24
S3620 HCPCS Newborn Metabolic Screening Panel, Includes Test Kit, Postage And The Laboratory… 1 1 — — $191.19 $191.19 $191.19 2026-07-24
97530 CPT Therapeutic Activities, Direct (one-on-one) Patient Contact (use Of Dynamic Acti… 15 2 — — $42.30 $274.92 $190.33 2026-07-24
88312 CPT Special Stain Including Interpretation And Report; Group I For Microorganisms (e… 6 2 — — $178.34 $375.46 $187.73 2026-07-24
88302 CPT Level Ii - Surgical Pathology, Gross And Microscopic Examination Appendix, Incid… 4 2 — — $186.94 $187.84 $187.39 2026-07-24
87077 CPT Culture, Bacterial; Aerobic Isolate, Additional Methods Required For Definitive … 9 2 — — $78.47 $387.80 $186.05 2026-07-24
0077U CPT Immunoglobulin Paraprotein (m-protein), Qualitative, Immunoprecipitation And Mas… 1 1 — — $185.77 $185.77 $185.77 2026-07-24
99282 CPT Emergency Department Visit For The Evaluation And Management Of A Patient, Which… 8 2 — — $6.39 $460.00 $183.62 2026-07-24
87420 CPT Infectious Agent Antigen Detection By Immunoassay Technique (eg, Enzyme Immunoas… 1 1 — — $183.49 $183.49 $183.49 2026-07-24
82077 CPT Alcohol (ethanol); Any Specimen Except Urine And Breath, Immunoassay (eg, Ia, Ei… 2 2 — — $178.10 $187.47 $182.78 2026-07-24
82653 CPT Elastase, Pancreatic (el-1), Fecal; Quantitative 2 2 — — $121.60 $243.20 $182.40 2026-07-24
92526 CPT Treatment Of Swallowing Dysfunction And/or Oral Function For Feeding 4 2 — — $60.56 $302.82 $181.69 2026-07-24
88108 CPT Cytopathology, Concentration Technique, Smears And Interpretation (eg, Saccomann… 2 1 — — $180.18 $180.18 $180.18 2026-07-24
87116 CPT Culture, Tubercle Or Other Acid-fast Bacilli (eg, Tb, Afb, Mycobacteria) Any Sou… 1 1 — — $179.11 $179.11 $179.11 2026-07-24
86235 CPT Extractable Nuclear Antigen, Antibody To, Any Method (eg, Nrnp, Ss-a, Ss-b, Sm, … 3 2 — — $177.38 $186.72 $177.39 2026-07-24
84484 CPT Troponin, Quantitative 1 1 — — $176.82 $176.82 $176.82 2026-07-24
80285 CPT Voriconazole 1 1 — — $176.61 $176.61 $176.61 2026-07-24
80305 CPT Drug Test(s), Presumptive, Any Number Of Drug Classes, Any Number Of Devices Or … 2 2 — — $173.72 $179.27 $176.50 2026-07-24
84445 CPT Thyroid Stimulating Immune Globulins (tsi) 1 1 — — $175.00 $175.00 $175.00 2026-07-24
87338 CPT Infectious Agent Antigen Detection By Immunoassay Technique (eg, Enzyme Immunoas… 2 2 — — $169.78 $178.72 $174.25 2026-07-24
88323 CPT Consultation And Report On Referred Material Requiring Preparation Of Slides 2 1 — — $174.00 $174.00 $174.00 2026-07-24
99284 CPT Emergency Department Visit For The Evaluation And Management Of A Patient, Which… 8 2 — — $18.43 $1,200.00 $171.69 2026-07-24
85379 CPT Fibrin Degradation Products, D-dimer; Quantitative 3 2 — — $146.71 $180.47 $171.45 2026-07-24
84305 CPT Somatomedin 1 1 — — $169.22 $169.22 $169.22 2026-07-24
87400 CPT Infectious Agent Antigen Detection By Immunoassay Technique (eg, Enzyme Immunoas… 2 2 — — $162.94 $171.52 $167.23 2026-07-24
See an error in this hospital's data? Submit a correction