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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

TIOGA MEDICAL CENTER

Tioga, ND · CCN 351300 · Rates published

3,760 distinct procedures filed
1 distinct payers
4,188 rate rows
2026-01-21 last MRF observed
Data quality

4,188 of 4,188 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://secure.claraprice.net/price-transparency/CKCV-1764013429670/machine-readable/450308484_tioga-medical-center_standardcharges.json
Found on page https://secure.claraprice.net/price-transparency/tioga-medical-center-nd
Discovered viaCMS hospital list
Last fetch success · 2026-11-03
Content fingerprint de0488010c32fb6e… · 1,947,246 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
28725
CPT 		Hc Fusion Foot Bones,subtalar 1 $25,986.00 $25,986.00 $25,986.00 nat. median
$10,483
outlier · 2.5×
27702
CPT 		Arthroplasty Ankle W/implant 1 $24,984.00 $25,986.00 $25,485.00 nat. median
$15,294
1.7× median
129288
CDM 		Ustekinumab 90 Mg/ml Sc Sosy 1 $14,097.00 $14,097.00 $14,097.00 nat. median
$906
outlier · 15.6×
CP17679084990107649
CDM 		Ustekinumab 90 Mg/ml Sc Sosy 1 $14,097.00 $14,097.00 $14,097.00 nat. median
$14,097
1.0× median
CP17679084990144474
CDM 		Tenecteplase 50 Mg IV Kit 1 $13,587.00 $13,587.00 $13,587.00 nat. median
$13,587
1.0× median
600949
CDM 		Tenecteplase 50mg IV For Stroke 1 $13,587.00 $13,587.00 $13,587.00 nat. median
$33
outlier · 406.3×
600948
CDM 		Tenecteplase 50mg IV For Cardiac / Pe 1 $13,587.00 $13,587.00 $13,587.00 nat. median
$142
outlier · 95.4×
28530
CDM 		Tenecteplase 50 Mg IV Kit 1 $13,587.00 $13,587.00 $13,587.00 nat. median
$229
outlier · 59.3×
27654
CPT 		Hc Rpr Achilles Tendon 1 $13,553.00 $13,553.00 $13,553.00 nat. median
$6,824
2.0× median
28740
CPT 		Hc Fusion Of Foot Bones 1 $13,553.00 $13,553.00 $13,553.00 nat. median
$6,895
2.0× median
28322
CPT 		Hc Repair Of Metatarsals 1 $13,548.00 $13,548.00 $13,548.00 nat. median
$6,571
outlier · 2.1×
28298
CPT 		Hc Correct Bunion,phalanx Osteotomy 1 $13,548.00 $13,548.00 $13,548.00 nat. median
$6,642
outlier · 2.0×
28750
CPT 		Hc Fusion Big Toe,mt-p Jt 1 $13,548.00 $13,548.00 $13,548.00 nat. median
$7,026
1.9× median
28297
CPT 		Hc Correct Bunion,lapidus Type 1 $13,548.00 $13,548.00 $13,548.00 nat. median
$7,597
1.8× median
27822
CPT 		Hc Open Rx Trimalleolar Fx 1 $13,548.00 $13,548.00 $13,548.00 nat. median
$7,102
1.9× median
28755
CPT 		Hc Fusion Big Toe,i-p Joint 1 $13,548.00 $13,548.00 $13,548.00 nat. median
$6,216
outlier · 2.2×
28306
CPT 		Hc Osteotomy 1st Metatarsal,base/shaft 1 $13,548.00 $13,548.00 $13,548.00 nat. median
$6,275
outlier · 2.2×
27691
CPT 		Hc Revis Lower Leg Tendon 1 $13,548.00 $13,548.00 $13,548.00 nat. median
$6,958
1.9× median
27814
CPT 		Hc Open Rx Bimalleolar Fx 1 $13,419.00 $13,419.00 $13,419.00 nat. median
$7,155
1.9× median
27695
CPT 		Hc Repair 1 Collat Ankle Ligmnt,primary 1 $13,419.00 $13,419.00 $13,419.00 nat. median
$6,570
outlier · 2.0×
28291
CPT 		Hc Corrj Halux Rigdus W/implt 1 $13,419.00 $13,419.00 $13,419.00 nat. median
$7,179
1.9× median
28107
CPT 		Hc Remove/graft Foot Lesion 1 $13,220.00 $13,220.00 $13,220.00 nat. median
$6,849
1.9× median
28299
CPT 		Hc Correct Bunion,othr Methods 1 $13,220.00 $13,220.00 $13,220.00 nat. median
$6,845
1.9× median
28300
CPT 		Hc Incision Of Heel Bone 1 $13,220.00 $13,220.00 $13,220.00 nat. median
$6,724
2.0× median
28070
CPT 		Hc Removal Of Foot Joint Lining 1 $13,220.00 $13,220.00 $13,220.00 nat. median
$6,161
outlier · 2.1×
28615
CPT 		Hc Repair Foot Dislocation 1 $13,220.00 $13,220.00 $13,220.00 nat. median
$6,795
1.9× median
28310
CPT 		Hc Revision Of Big Toe 1 $13,220.00 $13,220.00 $13,220.00 nat. median
$6,095
outlier · 2.2×
27700
CPT 		Hc Revision Of Ankle Joint 1 $13,220.00 $13,220.00 $13,220.00 nat. median
$6,954
1.9× median
28309
CPT 		Hc Incision Of Metatarsals 1 $13,220.00 $13,220.00 $13,220.00 nat. median
$6,876
1.9× median
28302
CPT 		Hc Incision Of Ankle Bone 1 $13,220.00 $13,220.00 $13,220.00 nat. median
$6,536
outlier · 2.0×
27698
CPT 		Hc Repair Collat Ankle Ligmnt,secondar 1 $13,219.00 $13,220.00 $13,219.50 nat. median
$6,559
outlier · 2.0×
28238
CPT 		Hc Revision Of Foot Tendon 1 $13,219.00 $13,219.00 $13,219.00 nat. median
$6,752
2.0× median
27696
CPT 		Hc Repair Of Ankle Ligaments 1 $13,219.00 $13,219.00 $13,219.00 nat. median
$6,711
2.0× median
28415
CPT 		Open Treatment Calcaneal Fracture 1 $13,219.00 $13,219.00 $13,219.00 nat. median
$7,313
1.8× median
28307
CPT 		Hc Osteotomy 1st Metatarsal,autograft 1 $12,710.00 $12,710.00 $12,710.00 nat. median
$6,344
outlier · 2.0×
27659
CPT 		Hc Repair Flex Leg Tendon,second,ea 1 $12,710.00 $12,710.00 $12,710.00 nat. median
$6,191
outlier · 2.1×
28103
CPT 		Hc Remove/graft Foot Lesion 1 $12,710.00 $12,710.00 $12,710.00 nat. median
$6,823
1.9× median
28305
CPT 		Hc Osteotomy Midtarsal,autograft 1 $12,710.00 $12,710.00 $12,710.00 nat. median
$6,929
1.8× median
81162
CPT 		Th Brca1&2 Seq & Full Dup/del/tlo 1 $11,606.00 $11,606.00 $11,606.00 nat. median
$1,825
outlier · 6.4×
15830
CPT 		Hc Abdominoplasty 1 $11,409.00 $11,409.00 $11,409.00 nat. median
$6,587
1.7× median
L8642
HCPCS 		Or-implant-cartiva-10-US 1 $7,901.00 $7,901.00 $7,901.00 nat. median
$448
outlier · 17.6×
49507
CPT 		Hc Rpr Initial Hernia >5 Yrs Strang 1 $7,245.00 $7,245.00 $7,245.00 nat. median
$3,886
1.9× median
49525
CPT 		Hc Repair Ing Hernia,slidin 1 $7,234.00 $7,234.00 $7,234.00 nat. median
$3,705
2.0× median
70559
CPT 		MRI Brain Without & With Contrast 1 $6,937.00 $6,937.00 $6,937.00 nat. median
$365
outlier · 19.0×
3240269
CDM 		Or-augment Inj. Kit 1 $6,868.00 $6,868.00 $6,868.00 nat. median
$6,868
1.0× median
47562
CPT 		Removal Of Gallbladder Using An Endoscope 1 $2,119.00 $11,291.00 $6,705.00 nat. median
$6,019
1.1× median
CP17679084990109498
CDM 		Pegfilgrastim 6 Mg/0.6ml Sc Sosy 1 $6,350.00 $6,350.00 $6,350.00 nat. median
$6,350
1.0× median
133089
CDM 		Pegfilgrastim 6 Mg/0.6ml Sc Sosy 1 $6,350.00 $6,350.00 $6,350.00 nat. median
$6,350
1.0× median
23020
CPT 		Hc Release Shoulder Joint 1 $6,238.00 $6,238.00 $6,238.00 nat. median
$3,402
1.8× median
28270
CPT 		Hc Release Of Foot Contracture 1 $6,238.00 $6,238.00 $6,238.00 nat. median
$3,331
1.9× median

Other procedures at this hospital

Browse this hospital's 3,760 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
             
28820 CPT Amputation Toe Metatarsophalangeal Joint 1 1 $5,971.00 $5,971.00 $5,971.00 $5,971.00 $5,971.00 2026-01-21
27702 CPT Arthroplasty Ankle W/implant 2 1 $25,485.00 $25,485.00 $24,984.00 $25,986.00 $25,485.00 2026-01-21
29877 CPT Arthrs Knee Surg Debridement/shvg Artclr Crtlg 2 1 $4,113.00 $4,113.00 $1,989.00 $6,237.00 $4,113.00 2026-01-21
71552 CPT Chest Wo/w Dye 1 1 $5,217.00 $5,217.00 $5,217.00 $5,217.00 $5,217.00 2026-01-21
25505 CPT Closed Tx Radial Shaft Fracture W/manipulation 2 1 $2,196.00 $2,196.00 $1,418.00 $2,974.00 $2,196.00 2026-01-21
25565 CPT Closed Tx Radial&ulnar Shaft Fractures W/mnpj 2 1 $2,280.50 $2,280.50 $1,439.00 $3,122.00 $2,280.50 2026-01-21
27510 CPT Cltx Fem Fx Dstl End Medial/lat Condyle W/manj 2 1 $2,418.50 $2,418.50 $2,012.00 $2,825.00 $2,418.50 2026-01-21
27252 CPT Cltx Hip Dislocation Traumatic Req Anesthesia 1 1 $2,833.00 $2,833.00 $2,833.00 $2,833.00 $2,833.00 2026-01-21
27762 CPT Cltx Medial Malls Fx W/manj W/wo Skn/skel Tracj 2 1 $2,265.50 $2,265.50 $1,409.00 $3,122.00 $2,265.50 2026-01-21
45384 CPT Colonoscopy 1 1 $2,414.00 $2,414.00 $2,414.00 $2,414.00 $2,414.00 2026-01-21
74170 CPT CT Abdomen 1 1 $2,922.00 $2,922.00 $2,922.00 $2,922.00 $2,922.00 2026-01-21
74160 CPT CT Abdomen 1 1 $2,360.00 $2,360.00 $2,360.00 $2,360.00 $2,360.00 2026-01-21
74178 CPT CT Abdomen/pelvis 1 1 $3,763.00 $3,763.00 $3,763.00 $3,763.00 $3,763.00 2026-01-21
74176 CPT CT Abdomen/pelvis 1 1 $2,039.00 $2,039.00 $2,039.00 $2,039.00 $2,039.00 2026-01-21
70481 CPT CT Ear 1 1 $2,223.00 $2,223.00 $2,223.00 $2,223.00 $2,223.00 2026-01-21
73702 CPT CT Lower Extremity 1 1 $2,559.00 $2,559.00 $2,559.00 $2,559.00 $2,559.00 2026-01-21
73701 CPT CT Lower Extremity 1 1 $2,039.00 $2,039.00 $2,039.00 $2,039.00 $2,039.00 2026-01-21
72194 CPT CT Pelvis 1 1 $2,922.00 $2,922.00 $2,922.00 $2,922.00 $2,922.00 2026-01-21
72192 CPT CT Pelvis 1 1 $2,039.00 $2,039.00 $2,039.00 $2,039.00 $2,039.00 2026-01-21
74177 CPT CT Scan Of Abdomen And Pelvis With Contrast 1 1 $2,777.00 $2,777.00 $2,777.00 $2,777.00 $2,777.00 2026-01-21
72193 CPT CT Scan Of Pelvis With Contrast 1 1 $2,360.00 $2,360.00 $2,360.00 $2,360.00 $2,360.00 2026-01-21
71270 CPT CT Thorax 1 1 $3,046.00 $3,046.00 $3,046.00 $3,046.00 $3,046.00 2026-01-21
73202 CPT CT Upper Extremity 1 1 $2,559.00 $2,559.00 $2,559.00 $2,559.00 $2,559.00 2026-01-21
73201 CPT CT Upper Extremity 1 1 $2,039.00 $2,039.00 $2,039.00 $2,039.00 $2,039.00 2026-01-21
70470 CPT CT-brain 1 1 $2,434.00 $2,434.00 $2,434.00 $2,434.00 $2,434.00 2026-01-21
72127 CPT CT-cervical Spine 1 1 $3,046.00 $3,046.00 $3,046.00 $3,046.00 $3,046.00 2026-01-21
72126 CPT CT-cervical Spine 1 1 $2,434.00 $2,434.00 $2,434.00 $2,434.00 $2,434.00 2026-01-21
72125 CPT CT-cervical Spine 1 1 $2,039.00 $2,039.00 $2,039.00 $2,039.00 $2,039.00 2026-01-21
71275 CPT CT-chest 1 1 $3,426.00 $3,426.00 $3,426.00 $3,426.00 $3,426.00 2026-01-21
70482 CPT CT-ear 1 1 $2,454.00 $2,454.00 $2,454.00 $2,454.00 $2,454.00 2026-01-21
70488 CPT CT-facial Bones 1 1 $2,434.00 $2,434.00 $2,434.00 $2,434.00 $2,434.00 2026-01-21
72132 CPT CT-lumbar Spine 1 1 $2,434.00 $2,434.00 $2,434.00 $2,434.00 $2,434.00 2026-01-21
72131 CPT CT-lumbar Spine 1 1 $2,039.00 $2,039.00 $2,039.00 $2,039.00 $2,039.00 2026-01-21
70492 CPT CT-neck 1 1 $2,434.00 $2,434.00 $2,434.00 $2,434.00 $2,434.00 2026-01-21
72130 CPT CT-thoracic Spine 1 1 $3,046.00 $3,046.00 $3,046.00 $3,046.00 $3,046.00 2026-01-21
72129 CPT CT-thoracic Spine 1 1 $2,434.00 $2,434.00 $2,434.00 $2,434.00 $2,434.00 2026-01-21
72128 CPT CT-thoracic Spine 1 1 $2,039.00 $2,039.00 $2,039.00 $2,039.00 $2,039.00 2026-01-21
71260 CPT CT-thorax 1 1 $2,434.00 $2,434.00 $2,434.00 $2,434.00 $2,434.00 2026-01-21
71250 CPT CT-thorax 1 1 $2,039.00 $2,039.00 $2,039.00 $2,039.00 $2,039.00 2026-01-21
0070U CPT Cyp2d6 Genotype Cascade, B/mayo 1 1 $2,962.00 $2,962.00 $2,962.00 $2,962.00 $2,962.00 2026-01-21
128552 CDM Dalbavancin Hcl 500 Mg IV Solr 1 1 $2,144.00 $2,144.00 $2,144.00 $2,144.00 $2,144.00 2026-01-21
CP17679084990107104 CDM Dalbavancin Hcl 500 Mg IV Solr 1 1 $2,144.00 $2,144.00 $2,144.00 $2,144.00 $2,144.00 2026-01-21
128883 CDM Dantrolene Sodium 250 Mg IV Susr 1 1 $2,984.00 $2,984.00 $2,984.00 $2,984.00 $2,984.00 2026-01-21
CP17679084990108396 CDM Dantrolene Sodium 250 Mg IV Susr 1 1 $2,984.00 $2,984.00 $2,984.00 $2,984.00 $2,984.00 2026-01-21
133125 CDM Darbepoetin Alfa 300 Mcg/0.6ml Inj Sosy 1 1 $2,695.00 $2,695.00 $2,695.00 $2,695.00 $2,695.00 2026-01-21
CP17679084990101651 CDM Darbepoetin Alfa 300 Mcg/0.6ml Inj Sosy 1 1 $2,695.00 $2,695.00 $2,695.00 $2,695.00 $2,695.00 2026-01-21
51102 CPT Drain W/cath Insertion 1 1 $3,739.00 $3,739.00 $3,739.00 $3,739.00 $3,739.00 2026-01-21
11446 CPT Exc B9 Lesion Mrgn Xcp Sk Tg F/e/e/n/l/m > 4.0cm 2 1 $3,161.50 $3,161.50 $1,037.00 $5,286.00 $3,161.50 2026-01-21
11426 CPT Exc B9 Lesion Mrgn Xcp Sk Tg S/n/h/f/g > 4.0cm 2 1 $3,084.50 $3,084.50 $883.00 $5,286.00 $3,084.50 2026-01-21
21555 CPT Exc Tumor Soft Tissue Neck/ant Thorax Subq <3cm 1 1 $2,969.00 $2,969.00 $2,969.00 $2,969.00 $2,969.00 2026-01-21
28104 CPT Exc/curtg Bone Cyst/b9 Tumortarsal/metatarsal 2 1 $3,690.50 $3,690.50 $1,144.00 $6,237.00 $3,690.50 2026-01-21
11606 CPT Excision Malignant Lesion Trunk/arm/leg > 4.0 Cm 2 1 $2,043.00 $2,043.00 $1,029.00 $3,057.00 $2,043.00 2026-01-21
27043 CPT Excision Tumor Soft Tissue Pelvis&hip Subq 3cm/> 2 1 $3,220.00 $3,220.00 $1,438.00 $5,002.00 $3,220.00 2026-01-21
27620 CPT Exploration Of Ankle Joint 1 1 $5,971.00 $5,971.00 $5,971.00 $5,971.00 $5,971.00 2026-01-21
27610 CPT Exploration, Drainage, Or Removal Of Foreign Body Of Ankle 1 1 $5,971.00 $5,971.00 $5,971.00 $5,971.00 $5,971.00 2026-01-21
28008 CPT Fasciotomy Foot&/toe 2 1 $3,814.00 $3,814.00 $1,391.00 $6,237.00 $3,814.00 2026-01-21
81249 CPT G6pd Full Gene Sequence/mayo 1 1 $4,089.00 $4,089.00 $4,089.00 $4,089.00 $4,089.00 2026-01-21
87902 CPT Genotype Dna,hep C/mayo 2 1 $1,969.00 $1,969.00 $1,879.00 $2,059.00 $1,969.00 2026-01-21
CP17679084990106697 CDM Golimumab 50 Mg/0.5ml Sc Sosy 1 1 $4,004.00 $4,004.00 $4,004.00 $4,004.00 $4,004.00 2026-01-21
129311 CDM Golimumab 50 Mg/0.5ml Sc Sosy 1 1 $4,004.00 $4,004.00 $4,004.00 $4,004.00 $4,004.00 2026-01-21
81364 CPT Hbb Full Gene Sequence/mayo 1 1 $2,211.00 $2,211.00 $2,211.00 $2,211.00 $2,211.00 2026-01-21
15830 CPT Hc Abdominoplasty 1 1 $11,409.00 $11,409.00 $11,409.00 $11,409.00 $11,409.00 2026-01-21
14040 CPT Hc Adj Tiss Xfer Head,fac,hand <10sqcm 1 1 $3,537.00 $3,537.00 $3,537.00 $3,537.00 $3,537.00 2026-01-21
14020 CPT Hc Adj Tiss Xfer Scalp,extrem <10sqcm 1 1 $3,537.00 $3,537.00 $3,537.00 $3,537.00 $3,537.00 2026-01-21
29898 CPT Hc Ankle Scope,extens Debridemnt 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
29893 CPT Hc Ankle Scope,plantar Fasciotomy 1 1 $6,237.00 $6,237.00 $6,237.00 $6,237.00 $6,237.00 2026-01-21
29891 CPT Hc Arthroscopy/ankle,surgical 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
28272 CPT Hc Capsulotomy Ip Jnt Sgl Ea Jnt 1 1 $3,122.00 $3,122.00 $3,122.00 $3,122.00 $3,122.00 2026-01-21
64721 CPT Hc Carpal Tunnel Medidan Nerve 1 1 $4,340.00 $4,340.00 $4,340.00 $4,340.00 $4,340.00 2026-01-21
25605 CPT Hc Closed Rx Dist Rad/ulna Fx,manipul 1 1 $3,122.00 $3,122.00 $3,122.00 $3,122.00 $3,122.00 2026-01-21
24605 CPT Hc Closed Rx Elbow Dislocatn,anesthesi 1 1 $2,974.00 $2,974.00 $2,974.00 $2,974.00 $2,974.00 2026-01-21
27502 CPT Hc Closed Rx Femur Shaft Fx+manip 1 1 $3,093.00 $3,093.00 $3,093.00 $3,093.00 $3,093.00 2026-01-21
26705 CPT Hc Closed Rx Mc-p Disloc,anesth 1 1 $3,122.00 $3,122.00 $3,122.00 $3,122.00 $3,122.00 2026-01-21
23655 CPT Hc Closed Rx Shldr Disloc,anesthesia 1 1 $3,679.00 $3,679.00 $3,679.00 $3,679.00 $3,679.00 2026-01-21
28435 CPT Hc Closed Rx Talus Fx,manipulatn 1 1 $3,122.00 $3,122.00 $3,122.00 $3,122.00 $3,122.00 2026-01-21
27752 CPT Hc Closed Rx Tibia Shaft Fx,manipulatn 1 1 $3,122.00 $3,122.00 $3,122.00 $3,122.00 $3,122.00 2026-01-21
27818 CPT Hc Closed Rx Trimalleolar Fx,manip 1 1 $2,941.00 $2,941.00 $2,941.00 $2,941.00 $2,941.00 2026-01-21
28292 CPT Hc Correct Bunion,keller/mcbride/mayo 1 1 $6,237.00 $6,237.00 $6,237.00 $6,237.00 $6,237.00 2026-01-21
28297 CPT Hc Correct Bunion,lapidus Type 1 1 $13,548.00 $13,548.00 $13,548.00 $13,548.00 $13,548.00 2026-01-21
28296 CPT Hc Correct Bunion,metatarsal Osteotomy 1 1 $6,237.00 $6,237.00 $6,237.00 $6,237.00 $6,237.00 2026-01-21
28299 CPT Hc Correct Bunion,othr Methods 1 1 $13,220.00 $13,220.00 $13,220.00 $13,220.00 $13,220.00 2026-01-21
28298 CPT Hc Correct Bunion,phalanx Osteotomy 1 1 $13,548.00 $13,548.00 $13,548.00 $13,548.00 $13,548.00 2026-01-21
28295 CPT Hc Correction Hallux Valgus 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
28291 CPT Hc Corrj Halux Rigdus W/implt 1 1 $13,419.00 $13,419.00 $13,419.00 $13,419.00 $13,419.00 2026-01-21
72133 CPT Hc CT Spine Lumbar W/wo Dye 1 1 $3,046.00 $3,046.00 $3,046.00 $3,046.00 $3,046.00 2026-01-21
74175 CPT Hc CTA Abdomen 1 1 $2,747.00 $2,747.00 $2,747.00 $2,747.00 $2,747.00 2026-01-21
74174 CPT Hc CTA Abdomen/pelvis W/contrast 1 1 $3,231.00 $3,231.00 $3,231.00 $3,231.00 $3,231.00 2026-01-21
75635 CPT Hc CTA Abdominal Arteries 1 1 $3,491.00 $3,491.00 $3,491.00 $3,491.00 $3,491.00 2026-01-21
70496 CPT Hc CTA Head 1 1 $2,246.00 $2,246.00 $2,246.00 $2,246.00 $2,246.00 2026-01-21
73706 CPT Hc CTA Lower Extremity 1 1 $2,816.00 $2,816.00 $2,816.00 $2,816.00 $2,816.00 2026-01-21
70498 CPT Hc CTA Neck 1 1 $2,757.00 $2,757.00 $2,757.00 $2,757.00 $2,757.00 2026-01-21
72191 CPT Hc CTA Pelvis 1 1 $2,747.00 $2,747.00 $2,747.00 $2,747.00 $2,747.00 2026-01-21
25020 CPT Hc Decompress Of Forearm,1 Space 1 1 $2,974.00 $2,974.00 $2,974.00 $2,974.00 $2,974.00 2026-01-21
28035 CPT Hc Decompression Of Tibia Nerve 1 1 $3,702.00 $3,702.00 $3,702.00 $3,702.00 $3,702.00 2026-01-21
41899 CPT Hc Dental Surgery Procedure 1 1 $3,404.00 $3,404.00 $3,404.00 $3,404.00 $3,404.00 2026-01-21
43202 CPT Hc Esophagoscopy W/biopsy 1 1 $3,822.00 $3,822.00 $3,822.00 $3,822.00 $3,822.00 2026-01-21
21931 CPT Hc Exc Back Lesion Sc=3cm 1 1 $2,973.00 $2,973.00 $2,973.00 $2,973.00 $2,973.00 2026-01-21
23071 CPT Hc Exc Shoulder Les Sc>3cm 1 1 $2,968.00 $2,968.00 $2,968.00 $2,968.00 $2,968.00 2026-01-21
28045 CPT Hc Excis Foot Tumor,deep 1 1 $5,002.00 $5,002.00 $5,002.00 $5,002.00 $5,002.00 2026-01-21
28043 CPT Hc Excis Foot Tumor,subcutaneous 1 1 $3,271.00 $3,271.00 $3,271.00 $3,271.00 $3,271.00 2026-01-21
40819 CPT Hc Excise Lip Or Cheek Fold 1 1 $3,019.00 $3,019.00 $3,019.00 $3,019.00 $3,019.00 2026-01-21
21552 CPT Hc Exe Neck Les Sc=3 Cm 1 1 $5,599.00 $5,599.00 $5,599.00 $5,599.00 $5,599.00 2026-01-21
27625 CPT Hc Explor Ankle Jt+synovectomy 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
28022 CPT Hc Explor Metatarso-phalang Jt 1 1 $6,237.00 $6,237.00 $6,237.00 $6,237.00 $6,237.00 2026-01-21
28020 CPT Hc Explor Tarsal/tarsometatar Jt 1 1 $6,237.00 $6,237.00 $6,237.00 $6,237.00 $6,237.00 2026-01-21
27860 CPT Hc Fixation Of Ankle Joint 1 1 $5,972.00 $5,673.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
28113 CPT Hc Full Excis 5th Metatarsal Head 1 1 $6,092.00 $6,092.00 $6,092.00 $6,092.00 $6,092.00 2026-01-21
28755 CPT Hc Fusion Big Toe,i-p Joint 1 1 $13,548.00 $13,548.00 $13,548.00 $13,548.00 $13,548.00 2026-01-21
28750 CPT Hc Fusion Big Toe,mt-p Jt 1 1 $13,548.00 $13,548.00 $13,548.00 $13,548.00 $13,548.00 2026-01-21
28730 CPT Hc Fusion Foot Bones,midtarsal,multi 1 1 $2,245.00 $2,245.00 $2,245.00 $2,245.00 $2,245.00 2026-01-21
28725 CPT Hc Fusion Foot Bones,subtalar 1 1 $25,986.00 $25,986.00 $25,986.00 $25,986.00 $25,986.00 2026-01-21
26860 CPT Hc Fusion Of Finger Joint 1 1 $6,237.00 $6,237.00 $6,237.00 $6,237.00 $6,237.00 2026-01-21
28740 CPT Hc Fusion Of Foot Bones 1 1 $13,553.00 $13,553.00 $13,553.00 $13,553.00 $13,553.00 2026-01-21
46250 CPT Hc Hemorrhoidectomy External 1 1 $5,730.00 $5,730.00 $5,730.00 $5,730.00 $5,730.00 2026-01-21
2000000 CDM Hc ICU Room & Nursing 1 1 $3,007.00 $3,007.00 $3,007.00 $3,007.00 $3,007.00 2026-01-21
26055 CPT Hc Incise Finger Tendon Sheath 1 1 $3,093.00 $3,093.00 $3,093.00 $3,093.00 $3,093.00 2026-01-21
28230 CPT Hc Incision Flex Foot Tendon(s) 1 1 $2,914.00 $2,914.00 $2,914.00 $2,914.00 $2,914.00 2026-01-21
28232 CPT Hc Incision Flex Toe Tendon 1 1 $3,122.00 $3,122.00 $3,122.00 $3,122.00 $3,122.00 2026-01-21
27606 CPT Hc Incision Of Achilles Tendon 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
28302 CPT Hc Incision Of Ankle Bone 1 1 $13,220.00 $13,220.00 $13,220.00 $13,220.00 $13,220.00 2026-01-21
28234 CPT Hc Incision Of Foot Tendon 1 1 $3,122.00 $3,122.00 $3,122.00 $3,122.00 $3,122.00 2026-01-21
28300 CPT Hc Incision Of Heel Bone 1 1 $13,220.00 $13,220.00 $13,220.00 $13,220.00 $13,220.00 2026-01-21
28309 CPT Hc Incision Of Metatarsals 1 1 $13,220.00 $13,220.00 $13,220.00 $13,220.00 $13,220.00 2026-01-21
32556 CPT Hc Insert Cath Pleura Without Image 1 1 $3,389.00 $3,389.00 $3,389.00 $3,389.00 $3,389.00 2026-01-21
G0289 HCPCS Hc Knee Arthroscopy Add-on 1 1 $5,938.00 $5,938.00 $5,938.00 $5,938.00 $5,938.00 2026-01-21
29883 CPT Hc Knee Arthroscopy Surgery 1 1 $6,237.00 $6,237.00 $6,237.00 $6,237.00 $6,237.00 2026-01-21
29882 CPT Hc Knee Scope,med Or Lat Menis Repair 1 1 $6,238.00 $6,238.00 $6,238.00 $6,238.00 $6,238.00 2026-01-21
29880 CPT Hc Knee Scope,single Meniscectomy 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
12047 CPT Hc Layr Clos Wnd Rest Body >30cm 1 1 $3,537.00 $3,537.00 $3,537.00 $3,537.00 $3,537.00 2026-01-21
12037 CPT Hc Layr Clos Wnd Trunk,arm,leg >30cm 1 1 $3,949.00 $3,949.00 $3,949.00 $3,949.00 $3,949.00 2026-01-21
73719 CPT Hc Lower Ext With Contrast 1 1 $3,219.00 $3,219.00 $3,219.00 $3,219.00 $3,219.00 2026-01-21
26340 CPT Hc Manipulate Finger With Anesth 2 1 $2,098.50 $2,098.50 $1,075.00 $3,122.00 $2,098.50 2026-01-21
41115 CPT Hc Mouth Frenulectmy 1 1 $3,019.00 $3,019.00 $3,019.00 $3,019.00 $3,019.00 2026-01-21
70545 CPT Hc MRA Head With Contrast 1 1 $3,260.00 $3,260.00 $3,260.00 $3,260.00 $3,260.00 2026-01-21
70546 CPT Hc MRA Head W/wo Dye 1 1 $5,070.00 $5,070.00 $5,070.00 $5,070.00 $5,070.00 2026-01-21
73725 CPT Hc MRA Lower Ext W/wo Dye 1 1 $3,284.00 $3,284.00 $3,284.00 $3,284.00 $3,284.00 2026-01-21
70548 CPT Hc MRA Neck With Contrast 1 1 $3,516.00 $3,516.00 $3,516.00 $3,516.00 $3,516.00 2026-01-21
73225 CPT Hc MRA Upper Ext W/wo Dye 1 1 $3,280.00 $3,280.00 $3,280.00 $3,280.00 $3,280.00 2026-01-21
28055 CPT Hc Neurectomy Foot 1 1 $3,701.00 $3,701.00 $3,701.00 $3,701.00 $3,701.00 2026-01-21
27814 CPT Hc Open Rx Bimalleolar Fx 1 1 $13,419.00 $13,419.00 $13,419.00 $13,419.00 $13,419.00 2026-01-21
27822 CPT Hc Open Rx Trimalleolar Fx 1 1 $13,548.00 $13,548.00 $13,548.00 $13,548.00 $13,548.00 2026-01-21
28307 CPT Hc Osteotomy 1st Metatarsal,autograft 1 1 $12,710.00 $12,710.00 $12,710.00 $12,710.00 $12,710.00 2026-01-21
28306 CPT Hc Osteotomy 1st Metatarsal,base/shaft 1 1 $13,548.00 $13,548.00 $13,548.00 $13,548.00 $13,548.00 2026-01-21
28308 CPT Hc Osteotomy Metatarsal (Not 1st) 1 1 $6,238.00 $6,238.00 $6,238.00 $6,238.00 $6,238.00 2026-01-21
28305 CPT Hc Osteotomy Midtarsal,autograft 1 1 $12,710.00 $12,710.00 $12,710.00 $12,710.00 $12,710.00 2026-01-21
28110 CPT Hc Part Excis 5th Metatarsal Head 1 1 $6,237.00 $6,237.00 $6,237.00 $6,237.00 $6,237.00 2026-01-21
26123 CPT Hc Part Palmar Fasciec,open 1 Digit 1 1 $6,092.00 $6,092.00 $6,092.00 $6,092.00 $6,092.00 2026-01-21
28288 CPT Hc Part Removal Of Foot Bone 1 1 $6,237.00 $6,237.00 $6,237.00 $6,237.00 $6,237.00 2026-01-21
28124 CPT Hc Part Remv Phalanx Of Toe 1 1 $6,237.00 $6,237.00 $6,237.00 $6,237.00 $6,237.00 2026-01-21
40510 CPT Hc Partial Excis Lip,wedge Prim Clos 1 1 $6,107.00 $6,107.00 $6,107.00 $6,107.00 $6,107.00 2026-01-21
28120 CPT Hc Partial Removal Of Ankle/heel 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
27641 CPT Hc Partial Removal Of Fibula 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
28122 CPT Hc Partial Removal Of Foot Bone 1 1 $6,238.00 $6,238.00 $6,238.00 $6,238.00 $6,238.00 2026-01-21
27640 CPT Hc Partial Removal Of Tibia 1 1 $6,177.00 $6,177.00 $6,177.00 $6,177.00 $6,177.00 2026-01-21
28060 CPT Hc Partial Removal,foot Fascia 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
28225 CPT Hc Release Exten Foot Tendon,single 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
27680 CPT Hc Release Lower Leg Tendon 2 1 $5,971.50 $5,971.50 $5,971.00 $5,972.00 $5,971.50 2026-01-21
28270 CPT Hc Release Of Foot Contracture 1 1 $6,238.00 $6,238.00 $6,238.00 $6,238.00 $6,238.00 2026-01-21
28264 CPT Hc Release Of Midfoot Joint 1 1 $2,974.00 $2,974.00 $2,974.00 $2,974.00 $2,974.00 2026-01-21
23020 CPT Hc Release Shoulder Joint 1 1 $6,238.00 $6,238.00 $6,238.00 $6,238.00 $6,238.00 2026-01-21
20680 CPT Hc Removal Deep Implant 1 1 $5,654.00 $5,654.00 $5,654.00 $5,654.00 $5,654.00 2026-01-21
28070 CPT Hc Removal Of Foot Joint Lining 1 1 $13,220.00 $13,220.00 $13,220.00 $13,220.00 $13,220.00 2026-01-21
64776 CPT Hc Remove Digit Nerve Lesion 1 1 $4,340.00 $4,340.00 $4,340.00 $4,340.00 $4,340.00 2026-01-21
28080 CPT Hc Remove Foot Lesion Sngl Ea 1 1 $3,122.00 $3,122.00 $3,122.00 $3,122.00 $3,122.00 2026-01-21
28090 CPT Hc Remove Foot Lesion,tendon,shealth,capsule 1 1 $3,311.00 $3,311.00 $3,311.00 $3,311.00 $3,311.00 2026-01-21
25248 CPT Hc Remove Forearm Foreign Body 1 1 $2,974.00 $2,974.00 $2,974.00 $2,974.00 $2,974.00 2026-01-21
28118 CPT Hc Remove Heel Bone 1 1 $6,177.00 $6,177.00 $6,177.00 $6,177.00 $6,177.00 2026-01-21
28119 CPT Hc Remove Heel Spur 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
27635 CPT Hc Remove Lower Leg Bone Lesion 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
27630 CPT Hc Remove Tendon Lesion 1 1 $5,971.00 $5,971.00 $5,971.00 $5,971.00 $5,971.00 2026-01-21
26160 CPT Hc Remove Tendon Sheath Lesion 1 1 $3,122.00 $3,122.00 $3,122.00 $3,122.00 $3,122.00 2026-01-21
28092 CPT Hc Remove Toe Lesions 1 1 $3,122.00 $3,122.00 $3,122.00 $3,122.00 $3,122.00 2026-01-21
28107 CPT Hc Remove/graft Foot Lesion 1 1 $13,220.00 $13,220.00 $13,220.00 $13,220.00 $13,220.00 2026-01-21
28103 CPT Hc Remove/graft Foot Lesion 1 1 $12,710.00 $12,710.00 $12,710.00 $12,710.00 $12,710.00 2026-01-21
27695 CPT Hc Repair 1 Collat Ankle Ligmnt,primary 1 1 $13,419.00 $12,748.00 $13,419.00 $13,419.00 $13,419.00 2026-01-21
27698 CPT Hc Repair Collat Ankle Ligmnt,secondar 2 1 $13,219.50 $12,889.00 $13,219.00 $13,220.00 $13,219.50 2026-01-21
28208 CPT Hc Repair Exten Leg Tendon,prim,ea 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
28200 CPT Hc Repair Flex Foot Tendon,ea 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
27658 CPT Hc Repair Flex Leg Tendon,prim,ea 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
27659 CPT Hc Repair Flex Leg Tendon,second,ea 1 1 $12,710.00 $12,710.00 $12,710.00 $12,710.00 $12,710.00 2026-01-21
28615 CPT Hc Repair Foot Dislocation 1 1 $13,220.00 $13,220.00 $13,220.00 $13,220.00 $13,220.00 2026-01-21
28289 CPT Hc Repair Hallux Rigidus 1 1 $6,177.00 $6,177.00 $6,177.00 $6,177.00 $6,177.00 2026-01-21
49525 CPT Hc Repair Ing Hernia,slidin 1 1 $7,234.00 $7,234.00 $7,234.00 $7,234.00 $7,234.00 2026-01-21
27696 CPT Hc Repair Of Ankle Ligaments 1 1 $13,219.00 $13,219.00 $13,219.00 $13,219.00 $13,219.00 2026-01-21
28285 CPT Hc Repair Of Hammertoe 1 1 $6,238.00 $6,238.00 $6,238.00 $6,238.00 $6,238.00 2026-01-21
28322 CPT Hc Repair Of Metatarsals 1 1 $13,548.00 $13,548.00 $13,548.00 $13,548.00 $13,548.00 2026-01-21
13100 CPT Hc Repr Cmpl Wnd Trunk 1.1-2.5cm 1 1 $3,949.00 $3,949.00 $3,949.00 $3,949.00 $3,949.00 2026-01-21
28160 CPT Hc Resec Toe At I-p Jt,single,ea 1 1 $5,972.00 $5,972.00 $5,972.00 $5,972.00 $5,972.00 2026-01-21
27691 CPT Hc Revis Lower Leg Tendon 1 1 $13,548.00 $13,548.00 $13,548.00 $13,548.00 $13,548.00 2026-01-21
64708 CPT Hc Revise Arm/leg Nerve 1 1 $4,431.00 $4,431.00 $4,431.00 $4,431.00 $4,431.00 2026-01-21
64704 CPT Hc Revise Hand/foot Nerve 1 1 $4,431.00 $4,431.00 $4,431.00 $4,431.00 $4,431.00 2026-01-21
27685 CPT Hc Revise Lower Leg Tendon 1 1 $2,044.00 $2,044.00 $2,044.00 $2,044.00 $2,044.00 2026-01-21
27690 CPT Hc Revise Lower Leg Tendon 1 1 $1,967.00 $1,967.00 $1,967.00 $1,967.00 $1,967.00 2026-01-21
27700 CPT Hc Revision Of Ankle Joint 1 1 $13,220.00 $13,220.00 $13,220.00 $13,220.00 $13,220.00 2026-01-21
28310 CPT Hc Revision Of Big Toe 1 1 $13,220.00 $13,220.00 $13,220.00 $13,220.00 $13,220.00 2026-01-21
27687 CPT Hc Revision Of Calf Tendon 1 1 $6,177.00 $6,177.00 $6,177.00 $6,177.00 $6,177.00 2026-01-21
28737 CPT Hc Revision Of Foot Bones 1 1 $2,083.00 $2,083.00 $2,083.00 $2,083.00 $2,083.00 2026-01-21
28238 CPT Hc Revision Of Foot Tendon 1 1 $13,219.00 $13,219.00 $13,219.00 $13,219.00 $13,219.00 2026-01-21
1210010 CDM Hc Room & Nursing W/telemetry 1 1 $2,594.00 $2,594.00 $2,594.00 $2,594.00 $2,594.00 2026-01-21
49592 CPT Hc Rpr Aa Hernia 1st < 3 Cm Ncrc8/strangulated 2 1 $4,081.50 $4,081.50 $691.00 $7,472.00 $4,081.50 2026-01-21
27654 CPT Hc Rpr Achilles Tendon 1 1 $13,553.00 $13,553.00 $13,553.00 $13,553.00 $13,553.00 2026-01-21
49507 CPT Hc Rpr Initial Hernia >5 Yrs Strang 1 1 $7,245.00 $7,245.00 $7,245.00 $7,245.00 $7,245.00 2026-01-21
45338 CPT Hc Sigmoidoscopy,tumor,polyp,oth Les W 1 1 $2,414.00 $2,414.00 $2,414.00 $2,414.00 $2,414.00 2026-01-21
95807 CPT Hc Sleep Study Attended 1 1 $2,014.00 $2,014.00 $2,014.00 $2,014.00 $2,014.00 2026-01-21
27842 CPT Hc Treat Ankle Dislocation 1 1 $3,581.00 $3,581.00 $3,581.00 $3,581.00 $3,581.00 2026-01-21
27552 CPT Hc Treat Knee Dislocation 1 1 $3,408.00 $3,408.00 $3,408.00 $3,408.00 $3,408.00 2026-01-21
73219 CPT Hc Upper Ext Wdye 1 1 $3,379.00 $3,379.00 $3,379.00 $3,379.00 $3,379.00 2026-01-21
59409 CPT Hc Vaginal Delivery 2 1 $4,067.50 $4,067.50 $2,599.00 $5,536.00 $4,067.50 2026-01-21
10180 CPT Hc Wound Drainage,cmplx 2 1 $2,927.00 $2,927.00 $568.00 $5,286.00 $2,927.00 2026-01-21
29848 CPT Hc Wrist Endoscopy/surgery 1 1 $3,122.00 $3,122.00 $3,122.00 $3,122.00 $3,122.00 2026-01-21
81405 CPT Hematologic Neoplasms, Tp53/mayo 1 1 $2,053.00 $2,053.00 $2,053.00 $2,053.00 $2,053.00 2026-01-21
81263 CPT Igh Somatic Hyper B-cl Lymp/mayo 1 1 $2,130.00 $2,130.00 $2,130.00 $2,130.00 $2,130.00 2026-01-21
CP17679084990087233 CDM Immune Globulin (Human) 10 Gm/100ml Inj Soln 1 1 $1,981.00 $1,981.00 $1,981.00 $1,981.00 $1,981.00 2026-01-21
110039 CDM Immune Globulin (Human) 10 Gm/100ml Inj Soln 1 1 $1,981.00 $1,981.00 $1,981.00 $1,981.00 $1,981.00 2026-01-21
124319 CDM Immune Globulin (Human) 40 Gm/400ml IV Soln 1 1 $3,686.00 $3,686.00 $3,686.00 $3,686.00 $3,686.00 2026-01-21
CP17679084990095975 CDM Immune Globulin (Human) 40 Gm/400ml IV Soln 1 1 $3,686.00 $3,686.00 $3,686.00 $3,686.00 $3,686.00 2026-01-21
3010030 CDM Isolation Room 1 1 $2,685.00 $2,685.00 $2,685.00 $2,685.00 $2,685.00 2026-01-21
72158 CPT L-spine 1 1 $4,934.00 $4,934.00 $4,934.00 $4,934.00 $4,934.00 2026-01-21
21108 CDM Leuprolide Acetate (4 Month) 30 Mg IM Kit 1 1 $5,391.00 $5,391.00 $5,391.00 $5,391.00 $5,391.00 2026-01-21
CP17679084990126479 CDM Leuprolide Acetate (4 Month) 30 Mg IM Kit 1 1 $5,391.00 $5,391.00 $5,391.00 $5,391.00 $5,391.00 2026-01-21
73722 CPT Lower Ext Joint With Contrast 1 1 $3,150.00 $3,150.00 $3,150.00 $3,150.00 $3,150.00 2026-01-21
73723 CPT Lower Ext Joint W/wo Dye 1 1 $4,814.00 $4,814.00 $4,814.00 $4,814.00 $4,814.00 2026-01-21
81407 CPT Mopath Procedure Level 8 Mayo 1 1 $5,766.00 $5,766.00 $5,766.00 $5,766.00 $5,766.00 2026-01-21
70544 CPT MRA-head 1 1 $3,307.00 $3,307.00 $3,307.00 $3,307.00 $3,307.00 2026-01-21
70549 CPT MRA-neck 1 1 $5,103.00 $5,103.00 $5,103.00 $5,103.00 $5,103.00 2026-01-21
70547 CPT MRA-neck 1 1 $3,321.00 $3,321.00 $3,321.00 $3,321.00 $3,321.00 2026-01-21
74183 CPT MRI Abdomen 1 1 $5,080.00 $5,080.00 $5,080.00 $5,080.00 $5,080.00 2026-01-21
74182 CPT MRI Abdomen 1 1 $3,660.00 $3,660.00 $3,660.00 $3,660.00 $3,660.00 2026-01-21
70558 CPT MRI Brain With Contrast 1 1 $2,426.00 $2,426.00 $2,426.00 $2,426.00 $2,426.00 2026-01-21
70559 CPT MRI Brain Without & With Contrast 1 1 $6,937.00 $6,937.00 $6,937.00 $6,937.00 $6,937.00 2026-01-21
70543 CPT MRI Eye/face/neck 1 1 $5,024.00 $5,024.00 $5,024.00 $5,024.00 $5,024.00 2026-01-21
73720 CPT MRI Lower Extremity 1 1 $5,075.00 $5,075.00 $5,075.00 $5,075.00 $5,075.00 2026-01-21
73718 CPT MRI Lower Extremity 1 1 $2,957.00 $2,957.00 $2,957.00 $2,957.00 $2,957.00 2026-01-21
70542 CPT MRI Orbit/face/neck 1 1 $3,196.00 $3,196.00 $3,196.00 $3,196.00 $3,196.00 2026-01-21
72197 CPT MRI Pelvis 1 1 $5,077.00 $5,077.00 $5,077.00 $5,077.00 $5,077.00 2026-01-21
70553 CPT MRI Scan 1 1 $5,010.00 $5,010.00 $5,010.00 $5,010.00 $5,010.00 2026-01-21
73721 CPT MRI Scan Of Leg Joint 1 1 $2,699.00 $2,699.00 $2,699.00 $2,699.00 $2,699.00 2026-01-21
72148 CPT MRI Scan Of Lower Spinal Canal 1 1 $2,673.00 $2,673.00 $2,673.00 $2,673.00 $2,673.00 2026-01-21
74181 CPT MRI-abdomen 1 1 $2,592.00 $2,592.00 $2,592.00 $2,592.00 $2,592.00 2026-01-21
70552 CPT MRI-brain 1 1 $3,118.00 $3,118.00 $3,118.00 $3,118.00 $3,118.00 2026-01-21
72156 CPT MRI-c-spine 1 1 $4,938.00 $4,938.00 $4,938.00 $4,938.00 $4,938.00 2026-01-21
72142 CPT MRI-c-spine 1 1 $3,112.00 $3,112.00 $3,112.00 $3,112.00 $3,112.00 2026-01-21
72141 CPT MRI-c-spine 1 1 $2,514.00 $2,514.00 $2,514.00 $2,514.00 $2,514.00 2026-01-21
70540 CPT MRI-eye/face/neck 1 1 $2,907.00 $2,907.00 $2,907.00 $2,907.00 $2,907.00 2026-01-21
72149 CPT MRI-lumbar Spine 1 1 $3,111.00 $3,111.00 $3,111.00 $3,111.00 $3,111.00 2026-01-21
72196 CPT MRI-pelvis 1 1 $3,233.00 $3,233.00 $3,233.00 $3,233.00 $3,233.00 2026-01-21
72147 CPT MRI-t-spine 1 1 $2,893.00 $2,893.00 $2,893.00 $2,893.00 $2,893.00 2026-01-21
72146 CPT MRI-t-spine 1 1 $2,673.00 $2,673.00 $2,673.00 $2,673.00 $2,673.00 2026-01-21
73220 CPT MRI-upper Extremity 1 1 $5,077.00 $5,077.00 $5,077.00 $5,077.00 $5,077.00 2026-01-21
73221 CPT MRI-upper Extremity 1 1 $2,646.00 $2,646.00 $2,646.00 $2,646.00 $2,646.00 2026-01-21
24436 CDM Octreotide Acetate 30 Mg IM Kit 1 1 $5,979.00 $5,979.00 $5,979.00 $5,979.00 $5,979.00 2026-01-21
CP17679084990138148 CDM Octreotide Acetate 30 Mg IM Kit 1 1 $5,979.00 $5,979.00 $5,979.00 $5,979.00 $5,979.00 2026-01-21
28415 CPT Open Treatment Calcaneal Fracture 1 1 $13,219.00 $13,219.00 $13,219.00 $13,219.00 $13,219.00 2026-01-21
3240269 CDM Or-augment Inj. Kit 1 1 $6,868.00 $6,868.00 $6,868.00 $6,868.00 $6,868.00 2026-01-21
C1734 HCPCS Or-ib Kit,bc,w/cc Ft And Jumpstart 1 1 $3,676.00 $3,676.00 $3,676.00 $3,676.00 $3,676.00 2026-01-21
C1776 HCPCS Or-implant System, Cpr Mini Scorpion Dx 1 1 $2,829.00 $2,829.00 $2,829.00 $2,829.00 $2,829.00 2026-01-21
L8642 HCPCS Or-implant-cartiva-10-US 1 1 $7,901.00 $7,901.00 $7,901.00 $7,901.00 $7,901.00 2026-01-21
3240361 CDM Or-implant-system,bio-comp Ach-ar-8928 1 1 $4,492.00 $4,492.00 $4,492.00 $4,492.00 $4,492.00 2026-01-21
3245223 CDM Or-implant-system-achilles-ar-8928bcj-cp 1 1 $4,905.00 $4,905.00 $4,905.00 $4,905.00 $4,905.00 2026-01-21
3240709 CDM Or-implant:hammerlock 2 15x7mm/0-lg 1 1 $2,807.00 $2,807.00 $2,807.00 $2,807.00 $2,807.00 2026-01-21
3240250 CDM Or-plate-curved (40-15011) 1 1 $2,141.00 $2,141.00 $2,141.00 $2,141.00 $2,141.00 2026-01-21
3240349 CDM Or-plate-curved(40-15013) 1 1 $2,324.00 $2,324.00 $2,324.00 $2,324.00 $2,324.00 2026-01-21
28116 CPT Ostectomy Tarsal Coalition 1 1 $5,971.00 $5,971.00 $5,971.00 $5,971.00 $5,971.00 2026-01-21
CP17679084990109498 CDM Pegfilgrastim 6 Mg/0.6ml Sc Sosy 1 1 $6,350.00 $6,350.00 $6,350.00 $6,350.00 $6,350.00 2026-01-21
133089 CDM Pegfilgrastim 6 Mg/0.6ml Sc Sosy 1 1 $6,350.00 $6,350.00 $6,350.00 $6,350.00 $6,350.00 2026-01-21
144183 CDM Pegfilgrastim-cbqv 6 Mg/0.6ml Sc Sosy 1 1 $4,715.00 $4,715.00 $4,715.00 $4,715.00 $4,715.00 2026-01-21
CP17679084990117303 CDM Pegfilgrastim-cbqv 6 Mg/0.6ml Sc Sosy 1 1 $4,715.00 $4,715.00 $4,715.00 $4,715.00 $4,715.00 2026-01-21
CP17679084990118863 CDM Pegfilgrastim-jmdb 6 Mg/0.6ml Sc Sosy 1 1 $3,100.00 $3,100.00 $3,100.00 $3,100.00 $3,100.00 2026-01-21
142968 CDM Pegfilgrastim-jmdb 6 Mg/0.6ml Sc Sosy 1 1 $3,100.00 $3,100.00 $3,100.00 $3,100.00 $3,100.00 2026-01-21
72195 CPT Pelvis 1 1 $3,004.00 $3,004.00 $3,004.00 $3,004.00 $3,004.00 2026-01-21
142372 CDM Rabies Immune Globulin 1500 Unit/5ml Inj Soln 1 1 $3,582.00 $3,582.00 $3,582.00 $3,582.00 $3,582.00 2026-01-21
CP17679084990106110 CDM Rabies Immune Globulin 1500 Unit/5ml Inj Soln 1 1 $3,582.00 $3,582.00 $3,582.00 $3,582.00 $3,582.00 2026-01-21
47562 CPT Removal Of Gallbladder Using An Endoscope 2 1 $6,705.00 $6,705.00 $2,119.00 $11,291.00 $6,705.00 2026-01-21
29881 CPT Removal Of One Knee Cartilage Using An Endoscope 1 1 $6,238.00 $6,238.00 $6,238.00 $6,238.00 $6,238.00 2026-01-21
19120 CPT Removal Of One Or More Breast Growth, Open Procedure 2 1 $3,918.50 $3,918.50 $1,327.00 $6,510.00 $3,918.50 2026-01-21
49505 CPT Repair Of Groin Hernia Patient Age 5 Years Or Older 2 1 $4,590.00 $4,590.00 $1,677.00 $7,503.00 $4,590.00 2026-01-21
87633 CPT Resp Virus 12-25 Targets 1 1 $3,042.00 $3,042.00 $3,042.00 $3,042.00 $3,042.00 2026-01-21
145223 CDM Romosozumab-aqqg 105 Mg/1.17ml Sc Sosy 1 1 $2,955.00 $2,955.00 $2,955.00 $2,955.00 $2,955.00 2026-01-21
CP17679084990119458 CDM Romosozumab-aqqg 105 Mg/1.17ml Sc Sosy 1 1 $2,955.00 $2,955.00 $2,955.00 $2,955.00 $2,955.00 2026-01-21
1110000 CDM Room & Nursing 1 1 $2,364.00 $2,364.00 $2,364.00 $2,364.00 $2,364.00 2026-01-21
1210000 CDM Room & Nursing 1 1 $2,049.00 $2,049.00 $2,049.00 $2,049.00 $2,049.00 2026-01-21
95811 CPT Sleep Study 1 1 $3,654.00 $3,654.00 $3,654.00 $3,654.00 $3,654.00 2026-01-21
95810 CPT Sleep Study 1 1 $3,463.00 $3,463.00 $3,463.00 $3,463.00 $3,463.00 2026-01-21
72157 CPT T-spine 1 1 $4,654.00 $4,654.00 $4,654.00 $4,654.00 $4,654.00 2026-01-21
CP17679084990144474 CDM Tenecteplase 50 Mg IV Kit 1 1 $13,587.00 $13,587.00 $13,587.00 $13,587.00 $13,587.00 2026-01-21
28530 CDM Tenecteplase 50 Mg IV Kit 1 1 $13,587.00 $13,587.00 $13,587.00 $13,587.00 $13,587.00 2026-01-21
600948 CDM Tenecteplase 50mg IV For Cardiac / Pe 1 1 $13,587.00 $13,587.00 $13,587.00 $13,587.00 $13,587.00 2026-01-21
600949 CDM Tenecteplase 50mg IV For Stroke 1 1 $13,587.00 $13,587.00 $13,587.00 $13,587.00 $13,587.00 2026-01-21
27605 CPT Tenotomy Prq Achilles Tendon Spx Local Anes 1 1 $2,937.00 $2,937.00 $2,937.00 $2,937.00 $2,937.00 2026-01-21
81162 CPT Th Brca1&2 Seq & Full Dup/del/tlo 1 1 $11,606.00 $11,606.00 $11,606.00 $11,606.00 $11,606.00 2026-01-21
3249118 CDM Th Bunionettes-implant 1 1 $3,824.00 $3,824.00 $3,824.00 $3,824.00 $3,824.00 2026-01-21
3249146 CDM Th Internal Brace Kit 1 1 $2,467.00 $2,467.00 $2,467.00 $2,467.00 $2,467.00 2026-01-21
3249147 CDM Th Knotless Fibertak Implant Kit 1 1 $2,625.00 $2,625.00 $2,625.00 $2,625.00 $2,625.00 2026-01-21
73222 CPT Upper Ext Joint With Contrast 1 1 $3,129.00 $3,129.00 $3,129.00 $3,129.00 $3,129.00 2026-01-21
73223 CPT Upper Ext Joint W/wo Dye 1 1 $4,825.00 $4,825.00 $4,825.00 $4,825.00 $4,825.00 2026-01-21
73218 CPT Upper Ext Without Contrast 1 1 $3,146.00 $3,146.00 $3,146.00 $3,146.00 $3,146.00 2026-01-21
137602 CDM Ustekinumab 130 Mg/26ml IV Soln 1 1 $2,375.00 $2,375.00 $2,375.00 $2,375.00 $2,375.00 2026-01-21
CP17679084990100604 CDM Ustekinumab 130 Mg/26ml IV Soln 1 1 $2,375.00 $2,375.00 $2,375.00 $2,375.00 $2,375.00 2026-01-21
129288 CDM Ustekinumab 90 Mg/ml Sc Sosy 1 1 $14,097.00 $14,097.00 $14,097.00 $14,097.00 $14,097.00 2026-01-21
CP17679084990107649 CDM Ustekinumab 90 Mg/ml Sc Sosy 1 1 $14,097.00 $14,097.00 $14,097.00 $14,097.00 $14,097.00 2026-01-21
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