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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

MOUNTRAIL COUNTY MEDICAL CENTER INC

Stanley, ND · CCN 351301 · Rates published

2,246 distinct procedures filed
9 distinct payers
32,445 rate rows
2025-08-27 last MRF observed
Data quality

32,445 of 32,445 rate rows are consumer-grade (100.0%)

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

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Source MRF file https://secure.claraprice.net/price-transparency/KNHL-1747862097603/machine-readable/450447670_mountrail-county-medical-center_standardcharges.json
Found on page https://secure.claraprice.net/price-transparency/mountrail-county-medical-center-nd
Discovered viaDiscovered by HANK
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-05-19
Content fingerprint f595029c78963255… · 158,895 bytes · first seen 2026-05-19

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
PHA6615
CDM 		Tenecteplase 50 Mg Rec I 9 $16,674.00 $36,247.00 $32,622.00 nat. median
$32,622
1.0× median
10180
CPT 		Etc-i&d Cplx Postop Wnd Inf 9 $2,241.00 $4,872.00 $4,385.00 nat. median
$2,867
1.5× median
53060
CPT 		Drain Skene Gland Abscess/cyst 9 $2,231.00 $4,849.00 $4,364.00 nat. median
$2,255
1.9× median
81410
CPT 		Marfan And Related Genetic Panel 9 $2,166.00 $4,708.00 $4,237.00 nat. median
$740
outlier · 5.7×
PHA17672
CDM 		Nirsevimab (Cvx 306) Alip Preservative-free 50 Mg/0.5 Ml Soln 9 $2,049.00 $4,455.00 $4,010.00 nat. median
$4,010
1.0× median
25260
CPT 		Etc Repair Forearm Tendon/musc 9 $1,971.00 $4,284.00 $3,856.00 nat. median
$3,485
1.1× median
78459
CPT 		PET Myocardial Imaging Metabolic 9 $1,833.00 $3,985.00 $3,587.00 nat. median
$1,819
2.0× median
C8930
HCPCS 		US Rest/stress Echo Complete W/co 9 $1,757.00 $3,819.00 $3,437.00 nat. median
$1,194
outlier · 2.9×
72240
CPT 		Xr Myelography Cervical Spine 9 $1,757.00 $3,819.00 $3,437.00 nat. median
$825
outlier · 4.2×
72255
CPT 		Xr Myelography Thoracic Spine 9 $1,757.00 $3,819.00 $3,437.00 nat. median
$811
outlier · 4.2×
C8925
HCPCS 		US Transesoph Echo W/contrast 9 $1,757.00 $3,819.00 $3,437.00 nat. median
$1,303
outlier · 2.6×
72270
CPT 		Xr Myelography Spine 2 Or More Ar 9 $1,757.00 $3,819.00 $3,437.00 nat. median
$842
outlier · 4.1×
72265
CPT 		Xr Myelography Lumbosacral 9 $1,757.00 $3,819.00 $3,437.00 nat. median
$841
outlier · 4.1×
C8929
HCPCS 		US Echocardiogram Comp W/contrast 9 $1,757.00 $3,819.00 $3,437.00 nat. median
$1,362
outlier · 2.5×
L0637
HCPCS 		Lso Sag-coronal Panel Prefab 9 $1,706.00 $3,708.00 $3,337.00 nat. median
$1,486
outlier · 2.2×
93350
CPT 		US Rest/stress Echocardiogram 9 $1,697.00 $3,689.00 $3,320.00 nat. median
$828
outlier · 4.0×
93312
CPT 		US Transesophageal Echo 9 $1,697.00 $3,689.00 $3,320.00 nat. median
$966
outlier · 3.4×
93351
CPT 		US Rest/stress Echo Complete 9 $1,697.00 $3,689.00 $3,320.00 nat. median
$856
outlier · 3.9×
26432
CPT 		Etc Repair Finger Tendon 32 9 $1,683.00 $3,658.00 $3,292.00 nat. median
$2,069
1.6× median
11012
CPT 		Etc Debride Skin Muscle Bone 9 $1,675.00 $3,642.00 $3,278.00 nat. median
$2,817
1.2× median
92979
CPT 		Cl Ivus Imaging-additional 9 $1,646.00 $3,579.00 $3,221.00 nat. median
$1,672
1.9× median
26037
CPT 		Etc Decompressive Fasciotomy Hand 9 $1,604.00 $3,486.00 $3,137.00 nat. median
$3,257
1.0× median
26418
CPT 		Etc Repair Finger Tendon 18 9 $1,599.00 $3,476.00 $3,128.00 nat. median
$2,051
1.5× median
71552
CPT 		MRI Chest With + Without Contrast 9 $1,585.00 $3,446.00 $3,101.00 nat. median
$1,093
outlier · 2.8×
78075
CPT 		Nm Adrenal/cortex/med Img 9 $1,541.00 $3,349.00 $3,014.00 nat. median
$1,341
outlier · 2.2×
92978
CPT 		Cl Ivus Imaging Initial 9 $1,519.00 $3,303.00 $2,973.00 nat. median
$2,657
1.1× median
42330
CPT 		Sialolithotomy Sm Uncomplicated 9 $1,519.00 $3,303.00 $2,973.00 nat. median
$3,221
0.9× median
31238
CPT 		Etc Nasal Endo W Bld Cntrl 9 $1,519.00 $3,302.00 $2,972.00 nat. median
$2,132
1.4× median
23665
CPT 		Cl Tx Shldr Disloc & Fx Gt W Man 9 $1,514.00 $3,292.00 $2,963.00 nat. median
$1,610
1.8× median
27532
CPT 		Cl Tx Prox Tibial Fx W Sk Tract 9 $1,492.00 $3,243.00 $2,919.00 nat. median
$3,337
0.9× median
72197
CPT 		MRI Pelvis With + Without Contrast 9 $1,482.00 $3,222.00 $2,900.00 nat. median
$1,065
outlier · 2.7×
70543
CPT 		MRI Face Neck Orbit With + Without Cont 9 $1,482.00 $3,222.00 $2,900.00 nat. median
$1,079
outlier · 2.7×
74183
CPT 		MRI Abdomen With + Without Contrast 9 $1,482.00 $3,222.00 $2,900.00 nat. median
$1,102
outlier · 2.6×
52310
CPT 		Cysto W Rem Fb/stnt, Ureth/bldr,s 9 $1,480.00 $3,217.00 $2,895.00 nat. median
$2,225
1.3× median
49406
CPT 		Etc Image Cath Fluid Peri/retro 9 $1,465.00 $3,185.00 $2,867.00 nat. median
$2,224
1.3× median
31525
CPT 		Etc Diagnostic Laryngoscopy 25 9 $1,448.00 $3,147.00 $2,832.00 nat. median
$2,020
1.4× median
53620
CPT 		Etc Dilate Urethral Stricture 9 $1,446.00 $3,144.00 $2,830.00 nat. median
$841
outlier · 3.4×
28435
CPT 		Etc Cl Tx Talus Fx, W Manip 9 $1,438.00 $3,127.00 $2,814.00 nat. median
$1,763
1.6× median
24565
CPT 		Cl Tx Ec Humerus Fx W Manip 9 $1,431.00 $3,111.00 $2,800.00 nat. median
$1,687
1.7× median
24505
CPT 		Etc-cl Tx Humerus Fx W Manip 9 $1,431.00 $3,111.00 $2,800.00 nat. median
$1,641
1.7× median
23575
CPT 		Cl Tx Scapular Fx, W Manip 9 $1,431.00 $3,111.00 $2,800.00 nat. median
$1,653
1.7× median
26645
CPT 		Cl Tx Cmc Fx Disloc, Thumb W Man 9 $1,431.00 $3,111.00 $2,800.00 nat. median
$1,601
1.7× median
25635
CPT 		Etc Cltx Carpl Bone Fx W Mnp Ea B 9 $1,431.00 $3,111.00 $2,800.00 nat. median
$1,648
1.7× median
27768
CPT 		Etc Cltx Post Ankle Fx W Mani 9 $1,431.00 $3,111.00 $2,800.00 nat. median
$1,608
1.7× median
23675
CPT 		Etc-cl Tx Shdr Disloc W Nk Fx W M 9 $1,431.00 $3,111.00 $2,800.00 nat. median
$1,668
1.7× median
73220
CPT 		MRI Forearm With + Without Contrast Bil 9 $1,315.00 $5,112.00 $2,786.00 nat. median
$1,185
outlier · 2.4×
59409
CPT 		Vaginal Delivery Only 9 $1,349.00 $3,575.00 $2,785.00 nat. median
$3,185
0.9× median
24620
CPT 		Cl Tx Monteggia Elb Fx W Manip 9 $1,409.00 $3,062.00 $2,756.00 nat. median
$2,050
1.3× median
59414
CPT 		Etc Delivery Of Placenta 9 $1,406.00 $3,057.00 $2,751.00 nat. median
$2,876
1.0× median
C8908
HCPCS 		MRI Breast With + Without Contrast Bila 9 $1,405.00 $3,055.00 $2,750.00 nat. median
$928
outlier · 3.0×

Other procedures at this hospital

Browse this hospital's 2,246 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
             
0219U CPT HIV-1 Genotyping, Plasma 9 9 $1,348.00 $1,213.00 $620.00 $1,348.00 $1,213.00 2025-08-27
10121 CPT Etc Remove Foreign Body 21 9 9 $2,587.00 $2,328.00 $1,190.00 $2,587.00 $2,328.00 2025-08-27
10180 CPT Etc-i&d Cplx Postop Wnd Inf 9 9 $4,872.00 $4,385.00 $2,241.00 $4,872.00 $4,385.00 2025-08-27
11012 CPT Etc Debride Skin Muscle Bone 9 9 $3,642.00 $3,278.00 $1,675.00 $3,642.00 $3,278.00 2025-08-27
11044 CPT Debride, Skin To Bone 9 9 $2,463.00 $2,217.00 $1,133.00 $2,463.00 $2,217.00 2025-08-27
11406 CPT Etc Exc Ben Les T/a/l, >4.0cm 18 9 $2,466.00 $2,219.00 $431.00 $3,996.00 $1,387.00 2025-08-27
11446 CPT Exc B9 Lesion Mrgn Xcp Sk Tg F/e/e/n/l/m 9 9 $1,307.00 $1,176.00 $601.00 $1,307.00 $1,176.00 2025-08-27
11606 CPT Excision Malignant Lesion Trunk/arm/leg 9 9 $1,227.00 $1,104.00 $564.00 $1,227.00 $1,104.00 2025-08-27
11626 CPT Excision Malignant Lesion S/n/h/f/g > 4. 9 9 $1,444.00 $1,300.00 $664.00 $1,444.00 $1,300.00 2025-08-27
11644 CPT Excision Malignant Lesion F/e/e/n/l 3.1- 9 9 $1,470.00 $1,323.00 $676.00 $1,470.00 $1,323.00 2025-08-27
11646 CPT Excision Malignant Lesion F/e/e/n/l > 4. 9 9 $1,910.00 $1,719.00 $879.00 $1,910.00 $1,719.00 2025-08-27
11760 CPT Etc Repair Of Nail Bed 9 9 $1,258.00 $1,132.00 $579.00 $1,258.00 $1,132.00 2025-08-27
12036 CPT Int Rep S/a/t/ex, 20.1-30.0cm 9 9 $1,281.00 $1,153.00 $589.00 $1,281.00 $1,153.00 2025-08-27
12046 CPT Int Rep N/h/f/g, 20.1-30.0cm 9 9 $1,226.00 $1,103.00 $564.00 $1,226.00 $1,103.00 2025-08-27
12056 CPT Int Rep F/e/n/l/mm, 20.1-30.0cm 9 9 $1,276.00 $1,148.00 $587.00 $1,276.00 $1,148.00 2025-08-27
13121 CPT Crep S/a/l, 2.6-7.5cm 18 9 $1,245.50 $1,121.00 $557.00 $1,281.00 $1,119.50 2025-08-27
13152 CPT Etc Repair Of Wound Or Lesion 18 9 $1,829.00 $1,646.50 $664.00 $2,214.00 $1,372.00 2025-08-27
16970 CPT Glucagon 1 Mg Rec I 9 9 $1,610.00 $1,449.00 $741.00 $1,610.00 $1,449.00 2025-08-27
17286 CPT Destruction Mal Lesion F/e/e/n/l/m > 4.0 9 9 $1,427.00 $1,284.00 $656.00 $1,427.00 $1,284.00 2025-08-27
17304 CPT Sumatriptan 6 Mg/0.5 Ml Sol 9 9 $2,053.00 $1,848.00 $944.00 $2,053.00 $1,848.00 2025-08-27
19000 CPT Punct Asp Brst Cystinitial 9 9 $1,451.00 $1,306.00 $667.00 $1,451.00 $1,306.00 2025-08-27
20101 CPT Expl P Wnd, Chest 9 9 $3,016.00 $2,714.00 $1,387.00 $3,016.00 $2,714.00 2025-08-27
20520 CPT Rem Fb Muscle, Smpl 9 9 $1,969.00 $1,772.00 $906.00 $1,969.00 $1,772.00 2025-08-27
20950 CPT Etc Intracompartmental Pressure M 9 9 $1,364.00 $1,228.00 $627.00 $1,364.00 $1,228.00 2025-08-27
21315 CPT Etc Treatment Of Nose Fracture 9 9 $1,500.00 $1,350.00 $690.00 $1,500.00 $1,350.00 2025-08-27
21320 CPT Cl Tx Of Nasal Bone Fx, W Stabili 9 9 $2,000.00 $1,800.00 $920.00 $2,000.00 $1,800.00 2025-08-27
23330 CPT Rem Fb Shoulder, Sq 9 9 $2,462.00 $2,216.00 $1,133.00 $2,462.00 $2,216.00 2025-08-27
23575 CPT Cl Tx Scapular Fx, W Manip 9 9 $3,111.00 $2,800.00 $1,431.00 $3,111.00 $2,800.00 2025-08-27
23665 CPT Cl Tx Shldr Disloc & Fx Gt W Man 9 9 $3,292.00 $2,963.00 $1,514.00 $3,292.00 $2,963.00 2025-08-27
23675 CPT Etc-cl Tx Shdr Disloc W Nk Fx W M 9 9 $3,111.00 $2,800.00 $1,431.00 $3,111.00 $2,800.00 2025-08-27
24505 CPT Etc-cl Tx Humerus Fx W Manip 9 9 $3,111.00 $2,800.00 $1,431.00 $3,111.00 $2,800.00 2025-08-27
24535 CPT Cl Tx Sc/tx Humerus Shft Fx W Man 18 9 $2,575.00 $2,318.00 $1,116.00 $2,725.00 $2,243.50 2025-08-27
24565 CPT Cl Tx Ec Humerus Fx W Manip 9 9 $3,111.00 $2,800.00 $1,431.00 $3,111.00 $2,800.00 2025-08-27
24605 CPT Tx Cl Elbow Disloc W Anesth 9 9 $2,301.00 $2,071.00 $1,058.00 $2,301.00 $2,071.00 2025-08-27
24620 CPT Cl Tx Monteggia Elb Fx W Manip 9 9 $3,062.00 $2,756.00 $1,409.00 $3,062.00 $2,756.00 2025-08-27
24655 CPT Cl Tx Radial Hd/neck Fx, W Manip 18 9 $1,768.50 $1,591.50 $762.00 $1,880.00 $1,539.00 2025-08-27
24675 CPT Cl Tx Prox Ulnar Fx W Manip 18 9 $2,275.50 $2,048.00 $662.00 $3,111.00 $1,431.00 2025-08-27
25260 CPT Etc Repair Forearm Tendon/musc 9 9 $4,284.00 $3,856.00 $1,971.00 $4,284.00 $3,856.00 2025-08-27
25505 CPT Cl Tx Radial Shft Fx W Manip 9 9 $1,975.00 $1,778.00 $909.00 $1,975.00 $1,778.00 2025-08-27
25565 CPT Cl Tx Radial & Ulna Fx W Manip 9 9 $1,935.00 $1,742.00 $890.00 $1,935.00 $1,742.00 2025-08-27
25605 CPT Cl Tx Of D Rad Fx /Es, W Manip 18 9 $2,393.00 $2,154.00 $687.00 $3,292.00 $1,504.00 2025-08-27
25635 CPT Etc Cltx Carpl Bone Fx W Mnp Ea B 9 9 $3,111.00 $2,800.00 $1,431.00 $3,111.00 $2,800.00 2025-08-27
25690 CPT Cl Tx Lunate Disloc W Manip 9 9 $2,823.00 $2,541.00 $1,299.00 $2,823.00 $2,541.00 2025-08-27
26037 CPT Etc Decompressive Fasciotomy Hand 9 9 $3,486.00 $3,137.00 $1,604.00 $3,486.00 $3,137.00 2025-08-27
26080 CPT Etc Expl/rem Fb Iph Joint Ea 9 9 $2,440.00 $2,196.00 $1,122.00 $2,440.00 $2,196.00 2025-08-27
26236 CPT Part Exc, Bone, Distal Phalanx 9 9 $2,490.00 $2,241.00 $1,145.00 $2,490.00 $2,241.00 2025-08-27
26418 CPT Etc Repair Finger Tendon 18 9 9 $3,476.00 $3,128.00 $1,599.00 $3,476.00 $3,128.00 2025-08-27
26432 CPT Etc Repair Finger Tendon 32 9 9 $3,658.00 $3,292.00 $1,683.00 $3,658.00 $3,292.00 2025-08-27
26645 CPT Cl Tx Cmc Fx Disloc, Thumb W Man 9 9 $3,111.00 $2,800.00 $1,431.00 $3,111.00 $2,800.00 2025-08-27
26742 CPT Cl Tx Artfx, Mcp/ip Jnt, W Manip 18 9 $2,356.50 $2,121.00 $737.00 $3,111.00 $1,522.00 2025-08-27
26951 CPT Amp F/th 1/2 Jt/phalanx W/neurect W/dir 9 9 $2,312.00 $2,081.00 $1,064.00 $2,312.00 $2,081.00 2025-08-27
27086 CPT Etc Rem Fb Pelvis Or Hip, Sq 9 9 $1,695.00 $1,526.00 $780.00 $1,695.00 $1,526.00 2025-08-27
27222 CPT Cl Tx Acetabulum Fx, W Manip 9 9 $2,782.00 $2,504.00 $1,280.00 $2,782.00 $2,504.00 2025-08-27
27240 CPT Etc Cltx Intr/peri/sbtrchntc Fem 9 9 $1,838.00 $1,654.00 $845.00 $1,838.00 $1,654.00 2025-08-27
27252 CPT Cl Tx Trauma Hip Disloc W Anesth 9 9 $2,301.00 $2,071.00 $1,058.00 $2,301.00 $2,071.00 2025-08-27
27257 CPT Tx Spontan Hip Disloc W Anesth 9 9 $2,007.00 $1,806.00 $923.00 $2,007.00 $1,806.00 2025-08-27
27502 CPT Cl Tx Femoral Shaft Fx, W Manip 9 9 $2,530.00 $2,277.00 $1,164.00 $2,530.00 $2,277.00 2025-08-27
27510 CPT Cl Tx Femur Fx Or Epiphys Sep 9 9 $2,964.00 $2,668.00 $1,363.00 $2,964.00 $2,668.00 2025-08-27
27532 CPT Cl Tx Prox Tibial Fx W Sk Tract 9 9 $3,243.00 $2,919.00 $1,492.00 $3,243.00 $2,919.00 2025-08-27
27752 CPT Cl Tx Tib Shft Fx W Manip 9 9 $2,782.00 $2,504.00 $1,280.00 $2,782.00 $2,504.00 2025-08-27
27762 CPT Etc Cltx Med Ankle Fx W/mnpj 9 9 $2,530.00 $2,277.00 $1,164.00 $2,530.00 $2,277.00 2025-08-27
27768 CPT Etc Cltx Post Ankle Fx W Mani 9 9 $3,111.00 $2,800.00 $1,431.00 $3,111.00 $2,800.00 2025-08-27
27781 CPT Cl Tx Prox Fib/shaft Fx W Manip 9 9 $2,124.00 $1,912.00 $977.00 $2,124.00 $1,912.00 2025-08-27
27810 CPT Cl Tx Bimalleolr Ankle Fx W Man 18 9 $1,660.50 $1,494.50 $745.00 $1,701.00 $1,494.50 2025-08-27
27818 CPT Cl Tx Trimall Ankle Fx, W Manip 9 9 $1,620.00 $1,458.00 $745.00 $1,620.00 $1,458.00 2025-08-27
27825 CPT Cl Tx Wb Dstl Tib Fx W Manip 9 9 $2,530.00 $2,277.00 $1,164.00 $2,530.00 $2,277.00 2025-08-27
27842 CPT Cl Tx Ankle Disloc W Anesth 9 9 $2,301.00 $2,071.00 $1,058.00 $2,301.00 $2,071.00 2025-08-27
28435 CPT Etc Cl Tx Talus Fx, W Manip 9 9 $3,127.00 $2,814.00 $1,438.00 $3,127.00 $2,814.00 2025-08-27
31238 CPT Etc Nasal Endo W Bld Cntrl 9 9 $3,302.00 $2,972.00 $1,519.00 $3,302.00 $2,972.00 2025-08-27
31525 CPT Etc Diagnostic Laryngoscopy 25 9 9 $3,147.00 $2,832.00 $1,448.00 $3,147.00 $2,832.00 2025-08-27
31603 CPT Tracheostomy, Emergency Procedure 9 9 $1,783.00 $1,605.00 $820.00 $1,783.00 $1,605.00 2025-08-27
31605 CPT Tracheostomy Emerg, Cricothyroid 9 9 $1,835.00 $1,652.00 $844.00 $1,835.00 $1,652.00 2025-08-27
32551 CPT Nrs Insertion Of Chest Tube 25 9 $1,456.00 $1,310.00 $209.00 $1,457.00 $1,093.00 2025-08-27
32554 CPT Etc Aspirate Pleura Without Imaging ^ 9 9 $1,456.00 $1,310.00 $670.00 $1,456.00 $1,310.00 2025-08-27
32555 CPT Etc Aspirate Pleura W/img 9 9 $1,456.00 $1,310.00 $670.00 $1,456.00 $1,310.00 2025-08-27
33010 CPT Pericardiocentesis, Initial 9 9 $1,373.00 $1,236.00 $632.00 $1,373.00 $1,236.00 2025-08-27
33011 CPT Etc-pericardiocentesis, Subsequen 9 9 $1,373.00 $1,236.00 $632.00 $1,373.00 $1,236.00 2025-08-27
35226 CPT Repair Bld Vessel, Direct, Lwr Ex 9 9 $1,307.00 $1,176.00 $601.00 $1,307.00 $1,176.00 2025-08-27
36430 CPT Transfusion Blood Or Blood Compon 18 9 $1,583.00 $1,424.50 $536.00 $2,000.00 $1,108.00 2025-08-27
36555 CPT Ins Non-tunnel Cv Cath,< 5yrs 9 9 $2,005.00 $1,805.00 $922.00 $2,005.00 $1,805.00 2025-08-27
36556 CPT Ins Non-tunnel Cv Cath, >5 Yrs 9 9 $2,511.00 $2,260.00 $1,155.00 $2,511.00 $2,260.00 2025-08-27
36568 CPT Etc Insj Picc <5 Yr Without Imaging 18 9 $1,883.00 $1,695.00 $810.00 $2,005.00 $1,638.50 2025-08-27
36569 CPT Etc Insj Picc 5 Yr+ Without Imaging 9 9 $2,611.00 $2,350.00 $1,201.00 $2,611.00 $2,350.00 2025-08-27
36575 CPT Repair Cva Catheter 9 9 $1,402.00 $1,262.00 $645.00 $1,402.00 $1,262.00 2025-08-27
36580 CPT Replace Non-tunneled Cv Cath 9 9 $2,511.00 $2,260.00 $1,155.00 $2,511.00 $2,260.00 2025-08-27
36589 CPT Remove Tnl Cv Cath 9 9 $1,453.00 $1,308.00 $668.00 $1,453.00 $1,308.00 2025-08-27
36590 CPT Etc Rem Tunneled Cvad W Port/pump 9 9 $1,683.00 $1,515.00 $774.00 $1,683.00 $1,515.00 2025-08-27
40652 CPT Repair Lip, Ft, Up To Half Vertic 9 9 $1,925.00 $1,733.00 $886.00 $1,925.00 $1,733.00 2025-08-27
40654 CPT Repair Lip, Ft,> 1/2 V Hgt Or Com 9 9 $1,925.00 $1,733.00 $886.00 $1,925.00 $1,733.00 2025-08-27
40804 CPT Etc Rem Embedded Fb Mouth Vestib, 9 9 $1,915.00 $1,724.00 $881.00 $1,915.00 $1,724.00 2025-08-27
40819 CPT Etc Exc Of Frenum Labial/buccal 9 9 $2,674.00 $2,407.00 $1,230.00 $2,674.00 $2,407.00 2025-08-27
40831 CPT Etc Repair Mouth Laceration 9 9 $1,925.00 $1,733.00 $886.00 $1,925.00 $1,733.00 2025-08-27
41000 CPT I&d Absc/cyst, Tongue, Fom, Lingu 9 9 $2,354.00 $2,119.00 $1,083.00 $2,354.00 $2,119.00 2025-08-27
41010 CPT Incision Of Lingual Frenum 9 9 $2,674.00 $2,407.00 $1,230.00 $2,674.00 $2,407.00 2025-08-27
41252 CPT Etc Repair Of Tongue Laceration 9 9 $1,835.00 $1,652.00 $844.00 $1,835.00 $1,652.00 2025-08-27
41899 CPT Dental Surgery Procedure 9 9 $2,011.00 $1,810.00 $925.00 $2,011.00 $1,810.00 2025-08-27
42330 CPT Sialolithotomy Sm Uncomplicated 9 9 $3,303.00 $2,973.00 $1,519.00 $3,303.00 $2,973.00 2025-08-27
43215 CPT Esophagoscopy W Fb Removal 9 9 $2,791.00 $2,512.00 $1,284.00 $2,791.00 $2,512.00 2025-08-27
45900 CPT Reduction Of Procidentia Under An 9 9 $1,317.00 $1,185.00 $606.00 $1,317.00 $1,185.00 2025-08-27
46040 CPT Etc Incision Of Rectal Abscess 9 9 $1,500.00 $1,350.00 $690.00 $1,500.00 $1,350.00 2025-08-27
46608 CPT Anoscopy, W Rem Fb 9 9 $2,169.00 $1,952.00 $998.00 $2,169.00 $1,952.00 2025-08-27
49082 CPT Etc Abd Paracentesis 9 9 $1,388.00 $1,249.00 $638.00 $1,388.00 $1,249.00 2025-08-27
49083 CPT Etc Abd Paracentesis With Img 9 9 $1,388.00 $1,249.00 $638.00 $1,388.00 $1,249.00 2025-08-27
49084 CPT Etc Peritoneal Lavage 9 9 $1,388.00 $1,249.00 $638.00 $1,388.00 $1,249.00 2025-08-27
49406 CPT Etc Image Cath Fluid Peri/retro 9 9 $3,185.00 $2,867.00 $1,465.00 $3,185.00 $2,867.00 2025-08-27
50100 CPT Meningococcal Group B Vaccine Fully Recombinant Susp 9 9 $1,512.00 $1,361.00 $696.00 $1,512.00 $1,361.00 2025-08-27
52310 CPT Cysto W Rem Fb/stnt, Ureth/bldr,s 9 9 $3,217.00 $2,895.00 $1,480.00 $3,217.00 $2,895.00 2025-08-27
53060 CPT Drain Skene Gland Abscess/cyst 9 9 $4,849.00 $4,364.00 $2,231.00 $4,849.00 $4,364.00 2025-08-27
53620 CPT Etc Dilate Urethral Stricture 9 9 $3,144.00 $2,830.00 $1,446.00 $3,144.00 $2,830.00 2025-08-27
55100 CPT Drainage Of Scrotal Wall Abscess 9 9 $1,500.00 $1,350.00 $690.00 $1,500.00 $1,350.00 2025-08-27
59409 CPT Vaginal Delivery Only 18 9 $3,253.50 $2,928.50 $1,349.00 $3,575.00 $2,785.00 2025-08-27
59414 CPT Etc Delivery Of Placenta 9 9 $3,057.00 $2,751.00 $1,406.00 $3,057.00 $2,751.00 2025-08-27
62322 CPT Injection(s) Of Therapeutic Substance 9 9 $1,370.00 $1,233.00 $630.00 $1,370.00 $1,233.00 2025-08-27
62326 CPT Njx Interlaminar Lmbr/sac 9 9 $2,223.00 $2,001.00 $1,023.00 $2,223.00 $2,001.00 2025-08-27
64119 CPT Human Papillomavirus Vaccine 9-valent Susp 9 9 $2,276.00 $2,048.00 $1,047.00 $2,276.00 $2,048.00 2025-08-27
64347 CPT Pneumococcal 21-valent Conjugate Vaccine (Cvx 327)susp 9 9 $2,583.00 $2,325.00 $1,188.00 $2,583.00 $2,325.00 2025-08-27
65270 CPT Rep Lacer Conj, Dir Cl 9 9 $2,767.00 $2,490.00 $1,273.00 $2,767.00 $2,490.00 2025-08-27
68020 CPT Etc Incise/drain Eyelid Lining 9 9 $2,913.00 $2,622.00 $1,340.00 $2,913.00 $2,622.00 2025-08-27
70130 CPT Xr Mastoids Complete Bilateral 9 9 $1,537.00 $1,383.00 $707.00 $1,537.00 $1,383.00 2025-08-27
70170 CPT Xr Dacryocystography 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
70310 CPT Xr Teeth Partial 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
70320 CPT Xr Teeth Complete Full Mouth 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
70336 CPT MRI Tmj 9 9 $1,215.00 $1,094.00 $559.00 $1,215.00 $1,094.00 2025-08-27
70390 CPT Xr Sialogram 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
70460 CPT CT Head Or Brain With Contrast 9 9 $1,552.00 $1,397.00 $714.00 $1,552.00 $1,397.00 2025-08-27
70470 CPT CT Head Or Brain With + Without Contras 9 9 $2,075.00 $1,868.00 $955.00 $2,075.00 $1,868.00 2025-08-27
70481 CPT CT Orbit Sella Etc. With Contrast 9 9 $1,649.00 $1,484.00 $759.00 $1,649.00 $1,484.00 2025-08-27
70482 CPT CT Orbit Sella Etc. With + Without Cont 9 9 $2,149.00 $1,934.00 $989.00 $2,149.00 $1,934.00 2025-08-27
70487 CPT CT Maxillofacial With Contrast 9 9 $1,547.00 $1,392.00 $712.00 $1,547.00 $1,392.00 2025-08-27
70488 CPT CT Maxillofacial With + Without Contras 9 9 $2,047.00 $1,842.00 $942.00 $2,047.00 $1,842.00 2025-08-27
70491 CPT CT Soft Tissue Neck With Contrast 9 9 $1,499.00 $1,349.00 $690.00 $1,499.00 $1,349.00 2025-08-27
70492 CPT CT Soft Tissue Neck With + Without Cont 9 9 $1,542.00 $1,388.00 $709.00 $1,542.00 $1,388.00 2025-08-27
70496 CPT CT Angiography Head With + Without Cont 18 9 $2,162.50 $1,946.50 $667.00 $2,875.00 $1,378.00 2025-08-27
70498 CPT CT Angiography Neck 9 9 $2,299.00 $2,069.00 $1,058.00 $2,299.00 $2,069.00 2025-08-27
70540 CPT MRI Face Neck Orbit Without Contrast 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
70543 CPT MRI Face Neck Orbit With + Without Cont 9 9 $3,222.00 $2,900.00 $1,482.00 $3,222.00 $2,900.00 2025-08-27
70544 CPT MRA Head Without Contrast 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
70546 CPT Mrv Head W + Without Contrast-exam 9 9 $2,555.00 $2,300.00 $1,175.00 $2,555.00 $2,300.00 2025-08-27
70547 CPT MRA Neck Without Contrast 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
70548 CPT MRA Neck With Contrast 9 9 $1,764.00 $1,588.00 $811.00 $1,764.00 $1,588.00 2025-08-27
70551 CPT MRI Brain Without Contrast 9 9 $1,415.00 $1,274.00 $651.00 $1,415.00 $1,274.00 2025-08-27
70552 CPT MRI Brain With Contrast 9 9 $1,915.00 $1,724.00 $881.00 $1,915.00 $1,724.00 2025-08-27
70553 CPT MRI Scan 9 9 $2,415.00 $2,174.00 $1,111.00 $2,415.00 $2,174.00 2025-08-27
71260 CPT CT Chest With Contrast 9 9 $1,808.00 $1,627.00 $832.00 $1,808.00 $1,627.00 2025-08-27
71270 CPT CT Chest With + Without Contrast 9 9 $2,308.00 $2,077.00 $1,062.00 $2,308.00 $2,077.00 2025-08-27
71275 CPT CT Angiography Chest 9 9 $2,608.00 $2,347.00 $1,200.00 $2,608.00 $2,347.00 2025-08-27
71550 CPT MRI Chest Without Contrast 9 9 $2,527.00 $2,274.00 $1,162.00 $2,527.00 $2,274.00 2025-08-27
71552 CPT MRI Chest With + Without Contrast 9 9 $3,446.00 $3,101.00 $1,585.00 $3,446.00 $3,101.00 2025-08-27
72126 CPT CT Spine Cervical With Contrast 9 9 $1,563.00 $1,407.00 $719.00 $1,563.00 $1,407.00 2025-08-27
72127 CPT CT Spine Cervical W+without Contrast 9 9 $2,063.00 $1,857.00 $949.00 $2,063.00 $1,857.00 2025-08-27
72129 CPT CT Spine Thoracic With Contrast 9 9 $1,590.00 $1,431.00 $731.00 $1,590.00 $1,431.00 2025-08-27
72130 CPT CT Spine Thoracic W/+without Contrast 9 9 $1,590.00 $1,431.00 $731.00 $1,590.00 $1,431.00 2025-08-27
72132 CPT CT Spine Lumbar With Contrast 9 9 $1,590.00 $1,431.00 $731.00 $1,590.00 $1,431.00 2025-08-27
72133 CPT CT Spine Lumbar W/+without Contrast 9 9 $2,090.00 $1,881.00 $961.00 $2,090.00 $1,881.00 2025-08-27
72141 CPT MRI Spine Cervical Without Contrast 9 9 $1,935.00 $1,742.00 $890.00 $1,935.00 $1,742.00 2025-08-27
72142 CPT MRI Spine Cervical With Contrast 9 9 $2,435.00 $2,192.00 $1,120.00 $2,435.00 $2,192.00 2025-08-27
72146 CPT MRI Spine Thoracic Without Contrast 9 9 $2,244.00 $2,020.00 $1,032.00 $2,244.00 $2,020.00 2025-08-27
72147 CPT MRI Spine Thoracic With Contrast 9 9 $2,435.00 $2,192.00 $1,120.00 $2,435.00 $2,192.00 2025-08-27
72148 CPT MRI Scan Of Lower Spinal Canal 9 9 $1,935.00 $1,742.00 $890.00 $1,935.00 $1,742.00 2025-08-27
72149 CPT MRI Spine Lumbar With Contrast 9 9 $2,435.00 $2,192.00 $1,120.00 $2,435.00 $2,192.00 2025-08-27
72156 CPT MRI Spine Cervical With + Without Contr 9 9 $2,935.00 $2,642.00 $1,350.00 $2,935.00 $2,642.00 2025-08-27
72157 CPT MRI Spine Thoracic With + Without Contr 9 9 $2,935.00 $2,642.00 $1,350.00 $2,935.00 $2,642.00 2025-08-27
72158 CPT MRI Spine Lumbar With + Without Contras 9 9 $2,935.00 $2,642.00 $1,350.00 $2,935.00 $2,642.00 2025-08-27
72159 CPT MRA Spinal Canal + Contents 9 9 $2,500.00 $2,250.00 $1,150.00 $2,500.00 $2,250.00 2025-08-27
72191 CPT CT Angiography Pelvis 9 9 $2,390.00 $2,151.00 $1,099.00 $2,390.00 $2,151.00 2025-08-27
72193 CPT CT Scan Of Pelvis With Contrast 9 9 $1,590.00 $1,431.00 $731.00 $1,590.00 $1,431.00 2025-08-27
72194 CPT CT Pelvis With + Without Contrast 9 9 $2,090.00 $1,881.00 $961.00 $2,090.00 $1,881.00 2025-08-27
72195 CPT MRI Pelvis Without Contrast 9 9 $2,440.00 $2,196.00 $1,122.00 $2,440.00 $2,196.00 2025-08-27
72196 CPT MRI Pelvis With Contrast 9 9 $2,940.00 $2,646.00 $1,352.00 $2,940.00 $2,646.00 2025-08-27
72197 CPT MRI Pelvis With + Without Contrast 9 9 $3,222.00 $2,900.00 $1,482.00 $3,222.00 $2,900.00 2025-08-27
72240 CPT Xr Myelography Cervical Spine 9 9 $3,819.00 $3,437.00 $1,757.00 $3,819.00 $3,437.00 2025-08-27
72255 CPT Xr Myelography Thoracic Spine 9 9 $3,819.00 $3,437.00 $1,757.00 $3,819.00 $3,437.00 2025-08-27
72265 CPT Xr Myelography Lumbosacral 9 9 $3,819.00 $3,437.00 $1,757.00 $3,819.00 $3,437.00 2025-08-27
72270 CPT Xr Myelography Spine 2 Or More Ar 9 9 $3,819.00 $3,437.00 $1,757.00 $3,819.00 $3,437.00 2025-08-27
73040 CPT Xr Arthrogram Shoulder Left 9 9 $2,555.00 $2,300.00 $1,175.00 $2,555.00 $2,300.00 2025-08-27
73085 CPT Xr Arthrogram Elbow Left 9 9 $2,555.00 $2,300.00 $1,175.00 $2,555.00 $2,300.00 2025-08-27
73115 CPT Xr Arthrogram Wrist Left 9 9 $1,415.00 $1,274.00 $651.00 $1,415.00 $1,274.00 2025-08-27
73201 CPT CT Elbow With Contrast Bilateral 18 9 $2,210.00 $1,989.00 $731.00 $2,830.00 $1,511.00 2025-08-27
73202 CPT CT Elbow With + Without Contrast Bilate 27 9 $2,090.00 $1,881.00 $913.00 $2,830.00 $1,886.00 2025-08-27
73206 CPT CT Angiography Upper Extremity Bi 18 9 $3,010.00 $2,709.00 $1,099.00 $3,630.00 $2,271.00 2025-08-27
73218 CPT MRI Forearm Without Contrast Bilatera 18 9 $2,788.50 $2,509.50 $855.00 $3,718.00 $1,766.00 2025-08-27
73219 CPT MRI Forearm With Contrast Bilateral 18 9 $3,735.50 $3,362.00 $1,085.00 $5,112.00 $2,352.00 2025-08-27
73220 CPT MRI Forearm With + Without Contrast Bil 27 9 $3,482.00 $3,134.00 $1,315.00 $5,112.00 $2,786.00 2025-08-27
73221 CPT MRI Elbow Without Contrast Bilateral 27 9 $1,859.00 $1,673.00 $823.00 $3,718.00 $1,710.00 2025-08-27
73222 CPT MRI Elbow With Contrast Left 18 9 $2,324.50 $2,092.00 $1,053.00 $2,359.00 $2,092.00 2025-08-27
73223 CPT MRI Elbow With + Without Contrast Bilat 27 9 $2,859.00 $2,573.00 $1,283.00 $5,112.00 $2,651.00 2025-08-27
73225 CPT MRA Upper Extremity Bil W/+without Co 9 9 $2,898.00 $2,608.00 $1,333.00 $2,898.00 $2,608.00 2025-08-27
73525 CPT Xr Arthrogram Hip Left 9 9 $2,555.00 $2,300.00 $1,175.00 $2,555.00 $2,300.00 2025-08-27
73580 CPT Xr Arthrogram Knee Left 9 9 $2,555.00 $2,300.00 $1,175.00 $2,555.00 $2,300.00 2025-08-27
73615 CPT Xr Arthrogram Ankle Left 9 9 $2,555.00 $2,300.00 $1,175.00 $2,555.00 $2,300.00 2025-08-27
73701 CPT CT Ankle With Contrast Bilateral 18 9 $2,210.00 $1,989.00 $731.00 $2,830.00 $1,511.00 2025-08-27
73702 CPT CT Ankle With + Without Contrast Bilate 36 9 $2,037.50 $1,834.00 $731.00 $2,830.00 $1,631.00 2025-08-27
73706 CPT CT Angiography Lower Extremity Bi 18 9 $2,692.50 $2,423.50 $1,058.00 $3,085.00 $2,185.00 2025-08-27
73718 CPT MRI Femur Without Contrast Bilat 36 9 $2,250.00 $2,025.00 $802.00 $3,718.00 $1,710.00 2025-08-27
73719 CPT MRI Femur With Contrast Bilat 36 9 $2,565.00 $2,308.50 $1,032.00 $3,450.00 $2,158.50 2025-08-27
73720 CPT MRI Femur With + Without Contrast Bilat 45 9 $3,482.00 $3,134.00 $1,262.00 $5,112.00 $2,660.00 2025-08-27
73721 CPT MRI Scan Of Leg Joint 27 9 $1,800.00 $1,620.00 $802.00 $3,718.00 $1,710.00 2025-08-27
73722 CPT MRI Ankle With Contrast Bilateral 36 9 $2,400.00 $2,160.00 $1,032.00 $3,366.00 $2,132.00 2025-08-27
73723 CPT MRI Ankle With + Without Contrast Bilat 36 9 $3,458.00 $3,112.00 $1,262.00 $5,112.00 $2,660.00 2025-08-27
73725 CPT MRA Lower Extremity Bil Without Contr 9 9 $2,500.00 $2,250.00 $1,150.00 $2,500.00 $2,250.00 2025-08-27
74160 CPT CT Abdomen With Contrast 9 9 $1,500.00 $1,350.00 $690.00 $1,500.00 $1,350.00 2025-08-27
74170 CPT CT Abdomen With + Without Contrast 9 9 $2,000.00 $1,800.00 $920.00 $2,000.00 $1,800.00 2025-08-27
74174 CPT CT Angio Abdomen/pelvis W/contras 9 9 $2,735.00 $2,462.00 $1,258.00 $2,735.00 $2,462.00 2025-08-27
74175 CPT CT Angiography Abdomen 9 9 $2,300.00 $2,070.00 $1,058.00 $2,300.00 $2,070.00 2025-08-27
74176 CPT CT Abdomen/pelvis Without Contrast 9 9 $1,853.00 $1,668.00 $852.00 $1,853.00 $1,668.00 2025-08-27
74177 CPT CT Scan Of Abdomen And Pelvis With Contrast 9 9 $1,935.00 $1,742.00 $890.00 $1,935.00 $1,742.00 2025-08-27
74178 CPT CT Abdomen/pelvis 1+ Section/regn 9 9 $2,435.00 $2,192.00 $1,120.00 $2,435.00 $2,192.00 2025-08-27
74181 CPT MRI Abdomen Without Contrast 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
74182 CPT MRI Abdomen With Contrast 9 9 $2,555.00 $2,300.00 $1,175.00 $2,555.00 $2,300.00 2025-08-27
74183 CPT MRI Abdomen With + Without Contrast 9 9 $3,222.00 $2,900.00 $1,482.00 $3,222.00 $2,900.00 2025-08-27
74185 CPT MRA Abdomen Without Contrast 9 9 $1,805.00 $1,625.00 $830.00 $1,805.00 $1,625.00 2025-08-27
74220 CPT Xr Esophagus Single Contrast 9 9 $1,415.00 $1,274.00 $651.00 $1,415.00 $1,274.00 2025-08-27
74240 CPT Xr Upper Gi With Kub Single Contras 9 9 $1,415.00 $1,274.00 $651.00 $1,415.00 $1,274.00 2025-08-27
74246 CPT Xr Upper Gi With Air Contrast 9 9 $1,415.00 $1,274.00 $651.00 $1,415.00 $1,274.00 2025-08-27
74270 CPT Xr Defacography 9 9 $1,415.00 $1,274.00 $651.00 $1,415.00 $1,274.00 2025-08-27
74400 CPT Xr Ivp 9 9 $1,415.00 $1,274.00 $651.00 $1,415.00 $1,274.00 2025-08-27
74430 CPT Xr Cystography 9 9 $1,415.00 $1,274.00 $651.00 $1,415.00 $1,274.00 2025-08-27
74440 CPT Xr Vasogram/vesiculogram 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
74740 CPT Xr Hysterosalpingography 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
75557 CPT MRI Cardiac Morphology Without Contra 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
75635 CPT CT Angiography Abd Aorta + Iliofe 9 9 $2,735.00 $2,462.00 $1,258.00 $2,735.00 $2,462.00 2025-08-27
75820 CPT Xr Venogram Lower Extremity Left 9 9 $1,816.00 $1,634.00 $835.00 $1,816.00 $1,634.00 2025-08-27
75822 CPT Xr Venogram Lower Extremity Bilat 9 9 $2,494.00 $2,245.00 $1,147.00 $2,494.00 $2,245.00 2025-08-27
76831 CPT US Hysterosonogram 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
76936 CPT US Pseudoaneurysm Compression 9 9 $1,214.00 $1,093.00 $558.00 $1,214.00 $1,093.00 2025-08-27
77011 CPT CT Stereotacic Localization 9 9 $1,313.00 $1,182.00 $604.00 $1,313.00 $1,182.00 2025-08-27
77046 CPT MRI Breast Without Contrast Left 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
77047 CPT MRI Breast Without Contrast Bilateral 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
78018 CPT Nm I-131 Whole Body Scan 9 9 $1,361.00 $1,225.00 $626.00 $1,361.00 $1,225.00 2025-08-27
78075 CPT Nm Adrenal/cortex/med Img 9 9 $3,349.00 $3,014.00 $1,541.00 $3,349.00 $3,014.00 2025-08-27
78195 CPT Nm Lymphoscintigraphy 9 9 $1,270.00 $1,143.00 $584.00 $1,270.00 $1,143.00 2025-08-27
78315 CPT Nm Bone Three Phase Study 9 9 $1,261.00 $1,135.00 $580.00 $1,261.00 $1,135.00 2025-08-27
78451 CPT Nm Myocardial Spect Single Rest/s 9 9 $2,488.00 $2,239.00 $1,144.00 $2,488.00 $2,239.00 2025-08-27
78452 CPT Nm Myocardial Spect Multi Rest/st 9 9 $2,615.00 $2,354.00 $1,203.00 $2,615.00 $2,354.00 2025-08-27
78459 CPT PET Myocardial Imaging Metabolic 9 9 $3,985.00 $3,587.00 $1,833.00 $3,985.00 $3,587.00 2025-08-27
78469 CPT Nm Myocardial Infarct Spect 9 9 $2,845.00 $2,561.00 $1,309.00 $2,845.00 $2,561.00 2025-08-27
78473 CPT Nm Rvg Cardiac Blood Pool Gated R 9 9 $1,554.00 $1,399.00 $715.00 $1,554.00 $1,399.00 2025-08-27
78582 CPT Nm Pulmonary Perfusion With Vent Ae 9 9 $1,919.00 $1,727.00 $883.00 $1,919.00 $1,727.00 2025-08-27
78630 CPT Nm Cisternography 9 9 $1,508.00 $1,357.00 $694.00 $1,508.00 $1,357.00 2025-08-27
78650 CPT Nm Cerebrospinal Fluid Leakage De 9 9 $1,479.00 $1,331.00 $680.00 $1,479.00 $1,331.00 2025-08-27
78707 CPT Nm Kidney Imaging With Flow Without Pha 9 9 $1,241.00 $1,117.00 $571.00 $1,241.00 $1,117.00 2025-08-27
78708 CPT Nm Kidney Imaging With Flow With Phar 9 9 $1,241.00 $1,117.00 $571.00 $1,241.00 $1,117.00 2025-08-27
79005 CPT Nm Thyroid Metastatic Therapy 15 9 $1,407.00 $1,266.00 $647.00 $1,407.00 $1,336.00 2025-08-27
81226 CPT Cyp2d6 Genotype Cascade 9 9 $1,208.00 $1,087.00 $556.00 $1,208.00 $1,087.00 2025-08-27
81229 CPT Chromosomal Microarray, Congenita 27 9 $1,764.00 $1,588.00 $758.00 $2,382.00 $1,566.00 2025-08-27
81235 CPT 74537 Egfr Gene Com Variants 9 9 $1,379.00 $1,241.00 $634.00 $1,379.00 $1,241.00 2025-08-27
81288 CPT 74804 Mlbrf,mlh1 Gene 9 9 $2,215.00 $1,994.00 $1,019.00 $2,215.00 $1,994.00 2025-08-27
81292 CPT 74970 M1m2z,mlh1 Gene Full Seq 18 9 $2,110.50 $1,899.50 $779.00 $2,527.00 $1,609.00 2025-08-27
81317 CPT Pms2 Gene Full Seq Analysis 9 9 $2,049.00 $1,844.00 $943.00 $2,049.00 $1,844.00 2025-08-27
81321 CPT 74882 Ptens,pten Gene Full Sequen 9 9 $2,059.00 $1,853.00 $947.00 $2,059.00 $1,853.00 2025-08-27
81406 CPT 74591 Mopath Procedure Level 7 45 9 $1,735.00 $1,562.00 $155.00 $3,335.00 $1,301.00 2025-08-27
81408 CPT 81408 Mopath Procedure Level 9 27 9 $2,722.00 $2,450.00 $1,147.00 $3,571.00 $2,369.00 2025-08-27
81410 CPT Marfan And Related Genetic Panel 9 9 $4,708.00 $4,237.00 $2,166.00 $4,708.00 $4,237.00 2025-08-27
81445 CPT 74717 Cancp,targeted Genomic Seq 18 9 $2,438.00 $2,194.00 $1,042.00 $2,610.00 $2,120.50 2025-08-27
81448 CPT Hereditary Motor And Sensory Neur 18 9 $2,539.00 $2,285.00 $1,042.00 $2,812.00 $2,153.00 2025-08-27
87507 CPT Iadna-dna/rna Probe Tq 12-25 9 9 $1,494.00 $1,345.00 $687.00 $1,494.00 $1,345.00 2025-08-27
87902 CPT Hcv Genotype Resolution-mayo 36 9 $1,379.00 $1,241.00 $432.00 $1,782.00 $1,123.00 2025-08-27
88120 CPT Urovysion For Bladder Cancer 9 9 $1,339.00 $1,205.00 $616.00 $1,339.00 $1,205.00 2025-08-27
92953 CPT Cl Pacemaker Transcutaneous 18 9 $1,352.00 $1,217.00 $598.00 $1,403.00 $1,203.50 2025-08-27
92975 CPT Cl Thrombolytic Therapy Coronary 9 9 $3,024.00 $2,722.00 $1,391.00 $3,024.00 $2,722.00 2025-08-27
92978 CPT Cl Ivus Imaging Initial 9 9 $3,303.00 $2,973.00 $1,519.00 $3,303.00 $2,973.00 2025-08-27
92979 CPT Cl Ivus Imaging-additional 9 9 $3,579.00 $3,221.00 $1,646.00 $3,579.00 $3,221.00 2025-08-27
93312 CPT US Transesophageal Echo 9 9 $3,689.00 $3,320.00 $1,697.00 $3,689.00 $3,320.00 2025-08-27
93350 CPT US Rest/stress Echocardiogram 9 9 $3,689.00 $3,320.00 $1,697.00 $3,689.00 $3,320.00 2025-08-27
93351 CPT US Rest/stress Echo Complete 9 9 $3,689.00 $3,320.00 $1,697.00 $3,689.00 $3,320.00 2025-08-27
93925 CPT US Le Arterial Duplex Bilateral 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
93975 CPT US Art/vein Abd/pelvis/scrotal Co 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
95782 CPT Polysom <6 Yrs 4/> Paramtrs 95782 9 9 $2,374.00 $2,137.00 $1,092.00 $2,374.00 $2,137.00 2025-08-27
95783 CPT Polysom <6 Yrs Cpap/bilvl 95783 9 9 $2,484.00 $2,236.00 $1,143.00 $2,484.00 $2,236.00 2025-08-27
95805 CPT Maintenance Of Wakefulness Test 18 9 $2,344.00 $2,110.00 $1,055.00 $2,394.00 $2,110.00 2025-08-27
95810 CPT Sleep Study 18 9 $2,261.00 $2,035.00 $884.00 $2,600.00 $1,826.00 2025-08-27
95811 CPT Polysomnography-cpap Study 27 9 $2,394.00 $2,155.00 $951.00 $2,600.00 $1,965.00 2025-08-27
C8900 HCPCS MRA Abdomen With Contrast 9 9 $1,415.00 $1,274.00 $651.00 $1,415.00 $1,274.00 2025-08-27
C8902 HCPCS MRA Abdomen W/+without Contrast 9 9 $2,555.00 $2,300.00 $1,175.00 $2,555.00 $2,300.00 2025-08-27
C8903 HCPCS MRI Breast With Contrast Left 9 9 $2,359.00 $2,123.00 $1,085.00 $2,359.00 $2,123.00 2025-08-27
C8905 HCPCS MRI Breast With + Without Contrast Left 9 9 $2,859.00 $2,573.00 $1,315.00 $2,859.00 $2,573.00 2025-08-27
C8906 HCPCS MRI Breast With Contrast Bilateral 9 9 $2,555.00 $2,300.00 $1,175.00 $2,555.00 $2,300.00 2025-08-27
C8908 HCPCS MRI Breast With + Without Contrast Bila 9 9 $3,055.00 $2,750.00 $1,405.00 $3,055.00 $2,750.00 2025-08-27
C8909 HCPCS MRA Chest With Contrast 9 9 $1,415.00 $1,274.00 $651.00 $1,415.00 $1,274.00 2025-08-27
C8910 HCPCS MRA Chest Without Contrast 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
C8911 HCPCS MRA Chest W/+without Contrast 9 9 $2,555.00 $2,300.00 $1,175.00 $2,555.00 $2,300.00 2025-08-27
C8912 HCPCS MRA Lower Extremity Left W/con 9 9 $2,555.00 $2,300.00 $1,175.00 $2,555.00 $2,300.00 2025-08-27
C8913 HCPCS MRA Lower Extremity Bil Without Con 18 9 $2,788.50 $2,509.50 $855.00 $3,718.00 $1,766.00 2025-08-27
C8918 HCPCS MRA Pelvis With Contrast 9 9 $1,415.00 $1,274.00 $651.00 $1,415.00 $1,274.00 2025-08-27
C8919 HCPCS MRA Pelvis Without Contrast 9 9 $1,859.00 $1,673.00 $855.00 $1,859.00 $1,673.00 2025-08-27
C8920 HCPCS MRA Pelvis W/+without Contrast 9 9 $2,555.00 $2,300.00 $1,175.00 $2,555.00 $2,300.00 2025-08-27
C8925 HCPCS US Transesoph Echo W/contrast 9 9 $3,819.00 $3,437.00 $1,757.00 $3,819.00 $3,437.00 2025-08-27
C8929 HCPCS US Echocardiogram Comp W/contrast 9 9 $3,819.00 $3,437.00 $1,757.00 $3,819.00 $3,437.00 2025-08-27
C8930 HCPCS US Rest/stress Echo Complete W/co 9 9 $3,819.00 $3,437.00 $1,757.00 $3,819.00 $3,437.00 2025-08-27
G0269 HCPCS Cl Occlusive Device Vasc Placeme 9 9 $1,223.00 $1,101.00 $563.00 $1,223.00 $1,101.00 2025-08-27
G0278 HCPCS Cl Angio Iliac With Cardic Cath 9 9 $1,970.00 $1,773.00 $906.00 $1,970.00 $1,773.00 2025-08-27
G0288 HCPCS CTA Reconstruction Aorta 9 9 $1,365.00 $1,229.00 $628.00 $1,365.00 $1,229.00 2025-08-27
L0637 HCPCS Lso Sag-coronal Panel Prefab 9 9 $3,708.00 $3,337.00 $1,706.00 $3,708.00 $3,337.00 2025-08-27
L1845 HCPCS Brace Knee Legend 9 9 $1,218.00 $1,096.00 $560.00 $1,218.00 $1,096.00 2025-08-27
PHA16295 CDM Daptomycin 500 Mg Rec 9 9 $2,331.00 $2,098.00 $1,072.00 $2,331.00 $2,098.00 2025-08-27
PHA17291 CDM Meningococcal Group B Vaccine Recombinant, Omv, Adjuvanted Susp 9 9 $1,811.00 $1,630.00 $833.00 $1,811.00 $1,630.00 2025-08-27
PHA17576 CDM Diphtheria/haem/hepb/pert,acel/polio/tetansusp 9 9 $1,252.00 $1,127.00 $576.00 $1,252.00 $1,127.00 2025-08-27
PHA17672 CDM Nirsevimab (Cvx 306) Alip Preservative-free 50 Mg/0.5 Ml Soln 9 9 $4,455.00 $4,010.00 $2,049.00 $4,455.00 $4,010.00 2025-08-27
PHA17673 CDM Nirsevimab (Cvx 307) Alip Preservative-free 100 Mg/ml Soln 9 9 $2,228.00 $2,005.00 $1,025.00 $2,228.00 $2,005.00 2025-08-27
PHA6615 CDM Tenecteplase 50 Mg Rec I 9 9 $36,247.00 $32,622.00 $16,674.00 $36,247.00 $32,622.00 2025-08-27
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