Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

ST ANDREW'S HOSPITAL

Bottineau, ND · CCN 351307 · Rates published

1,923 distinct procedures filed
5 distinct payers
16,175 rate rows
2026-11-06 last MRF observed
Data quality

15,102 of 16,175 rate rows are consumer-grade (93.4%)

1,073 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
professional (physician) fee — not the facility price 1,052
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 14
per-diem day rate — not a per-procedure price 7
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://secure.claraprice.net/price-transparency/CKEC-1760711468288/machine-readable/450226426_smp-health---st-andrews_standardcharges.json
Found on page https://secure.claraprice.net/price-transparency/smp-health-st-andrews-nd
Discovered viaCMS hospital list
Last fetch success · 2026-11-10
Content fingerprint b87127f00a75086c… · 3,596,504 bytes · first seen 2026-11-10

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
4085130
CDM 		Lanreotide 60 Mg/0.2 Ml Sol 5 $21,931.00 $45,690.00 $40,527.00 nat. median
$40,527
1.0× median
4082770
CDM 		Lanreotide 120 Mg/0.5 Ml Sol 5 $6,899.00 $14,373.00 $12,749.00 nat. median
$12,749
1.0× median
4080066
CDM 		Alteplase 100 Mg Pow 5 $6,351.00 $13,231.00 $11,736.00 nat. median
$2,938
outlier · 4.0×
4084925
CDM 		Vedolizumab 300 Mg Pow 5 $6,254.00 $13,030.00 $11,557.50 nat. median
$11,558
1.0× median
4089062
CDM 		Tenecteplase 50 Mg Pow 5 $5,988.00 $12,476.00 $11,066.00 nat. median
$11,066
1.0× median
4082620
CDM 		Lanreotide 90. 5 $5,852.00 $12,192.00 $10,814.50 nat. median
$10,814
1.0× median
4084631
CDM 		Romiplostim 500 Mcg Pow 5 $3,449.00 $7,185.00 $6,280.00 nat. median
$6,280
1.0× median
4082120
CDM 		Rituximab 500. 5 $3,396.00 $7,076.00 $6,184.00 nat. median
$3,396
1.8× median
4085240
CDM 		Alteplase 50 Mg Pow 5 $3,182.00 $6,630.00 $5,795.00 nat. median
$5,795
1.0× median
4083190
CDM 		Octreotide 20. Mg Powder-inj ER 5 $3,146.00 $6,555.00 $5,729.00 nat. median
$4,264
1.3× median
59414
CPT 		59414delivery Of Placenta 5 $2,982.00 $6,212.00 $5,429.00 nat. median
$2,860
1.9× median
59409
CPT 		59409-vaginal Delivery Only 5 $2,982.00 $6,212.00 $5,429.00 nat. median
$3,153
1.7× median
4083678
CDM 		Pegfilgrastim Apgf 6 Mg/0.6 Ml Sol 5 $2,841.00 $5,918.00 $5,172.00 nat. median
$5,172
1.0× median
4080046
CDM 		Darbepoetin Alfa 500. 5 $2,801.00 $5,835.00 $5,100.00 nat. median
$344
outlier · 14.8×
4082517
CDM 		Immune Globulin Intravenous And Subcutaneous 10% Sol 5 $2,798.00 $5,830.00 $5,095.00 nat. median
$5,095
1.0× median
70549
CPT 		MRA Neck With + Without Contrast 5 $2,755.00 $5,739.00 $5,016.00 nat. median
$1,045
outlier · 4.8×
10180
CPT 		10180-i&d Postop Wound Infection Complex 5 $2,712.00 $5,649.00 $4,937.00 nat. median
$2,870
1.7× median
70546
CPT 		MRA Brain/head With + Without Contrast 5 $2,606.00 $5,430.00 $4,746.00 nat. median
$1,051
outlier · 4.5×
71552
CPT 		MRI Chest With + Without Contrast 5 $2,520.00 $5,249.00 $4,588.00 nat. median
$1,088
outlier · 4.2×
73720
CPT 		MRI Lower Extremity With + Without Cnt Left 5 $2,124.00 $4,424.00 $3,867.00 nat. median
$1,118
outlier · 3.5×
73220
CPT 		MRI Upper Extremity With + Without Cnt Left 5 $2,119.00 $4,424.00 $3,863.00 nat. median
$1,119
outlier · 3.5×
74183
CPT 		MRI Abdomen With + Without Contrast 5 $2,115.00 $4,407.00 $3,852.00 nat. median
$1,095
outlier · 3.5×
72197
CPT 		MRI Pelvis With + Without Contrast 5 $2,110.00 $4,395.00 $3,841.00 nat. median
$1,055
outlier · 3.6×
71551
CPT 		MRI Chest With Contrast 5 $2,018.00 $4,205.00 $3,675.00 nat. median
$1,158
outlier · 3.2×
74182
CPT 		MRI Abdomen With Contrast 5 $1,978.00 $4,121.00 $3,602.00 nat. median
$964
outlier · 3.7×
4083530
CDM 		Leuprolide 45 Mg/6 Months Pow 5 $1,966.00 $4,095.00 $3,579.00 nat. median
$3,579
1.0× median
73223
CPT 		MRI Shoulder With + Without Contrast Left 5 $1,960.00 $4,083.00 $3,569.00 nat. median
$1,156
outlier · 3.1×
73723
CPT 		MRI Knee With + Without Contrast Left 5 $1,958.00 $4,080.00 $3,566.00 nat. median
$1,185
outlier · 3.0×
12037
CPT 		12037-scalp/trunk/extremity Greater Than 30.0 Cm 5 $1,905.00 $3,968.00 $3,468.00 nat. median
$1,946
1.8× median
70543
CPT 		MRI Face Neck Orbit With + Without Contrast 5 $1,905.00 $3,968.00 $3,468.00 nat. median
$1,076
outlier · 3.2×
12047
CPT 		12047-neck/hand/feet/genital Greater Than 30.0 Cm 5 $1,905.00 $3,968.00 $3,468.00 nat. median
$1,824
1.9× median
4084928
CDM 		Aflibercept Ophthalmic 114.3 Mg/ml Sol 5 $1,905.00 $3,968.00 $3,468.00 nat. median
$3,468
1.0× median
70548
CPT 		MRA Neck With Contrast 5 $1,900.00 $3,959.00 $3,460.00 nat. median
$917
outlier · 3.8×
71550
CPT 		MRI Chest Without Contrast 5 $1,848.00 $3,850.00 $3,365.00 nat. median
$824
outlier · 4.1×
4083585
CDM 		Romosozumab 105 Mg/1.17 Ml Sol 5 $1,817.00 $3,786.00 $3,309.00 nat. median
$2,140
1.5× median
70547
CPT 		MRA Neck Without Contrast 5 $1,797.00 $3,743.00 $3,271.00 nat. median
$762
outlier · 4.3×
70544
CPT 		MRA Brain/head Without Contrast 5 $1,787.00 $3,723.00 $3,254.00 nat. median
$824
outlier · 3.9×
32556
CPT 		32556drainage, Percutaneous Without Guidance 5 $1,763.00 $3,672.00 $3,209.00 nat. median
$1,995
1.6× median
73719
CPT 		MRI Lower Extremity With Contrast Left 5 $1,741.00 $3,628.00 $3,171.00 nat. median
$980
outlier · 3.2×
72196
CPT 		MRI Pelvis With Contrast 5 $1,741.00 $3,628.00 $3,171.00 nat. median
$940
outlier · 3.4×
74174
CPT 		CT Angio Abdomen And Pelvis 5 $1,740.00 $3,626.00 $3,169.00 nat. median
$978
outlier · 3.2×
73219
CPT 		MRI Upper Extremity With Contrast Left 5 $1,740.00 $3,624.00 $3,167.00 nat. median
$962
outlier · 3.3×
4084630
CDM 		Romiplostim 250 Mcg Pow 5 $1,731.00 $3,607.00 $3,153.00 nat. median
$3,153
1.0× median
4080197
CDM 		Darbepoetin Alfa 300. 5 $1,686.00 $3,513.00 $3,070.00 nat. median
$1,686
1.8× median
70545
CPT 		MRA Brain/head With Contrast 5 $1,684.00 $3,508.00 $3,066.00 nat. median
$879
outlier · 3.5×
4083041
CDM 		Faricimab Ophthalmic Svoa 6 Mg/0.05 Ml Sol 5 $1,663.00 $3,464.00 $3,028.00 nat. median
$3,028
1.0× median
72195
CPT 		MRI Pelvis Without Contrast 5 $1,625.00 $3,385.00 $2,958.00 nat. median
$803
outlier · 3.7×
73722
CPT 		MRI Knee With Contrast Left 5 $1,623.00 $3,381.00 $2,955.00 nat. median
$1,278
outlier · 2.3×
73218
CPT 		MRI Upper Extremity Without Contrast Left 5 $1,613.00 $3,361.00 $2,938.00 nat. median
$860
outlier · 3.4×
73222
CPT 		MRI Shoulder With Contrast Left 5 $1,609.00 $3,353.00 $2,931.00 nat. median
$1,278
outlier · 2.3×

Other procedures at this hospital

Browse this hospital's 1,923 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
             
P9034 HCPCS E3087 Aph Plt Acda Lr 1 7 5 $1,874.00 $1,687.00 $900.00 $1,874.00 $1,638.00 2026-11-06
P9016 HCPCS E0336 Rbc Cpd As1 500 Lr 7 5 $839.00 $755.00 $403.00 $839.00 $733.00 2026-11-06
G0480 HCPCS Amphetamines Confirmation, Random, Urine 7 5 $623.00 $561.00 $299.00 $623.00 $545.00 2026-11-06
G0438 HCPCS G0438 Annual Wellness Visit; Includes A Personalized Prevention Plan Of Service,… 7 5 $574.00 $517.00 $276.00 $574.00 $502.00 2026-11-06
99291 CPT 99291critical Care, 30-74 7 5 $2,613.00 $2,352.00 $1,254.00 $2,613.00 $2,284.00 2026-11-06
99285 CPT 99285level 5 9 5 $1,423.00 $1,281.00 $290.00 $1,423.00 $926.00 2026-11-06
99284 CPT 99284level 4 9 5 $977.00 $879.00 $199.00 $977.00 $636.00 2026-11-06
99223 CPT 99223 Initial Hospital Care, Level 3 7 5 $679.00 $611.00 $326.00 $679.00 $593.00 2026-11-06
99205 CPT New Patient Office Or Other Outpatient Visit, 60 Min 7 5 $692.00 $623.00 $332.00 $692.00 $605.00 2026-11-06
96413 CPT Stan 96413 IV Admin Remicade/infliximab 1st Hour 7 5 $878.00 $790.00 $421.00 $878.00 $767.00 2026-11-06
93976 CPT Stan US Limited Arterial Duplex 7 5 $639.00 $575.00 $307.00 $639.00 $558.00 2026-11-06
93975 CPT US Renal Artery Duplex Bilateral 7 5 $1,074.00 $967.00 $516.00 $1,074.00 $939.00 2026-11-06
93970 CPT US Upper Ext Venous Duplex Bilateral 7 5 $827.00 $744.00 $397.00 $827.00 $723.00 2026-11-06
93880 CPT US Carotid Duplex Bilateral 7 5 $824.00 $742.00 $396.00 $824.00 $720.00 2026-11-06
93306 CPT US Echocardiogram Complete 7 5 $836.00 $752.00 $401.00 $836.00 $731.00 2026-11-06
92960 CPT 92960cardioversion; Elective 7 5 $921.00 $829.00 $442.00 $921.00 $805.00 2026-11-06
92950 CPT 92950-cardiopulmonary Resuscitation 7 5 $1,683.00 $1,515.00 $808.00 $1,683.00 $1,471.00 2026-11-06
92523 CPT Slp Eval Lang Comprehension,express Unit 7 5 $1,168.00 $1,051.00 $561.00 $1,168.00 $1,021.00 2026-11-06
87507 CPT Gastrointestinal (Gi) Panel, Pcr, Biofire Trin 7 5 $603.00 $543.00 $289.00 $603.00 $527.00 2026-11-06
86870 CPT Bill Only Abid Panel 7 5 $663.00 $597.00 $318.00 $663.00 $579.00 2026-11-06
85366 CPT Thrombophilia Profile-mayo Trin 7 5 $615.00 $554.00 $295.00 $615.00 $538.00 2026-11-06
83013 CPT H Pylori C Urea Breath Test-mayo Trin 7 5 $579.00 $521.00 $278.00 $579.00 $506.00 2026-11-06
81339 CPT Mpl Exon 10 Mutation Detection, R Trin 7 5 $973.00 $876.00 $467.00 $973.00 $850.00 2026-11-06
81270 CPT Jak2 V617f Trin 7 5 $750.00 $675.00 $360.00 $750.00 $656.00 2026-11-06
81219 CPT Calreticulin-mayo Trin 7 5 $973.00 $876.00 $467.00 $973.00 $850.00 2026-11-06
81208 CPT Stan Bcr/abl1 Other Bp 7 5 $1,640.00 $1,476.00 $787.00 $1,640.00 $1,433.00 2026-11-06
81207 CPT Stan Bcr/abl1 Minor Bp 7 5 $1,130.00 $1,017.00 $542.00 $1,130.00 $988.00 2026-11-06
81206 CPT Bcr/abl1-mayo Trin 7 5 $1,278.00 $1,150.00 $613.00 $1,278.00 $1,117.00 2026-11-06
81162 CPT Brca1/brca2 Genes, Full Gene Analysis Mayo Trin 7 5 $3,225.00 $2,903.00 $1,548.00 $3,225.00 $2,819.00 2026-11-06
78803 CPT Nm Bone Spect 7 5 $2,125.00 $1,913.00 $1,020.00 $2,125.00 $1,857.00 2026-11-06
78708 CPT Nm Kidney Imaging Single With Pharm 7 5 $770.00 $693.00 $370.00 $770.00 $673.00 2026-11-06
78707 CPT Nm Kidney Morphology With Vascular Flow 7 5 $1,239.00 $1,115.00 $595.00 $1,239.00 $1,083.00 2026-11-06
78700 CPT Nm Kidney Imaging 7 5 $996.00 $896.00 $478.00 $996.00 $871.00 2026-11-06
78582 CPT Nm Lung Vent/perf Imaging 7 5 $1,886.00 $1,697.00 $905.00 $1,886.00 $1,648.00 2026-11-06
78580 CPT Nm Lung Perfusion Imaging 7 5 $1,352.00 $1,217.00 $649.00 $1,352.00 $1,182.00 2026-11-06
78579 CPT Nm Lung Ventilation Imaging 7 5 $1,087.00 $978.00 $522.00 $1,087.00 $950.00 2026-11-06
78483 CPT Nm Cardiac Muga 7 5 $1,196.00 $1,076.00 $574.00 $1,196.00 $1,045.00 2026-11-06
78452 CPT Nm Myocardial Spect Rest And Stress 7 5 $2,757.00 $2,481.00 $1,323.00 $2,757.00 $2,410.00 2026-11-06
78451 CPT Nm Myocardial Spect Single Study 7 5 $1,920.00 $1,728.00 $922.00 $1,920.00 $1,678.00 2026-11-06
78315 CPT Nm Bone Three Phase Study 7 5 $2,076.00 $1,868.00 $996.00 $2,076.00 $1,814.00 2026-11-06
78306 CPT Nm Bone Imaging Whole Body 7 5 $1,661.00 $1,495.00 $797.00 $1,661.00 $1,452.00 2026-11-06
78305 CPT Nm Bone Imaging Multiple Areas 7 5 $1,528.00 $1,375.00 $733.00 $1,528.00 $1,335.00 2026-11-06
78300 CPT Nm Bone Imaging Limited 7 5 $1,273.00 $1,146.00 $611.00 $1,273.00 $1,113.00 2026-11-06
78227 CPT Nm Hepatobiliary Imaging With Drug 7 5 $2,835.00 $2,552.00 $1,361.00 $2,835.00 $2,478.00 2026-11-06
78226 CPT Nm Hepatobiliary Imaging 7 5 $2,064.00 $1,858.00 $991.00 $2,064.00 $1,804.00 2026-11-06
78215 CPT Nm Liver/spleen Imaging 7 5 $1,136.00 $1,022.00 $545.00 $1,136.00 $993.00 2026-11-06
77067 CPT Mammography, Screening, Bilateral 14 5 $622.00 $559.50 $291.00 $637.00 $538.50 2026-11-06
77066 CPT Mammography Of Both Breasts 7 5 $772.00 $695.00 $371.00 $772.00 $675.00 2026-11-06
77065 CPT Mammography Of One Breast 7 5 $603.00 $543.00 $289.00 $603.00 $527.00 2026-11-06
76872 CPT US Prostate Transrectal 7 5 $931.00 $838.00 $447.00 $931.00 $814.00 2026-11-06
76830 CPT Ultrasound Pelvis Through Vagina 7 5 $592.00 $533.00 $284.00 $592.00 $517.00 2026-11-06
76805 CPT Abdomial Ultrasound Of Pregnant Uterus 7 5 $620.00 $558.00 $298.00 $620.00 $542.00 2026-11-06
76536 CPT US Thyroid 7 5 $596.00 $536.00 $286.00 $596.00 $521.00 2026-11-06
76380 CPT CT Limited Or Localized F/u Study 7 5 $1,151.00 $1,036.00 $552.00 $1,151.00 $1,006.00 2026-11-06
74400 CPT Xr Ivp 7 5 $675.00 $608.00 $324.00 $675.00 $590.00 2026-11-06
74183 CPT MRI Abdomen With + Without Contrast 7 5 $4,407.00 $3,966.00 $2,115.00 $4,407.00 $3,852.00 2026-11-06
74182 CPT MRI Abdomen With Contrast 7 5 $4,121.00 $3,709.00 $1,978.00 $4,121.00 $3,602.00 2026-11-06
74181 CPT MRI Abdomen Without Contrast 7 5 $2,911.00 $2,620.00 $1,397.00 $2,911.00 $2,544.00 2026-11-06
74178 CPT CT Abdomen And Pelvis With + Without Contrast 7 5 $3,285.00 $2,957.00 $1,577.00 $3,285.00 $2,871.00 2026-11-06
74177 CPT CT Scan Of Abdomen And Pelvis With Contrast 7 5 $2,907.00 $2,616.00 $1,395.00 $2,907.00 $2,541.00 2026-11-06
74176 CPT CT Abdomen And Pelvis Without Contrast 7 5 $1,339.00 $1,205.00 $643.00 $1,339.00 $1,170.00 2026-11-06
74174 CPT CT Angio Abdomen And Pelvis 7 5 $3,626.00 $3,263.00 $1,740.00 $3,626.00 $3,169.00 2026-11-06
74170 CPT CT Abdomen With + Without Contrast 7 5 $2,589.00 $2,330.00 $1,243.00 $2,589.00 $2,263.00 2026-11-06
74160 CPT CT Abdomen With Contrast 7 5 $2,285.00 $2,057.00 $1,097.00 $2,285.00 $1,997.00 2026-11-06
74150 CPT CT Abdomen Without Contrast 7 5 $1,070.00 $963.00 $514.00 $1,070.00 $935.00 2026-11-06
73723 CPT MRI Knee With + Without Contrast Left 7 5 $4,080.00 $3,672.00 $1,958.00 $4,080.00 $3,566.00 2026-11-06
73722 CPT MRI Knee With Contrast Left 7 5 $3,381.00 $3,043.00 $1,623.00 $3,381.00 $2,955.00 2026-11-06
73721 CPT MRI Scan Of Leg Joint 7 5 $1,905.00 $1,715.00 $914.00 $1,905.00 $1,665.00 2026-11-06
73720 CPT MRI Lower Extremity With + Without Cnt Left 7 5 $4,424.00 $3,982.00 $2,124.00 $4,424.00 $3,867.00 2026-11-06
73719 CPT MRI Lower Extremity With Contrast Left 7 5 $3,628.00 $3,265.00 $1,741.00 $3,628.00 $3,171.00 2026-11-06
73718 CPT MRI Lower Extremity Without Contrast Left 7 5 $3,330.00 $2,997.00 $1,598.00 $3,330.00 $2,910.00 2026-11-06
73702 CPT CT Lower Extremity W/+without Contrast Bilat 7 5 $2,451.00 $2,206.00 $1,176.00 $2,451.00 $2,142.00 2026-11-06
73701 CPT CT Lower Extremity With Contrast Bilat 7 5 $1,930.00 $1,737.00 $926.00 $1,930.00 $1,687.00 2026-11-06
73700 CPT CT Lower Extremity Without Contrast Bilat 7 5 $1,491.00 $1,342.00 $716.00 $1,491.00 $1,303.00 2026-11-06
73223 CPT MRI Shoulder With + Without Contrast Left 7 5 $4,083.00 $3,675.00 $1,960.00 $4,083.00 $3,569.00 2026-11-06
73222 CPT MRI Shoulder With Contrast Left 7 5 $3,353.00 $3,018.00 $1,609.00 $3,353.00 $2,931.00 2026-11-06
73221 CPT MRI Shoulder Without Contrast Left 7 5 $1,905.00 $1,715.00 $914.00 $1,905.00 $1,665.00 2026-11-06
73220 CPT MRI Upper Extremity With + Without Cnt Left 14 5 $4,419.50 $3,978.00 $2,119.00 $4,424.00 $3,863.00 2026-11-06
73219 CPT MRI Upper Extremity With Contrast Left 7 5 $3,624.00 $3,262.00 $1,740.00 $3,624.00 $3,167.00 2026-11-06
73218 CPT MRI Upper Extremity Without Contrast Left 7 5 $3,361.00 $3,025.00 $1,613.00 $3,361.00 $2,938.00 2026-11-06
73202 CPT CT Upper Extremity W/+without Contrast Bilat 7 5 $2,594.00 $2,335.00 $1,245.00 $2,594.00 $2,267.00 2026-11-06
73201 CPT CT Upper Extremity With Contrast Bilat 7 5 $1,968.00 $1,771.00 $945.00 $1,968.00 $1,720.00 2026-11-06
73200 CPT CT Upper Extremity Without Contrast Bilat 7 5 $1,541.00 $1,387.00 $740.00 $1,541.00 $1,347.00 2026-11-06
72197 CPT MRI Pelvis With + Without Contrast 7 5 $4,395.00 $3,956.00 $2,110.00 $4,395.00 $3,841.00 2026-11-06
72196 CPT MRI Pelvis With Contrast 7 5 $3,628.00 $3,265.00 $1,741.00 $3,628.00 $3,171.00 2026-11-06
72195 CPT MRI Pelvis Without Contrast 7 5 $3,385.00 $3,047.00 $1,625.00 $3,385.00 $2,958.00 2026-11-06
72194 CPT CT Pelvis With + Without Contrast 7 5 $2,598.00 $2,338.00 $1,247.00 $2,598.00 $2,271.00 2026-11-06
72193 CPT CT Scan Of Pelvis With Contrast 7 5 $2,293.00 $2,064.00 $1,101.00 $2,293.00 $2,004.00 2026-11-06
72192 CPT CT Pelvis Without Contrast 7 5 $1,082.00 $974.00 $519.00 $1,082.00 $946.00 2026-11-06
72158 CPT MRI Spine Lumbar With + Without Contrast 7 5 $2,979.00 $2,681.00 $1,430.00 $2,979.00 $2,604.00 2026-11-06
72157 CPT MRI Spine Thoracic With + Without Contrast 7 5 $2,999.00 $2,699.00 $1,440.00 $2,999.00 $2,621.00 2026-11-06
72156 CPT MRI Spine Cervical With + Without Contrast 7 5 $2,990.00 $2,691.00 $1,435.00 $2,990.00 $2,613.00 2026-11-06
72149 CPT MRI Spine Lumbar With Contrast 7 5 $2,618.00 $2,356.00 $1,257.00 $2,618.00 $2,288.00 2026-11-06
72148 CPT MRI Scan Of Lower Spinal Canal 7 5 $1,692.00 $1,523.00 $812.00 $1,692.00 $1,479.00 2026-11-06
72147 CPT MRI Spine Thoracic With Contrast 7 5 $2,644.00 $2,380.00 $1,269.00 $2,644.00 $2,311.00 2026-11-06
72146 CPT MRI Spine Thoracic Without Contrast 7 5 $1,695.00 $1,526.00 $814.00 $1,695.00 $1,481.00 2026-11-06
72142 CPT MRI Spine Cervical With Contrast 7 5 $2,665.00 $2,399.00 $1,279.00 $2,665.00 $2,329.00 2026-11-06
72141 CPT MRI Spine Cervical Without Contrast 7 5 $1,692.00 $1,523.00 $812.00 $1,692.00 $1,479.00 2026-11-06
72132 CPT CT Spine Lumbar With Contrast 7 5 $1,917.00 $1,725.00 $920.00 $1,917.00 $1,675.00 2026-11-06
72131 CPT CT Spine Lumbar Without Contrast 7 5 $1,491.00 $1,342.00 $716.00 $1,491.00 $1,303.00 2026-11-06
72128 CPT CT Spine Thoracic Without Contrast 7 5 $1,499.00 $1,349.00 $720.00 $1,499.00 $1,310.00 2026-11-06
72126 CPT CT Spine Cervical With Contrast 7 5 $1,913.00 $1,722.00 $918.00 $1,913.00 $1,672.00 2026-11-06
72125 CPT CT Spine Cervical Without Contrast 7 5 $1,503.00 $1,353.00 $721.00 $1,503.00 $1,314.00 2026-11-06
71552 CPT MRI Chest With + Without Contrast 7 5 $5,249.00 $4,724.00 $2,520.00 $5,249.00 $4,588.00 2026-11-06
71551 CPT MRI Chest With Contrast 7 5 $4,205.00 $3,785.00 $2,018.00 $4,205.00 $3,675.00 2026-11-06
71550 CPT MRI Chest Without Contrast 7 5 $3,850.00 $3,465.00 $1,848.00 $3,850.00 $3,365.00 2026-11-06
71275 CPT CT Angio Chest 7 5 $2,553.00 $2,298.00 $1,225.00 $2,553.00 $2,231.00 2026-11-06
71271 CPT CT Lung Cancer Screening 7 5 $1,139.00 $1,025.00 $547.00 $1,139.00 $995.00 2026-11-06
71270 CPT CT Chest With + Without Contrast 7 5 $2,307.00 $2,076.00 $1,107.00 $2,307.00 $2,016.00 2026-11-06
71260 CPT CT Chest With Contrast 7 5 $1,872.00 $1,685.00 $899.00 $1,872.00 $1,636.00 2026-11-06
71250 CPT CT Chest Without Contrast 7 5 $1,450.00 $1,305.00 $696.00 $1,450.00 $1,267.00 2026-11-06
70553 CPT MRI Scan 7 5 $2,968.00 $2,671.00 $1,425.00 $2,968.00 $2,594.00 2026-11-06
70552 CPT MRI Brain With Contrast 7 5 $2,601.00 $2,341.00 $1,248.00 $2,601.00 $2,273.00 2026-11-06
70551 CPT MRI Brain Without Contrast 7 5 $1,762.00 $1,586.00 $846.00 $1,762.00 $1,540.00 2026-11-06
70549 CPT MRA Neck With + Without Contrast 7 5 $5,739.00 $5,165.00 $2,755.00 $5,739.00 $5,016.00 2026-11-06
70548 CPT MRA Neck With Contrast 7 5 $3,959.00 $3,563.00 $1,900.00 $3,959.00 $3,460.00 2026-11-06
70547 CPT MRA Neck Without Contrast 7 5 $3,743.00 $3,369.00 $1,797.00 $3,743.00 $3,271.00 2026-11-06
70546 CPT MRA Brain/head With + Without Contrast 7 5 $5,430.00 $4,887.00 $2,606.00 $5,430.00 $4,746.00 2026-11-06
70545 CPT MRA Brain/head With Contrast 7 5 $3,508.00 $3,157.00 $1,684.00 $3,508.00 $3,066.00 2026-11-06
70544 CPT MRA Brain/head Without Contrast 7 5 $3,723.00 $3,351.00 $1,787.00 $3,723.00 $3,254.00 2026-11-06
70543 CPT MRI Face Neck Orbit With + Without Contrast 7 5 $3,968.00 $3,571.00 $1,905.00 $3,968.00 $3,468.00 2026-11-06
70542 CPT MRI Face Neck Orbit With Contrast 7 5 $3,310.00 $2,979.00 $1,589.00 $3,310.00 $2,893.00 2026-11-06
70540 CPT MRI Face Neck Orbit Without Contrast 7 5 $3,015.00 $2,714.00 $1,447.00 $3,015.00 $2,635.00 2026-11-06
70492 CPT CT Neck Soft Tissue With + Without Contrast 7 5 $2,297.00 $2,067.00 $1,103.00 $2,297.00 $2,008.00 2026-11-06
70491 CPT CT Neck Soft Tissue With Contrast 7 5 $1,860.00 $1,674.00 $893.00 $1,860.00 $1,626.00 2026-11-06
70490 CPT CT Neck Soft Tissue Without Contrast 7 5 $1,441.00 $1,297.00 $692.00 $1,441.00 $1,259.00 2026-11-06
70488 CPT CT Maxillofacial With + Without Contrast 7 5 $1,671.00 $1,504.00 $802.00 $1,671.00 $1,460.00 2026-11-06
70487 CPT CT Maxillofacial With Contrast 7 5 $1,314.00 $1,183.00 $631.00 $1,314.00 $1,148.00 2026-11-06
70486 CPT CT Maxillofacial Without Contrast 7 5 $1,151.00 $1,036.00 $552.00 $1,151.00 $1,006.00 2026-11-06
70482 CPT CT Orbits Sella With + Without Contrast 7 5 $2,623.00 $2,361.00 $1,259.00 $2,623.00 $2,293.00 2026-11-06
70481 CPT CT Orbits Sella With Contrast 7 5 $2,377.00 $2,139.00 $1,141.00 $2,377.00 $2,077.00 2026-11-06
70480 CPT CT Orbits Sella Without Contrast 7 5 $1,941.00 $1,747.00 $932.00 $1,941.00 $1,696.00 2026-11-06
70470 CPT CT Head With + Without Contrast 7 5 $1,512.00 $1,361.00 $726.00 $1,512.00 $1,321.00 2026-11-06
70460 CPT CT Head With Contrast 7 5 $1,256.00 $1,130.00 $603.00 $1,256.00 $1,098.00 2026-11-06
70450 CPT CT Scan 7 5 $865.00 $779.00 $415.00 $865.00 $756.00 2026-11-06
67028 CPT Injection Therapeutic Agent Eye 14 5 $849.00 $764.00 $389.00 $887.00 $719.50 2026-11-06
59414 CPT 59414delivery Of Placenta 7 5 $6,212.00 $5,591.00 $2,982.00 $6,212.00 $5,429.00 2026-11-06
59409 CPT 59409-vaginal Delivery Only 7 5 $6,212.00 $5,591.00 $2,982.00 $6,212.00 $5,429.00 2026-11-06
51700 CPT 51700-bladder Irrigation Simple Lavage/instill 7 5 $623.00 $561.00 $299.00 $623.00 $545.00 2026-11-06
49083 CPT Charge: Paracentesis With Imaging Guidance 7 5 $2,027.00 $1,824.00 $973.00 $2,027.00 $1,772.00 2026-11-06
49082 CPT 49082-abdominal Paracentesis Without Imaging Guide 10 5 $2,028.00 $1,825.00 $973.00 $2,028.00 $1,824.50 2026-11-06
46083 CPT 46083-incision Hemorrhoid Thrombosed External 7 5 $726.00 $653.00 $348.00 $726.00 $635.00 2026-11-06
45385 CPT Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope 7 5 $2,597.00 $2,337.00 $1,247.00 $2,597.00 $2,270.00 2026-11-06
45380 CPT Biopsy Exam Of Large Bowel Using An Endoscope 7 5 $2,597.00 $2,337.00 $1,247.00 $2,597.00 $2,270.00 2026-11-06
45378 CPT Diagnostic Exam Of Large Bowel Using An Endoscope 7 5 $1,988.00 $1,789.00 $954.00 $1,988.00 $1,738.00 2026-11-06
43753 CPT 43753-gastric Intubation With Lavage 7 5 $663.00 $597.00 $318.00 $663.00 $579.00 2026-11-06
43239 CPT Biopsy Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 7 5 $2,028.00 $1,825.00 $973.00 $2,028.00 $1,772.00 2026-11-06
43235 CPT Diagnostic Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 7 5 $2,028.00 $1,825.00 $973.00 $2,028.00 $1,772.00 2026-11-06
4089062 CDM Tenecteplase 50 Mg Pow 6 5 $12,476.00 $11,228.00 $5,988.00 $12,476.00 $11,066.00 2026-11-06
4087835 CDM Proparacaine Ophth 0.5% Sol[stan] 7 5 $821.00 $739.00 $394.00 $821.00 $718.00 2026-11-06
4086440 CDM Tbo-filgrastim 480 Mcg/0.8 Ml Sol[stan] 7 5 $575.00 $518.00 $276.00 $575.00 $503.00 2026-11-06
4085394 CDM Denosumab Bbdz 60 Mg/ml Solution[stan] 7 5 $2,436.00 $2,192.00 $1,169.00 $2,436.00 $2,129.00 2026-11-06
4085374 CDM Semaglutide 8 Mg/3 Ml (2 Mg Dose) Sol 7 5 $1,453.00 $1,308.00 $697.00 $1,453.00 $1,270.00 2026-11-06
4085330 CDM Immune Globulin Intravenous And Subcutaneous 10% Solution[stan](nf) 7 5 $1,480.00 $1,332.00 $710.00 $1,480.00 $1,294.00 2026-11-06
4085325 CDM Immune Globulin Intravenous And Subcutaneous 10% Solution 7 5 $755.00 $680.00 $362.00 $755.00 $660.00 2026-11-06
4085240 CDM Alteplase 50 Mg Pow 7 5 $6,630.00 $5,967.00 $3,182.00 $6,630.00 $5,795.00 2026-11-06
4085135 CDM Ferumoxytol 30 Mg/ml Solution 7 5 $1,388.00 $1,249.00 $666.00 $1,388.00 $1,213.00 2026-11-06
4085130 CDM Lanreotide 60 Mg/0.2 Ml Sol 6 5 $45,690.00 $41,121.00 $21,931.00 $45,690.00 $40,527.00 2026-11-06
4085012 CDM Dalbavancin 500 Mg Pow 7 5 $2,699.00 $2,429.00 $1,296.00 $2,699.00 $2,359.00 2026-11-06
4084995 CDM Leuprolide 30 Mg/4 Months Pow 7 5 $2,740.00 $2,466.00 $1,315.00 $2,740.00 $2,395.00 2026-11-06
4084932 CDM Ranibizumab Ophthalmic Eqrn 10 Mg/ml Sol 7 5 $2,070.00 $1,863.00 $994.00 $2,070.00 $1,809.00 2026-11-06
4084928 CDM Aflibercept Ophthalmic 114.3 Mg/ml Sol 7 5 $3,968.00 $3,571.00 $1,905.00 $3,968.00 $3,468.00 2026-11-06
4084925 CDM Vedolizumab 300 Mg Pow 6 5 $13,030.00 $11,727.00 $6,254.00 $13,030.00 $11,557.50 2026-11-06
4084670 CDM Bevacizumab 2.75 Mg Injection 7 5 $1,225.00 $1,103.00 $588.00 $1,225.00 $1,071.00 2026-11-06
4084631 CDM Romiplostim 500 Mcg Pow 7 5 $7,185.00 $6,467.00 $3,449.00 $7,185.00 $6,280.00 2026-11-06
4084630 CDM Romiplostim 250 Mcg Pow 7 5 $3,607.00 $3,246.00 $1,731.00 $3,607.00 $3,153.00 2026-11-06
4084220 CDM Romiplostim 125 Mcg Pow[stan] 7 5 $1,819.00 $1,637.00 $873.00 $1,819.00 $1,590.00 2026-11-06
4084040 CDM Pegfilgrastim Jmdb 6 Mg/0.6 Ml Sol 7 5 $3,161.00 $2,845.00 $1,517.00 $3,161.00 $2,763.00 2026-11-06
4083963 CDM Filgrastim 300 Mcg/0.5 Ml Sol 7 5 $1,031.00 $928.00 $495.00 $1,031.00 $901.00 2026-11-06
4083678 CDM Pegfilgrastim Apgf 6 Mg/0.6 Ml Sol 7 5 $5,918.00 $5,326.00 $2,841.00 $5,918.00 $5,172.00 2026-11-06
4083590 CDM Infliximab Dyyb 100 Mg Pow[stan] 7 5 $1,449.00 $1,304.00 $696.00 $1,449.00 $1,266.00 2026-11-06
4083585 CDM Romosozumab 105 Mg/1.17 Ml Sol 7 5 $3,786.00 $3,407.00 $1,817.00 $3,786.00 $3,309.00 2026-11-06
4083530 CDM Leuprolide 45 Mg/6 Months Pow 7 5 $4,095.00 $3,686.00 $1,966.00 $4,095.00 $3,579.00 2026-11-06
4083190 CDM Octreotide 20. Mg Powder-inj ER 7 5 $6,555.00 $5,900.00 $3,146.00 $6,555.00 $5,729.00 2026-11-06
4083041 CDM Faricimab Ophthalmic Svoa 6 Mg/0.05 Ml Sol 7 5 $3,464.00 $3,118.00 $1,663.00 $3,464.00 $3,028.00 2026-11-06
4083025 CDM Fluticasone/umeclidinium/vilanterol 100 Mcg-62.5 Mcg-25 Mcg/inh Pow 7 5 $1,016.00 $914.00 $488.00 $1,016.00 $888.00 2026-11-06
4082770 CDM Lanreotide 120 Mg/0.5 Ml Sol 6 5 $14,373.00 $12,936.00 $6,899.00 $14,373.00 $12,749.00 2026-11-06
4082620 CDM Lanreotide 90. 6 5 $12,192.00 $10,973.00 $5,852.00 $12,192.00 $10,814.50 2026-11-06
4082517 CDM Immune Globulin Intravenous And Subcutaneous 10% Sol 7 5 $5,830.00 $5,247.00 $2,798.00 $5,830.00 $5,095.00 2026-11-06
4082120 CDM Rituximab 500. 7 5 $7,076.00 $6,368.00 $3,396.00 $7,076.00 $6,184.00 2026-11-06
4082115 CDM Remdesivir 100 Mg Pow 7 5 $810.00 $729.00 $389.00 $810.00 $708.00 2026-11-06
4081995 CDM Albuterol-ipratropium 100 Mcg-20 Mcg/inh Aer[stan] 7 5 $713.00 $642.00 $342.00 $713.00 $623.00 2026-11-06
4081825 CDM Immune Globulin Intravenous And Subcutaneous 10% Sol 7 5 $2,930.00 $2,637.00 $1,406.00 $2,930.00 $2,561.00 2026-11-06
4081762 CDM Ranibizumab Ophthalmic 6 Mg/ml Sol 7 5 $1,785.00 $1,607.00 $857.00 $1,785.00 $1,560.00 2026-11-06
4081666 CDM Ferric Carboxymaltose 7 5 $1,954.00 $1,759.00 $938.00 $1,954.00 $1,708.00 2026-11-06
4081568 CDM Filgrastim 480 Mcg/0.8 Ml Sol[stan] 7 5 $1,026.00 $923.00 $492.00 $1,026.00 $897.00 2026-11-06
4081230 CDM Degarelix 80 Mg Pow 7 5 $763.00 $687.00 $366.00 $763.00 $667.00 2026-11-06
4080840 CDM Aflibercept Ophthalmic 2mg/0.05ml Sol 7 5 $2,805.00 $2,525.00 $1,346.00 $2,805.00 $2,452.00 2026-11-06
4080810 CDM Ranibizumab Ophthalmic 10 Mg/ml Sol 7 5 $2,955.00 $2,660.00 $1,418.00 $2,955.00 $2,583.00 2026-11-06
4080743 CDM Fulvestrant 250. 7 5 $2,757.00 $2,481.00 $1,323.00 $2,757.00 $2,410.00 2026-11-06
4080635 CDM Omalizumab 7 5 $1,953.00 $1,758.00 $937.00 $1,953.00 $1,707.00 2026-11-06
4080610 CDM Omalizumab 7 5 $992.00 $893.00 $476.00 $992.00 $867.00 2026-11-06
4080450 CDM Tiotropium 2.5 Mcg/inh Aer 7 5 $768.00 $691.00 $369.00 $768.00 $671.00 2026-11-06
4080442 CDM Daptomycin 500 Mg Pow 7 5 $698.00 $628.00 $335.00 $698.00 $610.00 2026-11-06
4080436 CDM Dorzolamide-timolol Ophthalmic 2%-0.5% 7 5 $844.00 $760.00 $405.00 $844.00 $738.00 2026-11-06
4080389 CDM Rabies Immune Globulin, Human 7 5 $1,095.00 $986.00 $526.00 $1,095.00 $957.00 2026-11-06
4080386 CDM Rabies Vaccine, Purified Chick Embryo Cell 2.5 Intlunit Powder-inj 7 5 $627.00 $564.00 $301.00 $627.00 $548.00 2026-11-06
4080343 CDM Darbepoetin Alfa 200. 7 5 $2,352.00 $2,117.00 $1,129.00 $2,352.00 $2,056.00 2026-11-06
4080324 CDM Fluticasone 220. Mcg Aerosol 7 5 $638.00 $574.00 $306.00 $638.00 $558.00 2026-11-06
4080206 CDM Leuprolide 7.5 Mg/month Kit [Stan] 7 5 $2,950.00 $2,655.00 $1,416.00 $2,950.00 $2,578.00 2026-11-06
4080197 CDM Darbepoetin Alfa 300. 7 5 $3,513.00 $3,162.00 $1,686.00 $3,513.00 $3,070.00 2026-11-06
4080191 CDM Epoetin Alfa 7 5 $1,634.00 $1,471.00 $784.00 $1,634.00 $1,428.00 2026-11-06
4080188 CDM Epoetin Alfa 20000. 7 5 $832.00 $749.00 $399.00 $832.00 $727.00 2026-11-06
4080066 CDM Alteplase 100 Mg Pow 6 5 $13,231.00 $11,908.00 $6,351.00 $13,231.00 $11,736.00 2026-11-06
4080057 CDM Denosumab 60 Mg/ml Sol 7 5 $2,709.00 $2,438.00 $1,300.00 $2,709.00 $2,368.00 2026-11-06
4080046 CDM Darbepoetin Alfa 500. 7 5 $5,835.00 $5,252.00 $2,801.00 $5,835.00 $5,100.00 2026-11-06
40064 CPT Bill Only Hla 7 5 $663.00 $597.00 $318.00 $663.00 $579.00 2026-11-06
36680 CPT 36680-place Needle Intraosseous Infusion 7 5 $989.00 $890.00 $475.00 $989.00 $864.00 2026-11-06
36430 CPT 1-4 Hoursblood Administration Charges 21 5 $1,049.00 $944.00 $497.00 $1,087.00 $917.00 2026-11-06
32556 CPT 32556drainage, Percutaneous Without Guidance 7 5 $3,672.00 $3,305.00 $1,763.00 $3,672.00 $3,209.00 2026-11-06
32555 CPT Charge:thoracentesis With Imaging Guidance 7 5 $1,223.00 $1,101.00 $587.00 $1,223.00 $1,069.00 2026-11-06
32554 CPT 32554-thoracentesis Without Imaging Guidance 7 5 $1,223.00 $1,101.00 $587.00 $1,223.00 $1,069.00 2026-11-06
32551 CPT 32551-insertion Chest Tube 7 5 $3,176.00 $2,858.00 $1,524.00 $3,176.00 $2,776.00 2026-11-06
31605 CPT 31605-tracheostomy,emergency Procedure 7 5 $979.00 $881.00 $470.00 $979.00 $856.00 2026-11-06
31603 CPT 31603-tracheostomy Transtracheal 7 5 $3,057.00 $2,751.00 $1,467.00 $3,057.00 $2,672.00 2026-11-06
3020040 CDM Telemetry Chargeinpatient 7 5 $2,372.00 $2,135.00 $1,139.00 $2,372.00 $2,073.00 2026-11-06
3020020 CDM Room/bed: Acute 7 5 $2,158.00 $1,942.00 $1,036.00 $2,158.00 $1,886.00 2026-11-06
29425 CPT 29425application Short Leg Cast 7 5 $599.00 $539.00 $288.00 $599.00 $524.00 2026-11-06
29405 CPT 29405-app Of Short Leg Cast (Below Knee To Toes) 7 5 $599.00 $539.00 $288.00 $599.00 $524.00 2026-11-06
29365 CPT 29365 Cylinger Cast Thigh/ankle 7 5 $599.00 $539.00 $288.00 $599.00 $524.00 2026-11-06
29355 CPT 29355 Long Leg Cast-ambul Type 7 5 $599.00 $539.00 $288.00 $599.00 $524.00 2026-11-06
29345 CPT 29345-application Of Long Leg Cast Thigh To Toes 7 5 $599.00 $539.00 $288.00 $599.00 $524.00 2026-11-06
29075 CPT 29075-cast Application Elbow To Finger (Short Arm) 7 5 $599.00 $539.00 $288.00 $599.00 $524.00 2026-11-06
29065 CPT 29065 Casting Long Arm Opc 7 5 $599.00 $539.00 $288.00 $599.00 $524.00 2026-11-06
28470 CPT 28470metatarsal Without Manipulation 7 5 $753.00 $678.00 $361.00 $753.00 $658.00 2026-11-06
27825 CPT 27825-distal Tibia With Traction Or Manipulation 7 5 $3,297.00 $2,967.00 $1,583.00 $3,297.00 $2,882.00 2026-11-06
27810 CPT 27810-bimalleolar Ankle With Manipulation 7 5 $3,337.00 $3,003.00 $1,602.00 $3,337.00 $2,917.00 2026-11-06
27788 CPT 27788-distal Fibular With Manipulation 7 5 $595.00 $536.00 $286.00 $595.00 $520.00 2026-11-06
27786 CPT 27786-distal Fibular Without Manipulation 7 5 $1,090.00 $981.00 $523.00 $1,090.00 $953.00 2026-11-06
27780 CPT 27780-proximal Fibula/shaft 7 5 $1,071.00 $964.00 $514.00 $1,071.00 $936.00 2026-11-06
27762 CPT 27762-medial Malleolus With Manipulation 7 5 $3,297.00 $2,967.00 $1,583.00 $3,297.00 $2,882.00 2026-11-06
27752 CPT 27752-tibial Shaft With Manipulation 7 5 $3,337.00 $3,003.00 $1,602.00 $3,337.00 $2,917.00 2026-11-06
27552 CPT 27552-closed Treatment Of Knee Dislocation; Requiring Anesthesia 7 5 $3,297.00 $2,967.00 $1,583.00 $3,297.00 $2,882.00 2026-11-06
27550 CPT 27550-knee Without Anesthesia 7 5 $595.00 $536.00 $286.00 $595.00 $520.00 2026-11-06
27510 CPT 27510-femoral Distal With Manipulation 7 5 $3,337.00 $3,003.00 $1,602.00 $3,337.00 $2,917.00 2026-11-06
26750 CPT 26750-distal Phalangeal Without Manipulation 7 5 $646.00 $581.00 $310.00 $646.00 $565.00 2026-11-06
26700 CPT 26700-metacarpophalangeal/knuckle 7 5 $595.00 $536.00 $286.00 $595.00 $520.00 2026-11-06
26600 CPT 26600clsd Tx Metacarpal Fracture Without Manip 7 5 $1,040.00 $936.00 $499.00 $1,040.00 $909.00 2026-11-06
25605 CPT 25605 Cltx Dstl Rdl Fx/epiphysl Sep W/manj When Perf 7 5 $3,297.00 $2,967.00 $1,583.00 $3,297.00 $2,882.00 2026-11-06
25600 CPT 25600 Closed Treatment Of Distal Radial Fracture; Without Manipulation 7 5 $1,167.00 $1,050.00 $560.00 $1,167.00 $1,020.00 2026-11-06
25565 CPT 25565-radial&ulnar Shaft With Manipulation 7 5 $3,337.00 $3,003.00 $1,602.00 $3,337.00 $2,917.00 2026-11-06
25505 CPT 25505-radial Shaft With Manipulation 7 5 $3,337.00 $3,003.00 $1,602.00 $3,337.00 $2,917.00 2026-11-06
24675 CPT 24675-ulna Proximal End With Manipulation 7 5 $3,337.00 $3,003.00 $1,602.00 $3,337.00 $2,917.00 2026-11-06
24670 CPT 24670ulnar Proximal End Without Manipulation 7 5 $1,279.00 $1,151.00 $614.00 $1,279.00 $1,118.00 2026-11-06
24655 CPT 24655radial Head/neck With Manipulation 7 5 $3,337.00 $3,003.00 $1,602.00 $3,337.00 $2,917.00 2026-11-06
24576 CPT 24576 Closed Treatment Of Humeral Condylar Fracture, Medial Or Lateral; Without … 7 5 $858.00 $772.00 $412.00 $858.00 $750.00 2026-11-06
24505 CPT 24505-humeral Shaft With Manipulation 7 5 $3,337.00 $3,003.00 $1,602.00 $3,337.00 $2,917.00 2026-11-06
23655 CPT 23655-shoulder With Anesthesia 7 5 $3,337.00 $3,003.00 $1,602.00 $3,337.00 $2,917.00 2026-11-06
23505 CPT 23505 Clavicle Fx With Manipulat 7 5 $3,337.00 $3,003.00 $1,602.00 $3,337.00 $2,917.00 2026-11-06
21315 CPT 21315nasal Bone Fx Without Stabilization 7 5 $3,249.00 $2,924.00 $1,560.00 $3,249.00 $2,840.00 2026-11-06
20611 CPT 20611 Arthrocentesis, Aspiration And/or Injection, Major Joint Or Bursa; With Ul… 7 5 $620.00 $558.00 $298.00 $620.00 $542.00 2026-11-06
20606 CPT 20606 Arthrocentesis, Aspiration And/or Injection, Intermediate Joint Or Bursa; … 7 5 $1,503.00 $1,353.00 $721.00 $1,503.00 $1,314.00 2026-11-06
20604 CPT 20604 Arthrocentesis, Aspiration And/or Injection, Small Joint Or Bursa (Eg, Fin… 7 5 $620.00 $558.00 $298.00 $620.00 $542.00 2026-11-06
20552 CPT 20552 Joints Trp. Inj. One-two Muscles 7 5 $629.00 $566.00 $302.00 $629.00 $550.00 2026-11-06
16030 CPT 16030-burn Dressings/debridement Large 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
13152 CPT 13152-eye/ear/nose/lip 2.6-7.5 Cm 7 5 $1,213.00 $1,092.00 $582.00 $1,213.00 $1,060.00 2026-11-06
13151 CPT 13151-eyes/ears/nose/lip 1.1-2.5 Cm 7 5 $1,213.00 $1,092.00 $582.00 $1,213.00 $1,060.00 2026-11-06
13132 CPT 13132-face/neck/hand/feet/genital 2.6-7.5 Cm 7 5 $1,213.00 $1,092.00 $582.00 $1,213.00 $1,060.00 2026-11-06
13131 CPT 13131-face/neck/hand/feet/genital 1.1-2.5 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
13121 CPT 13121-scalp/arms/legs 2.6-7.5 Cm 7 5 $1,213.00 $1,092.00 $582.00 $1,213.00 $1,060.00 2026-11-06
13120 CPT 13120-scalp/arms/legs 1.1-2.5 Cm 7 5 $1,213.00 $1,092.00 $582.00 $1,213.00 $1,060.00 2026-11-06
13101 CPT 13101-trunk 2.6-7.5 Cm 7 5 $1,213.00 $1,092.00 $582.00 $1,213.00 $1,060.00 2026-11-06
13100 CPT 13100-trunk 1.1-2.5 Cm 7 5 $1,213.00 $1,092.00 $582.00 $1,213.00 $1,060.00 2026-11-06
12057 CPT 12057-face/ear/eye/nose/lip Greater Than 30.0 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12056 CPT 12056-face/ear/eye/nose/lip 20.1-30.0 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12055 CPT 12055-face/ear/eye/nose/lip 12.6-20.0 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12054 CPT 12054-face/ear/eye/nose/lip 7.6-12.5 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12053 CPT 12053-face/ear/eye/nose/lip 5.1-7.5 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12052 CPT 12052-face/ear/eye/nose/lip 2.6-5.0 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12051 CPT 12051-face/ear/eye/nose/lip Less Than/equal To 2.5 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12047 CPT 12047-neck/hand/feet/genital Greater Than 30.0 Cm 7 5 $3,968.00 $3,571.00 $1,905.00 $3,968.00 $3,468.00 2026-11-06
12046 CPT 12046-neck/hand/feet/genital 20.1-30.0 Cm 7 5 $1,213.00 $1,092.00 $582.00 $1,213.00 $1,060.00 2026-11-06
12045 CPT 12045-neck/hand/feet/genital 12.6-20.0 Cm 7 5 $1,213.00 $1,092.00 $582.00 $1,213.00 $1,060.00 2026-11-06
12044 CPT 12044-neck/hand/feet/genital 7.6-12.5 Cm 7 5 $1,213.00 $1,092.00 $582.00 $1,213.00 $1,060.00 2026-11-06
12042 CPT 12042-neck/hand/feet/genital 2.6-7.5 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12041 CPT 12041-neck/hand/feet/genital Less Than/equal To 2.5 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12037 CPT 12037-scalp/trunk/extremity Greater Than 30.0 Cm 7 5 $3,968.00 $3,571.00 $1,905.00 $3,968.00 $3,468.00 2026-11-06
12036 CPT 12036-scalp/trunk/extremity 20.1-30.0 Cm 7 5 $1,213.00 $1,092.00 $582.00 $1,213.00 $1,060.00 2026-11-06
12035 CPT 12035-scalp/trunk/extremity 12.6-20.0 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12034 CPT 12034-scalp/trunk/extremity 7.6-12.5 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12032 CPT 12032-scalp/trunk/extremity 2.6-7.5cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12031 CPT 12031-scalp/trunk/extremity Less Than/equal To 2.5 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12021 CPT 12021-superficial Dehiscence W/packing 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12020 CPT 12020-treatment Superficial Wound Dehiscence 7 5 $1,213.00 $1,092.00 $582.00 $1,213.00 $1,060.00 2026-11-06
12017 CPT 12017-face/ear/eyelid/nose/lip 20.1-30.0 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12016 CPT 12016-face/ear/eyelid/nose/lip 12.6-20.0 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12006 CPT 12006-scalp/neck/trunk/genital/extremity 20.1-30 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
12005 CPT 12005-scalp/neck/trunk/genital/extremity 12.6-20.0 Cm 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
11760 CPT 11760-repair Of Nail Bed 7 5 $1,213.00 $1,092.00 $582.00 $1,213.00 $1,060.00 2026-11-06
11750 CPT 11750-excision Nail & Matrix 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
11642 CPT 11642 Excision, Malignant Lesion Including Margins, Face, Ears, Eyelids, Nose, L… 7 5 $927.00 $834.00 $445.00 $927.00 $810.00 2026-11-06
11623 CPT 11623 Op Excision, Malignant Lesion Including Margins, Scalp, Neck, H 7 5 $688.00 $619.00 $330.00 $688.00 $601.00 2026-11-06
11622 CPT 11622 Excision, Malignant Lesion Including Margins, Scalp, Neck, Hands, Feet, Ge… 7 5 $875.00 $788.00 $420.00 $875.00 $765.00 2026-11-06
11603 CPT 11603 Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; 2.1-3.… 7 5 $964.00 $868.00 $463.00 $964.00 $843.00 2026-11-06
11402 CPT 11402-excision Lesion Benign Trunk/extremity 1.1-2.0 Cm 7 5 $594.00 $535.00 $285.00 $594.00 $519.00 2026-11-06
10180 CPT 10180-i&d Postop Wound Infection Complex 7 5 $5,649.00 $5,084.00 $2,712.00 $5,649.00 $4,937.00 2026-11-06
10160 CPT 10160-aspiration Abscess/cyst/hematoma 7 5 $800.00 $720.00 $384.00 $800.00 $699.00 2026-11-06
10140 CPT 10140-i&d Hematoma/seroma/fluid 14 5 $1,928.00 $1,735.00 $283.00 $3,267.00 $1,078.50 2026-11-06
10080 CPT 10080 I & D Of Pilonidal Cyst Simple 7 5 $1,440.00 $1,296.00 $691.00 $1,440.00 $1,259.00 2026-11-06
10061 CPT 10061 Op I&d Abscess/cyst/hematoma Complicated 14 5 $762.50 $686.50 $348.00 $800.00 $643.50 2026-11-06
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