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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

SANFORD HILLSBORO

Hillsboro, ND · CCN 351329 · Rates published

1,635 distinct procedures filed
15 distinct payers
149,996 rate rows
2026-03-04 last MRF observed
Data quality

149,414 of 149,996 rate rows are consumer-grade (99.6%)

582 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
percent-of-charges filed in the dollar field — excluded from medians 466
per-diem day rate — not a per-procedure price 116
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/8382/450409348_sanford-hillsboro-medical-center_standardcharges.csv
Found on page https://search.hospitalpriceindex.com/hpi2/machineReadable/SanfordMedicalCenterHillsboro/8382
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-18
Content fingerprint 32eb5a92dd5887ec… · 49,751,401 bytes · first seen 2026-05-13

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
J2350
HCPCS 		Ocrelizumab Soln For IV Infusion 300 Mg/10ml 15 $60.94 $20,066.89 $15,975.51 nat. median
$683
outlier · 23.4×
J3101
HCPCS 		Tenecteplase For IV Soln Kit 50 Mg 15 $1,819.30 $6,978.87 $5,555.97 nat. median
$5,957
0.9× median
J0225
HCPCS 		Inj, Vutrisiran, 1 Mg 1 $5,018.93 $5,018.93 $5,018.93 nat. median
$8,223
0.6× median
J0717
HCPCS 		Certolizumab Pegol Prefilled Syringe Kit 200 Mg/ml 15 $4.73 $5,819.75 $4,633.18 nat. median
$1,372
outlier · 3.4×
J0517
HCPCS 		Benralizumab Subcutaneous Soln Prefilled Syringe 30 Mg/ml 15 $170.48 $5,549.66 $4,418.15 nat. median
$914
outlier · 4.8×
74174
CPT 		CTA Abd Pelvis W Contrast+wo If Perform 15 $607.75 $5,254.58 $4,183.24 nat. median
$959
outlier · 4.4×
95811
CPT 		Psg Cpap Bipap 4+ Parameters 15 $1,299.35 $4,984.33 $3,968.09 nat. median
$2,026
2.0× median
Q5127
HCPCS 		Pegfilgrastim-fpgk Soln Prefilled Syringe 6 Mg/0.6ml 15 $311.44 $4,846.88 $3,858.66 nat. median
$418
outlier · 9.2×
66982
CPT 		Surg 66982 Rmvl Eccr Iol Insrt Cmplx 15 $1,259.16 $4,830.17 $3,845.36 nat. median
$2,968
1.3× median
66984
CPT 		Surg 66984 Extracap Catarct Rmvl Insert Io Lens Prosth Without Ecp 15 $1,259.16 $4,830.17 $3,845.36 nat. median
$2,927
1.3× median
95810
CPT 		Psg 4+ Parameters 15 $1,199.85 $4,602.64 $3,664.22 nat. median
$1,870
2.0× median
Q5111
HCPCS 		Pegfilgrastim-cbqv Soln Prefilled Syringe 6 Mg/0.6ml 15 $146.06 $4,591.27 $3,655.17 nat. median
$2,102
1.7× median
72158
CPT 		MRI L Spine Wo Then W Cont 15 $607.75 $4,555.27 $3,626.51 nat. median
$1,081
outlier · 3.4×
72157
CPT 		MRI T Spine Wo Then W Cont 15 $607.75 $4,476.33 $3,563.66 nat. median
$1,094
outlier · 3.3×
J2507
HCPCS 		Pegloticase Injection 1 $3,547.84 $3,547.84 $3,547.84 nat. median
$8,536
outlier · 0.4×
J1301
HCPCS 		Edaravone Inj 30 Mg/100ml (0.3 Mg/ml) 15 $22.58 $4,432.13 $3,528.47 nat. median
$39
outlier · 90.4×
72156
CPT 		MRI C Spine Wo Then W Cont 15 $607.75 $4,409.47 $3,510.43 nat. median
$1,092
outlier · 3.2×
72197
CPT 		MRI Pelvis Wo Then W Cont 15 $607.75 $4,392.75 $3,497.12 nat. median
$1,065
outlier · 3.3×
0474T
CPT 		Surg 0474t Insert Ant Seg Aqueous DRG Dev W/io Rsvr 15 $1,137.14 $4,362.10 $3,472.72 nat. median
$5,681
0.6× median
70553
CPT 		MRI Brain Wo Then W Cont 15 $607.75 $4,330.53 $3,447.59 nat. median
$1,122
outlier · 3.1×
65235
CPT 		Ed 65235 Remv Fb Eye Intraocular 15 $1,114.39 $4,274.81 $3,403.23 nat. median
$2,552
1.3× median
71552
CPT 		MRI Chest Wo Then W Cont 15 $607.75 $4,258.09 $3,389.92 nat. median
$1,093
outlier · 3.1×
70543
CPT 		MRI Face Neck Orb Wo Then W Cont 15 $607.75 $4,244.16 $3,378.83 nat. median
$1,079
outlier · 3.1×
74183
CPT 		MRI Abdomen Wo Then W Cont 15 $607.75 $4,219.08 $3,358.86 nat. median
$1,102
outlier · 3.0×
70546
CPT 		MRA Head Wo Then W Cont 15 $607.75 $4,182.86 $3,330.03 nat. median
$1,043
outlier · 3.2×
67904
CPT 		Surg 67904 Rpr Blepharoptosis Levator Rescj/advmnt Xtrnl 15 $1,083.88 $4,157.79 $3,310.07 nat. median
$2,992
1.1× median
73223
CPT 		MRI Upper Ext Jt Wo Then W Cont 15 $607.75 $4,140.14 $3,296.02 nat. median
$1,225
outlier · 2.7×
73723
CPT 		MRI Lower Ext Jt Wo Then W Cont 15 $607.75 $4,076.06 $3,245.01 nat. median
$1,264
outlier · 2.6×
70549
CPT 		MRA Neck Wo Then W Cont 15 $607.75 $4,036.13 $3,213.22 nat. median
$1,051
outlier · 3.1×
15823
CPT 		Surg 15823 Blephropl Upper Exc Skin 15 $1,036.19 $3,974.84 $3,164.42 nat. median
$2,601
1.2× median
73220
CPT 		MRI Upper Ext Wo Then W Cont 15 $607.75 $3,946.05 $3,141.50 nat. median
$1,185
outlier · 2.7×
59409
CPT 		Ed 59409 Ed Delivery Vaginal Only 15 $1,010.28 $3,875.47 $3,085.31 nat. median
$3,185
1.0× median
73720
CPT 		MRI Lower Ext Wo Then W Cont 15 $607.75 $3,836.46 $3,054.26 nat. median
$1,190
outlier · 2.6×
72147
CPT 		MRI T Spine W Contrast 15 $607.75 $3,695.30 $2,941.88 nat. median
$965
outlier · 3.0×
26607
CPT 		Ed 26607 Clsd Tx Mtcrpal Fx Wmanip 15 $957.51 $3,673.01 $2,924.13 nat. median
$3,137
0.9× median
72149
CPT 		MRI L Spine W Contrast 15 $607.75 $3,671.15 $2,922.65 nat. median
$970
outlier · 3.0×
72142
CPT 		MRI C Spine W Contrast 15 $607.75 $3,669.29 $2,921.17 nat. median
$959
outlier · 3.0×
70552
CPT 		MRI Brain W Contrast 15 $607.75 $3,585.71 $2,854.63 nat. median
$960
outlier · 3.0×
73222
CPT 		MRI Up Ext Jt Wcont 15 $611.05 $3,580.14 $2,850.20 nat. median
$1,313
outlier · 2.2×
12037
CPT 		Ed 12037 Lyr Clsr Of Wnd >30.0cm 15 $929.18 $3,564.35 $2,837.62 nat. median
$1,995
1.4× median
52281
CPT 		Cysto Wdilatation Ofurethra 15 $918.77 $3,524.42 $2,805.84 nat. median
$2,200
1.3× median
74178
CPT 		CT Abd Pelvis Wo Then W Cont 15 $607.75 $3,487.27 $2,776.26 nat. median
$979
outlier · 2.8×
37609
CPT 		Surg 37609 Ligation/biopsy Temporal Artery 15 $898.19 $3,445.48 $2,742.99 nat. median
$1,910
1.4× median
74170
CPT 		CT Abdomen Wo Then W Cont 15 $446.60 $3,411.12 $2,715.64 nat. median
$703
outlier · 3.9×
J3262
HCPCS 		Tocilizumab IV Inj 400 Mg/20ml 15 $6.08 $3,407.79 $2,712.99 nat. median
$1,425
1.9× median
67917
CPT 		Surg 67917 Repair Ectropion Extensive 15 $885.12 $3,395.33 $2,703.07 nat. median
$2,918
0.9× median
27603
CPT 		Tx Rm 27603 I&d Abscess Hematoma Leg Ankle Deep 15 $883.67 $3,389.76 $2,698.63 nat. median
$3,016
0.9× median
J3111
HCPCS 		Romosozumab-aqqg Inj Soln Prefilled Syringe 105 Mg/1.17ml 15 $11.36 $3,316.41 $2,640.24 nat. median
$1,003
outlier · 2.6×
67924
CPT 		Surg 67924 Repair Entropion Extensive 15 $864.54 $3,316.39 $2,640.22 nat. median
$2,968
0.9× median
21337
CPT 		Ed 21337 Clsd Tx Nose Fxw Wo Stabl 15 $833.55 $3,197.51 $2,545.58 nat. median
$3,215
0.8× median

Other procedures at this hospital

Browse this hospital's 1,635 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
             
0110 RC Routine Room & Board 56 11 $1,181.00 $944.80 $228.54 $1,316.90 $861.50 2026-03-04
0120 RC Semi Private Room 84 11 $1,418.00 $1,134.40 $202.29 $1,630.80 $1,176.94 2026-03-04
0202U CPT Cdmr Nfct Ds 22 Trgt Sars-cov-2 0202u 68 15 $1,375.00 $1,100.00 20% off $332.89 $1,276.96 $1,016.61 2026-03-04
0360 RC Cystoscopy 160 15 $1,343.00 $1,074.40 $200.94 $3,939.55 $992.95 2026-03-04
0474T CPT Surg 0474t Insert Ant Seg Aqueous DRG Dev W/io Rsvr 68 15 $4,697.00 $3,757.60 20% off $1,137.14 $4,362.10 $3,472.72 2026-03-04
0689 RC Trauma Activation Full 68 15 $1,966.00 $1,572.80 20% off $475.97 $1,825.82 $1,453.56 2026-03-04
10120 CPT Ed 10120 Inc&remv Fb Smpl 68 15 $939.00 $751.20 $227.33 $872.05 $694.25 2026-03-04
10121 CPT Ed 10121 Inc&remv Fb Compl 68 15 $2,862.00 $2,289.60 20% off $692.89 $2,657.94 $2,116.02 2026-03-04
10140 CPT Ed 10140 I&d Hematoma Fluid 68 15 $2,559.00 $2,047.20 20% off $619.53 $2,376.54 $1,891.99 2026-03-04
11010 CPT Ed 11010 Debr Skin Fx Disloc 68 15 $2,220.00 $1,776.00 20% off $537.46 $2,061.71 $1,641.36 2026-03-04
11402 CPT Tx Rm 11402 Excision Lesion Benign Trunk Arm Leg 1.1 To 2.0cm 68 15 $1,200.00 $960.00 20% off $290.52 $1,114.44 $887.22 2026-03-04
11760 CPT Ed 11760 Rpr Of Nail Bed 68 15 $1,191.00 $952.80 20% off $288.34 $1,106.08 $880.57 2026-03-04
12006 CPT Ed 12006 Rpr Suprfl Wnd 20.1-30.0cm 68 15 $947.00 $757.60 20% off $229.27 $879.48 $700.16 2026-03-04
12007 CPT Ed 12007 Rpr Superfcl Wnd >30cm 68 15 $929.00 $743.20 $224.91 $862.76 $686.86 2026-03-04
12020 CPT Ed 12020 Wnd Tx Dehiscence Superfcl 68 15 $1,749.00 $1,399.20 20% off $423.43 $1,624.30 $1,293.12 2026-03-04
12021 CPT Ed 12021 Wnd Tx Dehiscence Wpack 68 15 $961.00 $768.80 20% off $232.66 $892.48 $710.51 2026-03-04
12031 CPT Ed 12031 Lyr Clsr Of Wnd 2.5cm Or < 68 15 $1,078.00 $862.40 20% off $260.98 $1,001.14 $797.02 2026-03-04
12032 CPT Ed 12032 Lyr Clsr Of Wnd 2.6-7.5cm 68 15 $1,035.00 $828.00 20% off $250.57 $961.20 $765.23 2026-03-04
12035 CPT Ed 12035 Lyr Clsr Of Wd 12.6-20.0cm 68 15 $1,078.00 $862.40 20% off $260.98 $1,001.14 $797.02 2026-03-04
12036 CPT Ed 12036 Lyr Clsr Wd 20.1-30.0 Cm 68 15 $1,233.00 $986.40 20% off $298.51 $1,145.09 $911.62 2026-03-04
12037 CPT Ed 12037 Lyr Clsr Of Wnd >30.0cm 68 15 $3,838.00 $3,070.40 20% off $929.18 $3,564.35 $2,837.62 2026-03-04
12042 CPT Ed 12042 Lyr Clsr Wnd 2.6-7.5cm Nhf 68 15 $978.00 $782.40 20% off $236.77 $908.27 $723.09 2026-03-04
12044 CPT Ed 12044 Lyr Clsr Wd 7.6-12.5cm Nhf 68 15 $1,078.00 $862.40 20% off $260.98 $1,001.14 $797.02 2026-03-04
12045 CPT Ed 12045 Lyr Clr Wd 12.6-20.0cm Nhf 68 15 $1,078.00 $862.40 20% off $260.98 $1,001.14 $797.02 2026-03-04
12046 CPT Ed 12046 Intrmd Rpr Lac Nck Hnds Feet Gntl 20.1-30.0cm 68 15 $1,408.00 $1,126.40 $340.88 $1,307.61 $1,041.01 2026-03-04
12047 CPT Ed 12047 Lyr Clsr Wnd >30.0cm Nhf 68 15 $2,277.00 $1,821.60 20% off $551.26 $2,114.65 $1,683.50 2026-03-04
12052 CPT Ed 12052 Lyr Clsr Of Wnd 2.6-5.0cm 68 15 $1,058.00 $846.40 20% off $256.14 $982.56 $782.23 2026-03-04
12053 CPT Ed 12053 Lyr Clsr Of Wnd 5.1-7.5cm 68 15 $1,095.00 $876.00 20% off $265.10 $1,016.93 $809.59 2026-03-04
12054 CPT Ed 12054 Lyr Clsr Of Wnd 7.6-12.5cm 68 15 $1,078.00 $862.40 20% off $260.98 $1,001.14 $797.02 2026-03-04
12055 CPT Ed 12055 Lyr Clsr Wnd 12.6-20.0cm 68 15 $1,213.00 $970.40 20% off $293.67 $1,126.51 $896.83 2026-03-04
12056 CPT Ed 12056 Intrmd Rpr Lac Fce Ear Lid Ns Lp Mth20.1-30cm 68 15 $1,560.00 $1,248.00 20% off $377.68 $1,448.77 $1,153.38 2026-03-04
12057 CPT Ed 12057 Intrmd Rpr Lac Fce Ear Lid Nse Lip Mth>30.0cm 68 15 $1,539.00 $1,231.20 20% off $372.59 $1,429.27 $1,137.86 2026-03-04
13101 CPT Ed 13101 Rpr Cmplx Trunk 2.6-7.5cm 68 15 $1,982.00 $1,585.60 20% off $479.84 $1,840.68 $1,465.39 2026-03-04
13120 CPT Ed 13120 Rpr Cmplx Wnd 1.1-2.5cm 68 15 $936.00 $748.80 20% off $226.61 $869.26 $692.03 2026-03-04
13121 CPT Ed 13121 Rpr Cmplx Wnd 2.6-7.5 Cm 68 15 $1,038.00 $830.40 20% off $251.30 $963.99 $767.45 2026-03-04
13132 CPT Ed 13132 Rpr Cpx Wd Or Lsn 2.6-7.5cm 68 15 $1,229.00 $983.20 $297.54 $1,141.37 $908.66 2026-03-04
15823 CPT Surg 15823 Blephropl Upper Exc Skin 68 15 $4,280.00 $3,424.00 20% off $1,036.19 $3,974.84 $3,164.42 2026-03-04
20520 CPT Ed 20520 Rmvl Fb Musc Tend Smpl 68 15 $2,338.00 $1,870.40 $566.03 $2,171.30 $1,728.60 2026-03-04
21315 CPT Ed 21315 Clsd Tx Nsl Bone Fx W Manip Wo Stab 68 15 $2,991.00 $2,392.80 $724.12 $2,777.74 $2,211.39 2026-03-04
21337 CPT Ed 21337 Clsd Tx Nose Fxw Wo Stabl 68 15 $3,443.00 $2,754.40 20% off $833.55 $3,197.51 $2,545.58 2026-03-04
21401 CPT Ed 21401 Cl Tx Fx Orbit Wo Blowout W Man 68 15 $1,246.00 $996.80 20% off $301.66 $1,157.16 $921.23 2026-03-04
23605 CPT Ed 23605 Clsd Tx Humeral Wmanip 68 15 $2,547.00 $2,037.60 20% off $616.63 $2,365.40 $1,883.12 2026-03-04
23655 CPT Ed 23655 Clsd Tx Sldr Dsl Wmnp Ans 68 15 $3,028.00 $2,422.40 20% off $733.08 $2,812.10 $2,238.75 2026-03-04
23931 CPT Ed 23931 I&d Elbow Bursa 68 15 $3,114.00 $2,491.20 20% off $753.90 $2,891.97 $2,302.34 2026-03-04
24620 CPT Ed 24620 Clsd Tx Elbow Fx 68 15 $2,657.00 $2,125.60 20% off $643.26 $2,467.56 $1,964.45 2026-03-04
24655 CPT Ed 24655 Clsd Tx Rad Head Neck Fx Wman 68 15 $1,993.00 $1,594.40 $482.51 $1,850.90 $1,473.53 2026-03-04
24675 CPT Ed 24675 Clsd Tx Ulna Fx Wmanip 68 15 $2,032.00 $1,625.60 20% off $491.95 $1,887.12 $1,502.36 2026-03-04
25505 CPT Ed 25505 Clsd Tx Rad Shaft Fx W Manip 68 15 $1,842.00 $1,473.60 20% off $445.95 $1,710.67 $1,361.88 2026-03-04
25535 CPT Ed 25535 Clsd Tx Ulnar Shaft Fx Wmanip 68 15 $1,234.00 $987.20 $298.75 $1,146.02 $912.36 2026-03-04
25565 CPT Ed 25565 Clsd Tx Rad Ulnar Shaft Wmanip 68 15 $1,934.00 $1,547.20 20% off $468.22 $1,796.11 $1,429.90 2026-03-04
25605 CPT Ed 25605 Clsd Tx Distal Radial Wmanip 68 15 $1,777.00 $1,421.60 20% off $430.21 $1,650.30 $1,313.83 2026-03-04
26605 CPT Ed 26605 Clsd Tx Metacarpal Fx Wmanip 68 15 $1,125.00 $900.00 20% off $272.36 $1,044.79 $831.77 2026-03-04
26607 CPT Ed 26607 Clsd Tx Mtcrpal Fx Wmanip 68 15 $3,955.00 $3,164.00 20% off $957.51 $3,673.01 $2,924.13 2026-03-04
26725 CPT Ed 26725 Clsd Tx Finger Fx Wmanip 68 15 $1,187.00 $949.60 20% off $287.37 $1,102.37 $877.61 2026-03-04
27238 CPT Ed 27238 Clsd Tx Femur Fx 68 15 $1,954.00 $1,563.20 20% off $473.06 $1,814.68 $1,444.69 2026-03-04
27252 CPT Ed 27252 Clsd Tx Hip Dslc Trm Wans 68 15 $2,664.00 $2,131.20 20% off $644.95 $2,474.06 $1,969.63 2026-03-04
27500 CPT Ed 27500 Clsd Tx Fem Shaft Fx Wo Manip 68 15 $995.00 $796.00 20% off $240.89 $924.06 $735.65 2026-03-04
27502 CPT Ed 27502 Clsd Tx Fmrl Shft Fx Wmnp 68 15 $2,730.00 $2,184.00 20% off $660.93 $2,535.35 $2,018.42 2026-03-04
27530 CPT Ed 27530 Clsd Tx Tibial Fx Prox 68 15 $922.00 $737.60 20% off $223.22 $856.26 $681.68 2026-03-04
27603 CPT Tx Rm 27603 I&d Abscess Hematoma Leg Ankle Deep 68 15 $3,650.00 $2,920.00 20% off $883.67 $3,389.76 $2,698.63 2026-03-04
27788 CPT Ed 27788 Clsd Tx Ankle Fx Wmanip 68 15 $957.00 $765.60 20% off $231.69 $888.77 $707.56 2026-03-04
27818 CPT Ed 27818 Clsd Tx Trimal Wmanip 68 15 $1,662.00 $1,329.60 20% off $402.37 $1,543.50 $1,228.80 2026-03-04
28190 CPT Ed 28190 Remv Fb Foot 68 15 $1,760.00 $1,408.00 20% off $426.10 $1,634.51 $1,301.26 2026-03-04
32551 CPT Ed 32551 Tube Thoracostomy 68 15 $1,985.00 $1,588.00 20% off $480.57 $1,843.47 $1,467.61 2026-03-04
36430 CPT Transfusion Blood 68 15 $1,056.00 $844.80 20% off $255.66 $980.71 $780.75 2026-03-04
36589 CPT Ed 36589 Rmv Tun Cv Cth Wo Sbq Prt 68 15 $2,040.00 $1,632.00 20% off $493.88 $1,894.55 $1,508.28 2026-03-04
37609 CPT Surg 37609 Ligation/biopsy Temporal Artery 68 15 $3,710.00 $2,968.00 20% off $898.19 $3,445.48 $2,742.99 2026-03-04
40650 CPT Ed 40650 Rpr Lip Full Thick Vermilion Only 68 15 $1,871.00 $1,496.80 20% off $452.97 $1,737.60 $1,383.33 2026-03-04
40654 CPT Ed 40654 Repair Lip Full Thickness 68 15 $1,964.00 $1,571.20 20% off $475.48 $1,823.97 $1,452.09 2026-03-04
40804 CPT Ed 40804 Exc Fb Vest Mouth Smp 68 15 $939.00 $751.20 $227.33 $872.05 $694.25 2026-03-04
40831 CPT Ed 40831 Clsr Mouth Lacrn > 2.5cm 68 15 $1,403.00 $1,122.40 $339.67 $1,302.97 $1,037.31 2026-03-04
41252 CPT Ed 41252 Rpr Lac Mouth Floor/tongue > 2.6cm/cmplx 68 15 $1,283.00 $1,026.40 $310.61 $1,191.52 $948.59 2026-03-04
43202 CPT Esophagoscopy Wbx 68 15 $2,800.00 $2,240.00 20% off $677.88 $2,600.36 $2,070.18 2026-03-04
43235 CPT Egd Diag 68 15 $2,200.00 $1,760.00 20% off $1,003.20 $2,270.40 $1,626.57 2026-03-04
43239 CPT Egd Wbiop Sing Mult 68 15 $2,200.00 $1,760.00 20% off $1,003.20 $2,270.40 $1,626.57 2026-03-04
43245 CPT Surg 43245 Egd Dilation Gastric/duodenal Stricture 68 15 $2,854.00 $2,283.20 20% off $690.95 $2,650.51 $2,110.11 2026-03-04
43249 CPT Egd Wballoon Dil 68 15 $2,996.00 $2,396.80 $958.10 $2,782.39 $2,215.09 2026-03-04
43251 CPT Surg 43251 Egd Removal Tumor Polyp Other Lesion Snare 68 15 $2,997.00 $2,397.60 20% off $725.57 $2,783.31 $2,215.83 2026-03-04
43254 CPT Surg 43254 Egd Transoral Endoscopic Mucosal Resection 68 15 $2,996.00 $2,396.80 $725.33 $2,782.39 $2,215.09 2026-03-04
44388 CPT Colon Thru Stoma Diag 68 15 $2,648.00 $2,118.40 $641.08 $2,459.20 $1,957.80 2026-03-04
44389 CPT Colon Thru Stoma Wbx 68 15 $2,743.00 $2,194.40 $664.08 $2,547.42 $2,028.04 2026-03-04
44394 CPT Colon Thru Stome Wsnare 68 15 $2,815.00 $2,252.00 20% off $681.51 $2,614.29 $2,081.27 2026-03-04
45330 CPT Flex Sig Diag 68 15 $2,192.00 $1,753.60 20% off $530.68 $2,035.71 $1,620.65 2026-03-04
45331 CPT Flex Sig Wbx 68 15 $1,973.00 $1,578.40 $477.66 $1,832.33 $1,458.74 2026-03-04
45378 CPT Surg 45378 Colonoscopy Flexible 68 15 $2,308.00 $1,846.40 $1,052.45 $2,742.30 $1,706.42 2026-03-04
45380 CPT Surg 45380 Colonoscopy Wbx 70 15 $2,308.00 $1,846.40 $1,052.45 $2,382.60 $1,706.42 2026-03-04
45381 CPT Surg 45381 Colonoscopy Submucious Inj 68 15 $2,308.00 $1,846.40 $558.77 $2,143.44 $1,706.42 2026-03-04
45384 CPT Surg 45384 Colonoscopy Wforceps 68 15 $2,308.00 $1,846.40 $1,052.45 $2,382.60 $1,706.42 2026-03-04
45385 CPT Colon Wrem Tumor Snare 70 15 $2,448.00 $1,958.40 $1,116.29 $2,382.60 $1,809.93 2026-03-04
45390 CPT Colonoscopy Flex Wendo Mucosal Resection 68 15 $2,339.00 $1,871.20 20% off $566.27 $2,172.23 $1,729.34 2026-03-04
46050 CPT Ed 46050 I&d Perial Abscess Suprfcl 68 15 $2,588.00 $2,070.40 $626.55 $2,403.48 $1,913.44 2026-03-04
46221 CPT Ed 46221 Hemorrhoidectomy Smpl Lig 68 15 $2,104.00 $1,683.20 20% off $509.38 $1,953.98 $1,555.59 2026-03-04
49440 CPT Surg 49440 G-tube Plmt 68 15 $2,858.00 $2,286.40 $691.92 $2,654.22 $2,113.06 2026-03-04
52000 CPT Surg 52000 Cystourethroscopy 68 15 $1,308.00 $1,046.40 $316.67 $1,214.74 $967.07 2026-03-04
52281 CPT Cysto Wdilatation Ofurethra 68 15 $3,795.00 $3,036.00 20% off $918.77 $3,524.42 $2,805.84 2026-03-04
59300 CPT Ed 59300 Episiotomy Vaginal Rpr Other Than Attending Physician 68 15 $2,009.00 $1,607.20 20% off $486.38 $1,865.76 $1,485.36 2026-03-04
59409 CPT Ed 59409 Ed Delivery Vaginal Only 68 15 $4,173.00 $3,338.40 20% off $1,010.28 $3,875.47 $3,085.31 2026-03-04
59414 CPT Ed 59414 Delivery Of Placenta 68 15 $1,331.00 $1,064.80 20% off $322.24 $1,236.10 $984.08 2026-03-04
62270 CPT Ed 62270 Spinal Tap Lumbar Diag 68 15 $1,511.00 $1,208.80 20% off $365.81 $1,403.27 $1,117.16 2026-03-04
64400 CPT Ed 64400 Inj Anes Ag Trig Nrv Ea Branch 68 15 $1,331.00 $1,064.80 20% off $322.24 $1,236.10 $984.08 2026-03-04
64450 CPT Ed 64450 Inj Nerve Block Oth Prphrl 68 15 $1,241.00 $992.80 20% off $300.45 $1,152.52 $917.53 2026-03-04
65235 CPT Ed 65235 Remv Fb Eye Intraocular 68 15 $4,603.00 $3,682.40 20% off $1,114.39 $4,274.81 $3,403.23 2026-03-04
66982 CPT Surg 66982 Rmvl Eccr Iol Insrt Cmplx 68 15 $5,201.00 $4,160.80 $1,259.16 $4,830.17 $3,845.36 2026-03-04
66984 CPT Surg 66984 Extracap Catarct Rmvl Insert Io Lens Prosth Without Ecp 68 15 $5,201.00 $4,160.80 $1,259.16 $4,830.17 $3,845.36 2026-03-04
67005 CPT Surg 67005 Rmvl Vitreous Ant Appr Partial Removal 68 15 $3,004.00 $2,403.20 20% off $727.27 $2,789.81 $2,221.01 2026-03-04
67904 CPT Surg 67904 Rpr Blepharoptosis Levator Rescj/advmnt Xtrnl 68 15 $4,477.00 $3,581.60 20% off $1,083.88 $4,157.79 $3,310.07 2026-03-04
67917 CPT Surg 67917 Repair Ectropion Extensive 68 15 $3,656.00 $2,924.80 $885.12 $3,395.33 $2,703.07 2026-03-04
67924 CPT Surg 67924 Repair Entropion Extensive 68 15 $3,571.00 $2,856.80 $864.54 $3,316.39 $2,640.22 2026-03-04
70336 CPT MRI Temporomandibular Joint 68 15 $3,063.00 $2,450.40 20% off $578.05 $2,844.61 $2,264.63 2026-03-04
70450 CPT CT Head Wo Contrast 68 15 $1,836.00 $1,468.80 20% off $470.25 $1,705.09 $1,357.44 2026-03-04
70460 CPT CT Head W Contrast 68 15 $2,201.00 $1,760.80 20% off $446.60 $2,044.07 $1,627.31 2026-03-04
70470 CPT CT Head Wo Then W Contrast 68 15 $2,865.00 $2,292.00 20% off $446.60 $2,660.73 $2,118.24 2026-03-04
70480 CPT CT Orbit Sella Fossa Ear Wo Contrast 68 15 $2,412.00 $1,929.60 20% off $352.55 $2,240.02 $1,783.31 2026-03-04
70481 CPT CT Orbit Sella Fossa Ear W Contrast 68 15 $2,625.00 $2,100.00 20% off $446.60 $2,437.84 $1,940.80 2026-03-04
70482 CPT CT Orbit Sella Fossa Ear Wo Then W Contrast 68 15 $2,905.00 $2,324.00 20% off $446.60 $2,697.87 $2,147.81 2026-03-04
70486 CPT CT Maxillofacial Wo Cont 70 15 $1,442.00 $1,153.60 20% off $352.55 $1,339.19 $1,066.14 2026-03-04
70487 CPT CT Maxillofacial W Cont 68 15 $1,958.00 $1,566.40 $446.60 $1,818.39 $1,447.64 2026-03-04
70488 CPT CT Maxillofacial Wo W Cont 68 15 $3,228.00 $2,582.40 20% off $446.60 $2,997.84 $2,386.62 2026-03-04
70490 CPT CT Soft Tissue Neck Wo Con 68 15 $1,836.00 $1,468.80 20% off $352.55 $1,705.09 $1,357.44 2026-03-04
70491 CPT CT Soft Tissue Neck W Contrast 68 15 $2,238.00 $1,790.40 $446.60 $2,078.43 $1,654.66 2026-03-04
70492 CPT CT Sft Tisue Neck Wwo Then W 68 15 $3,203.00 $2,562.40 20% off $446.60 $2,974.63 $2,368.14 2026-03-04
70496 CPT CTA Head W Cont Wo If Perf 68 15 $3,145.00 $2,516.00 20% off $446.60 $2,920.76 $2,325.26 2026-03-04
70498 CPT CT Angio Neck W Con+wo If Perf 68 15 $3,145.00 $2,516.00 20% off $446.60 $2,920.76 $2,325.26 2026-03-04
70540 CPT MRI Face Neck Orb Wo Contrast 68 15 $3,270.00 $2,616.00 20% off $578.05 $3,036.85 $2,417.68 2026-03-04
70542 CPT MRI Orbit/face/neck With Contrast 4 1 — — $607.75 $1,215.50 $911.62 2026-03-04
70543 CPT MRI Face Neck Orb Wo Then W Cont 70 15 $4,570.00 $3,656.00 20% off $607.75 $4,244.16 $3,378.83 2026-03-04
70544 CPT MRA Head Wo Contrast 68 15 $2,846.00 $2,276.80 $578.05 $2,643.08 $2,104.19 2026-03-04
70545 CPT MRA Head W Contrast 68 15 $3,415.00 $2,732.00 20% off $607.75 $3,171.51 $2,524.88 2026-03-04
70546 CPT MRA Head Wo Then W Cont 68 15 $4,504.00 $3,603.20 20% off $607.75 $4,182.86 $3,330.03 2026-03-04
70547 CPT MRA Neck Wo Contrast 68 15 $3,086.00 $2,468.80 $578.05 $2,865.97 $2,281.64 2026-03-04
70548 CPT MRA Neck W Contrast 68 15 $3,056.00 $2,444.80 $607.75 $2,838.11 $2,259.45 2026-03-04
70549 CPT MRA Neck Wo Then W Cont 68 15 $4,346.00 $3,476.80 $607.75 $4,036.13 $3,213.22 2026-03-04
70551 CPT MRI Brain Wo Contrast 68 15 $2,675.00 $2,140.00 20% off $578.05 $2,484.27 $1,977.76 2026-03-04
70552 CPT MRI Brain W Contrast 68 15 $3,861.00 $3,088.80 $607.75 $3,585.71 $2,854.63 2026-03-04
70553 CPT MRI Brain Wo Then W Cont 70 15 $4,663.00 $3,730.40 20% off $607.75 $4,330.53 $3,447.59 2026-03-04
70554 CPT Fmri Brain By Tech 4 1 — — $578.05 $1,156.10 $867.07 2026-03-04
70555 CPT Fmri Brain By Phys/psych 4 1 — — $578.05 $1,156.10 $867.07 2026-03-04
71250 CPT CT Thorax Diagnostic Wo Contrast 68 15 $1,779.00 $1,423.20 20% off $352.55 $1,652.16 $1,315.31 2026-03-04
71260 CPT CT Thorax Diagnostic With Contrast 68 15 $2,127.00 $1,701.60 20% off $446.60 $1,975.34 $1,572.60 2026-03-04
71270 CPT CT Thorax Diagnostic Wo Then W Contrast 68 15 $3,259.00 $2,607.20 20% off $446.60 $3,026.63 $2,409.54 2026-03-04
71275 CPT CTA Chest Wcont +wo If Perf 68 15 $3,052.00 $2,441.60 20% off $446.60 $2,834.39 $2,256.49 2026-03-04
71550 CPT MRI Chest Wo Contrast 68 15 $3,312.00 $2,649.60 20% off $578.05 $3,075.85 $2,448.72 2026-03-04
71551 CPT MRI Chest With Contrast 4 1 — — $611.05 $1,222.10 $916.57 2026-03-04
71552 CPT MRI Chest Wo Then W Cont 68 15 $4,585.00 $3,668.00 20% off $607.75 $4,258.09 $3,389.92 2026-03-04
71555 CPT MRI Angio Chest W Or Without Contrast 4 1 — — $578.05 $1,156.10 $867.07 2026-03-04
72052 CPT Rad Exam Spine Cerv 6 + Vws 68 15 $918.00 $734.40 20% off $222.25 $852.55 $678.73 2026-03-04
72125 CPT CT Cervical Spine Wo Contrast 68 15 $1,840.00 $1,472.00 20% off $352.55 $1,708.81 $1,360.40 2026-03-04
72126 CPT CT Cervical Spine W Contrast 68 15 $2,958.00 $2,366.40 $607.75 $2,747.09 $2,186.99 2026-03-04
72128 CPT CT Thoracic Spine Wo Cont 68 15 $1,836.00 $1,468.80 20% off $352.55 $1,705.09 $1,357.44 2026-03-04
72129 CPT CT Thoracic Spine W Contrast 68 15 $2,823.00 $2,258.40 $446.60 $2,621.72 $2,087.18 2026-03-04
72130 CPT CT Chest Spine Without & With Contrast 4 1 — — $446.60 $893.20 $669.90 2026-03-04
72131 CPT CT Lumbar Spine Wo Cont 68 15 $1,836.00 $1,468.80 20% off $352.55 $1,705.09 $1,357.44 2026-03-04
72132 CPT CT Lumbar Spine With Contrast 4 1 — — $607.75 $1,215.50 $911.62 2026-03-04
72133 CPT CT Lumbar Spine Without & With Contrast 4 1 — — $446.60 $893.20 $669.90 2026-03-04
72141 CPT MRI C Spine Wo Contrast 70 15 $2,583.00 $2,066.40 $578.05 $2,398.83 $1,909.74 2026-03-04
72142 CPT MRI C Spine W Contrast 68 15 $3,951.00 $3,160.80 $607.75 $3,669.29 $2,921.17 2026-03-04
72146 CPT MRI T Spine Wo Contrast 68 15 $2,628.00 $2,102.40 $578.05 $2,440.62 $1,943.01 2026-03-04
72147 CPT MRI T Spine W Contrast 68 15 $3,979.00 $3,183.20 20% off $607.75 $3,695.30 $2,941.88 2026-03-04
72148 CPT MRI L Spine Wo Contrast 74 15 $2,753.00 $2,202.40 $578.05 $2,556.71 $2,035.43 2026-03-04
72149 CPT MRI L Spine W Contrast 68 15 $3,953.00 $3,162.40 20% off $607.75 $3,671.15 $2,922.65 2026-03-04
72156 CPT MRI C Spine Wo Then W Cont 68 15 $4,748.00 $3,798.40 20% off $607.75 $4,409.47 $3,510.43 2026-03-04
72157 CPT MRI T Spine Wo Then W Cont 68 15 $4,820.00 $3,856.00 20% off $607.75 $4,476.33 $3,563.66 2026-03-04
72158 CPT MRI L Spine Wo Then W Cont 68 15 $4,905.00 $3,924.00 20% off $607.75 $4,555.27 $3,626.51 2026-03-04
72159 CPT Mr Angio Spine W/O&with Contrast 4 1 — — $578.05 $1,156.10 $867.07 2026-03-04
72191 CPT CT Angiograph Pelv W/O&with Contrast 4 1 — — $446.60 $893.20 $669.90 2026-03-04
72192 CPT CT Pelvis Wo Contrast 68 15 $1,850.00 $1,480.00 20% off $352.55 $1,718.10 $1,367.80 2026-03-04
72193 CPT CT Pelvis W Contrast 68 15 $2,691.00 $2,152.80 $446.60 $2,499.13 $1,989.59 2026-03-04
72194 CPT CT Pelvis Wo Then W Cont 68 15 $3,075.00 $2,460.00 20% off $446.60 $2,855.75 $2,273.50 2026-03-04
72195 CPT MRI Pelvis Wo Contrast 68 15 $3,209.00 $2,567.20 20% off $578.05 $2,980.20 $2,372.57 2026-03-04
72196 CPT MRI Pelvis With Contrast 4 1 — — $607.75 $1,215.50 $911.62 2026-03-04
72197 CPT MRI Pelvis Wo Then W Cont 70 15 $4,730.00 $3,784.00 20% off $607.75 $4,392.75 $3,497.12 2026-03-04
72198 CPT MRA Pelvis Wo Then W Cont 68 15 $3,100.00 $2,480.00 20% off $578.05 $2,878.97 $2,291.99 2026-03-04
73200 CPT CT Ext Upper Wo Cont 68 15 $1,969.00 $1,575.20 20% off $352.55 $1,828.61 $1,455.78 2026-03-04
73201 CPT CT Ext Upper W Cont 68 15 $2,528.00 $2,022.40 $607.75 $2,347.75 $1,869.08 2026-03-04
73202 CPT CT Ext Upper Wwo Contrast 68 15 $2,847.00 $2,277.60 20% off $446.60 $2,644.01 $2,104.93 2026-03-04
73206 CPT CT Angio Upr Extrm W/O&with Contrast 4 1 — — $446.60 $893.20 $669.90 2026-03-04
73218 CPT MRI Up Ext Wo Cont 68 15 $3,079.00 $2,463.20 20% off $578.05 $2,859.47 $2,276.46 2026-03-04
73219 CPT MRI Upper Extremity With Contrast 4 1 — — $607.75 $1,215.50 $911.62 2026-03-04
73220 CPT MRI Upper Ext Wo Then W Cont 68 15 $4,249.00 $3,399.20 20% off $607.75 $3,946.05 $3,141.50 2026-03-04
73221 CPT MRI Upper Ext Jt Wo Contrast 70 15 $3,146.00 $2,516.80 $578.05 $2,921.69 $2,325.99 2026-03-04
73222 CPT MRI Up Ext Jt Wcont 68 15 $3,855.00 $3,084.00 20% off $611.05 $3,580.14 $2,850.20 2026-03-04
73223 CPT MRI Upper Ext Jt Wo Then W Cont 68 15 $4,458.00 $3,566.40 20% off $607.75 $4,140.14 $3,296.02 2026-03-04
73225 CPT MRA Upper Ext Wo Then W Cont 68 15 $2,451.00 $1,960.80 20% off $578.05 $2,276.24 $1,812.14 2026-03-04
73700 CPT CT Ext Lower Wo Cont 68 15 $1,544.00 $1,235.20 20% off $352.55 $1,433.91 $1,141.56 2026-03-04
73701 CPT CT Ext Lower W Cont 68 15 $2,481.00 $1,984.80 20% off $446.60 $2,304.10 $1,834.33 2026-03-04
73702 CPT CT Lwr Extremity W/O&with Contrast 4 1 — — $446.60 $893.20 $669.90 2026-03-04
73706 CPT CT Angio Lwr Extr W/O&with Contrast 4 1 — — $446.60 $893.20 $669.90 2026-03-04
73718 CPT MRI Lower Ext Wo Contrast 68 15 $3,097.00 $2,477.60 20% off $578.05 $2,876.18 $2,289.76 2026-03-04
73719 CPT MRI Lower Extremity With Contrast 4 1 — — $607.75 $1,215.50 $911.62 2026-03-04
73720 CPT MRI Lower Ext Wo Then W Cont 68 15 $4,131.00 $3,304.80 $607.75 $3,836.46 $3,054.26 2026-03-04
73721 CPT MRI Lower Ext Jt Wo Contrast 72 15 $3,139.00 $2,511.20 20% off $578.05 $2,915.19 $2,320.82 2026-03-04
73722 CPT MRI Joint Of Lwr Extr With Contrast 4 1 — — $611.05 $1,222.10 $916.57 2026-03-04
73723 CPT MRI Lower Ext Jt Wo Then W Cont 68 15 $4,389.00 $3,511.20 20% off $607.75 $4,076.06 $3,245.01 2026-03-04
73725 CPT MRA Lower Ext Wo Then W Cont 68 15 $2,839.00 $2,271.20 20% off $578.05 $2,636.58 $2,099.01 2026-03-04
74150 CPT CT Abdomen Wo Contrast 68 15 $2,187.00 $1,749.60 20% off $352.55 $2,031.07 $1,616.96 2026-03-04
74160 CPT CT Abdomen W Contrast 68 15 $2,997.00 $2,397.60 20% off $446.60 $2,783.31 $2,215.83 2026-03-04
74170 CPT CT Abdomen Wo Then W Cont 70 15 $3,673.00 $2,938.40 20% off $446.60 $3,411.12 $2,715.64 2026-03-04
74174 CPT CTA Abd Pelvis W Contrast+wo If Perform 68 15 $5,658.00 $4,526.40 20% off $607.75 $5,254.58 $4,183.24 2026-03-04
74175 CPT CTA Abd Wcont +wo If Perf 68 15 $3,211.00 $2,568.80 $446.60 $2,982.06 $2,374.05 2026-03-04
74176 CPT CT Abd Pelvis Wo Contrast 70 15 $2,601.00 $2,080.80 $578.05 $2,415.55 $1,923.05 2026-03-04
74177 CPT CT Abd Pelvis W Contrast 70 15 $3,116.00 $2,492.80 $607.75 $2,893.83 $2,303.82 2026-03-04
74178 CPT CT Abd Pelvis Wo Then W Cont 68 15 $3,755.00 $3,004.00 20% off $607.75 $3,487.27 $2,776.26 2026-03-04
74181 CPT MRI Abdomen Wo Contrast 68 15 $2,990.00 $2,392.00 20% off $578.05 $2,776.81 $2,210.66 2026-03-04
74182 CPT MRI Abdomen W/contrast 4 1 — — $607.75 $1,215.50 $911.62 2026-03-04
74183 CPT MRI Abdomen Wo Then W Cont 70 15 $4,543.00 $3,634.40 20% off $607.75 $4,219.08 $3,358.86 2026-03-04
74185 CPT MRA Abdomen Wo Then W Cont 68 15 $2,631.00 $2,104.80 $578.05 $2,443.41 $1,945.23 2026-03-04
74240 CPT Rad Exam Gi Upper W Wo Delayed Img Wo Kub 68 15 $1,011.00 $808.80 20% off $244.76 $938.92 $747.49 2026-03-04
74246 CPT Rad Exam Gi Upper W Air Cntrst Wo Kub 68 15 $1,085.00 $868.00 20% off $262.68 $1,007.64 $802.20 2026-03-04
74250 CPT Radiologic Exam Small Bowel Wmultiple Serial Films Sgl Cntrst 68 15 $940.00 $752.00 20% off $227.57 $872.98 $694.99 2026-03-04
74262 CPT CT Colonography Dx With Contrast 4 1 — — $446.60 $893.20 $669.90 2026-03-04
74270 CPT Radiologic Exam Colon W Scout Sgl Cntrst 68 15 $1,091.00 $872.80 20% off $264.13 $1,013.21 $806.63 2026-03-04
74280 CPT Rad Exam Colon W Scout Dbl Cntrst W Gluc 68 15 $1,426.00 $1,140.80 20% off $345.23 $1,324.33 $1,054.32 2026-03-04
74300 CPT Rad S&i Cholangio And Or Pancreato Intraop 68 15 $962.00 $769.60 20% off $232.90 $893.41 $711.25 2026-03-04
74712 CPT MRI Fetal Sngl/1st Gestation 4 1 — — $578.05 $1,156.10 $867.07 2026-03-04
75557 CPT Cardiac MRI For Morph 4 1 — — $578.05 $1,156.10 $867.07 2026-03-04
75561 CPT Cardiac MRI For Morph With Contrast 4 1 — — $607.75 $1,215.50 $911.62 2026-03-04
75563 CPT Card MRI W/stress Img & Dye 4 1 — — $611.05 $1,222.10 $916.57 2026-03-04
75572 CPT CT Hrt W/3d Image 4 1 — — $446.60 $893.20 $669.90 2026-03-04
75573 CPT CT Hrt C+ Strux Cgen Hrt Ds 4 1 — — $446.60 $893.20 $669.90 2026-03-04
75574 CPT CT Angio Hrt W/3d Image 4 1 — — $446.60 $893.20 $669.90 2026-03-04
76380 CPT CT Limited Or Localized Follow Up Study 68 15 $1,011.00 $808.80 20% off $244.76 $938.92 $747.49 2026-03-04
76942 CPT US S&i Guid Ndle Plmt 68 15 $1,026.00 $820.80 20% off $248.39 $952.85 $758.58 2026-03-04
77046 CPT MRI Breast C- Unilateral 4 1 — — $578.05 $1,156.10 $867.07 2026-03-04
77047 CPT MRI Breast C- Bilateral 4 1 — — $578.05 $1,156.10 $867.07 2026-03-04
77048 CPT MRI Breast C-+ W/cad Uni 4 1 — — $446.60 $893.20 $669.90 2026-03-04
77049 CPT MRI Breast C-+ W/cad Bi 4 1 — — $446.60 $893.20 $669.90 2026-03-04
77075 CPT Rad Exam Osseous Survey Compl 68 15 $1,071.00 $856.80 20% off $259.29 $994.64 $791.85 2026-03-04
77084 CPT MRI Bone Marrow Blood Supply 4 1 — — $578.05 $1,156.10 $867.07 2026-03-04
78227 CPT Nm Hepatobiliary Img Incl Gallbladder W Pharm Intv 68 15 $2,479.00 $1,983.20 20% off $600.17 $2,302.25 $1,832.85 2026-03-04
78300 CPT Nm Bone And Or Jnt Img Ltd Area 68 15 $1,629.00 $1,303.20 20% off $394.38 $1,512.85 $1,204.40 2026-03-04
78305 CPT Nm Bone And Or Jnt Img Mult Area 68 15 $1,737.00 $1,389.60 20% off $420.53 $1,613.15 $1,284.25 2026-03-04
78306 CPT Nm Bone And Or Jnt Img Whole Body 68 15 $2,308.00 $1,846.40 $558.77 $2,143.44 $1,706.42 2026-03-04
78452 CPT Ht Muscle Image Spect Mult 4 1 — — $1,556.50 $3,113.00 $2,334.75 2026-03-04
81220 CPT Cftr Gene Analysis Common Variants 81220.900 68 15 $1,670.00 $1,336.00 20% off $404.31 $1,550.93 $1,234.71 2026-03-04
81222 CPT Cdmr Cftr Gene Analysis Variant 81222.900 68 15 $1,327.00 $1,061.60 20% off $321.27 $1,232.38 $981.12 2026-03-04
81229 CPT Cdmr Cytog Alys Chrmoml Abnor Cpy Number&snp Vrnt Cgh 81229 160 15 $3,818.00 $3,054.40 20% off $139.21 $3,721.30 $1,886.09 2026-03-04
81372 CPT Hla1 Lo Resol Complete 81372 114 15 $985.00 $788.00 20% off $216.20 $914.77 $728.26 2026-03-04
86832 CPT Hla Aby Analysis Class I 68 15 $1,005.00 $804.00 20% off $243.31 $933.34 $743.04 2026-03-04
86833 CPT Hla Aby Analysis Class Ii 68 15 $1,011.00 $808.80 20% off $244.76 $938.92 $747.49 2026-03-04
87506 CPT Iadna-dna/rna Gi Pthgn Multiplex Probe Tq 6-11 87506 114 15 $932.00 $745.60 20% off $210.87 $865.55 $689.08 2026-03-04
87507 CPT Cdmr Infectious Agent Nucleic Acid Gi 12-25 Targets 87507 68 15 $1,534.00 $1,227.20 20% off $371.38 $1,424.63 $1,134.16 2026-03-04
88120 CPT Fish Urovysion Per Probe 88120 68 15 $1,509.00 $1,207.20 20% off $365.33 $1,401.41 $1,115.68 2026-03-04
90375 CPT Rabies Immune Globulin (Human) Inj 300 Unit/ML 68 15 $1,168.69 $934.96 $282.94 $1,085.36 $864.07 2026-03-04
92950 CPT Ed 92950 Cardiopulmon Resuscitation 68 15 $1,194.00 $955.20 $289.07 $1,108.87 $882.78 2026-03-04
92960 CPT Ed 92960 Cardioversion Elective External 68 15 $2,003.00 $1,602.40 $484.93 $1,860.19 $1,480.92 2026-03-04
93303 CPT Echo Congenitl Comp 68 15 $1,506.00 $1,204.80 20% off $364.60 $1,398.62 $1,113.46 2026-03-04
93306 CPT Echo (2d) Complete W Doppler & Color 68 15 $2,077.00 $1,661.60 20% off $849.75 $1,928.91 $1,535.63 2026-03-04
93307 CPT Echo 2d Wo Dop Col Comp 68 15 $1,800.00 $1,440.00 20% off $435.78 $1,671.66 $1,330.83 2026-03-04
93312 CPT Echo Transesophageal 68 15 $3,087.00 $2,469.60 20% off $747.36 $2,866.90 $2,282.38 2026-03-04
93350 CPT Echo 2d With Stress 68 15 $2,318.00 $1,854.40 $561.19 $2,152.73 $1,713.82 2026-03-04
93880 CPT Dup Carotid Bilat 68 15 $1,297.00 $1,037.60 20% off $314.00 $1,204.52 $958.93 2026-03-04
93970 CPT Duplex Venous Ext Cmpl Bilat 68 15 $1,160.00 $928.00 20% off $280.84 $1,077.29 $857.64 2026-03-04
93975 CPT Duplex Abd Pelvis Retroperitoneal Cmpl 68 15 $1,451.00 $1,160.80 20% off $351.29 $1,347.54 $1,072.80 2026-03-04
93976 CPT Duplex Abd Pelvis Retroperitoneal Ltd 68 15 $1,043.00 $834.40 20% off $252.51 $968.63 $771.14 2026-03-04
94002 CPT Vent Initial Day 68 15 $1,792.00 $1,433.60 20% off $433.84 $1,664.23 $1,324.91 2026-03-04
95810 CPT Psg 4+ Parameters 68 15 $4,956.00 $3,964.80 $1,199.85 $4,602.64 $3,664.22 2026-03-04
95811 CPT Psg Cpap Bipap 4+ Parameters 68 15 $5,367.00 $4,293.60 $1,299.35 $4,984.33 $3,968.09 2026-03-04
96440 CPT Chmotx Admn Plrl Cav Thrcnts 2 1 — — $1,822.40 $1,822.40 $1,822.40 2026-03-04
99284 CPT Ed 99284 Emer Case Level IV 74 15 $1,197.00 $957.60 20% off $289.79 $1,111.65 $885.00 2026-03-04
99285 CPT Ed 99285 Emer Case Level V 74 15 $1,764.00 $1,411.20 20% off $427.06 $1,638.23 $1,304.21 2026-03-04
99291 CPT Ed 99291 Critical Care E&m 30-74 Min 70 15 $3,187.00 $2,549.60 20% off $771.57 $2,959.77 $2,356.31 2026-03-04
99292 CPT Ed 99292 Crit Care Ea Addl 30 Mins 68 15 $1,017.00 $813.60 20% off $246.22 $944.49 $751.92 2026-03-04
C8908 HCPCS MRI Without Fol W/cont, Breast, 4 1 — — $607.75 $1,215.50 $911.62 2026-03-04
C8924 HCPCS Echo Wwo Fol Wcontrast 2d Lmtd 68 15 $1,494.00 $1,195.20 20% off $361.70 $1,387.48 $1,104.59 2026-03-04
C8929 HCPCS Echo Wwo Fol Wcont 2d Complete 68 15 $2,503.00 $2,002.40 $605.98 $2,324.54 $1,850.60 2026-03-04
G0104 HCPCS Screening Flex Sig 68 15 $1,868.00 $1,494.40 $452.24 $1,734.81 $1,381.11 2026-03-04
G0105 HCPCS Screen Colon Whi Risk 68 15 $2,331.00 $1,864.80 20% off $1,062.94 $2,285.80 $1,723.42 2026-03-04
G0121 HCPCS Screen Colon Wo Hi Risk 68 15 $2,240.00 $1,792.00 20% off $1,021.44 $2,285.80 $1,656.14 2026-03-04
G0390 HCPCS Trauma Activation Full W Ccare 68 15 $1,966.00 $1,572.80 20% off $475.97 $1,825.82 $1,453.56 2026-03-04
J0129 HCPCS Abatacept For IV Soln 250 Mg 70 15 $1,956.18 $1,564.95 $44.25 $1,816.70 $1,446.30 2026-03-04
J0202 HCPCS Injection, Alemtuzumab 2 1 — — $2,381.81 $2,381.81 $2,381.81 2026-03-04
J0225 HCPCS Inj, Vutrisiran, 1 Mg 2 1 — — $5,018.93 $5,018.93 $5,018.93 2026-03-04
J0248 HCPCS Remdesivir For IV Soln 100 Mg 68 15 $1,100.00 $880.00 20% off $266.31 $1,021.57 $813.28 2026-03-04
J0517 HCPCS Benralizumab Subcutaneous Soln Prefilled Syringe 30 Mg/ml 70 15 $5,975.73 $4,780.59 $170.48 $5,549.66 $4,418.15 2026-03-04
J0717 HCPCS Certolizumab Pegol Prefilled Syringe Kit 200 Mg/ml 70 15 $6,266.56 $5,013.25 $4.73 $5,819.75 $4,633.18 2026-03-04
J0897 HCPCS Denosumab Inj Soln Prefilled Syringe 60 Mg/ml 160 15 $2,735.76 $2,188.61 $483.66 $3,151.75 $1,797.98 2026-03-04
J1301 HCPCS Edaravone Inj 30 Mg/100ml (0.3 Mg/ml) 70 15 $4,772.40 $3,817.92 $22.58 $4,432.13 $3,528.47 2026-03-04
J1437 HCPCS Ferric Derisomaltose (One Dose) IV Sol 1000 Mg/10ml (Fe Eq) 68 15 $3,060.52 $2,448.42 $740.95 $2,842.30 $2,262.80 2026-03-04
J1439 HCPCS Ferric Carboxymaltose IV Soln 750 Mg/15ml (Fe Equivalent) 68 15 $1,286.84 $1,029.48 $311.54 $1,195.09 $951.42 2026-03-04
J1745 HCPCS Infliximab For IV Inj 100 Mg 70 15 $1,820.51 $1,456.41 $32.81 $1,690.71 $1,345.99 2026-03-04
J2350 HCPCS Ocrelizumab Soln For IV Infusion 300 Mg/10ml 70 15 $21,607.50 $17,286.00 20% off $60.94 $20,066.89 $15,975.51 2026-03-04
J2357 HCPCS Omalizumab Subcutaneous Soln Prefilled Syringe 150 Mg/ml 116 15 $1,895.66 $1,516.53 $39.04 $1,760.50 $974.10 2026-03-04
J2426 HCPCS Paliperidone Palmitate ER Susp Pref Syr 117 Mg/0.75ml 68 15 $2,086.70 $1,669.36 20% off $505.19 $1,937.92 $1,542.81 2026-03-04
J2507 HCPCS Pegloticase Injection 2 1 — — $3,547.84 $3,547.84 $3,547.84 2026-03-04
J2802 HCPCS Romiplostim For Inj 125 Mcg 160 15 $3,454.00 $2,763.20 20% off $483.48 $5,410.68 $1,797.31 2026-03-04
J3101 HCPCS Tenecteplase For IV Soln Kit 50 Mg 68 15 $7,514.67 $6,011.74 $1,819.30 $6,978.87 $5,555.97 2026-03-04
J3111 HCPCS Romosozumab-aqqg Inj Soln Prefilled Syringe 105 Mg/1.17ml 70 15 $3,571.02 $2,856.82 $11.36 $3,316.41 $2,640.24 2026-03-04
J3262 HCPCS Tocilizumab IV Inj 400 Mg/20ml 70 15 $3,669.42 $2,935.54 $6.08 $3,407.79 $2,712.99 2026-03-04
J7168 HCPCS Prothrombin Complex Conc Human For Inj Kit 500 Unit 68 15 $1,525.00 $1,220.00 20% off $369.20 $1,416.27 $1,127.51 2026-03-04
J9217 HCPCS Leuprolide Acetate (6 Month) For Inj Kit 45 Mg 114 15 $1,392.44 $1,113.96 $173.59 $1,293.16 $687.87 2026-03-04
M0224 HCPCS Pemivibart Infusion 68 15 $979.00 $783.20 $237.02 $909.20 $723.83 2026-03-04
M0243 HCPCS Carve Outs 4 1 — — $495.55 $991.10 $743.33 2026-03-04
P9035 HCPCS Platelet Pheresis Leukoreduced Ea Unit P9035 68 15 $1,760.00 $1,408.00 20% off $426.10 $1,634.51 $1,301.26 2026-03-04
P9037 HCPCS Plate Pher Leuk Red Iradp9037 68 15 $1,645.00 $1,316.00 20% off $398.25 $1,527.71 $1,216.23 2026-03-04
Q5104 HCPCS Infliximab-abda For IV Inj 100 Mg 70 15 $1,109.95 $887.96 20% off $27.68 $1,030.81 $820.64 2026-03-04
Q5108 HCPCS Pegfilgrastim-jmdb Soln Prefilled Syringe 6 Mg/0.6ml 70 15 $2,069.84 $1,655.88 $138.08 $1,922.26 $1,530.34 2026-03-04
Q5111 HCPCS Pegfilgrastim-cbqv Soln Prefilled Syringe 6 Mg/0.6ml 70 15 $4,943.76 $3,955.01 $146.06 $4,591.27 $3,655.17 2026-03-04
Q5115 HCPCS Rituximab-abbs IV Soln 100 Mg/10ml (10 Mg/ml) 68 15 $1,096.48 $877.19 $265.46 $1,018.30 $810.68 2026-03-04
Q5120 HCPCS Pegfilgrastim-bmez Soln Prefilled Syringe 6 Mg/0.6ml 70 15 $3,108.52 $2,486.82 $327.13 $2,886.88 $2,298.28 2026-03-04
Q5127 HCPCS Pegfilgrastim-fpgk Soln Prefilled Syringe 6 Mg/0.6ml 70 15 $5,218.99 $4,175.20 $311.44 $4,846.88 $3,858.66 2026-03-04
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