Price Transparency 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

BELLA VISTA HOSPITAL

Mayaguez, PR · CCN 400014 · Rates published

614 distinct procedures filed
19 distinct payers
9,765 rate rows
2026-03-10 last MRF observed
Data quality

9,724 of 9,765 rate rows are consumer-grade (99.6%)

41 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
exceeds 10× this hospital's gross charge — excluded from medians 41
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.bvhpr.org/assets/files/660204776_bella-vista-hospital,-inc_standardcharges.csv
Found on page https://bvhpr.org/price-transparency
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-17
Content fingerprint 726f4b0757cf6491… · 1,913,758 bytes · first seen 2026-05-09

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
45391
CPT 		Colonoscopy W/endoscopy Ultr E 17 $261.42 $4,200.00 $3,600.00 nat. median
$1,568
outlier · 2.3×
93452
CPT 		Left Heart Cath 17 $240.11 $2,410.00 $2,000.00 nat. median
$5,130
outlier · 0.4×
77301
CPT 		Imrt Plan 7 $686.73 $1,524.85 $1,524.85 nat. median
$2,773
0.5× median
55866
CPT 		Laparoscopy,prostatectomy Radi 14 $850.00 $6,936.78 $1,357.00 nat. median
$10,516
outlier · 0.1×
74363
CPT 		Tipps(transj Intrahep Porto Sy 14 $42.99 $4,167.45 $1,350.00 nat. median
$568
outlier · 2.4×
75898
CPT 		Angio. Thru Exist. Cath. 14 $90.07 $2,100.00 $1,200.00 nat. median
$2,352
0.5× median
75716
CPT 		Angio. Extremity Bilateral 16 $56.78 $2,310.31 $1,195.50 nat. median
$3,281
outlier · 0.4×
75825
CPT 		Venogram Abd.(icv) 16 $50.41 $2,190.31 $1,191.00 nat. median
$3,163
outlier · 0.4×
75605
CPT 		Aortography Thoracic By Serial 15 $74.91 $3,983.07 $1,191.00 nat. median
$4,985
outlier · 0.2×
75741
CPT 		Angiogra. Pulmonary Unil. 13 $57.04 $1,500.00 $1,191.00 nat. median
$3,082
outlier · 0.4×
75840
CPT 		Venog Adrenal Unilat Select 11 $83.00 $1,365.00 $1,191.00 nat. median
$2,978
outlier · 0.4×
75743
CPT 		Angiog Pulmonary Bilateral 13 $57.80 $1,500.00 $1,191.00 nat. median
$3,174
outlier · 0.4×
75736
CPT 		Angiogr. Pelvic,select./suprse 13 $69.00 $1,500.00 $1,191.00 nat. median
$4,936
outlier · 0.2×
75630
CPT 		Aorth. Abdom Plus Bilat Iliofe 15 $72.45 $2,190.66 $1,191.00 nat. median
$3,277
outlier · 0.4×
75831
CPT 		Venogram Renal Unilat. 13 $75.61 $1,500.00 $1,191.00 nat. median
$3,076
outlier · 0.4×
75810
CPT 		Splenoportogram 13 $48.17 $1,500.00 $1,191.00 nat. median
$3,146
outlier · 0.4×
75625
CPT 		Aortography Abdominal By Seria 17 $68.23 $2,310.31 $1,191.00 nat. median
$3,180
outlier · 0.4×
77373
CPT 		Stereo.body Radiat.1 Or More 4 $1,181.27 $1,181.27 $1,181.27 nat. median
$3,714
outlier · 0.3×
75872
CPT 		Venogram Epidural 14 $83.00 $1,500.00 $1,145.50 nat. median
$659
1.7× median
75746
CPT 		Angio Pulmonar By Non-sel Cath 14 $63.65 $1,500.00 $1,145.50 nat. median
$2,676
outlier · 0.4×
75842
CPT 		Venog Adrenal Bilat Select 14 $95.65 $1,500.00 $1,145.50 nat. median
$3,845
outlier · 0.3×
75827
CPT 		Venograp,caval,sup Pro/int,xr 14 $74.56 $1,500.00 $1,145.50 nat. median
$1,606
0.7× median
75733
CPT 		Angiogr. Adrenal Bilateral 14 $80.45 $1,500.00 $1,145.50 nat. median
$3,156
outlier · 0.4×
75774
CPT 		Angio Selec Ea Adit.ves Std Ex 14 $42.27 $1,500.00 $1,145.50 nat. median
$1,097
1.0× median
75726
CPT 		Angiography Visceral Selective 14 $61.62 $1,500.00 $1,145.50 nat. median
$5,021
outlier · 0.2×
75833
CPT 		Venogram Renal Bilat. 14 $84.40 $1,500.00 $1,145.50 nat. median
$3,177
outlier · 0.4×
75756
CPT 		Angiography Internal Mammary 14 $77.15 $1,500.00 $1,145.50 nat. median
$2,919
outlier · 0.4×
75860
CPT 		Venogram Sinus Or Jugular 14 $81.59 $1,500.00 $1,145.50 nat. median
$2,915
outlier · 0.4×
75870
CPT 		Venog. Sup. Sagitta Sinus 14 $115.36 $1,500.00 $1,145.50 nat. median
$2,610
outlier · 0.4×
75710
CPT 		Angio. Extremity Unilater 16 $55.51 $2,310.31 $1,145.50 nat. median
$3,153
outlier · 0.4×
75731
CPT 		Angiography Adrenal Unilat. 14 $75.87 $1,500.00 $1,145.50 nat. median
$2,932
outlier · 0.4×
47562
CPT 		Laparoscopic Cholecystectomy 15 $350.00 $1,415.00 $1,100.00 nat. median
$5,956
outlier · 0.2×
75822
CPT 		Venogram Extrem. Bilat. 14 $47.46 $1,500.00 $1,090.00 nat. median
$1,526
0.7× median
75705
CPT 		Angiog Spinal Select.ea Vessel 14 $96.99 $1,500.00 $1,090.00 nat. median
$5,049
outlier · 0.2×
77372
CPT 		Rad.treat. Delivery(srs) Multi 4 $1,082.13 $1,082.13 $1,082.13 nat. median
$9,062
outlier · 0.1×
75600
CPT 		Aortograp Thoracic Without Serialo 13 $183.59 $1,500.00 $1,080.00 nat. median
$3,062
outlier · 0.4×
75820
CPT 		Venography Extrem. Unil. 14 $20.00 $1,500.00 $1,080.00 nat. median
$1,443
0.7× median
78812
CPT 		PET CT Skull Base To Mid-thigh 15 $91.21 $2,710.00 $1,044.65 nat. median
$1,862
0.6× median
78813
CPT 		PET Whole Body 15 $91.55 $2,710.00 $1,044.65 nat. median
$1,855
0.6× median
78814
CPT 		PET W CT Localiz Imaging,limit 15 $104.48 $3,000.00 $1,044.65 nat. median
$2,306
outlier · 0.5×
78815
CPT 		PET W CT Skll Base To Mid-thig 17 $85.28 $2,100.00 $926.63 nat. median
$2,794
outlier · 0.3×
78608
CPT 		Brain Imaging Positron Emi(pet 14 $70.59 $2,710.00 $903.26 nat. median
$2,352
outlier · 0.4×
78816
CPT 		PET W CT Whole Body 17 $85.53 $2,200.00 $903.26 nat. median
$2,707
outlier · 0.3×
73580
CPT 		Arthrogram Knee 13 $51.26 $1,500.00 $700.00 nat. median
$460
1.5× median
75893
CPT 		Venous Sampling 12 $87.57 $1,500.00 $695.50 nat. median
$4,948
outlier · 0.1×
77435
CPT 		Ster.body Rad.therapy 1-more L 4 $648.12 $648.12 $648.12 nat. median
$964
0.7× median
77772
CPT 		Hdr Over 12 Channels 7 $387.62 $821.00 $643.19 nat. median
$1,146
0.6× median
78811
CPT 		PET Ct(chest,head/neck) Limit 15 $72.69 $2,710.00 $600.00 nat. median
$1,668
outlier · 0.4×
77620
CPT 		Hyperther. Generated By Intrac 7 $150.00 $585.58 $585.58 nat. median
$625
0.9× median
19120
CPT 		Exc Cyst,fibroadenoma Oth Beni 5 $536.10 $1,700.00 $536.10 nat. median
$3,650
outlier · 0.1×

Other procedures at this hospital

Browse this hospital's 614 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
             
19120 CPT Exc Cyst,fibroadenoma Oth Beni 5 5 $1,700.00 $1,700.00 $536.10 $1,700.00 $536.10 2026-03-10
43235 CPT Gastrojejunostomy Without Specim 24 17 $224.00 $224.00 $111.00 $696.29 $197.50 2026-03-10
43239 CPT Gastrointestinal Endo W Biopsy 28 17 $241.00 $241.00 $127.00 $696.29 $403.26 2026-03-10
45378 CPT Colonoscopia 17 17 $126.00 $126.00 $127.00 $677.09 $161.00 2026-03-10
45380 CPT Colonoscopy W Biopsy Sing/mult 17 17 $538.99 $538.99 $127.00 $875.66 $161.00 2026-03-10
45385 CPT Colonoscopy Lesion Removal 17 17 $500.00 $500.00 $127.00 $875.66 $161.00 2026-03-10
45391 CPT Colonoscopy W/endoscopy Ultr E 17 17 $4,000.00 $4,000.00 $261.42 $4,200.00 $3,600.00 2026-03-10
47562 CPT Laparoscopic Cholecystectomy 15 15 $819.00 $819.00 $350.00 $1,415.00 $1,100.00 2026-03-10
55700 CPT Biopsy Prostate 14 14 $650.00 $650.00 $257.60 $690.00 $485.56 2026-03-10
55866 CPT Laparoscopy,prostatectomy Radi 14 14 $906.00 $906.00 $850.00 $6,936.78 $1,357.00 2026-03-10
70332 CPT Arthrogram Tmj 13 13 $1,400.00 $1,400.00 $29.09 $1,500.00 $85.00 2026-03-10
70336 CPT MRI Tmj 15 15 $750.00 $750.00 $164.49 $625.00 $250.00 2026-03-10
70450 CPT CT Head Or Brain Without Cont 25 19 $325.00 $325.00 $52.44 $300.00 $112.50 2026-03-10
70451 CPT CT Pituit. With Contrast 11 11 $390.00 $390.00 $36.12 $350.00 $162.50 2026-03-10
70460 CPT CT Head W/contrast 19 19 $390.00 $390.00 $76.13 $350.00 $137.20 2026-03-10
70470 CPT CT Head W&without Contrast 22 19 $450.00 $450.00 $52.52 $450.00 $135.19 2026-03-10
70480 CPT CT Sinus Limited 29 19 $325.00 $325.00 $79.19 $350.00 $112.50 2026-03-10
70481 CPT CT Orbits With Contrast 24 18 $390.00 $390.00 $80.69 $350.00 $147.12 2026-03-10
70482 CPT CT Orbits W&without Contra 21 19 $450.00 $450.00 $128.59 $450.00 $175.49 2026-03-10
70486 CPT CT Maxillof. Without Contr 19 19 $325.00 $325.00 $72.40 $350.00 $112.50 2026-03-10
70487 CPT CT Maxilof. W/contrast 17 17 $390.00 $390.00 $79.52 $350.00 $137.50 2026-03-10
70488 CPT CT MAXILLOF.W&without Cont 18 18 $450.00 $450.00 $100.74 $450.00 $142.28 2026-03-10
70490 CPT CT Neck Without Contrast 21 19 $325.00 $325.00 $72.14 $350.00 $112.50 2026-03-10
70491 CPT CT Neck With Contrast 24 19 $390.00 $390.00 $95.91 $350.00 $138.50 2026-03-10
70492 CPT CT Neck W&without Contrast 21 19 $450.00 $450.00 $117.24 $450.00 $156.56 2026-03-10
70496 CPT CT Scan Angiography Head W Con 17 17 $450.00 $450.00 $128.59 $350.00 $180.07 2026-03-10
70498 CPT CT Scan Angiography Neck W/wo 18 18 $450.00 $450.00 $128.59 $350.00 $180.07 2026-03-10
70540 CPT MRI Face/orbit/neck Without Contra 21 19 $750.00 $750.00 $134.44 $650.00 $227.50 2026-03-10
70542 CPT MRI Orbit,neck,face W Cont. 17 16 $850.00 $850.00 $163.22 $650.00 $271.25 2026-03-10
70543 CPT MRI Orbit,neck,face W/wo Contr 17 17 $850.00 $850.00 $201.93 $650.00 $285.93 2026-03-10
70544 CPT MRA Head Wo Contr. 19 17 $750.00 $750.00 $134.44 $625.00 $186.40 2026-03-10
70545 CPT MRA Head W Contrast 17 17 $850.00 $850.00 $161.82 $650.00 $271.25 2026-03-10
70546 CPT MRA Head W/wo C 17 17 $850.00 $850.00 $134.44 $625.00 $286.80 2026-03-10
70547 CPT MRA Neck Without Contrast 17 17 $750.00 $750.00 $134.44 $625.00 $227.50 2026-03-10
70548 CPT MRA Neck W Contrast 16 16 $850.00 $850.00 $174.55 $600.00 $268.85 2026-03-10
70549 CPT MRA Neck W Without Contrast 16 15 $850.00 $850.00 $223.32 $900.00 $304.56 2026-03-10
70551 CPT MRI Brain(stem) Wo Contrast 19 19 $750.00 $750.00 $106.18 $625.00 $250.00 2026-03-10
70552 CPT MRI Brain(stem) W Contrast 18 18 $850.00 $850.00 $156.86 $625.00 $271.39 2026-03-10
70553 CPT MRI Brain(stem) W/wo Contrast 17 17 $850.00 $850.00 $178.75 $657.00 $278.74 2026-03-10
70554 CPT MRI Brain, With Fuctional MRI 15 15 $750.00 $750.00 $233.50 $625.00 $325.00 2026-03-10
70559 CPT MRI Brain Stem & Skull W/wo 13 13 $850.00 $850.00 $128.59 $575.00 $193.75 2026-03-10
71250 CPT CT Thorax Without Contrast 19 19 $325.00 $325.00 $78.97 $350.00 $105.00 2026-03-10
71260 CPT CT Thorax W/contrast 19 19 $390.00 $390.00 $95.49 $350.00 $139.12 2026-03-10
71270 CPT CT Thorax W&without Contra 19 19 $450.00 $450.00 $124.90 $450.00 $150.00 2026-03-10
71275 CPT CT Scan Angiography Chest W C 18 18 $450.00 $450.00 $128.59 $350.00 $170.50 2026-03-10
71550 CPT MRI Chest Without Contrast 17 17 $750.00 $750.00 $164.24 $625.00 $262.50 2026-03-10
71551 CPT MRI Chest W Contrast 14 14 $850.00 $850.00 $250.00 $650.00 $320.07 2026-03-10
71552 CPT MRI Chest W Without Contrast 17 17 $850.00 $850.00 $193.75 $650.00 $348.75 2026-03-10
71555 CPT MRA Chest W/wo Contrast 15 15 $850.00 $850.00 $210.58 $575.00 $298.23 2026-03-10
72125 CPT CT Spine Cervical Without C 19 19 $325.00 $325.00 $75.37 $300.00 $105.00 2026-03-10
72126 CPT CT Spine Cervical W Cont. 16 16 $390.00 $390.00 $96.00 $350.00 $132.59 2026-03-10
72127 CPT CT Spine Cervical W Without Cont. 16 16 $450.00 $450.00 $119.17 $350.00 $154.13 2026-03-10
72128 CPT CT Spine Thoraxic Without 18 18 $325.00 $325.00 $75.37 $350.00 $112.50 2026-03-10
72129 CPT CT Spine Thoracic W Contrast 17 17 $350.00 $350.00 $97.01 $350.00 $140.00 2026-03-10
72130 CPT CT Spine Thoracic W Without Cont 18 18 $450.00 $450.00 $119.43 $350.00 $154.66 2026-03-10
72131 CPT CT Spine Lumbar Without Cont. 19 19 $325.00 $325.00 $74.87 $350.00 $105.00 2026-03-10
72132 CPT CT Spine Lumbar W Cont. 17 17 $390.00 $390.00 $96.25 $350.00 $150.00 2026-03-10
72133 CPT CT Spine Lumbar W Without Cont. 17 17 $450.00 $450.00 $118.66 $350.00 $150.00 2026-03-10
72141 CPT MRI Spinal Canal/cervical Wo C 19 19 $750.00 $750.00 $101.86 $650.00 $177.61 2026-03-10
72142 CPT MRI Spinal Canal/cervical W Co 19 19 $850.00 $850.00 $161.43 $700.00 $262.50 2026-03-10
72146 CPT MRI Thoracic Wo Contrast 19 19 $750.00 $750.00 $101.86 $625.00 $195.00 2026-03-10
72147 CPT MRI Thoracic W Contrast 19 19 $850.00 $850.00 $160.17 $625.00 $262.50 2026-03-10
72148 CPT MRI Lumbar Wo Contrast 18 18 $750.00 $750.00 $102.11 $625.00 $238.75 2026-03-10
72149 CPT MRI Lumbar W Contrast 19 19 $850.00 $850.00 $158.12 $625.00 $278.74 2026-03-10
72156 CPT MRI Spinalcanal/cervical W/wo 19 18 $850.00 $850.00 $180.79 $650.00 $278.74 2026-03-10
72157 CPT MRI Thoracic W/wo Contras 17 17 $850.00 $850.00 $181.30 $650.00 $262.50 2026-03-10
72158 CPT MRI Lumbar W/wo Contrast 18 18 $850.00 $850.00 $180.28 $650.00 $263.87 2026-03-10
72159 CPT MRA Spine Canal& Cont. W/wo C 14 14 $850.00 $850.00 $178.39 $575.00 $310.54 2026-03-10
72191 CPT CT Scan Angiog Pelvis W Cont 11 11 $390.00 $390.00 $128.59 $350.00 $179.72 2026-03-10
72192 CPT CT Pelvis Without Contrast 19 19 $325.00 $325.00 $65.46 $350.00 $96.00 2026-03-10
72193 CPT CT Pelvis With Contrast 19 19 $390.00 $390.00 $120.02 $350.00 $178.50 2026-03-10
72194 CPT CT Pelvis W&without Contra 17 17 $450.00 $450.00 $128.59 $450.00 $180.07 2026-03-10
72195 CPT MRI Pelvis Wo Contrast 18 18 $750.00 $750.00 $137.75 $650.00 $211.25 2026-03-10
72196 CPT MRI Pelvis W Contrast 19 19 $850.00 $850.00 $160.42 $650.00 $265.23 2026-03-10
72197 CPT MRI Pelvis W Without Contrast 17 17 $850.00 $850.00 $200.91 $650.00 $286.80 2026-03-10
72198 CPT MRA Pelvis W/wo Contrast 14 14 $850.00 $850.00 $212.36 $575.00 $301.04 2026-03-10
72240 CPT Cervical Myelogram 12 12 $251.00 $251.00 $48.37 $1,500.00 $86.17 2026-03-10
72270 CPT Entire Spinal Canal Myel. 13 13 $332.00 $332.00 $53.32 $1,500.00 $98.00 2026-03-10
72295 CPT Dyskography Lumbar Ea Lev 12 12 $371.00 $371.00 $40.27 $1,500.00 $110.00 2026-03-10
73085 CPT Arthrogram Elbow 13 13 $1,400.00 $1,400.00 $42.44 $1,500.00 $125.00 2026-03-10
73115 CPT Arthrogram Wrist 13 13 $1,400.00 $1,400.00 $47.52 $1,500.00 $125.00 2026-03-10
73200 CPT CT Extremity Upper Without Cont 25 19 $325.00 $325.00 $72.14 $350.00 $109.73 2026-03-10
73201 CPT CT Extremity Upper W Cont. 18 18 $390.00 $390.00 $117.74 $350.00 $170.23 2026-03-10
73202 CPT CT Extremity Upper W Without Cont. 16 16 $450.00 $450.00 $117.24 $350.00 $177.53 2026-03-10
73206 CPT CT Scan Angio Upper Ext W Cont 11 11 $390.00 $390.00 $128.59 $350.00 $180.06 2026-03-10
73218 CPT MRI Arm Oth Joint Without Cont 20 17 $750.00 $750.00 $162.50 $625.00 $232.12 2026-03-10
73219 CPT MRI Arm Oth Any Joint W Cont 19 15 $850.00 $850.00 $162.50 $650.00 $308.80 2026-03-10
73221 CPT MRI Elbow Without Contrast 23 18 $750.00 $750.00 $115.09 $650.00 $177.66 2026-03-10
73222 CPT MRI Finger Upper Ext. W Contra 16 16 $850.00 $850.00 $202.94 $650.00 $287.69 2026-03-10
73223 CPT MRI Arm Upp. Extrem W Without C 24 19 $850.00 $850.00 $162.50 $900.00 $311.25 2026-03-10
73225 CPT MRA Arm Upper Ext. W/wo C 15 15 $850.00 $850.00 $178.39 $575.00 $310.54 2026-03-10
73525 CPT Arthrogram Hip 13 13 $1,400.00 $1,400.00 $46.32 $1,500.00 $125.00 2026-03-10
73580 CPT Arthrogram Knee 13 13 $1,400.00 $1,400.00 $51.26 $1,500.00 $700.00 2026-03-10
73615 CPT Arthrogram Ankle 13 13 $1,400.00 $1,400.00 $48.20 $1,500.00 $125.00 2026-03-10
73700 CPT CT Knee Without Contrast 22 19 $325.00 $325.00 $55.38 $350.00 $108.75 2026-03-10
73701 CPT CT Hip W Cont. 18 17 $390.00 $390.00 $97.01 $350.00 $140.00 2026-03-10
73702 CPT CT Extremity Lower W Without C. 15 15 $450.00 $450.00 $123.24 $350.00 $156.86 2026-03-10
73706 CPT CT Scan Angiogr Lower Extrem 17 17 $390.00 $390.00 $128.59 $350.00 $180.06 2026-03-10
73718 CPT MRI Lower Extremity Without Contr. 17 17 $750.00 $750.00 $135.98 $650.00 $227.50 2026-03-10
73719 CPT MRI Low Ext Oth Joint W Cont 17 17 $850.00 $850.00 $159.71 $625.00 $271.25 2026-03-10
73720 CPT MRI Leg Lower Ext. W Without Contr 17 17 $850.00 $850.00 $202.43 $650.00 $290.63 2026-03-10
73721 CPT MRI Ankle Low Ext.anyjoint Without 21 19 $750.00 $750.00 $115.09 $625.00 $179.52 2026-03-10
73722 CPT MRI Low Ext Any Joint W Cont 15 15 $850.00 $850.00 $203.46 $625.00 $288.40 2026-03-10
73723 CPT MRI Lower Extremity W Without Cont 21 16 $850.00 $850.00 $228.38 $650.00 $310.00 2026-03-10
73725 CPT MRA Leg Lower Ext. W/wo C 16 16 $850.00 $850.00 $181.43 $650.00 $299.29 2026-03-10
74150 CPT CT Abdomen Without Contras 25 19 $325.00 $325.00 $64.45 $350.00 $140.00 2026-03-10
74160 CPT CT Abdomen W/contrast 24 19 $390.00 $390.00 $64.45 $350.00 $163.06 2026-03-10
74170 CPT CT Abdomen W&without Contr 20 19 $450.00 $450.00 $128.59 $450.00 $180.07 2026-03-10
74174 CPT CT Angio Abdomen & Pelvis W Co 15 15 $390.00 $390.00 $143.53 $350.00 $297.19 2026-03-10
74175 CPT CT Scan Angiog Abdomen W Cont 14 14 $390.00 $390.00 $128.59 $350.00 $179.72 2026-03-10
74176 CPT CT Abdomen & Pelvis Wo Contr 18 18 $425.00 $425.00 $81.00 $425.00 $179.21 2026-03-10
74177 CPT CT Abdomen & Pelvis W Contr 18 18 $475.00 $475.00 $137.50 $475.00 $250.21 2026-03-10
74178 CPT CT Abdomen & Pelvis W/wo Contr 17 17 $475.00 $475.00 $162.50 $475.00 $265.34 2026-03-10
74181 CPT MRI Abdomen Without Contrast 20 19 $750.00 $750.00 $128.61 $625.00 $207.50 2026-03-10
74182 CPT MRI Abdomen W Contrast 17 17 $850.00 $850.00 $189.45 $625.00 $278.74 2026-03-10
74183 CPT MRI Abdomen W/wo Contrast 18 18 $850.00 $850.00 $201.42 $650.00 $286.80 2026-03-10
74185 CPT MRA Abdomen W/wo Contrast 16 16 $850.00 $850.00 $213.38 $650.00 $301.40 2026-03-10
74245 CPT Fluroscopy W Small Intestine 2 2 $100.00 $100.00 $89.70 $92.00 $90.85 2026-03-10
74283 CPT Ther. Enema C/air Reduc. Obstr 13 13 $214.75 $214.75 $29.00 $250.00 $168.12 2026-03-10
74363 CPT Tipps(transj Intrahep Porto Sy 14 14 $850.00 $850.00 $42.99 $4,167.45 $1,350.00 2026-03-10
75557 CPT Cardiac MRI Morpho/func Wo Con 17 15 $750.00 $750.00 $123.99 $625.00 $207.86 2026-03-10
75559 CPT Cardiac MRI Morpho/func W Stre 14 14 $750.00 $750.00 $163.67 $625.00 $307.04 2026-03-10
75561 CPT Cardiac MRI Morpho/func W Without 15 15 $750.00 $750.00 $209.06 $625.00 $299.45 2026-03-10
75600 CPT Aortograp Thoracic Without Serialo 13 13 $1,750.00 $1,750.00 $183.59 $1,500.00 $1,080.00 2026-03-10
75605 CPT Aortography Thoracic By Serial 15 15 $1,750.00 $1,750.00 $74.91 $3,983.07 $1,191.00 2026-03-10
75625 CPT Aortography Abdominal By Seria 17 17 $1,750.00 $1,750.00 $68.23 $2,310.31 $1,191.00 2026-03-10
75630 CPT Aorth. Abdom Plus Bilat Iliofe 15 15 $1,750.00 $1,750.00 $72.45 $2,190.66 $1,191.00 2026-03-10
75635 CPT CT Scan Angiog Abdom Aort W Co 14 14 $390.00 $390.00 $128.59 $1,365.00 $180.07 2026-03-10
75705 CPT Angiog Spinal Select.ea Vessel 14 14 $1,400.00 $1,400.00 $96.99 $1,500.00 $1,090.00 2026-03-10
75710 CPT Angio. Extremity Unilater 18 16 $1,400.00 $1,400.00 $55.51 $2,310.31 $1,145.50 2026-03-10
75716 CPT Angio. Extremity Bilateral 16 16 $1,400.00 $1,400.00 $56.78 $2,310.31 $1,195.50 2026-03-10
75726 CPT Angiography Visceral Selective 14 14 $1,400.00 $1,400.00 $61.62 $1,500.00 $1,145.50 2026-03-10
75731 CPT Angiography Adrenal Unilat. 14 14 $1,400.00 $1,400.00 $75.87 $1,500.00 $1,145.50 2026-03-10
75733 CPT Angiogr. Adrenal Bilateral 14 14 $1,400.00 $1,400.00 $80.45 $1,500.00 $1,145.50 2026-03-10
75736 CPT Angiogr. Pelvic,select./suprse 13 13 $1,400.00 $1,400.00 $69.00 $1,500.00 $1,191.00 2026-03-10
75741 CPT Angiogra. Pulmonary Unil. 13 13 $1,400.00 $1,400.00 $57.04 $1,500.00 $1,191.00 2026-03-10
75743 CPT Angiog Pulmonary Bilateral 13 13 $1,400.00 $1,400.00 $57.80 $1,500.00 $1,191.00 2026-03-10
75746 CPT Angio Pulmonar By Non-sel Cath 14 14 $1,400.00 $1,400.00 $63.65 $1,500.00 $1,145.50 2026-03-10
75756 CPT Angiography Internal Mammary 14 14 $1,400.00 $1,400.00 $77.15 $1,500.00 $1,145.50 2026-03-10
75774 CPT Angio Selec Ea Adit.ves Std Ex 14 14 $1,400.00 $1,400.00 $42.27 $1,500.00 $1,145.50 2026-03-10
75803 CPT Lymphagiogram Ext. Bilat. 13 13 $272.00 $272.00 $57.32 $1,500.00 $115.50 2026-03-10
75805 CPT Lymphagiog.pelvic/abd Uni 10 10 $277.00 $277.00 $39.84 $2,019.13 $202.00 2026-03-10
75807 CPT Lymphagiog.pelvic/abd.bil 12 12 $297.50 $297.50 $54.14 $2,019.13 $165.50 2026-03-10
75810 CPT Splenoportogram 13 13 $1,700.00 $1,700.00 $48.17 $1,500.00 $1,191.00 2026-03-10
75820 CPT Venography Extrem. Unil. 19 14 $180.00 $180.00 $20.00 $1,500.00 $1,080.00 2026-03-10
75822 CPT Venogram Extrem. Bilat. 16 14 $190.00 $190.00 $47.46 $1,500.00 $1,090.00 2026-03-10
75825 CPT Venogram Abd.(icv) 17 16 $581.00 $581.00 $50.41 $2,190.31 $1,191.00 2026-03-10
75827 CPT Venograp,caval,sup Pro/int,xr 14 14 $581.00 $581.00 $74.56 $1,500.00 $1,145.50 2026-03-10
75831 CPT Venogram Renal Unilat. 13 13 $581.00 $581.00 $75.61 $1,500.00 $1,191.00 2026-03-10
75833 CPT Venogram Renal Bilat. 14 14 $605.00 $605.00 $84.40 $1,500.00 $1,145.50 2026-03-10
75840 CPT Venog Adrenal Unilat Select 11 11 $600.00 $600.00 $83.00 $1,365.00 $1,191.00 2026-03-10
75842 CPT Venog Adrenal Bilat Select 14 14 $600.00 $600.00 $95.65 $1,500.00 $1,145.50 2026-03-10
75860 CPT Venogram Sinus Or Jugular 14 14 $581.00 $581.00 $81.59 $1,500.00 $1,145.50 2026-03-10
75870 CPT Venog. Sup. Sagitta Sinus 14 14 $581.00 $581.00 $115.36 $1,500.00 $1,145.50 2026-03-10
75872 CPT Venogram Epidural 14 14 $581.00 $581.00 $83.00 $1,500.00 $1,145.50 2026-03-10
75880 CPT Venogram Orbital 5 5 $84.00 $84.00 $82.65 $419.00 $82.65 2026-03-10
75885 CPT Perc. Trans. Portogr W Hemo Ev 12 12 $366.41 $366.41 $58.06 $1,500.00 $325.18 2026-03-10
75889 CPT Hepatic Venog Wedge/free W Eva 13 13 $581.00 $581.00 $80.19 $1,500.00 $419.00 2026-03-10
75891 CPT Hepatic Without Hemodin. Eval 12 12 $581.00 $581.00 $80.89 $1,500.00 $289.50 2026-03-10
75893 CPT Venous Sampling 12 12 $543.00 $543.00 $87.57 $1,500.00 $695.50 2026-03-10
75898 CPT Angio. Thru Exist. Cath. 14 14 $1,400.00 $1,400.00 $90.07 $2,100.00 $1,200.00 2026-03-10
75984 CPT Change Perc.tube/drain Cath Xr 12 12 $150.00 $150.00 $37.20 $1,500.00 $119.12 2026-03-10
75989 CPT Rx Guide(flurosc,us,ct)pda Spe 26 16 $403.05 $403.05 $23.50 $800.00 $217.50 2026-03-10
76096 CPT Mammog.guid.breast Add. Local 1 1 $64.00 $64.00 $100.00 $100.00 $100.00 2026-03-10
76380 CPT CT Limit Or Local Follow Up In 18 15 $400.00 $400.00 $43.90 $350.00 $81.59 2026-03-10
76499 CPT Laryngogram Radiological 2 2 $100.00 $100.00 $40.00 $700.00 $370.00 2026-03-10
76873 CPT Prostate Volume Study Brachy. 7 7 $125.00 $125.00 $40.00 $104.10 $104.10 2026-03-10
76936 CPT US Guided Repair Arte Pseudoan 11 11 $110.00 $110.00 $40.00 $288.00 $181.11 2026-03-10
76940 CPT US Guidan Monitor For Ablation 13 13 $100.00 $100.00 $25.00 $450.00 $102.66 2026-03-10
77001 CPT Flurosc Guidan Cental Venous 7 7 $65.31 $65.31 $36.18 $86.87 $86.87 2026-03-10
77002 CPT Fluros.guid.(bx,asp,inj,other) 16 16 $325.00 $325.00 $22.50 $772.00 $91.79 2026-03-10
77012 CPT CT Guide Plcm(bx,asp,inj,dev) 14 13 $376.75 $376.75 $55.39 $772.00 $134.50 2026-03-10
77013 CPT CT Guid Monitor For Ablation 10 10 $180.00 $180.00 $81.50 $225.00 $187.60 2026-03-10
77014 CPT CT Guidance 6 6 $137.00 $137.00 $57.11 $81.59 $81.59 2026-03-10
77021 CPT MRI Guide Plcm(bx,asp,inj,dev) 15 15 $300.00 $300.00 $175.46 $772.00 $325.00 2026-03-10
77022 CPT Mr Guidan Monitor For Ablation 13 13 $200.00 $200.00 $211.81 $325.00 $257.99 2026-03-10
77031 CPT Stereo. Loc Guide Breast Ea Le 4 4 $130.00 $130.00 $80.00 $300.00 $232.50 2026-03-10
77046 CPT MRI Breast Without Cont Unil 12 12 $800.00 $800.00 $177.61 $650.00 $323.38 2026-03-10
77047 CPT MRI Breast Bilateral Without Cont 15 15 $950.00 $950.00 $145.60 $650.00 $281.76 2026-03-10
77048 CPT MRI Breast W & Without Uni 15 15 $950.00 $950.00 $177.66 $625.00 $265.23 2026-03-10
77049 CPT MRI Breast W/wo Cont Bilat 15 15 $950.00 $950.00 $177.66 $625.00 $265.23 2026-03-10
77058 CPT MRI Breast W/wo Cont Unil 12 12 $800.00 $800.00 $177.61 $900.00 $323.38 2026-03-10
77066 CPT Mammography Bilat.(diagnostic 18 16 $90.00 $90.00 $41.00 $117.82 $82.53 2026-03-10
77084 CPT MRI Bone Marrow Study 15 15 $850.00 $850.00 $163.67 $625.00 $260.00 2026-03-10
77262 CPT Treatment Planning Inmed(pfee) 5 5 $110.00 $110.00 $109.42 $160.00 $109.42 2026-03-10
77263 CPT Treatment Planning Complex(pfe 6 6 $160.00 $160.00 $170.24 $200.00 $170.24 2026-03-10
77280 CPT Simulation-simple Verification 6 6 $101.00 $101.00 $104.86 $253.23 $253.23 2026-03-10
77285 CPT Simulation-intermediate 8 8 $200.00 $200.00 $125.00 $425.57 $361.74 2026-03-10
77290 CPT Simulation Complex 8 8 $282.00 $282.00 $179.10 $422.40 $360.42 2026-03-10
77295 CPT Simulation 3-d 8 8 $660.00 $660.00 $187.39 $980.00 $266.57 2026-03-10
77301 CPT Imrt Plan 7 7 $1,196.00 $1,196.00 $686.73 $1,524.85 $1,524.85 2026-03-10
77307 CPT Telethera Isodose Plan-complex 6 6 $130.00 $130.00 $97.76 $142.00 $139.60 2026-03-10
77316 CPT Brachytherapy Isodose Plan-sim 8 8 $132.00 $132.00 $78.39 $163.87 $147.94 2026-03-10
77317 CPT Brachytherapy Isodose Plan Int 8 8 $203.00 $203.00 $102.79 $215.57 $209.28 2026-03-10
77318 CPT Brachytherapy Isodose Plan-com 8 8 $275.00 $275.00 $130.00 $291.18 $283.09 2026-03-10
77333 CPT Treatment Devices-intermediate 8 8 $103.00 $103.00 $43.88 $103.00 $96.36 2026-03-10
77336 CPT Radiation Physics Consult 6 6 $275.00 $275.00 $40.00 $83.31 $83.31 2026-03-10
77338 CPT Imrt Mcl Devices 7 7 $119.79 $119.79 $174.96 $293.00 $256.01 2026-03-10
77370 CPT Special Physics Consult 6 6 $95.00 $95.00 $80.00 $131.80 $131.80 2026-03-10
77372 CPT Rad.treat. Delivery(srs) Multi 4 4 $680.00 $680.00 $1,082.13 $1,082.13 $1,082.13 2026-03-10
77373 CPT Stereo.body Radiat.1 Or More 4 4 $1,300.00 $1,300.00 $1,181.27 $1,181.27 $1,181.27 2026-03-10
77385 CPT Imrt Treatment 2 2 $586.00 $586.00 $350.00 $350.00 $350.00 2026-03-10
77412 CPT Radiation Tx. Complex 5 Mev 2 2 $141.00 $141.00 $75.00 $86.00 $80.50 2026-03-10
77413 CPT Radiation Tx. Complex 6-10 Mev 2 2 $142.00 $142.00 $75.00 $86.00 $80.50 2026-03-10
77414 CPT Radiation Tx.complex 11-19 Mev 2 2 $158.00 $158.00 $75.00 $86.00 $80.50 2026-03-10
77416 CPT Radiation Tx.ccomplex 20 Mev 2 2 $159.00 $159.00 $75.00 $86.00 $80.50 2026-03-10
77427 CPT Rad.treatment Mangement 5 Trea 6 6 $200.00 $200.00 $125.00 $192.31 $192.31 2026-03-10
77431 CPT Rad.therapy Mangement 1-2 Frac 6 6 $100.00 $100.00 $77.00 $108.07 $108.07 2026-03-10
77432 CPT Ster.rad.treat. Of Cranial Les 5 5 $400.00 $400.00 $374.00 $429.61 $429.61 2026-03-10
77435 CPT Ster.body Rad.therapy 1-more L 4 4 $650.00 $650.00 $648.12 $648.12 $648.12 2026-03-10
77620 CPT Hyperther. Generated By Intrac 7 7 $360.00 $360.00 $150.00 $585.58 $585.58 2026-03-10
77750 CPT Infusion Radio-elem 13 11 $194.00 $194.00 $90.58 $512.00 $138.22 2026-03-10
77761 CPT Intracavity Application 14 13 $299.00 $299.00 $110.00 $900.00 $256.40 2026-03-10
77762 CPT Intracavitary Radiation-interm 7 7 $450.00 $450.00 $171.56 $525.00 $245.08 2026-03-10
77763 CPT Intracavitary Radiation-comple 7 7 $620.00 $620.00 $219.80 $750.00 $314.00 2026-03-10
77770 CPT Hdr 1 Channel 7 7 $670.00 $670.00 $120.86 $646.00 $252.50 2026-03-10
77771 CPT Hdr 2-12 Channels 7 7 $738.00 $738.00 $292.94 $738.00 $418.48 2026-03-10
77772 CPT Hdr Over 12 Channels 7 7 $821.00 $821.00 $387.62 $821.00 $643.19 2026-03-10
78006 CPT Thyroid Imag W/uptk Single Det 11 11 $300.00 $300.00 $71.50 $236.00 $160.00 2026-03-10
78011 CPT Thyroid Scan W Vascular Flow 11 11 $180.00 $180.00 $58.67 $136.00 $115.00 2026-03-10
78013 CPT Thyroid Imaging; Only 17 17 $195.00 $195.00 $39.00 $184.27 $115.00 2026-03-10
78014 CPT Thyroid Imag W Single Or Mult. 16 15 $240.00 $240.00 $17.46 $157.09 $81.37 2026-03-10
78018 CPT Whole Body(thyroid Scan ) 16 16 $437.00 $437.00 $90.00 $350.00 $283.45 2026-03-10
78020 CPT Thyroid Carcin Metast Imag 14 14 $132.00 $132.00 $31.61 $350.00 $82.50 2026-03-10
78070 CPT Parathyroid Imaging 16 16 $271.00 $271.00 $60.45 $300.00 $143.00 2026-03-10
78102 CPT Bone Marrow Imag Limit Area 14 14 $160.00 $160.00 $60.00 $151.91 $120.00 2026-03-10
78104 CPT Whole Body(bone Marrow) 18 18 $225.00 $225.00 $92.50 $218.74 $185.00 2026-03-10
78185 CPT Sple Imag Only W/wo Vascflo In 18 17 $134.00 $134.00 $12.83 $170.00 $140.00 2026-03-10
78195 CPT Lymphatics & Lymph Nodes Imag 19 19 $224.00 $224.00 $87.50 $374.59 $175.00 2026-03-10
78201 CPT Liver Imaging; Static Only 17 17 $110.50 $110.50 $47.50 $290.00 $150.00 2026-03-10
78202 CPT Liver Imag W Vascular Flow 14 14 $294.00 $294.00 $75.00 $192.36 $165.00 2026-03-10
78205 CPT Liver Imaging(spect) 12 12 $477.00 $477.00 $91.58 $400.00 $235.00 2026-03-10
78215 CPT Liver & Spleen Imag Static Onl 18 18 $238.00 $238.00 $75.86 $288.65 $167.50 2026-03-10
78216 CPT Liver/spleen Ima W Vasc Flow 15 15 $327.00 $327.00 $74.58 $190.00 $106.54 2026-03-10
78226 CPT Hida Imaging(hepatobiliary 19 19 $225.00 $225.00 $82.44 $302.44 $200.00 2026-03-10
78227 CPT Hida W Pharmacologic Interv. 16 16 $225.00 $225.00 $111.95 $411.83 $317.13 2026-03-10
78230 CPT Salivary Gland Imaging 15 15 $240.00 $240.00 $29.04 $110.75 $87.50 2026-03-10
78232 CPT Salivary Gland Imaging 15 15 $155.00 $155.00 $55.00 $185.00 $87.90 2026-03-10
78258 CPT Esophageal Motility(t-tim 14 14 $124.00 $124.00 $53.50 $200.00 $130.00 2026-03-10
78262 CPT Gastroesophagial Reflux 15 15 $200.00 $200.00 $91.62 $216.98 $190.00 2026-03-10
78264 CPT Gastric Emptying Study 15 15 $361.00 $361.00 $85.00 $304.90 $214.39 2026-03-10
78278 CPT Acute Gastroint. Blood Loss IM 17 17 $428.00 $428.00 $95.00 $428.00 $200.00 2026-03-10
78290 CPT Intestine Imag(ectopic,meckel) 16 16 $250.00 $250.00 $73.50 $308.42 $185.00 2026-03-10
78300 CPT Bone/joint Imaging Limit Area 15 15 $256.00 $256.00 $55.00 $206.78 $110.00 2026-03-10
78305 CPT Bone/joint Imaging Mult Area 14 14 $140.00 $140.00 $78.00 $247.23 $156.00 2026-03-10
78306 CPT Bone/joint Imagine(whole Body) 18 18 $369.00 $369.00 $87.50 $298.94 $180.00 2026-03-10
78315 CPT Bone/joint(three Phase Stdy) 19 19 $200.00 $200.00 $125.00 $308.42 $200.00 2026-03-10
78445 CPT Non-cardi Vasc Flow Imag 14 14 $135.00 $135.00 $65.00 $186.73 $85.00 2026-03-10
78451 CPT Myocard Perf Tomog Spect Sing 26 17 $477.00 $477.00 $56.24 $1,029.20 $285.21 2026-03-10
78452 CPT Myocrd Perf Spect Mult Stdy 25 17 $954.00 $954.00 $66.41 $1,029.20 $411.82 2026-03-10
78453 CPT Myocard Perf W Wall Mot.qual 7 7 $137.00 $137.00 $184.60 $480.00 $260.60 2026-03-10
78457 CPT Venous Thromb. Imag Unilat 14 14 $140.50 $140.50 $47.50 $190.00 $133.50 2026-03-10
78458 CPT Venous Thromb. Imag Bilat 16 16 $225.00 $225.00 $52.00 $190.00 $167.74 2026-03-10
78466 CPT Myocardial Imag Infarct Scan 16 16 $124.00 $124.00 $82.56 $190.00 $169.50 2026-03-10
78468 CPT Myoc.imag. W Ejec. First Pass 13 13 $250.00 $250.00 $65.00 $383.81 $165.28 2026-03-10
78469 CPT Myoc/imag/ W Ejec/w/wo Quant 16 16 $424.00 $424.00 $85.00 $380.00 $182.86 2026-03-10
78472 CPT Cardiac Blood Pool Gait R/s Si 19 17 $446.00 $446.00 $34.66 $295.70 $188.14 2026-03-10
78473 CPT Cardiac Blood Pool Gaited Mult 16 16 $525.00 $525.00 $142.80 $525.00 $247.50 2026-03-10
78481 CPT Cardiac Blood Pool Imag Sing 14 14 $460.00 $460.00 $94.77 $265.00 $135.38 2026-03-10
78483 CPT Cardiac Blood Imag Mult R/s 14 14 $510.00 $510.00 $125.05 $377.00 $178.64 2026-03-10
78579 CPT Pulmon Vent(eg,aer,gas)perf IM 31 17 $263.00 $263.00 $44.03 $292.59 $169.85 2026-03-10
78580 CPT Pulmonary Perf Imag(eg,aero,ga 18 18 $166.75 $166.75 $75.00 $230.00 $150.00 2026-03-10
78597 CPT Pulm Ventilat Mult. Projec 6 6 $260.00 $260.00 $92.34 $173.72 $173.72 2026-03-10
78598 CPT Pulmon Quant Vent/perf Stdy 15 15 $420.00 $420.00 $76.36 $285.00 $250.00 2026-03-10
78606 CPT Brain Imag.compl W Vasc Flow 16 16 $204.00 $204.00 $80.00 $311.59 $170.00 2026-03-10
78608 CPT Brain Imaging Positron Emi(pet 14 14 $2,000.00 $2,000.00 $70.59 $2,710.00 $903.26 2026-03-10
78630 CPT Cerebspinal Fluid Flow Cister 16 16 $424.00 $424.00 $129.06 $315.81 $272.50 2026-03-10
78635 CPT Ventriculography(vein Shunt) 15 15 $120.00 $120.00 $50.00 $318.97 $140.00 2026-03-10
78645 CPT Csf Flow Shuntogram 14 14 $288.00 $288.00 $87.50 $307.72 $140.00 2026-03-10
78647 CPT Cerebspinal Fluid Tomog Spect 10 10 $300.00 $300.00 $92.50 $350.00 $200.59 2026-03-10
78660 CPT Radiograph. Dacrocytography 14 14 $290.00 $290.00 $59.00 $169.85 $95.00 2026-03-10
78700 CPT Kidney Imaging Morphology(rena 16 16 $185.00 $185.00 $70.00 $195.00 $155.78 2026-03-10
78701 CPT Renal Imag W Vascular Flow 16 16 $393.00 $393.00 $70.00 $340.00 $203.97 2026-03-10
78707 CPT Renal Scan W/v Flow W/renog 29 18 $200.00 $200.00 $45.00 $460.00 $150.00 2026-03-10
78708 CPT Kidney Fun.including Pharmacol 16 16 $260.00 $260.00 $86.88 $347.00 $182.43 2026-03-10
78709 CPT Kidney Imaging W Vasc Flow Mul 13 13 $325.00 $325.00 $159.32 $357.00 $312.64 2026-03-10
78710 CPT Kidney Scan (spect) 11 11 $477.00 $477.00 $85.00 $350.00 $219.38 2026-03-10
78725 CPT Kidney Funct Study Non Imaging 14 14 $100.00 $100.00 $45.00 $150.00 $91.55 2026-03-10
78740 CPT Ureteral Reflux St(cystogram) 15 15 $56.50 $56.50 $75.00 $200.80 $150.00 2026-03-10
78761 CPT Testicular Imaging W/vasc Flow 17 17 $258.00 $258.00 $75.00 $183.57 $120.00 2026-03-10
78800 CPT Tumor Locc Whole Body Single D 16 15 $282.00 $282.00 $72.50 $282.00 $155.00 2026-03-10
78801 CPT Radioph Loc Multiple Area 15 15 $350.00 $350.00 $92.50 $256.37 $175.00 2026-03-10
78802 CPT Radionucl Loc.tumor Whole Body 16 16 $530.00 $530.00 $112.50 $285.22 $225.00 2026-03-10
78803 CPT Tumor Localization (spect 35 19 $518.00 $518.00 $119.00 $999.57 $300.00 2026-03-10
78804 CPT Whole Body Req 2 Or More Days 15 15 $403.00 $403.00 $144.82 $634.44 $252.13 2026-03-10
78805 CPT Abscess Local (ga-61 Or 10 10 $447.00 $447.00 $59.50 $210.00 $128.93 2026-03-10
78806 CPT Gallium Whole Body Scan 13 13 $306.00 $306.00 $95.62 $305.00 $225.00 2026-03-10
78807 CPT Gallium Whole Scan Spect 10 10 $250.00 $250.00 $106.25 $307.00 $232.25 2026-03-10
78811 CPT PET Ct(chest,head/neck) Limit 17 15 $2,000.00 $2,000.00 $72.69 $2,710.00 $600.00 2026-03-10
78812 CPT PET CT Skull Base To Mid-thigh 15 15 $2,000.00 $2,000.00 $91.21 $2,710.00 $1,044.65 2026-03-10
78813 CPT PET Whole Body 15 15 $2,000.00 $2,000.00 $91.55 $2,710.00 $1,044.65 2026-03-10
78814 CPT PET W CT Localiz Imaging,limit 15 15 $2,000.00 $2,000.00 $104.48 $3,000.00 $1,044.65 2026-03-10
78815 CPT PET W CT Skll Base To Mid-thig 24 17 $2,000.00 $2,000.00 $85.28 $2,100.00 $926.63 2026-03-10
78816 CPT PET W CT Whole Body 25 17 $2,000.00 $2,000.00 $85.53 $2,200.00 $903.26 2026-03-10
79005 CPT Radiopharm Therapy,intrav Adm 29 15 $152.00 $152.00 $38.13 $950.00 $160.00 2026-03-10
79445 CPT Radiopha Therapy Intra Arteria 11 11 $200.00 $200.00 $48.81 $206.72 $112.48 2026-03-10
93452 CPT Left Heart Cath 17 17 $2,300.00 $2,300.00 $240.11 $2,410.00 $2,000.00 2026-03-10
99203 CPT E&m New Pt-(intermediate) 20 17 $332.99 $332.99 $30.00 $504.00 $235.83 2026-03-10
99204 CPT E&m New Pt-(extended) 17 17 $456.96 $456.96 $170.39 $504.00 $248.00 2026-03-10
99205 CPT E&m New Pt-(complex) 17 17 $618.45 $618.45 $180.00 $504.00 $248.00 2026-03-10
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