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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

HOSPITAL PAVIA SANTURCE

San Juan, PR · CCN 400019 · Rates published

4,207 distinct procedures filed
29 distinct payers
11,893 rate rows
2026-07-31 last MRF observed
Data quality

7,892 of 11,893 rate rows are consumer-grade (66.4%)

4,001 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 3,949
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 52
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://hpt.inmediata.com/?handler=DF&d=0C7D0EB4-7AFE-4319-B440-FF3C21B8684D
Found on page https://hpt.inmediata.com/index?h=0C7D0EB4-7AFE-4319-B440-FF3C21B8684D
Discovered viaCMS hospital list
Last fetch success · 2026-11-11
Content fingerprint e832b9219a5714f5… · 1,111,184 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
93452
CPT 		Exam Of Left Heart With Catheter Insertion 3 $2,100.00 $2,698.00 $2,100.00 nat. median
$5,113
outlier · 0.4×
55700
CPT 		Biopsy Of Prostate Using Needle 4 $400.00 $900.00 $500.00 nat. median
$2,090
outlier · 0.2×
78452
CPT 		Multiple Spect Scans Of Heart Muscle 18 $123.68 $1,000.00 $352.99 nat. median
$1,797
outlier · 0.2×
74183
CPT 		MRI Of Abdomen With And Without Contrast 25 $112.96 $1,300.00 $315.95 nat. median
$1,096
outlier · 0.3×
47562
CPT 		Removal Of Gallbladder Using Laparoscope 7 $168.00 $350.00 $307.87 nat. median
$6,019
outlier · 0.1×
70553
CPT 		MRI Of Brain With And Without Contrast 23 $101.52 $1,300.00 $306.03 nat. median
$1,122
outlier · 0.3×
70543
CPT 		MRI Of Face Or Neck With And Without Contrast 25 $109.71 $1,300.00 $304.50 nat. median
$1,080
outlier · 0.3×
72197
CPT 		MRI Of Pelvis With And Without Contrast 25 $112.96 $1,300.00 $298.74 nat. median
$1,058
outlier · 0.3×
74182
CPT 		MRI Of Abdomen With Contrast 25 $89.14 $800.00 $295.64 nat. median
$964
outlier · 0.3×
73722
CPT 		MRI Of Leg Joint With Contrast 24 $83.73 $800.00 $290.65 nat. median
$1,282
outlier · 0.2×
77049
CPT 		MRI Of Both Breasts With And Without Contrast 17 $117.65 $800.00 $280.56 nat. median
$954
outlier · 0.3×
72157
CPT 		MRI Of Middle Spinal Canal With And Without Contrast 25 $116.95 $1,300.00 $278.75 nat. median
$1,099
outlier · 0.3×
72156
CPT 		MRI Of Upper Spinal Canal With And Without Contrast 25 $116.74 $1,300.00 $278.38 nat. median
$1,096
outlier · 0.3×
72158
CPT 		MRI Of Lower Spinal Canal With And Without Contrast 25 $116.52 $1,300.00 $277.84 nat. median
$1,083
outlier · 0.3×
77048
CPT 		MRI Of Single Breast With And Without Contrast 16 $107.54 $800.00 $276.25 nat. median
$903
outlier · 0.3×
72196
CPT 		MRI Of Pelvis With Contrast 26 $89.14 $800.00 $267.52 nat. median
$941
outlier · 0.3×
70552
CPT 		MRI Of Brain With Contrast 23 $91.67 $800.00 $256.16 nat. median
$956
outlier · 0.3×
73719
CPT 		MRI Of Leg Not Including Joint With Contrast 24 $83.37 $800.00 $254.47 nat. median
$977
outlier · 0.3×
72195
CPT 		MRI Of Pelvis Without Contrast 25 $75.07 $800.00 $246.87 nat. median
$802
outlier · 0.3×
70544
CPT 		MRI Of Blood Vessels Of Head Without Contrast 22 $61.71 $800.00 $246.86 nat. median
$822
outlier · 0.3×
73718
CPT 		MRI Of Leg Not Including Joint Without Contrast 24 $69.29 $800.00 $245.42 nat. median
$866
outlier · 0.3×
73222
CPT 		MRI Of Arm With Contrast 25 $83.55 $650.00 $240.11 nat. median
$1,282
outlier · 0.2×
73219
CPT 		MRI Of Arm With Contrast 25 $83.55 $650.00 $240.11 nat. median
$960
outlier · 0.3×
70551
CPT 		MRI Of Brain Without Contrast 24 $71.02 $800.00 $239.02 nat. median
$779
outlier · 0.3×
72149
CPT 		MRI Of Lower Spinal Canal With Contrast 26 $92.03 $800.00 $238.52 nat. median
$974
outlier · 0.2×
70545
CPT 		MRI Of Blood Vessels Of Head With Contrast 22 $61.71 $800.00 $232.50 nat. median
$878
outlier · 0.3×
72148
CPT 		MRI Of Lower Spinal Canal Without Contrast 26 $69.05 $800.00 $227.50 nat. median
$803
outlier · 0.3×
73721
CPT 		MRI Of Leg Joint Without Contrast 25 $70.02 $800.00 $217.67 nat. median
$854
outlier · 0.3×
74181
CPT 		MRI Of Abdomen Without Contrast 26 $75.07 $800.00 $214.60 nat. median
$816
outlier · 0.3×
74178
CPT 		Cat Scan Of Abdomen And Pelvis With And Without Contrast 21 $94.42 $450.00 $202.49 nat. median
$1,023
outlier · 0.2×
G0121
HCPCS 		Exam Of Entire Large Intestine Using Colonoscope 7 $72.73 $200.00 $200.00 nat. median
$1,306
outlier · 0.2×
45378
CPT 		Exam Of Entire Large Intestine Using Colonoscope 7 $72.73 $200.00 $200.00 nat. median
$1,342
outlier · 0.1×
G0105
HCPCS 		Exam Of Entire Large Intestine Using Colonoscope 7 $72.73 $200.00 $200.00 nat. median
$1,320
outlier · 0.2×
74174
CPT 		Cat Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 20 $111.87 $450.00 $200.00 nat. median
$980
outlier · 0.2×
72146
CPT 		MRI Of Middle Spinal Canal Without Contrast 26 $69.12 $800.00 $199.60 nat. median
$794
outlier · 0.3×
72141
CPT 		MRI Of Upper Spinal Canal Without Contrast 26 $69.12 $800.00 $199.60 nat. median
$778
outlier · 0.3×
74177
CPT 		Cat Scan Of Abdomen And Pelvis With Contrast 22 $83.47 $450.00 $197.00 nat. median
$970
outlier · 0.2×
73221
CPT 		MRI Of Arm Without Contrast 26 $69.84 $650.00 $196.95 nat. median
$844
outlier · 0.2×
73218
CPT 		MRI Of Arm Without Contrast 26 $69.84 $650.00 $196.95 nat. median
$864
outlier · 0.2×
78803
CPT 		Spect Scan To Locate Tumor Or Infection 17 $95.14 $350.29 $190.95 nat. median
$1,376
outlier · 0.1×
78227
CPT 		Nuclear Medicine Study Of Liver And Bile Ducts 20 $95.00 $431.00 $190.00 nat. median
$931
outlier · 0.2×
78018
CPT 		Whole Body Nuclear Medicine Study To Determine Spread Of Thyroid Cancer 20 $90.00 $400.00 $187.19 nat. median
$778
outlier · 0.2×
73706
CPT 		Cat Scan Of Blood Vessels Of Leg With Contrast 21 $93.21 $450.00 $171.42 nat. median
$749
outlier · 0.2×
74175
CPT 		Cat Scan Of Blood Vessels Of Abdomen With Contrast 21 $89.58 $450.00 $165.00 nat. median
$714
outlier · 0.2×
71275
CPT 		Cat Scan Of Blood Vessels In Chest With Contrast 21 $80.60 $450.00 $165.00 nat. median
$753
outlier · 0.2×
70498
CPT 		Cat Scan Of Blood Vessels In Neck With Contrast 23 $68.75 $450.00 $163.75 nat. median
$735
outlier · 0.2×
74170
CPT 		Cat Scan Of Abdomen With And Without Contrast 23 $71.82 $650.00 $163.75 nat. median
$710
outlier · 0.2×
72193
CPT 		Cat Scan Of Pelvis With Contrast 24 $59.91 $450.00 $162.50 nat. median
$636
outlier · 0.3×
74160
CPT 		Cat Scan Of Abdomen With Contrast 24 $65.32 $450.00 $162.50 nat. median
$650
outlier · 0.2×
75574
CPT 		Cat Scan Of Blood Vessels Of Heart With Contrast 6 $106.69 $494.00 $161.35 nat. median
$592
outlier · 0.3×

Other procedures at this hospital

Browse this hospital's 4,207 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
             
100042 CDM 24 Hrs Rooming In Unless Specified 0 0 — — — — — 2026-07-31
100005 CDM Ak 15703 Three Lumen (arrow Ak) 0 0 $263.58 — — — — 2026-07-31
100048 CDM Ambulate 0 0 — — — — — 2026-07-31
100001 CDM Arrow Ak 17702 0 0 $99.36 — — — — 2026-07-31
100037 CDM Arterial Pressure Tubing (cordis Press) 0 0 $10.59 — — — — 2026-07-31
55700 CPT Biopsy Of Prostate Using Needle 4 4 $797.50 $797.50 $400.00 $900.00 $500.00 2025-04-10
10002 CDM Blazer Dx-/7f/sup Lg/2-5mm-20e 0 0 $2,385.00 — — — — 2026-07-31
10003 CDM Blazer Dx-20/7f/med/2-5-2mm-20e 0 0 $2,385.00 — — — — 2026-07-31
10001 CDM Blazer Dx-20/7f/sup Lg/5-5-5mm-zoe 0 0 $2,385.00 — — — — 2026-07-31
100043 CDM Breastfeed 24 Hrs Unless Specified 0 0 — — — — — 2026-07-31
10005 CDM Cable, Dx-20-20 Pin,5ft. 0 0 $1,020.00 — — — — 2026-07-31
74178 CPT Cat Scan Of Abdomen And Pelvis With And Without Contrast 28 21 $954.97 $954.97 $94.42 $450.00 $202.49 2025-04-10
74177 CPT Cat Scan Of Abdomen And Pelvis With Contrast 29 22 $954.97 $954.97 $83.47 $450.00 $197.00 2025-04-10
74176 CPT Cat Scan Of Abdomen And Pelvis Without Contrast 31 24 $937.12 $937.12 $63.59 $450.00 $116.00 2025-04-10
74170 CPT Cat Scan Of Abdomen With And Without Contrast 30 23 $937.12 $937.12 $71.82 $650.00 $163.75 2025-04-10
74160 CPT Cat Scan Of Abdomen With Contrast 31 24 $805.27 $805.27 $65.32 $450.00 $162.50 2025-04-10
74150 CPT Cat Scan Of Abdomen Without Contrast 31 24 $703.40 $703.40 $47.26 $450.00 $114.00 2025-04-10
73200 CPT Cat Scan Of Arm Without Contrast 31 24 $703.40 $703.40 $50.64 $450.00 $122.50 2025-04-10
71275 CPT Cat Scan Of Blood Vessels In Chest With Contrast 28 21 $676.70 $676.70 $80.60 $450.00 $165.00 2025-04-10
70496 CPT Cat Scan Of Blood Vessels In Head With Contrast 30 23 $668.64 $668.64 $68.75 $450.00 $156.90 2025-04-10
70498 CPT Cat Scan Of Blood Vessels In Neck With Contrast 30 23 $1,448.31 $1,448.31 $68.75 $450.00 $163.75 2025-04-10
74174 CPT Cat Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 27 20 $954.97 $954.97 $111.87 $450.00 $200.00 2025-04-10
74175 CPT Cat Scan Of Blood Vessels Of Abdomen With Contrast 28 21 $676.70 $676.70 $89.58 $450.00 $165.00 2025-04-10
75574 CPT Cat Scan Of Blood Vessels Of Heart With Contrast 8 6 $805.27 $805.27 $106.69 $494.00 $161.35 2025-04-10
73706 CPT Cat Scan Of Blood Vessels Of Leg With Contrast 28 21 $676.70 $676.70 $93.21 $450.00 $171.42 2025-04-10
71270 CPT Cat Scan Of Chest With And Without Contrast 31 24 $954.97 $954.97 $71.10 $650.00 $158.97 2025-04-10
71260 CPT Cat Scan Of Chest With Contrast 31 24 $805.27 $805.27 $50.39 $450.00 $141.31 2025-04-10
71250 CPT Cat Scan Of Chest Without Contrast 33 26 $711.97 $711.97 $43.93 $450.00 $107.56 2025-04-10
70480 CPT Cat Scan Of Eye, Ear, Or Sella Turcica Without Contrast 33 26 $703.40 $703.40 $53.55 $450.00 $119.62 2025-04-10
70488 CPT Cat Scan Of Facial Bones With And Without Contrast 32 25 $703.40 $703.40 $64.04 $650.00 $144.23 2025-04-10
70487 CPT Cat Scan Of Facial Bones With Contrast 33 26 $730.42 $730.42 $52.71 $450.00 $122.50 2025-04-10
70486 CPT Cat Scan Of Facial Bones Without Contrast 33 26 $703.40 $703.40 $43.73 $450.00 $109.85 2025-04-10
70470 CPT Cat Scan Of Head Or Brain With And Without Contrast 32 25 $824.55 $824.55 $60.18 $650.00 $139.51 2025-04-10
70460 CPT Cat Scan Of Head Or Brain With Contrast 33 26 $730.42 $730.42 $54.80 $450.00 $122.50 2025-04-10
70450 CPT Cat Scan Of Head Or Brain Without Contrast 33 26 $703.40 $703.40 $36.50 $450.00 $105.00 2025-04-10
75571 CPT Cat Scan Of Heart Without Contrast 8 6 $711.97 $711.97 $26.12 $400.00 $44.77 2025-04-10
74261 CPT Cat Scan Of Large Intestine Without Contrast 26 19 $300.00 $300.00 $74.43 $450.00 $123.43 2025-04-10
73701 CPT Cat Scan Of Leg With Contrast 31 24 $748.98 $748.98 $59.91 $450.00 $150.00 2025-04-10
73700 CPT Cat Scan Of Leg Without Contrast 31 24 $703.40 $703.40 $49.56 $450.00 $119.97 2025-04-10
72131 CPT Cat Scan Of Lower Spine Without Contrast 31 24 $711.97 $711.97 $49.56 $450.00 $119.97 2025-04-10
72128 CPT Cat Scan Of Mid Spine Without Contrast 31 24 $805.27 $805.27 $49.68 $450.00 $119.97 2025-04-10
72125 CPT Cat Scan Of Neck Spine Without Contrast 31 24 $711.97 $711.97 $50.25 $450.00 $120.51 2025-04-10
72193 CPT Cat Scan Of Pelvis With Contrast 31 24 $786.11 $786.11 $59.91 $450.00 $162.50 2025-04-10
72192 CPT Cat Scan Of Pelvis Without Contrast 31 24 $703.40 $703.40 $45.97 $450.00 $114.00 2025-04-10
70492 CPT Cat Scan Of Soft Tissue Of The Neck With And Without Contrast 32 25 $824.55 $824.55 $68.75 $450.00 $156.08 2025-04-10
70491 CPT Cat Scan Of Soft Tissue Of The Neck With Contrast 33 26 $730.42 $730.42 $67.82 $450.00 $137.87 2025-04-10
70490 CPT Cat Scan Of Soft Tissue Of The Neck Without Contrast 33 26 $703.40 $703.40 $53.52 $450.00 $109.70 2025-04-10
78708 CPT Complete Nuclear Medicine Study Of Kidney With Drug Administration 26 19 $560.00 $560.00 $57.83 $191.00 $124.39 2025-04-10
76700 CPT Complete Ultrasound Of Abdomen 31 24 $264.89 $264.89 $33.40 $150.00 $55.00 2025-04-10
76856 CPT Complete Ultrasound Of Female Pelvis Unrelated To Pregnancy 30 23 $168.98 $168.98 $29.78 $150.00 $47.08 2025-04-10
76881 CPT Complete Ultrasound Of Joint 29 22 $130.00 $130.00 $19.00 $150.00 $45.45 2025-04-10
76770 CPT Complete Ultrasound Of Kidneys, Aorta, And Lymph Nodes 31 24 $317.73 $317.73 $28.00 $150.00 $51.02 2025-04-10
100034 CDM Compression Stockings Below Knee 0 0 — — — — — 2026-07-31
100047 CDM Connect To Fetal Monitor 0 0 — — — — — 2026-07-31
100002 CDM Cook Cvc C-pum 601j 0 0 $105.31 — — — — 2026-07-31
77066 CPT Diagnostic Mammogram Of Both Breasts 26 19 $290.00 $290.00 $42.50 $151.17 $77.86 2025-04-10
77065 CPT Diagnostic Mammogram Of One Breast 27 20 $225.00 $225.00 $31.00 $203.80 $61.44 2025-04-10
100039 CDM Diet 0 0 — — — — — 2026-07-31
100050 CDM Discontinue Insulin Infusion Protocol 0 0 — — — — — 2026-07-31
100056 CDM Double Lumen Endotrach Tu 0 0 $207.89 — — — — 2026-07-31
G0121 HCPCS Exam Of Entire Large Intestine Using Colonoscope 7 7 $234.43 $234.43 $72.73 $200.00 $200.00 2025-04-10
45378 CPT Exam Of Entire Large Intestine Using Colonoscope 7 7 $234.43 $234.43 $72.73 $200.00 $200.00 2025-04-10
G0105 HCPCS Exam Of Entire Large Intestine Using Colonoscope 7 7 $234.43 $234.43 $72.73 $200.00 $200.00 2025-04-10
93452 CPT Exam Of Left Heart With Catheter Insertion 3 3 $1,125.00 $1,125.00 $2,100.00 $2,698.00 $2,100.00 2025-04-10
76801 CPT External Ultrasound Of Pregnant Uterus In 1st Trimester 30 23 $45.00 $45.00 $25.00 $150.00 $52.29 2025-04-10
76805 CPT External Ultrasound Of Pregnant Uterus In 2nd Or 3rd Trimester 30 23 $198.73 $198.73 $35.00 $150.00 $52.50 2025-04-10
100058 CDM Hearing Screening 0 0 — — — — — 2026-07-31
100004 CDM Hemo Cath Doble Lumen' 0 0 $380.08 — — — — 2026-07-31
100052 CDM Hemodialysis 0 0 — — — — — 2026-07-31
97110 CPT Individual Physical Therapy Exercises 20 16 $20.00 $20.00 $10.73 $27.12 $20.00 2025-04-10
1 CDM IV-normal Saline 0.45% 1000ml 0 0 $2.95 — — — — 2026-07-31
1000 CDM KlonoPIN 0.5mg Tab 0 0 $0.20 — — — — 2026-07-31
82088 CPT Lab Test - Aldosterone Hormone Level 32 25 $304.04 $304.04 $37.21 $146.00 $68.50 2025-04-10
82150 CPT Lab Test - Amylase Enzyme Level 33 26 $304.04 $304.04 $6.00 $16.00 $9.85 2025-04-10
80048 CPT Lab Test - Basic Metabolic Panel With Total Calcium 32 25 $76.87 $76.87 $7.69 $40.00 $11.36 2025-04-10
86901 CPT Lab Test - Blood Typing For Group And Rh Status 33 26 $21.42 $21.42 $2.00 $15.00 $6.50 2025-04-10
86900 CPT Lab Test - Blood Typing For Group And Rh Status 33 26 $21.42 $21.42 $2.00 $15.00 $6.50 2025-04-10
82575 CPT Lab Test - Calculation Of Creatinine Clearance 33 26 $25.00 $25.00 $8.59 $23.75 $10.67 2025-04-10
80061 CPT Lab Test - Cholesterol Panel 33 26 $93.29 $93.29 $12.17 $60.00 $25.00 2025-04-10
85025 CPT Lab Test - Complete Blood Cell Count With White Blood Cell Percentage 32 25 $35.10 $35.10 $6.64 $16.00 $9.00 2025-04-10
85027 CPT Lab Test - Complete Blood Cell Count Without White Blood Cell Percentage 28 23 $35.10 $35.10 $4.80 $14.25 $7.38 2025-04-10
80053 CPT Lab Test - Comprehensive Metabolic Panel 33 26 $100.00 $100.00 $9.60 $80.00 $17.50 2025-04-10
82533 CPT Lab Test - Cortisol Hormone Level 33 26 $285.00 $285.00 $14.82 $45.00 $25.00 2025-04-10
82540 CPT Lab Test - Creatine Level 33 26 $58.19 $58.19 $4.92 $45.00 $6.32 2025-04-10
82565 CPT Lab Test - Creatinine Level In Blood Sample 33 26 $107.10 $107.10 $4.66 $10.45 $7.00 2025-04-10
82570 CPT Lab Test - Creatinine Level In Sample Other Than Blood 33 26 $46.88 $46.88 $4.51 $12.73 $6.00 2025-04-10
82248 CPT Lab Test - Direct Bilirubin Level 31 24 $35.10 $35.10 $4.56 $10.59 $7.23 2025-04-10
80051 CPT Lab Test - Electrolyte Panel 33 26 $39.74 $39.74 $6.38 $40.00 $10.00 2025-04-10
82677 CPT Lab Test - Estriol Hormone Level 31 24 $89.25 $89.25 $21.98 $72.00 $33.00 2025-04-10
82672 CPT Lab Test - Estrogen Hormone Level 33 26 $249.90 $249.90 $19.72 $76.00 $31.83 2025-04-10
85008 CPT Lab Test - Examination Of White Blood Cells Using Microscope 33 26 $12.00 $12.00 $2.51 $17.00 $4.68 2025-04-10
82728 CPT Lab Test - Ferritin Level 33 26 $93.29 $93.29 $12.34 $43.53 $17.26 2025-04-10
82746 CPT Lab Test - Folic Acid Level 33 26 $93.29 $93.29 $9.33 $48.75 $18.00 2025-04-10
84154 CPT Lab Test - Free Prostate Specific Antigen Level 31 24 $318.68 $318.68 $16.72 $145.00 $25.42 2025-04-10
84481 CPT Lab Test - Free T3 Thyroid Hormone Level 32 25 $160.65 $160.65 $15.40 $115.00 $34.80 2025-04-10
84402 CPT Lab Test - Free Testosterone Level 33 26 $214.20 $214.20 $23.16 $170.00 $45.62 2025-04-10
84439 CPT Lab Test - Free Thyroxine Level 32 25 $35.34 $35.34 $8.19 $41.83 $15.06 2025-04-10
83001 CPT Lab Test - Fsh Hormone Level 33 26 $28.91 $28.91 $16.89 $76.00 $27.16 2025-04-10
80050 CPT Lab Test - General Health Panel 11 11 $75.00 $75.00 $10.07 $90.00 $54.00 2025-04-10
82951 CPT Lab Test - Glucose Level Following Sugar Intake 33 26 $69.61 $69.61 $6.08 $30.67 $10.40 2025-04-10
82950 CPT Lab Test - Glucose Level Following Sugar Intake 33 26 $69.61 $69.61 $6.08 $30.67 $10.40 2025-04-10
82947 CPT Lab Test - Glucose Level In Blood 33 26 $23.20 $23.20 $4.47 $16.00 $5.94 2025-04-10
82948 CPT Lab Test - Glucose Level In Blood Using Strip 29 24 $12.61 $12.61 $1.77 $8.00 $5.00 2025-04-10
82945 CPT Lab Test - Glucose Level In Body Fluid Other Than Blood 31 24 $23.20 $23.20 $3.66 $44.00 $5.21 2025-04-10
83036 CPT Lab Test - Hemoglobin A1c Level 33 26 $22.49 $22.49 $8.83 $30.00 $15.00 2025-04-10
85018 CPT Lab Test - Hemoglobin Blood Count 33 26 $12.61 $12.61 $1.78 $6.65 $3.00 2025-04-10
86769 CPT Lab Test - Identification Of Covid-19 Antibody 22 15 $45.00 $45.00 $19.00 $62.00 $25.00 2025-04-10
87635 CPT Lab Test - Identification Of Covid-19 Virus DNA Using Amplified Probe Technique 14 8 $171.33 $171.33 $51.33 $76.33 $60.66 2025-04-10
87426 CPT Lab Test - Identification Of Covid-19 Virus Using Multiple-step Immunoassay Meth… 24 17 $75.00 $75.00 $45.23 $45.23 $45.23 2025-04-10
82270 CPT Lab Test - Identification Of Hidden Blood In Stool Sample Using Chemical Reagent… 32 25 $23.20 $23.20 $2.69 $20.80 $4.38 2025-04-10
82274 CPT Lab Test - Identification Of Hidden Blood In Stool Using Immunoassay 28 22 $54.00 $54.00 $7.00 $48.00 $21.70 2025-04-10
85045 CPT Lab Test - Immature Red Blood Cell Count 27 22 $12.00 $12.00 $3.63 $10.00 $5.44 2025-04-10
82330 CPT Lab Test - Ionized Calcium Level 32 25 $70.00 $70.00 $9.00 $52.00 $20.64 2025-04-10
83540 CPT Lab Test - Iron Level 33 26 $47.00 $47.00 $5.17 $16.00 $7.03 2025-04-10
80069 CPT Lab Test - Kidney Function Panel 33 26 $40.00 $40.00 $7.89 $53.00 $12.21 2025-04-10
83615 CPT Lab Test - Ldh Enzyme Level 33 26 $47.00 $47.00 $4.66 $28.00 $7.27 2025-04-10
83002 CPT Lab Test - Lh Hormone Level 33 26 $28.91 $28.91 $16.83 $40.00 $25.00 2025-04-10
83690 CPT Lab Test - Lipase Enzyme Level 33 26 $47.00 $47.00 $5.76 $20.00 $8.25 2025-04-10
80076 CPT Lab Test - Liver Function Panel 32 25 $70.21 $70.21 $7.43 $80.00 $11.62 2025-04-10
81003 CPT Lab Test - Machine Analysis Of Urine By Dipstick 18 17 $12.61 $12.61 $2.04 $8.00 $2.77 2025-04-10
81001 CPT Lab Test - Machine Analysis Of Urine By Dipstick With Microscope Evaluation 33 26 $23.20 $23.20 $2.88 $8.00 $5.00 2025-04-10
83735 CPT Lab Test - Magnesium Level 33 26 $47.00 $47.00 $6.09 $24.00 $9.18 2025-04-10
81000 CPT Lab Test - Manual Analysis Of Urine By Dipstick With Microscope Evaluation 30 23 $12.00 $12.00 $2.92 $16.00 $5.47 2025-04-10
85300 CPT Lab Test - Measurement Of Antithrombin Iii Blood Clotting Inhibitor Activity 31 24 $428.40 $428.40 $10.78 $140.00 $28.77 2025-04-10
85384 CPT Lab Test - Measurement Of Blood Clot Activity 32 25 $47.00 $47.00 $7.72 $38.49 $11.29 2025-04-10
85240 CPT Lab Test - Measurement Of Blood Clotting Factor Viii Deficiency 32 25 $141.13 $141.13 $16.27 $125.00 $34.08 2025-04-10
85613 CPT Lab Test - Measurement Of Blood Clotting Factor X Using Diluted Russell Viper Ve… 31 25 $173.85 $173.85 $5.55 $88.00 $13.15 2025-04-10
86140 CPT Lab Test - Measurement Of C-reactive Protein Levels 33 26 $35.10 $35.10 $3.66 $20.00 $7.05 2025-04-10
86360 CPT Lab Test - Measurement Of Cd4 And Cd8 White Blood T Cells With Ratio 30 23 $267.75 $267.75 $9.52 $136.83 $56.56 2025-04-10
86361 CPT Lab Test - Measurement Of Cd4 White Blood T Cells 30 23 $624.75 $624.75 $5.71 $108.00 $36.47 2025-04-10
85306 CPT Lab Test - Measurement Of Free Protein S Blood Clotting Inhibitor Level 31 24 $253.00 $253.00 $13.93 $140.00 $24.10 2025-04-10
85303 CPT Lab Test - Measurement Of Protein C Blood Clotting Inhibitor Activity 31 24 $518.54 $518.54 $12.58 $180.00 $42.58 2025-04-10
85610 CPT Lab Test - Measurement Of Prothrombin Time 33 26 $35.10 $35.10 $3.58 $20.00 $8.40 2025-04-10
80055 CPT Lab Test - Panel For Pregnant Patients Without HIV Testing 21 16 $75.00 $75.00 $45.00 $175.00 $54.00 2025-04-10
83970 CPT Lab Test - Parathyroid Hormone Level 31 24 $340.34 $340.34 $37.52 $130.00 $69.21 2025-04-10
84100 CPT Lab Test - Phosphate Level 33 26 $35.10 $35.10 $4.13 $16.00 $6.00 2025-04-10
82024 CPT Lab Test - Pituitary Hormone Level 32 25 $327.13 $327.13 $35.11 $160.00 $69.80 2025-04-10
84030 CPT Lab Test - Pku Test 33 26 $126.00 $126.00 $5.00 $97.50 $12.00 2025-04-10
85049 CPT Lab Test - Platelet Count 30 23 $35.10 $35.10 $3.00 $8.00 $5.00 2025-04-10
84132 CPT Lab Test - Potassium Level 33 26 $47.00 $47.00 $4.11 $16.00 $7.00 2025-04-10
84703 CPT Lab Test - Pregnancy Hormone Identification 33 26 $116.62 $116.62 $6.84 $49.00 $11.88 2025-04-10
84702 CPT Lab Test - Pregnancy Hormone Level 33 26 $116.62 $116.62 $14.36 $58.83 $22.71 2025-04-10
84144 CPT Lab Test - Progesterone Hormone Level 32 25 $163.62 $163.62 $18.96 $65.00 $32.02 2025-04-10
84146 CPT Lab Test - Prolactin Hormone Level 33 26 $32.13 $32.13 $17.61 $68.83 $30.00 2025-04-10
84165 CPT Lab Test - Protein Level In Blood 33 26 $71.40 $71.40 $11.61 $40.00 $14.65 2025-04-10
84166 CPT Lab Test - Protein Level In Body Fluid Other Than Blood 27 21 $270.00 $270.00 $15.53 $50.00 $24.00 2025-04-10
85379 CPT Lab Test - Quantitative D-dimer Test 28 23 $135.00 $135.00 $9.71 $20.00 $13.54 2025-04-10
85014 CPT Lab Test - Red Blood Cell Volume 33 26 $12.61 $12.61 $2.07 $7.00 $3.00 2025-04-10
85660 CPT Lab Test - Screening For Sickle Cell Anemia 33 26 $35.10 $35.10 $3.00 $16.00 $5.75 2025-04-10
85651 CPT Lab Test - Sedimentation Rate 33 26 $23.20 $23.20 $3.23 $8.55 $4.83 2025-04-10
84450 CPT Lab Test - Sgot Enzyme Level 33 26 $47.00 $47.00 $4.71 $12.00 $7.05 2025-04-10
84460 CPT Lab Test - Sgpt Enzyme Level 33 26 $47.00 $47.00 $5.05 $16.00 $7.22 2025-04-10
84300 CPT Lab Test - Sodium Level In Urine Sample 33 26 $47.00 $47.00 $3.06 $8.00 $6.00 2025-04-10
87045 CPT Lab Test - Stool Culture For Bacteria 33 26 $81.51 $81.51 $6.45 $28.33 $12.56 2025-04-10
87046 CPT Lab Test - Stool Culture For Bacteria 33 26 $81.51 $81.51 $6.45 $28.33 $12.56 2025-04-10
85730 CPT Lab Test - Thromboplastin Time 33 26 $35.10 $35.10 $5.19 $20.00 $9.00 2025-04-10
84432 CPT Lab Test - Thyroglobulin Hormone Level 31 24 $57.12 $57.12 $18.25 $157.50 $23.51 2025-04-10
84479 CPT Lab Test - Thyroid Hormone Uptake Analysis 33 26 $47.00 $47.00 $5.88 $24.00 $9.41 2025-04-10
84443 CPT Lab Test - Thyroid Stimulating Hormone Level 33 26 $116.62 $116.62 $15.28 $42.75 $25.00 2025-04-10
84075 CPT Lab Test - Total Alkaline Phosphatase Level 33 26 $15.00 $15.00 $4.30 $20.00 $7.00 2025-04-10
82247 CPT Lab Test - Total Bilirubin Level 32 25 $70.21 $70.21 $4.20 $24.00 $6.83 2025-04-10
82310 CPT Lab Test - Total Calcium Level In Blood 33 26 $15.00 $15.00 $4.26 $27.40 $6.37 2025-04-10
82465 CPT Lab Test - Total Cholesterol Level 33 26 $35.10 $35.10 $3.95 $10.00 $6.12 2025-04-10
80185 CPT Lab Test - Total Phenytoin Level 32 25 $93.29 $93.29 $12.05 $41.25 $17.78 2025-04-10
84153 CPT Lab Test - Total Prostate Specific Antigen Level 33 26 $29.75 $29.75 $20.91 $120.00 $30.00 2025-04-10
84157 CPT Lab Test - Total Protein Level In Body Fluid Other Than Blood Or Urine 29 22 $18.00 $18.00 $3.34 $52.00 $5.60 2025-04-10
84156 CPT Lab Test - Total Protein Level In Urine 29 22 $15.00 $15.00 $3.34 $30.00 $5.50 2025-04-10
84480 CPT Lab Test - Total T3 Thyroid Hormone Level 32 25 $28.91 $28.91 $12.89 $48.00 $22.33 2025-04-10
84403 CPT Lab Test - Total Testosterone Level 33 26 $48.19 $48.19 $23.47 $83.67 $35.13 2025-04-10
84436 CPT Lab Test - Total Thyroxine Level 32 25 $58.19 $58.19 $6.24 $24.00 $9.35 2025-04-10
84520 CPT Lab Test - Urea Nitrogen Level In Blood 33 26 $35.10 $35.10 $3.59 $16.00 $6.00 2025-04-10
84540 CPT Lab Test - Urea Nitrogen Level In Urine 33 26 $47.00 $47.00 $3.73 $12.73 $5.56 2025-04-10
84550 CPT Lab Test - Uric Acid Level 33 26 $35.10 $35.10 $4.11 $12.00 $6.16 2025-04-10
82607 CPT Lab Test - Vitamin B-12 Level 33 26 $93.29 $93.29 $13.71 $49.33 $20.00 2025-04-10
82306 CPT Lab Test - Vitamin D-3 Level 32 25 $357.00 $357.00 $26.91 $120.00 $57.19 2025-04-10
76705 CPT Limited Or Follow-up Ultrasound Of Abdomen 29 22 $132.44 $132.44 $28.76 $150.00 $45.00 2025-04-10
76857 CPT Limited Or Follow-up Ultrasound Of Female Pelvis Unrelated To Pregnancy 30 23 $88.06 $88.06 $15.48 $150.00 $25.62 2025-04-10
100 CDM Marcapaso (pacemaker) 0 0 $7,600.00 — — — — 2026-07-31
10004 CDM Measure Respirations 0 0 — — — — — 2026-07-31
10006 CDM Measure Vitals Every 15 Min (not Available In Fre) 0 0 — — — — — 2026-07-31
77080 CPT Measurement Of Bone Density Using Dual-energy X-rays Of Hips, Pelvis, And/or Spi… 27 20 $125.00 $125.00 $10.44 $90.00 $32.62 2025-04-10
74183 CPT MRI Of Abdomen With And Without Contrast 32 25 $1,502.60 $1,502.60 $112.96 $1,300.00 $315.95 2025-04-10
74182 CPT MRI Of Abdomen With Contrast 32 25 $1,788.09 $1,788.09 $89.14 $800.00 $295.64 2025-04-10
74181 CPT MRI Of Abdomen Without Contrast 33 26 $1,456.91 $1,456.91 $75.07 $800.00 $214.60 2025-04-10
73222 CPT MRI Of Arm With Contrast 32 25 $1,502.60 $1,502.60 $83.55 $650.00 $240.11 2025-04-10
73219 CPT MRI Of Arm With Contrast 32 25 $1,502.60 $1,502.60 $83.55 $650.00 $240.11 2025-04-10
73221 CPT MRI Of Arm Without Contrast 33 26 $1,456.91 $1,456.91 $69.84 $650.00 $196.95 2025-04-10
73218 CPT MRI Of Arm Without Contrast 33 26 $1,456.91 $1,456.91 $69.84 $650.00 $196.95 2025-04-10
70545 CPT MRI Of Blood Vessels Of Head With Contrast 29 22 $1,727.99 $1,727.99 $61.71 $800.00 $232.50 2025-04-10
70544 CPT MRI Of Blood Vessels Of Head Without Contrast 29 22 $1,456.91 $1,456.91 $61.71 $800.00 $246.86 2025-04-10
77049 CPT MRI Of Both Breasts With And Without Contrast 24 17 $1,762.39 $1,762.39 $117.65 $800.00 $280.56 2025-04-10
70553 CPT MRI Of Brain With And Without Contrast 30 23 $1,788.09 $1,788.09 $101.52 $1,300.00 $306.03 2025-04-10
70552 CPT MRI Of Brain With Contrast 30 23 $1,788.09 $1,788.09 $91.67 $800.00 $256.16 2025-04-10
70551 CPT MRI Of Brain Without Contrast 31 24 $1,456.91 $1,456.91 $71.02 $800.00 $239.02 2025-04-10
70543 CPT MRI Of Face Or Neck With And Without Contrast 32 25 $1,502.60 $1,502.60 $109.71 $1,300.00 $304.50 2025-04-10
73722 CPT MRI Of Leg Joint With Contrast 31 24 $1,502.60 $1,502.60 $83.73 $800.00 $290.65 2025-04-10
73721 CPT MRI Of Leg Joint Without Contrast 32 25 $1,456.91 $1,456.91 $70.02 $800.00 $217.67 2025-04-10
73719 CPT MRI Of Leg Not Including Joint With Contrast 31 24 $1,456.91 $1,456.91 $83.37 $800.00 $254.47 2025-04-10
73718 CPT MRI Of Leg Not Including Joint Without Contrast 31 24 $1,456.91 $1,456.91 $69.29 $800.00 $245.42 2025-04-10
72158 CPT MRI Of Lower Spinal Canal With And Without Contrast 32 25 $1,788.09 $1,788.09 $116.52 $1,300.00 $277.84 2025-04-10
72149 CPT MRI Of Lower Spinal Canal With Contrast 33 26 $1,788.09 $1,788.09 $92.03 $800.00 $238.52 2025-04-10
72148 CPT MRI Of Lower Spinal Canal Without Contrast 33 26 $1,456.91 $1,456.91 $69.05 $800.00 $227.50 2025-04-10
72157 CPT MRI Of Middle Spinal Canal With And Without Contrast 32 25 $1,788.09 $1,788.09 $116.95 $1,300.00 $278.75 2025-04-10
72146 CPT MRI Of Middle Spinal Canal Without Contrast 33 26 $1,456.91 $1,456.91 $69.12 $800.00 $199.60 2025-04-10
72197 CPT MRI Of Pelvis With And Without Contrast 32 25 $1,502.60 $1,502.60 $112.96 $1,300.00 $298.74 2025-04-10
72196 CPT MRI Of Pelvis With Contrast 33 26 $1,456.91 $1,456.91 $89.14 $800.00 $267.52 2025-04-10
72195 CPT MRI Of Pelvis Without Contrast 32 25 $1,371.21 $1,371.21 $75.07 $800.00 $246.87 2025-04-10
77048 CPT MRI Of Single Breast With And Without Contrast 23 16 $975.00 $975.00 $107.54 $800.00 $276.25 2025-04-10
72156 CPT MRI Of Upper Spinal Canal With And Without Contrast 32 25 $1,788.09 $1,788.09 $116.74 $1,300.00 $278.38 2025-04-10
72141 CPT MRI Of Upper Spinal Canal Without Contrast 33 26 $1,456.91 $1,456.91 $69.12 $800.00 $199.60 2025-04-10
78452 CPT Multiple Spect Scans Of Heart Muscle 24 18 $2,059.40 $2,059.40 $123.68 $1,000.00 $352.99 2025-04-10
100040 CDM Notify Md 0 0 — — — — — 2026-07-31
78013 CPT Nuclear Medicine Scan Of Thyroid 23 16 $299.99 $299.99 $57.50 $185.23 $90.81 2025-04-10
78306 CPT Nuclear Medicine Study Of Bones And/or Joints In Whole Body 29 22 $656.99 $656.99 $68.28 $278.76 $119.17 2025-04-10
78315 CPT Nuclear Medicine Study Of Bones And/or Joints With Delayed Images In 3 Phases 28 21 $833.83 $833.83 $77.68 $316.45 $117.50 2025-04-10
78227 CPT Nuclear Medicine Study Of Liver And Bile Ducts 27 20 $795.27 $795.27 $95.00 $431.00 $190.00 2025-04-10
78195 CPT Nuclear Medicine Study Of Lymph Nodes 27 20 $435.65 $435.65 $52.50 $317.90 $109.38 2025-04-10
78070 CPT Nuclear Medicine Study Of Parathyroid Gland 27 20 $774.21 $774.21 $41.84 $278.76 $78.65 2025-04-10
78264 CPT Nuclear Medicine Study Of Stomach Emptying 27 20 $695.31 $695.31 $74.50 $317.18 $110.00 2025-04-10
78012 CPT Nuclear Medicine Study Of Thyroid By Measurement Of Iodine Uptake 23 16 $262.27 $262.27 $29.00 $85.00 $50.00 2025-04-10
78802 CPT Nuclear Medicine Study To Locate Tumor Or Infection With Whole Body Imaging Comp… 28 21 $3,816.15 $3,816.15 $61.25 $301.23 $132.81 2025-04-10
100057 CDM Obtain Telemetry Strip 0 0 — — — — — 2026-07-31
100049 CDM Place Patient In Protective Isolation 0 0 — — — — — 2026-07-31
100022 CDM Press Minitoring Single Dt4812 0 0 $107.33 — — — — 2026-07-31
100036 CDM Pressure Tubing Ta-2000 (manifold) 0 0 $29.15 — — — — 2026-07-31
100030 CDM R.o.s.e 0 0 $15.23 — — — — 2026-07-31
47562 CPT Removal Of Gallbladder Using Laparoscope 10 7 $350.00 $350.00 $168.00 $350.00 $307.87 2025-04-10
100059 CDM Report Any Of The Following 0 0 — — — — — 2026-07-31
100045 CDM Rooming In 0 0 — — — — — 2026-07-31
77067 CPT Screening Mammogram 27 20 $245.00 $245.00 $31.99 $121.82 $59.37 2025-04-10
78472 CPT Single Nuclear Medicine Study To Evaluate Blood Ejection From The Heart During S… 26 19 $890.83 $890.83 $75.74 $250.00 $125.00 2025-04-10
78803 CPT Spect Scan To Locate Tumor Or Infection 22 17 $3,816.15 $3,816.15 $95.14 $350.29 $190.95 2025-04-10
100028 CDM Spectramed Simult/3 Press 0 0 $284.17 — — — — 2026-07-31
100026 CDM Transducer Double Dt 481 2d 0 0 $55.57 — — — — 2026-07-31
100038 CDM Transfer 0 0 — — — — — 2026-07-31
100003 CDM Two Lumen Catheter 0 0 $79.49 — — — — 2026-07-31
100054 CDM Ulcer Protocol 0 0 — — — — — 2026-07-31
76818 CPT Ultrasound Evaluation Of Fetal Viability With Non-stress Test 27 20 $132.44 $132.44 $30.00 $150.00 $59.04 2025-04-10
76641 CPT Ultrasound Of Breast 25 18 $89.25 $89.25 $33.15 $150.00 $40.60 2025-04-10
76604 CPT Ultrasound Of Chest 33 26 $176.83 $176.83 $15.00 $150.00 $38.28 2025-04-10
76830 CPT Ultrasound Of Non-pregnant Uterus 31 24 $168.98 $168.98 $32.86 $150.00 $55.17 2025-04-10
76872 CPT Ultrasound Of Pelvic Cavity Via Rectum 32 25 $165.52 $165.52 $25.00 $150.00 $55.86 2025-04-10
76870 CPT Ultrasound Of Scrotum 33 26 $165.52 $165.52 $20.50 $150.00 $41.00 2025-04-10
76536 CPT Ultrasound Of Soft Tissue Of Head And Neck 33 26 $225.14 $225.14 $15.00 $150.00 $42.07 2025-04-10
76817 CPT Vaginal Ultrasound Of Pregnant Uterus In 1st Trimester 30 23 $198.73 $198.73 $26.90 $150.00 $50.03 2025-04-10
78018 CPT Whole Body Nuclear Medicine Study To Determine Spread Of Thyroid Cancer 27 20 $1,004.00 $1,004.00 $90.00 $400.00 $187.19 2025-04-10
74018 CPT X-ray Of Abdomen, 1 View 29 22 $69.61 $69.61 $4.90 $23.33 $11.50 2025-04-10
74019 CPT X-ray Of Abdomen, 2 Views 28 21 $98.77 $98.77 $6.30 $31.45 $16.24 2025-04-10
74021 CPT X-ray Of Abdomen, 3 Or More Views 27 20 $84.72 $84.72 $8.75 $33.73 $19.21 2025-04-10
73600 CPT X-ray Of Ankle, 2 Views 33 26 $78.89 $78.89 $6.50 $26.48 $12.67 2025-04-10
73610 CPT X-ray Of Ankle, 3 Or More Views 33 26 $98.77 $98.77 $7.00 $28.83 $15.50 2025-04-10
73521 CPT X-ray Of Both Hips, 2 Views 29 22 $170.20 $170.20 $9.00 $35.39 $17.94 2025-04-10
73522 CPT X-ray Of Both Hips, 3-4 Views 21 16 $170.20 $170.20 $12.71 $43.66 $23.53 2025-04-10
73565 CPT X-ray Of Both Knees With Standing Views 33 26 $78.89 $78.89 $6.00 $33.05 $15.00 2025-04-10
71045 CPT X-ray Of Chest, 1 View 29 22 $84.72 $84.72 $4.90 $24.89 $11.20 2025-04-10
71046 CPT X-ray Of Chest, 2 Views 29 22 $88.06 $88.06 $6.50 $56.72 $15.79 2025-04-10
73000 CPT X-ray Of Collarbone 33 26 $69.61 $69.61 $4.20 $24.64 $11.00 2025-04-10
73070 CPT X-ray Of Elbow , 2 Views 33 26 $78.89 $78.89 $6.50 $24.28 $12.00 2025-04-10
73080 CPT X-ray Of Elbow, 3 Or More Views 33 26 $98.77 $98.77 $7.00 $27.76 $15.40 2025-04-10
72082 CPT X-ray Of Entire Back For Scoliosis Evaluation, 2-3 Views 25 18 $98.77 $98.77 $10.00 $56.27 $31.84 2025-04-10
74220 CPT X-ray Of Esophagus With Single Contrast Agent 33 26 $158.98 $158.98 $14.35 $78.56 $34.10 2025-04-10
73140 CPT X-ray Of Fingers 33 26 $58.19 $58.19 $4.90 $31.30 $11.29 2025-04-10
73620 CPT X-ray Of Foot, 2 Views 33 26 $78.89 $78.89 $6.50 $23.10 $12.00 2025-04-10
73630 CPT X-ray Of Foot, 3 Or More Views 33 26 $88.06 $88.06 $7.00 $26.72 $15.41 2025-04-10
73120 CPT X-ray Of Hand, 2 Views 33 26 $65.56 $65.56 $6.50 $23.56 $12.67 2025-04-10
73130 CPT X-ray Of Hand, 3 Or More Views 33 26 $78.89 $78.89 $7.00 $28.48 $15.00 2025-04-10
73650 CPT X-ray Of Heel 33 26 $58.19 $58.19 $6.25 $25.00 $12.52 2025-04-10
73560 CPT X-ray Of Knee, 1 Or 2 Views 33 26 $78.89 $78.89 $6.75 $27.40 $12.90 2025-04-10
73562 CPT X-ray Of Knee, 3 Views 33 26 $78.89 $78.89 $7.00 $32.00 $14.00 2025-04-10
73564 CPT X-ray Of Knee, 4 Or More Views 32 25 $46.00 $46.00 $8.75 $35.87 $17.74 2025-04-10
73090 CPT X-ray Of Lower Arm 33 26 $88.06 $88.06 $6.75 $23.10 $12.42 2025-04-10
72100 CPT X-ray Of Lower Back, 2-3 Views 33 26 $98.77 $98.77 $8.50 $31.40 $16.09 2025-04-10
72110 CPT X-ray Of Lower Back, Minimum Of 4 Views 31 24 $147.67 $147.67 $14.35 $43.77 $24.00 2025-04-10
73590 CPT X-ray Of Lower Leg 33 26 $78.89 $78.89 $6.75 $27.50 $12.67 2025-04-10
72070 CPT X-ray Of Mid Back, 2 Views 30 23 $98.77 $98.77 $9.11 $30.48 $14.21 2025-04-10
72072 CPT X-ray Of Mid Back, 3 Views 30 23 $45.00 $45.00 $11.19 $30.78 $17.06 2025-04-10
72080 CPT X-ray Of Mid/Lower Back Junction 33 26 $98.77 $98.77 $7.70 $29.00 $15.32 2025-04-10
72040 CPT X-ray Of Neck, 2 Or 3 Views 27 22 $88.06 $88.06 $11.12 $29.55 $16.00 2025-04-10
72050 CPT X-ray Of Neck, 4 Or 5 Views 30 23 $118.64 $118.64 $15.13 $40.69 $22.25 2025-04-10
70210 CPT X-ray Of Paranasal Sinuses, 1-2 Views 33 26 $78.89 $78.89 $7.35 $26.53 $13.70 2025-04-10
70220 CPT X-ray Of Paranasal Sinuses, 3 Or More Views 33 26 $118.64 $118.64 $10.00 $33.70 $17.50 2025-04-10
72170 CPT X-ray Of Pelvis, 1-2 Views 33 26 $63.66 $63.66 $5.25 $28.37 $12.40 2025-04-10
72190 CPT X-ray Of Pelvis, 3 Or More Views 33 26 $66.28 $66.28 $3.20 $33.80 $17.00 2025-04-10
71111 CPT X-ray Of Ribs On Both Sides And Chest, 4 Or More Views 30 23 $55.00 $55.00 $12.25 $43.20 $20.89 2025-04-10
71110 CPT X-ray Of Ribs On Both Sides, 3 Or More Views 33 26 $127.80 $127.80 $10.00 $33.81 $18.15 2025-04-10
71100 CPT X-ray Of Ribs On One Side, 2 Views 33 26 $108.64 $108.64 $7.75 $29.55 $15.50 2025-04-10
71101 CPT X-ray Of Ribs One On Side And Chest, 3 Or More Views 31 24 $44.00 $44.00 $12.23 $32.81 $17.49 2025-04-10
72200 CPT X-ray Of Sacroiliac Joints, 1-2 Views 33 26 $108.64 $108.64 $4.20 $21.60 $13.27 2025-04-10
73020 CPT X-ray Of Shoulder, 1 View 33 26 $69.61 $69.61 $4.90 $20.59 $9.50 2025-04-10
73030 CPT X-ray Of Shoulder, 2 Or More Views 33 26 $88.06 $88.06 $7.25 $25.97 $14.00 2025-04-10
73501 CPT X-ray Of Single Hip, 1 View 29 22 $60.92 $60.92 $5.00 $26.58 $13.76 2025-04-10
73502 CPT X-ray Of Single Hip, 2-3 Views 25 18 $88.06 $88.06 $12.50 $36.93 $19.50 2025-04-10
70250 CPT X-ray Of Skull Bones, 1-3 Views 33 26 $55.00 $55.00 $7.35 $32.42 $15.00 2025-04-10
70360 CPT X-ray Of Soft Tissue Of The Neck 33 26 $118.64 $118.64 $4.90 $24.99 $10.13 2025-04-10
72220 CPT X-ray Of Tailbone 30 23 $78.89 $78.89 $9.02 $24.99 $13.70 2025-04-10
73660 CPT X-ray Of Toes 33 26 $69.61 $69.61 $4.90 $24.79 $10.14 2025-04-10
73060 CPT X-ray Of Upper Arm 33 26 $78.89 $78.89 $7.25 $25.86 $12.67 2025-04-10
73551 CPT X-ray Of Upper Leg, 1 View 27 20 $60.92 $60.92 $8.50 $28.80 $13.07 2025-04-10
73552 CPT X-ray Of Upper Leg, 2 Or More Views 30 23 $88.06 $88.06 $7.25 $45.36 $14.92 2025-04-10
73100 CPT X-ray Of Wrist, 2 Views 33 26 $98.77 $98.77 $6.50 $26.37 $12.84 2025-04-10
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