Hospital

DOCTORS' CENTER BAYAMON

Bayamon, PR · CCN 400102 · Rates published

2,313 distinct procedures filed

8 distinct payers

20,528 rate rows

2026-10-19 last MRF observed

Data quality

10,530 of 20,528 rate rows are consumer-grade (51.3%)

9,998 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 — reason	Rows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	9,877
exceeds 10× this hospital's gross charge — excluded from medians	111
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	9
professional (physician) fee — not the facility price	1

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://secure.claraprice.net/price-transparency/MYXK-1698155707958/machine-readable/660265947_doctors-center-hospital---bayamón_standardcharges.json
Found on page	https://secure.claraprice.net/price-transparency/dchpr-bayamon
Discovered via	Discovered by HANK (automated)
Last fetch	success · 2026-11-05
Content fingerprint	34928fee9e757a98… · 7,053,728 bytes · first seen 2026-11-05

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
250000398 CDM	Diatrizoate Meglumine & Sod 30ml	1	$22,922.00	$22,922.00	$22,922.00	nat. median $22,922 1.0× median
250000073 CDM	Alprazolam 0.5mg Tab	1	$21,611.00	$21,611.00	$21,611.00	nat. median $21,611 1.0× median
250001646 CDM	Propranolol 60mg Tab	1	$21,611.00	$21,611.00	$21,611.00	nat. median $21,611 1.0× median
250002042 CDM	Human Papillomavirus (Hpv) 0.5ml Inj	1	$19,918.00	$19,918.00	$19,918.00	nat. median $19,918 1.0× median
250001576 CDM	Guaifen-dm 10 Ml Udc Rdm	1	$18,589.00	$18,589.00	$18,589.00	nat. median $18,589 1.0× median
250000406 CDM	Dicyclomine 20mg Tab	1	$16,760.00	$16,760.00	$16,760.00	nat. median $16,760 1.0× median
250000239 CDM	Captopril 25mg Tab	1	$16,760.00	$16,760.00	$16,760.00	nat. median $16,760 1.0× median
250000428 CDM	Dimenhydrinate 50mg Tab	1	$16,148.00	$16,148.00	$16,148.00	nat. median $16,148 1.0× median
250000877 CDM	Lorazepam 1mg Tab	1	$16,148.00	$16,148.00	$16,148.00	nat. median $16,148 1.0× median
250000456 CDM	Docusate Sod 10mg/ml 25ml Ud	1	$16,148.00	$16,148.00	$16,148.00	nat. median $16,148 1.0× median
250000238 CDM	Captopril 12.5mg Tab	1	$16,148.00	$16,148.00	$16,148.00	nat. median $16,148 1.0× median
250001214 CDM	Povidone-iodine 10% 473ml	1	$16,148.00	$16,148.00	$16,148.00	nat. median $16,148 1.0× median
250000199 CDM	Bisacodyl 10mg Sup	1	$15,523.00	$15,523.00	$15,523.00	nat. median $15,523 1.0× median
250000031 CDM	Acetaminophen W/codeine #3 Tab	1	$12,833.00	$12,833.00	$12,833.00	nat. median $12,833 1.0× median
20982 CPT	Abla Bone Tumor Radiofrequency	1	$10,748.00	$10,748.00	$10,748.00	nat. median $10,732 1.0× median
93654 CPT	Icar Ablt Arrhyt Foc Ventri Ec	2	$4,500.00	$16,022.00	$10,261.00	nat. median $27,032 outlier · 0.4×
93653 CPT	Icar Ablt Arrhyt Foc Supravent	2	$4,500.00	$16,022.00	$10,261.00	nat. median $26,661 outlier · 0.4×
250001978 CDM	Magnesium Sulfate 1gm/100ml D5w Bag	1	$9,718.00	$9,718.00	$9,718.00	nat. median $9,718 1.0× median
250000095 CDM	Aminocaproic Acid 250mg/ml Vial	1	$9,718.00	$9,718.00	$9,718.00	nat. median $9,718 1.0× median
250001880 CDM	Potassium Phosphate 3mmole/ml	1	$9,718.00	$9,718.00	$9,718.00	nat. median $9,718 1.0× median
250002362 CDM	Iodixanol 320mg/ml Vial	1	$9,446.00	$9,446.00	$9,446.00	nat. median $9,446 1.0× median
250002354 CDM	Iohexol 300mg/ml 100ml Vial	1	$9,446.00	$9,446.00	$9,446.00	nat. median $9,446 1.0× median
250000611 CDM	Glucagon 1mg Vial	1	$7,564.00	$7,564.00	$7,564.00	nat. median $7,564 1.0× median
61623 CPT	Cerebral Balloon Occl Emboliza	1	$7,076.00	$7,076.00	$7,076.00	nat. median $11,341 0.6× median
92924 CPT	Translumina Atherect Ea Periph	1	$7,076.00	$7,076.00	$7,076.00	nat. median $13,242 0.5× median
250001922 CDM	Chlorhexidine 0.12% Mouth 15ml Udbtl	1	$6,964.00	$6,964.00	$6,964.00	nat. median $6,964 1.0× median
250002584 CDM	Methylene Blue(antidote) 50mg/	1	$6,843.00	$6,843.00	$6,843.00	nat. median $6,843 1.0× median
250002168 CDM	Furosemide 10mg/ml Bottle	1	$6,611.00	$6,611.00	$6,611.00	nat. median $6,611 1.0× median
250000838 CDM	Lidocaine 2% Viscous 100ml	1	$6,611.00	$6,611.00	$6,611.00	nat. median $6,611 1.0× median
250001968 CDM	Propranolol 20mg/5ml Oral Solution	1	$6,611.00	$6,611.00	$6,611.00	nat. median $6,611 1.0× median
250001731 CDM	Dexamethasone 0.5mg/5ml 15ml Ud	1	$6,611.00	$6,611.00	$6,611.00	nat. median $6,611 1.0× median
250000837 CDM	Lidocaine 4% (Topic) 50ml Bottle	1	$6,611.00	$6,611.00	$6,611.00	nat. median $6,611 1.0× median
47554 CPT	Cholangios Perc W Calculo Md	1	$6,516.00	$6,516.00	$6,516.00	nat. median $8,971 0.7× median
50593 CPT	Renal Tumor Perc Uni Cryothera	1	$6,516.00	$6,516.00	$6,516.00	nat. median $10,411 0.6× median
32608 CPT	Thoracoscopy Bx Lung Nodu Mass	1	$6,516.00	$6,516.00	$6,516.00	nat. median $9,248 0.7× median
47383 CPT	Abla Liver Tumor Perc Cryoabla	1	$6,516.00	$6,516.00	$6,516.00	nat. median $9,716 0.7× median
250001669 CDM	Terbutaline 2.5mg Tab	1	$6,439.00	$6,439.00	$6,439.00	nat. median $6,439 1.0× median
250000886 CDM	Alum & Mag Hydrox-simethicone	1	$6,211.00	$6,211.00	$6,211.00	nat. median $6,211 1.0× median
61624 CPT	Embolization Central Nervous S	2	$1,113.00	$11,237.00	$6,175.00	nat. median $7,859 0.8× median
250000755 CDM	Isoniazid 300mg Tab	1	$5,619.00	$5,619.00	$5,619.00	nat. median $5,619 1.0× median
250001085 CDM	Norgest& Ethin Estrad Tab	1	$5,619.00	$5,619.00	$5,619.00	nat. median $5,619 1.0× median
250000913 CDM	Megestrol Acetate 40mg/ml	1	$5,333.00	$5,333.00	$5,333.00	nat. median $5,333 1.0× median
250000032 CDM	Acetaminophen With Codeine 120mg-12mg/5ml	1	$5,333.00	$5,333.00	$5,333.00	nat. median $5,333 1.0× median
250001767 CDM	Metoclopramide 5mg/5ml 15mlud	1	$5,333.00	$5,333.00	$5,333.00	nat. median $5,333 1.0× median
250000318 CDM	Sodium Cit & Citric Acid 30ml Ud	1	$5,333.00	$5,333.00	$5,333.00	nat. median $5,333 1.0× median
250001752 CDM	Metoclopramide 1mg/1ml Oralsyr	1	$5,333.00	$5,333.00	$5,333.00	nat. median $5,333 1.0× median
250002394 CDM	Diphenhydramine 25mg/10ml Udc	1	$5,333.00	$5,333.00	$5,333.00	nat. median $5,333 1.0× median
250001751 CDM	Metoclopramide 3mg/3ml Oralsyr	1	$5,333.00	$5,333.00	$5,333.00	nat. median $5,333 1.0× median
250000962 CDM	Metoclopramide 5mg/5ml Oral	1	$5,333.00	$5,333.00	$5,333.00	nat. median $5,333 1.0× median
37233 CPT	Atherectomy	2	$4,500.00	$4,800.00	$4,650.00	nat. median $7,980 0.6× median

Other procedures at this hospital

Browse this hospital's 2,313 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

36565	CPT	2 Tunneled Cath 2 Access	3	3	$2,100.00	$2,100.00	$1,200.00	$1,935.00	$1,200.00	2026-10-19
36566	CPT	2 Tunneled Cath 2access Sites	3	3	$2,100.00	$2,100.00	$1,200.00	$3,411.00	$1,200.00	2026-10-19
20983	CPT	Abla Bone Tumor Cryoablation	1	1	$2,100.00	$2,100.00	$4,448.00	$4,448.00	$4,448.00	2026-10-19
20982	CPT	Abla Bone Tumor Radiofrequency	1	1	$2,100.00	$2,100.00	$10,748.00	$10,748.00	$10,748.00	2026-10-19
47383	CPT	Abla Liver Tumor Perc Cryoabla	1	1	$2,100.00	$2,100.00	$6,516.00	$6,516.00	$6,516.00	2026-10-19
47382	CPT	Abla Liver Tumor Perc Radiofre	2	2	$2,100.00	$2,100.00	$450.00	$3,706.00	$2,078.00	2026-10-19
50592	CPT	Abla Renal Tumor Perc Radiofre	2	2	$2,100.00	$2,100.00	$3,165.00	$3,706.00	$3,435.50	2026-10-19
250000032	CDM	Acetaminophen With Codeine 120mg-12mg/5ml	1	1	$1.00	$1.00	$5,333.00	$5,333.00	$5,333.00	2026-10-19
250000031	CDM	Acetaminophen W/codeine #3 Tab	1	1	$2.00	$2.00	$12,833.00	$12,833.00	$12,833.00	2026-10-19
36248	CPT	Aditional Order Abdominal	4	4	—	—	$1,080.00	$1,290.00	$1,201.00	2026-10-19
250000073	CDM	Alprazolam 0.5mg Tab	1	1	$6.00	$6.00	$21,611.00	$21,611.00	$21,611.00	2026-10-19
250000886	CDM	Alum & Mag Hydrox-simethicone	1	1	$1.00	$1.00	$6,211.00	$6,211.00	$6,211.00	2026-10-19
250000095	CDM	Aminocaproic Acid 250mg/ml Vial	1	1	$1.00	$1.00	$9,718.00	$9,718.00	$9,718.00	2026-10-19
36907	CPT	Angioplasty Central Dialysis S	2	2	—	—	$1,200.00	$1,200.00	$1,200.00	2026-10-19
46615	CPT	Anoscopy W Ablation Tumor Lesi	1	1	$3,500.00	$3,500.00	$1,701.00	$1,701.00	$1,701.00	2026-10-19
37242	CPT	Arterial Embolization Hemorrha	3	3	$2,100.00	$2,100.00	$1,200.00	$11,237.00	$2,000.00	2026-10-19
37211	CPT	Arterial Thrombolytic Infusion	3	3	$2,800.00	$2,800.00	$1,200.00	$3,411.00	$2,000.00	2026-10-19
37244	CPT	Arterial/venous Hemorrhage Emb	3	3	$2,100.00	$2,100.00	$1,200.00	$7,076.00	$2,000.00	2026-10-19
75736	CPT	Artery X-rays Pelvis	2	2	$4,816.00	$4,816.00	$160.00	$3,411.00	$1,785.50	2026-10-19
75705	CPT	Artery X-rays Spine	2	2	$5,810.00	$5,810.00	$177.00	$3,411.00	$1,794.00	2026-10-19
37225	CPT	Artherectomy W/pta Ve Perf Uni	2	2	—	—	$4,500.00	$4,800.00	$4,650.00	2026-10-19
51102	CPT	Aspiration Bladder W Ins Supra	1	1	$2,100.00	$2,100.00	$1,281.00	$1,281.00	$1,281.00	2026-10-19
250000140	CDM	Atenolol 100mg Tab	1	1	$9.00	$9.00	$4,235.00	$4,235.00	$4,235.00	2026-10-19
37233	CPT	Atherectomy	2	2	—	—	$4,500.00	$4,800.00	$4,650.00	2026-10-19
58900	CPT	Biopsy Of Ovary	1	1	$875.00	$875.00	$1,984.00	$1,984.00	$1,984.00	2026-10-19
250000199	CDM	Bisacodyl 10mg Sup	1	1	$2.00	$2.00	$15,523.00	$15,523.00	$15,523.00	2026-10-19
78608	CPT	Brain Imaging (Pet)	4	4	$5,600.00	$5,600.00	$877.00	$1,750.00	$1,360.00	2026-10-19
81214	CPT	Brca1 Full Seq & Com Dup/del	1	1	—	—	$1,750.00	$1,750.00	$1,750.00	2026-10-19
81211	CPT	Brca1&2 Seq & Com Dup/del	1	1	—	—	$3,340.00	$3,340.00	$3,340.00	2026-10-19
250002256	CDM	Bumetanide 0.25mg/ml	1	1	$3.00	$3.00	$3,422.00	$3,422.00	$3,422.00	2026-10-19
54000	CPT	Calcitriol 0.25 Mcg Cap	1	1	$9.00	$9.00	$2,161.00	$2,161.00	$2,161.00	2026-10-19
250000238	CDM	Captopril 12.5mg Tab	1	1	$5.00	$5.00	$16,148.00	$16,148.00	$16,148.00	2026-10-19
250000239	CDM	Captopril 25mg Tab	1	1	$6.00	$6.00	$16,760.00	$16,760.00	$16,760.00	2026-10-19
36903	CPT	Cath Dialysis Cir W/angio Sten	3	3	$2,100.00	$2,100.00	$1,200.00	$7,076.00	$1,200.00	2026-10-19
36902	CPT	Cath Dialysis Circuit W/angiop	3	3	$2,100.00	$2,100.00	$1,200.00	$3,489.00	$1,200.00	2026-10-19
93454	CPT	Cath Placement Coronary Art	5	5	$15,400.00	$15,400.00	$1,680.00	$2,226.00	$2,000.00	2026-10-19
36215	CPT	Catheter Placement	4	4	—	—	$1,080.00	$1,390.00	$1,264.50	2026-10-19
36015	CPT	Catheter Placement	3	3	—	—	$1,080.00	$1,371.00	$1,219.00	2026-10-19
36014	CPT	Catheter Placement	4	4	—	—	$149.00	$1,322.00	$1,148.50	2026-10-19
61623	CPT	Cerebral Balloon Occl Emboliza	1	1	$2,100.00	$2,100.00	$7,076.00	$7,076.00	$7,076.00	2026-10-19
47525	CPT	Change Of Biliary Drainage Ca	1	1	—	—	$1,380.00	$1,380.00	$1,380.00	2026-10-19
55500	CPT	Chlordiazepoxide 10mg Cap	1	1	$3.00	$3.00	$2,161.00	$2,161.00	$2,161.00	2026-10-19
250001922	CDM	Chlorhexidine 0.12% Mouth 15ml Udbtl	1	1	$3.00	$3.00	$6,964.00	$6,964.00	$6,964.00	2026-10-19
250001917	CDM	Chlorthalidone 50mg Tab	1	1	$5.00	$5.00	$4,235.00	$4,235.00	$4,235.00	2026-10-19
47554	CPT	Cholangios Perc W Calculo Md	1	1	$2,100.00	$2,100.00	$6,516.00	$6,516.00	$6,516.00	2026-10-19
47553	CPT	Cholangioscopy Perc W/biop Md	1	1	$2,100.00	$2,100.00	$3,968.00	$3,968.00	$3,968.00	2026-10-19
47552	CPT	Cholangioscopy W-without Brush Md	1	1	$2,100.00	$2,100.00	$3,968.00	$3,968.00	$3,968.00	2026-10-19
250000334	CDM	Clonidine 0.3mg/24hr Patch	1	1	$543.00	$543.00	$4,235.00	$4,235.00	$4,235.00	2026-10-19
93453	CPT	Comb Rt & Lf Heart Cath & Ventri	5	5	$17,500.00	$17,500.00	$1,680.00	$2,226.00	$2,000.00	2026-10-19
93531	CPT	Comb Rt Heart Cath Retrogr Lt	4	4	—	—	$1,680.00	$2,226.00	$2,035.00	2026-10-19
93533	CPT	Comb Rt Heart Cath Trans Lt He	4	4	—	—	$1,680.00	$2,226.00	$2,035.00	2026-10-19
93532	CPT	Comb Rt Heart Cath Trans Lt Tr	4	4	—	—	$1,680.00	$2,226.00	$2,035.00	2026-10-19
93620	CPT	Compre Electrophysiolog Arrhyt	2	2	$14,000.00	$14,000.00	$2,400.00	$4,781.00	$3,590.50	2026-10-19
37213	CPT	Continued Trombolytic Inf Suse	3	3	$2,800.00	$2,800.00	$1,200.00	$2,000.00	$1,935.00	2026-10-19
75625	CPT	Contrast Exam Abdominl Aorta	1	1	$5,215.00	$5,215.00	$1,935.00	$1,935.00	$1,935.00	2026-10-19
75605	CPT	Contrast Exam Thoracic Aorta	2	2	$4,830.00	$4,830.00	$181.00	$3,411.00	$1,796.00	2026-10-19
49424	CPT	Contrast Inj Asses Abscess Cys	2	2	—	—	$1,200.00	$1,200.00	$1,200.00	2026-10-19
44373	CPT	Conv Of Percutaneus Gastrostom	1	1	$350.00	$350.00	$1,176.00	$1,176.00	$1,176.00	2026-10-19
47535	CPT	Conversion Ext Bil Draing Cath	3	3	$2,100.00	$2,100.00	$1,080.00	$2,195.00	$1,200.00	2026-10-19
49446	CPT	Conversion G-tube To G-j Tube	1	1	$4,200.00	$4,200.00	$1,176.00	$1,176.00	$1,176.00	2026-10-19
50434	CPT	Convert Nephrostomy Catheter	2	2	$2,800.00	$2,800.00	$1,200.00	$1,281.00	$1,240.50	2026-10-19
36595	CPT	Cva Maintenance Fibria Strippi	3	3	$2,100.00	$2,100.00	$1,200.00	$1,935.00	$1,200.00	2026-10-19
64633	CPT	Destr Cerv/thoracic Single Fac	1	1	$2,100.00	$2,100.00	$1,197.00	$1,197.00	$1,197.00	2026-10-19
64635	CPT	Destr Lumbar/sacral Single Fac	1	1	$2,100.00	$2,100.00	$1,197.00	$1,197.00	$1,197.00	2026-10-19
250001731	CDM	Dexamethasone 0.5mg/5ml 15ml Ud	1	1	$2.00	$2.00	$6,611.00	$6,611.00	$6,611.00	2026-10-19
250000398	CDM	Diatrizoate Meglumine & Sod 30ml	1	1	$5.00	$5.00	$22,922.00	$22,922.00	$22,922.00	2026-10-19
250000406	CDM	Dicyclomine 20mg Tab	1	1	$8.00	$8.00	$16,760.00	$16,760.00	$16,760.00	2026-10-19
250001732	CDM	Dicyclomine 2mg/ml 3ml Oralsyr	1	1	$4.00	$4.00	$3,757.00	$3,757.00	$3,757.00	2026-10-19
250001733	CDM	Dicyclomine 2mg/ml 5ml Oralsyr	1	1	$4.00	$4.00	$3,757.00	$3,757.00	$3,757.00	2026-10-19
50436	CPT	Dilat Nephrostomy Tract/pye Md	1	1	$2,100.00	$2,100.00	$2,161.00	$2,161.00	$2,161.00	2026-10-19
250000428	CDM	Dimenhydrinate 50mg Tab	1	1	$1.00	$1.00	$16,148.00	$16,148.00	$16,148.00	2026-10-19
250002394	CDM	Diphenhydramine 25mg/10ml Udc	1	1	$7.00	$7.00	$5,333.00	$5,333.00	$5,333.00	2026-10-19
250000456	CDM	Docusate Sod 10mg/ml 25ml Ud	1	1	$2.00	$2.00	$16,148.00	$16,148.00	$16,148.00	2026-10-19
250000469	CDM	Doxazosin 4mg Tab	1	1	$7.00	$7.00	$3,387.00	$3,387.00	$3,387.00	2026-10-19
21501	CPT	Drain Soft Tissues Neck/thorax	1	1	$2,100.00	$2,100.00	$1,781.00	$1,781.00	$1,781.00	2026-10-19
93624	CPT	Electrophy Follow Up Study W P	2	2	$14,000.00	$14,000.00	$2,400.00	$4,781.00	$3,590.50	2026-10-19
34201	CPT	Embolec/throm Fem-pop Aortoili	1	1	$2,100.00	$2,100.00	$3,411.00	$3,411.00	$3,411.00	2026-10-19
61624	CPT	Embolization Central Nervous S	2	2	$2,100.00	$2,100.00	$1,113.00	$11,237.00	$6,175.00	2026-10-19
93505	CPT	Endomycardial Biopsy	1	1	$5,250.00	$5,250.00	$1,935.00	$1,935.00	$1,935.00	2026-10-19
62380	CPT	Endoscopic Descompressi Spinal	2	2	$50,750.00	$50,750.00	$3,900.00	$4,448.00	$4,174.00	2026-10-19
36478	CPT	Endovenous Ablat Laser 1st Vei	3	3	$2,100.00	$2,100.00	$1,200.00	$2,000.00	$1,935.00	2026-10-19
36479	CPT	Endovenous Ablat Laser Sub Vei	2	2	—	—	$1,200.00	$2,000.00	$1,600.00	2026-10-19
36476	CPT	Endovenous Ablat The Subs Vein	2	2	—	—	$1,200.00	$2,000.00	$1,600.00	2026-10-19
36475	CPT	Endovenous Ablat Ther 1st Vein	3	3	$2,100.00	$2,100.00	$1,200.00	$2,000.00	$1,935.00	2026-10-19
36473	CPT	Endovenous Mechanochemical 1st	2	2	$2,100.00	$2,100.00	$1,200.00	$1,935.00	$1,567.50	2026-10-19
36474	CPT	Endovenous Mechanochemical Add	1	1	—	—	$1,200.00	$1,200.00	$1,200.00	2026-10-19
44300	CPT	Enterostomy-external Md	1	1	$2,100.00	$2,100.00	$1,176.00	$1,176.00	$1,176.00	2026-10-19
93640	CPT	Ephys Eval Cvdfb Lds Init Impl	1	1	—	—	$2,400.00	$2,400.00	$2,400.00	2026-10-19
93642	CPT	Ephys Eval Cvdfb Promg/repro P	2	2	$14,000.00	$14,000.00	$746.00	$2,400.00	$1,573.00	2026-10-19
43260	CPT	Ercp	6	6	$22,400.00	$22,400.00	$1,100.00	$2,363.00	$1,268.00	2026-10-19
43265	CPT	Ercp Calculus/calc Destruct	6	6	$22,400.00	$22,400.00	$1,100.00	$3,721.00	$1,373.00	2026-10-19
43264	CPT	Ercp Calculus/calc Removal	6	6	$22,400.00	$22,400.00	$1,100.00	$2,363.00	$1,373.00	2026-10-19
43274	CPT	Ercp Ins Nasobiliar/pancrea	3	3	$22,400.00	$22,400.00	$989.00	$3,721.00	$1,200.00	2026-10-19
43262	CPT	Ercp Spincterotomy/papillotomy	6	6	$22,400.00	$22,400.00	$1,100.00	$2,363.00	$1,458.00	2026-10-19
43276	CPT	Ercp Stent Exchange W/dilate	2	2	$22,400.00	$22,400.00	$989.00	$3,721.00	$2,355.00	2026-10-19
43261	CPT	Ercp W Biopsy, Sing/mult	6	6	$22,400.00	$22,400.00	$989.00	$2,363.00	$1,200.00	2026-10-19
43251	CPT	Esophagoga Remove Lesion Snare	1	1	$4,900.00	$4,900.00	$1,176.00	$1,176.00	$1,176.00	2026-10-19
43453	CPT	Esophaus Dilation Md	1	1	$2,100.00	$2,100.00	$1,176.00	$1,176.00	$1,176.00	2026-10-19
47536	CPT	Exchange Biliary Drainage Cath	3	3	$2,100.00	$2,100.00	$1,080.00	$2,195.00	$1,200.00	2026-10-19
35860	CPT	Exploration Post-op Infection	1	1	$1,050.00	$1,050.00	$1,935.00	$1,935.00	$1,935.00	2026-10-19
58345	CPT	Fallopian Dilatation	1	1	$2,100.00	$2,100.00	$1,984.00	$1,984.00	$1,984.00	2026-10-19
250002168	CDM	Furosemide 10mg/ml Bottle	1	1	$2.00	$2.00	$6,611.00	$6,611.00	$6,611.00	2026-10-19
250000611	CDM	Glucagon 1mg Vial	1	1	$924.00	$924.00	$7,564.00	$7,564.00	$7,564.00	2026-10-19
250000620	CDM	Glyburide 3mg Tab	1	1	$5.00	$5.00	$3,387.00	$3,387.00	$3,387.00	2026-10-19
23155	CPT	Glyburide 5mg Tab	1	1	$9.00	$9.00	$4,448.00	$4,448.00	$4,448.00	2026-10-19
250000621	CDM	Glyburide 6mg Tab	1	1	$8.00	$8.00	$3,387.00	$3,387.00	$3,387.00	2026-10-19
250001576	CDM	Guaifen-dm 10 Ml Udc Rdm	1	1	$6.00	$6.00	$18,589.00	$18,589.00	$18,589.00	2026-10-19
14040	CPT	Hugger Cover Or Lower	1	1	$504.00	$504.00	$1,265.00	$1,265.00	$1,265.00	2026-10-19
250002042	CDM	Human Papillomavirus (Hpv) 0.5ml Inj	1	1	$2,378.00	$2,378.00	$19,918.00	$19,918.00	$19,918.00	2026-10-19
250001580	CDM	Hydrogen Peroxide 3% 237ml	1	1	$1.00	$1.00	$2,777.00	$2,777.00	$2,777.00	2026-10-19
250000701	CDM	Hydroxyzine Pamoate 25mg Cap	1	1	$3.00	$3.00	$3,357.00	$3,357.00	$3,357.00	2026-10-19
93653	CPT	Icar Ablt Arrhyt Foc Supravent	2	2	$49,000.00	$49,000.00	$4,500.00	$16,022.00	$10,261.00	2026-10-19
93654	CPT	Icar Ablt Arrhyt Foc Ventri Ec	2	2	$49,000.00	$49,000.00	$4,500.00	$16,022.00	$10,261.00	2026-10-19
93650	CPT	Icar Cath Ablation Atrioven No	2	2	$14,000.00	$14,000.00	$4,500.00	$4,781.00	$4,640.50	2026-10-19
A9507	HCPCS	In-111 Prostascint	1	1	$14,000.00	$14,000.00	$1,730.00	$1,730.00	$1,730.00	2026-10-19
37192	CPT	Inc Filter Respositioning	3	3	$2,800.00	$2,800.00	$1,200.00	$1,935.00	$1,200.00	2026-10-19
37193	CPT	Inc Filter Retriveral (Removal	3	3	$2,800.00	$2,800.00	$1,200.00	$1,935.00	$1,200.00	2026-10-19
36247	CPT	Initial Third	4	4	—	—	$124.00	$1,444.00	$1,154.00	2026-10-19
36217	CPT	Initial Third	4	4	—	—	$234.00	$1,305.00	$1,153.00	2026-10-19
47531	CPT	Inj Cholangiogram Existi Acces	4	4	$2,100.00	$2,100.00	$1,080.00	$2,195.00	$1,170.00	2026-10-19
93544	CPT	Injec Cardiac Cath Aortography	3	3	—	—	$1,680.00	$2,226.00	$2,000.00	2026-10-19
93540	CPT	Injec Cardiac Cath Opac Aortoc	3	3	—	—	$1,680.00	$2,226.00	$2,000.00	2026-10-19
93541	CPT	Injec Cardiac Cath Pulmo Angio	3	3	—	—	$1,680.00	$2,226.00	$2,000.00	2026-10-19
93543	CPT	Injec Cardiac Cath Sel Lt Vent	3	3	—	—	$1,680.00	$2,226.00	$2,000.00	2026-10-19
93542	CPT	Injec Cardiac Cath Sel Rt Vent	3	3	—	—	$1,680.00	$2,226.00	$2,000.00	2026-10-19
47532	CPT	Injection Cholangiogram New Ac	3	3	$2,100.00	$2,100.00	$1,080.00	$2,195.00	$1,200.00	2026-10-19
37790	CPT	Injection Lumphangiography	1	1	$2,100.00	$2,100.00	$2,161.00	$2,161.00	$2,161.00	2026-10-19
36005	CPT	Injection Procedure For Extrem	5	5	—	—	$1,080.00	$1,245.00	$1,195.00	2026-10-19
49418	CPT	Ins Periton Tunneled Cath W/im	2	2	$2,100.00	$2,100.00	$1,200.00	$2,195.00	$1,697.50	2026-10-19
36555	CPT	Ins/central Ven Access Devi Md	1	1	$1,750.00	$1,750.00	$1,935.00	$1,935.00	$1,935.00	2026-10-19
36260	CPT	Inser Implant Intra Art Pum Md	1	1	$2,713.00	$2,713.00	$3,411.00	$3,411.00	$3,411.00	2026-10-19
93503	CPT	Insert Placement Flow Cath Monitoring	4	4	$5,250.00	$5,250.00	$965.00	$2,226.00	$1,840.00	2026-10-19
36570	CPT	Inserted Central Venous(sqport	3	3	$1,750.00	$1,750.00	$1,200.00	$1,935.00	$1,200.00	2026-10-19
36800	CPT	Insertion Of C Annula Hemodial	1	1	$1,750.00	$1,750.00	$3,411.00	$3,411.00	$3,411.00	2026-10-19
93452	CPT	Insertion Of Catheter Into Left Heart For Diagnosis	6	6	$15,400.00	$15,400.00	$1,680.00	$2,226.00	$1,993.50	2026-10-19
37237	CPT	Intrav Stent Open/perc Add Art	2	2	—	—	$1,200.00	$2,000.00	$1,600.00	2026-10-19
37239	CPT	Intrav Stent Open/perc Add Vei	2	2	—	—	$1,200.00	$2,000.00	$1,600.00	2026-10-19
37236	CPT	Intrav Stent Open/perc Ini Art	3	3	$2,100.00	$2,100.00	$1,200.00	$7,076.00	$2,000.00	2026-10-19
37238	CPT	Intrav Stent Open/perc Ini Vei	3	3	$2,100.00	$2,100.00	$1,200.00	$7,076.00	$2,000.00	2026-10-19
37216	CPT	Intravasc Stent Without Dis Emboli	1	1	—	—	$1,200.00	$1,200.00	$1,200.00	2026-10-19
37253	CPT	Intravasc US Add Noncoronary V	3	3	—	—	$1,080.00	$2,000.00	$1,140.00	2026-10-19
37252	CPT	Intravasc US Initial Noncorona	3	3	—	—	$1,080.00	$2,000.00	$1,140.00	2026-10-19
36901	CPT	Intro Cath Dialysis Circuit	3	3	$2,100.00	$2,100.00	$965.00	$1,200.00	$1,200.00	2026-10-19
47511	CPT	Intro Percu Biliary Drai Ca Md	2	2	—	—	$1,200.00	$1,542.00	$1,371.00	2026-10-19
36010	CPT	Introd Cath Sup/inf Vena Cava	4	4	—	—	$1,080.00	$1,295.00	$1,221.50	2026-10-19
36160	CPT	Introd Of Niddle Or Intracathe	3	3	—	—	$1,140.00	$1,299.00	$1,216.00	2026-10-19
A9582	HCPCS	Iobenguane I-123 Diag Up-15mci	1	1	$36,750.00	$36,750.00	$2,318.00	$2,318.00	$2,318.00	2026-10-19
250002362	CDM	Iodixanol 320mg/ml Vial	1	1	$308,135.00	$308,135.00	$9,446.00	$9,446.00	$9,446.00	2026-10-19
250002354	CDM	Iohexol 300mg/ml 100ml Vial	1	1	$228,270.00	$228,270.00	$9,446.00	$9,446.00	$9,446.00	2026-10-19
250000755	CDM	Isoniazid 300mg Tab	1	1	$1.00	$1.00	$5,619.00	$5,619.00	$5,619.00	2026-10-19
37191	CPT	Ivc Endovas Vena Cava Filtr Ap	3	3	$2,800.00	$2,800.00	$1,200.00	$3,411.00	$2,000.00	2026-10-19
22515	CPT	Kypho Eac Add T Or L Vert Body	1	1	—	—	$3,500.00	$3,500.00	$3,500.00	2026-10-19
22514	CPT	Kypho Lumbar One Vert Body	2	2	$2,100.00	$2,100.00	$3,500.00	$4,448.00	$3,974.00	2026-10-19
22513	CPT	Kypho Thoracic One Vert Body	2	2	$2,100.00	$2,100.00	$3,500.00	$4,448.00	$3,974.00	2026-10-19
31300	CPT	Laryngotomy(thyrotomy,laryngofissure)	1	1	$3,150.00	$3,150.00	$2,032.00	$2,032.00	$2,032.00	2026-10-19
93458	CPT	Left Heart Catherization Retro	1	1	$15,400.00	$15,400.00	$1,987.00	$1,987.00	$1,987.00	2026-10-19
250002744	CDM	Levothryoxine 50 Mcg Tab Gen	1	1	$4.00	$4.00	$4,235.00	$4,235.00	$4,235.00	2026-10-19
250000838	CDM	Lidocaine 2% Viscous 100ml	1	1	$2.00	$2.00	$6,611.00	$6,611.00	$6,611.00	2026-10-19
250000837	CDM	Lidocaine 4% (Topic) 50ml Bottle	1	1	$9.00	$9.00	$6,611.00	$6,611.00	$6,611.00	2026-10-19
50590	CPT	Lithotripsy Extracorporeal Shock Wave	6	6	$2,100.00	$2,100.00	$2,161.00	$4,050.00	$3,500.00	2026-10-19
250000877	CDM	Lorazepam 1mg Tab	1	1	$7.00	$7.00	$16,148.00	$16,148.00	$16,148.00	2026-10-19
32998	CPT	Lung Ablation	1	1	$2,100.00	$2,100.00	$3,706.00	$3,706.00	$3,706.00	2026-10-19
49614	CPT	Magnesium Citrate 296ml Bottle	1	1	$1.00	$1.00	$3,706.00	$3,706.00	$3,706.00	2026-10-19
250001978	CDM	Magnesium Sulfate 1gm/100ml D5w Bag	1	1	$7.00	$7.00	$9,718.00	$9,718.00	$9,718.00	2026-10-19
36904	CPT	Mech Thrombectomy Or Thromboly	3	3	$2,100.00	$2,100.00	$1,200.00	$3,489.00	$1,200.00	2026-10-19
52235	CPT	Medium Bladder Tumor	1	1	$1,050.00	$1,050.00	$2,161.00	$2,161.00	$2,161.00	2026-10-19
250000913	CDM	Megestrol Acetate 40mg/ml	1	1	$5.00	$5.00	$5,333.00	$5,333.00	$5,333.00	2026-10-19
250002584	CDM	Methylene Blue(antidote) 50mg/	1	1	$1,223.00	$1,223.00	$6,843.00	$6,843.00	$6,843.00	2026-10-19
250001767	CDM	Metoclopramide 5mg/5ml 15mlud	1	1	$2.00	$2.00	$5,333.00	$5,333.00	$5,333.00	2026-10-19
250001752	CDM	Metoclopramide 1mg/1ml Oralsyr	1	1	$2.00	$2.00	$5,333.00	$5,333.00	$5,333.00	2026-10-19
250001751	CDM	Metoclopramide 3mg/3ml Oralsyr	1	1	$2.00	$2.00	$5,333.00	$5,333.00	$5,333.00	2026-10-19
250000961	CDM	Metoclopramide 5mg Tab	1	1	$3.00	$3.00	$3,387.00	$3,387.00	$3,387.00	2026-10-19
250000962	CDM	Metoclopramide 5mg/5ml Oral	1	1	$2.00	$2.00	$5,333.00	$5,333.00	$5,333.00	2026-10-19
19499	CPT	Mibb Device	1	1	$3,500.00	$3,500.00	$2,400.00	$2,400.00	$2,400.00	2026-10-19
50432	CPT	Nephrostomy	3	3	$2,100.00	$2,100.00	$1,200.00	$1,700.00	$1,281.00	2026-10-19
50435	CPT	Nephrostomy Tube Change	2	2	$2,100.00	$2,100.00	$1,200.00	$1,281.00	$1,240.50	2026-10-19
36221	CPT	Non Selective Aortic Inj W/img	4	4	$263.00	$263.00	$1,080.00	$1,935.00	$1,200.00	2026-10-19
36556	CPT	Non Tunneled (5+older)	5	5	$875.00	$875.00	$81.00	$1,935.00	$1,222.00	2026-10-19
36569	CPT	Non Tunneled Picc(5+older)	5	5	$1,400.00	$1,400.00	$965.00	$1,284.00	$1,225.00	2026-10-19
36568	CPT	Non-tunneled Picc(child<5)	3	3	$1,400.00	$1,400.00	$965.00	$1,200.00	$1,200.00	2026-10-19
250001085	CDM	Norgest& Ethin Estrad Tab	1	1	$8.00	$8.00	$5,619.00	$5,619.00	$5,619.00	2026-10-19
A9572	HCPCS	Octreoscan 3.3 Mci In-111	1	1	$6,650.00	$6,650.00	$2,001.00	$2,001.00	$2,001.00	2026-10-19
250001335	CDM	Ophthalmic Irrigation Solution 120ml	1	1	$1.00	$1.00	$3,512.00	$3,512.00	$3,512.00	2026-10-19
250001015	CDM	Pediatric Multiple Vitamin Drops 50ml	1	1	$2.00	$2.00	$4,013.00	$4,013.00	$4,013.00	2026-10-19
47556	CPT	Perc Dil Biliar Stricture W St	2	2	$2,100.00	$2,100.00	$306.00	$6,516.00	$3,411.00	2026-10-19
47555	CPT	Perc Dil Biliar Stricture Without	1	1	$2,100.00	$2,100.00	$3,968.00	$3,968.00	$3,968.00	2026-10-19
49421	CPT	Peritoneal Dialysis Cath Place	1	1	$2,100.00	$2,100.00	$2,195.00	$2,195.00	$2,195.00	2026-10-19
78813	CPT	PET Image Full Body	6	6	$5,250.00	$5,250.00	$877.00	$1,750.00	$1,444.00	2026-10-19
78811	CPT	PET Image Ltd Area	6	6	$5,250.00	$5,250.00	$794.00	$1,750.00	$1,444.00	2026-10-19
78812	CPT	PET Image Skull-thigh	6	6	$5,250.00	$5,250.00	$877.00	$1,750.00	$1,444.00	2026-10-19
78816	CPT	PET Image W/ct Full Body	7	7	$9,450.00	$9,450.00	$877.00	$3,000.00	$1,743.00	2026-10-19
78814	CPT	PET Image W/ct Lmtd	6	6	$6,650.00	$6,650.00	$877.00	$2,000.00	$1,603.50	2026-10-19
78815	CPT	PET Image W/ct Skull-thigh	6	6	$8,750.00	$8,750.00	$877.00	$2,250.00	$1,607.50	2026-10-19
250001151	CDM	Phenobarbital 60mg Tab	1	1	$3.00	$3.00	$3,757.00	$3,757.00	$3,757.00	2026-10-19
36218	CPT	Place Cath Add Beyond Thoracic	4	4	—	—	$1,080.00	$1,426.00	$1,228.50	2026-10-19
47533	CPT	Placemt Biliary Drainage Cath	3	3	$2,100.00	$2,100.00	$1,080.00	$2,195.00	$1,200.00	2026-10-19
47541	CPT	Plcmt Access Biliary Perc New	4	4	$2,100.00	$2,100.00	$1,080.00	$3,968.00	$1,170.00	2026-10-19
47540	CPT	Plcmt Bile Duct Stent New W Dr	3	3	$2,100.00	$2,100.00	$1,080.00	$3,706.00	$1,200.00	2026-10-19
47539	CPT	Plcmt Bile Duct Stent New Without	3	3	$2,100.00	$2,100.00	$1,080.00	$3,706.00	$1,200.00	2026-10-19
50433	CPT	Plcmt Nephroureteral Cath New	2	2	$2,800.00	$2,800.00	$1,200.00	$2,161.00	$1,680.50	2026-10-19
50695	CPT	Plcmt Ure Stent New Acc W Sep	2	2	$2,100.00	$2,100.00	$1,200.00	$2,161.00	$1,680.50	2026-10-19
50694	CPT	Plcmt Ure Stent New Acc Without Se	3	3	$2,100.00	$2,100.00	$1,200.00	$2,161.00	$1,700.00	2026-10-19
50693	CPT	Plcmt Ureteral Stent Exist Rep	3	3	$2,100.00	$2,100.00	$700.00	$2,161.00	$1,200.00	2026-10-19
32556	CPT	Pleural Drainage Perc Without Imag	1	1	$2,450.00	$2,450.00	$1,176.00	$1,176.00	$1,176.00	2026-10-19
250001190	CDM	Potassium Chloride 10% 20meq/15ml Ud	1	1	$4.00	$4.00	$3,757.00	$3,757.00	$3,757.00	2026-10-19
250001201	CDM	Potassium Chloride 8meq Tab	1	1	$4.00	$4.00	$4,235.00	$4,235.00	$4,235.00	2026-10-19
250001880	CDM	Potassium Phosphate 3mmole/ml	1	1	$6.00	$6.00	$9,718.00	$9,718.00	$9,718.00	2026-10-19
250001214	CDM	Povidone-iodine 10% 473ml	1	1	$1.00	$1.00	$16,148.00	$16,148.00	$16,148.00	2026-10-19
37185	CPT	Primary Arterial Tromb 2nd Sub	1	1	—	—	$1,200.00	$1,200.00	$1,200.00	2026-10-19
37184	CPT	Primary Arterial Tromb Initial	3	3	$2,100.00	$2,100.00	$1,200.00	$11,237.00	$2,000.00	2026-10-19
250001968	CDM	Propranolol 20mg/5ml Oral Solution	1	1	$4.00	$4.00	$6,611.00	$6,611.00	$6,611.00	2026-10-19
250001646	CDM	Propranolol 60mg Tab	1	1	$9.00	$9.00	$21,611.00	$21,611.00	$21,611.00	2026-10-19
50580	CPT	Pseudoephed 15mg/5ml 120ml (Violeta)	1	1	$2.00	$2.00	$3,287.00	$3,287.00	$3,287.00	2026-10-19
37222	CPT	Pta Each Add'i Ipsilateral Ili	3	3	—	—	$1,200.00	$3,500.00	$2,000.00	2026-10-19
A9604	HCPCS	Quadramet (sm-153) Mci	1	1	$7,000.00	$7,000.00	$3,160.00	$3,160.00	$3,160.00	2026-10-19
49422	CPT	Rem Tunneled Peritoneal Cathet	3	3	$2,100.00	$2,100.00	$1,200.00	$1,935.00	$1,700.00	2026-10-19
50382	CPT	Remov/replace Uret Stent Percu	1	1	$2,800.00	$2,800.00	$1,281.00	$1,281.00	$1,281.00	2026-10-19
50385	CPT	Remov/replace Uret Stent Trans	1	1	$2,800.00	$2,800.00	$1,281.00	$1,281.00	$1,281.00	2026-10-19
47562	CPT	Removal Of Gallbladder Using An Endoscope	1	1	$4,600.00	$4,600.00	$3,706.00	$3,706.00	$3,706.00	2026-10-19
49429	CPT	Removal Peritoneal Venous Shun	1	1	$2,100.00	$2,100.00	$1,935.00	$1,935.00	$1,935.00	2026-10-19
36590	CPT	Removal Tunneled Central Venou	3	3	$1,050.00	$1,050.00	$965.00	$1,200.00	$1,200.00	2026-10-19
50384	CPT	Removal Ureteral Stent Percuta	2	2	$2,800.00	$2,800.00	$1,200.00	$1,281.00	$1,240.50	2026-10-19
50386	CPT	Removal Ureteral Stent Transur	1	1	$2,800.00	$2,800.00	$1,281.00	$1,281.00	$1,281.00	2026-10-19
36252	CPT	Renal Selec,bil,angiogram Incl	3	3	$2,100.00	$2,100.00	$1,080.00	$1,935.00	$1,200.00	2026-10-19
36251	CPT	Renal Selec,uni,angiogram Incl	4	4	$2,100.00	$2,100.00	$1,080.00	$1,935.00	$1,200.00	2026-10-19
36254	CPT	Renal Superlective Bilateral	5	5	$2,100.00	$2,100.00	$1,080.00	$1,935.00	$1,200.00	2026-10-19
36253	CPT	Renal Superlective Unilateral	2	2	$2,100.00	$2,100.00	$1,080.00	$3,411.00	$2,245.50	2026-10-19
50593	CPT	Renal Tumor Perc Uni Cryothera	1	1	$2,100.00	$2,100.00	$6,516.00	$6,516.00	$6,516.00	2026-10-19
35286	CPT	Repair Blood W/other Lower Ext	1	1	$2,100.00	$2,100.00	$3,411.00	$3,411.00	$3,411.00	2026-10-19
35256	CPT	Repair Blood W/vein Lower Extr	1	1	$2,100.00	$2,100.00	$3,411.00	$3,411.00	$3,411.00	2026-10-19
49505	CPT	Repair Of Groin Hernia Patient Age 5 Years Or Older	1	1	$875.00	$875.00	$2,195.00	$2,195.00	$2,195.00	2026-10-19
36575	CPT	Repair Of Tunneled	3	3	$2,100.00	$2,100.00	$385.00	$1,200.00	$1,200.00	2026-10-19
36578	CPT	Replace Cath Central Venous Ac	3	3	$2,800.00	$2,800.00	$1,200.00	$1,935.00	$1,200.00	2026-10-19
36584	CPT	Replace Complete Picc Without Port	3	3	$657.00	$657.00	$965.00	$1,200.00	$1,200.00	2026-10-19
36585	CPT	Replace Complete Picc W/port	3	3	$657.00	$657.00	$1,200.00	$1,935.00	$1,200.00	2026-10-19
36583	CPT	Replace Complete Tunneled Cent	3	3	$657.00	$657.00	$1,200.00	$3,411.00	$1,200.00	2026-10-19
37224	CPT	Revascularization Endovascular	3	3	—	—	$1,200.00	$3,500.00	$2,000.00	2026-10-19
37220	CPT	Revascularization Endovascular	3	3	—	—	$1,200.00	$3,500.00	$2,000.00	2026-10-19
37232	CPT	Revascularization, Endovascul	2	2	—	—	$1,200.00	$4,800.00	$3,000.00	2026-10-19
49426	CPT	Revisi Peritoneal-venous Shunt	1	1	$2,100.00	$2,100.00	$2,195.00	$2,195.00	$2,195.00	2026-10-19
93530	CPT	Right Heart Cath Congenital Ca	4	4	—	—	$1,680.00	$2,226.00	$2,035.00	2026-10-19
93451	CPT	Right Heart Catherization	5	5	$15,400.00	$15,400.00	$1,680.00	$2,226.00	$2,000.00	2026-10-19
250001839	CDM	Salicylic Acid 2% Powder	1	1	$1.00	$1.00	$2,777.00	$2,777.00	$2,777.00	2026-10-19
37186	CPT	Secondary Mech Thromb Suction	1	1	—	—	$1,200.00	$1,200.00	$1,200.00	2026-10-19
36227	CPT	Sel Ext Carotid Artery W/car I	2	2	—	—	$1,080.00	$1,200.00	$1,140.00	2026-10-19
36225	CPT	Sel Inno/subelavi W/verteb Img	3	3	$263.00	$263.00	$1,080.00	$1,935.00	$1,200.00	2026-10-19
36228	CPT	Sel Intracranial Bran Ica/ver	3	3	—	—	$1,080.00	$1,200.00	$1,200.00	2026-10-19
36224	CPT	Selective Ica W Cerv/cereb Img	2	2	—	—	$1,080.00	$1,200.00	$1,140.00	2026-10-19
36222	CPT	Selective Inno/cca W Cerv Caro	3	3	$263.00	$263.00	$1,080.00	$1,935.00	$1,200.00	2026-10-19
36223	CPT	Selective Inno/cca W Cerv Cere	2	2	—	—	$1,080.00	$1,200.00	$1,140.00	2026-10-19
36226	CPT	Selective Vertebral W Vert Img	2	2	—	—	$1,080.00	$1,200.00	$1,140.00	2026-10-19
250001657	CDM	Simple Syrup 85%	1	1	$1.00	$1.00	$2,777.00	$2,777.00	$2,777.00	2026-10-19
250000318	CDM	Sodium Cit & Citric Acid 30ml Ud	1	1	$1.00	$1.00	$5,333.00	$5,333.00	$5,333.00	2026-10-19
37765	CPT	Stab Phlebectomy Var Vei 10-20	2	2	$2,100.00	$2,100.00	$1,200.00	$1,935.00	$1,567.50	2026-10-19
37766	CPT	Stab Phlebectomy Var Vein 21 +	2	2	$2,100.00	$2,100.00	$1,200.00	$1,935.00	$1,567.50	2026-10-19
37227	CPT	Stent & Atherectomy W/pta Perf	4	4	—	—	$518.00	$4,932.00	$2,563.50	2026-10-19
37221	CPT	Stent Placement W/pta Pef Uni	3	3	—	—	$1,200.00	$3,500.00	$2,000.00	2026-10-19
37226	CPT	Stent Placement W/pta Perf Uni	2	2	—	—	$1,200.00	$2,000.00	$1,600.00	2026-10-19
37223	CPT	Stent Placement W/pta Within	3	3	—	—	$1,200.00	$3,500.00	$2,000.00	2026-10-19
37217	CPT	Stent,open Ipsilateral Cervic	1	1	—	—	$1,200.00	$1,200.00	$1,200.00	2026-10-19
54348	CPT	Sulfamet-trimet 800mg/160mg Tab	1	1	$5.00	$5.00	$3,287.00	$3,287.00	$3,287.00	2026-10-19
42806	CPT	Sulindac 200mg Tab	1	1	$9.00	$9.00	$2,032.00	$2,032.00	$2,032.00	2026-10-19
250001669	CDM	Terbutaline 2.5mg Tab	1	1	$4.00	$4.00	$6,439.00	$6,439.00	$6,439.00	2026-10-19
32608	CPT	Thoracoscopy Bx Lung Nodu Mass	1	1	$2,100.00	$2,100.00	$6,516.00	$6,516.00	$6,516.00	2026-10-19
36906	CPT	Thrombect/thrombol W/ang & Ste	3	3	$2,100.00	$2,100.00	$1,200.00	$11,237.00	$1,200.00	2026-10-19
36905	CPT	Thrombectomy/thromboly W/angio	3	3	$2,100.00	$2,100.00	$1,200.00	$7,076.00	$1,200.00	2026-10-19
35372	CPT	Thromboendarterectomy Deep Fem	1	1	$2,100.00	$2,100.00	$3,411.00	$3,411.00	$3,411.00	2026-10-19
J3240	HCPCS	Thyrogen(alpha-1 Antitrypsin 2	1	1	$12,250.00	$12,250.00	$2,155.00	$2,155.00	$2,155.00	2026-10-19
37231	CPT	Tib/peroneal Vasc W Pta Athere	2	2	—	—	$4,500.00	$4,800.00	$4,650.00	2026-10-19
37230	CPT	Tib/peroneal Vasc W Trans Sten	2	2	—	—	$1,200.00	$4,800.00	$3,000.00	2026-10-19
37229	CPT	Tibial/peroneal Vasc W Pta Ang	2	2	—	—	$4,500.00	$4,800.00	$4,650.00	2026-10-19
37182	CPT	Tips	4	4	$2,800.00	$2,800.00	$3,500.00	$11,237.00	$3,800.00	2026-10-19
37183	CPT	Tips Revision	4	4	$2,800.00	$2,800.00	$3,489.00	$4,000.00	$3,550.00	2026-10-19
37215	CPT	Transcath Stnt Cca W/dis Embo	1	1	—	—	$1,200.00	$1,200.00	$1,200.00	2026-10-19
37197	CPT	Transcatheter F.b. Retrieval	3	3	$2,800.00	$2,800.00	$1,200.00	$2,000.00	$1,935.00	2026-10-19
92924	CPT	Translumina Atherect Ea Periph	1	1	$1,575.00	$1,575.00	$7,076.00	$7,076.00	$7,076.00	2026-10-19
37228	CPT	Transluminal Angioplasty	2	2	—	—	$1,200.00	$4,800.00	$3,000.00	2026-10-19
37235	CPT	Transluminal Stent	2	2	—	—	$4,500.00	$4,800.00	$4,650.00	2026-10-19
37234	CPT	Transluminal Stent Placement	2	2	—	—	$1,200.00	$4,800.00	$3,000.00	2026-10-19
37214	CPT	Trombolytic Infusion Final Day	3	3	$2,800.00	$2,800.00	$1,200.00	$2,000.00	$1,935.00	2026-10-19
37243	CPT	Tumor Organ Ischemia/inf Embol	3	3	$2,100.00	$2,100.00	$1,200.00	$7,076.00	$2,000.00	2026-10-19
36557	CPT	Tunneled <5 No Port,no Pump	4	4	$875.00	$875.00	$120.00	$3,411.00	$1,228.00	2026-10-19
36563	CPT	Tunneled Cath W/pump	3	3	$2,100.00	$2,100.00	$1,200.00	$3,411.00	$1,200.00	2026-10-19
36560	CPT	Tunneled Cath.w/port(child<5)	3	3	$1,050.00	$1,050.00	$1,200.00	$1,935.00	$1,200.00	2026-10-19
36582	CPT	Tunneled Port	3	3	$657.00	$657.00	$1,200.00	$1,935.00	$1,200.00	2026-10-19
36561	CPT	Tunneled Port 5+older Md	5	5	$1,050.00	$1,050.00	$1,140.00	$1,935.00	$1,304.00	2026-10-19
36558	CPT	Tunneled(5+ Older) No Port,pum	5	5	$1,050.00	$1,050.00	$90.00	$1,935.00	$1,255.00	2026-10-19
36581	CPT	Tunneled,no Port,no Pump	5	5	$1,313.00	$1,313.00	$1,140.00	$1,935.00	$1,250.00	2026-10-19
36514	CPT	Uso Terapeutic Plasmaferesis	5	5	$14,000.00	$14,000.00	$955.00	$1,400.00	$1,200.00	2026-10-19
75885	CPT	Vein X-ray Liver W/hemodynam	1	1	$6,300.00	$6,300.00	$1,935.00	$1,935.00	$1,935.00	2026-10-19
37241	CPT	Venous Embolization Hemorrhage	3	3	$2,100.00	$2,100.00	$1,200.00	$7,076.00	$2,000.00	2026-10-19
37212	CPT	Venous Infusion For Thrombolys	3	3	$2,800.00	$2,800.00	$1,200.00	$2,000.00	$1,935.00	2026-10-19
37188	CPT	Venous Mech Tromb Repeat Sub D	2	2	$2,100.00	$2,100.00	$1,200.00	$1,935.00	$1,567.50	2026-10-19
37187	CPT	Venous Mech Tromb-day 1	2	2	$2,100.00	$2,100.00	$1,200.00	$7,076.00	$4,138.00	2026-10-19
75893	CPT	Venous Sampling By Catheter	2	2	$6,125.00	$6,125.00	$150.00	$3,411.00	$1,780.50	2026-10-19
22512	CPT	Vertebroplasty Each Add	1	1	—	—	$3,500.00	$3,500.00	$3,500.00	2026-10-19
22510	CPT	Vertebroplasty(cervicothiracic	2	2	$2,100.00	$2,100.00	$2,006.00	$3,500.00	$2,753.00	2026-10-19
22511	CPT	Vertebroplasty(lumbosacral)	2	2	$2,100.00	$2,100.00	$2,006.00	$3,500.00	$2,753.00	2026-10-19
250002757	CDM	Warfarin 1 Mg Tab Gen	1	1	$5.00	$5.00	$3,387.00	$3,387.00	$3,387.00	2026-10-19
250001508	CDM	Zinc Oxide 20% Oint 56gm	1	1	$8.00	$8.00	$3,512.00	$3,512.00	$3,512.00	2026-10-19

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