Hospital

HOSPITAL SAN CARLOS BORROMEO

Moca, PR · CCN 400111 · Rates published

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You selected 93306 (CPT)

ECHOCARDIOGRAPHY

This hospital’s price: $123 across 15 payers · range $65-$394

Source: https://hscbmocaorg.ipage.com/prices/data/660371418_Hospital-San-Carlos-Inc.json · observed 2025-02-19

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

296 distinct procedures filed

28 distinct payers

7,582 rate rows

2025-02-19 last MRF observed · ⚠ 20 mo old

Data quality

7,553 of 7,582 rate rows are consumer-grade (99.6%)

29 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
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	17
exceeds 10× this hospital's gross charge — excluded from medians	6
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	6

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

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

Source MRF file	https://hscbmocaorg.ipage.com/prices/data/660371418_Hospital-San-Carlos-Inc.json
Found on page	https://hscbmocaorg.ipage.com/cms-hpt.txt
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-10-01
Content fingerprint	76c92e8d1d62e0b5… · 2,005,081 bytes · first seen 2026-06-16

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
J3101 HCPCS	Tnkase	12	$162.43	$7,959.57	$7,959.57	nat. median $3,787 outlier · 2.1×
J1160 HCPCS	Digifab 40mg	11	$8.82	$4,588.34	$4,588.34	nat. median $23 outlier · 196.3×
J9217 HCPCS	Lupron 7.5mg	10	$180.79	$2,058.96	$2,058.96	nat. median $1,573 1.3× median
J1950 HCPCS	Lupron 3.75mg	10	$1,666.78	$1,727.81	$1,727.81	nat. median $3,921 outlier · 0.4×
29881 CPT	Artro Knee Sur Median Or Lat	18	$450.00	$2,314.19	$1,475.00	nat. median $3,838 outlier · 0.4×
47562 CPT	Cholecystectomy Laparoscopic	21	$450.00	$4,125.27	$1,412.50	nat. median $5,988 outlier · 0.2×
49320 CPT	Laparoscop Abdomen, Peritoneum	21	$450.00	$4,125.27	$1,412.50	nat. median $5,644 outlier · 0.3×
29826 CPT	Artro Sholder Sur Descompresio	14	$450.00	$1,595.00	$1,393.00	nat. median $3,122 outlier · 0.4×
58662 CPT	Laparoscopy, Surgical	20	$450.00	$4,125.27	$1,250.00	nat. median $6,065 outlier · 0.2×
58670 CPT	Hysterectomy	19	$450.00	$4,125.27	$763.50	nat. median $5,671 outlier · 0.1×
J0630 HCPCS	Miacalcin 400units/2ml	10	$762.65	$1,142.41	$762.65	nat. median $1,896 outlier · 0.4×
26615 CPT	Open Tx Metacarpal Frac Ex Fix	19	$450.00	$2,314.19	$757.00	nat. median $3,818 outlier · 0.2×
26442 CPT	Tenolysis Flexor Tendon	19	$394.22	$2,314.19	$757.00	nat. median $3,546 outlier · 0.2×
27086 CPT	Remove Pelvis Hip F Body	19	$450.00	$2,031.54	$757.00	nat. median $2,701 outlier · 0.3×
25000 CPT	De Quervains Disease,incision	19	$450.00	$1,453.36	$757.00	nat. median $2,115 outlier · 0.4×
25101 CPT	Arthrotom Wrist Jnt W Jnt Expl	19	$450.00	$2,314.19	$757.00	nat. median $3,446 outlier · 0.2×
26445 CPT	Tenolysi Ext Tendon Dors Hand	19	$450.00	$2,314.19	$757.00	nat. median $3,332 outlier · 0.2×
25628 CPT	Open Tx Carpal Scahoid Ext Fix	19	$450.00	$5,114.83	$757.00	nat. median $7,134 outlier · 0.1×
21556 CPT	Excisio,tumor,tiss,neck,thorax	19	$450.00	$2,031.54	$757.00	nat. median $2,936 outlier · 0.3×
58558 CPT	Hysteroscopy	19	$450.00	$2,235.21	$757.00	nat. median $3,307 outlier · 0.2×
25609 CPT	Opn Tx Dist Radi Intr-art Fra3	16	$450.00	$3,213.65	$757.00	nat. median $7,233 outlier · 0.1×
49505 CPT	Herniorrhaphy Inguinal	19	$450.00	$2,473.50	$757.00	nat. median $3,855 outlier · 0.2×
23615 CPT	Open Tx Proximal Hum Int Fix	16	$450.00	$6,183.29	$748.50	nat. median $11,353 outlier · 0.1×
23472 CPT	Reverse Total Shoulder Arthrop	15	$450.00	$1,504.00	$748.50	nat. median $16,677 outlier · 0.0×
19120 CPT	Excision Procedu On The Breast	19	$450.00	$2,725.22	$748.50	nat. median $3,667 outlier · 0.2×
20900 CPT	Bonegraft Any Donor Area Sm	16	$450.00	$1,504.00	$748.50	nat. median $6,211 outlier · 0.1×
27814 CPT	Clos Tx Bimaleol Ankle Fra Fix	16	$450.00	$3,213.65	$748.50	nat. median $7,144 outlier · 0.1×
58120 CPT	Dilatation & Curettage	19	$450.00	$2,235.21	$740.00	nat. median $3,185 outlier · 0.2×
57250 CPT	Post Repair Vaginal	19	$450.00	$3,556.12	$740.00	nat. median $4,890 outlier · 0.2×
52318 CPT	Cystolitholapaxy	19	$450.00	$2,492.44	$740.00	nat. median $3,725 outlier · 0.2×
52276 CPT	Uretherotomy	19	$450.00	$1,456.23	$740.00	nat. median $2,367 outlier · 0.3×
43870 CPT	Fistula Gastrocutanea	19	$450.00	$2,738.10	$734.00	nat. median $3,804 outlier · 0.2×
38760 CPT	Exc. Of Multip Subcutan Lesion	19	$450.00	$4,662.28	$734.00	nat. median $5,739 outlier · 0.1×
57522 CPT	Cervical Cone Biopsy	19	$450.00	$2,235.21	$734.00	nat. median $3,162 outlier · 0.2×
36561 CPT	Venus Port	19	$450.00	$2,278.90	$734.00	nat. median $3,751 outlier · 0.2×
36590 CPT	Removal Of Central Venous Acce	20	$450.00	$1,145.02	$728.00	nat. median $1,778 outlier · 0.4×
59820 CPT	Treatment Of Missed Abortion	15	$450.00	$1,595.00	$727.50	nat. median $3,314 outlier · 0.2×
59812 CPT	Treatment Imcompl Abortion Tri	15	$450.00	$1,595.00	$727.50	nat. median $3,249 outlier · 0.2×
64721 CPT	Carpal Tunnel Release	19	$450.00	$1,380.42	$727.50	nat. median $2,392 outlier · 0.3×
58700 CPT	Partial Bilatera Salpingectomy	15	$450.00	$1,595.00	$727.50	nat. median $2,747 outlier · 0.3×
58150 CPT	Total Vaginal Hysterectomy	15	$450.00	$822.00	$727.00	nat. median $3,275 outlier · 0.2×
54160 CPT	Circumcision	15	$450.00	$974.21	$727.00	nat. median $863 0.8× median
49585 CPT	Herniorrhaphy Umbilical	15	$450.00	$1,200.00	$727.00	nat. median $3,104 outlier · 0.2×
11042 CPT	Cleaning And Debridement (c&d)	19	$285.08	$822.00	$712.00	nat. median $523 1.4× median
10060 CPT	Incision And Drainage (i/d)	19	$66.80	$822.00	$710.50	nat. median $292 outlier · 2.4×
J0270 HCPCS	Prostin E2 Supp	10	$66.00	$10,951.38	$665.88	nat. median $330 outlier · 2.0×
J0248 HCPCS	Veklury 100mg	10	$6.35	$634.85	$634.85	nat. median $516 1.2× median
J1573 HCPCS	HyperTet 1ml Syr	10	$65.94	$608.40	$608.40	nat. median $121 outlier · 5.0×
J0714 HCPCS	Avycaz 2g/0.5g Sdv	10	$100.73	$398.46	$398.46	nat. median $385 1.0× median
J1410 HCPCS	Premarin 25mg	11	$102.42	$382.91	$350.70	nat. median $614 0.6× median

Other procedures at this hospital

Browse this hospital's 296 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

J3101	HCPCS	Tnkase	16	12	$9,956.17	—	$162.43	$7,959.57	$7,959.57	2025-02-19
J1160	HCPCS	Digifab 40mg	15	11	$5,739.60	—	$8.82	$4,588.34	$4,588.34	2025-02-19
J9217	HCPCS	Lupron 7.5mg	13	10	$2,575.57	—	$180.79	$2,058.96	$2,058.96	2025-02-19
J1950	HCPCS	Lupron 3.75mg	13	10	$2,161.33	—	$1,666.78	$1,727.81	$1,727.81	2025-02-19
29881	CPT	Artro Knee Sur Median Or Lat	21	18	$1.00	—	$450.00	$2,314.19	$1,475.00	2025-02-19
49320	CPT	Laparoscop Abdomen, Peritoneum	28	21	$1.00	—	$450.00	$4,125.27	$1,412.50	2025-02-19
47562	CPT	Cholecystectomy Laparoscopic	28	21	$1.00	—	$450.00	$4,125.27	$1,412.50	2025-02-19
29826	CPT	Artro Sholder Sur Descompresio	17	14	$1.00	—	$450.00	$1,595.00	$1,393.00	2025-02-19
58662	CPT	Laparoscopy, Surgical	25	20	$1.00	—	$450.00	$4,125.27	$1,250.00	2025-02-19
58670	CPT	Hysterectomy	24	19	$1.00	—	$450.00	$4,125.27	$763.50	2025-02-19
J0630	HCPCS	Miacalcin 400units/2ml	13	10	$1,800.00	—	$762.65	$1,142.41	$762.65	2025-02-19
27086	CPT	Remove Pelvis Hip F Body	24	19	$1.00	—	$450.00	$2,031.54	$757.00	2025-02-19
21556	CPT	Excisio,tumor,tiss,neck,thorax	25	19	$1.00	—	$450.00	$2,031.54	$757.00	2025-02-19
25000	CPT	De Quervains Disease,incision	25	19	$1.00	—	$450.00	$1,453.36	$757.00	2025-02-19
25101	CPT	Arthrotom Wrist Jnt W Jnt Expl	26	19	$1.00	—	$450.00	$2,314.19	$757.00	2025-02-19
25609	CPT	Opn Tx Dist Radi Intr-art Fra3	23	16	$1.00	—	$450.00	$3,213.65	$757.00	2025-02-19
25628	CPT	Open Tx Carpal Scahoid Ext Fix	25	19	$1.00	—	$450.00	$5,114.83	$757.00	2025-02-19
26442	CPT	Tenolysis Flexor Tendon	26	19	$1.00	—	$394.22	$2,314.19	$757.00	2025-02-19
26445	CPT	Tenolysi Ext Tendon Dors Hand	26	19	$1.00	—	$450.00	$2,314.19	$757.00	2025-02-19
26615	CPT	Open Tx Metacarpal Frac Ex Fix	24	19	$1.00	—	$450.00	$2,314.19	$757.00	2025-02-19
49505	CPT	Herniorrhaphy Inguinal	26	19	$1.00	—	$450.00	$2,473.50	$757.00	2025-02-19
58558	CPT	Hysteroscopy	24	19	$1.00	—	$450.00	$2,235.21	$757.00	2025-02-19
20900	CPT	Bonegraft Any Donor Area Sm	22	16	$1.00	—	$450.00	$1,504.00	$748.50	2025-02-19
23472	CPT	Reverse Total Shoulder Arthrop	20	15	$1.00	—	$450.00	$1,504.00	$748.50	2025-02-19
27814	CPT	Clos Tx Bimaleol Ankle Fra Fix	22	16	$1.00	—	$450.00	$3,213.65	$748.50	2025-02-19
19120	CPT	Excision Procedu On The Breast	26	19	$1.00	—	$450.00	$2,725.22	$748.50	2025-02-19
23615	CPT	Open Tx Proximal Hum Int Fix	22	16	$1.00	—	$450.00	$6,183.29	$748.50	2025-02-19
52318	CPT	Cystolitholapaxy	25	19	$1.00	—	$450.00	$2,492.44	$740.00	2025-02-19
58120	CPT	Dilatation & Curettage	25	19	$1.00	—	$450.00	$2,235.21	$740.00	2025-02-19
57250	CPT	Post Repair Vaginal	25	19	$1.00	—	$450.00	$3,556.12	$740.00	2025-02-19
52276	CPT	Uretherotomy	25	19	$1.00	—	$450.00	$1,456.23	$740.00	2025-02-19
36561	CPT	Venus Port	24	19	$1.00	—	$450.00	$2,278.90	$734.00	2025-02-19
38760	CPT	Exc. Of Multip Subcutan Lesion	24	19	$1.00	—	$450.00	$4,662.28	$734.00	2025-02-19
43870	CPT	Fistula Gastrocutanea	24	19	$1.00	—	$450.00	$2,738.10	$734.00	2025-02-19
57522	CPT	Cervical Cone Biopsy	24	19	$1,923.81	—	$450.00	$2,235.21	$734.00	2025-02-19
36590	CPT	Removal Of Central Venous Acce	25	20	$1.00	—	$450.00	$1,145.02	$728.00	2025-02-19
59812	CPT	Treatment Imcompl Abortion Tri	20	15	$1.00	—	$450.00	$1,595.00	$727.50	2025-02-19
59820	CPT	Treatment Of Missed Abortion	20	15	$1.00	—	$450.00	$1,595.00	$727.50	2025-02-19
64721	CPT	Carpal Tunnel Release	26	19	$1.00	—	$450.00	$1,380.42	$727.50	2025-02-19
58700	CPT	Partial Bilatera Salpingectomy	20	15	$1.00	—	$450.00	$1,595.00	$727.50	2025-02-19
58150	CPT	Total Vaginal Hysterectomy	20	15	$1.00	—	$450.00	$822.00	$727.00	2025-02-19
49585	CPT	Herniorrhaphy Umbilical	20	15	$1.00	—	$450.00	$1,200.00	$727.00	2025-02-19
54160	CPT	Circumcision	21	15	$1.00	—	$450.00	$974.21	$727.00	2025-02-19
11042	CPT	Cleaning And Debridement (c&d)	25	19	$1.00	—	$285.08	$822.00	$712.00	2025-02-19
10060	CPT	Incision And Drainage (i/d)	26	19	$1.00	—	$66.80	$822.00	$710.50	2025-02-19
J0270	HCPCS	Prostin E2 Supp	24	10	$6,754.40	—	$66.00	$10,951.38	$665.88	2025-02-19
J0248	HCPCS	Veklury 100mg	13	10	$761.82	—	$6.35	$634.85	$634.85	2025-02-19
J1573	HCPCS	HyperTet 1ml Syr	13	10	$779.00	—	$65.94	$608.40	$608.40	2025-02-19
J0714	HCPCS	Avycaz 2g/0.5g Sdv	13	10	$498.44	—	$100.73	$398.46	$398.46	2025-02-19
J1410	HCPCS	Premarin 25mg	15	11	$452.26	—	$102.42	$382.91	$350.70	2025-02-19
73222	CPT	MRI-any Jt Upper Ext. W/c Rt	30	21	$630.00	—	$193.20	$572.45	$318.75	2025-02-19
73722	CPT	MRI Lower Ext.any Joint W/c Lt	30	21	$630.00	—	$200.92	$572.45	$310.31	2025-02-19
J1440	HCPCS	Neupogen/Zarxio 300mg	10	9	$377.80	—	$301.72	$301.72	$301.72	2025-02-19
J1441	HCPCS	Neupogen/Zarxio 480mg	10	9	$601.60	—	$300.28	$300.28	$300.28	2025-02-19
J1442	HCPCS	Neupogen/Zarxio 300mg	9	4	$377.80	—	$0.98	$425.58	$293.22	2025-02-19
70546	CPT	MRA-brain Without And W/c	29	20	$700.00	—	$215.56	$500.00	$287.50	2025-02-19
72197	CPT	MRI-pelvis Without And W/c	29	20	$630.00	—	$198.55	$500.00	$274.95	2025-02-19
70548	CPT	MRA-neck W/contrast	29	20	$700.00	—	$146.24	$500.00	$274.95	2025-02-19
70552	CPT	MRI-brain With Contrast	30	21	$630.00	—	$156.18	$500.00	$274.95	2025-02-19
70553	CPT	MRI-brain Without And W/c	29	20	$630.00	—	$177.62	$500.00	$274.95	2025-02-19
72142	CPT	MRI-cervical Spine W Contrast	30	21	$630.00	—	$161.15	$500.00	$274.95	2025-02-19
72149	CPT	MRI-lumbar Spine W Contrast	30	21	$630.00	—	$157.22	$500.00	$274.95	2025-02-19
72156	CPT	MRI-cervical Without And W/c	29	20	$630.00	—	$179.20	$500.00	$274.95	2025-02-19
72158	CPT	MRI-lumbar Without And W/c	29	20	$630.00	—	$178.42	$500.00	$274.95	2025-02-19
72196	CPT	MRI-pelvis W Contrast	30	21	$630.00	—	$158.54	$500.00	$274.95	2025-02-19
74183	CPT	MRI-abdomen Without And W/c	30	21	$630.00	—	$199.34	$500.00	$274.95	2025-02-19
74182	CPT	MRI-abdomen W Contrast	29	20	$630.00	—	$186.53	$500.00	$274.95	2025-02-19
74178	CPT	Abdom/pelv Without & W/c CT	30	21	$240.00	—	$137.50	$450.00	$252.88	2025-02-19
J0712	HCPCS	Teflaro 600mg	13	10	$308.95	—	$3.95	$239.57	$239.57	2025-02-19
73218	CPT	MRI Upp Ext.oth.than J. Without Lt	29	20	$555.00	—	$162.50	$500.00	$235.08	2025-02-19
J3246	HCPCS	Aggrastat 12.5 Mg Bag 250 Ml	14	11	$272.46	—	$3.62	$496.20	$234.71	2025-02-19
74177	CPT	Abdomino/pelvico W Contrast CT	30	21	$240.00	—	$137.50	$450.00	$225.00	2025-02-19
73718	CPT	MRI Low Ex.oth Tha Join Wo Rt	30	20	$555.00	—	$134.72	$500.00	$217.89	2025-02-19
72195	CPT	MRI-pelvis	29	20	$555.00	—	$135.77	$500.00	$193.78	2025-02-19
70544	CPT	MRA-head Without Cont	29	20	$600.00	—	$132.11	$500.00	$186.40	2025-02-19
74181	CPT	Mrcp Mag Res Cholang Pancreat	30	21	$555.00	—	$107.01	$500.00	$184.28	2025-02-19
J2997	HCPCS	Activase Cathflo 2mg	14	11	$222.20	—	$32.12	$177.64	$177.64	2025-02-19
93925	CPT	Arteria Bilateral Lower Ext	20	15	$118.55	—	$30.82	$229.09	$175.19	2025-02-19
70551	CPT	MRI-brain	30	21	$555.00	—	$105.68	$500.00	$175.19	2025-02-19
73721	CPT	MRI-lower Extremity Lt	30	21	$555.00	—	$115.09	$500.00	$175.19	2025-02-19
73221	CPT	MRI-upper Extr. Any Joint Lt	30	21	$555.00	—	$115.09	$500.00	$175.19	2025-02-19
72141	CPT	MRI-cervical Spine	30	21	$555.00	—	$101.76	$500.00	$175.19	2025-02-19
72146	CPT	MRI-thoracic Spine	30	21	$555.00	—	$101.76	$500.00	$175.19	2025-02-19
72148	CPT	MRI-lumbar Spine	30	21	$555.00	—	$102.02	$500.00	$175.19	2025-02-19
J1571	HCPCS	Hyper Hep B	13	10	$200.15	—	$65.94	$171.84	$171.84	2025-02-19
74176	CPT	Abdomino/pelvico CT	30	21	$225.00	—	$80.47	$450.00	$162.59	2025-02-19
43246	CPT	Peg Tube Placement	23	18	$593.00	—	$111.00	$1,360.43	$158.00	2025-02-19
72126	CPT	Cervical Spine W/contrast CT	30	21	$240.00	—	$89.25	$274.95	$156.25	2025-02-19
93930	CPT	Arteria Bilateral Upper Ext	20	15	$118.55	—	$25.74	$175.19	$155.67	2025-02-19
Q5110	HCPCS	Nivestym 300mcg Pfs 0.5 Ml	23	10	$262.80	—	$0.29	$242.03	$151.27	2025-02-19
74170	CPT	Abdomen Without And W/c CT	29	20	$240.00	—	$125.00	$260.00	$150.00	2025-02-19
71275	CPT	Angio Chest Without And W/c CT	30	21	$225.00	—	$89.25	$400.00	$150.00	2025-02-19
93970	CPT	Venoso Bilateral Lower	20	15	$118.55	—	$29.00	$175.19	$148.83	2025-02-19
45330	CPT	Sigmoidoscopy	21	17	$1.00	—	$111.00	$757.00	$147.00	2025-02-19
93880	CPT	Carotidas Extracraneal	19	14	$100.00	—	$32.40	$175.19	$146.55	2025-02-19
45378	CPT	Colonoscopy	24	18	$250.00	—	$111.00	$653.44	$145.00	2025-02-19
43239	CPT	Gastroscopy	23	18	$240.00	—	$111.00	$648.09	$145.00	2025-02-19
45385	CPT	Colonoscopy, Flexib; With Remova	23	17	$250.00	—	$111.00	$843.69	$145.00	2025-02-19
45380	CPT	Colonoscopy W/biopsy	25	18	$250.00	—	$111.00	$843.69	$145.00	2025-02-19
72193	CPT	Pelvic W/contrast CT	30	21	$240.00	—	$89.25	$260.00	$143.75	2025-02-19
74160	CPT	Abdomen W/contrast CT	30	21	$240.00	—	$89.25	$260.00	$143.75	2025-02-19
43235	CPT	Upper Gi Endoscopy- Diagnosis	22	17	$240.00	—	$111.00	$648.09	$143.61	2025-02-19
71270	CPT	Chest, Thorax Without & W/c CT	30	21	$240.00	—	$89.25	$260.00	$139.47	2025-02-19
70492	CPT	Neck Without And W/c CT	30	21	$240.00	—	$100.50	$260.00	$137.50	2025-02-19
70460	CPT	Brain W/contrast CT	30	21	$240.00	—	$76.13	$260.00	$131.36	2025-02-19
71260	CPT	Chest W/contrast CT	30	21	$240.00	—	$89.25	$260.00	$131.36	2025-02-19
70491	CPT	Neck W/contrast CT	30	21	$240.00	—	$89.25	$260.00	$131.36	2025-02-19
70487	CPT	Maxillofacial W/contrast CT	30	21	$240.00	—	$78.94	$260.00	$131.36	2025-02-19
70470	CPT	Brain Without And W/c CT	29	20	$240.00	—	$91.16	$260.00	$131.36	2025-02-19
93306	CPT	Echocardiography	36	15	$300.00	—	$65.43	$394.42	$123.43	2025-02-19
J1610	HCPCS	Glucagon HCl	13	10	$303.22	—	$118.35	$184.18	$118.35	2025-02-19
77066	CPT	Bilateral Mammograph Digital	29	20	$104.39	—	$40.00	$123.61	$109.00	2025-02-19
73200	CPT	Upper Extremity CT Lt	30	21	$225.00	—	$78.60	$260.00	$107.62	2025-02-19
70480	CPT	Orbit,ear,mastoids CT Lt	30	21	$225.00	—	$53.55	$260.00	$101.54	2025-02-19
70490	CPT	Neck CT	30	21	$225.00	—	$71.55	$260.00	$97.85	2025-02-19
70486	CPT	Maxillofacial CT	30	21	$225.00	—	$68.75	$260.00	$90.34	2025-02-19
72125	CPT	Cervical Spine CT	30	21	$225.00	—	$68.54	$260.00	$90.16	2025-02-19
72128	CPT	Thoracic Spine CT	30	21	$225.00	—	$68.28	$260.00	$89.82	2025-02-19
73700	CPT	Lower Extremity CT Lt	30	21	$225.00	—	$68.02	$260.00	$89.48	2025-02-19
72131	CPT	Lumbar Spine CT	30	21	$225.00	—	$68.02	$260.00	$89.31	2025-02-19
71250	CPT	Chest CT	30	21	$225.00	—	$67.76	$260.00	$89.14	2025-02-19
72192	CPT	Pelvic CT	30	21	$225.00	—	$64.93	$260.00	$88.96	2025-02-19
J8499	HCPCS	Olumiant 2mg	9	8	$110.70	—	$88.49	$88.49	$88.49	2025-02-19
74150	CPT	Abdomen CT	30	21	$225.00	—	$63.91	$260.00	$87.74	2025-02-19
J2730	HCPCS	Protopam	12	10	$104.04	—	$85.57	$104.04	$85.57	2025-02-19
77065	CPT	Unilateral Mammogr Digital Lt	28	19	$80.20	—	$32.50	$96.79	$85.00	2025-02-19
93926	CPT	Arteria Unilat Lower Ext Lt	20	15	$118.55	—	$15.68	$115.27	$83.61	2025-02-19
77067	CPT	Screening Mammogra Digital Lt	30	21	$105.18	—	$32.50	$102.22	$82.25	2025-02-19
J1572	HCPCS	Flebogama (price Per Gm)	15	11	$209.53	—	$56.12	$127.05	$80.77	2025-02-19
J1569	HCPCS	Gammagard (price Per Gm)	15	11	$209.53	—	$46.46	$127.05	$80.77	2025-02-19
J1568	HCPCS	Octagam	15	11	$209.53	—	$49.30	$127.05	$80.77	2025-02-19
J1561	HCPCS	Gamunex (price Per Gm	15	11	$209.53	—	$49.00	$127.05	$80.77	2025-02-19
93931	CPT	Arteria Unilat Upper Ext Lt	20	15	$118.55	—	$17.55	$109.11	$79.06	2025-02-19
76805	CPT	Obstetric >= 14week Fetus US	27	19	$55.00	—	$35.00	$94.97	$78.60	2025-02-19
70450	CPT	Brain CT	30	21	$225.00	—	$51.94	$260.00	$78.60	2025-02-19
93971	CPT	Venoso Unilateral Lower Lt	20	15	$118.55	—	$15.60	$101.50	$78.60	2025-02-19
76830	CPT	Endovaginal No Obst. US	29	20	$90.00	—	$34.30	$110.00	$78.60	2025-02-19
76872	CPT	Prostatico (transrectal) US	29	20	$90.00	—	$35.00	$110.08	$78.60	2025-02-19
76700	CPT	Abdominal Complete US	30	21	$80.00	—	$35.00	$90.00	$77.80	2025-02-19
J2790	HCPCS	Rhophylac 300mcg	15	11	$192.46	—	$76.00	$110.27	$76.00	2025-02-19
76770	CPT	Renal-kidney/bladder US Lt	30	21	$48.00	—	$28.00	$80.00	$72.86	2025-02-19
76536	CPT	Tiroide US	30	21	$48.00	—	$21.00	$91.79	$72.78	2025-02-19
76856	CPT	Pelvico Complete US	28	19	$55.00	—	$31.00	$78.78	$72.53	2025-02-19
76801	CPT	Obstetric <= 14week Fetus US	29	20	$48.00	—	$19.50	$80.00	$70.23	2025-02-19
76641	CPT	Breast Compl.sonomamogra US Lt	29	19	$75.00	—	$26.50	$83.00	$67.59	2025-02-19
76506	CPT	Head US	26	19	$48.00	—	$24.38	$83.08	$62.28	2025-02-19
76705	CPT	Abdominal Limited US	30	21	$65.00	—	$17.50	$80.00	$59.01	2025-02-19
76817	CPT	Endovaginal Obstetric US	28	19	$90.00	—	$37.50	$110.00	$57.50	2025-02-19
76642	CPT	Breast Limited Sonomamog US	24	19	$60.00	—	$22.86	$70.00	$54.12	2025-02-19
76870	CPT	Scrotum (testiculo) US	30	21	$48.00	—	$21.00	$78.60	$48.73	2025-02-19
80055	CPT	Obstetric Panel	24	17	$60.00	—	$45.58	$80.00	$47.81	2025-02-19
80074	CPT	Hepatitis Panel Acute	25	18	$190.00	—	$45.42	$80.00	$47.63	2025-02-19
72082	CPT	Thor-lumb,skull,cerv &sacr 2,3	28	19	$57.00	—	$10.00	$78.60	$47.12	2025-02-19
J0348	HCPCS	Eraxis 100mg	15	11	$229.07	—	$0.51	$216.00	$43.17	2025-02-19
76810	CPT	Obstetric>=14wk Fetus+gest US	28	19	$20.00	—	$30.52	$80.00	$42.73	2025-02-19
77080	CPT	Densitometria Osea Prod. Xr	30	21	$55.00	—	$21.13	$78.28	$42.50	2025-02-19
83880	CPT	Natriuretic Peptide (bnp)	23	17	$265.80	—	$32.37	$90.00	$39.26	2025-02-19
82652	CPT	Dihydroxyvitamin D,1,25	25	17	$376.00	—	$36.71	$195.00	$38.50	2025-02-19
72052	CPT	Cervical Sp. Comp. Xr	30	21	$43.68	—	$21.94	$78.60	$38.42	2025-02-19
J0288	HCPCS	Amphotecin B 50mg	16	12	$60.00	—	$23.97	$93.33	$38.00	2025-02-19
Q9967	HCPCS	Omnipaque 9mgl/ml	43	10	$62.75	—	$0.14	$51.45	$37.80	2025-02-19
J0637	HCPCS	Cancidas 50mg	25	11	$117.50	—	$5.05	$421.06	$37.50	2025-02-19
59025	CPT	Non Stress Test	12	9	$45.00	—	$18.00	$55.00	$37.36	2025-02-19
J0885	HCPCS	Retacrit (Epogen) 4,000 Units/1ml- For Esrd	25	11	$52.94	—	$6.46	$693.12	$34.28	2025-02-19
72110	CPT	L.s.s. Complete Obligues Xr	30	21	$48.18	—	$20.48	$78.60	$33.71	2025-02-19
J0457	HCPCS	Azactam 1gm	23	10	$40.79	—	$2.07	$64.69	$32.61	2025-02-19
93000	CPT	EKG	3	3	$35.34	—	$30.00	$32.00	$30.00	2025-02-19
73564	CPT	Knee Comp. 4 View Left Xr	30	21	$29.22	—	$12.50	$78.60	$28.37	2025-02-19
73502	CPT	Hip Unil W/pelvis 2-3v Left Xr	31	22	$29.22	—	$13.00	$64.96	$28.25	2025-02-19
J2430	HCPCS	Aredia 90mg	15	11	$112.27	—	$12.58	$48.00	$26.92	2025-02-19
73565	CPT	Knees Both (bilat) Prod. Xr	30	21	$34.18	—	$10.73	$64.96	$26.33	2025-02-19
73110	CPT	Wrist Comp. Xr Rt	30	21	$29.22	—	$12.68	$64.96	$26.09	2025-02-19
82803	CPT	Gases Blood, Any Combin Of Ph	29	21	$94.20	—	$18.45	$75.00	$26.07	2025-02-19
73521	CPT	Hips Bilat. 2 View W Pelvis Xr	30	21	$38.92	—	$13.00	$78.60	$25.91	2025-02-19
73562	CPT	Knee 3 View Left Xr	30	21	$33.84	—	$10.24	$64.96	$25.84	2025-02-19
71110	CPT	Ribs Bilateral Xr	30	21	$43.32	—	$15.00	$78.60	$25.73	2025-02-19
72190	CPT	Pelvis Comp. Xr	30	21	$29.22	—	$13.00	$78.60	$25.55	2025-02-19
70220	CPT	Paranasal Sinus,water View Xr	30	21	$38.52	—	$16.50	$64.96	$25.37	2025-02-19
73140	CPT	Fingers Xr Rt	30	21	$19.92	—	$6.83	$64.96	$24.89	2025-02-19
74021	CPT	Abdomen Comp. More Than 2 Xr	30	21	$34.02	—	$10.50	$78.60	$24.87	2025-02-19
76802	CPT	Obstetric<=14wk Fetus=gest US	29	20	$20.00	—	$10.00	$80.00	$24.50	2025-02-19
87389	CPT	Hiv1 Antg W Hiv1 Hiv2 Ab Sing	22	16	$102.36	—	$17.00	$40.00	$24.08	2025-02-19
72100	CPT	Lumbo Sacral Spine Xr	30	21	$33.72	—	$13.00	$78.60	$23.64	2025-02-19
73610	CPT	Ankle Comp. Xr Rt	30	21	$34.02	—	$12.68	$64.96	$23.09	2025-02-19
73552	CPT	Femur Ap & Lat Left Xr	31	22	$29.22	—	$10.50	$64.96	$23.00	2025-02-19
72080	CPT	Thoraco-lumber Spine Xr	30	21	$38.52	—	$9.50	$64.96	$22.83	2025-02-19
73130	CPT	Hand Minimum Of 3 Views Lt Xr	30	21	$33.84	—	$11.00	$64.96	$22.77	2025-02-19
71100	CPT	Rib Unilateral Left Xr	30	21	$30.84	—	$13.50	$64.96	$22.47	2025-02-19
72040	CPT	Cervical Spine Ap & Lat Xr	27	19	$24.42	—	$12.00	$64.96	$22.47	2025-02-19
74019	CPT	Abdomen Antepost. And Obliq Xr	30	21	$38.46	—	$9.21	$78.60	$22.11	2025-02-19
73560	CPT	Knee 1 Or 2 View Left Xr	30	21	$24.42	—	$9.50	$64.96	$21.80	2025-02-19
73100	CPT	Wrist Left Xr	30	21	$24.42	—	$9.50	$64.96	$21.66	2025-02-19
73660	CPT	Toes Xr Rt	30	21	$19.92	—	$7.00	$64.96	$21.59	2025-02-19
73630	CPT	Foot Comp.(ap-lat-oblq) Xr Rt	30	21	$33.36	—	$13.00	$64.96	$21.38	2025-02-19
82378	CPT	Cea (carcinoembryonic Antigen	28	20	$87.00	—	$18.09	$62.00	$21.19	2025-02-19
72070	CPT	Thoracic Spine Xr	30	21	$29.22	—	$10.50	$78.60	$20.56	2025-02-19
73600	CPT	Ankle Left Xr	30	21	$24.42	—	$9.26	$64.96	$20.42	2025-02-19
80170	CPT	Gentamicin	29	21	$36.00	—	$11.47	$60.00	$20.22	2025-02-19
73030	CPT	Shoulder 2 O Mas Vistas Lt Xr	30	21	$34.02	—	$11.50	$64.96	$20.14	2025-02-19
84443	CPT	Tsh (thyroid Stimulating Horm	29	21	$55.00	—	$16.02	$50.00	$20.00	2025-02-19
J0878	HCPCS	Cubicin 500mg	15	11	$28.80	—	$0.04	$255.10	$19.96	2025-02-19
73060	CPT	Arm (humerus) Left Xr	30	21	$29.22	—	$9.50	$64.96	$19.92	2025-02-19
87230	CPT	Clostridium-toxin-difficile	25	18	$19.00	—	$8.34	$67.00	$19.74	2025-02-19
73590	CPT	Tibia & Fibula (leg) Lt Xr	30	21	$24.42	—	$9.50	$64.96	$19.62	2025-02-19
72220	CPT	Sacrum Coccyx Xr	30	21	$29.22	—	$9.26	$64.96	$19.38	2025-02-19
73120	CPT	Hand Left Xr	30	21	$24.42	—	$9.50	$78.60	$19.17	2025-02-19
70360	CPT	Neck Soft Tissue (c.s.) Xr	30	21	$19.92	—	$6.83	$64.96	$19.04	2025-02-19
80305	CPT	Drug Panel 10 Urine/blood Toxi	3	2	$130.00	—	$19.00	$19.00	$19.00	2025-02-19
71046	CPT	Chest Pa & Lat Xr	30	21	$29.22	—	$10.50	$64.96	$18.99	2025-02-19
82607	CPT	Cyanocobalamin (vitamin B-12)	29	21	$48.00	—	$14.38	$45.00	$18.61	2025-02-19
84153	CPT	Prostat Specif Antig Tot(psa	27	19	$40.00	—	$17.54	$58.00	$18.39	2025-02-19
73501	CPT	Hip With Pelvis 1 View Left Xr	31	22	$24.42	—	$7.00	$64.96	$18.31	2025-02-19
73070	CPT	Elbow Ap & Lat. Left Xr	30	21	$22.14	—	$9.26	$64.96	$18.29	2025-02-19
72170	CPT	Pelvis "ap" Xr	30	21	$19.92	—	$8.00	$78.60	$17.97	2025-02-19
73620	CPT	Foot Left Xr	30	21	$24.42	—	$9.50	$64.96	$17.92	2025-02-19
73090	CPT	Forearm Left Xr	30	21	$29.22	—	$9.26	$64.96	$17.38	2025-02-19
93005	CPT	EKG Produccion	27	20	$58.90	—	$6.00	$80.00	$17.00	2025-02-19
82728	CPT	Ferritin	29	21	$30.00	—	$13.00	$40.00	$16.83	2025-02-19
80202	CPT	Vancomycin	29	21	$44.00	—	$12.92	$74.00	$16.72	2025-02-19
87804	CPT	Influenza	20	14	$70.00	—	$14.83	$52.00	$16.55	2025-02-19
80061	CPT	Lipid Panel	29	21	$45.00	—	$12.77	$45.00	$16.53	2025-02-19
80162	CPT	Digoxin (lanoxin) Total	29	21	$54.60	—	$12.66	$35.00	$16.39	2025-02-19
74018	CPT	Abdomen (abd) Xr	34	21	$19.92	—	$6.00	$64.96	$16.18	2025-02-19
84702	CPT	Beta Sub Unit (pregna) Qn Hcg	29	21	$50.00	—	$14.36	$60.00	$15.05	2025-02-19
80185	CPT	Phenytoin; Total	29	21	$29.00	—	$12.64	$45.00	$15.00	2025-02-19
82140	CPT	Ammonia	29	21	$32.00	—	$12.75	$40.00	$15.00	2025-02-19
J3465	HCPCS	V-fend 200mg Vial	15	11	$72.36	—	$0.97	$136.67	$14.38	2025-02-19
82553	CPT	Mb Fraction Only	29	21	$36.40	—	$11.01	$40.00	$14.26	2025-02-19
73020	CPT	Shoulder 1 View Left Xr	30	21	$24.42	—	$6.83	$64.96	$13.34	2025-02-19
86738	CPT	Antibody; Mycoplasma	25	18	$84.00	—	$12.63	$67.86	$13.24	2025-02-19
80053	CPT	Comprehensive Metabolic Panel	28	20	$80.00	—	$10.07	$55.00	$13.04	2025-02-19
71045	CPT	Chest Pa Portable Xr	30	21	$42.36	—	$7.00	$64.96	$13.02	2025-02-19
87040	CPT	Culture Blood Aerobic	29	21	$39.10	—	$9.85	$35.00	$12.74	2025-02-19
84484	CPT	Troponin Quan.	26	19	$110.00	—	$9.38	$65.00	$12.47	2025-02-19
85370	CPT	Fibrin(ogen) Quantitative	23	18	$25.00	—	$10.83	$34.00	$12.43	2025-02-19
83036	CPT	Hemoglobin; Glycosylated	29	21	$20.80	—	$9.25	$30.00	$11.99	2025-02-19
87045	CPT	Culture Feces	29	21	$39.10	—	$9.00	$28.00	$11.66	2025-02-19
83605	CPT	Lactate (lactic Acid)	25	18	$70.00	—	$10.19	$49.00	$11.57	2025-02-19
80069	CPT	Renal Function Panel	29	21	$150.00	—	$8.28	$70.00	$10.72	2025-02-19
J3243	HCPCS	Tygacil 50mg	13	10	$18.72	—	$0.63	$10.55	$10.55	2025-02-19
80048	CPT	Basic Metabolic Panel Ctotal	28	20	$70.60	—	$8.06	$40.00	$10.44	2025-02-19
87340	CPT	Hepatitis B Surf Ag (hbs Ag)	26	19	$23.00	—	$9.85	$33.00	$10.33	2025-02-19
80076	CPT	Hepatic Function Panel(liverp	29	21	$54.60	—	$7.79	$35.00	$10.09	2025-02-19
83550	CPT	Iron Binding Capacity (tibc)	29	21	$31.60	—	$8.34	$17.00	$10.00	2025-02-19
85378	CPT	Fibrin Degradation Prod Dimer	25	17	$16.00	—	$6.80	$48.00	$9.72	2025-02-19
87070	CPT	Culture Any Other Source	28	20	$39.10	—	$8.22	$30.00	$9.63	2025-02-19
84703	CPT	Beta Sub Unit (pregna) Ql Hcg	29	21	$18.00	—	$7.17	$25.00	$9.29	2025-02-19
87186	CPT	Antimicrobial Agent (mic)	22	18	$19.00	—	$3.00	$50.00	$8.65	2025-02-19
83735	CPT	Magnesium	29	21	$18.70	—	$6.38	$15.00	$8.27	2025-02-19
86156	CPT	Cold Agglutinin; Screen	28	21	$15.00	—	$6.38	$58.20	$8.17	2025-02-19
87076	CPT	Culture Anaerobic Isolate	25	18	$39.10	—	$5.00	$50.00	$8.08	2025-02-19
87086	CPT	Culture Urine	29	21	$39.10	—	$3.00	$32.00	$8.07	2025-02-19
82550	CPT	Cpk Total (creatine Kinase)	29	21	$37.00	—	$6.21	$20.00	$8.04	2025-02-19
82150	CPT	Amylase	29	21	$36.00	—	$6.18	$14.00	$8.00	2025-02-19
85025	CPT	Cbc	27	19	$25.00	—	$7.41	$11.57	$7.77	2025-02-19
J2020	HCPCS	Zyvox 600mg/300ml	13	10	$22.80	—	$2.98	$7.67	$7.67	2025-02-19
85730	CPT	Ptt (thromboplastin Time)	29	21	$25.85	—	$5.73	$14.00	$7.42	2025-02-19
86885	CPT	Coombs Test Indirect Ql	29	21	$44.00	—	$4.95	$20.00	$7.00	2025-02-19
83540	CPT	Iron	29	21	$23.50	—	$6.17	$14.00	$7.00	2025-02-19
83690	CPT	Lipase	28	20	$25.00	—	$6.00	$15.00	$6.89	2025-02-19
84030	CPT	Phenylalanine (pku), Blood	28	20	$105.00	—	$5.24	$130.00	$6.79	2025-02-19
87081	CPT	Culture Presump Screening Onl	25	18	$39.10	—	$6.32	$30.00	$6.63	2025-02-19
84460	CPT	Sgpt (transferase Alanine Ami	29	21	$30.00	—	$5.05	$10.00	$6.54	2025-02-19
83615	CPT	Ldh (lactate Dehydrigenas)	28	20	$30.00	—	$5.75	$10.00	$6.52	2025-02-19
84450	CPT	Sgot (transf Aspartate Amino)	29	21	$30.00	—	$4.94	$10.00	$6.39	2025-02-19
86901	CPT	Blood Typing; Rh (d)	29	21	$10.00	—	$2.85	$29.02	$6.00	2025-02-19
84300	CPT	Sodium; Urine	29	21	$16.10	—	$4.64	$8.00	$6.00	2025-02-19
84100	CPT	Phosphorus Inoganic	29	21	$18.70	—	$4.52	$10.00	$5.85	2025-02-19
82043	CPT	Albumin Urine; Microalbumin Qn	25	18	$13.00	—	$5.51	$70.00	$5.78	2025-02-19
84132	CPT	Potassium; Serum	29	21	$18.00	—	$4.38	$10.00	$5.68	2025-02-19
82248	CPT	Bilirubin; Direct	28	20	$47.00	—	$4.78	$12.00	$5.51	2025-02-19
86880	CPT	Coombs Test Direct	29	21	$30.00	—	$5.13	$30.39	$5.49	2025-02-19
86140	CPT	C-reactive Protein	29	21	$27.00	—	$3.90	$15.00	$5.18	2025-02-19
82570	CPT	Creatini Oth Source 24 Hr Uri	29	21	$12.00	—	$4.88	$12.00	$5.18	2025-02-19
82565	CPT	Creatinine;blood	29	21	$23.50	—	$4.89	$10.00	$5.12	2025-02-19
82247	CPT	Bilirubin; Total	28	20	$24.00	—	$4.78	$24.00	$5.02	2025-02-19
86592	CPT	Syphilis Test; Qual. (vdrl)	29	21	$15.50	—	$4.07	$12.00	$5.00	2025-02-19
84550	CPT	Uric Acid Blood	29	21	$20.00	—	$4.31	$10.00	$5.00	2025-02-19
82040	CPT	Albumin; Serum	29	21	$19.00	—	$1.50	$8.00	$4.95	2025-02-19
85610	CPT	Pt (prothrombin Time)	29	21	$25.85	—	$3.75	$12.00	$4.85	2025-02-19
82947	CPT	Glucose;quan,blood(except Re	29	21	$19.00	—	$3.74	$8.00	$4.85	2025-02-19
85002	CPT	Bleeding Time	26	19	$23.00	—	$2.00	$12.00	$4.82	2025-02-19
82009	CPT	Ketone Body Qual (acetone)	26	19	$14.00	—	$1.40	$6.40	$4.52	2025-02-19
82270	CPT	Blood Occult,qual,feces,1-3	26	19	$15.50	—	$3.00	$24.00	$4.38	2025-02-19
84520	CPT	Bun (urea Nitrogen) Serum	29	21	$21.40	—	$3.76	$10.00	$4.30	2025-02-19
89055	CPT	Fecal Leukocytes Quan Oe Semi	19	15	$12.10	—	$4.07	$10.00	$4.27	2025-02-19
85651	CPT	Sedimentation Rate (sed Rate)	29	21	$19.00	—	$3.38	$8.00	$4.27	2025-02-19
86900	CPT	Blood Typing; Abo	29	21	$30.80	—	$2.85	$35.53	$4.00	2025-02-19
81001	CPT	Urinalysis Automated W Microsc	28	20	$15.00	—	$3.02	$8.00	$3.69	2025-02-19
85014	CPT	Hematocrito	29	21	$8.50	—	$2.26	$6.55	$2.93	2025-02-19
85018	CPT	Hemoglobin	29	21	$8.50	—	$1.78	$6.55	$2.37	2025-02-19
81003	CPT	Urinalis Automat Without Microsc	26	19	$4.00	—	$1.95	$8.00	$2.25	2025-02-19
59610	CPT	Vag Del W/antp&post Wo W Epis	0	0	$1,410.24	—	—	—	—	2025-02-19
59510	CPT	C-section W Antpar&postpartum	0	0	$2,267.50	—	—	—	—	2025-02-19
59400	CPT	Vaginal Delivery With Ante&postp	0	0	$1,999.93	—	—	—	—	2025-02-19
743	MS_DRG	Uterine And Adnexa Procedures For Non-malignancy Without Comorbid Conditions (cc…	0	0	$8,970.53	—	—	—	—	2025-02-19

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