Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

HOSPITAL SAN ANTONIO INC

Mayaguez, PR · CCN 400136 · Rates published

1,184 distinct procedures filed
12 distinct payers
13,730 rate rows
2026-05-26 last MRF observed
Data quality

1,156 of 13,730 rate rows are consumer-grade (8.4%)

12,574 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
per-diem day rate — not a per-procedure price 12,529
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 36
placeholder amount (≤ $0.02) — excluded from medians 5
exceeds 10× this hospital's gross charge — excluded from medians 4
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.mayaguezmedicalsanantonio.com/wp-content/price-transparency/MMCSA%20Price%20Transparency.csv
Found on page https://www.mayaguezmedicalsanantonio.com/wp-content/price-transparency/
Discovered viaDiscovered by HANK (automated)
Last fetch success · 2026-10-07
Content fingerprint 90b2ae4fd009f1b5… · 3,986,503 bytes · first seen 2026-10-07

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
57059738
LOCAL 		Impella Cp Set 2 $1.00 $25,000.00 $12,500.50 —
250002001
LOCAL 		Novoseven 1 $10,800.00 $10,800.00 $10,800.00 —
100000000
LOCAL 		Semi Private (Case Rate) 1 $5,890.00 $5,890.00 $5,890.00 —
93613
CPT 		Eps 3d Mapping Without Cat 3 $0.01 $7,565.00 $5,456.43 nat. median
$2,857
1.9× median
93653
CPT 		Electrophysiology Ablat 8 $4,300.00 $6,395.00 $5,249.05 nat. median
$25,502
outlier · 0.2×
J2783
HCPCS 		Rasburicase 7.5mg Vial 6 $172.49 $5,528.00 $5,041.14 nat. median
$1,129
outlier · 4.5×
7015104
LOCAL 		Davinci Operating Room Use H/n 2 $5,000.00 $5,000.00 $5,000.00 —
57059946
LOCAL 		Cover Stent Papyrus-all Sizes 1 $2,850.00 $2,850.00 $2,850.00 —
250002663
LOCAL 		Andexxa 200mg Vial 7 $2,500.00 $2,500.00 $2,500.00 —
J3262
HCPCS 		Tocilizumab 400mg/20ml Vial 8 $2,305.80 $2,305.80 $2,305.80 nat. median
$1,287
1.8× median
J9312
HCPCS 		Rituximab 500 Mg/50 Ml Vial 8 $730.50 $3,652.48 $2,254.58 nat. median
$739
outlier · 3.1×
J3101
HCPCS 		Tenecteplase 50 Mg Kit 8 $1.00 $7,378.26 $2,245.39 nat. median
$498
outlier · 4.5×
93458
CPT 		Cath W/Njx Angio Img Si 9 $1,680.00 $2,976.75 $2,156.40 nat. median
$4,063
0.5× median
129000000
LOCAL 		Epilepsy Unit 1 $1,800.00 $1,800.00 $1,800.00 —
2212038
LOCAL 		Wallflex Stent Metalic 10/80 1 $1,650.00 $1,650.00 $1,650.00 —
J0897
HCPCS 		Xgeva 120mg/1.7ml Vial 3 $1.00 $3,239.55 $1,623.23 nat. median
$86
outlier · 18.9×
4444000018
LOCAL 		Laparascopy Cholecystectomy 8 $581.00 $3,901.37 $1,597.96 —
4444000017
LOCAL 		Laparascopy Appendectomy 8 $581.00 $3,697.76 $1,516.91 —
4444000020
LOCAL 		Laparascopy Hernia 8 $581.00 $3,697.76 $1,497.85 —
4444000550
LOCAL 		Surgery Mammoplasty 3 $1,100.00 $2,100.00 $1,496.50 —
95829
CPT 		Electrocorticogram At Surgery 1 $745.88 $1,965.44 $1,490.40 nat. median
$1,277
1.2× median
4444000016
LOCAL 		Surgery Thyroidectomy 7 $581.00 $2,205.00 $1,474.83 —
92978
CPT 		Ivus Inicial 8 $1,170.00 $2,023.00 $1,420.67 nat. median
$1,057
1.3× median
4444000021
LOCAL 		Laparascopy Hysterectomy 9 $581.00 $2,411.28 $1,412.88 —
4444000024
LOCAL 		Laparascopy Surgical 3 4 $850.00 $2,205.00 $1,369.71 —
4444000560
LOCAL 		Laparascopy Surgical Iii Ipd 1 $850.00 $2,205.00 $1,365.22 —
93531
CPT 		R&l Heart Cath Congenital 7 $383.62 $2,000.00 $1,291.01 nat. median
$4,000
outlier · 0.3×
93532
CPT 		R&l Heart Cath Congenital 7 $341.78 $2,066.00 $1,285.29 nat. median
$3,802
outlier · 0.3×
57006015
LOCAL 		Filtro Vena Cava 1 $1,245.00 $1,245.00 $1,245.00 —
4444000552
LOCAL 		Surgery Thyroid 2 $700.00 $1,653.75 $1,222.75 —
57001081
LOCAL 		Stent Protege 1 $1,210.00 $1,210.00 $1,210.00 —
92979
CPT 		Ivus Subsequent 6 $800.00 $1,375.00 $1,187.91 nat. median
$504
outlier · 2.4×
93533
CPT 		R&l Heart Cath Congenital 7 $91.94 $1,985.00 $1,158.73 nat. median
$2,937
outlier · 0.4×
4444000013
LOCAL 		Surgery One Day 10 $455.52 $2,687.06 $1,055.96 —
4444000023
LOCAL 		Laparascopy Surgical 2 4 $500.00 $1,595.00 $1,044.67 —
4444000559
LOCAL 		Laparascopy Surgical Ii Ipd 1 $500.00 $1,819.13 $995.35 —
4444000014
LOCAL 		Surgery Orthopedic 11 $455.52 $1,250.00 $990.64 —
4444000610
LOCAL 		Ambulatory Apc Proc Vi 1 $960.00 $960.00 $960.00 —
4444000022
LOCAL 		Laparascopy Surgical 1 4 $350.00 $1,595.00 $958.79 —
J3240
HCPCS 		Thyrogen 2 $724.00 $1,131.20 $927.60 nat. median
$2,804
outlier · 0.3×
81406
CPT 		Presenilin-1 DNA Sequence 2 $600.00 $1,200.00 $900.00 nat. median
$426
outlier · 2.1×
57059957
LOCAL 		F8006 Impra Graft 6mmx80cm 7 $895.00 $895.00 $895.00 —
174000000
LOCAL 		NICU 6 $719.00 $1,033.00 $877.92 —
93571
CPT 		Heart Flow Reserve Measure 8 $25.73 $3,142.13 $839.40 nat. median
$825
1.0× median
200000000
LOCAL 		Intensive Care Unit 9 $617.76 $1,067.00 $824.78 —
203000000
LOCAL 		Picu 1 $824.00 $824.00 $824.00 —
210000000
LOCAL 		Cardiac Intensive Unit 8 $617.76 $1,067.00 $800.38 —
4444000558
LOCAL 		Laparascopy Surgical I Ipd 1 $350.00 $1,488.38 $795.49 —
201000000
LOCAL 		Surgical Intensive Care Unit 9 $617.76 $1,036.00 $781.39 —
7015106
LOCAL 		Davinci Operating Room Use Gen 2 $653.00 $892.00 $775.33 —

Other procedures at this hospital

Browse this hospital's 1,184 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
             
57059738 LOCAL Impella Cp Set 3 2 $37,500.00 $37,500.00 $1.00 $25,000.00 $12,500.50 2026-05-26
250002001 LOCAL Novoseven 2 1 $32,400.00 $32,400.00 $10,800.00 $10,800.00 $10,800.00 2026-05-26
100000000 LOCAL Semi Private (Case Rate) 2 1 $0.01 $0.01 $5,890.00 $5,890.00 $5,890.00 2026-05-26
93613 CPT Eps 3d Mapping Without Cat 8 3 $500.00 $500.00 $0.01 $7,565.00 $5,456.43 2026-05-26
93653 CPT Electrophysiology Ablat 15 8 $5,000.00 $5,000.00 $4,300.00 $6,395.00 $5,249.05 2026-05-26
J2783 HCPCS Rasburicase 7.5mg Vial 12 6 $8,290.80 $8,290.80 $172.49 $5,528.00 $5,041.14 2026-05-26
7015104 LOCAL Davinci Operating Room Use H/n 3 2 $1,000.00 $1,000.00 $5,000.00 $5,000.00 $5,000.00 2026-05-26
57059946 LOCAL Cover Stent Papyrus-all Sizes 2 1 $2,892.75 $2,892.75 $2,850.00 $2,850.00 $2,850.00 2026-05-26
250002663 LOCAL Andexxa 200mg Vial 11 7 $3,750.00 $3,750.00 $2,500.00 $2,500.00 $2,500.00 2026-05-26
J3262 HCPCS Tocilizumab 400mg/20ml Vial 13 8 $3,458.70 $3,458.70 $2,305.80 $2,305.80 $2,305.80 2026-05-26
J9312 HCPCS Rituximab 500 Mg/50 Ml Vial 24 8 $7,046.40 $7,046.40 $730.50 $3,652.48 $2,254.58 2026-05-26
J3101 HCPCS Tenecteplase 50 Mg Kit 14 8 $8,792.81 $8,792.81 $1.00 $7,378.26 $2,245.39 2026-05-26
93458 CPT Cath W/Njx Angio Img Si 21 9 $2,500.00 $2,500.00 $1,680.00 $2,976.75 $2,156.40 2026-05-26
129000000 LOCAL Epilepsy Unit 2 1 $450.00 $450.00 $1,800.00 $1,800.00 $1,800.00 2026-05-26
2212038 LOCAL Wallflex Stent Metalic 10/80 2 1 $2,475.00 $2,475.00 $1,650.00 $1,650.00 $1,650.00 2026-05-26
J0897 HCPCS Xgeva 120mg/1.7ml Vial 7 3 $6,203.69 $6,203.69 $1.00 $3,239.55 $1,623.23 2026-05-26
4444000018 LOCAL Laparascopy Cholecystectomy 14 8 $1,500.00 $1,500.00 $581.00 $3,901.37 $1,597.96 2026-05-26
4444000017 LOCAL Laparascopy Appendectomy 13 8 $1,500.00 $1,500.00 $581.00 $3,697.76 $1,516.91 2026-05-26
4444000020 LOCAL Laparascopy Hernia 11 8 $1,500.00 $1,500.00 $581.00 $3,697.76 $1,497.85 2026-05-26
4444000550 LOCAL Surgery Mammoplasty 9 3 $2,500.00 $2,500.00 $1,100.00 $2,100.00 $1,496.50 2026-05-26
95829 CPT Electrocorticogram At Surgery 4 1 $1,014.00 $1,014.00 $745.88 $1,965.44 $1,490.40 2026-05-26
4444000016 LOCAL Surgery Thyroidectomy 14 7 $2,500.00 $2,500.00 $581.00 $2,205.00 $1,474.83 2026-05-26
92978 CPT Ivus Inicial 14 8 $2,200.00 $2,200.00 $1,170.00 $2,023.00 $1,420.67 2026-05-26
4444000021 LOCAL Laparascopy Hysterectomy 13 9 $1,500.00 $1,500.00 $581.00 $2,411.28 $1,412.88 2026-05-26
4444000024 LOCAL Laparascopy Surgical 3 10 4 $850.00 $850.00 $850.00 $2,205.00 $1,369.71 2026-05-26
4444000560 LOCAL Laparascopy Surgical Iii Ipd 5 1 $867.00 $867.00 $850.00 $2,205.00 $1,365.22 2026-05-26
93531 CPT R&l Heart Cath Congenital 12 7 $800.00 $800.00 $383.62 $2,000.00 $1,291.01 2026-05-26
93532 CPT R&l Heart Cath Congenital 12 7 $1,000.00 $1,000.00 $341.78 $2,066.00 $1,285.29 2026-05-26
57006015 LOCAL Filtro Vena Cava 2 1 $2,755.00 $2,755.00 $1,245.00 $1,245.00 $1,245.00 2026-05-26
4444000552 LOCAL Surgery Thyroid 6 2 $1,500.00 $1,500.00 $700.00 $1,653.75 $1,222.75 2026-05-26
57001081 LOCAL Stent Protege 2 1 $1,100.00 $1,100.00 $1,210.00 $1,210.00 $1,210.00 2026-05-26
92979 CPT Ivus Subsequent 12 6 $1,800.00 $1,800.00 $800.00 $1,375.00 $1,187.91 2026-05-26
93533 CPT R&l Heart Cath Congenital 12 7 $800.00 $800.00 $91.94 $1,985.00 $1,158.73 2026-05-26
4444000013 LOCAL Surgery One Day 17 10 $1,500.00 $1,500.00 $455.52 $2,687.06 $1,055.96 2026-05-26
4444000023 LOCAL Laparascopy Surgical 2 10 4 $500.00 $500.00 $500.00 $1,595.00 $1,044.67 2026-05-26
4444000559 LOCAL Laparascopy Surgical Ii Ipd 5 1 $510.00 $510.00 $500.00 $1,819.13 $995.35 2026-05-26
4444000014 LOCAL Surgery Orthopedic 18 11 $1,500.00 $1,500.00 $455.52 $1,250.00 $990.64 2026-05-26
4444000610 LOCAL Ambulatory Apc Proc Vi 2 1 $0.01 $0.01 $960.00 $960.00 $960.00 2026-05-26
4444000022 LOCAL Laparascopy Surgical 1 10 4 $350.00 $350.00 $350.00 $1,595.00 $958.79 2026-05-26
J3240 HCPCS Thyrogen 3 2 $5,475.00 $5,475.00 $724.00 $1,131.20 $927.60 2026-05-26
81406 CPT Presenilin-1 DNA Sequence 3 2 $100.00 $100.00 $600.00 $1,200.00 $900.00 2026-05-26
57059957 LOCAL F8006 Impra Graft 6mmx80cm 12 7 $1,342.50 $1,342.50 $895.00 $895.00 $895.00 2026-05-26
174000000 LOCAL NICU 11 6 $575.00 $575.00 $719.00 $1,033.00 $877.92 2026-05-26
93571 CPT Heart Flow Reserve Measure 19 8 $2,850.00 $2,850.00 $25.73 $3,142.13 $839.40 2026-05-26
200000000 LOCAL Intensive Care Unit 15 9 $700.00 $700.00 $617.76 $1,067.00 $824.78 2026-05-26
203000000 LOCAL Picu 2 1 $700.00 $700.00 $824.00 $824.00 $824.00 2026-05-26
210000000 LOCAL Cardiac Intensive Unit 14 8 $700.00 $700.00 $617.76 $1,067.00 $800.38 2026-05-26
4444000558 LOCAL Laparascopy Surgical I Ipd 5 1 $357.00 $357.00 $350.00 $1,488.38 $795.49 2026-05-26
201000000 LOCAL Surgical Intensive Care Unit 15 9 $700.00 $700.00 $617.76 $1,036.00 $781.39 2026-05-26
7015106 LOCAL Davinci Operating Room Use Gen 4 2 $12,500.00 $12,500.00 $653.00 $892.00 $775.33 2026-05-26
4444000015 LOCAL Surgery Same Day 18 11 $1,100.00 $1,100.00 $415.00 $1,065.00 $752.56 2026-05-26
206000000 LOCAL Telemetry 15 9 $650.00 $650.00 $480.52 $945.00 $743.52 2026-05-26
250002690 LOCAL Infliximab Inj 100 Mg 10 7 $718.25 $718.25 $718.25 $818.25 $729.36 2026-05-26
160000000 LOCAL Isolation 15 9 $600.00 $600.00 $480.52 $922.00 $721.40 2026-05-26
81401 CPT Huntington's Disease 4 3 $100.00 $100.00 $110.00 $1,400.00 $718.58 2026-05-26
120000000 LOCAL Semi Private 16 10 $450.00 $450.00 $455.52 $881.00 $707.22 2026-05-26
170000000 LOCAL Nursery 7 4 $500.00 $500.00 $600.00 $845.00 $697.83 2026-05-26
110000000 LOCAL Private 14 8 $600.00 $600.00 $455.52 $878.00 $688.72 2026-05-26
172000000 LOCAL NICU Ii 4 3 $575.00 $575.00 $603.00 $790.00 $685.33 2026-05-26
87903 CPT HIV Phenotype 7 5 $2,010.93 $2,010.93 $600.00 $853.00 $680.44 2026-05-26
J0570 HCPCS Bicillin L-a 1200000 Unit/2 2 1 $285.00 $285.00 $650.08 $650.08 $650.08 2026-05-26
119000000 LOCAL Private Room Pay 2 1 $1.00 $1.00 $644.00 $644.00 $644.00 2026-05-26
2001694 LOCAL Vascular Graft #6 Straigh 3 1 $1,397.25 $1,397.25 $635.71 $635.71 $635.71 2026-05-26
70549 CPT Angio Neck Wo/W Con 15 9 $325.00 $325.00 $487.50 $1,031.12 $634.05 2026-05-26
4444000608 LOCAL Ambulatory Apc Proc IV 2 1 $0.01 $0.01 $633.60 $633.60 $633.60 2026-05-26
73220 CPT Ue Nonjoint Rt Wo/w Con 17 10 $325.00 $325.00 $386.75 $1,025.08 $625.47 2026-05-26
71552 CPT Breast Rt Wo/W Con 16 10 $325.00 $325.00 $345.00 $1,188.12 $619.23 2026-05-26
73723 CPT Le Joint Lt Wo/w Con 16 10 $325.00 $325.00 $386.75 $963.46 $618.48 2026-05-26
73223 CPT Ue Joint Rt Wo/w Con 17 10 $325.00 $325.00 $338.00 $964.90 $616.78 2026-05-26
73720 CPT Foot Bi Wo/w Con 16 10 $325.00 $325.00 $386.75 $872.10 $608.53 2026-05-26
70546 CPT Angio Head Wo/W Con 16 10 $325.00 $325.00 $298.00 $992.20 $607.76 2026-05-26
72159 CPT Angio Spine Wo Con 16 9 $325.00 $325.00 $346.76 $837.54 $605.95 2026-05-26
73722 CPT Le Joint Lt W Con 16 10 $325.00 $325.00 $391.77 $783.30 $605.28 2026-05-26
74183 CPT Kidney Wo/w Con 17 11 $325.00 $325.00 $438.00 $875.68 $603.72 2026-05-26
73219 CPT Ue Nonjoint Bi W Con 16 10 $325.00 $325.00 $289.00 $826.80 $600.40 2026-05-26
P9055 HCPCS Platelets Leuko Red Cmv Neg 2 1 $600.00 $600.00 $600.00 $600.00 $600.00 2026-05-26
P9053 HCPCS Platelets Phe Leuko Red 2 1 $600.00 $600.00 $600.00 $600.00 $600.00 2026-05-26
70336 CPT Tmj Wo Con 16 10 $325.00 $325.00 $309.15 $698.72 $597.07 2026-05-26
72198 CPT Angio Pelvis Wo/w Con 17 9 $325.00 $325.00 $410.93 $821.60 $596.09 2026-05-26
70548 CPT Angio Neck W Con 15 9 $325.00 $325.00 $331.62 $775.00 $596.02 2026-05-26
74185 CPT Angio Abdomen Wo/w Con 17 10 $325.00 $325.00 $413.47 $826.68 $596.00 2026-05-26
72197 CPT Sacrum Wo/w Con 16 10 $325.00 $325.00 $262.00 $873.50 $595.16 2026-05-26
73222 CPT Ue Joint Lt W Con 16 10 $325.00 $325.00 $272.00 $778.22 $594.41 2026-05-26
70553 CPT Head Wo/W Con 16 10 $325.00 $325.00 $233.00 $775.00 $584.66 2026-05-26
74182 CPT Kidney W Con 16 10 $325.00 $325.00 $236.00 $785.40 $584.61 2026-05-26
71555 CPT Angio Chest W Con 16 10 $325.00 $325.00 $409.84 $819.42 $582.01 2026-05-26
71551 CPT Breast Lt W Con 17 10 $325.00 $325.00 $281.00 $937.64 $580.37 2026-05-26
70543 CPT Orbits Face Neck Wo/w Con 18 10 $325.00 $325.00 $248.00 $827.88 $578.04 2026-05-26
70542 CPT Neck W Con 17 10 $325.00 $325.00 $198.00 $775.00 $573.88 2026-05-26
70552 CPT Head W Con 16 10 $325.00 $325.00 $230.00 $775.00 $572.67 2026-05-26
P9052 HCPCS Platelets Hla Matchleuko Red 2 1 $572.00 $572.00 $572.00 $572.00 $572.00 2026-05-26
87633 CPT Respiratory Panel 5 4 $1,715.16 $1,715.16 $560.00 $575.00 $569.61 2026-05-26
70545 CPT Venography Head W Con 18 10 $325.00 $325.00 $190.00 $775.00 $567.41 2026-05-26
57007880 LOCAL 25058 Flixene Graft 6mmx50cm 14 8 $849.11 $849.11 $566.07 $566.07 $566.07 2026-05-26
P9034 HCPCS Platelets Pheresis Sing Donor 13 5 $750.00 $750.00 $450.00 $997.50 $565.91 2026-05-26
71550 CPT Breast Lt Wo Con 19 10 $325.00 $325.00 $308.80 $851.56 $564.77 2026-05-26
73218 CPT Ue Nonjoint Lt Wo Con 16 10 $325.00 $325.00 $182.00 $752.32 $562.73 2026-05-26
72196 CPT Sacrum W Con 16 10 $325.00 $325.00 $285.64 $775.00 $559.87 2026-05-26
70547 CPT Angio Neck Wo Con 16 10 $325.00 $325.00 $296.18 $675.56 $558.90 2026-05-26
74181 CPT Kidney Wo Con 16 10 $325.00 $325.00 $289.59 $650.00 $558.65 2026-05-26
73225 CPT Angio Ue Lt Wo/W Con 16 10 $325.00 $325.00 $240.00 $836.86 $556.17 2026-05-26
93505 CPT Endomyocardial Biopsy 2 1 $1,083.71 $1,083.71 $555.24 $555.24 $555.24 2026-05-26
4444000556 LOCAL Biopsy Add Lesion 7 2 $350.00 $350.00 $137.59 $892.50 $551.85 2026-05-26
70544 CPT Venography Head Wo Con 17 10 $325.00 $325.00 $178.00 $671.94 $544.24 2026-05-26
73721 CPT Le Joint Lt Wo Con 17 11 $325.00 $325.00 $170.00 $665.44 $542.37 2026-05-26
73221 CPT Ue Joint Lt Wo Con 16 10 $325.00 $325.00 $170.00 $665.44 $540.23 2026-05-26
70540 CPT Neck Wo Con 18 10 $325.00 $325.00 $195.00 $650.00 $538.83 2026-05-26
87507 CPT Human Rhinovirus/ Enterovirus 3 2 $100.00 $100.00 $500.00 $571.72 $535.86 2026-05-26
70551 CPT Head Wo Con 16 10 $325.00 $325.00 $166.00 $650.00 $533.42 2026-05-26
4444000566 LOCAL Ambulatory Surgical Minor 5 2 $1.00 $1.00 $250.00 $837.90 $530.73 2026-05-26
73725 CPT Angio Le Bi Wo Con 17 10 $325.00 $325.00 $345.60 $822.32 $529.64 2026-05-26
J1670 HCPCS Tetanus Immune Globulin/Pf 250 11 8 $912.60 $912.60 $526.86 $534.14 $527.59 2026-05-26
72195 CPT Sacrum Wo Con 16 10 $325.00 $325.00 $216.00 $650.00 $523.85 2026-05-26
P9035 HCPCS Platelets Pheresis Leuk Red Ea 17 8 $662.50 $662.50 $1.00 $709.38 $495.57 2026-05-26
4444000607 LOCAL Ambulatory Apc Proc Iii 2 1 $0.01 $0.01 $492.00 $492.00 $492.00 2026-05-26
150000000 LOCAL ER Ward 16 10 $450.00 $450.00 $329.00 $750.00 $486.83 2026-05-26
J1561 HCPCS Immunoglobulina 10gm 100 Ml Vi 4 2 $1,472.70 $1,472.70 $58.65 $685.00 $476.22 2026-05-26
J3490 HCPCS Remdesivir 100mg Vial 42 9 $1,296.98 $1,296.98 $1.00 $952.00 $442.75 2026-05-26
81403 CPT Hemophilic DNA Mutation Screen 7 4 $100.00 $100.00 $185.20 $550.00 $432.32 2026-05-26
81220 CPT Cystic Fibrosis Specimen 6 3 $500.00 $500.00 $156.00 $700.00 $428.92 2026-05-26
74178 CPT Abdomen Pelvis Wo/W Con 16 10 $175.00 $175.00 $214.00 $722.84 $426.91 2026-05-26
36000189 LOCAL Total Tilt Top 8 4 $637.50 $637.50 $425.00 $425.00 $425.00 2026-05-26
74177 CPT Abdomen Pelvis W Con 17 11 $175.00 $175.00 $275.00 $638.16 $421.89 2026-05-26
250002051 LOCAL Inflectra 100mg Vial 3 2 $1,419.42 $1,419.42 $90.84 $722.34 $406.59 2026-05-26
J2997 HCPCS Alteplase 50 Mg Vial 15 9 $6,600.27 $6,600.27 $1.00 $5,410.28 $397.69 2026-05-26
57059947 LOCAL 50s06c Impra Graft Str 6mmx50c 8 4 $591.00 $591.00 $394.00 $394.00 $394.00 2026-05-26
P9037 HCPCS Platelets Phere Leuko Red Irra 7 3 $800.00 $800.00 $1.00 $600.00 $385.61 2026-05-26
81400 CPT Interleukin 8 7 4 $100.00 $100.00 $63.96 $550.00 $383.79 2026-05-26
7031625 LOCAL Bronchoscopy W/Biopsy(S) 2 1 $228.52 $228.52 $375.00 $375.00 $375.00 2026-05-26
97597 CPT Wound Care Initial 7 5 $500.00 $500.00 $72.21 $500.00 $372.04 2026-05-26
74176 CPT Guided Nephrostomy 22 11 $175.00 $175.00 $159.12 $664.18 $371.21 2026-05-26
P9058 HCPCS Rbc Leuko Red Cmv Neg 2 1 $365.00 $365.00 $365.00 $365.00 $365.00 2026-05-26
74174 CPT Angio Renal Bi 16 10 $562.50 $562.50 $150.00 $794.48 $359.86 2026-05-26
P9039 HCPCS Red Blood Cells Degly Ea 2 1 $350.00 $350.00 $350.00 $350.00 $350.00 2026-05-26
74175 CPT Angio Celiac 21 10 $412.50 $412.50 $150.00 $650.00 $346.24 2026-05-26
95807 CPT G Sleep Study 10 5 $351.41 $351.41 $258.00 $472.68 $346.11 2026-05-26
J1410 HCPCS Premarin 25 Mg Vial 5 2 $218.22 $218.22 $326.70 $349.38 $343.71 2026-05-26
250001976 LOCAL Filgrastin 480 Mcg 3 2 $599.84 $599.84 $342.73 $342.73 $342.73 2026-05-26
J1569 HCPCS Immunoglobulina 5gm 50ml Vial 11 3 $4,742.25 $4,742.25 $1.00 $1,580.80 $342.41 2026-05-26
81200 CPT Canavan Disease 3 2 $500.00 $500.00 $100.00 $576.00 $338.00 2026-05-26
73206 CPT Angio Ue Bi 21 10 $485.00 $485.00 $150.00 $671.50 $336.67 2026-05-26
73706 CPT Angio Le Bi CT 22 10 $425.00 $425.00 $150.00 $727.98 $335.08 2026-05-26
72191 CPT Angio Pelvis 20 10 $412.50 $412.50 $150.00 $625.82 $328.34 2026-05-26
87912 CPT Hepatitis B (Hbv) Genotype 3 2 $50.00 $50.00 $300.00 $353.15 $326.57 2026-05-26
J0714 HCPCS Ceftazidime/Avibactam 2.5 Gm V 6 2 $589.55 $589.55 $86.11 $382.07 $322.88 2026-05-26
71275 CPT Angio Thoracic W Serial 22 10 $412.50 $412.50 $150.00 $614.22 $317.48 2026-05-26
250000421 LOCAL Cuprimine 250 Mg Capsule 5 2 $392.84 $392.84 $316.00 $316.00 $316.00 2026-05-26
72126 CPT Cervical Spine W Con CT 16 10 $175.00 $175.00 $178.50 $698.72 $315.20 2026-05-26
70496 CPT Angio Head 19 10 $412.50 $412.50 $137.50 $600.00 $312.91 2026-05-26
70498 CPT Angio Neck 21 10 $412.50 $412.50 $121.28 $600.00 $312.54 2026-05-26
P9056 HCPCS Whole Blood Leuko Red Irra 2 1 $310.00 $310.00 $310.00 $310.00 $310.00 2026-05-26
P9051 HCPCS Whole Blood Or Rbc Leuko Reduc 2 1 $300.00 $300.00 $310.00 $310.00 $310.00 2026-05-26
73202 CPT Elbow Lt Wo/W Con CT 16 10 $175.00 $175.00 $148.75 $568.98 $300.19 2026-05-26
72130 CPT Thoracic Spine Wo/W Con CT 16 10 $175.00 $175.00 $167.00 $556.62 $300.18 2026-05-26
72133 CPT Lumbar Spine Wo/W Con CT 16 10 $175.00 $175.00 $166.00 $551.54 $299.60 2026-05-26
93306 CPT Echo Transthoracic Complete 17 10 $400.00 $400.00 $150.44 $490.28 $299.49 2026-05-26
87902 CPT Hcv Genotype 13 8 $1,059.45 $1,059.45 $190.00 $365.00 $298.82 2026-05-26
73702 CPT Lower Leg Lt Wo/w Con CT 17 10 $175.00 $175.00 $148.75 $561.74 $298.72 2026-05-26
250002673 LOCAL Risperdalconsta 12.5mg Kit 2 1 $446.07 $446.07 $297.38 $297.38 $297.38 2026-05-26
95827 CPT EEG All Night Recording 4 1 $564.00 $564.00 $63.18 $644.54 $293.63 2026-05-26
72194 CPT Hip Lt Wo/W Con CT 16 10 $175.00 $175.00 $160.00 $532.74 $292.65 2026-05-26
72127 CPT Cervical Spine Wo/W Con CT 16 10 $175.00 $175.00 $166.00 $553.00 $292.58 2026-05-26
72129 CPT Thoracic Spine W Con CT 16 10 $175.00 $175.00 $178.50 $468.94 $292.17 2026-05-26
72132 CPT Lumbar Spine W Con CT 16 10 $175.00 $175.00 $178.50 $466.76 $291.96 2026-05-26
71270 CPT Chest Wo/W Con CT 16 10 $175.00 $175.00 $178.50 $481.86 $290.13 2026-05-26
74170 CPT Abdomen Wo/W Con CT 16 10 $175.00 $175.00 $161.00 $537.68 $289.88 2026-05-26
73201 CPT Elbow Rt W Con CT 17 10 $175.00 $175.00 $137.00 $455.92 $288.85 2026-05-26
73701 CPT Le Lt W Con 17 10 $175.00 $175.00 $135.07 $462.44 $285.29 2026-05-26
71260 CPT Chest W Con CT 17 11 $175.00 $175.00 $178.50 $402.22 $284.85 2026-05-26
73200 CPT Hand Lt Wo Con CT 19 11 $175.00 $175.00 $163.63 $405.08 $283.67 2026-05-26
70492 CPT Soft Tissue Neck Wo/W Con 16 10 $175.00 $175.00 $182.00 $501.28 $282.54 2026-05-26
72193 CPT Hip Lt W Con CT 16 10 $175.00 $175.00 $178.50 $462.44 $282.19 2026-05-26
74160 CPT Abdomen W Con CT 16 10 $175.00 $175.00 $178.50 $472.52 $279.02 2026-05-26
70490 CPT Soft Tissue Neck Wo Con 16 10 $175.00 $175.00 $163.63 $550.00 $275.60 2026-05-26
70488 CPT Facial Bones Wo/W Con 16 10 $175.00 $175.00 $126.00 $418.14 $275.49 2026-05-26
70491 CPT Soft Tissue Neck W Con 16 10 $175.00 $175.00 $178.50 $415.88 $273.77 2026-05-26
P9072 HCPCS Platelets Pher Patho Red Rapid 5 3 $706.04 $706.04 $150.00 $641.85 $272.96 2026-05-26
70460 CPT Head/Brain W Con CT 16 10 $175.00 $175.00 $167.15 $350.00 $269.86 2026-05-26
70487 CPT Tmj Bi W Con 20 10 $175.00 $175.00 $171.50 $350.00 $268.94 2026-05-26
72128 CPT Thoracic Spine Wo Con CT 16 10 $175.00 $175.00 $163.63 $369.76 $268.39 2026-05-26
70470 CPT Head/Brain Wo/W Con CT 16 10 $175.00 $175.00 $118.00 $392.04 $266.61 2026-05-26
72131 CPT Lumbar Spine Wo Con CT 17 11 $175.00 $175.00 $163.63 $368.30 $263.43 2026-05-26
72125 CPT Cervical Spine Wo Con CT 17 11 $175.00 $175.00 $163.63 $377.68 $262.65 2026-05-26
71250 CPT Thoracic Post Myelogram 20 11 $175.00 $175.00 $150.00 $333.40 $262.36 2026-05-26
72192 CPT Renal Wo Con 19 10 $175.00 $175.00 $149.40 $457.00 $261.18 2026-05-26
70450 CPT Head/Brain Wo Con CT 17 11 $175.00 $175.00 $118.65 $327.26 $260.88 2026-05-26
70486 CPT Tmj Lt Wo Con 20 11 $175.00 $175.00 $142.58 $325.00 $257.19 2026-05-26
250002076 LOCAL Syprine 250 Mg Cap 3 1 $385.12 $385.12 $256.75 $256.75 $256.75 2026-05-26
93318 CPT Tee 2d Monitoring 13 7 $250.00 $250.00 $46.48 $469.57 $250.15 2026-05-26
74150 CPT Biopsy Abdomen Percutaneous 18 10 $175.00 $175.00 $150.00 $306.54 $248.91 2026-05-26
70482 CPT Sella Turcica Wo/w Con 20 10 $175.00 $175.00 $20.00 $615.22 $246.42 2026-05-26
P9016 HCPCS Red Blood Cell Leukoc Reduc Ea 17 10 $455.00 $455.00 $209.80 $280.00 $246.01 2026-05-26
J2355 HCPCS Neumega 5 Mg Vial 2 1 $661.16 $661.16 $245.80 $245.80 $245.80 2026-05-26
P9021 HCPCS Red Blood Cells Ea Unit 23 10 $300.00 $300.00 $175.00 $633.50 $242.77 2026-05-26
95813 CPT EEG Ext Monitoring Over 60 Min 5 2 $322.00 $322.00 $120.00 $416.77 $242.19 2026-05-26
73700 CPT Lower Extremity CT Scanogram 21 10 $364.00 $364.00 $30.00 $368.30 $240.93 2026-05-26
81225 CPT Cyp2c19 Genotype 3 2 $500.00 $500.00 $185.00 $293.40 $239.20 2026-05-26
87901 CPT HIV DNA (Pcr) Antibody 10 6 $50.00 $50.00 $19.84 $364.64 $236.62 2026-05-26
P9022 HCPCS Red Blood Cells Washed Ea Unit 7 3 $435.00 $435.00 $203.73 $290.00 $232.49 2026-05-26
2000172 LOCAL Surgipro Hernia-mate Plug 5mpl 2 1 $239.99 $239.99 $230.00 $230.00 $230.00 2026-05-26
70481 CPT Sella Turcica W Con 25 10 $424.50 $424.50 $20.00 $564.52 $229.75 2026-05-26
93312 CPT Tee 2d W/wo M Mode Rec 23 9 $341.79 $341.79 $115.00 $490.00 $224.92 2026-05-26
250002561 LOCAL Fetroja 1 Gm Vial 6 2 $298.86 $298.86 $222.76 $222.76 $222.76 2026-05-26
250001975 LOCAL Filgrastin 300mcg 3 2 $374.79 $374.79 $219.71 $219.71 $219.71 2026-05-26
P9031 HCPCS Platelets Leuko Reduced Ea 6 4 $225.00 $225.00 $100.45 $531.91 $215.41 2026-05-26
P9010 HCPCS Whole Blood (Pinta De Sangre) 9 4 $330.00 $330.00 $150.00 $240.00 $209.50 2026-05-26
90947 CPT Dialysis Subsequent 5 2 $250.00 $250.00 $200.00 $225.00 $208.75 2026-05-26
93350 CPT Echo Stress Exercise 14 8 $314.60 $314.60 $147.96 $300.00 $208.60 2026-05-26
2002086 LOCAL Lentes Intraoculares 4 2 $300.00 $300.00 $200.00 $225.00 $208.33 2026-05-26
2000324 LOCAL Lente Intraocular Cilco 4 2 $646.87 $646.87 $200.00 $225.00 $208.33 2026-05-26
90945 CPT Dialysis Initial 10 4 $250.00 $250.00 $170.00 $252.00 $206.50 2026-05-26
90940 CPT Hemodialysis Access Flow 4 1 $250.00 $250.00 $200.00 $210.00 $203.33 2026-05-26
70480 CPT Sella Turcica Wo Con 29 11 $175.00 $175.00 $20.00 $476.86 $202.60 2026-05-26
90935 CPT Hemodialysis Initial 10 5 $388.00 $388.00 $100.00 $388.00 $198.67 2026-05-26
97598 CPT Wound Care Subsequent 7 5 $300.00 $300.00 $43.88 $300.00 $198.15 2026-05-26
93975 CPT Duplex Scan Abd/Pelvic/Scrotal 6 3 $242.50 $242.50 $140.00 $310.31 $197.18 2026-05-26
76510 CPT Ophthalmic B&a Same Encount 15 9 $325.00 $325.00 $44.00 $281.56 $196.04 2026-05-26
93925 CPT Arterial Duplex Le Bi 15 9 $231.59 $231.59 $125.00 $277.89 $194.49 2026-05-26
93890 CPT Transcranial Dop Vaso React 12 6 $261.36 $261.36 $108.95 $312.34 $193.15 2026-05-26
95812 CPT EEG Ext Monitoring 41-60 Min 5 2 $297.00 $297.00 $88.20 $331.74 $187.28 2026-05-26
93886 CPT Transcranial Doppler 22 10 $229.91 $229.91 $100.00 $311.52 $186.02 2026-05-26
95816 CPT EEG Recording Awake/drowsy 20 10 $392.00 $392.00 $35.00 $433.71 $184.09 2026-05-26
J1610 HCPCS Glucagon 1 Mg Kit 9 5 $421.20 $421.20 $182.85 $182.85 $182.85 2026-05-26
76825 CPT OB Fetal Echo 16 10 $350.00 $350.00 $63.00 $573.72 $180.05 2026-05-26
90937 CPT Hemodialysis Subsequent 10 5 $250.00 $250.00 $110.00 $210.00 $179.78 2026-05-26
87900 CPT HIV Genotype 3 2 $50.00 $50.00 $175.00 $178.80 $176.90 2026-05-26
93892 CPT Transcranial Dop Embo Wo Mb 11 5 $275.12 $275.12 $115.62 $325.73 $176.35 2026-05-26
93980 CPT Duplex Av Flow Penis Comp 13 7 $266.64 $266.64 $127.80 $308.78 $175.13 2026-05-26
95822 CPT EEG Recording Coma Or Sleep 9 4 $277.00 $277.00 $70.00 $391.92 $172.85 2026-05-26
87631 CPT Resp Sync Vir Pcr 5 3 $200.00 $200.00 $158.38 $176.34 $170.26 2026-05-26
P9033 HCPCS Platelets Leuko Irradiated Ea 2 1 $225.00 $225.00 $170.00 $170.00 $170.00 2026-05-26
93893 CPT Transcranial Dop Embo W Mb 12 6 $275.12 $275.12 $107.00 $325.73 $169.90 2026-05-26
93970 CPT Venous Duplex Ue Bi 22 9 $200.88 $200.88 $117.00 $220.04 $169.55 2026-05-26
86930 CPT Frozen Blood Freezing 5 2 $1.00 $1.00 $35.00 $213.53 $168.90 2026-05-26
93224 CPT Holter Recording 48 Hrs 24 10 $150.00 $150.00 $51.85 $253.38 $168.17 2026-05-26
86965 CPT Terapeutic Apheresis 8 5 $257.50 $257.50 $1.00 $600.00 $167.00 2026-05-26
93880 CPT Carotid Duplex Bi 16 10 $211.30 $211.30 $100.00 $251.60 $164.99 2026-05-26
86890 CPT Autologous Blood Or Component 13 8 $273.75 $273.75 $25.00 $250.00 $164.44 2026-05-26
72270 CPT Myelogram Spine Total 15 10 $325.00 $325.00 $95.56 $355.50 $164.28 2026-05-26
93660 CPT G Tilt Table Test 12 6 $191.78 $191.78 $122.92 $337.84 $164.13 2026-05-26
92960 CPT Cardioversion Elective Arrhyt 12 6 $165.00 $165.00 $25.88 $429.98 $163.51 2026-05-26
95819 CPT G Electroencephalogram 19 10 $443.00 $443.00 $50.74 $435.05 $162.43 2026-05-26
6610016 LOCAL Uso Se Pediatrica Trauma 12 9 $129.37 $129.37 $112.00 $241.00 $161.56 2026-05-26
95830 CPT EEG Sphenoidal Electrodes 5 2 $146.00 $146.00 $94.83 $278.00 $159.21 2026-05-26
402000207 LOCAL Venous Mapping Bypass 4 2 $1.00 $1.00 $129.00 $203.14 $158.12 2026-05-26
6610015 LOCAL Uso Se Pediatrica Aguda Enfe 11 8 $129.37 $129.37 $112.00 $200.00 $157.22 2026-05-26
93015 CPT Stress Test W/sup, Int & Rep 25 10 $301.13 $301.13 $51.11 $307.12 $154.60 2026-05-26
76811 CPT OB Level 2 19 9 $250.00 $250.00 $39.00 $377.02 $151.65 2026-05-26
93978 CPT Duplex Aorta 13 7 $186.69 $186.69 $120.00 $216.22 $150.86 2026-05-26
93930 CPT Arterial Duplex Ue Bi 14 8 $187.76 $187.76 $100.00 $216.78 $150.41 2026-05-26
P9038 HCPCS Red Blood Cells Irrad Ea 3 2 $200.00 $200.00 $30.00 $268.00 $149.00 2026-05-26
250002616 LOCAL Surgiflo Syr Kit 4 2 $147.61 $147.61 $147.61 $147.61 $147.61 2026-05-26
P9023 HCPCS Plasma Pooled Mult Donor 9 4 $225.00 $225.00 $1.00 $600.00 $139.62 2026-05-26
93307 CPT Echo Limited 21 8 $250.00 $250.00 $13.48 $300.00 $138.58 2026-05-26
72240 CPT Myelogram Spine Cervical 15 10 $250.00 $250.00 $59.50 $268.50 $138.24 2026-05-26
93924 CPT Physiologyc Studies Doppler 7 3 $152.25 $152.25 $105.30 $194.21 $137.77 2026-05-26
76813 CPT OB 1t Fetal Nuc Measure 14 8 $250.00 $250.00 $39.00 $251.42 $136.71 2026-05-26
76812 CPT OB Add Gestation Level 2 18 9 $175.00 $175.00 $40.00 $421.34 $136.62 2026-05-26
72255 CPT Myelogram Spine Thoracic 14 9 $250.00 $250.00 $64.36 $249.00 $132.66 2026-05-26
P9011 HCPCS Blood Split Unit 10 5 $390.00 $390.00 $1.00 $260.00 $132.27 2026-05-26
J1573 HCPCS Hyperhep B Inmunoglubulin 0.5m 3 2 $138.98 $138.98 $92.65 $171.84 $132.25 2026-05-26
J3243 HCPCS Tigecycline 50 Mg Vial 11 6 $27.90 $27.90 $2.00 $156.50 $130.40 2026-05-26
76706 CPT Abdominal Aortic Aneurysm 14 9 $100.94 $100.94 $80.00 $501.88 $130.03 2026-05-26
86710 CPT Influenza Ab Antibody Quantita 2 1 $30.00 $30.00 $130.00 $130.00 $130.00 2026-05-26
P9032 HCPCS Platelets Irradiated Ea 2 1 $150.00 $150.00 $130.00 $130.00 $130.00 2026-05-26
70010 CPT Myelogram Brain 13 8 $250.00 $250.00 $34.76 $270.00 $129.30 2026-05-26
72265 CPT Myelogram Spine Lumbosacral 15 10 $225.00 $225.00 $80.50 $234.00 $128.88 2026-05-26
91112 CPT Colon Transit Study Xr 3 1 $250.00 $250.00 $7.00 $250.00 $128.50 2026-05-26
93990 CPT Hemodialysis Access 10 5 $246.60 $246.60 $100.18 $193.38 $127.20 2026-05-26
93503 CPT Pulmonary Artery Catheter Ins 11 6 $150.00 $150.00 $78.00 $415.67 $125.81 2026-05-26
250001998 LOCAL Bridion 200mg/2 Ml 4 3 $172.04 $172.04 $125.25 $125.25 $125.25 2026-05-26
81240 CPT Factor Ii(Prothrombin) DNA Ana 10 5 $199.50 $199.50 $53.57 $200.00 $122.70 2026-05-26
87536 CPT HIV-1 RNA (Pcr) 14 9 $350.19 $350.19 $75.00 $190.00 $121.48 2026-05-26
93923 CPT Tcom Ue Multi Level 16 9 $152.37 $152.37 $77.00 $171.60 $120.75 2026-05-26
82731 CPT Fetal Fibronectin 12 7 $265.08 $265.08 $26.20 $192.94 $120.57 2026-05-26
J1110 HCPCS Dhe 45 1mg/Ml Ampul 2 1 $42.00 $42.00 $119.79 $119.79 $119.79 2026-05-26
93320 CPT Echo Doppler Complete 15 9 $156.20 $156.20 $36.98 $300.00 $119.48 2026-05-26
80307 CPT Urine Drug Screen 9 7 $285.00 $285.00 $19.00 $285.00 $118.98 2026-05-26
81241 CPT Factor V Leiden Mutation 11 6 $251.46 $251.46 $15.00 $200.00 $118.96 2026-05-26
76776 CPT Renal Transplant W Dop 16 9 $150.00 $150.00 $70.00 $323.54 $118.46 2026-05-26
S3620 HCPCS Neonatal Screening 9 5 $163.50 $163.50 $107.00 $138.00 $117.56 2026-05-26
J3489 HCPCS Zometa 4 Mg/100 Ml Piggyback 3 2 $540.00 $540.00 $14.40 $219.39 $116.89 2026-05-26
99284 CPT Uso Sala Emergencia - Trauma 26 10 $275.00 $275.00 $8.78 $241.00 $116.89 2026-05-26
96369 CPT Subcut Inf Init 1hr W/Pum Set 2 1 $116.55 $116.55 $116.55 $116.55 $116.55 2026-05-26
76826 CPT OB Fetal Echo F/u 14 8 $125.00 $125.00 $59.00 $338.72 $114.76 2026-05-26
93931 CPT Arterial Duplex Ue Rt 16 7 $111.79 $111.79 $73.13 $159.55 $112.04 2026-05-26
93325 CPT Doppler Color Flow 15 9 $400.00 $400.00 $23.20 $300.00 $111.08 2026-05-26
76800 CPT Sma 16 10 $150.00 $150.00 $70.00 $299.94 $110.37 2026-05-26
93888 CPT Transcranial Doppler Limitd 16 7 $133.35 $133.35 $69.39 $154.44 $110.21 2026-05-26
2002937 LOCAL Ultrapro Umm3 Monocryl Prolene 2 1 $200.00 $200.00 $110.00 $110.00 $110.00 2026-05-26
92950 CPT Cpr 26 7 $400.00 $400.00 $19.50 $282.41 $109.91 2026-05-26
76377 CPT 3d Rendering W Post Process 15 9 $225.00 $225.00 $33.23 $191.80 $107.93 2026-05-26
76831 CPT Sonohysterography 15 9 $200.00 $200.00 $70.00 $246.70 $107.42 2026-05-26
81291 CPT Methylenetetrahydrofolate Redu 7 5 $179.64 $179.64 $47.52 $350.00 $107.05 2026-05-26
87502 CPT Influenza Pcr 5 3 $200.00 $200.00 $100.00 $116.73 $105.45 2026-05-26
93308 CPT Echo Transthoracic Limited 14 8 $129.34 $129.34 $35.00 $300.00 $105.33 2026-05-26
73580 CPT Arthrogram Knee Lt 15 10 $175.00 $175.00 $15.75 $239.56 $104.79 2026-05-26
74240 CPT Upper Gi W Gastrografin 27 11 $175.00 $175.00 $63.00 $262.14 $104.09 2026-05-26
76830 CPT Transvaginal 16 10 $150.00 $150.00 $40.00 $251.80 $103.72 2026-05-26
76700 CPT Abdomen Complete 19 11 $145.00 $145.00 $70.00 $252.46 $103.44 2026-05-26
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