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

HANS P PETERSON MEMORIAL HOSPITAL - CAH

Philip, SD · CCN 431319 · Rates published

1,665 distinct procedures filed
4 distinct payers
9,637 rate rows
2024-07-01 last MRF observed · ⚠ 27 mo old
Data quality

9,614 of 9,637 rate rows are consumer-grade (99.8%)

23 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
placeholder amount (≤ $0.02) — excluded from medians 23

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 27 months old.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://www.philiphealthservices.com/460361016_Philip-Health-Services-Inc_standardcharges.csv
Found on page https://www.philiphealthservices.com/about-us/pricing-transparency/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-31
Content fingerprint f1daea8018e02d4c… · 4,964,497 bytes · first seen 2026-05-17

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
J1930
HCPCS 		Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe 4 $25,867.42 $28,519.76 $27,806.76 nat. median
$5,088
outlier · 5.5×
J2353
HCPCS 		Octreotide Microspheres ER 30 Mg Intramuscular Susp Extended Release 4 $18,340.01 $20,220.52 $19,715.01 nat. median
$5,573
outlier · 3.5×
J2506
HCPCS 		Pegfilgrastim 6 Mg/0.6 Ml Subcutaneous Syringe 4 $17,369.61 $19,150.62 $18,671.85 nat. median
$1,646
outlier · 11.3×
J3101
HCPCS 		Tenecteplase 50 Mg Intravenous Solution - Mi 4 $12,347.09 $22,671.84 $17,088.24 nat. median
$3,820
outlier · 4.5×
J0517
HCPCS 		Benralizumab 30 Mg/ml Subcutaneous Syringe 4 $15,366.14 $16,941.72 $16,518.18 nat. median
$919
outlier · 18.0×
J2997
HCPCS 		Alteplase 100 Mg Intravenous Solution 4 $710.46 $26,250.08 $12,296.06 nat. median
$500
outlier · 24.6×
J2356
HCPCS 		Tezepelumab-ekko 210 Mg/1.91 Ml (110 Mg/ml) Subcutaneous Syringe 4 $10,941.48 $12,063.37 $11,761.78 nat. median
$81
outlier · 144.7×
J2182
HCPCS 		Mepolizumab 100 Mg Subcutaneous Solution 4 $9,244.13 $10,191.99 $9,937.19 nat. median
$2,791
outlier · 3.6×
J1306
HCPCS 		Inclisiran 284 Mg/1.5 Ml Subcutaneous Syringe 4 $9,140.54 $10,077.77 $9,825.83 nat. median
$44
outlier · 222.5×
J0717
HCPCS 		Certolizumab Pegol 400 Mg (200 Mg X 2 Vials) Lypholized Powder 4 $7,751.77 $8,546.60 $8,332.94 nat. median
$1,598
outlier · 5.2×
J1561
HCPCS 		Immune Globulin (gamunex-c Gammaked) 10% Injection Solution Wrapper 4 $7,572.31 $8,348.74 $8,140.02 nat. median
$1,093
outlier · 7.4×
Q5111
HCPCS 		Pegfilgrastim-cbqv 6 Mg/0.6 Ml Subcutaneous Syringe 4 $6,891.84 $7,598.50 $7,408.54 nat. median
$1,982
outlier · 3.7×
J3111
HCPCS 		Romosozumab-aqqg 210 Mg/2.34 Ml(105 Mg/1.17 Ml X2)subcutaneous Syringe 4 $6,602.42 $7,279.40 $7,097.42 nat. median
$681
outlier · 10.4×
Q5120
HCPCS 		Pegfilgrastim-bmez 6 Mg/0.6 Ml Subcutaneous Syringe 4 $6,480.03 $7,144.47 $6,965.86 nat. median
$371
outlier · 18.8×
J0897
HCPCS 		Denosumab 120 Mg/1.7 Ml (70 Mg/ml) Subcutaneous Solution 4 $4,716.55 $9,544.40 $6,928.47 nat. median
$1,972
outlier · 3.5×
J9217
HCPCS 		Leuprolide 22.5 Mg (eligard) Subcutaneous Syringe (3 Month) 4 $1,784.31 $36,573.96 $6,732.10 nat. median
$1,575
outlier · 4.3×
74174
CPT 		CT Angio Abd&Plvis Cntrst Mtrl W/wo Cntrst Img 4 $6,078.71 $6,702.00 $6,534.45 nat. median
$988
outlier · 6.6×
74178
CPT 		CT Abdomen & Pelvis Without Contrst Followed By W Contrst 1/> Body Re 4 $5,838.36 $6,437.00 $6,276.08 nat. median
$1,024
outlier · 6.1×
74177
CPT 		CT Abdomen & Pelvis W/Contrast Material 4 $5,220.69 $5,756.00 $5,612.10 nat. median
$974
outlier · 5.8×
J3032
HCPCS 		Eptinezumab-jjmr 100 Mg/ml Intravenous Solution 4 $4,800.61 $5,292.84 $5,160.51 nat. median
$76
outlier · 68.3×
J7168
HCPCS 		Prothrombin Cplx Human (pcc)4fact 1 000 Unit (800-1 240 Unit) IV Solution 4 $4,709.43 $5,192.32 $5,062.51 nat. median
$21
outlier · 241.1×
75635
CPT 		CTA Abdl Aorta&Bi Iliofem W/Contrast&Postp 4 $4,578.54 $5,048.00 $4,921.80 nat. median
$722
outlier · 6.8×
74176
CPT 		CT Abdomen & Pelvis Without Contrast Material 4 $3,968.13 $4,375.00 $4,265.62 nat. median
$694
outlier · 6.2×
74175
CPT 		CT Angiography Abdomen W/Contrast/Noncontrast 4 $3,864.73 $4,261.00 $4,154.48 nat. median
$714
outlier · 5.8×
71275
CPT 		CT Angiography Chest W/Contrast/Noncontrast 4 $3,784.91 $4,173.00 $4,068.68 nat. median
$754
outlier · 5.4×
J1439
HCPCS 		Ferric Carboxymaltose 50 Mg Iron/ml Intravenous Solution 4 $3,774.40 $4,161.41 $4,057.38 nat. median
$14
outlier · 286.2×
74170
CPT 		CT Abdomen Without & W/Contrast Material 4 $3,678.79 $4,056.00 $3,954.60 nat. median
$710
outlier · 5.6×
J0841
HCPCS 		Antivenin Crotalidae (equine) Solution For Injection 4 $3,590.45 $3,958.60 $3,859.64 nat. median
$1,879
outlier · 2.1×
72191
CPT 		CT Angiography Pelvis W/Contrast/Noncontrast 4 $3,526.42 $3,888.00 $3,790.80 nat. median
$632
outlier · 6.0×
70496
CPT 		CT Angiography Head W/Contrast/Noncontrast 4 $3,453.86 $3,808.00 $3,712.80 nat. median
$747
outlier · 5.0×
70492
CPT 		CT Soft Tissue Neck Without & W/Contrast Material 4 $3,392.18 $3,740.00 $3,646.50 nat. median
$647
outlier · 5.6×
71270
CPT 		Diagnostic Computed Tomography Thorax C-/c+ 4 $3,307.83 $3,647.00 $3,555.82 nat. median
$672
outlier · 5.3×
74160
CPT 		CT Abdomen W/Contrast Material 4 $3,302.39 $3,641.00 $3,549.97 nat. median
$652
outlier · 5.4×
70498
CPT 		CT Angiography Neck W/Contrast/Noncontrast 4 $3,250.69 $3,584.00 $3,494.40 nat. median
$739
outlier · 4.7×
72194
CPT 		CT Pelvis Without & W/Contrast Material 4 $3,248.87 $3,582.00 $3,492.45 nat. median
$664
outlier · 5.3×
72193
CPT 		CT Pelvis W/Contrast Material 4 $3,244.34 $3,577.00 $3,487.57 nat. median
$637
outlier · 5.5×
73702
CPT 		CT Lower Extremity Without & W/Contrast Matrl 4 $3,220.76 $3,551.00 $3,462.22 nat. median
$703
outlier · 4.9×
70482
CPT 		CT Orbit Sella/Post Fossa/Ear Without & W/Contr Matr 4 $3,192.64 $3,520.00 $3,432.00 nat. median
$656
outlier · 5.2×
J1745
HCPCS 		Infliximab 100 Mg Intravenous Solution 4 $3,179.13 $3,505.11 $3,417.49 nat. median
$398
outlier · 8.6×
J0882
HCPCS 		Darbepoetin Alfa 150 Mcg/0.3 Ml In Polysorbate Injection Syringe 4 $777.34 $6,944.56 $3,397.66 nat. median
$127
outlier · 26.7×
72126
CPT 		CT Cervical Spine W/Contrast Material 4 $3,150.01 $3,473.00 $3,386.18 nat. median
$756
outlier · 4.5×
70488
CPT 		CT Maxillofacial Without & W/Contrast Material 4 $3,059.31 $3,373.00 $3,288.68 nat. median
$637
outlier · 5.2×
71260
CPT 		Diagnostic Computed Tomography Thorax W/Contrast 4 $3,052.96 $3,366.00 $3,281.85 nat. median
$648
outlier · 5.1×
73201
CPT 		CT Upper Extremity W/Contrast Material 4 $2,991.29 $3,298.00 $3,215.55 nat. median
$804
outlier · 4.0×
70481
CPT 		CT Orbit Sella/Post Fossa/Ear W/Contrast Matrl 4 $2,960.45 $3,264.00 $3,182.40 nat. median
$627
outlier · 5.1×
70470
CPT 		CT Head/Brain Without & W/Contrast Material 4 $2,956.82 $3,260.00 $3,178.50 nat. median
$622
outlier · 5.1×
70460
CPT 		CT Head/Brain W/Contrast Material 4 $2,915.10 $3,214.00 $3,133.65 nat. median
$576
outlier · 5.4×
73701
CPT 		CT Lower Extremity W/Contrast Material 4 $2,896.05 $3,193.00 $3,113.18 nat. median
$671
outlier · 4.6×
70487
CPT 		CT Maxillofacial W/Contrast Material 4 $2,868.84 $3,163.00 $3,083.93 nat. median
$605
outlier · 5.1×
70491
CPT 		CT Soft Tissue Neck W/Contrast Material 4 $2,852.51 $3,145.00 $3,066.38 nat. median
$627
outlier · 4.9×

Other procedures at this hospital

Browse this hospital's 1,665 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
             
J1930 HCPCS Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe 4 4 $28,519.76 $28,519.76 $25,867.42 $28,519.76 $27,806.76 2024-07-01
J2353 HCPCS Octreotide Microspheres ER 30 Mg Intramuscular Susp Extended Release 4 4 $20,220.52 $20,220.52 $18,340.01 $20,220.52 $19,715.01 2024-07-01
J2506 HCPCS Pegfilgrastim 6 Mg/0.6 Ml Subcutaneous Syringe 4 4 $19,150.62 $19,150.62 $17,369.61 $19,150.62 $18,671.85 2024-07-01
J3101 HCPCS Tenecteplase 50 Mg Intravenous Solution - Mi 8 4 $18,142.47 $18,142.47 $12,347.09 $22,671.84 $17,088.24 2024-07-01
J0517 HCPCS Benralizumab 30 Mg/ml Subcutaneous Syringe 4 4 $16,941.72 $16,941.72 $15,366.14 $16,941.72 $16,518.18 2024-07-01
J2997 HCPCS Alteplase 100 Mg Intravenous Solution 8 4 $13,516.69 $13,516.69 $710.46 $26,250.08 $12,296.06 2024-07-01
J2356 HCPCS Tezepelumab-ekko 210 Mg/1.91 Ml (110 Mg/ml) Subcutaneous Syringe 4 4 $12,063.37 $12,063.37 $10,941.48 $12,063.37 $11,761.78 2024-07-01
J2182 HCPCS Mepolizumab 100 Mg Subcutaneous Solution 4 4 $10,191.99 $10,191.99 $9,244.13 $10,191.99 $9,937.19 2024-07-01
J1306 HCPCS Inclisiran 284 Mg/1.5 Ml Subcutaneous Syringe 4 4 $10,077.77 $10,077.77 $9,140.54 $10,077.77 $9,825.83 2024-07-01
J0717 HCPCS Certolizumab Pegol 400 Mg (200 Mg X 2 Vials) Lypholized Powder 4 4 $8,546.60 $8,546.60 $7,751.77 $8,546.60 $8,332.94 2024-07-01
J1561 HCPCS Immune Globulin (gamunex-c Gammaked) 10% Injection Solution Wrapper 4 4 $8,348.74 $8,348.74 $7,572.31 $8,348.74 $8,140.02 2024-07-01
Q5111 HCPCS Pegfilgrastim-cbqv 6 Mg/0.6 Ml Subcutaneous Syringe 4 4 $7,598.50 $7,598.50 $6,891.84 $7,598.50 $7,408.54 2024-07-01
J3111 HCPCS Romosozumab-aqqg 210 Mg/2.34 Ml(105 Mg/1.17 Ml X2)subcutaneous Syringe 4 4 $7,279.40 $7,279.40 $6,602.42 $7,279.40 $7,097.42 2024-07-01
Q5120 HCPCS Pegfilgrastim-bmez 6 Mg/0.6 Ml Subcutaneous Syringe 4 4 $7,144.47 $7,144.47 $6,480.03 $7,144.47 $6,965.86 2024-07-01
J0897 HCPCS Denosumab 120 Mg/1.7 Ml (70 Mg/ml) Subcutaneous Solution 8 4 $7,372.28 $7,372.28 $4,716.55 $9,544.40 $6,928.47 2024-07-01
J9217 HCPCS Leuprolide 22.5 Mg (eligard) Subcutaneous Syringe (3 Month) 32 4 $7,108.81 $7,108.81 $1,784.31 $36,573.96 $6,732.10 2024-07-01
74174 CPT CT Angio Abd&Plvis Cntrst Mtrl W/wo Cntrst Img 4 4 $6,702.00 $6,702.00 $6,078.71 $6,702.00 $6,534.45 2024-07-01
74178 CPT CT Abdomen & Pelvis Without Contrst Followed By W Contrst 1/> Body Re 4 4 $6,437.00 $6,437.00 $5,838.36 $6,437.00 $6,276.08 2024-07-01
74177 CPT CT Abdomen & Pelvis W/Contrast Material 4 4 $5,756.00 $5,756.00 $5,220.69 $5,756.00 $5,612.10 2024-07-01
J3032 HCPCS Eptinezumab-jjmr 100 Mg/ml Intravenous Solution 4 4 $5,292.84 $5,292.84 $4,800.61 $5,292.84 $5,160.51 2024-07-01
J7168 HCPCS Prothrombin Cplx Human (pcc)4fact 1 000 Unit (800-1 240 Unit) IV Solution 4 4 $5,192.32 $5,192.32 $4,709.43 $5,192.32 $5,062.51 2024-07-01
75635 CPT CTA Abdl Aorta&Bi Iliofem W/Contrast&Postp 4 4 $5,048.00 $5,048.00 $4,578.54 $5,048.00 $4,921.80 2024-07-01
74176 CPT CT Abdomen & Pelvis Without Contrast Material 4 4 $4,375.00 $4,375.00 $3,968.13 $4,375.00 $4,265.62 2024-07-01
74175 CPT CT Angiography Abdomen W/Contrast/Noncontrast 4 4 $4,261.00 $4,261.00 $3,864.73 $4,261.00 $4,154.48 2024-07-01
71275 CPT CT Angiography Chest W/Contrast/Noncontrast 4 4 $4,173.00 $4,173.00 $3,784.91 $4,173.00 $4,068.68 2024-07-01
J1439 HCPCS Ferric Carboxymaltose 50 Mg Iron/ml Intravenous Solution 4 4 $4,161.41 $4,161.41 $3,774.40 $4,161.41 $4,057.38 2024-07-01
74170 CPT CT Abdomen Without & W/Contrast Material 4 4 $4,056.00 $4,056.00 $3,678.79 $4,056.00 $3,954.60 2024-07-01
J0841 HCPCS Antivenin Crotalidae (equine) Solution For Injection 4 4 $3,958.60 $3,958.60 $3,590.45 $3,958.60 $3,859.64 2024-07-01
72191 CPT CT Angiography Pelvis W/Contrast/Noncontrast 4 4 $3,888.00 $3,888.00 $3,526.42 $3,888.00 $3,790.80 2024-07-01
70496 CPT CT Angiography Head W/Contrast/Noncontrast 4 4 $3,808.00 $3,808.00 $3,453.86 $3,808.00 $3,712.80 2024-07-01
70492 CPT CT Soft Tissue Neck Without & W/Contrast Material 4 4 $3,740.00 $3,740.00 $3,392.18 $3,740.00 $3,646.50 2024-07-01
71270 CPT Diagnostic Computed Tomography Thorax C-/c+ 4 4 $3,647.00 $3,647.00 $3,307.83 $3,647.00 $3,555.82 2024-07-01
74160 CPT CT Abdomen W/Contrast Material 4 4 $3,641.00 $3,641.00 $3,302.39 $3,641.00 $3,549.97 2024-07-01
70498 CPT CT Angiography Neck W/Contrast/Noncontrast 4 4 $3,584.00 $3,584.00 $3,250.69 $3,584.00 $3,494.40 2024-07-01
72194 CPT CT Pelvis Without & W/Contrast Material 4 4 $3,582.00 $3,582.00 $3,248.87 $3,582.00 $3,492.45 2024-07-01
72193 CPT CT Pelvis W/Contrast Material 4 4 $3,577.00 $3,577.00 $3,244.34 $3,577.00 $3,487.57 2024-07-01
73702 CPT CT Lower Extremity Without & W/Contrast Matrl 4 4 $3,551.00 $3,551.00 $3,220.76 $3,551.00 $3,462.22 2024-07-01
70482 CPT CT Orbit Sella/Post Fossa/Ear Without & W/Contr Matr 4 4 $3,520.00 $3,520.00 $3,192.64 $3,520.00 $3,432.00 2024-07-01
J1745 HCPCS Infliximab 100 Mg Intravenous Solution 4 4 $3,505.11 $3,505.11 $3,179.13 $3,505.11 $3,417.49 2024-07-01
J0882 HCPCS Darbepoetin Alfa 150 Mcg/0.3 Ml In Polysorbate Injection Syringe 20 4 $3,484.78 $3,484.78 $777.34 $6,944.56 $3,397.66 2024-07-01
72126 CPT CT Cervical Spine W/Contrast Material 4 4 $3,473.00 $3,473.00 $3,150.01 $3,473.00 $3,386.18 2024-07-01
70488 CPT CT Maxillofacial Without & W/Contrast Material 4 4 $3,373.00 $3,373.00 $3,059.31 $3,373.00 $3,288.68 2024-07-01
71260 CPT Diagnostic Computed Tomography Thorax W/Contrast 4 4 $3,366.00 $3,366.00 $3,052.96 $3,366.00 $3,281.85 2024-07-01
73201 CPT CT Upper Extremity W/Contrast Material 4 4 $3,298.00 $3,298.00 $2,991.29 $3,298.00 $3,215.55 2024-07-01
70481 CPT CT Orbit Sella/Post Fossa/Ear W/Contrast Matrl 4 4 $3,264.00 $3,264.00 $2,960.45 $3,264.00 $3,182.40 2024-07-01
70470 CPT CT Head/Brain Without & W/Contrast Material 4 4 $3,260.00 $3,260.00 $2,956.82 $3,260.00 $3,178.50 2024-07-01
70460 CPT CT Head/Brain W/Contrast Material 4 4 $3,214.00 $3,214.00 $2,915.10 $3,214.00 $3,133.65 2024-07-01
73701 CPT CT Lower Extremity W/Contrast Material 4 4 $3,193.00 $3,193.00 $2,896.05 $3,193.00 $3,113.18 2024-07-01
70487 CPT CT Maxillofacial W/Contrast Material 4 4 $3,163.00 $3,163.00 $2,868.84 $3,163.00 $3,083.93 2024-07-01
70491 CPT CT Soft Tissue Neck W/Contrast Material 4 4 $3,145.00 $3,145.00 $2,852.51 $3,145.00 $3,066.38 2024-07-01
81263 CPT Ref Igh Somatic Hypermutation In B-cll(mayo) 4 4 $3,116.00 $3,116.00 $2,826.21 $3,116.00 $3,038.10 2024-07-01
72132 CPT CT Lumbar Spine W/Contrast Material 4 4 $3,115.00 $3,115.00 $2,825.30 $3,115.00 $3,037.12 2024-07-01
73202 CPT CT Upper Extremity Without & W/Contrast Material 4 4 $3,056.00 $3,056.00 $2,771.79 $3,056.00 $2,979.60 2024-07-01
73206 CPT CT Angiography Upper Extremity 4 4 $2,891.00 $2,891.00 $2,622.14 $2,891.00 $2,818.72 2024-07-01
73706 CPT CT Angiography Lower Extremity 4 4 $2,891.00 $2,891.00 $2,622.14 $2,891.00 $2,818.72 2024-07-01
93306 CPT Echo Tthrc R-t 2d W/wom-mode Compl Spec&Colr D 4 4 $2,791.00 $2,791.00 $2,531.44 $2,791.00 $2,721.22 2024-07-01
72125 CPT CT Cervical Spine Without Contrast Material 4 4 $2,702.00 $2,702.00 $2,450.71 $2,702.00 $2,634.45 2024-07-01
71250 CPT Diagnostic Computed Tomography Thorax Without Cntrst 4 4 $2,628.00 $2,628.00 $2,383.60 $2,628.00 $2,562.30 2024-07-01
73700 CPT CT Lower Extremity Without Contrast Material 4 4 $2,614.00 $2,614.00 $2,370.90 $2,614.00 $2,548.65 2024-07-01
72131 CPT CT Lumbar Spine Without Contrast Material 4 4 $2,598.00 $2,598.00 $2,356.39 $2,598.00 $2,533.05 2024-07-01
72128 CPT CT Thoracic Spine Without Contrast Material 4 4 $2,584.00 $2,584.00 $2,343.69 $2,584.00 $2,519.40 2024-07-01
90375 HCPCS Rabies Immune Globulin (pf) 300 Unit/ml Intramuscular Solution 4 4 $2,576.88 $2,576.88 $2,337.23 $2,576.88 $2,512.45 2024-07-01
72192 CPT CT Pelvis Without Contrast Material 4 4 $2,574.00 $2,574.00 $2,334.62 $2,574.00 $2,509.65 2024-07-01
74150 CPT CT Abdomen Without Contrast Material 4 4 $2,517.00 $2,517.00 $2,282.92 $2,517.00 $2,454.07 2024-07-01
70480 CPT CT Orbit Sella/Post Fossa/Ear Without Contrast Matrl 4 4 $2,432.00 $2,432.00 $2,205.82 $2,432.00 $2,371.20 2024-07-01
73200 CPT CT Upper Extremity Without Contrast Material 4 4 $2,361.00 $2,361.00 $2,141.43 $2,361.00 $2,301.98 2024-07-01
70450 CPT CT Head/Brain Without Contrast Material 4 4 $2,326.00 $2,326.00 $2,109.68 $2,326.00 $2,267.85 2024-07-01
99291 CPT Critical Care Ill/Injured Patient Init 30-74 Min 4 4 $2,323.00 $2,323.00 $2,106.96 $2,323.00 $2,264.93 2024-07-01
70490 CPT CT Soft Tissue Neck Without Contrast Material 4 4 $2,318.00 $2,318.00 $2,102.43 $2,318.00 $2,260.05 2024-07-01
13160 CPT Secondary Closure Surg Wound/Dehsn Extsv/Complic 4 4 $2,206.00 $2,206.00 $2,000.84 $2,206.00 $2,150.85 2024-07-01
70486 CPT CT Maxillofacial Without Contrast Material 4 4 $2,099.00 $2,099.00 $1,903.79 $2,099.00 $2,046.53 2024-07-01
72129 CPT CT Thoracic Spine W/Contrast Material 4 4 $2,031.00 $2,031.00 $1,842.12 $2,031.00 $1,980.22 2024-07-01
Q4081 HCPCS Epoetin Alfa 20 000 Unit/ml Injection Solution 4 4 $2,029.38 $2,029.38 $1,840.65 $2,029.38 $1,978.64 2024-07-01
J1327 HCPCS Eptifibatide 0.75 Mg/ml Intravenous Solution 4 4 $1,955.50 $1,955.50 $1,773.64 $1,955.50 $1,906.62 2024-07-01
77075 CPT Radiologic Examination Osseous Survey Compl 4 4 $1,784.00 $1,784.00 $1,618.09 $1,784.00 $1,739.40 2024-07-01
PX-1110000100 CDM Room Private W Tele 4 4 $1,716.00 $1,716.00 $1,556.41 $1,716.00 $1,673.10 2024-07-01
PX-1210000100 CDM Room Semi Private W Tele 4 4 $1,716.00 $1,716.00 $1,556.41 $1,716.00 $1,673.10 2024-07-01
93970 CPT Dup-scan Xtr Veins Complete Bilateral Study 4 4 $1,681.00 $1,681.00 $1,524.67 $1,681.00 $1,638.97 2024-07-01
93308 CPT Echo Transthorc R-t 2d W/wo M-mode Rec F-up/lmtd 4 4 $1,645.00 $1,645.00 $1,492.02 $1,645.00 $1,603.88 2024-07-01
PX-1300000100 CDM Room Semi-private 3 Or 4 Per Room 4 4 $1,587.00 $1,587.00 $1,439.41 $1,587.00 $1,547.33 2024-07-01
PX-1210000200 CDM Room Semi Private 4 4 $1,587.00 $1,587.00 $1,439.41 $1,587.00 $1,547.33 2024-07-01
PX-1110000200 CDM Room Private 4 4 $1,587.00 $1,587.00 $1,439.41 $1,587.00 $1,547.33 2024-07-01
93925 CPT Dup-scan Lxtr Art/Artl Bpgs Compl Bi Study 4 4 $1,571.00 $1,571.00 $1,424.90 $1,571.00 $1,531.72 2024-07-01
59426 CPT Hc Antepartum Care Only >7 Visits 8 4 $1,606.00 $1,606.00 $1,069.35 $2,033.00 $1,511.47 2024-07-01
Q5101 HCPCS Filgrastim-sndz 300 Mcg/0.5 Ml Injection Syringe 8 4 $1,558.68 $1,558.68 $1,092.71 $1,912.62 $1,469.75 2024-07-01
87507 CPT Gi Pcr Panel 12-25 Targets 4 4 $1,494.00 $1,494.00 $1,355.06 $1,494.00 $1,456.65 2024-07-01
93975 CPT Dup-scan Artl Flo Abdl/Pel/Scrot&/Rpr Orgn Com 4 4 $1,492.00 $1,492.00 $1,353.24 $1,492.00 $1,454.70 2024-07-01
93880 CPT Duplex Scan Extracranial Art Compl Bi Study 4 4 $1,462.00 $1,462.00 $1,326.03 $1,462.00 $1,425.45 2024-07-01
Q4170 HCPCS Skin Sub Cygnus Per Sq Cm 4 4 $1,450.00 $1,450.00 $1,315.15 $1,450.00 $1,413.75 2024-07-01
81372 CPT Ref Hla I Class Molecular 4 4 $1,433.00 $1,433.00 $1,299.73 $1,433.00 $1,397.17 2024-07-01
76706 CPT US Abdominal Aorta Real Time Screen Study Aaa 4 4 $1,387.00 $1,387.00 $1,258.01 $1,387.00 $1,352.33 2024-07-01
93930 CPT Dup-scan Uxtr Art/Artl Bpgs Compl Bi Study 4 4 $1,387.00 $1,387.00 $1,258.01 $1,387.00 $1,352.33 2024-07-01
99285 CPT Hc Emergency Dept Visit High Mdm 4 4 $1,381.00 $1,381.00 $1,252.57 $1,381.00 $1,346.47 2024-07-01
59409 CPT Vaginal Delivery Only 4 4 $1,376.00 $1,376.00 $1,248.03 $1,376.00 $1,341.60 2024-07-01
25605 CPT Cltx Dstl Rdl Fx/Epiphysl Sep W/Manj When Perf 4 4 $1,319.00 $1,319.00 $1,196.33 $1,319.00 $1,286.03 2024-07-01
G0390 HCPCS Trauma Resp W Activation Cah 4 4 $1,297.00 $1,297.00 $1,176.38 $1,297.00 $1,264.57 2024-07-01
25565 CPT Closed Tx Radial&Ulnar Shaft Fractures W/Manj 4 4 $1,275.00 $1,275.00 $1,156.42 $1,275.00 $1,243.12 2024-07-01
76776 CPT US Trnsplnt Kidney Real Time W/Image Docmtn 4 4 $1,271.00 $1,271.00 $1,152.80 $1,271.00 $1,239.22 2024-07-01
87506 CPT Hc Chronic Gi Pcr Panel 6-11 Targets 4 4 $1,258.00 $1,258.00 $1,141.01 $1,258.00 $1,226.55 2024-07-01
74280 CPT Radex Colon W/Spec Hi Dns Barium W/wo Glucagon 4 4 $1,242.00 $1,242.00 $1,126.49 $1,242.00 $1,210.95 2024-07-01
93978 CPT Dup-scan Aorta Ivc Iliac Vascl/Bpgs Complete 4 4 $1,237.00 $1,237.00 $1,121.96 $1,237.00 $1,206.08 2024-07-01
93226 CPT External ECG Scanning Analysis Report 4 4 $1,232.00 $1,232.00 $1,117.42 $1,232.00 $1,201.20 2024-07-01
J0561 HCPCS Penicillin G Benzathine 1 200 000 Unit/2 Ml Intramuscular Syringe 4 4 $1,217.23 $1,217.23 $1,104.03 $1,217.23 $1,186.80 2024-07-01
93926 CPT Dup-scan Lxtr Art/Artl Bpgs Uni/Lmtd Study 4 4 $1,175.00 $1,175.00 $1,065.72 $1,175.00 $1,145.62 2024-07-01
25535 CPT Closed Rx Ulna Shaft Fx Manipulatn 4 4 $1,174.00 $1,174.00 $1,064.82 $1,174.00 $1,144.65 2024-07-01
24505 CPT Closed Treatment Of Humeral Shaft Fracture; With Manipulation With Or Without S… 4 4 $1,162.00 $1,162.00 $1,053.93 $1,162.00 $1,132.95 2024-07-01
93971 CPT Dup-scan Xtr Veins Unilateral/Limited Study 4 4 $1,148.00 $1,148.00 $1,041.24 $1,148.00 $1,119.30 2024-07-01
11044 CPT Debridement Bone Muscle &/Fascia 20 Sq Cm/< 4 4 $1,148.00 $1,148.00 $1,041.24 $1,148.00 $1,119.30 2024-07-01
27818 CPT Cltx Trimalleolar Ankle Fx W/Manipulation 4 4 $1,139.00 $1,139.00 $1,033.07 $1,139.00 $1,110.53 2024-07-01
P9040 HCPCS Rbc Leukoreduced Irradiated 4 4 $1,138.00 $1,138.00 $1,032.17 $1,138.00 $1,109.55 2024-07-01
27810 CPT Closed Tx Bimalleolar Ankle Fracture W/Manj 4 4 $1,113.00 $1,113.00 $1,009.49 $1,113.00 $1,085.17 2024-07-01
J1610 HCPCS Glucagon Hcl 1 Mg/ml Solution For Injection 4 4 $1,111.53 $1,111.53 $1,008.16 $1,111.53 $1,083.74 2024-07-01
J1740 HCPCS Ibandronate 3 Mg/3 Ml Intravenous Syringe 4 4 $1,100.00 $1,100.00 $997.70 $1,100.00 $1,072.50 2024-07-01
PX-1100000100 CDM Room Private Swingbed Skilled 4 4 $1,092.00 $1,092.00 $990.44 $1,092.00 $1,064.70 2024-07-01
PX-1200000200 CDM Room Semi Private Swingbed Skilled 4 4 $1,092.00 $1,092.00 $990.44 $1,092.00 $1,064.70 2024-07-01
76380 CPT CT Limited/Localized Follow Up Study 4 4 $1,076.00 $1,076.00 $975.93 $1,076.00 $1,049.10 2024-07-01
23665 CPT Cltx Shoulder Dislc W/Fx Humeral Tubrst W/Manj 4 4 $1,075.00 $1,075.00 $975.02 $1,075.00 $1,048.12 2024-07-01
93923 CPT Non-invasive Physiologic Study Extremity 3 Levls 4 4 $1,067.00 $1,067.00 $967.77 $1,067.00 $1,040.33 2024-07-01
M0247 HCPCS Hc IV Infusion Sotrovimab Includes Infusion And Post Administration Monitoring 4 4 $1,065.00 $1,065.00 $965.96 $1,065.00 $1,038.38 2024-07-01
M0245 HCPCS IV Infusion Bamlanivimab And Etesevimab Includes Infusion And Post Administrat… 4 4 $1,065.00 $1,065.00 $965.96 $1,065.00 $1,038.38 2024-07-01
M0243 HCPCS IV Infusion Casirivimab And Imdevimab Includes Infusion And Post Administration… 4 4 $1,065.00 $1,065.00 $965.96 $1,065.00 $1,038.38 2024-07-01
12056 CPT Repair Intermediate F/E/E/N/L&/Muc 20.1-30.0cm 4 4 $1,060.00 $1,060.00 $961.42 $1,060.00 $1,033.50 2024-07-01
28810 CPT Amputation Metatarsal W/Toe Single 4 4 $1,044.00 $1,044.00 $946.91 $1,044.00 $1,017.90 2024-07-01
J3489 HCPCS Zoledronic Acid 5 Mg/100 Ml In Mannitol 5 %-water Intravenous Piggybck 4 4 $1,035.50 $1,035.50 $939.20 $1,035.50 $1,009.61 2024-07-01
M0222 HCPCS Intravenous Injection Bebtelovimab Includes Injection And Post Administration … 4 4 $1,014.00 $1,014.00 $919.70 $1,014.00 $988.65 2024-07-01
M0220 HCPCS Injection Tixagevimab And Cilgavimab For The Pre-exposure Prophylaxis Includes… 4 4 $1,014.00 $1,014.00 $919.70 $1,014.00 $988.65 2024-07-01
93882 CPT Duplex Scan Extracranial Art Uni/Lmtd Study 4 4 $986.00 $986.00 $894.30 $986.00 $961.35 2024-07-01
27788 CPT Cltx Dstl Fibular Fx Lat Malls W/Manj 4 4 $976.00 $976.00 $885.23 $976.00 $951.60 2024-07-01
J0558 HCPCS Penicillin G Benzathine Procain 900 000 Unit-300k Unit/2 Ml IM Syringe 4 4 $975.37 $975.37 $884.66 $975.37 $950.99 2024-07-01
99284 CPT Hc Emergency Department Visit Level 4 Mod Severity 4 4 $967.00 $967.00 $877.07 $967.00 $942.83 2024-07-01
76604 CPT US Chest Real Time W/Image Documentation 4 4 $963.00 $963.00 $873.44 $963.00 $938.92 2024-07-01
76856 CPT US Pelvic Nonobstetric Real-time Image Complete 4 4 $963.00 $963.00 $873.44 $963.00 $938.92 2024-07-01
13152 CPT Repair Complex Eyelid/Nose/Ear/Lip 2.6-7.5 Cm 4 4 $960.00 $960.00 $870.72 $960.00 $936.00 2024-07-01
36430 CPT Transfusion Blood Or Blood Components 4 4 $954.00 $954.00 $865.28 $954.00 $930.15 2024-07-01
26725 CPT Cltx Phlngl Fx Prox/Middle Px/F/T W/Manj Ea 4 4 $930.00 $930.00 $843.51 $930.00 $906.75 2024-07-01
76700 CPT US Abdominal Real Time W/Image Documentation 4 4 $922.00 $922.00 $836.25 $922.00 $898.95 2024-07-01
76770 CPT US Retroperitoneal Real Time W/Image Complete 4 4 $920.00 $920.00 $834.44 $920.00 $897.00 2024-07-01
12037 CPT Repair Intermediate S/a/T/E >30.0 Cm 4 4 $910.00 $910.00 $825.37 $910.00 $887.25 2024-07-01
24600 CPT Treatment Closed Elbow Dislocation Without Anes 4 4 $899.00 $899.00 $815.39 $899.00 $876.52 2024-07-01
77074 CPT Radiologic Examination Osseous Survey Limited 4 4 $894.00 $894.00 $810.86 $894.00 $871.65 2024-07-01
26742 CPT Cltx Artclr Fx Invg Mtcarphlngl/Iphal Jt W/Manj 4 4 $879.00 $879.00 $797.25 $879.00 $857.02 2024-07-01
13132 CPT Repair Complex F/C/C/M/N/Ax/G/H/F 2.6-7.5 Cm 4 4 $873.00 $873.00 $791.81 $873.00 $851.17 2024-07-01
96413 CPT Chemotx Admn IV Nfs Tq Up 1 Hr 1/1st Sbst/Drug 4 4 $873.00 $873.00 $791.81 $873.00 $851.17 2024-07-01
74270 CPT Radex Colon Barium Enema W/wo Kub 4 4 $865.00 $865.00 $784.55 $865.00 $843.38 2024-07-01
93976 CPT Dup-scan Artl Flo Abdl/Pel/Scrot&/Rpr Orgn Lmt 4 4 $864.00 $864.00 $783.65 $864.00 $842.40 2024-07-01
74250 CPT Radex Small Intestine W/Multiple Serial Images 4 4 $863.00 $863.00 $782.74 $863.00 $841.42 2024-07-01
12046 CPT Rpr Intermediate N/H/F/Xtrnl Gent 20.1-30.0 Cm 4 4 $860.00 $860.00 $780.02 $860.00 $838.50 2024-07-01
76705 CPT US Abdominal Real Time W/Image Limited 4 4 $853.00 $853.00 $773.67 $853.00 $831.67 2024-07-01
36010 CPT Intro Catheter Superior/Inferior Vena Cava 4 4 $851.00 $851.00 $771.86 $851.00 $829.73 2024-07-01
90750 HCPCS Varicella-zoster Glycop E Vaccine (vial 2 Of 2) 50 Mcg IM Susp Kit 12 4 $875.95 $875.95 $7.12 $875.97 $822.09 2024-07-01
12055 CPT Repair Intermediate F/E/E/N/L&/Muc 12.6-20.0cm 4 4 $834.00 $834.00 $756.44 $834.00 $813.15 2024-07-01
25600 CPT Cltx Dstl Radial Fx/Epiphysl Sep Without Manj 4 4 $833.00 $833.00 $755.53 $833.00 $812.17 2024-07-01
76811 CPT US Preg Uterus W/Detail Fetal Anat 1st Gestation 4 4 $830.00 $830.00 $752.81 $830.00 $809.25 2024-07-01
26700 CPT Cltx Metacarpophalangeal Dislc W/Manj Without Anes 4 4 $803.00 $803.00 $728.32 $803.00 $782.92 2024-07-01
13151 CPT Repair Complex Eyelid/Nose/Ear/Lip 1.1-2.5 Cm 4 4 $799.00 $799.00 $724.69 $799.00 $779.02 2024-07-01
87505 CPT Hc Acute Gi Pcr Panel 3-5 Targets 4 4 $798.00 $798.00 $723.79 $798.00 $778.05 2024-07-01
76870 CPT US Scrotum & Contents 4 4 $791.00 $791.00 $717.44 $791.00 $771.22 2024-07-01
76775 CPT US Retroperitoneal Real Time W/Image Limited 4 4 $788.00 $788.00 $714.72 $788.00 $768.30 2024-07-01
23650 CPT Clsd Tx Shoulder Dislc W/Manipulation Without Anes 4 4 $784.00 $784.00 $711.09 $784.00 $764.40 2024-07-01
31500 CPT Intubation Endotracheal Emergency Procedure 8 4 $788.00 $788.00 $697.48 $807.00 $761.31 2024-07-01
12036 CPT Repair Intermediate S/a/T/E 20.1-30.0 Cm 4 4 $773.00 $773.00 $701.11 $773.00 $753.67 2024-07-01
90716 HCPCS Varicella Virus Vaccine Live (pf) 1 350 Unit/0.5 Ml Subcutaneous Susp 4 4 $771.37 $771.37 $699.63 $771.37 $752.09 2024-07-01
76536 CPT US Soft Tissue Head & Neck Real Time Imge Docm 4 4 $755.00 $755.00 $684.78 $755.00 $736.12 2024-07-01
13121 CPT Repair Complex Scalp/Arm/Leg 2.6-7.5 Cm 4 4 $748.00 $748.00 $678.44 $748.00 $729.30 2024-07-01
12045 CPT Repair Intermediate N/H/F/Xtrnl Gent 12.6-20 Cm 4 4 $748.00 $748.00 $678.44 $748.00 $729.30 2024-07-01
74455 CPT Urethrocystography Voiding Rs&I 4 4 $744.00 $744.00 $674.81 $744.00 $725.40 2024-07-01
56740 CPT Exc Bartholins Gland/Cyst 4 4 $741.00 $741.00 $672.09 $741.00 $722.47 2024-07-01
81219 CPT Ref Mpn Calr Gene Mutation 4 4 $727.00 $727.00 $659.39 $727.00 $708.83 2024-07-01
76805 CPT US Preg Uterus After 1st Trimest 1/1st Gestation 4 4 $726.00 $726.00 $658.48 $726.00 $707.85 2024-07-01
93922 CPT Non-invas Physiologic Std Extremity Art 2 Level 4 4 $724.00 $724.00 $656.67 $724.00 $705.90 2024-07-01
74240 CPT Radex Gi Tract Upper W/wo Delayed Images Without Kub 4 4 $720.00 $720.00 $653.04 $720.00 $702.00 2024-07-01
J2545 HCPCS Pentamidine 300 Mg Solution For Inhalation 4 4 $717.63 $717.63 $650.89 $717.63 $699.69 2024-07-01
81270 CPT Ref Jak2 Gene Anal P.Val617phe Vrn 4 4 $714.00 $714.00 $647.60 $714.00 $696.15 2024-07-01
76000 CPT Fluoroscopy Spx Up To 1 Hour Phys/Qhp Time 4 4 $713.00 $713.00 $646.69 $713.00 $695.17 2024-07-01
74220 CPT Radex Esophagus 4 4 $708.00 $708.00 $642.16 $708.00 $690.30 2024-07-01
J0695 HCPCS Ceftolozane-tazobactam 1.5 Gram Intravenous Solution 4 4 $707.20 $707.20 $641.43 $707.20 $689.52 2024-07-01
90734 HCPCS Meningoc Vac A C Y W-135 Dip(pf) 10 Mcg-5 Mcg/0.5 Ml IM Kit (2 Vials) 4 4 $698.39 $698.39 $633.44 $698.39 $680.93 2024-07-01
13131 CPT Repair Complex F/C/C/M/N/Ax/G/H/F 1.1-2.5 Cm 4 4 $697.00 $697.00 $632.18 $697.00 $679.58 2024-07-01
13101 CPT Repair Complex Trunk 2.6-7.5 Cm 4 4 $697.00 $697.00 $632.18 $697.00 $679.58 2024-07-01
76830 CPT US Transvaginal 4 4 $693.00 $693.00 $628.55 $693.00 $675.67 2024-07-01
88184 CPT Ref Leukemia/Lymphoma Immunophenotyping By Flow Cytometry 1st 4 4 $688.00 $688.00 $624.02 $688.00 $670.80 2024-07-01
92950 CPT Cardiopulmonary Resuscitation 8 4 $689.50 $689.50 $489.78 $839.00 $650.49 2024-07-01
76881 CPT US Xtr Non-vasc Complete 4 4 $667.00 $667.00 $604.97 $667.00 $650.33 2024-07-01
80169 CPT Ref Everolimus 4 4 $664.00 $664.00 $602.25 $664.00 $647.40 2024-07-01
12035 CPT Repair Intermediate S/a/T/E 12.6-20.0cm 4 4 $660.00 $660.00 $598.62 $660.00 $643.50 2024-07-01
13120 CPT Repair Complex Scalp/Arm/Leg 1.1-2.5 Cm 4 4 $660.00 $660.00 $598.62 $660.00 $643.50 2024-07-01
88307 CPT Ref Surg Path Level V Gross &Micro 4 4 $658.00 $658.00 $596.81 $658.00 $641.55 2024-07-01
99283 CPT Emergency Department Visit Level 3 Low Severity 4 4 $656.00 $656.00 $594.99 $656.00 $639.60 2024-07-01
76882 CPT US Extremity Non-vasc Real-time Img Lmtd 4 4 $629.00 $629.00 $570.50 $629.00 $613.27 2024-07-01
74400 CPT Urography IV W/wo Kub W/wo Tomography 4 4 $615.00 $615.00 $557.80 $615.00 $599.62 2024-07-01
84588 CPT Ref Arginine Vasopressin 4 4 $613.00 $613.00 $555.99 $613.00 $597.67 2024-07-01
G0379 HCPCS Sso Direct Admit 4 4 $612.00 $612.00 $555.08 $612.00 $596.70 2024-07-01
12054 CPT Repair Intermediate F/E/E/N/L&/Muc 7.6-12.5 Cm 4 4 $612.00 $612.00 $555.08 $612.00 $596.70 2024-07-01
82261 CPT Ref Biotinidase Deficiency Screen 4 4 $610.00 $610.00 $553.27 $610.00 $594.75 2024-07-01
73522 CPT Radex Hips Bilateral With Pelvis 3-4 Views 4 4 $606.00 $606.00 $549.64 $606.00 $590.85 2024-07-01
P9016 HCPCS Rbc Leuko Reduced 4 4 $606.00 $606.00 $549.64 $606.00 $590.85 2024-07-01
71111 CPT Radex Ribs Bi W/Posteroant Ch Minimum 4 Views 4 4 $605.00 $605.00 $548.74 $605.00 $589.88 2024-07-01
87517 CPT Ref Hepatitis B DNA Quant 4 4 $603.00 $603.00 $546.92 $603.00 $587.92 2024-07-01
76819 CPT Fetal Biophysical Profile Without Non-stress Testing 4 4 $602.00 $602.00 $546.01 $602.00 $586.95 2024-07-01
87150 CPT Hc Ref IV Mec A Pcr (Mayo) 8 4 $644.00 $644.00 $44.44 $1,239.00 $586.38 2024-07-01
12044 CPT Repair Intermediate N/H/F/Xtrnl Gent 7.6-12.5cm 4 4 $597.00 $597.00 $541.48 $597.00 $582.08 2024-07-01
12053 CPT Repair Intermediate F/E/E/N/L&/Muc 5.1-7.5 Cm 4 4 $597.00 $597.00 $541.48 $597.00 $582.08 2024-07-01
76817 CPT US Preg Uterus Real Time W/Image Dcmtn Transvag 4 4 $596.00 $596.00 $540.57 $596.00 $581.10 2024-07-01
76801 CPT US Pregnant Uterus 14 Wk Transabdl 1/1st Gestat 4 4 $593.00 $593.00 $537.85 $593.00 $578.17 2024-07-01
74022 CPT Radex Abd Compl Aqt Abd W/s/e/d Views 1 View Ch 4 4 $592.00 $592.00 $536.94 $592.00 $577.20 2024-07-01
87118 CPT Hc Ref Mycobacteria Identification (Mayo) 4 4 $590.00 $590.00 $535.13 $590.00 $575.25 2024-07-01
86757 CPT Ref Spotted Fever Group Ab Igg Or Igm 4 4 $589.00 $589.00 $534.22 $589.00 $574.28 2024-07-01
76376 CPT 3d Rendering W/Interp & Postprocess Supervision- CT 4 4 $587.00 $587.00 $532.41 $587.00 $572.33 2024-07-01
12034 CPT Repair Intermediate S/a/T/E 7.6-12.5 Cm 4 4 $573.00 $573.00 $519.71 $573.00 $558.67 2024-07-01
13100 CPT Repair Complex Trunk 1.1-2.5 Cm 4 4 $573.00 $573.00 $519.71 $573.00 $558.67 2024-07-01
72052 CPT Radex Spine Cervical 6 Or More Views 4 4 $573.00 $573.00 $519.71 $573.00 $558.67 2024-07-01
86778 CPT Ref Toxoplasmosis Igm Antibody 4 4 $568.00 $568.00 $515.18 $568.00 $553.80 2024-07-01
86702 CPT Ref HIV 2 Antibody 4 4 $565.00 $565.00 $512.46 $565.00 $550.88 2024-07-01
12052 CPT Repair Intermediate F/E/E/N/L&/Muc 2.6-5.0 Cm 4 4 $561.00 $561.00 $508.83 $561.00 $546.97 2024-07-01
72110 CPT Radex Spine Lumbosacral Minimum 4 Views 4 4 $552.00 $552.00 $500.66 $552.00 $538.20 2024-07-01
12042 CPT Repair Intermediate N/H/F/Xtrnl Gent 2.6-7.5 Cm 4 4 $549.00 $549.00 $497.94 $549.00 $535.27 2024-07-01
72050 CPT Radex Spine Cervical 4 Or 5 Views 4 4 $548.00 $548.00 $497.04 $548.00 $534.30 2024-07-01
77080 CPT Dxa Bone Density Study 1/> Sites Axial Skel 4 4 $548.00 $548.00 $497.04 $548.00 $534.30 2024-07-01
87633 CPT Resp Panel Virus By Pcr 12-25 4 4 $540.00 $540.00 $489.78 $540.00 $526.50 2024-07-01
90680 HCPCS Rotavirus Vaccine Live Pentavalent 2 Ml Oral Solution 4 4 $539.15 $539.15 $489.01 $539.15 $525.67 2024-07-01
73521 CPT Radex Hips Bilateral With Pelvis 2 Views 4 4 $537.00 $537.00 $487.06 $537.00 $523.58 2024-07-01
94060 CPT Brncdilat Rspse Spmtry Pre&post-brncdilat Admn 4 4 $537.00 $537.00 $487.06 $537.00 $523.58 2024-07-01
12032 CPT Repair Intermediate S/a/T/E 2.6-7.5 Cm 4 4 $536.00 $536.00 $486.15 $536.00 $522.60 2024-07-01
90723 HCPCS Hep B-dp(a)t-polio Vacc (pf) 10 Mcg-25lf-25 Mcg-10lf/0.5 Ml IM Syringe 4 4 $533.78 $533.78 $484.14 $533.78 $520.43 2024-07-01
73523 CPT Radex Hips Bilateral With Pelvis Minimum 5 Views 4 4 $532.00 $532.00 $482.52 $532.00 $518.70 2024-07-01
86480 CPT TB Gold 4 4 $532.00 $532.00 $482.52 $532.00 $518.70 2024-07-01
81375 CPT Ref Hla Dr-dq Disassoc Typing Lowres(Mayo) 4 4 $530.00 $530.00 $480.71 $530.00 $516.75 2024-07-01
J2248 HCPCS Micafungin 100 Mg Intravenous Solution 4 4 $529.90 $529.90 $480.62 $529.90 $516.65 2024-07-01
90732 HCPCS Pneumococcal 23 Polyvalent Vaccine 25 Mcg/0.5 Ml Injection Syringe 4 4 $528.45 $528.45 $479.30 $528.45 $515.24 2024-07-01
J1335 HCPCS Ertapenem 1 Gram Solution For Injection 4 4 $528.41 $528.41 $479.27 $528.41 $515.20 2024-07-01
87902 CPT Ref Hcv Genotype 4 4 $526.00 $526.00 $477.08 $526.00 $512.85 2024-07-01
76810 CPT US Preg Uterus > 1st Trimester Abdl Ea Gestatio 4 4 $526.00 $526.00 $477.08 $526.00 $512.85 2024-07-01
87637 CPT Hc Sars/Influenza/Rsv Quadruplex Pcr 4 4 $519.00 $519.00 $470.73 $519.00 $506.02 2024-07-01
12002 CPT Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5cm 4 4 $517.00 $517.00 $468.92 $517.00 $504.08 2024-07-01
82610 CPT Ref Cystatin C With Estimated Gfr(Mayo) 4 4 $515.00 $515.00 $467.11 $515.00 $502.12 2024-07-01
93225 CPT ECG Monit/Reprt Up To 48 Hrs 4 4 $515.00 $515.00 $467.11 $515.00 $502.12 2024-07-01
71101 CPT Radex Ribs Uni W/Posteroant Ch Minimum 3 Views 4 4 $514.00 $514.00 $466.20 $514.00 $501.15 2024-07-01
90707 HCPCS Measles Mumps Rubella Vaccine Live(pf)1 000-12 500tcid50/0.5 Ml Subcut 4 4 $512.32 $512.32 $464.67 $512.32 $499.51 2024-07-01
86481 CPT TB Gold 4 4 $512.00 $512.00 $464.38 $512.00 $499.20 2024-07-01
72072 CPT Radex Spine Thoracic 3 Views 4 4 $511.00 $511.00 $463.48 $511.00 $498.23 2024-07-01
80076 CPT Hepatic Function Panel 4 4 $501.00 $501.00 $454.41 $501.00 $488.48 2024-07-01
96105 CPT Assessment Aphasia W/Interp & Report Per Hour 4 4 $501.00 $501.00 $454.41 $501.00 $488.48 2024-07-01
76815 CPT US Pregnant Uterus Limited 1/> Fetuses 4 4 $498.00 $498.00 $451.69 $498.00 $485.55 2024-07-01
80193 CPT Drug Assay Leflunomide 4 4 $494.00 $494.00 $448.06 $494.00 $481.65 2024-07-01
87899 CPT Infect Agent By Ia Direct Obs 8 4 $510.50 $510.50 $299.31 $691.00 $478.37 2024-07-01
J2404 HCPCS Nicardipine 25 Mg/10 Ml Intravenous Solution 8 4 $519.66 $519.66 $126.71 $899.62 $477.83 2024-07-01
76802 CPT US Preg Uterus 14 Wk Transabdl Each Gestation 4 4 $490.00 $490.00 $444.43 $490.00 $477.75 2024-07-01
76857 CPT US Pelvic Nonobstetric Image Dcmtn Limited/F/U 4 4 $488.00 $488.00 $442.62 $488.00 $475.80 2024-07-01
76800 CPT Ultrasound Spinal Canal & Contents 4 4 $487.00 $487.00 $441.71 $487.00 $474.82 2024-07-01
70150 CPT Radex Facial Bones Complete Minimum 3 Views 4 4 $486.00 $486.00 $440.80 $486.00 $473.85 2024-07-01
87581 CPT Ref Mycoplasma Pneumo DNA Qual Pc 8 4 $518.50 $518.50 $43.54 $989.00 $472.51 2024-07-01
32551 CPT Tube Thoracostomy Includes Water Seal 4 4 $479.00 $479.00 $434.45 $479.00 $467.02 2024-07-01
71110 CPT Radex Ribs Bilateral 3 Views 4 4 $478.00 $478.00 $433.55 $478.00 $466.05 2024-07-01
72100 CPT Radex Spine Lumbosacral 2/3 Views 4 4 $477.00 $477.00 $432.64 $477.00 $465.07 2024-07-01
70260 CPT Radiologic Exam Skull Complete Minimum 4 Views 4 4 $476.00 $476.00 $431.73 $476.00 $464.10 2024-07-01
83993 CPT Hc Calprotectin Fecal Stool 8 4 $490.00 $490.00 $367.33 $575.00 $463.26 2024-07-01
PX-2703000512 CDM Hc Phs Supp Picc Line Kt 4 4 $474.00 $474.00 $429.92 $474.00 $462.15 2024-07-01
12018 CPT Simple Repair F/e/e/n/l/m >30.0 Cm 4 4 $474.00 $474.00 $429.92 $474.00 $462.15 2024-07-01
83013 CPT Ref Helicobacter Pylori Breath Tes 4 4 $474.00 $474.00 $429.92 $474.00 $462.15 2024-07-01
12051 CPT Repair Intermediate F/E/E/N/L&/Muc 2.5 Cm/< 4 4 $474.00 $474.00 $429.92 $474.00 $462.15 2024-07-01
85240 CPT Ref Factor 8 Inhibitor Evaluation(Mayo) 8 4 $493.00 $493.00 $206.80 $758.00 $457.75 2024-07-01
90632 HCPCS Hepatitis A Vaccine (pf) 1 440 Elisa Unit/ml Intramuscular Syringe 4 4 $468.43 $468.43 $424.87 $468.43 $456.72 2024-07-01
70200 CPT Radex Orbits Complete Minimum 4 Views 4 4 $467.00 $467.00 $423.57 $467.00 $455.33 2024-07-01
20610 CPT Arthrocentesis Aspir&/Inj Major Jt/Bursa Without US 4 4 $467.00 $467.00 $423.57 $467.00 $455.33 2024-07-01
70110 CPT Radiolog Exam Mandible Compl Minimum 4 Views 4 4 $459.00 $459.00 $416.31 $459.00 $447.52 2024-07-01
87636 CPT Hc Sars/Influenza Molecular Detection 4 4 $459.00 $459.00 $416.31 $459.00 $447.52 2024-07-01
J3243 HCPCS Tigecycline 50 Mg Intravenous Solution 4 4 $455.00 $455.00 $412.69 $455.00 $443.62 2024-07-01
J0873 HCPCS Daptomycin 500 Mg Intravenous Solution 4 4 $455.00 $455.00 $412.69 $455.00 $443.62 2024-07-01
75822 CPT Venography Extremity Bilateral Rs&I 4 4 $453.00 $453.00 $410.87 $453.00 $441.68 2024-07-01
99282 CPT Emergency Department Visit St Fwd Mdm 4 4 $452.00 $452.00 $409.96 $452.00 $440.70 2024-07-01
97597 CPT Debridement Open Wound 20 Sq Cm/< 4 4 $452.00 $452.00 $409.96 $452.00 $440.70 2024-07-01
82542 CPT Hc Ref Bile Acids Bowel Dysfunction 48 Hour Feces(Mayo) 12 4 $450.00 $450.00 $195.00 $896.00 $438.75 2024-07-01
72190 CPT Radiologic Exam Pelvis Compl Minimum 3 Views 4 4 $449.00 $449.00 $407.24 $449.00 $437.77 2024-07-01
80307 CPT Benzodiazepines Urine Confirmation(Medtox) 8 4 $464.50 $464.50 $299.31 $599.00 $436.64 2024-07-01
74019 CPT Radiologic Exam Abdomen 2 Views 4 4 $447.00 $447.00 $405.43 $447.00 $435.82 2024-07-01
12001 CPT Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5cm/< 4 4 $447.00 $447.00 $405.43 $447.00 $435.82 2024-07-01
83695 CPT Ref Lipoprotein A Serum 4 4 $445.00 $445.00 $403.62 $445.00 $433.88 2024-07-01
76816 CPT US Preg Uterus Real Time F/u Trnsabdl Per Fetus 4 4 $445.00 $445.00 $403.62 $445.00 $433.88 2024-07-01
86335 CPT Ref Immunofixation Urine 8 4 $459.50 $459.50 $321.08 $565.00 $433.23 2024-07-01
86638 CPT Ref Q Fever Ab Igg Or Igm 4 4 $444.00 $444.00 $402.71 $444.00 $432.90 2024-07-01
87641 CPT Mrsa Pcr 4 4 $439.00 $439.00 $398.17 $439.00 $428.02 2024-07-01
J1756 HCPCS Iron Sucrose 100 Mg Iron/5 Ml Intravenous Solution 8 4 $453.52 $453.52 $322.52 $551.45 $427.88 2024-07-01
27250 CPT Cltx Hip Dislocation Traumatic Without Anesthesia 4 4 $434.00 $434.00 $393.64 $434.00 $423.15 2024-07-01
86022 CPT Ref Platelet Ab S 4 4 $432.00 $432.00 $391.82 $432.00 $421.20 2024-07-01
80050 CPT General Health Panel 4 4 $430.00 $430.00 $390.01 $430.00 $419.25 2024-07-01
74021 CPT Radiologic Exam Abdomen 3+ Views 4 4 $428.00 $428.00 $388.20 $428.00 $417.30 2024-07-01
12031 CPT Repair Intermediate S/a/T/E 2.5 Cm/< 4 4 $424.00 $424.00 $384.57 $424.00 $413.40 2024-07-01
12017 CPT Simple Repair F/e/e/n/l/m 20.1cm-30.0 Cm 4 4 $424.00 $424.00 $384.57 $424.00 $413.40 2024-07-01
10061 CPT Incision & Drainage Abscess Complicated/Multiple 4 4 $423.00 $423.00 $383.66 $423.00 $412.43 2024-07-01
86902 CPT Antigen Test Donor Bld Ea Unit 4 4 $422.00 $422.00 $382.75 $422.00 $411.45 2024-07-01
J0457 HCPCS Aztreonam 2 Gram Solution For Injection 4 4 $420.88 $420.88 $381.74 $420.88 $410.36 2024-07-01
96365 CPT IV Infusion Therapy/Prophylaxis /Dx 1st To 1 Hr 4 4 $419.00 $419.00 $380.03 $419.00 $408.52 2024-07-01
80145 CPT Ref Adalimumab Quantitation With Reflex To Antibogy(Mayo) 4 4 $419.00 $419.00 $380.03 $419.00 $408.52 2024-07-01
26770 CPT Cltx Iphal Jt Dislc W/Manj Without Anes 4 4 $419.00 $419.00 $380.03 $419.00 $408.52 2024-07-01
J0360 HCPCS Hydralazine 20 Mg/ml Injection Solution 4 4 $417.04 $417.04 $378.26 $417.04 $406.62 2024-07-01
73503 CPT Radex Hip Unilateral With Pelvis Minimum 4 Views 4 4 $417.00 $417.00 $378.22 $417.00 $406.58 2024-07-01
85397 CPT Ref Von Willebrand Factor Activity P (Mayo) Avwpr Panel 4 4 $417.00 $417.00 $378.22 $417.00 $406.58 2024-07-01
J1050 HCPCS Medroxyprogesterone 150 Mg/ml Intramuscular Suspension Wrapper 4 4 $413.80 $413.80 $375.32 $413.80 $403.45 2024-07-01
75820 CPT Venography Extremity Unilateral Rs&I 4 4 $411.00 $411.00 $372.78 $411.00 $400.73 2024-07-01
70220 CPT Radex Sinuses Paranasal Compl Minimum 3 Views 4 4 $411.00 $411.00 $372.78 $411.00 $400.73 2024-07-01
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