Hospital

HANS P PETERSON MEMORIAL HOSPITAL - CAH

Philip, SD · CCN 431319 · Rates published

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You selected 93306 (CPT)

Echo Tthrc R-T 2d W/Wom-Mode Compl Spec&Colr D

This hospital’s price: $2,721 across 4 payers · range $2,531-$2,791

Source: https://www.philiphealthservices.com/460361016_Philip-Health-Services-Inc_standardcharges.csv · observed 2024-07-01

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.

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 — reason	Rows
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⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 27 months old.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 via	CMS hospital list
Last fetch	not_modified · 2026-10-19
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 $5,623 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 $1,659 outlier · 11.3×
J3101 HCPCS	Tenecteplase 50 Mg Intravenous Solution - Mi	4	$12,347.09	$22,671.84	$17,088.24	nat. median $3,787 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 $76 outlier · 155.3×
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 · 224.7×
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 $1,635 outlier · 5.1×
J1561 HCPCS	Immune Globulin (gamunex-c Gammaked) 10% Injection Solution Wrapper	4	$7,572.31	$8,348.74	$8,140.02	nat. median $1,094 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 $1,984 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 $696 outlier · 10.2×
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 $1,982 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 $1,573 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 $998 outlier · 6.5×
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 $1,027 outlier · 6.1×
74177 CPT	CT Abdomen & Pelvis W/Contrast Material	4	$5,220.69	$5,756.00	$5,612.10	nat. median $976 outlier · 5.8×
J3032 HCPCS	Eptinezumab-jjmr 100 Mg/ml Intravenous Solution	4	$4,800.61	$5,292.84	$5,160.51	nat. median $73 outlier · 71.0×
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 $20 outlier · 248.9×
75635 CPT	CTA Abdl Aorta&Bi Iliofem W/Contrast&Postp	4	$4,578.54	$5,048.00	$4,921.80	nat. median $727 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 $718 outlier · 5.8×
71275 CPT	CT Angiography Chest W/Contrast/Noncontrast	4	$3,784.91	$4,173.00	$4,068.68	nat. median $759 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 · 300.5×
74170 CPT	CT Abdomen Without & W/Contrast Material	4	$3,678.79	$4,056.00	$3,954.60	nat. median $714 outlier · 5.5×
J0841 HCPCS	Antivenin Crotalidae (equine) Solution For Injection	4	$3,590.45	$3,958.60	$3,859.64	nat. median $1,873 outlier · 2.1×
72191 CPT	CT Angiography Pelvis W/Contrast/Noncontrast	4	$3,526.42	$3,888.00	$3,790.80	nat. median $640 outlier · 5.9×
70496 CPT	CT Angiography Head W/Contrast/Noncontrast	4	$3,453.86	$3,808.00	$3,712.80	nat. median $752 outlier · 4.9×
70492 CPT	CT Soft Tissue Neck Without & W/Contrast Material	4	$3,392.18	$3,740.00	$3,646.50	nat. median $650 outlier · 5.6×
71270 CPT	Diagnostic Computed Tomography Thorax C-/c+	4	$3,307.83	$3,647.00	$3,555.82	nat. median $684 outlier · 5.2×
74160 CPT	CT Abdomen W/Contrast Material	4	$3,302.39	$3,641.00	$3,549.97	nat. median $655 outlier · 5.4×
70498 CPT	CT Angiography Neck W/Contrast/Noncontrast	4	$3,250.69	$3,584.00	$3,494.40	nat. median $744 outlier · 4.7×
72194 CPT	CT Pelvis Without & W/Contrast Material	4	$3,248.87	$3,582.00	$3,492.45	nat. median $672 outlier · 5.2×
72193 CPT	CT Pelvis W/Contrast Material	4	$3,244.34	$3,577.00	$3,487.57	nat. median $643 outlier · 5.4×
73702 CPT	CT Lower Extremity Without & W/Contrast Matrl	4	$3,220.76	$3,551.00	$3,462.22	nat. median $708 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 $663 outlier · 5.2×
J1745 HCPCS	Infliximab 100 Mg Intravenous Solution	4	$3,179.13	$3,505.11	$3,417.49	nat. median $405 outlier · 8.4×
J0882 HCPCS	Darbepoetin Alfa 150 Mcg/0.3 Ml In Polysorbate Injection Syringe	4	$777.34	$6,944.56	$3,397.66	nat. median $119 outlier · 28.6×
72126 CPT	CT Cervical Spine W/Contrast Material	4	$3,150.01	$3,473.00	$3,386.18	nat. median $758 outlier · 4.5×
70488 CPT	CT Maxillofacial Without & W/Contrast Material	4	$3,059.31	$3,373.00	$3,288.68	nat. median $639 outlier · 5.1×
71260 CPT	Diagnostic Computed Tomography Thorax W/Contrast	4	$3,052.96	$3,366.00	$3,281.85	nat. median $651 outlier · 5.0×
73201 CPT	CT Upper Extremity W/Contrast Material	4	$2,991.29	$3,298.00	$3,215.55	nat. median $805 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 $632 outlier · 5.0×
70470 CPT	CT Head/Brain Without & W/Contrast Material	4	$2,956.82	$3,260.00	$3,178.50	nat. median $629 outlier · 5.1×
70460 CPT	CT Head/Brain W/Contrast Material	4	$2,915.10	$3,214.00	$3,133.65	nat. median $582 outlier · 5.4×
73701 CPT	CT Lower Extremity W/Contrast Material	4	$2,896.05	$3,193.00	$3,113.18	nat. median $677 outlier · 4.6×
70487 CPT	CT Maxillofacial W/Contrast Material	4	$2,868.84	$3,163.00	$3,083.93	nat. median $611 outlier · 5.0×
70491 CPT	CT Soft Tissue Neck W/Contrast Material	4	$2,852.51	$3,145.00	$3,066.38	nat. median $632 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.

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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