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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

PIONEER MEMORIAL HOSPITAL - CAH

Viborg, SD · CCN 431328 · Rates published

1,538 distinct procedures filed
10 distinct payers
30,165 rate rows
2026-04-30 last MRF observed
Data quality

30,029 of 30,165 rate rows are consumer-grade (99.5%)

136 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
percent-of-charges filed in the dollar field — excluded from medians 103
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 33
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/8088/460260288_pioneer-memorial-hospital-and-health-services_standardcharges.csv
Found on page https://search.hospitalpriceindex.com/hpi2/machineReadable/PioneerMemorialHealth/8088
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-09-20
Content fingerprint 56d7b2c9c10d62d5… · 19,699,615 bytes · first seen 2026-05-08

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
J2997
HCPCS 		Alteplase For Inj 100 Mg 10 $169.29 $13,210.23 $11,336.50 nat. median
$500
outlier · 22.7×
J3101
HCPCS 		Tenecteplase For IV Soln Kit 25 Mg 10 $3,804.81 $12,513.46 $10,040.67 nat. median
$3,787
outlier · 2.7×
J2353
HCPCS 		Octreotide Acetate For IM Inj Kit 30 Mg 10 $3,855.53 $10,575.16 $9,363.42 nat. median
$5,623
1.7× median
J0517
HCPCS 		Benralizumab Subcutaneous Soln Prefilled Syringe 30 Mg/ml 10 $3,073.97 $8,431.45 $7,465.35 nat. median
$919
outlier · 8.1×
J2506
HCPCS 		Pegfilgrastim Soln Prefilled Syringe 6 Mg/0.6ml 10 $2,897.54 $7,947.54 $7,036.89 nat. median
$1,659
outlier · 4.2×
J1306
HCPCS 		Inclisiran Sodium Subcutaneous Soln Pref Syr 284 Mg/1.5ml 10 $2,231.30 $6,120.13 $5,418.87 nat. median
$44
outlier · 123.9×
J3111
HCPCS 		Romosozumab-aqqg Inj Soln Prefilled Syringe 105 Mg/1.17ml 10 $1,897.59 $8,968.90 $5,042.17 nat. median
$696
outlier · 7.2×
74178
CPT 		CT Abd Pelvis Wo Then W Cont 10 $1,930.95 $5,296.32 $4,689.45 nat. median
$1,027
outlier · 4.6×
74174
CPT 		CTA Abd Pelvis W Contrast+wo If Perform 10 $1,925.00 $5,280.00 $4,675.00 nat. median
$998
outlier · 4.7×
74177
CPT 		CT Abd Pelvis W Contrast 10 $1,853.60 $5,084.16 $4,501.60 nat. median
$976
outlier · 4.6×
72127
CPT 		CT Cerv Spine Wo Then W Cont 10 $1,841.70 $5,051.52 $4,472.70 nat. median
$617
outlier · 7.3×
72126
CPT 		CT Cervical Spine W Contrast 10 $1,768.90 $4,851.84 $4,295.90 nat. median
$758
outlier · 5.7×
71275
CPT 		CTA Chest Wcont +wo If Perf 10 $1,687.35 $4,628.16 $4,097.85 nat. median
$759
outlier · 5.4×
71270
CPT 		CT Thorax Diagnostic Wo Then W Contrast 10 $1,673.35 $4,589.76 $4,063.85 nat. median
$684
outlier · 5.9×
73723
CPT 		MRI Lower Ext Jt Wo Then W Cont 10 $1,673.00 $4,588.80 $4,063.00 nat. median
$1,199
outlier · 3.4×
73223
CPT 		MRI Upper Ext Jt Wo Then W Cont 10 $1,673.00 $4,588.80 $4,063.00 nat. median
$1,158
outlier · 3.5×
73220
CPT 		MRI Upper Ext Wo Then W Cont 10 $1,673.00 $4,588.80 $4,063.00 nat. median
$1,136
outlier · 3.6×
73720
CPT 		MRI Lower Ext Wo Then W Cont 10 $1,673.00 $4,588.80 $4,063.00 nat. median
$1,135
outlier · 3.6×
72156
CPT 		MRI C Spine Wo Then W Cont 10 $1,673.00 $4,588.80 $4,039.10 nat. median
$1,110
outlier · 3.6×
72157
CPT 		MRI T Spine Wo Then W Cont 10 $1,673.00 $4,588.80 $4,039.10 nat. median
$1,114
outlier · 3.6×
72158
CPT 		MRI L Spine Wo Then W Cont 10 $1,673.00 $4,588.80 $4,039.10 nat. median
$1,097
outlier · 3.7×
J1437
HCPCS 		Ferric Derisomaltose (One Dose) IV Sol 1000 Mg/10ml (Fe Eq) 10 $1,650.01 $4,525.74 $4,007.16 nat. median
$45
outlier · 88.7×
72147
CPT 		MRI T Spine W Contrast 10 $1,648.15 $4,520.64 $4,002.65 nat. median
$972
outlier · 4.1×
72149
CPT 		MRI L Spine W Contrast 10 $1,648.15 $4,520.64 $4,002.65 nat. median
$979
outlier · 4.1×
72142
CPT 		MRI C Spine W Contrast 10 $1,648.15 $4,520.64 $4,002.65 nat. median
$978
outlier · 4.1×
73721
CPT 		MRI Lower Ext Jt Wo Contrast 10 $1,637.30 $4,490.88 $3,976.30 nat. median
$856
outlier · 4.6×
73221
CPT 		MRI Upper Ext Jt Wo Contrast 10 $1,637.30 $4,490.88 $3,976.30 nat. median
$844
outlier · 4.7×
Q5120
HCPCS 		Pegfilgrastim-bmez Soln Prefilled Syringe 6 Mg/0.6ml 10 $1,618.32 $4,438.83 $3,930.21 nat. median
$371
outlier · 10.6×
71260
CPT 		CT Thorax Diagnostic With Contrast 10 $1,606.85 $4,407.36 $3,902.35 nat. median
$651
outlier · 6.0×
70492
CPT 		CT Sft Tisue Neck Wwo Then W 10 $1,605.45 $4,403.52 $3,898.95 nat. median
$650
outlier · 6.0×
72146
CPT 		MRI T Spine Wo Contrast 10 $1,604.40 $4,400.64 $3,896.40 nat. median
$800
outlier · 4.9×
72141
CPT 		MRI C Spine Wo Contrast 10 $1,604.40 $4,400.64 $3,896.40 nat. median
$785
outlier · 5.0×
73218
CPT 		MRI Up Ext Wo Cont 10 $1,604.40 $4,400.64 $3,896.40 nat. median
$866
outlier · 4.5×
73718
CPT 		MRI Lower Ext Wo Contrast 10 $1,604.40 $4,400.64 $3,896.40 nat. median
$870
outlier · 4.5×
72148
CPT 		MRI L Spine Wo Contrast 10 $1,604.40 $4,400.64 $3,896.40 nat. median
$807
outlier · 4.8×
73702
CPT 		CT Ext Lower Wo Then W Cont 10 $1,604.40 $4,400.64 $3,896.40 nat. median
$708
outlier · 5.5×
73202
CPT 		CT Ext Upper Wwo Contrast 10 $1,604.40 $4,400.64 $3,896.40 nat. median
$714
outlier · 5.5×
73719
CPT 		MRI Lower Ext W Contrast 10 $1,569.40 $4,304.64 $3,811.40 nat. median
$965
outlier · 3.9×
70491
CPT 		CT Soft Tissue Neck W Contrast 10 $1,566.95 $4,297.92 $3,805.45 nat. median
$632
outlier · 6.0×
74183
CPT 		MRI Abdomen Wo Then W Cont 10 $1,561.00 $4,281.60 $3,791.00 nat. median
$1,105
outlier · 3.4×
Q5122
HCPCS 		Pegfilgrastim-apgf Soln Prefilled Syringe 6 Mg/0.6ml 10 $1,560.90 $4,281.33 $3,790.76 nat. median
$561
outlier · 6.8×
70543
CPT 		MRI Face Neck Orb Wo Then W Cont 10 $1,561.00 $4,281.60 $3,768.70 nat. median
$1,087
outlier · 3.5×
74176
CPT 		CT Abd Pelvis Wo Contrast 10 $1,544.90 $4,237.44 $3,751.90 nat. median
$694
outlier · 5.4×
73201
CPT 		CT Ext Upper W Cont 10 $1,540.35 $4,224.96 $3,740.85 nat. median
$805
outlier · 4.6×
73701
CPT 		CT Ext Lower W Cont 10 $1,540.35 $4,224.96 $3,740.85 nat. median
$677
outlier · 5.5×
70470
CPT 		CT Head Wo Then W Contrast 10 $1,515.50 $4,156.80 $3,680.50 nat. median
$629
outlier · 5.8×
72196
CPT 		MRI Pelvis W Contrast 10 $1,515.50 $4,156.80 $3,680.50 nat. median
$953
outlier · 3.9×
70549
CPT 		MRA Neck Wo Then W Cont 10 $1,510.25 $4,142.40 $3,667.75 nat. median
$1,063
outlier · 3.5×
72129
CPT 		CT Thoracic Spine W Contrast 10 $1,504.65 $4,127.04 $3,654.15 nat. median
$585
outlier · 6.2×
72125
CPT 		CT Cervical Spine Wo Contrast 10 $1,473.50 $4,041.60 $3,578.50 nat. median
$480
outlier · 7.4×

Other procedures at this hospital

Browse this hospital's 1,538 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
             
0120 RC Semi Private Room 33 10 $2,055.00 $2,055.00 $514.50 $2,092.80 $1,726.20 2026-04-30
0210 RC General Coronary Care Room Chg 11 10 $2,380.00 $2,380.00 $833.00 $2,284.80 $2,023.00 2026-04-30
0360 RC Additional 1 2 Hour 132 10 $1,824.50 $1,824.50 $81.55 $4,220.16 $1,497.34 2026-04-30
0370 RC General Anes Component 11 10 $1,746.00 $1,746.00 $611.10 $1,676.16 $1,484.10 2026-04-30
0689 RC Trauma Activation Full 11 10 $1,085.00 $1,085.00 $379.75 $1,041.60 $922.25 2026-04-30
0750 RC Colonoscopy Limited 77 10 $3,625.00 $3,625.00 $191.80 $3,746.88 $2,911.94 2026-04-30
0761 RC Tx Rm Paracentesis (op) 11 10 $737.00 $737.00 $257.95 $707.52 $626.45 2026-04-30
10180 CPT Incision & Drainage Cmplx Postop Wnd Infection 11 10 $927.00 $927.00 $324.45 $889.92 $787.95 2026-04-30
11404 CPT Exc Bengn Skn Lesn Inc Margin No Skn Tag Trnk Arm Leg Dia 3.1-4.0 Cm 11 10 $822.00 $822.00 $287.70 $789.12 $698.70 2026-04-30
11406 CPT Exc Bengn Skn Lesn Inc Margin No Skn Tag Trnk Arm Leg Dia > 4.0 Cm 11 10 $1,105.00 $1,105.00 $386.75 $1,060.80 $939.25 2026-04-30
11423 CPT Exc Bengn Skn Les Wmarg No Skin Tag Sclp Nck Hnd Ft Gen Dia 2.1-3.0cm 11 10 $808.00 $808.00 $282.80 $775.68 $686.80 2026-04-30
11424 CPT Exc Bengn Skn Les Wmarg No Skin Tag Sclp Nck Hnd Ft Gen Dia 3.1-4.0cm 11 10 $927.00 $927.00 $324.45 $889.92 $787.95 2026-04-30
11426 CPT Exc Bengn Skn Les Wmarg No Skin Tag Sclp Nck Hnd Ft Gen Dia > 4.0cm 11 10 $1,355.00 $1,355.00 $474.25 $1,300.80 $1,151.75 2026-04-30
11442 CPT Exc Benign Skin Lesn Incl Margins Face Exc Diam 1.1-2.0 Cm 11 10 $750.00 $750.00 $262.50 $720.00 $637.50 2026-04-30
11443 CPT Exc Benign Skin Lesn Incl Margins Face Exc Diam 2.1-3.0 Cm 11 10 $899.00 $899.00 $314.65 $863.04 $764.15 2026-04-30
11444 CPT Exc Benign Skin Lesn Incl Margins Face Exc Diam 3.1-4.0 Cm 11 10 $1,152.00 $1,152.00 $403.20 $1,105.92 $979.20 2026-04-30
11446 CPT Exc Benign Skin Lesn Incl Margins Face Exc Diam > 4.0 Cm 11 10 $1,570.00 $1,570.00 $549.50 $1,507.20 $1,334.50 2026-04-30
11600 CPT Exc Malig Lesn Incl Margins Trunk Arms Legs Exc Diam 0.5 Cm < 11 10 $755.00 $755.00 $264.25 $724.80 $641.75 2026-04-30
11601 CPT Exc Malig Lesn Incl Margins Trunk Arms Legs Exc Diam 0.6 To 1.0 Cm 11 10 $799.00 $799.00 $279.65 $767.04 $679.15 2026-04-30
11602 CPT Exc Malig Lesn Incl Margins Trunk Arms Legs Exc Diam 1.1 To 2.0 Cm 11 10 $891.00 $891.00 $311.85 $855.36 $757.35 2026-04-30
11603 CPT Exc Malig Lesn Incl Margins Trunk Arms Legs Exc Diam 2.1 To 3.0 Cm 11 10 $1,071.00 $1,071.00 $374.85 $1,028.16 $910.35 2026-04-30
11604 CPT Exc Malig Lesn Incl Margins Trunk Arms Legs Exc Diam 3.1 To 4.0 Cm 11 10 $1,211.00 $1,211.00 $423.85 $1,162.56 $1,029.35 2026-04-30
11606 CPT Exc Malig Lesn Incl Margins Trunk Arms Legs Exc Diam > 4.0 Cm 11 10 $1,712.00 $1,712.00 $599.20 $1,643.52 $1,455.20 2026-04-30
11620 CPT Exc Malig Lesn Inc Margin Scalp Nck Hnd Ft Genital Exc Diam 0.5 Cm < 11 10 $761.00 $761.00 $266.35 $730.56 $646.85 2026-04-30
11621 CPT Exc Malig Lesn Inc Margin Scalp Nck Hnd Ft Genital Exc Diam 0.6-1.0cm 11 10 $904.00 $904.00 $316.40 $867.84 $768.40 2026-04-30
11622 CPT Exc Malig Lesn Inc Margin Scalp Nck Hnd Ft Genital Exc Diam 1.1-2.0cm 11 10 $992.00 $992.00 $347.20 $952.32 $843.20 2026-04-30
11623 CPT Exc Malig Lesn Inc Margin Scalp Nck Hnd Ft Genital Exc Diam 2.1-3.0cm 11 10 $1,140.00 $1,140.00 $399.00 $1,094.40 $969.00 2026-04-30
11624 CPT Exc Malig Lesn Inc Margin Scalp Nck Hnd Ft Genital Exc Diam 3.1-4.0cm 11 10 $1,283.00 $1,283.00 $449.05 $1,231.68 $1,090.55 2026-04-30
11626 CPT Exc Malig Lesn Inc Margin Scalp Nck Hnd Ft Genital Exc Diam > 4.0cm 11 10 $1,570.00 $1,570.00 $549.50 $1,507.20 $1,334.50 2026-04-30
11641 CPT Exc Malig Lesn Incl Margins Face Exc Diam 0.6-1.0 Cm 11 10 $872.00 $872.00 $305.20 $837.12 $741.20 2026-04-30
11642 CPT Exc Malig Lesn Incl Margins Face Exc Diam 1.1-2.0 Cm 11 10 $1,069.00 $1,069.00 $374.15 $1,026.24 $908.65 2026-04-30
11643 CPT Exc Malig Lesn Incl Margins Face Exc Diam 2.1-3.0 Cm 11 10 $1,211.00 $1,211.00 $423.85 $1,162.56 $1,029.35 2026-04-30
11644 CPT Exc Malig Lesn Incl Margins Face Exc Diam 3.1-4.0 Cm 11 10 $1,511.00 $1,511.00 $528.85 $1,450.56 $1,284.35 2026-04-30
12034 CPT Ed 12034 Lyr Clsr Of Wnd 7.6-12.5cm 22 10 $951.50 $951.50 $233.45 $1,186.56 $620.31 2026-04-30
12035 CPT Ed 12035 Lyr Clsr Of Wd 12.6-20.0cm 22 10 $1,069.50 $1,069.50 $239.05 $1,397.76 $635.19 2026-04-30
12036 CPT Ed 12036 Lyr Clsr Wd 20.1-30.0 Cm 22 10 $1,230.00 $1,230.00 $246.05 $1,686.72 $653.79 2026-04-30
12037 CPT Ed 12037 Lyr Clsr Of Wnd >30.0cm 22 10 $1,400.50 $1,400.50 $252.70 $1,995.84 $710.38 2026-04-30
12044 CPT Ed 12044 Lyr Clsr Wd 7.6-12.5cm Nhf 22 10 $996.00 $996.00 $233.45 $1,272.00 $620.31 2026-04-30
12045 CPT Ed 12045 Lyr Clr Wd 12.6-20.0cm Nhf 22 10 $1,121.00 $1,121.00 $239.05 $1,496.64 $635.19 2026-04-30
12046 CPT Ed 12046 Intrmd Rpr Lac Nck Hnds Feet Gntl 20.1-30.0cm 22 10 $1,245.50 $1,245.50 $246.05 $1,716.48 $653.79 2026-04-30
12047 CPT Ed 12047 Lyr Clsr Wnd >30.0cm Nhf 11 10 $722.00 $722.00 $252.70 $693.12 $613.70 2026-04-30
12053 CPT Ed 12053 Lyr Clsr Of Wnd 5.1-7.5cm 22 10 $992.50 $992.50 $233.45 $1,265.28 $620.31 2026-04-30
12054 CPT Ed 12054 Lyr Clsr Of Wnd 7.6-12.5cm 22 10 $1,069.50 $1,069.50 $239.05 $1,397.76 $635.19 2026-04-30
12055 CPT Ed 12055 Lyr Clsr Wnd 12.6-20.0cm 22 10 $1,286.50 $1,286.50 $246.05 $1,795.20 $664.69 2026-04-30
12056 CPT Ed 12056 Intrmd Rpr Lac Fce Ear Lid Ns Lp Mth20.1-30cm 22 10 $1,462.00 $1,462.00 $252.70 $2,113.92 $731.91 2026-04-30
12057 CPT Ed 12057 Intrmd Rpr Lac Fce Ear Lid Nse Lip Mth>30.0cm 11 10 $738.00 $738.00 $258.30 $708.48 $627.30 2026-04-30
13131 CPT Rpr Cmplx Forehead Chk Chn Mouth Nck Axil Genital Hand Ft 1.1-2.5 Cm 11 10 $1,550.00 $1,550.00 $542.50 $1,488.00 $1,317.50 2026-04-30
13132 CPT Rpr Cmplx Forehead Chk Chn Mouth Nck Axil Genital Hand Ft 2.6-7.5 Cm 11 10 $1,988.00 $1,988.00 $695.80 $1,908.48 $1,689.80 2026-04-30
15271 CPT Tx Rm 15271 Skin Sub Graft Trnk Arm Leg 11 10 $3,169.00 $3,169.00 $1,109.15 $3,042.24 $2,693.65 2026-04-30
15275 CPT Tx Rm 15275 Skin Sub Graft Face Nk Hf G 11 10 $3,169.00 $3,169.00 $1,109.15 $3,042.24 $2,693.65 2026-04-30
17004 CPT Destruct Premalig Lesns Excpt Skin Tags Cutaneous Vasc Proliferative L 11 10 $763.00 $763.00 $267.05 $732.48 $648.55 2026-04-30
20220 CPT Surg 20220 Biopsy Bone 11 10 $3,903.00 $3,903.00 $1,366.05 $3,746.88 $3,317.55 2026-04-30
23075 CPT Exc Soft Tissue Tumor Shldr Area Subq 11 10 $2,140.00 $2,140.00 $749.00 $2,054.40 $1,819.00 2026-04-30
23540 CPT Closed Treat Acromioclavicular Dislocation Wo Manip 11 10 $822.00 $822.00 $287.70 $789.12 $698.70 2026-04-30
23545 CPT Closed Treat Acromioclavicular Dislocation Wmanip 11 10 $1,712.00 $1,712.00 $599.20 $1,643.52 $1,455.20 2026-04-30
23570 CPT Closed Treat Scapular Fx Wo Manip 11 10 $1,071.00 $1,071.00 $374.85 $1,028.16 $910.35 2026-04-30
23931 CPT Incision & Drainage Upper Arm Elbow Area Bursa 11 10 $1,561.00 $1,561.00 $546.35 $1,498.56 $1,326.85 2026-04-30
24105 CPT Exc Olecranon Bursa 11 10 $1,712.00 $1,712.00 $599.20 $1,643.52 $1,455.20 2026-04-30
24200 CPT Remvl Fb Upper Arm Elbow Area Subq 11 10 $999.00 $999.00 $349.65 $959.04 $849.15 2026-04-30
24505 CPT Closed Treat Humeral Shaft Fx Wmanip Wwo Skeletal Traction 11 10 $2,140.00 $2,140.00 $749.00 $2,054.40 $1,819.00 2026-04-30
25028 CPT Incision & Drainage Forearm & Or Wrist Deep Abscess Hematoma 11 10 $2,567.00 $2,567.00 $898.45 $2,464.32 $2,181.95 2026-04-30
25111 CPT Exc Ganglion Wrist (dorsal Volar) Prime 11 10 $1,570.00 $1,570.00 $549.50 $1,507.20 $1,334.50 2026-04-30
25248 CPT Exploration Wremvl Deep Fb Forearm Wrist 11 10 $2,190.00 $2,190.00 $766.50 $2,102.40 $1,861.50 2026-04-30
25605 CPT Closed Treat Distal Radial Fx Epiphyseal Separation Wmanip 22 10 $1,679.50 $1,679.50 $227.15 $2,601.60 $785.77 2026-04-30
26055 CPT Surg 26055 Tendon Sheath Incision 11 10 $3,903.00 $3,903.00 $1,366.05 $3,746.88 $3,317.55 2026-04-30
26075 CPT Arthrotomy Exploration Drainage Remvl Loose Fb Metacarpophalangeal Joi 11 10 $1,570.00 $1,570.00 $549.50 $1,507.20 $1,334.50 2026-04-30
26160 CPT Exc Lesn Tendon Sheath Joint Capsule Hand Finger 11 10 $2,710.00 $2,710.00 $948.50 $2,601.60 $2,303.50 2026-04-30
26705 CPT Closed Treat Metacarpophalangeal Dislocation Sngl Wmanip Wanes 11 10 $1,854.00 $1,854.00 $648.90 $1,779.84 $1,575.90 2026-04-30
26756 CPT Percutaneous Skeletal Fixn Distal Phalangeal Fx Finger Thumb Each 11 10 $1,854.00 $1,854.00 $648.90 $1,779.84 $1,575.90 2026-04-30
27096 CPT Inj Proc For Sacroiliac Joint Arthrography & Or Anesthetic Steroid 11 10 $857.00 $857.00 $299.95 $822.72 $728.45 2026-04-30
27200 CPT Closed Treat Coccygeal Fx 11 10 $963.00 $963.00 $337.05 $924.48 $818.55 2026-04-30
27220 CPT Closed Treat Acetabulum (hip Socket) Fx(s) Wo Manip 11 10 $2,427.00 $2,427.00 $849.45 $2,329.92 $2,062.95 2026-04-30
27327 CPT Exc Tumor Thigh Knee Area Subq 11 10 $2,140.00 $2,140.00 $749.00 $2,054.40 $1,819.00 2026-04-30
27500 CPT Closed Treat Femoral Shaft Fx Wo Manip 11 10 $2,427.00 $2,427.00 $849.45 $2,329.92 $2,062.95 2026-04-30
27520 CPT Closed Treat Patellar Fx Wo Manip 11 10 $1,570.00 $1,570.00 $549.50 $1,507.20 $1,334.50 2026-04-30
27530 CPT Closed Treat Tibial Fx Proximal Wo Manip 11 10 $1,427.00 $1,427.00 $499.45 $1,369.92 $1,212.95 2026-04-30
27560 CPT Closed Treat Patellar Dislocation Wo Anes 22 10 $1,655.50 $1,655.50 $559.65 $1,643.52 $1,390.06 2026-04-30
27613 CPT Bx Soft Tissue Leg Ankle Area Superl 11 10 $1,071.00 $1,071.00 $374.85 $1,028.16 $910.35 2026-04-30
27818 CPT Closed Treat Trimalleolar Ankle Fx Wmanip 11 10 $2,140.00 $2,140.00 $749.00 $2,054.40 $1,819.00 2026-04-30
27824 CPT Closed Treat Fx Wt Bearing Articular Portion Distal Tibia Wo Manip 11 10 $1,570.00 $1,570.00 $549.50 $1,507.20 $1,334.50 2026-04-30
27840 CPT Closed Treat Ankle Dislocation Wo Anes 11 10 $1,712.00 $1,712.00 $599.20 $1,643.52 $1,455.20 2026-04-30
28495 CPT Closed Treat Fx Great Toe Phalanx Phalanges Wmanip 11 10 $927.00 $927.00 $324.45 $889.92 $787.95 2026-04-30
28515 CPT Closed Treat Fx Phalanx Phalanges Not Great Toe Wmanip Each 11 10 $822.00 $822.00 $287.70 $789.12 $698.70 2026-04-30
28630 CPT Closed Treat Metatarsophalangeal Joint Dislocation Wo Anes 11 10 $822.00 $822.00 $287.70 $789.12 $698.70 2026-04-30
28820 CPT Amputation Toe Metatarsophalangeal Joint 11 10 $2,710.00 $2,710.00 $948.50 $2,601.60 $2,303.50 2026-04-30
29345 CPT Appln Long Leg Cast (thigh To Toes) 11 10 $745.00 $745.00 $260.75 $715.20 $633.25 2026-04-30
29355 CPT Appln Long Leg Cast (thigh To Toes) Walker Ambulatory Type 11 10 $770.00 $770.00 $269.50 $739.20 $654.50 2026-04-30
32551 CPT Surg 32551 Chest TB Place Open Proc 11 10 $3,903.00 $3,903.00 $1,366.05 $3,746.88 $3,317.55 2026-04-30
32554 CPT Aspirate Pleura Wo Imaging 22 10 $1,439.00 $1,439.00 $258.30 $2,054.40 $728.74 2026-04-30
32555 CPT Ed 32555 Thoracentesis W Imaging 11 10 $1,033.00 $1,033.00 $361.55 $991.68 $878.05 2026-04-30
32556 CPT Ed 32556 Pleural Drainage Perc W/insert Cath Wo Imaging Guid 11 10 $1,013.00 $1,013.00 $354.55 $972.48 $861.05 2026-04-30
36430 CPT Blood Admin 0-2 Hrs 55 10 $1,441.00 $1,441.00 $370.65 $1,861.44 $1,210.44 2026-04-30
36569 CPT Surg 36569 Insertion Picc Without Img Gdn 5 Yr/> 11 10 $3,903.00 $3,903.00 $1,366.05 $3,746.88 $3,317.55 2026-04-30
36584 CPT Surg 36584 Chg Picc Incl Imaging 11 10 $3,903.00 $3,903.00 $1,366.05 $3,746.88 $3,317.55 2026-04-30
38505 CPT Surg 38505 Biopsy Excision Lymph Node Needle Superficial 11 10 $3,903.00 $3,903.00 $1,366.05 $3,746.88 $3,317.55 2026-04-30
41800 CPT Drainage Abscess Cyst Hematoma Dentoalveolar Structures 11 10 $768.00 $768.00 $268.80 $737.28 $652.80 2026-04-30
42700 CPT Incision & Drainage Abscess Peritonsillar 11 10 $999.00 $999.00 $349.65 $959.04 $849.15 2026-04-30
43453 CPT Surg 43453 Dilation Esophagus Guide Wire 11 10 $3,903.00 $3,903.00 $1,366.05 $3,746.88 $3,317.55 2026-04-30
45330 CPT Flex Sig Diag 11 10 $1,346.00 $1,346.00 $471.10 $1,292.16 $1,144.10 2026-04-30
49082 CPT Ed 49082 Abd Paracentesis 22 10 $2,306.50 $2,306.50 $248.50 $3,746.88 $1,023.83 2026-04-30
49451 CPT Surg 49451 Replace Duod/jej Tube Perq 11 10 $3,903.00 $3,903.00 $1,366.05 $3,746.88 $3,317.55 2026-04-30
54161 CPT Circumcision Surgical Exc Othr Thn Clamp Device Dorsl Slit Excpt Nwbrn 11 10 $999.00 $999.00 $349.65 $959.04 $849.15 2026-04-30
55250 CPT Vasectomy Unilat Bilat Wpostoperative Semen Exam (sep Proc) 11 10 $1,997.00 $1,997.00 $698.95 $1,917.12 $1,697.45 2026-04-30
59425 CPT Antepartum Care Only 4 To 6 Visits 11 10 $1,319.00 $1,319.00 $461.65 $1,266.24 $1,121.15 2026-04-30
64450 CPT Ed 64450 Inj Nerve Block Oth Prphrl 11 10 $1,320.00 $1,320.00 $462.00 $1,267.20 $1,122.00 2026-04-30
70260 CPT Rad Exam Skull Compl Min 4 Vws 11 10 $724.00 $724.00 $253.40 $695.04 $615.40 2026-04-30
70336 CPT MRI Temporomandibular Joint 11 10 $3,950.00 $3,950.00 $1,382.50 $3,792.00 $3,357.50 2026-04-30
70450 CPT CT Head Wo Contrast 15 10 $3,464.00 $3,464.00 $1,212.40 $3,325.44 $2,944.40 2026-04-30
70460 CPT CT Head W Contrast 11 10 $4,154.00 $4,154.00 $1,453.90 $3,987.84 $3,530.90 2026-04-30
70470 CPT CT Head Wo Then W Contrast 11 10 $4,330.00 $4,330.00 $1,515.50 $4,156.80 $3,680.50 2026-04-30
70480 CPT CT Orbit Sella Fossa Ear Wo Contrast 11 10 $3,032.00 $3,032.00 $1,061.20 $2,910.72 $2,577.20 2026-04-30
70481 CPT CT Orbit Sella Fossa Ear W Contrast 11 10 $3,633.00 $3,633.00 $1,271.55 $3,487.68 $3,088.05 2026-04-30
70482 CPT CT Orbit Sella Fossa Ear Wo Then W Contrast 11 10 $3,786.00 $3,786.00 $1,325.10 $3,634.56 $3,218.10 2026-04-30
70486 CPT CT Maxillofacial Wo Cont 12 10 $3,032.00 $3,032.00 $1,061.20 $2,910.72 $2,577.20 2026-04-30
70487 CPT CT Maxillofacial W Cont 11 10 $2,997.00 $2,997.00 $1,048.95 $2,877.12 $2,547.45 2026-04-30
70488 CPT CT Maxillofacial Wo W Cont 11 10 $3,786.00 $3,786.00 $1,325.10 $3,634.56 $3,218.10 2026-04-30
70490 CPT CT Soft Tissue Neck Wo Con 11 10 $3,729.00 $3,729.00 $1,305.15 $3,579.84 $3,169.65 2026-04-30
70491 CPT CT Soft Tissue Neck W Contrast 14 10 $4,477.00 $4,477.00 $1,566.95 $4,297.92 $3,805.45 2026-04-30
70492 CPT CT Sft Tisue Neck Wwo Then W 11 10 $4,587.00 $4,587.00 $1,605.45 $4,403.52 $3,898.95 2026-04-30
70496 CPT CTA Head W Cont Wo If Perf 11 10 $2,868.00 $2,868.00 $1,003.80 $2,753.28 $2,437.80 2026-04-30
70540 CPT MRI Face Neck Orb Wo Contrast 11 10 $4,170.00 $4,170.00 $1,459.50 $4,003.20 $3,544.50 2026-04-30
70542 CPT MRI Face Neck Orb W Contrast 11 10 $4,183.00 $4,183.00 $1,464.05 $4,015.68 $3,555.55 2026-04-30
70543 CPT MRI Face Neck Orb Wo Then W Cont 12 10 $4,460.00 $4,460.00 $1,561.00 $4,281.60 $3,768.70 2026-04-30
70544 CPT MRA Head Wo Contrast 11 10 $4,022.00 $4,022.00 $1,407.70 $3,861.12 $3,418.70 2026-04-30
70545 CPT MRA Head W Contrast 11 10 $4,183.00 $4,183.00 $1,464.05 $4,015.68 $3,555.55 2026-04-30
70546 CPT MRA Head Wo Then W Cont 11 10 $4,145.00 $4,145.00 $1,450.75 $3,979.20 $3,523.25 2026-04-30
70547 CPT MRA Neck Wo Contrast 11 10 $4,022.00 $4,022.00 $1,407.70 $3,861.12 $3,418.70 2026-04-30
70549 CPT MRA Neck Wo Then W Cont 11 10 $4,315.00 $4,315.00 $1,510.25 $4,142.40 $3,667.75 2026-04-30
70551 CPT MRI Brain Wo Contrast 12 10 $4,170.00 $4,170.00 $1,459.50 $4,003.20 $3,523.65 2026-04-30
70553 CPT MRI Brain Wo Then W Cont 13 10 $3,070.00 $3,070.00 $1,074.50 $2,947.20 $2,609.50 2026-04-30
71048 CPT Rad Exam Chest 4 Or More Vws 11 10 $820.00 $820.00 $287.00 $787.20 $697.00 2026-04-30
71111 CPT Rad Exam Ribs Bilat W Chest Min 4 Vws 11 10 $736.00 $736.00 $257.60 $706.56 $625.60 2026-04-30
71250 CPT CT Thorax Diagnostic Wo Contrast 14 10 $3,825.00 $3,825.00 $1,338.75 $3,672.00 $3,232.12 2026-04-30
71260 CPT CT Thorax Diagnostic With Contrast 15 10 $4,591.00 $4,591.00 $1,606.85 $4,407.36 $3,902.35 2026-04-30
71270 CPT CT Thorax Diagnostic Wo Then W Contrast 11 10 $4,781.00 $4,781.00 $1,673.35 $4,589.76 $4,063.85 2026-04-30
71271 CPT CT Thorax Lw Dose Lung Ca Scr No Contrast 13 10 $2,175.00 $2,175.00 $761.25 $2,088.00 $1,848.75 2026-04-30
71275 CPT CTA Chest Wcont +wo If Perf 13 10 $4,821.00 $4,821.00 $1,687.35 $4,628.16 $4,097.85 2026-04-30
71550 CPT MRI Chest Wo Contrast 11 10 $4,170.00 $4,170.00 $1,459.50 $4,003.20 $3,544.50 2026-04-30
71551 CPT MRI Chest W Contrast 11 10 $4,183.00 $4,183.00 $1,464.05 $4,015.68 $3,555.55 2026-04-30
72125 CPT CT Cervical Spine Wo Contrast 13 10 $4,210.00 $4,210.00 $1,473.50 $4,041.60 $3,578.50 2026-04-30
72126 CPT CT Cervical Spine W Contrast 11 10 $5,054.00 $5,054.00 $1,768.90 $4,851.84 $4,295.90 2026-04-30
72127 CPT CT Cerv Spine Wo Then W Cont 11 10 $5,262.00 $5,262.00 $1,841.70 $5,051.52 $4,472.70 2026-04-30
72128 CPT CT Thoracic Spine Wo Cont 12 10 $3,584.00 $3,584.00 $1,254.40 $3,440.64 $3,046.40 2026-04-30
72129 CPT CT Thoracic Spine W Contrast 11 10 $4,299.00 $4,299.00 $1,504.65 $4,127.04 $3,654.15 2026-04-30
72131 CPT CT Lumbar Spine Wo Cont 12 10 $3,970.00 $3,970.00 $1,389.50 $3,811.20 $3,374.50 2026-04-30
72141 CPT MRI C Spine Wo Contrast 12 10 $4,584.00 $4,584.00 $1,604.40 $4,400.64 $3,896.40 2026-04-30
72142 CPT MRI C Spine W Contrast 11 10 $4,709.00 $4,709.00 $1,648.15 $4,520.64 $4,002.65 2026-04-30
72146 CPT MRI T Spine Wo Contrast 12 10 $4,584.00 $4,584.00 $1,604.40 $4,400.64 $3,896.40 2026-04-30
72147 CPT MRI T Spine W Contrast 11 10 $4,709.00 $4,709.00 $1,648.15 $4,520.64 $4,002.65 2026-04-30
72148 CPT MRI L Spine Wo Contrast 12 10 $4,584.00 $4,584.00 $1,604.40 $4,400.64 $3,896.40 2026-04-30
72149 CPT MRI L Spine W Contrast 11 10 $4,709.00 $4,709.00 $1,648.15 $4,520.64 $4,002.65 2026-04-30
72156 CPT MRI C Spine Wo Then W Cont 12 10 $4,780.00 $4,780.00 $1,673.00 $4,588.80 $4,039.10 2026-04-30
72157 CPT MRI T Spine Wo Then W Cont 12 10 $4,780.00 $4,780.00 $1,673.00 $4,588.80 $4,039.10 2026-04-30
72158 CPT MRI L Spine Wo Then W Cont 12 10 $4,780.00 $4,780.00 $1,673.00 $4,588.80 $4,039.10 2026-04-30
72192 CPT CT Pelvis Wo Contrast 11 10 $3,227.00 $3,227.00 $1,129.45 $3,097.92 $2,742.95 2026-04-30
72193 CPT CT Pelvis W Contrast 11 10 $3,874.00 $3,874.00 $1,355.90 $3,719.04 $3,292.90 2026-04-30
72194 CPT CT Pelvis Wo Then W Cont 11 10 $4,035.00 $4,035.00 $1,412.25 $3,873.60 $3,429.75 2026-04-30
72195 CPT MRI Pelvis Wo Contrast 12 10 $4,170.00 $4,170.00 $1,459.50 $4,003.20 $3,544.50 2026-04-30
72196 CPT MRI Pelvis W Contrast 11 10 $4,330.00 $4,330.00 $1,515.50 $4,156.80 $3,680.50 2026-04-30
73200 CPT CT Ext Upper Wo Cont 12 10 $3,672.00 $3,672.00 $1,285.20 $3,525.12 $3,121.20 2026-04-30
73201 CPT CT Ext Upper W Cont 11 10 $4,401.00 $4,401.00 $1,540.35 $4,224.96 $3,740.85 2026-04-30
73202 CPT CT Ext Upper Wwo Contrast 11 10 $4,584.00 $4,584.00 $1,604.40 $4,400.64 $3,896.40 2026-04-30
73218 CPT MRI Up Ext Wo Cont 11 10 $4,584.00 $4,584.00 $1,604.40 $4,400.64 $3,896.40 2026-04-30
73220 CPT MRI Upper Ext Wo Then W Cont 11 10 $4,780.00 $4,780.00 $1,673.00 $4,588.80 $4,063.00 2026-04-30
73221 CPT MRI Upper Ext Jt Wo Contrast 14 10 $4,678.00 $4,678.00 $1,637.30 $4,490.88 $3,976.30 2026-04-30
73223 CPT MRI Upper Ext Jt Wo Then W Cont 11 10 $4,780.00 $4,780.00 $1,673.00 $4,588.80 $4,063.00 2026-04-30
73700 CPT CT Ext Lower Wo Cont 12 10 $3,672.00 $3,672.00 $1,285.20 $3,525.12 $3,121.20 2026-04-30
73701 CPT CT Ext Lower W Cont 13 10 $4,401.00 $4,401.00 $1,540.35 $4,224.96 $3,740.85 2026-04-30
73702 CPT CT Ext Lower Wo Then W Cont 11 10 $4,584.00 $4,584.00 $1,604.40 $4,400.64 $3,896.40 2026-04-30
73718 CPT MRI Lower Ext Wo Contrast 13 10 $4,584.00 $4,584.00 $1,604.40 $4,400.64 $3,896.40 2026-04-30
73719 CPT MRI Lower Ext W Contrast 11 10 $4,484.00 $4,484.00 $1,569.40 $4,304.64 $3,811.40 2026-04-30
73720 CPT MRI Lower Ext Wo Then W Cont 11 10 $4,780.00 $4,780.00 $1,673.00 $4,588.80 $4,063.00 2026-04-30
73721 CPT MRI Lower Ext Jt Wo Contrast 14 10 $4,678.00 $4,678.00 $1,637.30 $4,490.88 $3,976.30 2026-04-30
73723 CPT MRI Lower Ext Jt Wo Then W Cont 11 10 $4,780.00 $4,780.00 $1,673.00 $4,588.80 $4,063.00 2026-04-30
74022 CPT Rad Exam Abd Series 2 Or > Abd Views And Sngl View Chest 11 10 $787.00 $787.00 $275.45 $755.52 $668.95 2026-04-30
74150 CPT CT Abdomen Wo Contrast 11 10 $2,814.00 $2,814.00 $984.90 $2,701.44 $2,391.90 2026-04-30
74160 CPT CT Abdomen W Contrast 11 10 $3,373.00 $3,373.00 $1,180.55 $3,238.08 $2,867.05 2026-04-30
74170 CPT CT Abdomen Wo Then W Cont 11 10 $3,521.00 $3,521.00 $1,232.35 $3,380.16 $2,992.85 2026-04-30
74174 CPT CTA Abd Pelvis W Contrast+wo If Perform 11 10 $5,500.00 $5,500.00 $1,925.00 $5,280.00 $4,675.00 2026-04-30
74175 CPT CTA Abd Wcont +wo If Perf 11 10 $3,424.00 $3,424.00 $1,198.40 $3,287.04 $2,910.40 2026-04-30
74176 CPT CT Abd Pelvis Wo Contrast 13 10 $4,414.00 $4,414.00 $1,544.90 $4,237.44 $3,751.90 2026-04-30
74177 CPT CT Abd Pelvis W Contrast 15 10 $5,296.00 $5,296.00 $1,853.60 $5,084.16 $4,501.60 2026-04-30
74178 CPT CT Abd Pelvis Wo Then W Cont 12 10 $5,517.00 $5,517.00 $1,930.95 $5,296.32 $4,689.45 2026-04-30
74181 CPT MRI Abdomen Wo Contrast 11 10 $4,170.00 $4,170.00 $1,459.50 $4,003.20 $3,544.50 2026-04-30
74183 CPT MRI Abdomen Wo Then W Cont 11 10 $4,460.00 $4,460.00 $1,561.00 $4,281.60 $3,791.00 2026-04-30
74400 CPT Rad Urography IV W Wo Kub W Wo Tomo 11 10 $1,141.00 $1,141.00 $399.35 $1,095.36 $969.85 2026-04-30
76499 CPT Xray Shunt Survey 11 10 $1,237.00 $1,237.00 $432.95 $1,187.52 $1,051.45 2026-04-30
76604 CPT US Chest 11 10 $1,033.00 $1,033.00 $361.55 $991.68 $878.05 2026-04-30
76700 CPT US Abd Complete 14 10 $1,364.00 $1,364.00 $477.40 $1,309.44 $1,159.40 2026-04-30
76705 CPT US Abd Limited 14 10 $1,276.00 $1,276.00 $446.60 $1,224.96 $1,084.60 2026-04-30
76770 CPT US Retroperitoneum 13 10 $1,167.00 $1,167.00 $408.45 $1,120.32 $991.95 2026-04-30
76775 CPT US Retroperitoneum Ltd 11 10 $729.00 $729.00 $255.15 $699.84 $619.65 2026-04-30
76801 CPT US Preg Uter 1st Tri Sgl 11 10 $794.00 $794.00 $277.90 $762.24 $674.90 2026-04-30
76802 CPT US Prg Utr 1st Tri Ea Ad 11 10 $794.00 $794.00 $277.90 $762.24 $674.90 2026-04-30
76805 CPT US Pg Utr 2-3tri Sgl 1st 11 10 $794.00 $794.00 $277.90 $762.24 $674.90 2026-04-30
76810 CPT US Pg Utr Mlt Gst 2-3tri 11 10 $794.00 $794.00 $277.90 $762.24 $674.90 2026-04-30
76817 CPT US Pg Utr Transvag 11 10 $830.00 $830.00 $290.50 $796.80 $705.50 2026-04-30
76819 CPT US Fetal Bpp Wo Nst 11 10 $844.00 $844.00 $295.40 $810.24 $717.40 2026-04-30
76830 CPT US Transvaginal 13 10 $1,009.00 $1,009.00 $353.15 $968.64 $857.65 2026-04-30
76856 CPT US Pelvic Complete 13 10 $1,013.00 $1,013.00 $354.55 $972.48 $861.05 2026-04-30
76870 CPT US Scrotum 13 10 $1,167.00 $1,167.00 $408.45 $1,120.32 $991.95 2026-04-30
76872 CPT US Transrectal 11 10 $1,169.00 $1,169.00 $409.15 $1,122.24 $993.65 2026-04-30
76882 CPT US Lmtd Jnt Or Foc Eval Real Time Wimage Doc 13 10 $900.00 $900.00 $315.00 $864.00 $765.00 2026-04-30
76942 CPT US S&i Guid Ndle Plmt 11 10 $1,033.00 $1,033.00 $361.55 $991.68 $878.05 2026-04-30
77085 CPT Dxa Scan Axial Skelet Inc Vert Fx Assess 11 10 $733.00 $733.00 $256.55 $703.68 $623.05 2026-04-30
78013 CPT Nm Thyroid Img W Vasc Flow 11 10 $1,248.00 $1,248.00 $436.80 $1,198.08 $1,060.80 2026-04-30
78014 CPT Nm Thyroid Img W Sngl Mult Uptake 11 10 $1,818.00 $1,818.00 $636.30 $1,745.28 $1,545.30 2026-04-30
78070 CPT Nm Parathyroid Planar Img 11 10 $1,619.00 $1,619.00 $566.65 $1,554.24 $1,376.15 2026-04-30
78071 CPT Nm Parathyroid Planar Img W Spect 11 10 $1,940.00 $1,940.00 $679.00 $1,862.40 $1,649.00 2026-04-30
78072 CPT Nm Parathyroid Planar Img W Spect And CT 11 10 $2,251.00 $2,251.00 $787.85 $2,160.96 $1,913.35 2026-04-30
78226 CPT Nm Hepatobiliary Img Incl Gallbladder 11 10 $2,025.00 $2,025.00 $708.75 $1,944.00 $1,721.25 2026-04-30
78227 CPT Nm Hepatobiliary Img Incl Gallbladder W Pharm Intv 11 10 $2,025.00 $2,025.00 $708.75 $1,944.00 $1,721.25 2026-04-30
78264 CPT Nm Gastric Emptying Img Study 11 10 $1,190.00 $1,190.00 $416.50 $1,142.40 $1,011.50 2026-04-30
78306 CPT Nm Bone And Or Jnt Img Whole Body 11 10 $1,876.00 $1,876.00 $656.60 $1,800.96 $1,594.60 2026-04-30
78315 CPT Nm Bone And Or Jnt Img 3 Phase Stdy 11 10 $1,812.00 $1,812.00 $634.20 $1,739.52 $1,540.20 2026-04-30
78451 CPT Nm Myocardial Spect Sngl Stdy 11 10 $1,948.00 $1,948.00 $681.80 $1,870.08 $1,655.80 2026-04-30
78452 CPT Nm Myocardial Spect Mult Stdy 11 10 $3,814.00 $3,814.00 $1,334.90 $3,661.44 $3,241.90 2026-04-30
78582 CPT Nm Pulm Ventilation And Perfusion Img 11 10 $2,646.00 $2,646.00 $926.10 $2,540.16 $2,249.10 2026-04-30
78708 CPT Nm Kidney Img Morph W Vasc Flow Func Sngl W Rx 11 10 $1,780.00 $1,780.00 $623.00 $1,708.80 $1,513.00 2026-04-30
78803 CPT Nm Rp Loc Tum Spect Sgl Area/acq Sgl Day 11 10 $983.00 $983.00 $344.05 $943.68 $835.55 2026-04-30
81206 CPT Cdmr Bcr/abl1 Major Breakpnt Qualitative/quantitative 81206 12 10 $825.00 $825.00 $288.75 $792.00 $697.12 2026-04-30
81270 CPT Jak2 V617f Mutuation Detection B 81270.902 11 10 $878.00 $878.00 $307.30 $842.88 $746.30 2026-04-30
81382 CPT Celiac Genetics Panel 81382.901 11 10 $1,149.00 $1,149.00 $402.15 $1,103.04 $976.65 2026-04-30
81418 CPT Cdmr Rx Metab Genomic Seq Alys Panel At Least 6 Genes 81418 11 10 $979.00 $979.00 $342.65 $939.84 $832.15 2026-04-30
86053 CPT Aquaporin-4 Antibody Nmo Flow Cytometry Each So 86053.902 11 10 $976.00 $976.00 $341.60 $936.96 $829.60 2026-04-30
86363 CPT Mog-igg1 Antibody Flow Cytometry So 86363.902 11 10 $1,408.00 $1,408.00 $492.80 $1,351.68 $1,196.80 2026-04-30
86596 CPT Pq Type Calcium Channel Ab So 86596.902 11 10 $1,256.00 $1,256.00 $439.60 $1,205.76 $1,067.60 2026-04-30
87154 CPT Culture Typing Id Blood Path Resist Type 6+trgt 87154 12 10 $779.00 $779.00 $272.65 $747.84 $662.15 2026-04-30
87483 CPT Meningitis/encephalitis Panel 87483 11 10 $835.00 $835.00 $292.25 $801.60 $709.75 2026-04-30
87902 CPT Hepatitis C Virus Genotype 87902.900 11 10 $984.00 $984.00 $344.40 $944.64 $836.40 2026-04-30
88309 CPT Surgical Path Level Vi 88309 11 10 $939.00 $939.00 $328.65 $901.44 $798.15 2026-04-30
90375 CPT Rabies Immune Globulin Rig Human Per 150 Iu 11 10 $904.00 $904.00 $316.40 $867.84 $768.40 2026-04-30
90675 CPT Rabies Vaccine IM Use 22 10 $931.95 $931.95 $239.40 $1,132.70 $636.12 2026-04-30
92950 CPT Cardiopulmonary Resuscitation 22 10 $1,439.50 $1,439.50 $380.80 $1,719.36 $1,011.84 2026-04-30
92960 CPT Cardioversion 11 10 $1,358.00 $1,358.00 $475.30 $1,303.68 $1,154.30 2026-04-30
93017 CPT Cardiac Stress Test Tracing 11 10 $1,053.00 $1,053.00 $368.55 $1,010.88 $895.05 2026-04-30
93303 CPT Echo Congenitl Comp 11 10 $1,135.00 $1,135.00 $397.25 $1,089.60 $964.75 2026-04-30
93306 CPT Echo (2d) Complete W Doppler & Color 13 10 $2,429.00 $2,429.00 $850.15 $2,331.84 $2,064.65 2026-04-30
93307 CPT Echo 2d Wo Dop Col Comp 11 10 $1,135.00 $1,135.00 $397.25 $1,089.60 $964.75 2026-04-30
93308 CPT Echo 2-d Limited 11 10 $869.00 $869.00 $304.15 $834.24 $738.65 2026-04-30
93350 CPT Echo 2d With Stress 11 10 $1,896.00 $1,896.00 $663.60 $1,820.16 $1,611.60 2026-04-30
93880 CPT Dup Carotid Bilat 12 10 $1,509.00 $1,509.00 $528.15 $1,448.64 $1,282.65 2026-04-30
93882 CPT Duplex Extracranial Carotid Unilat 11 10 $1,084.00 $1,084.00 $379.40 $1,040.64 $921.40 2026-04-30
93923 CPT Cmpl Bilat Physiologic Studies Ext Art 3+ Lvls 11 10 $1,038.00 $1,038.00 $363.30 $996.48 $882.30 2026-04-30
93925 CPT Duplex Art Lower Ext Cmpl Bilat 13 10 $1,033.00 $1,033.00 $361.55 $991.68 $878.05 2026-04-30
93926 CPT Duplex Art Lower Ext Unilat Ltd 12 10 $945.00 $945.00 $330.75 $907.20 $803.25 2026-04-30
93930 CPT Duplex Art Upper Ext Cmpl Bilat 11 10 $1,033.00 $1,033.00 $361.55 $991.68 $878.05 2026-04-30
93931 CPT Duplex Art Upper Ext Unilat Ltd 11 10 $945.00 $945.00 $330.75 $907.20 $803.25 2026-04-30
93970 CPT Duplex Venous Ext Cmpl Bilat 12 10 $1,293.00 $1,293.00 $452.55 $1,241.28 $1,092.59 2026-04-30
93971 CPT Duplex Venous Ext Ltd Unilat 12 10 $957.00 $957.00 $334.95 $918.72 $813.45 2026-04-30
93975 CPT Duplex Abd Pelvis Retroperitoneal Cmpl 24 10 $1,492.50 $1,492.50 $494.55 $1,509.12 $1,288.23 2026-04-30
93976 CPT Duplex Abd Pelvis Retroperitoneal Ltd 11 10 $1,097.00 $1,097.00 $383.95 $1,053.12 $932.45 2026-04-30
93978 CPT Duplex Aorta Ivc Iliac Or Graft Cmpl 11 10 $1,078.00 $1,078.00 $377.30 $1,034.88 $916.30 2026-04-30
95810 CPT Psg 4+ Parameters 11 10 $3,153.00 $3,153.00 $1,103.55 $3,026.88 $2,680.05 2026-04-30
95811 CPT Sleep Study Splt Nght 95811 11 10 $3,153.00 $3,153.00 $1,103.55 $3,026.88 $2,680.05 2026-04-30
96365 CPT Ed 96365 IV Infus Ther Proph Diag Initial Up To 1hr 30 10 $846.50 $846.50 $230.30 $993.60 $611.94 2026-04-30
96413 CPT Chemo Infusion 1st Hr 11 10 $1,035.00 $1,035.00 $362.25 $993.60 $879.75 2026-04-30
99223 CPT Init Hosp Care High Mdm 75 Min 11 10 $754.00 $754.00 $263.90 $723.84 $640.90 2026-04-30
99235 CPT Hosp Adm Dc Sm Day Mod Mdm 70 Min 11 10 $860.00 $860.00 $301.00 $825.60 $731.00 2026-04-30
99236 CPT Hosp Adm Dc Sm Day High Mdm 85 Min 11 10 $1,076.00 $1,076.00 $376.60 $1,032.96 $914.60 2026-04-30
99245 CPT Office Op Consult New/est High Mdm 55 Min 11 10 $787.00 $787.00 $275.45 $755.52 $668.95 2026-04-30
99255 CPT Hosp Consult New/est High Mdm 80 Min 11 10 $822.00 $822.00 $287.70 $789.12 $698.70 2026-04-30
99285 CPT Ed 99285 Emer Case Level V 28 10 $1,364.00 $1,364.00 $297.85 $1,801.92 $791.43 2026-04-30
99291 CPT Crit Care E&m 30-74 Min 24 10 $1,641.50 $1,641.50 $361.20 $2,160.96 $990.72 2026-04-30
A9562 HCPCS Tc99m Mertiatide Per Study Dose Up To 15 Mci 11 10 $1,313.00 $1,313.00 $459.55 $1,260.48 $1,116.05 2026-04-30
C8929 HCPCS Echo Wwo Fol Wcont 2d Complete 11 10 $2,649.00 $2,649.00 $927.15 $2,543.04 $2,251.65 2026-04-30
G0379 HCPCS Direct Admit Observation 11 10 $1,200.00 $1,200.00 $420.00 $1,152.00 $1,020.00 2026-04-30
G0390 HCPCS Trauma Activation Full W Ccare 11 10 $1,085.00 $1,085.00 $379.75 $1,041.60 $922.25 2026-04-30
J0129 HCPCS Abatacept For IV Soln 250 Mg 11 10 $3,220.81 $3,220.81 $1,127.28 $3,091.98 $2,737.69 2026-04-30
J0248 HCPCS Remdesivir For IV Soln 100 Mg 11 10 $1,780.00 $1,780.00 $623.00 $1,708.80 $1,513.00 2026-04-30
J0517 HCPCS Benralizumab Subcutaneous Soln Prefilled Syringe 30 Mg/ml 11 10 $8,782.76 $8,782.76 $3,073.97 $8,431.45 $7,465.35 2026-04-30
J0881 HCPCS Darbepoetin Alfa Soln Prefilled Syringe 100 Mcg/0.5ml 44 10 $1,657.76 $1,657.76 $182.59 $6,656.14 $1,101.75 2026-04-30
J0897 HCPCS Denosumab Inj Soln Prefilled Syringe 60 Mg/ml 22 10 $3,616.63 $3,616.63 $1,136.83 $3,825.76 $3,020.73 2026-04-30
J1306 HCPCS Inclisiran Sodium Subcutaneous Soln Pref Syr 284 Mg/1.5ml 11 10 $6,375.14 $6,375.14 $2,231.30 $6,120.13 $5,418.87 2026-04-30
J1437 HCPCS Ferric Derisomaltose (One Dose) IV Sol 1000 Mg/10ml (Fe Eq) 11 10 $4,714.31 $4,714.31 $1,650.01 $4,525.74 $4,007.16 2026-04-30
J1439 HCPCS Ferric Carboxymaltose IV Soln 750 Mg/15ml (Fe Equivalent) 11 10 $2,275.64 $2,275.64 $796.47 $2,184.61 $1,934.29 2026-04-30
J1569 HCPCS Immune Globulin (Human) IV Or Subcutaneous Soln 20 Gm/200ml 22 10 $4,725.95 $4,725.95 $1,164.42 $5,880.00 $3,094.02 2026-04-30
J2353 HCPCS Octreotide Acetate For IM Inj Kit 30 Mg 11 10 $11,015.79 $11,015.79 $3,855.53 $10,575.16 $9,363.42 2026-04-30
J2506 HCPCS Pegfilgrastim Soln Prefilled Syringe 6 Mg/0.6ml 11 10 $8,278.69 $8,278.69 $2,897.54 $7,947.54 $7,036.89 2026-04-30
J2997 HCPCS Alteplase For Inj 100 Mg 33 10 $13,495.83 $13,495.83 $169.29 $13,210.23 $11,336.50 2026-04-30
J3101 HCPCS Tenecteplase For IV Soln Kit 25 Mg 22 10 $11,952.87 $11,952.87 $3,804.81 $12,513.46 $10,040.67 2026-04-30
J3111 HCPCS Romosozumab-aqqg Inj Soln Prefilled Syringe 105 Mg/1.17ml 22 10 $7,382.15 $7,382.15 $1,897.59 $8,968.90 $5,042.17 2026-04-30
J3262 HCPCS Tocilizumab IV Inj 200 Mg/10ml 11 10 $3,152.23 $3,152.23 $1,103.28 $3,026.14 $2,679.40 2026-04-30
J3590 HCPCS Idarucizumab IV Soln 2.5 Gm/50ml 11 10 $3,007.19 $3,007.19 $1,052.52 $2,886.90 $2,556.11 2026-04-30
J7165 HCPCS Prothrombin Complex Concentrate Human-lans For Inj 500 Unit 11 10 $2,243.50 $2,243.50 $785.23 $2,153.76 $1,906.98 2026-04-30
J7168 HCPCS Prothrombin Complex Conc Human For Inj Kit 500 Unit 11 10 $2,263.75 $2,263.75 $792.31 $2,173.20 $1,924.19 2026-04-30
J7296 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System, 19.5 Mg 11 10 $739.00 $739.00 $258.65 $709.44 $628.15 2026-04-30
J7298 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System, 52 Mg 11 10 $1,599.00 $1,599.00 $559.65 $1,535.04 $1,359.15 2026-04-30
J7300 HCPCS Intraut Copper Contraceptive Paragard 11 10 $781.00 $781.00 $273.35 $749.76 $663.85 2026-04-30
J7301 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System 13.5 Mg 11 10 $1,542.00 $1,542.00 $539.70 $1,480.32 $1,310.70 2026-04-30
J7307 HCPCS Etonogestrel Implant System 11 10 $2,298.00 $2,298.00 $804.30 $2,206.08 $1,953.30 2026-04-30
P9035 HCPCS Platelet Pheresis Leukoreduced Ea Unit P9035 11 10 $869.00 $869.00 $304.15 $834.24 $738.65 2026-04-30
P9037 HCPCS Plate Pher Leuk Red Iradp9037 11 10 $921.00 $921.00 $322.35 $884.16 $782.85 2026-04-30
P9040 HCPCS Rbc Lr Irr Proc Unit P9040 11 10 $921.00 $921.00 $322.35 $884.16 $782.85 2026-04-30
Q4110 HCPCS Graft Primtx 3x3cm=9sq 22 10 $1,552.00 $1,552.00 $225.40 $2,361.60 $739.62 2026-04-30
Q5111 HCPCS Pegfilgrastim-cbqv Soln Prefilled Syringe 6 Mg/0.6ml 11 10 $2,946.44 $2,946.44 $1,031.25 $2,828.58 $2,504.47 2026-04-30
Q5119 HCPCS Rituximab-pvvr IV Soln 100 Mg/10ml (10 Mg/ml) 22 10 $2,676.41 $2,676.41 $405.65 $4,026.06 $1,290.24 2026-04-30
Q5120 HCPCS Pegfilgrastim-bmez Soln Prefilled Syringe 6 Mg/0.6ml 11 10 $4,623.78 $4,623.78 $1,618.32 $4,438.83 $3,930.21 2026-04-30
Q5122 HCPCS Pegfilgrastim-apgf Soln Prefilled Syringe 6 Mg/0.6ml 11 10 $4,459.72 $4,459.72 $1,560.90 $4,281.33 $3,790.76 2026-04-30
Q5157 HCPCS Denosumab-bmwo Inj Soln Prefilled Syringe 60 Mg/ml 11 10 $3,232.99 $3,232.99 $1,131.55 $3,103.67 $2,748.04 2026-04-30
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