Hospital

COTEAU DES PRAIRIES HEALTH CARE SYSTEM

Sisseton, SD · CCN 431339 · Rates published

Your selected procedure

You selected 93306 (CPT)

ECHO (2D) COMPLETE W DOPPLER & COLOR

This hospital’s price: $738 across 8 payers · range $512-$1,506

Source: https://sthpiprd.blob.core.windows.net/machine-readable-files/9467/460278210_coteau-des-prairies-hospital_standardcharges.csv · observed 2025-02-03

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.

2,017 distinct procedures filed

8 distinct payers

50,967 rate rows

2025-02-03 last MRF observed · ⚠ 20 mo old

Data quality

50,799 of 50,967 rate rows are consumer-grade (99.7%)

168 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
per-diem day rate — not a per-procedure price	84
percent-of-charges filed in the dollar field — excluded from medians	84

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old.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

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

Source MRF file	https://sthpiprd.blob.core.windows.net/machine-readable-files/9467/460278210_coteau-des-prairies-hospital_standardcharges.csv
Found on page	https://search.hospitalpriceindex.com/hpi2/machineReadable/CoteaudesPrairiesHealthCareSystem/9467
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-09-21
Content fingerprint	9abf85f64e537a42… · 21,283,414 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
J2427 HCPCS	Paliperidone Palmitate ER Susp Pref Syr 1,560 Mg/5ml	8	$10,620.09	$31,216.62	$24,458.38	nat. median $2,836 outlier · 8.6×
J3101 HCPCS	Tenecteplase For IV Soln Kit 50 Mg	8	$3,741.47	$10,997.65	$8,616.72	nat. median $3,787 outlier · 2.3×
J9217 HCPCS	Leuprolide Acetate (4 Month) For Inj Kit 30 Mg	8	$3,661.55	$10,762.75	$8,432.67	nat. median $1,573 outlier · 5.4×
28112 CPT	Ed 28112 Ostectomy Comp Exc Other Metatarsal Head (2nd 3rd 4th)	8	$2,532.09	$7,442.81	$5,831.48	nat. median $3,327 1.8× median
78452 CPT	Nm Myocardial Spect Mult Stdy	8	$2,353.23	$6,917.07	$5,419.56	nat. median $1,822 outlier · 3.0×
20816 CPT	Replantation Digit Wo Thumb (inc Metacarpophalang Joint To Insert Fle	8	$2,317.92	$6,813.28	$5,338.24	nat. median $3,784 1.4× median
J2356 HCPCS	Tezepelumab-ekko Subcutaneous Soln Pref Syr 210 Mg/1.91ml	8	$2,299.16	$6,758.15	$5,295.04	nat. median $76 outlier · 69.9×
J0896 HCPCS	Luspatercept-aamt For Subcutaneous Inj 25 Mg	8	$2,155.90	$18,310.67	$5,128.44	nat. median $4,569 1.1× median
20822 CPT	Replantation Digit Wo Thumb (distal Tip To Sublimis Tendon Insert) Co	8	$2,036.76	$5,986.84	$4,690.72	nat. median $2,350 2.0× median
J2997 HCPCS	Alteplase For Inj 100 Mg	8	$153.05	$12,660.04	$4,307.02	nat. median $500 outlier · 8.6×
Q5111 HCPCS	Pegfilgrastim-cbqv Soln Prefilled Syringe 6 Mg/0.6ml	8	$1,799.02	$5,288.02	$4,143.19	nat. median $1,984 outlier · 2.1×
72197 CPT	MRI Pelvis Wo Then W Cont	8	$1,718.97	$5,052.73	$3,958.84	nat. median $1,074 outlier · 3.7×
74183 CPT	MRI Abdomen Wo Then W Cont	8	$1,673.10	$4,917.90	$3,853.20	nat. median $1,105 outlier · 3.5×
J7168 HCPCS	Prothrombin Complex Conc Human For Inj Kit 500 Unit	8	$1,625.58	$4,778.22	$3,743.76	nat. median $20 outlier · 184.1×
72158 CPT	MRI L Spine Wo Then W Cont	8	$1,622.94	$4,770.46	$3,737.68	nat. median $1,097 outlier · 3.4×
70553 CPT	MRI Brain Wo Then W Cont	8	$1,612.05	$4,738.45	$3,712.60	nat. median $1,136 outlier · 3.3×
72157 CPT	MRI T Spine Wo Then W Cont	8	$1,600.17	$4,703.53	$3,685.24	nat. median $1,114 outlier · 3.3×
73220 CPT	MRI Upper Ext Wo Then W Cont	8	$1,574.43	$4,627.87	$3,625.96	nat. median $1,136 outlier · 3.2×
72156 CPT	MRI C Spine Wo Then W Cont	8	$1,569.48	$4,613.32	$3,614.56	nat. median $1,110 outlier · 3.3×
70543 CPT	MRI Face Neck Orb Wo Then W Cont	8	$1,558.59	$4,581.31	$3,589.48	nat. median $1,087 outlier · 3.3×
71552 CPT	MRI Chest Wo Then W Cont	8	$1,542.09	$4,532.81	$3,551.48	nat. median $1,103 outlier · 3.2×
73725 CPT	MRA Lower Ext Wo Contrast	8	$1,496.22	$4,397.98	$3,445.84	nat. median $1,252 outlier · 2.8×
74185 CPT	MRA Abdomen Wo Contrast	8	$1,496.22	$4,397.98	$3,445.84	nat. median $1,253 outlier · 2.8×
71555 CPT	MRA Chest Wo Contrast	8	$1,496.22	$4,397.98	$3,445.84	nat. median $1,151 outlier · 3.0×
70549 CPT	MRA Neck Wo Then W Cont	8	$1,496.22	$4,397.98	$3,445.84	nat. median $1,063 outlier · 3.2×
72198 CPT	MRA Pelvis W Contrast	8	$1,496.22	$4,397.98	$3,445.84	nat. median $1,136 outlier · 3.0×
70546 CPT	MRA Head Wo Then W Cont	8	$1,496.22	$4,397.98	$3,445.84	nat. median $1,073 outlier · 3.2×
73225 CPT	MRA Upper Ext Wo Then W Cont	8	$1,493.91	$4,391.19	$3,440.52	nat. median $1,211 outlier · 2.8×
C1874 HCPCS	Stnt Esoph Agile Fullcov14x119	8	$1,478.73	$6,594.06	$3,405.56	nat. median $4,814 0.7× median
78264 CPT	Nm Gastric Emptying Img Study	8	$1,470.81	$4,323.29	$3,387.32	nat. median $716 outlier · 4.7×
73723 CPT	MRI Lower Ext Jt Wo Then W Cont	8	$1,456.29	$4,280.61	$3,353.88	nat. median $1,199 outlier · 2.8×
73223 CPT	MRI Upper Ext Jt Wo Then W Cont	8	$1,456.29	$4,280.61	$3,353.88	nat. median $1,158 outlier · 2.9×
73720 CPT	MRI Lower Ext Wo Then W Cont	8	$1,456.29	$4,280.61	$3,353.88	nat. median $1,135 outlier · 3.0×
72142 CPT	MRI C Spine W Contrast	8	$1,435.83	$4,220.47	$3,306.76	nat. median $978 outlier · 3.4×
70552 CPT	MRI Brain W Contrast	8	$1,435.83	$4,220.47	$3,306.76	nat. median $965 outlier · 3.4×
95811 CPT	Psg Cpap Bipap 4+ Parameters	8	$1,400.85	$4,117.65	$3,226.20	nat. median $1,894 1.7× median
95805 CPT	Multiple Sleep Latency 95805	8	$1,400.85	$4,117.65	$3,226.20	nat. median $1,233 outlier · 2.6×
47600 CPT	Cholecystectomy	8	$1,385.67	$4,073.03	$3,191.24	nat. median $2,752 1.2× median
73719 CPT	MRI Lower Ext W Contrast	8	$1,379.40	$4,054.60	$3,176.80	nat. median $965 outlier · 3.3×
73219 CPT	MRI Upper Ext W Contrast	8	$1,379.40	$4,054.60	$3,176.80	nat. median $959 outlier · 3.3×
73722 CPT	MRI Lower Ext Jt W Contrast	8	$1,379.40	$4,054.60	$3,176.80	nat. median $1,282 outlier · 2.5×
73222 CPT	MRI Up Ext Jt Wcont	8	$1,379.40	$4,054.60	$3,176.80	nat. median $1,282 outlier · 2.5×
J0401 HCPCS	Aripiprazole IM For ER Susp Prefilled Syringe 400 Mg	8	$1,375.88	$4,044.26	$3,168.70	nat. median $1,912 1.7× median
J3111 HCPCS	Romosozumab-aqqg Inj Soln Prefilled Syringe 105 Mg/1.17ml	8	$1,352.59	$3,975.81	$3,115.07	nat. median $696 outlier · 4.5×
70336 CPT	MRI Temporomandibular Joint	8	$1,350.36	$3,969.24	$3,109.92	nat. median $756 outlier · 4.1×
74178 CPT	CT Abd Pelvis Wo Then W Cont	8	$1,344.42	$3,951.78	$3,096.24	nat. median $1,027 outlier · 3.0×
72149 CPT	MRI L Spine W Contrast	8	$1,338.48	$3,934.32	$3,082.56	nat. median $979 outlier · 3.2×
70548 CPT	MRA Neck W Contrast	8	$1,321.32	$3,883.88	$3,043.04	nat. median $922 outlier · 3.3×
70545 CPT	MRA Head W Contrast	8	$1,321.32	$3,883.88	$3,043.04	nat. median $893 outlier · 3.4×
74181 CPT	MRI Abdomen Wo Contrast	8	$1,303.50	$3,831.50	$3,002.00	nat. median $820 outlier · 3.7×

Other procedures at this hospital

Browse this hospital's 2,017 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

J2427	HCPCS	Paliperidone Palmitate ER Susp Pref Syr 1,560 Mg/5ml	18	8	$32,182.08	$32,182.08	$10,620.09	$31,216.62	$24,458.38	2025-02-03
J3101	HCPCS	Tenecteplase For IV Soln Kit 50 Mg	18	8	$11,337.78	$11,337.78	$3,741.47	$10,997.65	$8,616.72	2025-02-03
J9217	HCPCS	Leuprolide Acetate (4 Month) For Inj Kit 30 Mg	18	8	$11,095.62	$11,095.62	$3,661.55	$10,762.75	$8,432.67	2025-02-03
28112	CPT	Ed 28112 Ostectomy Comp Exc Other Metatarsal Head (2nd 3rd 4th)	18	8	$7,673.00	$7,673.00	$2,532.09	$7,442.81	$5,831.48	2025-02-03
78452	CPT	Nm Myocardial Spect Mult Stdy	18	8	$7,131.00	$7,131.00	$2,353.23	$6,917.07	$5,419.56	2025-02-03
20816	CPT	Replantation Digit Wo Thumb (inc Metacarpophalang Joint To Insert Fle	18	8	$7,024.00	$7,024.00	$2,317.92	$6,813.28	$5,338.24	2025-02-03
J2356	HCPCS	Tezepelumab-ekko Subcutaneous Soln Pref Syr 210 Mg/1.91ml	18	8	$6,967.16	$6,967.16	$2,299.16	$6,758.15	$5,295.04	2025-02-03
J0896	HCPCS	Luspatercept-aamt For Subcutaneous Inj 25 Mg	30	8	$6,533.04	$6,533.04	$2,155.90	$18,310.67	$5,128.44	2025-02-03
20822	CPT	Replantation Digit Wo Thumb (distal Tip To Sublimis Tendon Insert) Co	18	8	$6,172.00	$6,172.00	$2,036.76	$5,986.84	$4,690.72	2025-02-03
J2997	HCPCS	Alteplase For Inj 100 Mg	30	8	$13,051.59	$13,051.59	$153.05	$12,660.04	$4,307.02	2025-02-03
Q5111	HCPCS	Pegfilgrastim-cbqv Soln Prefilled Syringe 6 Mg/0.6ml	18	8	$5,451.57	$5,451.57	$1,799.02	$5,288.02	$4,143.19	2025-02-03
72197	CPT	MRI Pelvis Wo Then W Cont	18	8	$5,209.00	$5,209.00	$1,718.97	$5,052.73	$3,958.84	2025-02-03
74183	CPT	MRI Abdomen Wo Then W Cont	18	8	$5,070.00	$5,070.00	$1,673.10	$4,917.90	$3,853.20	2025-02-03
J7168	HCPCS	Prothrombin Complex Conc Human For Inj Kit 500 Unit	18	8	$4,926.00	$4,926.00	$1,625.58	$4,778.22	$3,743.76	2025-02-03
72158	CPT	MRI L Spine Wo Then W Cont	18	8	$4,918.00	$4,918.00	$1,622.94	$4,770.46	$3,737.68	2025-02-03
70553	CPT	MRI Brain Wo Then W Cont	18	8	$4,885.00	$4,885.00	$1,612.05	$4,738.45	$3,712.60	2025-02-03
72157	CPT	MRI T Spine Wo Then W Cont	18	8	$4,849.00	$4,849.00	$1,600.17	$4,703.53	$3,685.24	2025-02-03
73220	CPT	MRI Upper Ext Wo Then W Cont	18	8	$4,771.00	$4,771.00	$1,574.43	$4,627.87	$3,625.96	2025-02-03
72156	CPT	MRI C Spine Wo Then W Cont	18	8	$4,756.00	$4,756.00	$1,569.48	$4,613.32	$3,614.56	2025-02-03
70543	CPT	MRI Face Neck Orb Wo Then W Cont	18	8	$4,723.00	$4,723.00	$1,558.59	$4,581.31	$3,589.48	2025-02-03
71552	CPT	MRI Chest Wo Then W Cont	18	8	$4,673.00	$4,673.00	$1,542.09	$4,532.81	$3,551.48	2025-02-03
70549	CPT	MRA Neck Wo Then W Cont	18	8	$4,534.00	$4,534.00	$1,496.22	$4,397.98	$3,445.84	2025-02-03
70546	CPT	MRA Head Wo Then W Cont	18	8	$4,534.00	$4,534.00	$1,496.22	$4,397.98	$3,445.84	2025-02-03
73725	CPT	MRA Lower Ext Wo Contrast	18	8	$4,534.00	$4,534.00	$1,496.22	$4,397.98	$3,445.84	2025-02-03
72198	CPT	MRA Pelvis W Contrast	18	8	$4,534.00	$4,534.00	$1,496.22	$4,397.98	$3,445.84	2025-02-03
74185	CPT	MRA Abdomen Wo Contrast	18	8	$4,534.00	$4,534.00	$1,496.22	$4,397.98	$3,445.84	2025-02-03
71555	CPT	MRA Chest Wo Contrast	18	8	$4,534.00	$4,534.00	$1,496.22	$4,397.98	$3,445.84	2025-02-03
73225	CPT	MRA Upper Ext Wo Then W Cont	18	8	$4,527.00	$4,527.00	$1,493.91	$4,391.19	$3,440.52	2025-02-03
C1874	HCPCS	Stnt Esoph Agile Fullcov14x119	30	8	$4,481.00	$4,481.00	$1,478.73	$6,594.06	$3,405.56	2025-02-03
78264	CPT	Nm Gastric Emptying Img Study	18	8	$4,457.00	$4,457.00	$1,470.81	$4,323.29	$3,387.32	2025-02-03
73720	CPT	MRI Lower Ext Wo Then W Cont	18	8	$4,413.00	$4,413.00	$1,456.29	$4,280.61	$3,353.88	2025-02-03
73723	CPT	MRI Lower Ext Jt Wo Then W Cont	18	8	$4,413.00	$4,413.00	$1,456.29	$4,280.61	$3,353.88	2025-02-03
73223	CPT	MRI Upper Ext Jt Wo Then W Cont	18	8	$4,413.00	$4,413.00	$1,456.29	$4,280.61	$3,353.88	2025-02-03
70552	CPT	MRI Brain W Contrast	18	8	$4,351.00	$4,351.00	$1,435.83	$4,220.47	$3,306.76	2025-02-03
72142	CPT	MRI C Spine W Contrast	18	8	$4,351.00	$4,351.00	$1,435.83	$4,220.47	$3,306.76	2025-02-03
95805	CPT	Multiple Sleep Latency 95805	18	8	$4,245.00	$4,245.00	$1,400.85	$4,117.65	$3,226.20	2025-02-03
95811	CPT	Psg Cpap Bipap 4+ Parameters	18	8	$4,245.00	$4,245.00	$1,400.85	$4,117.65	$3,226.20	2025-02-03
47600	CPT	Cholecystectomy	18	8	$4,199.00	$4,199.00	$1,385.67	$4,073.03	$3,191.24	2025-02-03
73719	CPT	MRI Lower Ext W Contrast	18	8	$4,180.00	$4,180.00	$1,379.40	$4,054.60	$3,176.80	2025-02-03
73222	CPT	MRI Up Ext Jt Wcont	18	8	$4,180.00	$4,180.00	$1,379.40	$4,054.60	$3,176.80	2025-02-03
73219	CPT	MRI Upper Ext W Contrast	18	8	$4,180.00	$4,180.00	$1,379.40	$4,054.60	$3,176.80	2025-02-03
73722	CPT	MRI Lower Ext Jt W Contrast	18	8	$4,180.00	$4,180.00	$1,379.40	$4,054.60	$3,176.80	2025-02-03
J0401	HCPCS	Aripiprazole IM For ER Susp Prefilled Syringe 400 Mg	18	8	$4,169.34	$4,169.34	$1,375.88	$4,044.26	$3,168.70	2025-02-03
J3111	HCPCS	Romosozumab-aqqg Inj Soln Prefilled Syringe 105 Mg/1.17ml	18	8	$4,098.77	$4,098.77	$1,352.59	$3,975.81	$3,115.07	2025-02-03
70336	CPT	MRI Temporomandibular Joint	18	8	$4,092.00	$4,092.00	$1,350.36	$3,969.24	$3,109.92	2025-02-03
74178	CPT	CT Abd Pelvis Wo Then W Cont	18	8	$4,074.00	$4,074.00	$1,344.42	$3,951.78	$3,096.24	2025-02-03
72149	CPT	MRI L Spine W Contrast	18	8	$4,056.00	$4,056.00	$1,338.48	$3,934.32	$3,082.56	2025-02-03
70548	CPT	MRA Neck W Contrast	18	8	$4,004.00	$4,004.00	$1,321.32	$3,883.88	$3,043.04	2025-02-03
70545	CPT	MRA Head W Contrast	18	8	$4,004.00	$4,004.00	$1,321.32	$3,883.88	$3,043.04	2025-02-03
74181	CPT	MRI Abdomen Wo Contrast	18	8	$3,950.00	$3,950.00	$1,303.50	$3,831.50	$3,002.00	2025-02-03
71550	CPT	MRI Chest Wo Contrast	18	8	$3,946.00	$3,946.00	$1,302.18	$3,827.62	$2,998.96	2025-02-03
72147	CPT	MRI T Spine W Contrast	18	8	$3,944.00	$3,944.00	$1,301.52	$3,825.68	$2,997.44	2025-02-03
72141	CPT	MRI C Spine Wo Contrast	18	8	$3,938.00	$3,938.00	$1,299.54	$3,819.86	$2,992.88	2025-02-03
72195	CPT	MRI Pelvis Wo Contrast	18	8	$3,936.00	$3,936.00	$1,298.88	$3,817.92	$2,991.36	2025-02-03
78227	CPT	Nm Hepatobiliary Img Incl Gallbladder W Pharm Intv	18	8	$3,893.00	$3,893.00	$1,284.69	$3,776.21	$2,958.68	2025-02-03
70540	CPT	MRI Face Neck Orb Wo Contrast	18	8	$3,876.00	$3,876.00	$1,279.08	$3,759.72	$2,945.76	2025-02-03
74174	CPT	CTA Abd Pelvis W Contrast+wo If Perform	18	8	$3,874.00	$3,874.00	$1,278.42	$3,757.78	$2,944.24	2025-02-03
27580	CPT	Arthrodesis Knee Any Technique	18	8	$3,821.00	$3,821.00	$1,260.93	$3,706.37	$2,903.96	2025-02-03
70544	CPT	MRA Head Wo Contrast	18	8	$3,821.00	$3,821.00	$1,260.93	$3,706.37	$2,903.96	2025-02-03
95810	CPT	Psg 4+ Parameters	18	8	$3,815.00	$3,815.00	$1,258.95	$3,700.55	$2,899.40	2025-02-03
70551	CPT	MRI Brain Wo Contrast	18	8	$3,784.00	$3,784.00	$1,248.72	$3,670.48	$2,875.84	2025-02-03
72146	CPT	MRI T Spine Wo Contrast	18	8	$3,775.00	$3,775.00	$1,245.75	$3,661.75	$2,869.00	2025-02-03
70547	CPT	MRA Neck Wo Contrast	18	8	$3,769.00	$3,769.00	$1,243.77	$3,655.93	$2,864.44	2025-02-03
73221	CPT	MRI Upper Ext Jt Wo Contrast	18	8	$3,753.00	$3,753.00	$1,238.49	$3,640.41	$2,852.28	2025-02-03
73218	CPT	MRI Up Ext Wo Cont	18	8	$3,742.00	$3,742.00	$1,234.86	$3,629.74	$2,843.92	2025-02-03
73721	CPT	MRI Lower Ext Jt Wo Contrast	18	8	$3,730.00	$3,730.00	$1,230.90	$3,618.10	$2,834.80	2025-02-03
78278	CPT	Nm Acute Gastrointestinal Blood Loss Img	18	8	$3,677.00	$3,677.00	$1,213.41	$3,566.69	$2,794.52	2025-02-03
J1602	HCPCS	Golimumab IV Soln 50 Mg/4ml	18	8	$3,672.36	$3,672.36	$1,211.88	$3,562.19	$2,790.99	2025-02-03
72148	CPT	MRI L Spine Wo Contrast	18	8	$3,669.00	$3,669.00	$1,210.77	$3,558.93	$2,788.44	2025-02-03
73718	CPT	MRI Lower Ext Wo Contrast	18	8	$3,669.00	$3,669.00	$1,210.77	$3,558.93	$2,788.44	2025-02-03
J2426	HCPCS	Paliperidone Palmitate ER Susp Pref Syr 234 Mg/1.5ml	30	8	$4,777.37	$4,777.37	$1,207.50	$4,634.05	$2,780.91	2025-02-03
75635	CPT	CTA Abd Ao & Ext W Contrast+wo If Perform	18	8	$3,633.00	$3,633.00	$1,198.89	$3,524.01	$2,761.08	2025-02-03
73206	CPT	CTA Ext Upper Wcont+wo If Perf	18	8	$3,558.00	$3,558.00	$1,174.14	$3,451.26	$2,704.08	2025-02-03
70496	CPT	CTA Head W Cont Wo If Perf	18	8	$3,522.00	$3,522.00	$1,162.26	$3,416.34	$2,676.72	2025-02-03
11012	CPT	Ed 11012 Debr Assc Wop Fx Disloc	30	8	$8,037.00	$8,037.00	$346.50	$7,795.89	$2,652.21	2025-02-03
73706	CPT	CTA Ext Lower W Cont +wo If Perf	18	8	$3,481.00	$3,481.00	$1,148.73	$3,376.57	$2,645.56	2025-02-03
59409	CPT	Ed 59409 Ed Delivery Vaginal Only	30	8	$7,977.00	$7,977.00	$531.30	$7,737.69	$2,632.41	2025-02-03
27506	CPT	Open Tx Femoral Shaft Fx Winsert Intramedullary Implant Wwo Screwce	18	8	$3,463.00	$3,463.00	$1,142.79	$3,359.11	$2,631.88	2025-02-03
74177	CPT	CT Abd Pelvis W Contrast	18	8	$3,446.00	$3,446.00	$1,137.18	$3,342.62	$2,618.96	2025-02-03
49204	CPT	Exc Abd Tum Over 5 Cm	18	8	$3,427.00	$3,427.00	$1,130.91	$3,324.19	$2,604.52	2025-02-03
74175	CPT	CTA Abd Wcont +wo If Perf	18	8	$3,420.00	$3,420.00	$1,128.60	$3,317.40	$2,599.20	2025-02-03
71275	CPT	CTA Chest Wcont +wo If Perf	18	8	$3,389.00	$3,389.00	$1,118.37	$3,287.33	$2,575.64	2025-02-03
90378	CPT	Palivizumab IM Soln 50 Mg/0.5ml	30	8	$3,363.39	$3,363.39	$1,109.92	$5,514.28	$2,556.18	2025-02-03
78315	CPT	Nm Bone And Or Jnt Img 3 Phase Stdy	18	8	$3,347.00	$3,347.00	$1,104.51	$3,246.59	$2,543.72	2025-02-03
58152	CPT	Total Abdominal Hysterectomy Wwo Remvl Tube Ovary Wcolpo-urethrocyst	18	8	$3,340.00	$3,340.00	$1,102.20	$3,239.80	$2,538.40	2025-02-03
70498	CPT	CT Angio Neck W Con+wo If Perf	18	8	$3,330.00	$3,330.00	$1,098.90	$3,230.10	$2,530.80	2025-02-03
72191	CPT	CTA Pelvis Wcont +wo If Perf	18	8	$3,315.00	$3,315.00	$1,093.95	$3,215.55	$2,519.40	2025-02-03
74176	CPT	CT Abd Pelvis Wo Contrast	18	8	$3,306.00	$3,306.00	$1,090.98	$3,206.82	$2,512.56	2025-02-03
36558	CPT	Tx Rm 36558 Ins Cath Cv Tunlwo Port >5yrs	30	8	$7,610.00	$7,610.00	$479.16	$7,381.70	$2,511.30	2025-02-03
Q5119	HCPCS	Rituximab-pvvr IV Soln 500 Mg/50ml (10 Mg/ml)	18	8	$3,295.05	$3,295.05	$1,087.37	$3,196.20	$2,504.24	2025-02-03
J0897	HCPCS	Denosumab Inj Soln Prefilled Syringe 60 Mg/ml	18	8	$3,238.41	$3,238.41	$1,068.68	$3,141.26	$2,461.19	2025-02-03
G0390	HCPCS	Trauma Activation Full W Ccare	18	8	$3,195.00	$3,195.00	$1,054.35	$3,099.15	$2,428.20	2025-02-03
43840	CPT	Gastrorrhaphy Suture Perforated Duodenal Gastric Ulcer Wnd Injury	18	8	$3,170.00	$3,170.00	$1,046.10	$3,074.90	$2,409.20	2025-02-03
58290	CPT	Vaginal Hysterectomy Uterus >250 Gms	18	8	$3,096.00	$3,096.00	$1,021.68	$3,003.12	$2,352.96	2025-02-03
78306	CPT	Nm Bone And Or Jnt Img Whole Body	18	8	$3,065.00	$3,065.00	$1,011.45	$2,973.05	$2,329.40	2025-02-03
27244	CPT	Tx Inter Per Subtrochanteric Femoral Fx Wplate Screw Type Implant Ww	18	8	$3,058.00	$3,058.00	$1,009.14	$2,966.26	$2,324.08	2025-02-03
P9037	HCPCS	Plate Pher Leuk Red Iradp9037	18	8	$3,050.00	$3,050.00	$1,006.50	$2,958.50	$2,318.00	2025-02-03
J2315	HCPCS	Naltrexone For IM Extended Release Susp 380 Mg	18	8	$3,041.07	$3,041.07	$1,003.55	$2,949.84	$2,311.21	2025-02-03
44144	CPT	Colectomy Partial Wresection Wcolostmy Ileostmy & Creatn Mucofistula	18	8	$3,028.00	$3,028.00	$999.24	$2,937.16	$2,301.28	2025-02-03
78195	CPT	Nm Lymphatics And Lymph Nodes Img	18	8	$2,999.00	$2,999.00	$989.67	$2,909.03	$2,279.24	2025-02-03
27236	CPT	Open Tx Femoral Fx Proximal End Neck Internl Fixn Prosthetic Replace	18	8	$2,992.00	$2,992.00	$987.36	$2,902.24	$2,273.92	2025-02-03
51820	CPT	Cystourethroplasty Wunilat Bilat Ureteroneocystostomy	18	8	$2,983.00	$2,983.00	$984.39	$2,893.51	$2,267.08	2025-02-03
0174	RC	Newborn Level IV	5	5	$2,942.00	$2,942.00	$1,765.20	$2,853.74	$2,265.34	2025-02-03
0200	RC	Critical Care Room Charge	5	5	$2,942.00	$2,942.00	$1,765.20	$2,853.74	$2,265.34	2025-02-03
J1944	HCPCS	Aripiprazole Lauroxil IM ER Susp Prefilled Syr 441 Mg/1.6ml	30	8	$2,901.86	$2,901.86	$957.61	$3,860.82	$2,205.41	2025-02-03
J0129	HCPCS	Abatacept For IV Soln 250 Mg	18	8	$2,888.88	$2,888.88	$953.33	$2,802.21	$2,195.55	2025-02-03
A9520	HCPCS	Tc99m Tilmanocept Diag Up To 0.5 Mci	18	8	$2,854.00	$2,854.00	$941.82	$2,768.38	$2,169.04	2025-02-03
78071	CPT	Nm Parathyroid Planar Img W Spect	18	8	$2,850.00	$2,850.00	$940.50	$2,764.50	$2,166.00	2025-02-03
26356	CPT	Flexor Tendon Rpr Advance In Zone 2 No Man?s Land Prim Wo Free Grft E	18	8	$2,849.00	$2,849.00	$940.17	$2,763.53	$2,165.24	2025-02-03
70482	CPT	CT Orbit Sella Fossa Ear Wo Then W Contrast	18	8	$2,849.00	$2,849.00	$940.17	$2,763.53	$2,165.24	2025-02-03
13160	CPT	Ed 13160 Closure Wound Complex Secondary	30	8	$6,445.00	$6,445.00	$673.20	$6,251.65	$2,126.85	2025-02-03
74170	CPT	CT Abdomen Wo Then W Cont	18	8	$2,781.00	$2,781.00	$917.73	$2,697.57	$2,113.56	2025-02-03
J3590	HCPCS	Dupilumab Subcutaneous Soln Prefilled Syringe 300 Mg/2ml	30	8	$3,399.31	$3,399.31	$941.69	$3,297.33	$2,089.89	2025-02-03
35190	CPT	Rpr Acquired Traumatic Arteriovenous Fistula Extrem	18	8	$2,730.00	$2,730.00	$900.90	$2,648.10	$2,074.80	2025-02-03
J0717	HCPCS	Certolizumab Pegol For Inj Kit 2 X 200 Mg	30	8	$2,626.20	$2,626.20	$866.65	$8,719.19	$2,061.57	2025-02-03
P9034	HCPCS	Platelet Pheresis P9034	18	8	$2,676.00	$2,676.00	$883.08	$2,595.72	$2,033.76	2025-02-03
Q5108	HCPCS	Pegfilgrastim-jmdb Soln Prefilled Syringe 6 Mg/0.6ml	18	8	$2,639.78	$2,639.78	$871.13	$2,560.59	$2,006.24	2025-02-03
44604	CPT	Suture Large Intestine Wo Colostomy	18	8	$2,639.00	$2,639.00	$870.87	$2,559.83	$2,005.64	2025-02-03
44140	CPT	Colectomy Partial Wanastomosis	18	8	$2,625.00	$2,625.00	$866.25	$2,546.25	$1,995.00	2025-02-03
58150	CPT	Total Abdominal Hysterectomy Wwo Remvl Tube(s) Ovary(s)	18	8	$2,615.00	$2,615.00	$862.95	$2,536.55	$1,987.40	2025-02-03
58552	CPT	Laparoscpy Surg Wvaginal Hysterectomy Uterus 250gms < Wremvl Tube &	18	8	$2,601.00	$2,601.00	$858.33	$2,522.97	$1,976.76	2025-02-03
70492	CPT	CT Sft Tisue Neck Wwo Then W	18	8	$2,585.00	$2,585.00	$853.05	$2,507.45	$1,964.60	2025-02-03
44143	CPT	Colectomy Partial Wend Colostomy & Closure Distal Seg	18	8	$2,536.00	$2,536.00	$836.88	$2,459.92	$1,927.36	2025-02-03
58262	CPT	Vaginal Hysterectomy Uterus 250 Gms < Wremvl Tube(s) & Ovary(s)	18	8	$2,522.00	$2,522.00	$832.26	$2,446.34	$1,916.72	2025-02-03
72130	CPT	CT Thor Spine Wo Then W Cont	18	8	$2,466.00	$2,466.00	$813.78	$2,392.02	$1,874.16	2025-02-03
72133	CPT	CT Lumbar Spine Wo Then Wcon	18	8	$2,466.00	$2,466.00	$813.78	$2,392.02	$1,874.16	2025-02-03
72127	CPT	CT Cerv Spine Wo Then W Cont	18	8	$2,466.00	$2,466.00	$813.78	$2,392.02	$1,874.16	2025-02-03
J1745	HCPCS	Infliximab For IV Inj 100 Mg	18	8	$2,457.09	$2,457.09	$810.84	$2,383.38	$1,867.39	2025-02-03
0689	RC	Trauma Activation Full	18	8	$2,442.00	$2,442.00	$805.86	$2,368.74	$1,855.92	2025-02-03
70491	CPT	CT Soft Tissue Neck W Contrast	18	8	$2,439.00	$2,439.00	$804.87	$2,365.83	$1,853.64	2025-02-03
44204	CPT	Laparoscopy Surgical Colectomy Partial Wanastomosis	18	8	$2,432.00	$2,432.00	$802.56	$2,359.04	$1,848.32	2025-02-03
70481	CPT	CT Orbit Sella Fossa Ear W Contrast	18	8	$2,425.00	$2,425.00	$800.25	$2,352.25	$1,843.00	2025-02-03
44145	CPT	Colectomy Partial Wcoloproctostomy (low Pelvic Anastomosis)	18	8	$2,409.00	$2,409.00	$794.97	$2,336.73	$1,830.84	2025-02-03
58140	CPT	Myomectomy 1-4 Myoma(s) Wtotal Weight 250gms < Abdominal Apprch	18	8	$2,405.00	$2,405.00	$793.65	$2,332.85	$1,827.80	2025-02-03
81503	CPT	Ova-1 81503	18	8	$2,400.00	$2,400.00	$792.00	$2,328.00	$1,824.00	2025-02-03
70470	CPT	CT Head Wo Then W Contrast	18	8	$2,395.00	$2,395.00	$790.35	$2,323.15	$1,820.20	2025-02-03
71270	CPT	CT Thorax Diagnostic Wo Then W Contrast	18	8	$2,395.00	$2,395.00	$790.35	$2,323.15	$1,820.20	2025-02-03
27880	CPT	Amputation Leg Through Tibia & Fibula	18	8	$2,393.00	$2,393.00	$789.69	$2,321.21	$1,818.68	2025-02-03
21490	CPT	Open Treat Temporomandibular Dislocation	18	8	$2,379.00	$2,379.00	$785.07	$2,307.63	$1,808.04	2025-02-03
49002	CPT	Reopening Recent Laparotomy	18	8	$2,366.00	$2,366.00	$780.78	$2,295.02	$1,798.16	2025-02-03
72194	CPT	CT Pelvis Wo Then W Cont	18	8	$2,364.00	$2,364.00	$780.12	$2,293.08	$1,796.64	2025-02-03
0112	RC	Private Room Obstetrics Lvl Ii	16	8	$2,285.00	$2,285.00	$1,337.40	$2,216.45	$1,793.72	2025-02-03
58740	CPT	Lysis Adhesions (salpingolysis Ovariolysis)	18	8	$2,326.00	$2,326.00	$767.58	$2,256.22	$1,767.76	2025-02-03
72129	CPT	CT Thoracic Spine W Contrast	18	8	$2,304.00	$2,304.00	$760.32	$2,234.88	$1,751.04	2025-02-03
72126	CPT	CT Cervical Spine W Contrast	18	8	$2,304.00	$2,304.00	$760.32	$2,234.88	$1,751.04	2025-02-03
24515	CPT	Open Treat Humeral Shaft Fx Wplate Screws Wwo Cerclage	18	8	$2,296.00	$2,296.00	$757.68	$2,227.12	$1,744.96	2025-02-03
71260	CPT	CT Thorax Diagnostic With Contrast	18	8	$2,275.00	$2,275.00	$750.75	$2,206.75	$1,729.00	2025-02-03
72125	CPT	CT Cervical Spine Wo Contrast	18	8	$2,265.00	$2,265.00	$747.45	$2,197.05	$1,721.40	2025-02-03
44661	CPT	Closure Enterovesical Fistula Wintestine & Or Bladder Resection	18	8	$2,262.00	$2,262.00	$746.46	$2,194.14	$1,719.12	2025-02-03
27510	CPT	Ed 27510 Clsd Tx Femoral Fx Distal Wman	30	8	$5,205.00	$5,205.00	$251.13	$5,048.85	$1,717.65	2025-02-03
44626	CPT	Closure Enterostomy Large Small Intestine Wresection & Colorectal Ana	18	8	$2,237.00	$2,237.00	$738.21	$2,169.89	$1,700.12	2025-02-03
72193	CPT	CT Pelvis W Contrast	18	8	$2,231.00	$2,231.00	$736.23	$2,164.07	$1,695.56	2025-02-03
59515	CPT	Cesarean Delivery Only Wpostpartum Care	18	8	$2,219.00	$2,219.00	$732.27	$2,152.43	$1,686.44	2025-02-03
70488	CPT	CT Maxillofacial Wo W Cont	18	8	$2,218.00	$2,218.00	$731.94	$2,151.46	$1,685.68	2025-02-03
73202	CPT	CT Ext Upper Wwo Contrast	18	8	$2,218.00	$2,218.00	$731.94	$2,151.46	$1,685.68	2025-02-03
73702	CPT	CT Ext Lower Wo Then W Cont	18	8	$2,218.00	$2,218.00	$731.94	$2,151.46	$1,685.68	2025-02-03
0750	RC	Upper Endoscopy W Peg	126	8	$3,171.00	$3,171.00	$221.10	$4,940.21	$1,680.69	2025-02-03
71250	CPT	CT Thorax Diagnostic Wo Contrast	18	8	$2,210.00	$2,210.00	$729.30	$2,143.70	$1,679.60	2025-02-03
57265	CPT	Combined Anteropostr Colporrhaphy Wenterocele Rpr	18	8	$2,196.00	$2,196.00	$724.68	$2,130.12	$1,668.96	2025-02-03
58260	CPT	Vaginal Hysterectomy Uterus 250 Gms <	18	8	$2,194.00	$2,194.00	$724.02	$2,128.18	$1,667.44	2025-02-03
49592	CPT	Rpr Aa Hernia 1st < 3 Cm Incarcerated Strangulated	18	8	$2,190.00	$2,190.00	$722.70	$2,124.30	$1,664.40	2025-02-03
49594	CPT	Rpr Aa Hernia 1st 3-10 Cm Incarcerated Strangulated	18	8	$2,190.00	$2,190.00	$722.70	$2,124.30	$1,664.40	2025-02-03
87902	CPT	Hepatitis C Virus Genotype	30	8	$2,355.00	$2,355.00	$777.15	$2,376.50	$1,660.13	2025-02-03
58673	CPT	Laparoscopy Surgical Wsalpinostomy	18	8	$2,181.00	$2,181.00	$719.73	$2,115.57	$1,657.56	2025-02-03
70490	CPT	CT Soft Tissue Neck Wo Con	18	8	$2,168.00	$2,168.00	$715.44	$2,102.96	$1,647.68	2025-02-03
44120	CPT	Enterectomy Resection Small Intestine Sngl Resection & Anastomosis	18	8	$2,168.00	$2,168.00	$715.44	$2,102.96	$1,647.68	2025-02-03
27590	CPT	Amputation Thigh Through Femur Any Level	18	8	$2,152.00	$2,152.00	$710.16	$2,087.44	$1,635.52	2025-02-03
81382	CPT	Celiac Genetics 81382	30	8	$2,369.00	$2,369.00	$779.13	$2,297.93	$1,634.22	2025-02-03
43281	CPT	Lap Paraesoph Hernia Wo Mesh	18	8	$2,144.00	$2,144.00	$707.52	$2,079.68	$1,629.44	2025-02-03
38745	CPT	Axillary Lymphadenectomy Comp	18	8	$2,141.00	$2,141.00	$706.53	$2,076.77	$1,627.16	2025-02-03
73201	CPT	CT Ext Upper W Cont	18	8	$2,140.00	$2,140.00	$706.20	$2,075.80	$1,626.40	2025-02-03
35221	CPT	Rpr Blood Vessel Direct Intra-abdominal	18	8	$2,139.00	$2,139.00	$705.87	$2,074.83	$1,625.64	2025-02-03
70460	CPT	CT Head W Contrast	18	8	$2,139.00	$2,139.00	$705.87	$2,074.83	$1,625.64	2025-02-03
74160	CPT	CT Abdomen W Contrast	18	8	$2,139.00	$2,139.00	$705.87	$2,074.83	$1,625.64	2025-02-03
43425	CPT	Closure Esophagostomy Fistula Transthoracic Transabdominal Apprch	18	8	$2,138.00	$2,138.00	$705.54	$2,073.86	$1,624.88	2025-02-03
59121	CPT	Surgical Tx Ectopic Pregnancy Tubl Ovarin Wo Salpingectmy Oophorectmy	18	8	$2,137.00	$2,137.00	$705.21	$2,072.89	$1,624.12	2025-02-03
22315	CPT	Closed Tx Vert Fx Dislocation Requiring Casting Bracing Manip Traction	18	8	$2,136.00	$2,136.00	$704.88	$2,071.92	$1,623.36	2025-02-03
43332	CPT	Re Hiatal Hernia Lap Wo Mes	18	8	$2,131.00	$2,131.00	$703.23	$2,067.07	$1,619.56	2025-02-03
59120	CPT	Surgical Tx Ectopic Pregnancy Tubal Ovarian Wsalpingectmy Oophorectmy	18	8	$2,122.00	$2,122.00	$700.26	$2,058.34	$1,612.72	2025-02-03
36561	CPT	Insert Tunneled Centrally Inserted Venous Access Device Wsubq Port	18	8	$2,122.00	$2,122.00	$700.26	$2,058.34	$1,612.72	2025-02-03
27814	CPT	Open Treat Bimalleolar Ankle Fx Wwo Int Ext Fixn	18	8	$2,110.00	$2,110.00	$696.30	$2,046.70	$1,603.60	2025-02-03
58770	CPT	Salpingostomy (salpingoneostomy)	18	8	$2,094.00	$2,094.00	$691.02	$2,031.18	$1,591.44	2025-02-03
47605	CPT	Cholecystectomy Wcholangiography	18	8	$2,074.00	$2,074.00	$684.42	$2,011.78	$1,576.24	2025-02-03
70487	CPT	CT Maxillofacial W Cont	18	8	$2,074.00	$2,074.00	$684.42	$2,011.78	$1,576.24	2025-02-03
44820	CPT	Exc Lesn Mesentery (sep Proc)	18	8	$2,063.00	$2,063.00	$680.79	$2,001.11	$1,567.88	2025-02-03
35206	CPT	Rpr Blood Vessel Direct Upper Extremity	18	8	$2,062.00	$2,062.00	$680.46	$2,000.14	$1,567.12	2025-02-03
0110	RC	Routine Room & Board Lvl Ii	15	5	$2,035.00	$2,035.00	$1,188.00	$2,054.46	$1,566.95	2025-02-03
43333	CPT	Rep Hiatal Hernia Lap Wmesh	18	8	$2,058.00	$2,058.00	$679.14	$1,996.26	$1,564.08	2025-02-03
72192	CPT	CT Pelvis Wo Contrast	18	8	$2,051.00	$2,051.00	$676.83	$1,989.47	$1,558.76	2025-02-03
73700	CPT	CT Ext Lower Wo Cont	18	8	$2,051.00	$2,051.00	$676.83	$1,989.47	$1,558.76	2025-02-03
73701	CPT	CT Ext Lower W Cont	18	8	$2,051.00	$2,051.00	$676.83	$1,989.47	$1,558.76	2025-02-03
72131	CPT	CT Lumbar Spine Wo Cont	18	8	$2,051.00	$2,051.00	$676.83	$1,989.47	$1,558.76	2025-02-03
74150	CPT	CT Abdomen Wo Contrast	18	8	$2,051.00	$2,051.00	$676.83	$1,989.47	$1,558.76	2025-02-03
70480	CPT	CT Orbit Sella Fossa Ear Wo Contrast	18	8	$2,051.00	$2,051.00	$676.83	$1,989.47	$1,558.76	2025-02-03
73200	CPT	CT Ext Upper Wo Cont	18	8	$2,051.00	$2,051.00	$676.83	$1,989.47	$1,558.76	2025-02-03
70486	CPT	CT Scan Maxillofacial Area Wo Contrast Matl	18	8	$2,050.00	$2,050.00	$676.50	$1,988.50	$1,558.00	2025-02-03
70450	CPT	CT Scan Head Brain Wo Contrast Matl	18	8	$2,050.00	$2,050.00	$676.50	$1,988.50	$1,558.00	2025-02-03
23655	CPT	Ed 23655 Clsd Tx Sldr Dsl Wmnp Ans	30	8	$4,716.00	$4,716.00	$489.72	$4,574.52	$1,556.28	2025-02-03
59151	CPT	Laparoscopic Treat Ectopic Pregnancy Wsalpingectomy & Or Oophorectomy	18	8	$2,039.00	$2,039.00	$672.87	$1,977.83	$1,549.64	2025-02-03
11005	CPT	Debrid Skn Sq Tiss Muscl Fasc Necro Tiss Infex Abd Wwo Fascl Close	18	8	$2,033.00	$2,033.00	$670.89	$1,972.01	$1,545.08	2025-02-03
27252	CPT	Closed Treat Hip Dislocation Traumatic Requiring Anes	30	8	$1,968.00	$1,968.00	$649.44	$4,305.83	$1,544.88	2025-02-03
57288	CPT	Sling Operation Stress Incontinence	18	8	$2,031.00	$2,031.00	$670.23	$1,970.07	$1,543.56	2025-02-03
44960	CPT	Appendectomy Ruptured Appendix Wabscess Generalized Peritonitis	18	8	$2,026.00	$2,026.00	$668.58	$1,965.22	$1,539.76	2025-02-03
64420	CPT	Ed 64420 Inj Nerve Block Intercostl Sngl Lvl	18	8	$2,025.00	$2,025.00	$668.25	$1,964.25	$1,539.00	2025-02-03
26350	CPT	Flexor Tendon Rpr Advance Not In Zone 2 No Man's Land Prim Second Wo	18	8	$2,022.00	$2,022.00	$667.26	$1,961.34	$1,536.72	2025-02-03
10140	CPT	Ed 10140 I&d Hematoma Fluid	30	8	$4,648.00	$4,648.00	$120.45	$4,508.56	$1,533.84	2025-02-03
44205	CPT	Laparoscpy Surgical Colectomy Partial Wremvl Terminal Ileum Wileocol	18	8	$2,014.00	$2,014.00	$664.62	$1,953.58	$1,530.64	2025-02-03
0120	RC	Semi Private Room&board Lvl Ii	10	5	$1,986.00	$1,986.00	$1,166.40	$1,967.16	$1,529.22	2025-02-03
58700	CPT	Salpingectomy Comp Partial Unilat Bilat (sep Proc)	18	8	$2,011.00	$2,011.00	$663.63	$1,950.67	$1,528.36	2025-02-03
43280	CPT	Laparoscopy Surgical Esophagogastric Fundoplasty	18	8	$2,011.00	$2,011.00	$663.63	$1,950.67	$1,528.36	2025-02-03
59614	CPT	Vaginal Delivery Only Previous Cesarean Delivery Wpostpartum Care	18	8	$2,004.00	$2,004.00	$661.32	$1,943.88	$1,523.04	2025-02-03
49900	CPT	Suture Secondary Abdominal Wall Evisceration Dehiscence	18	8	$2,002.00	$2,002.00	$660.66	$1,941.94	$1,521.52	2025-02-03
45390	CPT	Colonoscopy Flexible Wendoscopic Mucosal Resection	18	8	$2,001.00	$2,001.00	$660.33	$1,940.97	$1,520.76	2025-02-03
86366	CPT	Muscle Specific Kinase Antibody	18	8	$2,000.00	$2,000.00	$660.00	$1,940.00	$1,520.00	2025-02-03
12037	CPT	Ed 12037 Lyr Clsr Of Wnd >30.0cm	30	8	$4,531.00	$4,531.00	$231.66	$4,395.07	$1,495.23	2025-02-03
15277	CPT	Tx Rm 15277 Skn Sub Grft F N Hf G Child	30	8	$4,531.00	$4,531.00	$179.19	$4,395.07	$1,495.23	2025-02-03
15275	CPT	Tx Rm 15275 Skin Sub Graft Face Nk Hf G	30	8	$4,531.00	$4,531.00	$129.03	$4,395.07	$1,495.23	2025-02-03
15273	CPT	Tx Rm 15273 Skin Sub Grft T Arm Lg Child	30	8	$4,531.00	$4,531.00	$165.00	$4,395.07	$1,495.23	2025-02-03
15271	CPT	Tx Rm 15271 Skin Sub Graft Trnk Arm Leg	30	8	$4,531.00	$4,531.00	$70.95	$4,395.07	$1,495.23	2025-02-03
10080	CPT	Ed 10080 I&d Pilonidal Cyst Smpl	18	8	$1,960.00	$1,960.00	$646.80	$1,901.20	$1,489.60	2025-02-03
34401	CPT	Thrombectomy Direct Wcatheter Vena Cava Iliac Vein Abdominal Incisn	18	8	$1,945.00	$1,945.00	$641.85	$1,886.65	$1,478.20	2025-02-03
57260	CPT	Combined Anteropostr Colporrhaphy	18	8	$1,944.00	$1,944.00	$641.52	$1,885.68	$1,477.44	2025-02-03
24605	CPT	Ed 24605 Clsd Tx Elbow Disloc W Anes	30	8	$4,439.00	$4,439.00	$383.13	$4,305.83	$1,464.87	2025-02-03
27266	CPT	Ed 27266 Clsd Tx Hip Disloc Wanes	30	8	$4,439.00	$4,439.00	$496.65	$4,305.83	$1,464.87	2025-02-03
27257	CPT	Ed 27257 Tx Disloc Hip Spontaneous W/anes W/manip	30	8	$4,439.00	$4,439.00	$302.94	$4,305.83	$1,464.87	2025-02-03
26705	CPT	Ed 26705 Tx Disl (m-p) W Anes Clsd	30	8	$4,439.00	$4,439.00	$283.80	$4,305.83	$1,464.87	2025-02-03
27762	CPT	Ed 27762 Clsd Tx Ankle Fx Wmanip	30	8	$4,438.00	$4,438.00	$405.24	$4,304.86	$1,464.54	2025-02-03
27596	CPT	Amputation Thigh Through Femur Any Level Re-amputation	18	8	$1,922.00	$1,922.00	$634.26	$1,864.34	$1,460.72	2025-02-03
58925	CPT	Ovarian Cystectomy Unilat Bilat	18	8	$1,920.00	$1,920.00	$633.60	$1,862.40	$1,459.20	2025-02-03
60240	CPT	Thyroidectomy Total Comp	18	8	$1,920.00	$1,920.00	$633.60	$1,862.40	$1,459.20	2025-02-03
72128	CPT	CT Thoracic Spine Wo Cont	18	8	$1,916.00	$1,916.00	$632.28	$1,858.52	$1,456.16	2025-02-03
59514	CPT	Cesarean Delivery Only	18	8	$1,902.00	$1,902.00	$627.66	$1,844.94	$1,445.52	2025-02-03
58720	CPT	Salpingo-oophorectomy Comp Partial Unilat Bilat (sep Proc)	18	8	$1,899.00	$1,899.00	$626.67	$1,842.03	$1,443.24	2025-02-03
19307	CPT	Mastect Rad + Lymph Wo Pectoral	18	8	$1,898.00	$1,898.00	$626.34	$1,841.06	$1,442.48	2025-02-03
44160	CPT	Colectomy Partial Wremvl Terminal Ileum Wileocolostomy	18	8	$1,892.00	$1,892.00	$624.36	$1,835.24	$1,437.92	2025-02-03
19101	CPT	Ed 19101 Biopsy Breast Open Incisional	30	8	$4,324.00	$4,324.00	$265.65	$4,194.28	$1,426.92	2025-02-03
43640	CPT	Vagotomy Wpyloroplasty Wwo Gastrostomy Truncal Selective	18	8	$1,864.00	$1,864.00	$615.12	$1,808.08	$1,416.64	2025-02-03
59410	CPT	Vaginal Delivery Only(wwo Episiotomy & Or Forceps) Wpostpartum Care	18	8	$1,845.00	$1,845.00	$608.85	$1,789.65	$1,402.20	2025-02-03
44620	CPT	Closure Enterostomy Large Small Intestine	18	8	$1,842.00	$1,842.00	$607.86	$1,786.74	$1,399.92	2025-02-03
0172	RC	Newborn Level Ii	5	5	$1,810.00	$1,810.00	$1,086.00	$1,755.70	$1,393.70	2025-02-03
65103	CPT	Enucleation Eye Wimplant Muscles Not Attached To Implant	18	8	$1,830.00	$1,830.00	$603.90	$1,775.10	$1,390.80	2025-02-03
36571	CPT	Insert Peripheral Central Venous Access Device Wsubq Port >5 Years	18	8	$1,808.00	$1,808.00	$596.64	$1,753.76	$1,374.08	2025-02-03
C1722	HCPCS	Del Sys Eltd S-icd	18	8	$1,803.00	$1,803.00	$594.99	$1,748.91	$1,370.28	2025-02-03
58180	CPT	Supracervical Abdominal Hysterectomy Wwo Remvl Tube(s) Ovary(s)	18	8	$1,799.00	$1,799.00	$593.67	$1,745.03	$1,367.24	2025-02-03
51840	CPT	Anterior Vesicourethropexy Urethropexy Smpl	18	8	$1,788.00	$1,788.00	$590.04	$1,734.36	$1,358.88	2025-02-03
43800	CPT	Pyloroplasty	18	8	$1,779.00	$1,779.00	$587.07	$1,725.63	$1,352.04	2025-02-03
93303	CPT	Echo Congenitl Comp	18	8	$1,765.00	$1,765.00	$582.45	$1,712.05	$1,341.40	2025-02-03
58662	CPT	Laparoscpy Surgical Wfulguration Exc Lesns Of Ovary Pelvic Viscera Pe	18	8	$1,758.00	$1,758.00	$580.14	$1,705.26	$1,336.08	2025-02-03
11044	CPT	Tx Rm 11044 Debr Skin Muscle Bone	30	8	$4,022.00	$4,022.00	$300.96	$3,901.34	$1,327.26	2025-02-03
58920	CPT	Wedge Resection Bisection Ovary Unilat Bilat	18	8	$1,739.00	$1,739.00	$573.87	$1,686.83	$1,321.64	2025-02-03
58661	CPT	Laparoscopy Surgical Wremvl Adnexal Structures	18	8	$1,739.00	$1,739.00	$573.87	$1,686.83	$1,321.64	2025-02-03
45400	CPT	Lap Proctopexy (for Prolapse)	18	8	$1,738.00	$1,738.00	$573.54	$1,685.86	$1,320.88	2025-02-03
43870	CPT	Closure Gastrostomy Surgical	18	8	$1,719.00	$1,719.00	$567.27	$1,667.43	$1,306.44	2025-02-03
27766	CPT	Open Treat Medial Malleolus Fx Wwo Int Ext Fixn	18	8	$1,707.00	$1,707.00	$563.31	$1,655.79	$1,297.32	2025-02-03
59612	CPT	Vaginal Delivery Only Previous Cesarean Delivery	18	8	$1,707.00	$1,707.00	$563.31	$1,655.79	$1,297.32	2025-02-03
57283	CPT	Colpopexy Vaginal Intra-peritoneal Apprch(uterosacrl Levatr Myorrhphy)	18	8	$1,704.00	$1,704.00	$562.32	$1,652.88	$1,295.04	2025-02-03
C1713	HCPCS	Plate Supr Curv Rt 6hl 75mm	30	8	$1,704.00	$1,704.00	$562.32	$2,250.40	$1,295.04	2025-02-03
72132	CPT	CT Lumbar Spine W Cont	18	8	$1,687.00	$1,687.00	$556.71	$1,636.39	$1,282.12	2025-02-03
43830	CPT	Gastrostomy Open Wo Construction Gastric Tube (sep Proc)	18	8	$1,685.00	$1,685.00	$556.05	$1,634.45	$1,280.60	2025-02-03
26951	CPT	Amputation Finger Thumb Prime Second Any Jnt Phalanx Sngl Wneurectomi	30	8	$1,619.00	$1,619.00	$534.27	$8,597.11	$1,270.91	2025-02-03
27552	CPT	Closed Treat Knee Dislocation Requiring Anes	30	8	$1,609.00	$1,609.00	$530.97	$3,914.92	$1,263.07	2025-02-03
57308	CPT	Closure Rectovaginal Fistula Transperineal Apprch Wreconstruct Wwo L	18	8	$1,659.00	$1,659.00	$547.47	$1,609.23	$1,260.84	2025-02-03
58660	CPT	Laparoscpy Surgical Wlysis Adhesions(salpingolysis Ovariolysis)(sep)	18	8	$1,634.00	$1,634.00	$539.22	$1,584.98	$1,241.84	2025-02-03
49505	CPT	Rpr Initial Inguinal Hernia Age 5+ Reducible	18	8	$1,626.00	$1,626.00	$536.58	$1,577.22	$1,235.76	2025-02-03
26418	CPT	Rpr Extensor Tendon Finger Prime Secondary Wo Free Graft Ea Tendon	18	8	$1,619.00	$1,619.00	$534.27	$1,570.43	$1,230.44	2025-02-03
26410	CPT	Rpr Extensor Tendon Hand Prime Secondary Wo Free Graft Ea Tendon	18	8	$1,619.00	$1,619.00	$534.27	$1,570.43	$1,230.44	2025-02-03
78300	CPT	Nm Bone And Or Jnt Img Ltd Area	18	8	$1,610.00	$1,610.00	$531.30	$1,561.70	$1,223.60	2025-02-03
45382	CPT	Colonoscopy Flexible Proximal To Splenic Flexure Wcontrol Bleeding	18	8	$1,607.00	$1,607.00	$530.31	$1,558.79	$1,221.32	2025-02-03
36556	CPT	Ed 36556 Inst Non-tnnl Cv Cth>5 Yrs	30	8	$3,697.00	$3,697.00	$238.59	$3,586.09	$1,220.01	2025-02-03
44970	CPT	Laparoscopy Surgical Appendectomy	18	8	$1,601.00	$1,601.00	$528.33	$1,552.97	$1,216.76	2025-02-03
44950	CPT	Appendectomy	18	8	$1,601.00	$1,601.00	$528.33	$1,552.97	$1,216.76	2025-02-03
78262	CPT	Nm Gastroesophageal Reflux Study	18	8	$1,599.00	$1,599.00	$527.67	$1,551.03	$1,215.24	2025-02-03
93304	CPT	Echo Congenitl Ltd	18	8	$1,593.00	$1,593.00	$525.69	$1,545.21	$1,210.68	2025-02-03
57250	CPT	Postr Colporrhaphy Rpr Rectocele Wwo Perineorrhaphy	18	8	$1,592.00	$1,592.00	$525.36	$1,544.24	$1,209.92	2025-02-03
27792	CPT	Open Treat Distal Fibular Fx Wwo Int Ext Fix	18	8	$1,587.00	$1,587.00	$523.71	$1,539.39	$1,206.12	2025-02-03
57555	CPT	Exc Cervical Stump Vaginal Apprch Wanterior & Or Postr Rpr	18	8	$1,585.00	$1,585.00	$523.05	$1,537.45	$1,204.60	2025-02-03
45393	CPT	Colonoscopy Flexible Wdecompression(for Pathologic Distention)	18	8	$1,582.00	$1,582.00	$522.06	$1,534.54	$1,202.32	2025-02-03
49203	CPT	Exc Abd Tum 5 Cm Or Less	18	8	$1,581.00	$1,581.00	$521.73	$1,533.57	$1,201.56	2025-02-03
44625	CPT	Closure Enterostomy Large Small Intestine Wresection & Anastomosis No	18	8	$1,577.00	$1,577.00	$520.41	$1,529.69	$1,198.52	2025-02-03
57240	CPT	Anterior Colporrhaphy Rpr Cystocele Wwo Rpr Urethrocele	18	8	$1,567.00	$1,567.00	$517.11	$1,519.99	$1,190.92	2025-02-03
25605	CPT	Closed Treat Distal Radial Fx Epiphyseal Separation Wmanip	30	8	$1,510.00	$1,510.00	$498.30	$4,305.83	$1,185.35	2025-02-03
93306	CPT	Echo (2d) Complete W Doppler & Color	18	8	$1,553.00	$1,553.00	$512.49	$1,506.41	$1,180.28	2025-02-03
49553	CPT	Rpr Initial Femoral Hernia Any Age Incarcerated Strangulated	18	8	$1,543.00	$1,543.00	$509.19	$1,496.71	$1,172.68	2025-02-03
26121	CPT	Fasciectomy Palm Only Wwo Z-plasty Local Tissue Rearrange Skin Grft(i	18	8	$1,541.00	$1,541.00	$508.53	$1,494.77	$1,171.16	2025-02-03
11004	CPT	Debride Skin Subq Tiss Muscle Fascia Necro Tiss Infexn Genitalia Perin	18	8	$1,512.00	$1,512.00	$498.96	$1,466.64	$1,149.12	2025-02-03
M0243	HCPCS	Cdmr IV Infusn Casirivimab & Imdevimab	18	8	$1,507.00	$1,507.00	$497.31	$1,461.79	$1,145.32	2025-02-03
M0245	HCPCS	Cdmr IV Infus Bamlan & Etesev Incl Infus & Post Monitor	18	8	$1,507.00	$1,507.00	$497.31	$1,461.79	$1,145.32	2025-02-03
M0222	HCPCS	Cdmr Bebtelovimab Injection And Post Monitor	18	8	$1,497.00	$1,497.00	$494.01	$1,452.09	$1,137.72	2025-02-03
58558	CPT	Hysteroscopy Surgical Wendometrial Bx & Or Polypectomy Wwo D&c	18	8	$1,496.00	$1,496.00	$493.68	$1,451.12	$1,136.96	2025-02-03
88309	CPT	Surgical Path Level Vi 88309	18	8	$1,495.00	$1,495.00	$493.35	$1,450.15	$1,136.20	2025-02-03
78012	CPT	Nm Thyroid Uptake Sngl Mult Quant Meas	18	8	$1,490.00	$1,490.00	$491.70	$1,445.30	$1,132.40	2025-02-03
45398	CPT	Colonoscopy Flexible Wb& Ligation(s)(eg Hemorrhoids)	18	8	$1,482.00	$1,482.00	$489.06	$1,437.54	$1,126.32	2025-02-03
43327	CPT	Esophago Fun Part Com Lap	18	8	$1,476.00	$1,476.00	$487.08	$1,431.72	$1,121.76	2025-02-03
45385	CPT	Colonoscopy Flexible Wremvl Lesn Snare	18	8	$1,476.00	$1,476.00	$487.08	$1,431.72	$1,121.76	2025-02-03
76700	CPT	Ultrasound Abdominal B-scan & Or Real Time Wimage Documentatn Comp	18	8	$1,461.00	$1,461.00	$482.13	$1,417.17	$1,110.36	2025-02-03
P9040	HCPCS	Rbc Lr Irr Proc Unit P9040	18	8	$1,460.00	$1,460.00	$481.80	$1,416.20	$1,109.60	2025-02-03
87801	CPT	Multiple Infectious Organism Nad Amp Probe 87801	18	8	$1,456.00	$1,456.00	$480.48	$1,412.32	$1,106.56	2025-02-03
49591	CPT	Rpr Aa Hernia 1st < 3 Cm Reducible	18	8	$1,453.00	$1,453.00	$479.49	$1,409.41	$1,104.28	2025-02-03
49407	CPT	Image Cath Fluid Trns Vgnl	18	8	$1,452.00	$1,452.00	$479.16	$1,408.44	$1,103.52	2025-02-03
19302	CPT	Mastectomy Partial Waxil Lymphadenect	18	8	$1,451.00	$1,451.00	$478.83	$1,407.47	$1,102.76	2025-02-03

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