Price Transparencybeta Hospital negotiated rates

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

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Hospital

THROCKMORTON COUNTY MEMORIAL HOSPITAL

Throckmorton, TX · CCN 451339 · Rates published

1,984 distinct procedures filed
6 distinct payers
18,037 rate rows
2026-01-16 last MRF observed
Data quality

17,966 of 18,037 rate rows are consumer-grade (99.6%)

71 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
template filing: same amount across many unrelated codes — excluded 45
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 26
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://secure.claraprice.net/price-transparency/BBQR-1704221260285/machine-readable/756003473_throckmorton-county-memorial-hospital_standardcharges.json
Found on page https://secure.claraprice.net/price-transparency/throckmorton-tx
Discovered viaDiscovered by HANK
Last fetch success · 2026-09-25
Content fingerprint b28122cfc87c3f75… · 5,388,367 bytes · first seen 2026-09-25

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
74400
CPT 		Ivp X-ray 5 $38.00 $11,750.00 $8,693.00 nat. median
$308
outlier · 28.2×
2591822
CDM 		Veklury IV Pwdforsoln 100mg 5 $4,648.00 $11,388.00 $8,424.50 nat. median
$8,424
1.0× median
72156
CPT 		MRI Spinal Can & Con Ce 4 $3,578.00 $5,195.00 $3,976.00 nat. median
$1,103
outlier · 3.6×
2590810
CDM 		Tnkase IV Powder For Solution 50mg 5 $2,167.00 $5,309.00 $3,927.50 nat. median
$3,928
1.0× median
73220
CPT 		MRI Ue Other Than Joint W & Without Contrast 4 $3,532.00 $5,127.00 $3,924.00 nat. median
$1,130
outlier · 3.5×
72158
CPT 		MRI Spin Can & Con Lumbar W 4 $3,513.00 $5,100.00 $3,903.00 nat. median
$1,093
outlier · 3.6×
2500266
CDM 		Crofab Solution I Gm Vial IV 5 $2,132.00 $5,224.00 $3,865.00 nat. median
$17
outlier · 232.1×
73723
CPT 		MRI Low Extr Of Any Join 4 $3,469.00 $5,036.00 $3,854.00 nat. median
$1,192
outlier · 3.2×
72157
CPT 		MRI Spinal Can & Con Thor With 4 $3,391.00 $4,923.00 $3,767.00 nat. median
$1,105
outlier · 3.4×
74183
CPT 		MRI Abdomen Without & With 4 $3,367.00 $4,888.00 $3,741.00 nat. median
$1,100
outlier · 3.4×
C8902
HCPCS 		MRI Angio Abd Without Or W 4 $3,360.00 $4,878.00 $3,734.00 nat. median
$1,044
outlier · 3.6×
73223
CPT 		MRI Ue Other Than Any Jnt W&without Contrast 4 $3,351.00 $4,865.00 $3,723.00 nat. median
$1,158
outlier · 3.2×
G0390
HCPCS 		Trauma Activation 5 $1,914.00 $4,689.00 $3,469.50 nat. median
$3,197
1.1× median
70543
CPT 		MRI Orbt/fac/nck W/o&w Dy 4 $3,056.00 $4,436.00 $3,395.00 nat. median
$1,083
outlier · 3.1×
72197
CPT 		MRI Pelvis Without Or With 4 $3,000.00 $4,356.00 $3,334.00 nat. median
$1,063
outlier · 3.1×
73720
CPT 		MRI Low Ext Without & W Dye 4 $2,959.00 $4,296.00 $3,288.00 nat. median
$1,129
outlier · 2.9×
73706
CPT 		Ct/angio Lower Ext W/wo C 5 $38.00 $4,313.00 $3,191.00 nat. median
$743
outlier · 4.3×
71552
CPT 		MRI Chest Without & With 4 $2,813.00 $4,085.00 $3,126.00 nat. median
$1,097
outlier · 2.8×
70549
CPT 		MRI Angio Neck Without & W 4 $2,707.00 $3,931.00 $3,008.00 nat. median
$1,055
outlier · 2.9×
73722
CPT 		MRI Low Joint With Contrast 4 $2,643.00 $3,837.00 $2,936.00 nat. median
$1,279
outlier · 2.3×
73222
CPT 		MRI Up Ext Of Any Joint With Contrast 4 $2,641.00 $3,834.00 $2,934.00 nat. median
$1,282
outlier · 2.3×
J7325
HCPCS 		Synvisc One 6ml 5 $1,598.00 $3,915.00 $2,896.50 nat. median
$143
outlier · 20.3×
74175
CPT 		Ct/angio Abd W & Without Cont 5 $38.00 $3,892.00 $2,879.00 nat. median
$714
outlier · 4.0×
70548
CPT 		MRI Angio Neck With 4 $2,585.00 $3,752.00 $2,872.00 nat. median
$922
outlier · 3.1×
73218
CPT 		MRI Ue Other Than Jnt Without Contrast 4 $2,435.00 $3,535.00 $2,705.00 nat. median
$864
outlier · 3.1×
74181
CPT 		MRI Abdomen Without 4 $2,417.00 $3,508.00 $2,685.00 nat. median
$820
outlier · 3.3×
70496
CPT 		Ct/angio Head W/wo Contra 5 $38.00 $3,563.00 $2,636.00 nat. median
$747
outlier · 3.5×
73718
CPT 		MRI Low Ext Without Contrast 4 $2,315.00 $3,361.00 $2,573.00 nat. median
$870
outlier · 3.0×
70546
CPT 		MRI Angio Head Without & W 4 $2,296.00 $3,334.00 $2,552.00 nat. median
$1,070
outlier · 2.4×
72142
CPT 		MRI Spinal Canal & Con C 4 $2,269.00 $3,295.00 $2,522.00 nat. median
$975
outlier · 2.6×
70544
CPT 		MRI Angio Head Without 4 $2,232.00 $3,240.00 $2,480.00 nat. median
$826
outlier · 3.0×
72195
CPT 		MRI Pelvis Without 4 $2,190.00 $3,180.00 $2,434.00 nat. median
$806
outlier · 3.0×
72147
CPT 		MRI Spinal Canal & Con Tho 4 $2,155.00 $3,129.00 $2,395.00 nat. median
$966
outlier · 2.5×
70547
CPT 		MRI Angio Neck Without 4 $2,128.00 $3,089.00 $2,364.00 nat. median
$761
outlier · 3.1×
72191
CPT 		Ct/angio Pelvis W/wo Cont 5 $38.00 $3,120.00 $2,308.50 nat. median
$632
outlier · 3.7×
70545
CPT 		MRI Angio Head With 4 $2,055.00 $2,983.00 $2,283.00 nat. median
$889
outlier · 2.6×
72149
CPT 		MRI Spinal Can & Cont Lumba 4 $2,001.00 $2,906.00 $2,224.00 nat. median
$978
outlier · 2.3×
72193
CPT 		CT Scan Of Pelvis With Contrast 4 $1,929.00 $2,801.00 $2,144.00 nat. median
$637
outlier · 3.4×
72194
CPT 		Pelvis Ctw/wo Contr 4 $1,909.00 $2,771.00 $2,121.00 nat. median
$664
outlier · 3.2×
C8910
HCPCS 		MRI Angio Chest Without Or 4 $1,877.00 $2,725.00 $2,086.00 nat. median
$732
outlier · 2.8×
2591727
CDM 		Rituxan Injection 10mg/ml 5 $1,128.00 $2,763.00 $2,043.50 nat. median
$2,044
1.0× median
J1602
HCPCS 		Simponi Aria Intravenous Soln 50mg/4ml 5 $1,112.00 $2,724.00 $2,015.50 nat. median
$273
outlier · 7.4×
36556
CPT 		Fac Insertion, Central IV Catheter, > 5 5 $54.00 $2,766.00 $1,940.00 nat. median
$2,483
0.8× median
73700
CPT 		CT Lower Extremity 4 $1,652.00 $2,399.00 $1,836.00 nat. median
$500
outlier · 3.7×
74182
CPT 		MRI Abdomen With 4 $1,569.00 $2,279.00 $1,744.00 nat. median
$971
1.8× median
2591590
CDM 		Hyperrab Inj Soln 300iu/1ml 5 $895.00 $2,192.00 $1,622.00 nat. median
$1,622
1.0× median
70553
CPT 		MRI Scan 4 $988.00 $2,579.00 $1,606.00 nat. median
$1,133
1.4× median
72196
CPT 		MRI Pelvis With 4 $1,413.00 $2,051.00 $1,570.00 nat. median
$950
1.7× median
93303
CPT 		Congenital Echo 5 $54.00 $2,050.00 $1,516.50 nat. median
$789
1.9× median
2502076
CDM 		Miacalcin(calcitonin)200u/ml Inj 5 $800.00 $1,960.00 $1,450.00 nat. median
$54
outlier · 27.1×

Other procedures at this hospital

Browse this hospital's 1,984 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
             
10061 CPT Drainage Of Skin Abscess 19 5 $175.00 $175.00 $54.00 $221.00 $168.00 2026-01-16
1010009 CDM Hospice Care 8 5 $400.00 $400.00 $160.00 $392.00 $290.00 2026-01-16
1096524 CDM O2 12 Hours Or > 8 5 $600.00 $600.00 $54.00 $588.00 $435.00 2026-01-16
1099999 CDM Leave Of Absence 8 5 $700.00 $700.00 $280.00 $686.00 $507.50 2026-01-16
11000 CPT Debrid/ext/eczem/inf T 8 5 $255.00 $255.00 $102.00 $250.00 $185.00 2026-01-16
11101 CPT Biopsy Skin Add-on 8 5 $279.00 $279.00 $112.00 $273.00 $202.00 2026-01-16
11106 CPT Incisional Biopsy Of Skin 8 5 $250.00 $250.00 $100.00 $245.00 $181.50 2026-01-16
11406 CPT Esc Tr-ext B9+marg>4.0 Cm 8 5 $240.00 $240.00 $96.00 $235.00 $174.00 2026-01-16
11424 CPT Exc H-f-nk-sp B9+marg 3.1-4 8 5 $300.00 $300.00 $120.00 $294.00 $217.50 2026-01-16
11440 CPT Esc Face-mm B9+marg 0.5 Cm 16 5 $565.50 $565.50 $60.00 $961.00 $269.50 2026-01-16
11441 CPT Esc Face-mm B9+marg 0.6-1 8 5 $1,106.00 $1,106.00 $442.00 $1,084.00 $802.00 2026-01-16
11446 CPT Exc Face-mm B9 + Marg > 4cm 8 5 $450.00 $450.00 $180.00 $441.00 $326.50 2026-01-16
11600 CPT Excision Malignant Lesion 0.5 Cm< 9 6 $250.00 $250.00 $100.00 $245.00 $175.00 2026-01-16
11601 CPT Malignant Lesion 0.6-1 8 5 $450.00 $450.00 $180.00 $441.00 $326.50 2026-01-16
11602 CPT Malignant Lesion 1.1-2 8 5 $375.00 $375.00 $150.00 $368.00 $272.00 2026-01-16
11604 CPT Exc Tr-ext Mal+marg 3.1-4cm 8 5 $275.00 $275.00 $110.00 $270.00 $199.50 2026-01-16
11606 CPT Exc Tr-exp Mal+marg>4 Cm 8 5 $310.00 $310.00 $124.00 $304.00 $225.00 2026-01-16
11620 CPT Exc H-f-nk-sp Mal+marg 0.5/< 8 5 $280.00 $280.00 $112.00 $274.00 $203.00 2026-01-16
11624 CPT Exc S/n/h/f/g Mal+marg 3.14 8 5 $360.00 $360.00 $144.00 $353.00 $261.00 2026-01-16
11626 CPT Exc S/n/h/f/g Mal+mrg > 4cm 8 5 $500.00 $500.00 $200.00 $490.00 $362.50 2026-01-16
11640 CPT Excision Of Malignancy 8 5 $450.00 $450.00 $180.00 $441.00 $326.50 2026-01-16
11641 CPT Exc F/e/e/n/l Mal + Marg .61 8 5 $400.00 $400.00 $160.00 $392.00 $290.00 2026-01-16
11643 CPT Exc F/e/e/n/l Mal+marg 2.1-3 8 5 $250.00 $250.00 $100.00 $245.00 $181.50 2026-01-16
11750 CPT Removal Of Nail Bed 8 5 $315.00 $315.00 $126.00 $309.00 $228.50 2026-01-16
11980 CPT Bio-te Hormone-female 16 5 $550.00 $550.00 $140.00 $735.00 $343.00 2026-01-16
12013 CPT Rpr F/e/e/l/m 2.6-5.0 23 5 $250.00 $250.00 $20.00 $550.00 $175.00 2026-01-16
12014 CPT Simple Repair, Superficial Wounds 12 5 $383.00 $383.00 $54.00 $375.00 $263.50 2026-01-16
12032 CPT Intmd Wnd Repair S/a/t/e 16 5 $542.00 $542.00 $20.00 $1,013.00 $160.00 2026-01-16
12034 CPT Intmd Rpr S/tr/ext 7.612.5 16 5 $317.00 $317.00 $54.00 $327.00 $217.50 2026-01-16
12035 CPT Intrmd Rpr S/a/t/ext 12.6-20 16 5 $400.00 $400.00 $54.00 $515.00 $218.00 2026-01-16
12042 CPT Intmd Rpr N-hf/genit2.6-7 16 5 $497.00 $497.00 $54.00 $778.00 $164.00 2026-01-16
12051 CPT Intmd Wnd Repair Face/mm 23 5 $992.00 $992.00 $20.00 $1,296.00 $694.00 2026-01-16
12052 CPT Intmd Rpr Face/mm 2.6-5.0 16 5 $469.00 $469.00 $54.00 $723.00 $168.00 2026-01-16
12053 CPT Intmd Rpr Face/mm 5.1-7.5cm 16 5 $631.00 $631.00 $54.00 $894.00 $254.00 2026-01-16
16000 CPT Initial Treatment Of Burn 16 5 $299.00 $299.00 $41.00 $375.00 $156.00 2026-01-16
17261 CPT Destruction Of Skin Lesions 8 5 $300.00 $300.00 $120.00 $294.00 $217.50 2026-01-16
18603 CPT Symbicort Inh Aer Liq 160mcg-4.5mcg 16 5 $387.50 $387.50 $2.00 $754.00 $157.00 2026-01-16
23650 CPT Treat Shoulder Dislocation 16 5 $350.00 $350.00 $54.00 $392.00 $280.00 2026-01-16
24576 CPT Treat Humerus Fracture 16 5 $305.00 $305.00 $54.00 $353.00 $252.00 2026-01-16
24640 CPT Closed Treatment, Nursemaid Elbow, Child 12 5 $250.00 $250.00 $54.00 $245.00 $172.00 2026-01-16
2500147 CDM Bentyl(dicyclomine)10 Mg/ml Inj 8 5 $220.00 $220.00 $88.00 $216.00 $159.50 2026-01-16
2500266 CDM Crofab Solution I Gm Vial IV 8 5 $5,331.00 $5,331.00 $2,132.00 $5,224.00 $3,865.00 2026-01-16
2502076 CDM Miacalcin(calcitonin)200u/ml Inj 8 5 $2,000.00 $2,000.00 $800.00 $1,960.00 $1,450.00 2026-01-16
2502113 CDM Bactrim Ds 200/40mg/5ml Susp Dispense 8 5 $412.00 $412.00 $165.00 $404.00 $298.50 2026-01-16
25028 CPT Incision/drainage Hand 8 5 $248.00 $248.00 $99.00 $243.00 $180.00 2026-01-16
2503228 CDM Orthovisc 15mg/ml Inj 8 5 $1,350.00 $1,350.00 $540.00 $1,323.00 $979.00 2026-01-16
2506604 CDM Pred-g 0.3%-0.6% Ophth Solution 8 5 $278.00 $278.00 $111.00 $272.00 $202.00 2026-01-16
2509019 CDM Tygacil/ns Ivpb : 50mg/100ml 8 5 $373.00 $373.00 $149.00 $366.00 $270.50 2026-01-16
2509020 CDM Tygacil/ns Ivpb : 100mg/100ml 8 5 $740.00 $740.00 $296.00 $725.00 $536.50 2026-01-16
25600 CPT Treat Fracture Radius/ul 9 6 $300.00 $300.00 $54.00 $312.00 $225.00 2026-01-16
25605 CPT Treat Fracture Of Radius/ulna 16 5 $575.00 $575.00 $54.00 $588.00 $420.00 2026-01-16
2590742 CDM Invanz(ertapenem Sodium) 1g 8 5 $250.00 $250.00 $100.00 $245.00 $181.50 2026-01-16
2590781 CDM Rabavert IM Powder For Suspension 2.5iu 8 5 $943.00 $943.00 $377.00 $924.00 $683.50 2026-01-16
2590810 CDM Tnkase IV Powder For Solution 50mg 8 5 $5,417.00 $5,417.00 $2,167.00 $5,309.00 $3,927.50 2026-01-16
2590820 CDM Dantrium 20mg IV 8 5 $294.00 $294.00 $118.00 $288.00 $213.50 2026-01-16
2590941 CDM Vivitrol IM ER 380mg 8 5 $1,806.00 $1,806.00 $722.00 $1,770.00 $1,309.50 2026-01-16
2591103 CDM Cubicin IV 500mg 8 5 $640.00 $640.00 $256.00 $627.00 $464.00 2026-01-16
2591590 CDM Hyperrab Inj Soln 300iu/1ml 8 5 $2,237.00 $2,237.00 $895.00 $2,192.00 $1,622.00 2026-01-16
2591727 CDM Rituxan Injection 10mg/ml 8 5 $2,819.00 $2,819.00 $1,128.00 $2,763.00 $2,043.50 2026-01-16
2591812 CDM Remdesivir 100mg Vial 8 5 $1,560.00 $1,560.00 $624.00 $1,529.00 $1,131.00 2026-01-16
2591822 CDM Veklury IV Pwdforsoln 100mg 8 5 $11,620.00 $11,620.00 $4,648.00 $11,388.00 $8,424.50 2026-01-16
2591849 CDM Flovent Hfa Inh Oral/neb 0.11mg/1act 8 5 $746.00 $746.00 $298.00 $731.00 $541.00 2026-01-16
26600 CPT Treat Metacarpal Fracture 15 5 $368.00 $368.00 $54.00 $361.00 $196.00 2026-01-16
26700 CPT Treat Knuckle Dislocation 15 5 $499.00 $499.00 $54.00 $489.00 $289.00 2026-01-16
26720 CPT Closed Treatment, Phalangeal Shaft Fx,pr 16 5 $339.50 $339.50 $54.00 $489.00 $197.00 2026-01-16
26725 CPT Treat Finger Fracture 12 5 $300.00 $300.00 $54.00 $310.00 $259.50 2026-01-16
26750 CPT Fx And/or Dislocation Tx On Hand/fingers 16 5 $550.00 $550.00 $54.00 $735.00 $254.00 2026-01-16
26770 CPT Closed Treatment Ip Joint Dislocation 12 5 $300.00 $300.00 $54.00 $296.00 $259.50 2026-01-16
2700015 CDM Forceps Kocher Artery 8 5 $351.00 $351.00 $140.00 $344.00 $254.50 2026-01-16
2700017 CDM Forcep Foerster 9 1/2 8 5 $349.00 $349.00 $140.00 $342.00 $253.00 2026-01-16
2700090 CDM Central Line Kit 8 5 $608.00 $608.00 $243.00 $596.00 $441.00 2026-01-16
2700101 CDM Cpap Adult Lg Flowsafe Mask 8 5 $366.00 $366.00 $146.00 $359.00 $265.50 2026-01-16
2700102 CDM Cpap Adult Sm Flowsafe Mask 8 5 $366.00 $366.00 $146.00 $359.00 $265.50 2026-01-16
2700201 CDM Pericardiocentesis Kit 8 5 $775.00 $775.00 $310.00 $760.00 $562.00 2026-01-16
2700208 CDM Pleur Evac Kit 8 5 $313.00 $313.00 $125.00 $307.00 $227.00 2026-01-16
2700209 CDM Pneumothorax Tray 8 5 $525.00 $525.00 $210.00 $515.00 $381.00 2026-01-16
2700586 CDM Mepilex 8x20 8 5 $243.00 $243.00 $97.00 $238.00 $176.00 2026-01-16
2700608 CDM Io 25mm Needle Set 8 5 $526.00 $526.00 $210.00 $515.00 $381.50 2026-01-16
27810 CPT Treatment Of Ankle Fracture 16 5 $779.50 $779.50 $54.00 $1,062.00 $448.00 2026-01-16
28660 CPT Treat Toe/foot Dislocation 8 5 $225.00 $225.00 $90.00 $221.00 $163.50 2026-01-16
29085 CPT Apply Hand/wrist Cast 8 5 $297.00 $297.00 $54.00 $291.00 $215.50 2026-01-16
29125 CPT Apply Forearm Splint 24 6 $330.00 $330.00 $16.00 $431.00 $231.00 2026-01-16
29515 CPT Application Lower Leg Sp Pf 23 5 $375.00 $375.00 $48.00 $489.00 $263.00 2026-01-16
29580 CPT Strapping Unna Boot 23 5 $283.00 $283.00 $23.00 $369.00 $198.00 2026-01-16
3000000 CDM Cardiac Profile-ckmb-cpk-troponin 8 5 $233.00 $233.00 $96.00 $228.00 $169.00 2026-01-16
32551 CPT Tube Thoracostomy Includes Water Seal 13 6 $700.00 $700.00 $54.00 $686.00 $473.00 2026-01-16
32554 CPT Aspirate Pleura Without Imag Pf 16 5 $678.00 $678.00 $54.00 $839.00 $362.50 2026-01-16
36430 CPT Blood Administration 8 5 $886.00 $886.00 $354.00 $868.00 $642.50 2026-01-16
36556 CPT Fac Insertion, Central IV Catheter, > 5 12 5 $2,822.00 $2,822.00 $54.00 $2,766.00 $1,940.00 2026-01-16
36589 CPT Removal Tunneled Cv Cathop 8 5 $530.00 $530.00 $54.00 $519.00 $384.50 2026-01-16
36680 CPT Placement, Needle, Intraosseous Infusion 8 5 $250.00 $250.00 $54.00 $245.00 $181.50 2026-01-16
4512007 CDM Trauma Alert 8 5 $1,400.00 $1,400.00 $560.00 $1,372.00 $1,015.00 2026-01-16
49082 CPT Abdominal Paracentesis 16 5 $1,840.50 $1,840.50 $54.00 $2,985.00 $460.50 2026-01-16
51700 CPT Bladder Irrigation Si 8 5 $455.00 $455.00 $54.00 $446.00 $330.00 2026-01-16
51701 CPT Straight Catheter Inse 8 5 $405.00 $405.00 $54.00 $397.00 $294.00 2026-01-16
51703 CPT Foley Cath Insertion Complicated 8 5 $343.00 $343.00 $54.00 $336.00 $248.50 2026-01-16
5211555 CDM Bio-te Hormone-male 8 5 $700.00 $700.00 $280.00 $686.00 $507.50 2026-01-16
5290669 CDM Pcv-7 (Prevnar) 8 5 $368.00 $368.00 $147.00 $361.00 $267.00 2026-01-16
56405 CPT I & D Of Vulva/perineum 23 5 $218.00 $218.00 $54.00 $294.00 $153.00 2026-01-16
58468009 CDM Synvisc Solution For Injection 2ml 8 5 $1,348.00 $1,348.00 $539.00 $1,321.00 $977.50 2026-01-16
62270 CPT Spinal Fluid Tab Diagnost 17 6 $1,023.00 $1,023.00 $54.00 $1,003.00 $350.00 2026-01-16
64450 CPT Injection, Anesthetic, Peripheral Nerve 8 5 $400.00 $400.00 $54.00 $392.00 $290.00 2026-01-16
64837 CPT Pneumovax-23 25mcg/0.5ml Inj 8 5 $238.00 $238.00 $95.00 $233.00 $173.00 2026-01-16
70030 CPT Eye-foreign Body X-ray 8 5 $348.00 $348.00 $38.00 $341.00 $252.50 2026-01-16
70110 CPT Mandible X-ray Minimum 4 View Right 8 5 $572.00 $572.00 $38.00 $561.00 $414.50 2026-01-16
70160 CPT Nose X-ray Minimum 3 View 8 5 $482.00 $482.00 $38.00 $472.00 $349.50 2026-01-16
70210 CPT Sinus Xray <3 Views 8 5 $386.00 $386.00 $38.00 $378.00 $280.00 2026-01-16
70260 CPT Skull (4) X-ray Minimum 4 View 8 5 $747.00 $747.00 $38.00 $732.00 $541.50 2026-01-16
70450 CPT CT Scan 7 4 $1,226.00 $1,226.00 $828.00 $1,201.00 $920.00 2026-01-16
70486 CPT CT Facial Bones 8 5 $873.00 $873.00 $38.00 $856.00 $633.00 2026-01-16
70491 CPT CT Soft Tissue Neck With Contrast 7 4 $522.00 $522.00 $352.00 $512.00 $392.00 2026-01-16
70496 CPT Ct/angio Head W/wo Contra 8 5 $3,636.00 $3,636.00 $38.00 $3,563.00 $2,636.00 2026-01-16
70498 CPT Ct/angio Neck W/wo Contra 8 5 $1,100.00 $1,100.00 $38.00 $1,078.00 $797.50 2026-01-16
70540 CPT MRI Orbit/face/neck Without D 15 5 $1,048.00 $1,048.00 $215.00 $3,407.00 $786.00 2026-01-16
70542 CPT MRI Orbit/face/neck With Contrast 7 4 $1,066.00 $1,066.00 $720.00 $1,045.00 $800.00 2026-01-16
70543 CPT MRI Orbt/fac/nck W/o&w Dy 7 4 $4,527.00 $4,527.00 $3,056.00 $4,436.00 $3,395.00 2026-01-16
70544 CPT MRI Angio Head Without 7 4 $3,306.00 $3,306.00 $2,232.00 $3,240.00 $2,480.00 2026-01-16
70545 CPT MRI Angio Head With 7 4 $3,044.00 $3,044.00 $2,055.00 $2,983.00 $2,283.00 2026-01-16
70546 CPT MRI Angio Head Without & W 7 4 $3,402.00 $3,402.00 $2,296.00 $3,334.00 $2,552.00 2026-01-16
70547 CPT MRI Angio Neck Without 7 4 $3,152.00 $3,152.00 $2,128.00 $3,089.00 $2,364.00 2026-01-16
70548 CPT MRI Angio Neck With 7 4 $3,829.00 $3,829.00 $2,585.00 $3,752.00 $2,872.00 2026-01-16
70549 CPT MRI Angio Neck Without & W 7 4 $4,011.00 $4,011.00 $2,707.00 $3,931.00 $3,008.00 2026-01-16
70551 CPT MRI Brain Without 15 5 $896.00 $896.00 $188.00 $1,636.00 $672.00 2026-01-16
70552 CPT MRI Brain With 15 5 $1,240.00 $1,240.00 $258.00 $3,768.00 $930.00 2026-01-16
70553 CPT MRI Scan 14 4 $2,048.00 $2,048.00 $988.00 $2,579.00 $1,606.00 2026-01-16
71048 CPT Chest Decub 8 5 $353.00 $353.00 $38.00 $346.00 $256.00 2026-01-16
71120 CPT Sternum Xray Minimum 2 View 8 5 $460.00 $460.00 $38.00 $451.00 $333.50 2026-01-16
71250 CPT CT Chest Without Contra 7 4 $1,000.00 $1,000.00 $675.00 $980.00 $750.00 2026-01-16
71260 CPT CT Chest W/contrast 7 4 $1,563.00 $1,563.00 $1,055.00 $1,532.00 $1,172.00 2026-01-16
71270 CPT CT Chest W & Wo Contrast 7 4 $1,800.00 $1,800.00 $1,215.00 $1,764.00 $1,350.00 2026-01-16
71275 CPT Ct/angio Chest W/wo Contr 7 4 $1,310.00 $1,310.00 $884.00 $1,284.00 $983.00 2026-01-16
71550 CPT MRI Chest Without 7 4 $1,780.00 $1,780.00 $1,202.00 $1,744.00 $1,335.00 2026-01-16
71551 CPT MRI Chest With 7 4 $1,642.00 $1,642.00 $1,108.00 $1,609.00 $1,232.00 2026-01-16
71552 CPT MRI Chest Without & With 7 4 $4,168.00 $4,168.00 $2,813.00 $4,085.00 $3,126.00 2026-01-16
72110 CPT X-ray Of Lower Back 8 5 $259.00 $259.00 $38.00 $254.00 $187.50 2026-01-16
72125 CPT CT Cervical Spine Without 7 4 $1,199.00 $1,199.00 $809.00 $1,175.00 $899.00 2026-01-16
72128 CPT CT Chest Spine Without Contrast 7 4 $357.00 $357.00 $241.00 $350.00 $268.00 2026-01-16
72131 CPT CT Lumbar Spine W/out 7 4 $935.00 $935.00 $631.00 $916.00 $701.00 2026-01-16
72141 CPT MRI Cervical Spine 15 5 $872.00 $872.00 $183.00 $1,637.00 $654.00 2026-01-16
72142 CPT MRI Spinal Canal & Con C 7 4 $3,362.00 $3,362.00 $2,269.00 $3,295.00 $2,522.00 2026-01-16
72146 CPT MRI Thoracic Spine Without Contrast 15 5 $873.00 $873.00 $183.00 $1,353.00 $655.00 2026-01-16
72147 CPT MRI Spinal Canal & Con Tho 7 4 $3,193.00 $3,193.00 $2,155.00 $3,129.00 $2,395.00 2026-01-16
72148 CPT MRI Scan Of Lower Spinal Canal 7 4 $1,678.00 $1,678.00 $1,133.00 $1,644.00 $1,259.00 2026-01-16
72149 CPT MRI Spinal Can & Cont Lumba 7 4 $2,965.00 $2,965.00 $2,001.00 $2,906.00 $2,224.00 2026-01-16
72156 CPT MRI Spinal Can & Con Ce 7 4 $5,301.00 $5,301.00 $3,578.00 $5,195.00 $3,976.00 2026-01-16
72157 CPT MRI Spinal Can & Con Thor With 7 4 $5,023.00 $5,023.00 $3,391.00 $4,923.00 $3,767.00 2026-01-16
72158 CPT MRI Spin Can & Con Lumbar W 7 4 $5,204.00 $5,204.00 $3,513.00 $5,100.00 $3,903.00 2026-01-16
72191 CPT Ct/angio Pelvis W/wo Cont 8 5 $3,184.00 $3,184.00 $38.00 $3,120.00 $2,308.50 2026-01-16
72192 CPT CT Pelvis Without Contrast 7 4 $1,098.00 $1,098.00 $741.00 $1,076.00 $824.00 2026-01-16
72193 CPT CT Scan Of Pelvis With Contrast 7 4 $2,858.00 $2,858.00 $1,929.00 $2,801.00 $2,144.00 2026-01-16
72194 CPT Pelvis Ctw/wo Contr 7 4 $2,828.00 $2,828.00 $1,909.00 $2,771.00 $2,121.00 2026-01-16
72195 CPT MRI Pelvis Without 7 4 $3,245.00 $3,245.00 $2,190.00 $3,180.00 $2,434.00 2026-01-16
72196 CPT MRI Pelvis With 7 4 $2,093.00 $2,093.00 $1,413.00 $2,051.00 $1,570.00 2026-01-16
72197 CPT MRI Pelvis Without Or With 7 4 $4,445.00 $4,445.00 $3,000.00 $4,356.00 $3,334.00 2026-01-16
72202 CPT Sacroiliac Joints 3< View 8 5 $395.00 $395.00 $38.00 $387.00 $286.50 2026-01-16
73010 CPT Scapula Xray Right 8 5 $389.00 $389.00 $38.00 $381.00 $282.00 2026-01-16
73200 CPT CT Upper Ext Without Contrast 8 5 $1,060.00 $1,060.00 $38.00 $1,039.00 $768.50 2026-01-16
73206 CPT Ct/angio Upper Ext W/wo C 8 5 $662.00 $662.00 $38.00 $649.00 $480.00 2026-01-16
73218 CPT MRI Ue Other Than Jnt Without Contrast 7 4 $3,607.00 $3,607.00 $2,435.00 $3,535.00 $2,705.00 2026-01-16
73219 CPT MRI Ue Other Than Jnt With Contrast 7 4 $1,066.00 $1,066.00 $720.00 $1,045.00 $800.00 2026-01-16
73220 CPT MRI Ue Other Than Joint W & Without Contrast 7 4 $5,232.00 $5,232.00 $3,532.00 $5,127.00 $3,924.00 2026-01-16
73221 CPT MRI Up Extre Of Any Joint Without Contrast 7 4 $907.00 $907.00 $612.00 $889.00 $680.00 2026-01-16
73222 CPT MRI Up Ext Of Any Joint With Contrast 7 4 $3,912.00 $3,912.00 $2,641.00 $3,834.00 $2,934.00 2026-01-16
73223 CPT MRI Ue Other Than Any Jnt W&without Contrast 7 4 $4,964.00 $4,964.00 $3,351.00 $4,865.00 $3,723.00 2026-01-16
73521 CPT Hip X Raybilateral 8 5 $661.00 $661.00 $38.00 $648.00 $479.50 2026-01-16
73700 CPT CT Lower Extremity 7 4 $2,448.00 $2,448.00 $1,652.00 $2,399.00 $1,836.00 2026-01-16
73706 CPT Ct/angio Lower Ext W/wo C 8 5 $4,401.00 $4,401.00 $38.00 $4,313.00 $3,191.00 2026-01-16
73718 CPT MRI Low Ext Without Contrast 7 4 $3,430.00 $3,430.00 $2,315.00 $3,361.00 $2,573.00 2026-01-16
73719 CPT MRI Low Extremity With Contrast 7 4 $662.00 $662.00 $447.00 $649.00 $497.00 2026-01-16
73720 CPT MRI Low Ext Without & W Dye 7 4 $4,384.00 $4,384.00 $2,959.00 $4,296.00 $3,288.00 2026-01-16
73721 CPT MRI Scan Of Leg Joint 7 4 $1,409.00 $1,409.00 $951.00 $1,381.00 $1,057.00 2026-01-16
73722 CPT MRI Low Joint With Contrast 7 4 $3,915.00 $3,915.00 $2,643.00 $3,837.00 $2,936.00 2026-01-16
73723 CPT MRI Low Extr Of Any Join 7 4 $5,139.00 $5,139.00 $3,469.00 $5,036.00 $3,854.00 2026-01-16
74021 CPT Abd 3 View X-ray 8 5 $210.00 $210.00 $38.00 $206.00 $152.50 2026-01-16
74150 CPT CT Abdomen Without Contras 7 4 $1,054.00 $1,054.00 $711.00 $1,033.00 $791.00 2026-01-16
74170 CPT CT Abdomen With Contra 7 4 $1,475.00 $1,475.00 $996.00 $1,446.00 $1,106.00 2026-01-16
74175 CPT Ct/angio Abd W & Without Cont 8 5 $3,971.00 $3,971.00 $38.00 $3,892.00 $2,879.00 2026-01-16
74176 CPT CT Abdomen Pelvis Without Contrast 7 4 $1,565.00 $1,565.00 $1,056.00 $1,534.00 $1,174.00 2026-01-16
74177 CPT CT Scan Of Abdomen And Pelvis With Contrast 7 4 $1,882.00 $1,882.00 $1,270.00 $1,844.00 $1,412.00 2026-01-16
74178 CPT Ct/abd And Pelvis W & Wo 7 4 $1,927.00 $1,927.00 $1,301.00 $1,888.00 $1,445.00 2026-01-16
74181 CPT MRI Abdomen Without 7 4 $3,580.00 $3,580.00 $2,417.00 $3,508.00 $2,685.00 2026-01-16
74182 CPT MRI Abdomen With 7 4 $2,325.00 $2,325.00 $1,569.00 $2,279.00 $1,744.00 2026-01-16
74183 CPT MRI Abdomen Without & With 7 4 $4,988.00 $4,988.00 $3,367.00 $4,888.00 $3,741.00 2026-01-16
74240 CPT Kub X-ray 8 5 $365.00 $365.00 $38.00 $358.00 $264.50 2026-01-16
74241 CPT Kub X-ray 13 5 $1,146.00 $1,146.00 $9.00 $1,123.00 $774.00 2026-01-16
74400 CPT Ivp X-ray 8 5 $11,990.00 $11,990.00 $38.00 $11,750.00 $8,693.00 2026-01-16
76536 CPT US Exam Of Head And Neck 16 5 $373.00 $373.00 $42.00 $340.00 $212.50 2026-01-16
76604 CPT US Chest 8 5 $716.00 $716.00 $42.00 $702.00 $519.00 2026-01-16
76641 CPT US Breast 8 5 $525.00 $525.00 $42.00 $515.00 $381.00 2026-01-16
76700 CPT Ultrasound Of Abdomen 15 5 $395.00 $395.00 $42.00 $387.00 $159.00 2026-01-16
76770 CPT US Retroperitoneal Complete 8 5 $461.00 $461.00 $42.00 $452.00 $334.50 2026-01-16
76775 CPT US Retroperitoneal Limited 8 5 $240.00 $240.00 $42.00 $235.00 $174.00 2026-01-16
76805 CPT Abdomial Ultrasound Of Pregnant Uterus 9 6 $986.00 $986.00 $37.00 $966.00 $690.00 2026-01-16
76811 CPT Pelvic OB Anatomic 8 5 $1,048.00 $1,048.00 $42.00 $1,027.00 $760.00 2026-01-16
76817 CPT Pelvic OB Transvaginal 8 5 $690.00 $690.00 $42.00 $676.00 $500.50 2026-01-16
76830 CPT Ultrasound Pelvis Through Vagina 15 5 $873.00 $873.00 $42.00 $856.00 $466.00 2026-01-16
76856 CPT Pelvic Non OB 16 5 $381.00 $381.00 $42.00 $326.00 $241.50 2026-01-16
76857 CPT US Bladder, Limited 8 5 $207.00 $207.00 $42.00 $203.00 $150.00 2026-01-16
76870 CPT Scrotum 8 5 $942.00 $942.00 $42.00 $923.00 $683.00 2026-01-16
76881 CPT US Extremity 16 5 $370.00 $370.00 $42.00 $338.00 $250.00 2026-01-16
76882 CPT Extremity Limited 8 5 $630.00 $630.00 $42.00 $617.00 $457.00 2026-01-16
76999 CPT Unlisted Ultrasound Proce 8 5 $471.00 $471.00 $42.00 $462.00 $341.50 2026-01-16
78999 CPT US Other 8 5 $518.00 $518.00 $42.00 $508.00 $376.00 2026-01-16
80050 CPT General Health Panel 8 5 $478.00 $478.00 $197.00 $468.00 $347.00 2026-01-16
80074 CPT Hepatitis Panel Abc 8 5 $416.00 $416.00 $171.00 $408.00 $301.50 2026-01-16
80156 CPT Tegretol 8 5 $249.00 $249.00 $102.00 $244.00 $180.50 2026-01-16
81241 CPT Factor V Leiden 8 5 $535.00 $535.00 $23.00 $524.00 $388.00 2026-01-16
81270 CPT Jak 2 Gene Mutation Analysis 8 5 $653.00 $653.00 $269.00 $640.00 $473.50 2026-01-16
82024 CPT Acth Adrenocorticotropic 8 5 $309.00 $309.00 $127.00 $303.00 $224.00 2026-01-16
82542 CPT Thiopurine Metabolites 8 5 $243.00 $243.00 $100.00 $238.00 $176.00 2026-01-16
82626 CPT Dhea 8 5 $361.00 $361.00 $149.00 $354.00 $262.00 2026-01-16
82652 CPT Vitamin D 1,25 Dihydroxy 24 5 $264.00 $264.00 $55.00 $270.00 $185.00 2026-01-16
82653 CPT Fecal Elastase 8 5 $243.00 $243.00 $100.00 $238.00 $176.00 2026-01-16
82668 CPT Erythropoietin Level 8 5 $208.00 $208.00 $86.00 $204.00 $151.00 2026-01-16
83090 CPT Homocysteine 8 5 $224.00 $224.00 $92.00 $220.00 $162.50 2026-01-16
83519 CPT Acetylcholine Receptor Binding Ab Panel 8 5 $291.00 $291.00 $120.00 $285.00 $211.00 2026-01-16
83605 CPT Lactic Acid 8 5 $214.00 $214.00 $88.00 $210.00 $155.50 2026-01-16
83993 CPT Fecal Calprotectin 8 5 $340.00 $340.00 $140.00 $333.00 $246.50 2026-01-16
84145 CPT Procalcitonin Level 8 5 $277.00 $277.00 $114.00 $271.00 $201.00 2026-01-16
84146 CPT Prolactin 8 5 $231.00 $231.00 $95.00 $226.00 $167.50 2026-01-16
84445 CPT Thyroid Stimulating Immunoglobulin 8 5 $364.00 $364.00 $150.00 $357.00 $264.00 2026-01-16
84585 CPT Vma 8 5 $254.00 $254.00 $105.00 $249.00 $184.50 2026-01-16
85415 CPT Plasminogen Activator 8 5 $566.00 $566.00 $233.00 $555.00 $410.50 2026-01-16
86021 CPT Asca 8 5 $349.00 $349.00 $144.00 $342.00 $253.00 2026-01-16
86022 CPT Anca 8 5 $213.00 $213.00 $88.00 $209.00 $154.50 2026-01-16
86301 CPT Bence Jones Protein 16 5 $259.00 $259.00 $94.00 $283.00 $202.00 2026-01-16
86304 CPT Ca-125 8 5 $268.00 $268.00 $110.00 $263.00 $194.50 2026-01-16
86360 CPT Lymphocyte Subset Panel 4 8 5 $361.00 $361.00 $149.00 $354.00 $262.00 2026-01-16
86664 CPT Epstein Barr Antibody 8 5 $202.00 $202.00 $83.00 $198.00 $146.50 2026-01-16
86803 CPT Hepatitis C Antibody 8 5 $221.00 $221.00 $91.00 $217.00 $160.50 2026-01-16
86900 CPT Blood Typing Abo 8 5 $243.00 $243.00 $100.00 $238.00 $176.00 2026-01-16
87102 CPT Vaginal/other Source 8 5 $248.00 $248.00 $102.00 $243.00 $180.00 2026-01-16
87522 CPT Hepatitis C Virus RNA Ultraquantitative 8 5 $499.00 $499.00 $205.00 $489.00 $361.50 2026-01-16
87536 CPT HIV-1 RNA Quantitative R 8 5 $500.00 $500.00 $206.00 $490.00 $362.50 2026-01-16
87591 CPT Gonorrheaurine 8 5 $249.00 $249.00 $102.00 $244.00 $180.50 2026-01-16
87633 CPT Respiratory Panel Pcr 8 5 $500.00 $500.00 $206.00 $490.00 $362.50 2026-01-16
87800 CPT Gc/chyamydia DNA Probe 8 5 $385.00 $385.00 $158.00 $377.00 $279.50 2026-01-16
88346 CPT Imunnofluorescence, Initial Single Stain 8 5 $301.00 $301.00 $124.00 $295.00 $218.50 2026-01-16
90375 CPT Rabies Immune Globulin, Human, IM Or Sq 8 5 $764.00 $764.00 $306.00 $749.00 $554.00 2026-01-16
90670 CPT Cl-prevnar 13 Vaccine 8 5 $407.00 $407.00 $163.00 $399.00 $295.00 2026-01-16
90716 CPT Varicella Vaccine 8 5 $300.00 $300.00 $120.00 $294.00 $217.50 2026-01-16
90732 CPT Cl-pneumovax 23 Vacc 8 5 $245.00 $245.00 $98.00 $240.00 $178.00 2026-01-16
90734 CPT Cl-meningitis Vaccine 8 5 $325.00 $325.00 $130.00 $319.00 $235.50 2026-01-16
90847 CPT Family Psychotherapy, Including Patient, 50 Min 8 5 $381.00 $381.00 $152.00 $373.00 $276.50 2026-01-16
92523 CPT Evaluation Of Speech Sound Production 8 5 $275.00 $275.00 $54.00 $270.00 $199.50 2026-01-16
92610 CPT Evaluation Of Swallowing Function 8 5 $275.00 $275.00 $54.00 $270.00 $199.50 2026-01-16
92950 CPT Cardiopulmonary Resusc 16 5 $344.50 $344.50 $54.00 $479.00 $168.00 2026-01-16
92960 CPT Cardioversion Electric Ext 16 5 $434.50 $434.50 $54.00 $411.00 $298.50 2026-01-16
92977 CPT Thrombolysis Coronary 8 5 $482.00 $482.00 $54.00 $472.00 $349.50 2026-01-16
93225 CPT Holter Monitor Up To 48 Conn, Rec & Disc 8 5 $262.00 $262.00 $105.00 $257.00 $190.00 2026-01-16
93226 CPT Holter Monitor Up To 48 Hr With Report 8 5 $300.00 $300.00 $120.00 $294.00 $217.50 2026-01-16
93241 CPT Holter Monitor 48-7 Days Global 8 5 $220.00 $220.00 $88.00 $216.00 $159.50 2026-01-16
93242 CPT Holter Epatch 3-7 Days; Hookup 8 5 $227.00 $227.00 $91.00 $222.00 $164.50 2026-01-16
93243 CPT Holter Epatch 3-7 Days; Cardio Analysis 8 5 $461.00 $461.00 $184.00 $452.00 $334.50 2026-01-16
93246 CPT Holter Epatch 8+days; Hookup 8 5 $227.00 $227.00 $54.00 $222.00 $164.50 2026-01-16
93247 CPT Holter Epatch 8+ Days; Cardio Analysis 8 5 $461.00 $461.00 $54.00 $452.00 $334.50 2026-01-16
93268 CPT 30 Day Cardiac Event M 8 5 $450.00 $450.00 $54.00 $441.00 $326.50 2026-01-16
93270 CPT Event Monitor Hook Rcd 8 5 $396.00 $396.00 $54.00 $388.00 $287.00 2026-01-16
93303 CPT Congenital Echo 8 5 $2,092.00 $2,092.00 $54.00 $2,050.00 $1,516.50 2026-01-16
93306 CPT Echocardiogram 16 5 $879.00 $879.00 $54.00 $925.00 $590.50 2026-01-16
93307 CPT Echocardiogram 2d/m-m 17 6 $2,183.00 $2,183.00 $44.00 $2,139.00 $387.00 2026-01-16
93308 CPT Echo Follow Up 8 5 $924.00 $924.00 $54.00 $906.00 $670.00 2026-01-16
93320 CPT Cardiac Doppler 9 6 $997.00 $997.00 $18.00 $977.00 $698.00 2026-01-16
93880 CPT Carotid Duplex Imaging 16 5 $641.50 $641.50 $181.00 $593.00 $357.50 2026-01-16
93925 CPT Arterial Duplex Lower 16 5 $740.50 $740.50 $188.00 $758.00 $378.50 2026-01-16
93926 CPT US Arterial Lower Extremity 16 5 $273.50 $273.50 $39.00 $441.00 $157.00 2026-01-16
93930 CPT Arterial Duplex Upper 8 5 $1,210.00 $1,210.00 $484.00 $1,186.00 $877.50 2026-01-16
93931 CPT Arterial Unilateral Upper 8 5 $990.00 $990.00 $396.00 $970.00 $718.00 2026-01-16
93970 CPT Venous Duplex Extremities Bilateral 16 5 $636.00 $636.00 $176.00 $572.00 $370.00 2026-01-16
93971 CPT Venous Uni Upper/lower 16 5 $493.00 $493.00 $42.00 $508.00 $339.00 2026-01-16
93975 CPT Venous Doppler Of Abd, Pelvic Or Scrotal 15 5 $251.00 $251.00 $100.00 $904.00 $248.00 2026-01-16
96360 CPT Hydration Initial Hour >31 Min 8 5 $286.00 $286.00 $193.00 $280.00 $247.50 2026-01-16
96365 CPT Infusion Therapy Initial Hour >15 Min 9 5 $384.00 $384.00 $54.00 $376.00 $288.00 2026-01-16
96368 CPT IV Infusion Concurrent 8 5 $202.00 $202.00 $136.00 $198.00 $175.00 2026-01-16
96379 CPT IV Push Hydration Flui 9 5 $244.00 $244.00 $54.00 $239.00 $183.00 2026-01-16
96523 CPT Port Flush 8 5 $277.00 $277.00 $54.00 $271.00 $201.00 2026-01-16
97001 CPT Pt Evaluation 8 5 $212.00 $212.00 $54.00 $208.00 $153.50 2026-01-16
97165 CPT Ot Eval Low Complex 30 Min 8 5 $291.00 $291.00 $54.00 $285.00 $211.00 2026-01-16
97166 CPT Ot Eval Mod Complex 45 Min 8 5 $350.00 $350.00 $54.00 $343.00 $254.00 2026-01-16
97167 CPT Ot Eval High Complex 60 Min 8 5 $375.00 $375.00 $54.00 $368.00 $272.00 2026-01-16
97168 CPT Ot Re Evaluation 8 5 $242.00 $242.00 $54.00 $237.00 $175.50 2026-01-16
99285 CPT Emergency Room V 16 5 $729.50 $729.50 $54.00 $940.00 $362.50 2026-01-16
99291 CPT Fac Critical Care, Eval &Mgmt First Hour 16 5 $999.50 $999.50 $54.00 $1,273.00 $507.50 2026-01-16
99292 CPT Critical Care Addl 30 Min Pf 16 5 $521.00 $521.00 $54.00 $776.00 $181.50 2026-01-16
A0420 HCPCS Als2-emergency 8 5 $650.00 $650.00 $439.00 $908.00 $562.50 2026-01-16
A0426 HCPCS Ambulance 8 5 $550.00 $550.00 $371.00 $768.00 $476.00 2026-01-16
A0427 HCPCS Ambulance Als Non-emer 8 5 $1,082.00 $1,082.00 $730.00 $1,511.00 $936.00 2026-01-16
A0428 HCPCS Ambulance Bls Non-emer 8 5 $350.00 $350.00 $236.00 $489.00 $303.00 2026-01-16
A0429 HCPCS Ambulance Als Emergenc 16 5 $437.50 $437.50 $253.00 $698.00 $368.00 2026-01-16
C8902 HCPCS MRI Angio Abd Without Or W 7 4 $4,978.00 $4,978.00 $3,360.00 $4,878.00 $3,734.00 2026-01-16
C8910 HCPCS MRI Angio Chest Without Or 7 4 $2,781.00 $2,781.00 $1,877.00 $2,725.00 $2,086.00 2026-01-16
C8913 HCPCS MRI Angio Low Ext Without 7 4 $565.00 $565.00 $381.00 $554.00 $424.00 2026-01-16
C8919 HCPCS MRI Angio Pelvis W Or 7 4 $565.00 $565.00 $381.00 $554.00 $424.00 2026-01-16
G0390 HCPCS Trauma Activation 8 5 $4,785.00 $4,785.00 $1,914.00 $4,689.00 $3,469.50 2026-01-16
G0480 HCPCS Drug Testing Confirmation 1-7 Classes 8 5 $294.00 $294.00 $121.00 $288.00 $213.50 2026-01-16
G0481 HCPCS Drug Testing Confirmation 8-14 Classes 8 5 $315.00 $315.00 $130.00 $309.00 $228.50 2026-01-16
J1602 HCPCS Simponi Aria Intravenous Soln 50mg/4ml 8 5 $2,780.00 $2,780.00 $1,112.00 $2,724.00 $2,015.50 2026-01-16
J7325 HCPCS Synvisc One 6ml 8 5 $3,995.00 $3,995.00 $1,598.00 $3,915.00 $2,896.50 2026-01-16
P9016 HCPCS Rbc, Leukocyte Reduced 8 5 $544.00 $544.00 $218.00 $533.00 $394.50 2026-01-16
P9021 HCPCS Blood # Of Units 8 5 $209.00 $209.00 $84.00 $205.00 $151.50 2026-01-16
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