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

Sheltering Arms Hospital

Mechanicsville, VA · CCN 493025 · Rates published

832 distinct procedures filed
15 distinct payers
15,321 rate rows
2026-07-30 last MRF observed
Data quality

5,842 of 15,321 rate rows are consumer-grade (38.1%)

9,479 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
per-diem day rate — not a per-procedure price 8,829
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 642
exceeds 10× this hospital's gross charge — excluded from medians 8
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://shelteringarmsinstitute.com/wp-content/uploads/2025/02/Price-Transparency-File-January-2025-SAI.csv
Found on page https://shelteringarmsinstitute.com/patients-and-visitors/fee-schedule/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-28
Content fingerprint 9ca43cdeb3c67537… · 635,359 bytes · first seen 2026-05-09

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
22513
CPT 		Ir Kyphoplasty Thoracic 4 $7,685.64 $7,685.64 $7,685.64 nat. median
$8,349
0.9× median
22514
CPT 		Ir Kyphoplasty Lumbar 4 $6,918.26 $6,918.26 $6,918.26 nat. median
$8,408
0.8× median
0201T
CPT 		CT Sacroplasty Bilat 2 Or More Needles 4 $3,814.70 $3,814.70 $3,814.70 nat. median
$8,289
outlier · 0.5×
0201T
OTHER 		Ir Sacroplasty Bilateral 4 $3,814.70 $3,814.70 $3,814.70 nat. median
$7,730
outlier · 0.5×
37191
CPT 		Ir Place Ivc Filter 4 $3,076.55 $3,076.55 $3,076.55 nat. median
$6,255
outlier · 0.5×
77295
CPT 		Simulation Field Setting - 3d 4 $2,873.79 $2,873.79 $2,873.79 nat. median
$1,940
1.5× median
62305
CPT 		Xr Myelogram 2 Or More Regions With Inject 4 $2,406.85 $2,406.85 $2,406.85 nat. median
$1,369
1.8× median
74174
CPT 		CT Angio Abdomen And Pelvis W+without Contrast 4 $2,195.95 $2,195.95 $2,195.95 nat. median
$988
outlier · 2.2×
73723
CPT 		MRI Ankle With + Without Contrast Left 4 $2,094.57 $2,094.57 $2,094.57 nat. median
$1,191
1.8× median
50693
CPT 		Ir Ureteral Stent Left Perc Place Existing Si 4 $2,054.24 $2,054.24 $2,054.24 nat. median
$4,215
outlier · 0.5×
72197
CPT 		MRI Pelvis Bone With + Without Contrast 4 $2,031.67 $2,031.67 $2,031.67 nat. median
$1,063
1.9× median
78264
CPT 		Nm Gastric Emptying Study 4 $2,002.44 $2,002.44 $2,002.44 nat. median
$715
outlier · 2.8×
74177
CPT 		CT Abdomen And Pelvis With Contrast 4 $1,981.72 $1,981.72 $1,981.72 nat. median
$972
outlier · 2.0×
72196
CPT 		MRI Pelvis Bone With Contrast 4 $1,961.00 $1,961.00 $1,961.00 nat. median
$947
outlier · 2.1×
77301
CPT 		Imrt Planning 4 $1,931.03 $1,931.03 $1,931.03 nat. median
$2,807
0.7× median
73220
CPT 		MRI Forearm With + Without Contrast Left 4 $1,901.80 $1,901.80 $1,901.80 nat. median
$1,128
1.7× median
70543
CPT 		MRI Face Neck Orbit With + Without Contrast 4 $1,901.80 $1,901.80 $1,901.80 nat. median
$1,083
1.8× median
72195
CPT 		MRI Pelvic Floor Study 4 $1,898.10 $1,898.10 $1,898.10 nat. median
$804
outlier · 2.4×
73720
CPT 		MRI Femur Left With + Without Contrast 4 $1,828.54 $1,901.80 $1,865.17 nat. median
$1,125
1.7× median
78315
CPT 		Nm Bone Three Phase Study 4 $1,768.60 $1,768.60 $1,768.60 nat. median
$782
outlier · 2.3×
72157
CPT 		MRI Spine Thoracic With + Without Contrast 4 $1,725.68 $1,725.68 $1,725.68 nat. median
$1,103
1.6× median
70553
CPT 		MRI Brain With + Without Contrast 4 $1,725.68 $1,725.68 $1,725.68 nat. median
$1,132
1.5× median
73718
CPT 		MRI Foot Without Contrast Left 4 $1,465.94 $1,898.10 $1,682.02 nat. median
$866
1.9× median
70470
CPT 		CT Brain/Head With + Without Contrast 4 $1,631.33 $1,631.33 $1,631.33 nat. median
$619
outlier · 2.6×
86905
CPT 		Ag Typing 4 $1,628.00 $1,628.00 $1,628.00 nat. median
$103
outlier · 15.8×
75557
CPT 		MRI Cardiac Morph Fnct Without Cnt 4 $1,622.08 $1,622.08 $1,622.08 nat. median
$538
outlier · 3.0×
72148
CPT 		MRI Spine Lumbar Without Contrast 4 $1,591.00 $1,591.00 $1,591.00 nat. median
$804
2.0× median
74249
CPT 		Xr Upper Gi Double Contrast With Small Bowel 4 $1,587.30 $1,587.30 $1,587.30 nat. median
$398
outlier · 4.0×
74245
CPT 		Xr Upper Gi Single Contrast With Small Bowel 4 $1,585.82 $1,585.82 $1,585.82 nat. median
$365
outlier · 4.3×
72146
CPT 		MRI Spine Thoracic Without Contrast 4 $1,563.99 $1,563.99 $1,563.99 nat. median
$794
2.0× median
72141
CPT 		MRI Spine Cervical Without Contrast 4 $1,563.99 $1,563.99 $1,563.99 nat. median
$778
outlier · 2.0×
74181
CPT 		MRI Abdomen And Pelvis Without Contrast (mrmc) 4 $1,563.99 $1,563.99 $1,563.99 nat. median
$819
1.9× median
70542
CPT 		MRI Brachial Plexus With Contrast 4 $1,561.77 $1,561.77 $1,561.77 nat. median
$923
1.7× median
73719
CPT 		MRI Femur Left With Contrast 4 $1,561.77 $1,561.77 $1,561.77 nat. median
$962
1.6× median
70491
CPT 		CT Neck And Chest With Contrast 4 $1,546.97 $1,546.97 $1,546.97 nat. median
$627
outlier · 2.5×
78306
CPT 		Nm Bone Imaging Whole Body 4 $1,532.17 $1,532.17 $1,532.17 nat. median
$759
outlier · 2.0×
70551
CPT 		MRI Brain Without Contrast 4 $1,465.94 $1,563.99 $1,514.97 nat. median
$782
1.9× median
73721
CPT 		MRI Ankle Without Contrast Left 4 $1,465.94 $1,563.99 $1,514.97 nat. median
$852
1.8× median
74183
CPT 		MRI Abdomen With + Without Contrast 4 $1,499.98 $1,499.98 $1,499.98 nat. median
$1,099
1.4× median
73218
CPT 		MRI Radius/Ulna Left Without Contrast 4 $1,465.94 $1,465.94 $1,465.94 nat. median
$860
1.7× median
73219
CPT 		MRI Humerus Left With Contrast 4 $1,465.94 $1,465.94 $1,465.94 nat. median
$953
1.5× median
73722
CPT 		MRI Lower Extremity Joint Left With Cont 4 $1,465.94 $1,465.94 $1,465.94 nat. median
$1,276
1.1× median
70540
CPT 		MRI Neck Soft Tissue Only Without Contrast 4 $1,465.94 $1,465.94 $1,465.94 nat. median
$792
1.9× median
74175
CPT 		CT Angio Abdomen With Contrast 4 $1,458.91 $1,458.91 $1,458.91 nat. median
$714
outlier · 2.0×
51102
CPT 		Ir Asp Bladder Supra Cath 4 $1,457.80 $1,457.80 $1,457.80 nat. median
$2,377
0.6× median
74170
CPT 		CT Abdomen With + Without Contrast 4 $1,421.54 $1,421.54 $1,421.54 nat. median
$710
outlier · 2.0×
77047
CPT 		MRI Breast Without Contrast Bilateral 4 $1,416.36 $1,416.36 $1,416.36 nat. median
$543
outlier · 2.6×
72125
CPT 		CT Spine Cervical Without Contrast 4 $1,401.19 $1,401.19 $1,401.19 nat. median
$472
outlier · 3.0×
73222
CPT 		MRI Shoulder With Contrast Right 4 $1,154.40 $1,624.30 $1,389.35 nat. median
$1,279
1.1× median
72131
CPT 		CT Spine Lumbar Without Contrast 4 $1,387.87 $1,387.87 $1,387.87 nat. median
$457
outlier · 3.0×

Other procedures at this hospital

Browse this hospital's 832 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
             
0001U CPT Hea Phenotype 4 4 $960.00 $960.00 $355.20 $355.20 $355.20 2024-06-14
0110 RC — 4 4 $2,450.00 $2,450.00 $906.50 $906.50 $906.50 2024-06-14
0120 RC — 4 4 $2,450.00 $2,450.00 $906.50 $906.50 $906.50 2024-06-14
0201T CPT CT Sacroplasty Bilat 2 Or More Needles 4 4 $10,310.00 $10,310.00 $3,814.70 $3,814.70 $3,814.70 2024-06-14
0201T OTHER Ir Sacroplasty Bilateral 4 4 $10,310.00 $10,310.00 $3,814.70 $3,814.70 $3,814.70 2024-06-14
10021 CPT US Guide Inj Pseudoaneurysm 4 4 $1,781.00 $1,781.00 $658.97 $658.97 $658.97 2024-06-14
10022 CPT Ir Insert Tunneled Cvc With Port > 5 Years 4 4 $1,419.00 $1,419.00 $525.03 $525.03 $525.03 2024-06-14
10104 CPT Court/deposition 1st Hour 4 4 $624.00 $624.00 $230.88 $230.88 $230.88 2024-06-14
20600 CPT Ir Picc Replacement Without Port/Pump 4 4 $1,798.00 $1,798.00 $665.26 $665.26 $665.26 2024-06-14
22513 CPT Ir Kyphoplasty Thoracic 4 4 $20,772.00 $20,772.00 $7,685.64 $7,685.64 $7,685.64 2024-06-14
22514 CPT Ir Kyphoplasty Lumbar 4 4 $18,698.00 $18,698.00 $6,918.26 $6,918.26 $6,918.26 2024-06-14
24220 CPT Ir Remove Tunneled Cvad With Port/Pump 4 4 $1,522.00 $1,522.00 $563.14 $563.14 $563.14 2024-06-14
31500 CPT Rt Charge Emergent Intubation -> Yes 4 4 $1,118.00 $1,118.00 $413.66 $413.66 $413.66 2024-06-14
32555 CPT US Thoracentesis 12 4 $1,365.00 $1,365.00 $490.25 $717.80 $505.05 2024-06-14
36002 CPT Ir Inj Pseudoaneurysm 4 4 $1,781.00 $1,781.00 $658.97 $658.97 $658.97 2024-06-14
36430 CPT Transfuse Fresh Frozen Plasma 8 4 $670.50 $670.50 $34.41 $461.76 $248.09 2024-06-14
36558 CPT Ir Insert Tunneled Cvc Without Port > 5 Years 4 4 $1,875.00 $1,875.00 $693.75 $693.75 $693.75 2024-06-14
36580 CPT Ir Replace Cvc Non Tunneled Without Port/Pump 4 4 $2,340.00 $2,340.00 $865.80 $865.80 $865.80 2024-06-14
36581 CPT Ir Replace Cvc Tunneled Without Port 4 4 $2,342.00 $2,342.00 $866.54 $866.54 $866.54 2024-06-14
36589 CPT Ir Remove Tunneled Cvad Without Port/Pump 4 4 $693.00 $693.00 $256.41 $256.41 $256.41 2024-06-14
36593 CPT Ir Declot Imp Vad Cath Thrombolytic 4 4 $547.00 $547.00 $202.39 $202.39 $202.39 2024-06-14
36901 CPT Ir Angiogram Arteriovenous Shunt 4 4 $2,273.00 $2,273.00 $841.01 $841.01 $841.01 2024-06-14
37191 CPT Ir Place Ivc Filter 4 4 $8,315.00 $8,315.00 $3,076.55 $3,076.55 $3,076.55 2024-06-14
38221 CPT CT Biopsy Bone Marrow With Bone Marrow Asp 4 4 $681.00 $681.00 $251.97 $251.97 $251.97 2024-06-14
43752 CPT Xr Tube Placement Ng Gastric (Stomach) 4 4 $620.00 $620.00 $229.40 $229.40 $229.40 2024-06-14
43761 CPT Xr Tube Reposition Gastric 4 4 $2,413.00 $2,413.00 $892.81 $892.81 $892.81 2024-06-14
47000 CPT Ir Biopsy Liver Percutaneous 4 4 $2,754.00 $2,754.00 $1,018.98 $1,018.98 $1,018.98 2024-06-14
49083 CPT CT Paracentesis 8 4 $2,210.50 $2,210.50 $687.83 $947.94 $817.88 2024-06-14
49440 CPT Ir Perc Gastrostomy Tube Placement 4 4 $2,156.00 $2,156.00 $797.72 $797.72 $797.72 2024-06-14
49446 CPT Ir Change G/j Tube Reposition 4 4 $2,445.00 $2,445.00 $904.65 $904.65 $904.65 2024-06-14
49450 CPT Ir Replace Gastro/Cecostomy Tube Perc 8 4 $945.50 $945.50 $52.54 $647.13 $349.84 2024-06-14
49451 CPT Xr Tube Replace D Or J With Fluoro With Cnt 4 4 $1,910.00 $1,910.00 $706.70 $706.70 $706.70 2024-06-14
49452 CPT Ir Replace Gastro/Jejuno Tube Perc 4 4 $2,364.00 $2,364.00 $874.68 $874.68 $874.68 2024-06-14
49460 CPT Xr Tube Remove Obst With Fluoro With Cnt 4 4 $1,938.00 $1,938.00 $717.06 $717.06 $717.06 2024-06-14
50693 CPT Ir Ureteral Stent Left Perc Place Existing Si 4 4 $5,552.00 $5,552.00 $2,054.24 $2,054.24 $2,054.24 2024-06-14
51102 CPT Ir Asp Bladder Supra Cath 4 4 $3,940.00 $3,940.00 $1,457.80 $1,457.80 $1,457.80 2024-06-14
62270 CPT Ir Spinal Puncture Lumbar Diagnostic 4 4 $3,517.00 $3,517.00 $1,301.29 $1,301.29 $1,301.29 2024-06-14
62305 CPT Xr Myelogram 2 Or More Regions With Inject 4 4 $6,505.00 $6,505.00 $2,406.85 $2,406.85 $2,406.85 2024-06-14
64483 CPT Ir Inj Foramin Epidural Lumbar Anes/Ster Single 4 4 $1,103.00 $1,103.00 $408.11 $408.11 $408.11 2024-06-14
64484 CPT Ir Inj Foramin Epidural Lumbar Anes/Ster Additional 4 4 $1,173.00 $1,173.00 $434.01 $434.01 $434.01 2024-06-14
70100 CPT Xr Mandible Less Than 4 Views 4 4 $832.00 $832.00 $307.84 $307.84 $307.84 2024-06-14
70110 CPT Xr Mandible Complete 4+ Views 4 4 $1,138.00 $1,138.00 $421.06 $421.06 $421.06 2024-06-14
70130 CPT Xr Mastoids Complete 3+ Views 4 4 $733.00 $733.00 $271.21 $271.21 $271.21 2024-06-14
70150 CPT Xr Facial Bones 3+ Views 4 4 $990.00 $990.00 $366.30 $366.30 $366.30 2024-06-14
70200 CPT Xr Orbits Complete 4+ Views 4 4 $624.00 $624.00 $230.88 $230.88 $230.88 2024-06-14
70210 CPT Xr Sinuses Paranasal 1-2 Views 4 4 $936.00 $936.00 $346.32 $346.32 $346.32 2024-06-14
70220 CPT Xr Sinuses Paranasal 3+ Views 4 4 $1,240.00 $1,240.00 $458.80 $458.80 $458.80 2024-06-14
70250 CPT Xr Skull 1-3 Views 4 4 $880.00 $880.00 $325.60 $325.60 $325.60 2024-06-14
70260 CPT Xr Skull Complete 4+ Views 4 4 $1,040.00 $1,040.00 $384.80 $384.80 $384.80 2024-06-14
70330 CPT Xr Tmj Open And Closed Bilateral 4 4 $1,041.00 $1,041.00 $385.17 $385.17 $385.17 2024-06-14
70360 CPT Xr Neck Soft Tissue 4 4 $946.00 $946.00 $350.02 $350.02 $350.02 2024-06-14
70450 CPT CT Brain/Head Without Contrast 8 4 $2,829.50 $2,829.50 $868.39 $1,225.44 $1,046.91 2024-06-14
70460 CPT CT Brain/Head With Contrast 4 4 $3,445.00 $3,445.00 $1,274.65 $1,274.65 $1,274.65 2024-06-14
70470 CPT CT Brain/Head With + Without Contrast 4 4 $4,409.00 $4,409.00 $1,631.33 $1,631.33 $1,631.33 2024-06-14
70480 CPT CT Orbits Sella Without Contrast 4 4 $2,347.00 $2,347.00 $868.39 $868.39 $868.39 2024-06-14
70481 CPT CT Orbits Sella With Contrast 4 4 $2,678.00 $2,678.00 $990.86 $990.86 $990.86 2024-06-14
70482 CPT CT Coronal Temperal Bone With And Without Cont 4 4 $2,917.00 $2,917.00 $1,079.29 $1,079.29 $1,079.29 2024-06-14
70486 CPT CT Maxillofacial Without Contrast 8 4 $3,001.50 $3,001.50 $868.39 $1,352.72 $1,110.56 2024-06-14
70487 CPT CT Maxillofacial With Contrast 8 4 $2,679.00 $2,679.00 $990.86 $991.60 $991.23 2024-06-14
70488 CPT CT Mandible With And Without Contrast 4 4 $2,917.00 $2,917.00 $1,079.29 $1,079.29 $1,079.29 2024-06-14
70491 CPT CT Neck And Chest With Contrast 4 4 $4,181.00 $4,181.00 $1,546.97 $1,546.97 $1,546.97 2024-06-14
70496 CPT CT Angio Head/Neck With And Without Contrast 8 4 $2,975.50 $2,975.50 $804.01 $1,397.86 $1,100.93 2024-06-14
70498 CPT CT Angio Neck With And Without Contrast 4 4 $1,676.00 $1,676.00 $620.12 $620.12 $620.12 2024-06-14
70540 CPT MRI Neck Soft Tissue Only Without Contrast 4 4 $3,962.00 $3,962.00 $1,465.94 $1,465.94 $1,465.94 2024-06-14
70542 CPT MRI Brachial Plexus With Contrast 4 4 $4,221.00 $4,221.00 $1,561.77 $1,561.77 $1,561.77 2024-06-14
70543 CPT MRI Face Neck Orbit With + Without Contrast 4 4 $5,140.00 $5,140.00 $1,901.80 $1,901.80 $1,901.80 2024-06-14
70544 CPT MRA Brain/Head Without Contrast 4 4 $1,740.00 $1,740.00 $643.80 $643.80 $643.80 2024-06-14
70547 CPT MRA Neck Without Contrast 4 4 $2,281.00 $2,281.00 $843.97 $843.97 $843.97 2024-06-14
70548 CPT MRA Neck With Contrast 4 4 $1,740.00 $1,740.00 $643.80 $643.80 $643.80 2024-06-14
70551 CPT MRI Brain Without Contrast 8 4 $4,094.50 $4,094.50 $1,465.94 $1,563.99 $1,514.97 2024-06-14
70553 CPT MRI Brain With + Without Contrast 4 4 $4,664.00 $4,664.00 $1,725.68 $1,725.68 $1,725.68 2024-06-14
71046 CPT Xr Chest 2 Views 4 4 $802.00 $802.00 $296.74 $296.74 $296.74 2024-06-14
71047 CPT Xr Chest 2 Views With Apical Lordotic 4 4 $802.00 $802.00 $296.74 $296.74 $296.74 2024-06-14
71048 CPT Xr Chest 4+ Views 8 4 $869.00 $869.00 $296.74 $346.32 $321.53 2024-06-14
71101 CPT Xr Ribs 2 Views With Pa Chest Left 4 4 $1,467.00 $1,467.00 $542.79 $542.79 $542.79 2024-06-14
71111 CPT Xr Ribs 3 Views With Pa Chest Bilateral 4 4 $812.00 $812.00 $300.44 $300.44 $300.44 2024-06-14
71120 CPT Xr Sternum 2+ Views 4 4 $820.00 $820.00 $303.40 $303.40 $303.40 2024-06-14
71130 CPT Xr Sternoclavicular Joint(s) 3+ Views 4 4 $936.00 $936.00 $346.32 $346.32 $346.32 2024-06-14
71250 CPT CT Thorax Without Contrast 4 4 $951.00 $951.00 $351.87 $351.87 $351.87 2024-06-14
71260 CPT CT Thorax With Contrast 8 4 $3,390.50 $3,390.50 $990.86 $1,518.11 $1,254.48 2024-06-14
71275 CPT CT Angio Chest With And Without Contrast 4 4 $2,384.00 $2,384.00 $882.08 $882.08 $882.08 2024-06-14
72020 CPT Xr Spine Lumbar 1 View 4 4 $812.00 $812.00 $300.44 $300.44 $300.44 2024-06-14
72040 CPT Xr Spine Cervical 1 View 8 4 $951.50 $951.50 $274.91 $429.20 $352.06 2024-06-14
72050 CPT Xr Spine Cervical 4 Or 5 Views 4 4 $1,733.00 $1,733.00 $641.21 $641.21 $641.21 2024-06-14
72052 CPT Xr Spine Cervical 6+ Views 4 4 $1,411.00 $1,411.00 $522.07 $522.07 $522.07 2024-06-14
72070 CPT Xr Spine Thoracic 2 Views 4 4 $1,348.00 $1,348.00 $498.76 $498.76 $498.76 2024-06-14
72072 CPT Xr Spine Thoracic 3 Views 4 4 $864.00 $864.00 $319.68 $319.68 $319.68 2024-06-14
72080 CPT Xr Spine Thoracolumbar Junction 2+ Views (sfmc) 4 4 $534.00 $534.00 $197.58 $197.58 $197.58 2024-06-14
72100 CPT Xr Spine Lumbosacral 2 Or 3 Views 4 4 $1,554.00 $1,554.00 $574.98 $574.98 $574.98 2024-06-14
72110 CPT Xr Spine Lumbosacral 4+ Views 4 4 $1,650.00 $1,650.00 $610.50 $610.50 $610.50 2024-06-14
72114 CPT Xr Spine Lumbosacral With Bending 6+ Views 4 4 $889.00 $889.00 $328.93 $328.93 $328.93 2024-06-14
72120 CPT Xr Spine Lumbosacral 4+ View With Flex/Ext 4 4 $1,650.00 $1,650.00 $610.50 $610.50 $610.50 2024-06-14
72125 CPT CT Spine Cervical Without Contrast 4 4 $3,787.00 $3,787.00 $1,401.19 $1,401.19 $1,401.19 2024-06-14
72126 CPT CT Spine Cervical With Contrast 8 4 $3,113.00 $3,113.00 $990.86 $1,312.76 $1,151.81 2024-06-14
72128 CPT CT Spine Thoracic Without Contrast 4 4 $951.00 $951.00 $351.87 $351.87 $351.87 2024-06-14
72129 CPT CT Spine Thoracic With Contrast 4 4 $3,548.00 $3,548.00 $1,312.76 $1,312.76 $1,312.76 2024-06-14
72131 CPT CT Spine Lumbar Without Contrast 4 4 $3,751.00 $3,751.00 $1,387.87 $1,387.87 $1,387.87 2024-06-14
72132 CPT CT Spine Lumbar With Contrast 4 4 $1,136.00 $1,136.00 $420.32 $420.32 $420.32 2024-06-14
72133 CPT CT Spine Lumbar With + Without Contrast 4 4 $1,459.00 $1,459.00 $539.83 $539.83 $539.83 2024-06-14
72141 CPT MRI Spine Cervical Without Contrast 4 4 $4,227.00 $4,227.00 $1,563.99 $1,563.99 $1,563.99 2024-06-14
72142 CPT MRI Spine Cervical With Contrast 4 4 $3,524.00 $3,524.00 $1,303.88 $1,303.88 $1,303.88 2024-06-14
72146 CPT MRI Spine Thoracic Without Contrast 4 4 $4,227.00 $4,227.00 $1,563.99 $1,563.99 $1,563.99 2024-06-14
72148 CPT MRI Spine Lumbar Without Contrast 4 4 $4,300.00 $4,300.00 $1,591.00 $1,591.00 $1,591.00 2024-06-14
72149 CPT MRI Spine Lumbar With Contrast 4 4 $3,524.00 $3,524.00 $1,303.88 $1,303.88 $1,303.88 2024-06-14
72156 CPT MRI Spine Cervical With + Without Contrast 4 4 $2,990.00 $2,990.00 $1,106.30 $1,106.30 $1,106.30 2024-06-14
72157 CPT MRI Spine Thoracic With + Without Contrast 4 4 $4,664.00 $4,664.00 $1,725.68 $1,725.68 $1,725.68 2024-06-14
72158 CPT MRI Spine Lumbar With + Without Contrast 4 4 $2,990.00 $2,990.00 $1,106.30 $1,106.30 $1,106.30 2024-06-14
72170 CPT Xr Pelvis 1 Or 2 Views 4 4 $750.00 $750.00 $277.50 $277.50 $277.50 2024-06-14
72190 CPT Xr Pelvis Complete 3+ Views 4 4 $745.00 $745.00 $275.65 $275.65 $275.65 2024-06-14
72191 CPT CT Angio Pelvis With And Without Contrast 4 4 $3,609.00 $3,609.00 $1,335.33 $1,335.33 $1,335.33 2024-06-14
72192 CPT CT Pelvis Without Contrast 8 4 $2,488.00 $2,488.00 $868.39 $972.73 $920.56 2024-06-14
72193 CPT CT Pelvis With Contrast 4 4 $2,998.00 $2,998.00 $1,109.26 $1,109.26 $1,109.26 2024-06-14
72194 CPT CT Pelvis With + Without Contrast 4 4 $3,522.00 $3,522.00 $1,303.14 $1,303.14 $1,303.14 2024-06-14
72195 CPT MRI Pelvic Floor Study 4 4 $5,130.00 $5,130.00 $1,898.10 $1,898.10 $1,898.10 2024-06-14
72196 CPT MRI Pelvis Bone With Contrast 4 4 $5,300.00 $5,300.00 $1,961.00 $1,961.00 $1,961.00 2024-06-14
72197 CPT MRI Pelvis Bone With + Without Contrast 4 4 $5,491.00 $5,491.00 $2,031.67 $2,031.67 $2,031.67 2024-06-14
72198 CPT MRA Pelvis Without Contrast 4 4 $2,247.00 $2,247.00 $831.39 $831.39 $831.39 2024-06-14
72200 CPT Xr Sacroiliac Joints 1 Or 2 Views 4 4 $1,043.00 $1,043.00 $385.91 $385.91 $385.91 2024-06-14
72202 CPT Xr Sacroiliac Joints 3+ Views 4 4 $1,352.00 $1,352.00 $500.24 $500.24 $500.24 2024-06-14
72220 CPT Xr Sacrum/Coccyx 2+ Views 4 4 $1,258.00 $1,258.00 $465.46 $465.46 $465.46 2024-06-14
73000 CPT Xr Clavicle Left 4 4 $1,220.00 $1,220.00 $451.40 $451.40 $451.40 2024-06-14
73010 CPT Xr Scapula Left 4 4 $1,075.00 $1,075.00 $397.75 $397.75 $397.75 2024-06-14
73020 CPT Xr Shoulder 1 View Left 4 4 $695.00 $695.00 $257.15 $257.15 $257.15 2024-06-14
73030 CPT Xr Shoulder Complete 2+ Views Left 4 4 $1,358.00 $1,358.00 $502.46 $502.46 $502.46 2024-06-14
73050 CPT Xr Ac Joints Bilateral 4 4 $1,152.00 $1,152.00 $426.24 $426.24 $426.24 2024-06-14
73060 CPT Xr Humerus Left 4 4 $743.00 $743.00 $274.91 $274.91 $274.91 2024-06-14
73080 CPT Xr Elbow Complete 3+ Views Left 4 4 $1,208.00 $1,208.00 $446.96 $446.96 $446.96 2024-06-14
73090 CPT Xr Forearm 2 Views Left 4 4 $667.00 $667.00 $246.79 $246.79 $246.79 2024-06-14
73100 CPT Xr Wrist 1-2 Views Left 4 4 $814.00 $814.00 $301.18 $301.18 $301.18 2024-06-14
73110 CPT Xr Wrist Complete 3+ Views Left 4 4 $1,159.00 $1,159.00 $428.83 $428.83 $428.83 2024-06-14
73120 CPT Xr Hand 1-2 Views Left 4 4 $714.00 $714.00 $264.18 $264.18 $264.18 2024-06-14
73130 CPT Xr Hand Complete 3+ Views Left 4 4 $1,259.00 $1,259.00 $465.83 $465.83 $465.83 2024-06-14
73140 CPT Xr Fingers 2+ Views Left 4 4 $824.00 $824.00 $304.88 $304.88 $304.88 2024-06-14
73200 CPT CT Upper Extremity Without Contrast Left 12 4 $2,374.00 $2,374.00 $868.39 $1,241.35 $878.38 2024-06-14
73201 CPT CT Elbow With Contrast Left 4 4 $2,678.00 $2,678.00 $990.86 $990.86 $990.86 2024-06-14
73202 CPT CT Elbow Left With And Without Contrast 4 4 $2,917.00 $2,917.00 $1,079.29 $1,079.29 $1,079.29 2024-06-14
73218 CPT MRI Radius/Ulna Left Without Contrast 4 4 $3,962.00 $3,962.00 $1,465.94 $1,465.94 $1,465.94 2024-06-14
73219 CPT MRI Humerus Left With Contrast 4 4 $3,962.00 $3,962.00 $1,465.94 $1,465.94 $1,465.94 2024-06-14
73220 CPT MRI Forearm With + Without Contrast Left 4 4 $5,140.00 $5,140.00 $1,901.80 $1,901.80 $1,901.80 2024-06-14
73221 CPT MRI Elbow Without Contrast Left 4 4 $3,288.00 $3,288.00 $1,216.56 $1,216.56 $1,216.56 2024-06-14
73222 CPT MRI Shoulder With Contrast Right 8 4 $3,755.00 $3,755.00 $1,154.40 $1,624.30 $1,389.35 2024-06-14
73225 CPT MRA Upper Extremity With Contrast Left 4 4 $3,490.00 $3,490.00 $1,291.30 $1,291.30 $1,291.30 2024-06-14
73502 CPT Xr Hip Left 2-3 Views 4 4 $1,023.00 $1,023.00 $378.51 $378.51 $378.51 2024-06-14
73503 CPT Xr Hip Left 4+ Views 4 4 $1,300.00 $1,300.00 $481.00 $481.00 $481.00 2024-06-14
73521 CPT Xr Hips Bilateral With Or Without Pelvis 2 Views 4 4 $1,519.00 $1,519.00 $562.03 $562.03 $562.03 2024-06-14
73522 CPT Xr Hips Bil With Or Without Pelvis 3-4 Views 4 4 $1,700.00 $1,700.00 $629.00 $629.00 $629.00 2024-06-14
73551 CPT Xr Femur Left 1 View 4 4 $815.00 $815.00 $301.55 $301.55 $301.55 2024-06-14
73552 CPT Xr Femur Left 2 Views 4 4 $1,128.00 $1,128.00 $417.36 $417.36 $417.36 2024-06-14
73560 CPT Xr Knee 1 Or 2 Views Left 8 4 $573.50 $573.50 $207.20 $217.19 $212.19 2024-06-14
73562 CPT Xr Knee 3 Views Left 4 4 $1,259.00 $1,259.00 $465.83 $465.83 $465.83 2024-06-14
73564 CPT Xr Knee Complete 4+ Views Left 4 4 $1,361.00 $1,361.00 $503.57 $503.57 $503.57 2024-06-14
73565 CPT Xr Knee 1 View Standing Ap Bilateral 4 4 $457.00 $457.00 $169.09 $169.09 $169.09 2024-06-14
73590 CPT Xr Tibia/Fibula Left 2 Views 8 4 $1,156.50 $1,156.50 $417.36 $438.45 $427.90 2024-06-14
73600 CPT Xr Ankle 2 Views Left 8 4 $748.00 $748.00 $268.62 $284.90 $276.76 2024-06-14
73610 CPT Xr Ankle Complete 3+ Views Left 4 4 $1,057.00 $1,057.00 $391.09 $391.09 $391.09 2024-06-14
73620 CPT Xr Toes 2 + Views Left 8 4 $506.50 $506.50 $174.27 $200.54 $187.41 2024-06-14
73630 CPT Xr Foot Complete 3+ Views Left 8 4 $799.50 $799.50 $200.54 $391.09 $295.81 2024-06-14
73650 CPT Xr Calcaneous 1 View Left 8 4 $683.50 $683.50 $212.75 $293.04 $252.90 2024-06-14
73660 CPT Xr Toes 2nd Digit Left 4 4 $508.00 $508.00 $187.96 $187.96 $187.96 2024-06-14
73700 CPT CT Ankle Without Contrast Left 4 4 $2,347.00 $2,347.00 $868.39 $868.39 $868.39 2024-06-14
73701 CPT CT Femur Left With Contrast 4 4 $2,678.00 $2,678.00 $990.86 $990.86 $990.86 2024-06-14
73702 CPT CT Femur Left With And Without Contrast 4 4 $2,917.00 $2,917.00 $1,079.29 $1,079.29 $1,079.29 2024-06-14
73718 CPT MRI Foot Without Contrast Left 8 4 $4,546.00 $4,546.00 $1,465.94 $1,898.10 $1,682.02 2024-06-14
73719 CPT MRI Femur Left With Contrast 4 4 $4,221.00 $4,221.00 $1,561.77 $1,561.77 $1,561.77 2024-06-14
73720 CPT MRI Femur Left With + Without Contrast 8 4 $5,041.00 $5,041.00 $1,828.54 $1,901.80 $1,865.17 2024-06-14
73721 CPT MRI Ankle Without Contrast Left 8 4 $4,094.50 $4,094.50 $1,465.94 $1,563.99 $1,514.97 2024-06-14
73722 CPT MRI Lower Extremity Joint Left With Cont 4 4 $3,962.00 $3,962.00 $1,465.94 $1,465.94 $1,465.94 2024-06-14
73723 CPT MRI Ankle With + Without Contrast Left 4 4 $5,661.00 $5,661.00 $2,094.57 $2,094.57 $2,094.57 2024-06-14
74018 CPT Xr Abdomen Kub - 1 View 8 4 $696.50 $696.50 $185.74 $329.67 $257.71 2024-06-14
74019 CPT Xr Abdomen Decubitus Bilateral 8 4 $472.50 $472.50 $136.90 $212.75 $174.82 2024-06-14
74020 CPT Xr Abdomen Kub Min 2 Views Portable 4 4 $1,374.00 $1,374.00 $508.38 $508.38 $508.38 2024-06-14
74022 CPT Xr Abdomen Kub + upright/Lt Decub Xray 4 4 $1,160.00 $1,160.00 $429.20 $429.20 $429.20 2024-06-14
74150 CPT CT Abdomen Without Contrast 4 4 $2,748.00 $2,748.00 $1,016.76 $1,016.76 $1,016.76 2024-06-14
74160 CPT CT Abdomen With Contrast + Pelvis With And Without Contrast 4 4 $3,085.00 $3,085.00 $1,141.45 $1,141.45 $1,141.45 2024-06-14
74170 CPT CT Abdomen With + Without Contrast 4 4 $3,842.00 $3,842.00 $1,421.54 $1,421.54 $1,421.54 2024-06-14
74174 CPT CT Angio Abdomen And Pelvis W+without Contrast 4 4 $5,935.00 $5,935.00 $2,195.95 $2,195.95 $2,195.95 2024-06-14
74175 CPT CT Angio Abdomen With Contrast 4 4 $3,943.00 $3,943.00 $1,458.91 $1,458.91 $1,458.91 2024-06-14
74176 CPT CT Abdomen And Pelvis Without Contrast 4 4 $3,547.00 $3,547.00 $1,312.39 $1,312.39 $1,312.39 2024-06-14
74177 CPT CT Abdomen And Pelvis With Contrast 4 4 $5,356.00 $5,356.00 $1,981.72 $1,981.72 $1,981.72 2024-06-14
74181 CPT MRI Abdomen And Pelvis Without Contrast (mrmc) 4 4 $4,227.00 $4,227.00 $1,563.99 $1,563.99 $1,563.99 2024-06-14
74183 CPT MRI Abdomen With + Without Contrast 4 4 $4,054.00 $4,054.00 $1,499.98 $1,499.98 $1,499.98 2024-06-14
74220 CPT Xr Barium Swallow Esophogram 4 4 $1,941.00 $1,941.00 $718.17 $718.17 $718.17 2024-06-14
74240 CPT Xr Upper Gi 4 4 $1,034.00 $1,034.00 $382.58 $382.58 $382.58 2024-06-14
74241 CPT Xr Upper Gi + Kub 4 4 $3,303.00 $3,303.00 $1,222.11 $1,222.11 $1,222.11 2024-06-14
74245 CPT Xr Upper Gi Single Contrast With Small Bowel 4 4 $4,286.00 $4,286.00 $1,585.82 $1,585.82 $1,585.82 2024-06-14
74249 CPT Xr Upper Gi Double Contrast With Small Bowel 4 4 $4,290.00 $4,290.00 $1,587.30 $1,587.30 $1,587.30 2024-06-14
74420 CPT Xr Retrograde Pyelogram Bilateral 8 4 $1,972.00 $1,972.00 $498.02 $961.26 $729.64 2024-06-14
74430 CPT Xr Cystogram 4 4 $678.00 $678.00 $250.86 $250.86 $250.86 2024-06-14
74455 CPT Xr Voiding Urethrocystography 4 4 $1,252.00 $1,252.00 $463.24 $463.24 $463.24 2024-06-14
75557 CPT MRI Cardiac Morph Fnct Without Cnt 4 4 $4,384.00 $4,384.00 $1,622.08 $1,622.08 $1,622.08 2024-06-14
75635 CPT CT Angio Abdomen Aorta + Iliofemoral 4 4 $3,424.00 $3,424.00 $1,266.88 $1,266.88 $1,266.88 2024-06-14
75984 CPT Ir Change Uret Tube Via Ileal Conduit (mrmc) 4 4 $890.00 $890.00 $329.30 $329.30 $329.30 2024-06-14
75989 CPT Ir Cholecystostomy Percutaneous Si 4 4 $1,675.00 $1,675.00 $619.75 $619.75 $619.75 2024-06-14
76000 CPT Ir Fluoroscopy < 1 Hour 4 4 $1,122.00 $1,122.00 $415.14 $415.14 $415.14 2024-06-14
76498 CPT MRI Whole Body With + Without Contrast 8 4 $3,365.50 $3,365.50 $488.77 $2,001.70 $1,245.24 2024-06-14
76536 CPT US Head/Neck Soft Tissue 8 4 $1,817.50 $1,817.50 $639.73 $705.22 $672.48 2024-06-14
76604 CPT US Chest 4 4 $1,906.00 $1,906.00 $705.22 $705.22 $705.22 2024-06-14
76642 CPT US Breast Limited Bilateral 4 4 $874.00 $874.00 $323.38 $323.38 $323.38 2024-06-14
76700 CPT US Abdomen Complete 4 4 $3,007.00 $3,007.00 $1,112.59 $1,112.59 $1,112.59 2024-06-14
76705 CPT Ir Ultrasound Abdomen Limited 12 4 $1,150.00 $1,150.00 $414.40 $528.73 $425.50 2024-06-14
76770 CPT US Aorta/Retroperitoneal Complete 8 4 $1,881.00 $1,881.00 $416.25 $975.69 $695.97 2024-06-14
76775 CPT US Urinary Bladder Limited 12 4 $1,020.00 $1,020.00 $377.03 $414.40 $377.40 2024-06-14
76776 CPT US Kidney Transplant 4 4 $1,040.00 $1,040.00 $384.80 $384.80 $384.80 2024-06-14
76801 CPT US Pregnant Uts < 14 Weeks Sngl 4 4 $1,952.00 $1,952.00 $722.24 $722.24 $722.24 2024-06-14
76830 CPT US Transvaginal Non-OB 8 4 $2,351.50 $2,351.50 $705.22 $1,034.89 $870.06 2024-06-14
76856 CPT US Pelvis Comp w/Transvag If Indicated 8 4 $2,351.50 $2,351.50 $705.22 $1,034.89 $870.06 2024-06-14
76870 CPT US Scrotum/Testicles 4 4 $1,673.00 $1,673.00 $619.01 $619.01 $619.01 2024-06-14
76881 CPT US Ankle Left 4 4 $1,906.00 $1,906.00 $705.22 $705.22 $705.22 2024-06-14
76942 CPT Ir Ultrasound Guided Needle Placement 4 4 $1,264.00 $1,264.00 $467.68 $467.68 $467.68 2024-06-14
76978 CPT US Aortic W/contrast 4 4 $1,587.00 $1,587.00 $587.19 $587.19 $587.19 2024-06-14
76999 CPT Ir Unlisted Ultrasound Procedure 4 4 $474.00 $474.00 $175.38 $175.38 $175.38 2024-06-14
77002 CPT Ir Inj/Asp/Arthro Large Joint/Bursa 4 4 $968.00 $968.00 $358.16 $358.16 $358.16 2024-06-14
77003 CPT Ir Inj Spine Fluoro Guided 4 4 $1,112.00 $1,112.00 $411.44 $411.44 $411.44 2024-06-14
77012 CPT CT Biopsy Bone Deep 4 4 $1,302.00 $1,302.00 $481.74 $481.74 $481.74 2024-06-14
77047 CPT MRI Breast Without Contrast Bilateral 4 4 $3,828.00 $3,828.00 $1,416.36 $1,416.36 $1,416.36 2024-06-14
77071 CPT Xr Ankle Stress Left Without Contra Joint 4 4 $750.00 $750.00 $277.50 $277.50 $277.50 2024-06-14
77072 CPT Xr Bone Age Extended 4 4 $508.00 $508.00 $187.96 $187.96 $187.96 2024-06-14
77073 CPT Xr Lower Extremity Leg Length Evaluation 4 4 $682.00 $682.00 $252.34 $252.34 $252.34 2024-06-14
77074 CPT Xr Bone Survey Limited 4 4 $1,160.00 $1,160.00 $429.20 $429.20 $429.20 2024-06-14
77075 CPT Xr Bone Survey Complete 4 4 $1,273.00 $1,273.00 $471.01 $471.01 $471.01 2024-06-14
77077 CPT Xr Joint Survey Hand/Wrist Single View 2+ Joints 4 4 $508.00 $508.00 $187.96 $187.96 $187.96 2024-06-14
77280 CPT Simulation Field Setting - Simple 4 4 $1,470.00 $1,470.00 $543.90 $543.90 $543.90 2024-06-14
77285 CPT Simulation Field Setting - Intermediate 4 4 $1,738.00 $1,738.00 $643.06 $643.06 $643.06 2024-06-14
77290 CPT Simulation Field Setting - Complex 4 4 $2,309.00 $2,309.00 $854.33 $854.33 $854.33 2024-06-14
77295 CPT Simulation Field Setting - 3d 4 4 $7,767.00 $7,767.00 $2,873.79 $2,873.79 $2,873.79 2024-06-14
77300 CPT Basic Dosimetry Calc 4 4 $496.00 $496.00 $183.52 $183.52 $183.52 2024-06-14
77301 CPT Imrt Planning 4 4 $5,219.00 $5,219.00 $1,931.03 $1,931.03 $1,931.03 2024-06-14
77306 CPT Isodone Plan - Complex 2d 4 4 $919.00 $919.00 $340.03 $340.03 $340.03 2024-06-14
77307 CPT Isodone Plan - Simple 2d 4 4 $919.00 $919.00 $340.03 $340.03 $340.03 2024-06-14
77321 CPT Special Teletherapy Port Plan 4 4 $2,023.00 $2,023.00 $748.51 $748.51 $748.51 2024-06-14
77331 CPT Special Dosimetry 4 4 $746.00 $746.00 $276.02 $276.02 $276.02 2024-06-14
77333 CPT Treatment Device - Intermediate 4 4 $524.00 $524.00 $193.88 $193.88 $193.88 2024-06-14
77334 CPT Treatment Device - Complex 4 4 $1,549.00 $1,549.00 $573.13 $573.13 $573.13 2024-06-14
77336 CPT Continued Radiation Physics Consult 4 4 $865.00 $865.00 $320.05 $320.05 $320.05 2024-06-14
77338 CPT Imrt Mlc Devices 4 4 $2,229.00 $2,229.00 $824.73 $824.73 $824.73 2024-06-14
77385 CPT Imrt - Simplex 4 4 $2,028.00 $2,028.00 $750.36 $750.36 $750.36 2024-06-14
77386 CPT Imrt - Complex 4 4 $2,236.00 $2,236.00 $827.32 $827.32 $827.32 2024-06-14
77402 CPT Simple Radiation Treatment Delivery 4 4 $454.00 $454.00 $167.98 $167.98 $167.98 2024-06-14
77407 CPT Intermediate Treatment Delivery 4 4 $700.00 $700.00 $259.00 $259.00 $259.00 2024-06-14
77412 CPT Complex Treatment Delivery 4 4 $1,010.00 $1,010.00 $373.70 $373.70 $373.70 2024-06-14
78264 CPT Nm Gastric Emptying Study 4 4 $5,412.00 $5,412.00 $2,002.44 $2,002.44 $2,002.44 2024-06-14
78278 CPT Nm Gastrointestinal Blood Loss Imaging 4 4 $945.00 $945.00 $349.65 $349.65 $349.65 2024-06-14
78300 CPT Nm Bone Imaging Limited 4 4 $626.00 $626.00 $231.62 $231.62 $231.62 2024-06-14
78306 CPT Nm Bone Imaging Whole Body 4 4 $4,141.00 $4,141.00 $1,532.17 $1,532.17 $1,532.17 2024-06-14
78315 CPT Nm Bone Three Phase Study 4 4 $4,780.00 $4,780.00 $1,768.60 $1,768.60 $1,768.60 2024-06-14
78582 CPT Nm Lung Perfusion Differential Imaging 4 4 $2,352.00 $2,352.00 $870.24 $870.24 $870.24 2024-06-14
78708 CPT Nm Kidney Imaging Single With Pharm 4 4 $2,282.00 $2,282.00 $844.34 $844.34 $844.34 2024-06-14
80195 CPT Sirolimus Level 4 4 $668.00 $668.00 $247.16 $247.16 $247.16 2024-06-14
80299 CPT Voriconazole Level, Trough 4 4 $620.00 $620.00 $229.40 $229.40 $229.40 2024-06-14
81241 CPT Factor V Leiden 4 4 $1,035.00 $1,035.00 $382.95 $382.95 $382.95 2024-06-14
81256 CPT Hemochromatosis (hfe) 3 Mutations 4 4 $1,222.00 $1,222.00 $452.14 $452.14 $452.14 2024-06-14
81270 CPT Jak2 Gene, V617f Mutation, Qualitative 4 4 $1,014.00 $1,014.00 $375.18 $375.18 $375.18 2024-06-14
81374 CPT Hla B27 4 4 $493.00 $493.00 $182.41 $182.41 $182.41 2024-06-14
84244 CPT Renin Other 12 4 $473.00 $473.00 $44.40 $180.56 $175.01 2024-06-14
86360 CPT Lymphocyte Subset Panel 4 - T-cell Subsets 4 4 $581.00 $581.00 $214.97 $214.97 $214.97 2024-06-14
86905 CPT Ag Typing 4 4 $4,400.00 $4,400.00 $1,628.00 $1,628.00 $1,628.00 2024-06-14
87109 CPT Mycoplasma Pneumoniae Culture. 4 4 $1,328.00 $1,328.00 $491.36 $491.36 $491.36 2024-06-14
87116 CPT Acid Fast Bacilli Culture 4 4 $491.00 $491.00 $181.67 $181.67 $181.67 2024-06-14
87498 CPT Enterovirus, Real-time Pcr, Stool 4 4 $627.00 $627.00 $231.99 $231.99 $231.99 2024-06-14
87521 CPT Hcv Rnanaa Qualitative 4 4 $562.00 $562.00 $207.94 $207.94 $207.94 2024-06-14
87536 CPT Hiv1 RNA Quantitative 4 4 $860.00 $860.00 $318.20 $318.20 $318.20 2024-06-14
87631 CPT Middle East Respiratory Syndrome (mers), Blood 4 4 $638.00 $638.00 $236.06 $236.06 $236.06 2024-06-14
87633 CPT Respiratory Virus Panel, Pcr 4 4 $2,890.00 $2,890.00 $1,069.30 $1,069.30 $1,069.30 2024-06-14
87635 CPT Sars-cov-2 Urgent 4 4 $450.00 $450.00 $166.50 $166.50 $166.50 2024-06-14
87799 CPT Bk Virus, Quantitative By Pcr 8 4 $519.50 $519.50 $38.85 $345.58 $192.21 2024-06-14
87902 CPT Hepatitis C Genotype 4 4 $862.00 $862.00 $318.94 $318.94 $318.94 2024-06-14
90935 CPT Hemodialysis Charge 4 4 $1,171.00 $1,171.00 $433.27 $433.27 $433.27 2024-06-14
92523 CPT Slp Eval Lang Comprehension,Express Unit 4 4 $676.00 $676.00 $192.40 $192.40 $192.40 2024-06-14
92612 CPT Slp Fees Scope Eval Swallow Units 4 4 $762.00 $762.00 $216.82 $216.82 $216.82 2024-06-14
93226 CPT Cv Holter Monitor 4 4 $776.00 $776.00 $287.12 $287.12 $287.12 2024-06-14
93880 CPT US Carotid Duplex Bilateral 4 4 $944.00 $944.00 $349.28 $349.28 $349.28 2024-06-14
93882 CPT US Carotid Duplex Left 4 4 $529.00 $529.00 $195.73 $195.73 $195.73 2024-06-14
93923 CPT US Arterial Eval Le/ue-bil/comp 4 4 $631.00 $631.00 $233.47 $233.47 $233.47 2024-06-14
93925 CPT US Lower Ext Arterial Duplex Bil Graft 4 4 $1,507.00 $1,507.00 $557.59 $557.59 $557.59 2024-06-14
93926 CPT US Lower Ext Arterial Duplex Left 4 4 $798.00 $798.00 $295.26 $295.26 $295.26 2024-06-14
93930 CPT US Upper Ext Bypass Graft Duplex Bilateral 8 4 $908.50 $908.50 $333.00 $339.29 $336.14 2024-06-14
93931 CPT US Upper Ext Bypass Graft Duplex Left 8 4 $614.50 $614.50 $220.15 $234.58 $227.37 2024-06-14
93970 CPT US Lower Ext Venous Duplex Bilateral 8 4 $2,791.50 $2,791.50 $637.14 $1,428.57 $1,032.86 2024-06-14
93971 CPT US Lower Ext Venous Duplex Left 8 4 $1,912.50 $1,912.50 $555.00 $860.25 $707.62 2024-06-14
93975 CPT US Liver Vascular Flow 4 4 $2,075.00 $2,075.00 $767.75 $767.75 $767.75 2024-06-14
93976 CPT US Abdomen Doppler Limited 4 4 $635.00 $635.00 $234.95 $234.95 $234.95 2024-06-14
93978 CPT US Aorta Ivc Iliac Duplex Complete 4 4 $2,080.00 $2,080.00 $769.60 $769.60 $769.60 2024-06-14
93979 CPT US Aorta Ivc Iliac Duplex Limited 4 4 $776.00 $776.00 $287.12 $287.12 $287.12 2024-06-14
93990 CPT US Hemodialysis Access 4 4 $678.00 $678.00 $250.86 $250.86 $250.86 2024-06-14
94762 CPT Rt Charge Pulse Oximetry Overnight -> Yes 4 4 $454.00 $454.00 $167.98 $167.98 $167.98 2024-06-14
95824 CPT Electroencephalogram 4 4 $2,931.00 $2,931.00 $1,084.47 $1,084.47 $1,084.47 2024-06-14
95912 CPT Ncs 11-12 Studies 95912 - Motor +/Sens 4 4 $694.00 $694.00 $256.78 $256.78 $256.78 2024-06-14
96450 CPT Xr Lumbar Puncture Chemo Cns (sfmc) 4 4 $899.00 $899.00 $332.63 $332.63 $332.63 2024-06-14
A9552 HCPCS Pet/ct Tumor Image Limited W (sub) 4 4 $794.00 $794.00 $293.78 $293.78 $293.78 2024-06-14
J0475 HCPCS Amb Baclofen Mg 5 5 $459.00 $459.00 $169.83 $169.83 $169.83 2024-06-14
L3674 HCPCS Adb Position, Lt 10 10 $2,097.00 $2,097.00 $775.89 $775.89 $775.89 2026-07-30
L3730 HCPCS Elbow Orthotic (eo), Ortho EXT/Flex, Lt 18 10 $1,647.00 $1,647.00 $595.70 $609.39 $595.70 2026-07-30
L3740 HCPCS Elbow Orthotic (eo), Ortho Adj Lock, Lt 10 10 $1,953.00 $1,953.00 $722.61 $722.61 $722.61 2026-07-30
L3763 HCPCS Ewho Ridgid Without Joint, Lt 10 10 $1,245.00 $1,245.00 $460.65 $460.65 $460.65 2026-07-30
L3764 HCPCS Ewho 1 Or More Joints, Lt 10 10 $1,626.00 $1,626.00 $601.62 $601.62 $601.62 2026-07-30
L3765 HCPCS Ewhfo Rigid Without Joints, Lt 10 10 $2,274.00 $2,274.00 $841.38 $841.38 $841.38 2026-07-30
L3766 HCPCS Ewhfo With Joint, Lt 10 10 $2,409.00 $2,409.00 $891.33 $891.33 $891.33 2026-07-30
L3900 HCPCS Whfo Flexor Hinge, Lt 18 10 $2,586.00 $2,586.00 $460.65 $956.82 $460.65 2026-07-30
L3905 HCPCS Who Nontorsion Joint, Lt 10 10 $1,759.00 $1,759.00 $650.83 $650.83 $650.83 2026-07-30
L3961 HCPCS Sewho Ap Design W/i Jt, Lt 10 10 $2,980.00 $2,980.00 $1,102.60 $1,102.60 $1,102.60 2026-07-30
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