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

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Hospital

LBJ TROPICAL MEDICAL CENTER

Pago Pago, AS · CCN 640001 · Rates published

139 distinct procedures filed
1 distinct payers
27,480 rate rows
2026-05-14 last MRF observed
Data quality

27,456 of 27,480 rate rows are consumer-grade (99.9%)

24 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
placeholder amount (≤ $0.02) — excluded from medians 18
percent-of-charges filed in the dollar field — excluded from medians 6
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file http://rca.elevatepfs.com/ptapp/api/cdm/export/oneclick?recno=8bd0a45af1f0f9b2a7d56f47dc7f9363623b9324d22929343acea9cf6fac83b9
Found on page https://lbjtmc.org/cms-hpt.txt
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-19
Content fingerprint 59b4c46ebe2c6d0c… · 7,838,164 bytes · first seen 2026-05-14

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
200
OTHER 		Covid ICU Room-board/isolation 1 $2,900.00 $4,000.00 $3,450.00 nat. median
$10,206
outlier · 0.3×
190
OTHER 		Covid Room-board/isolation 1 $3,000.00 $3,000.00 $3,000.00 nat. median
$10,982
outlier · 0.3×
360
OTHER 		Artery Bypass Graft 1 $23.94 $61,612.80 $2,592.22 nat. median
$7,392
outlier · 0.4×
160
OTHER 		Room-board/isolation 1 $1,600.00 $1,600.00 $1,600.00 nat. median
$4,091
outlier · 0.4×
110
OTHER 		Room-board/private 1 $1,440.00 $1,600.00 $1,520.00 nat. median
$1,680
0.9× median
209
OTHER 		Intensive Care 1 $1,500.00 $1,500.00 $1,500.00 nat. median
$23,389
outlier · 0.1×
860
OTHER 		Meg Recording And Analysis; For Evoked Magnetic Fields, Sngl Mod 1 $385.94 $2,600.90 $1,493.42 nat. median
$4
outlier · 376.2×
404
OTHER 		Brain Imaging (pet) 1 $154.66 $2,571.44 $1,363.05 nat. median
$3,927
outlier · 0.3×
120
OTHER 		Room-board/semi 1 $1,200.00 $1,440.00 $1,320.00 nat. median
$1,852
0.7× median
721
OTHER 		Antepartum Care Only 1 $1,305.32 $1,305.32 $1,305.32 nat. median
$24
outlier · 54.0×
121
OTHER 		Inpatient R&b 1 $990.00 $1,440.00 $1,215.00 nat. median
$10,782
outlier · 0.1×
206
OTHER 		Intensive Care 1 $1,200.00 $1,200.00 $1,200.00 nat. median
$9,116
outlier · 0.1×
130
OTHER 		Room-board/3&4 Bed 1 $1,070.00 $1,070.00 $1,070.00 nat. median
$1,931
0.6× median
170
OTHER 		Nursery - Newborn - Lvl 1 1 $600.00 $1,440.00 $1,020.00 nat. median
$1,398
0.7× median
150
OTHER 		Surg Ward Inpatient 1 $990.00 $990.00 $990.00 nat. median
$12,874
outlier · 0.1×
761
OTHER 		Abdom Paracentesisi Dx/ther Without Imaging Guidance 1 $80.92 $4,470.80 $975.74 nat. median
$1,231
0.8× median
901
OTHER 		Electroconvulsive Therapy 1 $892.24 $892.24 $892.24 nat. median
$29,541
outlier · 0.0×
450
OTHER 		Closure Of Split Wound 1 $12.44 $8,475.90 $859.90 nat. median
$1,147
0.7× median
612
OTHER 		Mr Angio Pelvis W/o&w Dye 1 $572.60 $965.78 $853.76 nat. median
$2,164
outlier · 0.4×
611
OTHER 		Magnetic Image, Jaw Joint 1 $572.60 $965.78 $853.76 nat. median
$1,777
outlier · 0.5×
202
OTHER 		ICU Medical 1 $100.00 $1,900.00 $845.00 nat. median
$9,777
outlier · 0.1×
610
OTHER 		Mr Ang Lwr Ext W Or Without Contrast 1 $572.60 $965.78 $809.82 nat. median
$2,142
outlier · 0.4×
174
OTHER 		Nursery - Newborn - Lvl 4 1 $800.00 $800.00 $800.00 nat. median
$4,092
outlier · 0.2×
111
OTHER 		Med/pvt 1 $30.00 $1,440.00 $735.00 nat. median
$4,074
outlier · 0.2×
720
OTHER 		Cesarean Delivery Only 1 $183.16 $3,690.94 $713.13 nat. median
$2,844
outlier · 0.3×
173
OTHER 		Nursery - Newborn - Lvl 3 1 $680.00 $680.00 $680.00 nat. median
$25,789
outlier · 0.0×
341
OTHER 		Abscess Imaging, Ltd Area 1 $30.78 $2,571.44 $669.08 nat. median
$1,279
0.5× median
123
OTHER 		Gy/2bed 1 $305.00 $990.00 $647.50 nat. median
$6,551
outlier · 0.1×
960
OTHER 		Repair Blood Vessel Lesion 1 $1.13 $6,840.79 $631.82 nat. median
$542
1.2× median
825
OTHER 		Esrd Srv,1 Visit,2-11 Yrs 1 $15.76 $1,897.46 $596.44 nat. median
$10,241
outlier · 0.1×
481
OTHER 		Cardiac Output Measurement 1 $32.48 $29,681.20 $581.42 nat. median
$11,210
outlier · 0.1×
342
OTHER 		Interstitial Nuclear Therapy 1 $553.64 $553.64 $553.64 nat. median
$1,130
outlier · 0.5×
351
OTHER 		CT Angiography, Head 1 $100.00 $800.00 $551.43 nat. median
$11,639
outlier · 0.0×
352
OTHER 		Abdomen 2 Views 1 $126.64 $1,284.00 $551.43 nat. median
$6,313
outlier · 0.1×
172
OTHER 		Nursery - Newborn - Lvl 2 1 $525.00 $525.00 $525.00 nat. median
$2,832
outlier · 0.2×
831
OTHER 		Dialysis, One Evaluation 1 $250.60 $773.58 $512.09 nat. median
$12,362
outlier · 0.0×
991
OTHER 		Cafeteria Charges 1 $10.00 $1,000.00 $505.00 nat. median
$19
outlier · 26.2×
929
OTHER 		Duplex Scan Lower Ext Lt Artery Unilateral 1 $388.02 $639.81 $481.92 nat. median
$1,920
outlier · 0.3×
359
OTHER 		CT Soft Tissue Neck With Contrast 1 $481.66 $481.66 $481.66 nat. median
$2,225
outlier · 0.2×
124
OTHER 		Psych Ward R & B All Incl. 1 $475.00 $475.00 $475.00 nat. median
$12,277
outlier · 0.0×
821
OTHER 		Intro Cath Dialysis Circuit 1 $101.68 $9,074.90 $435.71 nat. median
$17,778
outlier · 0.0×
750
OTHER 		Acid Perfusion Of Esophagus 1 $282.24 $657.22 $427.40 nat. median
$2,494
outlier · 0.2×
413
OTHER 		Hyperbaric Oxygen Therapy 1 $416.34 $416.34 $416.34 nat. median
$15,267
outlier · 0.0×
921
OTHER 		Extremity Study 1 $225.34 $871.26 $413.80 nat. median
$1,000
outlier · 0.4×
333
OTHER 		Radiation Therapy Planning 1 $35.14 $14,922.80 $386.34 nat. median
$4,903
outlier · 0.1×
483
OTHER 		Echo Transesophageal 1 $80.48 $1,473.60 $379.10 nat. median
$15,534
outlier · 0.0×
322
OTHER 		Arthrogram Rt Hip 1 $354.15 $354.15 $354.15 nat. median
$15,755
outlier · 0.0×
480
OTHER 		Electrophysiology Evaluation 1 $16.46 $20,000.00 $345.84 nat. median
$2,811
outlier · 0.1×
987
OTHER 		Hosp D/c Management <= 30 Min 1 $93.02 $2,109.45 $342.62 nat. median
$28,388
outlier · 0.0×
350
OTHER 		Cat Scan Follow-up Study 1 $118.68 $481.66 $330.31 nat. median
$1,785
outlier · 0.2×

Other procedures at this hospital

Browse this hospital's 139 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
             
960 OTHER Repair Blood Vessel Lesion 16,740 1 $631.82 $631.82 $1.13 $6,840.79 $631.82 2026-05-14
360 OTHER Artery Bypass Graft 5,025 1 $2,592.22 $2,592.22 $23.94 $61,612.80 $2,592.22 2026-05-14
270 OTHER Bandage Muslin Triangular 585 1 $66.00 $66.00 $0.35 $2,339.50 $66.00 2026-05-14
301 OTHER Assay Of Progesterone 543 1 $47.33 $47.33 $3.93 $510.59 $47.33 2026-05-14
510 OTHER Preventive Counseling, Indiv 477 1 $147.12 $147.12 $2.14 $4,470.80 $147.12 2026-05-14
300 OTHER Growth Hormone Panel 426 1 $115.77 $115.77 $5.48 $1,577.48 $115.77 2026-05-14
450 OTHER Closure Of Split Wound 333 1 $859.90 $859.90 $12.44 $8,475.90 $859.90 2026-05-14
320 OTHER Chest X-ray 288 1 $205.37 $205.37 $15.00 $10,645.04 $205.37 2026-05-14
302 OTHER Cytotoxic Antibody Screening 159 1 $60.88 $60.88 $10.32 $331.34 $60.88 2026-05-14
305 OTHER Acth Stimulation Panel 141 1 $23.95 $23.95 $6.46 $510.59 $23.95 2026-05-14
471 OTHER Endoscopy Swallow Tst (fees) 120 1 $141.67 $141.67 $8.32 $986.51 $141.67 2026-05-14
273 OTHER 0.9% Normal Saline Irrigation H20 120 1 $52.30 $52.30 $1.17 $418.89 $52.30 2026-05-14
306 OTHER Dark Field Examination 120 1 $45.71 $45.71 $11.62 $510.59 $45.71 2026-05-14
480 OTHER Electrophysiology Evaluation 102 1 $345.84 $345.84 $16.46 $20,000.00 $345.84 2026-05-14
402 OTHER Detail Anatomic Evaluation For More Than One Fetus 102 1 $143.40 $143.40 $30.00 $845.16 $143.40 2026-05-14
420 OTHER Electrical Stimulation 93 1 $64.83 $64.83 $12.18 $245.49 $64.83 2026-05-14
636 OTHER Adenovirus Vaccine, Type 4 90 1 $141.61 $141.61 $12.04 $495.14 $141.61 2026-05-14
341 OTHER Abscess Imaging, Ltd Area 84 1 $669.08 $669.08 $30.78 $2,571.44 $669.08 2026-05-14
512 OTHER Complete Dentures (full Set) Res 84 1 $162.62 $162.62 $18.00 $1,829.10 $162.62 2026-05-14
969 OTHER Home Visit, Est Patient 60 1 $163.97 $163.97 $9.20 $442.50 $163.97 2026-05-14
481 OTHER Cardiac Output Measurement 57 1 $581.42 $581.42 $32.48 $29,681.20 $581.42 2026-05-14
333 OTHER Radiation Therapy Planning 57 1 $386.34 $386.34 $35.14 $14,922.80 $386.34 2026-05-14
920 OTHER Analyze Neurostim, Complex 57 1 $261.86 $261.86 $6.44 $3,804.96 $261.86 2026-05-14
352 OTHER Abdomen 2 Views 54 1 $551.43 $551.43 $126.64 $1,284.00 $551.43 2026-05-14
740 OTHER Electroencephalogram (eeg) 54 1 $320.12 $320.12 $103.50 $1,707.92 $320.12 2026-05-14
310 OTHER Lab Pathology Consultation 51 1 $108.52 $108.52 $28.63 $1,654.38 $108.52 2026-05-14
987 OTHER Hosp D/c Management <= 30 Min 48 1 $342.62 $342.62 $93.02 $2,109.45 $342.62 2026-05-14
657 OTHER Inpatient Consultation 42 1 $267.08 $267.08 $89.50 $2,441.82 $267.08 2026-05-14
430 OTHER Aquatic Therapy/exercises 42 1 $80.37 $80.37 $5.38 $317.58 $80.37 2026-05-14
924 OTHER Allergy Skin Tests 42 1 $27.53 $27.53 $8.73 $172.65 $27.53 2026-05-14
825 OTHER Esrd Srv,1 Visit,2-11 Yrs 39 1 $596.44 $596.44 $15.76 $1,897.46 $596.44 2026-05-14
821 OTHER Intro Cath Dialysis Circuit 39 1 $435.71 $435.71 $101.68 $9,074.90 $435.71 2026-05-14
307 OTHER Pregnancy Test; Ur 36 1 $16.63 $16.63 $3.48 $510.59 $16.63 2026-05-14
250 OTHER Butalbital-acet-caff 50-325-40mg Tab 100 36 1 $15.00 $15.00 $0.34 $126.00 $15.00 2026-05-14
440 OTHER Speech/hearing Therapy 33 1 $158.96 $158.96 $47.26 $1,295.68 $158.96 2026-05-14
351 OTHER CT Angiography, Head 30 1 $551.43 $551.43 $100.00 $800.00 $551.43 2026-05-14
761 OTHER Abdom Paracentesisi Dx/ther Without Imaging Guidance 27 1 $975.74 $975.74 $80.92 $4,470.80 $975.74 2026-05-14
483 OTHER Echo Transesophageal 27 1 $379.10 $379.10 $80.48 $1,473.60 $379.10 2026-05-14
460 OTHER Breath Recording, Infant 27 1 $104.70 $104.70 $27.30 $2,532.72 $104.70 2026-05-14
942 OTHER Behav Chng Smoking > 10 Min 27 1 $55.14 $55.14 $26.75 $176.99 $55.14 2026-05-14
720 OTHER Cesarean Delivery Only 24 1 $713.13 $713.13 $183.16 $3,690.94 $713.13 2026-05-14
921 OTHER Extremity Study 24 1 $413.80 $413.80 $225.34 $871.26 $413.80 2026-05-14
330 OTHER Chemo, Infuse Method Add-on 24 1 $254.28 $254.28 $65.14 $570.00 $254.28 2026-05-14
4450 OTHER Autopsy Mortician (each) 24 1 $250.00 $250.00 $10.00 $1,039.00 $250.00 2026-05-14
311 OTHER Cell Cryopreserve/storage 24 1 $249.06 $249.06 $28.76 $989.90 $249.06 2026-05-14
329 OTHER Bone Survey Infant 24 1 $135.69 $135.69 $105.03 $359.91 $135.69 2026-05-14
730 OTHER ECG Routine W/least 12 Lds Trcg Only Without Ir 24 1 $70.94 $70.94 $15.00 $647.84 $70.94 2026-05-14
309 OTHER Abo Blood Group 24 1 $54.53 $54.53 $12.30 $255.29 $54.53 2026-05-14
610 OTHER Mr Ang Lwr Ext W Or Without Contrast 21 1 $809.82 $809.82 $572.60 $965.78 $809.82 2026-05-14
401 OTHER Diagnostic Mammo, Including (cad) Bilateral 21 1 $173.61 $173.61 $50.00 $232.00 $173.61 2026-05-14
961 OTHER Hypnotherapy 21 1 $108.95 $108.95 $37.74 $230.94 $108.95 2026-05-14
900 OTHER Behavior Health Inter, Ea 15 Min, Face-face; Fam (w/out The Pt 21 1 $100.24 $100.24 $20.00 $230.94 $100.24 2026-05-14
260 OTHER Hydration Adtnl Hrs Ea 21 1 $87.47 $87.47 $61.74 $216.40 $87.47 2026-05-14
771 OTHER Adm Sarscov2 30mc G/0.3ml 1st 21 1 $50.84 $50.84 $20.64 $150.00 $50.84 2026-05-14
111 OTHER Med/pvt 18 1 $735.00 $735.00 $30.00 $1,440.00 $735.00 2026-05-14
272 OTHER Needle 18 1 $179.35 $179.35 $106.00 $212.70 $179.35 2026-05-14
230 OTHER Rest Home Visit, Est Pat <= 15 Min 18 1 $175.78 $175.78 $110.98 $279.96 $175.78 2026-05-14
294 OTHER 0.9% Sod/ch.irrig 1000ml Btl 18 1 $6.71 $6.71 $2.40 $46.65 $6.71 2026-05-14
612 OTHER Mr Angio Pelvis W/o&w Dye 15 1 $853.76 $853.76 $572.60 $965.78 $853.76 2026-05-14
350 OTHER Cat Scan Follow-up Study 15 1 $330.31 $330.31 $118.68 $481.66 $330.31 2026-05-14
410 OTHER Aerosol Inhala Pentamidine Pc Pneumon 15 1 $329.12 $329.12 $35.97 $748.10 $329.12 2026-05-14
444 OTHER Behavioral And Qualitative Analysis Of Voice And Resonance 15 1 $306.57 $306.57 $181.16 $615.48 $306.57 2026-05-14
361 OTHER Dissolve Clot, Heart Vessel; ER 15 1 $263.38 $263.38 $90.54 $390.24 $263.38 2026-05-14
780 OTHER Mental-physician Telephone Eval 11 To 20 Min 15 1 $257.00 $257.00 $104.70 $385.00 $257.00 2026-05-14
922 OTHER Autonomic Nerv Function Test 15 1 $189.86 $189.86 $81.52 $545.20 $189.86 2026-05-14
570 OTHER Prolonged Service, Inpatient 15 1 $184.74 $184.74 $179.72 $261.34 $184.74 2026-05-14
940 OTHER Chiropractic Manipulation 15 1 $157.58 $157.58 $39.64 $340.80 $157.58 2026-05-14
731 OTHER Auto Activated ECG Rhythm Derived Event Recording 15 1 $156.88 $156.88 $53.70 $256.36 $156.88 2026-05-14
540 OTHER Ems Per Mile Facility Fee 15 1 $30.00 $30.00 $3.00 $70.00 $30.00 2026-05-14
370 OTHER Anes Dx Shoulder Arthroscopy 15 1 $22.11 $22.11 $2.30 $75.00 $22.11 2026-05-14
202 OTHER ICU Medical 12 1 $845.00 $845.00 $100.00 $1,900.00 $845.00 2026-05-14
762 OTHER Observation Care 12 1 $238.44 $238.44 $146.06 $374.48 $238.44 2026-05-14
490 OTHER Ablation, 1 Or More Liver Tumor(s), Percutaneous, Radiofrequency 12 1 $225.55 $225.55 $22.84 $8,188.58 $225.55 2026-05-14
914 OTHER Psychophysiological Therapy 12 1 $187.90 $187.90 $123.88 $230.94 $187.90 2026-05-14
482 OTHER Cardiovascular Stress Test 12 1 $100.02 $100.02 $29.36 $475.90 $100.02 2026-05-14
290 OTHER Advantage Meter 12 1 $80.62 $80.62 $49.35 $243.51 $80.62 2026-05-14
424 OTHER Body Muscle Testing, Manual 12 1 $44.13 $44.13 $32.94 $63.72 $44.13 2026-05-14
611 OTHER Magnetic Image, Jaw Joint 9 1 $853.76 $853.76 $572.60 $965.78 $853.76 2026-05-14
929 OTHER Duplex Scan Lower Ext Lt Artery Unilateral 9 1 $481.92 $481.92 $388.02 $639.81 $481.92 2026-05-14
750 OTHER Acid Perfusion Of Esophagus 9 1 $427.40 $427.40 $282.24 $657.22 $427.40 2026-05-14
312 OTHER Analysis Nerve 9 1 $255.29 $255.29 $172.87 $320.02 $255.29 2026-05-14
314 OTHER Biopsy Of Breast, Open 9 1 $237.26 $237.26 $228.98 $531.75 $237.26 2026-05-14
820 OTHER Dialysis Training, Complete 9 1 $190.46 $190.46 $20.00 $209.80 $190.46 2026-05-14
403 OTHER Mammogram - Unilat Screening 9 1 $180.44 $180.44 $165.40 $269.94 $180.44 2026-05-14
200 OTHER Covid ICU Room-board/isolation 6 1 $3,450.00 $3,450.00 $2,900.00 $4,000.00 $3,450.00 2026-05-14
110 OTHER Room-board/private 6 1 $1,520.00 $1,520.00 $1,440.00 $1,600.00 $1,520.00 2026-05-14
860 OTHER Meg Recording And Analysis; For Evoked Magnetic Fields, Sngl Mod 6 1 $1,493.42 $1,493.42 $385.94 $2,600.90 $1,493.42 2026-05-14
404 OTHER Brain Imaging (pet) 6 1 $1,363.05 $1,363.05 $154.66 $2,571.44 $1,363.05 2026-05-14
120 OTHER Room-board/semi 6 1 $1,320.00 $1,320.00 $1,200.00 $1,440.00 $1,320.00 2026-05-14
121 OTHER Inpatient R&b 6 1 $1,215.00 $1,215.00 $990.00 $1,440.00 $1,215.00 2026-05-14
170 OTHER Nursery - Newborn - Lvl 1 6 1 $1,020.00 $1,020.00 $600.00 $1,440.00 $1,020.00 2026-05-14
123 OTHER Gy/2bed 6 1 $647.50 $647.50 $305.00 $990.00 $647.50 2026-05-14
831 OTHER Dialysis, One Evaluation 6 1 $512.09 $512.09 $250.60 $773.58 $512.09 2026-05-14
991 OTHER Cafeteria Charges 6 1 $505.00 $505.00 $10.00 $1,000.00 $505.00 2026-05-14
4460 OTHER Embalming Adult 6 1 $225.00 $225.00 $150.00 $300.00 $225.00 2026-05-14
916 OTHER Family Psytx Without Patient 6 1 $189.98 $189.98 $132.06 $247.90 $189.98 2026-05-14
112 OTHER Normal Vag Delivery, Non Res, Facility Fee 6 1 $175.00 $175.00 $50.00 $300.00 $175.00 2026-05-14
470 OTHER Auditory Function + 15 Min 6 1 $139.00 $139.00 $42.19 $235.80 $139.00 2026-05-14
985 OTHER Ecg/review Interpret Only 6 1 $93.64 $93.64 $54.54 $132.74 $93.64 2026-05-14
972 OTHER CT - 3d Reconstr 6 1 $46.45 $46.45 $25.00 $67.91 $46.45 2026-05-14
999 OTHER Lbj Pbs Processing Fee 6 1 $29.00 $29.00 $28.00 $30.00 $29.00 2026-05-14
7200 OTHER Immigration Clearance Non Res 6 1 $7.50 $7.50 $5.00 $10.00 $7.50 2026-05-14
190 OTHER Covid Room-board/isolation 3 1 $3,000.00 $3,000.00 $3,000.00 $3,000.00 $3,000.00 2026-05-14
160 OTHER Room-board/isolation 3 1 $1,600.00 $1,600.00 $1,600.00 $1,600.00 $1,600.00 2026-05-14
209 OTHER Intensive Care 3 1 $1,500.00 $1,500.00 $1,500.00 $1,500.00 $1,500.00 2026-05-14
721 OTHER Antepartum Care Only 3 1 $1,305.32 $1,305.32 $1,305.32 $1,305.32 $1,305.32 2026-05-14
206 OTHER Intensive Care 3 1 $1,200.00 $1,200.00 $1,200.00 $1,200.00 $1,200.00 2026-05-14
130 OTHER Room-board/3&4 Bed 3 1 $1,070.00 $1,070.00 $1,070.00 $1,070.00 $1,070.00 2026-05-14
150 OTHER Surg Ward Inpatient 3 1 $990.00 $990.00 $990.00 $990.00 $990.00 2026-05-14
901 OTHER Electroconvulsive Therapy 3 1 $892.24 $892.24 $892.24 $892.24 $892.24 2026-05-14
174 OTHER Nursery - Newborn - Lvl 4 3 1 $800.00 $800.00 $800.00 $800.00 $800.00 2026-05-14
173 OTHER Nursery - Newborn - Lvl 3 3 1 $680.00 $680.00 $680.00 $680.00 $680.00 2026-05-14
342 OTHER Interstitial Nuclear Therapy 3 1 $553.64 $553.64 $553.64 $553.64 $553.64 2026-05-14
172 OTHER Nursery - Newborn - Lvl 2 3 1 $525.00 $525.00 $525.00 $525.00 $525.00 2026-05-14
359 OTHER CT Soft Tissue Neck With Contrast 3 1 $481.66 $481.66 $481.66 $481.66 $481.66 2026-05-14
124 OTHER Psych Ward R & B All Incl. 3 1 $475.00 $475.00 $475.00 $475.00 $475.00 2026-05-14
413 OTHER Hyperbaric Oxygen Therapy 3 1 $416.34 $416.34 $416.34 $416.34 $416.34 2026-05-14
322 OTHER Arthrogram Rt Hip 3 1 $354.15 $354.15 $354.15 $354.15 $354.15 2026-05-14
319 OTHER Electron Microscopy 3 1 $255.29 $255.29 $255.29 $255.29 $255.29 2026-05-14
983 OTHER Prep Of Report 3 1 $250.00 $250.00 $250.00 $250.00 $250.00 2026-05-14
917 OTHER Biofeedback Peri/uro/rectal 3 1 $226.38 $226.38 $226.38 $226.38 $226.38 2026-05-14
943 OTHER Cardiac Rehab 3 1 $206.52 $206.52 $206.52 $206.52 $206.52 2026-05-14
770 OTHER Prev Visit, Est, Age 18-39 3 1 $181.16 $181.16 $181.16 $181.16 $181.16 2026-05-14
434 OTHER Eval For Rx Of Non-speech-generating Augment And Alter Comm Devi 3 1 $181.16 $181.16 $181.16 $181.16 $181.16 2026-05-14
469 OTHER Measure Blood Oxygen Level 3 1 $164.42 $164.42 $164.42 $164.42 $164.42 2026-05-14
915 OTHER Group Psychotherapy 3 1 $132.06 $132.06 $132.06 $132.06 $132.06 2026-05-14
324 OTHER Chest X-ray, Single View 3 1 $103.50 $103.50 $103.50 $103.50 $103.50 2026-05-14
292 OTHER Walker 3 1 $78.21 $78.21 $78.21 $78.21 $78.21 2026-05-14
962 OTHER Office Consult Strt Forward 3 1 $68.02 $68.02 $68.02 $68.02 $68.02 2026-05-14
530 OTHER Osteopathic Manipulation 3 1 $39.64 $39.64 $39.64 $39.64 $39.64 2026-05-14
340 OTHER Breath Tst Attain/anal C-14 3 1 $21.40 $21.40 $21.40 $21.40 $21.40 2026-05-14
589 OTHER Home Visit Assist With Activities Of Daily Living And Personal Care 3 1 $20.00 $20.00 $20.00 $20.00 $20.00 2026-05-14
274 OTHER Device Handling 3 1 $20.00 $20.00 $20.00 $20.00 $20.00 2026-05-14
279 OTHER Patient Education Materials 3 1 $20.00 $20.00 $20.00 $20.00 $20.00 2026-05-14
981 OTHER Direct Advanced Life Support 3 1 $20.00 $20.00 $20.00 $20.00 $20.00 2026-05-14
489 OTHER Assembly&operj Pump Oxygenator/heat Exch Ea Hr 3 1 $20.00 $20.00 $20.00 $20.00 $20.00 2026-05-14
918 OTHER Developmental Test, Lim 3 1 $18.42 $18.42 $18.42 $18.42 $18.42 2026-05-14
4820 OTHER Med Supply/equip Res 3 1 $5.00 $5.00 $5.00 $5.00 $5.00 2026-05-14
990 OTHER Med Rec Misc 3 1 $5.00 $5.00 $5.00 $5.00 $5.00 2026-05-14
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