Price Transparency 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

MID COAST MEDICAL CENTER-TRINITY

Trinity, TX · CCN 670331 · Rates published

2,638 distinct procedures filed
1 distinct payers
7,542 rate rows
2025-03-01 last MRF observed · ⚠ 15 mo old
Data quality

7,540 of 7,542 rate rows are consumer-grade (100.0%)

2 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 2

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 15 months old.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://app.box.com/shared/static/i4fov2292agvi1btraj9co4h4uodvlig.csv
Found on page https://midcoasthealthsystem.org/cms-hpt.txt
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-05-19
Content fingerprint 125cd8942b51fde8… · 460,090 bytes · first seen 2026-05-15

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
3500446
LOCAL 		Idarucizumab 2.5gm/50ml Vial (praxbind) 1 $17,640.00 $17,640.00 $17,640.00 nat. median
$17,640
1.0× median
J3101
CPT 		Tenecteplase 50mg Vial 1 $13,552.25 $13,552.25 $13,552.25 nat. median
$5,949
outlier · 2.3×
J2997
CPT 		Alteplase 100mg/100 Ml Inj (activase) 1 $371.00 $21,531.00 $10,951.00 nat. median
$545
outlier · 20.1×
J2760
CPT 		Phentolamine 5mg/2ml Vial (regitine) 1 $10,710.00 $10,710.00 $10,710.00 nat. median
$741
outlier · 14.4×
33210
CPT 		Insertion Transvenous Pac 1 $644.00 $19,093.00 $9,868.50 nat. median
$8,289
1.2× median
J1162
CPT 		Digoxin Immune Fab 40mg Vial (digifab) 1 $8,520.25 $8,520.25 $8,520.25 nat. median
$7,316
1.2× median
59812
CPT 		Treatment Incomplete Abortion 1 $7,700.00 $7,700.00 $7,700.00 nat. median
$3,255
outlier · 2.4×
3507401
LOCAL 		Orbactiv 1200mg (nf) 1 $7,527.26 $7,527.26 $7,527.26 nat. median
$7,527
1.0× median
21337
CPT 		Closed Tx Nasal Fx 1 $7,150.00 $7,150.00 $7,150.00 nat. median
$3,215
outlier · 2.2×
J0840
CPT 		Crofab 1 $6,590.25 $6,590.25 $6,590.25 nat. median
$3,427
1.9× median
J0630
CPT 		Calcitonin 400unit/2ml Inj (miacalcin) 1 $5,754.50 $5,754.50 $5,754.50 nat. median
$1,885
outlier · 3.1×
3507016
LOCAL 		Golimumab 50mg/4ml 1 $4,807.19 $4,807.19 $4,807.19 nat. median
$4,807
1.0× median
3507731
LOCAL 		Actemra 400mg/20ml Vial 1 $4,756.48 $4,756.48 $4,756.48 nat. median
$4,756
1.0× median
75710
CPT 		Xr Angiography Extremity Unilateral 1 $4,730.00 $4,730.00 $4,730.00 nat. median
$3,153
1.5× median
27266
CPT 		Closed Trmt Post Hip Dislocation 1 $4,452.00 $4,452.00 $4,452.00 nat. median
$2,081
outlier · 2.1×
Q0247
CPT 		Sotrovimab 500mg/8ml 1 $4,410.00 $4,410.00 $4,410.00 nat. median
$2,470
1.8× median
59409
CPT 		Pf-vaginal Delivery Only 1 $2,717.00 $6,089.00 $4,403.00 nat. median
$3,185
1.4× median
69005
CPT 		Drainage Ext Ear, Complicated 1 $4,311.00 $4,311.00 $4,311.00 nat. median
$1,776
outlier · 2.4×
78451
CPT 		Nm Myocard Perf Image-single 1 $4,059.00 $4,059.00 $4,059.00 nat. median
$1,533
outlier · 2.6×
95811
CPT 		Sleep Study (cpap) 1 $3,990.00 $3,990.00 $3,990.00 nat. median
$2,026
2.0× median
G0399
CPT 		Sleep Study At Home 1 $3,805.00 $3,805.00 $3,805.00 nat. median
$357
outlier · 10.7×
95810
CPT 		Sleep Study 1 $3,805.00 $3,805.00 $3,805.00 nat. median
$1,870
outlier · 2.0×
95800
CPT 		Sleep Study Unattended 1 $3,805.00 $3,805.00 $3,805.00 nat. median
$361
outlier · 10.5×
J1569
CPT 		Crofab 1 $945.00 $6,590.25 $3,767.62 nat. median
$1,048
outlier · 3.6×
J0897
CPT 		Denosumab 60mg/1ml Inj (prolia) 1 $3,722.44 $3,722.44 $3,722.44 nat. median
$2,506
1.5× median
49407
CPT 		Peritoneal Procedures 1 $3,472.00 $3,472.00 $3,472.00 nat. median
$2,000
1.7× median
42300
CPT 		Drainage Salivary Gland 1 $3,425.00 $3,425.00 $3,425.00 nat. median
$1,680
outlier · 2.0×
78806
CPT 		Nm Indium 111 White Bld Cell 1 $3,389.00 $3,389.00 $3,389.00 nat. median
$1,133
outlier · 3.0×
78452
CPT 		Nm Cardiac Muga Scan 1 $1,155.00 $5,198.00 $3,176.50 nat. median
$1,765
1.8× median
J7325
CPT 		Synvisc-one 48mg/6ml Inj 1 $3,134.75 $3,134.75 $3,134.75 nat. median
$225
outlier · 13.9×
38300
CPT 		Drainage Lymph Node Lesio 1 $3,108.00 $3,108.00 $3,108.00 nat. median
$2,845
1.1× median
G0390
CPT 		Trauma Response Level 1 $3,000.00 $3,000.00 $3,000.00 nat. median
$3,172
0.9× median
26011
CPT 		Drainage Finger Abscess Complicated 1 $2,970.00 $2,970.00 $2,970.00 nat. median
$1,701
1.7× median
13132
CPT 		Pf-repair Complex Chin 2. 1 $1,462.00 $4,385.00 $2,923.50 nat. median
$877
outlier · 3.3×
23931
CPT 		I&d Upper Arm & Elbow Bu 1 $1,455.00 $4,366.00 $2,910.50 nat. median
$1,809
1.6× median
93312
CPT 		US Tee 1 $2,750.00 $2,750.00 $2,750.00 nat. median
$966
outlier · 2.8×
15240
CPT 		Full Thickness Graft 20 1 $1,211.00 $4,106.00 $2,658.50 nat. median
$2,239
1.2× median
28208
CPT 		Pf-repair Extensor Tendon 1 $223.00 $5,086.00 $2,654.50 nat. median
$3,359
0.8× median
P9052
CPT 		Bb Platelets 1 $2,580.00 $2,580.00 $2,580.00 nat. median
$1,109
outlier · 2.3×
14301
CPT 		Pf-adjacent Tissue Transf 1 $2,548.00 $2,548.00 $2,548.00 nat. median
$3,859
0.7× median
J0129
CPT 		Abatacept 250mg Vial (orencia) 1 $2,487.50 $2,487.50 $2,487.50 nat. median
$1,082
outlier · 2.3×
36556
CPT 		Central Line Insertion 5 1 $426.00 $3,322.00 $2,461.00 nat. median
$2,458
1.0× median
43999
CPT 		Unlisted Procedure Stomac 1 $2,460.00 $2,460.00 $2,460.00 nat. median
$1,544
1.6× median
25660
CPT 		Clsd Treat Carpal Disloca 1 $1,227.00 $3,676.00 $2,451.50 nat. median
$481
outlier · 5.1×
27792
CPT 		Fx Care Distal Fibula W/w 1 $806.00 $4,023.00 $2,414.50 nat. median
$6,842
outlier · 0.4×
11400
CPT 		Exc Lesion 0.5 Or Less 1 $2,401.00 $2,401.00 $2,401.00 nat. median
$713
outlier · 3.4×
26418
CPT 		Pf-repair Extensor Tendon 1 $273.00 $4,400.00 $2,336.50 nat. median
$2,051
1.1× median
46999
CPT 		Unlisted Proc Anus 1 $2,310.00 $2,310.00 $2,310.00 nat. median
$1,253
1.8× median
36569
CPT 		Insertion Picc Cath 1 $2,257.00 $2,257.00 $2,257.00 nat. median
$1,703
1.3× median
70015
CPT 		Cisternography S&i 1 $2,247.00 $2,247.00 $2,247.00 nat. median
$786
outlier · 2.9×

Other procedures at this hospital

Browse this hospital's 2,638 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
             
3500446 LOCAL Idarucizumab 2.5gm/50ml Vial (praxbind) 2 1 $17,640.00 $17,640.00 $17,640.00 $17,640.00 $17,640.00 2025-03-01
J3101 CPT Tenecteplase 50mg Vial 2 1 $13,552.25 $13,552.25 $13,552.25 $13,552.25 $13,552.25 2025-03-01
J2997 CPT Alteplase 100mg/100 Ml Inj (activase) 4 1 $10,951.00 $10,951.00 $371.00 $21,531.00 $10,951.00 2025-03-01
J2760 CPT Phentolamine 5mg/2ml Vial (regitine) 2 1 $10,710.00 $10,710.00 $10,710.00 $10,710.00 $10,710.00 2025-03-01
33210 CPT Insertion Transvenous Pac 4 1 $9,868.50 $9,868.50 $644.00 $19,093.00 $9,868.50 2025-03-01
J1162 CPT Digoxin Immune Fab 40mg Vial (digifab) 2 1 $8,520.25 $8,520.25 $8,520.25 $8,520.25 $8,520.25 2025-03-01
59812 CPT Treatment Incomplete Abortion 2 1 $7,700.00 $7,700.00 $7,700.00 $7,700.00 $7,700.00 2025-03-01
3507401 LOCAL Orbactiv 1200mg (nf) 2 1 $7,527.26 $7,527.26 $7,527.26 $7,527.26 $7,527.26 2025-03-01
21337 CPT Closed Tx Nasal Fx 2 1 $7,150.00 $7,150.00 $7,150.00 $7,150.00 $7,150.00 2025-03-01
J0840 CPT Crofab 2 1 $6,590.25 $6,590.25 $6,590.25 $6,590.25 $6,590.25 2025-03-01
J0630 CPT Calcitonin 400unit/2ml Inj (miacalcin) 2 1 $5,754.50 $5,754.50 $5,754.50 $5,754.50 $5,754.50 2025-03-01
3507016 LOCAL Golimumab 50mg/4ml 2 1 $4,807.19 $4,807.19 $4,807.19 $4,807.19 $4,807.19 2025-03-01
3507731 LOCAL Actemra 400mg/20ml Vial 2 1 $4,756.48 $4,756.48 $4,756.48 $4,756.48 $4,756.48 2025-03-01
75710 CPT Xr Angiography Extremity Unilateral 2 1 $4,730.00 $4,730.00 $4,730.00 $4,730.00 $4,730.00 2025-03-01
27266 CPT Closed Trmt Post Hip Dislocation 2 1 $4,452.00 $4,452.00 $4,452.00 $4,452.00 $4,452.00 2025-03-01
Q0247 CPT Sotrovimab 500mg/8ml 2 1 $4,410.00 $4,410.00 $4,410.00 $4,410.00 $4,410.00 2025-03-01
59409 CPT Pf-vaginal Delivery Only 4 1 $4,403.00 $4,403.00 $2,717.00 $6,089.00 $4,403.00 2025-03-01
69005 CPT Drainage Ext Ear, Complicated 2 1 $4,311.00 $4,311.00 $4,311.00 $4,311.00 $4,311.00 2025-03-01
78451 CPT Nm Myocard Perf Image-single 2 1 $4,059.00 $4,059.00 $4,059.00 $4,059.00 $4,059.00 2025-03-01
95811 CPT Sleep Study (cpap) 2 1 $3,990.00 $3,990.00 $3,990.00 $3,990.00 $3,990.00 2025-03-01
G0399 CPT Sleep Study At Home 2 1 $3,805.00 $3,805.00 $3,805.00 $3,805.00 $3,805.00 2025-03-01
95800 CPT Sleep Study Unattended 2 1 $3,805.00 $3,805.00 $3,805.00 $3,805.00 $3,805.00 2025-03-01
95810 CPT Sleep Study 2 1 $3,805.00 $3,805.00 $3,805.00 $3,805.00 $3,805.00 2025-03-01
J1569 CPT Crofab 4 1 $3,767.62 $3,767.62 $945.00 $6,590.25 $3,767.62 2025-03-01
J0897 CPT Denosumab 60mg/1ml Inj (prolia) 2 1 $3,722.44 $3,722.44 $3,722.44 $3,722.44 $3,722.44 2025-03-01
49407 CPT Peritoneal Procedures 2 1 $3,472.00 $3,472.00 $3,472.00 $3,472.00 $3,472.00 2025-03-01
42300 CPT Drainage Salivary Gland 2 1 $3,425.00 $3,425.00 $3,425.00 $3,425.00 $3,425.00 2025-03-01
78806 CPT Nm Indium 111 White Bld Cell 2 1 $3,389.00 $3,389.00 $3,389.00 $3,389.00 $3,389.00 2025-03-01
78452 CPT Nm Cardiac Muga Scan 4 1 $3,176.50 $3,176.50 $1,155.00 $5,198.00 $3,176.50 2025-03-01
J7325 CPT Synvisc-one 48mg/6ml Inj 2 1 $3,134.75 $3,134.75 $3,134.75 $3,134.75 $3,134.75 2025-03-01
38300 CPT Drainage Lymph Node Lesio 2 1 $3,108.00 $3,108.00 $3,108.00 $3,108.00 $3,108.00 2025-03-01
G0390 CPT Trauma Response Level 2 1 $3,000.00 $3,000.00 $3,000.00 $3,000.00 $3,000.00 2025-03-01
26011 CPT Drainage Finger Abscess Complicated 2 1 $2,970.00 $2,970.00 $2,970.00 $2,970.00 $2,970.00 2025-03-01
13132 CPT Pf-repair Complex Chin 2. 4 1 $2,923.50 $2,923.50 $1,462.00 $4,385.00 $2,923.50 2025-03-01
23931 CPT I&d Upper Arm & Elbow Bu 4 1 $2,910.50 $2,910.50 $1,455.00 $4,366.00 $2,910.50 2025-03-01
93312 CPT US Tee 2 1 $2,750.00 $2,750.00 $2,750.00 $2,750.00 $2,750.00 2025-03-01
15240 CPT Full Thickness Graft 20 4 1 $2,658.50 $2,658.50 $1,211.00 $4,106.00 $2,658.50 2025-03-01
28208 CPT Pf-repair Extensor Tendon 4 1 $2,654.50 $2,654.50 $223.00 $5,086.00 $2,654.50 2025-03-01
P9052 CPT Bb Platelets 2 1 $2,580.00 $2,580.00 $2,580.00 $2,580.00 $2,580.00 2025-03-01
14301 CPT Pf-adjacent Tissue Transf 2 1 $2,548.00 $2,548.00 $2,548.00 $2,548.00 $2,548.00 2025-03-01
J0129 CPT Abatacept 250mg Vial (orencia) 2 1 $2,487.50 $2,487.50 $2,487.50 $2,487.50 $2,487.50 2025-03-01
36556 CPT Central Line Insertion 5 6 1 $2,461.00 $2,461.00 $426.00 $3,322.00 $2,461.00 2025-03-01
43999 CPT Unlisted Procedure Stomac 2 1 $2,460.00 $2,460.00 $2,460.00 $2,460.00 $2,460.00 2025-03-01
25660 CPT Clsd Treat Carpal Disloca 4 1 $2,451.50 $2,451.50 $1,227.00 $3,676.00 $2,451.50 2025-03-01
27792 CPT Fx Care Distal Fibula W/w 4 1 $2,414.50 $2,414.50 $806.00 $4,023.00 $2,414.50 2025-03-01
11400 CPT Exc Lesion 0.5 Or Less 2 1 $2,401.00 $2,401.00 $2,401.00 $2,401.00 $2,401.00 2025-03-01
26418 CPT Pf-repair Extensor Tendon 4 1 $2,336.50 $2,336.50 $273.00 $4,400.00 $2,336.50 2025-03-01
46999 CPT Unlisted Proc Anus 2 1 $2,310.00 $2,310.00 $2,310.00 $2,310.00 $2,310.00 2025-03-01
36569 CPT Insertion Picc Cath 2 1 $2,257.00 $2,257.00 $2,257.00 $2,257.00 $2,257.00 2025-03-01
70015 CPT Cisternography S&i 2 1 $2,247.00 $2,247.00 $2,247.00 $2,247.00 $2,247.00 2025-03-01
72194 CPT CT Pelvis Wwo 2 1 $2,200.00 $2,200.00 $2,200.00 $2,200.00 $2,200.00 2025-03-01
46050 CPT Incision Of Anal Abscess 2 1 $2,193.00 $2,193.00 $2,193.00 $2,193.00 $2,193.00 2025-03-01
99285 CPT Emergency Room Lev 5 6 1 $2,193.00 $2,193.00 $576.00 $2,193.00 $2,193.00 2025-03-01
99291 CPT Critical Care 30-74 Min 6 1 $2,167.00 $2,167.00 $880.00 $2,926.00 $2,167.00 2025-03-01
93306 CPT US Echocardiogram 2d Doppler Color 2 1 $2,151.00 $2,151.00 $2,151.00 $2,151.00 $2,151.00 2025-03-01
73206 CPT CTA Upper Extremity 2 1 $2,145.00 $2,145.00 $2,145.00 $2,145.00 $2,145.00 2025-03-01
81455 CPT Next Generation Sequencing Panel 2 1 $2,138.00 $2,138.00 $2,138.00 $2,138.00 $2,138.00 2025-03-01
36430 CPT Bb Blood Administration 6-8 4 1 $2,123.00 $2,123.00 $924.00 $3,322.00 $2,123.00 2025-03-01
J3489 CPT Zoledronic Acid 5mg/100ml Vial (reclast) 2 1 $2,109.50 $2,109.50 $2,109.50 $2,109.50 $2,109.50 2025-03-01
6510259 LOCAL Derma Gel Wound Dressing 2 1 $2,104.76 $2,104.76 $2,104.76 $2,104.76 $2,104.76 2025-03-01
12037 CPT Rpr Scalp Trunk Over 30.0 2 1 $2,100.00 $2,100.00 $2,100.00 $2,100.00 $2,100.00 2025-03-01
70543 CPT MRI Orbit Face Neck Wwo 2 1 $2,090.00 $2,090.00 $2,090.00 $2,090.00 $2,090.00 2025-03-01
23505 CPT Trmt Clavicular Fx W/mani 2 1 $2,090.00 $2,090.00 $2,090.00 $2,090.00 $2,090.00 2025-03-01
70553 CPT MRI Brain Wwo 2 1 $2,090.00 $2,090.00 $2,090.00 $2,090.00 $2,090.00 2025-03-01
36590 CPT Removal Tunneled Central Venous Access 2 1 $2,090.00 $2,090.00 $2,090.00 $2,090.00 $2,090.00 2025-03-01
20822 CPT Pf-replantation Digit Amp 4 1 $2,081.50 $2,081.50 $1,675.00 $2,488.00 $2,081.50 2025-03-01
72157 CPT MRI T Spine Wwo 2 1 $1,980.00 $1,980.00 $1,980.00 $1,980.00 $1,980.00 2025-03-01
72156 CPT MRI C Spine Wwo 2 1 $1,980.00 $1,980.00 $1,980.00 $1,980.00 $1,980.00 2025-03-01
74183 CPT MRI Abdomen Wwo 2 1 $1,980.00 $1,980.00 $1,980.00 $1,980.00 $1,980.00 2025-03-01
72158 CPT MRI Spine Lumbar Wwo 2 1 $1,980.00 $1,980.00 $1,980.00 $1,980.00 $1,980.00 2025-03-01
72148 CPT MRI Spine Lumbar Wo 2 1 $1,980.00 $1,980.00 $1,980.00 $1,980.00 $1,980.00 2025-03-01
J1561 CPT Immune Globulin 10gm Vial (gamunex-c) 4 1 $1,968.75 $1,968.75 $1,312.50 $2,625.00 $1,968.75 2025-03-01
40800 CPT Drainage Abscess Mouth Simple 2 1 $1,891.00 $1,891.00 $1,891.00 $1,891.00 $1,891.00 2025-03-01
74177 CPT CT Abdomen Pelvis W 2 1 $1,870.00 $1,870.00 $1,870.00 $1,870.00 $1,870.00 2025-03-01
10081 CPT I&d Cyst Complicated 2 1 $1,870.00 $1,870.00 $1,870.00 $1,870.00 $1,870.00 2025-03-01
74178 CPT CT Abdomen Pelvis Wwo 2 1 $1,870.00 $1,870.00 $1,870.00 $1,870.00 $1,870.00 2025-03-01
70470 CPT CT Head Wwo 2 1 $1,870.00 $1,870.00 $1,870.00 $1,870.00 $1,870.00 2025-03-01
81404 CPT Apo E4 2 1 $1,812.00 $1,812.00 $1,812.00 $1,812.00 $1,812.00 2025-03-01
74170 CPT CT Abdomen Wwo 2 1 $1,760.00 $1,760.00 $1,760.00 $1,760.00 $1,760.00 2025-03-01
2100065 LOCAL Episiotomy Repair 2 1 $1,728.00 $1,728.00 $1,728.00 $1,728.00 $1,728.00 2025-03-01
90375 CPT Rabies Immune Globulin 2 1 $1,691.87 $1,691.87 $1,691.87 $1,691.87 $1,691.87 2025-03-01
55100 CPT Drainage Abscess Scrotum 4 1 $1,690.50 $1,690.50 $851.00 $2,530.00 $1,690.50 2025-03-01
78226 CPT Nm Hida Imaging Without Flow 2 1 $1,663.00 $1,663.00 $1,663.00 $1,663.00 $1,663.00 2025-03-01
78227 CPT Nm Hida Imaging W/flow 2 1 $1,663.00 $1,663.00 $1,663.00 $1,663.00 $1,663.00 2025-03-01
27752 CPT Fx Care Tibial Shaft W/ma 4 1 $1,650.50 $1,650.50 $1,559.00 $1,742.00 $1,650.50 2025-03-01
72141 CPT MRI C Spine Wo 2 1 $1,650.00 $1,650.00 $1,650.00 $1,650.00 $1,650.00 2025-03-01
70460 CPT CT Head W 2 1 $1,650.00 $1,650.00 $1,650.00 $1,650.00 $1,650.00 2025-03-01
72146 CPT MRI T Spine Wo 2 1 $1,650.00 $1,650.00 $1,650.00 $1,650.00 $1,650.00 2025-03-01
73221 CPT MRI Up Ext Joint Wo Left 6 1 $1,650.00 $1,650.00 $1,650.00 $1,650.00 $1,650.00 2025-03-01
70488 CPT CT Face Sinus Wwo 2 1 $1,650.00 $1,650.00 $1,650.00 $1,650.00 $1,650.00 2025-03-01
73702 CPT CT Low Ext Wwo Bilat 6 1 $1,650.00 $1,650.00 $1,018.00 $2,145.00 $1,650.00 2025-03-01
70491 CPT CT Neck Soft Tissue W 2 1 $1,650.00 $1,650.00 $1,650.00 $1,650.00 $1,650.00 2025-03-01
5360211 LOCAL Cytogenetics-chromosome A 2 1 $1,639.00 $1,639.00 $1,639.00 $1,639.00 $1,639.00 2025-03-01
73725 CPT MRA Low Ext Wo Left 12 1 $1,628.00 $1,628.00 $1,100.00 $3,366.00 $1,628.00 2025-03-01
73225 CPT MRA Up Ext Wwo Left 6 1 $1,628.00 $1,628.00 $1,628.00 $3,366.00 $1,628.00 2025-03-01
73720 CPT MRI Low Ext Nonjoint Wwo Left 4 1 $1,628.00 $1,628.00 $1,628.00 $1,628.00 $1,628.00 2025-03-01
70546 CPT MRA Head Wwo 2 1 $1,628.00 $1,628.00 $1,628.00 $1,628.00 $1,628.00 2025-03-01
73723 CPT MRI Low Ext Joint Wwo Left 6 1 $1,628.00 $1,628.00 $1,628.00 $3,366.00 $1,628.00 2025-03-01
70545 CPT MRA Head W 2 1 $1,628.00 $1,628.00 $1,628.00 $1,628.00 $1,628.00 2025-03-01
74182 CPT MRI Abdomen W 2 1 $1,628.00 $1,628.00 $1,628.00 $1,628.00 $1,628.00 2025-03-01
72198 CPT MRA Pelvis Wwo 2 1 $1,628.00 $1,628.00 $1,628.00 $1,628.00 $1,628.00 2025-03-01
73223 CPT MRI Up Ext Joint Wwo Left 4 1 $1,628.00 $1,628.00 $1,628.00 $1,628.00 $1,628.00 2025-03-01
74185 CPT MRA Abdomen Wwo 2 1 $1,628.00 $1,628.00 $1,628.00 $1,628.00 $1,628.00 2025-03-01
70549 CPT MRA Neck Wwo 2 1 $1,628.00 $1,628.00 $1,628.00 $1,628.00 $1,628.00 2025-03-01
49020 CPT Drainage Of Abscess 2 1 $1,614.00 $1,614.00 $1,614.00 $1,614.00 $1,614.00 2025-03-01
19285 CPT US Breast Localization 1st 2 1 $1,605.00 $1,605.00 $1,605.00 $1,605.00 $1,605.00 2025-03-01
27762 CPT Fx Care Medial Malleolus 4 1 $1,559.50 $1,559.50 $1,377.00 $1,742.00 $1,559.50 2025-03-01
1000001 LOCAL Step Down Private Room 2 1 $1,550.00 $1,550.00 $1,550.00 $1,550.00 $1,550.00 2025-03-01
73218 CPT MRI Up Ext Nonjoint Wo Left 6 1 $1,540.00 $1,540.00 $1,540.00 $2,310.00 $1,540.00 2025-03-01
72197 CPT MRI Pelvis Wwo 2 1 $1,540.00 $1,540.00 $1,540.00 $1,540.00 $1,540.00 2025-03-01
73220 CPT MRI Up Ext Nonjoint Wwo 2 1 $1,540.00 $1,540.00 $1,540.00 $1,540.00 $1,540.00 2025-03-01
G0257 CPT Unscheduled Outpt Dialysi 2 1 $1,529.00 $1,529.00 $1,529.00 $1,529.00 $1,529.00 2025-03-01
90935 CPT Hemodialysis W/phy Evalua 2 1 $1,522.00 $1,522.00 $1,522.00 $1,522.00 $1,522.00 2025-03-01
70010 CPT Myelography S&i 2 1 $1,507.00 $1,507.00 $1,507.00 $1,507.00 $1,507.00 2025-03-01
78582 CPT Nm Lung Perf W/vent 2 1 $1,502.00 $1,502.00 $1,502.00 $1,502.00 $1,502.00 2025-03-01
24605 CPT Pf-reduce Dislocated Elbo 4 1 $1,500.50 $1,500.50 $1,301.00 $1,700.00 $1,500.50 2025-03-01
81226 CPT Cytochrome P450-2d6 2 1 $1,498.00 $1,498.00 $1,498.00 $1,498.00 $1,498.00 2025-03-01
99284 CPT Emergency Room Lev 4 6 1 $1,486.00 $1,486.00 $377.00 $1,486.00 $1,486.00 2025-03-01
73580 CPT Xr Arthrogram Knee Supervision 4 1 $1,485.00 $1,485.00 $990.00 $1,980.00 $1,485.00 2025-03-01
46040 CPT I&d Perirectal Abscess 4 1 $1,478.50 $1,478.50 $1,227.00 $1,730.00 $1,478.50 2025-03-01
78306 CPT Nm Bone Imaging Whole Body 2 1 $1,448.00 $1,448.00 $1,448.00 $1,448.00 $1,448.00 2025-03-01
70492 CPT CT Neck Soft Tissue Wwo 2 1 $1,430.00 $1,430.00 $1,430.00 $1,430.00 $1,430.00 2025-03-01
72193 CPT CT Pelvis W 2 1 $1,430.00 $1,430.00 $1,430.00 $1,430.00 $1,430.00 2025-03-01
70450 CPT CT Head Wo 2 1 $1,430.00 $1,430.00 $1,430.00 $1,430.00 $1,430.00 2025-03-01
72132 CPT CT L Spine W 2 1 $1,430.00 $1,430.00 $1,430.00 $1,430.00 $1,430.00 2025-03-01
73701 CPT CT Low Ext W Bilat 6 1 $1,430.00 $1,430.00 $908.00 $1,925.00 $1,430.00 2025-03-01
74181 CPT MRI Abdomen Wo 2 1 $1,430.00 $1,430.00 $1,430.00 $1,430.00 $1,430.00 2025-03-01
70544 CPT MRA Head Wo 2 1 $1,430.00 $1,430.00 $1,430.00 $1,430.00 $1,430.00 2025-03-01
70551 CPT MRI Brain Wo 2 1 $1,430.00 $1,430.00 $1,430.00 $1,430.00 $1,430.00 2025-03-01
73721 CPT MRI Low Ext Joint Wo Left 6 1 $1,430.00 $1,430.00 $1,430.00 $2,310.00 $1,430.00 2025-03-01
72126 CPT CT Cervical Spine W 2 1 $1,430.00 $1,430.00 $1,430.00 $1,430.00 $1,430.00 2025-03-01
72195 CPT MRI Pelvis Wo 2 1 $1,430.00 $1,430.00 $1,430.00 $1,430.00 $1,430.00 2025-03-01
73718 CPT MRI Low Ext Nonjoint Wo Left 6 1 $1,430.00 $1,430.00 $1,430.00 $2,310.00 $1,430.00 2025-03-01
74176 CPT CT Abdomen Pelvis Wo 2 1 $1,430.00 $1,430.00 $1,430.00 $1,430.00 $1,430.00 2025-03-01
70547 CPT MRA Neck Wo 2 1 $1,430.00 $1,430.00 $1,430.00 $1,430.00 $1,430.00 2025-03-01
73201 CPT CT Up Ext W Bilat 6 1 $1,430.00 $1,430.00 $1,430.00 $1,925.00 $1,430.00 2025-03-01
74160 CPT CT Abdomen W 2 1 $1,430.00 $1,430.00 $1,430.00 $1,430.00 $1,430.00 2025-03-01
73719 CPT MRI Low Ext Nonjoint W Left 2 1 $1,409.00 $1,409.00 $1,409.00 $1,409.00 $1,409.00 2025-03-01
73222 CPT MRI Up Ext Joint W Left 4 1 $1,409.00 $1,409.00 $1,409.00 $1,409.00 $1,409.00 2025-03-01
71555 CPT MRA Chest Wwo 2 1 $1,409.00 $1,409.00 $1,409.00 $1,409.00 $1,409.00 2025-03-01
72149 CPT MRI Spine Lumber W 2 1 $1,409.00 $1,409.00 $1,409.00 $1,409.00 $1,409.00 2025-03-01
73219 CPT MRI Up Ext Nonjoint W Left 2 1 $1,409.00 $1,409.00 $1,409.00 $1,409.00 $1,409.00 2025-03-01
72147 CPT MRI T Spine W 2 1 $1,409.00 $1,409.00 $1,409.00 $1,409.00 $1,409.00 2025-03-01
73722 CPT MRI Low Ext Joint W Bilat 6 1 $1,409.00 $1,409.00 $1,409.00 $2,928.00 $1,409.00 2025-03-01
72142 CPT MRI C Spine W 2 1 $1,409.00 $1,409.00 $1,409.00 $1,409.00 $1,409.00 2025-03-01
70548 CPT MRA Neck W 2 1 $1,409.00 $1,409.00 $1,409.00 $1,409.00 $1,409.00 2025-03-01
72196 CPT MRI Pelvis W 2 1 $1,409.00 $1,409.00 $1,409.00 $1,409.00 $1,409.00 2025-03-01
70552 CPT MRI Brain W 2 1 $1,409.00 $1,409.00 $1,409.00 $1,409.00 $1,409.00 2025-03-01
71551 CPT MRI Chest W 2 1 $1,409.00 $1,409.00 $1,409.00 $1,409.00 $1,409.00 2025-03-01
45915 CPT Pf-rem Fecal Impact Fb With 4 1 $1,383.50 $1,383.50 $692.00 $2,075.00 $1,383.50 2025-03-01
36560 CPT Central Line Insert Under 4 1 $1,366.00 $1,366.00 $160.00 $2,572.00 $1,366.00 2025-03-01
32557 CPT Incision Pleura W Imaging 2 1 $1,364.00 $1,364.00 $1,364.00 $1,364.00 $1,364.00 2025-03-01
32555 CPT Thoracentesis W Imaging 2 1 $1,364.00 $1,364.00 $1,364.00 $1,364.00 $1,364.00 2025-03-01
1000008 LOCAL Isolation Room 2 1 $1,350.00 $1,350.00 $1,350.00 $1,350.00 $1,350.00 2025-03-01
1000005 LOCAL Telemetry Semi Private Room 2 1 $1,350.00 $1,350.00 $1,350.00 $1,350.00 $1,350.00 2025-03-01
1000004 LOCAL Telemetry Private Room 2 1 $1,350.00 $1,350.00 $1,350.00 $1,350.00 $1,350.00 2025-03-01
45999 CPT Rem Fecal Impact 2 1 $1,348.00 $1,348.00 $1,348.00 $1,348.00 $1,348.00 2025-03-01
78709 CPT Nm Kidney Scan W/flow & Func 2 1 $1,320.00 $1,320.00 $1,320.00 $1,320.00 $1,320.00 2025-03-01
78707 CPT Nm Kidney Imaging W/function 2 1 $1,320.00 $1,320.00 $1,320.00 $1,320.00 $1,320.00 2025-03-01
72125 CPT CT Cervical Spine Wo 2 1 $1,320.00 $1,320.00 $1,320.00 $1,320.00 $1,320.00 2025-03-01
70486 CPT CT Face Sinus Wo 2 1 $1,320.00 $1,320.00 $1,320.00 $1,320.00 $1,320.00 2025-03-01
70487 CPT CT Face Sinus W 2 1 $1,320.00 $1,320.00 $1,320.00 $1,320.00 $1,320.00 2025-03-01
70490 CPT CT Neck Soft Tissue Wo 2 1 $1,320.00 $1,320.00 $1,320.00 $1,320.00 $1,320.00 2025-03-01
49999 CPT Manual Reduction Of Herni 4 1 $1,313.50 $1,313.50 $414.00 $2,213.00 $1,313.50 2025-03-01
20103 CPT Exp Penetrating Wound Ext 4 1 $1,308.50 $1,308.50 $1,146.00 $1,471.00 $1,308.50 2025-03-01
88348 CPT Electron Microscopy 2 1 $1,300.00 $1,300.00 $1,300.00 $1,300.00 $1,300.00 2025-03-01
90970 CPT Esrd Dialysis Patient Ove 2 1 $1,300.00 $1,300.00 $1,300.00 $1,300.00 $1,300.00 2025-03-01
10140 CPT I & D Hematoma 4 1 $1,293.50 $1,293.50 $377.00 $2,210.00 $1,293.50 2025-03-01
78801 CPT Nm Scintigram - Multiple Are 2 1 $1,265.00 $1,265.00 $1,265.00 $1,265.00 $1,265.00 2025-03-01
78014 CPT Nm Thyroid Imaging Quantitat 2 1 $1,261.00 $1,261.00 $1,261.00 $1,261.00 $1,261.00 2025-03-01
1000003 LOCAL Step Down Semi Private Room 2 1 $1,250.00 $1,250.00 $1,250.00 $1,250.00 $1,250.00 2025-03-01
23655 CPT Pf-reduction/dis Shoulder 4 1 $1,249.50 $1,249.50 $1,189.00 $1,310.00 $1,249.50 2025-03-01
75820 CPT Xr Venogram Unilateral 2 1 $1,242.00 $1,242.00 $1,242.00 $1,242.00 $1,242.00 2025-03-01
11010 CPT Debridement W/fb Removal 4 1 $1,237.50 $1,237.50 $63.00 $2,412.00 $1,237.50 2025-03-01
78216 CPT Nm Liver/speen W/vascular Fl 2 1 $1,228.00 $1,228.00 $1,228.00 $1,228.00 $1,228.00 2025-03-01
78708 CPT Nm Kidney Imaging Single Stu 4 1 $1,221.00 $1,221.00 $1,122.00 $1,320.00 $1,221.00 2025-03-01
72131 CPT CT L Spine Wo 2 1 $1,210.00 $1,210.00 $1,210.00 $1,210.00 $1,210.00 2025-03-01
72192 CPT CT Pelvis Wo 2 1 $1,210.00 $1,210.00 $1,210.00 $1,210.00 $1,210.00 2025-03-01
73200 CPT CT Up Ext Wo Left 6 1 $1,210.00 $1,210.00 $1,210.00 $1,430.00 $1,210.00 2025-03-01
71271 CPT CT Low Dose Lung Ca Screening 2 1 $1,210.00 $1,210.00 $1,210.00 $1,210.00 $1,210.00 2025-03-01
72128 CPT CT Thoracic Spine Wo 2 1 $1,210.00 $1,210.00 $1,210.00 $1,210.00 $1,210.00 2025-03-01
74150 CPT CT Abdomen Wo 2 1 $1,210.00 $1,210.00 $1,210.00 $1,210.00 $1,210.00 2025-03-01
73700 CPT CT Low Ext Wo Bilat 6 1 $1,210.00 $1,210.00 $1,210.00 $1,210.00 $1,210.00 2025-03-01
71270 CPT CT Chest Wwo 4 1 $1,169.00 $1,169.00 $358.00 $1,980.00 $1,169.00 2025-03-01
70481 CPT CT Iac W 4 1 $1,169.00 $1,169.00 $908.00 $1,430.00 $1,169.00 2025-03-01
78195 CPT Nm Scintigraphy Lymphatics/n 2 1 $1,155.00 $1,155.00 $1,155.00 $1,155.00 $1,155.00 2025-03-01
46250 CPT Excision Of External Hemo 4 1 $1,151.50 $1,151.50 $268.00 $2,035.00 $1,151.50 2025-03-01
1000006 LOCAL Swing Bed 2 1 $1,150.00 $1,150.00 $1,150.00 $1,150.00 $1,150.00 2025-03-01
1000000 LOCAL Private Room 2 1 $1,150.00 $1,150.00 $1,150.00 $1,150.00 $1,150.00 2025-03-01
37618 CPT Arterial Ligation Extremi 2 1 $1,146.00 $1,146.00 $1,146.00 $1,146.00 $1,146.00 2025-03-01
J3486 CPT Ziprasidone 20mg Vial (geodon) 2 1 $1,144.00 $1,144.00 $1,144.00 $1,144.00 $1,144.00 2025-03-01
81270 CPT Jak2 Gene Mutation 2 1 $1,141.00 $1,141.00 $1,141.00 $1,141.00 $1,141.00 2025-03-01
84999 CPT Ova 1 4 1 $1,123.50 $1,123.50 $45.00 $2,202.00 $1,123.50 2025-03-01
J0878 CPT Daptomycin 500mg Vial (cubicin) 2 1 $1,122.75 $1,122.75 $1,122.75 $1,122.75 $1,122.75 2025-03-01
87912 CPT Hbv Genotype 2 1 $1,120.00 $1,120.00 $1,120.00 $1,120.00 $1,120.00 2025-03-01
J1670 CPT Tetanus Immune Glob 250 Unt(hypertet-sd) 2 1 $1,119.75 $1,119.75 $1,119.75 $1,119.75 $1,119.75 2025-03-01
66999 CPT Pf-unlisted Proc Anterio 4 1 $1,118.50 $1,118.50 $37.00 $2,200.00 $1,118.50 2025-03-01
93308 CPT US Echocardiogram Ltd-f/u 2 1 $1,114.00 $1,114.00 $1,114.00 $1,114.00 $1,114.00 2025-03-01
70336 CPT MRI Temporomandibular Joint 2 1 $1,100.00 $1,100.00 $1,100.00 $1,100.00 $1,100.00 2025-03-01
70540 CPT MRI Orbit Face Neck Wo 2 1 $1,100.00 $1,100.00 $1,100.00 $1,100.00 $1,100.00 2025-03-01
11401 CPT Exc Lesion 0.6-1.0 2 1 $1,100.00 $1,100.00 $1,100.00 $1,100.00 $1,100.00 2025-03-01
71550 CPT MRI Chest Wo 2 1 $1,100.00 $1,100.00 $1,100.00 $1,100.00 $1,100.00 2025-03-01
90945 CPT Dialysis Single Evaluati 2 1 $1,096.00 $1,096.00 $1,096.00 $1,096.00 $1,096.00 2025-03-01
J0248 CPT Remdesivir 100 Mg (veklury) Vial 2 1 $1,092.00 $1,092.00 $1,092.00 $1,092.00 $1,092.00 2025-03-01
37211 CPT Pf-transcatheter Therapy 2 1 $1,073.00 $1,073.00 $1,073.00 $1,073.00 $1,073.00 2025-03-01
25605 CPT Fx Care Distal Radius W/m 4 1 $1,071.00 $1,071.00 $365.00 $1,777.00 $1,071.00 2025-03-01
32556 CPT Incision Pleura Without Imagi 4 1 $1,058.00 $1,058.00 $466.00 $1,650.00 $1,058.00 2025-03-01
3500057 LOCAL Amoxicillin/clav 125mg/5ml 75ml Susp 2 1 $1,052.25 $1,052.25 $1,052.25 $1,052.25 $1,052.25 2025-03-01
11760 CPT Pf-repair Of Nail Bed 4 1 $1,042.00 $1,042.00 $413.00 $1,671.00 $1,042.00 2025-03-01
13131 CPT Repair Face, Hands, Feet 2 1 $1,023.00 $1,023.00 $1,023.00 $1,023.00 $1,023.00 2025-03-01
73202 CPT CT Up Ext Wwo Left 2 1 $1,018.00 $1,018.00 $1,018.00 $1,018.00 $1,018.00 2025-03-01
70482 CPT CT Orbits W/wo 2 1 $1,018.00 $1,018.00 $1,018.00 $1,018.00 $1,018.00 2025-03-01
72130 CPT CT Thoracic Spine Wwo 2 1 $1,018.00 $1,018.00 $1,018.00 $1,018.00 $1,018.00 2025-03-01
72133 CPT CT L Spine Wwo 2 1 $1,018.00 $1,018.00 $1,018.00 $1,018.00 $1,018.00 2025-03-01
3506785 LOCAL Granix 480mcg/0.8ml Syringe 2 1 $1,007.75 $1,007.75 $1,007.75 $1,007.75 $1,007.75 2025-03-01
12035 CPT Int Rpr Trunk/ext 12.6-20 4 1 $1,006.00 $1,006.00 $758.00 $1,254.00 $1,006.00 2025-03-01
1000002 LOCAL Semi Private Room 2 1 $1,000.00 $1,000.00 $1,000.00 $1,000.00 $1,000.00 2025-03-01
J1442 CPT Filgrastim 300mcg/1ml Vial (neupogen) 4 1 $999.50 $999.50 $771.25 $1,227.75 $999.50 2025-03-01
25565 CPT Fx Care Radius/ulna W/man 4 1 $996.00 $996.00 $518.00 $1,474.00 $996.00 2025-03-01
70480 CPT CT Orbits Wo 4 1 $990.00 $990.00 $660.00 $1,320.00 $990.00 2025-03-01
73040 CPT Xr Arthrogram Shoulder 2 1 $990.00 $990.00 $990.00 $990.00 $990.00 2025-03-01
78580 CPT Nm Lung Perf Without Vent 2 1 $990.00 $990.00 $990.00 $990.00 $990.00 2025-03-01
81401 CPT Huntington's Disease 4 1 $984.50 $984.50 $554.00 $1,415.00 $984.50 2025-03-01
76098 CPT Xr Breast Specimen 2 1 $983.00 $983.00 $983.00 $983.00 $983.00 2025-03-01
94003 CPT Vent Subs Day 2 1 $982.00 $982.00 $982.00 $982.00 $982.00 2025-03-01
94002 CPT Vent First Day 2 1 $982.00 $982.00 $982.00 $982.00 $982.00 2025-03-01
74249 CPT Xr Fluoro Ugi W Air W Sbft 2 1 $979.00 $979.00 $979.00 $979.00 $979.00 2025-03-01
P9022 CPT Bb Washed Rbc Unit 2 1 $956.00 $956.00 $956.00 $956.00 $956.00 2025-03-01
45900 CPT Pf-reduction Of Procident 4 1 $955.00 $955.00 $619.00 $1,291.00 $955.00 2025-03-01
81220 CPT Cystic Fibrosis Mutation 2 1 $952.00 $952.00 $952.00 $952.00 $952.00 2025-03-01
36593 CPT Declotting Of Implanted Vascular Access 2 1 $950.00 $950.00 $950.00 $950.00 $950.00 2025-03-01
78015 CPT Nm Body Thy C I131 Limited A 2 1 $949.00 $949.00 $949.00 $949.00 $949.00 2025-03-01
3500579 LOCAL Metronidazole 1% Topical Gel 2 1 $948.75 $948.75 $948.75 $948.75 $948.75 2025-03-01
27818 CPT Open Fx Ankle W/manipulat 4 1 $947.50 $947.50 $518.00 $1,377.00 $947.50 2025-03-01
25690 CPT Closed Trmt Lunate Disloc 4 1 $940.00 $940.00 $138.00 $1,742.00 $940.00 2025-03-01
93017 CPT EKG-stress Test 2 1 $936.00 $936.00 $936.00 $936.00 $936.00 2025-03-01
49082 CPT Abdominal Paracentesis 4 1 $931.50 $931.50 $249.00 $1,614.00 $931.50 2025-03-01
27265 CPT Closed Trmt Post Hip Disl 4 1 $928.50 $928.50 $625.00 $1,232.00 $928.50 2025-03-01
24600 CPT Pf-reduction Dislocated E 4 1 $926.00 $926.00 $844.00 $1,008.00 $926.00 2025-03-01
P9040 CPT Bb Packed Rbc - Irradiated L 2 1 $920.00 $920.00 $920.00 $920.00 $920.00 2025-03-01
78264 CPT Nm Gastric Empty Study 2 1 $915.00 $915.00 $915.00 $915.00 $915.00 2025-03-01
78315 CPT Nm Bone Scan 3 Phase 2 1 $912.00 $912.00 $912.00 $912.00 $912.00 2025-03-01
72129 CPT CT Thoracic Spine W 2 1 $908.00 $908.00 $908.00 $908.00 $908.00 2025-03-01
72270 CPT Xr Myelography 2 Or More W I 2 1 $908.00 $908.00 $908.00 $908.00 $908.00 2025-03-01
3507319 LOCAL Avycaz 2.5gm (nf) 2 1 $904.20 $904.20 $904.20 $904.20 $904.20 2025-03-01
93225 CPT Holter Monitor 24 Hours 6 1 $903.00 $903.00 $231.00 $1,218.00 $903.00 2025-03-01
71260 CPT CT Chest W 4 1 $894.00 $894.00 $358.00 $1,430.00 $894.00 2025-03-01
37609 CPT Ligation Temporal Artery 4 1 $892.00 $892.00 $273.00 $1,511.00 $892.00 2025-03-01
59414 CPT Delivery Of Placenta 4 1 $886.00 $886.00 $329.00 $1,443.00 $886.00 2025-03-01
73525 CPT MRI Shoulder Arthrogram 2 1 $884.00 $884.00 $884.00 $884.00 $884.00 2025-03-01
99283 CPT Emergency Room Lev 3 6 1 $883.00 $883.00 $256.00 $883.00 $883.00 2025-03-01
74247 CPT Xr Fluoro Ugi W Air W Kub 2 1 $876.00 $876.00 $876.00 $876.00 $876.00 2025-03-01
72265 CPT Xr Myelography Lumbosacral W 2 1 $873.00 $873.00 $873.00 $873.00 $873.00 2025-03-01
3500312 LOCAL Estrogens, Conj 0.625mg/gm Vag Crm 2 1 $870.50 $870.50 $870.50 $870.50 $870.50 2025-03-01
90937 CPT Hemodialysis Repeat Evalu 2 1 $867.00 $867.00 $867.00 $867.00 $867.00 2025-03-01
88309 CPT Frozen Sec 2 Spec 6 1 $859.00 $859.00 $487.00 $1,352.00 $859.00 2025-03-01
G0259 CPT Xr Arthrogram Sacroiliac Joints 2 1 $855.00 $855.00 $855.00 $855.00 $855.00 2025-03-01
76700 CPT US Abdomen Complete 2 1 $851.00 $851.00 $851.00 $851.00 $851.00 2025-03-01
5360520 LOCAL Myasthenia Gravis Panel # 2 1 $842.00 $842.00 $842.00 $842.00 $842.00 2025-03-01
27550 CPT Closed Trmt Knee Dislocat 4 1 $837.00 $837.00 $260.00 $1,414.00 $837.00 2025-03-01
74174 CPT CT CTA Aorta W Contrast 2 1 $835.00 $835.00 $835.00 $835.00 $835.00 2025-03-01
70498 CPT CTA Neck 2 1 $835.00 $835.00 $835.00 $835.00 $835.00 2025-03-01
71275 CPT CT CTA Chest W Contrast 2 1 $835.00 $835.00 $835.00 $835.00 $835.00 2025-03-01
24655 CPT Fx Care Radius W/manipula 4 1 $834.50 $834.50 $461.00 $1,208.00 $834.50 2025-03-01
23665 CPT Pf-reduce Shoulder Fx/dis 4 1 $834.50 $834.50 $461.00 $1,208.00 $834.50 2025-03-01
62272 CPT Pf-spinal Puncture For Dr 4 1 $833.50 $833.50 $361.00 $1,306.00 $833.50 2025-03-01
24065 CPT Pf-trmt Radial Fx Without Man 4 1 $828.50 $828.50 $146.00 $1,511.00 $828.50 2025-03-01
94726 CPT Total Lung Capacity 2 1 $825.00 $825.00 $825.00 $825.00 $825.00 2025-03-01
78070 CPT Nm Parathyroid Scan 2 1 $823.00 $823.00 $823.00 $823.00 $823.00 2025-03-01
87902 CPT Hcv Ns-5a Drug Resistant 2 1 $816.00 $816.00 $816.00 $816.00 $816.00 2025-03-01
78278 CPT Nm Gi Blood Localizatn 2 1 $814.00 $814.00 $814.00 $814.00 $814.00 2025-03-01
9002050 LOCAL Anchor Suture 2 1 $814.00 $814.00 $814.00 $814.00 $814.00 2025-03-01
27840 CPT Pf-reduction Dislocated A 4 1 $805.00 $805.00 $518.00 $1,092.00 $805.00 2025-03-01
92960 CPT Cardioversion 6 1 $800.00 $800.00 $219.00 $1,093.00 $800.00 2025-03-01
93975 CPT US Abd/renal/scrotal/pelvic Art 4 1 $798.00 $798.00 $747.00 $849.00 $798.00 2025-03-01
24565 CPT Fx Care Humerus W/manipul 4 1 $793.50 $793.50 $132.00 $1,455.00 $793.50 2025-03-01
95816 CPT EEG 2 1 $788.00 $788.00 $788.00 $788.00 $788.00 2025-03-01
40650 CPT Pf-repair Of Lip Full Th 4 1 $786.50 $786.50 $662.00 $911.00 $786.50 2025-03-01
93701 CPT Bioimped Thoracic Elect 2 1 $784.00 $784.00 $784.00 $784.00 $784.00 2025-03-01
71250 CPT CT Chest Wo 4 1 $784.00 $784.00 $358.00 $1,210.00 $784.00 2025-03-01
62270 CPT Lumbar Puncture 4 1 $784.00 $784.00 $262.00 $1,306.00 $784.00 2025-03-01
27750 CPT Fx Care Tibial Shaft Without 4 1 $782.50 $782.50 $624.00 $941.00 $782.50 2025-03-01
78800 CPT Nm Gallium Scan/rad Loclz Tu 2 1 $781.00 $781.00 $781.00 $781.00 $781.00 2025-03-01
31603 CPT Pf-tracheostomy Emergenc 4 1 $780.00 $780.00 $766.00 $794.00 $780.00 2025-03-01
26725 CPT Fx Care Finger W/manipula 4 1 $770.00 $770.00 $624.00 $916.00 $770.00 2025-03-01
73615 CPT Xr Arthrogram Ankle 2 1 $768.00 $768.00 $768.00 $768.00 $768.00 2025-03-01
64400 CPT Nerve Block Injection 2 1 $762.00 $762.00 $762.00 $762.00 $762.00 2025-03-01
6510312 LOCAL Multi-lumen Cvc Kit 2 1 $757.82 $757.82 $757.82 $757.82 $757.82 2025-03-01
3500636 LOCAL Nitroprusside 25mg/ml 2ml Vial 2 1 $756.00 $756.00 $756.00 $756.00 $756.00 2025-03-01
3500102 LOCAL Betaxolol 0.25% Ophth Drops (betoptic-s) 2 1 $755.50 $755.50 $755.50 $755.50 $755.50 2025-03-01
12036 CPT Pf-repair Lac Scalp 20.1- 4 1 $750.50 $750.50 $246.00 $1,255.00 $750.50 2025-03-01
27810 CPT Fx Care Bimalleolar Ankle 4 1 $749.00 $749.00 $377.00 $1,121.00 $749.00 2025-03-01
78999 CPT Nm Unlisted Misc Procedure 2 1 $746.00 $746.00 $746.00 $746.00 $746.00 2025-03-01
74430 CPT Xr Cystography 3 Views 2 1 $746.00 $746.00 $746.00 $746.00 $746.00 2025-03-01
26605 CPT Fx Care Metacarpal W/mani 4 1 $743.00 $743.00 $624.00 $862.00 $743.00 2025-03-01
74740 CPT Xr Fluoro Hysterosalpingography 2 1 $743.00 $743.00 $743.00 $743.00 $743.00 2025-03-01
J1720 CPT Hydrocortisone Sod Succ 100mg Vial 4 1 $738.25 $738.25 $46.00 $1,430.50 $738.25 2025-03-01
93923 CPT US Ankle/brachial Index Measurement 2 1 $729.00 $729.00 $729.00 $729.00 $729.00 2025-03-01
85247 CPT Von Willebrand Panel 2 1 $728.00 $728.00 $728.00 $728.00 $728.00 2025-03-01
29065 CPT Application Long Arm Cast 2 1 $728.00 $728.00 $728.00 $728.00 $728.00 2025-03-01
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