healthcosts.net

UPMC Western Maryland

12500 Willowbrook Road Se, Cumberland, MD · UPMC · · NPI 1609831247

Source: hospital's published price file ↗ · Published Mar 2, 2026 · Ingested Aug 13, 2026

Published prices by procedure

Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.

Procedure Cash price Gross charge Negotiated range Payers
#_benzodiazconfur CPT 80346 $48.60 $81.00 $81.00 – $81.00 1
#a/b/c/c/h pnl-candida albicans ab CPT 86628 $53.40 $89.00 $89.00 – $89.00 1
#acylcarnitineprfl CPT 82017 $210.60 $351.00 $351.00 – $351.00 1
#bac vag cand-c. albicans naa CPT 87481 $194.40 $324.00 $324.00 – $324.00 1
#cf-97variants CPT 81220 $1,299.00 $2,165.00 $2,165.00 – $2,165.00 1
#cmvcul-virus inoculation shell CPT 87254 $48.60 $81.00 $81.00 – $81.00 1
#coxa-coxsackie a serotype a16 CPT 86658 $64.80 $108.00 $108.00 – $108.00 1
#creutz-prot.,western blot CPT 84182 $121.80 $203.00 $203.00 – $203.00 1
(both sides) smear without diff wbc count CPT 85008 $7.80 $13.00 $13.00 – $13.00 1
11-desoxycortisol - sendout CPT 82634 $40.20 $67.00 $67.00 – $67.00 1
17-hydroxypregnenolone CPT 84143 $40.20 $67.00 $67.00 – $67.00 1
17-ketosteroids CPT 83586 $97.20 $162.00 $162.00 – $162.00 1
24 hr ambulatory b/p monitor CPT 93786 $66.00 $110.00 $110.00 – $110.00 1
2d tee w or without fol w/con,in HCPCS C8925 $405.00 $675.00 $675.00 – $675.00 1
2nd order venous cath CPT 36012 $0.60 $1.00 $1.00 – $1.00 1
3-d radiotherapy plan CPT 77295 $445.80 $743.00 $743.00 – $743.00 1
3d ech img cgen car anomal CPT 93319 $66.00 $110.00 $110.00 – $110.00 1
3d recon without postprocess indpndt CPT 76376 $259.20 $432.00 $19.00 – $19.00 1
5' nucleotidase - sendout CPT 83915 $24.00 $40.00 $40.00 – $40.00 1
Abatacept (with maltose) 250 mg intravenous solution HCPCS J0129 $1,429.80 $2,383.00 $2,383.00 – $2,383.00 1
Abd aorta w/runoff s&i CPT 75630 $0.60 $1.00 $1.00 – $1.00 1
Abd/low ext cath 1st CPT 36245 $0.60 $1.00 $1.00 – $1.00 1
Abd/low ext cath 2nd CPT 36246 $0.60 $1.00 $1.00 – $1.00 1
Abd/low ext cath 3rd CPT 36247 $0.60 $1.00 $1.00 – $1.00 1
Abd/low ext cath addl CPT 36248 $0.60 $1.00 $1.00 – $1.00 1
Abdominal CT scan (with and without contrast) CPT 74170 $160.80 $268.00 $268.00 – $268.00 1
Abdominal CT scan (with contrast) CPT 74160 $140.40 $234.00 $234.00 – $234.00 1
Abdominal CT scan (without contrast) CPT 74150 $74.40 $124.00 $124.00 – $124.00 1
Abdominal MRI (with and without contrast) CPT 74183 $654.00 $1,090.00 $1,090.00 – $1,090.00 1
Abdominal MRI (with contrast) CPT 74182 $607.20 $1,012.00 $1,012.00 – $1,012.00 1
Abdominal MRI (without contrast) CPT 74181 $430.20 $717.00 $717.00 – $717.00 1
Abdominal Ultrasound (complete) CPT 76700 $411.00 $685.00 $685.00 – $685.00 1
Abdominal Ultrasound (limited) CPT 76705 $321.60 $536.00 $536.00 – $536.00 1
Abdominal paracentesis w/image guidance CPT 49083 $0.60 $1.00 $1.00 – $1.00 1
Ablate arrhythmia add on CPT 93655 $0.60 $1.00 $1.00 – $1.00 1
Ablate heart dysrhythm focus CPT 93650 $0.60 $1.00 $1.00 – $1.00 1
Ablate pulm tumor perq rf CPT 32998 $0.60 $1.00 $1.00 – $1.00 1
Abscess drain retroperitoneal surg code CPT 49406 $0.60 $1.00 $1.00 – $1.00 1
Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 $8.40 $14.00 $14.00 – $14.00 1
Acute hepatitis panel CPT 80074 $145.80 $243.00 $243.00 – $243.00 1
Acyclovir 400 mg tablet HCPCS J8499 $67.80 $113.00 $10.00 – $10.00 1
Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 $6.00 $10.00 $10.00 – $10.00 1
Adapter b 8 channel 10cm HCPCS C1883 $471.00 $785.00 $220.00 – $220.00 1
Adenosine 3 mg/250 ml bag for osm HCPCS J0153 $55.20 $92.00 $92.00 – $92.00 1
Adenovirus antibody,serum - quest CPT 86603 $53.40 $89.00 $89.00 – $89.00 1
Adh-sendout CPT 84588 $40.20 $67.00 $67.00 – $67.00 1
Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 $124.20 $207.00 $13.00 – $13.00 1
Administration chemotherapy IV infusion each additional hour CPT 96415 $937.80 $1,563.00 $195.00 – $195.00 1
Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 $28.80 $48.00 $48.00 – $48.00 1
Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 $527.40 $879.00 $879.00 – $879.00 1
Administration chemotherapy IV push single/initial substance/drug CPT 96409 $292.80 $488.00 $488.00 – $488.00 1
Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 $204.60 $341.00 $341.00 – $341.00 1
Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 $204.60 $341.00 $341.00 – $341.00 1
Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 $6,328.80 $10,548.00 $6,592.00 – $6,592.00 1
Albumin (microalbumin) 24 hour urine quantitative CPT 82043 $24.00 $40.00 $40.00 – $40.00 1
Albumin body fluid quantitative each specimen CPT 82042 $16.20 $27.00 $27.00 – $27.00 1
Albumin serum plasma or whole blood CPT 82040 $3.00 $5.00 $5.00 – $5.00 1
Aldesleukin injection HCPCS J9015 $3,847.80 $6,413.00 $6,413.00 – $6,413.00 1
Alkaline phosphatase CPT 84075 $3.00 $5.00 $5.00 – $5.00 1
Allergen egg white ige CPT 86003 $24.00 $40.00 $40.00 – $40.00 1
Allergen specific ige qual multi scrn ea CPT 86005 $40.20 $67.00 $67.00 – $67.00 1
Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet HCPCS Q4100 $3,161.40 $5,269.00 $1,667.00 – $1,667.00 1
Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 $3,402.60 $5,671.00 $5,671.00 – $5,671.00 1
Alloskin HCPCS Q4115 $759.00 $1,265.00 $1,265.00 – $1,265.00 1
Alpha-fetoprotein tumor marker CPT 82105 $24.00 $40.00 $40.00 – $40.00 1
Alt/sgpt CPT 84460 $3.00 $5.00 $5.00 – $5.00 1
Alteplase 100 mg infusion from pyxis vial HCPCS J2997 $9,848.40 $16,414.00 $318.00 – $318.00 1
Aluminum - quest CPT 82108 $64.80 $108.00 $108.00 – $108.00 1
Ambl bp mntr w/sw a/r CPT 93788 $199.20 $332.00 $332.00 – $332.00 1
Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 $12.00 $20.00 $12.00 – $12.00 1
Amino acids quant 2-5 CPT 82136 $194.40 $324.00 $324.00 – $324.00 1
Aminolevulinic acid delta CPT 82135 $42.00 $70.00 $70.00 – $70.00 1
Amiodarone 50 mg/ml intravenous solution HCPCS J0282 $2.40 $4.00 $2.00 – $2.00 1
Amitriptyline (elavil) -sendout CPT 80335 $48.60 $81.00 $81.00 – $81.00 1
Ammonia CPT 82140 $32.40 $54.00 $54.00 – $54.00 1
Amphetamine confirm urine -sendout CPT 80324 $64.80 $108.00 $108.00 – $108.00 1
Amphotericin b lipid complex HCPCS J0287 $96.00 $160.00 $160.00 – $160.00 1
Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 $109.80 $183.00 $183.00 – $183.00 1
Ampicillin 1 gram solution for injection HCPCS J0290 $0.60 $1.00 $1.00 – $1.00 1
Amylase CPT 82150 $9.60 $16.00 $16.00 – $16.00 1
An cholangiogram percutaneous compl CPT 47531 $0.60 $1.00 $1.00 – $1.00 1
An fluoro guide for cvp CPT 77001 $0.60 $1.00 $1.00 – $1.00 1
Ana ds-dna CPT 86226 $49.80 $83.00 $83.00 – $83.00 1
Analgesics non-opioid definitive assay 1 or 2 acetaminophen CPT 80329 $48.60 $81.00 $40.00 – $40.00 1
Analysis gene f2 20210g>a variant CPT 81240 $259.80 $433.00 $433.00 – $433.00 1
Analysis gene f5 leiden variant CPT 81241 $154.20 $257.00 $257.00 – $257.00 1
Anca screen with reflex to titer -quest CPT 86021 $64.80 $108.00 $108.00 – $108.00 1
Angio balloon ctrl dialysis seg add-on CPT 36907 $0.60 $1.00 $1.00 – $1.00 1
Angio tib/peroneal/init ves/unila 37228 CPT 37228 $0.60 $1.00 $1.00 – $1.00 1
Angio trnslmnl balloon same artery ea addl CPT 37247 $0.60 $1.00 $1.00 – $1.00 1
Angio trnslmnl balloon same artery ini CPT 37246 $0.60 $1.00 $1.00 – $1.00 1
Angio trnslmnl balloon same vein ea addl CPT 37249 $0.60 $1.00 $1.00 – $1.00 1
Angio trnslmnl balloon same vein ini CPT 37248 $0.60 $1.00 $1.00 – $1.00 1
Angioplasty fem/pop unilat 37224 CPT 37224 $0.60 $1.00 $1.00 – $1.00 1
Angioplasty tib/pero/unilat/ea add 37232 CPT 37232 $0.60 $1.00 $1.00 – $1.00 1
Angioplasty/iliac/init ves/unilat 37220 CPT 37220 $0.60 $1.00 $1.00 – $1.00 1
Angiotensin ii 0.5 mg/ml soln 1 ml vial HCPCS J3490 $1,346.40 $2,244.00 $47.00 – $47.00 1
Ankle X-ray CPT 73610 $106.80 $178.00 $49.00 – $49.00 1
Anti-inhibitor HCPCS J7198 $2.40 $4.00 $4.00 – $4.00 1
Antibody bacterium, not elsewhere specified CPT 86609 $53.40 $89.00 $89.00 – $89.00 1
Antibody elution rbc reference CPT 86860 $32.40 $54.00 $54.00 – $54.00 1
Antibody htlv/hiv confirm test CPT 86689 $121.80 $203.00 $203.00 – $203.00 1
Antibody id rbc panel CPT 86870 $48.60 $81.00 $81.00 – $81.00 1
Antibody identification platelet antibodies heparin-pf4 igg CPT 86022 $81.00 $135.00 $135.00 – $135.00 1
Antibody screen rbc CPT 86850 $19.20 $32.00 $32.00 – $32.00 1
Antibody tetanus CPT 86774 $40.20 $67.00 $67.00 – $67.00 1
Antihemophilic factor-vwf 250 unit-600 unit intravenous solution HCPCS J7187 $0.60 $1.00 $1.00 – $1.00 1
Antinuclear antibodies CPT 86038 $24.00 $40.00 $40.00 – $40.00 1
Antinuclear antibodies titer CPT 86039 $45.00 $75.00 $75.00 – $75.00 1
Antiphosphatidylserine antibody CPT 86148 $32.40 $54.00 $54.00 – $54.00 1
Antistreptolysin o screen CPT 86063 $19.20 $32.00 $32.00 – $32.00 1
Antistreptolysin o titer CPT 86060 $40.20 $67.00 $67.00 – $67.00 1
Antithrombin iii activity CPT 85300 $30.60 $51.00 $51.00 – $51.00 1
Antithymocyte globuln rabbit HCPCS J7511 $905.40 $1,509.00 $1,509.00 – $1,509.00 1
Apl(pml-rara) quant - sendout CPT 81315 $194.40 $324.00 $324.00 – $324.00 1
Appl modality 1/> areas paraffin bath 97018 CPT 97018 $11.40 $19.00 $11.00 – $11.00 1
Appl modality 1/> areas vasopneumatic devices 97016 CPT 97016 $22.80 $38.00 $38.00 – $38.00 1
Appl multlay comprs arm/hand CPT 29584 $144.60 $241.00 $241.00 – $241.00 1
Application finger splntstatic 29130 CPT 29130 $48.00 $80.00 $80.00 – $80.00 1
Application multi layer compression below knee (both sides) CPT 29581 $240.00 $400.00 $241.00 – $241.00 1
Application of paste boot 29580 CPT 29580 $148.20 $247.00 $247.00 – $247.00 1
Apply forearm splintdynamic 29126 CPT 29126 $110.40 $184.00 $184.00 – $184.00 1
Apply interstit radiat compl CPT 77778 $482.40 $804.00 $804.00 – $804.00 1
Apply intrcav radiat compl CPT 77763 $475.80 $793.00 $793.00 – $793.00 1
Apply intrcav radiat interm CPT 77762 $367.80 $613.00 $613.00 – $613.00 1
Apply intrcav radiat simple CPT 77761 $319.20 $532.00 $532.00 – $532.00 1
Apply of finger splint 29131 CPT 29131 $69.00 $115.00 $115.00 – $115.00 1
Apply rigid leg cast 29445 CPT 29445 $217.20 $362.00 $362.00 – $362.00 1
Apply surf ldr radionuclide CPT 77789 $102.00 $170.00 $170.00 – $170.00 1
Aquatic exercise - group charge CPT 97150 $22.80 $38.00 $23.00 – $23.00 1
Argatroban nonesrd use 1mg HCPCS J0883 $246.00 $410.00 $390.00 – $390.00 1
Arterial blood draw/perc 36620 CPT 36620 $98.40 $164.00 $1.00 – $1.00 1
Artery x-rays adrenal gland CPT 75731 $0.60 $1.00 $1.00 – $1.00 1
Artery x-rays adrenals CPT 75733 $0.60 $1.00 $1.00 – $1.00 1
Artery x-rays arm/leg 75710-26 CPT 75710 $0.60 $1.00 $1.00 – $1.00 1
Artery x-rays arms/legs 75716-26 CPT 75716 $0.60 $1.00 $1.00 – $1.00 1
Artery x-rays lung CPT 75741 $0.60 $1.00 $1.00 – $1.00 1
Artery x-rays lung CPT 75746 $0.60 $1.00 $1.00 – $1.00 1
Artery x-rays lungs CPT 75743 $0.60 $1.00 $1.00 – $1.00 1
Artery x-rays spine CPT 75705 $0.60 $1.00 $1.00 – $1.00 1
Artery xray each vessel 7577426 CPT 75774 $0.60 $1.00 $1.00 – $1.00 1
Artery xray of abdomen 75726-26 CPT 75726 $0.60 $1.00 $1.00 – $1.00 1
Artery xrays of pelvis 75736 26 CPT 75736 $0.60 $1.00 $1.00 – $1.00 1
Ascenda two piece catheter HCPCS C1772 $16,771.20 $27,952.00 $27,952.00 – $27,952.00 1
Aspir/inj thyroid cyst 60300 CPT 60300 $0.60 $1.00 $1.00 – $1.00 1
Aspirate bladder/sprapubic cath 51102 CPT 51102 $0.60 $1.00 $1.00 – $1.00 1
Aspirate pleura without imaging 32554 CPT 32554 $0.60 $1.00 $1.00 – $1.00 1
Aspiration fine needle (fna) biopsy w/ultrasound guidance 1st lesion CPT 10005 $0.60 $1.00 $1.00 – $1.00 1
Assay free hydroxyproline CPT 83500 $97.20 $162.00 $162.00 – $162.00 1
Assay of corticosterone CPT 82528 $40.20 $67.00 $67.00 – $67.00 1
Assay of fluoride CPT 82735 $40.20 $67.00 $67.00 – $67.00 1
Assay of lrh hormone CPT 83727 $40.20 $67.00 $67.00 – $67.00 1
Assay of osteocalcin CPT 83937 $24.00 $40.00 $40.00 – $40.00 1
Assay of procainamide w/metab CPT 80192 $48.60 $81.00 $81.00 – $81.00 1
Assay of prostaglandin CPT 84150 $63.00 $105.00 $105.00 – $105.00 1
Assay of quinine CPT 84228 $49.80 $83.00 $83.00 – $83.00 1
Assay of sialic acid CPT 84275 $38.40 $64.00 $64.00 – $64.00 1
Assay of thiocyanate CPT 84430 $24.00 $40.00 $40.00 – $40.00 1
Assess aphasia/interp/rpt/per hr 96105 CPT 96105 $126.60 $211.00 $211.00 – $211.00 1
Assess cyst contrast inject CPT 49424 $0.60 $1.00 $1.00 – $1.00 1
Assessment leukocyte fecal qualitative/semiquantitative CPT 89055 $7.80 $13.00 $13.00 – $13.00 1
Ast/sgot CPT 84450 $3.00 $5.00 $5.00 – $5.00 1
Atezolizumab 60 mg/ml intravenous solution (wrapper) HCPCS J9022 $12,416.40 $20,694.00 $20,694.00 – $20,694.00 1
Athrectomy fem/pop/unilateral 37225 CPT 37225 $0.60 $1.00 $1.00 – $1.00 1
Athrectomy tib/pero/unilat/ini ves 37229 CPT 37229 $0.60 $1.00 $1.00 – $1.00 1
Attn at delivery+ 1 stabilization of newborn 99464 CPT 99464 $95.40 $159.00 $159.00 – $159.00 1
Augumentation percutaneous vertebral inc cavity creation ea addl thoracic/lumbar vertebral body CPT 22515 $0.60 $1.00 $1.00 – $1.00 1
Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic CPT 22513 $0.60 $1.00 $1.00 – $1.00 1
Autologous blood op salvage CPT 86891 $852.60 $1,421.00 $1,421.00 – $1,421.00 1
Autologous blood process CPT 86890 $276.00 $460.00 $460.00 – $460.00 1
Automated diff wbc count CPT 85004 $6.00 $10.00 $10.00 – $10.00 1
Avelumab 20 mg/ml intravenous solution HCPCS J9023 $2,189.40 $3,649.00 $3,649.00 – $3,649.00 1
Azacitidine injection HCPCS J9025 $237.60 $396.00 $47.00 – $47.00 1
Azathioprine parenteral HCPCS J7501 $250.80 $418.00 $418.00 – $418.00 1
Azithromycin 500 mg intravenous solution HCPCS J0456 $4.80 $8.00 $5.00 – $5.00 1
Aztreonam 1 gram solution for injection HCPCS J0457 $60.60 $101.00 $101.00 – $101.00 1
B cells total count CPT 86355 $81.00 $135.00 $135.00 – $135.00 1
Baclofen 2,000 mcg/ml intrathecal solution (wrapper) HCPCS J0475 $1,134.00 $1,890.00 $472.00 – $472.00 1
Baclofen 50 mcg/ml intrathecal solution (wrapper) HCPCS J0476 $197.40 $329.00 $329.00 – $329.00 1
Baclofen eval charges CPT 97750 $41.40 $69.00 $69.00 – $69.00 1
Bacterial meningitis antigen CPT 86403 $24.00 $40.00 $40.00 – $40.00 1
Bacterial vaginosis pcr CPT 87801 $194.40 $324.00 $324.00 – $324.00 1
Bag urine leg fbrc strap 32oz flipflo anti-reflux valve HCPCS A4358 $42.00 $70.00 $70.00 – $70.00 1
Balloon dilate urtrl strix CPT 50706 $0.60 $1.00 $1.00 – $1.00 1
Bendamustine 25 mg/ml intravenous solution (bendeka) HCPCS J9034 $24.00 $40.00 $40.00 – $40.00 1
Beta 2 glycoprotein 1 antibody iga CPT 86146 $32.40 $54.00 $54.00 – $54.00 1
Beta-2 microglobulin CPT 82232 $24.00 $40.00 $40.00 – $40.00 1
Betamethasone acetate and sodium phos 6 mg/ml suspension for injection HCPCS J0702 $39.00 $65.00 $65.00 – $65.00 1
Bevacizumab 25 mg/ml intravenous solution HCPCS J9035 $3,732.00 $6,220.00 $1,483.00 – $1,483.00 1
Bevacizumab-awwb 25 mg/ml intravenous solution HCPCS Q5107 $3,154.20 $5,257.00 $1,314.00 – $1,314.00 1
Bevacizumab-bvzr 25 mg/ml intravenous solution HCPCS Q5118 $620.40 $1,034.00 $108.00 – $108.00 1
Biliary endoscopy thru skin CPT 47553 $0.60 $1.00 $1.00 – $1.00 1
Biliary endoscopy thru skin CPT 47554 $0.60 $1.00 $1.00 – $1.00 1
Biliary endoscopy thru skin CPT 47555 $0.60 $1.00 $1.00 – $1.00 1
Biliary endoscopy thru skin CPT 47556 $0.60 $1.00 $1.00 – $1.00 1
Bilirubin direct CPT 82248 $9.60 $16.00 $16.00 – $16.00 1
Bilirubin total CPT 82247 $9.60 $16.00 $16.00 – $16.00 1
Biopsy abdominal mass CPT 49180 $0.60 $1.00 $1.00 – $1.00 1
Biopsy bone trocar/needle superficial CPT 20220 $0.60 $1.00 $1.00 – $1.00 1
Biopsy muscle percutaneous needle CPT 20206 $0.60 $1.00 $1.00 – $1.00 1
Biopsy needle liver percutaneous CPT 47000 $0.60 $1.00 $1.00 – $1.00 1
Biopsy needle lymph node superficial CPT 38505 $0.60 $1.00 $1.00 – $1.00 1
Biopsy of heart lining CPT 93505 $0.60 $1.00 $1.00 – $1.00 1
Biopsy of prostate CPT 55700 $0.60 $1.00 $1.00 – $1.00 1
Biopsy renal percutaneous trocar/needle (both sides) CPT 50200 $0.60 $1.00 $1.00 – $1.00 1
Biopsy(ies) & aspiration(s) bone marrow diagnostic (both sides) CPT 38222 $996.00 $1,660.00 $1,660.00 – $1,660.00 1
Bivalirudin HCPCS J0583 $94.80 $158.00 $153.00 – $153.00 1
Bleomycin 15 unit solution for injection HCPCS J9040 $48.00 $80.00 $59.00 – $59.00 1
Bln 1.2 mono emrg 15x1.2 HCPCS C1725 $3,525.00 $5,875.00 $127.00 – $127.00 1
Bln 30frx10mmx12cm renal nephromax HCPCS C1726 $1,200.00 $2,000.00 $525.00 – $525.00 1
Bln dil 900ml preperitnl HCPCS C1727 $2,203.20 $3,672.00 $3,672.00 – $3,672.00 1
Bln inpact admiral 4x150x130cm HCPCS C2623 $4,003.20 $6,672.00 $2,801.00 – $2,801.00 1
Bln press regulation 71-80cm HCPCS C1815 $10,432.80 $17,388.00 $7,956.00 – $7,956.00 1
Bln stent lg 19mm diam 10-12mm palmaz gen trnshpat unmtd HCPCS C1877 $1,683.00 $2,805.00 $1,559.00 – $1,559.00 1
Bln ureth 5ml 28f 2wy ltx st HCPCS A4338 $101.40 $169.00 $54.00 – $54.00 1
Blood Clotting (PT/INR) Test CPT 85610 $12.60 $21.00 $21.00 – $21.00 1
Blood Clotting (PTT) Test CPT 85730 $12.60 $21.00 $21.00 – $21.00 1
Blood Count (CBC) Test CPT 85025 $16.20 $27.00 $27.00 – $27.00 1
Blood Count (CBC) Test (without differential) CPT 85027 $12.60 $21.00 $21.00 – $21.00 1
Blood Culture Test CPT 87040 $64.80 $108.00 $108.00 – $108.00 1
Blood draw capillary 36416 CPT 36416 $9.60 $16.00 $16.00 – $16.00 1
Blood gases o2 saturation direct measurement CPT 82805 $49.80 $83.00 $83.00 – $83.00 1
Blood gases ph venous CPT 82800 $24.00 $40.00 $40.00 – $40.00 1
Blood occult feces colorectal neoplasm screening qualitative CPT 82270 $7.80 $13.00 $13.00 – $13.00 1
Blood occult peroxidase activity qualitative gastric CPT 82271 $6.00 $10.00 $10.00 – $10.00 1
Blood smear microscopic w manual differential wbc count CPT 85007 $16.20 $27.00 $27.00 – $27.00 1
Blood typing abo CPT 86900 $6.00 $10.00 $10.00 – $10.00 1
Blood typing ag donor ea ag CPT 86902 $24.00 $40.00 $40.00 – $40.00 1
Blood typing patient serum CPT 86904 $19.20 $32.00 $32.00 – $32.00 1
Blood typing rbc ag non abo/rh ea CPT 86905 $24.00 $40.00 $40.00 – $40.00 1
Blood typing rh (d) CPT 86901 $6.00 $10.00 $10.00 – $10.00 1
Blood typing rh phenotype complete reference CPT 86906 $48.60 $81.00 $81.00 – $81.00 1
Blood, l/r, irradiated HCPCS P9056 $438.60 $731.00 $731.00 – $731.00 1
Bone Density Scan (DEXA) CPT 77080 $160.80 $268.00 $268.00 – $268.00 1
Bone marrow biopsyneedle/trocar 38221 CPT 38221 $0.60 $1.00 $1.00 – $1.00 1
Bone/joint imaging ltd area CPT 78300 $161.40 $269.00 $269.00 – $269.00 1
Boot heel care softcare one sz HCPCS E0191 $100.20 $167.00 $167.00 – $167.00 1
Boot walker genesis full shell 3-strap s HCPCS L4360 $103.20 $172.00 $172.00 – $172.00 1
Borrelia burgdorferi (lyme disease) antibody nonspecific CPT 86618 $40.20 $67.00 $67.00 – $67.00 1
Bortezomib 3.5 mg (2.5 mg/ml) solution for subcutaneous injection HCPCS J9041 $1,923.60 $3,206.00 $3,206.00 – $3,206.00 1
Bowel imaging CPT 78290 $318.60 $531.00 $531.00 – $531.00 1
Brace afo lg left 6607 HCPCS L1930 $40.80 $68.00 $68.00 – $68.00 1
Brace ankle stablizing lg HCPCS L1902 $60.60 $101.00 $101.00 – $101.00 1
Brace back pinnacle lo 627 lumbar HCPCS L0627 $673.20 $1,122.00 $617.00 – $617.00 1
Brace back pinnacle tlso 464 HCPCS L0464 $1,009.80 $1,683.00 $953.00 – $953.00 1
Brace knee extender plus 22-30in HCPCS L1832 $504.60 $841.00 $291.00 – $291.00 1
Brace knee support neoprene padded open patella med HCPCS L1810 $243.60 $406.00 $66.00 – $66.00 1
Brace ortho exos 28-50in sm HCPCS L0637 $423.60 $706.00 $706.00 – $706.00 1
Brace ortho tlso 2xl 19in strnl y bar wst belt pd shldr HCPCS L0456 $571.80 $953.00 $953.00 – $953.00 1
Brace oths wrist hnd fngr without HCPCS L3807 $31.20 $52.00 $52.00 – $52.00 1
Brace tlso flex cust HCPCS L0450 $289.20 $482.00 $482.00 – $482.00 1
Brach/thor cath 1st CPT 36215 $0.60 $1.00 $1.00 – $1.00 1
Brach/thor cath 2nd CPT 36216 $0.60 $1.00 $1.00 – $1.00 1
Brach/thor cath 3rd CPT 36217 $0.60 $1.00 $1.00 – $1.00 1
Brach/thor cath addl CPT 36218 $0.60 $1.00 $1.00 – $1.00 1
Brachytx isodose complex CPT 77318 $337.20 $562.00 $562.00 – $562.00 1
Brachytx isodose intermed CPT 77317 $247.20 $412.00 $412.00 – $412.00 1
Brachytx isodose plan simple CPT 77316 $192.60 $321.00 $321.00 – $321.00 1
Braf gene CPT 81210 $194.40 $324.00 $324.00 – $324.00 1
Brain MRA (blood vessel MRI, with and without contrast) CPT 70546 $843.00 $1,405.00 $1,405.00 – $1,405.00 1
Brain MRA (blood vessel MRI, with contrast) CPT 70545 $542.40 $904.00 $904.00 – $904.00 1
Brain MRA (blood vessel MRI, without contrast) CPT 70544 $547.80 $913.00 $913.00 – $913.00 1
Brain MRI (with and without contrast) CPT 70553 $436.20 $727.00 $727.00 – $727.00 1
Brain MRI (with contrast) CPT 70552 $382.80 $638.00 $638.00 – $638.00 1
Brain MRI (without contrast) CPT 70551 $259.20 $432.00 $432.00 – $432.00 1
Brain flow imaging only CPT 78610 $172.20 $287.00 $287.00 – $287.00 1
Brain image w/flow 4 + views CPT 78606 $318.60 $531.00 $531.00 – $531.00 1
Breast Biopsy (ultrasound-guided, percutaneous) CPT 19083 $357.60 $596.00 $596.00 – $596.00 1
Brentuximab vedotin 50 mg intravenous solution HCPCS J9042 $13,562.40 $22,604.00 $22,604.00 – $22,604.00 1
Bronchial challenge CPT 94070 $276.00 $460.00 $460.00 – $460.00 1
Bumetanide in d5w IV syringe 0.04 mg/ml (neo/ped) - cnr HCPCS J1939 $2.40 $4.00 $4.00 – $4.00 1
Bundle his recording CPT 93600 $0.60 $1.00 $1.00 – $1.00 1
Bundled special stain group 1 microorganisms CPT 88312 $24.00 $40.00 $40.00 – $40.00 1
Bundled special stain group 2 CPT 88313 $16.20 $27.00 $27.00 – $27.00 1
Buprenorphine and metabolite - sendout CPT 80348 $64.80 $108.00 $108.00 – $108.00 1
Bur rotalink 2.15mm HCPCS C1724 $6,330.00 $10,550.00 $7,294.00 – $7,294.00 1
Bx bone trocar/ndl deep CPT 20225 $0.60 $1.00 $1.00 – $1.00 1
Bx breast 1st lesion mr imag CPT 19085 $754.20 $1,257.00 $1,257.00 – $1,257.00 1
Bx breast 1st lesion strtctc CPT 19081 $607.80 $1,013.00 $1,013.00 – $1,013.00 1
Bx breast add lesion Ultrasound imag CPT 19084 $214.20 $357.00 $357.00 – $357.00 1
Bx breast add lesion mr imag CPT 19086 $76.20 $127.00 $127.00 – $127.00 1
Bx breast add lesion strtctc CPT 19082 $303.60 $506.00 $506.00 – $506.00 1
Bx breast perq without image 19100 CPT 19100 $178.80 $298.00 $298.00 – $298.00 1
Bx liver with other CPT 47001 $0.60 $1.00 $1.00 – $1.00 1
Bx pancreas pq ndl CPT 48102 $0.60 $1.00 $1.00 – $1.00 1
Bx pleura pq ndl CPT 32400 $0.60 $1.00 $1.00 – $1.00 1
Bx skin punch ea sep/ addl les CPT 11105 $0.60 $1.00 $1.00 – $1.00 1
Bx spinal cord pq ndl CPT 62269 $0.60 $1.00 $1.00 – $1.00 1
Bx thyroid/percutan core needle 60100 CPT 60100 $0.60 $1.00 $1.00 – $1.00 1
C-Section Delivery (full care) CPT 59510 $5,346.60 $8,911.00 $4,335.00 – $4,335.00 1
C-peptide CPT 84681 $24.00 $40.00 $40.00 – $40.00 1
C-reactive protein CPT 86140 $24.00 $40.00 $40.00 – $40.00 1
C-reactive protein high sensitivity CPT 86141 $25.80 $43.00 $43.00 – $43.00 1
C-reactive protein, quantitative CPT 86406 $48.60 $81.00 $81.00 – $81.00 1
C1 esterase inhibitor func - sendout CPT 86161 $40.20 $67.00 $67.00 – $67.00 1
CT Angiogram of Abdomen and Pelvis CPT 74174 $232.80 $388.00 $388.00 – $388.00 1
CT Angiogram of the Chest (for blood clot) CPT 71275 $175.80 $293.00 $293.00 – $293.00 1
CT Angiogram of the Head CPT 70496 $172.80 $288.00 $288.00 – $288.00 1
CT Scan of Abdomen and Pelvis (with and without contrast) CPT 74178 $211.80 $353.00 $353.00 – $353.00 1
CT Scan of Abdomen and Pelvis (with contrast) CPT 74177 $184.80 $308.00 $308.00 – $308.00 1
CT Scan of Abdomen and Pelvis (without contrast) CPT 74176 $95.40 $159.00 $159.00 – $159.00 1
CT angio hrt w/3d image CPT 75574 $253.80 $423.00 $423.00 – $423.00 1
CT angio pelvis CPT 72191 $202.80 $338.00 $298.00 – $298.00 1
CT guid parench tis ablat CPT 77013 $0.60 $1.00 $1.00 – $1.00 1
CT guidance for needle placement CPT 77012 $0.60 $1.00 $1.00 – $1.00 1
CT guidance for percutaneous drain w/catheter placement supervision & interpretation CPT 75989 $0.60 $1.00 $1.00 – $1.00 1
CT heart w/evaluation of calcium without contrast CPT 75571 $59.40 $99.00 $99.00 – $99.00 1
CT hrt c+ strux cgen hrt ds CPT 75573 $220.80 $368.00 $368.00 – $368.00 1
CT hrt w/3d image CPT 75572 $163.80 $273.00 $273.00 – $273.00 1
CT limited or localized follow-up study CPT 76380 $80.40 $134.00 $74.00 – $74.00 1
CT lower extremity w/contrast (both sides) CPT 73701 $140.40 $234.00 $124.00 – $124.00 1
CT lower extremity without contrast (both sides) CPT 73700 $107.40 $179.00 $99.00 – $99.00 1
CT lwr extremity w/o&w/dye CPT 73702 $178.80 $298.00 $164.00 – $164.00 1
CT neck soft tissue w/contrast CPT 70491 $140.40 $234.00 $234.00 – $234.00 1
CT neck soft tissue without & w/contrast CPT 70492 $172.80 $288.00 $288.00 – $288.00 1
CT neck soft tissue without contrast CPT 70490 $107.40 $179.00 $179.00 – $179.00 1
CT orbit/sella/ or posterior outer inner or middle ear w/contrast CPT 70481 $172.80 $288.00 $139.00 – $139.00 1
CT orbit/sella/ or posterior outer inner or middle ear without contrast CPT 70480 $140.40 $234.00 $234.00 – $234.00 1
CT orbit/sella/fossa w/wo contrast CPT 70482 $190.80 $318.00 $179.00 – $179.00 1
CT t-spine w /wo contrast CPT 72130 $172.80 $288.00 $288.00 – $288.00 1
CT thoracic spine w/contrast CPT 72129 $140.40 $234.00 $234.00 – $234.00 1
CT thoracic spine without contrast CPT 72128 $107.40 $179.00 $99.00 – $99.00 1
CT thorax low dose for lung screening without contrast CPT 71271 $107.40 $179.00 $179.00 – $179.00 1
CT upper extremity w/contrast (both sides) CPT 73201 $137.40 $229.00 $124.00 – $124.00 1
CT upper extremity without contrast (both sides) CPT 73200 $107.40 $179.00 $99.00 – $99.00 1
CT uppr extremity w/o&w/dye CPT 73202 $98.40 $164.00 $164.00 – $164.00 1
Cabazitaxel 10 mg/ml (first dilution) intravenous solution HCPCS J9043 $15,841.20 $26,402.00 $26,402.00 – $26,402.00 1
Cable cath 22-pin diag HCPCS C1730 $495.00 $825.00 $190.00 – $190.00 1
Cadd pump refill CPT 96521 $175.80 $293.00 $293.00 – $293.00 1
Calcium 24 hour urine CPT 82340 $16.20 $27.00 $27.00 – $27.00 1
Calcium gluconate 2 gram/100 ml in sodium chloride,iso-osm IV solution HCPCS J0613 $10.80 $18.00 $18.00 – $18.00 1
Calcium ionized CPT 82330 $24.00 $40.00 $40.00 – $40.00 1
Calcium total CPT 82310 $3.00 $5.00 $5.00 – $5.00 1
Calculi urinary-sendout CPT 82360 $64.80 $108.00 $108.00 – $108.00 1
Calprotectin fecal CPT 83993 $24.00 $40.00 $40.00 – $40.00 1
Candida dna CPT 87480 $194.40 $324.00 $324.00 – $324.00 1
Cap nerve 2x15mm HCPCS C1763 $4,846.80 $8,078.00 $1,339.00 – $1,339.00 1
Cap trach decann 15mm HCPCS C1750 $543.00 $905.00 $540.00 – $540.00 1
Carbamazepine total therapeutic drug level CPT 80156 $24.00 $40.00 $40.00 – $40.00 1
Carbon dioxide CPT 82374 $3.00 $5.00 $5.00 – $5.00 1
Carboplatin 10 mg/ml desensitization HCPCS J9045 $2.40 $4.00 $1.00 – $1.00 1
Carcinoembryonic ag (cea) CPT 82378 $40.20 $67.00 $67.00 – $67.00 1
Card MRI veloc flow mapping CPT 75565 $70.20 $117.00 $117.00 – $117.00 1
Cardiac Stress Test CPT 93015 $0.60 $1.00 $1.00 – $1.00 1
Cardiac perf spect sgl/ef/wm rst/strs CPT 78451 $293.40 $489.00 $489.00 – $489.00 1
Cardiac rehabilitation op phase 2 w/continous ecg monitoring CPT 93798 $146.40 $244.00 $244.00 – $244.00 1
Cardiolipin antibody iga CPT 86147 $32.40 $54.00 $54.00 – $54.00 1
Cardioversion elective electrical conversion arrhythmia external CPT 92960 $298.80 $498.00 $1.00 – $1.00 1
Carfilzomib 10 mg intravenous solution HCPCS J9047 $3,574.20 $5,957.00 $5,957.00 – $5,957.00 1
Carmustine 100 mg intravenous powder for solution HCPCS J9050 $2,407.80 $4,013.00 $4,013.00 – $4,013.00 1
Carotene CPT 82380 $40.20 $67.00 $67.00 – $67.00 1
Carotid Artery Ultrasound (Duplex) CPT 93880 $822.00 $1,370.00 $1,370.00 – $1,370.00 1
Cath 2lum 14.5frx43cm maxid kt mahurkar HCPCS C1752 $799.20 $1,332.00 $316.00 – $316.00 1
Cath ablat bi-d d-d 8fr 115cm HCPCS C2630 $705.60 $1,176.00 $729.00 – $729.00 1
Cath ablt clsfast 7fx100cmx HCPCS C1888 $705.60 $1,176.00 $1,176.00 – $1,176.00 1
Cath acuity innr ic130 6f 63cm HCPCS C1887 $3,488.40 $5,814.00 $17.00 – $17.00 1
Cath acunav ge 10frx90cm HCPCS C1759 $1,402.80 $2,338.00 $2,338.00 – $2,338.00 1
Cath adherent clot 10mm 6f 10 HCPCS C1757 $17,505.60 $29,176.00 $117.00 – $117.00 1
Cath baloon occl urnry 34f 7x2x65 HCPCS C2628 $1,703.40 $2,839.00 $222.00 – $222.00 1
Cath blazer dx/20 2-10-2 space HCPCS C1731 $2,019.60 $3,366.00 $3,366.00 – $3,366.00 1
Cath combo lt&rt heart w/inj/s CPT 93453 $0.60 $1.00 $1.00 – $1.00 1
Cath council tip 16fr 5cc HCPCS A4344 $59.40 $99.00 $99.00 – $99.00 1
Cath cv dl inj 7fx16cm HCPCS C1751 $720.60 $1,201.00 $62.00 – $62.00 1
Cath del ampltz 12f 45d 80cm HCPCS C1893 $2,010.00 $3,350.00 $238.00 – $238.00 1
Cath follower heyman 20f HCPCS A4352 $50.40 $84.00 $54.00 – $54.00 1
Cath groshong MRI 8fr plstc port HCPCS C1788 $1,153.20 $1,922.00 $404.00 – $404.00 1
Cath hawkone s directional HCPCS C1714 $2,362.80 $3,938.00 $630.00 – $630.00 1
Cath imag ivus pv 8.5fx90 .035 HCPCS C1753 $7,839.60 $13,066.00 $2,019.00 – $2,019.00 1
Cath left heart transseptal punc CPT 93462 $0.60 $1.00 $1.00 – $1.00 1
Cath left heart/lv gram CPT 93452 $0.60 $1.00 $1.00 – $1.00 1
Cath lt/rt pulm art CPT 36014 $0.60 $1.00 $1.00 – $1.00 1
Cath malecot 28fr 4-wing ltx HCPCS C1729 $1,562.40 $2,604.00 $22.00 – $22.00 1
Cath occl flo-rester 2.25x12mm cor internal vessel occluder HCPCS C1817 $9,007.20 $15,012.00 $13,900.00 – $13,900.00 1
Cath place 1st order venous 36011 CPT 36011 $0.60 $1.00 $1.00 – $1.00 1
Cath plc art ang/grft lt/rt hr CPT 93461 $0.60 $1.00 $1.00 – $1.00 1
Cath plc art/angio/rt hrt cath CPT 93456 $0.60 $1.00 $1.00 – $1.00 1
Cath plc art/grft/angio right hrt CPT 93457 $0.60 $1.00 $1.00 – $1.00 1
Cath right heart w/o2 sat & card CPT 93451 $0.60 $1.00 $1.00 – $1.00 1
Cath right hrt mnpul art CPT 36013 $0.60 $1.00 $1.00 – $1.00 1
Cath segmntl pulm art CPT 36015 $0.60 $1.00 $1.00 – $1.00 1
Cath steerable flex adv 12f HCPCS C1766 $883.20 $1,472.00 $99.00 – $99.00 1
Cath uret open tp 6fx70cm HCPCS C1758 $381.00 $635.00 $200.00 – $200.00 1
Catheter declot mechanical CPT 36596 $0.60 $1.00 $1.00 – $1.00 1
Catheter stripping venous CPT 36595 $0.60 $1.00 $1.00 – $1.00 1
Cdna analysis for variants CPT 81403 $487.20 $812.00 $812.00 – $812.00 1
Cefazolin 10 mg/10 ml (dilution #2) IV desensitization - cnr HCPCS J0690 $10.80 $18.00 $2.00 – $2.00 1
Cefepime 1 gram solution for injection HCPCS J0692 $6.00 $10.00 $5.00 – $5.00 1
Cefoxitin 1 gram intravenous solution HCPCS J0694 $6.00 $10.00 $5.00 – $5.00 1
Ceftaroline fosamil 600 mg intravenous solution HCPCS J0712 $249.00 $415.00 $316.00 – $316.00 1
Ceftazidime 4.5 mg/0.2 ml intraocular injection - cnr HCPCS J0713 $6.60 $11.00 $5.00 – $5.00 1
Ceftazidime and avibactam HCPCS J0714 $430.20 $717.00 $717.00 – $717.00 1
Ceftriaxone 1 gram solution for injection HCPCS J0696 $18.00 $30.00 $1.00 – $1.00 1
Cefuroxime in ns IV syringe 30 mg/ml (neo/ped) - cnr HCPCS J0697 $3.60 $6.00 $4.00 – $4.00 1
Cell count body fluid CPT 89050 $32.40 $54.00 $54.00 – $54.00 1
Cell count w differential body fluid CPT 89051 $40.20 $67.00 $67.00 – $67.00 1
Cell marker study CPT 88182 $243.60 $406.00 $406.00 – $406.00 1
Cemiplimab-rwlc 50 mg/ml intravenous solution HCPCS J9119 $10,920.00 $18,200.00 $18,200.00 – $18,200.00 1
Cetuximab 100 mg/50 ml intravenous solution HCPCS J9055 $775.20 $1,292.00 $1,292.00 – $1,292.00 1
Change cystostomy tube simple CPT 51705 $0.60 $1.00 $1.00 – $1.00 1
Change nephroureteral cath CPT 50387 $0.60 $1.00 $1.00 – $1.00 1
Change stent via transureth CPT 50385 $0.60 $1.00 $1.00 – $1.00 1
Change ureter stent percut CPT 50382 $0.60 $1.00 $1.00 – $1.00 1
Chemo adm cns w/lmbr punct CPT 96450 $351.60 $586.00 $586.00 – $586.00 1
Chemo extend IV infus w/pump HCPCS G0498 $527.40 $879.00 $879.00 – $879.00 1
Chemotherapy injection 96542 CPT 96542 $175.80 $293.00 $293.00 – $293.00 1
Chest 2 vws w oblique CPT 71048 $124.80 $208.00 $208.00 – $208.00 1
Chest CT scan (with and without contrast) CPT 71270 $172.80 $288.00 $164.00 – $164.00 1
Chest CT scan (with contrast) CPT 71260 $140.40 $234.00 $234.00 – $234.00 1
Chest CT scan (without contrast) CPT 71250 $107.40 $179.00 $179.00 – $179.00 1
Chest X-ray CPT 71046 $89.40 $149.00 $49.00 – $49.00 1
Chest X-ray (single view) CPT 71045 $71.40 $119.00 $119.00 – $119.00 1
Chest apical lordotic proj CPT 71047 $124.80 $208.00 $178.00 – $178.00 1
Chg pr pul rehab for copd patients CPT 94626 $58.80 $98.00 $98.00 – $98.00 1
Chg radiologic exam esophagus double contrast CPT 74221 $375.00 $625.00 $625.00 – $625.00 1
Chlamydia culture CPT 87110 $49.80 $83.00 $83.00 – $83.00 1
Chlamydia type CPT 87140 $32.40 $54.00 $54.00 – $54.00 1
Chlnggrphy intraop addl s&i CPT 74301 $0.60 $1.00 $1.00 – $1.00 1
Chloride CPT 82435 $3.00 $5.00 $5.00 – $5.00 1
Chloride 24 hour urine CPT 82436 $16.20 $27.00 $27.00 – $27.00 1
Chloroprocaine hcl injection HCPCS J2401 $22.80 $38.00 $31.00 – $31.00 1
Chlorothiazide sodium 500 mg intravenous solution HCPCS J1205 $48.00 $80.00 $80.00 – $80.00 1
Chmotx admn plrl cav thrcnts CPT 96440 $351.60 $586.00 $586.00 – $586.00 1
Cholangiogram percutaneous compl CPT 47532 $0.60 $1.00 $1.00 – $1.00 1
Cholangiography and/or pancreatography intraoperative supervision & interpretation CPT 74300 $0.60 $1.00 $1.00 – $1.00 1
Cholecystostomy complete w/supervision & interpretation CPT 47490 $0.60 $1.00 $1.00 – $1.00 1
Cholesterol CPT 82465 $6.00 $10.00 $10.00 – $10.00 1
Cholesterol (Lipid) Test CPT 80061 $30.60 $51.00 $51.00 – $51.00 1
Chromatography CPT 83021 $40.20 $67.00 $67.00 – $67.00 1
Chromosome analysis 15-20 cell count CPT 88262 $519.60 $866.00 $866.00 – $866.00 1
Chromosome analysis 5 CPT 88261 $202.80 $338.00 $338.00 – $338.00 1
Chromosome count additional CPT 88285 $32.40 $54.00 $54.00 – $54.00 1
Chromosome karyotype study CPT 88280 $32.40 $54.00 $54.00 – $54.00 1
Chylomicron screen, bf - sendout CPT 82664 $40.20 $67.00 $67.00 – $67.00 1
Cilastatin sodium injection HCPCS J0743 $11.40 $19.00 $19.00 – $19.00 1
Cinacalcet 30 mg tablet HCPCS J0604 $93.60 $156.00 $104.00 – $104.00 1
Ciprofloxacin 400 mg/200 ml in 5 % dextrose intravenous piggyback HCPCS J0744 $1.20 $2.00 $2.00 – $2.00 1
Circumcision (newborn) CPT 54150 $433.20 $722.00 $722.00 – $722.00 1
Cisplatin 1 mg/ml desensitization HCPCS J9060 $1.20 $2.00 $2.00 – $2.00 1
Cladribine 10 mg/10 ml intravenous solution HCPCS J9065 $128.40 $214.00 $214.00 – $214.00 1
Clamp isol transpolr 5mmx6.5cm transpolar HCPCS C1733 $2,157.00 $3,595.00 $3,006.00 – $3,006.00 1
Clearance of airways CPT 31720 $23.40 $39.00 $39.00 – $39.00 1
Clindamycin 600 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J0736 $6.00 $10.00 $3.00 – $3.00 1
Clip ligating vesolock lg HCPCS C1760 $451.20 $752.00 $111.00 – $111.00 1
Clot factor xii hageman CPT 85280 $97.20 $162.00 $162.00 – $162.00 1
Clot factor xiii fibrin stab CPT 85290 $97.20 $162.00 $162.00 – $162.00 1
Cmv pcr-sendout CPT 87496 $194.40 $324.00 $324.00 – $324.00 1
Co-treatment - group 15 mins, st CPT 92508 $45.60 $76.00 $76.00 – $76.00 1
Coagulation factor viia 1,000 mcg/ml inj 1 ml HCPCS J7189 $4,809.00 $8,015.00 $4,007.00 – $4,007.00 1
Cold agglutinin titer CPT 86157 $42.00 $70.00 $70.00 – $70.00 1
Colistimethate sodium inj HCPCS J0770 $12.00 $20.00 $20.00 – $20.00 1
Collar cerv ascend 172 reg HCPCS L0172 $106.80 $178.00 $178.00 – $178.00 1
Collection blood specimen from completely implantable venous access device CPT 36591 $234.00 $390.00 $390.00 – $390.00 1
Collection blood specimen using established central/peripheral catheter venous nos CPT 36592 $263.40 $439.00 $439.00 – $439.00 1
Collection of venous blood by venipuncture CPT 36415 $12.60 $21.00 $21.00 – $21.00 1
Compatibility test each unit antiglobulin technique CPT 86922 $16.20 $27.00 $27.00 – $27.00 1
Compatibility test each unit electronic CPT 86923 $9.60 $16.00 $16.00 – $16.00 1
Compatibility test each unit immediate spin technique CPT 86920 $12.60 $21.00 $21.00 – $21.00 1
Compatibility test incubate CPT 86921 $1.20 $2.00 $2.00 – $2.00 1
Complement antigen each component c3 CPT 86160 $40.20 $67.00 $67.00 – $67.00 1
Complement fixation each CPT 86171 $24.00 $40.00 $40.00 – $40.00 1
Concentration infection agents any type CPT 87015 $32.40 $54.00 $54.00 – $54.00 1
Connect omega .5mm HCPCS L8613 $55.80 $93.00 $59.00 – $59.00 1
Consultation pathology during surgery frozen section each additional block CPT 88332 $7.80 $13.00 $13.00 – $13.00 1
Consultation pathology during surgery frozen section first tissue block CPT 88331 $48.60 $81.00 $81.00 – $81.00 1
Contrast exam abdominl aorta 75625-26 CPT 75625 $0.60 $1.00 $1.00 – $1.00 1
Contrast exam thoracic aorta 75605-26 CPT 75605 $0.60 $1.00 $1.00 – $1.00 1
Contrast x-ray of knee joint CPT 73580 $0.60 $1.00 $1.00 – $1.00 1
Contrast x-ray of wrist CPT 73115 $0.60 $1.00 $1.00 – $1.00 1
Controller infinity pt dbs HCPCS C1787 $2,937.60 $4,896.00 $2,618.00 – $2,618.00 1
Conversion ext bil drg cath CPT 47535 $0.60 $1.00 $1.00 – $1.00 1
Convert nephrostomy catheter CPT 50434 $0.60 $1.00 $1.00 – $1.00 1
Coombs direct CPT 86880 $12.60 $21.00 $21.00 – $21.00 1
Coombs indirect qualitative each reagent red cell reference CPT 86885 $19.20 $32.00 $32.00 – $32.00 1
Coombs indirect titer reference CPT 86886 $51.60 $86.00 $86.00 – $86.00 1
Core ndl bx lng/med perq CPT 32408 $0.60 $1.00 $1.00 – $1.00 1
Coronary angio/cath placement bypass graft/lv gram/lt heart CPT 93459 $0.60 $1.00 $1.00 – $1.00 1
Coronary angio/lv gram/lt heart CPT 93458 $0.60 $1.00 $1.00 – $1.00 1
Coronary angio/lv gram/rt&lt heart CPT 93460 $0.60 $1.00 $1.00 – $1.00 1
Coronary art/grft angio s&i CPT 93455 $0.60 $1.00 $1.00 – $1.00 1
Coronary catheterization w/angiography supervision & interpretation CPT 93454 $0.60 $1.00 $1.00 – $1.00 1
Cortisol total am CPT 82533 $24.00 $40.00 $40.00 – $40.00 1
Cosyntropin 0.25 mg solution for injection HCPCS J0834 $20.40 $34.00 $34.00 – $34.00 1
Counseling smoke cess interm >10mins CPT 99407 $31.80 $53.00 $53.00 – $53.00 1
Crbrospnl fld flw imag cistern CPT 78630 $326.40 $544.00 $544.00 – $544.00 1
Creatine kinase CPT 82550 $9.60 $16.00 $16.00 – $16.00 1
Creatine kinase isoenzymes CPT 82552 $40.20 $67.00 $67.00 – $67.00 1
Creatine kinase mb CPT 82553 $24.00 $40.00 $40.00 – $40.00 1
Creatinine CPT 82565 $3.00 $5.00 $5.00 – $5.00 1
Creatinine 24 hour urine CPT 82570 $16.20 $27.00 $27.00 – $27.00 1
Creatinine clearance urine CPT 82575 $19.20 $32.00 $32.00 – $32.00 1
Crisis psychotherapy 90839 CPT 90839 $263.40 $439.00 $439.00 – $439.00 1
Crisis psychotherapy additional 30 mins 90840 CPT 90840 $146.40 $244.00 $244.00 – $244.00 1
Crotalidae poly immune fab HCPCS J0840 $3,408.60 $5,681.00 $5,681.00 – $5,681.00 1
Crutches underarm other than wood adjustable or e0114 HCPCS E0114 $34.20 $57.00 $57.00 – $57.00 1
Cryofibrinogen qualitative - sendout CPT 82585 $22.20 $37.00 $37.00 – $37.00 1
Cryptococcus abs qn - sendout CPT 86641 $76.20 $127.00 $127.00 – $127.00 1
Crystal identification light microscopy CPT 89060 $24.00 $40.00 $40.00 – $40.00 1
Cta abdomen without & /or w/contrast CPT 74175 $181.80 $303.00 $303.00 – $303.00 1
Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast CPT 75635 $220.80 $368.00 $348.00 – $348.00 1
Cta lower extremity without & w/contrast (both sides) CPT 73706 $217.80 $363.00 $363.00 – $363.00 1
Cta neck without &/or w/contrast CPT 70498 $169.80 $283.00 $164.00 – $164.00 1
Cta upper extremity w &/or without contrast left CPT 73206 $202.80 $338.00 $333.00 – $333.00 1
Culture aerobic additional method definitive id each CPT 87077 $16.20 $27.00 $27.00 – $27.00 1
Culture afb any source CPT 87116 $97.20 $162.00 $162.00 – $162.00 1
Culture anaerobic additional method definitive id each CPT 87076 $16.20 $27.00 $27.00 – $27.00 1
Culture anaerobic except blood CPT 87075 $64.80 $108.00 $108.00 – $108.00 1
Culture bact stool aero addl path ea CPT 87046 $16.20 $27.00 $27.00 – $27.00 1
Culture body fluid CPT 87070 $64.80 $108.00 $108.00 – $108.00 1
Culture fungi definitive id mold CPT 87107 $16.20 $27.00 $27.00 – $27.00 1
Culture fungi definitive id yeast CPT 87106 $16.20 $27.00 $27.00 – $27.00 1
Culture fungi other (except blood) CPT 87102 $40.20 $67.00 $67.00 – $67.00 1
Culture fungi skin/hair/nail CPT 87101 $40.20 $67.00 $67.00 – $67.00 1
Culture mycobacteria definitive id each isolate CPT 87118 $123.00 $205.00 $205.00 – $205.00 1
Culture mycoplasma any source CPT 87109 $49.80 $83.00 $83.00 – $83.00 1
Culture quantitative aerobic other source CPT 87071 $64.80 $108.00 $108.00 – $108.00 1
Culture screening strep group a CPT 87081 $32.40 $54.00 $54.00 – $54.00 1
Culture typing nucleic acid probe amplified per culture/isolate each organism CPT 87150 $40.20 $67.00 $67.00 – $67.00 1
Culture virus isolation CPT 87250 $162.00 $270.00 $270.00 – $270.00 1
Cutter lead HCPCS C1773 $3,494.40 $5,824.00 $977.00 – $977.00 1
Cv line/pic reposition CPT 36597 $0.60 $1.00 $1.00 – $1.00 1
Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 $2.40 $4.00 $4.00 – $4.00 1
Cyanocobalamin unsat binding capacity CPT 82608 $37.20 $62.00 $62.00 – $62.00 1
Cyclic citrullinated peptide antibody CPT 86200 $40.20 $67.00 $67.00 – $67.00 1
Cyclophosphamide 1 gram intravenous powder for solution HCPCS J9075 $39.00 $65.00 $59.00 – $59.00 1
Cyclosporine 2 hour CPT 80158 $32.40 $54.00 $54.00 – $54.00 1
Cylinder pump set 20cm titan zero angl HCPCS C1813 $17,175.60 $28,626.00 $7,113.00 – $7,113.00 1
Cystatin c CPT 82610 $81.00 $135.00 $135.00 – $135.00 1
Cystine urine quantitative CPT 82131 $97.20 $162.00 $162.00 – $162.00 1
Cystogram >= 3 views supervision & interpretation CPT 74430 $0.60 $1.00 $1.00 – $1.00 1
Cytarabine 20 mg/ml injection solution HCPCS J9100 $8.40 $14.00 $14.00 – $14.00 1
Cytomegalovirus (cmv) antibody igg CPT 86644 $24.00 $40.00 $40.00 – $40.00 1
Cytomegalovirus (cmv) antibody igm CPT 86645 $40.20 $67.00 $67.00 – $67.00 1
Cytomegalovirus dfa CPT 87271 $40.20 $67.00 $67.00 – $67.00 1
Cytopath smear oth prep screen & interp CPT 88161 $113.40 $189.00 $189.00 – $189.00 1
Cytopath smear other source CPT 88160 $48.60 $81.00 $81.00 – $81.00 1
Cytopath tbs c/v manual CPT 88164 $32.40 $54.00 $54.00 – $54.00 1
Cytopathology cervical/vaginal thin layer manual screening CPT 88142 $64.80 $108.00 $108.00 – $108.00 1
Cytopathology concentration technique smears & interpretation CPT 88108 $113.40 $189.00 $189.00 – $189.00 1
Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 $48.60 $81.00 $81.00 – $81.00 1
Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 $145.80 $243.00 $243.00 – $243.00 1
Dacarbazine 100 mg intravenous solution HCPCS J9130 $10.80 $18.00 $18.00 – $18.00 1
Dalbavancin 500 mg intravenous solution HCPCS J0875 $18.00 $30.00 $30.00 – $30.00 1
Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 $21.00 $35.00 $35.00 – $35.00 1
Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln HCPCS J9144 $9,477.00 $15,795.00 $15,795.00 – $15,795.00 1
Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe HCPCS J0881 $2,336.40 $3,894.00 $77.00 – $77.00 1
Daunorubicin 5 mg/ml intravenous solution HCPCS J9150 $107.40 $179.00 $179.00 – $179.00 1
Dch validity tests CPT 81002 $6.00 $10.00 $10.00 – $10.00 1
Debridement (>20 cm) charge pt CPT 97598 $91.20 $152.00 $152.00 – $152.00 1
Decalcification CPT 88311 $7.80 $13.00 $13.00 – $13.00 1
Decitabine 50 mg intravenous solution HCPCS J0894 $108.00 $180.00 $180.00 – $180.00 1
Declotting thrombolytic agent implanted vas access device 36 CPT 36593 $292.80 $488.00 $1.00 – $1.00 1
Deep muscle biopsy 20205 CPT 20205 $0.60 $1.00 $1.00 – $1.00 1
Deferoxamine 500 mg solution for injection HCPCS J0895 $27.00 $45.00 $21.00 – $21.00 1
Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 $23.40 $39.00 $39.00 – $39.00 1
Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution HCPCS J0897 $24.00 $40.00 $40.00 – $40.00 1
Des thora aorta rpr without left sub art 33881 CPT 33881 $0.60 $1.00 $1.00 – $1.00 1
Descend thora aorta rpr/lt sub art 33880 CPT 33880 $0.60 $1.00 $1.00 – $1.00 1
Design mlc device for imrt CPT 77338 $475.80 $793.00 $793.00 – $793.00 1
Desmopressin 4 mcg/ml injection solution HCPCS J2597 $357.60 $596.00 $596.00 – $596.00 1
Desoxycorticosterone CPT 82633 $40.20 $67.00 $67.00 – $67.00 1
Destroy cervthor facet jnt 64633 CPT 64633 $0.60 $1.00 $1.00 – $1.00 1
Destroy cth facet jnt addl 64634 CPT 64634 $0.60 $1.00 $1.00 – $1.00 1
Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 $0.60 $1.00 $1.00 – $1.00 1
Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 $0.60 $1.00 $1.00 – $1.00 1
Detect agent nos dna dir CPT 87797 $194.40 $324.00 $324.00 – $324.00 1
Detect agnt mult dna direc CPT 87800 $194.40 $324.00 $324.00 – $324.00 1
Developmental screen/score/document 96110 CPT 96110 $34.20 $57.00 $57.00 – $57.00 1
Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 $89.40 $149.00 $149.00 – $149.00 1
Dexamethasone 4 mg tablet HCPCS J8540 $0.60 $1.00 $1.00 – $1.00 1
Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 $397.80 $663.00 $663.00 – $663.00 1
Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 $0.60 $1.00 $1.00 – $1.00 1
Dhea-s (dehydroepiand sulfate) CPT 82627 $24.00 $40.00 $40.00 – $40.00 1
Diabetes (HbA1c) Test CPT 83036 $32.40 $54.00 $54.00 – $54.00 1
Diagnostic Mammogram (both breasts) CPT 77066 $607.80 $1,013.00 $1,013.00 – $1,013.00 1
Diagnostic Mammogram (one breast) CPT 77065 $464.40 $774.00 $774.00 – $774.00 1
Diagnostic digital breast tomosynthesis bil CPT 77062 $124.80 $208.00 $208.00 – $208.00 1
Diagnostic digital breast tomosynthesis unil CPT 77061 $124.80 $208.00 $208.00 – $208.00 1
Dialysis one evaluation CPT 90945 $150.00 $250.00 $250.00 – $250.00 1
Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 $35.40 $59.00 $32.00 – $32.00 1
Diffusing capacity CPT 94729 $65.40 $109.00 $109.00 – $109.00 1
Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 $3.60 $6.00 $6.00 – $6.00 1
Digoxin total therapeutic drug level CPT 80162 $24.00 $40.00 $40.00 – $40.00 1
Dilat xst trc ndurlgc px CPT 50436 $0.60 $1.00 $1.00 – $1.00 1
Dilat xst trc new access rcs CPT 50437 $0.60 $1.00 $1.00 – $1.00 1
Dilate biliary duct/ampulla CPT 47542 $0.60 $1.00 $1.00 – $1.00 1
Dimethyl sulfoxide 50% 50 ml HCPCS J1212 $644.40 $1,074.00 $1,074.00 – $1,074.00 1
Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 $0.60 $1.00 $1.00 – $1.00 1
Disability dlco CPT 94727 $62.40 $104.00 $104.00 – $104.00 1
Disaccharidases CPT 82657 $64.80 $108.00 $108.00 – $108.00 1
Discography cerv/thor spine CPT 72285 $0.60 $1.00 $1.00 – $1.00 1
Dissolve clot heart vessel CPT 92975 $0.60 $1.00 $1.00 – $1.00 1
Dna antibody native/double stranded CPT 86225 $49.80 $83.00 $83.00 – $83.00 1
Dna gardnerella CPT 87510 $194.40 $324.00 $324.00 – $324.00 1
Dna probe chlamydia CPT 87490 $72.60 $121.00 $121.00 – $121.00 1
Dna probe gc CPT 87590 $72.60 $121.00 $121.00 – $121.00 1
Dna trichomonas CPT 87660 $72.60 $121.00 $121.00 – $121.00 1
Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 $31.20 $52.00 $52.00 – $52.00 1
Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 $0.60 $1.00 $1.00 – $1.00 1
Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 $2.40 $4.00 $3.00 – $3.00 1
Doppler echo complete CPT 93320 $66.00 $110.00 $110.00 – $110.00 1
Doppler intravascular pressure flow initial vessel CPT 93571 $0.60 $1.00 $1.00 – $1.00 1
Doppler upper/lower extremity arteries complete bilateral CPT 93923 $571.80 $953.00 $953.00 – $953.00 1
Doppler upper/lower extremity arteries limited bilateral CPT 93922 $375.00 $625.00 $625.00 – $625.00 1
Doripenem 50 mg/ml inj 10 ml HCPCS J1267 $43.20 $72.00 $39.00 – $39.00 1
Dostarlimab-gxly 50 mg/ml intravenous solution HCPCS J9272 $279.00 $465.00 $465.00 – $465.00 1
Doxorubicin 2 mg/ml intravenous solution (wrapper) HCPCS J9000 $232.80 $388.00 $3.00 – $3.00 1
Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension HCPCS Q2050 $642.60 $1,071.00 $1,071.00 – $1,071.00 1
Drain cath image guided peri/retroperitoneal transvag/transrectal CPT 49407 $0.60 $1.00 $1.00 – $1.00 1
Drain cath image guided visceral pq CPT 49405 $0.60 $1.00 $1.00 – $1.00 1
Drainage of kidney lesion CPT 50390 $0.60 $1.00 $1.00 – $1.00 1
Droperidol 2.5 mg/ml injection solution HCPCS J1790 $7.80 $13.00 $13.00 – $13.00 1
Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 $573.00 $955.00 $955.00 – $955.00 1
Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 $237.60 $396.00 $204.00 – $204.00 1
Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 $423.60 $706.00 $706.00 – $706.00 1
Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 $10,534.20 $17,557.00 $17,557.00 – $17,557.00 1
Drug admin & hemodynmic meas CPT 93463 $0.60 $1.00 $1.00 – $1.00 1
Drug assay caffeine CPT 80155 $24.00 $40.00 $40.00 – $40.00 1
Drug of abuse screen urine CPT 80305 $16.20 $27.00 $27.00 – $27.00 1
Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 $103.80 $173.00 $173.00 – $173.00 1
Drvvt confirm - quest CPT 85597 $81.00 $135.00 $135.00 – $135.00 1
Ductogram sgl duct CPT 77053 $196.20 $327.00 $327.00 – $327.00 1
Dup scan/hemodialysis access 93990 CPT 93990 $679.20 $1,132.00 $1,132.00 – $1,132.00 1
Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 $732.60 $1,221.00 $1,221.00 – $1,221.00 1
Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 $840.00 $1,400.00 $1,400.00 – $1,400.00 1
Duplex scan bilateral study 93985 CPT 93985 $1,144.20 $1,907.00 $1,907.00 – $1,907.00 1
Duplex scan unilateral study 93986 CPT 93986 $643.20 $1,072.00 $1,072.00 – $1,072.00 1
Durvalumab 50 mg/ml intravenous solution HCPCS J9173 $1,036.80 $1,728.00 $789.00 – $789.00 1
ER Visit (level 1, minor) CPT 99281 $97.80 $163.00 $163.00 – $163.00 1
ER Visit (level 2) CPT 99282 $195.60 $326.00 $163.00 – $163.00 1
ER Visit (level 3) CPT 99283 $293.40 $489.00 $326.00 – $326.00 1
ER Visit (level 4) CPT 99284 $489.60 $816.00 $653.00 – $653.00 1
ER Visit (level 5, high severity) CPT 99285 $783.60 $1,306.00 $1,142.00 – $1,142.00 1
Ecg 12 lead tracing only CPT 93005 $79.20 $132.00 $132.00 – $132.00 1
Ecg external < 48 hours recording CPT 93225 $66.00 $110.00 $110.00 – $110.00 1
Ecg external < 48 hours scanning analysis w/report CPT 93226 $331.80 $553.00 $553.00 – $553.00 1
Ecg external > 48 hours up to 7 days recording CPT 93242 $66.00 $110.00 $110.00 – $110.00 1
Ecg external >7 days up to 15 days recording CPT 93246 $66.00 $110.00 $110.00 – $110.00 1
Ecg/1-3 leads/tracing only 93041 CPT 93041 $33.00 $55.00 $55.00 – $55.00 1
Echo guide for artery repair CPT 76936 $0.60 $1.00 $1.00 – $1.00 1
Echo stress CPT 93350 $398.40 $664.00 $664.00 – $664.00 1
Echo tee probe placement image acquisition interpretation & report CPT 93312 $398.40 $664.00 $664.00 – $664.00 1
Echo transthoracic CPT 93303 $298.80 $498.00 $498.00 – $498.00 1
Echo transthoracic CPT 93304 $132.60 $221.00 $221.00 – $221.00 1
Echo tte 2d comp wo ctrst wo clr/dplr CPT 93307 $298.80 $498.00 $498.00 – $498.00 1
Echocardiogram (Heart Ultrasound) CPT 93306 $405.00 $675.00 $664.00 – $664.00 1
Echocardiography doppler color flow mapping CPT 93325 $33.00 $55.00 $55.00 – $55.00 1
Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler HCPCS C8929 $405.00 $675.00 $675.00 – $675.00 1
Echocardiography transthoracic 2d followup/limited CPT 93308 $139.20 $232.00 $221.00 – $221.00 1
Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast HCPCS C8924 $139.20 $232.00 $232.00 – $232.00 1
Ecmo/ecls remove perph cannula 0-5yrs perq 33965 CPT 33965 $0.60 $1.00 $1.00 – $1.00 1
Ecmo/ecls remove prph cannula 6yrs&older perq 33966 CPT 33966 $0.60 $1.00 $1.00 – $1.00 1
Eeg monitor/record/awake/drowsy 95816 CPT 95816 $421.80 $703.00 $703.00 – $703.00 1
Eeg recording awake and asleep CPT 95819 $501.00 $835.00 $835.00 – $835.00 1
Egfr gene com variants CPT 81235 $909.60 $1,516.00 $1,516.00 – $1,516.00 1
Electrd sq emblem s-icd HCPCS C1896 $6,672.00 $11,120.00 $10,975.00 – $10,975.00 1
Electrolyte panel CPT 80051 $12.60 $21.00 $21.00 – $21.00 1
Electron microscopy diagnostic CPT 88348 $649.20 $1,082.00 $1,082.00 – $1,082.00 1
Electrophysiology evaluation CPT 93619 $0.60 $1.00 $1.00 – $1.00 1
Electrophysiology evaluation CPT 93620 $0.60 $1.00 $1.00 – $1.00 1
Electrophysiology evaluation CPT 93621 $0.60 $1.00 $1.00 – $1.00 1
Electrophysiology evaluation CPT 93622 $0.60 $1.00 $1.00 – $1.00 1
Electrophysiology evaluation CPT 93641 $0.60 $1.00 $1.00 – $1.00 1
Electrophysiology evaluation CPT 93642 $0.60 $1.00 $1.00 – $1.00 1
Electrophysiology evaluation CPT 93644 $0.60 $1.00 $1.00 – $1.00 1
Elotuzumab 300 mg intravenous solution HCPCS J9176 $3,061.20 $5,102.00 $3,826.00 – $3,826.00 1
Embo or occlude vascular arterial s&i CPT 37242 $0.60 $1.00 $1.00 – $1.00 1
Embo or occlude vascular hemorrhage s&i CPT 37244 $0.60 $1.00 $1.00 – $1.00 1
Embo or occlude vascular tumor/organ/infarct s&i CPT 37243 $0.60 $1.00 $1.00 – $1.00 1
Embo or occlude vascular venous s&i CPT 37241 $0.60 $1.00 $1.00 – $1.00 1
Embolization s&i CPT 75894 $0.60 $1.00 $1.00 – $1.00 1
Emg 3 ext w-w/o paraspinal area 95863 CPT 95863 $163.80 $273.00 $273.00 – $273.00 1
Endoluminal bx biliary tree CPT 47543 $0.60 $1.00 $1.00 – $1.00 1
Endoluminl ivus oct c 1st CPT 92978 $0.60 $1.00 $1.00 – $1.00 1
Endoluminl ivus oct c ea CPT 92979 $0.60 $1.00 $1.00 – $1.00 1
Endovas iliac a device addon CPT 34808 $0.60 $1.00 $1.00 – $1.00 1
Endovasc visc aorta 2 graft CPT 34842 $0.60 $1.00 $1.00 – $1.00 1
Enfortumab vedotin-ejfv 20 mg intravenous solution HCPCS J9177 $36.60 $61.00 $61.00 – $61.00 1
Enoxaparin 30 mg/0.3 ml subcutaneous syringe HCPCS J1650 $35.40 $59.00 $4.00 – $4.00 1
Entamoeba histolytica ag eia - sendout CPT 87337 $64.80 $108.00 $108.00 – $108.00 1
Enzyme histochemistry CPT 88319 $81.00 $135.00 $135.00 – $135.00 1
Ep & ablate supravent arrhyt CPT 93653 $0.60 $1.00 $1.00 – $1.00 1
Ep & ablate ventric tachy CPT 93654 $0.60 $1.00 $1.00 – $1.00 1
Epirubicin 200 mg/100 ml intravenous solution HCPCS J9178 $33.00 $55.00 $55.00 – $55.00 1
Epoetin alfa in ns IV syringe 100 unit/ml (neo/ped) - cnr HCPCS J0885 $667.20 $1,112.00 $1,112.00 – $1,112.00 1
Epoetin alfa, 100 units esrd HCPCS Q4081 $164.40 $274.00 $274.00 – $274.00 1
Epstein barr early antigen antibody CPT 86663 $53.40 $89.00 $89.00 – $89.00 1
Epstein barr nuclear antigen antibody CPT 86664 $53.40 $89.00 $89.00 – $89.00 1
Epstein barr viral capsid antigen antibody igm CPT 86665 $76.20 $127.00 $127.00 – $127.00 1
Eptifibatide 0.75 mg/ml intravenous solution HCPCS J1327 $62.40 $104.00 $48.00 – $48.00 1
Eribulin 1 mg/2 ml (0.5 mg/ml) intravenous solution HCPCS J9179 $1,355.40 $2,259.00 $2,259.00 – $2,259.00 1
Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr HCPCS J1335 $55.80 $93.00 $93.00 – $93.00 1
Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only HCPCS J1805 $81.60 $136.00 $136.00 – $136.00 1
Esophageal dilat s&i CPT 74360 $0.60 $1.00 $1.00 – $1.00 1
Esophageal motility CPT 78258 $201.60 $336.00 $336.00 – $336.00 1
Establish access to artery CPT 36100 $0.60 $1.00 $1.00 – $1.00 1
Established Patient Office Visit (level 1) CPT 99211 $58.20 $97.00 $97.00 – $97.00 1
Established Patient Office Visit (level 2) CPT 99212 $87.60 $146.00 $146.00 – $146.00 1
Established Patient Office Visit (level 3) CPT 99213 $117.00 $195.00 $195.00 – $195.00 1
Established Patient Office Visit (level 4) CPT 99214 $146.40 $244.00 $244.00 – $244.00 1
Established Patient Office Visit (level 5) CPT 99215 $175.80 $293.00 $293.00 – $293.00 1
Estradiol total CPT 82670 $24.00 $40.00 $40.00 – $40.00 1
Estrogens total-sendout CPT 82672 $40.20 $67.00 $67.00 – $67.00 1
Ethylene glycol -sendout CPT 82693 $24.00 $40.00 $40.00 – $40.00 1
Euglobulin lysis CPT 85360 $12.60 $21.00 $21.00 – $21.00 1
Eval/fit voice prosthesis iii, st CPT 92607 $207.60 $346.00 $346.00 – $346.00 1
Evaluation cervicovaginal fluid for specific amniotic fluid proteins qualitative each specimen CPT 84112 $67.20 $112.00 $112.00 – $112.00 1
Evaluation of speech fluency 92521 CPT 92521 $150.00 $250.00 $250.00 – $250.00 1
Evaluation psychiatric diagnostic CPT 90791 $351.60 $586.00 $586.00 – $586.00 1
Evasc repair of iliac artery; endograft 34718 CPT 34718 $0.60 $1.00 $1.00 – $1.00 1
Evasc rpr a-ao ndgft 34701 CPT 34701 $0.60 $1.00 $1.00 – $1.00 1
Evasc rpr a-iliac ndgft 34717 CPT 34717 $0.60 $1.00 $1.00 – $1.00 1
Event monitor CPT 93270 $66.00 $110.00 $110.00 – $110.00 1
Evoked potential visual not glaucoma CPT 95930 $153.60 $256.00 $256.00 – $256.00 1
Exchange biliary drg cath CPT 47536 $0.60 $1.00 $1.00 – $1.00 1
Exchange drainage catheter CPT 49423 $0.60 $1.00 $1.00 – $1.00 1
Exchange nephrostomy cath CPT 50435 $0.60 $1.00 $1.00 – $1.00 1
Exercise w/hemodynamic meas CPT 93464 $0.60 $1.00 $1.00 – $1.00 1
Expander tiss 133s-mv-12-t 300ml natrelle smth HCPCS C1789 $15,240.60 $25,401.00 $1,200.00 – $1,200.00 1
External chromosome analysis 20-25 cells CPT 88264 $649.20 $1,082.00 $1,082.00 – $1,082.00 1
External pretreatment of serum for use in antibody identification by dilution CPT 86976 $49.80 $83.00 $83.00 – $83.00 1
External tissue culture neoplastic disorders bone marrow/blood cells CPT 88237 $243.60 $406.00 $406.00 – $406.00 1
Extractable nuclear antigen/antibody any method each antibody centromere CPT 86235 $45.00 $75.00 $75.00 – $75.00 1
F-18 fdg pet diag HCPCS A9552 $234.00 $390.00 $390.00 – $390.00 1
Facial bones <3 CPT 70140 $89.40 $149.00 $149.00 – $149.00 1
Factor ix CPT 85250 $97.20 $162.00 $162.00 – $162.00 1
Factor ix recombinant nos HCPCS J7195 $1.20 $2.00 $2.00 – $2.00 1
Factor viii CPT 85240 $97.20 $162.00 $162.00 – $162.00 1
Fam-trastuzumab deruxtecan-nxki 100 mg intravenous solution HCPCS J9358 $31.20 $52.00 $52.00 – $52.00 1
Family therapy with patient 50 min 90847 CPT 90847 $117.00 $195.00 $195.00 – $195.00 1
Family therapy without pt 50min 90846 CPT 90846 $117.00 $195.00 $195.00 – $195.00 1
Fat/lipids feces qualitative CPT 82705 $24.00 $40.00 $40.00 – $40.00 1
Feeding tube reposition CPT 74355 $0.60 $1.00 $1.00 – $1.00 1
Fem/popl revasc w/stent CPT 37226 $0.60 $1.00 $1.00 – $1.00 1
Feno poc CPT 95012 $49.20 $82.00 $82.00 – $82.00 1
Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) HCPCS J3010 $0.60 $1.00 $1.00 – $1.00 1
Ferritin CPT 82728 $24.00 $40.00 $40.00 – $40.00 1
Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution HCPCS Q0138 $472.80 $788.00 $788.00 – $788.00 1
Fetal biophys profile w/nst 76818 CPT 76818 $357.60 $596.00 $596.00 – $596.00 1
Fetal fibronectin CPT 82731 $283.80 $473.00 $473.00 – $473.00 1
Fetal hemoglobin (kleihauer betke) CPT 85460 $37.20 $62.00 $62.00 – $62.00 1
Fetal hemoglobin rosette CPT 85461 $24.00 $40.00 $40.00 – $40.00 1
Fetal non stress test CPT 59025 $722.40 $1,204.00 $1,204.00 – $1,204.00 1
Fibrin degradation d dimer quantitative CPT 85379 $24.00 $40.00 $40.00 – $40.00 1
Fibrin degradation products CPT 85362 $24.00 $40.00 $40.00 – $40.00 1
Fibrin degrade semiquant CPT 85378 $24.00 $40.00 $40.00 – $40.00 1
Fibrinogen activity CPT 85384 $14.40 $24.00 $24.00 – $24.00 1
Fibrinolytic antiplasmin CPT 85410 $81.00 $135.00 $135.00 – $135.00 1
Fibrinolytic plasminogen CPT 85415 $81.00 $135.00 $135.00 – $135.00 1
Fibrinolytic plasminogen xcpt antgnc asa CPT 85420 $37.20 $62.00 $62.00 – $62.00 1
Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr HCPCS J1442 $617.40 $1,029.00 $569.00 – $569.00 1
Filgrastim-aafi 300 mcg/0.5 ml subcutaneous syringe HCPCS Q5110 $296.40 $494.00 $309.00 – $309.00 1
Filgrastim-sndz 300 mcg/0.5 ml injection syringe HCPCS Q5101 $372.60 $621.00 $388.00 – $388.00 1
Filter spider fx 3mmx320cm HCPCS C1884 $2,570.40 $4,284.00 $3,825.00 – $3,825.00 1
Filter vena cava fem denali HCPCS C1880 $5,440.20 $9,067.00 $1,980.00 – $1,980.00 1
Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007 CPT 10007 $0.60 $1.00 $1.00 – $1.00 1
Fine needle aspiration biopsy w/us gdn; ea addtl 10006 CPT 10006 $0.60 $1.00 $1.00 – $1.00 1
Finger joint sz00 swanson w/grommets HCPCS L8630 $5,254.20 $8,757.00 $970.00 – $970.00 1
Fl exam g/colon tube w contrast CPT 49465 $0.60 $1.00 $1.00 – $1.00 1
Flow cytometry marker each additional CPT 88185 $81.00 $135.00 $135.00 – $135.00 1
Flow cytometry one marker technical component CPT 88184 $81.00 $135.00 $135.00 – $135.00 1
Flt3 gene CPT 81245 $243.60 $406.00 $406.00 – $406.00 1
Flt3 gene analysis CPT 81246 $243.60 $406.00 $406.00 – $406.00 1
Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback HCPCS J1450 $6.00 $10.00 $10.00 – $10.00 1
Fludarabine 50 mg intravenous solution HCPCS J9185 $103.80 $173.00 $173.00 – $173.00 1
Fluidotherapy charges pt CPT 97022 $34.20 $57.00 $57.00 – $57.00 1
Fluorescent antibody titer dna CPT 86256 $45.00 $75.00 $75.00 – $75.00 1
Fluoro polarize fetal lung CPT 83663 $40.20 $67.00 $67.00 – $67.00 1
Fluoroguide needle placement CPT 77002 $0.60 $1.00 $1.00 – $1.00 1
Fluoroscopy up to 1 hour CPT 76000 $196.20 $327.00 $1.00 – $1.00 1
Fluorouracil 50 mg/ml intravenous solution (wrapper) HCPCS J9190 $1.20 $2.00 $2.00 – $2.00 1
Fna bx w/ct gdn 1st les CPT 10009 $0.60 $1.00 $1.00 – $1.00 1
Fna bx w/ct gdn ea addl CPT 10010 $0.60 $1.00 $1.00 – $1.00 1
Folic acid CPT 82746 $24.00 $40.00 $40.00 – $40.00 1
Follow-up angiography CPT 75898 $0.60 $1.00 $1.00 – $1.00 1
Fomepizole 1 gram/ml intravenous solution HCPCS J1451 $684.00 $1,140.00 $1,140.00 – $1,140.00 1
Fondaparinux sodium HCPCS J1652 $34.20 $57.00 $57.00 – $57.00 1
Foot X-ray CPT 73630 $106.80 $178.00 $49.00 – $49.00 1
Fosaprepitant 150 mg intravenous powder for solution HCPCS J1453 $28.80 $48.00 $48.00 – $48.00 1
Fresh frozen plasma thawing ea un CPT 86927 $6.00 $10.00 $10.00 – $10.00 1
Fructosamine glycated protein CPT 82985 $24.00 $40.00 $40.00 – $40.00 1
Furosemide in ns IV syringe 2 mg/ml (neo/ped) - cnr HCPCS J1940 $0.60 $1.00 $1.00 – $1.00 1
Galactokinase - sendout CPT 82759 $55.20 $92.00 $92.00 – $92.00 1
Gamma glutamyltransferase CPT 82977 $3.00 $5.00 $5.00 – $5.00 1
Gammaglobulin iga CPT 82784 $24.00 $40.00 $40.00 – $40.00 1
Gammaglobulin ige CPT 82785 $24.00 $40.00 $40.00 – $40.00 1
Gamunex-c/gammaked HCPCS J1561 $1,390.20 $2,317.00 $2,317.00 – $2,317.00 1
Ganciclovir in ns IV syringe 10 mg/ml (neo/ped) - cnr HCPCS J1570 $18.60 $31.00 $31.00 – $31.00 1
Gastric emptying imag study CPT 78265 $373.80 $623.00 $623.00 – $623.00 1
Gastroesophageal reflux study CPT 78262 $223.20 $372.00 $372.00 – $372.00 1
Gated heart multiple CPT 78473 $234.60 $391.00 $391.00 – $391.00 1
Gemcitabine 1 gram intravenous solution HCPCS J9201 $2.40 $4.00 $4.00 – $4.00 1
Generator barostim neo2 2014 HCPCS C1767 $48,475.80 $80,793.00 $28,356.00 – $28,356.00 1
Generator emblem MRI sicd subq HCPCS C1722 $28,356.00 $47,260.00 $18,123.00 – $18,123.00 1
Gentamicin 10 mg/ml liquid compound - enteral use only HCPCS J1580 $3.60 $6.00 $1.00 – $1.00 1
Gentamicin peak therapeutic drug level CPT 80170 $24.00 $40.00 $40.00 – $40.00 1
Ghs HIV antibody CPT 86703 $40.20 $67.00 $67.00 – $67.00 1
Ghs IV inf sq injection, on-body injector CPT 96377 $117.00 $195.00 $195.00 – $195.00 1
Ghs IV infusion bamlanivimab/etesevimab HCPCS M0245 $573.60 $956.00 $956.00 – $956.00 1
Ghs IV infusion casirivimab/imdevimab HCPCS M0243 $573.60 $956.00 $956.00 – $956.00 1
Ghs IV infusion sotrovimab HCPCS M0247 $469.20 $782.00 $782.00 – $782.00 1
Ghs alcohol, methyl (methanol)-medtox CPT 84600 $48.60 $81.00 $81.00 – $81.00 1
Ghs antibodies (torch) igm CPT 86694 $40.20 $67.00 $67.00 – $67.00 1
Ghs bleeding time (ivy) CPT 85002 $24.00 $40.00 $40.00 – $40.00 1
Ghs central line insert < age 5, failed CPT 36555 $0.60 $1.00 $1.00 – $1.00 1
Ghs change cysto/gastrost CPT 43762 $0.60 $1.00 $1.00 – $1.00 1
Ghs chemo IV push, ea addtl CPT 96411 $117.00 $195.00 $195.00 – $195.00 1
Ghs community re-entry 15 minutes CPT 97537 $57.00 $95.00 $57.00 – $57.00 1
Ghs diphtheria toxoid ab igg CPT 86648 $53.40 $89.00 $89.00 – $89.00 1
Ghs ed peritoneal lavage w guidance if performed CPT 49084 $0.60 $1.00 $1.00 – $1.00 1
Ghs fish cytogen CPT 88271 $81.00 $135.00 $135.00 – $135.00 1
Ghs fish hybrid in situ 100-300 CPT 88275 $373.20 $622.00 $622.00 – $622.00 1
Ghs hepatitis c virus (hcv riba) CPT 86804 $162.00 $270.00 $270.00 – $270.00 1
Ghs histoplasma antigen CPT 87385 $64.80 $108.00 $108.00 – $108.00 1
Ghs hla-dr/dq, multiple antigens CPT 86817 $373.20 $622.00 $622.00 – $622.00 1
Ghs inf midline insertion CPT 36140 $0.60 $1.00 $1.00 – $1.00 1
Ghs inhibitor screen CPT 85335 $97.20 $162.00 $162.00 – $162.00 1
Ghs leukocyte alkaline phos (mayo) CPT 85540 $32.40 $54.00 $54.00 – $54.00 1
Ghs mbp CPT 83873 $97.20 $162.00 $162.00 – $162.00 1
Ghs myocardial strain img spckl track CPT 93356 $6.60 $11.00 $11.00 – $11.00 1
Ghs ng placement w fluoro guidance CPT 43752 $0.60 $1.00 $1.00 – $1.00 1
Ghs opcc repair cvp w subq port CPT 36576 $0.60 $1.00 $1.00 – $1.00 1
Ghs opcc repair cvp without subq port CPT 36575 $0.60 $1.00 $1.00 – $1.00 1
Ghs ot prosthetic training/15 min CPT 97761 $79.80 $133.00 $80.00 – $80.00 1
Ghs ot sensory integrative tech/15min CPT 97533 $96.60 $161.00 $161.00 – $161.00 1
Ghs pacing - transcutaneous CPT 92953 $0.60 $1.00 $1.00 – $1.00 1
Ghs paravert facet/nerve cerv ea add bil CPT 64492 $0.60 $1.00 $1.00 – $1.00 1
Ghs paravert facet/nerve lumb ea add bil CPT 64495 $0.60 $1.00 $1.00 – $1.00 1
Ghs phenylketonurid CPT 84030 $32.40 $54.00 $54.00 – $54.00 1
Ghs picc line insert < 5 CPT 36568 $0.60 $1.00 $1.00 – $1.00 1
Ghs plt ct-manual CPT 85032 $16.20 $27.00 $27.00 – $27.00 1
Ghs ppd (tb intradermal) CPT 86580 $9.00 $15.00 $15.00 – $15.00 1
Ghs pr without cont pulse ox CPT 94625 $55.80 $93.00 $93.00 – $93.00 1
Ghs prostatic acid phosphatase (mayo) CPT 84066 $24.00 $40.00 $40.00 – $40.00 1
Ghs protoporphyrins fract CPT 84202 $87.60 $146.00 $146.00 – $146.00 1
Ghs quinidine CPT 80194 $24.00 $40.00 $40.00 – $40.00 1
Ghs sedimentation rate CPT 85651 $9.60 $16.00 $16.00 – $16.00 1
Ghs semen analysis fert CPT 89320 $46.80 $78.00 $78.00 – $78.00 1
Ghs semen analysis, post-vas CPT 89300 $12.60 $21.00 $21.00 – $21.00 1
Ghs sensitivity (per antimicro) CPT 87184 $16.20 $27.00 $27.00 – $27.00 1
Ghs sp train/fitting sp device - kx CPT 92609 $172.80 $288.00 $288.00 – $288.00 1
Ghs speech-gen aug dev eval iii, st CPT 92608 $80.40 $134.00 $134.00 – $134.00 1
Ghs st - re-eval for alt comm CPT 92597 $91.80 $153.00 $153.00 – $153.00 1
Ghs urine, hydroxproline total CPT 83505 $97.20 $162.00 $162.00 – $162.00 1
Ghs urine, porphyrins quant CPT 84120 $56.40 $94.00 $94.00 – $94.00 1
Gi inhouse confirmation CPT 87045 $48.60 $81.00 $81.00 – $81.00 1
Glucagon 1 mg solution for injection HCPCS J1610 $95.40 $159.00 $159.00 – $159.00 1
Glucagon plasma - sendout CPT 82943 $40.20 $67.00 $67.00 – $67.00 1
Glucose 1 hr post dose CPT 82950 $6.00 $10.00 $10.00 – $10.00 1
Glucose blood by monitoring device cleared by fda for home use CPT 82962 $12.60 $21.00 $21.00 – $21.00 1
Glucose blood quantitative CPT 82947 $6.00 $10.00 $10.00 – $10.00 1
Glucose body fluid CPT 82945 $6.00 $10.00 $10.00 – $10.00 1
Glucose tolerance test (gtt) 3 specimens CPT 82951 $24.00 $40.00 $40.00 – $40.00 1
Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 $6.00 $10.00 $10.00 – $10.00 1
Gonadotropin follicle stimulating hormone (fsh) CPT 83001 $24.00 $40.00 $40.00 – $40.00 1
Gonadotropin luteinizing hormone (lh) CPT 83002 $40.20 $67.00 $67.00 – $67.00 1
Goserelin 10.8 mg subcutaneous implant HCPCS J9202 $1,831.20 $3,052.00 $1,270.00 – $1,270.00 1
Graft axiofill 1000mg HCPCS J3590 $2,287.80 $3,813.00 $55.00 – $55.00 1
Graft nerve adv 3-4x70mm HCPCS C1762 $19,465.20 $32,442.00 $462.00 – $462.00 1
Graft patch felt ptfe 2x2 HCPCS C1768 $5,095.20 $8,492.00 $415.00 – $415.00 1
Graft primatrix xcr 6cm x6cm n-q4110-cost per sq cm HCPCS Q4110 $2,860.20 $4,767.00 $2,581.00 – $2,581.00 1
Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 $1,879.20 $3,132.00 $3,132.00 – $3,132.00 1
Graft xenmtrx sft rect 15x20cm HCPCS C1781 $30,786.60 $51,311.00 $94.00 – $94.00 1
Graft xenmtrx sft rect 19x28cm HCPCS C2625 $1,882.20 $3,137.00 $527.00 – $527.00 1
Granisetron hcl injection HCPCS J1626 $3.00 $5.00 $5.00 – $5.00 1
Gu dilat ureter/urethra s&i CPT 74485 $0.60 $1.00 $1.00 – $1.00 1
Guid loc target vol rad tx CPT 77387 $120.60 $201.00 $201.00 – $201.00 1
Guide endoanchr sg-64 aaa 62cm HCPCS L8670 $169.80 $283.00 $283.00 – $283.00 1
Guide wire threaded 1.4x150mm HCPCS C1769 $1,409.40 $2,349.00 $15.00 – $15.00 1
Guide worley csg 9fx50cm std HCPCS C1892 $221.40 $369.00 $54.00 – $54.00 1
Guided cath fluid drainage 10030 CPT 10030 $0.60 $1.00 $1.00 – $1.00 1
Gw stiffened micro access kit HCPCS C1894 $5,951.40 $9,919.00 $14.00 – $14.00 1
H pylori (c-13) breath CPT 83013 $32.40 $54.00 $54.00 – $54.00 1
Haloperidol decanoate 50 mg/ml intramuscular solution HCPCS J1631 $22.80 $38.00 $38.00 – $38.00 1
Hand X-ray CPT 73130 $106.80 $178.00 $49.00 – $49.00 1
Haptoglobin quantitative CPT 83010 $24.00 $40.00 $40.00 – $40.00 1
Hbot, full body chamber, 30m HCPCS G0277 $756.60 $1,261.00 $315.00 – $315.00 1
Hc fl sm bowel enteroclss tube w kub double contrast CPT 74251 $1,930.80 $3,218.00 $3,218.00 – $3,218.00 1
Hc i-131 sodium iodide cap dx per mci HCPCS A9528 $11.40 $19.00 $19.00 – $19.00 1
Hc nm myocard infarct avid plnr tomo spect w/wo quant CPT 78469 $194.40 $324.00 $324.00 – $324.00 1
Hcg qualitative CPT 84703 $16.20 $27.00 $27.00 – $27.00 1
Hcg quantitative CPT 84702 $38.40 $64.00 $64.00 – $64.00 1
Hdr rdncl ntrstl/icav brchtx CPT 77770 $277.20 $462.00 $462.00 – $462.00 1
Hdr rdncl ntrstl/icav brchtx CPT 77771 $542.40 $904.00 $904.00 – $904.00 1
Hdr rdncl ntrstl/icav brchtx CPT 77772 $886.20 $1,477.00 $1,477.00 – $1,477.00 1
Head CT scan (with and without contrast) CPT 70470 $107.40 $179.00 $179.00 – $179.00 1
Head CT scan (with contrast) CPT 70460 $89.40 $149.00 $149.00 – $149.00 1
Head CT scan (without contrast) CPT 70450 $62.40 $104.00 $104.00 – $104.00 1
Helicobacter pylori antibody igm CPT 86677 $40.20 $67.00 $67.00 – $67.00 1
Hematocrit CPT 85014 $6.00 $10.00 $10.00 – $10.00 1
Hemodialysis one evaluation CPT 90935 $871.20 $1,452.00 $189.00 – $189.00 1
Hemoglobin CPT 85018 $6.00 $10.00 $10.00 – $10.00 1
Hemoglobin methemoglobin quantitative CPT 83050 $32.40 $54.00 $54.00 – $54.00 1
Hemoglobin plasma CPT 83051 $19.20 $32.00 $32.00 – $32.00 1
Hemolysin acid CPT 85475 $12.60 $21.00 $21.00 – $21.00 1
Hemolysins and agglutinins incubated CPT 86941 $28.80 $48.00 $48.00 – $48.00 1
Hepagam b im injection HCPCS J1571 $165.60 $276.00 $276.00 – $276.00 1
Heparin assay CPT 85520 $37.20 $62.00 $62.00 – $62.00 1
Heparin bolus from bag HCPCS J1644 $9.00 $15.00 $5.00 – $5.00 1
Hepatitis a antibody igm CPT 86709 $32.40 $54.00 $54.00 – $54.00 1
Hepatitis b core antibody igm CPT 86705 $32.40 $54.00 $54.00 – $54.00 1
Hepatitis b core antibody total CPT 86704 $32.40 $54.00 $54.00 – $54.00 1
Hepatitis b surface antibody CPT 86706 $32.40 $54.00 $54.00 – $54.00 1
Hepatitis c antibody CPT 86803 $40.20 $67.00 $67.00 – $67.00 1
Hepatobiliary system imaging CPT 78226 $315.00 $525.00 $525.00 – $525.00 1
Herpes simplex type 1 antibody igg CPT 86695 $40.20 $67.00 $67.00 – $67.00 1
Herpes simplex type 2 antibody igg CPT 86696 $40.20 $67.00 $67.00 – $67.00 1
Herpes simplex virus isolation CPT 87255 $97.20 $162.00 $162.00 – $162.00 1
Heterophile antibodies screening CPT 86308 $12.60 $21.00 $21.00 – $21.00 1
Hip X-ray CPT 73502 $142.80 $238.00 $238.00 – $238.00 1
Histochemical stains add-on CPT 88314 $48.60 $81.00 $81.00 – $81.00 1
Hla class i high defin qual CPT 86832 $227.40 $379.00 $379.00 – $379.00 1
Hla typing a b or c CPT 86813 $202.80 $338.00 $338.00 – $338.00 1
Hldr trach tb tie ad HCPCS A7526 $95.40 $159.00 $65.00 – $65.00 1
Home sleep test/type 3 porta HCPCS G0399 $148.80 $248.00 $248.00 – $248.00 1
Homocysteine CPT 83090 $48.60 $81.00 $81.00 – $81.00 1
Homogenization tissue CPT 87176 $243.60 $406.00 $406.00 – $406.00 1
Homovanillic acid (hva) CPT 83150 $48.60 $81.00 $81.00 – $81.00 1
Hyaluronidase, human recombinant 150 unit/ml injection solution HCPCS J3473 $57.00 $95.00 $95.00 – $95.00 1
Hydration IV infusion each additional hour CPT 96361 $703.20 $1,172.00 $146.00 – $146.00 1
Hydration IV infusion initial 31minutes - 1 hour CPT 96360 $234.00 $390.00 $390.00 – $390.00 1
Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J1720 $121.20 $202.00 $28.00 – $28.00 1
Hydromorphone 20-0.9 mg/100ml-% soln 100 ml cartridge HCPCS J7999 $18.60 $31.00 $31.00 – $31.00 1
Hysterosalpingography s&i CPT 74740 $0.60 $1.00 $1.00 – $1.00 1
I-123 sod iodide diag per 100 uci HCPCS A9516 $39.60 $66.00 $55.00 – $55.00 1
IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 $204.60 $341.00 $341.00 – $341.00 1
IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 $117.00 $195.00 $195.00 – $195.00 1
IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 $937.80 $1,563.00 $1.00 – $1.00 1
IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 $527.40 $879.00 $1.00 – $1.00 1
Ibutilide fumarate 0.1 mg/ml intravenous solution HCPCS J1742 $279.60 $466.00 $466.00 – $466.00 1
Icd cobalt xt dr MRI is1 df1 HCPCS C1721 $22,518.00 $37,530.00 $20,756.00 – $20,756.00 1
Icd crtd cobalt hf MRI is1 df1 HCPCS C1882 $28,568.40 $47,614.00 $22,448.00 – $22,448.00 1
Icd crtp serena MRI HCPCS C2621 $8,439.60 $14,066.00 $11,356.00 – $11,356.00 1
Icd reliance df4 ib 64cm HCPCS C1895 $4,837.20 $8,062.00 $1,267.00 – $1,267.00 1
Ifosfamide 1 gram intravenous solution HCPCS J9208 $97.20 $162.00 $44.00 – $44.00 1
Igh gene rearrange amp meth CPT 81261 $194.40 $324.00 $324.00 – $324.00 1
Igh@ var region somatic mutation analy CPT 81263 $194.40 $324.00 $324.00 – $324.00 1
Igk rearrangeabn clonal pop CPT 81264 $194.40 $324.00 $324.00 – $324.00 1
Ihc/icc per specimen each additional single antibody stain CPT 88341 $97.20 $162.00 $162.00 – $162.00 1
Ihc/icc per specimen each multiplex antibody stain CPT 88344 $97.20 $162.00 $162.00 – $162.00 1
Ihc/icc per specimen initial single antibody stain CPT 88342 $97.20 $162.00 $162.00 – $162.00 1
Iliac revasc add-on 37222 CPT 37222 $0.60 $1.00 $1.00 – $1.00 1
Immobilizer shldr dlx str 24-36in med HCPCS L1830 $44.40 $74.00 $48.00 – $48.00 1
Immune complex assay CPT 86332 $58.20 $97.00 $97.00 – $97.00 1
Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution HCPCS J1569 $660.60 $1,101.00 $550.00 – $550.00 1
Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution HCPCS J1568 $1,080.00 $1,800.00 $96.00 – $96.00 1
Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution HCPCS J1566 $779.40 $1,299.00 $129.00 – $129.00 1
Immunoassay tumor antigen quantitative ca 125 CPT 86304 $53.40 $89.00 $89.00 – $89.00 1
Immunoassay tumor antigen quantitative ca 19-9 CPT 86301 $53.40 $89.00 $89.00 – $89.00 1
Immunodiffusion nes CPT 86329 $12.60 $21.00 $21.00 – $21.00 1
Immunofixation electrophoresis serum CPT 86334 $64.80 $108.00 $108.00 – $108.00 1
Immunofluorescence per specimen each additional single antibody stain CPT 88350 $97.20 $162.00 $162.00 – $162.00 1
Immunofluorescence per specimen initial single antibody stain CPT 88346 $97.20 $162.00 $162.00 – $162.00 1
Immunoglobulin assay CPT 86023 $64.80 $108.00 $108.00 – $108.00 1
Implant cartilage 10mm synthetic HCPCS L8699 $56,712.00 $94,520.00 $2,019.00 – $2,019.00 1
Imuglucerase injection HCPCS J1786 $1,903.20 $3,172.00 $3,172.00 – $3,172.00 1
In situ hybridization per specimen each additional single probe stain CPT 88364 $243.60 $406.00 $406.00 – $406.00 1
In situ hybridization per specimen initial single probe stain CPT 88365 $243.60 $406.00 $406.00 – $406.00 1
In-111 oxyquinolin per 0.5 mci HCPCS A9547 $680.40 $1,134.00 $1,134.00 – $1,134.00 1
In-111 pentetate dtpa / 0.5 mci HCPCS A9548 $820.20 $1,367.00 $1,367.00 – $1,367.00 1
In-111 pentetreotide HCPCS A9572 $1,116.00 $1,860.00 $1,860.00 – $1,860.00 1
Infect ag ia optc obs influenza CPT 87804 $40.20 $67.00 $67.00 – $67.00 1
Infect ag if legionella pneumophila CPT 87278 $40.20 $67.00 $67.00 – $67.00 1
Infect ag na influenza r/amp 1st 2 types CPT 87502 $259.80 $433.00 $433.00 – $433.00 1
Infect ag na resp virus 12-25 targets CPT 87633 $292.20 $487.00 $487.00 – $487.00 1
Infectious agent antigen immunoassay direct optical observation sars-cov-2 CPT 87811 $40.20 $67.00 $67.00 – $67.00 1
Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin CPT 87324 $40.20 $67.00 $67.00 – $67.00 1
Infectious agent antigen immunoassay ql/sq multi step cryptococcus neoformans CPT 87327 $40.20 $67.00 $67.00 – $67.00 1
Infectious agent antigen immunoassay ql/sq multi step cryptosporidium CPT 87328 $40.20 $67.00 $67.00 – $67.00 1
Infectious agent antigen immunoassay ql/sq multi step giardia CPT 87329 $40.20 $67.00 $67.00 – $67.00 1
Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool CPT 87338 $48.60 $81.00 $81.00 – $81.00 1
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn CPT 87340 $40.20 $67.00 $67.00 – $67.00 1
Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization CPT 87341 $40.20 $67.00 $67.00 – $67.00 1
Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies CPT 87389 $40.20 $67.00 $67.00 – $67.00 1
Infectious agent antigen immunoassay ql/sq multi step legionella urine CPT 87449 $40.20 $67.00 $67.00 – $67.00 1
Infectious agent antigen immunoassay ql/sq multi step rotavirus CPT 87425 $40.20 $67.00 $67.00 – $67.00 1
Infectious agent nucleic acid amplified probe CPT 87798 $194.40 $324.00 $324.00 – $324.00 1
Infectious agent nucleic acid amplified probe chlamydia trachomatis CPT 87491 $72.60 $121.00 $121.00 – $121.00 1
Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s) CPT 87493 $194.40 $324.00 $324.00 – $324.00 1
Infectious agent nucleic acid amplified probe hsv-1 CPT 87529 $194.40 $324.00 $324.00 – $324.00 1
Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus CPT 87641 $194.40 $324.00 $324.00 – $324.00 1
Infectious agent nucleic acid amplified probe mycobacteria tuberculosis CPT 87556 $194.40 $324.00 $324.00 – $324.00 1
Infectious agent nucleic acid amplified probe neisseria gonorrhoeae CPT 87591 $72.60 $121.00 $121.00 – $121.00 1
Infectious agent nucleic acid amplified probe sars-cov-2/covid-19 CPT 87635 $194.40 $324.00 $324.00 – $324.00 1
Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b CPT 87636 $194.40 $324.00 $324.00 – $324.00 1
Infectious agent nucleic acid amplified probe streptococcus group a CPT 87651 $194.40 $324.00 $324.00 – $324.00 1
Infectious agent nucleic acid amplified probe trichomonas vaginalis CPT 87661 $72.60 $121.00 $121.00 – $121.00 1
Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets CPT 87507 $292.20 $487.00 $487.00 – $487.00 1
Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets CPT 87505 $97.20 $162.00 $162.00 – $162.00 1
Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets CPT 87506 $194.40 $324.00 $324.00 – $324.00 1
Infectious agent nucleic acid quantification bk virus CPT 87799 $259.80 $433.00 $433.00 – $433.00 1
Infectious agent nucleic acid quantification hepatitis b CPT 87517 $259.80 $433.00 $433.00 – $433.00 1
Infectious agent nucleic acid quantification hepatitis c CPT 87522 $259.80 $433.00 $433.00 – $433.00 1
Infectious agent nucleic acid quantification hiv-1 CPT 87536 $259.80 $433.00 $433.00 – $433.00 1
Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets CPT 87631 $97.20 $162.00 $162.00 – $162.00 1
Infliximab 100 mg intravenous solution HCPCS J1745 $540.60 $901.00 $901.00 – $901.00 1
Infliximab-axxq 100 mg intravenous solution HCPCS Q5121 $55.80 $93.00 $93.00 – $93.00 1
Infliximab-dyyb 100 mg intravenous solution HCPCS Q5103 $37.80 $63.00 $63.00 – $63.00 1
Influenza virus vaccine, inact hemagglutinin tiv pf inj CPT 90673 $75.60 $126.00 $126.00 – $126.00 1
Infuse radioactive materials CPT 77750 $186.60 $311.00 $311.00 – $311.00 1
Inhalation aerosol pentamidine pneumocystis pneumonia treatment/prophylaxis CPT 94642 $95.40 $159.00 $159.00 – $159.00 1
Initiation & management bipap/cpap initial day CPT 94660 $190.80 $318.00 $318.00 – $318.00 1
Inj ceftolozane tazobactam HCPCS J0695 $164.40 $274.00 $274.00 – $274.00 1
Inj cntr knee arthro incl ct/mri CPT 27369 $0.60 $1.00 $1.00 – $1.00 1
Inj crotalidae im f(ab')2 eq HCPCS J0841 $1,134.60 $1,891.00 $1,891.00 – $1,891.00 1
Inj dx for sinogram CPT 20501 $0.60 $1.00 $1.00 – $1.00 1
Inj for ext venography CPT 36005 $0.60 $1.00 $1.00 – $1.00 1
Inj hrt cath w/s&i nonsel p-art angrp CPT 93568 $0.60 $1.00 $1.00 – $1.00 1
Inj hrt cath w/s&i sel left vent CPT 93565 $0.60 $1.00 $1.00 – $1.00 1
Inj hrt cath w/s&i sel right vent CPT 93566 $0.60 $1.00 $1.00 – $1.00 1
Inj hydroxocobalamin IV 25mg HCPCS J3424 $1,125.60 $1,876.00 $1,876.00 – $1,876.00 1
Inj ivig privigen 500 mg HCPCS J1459 $4,935.60 $8,226.00 $694.00 – $694.00 1
Inj levocarnitine per 1 gm HCPCS J1955 $16.20 $27.00 $27.00 – $27.00 1
Inj melpha hydroch nos 50 mg HCPCS J9245 $1,156.20 $1,927.00 $1,927.00 – $1,927.00 1
Inj meropenem (wg crit care) HCPCS J2183 $34.20 $57.00 $57.00 – $57.00 1
Inj nephrosto/ureterogram w/img exstng access CPT 50431 $0.60 $1.00 $1.00 – $1.00 1
Inj ogivri 10 mg HCPCS Q5114 $1,344.00 $2,240.00 $220.00 – $220.00 1
Inj pegfilgrastim-bmez 0.5mg HCPCS Q5120 $5,157.00 $8,595.00 $8,595.00 – $8,595.00 1
Inj peritoneal venous shunt CPT 49427 $0.60 $1.00 $1.00 – $1.00 1
Inj retro urethrocysto CPT 51610 $0.60 $1.00 $1.00 – $1.00 1
Inj secretin synthetic human HCPCS J2850 $630.00 $1,050.00 $1,050.00 – $1,050.00 1
Inj w/fluor eval cv device CPT 36598 $0.60 $1.00 $1.00 – $1.00 1
Inj, cefepime hcl (b braun) HCPCS J0703 $20.40 $34.00 $34.00 – $34.00 1
Inj, clevidipine butyrate HCPCS C9248 $94.20 $157.00 $157.00 – $157.00 1
Inj, lanreotide, (cipla) 1mg HCPCS J1932 $8,487.60 $14,146.00 $14,146.00 – $14,146.00 1
Inj, sutimlimab-jome, 10 mg HCPCS J1302 $2,256.00 $3,760.00 $3,760.00 – $3,760.00 1
Inj, tislelizumab-jsgr HCPCS J9329 $64.20 $107.00 $107.00 – $107.00 1
Inj., benralizumab, 1 mg HCPCS J0517 $5,853.00 $9,755.00 $9,755.00 – $9,755.00 1
Inj., lumoxiti, 0.01 mg HCPCS J9313 $31.20 $52.00 $52.00 – $52.00 1
Inj., meropenem, vaborbactam HCPCS J2186 $198.00 $330.00 $330.00 – $330.00 1
Injection during cath supravalvular aortography CPT 93567 $0.60 $1.00 $1.00 – $1.00 1
Injection for bladder x-ray CPT 51600 $0.60 $1.00 $1.00 – $1.00 1
Injection for ureter x-ray CPT 50690 $0.60 $1.00 $1.00 – $1.00 1
Injection into brain canal CPT 61026 $117.00 $195.00 $195.00 – $195.00 1
Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug CPT 96374 $292.80 $488.00 $488.00 – $488.00 1
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug CPT 96375 $117.00 $195.00 $195.00 – $195.00 1
Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 $28.80 $48.00 $48.00 – $48.00 1
Injection therapeutic/prophylactic/diagnostic subcutaneous/im CPT 96372 $58.20 $97.00 $97.00 – $97.00 1
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level CPT 64491 $0.60 $1.00 $1.00 – $1.00 1
Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level CPT 64490 $0.60 $1.00 $1.00 – $1.00 1
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance CPT 64494 $0.60 $1.00 $1.00 – $1.00 1
Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level CPT 64493 $0.60 $1.00 $1.00 – $1.00 1
Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 $0.60 $1.00 $1.00 – $1.00 1
Injection, cangrelor HCPCS C9460 $1,013.40 $1,689.00 $1,689.00 – $1,689.00 1
Injection, daratumumab 10 mg HCPCS J9145 $3,195.00 $5,325.00 $1,331.00 – $1,331.00 1
Injection, fulvestrant HCPCS J9395 $71.40 $119.00 $119.00 – $119.00 1
Injection, renflexis HCPCS Q5104 $798.00 $1,330.00 $1,330.00 – $1,330.00 1
Injection,onabotulinumtoxina HCPCS J0585 $721.20 $1,202.00 $1,202.00 – $1,202.00 1
Ins cath ren art 1st bi CPT 36252 $0.60 $1.00 $1.00 – $1.00 1
Ins cath ren art 1st uni CPT 36251 $0.60 $1.00 $1.00 – $1.00 1
Ins cath ren art 2nd+ bi CPT 36254 $0.60 $1.00 $1.00 – $1.00 1
Ins cath ren art 2nd+ uni CPT 36253 $0.60 $1.00 $1.00 – $1.00 1
Ins icd gen exist mlt leads CPT 33231 $0.60 $1.00 $1.00 – $1.00 1
Ins icd gen exist sgl lead CPT 33240 $0.60 $1.00 $1.00 – $1.00 1
Ins lv lead exist pm/icd CPT 33224 $0.60 $1.00 $1.00 – $1.00 1
Ins picad w subq port 5yr> CPT 36571 $0.60 $1.00 $1.00 – $1.00 1
Ins pm gen exist dual lead CPT 33230 $0.60 $1.00 $1.00 – $1.00 1
Ins pm gen w/exist mlt leads CPT 33221 $0.60 $1.00 $1.00 – $1.00 1
Ins pq tunnld ip cath w/img CPT 49418 $0.60 $1.00 $1.00 – $1.00 1
Ins tun cv cath wo subq prt/pm CPT 36557 $0.60 $1.00 $1.00 – $1.00 1
Ins tun cv cath wo subq prt/pm CPT 36558 $0.60 $1.00 $1.00 – $1.00 1
Ins tun cvad 2 cath w/subq port(s) CPT 36566 $0.60 $1.00 $1.00 – $1.00 1
Ins tun intraperit dia cath CPT 49421 $0.60 $1.00 $1.00 – $1.00 1
Ins/rpl ldless pm right vent w img & eval CPT 33274 $0.60 $1.00 $1.00 – $1.00 1
Ins/rpl pm gen exist dual lead CPT 33213 $0.60 $1.00 $1.00 – $1.00 1
Ins/rpl pm gen exist sgl lead CPT 33212 $0.60 $1.00 $1.00 – $1.00 1
Ins/rpl pm w/tv ld atrl CPT 33206 $0.60 $1.00 $1.00 – $1.00 1
Insert abdomen-venous drain CPT 49425 $0.60 $1.00 $1.00 – $1.00 1
Insert hepatic shunt (tips) CPT 37182 $0.60 $1.00 $1.00 – $1.00 1
Insert picvad cath CPT 36570 $0.60 $1.00 $1.00 – $1.00 1
Insert pm/icd lead dual CPT 33217 $0.60 $1.00 $1.00 – $1.00 1
Insert sq defib electrode CPT 33271 $0.60 $1.00 $1.00 – $1.00 1
Insert swan-ganz cath CPT 93503 $0.60 $1.00 $1.00 – $1.00 1
Insert tunneled cv 2cath 2sits without port/pmp 36565 CPT 36565 $0.60 $1.00 $1.00 – $1.00 1
Insert tunneled cv cath CPT 36560 $0.60 $1.00 $1.00 – $1.00 1
Insert tunneled cv cath CPT 36563 $0.60 $1.00 $1.00 – $1.00 1
Insert vad art access left hrt arterial access CPT 33990 $0.60 $1.00 $1.00 – $1.00 1
Insert/repl sq defib w/eltrd CPT 33270 $0.60 $1.00 $1.00 – $1.00 1
Insertion catheter bladder non indwelling CPT 51701 $117.00 $195.00 $195.00 – $195.00 1
Insertion catheter bladder temporary simple CPT 51702 $117.00 $195.00 $195.00 – $195.00 1
Insertion catheter pleural indwelling tunneled with cuff CPT 32550 $0.60 $1.00 $1.00 – $1.00 1
Insertion intra aortic balloon assist device percutaneous CPT 33967 $0.60 $1.00 $1.00 – $1.00 1
Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance CPT 37191 $0.60 $1.00 $1.00 – $1.00 1
Insertion nontunneled centrally inserted central venous catheter >= 5 years old CPT 36556 $0.60 $1.00 $1.00 – $1.00 1
Insertion of catheter vein CPT 36481 $0.60 $1.00 $1.00 – $1.00 1
Insertion of catheter vein CPT 36500 $0.60 $1.00 $1.00 – $1.00 1
Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular CPT 33208 $0.60 $1.00 $1.00 – $1.00 1
Insertion of new/replacement ppm w/transvenous electrode(s) ventricular CPT 33207 $0.60 $1.00 $1.00 – $1.00 1
Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator CPT 33225 $0.60 $1.00 $1.00 – $1.00 1
Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years CPT 36569 $0.60 $1.00 $1.00 – $1.00 1
Insertion single tranvenous electrode/ppm/implantable defibrillator CPT 33216 $0.60 $1.00 $1.00 – $1.00 1
Insertion subcutaneous cardiac rhythm monitor CPT 33285 $0.60 $1.00 $1.00 – $1.00 1
Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides) CPT 36561 $0.60 $1.00 $1.00 – $1.00 1
Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber CPT 33249 $0.60 $1.00 $1.00 – $1.00 1
Insertion/replacement temporary single chamber electrode/pacemaker catheter CPT 33210 $0.60 $1.00 $1.00 – $1.00 1
Insitu hybridization auto CPT 88367 $267.60 $446.00 $446.00 – $446.00 1
Insitu hybridization manual CPT 88368 $243.60 $406.00 $406.00 – $406.00 1
Instillation anticarcinogenic agent bladder CPT 51720 $117.00 $195.00 $195.00 – $195.00 1
Insulin total CPT 83525 $24.00 $40.00 $40.00 – $40.00 1
Interferon alfa-2b inj HCPCS J9214 $1,585.20 $2,642.00 $528.00 – $528.00 1
Interrog evl pm/ldls pm ip CPT 93288 $0.60 $1.00 $1.00 – $1.00 1
Intra-atrial pacing CPT 93610 $0.60 $1.00 $1.00 – $1.00 1
Intra-atrial recording CPT 93602 $0.60 $1.00 $1.00 – $1.00 1
Intracard echo interv w/s&i CPT 93662 $0.60 $1.00 $1.00 – $1.00 1
Intraventricular pacing CPT 93612 $0.60 $1.00 $1.00 – $1.00 1
Intrinsic factor antibody CPT 86340 $56.40 $94.00 $94.00 – $94.00 1
Intro cath dialysis circuit CPT 36901 $0.60 $1.00 $1.00 – $1.00 1
Intro cath dialysis circuit w/pta CPT 36902 $0.60 $1.00 $1.00 – $1.00 1
Intro cath dialysis circuit w/stent plcmnt CPT 36903 $0.60 $1.00 $1.00 – $1.00 1
Intro cath svc/ivc CPT 36010 $0.60 $1.00 $1.00 – $1.00 1
Intro catheter aorta CPT 36200 $0.60 $1.00 $1.00 – $1.00 1
Intrvasc Ultrasound noncoronary 1st vessel CPT 37252 $0.60 $1.00 $1.00 – $1.00 1
Intrvasc Ultrasound noncoronary addl vessel CPT 37253 $0.60 $1.00 $1.00 – $1.00 1
Intubation endotracheal emergency procedure CPT 31500 $39.60 $66.00 $66.00 – $66.00 1
Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 $61.20 $102.00 $1.00 – $1.00 1
Ipilimumab 5 mg/ml intravenous solution (wrapper) HCPCS J9228 $200.40 $334.00 $294.00 – $294.00 1
Irinotecan 20 mg/ml intravenous solution (wrapper) HCPCS J9206 $2.40 $4.00 $4.00 – $4.00 1
Irinotecan liposomal 4.3 mg/ml intravenous HCPCS J9205 $78.00 $130.00 $130.00 – $130.00 1
Iron CPT 83540 $9.60 $16.00 $16.00 – $16.00 1
Iron binding capacity CPT 83550 $19.20 $32.00 $32.00 – $32.00 1
Iron dextran 50 mg/ml injection solution HCPCS J1750 $38.40 $64.00 $64.00 – $64.00 1
Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 $35.40 $59.00 $59.00 – $59.00 1
Irradiation of blood product each unit reference CPT 86945 $129.60 $216.00 $216.00 – $216.00 1
Irrigation implantable venous access device for drug delivery systems CPT 96523 $87.60 $146.00 $146.00 – $146.00 1
Ivc venogram s&i CPT 75825 $0.60 $1.00 $1.00 – $1.00 1
Ixabepilone 15 mg intravenous solution HCPCS J9207 $1,650.60 $2,751.00 $2,751.00 – $2,751.00 1
Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 $21.00 $35.00 $35.00 – $35.00 1
Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 $1.20 $2.00 $1.00 – $1.00 1
Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 $393.00 $655.00 $655.00 – $655.00 1
Kidney img w/bldflw sgl without rx CPT 78707 $198.00 $330.00 $330.00 – $330.00 1
Kit lead specify 5-6-5 HCPCS C1778 $8,840.40 $14,734.00 $3,060.00 – $3,060.00 1
Kit monitr cath camino icp w/integratd licox bolt fitting HCPCS A9279 $448.20 $747.00 $70.00 – $70.00 1
Kit tissue closure sealant adhesive air leak progel 4 ml pleura HCPCS C2615 $1,122.00 $1,870.00 $1,870.00 – $1,870.00 1
Knee MRI (with and without contrast) CPT 73723 $601.20 $1,002.00 $1,002.00 – $1,002.00 1
Knee MRI (with contrast) CPT 73722 $495.00 $825.00 $825.00 – $825.00 1
Knee MRI (without contrast) CPT 73721 $276.60 $461.00 $461.00 – $461.00 1
Knee X-ray CPT 73564 $142.80 $238.00 $98.00 – $98.00 1
Kras gene addl variants CPT 81276 $243.60 $406.00 $406.00 – $406.00 1
Kras gene variants exon 2 CPT 81275 $389.40 $649.00 $649.00 – $649.00 1
L/s ratio fetal lung CPT 83661 $194.40 $324.00 $324.00 – $324.00 1
Lacosamide 200 mg/20 ml intravenous solution HCPCS C9254 $63.60 $106.00 $106.00 – $106.00 1
Lactate dehydrogenase (ldh) CPT 83615 $6.00 $10.00 $10.00 – $10.00 1
Lactated ringers intravenous solution HCPCS J7120 $1.20 $2.00 $2.00 – $2.00 1
Lactic acid CPT 83605 $32.40 $54.00 $54.00 – $54.00 1
Lactoferrin fecal qualitative CPT 83630 $40.20 $67.00 $21.00 – $21.00 1
Lanreotide 120 mg/0.5 ml subcutaneous syringe HCPCS J1930 $11,474.40 $19,124.00 $19,124.00 – $19,124.00 1
Lanthanum carbonate oral 5mg HCPCS J0607 $6.60 $11.00 $11.00 – $11.00 1
Lead acuity x4 spiral l 86cm HCPCS C1900 $2,570.40 $4,284.00 $1,110.00 – $1,110.00 1
Lead capillary CPT 83655 $40.20 $67.00 $67.00 – $67.00 1
Lead ingevity 45cm pfret MRI HCPCS C1898 $4,174.20 $6,957.00 $897.00 – $897.00 1
Lead tachy durata sj4 58cm HCPCS C1777 $4,950.00 $8,250.00 $6,508.00 – $6,508.00 1
Leg Vein Ultrasound (DVT study, both legs) CPT 93970 $822.00 $1,370.00 $1,370.00 – $1,370.00 1
Lens iol ant bicnvx 24.0 multi HCPCS V2632 $1,993.80 $3,323.00 $330.00 – $330.00 1
Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 $4.80 $8.00 $6.00 – $6.00 1
Leukacyte transfusion CPT 86950 $974.40 $1,624.00 $1,624.00 – $1,624.00 1
Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 $4,876.80 $8,128.00 $2,375.00 – $2,375.00 1
Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 $6,209.40 $10,349.00 $218.00 – $218.00 1
Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 $13.20 $22.00 $16.00 – $16.00 1
Levetiracetam therapeutic drug level CPT 80177 $24.00 $40.00 $40.00 – $40.00 1
Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 $2.40 $4.00 $2.00 – $2.00 1
Liberta rc ipg HCPCS C1820 $32,526.00 $54,210.00 $3,978.00 – $3,978.00 1
Lidocaine therapeutic drug level CPT 80176 $24.00 $40.00 $40.00 – $40.00 1
Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 $37.80 $63.00 $63.00 – $63.00 1
Lipase CPT 83690 $12.60 $21.00 $21.00 – $21.00 1
Lipoprotein direct measurement hdl CPT 83718 $24.00 $40.00 $40.00 – $40.00 1
Lipoprotein direct measurement ldl CPT 83721 $24.00 $40.00 $40.00 – $40.00 1
Lithium therapeutic drug level CPT 80178 $24.00 $40.00 $40.00 – $40.00 1
Lithotripsy transluminal coronary percutaneous CPT 92972 $0.60 $1.00 $1.00 – $1.00 1
Liver Function Test CPT 80076 $17.40 $29.00 $29.00 – $29.00 1
Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 $4.80 $8.00 $8.00 – $8.00 1
Low frequency non-thermal Ultrasound CPT 97610 $45.60 $76.00 $76.00 – $76.00 1
Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 $172.80 $288.00 $288.00 – $288.00 1
Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 $140.40 $234.00 $234.00 – $234.00 1
Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 $107.40 $179.00 $179.00 – $179.00 1
Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 $436.20 $727.00 $727.00 – $727.00 1
Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 $382.80 $638.00 $638.00 – $638.00 1
Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 $247.20 $412.00 $412.00 – $412.00 1
Lower Back (Lumbar Spine) X-ray CPT 72100 $124.80 $208.00 $49.00 – $49.00 1
Lumbar diskogram s&i CPT 72295 $0.60 $1.00 $1.00 – $1.00 1
Lung Function Test (Spirometry) CPT 94010 $82.20 $137.00 $137.00 – $137.00 1
Lung perfusion imaging CPT 78580 $216.00 $360.00 $360.00 – $360.00 1
Lurbinectedin 4 mg intravenous solution HCPCS J9223 $234.60 $391.00 $391.00 – $391.00 1
Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 $44.40 $74.00 $74.00 – $74.00 1
Lymphatics/lymph node imaging CPT 78195 $318.60 $531.00 $531.00 – $531.00 1
M/phmtrc alys ishquant/semiq CPT 88373 $267.60 $446.00 $446.00 – $446.00 1
M/phmtrc alys ishquant/semiq CPT 88377 $324.60 $541.00 $541.00 – $541.00 1
M/phmtrc alysishquant/semiq CPT 88369 $243.60 $406.00 $406.00 – $406.00 1
MRA abdomen post contrast CPT 74185 $518.40 $864.00 $864.00 – $864.00 1
MRA aorta thoracic w/wo contrast CPT 71555 $513.00 $855.00 $855.00 – $855.00 1
MRA ext low(run-off)pst cntrst CPT 73725 $513.00 $855.00 $855.00 – $855.00 1
MRA upper extremity post contrast-bil CPT 73225 $536.40 $894.00 $894.00 – $894.00 1
MRI breast c- unilateral CPT 77046 $565.80 $943.00 $943.00 – $943.00 1
MRI breast c-+ w/cad uni CPT 77048 $760.20 $1,267.00 $1,267.00 – $1,267.00 1
MRI breast w IV cont bi CPT 77049 $754.20 $1,257.00 $1,257.00 – $1,257.00 1
MRI breast without cont bi CPT 77047 $565.80 $943.00 $943.00 – $943.00 1
MRI cardiac morph & func wo IV cont CPT 75557 $336.00 $560.00 $560.00 – $560.00 1
MRI cardiac morph & func wwo IV cont CPT 75561 $489.00 $815.00 $815.00 – $815.00 1
MRI chest without & w/contrast CPT 71552 $772.20 $1,287.00 $1,287.00 – $1,287.00 1
MRI chest without contrast CPT 71550 $565.80 $943.00 $943.00 – $943.00 1
MRI lower extremity other than joint without & w/contrast (both sides) CPT 73720 $654.00 $1,090.00 $1,090.00 – $1,090.00 1
MRI lower extremity other than joint without contrast (both sides) CPT 73718 $489.00 $815.00 $815.00 – $815.00 1
MRI orbit fac&nck w IV cont CPT 70542 $424.20 $707.00 $707.00 – $707.00 1
MRI orbit/face/neck without & w/contrast CPT 70543 $513.00 $855.00 $855.00 – $855.00 1
MRI orbit/face/neck without contrast CPT 70540 $388.80 $648.00 $648.00 – $648.00 1
MRI tmj CPT 70336 $412.20 $687.00 $687.00 – $687.00 1
MRI upper extremity other than joint without & w/contrast (both sides) CPT 73220 $648.60 $1,081.00 $1,081.00 – $1,081.00 1
MRI upper extremity other than joint without contrast (both sides) CPT 73218 $495.00 $825.00 $825.00 – $825.00 1
Magnesium CPT 83735 $9.60 $16.00 $16.00 – $16.00 1
Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 $7.80 $13.00 $2.00 – $2.00 1
Magnetic image bone marrow CPT 77084 $513.00 $855.00 $855.00 – $855.00 1
Manipulation chest wall demonstration/evaluation subsequent CPT 94668 $39.60 $66.00 $66.00 – $66.00 1
Manipulation chest wall initial demonstration/evaluation CPT 94667 $47.40 $79.00 $79.00 – $79.00 1
Margetuximab-cmkb 25 mg/ml intravenous solution HCPCS J9353 $258.00 $430.00 $430.00 – $430.00 1
Mastoids complete CPT 70130 $178.80 $298.00 $298.00 – $298.00 1
Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 $64.80 $108.00 $108.00 – $108.00 1
Mayo aathr protein s free CPT 85306 $81.00 $135.00 $135.00 – $135.00 1
Mayo activated protein c resistance assay CPT 85307 $97.20 $162.00 $162.00 – $162.00 1
Mayo alcohol definitive assay volatile screen CPT 80320 $48.60 $81.00 $81.00 – $81.00 1
Mayo alkaline phosphatase isoenzyme CPT 84080 $40.20 $67.00 $67.00 – $67.00 1
Mayo alpha 1 antitrypsin CPT 82103 $24.00 $40.00 $40.00 – $40.00 1
Mayo amikacin trough therapeutic drug level CPT 80150 $24.00 $40.00 $40.00 – $40.00 1
Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 $40.20 $67.00 $67.00 – $67.00 1
Mayo analysis gene jak2 p.val617phe variant CPT 81270 $194.40 $324.00 $324.00 – $324.00 1
Mayo androstenedione CPT 82157 $40.20 $67.00 $67.00 – $67.00 1
Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 $32.40 $54.00 $54.00 – $54.00 1
Mayo aspergillus fumigatus antibody CPT 86606 $53.40 $89.00 $89.00 – $89.00 1
Mayo barbiturates definitive assay confirmation urine CPT 80345 $40.20 $67.00 $67.00 – $67.00 1
Mayo bart bartonella henselae antibody igg CPT 86611 $53.40 $89.00 $89.00 – $89.00 1
Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 $194.40 $324.00 $324.00 – $324.00 1
Mayo blastomyces antibody immunodiffusion CPT 86612 $53.40 $89.00 $89.00 – $89.00 1
Mayo bordetella pertussis antibody igg CPT 86615 $53.40 $89.00 $89.00 – $89.00 1
Mayo brcmg brucella antibody igm CPT 86622 $53.40 $89.00 $89.00 – $89.00 1
Mayo c1 esterase inhibitor CPT 83883 $24.00 $40.00 $40.00 – $40.00 1
Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 $64.80 $108.00 $81.00 – $81.00 1
Mayo carnitine total and free quantitative each specimen plasma CPT 82379 $243.60 $406.00 $406.00 – $406.00 1
Mayo ceruloplasmin CPT 82390 $24.00 $40.00 $40.00 – $40.00 1
Mayo chemiluminescent parathyroid related peptide CPT 82397 $24.00 $40.00 $40.00 – $40.00 1
Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 $32.40 $54.00 $54.00 – $54.00 1
Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 $32.40 $54.00 $54.00 – $54.00 1
Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 $162.00 $270.00 $270.00 – $270.00 1
Mayo chromium CPT 82495 $64.80 $108.00 $108.00 – $108.00 1
Mayo cocaine definitive assay confirmation urine CPT 80353 $48.60 $81.00 $81.00 – $81.00 1
Mayo coccidioides antibody CPT 86635 $53.40 $89.00 $89.00 – $89.00 1
Mayo cocou cortisone urine CPT 82542 $48.60 $81.00 $81.00 – $81.00 1
Mayo cortisol free CPT 82530 $48.60 $81.00 $81.00 – $81.00 1
Mayo covid-19 antibody nucleocapsid total CPT 86769 $48.60 $81.00 $81.00 – $81.00 1
Mayo coxiella brunetii (q fever) igg antibody CPT 86638 $53.40 $89.00 $89.00 – $89.00 1
Mayo cyanide CPT 82600 $46.80 $78.00 $78.00 – $78.00 1
Mayo deoxyribonuclease antibody titer CPT 86215 $33.60 $56.00 $56.00 – $56.00 1
Mayo dhea (dehydroepiandrosterone) CPT 82626 $24.00 $40.00 $40.00 – $40.00 1
Mayo dihydrotestosterone CPT 82642 $48.60 $81.00 $81.00 – $81.00 1
Mayo estriol CPT 82677 $24.00 $40.00 $40.00 – $40.00 1
Mayo estrone CPT 82679 $40.20 $67.00 $67.00 – $67.00 1
Mayo ethosuximide therapeutic drug level CPT 80168 $24.00 $40.00 $40.00 – $40.00 1
Mayo factor ii CPT 85210 $97.20 $162.00 $162.00 – $162.00 1
Mayo factor v CPT 85220 $97.20 $162.00 $162.00 – $162.00 1
Mayo factor vii CPT 85230 $97.20 $162.00 $162.00 – $162.00 1
Mayo factor viii vw factor antigen CPT 85246 $97.20 $162.00 $162.00 – $162.00 1
Mayo factor viii vw factor ristocetin cofactor CPT 85245 $97.20 $162.00 $162.00 – $162.00 1
Mayo factor x CPT 85260 $97.20 $162.00 $162.00 – $162.00 1
Mayo factor xi CPT 85270 $97.20 $162.00 $162.00 – $162.00 1
Mayo fat/lipids feces quantitative CPT 82710 $64.80 $108.00 $108.00 – $108.00 1
Mayo fbl culture fungi blood CPT 87103 $48.60 $81.00 $81.00 – $81.00 1
Mayo ffspg allergen clam igg CPT 86001 $24.00 $40.00 $40.00 – $40.00 1
Mayo gabapentin bld/srm/plasma therapeutic drug level CPT 80171 $24.00 $40.00 $40.00 – $40.00 1
Mayo hiser histoplasma antibodies immunodiffusion CPT 86698 $32.40 $54.00 $54.00 – $54.00 1
Mayo hla typing a/b/c single antigen CPT 86812 $72.60 $121.00 $121.00 – $121.00 1
Mayo hvdip HIV 1 antibody CPT 86701 $40.20 $67.00 $67.00 – $67.00 1
Mayo hvdip HIV 2 antibody CPT 86702 $53.40 $89.00 $89.00 – $89.00 1
Mayo hydroxyprogesterone 17-d CPT 83498 $56.40 $94.00 $94.00 – $94.00 1
Mayo immunoassay c1 esterase inhibitor antibody quantitative CPT 83520 $40.20 $67.00 $67.00 – $67.00 1
Mayo immunoassay infectious agent antibody quantitative diptheria igg CPT 86317 $40.20 $67.00 $67.00 – $67.00 1
Mayo immunoassay tumor antigen quantitative ca 27.29 CPT 86300 $53.40 $89.00 $89.00 – $89.00 1
Mayo immunoassay tumor antigen quantitative chromogranin a CPT 86316 $53.40 $89.00 $89.00 – $89.00 1
Mayo infectious agent antigen immunoassay direct optical observation cryptococcus CPT 87899 $40.20 $67.00 $67.00 – $67.00 1
Mayo infectious agent antigen immunoassay ql/sq multi step aspergillus bal CPT 87305 $40.20 $67.00 $67.00 – $67.00 1
Mayo infectious agent nucleic acid amplified probe enterovirus CPT 87498 $194.40 $324.00 $324.00 – $324.00 1
Mayo infectious agent nucleic acid quantification cytomegalovirus CPT 87497 $259.80 $433.00 $433.00 – $433.00 1
Mayo infectious disease hepatitis c chronic six biochemical assays CPT 81596 $88.80 $148.00 $148.00 – $148.00 1
Mayo inhab inhibin a CPT 86336 $38.40 $64.00 $64.00 – $64.00 1
Mayo insulin antibodies CPT 86337 $60.00 $100.00 $100.00 – $100.00 1
Mayo iodine CPT 83789 $64.80 $108.00 $108.00 – $108.00 1
Mayo lamotrigine therapeutic drug level CPT 80175 $24.00 $40.00 $40.00 – $40.00 1
Mayo ld_i lactate dehydrogenase isoenzymes CPT 83625 $40.20 $67.00 $67.00 – $67.00 1
Mayo legionella antibody CPT 86713 $32.40 $54.00 $54.00 – $54.00 1
Mayo leptospira antibody igm CPT 86720 $32.40 $54.00 $54.00 – $54.00 1
Mayo lipoprotein electrophoresis CPT 83700 $40.20 $67.00 $67.00 – $67.00 1
Mayo lywb borrelia burgdorferi (lyme disease) antibody igg confirmatory CPT 86617 $97.20 $162.00 $162.00 – $162.00 1
Mayo manganese CPT 83785 $40.20 $67.00 $67.00 – $67.00 1
Mayo metanephrines plasma CPT 83835 $48.60 $81.00 $81.00 – $81.00 1
Mayo methadone definitive assay confirmation urine CPT 80358 $48.60 $81.00 $81.00 – $81.00 1
Mayo microsomal antibody liver-kidney CPT 86376 $35.40 $59.00 $59.00 – $59.00 1
Mayo mitotane (lysodren) therapeutic drug level CPT 80299 $64.80 $108.00 $40.00 – $40.00 1
Mayo molecular pathology procedure level 2 apoe genotype CPT 81401 $194.40 $324.00 $324.00 – $324.00 1
Mayo muramidase CPT 85549 $53.40 $89.00 $89.00 – $89.00 1
Mayo myoglobin CPT 83874 $32.40 $54.00 $54.00 – $54.00 1
Mayo opatu opiates definitive assay >=1 CPT 80361 $64.80 $108.00 $67.00 – $67.00 1
Mayo opatu opioid/analogs definitive assay 1 or 2 CPT 80362 $40.20 $67.00 $67.00 – $67.00 1
Mayo opatu oxycodone definitive assay CPT 80365 $40.20 $67.00 $67.00 – $67.00 1
Mayo organic acid methylmalonic single quantitative CPT 83921 $64.80 $108.00 $108.00 – $108.00 1
Mayo oxalate 24 hour urine CPT 83945 $24.00 $40.00 $40.00 – $40.00 1
Mayo pancreatic elastase fecal qualitative or semi quantitative CPT 82656 $40.20 $67.00 $67.00 – $67.00 1
Mayo parvs parvovirus b19 antibody igg CPT 86747 $48.60 $81.00 $81.00 – $81.00 1
Mayo paval fluorescent antibody screen agna type 1 CPT 86255 $24.00 $40.00 $40.00 – $40.00 1
Mayo phospholipid neutralization hexagonal lupus anticoagulant CPT 85598 $81.00 $135.00 $135.00 – $135.00 1
Mayo pntft phenytoin free therapeutic drug level CPT 80186 $24.00 $40.00 $40.00 – $40.00 1
Mayo prmb primidone therapeutic drug level CPT 80188 $48.60 $81.00 $81.00 – $81.00 1
Mayo proinsulin CPT 84206 $194.40 $324.00 $324.00 – $324.00 1
Mayo psaft prostate specific antigen free CPT 84154 $40.20 $67.00 $67.00 – $67.00 1
Mayo radioimmunoassay procollagen i intact n-terminal antibody quantitative CPT 83519 $40.20 $67.00 $67.00 – $67.00 1
Mayo receptor assay transferrin soluble CPT 84238 $121.80 $203.00 $203.00 – $203.00 1
Mayo renin CPT 84244 $24.00 $40.00 $40.00 – $40.00 1
Mayo repu protein electrophoresis urine CPT 84166 $40.20 $67.00 $67.00 – $67.00 1
Mayo selenium CPT 84255 $64.80 $108.00 $108.00 – $108.00 1
Mayo serotonin CPT 84260 $48.60 $81.00 $81.00 – $81.00 1
Mayo sfgp rickettsia rickettsii antibody igg CPT 86757 $32.40 $54.00 $54.00 – $54.00 1
Mayo sirolimus therapeutic drug level CPT 80195 $48.60 $81.00 $81.00 – $81.00 1
Mayo syphilis test non-treponemal antibody qualitative vdrl CPT 86592 $12.60 $21.00 $21.00 – $21.00 1
Mayo tcgr analysis gene rearrangement trb@ abnormal clonal population(s) amplification CPT 81340 $194.40 $324.00 $324.00 – $324.00 1
Mayo tgrp testosterone free CPT 84402 $24.00 $40.00 $40.00 – $40.00 1
Mayo tgrp testosterone total CPT 84403 $24.00 $40.00 $40.00 – $40.00 1
Mayo thyroglobulin CPT 84432 $40.20 $67.00 $67.00 – $67.00 1
Mayo ticks anaplasma phagocytophilum antibody igg CPT 86666 $53.40 $89.00 $89.00 – $89.00 1
Mayo ticks babesia microti antibody igg CPT 86753 $53.40 $89.00 $89.00 – $89.00 1
Mayo tramadol definitive assay w metabolite quantitative urine CPT 80373 $48.60 $81.00 $81.00 – $81.00 1
Mayo vasoactive intestinal peptide CPT 84586 $40.20 $67.00 $67.00 – $67.00 1
Mayo vitamin b-2 (riboflavin) CPT 84252 $40.20 $67.00 $67.00 – $67.00 1
Mayo vitamin b3 (niacin) CPT 84591 $81.00 $135.00 $135.00 – $135.00 1
Mayo vitamin k CPT 84597 $40.20 $67.00 $67.00 – $67.00 1
Measure kidney pressure CPT 50396 $0.60 $1.00 $1.00 – $1.00 1
Medroxyprogesterone 150 mg/ml im injection (wrapper) HCPCS J1050 $20.40 $34.00 $34.00 – $34.00 1
Meperidine (pf) 25 mg/ml injection (wrapper) HCPCS J2175 $6.60 $11.00 $4.00 – $4.00 1
Mepolizumab 100 mg/ml subcutaneous auto-injector HCPCS J2182 $3,571.80 $5,953.00 $5,953.00 – $5,953.00 1
Meropenem 1 gram intravenous solution HCPCS J2185 $6.60 $11.00 $7.00 – $7.00 1
Mesna 100 mg/ml intravenous solution HCPCS J9209 $1.80 $3.00 $3.00 – $3.00 1
Metabolic Blood Panel (Basic) CPT 80048 $17.40 $29.00 $29.00 – $29.00 1
Metabolic Blood Panel (Comprehensive) CPT 80053 $24.00 $40.00 $40.00 – $40.00 1
Methotrexate sodium (pf) 1 gram solution for injection HCPCS J9260 $19.80 $33.00 $3.00 – $3.00 1
Methotrexate sodium 2.5 mg tablet HCPCS J8610 $3.00 $5.00 $5.00 – $5.00 1
Methylnaltrexone 12 mg/0.6 ml subcutaneous injection (wrapper) HCPCS J2212 $150.00 $250.00 $250.00 – $250.00 1
Methylprednisolone sodium succinate 1,000 mg intravenous solution HCPCS J2919 $45.00 $75.00 $11.00 – $11.00 1
Micafungin 100 mg intravenous solution HCPCS J2248 $52.20 $87.00 $87.00 – $87.00 1
Microsatellite instability CPT 81301 $471.00 $785.00 $785.00 – $785.00 1
Midazolam 1 mg/ml injection solution HCPCS J2250 $33.00 $55.00 $1.00 – $1.00 1
Middle cerebral artery echo CPT 76821 $285.60 $476.00 $476.00 – $476.00 1
Minocycline hydrochloride HCPCS J2265 $216.60 $361.00 $361.00 – $361.00 1
Mirvetuximab soravtansine-gynx 5 mg/ml intravenous solution HCPCS J9063 $77.40 $129.00 $129.00 – $129.00 1
Mitomycin 40 mg intravenous solution HCPCS J9280 $1,516.20 $2,527.00 $127.00 – $127.00 1
Mitoxantrone 2 mg/ml concentrate,intravenous HCPCS J9293 $145.20 $242.00 $242.00 – $242.00 1
Mlh1 gene CPT 81288 $259.80 $433.00 $433.00 – $433.00 1
Monitor reveal linq ii cardiac HCPCS C1764 $8,081.40 $13,469.00 $9,426.00 – $9,426.00 1
Mopath procedure level 3 CPT 81402 $243.60 $406.00 $406.00 – $406.00 1
Mopath procedure level 5 CPT 81404 $584.40 $974.00 $974.00 – $974.00 1
Morphine (pf) 0.25 mg/0.5 ml injection (neo/ped) - cnr HCPCS J2274 $302.40 $504.00 $11.00 – $11.00 1
Morphine 4 mg/ml injection (wrapper) HCPCS J2270 $1.80 $3.00 $1.00 – $1.00 1
Morphometric analysis in situ hybridization computer-assisted per specimen each multiplex stain CPT 88374 $349.20 $582.00 $582.00 – $582.00 1
Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain computer-assisted CPT 88361 $145.80 $243.00 $243.00 – $243.00 1
Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain manual CPT 88360 $121.80 $203.00 $203.00 – $203.00 1
Mthfr gene analy common variants CPT 81291 $243.60 $406.00 $406.00 – $406.00 1
Mucin synovial fluid CPT 83872 $14.40 $24.00 $24.00 – $24.00 1
Multiple sleep latency test CPT 95805 $511.20 $852.00 $852.00 – $852.00 1
Mumps antibody igg CPT 86735 $32.40 $54.00 $54.00 – $54.00 1
Mycoplasma antibody igm CPT 86738 $32.40 $54.00 $54.00 – $54.00 1
Myelography via inj w/s&i 2+ regions CPT 62305 $0.60 $1.00 $1.00 – $1.00 1
Myelography via inj w/s&i cervical CPT 62302 $0.60 $1.00 $1.00 – $1.00 1
Myelography via inj w/s&i lumbosacral CPT 62304 $0.60 $1.00 $1.00 – $1.00 1
Myelography via inj w/s&i thoracic CPT 62303 $0.60 $1.00 $1.00 – $1.00 1
Myeloperoxidase ab multi step qualitative/semiquantitative CPT 83516 $40.20 $67.00 $67.00 – $67.00 1
Natalizumab 300 mg/15 ml intravenous solution HCPCS J2323 $8,221.80 $13,703.00 $13,703.00 – $13,703.00 1
Natriuretic peptide CPT 83880 $48.60 $81.00 $81.00 – $81.00 1
Natural killer cells total count CPT 86357 $81.00 $135.00 $135.00 – $135.00 1
Neck (Cervical Spine) CT scan (with and without contrast) CPT 72127 $172.80 $288.00 $164.00 – $164.00 1
Neck (Cervical Spine) CT scan (with contrast) CPT 72126 $140.40 $234.00 $124.00 – $124.00 1
Neck (Cervical Spine) CT scan (without contrast) CPT 72125 $110.40 $184.00 $99.00 – $99.00 1
Neck (Cervical Spine) MRI (with and without contrast) CPT 72156 $436.20 $727.00 $727.00 – $727.00 1
Neck (Cervical Spine) MRI (with contrast) CPT 72142 $388.80 $648.00 $648.00 – $648.00 1
Neck (Cervical Spine) MRI (without contrast) CPT 72141 $247.20 $412.00 $412.00 – $412.00 1
Neck MRA (blood vessel MRI, with contrast) CPT 70548 $583.20 $972.00 $972.00 – $972.00 1
Neck MRA (blood vessel MRI, without contrast) CPT 70547 $553.80 $923.00 $923.00 – $923.00 1
Nerve conduction studies 13+ CPT 95913 $153.60 $256.00 $256.00 – $256.00 1
New Patient Office Visit (level 2) CPT 99202 $87.60 $146.00 $146.00 – $146.00 1
New Patient Office Visit (level 3) CPT 99203 $117.00 $195.00 $195.00 – $195.00 1
New Patient Office Visit (level 4) CPT 99204 $146.40 $244.00 $244.00 – $244.00 1
New Patient Office Visit (level 5) CPT 99205 $175.80 $293.00 $293.00 – $293.00 1
Nfct ds bv&vaginitis dna alg CPT 81514 $462.60 $771.00 $771.00 – $771.00 1
Nitroblue tetrazolium dye CPT 86384 $81.00 $135.00 $135.00 – $135.00 1
Nitroglycerin 50 mg/250 ml (200 mcg/ml) in 5 % dextrose intravenous HCPCS J2305 $26.40 $44.00 $44.00 – $44.00 1
Nivolumab 10 mg/ml intravenous solution (wrapper) HCPCS J9299 $8,805.60 $14,676.00 $2,066.00 – $2,066.00 1
Njx px nfrosgrm &/urtrgrm CPT 50430 $0.60 $1.00 $1.00 – $1.00 1
Nm imaging bone/joint 3 phase study CPT 78315 $318.60 $531.00 $531.00 – $531.00 1
Nm imaging bone/joint whole body CPT 78306 $223.20 $372.00 $372.00 – $372.00 1
Nm imaging cardiac blood pooling planar single study at rest or stress CPT 78472 $194.40 $324.00 $324.00 – $324.00 1
Nm imaging gastric emptying study CPT 78264 $318.60 $531.00 $531.00 – $531.00 1
Nm imaging gastrointestinal acute blood loss CPT 78278 $322.80 $538.00 $538.00 – $538.00 1
Nm imaging hepatobiliary system w/pharmacologic intervention CPT 78227 $432.60 $721.00 $721.00 – $721.00 1
Nm imaging kidney morphology vascular flow/function single study w/pharmacological intervention CPT 78708 $124.20 $207.00 $207.00 – $207.00 1
Nm imaging pulmonary ventilation/perfusion CPT 78582 $300.60 $501.00 $501.00 – $501.00 1
Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s) CPT 78014 $231.00 $385.00 $385.00 – $385.00 1
Nm radiopharmaceutical therapy oral administration CPT 79005 $51.00 $85.00 $85.00 – $85.00 1
Nr lnr acclrtr tx max 5 sessions CPT 77373 $2,272.80 $3,788.00 $3,788.00 – $3,788.00 1
Nras gene variants exon 2&3 CPT 81311 $487.20 $812.00 $812.00 – $812.00 1
Ntsty modul rad tx dlvr cplx CPT 77386 $675.00 $1,125.00 $1,125.00 – $1,125.00 1
Ntsty modul rad tx dlvr smpl CPT 77385 $675.00 $1,125.00 $1,125.00 – $1,125.00 1
Nuclear Stress Test (Heart) CPT 78452 $421.80 $703.00 $703.00 – $703.00 1
Obinutuzumab 1,000 mg/40 ml intravenous solution HCPCS J9301 $8,218.20 $13,697.00 $13,697.00 – $13,697.00 1
Observation per hour HCPCS G0378 $144.00 $240.00 $1.00 – $1.00 1
Ocrelizumab 30 mg/ml intravenous solution HCPCS J2350 $19,500.00 $32,500.00 $32,500.00 – $32,500.00 1
Octreotide acetate 100 mcg/ml injection (wrapper) HCPCS J2354 $12.60 $21.00 $3.00 – $3.00 1
Octreotide,microspheres ER 20 mg intramuscular susp, extended release HCPCS J2353 $7,433.40 $12,389.00 $417.00 – $417.00 1
Ofatumumab 20 mg/ml intravenous solution (wrapper) HCPCS J9302 $5,899.80 $9,833.00 $3,122.00 – $3,122.00 1
Omalizumab 150 mg/ml subcutaneous syringe (wrapper) HCPCS J2357 $1,465.20 $2,442.00 $1,221.00 – $1,221.00 1
Oritavancin 400 mg intravenous solution HCPCS J2407 $27.60 $46.00 $46.00 – $46.00 1
Osmolality blood CPT 83930 $16.20 $27.00 $27.00 – $27.00 1
Osmolality urine CPT 83935 $16.20 $27.00 $27.00 – $27.00 1
Ot evaluation high complexity patient/family CPT 97167 $165.60 $276.00 $276.00 – $276.00 1
Ot evaluation low complexity patient/family CPT 97165 $55.20 $92.00 $92.00 – $92.00 1
Ot evaluation moderate complexity patient/family CPT 97166 $110.40 $184.00 $184.00 – $184.00 1
Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes CPT 97763 $125.40 $209.00 $126.00 – $126.00 1
Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes CPT 97760 $102.60 $171.00 $103.00 – $103.00 1
Ot manual therpy techniques >=1 region each 15 minutes CPT 97140 $274.20 $457.00 $46.00 – $46.00 1
Ot re-evaluation patient/family CPT 97168 $41.40 $69.00 $69.00 – $69.00 1
Ot therapeutic activities direct patient contact each 15 minutes CPT 97530 $480.00 $800.00 $80.00 – $80.00 1
Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes CPT 97130 $45.60 $76.00 $46.00 – $46.00 1
Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes CPT 97129 $45.60 $76.00 $46.00 – $46.00 1
Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes CPT 97110 $182.40 $304.00 $46.00 – $46.00 1
Ot therapeutic procedure neuromuscular reeducate each 15 minutes CPT 97112 $57.00 $95.00 $57.00 – $57.00 1
Ot training self care/home management direct contact each 15 minutes CPT 97535 $57.00 $95.00 $57.00 – $57.00 1
Oth resp proc, group HCPCS G0239 $49.20 $82.00 $82.00 – $82.00 1
Oth resp proc, indiv HCPCS G0238 $49.20 $82.00 $82.00 – $82.00 1
Oxaliplatin 5 mg/ml desensitization HCPCS J9263 $13.20 $22.00 $13.00 – $13.00 1
Oxytocin 10 unit/ml injection solution HCPCS J2590 $6.60 $11.00 $11.00 – $11.00 1
PSA (Prostate) Test CPT 84153 $32.40 $54.00 $54.00 – $54.00 1
Paclitaxel protein-bound 100 mg intravenous suspension HCPCS J9264 $1,656.00 $2,760.00 $2,760.00 – $2,760.00 1
Palivizumab 50 mg/0.5 ml inj CPT 90378 $3,154.20 $5,257.00 $2,784.00 – $2,784.00 1
Palonosetron hcl HCPCS J2469 $15.00 $25.00 $25.00 – $25.00 1
Pamidronate 30 mg/10 ml (3 mg/ml) intravenous solution HCPCS J2430 $31.80 $53.00 $16.00 – $16.00 1
Panitumumab 20 mg/ml intravenous solution (wrapper) HCPCS J9303 $6,081.60 $10,136.00 $2,814.00 – $2,814.00 1
Parathormone (pth) intact CPT 83970 $24.00 $40.00 $40.00 – $40.00 1
Parathyroid planar imaging CPT 78070 $278.40 $464.00 $464.00 – $464.00 1
Paricalcitol HCPCS J2501 $10.80 $18.00 $7.00 – $7.00 1
Passy muir valve metal trach HCPCS L8501 $241.20 $402.00 $310.00 – $310.00 1
Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector HCPCS J2506 $6,121.20 $10,202.00 $8,091.00 – $8,091.00 1
Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe HCPCS Q5122 $2,714.40 $4,524.00 $4,524.00 – $4,524.00 1
Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe HCPCS Q5111 $3,872.40 $6,454.00 $3,709.00 – $3,709.00 1
Pelvic CT scan (with and without contrast) CPT 72194 $166.80 $278.00 $278.00 – $278.00 1
Pelvic CT scan (with contrast) CPT 72193 $140.40 $234.00 $234.00 – $234.00 1
Pelvic CT scan (without contrast) CPT 72192 $77.40 $129.00 $129.00 – $129.00 1
Pelvic MRI (with and without contrast) CPT 72197 $648.60 $1,081.00 $1,081.00 – $1,081.00 1
Pelvic MRI (with contrast) CPT 72196 $536.40 $894.00 $894.00 – $894.00 1
Pelvic MRI (without contrast) CPT 72195 $501.00 $835.00 $835.00 – $835.00 1
Pelvic Ultrasound (complete) CPT 76856 $375.00 $625.00 $625.00 – $625.00 1
Pelvic Ultrasound (limited) CPT 76857 $124.80 $208.00 $208.00 – $208.00 1
Pembrolizumab 25 mg/ml intravenous solution HCPCS J9271 $6,668.40 $11,114.00 $11,114.00 – $11,114.00 1
Pemetrexed disodium 100 mg intravenous powder for solution HCPCS J9305 $124.80 $208.00 $21.00 – $21.00 1
Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr HCPCS J2540 $4.20 $7.00 $4.00 – $4.00 1
Penile rear tip xtnd 0.5cm HCPCS C2622 $12,691.80 $21,153.00 $14,447.00 – $14,447.00 1
Penile vascular study CPT 93980 $303.60 $506.00 $506.00 – $506.00 1
Pentostatin 10 mg intravenous solution HCPCS J9268 $2,382.00 $3,970.00 $3,970.00 – $3,970.00 1
Perc cryo ablate renal tum CPT 50593 $0.60 $1.00 $1.00 – $1.00 1
Perc rf ablate renal tumor CPT 50592 $0.60 $1.00 $1.00 – $1.00 1
Percut ablate liver rf CPT 47382 $0.60 $1.00 $1.00 – $1.00 1
Peri-proc device eval pm CPT 93286 $0.60 $1.00 $1.00 – $1.00 1
Pericardiocentesis wwo imaging CPT 33016 $0.60 $1.00 $1.00 – $1.00 1
Peritoneogram rs&i CPT 74190 $0.60 $1.00 $1.00 – $1.00 1
Perq clsr tcat l atr apndge CPT 33340 $0.60 $1.00 $1.00 – $1.00 1
Perq dev breast 1st mr guide CPT 19287 $754.20 $1,257.00 $1,257.00 – $1,257.00 1
Perq nl/pl lithotrp cplx>2cm CPT 50081 $0.60 $1.00 $1.00 – $1.00 1
Perq nl/pl lithotrp smpl<2cm CPT 50080 $0.60 $1.00 $1.00 – $1.00 1
Perq plmt bile duct stent CPT 47538 $0.60 $1.00 $1.00 – $1.00 1
Perq plmt bile duct stent CPT 47539 $0.60 $1.00 $1.00 – $1.00 1
Perq plmt bile duct stent CPT 47540 $0.60 $1.00 $1.00 – $1.00 1
Perq transcath closure pda CPT 93582 $0.60 $1.00 $1.00 – $1.00 1
Perq transcath septal reduxn CPT 93583 $0.60 $1.00 $1.00 – $1.00 1
Pertuzumab 30 mg/ml desensitization HCPCS J9306 $7,603.80 $12,673.00 $12,673.00 – $12,673.00 1
Pet CT skull-mid thgh initial CPT 78815 $1,595.40 $2,659.00 $2,659.00 – $2,659.00 1
Pet CT whole body initial CPT 78816 $1,815.60 $3,026.00 $3,026.00 – $3,026.00 1
Pet fdg brain metoblic eval sb CPT 78608 $1,320.00 $2,200.00 $2,200.00 – $2,200.00 1
Pet image ltd area CPT 78811 $990.00 $1,650.00 $1,650.00 – $1,650.00 1
Pet image skull-thigh CPT 78812 $1,320.00 $2,200.00 $2,200.00 – $2,200.00 1
Pet image w/ct lmtd CPT 78814 $1,320.00 $2,200.00 $2,200.00 – $2,200.00 1
Pfc sigma fem post aug sz3 8mm HCPCS C1776 $12,792.60 $21,321.00 $112.00 – $112.00 1
Ph body fluid CPT 83986 $12.60 $21.00 $21.00 – $21.00 1
Phencyclidine (pcp) CPT 83992 $24.00 $40.00 $40.00 – $40.00 1
Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 $20.40 $34.00 $24.00 – $24.00 1
Phenobarbital therapeutic drug level CPT 80184 $24.00 $40.00 $40.00 – $40.00 1
Phenytoin total therapeutic drug level CPT 80185 $24.00 $40.00 $40.00 – $40.00 1
Phlebotomy therapeutic CPT 99195 $292.80 $488.00 $488.00 – $488.00 1
Phosphorus CPT 84100 $3.00 $5.00 $5.00 – $5.00 1
Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 $52.80 $88.00 $88.00 – $88.00 1
Piflu f-18, dia 1 millicurie HCPCS A9595 $6,267.00 $10,445.00 $10,445.00 – $10,445.00 1
Pin caspar distraction 12mm HCPCS C1821 $9,426.00 $15,710.00 $950.00 – $950.00 1
Pinworm exam CPT 87172 $9.60 $16.00 $16.00 – $16.00 1
Piperacillin-tazobactam 3.375 gram intravenous solution HCPCS J2543 $81.60 $136.00 $4.00 – $4.00 1
Place cath intracranial art CPT 36228 $0.60 $1.00 $1.00 – $1.00 1
Place cath xtrnl carotid CPT 36227 $0.60 $1.00 $1.00 – $1.00 1
Place gastrostomy tube perc CPT 49440 $0.60 $1.00 $1.00 – $1.00 1
Place non-slctv cath thoracic arta CPT 36221 $0.60 $1.00 $1.00 – $1.00 1
Place slctv cath carotd art uni CPT 36224 $0.60 $1.00 $1.00 – $1.00 1
Place slctv cath carotid/inom art excrn uni CPT 36222 $0.60 $1.00 $1.00 – $1.00 1
Place slctv cath carotid/inom art intcrn uni CPT 36223 $0.60 $1.00 $1.00 – $1.00 1
Place slctv cath subclavian art CPT 36225 $0.60 $1.00 $1.00 – $1.00 1
Place slctv cath vertebral art uni CPT 36226 $0.60 $1.00 $1.00 – $1.00 1
Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides) CPT 19281 $607.80 $1,013.00 $1,013.00 – $1,013.00 1
Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left CPT 19282 $303.60 $506.00 $506.00 – $506.00 1
Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides) CPT 19285 $357.60 $596.00 $596.00 – $596.00 1
Placement nephrostomy catheter (both sides) CPT 50432 $0.60 $1.00 $1.00 – $1.00 1
Placement stent(s) intravascular transcatheter artery initial CPT 37236 $0.60 $1.00 $1.00 – $1.00 1
Platelet aggregation each agent teg CPT 85576 $97.20 $162.00 $162.00 – $162.00 1
Platelet automated CPT 85049 $6.00 $10.00 $10.00 – $10.00 1
Platelets irradiated ea unit HCPCS P9032 $105.00 $175.00 $175.00 – $175.00 1
Platelets leukocytes reduced each unit HCPCS P9031 $97.20 $162.00 $162.00 – $162.00 1
Platelets leukocytes reduced irradiated each unit HCPCS P9033 $113.40 $189.00 $189.00 – $189.00 1
Platelets pheresis leukocytes reduced each unit HCPCS P9035 $811.80 $1,353.00 $1,353.00 – $1,353.00 1
Platelets pheresis leukocytes reduced irradiated each unit HCPCS P9037 $942.00 $1,570.00 $1,570.00 – $1,570.00 1
Platelets pheresis pathogen-reduced each unit HCPCS P9073 $876.60 $1,461.00 $1,461.00 – $1,461.00 1
Plc pq device breast ea addl lesion Ultrasound guide CPT 19286 $214.20 $357.00 $357.00 – $357.00 1
Plcmnt biliary drainage cath w/img ext CPT 47533 $0.60 $1.00 $1.00 – $1.00 1
Plcmnt stent transcath ctrl dialysis seg add-on CPT 36908 $0.60 $1.00 $1.00 – $1.00 1
Plcmnt ureteral stent pq w/img exstng trct CPT 50693 $0.60 $1.00 $1.00 – $1.00 1
Plcmnt ureteral stent pq w/img new w/cath CPT 50695 $0.60 $1.00 $1.00 – $1.00 1
Plmt access bil tree sm bwl CPT 47541 $0.60 $1.00 $1.00 – $1.00 1
Plmt biliary drainage cath CPT 47534 $0.60 $1.00 $1.00 – $1.00 1
Plmt nephroureteral catheter CPT 50433 $0.60 $1.00 $1.00 – $1.00 1
Plmt ureteral stent prq CPT 50694 $0.60 $1.00 $1.00 – $1.00 1
Poct blood gases ph pco2 po2 arterial calculated o2 CPT 82803 $49.80 $83.00 $83.00 – $83.00 1
Polatuzumab vedotin-piiq 140 mg intravenous solution HCPCS J9309 $19,860.00 $33,100.00 $236.00 – $236.00 1
Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap CPT 95811 $734.40 $1,224.00 $1,224.00 – $1,224.00 1
Potassium 24 hour urine CPT 84133 $16.20 $27.00 $27.00 – $27.00 1
Potassium chloride 10 meq/100ml in sterile water intravenous piggyback HCPCS J3480 $5.40 $9.00 $1.00 – $1.00 1
Potassium serum/plasma/whole blood CPT 84132 $6.00 $10.00 $10.00 – $10.00 1
Pq biliary strict dil s&i CPT 74363 $0.60 $1.00 $1.00 – $1.00 1
Pq dr cath chg w cont s&i CPT 75984 $0.60 $1.00 $1.00 – $1.00 1
Pq kyphplsty 1 bdy lumb w/img CPT 22514 $0.60 $1.00 $1.00 – $1.00 1
Pq thr inj ext pse CPT 36002 $0.60 $1.00 $1.00 – $1.00 1
Pq vrtbrplst 1 bdy inj crv-thr w/img ini CPT 22510 $0.60 $1.00 $1.00 – $1.00 1
Pq vrtbrplst 1 bdy inj crv-thr/lmb-scr w/img addl CPT 22512 $0.60 $1.00 $1.00 – $1.00 1
Pq vrtbrplst 1 bdy inj lmb-scr w/img ini CPT 22511 $0.60 $1.00 $1.00 – $1.00 1
Pr application of long arm splint CPT 29105 $103.20 $172.00 $172.00 – $172.00 1
Pr application splint static short arm CPT 29125 $96.60 $161.00 $161.00 – $161.00 1
Pr biopsy skin punch single lesion CPT 11104 $0.60 $1.00 $1.00 – $1.00 1
Pr counseling smoke/tobacco intermediate greater 3 - 10 minutes CPT 99406 $15.60 $26.00 $26.00 – $26.00 1
Pr debridement open wound topical appl/wound asmt per session 20 sq cm/< CPT 97597 $251.40 $419.00 $419.00 – $419.00 1
Pr tube thoracostomy w/connection to drainage open CPT 32551 $0.60 $1.00 $1.00 – $1.00 1
Pralatrexate injection HCPCS J9307 $5,614.80 $9,358.00 $9,358.00 – $9,358.00 1
Pralidoxime 1 gram solution for injection HCPCS J2730 $97.80 $163.00 $163.00 – $163.00 1
Prcrd drg 6+yr without anomly CPT 33017 $0.60 $1.00 $1.00 – $1.00 1
Prealbumin CPT 84134 $24.00 $40.00 $40.00 – $40.00 1
Prednisone 1 mg tablet HCPCS J7512 $0.60 $1.00 $1.00 – $1.00 1
Pregabalin - sendout CPT 80366 $64.80 $108.00 $108.00 – $108.00 1
Pregnancy Ultrasound (complete, after first trimester) CPT 76805 $464.40 $774.00 $774.00 – $774.00 1
Pregnancy Ultrasound (first trimester) CPT 76801 $375.00 $625.00 $625.00 – $625.00 1
Pressure max expiratory/inspiratory CPT 94799 $190.80 $318.00 $39.00 – $39.00 1
Pressure velocity wire add ves CPT 93572 $0.60 $1.00 $1.00 – $1.00 1
Pretreat rbc absorption reference CPT 86978 $162.00 $270.00 $270.00 – $270.00 1
Pretreat rbc density gradient separation reference CPT 86972 $49.80 $83.00 $83.00 – $83.00 1
Pretreat rbc w chem/drugs reference CPT 86970 $49.80 $83.00 $83.00 – $83.00 1
Pretreat rbc w enzyme reference CPT 86971 $49.80 $83.00 $83.00 – $83.00 1
Pretreatment serum by diff red cell adsorption patient rbc/known phenotype each adsorption ref CPT 86977 $49.80 $83.00 $83.00 – $83.00 1
Prgr stim/pace a/iv drug CPT 93623 $0.60 $1.00 $1.00 – $1.00 1
Prgrmg dev eval pm/ldls pm CPT 93279 $0.60 $1.00 $1.00 – $1.00 1
Prim art mech thrmbc non-intracranial CPT 37184 $0.60 $1.00 $1.00 – $1.00 1
Prim art mech thrmbc non-intracranial add-on CPT 37185 $0.60 $1.00 $1.00 – $1.00 1
Procalcitonin CPT 84145 $243.60 $406.00 $406.00 – $406.00 1
Progesterone CPT 84144 $24.00 $40.00 $40.00 – $40.00 1
Prolactin CPT 84146 $32.40 $54.00 $54.00 – $54.00 1
Propofol infusion 10 mg/ml HCPCS J2704 $11.40 $19.00 $4.00 – $4.00 1
Protein c activity CPT 85303 $97.20 $162.00 $162.00 – $162.00 1
Protein electrophoretic fractionation & quantitation serum CPT 84165 $40.20 $67.00 $67.00 – $67.00 1
Protein s total CPT 85305 $97.20 $162.00 $162.00 – $162.00 1
Protein total 24 hour urine CPT 84156 $16.20 $27.00 $27.00 – $27.00 1
Protein total body fluid CPT 84157 $16.20 $27.00 $27.00 – $27.00 1
Protein total serum plasma whole blood CPT 84155 $3.00 $5.00 $5.00 – $5.00 1
Prothrombin complex kcentra HCPCS J7168 $1.80 $3.00 $3.00 – $3.00 1
Prq card revasc chronic addl CPT 92944 $0.60 $1.00 $1.00 – $1.00 1
Prq card revasc mi 1 vsl CPT 92941 $0.60 $1.00 $1.00 – $1.00 1
Prq card stent w/angio addl CPT 92929 $0.60 $1.00 $1.00 – $1.00 1
Prq cardiac angio addl art CPT 92921 $0.60 $1.00 $1.00 – $1.00 1
Prq revasc byp graft 1 art and/or branches CPT 92937 $0.60 $1.00 $1.00 – $1.00 1
Prq revasc byp graft addl CPT 92938 $0.60 $1.00 $1.00 – $1.00 1
Prq tcat plmt ntrac st 1 les CPT 92928 $0.60 $1.00 $1.00 – $1.00 1
Prq trlml c athrc st angiop1 CPT 92933 $0.60 $1.00 $1.00 – $1.00 1
Prq trluml c angiop 1art&/br CPT 92920 $0.60 $1.00 $1.00 – $1.00 1
Prq trluml c athrc 1 art&/br CPT 92924 $0.60 $1.00 $1.00 – $1.00 1
Prq trluml revsc ch occ ant CPT 92943 $0.60 $1.00 $1.00 – $1.00 1
Psychotherapy group therapy CPT 90853 $58.20 $97.00 $97.00 – $97.00 1
Psychotherapy patient individual therapy 30 minutes CPT 90832 $146.40 $244.00 $244.00 – $244.00 1
Psychotherapy patient individual therapy 45 minutes CPT 90834 $175.80 $293.00 $293.00 – $293.00 1
Psychotherapy patient individual therapy 60 minutes CPT 90837 $263.40 $439.00 $439.00 – $439.00 1
Pt application of modality >=1 area electrical stimulation each 15 minutes CPT 97032 $22.80 $38.00 $23.00 – $23.00 1
Pt application of modality >=1 area iontophoresis each 15 minutes CPT 97033 $34.20 $57.00 $34.00 – $34.00 1
Pt application of modality >=1 area ultrasound each 15 minutes CPT 97035 $22.80 $38.00 $23.00 – $23.00 1
Pt application of modality traction mechanical CPT 97012 $22.80 $38.00 $38.00 – $38.00 1
Pt evaluation high complexity patient/family CPT 97163 $274.20 $457.00 $457.00 – $457.00 1
Pt evaluation low complexity patient/family CPT 97161 $91.20 $152.00 $152.00 – $152.00 1
Pt evaluation moderate complexity patient/family CPT 97162 $182.40 $304.00 $304.00 – $304.00 1
Pt re-evaluation patient/family CPT 97164 $68.40 $114.00 $114.00 – $114.00 1
Pt stimulation electrial unattended >= 1 area other than wound care part of therapy plan HCPCS G0283 $34.20 $57.00 $23.00 – $23.00 1
Pt therapeutic procedure >=1 area gait training each 15 minutes CPT 97116 $45.60 $76.00 $76.00 – $76.00 1
Pt therapeutic procedure >=1 area massage each 15 minutes CPT 97124 $57.00 $95.00 $57.00 – $57.00 1
Pt wheelchair management each 15 minutes CPT 97542 $57.00 $95.00 $57.00 – $57.00 1
Pulmonary vent imaging CPT 78579 $172.20 $287.00 $287.00 – $287.00 1
Pulse ox continuous overnight monitoring CPT 94762 $98.40 $164.00 $164.00 – $164.00 1
Pulse ox multiple CPT 94761 $98.40 $164.00 $164.00 – $164.00 1
Pulse ox single CPT 94760 $25.80 $43.00 $43.00 – $43.00 1
Puncture arterial withdrawal blood for diagnosis CPT 36600 $49.20 $82.00 $82.00 – $82.00 1
Puncture spinal lumbar diagnostic CPT 62270 $175.80 $293.00 $1.00 – $1.00 1
Pyruvate CPT 84210 $48.60 $81.00 $81.00 – $81.00 1
Quant diff pulm perf and vent w/imaging CPT 78598 $282.00 $470.00 $470.00 – $470.00 1
Quant diff pulm perf w/imaging CPT 78597 $179.40 $299.00 $299.00 – $299.00 1
Quest t3 uptake CPT 84479 $24.00 $40.00 $40.00 – $40.00 1
Radiation handling CPT 77790 $72.00 $120.00 $120.00 – $120.00 1
Radiation physics consult CPT 77336 $126.60 $211.00 $211.00 – $211.00 1
Radiation therapy dose plan CPT 77300 $54.00 $90.00 $90.00 – $90.00 1
Radiation treatment aid(s) CPT 77332 $90.00 $150.00 $150.00 – $150.00 1
Radiation treatment aid(s) CPT 77333 $120.60 $201.00 $201.00 – $201.00 1
Radiation treatment aid(s) CPT 77334 $150.60 $251.00 $251.00 – $251.00 1
Radiation treatment delivery CPT 77402 $271.20 $452.00 $452.00 – $452.00 1
Radiation treatment delivery CPT 77412 $463.80 $773.00 $773.00 – $773.00 1
Radiology port images(s) CPT 77417 $18.00 $30.00 $30.00 – $30.00 1
Radiotherapy dose plan imrt CPT 77301 $2,562.60 $4,271.00 $4,271.00 – $4,271.00 1
Radphm lcl tmr plnr bdy sgl day img CPT 78802 $300.60 $501.00 $501.00 – $501.00 1
Radphm lcl tmr plnr bdy two day img CPT 78804 $550.20 $917.00 $917.00 – $917.00 1
Radphm lcl tomogr sgl area sgl day CPT 78803 $311.40 $519.00 $519.00 – $519.00 1
Radphm lcl tumor plr sgl day CPT 78800 $168.60 $281.00 $281.00 – $281.00 1
Ramucirumab 10 mg/ml intravenous solution HCPCS J9308 $8,319.60 $13,866.00 $2,773.00 – $2,773.00 1
Rasburicase 1.5 mg intravenous solution HCPCS J2783 $3,184.20 $5,307.00 $5,307.00 – $5,307.00 1
Rbc count only automated CPT 85041 $6.00 $10.00 $10.00 – $10.00 1
Rbc deglycerolized each unit HCPCS P9039 $421.80 $703.00 $703.00 – $703.00 1
Rbc serum pretx incubj drugs CPT 86975 $49.80 $83.00 $83.00 – $83.00 1
Red blood cells each unit HCPCS P9021 $145.80 $243.00 $243.00 – $243.00 1
Red blood cells frozen/deglycerolized/washed leukocytes reduced irradiated each unit HCPCS P9057 $641.40 $1,069.00 $1,069.00 – $1,069.00 1
Red blood cells leukocytes reduced cmv negative irradiated each unit HCPCS P9058 $397.80 $663.00 $663.00 – $663.00 1
Red blood cells leukocytes reduced each unit HCPCS P9016 $438.60 $731.00 $392.00 – $392.00 1
Red blood cells leukocytes reduced irradiated each unit HCPCS P9040 $365.40 $609.00 $609.00 – $609.00 1
Red blood cells washed each unit HCPCS P9022 $259.80 $433.00 $433.00 – $433.00 1
Redo endovas vena cava filtr CPT 37192 $0.60 $1.00 $1.00 – $1.00 1
Refill/maint pump/resvr syst CPT 96522 $175.80 $293.00 $293.00 – $293.00 1
Regadenoson 0.4 mg/5 ml intravenous syringe HCPCS J2785 $231.60 $386.00 $386.00 – $386.00 1
Relocation skin pocket aicd CPT 33223 $0.60 $1.00 $1.00 – $1.00 1
Relocation skin pocket pm CPT 33222 $0.60 $1.00 $1.00 – $1.00 1
Rem endovas vena cava filter CPT 37193 $0.60 $1.00 $1.00 – $1.00 1
Remdesivir 100 mg intravenous powder for solution HCPCS J0248 $685.20 $1,142.00 $1,142.00 – $1,142.00 1
Removal biliary drg cath CPT 47537 $0.60 $1.00 $1.00 – $1.00 1
Removal central venous catheter tunneled without port/pump CPT 36589 $0.60 $1.00 $1.00 – $1.00 1
Removal central venous device tunneled w/port/pump central/peripheral insertion CPT 36590 $0.60 $1.00 $1.00 – $1.00 1
Removal cerclage without anes CPT 59899 $722.40 $1,204.00 $1,204.00 – $1,204.00 1
Removal duct glbldr calculi CPT 47544 $0.60 $1.00 $1.00 – $1.00 1
Removal of shunt CPT 49429 $0.60 $1.00 $1.00 – $1.00 1
Removal tunnled intprtnl cath CPT 49422 $0.60 $1.00 $1.00 – $1.00 1
Removal/replacement ppm generator dual lead system CPT 33228 $0.60 $1.00 $1.00 – $1.00 1
Remove renal tube w/fluoro CPT 50389 $0.60 $1.00 $1.00 – $1.00 1
Remove ureter stent percut CPT 50384 $0.60 $1.00 $1.00 – $1.00 1
Renal cyst study s&i CPT 74470 $0.60 $1.00 $1.00 – $1.00 1
Renal function panel CPT 80069 $19.20 $32.00 $32.00 – $32.00 1
Renal venogram bil s&i CPT 75833 $0.60 $1.00 $1.00 – $1.00 1
Repair pm/icd lead dual CPT 33220 $0.60 $1.00 $1.00 – $1.00 1
Repair pm/icd lead sgl CPT 33218 $0.60 $1.00 $1.00 – $1.00 1
Replace aortic valve open axillry 33363 CPT 33363 $0.60 $1.00 $1.00 – $1.00 1
Replace aortic valve open femoral 33362 CPT 33362 $0.60 $1.00 $1.00 – $1.00 1
Replace aortic valve open iliac 33364 CPT 33364 $0.60 $1.00 $1.00 – $1.00 1
Replace aortic valve open transaortic 33365 CPT 33365 $0.60 $1.00 $1.00 – $1.00 1
Replace aortic valve w/byp cntrl aprch 33369 CPT 33369 $0.60 $1.00 $1.00 – $1.00 1
Replace aortic valve w/byp open aprch 33368 CPT 33368 $0.60 $1.00 $1.00 – $1.00 1
Replace aortic valve w/byp prq aprch 33367 CPT 33367 $0.60 $1.00 $1.00 – $1.00 1
Replace duod/jej tube perc CPT 49451 $0.60 $1.00 $1.00 – $1.00 1
Replace g-j tube perc CPT 49452 $0.60 $1.00 $1.00 – $1.00 1
Replace g/c tube perc CPT 49450 $0.60 $1.00 $1.00 – $1.00 1
Replace picvad cath CPT 36585 $0.60 $1.00 $1.00 – $1.00 1
Replace tunneled cv cath CPT 36578 $0.60 $1.00 $1.00 – $1.00 1
Repos lv lead pm/icd CPT 33226 $0.60 $1.00 $1.00 – $1.00 1
Repos sq defib eltrd CPT 33273 $0.60 $1.00 $1.00 – $1.00 1
Reposition pm/icd lead CPT 33215 $0.60 $1.00 $1.00 – $1.00 1
Reposition vad w/image rt/lt sep session CPT 33993 $0.60 $1.00 $1.00 – $1.00 1
Respirator motion mgmt simul CPT 77293 $609.00 $1,015.00 $1,015.00 – $1,015.00 1
Resuscitation cardiopulmonary CPT 92950 $127.20 $212.00 $1.00 – $1.00 1
Reteplase injection HCPCS J2993 $2,774.40 $4,624.00 $4,624.00 – $4,624.00 1
Reticulocyte automated CPT 85045 $16.20 $27.00 $27.00 – $27.00 1
Revise abdomen-venous shunt CPT 49426 $0.60 $1.00 $1.00 – $1.00 1
Revision of cervix CPT 59320 $1,444.80 $2,408.00 $2,408.00 – $2,408.00 1
Revision tips CPT 37183 $0.60 $1.00 $1.00 – $1.00 1
Revsc opn/prq tib/pero stent CPT 37234 $0.60 $1.00 $1.00 – $1.00 1
Rheumatoid factor qualitative CPT 86430 $12.60 $21.00 $21.00 – $21.00 1
Rheumatoid factor quantitative CPT 86431 $16.20 $27.00 $27.00 – $27.00 1
Rho d immune globulin inj HCPCS J2790 $96.60 $161.00 $161.00 – $161.00 1
Rho(d) immune globulin h, sd HCPCS J2792 $1,551.00 $2,585.00 $2,585.00 – $2,585.00 1
Right ventric recording CPT 93603 $0.60 $1.00 $1.00 – $1.00 1
Ring fx reform 11-13x17mm HCPCS L8610 $898.20 $1,497.00 $594.00 – $594.00 1
Rituximab 10 mg/ml concentrate,intravenous HCPCS J9312 $5,961.00 $9,935.00 $1,879.00 – $1,879.00 1
Rituximab-abbs 10 mg/ml intravenous solution HCPCS Q5115 $3,977.40 $6,629.00 $1,325.00 – $1,325.00 1
Rituximab-pvvr 10 mg/ml intravenous solution HCPCS Q5119 $3,402.00 $5,670.00 $1,134.00 – $1,134.00 1
Rmvl icd by tv extr CPT 33244 $0.60 $1.00 $1.00 – $1.00 1
Rmvl icd gen w/rplc icd gen dual lead sys CPT 33263 $0.60 $1.00 $1.00 – $1.00 1
Rmvl icd gen w/rplc icd gen mlt lead sys CPT 33264 $0.60 $1.00 $1.00 – $1.00 1
Rmvl icd gen w/rplc icd gen sgl lead sys CPT 33262 $0.60 $1.00 $1.00 – $1.00 1
Rmvl icd pulse gen only CPT 33241 $0.60 $1.00 $1.00 – $1.00 1
Rmvl ndwellg tun pleural cath CPT 32552 $0.60 $1.00 $1.00 – $1.00 1
Rmvl perm pm pulse gen CPT 33233 $0.60 $1.00 $1.00 – $1.00 1
Rmvl pm gen w/rplc pm gen mlt lead sys CPT 33229 $0.60 $1.00 $1.00 – $1.00 1
Rmvl pm gen w/rplc pm gen sgl lead sys CPT 33227 $0.60 $1.00 $1.00 – $1.00 1
Rmvl pq vad left hrt vein sep session CPT 33992 $0.60 $1.00 $1.00 – $1.00 1
Rmvl sq defib electrode CPT 33272 $0.60 $1.00 $1.00 – $1.00 1
Rmvl subq card rhythm mntr CPT 33286 $0.60 $1.00 $1.00 – $1.00 1
Rmvl tv pm lead dual CPT 33235 $0.60 $1.00 $1.00 – $1.00 1
Rmvl tv pm lead sgl CPT 33234 $0.60 $1.00 $1.00 – $1.00 1
Romiplostim 125 mcg subcutaneous solution HCPCS J2802 $2,861.40 $4,769.00 $2,384.00 – $2,384.00 1
Ropivacaine 0.2 % epidural pca - 1 hour dose limit HCPCS J2795 $5.40 $9.00 $9.00 – $9.00 1
Rp loclzj tum 2+area 1+d img CPT 78801 $238.20 $397.00 $397.00 – $397.00 1
Rpl non-tun cvc wo sbq prt/pmp CPT 36580 $0.60 $1.00 $1.00 – $1.00 1
Rpl picc wo subq port/pump incl image guidnc w/s&i CPT 36584 $0.60 $1.00 $1.00 – $1.00 1
Rpl tun cvc wo subq port CPT 36581 $0.60 $1.00 $1.00 – $1.00 1
Rpl tun-cvad w subq port CPT 36582 $0.60 $1.00 $1.00 – $1.00 1
Rpl tun-cvad w subq pump CPT 36583 $0.60 $1.00 $1.00 – $1.00 1
Rsv assay w/optic CPT 87807 $40.20 $67.00 $67.00 – $67.00 1
Rubella antibody igg CPT 86762 $24.00 $40.00 $40.00 – $40.00 1
Rubeola antibody igg CPT 86765 $32.40 $54.00 $54.00 – $54.00 1
Russell viper venom diluted CPT 85613 $24.00 $40.00 $40.00 – $40.00 1
Sacituzumab govitecan-hziy 180 mg intravenous solution HCPCS J9317 $35.40 $59.00 $59.00 – $59.00 1
Scan duplex abd/pelvis/retroperitoneal complete CPT 93975 $1,126.20 $1,877.00 $1,877.00 – $1,877.00 1
Scan duplex abd/pelvis/retroperitoneal limited CPT 93976 $625.80 $1,043.00 $1,043.00 – $1,043.00 1
Scan duplex aorta/ivc/iliac or bypass grafts complete CPT 93978 $768.60 $1,281.00 $1,281.00 – $1,281.00 1
Scan duplex aorta/ivc/iliac unilateral/limited CPT 93979 $482.40 $804.00 $804.00 – $804.00 1
Scan duplex extracranial arteries unilateral/limited study CPT 93882 $518.40 $864.00 $864.00 – $864.00 1
Scan duplex extremity veins unilateral/limited study CPT 93971 $500.40 $834.00 $327.00 – $327.00 1
Scan duplex lower extremity arteries complete bilateral CPT 93925 $1,108.20 $1,847.00 $1,847.00 – $1,847.00 1
Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 $643.20 $1,072.00 $1,072.00 – $1,072.00 1
Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 $518.40 $864.00 $864.00 – $864.00 1
Screening Mammogram CPT 77067 $500.40 $834.00 $834.00 – $834.00 1
Screening prostate cancer PSA HCPCS G0103 $32.40 $54.00 $54.00 – $54.00 1
Screw cortex 2.0 x 10mm HCPCS C1713 $15,714.60 $26,191.00 $26.00 – $26.00 1
Sec art mech thrmbc non-intracranial add-on CPT 37186 $0.60 $1.00 $1.00 – $1.00 1
Sedimentation rate erythrocyte automated CPT 85652 $7.80 $13.00 $13.00 – $13.00 1
Semen analysis presence/motility CPT 89321 $12.60 $21.00 $21.00 – $21.00 1
Sertraline (zoloft) - sendout CPT 80332 $48.60 $81.00 $81.00 – $81.00 1
Set radiation therapy field CPT 77280 $397.80 $663.00 $663.00 – $663.00 1
Set radiation therapy field CPT 77285 $627.00 $1,045.00 $1,045.00 – $1,045.00 1
Set radiation therapy field CPT 77290 $723.60 $1,206.00 $1,206.00 – $1,206.00 1
Sheath gldlight lasr 12fx50cm HCPCS C2629 $4,828.80 $8,048.00 $8,048.00 – $8,048.00 1
Shoulder MRI (with and without contrast) CPT 73223 $601.20 $1,002.00 $1,002.00 – $1,002.00 1
Shoulder MRI (with contrast) CPT 73222 $489.00 $815.00 $815.00 – $815.00 1
Shoulder MRI (without contrast) CPT 73221 $276.60 $461.00 $461.00 – $461.00 1
Shoulder X-ray CPT 73030 $89.40 $149.00 $49.00 – $49.00 1
Shunt glaucoma baerveldt 350mm HCPCS C1783 $2,356.20 $3,927.00 $3,927.00 – $3,927.00 1
Shuntogram nonvascular supervision & interpretation CPT 75809 $0.60 $1.00 $1.00 – $1.00 1
Sialography s&i CPT 70390 $0.60 $1.00 $1.00 – $1.00 1
Sickling rbc CPT 85660 $16.20 $27.00 $27.00 – $27.00 1
Sinus CT scan (with and without contrast) CPT 70488 $119.40 $199.00 $199.00 – $199.00 1
Sinus CT scan (with contrast) CPT 70487 $92.40 $154.00 $154.00 – $154.00 1
Sinus CT scan (without contrast) CPT 70486 $80.40 $134.00 $89.00 – $89.00 1
Sinus/juglr venogram s&i CPT 75860 $0.60 $1.00 $1.00 – $1.00 1
Sleep Study (Polysomnography) CPT 95810 $694.80 $1,158.00 $1,158.00 – $1,158.00 1
Sleep study unattended CPT 95806 $148.80 $248.00 $248.00 – $248.00 1
Sling arm deluxe w/pad xs HCPCS A4565 $177.00 $295.00 $179.00 – $179.00 1
Sling suprapubic suburetheral HCPCS C1771 $3,395.40 $5,659.00 $1,694.00 – $1,694.00 1
Slp eval non-spch gen comm dev CPT 92605 $103.80 $173.00 $173.00 – $173.00 1
Slp ther svc non-spch gen CPT 92606 $103.80 $173.00 $173.00 – $173.00 1
Sm-153 lexidron ther HCPCS A9604 $4,290.00 $7,150.00 $7,150.00 – $7,150.00 1
Smear fluorescent and/or acid fast stain CPT 87206 $32.40 $54.00 $54.00 – $54.00 1
Smear gram stain CPT 87205 $32.40 $54.00 $54.00 – $54.00 1
Smear special stain inclusion bodies/parasites CPT 87207 $24.00 $40.00 $40.00 – $40.00 1
Smear wet mount CPT 87210 $12.60 $21.00 $21.00 – $21.00 1
Sodium 24 hour urine CPT 84300 $16.20 $27.00 $27.00 – $27.00 1
Sodium chloride 0.9 % IV bolus HCPCS J7050 $75.00 $125.00 $125.00 – $125.00 1
Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 $9.60 $16.00 $16.00 – $16.00 1
Sodium serum/plasma/whole blood CPT 84295 $3.00 $5.00 $5.00 – $5.00 1
Special physics consult CPT 77370 $192.60 $321.00 $321.00 – $321.00 1
Special radiation dosimetry CPT 77331 $30.00 $50.00 $50.00 – $50.00 1
Special radiation treatment CPT 77470 $78.00 $130.00 $130.00 – $130.00 1
Special teletx port plan CPT 77321 $72.00 $120.00 $120.00 – $120.00 1
Specific gravity body fluid CPT 84315 $6.00 $10.00 $10.00 – $10.00 1
Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 $0.60 $1.00 $1.00 – $1.00 1
Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 $121.20 $202.00 $202.00 – $202.00 1
Splint arm vnyl coated padded lft med HCPCS Q4051 $49.80 $83.00 $83.00 – $83.00 1
Split blood or products CPT 86985 $32.40 $54.00 $54.00 – $54.00 1
Srs linear based CPT 77372 $1,790.40 $2,984.00 $2,984.00 – $2,984.00 1
St analysis behavior qualitative voice/resonance CPT 92524 $150.00 $250.00 $250.00 – $250.00 1
St evaluate speech sound production CPT 92522 $150.00 $250.00 $250.00 – $250.00 1
St evaluate speech sound production comprehensive/expressive CPT 92523 $334.80 $558.00 $558.00 – $558.00 1
St evaluation motion fluoroscopic swallow function cine/video CPT 92611 $265.20 $442.00 $442.00 – $442.00 1
St evaluation swallow function CPT 92610 $138.00 $230.00 $230.00 – $230.00 1
St treatment speech individual CPT 92507 $103.80 $173.00 $173.00 – $173.00 1
St treatment swallow dysfunction/oral CPT 92526 $138.00 $230.00 $230.00 – $230.00 1
Staph a dna amp probe CPT 87640 $194.40 $324.00 $324.00 – $324.00 1
Stent axios caut enh 15x10mm electrocaut HCPCS C1874 $26,519.40 $44,199.00 $486.00 – $486.00 1
Stent bili dbl pgtl 10fx5cm HCPCS C2617 $447.60 $746.00 $220.00 – $220.00 1
Stent bili rx wallflx 10x80 uncvr HCPCS C1876 $3,783.00 $6,305.00 $486.00 – $486.00 1
Stent bronch dumon sil 10x40mm HCPCS C1875 $544.20 $907.00 $907.00 – $907.00 1
Stent iliac/open or perc/uni/init 37221 CPT 37221 $0.60 $1.00 $1.00 – $1.00 1
Stent iliac/open/perc/ea ad/ipsila 37223 CPT 37223 $0.60 $1.00 $1.00 – $1.00 1
Stent/athrectomy/fem/pop/unilat 37227 CPT 37227 $0.60 $1.00 $1.00 – $1.00 1
Stent/tib/peroneal/unilat/initial 37230 CPT 37230 $0.60 $1.00 $1.00 – $1.00 1
Strep a ag ia CPT 87430 $40.20 $67.00 $67.00 – $67.00 1
Strep b dna amp probe CPT 87653 $194.40 $324.00 $324.00 – $324.00 1
Streptozocin injection HCPCS J9320 $375.60 $626.00 $626.00 – $626.00 1
Stress test pulmonary CPT 94618 $98.40 $164.00 $164.00 – $164.00 1
Sugars single quant CPT 84378 $6.00 $10.00 $10.00 – $10.00 1
Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 $5.40 $9.00 $9.00 – $9.00 1
Support clav 29.6-40.5in med HCPCS L3650 $86.40 $144.00 $144.00 – $144.00 1
Surgical pathology level 1 gross examination only CPT 88300 $32.40 $54.00 $54.00 – $54.00 1
Surgical pathology level 2 gross & microscopic examination CPT 88302 $40.20 $67.00 $67.00 – $67.00 1
Surgical pathology level 3 gross & microscopic examination CPT 88304 $64.80 $108.00 $108.00 – $108.00 1
Surgical pathology level 4 gross & microscopic examination CPT 88305 $97.20 $162.00 $162.00 – $162.00 1
Surgical pathology level 5 gross & microscopic examination CPT 88307 $162.00 $270.00 $270.00 – $270.00 1
Surgical pathology level 6 gross & microscopic examination CPT 88309 $202.80 $338.00 $338.00 – $338.00 1
Susceptibility agar dilution per agent CPT 87181 $16.20 $27.00 $27.00 – $27.00 1
Susceptibility enzyme detection per enzyme CPT 87185 $7.80 $13.00 $13.00 – $13.00 1
Susceptibility mic per plate CPT 87186 $16.20 $27.00 $27.00 – $27.00 1
Svc venogram s&i CPT 75827 $0.60 $1.00 $1.00 – $1.00 1
Syphilis test non-treponemal antibody quantitative rpr CPT 86593 $16.20 $27.00 $27.00 – $27.00 1
System pacing micra av HCPCS C1786 $6,455.40 $10,759.00 $4,819.00 – $4,819.00 1
System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 $7,971.60 $13,286.00 $5,661.00 – $5,661.00 1
T cells absolute cd 4 count CPT 86361 $81.00 $135.00 $135.00 – $135.00 1
T cells absolute cd4/cd8 including ratio CPT 86360 $162.00 $270.00 $270.00 – $270.00 1
T cells total count CPT 86359 $81.00 $135.00 $135.00 – $135.00 1
T3 (triiodothyronine) free CPT 84481 $24.00 $40.00 $40.00 – $40.00 1
T3 (triiodothyronine) total CPT 84480 $24.00 $40.00 $40.00 – $40.00 1
T4 (thyroxine) free CPT 84439 $24.00 $40.00 $40.00 – $40.00 1
T4 (thyroxine) total CPT 84436 $24.00 $40.00 $40.00 – $40.00 1
Tacrolimus therapeutic drug level CPT 80197 $48.60 $81.00 $81.00 – $81.00 1
Target gsa panel organ neop CPT 81445 $828.00 $1,380.00 $1,380.00 – $1,380.00 1
Tavr perq femoral CPT 33361 $0.60 $1.00 $1.00 – $1.00 1
Tb test cell mediated immunity antigen response gamma interferon CPT 86480 $56.40 $94.00 $94.00 – $94.00 1
Tc-99m apcitide diag HCPCS A9504 $420.00 $700.00 $700.00 – $700.00 1
Tc-99m diag per dose HCPCS A4641 $240.00 $400.00 $20.00 – $20.00 1
Tc-99m disofenin HCPCS A9510 $51.60 $86.00 $86.00 – $86.00 1
Tc-99m exame autol wbc diag per dose HCPCS A9569 $576.00 $960.00 $960.00 – $960.00 1
Tc-99m fanolesomab diag HCPCS A9566 $1,020.00 $1,700.00 $1,700.00 – $1,700.00 1
Tc-99m labeled rbc HCPCS A9560 $49.20 $82.00 $82.00 – $82.00 1
Tc-99m maa HCPCS A9540 $165.60 $276.00 $27.00 – $27.00 1
Tc-99m mebrofenin HCPCS A9537 $48.00 $80.00 $80.00 – $80.00 1
Tc-99m oxidronate HCPCS A9561 $15.00 $25.00 $25.00 – $25.00 1
Tc-99m pentetate dtpa HCPCS A9539 $22.20 $37.00 $37.00 – $37.00 1
Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 $51.60 $86.00 $86.00 – $86.00 1
Tc-99m sestamibi p study dose HCPCS A9500 $103.20 $172.00 $172.00 – $172.00 1
Tc-99m succimer (dmsa) HCPCS A9551 $129.60 $216.00 $216.00 – $216.00 1
Tc-99m sulfur colloid HCPCS A9541 $49.20 $82.00 $82.00 – $82.00 1
Telethx isodose plan cplx CPT 77307 $222.60 $371.00 $371.00 – $371.00 1
Telethx isodose plan simple CPT 77306 $120.60 $201.00 $201.00 – $201.00 1
Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln HCPCS J9330 $77.40 $129.00 $129.00 – $129.00 1
Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 $8,405.40 $14,009.00 $14,009.00 – $14,009.00 1
Test for porphobilinogen CPT 84106 $19.20 $32.00 $32.00 – $32.00 1
Test stress cardiovascular tracing only CPT 93017 $199.20 $332.00 $332.00 – $332.00 1
Test urine for porphyrins CPT 84119 $25.80 $43.00 $43.00 – $43.00 1
Tetanus immune globulin inj HCPCS J1670 $676.80 $1,128.00 $1,128.00 – $1,128.00 1
Theophylline therapeutic drug level CPT 80198 $24.00 $40.00 $40.00 – $40.00 1
Therapeutic procd strg endur HCPCS G0237 $49.20 $82.00 $82.00 – $82.00 1
Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 $87.60 $146.00 $146.00 – $146.00 1
Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 $4.20 $7.00 $7.00 – $7.00 1
Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 $0.60 $1.00 $1.00 – $1.00 1
Thrombectmy crnry perq mechanical CPT 92973 $0.60 $1.00 $1.00 – $1.00 1
Thrombectomy/inf pq dialysis circuit CPT 36904 $0.60 $1.00 $1.00 – $1.00 1
Thrombectomy/inf pq dialysis circuit w/pta CPT 36905 $0.60 $1.00 $1.00 – $1.00 1
Thrombectomy/inf pq dialysis circuit w/stent plcmnt CPT 36906 $0.60 $1.00 $1.00 – $1.00 1
Thrombin time CPT 85670 $16.20 $27.00 $27.00 – $27.00 1
Thromboplastin time partial (ptt) substitution fractions each CPT 85732 $38.40 $64.00 $64.00 – $64.00 1
Thyroglobulin antibody CPT 86800 $40.20 $67.00 $67.00 – $67.00 1
Thyroid (TSH) Test CPT 84443 $24.00 $40.00 $40.00 – $40.00 1
Thyroid Ultrasound CPT 76536 $447.00 $745.00 $745.00 – $745.00 1
Thyroid mets imag whole body CPT 78018 $289.20 $482.00 $482.00 – $482.00 1
Thyrotropin alfa 0.9 mg intramuscular solution HCPCS J3240 $2,199.00 $3,665.00 $3,665.00 – $3,665.00 1
Thyroxine binding globulin (tbg) CPT 84442 $24.00 $40.00 $40.00 – $40.00 1
Tib/per revasc stent & ather 37231 CPT 37231 $0.60 $1.00 $1.00 – $1.00 1
Tib/per revasc stnt & ather CPT 37235 $0.60 $1.00 $1.00 – $1.00 1
Tib/per revasc w/ather add-on 37233 CPT 37233 $0.60 $1.00 $1.00 – $1.00 1
Tigecycline injection HCPCS J3243 $58.20 $97.00 $97.00 – $97.00 1
Tisotumab vedotin-tftv 40 mg intravenous solution HCPCS J9273 $190.20 $317.00 $317.00 – $317.00 1
Tissue culture skin/biopsy CPT 88233 $324.60 $541.00 $541.00 – $541.00 1
Tl-201 thallium diag per mci HCPCS A9505 $140.40 $234.00 $234.00 – $234.00 1
Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 $1.80 $3.00 $3.00 – $3.00 1
Tobramycin peak therapeutic drug level CPT 80200 $24.00 $40.00 $40.00 – $40.00 1
Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 $7.20 $12.00 $11.00 – $11.00 1
Tomosynthesis breast screen bilateral CPT 77063 $124.80 $208.00 $208.00 – $208.00 1
Topotecan 4 mg/4 ml (1 mg/ml) intravenous solution HCPCS J9351 $0.60 $1.00 $1.00 – $1.00 1
Toxoplasma antibody igg CPT 86777 $40.20 $67.00 $67.00 – $67.00 1
Toxoplasma antibody igm CPT 86778 $40.20 $67.00 $67.00 – $67.00 1
Trabectedin 1 mg intravenous solution HCPCS J9352 $386.40 $644.00 $644.00 – $644.00 1
Trans cath replace aortic valve 33366 CPT 33366 $0.60 $1.00 $1.00 – $1.00 1
Transcath closure of asd CPT 93580 $0.60 $1.00 $1.00 – $1.00 1
Transcath closure of vsd CPT 93581 $0.60 $1.00 $1.00 – $1.00 1
Transcath rmvl perm ldss pmkr rv CPT 33275 $0.60 $1.00 $1.00 – $1.00 1
Transcatheter bx s&i CPT 75970 $0.60 $1.00 $1.00 – $1.00 1
Transferrin CPT 84466 $24.00 $40.00 $40.00 – $40.00 1
Transfusion blood/blood component(s) CPT 36430 $1,347.60 $2,246.00 $537.00 – $537.00 1
Trastuzumab 150 mg intravenous solution HCPCS J9355 $2,629.80 $4,383.00 $4,383.00 – $4,383.00 1
Trastuzumab-anns 150 mg intravenous solution HCPCS Q5117 $1,410.00 $2,350.00 $160.00 – $160.00 1
Trastuzumab-qyyp 150 mg intravenous solution HCPCS Q5116 $1,743.60 $2,906.00 $2,906.00 – $2,906.00 1
Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour CPT 94644 $54.00 $90.00 $90.00 – $90.00 1
Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour CPT 94645 $44.40 $74.00 $74.00 – $74.00 1
Treatment inhalation pressurized/nonpressurized acute airway obstruction CPT 94640 $765.00 $1,275.00 $106.00 – $106.00 1
Treatment radiation delivery level 2 CPT 77407 $433.80 $723.00 $723.00 – $723.00 1
Tremelimumab-actl 20 mg/ml intravenous solution HCPCS J9347 $156.00 $260.00 $260.00 – $260.00 1
Treponema pallidum antibody CPT 86780 $27.60 $46.00 $46.00 – $46.00 1
Trg gene rearrangement anal CPT 81342 $194.40 $324.00 $324.00 – $324.00 1
Triglycerides CPT 84478 $3.00 $5.00 $5.00 – $5.00 1
Trnscath plc stent crv crtd w/prtct CPT 37215 $0.60 $1.00 $1.00 – $1.00 1
Trnscath plc stent crv crtd without prtct CPT 37216 $0.60 $1.00 $1.00 – $1.00 1
Trnscath plc stnt ante carotid art CPT 37218 $0.60 $1.00 $1.00 – $1.00 1
Trnscath plc vas stent w/s&i ea addl artery CPT 37237 $0.60 $1.00 $1.00 – $1.00 1
Trnscath plc vas stent w/s&i ea addl vein CPT 37239 $0.60 $1.00 $1.00 – $1.00 1
Trnscath plc vas stent w/s&i ini vein CPT 37238 $0.60 $1.00 $1.00 – $1.00 1
Trnscath retrv pq vasc fb w/guide CPT 37197 $0.60 $1.00 $1.00 – $1.00 1
Trnscath tx thromblytc art/ven sbsq day CPT 37213 $0.60 $1.00 $1.00 – $1.00 1
Trnscath tx thromblytc artery non-intracrn ini day CPT 37211 $0.60 $1.00 $1.00 – $1.00 1
Trnscath tx thromblytc cath rmv sbsq day CPT 37214 $0.60 $1.00 $1.00 – $1.00 1
Trnscath tx thromblytc vein ini day CPT 37212 $0.60 $1.00 $1.00 – $1.00 1
Troponin quantitative CPT 84484 $40.20 $67.00 $67.00 – $67.00 1
Tte w or without fol w/con,stres HCPCS C8928 $405.00 $675.00 $675.00 – $675.00 1
Tube drain vert dev st 5-40f HCPCS A5200 $29.40 $49.00 $31.00 – $31.00 1
Tube trach disp innr can 5 xlt HCPCS A7521 $645.60 $1,076.00 $75.00 – $75.00 1
Tube trach fen sz 6 uncuffed HCPCS A7520 $119.40 $199.00 $115.00 – $115.00 1
Tx atrial fib pulm vein isol CPT 93656 $0.60 $1.00 $1.00 – $1.00 1
Ultrasound abdomen aorta screening study aaa CPT 76706 $339.60 $566.00 $566.00 – $566.00 1
Ultrasound breast complete CPT 76641 $357.60 $596.00 $596.00 – $596.00 1
Ultrasound breast unilateral limited (both sides) CPT 76642 $268.20 $447.00 $447.00 – $447.00 1
Ultrasound chest CPT 76604 $303.60 $506.00 $506.00 – $506.00 1
Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 $106.80 $178.00 $178.00 – $178.00 1
Ultrasound elastography ea l target les CPT 76983 $142.80 $238.00 $238.00 – $238.00 1
Ultrasound elastography parenchyma CPT 76981 $321.60 $536.00 $536.00 – $536.00 1
Ultrasound encephalogram CPT 76506 $429.00 $715.00 $715.00 – $715.00 1
Ultrasound exam k transpl w/doppler CPT 76776 $607.80 $1,013.00 $1,013.00 – $1,013.00 1
Ultrasound fetal biophysical profile without non-stress testing CPT 76819 $250.20 $417.00 $417.00 – $417.00 1
Ultrasound guidance for vascular access CPT 76937 $0.60 $1.00 $1.00 – $1.00 1
Ultrasound guide intraoperative CPT 76998 $196.20 $327.00 $327.00 – $327.00 1
Ultrasound guided needle placement supervision & interpretation CPT 76942 $0.60 $1.00 $1.00 – $1.00 1
Ultrasound hips infant dynamic CPT 76885 $553.80 $923.00 $923.00 – $923.00 1
Ultrasound infant hips ltd without stress CPT 76886 $393.00 $655.00 $655.00 – $655.00 1
Ultrasound joint complete left CPT 76881 $447.00 $745.00 $745.00 – $745.00 1
Ultrasound joint/nonvascular extremity limited left CPT 76882 $53.40 $89.00 $89.00 – $89.00 1
Ultrasound ob >=14wks ea addl gest CPT 76810 $214.20 $357.00 $357.00 – $357.00 1
Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 $106.80 $178.00 $178.00 – $178.00 1
Ultrasound pregnant uterus detailed fetal exam single/1st gestation CPT 76811 $429.00 $715.00 $715.00 – $715.00 1
Ultrasound pregnant uterus follow up per fetus CPT 76816 $357.60 $596.00 $596.00 – $596.00 1
Ultrasound pregnant uterus limited >= 1 fetuses CPT 76815 $268.20 $447.00 $447.00 – $447.00 1
Ultrasound pregnant uterus transvaginal CPT 76817 $303.60 $506.00 $506.00 – $506.00 1
Ultrasound prostate/transrectal CPT 76872 $303.60 $506.00 $506.00 – $506.00 1
Ultrasound retroperitoneal limited CPT 76775 $142.80 $238.00 $238.00 – $238.00 1
Ultrasound scrotum and contents CPT 76870 $178.80 $298.00 $298.00 – $298.00 1
Ultrasound spinal canal and contents CPT 76800 $411.00 $685.00 $685.00 – $685.00 1
Ultrasound transvaginal non obstetric CPT 76830 $447.00 $745.00 $745.00 – $745.00 1
Unlisted fluoroscopic px CPT 76496 $0.60 $1.00 $1.00 – $1.00 1
Unlisted mr procedure CPT 76498 $1,037.40 $1,729.00 $1,729.00 – $1,729.00 1
Unlisted procedure liver CPT 47399 $0.60 $1.00 $1.00 – $1.00 1
Unlisted px casting/strpg CPT 29799 $136.80 $228.00 $69.00 – $69.00 1
Unlisted transfusion med px CPT 86999 $1,015.20 $1,692.00 $94.00 – $94.00 1
Unlisted ultrasound procedure CPT 76999 $0.60 $1.00 $1.00 – $1.00 1
Upgrade pm system CPT 33214 $0.60 $1.00 $1.00 – $1.00 1
Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 $442.20 $737.00 $737.00 – $737.00 1
Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 $388.80 $648.00 $648.00 – $648.00 1
Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 $247.20 $412.00 $412.00 – $412.00 1
Urea nitrogen CPT 84520 $3.00 $5.00 $5.00 – $5.00 1
Urea nitrogen 24 hour urine CPT 84540 $16.20 $27.00 $27.00 – $27.00 1
Urea nitrogen clearance CPT 84545 $19.20 $32.00 $32.00 – $32.00 1
Urethrcystgrphy rtrgrde s&i CPT 74450 $0.60 $1.00 $1.00 – $1.00 1
Urethrocystography void s&i CPT 74455 $0.60 $1.00 $1.00 – $1.00 1
Uric acid blood CPT 84550 $3.00 $5.00 $5.00 – $5.00 1
Uric acid urine CPT 84560 $16.20 $27.00 $27.00 – $27.00 1
Urinalysis (with microscopy) CPT 81001 $14.40 $24.00 $24.00 – $24.00 1
Urinalysis (without microscopy) CPT 81003 $6.00 $10.00 $10.00 – $10.00 1
Urinalysis microscopic only CPT 81015 $7.80 $13.00 $13.00 – $13.00 1
Urinalysis qual/semiquant excpt ia CPT 81005 $14.40 $24.00 $24.00 – $24.00 1
Urine Culture Test CPT 87086 $32.40 $54.00 $54.00 – $54.00 1
Urine pregnancy test CPT 81025 $16.20 $27.00 $27.00 – $27.00 1
Urography, antegrade CPT 74425 $0.60 $1.00 $1.00 – $1.00 1
Use 1st target lesion CPT 76982 $321.60 $536.00 $536.00 – $536.00 1
Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 $246.60 $411.00 $411.00 – $411.00 1
Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 $115.80 $193.00 $193.00 – $193.00 1
Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 $11.40 $19.00 $19.00 – $19.00 1
Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 $297.00 $495.00 $495.00 – $495.00 1
Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im CPT 90682 $98.40 $164.00 $134.00 – $134.00 1
Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 $25.20 $42.00 $42.00 – $42.00 1
Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 $156.60 $261.00 $261.00 – $261.00 1
Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 $127.80 $213.00 $213.00 – $213.00 1
Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 $270.60 $451.00 $451.00 – $451.00 1
Vaccine respiratory syncytial virus bivalent subunit/preservative free im CPT 90678 $327.00 $545.00 $545.00 – $545.00 1
Vaccine varicella live subcutaneous CPT 90716 $162.00 $270.00 $270.00 – $270.00 1
Vaginal Delivery (full care) CPT 59400 $4,624.20 $7,707.00 $5,780.00 – $5,780.00 1
Valproic acid total therapeutic drug level CPT 80164 $24.00 $40.00 $40.00 – $40.00 1
Valvuloplasty aortic CPT 92986 $0.60 $1.00 $1.00 – $1.00 1
Valvuloplasty mitral CPT 92987 $0.60 $1.00 $1.00 – $1.00 1
Valvuloplasty pulmonary CPT 92990 $0.60 $1.00 $1.00 – $1.00 1
Vancomycin hcl injection HCPCS J3370 $33.60 $56.00 $3.00 – $3.00 1
Vancomycin peak therapeutic drug level CPT 80202 $24.00 $40.00 $40.00 – $40.00 1
Varicella zoster antibody igg CPT 86787 $32.40 $54.00 $54.00 – $54.00 1
Varicella-zoster immue globin im CPT 90396 $1,567.20 $2,612.00 $2,612.00 – $2,612.00 1
Vein x-ray adrenal gland CPT 75840 $0.60 $1.00 $1.00 – $1.00 1
Vein x-ray adrenal glands CPT 75842 $0.60 $1.00 $1.00 – $1.00 1
Vein x-ray eye socket CPT 75880 $0.60 $1.00 $1.00 – $1.00 1
Vein x-ray kidney CPT 75831 $0.60 $1.00 $1.00 – $1.00 1
Vein x-ray liver CPT 75891 $0.60 $1.00 $1.00 – $1.00 1
Vein x-ray liver w/hemodynam CPT 75885 $0.60 $1.00 $1.00 – $1.00 1
Vein x-ray liver w/hemodynam CPT 75889 $0.60 $1.00 $1.00 – $1.00 1
Vein x-ray skull CPT 75870 $0.60 $1.00 $1.00 – $1.00 1
Vein x-ray skull epidural CPT 75872 $0.60 $1.00 $1.00 – $1.00 1
Venogram ext bil s&i CPT 75822 $0.60 $1.00 $1.00 – $1.00 1
Venogram extremity supervision & interpretation unilateral CPT 75820 $0.60 $1.00 $1.00 – $1.00 1
Venous m-thrombectomy add-on CPT 37188 $0.60 $1.00 $1.00 – $1.00 1
Venous mech thrombectomy CPT 37187 $0.60 $1.00 $1.00 – $1.00 1
Venous sampling s&i CPT 75893 $0.60 $1.00 $1.00 – $1.00 1
Ventilator each subsequent day CPT 94003 $478.20 $797.00 $664.00 – $664.00 1
Ventilator initial day CPT 94002 $478.20 $797.00 $664.00 – $664.00 1
Version cephalic external CPT 59412 $1,444.80 $2,408.00 $2,408.00 – $2,408.00 1
Very long chain fatty acids CPT 82726 $194.40 $324.00 $324.00 – $324.00 1
Vinblastine 1 mg/ml intravenous solution HCPCS J9360 $3.60 $6.00 $6.00 – $6.00 1
Vincristine 1 mg/ml intravenous solution HCPCS J9370 $10.80 $18.00 $10.00 – $10.00 1
Vinorelbine 10 mg/ml intravenous solution (wrapper) HCPCS J9390 $9.60 $16.00 $16.00 – $16.00 1
Virus isolation addl studies ea CPT 87253 $40.20 $67.00 $67.00 – $67.00 1
Visc & infraren abd 1 prosth CPT 34845 $0.60 $1.00 $1.00 – $1.00 1
Visc & infraren abd 2 prosth CPT 34846 $0.60 $1.00 $1.00 – $1.00 1
Vital capacity test CPT 94150 $28.20 $47.00 $47.00 – $47.00 1
Vitamin D Test CPT 82306 $24.00 $40.00 $40.00 – $40.00 1
Vitamin b-12 CPT 82607 $24.00 $40.00 $40.00 – $40.00 1
Vol reduction of blood/prod CPT 86960 $32.40 $54.00 $54.00 – $54.00 1
Volume measurement urine timed CPT 81050 $3.00 $5.00 $5.00 – $5.00 1
Warde 1003990 aldosterone CPT 82088 $40.20 $67.00 $67.00 – $67.00 1
Warde 1005020 citrate 24 hour urine CPT 82507 $24.00 $40.00 $40.00 – $40.00 1
Warde 1005055 5-hiaa 24 hour urine CPT 83497 $48.60 $81.00 $81.00 – $81.00 1
Warde 1006955 catecholamines fractionated 24 hour urine CPT 82384 $145.80 $243.00 $243.00 – $243.00 1
Warde 1007138 vanillymandelic acid 24 hour urine CPT 84585 $48.60 $81.00 $81.00 – $81.00 1
Warde 3004000 immunoglobulin subclass 1 CPT 82787 $24.00 $40.00 $40.00 – $40.00 1
Warde 3008005 oligoclonal bands CPT 83916 $40.20 $67.00 $67.00 – $67.00 1
Warde 3016300 saccharomyces cerevisiae iga antibody CPT 86671 $24.00 $40.00 $40.00 – $40.00 1
Warde 3400652 ova & parasites direct smear concentration and id CPT 87177 $64.80 $108.00 $108.00 – $108.00 1
Warde 3400852 arsenic CPT 82175 $64.80 $108.00 $108.00 – $108.00 1
Warde 3708165 mercury urine CPT 83825 $40.20 $67.00 $67.00 – $67.00 1
Warde actin (smooth muscle) antibody each CPT 86015 $24.00 $40.00 $40.00 – $40.00 1
Warde adenosine deaminase pleural fluid CPT 84311 $40.20 $67.00 $67.00 – $67.00 1
Warde adrenocorticotropic hormone (acth) CPT 82024 $48.60 $81.00 $81.00 – $81.00 1
Warde aldolase CPT 82085 $24.00 $40.00 $40.00 – $40.00 1
Warde amino acids 6 or more quantitative each specimen CPT 82139 $243.60 $406.00 $406.00 – $406.00 1
Warde analysis translocation bcr/abl1 major breakpoint qualitative/quantitative CPT 81206 $194.40 $324.00 $324.00 – $324.00 1
Warde apolipoprotein b CPT 82172 $24.00 $40.00 $40.00 – $40.00 1
Warde bile acids CPT 82239 $40.20 $67.00 $67.00 – $67.00 1
Warde cadmium blood CPT 82300 $64.80 $108.00 $108.00 – $108.00 1
Warde calcitonin CPT 82308 $48.60 $81.00 $81.00 – $81.00 1
Warde calculus (stone) infrared CPT 82365 $64.80 $108.00 $108.00 – $108.00 1
Warde clozapine therapeutic drug level CPT 80159 $48.60 $81.00 $81.00 – $81.00 1
Warde cobalt heavy metal quantitative each nes CPT 83018 $48.60 $81.00 $81.00 – $81.00 1
Warde collagen cross links c-telopeptide CPT 82523 $40.20 $67.00 $67.00 – $67.00 1
Warde complement total hemolytic CPT 86162 $40.20 $67.00 $67.00 – $67.00 1
Warde copper CPT 82525 $40.20 $67.00 $67.00 – $67.00 1
Warde cryoglobulin CPT 82595 $22.20 $37.00 $37.00 – $37.00 1
Warde erythropoietin CPT 82668 $24.00 $40.00 $40.00 – $40.00 1
Warde estrogen fractionated CPT 82671 $40.20 $67.00 $67.00 – $67.00 1
Warde folic acid rbc CPT 82747 $24.00 $40.00 $40.00 – $40.00 1
Warde g6pd (glucose 6 phosphate dehydrogenase) quantitative CPT 82955 $24.00 $40.00 $40.00 – $40.00 1
Warde gastrin CPT 82941 $24.00 $40.00 $40.00 – $40.00 1
Warde growth hormone (hgh) CPT 83003 $51.60 $86.00 $86.00 – $86.00 1
Warde haloperidol therapeutic drug level CPT 80173 $48.60 $81.00 $81.00 – $81.00 1
Warde helminth antibody strongyloides igg CPT 86682 $53.40 $89.00 $89.00 – $89.00 1
Warde hemoglobin fractionation/quantitation electrophoresis CPT 83020 $40.20 $67.00 $67.00 – $67.00 1
Warde hepatitis a antibody CPT 86708 $32.40 $54.00 $54.00 – $54.00 1
Warde hepatitis be antibody CPT 86707 $32.40 $54.00 $54.00 – $54.00 1
Warde immunofixation electrophoresis urine CPT 86335 $71.40 $119.00 $119.00 – $119.00 1
Warde infectious agent antigen immunoassay ql/sq multi step hepatitis be agn CPT 87350 $32.40 $54.00 $54.00 – $54.00 1
Warde infectious agent nucleic acid genotype hepatitis c CPT 87902 $552.00 $920.00 $920.00 – $920.00 1
Warde islet cell antibody zinc transporter 8 CPT 86341 $32.40 $54.00 $54.00 – $54.00 1
Warde lipoprotein (a) CPT 83695 $40.20 $67.00 $67.00 – $67.00 1
Warde neutralization rabies CPT 86382 $81.00 $135.00 $135.00 – $135.00 1
Warde oxcarbazepine therapeutic drug level CPT 80183 $24.00 $40.00 $40.00 – $40.00 1
Warde pancreatic elastase fecal quantitative CPT 82653 $40.20 $67.00 $67.00 – $67.00 1
Warde protein c antigen CPT 85302 $97.20 $162.00 $162.00 – $162.00 1
Warde sex hormone binding globulin CPT 84270 $40.20 $67.00 $67.00 – $67.00 1
Warde somatomedin CPT 84305 $24.00 $40.00 $40.00 – $40.00 1
Warde sugars single qualitative each specimen stool CPT 84376 $12.60 $21.00 $21.00 – $21.00 1
Warde t3 (triiodothyronine) reverse CPT 84482 $24.00 $40.00 $40.00 – $40.00 1
Warde thyroid stimulating immunoglobulins CPT 84445 $40.20 $67.00 $67.00 – $67.00 1
Warde topiramate therapeutic drug level CPT 80201 $24.00 $40.00 $40.00 – $40.00 1
Warde virus isolation tissue culture innoculation presumptive id herpes simplex CPT 87252 $162.00 $270.00 $270.00 – $270.00 1
Warde viscosity CPT 85810 $40.20 $67.00 $67.00 – $67.00 1
Warde vitamin a CPT 84590 $48.60 $81.00 $81.00 – $81.00 1
Warde vitamin b-1 (thiamine) CPT 84425 $79.20 $132.00 $132.00 – $132.00 1
Warde vitamin b6 (pyridoxine) CPT 84207 $81.00 $135.00 $135.00 – $135.00 1
Warde vitamin c (ascorbic acid) CPT 82180 $40.20 $67.00 $67.00 – $67.00 1
Warde vitamin d (1 25 dihydroxy) CPT 82652 $40.20 $67.00 $67.00 – $67.00 1
Warde vitamin e (alpha-tocopherol) CPT 84446 $48.60 $81.00 $81.00 – $81.00 1
Warde zinc CPT 84630 $40.20 $67.00 $67.00 – $67.00 1
Wbc automated CPT 85048 $6.00 $10.00 $10.00 – $10.00 1
Western blot test CPT 84181 $97.20 $162.00 $162.00 – $162.00 1
Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit HCPCS P9054 $511.20 $852.00 $852.00 – $852.00 1
Whole blood/red blood cells leukocytes reduced cmv negative each unit HCPCS P9051 $267.60 $446.00 $446.00 – $446.00 1
Wound therapy negative pressure per session <= 50 sq cm CPT 97607 $125.40 $209.00 $209.00 – $209.00 1
Wound therapy negative pressure per session <= 50 sq cm dme CPT 97605 $125.40 $209.00 $209.00 – $209.00 1
Wound therapy negative pressure per session > 50 sq cm CPT 97608 $136.80 $228.00 $228.00 – $228.00 1
Wound therapy negative pressure per session > 50 sq cm dme CPT 97606 $136.80 $228.00 $228.00 – $228.00 1
Wrist X-ray CPT 73110 $124.80 $208.00 $49.00 – $49.00 1
X-ray abdomen 1 view CPT 74018 $71.40 $119.00 $119.00 – $119.00 1
X-ray abdomen 2 views CPT 74019 $124.80 $208.00 $208.00 – $208.00 1
X-ray abdomen >=3 views CPT 74021 $124.80 $208.00 $208.00 – $208.00 1
X-ray abdomen complete acute series including spine erect and/or decubitus single view chest CPT 74022 $142.80 $238.00 $238.00 – $238.00 1
X-ray acromioclavicular joints without or w/weighted distraction bilateral CPT 73050 $124.80 $208.00 $65.00 – $65.00 1
X-ray ankle 2 views (both sides) CPT 73600 $106.80 $178.00 $178.00 – $178.00 1
X-ray arthrogram shoulder supervision & interpretation (both sides) CPT 73040 $0.60 $1.00 $1.00 – $1.00 1
X-ray bone age studies CPT 77072 $71.40 $119.00 $119.00 – $119.00 1
X-ray bone length studies CPT 77073 $106.80 $178.00 $29.00 – $29.00 1
X-ray bone survey complete CPT 77075 $303.60 $506.00 $506.00 – $506.00 1
X-ray bone survey infant CPT 77076 $303.60 $506.00 $506.00 – $506.00 1
X-ray cervical spine 2-3 views CPT 72040 $106.80 $178.00 $49.00 – $49.00 1
X-ray cervical spine 4-5 views CPT 72050 $142.80 $238.00 $65.00 – $65.00 1
X-ray cervical spine >= 6 views CPT 72052 $196.20 $327.00 $82.00 – $82.00 1
X-ray clavicle complete (both sides) CPT 73000 $89.40 $149.00 $32.00 – $32.00 1
X-ray colon abdominal radiograph(s) & delayed images single contrast study CPT 74270 $571.80 $953.00 $953.00 – $953.00 1
X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study CPT 74280 $822.00 $1,370.00 $1,370.00 – $1,370.00 1
X-ray elbow 2 views (both sides) CPT 73070 $89.40 $149.00 $32.00 – $32.00 1
X-ray elbow >= 3 views (both sides) CPT 73080 $106.80 $178.00 $49.00 – $49.00 1
X-ray esophogram chest radiograph(s) & delayed images single contrast study CPT 74220 $321.60 $536.00 $536.00 – $536.00 1
X-ray exam entire spi 4/5 vw CPT 72083 $250.20 $417.00 $417.00 – $417.00 1
X-ray exam entire spi 6/> vw CPT 72084 $303.60 $506.00 $506.00 – $506.00 1
X-ray exam of arm infant CPT 73092 $89.40 $149.00 $32.00 – $32.00 1
X-ray exam of eye sockets CPT 70200 $142.80 $238.00 $82.00 – $82.00 1
X-ray exam of femur 1 CPT 73551 $89.40 $149.00 $149.00 – $149.00 1
X-ray exam of jaw joint CPT 70328 $106.80 $178.00 $49.00 – $49.00 1
X-ray exam of mastoids CPT 70120 $124.80 $208.00 $208.00 – $208.00 1
X-ray exam of middle ear CPT 70134 $58.80 $98.00 $98.00 – $98.00 1
X-ray exam of sinuses CPT 70210 $106.80 $178.00 $49.00 – $49.00 1
X-ray exam si joints CPT 72200 $89.40 $149.00 $149.00 – $149.00 1
X-ray exam thorac spine4/>vw CPT 72074 $142.80 $238.00 $82.00 – $82.00 1
X-ray eye detection foreign body (both sides) CPT 70030 $89.40 $149.00 $65.00 – $65.00 1
X-ray facial bones complete > 3 views CPT 70150 $142.80 $238.00 $82.00 – $82.00 1
X-ray femur >=2 views (both sides) CPT 73552 $106.80 $178.00 $178.00 – $178.00 1
X-ray finger(s) >= 2 views (both sides) CPT 73140 $124.80 $208.00 $32.00 – $32.00 1
X-ray foot 2 views (both sides) CPT 73620 $89.40 $149.00 $32.00 – $32.00 1
X-ray forearm 2 views (both sides) CPT 73090 $89.40 $149.00 $32.00 – $32.00 1
X-ray hand 2 views (both sides) CPT 73120 $89.40 $149.00 $32.00 – $32.00 1
X-ray heel/calcaneus > 2 views (both sides) CPT 73650 $89.40 $149.00 $32.00 – $32.00 1
X-ray hip uni w/wo pelvis min 4 views CPT 73503 $178.80 $298.00 $298.00 – $298.00 1
X-ray hip with pelvis when performed bilateral 2 views CPT 73521 $142.80 $238.00 $238.00 – $238.00 1
X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 $160.80 $268.00 $268.00 – $268.00 1
X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 $196.20 $327.00 $327.00 – $327.00 1
X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 $106.80 $178.00 $178.00 – $178.00 1
X-ray humerus >= 2 views left CPT 73060 $106.80 $178.00 $49.00 – $49.00 1
X-ray joint survey 1 view CPT 77077 $106.80 $178.00 $178.00 – $178.00 1
X-ray knee 1-2 views (both sides) CPT 73560 $106.80 $178.00 $32.00 – $32.00 1
X-ray knee 3 views (both sides) CPT 73562 $124.80 $208.00 $49.00 – $49.00 1
X-ray knee ap standing bilateral CPT 73565 $142.80 $238.00 $32.00 – $32.00 1
X-ray l/s-spine bend vw only 2-3 vw CPT 72120 $142.80 $238.00 $65.00 – $65.00 1
X-ray lower extremities infant > 2 views (both sides) CPT 73592 $89.40 $149.00 $149.00 – $149.00 1
X-ray lumbosacral spine >= 4 views CPT 72110 $160.80 $268.00 $98.00 – $98.00 1
X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 $232.20 $387.00 $148.00 – $148.00 1
X-ray mandible complete > 4 views CPT 70110 $124.80 $208.00 $208.00 – $208.00 1
X-ray mandible ltd <4 views CPT 70100 $124.80 $208.00 $208.00 – $208.00 1
X-ray nasal bones complete > 3 views CPT 70160 $124.80 $208.00 $49.00 – $49.00 1
X-ray neck soft tissue CPT 70360 $89.40 $149.00 $32.00 – $32.00 1
X-ray nose to rectum for foreign body child CPT 76010 $89.40 $149.00 $49.00 – $49.00 1
X-ray optic foramina CPT 70190 $29.40 $49.00 $49.00 – $49.00 1
X-ray pelvis 1-2 views CPT 72170 $106.80 $178.00 $49.00 – $49.00 1
X-ray pelvis complete > 3 views CPT 72190 $142.80 $238.00 $65.00 – $65.00 1
X-ray ribs 2 views left CPT 71100 $106.80 $178.00 $49.00 – $49.00 1
X-ray ribs 3 views bilateral CPT 71110 $124.80 $208.00 $82.00 – $82.00 1
X-ray ribs w/posterior anterior chest 3 views left CPT 71101 $106.80 $178.00 $82.00 – $82.00 1
X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 $160.80 $268.00 $115.00 – $115.00 1
X-ray sacroiliac joints >= 3 views CPT 72202 $124.80 $208.00 $65.00 – $65.00 1
X-ray sacrum/coccyx >= 2 views CPT 72220 $89.40 $149.00 $49.00 – $49.00 1
X-ray scapula complete (both sides) CPT 73010 $106.80 $178.00 $49.00 – $49.00 1
X-ray sella turcica CPT 70240 $39.00 $65.00 $65.00 – $65.00 1
X-ray shoulder 1 view (both sides) CPT 73020 $71.40 $119.00 $119.00 – $119.00 1
X-ray sinus tract/fistula/abscess CPT 76080 $142.80 $238.00 $1.00 – $1.00 1
X-ray sinuses paranasal complete > 3 views CPT 70220 $124.80 $208.00 $82.00 – $82.00 1
X-ray skull < 4 views CPT 70250 $124.80 $208.00 $49.00 – $49.00 1
X-ray skull > 4 views complete CPT 70260 $142.80 $238.00 $82.00 – $82.00 1
X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 $393.00 $655.00 $655.00 – $655.00 1
X-ray small intestine follow-through study CPT 74248 $232.20 $387.00 $387.00 – $387.00 1
X-ray spine single view CPT 72020 $71.40 $119.00 $32.00 – $32.00 1
X-ray sternoclavicular joint(s) > 3 views CPT 71130 $124.80 $208.00 $208.00 – $208.00 1
X-ray sternum > 2 views CPT 71120 $89.40 $149.00 $49.00 – $49.00 1
X-ray surgical specimen CPT 76098 $35.40 $59.00 $59.00 – $59.00 1
X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 $500.40 $834.00 $834.00 – $834.00 1
X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 $178.80 $298.00 $82.00 – $82.00 1
X-ray thoracic spine 2 views CPT 72070 $106.80 $178.00 $49.00 – $49.00 1
X-ray thoracic spine 3 views CPT 72072 $124.80 $208.00 $65.00 – $65.00 1
X-ray thoracolumbar spine >=2 views CPT 72080 $89.40 $149.00 $49.00 – $49.00 1
X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 $124.80 $208.00 $208.00 – $208.00 1
X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 $232.20 $387.00 $387.00 – $387.00 1
X-ray tibia/fibula 2 views (both sides) CPT 73590 $106.80 $178.00 $32.00 – $32.00 1
X-ray toe(s) > 2 views (both sides) CPT 73660 $106.80 $178.00 $32.00 – $32.00 1
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 $464.40 $774.00 $774.00 – $774.00 1
X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 $393.00 $655.00 $655.00 – $655.00 1
X-ray wrist 2 views (both sides) CPT 73100 $106.80 $178.00 $32.00 – $32.00 1
Xe133 xenon 10mci HCPCS A9558 $23.40 $39.00 $39.00 – $39.00 1
Xm archive tissue molec anal CPT 88363 $40.20 $67.00 $67.00 – $67.00 1
Xyntha inj HCPCS J7185 $1.80 $3.00 $3.00 – $3.00 1
Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr HCPCS J3485 $32.40 $54.00 $54.00 – $54.00 1
Zika virus dna/rna amp probe CPT 87662 $194.40 $324.00 $324.00 – $324.00 1
Ziv-aflibercept 25 mg/ml intravenous solution (wrapper) HCPCS J9400 $1,920.00 $3,200.00 $1,600.00 – $1,600.00 1
Zoledronic acid 4 mg/5 ml intravenous solution HCPCS J3489 $52.80 $88.00 $13.00 – $13.00 1
Zoster vaccine-live inj CPT 90736 $262.20 $437.00 $437.00 – $437.00 1
_afb id by dna probe rflx ast CPT 87149 $40.20 $67.00 $67.00 – $67.00 1

A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.