7869 procedures with published pricing. Cash pay ranges from $25 to $276,348.
Carolina East Medical Center in Charlotte publishes cash-pay pricing for 7869 procedures, as required by federal law under 45 CFR Part 180. The median cash price across all published procedures is $750, with individual procedure prices ranging from $25 to $276,348 as of 2026-10-04. Source: Carolina East Medical Center Machine-Readable File. ProcedureRadar.
By Kevin Monangai, Founder, ProcedureRadar.
Hospital profile pages are what we wish existed when our own family was trying to figure out a bill. Each one shows every procedure that hospital publishes, pulled straight from its own federally mandated transparency file, one of roughly 3,500 we track and refresh monthly. We link back to the raw file every time, so you can verify the prices yourself. No middleman, no spin.
Carolina East Medical Center's cash pay prices range from $25 (Aminocaproic Acid 500 Mg Tab) to $276,348 (Ecmo OR Tracheostomy with Mv >96 Hours OR Principal Diagnosis Except Face, Mo...).
| Category | Range | |||
|---|---|---|---|---|
| Aminocaproic Acid 500 Mg Tab | other | $25 | $11 to $42 | Low |
| Cervical, Semi-rigid, Adjustable | other | $25 | $11 to $86 | Low |
| Foley Urinary Catheter 18fr 5ml Silicone Council Tip #0196si18 12ea/cs | cardiac | $25 | $11 to $42 | Low |
| Dermatac Drape W/granufoam Dressing Small10pk | other | $25 | $11 to $42 | Low |
| Drop Foot Splint Standard Lg Lt #pls-ff-300l | other | $25 | $11 to $42 | Low |
| Drop Foot Splint Standard Lg Rt #pls-ff-300r | other | $25 | $11 to $42 | Low |
| Drop Foot Splint Standard Med Rt #pls-ff-200r | other | $25 | $11 to $42 | Low |
| Drop Foot Splint Standard Sm Rt #pls-ff-100r | other | $25 | $11 to $42 | Low |
| Trach Tube 6dct #6cn75h | other | $25 | $11 to $42 | Low |
| Clobetasol 0.05% Solution | other | $25 | $11 to $42 | Low |
| Trach Sz 8 Shiley Cuffed Trach Cann 8.5mm #8cn85h | other | $25 | $11 to $42 | Low |
| Trach Tube 4dct #4cn65h | other | $25 | $11 to $42 | Low |
| Drain Hemovac Replacement 5ea/1bx #00-2555-050 | surgery | $25 | $11 to $42 | Low |
| Splint Denver Nasal Thermoplastic Sm #10-4021-05ks 5/bx | other | $25 | $11 to $42 | Low |
| Pediatric Tracheostomy Tube Shiley Cuffless 4.0mm Id 6.0mm Od Medtronic 4.0pe... | other | $25 | $11 to $42 | Low |
| Butrans 5 Mcg/hr Patch | other | $25 | $11 to $42 | Low |
| Nasal 7.5 Epistaxis Ant/posterior 10ea/1bx | other | $26 | $11 to $43 | Low |
| Immobilizer Shoulder Lg W/block Deroyal | other | $26 | $11 to $43 | Low |
| Immobilizer Shoulder Med W/block Deroyal | other | $26 | $11 to $43 | Low |
| Immobilizer Shoulder Small W/block Deroyal | other | $26 | $11 to $43 | Low |
| Tube Trach Cuff Size 8 Low Pressure | other | $26 | $11 to $43 | Low |
| Tube Trach Cuff Sz-6 Low Pressure | other | $26 | $11 to $43 | Low |
| Tube Trach Cuffless Sz 4 W/cannula #4cfs | other | $26 | $11 to $43 | Low |
| Laser Trach Tube 3.0 #86400 Uncuffed | other | $26 | $11 to $43 | Low |
| Laser Trach Tube 3.5 #86401 Uncuffed | other | $26 | $11 to $43 | Low |
| Laser Trach Tube 4.0 #86402 Uncuffed | other | $26 | $11 to $43 | Low |
| Pin Guide 2.8 #ar | other | $26 | $11 to $43 | Low |
| Provisc #8065-18 | other | $26 | $11 to $43 | Low |
| Trach Sz 10 Shiley Cuffed Trach Cann 10.0mm 10cn10h | other | $26 | $11 to $43 | Low |
| Prosthetic Sock, Multiple Ply, Below Knee, Each | other | $26 | $12 to $43 | Low |
| Ultrasound Mak Kit #k12t-05493a **must Order Increments of 10 Each** | imaging | $26 | $12 to $43 | Low |
| Cath Cholangiogram Orc-b | other | $26 | $12 to $44 | Low |
| Clindamycin Ph 1% Gel | other | $26 | $12 to $44 | Low |
| Single Action Pumping Sys #m0067201001 | other | $26 | $12 to $44 | Low |
| Prednisolone Oral, Per 5 Mg | other | $26 | $12 to $44 | Low |
| Splint Nasal Intranasal 15-24050 5ea/1bx | other | $26 | $12 to $44 | Low |
| Pulmonary Biopsy Forcep Rj4 #m0515181 | lab | $26 | $12 to $44 | Low |
| Laser Flex Trach Tube 4.5mm #86397 Cuffed | other | $26 | $12 to $44 | Low |
| Laser Flex Trach Tube 5.5 #86395 Cuffed | other | $26 | $12 to $44 | Low |
| Laser Flex Tracheal Tube 6.0 Cuffed | other | $26 | $12 to $44 | Low |
| Injection, Lincomycin Hcl, Up to 300 Mg | other | $26 | $12 to $44 | Low |
| Urethral Needle for Macroplastique | other | $26 | $12 to $44 | Low |
| Vac Soft White Foam Sys Sm 10"x 7.5" M8275068 | other | $26 | $12 to $44 | Low |
| Pleuravac - Infant #a-8020-08lf | other | $27 | $12 to $44 | Low |
| Cannula Aortic Ez Glide 21fr X 35cm Ezs21ta | other | $27 | $12 to $44 | Low |
| Betamethasone Dp 0.05% Oint | other | $27 | $12 to $44 | Low |
| Cement Mix Bowl Quick Vac Vacuum | other | $27 | $12 to $45 | Low |
| Immobilizer Shoulder Xlg W/block Deroyal | other | $27 | $12 to $45 | Low |
| Cannula Endo 5fr Biliary ERCP 5-4-3 M00530880 | other | $27 | $12 to $45 | Low |
| Cor-knot Quick Load Singles #030850 | other | $27 | $12 to $45 | Low |
| Foot, Arch Support, Removable, Premolded, Metatarsal, Each | other | $27 | $12 to $90 | Low |
| Introducer Peritoneal Taut #pi | other | $27 | $12 to $45 | Low |
| Presto Inflation High Pressure Device with 30cc Barrel 5ea/ca Id4030 | other | $27 | $12 to $45 | Low |
| Semen Analysis; Presence And/or Motility of Sperm Excluding Huhner | other | $27 | $7 to $90 | Low |
| Splint, Prefabricated, Elbow | other | $27 | $12 to $90 | Low |
| Tray Epidural #182221 Ballard | other | $27 | $12 to $45 | Low |
| Pentam 300 Mg Vial | other | $27 | $12 to $45 | Low |
| Brexpiprazole 2 Mg Po Tabs | other | $27 | $12 to $45 | Low |
| Rexulti 1 Mg Tablet | other | $27 | $12 to $45 | Low |
| Rexulti 2 Mg Tablet | other | $27 | $12 to $45 | Low |
| Marker Scar Spee-d-line 3d Digital Breast | other | $27 | $12 to $45 | Low |
| Shiley Pediatric Tracheostomy Tube Cuffless 3.0mm Id 4.8mm Od 39mm 3.0 Pef #3... | other | $27 | $12 to $46 | Low |
| Shiley Pediatric Tracheostomy Tube Cuffless 4.5mm Id 6.7mm Od 42mm 4.5 Pef #4... | other | $27 | $12 to $46 | Low |
| Infusion Set Rapid #d-60hl Smith Med.10ea/1cs | surgery | $27 | $12 to $46 | Low |
| Catheter Duplocath Application 35cm #1506166 Be-10-01-106 for Billing Reference | cardiac | $27 | $12 to $46 | Low |
| Shiley Tracheostomy Tube Twist Lock Ic Size 10.0 Adult #10fen | other | $28 | $12 to $46 | Low |
| Tube Trach Cuff Size 6fen 1ea | other | $28 | $12 to $46 | Low |
| Tube Trach Cuff Size 8fen 1ea | other | $28 | $12 to $46 | Low |
| Administration of Hepatitis B Vaccine | preventive | $28 | $12 to $92 | Low |
| Administration of Influenza Virus Vaccine | preventive | $28 | $12 to $92 | Low |
| Administration of Pneumococcal Vaccine | preventive | $28 | $12 to $92 | Low |
| Trocar 15mm X 100 6/bx #c0r37 | other | $28 | $12 to $46 | Low |
| Cannula 15fr Coronary Ostial Perfusion | surgery | $28 | $12 to $46 | Low |
| Cannula 17fr Coronary Ostial Perfusion | surgery | $28 | $12 to $46 | Low |
| Cannula 20fr Coronary Ostial Perfusion | surgery | $28 | $12 to $46 | Low |
| Sheath Storz/xomed 4mm/30" #1912010 Sc | other | $28 | $12 to $46 | Low |
| Sheath Storz/xomed 4mm/45" #1912013 Sc | other | $28 | $12 to $46 | Low |
| Lumbar Support Basic Xlrg #10155 | other | $28 | $12 to $46 | Low |
| Stylet S 53-j | other | $28 | $13 to $47 | Low |
| Stylet S 53-jl | other | $28 | $13 to $47 | Low |
| Stylet S 53-s | other | $28 | $13 to $47 | Low |
| Stylet S53-k | other | $28 | $13 to $47 | Low |
| Torque Wrench | other | $28 | $13 to $47 | Low |
| Tobramycin-dexameth Ophth Susp | imaging | $28 | $13 to $47 | Low |
| Tobramycin-dexamethasone 0.3-0.1 % Op Susp | imaging | $28 | $13 to $47 | Low |
| Deluxe Paring Board 1ea | other | $28 | $13 to $47 | Low |
| Neomyc-polym-gramicid Eye Drop | other | $28 | $13 to $47 | Low |
| Cath Word Bartholin Gland 10fr 6ea/1bx | other | $28 | $13 to $47 | Low |
| Cannula Arterial 18fr Eopa Elongated One Piec | other | $28 | $13 to $47 | Low |
| Cannula Arterial 20fr Eopa Elongated One Piec | other | $28 | $13 to $47 | Low |
| Cannula Arterial 22fr Eopa Elongated One Piec | other | $28 | $13 to $47 | Low |
| Boot Prevalon Iii W/wedge #7355 8ea/cs | other | $29 | $13 to $48 | Low |
| Prosthetic Sock, Multiple Ply, Above Knee, Each | other | $29 | $13 to $48 | Low |
| Injection, Insulin, Per 5 Units | other | $29 | $13 to $48 | Low |
| Insulin for Administration Through DME (i.e., Insulin Pump) Per 50 Units | other | $29 | $13 to $48 | Low |
| Muscle Biopsy Clamp Rayport 12mm #su130 | lab | $29 | $13 to $48 | Low |
| Iodosorb Gel | other | $29 | $13 to $48 | Low |
| Tube Endobronchial 35fr Left #125035 | other | $29 | $13 to $48 | Low |
| Tube Endobronchial 37fr Left #125037 | other | $29 | $13 to $48 | Low |
| Tube Endobronchial 39fr Left #125039 | other | $29 | $13 to $48 | Low |
| Tube Endobronchial 41fr Left #125041 | other | $29 | $13 to $48 | Low |
| Surgiclip Lrg 13.0 #134048 | other | $29 | $13 to $48 | Low |
| Surgiclip Sm 9.0 #133650 | other | $29 | $13 to $48 | Low |
| Tube Trach Metal Jackson Sz 7 #pm1034317 | other | $29 | $13 to $48 | Low |
| Ligaclip Medium 11.5 6/bx #134053 | other | $29 | $13 to $48 | Low |
| Sensor Rectal Pressure #pg | other | $29 | $13 to $48 | Low |
| Sensor Vaginal Emg #pg | other | $29 | $13 to $48 | Low |
| Surgiclip Med 9.75 6 Ea/bx #134051 | other | $29 | $13 to $48 | Low |
| Vac Pad Large Black 10ea/1ca | other | $29 | $13 to $48 | Low |
| Irrigation Sys Bard Assist #160130 | other | $29 | $13 to $48 | Low |
| Catheter Kit 5.0" Pain On Q Silversoaker 5/bx | cardiac | $29 | $13 to $48 | Low |
| Avitene Ultrafoam Collagen Sponge 100 SQ Cm 8cm X 12.5cm 3-1/18" X 5" 1050040 | other | $29 | $13 to $49 | Low |
| Tube Trach Metal Jackson Sz 5 #pm1034915 | other | $29 | $13 to $49 | Low |
| Rbn-114 Bone Marrow Biopsy Needle 11 Gauge X 4" Snarecoil Box/10each | lab | $29 | $13 to $49 | Low |
| Rbn-116 Bone Marrow Biopsy Needle 11 Gauge X 6" Snarecoil Box/10each | lab | $29 | $13 to $49 | Low |
| Immobilizer Arm/shoulder Atlas#00052 Breg | other | $29 | $13 to $49 | Low |
| Hydro-surg Plus Laparoscopic Irrigator with Nezhat-dorsey Smokevac Trumpet Va... | surgery | $29 | $13 to $49 | Low |
| Safety Amniocentesis 20gx3.5 29-am1sfa 10ea/case | other | $29 | $13 to $49 | Low |
| Buprenorphine 10 Mcg/hr Patch | other | $29 | $13 to $49 | Low |
| Immobilizer Sling Shot Sz Large Breg | other | $30 | $13 to $49 | Low |
| Immobilizer Sling Shot Sz Medium | other | $30 | $13 to $49 | Low |
| Immobilizer Sling Shot Sz Small | other | $30 | $13 to $49 | Low |
| Immobilizer Sling Shot Sz Xlarge Breg | other | $30 | $13 to $49 | Low |
| Lap Probe Monopolar J Hook Tip | other | $30 | $13 to $49 | Low |
| Viscera Retainer-medium Hs3204-1 Bx/10 | other | $30 | $13 to $50 | Low |
| Tube Ear Ventilation Richards T 1.14mm 240071 | other | $30 | $13 to $50 | Low |
| Nasal 4.5 Epistaxis Anterior 10ea/1bx | other | $30 | $13 to $50 | Low |
| Nasal 5.5 Epistaxis Anterior 10ea/1bx | other | $30 | $13 to $50 | Low |
| Cannula Endo 1.83mm X 210cm Tandem M00545820 | other | $30 | $13 to $50 | Low |
| Nystatin-triamcinolone 100000-0.1 Unit/gm-% Ex Oint | other | $30 | $13 to $50 | Low |
| Nystatin-triamcinolone Ointm | other | $30 | $13 to $50 | Low |
| Guardian Ii Hemostasis Valve #8211 | other | $30 | $13 to $50 | Low |
| Polymyxin B-trimethoprim 10000-0.1 Unit/ml-% Op Soln | other | $30 | $13 to $50 | Low |
| 5% Dextrose in Lactated Ringers Infusion, Up to 1000 Cc | surgery | $30 | $13 to $50 | Low |
| 5% Dextrose/normal Saline | other | $30 | $13 to $50 | Low |
| 5% Dextrose/water | other | $30 | $13 to $50 | Low |
| Bacteriostatic Saline Vial | other | $30 | $13 to $50 | Low |
| Bupivacaine-epinephrine (pf) 0.5% -1:200000 Ij Soln | other | $30 | $13 to $50 | Low |
| Caffeine Cit 60 Mg/3 Ml Vial | other | $30 | $13 to $50 | Low |
| Cefazolin 5 Mg/ml + Heparin 2500 Units/ml Antibiotic Catheter Mixture - Compo... | cardiac | $30 | $13 to $50 | Low |
| Dextrose 2.5%-0.45% Nacl IV | other | $30 | $13 to $50 | Low |
| Dextrose 5%-0.2% Nacl IV Soln | other | $30 | $13 to $50 | Low |
| Dextrose 5%-0.45% Nacl IV Soln | other | $30 | $13 to $50 | Low |
| Diltiazem 25 Mg/5 Ml Vial | other | $30 | $13 to $50 | Low |
| Encore 40 Inflation Device M001394472540 | other | $30 | $13 to $50 | Low |
| Etomidate 2 Mg/ml IV Soln | other | $30 | $13 to $50 | Low |
| Evoke Epidural Needle 6.5' #3014 | other | $30 | $13 to $50 | Low |
| Flu Vaccination | preventive | $30 | $12 to $248 | High |
| Hc Dress Duoderm 5.5 X 5.5 Signal | other | $30 | $13 to $50 | Low |
| Infusion, Normal Saline Solution, 250 Cc | surgery | $30 | $13 to $50 | Low |
| Injection Fluconazole, 200 Mg | other | $30 | $13 to $50 | Low |
| Injection, Acetaminophen (fresenius Kabi), Not Therapeutically Equivalent to ... | other | $30 | $13 to $50 | Low |
| Injection, Acetylcysteine, 100 Mg | other | $30 | $13 to $50 | Low |
| Injection, Amikacin Sulfate, 100 Mg | other | $30 | $13 to $50 | Low |
| Injection, Amiodarone Hydrochloride, 30 Mg | other | $30 | $13 to $50 | Low |
| Injection, Ampicillin Sodium, 500 Mg | other | $30 | $13 to $50 | Low |
| Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm | other | $30 | $13 to $50 | Low |
| Injection, Atropine Sulfate, 0.01 Mg | other | $30 | $13 to $50 | Low |
| Injection, Bumetanide, 0.5 Mg | other | $30 | $13 to $50 | Low |
| Injection, Butorphanol Tartrate, 1 Mg | other | $30 | $13 to $50 | Low |
| Injection, Calcium Gluconate, Not Otherwise Specified, 10 Mg | other | $30 | $13 to $50 | Low |
| Injection, Ceftazidime, Per 500 Mg | other | $30 | $13 to $50 | Low |
| Injection, Ciprofloxacin for Intravenous Infusion, 200 Mg | surgery | $30 | $13 to $50 | Low |
| Injection, Clindamycin Phosphate, 300 Mg | other | $30 | $13 to $50 | Low |
| Injection, Dicyclomine Hcl, Up to 20 Mg | other | $30 | $13 to $50 | Low |
| Injection, Digoxin, Up to 0.5 Mg | other | $30 | $13 to $50 | Low |
| Injection, Diphenhydramine Hcl, Up to 50 Mg | other | $30 | $13 to $50 | Low |
| Injection, Dopamine Hcl, 40 Mg | other | $30 | $13 to $50 | Low |
| Injection, Famotidine, 0.25 Mg | other | $30 | $13 to $50 | Low |
| Injection, Fluphenazine Decanoate, Up to 25 Mg | other | $30 | $13 to $50 | Low |
| Injection, Folic Acid, 0.1 Mg | other | $30 | $13 to $50 | Low |
| Injection, Furosemide, 1 Mg | other | $30 | $13 to $50 | Low |
| Injection, Garamycin, Gentamicin, Up to 80 Mg | other | $30 | $13 to $50 | Low |
| Injection, Granisetron Hydrochloride, 100 Mcg | other | $30 | $13 to $50 | Low |
| Injection, Haloperidol, Up to 5 Mg | other | $30 | $13 to $50 | Low |
| Injection, Heparin Sodium, (heparin Lock Flush), Per 10 Units | other | $30 | $13 to $50 | Low |
| Injection, Hydralazine Hcl, Up to 20 Mg | other | $30 | $13 to $50 | Low |
| Injection, Ketorolac Tromethamine, Per 15 Mg | other | $30 | $30 to $50 | Low |
| Injection, Levofloxacin, 250 Mg | other | $30 | $13 to $50 | Low |
| Injection, Lidocaine Hydrochloride, 1 Mg | other | $30 | $13 to $50 | Low |
| Injection, Lorazepam, 2 Mg | other | $30 | $13 to $50 | Low |
| Injection, Magnesium Sulfate, Per 500 Mg | other | $30 | $13 to $50 | Low |
| Injection, Mannitol, 25% in 50 Ml | other | $30 | $13 to $50 | Low |
| Injection, Meperidine Hydrochloride, Per 100 Mg | other | $30 | $13 to $50 | Low |
| Injection, Methocarbamol, Up to 10 Ml | other | $30 | $13 to $50 | Low |
| Injection, Metoclopramide Hcl, Up to 10 Mg | other | $30 | $13 to $50 | Low |
| Injection, Midazolam Hydrochloride, Per 1 Mg | other | $30 | $13 to $50 | Low |
| Injection, Milrinone Lactate, 5 Mg | other | $30 | $13 to $50 | Low |
| Injection, Nalbuphine Hydrochloride, Per 10 Mg | other | $30 | $13 to $50 | Low |
| Injection, Paricalcitol, 1 Mcg | other | $30 | $13 to $50 | Low |
| Injection, Phenylephrine Hydrochloride (biorphen), 20 Micrograms | other | $30 | $13 to $50 | Low |
| Injection, Phenytoin Sodium, Per 50 Mg | other | $30 | $13 to $50 | Low |
| Injection, Piperacillin Sodium/tazobactam Sodium, 1 Gram/0.125 Grams | other | $30 | $13 to $50 | Low |
| Injection, Potassium Chloride, Per 2 Meq | other | $30 | $13 to $50 | Low |
| Injection, Sterile Cefuroxime Sodium, Per 750 Mg | other | $30 | $13 to $50 | Low |
| Injection, Terbutaline Sulfate, Up to 1 Mg | other | $30 | $13 to $50 | Low |
| Injection, Thiamine Hcl, 100 Mg | other | $30 | $13 to $50 | Low |
| Injection, Triamcinolone Acetonide, Not Otherwise Specified, 10 Mg | other | $30 | $13 to $50 | Low |
| Injection, Vitamin B-12 Cyanocobalamin, Up to 1000 Mcg | other | $30 | $13 to $50 | Low |
| Intraocular Vancomycin 10 Mg/ Ml- 3 Ml (for Dr. Ouano) - Compounded | other | $30 | $13 to $50 | Low |
| Kcl 20 Meq/l-d5w-0.45% Nacl | other | $30 | $13 to $50 | Low |
| Lactated Ringers Injection | other | $30 | $13 to $50 | Low |
| Lidocaine / Bicarb 1 Ml Syringe - Compounded | other | $30 | $13 to $50 | Low |
| Lidocaine / Sodium Bicarb 0.09 Meq/ Ml Vial - Compounded | other | $30 | $13 to $50 | Low |
| Lidocaine 0.5%-epi 1:200,000 | other | $30 | $13 to $50 | Low |
| Lidocaine-epinephrine 2 %-1:100000 Ij Soln | other | $30 | $13 to $50 | Low |
| Metoprolol Tartrate 5 Mg/5ml IV Soln | other | $30 | $13 to $50 | Low |
| Morphine 0.1 Mg/ml Peds Oral Solution - Compounded | other | $30 | $13 to $50 | Low |
| Moxifloxacin Intracameral 600 Mcg / 0.4 Ml Syringe-surgery Center - Compounded | surgery | $30 | $13 to $50 | Low |
| Neostigmine 10 Mg/10 Ml Vial | other | $30 | $13 to $50 | Low |
| Norepinephrine Bitartrate 1 Mg/ml IV Soln | other | $30 | $13 to $50 | Low |
| Removal of Sutures; By a Physician Other Than the Physician Who Originally Cl... | surgery | $30 | $13 to $100 | Low |
| Ringers Lactate Infusion, Up to 1000 Cc | surgery | $30 | $13 to $50 | Low |
| Rocuronium Bromide 50 Mg/5ml IV Soln | other | $30 | $13 to $50 | Low |
| Slitter Catheter for Agilis Hispro Steerable Catheter#ds3a001 | cardiac | $30 | $13 to $50 | Low |
| Sodium Acetate 40 Meq/20 Ml Vl | other | $30 | $13 to $50 | Low |
| Sodium Chloride 0.45% Soln | other | $30 | $13 to $50 | Low |
| Sterile Water for Irrigation | other | $30 | $13 to $50 | Low |
| Sterile Water, Saline And/or Dextrose, Diluent/flush, 10 Ml | other | $30 | $30 to $50 | Low |
| Tool Locking Helix for Tendril Sts Pacing Lead#a001helx | other | $30 | $13 to $50 | Low |
| Tranexamic Acid 1000 Mg/10ml IV Soln | other | $30 | $13 to $50 | Low |
| Valproate Sod 500 Mg/5 Ml Vl | other | $30 | $13 to $50 | Low |
| Vancomycin 2.5 Mg/ml + Heparin 2500 Units/ml Antibiotic Catheter Mixture - Co... | cardiac | $30 | $13 to $50 | Low |
| Vancomycin Retention Enema 500 Mg/ns 100 Ml - Compounded | other | $30 | $13 to $50 | Low |
| Verapamil 2.5 Mg/5 Ml Syringe (for Radial Cocktail) - Compounded | other | $30 | $13 to $50 | Low |
| Xylocaine 1%-epi 1:100,000 | other | $30 | $13 to $50 | Low |
| Ultrasharp Scleral Knife | other | $30 | $13 to $50 | Low |
| Xifaxan 550 Mg Tablet | other | $30 | $13 to $50 | Low |
| Hydrocolloid Dressing, Wound Cover, Sterile, Pad Size More Than 48 Sq. In., w... | other | $30 | $13 to $101 | Low |
| Geo Matt Chair 6ea/1cs | other | $30 | $13 to $51 | Low |
| Needle Angiody. Ministick Max 5f 10cm #h965457561 | other | $30 | $13 to $51 | Low |
| Vac Soft White Foam Sys Lrg 10"x 15" M8275067 | other | $31 | $14 to $51 | Low |
| Fosfomycin 3 Gm Sachet | other | $31 | $14 to $51 | Low |
| Caplyta 42 Mg Capsule | other | $31 | $14 to $51 | Low |
| Injection, Methotrexate Sodium, 50 Mg | other | $31 | $14 to $51 | Low |
| Benzoyl Peroxide-erythromycin 5-3 % Ex Gel | other | $31 | $14 to $51 | Low |
| Boot Prevalon Heel Protector Petite #7310 | other | $31 | $14 to $52 | Low |
| Sheath Storz/xomed 4mm/0" #1912000 Sc | other | $31 | $14 to $52 | Low |
| Surgiflo Endo Applicator 34cm #ms1995 | other | $31 | $14 to $52 | Low |
| Tube Endobronchial 35fr Left #116100350 | other | $31 | $14 to $52 | Low |
| Tube Endobronchial 37fr Left #5 | other | $31 | $14 to $52 | Low |
| Tube Endobronchial 39fr Left #116100390 | other | $31 | $14 to $52 | Low |
| Tube Endobronchial 41fr Left #5 | other | $31 | $14 to $52 | Low |
| Tube Gastrostomy Kangaroo 16fr #8884720163e 5ea/case | other | $31 | $14 to $52 | Low |
| Cialis 10 Mg Tablet | other | $31 | $14 to $52 | Low |
| Cialis 20 Mg Tablet | other | $31 | $14 to $52 | Low |
| Healon5 Pro 0.60 Ml 10340015 Dr. Ouano | other | $31 | $14 to $52 | Low |
| Irrigator Lap Suction W/pistol Grip/conmed | other | $31 | $14 to $52 | Low |
| Physostigmine 1 Mg/ml Ampul | other | $31 | $14 to $52 | Low |
| Splint System Bsn Dynacast Fiberglass Padded Roll Form 4inx15ft #7449804 1ea/... | other | $31 | $14 to $52 | Low |
| Dermatac Drape W/granufoam Dressing Med 10pk | other | $32 | $14 to $53 | Low |
| Kyphon Cement Mixer Only #a07a | other | $32 | $14 to $53 | Low |
| Coagulator Bipolar .5mm Tip Non-insul#20 | other | $32 | $14 to $53 | Low |
| Pushr Stent for 4/5fr Pancreatic Rx M00535010 | cardiac | $32 | $14 to $53 | Low |
| Addition to Lower Extremity Orthosis, Drop Lock Retainer, Each | other | $32 | $14 to $53 | Low |
| Ephedrine Sulfate (pressors) 50 Mg/ml Soln Wrapper | other | $32 | $14 to $53 | Low |
| Injection, Succinylcholine Chloride, Up to 20 Mg | other | $32 | $14 to $53 | Low |
| Ortho Glass 3" X 15 #og-3l22 Rolls/case | other | $32 | $14 to $53 | Low |
| Sole Wedge, Outside Sole | other | $32 | $14 to $54 | Low |
| Irrigation Tubeset for Bone Scalpel Mxb-t 5/b | other | $32 | $14 to $54 | Low |
| Neomycin-polymyxin-hc Ear Soln | other | $32 | $14 to $54 | Low |
| Vac Veraflo Veralink Cassette #ultlnk0500 | other | $32 | $14 to $54 | Low |
| Hydrocortisone 2.5 % Ex Crea | other | $32 | $14 to $54 | Low |
| Hydrocortisone 2.5% Cream | other | $32 | $14 to $54 | Low |
| Trocar Cannula Alcon 25g #8065751448 | other | $32 | $14 to $54 | Low |
| Bowl Cement Smart Mix #5401-76 | other | $32 | $14 to $54 | Low |
| Nipple Prosthesis, Prefabricated, Reusable, Any Type, Each | other | $32 | $14 to $54 | Low |
| Pin Fixation Pk #07.00656.002 | other | $32 | $14 to $54 | Low |
| Special Casting Material | other | $32 | $14 to $108 | Low |
| Injection, Cytarabine, 100 Mg | other | $33 | $1 to $54 | Low |
| Mask CPAP O2-resq Sys Sz Adult Med | other | $33 | $14 to $54 | Low |
| Mammary Support Medium W/cups | other | $33 | $14 to $54 | Low |
| Addition to Upper Extremity Orthosis, Sock, Fracture OR Equal, Each | other | $33 | $14 to $54 | Low |
| Levalbuterol Tar Hfa 45mcg Inh | other | $33 | $14 to $54 | Low |
| Geo Matt-foam Pressure Air 34x72x3.5 4ea/1cs | other | $33 | $15 to $55 | Low |
| Carbamazepine 100 Mg/5ml Po Susp | other | $33 | $15 to $55 | Low |
| 4fr Pigtail | other | $33 | $15 to $55 | Low |
| Blower Mister Kit Clearview #22150 | other | $33 | $15 to $55 | Low |
| Crutches Underarm, Other Than Wood, Adjustable OR Fixed, Pair, with Pads, Tip... | other | $33 | $15 to $110 | Low |
| Inflation Device Sphere 20cc #g31027 | other | $33 | $15 to $55 | Low |
| Plate Tack Acumed #pl-ptack | other | $33 | $15 to $55 | Low |
| Hydrocortisone 2.5% Ointment | other | $33 | $15 to $55 | Low |
| Tolvaptan 15 Mg Tablet | other | $33 | $15 to $55 | Low |
| Coag Bipolar Bayonet Non-insulated Tip1.5mm | other | $33 | $15 to $56 | Low |
| Desmopressin 10 Mcg/0.1 Ml Spr | other | $33 | $15 to $56 | Low |
| Tall Air Walker Lg #b | other | $33 | $15 to $56 | Low |
| Tall Air Walker Med #b | other | $33 | $15 to $56 | Low |
| Tall Air Walker Sm #b | other | $33 | $15 to $56 | Low |
| Tall Air Walker Xs #b | other | $33 | $15 to $56 | Low |
| Tru-pull Lite Left Knee Adult 15.5-18.5" Small #11-0261 | other | $34 | $15 to $56 | Low |
| Tru-pull Lite Left Knee Adult 18.5-21" Medium #11-0261 | other | $34 | $15 to $56 | Low |
| Tru-pull Lite Left Knee Adult 21-23.5" Large #11-0261 | other | $34 | $15 to $56 | Low |
| Tru-pull Lite Left Knee Adult 23.5-26.5" X-large #11-0261 | other | $34 | $15 to $56 | Low |
| Tru-pull Lite Right Knee Adult 18.5-21" Medium #11-0260 | other | $34 | $15 to $56 | Low |
| Tru-pull Lite Right Knee Adult 21-23.5" Large #11-0260 | other | $34 | $15 to $56 | Low |
| Tru-pull Lite Right Knee Adult 23.5-26.5" X-large #11-0260 | other | $34 | $15 to $56 | Low |
| Drill Solid Side Cutting 2x40 Drll-ssc | other | $34 | $15 to $56 | Low |
| Pressure Guard 12cm #82050 10ea/1bx | other | $34 | $15 to $56 | Low |
| Grasper Babcock 533-005-925 8ea/1bx | other | $34 | $15 to $56 | Low |
| Tube Endobronchial 35fr Right #126035 | other | $34 | $15 to $56 | Low |
| Tube Endobronchial 37fr Right #126037 | other | $34 | $15 to $56 | Low |
| Tube Endobroncial 39fr Right #126039 | other | $34 | $15 to $56 | Low |
| Temno Evolution Biopsy Needles Ctt1811 | lab | $34 | $15 to $56 | Low |
| Temno Evolution Biopsy Needles Ctt1815 | lab | $34 | $15 to $56 | Low |
| Temno Evolution Biopsy Needles Ctt1820 | lab | $34 | $15 to $56 | Low |
| Lantus 100 Unit/ml Vial | other | $34 | $15 to $57 | Low |
| Injection, Esmolol Hydrochloride, 10 Mg | other | $34 | $15 to $57 | Low |
| For Diabetics Only, Multiple Density Insert, Made By Direct Carving with Cam ... | other | $34 | $15 to $57 | Low |
| Ethyl Chloride Spray | other | $34 | $15 to $57 | Low |
| Drill Solid Side Cuttin 2.5x40 Drll-ssc | other | $34 | $15 to $57 | Low |
| Inflation Device Stonemaster V #maj | other | $34 | $15 to $57 | Low |
| Stylet Kit 58cm Ds06003/58 Ds06003 | other | $34 | $15 to $57 | Low |
| Lidocaine Hcl 2% Syringe | other | $34 | $15 to $57 | Low |
| Pin Skull Disp | other | $34 | $15 to $57 | Low |
| Gradient Compression Gauntlet, Each | other | $35 | $15 to $58 | Low |
| Tray Umbilical Vessel Insertion #43201 | other | $35 | $15 to $58 | Low |
| Diag Catheter 4fr Vert #srd6108 | cardiac | $35 | $15 to $58 | Low |
| Radial Cocktail 10 Ml Kit (2-5 Ml Syringes)-compounded | other | $35 | $15 to $58 | Low |
| Shoulder Suspension Kit 72200195 | other | $35 | $15 to $58 | Low |
| Sodium Chloride 3% IV Soln | other | $35 | $15 to $58 | Low |
| Marcaine 0.25%-epi 1:200,000 | other | $35 | $15 to $58 | Low |
| Resting Hand Orthosis Large Left 29rho-l-l | other | $35 | $15 to $58 | Low |
| Resting Hand Orthosis Large Right 29rho-l-r | other | $35 | $15 to $58 | Low |
| Resting Hand Orthosis Medium Right 29rho-m-r | other | $35 | $15 to $58 | Low |
| Resting Hand Orthosis Small Left 29rho-s-l | other | $35 | $15 to $58 | Low |
| Resting Hand Orthosis Small Right 29rho-s-r | other | $35 | $15 to $58 | Low |
| Resting Hand Orthosis X-large Left 29rho-xl-l | other | $35 | $15 to $58 | Low |
| Resting Hand Orthosis X-large Right 29rho-xl-r | other | $35 | $15 to $58 | Low |
| Resting Hand Othosis Medium Left 29rho-m-l | other | $35 | $15 to $58 | Low |
| Brachytherapy Source, Non-stranded, Iodine-125, Per Source | other | $35 | $15 to $58 | Low |
| Hc Epidural Anesthesia Time - Each Incremental 15 Minute | other | $35 | $15 to $58 | Low |
| Hc Spinal Anes Ea Addl 15 Min | other | $35 | $15 to $58 | Low |
| Stylet Kit 52cm Ds06001-52 Ds06001/52 | other | $35 | $15 to $58 | Low |
| Tall Air Walker Xl #b | other | $35 | $15 to $58 | Low |
| Pleur-evac Sahara Chest Drain #s-1100-08lf 6ea/case | other | $35 | $15 to $58 | Low |
| Brachytherapy Needle | other | $35 | $15 to $58 | Low |
| Monoka Mini #s1-1500u | other | $35 | $16 to $58 | Low |
| Vascular Sheath A/v Small Yellow | other | $35 | $16 to $58 | Low |
| Needle/sheath Injector #nm-221c-0427 1ea/1bx | other | $35 | $16 to $59 | Low |
| Picc Introducer 6.0fr Micro Bard | other | $35 | $16 to $59 | Low |
| Ped Trach Tapershape Cuff 5.0mm Id 7.3mm Od 5.0pcf 1ea | other | $35 | $16 to $59 | Low |
| Ped Trach Tapershape Cuff 5.5mm Id 7.9mm Od 5.5pcf 1ea | other | $35 | $16 to $59 | Low |
| Shiley Pediatric Tracheostomy Tubes with Taperguard Cuff 3.5pcf | other | $35 | $16 to $59 | Low |
| Shiley Pediatric Tracheostomy Tubes with Taperguard Cuff 4.0pcf | other | $35 | $16 to $59 | Low |
| Tube Trach Pediatric 4.5 Cuff Medtronic #4.5pcf | other | $35 | $16 to $59 | Low |
| Kcl 40 Meq/l-d5w-0.9% Nacl | other | $35 | $16 to $59 | Low |
| Potassium Cl 20 Meq-0.45% Nacl | other | $35 | $16 to $59 | Low |
| Cannula Tandem Xl Triple Lumen ERCP M00535700 | other | $35 | $16 to $59 | Low |
| Cannula Eopa Arterial 22fr 77622 10ea/1pk | other | $35 | $16 to $59 | Low |
| Loop Cutting 24fr #m0068802611 | other | $35 | $16 to $59 | Low |
| Repair Prosthetic Device, Labor Component, Per 15 Minutes | surgery | $36 | $16 to $60 | Low |
| Gabapentin 250 Mg/5 Ml Soln | other | $36 | $16 to $60 | Low |
| 10.0mm Shiley Flex Cuffless Reus Trach 10un10r | other | $36 | $16 to $60 | Low |
| Orthopedic Footwear, Ladies Shoe, Depth Inlay, Each | other | $36 | $16 to $60 | Low |
| Trach 4cfs 6.5mm Adt Flex Trach Cuffless 4un65r | other | $36 | $16 to $60 | Low |
| Trach Tube 6cfs #6un75r | other | $36 | $16 to $60 | Low |
| Trach Tube 8cfs #8un85r | other | $36 | $16 to $60 | Low |
| Verapamil 10 Mg/4 Ml Vial | other | $36 | $16 to $60 | Low |
| Viscoat #8065-18 | other | $36 | $16 to $60 | Low |
| Shiley Xlt Extended -length Tracheostomy Tube Distal Extension Size 6 Uncuffe... | other | $36 | $16 to $60 | Low |
| Trach Cuff Xlt 7.0mm #70xltcp | other | $36 | $16 to $60 | Low |
| Tracheostomy Tube Shiley Uncuffed Id 8.0mm 105mm #80xltud | other | $36 | $16 to $60 | Low |
| Tracheostomy Tube Shiley Uncuffed Size 6 Id 6mm 95mm 60xltup | other | $36 | $16 to $60 | Low |
| Tube Trach Cuff 6.0mm Xlt Prox | other | $36 | $16 to $60 | Low |
| Tube Trach Xlt 6.0 Distal Ext Cuffed | other | $36 | $16 to $60 | Low |
| Tube Trach Xlt 7.0 Distal Ext Cuffed | other | $36 | $16 to $60 | Low |
| Tube Trach Xlt 7.0 Uncuffed Proximal #70xltup | other | $36 | $16 to $60 | Low |
| Tube Trach Xlt 8.0 Distal Ext Cuffed | other | $36 | $16 to $60 | Low |
| Tube Trach Xlt 8.0 Proximal Ext Cuffed | other | $36 | $16 to $60 | Low |
| Tube Trach Xlt 8.0 Uncuff Proximal #80xltup | other | $36 | $16 to $60 | Low |
| 20fr Standard Peg Kit Push Box of 2 #m00568211 | other | $36 | $16 to $60 | Low |
| 24fr Standard Peg Kit Pull with Enfit M00509061 | other | $36 | $16 to $60 | Low |
| Aveta Waste Management Accessory 3.0 #205-2036 6ea/ct | other | $36 | $16 to $60 | Low |
| Breast Prosthesis, Mastectomy Bra, without Integrated Breast Prosthesis Form,... | other | $36 | $16 to $60 | Low |
| Cast Supplies, Long Leg Cast, Pediatric (0-10 Years), Fiberglass | other | $36 | $16 to $120 | Low |
| Gastrostomy 24fr Peg Kit/gastrodome #6824 | other | $36 | $16 to $60 | Low |
| Lap Gas Conditioning Device Vessel Guardian | other | $36 | $16 to $60 | Low |
| Passport 12 X 3 #ar-6592-12 | other | $36 | $16 to $60 | Low |
| Pessary, Reusable, Rubber, Any Type | other | $36 | $16 to $60 | Low |
| Trimming of Dystrophic Nails, Any Number | other | $36 | $7 to $120 | Low |
| Visit Complexity Inherent to Evaluation and Management Associated with Medica... | other | $36 | $14 to $120 | Low |
| Vecuronium 10 Mg Vial | other | $36 | $16 to $61 | Low |
| Vecuronium Bromide 10 Mg IV Solr | other | $36 | $16 to $61 | Low |
| Catheter Endo 5.5fr Ercp-1-cramer #g21765 | cardiac | $37 | $16 to $61 | Low |
| Metatarsal Bar Wedge, Rocker | other | $37 | $16 to $61 | Low |
| Tube Endobronchial 37fr Right #116200370 | other | $37 | $16 to $61 | Low |
| Purstring 65 Instrument Medtronic #020242 Case/3ea | other | $37 | $16 to $61 | Low |
| Splint Nasal Denver Aluminum Sm/md #10-1500-05ks | other | $37 | $16 to $62 | Low |
| Temno Evolution Biopsy Needle Ctt2011 | lab | $37 | $16 to $62 | Low |
| Temno Evolution Biopsy Needles Ctt2015 | lab | $37 | $16 to $62 | Low |
| Catheter, Guiding | cardiac | $37 | $16 to $62 | Low |
| Dermagraft, Per Square Centimeter | other | $37 | $16 to $124 | Low |
| Hc Regional Anesthesia Time - Each Incremental 15 Minutes | other | $37 | $16 to $62 | Low |
| Safeguard 24cm #82000 10ea/1bx | other | $37 | $16 to $62 | Low |
| Addition to Lower Extremity, Below Knee, Fork Strap | other | $38 | $17 to $63 | Low |
| Cns Monitor Icp Drain Bag 1ea | other | $38 | $17 to $63 | Low |
| Catheter Jet Ventilation Adult 30-02-013 | cardiac | $38 | $17 to $63 | Low |
| Catheter Jet Ventilation Child 30-02-014 | cardiac | $38 | $17 to $63 | Low |
| Catheter Jet Ventilation Infant 30-02-018 | cardiac | $38 | $17 to $63 | Low |
| Starchmark Ultracore Marker Ss 14g #stmk14gss | other | $38 | $17 to $63 | Low |
| Ultra Clip Dual Trigger Marker #862017d | other | $38 | $17 to $63 | Low |
| Ultra Clip Dual Trigger Marker Ribb #863017d | other | $38 | $17 to $63 | Low |
| Ultraclip Dual Trigger Marker 108 Coil | other | $38 | $17 to $63 | Low |
| Ultraclip Dual Trigger Marker 108 Venus | other | $38 | $17 to $63 | Low |
| Ultraclip Dual Trigger Marker Titanium Heart | cardiac | $38 | $17 to $63 | Low |
| Injection, Testosterone Cypionate, 1 Mg | other | $38 | $17 to $63 | Low |
| Aprepitant, Oral, 5 Mg | other | $38 | $17 to $63 | Low |
| Pump Cold Therapy Polar Care Cube | other | $38 | $17 to $64 | Low |
| Smark Atec-2s-13 | other | $38 | $17 to $64 | Low |
| Catheter Ph Internal 10cm Disp Dual Versaflex | cardiac | $38 | $17 to $64 | Low |
| Restraint Vest Xxlrg #m227b-xl | other | $38 | $17 to $64 | Low |
| Splint Ortho-glass 4"x15' 2rl/cs #og-4l2 | other | $38 | $17 to $64 | Low |
| Vascular Sheath Blue #9009 | other | $39 | $17 to $64 | Low |
| Miami Slim Lumbar 2xl #lmbsl | other | $39 | $17 to $65 | Low |
| Injection, Pyridoxine Hcl, 100 Mg | other | $39 | $17 to $65 | Low |
| Potassium Alum Powder | other | $39 | $17 to $65 | Low |
| Crown Fistula Wound 00860013000301 | other | $39 | $17 to $65 | Low |
| Balloon Armada 35 Wh 12x80x135cm #b2120 | other | $39 | $17 to $65 | Low |
| Bellaire Comfort Lso Universal Fits Waist Circumference: 25-60inch (64-152cm)... | other | $39 | $17 to $65 | Low |
| Wound Retractor/protector Medium | other | $39 | $17 to $65 | Low |
| Wound Retractor/protector Small 5 Ea/bx #c8401 | other | $39 | $17 to $65 | Low |
| Trimark Eviva 2s | other | $39 | $17 to $65 | Low |
| Trimark Td 1309 | other | $39 | $17 to $65 | Low |
| Infusion Supplies for External Drug Infusion Pump, Per Cassette OR Bag | surgery | $39 | $17 to $131 | Low |
| Surgicel 1/2 X 2 #1955s 12ea/cs | other | $39 | $17 to $65 | Low |
| Electrode-bugbee Fulgurating 5frx58cm #be | other | $39 | $17 to $65 | Low |
| Valved Entry System 23ga 4mm #8065751585 | other | $39 | $17 to $65 | Low |
| Miami Slim Lumbar 6xl #lmbsl | other | $39 | $17 to $66 | Low |
| Tcc-ez Regular Boot Tcc21100 1 Each | other | $39 | $17 to $66 | Low |
| Dermatac Drape W/granufoam Dressing Lg 10pk | other | $39 | $18 to $66 | Low |
| Injection, Phenylephrine Hydrochloride, 20 Micrograms | other | $40 | $18 to $66 | Low |
| Amox-clav 600-42.9 Mg/5 Ml Sus | other | $40 | $18 to $66 | Low |
| Amoxicillin-pot Clavulanate 600-42.9 Mg/5ml Po Susr | other | $40 | $18 to $66 | Low |
| Cast Supplies, Long Arm Cast, Pediatric (0-10 Years), Plaster | other | $40 | $8 to $132 | Low |
| Rom Elbow Orthosis Right #w | other | $40 | $18 to $66 | Low |
| 10.0mm Shiley Flex Cuffed Reus Trach 10cn10r | other | $40 | $18 to $66 | Low |
| 6.5mm Shiley Flex Cuffed Reus Trach 4cn65r | other | $40 | $18 to $66 | Low |
| 8.5mm S Shiley Flex Cuffed Reus Trach 8cn85r | other | $40 | $18 to $66 | Low |
| Trach Tube Shiley Cuffed 7mm Id 10.1mm Od 68mm Reusable 5cn70r 1ea | other | $40 | $18 to $66 | Low |
| Packing Silverstein #14 | other | $40 | $18 to $66 | Low |
| Fogarty Insert Safe Jaw 33mm Safehy33 | other | $40 | $18 to $67 | Low |
| Tray Snarecoil Bone Marrow 11x4 W/rbn-114 Needle No Aspiration Needle Include... | other | $40 | $18 to $67 | Low |
| Vascular Sheath Large Orange #9009 | other | $40 | $18 to $67 | Low |
| Cement Mixer Smart Mix Mini #5401-39 | other | $40 | $18 to $67 | Low |
| Marker Biopsy Site Stainless Steel Stoplight Shape for Securmark MRI #smark-m... | imaging | $40 | $18 to $67 | Low |
| Marker Breast Biopsy Clip 9 Gauge Stainless Steel Securmark Atec #smark-m-ss2... | lab | $40 | $18 to $67 | Low |
| Marker Breast Biopsy Clip Stainless Steel Securmark Atec #smark-m-ss1 10ea/box | lab | $40 | $18 to $67 | Low |
| Cold Therapy Unit Donjoy Iceman Clear 11 | other | $40 | $18 to $67 | Low |
| Injection, Lidocaine Hcl in 5% Dextrose, 1 Mg | other | $40 | $18 to $67 | Low |
| Kcl 10 Meq/l-d5w-0.45% Nacl | other | $40 | $18 to $67 | Low |
| Kcl 20 Meq/l-d5w-0.9% Nacl | other | $40 | $18 to $67 | Low |
| Kcl 40 Meq/l-d5w-0.45% Nacl | other | $40 | $18 to $67 | Low |
| Loop Cutting 24fr .012 #g46209 | other | $41 | $18 to $68 | Low |
| Compass Lumbar Puncture #clph2o001-5 5ea/case | other | $41 | $18 to $68 | Low |
| Aztreonam 2 Gm/ Ns 50 Ml Mini Bag Plus - Compounded | other | $41 | $18 to $68 | Low |
| Cefdinir 250 Mg/5 Ml Susp | other | $41 | $18 to $68 | Low |
| Cefdinir 250 Mg/5ml Po Susr | other | $41 | $18 to $68 | Low |
| 14fr Entuit Gastrostomy Tube #g35615 | other | $41 | $18 to $68 | Low |
| Entuit Gastrostomy Tube | other | $41 | $18 to $68 | Low |
| Gastrostomy/jejunostomy Tube, Low-profile, Any Material, Any Type, Each | other | $41 | $18 to $68 | Low |
| Physician OR Allowed Practitioner Re-certification for Medicare-covered Home ... | other | $41 | $18 to $136 | Low |
| Rom Elbow Orthosis Left #w | other | $41 | $18 to $68 | Low |
| Cystotome Kelman Sharp 22g #e01412s | other | $41 | $18 to $68 | Low |
| Auto Effluent Set #115370 Ca/ 8ea | other | $41 | $18 to $69 | Low |
| Vascular Sheath Sm Green | other | $41 | $18 to $69 | Low |
| 7.5mm Shiley Flex Cuffed Reus Trach 6cn75r | other | $41 | $18 to $69 | Low |
| Cefpodoxime Proxetil 100 Mg/5ml Po Susr | other | $41 | $18 to $69 | Low |
| Pap Smear | preventive | $41 | $15 to $218 | High |
| For Diabetics Only, Multiple Density Insert, Custom Molded From Model of Pati... | other | $42 | $18 to $69 | Low |
| Injection, Methylprednisolone Acetate, 1 Mg | other | $42 | $18 to $69 | Low |
| Soft-flow Angled Tip Arterial Cannula with Suture Bulb 21fr X 14" ( 7.0mm ) 5761 | other | $42 | $18 to $69 | Low |
| Tray Paracentesis Quick Tap 15x3-1/4 4ea/1cs | other | $42 | $19 to $70 | Low |
| Tumark Pro X for Brevara Std Tumark-brev-s-x | other | $42 | $19 to $70 | Low |
| Tumark Profess Q for Eviva Std Tumark-e13-s-q | other | $42 | $19 to $70 | Low |
| Tumark Professional Q Shape 10cm 351220 Bx/10ea | other | $42 | $19 to $70 | Low |
| Tumark Professional X Shape 10cm 351210 Bx/10ea | other | $42 | $19 to $70 | Low |
| Tumark Vq for Brevera Standard 127.5mm 18g Tumark-brev-s-q-02 10/bx | other | $42 | $19 to $70 | Low |
| Endoclip Ii Ml 10mm #176657 | other | $42 | $19 to $70 | Low |
| Eric Arch Bar/6" Per Chrge | other | $42 | $19 to $70 | Low |
| Exofin Fusion Skin Closure 22cm #ef70401 | surgery | $42 | $19 to $70 | Low |
| Manta 14f Depth Locator 5 Ea/bx 114f | other | $42 | $19 to $70 | Low |
| Shoulder Orthosis, Figure of Eight Design Abduction Restrainer, Prefabricated... | other | $42 | $19 to $140 | Low |
| Stylet for Peritoneal Cath #sst | other | $42 | $19 to $70 | Low |
| Wrist Hand Orthosis, Wrist Extension Control Cock-up, Non Molded, Prefabricat... | other | $42 | $19 to $140 | Low |
| 4fr Pedal Access Set Micropuncture Transitionless #g02972 | other | $42 | $19 to $70 | Low |
| 5fr Pedal Access Set Micropuncture Transitionless #g02988 | other | $42 | $19 to $70 | Low |
| Bivona Uncuffed Tracheostomy Tube Flextend Size 8.0 Pediatric #60pfs55 | other | $42 | $19 to $70 | Low |
| Tretinoin 0.025 % Ex Gel | other | $42 | $19 to $71 | Low |
| Swan Ganz Catheter #131f7p 5/cs | cardiac | $43 | $19 to $71 | Low |
| Duovisc Viscoelastic System | other | $43 | $19 to $71 | Low |
| Hydromorphone 6 Mg/30 Ml-ns | other | $43 | $19 to $71 | Low |
| Injection, Procainamide Hcl, Up to 1 Gm | other | $43 | $19 to $295 | Low |
| Sodium Chloride 120 Meq/30 Ml | other | $43 | $19 to $71 | Low |
| Fluorometholone 0.1% Eye Drop | other | $43 | $19 to $71 | Low |
| Foot, Molded Shoe Plastazote (or Similar) Custom Fitted, Each | other | $43 | $19 to $72 | Low |
| Orthopedic Footwear, Custom Shoe, Depth Inlay, Each | other | $43 | $19 to $72 | Low |
| Orthopedic Footwear, Mens Shoe, Depth Inlay, Each | other | $43 | $19 to $72 | Low |
| Vascular Occluder 30mm 1.50 5ea/bx | other | $43 | $19 to $72 | Low |
| Vascular Occluders 1.25mm | other | $43 | $19 to $72 | Low |
| Drill Flexible 25mm 71362925 S&n | other | $43 | $19 to $72 | Low |
| Retrograde Cardioplegia Cannula Self Inflating Balloon 18mm and Sure Touch Ha... | other | $43 | $19 to $72 | Low |
| Barron Vacuum Punch 9.0mm | other | $43 | $19 to $72 | Low |
| Healon Gv Pro 0.85ml 10340014 | other | $43 | $19 to $72 | Low |
| Elite Irrigation Sleeve 7cm #5407-010 | other | $43 | $19 to $72 | Low |
| Obgyn Vacuum Palm Delivery Pump Mini Vac-6000m 5ea/1bx | obstetric | $44 | $19 to $73 | Low |
| Obgyn Vacuum Palm Delivery Small Pump Vac-6000s 5ea/1bx | obstetric | $44 | $19 to $73 | Low |
| Tip Wet-field Bipolar Hemostatic Eraser 25g | other | $44 | $20 to $73 | Low |
| Speed Pins 3.2x110 #74013401 3ea/bx | other | $44 | $20 to $74 | Low |
| Valve Speaking Passy-muir Trach #pmv | other | $44 | $20 to $74 | Low |
| Anesthesia for Electroshock Therapy | other | $44 | $16 to $148 | Low |
| Vascular Occluders 1.75mm | other | $44 | $20 to $74 | Low |
| Vessel Occluder Coronary 12mm 2.50 | cardiac | $44 | $20 to $74 | Low |
| Vessel Occluders 1.50mm | other | $44 | $20 to $74 | Low |
| Vessel Occuluder 2.0mm #50200 | other | $44 | $20 to $74 | Low |
| Blake Drain 19fr R/f #2230 Case/10ea | other | $44 | $20 to $74 | Low |
| Bowl and Spatula Bone Cement Mixing Universal System Vacuum Rotor without Noz... | other | $44 | $20 to $74 | Low |
| Shunt Javid Carotid 10frx27cm #007714 | other | $44 | $20 to $74 | Low |
| Injection, Labetalol Hydrochloride, 5 Mg | other | $44 | $20 to $74 | Low |
| Lap Sac Tissue Pouch 4" X 6" #g16495 | other | $45 | $20 to $74 | Low |
| Lap Sac Tissue Pouch 8" X 10" #g16497 | other | $45 | $20 to $74 | Low |
| Electrode Pacing Bipolar 4fr 5ea/1bx | other | $45 | $20 to $74 | Low |
| Electrode Pacing Bipolar 5fr 5ea/1bx | other | $45 | $20 to $74 | Low |
| Electrode Pacing Bipolar 6fr - 5ea/1bx | other | $45 | $20 to $74 | Low |
| Injection, Nafcillin Sodium, 20 Mg | other | $45 | $20 to $75 | Low |
| Outflare Wedge | other | $45 | $20 to $75 | Low |
| Relpax 20 Mg Tablet | other | $45 | $20 to $75 | Low |
| Relpax 40 Mg Tablet | other | $45 | $20 to $75 | Low |
| Bone Hemostasis 2.5gm #bw012 Ostene | other | $45 | $20 to $75 | Low |
| Ketamine 500 Mg/5 Ml Vial | other | $45 | $20 to $75 | Low |
| Abdominal Ultrasound | imaging | $45 | $17 to $161 | High |
| Aerotech I Aerosol Unit Ca-1124 | other | $45 | $20 to $75 | Low |
| Inserter Tip for Tibial Tray #00584305201 | other | $45 | $20 to $75 | Low |
| Insertion Needle 6" #acck1015 | other | $45 | $20 to $75 | Low |
| Interrogation Device Evaluation(s), (remote) Up to 30 Days; Implantable Cardi... | surgery | $45 | $20 to $150 | Low |
| Needle Epimed 4" #epmd1040 | other | $45 | $20 to $75 | Low |
| Omo Neurexa Plus Left Small 5065n=l-s | other | $45 | $20 to $75 | Low |
| Omo Neurexa Plus Right Small 5065n=r-s | other | $45 | $20 to $75 | Low |
| Omo Neurexa Plus Right Xlarge 5065n=r-xl | other | $45 | $20 to $75 | Low |
| Optetrak (4) Holding Pins Mni Head Sharp Point Mini Length Diameter 3.2mm #20... | other | $45 | $20 to $75 | Low |
| Optetrak (4) Short Head Pins 1.125in (28.575mm) Diameter 3.175mm Item # 201-78 | other | $45 | $20 to $75 | Low |
| Optetrak Quick Release Pins with Collar 40mm #201-78 | other | $45 | $20 to $75 | Low |
| Orthopedic Shoe, Oxford with Supinator OR Pronator, Infant | other | $45 | $20 to $150 | Low |
| Pin Fixation 2.3in Threaded Collared #521-78 | other | $45 | $20 to $75 | Low |
| Screening Papanicolaou Smear; Obtaining, Preparing and Conveyance of Cervical... | preventive | $45 | $15 to $150 | Low |
| Sensa Ii Ipg Template #acck7200 | other | $45 | $20 to $75 | Low |
| Torque Wrench Kit #acck6006 | other | $45 | $20 to $75 | Low |
| Hook Blunt 5mm #3316-8g 8ea/pk | other | $45 | $20 to $75 | Low |
| Retractor Ring Plastic Single Use #3304-g | other | $45 | $20 to $75 | Low |
| Marker Breast MRI Compatible Senomark#smuc13c | imaging | $45 | $20 to $76 | Low |
| Potassium Cl 40 Meq/1,000ml-ns | other | $45 | $20 to $76 | Low |
| Brace Knee Post Op Warrior Kb9000 | other | $45 | $20 to $76 | Low |
| Tube Inner Ear Myringotomy Ventilation Reuter Bobbin without Flange Holes 1 M... | other | $45 | $20 to $76 | Low |
| Drill for Bi-cortical Post #ar-1365d | other | $46 | $20 to $76 | Low |
| Post Op Knee Brace Regular #423100 | other | $46 | $20 to $76 | Low |
| Vessel Occluder 1.75mm #50175 | other | $46 | $20 to $76 | Low |
| Orthopedic Shoe Addition, Sole, Full | other | $46 | $20 to $76 | Low |
| Methacholine Chloride Administered As Inhalation Solution Through a Nebulizer... | other | $46 | $20 to $77 | Low |
| Provocholine (methacholine) Dilutions (vials a -e) - Compounded | other | $46 | $20 to $77 | Low |
| Midline Indicator Pdl | other | $46 | $20 to $77 | Low |
| Globo Ped Mobil Gr Lg #36628000030000eu | other | $46 | $20 to $77 | Low |
| Globo Ped Mobil Gr Shoe Med 36628000020000 | other | $46 | $20 to $77 | Low |
| Cath Airway Exchange Cook 14fr Dbl #g57628 | other | $46 | $20 to $77 | Low |
| Mupirocin Calcium 2 % Ex Crea | other | $46 | $20 to $77 | Low |
| Transfer Set 6" Mini Cap 6ea/cs | other | $46 | $20 to $77 | Low |
| Addition to Lower Extremity, Limited Ankle Motion, Each Joint | other | $46 | $20 to $77 | Low |
| C-reamer 9mm #8772a 4/bx | other | $46 | $21 to $77 | Low |
| Gelfoam Powder | other | $46 | $21 to $77 | Low |
| Lap Sac Tissue Pouch 5" X 8" #g16496 | other | $47 | $21 to $78 | Low |
| 45 Degree Kelman Mini-flare Tip | other | $47 | $21 to $78 | Low |
| Marker Breast Stereotactic Senomark #smev9c | other | $47 | $21 to $78 | Low |
| Tcc-ez Large Boot Tcc21114 1 Each | other | $47 | $21 to $78 | Low |
| Omo Neurexa Plus Left Xlarge 5065n=l-xl | other | $47 | $21 to $78 | Low |
| Lift, Elevation, Heel, Tapered to Metatarsals, Per Inch | other | $47 | $21 to $78 | Low |
| Acclarent Balloon Inflation Device 5 Ea/bxdib30 | other | $47 | $21 to $78 | Low |
| Inflation Device Acclarent Se #seid Order By Bx/5ea | other | $47 | $21 to $78 | Low |
| Funnel Fistula 00860013000325 | other | $47 | $21 to $78 | Low |
| Xomed Nasal Postpac #15-26800 5/pk | other | $47 | $21 to $78 | Low |
| Uterine Manipulator Dx Vcare | other | $47 | $21 to $79 | Low |
| Flumazenil 0.5 Mg/5ml IV Soln | other | $47 | $21 to $79 | Low |
| Brace Rcai Contour Fit Lso Med 451-cf-lso-m | other | $47 | $21 to $79 | Low |
| Brace Rcai Control Fit Lso Large 451-cf-lso-l | other | $47 | $21 to $79 | Low |
| Water for Injection Vial | other | $47 | $21 to $79 | Low |
| Bio-medicus Venous Insertion Kit 5 Ea/pk 96551 | other | $48 | $21 to $79 | Low |
| Addition to Lower Extremity, Below Knee, Waist Belt, Webbing | other | $48 | $21 to $79 | Low |
| Interstim Therapy Antenna #3709 | other | $48 | $21 to $80 | Low |
| Injection, Vancomycin Hcl, 500 Mg | other | $48 | $21 to $80 | Low |
| Tranexamic 1,000 Mg/100ml-nacl | other | $48 | $21 to $80 | Low |
| Ephedrine Sulfate (pressors) 5 Mg/ml IV Soln | other | $48 | $21 to $80 | Low |
| Anesthesia for Access to Central Vein | other | $48 | $2 to $532 | Low |
| Cath Cholangiogram #lap-13 6each/1box | other | $48 | $21 to $80 | Low |
| Drill 3.0mm Step #ar-1250lt | other | $48 | $21 to $80 | Low |
| Tissue Orientation Correct Clip #lcc6 | other | $48 | $21 to $80 | Low |
| Cyclogyl 0.5% Eye Drops | other | $48 | $21 to $81 | Low |
| Viagra 100 Mg Tablet | other | $48 | $21 to $81 | Low |
| Viagra 50 Mg Tablet | other | $48 | $21 to $81 | Low |
| Shunt Coronary Coil 1.5mm X 18mm Cts Flo | cardiac | $48 | $21 to $81 | Low |
| Shunt Coronary Coil 2.5mm X 18mm #ft | cardiac | $48 | $21 to $81 | Low |
| Small Parts Kit 23g Cannl&plugset #8065752149 | other | $49 | $22 to $81 | Low |
| Tube Trach Hyperflex Sz 7 Cuffed #67fhxl70 | other | $49 | $22 to $81 | Low |
| Wellbutrin Xl 300 Mg Tablet | other | $49 | $22 to $81 | Low |
| Cath 7fr Navilflex Rx Delivery Sys M00533560 | obstetric | $49 | $22 to $82 | Low |
| Delivery System Rx 10fr Biliary M00533580 | obstetric | $49 | $22 to $82 | Low |
| Delivery System Rx 7fr Biliary M00533560 | obstetric | $49 | $22 to $82 | Low |
| Tcc-ez Extra Large Boot Tcc21124 1 Each | other | $49 | $22 to $82 | Low |
| Full Sole and Heel Wedge, Between Sole | other | $49 | $22 to $82 | Low |
| Cath Fogarty Biliary 5fr 23cm 410235fp 5ea/case | other | $50 | $22 to $83 | Low |
| Cath Fogarty Biliary 6fr 23cm 410236fp 5ea/case | other | $50 | $22 to $83 | Low |
| External Breast Prosthesis Garment, with Mastectomy Form, Post Mastectomy | other | $50 | $22 to $83 | Low |
| 4.2mm Trocar 210mm 03.010.070 | other | $50 | $22 to $83 | Low |
| Strip Fistula Isolator 00860013000318 | other | $50 | $22 to $83 | Low |
| Eleview Submucosal Injectable Composition 10ml Ampoule 5ea/bx #9000020 | other | $50 | $22 to $84 | Low |
| Addition to Lower Extremity, Extended Steel Shank | other | $50 | $22 to $84 | Low |
| Needle Transbronchial 19ga Aspiration W/syr | other | $50 | $22 to $84 | Low |
| Needle Transbronchial 20ga Aspiration W/syr | other | $50 | $22 to $84 | Low |
| Needle Transbronchial 21ga Aspiration W/syr | other | $50 | $22 to $84 | Low |
| Fresh Frozen Plasma (single Donor), Frozen Within 8 Hours of Collection, Each... | other | $50 | $22 to $86 | Low |
| Endopath Electrosurgery Probe Plus Ii 5mm Hook 34cm Length Eps01 | surgery | $51 | $22 to $84 | Low |
| Endopath Electrosurgery Probe Plus Ii 5mm Hook 29cm Length Eps05 | surgery | $51 | $22 to $84 | Low |
| Shunt Coronary Coil 2.0mm X 18mm Cts Flo | cardiac | $51 | $23 to $85 | Low |
| Barron Vacuum Punch 7.5mm | other | $51 | $23 to $85 | Low |
| Barron Vacuum Punch 8.0mm | other | $51 | $23 to $85 | Low |
| Counseling Visit to Discuss Need for Lung Cancer Screening Using Low Dose CT ... | preventive | $51 | $22 to $170 | Low |
| Endoscopic Clip Applier 5mm M/l Port Universal Epix #ca500 3ea/box | other | $51 | $23 to $85 | Low |
| Punch Barron Donor 7.75 K20 | other | $51 | $23 to $85 | Low |
| Rd Rainbow Set 2 Adult Adhesive Sensor 4026 Box/10ea | other | $51 | $23 to $85 | Low |
| Rd Rainbow Set 2 Neo Adhesive Sensor 4029 Box/10ea | other | $51 | $23 to $85 | Low |
| Sensor Large Foresight Elite #fsesl Bx/20 | other | $51 | $23 to $85 | Low |
| Stylet Faller for Pd Cath #fs | other | $51 | $23 to $85 | Low |
| Tube Fastrach Combo Sz 3 #135130 5ea/1case | other | $51 | $23 to $85 | Low |
| Tube Fastrach Combo Sz 4 | other | $51 | $23 to $85 | Low |
| Tube Fastrach Combo Sz 5 | other | $51 | $23 to $85 | Low |
| Brush Biopsy Deflection 3.2frx115cm #g15045 | lab | $51 | $23 to $85 | Low |
| Injection, Aminocaproic Acid, 1 Gram | other | $51 | $23 to $85 | Low |
| Reaming Rod 3.0 W/offset Ball Tip 950mm Nonst | other | $51 | $23 to $85 | Low |
| Reaming Rod 3.0mm X 950mm #351.76 | other | $51 | $23 to $85 | Low |
| Injection, Aminophyllin, Up to 250 Mg | other | $51 | $23 to $85 | Low |
| Centurion 45 Fms Cassette Only | other | $51 | $23 to $85 | Low |
| Cook Chest Drain Valve #g36370 | other | $51 | $23 to $86 | Low |
| Fogarty Insert Dbl Hydrajaw 33mm | other | $52 | $23 to $86 | Low |
| Closure Surgical Skin 16cm Zip16 Ps1160 10/pk | surgery | $52 | $23 to $86 | Low |
| Gradient Compression Glove, Each | other | $52 | $23 to $86 | Low |
| Retractor Ring Lone Star Disposable 3307g | other | $52 | $23 to $86 | Low |
| Grasping Forceps Rescue Combo #m00538351 | other | $52 | $23 to $86 | Low |
| Retrieval Net 30mm Rescue Net #dgn-538 | other | $52 | $23 to $86 | Low |
| Sodium Bicarbonate 8.4 % IV Soln | other | $52 | $23 to $87 | Low |
| Globo Ped Mobil Gr Small #36628000010000eu | other | $52 | $23 to $87 | Low |
| Globo Ped Mobil Gr X-large #36628000040000 | other | $52 | $23 to $87 | Low |
| Micro Nester .018 3mm X 14cm | other | $52 | $23 to $87 | Low |
| Micro Nester .018 4mm X 14cm | other | $52 | $23 to $87 | Low |
| Micro Nester .018 6mm X 14cn | other | $52 | $23 to $87 | Low |
| Micro Nester .018 8mm X 7cm | other | $52 | $23 to $87 | Low |
| Nester .035 16mm X 14cm | other | $52 | $23 to $87 | Low |
| Nester .035 20mm X 14cm | other | $52 | $23 to $87 | Low |
| Nester .035 3mm X 7cm | other | $52 | $23 to $87 | Low |
| Nester .035 4mm X 14cm | other | $52 | $23 to $87 | Low |
| Nester .035 6mm X 14cm | other | $52 | $23 to $87 | Low |
| Injection, Mesna, 200 Mg | other | $52 | $2 to $87 | Low |
| Addition to Lower Extremity, Varus/valgus Correction ('t') Strap, Padded/line... | other | $52 | $23 to $87 | Low |
| Tcc-ez Transmet Boot Tcc21131 1 Each | other | $52 | $23 to $87 | Low |
| Electrode Hf Needle 45deg 24-28fr #a22255c | other | $52 | $23 to $87 | Low |
| Electrode Monopolar Roller Ball24-28f A22251c | other | $52 | $23 to $87 | Low |
| Single Sensor W/lumen 7fr Catheter | cardiac | $52 | $23 to $87 | Low |
| Cannula Grundy Retrograde 15fr #94115t | other | $52 | $23 to $87 | Low |
| Cannula Perfusion Retrograde 15 Fr 32 Cm Length Stopcock Wirewound Body #9462... | surgery | $52 | $23 to $87 | Low |
| Levemir 100 Unit/ml Vial | other | $52 | $23 to $87 | Low |
| Brace Knee T-scope Post Op #08814 | other | $52 | $23 to $87 | Low |
| Neomycin-polymyxin-hc Ear Susp | other | $52 | $23 to $87 | Low |
| Uterine Manipulator Lrge Vcare | other | $52 | $23 to $87 | Low |
| Uterine Manipulator Medium Vcare | other | $52 | $23 to $87 | Low |
| Uterine Manipulator Small Vcare | other | $52 | $23 to $87 | Low |
| Cement Mixer Sys Acm Stryker(used for Hip Rar | other | $52 | $23 to $87 | Low |
| Electrode Monopolar Loop A22205c | other | $53 | $23 to $88 | Low |
| Alcohol And/or Substance (other Than Tobacco) Misuse Structured Assessment (e... | other | $53 | $23 to $176 | Low |
| Barron Vacuum Punch 8.25mm | other | $53 | $23 to $88 | Low |
| Catheter Dilation Soehendra Biliary G21571 | cardiac | $53 | $23 to $88 | Low |
| Punch Cornea 8.5mm Barron Vacuum | other | $53 | $23 to $88 | Low |
| Pigazzi Pad Pink Xl #40583 4ea/1cs | other | $53 | $23 to $88 | Low |
| Snare System Lariat 30mm10mm6mm Port 2.5mm | other | $53 | $24 to $89 | Low |
| Injection, Irinotecan, 20 Mg | other | $53 | $2 to $89 | Low |
| Pessary, Reusable, Non Rubber, Any Type | other | $53 | $24 to $178 | Low |
| Physician OR Allowed Practitioner Certification for Medicare-covered Home Hea... | other | $53 | $24 to $178 | Low |
| Sulfacetamide 10% Eye Drops | other | $53 | $24 to $89 | Low |
| Sulfacetamide Sodium 10 % Op Soln | other | $53 | $24 to $89 | Low |
| Tcc-ez Large Charcot Boot Tcc21116 1 Each | other | $54 | $24 to $90 | Low |
| Endovive Soft Peg Pull 20f 2/bx M00509001 | other | $54 | $24 to $90 | Low |
| Gastrostomy Safety Peg 24fr Kit Pull | other | $54 | $24 to $90 | Low |
| Gastrostomy Safety Peg Set 20fr W/xylocaine | other | $54 | $24 to $90 | Low |
| Olumiant 1 Mg Tablet | other | $54 | $24 to $90 | Low |
| Bra Cardiac Surgery Sz-40b-52dd 1ea | surgery | $54 | $24 to $90 | Low |
| Cath Cholangiogram Aerostat Rigid Tip #c1002 | other | $54 | $24 to $90 | Low |
| Prolonged Office OR Other Outpatient Evaluation and Management Service(s) Bey... | other | $54 | $24 to $180 | Low |
| Retractor Alexis O Lg C-section 9-14cm #g6313 | obstetric | $54 | $24 to $90 | Low |
| Wound Retractor/protector Large #c8403 | other | $54 | $24 to $90 | Low |
| 9986-21-20 Flexible Osteotome Short 8 Mm | other | $54 | $24 to $90 | Low |
| 9986-21-21 Flexible Osteotome Short 10 Mm | other | $54 | $24 to $90 | Low |
| 9986-21-22 Flexible Osteotome Short 12 Mm | other | $54 | $24 to $90 | Low |
| 9986-21-24 Flexible Osteotome Short Curved | other | $54 | $24 to $90 | Low |
| 9986-21-26 Flexible Osteotome Long 10 Mm | other | $54 | $24 to $90 | Low |
| 9986-21-27 Flexible Osteotome Long 8 Mm | other | $54 | $24 to $90 | Low |
| Injection, Morphine Sulfate (fresenius Kabi), Not Therapeutically Equivalent ... | other | $54 | $24 to $90 | Low |
| Zomig 5 Mg Nasal Spray | other | $54 | $24 to $90 | Low |
| Omo Neurexa Plus Left Medium 5065n=l-m | other | $54 | $24 to $90 | Low |
| Addition to Lower Extremity, Below Knee, Cuff Suspension | other | $54 | $24 to $91 | Low |
| Humeral Splint Ext Length Medium 37-2162 | other | $55 | $24 to $91 | Low |
| Humeral Splint Ext. Length Lg | other | $55 | $24 to $91 | Low |
| Humeral Splint Ext. Length Xlg | other | $55 | $24 to $91 | Low |
| Humeral Splint Mid Length Lg | other | $55 | $24 to $91 | Low |
| Humeral Splint Mid Length Med. | other | $55 | $24 to $91 | Low |
| Humeral Splint Mid Length Small | other | $55 | $24 to $91 | Low |
| Rally Vacuum Mixing Bowl7127 | other | $55 | $24 to $92 | Low |
| Bard Single Lumen Picc 5fr #3195335 | other | $55 | $24 to $92 | Low |
| Loop 3mm 12 Deg for Small Tur Set #wa47050c | other | $55 | $24 to $92 | Low |
| 16fr Entuit Gastrostomy Tube #g35616 | other | $55 | $24 to $92 | Low |
| Dressing Nasal Foam Stammberger Sinus #rr650 | other | $55 | $24 to $92 | Low |
| G Tube Entuit #g35618 | other | $55 | $24 to $92 | Low |
| 1.5mm Quick Release Drill Msdc15 Ms-dc15 | other | $55 | $24 to $92 | Low |
| Compass Compartment #cmps001 | other | $55 | $25 to $92 | Low |
| Nasal Packing Epostat 1ea | other | $55 | $25 to $92 | Low |
| Nitroglycerin 400 Mcg Spray | other | $55 | $25 to $92 | Low |
| Cath Nasal Posterior Epistaxis Rapid Rhino | other | $56 | $25 to $93 | Low |
| Removal of Impacted Cerumen (one OR Both Ears) By Physician On Same Date of S... | surgery | $56 | $25 to $186 | Low |
| Nasogastric/nasointestinal Feeding Tube Retention System 12fr White Corgrip S... | other | $56 | $25 to $93 | Low |
| Nasogastric/nasointestinal Feeding Tube Retention System 14fr Yellow Corgrip ... | other | $56 | $25 to $93 | Low |
| Nasogastric/nasointestinal Feeding Tube Retention System Corgrip Sr 10fr Pink... | other | $56 | $25 to $93 | Low |
| Nasogastric/nasointestinal Feeding Tube Retention System Corgrip Sr 16fr Oran... | other | $56 | $25 to $93 | Low |
| Nasogastric/nasointestinal Feeding Tube Retention System Corgrip Sr 18fr Tan ... | other | $56 | $25 to $93 | Low |
| Omo Neurexa Plus Left Large 5065n=l-l | other | $56 | $25 to $94 | Low |
| Omo Neurexa Plus Right Large 5065n=r-l | other | $56 | $25 to $94 | Low |
| Omo Neurexa Plus Right Medium 5065n=r-m | other | $56 | $25 to $94 | Low |
| Basket Retrieval 2.5x230cm Disp Roth 00711050 | other | $56 | $25 to $94 | Low |
| Gradient Compression Arm Sleeve, Each | other | $56 | $25 to $94 | Low |
| Guide Wire | other | $56 | $25 to $94 | Low |
| Roth Net Retrieval Basket #bx00711150 | other | $56 | $25 to $94 | Low |
| Adapter/extension, Pacing Lead OR Neurostimulator Lead | other | $56 | $25 to $94 | Low |
| Tcc-ez Extra Large Charcot Boot Tcc21126 1 Each | other | $57 | $25 to $94 | Low |
| Hc Medihoney Alginate Dressing | other | $57 | $25 to $95 | Low |
| Aplisol 5t Unit/0.1 Ml Vial | other | $57 | $25 to $95 | Low |
| Duovisc Large #8065183150 | other | $57 | $25 to $95 | Low |
| 5.5x85mm Rod Ti Alloy Curved Vitality #07.02015.014 | other | $57 | $25 to $95 | Low |
| Cast Supplies | other | $57 | $25 to $190 | Low |
| Home Sleep Test (hst) with Type IV Portable Monitor, Unattended; Minimum of 3... | other | $57 | $25 to $190 | Low |
| Lineum 3.5mm X 80mm Ti Rod #14 | other | $57 | $25 to $95 | Low |
| Presbyopia Correcting Function of Intraocular Lens | other | $57 | $25 to $95 | Low |
| Tornado .018 8mm X 4mm | other | $57 | $25 to $95 | Low |
| Tornado .035 10mm X 5mm | other | $57 | $25 to $95 | Low |
| Tornado Coil .035 10mm X 4mm | other | $57 | $25 to $95 | Low |
| Vitality 5.5x300mm Rod Ti Alloy Straight #07.02013.001 | other | $57 | $25 to $95 | Low |
| Foot Drop Splint, Recumbent Positioning Device, Prefabricated, Off-the-shelf | other | $57 | $25 to $95 | Low |
| Orthopedic Footwear, Woman's Shoe, Oxford, Used As an Integral Part of a Brace | other | $57 | $25 to $95 | Low |
| Hc Dress Aquacl Ag Xtr | other | $57 | $25 to $96 | Low |
| Instrument Tracker 9733533xom ENT | other | $57 | $25 to $96 | Low |
| Oxcarbazepine 300 Mg/5 Ml Susp | other | $58 | $26 to $96 | Low |
| Kit Mickey Gastrostomy Feeding Tube 14fr2.3cm | other | $58 | $26 to $96 | Low |
| Kit Mickey Gastrostomy Feeding Tube 16fr2.3cm | other | $58 | $26 to $96 | Low |
| Tube Inner Ear Myringotomy Ventilation Notched Flange with Tab 1.14 Mm Id Sof... | other | $58 | $26 to $96 | Low |
| Pillow Intubating Positioner Including Disposable Head Cradle #10-910-00 3/bx | other | $58 | $26 to $96 | Low |
| Tri-lumen Filtered Tube Set 6ea/cs | other | $58 | $26 to $96 | Low |
| Foot, Arch Support, Removable, Premolded, Longitudinal/ Metatarsal, Each | other | $58 | $26 to $97 | Low |
| Humeral Splint Mid Length 2xl #37-2185 | other | $59 | $26 to $98 | Low |
| Adhesion Barrier | other | $59 | $26 to $98 | Low |
| Smart Ablate Irrigation Tubing #sat001 | other | $59 | $26 to $98 | Low |
| Injection, Gemcitabine Hydrochloride (accord), Not Therapeutically Equivalent... | other | $59 | $26 to $98 | Low |
| Catheter, Occlusion | cardiac | $59 | $26 to $98 | Low |
| Cement Mixer Smart Mix Tower #5401-98 | other | $59 | $26 to $98 | Low |
| Addition to Lower Extremity Orthosis, Knee Control, Full Kneecap | other | $59 | $26 to $99 | Low |
| Injection, Methylnaltrexone, 0.1 Mg | other | $59 | $26 to $99 | Low |
| C-reamer 10mm Linvatec #8773a 4/bx | other | $59 | $26 to $99 | Low |
| Sternal Zipfix with Needle Pk/20ea #08.501.001.20s | other | $59 | $26 to $99 | Low |
| Diabetes Outpatient Self-management Training Services, Individual, Per 30 Min... | other | $59 | $26 to $198 | Low |
| Kyphon Bone Biopsy Device #3 #f05a | lab | $59 | $26 to $99 | Low |
| Transfer of an Orthosis From One Shoe to Another, Caliper Plate, Existing | other | $59 | $26 to $99 | Low |
| Bone Marrow Asp Sys Dstl Hole 11g 710.150.97s | other | $59 | $26 to $99 | Low |
| Hearing Service, Miscellaneous | other | $60 | $27 to $199 | Low |
| Indocin 50 Mg Suppository | other | $60 | $27 to $100 | Low |
| Balloon Wedge Pressure Catheter 5fr 110cm | cardiac | $60 | $27 to $100 | Low |
| Entrada Needle 11cm $sc-4220 | other | $60 | $27 to $100 | Low |
| Entrada Needle 15cm #sc-4220 | other | $60 | $27 to $100 | Low |
| Hand Finger Orthosis, without Joints, May Include Soft Interface, Straps, Pre... | other | $60 | $27 to $200 | Low |
| Irrigation Tubing #rob10031 | other | $60 | $27 to $100 | Low |
| Pin Plug #6725 Medtronic | other | $60 | $27 to $100 | Low |
| Stent Introducer Set G22684 | cardiac | $60 | $27 to $100 | Low |
| Sheath Uropass 11/13 Fr X 38cm #61138bx | other | $60 | $27 to $100 | Low |
| Addition to Lower Extremity Orthosis, Femoral Length Sock, Fracture OR Equal,... | other | $60 | $27 to $100 | Low |
| Needle Ebus 22g #na-201sx-4022-a | other | $60 | $27 to $100 | Low |
| Nasal Tube Bridal Pro System 12-14 Fr Dark Blue5ea/box #4 | other | $60 | $27 to $101 | Low |
| Nasal Tube Bridle Pro System 16-18fr Yellow 5ea/box #4 | other | $60 | $27 to $101 | Low |
| Nasal Tube Bridle Pro System 5-6 Fr Purple 5ea/box#4 | other | $60 | $27 to $101 | Low |
| Nasal Tube Bridle Pro System 8-10 Fr Teal 5ea/box# 4 | other | $60 | $27 to $101 | Low |
| Coil Embolization Nester 8mmx7cm #g52744 | other | $60 | $27 to $101 | Low |
| Cook Catheter Willis Oglesby Tube #g09892 | cardiac | $60 | $27 to $101 | Low |
| Calcium Chloride 10 % IV Soln | other | $61 | $27 to $101 | Low |
| Albendazole 200 Mg Po Tabs | other | $61 | $27 to $102 | Low |
| Guide Pin D1.5 Lg 300mm Gleno #230796000 | other | $61 | $27 to $102 | Low |
| Guide Pin Metaglene 2.5 #2307-87 | other | $61 | $27 to $102 | Low |
| Technetium Tc 99m Pentetate Diagnostic 25 Mci | other | $61 | $27 to $102 | Low |
| Belt, Strap, Sleeve, Garment, OR Covering, Any Type | other | $62 | $27 to $103 | Low |
| Cath Cholangiogram/taut 4fr X 18in | other | $62 | $27 to $103 | Low |
| Fulgurating Endo Electrode 2fr 105cm #be | other | $62 | $27 to $103 | Low |
| 3.0mm Round Diamond 5820-012-030d | other | $62 | $27 to $103 | Low |
| 4.0mm Round Diamond 5820-012-040d | other | $62 | $27 to $103 | Low |
| Cement Bone Mixing System #414702 1pk/10ea | other | $62 | $28 to $104 | Low |
| Knee Brace Recover Neo Long Large #00364 | other | $62 | $28 to $104 | Low |
| Knee Brace Recover Neo Long Medium #00363 | other | $62 | $28 to $104 | Low |
| Knee Brace Recover Neo Long Small #00362 | other | $62 | $28 to $104 | Low |
| Knee Brace Recover Neo Long Xlarge #00365 | other | $62 | $28 to $104 | Low |
| Knee Brace Recover Neo Long Xxl #00366 | other | $62 | $28 to $104 | Low |
| Endostitch Device 10mm #173016 | other | $62 | $28 to $104 | Low |
| I&a Tip Straight | other | $62 | $28 to $104 | Low |
| Diltiazem 100 Mg/100 Ml - Compounded | other | $62 | $28 to $104 | Low |
| Potassium Acet 100 Meq/50 Ml | other | $62 | $28 to $104 | Low |
| Diltiazem 100 Mg Add-van Vial | other | $62 | $28 to $104 | Low |
| 2.2mm Match Head 5820-107 | other | $63 | $28 to $105 | Low |
| Hydrocort-pramoxine 1%-1% Crm | other | $63 | $28 to $105 | Low |
| Food Bolus 4cmx2.5mmx160cm Rothnet Bx00711155 | other | $63 | $28 to $105 | Low |
| Coil Vascular Loop Shape Standard Stretch 8 Mm Dia 10 Cm Length Pushable 0.03... | other | $63 | $28 to $106 | Low |
| Mreye .035 10mm X 10cm | other | $63 | $28 to $106 | Low |
| Mreye .035 10mm X 15cm | other | $63 | $28 to $106 | Low |
| Mreye .035 10mm X 8cm | other | $63 | $28 to $106 | Low |
| Mreye .035 15mm X 15cm | other | $63 | $28 to $106 | Low |
| Mreye .035 20mm X 15cm | other | $63 | $28 to $106 | Low |
| Mreye .035 4mm X 4cm | other | $63 | $28 to $106 | Low |
| Mreye .035 5mm X 3cm | other | $63 | $28 to $106 | Low |
| Mreye .035 5mm X 5cm | other | $63 | $28 to $106 | Low |
| Mreye .035 5mm X 8cm | other | $63 | $28 to $106 | Low |
| Mreye .035 6mm X 5cm | other | $63 | $28 to $106 | Low |
| Mreye .035 8mm X 8cm | other | $63 | $28 to $106 | Low |
| Lumbar Orthosis, Sagittal Control, with Rigid Posterior Panel(s), Posterior E... | lab | $63 | $28 to $106 | Low |
| Rasp #5100-037-114 Stryker (bone Shaver | other | $64 | $28 to $106 | Low |
| Rasp Large Tear #5100-037 | other | $64 | $28 to $106 | Low |
| Rasp Small Tear #5100-37 | other | $64 | $28 to $106 | Low |
| Probe Vascular 2.0-2.5mm 45cm 5/bx | other | $64 | $28 to $106 | Low |
| Introducer/sheath, Guiding, Intracardiac Electrophysiological, Fixed-curve, O... | cardiac | $64 | $28 to $106 | Low |
| Introducer/sheath, Guiding, Intracardiac Electrophysiological, Steerable, Oth... | cardiac | $64 | $28 to $106 | Low |
| Injection, Leucovorin Calcium, Per 50 Mg | other | $64 | $28 to $106 | Low |
| Cannula I&a Simcoe | other | $64 | $28 to $106 | Low |
| Vincristine Sulfate, 1 Mg | other | $64 | $5 to $107 | Low |
| Addition to Lower Extremity Fracture Orthosis, Drop Lock Knee Joint | other | $64 | $28 to $107 | Low |
| Reaming Rod 2.5mm X 850mm Ti Cannulated | other | $64 | $28 to $107 | Low |
| Gastrointestinal Suture Anchor Kit #g04474 | other | $64 | $28 to $107 | Low |
| Injection, Nitroglycerin, 5 Mg | other | $64 | $28 to $107 | Low |
| Detractor Guhl Ankle 6ea/bx | other | $65 | $29 to $108 | Low |
| Mental Health Evaluation | therapy | $65 | $29 to $430 | High |
| Injection, Adrenalin, Epinephrine, 0.1 Mg | other | $65 | $29 to $109 | Low |
| Tretinoin 0.05 % Ex Crea | other | $65 | $29 to $109 | Low |
| Precedex 200 Mcg/50 Ml Bottle | other | $65 | $29 to $109 | Low |
| Probe Bio Vascular 1.0-1.5mm 5/bx | other | $65 | $29 to $109 | Low |
| Cuffed Tracheostomy Tube Bivona Fome-cuf Disposable Ic Size 6.0 Adult 850160 | other | $66 | $29 to $109 | Low |
| Cuffed Tracheostomy Tube Bivona Fome-cuf Disposable Ic Size 7.0 Adult 850170 | other | $66 | $29 to $109 | Low |
| Tray Pneumothorax Infant 5ea/1cs | other | $66 | $29 to $109 | Low |
| Centurion 30 Fms Cassette Only #8065000138 6ea/bx | other | $66 | $29 to $109 | Low |
| Orthopedic Footwear, Man's Shoe, Oxford, Used As an Integral Part of a Brace | other | $66 | $29 to $110 | Low |
| Nail Nippers 4" #881302 | other | $66 | $29 to $110 | Low |
| Tretinoin 0.1 % Ex Crea | other | $66 | $29 to $110 | Low |
| Cement Mixer 00-4501-090-00 00450109000 | other | $66 | $29 to $110 | Low |
| Clip Avalon Filshie #avm-851j | other | $66 | $29 to $110 | Low |
| Resure Sealant Ocular #rs-1004-us-10 10/bx | other | $66 | $29 to $110 | Low |
| 7fr Single Sensor W/lumen/coude Tip | other | $66 | $29 to $110 | Low |
| Hc Dress Aquacl Ag Hydrofiber | other | $66 | $29 to $111 | Low |
| Lift, Elevation, Inside Shoe, Tapered, Up to One-half Inch | other | $66 | $29 to $111 | Low |
| Closure Pilot Guides 5mm & 10/12mm Set | other | $66 | $29 to $111 | Low |
| 2.3mm Tapered Router5407-fa2 | other | $67 | $30 to $111 | Low |
| 3.0mm Tapered Router5407-fa3 | other | $67 | $30 to $111 | Low |
| Electrode Emg 18mm Needle 2 Channel 1m Cable Muscle Specific Prass Paired Ins... | other | $67 | $30 to $111 | Low |
| Development of Cognitive Skills to Improve Attention, Memory, Problem Solving... | other | $67 | $30 to $111 | Low |
| Nester .035 4mm X 7cm #g47372 | other | $67 | $30 to $111 | Low |
| Dexmedetomidine Hcl in Nacl 80 Mcg/20ml IV Soln | other | $67 | $30 to $112 | Low |
| Therapeutic Procedures to Improve Respiratory Function, Other Than Described ... | other | $67 | $28 to $112 | Low |
| Zimmer Compact Vacuum Cement Mixing System #00-5049-035 | other | $67 | $30 to $112 | Low |
| Side-by-side Bipolar Stimulating Probe 5ea/pk #8225401 | other | $67 | $30 to $112 | Low |
| Handle Sizer for Inhance Shoulder System #720530301 #7205-30 | other | $68 | $30 to $113 | Low |
| Repair/modification of a Hearing Aid | surgery | $68 | $30 to $632 | Low |
| Dificid 200 Mg Tablet | other | $68 | $30 to $113 | Low |
| Vac Veraflo Dress Sys-medium #ultvfl05md | other | $68 | $30 to $113 | Low |
| Ankle Orthosis, Ankle Gauntlet OR Similar, with OR without Joints, Prefabrica... | other | $68 | $30 to $226 | Low |
| Digoxin 0.05 Mg/ml Solution | other | $68 | $30 to $114 | Low |
| Injection, Cilastatin Sodium; Imipenem, Per 250 Mg | other | $68 | $30 to $114 | Low |
| Cryoprecipitate, Each Unit | other | $68 | $30 to $114 | Low |
| Injection, Triamcinolone Acetonide, Preservative Free, 1 Mg | other | $69 | $25 to $114 | Low |
| Surgicel Original Hemostat 2in X 3in 1953s | other | $69 | $31 to $115 | Low |
| Ear Mold/insert, Not Disposable, Any Type | other | $69 | $31 to $300 | Low |
| Nanoneedle Diagnostic Sheath Kit 125 Mm #ar-3210 | other | $69 | $31 to $115 | Low |
| Needle Osteo-site Bn Bx M2 #g36211 Dbbn-11-10.0-m2s | other | $69 | $31 to $115 | Low |
| Needle Osteo-site Long #g36406 | other | $69 | $31 to $115 | Low |
| Polyloop Ligating Device #hx-400u | other | $69 | $31 to $115 | Low |
| Testosterone Pellet, 75 Mg | other | $69 | $31 to $230 | Low |
| Endoclip 5mm #176630 | other | $69 | $31 to $115 | Low |
| Reaming Rod 3.0mm X 950mm W/balltip Sterile | other | $69 | $31 to $115 | Low |
| Reaming Rod 3.0mm X950mm W/offset Tip | other | $69 | $31 to $115 | Low |
| Patient Tracker Noninvasive #9734887xom | other | $69 | $31 to $116 | Low |
| Wound Retractor/protector Xlrg #c8404 | other | $70 | $31 to $116 | Low |
| Injection, Protamine Sulfate, Per 10 Mg | other | $70 | $31 to $116 | Low |
| Tornade Embolization Coil 10 X 4 #g09217 | other | $70 | $31 to $116 | Low |
| Addition to Lower Extremity Orthosis, Non-corrosive Finish, Per Bar | other | $70 | $31 to $116 | Low |
| 12.6mm X 10.4mm Boring Toolstryker #5130-123 | other | $70 | $31 to $117 | Low |
| 9.5mm X 10.4mm Boring Tool 5130-123 | other | $70 | $31 to $117 | Low |
| Plasma-lyte a Ph 7.4 Soln. | other | $71 | $31 to $118 | Low |
| Pin Steinmann 3.2mm 9" #110003484 | other | $71 | $31 to $118 | Low |
| Sheath Navigator 11/13frx36cm #250-222 Bossci | other | $71 | $31 to $118 | Low |
| Gastro Anchor Set Saf-t-pexy T-fastener | other | $71 | $31 to $118 | Low |
| Commode Patient Bariatric (800lbs) Cpat0008d | other | $71 | $32 to $119 | Low |
| Meniscal Knot Pusher/cutter #72201537 | other | $71 | $32 to $119 | Low |
| Codman Disposable Catheter Passer #82 | cardiac | $72 | $32 to $119 | Low |
| Avitene Microfibril Collagen Hemostat 1010020 | other | $72 | $32 to $119 | Low |
| Resolution Clips 2.8mmx235cm 20ea/1bx | other | $72 | $32 to $120 | Low |
| Occluder Colpo Pneumo Occluder | other | $72 | $32 to $120 | Low |
| Dornase Alfa, Inhalation Solution, Fda-approved Final Product, Non-compounded... | other | $72 | $32 to $120 | Low |
| Button Replacement 24fr X 2.4cm Low Profile | surgery | $72 | $32 to $120 | Low |
| Gastrostomy Tube 24fr 3.4cm Kit Replacement | surgery | $72 | $32 to $120 | Low |
| Hard-bone Drill 1.5 Mm Ar-9938 | other | $72 | $32 to $120 | Low |
| Hard-bone Drill 1.7 Mm Ar-9938 | other | $72 | $32 to $120 | Low |
| Inner Vision Fiber Optic Tip 56fr 1465 | other | $72 | $32 to $120 | Low |
| Tip Detachable 40fr Transillumination #1465 | other | $72 | $32 to $120 | Low |
| Fluticasone Furoate 27.5 Mcg/spray Na Susp | other | $72 | $32 to $120 | Low |
| Pigazzi Pad #40595 3/cs | other | $72 | $32 to $120 | Low |
| Neomy-polymyxin B 40 Mg/ml Amp | other | $72 | $32 to $120 | Low |
| Basket Roth Net Pedia Foreign Body Bx00711057 | other | $73 | $32 to $121 | Low |
| Potassium Phosph 15 Mmol/5 Ml | other | $73 | $32 to $121 | Low |
| Hetastarch 6%-0.9% Nacl Bag | other | $73 | $32 to $122 | Low |
| Catheter Kit 7.5" Pain On Q Silversoaker 5/bx | cardiac | $73 | $32 to $122 | Low |
| Lift, Elevation, Heel and Sole, Neoprene, Per Inch | other | $73 | $32 to $122 | Low |
| Ofloxacin 0.3% Ear Drops | other | $73 | $32 to $122 | Low |
| Steinmann Pin 9" Shoulder #405800 | other | $74 | $33 to $123 | Low |
| Common Carotid Intima-media Thickness (imt) Study for Evaluation of Atheroscl... | other | $74 | $27 to $246 | Low |
| Sensor Arterial Cdi #cdi510h | other | $74 | $33 to $123 | Low |
| Dextrose 50%-water Abboject | other | $74 | $33 to $123 | Low |
| Addition to Lower Extremity Orthosis, Rocker Bottom for Total Contact Ankle F... | other | $74 | $33 to $124 | Low |
| Addition to Lower Extremity, Split Flat Caliper Stirrups and Plate Attachment | other | $75 | $33 to $124 | Low |
| Injection, Infliximab-abda, Biosimilar, (renflexis), 10 Mg | other | $75 | $33 to $249 | Low |
| 2.0mm Round Diamond 5820-012-020d | other | $75 | $33 to $125 | Low |
| Ligator Band 7 Speedband 4ea/1bx M00542253 | other | $75 | $33 to $125 | Low |
| Addition to Lower Extremity, Dorsiflexion Assist (plantar Flexion Resist), Ea... | other | $75 | $33 to $125 | Low |
| Hydrocortisone-acetic Ear Drop | other | $75 | $33 to $125 | Low |
| Ankle Control Orthosis, Stirrup Style, Rigid, Includes Any Type Interface (e.... | other | $75 | $33 to $250 | Low |
| Catheter Venogram Balloon #6215 Mdt | cardiac | $75 | $33 to $125 | Low |
| Corneal Vacuum Punch 8.00mm #17200d800 | other | $75 | $33 to $125 | Low |
| Extension Titanium for Pd Catheter #ta | cardiac | $75 | $33 to $125 | Low |
| Hc Monitored Anesthesia Care Anesthesia Time - Each Incremental 15 Minutes | other | $75 | $33 to $125 | Low |
| Punch Cornea Vacuum 7.75mm #17200d775 | other | $75 | $33 to $125 | Low |
| Punch Corneal Vacuum 7.50mm #17200d750 | other | $75 | $33 to $125 | Low |
| Injection, Octreotide, Non-depot Form for Subcutaneous OR Intravenous Injecti... | other | $75 | $1 to $125 | Low |
| Loop 12 Degree for Long Tur Set #wa22037c | other | $75 | $33 to $125 | Low |
| Neomycin-poly-hc Eye Drops | other | $75 | $33 to $126 | Low |
| Screw Hex Female 2.5mm #42-5099-025 | other | $75 | $33 to $126 | Low |
| Prosthetic Shrinker, Above Knee, Each | other | $75 | $33 to $126 | Low |
| Dacarbazine, 100 Mg | other | $75 | $33 to $126 | Low |
| Hc Coban 2 #2094 1bx=1kit | other | $76 | $34 to $126 | Low |
| Hc Coban 2 Lite #2794 1bx=1kit | other | $76 | $34 to $126 | Low |
| Needle Ebus 21g #na-201sx | other | $76 | $34 to $126 | Low |
| Super-dimension Premarked Biopsy Forceps #sdbf1000 5/ct | lab | $76 | $34 to $127 | Low |
| Sizing Catheter Sf #g47308 5ea/1bx | cardiac | $76 | $34 to $127 | Low |
| Cannula Retrograde 14fr Research Med | other | $76 | $34 to $127 | Low |
| Catheter, Drainage | cardiac | $76 | $34 to $127 | Low |
| Post Op Knee Brace Xlg #423101 | other | $76 | $34 to $127 | Low |
| Addition to Knee Joint, Lift Loop for Drop Lock Ring | other | $77 | $34 to $129 | Low |
| Vac Veraflo Cleanse Dress Sys Med #ultvcl05md | other | $78 | $34 to $129 | Low |
| Biktarvy 50-200-25 Mg Tablet | other | $78 | $34 to $129 | Low |
| Stone Extractor Perc Ncircle #g32862 | other | $78 | $34 to $129 | Low |
| Pad Electrode Adult One Piece for Auto External Defibrillator Cpr-d-padz 8900... | other | $78 | $34 to $130 | Low |
| Electrode Barrie Bar 3mm Storz #27050nx-s | other | $78 | $35 to $130 | Low |
| Chest Tube Tray #cht2085 20ea/case6-8 Week Lead Time | other | $78 | $35 to $130 | Low |
| Aveta Fluid Management Accessory #205-212 3/ctn | other | $78 | $35 to $130 | Low |
| Endo Clip Applier 5mm #ae05ml 3 Ea/1bx | other | $78 | $35 to $130 | Low |
| Fecal Collector Flexi Seal Sys #418000 1ea/bx | other | $78 | $35 to $130 | Low |
| Knee Orthosis, Immobilizer, Canvas Longitudinal, Prefabricated, Off-the-shelf | other | $78 | $35 to $260 | Low |
| Alvimopan 12 Mg Capsule | other | $78 | $35 to $130 | Low |
| Stopcock Universal #75u | other | $78 | $35 to $131 | Low |
| Opticath High Flow Cath Lfr 8fr 110cm 6/cs | other | $78 | $35 to $131 | Low |
| Pneumothorax Cath Tray Disp Arrow 5ea/1bx | other | $79 | $35 to $131 | Low |
| Injection, Tobramycin Sulfate, Up to 80 Mg | other | $79 | $35 to $132 | Low |
| Addition to Lower Extremity, Torsion Control, Ankle Joint and Half Solid Stirrup | other | $79 | $35 to $132 | Low |
| Knot Pusher/suture Cutter and Slotted Cannula Set 72202674 | other | $79 | $35 to $132 | Low |
| Closure Surgical Skin 24cm Zip24 Ps1240 5/pk | surgery | $79 | $35 to $132 | Low |
| Grasping Device-endo Raptor Disp #bx00711177 | other | $79 | $35 to $132 | Low |
| Norepinephrine 4 Mg / 250 Ml Ns Bag - Compounded | other | $79 | $35 to $132 | Low |
| Pressure Monitor Set/stryker Quick | other | $80 | $35 to $133 | Low |
| Injection, Nicardipine, 0.1 Mg | other | $80 | $35 to $133 | Low |
| Hemostatic Sealant Floseal Matrix Recothrom 5ml 6/cs | other | $80 | $35 to $133 | Low |
| Injection, Ziprasidone Mesylate, 10 Mg | other | $80 | $36 to $134 | Low |
| Electrodes-4 Channel Paired Subdermal Ea=set | other | $81 | $36 to $134 | Low |
| Injection, Oxytocin, Up to 10 Units | other | $81 | $36 to $134 | Low |
| Oxytocin 20 Unit/1,000 Ml-ns | other | $81 | $36 to $134 | Low |
| Bonopty Biopsy Set 16cm #10 | lab | $81 | $36 to $135 | Low |
| Bonopty Penetration Set 9.5cms #10 | other | $81 | $36 to $135 | Low |
| Drill Twist Trimed #drill-2.30l | other | $81 | $36 to $135 | Low |
| Laser Fiber 200 Rnd Tip #dfs-200-rtsb | other | $81 | $36 to $135 | Low |
| Laser Fiber 272mic #dfs-272sb | other | $81 | $36 to $135 | Low |
| Shoulder Gps Threaded Pin Kit(1) Shoulder Gps Coracoid Pin Long(1) Shoulder G... | other | $81 | $36 to $135 | Low |
| Vac Veraflo Cleanse Choice Medium Ultvcc05md | other | $81 | $36 to $135 | Low |
| Conformity Evaluation | other | $81 | $36 to $271 | Low |
| Loop 24fr Monopolar Angled 27050g-s Cysview | other | $81 | $36 to $136 | Low |
| Technetium Tc 99m Pyrophosphate | other | $81 | $36 to $136 | Low |
| Feeding Tube Mic Jejunal #0200-12lv | other | $81 | $36 to $136 | Low |
| Scraper Membrane Stiff 25g | other | $82 | $36 to $137 | Low |
| Replace Leather Cuff Kafo-afo, Calf OR Distal Thigh | other | $82 | $37 to $137 | Low |
| Ball 24fr Monopolar Coag 3mm 27050n-s Cysview | other | $83 | $37 to $138 | Low |
| Cath Laparoscopic Chole Arrow | surgery | $83 | $37 to $138 | Low |
| Feeding Tube Endovive Jejunal 12fr #m00566340 | other | $83 | $37 to $138 | Low |
| Stone Extractor Tipless 4.5frx65cm #g17520 | other | $83 | $37 to $139 | Low |
| Cement Mixer | other | $83 | $37 to $139 | Low |
| Injection, Fosphenytoin, 50 Mg Phenytoin Equivalent | other | $83 | $1 to $139 | Low |
| Transfer of an Orthosis From One Shoe to Another, Solid Stirrup, New | other | $84 | $37 to $140 | Low |
| Uterine Manipulator X-large Vcare | other | $84 | $37 to $140 | Low |
| Nevirapine 50 Mg/5 Ml Susp | other | $84 | $37 to $140 | Low |
| Catheter, Suprapubic/cystoscopic | cardiac | $84 | $37 to $140 | Low |
| Kit Fecal Management Flexi-seal Protect Plus Enfit Connection Bag Nonsterile ... | other | $84 | $37 to $140 | Low |
| Drain Ethicon Blake Silicon Surg 15fr #2229 | other | $84 | $37 to $140 | Low |
| Addition to Lower Extremity Orthosis, Soft Interface for Molded Plastic, Belo... | other | $84 | $37 to $141 | Low |
| Needle Ez Io Ld 15ga 45mm #9079 | other | $85 | $38 to $141 | Low |
| Needle-ez Io Ld 15g Io Set 25mm #9001 Vidacre | other | $85 | $38 to $141 | Low |
| Needle-ez Io Pd 15g Io Set 15mm #9018 Vidacre | other | $85 | $38 to $141 | Low |
| Maxgrip Revolution Disp Forceps 23g #706.13 | other | $85 | $38 to $141 | Low |
| Cath Single Lumen 6.6fr | other | $85 | $38 to $142 | Low |
| Elbow Orthosis, Rigid, without Joints, Includes Soft Interface Material, Pref... | other | $85 | $38 to $284 | Low |
| Tube Inner Ear Myringotomy Ventilation Flange 4.8 Mm Length 1.32 Mm Id Silico... | other | $86 | $38 to $143 | Low |
| 1203105 9.0 Uniblocker 1/ea | other | $86 | $38 to $143 | Low |
| Therapeutic Procedures to Increase Strength OR Endurance of Respiratory Muscl... | other | $86 | $28 to $143 | Low |
| Smog Enema - Compounded | other | $86 | $38 to $143 | Low |
| Addition to Lower Extremity, Dorsiflexion and Plantar Flexion Assist/resist, ... | other | $86 | $38 to $143 | Low |
| Addition to Lower Extremity, Torsion Control, Straight Knee Joint, Each Joint | other | $86 | $38 to $144 | Low |
| Curved Knot Pusher/suture Cutter #72202675 | other | $86 | $38 to $144 | Low |
| Timolol 0.5% Gfs Gel-solution | other | $86 | $38 to $144 | Low |
| Forcep Micro Holding 23g #dfh | other | $87 | $38 to $144 | Low |
| Tube Blakemore Ng 20fr | other | $87 | $38 to $144 | Low |
| Extractor Balloon 15-18mm Rx Pro #4702 | other | $87 | $38 to $145 | Low |
| Extractor Pro Rx Below Injection 12-15 M00547040 | other | $87 | $38 to $145 | Low |
| Extractor Pro Rx Below Injection 15-18 M00547050 | other | $87 | $38 to $145 | Low |
| Extractor Pro Rx Below Injection 9-12 M00547030 | other | $87 | $38 to $145 | Low |
| Extractor Retrieval Balloon 12.0-15mm Rx Pro | other | $87 | $38 to $145 | Low |
| Extractor Retrieval Balloon 9-12mm Rx Pro | other | $87 | $38 to $145 | Low |
| Injection, Sulfamethoxazole 5 Mg and Trimethoprim 1 Mg | other | $87 | $39 to $145 | Low |
| Olopatadine Hcl 0.1 % Op Soln | other | $87 | $39 to $146 | Low |
| Sodium Ferric Gluconate (ferrlecit) 125 Mg/ Ns 100 Mls - Compounded | other | $87 | $39 to $146 | Low |
| Malyugin Ring 6.25mm Disp #mal-0001-d | other | $88 | $39 to $146 | Low |
| Malyugin Ring 7.00mm Disp #mal-0002-d | other | $88 | $39 to $146 | Low |
| D Stat Flowable #4000 | other | $88 | $39 to $146 | Low |
| Gia Endo 30 2.5 Roticular Load #030451 | other | $88 | $39 to $147 | Low |
| Gia Endo 30 3.5 Roticular Load #030452 | other | $88 | $39 to $147 | Low |
| Gradient Compression Stocking, Below Knee, 30-40 Mmhg, Used As a Surgical Dre... | surgery | $88 | $39 to $147 | Low |
| Mannitol 20% | other | $88 | $39 to $147 | Low |
| Catheter Passer Disposable 38cm #8591 | cardiac | $88 | $39 to $147 | Low |
| Catheter Passer Disposable 4.8mm X 3.3mm X 38cm #48407 | cardiac | $88 | $39 to $147 | Low |
| Nail Nippers 6" #881862 | other | $89 | $39 to $148 | Low |
| Budesonide 32 Mcg/act Na Susp | other | $89 | $40 to $149 | Low |
| Laser Fiber 365mic #dfs-365sb | other | $90 | $40 to $149 | Low |
| Guide Sheath Kit Endo Sz 2mm 105cm #k | other | $90 | $40 to $150 | Low |
| Needle Entrada #sc-4200 | other | $90 | $40 to $150 | Low |
| Profile Drill 3.5mm Beveled Ft #ar-8741 | other | $90 | $40 to $150 | Low |
| Profile Drill for Micro Compression Ft #ar-8737 | other | $90 | $40 to $150 | Low |
| Knee Orthosis, Elastic with Joints, Prefabricated, Off-the-shelf | other | $90 | $40 to $151 | Low |
| Transfer of an Orthosis From One Shoe to Another, Caliper Plate, New | other | $90 | $40 to $151 | Low |
| Diag Catheter 6fr Langston #5540 5/pk | cardiac | $91 | $40 to $151 | Low |
| Dextrose 70%-water IV Soln | other | $91 | $40 to $151 | Low |
| Injection, Chloramphenicol Sodium Succinate, Up to 1 Gm | other | $91 | $40 to $152 | Low |
| Addition to Knee Joint, Drop Lock, Each | other | $91 | $40 to $152 | Low |
| Catheter Bernstein 4fr 140cm #h787107227085 | cardiac | $91 | $40 to $152 | Low |
| Dissecting Tool Disp #14mh30 Midas | other | $92 | $41 to $153 | Low |
| Femoral Bone Cementing Prep Kit W/o Cement 00-5049-055-00 00504905500 | other | $92 | $41 to $153 | Low |
| Intralipid 20% IV Fat Emul | lab | $92 | $41 to $153 | Low |
| Ibandronate Sodium 150 Mg Po Tabs | other | $92 | $41 to $153 | Low |
| Injection, Voriconazole, 10 Mg | other | $92 | $41 to $153 | Low |
| Coil Pusher 16 | other | $93 | $41 to $155 | Low |
| Drill Cann Plyaxial Lck Screw 2mm Drll-pls | other | $93 | $41 to $155 | Low |
| Knee Orthosis, Elastic with Condylar Pads and Joints, with OR without Patella... | other | $93 | $41 to $310 | Low |
| Pack Robotic Rf | other | $94 | $41 to $156 | Low |
| Sodium Citrate 4% Soln | other | $94 | $41 to $156 | Low |
| Addition to Lower Extremity, Straight Knee Joint, Heavy Duty, Each Joint | other | $94 | $42 to $156 | Low |
| Sumatriptan 6 Mg/0.5ml Autoinj | other | $94 | $42 to $156 | Low |
| Seprafilm #508602 6ea/pk & 5pk/bx | other | $94 | $42 to $157 | Low |
| Probe Incrementing Nerve Stim W/std Prasstip #8225825x | other | $94 | $42 to $157 | Low |
| Cyclosporine, Oral, 100 Mg | other | $94 | $42 to $157 | Low |
| Grasping Device/endo Talon #00711175 | other | $94 | $42 to $157 | Low |
| Prep Kit W/restrictors #5461-01 | other | $95 | $42 to $158 | Low |
| Addition to Lower Extremity Orthosis, Soft Interface for Molded Plastic, Abov... | other | $95 | $42 to $158 | Low |
| Oats 70 Degree Measure Probe #ar-4070-70s | other | $95 | $42 to $158 | Low |
| Intubation Set Cook Retrograde | other | $95 | $42 to $158 | Low |
| Mometasone Furoate 50 Mcg/act Na Susp | other | $95 | $42 to $158 | Low |
| Flulaval Trivalent 2024-25 Syr | other | $96 | $42 to $159 | Low |
| Injection, Pemetrexed, Not Otherwise Specified, 10 Mg | other | $96 | $4 to $160 | Low |
| 25 Left Quick Pass Lasso #ar-6068-25tl | other | $96 | $43 to $160 | Low |
| 25 Right Quick Pass Lasso #ar-6068-25tr | other | $96 | $43 to $160 | Low |
| 45 Left Quick Pass Lasso #ar-6068-45l | other | $96 | $43 to $160 | Low |
| 45 Right Quick Pass Lasso #ar-6068-45r | other | $96 | $43 to $160 | Low |
| 90 Degree Curve Left Quick Pass Lasso #ar-6068-90l | other | $96 | $43 to $160 | Low |
| 90 Degree Curve Right Quick Pass Lasso #ar-6068-90r | other | $96 | $43 to $160 | Low |
| 90 Degree Curve Straight Quick Pass Lasso #ar-6068 | other | $96 | $43 to $160 | Low |
| Ankle Foot Orthosis, Multiligamentous Ankle Support, Prefabricated, Off-the-s... | other | $96 | $43 to $320 | Low |
| Bonopty Biopsy Set 16.5cm #12 | lab | $96 | $43 to $160 | Low |
| Bonopty Penetration Set 10cm #12 | other | $96 | $43 to $160 | Low |
| Crescent Quick Pass Lasso #ar-6068c | other | $96 | $43 to $160 | Low |
| Initial Preventive Physical Examination; Face-to-face Visit, Services Limited... | preventive | $96 | $43 to $320 | Low |
| Injection, Oxaliplatin, 0.5 Mg | other | $96 | $96 to $161 | Low |
| Endopath Electrosurgery Probe Plus Ii Pistol Hand Control Eph02 | surgery | $97 | $43 to $161 | Low |
| Inflator Kit Balloon ENT #18infkit | other | $97 | $43 to $161 | Low |
| Rod Carbon Fiber 11.0mm X 200mm External | other | $97 | $43 to $162 | Low |
| Extractor Foreign Body 5/cs #fb 5000 5ea/1cs | other | $97 | $43 to $162 | Low |
| Tray Disp Exchange Transfusion 1ea #275.00 | surgery | $98 | $43 to $163 | Low |
| Progel Extended Applicator Spray Tip 16cm | other | $98 | $44 to $164 | Low |
| Pericardiocentesis Kit Latex Free 3ea/1bx#m00443151 | other | $99 | $44 to $165 | Low |
| Reaming Rod/3.8mm Ball Tip 950mm Sterile #03.233.010s | other | $99 | $44 to $165 | Low |
| Addition to Knee Lock with Integrated Release Mechanism (bail, Cable, OR Equa... | other | $99 | $44 to $165 | Low |
| Cervical, Collar, Semi-rigid Thermoplastic Foam, Two-piece, Prefabricated, Of... | other | $99 | $44 to $330 | Low |
| Moderate Sedation Services Provided By the Same Physician OR Other Qualified ... | other | $99 | $5 to $330 | Low |
| Needle Transeptal Adult #tsnc-18-71.0 | other | $99 | $44 to $165 | Low |
| Needle Transseptal Brk 18ga 71cm #407200 | other | $99 | $44 to $165 | Low |
| Shoulder Orthosis, Acromio/clavicular (canvas and Webbing Type), Prefabricate... | other | $99 | $44 to $330 | Low |
| Sheath Access 12/14fr X38cm #61238bx | other | $99 | $44 to $165 | Low |
| Wand 3.0mm 45 Degree Turbo | other | $100 | $44 to $167 | Low |
| Wand Arthro 2.5mm 60deg Dome #ac3525 | other | $100 | $44 to $167 | Low |
| Wand Arthro 3.5mm 90deg Rt Angle #ac1340 | other | $100 | $44 to $167 | Low |
| Wand Ortho Super Multivac 50 | other | $100 | $44 to $167 | Low |
| Wand Saber 30 W/cable Arthrocare #ac4330 | other | $100 | $44 to $167 | Low |
| Gradient Compression Wrap, Non-elastic, Below Knee, 30-50 Mmhg, Used As a Sur... | other | $100 | $44 to $333 | Low |
| Kit Carotid Rf 2ea/1cs #dynj906961f | other | $100 | $45 to $167 | Low |
| Hip Orthosis, Abduction Control of Hip Joints, Flexible, (pavlik Harness), Pr... | other | $101 | $45 to $168 | Low |
| Epidisc Patch Kit #1417151 Xomed | other | $101 | $45 to $168 | Low |
| Alpena Contour Lso Universal Fits Waist Circumference: 25-60inch (64-152cm) #... | other | $101 | $45 to $168 | Low |
| Aspiration Tubing Kit #72-00114 | other | $101 | $45 to $168 | Low |
| Wand Arthro 3.5x90deg Suc Foot #asc4250 | other | $102 | $45 to $169 | Low |
| Wand Arthrocare 90deg W/suct & Finger Switch | other | $102 | $45 to $169 | Low |
| Contact Layer, Sterile, More Than 48 Sq. In., Each Dressing | other | $102 | $45 to $339 | Low |
| Injection, Phenobarbital Sodium, Up to 120 Mg | other | $102 | $45 to $170 | Low |
| Stone Extractor Basket 3.0frx120cm #390 | other | $102 | $45 to $170 | Low |
| Tisseel Vhsd 2 Ml Kit | other | $102 | $45 to $171 | Low |
| Insulin (novolin) R 100 Units / 100 Ml Ns - Compounded | other | $103 | $45 to $171 | Low |
| Myxredlin 100 Unit/100 Ml Bag | other | $103 | $45 to $171 | Low |
| Tissue Marker, Implantable, Any Type, Each | surgery | $103 | $46 to $172 | Low |
| Tvt70100as - Tube Endotracheal L312mm Od10mm Id7mm Pvc Single Lumen Visualize... | other | $104 | $46 to $173 | Low |
| Tvt75105as - Tube Endotracheal L323mm Od10.5mm Id7.5mm Pvc Single Lumen Visua... | other | $104 | $46 to $173 | Low |
| Tvt80110as - Tube Endotracheal L323mm Od11mm Id8mm Pvc Single Lumen Visualize... | other | $104 | $46 to $173 | Low |
| Dextrose 25%-water Syringe | other | $104 | $46 to $173 | Low |
| Breast Prosthesis, Mastectomy Bra, with Integrated Breast Prosthesis Form, Un... | other | $104 | $46 to $173 | Low |
| Rod Carbon Fiber 11.0mm X 250mm External | other | $104 | $46 to $174 | Low |
| Rod Carbon Fiber 11.0mm X 300mm External | other | $104 | $46 to $174 | Low |
| Rod Carbon Fiber 11.0mm X 350mm External | other | $104 | $46 to $174 | Low |
| Flovent Hfa 44 Mcg Inhaler | other | $104 | $46 to $174 | Low |
| Hydromorphone Pca 1 Mg/ml *high Concentration* Cemc Batched Compounded | other | $105 | $46 to $175 | Low |
| Carbojet Co2 Tube Set #25-100 | other | $105 | $47 to $175 | Low |
| Mini Bio-anchor Disp Kit | other | $105 | $47 to $175 | Low |
| Pushlock Kit for 2.9mm Shrt Pshlck #ar-2923ds | other | $105 | $47 to $175 | Low |
| Sheath Access 12/14fr X24cm #61224bx | other | $105 | $47 to $175 | Low |
| Sheath Access 12/14fr X54cm #61254bx | other | $105 | $47 to $175 | Low |
| Dissecting Tool 3.0 Matchstick Long #10mh30l | other | $105 | $47 to $175 | Low |
| Gallium Citrate Ga 67 | other | $105 | $47 to $175 | Low |
| Wand Artho 3.0mm 50deg Suction #asc2530 | other | $105 | $47 to $176 | Low |
| Doxycycline 100 Mg/100 Ml Ns Mini-bag Plus - Compounded | other | $105 | $47 to $176 | Low |
| Doxy 100 Mg Vial | other | $106 | $47 to $176 | Low |
| Cath Reddick Cystic Duct 2401-52 *min Order 5 | other | $106 | $47 to $177 | Low |
| Papaverine 60 Mg/2 Ml Vial | other | $106 | $47 to $177 | Low |
| Barone Jejunostomy Set | other | $107 | $47 to $178 | Low |
| Velys Array Drill Pin 125mm X 4mm 4515-70-005 Minimum Order 10 Each | other | $108 | $48 to $180 | Low |
| Velys Array Drill Pin 175mm X 4mm 4515-70-006 Minimum Order 10 Each | other | $108 | $48 to $180 | Low |
| 2.5mm Mtch Hd 16cm Stryker #8470-107 | other | $108 | $48 to $180 | Low |
| Rasp Small Riordan #5100-037 | other | $109 | $48 to $181 | Low |
| Dilator Healicoil Rg 4.75mm #72203951 | other | $109 | $48 to $181 | Low |
| Dilator Healicoil Rg 5.5mm #72203952 | other | $109 | $48 to $181 | Low |
| Injection, Ibuprofen, 100 Mg | other | $109 | $48 to $181 | Low |
| Flovent Hfa 110 Mcg Inhaler | other | $109 | $48 to $182 | Low |
| Clinolipid 20% | lab | $109 | $48 to $182 | Low |
| Kyphon Bone Biopsy Device #2 #f07a | lab | $109 | $48 to $182 | Low |
| Wound Retractor/protector Xxlrg #c8405 | other | $109 | $48 to $182 | Low |
| Cxi .014 X 90cm | other | $110 | $49 to $183 | Low |
| Margin Marker #mms6 | other | $110 | $49 to $183 | Low |
| Overtube Guardus Endo 3/bx #bx00711147 | other | $112 | $49 to $186 | Low |
| Grieshaber Revolution Dsp Ilm Forceps 25g | other | $112 | $50 to $186 | Low |
| Injection, Bortezomib, 0.1 Mg | other | $112 | $7 to $187 | Low |
| Injection, Fluorouracil, 500 Mg | other | $112 | $3 to $187 | Low |
| Scissors Ophthalmic 23ga Vertical Grieshaber | other | $113 | $50 to $188 | Low |
| Symbicort 80-4.5 Mcg Inhaler | other | $113 | $50 to $189 | Low |
| Anesthesia for Procedure to Drain Brain and Spinal Cord Fluid | other | $113 | $41 to $378 | Low |
| Kit for 1.8mm Q-fix Implant #25 | surgery | $113 | $50 to $189 | Low |
| Addition to Lower Extremity Fracture Orthosis, Plastic Shoe Insert with Ankle... | other | $114 | $50 to $190 | Low |
| Addition to Lower Extremity, Long Tongue Stirrup | other | $114 | $51 to $191 | Low |
| Dexmedetomidin 400mcg/100ml-ns | other | $114 | $51 to $191 | Low |
| Probe Laser Illuminated Directional 55.47.25p | other | $114 | $51 to $191 | Low |
| Rod Carbon Fiber 11.0mm X 400mm External | other | $115 | $51 to $191 | Low |
| Vital-vue Urol/gen #8280-06 Extended Yank | other | $115 | $51 to $191 | Low |
| Addition to Lower Extremity Prosthesis, Below Knee, Suspension/sealing Sleeve... | other | $116 | $51 to $193 | Low |
| Wrist Hand Finger Orthosis, without Joint(s), Prefabricated Item That Has Bee... | other | $116 | $51 to $386 | Low |
| Falope-ring Band Disp 8ea/bx | other | $116 | $51 to $193 | Low |
| Super Multivac 50 Wand-amblient | other | $116 | $51 to $194 | Low |
| Wand 90 Degree Superturbovac Amb Fingerswitch | other | $116 | $51 to $194 | Low |
| Injection, Meropenem (b. Braun), Not Therapeutically Equivalent to J2185, 100 Mg | other | $116 | $52 to $194 | Low |
| Addition to Lower Extremity, Below Knee, Molded Distal Cushion | other | $117 | $52 to $195 | Low |
| Sodium Bicarb 4.2% Abboject | other | $117 | $52 to $195 | Low |
| Syringe Orise Twnpk23g Intej Needle M00519211 | other | $117 | $52 to $195 | Low |
| Raltegravir Potassium 400 Mg Po Tabs #6 Dispense Pack | other | $117 | $52 to $195 | Low |
| Sodium Phosphate 45 Mmol/15 Ml | other | $117 | $52 to $195 | Low |
| Basket Nitinol 1.9 #390 | other | $117 | $52 to $195 | Low |
| Decompression Set 14fr #cdsg-14 | other | $117 | $52 to $195 | Low |
| Needle Scorpion W/megaloader #ar-13999hdn 5ea/bx | other | $117 | $52 to $195 | Low |
| Injection, Alprostadil, 1.25 Mcg | other | $117 | $52 to $195 | Low |
| Arc Smart Argon Probe 2.3/220 G1140001 | other | $117 | $52 to $196 | Low |
| Retractor Dexterity 9-14cm #100301 | other | $118 | $52 to $197 | Low |
| Knee Orthosis, Elastic with Joints, Prefabricated Item That Has Been Trimmed,... | other | $119 | $53 to $396 | Low |
| Ligasure Xtd Disp #ls3112 | other | $119 | $53 to $198 | Low |
| Dilator Urethral Set 14f to 26f #g14893 | other | $119 | $53 to $199 | Low |
| Urethral S-curve Dilator Set 8fr-20fr #g32789 | other | $119 | $53 to $199 | Low |
| Injection, Midazolam in 0.9% Sodium Chloride, Intravenous, Not Therapeuticall... | other | $119 | $53 to $199 | Low |
| Stent, Non-coronary, Temporary, without Delivery System | cardiac | $119 | $53 to $199 | Low |
| Cannulated Hex Driver 3.5 Ar-8967d | other | $120 | $53 to $200 | Low |
| Carbonaid C02 Diffuser #carbonaid | other | $120 | $53 to $200 | Low |
| Ear Impression, Each | other | $120 | $53 to $400 | Low |
| Equinoxe Torque Defining Square Drive Screw Kit #300-20 | other | $120 | $53 to $200 | Low |
| Hex Driver 2.0 70mm Ao Marked Cannulated #dvhx-2.0/070mc Ao | other | $120 | $53 to $200 | Low |
| Laser Fiber 200micron Disp #clt1020fl | other | $120 | $53 to $200 | Low |
| Shoulder Gps Reverse Shoulder Drill Kit (1) 2mm Drill (1) 3.2mm Drill #531-20 | other | $120 | $53 to $200 | Low |
| Shoulder Orthosis, Vest Type Abduction Restrainer, Canvas Webbing Type OR Equ... | other | $120 | $53 to $400 | Low |
| Spacer 36+6mm #ar-9555 | other | $120 | $53 to $200 | Low |
| Fentanyl 2 Mcg/ml, Bupivacaine 0.125% Epidural | other | $120 | $53 to $200 | Low |
| Fentanyl 2 Mcg/ml, Bupivacaine 0.125% Epidural Pca - Compounded | other | $120 | $53 to $200 | Low |
| Wand Arthro 3.0mm Capsure Low Temperature | other | $120 | $53 to $201 | Low |
| Hyaluronan OR Derivative, Euflexxa, for Intra-articular Injection, Per Dose | other | $122 | $54 to $203 | Low |
| Resolution 360 Clip 235cm X 2.8mm #m00521232 | other | $123 | $54 to $204 | Low |
| Arista Surgical Hemostatic Powder 5 Gm Polysaccharide Hemospheres Absorbable ... | surgery | $123 | $55 to $205 | Low |
| Electrode Pacing Bipolar 5fr-usci 5ea/1ca | other | $123 | $55 to $205 | Low |
| Reamer Coring 10mm #ar-1224s W/collared Pin | other | $123 | $55 to $205 | Low |
| Reamer Coring 11mm #ar-1226s | other | $123 | $55 to $205 | Low |
| Reamer Coring 12mm Cannulated | other | $123 | $55 to $205 | Low |
| Reamer Coring 8mm Cannulated W/collared Pin | other | $123 | $55 to $205 | Low |
| Reamer Coring 9mm #ar-1223s W/collarded Pin | other | $123 | $55 to $205 | Low |
| Sodium Phosphate 15 Mmol/5 Ml | other | $124 | $55 to $207 | Low |
| Paragon T2 Wand | other | $124 | $55 to $207 | Low |
| Sodium Chloride 0.9% Irrig. | other | $125 | $55 to $208 | Low |
| Hip Knee Ankle Foot Orthosis, Torsion Control, Bilateral Rotation Straps, Pel... | other | $126 | $56 to $210 | Low |
| Eviva Trocar 9g 10cm Length 12mm Aperture | other | $126 | $56 to $209 | Low |
| Eviva_0913-20 9ga 13cm Length 20mm Aperture | other | $126 | $56 to $209 | Low |
| Expect Slimline 25g Eus Needle #m00555521 Bx/5ea | other | $126 | $56 to $209 | Low |
| Needle Eus 19ga Expect Slimline #m00555501 | other | $126 | $56 to $209 | Low |
| Needle Eus 22ga Expect Slimline #m00555511 | other | $126 | $56 to $209 | Low |
| Surgicel 4 X 8 #1952s 12ea/case | other | $126 | $56 to $210 | Low |
| Pin Threaded Tip 1/8 X 2.5in #406669 | other | $126 | $56 to $210 | Low |
| Annual Wellness Visit; Includes a Personalized Prevention Plan of Service (pp... | preventive | $126 | $56 to $420 | Low |
| Hydrocodone-chlorphen ER Susp | other | $126 | $56 to $210 | Low |
| Acu-dispo-cautery2 Fine Tip-s #dcft2 | other | $127 | $56 to $211 | Low |
| Carbojet Xf Handpiece Set with 40" Nozzle (10-unit Multi-pack) #27-100 | other | $127 | $56 to $211 | Low |
| Stone Extractor Tipless 2.2frx115cm Ncircle | other | $127 | $56 to $211 | Low |
| Stone Extractor Tipless 3.0frx115cm Ncircle | other | $127 | $56 to $211 | Low |
| Addition to Lower Extremity, Varus/valgus Correction, Plastic Modification, P... | other | $127 | $56 to $212 | Low |
| Septal Button Nasal 2 Part #1524110 | other | $128 | $57 to $213 | Low |
| Injection, Cosyntropin, 0.25 Mg | other | $128 | $57 to $213 | Low |
| Gold Probe Injection 10fr #6016 | other | $129 | $57 to $214 | Low |
| Gold Probe W/injector 7fr/210cm #6015 | other | $129 | $57 to $214 | Low |
| M00521231 - Clip Internal L235cm Channel 2.8mm with Ergonomic Handle Braided ... | other | $129 | $57 to $214 | Low |
| Reamer Cann Head 6.5mm #ar-1406.5 | other | $129 | $57 to $215 | Low |
| Reamer Cann Head 6mm #ar | other | $129 | $57 to $215 | Low |
| Reamer Cann Head 7.5mm #ar-1407.5 | other | $129 | $57 to $215 | Low |
| Reamer Cann Head 7mm #ar | other | $129 | $57 to $215 | Low |
| Reamer Cann Head 8mm #ar | other | $129 | $57 to $215 | Low |
| Symbicort 160-4.5 Mcg Inhaler | other | $130 | $57 to $216 | Low |
| Amplatz Grad Renal Dilation Set | other | $130 | $58 to $217 | Low |
| Blade Shave Biopsy Flex Dermablade 8ea/1cs | lab | $130 | $58 to $217 | Low |
| Needle Eus 22g Expect Slimline #m00555510 | other | $131 | $58 to $218 | Low |
| Injection, Epoprostenol, 0.5 Mg | other | $131 | $17 to $218 | Low |
| Arc Smart Argon Probe 2.3/330 G1140002 | other | $131 | $58 to $218 | Low |
| Picc Cath 4fr Single Lumen Sapiens | other | $131 | $58 to $219 | Low |
| Catheter Oximetry Nonheparin Swan-ganz782f75m | cardiac | $132 | $59 to $220 | Low |
| A-scope 4 Rhinolaryngo Slim 510001000 5ea/1bx | other | $132 | $59 to $220 | Low |
| Helmet, Protective, Hard, Prefabricated, Includes All Components and Accessories | other | $132 | $59 to $220 | Low |
| Knot Pusher Suture Cutter #ar | other | $132 | $59 to $220 | Low |
| Microspheres 700-900 S820gh 5ea/box | other | $132 | $59 to $220 | Low |
| Robotic Suction Irrigator #410299 | other | $132 | $59 to $220 | Low |
| Addition, Endoskeletal System, Above Knee OR Hip Disarticulation, Knee Extens... | other | $132 | $59 to $221 | Low |
| Carbojet Xf Handpiece Set with 40" Nozzle Individual Handpiece #27-100 | other | $133 | $59 to $221 | Low |
| Injection, Hydroxyzine Hcl, Up to 25 Mg | other | $134 | $59 to $223 | Low |
| Cannula Simcoe | other | $134 | $59 to $223 | Low |
| 2.5mm Prcsn Mtch Hd 13cm8450-107 | other | $134 | $60 to $224 | Low |
| Tretinoin 0.01 % Ex Gel | other | $135 | $60 to $224 | Low |
| Lap Grasper 5mm 6ea/bx #5dsg | other | $135 | $60 to $225 | Low |
| Urethral Dilator Set 8fr-24fr #g14185 | other | $135 | $60 to $225 | Low |
| 2.0 Mm Drive Shaft for Quickfix Screw System Ar-8930d | other | $135 | $60 to $225 | Low |
| 3.0 Drive Shft for Quickfix Screw System Ar-8930d | other | $135 | $60 to $225 | Low |
| Clip Resolution 360 Ultra17mm M00521402 20/bx | other | $135 | $60 to $225 | Low |
| Erythromycin 200 Mg/5 Ml Susp | other | $135 | $60 to $225 | Low |
| Pinning System #2544-00 | other | $135 | $60 to $225 | Low |
| Ruby Coil Detachment Handle | other | $135 | $60 to $225 | Low |
| Tube Nasal Moss Feed 18fr 44" Min Order of 2 | other | $135 | $60 to $225 | Low |
| 2.0mm Carbide Round 5820-110-020c | other | $135 | $60 to $225 | Low |
| 3.0mm Carbide Round5820-110-030c | other | $135 | $60 to $225 | Low |
| 4.0mm Carbide Round 5820-110-040c | other | $135 | $60 to $225 | Low |
| Injection, Gadolinium-based Magnetic Resonance Contrast Agent, Not Otherwise ... | other | $135 | $60 to $225 | Low |
| Addition to Lower Extremity Orthosis, High Strength, Lightweight Material, Al... | other | $137 | $61 to $228 | Low |
| Static OR Dynamic Ankle Foot Orthosis, Including Soft Interface Material, Adj... | other | $137 | $61 to $228 | Low |
| Breast Prosthesis, Mastectomy Bra, with Integrated Breast Prosthesis Form, Bi... | other | $137 | $61 to $228 | Low |
| Power Picc Solo Catheter 4f Sl 3cg #ck001030 3kits/1 Case | cardiac | $137 | $61 to $229 | Low |
| Epinephrine Hcl (nasal) 0.1 % Na Soln | other | $138 | $61 to $230 | Low |
| Gradient Compression Arm Sleeve, Custom, Medium Weight, Each | other | $138 | $61 to $231 | Low |
| Injection, Desmopressin Acetate, Per 1 Mcg | other | $140 | $62 to $234 | Low |
| Mic Tube Feeding Jejunal 18fr 30cm #0250-18 | other | $140 | $62 to $234 | Low |
| Electrode Pacing Non-heparin 5frx110cm 5ea/ca | other | $140 | $62 to $234 | Low |
| 2.0 Cann Driver Tip Ht | other | $140 | $62 to $234 | Low |
| Walking Boot, Non-pneumatic, with OR without Joints, with OR without Interfac... | other | $140 | $62 to $468 | Low |
| Arndt Endobronchial Blocker Set 7fr G44114 | other | $141 | $62 to $235 | Low |
| Tobrex 0.3% Eye Ointment | other | $141 | $63 to $235 | Low |
| Optisphere 700-1000 #osl271 5ea/1bx | other | $141 | $63 to $235 | Low |
| Medtronic Percutaneous Extention Kit 3560022 | other | $141 | $63 to $236 | Low |
| 3.0 Precision Round 2flute5820-009 | other | $142 | $63 to $236 | Low |
| 4.0 Precision Round 2flute5820-009 | other | $142 | $63 to $236 | Low |
| 5.0 Precision Round 2flute5820-009 | other | $142 | $63 to $236 | Low |
| 6.0 Precision Round 2flute5820-009 | other | $142 | $63 to $236 | Low |
| Desonide 0.05 % Ex Lotn | other | $142 | $63 to $237 | Low |
| Hc General Anesthesia Time - Each Incremental 15 Minutes | other | $143 | $63 to $238 | Low |
| Pulmonary Needle Arcpoint 21g #ils-2100-pn 5/pk | other | $143 | $63 to $238 | Low |
| Pneumothorax Cath Set 10.2fr #c-tpt-200 1ea | other | $143 | $63 to $239 | Low |
| Coblator Evac 70 Xtra W/cable | other | $144 | $64 to $240 | Low |
| Hc Epidural Anesthesia Time - Initial Base Charge | other | $144 | $64 to $240 | Low |
| Hc Spinal Anes 1st 30 | other | $144 | $64 to $240 | Low |
| Injection, Acyclovir, 5 Mg | other | $144 | $64 to $240 | Low |
| Injection, Ertapenem Sodium, 500 Mg | other | $145 | $64 to $241 | Low |
| Fiapc Probe W/ Filter 2200 a Od 2.3 Mm / 6.9 Fr; L 2.2 M / 7.2 Ft - #20132-21... | other | $146 | $65 to $243 | Low |
| Fiapc Probe W/ Filter 2200 Cod 2.3 Mm / 6.9 Fr; L 2.2 M / 7.2 Ftno. #20132-21... | other | $146 | $65 to $243 | Low |
| Embospheres 500-700 #s620gh 5ea/bx | other | $146 | $65 to $243 | Low |
| Microspheres 300-500 #s420gh 5ea/box | other | $146 | $65 to $243 | Low |
| Lacosamide 200 Mg/20 Ml Vial | other | $146 | $65 to $243 | Low |
| Forcep Long Kleppinger 45cm 5mm #910010pk | other | $146 | $65 to $244 | Low |
| Hemostatic Sealant Floseal Matrix 10ml 6/ca | other | $146 | $65 to $244 | Low |
| Ergo Gps Drill 3.2mm #531-55 | other | $147 | $65 to $245 | Low |
| Twist Drill 1.0mm X 20mm L76mm Ao Fixation #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.0mm X 20mml82mm Dental Fixation #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.0mm X 20mml82mm Stryker Fixation #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.2mm X 10mm L66mm Ao Lag #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.2mm X 10mm L72mm Dental Lag #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.2mm X 10mm L72mm Stryker Lag #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.2mm X 25mm L81mm Ao Fixation #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.2mm X 25mm L87mm Dental Fixation #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.2mm X 25mm L87mm Stryker Fixation #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.6mm X 10mm L66mm Ao Lag #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.6mm X 10mm L72mm Dental Lag #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.6mm X 10mm L72mm Stryker Lag #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.6mm X 25mm L81mm Ao Fixation #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.6mm X 25mm L87mm Dental Fixation #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.6mm X 25mm L87mm Stryker Fixation #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.9mm X 35mm L91mm Ao Fixation #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.9mm X 35mm L97mm Dental Fixation #a | other | $147 | $65 to $245 | Low |
| Twist Drill 1.9mm X 35mm L97mm Stryker Fixation #a | other | $147 | $65 to $245 | Low |
| Twist Drill 2.1mm X 10mm L66mm Ao Lag #a | other | $147 | $65 to $245 | Low |
| Twist Drill 2.1mm X 10mm L72 Stryker Lag #a | other | $147 | $65 to $245 | Low |
| Twist Drill 2.1mm X 10mm L72mm Dental Lag #a | other | $147 | $65 to $245 | Low |
| Twist Drill 2.35mm X 10mm L66mm Ao Lag #a | other | $147 | $65 to $245 | Low |
| Twist Drill 2.35mm X 10mm L72mm Dental Lag #a | other | $147 | $65 to $245 | Low |
| Infusion, Albumin (human), 25%, 50 Ml | surgery | $147 | $53 to $246 | Low |
| Balloon Oval Kidney Shape Str #omspdbs2 | other | $147 | $65 to $246 | Low |
| Hc Regional Anesthesia Time - Initial Base Charge | other | $148 | $66 to $247 | Low |
| Injection, Chlorpromazine Hcl, Up to 50 Mg | other | $148 | $66 to $247 | Low |
| Tralement Vial | other | $148 | $66 to $247 | Low |
| Adapalene 0.3% Gel | other | $149 | $66 to $248 | Low |
| Sensors Starling W/leadwires 25pk/1bx #cms25 | other | $149 | $66 to $248 | Low |
| Injection, Erythromycin Lactobionate, Per 500 Mg | other | $149 | $66 to $249 | Low |
| Reaming Rod Push Rod with Ball Handle 03.010.093 | other | $149 | $66 to $249 | Low |
| Centurion Anterior Vitrectomy Probe | other | $149 | $66 to $249 | Low |
| Assistive Listening Device, Television Amplifier, Any Type | other | $150 | $67 to $500 | Low |
| Aveta Coral Disposable Hysteroscope 4.6mm #214 | other | $150 | $67 to $250 | Low |
| Aveta Pearl Disposable Hysteroscope 5.7mm #214 | other | $150 | $67 to $250 | Low |
| Cables Ensite X Extension for Magnet #a-ens-magext-cbl | other | $150 | $67 to $250 | Low |
| Custom Peg Board Kit #1 #pbk10001 | other | $150 | $67 to $250 | Low |
| Ensnare 18-30mm #en2007030 Elgx | other | $150 | $67 to $250 | Low |
| Hearing Aid OR Assistive Listening Device/supplies/accessories, Not Otherwise... | other | $150 | $67 to $500 | Low |
| Pins 4x127 #rob10010 4ea/bx | other | $150 | $67 to $250 | Low |
| Pins 4x152 #rob10011 2ea/bx | other | $150 | $67 to $250 | Low |
| Screwdriver Bit Headless 3.0mm 212-40 | other | $150 | $67 to $250 | Low |
| Tobradex Eye Ointment | other | $150 | $67 to $250 | Low |
| Ingrezza 40 Mg Capsule | other | $150 | $67 to $250 | Low |
| Powerpicc Solo Provena Catheter 4f Dl 3cg #ck001031 3kt/cs | cardiac | $150 | $67 to $251 | Low |
| Catheter Angiographic Coronary OR Peripheral Guiding W/o Sideholes Right C315... | imaging | $151 | $67 to $251 | Low |
| Alvarado Traction Boot #00132021000 | other | $151 | $67 to $252 | Low |
| Prevena Dressing 13cm #pre1155us 5/cs | other | $152 | $67 to $254 | Low |
| Prevena Dressing 20cm #pre1055us 5/cs | other | $152 | $67 to $254 | Low |
| Dressing Neg Press Veraflo Lg 5pk Ultvcc05lg | other | $152 | $68 to $254 | Low |
| Drill Tip Set-acl Patella Tendon Reusable | other | $153 | $68 to $254 | Low |
| Back Brace Aspen Summit 637 X-large 992380 | other | $153 | $68 to $255 | Low |
| Ligator Six Bander #mbl-6-ov Implant | surgery | $153 | $68 to $255 | Low |
| 8813e Suture Kit Dr Dumicz Oh Only 5kt/bx | other | $154 | $68 to $256 | Low |
| Amnioexcel, Amnioexcel Plus OR Biodexcel, Per Square Centimeter | other | $154 | $68 to $257 | Low |
| Injection, Levocarnitine, Per 1 Gm | other | $155 | $69 to $258 | Low |
| Candin Skin Test | other | $155 | $69 to $258 | Low |
| Basket Trapezoid 3cm #m00510890 | other | $155 | $69 to $258 | Low |
| Basket Wireguided Retrieval 2.0 X .035 | other | $155 | $69 to $258 | Low |
| Basket Wireguided Retrieval 2.5 X .035 | other | $155 | $69 to $258 | Low |
| **discontinued 2/19/2021** Percut Kit 19fr X 18cm Femoral Arterial | other | $155 | $69 to $259 | Low |
| Percut Kit 21fr X 18cm Femoral Arterial | other | $155 | $69 to $259 | Low |
| 8815e Suture Dr Halligan CABG 1ea=1kt 5kt/1bx | other | $155 | $69 to $259 | Low |
| Cvvh Prisma Dilution Set #106697 4ea/cs | other | $156 | $69 to $259 | Low |
| Hti Regulator Kit H80215901011 15901 | other | $156 | $69 to $260 | Low |
| Tube Endobronchial 35 Vivasight-dl #dlvt35las | other | $156 | $69 to $260 | Low |
| Tube Endobronchial 37 Vivasight-dl #dlvt37las | other | $156 | $69 to $260 | Low |
| Tube Endobronchial 39 Vivasight-dl #dlvt39las | other | $156 | $69 to $260 | Low |
| Tube Endobronchial 41 Vivasight-dl #dlvt41las | other | $156 | $69 to $260 | Low |
| Santyl Ointment | other | $156 | $69 to $261 | Low |
| Fitting/orientation/checking of Hearing Aid | other | $156 | $15 to $2,690 | Low |
| Hemostat Surgicel Snow 2x4 Absrb Ster #2082 | other | $156 | $69 to $261 | Low |
| Laser Probe 25g Vekt Illum Directl8065 | other | $157 | $69 to $261 | Low |
| Percut Kit 15fr X 18cm Femoral Arterial | other | $157 | $70 to $262 | Low |
| Ligator Band 7 Band Speed | other | $157 | $70 to $262 | Low |
| Retrieval Device, Insertable | other | $158 | $70 to $263 | Low |
| Laryngectomy Tubes: Provox Larytube Laryngectomy Tube 9/27 Inner Diameter 10.... | other | $158 | $70 to $263 | Low |
| Laryngectomy Tubes: Provox Larytube Laryngectomy Tube 9/36 Inner Diameter 13.... | other | $158 | $70 to $263 | Low |
| Laproscopic Alligator Grasper | other | $159 | $70 to $265 | Low |
| Waveguide 12fr #1911273 | other | $159 | $70 to $265 | Low |
| Injection, Bleomycin Sulfate, 15 Units | other | $159 | $27 to $265 | Low |
| Injection, Benztropine Mesylate, Per 1 Mg | other | $160 | $71 to $266 | Low |
| Injection, Acetazolamide Sodium, Up to 500 Mg | other | $160 | $71 to $266 | Low |
| Disposable Distal Attachment D-201 | other | $160 | $71 to $267 | Low |
| Silicone Elastomer T-tube 10fr Su130 | other | $161 | $71 to $268 | Low |
| Silicone Elastomer T-tube 12fr Su130 | other | $161 | $71 to $268 | Low |
| Silicone Elastomer T-tube 14fr Su130 | other | $161 | $71 to $268 | Low |
| Silicone Elastomer T-tube 16fr Su130 | other | $161 | $71 to $268 | Low |
| Stonetome 5.5fr 20mm #3511 | other | $161 | $71 to $268 | Low |
| Bflex 2 Slim 3.8 Single-use Bronchoscope 0570-0448 Bx=pk/5ea | other | $161 | $71 to $269 | Low |
| Non-canulated Non-sterile Torque Driver #00-8401-080 | other | $161 | $72 to $269 | Low |
| Injection, Cisplatin, Powder OR Solution, 10 Mg | other | $161 | $2 to $269 | Low |
| Electrode Hf Loop 24fr .2 Wire #a22201d | other | $162 | $72 to $269 | Low |
| Addition to Knee Joint, Disc OR Dial Lock for Adjustable Knee Flexion, Each J... | other | $162 | $72 to $270 | Low |
| Wand Arthro 2.3mm 35 Deg Short Bevel Sm Joint | other | $162 | $72 to $270 | Low |
| Overtube Guardus Endo 50cm 3ea/bx #bx00711149 | other | $163 | $72 to $272 | Low |
| Guidepin Resection 3mm X 100mm for Inhance Shoulder System #700030100 #7000-30 | other | $164 | $73 to $273 | Low |
| Technetium Tc 99m Labeled Red Blood Cell Diagnostic 30 Mci | other | $164 | $73 to $274 | Low |
| Percut Kit 23fr X 18cm Femoral Venous | other | $165 | $73 to $275 | Low |
| Acp Max Prp System W/acda Abs | other | $165 | $73 to $275 | Low |
| Bone Density Scan | imaging | $165 | $9 to $550 | High |
| Driver Surgical T8 Solid Ao for Colink Screw P04s0051 #p04 S0051 | surgery | $165 | $73 to $275 | Low |
| Knot Pusher #kp1 Cardiac Surg Only | cardiac | $165 | $73 to $275 | Low |
| Lag Screw Driver T8 Cannulated Sterile Single Use #p06 S0411 | other | $165 | $73 to $275 | Low |
| Tube Feed Gastrostomy 18fr Moss | other | $165 | $73 to $275 | Low |
| Clevercut Tome 7mm Tip 20mm Wire | other | $165 | $73 to $275 | Low |
| Kyphon Bevel Osteo Introducer #t15k | other | $166 | $74 to $277 | Low |
| Endowrist Suction Irrigator #480299 6ea/1bx | other | $167 | $74 to $278 | Low |
| Injection, Topotecan, 0.1 Mg | other | $167 | $1 to $279 | Low |
| Injection, Carboplatin, 50 Mg | other | $168 | $3 to $280 | Low |
| Ibs 2in1 Drill 2.2 Diam / Lg22mm Ao Sterile Cannulated Lg65mm G01 00721 | other | $168 | $74 to $280 | Low |
| Tool Delivery Large Cps Locator 3d#ds2c300 | obstetric | $168 | $74 to $280 | Low |
| Tool Delivery Large Xlong Cps Locator 3d#ds2c300 | obstetric | $168 | $74 to $280 | Low |
| Tool Delivery Medium Cps Locator 3d#ds2c200 | obstetric | $168 | $74 to $280 | Low |
| Tool Delivery Medium Xlong Cps Locator 3d#ds2c200 | obstetric | $168 | $74 to $280 | Low |
| Tool Delivery Small Cps Locator 3d#ds2c100 | obstetric | $168 | $74 to $280 | Low |
| Hc Dressing Aquacel Ag 3.5x6 | other | $168 | $75 to $281 | Low |
| Flovent Hfa 220 Mcg Inhaler | other | $169 | $75 to $282 | Low |
| Foot, Insert, Removable, Molded to Patient Model, Longitudinal Arch Support, ... | other | $170 | $75 to $283 | Low |
| 11mm Mcglamry Metatarsal Elevator Ar-8930m | other | $171 | $76 to $285 | Low |
| Connecting Tube #maj | other | $171 | $76 to $285 | Low |
| Splinting Tube 11mm X 13.2mm for Enteroscopy | other | $172 | $76 to $287 | Low |
| Needle Ultrafast Fix Straight | other | $173 | $77 to $288 | Low |
| Pack Arthroscopic 1.2 Disposable Rap-pac B #72202797 | surgery | $173 | $77 to $288 | Low |
| For Diabetics Only, Fitting (including Follow-up), Custom Preparation and Sup... | other | $173 | $77 to $289 | Low |
| Laryngectomy Tubes: Provox Larytube Laryngectomy Tube 8/27 Standard Inner Dia... | other | $173 | $77 to $289 | Low |
| Bone Mill #bm210 Fine | other | $174 | $77 to $290 | Low |
| All Lower Extremity Prosthesis, Solid Ankle Cushion Heel (sach) Foot, Replace... | other | $174 | $77 to $290 | Low |
| S1294108d5 - Power Picc 4fr Dual 3ea/case | other | $175 | $78 to $292 | Low |
| Powerpicc Solo Catheter 5f Tl Hf 3cg #ck001032 3kt/1cs | cardiac | $175 | $78 to $292 | Low |
| Laryngectomy Tubes: Provox Larytube Laryngectomy Tube 8/36 Nonsterile Single-... | other | $175 | $78 to $292 | Low |
| Gore Smoother 7.9mm Disp | other | $176 | $78 to $293 | Low |
| Gore Smoother 9.5mm Disp | other | $176 | $78 to $293 | Low |
| Balloon Cre Rx Biliary 10-11-12mm #m00558930 | other | $177 | $78 to $294 | Low |
| Balloon Cre Rx Biliary 6-7-8mmx5.5 #m00558860 | other | $177 | $78 to $295 | Low |
| Balloon Cre Rx Biliary 8-9-10mm #m00558920 | other | $177 | $78 to $295 | Low |
| Balloon Cre Rx Biliary12-13.5-15mm #m00558940 | other | $177 | $78 to $295 | Low |
| Bio-tenodesis Disp Kit #ar-1530ds | other | $177 | $78 to $295 | Low |
| Addition to Lower Extremity Fracture Orthosis, Adjustable Motion Knee Joint, ... | other | $178 | $79 to $296 | Low |
| Cns Drainage System /latex Free #10-110 1ea | other | $179 | $79 to $298 | Low |
| Injection, Olanzapine, 0.5 Mg | other | $179 | $80 to $299 | Low |
| Cables Ensite X Inquiry Quad #d-ens-inq-q-cbl | other | $180 | $80 to $300 | Low |
| Cables Ensite X Supreme Quad #d-ens-sup-q-cbl | other | $180 | $80 to $300 | Low |
| Catheter, Balloon Dilatation, Non-vascular | cardiac | $180 | $80 to $300 | Low |
| Heel, New Rubber, Standard | other | $180 | $42 to $600 | Low |
| Ocular Implant | surgery | $180 | $80 to $784 | Low |
| Nim Trivantage Emg Endotracheal Tube 5.0 #8229705 | other | $180 | $80 to $301 | Low |
| Tube Emg Trivantage 6mm #8229706 | other | $180 | $80 to $301 | Low |
| Tube Emg Trivantage 7mm #8229707 | other | $180 | $80 to $301 | Low |
| Tube Emg Trivantage 8mm #8229708 | other | $180 | $80 to $301 | Low |
| Balloon Seeker 6x17mm Em Sphn #1830617sph | other | $180 | $80 to $301 | Low |
| Destination Slender Seath Guide 6fr 85cm Gs-r6st1c85w | other | $181 | $80 to $302 | Low |
| Pedvaxhib Vaccine Vial | preventive | $181 | $80 to $302 | Low |
| Electrode Hf Roller Lg 24-28fr 12/30deg | other | $182 | $81 to $303 | Low |
| Rod Attacment for Lrg Multi-pin Clamp Externa | other | $182 | $81 to $304 | Low |
| Reflex Ultra 45 Coblator Ii #eica4845 | other | $182 | $81 to $304 | Low |
| Extracorp Shock Wv Tx Ms Nos | other | $183 | $67 to $610 | Low |
| Mtp Cup Reamer 22mm Gen #58890122 | other | $184 | $82 to $307 | Low |
| Vital-vue/ob Gyn #8281-06 Slender Tip | other | $184 | $82 to $307 | Low |
| Forceps Biopsy Piranha #m0065051600 | lab | $185 | $82 to $308 | Low |
| Wrist Hand Finger Orthosis, without Joint(s), Prefabricated, Off-the-shelf, A... | other | $185 | $82 to $309 | Low |
| Temno Biopsy Needle 20x20 Ctt2020 | lab | $185 | $82 to $309 | Low |
| Breast Prosthesis, Mastectomy Form | other | $187 | $83 to $312 | Low |
| Methohexital 10 Mg/ml Injection - Compounded | other | $187 | $83 to $312 | Low |
| Photon Guide #104015 | other | $188 | $83 to $313 | Low |
| Firstpass Mini Suture Passer - Left Curved 72290129 | other | $189 | $84 to $315 | Low |
| Firstpass Mini Suture Passer - Right Curved 72290130 | other | $189 | $84 to $315 | Low |
| Firstpass Mini Suture Passer - Straight 72290128 | other | $189 | $84 to $315 | Low |
| C-reamer 11mm Linvatec #8774a 4/bx | other | $189 | $84 to $315 | Low |
| Prismaflex St150 Set Us #107640us | other | $190 | $84 to $317 | Low |
| Wand Turbinator Arthrocare #eica6895 | other | $190 | $84 to $317 | Low |
| Estradiol 0.01% Cream | other | $191 | $85 to $318 | Low |
| Bcg Live Intravesical Instillation, 1 Mg | other | $191 | $3 to $318 | Low |
| Photonblade Rf Cautery #pb1 | other | $192 | $85 to $319 | Low |
| Coblator Probe ENT Reflex #eica4835 | other | $192 | $85 to $319 | Low |
| Brav0 Cf Capsule Delivery Dev 5-pk #fgs | obstetric | $192 | $85 to $320 | Low |
| Drill Staple Comp Charlotte #43112032 | other | $193 | $86 to $322 | Low |
| Bflex 2 Ultraslim 2.8 Single-use Bronchoscope 0570-0447 Bx=pk/5ea | other | $193 | $86 to $322 | Low |
| Foot, Insert, Removable, Molded to Patient Model, Longitudinal/ Metatarsal Su... | other | $194 | $86 to $323 | Low |
| 10.5mm Short Flipcutter #ar-1204as | other | $195 | $86 to $325 | Low |
| Flipcutter Ii Short 8.5mm #ar-1204as | other | $195 | $86 to $325 | Low |
| Flipcutter Ii Short 8mm #ar-1204as | other | $195 | $86 to $325 | Low |
| Flipcutter Ii Short 9.5mm #ar-1204as | other | $195 | $86 to $325 | Low |
| Flipcutter Ii Short 9mm #ar-1204as | other | $195 | $86 to $325 | Low |
| Flipcutter Short 10mm #ar-1204as | other | $195 | $86 to $325 | Low |
| Flipcutter Short 7.5mm #ar-1204as | other | $195 | $86 to $325 | Low |
| Flipcutter Short 7mm #ar-1204as | other | $195 | $86 to $325 | Low |
| Flat Markers #pfsdv0016 18ea/bx | other | $195 | $86 to $325 | Low |
| Prevena Plus Dressing #pre4055us 5/cs | other | $196 | $87 to $326 | Low |
| Caffeine-sod Benzoat 250 Mg/ml | other | $196 | $87 to $326 | Low |
| Home Sleep Test (hst) with Type Iii Portable Monitor, Unattended; Minimum of ... | other | $196 | $87 to $654 | Low |
| Micro Acutrak 2 Extended Long Drill Acumed #80 | other | $197 | $87 to $328 | Low |
| Hand Orthosis, without Joints, May Include Soft Interface, Straps, Custom Fab... | other | $197 | $87 to $328 | Low |
| Patch Vascular 1cm X 10cm Xenosure E1p10 | other | $197 | $88 to $329 | Low |
| Captivator Emr Large Scope Single #m00561610 | other | $198 | $88 to $329 | Low |
| Captivator Emr Standard Scope Single #m00561600 | other | $198 | $88 to $329 | Low |
| Norepinephrine 16 Mg/250ml-d5w | other | $198 | $88 to $330 | Low |
| Percut Kit 17fr X 18cm Femoral Arterial | other | $198 | $88 to $330 | Low |
| Ensnare 7fr 45mm #en2007045 | other | $199 | $88 to $331 | Low |
| Acyclovir 200 Mg/5 Ml Susp | other | $199 | $88 to $331 | Low |
| Dressing Dermabond Prineo (2/bx) #clr222us | other | $199 | $88 to $331 | Low |
| Mitomycin 1.5 Ml (0.4 Mg/ Ml) - for Ophthalmic Use Only - Compounded | other | $200 | $89 to $334 | Low |
| Injection, Ropivacaine Hydrochloride, 1 Mg | other | $200 | $89 to $334 | Low |
| Mtp Cone Reamer 22mm Gen #58890222 | other | $201 | $89 to $334 | Low |
| ACL Reconstruction | surgery | $201 | $89 to $9,920 | High |
| Arthrex Acl Fibertag Tightrope Abs Implant #ar-1588tnt | surgery | $201 | $89 to $335 | Low |
| Forcep Biopsy Oval Cup 3.3frx15cm #g15054 | lab | $201 | $89 to $335 | Low |
| Anesthesia for Tying OR Incision of Fallopian Tubes Using an Endoscope | other | $202 | $73 to $851 | Low |
| Injection, Ganciclovir Sodium, 500 Mg | other | $202 | $51 to $336 | Low |
| Injection, Chlorothiazide Sodium, Per 500 Mg | other | $202 | $90 to $337 | Low |
| Dissector Ultrasonic 13cm #scd13 Sonicision | other | $204 | $90 to $340 | Low |
| Dissector Ultrasonic 26cm #scd26 Sonicision | other | $204 | $90 to $340 | Low |
| Injection, Adenosine, 1 Mg | other | $204 | $91 to $340 | Low |
| Wand ENT Procise Max W/cable #eica8898 | other | $204 | $91 to $341 | Low |
| 2.3mm X 30.0mm Tapered Routerstryker# 5130-071-223s1 | other | $205 | $91 to $341 | Low |
| Injection, Moxifloxacin, 100 Mg | other | $205 | $91 to $342 | Low |
| Injection, Linezolid, 200 Mg | other | $206 | $91 to $343 | Low |
| Revision OR Removal of Sacral Integrated Nerve Stimulating System with Electr... | surgery | $206 | $91 to $686 | Low |
| OB Cath System Bakri Balloon #g24237 | other | $206 | $91 to $344 | Low |
| Cervical, Collar, Semi-rigid, Thermoplastic Foam, Two Piece with Thoracic Ext... | other | $208 | $92 to $347 | Low |
| Hemostat Surgicel Snow 4x4 Absrb Ster #2083 | other | $208 | $92 to $347 | Low |
| Cables Ensite X Livewire Deca #d-ens-l/r-hod-cbl | other | $210 | $93 to $350 | Low |
| Concave Cone Reamer 21mm P04 N0033 | other | $210 | $93 to $350 | Low |
| Cone Reamer 23mm Non-sterile P04 N0034 | other | $210 | $93 to $350 | Low |
| Convex Cup Reamer 21mm P04 N0023 | other | $210 | $93 to $350 | Low |
| Cup Reamer 23mm Non-sterile P04 N0024 | other | $210 | $93 to $350 | Low |
| Mic-key Gastric Jejunal Feeding Tube K 1 Ea/ca 0270-18-2.3 | other | $211 | $93 to $351 | Low |
| Ipol Vial | other | $212 | $94 to $354 | Low |
| Angiojet Power Pulse Kit #104834 | other | $212 | $94 to $354 | Low |
| Needle Biopsy Fine Endobronchial Ultrasound Acquire Pulmonary M00552350 | imaging | $212 | $94 to $354 | Low |
| Forcep Bipolar Non Stick with Stop Insulated 0.5mm Tip 8 1/2in Buzz Hardy #nh05 | other | $213 | $94 to $354 | Low |
| Biocomposite Corkscrew Ft Suture Anchor 4.75 Mm X 14 Mm W/two 1.3 Mm Sutureta... | other | $213 | $94 to $355 | Low |
| Kit-interstim Neurostimulator Extern #353101 | other | $213 | $94 to $355 | Low |
| Upper Extremity Fracture Orthosis, Humeral, Prefabricated, Includes Fitting a... | other | $213 | $94 to $710 | Low |
| IUD Insertion | other | $214 | $55 to $712 | High |
| Brachytherapy Source, Non-stranded, Non-high Dose Rate Iridium-192, Per Source | other | $215 | $95 to $909 | Low |
| Injection, Vasopressin, 1 Unit | other | $216 | $96 to $360 | Low |
| Nitirol Tipped Stone Extractor G36250 | other | $217 | $96 to $361 | Low |
| Injection, Micafungin Sodium, 1 Mg | other | $217 | $96 to $362 | Low |
| Sodium Floride F 18 Diagnostic 30 Mci | other | $218 | $97 to $363 | Low |
| Gradient Compression Garment, Arm, Padded, for Nighttime Use, Each | other | $218 | $97 to $363 | Low |
| Osteocool Bone Access Kit 10g | other | $218 | $97 to $364 | Low |
| Dissector Ultrasonic 39cm #scd396 Sonicision | other | $219 | $97 to $365 | Low |
| Penumbra Max Canister | other | $219 | $97 to $365 | Low |
| Laser Fiber 150 Micron Tfl Single Use Tfl-fbx150s 5/box | other | $220 | $97 to $366 | Low |
| Laser Fiber 200 Micron Tfl Single Use Tfl-fbx200s 5/box | other | $220 | $97 to $366 | Low |
| Laser Fiber 365 Micron Tfl Single Use Tfl-fbx365s 5/box | other | $220 | $97 to $366 | Low |
| Arterial Cannula 19fr 96530 | other | $220 | $97 to $366 | Low |
| Injection, Sodium Ferric Gluconate Complex in Sucrose Injection, 12.5 Mg | other | $220 | $4 to $367 | Low |
| Injection, Vinorelbine Tartrate, 10 Mg | other | $221 | $8 to $368 | Low |
| Staple Boyd Fixation Medium Short #128724 | other | $221 | $98 to $369 | Low |
| Clinimix 8%-10% Solution | other | $222 | $98 to $370 | Low |
| Injection, Amiodarone Hydrochloride (nexterone), 30 Mg | other | $222 | $98 to $370 | Low |
| Hc Monitored Anesthesia Care Anesthesia Time - Initial Base Charge | other | $223 | $99 to $372 | Low |
| Low Osmolar Contrast Material, 200-299 Mg/ml Iodine Concentration, Per Ml | other | $224 | $99 to $373 | Low |
| Ligasure 5mm #ls1500 | other | $224 | $99 to $373 | Low |
| Basket Memory 2x4cm Eight Wire ERCP G21538 | other | $224 | $99 to $374 | Low |
| ERCP (Gallstone Removal) | other | $224 | $99 to $5,821 | High |
| Knife Bayonet Disc Non Pt Charge | other | $226 | $100 to $376 | Low |
| Red Blood Cells, Leukocytes Reduced, Each Unit | other | $227 | $101 to $378 | Low |
| Balloon Seeker 6x7mm Em Maxl #1830607max | other | $227 | $101 to $378 | Low |
| Injection, Dihydroergotamine Mesylate, Per 1 Mg | other | $227 | $101 to $378 | Low |
| 6' Dx Cable 10 Pin #c6tmrmst10sa | other | $227 | $101 to $379 | Low |
| Ligasure Small Jaw Open #lf1212a | other | $229 | $101 to $381 | Low |
| Blind Obt 22.5fr for A20914a #a20906a | other | $229 | $102 to $382 | Low |
| Blind Obturator for A20931a 17fr #a20909a | other | $229 | $102 to $382 | Low |
| Methohexital 100 Mg/10ml-water | other | $229 | $102 to $382 | Low |
| Potassium Phosp 45 Mmol/15 Ml | other | $230 | $102 to $383 | Low |
| Ankle Foot Orthosis, Plastic OR Other Material, Prefabricated, Includes Fitti... | other | $230 | $102 to $383 | Low |
| Tisseel Vhsd Frozen Prima 10ml #1506080 | other | $230 | $102 to $383 | Low |
| Injection, Azacitidine, 1 Mg | other | $230 | $230 to $384 | Low |
| Combivent Respimat 20-100 Mcg | other | $230 | $102 to $384 | Low |
| Shingrix Vial Kit | other | $230 | $102 to $384 | Low |
| Catheter, Electrophysiology, Diagnostic, Other Than 3d Mapping | cardiac | $230 | $102 to $384 | Low |
| Immediate Post Surgical OR Early Fitting, Application of Non-weight Bearing R... | surgery | $231 | $102 to $501 | Low |
| Aztreonam 1 G/3ml Ij | other | $231 | $102 to $385 | Low |
| Aztreonam 1 Gm Vial | other | $231 | $102 to $385 | Low |
| Alexis Extraction System #gtk17 | other | $231 | $102 to $385 | Low |
| Fiber Laser 365um 6j 80hz 120w D/f/l for Lithotripsy Moses Ac | other | $232 | $103 to $386 | Low |
| Topaz Ifs Microdebrider Wand Ez #ach4041 | other | $232 | $103 to $387 | Low |
| Forcep Bipolar Non Stick Insulated 1.2mm Tip 7 1/2in Buzz Cushing #n19c12 | other | $232 | $103 to $387 | Low |
| Tumor Markers 1 Inteliq 6x2ml #12008289 | other | $233 | $103 to $388 | Low |
| Tumor Markers 2 Inteliq 6x2ml #12008290 | other | $233 | $103 to $388 | Low |
| Loop Cysview Bipolar 24/26fr Longitudinal | other | $234 | $104 to $390 | Low |
| Ambulatory Infusion Pump, Single OR Multiple Channels, Electric OR Battery Op... | surgery | $235 | $104 to $782 | Low |
| Laser Fiber 1000mic #dfs-1000sb | other | $235 | $104 to $391 | Low |
| Electrode Hf Band 30deg #wa22623s | other | $235 | $104 to $392 | Low |
| Electrode Hf Loop Med 30deg #wa22606s | other | $235 | $104 to $392 | Low |
| Lumbar Drainage Kit #10 | other | $236 | $105 to $393 | Low |
| Removal of Bone, Each Additional 20.0 SQ Cm OR Less | surgery | $236 | $80 to $11,047 | Low |
| Clamp Lrg Open Adjustable External Mr Safe | other | $236 | $105 to $393 | Low |
| Needle Acquire Fnb 22 Ga #m00555540 1ea/1bx | other | $236 | $105 to $394 | Low |
| Injection, Betamethasone Acetate 3 Mg and Betamethasone Sodium Phosphate 3 Mg | other | $237 | $105 to $395 | Low |
| Injection, Glucagon Hydrochloride (fresenius Kabi), Not Therapeutically Equiv... | other | $238 | $106 to $397 | Low |
| Graft Hemashield 15cm 18mm #m00202175118p0 | other | $239 | $106 to $399 | Low |
| Graft Oh Hemashield 15cm 24mm #175124p | other | $239 | $106 to $399 | Low |
| Norepinephrine 16 Mg / 250 Ml Ns Bag (quad Concentrate) - Compounded | other | $239 | $106 to $399 | Low |
| Cables Ensite X Inquiry Deca #d-ens-inq-od-cbl | other | $240 | $106 to $400 | Low |
| Carpal Tunnel Release | surgery | $240 | $47 to $1,806 | High |
| Ensite X Duo Deca X Cable #d-ens-l/r-ddy-cbl | other | $240 | $106 to $400 | Low |
| Port, Indwelling | other | $240 | $106 to $400 | Low |
| Vitality Polyaxial 7.0x55mm #701m7055 | other | $240 | $106 to $400 | Low |
| All Lower Extremity Prostheses, Foot, Single Axis Ankle/foot | other | $241 | $107 to $402 | Low |
| Needle Del Sys 360 Curved 72202468 | other | $242 | $107 to $404 | Low |
| Needle Del Sys 360 Reverse Curved #72202469 | other | $242 | $107 to $404 | Low |
| Hydratome Rx44 450cm X .035" 20mm Cut Wire | other | $245 | $109 to $408 | Low |
| Electrode Plasmabutton 12/30deg #wa22657s | other | $245 | $109 to $408 | Low |
| Cellutome Harvester 5cm X 5cm #ct-h50 | other | $246 | $109 to $410 | Low |
| Graft Oh Hemashield 15cm 22mm #m00202175122p0 | other | $246 | $109 to $410 | Low |
| Foot, Insert, Removable, Molded to Patient Model, 'ucb' Type, Berkeley Shell,... | other | $247 | $109 to $411 | Low |
| Adult Venous Cannula 25fr 96600 | other | $247 | $109 to $411 | Low |
| Adult Venous Cannula 96600 | other | $247 | $109 to $411 | Low |
| Percut Kit 21fr X 60cm Femoral Venous | other | $247 | $109 to $411 | Low |
| Percut Kit 25fr X 60cm Femoral Venous | other | $247 | $109 to $411 | Low |
| Loop Cysview 24/26 Fr Bipolar Std27040gp130-s | other | $248 | $110 to $413 | Low |
| Walking Boot, Pneumatic And/or Vacuum, with OR without Joints, with OR withou... | other | $248 | $110 to $828 | Low |
| Adapalene 0.1 % Ex Gel | other | $250 | $111 to $417 | Low |
| Guide Precision Bipolar Clear 6ea/bx | other | $252 | $112 to $419 | Low |
| Addition to Lower Extremity Fracture Orthosis, Hip Joint, Pelvic Band, Thigh ... | other | $252 | $112 to $421 | Low |
| Assistant W/stable Soft 3l #401-209s | other | $253 | $112 to $422 | Low |
| Intermediate Repair of Wound of Face, Ears, Eyelids, Nose, Lips, OR Mouth, 20... | surgery | $254 | $113 to $12,056 | Low |
| Intermediate Repair of Wound of Face, Ears, Eyelids, Nose, Lips, OR Mouth, Mo... | surgery | $254 | $113 to $12,057 | Low |
| Graft Hemashield 15cm 28mm #175128p | other | $255 | $113 to $425 | Low |
| Graft Hemashield 15cm 30mm #175130p | other | $255 | $113 to $425 | Low |
| Graft Hemashield 15cm 32mm #175132p | other | $255 | $113 to $425 | Low |
| Graft Hemashield 15cmx38mm #175138p | other | $255 | $113 to $425 | Low |
| Pad Temp Arctic Sun Universal #317-00 | other | $256 | $113 to $426 | Low |
| Tetracaine 1% (20 Mg/2 Ml) Vl | other | $256 | $113 to $426 | Low |
| Electrode Electrosurgical 24fr Angled Needle 12-30deg Hf Resection Plasma Nee... | surgery | $257 | $114 to $429 | Low |
| Electrode Electrosurgical 24fr Standard Band 12-30deg Hf Resection Plasma Ban... | surgery | $257 | $114 to $429 | Low |
| Esg Plasmaloop - Long Medium Wa22737s Bx/5ea | other | $257 | $114 to $429 | Low |
| Generator Electrosurgical M Plasmaloop #wa22706s | surgery | $257 | $114 to $429 | Low |
| Loop TURP Plasmakinetic Superpuls #784415 | other | $258 | $114 to $430 | Low |
| Proximal Reamer Headless 2.0mm Non-sterile #cd-fx | other | $259 | $115 to $432 | Low |
| Proximal Reamer Headless 2.0mm Sterile #cd-fx-2520-s | other | $259 | $115 to $432 | Low |
| Proximal Reamer Headless 3.0mm #cd-fx | other | $259 | $115 to $432 | Low |
| Ligasure Maryland Short Jaw #lf1923 | other | $261 | $116 to $435 | Low |
| Prostate Biopsy | other | $261 | $95 to $878 | High |
| Upper Extremity Fracture Orthosis, Radius/ulnar, Prefabricated, Includes Fitt... | other | $261 | $116 to $870 | Low |
| Atrovent 17 Mcg Hfa Inhaler | other | $261 | $116 to $436 | Low |
| Hyaluronan OR Derivative, Hyalgan, Supartz OR Visco-3, for Intra-articular In... | other | $263 | $78 to $438 | Low |
| **discontinued**laser Fiber 200 Ball Tip #m0068403961 | other | $263 | $116 to $438 | Low |
| Pronto Lp #5010 | other | $265 | $118 to $442 | Low |
| Centered Nano Alto Partial #651 1/bx | other | $266 | $118 to $443 | Low |
| Centered Nano Alton Total #611 1/bx | other | $266 | $118 to $443 | Low |
| Bss Plus Eye Irrig Solution | other | $267 | $118 to $445 | Low |
| Snare Kit 18-30mm #382007030 | other | $268 | $119 to $446 | Low |
| Flexiva Pulse Id Tractip M006l8406960 | other | $268 | $119 to $447 | Low |
| Electrode Plasma Button Front Loading | other | $269 | $119 to $448 | Low |
| Allograft Mis Dispenser Bl-1900-gun | other | $270 | $120 to $450 | Low |
| Cables Ensite X Advisor/grid #d-ens-avse-6-cbl | other | $270 | $120 to $450 | Low |
| Ligasure Maryland Jaw #lf1937 6/cs | other | $270 | $120 to $450 | Low |
| Metatarsal Reamer 16 Mm #ar-8944mr | other | $270 | $120 to $450 | Low |
| Metatarsal Reamer 18 Mm #ar-8944mr | other | $270 | $120 to $450 | Low |
| Metatarsal Reamer 20 Mm #ar-8944mr | other | $270 | $120 to $450 | Low |
| Metatarsal Reamer 22 Mm #ar-8944mr | other | $270 | $120 to $450 | Low |
| Phalangeal Reamer 14 Mm #ar-8944pr | other | $270 | $120 to $450 | Low |
| Phalangeal Reamer 16 Mm #ar-8944pr | other | $270 | $120 to $450 | Low |
| Phalangeal Reamer 18 Mm #ar-8944pr | other | $270 | $120 to $450 | Low |
| Phalangeal Reamer 20 Mm #ar-8944pr | other | $270 | $120 to $450 | Low |
| Phalangeal Reamer 22 Mm #ar-8944pr | other | $270 | $120 to $450 | Low |
| Breast Prosthesis, Silicone OR Equal, with Integral Adhesive | other | $270 | $120 to $451 | Low |
| Breast Prosthesis, Silicone OR Equal, without Integral Adhesive | other | $270 | $120 to $451 | Low |
| Children's Tylenol 160 Mg/5 Ml | other | $272 | $121 to $454 | Low |
| Graft Hemashield 15cm 34mm #175134p M00202175134po | other | $273 | $121 to $455 | Low |
| Tlso Flexible, Provides Trunk Support, Extends From Sacrococcygeal Junction t... | other | $275 | $122 to $458 | Low |
| Retinal Tamponade Device, Silicone Oil | other | $276 | $122 to $460 | Low |
| Wrist Hand Finger Orthosis, Rigid without Joints, May Include Soft Interface ... | other | $276 | $122 to $920 | Low |
| Wilson Retractor System Tlc-5042-m | other | $277 | $123 to $461 | Low |
| Liver Access/ Biopsy Needle Set | lab | $280 | $124 to $466 | Low |
| Porous Purified Collagen Matrix Bone Void Filler (integra Mozaik Osteoconduct... | other | $280 | $124 to $466 | Low |
| Tunneler #402 Vns Cyberonics | other | $281 | $124 to $468 | Low |
| All Lower Extremity Prostheses, Foot, Flexible Keel | other | $281 | $125 to $468 | Low |
| Dressing Ab Thera Sensa Trac #m8275026/5 | other | $281 | $125 to $469 | Low |
| Loop TURP Plasmakinetic Supersect #784515 | other | $283 | $126 to $472 | Low |
| Clamp Lrg Combination #390.005 External | other | $287 | $127 to $478 | Low |
| Addition to Lower Extremity, Test Socket, Below Knee | other | $288 | $127 to $479 | Low |
| Nipride Rtu 50 Mg/100 Ml Vial | other | $288 | $128 to $479 | Low |
| Addition to Lower Extremity, Socket Insert, Below Knee | other | $291 | $129 to $485 | Low |
| Lead, Neurostimulator Test Kit | other | $291 | $129 to $485 | Low |
| Patch Pericardial W/encap 9x14cm #c0914 | other | $291 | $129 to $485 | Low |
| Snare Kit 27-45mm #382007045 | other | $291 | $129 to $485 | Low |
| Wrist Hand Finger Orthosis, Includes One OR More Nontorsion Joint(s), Turnbuc... | other | $291 | $129 to $970 | Low |
| Cardene-nacl 40 Mg/200 Ml IV | other | $292 | $130 to $487 | Low |
| Clinimix 4.25%-10% Solution | other | $292 | $130 to $487 | Low |
| Clinimix 4.25%-5% Solution | other | $292 | $130 to $487 | Low |
| Fiber Laser 200um 2j 80hz 60w D/f/l for Lithotripsy Moses Ac | other | $293 | $130 to $488 | Low |
| Differin 0.1% Cream | other | $293 | $130 to $488 | Low |
| Bone Dowel Revision Kit 10 Mm #abs-2850 | other | $294 | $130 to $490 | Low |
| Mantis 235cm Closure Clip #m00521422 Bx/20 | other | $294 | $130 to $490 | Low |
| Forcep Spybite Biopsy #moo546270 | lab | $296 | $131 to $494 | Low |
| Spybite Max Biopsy Forceps #m00546470 | lab | $296 | $131 to $494 | Low |
| Addition to Lower Extremity, Lacer Molded to Patient Model, for Custom Fabric... | other | $297 | $132 to $495 | Low |
| Blade Kahook Dual#kdb Glide | other | $297 | $132 to $495 | Low |
| Ligasure Exact Dissector Lf2019 6ea/1cs | other | $298 | $132 to $496 | Low |
| Addition to Lower Extremity, Below Knee, Total Contact | other | $299 | $132 to $498 | Low |
| 12x11x14mm 7 Degree Vista-s Dev #06-401 | other | $300 | $133 to $500 | Low |
| 5x11x14mm Vista-s Dev #06-401 | other | $300 | $133 to $500 | Low |
| Harvest and Injections of Platelet Rich Plasma Using Imaging Guidance | other | $300 | $133 to $1,000 | Low |
| Lead, Pacemaker, Other Than Transvenous Vdd Single Pass | cardiac | $300 | $133 to $500 | Low |
| Hith Kit #inshith | other | $301 | $133 to $502 | Low |
| Bear Claw Otsc Sys Set 11/6t 165cm #100.10 | other | $305 | $135 to $509 | Low |
| Bear Claw Otsc Sys Set 12/6t 220cm #100.31 | other | $305 | $135 to $509 | Low |
| Otsc 11/6a Bear Claw System Set #100.09 | other | $305 | $135 to $509 | Low |
| Dissector Spacemaker Pro 10mm-12mm #smsbtovlx | cardiac | $306 | $136 to $510 | Low |
| Prog Eval Inper Leadls Pm | other | $307 | $136 to $1,024 | Low |
| Spy Bite Basket Retrieval Working L286cm Channel 1.2mm Cable Dia 1mm for Dire... | other | $309 | $137 to $515 | Low |
| Sonicone OR Sharpvac Mxc-c2-vac 5ea/1bx | other | $310 | $137 to $516 | Low |
| Sonicvac Kit Mxc-x2-vac 5ea/bx | other | $310 | $137 to $516 | Low |
| Graft Hemashield 30cm X 6mm #175206p | other | $311 | $138 to $518 | Low |
| Graft Hemashield 30cm X 8mm #175208p | other | $311 | $138 to $518 | Low |
| Stapler Hemorrhoid Ph #ppho3 3/bx | other | $312 | $138 to $519 | Low |
| Hernia Tacker #abstack30 | other | $312 | $138 to $521 | Low |
| Electrode Electrosurgical Resection with Hf Cable Plasma Oval Button | surgery | $313 | $139 to $521 | Low |
| Tlso, Triplanar Control, Hyperextension, Rigid Anterior and Lateral Frame Ext... | other | $313 | $139 to $529 | Low |
| Arexvy Vial Kit | other | $314 | $139 to $523 | Low |
| Fiber Laser 550um 6j 80hz 120w D/f/l for Lithotripsy Moses Ac | other | $315 | $140 to $525 | Low |
| 3.0 Knotless Suture Tak Anchor #ar-8934bck | other | $315 | $140 to $525 | Low |
| Arthrex Acl Fibertag Tightrope Implant #ar-1588rtt | surgery | $315 | $140 to $525 | Low |
| Nano Swivelock Suture Anchor #ar-8998t | other | $315 | $140 to $525 | Low |
| Nanoneedle Scope 125 Mm #ar-3210 | other | $315 | $140 to $525 | Low |
| Clamp Large Multi-pin 4position External | other | $317 | $140 to $528 | Low |
| Mantis Closure Clip Box 10 #m00521421 | other | $317 | $140 to $528 | Low |
| Versajet Ii Plus Handset 45deg/14mm #66800044 | other | $317 | $141 to $529 | Low |
| Versajet Ii Plus Handset 45deg/8mm #66800045 | other | $317 | $141 to $529 | Low |
| Autoinjector Endologix #tv-a101-n | other | $318 | $141 to $530 | Low |
| Computer-assisted, Fluoroscopic Image-guided Musculoskeletal Surgical Navigat... | surgery | $318 | $116 to $1,060 | Low |
| External Counterpulsation, Per Treatment Session | other | $318 | $96 to $1,060 | Low |
| Ventriculostomy Kit - Ghajar Guide | other | $323 | $143 to $538 | Low |
| Clamp Large Multi-pin External Fix 6 Position | other | $326 | $144 to $543 | Low |
| Primatrix, Per Square Centimeter | other | $327 | $119 to $544 | Low |
| Epifix OR Epicord | other | $327 | $145 to $1,090 | Low |
| Mesh Fixation Device 5mm W/25 Absorb Straps | other | $327 | $145 to $546 | Low |
| Laser Fiber 150 Micron Tfl Ball Tip Single Use Tfl-fbx150bs 5/box | other | $328 | $145 to $546 | Low |
| Laser Fiber 200 Micron Tfl Ball Tip Single Use Tfl-fbx200bs 5/box | other | $328 | $145 to $546 | Low |
| Injection, Hyaluronidase, Recombinant, 1 Usp Unit | other | $328 | $328 to $547 | Low |
| Addition to Lower Extremity, Below Knee, Acrylic Socket | other | $329 | $146 to $548 | Low |
| Needle Acquire Fnb 19 Ga #m00555580 1ea/1bx | other | $329 | $146 to $549 | Low |
| Endoclip Cartridge M/l-#1112 Microline Clip Titanium K2 Single Use 19/clip 10/bx | other | $329 | $146 to $549 | Low |
| Obturator 24 Fr #a22081a | other | $329 | $146 to $549 | Low |
| Drg Tunneling Tool #mn15000 | other | $330 | $146 to $550 | Low |
| Flexcath Cross Ag 61cm # 900300 | other | $330 | $146 to $550 | Low |
| Flexcath Cross Ag 71cm# 900301 | other | $330 | $146 to $550 | Low |
| Flexcath Cross Fc 65cm# 900304 | other | $330 | $146 to $550 | Low |
| Flexcath Cross Sl 63cm# 900302 | other | $330 | $146 to $550 | Low |
| Flexcath Cross Sl 81cm# 900309 | other | $330 | $146 to $550 | Low |
| Flexcath Cross Vz 71cm# 900303 | other | $330 | $146 to $550 | Low |
| Flexcath Cross Wt 75cm# 900308 | other | $330 | $146 to $550 | Low |
| Jeti Non-sterile Cannister Set Wv1500a | other | $330 | $146 to $550 | Low |
| Reference Patch Carto 3 (6pack) #crefp6 | other | $330 | $146 to $550 | Low |
| Cisatracurium 200 Mg/20 Ml Vl | other | $330 | $146 to $550 | Low |
| Repair of Prosthetic Device, Repair OR Replace Minor Parts | surgery | $331 | $147 to $551 | Low |
| Atrial Depressor W/quick Connect Clearview Mv | other | $334 | $148 to $557 | Low |
| Hip Knee Ankle Foot Orthosis, Torsion Control, Bilateral Torsion Cables, Hip ... | other | $335 | $148 to $559 | Low |
| Acutrak 2 Drill Acumed #at2-m1813 | other | $335 | $148 to $558 | Low |
| Prevena Plus System Kit #pre4001us | other | $335 | $149 to $559 | Low |
| Sensor Persona Cr Zimmer Bio Cd39-l Zbh-psncr | other | $335 | $149 to $559 | Low |
| Sensor Persona Cr Zimmer Bio Cd39-r Zbh-psncr | other | $335 | $149 to $559 | Low |
| Sensor Persona Cr Zimmer Bio Ef311l Zbh-psncr | other | $335 | $149 to $559 | Low |
| Sensor Persona Cr Zimmer Bio Ef311r Zbh-psncr | other | $335 | $149 to $559 | Low |
| Sensor Persona Cr Zimmer Bio Gh712l Zbh-psncr | other | $335 | $149 to $559 | Low |
| Sensor Persona Cr Zimmer Bio Gh712r Zbh-psncr | other | $335 | $149 to $559 | Low |
| Verasense Journey Bcs 1-2 Lt #snn-jrnybcs12-l | other | $335 | $149 to $559 | Low |
| Verasense Journey Bcs 1-2 Rt #snn-jrnybcs12-r | other | $335 | $149 to $559 | Low |
| Verasense Journey Bcs 3-4 Lt #snn-jrnybcs34-l | other | $335 | $149 to $559 | Low |
| Verasense Journey Bcs 3-4 Rt #snn-jrnybcs34-r | other | $335 | $149 to $559 | Low |
| Verasense Journey Bcs 5-6 Lt #snn-jrnybcs56-l | other | $335 | $149 to $559 | Low |
| Verasense Journey Bcs 5-6 Rt #snn-jrnybcs56-r | other | $335 | $149 to $559 | Low |
| Verasense Journey Bcs 7-8 Lt #snn-jrnybcs78-l | other | $335 | $149 to $559 | Low |
| Verasense Journey Bcs 7-8 Rt #snn-jrnybcs78-r | other | $335 | $149 to $559 | Low |
| Verasense Legion Ps 1-2 #snn-lgnps12 | other | $335 | $149 to $559 | Low |
| Verasense Legion Ps 3-4 #snn-lgnps34 | other | $335 | $149 to $559 | Low |
| Verasense Legion Ps 5-6 #snn-lgnps56 | other | $335 | $149 to $559 | Low |
| Verasense Legion Ps 7-8 #snn-lgnps78 | other | $335 | $149 to $559 | Low |
| Graft Accessory Component Kit #hero 1003 | other | $336 | $149 to $560 | Low |
| Progreat 2.8fr Microcatheter Mc*pe28151yv 1ea/1box | cardiac | $336 | $149 to $560 | Low |
| Scrotal Retraction System Skw Deep #72403867 | other | $336 | $149 to $560 | Low |
| Laser Fiber 550 Micron Tfl Single Use Tfl-fbx550s 5/box | other | $337 | $150 to $562 | Low |
| Injection, Epoetin Alfa, (for Non-esrd Use), 1000 Units | other | $338 | $9 to $563 | Low |
| Bipolar Sealer 2.3 Neuro Aquamantys | other | $338 | $150 to $563 | Low |
| Surgical Supply; Miscellaneous | surgery | $339 | $150 to $565 | Low |
| Retractor-reddick Saye Screw #e2504 | other | $339 | $150 to $566 | Low |
| Chord-x Pre-measured Loops for Mitral Chordal Replacement 2-0 U.s.p 16mm Cxl-... | surgery | $340 | $151 to $566 | Low |
| Mantis Clip L235cm 2.8mm Minimum Working Channel #m00521420 | other | $340 | $151 to $567 | Low |
| Injection, Vinblastine Sulfate, 1 Mg | other | $340 | $4 to $567 | Low |
| Elbow Orthosis (eo), with Adjustable Position Locking Joint(s), Prefabricated... | other | $342 | $152 to $1,140 | Low |
| Dispensing Fee, Monaural Hearing Aid, Any Type | other | $343 | $152 to $1,143 | Low |
| Laser Fiber Sidefire 600 #ftir600 | other | $343 | $152 to $572 | Low |
| Harmonic Ace Curved Shears Xi #480275 6ea/1bx | other | $343 | $152 to $572 | Low |
| Clamp 4.0 Adj for Distal Radius Fixatr Extern | other | $344 | $153 to $573 | Low |
| Gps User Kit for Gps Station V2 Ref# A10012 | other | $345 | $153 to $575 | Low |
| Intraocular Vancomycin 10 Mg/ Ml- **10ml** (for Dr. Ouano) - Compounded | other | $347 | $154 to $578 | Low |
| 8mm Blunt Xi #470008 | other | $347 | $154 to $578 | Low |
| Addition to Lower Extremity, Suction Suspension, Above Knee OR Knee Disarticu... | other | $351 | $156 to $586 | Low |
| Ligasure Impact #lf4418 | other | $352 | $156 to $586 | Low |
| Cannula 8mm #420002 | other | $353 | $156 to $588 | Low |
| Clinimix 5%-15% Solution | other | $353 | $156 to $588 | Low |
| Fluzone High-dose Triv 2024 | other | $354 | $157 to $589 | Low |
| Gradient Compression Garment, Glove, Padded, for Nighttime Use, Custom, Each | other | $356 | $158 to $593 | Low |
| Astigmatism Correcting Function of Intraocular Lens | other | $357 | $158 to $595 | Low |
| Vessel Sealer (6/bx) #410322 | other | $357 | $158 to $595 | Low |
| Vessel Sealer # 480322 Intuitive Surgical | surgery | $357 | $158 to $595 | Low |
| Obturator Deflecting Tip 24 Fr #a22085 | other | $358 | $159 to $596 | Low |
| Proximal Reamer Cannulated 3.0mm #cd-fx | other | $359 | $159 to $598 | Low |
| Aveta Smol Disposable Resecting Device 2.9mm #210-100 3/ctn | other | $360 | $160 to $600 | Low |
| Dispensing Fee, Binaural | other | $360 | $160 to $1,200 | Low |
| Laser Fiber Sidefire 550 | other | $360 | $160 to $600 | Low |
| Auto-id Quad Cable; Vizigo Cable #cy1212ct | other | $362 | $161 to $604 | Low |
| Carto 3 Ablation Cable Irrigated #cr3434ct | other | $362 | $161 to $604 | Low |
| Carto 3 Dx Cable Vizigo #cb3412ct | other | $362 | $161 to $604 | Low |
| Decanav Cable #cb3434ct | other | $362 | $161 to $604 | Low |
| Pentaray and Lasso Cable #d134401 | other | $362 | $161 to $604 | Low |
| Ligasure Retractable L-hook 37cm Lf5637 6/cs | other | $363 | $161 to $605 | Low |
| Dressing Kit Open Abdomen Abthera Advance | other | $365 | $162 to $609 | Low |
| Viscoat Syringe | other | $366 | $162 to $610 | Low |
| Obturator Optical 24 Fr #a22071a | other | $370 | $164 to $616 | Low |
| Repair Device, Urinary, Incontinence, without Sling Graft | surgery | $372 | $165 to $620 | Low |
| Addition, Endoskeletal System, Below Knee, Alignable System | other | $375 | $166 to $624 | Low |
| Injection, Decitabine, 1 Mg | other | $376 | $3 to $626 | Low |
| Addition to Lower Extremity, Test Socket, Above Knee | other | $376 | $167 to $627 | Low |
| Cervical, Multiple Post Collar, Occipital/mandibular Supports, Adjustable Cer... | other | $377 | $167 to $629 | Low |
| Cannula 8 Mm Size Reusable for Da Vinci X/xi Endoscopic System #470002 | other | $378 | $168 to $630 | Low |
| Injection, Paclitaxel, 1 Mg | other | $378 | $378 to $631 | Low |
| Azactam 2 Gm Vial | other | $380 | $169 to $634 | Low |
| Injection, Aztreonam, 100 Mg | other | $380 | $169 to $634 | Low |
| Cup Removal System 52mm #00705305220 | surgery | $384 | $170 to $640 | Low |
| Cup Removal System Full 48mm #00705304820 | surgery | $384 | $170 to $640 | Low |
| Cup Removal System Full 50mm #00705305020 | surgery | $384 | $170 to $640 | Low |
| Cup Removal System Full 54mm #00705305420 | surgery | $384 | $170 to $640 | Low |
| Cup Removal System Full 56mm #00705305620 | surgery | $384 | $170 to $640 | Low |
| Cup Removal System Full 58mm #00705305820 | surgery | $384 | $170 to $640 | Low |
| Cup Removal System Full 60mm #00705306020 | surgery | $384 | $170 to $640 | Low |
| Cup Removal System Truncatd 50mm #00705305010 | surgery | $384 | $170 to $640 | Low |
| Cup Removal System Truncatd 52mm #00705305210 | surgery | $384 | $170 to $640 | Low |
| Cup Removal System Truncatd 54mm #00705305410 | surgery | $384 | $170 to $640 | Low |
| Cup Removal System Truncatd 58mm #00705305810 | surgery | $384 | $170 to $640 | Low |
| Injection, Degarelix, 1 Mg | other | $386 | $4 to $644 | Low |
| Nicardipin 40mg/200ml-0.9%nacl | other | $389 | $173 to $649 | Low |
| Ankle Foot Orthosis, Plastic OR Other Material with Ankle Joint, Prefabricate... | other | $390 | $173 to $650 | Low |
| Catheter Angiographic Coronary OR Peripheral Delivery 45 Degree Angled Tip 15... | imaging | $390 | $173 to $650 | Low |
| Cyberwand Probe Set #cw-rbpbx | other | $390 | $173 to $650 | Low |
| Injection, Methylprednisolone Sodium Succinate, Up to 125 Mg | other | $391 | $173 to $652 | Low |
| Injection, Iron Sucrose, 1 Mg | other | $393 | $393 to $655 | Low |
| Vessel Xi Sealer Extnd #480422 Intuitive Surg | other | $394 | $175 to $656 | Low |
| Injection, Aprepitant, (aponvie), 1 Mg | other | $394 | $2 to $656 | Low |
| Forcep Flexo Grasping #fg53s-x | other | $394 | $175 to $657 | Low |
| Unclassified Biologics | other | $395 | $175 to $658 | Low |
| Nanoscope Handpiece #ar-3210 | other | $395 | $175 to $659 | Low |
| Visual Obturator 22.5 Fr #a20924a | other | $398 | $176 to $663 | Low |
| Laser Fiber 940 Micron Tfl Single Use Tfl-fbx940s 5/box | other | $399 | $177 to $665 | Low |
| Wrist Hand Orthosis, without Joints, May Include Soft Interface, Straps, Cust... | other | $401 | $178 to $668 | Low |
| Addition to Lower Extremity, Pelvic Control, Hip Joint, Adjustable Flexion, E... | other | $405 | $179 to $675 | Low |
| Red Blood Cells, Washed, Each Unit | other | $407 | $180 to $678 | Low |
| Trimark Td 13mr Breast Biopsy Site Marker MRI | imaging | $408 | $181 to $680 | Low |
| Biomed Fiber Optic Probe Assembly Pteye | other | $410 | $182 to $683 | Low |
| Cannula Long 8mm #470004 | other | $410 | $182 to $683 | Low |
| All Lower Extremity Prostheses, Energy Storing Foot | other | $415 | $184 to $692 | Low |
| Pr Rom Rad Therapy Bone Mets, Pc | other | $416 | $185 to $1,388 | Low |
| Fetal Pillow #fp-010 6ea/bx | other | $417 | $185 to $695 | Low |
| Stabilizer Enclose #en240 | other | $417 | $185 to $695 | Low |
| Hyperbaric Oxygen Under Pressure, Full Body Chamber, Per 30 Minute Interval | other | $419 | $132 to $698 | Low |
| Intracept Access Instruments Additional Level #rlv 0075 | other | $420 | $186 to $700 | Low |
| Placement of Occlusive Device Into Either a Venous OR Arterial Access Site, P... | other | $420 | $186 to $1,400 | Low |
| Harmonic Lap Dissector 9cm #har9f 6ea/bx | other | $426 | $189 to $710 | Low |
| Room & Board - Private (one Bed) - Pediatric | other | $426 | $189 to $710 | Low |
| Gelport Laparoscopic Colectomy 120mm | surgery | $429 | $190 to $715 | Low |
| Injection, Rho(d) Immune Globulin (human), (rhophylac), Intramuscular OR Intr... | other | $439 | $6 to $732 | Low |
| Room & Board - Private (one Bed) - General Classification | other | $440 | $195 to $733 | Low |
| Material for Vocal Cord Medialization, Synthetic | other | $441 | $196 to $735 | Low |
| Ankle Orthosis, Supramalleolar with Straps, with OR without Interface/pads, C... | other | $443 | $196 to $738 | Low |
| Twin Grasper Otsc 220cm #200.45 | other | $443 | $197 to $739 | Low |
| Fluciclovine F-18, Diagnostic, 1 Millicurie | other | $448 | $198 to $746 | Low |
| Bactisure Wound Lavage #00888700200(qtys of 6 | other | $450 | $200 to $750 | Low |
| Coil Vascular 2mm X 1cm Ruby #rby4c0201 | other | $450 | $200 to $750 | Low |
| Coil Vascular 2mm X 2cm Ruby #rby4c0202 | other | $450 | $200 to $750 | Low |
| Coil Vascular 2mm X 4cm Ruby #rby4c0204 | other | $450 | $200 to $750 | Low |
| Coil Vascular 3mm X 5cm Ruby #rby4c0305 | other | $450 | $200 to $750 | Low |
| Cooled Radiofrequency Kit #crk-17-75 | other | $450 | $200 to $750 | Low |
| Cooled Rf Probe Kit #crk-17-50 | other | $450 | $200 to $750 | Low |
| Gelpoint Mini Advanced Access Platform | other | $450 | $200 to $750 | Low |
| Hemostatic Agent, Gastrointestinal, Topical | other | $450 | $200 to $750 | Low |
| Pars Suture Implant Ar-8860ds | surgery | $450 | $200 to $750 | Low |
| Ruby Complex Soft 3 Mm X 15 Cm | other | $450 | $200 to $750 | Low |
| Ruby Complex Soft 4 Mm X 6 Cm | other | $450 | $200 to $750 | Low |
| Ruby Complex Standard 3mm X 5cm | other | $450 | $200 to $750 | Low |
| Vas-q-clip Applier 10mm - 45cm #an1462-l | other | $450 | $200 to $750 | Low |
| All Endoskeletal Lower Extremity Prosthesis, Axial Rotation Unit, with OR wit... | other | $451 | $200 to $752 | Low |
| Addition to Lower Extremity, Above Knee OR Knee Disarticulation, Acrylic Socket | other | $455 | $202 to $758 | Low |
| Reamer 40/44 Depuy Low Profile #2230-00 | other | $456 | $202 to $760 | Low |
| Reamer 48/52/56 Depuy #2230-00-031 Low Profil | other | $456 | $202 to $760 | Low |
| Reamer Shoulder 40mm Depuy #223600008 | other | $456 | $202 to $760 | Low |
| Reamer Shoulder 48mm #223000010 Depuy | other | $456 | $202 to $760 | Low |
| Injection, Calcitonin Salmon, Up to 400 Units | other | $457 | $202 to $761 | Low |
| Ankle Foot Orthosis, Double Upright Free Plantar Dorsiflexion, Solid Stirrup,... | other | $458 | $203 to $763 | Low |
| Aspiration And/or Injection of Fluid From Medium Joint Using Ultrasound Guidance | imaging | $459 | $203 to $20,606 | Low |
| Cor-knot Mini Device Kit W/ Loads #031350 | other | $459 | $203 to $765 | Low |
| Carboprost 250 Mcg/ml Vial | other | $460 | $204 to $767 | Low |
| Aortic Balloon Pump Cath 7.5fr 34cc 0684-00-0479-01u | other | $463 | $205 to $771 | Low |
| Nursery - Newborn - Level I | obstetric | $465 | $206 to $774 | Low |
| Fibrin Sealant Patch Large Tachosil #1144922 | other | $466 | $207 to $777 | Low |
| Balloon Seeker 70dg Frt 6x17 #1830617frt0 | other | $467 | $207 to $778 | Low |
| Positioner Heart Urchin Evo #hp3500 | cardiac | $467 | $207 to $779 | Low |
| Reamer / + 5.5mm 03.045.029 | other | $473 | $210 to $789 | Low |
| Lap Harmonic Shear Curved 36cm 6/bx #har36 | other | $473 | $210 to $789 | Low |
| Room & Board - Private (one Bed) - Rehabilitation | therapy | $474 | $210 to $790 | Low |
| Room & Board - Semi-private (two Beds) - General Classification | other | $474 | $210 to $790 | Low |
| Pr Rom Rad Therapy Brain Mets, Pc | other | $475 | $211 to $1,584 | Low |
| Kyphon Osteo Introducer Size 2 #t34a | other | $475 | $211 to $792 | Low |
| Kyphon Osteo Introducer Size 3 #t15j | other | $475 | $211 to $792 | Low |
| Prosthesis, Breast | other | $477 | $211 to $795 | Low |
| Rts Instruments Size 1-2 M03 S0002 | other | $477 | $211 to $795 | Low |
| Olm Intracranial Pressure Monitor Kit 1ea | other | $479 | $212 to $799 | Low |
| Aveta Flex Disposable Resecting Device 2.9mm #210-080 3/ctn | other | $480 | $213 to $800 | Low |
| Fixate Suture Device Band Pk=2ea Fb-201-01 Sc | other | $480 | $213 to $800 | Low |
| Orthoalign Plus Unit #403001 | other | $480 | $213 to $800 | Low |
| Placement of Locating Device in Breast Using Imaging Guidance, Each Additiona... | other | $480 | $40 to $19,282 | Low |
| Echelon Contour Curved Cutter Stapler Blue 2.0 Gcs40g Bx/3ea | other | $485 | $215 to $809 | Low |
| Amniotic Membrane for Surgical Reconstruction, Per Procedure | surgery | $486 | $215 to $810 | Low |
| Waterjet Destruction of Prostrate Accessed Through the Urethra | other | $486 | $215 to $1,620 | Low |
| Hyaluronan OR Derivative, Synvisc OR Synvisc-one, for Intra-articular Injecti... | other | $487 | $8 to $812 | Low |
| Rom Rad Therapy Lymphoma, Pc | other | $497 | $220 to $1,655 | Low |
| Hc an Epidural Block Charge | other | $497 | $220 to $828 | Low |
| Dmsa Injection Kit | other | $501 | $222 to $834 | Low |
| Addition, Endoskeletal System, Below Knee, Flexible Protective Outer Surface ... | other | $502 | $223 to $837 | Low |
| Additions to Lower Extremity, Total Contact, Above Knee OR Knee Disarticulati... | other | $505 | $224 to $842 | Low |
| Inceptiv Programming Handset and Communicator #th91scsr | other | $505 | $224 to $842 | Low |
| Spinal Pt Programmer #97740 Restoresensor | other | $505 | $224 to $842 | Low |
| Gradient Compression Garment, Arm, Padded, for Nighttime Use, Custom, Each | other | $517 | $229 to $861 | Low |
| Addition, Endoskeletal System, Below Knee, Ultra-light Material | other | $519 | $230 to $865 | Low |
| Ankle Foot Orthosis, Plastic OR Other Material, Custom Fabricated | other | $519 | $230 to $865 | Low |
| Room & Board - Private | other | $525 | $233 to $875 | Low |
| Addition to Lower Extremity, Pre-tibial Shell, Molded to Patient Model | other | $529 | $235 to $882 | Low |
| Hyaluronan OR Derivative, Orthovisc, for Intra-articular Injection, Per Dose | other | $529 | $115 to $882 | Low |
| Anchor/screw for Opposing Bone-to-bone OR Soft Tissue-to-bone | other | $537 | $238 to $895 | Low |
| Coring Reamer Cannulated 6 Mm #ar-8900cr | other | $537 | $238 to $895 | Low |
| Coring Reamer Cannulated 8 Mm #ar-8901cr | other | $537 | $238 to $895 | Low |
| Endoblade Plantar Fascia Release Ar-8856ds | other | $537 | $238 to $895 | Low |
| Ankle Foot Orthosis, Posterior Solid Ankle, Plastic, Custom Fabricated | other | $538 | $239 to $897 | Low |
| Leadless C Pm Ins/rpl Ventr | other | $538 | $239 to $1,794 | Low |
| Wand Laryngeal Procise Mlw #eica7071 | other | $545 | $241 to $908 | Low |
| Wand Procise Lw Arthrocare #eica7070 | other | $545 | $241 to $908 | Low |
| Partial Foot, Shoe Insert with Longitudinal Arch, Toe Filler | other | $547 | $243 to $912 | Low |
| Gradient Compression Garment, Lower Leg and Foot, Padded, for Nighttime Use, ... | other | $549 | $243 to $915 | Low |
| Addition, Endoskeletal System, Above Knee OR Hip Disarticulation, Alignable S... | other | $549 | $243 to $915 | Low |
| Grafix Prime, Grafixpl Prime, Stravix and Stravixpl, Per Square Centimeter | other | $549 | $119 to $915 | Low |
| Periprosthetic Wire Guide 03.233.000 | other | $551 | $244 to $918 | Low |
| Microcatheter Canaloplasty Itrack 250a | cardiac | $553 | $245 to $922 | Low |
| Protopam Chloride 1 Gm Vial | other | $554 | $246 to $924 | Low |
| Custom Shaped Protective Cover, Below Knee | other | $554 | $246 to $924 | Low |
| Closed Treatment of Broken Wrist Bone Near Base of Thumb | other | $563 | $250 to $25,622 | Low |
| Vena Cava Filter | other | $564 | $250 to $940 | Low |
| Shoulder Elbow Wrist Hand Orthosis, Abduction Positioning, Airplane Design, P... | other | $565 | $250 to $941 | Low |
| Platelets, Pheresis, Leukocytes Reduced, Each Unit | other | $570 | $253 to $950 | Low |
| Ruby Complex Soft 4 Mm X 15 Cm | other | $570 | $253 to $950 | Low |
| Ruby Complex Soft 6 Mm X 20 Cm | other | $570 | $253 to $950 | Low |
| Ruby Complex Standard 3mm X 12cm | other | $570 | $253 to $950 | Low |
| Ruby Complex Standard 3mm X 20cm | other | $570 | $253 to $950 | Low |
| Ruby Complex Standard 4mm X 10cm | other | $570 | $253 to $950 | Low |
| Ruby Complex Standard 4mm X 15cm | other | $570 | $253 to $950 | Low |
| Ruby Complex Standard 4mm X 20cm | other | $570 | $253 to $950 | Low |
| Ruby Complex Standard 5mm X 12cm | other | $570 | $253 to $950 | Low |
| Ruby Complex Standard 6mm X 20cm | other | $570 | $253 to $950 | Low |
| Ruby Complex Standard 7mm X 25cm | other | $570 | $253 to $950 | Low |
| Ruby Complex Standard 8mm X 25cm | other | $570 | $253 to $950 | Low |
| Injection, Ibutilide Fumarate, 1 Mg | other | $572 | $172 to $953 | Low |
| Injection, Infliximab-axxq, Biosimilar, (avsola), 10 Mg | other | $573 | $20 to $956 | Low |
| Bupivacaine, Collagen-matrix Implant, 1 Mg | surgery | $575 | $255 to $959 | Low |
| Implantation of Biologic Implant to Soft Tissue | surgery | $578 | $172 to $15,777 | Low |
| Stent, Non-coronary, Temporary, with Delivery System | cardiac | $584 | $259 to $973 | Low |
| Addition, Endoskeletal Knee-shin System, Single Axis, Friction Swing and Stan... | other | $585 | $259 to $975 | Low |
| Implant System Achillies Midsubstance Speedbridge Ar-8929bc-cp | surgery | $585 | $259 to $975 | Low |
| Vein Harvest Dumicz Endovascular #vsp550ex | other | $589 | $261 to $981 | Low |
| Closed Treatment of Broken Kneecap | other | $592 | $263 to $27,520 | Low |
| Pr Rom Rad Therapy Breast, Pc | other | $593 | $263 to $1,978 | Low |
| Hc General Anesthesia Time - Initial Base Charge | other | $593 | $263 to $989 | Low |
| Aveta Wave+ Disposable Resecting Device 3.9mm #210-2005 3/ctn | other | $594 | $263 to $990 | Low |
| Ruby Complex Standard 5mm X 20cm | other | $594 | $263 to $990 | Low |
| Ruby Complex Standard 6mm X 12cm | other | $594 | $263 to $990 | Low |
| Addition to Lower Extremity, Below Knee / Above Knee Suspension Locking Mecha... | other | $595 | $264 to $991 | Low |
| Scleral Tutoplast Processed | other | $595 | $264 to $992 | Low |
| Brevital Sodium 500 Mg Vial | other | $597 | $265 to $995 | Low |
| Spiration Deployment Catheter and Loader Hudhus-c26n | cardiac | $600 | $266 to $1,000 | Low |
| Watchman Fxd Access System Double Curve Tu8002 | other | $600 | $266 to $1,000 | Low |
| Watchman Trueseal Access System Anterior Curve Tu7004 | other | $600 | $266 to $1,000 | Low |
| Removal of Infected Artificial Material OR Mesh From Abdomen | surgery | $601 | $227 to $11,008 | Low |
| Injectable Bulking Agent, Collagen Implant, Urinary Tract, 2.5 Ml Syringe, In... | surgery | $611 | $271 to $1,019 | Low |
| Addition to Lower Extremity, Below Knee/above Knee, Custom Fabricated From Ex... | other | $613 | $272 to $1,022 | Low |
| Graft, Vascular | other | $617 | $273 to $1,028 | Low |
| All Lower Extremity Prostheses, Multi-axial Rotation Unit | other | $618 | $274 to $1,031 | Low |
| Cranial Neurostim Complex | other | $622 | $622 to $1,036 | Low |
| Closed Treatment of Dislocated Finger Joint with Manipulation Under Anesthesia | other | $623 | $276 to $26,775 | Low |
| Repair of Wound By Transferring Skin, Each Additional 30.0 SQ Cm | surgery | $625 | $172 to $14,302 | Low |
| Pr Renal Angio, Cardiac Cath | cardiac | $627 | $278 to $2,090 | Low |
| Removal of Nasal Air Passage | surgery | $627 | $278 to $30,130 | Low |
| Ensite X Surface Electrodes #ensite-sek-5-01 5ea/bx | other | $630 | $279 to $1,050 | Low |
| Ankle Foot Orthosis, Spiral, (institute of Rehabilitative Medicine Type), Pla... | other | $630 | $280 to $1,051 | Low |
| Custom Seal Kit Endologix #tv-cs14-g | other | $636 | $282 to $1,060 | Low |
| Application of Walking Cast Covering Foot, Ankle, and Lower Leg | other | $638 | $268 to $29,445 | Low |
| Injection, Non-radioactive, Non-contrast, Visualization Adjunct (e.g., Methyl... | other | $639 | $9 to $1,066 | Low |
| Mesh | other | $641 | $284 to $1,068 | Low |
| Addition to Lower Extremity, Below Knee Suction Socket | other | $641 | $284 to $1,069 | Low |
| Injection, Imipenem 4 Mg, Cilastatin 4 Mg and Relebactam 2 Mg | other | $642 | $285 to $1,071 | Low |
| Rom Rad Therapy Lung, Pc | other | $643 | $285 to $2,142 | Low |
| Glucagon Kit - Compounded | other | $645 | $286 to $1,076 | Low |
| Hem-o-lok Medium/large 5mm Endo Applier # 544965 | other | $647 | $287 to $1,079 | Low |
| Progel Pleural Air Leak Sealant 4ml 4ea/capgps002 | other | $651 | $288 to $1,084 | Low |
| Pegasys 180 Mcg/ml Vial | other | $651 | $289 to $1,086 | Low |
| Injection, Triamcinolone Acetonide, Preservative-free, Extended-release, Micr... | other | $653 | $18 to $1,088 | Low |
| Implantable Breast Prosthesis, Silicone OR Equal | surgery | $657 | $291 to $1,095 | Low |
| Removal of Growth Under Skin of Face OR Scalp, Less Than 2.0 Cm | surgery | $658 | $235 to $21,011 | Low |
| Resecting Device Symphion #fg | other | $659 | $292 to $1,099 | Low |
| Afo, Rigid Anterior Tibial Section, Total Carbon Fiber OR Equal Material, Pre... | other | $660 | $293 to $1,103 | Low |
| Joint Device | other | $660 | $293 to $1,100 | Low |
| Injection, Amphotericin B Liposome, 10 Mg | other | $661 | $21 to $1,101 | Low |
| Release of Tissue of Palm | other | $663 | $289 to $26,040 | Low |
| Injection, Etoposide, 10 Mg | other | $667 | $667 to $1,111 | Low |
| Knee Orthosis, Adjustable Knee Joints (unicentric OR Polycentric), Positional... | other | $669 | $297 to $2,230 | Low |
| Alexis Ces W/gel Point Mini #gtm14 | other | $669 | $297 to $1,115 | Low |
| Destino Catheter (steerable Sheath 55cm 7mm Curve) #dst0655507d2 | cardiac | $669 | $297 to $1,115 | Low |
| Removal of Growth Under Skin of Face OR Scalp, 2.0 Cm OR More | surgery | $670 | $297 to $21,012 | Low |
| Knee Orthosis (ko), Single Upright, Thigh and Calf, with Adjustable Flexion a... | other | $671 | $297 to $1,118 | Low |
| Sodium Nitrite 300 Mg/10 Ml Vl | other | $672 | $298 to $1,120 | Low |
| Sodium Thiosulfat 12.5 G/50 Ml | other | $672 | $298 to $1,120 | Low |
| Accessory Kit Ams 700 #72401850 | other | $675 | $299 to $1,125 | Low |
| Knee Orthosis, Single Upright, Thigh and Calf, with Adjustable Flexion and Ex... | other | $675 | $299 to $1,126 | Low |
| Signature One Alliance Glenoid Shoulder Guide and Bone Model Left 20-8090-008 | other | $677 | $300 to $1,128 | Low |
| Bridion 200 Mg/2 Ml Vial | other | $678 | $301 to $1,131 | Low |
| Ultraflex Intra-aortic Ballon 7.5fr 40cc Iab-06840-u | other | $684 | $303 to $1,140 | Low |
| Endobronchial Us Add-on | other | $685 | $304 to $31,620 | Low |
| Prostin Vr Pedi 500 Mcg/ml Amp | other | $688 | $305 to $1,147 | Low |
| Shunt Carotid Pruitt W/t-port(outlying)*min 3 | other | $689 | $306 to $1,149 | Low |
| Injectable Bulking Agent, Synthetic Implant, Urinary Tract, 1 Ml Syringe, Inc... | surgery | $690 | $282 to $1,150 | Low |
| Speed Compression Implant Kit #se | surgery | $691 | $306 to $1,152 | Low |
| Biopsy of Voice Box Using an Endoscope with Operating Microscope OR Telescope | lab | $693 | $170 to $31,536 | Low |
| Tactiflex Radiofrequency Cable #tsq-rf-tfse-cbl | other | $693 | $307 to $1,155 | Low |
| Nursery - Newborn - Level Ii | obstetric | $696 | $309 to $1,160 | Low |
| Injection, Doxorubicin Hydrochloride, 10 Mg | other | $697 | $3 to $1,162 | Low |
| Knee Orthosis (ko), Double Upright, Thigh and Calf, with Adjustable Flexion a... | other | $700 | $310 to $1,167 | Low |
| Cardioplegia Del Nido Formula | other | $706 | $313 to $1,176 | Low |
| Repair Device, Urinary, Incontinence, with Sling Graft | surgery | $706 | $313 to $1,176 | Low |
| Drainage of Fluid From Chest Cavity with Insertion of Indwelling Tube | other | $710 | $106 to $32,556 | Low |
| Removal of Foreign Body in Voice Box Using an Endoscope with Operating Micros... | surgery | $712 | $172 to $31,531 | Low |
| Patient Programmer, Neurostimulator | other | $714 | $317 to $1,190 | Low |
| Rom Rad Therapy Pancreas, Pc | other | $714 | $317 to $2,382 | Low |
| Incision of Achilles Tendon Using Local Anesthetic | other | $717 | $165 to $27,605 | Low |
| Room & Board - Private (one Bed) - Psychiatric | therapy | $720 | $319 to $1,200 | Low |
| Right Angled Slimline Cryoprobe #pcs | other | $720 | $319 to $1,200 | Low |
| Closed Treatment of Broken Shin Bone | other | $722 | $281 to $27,530 | Low |
| Pr Rom Rad Therapy Colorectal, Pc | other | $722 | $320 to $2,408 | Low |
| Removal of Blood Flow Assist Device in Left Lower Heart Chamber Through the Skin | surgery | $724 | $154 to $33,992 | Low |
| Removal of Growth of Throat And/or Stripping of Vocal Cords Using an Endoscope | surgery | $725 | $195 to $31,540 | Low |
| Removal of Growth of Voice Box Using an Endoscope | surgery | $730 | $122 to $31,578 | Low |
| Duraseal Exact 5ml Spine Sealant Sys #206520 | other | $732 | $325 to $1,220 | Low |
| Biopsy of Fluid Collection of Lung Using an Endoscope | lab | $736 | $269 to $32,607 | Low |
| Incision of Nasal Sinus Through Nose | other | $736 | $308 to $31,020 | Low |
| Pr Rom Rad Therapy Cns, Pc | other | $737 | $327 to $2,455 | Low |
| Catheter Frontrunner Xp Ctd #fbp39140 | cardiac | $740 | $328 to $1,234 | Low |
| Tlso, Flexible, Provides Trunk Support, Thoracic Region, Rigid Posterior Pane... | other | $744 | $330 to $1,239 | Low |
| Extensive Removal of Nasal Polyp | surgery | $744 | $330 to $30,115 | Low |
| Injection Into Vocal Cords Using an Endoscope | other | $749 | $186 to $31,570 | Low |
| Other Procedure On Voice Box | other | $749 | $332 to $31,599 | Low |
| Jada System 2.0 Vacuum Induced Hemorrhage Control System Blue Seal Valve Gree... | other | $750 | $333 to $1,250 | Low |
| Packing Coil 45cm Rbypodj45 | other | $750 | $333 to $1,250 | Low |
| Pod J-soft Packing Coil 60cm Rbypodj60 | other | $750 | $333 to $1,250 | Low |
| Removal of Growth of Soft Tissue of Abdominal Wall, Less Than 3.0 Cm | surgery | $750 | $308 to $22,902 | Low |
| Ruby Coil Standard 10 Mm X 35 Cm Rby2c1035 | other | $750 | $333 to $1,250 | Low |
| Ruby Coil Standard 12 Mm X 60 Cm Rby2c1260 | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Soft 16 Mm X 50 Cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Soft 20 Mm X 60 Cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Soft 6 Mm X 30 Cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Soft 8 Mm X 35 Cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Soft 8 Mm X 60 Cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Standard 14mm X 60cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Standard 16mm X 60cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Standard 18mm X 57cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Standard 20mm X 60cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Standard 24mm X 57cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Standard 28mm X 60cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Standard 32mm X 60cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Standard 4mm X 35cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Standard 5mm X 30cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Standard 6mm X 30cm | other | $750 | $333 to $1,250 | Low |
| Ruby Complex Standard 8mm X 40cm | other | $750 | $333 to $1,250 | Low |
| Insertion of Temporary Pacemaker Lead in Upper and Lower Heart Chambers | cardiac | $751 | $136 to $33,211 | Low |
| Grafix Core and Grafixpl Core, Per Square Centimeter | other | $753 | $119 to $1,256 | Low |
| Matristem Micromatrix, 1 Mg | other | $755 | $335 to $1,258 | Low |
| CT Head | imaging | $755 | $38 to $2,518 | High |
| Graft Hemashield 28x10x50 | other | $760 | $337 to $1,267 | Low |
| Graft Hemashield 30x10x50 | other | $760 | $337 to $1,267 | Low |
| Insertion of Device to Block Groin Artery | other | $763 | $168 to $34,808 | Low |
| Emergent Incision of Windpipe for Insertion of Breathing Tube | other | $767 | $283 to $31,605 | Low |
| Accessory Kit Ams 800 #720066 | other | $768 | $340 to $1,280 | Low |
| Rom Rad Therapy Gi, Pc | other | $768 | $341 to $2,561 | Low |
| Injection, Ferumoxytol, for Treatment of Iron Deficiency Anemia, 1 Mg | other | $770 | $770 to $1,283 | Low |
| Spacemaker Pro Trocar Endoscoic Blunt Tip W/oval Dissection Balloon #smbttovlx | cardiac | $771 | $342 to $1,285 | Low |
| Harvest of Artery From Arm for Heart Bypass Graft Using an Endoscope | cardiac | $773 | $147 to $33,509 | Low |
| Ruby Complex Soft 10 Mm X 35 Cm | other | $774 | $343 to $1,290 | Low |
| Ruby Complex Soft 12 Mm X 40 Cm | other | $774 | $343 to $1,290 | Low |
| Ruby Complex Standard 12mm X 40cm | other | $774 | $343 to $1,290 | Low |
| Ruby Complex Standard 14mm X 40cm | other | $774 | $343 to $1,290 | Low |
| Ruby Complex Standard 4mm X 30cm | other | $774 | $343 to $1,290 | Low |
| Ruby Complex Standard 7mm X 40cm | other | $774 | $343 to $1,290 | Low |
| Ruby Complex Standard 9mm X 30cm | other | $774 | $343 to $1,290 | Low |
| Amputation of Toe At Toe Joint | other | $777 | $149 to $28,825 | Low |
| Shunt Carotid Flexcel Inlying #2020 | other | $777 | $344 to $1,295 | Low |
| Shunt Carotid Pruitt F3 T-port 8f #e2013 | other | $779 | $346 to $1,299 | Low |
| Shunt Carotid Pruitt Inahara 2012-11 Min. 3 | other | $779 | $346 to $1,299 | Low |
| Skin Substitute, Not Otherwise Specified | other | $779 | $346 to $1,299 | Low |
| Ankle Foot Orthosis, Fracture Orthosis, Tibial Fracture Cast Orthosis, Custom... | other | $781 | $346 to $1,301 | Low |
| Removal of Growth Under Skin of Leg OR Ankle, Less Than 3.0 Cm | surgery | $781 | $279 to $27,618 | Low |
| Insertion of Vein Patch At Lowest Portion of Bypass Graft | other | $784 | $166 to $35,685 | Low |
| Removal of Connective Tissue of Palm and Release of Finger, Each Additional D... | surgery | $784 | $214 to $26,125 | Low |
| Removal of Growth Under Skin of Leg OR Ankle, 3.0 Cm OR More | surgery | $788 | $350 to $27,632 | Low |
| Revision of Permanent Windpipe Opening Scar | other | $788 | $313 to $31,830 | Low |
| Graft Hemashield 32x10x50 | other | $789 | $350 to $1,314 | Low |
| Rom Rad Therapy Uterus, Pc | other | $789 | $350 to $2,629 | Low |
| Exam of Windpipe and Lung Airways Through Permanent Windpipe Opening Using an... | other | $789 | $350 to $31,615 | Low |
| Removal of Growth Under Skin of Upper Arm OR Elbow, 3.0 Cm OR More | surgery | $791 | $351 to $24,071 | Low |
| Injection, Baclofen, 10 Mg | other | $792 | $181 to $1,320 | Low |
| Twist Drill U44-645 | other | $795 | $352 to $1,325 | Low |
| Ankle Foot Orthosis, Plastic with Ankle Joint, Custom Fabricated | other | $796 | $353 to $1,327 | Low |
| Vh-4000 - System Vein Harvest Connical Dissector Tip with Insulated Jaw Short... | other | $800 | $354 to $1,333 | Low |
| Closure of Permanent Windpipe Opening OR Abnormal Drainage Tract | other | $800 | $284 to $31,820 | Low |
| Removal of Growth Under Skin of Thigh OR Knee, Less Than 3.0 Cm | surgery | $802 | $355 to $27,337 | Low |
| Pr Rom Rad Therapy Bladder, Pc | other | $803 | $356 to $2,677 | Low |
| Nursery - Newborn - Level Iii | obstetric | $803 | $356 to $1,339 | Low |
| Removal of Growth of Muscle of Foot OR Toe, 1.5 Cm OR More | surgery | $806 | $358 to $28,041 | Low |
| Incision of Lower Finger Joint for Exploration, Fluid Drainage, OR Removal of... | surgery | $808 | $309 to $26,075 | Low |
| Biopsy OR Removal of Deep Lymph Nodes of Underarm | surgery | $810 | $359 to $38,525 | Low |
| Fuzeright Peg and Hole Reaming Kit Sterile #ht-60-8000-s | other | $810 | $359 to $1,350 | Low |
| Addition, Endoskeletal System, Above Knee, Ultra-light Material | other | $811 | $360 to $1,352 | Low |
| Cath Intra-aortic Balloon 30cc #iab-05830-lws | other | $813 | $360 to $1,355 | Low |
| Cath Intra-aortic Balloon 40cc #iab-05840-lws | other | $813 | $360 to $1,355 | Low |
| Menquadfi Vial | other | $813 | $361 to $1,355 | Low |
| Removal of Growth of Soft Tissue Under Skin of Neck OR Front of Chest, 3.0 Cm... | surgery | $815 | $361 to $21,552 | Low |
| Fusion of Big Toe Between Toe Joints | surgery | $817 | $362 to $28,755 | Low |
| Removal of Growth Under Skin of Shoulder Area, 3.0 Cm OR More | surgery | $817 | $362 to $23,071 | Low |
| Stabilizer Tissue Octopus 4.3 #ts2000 | other | $820 | $364 to $1,367 | Low |
| Rotalink Plus Burr 1.25mm #23631 | other | $825 | $366 to $1,374 | Low |
| Removal of Growth of Mouth with Complicated Repair | surgery | $825 | $250 to $40,814 | Low |
| Low Osmolar Contrast Material, 100-199 Mg/ml Iodine Concentration, Per Ml | other | $825 | $366 to $1,375 | Low |
| Kafo, Fracture Orthosis, Femoral Fracture Cast Orthosis, Rigid, Prefabricated... | other | $826 | $366 to $1,376 | Low |
| Removal of Growth of Soft Tissue of Abdominal Wall, 3.0 Cm OR More | surgery | $826 | $366 to $22,903 | Low |
| Removal (1.5 Centimeters OR Greater) Tissue Growth Beneath the Skin of Foot O... | surgery | $832 | $300 to $28,039 | Low |
| Incision of Artery for Creation of Channel for Ecmo External Blood Circulatio... | other | $836 | $177 to $33,987 | Low |
| Inceptiv Recharger #rs7230 | other | $842 | $373 to $1,404 | Low |
| Recharger 97755 Intellis Rtm #97755 | other | $842 | $373 to $1,404 | Low |
| Removal of Growth Under Skin of Forearm OR Wrist, 3.0 Cm OR More | surgery | $844 | $374 to $25,071 | Low |
| Repositioning of Blood Flow Assist Device in Lower Heart Chamber Using Imagin... | cardiac | $844 | $134 to $33,993 | Low |
| Pad Temp Arctic Sun Large Kit #317-09 | other | $845 | $375 to $1,409 | Low |
| Pad Temp Arctic Sun Sml Kit #3170502 2ea/1cs | other | $845 | $375 to $1,409 | Low |
| Injection Into Vocal Cords Using an Endoscope with Operating Microscope OR Te... | other | $850 | $201 to $31,571 | Low |
| Removal of Growth of Lung Airways Using an Endoscope | surgery | $852 | $210 to $31,640 | Low |
| Amputation of Toe and Midfoot Bone | other | $854 | $375 to $28,810 | Low |
| Octaray Mapping Cable #d-1344 | other | $860 | $381 to $1,433 | Low |
| Insertion of Tube Into Artery OR Vein for Drug Infusion for Blood Clot with R... | surgery | $865 | $191 to $37,213 | Low |
| Primary Repair of Tendon OR Muscle of Palm Side of Forearm OR Wrist | surgery | $868 | $385 to $25,260 | Low |
| Removal of Nasal Air Passage Under Lining Tissue | surgery | $870 | $145 to $30,140 | Low |
| Inner 24 Fr for 26 Fr Outer #a22040a | other | $872 | $386 to $1,453 | Low |
| Preparation of Skin Graft Site of Face, Scalp, Eyelids, Mouth, Neck, Ears, Ar... | other | $872 | $217 to $15,004 | Low |
| Placement of Stabilizing Device for Broken End of Finger OR Thumb | other | $872 | $387 to $26,756 | Low |
| Rom Rad Therapy Cervical, Pc | other | $875 | $388 to $2,916 | Low |
| Removal of Growth Under Skin of Back OR Lower Sides, 3.0 Cm OR More | surgery | $878 | $389 to $21,931 | Low |
| Incision of Windpipe for Insertion of Breathing Tube | other | $881 | $257 to $31,600 | Low |
| Large Clip Applier #470230 | other | $882 | $391 to $1,470 | Low |
| Injection, Mycophenolate Mofetil, 10 Mg | other | $884 | $392 to $1,473 | Low |
| Addition, Endoskeletal Knee-shin System, Polycentric, Mechanical Stance Phase... | other | $885 | $392 to $1,475 | Low |
| Amputation of Toe At Joint Between Forefoot and Toes | other | $885 | $154 to $28,820 | Low |
| Injection, Aprepitant, 1 Mg | other | $885 | $2 to $1,476 | Low |
| Destruction of Growth OR Narrowing of Lung Airway Using an Endoscope | other | $886 | $216 to $31,641 | Low |
| Elastomeric Pump Reservoir 8 Ml/hr | other | $891 | $395 to $1,485 | Low |
| Tissueblue 0.025% Syringe | other | $892 | $396 to $1,487 | Low |
| Repair of Abdominal OR Groin Artery with Prosthesis with Review By Radiologist | surgery | $893 | $268 to $34,709 | Low |
| Rom Rad Therapy Anal, Pc | other | $894 | $396 to $2,980 | Low |
| Rom Rad Ther Head/neck, Pc | other | $895 | $397 to $2,984 | Low |
| Epifix, Per Square Centimeter | other | $897 | $119 to $1,495 | Low |
| Removal of Growth Under Skin of Pelvis and Hip, Less Than 3.0 Cm | surgery | $898 | $328 to $27,047 | Low |
| Injection, Ceftolozane 50 Mg and Tazobactam 25 Mg | other | $900 | $9 to $1,499 | Low |
| Bypass of Upper OR Lower Leg Artery Reoperation More Than 1 Month After Origi... | other | $900 | $127 to $35,700 | Low |
| Clip Flex 35mm Atriclip #ach235 | other | $900 | $399 to $1,500 | Low |
| Clip Flex 40mm Atriclip #ach240 | other | $900 | $399 to $1,500 | Low |
| Clip Flex 45mm Atriclip #ach245 | other | $900 | $399 to $1,500 | Low |
| Endoscope, Single-use | other | $900 | $399 to $1,500 | Low |
| Laa Exclusion Sys Flex 50mm Clip #a000919 | other | $900 | $399 to $1,500 | Low |
| Stent, Non-coated/non-covered, with Delivery System | cardiac | $900 | $399 to $1,500 | Low |
| Gradient Compression Garment, Full Leg and Foot, Padded, for Nighttime Use, C... | other | $904 | $401 to $1,506 | Low |
| Bexsero Prefilled Syringe | other | $905 | $401 to $1,508 | Low |
| Removal of Growth Under Skin of Pelvis and Hip, 3.0 Cm OR More | surgery | $905 | $401 to $27,043 | Low |
| Programmer Kit Interstim Smart #th90q01 | other | $906 | $402 to $1,510 | Low |
| Removal of Growth of Leg And/or Ankle Tendon Lining OR Capsule | surgery | $906 | $327 to $27,630 | Low |
| Removal of Fluid-filled Sac (bursa) OR Calcium Deposit of Pelvis | surgery | $913 | $405 to $27,062 | Low |
| Balloon Dilation of Large Bowel Using a Flexible Endoscope | other | $914 | $179 to $45,386 | Low |
| Injection, Doxorubicin Hydrochloride, Liposomal, Not Otherwise Specified, 10 Mg | other | $916 | $83 to $1,526 | Low |
| Biopsy OR Removal of Lymph Nodes of Neck with Removal of Fat Pad | surgery | $916 | $406 to $38,520 | Low |
| Ultrasound Guided Needle Aspiration OR Biopsy of Esophagus, Stomach, And/or U... | imaging | $916 | $220 to $43,242 | Low |
| Biopsy OR Removal of Deep Lymph Nodes of Neck | surgery | $919 | $355 to $38,510 | Low |
| Aspiration of Initial Secretion of Lung Airway Using an Endoscope | other | $919 | $408 to $31,645 | Low |
| Incision of Connective Tissue of Front OR Side of Lower Leg to Relieve Pressure | other | $920 | $352 to $27,600 | Low |
| Removal of Growth of Tongue And/or Stripping of Vocal Cord Using an Endoscope... | surgery | $920 | $212 to $31,541 | Low |
| Primary Repair of Tendon On Front of Leg | surgery | $923 | $324 to $27,664 | Low |
| Knee Orthosis, without Knee Joint, Rigid, Custom Fabricated | other | $926 | $410 to $1,543 | Low |
| Lumbar-sacral Orthosis, Sagittal-coronal Control, Rigid Shell(s)/panel(s), Po... | lab | $926 | $411 to $1,544 | Low |
| Removal (1.5 Centimeters OR Greater) Tissue Beneath the Skin Growth of Hand O... | surgery | $927 | $368 to $26,111 | Low |
| Insertion of Tube Into Vena Cava | other | $932 | $90 to $36,010 | Low |
| Closed Treatment of Back Portion of Shin Bone At Ankle with Manipulation | other | $940 | $413 to $27,768 | Low |
| Complicated Control of Bleeding of Throat | other | $940 | $417 to $42,962 | Low |
| Complicated Drainage of Abscess of Saliva Gland | other | $940 | $364 to $42,305 | Low |
| Control of Bleeding of Upper Large Bowel Using a Flexible Endoscope | other | $942 | $217 to $45,382 | Low |
| Incision of Tendon Covering of Finger | other | $942 | $269 to $26,055 | Low |
| Simple Revision of Permanent Opening of Windpipe for Breathing | other | $948 | $373 to $31,613 | Low |
| Removal of Salivary Cyst Under Tongue | surgery | $950 | $306 to $42,408 | Low |
| Partial Removal of Breast | surgery | $954 | $423 to $19,301 | Low |
| Microporous Collagen Implantable Tube (neuragen Nerve Guide), Per Centimeter ... | surgery | $960 | $426 to $1,600 | Low |
| Emergent Incision of Windpipe Through Neck for Insertion of Breathing Tube | other | $962 | $262 to $31,603 | Low |
| Radiation Therapy | other | $966 | $76 to $3,220 | High |
| Hip Orthosis, Abduction Control of Hip Joint, Postoperative Hip Abduction Typ... | other | $967 | $429 to $1,612 | Low |
| Exposure of Arm Artery for Insertion of Prosthesis | other | $969 | $108 to $34,834 | Low |
| Rom Rad Therapy Prostate, Pc | other | $974 | $432 to $3,246 | Low |
| Removal of Lining of Large Bowel Using an Endoscope Inserted Through Surgical... | surgery | $979 | $434 to $44,403 | Low |
| Removal of Multiple Hemorrhoid Groups and Chronic Tear in Anus | surgery | $985 | $437 to $46,261 | Low |
| Mometasone Furoate Sinus Implant, 370 Micrograms | surgery | $987 | $438 to $3,290 | Low |
| Closed Treatment of Broken Hand Bone with Manipulation and Placement of Exter... | other | $989 | $439 to $26,607 | Low |
| Custom Shaped Protective Cover, Above Knee | other | $991 | $439 to $1,651 | Low |
| Removal of Growth of Muscle of Face OR Scalp, Less Than 2.0 Cm | surgery | $991 | $349 to $21,013 | Low |
| Diagnostic Exam of Lungs, Heart Sac, Chest Cavity, OR Lung Lining Using an En... | cardiac | $992 | $268 to $32,601 | Low |
| Biopsy of Abdomen Using an Endoscope | lab | $993 | $307 to $49,321 | Low |
| Exam of Chest with Biopsy of Lymph Node Using an Endoscope | lab | $994 | $351 to $39,402 | Low |
| Repair of Abnormal Drainage Tract in Anal Sphincter | surgery | $994 | $399 to $46,275 | Low |
| Repair of Fibrous Tissue of Arch of Foot Using an Endoscope | surgery | $994 | $398 to $29,893 | Low |
| Placement of Stabilizing Device for Broken Finger OR Thumb At Midportion OR P... | other | $997 | $428 to $26,727 | Low |
| Stent, Non-coated/non-covered, without Delivery System | cardiac | $997 | $442 to $1,662 | Low |
| Control of Bleeding of Small Bowel Using an Endoscope | other | $998 | $320 to $44,378 | Low |
| Harvest of Arm Artery Segment for Heart Byplass Procedure | cardiac | $1,000 | $157 to $35,600 | Low |
| Incision of Finger Joint for Exploration, Fluid Drainage, OR Removal of Forei... | surgery | $1,001 | $363 to $26,080 | Low |
| Removal of Polyps OR Growths of Large Bowel Using a Flexible Endoscope with E... | surgery | $1,001 | $193 to $45,384 | Low |
| Graft Hemashield 30x10x8x8x10mm #175930p | other | $1,002 | $444 to $1,670 | Low |
| Removal of Growth of Tendon Finger OR Hand | surgery | $1,002 | $289 to $26,160 | Low |
| Insertion of Abdominal Cavity Tube Using an Endoscope | other | $1,005 | $340 to $49,324 | Low |
| Repair of Abnormal Drainage Tract Between Nasal Sinuses | surgery | $1,009 | $398 to $30,580 | Low |
| Removal (less Than 1.5 Centimeters) Tissue Beneath the Skin Growth of Hand OR... | surgery | $1,010 | $301 to $26,115 | Low |
| Repair Umbilical Hernia, Age 5 Years OR Older; Reducible | surgery | $1,013 | $449 to $49,585 | Low |
| Aspiration And/or Injection of Cyst of Kidney | other | $1,013 | $449 to $50,390 | Low |
| Injection, Ceftaroline Fosamil, 10 Mg | other | $1,013 | $4 to $1,689 | Low |
| Pod 12mm X 60cm Coil Rbypod12 | other | $1,014 | $450 to $1,690 | Low |
| Exploration, Drainage, Biopsy, OR Removal of Foreign Body in Chest Cavity Thr... | surgery | $1,016 | $450 to $39,000 | Low |
| Treatment of Broken Midportion of Foot | other | $1,019 | $452 to $28,485 | Low |
| Coronary Artery Bypass Using Vein OR Artery Graft, 1 Graft | cardiac | $1,021 | $158 to $33,517 | Low |
| Removal OR Scraping of Skin On Nose | surgery | $1,025 | $354 to $30,120 | Low |
| Bydureon Bcise 2 Mg Autoinject | other | $1,028 | $456 to $1,714 | Low |
| Exposure of Major Groin Artery with Creation of Conduit | other | $1,029 | $228 to $34,714 | Low |
| Placement of Locating Device in Breast Using Imaging Guidance, First Growth | other | $1,029 | $456 to $19,281 | Low |
| Cranial Access W/subdural Port Medtronic | other | $1,030 | $457 to $1,716 | Low |
| Intensive Care Unit - Intermediate ICU | other | $1,032 | $458 to $1,720 | Low |
| Repair of Abdomen Using Abdominal Lining Graft | surgery | $1,033 | $294 to $49,905 | Low |
| Procedure Kit Illumisite 180 #ils-1800-kt | other | $1,034 | $459 to $1,724 | Low |
| Repair of Groin Hernia Using an Endoscope | surgery | $1,036 | $394 to $49,650 | Low |
| Removal of Growth of Muscle of Face OR Scalp, 2.0 Cm OR More | surgery | $1,037 | $451 to $21,014 | Low |
| Repair of Abnormal Drainage Tract Around Anal Sphincter | surgery | $1,037 | $453 to $46,280 | Low |
| Biopsy of Esophagus Using a Flexible Endoscope Through Mouth | lab | $1,040 | $461 to $43,202 | Low |
| Injection Into Esophagus Using a Flexible Endoscope | other | $1,040 | $461 to $43,201 | Low |
| Drainage of Tendon of Finger And/or Palm | other | $1,042 | $462 to $26,020 | Low |
| Diagnostic Exam of Esophagus Using a Flexible Endoscope Through Mouth | other | $1,045 | $463 to $43,200 | Low |
| Balloon Dilation of Esophagus Using a Flexible Endoscope, Less Than 3.0 Cm | other | $1,046 | $464 to $43,220 | Low |
| Dilation of Esophagus with Insertion of Guide Wire Using a Flexible Endoscope | other | $1,046 | $464 to $43,226 | Low |
| Needle Biopsy OR Removal of Surface Lymph Nodes | surgery | $1,046 | $464 to $38,505 | Low |
| Removal of Foreign Bodies in Esophagus Using a Flexible Endoscope | surgery | $1,046 | $464 to $43,215 | Low |
| Removal of Polyps OR Growths of Large Bowel Using an Endoscope with Mechanica... | surgery | $1,047 | $213 to $45,385 | Low |
| Infusion, Albumin (human), 5%, 50 Ml | surgery | $1,048 | $11 to $1,747 | Low |
| Creation of Window Into Nasal Sinus | other | $1,054 | $1,054 to $1,757 | Low |
| Daily Management of Ecmo External Vein to Artery Blood Circulation in Heart a... | cardiac | $1,055 | $198 to $33,949 | Low |
| Biopsy of Growth of Lung Using an Endoscope | lab | $1,057 | $328 to $32,608 | Low |
| Biopsy of Lung Lining Using an Endoscope | lab | $1,057 | $223 to $32,609 | Low |
| Removal of Infected Skin, Tissue OR Muscle of Genitals | surgery | $1,061 | $470 to $11,004 | Low |
| Biopsy of Lung Airway Using an Endoscope | lab | $1,068 | $473 to $31,625 | Low |
| Diagnostic Exam of Lung Airway Using an Endoscope | other | $1,068 | $473 to $31,622 | Low |
| Exam of Lung Airways Using an Endoscope | other | $1,068 | $473 to $31,623 | Low |
| Irrigation and Suction of Lung Airways to Obtain Cells Using an Endoscope | other | $1,068 | $473 to $31,624 | Low |
| Needle Biopsy of Lobe of Lung Using an Endoscope, Each Additional Lobe | lab | $1,068 | $54 to $31,633 | Low |
| Needle Biopsy of Windpipe Cartilage, Airway, And/or Lung Using an Endoscope | lab | $1,068 | $473 to $31,629 | Low |
| Removal of Foreign Body in Lung Airways Using an Endoscope | surgery | $1,068 | $473 to $31,635 | Low |
| Addition to Lower Extremity, Below Knee/above Knee, Custom Fabricated Socket ... | other | $1,072 | $475 to $1,787 | Low |
| Incision of Bladder with Removal of Bladder Stone | surgery | $1,073 | $412 to $51,050 | Low |
| Vivigen Mis Delivery System Bl-1900 | obstetric | $1,075 | $476 to $1,791 | Low |
| Amniomatrix OR Biodmatrix, Injectable, 1 Cc | other | $1,079 | $479 to $1,799 | Low |
| Hip Extraction System S9-hip S9hip | other | $1,080 | $479 to $1,800 | Low |
| Universal Knee Implant Extraction System #s9kne #s9knee | surgery | $1,080 | $479 to $1,800 | Low |
| Removal of Vocal Cord Growths and Reconstruction with Local Tissue Flap Using... | surgery | $1,082 | $290 to $31,545 | Low |
| Diagnostic Exam of Small Bowel Using an Endoscope Inserted Through Surgically... | surgery | $1,085 | $481 to $44,380 | Low |
| Replacement of Peripherally Inserted Central Venous Tube (picc) with Review B... | surgery | $1,085 | $481 to $36,584 | Low |
| Repair of Abnormal Anal Drainage Tract with Rectal Tissue Flap | surgery | $1,091 | $484 to $46,288 | Low |
| Removal of Saliva Gland Under Floor of Mouth | surgery | $1,096 | $350 to $42,440 | Low |
| Needle Biopsy of Lining of Lung | lab | $1,099 | $487 to $32,400 | Low |
| Needle Biopsy of Pancreas | lab | $1,099 | $487 to $48,102 | Low |
| Secondary Closure OR Revision of Scar At Previous Thigh Amputation | other | $1,099 | $445 to $27,594 | Low |
| Treatment of Broken Finger Bone with Stabilizing Device Accessed Through Skin | other | $1,100 | $435 to $26,608 | Low |
| Removal and Replacement of Single Lead Permanent Pacemaker | surgery | $1,100 | $281 to $33,227 | Low |
| Graft Hemashield 32x12x10x10x10mm #175732p | other | $1,101 | $488 to $1,836 | Low |
| Repair of Groin Hernia | surgery | $1,106 | $471 to $49,505 | Low |
| Lumbar-sacral Orthosis, Sagittal-coronal Control, with Rigid Anterior and Pos... | other | $1,107 | $491 to $1,846 | Low |
| Removal of Multiple Hemorrhoid Groups | surgery | $1,108 | $449 to $46,260 | Low |
| Exploration (not Followed By Surgical Repair), with OR without Lysis of Arter... | surgery | $1,108 | $491 to $35,761 | Low |
| Clip Flexv Dvice W/vclp 50mm Atriclip Achv50 | other | $1,110 | $492 to $1,850 | Low |
| Dissector Articlating Instrument #mid1 | other | $1,110 | $492 to $1,850 | Low |
| Tlso, Triplanar Control, Modular Segmented Spinal System, Four Rigid Plastic ... | other | $1,111 | $493 to $1,852 | Low |
| Complications of Treatment without Cc/mcc | other | $1,111 | $493 to $14,849 | Low |
| Cable Torch Grip 5 X 115mm 71340004 | other | $1,113 | $493 to $1,855 | Low |
| Incision of Connective Tissue of Back of Lower Leg to Relieve Pressure | other | $1,115 | $392 to $27,601 | Low |
| Injection, Etanercept, 25 Mg | other | $1,115 | $494 to $1,858 | Low |
| Injection of Implant Material Beneath Lining of Bladder And/or Urethra Using ... | surgery | $1,117 | $167 to $51,715 | Low |
| Removal of Cyst OR Growth of Wrist Bone | surgery | $1,122 | $404 to $25,130 | Low |
| Delayed Insertion of Prosthesis for Repair of Abdominal OR Groin Artery with ... | surgery | $1,124 | $245 to $34,711 | Low |
| Removal of Growth of Rectum Through Anus | surgery | $1,126 | $499 to $45,171 | Low |
| Intracept Access Instruments #rlv 0045 | other | $1,128 | $500 to $1,880 | Low |
| Repair of Femoral Groin Hernia | surgery | $1,128 | $500 to $49,550 | Low |
| Diagnostic Exam of Shoulder Using an Endoscope | other | $1,129 | $420 to $29,805 | Low |
| Removal of Extra Breast Tissue in Male | surgery | $1,129 | $397 to $19,300 | Low |
| Ocular Implant, Aqueous Drainage Assist Device | surgery | $1,132 | $502 to $1,887 | Low |
| Closure of Permanent Windpipe Opening OR Abnormal Drainage Tract with Plastic... | other | $1,133 | $407 to $31,825 | Low |
| Removal of Growth of Muscle of Hand OR Finger, Less Than 1.5 Cm | surgery | $1,133 | $463 to $26,116 | Low |
| Knee Ankle Foot Orthosis, Double Upright, Free Ankle, Solid Stirrup, Thigh an... | other | $1,134 | $503 to $1,889 | Low |
| Exposure of Underarm OR Upper Chest Artery for Delivery of Prosthesis | obstetric | $1,135 | $250 to $34,715 | Low |
| Diagnostic Exam of Knee Using an Endoscope | other | $1,136 | $374 to $29,870 | Low |
| Spinal Cs Charging Sys Restoresensor #97754 | other | $1,137 | $504 to $1,895 | Low |
| V-shaped Removal of Lip Tissue | surgery | $1,138 | $308 to $40,520 | Low |
| Placement of Stabilizing Device for Dislocated Hand Bone At Wrist Joint with ... | other | $1,139 | $458 to $26,676 | Low |
| 23x11x14mm Vbr-s Dev #06-115 | other | $1,140 | $505 to $1,900 | Low |
| 41x11x14mm Vbr-s Dev #06-115 | other | $1,140 | $505 to $1,900 | Low |
| Connective Tissue, Human | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 4x100mm #lx1813041004f | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 4x40mm #lx181304404f | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 4x60mm #lx181304604f | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 4x80mm #lx181304804f | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 5x100mm #lx1813051005f | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 5x40mm #lx181305405f | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 5x60mm #lx181305605f | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 5x80mm #lx181305805f | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 6x100mm #lx1813061005f | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 6x40mm #lx181306405f | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 6x60mm #lx181306605f | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 7x100mm #lx1813071005f | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 7x40mm #lx181307405f | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 7x60mm #lx181307605f | other | $1,140 | $505 to $1,900 | Low |
| Lutonix .018" Dcb 130cm 7x80mm #lx181307805f | other | $1,140 | $505 to $1,900 | Low |
| Removal of Growth of Soft Tissue of Pelvis and Hip, Less Than 5.0 Cm | surgery | $1,140 | $505 to $27,048 | Low |
| Revision of Abdominal Cavity Tube Using an Endoscope | other | $1,140 | $361 to $49,325 | Low |
| Vbr-s Dev 26mm X 11mm X 14mm #06-115 | other | $1,140 | $505 to $1,900 | Low |
| Vbr-s Dev 29mm X 11mm X 14mm #06-115 | other | $1,140 | $505 to $1,900 | Low |
| Removal of Saliva Gland Under Tongue | surgery | $1,147 | $311 to $42,450 | Low |
| Removal and Replacement of Dual Lead Permanent Pacemaker | surgery | $1,148 | $294 to $33,228 | Low |
| Other Circulatory System Diagnoses without Cc/mcc | other | $1,149 | $509 to $22,167 | Low |
| Removal OR Partial Removal of Lower End of Forearm Bone On Small Finger Side ... | surgery | $1,152 | $385 to $25,240 | Low |
| Diagnostic Exam of Wrist Using an Endoscope | other | $1,154 | $412 to $29,840 | Low |
| Treatment of Broken Finger At Midportion OR Part Near Hand | other | $1,157 | $513 to $26,735 | Low |
| Diagnostic Exam of Jaw Joint Using an Endoscope | other | $1,159 | $476 to $29,800 | Low |
| Removal of Tube for Ecmo External Blood Circulation in Heart and Lungs Using ... | surgery | $1,159 | $240 to $33,984 | Low |
| Immediate Post Surgical OR Early Fitting, Application of Initial Rigid Dressi... | surgery | $1,167 | $517 to $1,945 | Low |
| Partial Removal of Wrist Bone Near Thumb | surgery | $1,168 | $388 to $25,230 | Low |
| Insertion of Blood Flow Assist Device in Aorta Through Upper Leg Artery | other | $1,169 | $293 to $33,970 | Low |
| Removal of Wrist Bone | surgery | $1,171 | $438 to $25,210 | Low |
| Removal of Voice Box Cartilage Using an Endoscope with Operating Microscope O... | surgery | $1,172 | $273 to $31,561 | Low |
| Removal of Growth of Muscle of Leg OR Ankle, Less Than 5.0 Cm | surgery | $1,173 | $411 to $27,619 | Low |
| Treatment of Broken Midhand Bone | other | $1,175 | $513 to $26,615 | Low |
| Removal of Growth of Muscle of Forearm OR Wrist, 3.0 Cm OR More | surgery | $1,177 | $475 to $25,073 | Low |
| Injection, Cyclophosphamide (dr. Reddy's), 5 Mg | other | $1,177 | $1,177 to $1,962 | Low |
| Repair of Bulging of Rectum Into Vagina | surgery | $1,177 | $522 to $45,560 | Low |
| Biopsy of Tissue of Chest Using an Endoscope | lab | $1,181 | $398 to $32,606 | Low |
| Removal of Cyst OR Growth of Wrist Bone with Self Bone Graft | surgery | $1,183 | $506 to $25,135 | Low |
| Insertion of Small Bowel Tube Using Fluoroscopic Guidance with Contrast | other | $1,186 | $526 to $49,441 | Low |
| Insertion of Stomach Tube Using Fluoroscopic Guidance with Contrast | other | $1,186 | $526 to $49,440 | Low |
| Harvest of Upper Leg to Thigh Vein Segment | other | $1,187 | $285 to $35,572 | Low |
| Tying of Sphenopalatine Artery Using an Endoscope | other | $1,187 | $354 to $31,241 | Low |
| Removal of Tendon of Forearm And/or Wrist | surgery | $1,187 | $475 to $25,109 | Low |
| Incision of Elbow Tendon with Removal of Tissue | surgery | $1,189 | $468 to $24,358 | Low |
| Cortisone Shot (Joint Injection) | surgery | $1,190 | $5 to $1,984 | High |
| Hyaluronan OR Derivative, Durolane, for Intra-articular Injection, 1 Mg | other | $1,190 | $7 to $1,984 | Low |
| Drainage of Abscess of Throat From Outside Mouth | other | $1,192 | $528 to $42,725 | Low |
| Removal of Growth of Muscle of Abdomen, 5.0 Cm OR More | surgery | $1,192 | $528 to $22,901 | Low |
| Tlso, Triplanar Control, One Piece Rigid Plastic Shell with Interface Liner, ... | other | $1,193 | $529 to $1,988 | Low |
| Addition to Lower Extremity, Endoskeletal System, Above Knee - Knee Disarticu... | other | $1,193 | $529 to $1,989 | Low |
| Removal and Replacement of Multiple Lead Permanent Pacemaker | surgery | $1,195 | $307 to $33,229 | Low |
| Removal of Deep Lymph Nodes of Neck | surgery | $1,201 | $442 to $38,542 | Low |
| Incision of Connective Tissue of Front And/or Side and Back of Lower Leg to R... | other | $1,201 | $413 to $27,602 | Low |
| Insertion of Defibrillator with Existing Dual Leads | other | $1,205 | $310 to $33,230 | Low |
| Removal of Large Bowel Tissue Using a Flexible Endoscope | surgery | $1,209 | $536 to $45,390 | Low |
| Release of Ligaments of Knee Joint | other | $1,211 | $414 to $27,425 | Low |
| Ankle Foot Orthosis, Walking Boot Type, Varus/valgus Correction, Rocker Botto... | other | $1,214 | $538 to $2,023 | Low |
| Biopsy and Removal of Lymph Nodes of Abdominal Cavity Using an Endoscope | surgery | $1,216 | $450 to $38,570 | Low |
| Knee Orthosis, Double Upright, Thigh and Calf, with Adjustable Flexion and Ex... | other | $1,226 | $543 to $2,043 | Low |
| Insertion of Tube Into Vein for Drug Infusion for Blood Clot with Review By R... | surgery | $1,227 | $278 to $37,212 | Low |
| Removal of Joint Lining and Repair of Tendon On the Topside of Finger | surgery | $1,228 | $451 to $26,140 | Low |
| Exposure of Thigh Artery for Insertion of Prosthesis | other | $1,228 | $171 to $34,812 | Low |
| Tying of Ethmoidal Artery Ethmoidal for Control of Nose Bleed | other | $1,232 | $510 to $30,915 | Low |
| Removal of Foreign Body OR Stone in Kidney Using an Endoscope Inserted Throug... | surgery | $1,236 | $330 to $50,561 | Low |
| Removal of Growth of Saliva Gland OR Saliva Gland, Lateral Lobe | surgery | $1,239 | $526 to $42,410 | Low |
| Repair Recurrent Incisional OR Ventral Hernia; Reducible | surgery | $1,240 | $550 to $49,565 | Low |
| Addition to Lower Extremity, Above Knee, Flexible Inner Socket, External Frame | other | $1,242 | $551 to $2,070 | Low |
| Addition to Lower Extremity, Below Knee, Flexible Inner Socket, External Frame | other | $1,242 | $551 to $2,070 | Low |
| Secondary Closure OR Revision of Scar of Lower Leg Bone Amputation | other | $1,243 | $510 to $2,072 | Low |
| Removal of Plaque From Heart Artery At Time of Coronary Artery Bypass | surgery | $1,244 | $195 to $33,572 | Low |
| Removal of Growth of Muscle of Back OR Lower Sides, Less Than 5.0 Cm | surgery | $1,248 | $553 to $21,932 | Low |
| Removal of Growth of Muscle of Hand OR Finger, 1.5 Cm OR More | surgery | $1,248 | $480 to $26,113 | Low |
| Partial Removal of Lymph Nodes of Underarm | surgery | $1,251 | $555 to $38,740 | Low |
| Interfyl, 1 Mg | other | $1,254 | $556 to $2,090 | Low |
| Insertion of Pacemaker Pulse Generator with Existing Multiple Leads | cardiac | $1,256 | $297 to $33,221 | Low |
| Fusion of Finger Joint, Initial Joint | surgery | $1,256 | $557 to $26,860 | Low |
| Repair of Recurrent Groin Hernia Using an Endoscope | surgery | $1,258 | $510 to $49,651 | Low |
| Drainage of Fluid From Chest Cavity with Insertion of Indwelling Tube Using I... | other | $1,259 | $124 to $32,557 | Low |
| Repair of Tendon, Finger, And/or Palm of Hand | surgery | $1,260 | $457 to $26,145 | Low |
| Reshaping of Nasal Cartilage | other | $1,260 | $559 to $30,520 | Low |
| Repair Initial Incisional OR Ventral Hernia; Reducible | surgery | $1,261 | $559 to $49,560 | Low |
| Repair of Recurrent Femoral Groin Hernia | surgery | $1,261 | $541 to $49,555 | Low |
| Repair of Trapped Femoral Groin Hernia | surgery | $1,261 | $559 to $49,553 | Low |
| Diagnostic Exam of Small Bowel (excluding Lower Small Intestine) Using an End... | other | $1,262 | $559 to $44,360 | Low |
| Biopsy of Small Bowel (except Ileum) Using an Endoscope | lab | $1,266 | $561 to $44,361 | Low |
| Injection, Penicillin G Benzathine and Penicillin G Procaine, 100,000 Units | other | $1,272 | $20 to $2,120 | Low |
| Removal of Appendix | surgery | $1,277 | $563 to $44,950 | Low |
| Connective Tissue, Non-human | other | $1,284 | $569 to $2,140 | Low |
| Repair of Sliding Groin Hernia | surgery | $1,286 | $514 to $49,525 | Low |
| 8x21x32mm 7 Degree Tm-400 Dev #06-131 | other | $1,290 | $572 to $2,150 | Low |
| Velys Puresight Array Set Knee 4515-70-011 Minimum Order 5 Each | other | $1,293 | $573 to $2,155 | Low |
| Biopsy of Lobe of Lung Using an Endoscope, Each Additional Lobe | lab | $1,294 | $42 to $31,632 | Low |
| Amputation of Foot Across Instep | other | $1,295 | $574 to $28,805 | Low |
| Removal of Congenital Cyst OR Abnormal Drainage Tract of Neck And/or Throat | surgery | $1,303 | $452 to $42,815 | Low |
| Biopsy of Large Bowel Using an Endoscope Inserted Through Surgically Created ... | surgery | $1,303 | $578 to $44,389 | Low |
| Other Procedure On Appendix Using an Endoscope | other | $1,308 | $580 to $44,979 | Low |
| Removal of Appendix Using an Endoscope | surgery | $1,308 | $537 to $44,970 | Low |
| Tying of Dilated Veins of Stomach And/or Esophagus Using a Flexible Endoscope | other | $1,308 | $580 to $43,244 | Low |
| Removal of Border of Lip | surgery | $1,316 | $315 to $40,500 | Low |
| Closure Device, Vascular | other | $1,320 | $585 to $2,200 | Low |
| Lutonix .018" Dcb 130cm 5x150mm #lx1813051505f | other | $1,320 | $585 to $2,200 | Low |
| Lutonix .018" Dcb 130cm 6x150mm #lx1813061505f | other | $1,320 | $585 to $2,200 | Low |
| Lutonix .018" Dcb 130cm 7x150mm #lx1813071505f | other | $1,320 | $585 to $2,200 | Low |
| Microporous Collagen Implantable Slit Tube (neurawrap Nerve Protector), Per C... | surgery | $1,320 | $585 to $2,200 | Low |
| Injection of Esophagus, Stomach, And/or Upper Small Bowel Using a Flexible En... | other | $1,326 | $588 to $43,236 | Low |
| Drainage of Lymph Fluid to Abdominal Cavity Using an Endoscope | other | $1,330 | $563 to $49,323 | Low |
| Dilation of Stomach Outlet Using a Flexible Endoscope | other | $1,331 | $590 to $43,245 | Low |
| Repair of Trapped Groin Hernia | surgery | $1,336 | $527 to $49,507 | Low |
| Exploration of Stomach OR Removal of Foreign Body in Stomach | surgery | $1,337 | $593 to $43,500 | Low |
| Repair of Groin Hernia That Is Not Trapped | surgery | $1,339 | $564 to $49,520 | Low |
| Placement of Stabilizing Device for Broken Forearm Bone On Thumb Side At Wrist | other | $1,341 | $595 to $25,606 | Low |
| Lengthening OR Shortening of Tendon of Leg OR Ankle | other | $1,342 | $419 to $27,685 | Low |
| Initiation of Ecmo External Vein to Artery Blood Circulation in Heart and Lun... | cardiac | $1,343 | $288 to $33,947 | Low |
| Injection, Regadenoson, 0.1 Mg | other | $1,349 | $598 to $2,248 | Low |
| Removal OR Destruction of Growth of Nose Through Nose | surgery | $1,349 | $352 to $30,117 | Low |
| Removal and Replacement of Single Lead Defibrillator | surgery | $1,354 | $307 to $33,262 | Low |
| Injection, Infliximab, Excludes Biosimilar, 10 Mg | other | $1,366 | $31 to $2,276 | Low |
| Release of Hand Muscle | other | $1,367 | $595 to $26,593 | Low |
| Removal of Growth of Muscle of Neck OR Front of Chest, 5.0 Cm OR More | surgery | $1,367 | $606 to $21,554 | Low |
| Revision of Permanent Opening of Windpipe for Breathing with Flap Rotation | other | $1,372 | $606 to $31,614 | Low |
| Removal of Defect in Wall of Esophagus Using a Rigid Endoscope | surgery | $1,374 | $454 to $43,180 | Low |
| Removal of Growth of Muscle of Upper Arm OR Elbow, 5.0 Cm OR More | surgery | $1,374 | $609 to $24,073 | Low |
| Removal of Wedge of Lip Tissue with Closure | surgery | $1,375 | $300 to $40,510 | Low |
| Needle Biopsy of Kidney | lab | $1,376 | $610 to $50,200 | Low |
| Exposure of Underarm OR Upper Chest Artery with Creation of Conduit | other | $1,378 | $314 to $34,716 | Low |
| Insertion of Implant in Urethra Within Prostate Gland Using an Endoscope, Eac... | surgery | $1,379 | $42 to $52,442 | Low |
| Other Procedure On Stomach Using an Endoscope | other | $1,380 | $612 to $43,659 | Low |
| Shaving of Part of Shoulder Bone and Repair of Ligament Using an Endoscope | surgery | $1,380 | $139 to $29,826 | Low |
| Incision of Hand OR Finger Bone | other | $1,382 | $493 to $26,034 | Low |
| Forcep - Prograsp | other | $1,386 | $614 to $2,310 | Low |
| Forceps Tenaculum for Davinci Xi/x 8mm Instrument #470207 | other | $1,386 | $614 to $2,310 | Low |
| Repair of Openings of Nasal Cartilage | surgery | $1,386 | $573 to $30,630 | Low |
| Technetium Tc 99m Exametazime Diagnostic 25 Mci | other | $1,386 | $615 to $2,310 | Low |
| Removal of Growth of Muscle of Shoulder, 5.0 Cm OR More | surgery | $1,388 | $614 to $23,073 | Low |
| Insertion of Defibrillator with Existing Multiple Leads | other | $1,392 | $331 to $33,231 | Low |
| Repair of Defect OR Tear of Eardrum | surgery | $1,393 | $426 to $69,620 | Low |
| Treatment of Ligament Tear At Ankle Joint | other | $1,393 | $618 to $27,829 | Low |
| Removal of Lining Covering Abdominal Organs | surgery | $1,397 | $619 to $49,255 | Low |
| Amputation of Finger OR Thumb with Direct Closure | other | $1,398 | $620 to $26,951 | Low |
| Partial Removal of Collar Bone At Shoulder Using an Endoscope | surgery | $1,398 | $598 to $29,824 | Low |
| Primary Repair of Tendon OR Muscle of Top Side of Forearm OR Wrist | surgery | $1,398 | $441 to $25,270 | Low |
| Drainage of Fluid Collection By Tube Through Skin Using Imaging Guidance | other | $1,411 | $626 to $49,405 | Low |
| Removal and Replacement of Dual Lead Defibrillator | surgery | $1,417 | $319 to $33,263 | Low |
| Release of Finger Nerve | other | $1,417 | $459 to $64,702 | Low |
| Removal of Growth of Muscle of Back OR Lower Sides, 5.0 Cm OR More | surgery | $1,417 | $628 to $21,933 | Low |
| Repair of Abdominal Muscle Hernia | surgery | $1,421 | $597 to $49,540 | Low |
| Victoza 3-pak 18 Mg/3 Ml Pen | other | $1,422 | $630 to $2,370 | Low |
| Aspiration of Bone Marrow Sample for Diagnosis | other | $1,436 | $637 to $38,220 | Low |
| Creation of Opening From Small Bowel to Skin with Insertion of a Tube for Dec... | other | $1,436 | $580 to $44,186 | Low |
| Annuloplasty Ring 25mm #tarp | other | $1,437 | $637 to $2,395 | Low |
| Annuloplasty Ring 29mm #tarp | other | $1,437 | $637 to $2,395 | Low |
| Annuloplasty Ring 31mm #tarp | other | $1,437 | $637 to $2,395 | Low |
| Annuloplasty Ring 33mm #tarp | other | $1,437 | $637 to $2,395 | Low |
| Treatment of Broken Outer Lower Leg Bone At Ankle | other | $1,439 | $570 to $27,792 | Low |
| Lead, Cardioverter-defibrillator, Endocardial Dual Coil | other | $1,440 | $638 to $2,400 | Low |
| Lead, Left Ventricular Coronary Venous System | cardiac | $1,440 | $638 to $2,400 | Low |
| Repair Recurrent Incisional OR Ventral Hernia; Incarcerated OR Strangulated | surgery | $1,441 | $639 to $49,566 | Low |
| Removal of Cyst OR Growth of Lower Leg Bone | surgery | $1,441 | $513 to $27,635 | Low |
| Multiple Incisions of Connective Tissue of Thigh And/or Knee to Relieve Pressure | other | $1,442 | $584 to $27,498 | Low |
| Repair of Joint Between Hand and Finger Bones with Prosthesis | surgery | $1,450 | $552 to $26,531 | Low |
| Shock Wave Crushing of Kidney Stones | other | $1,450 | $495 to $50,590 | Low |
| Preparatory, Below Knee 'ptb' Type Socket, Non-alignable System, No Cover, Sa... | other | $1,453 | $644 to $2,422 | Low |
| Drainage of Deep Abscess OR Blood Accumulation of Pelvis OR Hip Near Joint | other | $1,460 | $617 to $26,990 | Low |
| Removal and Replacement of Multiple Lead Defibrillator | surgery | $1,460 | $331 to $33,264 | Low |
| Removal of Polyps OR Growths of Esophagus, Stomach, And/or Upper Small Bowel ... | surgery | $1,461 | $648 to $43,251 | Low |
| Release of Ligaments At Outer Side of Knee Joint Using an Endoscope | other | $1,463 | $487 to $29,873 | Low |
| Limited Removal of Abnormal Shoulder Joint Tissue Using Endoscope | surgery | $1,467 | $483 to $29,822 | Low |
| Correction of Rigid Deformity of First Joint of Big Toe Using Implant | surgery | $1,470 | $424 to $28,291 | Low |
| Exam of Nose and Sinus with Removal of Nasal Sinus Using an Endoscope | surgery | $1,473 | $356 to $31,257 | Low |
| Removal of Foreign Body in Abdominal Cavity | surgery | $1,474 | $653 to $49,402 | Low |
| Incision of Tendon of Forearm And/or Wrist, Open Procedure | other | $1,475 | $389 to $25,290 | Low |
| Repair of Tendon OR Muscle On Top Side of Forearm OR Wrist with Graft | surgery | $1,475 | $578 to $25,274 | Low |
| Partial Removal of Knee Joint Lining Using an Endoscope | surgery | $1,477 | $444 to $29,875 | Low |
| Lengthening OR Shortening of Tendon of Forearm And/or Wrist | other | $1,480 | $499 to $25,280 | Low |
| Treatment of Broken Midpart of Forearm Bone On Thumb Side | other | $1,480 | $594 to $25,515 | Low |
| Creation of Surgical Opening From Stomach to Skin Using an Endoscope | surgery | $1,486 | $525 to $43,653 | Low |
| Destruction of Growth of Rectum | other | $1,489 | $636 to $45,190 | Low |
| Repair of Trapped OR Strangulated Groin Hernia | surgery | $1,493 | $636 to $49,521 | Low |
| Removal of Tissue From Sphenoid Sinus Using an Endoscope | surgery | $1,494 | $377 to $31,259 | Low |
| Insertion of Stomach Feeding Tube | other | $1,496 | $628 to $43,830 | Low |
| Laparoscopy, Surgical, Repair, Ventral, Umbilical, Spigelian OR Epigastric He... | surgery | $1,497 | $664 to $49,653 | Low |
| Laparoscopy, Surgical, Repair, Incisional Hernia (includes Mesh Insertion, Wh... | surgery | $1,500 | $665 to $49,655 | Low |
| Laparoscopy, Surgical, Repair, Recurrent Incisional Hernia (includes Mesh Ins... | surgery | $1,500 | $665 to $49,657 | Low |
| Probe 10cm Malleable A000683 | other | $1,500 | $665 to $2,500 | Low |
| Removal of Diseased Part of Forearm Bone On Small Finger Side | surgery | $1,503 | $501 to $25,150 | Low |
| Biopsy of Breast and Placement of Locating Device Using Mri, Each Additional ... | imaging | $1,506 | $73 to $19,086 | Low |
| Repair Initial Incisional OR Ventral Hernia; Incarcerated OR Strangulated | surgery | $1,506 | $668 to $49,561 | Low |
| Addition to Lower Limb Prosthesis, Vertical Shock Reducing Pylon Feature | other | $1,507 | $668 to $2,512 | Low |
| Exchange of Abdominal Cavity Drainage Tube Using Imaging Guidance | other | $1,516 | $672 to $49,423 | Low |
| Removal and Replacement of Stent in Kidney and Ureter Using Fluoroscopic Guid... | surgery | $1,517 | $672 to $50,387 | Low |
| Treatment of Broken Wrist Bone Located Near Base of Thumb | other | $1,519 | $628 to $25,628 | Low |
| Deep Biopsy of Bone Using Needle OR Trocar | lab | $1,519 | $674 to $20,225 | Low |
| Incision and Repair of Elbow Tendon with Removal of Tissue OR Bone | surgery | $1,520 | $578 to $24,359 | Low |
| Instillation, Bupivacaine and Meloxicam, 1 Mg/0.03 Mg | other | $1,527 | $677 to $2,546 | Low |
| Insertion of Tube Into Small Bowel | other | $1,528 | $677 to $44,300 | Low |
| Creation of Permanent Opening of Windpipe for Breathing | other | $1,529 | $678 to $31,610 | Low |
| Catheter, Transluminal Angioplasty, Drug-coated, Non-laser | cardiac | $1,530 | $678 to $2,550 | Low |
| Treatment of Broken Finger OR Hand At Base of Finger | other | $1,530 | $646 to $26,746 | Low |
| Fusion of Joint Between Finger and Hand | surgery | $1,533 | $662 to $26,850 | Low |
| Complicated Plastic Repair of Salivary Duct | surgery | $1,538 | $388 to $42,505 | Low |
| Core Needle Biopsy of Lung OR Center Cavity of Chest (mediastinum), Accessed ... | lab | $1,539 | $682 to $32,408 | Low |
| Biopsy of Esophagus, Stomach, And/or Upper Small Bowel Using a Flexible Endos... | lab | $1,543 | $684 to $43,239 | Low |
| Control of Bleeding of Esophagus, Stomach, And/or Upper Small Bowel Using a F... | other | $1,543 | $684 to $43,255 | Low |
| Insertion of Guide Wire with Dilation of Esophagus Using a Flexible Endoscope | other | $1,543 | $684 to $43,248 | Low |
| Insertion of Stomach Tube Using a Flexible Endoscope | other | $1,543 | $684 to $43,246 | Low |
| Coronary Artery Bypass Using Vein OR Artery Graft, 2 Grafts | cardiac | $1,547 | $347 to $33,518 | Low |
| Intracept Access Instrument Rlv 0055 | other | $1,548 | $686 to $2,580 | Low |
| Destruction of Subsequent Incompetent Veins of Arm OR Leg Using Radiofrequenc... | other | $1,549 | $110 to $36,476 | Low |
| Repair of Wound of Eyelid Margin | surgery | $1,550 | $352 to $67,935 | Low |
| Suture of Recent Wound of Eyelid | other | $1,550 | $188 to $67,930 | Low |
| Incision of Bladder with Insertion of Tube OR Stent in Ureter | cardiac | $1,552 | $431 to $51,045 | Low |
| Removal of Bony Growths of Ear Canal | surgery | $1,552 | $688 to $69,140 | Low |
| Express Tray 15/2 First Fracture with Kyphx | other | $1,554 | $689 to $2,591 | Low |
| Removal OR Repair of Wrist Cartilage Using an Endoscope | surgery | $1,556 | $458 to $29,846 | Low |
| Removal OR Shaving of Knee Joint Cartilage Using an Endoscope | surgery | $1,557 | $549 to $29,877 | Low |
| Removal of Growth of Muscle of Pelvis and Hip, 5.0 Cm OR More | surgery | $1,558 | $646 to $27,045 | Low |
| Repair of Ligament of Finger OR Hand and Finger Joint | surgery | $1,559 | $636 to $26,540 | Low |
| Clamp Long Jaw A000362 | other | $1,560 | $692 to $2,600 | Low |
| Clamp Short Jaw A000432 | other | $1,560 | $692 to $2,600 | Low |
| Endovascular Repair of Iliac Artery (eg, Aneurysm, Pseudoaneurysm, Arterioven... | surgery | $1,560 | $692 to $34,900 | Low |
| Balloon Dilation of Groin Artery, Each Additional Vessel | other | $1,561 | $692 to $37,222 | Low |
| Tying, Incision, and Stripping of Short Leg Vein | other | $1,561 | $337 to $37,718 | Low |
| Other Antepartum Diagnoses without O.r. Procedures without Cc/mcc | other | $1,562 | $693 to $14,072 | Low |
| Relocation of Tendon of Forearm And/or Wrist | other | $1,562 | $627 to $25,310 | Low |
| Removal of Infected Skin, Tissue OR Muscle of Genitals, Perineum, OR Abdomen | surgery | $1,562 | $583 to $11,006 | Low |
| Repositioning of Defibrillator Electrode | other | $1,564 | $334 to $33,273 | Low |
| Treatment of Broken Thumb At Wrist | other | $1,564 | $543 to $26,665 | Low |
| Exploration of Abdominal Cavity | other | $1,566 | $678 to $49,000 | Low |
| Complete Exam of Nose and Sinuses Using an Endoscope | other | $1,569 | $399 to $31,253 | Low |
| Repair of Congenital Defect of Bladder | surgery | $1,570 | $552 to $51,500 | Low |
| Removal of Loose OR Foreign Body in Knee Joint Using an Endoscope | surgery | $1,576 | $474 to $29,874 | Low |
| Amputation of Finger OR Thumb | other | $1,582 | $693 to $26,910 | Low |
| Removal of Growth of Rectum Through Anus with Removal of a Portion of Muscle | surgery | $1,585 | $703 to $45,172 | Low |
| Amputation of Thigh Through Thigh Bone Leaving Wound | other | $1,587 | $585 to $27,592 | Low |
| Removal of Growth Under Nasal Bone OR Cartilage | surgery | $1,588 | $557 to $30,125 | Low |
| Removal of Scar Tissue to Release Tendon of Forearm OR Wrist | surgery | $1,589 | $466 to $25,295 | Low |
| Catheter, Intravascular Ultrasound | imaging | $1,590 | $705 to $2,650 | Low |
| Insertion of Tube Into Right Heart OR Main Pulmonary Artery | cardiac | $1,594 | $106 to $36,013 | Low |
| Diagnostic Exam of Large Bowel Using an Endoscope Inserted Through Surgically... | surgery | $1,603 | $711 to $44,388 | Low |
| Removal of Growths OR Polyps of Large Bowel By Mechanical Snare Using an Endo... | surgery | $1,603 | $711 to $44,394 | Low |
| Insertion of Tube Into Chest Aorta for Diagnosis OR Treatment with Review By ... | other | $1,604 | $166 to $36,221 | Low |
| Stress Test | cardiac | $1,604 | $34 to $2,674 | High |
| Destruction of Nasal Nerve By Heat Using an Endoscope | other | $1,605 | $128 to $31,242 | Low |
| Removal of Multiple Wrist Bones | surgery | $1,610 | $542 to $25,215 | Low |
| Anchoring of Flexing Tendon of Fingers to Wrist Bone | other | $1,611 | $614 to $25,300 | Low |
| Repair of Ruptured Achilles Tendon | surgery | $1,611 | $588 to $27,650 | Low |
| Repair of Ligament of Hand to Finger Joint with Local Tissue | surgery | $1,612 | $652 to $26,542 | Low |
| Removal of Blood Clot and Portion of Tibial OR Peroneal Artery, Each Addition... | surgery | $1,615 | $373 to $35,306 | Low |
| Removal of Connective Tissue of Palm | surgery | $1,616 | $527 to $26,121 | Low |
| Insertion of Tube Into Vein, First Order Branch | other | $1,619 | $129 to $36,011 | Low |
| Creation of Opening of Windpipe and Insertion of Speech Prosthesis | other | $1,622 | $463 to $31,611 | Low |
| Delivery of Simple High Precision Radiation Treatment | obstetric | $1,624 | $720 to $77,385 | Low |
| Incision of Corner of Eye At Eyelid | other | $1,624 | $720 to $67,715 | Low |
| Biopsy of Lung Lining | lab | $1,627 | $671 to $32,098 | Low |
| Repair of Joint Between Finger and Palm | surgery | $1,639 | $717 to $26,548 | Low |
| Insertion of Indwelling Tube for Drainage of Lung Fluid | other | $1,642 | $173 to $32,550 | Low |
| Removal of Infected Neck Graft | surgery | $1,645 | $407 to $35,901 | Low |
| Transfer of Deep Tendon of Foot with Muscle Rerouting | other | $1,645 | $661 to $27,691 | Low |
| Insertion of Tube Into Artery for Drug Infusion for Blood Clot with Review By... | surgery | $1,646 | $318 to $37,211 | Low |
| Catheter Spyscope Ds #m00546600 | cardiac | $1,646 | $730 to $2,743 | Low |
| Spyscope Ds Ii Access & Delivery Catheter M00546610 | cardiac | $1,646 | $730 to $2,743 | Low |
| Partial Removal of Shoulder Joint Lining Using an Endoscope | surgery | $1,649 | $471 to $29,820 | Low |
| Clip Pro 35mm Atriclip #a000824 | other | $1,650 | $732 to $2,750 | Low |
| Clip Pro 40mm Atriclip #a000825 | other | $1,650 | $732 to $2,750 | Low |
| Clip Pro 50mm Atriclip #a000827 | other | $1,650 | $732 to $2,750 | Low |
| Hearing Aid, Digital, Monaural, Bte | other | $1,650 | $732 to $5,500 | Low |
| Scp Foot & Ankle Kit #514.315 | other | $1,650 | $732 to $2,750 | Low |
| Drainage of Fluid Collection of Abdominal Cavity By Tube Using Imaging Guidance | other | $1,651 | $732 to $49,406 | Low |
| X-ray of Lower Spinal Canal with Review By Radiologist | imaging | $1,652 | $732 to $62,304 | Low |
| Partial Removal of Liver Tissue | surgery | $1,655 | $734 to $47,100 | Low |
| X-ray of Middle Spinal Canal with Review By Radiologist | imaging | $1,656 | $734 to $62,303 | Low |
| X-ray of Upper Spinal Canal with Review By Radiologist | imaging | $1,656 | $734 to $62,302 | Low |
| Ultrasound Guided Needle Aspiration OR Biopsy of Esophagus Using a Flexible E... | imaging | $1,659 | $735 to $43,238 | Low |
| Destruction of Polyp OR Growth of Lower Large Bowel Using a Flexible Endoscope | other | $1,661 | $136 to $45,346 | Low |
| Complicated Treatment of Dislocated Midhand Bone At Wrist | other | $1,663 | $554 to $26,686 | Low |
| Nuclear Medicine Study of Whole Body for Thyroid Cancer | imaging | $1,664 | $521 to $78,018 | Low |
| Knee Ankle Foot Orthosis, Fracture Orthosis, Femoral Fracture Cast Orthosis, ... | other | $1,665 | $738 to $2,775 | Low |
| Repair of Joint Capsule of Hand and Palm, 1 Finger | surgery | $1,669 | $672 to $26,516 | Low |
| Closure of Surgically Created Opening From Stomach to Skin | surgery | $1,673 | $627 to $43,870 | Low |
| Biopsy of Fluid Collection of Lung | lab | $1,674 | $710 to $32,096 | Low |
| Treatment of 2 Broken Lower Forearm Bone Pieces On Thumb Side Inside Wrist Jo... | other | $1,675 | $723 to $25,608 | Low |
| Lutonix .018" Dcb 130cm 4x220mm # Lx1813042204f | other | $1,680 | $745 to $2,800 | Low |
| Lutonix .018" Dcb 130cm 5x220mm #lx1813052205f | other | $1,680 | $745 to $2,800 | Low |
| Lutonix .018" Dcb 130cm 6x220mm #lx1813062205f | other | $1,680 | $745 to $2,800 | Low |
| Lutonix .018" Dcb 130cm 7x220mm #lx1813072205f | other | $1,680 | $745 to $2,800 | Low |
| Injection, Tbo-filgrastim, 1 Microgram | other | $1,680 | $1,680 to $2,800 | Low |
| Repair of Nasal Passage Through Nose | surgery | $1,685 | $634 to $30,540 | Low |
| Reshaping of Tip of Nose | other | $1,685 | $747 to $30,400 | Low |
| Repair of Hand Muscle | surgery | $1,693 | $461 to $26,591 | Low |
| Simple Complete Removal of Breast | surgery | $1,695 | $751 to $19,303 | Low |
| Byfavo 20 Mg Vial | other | $1,696 | $752 to $2,826 | Low |
| Remimazolam Besylate 20 Mg IV Solr | other | $1,696 | $752 to $2,826 | Low |
| Repair of Non-healed Wrist Bone, Scaphoid OR Navicular At the Base of the Thumb | surgery | $1,697 | $661 to $25,440 | Low |
| Removal of Growth of Muscle of Thigh OR Knee, 5.0 Cm OR More | surgery | $1,699 | $666 to $27,339 | Low |
| Exploration of Arm OR Leg for Bleeding, Blood Clot, OR Infection After Surgery | surgery | $1,699 | $721 to $35,860 | Low |
| Prosthetic Implant, Not Otherwise Specified | surgery | $1,700 | $754 to $2,833 | Low |
| Forcep - Fenestrated Bipolar | other | $1,701 | $754 to $2,835 | Low |
| Forcep Maryland Bipolar | other | $1,701 | $754 to $2,835 | Low |
| Forceps Cadiere #471049 | other | $1,701 | $754 to $2,835 | Low |
| Forceps Prograsp #471093 | other | $1,701 | $754 to $2,835 | Low |
| Intensive Care Unit - General Classification | other | $1,701 | $754 to $2,835 | Low |
| Partial Removal of Wrist Joint Lining Using an Endoscope | surgery | $1,706 | $441 to $29,844 | Low |
| Conversion of Kidney Tube to Nephroureteral Tube Using Imaging Guidance and S... | other | $1,707 | $757 to $50,434 | Low |
| Treatment of Dislocated Wrist Bones | other | $1,708 | $542 to $25,670 | Low |
| Kyphon 10/2 #kex102eb | other | $1,710 | $758 to $2,850 | Low |
| Kyphon Kit 15/2 #kex152eb | other | $1,710 | $758 to $2,850 | Low |
| Stent, Coated/covered, with Delivery System | cardiac | $1,710 | $758 to $2,850 | Low |
| Kyphon 15/3 Expender Ii Tray #kpx153pb | other | $1,711 | $758 to $2,851 | Low |
| Injection, Abatacept, 10 Mg | other | $1,711 | $44 to $2,852 | Low |
| Drug Delivery Using a Drug-coated Balloon for Male Treatment of Urethral Stri... | obstetric | $1,713 | $139 to $52,284 | Low |
| Removal of Extensive Shoulder Joint Tissue Using an Endoscope | surgery | $1,718 | $523 to $29,823 | Low |
| Repair of Muscle of Stomach Outlet Into Upper Small Bowel | surgery | $1,721 | $763 to $43,800 | Low |
| Repair of Forearm And/or Wrist Tendon Covering with Graft | surgery | $1,723 | $585 to $25,275 | Low |
| Removal of Gallbladder Using an Endoscope | surgery | $1,725 | $586 to $47,562 | Low |
| Biopsy of Growth of Lung | lab | $1,731 | $716 to $32,097 | Low |
| Ca15l2 15cm Reinforced Percutaneous Antenna X1 | other | $1,731 | $767 to $2,885 | Low |
| Ca20l2 Reinforced Percutaneous Antenna Emprint X1 | other | $1,731 | $767 to $2,885 | Low |
| Control of Bleeding of First OR Second Part of Small Bowel Using an Endoscope | other | $1,735 | $769 to $44,366 | Low |
| Treatment of Broken Kneecap with Placement of Stabilizing Device And/or Remov... | other | $1,735 | $660 to $27,524 | Low |
| Cardiac Congenital and Valvular Disorders without Mcc | cardiac | $1,737 | $770 to $21,359 | Low |
| CT Scan of Abdominal Aorta and Both Leg Arteries with Contrast | imaging | $1,741 | $106 to $75,635 | Low |
| Amputation of Thigh Through Thigh Bone | other | $1,742 | $670 to $27,590 | Low |
| Biopsy and Aspiration of Bone Marrow Sample for Diagnosis | lab | $1,742 | $772 to $38,222 | Low |
| Treatment of Both Broken Lower Leg Bones At Ankle | other | $1,744 | $670 to $27,814 | Low |
| Destruction of Second and Third Division of Face Nerve Branch | other | $1,745 | $385 to $64,605 | Low |
| Vascular Graft Material, Synthetic, Implant | surgery | $1,745 | $681 to $2,909 | Low |
| Removal of Knee Cartilage Using an Endoscope | surgery | $1,746 | $483 to $29,881 | Low |
| Nuclear Medicine Studies of Heart Muscle At Rest and with Stress and SPECT | imaging | $1,747 | $72 to $78,452 | Low |
| Removal of Loose OR Foreign Body in Shoulder Joint Using an Endoscope | surgery | $1,747 | $516 to $29,819 | Low |
| Initiation of Ecmo External Vein to Vein Blood Circulation in Heart and Lungs... | cardiac | $1,753 | $262 to $33,946 | Low |
| Removal of Lymph Nodes of Groin | surgery | $1,757 | $729 to $38,760 | Low |
| Removal of Shoulder Scar Tissue Using an Endoscope | surgery | $1,759 | $518 to $29,825 | Low |
| Small Clip Applier Xi #470401 Intuitive Surgical | surgery | $1,764 | $782 to $2,940 | Low |
| Exploration of Neck for Bleeding, Blood Clot, OR Infection After Surgery | surgery | $1,765 | $620 to $35,800 | Low |
| Genomic Sequence Analysis Panel of Dna OR Combined Dna and Rna of 5-50 Genes ... | lab | $1,769 | $760 to $81,450 | Low |
| Destruction of Polyp OR Growth of Small Bowel Using an Endoscope | other | $1,775 | $787 to $44,369 | Low |
| Suture Repair of Ureter | surgery | $1,780 | $725 to $50,900 | Low |
| Removal of Scar Tissue From Knee Using an Endoscope | surgery | $1,781 | $549 to $29,884 | Low |
| Preparatory, Below Knee 'ptb' Type Socket, Non-alignable System, Pylon, No Co... | other | $1,787 | $792 to $2,978 | Low |
| Catheter, Intracardiac Echocardiography | imaging | $1,787 | $792 to $2,979 | Low |
| Echocardiogram | imaging | $1,787 | $66 to $6,528 | High |
| CT Scan of Leg with Contrast Material | imaging | $1,789 | $168 to $73,701 | Low |
| Incision OR Partial Removal of Middle Portion of Thigh Bone | surgery | $1,791 | $713 to $27,448 | Low |
| Severing of Muscle At Stomach Outlet to Upper Small Bowel | other | $1,794 | $631 to $43,520 | Low |
| Release of Small Bowel Scar Tissue Using an Endoscope | other | $1,795 | $796 to $44,180 | Low |
| MRI Scan of Pelvis Before and After Contrast | imaging | $1,795 | $98 to $72,197 | Low |
| Knee Ankle Foot Orthosis, Full Plastic, Double Upright, with OR without Free ... | other | $1,801 | $799 to $3,002 | Low |
| Insertion of Implant in Urethra Within Prostate Gland Using an Endoscope, 1 I... | surgery | $1,802 | $176 to $52,441 | Low |
| Closure of Surgically Created Large OR Small Bowel Opening | surgery | $1,804 | $752 to $44,620 | Low |
| Amputation of Both Lower Leg Bones | other | $1,805 | $765 to $27,880 | Low |
| Fusion of Thumb At Wrist with Bone Graft | surgery | $1,805 | $763 to $26,842 | Low |
| Injection, Filgrastim-sndz, Biosimilar, (zarxio), 1 Microgram | other | $1,808 | $1,808 to $3,013 | Low |
| Replacement of Kidney Drainage Tube Using Imaging Guidance with Review By Rad... | surgery | $1,816 | $805 to $50,435 | Low |
| Treatment of 3 OR More Broken Lower Forearm Bone Pieces On Thumb Side Inside ... | other | $1,819 | $807 to $25,609 | Low |
| Balloon Dilation of Artery of Leg, Each Additional Vessel | other | $1,821 | $807 to $37,232 | Low |
| X-ray of Multiple Regions of Spinal Canal with Review By Radiologist | imaging | $1,822 | $752 to $62,305 | Low |
| Removal of Defect in Wall of Esophagus Through Neck | surgery | $1,823 | $672 to $43,130 | Low |
| Partial Removal of Roof of Mouth | surgery | $1,825 | $809 to $42,120 | Low |
| Tlso, Triplanar Control, Two Piece Rigid Plastic Shell with Interface Liner, ... | other | $1,830 | $812 to $3,051 | Low |
| Primary Repair of Torn Ligament OR Joint Capsule At Outside Part of Knee | surgery | $1,831 | $597 to $27,405 | Low |
| Injection, Dactinomycin, 0.5 Mg | other | $1,831 | $328 to $3,052 | Low |
| Partial Removal of Finger Bone | surgery | $1,838 | $655 to $26,567 | Low |
| Release of Arm OR Leg Nerve | other | $1,839 | $439 to $64,708 | Low |
| Removal of Lymph Nodes From Chin to Thyroid Cartilage | surgery | $1,843 | $672 to $38,700 | Low |
| Review By Radiologist of Major Upper Body Vein Image | other | $1,844 | $817 to $75,827 | Low |
| Incision OR Removal of Spinal Nerve | surgery | $1,847 | $485 to $64,772 | Low |
| Removal and Replacement of Stent in Ureter with Review By Radiologist | surgery | $1,848 | $819 to $50,382 | Low |
| Secondary Repair of Ruptured Achilles Tendon | surgery | $1,855 | $638 to $27,654 | Low |
| Plastic OR Reconstructive Repair of Throat | surgery | $1,857 | $690 to $42,950 | Low |
| Repair of Torn Ligament And/or Joint Capsule At Front of Knee | surgery | $1,859 | $700 to $27,407 | Low |
| Creation of Open Flap Tract for Drainage of Infected Material From Lining Aro... | other | $1,861 | $720 to $32,036 | Low |
| Insertion of Tube Into Extracranial Artery for Diagnosis OR Treatment with Re... | other | $1,868 | $234 to $36,222 | Low |
| Removal of Leg At Knee Joint | surgery | $1,873 | $600 to $27,598 | Low |
| Addition, Endoskeletal, Knee-shin System, Stance Flexion Feature, Adjustable | other | $1,875 | $831 to $3,125 | Low |
| Nuclear Medicine Study, Whole Body Requiring Multiple Imaging Days | imaging | $1,876 | $521 to $78,804 | Low |
| Exploration Behind Abdominal Cavity | other | $1,878 | $803 to $49,010 | Low |
| MRI Scan of Blood Vessels of Neck without Contrast | imaging | $1,884 | $229 to $70,547 | Low |
| Complex Measurement of Pressure of Urine Flow in Bladder with Urethra Pressur... | other | $1,888 | $120 to $51,729 | Low |
| Relocation of Nerve and Muscle to Restore Voice Box Function | other | $1,888 | $829 to $31,590 | Low |
| Removal of Infected Skin, Tissue OR Muscle of Abdomen | surgery | $1,888 | $644 to $11,005 | Low |
| Ca30l2 Reinforced Percutaneous Antenna Emprint X1 | other | $1,889 | $837 to $3,148 | Low |
| Cath Ensite Cath Array #ec1000-204 5/bx | other | $1,890 | $838 to $3,150 | Low |
| Removal of Gallbladder with X-ray Study of Bile Ducts Using an Endoscope | imaging | $1,891 | $635 to $47,563 | Low |
| Ropivacaine/ Ketorolac 400 Ml On-q Pump (greenlaw) - Compounded | other | $1,900 | $842 to $3,167 | Low |
| Repair of Knee Joint with Drilling and OR Scraping of Joint Using an Endoscope | surgery | $1,902 | $583 to $29,879 | Low |
| Replacement of Joint Between Wrist and Fingers Using Tissue | surgery | $1,915 | $698 to $25,447 | Low |
| Lead, Neurostimulator | other | $1,920 | $851 to $3,200 | Low |
| Removal of Lymph Nodes of Underarm | surgery | $1,920 | $781 to $38,745 | Low |
| Adhesion of Linings of Lung Using an Endoscope | other | $1,923 | $605 to $32,650 | Low |
| Injection, Estrogen Conjugated, Per 25 Mg | other | $1,926 | $392 to $3,209 | Low |
| Reopening of Recent Abdominal Incision | other | $1,927 | $854 to $49,002 | Low |
| Insertion of Stents with Balloon Dilation of Coronary Artery OR Branch, Each ... | cardiac | $1,928 | $855 to $92,929 | Low |
| Partial Removal of Breast and Underarm Lymph Nodes | surgery | $1,931 | $805 to $19,302 | Low |
| Recording of Right Lower Heart Chamber Rhythm | cardiac | $1,939 | $859 to $93,603 | Low |
| Removal of Gallbladder | surgery | $1,945 | $862 to $47,600 | Low |
| Relocation of Defibrillator Skin Pocket | other | $1,950 | $865 to $33,223 | Low |
| Relocation of Pacemaker Skin Pocket | cardiac | $1,950 | $865 to $33,222 | Low |
| Removal of Gallbladder with Exploration of Common Bile Duct Using an Endoscope | surgery | $1,951 | $865 to $47,564 | Low |
| Repair of Shoulder Rotator Cuff Using an Endoscope | surgery | $1,953 | $866 to $29,827 | Low |
| Removal of Connective Tissue of Palm and Release of Finger, First Digit | surgery | $1,955 | $733 to $26,123 | Low |
| Balloon Dilation of Artery with Review By Radiologist, Each Additional Artery | other | $1,959 | $143 to $37,247 | Low |
| Repair of Shoulder Joint Capsule Using an Endoscope | surgery | $1,961 | $870 to $29,806 | Low |
| Shortening of One of the Forearm Bones | other | $1,967 | $661 to $25,390 | Low |
| Suture of Hand OR Foot Digital Nerve, First Digital Nerve | other | $1,968 | $604 to $64,831 | Low |
| Treatment of 3 Broken Lower Leg Bones At Ankle | other | $1,969 | $774 to $27,822 | Low |
| Insertion of Tube for Ecmo External Blood Circulation in Heart and Lungs Usin... | cardiac | $1,970 | $402 to $33,954 | Low |
| Reconstruction of Opening From Small Bowel to Skin | other | $1,970 | $874 to $44,314 | Low |
| CT Scan of Arm with Contrast | imaging | $1,971 | $335 to $73,201 | Low |
| Release And/or Relocation of Cranial Nerve | other | $1,972 | $442 to $64,716 | Low |
| MRI Scan of Jaw Joint | imaging | $1,972 | $229 to $70,336 | Low |
| Valvulotome 1.8 Expandable #1009 | other | $1,979 | $878 to $3,299 | Low |
| CT Scan of Leg Before and After Contrast | imaging | $1,980 | $168 to $73,702 | Low |
| Re-amputation of Thigh Through Thigh Bone | other | $1,981 | $615 to $27,596 | Low |
| Treatment of Broken Shin Bone At Knee | other | $1,982 | $713 to $27,540 | Low |
| Catheter, Transluminal Atherectomy, Rotational | cardiac | $1,984 | $879 to $3,306 | Low |
| MRI Scan of Blood Vessels of Head without Contrast | imaging | $1,985 | $229 to $70,544 | Low |
| Balloon Dilation of Coronary Artery OR Branch, Each Additional Artery OR Branch | cardiac | $1,986 | $880 to $92,921 | Low |
| MRI Scan of Both Breasts without Contrast | imaging | $1,987 | $229 to $77,047 | Low |
| Release of Intestinal Scar Tissue | other | $1,994 | $884 to $44,005 | Low |
| Coronary Artery Bypass Using Vein OR Artery Graft, 3 Grafts | cardiac | $1,995 | $459 to $33,519 | Low |
| Indium-111 Pentetate | other | $1,996 | $885 to $3,326 | Low |
| Catheter, Extravascular Tissue Ablation, Any Modality | cardiac | $1,997 | $885 to $3,328 | Low |
| Skin Graft Except for Skin Ulcer OR Cellulitis without Cc/mcc | other | $1,999 | $886 to $26,372 | Low |
| Review By Radiologist of Liver Vein Image with Assessment of Blood Flow | other | $2,009 | $891 to $75,889 | Low |
| Repair of Throat At Esophagus | surgery | $2,015 | $841 to $42,953 | Low |
| MRI Scan of Bone of Eye Socket, Face, And/or Neck without Contrast | imaging | $2,015 | $229 to $70,540 | Low |
| Repair of Twisted OR Herniated Small Bowel | surgery | $2,019 | $818 to $44,050 | Low |
| Biopsy OR Removal of Lymph Nodes of Breast | surgery | $2,024 | $496 to $38,530 | Low |
| Complicated Reconstruction of Opening From Large Bowel to Skin | other | $2,033 | $901 to $44,345 | Low |
| Csi Burr 1.5 Classic | other | $2,037 | $903 to $3,395 | Low |
| Csi Burr 2.0 Classic | other | $2,037 | $903 to $3,395 | Low |
| Stealth 1.5 Classic Crown #dbp-150classic145 | other | $2,037 | $903 to $3,395 | Low |
| Stealth 2.0 #dbp-200classic145 | other | $2,037 | $903 to $3,395 | Low |
| Stealth Th 1.5 Solid Crown #dbp-150solid145 | other | $2,037 | $903 to $3,395 | Low |
| Suture of Tear OR Hole in Large Bowel | other | $2,037 | $903 to $44,604 | Low |
| Fusion of Part of Wrist Joint with Patient-derived Bone Graft | surgery | $2,039 | $698 to $25,825 | Low |
| Exploration of Ureter | other | $2,041 | $800 to $50,600 | Low |
| MRI Scan of Arm with Contrast | imaging | $2,046 | $335 to $73,219 | Low |
| Extensive Removal of Tonsils, Tissue, Muscle, and Bone | surgery | $2,048 | $859 to $42,842 | Low |
| Tonsillectomy | surgery | $2,048 | $230 to $6,828 | High |
| Insertion of Sacral Nerve Neurostimulator Electrode | other | $2,051 | $558 to $64,581 | Low |
| Repair of Ruptured Bowel Into Bladder | surgery | $2,054 | $735 to $51,525 | Low |
| Removal of Joint Lining From Multiple Knee Joint Compartments Using an Endoscope | surgery | $2,056 | $576 to $29,876 | Low |
| Injection, Ceftazidime and Avibactam, 0.5 G/0.125 G | other | $2,069 | $105 to $3,448 | Low |
| Catheter, Transluminal Intravascular Lithotripsy, Coronary | cardiac | $2,070 | $918 to $3,450 | Low |
| Implantable/insertable Device, Not Otherwise Classified | surgery | $2,070 | $918 to $3,450 | Low |
| Forceps Maryland Bipolar #471172 | other | $2,073 | $919 to $3,455 | Low |
| Removal of Infected Graft of Arm OR Leg | surgery | $2,074 | $481 to $35,903 | Low |
| Respiratory Syncytial Virus Antibody for Injection Into Tissue OR Muscle | other | $2,075 | $920 to $90,378 | Low |
| MRI Scan of Pelvis without Contrast | imaging | $2,078 | $229 to $72,195 | Low |
| Removal of Less Than Half of Tongue | surgery | $2,087 | $921 to $41,120 | Low |
| Repair of Tendons of Outer Forearm At Wrist Joint | surgery | $2,089 | $777 to $25,337 | Low |
| MRI Scan of Chest without Contrast | imaging | $2,090 | $229 to $71,550 | Low |
| Initial Removal of Wedge of Lung Tissue | surgery | $2,092 | $832 to $32,505 | Low |
| Probe, Image-guided, Robotic, Waterjet Ablation | other | $2,094 | $928 to $3,490 | Low |
| Repair Non-healed Fracture of Forearm Bone | surgery | $2,096 | $691 to $25,400 | Low |
| Repair of Eardrum and Ear Canal with Opening to Ear Bones | surgery | $2,096 | $754 to $69,631 | Low |
| Removal of Blood Flow Assist Device in Aorta with Repair of Upper Leg Artery | surgery | $2,101 | $625 to $33,971 | Low |
| Repair of Wound By Transferring Skin, 30.1-60.0 SQ Cm | surgery | $2,102 | $724 to $14,301 | Low |
| Exploration, Drainage, Biopsy, OR Removal of Foreign Body in Chest Cavity | surgery | $2,102 | $709 to $39,010 | Low |
| Removal of Middle Ear (mastoid) Bone | surgery | $2,103 | $794 to $69,502 | Low |
| Simple Partial Removal of Bladder | surgery | $2,103 | $826 to $51,550 | Low |
| Fusion of Wrist Joint with Graft From Hip OR Other Bone | surgery | $2,104 | $745 to $25,810 | Low |
| Dupixent 200 Mg/1.14 Ml Syring | other | $2,106 | $933 to $3,509 | Low |
| Dupixent 300 Mg/2 Ml Syringe | other | $2,106 | $933 to $3,509 | Low |
| Repair of Dislocating Kneecap with Realignment | surgery | $2,107 | $654 to $27,422 | Low |
| Pacemaker, Single Chamber, Rate-responsive | cardiac | $2,111 | $936 to $3,518 | Low |
| Partial Removal of Pelvic and Aortic Lymph Nodes | surgery | $2,111 | $627 to $38,562 | Low |
| Replacement of Tunneled Central Venous Tube | surgery | $2,111 | $936 to $36,581 | Low |
| Repositioning of Left Lower Heart Electrode | cardiac | $2,111 | $936 to $33,226 | Low |
| Removal of Growth of Peripheral Nerve | surgery | $2,112 | $631 to $64,784 | Low |
| Delivery of Complex High Precision Radiation Treatment | obstetric | $2,114 | $937 to $77,386 | Low |
| Insertion of Tube Through the Skin for Ecmo External Blood Circulation in Hea... | other | $2,116 | $359 to $33,952 | Low |
| Creation of Opening From Large Bowel to Skin | other | $2,126 | $942 to $44,320 | Low |
| Initial Removal of Wedge of Lung Tissue Using an Endoscope | surgery | $2,126 | $780 to $32,666 | Low |
| Incision of Mastoid Bone | other | $2,131 | $600 to $69,501 | Low |
| Tying, Incision, and Stripping of Long Leg Vein | other | $2,131 | $394 to $37,722 | Low |
| Removal of Gallbladder with X-ray Study of Bile Ducts | imaging | $2,137 | $947 to $47,605 | Low |
| Balloon Viabahn Bx 7mmx59mm 7fr Bxa075902a | other | $2,138 | $948 to $3,563 | Low |
| Removal of Growth of Esophagus Through Chest OR Abdomen | surgery | $2,138 | $900 to $43,101 | Low |
| MRI Scan of Lower Spinal Canal without Contrast | imaging | $2,140 | $229 to $72,148 | Low |
| MRI Scan of Middle Spinal Canal without Contrast | imaging | $2,140 | $229 to $72,146 | Low |
| Insertion of Blood Flow Assist Device in Aorta Through Skin | other | $2,143 | $210 to $33,967 | Low |
| Removal of Blood Flow Assist Device in Aorta | surgery | $2,143 | $28 to $33,968 | Low |
| Release And/or Relocation of Elbow Nerve | other | $2,145 | $538 to $64,718 | Low |
| MRI Scan of Leg Joint without Contrast | imaging | $2,149 | $229 to $73,721 | Low |
| Repair of Prolapsed Rectum Through Anus | surgery | $2,152 | $946 to $45,130 | Low |
| Removal of Blood Clot in Artery of Upper Arm | surgery | $2,154 | $504 to $34,101 | Low |
| Theraskin, Per Square Centimeter | other | $2,157 | $119 to $3,595 | Low |
| Infasurf 35 Mg/ml Vial | other | $2,159 | $957 to $3,598 | Low |
| Destruction of Cyst of Kidney Using an Endoscope | other | $2,160 | $782 to $50,541 | Low |
| Creation of Opening From Small Bowel to Skin | other | $2,162 | $903 to $44,310 | Low |
| Repair of Inside OR Outside Knee Joint Cartilage Using an Endoscope | surgery | $2,162 | $602 to $29,882 | Low |
| Extensive Removal of Growth of Face OR Scalp, 2.0 Cm OR More | surgery | $2,163 | $847 to $21,016 | Low |
| Removal of Gallbladder with Exploration of Common Bile Duct | surgery | $2,166 | $960 to $47,610 | Low |
| Removal of Both Knee Cartilages Using an Endoscope | surgery | $2,168 | $499 to $29,880 | Low |
| Repair of Dislocating Kneecap | surgery | $2,173 | $659 to $27,420 | Low |
| Insertion of Brain Neurostimulator Pulse Device with Connection to 2 OR More ... | other | $2,175 | $851 to $61,886 | Low |
| Creation of Opening From Large Bowel to Skin with Multiple Bowel Biopsies | other | $2,176 | $913 to $44,322 | Low |
| MRI Scan of Brain without Contrast | imaging | $2,179 | $229 to $70,551 | Low |
| Creation of Opening From Small Bowel to Skin Using an Endoscope | other | $2,190 | $961 to $44,187 | Low |
| Implantation of Cochlear Stimulating System Into Skull with Attachment Throug... | surgery | $2,191 | $413 to $69,714 | Low |
| Creation of Flap Graft to Nose, Forehead, Temple, OR Scalp | other | $2,192 | $829 to $15,731 | Low |
| Limb Ext Iliac Cuff Left #is20-25/c55 Sa | other | $2,196 | $974 to $3,660 | Low |
| Limb Extension Cuff #is20-25/c65 Sa | other | $2,196 | $974 to $3,660 | Low |
| Limb Extensions Cuff #i16-16/c55f Sa | other | $2,196 | $974 to $3,660 | Low |
| Limb Extensions Cuff #i20-13/c88f Sa | other | $2,196 | $974 to $3,660 | Low |
| Limb Extensions Cuff #i20-20/c55f Sa | other | $2,196 | $974 to $3,660 | Low |
| Removal of Growth of Ear Canal | surgery | $2,196 | $849 to $69,150 | Low |
| Suture of Perforated Ulcer, Wound, OR Injury of Stomach OR Upper Small Bowel | other | $2,203 | $976 to $43,840 | Low |
| Repair of Knee Joint with Bone Graft Using an Endoscope | surgery | $2,204 | $666 to $29,885 | Low |
| Revision of Opening From Large Bowel to Skin with Repair of Hernia | surgery | $2,206 | $978 to $44,346 | Low |
| Gore Excluder Endorosthesis Iliac Branch Comp #hgb161007a | other | $2,210 | $980 to $3,684 | Low |
| Repair of Nerve Using Nerve Graft, First Strand | surgery | $2,215 | $768 to $64,912 | Low |
| Reconstruction of Dislocating Kneecap with Removal | surgery | $2,217 | $658 to $27,424 | Low |
| Repair of Penis | surgery | $2,225 | $589 to $54,437 | Low |
| Imaging of Esophagus Done From the Inside of the Esophagus | other | $2,231 | $46 to $91,111 | Low |
| Review By Radiologist of Image for Insertion of Material to Block Blood Flow | other | $2,234 | $295 to $75,894 | Low |
| Coronary Artery Bypass OR Valve Procedure Reoperation More Than 1 Month After... | cardiac | $2,242 | $444 to $33,530 | Low |
| Repair of Nerve with Graft | surgery | $2,242 | $656 to $64,910 | Low |
| Injection of Bile Duct for X-ray Through Already Existing Skin Access Using I... | imaging | $2,243 | $995 to $47,531 | Low |
| Removal of Blood Clot of Artery OR Vein Graft | surgery | $2,245 | $500 to $35,875 | Low |
| Injection, Tocilizumab-aazg (tyenne), Biosimilar, 1 Mg | other | $2,246 | $4 to $3,743 | Low |
| Mechanical Heart Valve Aortic Size 27mm 27agn | cardiac | $2,250 | $998 to $3,750 | Low |
| Suture of Bleeding Stomach Ulcer | other | $2,251 | $998 to $43,501 | Low |
| Gore Excluder Aaa Endoprosthesis 12fr Pll161207 | other | $2,252 | $998 to $3,753 | Low |
| Gore Excluder Aaa Endoprosthesis 16mm X 14.5mm Pll161407 | other | $2,252 | $998 to $3,753 | Low |
| Repair of Nasal Passage | surgery | $2,255 | $870 to $30,465 | Low |
| Biopsy OR Removal of Foreign Body in Large Bowel | surgery | $2,257 | $855 to $44,025 | Low |
| Suture of Hand Median Motor Nerve | other | $2,259 | $706 to $64,835 | Low |
| Dilation of Windpipe Cartilage OR Treatment of Broken Windpipe Cartilage Usin... | other | $2,263 | $1,003 to $31,630 | Low |
| Incision of Chest Cavity for Complications After Surgery | surgery | $2,267 | $789 to $32,120 | Low |
| MRI Scan of Upper Spinal Canal without Contrast | imaging | $2,276 | $229 to $72,141 | Low |
| Repair of Wrist Joint | surgery | $2,279 | $727 to $25,332 | Low |
| Hearing Aid, Digital, Binaural, Ite | other | $2,280 | $1,011 to $7,600 | Low |
| MRI Scan of Pelvis with Contrast | imaging | $2,280 | $335 to $72,196 | Low |
| Removal of Growth of Windpipe Cartilage | surgery | $2,281 | $872 to $31,785 | Low |
| Reshaping of Bone, Cartilage, And/or Tip of Nose | other | $2,281 | $1,011 to $30,410 | Low |
| Insertion of Stent in Ureter | cardiac | $2,292 | $872 to $50,605 | Low |
| Reconstruction of Ligaments Outside Knee Joint | other | $2,295 | $621 to $27,427 | Low |
| Repair of Upper End of Shin Bone At Knee Joint | surgery | $2,295 | $715 to $27,418 | Low |
| MRI Scan of Bone of Eye Socket, Face, And/or Neck with Contrast | imaging | $2,296 | $335 to $70,542 | Low |
| Suture of Tear of Hole in Small Bowel | other | $2,308 | $1,023 to $44,602 | Low |
| Partial Removal of Small Bowel with Reconnection | surgery | $2,311 | $1,024 to $44,120 | Low |
| Injection, Tetanus Immune Globulin, Human, Up to 250 Units | other | $2,313 | $593 to $3,854 | Low |
| Removal of Growth Plate of Both Lower Leg Bones | surgery | $2,316 | $643 to $27,477 | Low |
| Isoproterenol 1 Mg/5 Ml Vial | other | $2,319 | $1,028 to $3,866 | Low |
| Removal OR Destruction of Growth(s) in the Abdomen, 5.0 Cm OR Less | surgery | $2,320 | $1,028 to $49,186 | Low |
| Revision to Reshape Nasal Bones After Previous Repair | surgery | $2,323 | $1,030 to $30,435 | Low |
| Gore Excluder Aortic Extender Endoprosthesis 28.5mm X 3.3cm #pla280300 | other | $2,326 | $1,031 to $3,877 | Low |
| Implantation of Self Cartilage Cells Into Knee Bone | surgery | $2,326 | $844 to $27,416 | Low |
| Removal of Growth of Saliva Gland with Release of Facial Nerve | surgery | $2,329 | $871 to $42,415 | Low |
| Balloon Dilation Treatment of Stricture of Ureter Using Imaging Guidance with... | other | $2,332 | $149 to $50,706 | Low |
| Arthroflex, Per Square Centimeter | other | $2,333 | $119 to $3,889 | Low |
| Removal of Bone Cavity Behind Eye for Decompression | surgery | $2,334 | $1,035 to $67,414 | Low |
| Removal of Extra Finger | surgery | $2,335 | $908 to $26,587 | Low |
| Catheter, Electrophysiology, Diagnostic/ablation, Other Than 3d OR Vector Map... | cardiac | $2,340 | $1,037 to $3,900 | Low |
| Lead, Cardioverter-defibrillator, Endocardial Single Coil | other | $2,340 | $1,037 to $3,900 | Low |
| Valve Aortic 19mm #esp100-19-00 Epic Supra | other | $2,340 | $1,037 to $3,900 | Low |
| Valve Aortic 21mm #e100-21a-00 Epic | other | $2,340 | $1,037 to $3,900 | Low |
| Valve Aortic 21mm #esp100-21-00 Epic Supra | other | $2,340 | $1,037 to $3,900 | Low |
| Valve Aortic 23mm #e100-23a-00 Epic | other | $2,340 | $1,037 to $3,900 | Low |
| Valve Aortic 23mm #esp100-23-00 Epic Supra | other | $2,340 | $1,037 to $3,900 | Low |
| Valve Aortic 25mm #e100-25a-00 Epic | other | $2,340 | $1,037 to $3,900 | Low |
| Valve Aortic 25mm #esp100-25-00 Epic Supra | other | $2,340 | $1,037 to $3,900 | Low |
| Valve Aortic 27mm #e100-27a-00 Epic | other | $2,340 | $1,037 to $3,900 | Low |
| Valve Aortic 27mm #esp100-27-00 Epic Supra | other | $2,340 | $1,037 to $3,900 | Low |
| Insertion of Tube Into First Order Main and Accessory Arteries of Kidney for ... | other | $2,341 | $211 to $36,251 | Low |
| Repair of Knee Joint with Bone Graft and Internal Stabilizing Device Using an... | surgery | $2,345 | $664 to $29,887 | Low |
| Delivery of Fixation Device to Graft with Review By Radiologist | obstetric | $2,355 | $552 to $34,712 | Low |
| Repositioning of Pacemaker OR Defibrillator Electrode | cardiac | $2,359 | $1,046 to $33,215 | Low |
| Injection of Bile Duct for X-ray Through New Skin Access Using Imaging Guidan... | imaging | $2,366 | $1,049 to $47,532 | Low |
| Placement of External Drainage Tube of Biliary Duct Using Imaging Guidance wi... | other | $2,366 | $1,049 to $47,533 | Low |
| Placement of Internal-external Drainage Tube of Biliary Duct Using Imaging Gu... | other | $2,366 | $1,049 to $47,534 | Low |
| Replacement of Liver Duct Drainage Tube Using Imaging Guidance with Review By... | surgery | $2,366 | $1,049 to $47,536 | Low |
| MRI Scan of Leg with Contrast | imaging | $2,377 | $335 to $73,719 | Low |
| Removal of Stone OR Debris From Bile OR Pancreatic Duct Using a Flexible Endo... | surgery | $2,378 | $1,054 to $43,264 | Low |
| Dissector Curved Bipolar #471344 | other | $2,381 | $1,056 to $3,969 | Low |
| Partial Destruction and Reconstruction of Right Upper Heart Chamber | cardiac | $2,385 | $529 to $33,257 | Low |
| CT Scan of Upper Spine Before and After Contrast | imaging | $2,396 | $168 to $72,127 | Low |
| Insertion of Tube Into External Neck Artery for Diagnosis OR Treatment with R... | other | $2,398 | $99 to $36,227 | Low |
| **obsolete** Valve Mitral 25mm Bicor #b100-25m | other | $2,400 | $1,064 to $4,000 | Low |
| Valve Mitral 25mm #e100-25m-00 Epic | other | $2,400 | $1,064 to $4,000 | Low |
| Valve Mitral 27mm #b100-27m Bicor | other | $2,400 | $1,064 to $4,000 | Low |
| Valve Mitral 27mm #e100-27m-00 Epic | other | $2,400 | $1,064 to $4,000 | Low |
| Valve Mitral 29mm #b100-29m Bicor | other | $2,400 | $1,064 to $4,000 | Low |
| Valve Mitral 29mm #e100-29m-00 Epic | other | $2,400 | $1,064 to $4,000 | Low |
| Valve Mitral 31mm #e100-31m-00 Epic | other | $2,400 | $1,064 to $4,000 | Low |
| Valve Mitral 33mm #e100-33m-00 Epic | other | $2,400 | $1,064 to $4,000 | Low |
| Injection, Carfilzomib, 1 Mg | other | $2,407 | $49 to $4,012 | Low |
| MRI Scan of Chest with Contrast | imaging | $2,408 | $752 to $71,551 | Low |
| CT Scan of Middle Spine Before and After Contrast | imaging | $2,412 | $168 to $72,130 | Low |
| Removal of Lymph Nodes of Neck | surgery | $2,413 | $1,070 to $38,720 | Low |
| Injection, Crotalidae Polyvalent Immune Fab (ovine), Up to 1 Gram | other | $2,418 | $1,072 to $4,029 | Low |
| Replacement of Joint Between Wrist and Fingers Using Tendon OR Stitches | surgery | $2,424 | $769 to $25,448 | Low |
| Ustekinumab, for Intravenous Injection, 1 Mg | other | $2,428 | $13 to $4,047 | Low |
| Treatment of Broken Side of Lower End of Thigh Bone | other | $2,429 | $819 to $27,514 | Low |
| MRI Scan of Abdomen without Contrast | imaging | $2,435 | $229 to $74,181 | Low |
| Injection, Phentolamine Mesylate, Up to 5 Mg | other | $2,435 | $432 to $4,059 | Low |
| Normal Newborn | other | $2,436 | $1,080 to $5,975 | Low |
| Thyroidectomy | surgery | $2,442 | $777 to $8,140 | High |
| Partial Removal of Large Bowel with Connection | surgery | $2,444 | $1,083 to $44,140 | Low |
| Extensive Removal of Growth of Forearm OR Wrist, 3.0 Cm OR More | surgery | $2,446 | $1,010 to $25,078 | Low |
| Release of Tendon Connecting Biceps Muscle and Shoulder Using an Endoscope | other | $2,451 | $791 to $29,828 | Low |
| Removal of Ureter and Partial Removal of Bladder | surgery | $2,453 | $885 to $50,650 | Low |
| Injection, Trastuzumab-anns, Biosimilar, (kanjinti), 10 Mg | other | $2,456 | $30 to $4,094 | Low |
| Strengthening of Muscle Between Esophagus and Stomach By Wrapping Part of Sto... | other | $2,461 | $939 to $43,280 | Low |
| Coronary Artery Bypass Using Vein OR Artery Graft, 4 Grafts | cardiac | $2,462 | $551 to $33,521 | Low |
| Removal of Kidney Stone | surgery | $2,463 | $971 to $50,060 | Low |
| Release of Scar Tissue At Ureter | other | $2,464 | $1,048 to $50,715 | Low |
| Partial Removal of Small Bowel with Creation of Opening to Skin | surgery | $2,466 | $1,022 to $44,125 | Low |
| Removal of Lower Part of Stomach with Reattachment of Remaining Stomach to Fi... | surgery | $2,467 | $1,094 to $43,631 | Low |
| Addition to Lower Extremity, Ischial Containment/narrow M-l Socket | other | $2,468 | $1,094 to $4,113 | Low |
| Repair Non-healed Fracture of Forearm Bone with Patient-derived Bone Graft | surgery | $2,468 | $881 to $25,405 | Low |
| CT Scan of Lower Spine Before and After Contrast | imaging | $2,471 | $168 to $72,133 | Low |
| Removal of Foreign Body in Lining of Chest Cavity Using an Endoscope | surgery | $2,479 | $937 to $32,653 | Low |
| Leuprolide Acetate (for Depot Suspension), 7.5 Mg | other | $2,487 | $176 to $4,145 | Low |
| Repair of Side of Voice Box By Moving Vocal Cord to Middle | surgery | $2,488 | $943 to $31,591 | Low |
| Injection, Belimumab, 10 Mg | other | $2,489 | $54 to $4,148 | Low |
| Removal of Breast and Underarm Lymph Nodes | surgery | $2,491 | $1,046 to $19,307 | Low |
| Probe/needle, Cryoablation | other | $2,493 | $1,105 to $4,155 | Low |
| Endograft Iliac Limb 14x12x160 | other | $2,496 | $1,107 to $4,160 | Low |
| Removal of Defibrillator | surgery | $2,502 | $1,109 to $33,241 | Low |
| Removal of Single Electrode From Right Heart | surgery | $2,502 | $1,109 to $33,234 | Low |
| Primary Removal and Dissolving of Blood Clot From Artery OR Artery Graft Usin... | surgery | $2,508 | $133 to $37,185 | Low |
| Removal of Stomach Ulcer OR Growth | surgery | $2,508 | $854 to $43,610 | Low |
| Stabilization of Thigh Bone with Device | other | $2,508 | $969 to $27,495 | Low |
| MRI Scan of Leg Joint with Contrast | imaging | $2,510 | $752 to $73,722 | Low |
| Creation of Large Bowel Opening Using an Endoscope | other | $2,528 | $1,064 to $44,188 | Low |
| Insertion of Tube in Peripheral Blood Vessel for Heart-lung Machine Support | cardiac | $2,531 | $630 to $33,368 | Low |
| Removal of Malignant Growth of Stomach | surgery | $2,538 | $1,068 to $43,611 | Low |
| Removal of Plaque with Balloon Dilation of Single Coronary Artery OR Branch | surgery | $2,538 | $437 to $92,924 | Low |
| Repair of Eardrum, Ear Canal, and Bones with Insertion of Prosthesis | surgery | $2,539 | $889 to $69,633 | Low |
| Injection, Tafasitamab-cxix, 2 Mg | other | $2,548 | $14 to $4,247 | Low |
| Injection, Secukinumab, Intravenous, 1 Mg | other | $2,551 | $18 to $4,251 | Low |
| MRI Scan of Brain with Contrast | imaging | $2,555 | $335 to $70,552 | Low |
| White Blood Cell Count | other | $2,555 | $6 to $85,004 | Low |
| Biopsy of Gallbladder, Pancreatic, Liver, and Bile Ducts Using a Flexible End... | lab | $2,558 | $1,134 to $43,261 | Low |
| Repair of Paraesophageal Hernia Through Abdomen | surgery | $2,563 | $1,001 to $43,332 | Low |
| Review By Radiologist of Abdominal Aorta Image | other | $2,564 | $1,137 to $75,625 | Low |
| Exploration of Neck Artery | other | $2,566 | $361 to $35,701 | Low |
| Complex Repair of Eardrum and Ear Canal with Removal of Mastoid Bone | surgery | $2,583 | $876 to $69,641 | Low |
| Biopsy of Lobe of Lung Using an Endoscope, 1 Lobe | lab | $2,587 | $1,147 to $31,628 | Low |
| Repair of Shoulder Socket Using an Endoscope | surgery | $2,590 | $891 to $29,807 | Low |
| Suture and Relocation of Arm OR Leg Peripheral Nerve | other | $2,593 | $857 to $64,856 | Low |
| Insertion of Tube Into Gallbladder Using Imaging Guidance with Review By Radi... | other | $2,600 | $1,153 to $47,490 | Low |
| Incision and Exploration of Chest Cavity | other | $2,601 | $723 to $32,100 | Low |
| Repair of Paraesophageal Hernia Through Chest | surgery | $2,610 | $1,083 to $43,334 | Low |
| Incision of Pancreatic Outlet Using a Flexible Endoscope | other | $2,630 | $1,166 to $43,262 | Low |
| Removal of Gallbladder and Creation of Bile Duct Drainage to Bowel | surgery | $2,634 | $1,104 to $47,612 | Low |
| Removal of Kidney and Partial Removal of Ureter Using an Endoscope | surgery | $2,635 | $1,026 to $50,546 | Low |
| Repositioning of Ureter Using an Endoscope | other | $2,638 | $1,078 to $50,948 | Low |
| Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm OR Dissection; Us... | surgery | $2,641 | $1,171 to $34,804 | Low |
| Repair of Rectal Prolapse Using an Endoscope | surgery | $2,641 | $984 to $45,400 | Low |
| Injection, Remdesivir, 1 Mg | other | $2,644 | $7 to $4,406 | Low |
| Veklury 100 Mg Vial | other | $2,644 | $1,172 to $4,406 | Low |
| Removal of Defibrillator Electrodes Through Vein | surgery | $2,644 | $1,172 to $33,244 | Low |
| Removal of Dual Electrodes From Right Heart | surgery | $2,644 | $1,172 to $33,235 | Low |
| Endograft Iliac Limb 14x10x100 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x10x160 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x12x100 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x12x120 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x12x140 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x14x100 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x14x120 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x14x140 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x14x160 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x14x80 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x16x100 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x16x120 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x16x140 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x16x160 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x18x120 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x18x140 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x22x140 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x22x160 | other | $2,646 | $1,173 to $4,410 | Low |
| Endograft Iliac Limb 14x28x140 | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Ext System Ovation Ix Pma 10-10-45 #tv-ex101045-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Ext System Ovation Ix Pma 12-12-45 #tv-ex121245-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Ext System Ovation Ix Pma 14-14-45 #tv-ex141445-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Ext System Ovation Ix Pma 16-16-45 #tv-ex161645-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Ext System Ovation Ix Pma 18-18-45 #tv-ex181845-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Ext System Ovation Ix Pma 28-28-45 #tv-ex282845-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Limb System Ovation Ix Pma 14-10-120 #tv-il1410120-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Limb System Ovation Ix Pma 14-10-80 #tv-il141080-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Limb System Ovation Ix Pma 14-12-80 #tv-il141280-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Limb System Ovation Ix Pma 14-16-80 #tv-il141680-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Limb System Ovation Ix Pma 14-18-100 #tv-il1418100-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Limb System Ovation Ix Pma 14-18-160 #tv-il1418160-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Limb System Ovation Ix Pma 14-18-80 #tv-il141880-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Limb System Ovation Ix Pma 14-22-100 #tv-il1422100-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Limb System Ovation Ix Pma 14-22-120 #tv-il1422120-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Limb System Ovation Ix Pma 14-22-80 #tv-il142280-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Limb System Ovation Ix Pma 14-28-100 #tv-il1428100-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Limb System Ovation Ix Pma 14-28-120 #tv-il1428120-j | other | $2,646 | $1,173 to $4,410 | Low |
| Iliac Limb System Ovation Ix Pma 14-28-80 #tv-il142880-j | other | $2,646 | $1,173 to $4,410 | Low |
| Ovation Ix Iliac Stent Graft Tv-il1428160-j | cardiac | $2,646 | $1,173 to $4,410 | Low |
| Placement of Tube of Kidney Using Imaging Guidance with Review By Radiologist | other | $2,647 | $1,174 to $50,432 | Low |
| Exploration of Abdomen for Bleeding, Blood Clot, OR Infection After Surgery | surgery | $2,648 | $1,044 to $35,840 | Low |
| Insertion of Stent in Groin Artery, Additional Vessel | cardiac | $2,648 | $1,174 to $37,223 | Low |
| Injection, Trastuzumab-dkst, Biosimilar, (ogivri), 10 Mg | other | $2,651 | $40 to $4,418 | Low |
| Extensive Removal of Growth of Neck OR Front of Chest, 5.0 Cm OR More | surgery | $2,651 | $1,143 to $21,558 | Low |
| Removal of Plaque, Insertion of Stent and Balloon Dilation of Single Coronary... | surgery | $2,653 | $516 to $92,933 | Low |
| Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Li... | other | $2,654 | $51 to $4,423 | Low |
| Insertion of Tube Into First Order Main and Accessory Arteries of Both Kidney... | other | $2,657 | $289 to $36,252 | Low |
| Reconstruction of Wrist Joint | other | $2,665 | $870 to $25,320 | Low |
| Hysterectomy (Laparoscopic) | surgery | $2,672 | $683 to $8,908 | High |
| Removal of Uterus, Tubes, And/or Ovaries Through Abdomen Using an Endoscope, ... | surgery | $2,672 | $1,037 to $58,573 | Low |
| MRI Scan of Arm without Contrast | imaging | $2,676 | $229 to $73,218 | Low |
| Connection of Ureter to Bladder | other | $2,679 | $953 to $50,780 | Low |
| MRI Scan of Lower Spinal Canal with Contrast | imaging | $2,679 | $335 to $72,149 | Low |
| Partial Removal of Small and Large Bowel with Attachment of Small and Large B... | surgery | $2,687 | $1,147 to $44,205 | Low |
| Injection, Fomepizole, 15 Mg | other | $2,694 | $6 to $4,491 | Low |
| Repair of Knee Cartilage and Bone with Patient-derived Healthy Cartilage Tran... | surgery | $2,702 | $916 to $29,866 | Low |
| MRI Scan of Abdomen with Contrast | imaging | $2,704 | $335 to $74,182 | Low |
| Removal of Vena Cava Filter with Review By Radiologist | surgery | $2,705 | $287 to $37,193 | Low |
| Closure of Abnormal Drainage Tract From Small Bowel to Urinary Bladder with R... | other | $2,706 | $1,200 to $44,661 | Low |
| Injection, Risperidone (risperdal Consta), 0.5 Mg | other | $2,710 | $11 to $4,517 | Low |
| Angiojet Solent Dista Set #111303 | other | $2,712 | $1,202 to $4,520 | Low |
| Destruction of Heart Conduction Tissue to Create Heart Block | cardiac | $2,719 | $463 to $93,650 | Low |
| Transfer of Chest Artery to Neck Artery and Repair of Descending Aorta | surgery | $2,728 | $1,210 to $33,889 | Low |
| Ultrasound Evaluation of Heart Blood Vessel During Diagnosis OR Treatment, In... | imaging | $2,743 | $1,216 to $93,571 | Low |
| Repair of Tear of Lung And/or Control of Traumatic Bleeding Through Chest | surgery | $2,746 | $1,217 to $32,110 | Low |
| Reconstruction of Ear Canal | other | $2,755 | $976 to $69,310 | Low |
| Removal of Total Knee Joint Prosthesis | surgery | $2,756 | $1,029 to $27,488 | Low |
| Insertion of Abdominal Tube Using Imaging Guidance with Review By Radiologist | other | $2,759 | $1,223 to $49,418 | Low |
| Simple Surgical Treatment of Kidney Stone with Imaging Guidance | surgery | $2,759 | $598 to $50,080 | Low |
| Partial Removal of Chest Cavity Lining and Lung Lining Using an Endoscope | surgery | $2,759 | $966 to $32,651 | Low |
| Repair of Eardrum, Ear Canal, and Bones | surgery | $2,763 | $914 to $69,632 | Low |
| Injection, Cangrelor, 1 Mg | other | $2,768 | $20 to $4,614 | Low |
| Addition to Lower Limb Prosthesis, Multiaxial Ankle with Swing Phase Active D... | other | $2,771 | $1,229 to $4,619 | Low |
| MRI Scan of Leg Before and After Contrast | imaging | $2,773 | $335 to $73,720 | Low |
| Repair of Rectal Prolapse with Partial Removal of Lower Large Bowel Using an ... | surgery | $2,782 | $1,233 to $45,402 | Low |
| Event Recorder, Cardiac | cardiac | $2,787 | $1,236 to $4,645 | Low |
| Processing, Preserving and Transporting Corneal Tissue | other | $2,790 | $1,237 to $4,650 | Low |
| Removal of Growth of Saliva Gland OR Saliva Gland with Release of Facial Nerve | surgery | $2,791 | $972 to $42,420 | Low |
| Removal of Lymph Nodes of Both Sides of Pelvis Using an Endoscope | surgery | $2,795 | $566 to $38,571 | Low |
| Hearing Aid, Digital, Binaural, Bte | other | $2,796 | $811 to $9,320 | Low |
| Repair of Chronic Injury to Muscle Separating Chest and Abdominal Cavities | surgery | $2,804 | $824 to $39,541 | Low |
| Removal of Air Sac of Lung Using an Endoscope | surgery | $2,806 | $851 to $32,655 | Low |
| MRI Scan of Upper Spinal Canal with Contrast | imaging | $2,812 | $335 to $72,142 | Low |
| Partial Removal of Large Bowel Using an Endoscope | surgery | $2,815 | $1,248 to $44,204 | Low |
| Removal of Thymus Gland Using an Endoscope | surgery | $2,817 | $1,069 to $32,673 | Low |
| Catheter, Transluminal Angioplasty, Non-laser | cardiac | $2,820 | $1,250 to $4,700 | Low |
| Ethacrynate Sodium 50 Mg Vial | other | $2,825 | $1,252 to $4,709 | Low |
| Destruction of Stone of Bile OR Pancreatic Duct Using a Flexible Endoscope | other | $2,827 | $1,253 to $43,265 | Low |
| Injection, Secretin, Synthetic, Human, 1 Microgram | other | $2,834 | $39 to $4,723 | Low |
| MRI Scan of Middle Spinal Canal with Contrast | imaging | $2,835 | $335 to $72,147 | Low |
| Endurant Ii Contralateral Limb 16mm X 16mm X 124mm #etlw1616c124e | other | $2,837 | $1,258 to $4,728 | Low |
| Suture of Injured Bile Duct | other | $2,839 | $1,203 to $47,900 | Low |
| Below Knee, Molded Socket, Shin, Sach Foot, Endoskeletal System | other | $2,845 | $1,261 to $4,742 | Low |
| Catheter, Electrophysiology, Diagnostic/ablation, 3d OR Vector Mapping | cardiac | $2,846 | $1,262 to $4,743 | Low |
| Repair of Prolapsed Rectum Through Abdomen and Anus | surgery | $2,847 | $1,134 to $45,135 | Low |
| Extensive Removal of Growth of Back OR Lower Side, 5.0 Cm OR More | surgery | $2,849 | $1,218 to $21,936 | Low |
| Injection, Onabotulinumtoxina, 1 Unit | other | $2,849 | $7 to $4,748 | Low |
| Kidney and Urinary Tract Neoplasms without Cc/mcc | other | $2,853 | $1,265 to $30,404 | Low |
| Pacemaker, Dual Chamber, Rate-responsive | cardiac | $2,856 | $1,266 to $4,760 | Low |
| MRI Scan of Blood Vessels of Neck Before and After Contrast | imaging | $2,863 | $335 to $70,549 | Low |
| Partial Removal of Large Bowel with Creation of Opening From Large Bowel to Skin | surgery | $2,873 | $1,274 to $44,143 | Low |
| Drainage of Abscess OR Cyst of Liver | other | $2,885 | $1,061 to $47,010 | Low |
| Neonate with Other Significant Problems | other | $2,895 | $1,283 to $12,894 | Low |
| Insertion of Sacral Nerve Neurostimulator Electrode Array | other | $2,896 | $258 to $64,561 | Low |
| Partial Removal of Large Bowel with Creation of Opening From Large Bowel to S... | surgery | $2,899 | $1,285 to $44,206 | Low |
| Closure of Surgically Created Large OR Small Bowel Opening with Bowel Removal... | surgery | $2,900 | $1,286 to $44,626 | Low |
| Replacement of Knee Joint On Side of Knee | surgery | $2,906 | $980 to $27,446 | Low |
| MRI Scan of Leg Joint Before and After Contrast | imaging | $2,911 | $335 to $73,723 | Low |
| Bronchitis and Asthma without Cc/mcc | other | $2,915 | $1,292 to $12,852 | Low |
| Addition, Endoskeletal System, High Activity Knee Control Frame | other | $2,916 | $1,293 to $4,861 | Low |
| Repair of Paraesophageal Hernia with Mesh Implant Through Abdomen | surgery | $2,920 | $1,091 to $43,333 | Low |
| Addition, Endoskeletal Knee-shin System, Single Axis, Fluid Swing and Stance ... | other | $2,921 | $1,295 to $4,868 | Low |
| Diagnostic Exam of Gallbladder and Pancreatic, Liver, and Bile Ducts Using an... | other | $2,924 | $1,296 to $43,260 | Low |
| Coronary Artery Bypass Using Vein OR Artery Graft, 5 Grafts | cardiac | $2,936 | $618 to $33,522 | Low |
| Injection, Trastuzumab, Excludes Biosimilar, 10 Mg | other | $2,945 | $75 to $4,909 | Low |
| Injection, Dalbavancin, 5 Mg | other | $2,947 | $16 to $4,912 | Low |
| Closure of Opening From Large OR Small Bowel to Skin Using an Endoscope | other | $2,953 | $1,309 to $44,227 | Low |
| Repair of Nonhealed Broken Thigh Bone with Self Bone Graft | surgery | $2,954 | $1,081 to $27,472 | Low |
| Insertion of Tube Into Second OR Third Order Branches of Arteries of Kidney f... | other | $2,959 | $292 to $36,253 | Low |
| Replacement, Socket, Below Knee, Molded to Patient Model | surgery | $2,963 | $1,314 to $4,939 | Low |
| Repair of Anterior Cruciate Ligament of Knee Using an Endoscope | surgery | $2,976 | $834 to $29,888 | Low |
| Epic Plus Aortic Valve 29mm E200-29a | other | $2,983 | $1,323 to $4,972 | Low |
| Epic Supra Plus Aortic Valve 19mm Esp200 | other | $2,983 | $1,323 to $4,972 | Low |
| Epic Supra Plus Aortic Valve 21mm Esp200 | other | $2,983 | $1,323 to $4,972 | Low |
| Epic Supra Plus Aortic Valve 23mm Esp200 | other | $2,983 | $1,323 to $4,972 | Low |
| Epic Supra Plus Aortic Valve 25mm Esp200 | other | $2,983 | $1,323 to $4,972 | Low |
| Epic Supra Plus Aortic Valve 27mm Esp200 | other | $2,983 | $1,323 to $4,972 | Low |
| Repair of Eardrum and Ear Canal with Removal of Middle Ear Bone | surgery | $2,986 | $1,026 to $69,643 | Low |
| Injection, Paclitaxel Protein-bound Particles, 1 Mg | other | $2,986 | $11 to $4,977 | Low |
| MRI Scan of Bone of Eye Socket, Face, And/or Neck Before and After Contrast | imaging | $2,996 | $335 to $70,543 | Low |
| Repair of Muscle At Lower Esophagus and Stomach Using an Endoscope | surgery | $2,997 | $1,113 to $43,279 | Low |
| Other Procedure On Stomach | other | $3,000 | $1,330 to $43,999 | Low |
| Repair of Kidney Using an Endoscope | surgery | $3,004 | $1,051 to $50,544 | Low |
| Endograft Vela Infrarenal #a25-25/c75v | other | $3,015 | $1,337 to $5,025 | Low |
| Endograft Vela Infrarenal #a28-28/c95v | other | $3,015 | $1,337 to $5,025 | Low |
| Endograft Vela Infrarenal #a34-34/c100v | other | $3,015 | $1,337 to $5,025 | Low |
| Endograft Vela Infrarenal #a34-34/c80v | other | $3,015 | $1,337 to $5,025 | Low |
| Vela Suprarenal Endograft 25mm X 25mm / 75mm X 20mm #a25-25/c75-o20v | other | $3,015 | $1,337 to $5,025 | Low |
| Insertion of Tube Into Chest Artery for Diagnosis OR Treatment with Review By... | other | $3,018 | $271 to $36,225 | Low |
| Partial Replacement of Thigh Bone At Hip Joint with Prosthesis | surgery | $3,021 | $969 to $27,125 | Low |
| Addition, Endoskeletal Knee-shin System, Polycentric, Hydraulic Swing Phase C... | other | $3,027 | $1,342 to $5,045 | Low |
| Repair of Eardrum, Ear Canal, and Bones with Placement of Implant and Opening... | surgery | $3,029 | $1,211 to $69,637 | Low |
| Custom Breast Prosthesis, Post Mastectomy, Molded to Patient Model | other | $3,037 | $1,346 to $5,062 | Low |
| Removal of Kidney, Lymph Nodes, And/or Blood Clot From Major Vein with Partia... | surgery | $3,037 | $1,086 to $50,230 | Low |
| Closure of Abnormal Drainage Tract Within Small Bowel OR Small to Large Bowel | other | $3,039 | $1,235 to $44,650 | Low |
| MRI Scan of Middle Spinal Canal Before and After Contrast | imaging | $3,045 | $335 to $72,157 | Low |
| Injection, Belatacept, 1 Mg | other | $3,055 | $4 to $5,092 | Low |
| Release of Major Arm OR Leg Nerve | other | $3,056 | $695 to $64,713 | Low |
| 25mj-501 Valve Mitral Size 25 Mm Rotatable Standard Cuff Mechanical | other | $3,060 | $1,357 to $5,100 | Low |
| Valve Aortic Mechanical 21mm #21aj | other | $3,060 | $1,357 to $5,100 | Low |
| Valve Mitral 27mm St Jude Cuffed #27mj | other | $3,060 | $1,357 to $5,100 | Low |
| Valve Mitral 29mm St Jude Cuffed #29mj | other | $3,060 | $1,357 to $5,100 | Low |
| Valve Mitral 31mm St Jude Cuffed #31mj | other | $3,060 | $1,357 to $5,100 | Low |
| Valve Mitral 33mm St Jude Cuffed #33mj | other | $3,060 | $1,357 to $5,100 | Low |
| Biopsy of Breast and Placement of Locating Device Using Mri, First Growth | imaging | $3,061 | $1,357 to $19,085 | Low |
| Partial Removal of Large Bowel and Reattachment to Rectum | surgery | $3,061 | $1,357 to $44,145 | Low |
| Insertion of Electrode to Outer Layer of Heart | cardiac | $3,067 | $689 to $33,202 | Low |
| Insertion of Electrode to Outer Layer of Heart Using an Endoscope | cardiac | $3,071 | $716 to $33,203 | Low |
| Removal of Cyst Below Breast Bone | surgery | $3,072 | $773 to $39,200 | Low |
| MRI Scan of Abdomen Before and After Contrast | imaging | $3,074 | $335 to $74,183 | Low |
| MRI Scan of Upper Spinal Canal Before and After Contrast | imaging | $3,084 | $335 to $72,156 | Low |
| Partial Removal of Large Bowel with Creation of Opening to Skin | surgery | $3,092 | $1,371 to $44,141 | Low |
| All Lower Extremity Prostheses, Flex-walk System OR Equal | other | $3,098 | $1,373 to $5,164 | Low |
| Review By Radiologist of Imaging Guidance for Removal of Blood Sample | surgery | $3,104 | $1,376 to $75,893 | Low |
| Removal of Blood Clot in Artery of Lower Leg | surgery | $3,106 | $800 to $34,203 | Low |
| Removal of Air Sac of Lung Through Chest | surgery | $3,107 | $1,332 to $32,141 | Low |
| CT Scan of Arm Before and After Contrast | imaging | $3,119 | $168 to $73,202 | Low |
| Repair of Collapsed Nostril Using Implant in Side of Nose | surgery | $3,119 | $138 to $30,468 | Low |
| Valve Aortic 19mm Mech #19agn | other | $3,120 | $1,383 to $5,200 | Low |
| Valve Aortic 21mm Mech #21agn | other | $3,120 | $1,383 to $5,200 | Low |
| Valve Aortic 23mm Mech #23agn | other | $3,120 | $1,383 to $5,200 | Low |
| Valve Aortic 25mm Mech #25agn | other | $3,120 | $1,383 to $5,200 | Low |
| Reshaping of Bony Cartilage Dividing Nasal Passages | other | $3,127 | $1,237 to $30,420 | Low |
| Removal of Blood Clot and Portion of Upper Thigh Artery | surgery | $3,127 | $686 to $35,371 | Low |
| Removal of Kidney and Ureter Using an Endoscope | surgery | $3,128 | $1,135 to $50,548 | Low |
| Removal of Defect in Wall of Esophagus Through Chest | surgery | $3,131 | $1,289 to $43,135 | Low |
| Partial Removal of Kidney Using an Endoscope | surgery | $3,137 | $1,266 to $50,543 | Low |
| Review By Radiologist of Arteries of Both Lungs Image | other | $3,139 | $1,391 to $75,743 | Low |
| Partial Removal and Reconnection of Small Bowel Using an Endoscope | surgery | $3,145 | $1,199 to $44,202 | Low |
| MRI Scan of Brain Before and After Contrast | imaging | $3,147 | $335 to $70,553 | Low |
| MRI Scan of Lower Spinal Canal Before and After Contrast | imaging | $3,148 | $335 to $72,158 | Low |
| Partial Removal of Kidney | surgery | $3,157 | $1,133 to $50,240 | Low |
| Insertion OR Replacement of Ear Bone Hearing Device | surgery | $3,165 | $1,403 to $69,710 | Low |
| Complex Surgical Treatment of Kidney Stone with Imaging Guidance | surgery | $3,171 | $955 to $50,081 | Low |
| Correction of Abnormal Rotation of Small Bowel | other | $3,173 | $1,279 to $44,055 | Low |
| Repositioning of Ureter and Insertion of Stent Using an Endoscope | cardiac | $3,173 | $1,175 to $50,947 | Low |
| Extensive Repair of Eardrum and Ear Canal with Removal of Middle Ear Bone | surgery | $3,175 | $1,273 to $69,645 | Low |
| Placement of Stent of Ureter and Separate Tube in Kidney Through New Skin Acc... | cardiac | $3,178 | $1,409 to $50,695 | Low |
| Epic Mitral Plus Mitral Valve 29mm E200-29m | other | $3,180 | $1,410 to $5,300 | Low |
| Epic Mitral Plus Mitral Valve 31mm E200-31m | other | $3,180 | $1,410 to $5,300 | Low |
| Epic Mitral Plus Mitral Valve 33mm E200-33m | other | $3,180 | $1,410 to $5,300 | Low |
| Injection, Tocilizumab, 1 Mg | other | $3,187 | $6 to $5,312 | Low |
| Removal of Cyst OR Growth of Chest Cavity Using an Endoscope | surgery | $3,187 | $800 to $32,662 | Low |
| Partial Removal of Large Bowel with Creation of 2 Openings From Small OR Larg... | surgery | $3,190 | $1,414 to $44,144 | Low |
| Extensive Removal of Growth of Pelvis and Hip, Less Than 5.0 Cm | surgery | $3,191 | $1,209 to $27,049 | Low |
| MRI Scan of Leg without Contrast | imaging | $3,200 | $229 to $73,718 | Low |
| Gore Excluder Aaa Endoprosthesis 12fr Plc121000 | other | $3,201 | $1,419 to $5,335 | Low |
| Gore Excluder Aaa Endoprosthesis Plc141000 | other | $3,201 | $1,419 to $5,335 | Low |
| Gore Excluder Aaa Endoprosthesis Plc141200 | other | $3,201 | $1,419 to $5,335 | Low |
| Gore Excluder Aaa Endoprosthesis 16mm X 1105cm Plc161200 | other | $3,203 | $1,420 to $5,339 | Low |
| Removal of Kidney and Ureter with Partial Removal of Bladder Through Same Inc... | surgery | $3,206 | $1,104 to $50,234 | Low |
| Repair of Lung Airway with Graft | surgery | $3,211 | $1,164 to $31,770 | Low |
| Exclusion of Appendage of Left Upper Chamber of Heart Using an Endoscope | cardiac | $3,218 | $740 to $33,269 | Low |
| Implantation of Donor Cartilage Cells Into Knee Joint | surgery | $3,229 | $1,177 to $27,415 | Low |
| Dental and Oral Diseases without Cc/mcc | other | $3,229 | $1,431 to $14,905 | Low |
| Injection, Dmso, Dimethyl Sulfoxide, 50%, 50 Ml | other | $3,232 | $749 to $5,387 | Low |
| Insertion of Tube Through the Chest for Ecmo External Blood Circulation in He... | other | $3,235 | $704 to $33,956 | Low |
| Atricure Isolator Synergy Encompass Long #olh | other | $3,240 | $1,436 to $5,400 | Low |
| Reconstruction Ligaments Inside Knee Joint | other | $3,242 | $973 to $27,428 | Low |
| MRI Scan of Chest Before and After Contrast | imaging | $3,247 | $335 to $71,552 | Low |
| Addition to Lower Limb Prosthesis, Vacuum Pump, Residual Limb Volume Manageme... | other | $3,261 | $1,446 to $5,436 | Low |
| Removal of Blood Clot in Neck to Chest Artery | surgery | $3,263 | $774 to $34,001 | Low |
| Removal of Lobe of Lung | surgery | $3,271 | $1,303 to $32,480 | Low |
| Secondary Removal and Dissolving of Blood Clot From Artery OR Artery Graft Us... | surgery | $3,277 | $204 to $37,186 | Low |
| Osteogenesis Stimulator, Electrical, Surgically Implanted | surgery | $3,285 | $344 to $5,476 | Low |
| Removal of Rectum for Congenital Defect Through Abdomen and Region Between Th... | surgery | $3,292 | $1,388 to $45,120 | Low |
| Partial Removal of Stomach with Attachment of Stomach to Small Bowel | surgery | $3,293 | $1,167 to $43,820 | Low |
| Atriclip Pro-v Device 35mm #prov35 | other | $3,300 | $1,463 to $5,500 | Low |
| Atriclip Pro-v Device 45mm #prov45 | other | $3,300 | $1,463 to $5,500 | Low |
| Atriclip Pro-v Device 50mm #prov50 | other | $3,300 | $1,463 to $5,500 | Low |
| Atriclip Prov-5 Device 40mm #prov40 | other | $3,300 | $1,463 to $5,500 | Low |
| Repair of Knee Cartilage and Bone with Donor Cartilage Graft Using an Endoscope | surgery | $3,302 | $1,102 to $29,867 | Low |
| Replacement of Knee Joint, Both Sides of Knee | surgery | $3,308 | $1,085 to $27,447 | Low |
| Repair of Aneurysm OR Arm Artery with Graft | surgery | $3,317 | $847 to $35,011 | Low |
| Repair of Abnormal Artery-vein Connection in Arm OR Leg | surgery | $3,330 | $637 to $35,190 | Low |
| Placement of Stent of Ureter Through Existing Skin Access Using Imaging Guida... | cardiac | $3,342 | $1,482 to $50,693 | Low |
| Removal of Chest Cavity Lining and Lung Lining Using an Endoscope | surgery | $3,343 | $1,458 to $32,652 | Low |
| Removal of Blood Clot in Artery of Groin and Leg | surgery | $3,354 | $860 to $34,201 | Low |
| Byetta 5 Mcg Dose Pen Inj | other | $3,355 | $1,487 to $5,591 | Low |
| Byetta 10 Mcg Dose Pen Inj | other | $3,355 | $1,487 to $5,591 | Low |
| Removal of Extra Skin and Tissue of Abdomen | surgery | $3,355 | $1,000 to $15,830 | Low |
| Gore Excluder Aaa Endoproshesis Contralateral Leg 16mm X 20mm X 13.5cm 12fr P... | other | $3,361 | $1,490 to $5,602 | Low |
| Gore Excluder Aaa Endoprosthesis Plc201200 | other | $3,361 | $1,490 to $5,602 | Low |
| Gore Excluder Aaa Endoprosthesis Plc271400 | other | $3,361 | $1,490 to $5,602 | Low |
| Gore Excluder Aortic Extender Endoprosthesis 23mm X 10cm #plc231000 | other | $3,361 | $1,490 to $5,602 | Low |
| Gore Excluder Endoprosthesis Aaa #plc181200 | other | $3,361 | $1,490 to $5,602 | Low |
| Gore Excluder Endoprosthesis Aaa #plc271200 | other | $3,361 | $1,490 to $5,602 | Low |
| Revision of Component of Total Knee Joint Prosthesis | other | $3,368 | $1,193 to $27,486 | Low |
| Removal of Lymph Nodes, Muscle, and Tissue of Neck | surgery | $3,372 | $1,194 to $38,724 | Low |
| Removal of Blood Clot in Artery of Lower Arm | surgery | $3,373 | $505 to $34,111 | Low |
| Acute Myocardial Infarction, Expired without Cc/mcc | other | $3,376 | $1,497 to $25,738 | Low |
| Repair of Hernia of Muscle At Esophagus and Stomach Using an Endoscope | surgery | $3,379 | $1,321 to $43,281 | Low |
| Removal of Defibrillator Electrode | surgery | $3,389 | $1,502 to $33,272 | Low |
| Partial Removal of Pancreas | surgery | $3,397 | $1,353 to $48,140 | Low |
| Extensive Destruction and Reconstruction of Right Upper Heart Chamber On Hear... | cardiac | $3,397 | $764 to $33,259 | Low |
| Indium in 111 Labeled Autologous White Blood Cells | other | $3,402 | $1,508 to $5,670 | Low |
| Repair of 2 Electrodes for Permanent Pacemaker OR Defibrillator | surgery | $3,407 | $1,510 to $33,220 | Low |
| Repair of Blood Vessel of Arm with Graft | surgery | $3,421 | $731 to $35,266 | Low |
| Repair of Blood Vessel of Leg with Graft | surgery | $3,421 | $781 to $35,286 | Low |
| Removal OR Destruction of Growth(s) in the Abdomen, 10.1 to 20.0 Cm | surgery | $3,422 | $1,517 to $49,188 | Low |
| Removal of Blood Clot and Portion of Superficial Femoral Artery | surgery | $3,433 | $939 to $35,302 | Low |
| Repair of Blood Vessel of Arm | surgery | $3,440 | $675 to $35,206 | Low |
| Complex Removal of Soft Tissue of Roof of Mouth | surgery | $3,441 | $575 to $42,145 | Low |
| Removal and Dissolving of Blood Clot From Vein Using Fluoroscopic Guidance, R... | surgery | $3,443 | $1,527 to $37,188 | Low |
| Partial Removal of Large Bowel and Reattachment to Rectum Using an Endoscope | surgery | $3,447 | $1,528 to $44,207 | Low |
| Repair of Aneurysm OR Forearm Artery with Graft | surgery | $3,447 | $809 to $35,045 | Low |
| Repositioning of Ureter with Creation of Bladder OR Muscle Flap | other | $3,449 | $1,032 to $50,785 | Low |
| Injection, Eptinezumab-jjmr, 1 Mg | other | $3,455 | $20 to $5,758 | Low |
| Injection, Cetuximab, 10 Mg | other | $3,457 | $76 to $5,762 | Low |
| Repair of Eardrum, Ear Canal, and Bones with Removal of Mastoid Bone, with In... | surgery | $3,460 | $1,293 to $69,644 | Low |
| Technetium Tc-99m Exametazime Labeled Autologous White Blood Cells, Diagnosti... | other | $3,465 | $934 to $5,776 | Low |
| Viral Meningitis without Cc/mcc | other | $3,476 | $1,541 to $13,163 | Low |
| Repair of Blood Vessel of Leg | surgery | $3,479 | $702 to $35,226 | Low |
| Removal of Growth OR Cyst of From Heart Sac | surgery | $3,491 | $900 to $33,050 | Low |
| Removal of Blood Clot and Portion of Deep Upper Thigh Artery | surgery | $3,502 | $821 to $35,372 | Low |
| Repair of Hernia of Muscle At Esophagus and Stomach with Implantation of Mesh... | surgery | $3,519 | $1,485 to $43,282 | Low |
| Bypass of Diseased OR Blocked Arm to Chest Artery with Other Than Vein | other | $3,522 | $919 to $35,621 | Low |
| Neonates, Died OR Transferred to Another Acute Care Facility | other | $3,532 | $1,566 to $47,576 | Low |
| Catheter, Transluminal Atherectomy, Directional | cardiac | $3,534 | $1,567 to $5,890 | Low |
| Drainage OR Removal of Bile Duct Stone with Redirection of Bile Flow and Inci... | surgery | $3,542 | $1,190 to $47,425 | Low |
| Repair of Aorta OR Great Vessels with Sutures | surgery | $3,557 | $945 to $33,320 | Low |
| Replacement, Socket, Above Knee/knee Disarticulation, Including Attachment Pl... | surgery | $3,559 | $1,578 to $5,932 | Low |
| Full Term Neonate with Major Problems | other | $3,563 | $1,580 to $36,427 | Low |
| Prothrombin Complex Concentrate (human), Kcentra, Per I.u. of Factor Ix Activity | other | $3,569 | $2 to $5,949 | Low |
| Placement of Tubes in Breast for Radiation Treatment Using Imaging Guidance D... | other | $3,580 | $254 to $19,298 | Low |
| Bypass of Diseased OR Blocked Chest to Opposite Chest Artery with Other Than ... | other | $3,581 | $884 to $35,612 | Low |
| Injection, Mepolizumab, 1 Mg | other | $3,595 | $31 to $5,991 | Low |
| Repair of Blood Vessel of Neck | surgery | $3,596 | $787 to $35,201 | Low |
| Removal of Rectum with Creation of Opening From Large Bowel to Skin Through A... | surgery | $3,603 | $1,573 to $45,110 | Low |
| Factor Ix, Complex, Per I.u. | other | $3,605 | $2 to $6,009 | Low |
| Dilation of Nasal Sinus Using an Endoscope | other | $3,611 | $128 to $31,295 | Low |
| Image-guided Robotic Linear Accelerator-based Stereotactic Radiosurgery, Deli... | surgery | $3,622 | $1,606 to $12,072 | Low |
| Addition, Endoskeletal Knee/shin System, 4-bar Linkage OR Multiaxial, Pneumat... | other | $3,629 | $1,609 to $6,048 | Low |
| Injection, Zolbetuximab-clzb, 1 Mg | other | $3,629 | $1,609 to $6,048 | Low |
| Vyloy 100 Mg Vial | other | $3,629 | $1,609 to $6,048 | Low |
| Replacement of Aortic Valve Through the Skin and Femoral Artery | surgery | $3,630 | $1,004 to $33,361 | Low |
| Revision of Leg Artery Bypass with Vein Patch | other | $3,640 | $780 to $35,879 | Low |
| Division of Extra Arch of Aorta | other | $3,647 | $971 to $33,802 | Low |
| Injection, Avelumab, 10 Mg | other | $3,659 | $100 to $6,099 | Low |
| Removal of Lung Segment to Reduce Lung Volume Through Chest | surgery | $3,662 | $1,307 to $32,491 | Low |
| Endurant Ii Contralateral Limb 16mm X 13mm X 146mm Etlw1613c146e | other | $3,686 | $1,634 to $6,144 | Low |
| Injection, Pegfilgrastim-bmez (ziextenzo), Biosimilar, 0.5 Mg | other | $3,710 | $30 to $6,183 | Low |
| Replacement of Thigh Bone and Hip Joint with Prosthesis | surgery | $3,711 | $1,087 to $27,130 | Low |
| Destruction of Tongue Tissue, Per Session | other | $3,715 | $340 to $41,530 | Low |
| Removal of Rectum with Creation of Opening From Large Bowel to Skin Using an ... | surgery | $3,726 | $1,652 to $45,395 | Low |
| Postpartum and Post Abortion Diagnoses without O.r. Procedures | obstetric | $3,733 | $1,655 to $12,888 | Low |
| Incision OR Partial Removal of Upper Portion of Lower Leg Bone to Repair Defo... | surgery | $3,734 | $835 to $27,455 | Low |
| Repair of Groin Artery with Graft for Other Than Rupture with Review By Radio... | surgery | $3,734 | $976 to $34,707 | Low |
| MRI Scan of Arm Joint with Contrast | imaging | $3,737 | $752 to $73,222 | Low |
| Injection, Thyrotropin Alpha, 0.9 Mg, Provided in 1.1 Mg Vial | other | $3,737 | $1,657 to $6,228 | Low |
| Injection, Bevacizumab-bvzr, Biosimilar, (zirabev), 10 Mg | other | $3,743 | $26 to $6,239 | Low |
| Placement of Stent of Ureter Through New Skin Access Using Imaging Guidance w... | cardiac | $3,747 | $1,661 to $50,694 | Low |
| Removal of Blood Clot and Portion of Popliteal Artery | surgery | $3,750 | $1,033 to $35,303 | Low |
| Indium In-111 Pentetreotide IV Diagnostic | other | $3,755 | $1,665 to $6,259 | Low |
| Injection, Pegfilgrastim-apgf (nyvepria), Biosimilar, 0.5 Mg | other | $3,778 | $131 to $6,296 | Low |
| Insertion of Hypoglossal Nerve Neurostimulator Electrode and Generator and Br... | other | $3,791 | $685 to $64,582 | Low |
| Insertion of Vena Cava Filter with Review By Radiologist | other | $3,793 | $1,681 to $37,191 | Low |
| Removal of Blood Clot and Revision of Artery OR Vein Graft | surgery | $3,796 | $795 to $35,876 | Low |
| Removal of Lower Portion of Stomach with Reattachment of Upper Portion of Rem... | surgery | $3,799 | $1,649 to $43,633 | Low |
| Balloon Dilation of Groin Artery, Initial Vessel | other | $3,806 | $1,687 to $37,220 | Low |
| Ultrasound Evaluation of Heart Blood Vessel OR Graft with Review By Radiologi... | imaging | $3,808 | $1,688 to $92,978 | Low |
| Bypass of Diseased OR Blocked Knee to Lower Leg Arteries with Other Than Vein | other | $3,826 | $954 to $35,671 | Low |
| Removal of Blood Clot and Portion of Artery of Upper Thigh | surgery | $3,830 | $865 to $35,355 | Low |
| All Lower Extremity Prostheses, Flex Foot System | other | $3,835 | $1,700 to $6,392 | Low |
| Depressive Neuroses | other | $3,836 | $1,700 to $8,220 | Low |
| Review By Radiologist of Pelvis Artery Image | other | $3,841 | $1,703 to $75,736 | Low |
| Bypass of Diseased OR Blocked Upper Leg to Lower Thigh Artery with Other Than... | other | $3,848 | $902 to $35,656 | Low |
| Other Multiple Significant Trauma with Cc | emergency | $3,858 | $1,710 to $40,352 | Low |
| Ultrasound Evaluation of Heart Blood Vessel with Review By Radiologist | imaging | $3,860 | $1,711 to $93,662 | Low |
| Removal of Blood Clot and Portion of Chest, Neck, OR Brain Artery | surgery | $3,860 | $951 to $35,301 | Low |
| Papaverine 30 Mg in 100 Ml 0.9% Sodium Chloride - Irrigation - Compounded | other | $3,866 | $1,714 to $6,443 | Low |
| Bypass of Diseased OR Blocked Upper Arm to Opposite Arm Artery with Vein | other | $3,866 | $928 to $35,525 | Low |
| Repair of Descending Aorta, Initial Extension | surgery | $3,870 | $894 to $33,883 | Low |
| Repair of Aneurysm OR Upper Thigh Artery with Graft | surgery | $3,871 | $919 to $35,141 | Low |
| Incision and Exploration of Heart | cardiac | $3,872 | $1,052 to $33,310 | Low |
| Bypass of Diseased OR Blocked Upper Leg to Opposite Upper Leg Artery with Oth... | other | $3,878 | $911 to $35,661 | Low |
| Removal of Kidney and Lymph Nodes Using an Endoscope | surgery | $3,882 | $1,130 to $50,545 | Low |
| Revision of Hip Socket Part of Hip Prosthesis | other | $3,887 | $1,233 to $27,137 | Low |
| Ryanodex 250 Mg Vial | other | $3,900 | $1,729 to $6,501 | Low |
| Revision to Reshape Nasal Bones and Tip of Nose After Previous Repair | surgery | $3,908 | $1,539 to $30,450 | Low |
| Removal of Large Bowel with Attachment of Small Bowel to Rectum OR Creation o... | surgery | $3,919 | $1,530 to $44,210 | Low |
| Major Hematological and Immunological Diagnoses Except Sickle Cell Crisis and... | other | $3,928 | $1,742 to $17,447 | Low |
| Retrieval of Foreign Body in Blood Vessel with Review By Radiologist | other | $3,929 | $250 to $37,197 | Low |
| Revision of Leg Artery Bypass with Placement of Relocated Vein | other | $3,935 | $867 to $35,881 | Low |
| Injection, Trastuzumab-qyyp, Biosimilar, (trazimera), 10 Mg | other | $3,947 | $28 to $6,579 | Low |
| Prematurity without Major Problems | other | $3,950 | $1,751 to $25,411 | Low |
| MRI Scan of Arm Before and After Contrast | imaging | $3,950 | $335 to $73,220 | Low |
| Repair of Aorta with Graft for Other Than Rupture with Review By Radiologist | surgery | $3,975 | $1,036 to $34,701 | Low |
| Coronary Artery Bypass Using Vein OR Artery Graft, 6 OR More Grafts | cardiac | $3,980 | $704 to $33,523 | Low |
| Exclusion of Appendage of Left Upper Chamber of Heart | cardiac | $3,981 | $919 to $33,267 | Low |
| Removal of Segment of Lung Tissue Using an Endoscope | surgery | $3,982 | $1,177 to $32,669 | Low |
| Repair of Aorta OR Great Vessels with Sutures Using a Shunt Bypass | surgery | $3,984 | $1,065 to $33,321 | Low |
| Extensive Repair and Reconstruction of Eardrum and Ear Canal with Removal of ... | surgery | $4,015 | $1,349 to $69,646 | Low |
| Repair of Blood Vessel of Leg with Vein Graft | surgery | $4,022 | $863 to $35,256 | Low |
| Balloon Dilation of Artery of Leg | other | $4,028 | $1,786 to $37,224 | Low |
| Removal of Blood Clot and Portion of Artery of Groin | surgery | $4,040 | $1,085 to $35,351 | Low |
| Removal of 2 Lobes of Lung Using an Endoscope | surgery | $4,043 | $1,394 to $32,670 | Low |
| Antithrombin Iii (human), Per I.u. | other | $4,049 | $4 to $6,748 | Low |
| Injection, Inclisiran, 1 Mg | other | $4,058 | $12 to $6,763 | Low |
| Repair of Blood Vessel of Neck with Graft | surgery | $4,061 | $832 to $35,261 | Low |
| Revision of Thigh Bone Prosthesis | other | $4,072 | $1,279 to $27,138 | Low |
| Removal of Lung | surgery | $4,084 | $1,384 to $32,440 | Low |
| Destruction of Growth OR Polyp of Large Bowel Using an Endoscope Inserted Thr... | other | $4,096 | $204 to $44,401 | Low |
| Extensive Removal of Growth of Thigh OR Knee, 5.0 Cm OR More | surgery | $4,097 | $1,336 to $27,364 | Low |
| Insertion of Tube in Upper And/or Lower Heart Chambers to Record and Identify... | cardiac | $4,105 | $1,820 to $93,609 | Low |
| MRI Scan of Arm Joint Before and After Contrast | imaging | $4,106 | $335 to $73,223 | Low |
| Above Knee, Molded Socket, Open End, Sach Foot, Endoskeletal System, Single A... | other | $4,124 | $1,828 to $6,873 | Low |
| Placement of Tube of Kidney and Urinary Tube Through New Skin Access Using Im... | other | $4,127 | $1,830 to $50,433 | Low |
| Traumatic Injury without Mcc | emergency | $4,129 | $1,831 to $20,348 | Low |
| Removal of 2 Lobes of Lung | surgery | $4,135 | $1,397 to $32,482 | Low |
| Revision OR Replacement of Hypoglossal Nerve Neurostimulator Electrode and Br... | surgery | $4,136 | $707 to $64,583 | Low |
| Repair of Electrode for Permanent Pacemaker OR Defibrillator | surgery | $4,143 | $1,837 to $33,218 | Low |
| Repair of Aneurysm OR Lower Leg Artery with Graft | surgery | $4,154 | $1,042 to $35,151 | Low |
| Graft Conduit 21mm Aortic Valved 21cavgj | other | $4,170 | $1,849 to $6,950 | Low |
| Graft Conduit 23mm Aortic Valved 23cavgj | other | $4,170 | $1,849 to $6,950 | Low |
| Graft Conduit 27mm Aortic Valved 27cavgj | other | $4,170 | $1,849 to $6,950 | Low |
| Graft Conduit 29mm Aortic Valved 29cavgj | other | $4,170 | $1,849 to $6,950 | Low |
| Graft Conduit 31mm Aortic Valved 31cavgj | other | $4,170 | $1,849 to $6,950 | Low |
| Removal of Growth of Saliva Gland OR Saliva Gland, and Surrounding Lymph Node... | surgery | $4,190 | $1,103 to $42,426 | Low |
| Removal of Blood Clot and Portion of Tibial OR Peroneal Artery, Initial Artery | surgery | $4,195 | $1,021 to $35,305 | Low |
| Pacemaker, Other Than Single OR Dual Chamber | cardiac | $4,197 | $1,861 to $6,995 | Low |
| Bypass of Diseased OR Blocked Upper Leg to Opposite Upper Leg Artery with Vein | other | $4,199 | $1,024 to $35,558 | Low |
| Repair of Ruptured Aneurysm of Arm Artery with Graft | surgery | $4,228 | $1,001 to $35,013 | Low |
| Insertion of Stent and Blood Clot Protection Device in Neck Artery with Revie... | cardiac | $4,232 | $823 to $37,215 | Low |
| Relocation And/or Reimplantation of Neck Artery to Chest Artery | surgery | $4,254 | $867 to $35,695 | Low |
| Insertion of Catheters for Recording, Pacing, and Induction of Abnormal Heart... | cardiac | $4,256 | $1,887 to $93,624 | Low |
| Repair of Aneurysm OR Upper Chest OR Neck Artery with Graft | surgery | $4,279 | $1,126 to $35,021 | Low |
| Septal Defect Implant System, Intracardiac | surgery | $4,294 | $1,904 to $7,156 | Low |
| Removal of Growth of Lung and Reconstruction of Chest Wall | surgery | $4,306 | $1,782 to $32,504 | Low |
| Bypass of Diseased OR Blocked Arm to Both Lower Thigh Arteries with Other Tha... | other | $4,333 | $1,147 to $35,654 | Low |
| Bypass of Diseased OR Blocked Upper Arm to Arm Artery with Vein | other | $4,346 | $1,038 to $35,523 | Low |
| Partial Removal of Large Bowel and Reattachment to Rectum and Creation of Lar... | surgery | $4,352 | $1,811 to $44,146 | Low |
| Removal of Blood Clot and Portion of Tibioperoneal Trunk Artery | surgery | $4,364 | $1,071 to $35,304 | Low |
| Nuclear Medicine Study From Skull Base to Mid-thigh with CT Scan | imaging | $4,365 | $1,371 to $78,815 | Low |
| Repair of Blood Vessel of Arm with Vein Graft | surgery | $4,384 | $854 to $35,236 | Low |
| Revision of Total Shoulder Repair, Total Shoulder | surgery | $4,397 | $1,455 to $23,474 | Low |
| Shoulder Surgery | surgery | $4,397 | $741 to $14,656 | High |
| Transfer of Nerve to Injured Nerve, Stage 1 of 2 | other | $4,409 | $835 to $64,905 | Low |
| Repair of Aortic Arch with Graft On Heart-lung Machine | surgery | $4,414 | $1,957 to $33,871 | Low |
| Injection, Margetuximab-cmkb, 5 Mg | other | $4,464 | $52 to $7,440 | Low |
| Injection, Von Willebrand Factor Complex (humate-p), Per Iu Vwf:rco | other | $4,472 | $1 to $7,454 | Low |
| Bypass of Diseased OR Blocked Neck to Chest Artery with Other Than Vein | other | $4,475 | $988 to $35,606 | Low |
| Repair of Ruptured Aneurysm of Upper Thigh Artery with Graft | surgery | $4,482 | $1,108 to $35,142 | Low |
| Nuclear Medicine Study Whole Body with CT Scan | imaging | $4,499 | $1,371 to $78,816 | Low |
| Pericardial Tissue Heart Valve All Sizes #3300tfx | cardiac | $4,500 | $1,995 to $7,500 | Low |
| Removal of Growth Below Breast Bone | surgery | $4,502 | $995 to $39,220 | Low |
| Insertion of Stent in Groin Artery, Initial Vessel | cardiac | $4,511 | $2,000 to $37,221 | Low |
| Prosthesis, Urinary Sphincter | other | $4,512 | $2,000 to $7,520 | Low |
| Bypass of Diseased OR Blocked Thigh to Knee Artery with Vein Graft | other | $4,528 | $1,208 to $35,583 | Low |
| Limited Reconstruction of Upper Heart Chamber and Alteration of Electrical Pa... | cardiac | $4,529 | $1,203 to $33,265 | Low |
| Partial Destruction and Reconstruction of Upper Heart Chamber | cardiac | $4,535 | $1,203 to $33,254 | Low |
| Injection, Belinostat, 10 Mg | other | $4,539 | $52 to $7,566 | Low |
| Injection, Icatibant, 1 Mg | other | $4,546 | $146 to $7,577 | Low |
| Bypass of Diseased OR Blocked Lower Leg to Lower Leg Artery with Vein | other | $4,551 | $1,113 to $35,571 | Low |
| Complicated Partial Removal of Bladder | surgery | $4,564 | $1,074 to $51,555 | Low |
| Repair of Aorta OR Great Vessels with Sutures On Heart-lung Machine | surgery | $4,611 | $1,234 to $33,322 | Low |
| Bypass of Diseased OR Blocked Upper Leg to Lower Leg Artery with Other Than Vein | other | $4,621 | $1,083 to $35,666 | Low |
| Bypass of Diseased OR Blocked Groin to Upper Leg Artery with Other Than Vein | other | $4,642 | $989 to $35,665 | Low |
| Implant Pat-active Ht Record | surgery | $4,646 | $2,060 to $33,282 | Low |
| Repair of Aneurysm OR Neck OR Upper Chest Artery with Graft | surgery | $4,650 | $934 to $35,001 | Low |
| Revision of Groin Artery Bypass with Patch Graft | other | $4,650 | $1,005 to $35,883 | Low |
| Repair of Infrarenal Aorta and Groin Artery with Graft for Other Than Rupture... | surgery | $4,652 | $1,276 to $34,705 | Low |
| Removal of Blood Clot and Portion of Artery of Abdominal Organ | surgery | $4,655 | $1,154 to $35,341 | Low |
| Injection, Sacituzumab Govitecan-hziy, 2.5 Mg | other | $4,657 | $36 to $7,761 | Low |
| Otitis Media and Uri without Mcc | other | $4,670 | $2,071 to $13,756 | Low |
| Partial Removal of Large Bowel and Reattachment to Rectum and Creation of Ope... | surgery | $4,678 | $1,690 to $44,208 | Low |
| Repair of Aneurysm OR Groin Artery with Graft | surgery | $4,681 | $1,168 to $35,131 | Low |
| Partial Removal of Tongue and Surrounding Lymph Nodes On Side of Neck | surgery | $4,709 | $1,811 to $41,135 | Low |
| Revision of Thigh and Lower Leg Bone Components of Total Knee Joint Prosthesis | other | $4,718 | $1,473 to $27,487 | Low |
| Injection, Aripiprazole (abilify Maintena), 1 Mg | other | $4,721 | $7 to $7,868 | Low |
| Anesthesia for Procedure On Esophagus | other | $4,724 | $500 to $15,746 | Low |
| Balloon Dilation of Artery with Review By Radiologist, Initial Artery | other | $4,740 | $2,101 to $37,246 | Low |
| Repair of Ruptured Aneurysm of Lower Leg Artery with Graft | surgery | $4,747 | $1,179 to $35,152 | Low |
| Revision of Groin Artery Bypass with Vein Patch Graft | other | $4,757 | $1,045 to $35,884 | Low |
| Bypass of Diseased OR Blocked Upper to Lower Leg Artery with Vein | other | $4,782 | $1,171 to $35,556 | Low |
| Repair of Congenital Bowel Defect | surgery | $4,793 | $688 to $44,800 | Low |
| Bypass of Diseased OR Blocked Neck to Opposite Neck Artery with Vein | other | $4,806 | $1,191 to $35,509 | Low |
| Removal of Blood Clot and Portion of Chest OR Neck Artery | surgery | $4,846 | $1,361 to $35,311 | Low |
| Other Antepartum Diagnoses without O.r. Procedures with Cc | other | $4,867 | $2,158 to $17,088 | Low |
| Repair of Blood Vessel of Chest with Vein Graft On Heart-lung Machine | surgery | $4,868 | $1,275 to $35,241 | Low |
| Replacement of Aortic Valve By Through Femoral Artery | surgery | $4,879 | $1,093 to $33,362 | Low |
| Balloon Dilation of Pulmonary Artery, Single Vessel | other | $4,888 | $514 to $92,997 | Low |
| Balloon Dilation of Artery of Leg, Initial Vessel | other | $4,914 | $2,179 to $37,228 | Low |
| Inspira Resilian Aortic Valve 19mm #11500a19 | other | $4,920 | $2,181 to $8,200 | Low |
| Inspira Resilian Aortic Valve 21mmá #11500a21 | other | $4,920 | $2,181 to $8,200 | Low |
| Inspira Resilian Aortic Valve 23mmá #11500a23 | other | $4,920 | $2,181 to $8,200 | Low |
| Inspira Resilian Aortic Valve 25mmá #11500a25 | other | $4,920 | $2,181 to $8,200 | Low |
| Inspira Resilian Aortic Valve 27mmá #11500a27 | other | $4,920 | $2,181 to $8,200 | Low |
| Inspira Resilian Aortic Valve 29mmá #11500a29 | other | $4,920 | $2,181 to $8,200 | Low |
| Image-guided Robotic Linear Accelerator-based Stereotactic Radiosurgery, Comp... | surgery | $4,929 | $2,185 to $16,430 | Low |
| Removal of Remaining Lung After Previous Partial Removal of Lung | surgery | $4,972 | $2,079 to $32,488 | Low |
| Flotufolastat F 18, Diagnostic, 1 Millicurie | other | $4,978 | $671 to $8,296 | Low |
| Dilation of Sphenoid Nasal Sinus Using an Endoscope | other | $4,996 | $117 to $31,297 | Low |
| Bypass of Diseased OR Blocked Under Arm to Arm Artery with Vein | other | $5,039 | $987 to $35,522 | Low |
| Dilation of Frontal Nasal Sinus Using an Endoscope | other | $5,043 | $145 to $31,296 | Low |
| Replacement of Aortic Valve Through Axillary Artery | surgery | $5,044 | $1,136 to $33,363 | Low |
| Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg | other | $5,064 | $29 to $8,440 | Low |
| Bypass of Diseased OR Blocked Upper Leg to Lower Leg Artery with Vein Graft | other | $5,068 | $1,398 to $35,585 | Low |
| Removal of Blood Clot and Portion of Abdominal Aorta and Groin Artery | surgery | $5,159 | $1,283 to $35,361 | Low |
| Other Kidney and Urinary Tract Diagnoses without Cc/mcc | other | $5,189 | $2,301 to $16,861 | Low |
| Insertion of Catheters for Recording and Pacing of Left Lower Heart Chamber R... | cardiac | $5,230 | $2,319 to $93,622 | Low |
| Bypass of Diseased OR Blocked Aorta to Upper Leg Artery with Other Than Vein | other | $5,260 | $1,260 to $35,647 | Low |
| Goserelin Acetate Implant, Per 3.6 Mg | surgery | $5,261 | $629 to $8,768 | Low |
| Vaginal Delivery | obstetric | $5,270 | $666 to $21,288 | High |
| Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg | other | $5,270 | $28 to $8,783 | Low |
| Injection, Fam-trastuzumab Deruxtecan-nxki, 1 Mg | other | $5,308 | $30 to $8,846 | Low |
| Destruction of First Incompetent Vein of Arm OR Leg Using Radiofrequency and ... | other | $5,326 | $230 to $36,475 | Low |
| Repair of Knee Cartilage with Donor Cartilage Graft Using an Endoscope | surgery | $5,332 | $1,415 to $29,868 | Low |
| Insertion of Stent in Artery of Leg, Each Additional Vessel | cardiac | $5,354 | $2,374 to $37,234 | Low |
| Injection, Irinotecan Liposome, 1 Mg | other | $5,358 | $66 to $8,930 | Low |
| Bypass of Diseased OR Blocked Major Upper to Lower Leg Artery with Vein | other | $5,412 | $1,393 to $35,566 | Low |
| Removal of Blood Clot in Artery of Abdominal Organs | surgery | $5,426 | $1,172 to $34,151 | Low |
| Other Skin, Subcutaneous Tissue and Breast Procedures without Cc/mcc | other | $5,433 | $2,409 to $31,226 | Low |
| Treatment of Broken Lower Spine Bone with Placement of Stabilizing Device | other | $5,435 | $2,410 to $22,514 | Low |
| Treatment of Broken Middle Spine Bone with Placement of Stabilizing Device Us... | other | $5,435 | $2,410 to $22,513 | Low |
| Treatment of Broken Spine Bone with Stabilizing Device, Each Additional Segment | other | $5,435 | $177 to $22,515 | Low |
| Insertion of Left Lower Heart Electrode for Pacemaker OR Defibrillator | cardiac | $5,480 | $367 to $33,225 | Low |
| Extensive Destruction and Reconstruction of Upper Heart Chamber | cardiac | $5,485 | $1,443 to $33,255 | Low |
| Injection, Certolizumab Pegol, 1 Mg | other | $5,490 | $4 to $9,151 | Low |
| Repair of Ruptured Aneurysm of Groin Artery with Graft | surgery | $5,497 | $1,377 to $35,132 | Low |
| Partial Removal of Lower Esophagus | surgery | $5,505 | $2,441 to $43,117 | Low |
| Endocrine Disorders with Cc | other | $5,530 | $2,452 to $25,065 | Low |
| Injection, Daratumumab, 10 Mg | other | $5,531 | $71 to $9,219 | Low |
| Interspinous Process Distraction Device | other | $5,550 | $2,461 to $9,250 | Low |
| Revision of Thigh Bone and Hip Joint Prosthesis | other | $5,588 | $1,586 to $27,134 | Low |
| Balloon Dilation of Vein with Review By Radiologist, Initial Vein | other | $5,596 | $2,481 to $37,248 | Low |
| Bypass of Diseased OR Blocked Artery Aorta to Upper Leg and Opposite Upper Le... | other | $5,599 | $1,431 to $35,646 | Low |
| Uncomplicated Peptic Ulcer with Mcc | other | $5,605 | $2,485 to $22,735 | Low |
| Iodine I-123 Iobenguane, Diagnostic, Per Study Dose, Up to 15 Millicuries | other | $5,605 | $2,318 to $9,342 | Low |
| Injection, Elotuzumab, 1 Mg | other | $5,622 | $8 to $9,370 | Low |
| Dilation of Bile Ducts with Stent Insertion Using an Endoscope | cardiac | $5,626 | $2,494 to $47,556 | Low |
| Insertion of Temporary Pacemaker Lead in Single Heart Chamber | cardiac | $5,634 | $2,498 to $33,210 | Low |
| Repair of Aorta OR Great Vessels with Graft | surgery | $5,635 | $1,269 to $33,330 | Low |
| Removal of Infected Chest Graft | surgery | $5,677 | $1,415 to $35,905 | Low |
| Repair of Ruptured Aorta with Graft with Review By Radiologist | surgery | $5,686 | $1,509 to $34,702 | Low |
| Repair of Groin Artery with Graft for Rupture with Review By Radiologist | surgery | $5,709 | $1,529 to $34,708 | Low |
| Insertion of Pacemaker Pulse Generator with Existing Single Lead | cardiac | $5,731 | $2,541 to $33,212 | Low |
| Insertion of 1 Electrode for Permanent Pacemaker OR Defibrillator | cardiac | $5,740 | $2,545 to $33,216 | Low |
| Stent Endograft Endurant Iis Bifurcated 28mm X 14mm X 103mm #esbf2814c103e | cardiac | $5,746 | $2,547 to $9,576 | Low |
| Dilation of Canal Between Middle Ear and Throat (eustachian Tube) On One Side... | other | $5,750 | $141 to $69,705 | Low |
| Dental and Oral Diseases with Cc | other | $5,753 | $2,550 to $22,875 | Low |
| Catheter, Thrombectomy/embolectomy | cardiac | $5,790 | $2,567 to $9,650 | Low |
| Ascending Aorta Graft, with Cardiopulmonary Bypass, Includes Valve Suspension... | other | $5,792 | $2,568 to $33,860 | Low |
| Removal of Plaque in Artery of Leg, Each Additional Vessel | surgery | $5,811 | $2,576 to $37,233 | Low |
| Bypass of Diseased OR Blocked Aorta to Groin Artery with Other Than Vein | other | $5,825 | $1,398 to $35,637 | Low |
| Removal of Large Bowel, Rectum, Bladder and Ureter | surgery | $5,858 | $2,342 to $45,126 | Low |
| Integra Bilayer Matrix Wound Dressing (bmwd), Per Square Centimeter | other | $5,866 | $119 to $9,776 | Low |
| Removal of Permanent Pacemaker Pulse Generator | surgery | $5,916 | $2,623 to $33,233 | Low |
| Iris Prosthesis | other | $5,940 | $2,633 to $9,900 | Low |
| Dilation of Canal Between Middle Ear and Throat (eustachian Tube) On Both Sid... | other | $5,961 | $195 to $69,706 | Low |
| Dermacell, Dermacell Awm OR Dermacell Awm Porous, Per Square Centimeter | other | $5,997 | $119 to $9,995 | Low |
| Prematurity with Major Problems | other | $6,005 | $2,662 to $65,748 | Low |
| Injection, Bevacizumab, 10 Mg | other | $6,025 | $73 to $10,041 | Low |
| Injection, Benralizumab, 1 Mg | other | $6,029 | $165 to $10,048 | Low |
| Repair of Wound to Heart | surgery | $6,036 | $2,108 to $33,300 | Low |
| Extensive Reconstruction of Upper Heart Chamber and Alteration of Electrical ... | cardiac | $6,092 | $1,618 to $33,266 | Low |
| Peripheral Vascular Disorders without Cc/mcc | other | $6,154 | $2,728 to $20,524 | Low |
| Anesthesia for Closed Drainage of Lung Fluid | other | $6,158 | $524 to $20,528 | Low |
| Repair of Aorta OR Great Vessels with Graft On Heart-lung Machine | surgery | $6,198 | $1,647 to $33,335 | Low |
| Insertion of Stent in Artery of Leg, Initial Vessel | cardiac | $6,208 | $2,752 to $37,230 | Low |
| Injection, C-1 Esterase Inhibitor (human), Cinryze, 10 Units | other | $6,257 | $66 to $10,428 | Low |
| Injection, Anifrolumab-fnia, 1 Mg | other | $6,275 | $18 to $10,459 | Low |
| Psychoses | therapy | $6,288 | $2,788 to $21,896 | Low |
| Dilation of Sphenoid and Frontal Nasal Sinus Using an Endoscope | other | $6,326 | $205 to $31,298 | Low |
| Exploration of Chest for Bleeding, Blood Clot, OR Infection After Surgery | surgery | $6,376 | $1,739 to $35,820 | Low |
| Extensive Destruction and Reconstruction of Upper Heart Chamber On Heart-lung... | cardiac | $6,448 | $1,701 to $33,256 | Low |
| Skin Ulcers with Cc | other | $6,467 | $2,867 to $32,350 | Low |
| Allergic Reactions without Mcc | other | $6,468 | $2,868 to $16,652 | Low |
| Other Respiratory System Diagnoses without Mcc | other | $6,473 | $2,870 to $21,706 | Low |
| Repair of Aneurysm OR Abdominal Aorta with Graft | surgery | $6,485 | $1,460 to $35,081 | Low |
| Other Kidney and Urinary Tract Procedures without Cc/mcc | other | $6,520 | $2,890 to $47,927 | Low |
| Coronary Artery Bypass Using Vein Graft, 1 Graft | cardiac | $6,543 | $1,687 to $33,510 | Low |
| Major Skin Disorders with Mcc | other | $6,568 | $2,912 to $50,036 | Low |
| Acute Myocardial Infarction, Expired with Cc | other | $6,616 | $2,933 to $25,738 | Low |
| Insertion of 2 Electrodes for Permanent Pacemaker OR Defibrillator | cardiac | $6,623 | $2,936 to $33,217 | Low |
| Bypass of Diseased OR Blocked Aorta to Groin to Opposite Groin Artery with Ot... | other | $6,736 | $1,467 to $35,638 | Low |
| Abortion without D&c | other | $6,853 | $3,038 to $15,891 | Low |
| Epi-sense Guided 6130 Device #cdp-4330 | other | $6,900 | $3,059 to $11,500 | Low |
| Testes Procedures without Cc/mcc | other | $6,930 | $3,072 to $31,224 | Low |
| Injection, Dostarlimab-gxly, 10 Mg | other | $6,938 | $244 to $11,563 | Low |
| Repair of Infrarenal Aorta and Groin Artery with Graft for Rupture On Both Si... | surgery | $6,941 | $1,903 to $34,706 | Low |
| Graft Bifurcated Stent #ba28-100/i16 | cardiac | $6,948 | $3,080 to $11,580 | Low |
| Respiratory Neoplasms without Cc/mcc | other | $6,953 | $3,083 to $31,399 | Low |
| Repair of Infrarenal Aorta and Groin Artery with Graft for Rupture with Revie... | surgery | $6,961 | $1,872 to $34,704 | Low |
| Repair of Descending Aorta and Subclavian Artery with Insertion of Graft and ... | surgery | $6,964 | $1,195 to $33,880 | Low |
| Viral Illness without Mcc | other | $6,991 | $3,099 to $16,207 | Low |
| Bypass of Diseased OR Blocked Arm to Lower Thigh OR Leg Artery with Other Tha... | other | $7,006 | $1,376 to $35,626 | Low |
| Otitis Media and Uri with Mcc | other | $7,032 | $3,118 to $27,658 | Low |
| Other Factors Influencing Health Status | other | $7,059 | $3,129 to $11,765 | Low |
| Postpartum and Post Abortion Diagnoses with O.r. Procedures | obstetric | $7,121 | $3,157 to $38,052 | Low |
| Injection, Darbepoetin Alfa, 1 Microgram | other | $7,124 | $3 to $11,874 | Low |
| Shockwave Destruction of Calcified Plaque in Coronary Artery Accessed Through... | cardiac | $7,129 | $118 to $92,972 | Low |
| Coronary Artery Bypass Using Artery Graft, 1 Graft | cardiac | $7,139 | $1,634 to $33,533 | Low |
| Injection, Bezlotoxumab, 10 Mg | other | $7,182 | $40 to $11,970 | Low |
| Insertion of Tube for 3d Mapping of Electrical Impulses to Heart Muscle | cardiac | $7,185 | $231 to $93,613 | Low |
| Destruction of Growth of Kidney By Freezing | other | $7,207 | $3,195 to $50,593 | Low |
| Injection, Trastuzumab-pkrb, Biosimilar, (herzuma), 10 Mg | other | $7,236 | $35 to $12,061 | Low |
| Alcohol, Drug Abuse OR Dependence, Left Ama | other | $7,241 | $1,427 to $12,069 | Low |
| Repair of Blood Vessel of Chest | surgery | $7,265 | $1,775 to $35,216 | Low |
| Alloderm 1518320 | other | $7,326 | $3,248 to $12,210 | Low |
| Removal of Growth of Heart On Heart-lung Machine | surgery | $7,361 | $1,814 to $33,120 | Low |
| Endograft Aortic Body 23mm Tv-ab2380-j | other | $7,383 | $3,273 to $12,305 | Low |
| Endograft Aortic Body 26mm Tv-ab2680-n | other | $7,383 | $3,273 to $12,305 | Low |
| Endograft Aortic Body 29mm Tv-ab2980-n | other | $7,383 | $3,273 to $12,305 | Low |
| Endograft Aortic Body 34mm Tv-ab3480-n | other | $7,383 | $3,273 to $12,305 | Low |
| Injection, Isatuximab-irfc, 10 Mg | other | $7,480 | $82 to $12,466 | Low |
| Incision OR Removal of Tissue Below Aortic Valve | surgery | $7,500 | $1,770 to $33,415 | Low |
| Insertion of Pacemaker Pulse Generator with Existing Dual Leads | cardiac | $7,519 | $3,333 to $33,213 | Low |
| Insertion of Stent in Arteries of Leg | cardiac | $7,522 | $856 to $37,226 | Low |
| All Lower Extremity Prosthesis, Shank Foot System with Vertical Loading Pylon | other | $7,524 | $3,336 to $12,541 | Low |
| Strattice Tm, Per Square Centimeter | other | $7,532 | $119 to $12,553 | Low |
| Vaginal Delivery with OR Procedure except Sterilization/D&C | obstetric | $7,588 | $3,364 to $22,892 | Low |
| Cardioverter-defibrillator, Dual Chamber | other | $7,620 | $3,378 to $12,700 | Low |
| Coronary Artery Bypass Using Vein Graft, 2 Grafts | cardiac | $7,721 | $1,854 to $33,511 | Low |
| Removal and Dissolving of Blood Clot From Vein Using Fluoroscopic Guidance, I... | surgery | $7,753 | $3,437 to $37,187 | Low |
| Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy w... | other | $7,796 | $3,456 to $22,966 | Low |
| Injection, Durvalumab, 10 Mg | other | $7,802 | $85 to $13,003 | Low |
| Infections, Female Reproductive System without Cc/mcc | other | $7,806 | $3,461 to $14,813 | Low |
| Gore Excluder Aaa Endoprosthesis 26mm X 14.5mm Rlt261414 | other | $7,807 | $3,461 to $13,012 | Low |
| Repair of Aorta At Heart | surgery | $7,811 | $1,467 to $33,417 | Low |
| Repair of Aneurysm Above Heart Valve to Lung On Heart-lung Machine | surgery | $7,831 | $1,361 to $33,720 | Low |
| Injection, Rho D Immune Globulin, Intravenous, Human, Solvent Detergent, 100 Iu | other | $7,838 | $25 to $13,063 | Low |
| Hand OR Wrist Procedures, Except Major Thumb OR Joint Procedures without Cc/mcc | other | $7,853 | $3,482 to $23,277 | Low |
| Cardioverter-defibrillator, Single Chamber | other | $7,862 | $3,486 to $13,104 | Low |
| Insertion of Left Lower Heart Electrode and Attachment to Pacemaker OR Defibr... | cardiac | $7,895 | $3,500 to $33,224 | Low |
| Insertion of Pacemaker and Lower Heart Chamber Electrode | cardiac | $7,895 | $3,500 to $33,207 | Low |
| Injection, Collagenase, Clostridium Histolyticum, 0.01 Mg | other | $7,901 | $70 to $13,169 | Low |
| Repair of Congenital Defect Between Upper Heart Chambers On Heart-lung Machine | surgery | $7,902 | $1,424 to $33,641 | Low |
| Gore Excluder Endoporsthesis Iliac Branch Comp #ceb231010a | other | $7,919 | $3,511 to $13,199 | Low |
| Gore Excluder Iliac Branch Endoprosthesis Iliac Branch Component 14.35mm X 10... | other | $7,919 | $3,511 to $13,199 | Low |
| Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg | other | $7,924 | $89 to $13,206 | Low |
| Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes wit... | other | $7,934 | $3,518 to $21,657 | Low |
| Insertion of 2 Chamber Pacemaker System | cardiac | $7,936 | $3,518 to $33,214 | Low |
| Aftercare without Cc/mcc | other | $7,944 | $3,522 to $39,155 | Low |
| Injection, Enfortumab Vedotin-ejfv, 0.25 Mg | other | $7,964 | $37 to $13,273 | Low |
| Bypass of Diseased OR Blocked Artery Aorta to Abdominal OR Kidney Artery with... | other | $7,969 | $1,553 to $35,631 | Low |
| Other Ear, Nose, Mouth and Throat O.r. Procedures with Mcc | other | $8,025 | $3,558 to $84,423 | Low |
| Insertion of Catheters for Recording and Pacing of Left Upper Heart Chamber R... | cardiac | $8,057 | $3,572 to $93,621 | Low |
| Other Cerebrovascular Disorders without Cc/mcc | other | $8,057 | $3,572 to $18,397 | Low |
| Gore Excluder Ipsilateral Leg Endoprosthesis 28.5mm X 14.5mm X 12cm #rlt281412 | other | $8,065 | $3,575 to $13,441 | Low |
| Removal of Heart Sac On Heart-lung Machine | surgery | $8,090 | $2,148 to $33,031 | Low |
| Renal Failure without CC/MCC | other | $8,148 | $3,612 to $19,373 | Low |
| Wound Debridements for Injuries without Cc/mcc | other | $8,164 | $3,619 to $36,578 | Low |
| Disorders of Pancreas Except Malignancy without Cc/mcc | other | $8,240 | $3,653 to $18,435 | Low |
| Other O.r. Procedures of the Blood and Blood Forming Organs without Cc/mcc | other | $8,292 | $3,676 to $60,519 | Low |
| Coronary Artery Bypass Using Artery Graft, 2 Grafts | cardiac | $8,302 | $1,916 to $33,534 | Low |
| Skin Debridement without Cc/mcc | other | $8,316 | $3,687 to $26,843 | Low |
| Major Chest Trauma without Cc/mcc | emergency | $8,340 | $3,698 to $25,457 | Low |
| Injection, Digoxin Immune Fab (ovine), Per Vial | other | $8,341 | $3,698 to $13,902 | Low |
| Coronary Artery Bypass Using Vein Graft, 3 Grafts | cardiac | $8,342 | $2,100 to $33,512 | Low |
| Insertion of Pacemaker and Upper and Lower Heart Chamber Electrode | cardiac | $8,377 | $3,714 to $33,208 | Low |
| Hepatobiliary Diagnostic Procedures with Cc | other | $8,393 | $3,721 to $58,553 | Low |
| Multiple Sclerosis and Cerebellar Ataxia with Cc | other | $8,393 | $3,721 to $30,345 | Low |
| Coronary Artery Bypass Using Vein Graft, 4 Grafts | cardiac | $8,424 | $2,143 to $33,513 | Low |
| Coronary Artery Bypass Using Vein Graft, 5 Grafts | cardiac | $8,567 | $2,282 to $33,514 | Low |
| Major Gastrointestinal Disorders and Peritoneal Infections without Cc/mcc | other | $8,596 | $3,811 to $16,685 | Low |
| Cardiac Arrhythmia and Conduction Disorders without Cc/mcc | cardiac | $8,608 | $3,816 to $17,027 | Low |
| Bifurcated Stent #bea28-90/i16 | cardiac | $8,613 | $3,818 to $14,355 | Low |
| Bifurcated Stent #bea28-90/i20 | cardiac | $8,613 | $3,818 to $14,355 | Low |
| Bifurcated Stent Bea22-60/i16 | cardiac | $8,613 | $3,818 to $14,355 | Low |
| Graft Bifurcated Afx2 #bea25-100/i16 | other | $8,613 | $3,818 to $14,355 | Low |
| Graft Bifurcated Afx2 #bea25-100/i20 | other | $8,613 | $3,818 to $14,355 | Low |
| Graft Bifurcated Afx2 #bea25-90/i16 | other | $8,613 | $3,818 to $14,355 | Low |
| Graft Bifurcated Afx2 #bea28-100/i16 | other | $8,613 | $3,818 to $14,355 | Low |
| Graft Bifurcated Afx2 #bea28-70/i16 | other | $8,613 | $3,818 to $14,355 | Low |
| Graft Bifurcated Afx2 #bea28-80/i16 | other | $8,613 | $3,818 to $14,355 | Low |
| Graft Bifurcated Afx2 #bea28-80/i20 | other | $8,613 | $3,818 to $14,355 | Low |
| Graft Bifurcated Stent #ba25-100/i20 | cardiac | $8,613 | $3,818 to $14,355 | Low |
| Graft Bifurcated Stent #bea25-90/i20 | cardiac | $8,613 | $3,818 to $14,355 | Low |
| Bronchitis and Asthma with Cc/mcc | other | $8,635 | $3,828 to $20,967 | Low |
| Removal of Blood Clot in Pulmonary Artery On Heart-lung Machine | surgery | $8,664 | $2,284 to $33,910 | Low |
| Abortion with D&c, Aspiration Curettage OR Hysterotomy | other | $8,748 | $3,878 to $21,239 | Low |
| Balloon Dilation Repair of Aortic Valve | surgery | $8,755 | $3,881 to $92,986 | Low |
| Injection, Rituximab, 10 Mg | other | $8,878 | $75 to $14,797 | Low |
| Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg | other | $8,974 | $1,599 to $14,957 | Low |
| Repair of Tricuspid Valve with Ring Insertion | surgery | $8,988 | $2,115 to $33,464 | Low |
| Gore Excluder Conformable Aaa Endoprosthesis 18fr Cxt321414 | other | $9,013 | $3,996 to $15,022 | Low |
| Gore Excluder Conformable Aaa Endoprosthesis Cxt281412 | other | $9,013 | $3,996 to $15,022 | Low |
| Principal Diagnosis Invalid As Discharge Diagnosis | other | $9,015 | $3,996 to $15,024 | Low |
| Destruction of Growths and Adjacent Soft Tissue | other | $9,029 | $4,003 to $20,982 | Low |
| Replacement of Aortic Valve On Heart-lung Machine | surgery | $9,034 | $1,976 to $33,405 | Low |
| Spinal Fusion | surgery | $9,081 | $4,026 to $85,908 | High |
| Other O.r. Procedures for Injuries without Cc/mcc | other | $9,164 | $4,063 to $29,097 | Low |
| Hand Procedures for Injuries | other | $9,222 | $4,088 to $63,296 | Low |
| Pulmonary Embolism without MCC | other | $9,283 | $4,115 to $24,006 | Low |
| Aftercare, Musculoskeletal System and Connective Tissue without Cc/mcc | other | $9,303 | $4,124 to $33,389 | Low |
| Infections, Female Reproductive System with Mcc | other | $9,307 | $4,126 to $37,637 | Low |
| Gore Excluder Endoprosthesis Aaa Conformable Endo #cxt261412 | other | $9,311 | $4,128 to $15,518 | Low |
| Coronary Artery Bypass Using Artery Graft, 4 Grafts | cardiac | $9,332 | $2,287 to $33,536 | Low |
| Insertion of Catheters for Recording and Pacing of Right Heart Chambers Rhyth... | cardiac | $9,391 | $4,163 to $93,620 | Low |
| Hypertension without Mcc | other | $9,398 | $4,167 to $22,215 | Low |
| Local Excision and Removal of Internal Fixation Devices Except Hip and Femur ... | surgery | $9,438 | $4,184 to $34,278 | Low |
| Occlusion of Growths OR Obstructed Vessels with Review By Radiologist | other | $9,451 | $4,190 to $37,243 | Low |
| Occlusion of Vein with Review By Radiologist | other | $9,451 | $4,190 to $37,241 | Low |
| Other Disorders of Nervous System without Cc/mcc | other | $9,547 | $4,232 to $21,683 | Low |
| Diabetes with Cc | other | $9,549 | $4,234 to $21,948 | Low |
| Gastrointestinal Obstruction without Cc/mcc | other | $9,572 | $4,244 to $15,954 | Low |
| Major Skin Disorders without Mcc | other | $9,574 | $4,244 to $18,389 | Low |
| Peripheral Vascular Disorders with Cc | other | $9,589 | $4,251 to $25,572 | Low |
| Insertion of Pacemaker and Upper Heart Chamber Electrode | cardiac | $9,599 | $4,255 to $33,206 | Low |
| Repair of Mitral Valve with Artificial Valve On Heart-lung Machine | surgery | $9,614 | $2,074 to $33,426 | Low |
| Replacement of Tricuspid Valve On Heart-lung Machine | surgery | $9,622 | $2,384 to $33,465 | Low |
| Cirrhosis and Alcoholic Hepatitis without Cc/mcc | other | $9,672 | $4,288 to $18,896 | Low |
| Radical Reconstruction of Mitral Valve On Heart-lung Machine | cardiac | $9,679 | $2,116 to $33,427 | Low |
| Insertion of Expandable Tube in Breast for Radiation Treatment Using Imaging ... | other | $9,700 | $180 to $32,334 | Low |
| Kidney and Urinary Tract Infections without MCC | other | $9,737 | $4,317 to $19,309 | Low |
| Cardioverter-defibrillator, Other Than Single OR Dual Chamber | other | $9,742 | $4,319 to $16,237 | Low |
| Chest Pain | other | $9,746 | $4,321 to $20,845 | Low |
| Acute Major Eye Infections with Cc/mcc | other | $9,813 | $4,350 to $23,264 | Low |
| Other Digestive System Diagnoses without Cc/mcc | other | $9,849 | $4,366 to $18,076 | Low |
| Injection, Romiplostim, 1 Microgram | other | $9,910 | $11 to $16,516 | Low |
| Red Blood Cell Disorders without Mcc | other | $9,980 | $4,425 to $24,538 | Low |
| Other Antepartum Diagnoses without O.r. Procedures with Mcc | other | $10,010 | $4,438 to $22,673 | Low |
| Other Musculoskeletal System and Connective Tissue Diagnoses without Cc/mcc | other | $10,018 | $4,442 to $24,624 | Low |
| Cellulitis without Mcc | other | $10,034 | $4,448 to $20,593 | Low |
| Prosthesis, Penile, Inflatable | other | $10,062 | $4,461 to $16,770 | Low |
| Pneumothorax without Cc/mcc | other | $10,068 | $4,463 to $17,750 | Low |
| Skin Grafts for Injuries with Cc/mcc | other | $10,077 | $4,467 to $126,176 | Low |
| Non-malignant Breast Disorders without Cc/mcc | other | $10,086 | $4,471 to $16,810 | Low |
| Replacement of Mitral Valve On Heart-lung Machine | surgery | $10,099 | $2,438 to $33,664 | Low |
| Urinary Stones without Mcc | other | $10,152 | $4,501 to $17,243 | Low |
| Injection, Rasburicase, 0.5 Mg | other | $10,154 | $370 to $16,924 | Low |
| Septic Arthritis with Cc | other | $10,188 | $4,517 to $30,381 | Low |
| Watchman Flex Device 20mm Wu5020 | other | $10,200 | $4,522 to $17,000 | Low |
| Watchman Flex Device 24mm Wu5024 | other | $10,200 | $4,522 to $17,000 | Low |
| Watchman Flex Device 27mm Wu5027 | other | $10,200 | $4,522 to $17,000 | Low |
| Watchman Flex Device 31mm Wu5031 | other | $10,200 | $4,522 to $17,000 | Low |
| Watchman Flx Pro Laa Closure 20mm Wu6020 M635wu60200 | other | $10,200 | $4,522 to $17,000 | Low |
| Watchman Flx Pro Laa Closure 24mm Wu6024 M635wu60240 | other | $10,200 | $4,522 to $17,000 | Low |
| Watchman Flx Pro Laa Closure 27mm Wu6027 M635wu60270 | other | $10,200 | $4,522 to $17,000 | Low |
| Watchman Flx Pro Laa Closure 31mm Wu6031 M635wu60310 | other | $10,200 | $4,522 to $17,000 | Low |
| Watchman Flx Pro Laa Closure 35mm Wu6035 M635wu60350 | other | $10,200 | $4,522 to $17,000 | Low |
| Watchman Flx Pro Laa Closure 40mm Wu6040 M635wu60400 | other | $10,200 | $4,522 to $17,000 | Low |
| Skin Debridement with Mcc | other | $10,298 | $4,566 to $78,203 | Low |
| Cardiac Arrhythmia and Conduction Disorders with Cc | cardiac | $10,322 | $4,576 to $23,738 | Low |
| Simple Pneumonia with CC | other | $10,393 | $4,608 to $21,349 | Low |
| Mouth Procedures without Cc/mcc | other | $10,398 | $4,610 to $28,779 | Low |
| Injection, Vedolizumab, Intravenous, 1 Mg | other | $10,400 | $21 to $17,333 | Low |
| Insertion of Stent in Vein with Review By Radiologist, Initial Vein | cardiac | $10,402 | $4,611 to $37,238 | Low |
| Reticuloendothelial and Immunity Disorders with Cc | other | $10,426 | $4,622 to $20,190 | Low |
| Nervous System Neoplasms without Mcc | other | $10,531 | $4,669 to $22,169 | Low |
| Removal of Thickened Heart Muscle At Left Lower Heart Chamber | surgery | $10,585 | $1,768 to $35,284 | Low |
| Tendonitis, Myositis and Bursitis without Mcc | other | $10,596 | $4,698 to $18,053 | Low |
| Hypertension with Mcc | other | $10,598 | $4,699 to $33,353 | Low |
| Renal Failure with CC | other | $10,637 | $4,716 to $22,653 | Low |
| Kidney and Urinary Tract Signs and Symptoms without Mcc | other | $10,693 | $4,741 to $18,285 | Low |
| COPD with CC | other | $10,697 | $4,742 to $23,539 | Low |
| Traumatic Stupor and Coma >1 Hour with Cc | emergency | $10,738 | $4,760 to $28,335 | Low |
| Amplatzer Amulet Laao 16mm 9-acp2-007 | other | $10,800 | $4,788 to $18,000 | Low |
| Amplatzer Amulet Laao 18mm 9-acp2-007 | other | $10,800 | $4,788 to $18,000 | Low |
| Amplatzer Amulet Laao 20mm 9-acp2-007 | other | $10,800 | $4,788 to $18,000 | Low |
| Amplatzer Amulet Laao 22mm 9-acp2-007 | other | $10,800 | $4,788 to $18,000 | Low |
| Amplatzer Amulet Laao 25mm 9-acp2-010 | other | $10,800 | $4,788 to $18,000 | Low |
| Amplatzer Amulet Laao 28mm 9-acp2-010 | other | $10,800 | $4,788 to $18,000 | Low |
| Amplatzer Amulet Laao 31mm 9-acp2-010 | other | $10,800 | $4,788 to $18,000 | Low |
| Amplatzer Amulet Laao 34mm 9-acp2-010 | other | $10,800 | $4,788 to $18,000 | Low |
| Watchman Device 27mm | other | $10,800 | $4,788 to $18,000 | Low |
| Watchman Device 30mm | other | $10,800 | $4,788 to $18,000 | Low |
| Watchman Device 33mm | other | $10,800 | $4,788 to $18,000 | Low |
| Watchman Flex Device 35mm Wu5035 | other | $10,800 | $4,788 to $18,000 | Low |
| Esophagitis and GI Disorders with MCC | other | $10,800 | $4,788 to $18,838 | Low |
| Anal and Stomal Procedures with Cc | other | $10,852 | $4,811 to $26,525 | Low |
| Cranial and Peripheral Nerve Disorders without Mcc | other | $10,857 | $4,813 to $27,227 | Low |
| Valiant Thoracic Stent Graft W/ Captivia Delivery System 38mm X 34mm X 150mm ... | cardiac | $10,875 | $4,821 to $18,125 | Low |
| Pneumothorax with Cc | other | $10,919 | $4,841 to $23,562 | Low |
| Injection, Pembrolizumab, 1 Mg | other | $10,928 | $60 to $18,214 | Low |
| Repair of Wound to Heart On Heart-lung Machine | surgery | $10,953 | $3,500 to $36,510 | Low |
| Coronary Artery Bypass Using Vein Graft, 6 OR More Grafts | cardiac | $10,997 | $2,364 to $36,658 | Low |
| Uncomplicated Peptic Ulcer without Mcc | other | $11,039 | $4,894 to $22,735 | Low |
| Trauma to the Skin, Subcutaneous Tissue and Breast without Mcc | emergency | $11,077 | $4,911 to $22,999 | Low |
| Replacement of Aortic Valve with Aorta Enlargement | surgery | $11,107 | $2,897 to $37,022 | Low |
| Fractures of Hip and Pelvis without Mcc | other | $11,128 | $4,933 to $31,152 | Low |
| Myeloproliferative Disorders OR Poorly Differentiated Neoplasms with Other Pr... | other | $11,193 | $4,962 to $59,078 | Low |
| Minor Bladder Procedures without Cc/mcc | other | $11,211 | $4,970 to $32,940 | Low |
| Gastrointestinal Hemorrhage without Cc/mcc | other | $11,309 | $5,014 to $19,586 | Low |
| Foot Procedures with Cc | other | $11,322 | $5,019 to $48,587 | Low |
| Skin Graft for Skin Ulcer OR Cellulitis without Cc/mcc | other | $11,325 | $5,021 to $80,203 | Low |
| Peripheral, Cranial Nerve and Other Nervous System Procedures without Cc/mcc | other | $11,350 | $5,032 to $33,671 | Low |
| Injection, Siltuximab, 10 Mg | other | $11,351 | $163 to $18,918 | Low |
| Acute and Subacute Endocarditis with Cc | other | $11,357 | $5,035 to $58,749 | Low |
| Respiratory Infections and Inflammations with Cc | other | $11,396 | $5,052 to $29,066 | Low |
| Generator, Neurostimulator (implantable), with Rechargeable Battery and Charg... | surgery | $11,400 | $5,054 to $19,000 | Low |
| Osteomyelitis with Cc | other | $11,416 | $5,061 to $36,542 | Low |
| Valiant Thoracic Stent Graft with the Captivia Delivery System Vamf3838c200tu | cardiac | $11,463 | $5,082 to $19,105 | Low |
| Extracranial Procedures with Cc | other | $11,529 | $5,111 to $54,422 | Low |
| Graft Thoracic 10cmx21mmx21mm Tgm212110 | other | $11,647 | $5,163 to $19,411 | Low |
| Graft Thoracic 10cmx28mmx28mm Tgm282810 | other | $11,647 | $5,163 to $19,411 | Low |
| Graft Thoracic 10cmx31mmx26mm Tgmr312610 | other | $11,647 | $5,163 to $19,411 | Low |
| Graft Thoracic 10cmx31mmx31mm Tgmr313110 | other | $11,647 | $5,163 to $19,411 | Low |
| Graft Thoracic 15cmx31mmx31mm Tgmr313115 | other | $11,647 | $5,163 to $19,411 | Low |
| Graft Thoracic 15cmx34mmx34mm Tgm343415 | other | $11,647 | $5,163 to $19,411 | Low |
| Graft Thoracic 15cmx37mmx37mm Tgmr373715 | other | $11,647 | $5,163 to $19,411 | Low |
| Graft Thoracic 15cmx40mmx40mm Tgmr404015 | other | $11,647 | $5,163 to $19,411 | Low |
| Graft Thoracic 15cmx45mmx45mm Tgm454515 | other | $11,647 | $5,163 to $19,411 | Low |
| Graft Thoracic 20cmx31mmx31mm Tgmr313120 | other | $11,647 | $5,163 to $19,411 | Low |
| Graft Thoracic 20cmx37mmx37mm Tgmr373720 | other | $11,647 | $5,163 to $19,411 | Low |
| Graft Thoracic 20cmx40mmx40mm Tgmr404020 | other | $11,647 | $5,163 to $19,411 | Low |
| Graft Thoracic 20cmx45mmx45mm Tgm454520 | other | $11,647 | $5,163 to $19,411 | Low |
| Pleural Effusion with Cc | surgery | $11,688 | $5,182 to $28,761 | Low |
| Major Esophageal Disorders with Cc | other | $11,720 | $5,196 to $24,754 | Low |
| Other Ear, Nose, Mouth and Throat O.r. Procedures without Cc/mcc | other | $11,738 | $5,204 to $21,196 | Low |
| Hypertensive Encephalopathy with Cc | other | $11,740 | $5,205 to $19,566 | Low |
| C-Section (Cesarean Delivery) | obstetric | $11,803 | $230 to $28,006 | High |
| Repair of Mitral Valve On Heart-lung Machine | surgery | $11,803 | $2,370 to $39,342 | Low |
| Inflammatory Bowel Disease with Cc | other | $11,857 | $5,256 to $27,284 | Low |
| Syncope and Collapse | other | $11,859 | $5,258 to $23,659 | Low |
| Injection, Ado-trastuzumab Emtansine, 1 Mg | other | $11,886 | $42 to $19,811 | Low |
| Injection, Octreotide, Depot Form for Intramuscular Injection, 1 Mg | other | $11,934 | $204 to $19,890 | Low |
| Headaches without Mcc | other | $11,987 | $5,314 to $21,089 | Low |
| Heart Failure and Shock without CC/MCC | cardiac | $12,023 | $4,945 to $21,970 | Low |
| Medical Back Problems without Mcc | other | $12,075 | $5,353 to $25,203 | Low |
| Repositioning of Tricuspid Valve | other | $12,083 | $2,109 to $40,276 | Low |
| Signs and Symptoms of Musculoskeletal System and Connective Tissue without Mcc | other | $12,090 | $5,360 to $24,296 | Low |
| Menstrual and Other Female Reproductive System Disorders without Cc/mcc | other | $12,233 | $4,976 to $20,388 | Low |
| Generator, Neurostimulator (implantable), Non-rechargeable | surgery | $12,300 | $5,453 to $20,500 | Low |
| COPD Management | other | $12,330 | $86 to $23,539 | High |
| COPD without CC/MCC | other | $12,330 | $5,466 to $20,550 | Low |
| Injection, Pertuzumab, 1 Mg | other | $12,336 | $15 to $20,559 | Low |
| Neurological Eye Disorders | other | $12,339 | $5,470 to $21,082 | Low |
| Prostatectomy with Cc | other | $12,381 | $5,489 to $44,593 | Low |
| Injection, Rituximab 10 Mg and Hyaluronidase | other | $12,430 | $37 to $20,716 | Low |
| Repair of Lower Heart Chamber Following Heart Attack | surgery | $12,464 | $2,669 to $41,546 | Low |
| Concussion with Cc | other | $12,477 | $5,532 to $25,633 | Low |
| Major Chest Trauma with Cc | emergency | $12,614 | $5,592 to $27,469 | Low |
| Alcohol/Drug Abuse or Dependence without Rehabilitation without MCC | therapy | $12,624 | $5,597 to $21,040 | Low |
| Fractures of Hip and Pelvis with Mcc | other | $12,637 | $5,602 to $33,547 | Low |
| Prostatectomy without Cc/mcc | other | $12,698 | $5,630 to $44,593 | Low |
| Injection, Panitumumab, 10 Mg | other | $12,717 | $154 to $21,194 | Low |
| Mastectomy for Malignancy without Cc/mcc | other | $12,732 | $5,644 to $72,447 | Low |
| Implantable Wireless Pulmonary Artery Pressure Sensor with Delivery Catheter,... | surgery | $12,840 | $5,692 to $21,400 | Low |
| Hernia Procedures Except Inguinal and Femoral without Cc/mcc | other | $12,871 | $5,706 to $31,848 | Low |
| Urethral Stricture | other | $12,876 | $5,709 to $29,550 | Low |
| Repair of Tricuspid Valve | surgery | $12,910 | $2,665 to $43,034 | Low |
| Pulmonary Edema and Respiratory Failure | other | $12,929 | $5,732 to $30,302 | Low |
| Atherosclerosis without Mcc | other | $12,938 | $5,736 to $21,563 | Low |
| D&c, Conization, Laparoscopy and Tubal Interruption with Cc/mcc | surgery | $12,941 | $5,737 to $44,180 | Low |
| Angina Pectoris | other | $12,988 | $5,758 to $21,646 | Low |
| Hand OR Wrist Procedures, Except Major Thumb OR Joint Procedures with Cc/mcc | other | $13,043 | $5,782 to $36,753 | Low |
| Extracranial Vascular Procedures with MCC | other | $13,071 | $5,795 to $33,547 | Low |
| Repair of Ascending Aorta with Graft On Heart-lung Machine with Aortic Root R... | surgery | $13,073 | $2,757 to $43,576 | Low |
| Complications of Treatment with Cc | other | $13,084 | $5,800 to $29,448 | Low |
| Disorders of Pancreas Except Malignancy with Cc | other | $13,084 | $5,801 to $25,738 | Low |
| Other Endocrine, Nutritional and Metabolic O.r. Procedures without Cc/mcc | lab | $13,119 | $5,816 to $54,231 | Low |
| Removal of Plaque in Artery of Leg, Initial Vessel | surgery | $13,163 | $5,836 to $43,876 | Low |
| Signs and Symptoms with Mcc | other | $13,183 | $5,844 to $46,338 | Low |
| Multiple Sclerosis and Cerebellar Ataxia with Mcc | other | $13,193 | $5,849 to $52,695 | Low |
| Kidney and Urinary Tract Neoplasms with Cc | other | $13,228 | $5,865 to $30,404 | Low |
| Endocrine Disorders with Mcc | other | $13,230 | $5,865 to $47,935 | Low |
| Seizures without MCC | other | $13,299 | $5,896 to $22,166 | Low |
| Heart Failure and Shock with MCC | cardiac | $13,342 | $5,915 to $35,421 | Low |
| Heart Failure and Shock with CC | cardiac | $13,428 | $5,953 to $28,674 | Low |
| Coronary Artery Bypass Using Artery Graft, 3 Grafts | cardiac | $13,447 | $2,125 to $44,822 | Low |
| Nutritional and Metabolic Disorders without MCC | other | $13,463 | $5,968 to $41,325 | Low |
| Simple Pneumonia with MCC | other | $13,466 | $5,970 to $31,089 | Low |
| Postoperative OR Post-traumatic Infections with O.r. Procedures with Cc | emergency | $13,512 | $5,990 to $54,012 | Low |
| Gastrointestinal Obstruction with Cc | other | $13,521 | $5,994 to $22,536 | Low |
| Fever and Inflammatory Conditions | other | $13,616 | $6,037 to $22,694 | Low |
| Injection, Tenecteplase, 1 Mg | other | $13,651 | $172 to $22,751 | Low |
| Other Kidney and Urinary Tract Diagnoses with Cc | other | $13,707 | $6,077 to $26,058 | Low |
| Injection, Immune Globulin, (octagam), Intravenous, Non-lyophilized (e.g., Li... | other | $13,711 | $47 to $22,851 | Low |
| COPD with MCC | other | $13,725 | $6,085 to $29,217 | Low |
| Tracheostomy for Face, Mouth and Neck Diagnoses OR Laryngectomy without Cc/mcc | other | $13,747 | $6,094 to $94,374 | Low |
| Injection, Ramucirumab, 5 Mg | other | $13,767 | $74 to $22,944 | Low |
| Septicemia or Severe Sepsis without Ventilator 96+ Hours without MCC | other | $13,789 | $6,113 to $26,188 | Low |
| Minor Skin Disorders without Mcc | other | $13,819 | $6,126 to $24,439 | Low |
| Other Disorders of Nervous System with Cc | other | $13,861 | $6,145 to $33,004 | Low |
| GI Hemorrhage with CC | other | $13,863 | $6,146 to $28,086 | Low |
| Connective Tissue Disorders with Mcc | other | $13,937 | $6,179 to $54,621 | Low |
| Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh ... | other | $13,973 | $6,195 to $27,021 | Low |
| Red Blood Cell Disorders with Mcc | other | $14,054 | $6,231 to $38,238 | Low |
| Disorders of Liver Except Malignancy, Cirrhosis OR Alcoholic Hepatitis with Cc | other | $14,061 | $6,234 to $27,434 | Low |
| Other Musculoskeletal System and Connective Tissue Diagnoses with Cc | other | $14,139 | $6,268 to $34,904 | Low |
| Skin Graft for Skin Ulcer OR Cellulitis with Cc | other | $14,151 | $6,274 to $89,252 | Low |
| Removal of Plaque in Arteries of Leg | surgery | $14,195 | $6,293 to $47,316 | Low |
| Amputation for Musculoskeletal System and Connective Tissue Disorders without... | other | $14,263 | $6,323 to $42,064 | Low |
| Allergic Reactions with Mcc | other | $14,271 | $6,327 to $44,911 | Low |
| Peripheral Vascular Disorders with Mcc | other | $14,276 | $6,329 to $32,563 | Low |
| Other Circulatory System Diagnoses with Cc | other | $14,285 | $6,333 to $35,118 | Low |
| Cellulitis with Mcc | other | $14,363 | $6,368 to $38,113 | Low |
| Inflammation of the Male Reproductive System without Mcc | other | $14,399 | $6,384 to $23,999 | Low |
| Injection, Nivolumab, 1 Mg | other | $14,429 | $33 to $24,049 | Low |
| Minor Skin Disorders with Mcc | other | $14,470 | $6,415 to $35,421 | Low |
| Other Injury, Poisoning and Toxic Effect Diagnoses without Mcc | other | $14,482 | $6,420 to $24,136 | Low |
| Major Head and Neck Procedures with Cc | other | $14,583 | $6,465 to $57,473 | Low |
| Malignant Breast Disorders with Cc | other | $14,741 | $6,535 to $33,903 | Low |
| Tendonitis, Myositis and Bursitis with Mcc | other | $14,945 | $6,626 to $39,728 | Low |
| Other Infectious and Parasitic Diseases Diagnoses with Mcc | other | $14,947 | $6,627 to $60,094 | Low |
| Impella Cp #4000021 | other | $15,000 | $6,650 to $25,000 | Low |
| Other Respiratory System O.r. Procedures without Cc/mcc | other | $15,033 | $6,664 to $38,264 | Low |
| Respiratory Neoplasms with Cc | other | $15,084 | $6,687 to $31,399 | Low |
| Injection, Lurbinectedin, 0.1 Mg | other | $15,177 | $207 to $25,295 | Low |
| Cardiac Pacemaker Revision Except Device Replacement with Cc | surgery | $15,219 | $6,747 to $58,836 | Low |
| Kidney and Urinary Tract Infections with MCC | other | $15,222 | $6,748 to $32,245 | Low |
| Major Gastrointestinal Disorders and Peritoneal Infections with Cc | other | $15,252 | $6,762 to $25,855 | Low |
| Samarium Sm 153 Lexidronam 1850 Mbq/ml IV Soln | other | $15,265 | $6,767 to $25,442 | Low |
| Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders with Mcc | other | $15,296 | $6,781 to $35,500 | Low |
| Aftercare, Musculoskeletal System and Connective Tissue with Mcc | other | $15,426 | $6,839 to $51,562 | Low |
| Intracranial Hemorrhage or Cerebral Infarction with CC | other | $15,453 | $5,979 to $25,754 | Low |
| Signs and Symptoms without Mcc | other | $15,489 | $6,867 to $25,815 | Low |
| Cardiac Arrhythmia and Conduction Disorders with Mcc | cardiac | $15,493 | $6,869 to $40,678 | Low |
| Injection, Natalizumab, 1 Mg | other | $15,516 | $24 to $25,859 | Low |
| Craniotomy and Endovascular Intracranial Procedures without Cc/mcc | other | $15,543 | $6,891 to $62,127 | Low |
| Injection, Obinutuzumab, 10 Mg | other | $15,577 | $74 to $25,962 | Low |
| Generator, Neurostimulator (implantable), High Frequency, with Rechargeable B... | surgery | $15,600 | $6,916 to $26,000 | Low |
| Malignancy, Female Reproductive System with Cc | other | $15,827 | $7,017 to $31,130 | Low |
| Other Disorders of Nervous System with Mcc | other | $15,852 | $7,028 to $57,758 | Low |
| Renal Failure with MCC | other | $15,914 | $7,055 to $41,995 | Low |
| Aftercare with Cc/mcc | other | $15,919 | $7,058 to $59,796 | Low |
| Intracranial Hemorrhage or Cerebral Infarction | other | $15,952 | $7,072 to $35,783 | Low |
| Minor Bladder Procedures with Mcc | other | $15,982 | $7,085 to $72,636 | Low |
| Removal of Plaque and Insertion of Stents in Arteries of Leg | surgery | $16,022 | $7,103 to $53,406 | Low |
| Medical Back Problems with Mcc | other | $16,031 | $7,107 to $46,108 | Low |
| Seizures with Mcc | other | $16,037 | $7,110 to $43,628 | Low |
| Urinary Stones with Mcc | other | $16,082 | $7,130 to $32,011 | Low |
| Organic Disturbances and Intellectual Disability | other | $16,166 | $7,167 to $26,943 | Low |
| Other Injury, Poisoning and Toxic Effect Diagnoses with Mcc | other | $16,195 | $7,180 to $59,088 | Low |
| Thyroid, Parathyroid and Thyroglossal Procedures without Cc/mcc | other | $16,196 | $7,180 to $30,286 | Low |
| Other Antepartum Diagnoses with O.r. Procedures without Cc/mcc | other | $16,256 | $7,207 to $27,093 | Low |
| Epistaxis without Mcc | other | $16,286 | $6,412 to $27,144 | Low |
| Cirrhosis and Alcoholic Hepatitis with Cc | other | $16,386 | $7,265 to $30,432 | Low |
| Postoperative and Post-traumatic Infections with Mcc | emergency | $16,447 | $7,292 to $33,109 | Low |
| Aftercare, Musculoskeletal System and Connective Tissue with Cc | other | $16,527 | $7,327 to $37,637 | Low |
| Dysequilibrium | other | $16,562 | $6,566 to $27,603 | Low |
| Other Cerebrovascular Disorders with Cc | other | $16,664 | $7,388 to $30,564 | Low |
| Digestive Malignancy with Mcc | other | $16,690 | $7,399 to $59,226 | Low |
| Transurethral Procedures with Cc | other | $16,896 | $7,490 to $48,225 | Low |
| Simple Pneumonia without CC/MCC | other | $16,988 | $5,491 to $28,313 | Low |
| Biliary Tract Procedures Except Only Cholecystectomy with OR without C.d.e. w... | other | $17,111 | $7,586 to $39,260 | Low |
| Extensive O.r. Procedures Unrelated to Principal Diagnosis without Cc/mcc | other | $17,123 | $7,591 to $36,078 | Low |
| Spinal Disorders and Injuries with Cc/mcc | other | $17,144 | $7,601 to $61,299 | Low |
| Concussion with Mcc | other | $17,484 | $7,751 to $36,748 | Low |
| Kidney and Ureter Procedures for Non-neoplasm without Cc/mcc | other | $17,491 | $7,754 to $29,152 | Low |
| Coagulation Disorders | other | $17,493 | $7,755 to $44,494 | Low |
| Nervous System Neoplasms with Mcc | other | $17,522 | $7,768 to $44,713 | Low |
| Insertion of Defibrillator with Existing Single Lead | other | $17,575 | $7,792 to $33,240 | Low |
| Soft Tissue Procedures with Cc | other | $17,591 | $7,799 to $48,826 | Low |
| Dental and Oral Diseases with Mcc | other | $17,714 | $7,853 to $56,651 | Low |
| Other Kidney and Urinary Tract Diagnoses with Mcc | other | $17,745 | $7,867 to $43,605 | Low |
| Peritoneal Adhesiolysis without Cc/mcc | other | $17,757 | $7,872 to $39,061 | Low |
| Postoperative OR Post-traumatic Infections with O.r. Procedures without Cc/mcc | emergency | $17,819 | $7,900 to $38,712 | Low |
| HIV with Major Related Condition without Cc/mcc | other | $17,886 | $7,815 to $29,818 | Low |
| Degenerative Nervous System Disorders with Mcc | other | $18,046 | $8,000 to $100,337 | Low |
| Injection, Lanreotide, (cipla), 1 Mg | other | $18,072 | $30 to $30,120 | Low |
| Inguinal and Femoral Hernia Procedures without Cc/mcc | other | $18,208 | $8,072 to $30,346 | Low |
| Malignancy, Female Reproductive System with Mcc | other | $18,277 | $8,103 to $49,651 | Low |
| Ungroupable | other | $18,293 | $8,110 to $30,489 | Low |
| Other Musculoskeletal System and Connective Tissue Diagnoses with Mcc | other | $18,318 | $8,121 to $43,256 | Low |
| Appendectomy (Laparoscopic) | surgery | $18,379 | $70 to $30,632 | High |
| Lymphoma and Non-acute Leukemia with Cc | other | $18,383 | $8,150 to $50,143 | Low |
| Major Head and Neck Procedures without Cc/mcc | other | $18,422 | $8,167 to $46,164 | Low |
| Acute Adjustment Reaction and Psychosocial Dysfunction | other | $18,482 | $8,193 to $30,803 | Low |
| Other Digestive System Diagnoses with Cc | other | $18,585 | $8,175 to $30,974 | Low |
| Transient Ischemia | other | $18,833 | $6,979 to $31,389 | Low |
| Injection, Daratumumab, 10 Mg and Hyaluronidase-fihj | other | $18,848 | $56 to $31,413 | Low |
| Lower Extremity and Humerus Procedures Except Hip, Foot and Femur without Cc/mcc | other | $18,912 | $8,384 to $40,571 | Low |
| Digestive Malignancy with Cc | other | $18,935 | $8,395 to $34,257 | Low |
| Biopsies of Musculoskeletal System and Connective Tissue without Cc/mcc | other | $18,962 | $8,406 to $44,901 | Low |
| Hip and Femur Procedures except Major Joint without CC/MCC | surgery | $19,055 | $8,448 to $38,554 | Low |
| Kidney and Urinary Tract Neoplasms with Mcc | other | $19,080 | $8,459 to $52,968 | Low |
| Alcohol, Drug Abuse OR Dependence without Rehabilitation Therapy with Mcc | therapy | $19,236 | $8,528 to $32,060 | Low |
| Infectious and Parasitic Diseases with O.r. Procedures with Cc | other | $19,245 | $8,532 to $53,367 | Low |
| Other Myeloproliferative Disorders OR Poorly Differentiated Neoplastic Diagno... | other | $19,283 | $8,549 to $55,441 | Low |
| Pulmonary Embolism with MCC | other | $19,292 | $8,553 to $42,489 | Low |
| Transcath Heart Valve 20mm Sapien 3 Ref# S3ucm220a | cardiac | $19,500 | $8,645 to $32,500 | Low |
| Transcath Heart Valve 23mm Sapien 3 S3ucm223a | cardiac | $19,500 | $8,645 to $32,500 | Low |
| Transcath Heart Valve 26mm Sapien 3 S3ucm226a | cardiac | $19,500 | $8,645 to $32,500 | Low |
| Transcath Heart Valve 29mm Sapien 3 9600cm29a | cardiac | $19,500 | $8,645 to $32,500 | Low |
| Hepatobiliary Diagnostic Procedures without Cc/mcc | other | $19,526 | $8,656 to $49,437 | Low |
| Other Skin, Subcutaneous Tissue and Breast Procedures with Cc | other | $19,551 | $8,668 to $40,166 | Low |
| Complicated Peptic Ulcer with Cc | other | $19,556 | $8,670 to $32,594 | Low |
| Soft Tissue Procedures with Mcc | other | $19,609 | $8,693 to $93,149 | Low |
| Inborn and Other Disorders of Metabolism | other | $19,676 | $8,723 to $33,944 | Low |
| Other Infectious and Parasitic Diseases Diagnoses with Cc | other | $19,684 | $8,727 to $32,807 | Low |
| Skin Ulcers with Mcc | other | $19,703 | $8,735 to $53,793 | Low |
| Major Gastrointestinal Disorders and Peritoneal Infections with Mcc | other | $19,706 | $8,737 to $46,007 | Low |
| Connective Tissue Disorders with Cc | other | $19,745 | $8,754 to $32,908 | Low |
| Respiratory Infections with MCC | other | $19,771 | $8,765 to $43,139 | Low |
| Cranial and Peripheral Nerve Disorders with Mcc | other | $19,801 | $8,779 to $41,086 | Low |
| Injection, Glofitamab-gxbm, 2.5 Mg | other | $19,893 | $2,768 to $33,155 | Low |
| Bone Diseases and Arthropathies without Mcc | other | $20,029 | $7,252 to $33,381 | Low |
| Other Antepartum Diagnoses with O.r. Procedures with Mcc | other | $20,112 | $8,916 to $40,457 | Low |
| Postoperative and Post-traumatic Infections without Mcc | emergency | $20,115 | $8,718 to $33,524 | Low |
| Inguinal and Femoral Hernia Procedures with Cc | other | $20,206 | $8,958 to $50,968 | Low |
| Trauma to the Skin, Subcutaneous Tissue and Breast with Mcc | emergency | $20,291 | $8,996 to $44,099 | Low |
| Penis Procedures with Cc/mcc | other | $20,313 | $9,005 to $63,308 | Low |
| Transcath Heart Valve 20mm Sapien 3 Resilia S3urcm20a | cardiac | $20,400 | $9,044 to $34,000 | Low |
| Transcath Heart Valve 23mm Sapien 3 Resilia S3urcm23a | cardiac | $20,400 | $9,044 to $34,000 | Low |
| Transcath Heart Valve 26mm Sapien 3 Resilia S3urcm26a | cardiac | $20,400 | $9,044 to $34,000 | Low |
| Transcath Heart Valve 29mm Sapien 3 Resilia S3urcm29a | cardiac | $20,400 | $9,044 to $34,000 | Low |
| Viral Illness with Mcc | other | $20,434 | $9,059 to $34,057 | Low |
| Repair of Congenital Abnormality in Wall Between Upper Heart Chambers with Im... | surgery | $20,446 | $9,064 to $93,580 | Low |
| Uterine and Adnexa Procedures for Non-malignancy with Cc/mcc | other | $20,460 | $9,071 to $34,101 | Low |
| Upper Limb and Toe Amputation for Circulatory System Disorders with Cc | other | $20,540 | $9,106 to $39,535 | Low |
| Disorders of the Biliary Tract without Cc/mcc | other | $20,552 | $7,228 to $34,253 | Low |
| Complicated Peptic Ulcer with Mcc | other | $20,692 | $9,173 to $62,002 | Low |
| Other Digestive System Diagnoses with Mcc | other | $20,711 | $9,182 to $43,523 | Low |
| Spinal Procedures without Cc/mcc | other | $20,878 | $9,256 to $43,462 | Low |
| Skin Debridement with Cc | other | $20,886 | $9,260 to $43,865 | Low |
| Other Respiratory System O.r. Procedures with Cc | other | $20,921 | $9,275 to $69,108 | Low |
| Knee Procedures without Principal Diagnosis of Infection without Cc/mcc | other | $20,986 | $9,304 to $46,895 | Low |
| Intracranial Hemorrhage OR Cerebral Infarction with Mcc | other | $21,006 | $9,313 to $66,406 | Low |
| Cirrhosis and Alcoholic Hepatitis with Mcc | other | $21,007 | $9,313 to $52,629 | Low |
| Factor Viia (antihemophilic Factor, Recombinant), (novoseven Rt), 1 Microgram | other | $21,174 | $2 to $35,290 | Low |
| Other Male Reproductive System O.r. Procedures Except Malignancy without Cc/mcc | other | $21,199 | $9,398 to $35,332 | Low |
| Degenerative Nervous System Disorders without Mcc | other | $21,251 | $9,421 to $44,606 | Low |
| Diabetes with Mcc | other | $21,311 | $9,448 to $36,519 | Low |
| Acute Myocardial Infarction Discharged Alive with MCC | cardiac | $21,487 | $9,526 to $42,983 | Low |
| Adrenal and Pituitary Procedures with CC/MCC | surgery | $21,528 | $9,544 to $45,698 | Low |
| Other Hepatobiliary OR Pancreas O.r. Procedures with Cc | other | $21,575 | $9,565 to $63,112 | Low |
| Cardiac Pacemaker Revision Except Device Replacement without Cc/mcc | surgery | $21,697 | $9,619 to $57,262 | Low |
| Inflammation of the Male Reproductive System with Mcc | other | $21,707 | $9,623 to $36,178 | Low |
| Lymphoma and Non-acute Leukemia with Mcc | other | $21,741 | $9,639 to $93,809 | Low |
| Other Respiratory System Diagnoses with Mcc | other | $21,742 | $9,639 to $37,441 | Low |
| Disorders of Liver Except Malignancy, Cirrhosis OR Alcoholic Hepatitis with Mcc | other | $21,808 | $9,668 to $50,459 | Low |
| Kidney and Ureter Procedures for Neoplasm without Cc/mcc | other | $21,871 | $9,696 to $38,692 | Low |
| Reticuloendothelial and Immunity Disorders with Mcc | other | $21,898 | $9,708 to $58,306 | Low |
| Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liqu... | other | $21,997 | $49 to $36,661 | Low |
| Minor Small and Large Bowel Procedures with Mcc | other | $22,124 | $9,808 to $44,894 | Low |
| Myeloproliferative Disorders OR Poorly Differentiated Neoplasms with Major O.... | other | $22,152 | $9,821 to $59,055 | Low |
| Minor Bladder Procedures with Cc | other | $22,188 | $9,837 to $45,044 | Low |
| Injection, Brentuximab Vedotin, 1 Mg | other | $22,192 | $231 to $36,987 | Low |
| Respiratory Infections and Inflammations without Cc/mcc | other | $22,398 | $6,596 to $37,330 | Low |
| Repair of Left Upper Heart Chamber with Implant with Review By Radiologist | surgery | $22,408 | $576 to $37,347 | Low |
| Injection, Luspatercept-aamt, 0.25 Mg | other | $22,416 | $42 to $37,360 | Low |
| Cervical Spinal Fusion with CC | surgery | $22,505 | $9,977 to $53,956 | Low |
| Gastrointestinal Obstruction with Mcc | other | $22,558 | $10,001 to $37,596 | Low |
| Traumatic Stupor and Coma <1 Hour with Mcc | emergency | $22,705 | $10,066 to $46,080 | Low |
| Other Kidney and Urinary Tract Procedures with Cc | other | $22,936 | $10,168 to $62,139 | Low |
| Thyroid, Parathyroid and Thyroglossal Procedures with Cc | other | $23,002 | $10,198 to $38,875 | Low |
| Injection, Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf, Per 10 Mg | other | $23,005 | $62 to $38,342 | Low |
| Inflammatory Bowel Disease with Mcc | other | $23,165 | $10,270 to $40,151 | Low |
| Acute Myocardial Infarction Discharged Alive with CC | cardiac | $23,194 | $8,030 to $38,657 | Low |
| Major Shoulder OR Elbow Joint Procedures with Cc/mcc | other | $23,280 | $10,321 to $47,270 | Low |
| Acute Myocardial Infarction Discharged Alive without CC/MCC | cardiac | $23,299 | $6,317 to $38,831 | Low |
| Other Female Reproductive System O.r. Procedures without Cc/mcc | other | $23,317 | $10,337 to $46,559 | Low |
| Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders w... | lab | $23,598 | $10,462 to $50,494 | Low |
| Tracheostomy for Face, Mouth and Neck Diagnoses OR Laryngectomy with Cc | other | $23,604 | $10,465 to $106,816 | Low |
| Injection, Ocrelizumab, 1 Mg | other | $23,657 | $59 to $39,429 | Low |
| Minor Small and Large Bowel Procedures with Cc | other | $23,665 | $10,492 to $39,442 | Low |
| Major Esophageal Disorders with Mcc | other | $23,819 | $10,560 to $41,692 | Low |
| Transurethral Procedures with Mcc | other | $23,850 | $10,574 to $77,197 | Low |
| Complications of Treatment with Mcc | other | $23,880 | $10,587 to $41,745 | Low |
| Septicemia or Severe Sepsis without Ventilator 96+ Hours with MCC | other | $24,013 | $10,646 to $52,015 | Low |
| Kidney and Ureter Procedures for Neoplasm with Cc | other | $24,140 | $10,702 to $55,805 | Low |
| Non-bacterial Infection of Nervous System Except Viral Meningitis without Cc/mcc | other | $24,175 | $10,717 to $43,414 | Low |
| Disorders of Pancreas Except Malignancy with Mcc | other | $24,193 | $10,726 to $49,809 | Low |
| Cardiac Catheterization | cardiac | $24,315 | $29 to $175,183 | High |
| Major Male Pelvic Procedures without Cc/mcc | other | $24,429 | $10,830 to $57,178 | Low |
| Respiratory Neoplasms with Mcc | other | $24,433 | $10,832 to $54,863 | Low |
| Insertion of Implantable Defibrillator System | surgery | $24,494 | $10,859 to $40,824 | Low |
| Hernia Procedures Except Inguinal and Femoral with Cc | other | $24,514 | $10,868 to $49,743 | Low |
| Appendix Procedures with Cc | other | $24,717 | $10,958 to $41,196 | Low |
| Other Cerebrovascular Disorders with Mcc | other | $24,731 | $10,964 to $58,989 | Low |
| Poisoning and Toxic Effects of Drugs with MCC | emergency | $24,911 | $11,044 to $41,518 | Low |
| Lower Extremity and Humerus Procedures Except Hip, Foot and Femur with Cc | other | $24,920 | $11,048 to $57,914 | Low |
| Lymphoma and Non-acute Leukemia with Other Procedures with Cc | other | $24,989 | $11,079 to $70,127 | Low |
| Hip and Femur Procedures except Major Joint with CC | surgery | $25,023 | $11,094 to $54,269 | Low |
| Traumatic Injury with Mcc | emergency | $25,040 | $11,101 to $45,716 | Low |
| Shoulder, Elbow OR Forearm Procedures, Except Major Joint Procedures without ... | other | $25,340 | $11,234 to $42,234 | Low |
| Splenic Procedures without Cc/mcc | other | $25,441 | $11,279 to $50,235 | Low |
| Disorders of the Biliary Tract with Cc | other | $25,519 | $9,561 to $42,532 | Low |
| Stomach, Esophageal and Duodenal Procedures without Cc/mcc | other | $25,605 | $11,351 to $42,675 | Low |
| Non-extensive O.r. Procedures Unrelated to Principal Diagnosis with Mcc | other | $25,677 | $11,384 to $122,908 | Low |
| Chemotherapy without Acute Leukemia As Secondary Diagnosis with Cc | other | $25,764 | $11,422 to $42,940 | Low |
| Major Small and Large Bowel Procedures without CC/MCC | surgery | $25,899 | $11,482 to $43,166 | Low |
| Osteomyelitis with Mcc | other | $26,105 | $11,573 to $60,583 | Low |
| Bone Diseases and Arthropathies with Mcc | other | $26,267 | $11,325 to $43,779 | Low |
| Extracranial Procedures with Mcc | other | $26,304 | $11,661 to $112,802 | Low |
| Cholecystectomy with C.d.e. with Mcc | other | $26,332 | $11,674 to $73,430 | Low |
| Hypertensive Encephalopathy without Cc/mcc | other | $26,468 | $5,780 to $44,113 | Low |
| Rectal Resection without Cc/mcc | other | $26,532 | $11,762 to $57,241 | Low |
| Appendix Procedures without Cc/mcc | other | $26,634 | $10,001 to $44,389 | Low |
| Wound Debridement and Skin Graft Except Hand for Musculoskeletal and Connecti... | other | $26,685 | $11,830 to $54,096 | Low |
| Kidney and Ureter Procedures for Non-neoplasm with Cc | other | $26,889 | $11,547 to $44,815 | Low |
| Total Hip Replacement | surgery | $26,956 | $2 to $62,822 | High |
| Cardiac Congenital and Valvular Disorders with Mcc | cardiac | $27,004 | $11,972 to $45,006 | Low |
| Knee Procedures with Principal Diagnosis of Infection without Cc/mcc | other | $27,149 | $12,036 to $45,248 | Low |
| Skin Graft Except for Skin Ulcer OR Cellulitis with Mcc | other | $27,712 | $12,286 to $218,745 | Low |
| Other Vascular Procedures without Cc/mcc | other | $27,836 | $12,341 to $48,877 | Low |
| Major Hip and Knee Joint Replacement without MCC | surgery | $27,879 | $12,360 to $53,890 | Low |
| Total Knee Replacement | surgery | $27,879 | $2 to $93,783 | High |
| Peritoneal Adhesiolysis with Mcc | other | $28,142 | $12,477 to $103,521 | Low |
| Non-extensive O.r. Procedures Unrelated to Principal Diagnosis with Cc | other | $28,188 | $12,497 to $46,979 | Low |
| Other Hepatobiliary OR Pancreas O.r. Procedures with Mcc | other | $28,197 | $12,501 to $111,903 | Low |
| Insertion OR Replacement of Defibrillator with Electrode | surgery | $28,391 | $12,587 to $47,318 | Low |
| Major Bladder Procedures without Cc/mcc | other | $28,501 | $12,635 to $79,171 | Low |
| GI Hemorrhage with MCC | other | $28,844 | $12,788 to $49,246 | Low |
| Pneumothorax with Mcc | other | $28,958 | $12,838 to $48,264 | Low |
| Other Vascular Procedures with Cc | other | $29,070 | $12,888 to $70,504 | Low |
| Gallbladder Removal (Laparoscopic) | surgery | $29,483 | $586 to $63,796 | High |
| Laparoscopic Cholecystectomy without CC/MCC | surgery | $29,483 | $11,932 to $49,139 | Low |
| Zevalin Y-90 Vial | other | $29,579 | $13,113 to $49,298 | Low |
| Uterine and Adnexa Procedures for Non-ovarian and Non-adnexal Malignancy with Cc | other | $29,587 | $13,117 to $49,312 | Low |
| Cardiac Pacemaker Revision Except Device Replacement with Mcc | surgery | $29,687 | $13,161 to $110,066 | Low |
| Other Endocrine, Nutritional and Metabolic O.r. Procedures with Cc | lab | $29,750 | $13,189 to $54,231 | Low |
| Major Joint OR Limb Reattachment Procedures of Upper Extremities | other | $29,995 | $13,298 to $73,769 | Low |
| Disorders of the Biliary Tract with Mcc | other | $30,102 | $13,345 to $50,170 | Low |
| Other Digestive System O.r. Procedures with Cc | other | $30,373 | $13,465 to $55,043 | Low |
| Other Circulatory System O.r. Procedures | other | $30,821 | $13,664 to $90,984 | Low |
| Malignancy of Hepatobiliary System OR Pancreas with Cc | other | $30,885 | $9,882 to $51,475 | Low |
| Malignancy of Hepatobiliary System OR Pancreas with Mcc | other | $30,889 | $13,694 to $51,481 | Low |
| Other O.r. Procedures for Injuries with Mcc | other | $30,891 | $13,695 to $124,161 | Low |
| Major Chest Procedures without Cc/mcc | other | $30,976 | $13,733 to $51,893 | Low |
| Pacemaker Insertion | cardiac | $31,032 | $3,605 to $72,510 | High |
| Permanent Cardiac Pacemaker Implant without Cc/mcc | surgery | $31,032 | $13,758 to $60,754 | Low |
| Bilateral or Multiple Major Joint Procedures of Lower Extremity | surgery | $31,126 | $13,799 to $110,757 | Low |
| Laparoscopic Cholecystectomy without Common Duct with CC | surgery | $31,281 | $13,868 to $52,136 | Low |
| Ischemic Stroke, Precerebral Occlusion OR Transient Ischemia with Thrombolyti... | other | $31,340 | $12,264 to $52,233 | Low |
| Amputation for Circulatory System Disorders Except Upper Limb and Toe with Cc | other | $31,452 | $13,944 to $77,299 | Low |
| Local Excision and Removal of Internal Fixation Devices of Hip and Femur with... | surgery | $31,858 | $14,124 to $72,467 | Low |
| Adrenal and Pituitary Procedures without Cc/mcc | other | $31,880 | $12,225 to $53,133 | Low |
| Kidney and Ureter Procedures for Neoplasm with Mcc | other | $32,046 | $14,207 to $62,730 | Low |
| Percutaneous Cardiovascular Procedures without Intraluminal Device without Mcc | cardiac | $32,638 | $13,056 to $54,396 | Low |
| Peritoneal Adhesiolysis with Cc | other | $32,708 | $14,500 to $54,513 | Low |
| Hip and Femur Procedures except Major Joint with MCC | surgery | $32,777 | $14,531 to $97,364 | Low |
| Transurethral Prostatectomy with Cc/mcc | other | $33,068 | $13,134 to $55,113 | Low |
| Anal and Stomal Procedures with Mcc | other | $33,214 | $14,725 to $67,343 | Low |
| Testes Procedures with Cc/mcc | other | $33,471 | $14,839 to $58,688 | Low |
| Knee Procedures with Principal Diagnosis of Infection with Mcc | other | $33,924 | $15,040 to $105,056 | Low |
| Cardiac Pacemaker Device Replacement with Mcc | surgery | $34,188 | $15,157 to $97,634 | Low |
| Lymphoma and Leukemia with Major O.r. Procedures without Cc/mcc | other | $34,439 | $10,519 to $57,398 | Low |
| Cholecystectomy Except By Laparoscope without C.d.e. without Cc/mcc | surgery | $34,450 | $11,910 to $57,417 | Low |
| Shoulder, Elbow OR Forearm Procedures, Except Major Joint Procedures with Cc | other | $34,555 | $15,319 to $57,591 | Low |
| Upper Limb and Toe Amputation for Circulatory System Disorders with Mcc | other | $34,653 | $15,363 to $82,419 | Low |
| Kidney and Ureter Procedures for Non-neoplasm with Mcc | other | $34,658 | $15,365 to $65,524 | Low |
| Other Musculoskeletal System and Connective Tissue O.r. Procedures with Mcc | other | $34,782 | $15,420 to $97,403 | Low |
| Fractures of Femur with Mcc | other | $34,933 | $13,696 to $58,222 | Low |
| Prostatectomy | other | $35,037 | $719 to $58,395 | High |
| Transurethral Prostatectomy without Cc/mcc | other | $35,037 | $9,238 to $58,395 | Low |
| Respiratory System Diagnosis with Ventilator Support <=96 Hours | other | $35,116 | $15,568 to $61,913 | Low |
| Wound Debridements for Injuries with Mcc | other | $35,161 | $15,588 to $136,606 | Low |
| Injection, Pegloticase, 1 Mg | other | $35,183 | $3,457 to $58,638 | Low |
| Other Circulatory System Diagnoses with Mcc | other | $35,320 | $15,658 to $66,938 | Low |
| Biopsies of Musculoskeletal System and Connective Tissue with Cc | other | $35,513 | $15,744 to $61,620 | Low |
| Sipuleucel-t, Minimum of 50 Million Autologous Cd54+ Cells Activated with Pap... | other | $35,602 | $15,783 to $118,672 | Low |
| Stomach, Esophageal and Duodenal Procedures with Cc | other | $35,720 | $15,836 to $59,533 | Low |
| Benign Prostatic Hypertrophy with Mcc | other | $36,105 | $10,223 to $60,175 | Low |
| Extensive O.r. Procedures Unrelated to Principal Diagnosis with Cc | other | $36,186 | $16,042 to $66,209 | Low |
| Permanent Cardiac Pacemaker Implant with Mcc | surgery | $36,642 | $16,245 to $98,495 | Low |
| Pleural Effusion with Mcc | surgery | $36,791 | $13,616 to $61,318 | Low |
| Other Skin, Subcutaneous Tissue and Breast Procedures with Mcc | other | $36,837 | $16,331 to $101,908 | Low |
| Peripheral, Cranial Nerve and Other Nervous System Procedures with Mcc | other | $37,012 | $16,409 to $96,346 | Low |
| Major Chest Procedures with Cc | other | $37,220 | $16,501 to $73,012 | Low |
| Acute Myocardial Infarction, Expired with Mcc | other | $37,475 | $16,614 to $62,459 | Low |
| Cervical Spinal Fusion without CC/MCC | surgery | $37,516 | $16,632 to $110,448 | Low |
| Spinal Fusion except Cervical without MCC | surgery | $37,562 | $16,653 to $62,604 | Low |
| Amputation for Circulatory System Disorders Except Upper Limb and Toe with Mcc | other | $37,877 | $16,792 to $122,712 | Low |
| Ear, Nose, Mouth and Throat Malignancy with Mcc | other | $38,095 | $16,889 to $63,492 | Low |
| Minor Small and Large Bowel Procedures without Cc/mcc | other | $38,389 | $10,363 to $63,982 | Low |
| Amputation for Musculoskeletal System and Connective Tissue Disorders with Cc | other | $38,396 | $17,022 to $68,425 | Low |
| Other Respiratory System O.r. Procedures with Mcc | other | $39,414 | $17,474 to $139,831 | Low |
| Cardiac Pacemaker Device Replacement without Mcc | surgery | $39,633 | $17,571 to $66,055 | Low |
| Percutaneous Cardiovascular Procedures with Intraluminal Device without Mcc | cardiac | $39,800 | $15,402 to $66,334 | Low |
| Cholecystectomy with C.d.e. with Cc | other | $39,851 | $17,667 to $73,430 | Low |
| Major Hip and Knee Joint Replacement with MCC | surgery | $40,157 | $17,803 to $95,864 | Low |
| Major Small and Large Bowel Procedures with CC | surgery | $40,553 | $17,979 to $67,589 | Low |
| Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Di... | lab | $40,821 | $15,672 to $68,034 | Low |
| O.r. Procedures with Principal Diagnosis of Mental Illness | other | $41,674 | $18,475 to $69,457 | Low |
| Hepatobiliary Diagnostic Procedures with Mcc | other | $41,782 | $18,524 to $114,121 | Low |
| Stomach, Esophageal and Duodenal Procedures with Mcc | other | $42,913 | $19,025 to $109,419 | Low |
| Major Bladder Procedures with Cc | other | $43,066 | $19,092 to $104,297 | Low |
| Carotid Artery Stent Procedures without Cc/mcc | cardiac | $43,763 | $16,973 to $72,938 | Low |
| Other Musculoskeletal System and Connective Tissue O.r. Procedures with Cc | other | $44,511 | $18,155 to $74,186 | Low |
| Cardiac Arrest, Unexplained with Mcc | cardiac | $44,660 | $13,645 to $74,434 | Low |
| Amputation for Circulatory System Disorders Except Upper Limb and Toe without... | other | $44,830 | $12,095 to $74,716 | Low |
| Permanent Cardiac Pacemaker Implant with Cc | surgery | $45,283 | $18,616 to $75,471 | Low |
| Bacterial and Tuberculous Infections of Nervous System with Cc | other | $45,523 | $20,182 to $75,871 | Low |
| Other Musculoskeletal System and Connective Tissue O.r. Procedures without Cc... | other | $45,545 | $13,425 to $75,908 | Low |
| Hernia Procedures Except Inguinal and Femoral with Mcc | other | $46,298 | $20,526 to $84,683 | Low |
| Back and Neck Procedures except Spinal Fusion without CC/MCC | surgery | $46,565 | $20,644 to $90,579 | Low |
| Bacterial and Tuberculous Infections of Nervous System without Cc/mcc | other | $46,942 | $20,811 to $78,236 | Low |
| Knee Procedures with Principal Diagnosis of Infection with Cc | other | $47,453 | $18,269 to $79,088 | Low |
| Lymphoma and Non-acute Leukemia with Other Procedures with Mcc | other | $47,576 | $21,092 to $139,280 | Low |
| Postoperative OR Post-traumatic Infections with O.r. Procedures with Mcc | emergency | $47,632 | $21,117 to $96,975 | Low |
| Appendix Procedures with Mcc | other | $48,639 | $20,923 to $81,065 | Low |
| Carotid Artery Stent Procedures with Cc | cardiac | $48,941 | $20,884 to $81,568 | Low |
| Other O.r. Procedures for Injuries with Cc | other | $49,025 | $17,431 to $81,709 | Low |
| Coronary Bypass without Cardiac Catheter without MCC | cardiac | $50,278 | $22,290 to $111,047 | Low |
| Other Kidney and Urinary Tract Procedures with Mcc | other | $51,190 | $22,694 to $124,248 | Low |
| Non-bacterial Infection of Nervous System Except Viral Meningitis with Mcc | other | $51,239 | $22,716 to $137,905 | Low |
| Lymphoma and Non-acute Leukemia with Other Procedures without Cc/mcc | other | $51,684 | $11,789 to $86,140 | Low |
| Percutaneous Cardiovascular Procedures without Intraluminal Device with Mcc | cardiac | $52,231 | $19,067 to $87,052 | Low |
| O.r. Procedures with Diagnoses of Other Contact with Health Services with Cc | other | $52,433 | $20,416 to $87,389 | Low |
| Other Digestive System O.r. Procedures with Mcc | other | $53,092 | $23,538 to $116,650 | Low |
| Percutaneous Cardiovascular Procedures with Intraluminal Device with Mcc OR 4... | cardiac | $53,521 | $23,728 to $89,202 | Low |
| Other Vascular Procedures with Mcc | other | $53,931 | $23,909 to $99,371 | Low |
| Infectious and Parasitic Diseases with O.r. Procedures with Mcc | other | $54,087 | $23,978 to $149,425 | Low |
| Splenic Procedures with Mcc | other | $58,069 | $25,744 to $118,186 | Low |
| Thyroid, Parathyroid and Thyroglossal Procedures with Mcc | other | $58,274 | $25,835 to $97,123 | Low |
| Extensive O.r. Procedures Unrelated to Principal Diagnosis with Mcc | other | $60,761 | $26,937 to $139,548 | Low |
| Other Cardiothoracic Procedures without Mcc | other | $61,122 | $27,097 to $101,870 | Low |
| Malignancy, Male Reproductive System with Mcc | other | $63,039 | $15,810 to $105,064 | Low |
| Respiratory System Diagnosis with Ventilator 96+ Hours | other | $65,137 | $28,878 to $172,058 | Low |
| Aortic and Heart Assist Procedures Except Pulsation Balloon without Mcc | cardiac | $65,477 | $29,028 to $109,128 | Low |
| Injection, Ipilimumab, 1 Mg | other | $65,796 | $179 to $109,659 | Low |
| Coronary Intravascular Lithotripsy with Intraluminal Device without Mcc | cardiac | $66,999 | $27,528 to $111,665 | Low |
| Kidney Stone Removal | other | $66,999 | $297 to $111,665 | High |
| Tracheostomy for Face, Mouth and Neck Diagnoses OR Laryngectomy with Mcc | other | $70,353 | $31,190 to $127,814 | Low |
| Other Major Cardiovascular Procedures with Cc | cardiac | $70,427 | $31,069 to $117,378 | Low |
| Septicemia OR Severe Sepsis with Mv >96 Hours | other | $72,630 | $32,199 to $188,578 | Low |
| Other Endovascular Cardiac Valve Procedures with Mcc | cardiac | $73,126 | $32,419 to $128,425 | Low |
| Cardiac Valve and Other Major Cardiothoracic without Cardiac Catheter | cardiac | $73,328 | $32,509 to $212,499 | Low |
| Major Small and Large Bowel Procedures with MCC | surgery | $73,425 | $32,552 to $122,375 | Low |
| O.r. Procedures with Diagnoses of Other Contact with Health Services without ... | other | $73,945 | $17,715 to $123,242 | Low |
| Aortic and Heart Assist Procedures Except Pulsation Balloon with Mcc | cardiac | $76,415 | $33,878 to $218,222 | Low |
| Acute and Subacute Endocarditis with Mcc | other | $80,377 | $23,642 to $133,961 | Low |
| Ultrasound Accelerated and Other Thrombolysis of Peripheral Vascular Structur... | imaging | $80,813 | $31,507 to $134,689 | Low |
| Spinal Procedures with Mcc | other | $82,354 | $36,510 to $186,438 | Low |
| Major Chest Procedures with Mcc | other | $82,621 | $36,629 to $137,702 | Low |
| Other Major Cardiovascular Procedures with Mcc | cardiac | $82,736 | $36,680 to $151,297 | Low |
| Coronary Intravascular Lithotripsy with Intraluminal Device with Mcc | cardiac | $86,743 | $37,806 to $144,572 | Low |
| Foot Procedures with Mcc | other | $88,313 | $24,384 to $147,189 | Low |
| Percutaneous and Other Intracardiac Procedures without Mcc | cardiac | $89,756 | $28,757 to $149,594 | Low |
| Cardiac Defibrillator Implant without Mcc | surgery | $96,095 | $40,349 to $160,158 | Low |
| Major Bladder Procedures with Mcc | other | $98,472 | $43,656 to $164,119 | Low |
| Angioplasty with Stent (PCI) | other | $99,732 | $432 to $190,761 | High |
| Coronary Bypass with PTCA without Mcc | cardiac | $99,732 | $44,214 to $190,761 | Low |
| Percutaneous and Other Intracardiac Procedures with Mcc | cardiac | $99,837 | $36,042 to $166,395 | Low |
| Coronary Bypass with PTCA with MCC | cardiac | $100,179 | $44,413 to $231,406 | Low |
| Cardiac Defibrillator Implant with Mcc OR Carotid Sinus Neurostimulator | surgery | $103,200 | $45,752 to $171,999 | Low |
| Other Major Cardiovascular Procedures without Cc/mcc | cardiac | $107,434 | $22,304 to $179,057 | Low |
| Coronary Bypass with Cardiac Catheter with MCC | cardiac | $112,142 | $49,716 to $186,904 | Low |
| Endovascular Cardiac Valve Replacement and Supplement Procedures without Mcc | surgery | $114,394 | $41,592 to $190,656 | Low |
| Heart Valve Replacement | other | $114,394 | $1,093 to $199,642 | High |
| Cardiac Valve and Other Major Cardiothoracic with Cardiac Catheter | cardiac | $114,409 | $50,721 to $317,734 | Low |
| Endovascular Cardiac Valve Replacement and Supplement Procedures with Mcc | surgery | $134,471 | $53,540 to $224,119 | Low |
| Cholecystectomy Except By Laparoscope without C.d.e. with Mcc | surgery | $143,226 | $31,124 to $238,709 | Low |
| Other Heart Assist System Implant | surgery | $144,810 | $64,199 to $241,350 | Low |
| Aicd Generator Procedures | other | $171,794 | $39,859 to $286,323 | Low |
| Tracheostomy with Mv >96 Hours OR Principal Diagnosis Except Face, Mouth and ... | other | $205,313 | $91,022 to $528,873 | Low |
| Ecmo OR Tracheostomy with Mv >96 Hours OR Principal Diagnosis Except Face, Mo... | other | $276,348 | $122,514 to $572,885 | Low |
| Oseltamivir Phos 30 Mg Capsule | other | N/A | $1 to $2 | Low |
| Desogestrel-ethinyl Estradiol 0.15-30 Mg-mcg Po Tabs | other | N/A | $1 to $2 | Low |
| Fleet Pedia-lax Enema | other | N/A | $1 to $2 | Low |
| Nicotine 14 Mg/24hr Patch | other | N/A | $1 to $2 | Low |
| Nicotine 21 Mg/24hr Patch | other | N/A | $1 to $2 | Low |
| Menest 0.3 Mg Tablet | other | N/A | $1 to $2 | Low |
| Milk of Magnesia - 30ml - Repackaging | other | N/A | $1 to $2 | Low |
| Oxycodone-acetaminophen 10 | other | N/A | $1 to $2 | Low |
| Paliperidone ER 3 Mg Tablet | other | N/A | $1 to $2 | Low |
| Docusate Sod 100 Mg/10 Ml Cup | other | N/A | $1 to $2 | Low |
| Injection, Azithromycin, 500 Mg | other | N/A | $1 to $2 | Low |
| Valproic Acid 250 Mg/5 Ml Cup | other | N/A | $1 to $2 | Low |
| Valproic Acid Oral Soln 250 Mg/5 Ml - Repackaging | other | N/A | $1 to $2 | Low |
| Sore Throat 1.4% Spray | other | N/A | $1 to $2 | Low |
| Emtricitabine-tenofovir Df 200-300 Mg Po Tabs #3 Dispense Pack | other | N/A | $1 to $2 | Low |
| Lansoprazole Dr 15 Mg Capsule | other | N/A | $1 to $2 | Low |
| Lansoprazole Dr 30 Mg Capsule | other | N/A | $1 to $2 | Low |
| Liquid E-z Paque 60% Susp | other | N/A | $1 to $2 | Low |
| Mesalamine Dr 400 Mg Capsule | other | N/A | $1 to $2 | Low |
| Milk of Magnesia Suspension | other | N/A | $1 to $2 | Low |
| Readi-cat 2 2% Suspension | other | N/A | $1 to $2 | Low |
| Hydrocortisone 1% Ointment | other | N/A | $1 to $2 | Low |
| Hydrocortisone-aloe 1% Cream | other | N/A | $1 to $2 | Low |
| Rasagiline Mesylate 1 Mg Po Tabs | other | N/A | $1 to $2 | Low |
| Rasagiline Mesylate 1 Mg Tab | other | N/A | $1 to $2 | Low |
| Phenobarbital 20 Mg/5 Ml Cup | other | N/A | $1 to $2 | Low |
| Primaquine 26.3 Mg Tablet | other | N/A | $1 to $2 | Low |
| Sevelamer 0.8 Gm Powder Packet | other | N/A | $1 to $2 | Low |
| Fenofibrate 160 Mg Tablet | other | N/A | $1 to $2 | Low |
| Glucerna Shake | other | N/A | $1 to $2 | Low |
| Memantine Hcl ER 28 Mg Capsule | other | N/A | $1 to $2 | Low |
| Memantine Hcl ER 28 Mg Po Cp24 | other | N/A | $1 to $2 | Low |
| Nifedipine ER 90 Mg Po Tb24 | other | N/A | $1 to $2 | Low |
| Zenpep Dr 5,000 Unit Capsule | other | N/A | $1 to $2 | Low |
| Mirtazapine 7.5 Mg Tablet | other | N/A | $1 to $2 | Low |
| Piroxicam 20 Mg Capsule | other | N/A | $1 to $2 | Low |
| Arformoterol, Inhalation Solution, Fda Approved Final Product, Non-compounded... | other | N/A | $1 to $2 | Low |
| Pradaxa 110 Mg Capsule | other | N/A | $1 to $2 | Low |
| Cevimeline Hcl 30 Mg Capsule | other | N/A | $1 to $2 | Low |
| Light Compression Bandage, Elastic, Knitted/woven, Width Less Than Three Inch... | other | N/A | $1 to $4 | Low |
| Ondansetron, Oral, 4 Mg | other | N/A | $1 to $4 | Low |
| Osmolite 1 Cal Liquid | other | N/A | $1 to $2 | Low |
| Acetaminophen 650mg/20.3ml Cup | other | N/A | $1 to $2 | Low |
| Nitro-bid 2% Ointment | other | N/A | $1 to $2 | Low |
| Darifenacin ER 7.5 Mg Tablet | other | N/A | $1 to $2 | Low |
| Fluoxetine 20 Mg/ 5 Ml Oral Solution - Repackaging | other | N/A | $1 to $2 | Low |
| Fluoxetine 20 Mg/5 Ml Soln Cup | other | N/A | $1 to $2 | Low |
| Ziprasidone Hcl 20 Mg Capsule | other | N/A | $1 to $2 | Low |
| Ziprasidone Hcl 80 Mg Capsule | other | N/A | $1 to $2 | Low |
| Ziprasidone Hcl 80 Mg Po Caps | other | N/A | $1 to $2 | Low |
| Pilocarpine Hcl 5 Mg Tablet | other | N/A | $1 to $2 | Low |
| Valganciclovir 225 Mg Half Tablet | other | N/A | $1 to $2 | Low |
| Valganciclovir 450 Mg Tablet | other | N/A | $1 to $2 | Low |
| Hemorrhoidal Ointment | other | N/A | $1 to $2 | Low |
| Juven Packet | other | N/A | $1 to $2 | Low |
| Propranolol ER 80 Mg Capsule | other | N/A | $1 to $2 | Low |
| Propranolol Hcl ER 80 Mg Po Cp24 | other | N/A | $1 to $2 | Low |
| Fenofibrate 48 Mg Po Tabs | other | N/A | $1 to $2 | Low |
| Fenofibrate 48 Mg Tablet | other | N/A | $1 to $2 | Low |
| Ritonavir 100 Mg Tablet | other | N/A | $1 to $2 | Low |
| Propylthiouracil 50 Mg Tablet | other | N/A | $1 to $2 | Low |
| Timolol Maleate 0.25% Eye Drop | other | N/A | $1 to $2 | Low |
| Bupropion Hcl 75 Mg Po Tabs | other | N/A | $1 to $2 | Low |
| Bupropion Hcl 75 Mg Tablet | other | N/A | $1 to $2 | Low |
| Silver Nitrate Applicators - #10 - Repackaged | other | N/A | $1 to $2 | Low |
| Hydrocodone-chlorpheniramine ER Susp 5ml - Repackaged | other | N/A | $1 to $2 | Low |
| Ethacrynic Acid 25 Mg Tablet | other | N/A | $1 to $2 | Low |
| Trazodone 100 Mg Tablet | other | N/A | $1 to $2 | Low |
| Trazodone Hcl 100 Mg Po Tabs | other | N/A | $1 to $2 | Low |
| Fluconazole 10 Mg/ml Susp | other | N/A | $1 to $2 | Low |
| Glucose 40 % Po Gel | other | N/A | $1 to $2 | Low |
| Doxycycline Hyclate 100 Mg Po Tabs | other | N/A | $1 to $2 | Low |
| Doxycycline Hyclate 100 Mg Tab | other | N/A | $1 to $2 | Low |
| Omega-3 Ethyl Esters 1 Gm Cap | other | N/A | $1 to $2 | Low |
| Magnesium Citrate Solution | other | N/A | $1 to $2 | Low |
| Olmesartan Medoxomil 40 Mg Po Tabs | other | N/A | $1 to $2 | Low |
| Theophylline ER 300 Mg Po Tb12 | other | N/A | $1 to $2 | Low |
| Theophylline ER 300 Mg Tablet | other | N/A | $1 to $2 | Low |
| Loperamide 2 Mg/15 Ml Oral Soln - Repackaging | other | N/A | $1 to $2 | Low |
| Loperamide 2 Mg/15 Ml Soln Cup | other | N/A | $1 to $2 | Low |
| Linezolid 600 Mg Tablet | other | N/A | $1 to $2 | Low |
| Menest 0.625 Mg Tablet | other | N/A | $1 to $2 | Low |
| Methotrexate; Oral, 2.5 Mg | other | N/A | $1 to $2 | Low |
| Triamcinolone 0.1% Cream | other | N/A | $1 to $2 | Low |
| Triamcinolone Acetonide 0.1 % Ex Crea | other | N/A | $1 to $2 | Low |
| Nitroglycerin 0.2 Mg / 5 Ml Syringe (for Radial Cocktail) - Compounded | other | N/A | $2 to $3 | Low |
| Medroxyprogesterone Acetate 10 Mg Po Tabs | other | N/A | $2 to $3 | Low |
| Clotrimazole 10 Mg Troche | other | N/A | $2 to $3 | Low |
| Fleet Mineral Oil Enema | other | N/A | $2 to $3 | Low |
| Rivastigmine 1.5 Mg Capsule | other | N/A | $2 to $3 | Low |
| Injection, Pantoprazole Sodium, 40 Mg | other | N/A | $2 to $3 | Low |
| Levetiracetam 500 Mg/5 Ml Cup | other | N/A | $2 to $3 | Low |
| Raloxifene Hcl 60 Mg Tablet | other | N/A | $2 to $3 | Low |
| Nebivolol 10 Mg Tablet | other | N/A | $2 to $3 | Low |
| Nebivolol 2.5 Mg Tablet | other | N/A | $2 to $3 | Low |
| Nebivolol Hcl 10 Mg Po Tabs | other | N/A | $2 to $3 | Low |
| Temazepam 7.5 Mg Capsule | other | N/A | $2 to $3 | Low |
| Efavirenz 600 Mg Tablet | other | N/A | $2 to $3 | Low |
| Intermittent Urinary Catheter; Straight Tip, with OR without Coating (teflon,... | cardiac | N/A | $2 to $5 | Low |
| Arthritis Hot 15%-10% Cream | other | N/A | $2 to $3 | Low |
| Moxifloxacin Hcl 400 Mg Tablet | other | N/A | $2 to $3 | Low |
| Imatinib Mesylate 100 Mg Tab | other | N/A | $2 to $3 | Low |
| Nadolol 20 Mg Po Tabs | other | N/A | $2 to $3 | Low |
| Nadolol 20 Mg Tablet | other | N/A | $2 to $3 | Low |
| Repaglinide 1 Mg Po Tabs | other | N/A | $2 to $3 | Low |
| Repaglinide 1 Mg Tablet | other | N/A | $2 to $3 | Low |
| Lidocaine 5% Patch | other | N/A | $2 to $3 | Low |
| Fluconazole 150 Mg Po Tabs | other | N/A | $2 to $3 | Low |
| Fluconazole 150 Mg Tablet | other | N/A | $2 to $3 | Low |
| Dibucaine 1% Ointment | other | N/A | $2 to $3 | Low |
| Lanolin Cream | other | N/A | $2 to $3 | Low |
| Nystatin 100,000 Unit/gm Oint | other | N/A | $2 to $3 | Low |
| Lacosamide 10 Mg/ml 20 Ml Ud Oral Soln - Repackaged | other | N/A | $2 to $3 | Low |
| Dextroamphetamine Sulfate ER 5 Mg Po Cp24 | other | N/A | $2 to $3 | Low |
| Mycophenolic Acid, Oral, 180 Mg | other | N/A | $2 to $3 | Low |
| Isosorbide Mononit ER 30 Mg Tb | other | N/A | $2 to $3 | Low |
| Isosorbide Mononitrate ER 30 Mg Po Tb24 | other | N/A | $2 to $3 | Low |
| Amoxicillin 125 Mg/5ml Po Susr | other | N/A | $2 to $3 | Low |
| Cefpodoxime 200 Mg Tablet | other | N/A | $2 to $3 | Low |
| Lactulose 10 Gm/15 Ml - 300 Ml (for Enemas) - Compounded | other | N/A | $2 to $3 | Low |
| Splint, Prefabricated, Digit | other | N/A | $2 to $6 | Low |
| Transparent Film, Sterile, 16 Sq. In. OR Less, Each Dressing | other | N/A | $2 to $6 | Low |
| Vitamin D3 10 Mcg/ml Liquid | other | N/A | $2 to $3 | Low |
| Prevena V.a.c. Connector 10/pk Pre9090 | other | N/A | $2 to $3 | Low |
| Short Ballard Adapter Tracheostomy 12 in Od14 Fr T-piece Swivel Clear #220135... | other | N/A | $2 to $3 | Low |
| Specialty Absorptive Dressing, Wound Cover, Sterile, Pad Size More Than 16 Sq... | other | N/A | $2 to $5 | Low |
| Injection, Promethazine Hcl, Up to 50 Mg | other | N/A | $2 to $3 | Low |
| Eplerenone 25 Mg Tablet | other | N/A | $2 to $3 | Low |
| Carbamazepine ER 200 Mg Po Tb12 | other | N/A | $2 to $3 | Low |
| Carbamazepine ER 200 Mg Tablet | other | N/A | $2 to $3 | Low |
| Ligaclip Medium St Titanium Blue 30pk/1bx | other | N/A | $2 to $3 | Low |
| Metaxalone 800 Mg Po Tabs | other | N/A | $2 to $3 | Low |
| Metaxalone 800 Mg Tablet | other | N/A | $2 to $3 | Low |
| Closed Sys Female Ll Connector #fc-1 120ea/bx | other | N/A | $2 to $3 | Low |
| **discontinued** Endotrach Tube 2.0 Uncuffed 10ea/1bx | other | N/A | $2 to $3 | Low |
| Endotrach Tube 3.0 Uncuffed 10ea/1bx | other | N/A | $2 to $3 | Low |
| Endotrach Tube 3.5 Uncuffed 10ea/1bx | other | N/A | $2 to $3 | Low |
| Endotrach Tube 4.0 Uncuffed 10ea/1bx | other | N/A | $2 to $3 | Low |
| Endotrach Tube 4.5 Uncuffed | other | N/A | $2 to $3 | Low |
| Tube Endotracheal Rusch Slick-set 160mm Od 3.3mm Id 2.5mm Uncuffed Pre Stylet... | other | N/A | $2 to $3 | Low |
| Ursodiol 300 Mg Capsule | other | N/A | $2 to $3 | Low |
| Entry Needle 21g X 7cm | other | N/A | $2 to $3 | Low |
| Tape Cast W5inxl4yd White Fiberglass Polyurethane Delta-lite Plus 7345804 10e... | other | N/A | $2 to $3 | Low |
| Azithromycin 250 Mg Po Tabs | other | N/A | $2 to $3 | Low |
| Dressing Nugauze Iodoform 2 Inch | other | N/A | $2 to $3 | Low |
| Metoclopramide 10 Mg/10 Ml Cup | other | N/A | $2 to $3 | Low |
| Nadolol 40 Mg Po Tabs | other | N/A | $2 to $3 | Low |
| Nadolol 40 Mg Tablet | other | N/A | $2 to $3 | Low |
| Skintegrity Wound Cleanser 8oz Bottles with Trigger Sprayer #msc6008 6bt/case | other | N/A | $2 to $3 | Low |
| Zithromax 250 Mg Tablet | other | N/A | $2 to $3 | Low |
| Cath Coude Tiemann 12fr /rusch | other | N/A | $2 to $3 | Low |
| Catheter Foley 18 Fr 5cc Silicone St | cardiac | N/A | $2 to $3 | Low |
| Urethral Catheter Bardex 2-way Foley 16fr 5ml Balloon Silicone Sterile Latex ... | cardiac | N/A | $2 to $3 | Low |
| Brace Wrist Elastic Right Sm #79 | other | N/A | $2 to $3 | Low |
| Galantamine Hbr 4 Mg Tablet | other | N/A | $2 to $3 | Low |
| Risperidone 0.5 Mg Odt | other | N/A | $2 to $3 | Low |
| Theo-24 ER 100 Mg Capsule | other | N/A | $2 to $3 | Low |
| Colchicine 0.3 Mg Half Tablet | other | N/A | $2 to $3 | Low |
| Needle Cook Entry 21 X 15 Echotip #g08700 | imaging | N/A | $2 to $3 | Low |
| Entry Needle 21g X 15cm | other | N/A | $2 to $3 | Low |
| Tape-elastoplast-2 Inch 0294002 Latex 36ea/case | other | N/A | $2 to $3 | Low |
| Amoxicillin 250 Mg/5 Ml Susp | other | N/A | $2 to $3 | Low |
| Capsaicin 0.025% Cream | other | N/A | $2 to $3 | Low |
| Aquacel Adhesive Foam Dressing 4 X 10 #421153 140ea/case | other | N/A | $2 to $3 | Low |
| Blade Beaver #bb365r Aesculap | other | N/A | $2 to $3 | Low |
| Electrode Needle Tip #0013 12/bx | other | N/A | $2 to $3 | Low |
| Nisoldipine ER 8.5 Mg Tablet | other | N/A | $2 to $3 | Low |
| Valve-ambu Peep Disp #2k8082 10ea/cs | other | N/A | $2 to $3 | Low |
| Sucralfate 1 Gm/10 Ml Susp | other | N/A | $2 to $3 | Low |
| Sucralfate 1 Gm/10 Ml Susp - 10 Ml - Repackaging | other | N/A | $2 to $3 | Low |
| Addition to Ctlso OR Scoliosis Orthosis, Kyphosis Pad | other | N/A | $2 to $128 | Low |
| Memantine Hcl ER 14 Mg Po Cp24 | other | N/A | $2 to $3 | Low |
| Cannula Inner Sz 4 Fen #4dicfen | other | N/A | $2 to $3 | Low |
| Cannula Inner Sz 6 Fen #6dicfen | other | N/A | $2 to $3 | Low |
| Cannula Inner Sz 8 Fen #8dicfen 10ea/bx | other | N/A | $2 to $3 | Low |
| Cannula Inner Sz10 Fen #10dicfen | other | N/A | $2 to $3 | Low |
| Electrode Est Thymapad Disposable 96ea/1cs | other | N/A | $2 to $3 | Low |
| Tranexamic Acid 650 Mg Po Tabs | other | N/A | $2 to $3 | Low |
| Tranexamic Acid 650 Mg Tablet | other | N/A | $2 to $3 | Low |
| Cast Tape 5"x4yd White Scotchcast #82005 | other | N/A | $2 to $3 | Low |
| Precutaneous Entry Thinwall Needle 18g X 9cmsdn-18-9.0 G00273 | other | N/A | $2 to $3 | Low |
| Diphenhydramine 12.5mg/5ml Cup | other | N/A | $2 to $4 | Low |
| Ferrous Sulf 15 Mg Iron/ml Drp | other | N/A | $2 to $4 | Low |
| Phenytoin 100 Mg/4 Ml Susp Cup | other | N/A | $2 to $4 | Low |
| Speculum Vaginal Med Disp Lighted #c020110 | other | N/A | $2 to $4 | Low |
| Cyclosporine 0.05% Eye Emuls | other | N/A | $2 to $4 | Low |
| Electrode Dysphagia Ped .68"x.87" #05a170 | other | N/A | $2 to $4 | Low |
| Heel and Elbow Protectors | other | N/A | $2 to $4 | Low |
| Lidocaine 2% Viscous 15 Ml Cup | other | N/A | $2 to $4 | Low |
| Morphine Sulfate ER 20 Mg Cap | other | N/A | $2 to $4 | Low |
| Oxycodone Hcl 5 Mg/5 Ml Cup | other | N/A | $2 to $4 | Low |
| Quetiapine Fumarate 25 Mg Po Tabs | other | N/A | $2 to $4 | Low |
| Quetiapine Fumarate 25 Mg Tab | other | N/A | $2 to $4 | Low |
| Catheter Foley 12fr 5ml Silicone Hydrogel Coating Lf 175812 12ea/case | cardiac | N/A | $2 to $4 | Low |
| Alaris Pump Module Admin Set 10942011 20ea/cs | other | N/A | $2 to $4 | Low |
| Ammonium Lactate 12% Lotion | other | N/A | $2 to $4 | Low |
| Benzoyl Peroxide 5 % Ex Gel | other | N/A | $2 to $4 | Low |
| Clarithromycin 500 Mg Po Tabs | other | N/A | $2 to $4 | Low |
| Clarithromycin 500 Mg Tablet | other | N/A | $2 to $4 | Low |
| Dextroamphetamine Sulfate ER 10 Mg Po Cp24 | other | N/A | $2 to $4 | Low |
| Erythromycin 250 Mg Tablet | other | N/A | $2 to $4 | Low |
| Miconazole 2% Topical Cream | other | N/A | $2 to $4 | Low |
| Minerin Creme | other | N/A | $2 to $4 | Low |
| Sumatriptan 6 Mg/0.5 Ml Vial | other | N/A | $2 to $4 | Low |
| Grounding Pad Surgical Peds #425 | surgery | N/A | $2 to $4 | Low |
| Colostomy OR Set #416928 5ea/1bx | other | N/A | $2 to $4 | Low |
| Hcs Non-adhesive 2.4x2.4 Medihoney #31622 | other | N/A | $2 to $4 | Low |
| Restraints Wrist & Ankle #m20116 1pr/1ea | other | N/A | $2 to $4 | Low |
| Dex 5%/0.45% Sodium Chl Inj Usp 1000m 14ea/cs | other | N/A | $2 to $4 | Low |
| Cane Standard Aluminum Adjustable 30"-38" 300lbs 6/cs #mds86415 | other | N/A | $2 to $4 | Low |
| Catheter Coude 12fr | cardiac | N/A | $2 to $4 | Low |
| Catheter Coude 16fr 12ea/1cs | cardiac | N/A | $2 to $4 | Low |
| Catheter Coude 18fr 12ea/1dz | cardiac | N/A | $2 to $4 | Low |
| Methylphenidate ER 27 Mg Tab | other | N/A | $2 to $4 | Low |
| Phenytoin Susp - 100 Mg/4 Ml - Repackaging | other | N/A | $2 to $4 | Low |
| Cath IV 14ga X 3.25 Angiocath Spec. Prodce | other | N/A | $2 to $4 | Low |
| Centrum Adult Po Liqd | other | N/A | $2 to $4 | Low |
| Convafoam Border Multisite 7.8x5x5 #423267 5ea/box | other | N/A | $2 to $4 | Low |
| Feed Spike Set W/flush Bag #775100 1ea | other | N/A | $2 to $4 | Low |
| Mvi W/iron Liquid - 15 Ml - Adult Oral Ud - Repackaged | other | N/A | $2 to $4 | Low |
| Fecal Collector Sys Flexi Seal W/tail Closure | other | N/A | $2 to $4 | Low |
| Sodium Chloride 5% Eye Drop | other | N/A | $2 to $4 | Low |
| Preemie Little Sucker W/cover #n204c | other | N/A | $1 to $4 | Low |
| Slings | other | N/A | $1 to $11 | Low |
| Teds Thigh 2x-large Regular Novaplus #v8805r | other | N/A | $1 to $4 | Low |
| Teds Thigh Large Long Novaplus #v9303l | other | N/A | $1 to $4 | Low |
| Teds Thigh Large Short Novaplus #v8303s | other | N/A | $1 to $4 | Low |
| Teds Thigh Medium Long Novaplus #v9302l | other | N/A | $1 to $4 | Low |
| Teds Thigh Medium Regular Novaplus #v8802r | other | N/A | $1 to $4 | Low |
| Teds Thigh Small Regular Novaplus #v8801r | other | N/A | $1 to $4 | Low |
| Teds Thigh Small Short Novaplus #v8301s | other | N/A | $1 to $4 | Low |
| Teds Thigh W/belt Xl Long Novaplus #v9304l | other | N/A | $1 to $4 | Low |
| Teds Thigh W/belt Xl Regular Novaplus #v8804r | other | N/A | $1 to $4 | Low |
| Dressing Colactive Plus Nonsilver2x2 10160000 | other | N/A | $1 to $4 | Low |
| Unclassified Drugs | other | N/A | $1 to $4 | Low |
| Bupropion Hcl ER (xl) 150 Mg Po Tb24 | other | N/A | $1 to $4 | Low |
| Bupropion Hcl Xl 150 Mg Tablet | other | N/A | $1 to $4 | Low |
| Olmesartan Medoxomil 20 Mg Po Tabs | other | N/A | $1 to $4 | Low |
| Picc Cath Statlock Secure Device 50ea/1ca | other | N/A | $1 to $4 | Low |
| Wound Filler, Gel/paste, Per Fluid Ounce, Not Otherwise Specified | other | N/A | $1 to $8 | Low |
| Carbamide Peroxide 6.5 % Ot Soln | other | N/A | $1 to $4 | Low |
| Dressing Aquacel Foam 7x7 #420621 10ea/1bx | other | N/A | $1 to $4 | Low |
| Ear Drops 6.5% | other | N/A | $1 to $4 | Low |
| Blade Laryngoscope Disp Led Millr Sz00 1039.c | other | N/A | $1 to $4 | Low |
| Sodium Chl 0.9% Irrigation 500ml Btl 18ea/1ca | other | N/A | $1 to $4 | Low |
| Methylphenidate ER 36 Mg Tab | other | N/A | $1 to $4 | Low |
| Pencan Spinal Needle 24g X 4" with 20g Introducer Sterile 25ea/ct #333884 | other | N/A | $1 to $4 | Low |
| Cath Coude Tiemann 20fr Rusch 50ea/1bx | other | N/A | $1 to $4 | Low |
| Cozaar 100 Mg Tablet | other | N/A | $1 to $4 | Low |
| Handle Laryngoscope Dispos Led Medium 2015.c | other | N/A | $1 to $4 | Low |
| Handle Laryngoscope Dispos Led Pediatr 2016.c | other | N/A | $1 to $4 | Low |
| Handle Laryngoscope Dispos Std Stubby 2017.c | other | N/A | $1 to $4 | Low |
| Niacin ER (antihyperlipidemic) 500 Mg Po Tbcr | lab | N/A | $1 to $4 | Low |
| Niacin ER 500 Mg Tablet | other | N/A | $1 to $4 | Low |
| Dressing Hydrocolloid 6 X 6in | other | N/A | $1 to $4 | Low |
| Nipple Shield 20mm Sma Contact 6ea/1cs | other | N/A | $1 to $4 | Low |
| Ted Hose Anti Emb Thigh Sm Short 3071lf- | other | N/A | $1 to $4 | Low |
| Ted Hose Comp Thigh Lg Long Open Toe 3856lf | other | N/A | $1 to $4 | Low |
| Ted Hose Comp Thigh Lg Reg Open Toe 3728lf- | other | N/A | $1 to $4 | Low |
| Ted Hose Comp Thigh Lg Short Open Toe 3634lf | other | N/A | $1 to $4 | Low |
| Ted Hose Comp Thigh Med Long Open Toe 3549lf | other | N/A | $1 to $4 | Low |
| Ted Hose Comp Thigh Med Reg Close Toe 3416lf- | other | N/A | $1 to $4 | Low |
| Ted Hose Comp Thigh Short Med Open Toe 3310lf | other | N/A | $1 to $4 | Low |
| Ted Hose Comp Thigh Small Reg Open Toe 3130lf | other | N/A | $1 to $4 | Low |
| Ted Hose Comp Thigh Xl Long Open Toe 3182lf | other | N/A | $1 to $4 | Low |
| Ted Hose Comp Thigh Xl Reg Open Toe 3181lf | other | N/A | $1 to $4 | Low |
| Ted Hose Comp Thigh Xxl Reg Open Toe 3184lf | other | N/A | $1 to $4 | Low |
| Cannula Nasal Adult Oral 7ft O2 #4797-7-7 | other | N/A | $1 to $4 | Low |
| Dressing Comfeel Plus 3" Butterfly #3350 | other | N/A | $1 to $4 | Low |
| Dressing Foam Adhesive Heel Design #m90619 | other | N/A | $1 to $4 | Low |
| Nyamyc 100,000 Unit/gm Powder | other | N/A | $1 to $4 | Low |
| Speculum Vaginal Small Disp Lighted C020100-1 Bx/18ea | other | N/A | $1 to $4 | Low |
| Assessment By Trained Clinical Staff of Implant And/or Foreign Body for Mr Sa... | surgery | N/A | $1 to $76,015 | Low |
| Dextrose 10%-water IV Solution | other | N/A | $1 to $4 | Low |
| Irrigation Kit Stoma Cone/tube Hollister #7721 1ea/1bx | other | N/A | $1 to $4 | Low |
| Endotrach Tube Cuffed Oral 5.0 | other | N/A | $1 to $4 | Low |
| Endotrach Tube Cuffed Oral 5.5 | other | N/A | $1 to $4 | Low |
| Endotrach Tube Cuffed Oral 6.0 | other | N/A | $1 to $4 | Low |
| Endotrach Tube Cuffed Oral 6.5 | other | N/A | $1 to $4 | Low |
| Tube Endo Trach Nasal Cuffed 4.5 | other | N/A | $1 to $4 | Low |
| Tube Endo Trach Nasal Cuffed 5.0 | other | N/A | $1 to $4 | Low |
| Tube Endo Trach Nasal Cuffed 5.5 | other | N/A | $1 to $4 | Low |
| Tube Endo Trach Nasal/cuffed 4.0 | other | N/A | $1 to $4 | Low |
| Fenofibrate Micronized 200 Mg Po Caps | other | N/A | $1 to $4 | Low |
| Dressing Silvasorb Circular #msc9310ep | other | N/A | $1 to $4 | Low |
| Perfusion Adaptor 1/4" #10007 Dlp | surgery | N/A | $1 to $4 | Low |
| Skin Trac Large 3"x40" #3874-13 24ea/1bx | other | N/A | $1 to $4 | Low |
| Dressing Aquagel Adv Hydrofiber 2x2" #422297 | other | N/A | $1 to $4 | Low |
| Flexinet Sz 3 Width 7/8"x25yds/bx #mto3a | other | N/A | $1 to $4 | Low |
| Oxycontin ER 10 Mg Tablet | other | N/A | $1 to $4 | Low |
| Hydrocodone-acetamn 7.5-325/15 | other | N/A | $1 to $4 | Low |
| Methylphenidate ER 54 Mg Tab | other | N/A | $1 to $4 | Low |
| Stopcock Plastic Three-way Ptws-2fll-mll-r #g00219 | other | N/A | $1 to $4 | Low |
| Hydralazine 50 Mg Tablet | other | N/A | $1 to $4 | Low |
| Luki-disp Aspirating Tubes Argyle 20ml 6.25in #8886864604 48ea/1cs | other | N/A | $1 to $4 | Low |
| Nisoldipine ER 17 Mg Po Tb24 | other | N/A | $1 to $4 | Low |
| Nisoldipine ER 17 Mg Tablet | other | N/A | $1 to $4 | Low |
| Nystatin 100000 Unit/ml Mt Susp | other | N/A | $1 to $4 | Low |
| Nystatin 500,000 Unit/5 Ml Cup | other | N/A | $1 to $4 | Low |
| Ortho-glass Splint W2xl12in Fiberglass Double Sided Padded #og-2pc 10ea/bx | other | N/A | $1 to $4 | Low |
| Yasmin 28 Tablet | other | N/A | $1 to $4 | Low |
| Amphetamine-dextroamphet ER 10 Mg Po Cp24 | other | N/A | $1 to $4 | Low |
| Cinacalcet Hcl 30 Mg Tablet | other | N/A | $1 to $4 | Low |
| Injector N35-o #515052 1cs/200ea | other | N/A | $1 to $4 | Low |
| Sirolimus, Oral, 1 Mg | other | N/A | $1 to $4 | Low |
| Dressing Steri-strip 1/4x1-1/2 (6/bx) #r1542 | other | N/A | $1 to $4 | Low |
| Feeding Administration Set Kangaroo 1000ml for Pump Flush Baf Dehp-free Latex... | other | N/A | $1 to $4 | Low |
| Dressing Aquacel Foam Sacral Sm 8"x7" #421579 | other | N/A | $1 to $4 | Low |
| Saf-gel 1ea #145730 | other | N/A | $1 to $4 | Low |
| Feed Tube 12fr Kendall #8884-711501 10ea/1cs | other | N/A | $1 to $4 | Low |
| Feeding Set Kangaroo Omni W/flush Bag 1000ml and Enplus Spike #bspff 30ea/case | other | N/A | $1 to $4 | Low |
| Optilock Nonadhesive Super Absorbant Wound Dressing Msc64610ep 10ea/bx 5bx/ca... | other | N/A | $1 to $4 | Low |
| Sodium Chloride 0.9 % in Aers | other | N/A | $1 to $4 | Low |
| Triple Dye Swab | other | N/A | $1 to $4 | Low |
| Boot Cast Gelo Unna's 12ea/1cs | other | N/A | $1 to $4 | Low |
| Cefpodoxime Proxetil 100 Mg Po Tabs | other | N/A | $1 to $4 | Low |
| Electrode Needle Tip #0013m 12/bx | other | N/A | $1 to $4 | Low |
| Nebulizer Kit 1000ml #ck0010 | other | N/A | $1 to $4 | Low |
| Airway Ovassapian #bd6075 5/cs | other | N/A | $1 to $4 | Low |
| Benadryl Itch Stop 1%-0.1% Crm | other | N/A | $1 to $4 | Low |
| Neo-synephrine 0.5% Spray | other | N/A | $1 to $4 | Low |
| Quinine Sulfate 324 Mg Capsule | other | N/A | $1 to $4 | Low |
| Doxycycline Hyclate 100 Mg Po Caps | other | N/A | $1 to $4 | Low |
| Endotrach Tube 6.5mm Nasal Rae #96365 | other | N/A | $1 to $4 | Low |
| Endotrach Tube 7.0mm Nasal Rae #96370 | other | N/A | $1 to $4 | Low |
| Endotrach Tube Oral Rae 5.0mm Cuff #76251 | other | N/A | $1 to $4 | Low |
| Endotrach Tube Oral Rae 5.5mm Cuff #76255 | other | N/A | $1 to $4 | Low |
| Endotrach Tube Oral Rae 6.0mm Cuff #76260 | other | N/A | $1 to $4 | Low |
| Endotrach Tube Oral Rae 6.5mm Cuff #76265 | other | N/A | $1 to $4 | Low |
| Endotrach Tube Oral Rae 7.5mm Cuff #76275 | other | N/A | $1 to $4 | Low |
| Endotrach Tube Oral Rae Cuffed 4.0mm 10/bx | other | N/A | $1 to $4 | Low |
| Oxymorphone Hcl ER 5 Mg Tablet | other | N/A | $1 to $4 | Low |
| Sleeve Smoke Evac Suction 165mm 10/pk 0703-005 | other | N/A | $1 to $4 | Low |
| Blade Laryngoscope Dispo Robert Shaw 1 2011.c | other | N/A | $1 to $4 | Low |
| Brace Wrist Right Small #79 | other | N/A | $1 to $4 | Low |
| Clotrimazole-betamethasone Crm | other | N/A | $1 to $4 | Low |
| 5fr Obturator | other | N/A | $1 to $4 | Low |
| 6fr Obturator | other | N/A | $1 to $4 | Low |
| 7fr Obturator | other | N/A | $1 to $4 | Low |
| Jackson Pratt Drain Flat 10mm | other | N/A | $1 to $5 | Low |
| Focalin Xr 5 Mg Capsule | other | N/A | $1 to $5 | Low |
| Ketorolac 10 Mg Tablet | other | N/A | $1 to $5 | Low |
| Dressing Border 6x6 Mepilex #295400b | other | N/A | $1 to $5 | Low |
| Arnuity Ellipta 100 Mcg Inh | other | N/A | $1 to $5 | Low |
| Cast Splint 4"x 15" Comformable 10ea/1cs | other | N/A | $1 to $5 | Low |
| Dutasteride 0.5 Mg Capsule | other | N/A | $1 to $5 | Low |
| Dutasteride 0.5 Mg Po Caps | other | N/A | $1 to $5 | Low |
| Levalbuterol, Inhalation Solution, Fda-approved Final Product, Non-compounded... | other | N/A | $1 to $5 | Low |
| Ure-na 15 Gram Powder Packet | other | N/A | $1 to $5 | Low |
| Focalin Xr 10 Mg Capsule | other | N/A | $1 to $5 | Low |
| Mesalamine ER 0.375 Gram Cap | other | N/A | $1 to $5 | Low |
| Tobramycin 0.3% Eye Drop | other | N/A | $1 to $5 | Low |
| Belt Gait W/ Buckle 72" #655702 | other | N/A | $1 to $5 | Low |
| Fluvastatin Sodium 20 Mg Po Caps | other | N/A | $1 to $5 | Low |
| Fluvastatin Sodium 40 Mg Po Caps | other | N/A | $1 to $5 | Low |
| Cannula Anterior Chamber 27 Ga | other | N/A | $1 to $5 | Low |
| Dextroamphetamine Sulfate ER 15 Mg Po Cp24 | other | N/A | $1 to $5 | Low |
| Boot Cast Extra Large 1ea | other | N/A | $1 to $5 | Low |
| Boot Cast Small #2035-02 1ea | other | N/A | $1 to $5 | Low |
| Boot Cast-large | other | N/A | $1 to $5 | Low |
| Boot Cast-medium | other | N/A | $1 to $5 | Low |
| Ortho-glass Splint W3xl12in Fiberglass Double Sided Padded #og-3pc 10ea/bx | other | N/A | $1 to $5 | Low |
| Amox-clav 200-28.5 Mg/5 Ml Sus | other | N/A | $1 to $5 | Low |
| Partitioned Scoop Dish #1388 | other | N/A | $1 to $5 | Low |
| Anes Breathing Circuit Adult 3l #a4y520xxf | other | N/A | $1 to $5 | Low |
| Ciprofloxacin 0.3% Eye Drop | other | N/A | $1 to $5 | Low |
| Focalin Xr 15 Mg Capsule | other | N/A | $1 to $5 | Low |
| Focalin Xr 20 Mg Capsule | other | N/A | $1 to $5 | Low |
| Splint Wrist Cockup Left Universal | other | N/A | $1 to $5 | Low |
| Splint Wrist Cockup Right Universal | other | N/A | $1 to $5 | Low |
| Cannula Nasal 50' #0150 | other | N/A | $1 to $5 | Low |
| Eye Itch Relief 0.025% Drops | other | N/A | $1 to $5 | Low |
| Foam Dressing, Wound Cover, Sterile, Pad Size More Than 16 Sq. In. But Less T... | other | N/A | $1 to $28 | Low |
| Adaptor Meconium Aspiration #n0101 40ea/bx | other | N/A | $1 to $5 | Low |
| Boudreauxs Butt Paste | other | N/A | $1 to $5 | Low |
| Namenda 5-10 Mg Titration Pk | other | N/A | $1 to $5 | Low |
| Methylphenidate ER 18 Mg Tab | other | N/A | $1 to $5 | Low |
| Azithromycin 500 Mg Po Tabs | other | N/A | $1 to $5 | Low |
| Azithromycin 500 Mg Tablet | other | N/A | $1 to $5 | Low |
| Brace Thumb Splint Universal #5026 | other | N/A | $1 to $5 | Low |
| Cannula Inner 6.0 Xltin Ext Length | other | N/A | $1 to $5 | Low |
| Cannula Inner 7.0 Xltin Ext Length 12.3/100mm | other | N/A | $1 to $5 | Low |
| Cannula Inner 8.0 Xltin Ext Length 13.3/105mm | other | N/A | $1 to $5 | Low |
| Splint Wrist/forearm Left Large 1ea | other | N/A | $1 to $5 | Low |
| Splint Wrist/forearm Left Medium 1ea | other | N/A | $1 to $5 | Low |
| Splint Wrist/forearm Rt Medium 1ea | other | N/A | $1 to $5 | Low |
| Catheter Coude 14fr #120614 Cs/12ea | cardiac | N/A | $1 to $5 | Low |
| Aripiprazole 5 Mg Po Tabs | other | N/A | $1 to $5 | Low |
| Aripiprazole 5 Mg Tablet | other | N/A | $1 to $5 | Low |
| Vilazodone Hcl 10 Mg Tablet | other | N/A | $1 to $5 | Low |
| Vilazodone Hcl 20 Mg Po Tabs | other | N/A | $1 to $5 | Low |
| Vilazodone Hcl 20 Mg Tablet | other | N/A | $1 to $5 | Low |
| Vilazodone Hcl 40 Mg Po Tabs | other | N/A | $1 to $5 | Low |
| Vilazodone Hcl 40 Mg Tablet | other | N/A | $1 to $5 | Low |
| Tube Salem Sump Multi-functional Port Enfit Connection 18fr #7771810e | other | N/A | $1 to $5 | Low |
| Eye Protector Regular/newborn 33-38cm | obstetric | N/A | $1 to $5 | Low |
| Quinidine Gluc ER 324 Mg Tab | other | N/A | $1 to $5 | Low |
| Urinary Catheter Anchoring Device, Adhesive Skin Attachment, Each | cardiac | N/A | $1 to $10 | Low |
| Urinary Catheter Anchoring Device, Leg Strap, Each | cardiac | N/A | $1 to $10 | Low |
| Endotrach Tube Oral Rae 7.0mm Cuff #76270 | other | N/A | $1 to $5 | Low |
| Tube Port Gientri 12fr Salem Sump #7771210 | other | N/A | $1 to $5 | Low |
| Tube Port Gientri 14fr Salem Sump #7771410 | other | N/A | $1 to $5 | Low |
| Tube Port Gientri 16fr Salem Sump #7771610 | other | N/A | $1 to $5 | Low |
| Feeding Set Kangaroo Omni W/flush Bag 1000ml #b10ff 30ea/case | other | N/A | $1 to $5 | Low |
| Feeding Set Kangaroo Omni W/flush Bag 500ml #b5ff 30ea/case | other | N/A | $1 to $5 | Low |
| Aliskiren 150 Mg Tablet | other | N/A | $1 to $5 | Low |
| Aspirin-dipyridam ER 25-200 Mg | other | N/A | $1 to $5 | Low |
| Aspirin-dipyridamole ER 25-200 Mg Po Cp12 | other | N/A | $1 to $5 | Low |
| Desitin 40% Paste | other | N/A | $1 to $5 | Low |
| Amox-clav 400-57 Mg/5 Ml Susp | other | N/A | $1 to $5 | Low |
| Orajel 3x Toothache-gum Gel | other | N/A | $1 to $5 | Low |
| Adhesive, Liquid OR Equal, Any Type, Per Oz | other | N/A | $1 to $5 | Low |
| Flexinet Sz 5 Width 1-1/4"x25yds/bx #mto5a | other | N/A | $1 to $5 | Low |
| Lanthanum Carb 500 Mg Tab Chew | other | N/A | $1 to $5 | Low |
| Lanthanum Carbonate 500 Mg Po Chew | other | N/A | $1 to $5 | Low |
| Dressing Xtrasorb Classic 6"x9" #89569 | other | N/A | $1 to $5 | Low |
| Wound Cleanser 12 Oz Safe Clens #159712 6/cs | other | N/A | $1 to $5 | Low |
| Clopidogrel 300 Mg Tablet | other | N/A | $1 to $5 | Low |
| Dish Scoop Round 8 Inch 1ea | other | N/A | $1 to $5 | Low |
| Dressing Foam Allevyn 7x7 Gntle Brdr 66800280 | other | N/A | $1 to $5 | Low |
| Splint Cool Blue Wrist Left #d5040 | other | N/A | $1 to $5 | Low |
| Splint Wrist Univ Rt Cool Blue #d5040 | other | N/A | $1 to $5 | Low |
| Montelukast Sod 5 Mg Tab Chew | other | N/A | $1 to $5 | Low |
| Montelukast Sodium 4 Mg Po Chew | other | N/A | $1 to $5 | Low |
| Montelukast Sodium 5 Mg Po Chew | other | N/A | $1 to $5 | Low |
| Needle for Infusion Port Powerloc 20 Ga X 0.75in Injectable without Y Injecti... | surgery | N/A | $1 to $5 | Low |
| Pvc Drain Surgical 10 Fr Round Mid Perforation 100 Cc Reservoir Standard Leng... | surgery | N/A | $1 to $5 | Low |
| Tolterodine Tart ER 2 Mg Cap | other | N/A | $1 to $5 | Low |
| Valve Biopsy #maj-210 Endo/non-chrg | lab | N/A | $1 to $5 | Low |
| Brimonidine 0.2% Eye Drop | other | N/A | $1 to $5 | Low |
| Dressing Calcium Alginate 2x2 #31022 | other | N/A | $1 to $5 | Low |
| Skin Protectant Medline/remedy Specialized Extra Thick Zinc Oxide Paste 4oz #... | other | N/A | $1 to $5 | Low |
| Weighted Spork 1ea | other | N/A | $1 to $5 | Low |
| Electrode Ultra Clean Accessory | other | N/A | $1 to $5 | Low |
| Furosemide 10 Mg/ml Solution | other | N/A | $1 to $5 | Low |
| Nafcillin 1 Gm/ 50 Ml Ns Mini-bag Plus - Compounded | other | N/A | $1 to $5 | Low |
| Nafcillin 2 Gm / 100 Ml Ns Mini-bag Plus - Compounded | other | N/A | $1 to $5 | Low |
| Teds Thigh 3x-large Regular Ultra Care Open Toe Purple Latex Free #868-06 Cas... | other | N/A | $1 to $5 | Low |
| Bactine Max 0.13% Solution | other | N/A | $1 to $5 | Low |
| Wrist Splint 6" W/stays Left Lg #5015 | other | N/A | $1 to $5 | Low |
| Wrist Splint 6" W/stays Left Md #5015 | other | N/A | $1 to $5 | Low |
| Wrist Splint 6" W/stays Right Lg #5015 | other | N/A | $1 to $5 | Low |
| Wrist Splint 6" W/stays Right Md #5015 | other | N/A | $1 to $5 | Low |
| Colchicine 0.6 Mg Po Tabs | other | N/A | $1 to $5 | Low |
| Colchicine 0.6 Mg Tablet | other | N/A | $1 to $5 | Low |
| Bss Eye Solution | other | N/A | $1 to $5 | Low |
| Mask Lma Unique Silicone W/cuff Pilot Size 1 | other | N/A | $1 to $6 | Low |
| Mask Lma Unique Silicone W/cuff Pilot Size 2 | other | N/A | $1 to $6 | Low |
| Mask Lma Unique Silicone W/cuff Pilot Sz 1.5 | other | N/A | $1 to $6 | Low |
| Mask Lma Unique Silicone W/cuff Pilot Sz 2.5 | other | N/A | $1 to $6 | Low |
| Tube Salem Sump 14fr W/filter&valve | other | N/A | $1 to $6 | Low |
| Tube Salem Sump 16fr W/filter&valve | other | N/A | $1 to $6 | Low |
| Daytrana 10 Mg/9 Hr Patch | other | N/A | $1 to $6 | Low |
| Daytrana 15 Mg/9 Hr Patch | other | N/A | $1 to $6 | Low |
| Daytrana 20 Mg/9 Hour Patch | other | N/A | $1 to $6 | Low |
| Daytrana 30 Mg/9 Hour Patch | other | N/A | $1 to $6 | Low |
| Filter Disp W/connector Tube Obgyn Berkeley | other | N/A | $1 to $6 | Low |
| Bag Phlebotomy Set 25/bx #bk-64a | other | N/A | $1 to $6 | Low |
| Electrode Disposable Pre-gel Monitoring 25/bg | other | N/A | $1 to $6 | Low |
| Mesalamine ER 250 Mg Po Cpcr | other | N/A | $1 to $6 | Low |
| Pentasa 250 Mg Capsule | other | N/A | $1 to $6 | Low |
| Iontophoris Pad - Sp 6ea/1bx | other | N/A | $1 to $6 | Low |
| Bandage Comprilan 6cm 20ea/1cs | other | N/A | $2 to $6 | Low |
| Desloratadine 5 Mg Po Tabs | other | N/A | $2 to $6 | Low |
| Forcep Surgical Adson Dressing Serrated 4.75 | surgery | N/A | $2 to $6 | Low |
| Glove Edema Compression Large Left 1ea | other | N/A | $2 to $6 | Low |
| Glove Edema Compression Lrg Right 1ea | other | N/A | $2 to $6 | Low |
| Glove Edema Compression Med Right 1ea | other | N/A | $2 to $6 | Low |
| Glove Edema Compression Medium Left 1ea | other | N/A | $2 to $6 | Low |
| Dressing Biatain 5x5" Silicone Foam #33436 | other | N/A | $2 to $6 | Low |
| Yaz 28 Tablet | other | N/A | $2 to $6 | Low |
| Support Abducted Thumbspica Uni #79 | other | N/A | $2 to $6 | Low |
| Support Abducted Thumbspica Uni Lt #79 | other | N/A | $2 to $6 | Low |
| Cuff Universal Lrg 3-1/2in #1489 | other | N/A | $2 to $6 | Low |
| Dermoplast Pain Relieving Spry | other | N/A | $2 to $6 | Low |
| Forcep Surgical Adson Tissue 1x2 4.75in | surgery | N/A | $2 to $6 | Low |
| Midazolam Hcl 10 Mg/5 Ml Cup | other | N/A | $2 to $6 | Low |
| Aripiprazole 2 Mg Tablet | other | N/A | $2 to $6 | Low |
| Tropicamide 0.5% Eye Drops | other | N/A | $2 to $6 | Low |
| Irrigation Tur Set 21" #2c4006 12ea/1ca | other | N/A | $2 to $6 | Low |
| Flexiseal Collect Bags W Fil 5ea/bx 6bx/cs #422291 | other | N/A | $2 to $6 | Low |
| Injection, Fondaparinux Sodium, 0.5 Mg | other | N/A | $2 to $6 | Low |
| Iontophoris Pad - 80 6ea/1bx | other | N/A | $2 to $6 | Low |
| Montelukast Sod 10 Mg Tablet | other | N/A | $2 to $6 | Low |
| Spear Eye #10 Merocel 10ea/pk | other | N/A | $2 to $6 | Low |
| Adaptic Finger Dressing Large 1-1/8" #mad023u Case=17bx=170each | other | N/A | $2 to $6 | Low |
| Adaptic Finger Dressing Small 3/4" #mad003u Case=17bx=170each | other | N/A | $2 to $6 | Low |
| Cuff Universal Medium 3in #1487 | other | N/A | $2 to $6 | Low |
| Glove Edema Compression Sm Left 1ea | other | N/A | $2 to $6 | Low |
| 1/2 Circle Rev Cut Richard Allen #209106 | other | N/A | $2 to $6 | Low |
| Dress Aquacel Advantage Hydrofbr Rope #422300 | other | N/A | $2 to $6 | Low |
| Ligaclip-lg Titanium Orange #004200 120ea/bx | other | N/A | $2 to $6 | Low |
| Thoracic Chest Tube 32fr 10ea/1cs | other | N/A | $2 to $6 | Low |
| Demeclocycline Hcl 150 Mg Po Tabs | other | N/A | $2 to $6 | Low |
| Extension Set W/controller 60ea/1cs | other | N/A | $2 to $6 | Low |
| Lavage Tray 34fr Argyle #88 | other | N/A | $2 to $6 | Low |
| Amoxicillin 400 Mg/5 Ml Susp | other | N/A | $2 to $6 | Low |
| Connector Straight 3/8 X 1/4" #050516000 | other | N/A | $2 to $6 | Low |
| Hc Remote Cardiac Monitoring-additional Hrs | cardiac | N/A | $2 to $6 | Low |
| Merit Medical K-50 Tube #08-01859 15/bx | other | N/A | $2 to $6 | Low |
| Nausea Aromatic Pk Disp/quease Ease 30ea/1ca | other | N/A | $2 to $6 | Low |
| Suction Cath-14fr-coude 20ea/1cs | other | N/A | $2 to $6 | Low |
| Cannula Vessel One Way Flow Bevd Tip #30000 | other | N/A | $2 to $6 | Low |
| Rosuvastatin Calcium 10 Mg Po Tabs | other | N/A | $2 to $6 | Low |
| Rosuvastatin Calcium 10 Mg Tab | other | N/A | $2 to $6 | Low |
| Rosuvastatin Calcium 20 Mg Po Tabs | other | N/A | $2 to $6 | Low |
| Rosuvastatin Calcium 40 Mg Po Tabs | other | N/A | $2 to $6 | Low |
| Rosuvastatin Calcium 40 Mg Tab | other | N/A | $2 to $6 | Low |
| Rosuvastatin Calcium 5 Mg Po Tabs | other | N/A | $2 to $6 | Low |
| Rosuvastatin Calcium 5 Mg Tab | other | N/A | $2 to $6 | Low |
| Varenicline 1 Mg Tablet | other | N/A | $2 to $6 | Low |
| Varenicline Tartrate 1 Mg Po Tabs | other | N/A | $2 to $6 | Low |
| Adaptic Toe Dressing 1-1/8" Size Lg #mad062u 10ea/bx | other | N/A | $2 to $6 | Low |
| Splint Wrist Lrg Right 1ea | other | N/A | $2 to $6 | Low |
| Splint Wrist Med Left 1ea | other | N/A | $2 to $6 | Low |
| Oxycontin ER 15 Mg Tablet | other | N/A | $2 to $6 | Low |
| Ezetimibe-simvastatin 10-40 Mg Po Tabs | other | N/A | $2 to $6 | Low |
| Ezetimibe-simvastatin 10-80 Mg Po Tabs | other | N/A | $2 to $6 | Low |
| Penicillin Vk 250 Mg/5 Ml Soln | other | N/A | $2 to $6 | Low |
| Ortho-glass Splint W4xl15in Fiberglass Double Sided Padded Og-4pc 10ea/bx | other | N/A | $2 to $6 | Low |
| Wilson Frame Headrest #1937dz 12/cs | other | N/A | $2 to $6 | Low |
| Arnuity Ellipta 200 Mcg Inh | other | N/A | $2 to $6 | Low |
| Splint Clavicle-adult/large #3004 | other | N/A | $2 to $6 | Low |
| Splint Clavicle-adult/x-lrg #3004 | other | N/A | $2 to $6 | Low |
| Splint Clavicle-medium #3004 | other | N/A | $2 to $6 | Low |
| Venlafaxine Hcl ER 37.5 Mg Cap | other | N/A | $2 to $6 | Low |
| Venlafaxine Hcl ER 37.5 Mg Po Cp24 | other | N/A | $2 to $6 | Low |
| Carvedilol ER 10 Mg Capsule | other | N/A | $2 to $6 | Low |
| Carvedilol ER 20 Mg Capsule | other | N/A | $2 to $6 | Low |
| Carvedilol Phosphate ER 20 Mg Po Cp24 | other | N/A | $2 to $6 | Low |
| Cast Splint 3" X 12" Comformable 10ea/1csquick Step Splint Scotchcast 3" X 12" | other | N/A | $2 to $6 | Low |
| Alginate OR Other Fiber Gelling Dressing, Wound Filler, Sterile, Per 6 Inches | other | N/A | $2 to $8 | Low |
| Calmoseptine Ointment | other | N/A | $2 to $6 | Low |
| Fluvastatin Sodium ER 80 Mg Po Tb24 | other | N/A | $2 to $6 | Low |
| Single Use Distal Cover #maj-2315 20ea/bx | other | N/A | $2 to $6 | Low |
| Methylphenidate Hcl ER (cd) 10 Mg Po Cpcr | other | N/A | $2 to $6 | Low |
| Methylphenidate Hcl ER (cd) 20 Mg Po Cpcr | other | N/A | $2 to $6 | Low |
| Methylphenidate Hcl ER (cd) 30 Mg Po Cpcr | other | N/A | $2 to $6 | Low |
| Binder Abdominal 10" 27"-48" #ort21200 | other | N/A | $2 to $6 | Low |
| Resuscitator Bag W/mask Child Manual Spur Ii Ambu 531613000 Case/6ea | other | N/A | $2 to $6 | Low |
| Nasal Aspirator without Syringe #mad300 | other | N/A | $2 to $6 | Low |
| Disposable Temperature Probe Sterile 400 Series Molex Esophageal OR Rectal Pr... | other | N/A | $2 to $6 | Low |
| Estrogens Conjugated 0.625 Mg Po Tabs | other | N/A | $2 to $6 | Low |
| Premarin 0.3 Mg Tablet | other | N/A | $2 to $6 | Low |
| Premarin 0.625 Mg Tablet | other | N/A | $2 to $6 | Low |
| Anes Breathing Circuit Ped 2l W/mask B1557xx4 | other | N/A | $2 to $6 | Low |
| Jackson Rees Modification Circuit #3842-61z | other | N/A | $2 to $6 | Low |
| Fenofibrate 145 Mg Po Tabs | other | N/A | $2 to $6 | Low |
| Fenofibrate 145 Mg Tablet | other | N/A | $2 to $6 | Low |
| Brace Wrist/forearm Support Left #79 | other | N/A | $2 to $6 | Low |
| Endotrach Tube 5mm Micro Oral/nasal #86387 | other | N/A | $2 to $6 | Low |
| Endotrach Tube Oral/nasal Cuffed Murphy Eye 6mm 10ea/pk #86389 | other | N/A | $2 to $6 | Low |
| Scopolamine 1 Mg/3days Td Pt72 | other | N/A | $2 to $7 | Low |
| Biofreeze W/ilex 4oz Tube 1ea | other | N/A | $2 to $7 | Low |
| Chemotherapy Administration | other | N/A | $1 to $1,780 | High |
| Clotrimazole 1 % Ex Crea | other | N/A | $2 to $7 | Low |
| Dronabinol, 2.5 Mg, Oral, Fda Approved Prescription Anti-emetic, for Use As a... | other | N/A | $2 to $7 | Low |
| Dressing Port Chg Tegaderm #1665 | other | N/A | $2 to $7 | Low |
| Pressure Damping Device #r.o.s.e. 25ea/1bx | other | N/A | $2 to $7 | Low |
| Adderall Xr 20 Mg Capsule | other | N/A | $2 to $7 | Low |
| Adderall Xr 25 Mg Capsule | other | N/A | $2 to $7 | Low |
| Adderall Xr 30 Mg Capsule | other | N/A | $2 to $7 | Low |
| Adderall Xr 5 Mg Capsule | other | N/A | $2 to $7 | Low |
| Foam Dressing, Wound Cover, Sterile, Pad Size 16 Sq. In. OR Less, without Adh... | other | N/A | $2 to $11 | Low |
| Green Enternal Feeding Tube Declogger 20-22fr 39.5cm Item 913 | other | N/A | $2 to $7 | Low |
| Putty Exercise Progressive Purple 1ea | other | N/A | $2 to $7 | Low |
| Flexinet Sz 10 Width 3"x25yds/bx #mt1oa | other | N/A | $2 to $7 | Low |
| Anesthesia for Other Repair of Upper Abdomen Hernia | surgery | N/A | $1 to $750 | Low |
| Selenium Sulfide 2.5% Lotion | other | N/A | $2 to $7 | Low |
| Enulose 10 Gm/15 Ml Solution | other | N/A | $2 to $7 | Low |
| Anesthesia for Procedure On Veins in Upper Leg | other | N/A | $1 to $1,260 | Low |
| Catheter Purewick Female External Ltx #pwf030 | cardiac | N/A | $2 to $7 | Low |
| Hydrodissector Cortical Clearing | other | N/A | $2 to $7 | Low |
| Dressing Restore Wound Care 4x4 #519930 5/bx | other | N/A | $2 to $7 | Low |
| Amoxicillin 200 Mg/5 Ml Susp | other | N/A | $2 to $7 | Low |
| Cocoa Butter Balm 1ea | other | N/A | $2 to $7 | Low |
| Erythromycin 0.5% Eye Ointment | other | N/A | $2 to $7 | Low |
| Bandage Comprilan 8cm 20ea/1cs | other | N/A | $2 to $7 | Low |
| Pantoprazole Dr 40 Mg Susp Pkt | other | N/A | $2 to $7 | Low |
| Drawtex Hydroconductive Dressing 18 Inch Strip 10/bx #00321 | other | N/A | $2 to $7 | Low |
| Dilator Cook 5fr #g00972 | other | N/A | $2 to $7 | Low |
| Dilator Cook 6fr X 20cm Long #g00937 | other | N/A | $2 to $7 | Low |
| Fentanyl 25 Mcg/hr Patch | other | N/A | $2 to $7 | Low |
| Dressing Drawtex Tracheostomy 4x4 #00310 | other | N/A | $2 to $7 | Low |
| Forcep Surgical Fine 3.5in | surgery | N/A | $2 to $7 | Low |
| Wrist Brace Form Fit Lrg R #317077 | other | N/A | $2 to $7 | Low |
| Bandage Comprilan 10cm 20ea/1cs | other | N/A | $2 to $7 | Low |
| Dressing Aquacel Foam Sacral Lg 9.4"x8.4" | other | N/A | $2 to $7 | Low |
| Lidocaine Hcl 2% Jelly Uro-jet | other | N/A | $2 to $7 | Low |
| Elevator Foam Arm 20x20.5 Lf Non Ster | other | N/A | $2 to $7 | Low |
| Eliquis 5 Mg Tablet | other | N/A | $2 to $7 | Low |
| Venlafaxine Hcl ER 75 Mg Cap | other | N/A | $2 to $7 | Low |
| Venlafaxine Hcl ER 75 Mg Po Cp24 | other | N/A | $2 to $7 | Low |
| Brilinta 60 Mg Tablet | other | N/A | $2 to $7 | Low |
| Brilinta 90 Mg Tablet | other | N/A | $2 to $7 | Low |
| Ticagrelor 90 Mg Po Tabs | other | N/A | $2 to $7 | Low |
| Tranexamic Acid 1000 Mg / 100 Ml Ns - Compounded | other | N/A | $2 to $7 | Low |
| Auryxia 210 Mg Tablet | other | N/A | $2 to $7 | Low |
| Niacin ER (antihyperlipidemic) 1000 Mg Po Tbcr | lab | N/A | $2 to $7 | Low |
| Anes Breathing Circuit Ped 1l 20/cs B1554xx4 | other | N/A | $2 to $7 | Low |
| Binder Abdominal 12" 27"-48" #ort21300 | other | N/A | $2 to $7 | Low |
| Composite Dressing, Sterile, Pad Size More Than 16 Sq. In. But Less Than OR E... | other | N/A | $2 to $14 | Low |
| Sock and Stocking Aid W/notch #081007673 | other | N/A | $2 to $7 | Low |
| Scar Tissue Massage Tool #a8113 | other | N/A | $2 to $7 | Low |
| Filter Line Sampling Adult Pediatric 13ft Long Intubated Microstream Advance ... | other | N/A | $2 to $7 | Low |
| T-tube Drain 12fr | other | N/A | $2 to $7 | Low |
| T-tube Drain 14fr | other | N/A | $2 to $7 | Low |
| T-tube Drain 16fr | other | N/A | $2 to $7 | Low |
| T-tube Drain 18fr | other | N/A | $2 to $7 | Low |
| T-tube Drain 20fr | other | N/A | $2 to $7 | Low |
| Promethazine Hcl 25 Mg Re Supp #2 Dispense Pack | other | N/A | $2 to $7 | Low |
| Wrist Brace Form Fit Lrg. L #317087 | other | N/A | $2 to $7 | Low |
| Wrist Brace Form Fit Med L #317085 | other | N/A | $2 to $7 | Low |
| Wrist Brace Form Fit Med R #317075 | other | N/A | $2 to $7 | Low |
| Wrist Brace Form Fit Small L #317083 | other | N/A | $2 to $7 | Low |
| Wrist Brace Form Fit Small R #317073 | other | N/A | $2 to $7 | Low |
| Biotene Moisturizing Mouth Spr | other | N/A | $2 to $7 | Low |
| Cannula Inner Sz 6 Spare #6sic Shiley | other | N/A | $2 to $7 | Low |
| Cannula Inner Sz 8 Spare #8sic Shiley | other | N/A | $2 to $7 | Low |
| Needle Tuohy Epidural 20ga X 3.5" Lf 25ea/cs | other | N/A | $2 to $7 | Low |
| Anesthesia for Repair of Bulging (aneurysm) Defect in Knee Artery | surgery | N/A | $2 to $1,444 | Low |
| Anesthesia for Extensive Removal of Prostate | surgery | N/A | $2 to $865 | Low |
| Stylet Glidescope Pediatric Disp #0270 | other | N/A | $2 to $7 | Low |
| Catheter Foley 22fr 5cc Silver Coat 12ea/1dz | cardiac | N/A | $2 to $7 | Low |
| Catheter Foley 24fr 5cc Silver 12ea/1dz | cardiac | N/A | $2 to $7 | Low |
| Catheter Foley Peds 10fr 3cc Silvr 12ea/1cs | cardiac | N/A | $2 to $7 | Low |
| Catheter Foley Peds 8fr 3cc Silver 12ea/1cs | cardiac | N/A | $2 to $7 | Low |
| Flexinet Sz 6 Width 1-1/2"x25yds/bx #mto6a | other | N/A | $2 to $7 | Low |
| Splint Wrist W/thumb Left #a125107 | other | N/A | $2 to $7 | Low |
| Splint Wrist W/thumb Left Med #a125106 | other | N/A | $2 to $7 | Low |
| Splint Wrist W/thumb Left Sm #a125105 | other | N/A | $2 to $7 | Low |
| Splint Wrist W/thumb Right Lrg #a125207 | other | N/A | $2 to $7 | Low |
| Splint Wrist W/thumb Right Med #a125206 | other | N/A | $2 to $7 | Low |
| Splint Wrist W/thumb Right Sm #a125205 | other | N/A | $2 to $7 | Low |
| Anesthesia for Other Procedures On Nerves, Muscles, Tendons, and Tissue of Up... | other | N/A | $2 to $1,710 | Low |
| Anesthesia for Procedure On Nerves, Muscles, Tendons, and Tissue of Knee | other | N/A | $2 to $1,320 | Low |
| Sheath Probe Cover W/gel Site Rite #9001c0197 10ea/sp | other | N/A | $2 to $7 | Low |
| Thoracic Chest Tube 28fr 10ea/1cs | other | N/A | $2 to $7 | Low |
| Anesthesia for Procedure On Saliva Gland | other | N/A | $2 to $100 | Low |
| Convamax Superabsorber 8 X 16 Dropship Only 10ea/bx 5bx/cs. #422574 | other | N/A | $2 to $7 | Low |
| Teds Thigh Large Regular Novaplus #v8803r | other | N/A | $2 to $7 | Low |
| Dressing Aquacel Ag Advantage 4 X 5in Hydrofiber #422299 | other | N/A | $2 to $7 | Low |
| Pin Ball Cover .035(.9mm) #wo35-db | other | N/A | $2 to $7 | Low |
| Pin Ball Cover .062(1.1mm) #wo62-gn | other | N/A | $2 to $7 | Low |
| Pin Ball Cover 5/64(2mm) #w564-bl | other | N/A | $2 to $7 | Low |
| Wilson Frame Pad #m60 | other | N/A | $2 to $7 | Low |
| Catheter Sheath Introducer 5fr#504605x 5ea/bx | cardiac | N/A | $2 to $7 | Low |
| Catheter Sheath Introducer 6fr#504606x 5ea/bx | cardiac | N/A | $2 to $7 | Low |
| Catheter Sheath Introducer 8fr #504608x | cardiac | N/A | $2 to $7 | Low |
| Anesthesia for Procedure On Nerves, Muscles, Tendons, Fascia, and Bursae of S... | other | N/A | $2 to $1,610 | Low |
| Cvvh Prisma 5l Effluent Bag #114423 50/cs | other | N/A | $2 to $7 | Low |
| Resuscitator Bag W/mask Adult Manual 12ea/cs | other | N/A | $2 to $7 | Low |
| Collagen Dressing, Sterile, Size 16 Sq. In. OR Less, Each | other | N/A | $2 to $30 | Low |
| Esenta Sting Free Adhesive Remover Spray 50ml Can #423289 12cn/case | other | N/A | $2 to $7 | Low |
| Pant Clips -white 1ea | other | N/A | $2 to $7 | Low |
| Anesthesia for Other Procedure On Artery of Upper Leg | other | N/A | $2 to $1,270 | Low |
| Tolterodine Tart ER 4 Mg Cap | other | N/A | $2 to $7 | Low |
| Tolterodine Tartrate ER 4 Mg Po Cp24 | other | N/A | $2 to $7 | Low |
| Feed Tube 12fr 43" Entriflex | other | N/A | $2 to $7 | Low |
| Anesthesia for Other Procedure On Upper Front Abdomen | other | N/A | $2 to $700 | Low |
| 20fr Y Ports #m00580641 10ea/bx | other | N/A | $2 to $8 | Low |
| 24fr Y Ports #m00580651 10ea/bx | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 10f/11cm M00115726b1 15-726b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 10f/25cm M00115735b1 15-735b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 11f/25cm M00115736b1 15-736b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 12f/11cm M00115728b1 15-728b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 12f/25cm M00115737b1 15-737b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 14f/11cm M00115740b1 15-740b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 14f/25cm M00115739b1 15-739b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 4f/11cm M00115720b1 15-720b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 5f/11cm M00115721b1 15-721b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 5f/25cm M00115730b1 15-730b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 6f/11cm M00115722b1 15-722b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 6f/25cm M00115731b1 15-731b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 7f/11cm M00115723b1 15-723b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 7f/25cm M00115732b1 15-732b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 8f/11cm M00115724b1 15-724b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 8f/25cm M00115733b1 15-733b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 9f/11cm M00115725b1 15-725b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer Guide Wire Not Included 9f/25cm M00115734b1 15-734b | other | N/A | $2 to $8 | Low |
| Venlafaxine Hcl ER 150 Mg Po Cp24 | other | N/A | $2 to $8 | Low |
| Anesthesia for Total Elbow Joint Replacement | surgery | N/A | $2 to $1,760 | Low |
| Anesthesia for Repair OR Removal of Vagina and Urinary Procedure | surgery | N/A | $2 to $942 | Low |
| Imipramine Hcl 25 Mg Po Tabs | other | N/A | $2 to $8 | Low |
| Catheter Foley 18fr30cc 2way Silver 12ea/dz | cardiac | N/A | $2 to $8 | Low |
| Catheter Foley 20fr 30cc 2way Silver Coat | cardiac | N/A | $2 to $8 | Low |
| Catheter Foley 24fr 30cc 2way Silver 12ea/dz | cardiac | N/A | $2 to $8 | Low |
| Catheter Foley 26fr 30cc 2way 12ea/1cs | cardiac | N/A | $2 to $8 | Low |
| Catheter Foley 28fr 30cc 2way Silver Coated | cardiac | N/A | $2 to $8 | Low |
| Cavilon Adv Skin Protectant #5050 20ea/1cs | other | N/A | $2 to $8 | Low |
| Procto-med Hc 2.5% Cream | other | N/A | $2 to $8 | Low |
| Mask Lma Unique Evo W/cuff Pilot Size 3 | other | N/A | $2 to $8 | Low |
| Mask Lma Unique Evo W/cuff Pilot Size 4 | other | N/A | $2 to $8 | Low |
| Mask Lma Unique Evo W/cuff Pilot Size 5 | other | N/A | $2 to $8 | Low |
| Anesthesia for Insertion of Penile Prosthesis | other | N/A | $2 to $938 | Low |
| Catheter Bern 5fr/65cm/035 Angiograph #31 | imaging | N/A | $2 to $8 | Low |
| Amox-clav 250-62.5 Mg/5 Ml Sus | other | N/A | $2 to $8 | Low |
| Anesthesia for Removal of Testicle Through Groin | surgery | N/A | $2 to $926 | Low |
| Cath Coude Tiemann 22fr Rusch 50ea/1bx | other | N/A | $2 to $8 | Low |
| Pin Ball Cover .045(.9mm) #wo45-yl | other | N/A | $2 to $8 | Low |
| Pin Ball Cover 3/32(2.5mm) #w332-cr | other | N/A | $2 to $8 | Low |
| Duloxetine Hcl 20 Mg Po Cpep | other | N/A | $2 to $8 | Low |
| Duloxetine Hcl Dr 20 Mg Cap | other | N/A | $2 to $8 | Low |
| Gauze, Impregnated, Hydrogel, for Direct Wound Contact, Sterile, Pad Size 16 ... | other | N/A | $2 to $15 | Low |
| Grounding Pad Split #cra-sgp 1cs/10ea | other | N/A | $2 to $8 | Low |
| Hcs Adhesive 2.8x2.8 Medihoney #31722 50/cs | other | N/A | $2 to $8 | Low |
| Refresh Tears 0.5% Eye Drop | other | N/A | $2 to $8 | Low |
| Anesthesia for Other Procedure On Lower Leg, Ankle, and Foot Bones | other | N/A | $2 to $1,480 | Low |
| Mycophenolate Mofetil, Oral, 250 Mg | other | N/A | $2 to $8 | Low |
| Oxymetazoline Hcl 0.05 % Na Soln | other | N/A | $2 to $8 | Low |
| Tropicamide 1% Eye Drops | other | N/A | $2 to $8 | Low |
| Cath Purewick Female Ext Pwf030k 30ea/1cs | other | N/A | $2 to $8 | Low |
| Metronidazole 500 Mg Po Tabs | other | N/A | $2 to $8 | Low |
| Metronidazole 500 Mg Tablet | other | N/A | $2 to $8 | Low |
| Bile Bag with Straps 0015850 12ea/case | other | N/A | $2 to $8 | Low |
| Procare Wrist Adult Left Suede/flannel <5.5" X-small 7"#79 | other | N/A | $2 to $8 | Low |
| Procare Wrist Adult Left Suede/flannel 5.5-6.5" Small 7"#79 | other | N/A | $2 to $8 | Low |
| Procare Wrist Adult Left Suede/flannel 6.5-7.5" Medium 7" #79 | other | N/A | $2 to $8 | Low |
| Procare Wrist Adult Left Suede/flannel 7.5-8.5" Large 7" #79 | other | N/A | $2 to $8 | Low |
| Procare Wrist Adult Left Suede/flannel 8.5+" X-large 7" #79 | other | N/A | $2 to $8 | Low |
| Procare Wrist Adult Right Suede/flannel 5.5-6.5" Small 7"#79 | other | N/A | $2 to $8 | Low |
| Procare Wrist Adult Right Suede/flannel 5.5" X-small 7"#79 | other | N/A | $2 to $8 | Low |
| Procare Wrist Adult Right Suede/flannel 6.5-7.5" Large 7"#79 | other | N/A | $2 to $8 | Low |
| Procare Wrist Adult Right Suede/flannel 6.5-7.5" Medium 7" #79 | other | N/A | $2 to $8 | Low |
| Procare Wrist Adult Right Suede/flannel 8.5+" X-large 7" #79 | other | N/A | $2 to $8 | Low |
| Anesthesia for Repair of Abdominal Wall Hernia | surgery | N/A | $2 to $832 | Low |
| Refresh P.m. Ointment | other | N/A | $2 to $8 | Low |
| Anesthesia for Other Procedure On Artery of Knee | other | N/A | $2 to $1,440 | Low |
| Dilator 10fr #jcd10.0-38 | other | N/A | $2 to $8 | Low |
| Dilator 8fr 20cm | other | N/A | $2 to $8 | Low |
| Anesthesia for Open Amputation Below the Knee | other | N/A | $2 to $1,482 | Low |
| Anesthesia for Other Procedure On Elbow | other | N/A | $2 to $1,740 | Low |
| Diag Catheter 6fr IM Merit #7511 | cardiac | N/A | $2 to $8 | Low |
| Sleeve Advanced Fixation 5x100mm #cfs02 | other | N/A | $2 to $8 | Low |
| Sleeve Z-thread 5x100mm #cts02 | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer with Guide Wire 10f/11cm .035 M00115716b1 15-716b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer with Guide Wire 11f/11cm .035 M00115717b1 15-717b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer with Guide Wire 4f/11cm .035 M00115710b1 15-710b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer with Guide Wire 5f/11cm .035 M00115711b1 15-711b | other | N/A | $2 to $8 | Low |
| Super Sheath Introducer with Guide Wire 9f/11cm .035 M00115715b1 15-715b | other | N/A | $2 to $8 | Low |
| Azelastine 0.1% (137 Mcg) Spry | other | N/A | $2 to $8 | Low |
| Vashe Wound Solution 4 Oz Bottle #00312 24ea/case | other | N/A | $2 to $8 | Low |
| Dotti 0.05 Mg Patch | other | N/A | $2 to $8 | Low |
| Anesthesia for Procedure to Repair Upper Abdominal Incisional Hernia And/or W... | surgery | N/A | $2 to $752 | Low |
| Dotti 0.1 Mg Patch | other | N/A | $2 to $8 | Low |
| Suture Surgilon 6-0 Bk 18 Pc-10 #sbs566g | other | N/A | $2 to $8 | Low |
| Anesthesia for Reconstruction of Breast | other | N/A | $2 to $402 | Low |
| Isentress 100 Mg Powder Packet | other | N/A | $2 to $8 | Low |
| Anesthesia for Other Procedure On Top of Arm Bone and Shoulder Joint | other | N/A | $2 to $1,630 | Low |
| Feed Tube 12fr 43" Dobbhoff Kangaroo 10ea/cs | other | N/A | $2 to $8 | Low |
| Feed Tube 8fr 43" Dobbhoff Kangaroo 10ea/1cs 8884710859e | other | N/A | $2 to $8 | Low |
| Anesthesia for Other Repair of Lower Abdomen Hernia | surgery | N/A | $2 to $834 | Low |
| Anesthesia for Removal of All OR Part of Breast | surgery | N/A | $2 to $404 | Low |
| Anesthesia for Procedure On Gallbladder, Pancreas, OR Liver Using an Endoscope | other | N/A | $2 to $732 | Low |
| Anesthesia for Procedure On Upper Urinary Tubes OR Removal of Kidney for Tran... | surgery | N/A | $2 to $862 | Low |
| Prasugrel 10 Mg Tablet | other | N/A | $2 to $8 | Low |
| Prasugrel Hcl 10 Mg Po Tabs | other | N/A | $2 to $8 | Low |
| Prasugrel Hcl 5 Mg Po Tabs | other | N/A | $2 to $8 | Low |
| Trap Tissue Berkeley Safetouch 10/bx | other | N/A | $2 to $8 | Low |
| Anesthesia for Other Procedure On Collar Bone and Shoulder Blade | other | N/A | $2 to $450 | Low |
| Gelfoam 12-7mm Sponge | other | N/A | $2 to $8 | Low |
| Anesthesia for Procedure On Kneecap And/or Upper Part of Lower Leg Bones | other | N/A | $2 to $1,392 | Low |
| Laryngoscope Handle Dispoled #77700 | other | N/A | $2 to $8 | Low |
| Anesthesia for Other Procedure On Male Genitals | other | N/A | $2 to $920 | Low |
| Anesthesia for Other Procedure On Lower Spine | other | N/A | $2 to $630 | Low |
| Morphine Sulf 10 Mg/5 Ml Soln | other | N/A | $2 to $8 | Low |
| Anesthesia for Other Procedure On Lower Abdomen | other | N/A | $2 to $840 | Low |
| Splint Wrist Lrg Left 1ea | other | N/A | $2 to $8 | Low |
| Splint Wrist Med Right 1ea | other | N/A | $2 to $8 | Low |
| Splint Wrist Sml Left 1ea | other | N/A | $2 to $8 | Low |
| Splint Wrist Sml Right 1ea | other | N/A | $2 to $8 | Low |
| Splint Wrist Xlg Left 1ea | other | N/A | $2 to $8 | Low |
| Splint Wrist Xlg Right 1ea | other | N/A | $2 to $8 | Low |
| Securement Device Picc/cvc 3m #1877 | other | N/A | $2 to $8 | Low |
| Nexium Dr 40 Mg Capsule | other | N/A | $2 to $8 | Low |
| Anesthesia for Other Procedure On Skin of Arms, Legs, and Front Body | other | N/A | $2 to $400 | Low |
| Locking Device W/biopsy Cup #m00545261 | lab | N/A | $2 to $8 | Low |
| Super Sheath Ro Introducer Guide Wire Not Included 4f/11cm M00115960b1 15-960b | other | N/A | $2 to $9 | Low |
| Super Sheath Ro Introducer Guide Wire Not Included 4f/25cm M00115970b1 15-970b | other | N/A | $2 to $9 | Low |
| Super Sheath Ro Introducer Guide Wire Not Included 5f/11cm M00115961b1 15-961b | other | N/A | $2 to $9 | Low |
| Super Sheath Ro Introducer Guide Wire Not Included 5f/25cm M00115971b1 15-971b | other | N/A | $2 to $9 | Low |
| Super Sheath Ro Introducer Guide Wire Not Included 5f/7cm M00115956b1 15-956b | other | N/A | $2 to $9 | Low |
| Super Sheath Ro Introducer Guide Wire Not Included 6f/11cm M00115962b1 15-962b | other | N/A | $2 to $9 | Low |
| Super Sheath Ro Introducer Guide Wire Not Included 6f/25cm M00115965b1 15-965b | other | N/A | $2 to $9 | Low |
| Super Sheath Ro Introducer Guide Wire Not Included 7f/11cm M00115963b1 15-963b | other | N/A | $2 to $9 | Low |
| Super Sheath Ro Introducer Guide Wire Not Included 7f/25cm M00115966b1 15-966b | other | N/A | $2 to $9 | Low |
| Super Sheath Ro Introducer Guide Wire Not Included 8f/11cm M00115964b1 15-964b | other | N/A | $2 to $9 | Low |
| Super Sheath Ro Introducer Guide Wire Not Included 8f/25cm M00115967b1 15-967b | other | N/A | $2 to $9 | Low |
| Super Sheath Ro Introducer Guide Wire Not Included 9f/11cm M00115969b1 15-969b | other | N/A | $2 to $9 | Low |
| Super Sheath Ro Introducer Guide Wire Not Included 9f/25cm M00115968b1 15-968b | other | N/A | $2 to $9 | Low |
| Super Sheath Ro Introducer Guide Wire Not Included 9f/7cm M00115955b1 15-955b | other | N/A | $2 to $9 | Low |
| Anesthesia for Extensive Partial Removal of Rib | surgery | N/A | $2 to $474 | Low |
| Anesthesia for Exam of Knee Joint Using an Endoscope | other | N/A | $2 to $1,382 | Low |
| Anesthesia for Other Procedure On Nerves, Muscles, Tendons, and Tissue of Low... | other | N/A | $2 to $1,470 | Low |
| Methylphenidate Hcl ER (cd) 40 Mg Po Cpcr | other | N/A | $2 to $9 | Low |
| Anesthesia for Closed Procedure On Upper 2/3rd of Thigh Bone | other | N/A | $2 to $1,220 | Low |
| Catheter Single Lumen Infusion 25/cs | surgery | N/A | $2 to $9 | Low |
| Anesthesia for Repair of Achilles Tendon | surgery | N/A | $2 to $1,472 | Low |
| Duloxetine Hcl 30 Mg Po Cpep | other | N/A | $2 to $9 | Low |
| Duloxetine Hcl Dr 30 Mg Cap | other | N/A | $2 to $9 | Low |
| Anesthesia for Closed Procedure On Top of Arm Bone and Shoulder Joint | other | N/A | $2 to $1,620 | Low |
| Anesthesia for Vaginal Removal of Uterus | surgery | N/A | $2 to $944 | Low |
| Exsept Plus Skin and Wound Cleanser #15108 Angelini Pharma 24ea/case | other | N/A | $2 to $9 | Low |
| Anesthesia for Procedure On Tendon of Upper Arm Muscle | other | N/A | $2 to $1,716 | Low |
| Dressing Prisma 4.34 SQ in #ma028 | other | N/A | $2 to $9 | Low |
| Anesthesia for Closed Procedure On Lower Leg, Ankle, and Foot | other | N/A | $2 to $1,462 | Low |
| Injection, Gadoteridol, (prohance Multipack), Per Ml | other | N/A | $2 to $9 | Low |
| Anesthesia for Other Procedure On Female Genitals | other | N/A | $2 to $940 | Low |
| Loestrin 21 1-20 Tablet | other | N/A | $2 to $9 | Low |
| Snare Medium Oval-flex 27mmx240cm #m00562673 | other | N/A | $2 to $9 | Low |
| Abdominal Support 9in 1ea | other | N/A | $2 to $9 | Low |
| Nasal Tampon 4.5cm #400400 20ea/1pk | other | N/A | $2 to $9 | Low |
| Nortriptyline Hcl 25 Mg Cap | other | N/A | $2 to $9 | Low |
| Nortriptyline Hcl 25 Mg Po Caps | other | N/A | $2 to $9 | Low |
| Anesthesia for Removal of Breast Bone Tissue | surgery | N/A | $2 to $550 | Low |
| Transducer Probe Cover X-large L/f #610 | other | N/A | $2 to $9 | Low |
| Dressing Tritec Silver 4x5 Precut 3000112331 | other | N/A | $2 to $9 | Low |
| Thoracic Cath 32f Angled/argyle | other | N/A | $2 to $9 | Low |
| Catheter Tray Add-a-foley Silver 10ea/1cs | cardiac | N/A | $2 to $9 | Low |
| Anesthesia for Other Procedure On Large Bowel Using an Endoscope | other | N/A | $2 to $811 | Low |
| Anesthesia for Procedure On Lower 1/3rd of Thigh Bone | other | N/A | $2 to $1,360 | Low |
| Anesthesia for Procedure On Nerves, Muscles, Tendons, and Tissue of Upper Leg | other | N/A | $2 to $1,250 | Low |
| Gentamicin 0.1% Cream | other | N/A | $2 to $9 | Low |
| Resuscitator Bag W/mask Infant 12ea/1cs Ambu | other | N/A | $2 to $9 | Low |
| Cast Splint 3" X 35" Comformable 10ea/1cs | other | N/A | $2 to $9 | Low |
| Lt200 Ligaclip Medium 36/bx | other | N/A | $2 to $9 | Low |
| Anesthesia for Other Procedure On Upper Abdomen | other | N/A | $2 to $790 | Low |
| Anesthesia for Other Procedure On Urinary System Through Urethra | other | N/A | $2 to $910 | Low |
| Splint Wrist/forearm Left Small 1ea | other | N/A | $2 to $9 | Low |
| Splint Wrist/forearm Left Xlarge | other | N/A | $2 to $9 | Low |
| Splint Wrist/forearm Rt Large 1ea | other | N/A | $2 to $9 | Low |
| Splint Wrist/forearm Rt Small 1ea | other | N/A | $2 to $9 | Low |
| Anesthesia for Relocation of Undescended Testicle Into Scrotum | other | N/A | $2 to $930 | Low |
| Femoral Canal Suction/irrigation Tip 12ea/pk #0210-004 | other | N/A | $2 to $9 | Low |
| Bra Compression White 34 #e5001 | other | N/A | $2 to $9 | Low |
| Bra Compression White 36 #e5001 | other | N/A | $2 to $9 | Low |
| Bra Compression White 38 #e5001 | other | N/A | $2 to $9 | Low |
| Bra Compression White 40 #e5001 | other | N/A | $2 to $9 | Low |
| Bra Compression White 42 #e5001 | other | N/A | $2 to $9 | Low |
| Bra Compression White 44 #e5001 | other | N/A | $2 to $9 | Low |
| Brace Ankle Air Gel 9in Small #79 | other | N/A | $2 to $9 | Low |
| Cerebrospinal Fluid, OR Amniotic Fluid Albumin (protein) Level | other | N/A | $2 to $82,042 | Low |
| Mobility Glove Black Mesh Small #081173632 | other | N/A | $2 to $9 | Low |
| Wheelchair Gloves Large #660802 | other | N/A | $2 to $9 | Low |
| Wheelchair Gloves Medium #660801 | other | N/A | $2 to $9 | Low |
| Wheelchair Gloves Xlarge #660803 | other | N/A | $2 to $9 | Low |
| Anesthesia for Other Procedure On Skin, Muscles, OR Nerves of Head, Neck, and... | other | N/A | $2 to $300 | Low |
| Refresh Lacri-lube Ointment | other | N/A | $2 to $9 | Low |
| 6 Fr Ultimate 4-t40 | other | N/A | $2 to $9 | Low |
| Catheter Foley 14fr 5cc Lf Silver | cardiac | N/A | $2 to $9 | Low |
| Catheter Foley 18fr 5cc Latex Free Silver | cardiac | N/A | $2 to $9 | Low |
| Catheter Foley 20fr Lf 5cc #1758si20 | cardiac | N/A | $2 to $9 | Low |
| Catheter Foley 24fr 5cc Ltx Free Silver | cardiac | N/A | $2 to $9 | Low |
| Anesthesia for Other Procedure OR Exam of Knee Joint Using an Endoscope | other | N/A | $2 to $1,400 | Low |
| Suction Cauterizer 12fr X 6" Handswitch | other | N/A | $2 to $9 | Low |
| Knife 2.75mm Angld Slit Dbl Bevel #ab-asl27db | other | N/A | $2 to $9 | Low |
| Anesthesia for Other Procedure On Nose and Sinuses | other | N/A | $2 to $160 | Low |
| Anesthesia for Removal of Tissue From Around Lung | surgery | N/A | $2 to $542 | Low |
| Celexa 40 Mg Tablet | other | N/A | $2 to $9 | Low |
| Anesthesia for Other Procedure On Hip Joint | other | N/A | $2 to $1,210 | Low |
| Anesthesia for Other Procedure On Lower Front Abdomen | other | N/A | $2 to $800 | Low |
| Brace Ankle Air Gel 8.5in Med #79 | other | N/A | $2 to $9 | Low |
| Sam Splint Standard Roll Gray #61109 | other | N/A | $2 to $9 | Low |
| Anesthesia for Open OR Endoscopic Total Shoulder Joint Replacement | surgery | N/A | $2 to $1,638 | Low |
| Cast Splint 4"x 30" Comformable 1ea | other | N/A | $2 to $9 | Low |
| Corlanor 5 Mg Tablet | other | N/A | $2 to $9 | Low |
| Tip Bone Cleaning #210 | other | N/A | $2 to $9 | Low |
| 6 Fr Cas 1 | other | N/A | $2 to $9 | Low |
| Cannula Arteriotomy 2.3 X 2mm #31102 20/pk | other | N/A | $2 to $9 | Low |
| Cannula Arteriotomy 2.3 X 3mm #31103 20/pk | other | N/A | $2 to $9 | Low |
| Cannula Arteriotomy 2.3 X 4mm #31104 | other | N/A | $2 to $9 | Low |
| Diag Catheter 6fr 3drc #533676 3/bx | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Al1 #533-645 5/bx | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Al2 #533646 5/bx | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Al3 #533647 5/bx | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Angled Pigtail #532652s | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Ar Mod #533648 | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Ar1 Mod #533641 5ea/bx | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Arii Mod #533643 | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr IM #533660 5/bx | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Jl3.5 #533618 | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Jl4 #533 | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Jl5 #533 | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Jr3.5 #533619 | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Jr4 Classic #533 | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Lcb #533672 5/bx | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Mpb2 #533649 5/bx | cardiac | N/A | $2 to $9 | Low |
| Diag Catheter 6fr Rbc #533 | cardiac | N/A | $2 to $9 | Low |
| Cast Stockinette Delta-net Tubular Synthetic 1inx25yd Black #7272300 2rl/case | other | N/A | $2 to $9 | Low |
| Jackson Pratt 15fr Round Drain Sil 1ea | other | N/A | $2 to $9 | Low |
| Fentanyl 12 Mcg/hr Patch | other | N/A | $2 to $9 | Low |
| Atomizer Mucosal Atomization Device | other | N/A | $2 to $9 | Low |
| Clobetasol 0.05% Cream | other | N/A | $2 to $9 | Low |
| Anesthesia for Procedure On Tendon of Elbow to Shoulder | other | N/A | $2 to $1,712 | Low |
| Ankle Gel Splint #79 | other | N/A | $2 to $9 | Low |
| Crutch Adult Tall 300lb 5'10"-6'6" 8pr/1cs | other | N/A | $2 to $9 | Low |
| Crutch Medium Adult 300lb 5'2"-5'10" 8pr/cs | other | N/A | $2 to $9 | Low |
| Crutch Youth 300lb 4'6"-5'2" 8pr/1cs | other | N/A | $2 to $9 | Low |
| Anesthesia for Procedure On Ankle OR Foot Using an Endoscope | other | N/A | $2 to $1,464 | Low |
| Lyrica 100 Mg Capsule | other | N/A | $2 to $9 | Low |
| Lyrica 75 Mg Capsule | other | N/A | $2 to $9 | Low |
| Pregabalin 150 Mg Capsule | other | N/A | $2 to $9 | Low |
| Pregabalin 150 Mg Po Caps | other | N/A | $2 to $9 | Low |
| Pregabalin 25 Mg Capsule | other | N/A | $2 to $9 | Low |
| Pregabalin 25 Mg Po Caps | other | N/A | $2 to $9 | Low |
| Hurricaine One 20% U-d Spray | other | N/A | $2 to $9 | Low |
| Anesthesia for Heart Artery Bypass Grafting On Heart-lung Machine | cardiac | N/A | $2 to $567 | Low |
| Anesthesia for Procedure On Upper 2/3rd of Thigh Bone | other | N/A | $2 to $1,230 | Low |
| Diag Catheter 6fr Mpa1 #7513-b3 | cardiac | N/A | $3 to $9 | Low |
| Diag Catheter 6fr Mpb1 #7513-e3 | cardiac | N/A | $3 to $9 | Low |
| Anesthesia for Closed Procedure On Lower 1/3rd of Thigh Bone | other | N/A | $2 to $1,340 | Low |
| Anesthesia for Procedure On Eye for Corneal Transplant | surgery | N/A | $2 to $144 | Low |
| Budesonide, Inhalation Solution, Fda-approved Final Product, Non-compounded, ... | other | N/A | $3 to $9 | Low |
| Anesthesia for Other Procedure On Large Blood Vessel of Neck | other | N/A | $2 to $350 | Low |
| Cannula Nomoline Lh Adt Gas Sampling Adult Nasal Oral with Oxygen #3824 25ea/box | other | N/A | $3 to $10 | Low |
| Abdominal Support 10in 1ea | other | N/A | $3 to $10 | Low |
| Zzzquil 50 Mg/30 Ml Liquid | other | N/A | $3 to $10 | Low |
| Injection, Phytonadione (vitamin K), Per 1 Mg | other | N/A | $3 to $10 | Low |
| Mesalamine 4 Gm/60 Ml Enema | other | N/A | $3 to $10 | Low |
| Anesthesia for Exam of Shoulder Joint Using an Endoscope | other | N/A | $2 to $1,622 | Low |
| Anesthesia for Repair of Calf Muscle | surgery | N/A | $2 to $1,474 | Low |
| Anesthesia for Repair of Elbow to Shoulder Tendon | surgery | N/A | $2 to $1,714 | Low |
| Belt Gait W/buckle 48" 1ea | other | N/A | $3 to $10 | Low |
| Electrodes, (e.g., Apnea Monitor), Per Pair | other | N/A | $3 to $15 | Low |
| Knife 300 Micron Precision 6ea/bx | other | N/A | $3 to $10 | Low |
| Tetracycline Hcl 500 Mg Po Caps | other | N/A | $3 to $10 | Low |
| Lidocaine-prilocaine 2.5-2.5 % Ex Crea | other | N/A | $3 to $10 | Low |
| Lidocaine-prilocaine Cream | other | N/A | $3 to $10 | Low |
| Ketoconazole 2% Shampoo | other | N/A | $3 to $10 | Low |
| Blm Mouthwash - 10 Ml - Compounded | other | N/A | $3 to $10 | Low |
| First-mouthwash Blm Mt Susp | other | N/A | $3 to $10 | Low |
| Dressing Foam Ultra Silver 4x5ster Mk30051018 | other | N/A | $3 to $10 | Low |
| Nucynta 50 Mg Tablet | other | N/A | $3 to $10 | Low |
| Xifaxan 200 Mg Tablet | other | N/A | $3 to $10 | Low |
| Hook Single Stay 5mm Sharp #3311-1g | other | N/A | $3 to $10 | Low |
| Forceps Cold Biopsy Radial Jaw #m00513334 | lab | N/A | $3 to $10 | Low |
| Adaptive Mug Alimed #2970010571 Pk/20ea | other | N/A | $3 to $10 | Low |
| Ankle Brace-air/gel 10" Universal | other | N/A | $3 to $10 | Low |
| Cervical, Flexible, Non-adjustable, Prefabricated, Off-the-shelf | other | N/A | $3 to $35 | Low |
| Dorzolamide Hcl 2% Eye Drops | other | N/A | $3 to $10 | Low |
| Lidocaine 5% Ointment | other | N/A | $3 to $10 | Low |
| Bandage Comprilan 12cm 20ea/1cs | other | N/A | $3 to $10 | Low |
| Anesthesia for Extensive Procedure On Perineum | other | N/A | $2 to $904 | Low |
| Aspirin 1 Mg/1 Ml Po Suspension | other | N/A | $3 to $10 | Low |
| Belt Gait W/buckle 60" 1ea | other | N/A | $3 to $10 | Low |
| Cast Supplies, Long Arm Splint, Pediatric (0-10 Years), Fiberglass | other | N/A | $3 to $20 | Low |
| Cast Supplies, Short Arm Splint, Pediatric (0-10 Years), Fiberglass | other | N/A | $3 to $20 | Low |
| EKG (Electrocardiogram) | cardiac | N/A | $3 to $93,271 | High |
| Pedialyte Advanced Care Soln | other | N/A | $3 to $10 | Low |
| Pedialyte Solution | other | N/A | $3 to $10 | Low |
| Pr Supplies&materials Above/beyond Prov By Phys/qhp | other | N/A | $3 to $99,070 | Low |
| Vent Tube Paparella Pair (100pr/pk) #1040019 | other | N/A | $3 to $10 | Low |
| Catheter Filiform W/olive Tip 3fr | cardiac | N/A | $3 to $10 | Low |
| Catheter Filiform W/olive Tip 5fr | cardiac | N/A | $3 to $10 | Low |
| Catheter Filiform W/olive Tip 6fr | cardiac | N/A | $3 to $10 | Low |
| **discontinued** Filter Line H Set M1920a 25ea/1cs | other | N/A | $3 to $10 | Low |
| Procare Wrist Adult Left Suede/flannel 5.5-6.5" Small 10"#79 | other | N/A | $3 to $10 | Low |
| Procare Wrist Adult Left Suede/flannel 6.5-7.5" Medium 10" #79 | other | N/A | $3 to $10 | Low |
| Procare Wrist Adult Right Suede/flannel 5.5-6.5" Small 10"#79 | other | N/A | $3 to $10 | Low |
| Procare Wrist Adult Right Suede/flannel 6.5-7.5" Medium 10" #79 | other | N/A | $3 to $10 | Low |
| Procare Wrist Adult Right Suede/flannel 7.5-8.5" Large 10" #79 | other | N/A | $3 to $10 | Low |
| Anesthesia for Procedure to Control Urinary System Bleeding Including Use of ... | other | N/A | $2 to $916 | Low |
| Wrap 2" Edema/pain Kinesio 6ea/1bx | other | N/A | $3 to $10 | Low |
| Anesthesia for Insertion OR Replace of Pacing Heart Defibrillator | cardiac | N/A | $2 to $534 | Low |
| Anesthesia for Other Procedure On Mouth | other | N/A | $2 to $170 | Low |
| Anesthesia for Procedure On Chest with 1 Lung Inflated | other | N/A | $2 to $541 | Low |
| Anesthesia for Insertion of Permanent Heart Pacemaker | cardiac | N/A | $2 to $530 | Low |
| Breast Comfort Gel Pads #17264 50ea/1cs | other | N/A | $3 to $10 | Low |
| Dilator Cook 4fr #g02366 | other | N/A | $3 to $10 | Low |
| Feed Tube Extension Rt Angle Mickey 5ea/1ca | other | N/A | $3 to $10 | Low |
| Feed Tube Extension Set Mickey Secure 5ea/1ca | other | N/A | $3 to $10 | Low |
| Catheter Tray Sure Step Add a Foley Silver | cardiac | N/A | $3 to $10 | Low |
| Knee Immobilizer-16" Med | other | N/A | $3 to $10 | Low |
| Nucynta ER 50 Mg Tablet | other | N/A | $3 to $10 | Low |
| Acuvail 0.45% Ophth Solution | other | N/A | $3 to $10 | Low |
| Anesthesia for Procedure for Total Knee Joint Replacement | surgery | N/A | $2 to $1,402 | Low |
| Anesthesia for Removal of Prostate Including Use of an Endoscope | surgery | N/A | $2 to $914 | Low |
| Diclofenac Sodium 1% Gel | other | N/A | $3 to $10 | Low |
| Anesthesia for Procedure On Lower Rear Abdomen | other | N/A | $2 to $820 | Low |
| Morphine Sulf 100 Mg/5 Ml Conc | other | N/A | $3 to $10 | Low |
| Anesthesia for Procedure On Anus and Rectum | other | N/A | $2 to $902 | Low |
| Graft Sizer Disp Sz 24mm-38mm #m002363200211 | other | N/A | $3 to $10 | Low |
| Elmiron 100 Mg Capsule | other | N/A | $3 to $10 | Low |
| Anesthesia for Other Procedure On Face Bones OR Skull | other | N/A | $2 to $190 | Low |
| Hemoclip Small Titan Cartridge 25ea/bx Yellow | other | N/A | $3 to $10 | Low |
| Ligating Clip Small 24/pkg #1205 Horizon | other | N/A | $3 to $10 | Low |
| Fluticasone Prop 50 Mcg Spray | other | N/A | $3 to $10 | Low |
| Fluticasone Propionate 50 Mcg/act Na Susp | other | N/A | $3 to $10 | Low |
| Entresto 24 Mg-26 Mg Tablet | other | N/A | $3 to $10 | Low |
| Entresto 49 Mg-51 Mg Tablet | other | N/A | $3 to $10 | Low |
| Entresto 97 Mg-103 Mg Tablet | other | N/A | $3 to $10 | Low |
| Forcep Surgical Lucae Serrated Bayonet 5.5in | surgery | N/A | $3 to $11 | Low |
| Trap Polyp Endo Suction #h334 #bx00711099 | other | N/A | $3 to $11 | Low |
| Transducer Kit-disposable | other | N/A | $3 to $11 | Low |
| Anesthesia for Heart Artery Bypass Grafting | cardiac | N/A | $2 to $566 | Low |
| Anesthesia for Lens Surgery | surgery | N/A | $2 to $142 | Low |
| Wrist/thumb Brace with Thumb Spica Left Cotton/foam Large/x-large #79 | other | N/A | $3 to $11 | Low |
| Wrist/thumb Brace with Thumb Spica Right Cotton/foam Large/x-large #79 | other | N/A | $3 to $11 | Low |
| Anesthesia for Removal of Urinary Bladder Tumors Including Use of an Endoscope | surgery | N/A | $2 to $912 | Low |
| Desvenlafaxine Succnt ER 25 Mg | other | N/A | $3 to $11 | Low |
| Methylphenidate Hcl ER (cd) 50 Mg Po Cpcr | other | N/A | $3 to $11 | Low |
| Methylphenidate Hcl ER (cd) 60 Mg Po Cpcr | other | N/A | $3 to $11 | Low |
| Fluid Warming Set Std Flow 3m Ranger 24240 | other | N/A | $3 to $11 | Low |
| Dressing Col-active Ag Plus 4x4 #10340000 | other | N/A | $3 to $11 | Low |
| Procare Super Knee Splint Adult Foam 14-16" Small #79 | other | N/A | $3 to $11 | Low |
| Procare Super Knee Splint Adult Foam 16-19" Medium 20" #79 | other | N/A | $3 to $11 | Low |
| Procare Super Knee Splint Adult Foam 19-22" Large #79 | other | N/A | $3 to $11 | Low |
| Anesthesia for Amputation On Upper 2/3rd of Thigh Bone | other | N/A | $2 to $1,232 | Low |
| Eszopiclone 2 Mg Po Tabs | other | N/A | $3 to $11 | Low |
| Anesthesia for Fragmenting, Manipulation And/or Removal of Kidney Stone Inclu... | surgery | N/A | $2 to $918 | Low |
| Forcep Surgical Tiss Del 4.75in Reuse 130 | surgery | N/A | $3 to $11 | Low |
| Tetracaine 0.5% Steri-unit Sol | other | N/A | $3 to $11 | Low |
| Marker Coronary Bypass Graft #40149 | cardiac | N/A | $3 to $11 | Low |
| Wheels Walker Guardian #7722 for Walker 1pr | other | N/A | $3 to $11 | Low |
| Guaifen-codeine 100-10 Mg/5 Ml | other | N/A | $3 to $11 | Low |
| Mepilex Ag Antimicrobial Foam Dressings with Safetac Technology 4" X 5" | other | N/A | $3 to $11 | Low |
| Wound Irrigation Cap System # Irig8 Centurion | other | N/A | $3 to $11 | Low |
| Anesthesia for Procedure to Correct Abnormal Heart Rhythm | cardiac | N/A | $2 to $410 | Low |
| Anesthesia for Other Procedure On Arteries of Upper Arm and Elbow | other | N/A | $2 to $1,770 | Low |
| 12 Ga Sertera Introducer5ea/bx #sertera Intro | other | N/A | $3 to $11 | Low |
| Cannula Nasal Adult 4m Co2/o2 Nomoline Lh #4624 25ea/box | other | N/A | $3 to $11 | Low |
| Catheterization for Collection of Specimen, Single Patient, All Places of Ser... | lab | N/A | $3 to $22 | Low |
| Clobetasol 0.05% Ointment | other | N/A | $3 to $11 | Low |
| Knife 2.4mm Angld Slit Dbl Bevel #ab-asl24db | other | N/A | $3 to $11 | Low |
| Rd Sedline Eeg Sensor 25/box #4248 | other | N/A | $3 to $11 | Low |
| Splint Wrist 8" #b | other | N/A | $3 to $11 | Low |
| Introducer Bougie Coude Tip Adult 15fr X 70cm | other | N/A | $3 to $11 | Low |
| Introducer Bougie Coude Tip Peds 10fr X 70cm | other | N/A | $3 to $11 | Low |
| Univ Ankle Brace #79 | other | N/A | $3 to $11 | Low |
| Anesthesia for Other Procedure On Upper Spine | other | N/A | $2 to $600 | Low |
| Lopinavir-ritonavr 200-50mg Tb | other | N/A | $3 to $11 | Low |
| Tube Medihoney Gel 1.5 Oz #31815 | other | N/A | $3 to $11 | Low |
| Support Ankle Stabilizing Large #79 | other | N/A | $3 to $11 | Low |
| Support Ankle Stabilizing Medium #79 | other | N/A | $3 to $11 | Low |
| Support Ankle Stabilizing Small #79 | other | N/A | $3 to $11 | Low |
| Exofin Precision Pen Skin Adhesive #ep70412 12ea/bx | other | N/A | $3 to $11 | Low |
| Lymphedema Tube Gauze Band Med Tg7 18ea/1cs | other | N/A | $3 to $11 | Low |
| Anesthesia for Exam of Uterus Using an Endoscope | other | N/A | $2 to $952 | Low |
| Coban 2 #2094 1bx=1kit | other | N/A | $3 to $11 | Low |
| Coban 2 Lite #2794 1bx=1kit | other | N/A | $3 to $11 | Low |
| Doxycycline 25 Mg/5 Ml Susp | other | N/A | $3 to $11 | Low |
| Collar Button Vent Tube 60 Ea/bx 70241060 | other | N/A | $3 to $11 | Low |
| Wheels Walker Heavy Duty Extn Set #g07725 1st | other | N/A | $3 to $11 | Low |
| Nix 1% Creme Rinse Liquid | other | N/A | $3 to $11 | Low |
| Splint Hand Mason Allen Small 1ea | other | N/A | $3 to $11 | Low |
| Brace Ankle As0 Large #ab2900 | other | N/A | $3 to $11 | Low |
| Brace Ankle As0 Medium #ab2900 | other | N/A | $3 to $11 | Low |
| Brace Ankle As0 Small #ab2900 | other | N/A | $3 to $11 | Low |
| Brace Ankle As0 Xlarge #ab2900 | other | N/A | $3 to $11 | Low |
| Anesthesia for Other Procedure On External Middle and Inner Ear | other | N/A | $2 to $120 | Low |
| Nasal Tampon 8.0 Cm 20ea/1pk | other | N/A | $3 to $11 | Low |
| Lymphedema Tube Gauze Band Lrg Tg9 12ea/1cs | other | N/A | $3 to $11 | Low |
| Cast Splint 5" X 30" Comformable 10ea/1cs | other | N/A | $3 to $11 | Low |
| Catheter Malecot 14fr #086014 | cardiac | N/A | $3 to $12 | Low |
| Catheter Malecot 16fr #086016 | cardiac | N/A | $3 to $12 | Low |
| Catheter Malecot 20fr #086020 | cardiac | N/A | $3 to $12 | Low |
| Catheter Malecot 30fr #086030 | cardiac | N/A | $3 to $12 | Low |
| Anucort-hc 25 Mg Suppository | other | N/A | $3 to $12 | Low |
| Hydrocortisone Acetate 25 Mg Re Supp | other | N/A | $3 to $12 | Low |
| Trocar Natura Cannula 5mmx100mm #100-005 | other | N/A | $3 to $12 | Low |
| Needle Jamshidi Infant Disp | other | N/A | $3 to $12 | Low |
| Diovan 320 Mg Tablet | other | N/A | $3 to $12 | Low |
| Ocular Device, Intraoperative, Detached Retina | other | N/A | $3 to $12 | Low |
| Set Airway Adapter Adult/pediatric Nomoline-o Lh #4630 25ea/box | other | N/A | $3 to $12 | Low |
| Dilator 10fr 20cm G10207 | other | N/A | $3 to $12 | Low |
| Dilator 6fr 20cm #g10284 | other | N/A | $3 to $12 | Low |
| Trueplus Glucose 15 Gram Liq | other | N/A | $3 to $12 | Low |
| Ritalin La 10 Mg Capsule | other | N/A | $3 to $12 | Low |
| Ritalin La 20 Mg Capsule | other | N/A | $3 to $12 | Low |
| Catheter Guard Cont Shield 25ea/1cs | cardiac | N/A | $3 to $12 | Low |
| Ortho-glass Splint W4xl30in Fiberglass Double Sided Padded #og-430pc 5ea/bx | other | N/A | $3 to $12 | Low |
| Anesthesia for Procedure On Heart and Large Blood Vessels Using Heart-lung Ma... | cardiac | N/A | $3 to $563 | Low |
| Male External Catheter, with OR without Adhesive, Disposable, Each | cardiac | N/A | $3 to $12 | Low |
| Cath Rim 5ea/bx | other | N/A | $3 to $12 | Low |
| Anesthesia for Other Procedure On Neck Area | other | N/A | $2 to $320 | Low |
| Nasal Tampon 10.0 Cm 20ea/1pk #10115-c | other | N/A | $3 to $12 | Low |
| High Osmolar Contrast Material, 350-399 Mg/ml Iodine Concentration, Per Ml | other | N/A | $3 to $12 | Low |
| Ritalin La 30 Mg Capsule | other | N/A | $3 to $12 | Low |
| Crutch Youth 300lb 4'6"-5'2" 8pr/case | other | N/A | $3 to $12 | Low |
| Splint Knee Univ 18" Basic #79 | other | N/A | $3 to $12 | Low |
| Vyvanse 10 Mg Capsule | other | N/A | $3 to $12 | Low |
| Vyvanse 20 Mg Capsule | other | N/A | $3 to $12 | Low |
| Vyvanse 30 Mg Capsule | other | N/A | $3 to $12 | Low |
| Vyvanse 40 Mg Capsule | other | N/A | $3 to $12 | Low |
| Vyvanse 50 Mg Capsule | other | N/A | $3 to $12 | Low |
| Vyvanse 60 Mg Capsule | other | N/A | $3 to $12 | Low |
| Vyvanse 70 Mg Capsule | other | N/A | $3 to $12 | Low |
| Cath Foley 26fr 30cc 3-way 12ea/1dz | other | N/A | $3 to $12 | Low |
| Catheter Foley 16fr 30cc 3way Silver Coat | cardiac | N/A | $3 to $12 | Low |
| Catheter Foley 18fr 30cc 3way Silver Coat | cardiac | N/A | $3 to $12 | Low |
| Coagulator Foot Control Suction 10fr #130187 | other | N/A | $3 to $12 | Low |
| Vimpat 50 Mg Tablet | other | N/A | $3 to $12 | Low |
| Chiba Biopsy Needle 20ga L20cm Aspiration #g00810 | lab | N/A | $3 to $12 | Low |
| Chiba Biopsy Needle Dchn-20-15.0 #g00777 | lab | N/A | $3 to $12 | Low |
| Dressing Wound Drawtex Wrap 4"x11.5 Ft #00352 | other | N/A | $3 to $12 | Low |
| Angiocath 16ga 3-1/4 Bd #382258 | other | N/A | $3 to $12 | Low |
| Dressing Mepilex Border Sacrum 7.2x7.2 Foam | other | N/A | $3 to $12 | Low |
| Guide Spring J-wire Curved 150cm | other | N/A | $3 to $12 | Low |
| Light Compression Bandage, Elastic, Knitted/woven, Width Greater Than OR Equa... | other | N/A | $3 to $24 | Low |
| Perfusion Set Y-type 20/bx #per-1006s | surgery | N/A | $3 to $12 | Low |
| Topical Skin Adhesive 2-octyl Lx6 6ea/1bx | other | N/A | $3 to $12 | Low |
| Urinary Drainage Bag, Leg OR Abdomen, Vinyl, with OR without Tube, with Strap... | other | N/A | $3 to $24 | Low |
| Collection Trap System Safetouch OB Gyn | other | N/A | $3 to $12 | Low |
| Dronedarone 200 Mg Half Tablet | other | N/A | $3 to $12 | Low |
| Fentanyl 50 Mcg/hr Patch | other | N/A | $3 to $12 | Low |
| Multaq 400 Mg Tablet | other | N/A | $3 to $12 | Low |
| Thoracic Chest Tube 24fr 10ea/1bx | other | N/A | $3 to $12 | Low |
| Alginate OR Other Fiber Gelling Dressing, Wound Cover, Sterile, Pad Size 16 S... | other | N/A | $3 to $24 | Low |
| Boots Sta-dri Knee-hi #kh | other | N/A | $3 to $12 | Low |
| Forcep Surgical Dressing Serrated 4.5in | surgery | N/A | $3 to $12 | Low |
| Strattera 18 Mg Capsule | other | N/A | $3 to $12 | Low |
| Mirabegron ER 50 Mg Po Tb24 | other | N/A | $3 to $12 | Low |
| Mirabegron ER 50 Mg Tablet | other | N/A | $3 to $12 | Low |
| Anesthesia for Closed Procedure On Hip Joint | other | N/A | $3 to $1,200 | Low |
| Ritalin La 40 Mg Capsule | other | N/A | $3 to $12 | Low |
| Dilator Syracuse Medic Vaginal Small 7/8 22mm #sm-vd-s | other | N/A | $3 to $12 | Low |
| Dilator Syracuse Medical Vaginal X-small Plus 1 1/16 18mm #sm-vd-xs Plus | other | N/A | $3 to $12 | Low |
| Dilator Vaginal Syracuse Med X-small 1/2 13mm #sm-vd-xs | other | N/A | $3 to $12 | Low |
| Valacyclovir Hcl 500 Mg Po Tabs | other | N/A | $3 to $12 | Low |
| Valacyclovir Hcl 500 Mg Tablet | other | N/A | $3 to $12 | Low |
| Splint Hand Mason Allen Large 1ea | other | N/A | $3 to $12 | Low |
| Sorbitol 70% Solution | other | N/A | $3 to $12 | Low |
| Stylet Gliderite Single Use Large 0270 | other | N/A | $3 to $12 | Low |
| Catheter Malecot 22fr #086022 | cardiac | N/A | $3 to $12 | Low |
| Catheter Malecot 24fr #086024 | cardiac | N/A | $3 to $12 | Low |
| Catheter Malecot 26fr #086026 | cardiac | N/A | $3 to $12 | Low |
| Catheter Malecot 28fr #086028 | cardiac | N/A | $3 to $12 | Low |
| Knee Immobilizer-22" Long | other | N/A | $3 to $12 | Low |
| Injection, Hydromorphone, 0.1 Mg | other | N/A | $3 to $12 | Low |
| Tc-99m From Non-highly Enriched Uranium Source, Full Cost Recovery Add-on, Pe... | other | N/A | $3 to $13 | Low |
| Splint Knee Univ 20" Basic #79 | other | N/A | $3 to $13 | Low |
| Tube Vent Collar Button #70241014 | other | N/A | $3 to $13 | Low |
| Bard Foley Drainage Syestem #a304400a | other | N/A | $3 to $13 | Low |
| Estradiol 0.05 Mg Patch | other | N/A | $3 to $13 | Low |
| Tube Salem Sump 10fr Ltx Fr W/reflux Filter | other | N/A | $3 to $13 | Low |
| Anesthesia for Other Procedure On Lower Abdomen Outside Abdominal Cavity | other | N/A | $2 to $860 | Low |
| Cast Stockinette Delta-net Tubular Synthetic 2inx25yd Black #7272301 2rl/case | other | N/A | $3 to $13 | Low |
| Roylan Wr Brace 6" Left-large | other | N/A | $3 to $13 | Low |
| Roylan Wr Brace 6" Left-medium | other | N/A | $3 to $13 | Low |
| Roylan Wr Brace 6" Left-small | other | N/A | $3 to $13 | Low |
| Roylan Wr Brace 6" Left-xlarge | other | N/A | $3 to $13 | Low |
| Roylan Wr Brace 6" Right Medium | other | N/A | $3 to $13 | Low |
| Roylan Wr Brace 6" Right-large | other | N/A | $3 to $13 | Low |
| Roylan Wr Brace 6" Right-xlarge | other | N/A | $3 to $13 | Low |
| Roylan Wr Brace 6" Rt-small | other | N/A | $3 to $13 | Low |
| Splint Knee Univ 22" Basic #79 | other | N/A | $3 to $13 | Low |
| Anesthesia for Closed Procedure On Knee Joint | other | N/A | $3 to $1,380 | Low |
| Prevacid Dr 30 Mg Solutab | other | N/A | $3 to $13 | Low |
| Simple Syrup | other | N/A | $3 to $13 | Low |
| Walker Basket 1ea | other | N/A | $3 to $13 | Low |
| Betamethasone Va 0.1% Cream | other | N/A | $3 to $13 | Low |
| Collar Button Vent Tube 1.27mm Uncoated Silicon 6/pk #240014 | other | N/A | $3 to $13 | Low |
| Oxycontin ER 40 Mg Tablet | other | N/A | $3 to $13 | Low |
| Bone Wax 2.5 Gram Non-absorbable #bw25g | other | N/A | $3 to $13 | Low |
| Don-joy Knee Immoblizer 20" #79 | other | N/A | $3 to $13 | Low |
| Dressing Gel Silvasorb 1.5oz #msc9301ep | other | N/A | $3 to $13 | Low |
| Dilator Syracuse Med Vaginal Sm Plus 1" 25mm #sm-vd-s Plus | other | N/A | $3 to $13 | Low |
| Drain Btl W/o Drainln 1000m 12ea/1cs #sv1000s | other | N/A | $3 to $13 | Low |
| Snare Loop Hexagonal #m00562341 | other | N/A | $3 to $13 | Low |
| Chiba 22g X 20cm Needle | other | N/A | $3 to $13 | Low |
| Chiba Biopsy Needle Dchn-22-15.0 #g00012 | lab | N/A | $3 to $13 | Low |
| Hydrocolloid Dressing, Wound Cover, Sterile, Pad Size 16 Sq. In. OR Less, wit... | other | N/A | $3 to $26 | Low |
| Electrode Dysphagia Therapy 1.0" #05a160 | other | N/A | $3 to $13 | Low |
| Hospital Observation Service, Per Hour | other | N/A | $3 to $13 | Low |
| Needle Insufflation Laproscopic | other | N/A | $3 to $13 | Low |
| Sprotte 27g X 4'' (103mm) Needle with Introducer and Magnifying Hub Minimum O... | other | N/A | $3 to $13 | Low |
| Anesthesia for Closed Exam of Chest Using an Endoscope with 1 Lung Inflated | other | N/A | $3 to $529 | Low |
| Detector Co2 Easy Colorimetric Indicator Adult #562134 10ea/1cs | other | N/A | $3 to $13 | Low |
| Sump Intracardiac 12fr #12013 20/bx | cardiac | N/A | $3 to $13 | Low |
| Tube Vent Armstrong 1.14mm Short #10 | other | N/A | $3 to $13 | Low |
| Sleeve Scd Knee Lengthmed Comfrt#74022 5pr/cs | other | N/A | $3 to $13 | Low |
| Anesthesia for Extensive Surgery On Spine | surgery | N/A | $3 to $670 | Low |
| Tube Inner Ear Myringotomy Ventilation Notched Flange with Tab 1.14 Mm Id Sil... | other | N/A | $3 to $13 | Low |
| Anesthesia for Procedure to Assess Heart Electrical Activity | cardiac | N/A | $3 to $537 | Low |
| Xarelto 10 Mg Tablet | other | N/A | $4 to $13 | Low |
| Hemoclip Medium Titan Cartridge #002204 24ea/pk/ 25pk/bx Blue | other | N/A | $4 to $13 | Low |
| Anesthesia for Retinal Surgery | surgery | N/A | $3 to $145 | Low |
| Comfortform Left Wrist/thumb Adult Foam Laminate 5.5-6.5" Small 7.5" #79 | other | N/A | $4 to $13 | Low |
| Comfortform Left Wrist/thumb Adult Foam Laminate 6.5-7.5" Medium 8" #79 | other | N/A | $4 to $13 | Low |
| Comfortform Left Wrist/thumb Adult Foam Laminate 7.5-8.5" Large 8.5" #79 | other | N/A | $4 to $13 | Low |
| Comfortform Right Wrist/thumb Adult Foam Laminate 5.5-6.5" Small 7.5"#79 | other | N/A | $4 to $13 | Low |
| Comfortform Right Wrist/thumb Adult Foam Laminate 6.5-7.5" Medium 8"#79 | other | N/A | $4 to $13 | Low |
| Comfortform Right Wrist/thumb Adult Foam Laminate 7.5-8.5" Large 8.5"#79 | other | N/A | $4 to $13 | Low |
| Comfortform Right Wrist/thumb Adult Foam Laminate 8.5+" X-large 7.5"#79 | other | N/A | $4 to $13 | Low |
| Diovan Hct 320-12.5 Mg Tab | other | N/A | $4 to $13 | Low |
| Strattera 60 Mg Capsule | other | N/A | $4 to $13 | Low |
| Sodium Chloride Uromatic Irrigation .9% 3000ml Baxter Product Code #2b7127 4e... | other | N/A | $4 to $13 | Low |
| 5 Fr Barbeau | other | N/A | $4 to $13 | Low |
| 5 Fr IM | other | N/A | $4 to $13 | Low |
| 5 Fr Jr 3.5 | other | N/A | $4 to $13 | Low |
| Diag Catheter 5fr Jl4 #534520t | cardiac | N/A | $4 to $13 | Low |
| Diag Catheter 5fr Jr4 #534521t | cardiac | N/A | $4 to $13 | Low |
| Anesthesia for Procedure On Eyelid | other | N/A | $3 to $103 | Low |
| Kittner Lap Dual Tip 20/bx Kt | other | N/A | $4 to $13 | Low |
| Ortho-glass Splint W3xl35in Fiberglass Double Sided Padded #og-335pc 5ea/bx | other | N/A | $4 to $13 | Low |
| Thoracic Chest Tube 36fr 10ea/1cs | other | N/A | $4 to $13 | Low |
| Vashe Wound Therapy 250ml Bottle #00313 | other | N/A | $4 to $13 | Low |
| Mask Procedural O2 Adult Elite 301-0318lt-msa | other | N/A | $4 to $13 | Low |
| Knife 1mm Angled Dual Bevel 6/bx | other | N/A | $4 to $13 | Low |
| Stone Interceptor 12ea/1pk | other | N/A | $4 to $13 | Low |
| Pantoprazole Sod Dr 40 Mg Tab | other | N/A | $4 to $13 | Low |
| Pantoprazole Sodium 40 Mg Po Tbec | other | N/A | $4 to $13 | Low |
| Anesthesia for Other Procedure On Eye | other | N/A | $3 to $140 | Low |
| Digi-flex Exercisor Green 5.0lbs | other | N/A | $4 to $13 | Low |
| Digi-flex Exercisor Red 3.0lbs | other | N/A | $4 to $13 | Low |
| Foot Brush 1ea | other | N/A | $4 to $13 | Low |
| Cyclopentolate 1% Eye Drops | other | N/A | $4 to $13 | Low |
| Donaldson Vent Tube 1.14 Mm I.d. Ultrasil Silicone 6 Ea/bx 70241015 | other | N/A | $4 to $13 | Low |
| Cast Supplies, Short Arm Cast, Adult (11 Years +), Plaster | other | N/A | $4 to $27 | Low |
| Escitalopram 10 Mg Tablet | other | N/A | $4 to $14 | Low |
| Escitalopram Oxalate 10 Mg Po Tabs | other | N/A | $4 to $14 | Low |
| Atovaquone 750 Mg/5ml Susp Cup | other | N/A | $4 to $14 | Low |
| Fluocinonide 0.05% Ointment | other | N/A | $4 to $14 | Low |
| Forcep Surgical Tissue Teeth 1x2 4.5in | surgery | N/A | $4 to $14 | Low |
| Dressing Acticoat Flex 7 4x5in Strl #66800405 | other | N/A | $4 to $14 | Low |
| Irrigation Tur Y Set 80" #2c4041 12ea/1ca | other | N/A | $4 to $14 | Low |
| Dilator Syracuse Med Vaginal Medium 1 1/8 29mm #sm-vd-m | other | N/A | $4 to $14 | Low |
| Clobazam 5 Mg Half Tablet | other | N/A | $4 to $14 | Low |
| Catheter Trocar 10fr 10ea/1bx | cardiac | N/A | $4 to $14 | Low |
| Catheter Trocar 20fr 10ea/1cs | cardiac | N/A | $4 to $14 | Low |
| Needle Cook 19x15 #g06275 | other | N/A | $4 to $14 | Low |
| Clotrimazole 1 % Ex Soln | other | N/A | $4 to $14 | Low |
| Purastat Catheter 20ea/bxwp-18/2200 | cardiac | N/A | $4 to $14 | Low |
| Bovie High Temp Fine Tip Cautery Surgical Disposable Aspen # Aa01 10ea/1bx | surgery | N/A | $4 to $14 | Low |
| Catheter, Ureteral | cardiac | N/A | $4 to $14 | Low |
| Nystatin 100,000 Unit/gm Cream | other | N/A | $4 to $14 | Low |
| Nystatin 100000 Unit/gm Ex Crea | other | N/A | $4 to $14 | Low |
| Promote Liquid | other | N/A | $4 to $14 | Low |
| Suction System Oral Swab Kit 20/cs #6464 | other | N/A | $4 to $14 | Low |
| Oseltamivir Phos 75 Mg Capsule | other | N/A | $4 to $14 | Low |
| Oseltamivir Phosphate 75 Mg Po Caps | other | N/A | $4 to $14 | Low |
| Lap 5mm Sump Cannula Gleeson Flovac | other | N/A | $4 to $14 | Low |
| Lexapro 20 Mg Tablet | other | N/A | $4 to $14 | Low |
| Opthalmic Burr 10ea/1bx | other | N/A | $4 to $14 | Low |
| Cannula Ima 1mm Tip #31001 | other | N/A | $4 to $14 | Low |
| Espocaná18 Ga. X 3+ In. Tuohy with Backeye Lumen Pencan Á27 Ga. X 5 In. Penci... | other | N/A | $4 to $14 | Low |
| Myrbetriq ER 25 Mg Tablet | other | N/A | $4 to $14 | Low |
| Cannula Hydroexpression (corydon) 10/sp | other | N/A | $4 to $14 | Low |
| Strattera 80 Mg Capsule | other | N/A | $4 to $14 | Low |
| Sump Cardiac 20fr #12112 20/bx | cardiac | N/A | $4 to $14 | Low |
| Sterilid Eyelid Cleanser Foam | other | N/A | $4 to $14 | Low |
| Arch Support Medium #mdy10520 | other | N/A | $4 to $14 | Low |
| Probe Myocardial Temp 15mm 20/bx | other | N/A | $4 to $14 | Low |
| Restraint Vest Medium 3350m | other | N/A | $4 to $14 | Low |
| Restraint Vest Small 3350s | other | N/A | $4 to $14 | Low |
| Restraint Vest Xlarge 3350xl | other | N/A | $4 to $14 | Low |
| Catheter Foley Coude 18fr 5cc Silver 12ea/1cs | cardiac | N/A | $4 to $14 | Low |
| Catheter Foley Coude 20fr 5cc Silver 12ea/1cs | cardiac | N/A | $4 to $14 | Low |
| Knee Immobilizer 24" X-long | other | N/A | $4 to $14 | Low |
| Epidural Anes Kit-18ga Burron 10ea/1cs | other | N/A | $4 to $14 | Low |
| Sleeve Foot Compression Regular #5897 10ea/cs | other | N/A | $4 to $14 | Low |
| Dilator Vaginal Syracuse Medical Med Plus 1 1/4 32mm #sm-vd-m Plus | other | N/A | $4 to $15 | Low |
| Tradjenta 5 Mg Tablet | other | N/A | $4 to $15 | Low |
| Catheter Mediastinal 10/bx #14409 | cardiac | N/A | $4 to $15 | Low |
| Ortho-glass Splint W5xl30in Fiberglass Double Sided Paddedog-5pc 5ea/bx | other | N/A | $4 to $15 | Low |
| Abdominal Support 12in 1ea | other | N/A | $4 to $15 | Low |
| Needle Weiss 18ga X 5" 10/bx | other | N/A | $4 to $15 | Low |
| Trap Digit Finger Large #9903 | other | N/A | $4 to $15 | Low |
| Sleeve Foot Compression Large #5898 10ea/1cs | other | N/A | $4 to $15 | Low |
| 25-40cc Iabp Adaptor#0684-00-0510-01 5ea/pk | other | N/A | $4 to $15 | Low |
| Probe Cover Civ-flex 5.5"x96"sterile 610 | other | N/A | $4 to $15 | Low |
| Knife 2.75mm Angled Split | other | N/A | $4 to $15 | Low |
| Trap Digit Finger Small .63 #9906 Bx/20ea | other | N/A | $4 to $15 | Low |
| Jardiance 10 Mg Tablet | other | N/A | $4 to $15 | Low |
| Jardiance 25 Mg Tablet | other | N/A | $4 to $15 | Low |
| Mirror Flexible #6220 1ea | other | N/A | $4 to $15 | Low |
| Dilator Vaginal Syracuse Medical Large 1 3/8 35mm #sm-vd-l | other | N/A | $4 to $15 | Low |
| Polyethylene Glycol 3350 17 Gm/scoop Po Powd | other | N/A | $4 to $15 | Low |
| Application of Hot OR Cold Packs | other | N/A | $4 to $97,010 | Low |
| Blanket-nsy Disp Therm Med #37.09.15 | other | N/A | $4 to $15 | Low |
| Blanket-nsy Disp Therm Sm #37.09.14 | other | N/A | $4 to $15 | Low |
| Cast Supplies, Gauntlet Cast (includes Lower Forearm and Hand), Pediatric (0-... | other | N/A | $4 to $30 | Low |
| Cast Supplies, Long Arm Cast, Adult (11 Years +), Plaster | other | N/A | $4 to $30 | Low |
| Diovan Hct 320-25 Mg Tablet | other | N/A | $4 to $15 | Low |
| Guidewire W/ Trocar Tip 0.45" #ar-8737 | other | N/A | $4 to $15 | Low |
| Injection, Aztreonam, 500 Mg | other | N/A | $4 to $30 | Low |
| Non-elastic Binder for Extremity | other | N/A | $4 to $30 | Low |
| Nystatin-triamcinolone 100000-0.1 Unit/gm-% Ex Crea | other | N/A | $4 to $15 | Low |
| Nystatin-triamcinolone Cream | other | N/A | $4 to $15 | Low |
| Osmolite 1.5 Cal Liquid | other | N/A | $4 to $15 | Low |
| Smoke Elimination Device 15/cs | other | N/A | $4 to $15 | Low |
| Smoking and Tobacco Use Intermediate Counseling, 3-10 Minutes | therapy | N/A | $4 to $99,406 | Low |
| Needle Jamshidi Adult Disp | other | N/A | $4 to $15 | Low |
| Knee Immobilizer-12" X-small | other | N/A | $4 to $15 | Low |
| Trintellix 10 Mg Tablet | other | N/A | $4 to $15 | Low |
| Trintellix 5 Mg Tablet | other | N/A | $4 to $15 | Low |
| Vortioxetine Hbr 10 Mg Po Tabs | other | N/A | $4 to $15 | Low |
| Oxymorphone Hcl ER 20 Mg Tab | other | N/A | $4 to $15 | Low |
| Prosthetic Sock, Single Ply, Fitting, Below Knee, Each | other | N/A | $4 to $15 | Low |
| CPAP Nasal Mask Large #niv042l | other | N/A | $4 to $15 | Low |
| Docusate Sodium 50 Mg/5 Ml Liq | other | N/A | $4 to $15 | Low |
| Dressing Contact Layer W6xl8in Silver Urgotul #509342 10ea/bx | other | N/A | $4 to $15 | Low |
| 4fr Simmons 1 | other | N/A | $4 to $15 | Low |
| 4fr Sos 1 | other | N/A | $4 to $15 | Low |
| 5fr Simmons 2 | other | N/A | $4 to $15 | Low |
| 5fr Sos 2 | other | N/A | $4 to $15 | Low |
| Binder Abdominal 12" 46-62" #13982000 | other | N/A | $4 to $15 | Low |
| Snare Cold Captivator 10mm Rnd M00561103 | other | N/A | $4 to $15 | Low |
| Intubated Filter Lines Adult/pediatric Short Term Mfg# 989803204521 25ea/bx | other | N/A | $4 to $15 | Low |
| Cannula Nasal Co2 Adult 10ea/1bx | other | N/A | $4 to $16 | Low |
| Co2 Sampling O2 Delivery Cannula #989803206641 10ea/pk | obstetric | N/A | $4 to $16 | Low |
| Dilating Mixture 0.5 Ml - Compounded | other | N/A | $4 to $16 | Low |
| Male Purewick External Catheter #pwm030 30ea/case | cardiac | N/A | $4 to $16 | Low |
| Tray Catheter 14fr Foley/bag #a300314a | cardiac | N/A | $4 to $16 | Low |
| Tray Catheter 16fr Foley/bag #a300316a | cardiac | N/A | $4 to $16 | Low |
| Tray Catheter 18fr Foley/bag #a300318a | cardiac | N/A | $4 to $16 | Low |
| Anesthesia for Exam of Colon Using an Endoscope | other | N/A | $3 to $812 | Low |
| Y-adapter Ureteroscope Gateway #m0067301501 | other | N/A | $4 to $16 | Low |
| Spiriva Handihaler 18 Mcg Cap | other | N/A | $4 to $16 | Low |
| Tape Elastic 4" 6/bx #5177 | other | N/A | $4 to $16 | Low |
| Paparella Vent Tube #240044 6ea/1bx | other | N/A | $4 to $16 | Low |
| Prosthetic Sock, Single Ply, Fitting, Above Knee, Each | other | N/A | $4 to $16 | Low |
| Tobramycin, Inhalation Solution, Fda-approved Final Product, Non-compounded, ... | other | N/A | $4 to $28 | Low |
| Seal 8mm Cannula Disp #400077 | other | N/A | $4 to $16 | Low |
| Catheter Foley Council 16fr 5cc Ribbed Silver | cardiac | N/A | $4 to $16 | Low |
| Catheter Foley Council 20fr 5cc Silver Coat | cardiac | N/A | $4 to $16 | Low |
| Suction Cauterizer 10fr X 6" Handswitch | other | N/A | $4 to $16 | Low |
| Sleeve Scd Knee Length Smcomfrt #74021 5pr/cs | other | N/A | $4 to $16 | Low |
| Cannula Shoulder 7cm #9718 | other | N/A | $4 to $16 | Low |
| Detector Co2 Easy Colorimetric Indicator Pediatric Carbon Dioxide Detector #5... | other | N/A | $4 to $16 | Low |
| Mitt Hand Peek-a-boo #2811 12pr/cs 1pr=1ea | other | N/A | $4 to $16 | Low |
| Neomyc-bacit-polymix Eye Oint | other | N/A | $4 to $16 | Low |
| Xodus Pillow Abduction Hip Large Disp #40410 4ea/case | other | N/A | $4 to $16 | Low |
| Dilator Vaginal Syracuse Med Large Plus 39mm Sm-vd-l+ | other | N/A | $4 to $16 | Low |
| Trocar 18g X 15cm | other | N/A | $4 to $16 | Low |
| Composite Dressing, Sterile, Pad Size 16 Sq. In. OR Less, with Any Size Adhes... | other | N/A | $4 to $32 | Low |
| Indwelling Catheter; Foley Type, Two-way Latex with Coating (teflon, Silicone... | cardiac | N/A | $4 to $32 | Low |
| Jumpstart 2" X 5" Antimicrobial Wound Dressing Abs | other | N/A | $4 to $16 | Low |
| Needle, Sterile, Any Size, Each | other | N/A | $4 to $32 | Low |
| Pacemaker Lead End Kit #5867-3m | cardiac | N/A | $4 to $16 | Low |
| Test for Allergy Using Allergenic Extract | other | N/A | $3 to $95,004 | Low |
| Needle Disp. 2-part Trocar 18gax15cm #g14461 | other | N/A | $4 to $16 | Low |
| Needle Disp. 2-part Trocar 18gax20cm #g14255 | other | N/A | $4 to $16 | Low |
| Pressurizer Large 6ea/pk 0206-547 | other | N/A | $4 to $16 | Low |
| Pressurizer Medium 6ea/pk #0206-546 | other | N/A | $4 to $16 | Low |
| Dripline Ii Water Trap Adult 10ea/1bx | other | N/A | $4 to $16 | Low |
| Tube Vent Armstrong 1.14mm - Sc | other | N/A | $4 to $16 | Low |
| Reddie Wraparound Knee Brace Adult Neoprene 13.5-15.5" X-small #79 | other | N/A | $4 to $16 | Low |
| Reddie Wraparound Knee Brace Adult Neoprene 15.5-18" Small #79 | other | N/A | $4 to $16 | Low |
| Reddie Wraparound Knee Brace Adult Neoprene 18-20.5" Medium #79 | other | N/A | $4 to $16 | Low |
| Reddie Wraparound Knee Brace Adult Neoprene 20.5-23" Large #79 | other | N/A | $4 to $16 | Low |
| Breast Pump One-hand Manual #17161 | other | N/A | $4 to $16 | Low |
| Lymphedema Tube Gauze Band X-lrg K1 10ea/1cs | other | N/A | $4 to $16 | Low |
| Sleeve Scd Knee Length Lg Comfrt#74023 5pr/cs | other | N/A | $4 to $16 | Low |
| Electrode Vital Stim Adlt Julia Jones 12ea/pk | other | N/A | $4 to $16 | Low |
| Reddie Wraparound Knee Brace Adult Neoprene 23-25.5" X-large #79 | other | N/A | $4 to $17 | Low |
| Crutch Steel Bariatric Adult 5'2"-5'10" 650lb #mds80335xw 1pr/case | other | N/A | $4 to $17 | Low |
| Dressing Shield Zip Ds Ps1241 5ea/pk | other | N/A | $4 to $17 | Low |
| Elastomer Vascular Loop #1041 (retract-o-tape | other | N/A | $4 to $17 | Low |
| Tracheal Suction Catheter, Any Type Other Than Closed System, Each | cardiac | N/A | $3 to $17 | Low |
| Caffeine Citrate 10 Mg/ml D5w Syringe - Peds - Compounded | other | N/A | $4 to $17 | Low |
| Linaclotide 145 Mcg Po Caps | other | N/A | $4 to $17 | Low |
| Linzess 145 Mcg Capsule | other | N/A | $4 to $17 | Low |
| Linzess 72 Mcg Capsule | other | N/A | $4 to $17 | Low |
| Needle Biopsy Tru-cut Disp #2n2702x | lab | N/A | $4 to $17 | Low |
| Levofloxacin 250 Mg Po Tabs | other | N/A | $4 to $17 | Low |
| Levofloxacin 250 Mg Tablet | other | N/A | $4 to $15 | Low |
| Pad-sensa Trac W/tube/clamp/conn #m8275057/10 | other | N/A | $4 to $17 | Low |
| Levofloxacin 500 Mg Po Tabs | other | N/A | $4 to $17 | Low |
| Levofloxacin 500 Mg Tablet | other | N/A | $4 to $17 | Low |
| Pad Spider Elbow Slv Xxxl Blk 11-0392-7 | other | N/A | $4 to $17 | Low |
| Reddie Wraparound Knee Brace Adult Neoprene 25.5-28" 2x-large #79 | other | N/A | $4 to $17 | Low |
| Thera Tears Sterilid Cleanser | other | N/A | $4 to $17 | Low |
| Nasal Tampon W/tube 8.0 Cm #400410 20ea/1pk | other | N/A | $4 to $17 | Low |
| 5fr Sos 80cm | other | N/A | $5 to $17 | Low |
| Foam Dressing, Wound Cover, Sterile, Pad Size 16 Sq. In. OR Less, with Any Si... | other | N/A | $5 to $34 | Low |
| Needle Spinal Sterile 22gx20cm #dsn-22-20.0 | other | N/A | $5 to $17 | Low |
| LASIK Eye Surgery | other | N/A | $5 to $182 | High |
| Lasik Flap Roller | other | N/A | $5 to $17 | Low |
| Tubing Set Ext Compress System 4ft #9595 20ea/case | other | N/A | $5 to $17 | Low |
| Flow Cytometry Technique for Dna OR Cell Analysis, Each Additional Marker | other | N/A | $5 to $88,185 | Low |
| Guide Aiming 1.5mm Single Use Pdg-aim | other | N/A | $5 to $17 | Low |
| Male External Catheter with Integral Collection Chamber, Any Type, Each | cardiac | N/A | $5 to $34 | Low |
| Paracervical-pudenal Block Tray Includes 20g X 6" Spinal Needle Trumpet Needl... | other | N/A | $5 to $17 | Low |
| Punch Aortic 2.8mm #dp-28k | other | N/A | $5 to $17 | Low |
| Lap Spatula Elec 5mm X 32mm 60-5272 | other | N/A | $5 to $17 | Low |
| Freestyle Lite Meter | other | N/A | $5 to $17 | Low |
| Avitene Ultrafoam Collagen Hemostatic Sponge 3/4 X 2-1/2 X 1/4 12 Ea/bx 1050020 | other | N/A | $5 to $17 | Low |
| **discontinued** Catheter Imager Ii Cobra 5fr M0064003011 5/bx | cardiac | N/A | $5 to $17 | Low |
| Jackson Pratt Drain 19fr #su130 | other | N/A | $5 to $17 | Low |
| Drain Catheter 12fr Pezzer #064012 6ea/1bx | cardiac | N/A | $5 to $17 | Low |
| Drain Catheter 14fr Pezzer #064014 6ea/1cs | cardiac | N/A | $5 to $17 | Low |
| Immobilizer Knee 20" Black Elastic #bf7072 | other | N/A | $5 to $17 | Low |
| Reddie Wraparound Knee Brace Adult Neoprene 28-31" 3x-large #79-82399 | other | N/A | $5 to $17 | Low |
| Splint Nasal Septal Small | other | N/A | $5 to $17 | Low |
| Dialator Cook 16fr #g03947 | other | N/A | $5 to $17 | Low |
| Dilator 12fr #jcd12.0-38-20-coons | other | N/A | $5 to $17 | Low |
| Dilator 14fr #jcd14.0-38-20-coons | other | N/A | $5 to $17 | Low |
| Cautery Hot Biopsy Polyp #m00515033 | lab | N/A | $5 to $17 | Low |
| Knee Immobilizer-19" Med" | other | N/A | $5 to $17 | Low |
| Lap Electrode L Hook 5 X 32mm | other | N/A | $5 to $17 | Low |
| M00561101 - Snare Vascular L240cm Loop W10mm Sheath Dia2.4mm Round Stiff Cold... | other | N/A | $5 to $17 | Low |
| Arch Support Large #mdy10530 | other | N/A | $5 to $17 | Low |
| Cannula Air Injection 27g | other | N/A | $5 to $18 | Low |
| Catheter Trocar 32fr | cardiac | N/A | $5 to $18 | Low |
| Catheter Kit Coude/foley Complete Care 16fr | cardiac | N/A | $5 to $18 | Low |
| Cephalexin 125 Mg/5 Ml Susp | other | N/A | $5 to $18 | Low |
| Endostitch 2-0 Polysorb #170053 | other | N/A | $5 to $18 | Low |
| Needle Sonoplex Ii 20g X 6" (150mm) Echogenic Needle with Facet S Tip Nanolin... | imaging | N/A | $5 to $18 | Low |
| Resuscitator Bag Infant W/peep Mask 6ea/1cs | other | N/A | $5 to $18 | Low |
| Desonide 0.05% Cream | other | N/A | $5 to $18 | Low |
| Brace Elbow 11 Inch Adult #79 | other | N/A | $5 to $18 | Low |
| Knife 4.1mm Angled Shortcut | other | N/A | $5 to $18 | Low |
| Uterine Vac 5mm Flexible #505 Milex | other | N/A | $5 to $18 | Low |
| Dakin's 0.25% Solution | other | N/A | $5 to $18 | Low |
| Dakin's 0.5% Solution | other | N/A | $5 to $18 | Low |
| Desonide 0.05% Ointment | other | N/A | $5 to $18 | Low |
| Cast Supplies, Short Arm Cast, Pediatric (0-10 Years), Fiberglass | other | N/A | $5 to $36 | Low |
| Cps Universal Ii Slitter Ds2a006 | other | N/A | $5 to $18 | Low |
| Endotrach Tube Reinforced 6.0mm #86548 | other | N/A | $5 to $18 | Low |
| Endotrach Tube Reinforced 6.5mm #86549 | other | N/A | $5 to $18 | Low |
| Endotrach Tube Reinforced 7.0mm #86550 | other | N/A | $5 to $18 | Low |
| Endotrach Tube Reinforced 7.5mm #86551 | other | N/A | $5 to $18 | Low |
| Endotrach Tube Reinforced 8.0mm #86552 | other | N/A | $5 to $18 | Low |
| Quick-use Disposable Bone Cement Curette 10 Ea/bx 00504905300#5049 | other | N/A | $5 to $18 | Low |
| Catheter Trocar 12fr 10ea/1cs | cardiac | N/A | $5 to $18 | Low |
| Pad Cold Therapy Univ Wrap On 11-0679-9 | other | N/A | $5 to $18 | Low |
| Pad Cold Therapy Univ Wrap Xl 11-0681-9 | other | N/A | $5 to $18 | Low |
| Dressing Calcium Alginate 4x5 #31045 | other | N/A | $5 to $18 | Low |
| Cannula Air Injection 30g | other | N/A | $5 to $18 | Low |
| Pin Steinman 5/32" Threaded 9" | other | N/A | $5 to $18 | Low |
| Pin Steinman 5/64" Threaded 9" #262-07 | other | N/A | $5 to $18 | Low |
| Pin Steinman 7/64 X 229mm Threaded #262-05 | other | N/A | $5 to $18 | Low |
| Pin Steinman Threaded 1/8 X 229mm #262-06 | other | N/A | $5 to $18 | Low |
| Pin Steinman Threaded 7/64" X 229mm | other | N/A | $5 to $18 | Low |
| Steinman Pin Threaded 9/64 X 229mm #262-03 | other | N/A | $5 to $18 | Low |
| Cast Stockinette Delta-net Tubular Synthetic 3inx25yd Non-sterile #7272302 2r... | other | N/A | $5 to $18 | Low |
| Snare Rotatable 20mm #m00561831 | other | N/A | $5 to $18 | Low |
| Immobilizer Knee 18" W/elastc Straps #7071 | other | N/A | $5 to $18 | Low |
| Uterine Vac 6mm Flexible #506 Milex 10ea/1bx | other | N/A | $5 to $18 | Low |
| Tacrolimus, Immediate Release, Oral, 1 Mg | other | N/A | $5 to $18 | Low |
| Muri-lube Mineral Oil Vial | other | N/A | $5 to $18 | Low |
| Nail Clipper W/file for One-handed Nail Care 1ea A85410 | other | N/A | $5 to $18 | Low |
| Endostitch 0 Surgidac #173024 | other | N/A | $5 to $18 | Low |
| Suspensory W/straps-large-adult Pfpfp02570lg | other | N/A | $5 to $18 | Low |
| Suspensory W/straps-xlarge-adult Pfp2570xl | other | N/A | $5 to $18 | Low |
| Sleeve Scd Knee Length Xl Exprss #9790 5pr/cs | other | N/A | $5 to $19 | Low |
| Perfusion Set Multiple #14000 | surgery | N/A | $5 to $19 | Low |
| Dorzolamide-timolol Eye Drops | other | N/A | $5 to $19 | Low |
| Ez-stabilizer 9066-vc-005 5ea/1bx | other | N/A | $5 to $19 | Low |
| Closed Injectate Delivery Sys (cardiac Output | cardiac | N/A | $5 to $19 | Low |
| Akten 3.5% Gel Drops | other | N/A | $5 to $19 | Low |
| Suspensory W/straps-medium-adult Pfp02570m | other | N/A | $5 to $19 | Low |
| Vimpat 100 Mg Tablet | other | N/A | $5 to $19 | Low |
| Forceps Radial Jaw 4 Jumbo 80/bx M00513374 | other | N/A | $5 to $19 | Low |
| Dressing Sorbson Wound Packing 12" | other | N/A | $5 to $19 | Low |
| Diag Catheter 6fr Uf #451-504v5 | cardiac | N/A | $5 to $19 | Low |
| Paparella-type Vent Tube 1.27 Mm I.d. Ultrasil Silicone 6 Ea/bx 70241046 | other | N/A | $5 to $19 | Low |
| Vashe Wound Vac Wash 8.5oz Antimicrobial Bottle Non-cytotoxic #00316 12ea/case | other | N/A | $5 to $19 | Low |
| Cannula Seal 5mm-8mm #470361 Intuitive Surgic | other | N/A | $5 to $19 | Low |
| Laryngoscope Blade - Gvl 3 Stat #0270 | other | N/A | $5 to $19 | Low |
| Laryngoscope Blade - Gvl 4 Stat #0270 | other | N/A | $5 to $19 | Low |
| Lap 5mm/44cm Sump Cannula Gleeson Flovac | other | N/A | $5 to $19 | Low |
| Red Blood Cell Count, Automated Test | other | N/A | $3 to $85,041 | Low |
| Fentanyl 75 Mcg/hr Patch | other | N/A | $5 to $19 | Low |
| Fentanyl 75 Mcg/hr Td Pt72 | other | N/A | $5 to $19 | Low |
| Urovac Bladder Evacuator #m0067301251 | other | N/A | $5 to $19 | Low |
| Dermatac Drape 10 Pack Dtac10ldp | other | N/A | $5 to $19 | Low |
| Monsel's Ferric Subsulfate Sol | other | N/A | $5 to $19 | Low |
| Channel Drain Round Silicone with Trocar 15fr 3/16" Full Fluted #dynjwe2189 1... | other | N/A | $5 to $19 | Low |
| Valtrex 1 Gram Caplet | other | N/A | $5 to $19 | Low |
| Xodus Pillow Abduction Hip Small W/straps Disp #40408b 6ea/case | other | N/A | $5 to $19 | Low |
| Quikclot 4x4 Topical Hemostatic #459 | other | N/A | $5 to $19 | Low |
| Derma Hook | other | N/A | $5 to $19 | Low |
| Micropuncture 5fr Access Set #g53574 | other | N/A | $5 to $20 | Low |
| Crutch Steel Bariatric Tall Adult 5'10"-6'6" 650lb 1pr/case #mds80334xw | other | N/A | $5 to $20 | Low |
| Catheter Phillips Follower 12fr Lf 10ea/bx | cardiac | N/A | $5 to $20 | Low |
| Catheter Philllips Folllower 18fr Lf 10ea/bx | cardiac | N/A | $5 to $20 | Low |
| Angiographic Catheter 5f (1.8mm) X 90cm Cobra 2 #10719711 5ea/bx | imaging | N/A | $5 to $20 | Low |
| Profile Extra Small Oval Flexible Single Use Snare 10ea/bx M00562531 | other | N/A | $5 to $20 | Low |
| Forceps Radial Jaw 4 Jumbo #m00513372 40/1bx | other | N/A | $5 to $20 | Low |
| Knee Support Med Neoprene Hinged #302155blk | other | N/A | $5 to $20 | Low |
| Cpm Pads Synthetic Patient Kit 1ea | other | N/A | $5 to $20 | Low |
| Diphenhydramine Hydrochloride, 50 Mg, Oral, Fda Approved Prescription Anti-em... | other | N/A | $5 to $20 | Low |
| Ambien 10 Mg Tablet | other | N/A | $5 to $20 | Low |
| Brace Foot Left Large Ab2801 | other | N/A | $5 to $20 | Low |
| Brace Foot Left Medium Ab2801 | other | N/A | $5 to $20 | Low |
| Brace Foot Left Small Ab2801 | other | N/A | $5 to $20 | Low |
| Brace Foot Left Xlarge Ab2801 | other | N/A | $5 to $20 | Low |
| Brace Foot Left Xsmall Ab2801 | other | N/A | $5 to $20 | Low |
| Brace Foot Right Large Ab2801 | other | N/A | $5 to $20 | Low |
| Brace Foot Right Medium Ab2801 | other | N/A | $5 to $20 | Low |
| Brace Foot Right Small Ab2801 | other | N/A | $5 to $20 | Low |
| Brace Foot Right Xlarge Ab2801 | other | N/A | $5 to $20 | Low |
| Brace Foot Right Xsmall Ab2801 | other | N/A | $5 to $20 | Low |
| Comfort Cool Thumb Cmc Left-large | other | N/A | $5 to $20 | Low |
| Comfort Cool Thumb Cmc Left-medium | other | N/A | $5 to $20 | Low |
| Comfort Cool Thumb Cmc Left-small | other | N/A | $5 to $20 | Low |
| Comfort Cool Thumb Cmc Left-xlarge | other | N/A | $5 to $20 | Low |
| Comfort Cool Thumb Cmc Right-large | other | N/A | $5 to $20 | Low |
| Comfort Cool Thumb Cmc Right-medium | other | N/A | $5 to $20 | Low |
| Comfort Cool Thumb Cmc Right-small | other | N/A | $5 to $20 | Low |
| Comfort Cool Thumb Cmc Right-xlarge | other | N/A | $5 to $20 | Low |
| Lap Electrode Ball 3mm Ext | other | N/A | $5 to $20 | Low |
| Lap Electrode Loop Medium 15x10mm | other | N/A | $5 to $20 | Low |
| Lap Electrode Loop Small 12x8mm | other | N/A | $5 to $20 | Low |
| Endotrach Tube Reinforced 6.0mm 5/bx #5 | other | N/A | $5 to $20 | Low |
| Endotrach Tube Reinforced 6.5mm 5/bx #5 | other | N/A | $5 to $20 | Low |
| Endotrach Tube Reinforced 7.0mm #5 | other | N/A | $5 to $20 | Low |
| Administration and Interpretation of Caregiver-focused Health Risk Assessment | other | N/A | $3 to $96,161 | Low |
| Blood Count, Hemoglobin | other | N/A | $2 to $85,018 | Low |
| Delflex with 1.5% Dextrose | other | N/A | $5 to $20 | Low |
| Delflex with 2.5% Dextrose | other | N/A | $5 to $20 | Low |
| Finger Splint, Static | other | N/A | $3 to $40 | Low |
| Golytely Solution | other | N/A | $5 to $20 | Low |
| Hc Ehc Rev | other | N/A | $5 to $20 | Low |
| Indwelling Catheter, Foley Type, Two-way, All Silicone OR Polyurethane, Each | cardiac | N/A | $5 to $40 | Low |
| Injection, Metronidazole, 500 Mg | other | N/A | $5 to $40 | Low |
| Intuitive Da Vinci Xi Universal Seal 5mm-12mm10 Ea/bx 470500 | other | N/A | $5 to $20 | Low |
| Non-coring Needle OR Stylet with OR without Catheter | cardiac | N/A | $5 to $40 | Low |
| Orthopedic Shoe, Hightop with Supinator OR Pronator, Child | other | N/A | $5 to $40 | Low |
| Pom Mask #1001-msa 30ea/pk | other | N/A | $5 to $20 | Low |
| Spirometer, Non-electronic, Includes All Accessories | other | N/A | $5 to $40 | Low |
| Splint | other | N/A | $5 to $40 | Low |
| Tvi Tool #tvi-07 Medtronic 5/pk | other | N/A | $5 to $20 | Low |
| Urinalysis | lab | N/A | $3 to $81,015 | High |
| Gradient Compression Garment, Not Otherwise Specified | other | N/A | $5 to $20 | Low |
| Hydrocolloid Dressing, Wound Filler, Paste, Sterile, Per Ounce | other | N/A | $5 to $40 | Low |
| Suction Control Valve/am Omi Cardiac | cardiac | N/A | $5 to $20 | Low |
| Catheter Phillips Follower 22fr Lf 10ea/1bx | cardiac | N/A | $5 to $20 | Low |
| Splint Bucks Traction-xlarge #8106 | other | N/A | $5 to $20 | Low |
| Catheter Phillips Follower 10fr Lf 10ea/bx | cardiac | N/A | $5 to $20 | Low |
| Catheter Tray Urine Meter E/ Foley 350ml | cardiac | N/A | $5 to $20 | Low |
| Crutch Child Small 4'-4'6" 300 Lb 1pr | other | N/A | $5 to $20 | Low |
| Walker Palm Relfoldguardian #g30756 4ea/1cs | other | N/A | $5 to $20 | Low |
| Glycerin Skin Protectant Liq | other | N/A | $5 to $20 | Low |
| Lindane 1 % Ex Sham | other | N/A | $5 to $20 | Low |
| Wire Breast Localization 10/bx #47720 | other | N/A | $5 to $20 | Low |
| Wire Breast Localization 20gx5cm | other | N/A | $5 to $20 | Low |
| Forceps Magill Child #792-9-3018 | other | N/A | $5 to $20 | Low |
| Thermax Blood Warmer Disposable #955516 Ca/ 24ea | other | N/A | $5 to $21 | Low |
| 4fr Sos Mini Omni 65cm - Must Be Ordered in Qty's of 5 Ea | other | N/A | $5 to $21 | Low |
| Pillow Abduction Hip Small Disp #m60-076-s | other | N/A | $5 to $21 | Low |
| Tube Vent Armstrong 1.14mm Reg #10 | other | N/A | $6 to $21 | Low |
| Juzo Compress Hose Belo Knee 20-30mmhg Ad Iii | other | N/A | $6 to $21 | Low |
| Juzo Compress Hose Below Knee 20-30mmhg Ad I | other | N/A | $6 to $21 | Low |
| Juzo Compress Hose Below Knee 20-30mmhg Ad Ii | other | N/A | $6 to $21 | Low |
| Juzo Compress Hose Below Knee 20-30mmhg Ad IV | other | N/A | $6 to $21 | Low |
| Juzo Compress Hose Below Knee 20-30mmhg Ad V | other | N/A | $6 to $21 | Low |
| Dressing Ear Pediatric Glasscock #s | other | N/A | $6 to $21 | Low |
| Oasis Wound Matrix, Per Square Centimeter | other | N/A | $6 to $119 | Low |
| Electrode Eletrosurgical OR Electrocautery 5.12 Inch Length 20 Mm Diameter T ... | surgery | N/A | $6 to $21 | Low |
| Lap Electrode Ball 5mm Ext | other | N/A | $6 to $21 | Low |
| Lap Electrode Loop Lrge 20x10mm | other | N/A | $6 to $21 | Low |
| Permethrin 5% Cream | other | N/A | $6 to $21 | Low |
| Chiba 19g X 20cm Needle | other | N/A | $6 to $21 | Low |
| Dressing Aquacel Ag Advantage 3.5x6" #422604 10ea/1bx | other | N/A | $6 to $21 | Low |
| Tip Cover Accessory Version 12 | other | N/A | $6 to $21 | Low |
| Spacer Sock-hole in Toe Med #6ss040hv | other | N/A | $6 to $21 | Low |
| Bacitracin-polymyxin Eye Oint | other | N/A | $6 to $21 | Low |
| Lap J-hook Elec 5mm X 32mm Plus #60-5274 | other | N/A | $6 to $21 | Low |
| Abreva 10% Cream | other | N/A | $6 to $21 | Low |
| Catheter Trocar 8fr Chest Tube 10ea/1cs | cardiac | N/A | $6 to $21 | Low |
| Cephalexin 250 Mg/5 Ml Susp | other | N/A | $6 to $21 | Low |
| Knee Support Large Neoprene Hinged #302157blk | other | N/A | $6 to $21 | Low |
| Clozex Skin Closure 40mm X 50mm Cl1040l | other | N/A | $6 to $21 | Low |
| Encore 26 Inflation Device M001151062 15 | other | N/A | $6 to $21 | Low |
| Anesthesia for Incision of Ear Drum | other | N/A | $5 to $126 | Low |
| Dressing Mepilex 4x6 Post Op Ag 5/bx 498300 | other | N/A | $6 to $22 | Low |
| Anesthesia for Exam of Ear Using an Endoscope | other | N/A | $5 to $124 | Low |
| Suction Canister Omnijug W/cap #5036 | other | N/A | $6 to $22 | Low |
| Pad Cold Therapy Shoulder Wrap11-1397-9 | other | N/A | $6 to $22 | Low |
| Ultrasound Probe Cover Gel #610-833 12ea/1bx | imaging | N/A | $6 to $22 | Low |
| Catheter Trocar 28fr 10ea/1cs | cardiac | N/A | $6 to $22 | Low |
| Albuterol Hfa 90 Mcg Inhaler | other | N/A | $6 to $22 | Low |
| Albuterol Sulfate Hfa 108 (90 Base) Mcg/act in Aers | other | N/A | $6 to $22 | Low |
| Blood Glucose (sugar) Measurement Using Reagent Strip | other | N/A | $5 to $82,948 | Low |
| Cast Supplies, Long Arm Cast, Adult (11 Years +), Fiberglass | other | N/A | $6 to $44 | Low |
| Cast Supplies, Long Arm Splint, Adult (11 Years +), Plaster | other | N/A | $6 to $44 | Low |
| Clozex Skin Closure 50mm X 50mm Cl1050l | other | N/A | $6 to $22 | Low |
| Microscopic Examination for White Blood Cells | other | N/A | $3 to $85,008 | Low |
| Stool Analysis for Blood to Screen for Colon Tumors | other | N/A | $4 to $82,270 | Low |
| Trocar 21g X 15cm | other | N/A | $6 to $22 | Low |
| Tube Vent Sheehy #10-26145 Implant | surgery | N/A | $6 to $22 | Low |
| Chemet 100 Mg Capsule | other | N/A | $6 to $22 | Low |
| Injection, Penicillin G Potassium, Up to 600,000 Units | other | N/A | $6 to $22 | Low |
| Walker Folding - Guardianmust Order By Case/4each | other | N/A | $6 to $22 | Low |
| Vas-q Ligation Clip Adler #an2232 14ea/bx | other | N/A | $6 to $22 | Low |
| Endo Close Trocar Site Closure Device 173022 12ea/case | other | N/A | $6 to $22 | Low |
| Prosthetic Shrinker, Below Knee, Each | other | N/A | $6 to $64 | Low |
| Sps 15 Gm/60 Ml Suspension | other | N/A | $6 to $22 | Low |
| Clindamycin Ph 1% Solution | other | N/A | $6 to $22 | Low |
| Prevena Plus 150ml Canister #pre4095us | other | N/A | $6 to $22 | Low |
| Pledget Oval 4.5 X 6 Soft 10 Pk #vpg56se | other | N/A | $6 to $22 | Low |
| Vacuum Birth Cup 60mm/tender Touch 10ea/1bx | other | N/A | $6 to $23 | Low |
| Vacuum Birth Cup 65mm/tender Touch 10ea/1bx | other | N/A | $6 to $23 | Low |
| Epidural Tray Perifix Tuohy 17ga X 3.5 Drape/syringe Latex Free Sterile #3320... | other | N/A | $6 to $23 | Low |
| Forceps Magill Adult #792-9-3018 | other | N/A | $6 to $23 | Low |
| Tube Vent Otologic 1.14mm Paprella Vt-0300-01 10ea/bx | other | N/A | $6 to $23 | Low |
| Spacer Sock-hole in Toe Wide #6ss045hv | other | N/A | $6 to $23 | Low |
| Cromolyn Sodium 4 % Op Soln | other | N/A | $6 to $23 | Low |
| Tube Vent Ultrasil #70241071 Implant | surgery | N/A | $6 to $23 | Low |
| Lap Electrode L-hook #04-500mb | other | N/A | $6 to $23 | Low |
| Application of Hot Wax Bath | other | N/A | $6 to $97,018 | Low |
| Blood Sodium Level | other | N/A | $5 to $84,295 | Low |
| Co-set Cold Injection System 10ea/1cs | other | N/A | $6 to $23 | Low |
| Famotidine 40 Mg/5 Ml Susp | other | N/A | $6 to $23 | Low |
| Healon Pro 0.55ml 10340011 | other | N/A | $6 to $23 | Low |
| Influenza Virus Vaccine, Split Virus, When Administered to Individuals 3 Year... | preventive | N/A | $6 to $46 | Low |
| Introducer/sheath, Other Than Guiding, Other Than Intracardiac Electrophysiol... | cardiac | N/A | $6 to $23 | Low |
| Kit Pacing Stylet 0.014in X 52cm Blue Knob Stainless Steel Ball Tip Straight ... | other | N/A | $6 to $23 | Low |
| Kit Stylet L52cm Dia0.014in Stainless Steel Blue Knob Extended Taper Ball Tip... | other | N/A | $6 to $23 | Low |
| Kit Stylet Lead Acc #6056m | other | N/A | $6 to $23 | Low |
| Stylet Kit #6094 | other | N/A | $6 to $23 | Low |
| Stylet Kit 0.014in X 58cm #6082 | other | N/A | $6 to $23 | Low |
| Catheter Filiform with Spiral Tip 4f Sterile 10ea/bx #343104 | cardiac | N/A | $6 to $23 | Low |
| Shield Corneal W/ Suction Cups Med #ssa-02 | other | N/A | $6 to $23 | Low |
| Suction Wand Intracardiac Rigid #su | cardiac | N/A | $6 to $23 | Low |
| Quikclot Hemostatic #467z 10/bx | other | N/A | $6 to $23 | Low |
| Econazole Nitrate 1 % Ex Crea | other | N/A | $6 to $23 | Low |
| Knife Straight Cresent | other | N/A | $6 to $23 | Low |
| Cannula Aortic Root 14ga Reg Tip #20014 | other | N/A | $6 to $23 | Low |
| Carrying Bag for Walker #6447 | other | N/A | $6 to $24 | Low |
| Pin Fixation L65mm Speed for Journey Ii Bcs Knee System 3ea/bx #74013480 | other | N/A | $6 to $24 | Low |
| Sling Sara Disposable #mfa3000 10/bx | other | N/A | $6 to $24 | Low |
| Ertapenem (invanz) 1 Gm / 50 Ml Ns Mini-bag Plus - Compounded | other | N/A | $6 to $24 | Low |
| Tray Laceration Disp 12ea/1cs | other | N/A | $6 to $24 | Low |
| Amerigel Wound Dressing Gel | other | N/A | $6 to $24 | Low |
| Copilot #1003330 | other | N/A | $6 to $24 | Low |
| CPAP Mask Full Face Medium Disp #niv040m | other | N/A | $6 to $24 | Low |
| Crutches Underarm, Wood, Adjustable OR Fixed, Pair, with Pads, Tips and Handg... | other | N/A | $6 to $48 | Low |
| Laryngoscope Blade - Gvl 1 Stat #0270 | other | N/A | $6 to $24 | Low |
| Laryngoscope Blade - Gvl 2 Stat #0270 | other | N/A | $6 to $24 | Low |
| Splint, Prefabricated, Wrist OR Ankle | other | N/A | $6 to $48 | Low |
| Heart Left Vent Catheter 20fr | cardiac | N/A | $6 to $24 | Low |
| Splint Nasal Airway Doyle Ii | other | N/A | $6 to $24 | Low |
| Oseltamivir 6 Mg/ml Suspension | other | N/A | $6 to $24 | Low |
| Drive Walker Basket #563285 | other | N/A | $6 to $24 | Low |
| CPAP Mask Full Face Small Disp #niv040s | other | N/A | $6 to $24 | Low |
| Diag Catheter 5fr Sim 1 #g08584 | cardiac | N/A | $7 to $24 | Low |
| Promethazine-codeine 6.25-10 Mg/5ml Po Syrp | other | N/A | $7 to $25 | Low |
| Promethazine-codeine Solution | other | N/A | $7 to $25 | Low |
| Ligating Clip Lrg Vesolock #61114v | other | N/A | $7 to $25 | Low |
| Knife V-lance Ophthalmic | other | N/A | $7 to $25 | Low |
| Arch Support Xlarge #mdy10540 | other | N/A | $7 to $25 | Low |
| Ketoconazole 2 % Ex Crea | other | N/A | $7 to $25 | Low |
| Punch Aortic Rotating #rcb40 Sz 4.0 | other | N/A | $7 to $25 | Low |
| Punch Aortic Rotating #rcb45 Sz 4.5 | other | N/A | $7 to $25 | Low |
| Gelfoam Sponge Sz 100 8cmx12.5cm Sterile | other | N/A | $7 to $25 | Low |
| Scalpel Micro Feather 0.4mm | other | N/A | $7 to $25 | Low |
| Silver Sulfadiazine 1% Cream | other | N/A | $7 to $25 | Low |
| Electrode Defib Pads Quik-combo Adult 1pk/1ea | other | N/A | $7 to $25 | Low |
| Spinal/single Wall 20g X 15cm Needle | other | N/A | $7 to $25 | Low |
| Spinal/single Wall 22g X 15cm Needle | other | N/A | $7 to $25 | Low |
| Cannula Twist in 7x7mm Fully Threaded 5ea/1bx | other | N/A | $7 to $25 | Low |
| Cannula Twist-in 5.75mmx7cm | other | N/A | $7 to $25 | Low |
| Cannula Twist-in 6mm X 9cm | other | N/A | $7 to $25 | Low |
| Cannula Twist-in 7mm X 7 Partial Thread | other | N/A | $7 to $25 | Low |
| Cannula Twist-in 7mm X 7cm | other | N/A | $7 to $25 | Low |
| Cannula Twist-in 8.25mm X 7cm | other | N/A | $7 to $25 | Low |
| Cannula Twist-in 8.25mm X 9cm #ar | other | N/A | $7 to $25 | Low |
| Capella Coaxial Micro-introducer Kit Nitinol with Gold/tungsten Tip 5f Sheath... | other | N/A | $7 to $25 | Low |
| Cast Supplies, Long Arm Splint, Adult (11 Years +), Fiberglass | other | N/A | $7 to $50 | Low |
| Cast Supplies, Short Leg Splint, Adult (11 Years +), Fiberglass | other | N/A | $7 to $50 | Low |
| Finger Orthosis, Proximal Interphalangeal (pip)/distal Interphalangeal (dip),... | other | N/A | $7 to $50 | Low |
| Hdl Cholesterol Level | other | N/A | $7 to $83,718 | Low |
| Infusion, Albumin (human), 25%, 20 Ml | surgery | N/A | $7 to $50 | Low |
| Large Neurostimulator Fixation Belt #fp9000l | other | N/A | $7 to $25 | Low |
| Microscopic Examination for White Blood Cells with Manual Cell Count | other | N/A | $4 to $85,007 | Low |
| Ocucoat 1ml 6/bx #cc065s | other | N/A | $7 to $25 | Low |
| Patient Programmer Case #casea10e | other | N/A | $7 to $25 | Low |
| Physician Review, Interpretation, and Patient Management of Home Inr Testing ... | other | N/A | $7 to $50 | Low |
| Preparation of Special Reports Beyond What Is Found in the Medical Record | other | N/A | $7 to $99,080 | Low |
| Purastat Adapter 10ea/bx#001 | other | N/A | $7 to $25 | Low |
| Rotation Tool Kit #6056 for Leads | other | N/A | $7 to $25 | Low |
| Splint Supplies, Miscellaneous | other | N/A | $7 to $50 | Low |
| Surgical Trays | surgery | N/A | $7 to $50 | Low |
| Uroseal Adjustable Endoscopic Valve 5ea/bx #bx00913410 | other | N/A | $7 to $25 | Low |
| Wrench Hex 7.6cm #sc-4276 Sc | other | N/A | $7 to $25 | Low |
| Adapter Tuohy-borst #g18813 | other | N/A | $7 to $25 | Low |
| Sensica Uo Pt Ring ICU Sspk1025 25ea/1bx | other | N/A | $7 to $25 | Low |
| Sensica Uo Pt Ring OR Sror1025 25ea/1bx | other | N/A | $7 to $25 | Low |
| Vent Tube Venturi Reuter Bobbin #1070032 | other | N/A | $7 to $25 | Low |
| Cath Soft Simplastic 20fr 3-way 30cc #570620 | other | N/A | $7 to $25 | Low |
| Cath Soft Simplastic 24fr 3way 30cc #570624 | other | N/A | $7 to $25 | Low |
| Anesthesia for Procedure On Small and Large Bowel Using an Endoscope | other | N/A | $5 to $813 | Low |
| Terconazole 80 Mg Suppository | other | N/A | $7 to $25 | Low |
| Aztreonam 1 Gm/ Ns 50 Ml Mini Bag Plus - Compounded | other | N/A | $7 to $25 | Low |
| Pin High Strength #9744 5ea/1bx | other | N/A | $7 to $25 | Low |
| Pin High Strength 3/32 X 9" 5ea/bx #9742 | other | N/A | $7 to $25 | Low |
| Albuterol, Up to 2.5 Mg and Ipratropium Bromide, Up to 0.5 Mg, Fda-approved F... | other | N/A | $15 to $29 | Low |
| Fischer Cone Biopsy Excisor Medium Extended | lab | N/A | $7 to $25 | Low |
| Cdm9801 10-0 Nylon 2xm1-160 (corneal Transpl | other | N/A | $7 to $25 | Low |
| Eye-stream Solution | other | N/A | $7 to $25 | Low |
| Splint Nasal Reuter #15 | other | N/A | $7 to $25 | Low |
| Tubing Irrigation Set #031229-10 10/pk | other | N/A | $7 to $25 | Low |
| Cannula Coronary Soft Tip Modified | cardiac | N/A | $7 to $26 | Low |
| M654g #6 Sternal Wire 4wires/pk 1pk=1ea | other | N/A | $7 to $26 | Low |
| Lidocaine Hcl 4% Solution | other | N/A | $7 to $26 | Low |
| Haloperidol Lac 2 Mg/ml Conc | other | N/A | $7 to $26 | Low |
| Comfort Cool Thumb Cmc Left Small Plus | other | N/A | $7 to $26 | Low |
| Comfort Cool Thumb Cmc Left-large Plus | other | N/A | $7 to $26 | Low |
| Comfort Cool Thumb Cmc Left-medium Plus | other | N/A | $7 to $26 | Low |
| Comfort Cool Thumb Cmc Right Large Plus | other | N/A | $7 to $26 | Low |
| Comfort Cool Thumb Cmc Right Small Plus | other | N/A | $7 to $26 | Low |
| Comfort Cool Thumb Cmc Right-medium Plus | other | N/A | $7 to $26 | Low |
| Novolog 100 Unit/ml Flexpen | other | N/A | $7 to $26 | Low |
| CPAP Mask Full Face Large Disp #niv040l | other | N/A | $7 to $26 | Low |
| Neupro 2 Mg/24 Hr Patch | other | N/A | $7 to $26 | Low |
| Adapter Connecting Ureteral Cath #uca5 | other | N/A | $7 to $26 | Low |
| Blood Glucose (sugar) Test Performed By Hand-held Instrument | other | N/A | $3 to $82,962 | Low |
| Blood Glucose (sugar) Tolerance Test, Each Additional Beyond 3 Specimens | lab | N/A | $4 to $82,952 | Low |
| Guidewire .045" Trocar Thrded #ar-8737 | other | N/A | $7 to $26 | Low |
| Insert Pad 61mm Surgical 15/bx | surgery | N/A | $7 to $26 | Low |
| Insert Pad 86mm/surg Clamp Fog | other | N/A | $7 to $26 | Low |
| Insert Pad Sz 5 10/bx #a0c04 | other | N/A | $7 to $26 | Low |
| Insertion Tray with Drainage Bag with Indwelling Catheter, Foley Type, Two-wa... | cardiac | N/A | $7 to $52 | Low |
| Insertion Tray without Drainage Bag with Indwelling Catheter, Foley Type, Two... | cardiac | N/A | $7 to $52 | Low |
| Liver Enzyme (sgot), Level | other | N/A | $5 to $84,450 | Low |
| Molecular Pathology Procedure | lab | N/A | $7 to $81,479 | Low |
| Test for Allergy Using Allergenic Extract Injected Into Skin with Delayed Rea... | other | N/A | $7 to $95,028 | Low |
| Urea Nitrogen Level to Assess Kidney Function, Quantitative | other | N/A | $4 to $84,520 | Low |
| Fentanyl 100 Mcg/hr Patch | other | N/A | $7 to $26 | Low |
| Pleur-evac Chest Drain System Single Collection Chamber 2500ml 16l/min Pleura... | other | N/A | $7 to $26 | Low |
| Mini Enteral Extension Set Right Angle Connector with Y-port Adapter Amt Mini... | other | N/A | $7 to $26 | Low |
| Electrode Loop 15 X 12mm Electrosurgical OR Electrocautery 5.12 Inch Length 1... | surgery | N/A | $7 to $27 | Low |
| Moxifloxacin 0.5% Eye Drops | other | N/A | $7 to $27 | Low |
| CPAP Mask - Lge #73-1019480ea | other | N/A | $7 to $27 | Low |
| CPAP Mask - Med #73-1019479ea | other | N/A | $7 to $27 | Low |
| CPAP Mask - Small #73-1019478ea | other | N/A | $7 to $27 | Low |
| Hydrogel Dressing, Wound Filler, Gel, Per Fluid Ounce | other | N/A | $7 to $53 | Low |
| Tube Ultrasil Modified T-tube #70241072 | other | N/A | $7 to $27 | Low |
| Tube Vent Ultrasil Duravent #70241075 Implant | surgery | N/A | $7 to $27 | Low |
| Zinc Oxide 20 % Ex Oint | other | N/A | $7 to $27 | Low |
| Ball Electrode 3mm Vaginal #e1563 | other | N/A | $7 to $27 | Low |
| Electrode Loop 20x15mm Vag #e1562 | other | N/A | $7 to $27 | Low |
| Sleeve Scd Thigh Med Comfort #74012- 5pr/1cs | other | N/A | $7 to $27 | Low |
| Tray Jamshidi Bone Marrow Latex Free 1ea | other | N/A | $7 to $27 | Low |
| Dressing Mepilex 4x10 Post Op Ag 5/bx 498450 | other | N/A | $7 to $27 | Low |
| Albumin (protein) Level | other | N/A | $5 to $82,040 | Low |
| Kirschner Wire .045 Threaded #47-0262 | other | N/A | $7 to $27 | Low |
| Lead Cap 4033a | other | N/A | $7 to $27 | Low |
| Liver Enzyme (sgpt), Level | other | N/A | $5 to $84,460 | Low |
| Phosphatase (enzyme) Level, Alkaline | other | N/A | $5 to $84,075 | Low |
| Valve Hemostasis #hva | other | N/A | $7 to $27 | Low |
| Wet Mounts, Including Preparations of Vaginal, Cervical OR Skin Specimens | lab | N/A | $7 to $54 | Low |
| Cannula Soft Tip 25g | other | N/A | $7 to $27 | Low |
| Fluocinonide 0.05% Cream | other | N/A | $7 to $27 | Low |
| Diag Catheter 6fr Multipack #cp0255 5/bx | cardiac | N/A | $7 to $27 | Low |
| Interventional Kit K05-02131c | other | N/A | $7 to $27 | Low |
| Medical Nutrition Therapy; Reassessment and Subsequent Intervention(s) Follow... | other | N/A | $7 to $55 | Low |
| Endovive Gastrostomy Tube with Enfit 24fr Straight5 Ea / Bx M00509941 | other | N/A | $7 to $28 | Low |
| G Tube 18fr Straight W/enfit M00509911 Bx/5ea | other | N/A | $7 to $28 | Low |
| G Tube 20fr Straight W/enfit M00509921 Bx/5ea | other | N/A | $7 to $28 | Low |
| Gastrostomy Tube Repl 16fr Straight M00582060 | other | N/A | $7 to $28 | Low |
| Gastrostomy Tube Repl 20fr Std Balloon Straig | other | N/A | $7 to $28 | Low |
| Gastrostomy Tube Repl 24fr Std Balloon Straig | other | N/A | $7 to $28 | Low |
| Gastrostomy/jejunostomy Tube, Standard, Any Material, Any Type, Each | other | N/A | $7 to $28 | Low |
| Proparacaine 0.5% Eye Drops | other | N/A | $7 to $28 | Low |
| Antivenin (latrodectus) Vial | other | N/A | $7 to $28 | Low |
| Vardenafil Hcl 20 Mg Po Tabs | other | N/A | $7 to $28 | Low |
| Ball Electrode 5mm Vaginal #e1564 | other | N/A | $7 to $28 | Low |
| Cholesterol Level | other | N/A | $4 to $82,465 | Low |
| Slitter Universal #6230uni Medtronic | other | N/A | $7 to $28 | Low |
| Special Stained Specimen Slides to Examine Tissue Including Interpretation an... | lab | N/A | $7 to $88,313 | Low |
| Logicut Disp Lap Coag Mp Scissor #120 | other | N/A | $7 to $28 | Low |
| Wire Pass Drill #1608-002 | other | N/A | $7 to $28 | Low |
| Tretinoin 0.025% Cream | other | N/A | $7 to $28 | Low |
| Electrode Defib Pediatric Quick Combo 1ea | other | N/A | $7 to $28 | Low |
| Knee Pad-polar Wrap On Regular #04700 | other | N/A | $7 to $28 | Low |
| Pacemaker Cable Adapter #adap-2000 | cardiac | N/A | $8 to $28 | Low |
| Walker Extra Duty Folding Guardian 1ea | other | N/A | $8 to $28 | Low |
| Tunnelers-sheaths Disp On Q 11ga X 12" 5/bx | other | N/A | $8 to $29 | Low |
| Roylan Wr&th Spica Left-large | other | N/A | $8 to $29 | Low |
| Roylan Wr&th Spica Left-medium | other | N/A | $8 to $29 | Low |
| Roylan Wr&th Spica Left-small | other | N/A | $8 to $29 | Low |
| Roylan Wr&th Spica Left-xlarge | other | N/A | $8 to $29 | Low |
| Roylan Wr&th Spica Left-xsmall | other | N/A | $8 to $29 | Low |
| Roylan Wr&th Spica Rt-large | other | N/A | $8 to $29 | Low |
| Roylan Wr&th Spica Rt-medium | other | N/A | $8 to $29 | Low |
| Roylan Wr&th Spica Rt-small | other | N/A | $8 to $29 | Low |
| Roylan Wr&th Spica Rt-xlarge | other | N/A | $8 to $29 | Low |
| Roylan Wr&th Spica Rt-xsmall | other | N/A | $8 to $29 | Low |
| Lap Electrode L Hook 5 X 27mm | other | N/A | $8 to $29 | Low |
| Lap Spatula Tip Solid Shaft #60-5159 | other | N/A | $8 to $29 | Low |
| Dressing Aquacel Ag Advantage 3.5 X 10" #422605 10ea/bx | other | N/A | $8 to $29 | Low |
| Bilirubin Level, Total | other | N/A | $5 to $82,247 | Low |
| Urine Sodium Level | other | N/A | $5 to $84,300 | Low |
| Tube Trach 4.0 Ped Cuffless | other | N/A | $8 to $29 | Low |
| Tube Trach Ped 5.0 Cuffless | other | N/A | $8 to $29 | Low |
| Tube Trach Ped 5.5 Cuffless | other | N/A | $8 to $29 | Low |
| Cefprozil 250 Mg/5ml Po Susr | other | N/A | $8 to $29 | Low |
| Catheter Phillips Follower 8fr Lf 10ea/bx | cardiac | N/A | $8 to $29 | Low |
| Closure Pilot Guide 15mm #pg-15s 5ea/bx | other | N/A | $8 to $29 | Low |
| Cyclomydril Eye Drops | other | N/A | $8 to $29 | Low |
| Short Cam Walker Lg #w0900blk | other | N/A | $8 to $30 | Low |
| Short Cam Walker Med #w0700blk | other | N/A | $8 to $30 | Low |
| Short Cam Walker Sm #w0500blk | other | N/A | $8 to $30 | Low |
| Cardioplegia Table Line #029463000 | other | N/A | $8 to $30 | Low |
| Interpulse Handpiece W/coaxial Highflo | other | N/A | $8 to $30 | Low |
| Veltassa 16.8 Gm Powder Packet | other | N/A | $8 to $30 | Low |
| Veltassa 8.4 Gm Powder Packet | other | N/A | $8 to $30 | Low |
| Catheter Phillips Follower 20fr Lf 10ea/bx | cardiac | N/A | $8 to $30 | Low |
| Lymphedema Foam 1/2" #cr-2-c 5ea/1cs | other | N/A | $8 to $30 | Low |
| Electrode Defib Preconnect Quik-combo 1st/1ea | other | N/A | $8 to $30 | Low |
| Mini Access Kit Stiff #s-mak501n | other | N/A | $8 to $30 | Low |
| Rybelsus 14 Mg Tablet | other | N/A | $8 to $30 | Low |
| Rybelsus 3 Mg Tablet | other | N/A | $8 to $30 | Low |
| Rybelsus 7 Mg Tablet | other | N/A | $8 to $30 | Low |
| Semaglutide 14 Mg Po Tabs | other | N/A | $8 to $30 | Low |
| Semaglutide 7 Mg Po Tabs | other | N/A | $8 to $30 | Low |
| Levemir Flexpen 100 Unit/ml | other | N/A | $8 to $30 | Low |
| Tray Cath Surestep Urine Meter 14fr A319414am | other | N/A | $8 to $30 | Low |
| Tray Cath Surestep Urine Meter 18fr A319418am | other | N/A | $8 to $30 | Low |
| Catheter H/s 5fr #ua61-5005 10/bx | cardiac | N/A | $8 to $30 | Low |
| Vision Supply, Accessory And/or Service Component of Another Hcpcs Vision Code | other | N/A | $8 to $30 | Low |
| Administration and Interpretation of Patient-focused Health Risk Assessment | other | N/A | $3 to $96,160 | Low |
| Blood Creatinine Level | other | N/A | $5 to $82,565 | Low |
| Blood Glucose (sugar) Level | other | N/A | $4 to $82,947 | Low |
| Cable PSA Disp #6651 | other | N/A | $8 to $30 | Low |
| Cane, Includes Canes of All Materials, Adjustable OR Fixed, with Tip | other | N/A | $8 to $60 | Low |
| Cast Supplies, Gauntlet Cast (includes Lower Forearm and Hand), Adult (11 Yea... | other | N/A | $8 to $60 | Low |
| Diag Catheter 6fr Jacky Radial 110cm #40 | cardiac | N/A | $8 to $30 | Low |
| Diag Catheter 6fr Radial Tig 110cm #40 | cardiac | N/A | $8 to $30 | Low |
| Diag Catheter 6fr Radial Tig 4.0 #40 | cardiac | N/A | $8 to $30 | Low |
| Electrical Stimulation, (unattended), to One OR More Areas, for Chronic Stage... | other | N/A | $8 to $60 | Low |
| Glutamyltransferase (liver Enzyme) Level | other | N/A | $7 to $82,977 | Low |
| Handling And/or Conveyance of Specimen for Transfer From Physician Office to ... | lab | N/A | $8 to $99,000 | Low |
| Indwelling Catheter; Specialty Type, (e.g., Coude, Mushroom, Wing, Etc.), Each | cardiac | N/A | $8 to $60 | Low |
| Iodine I-131 Sodium Iodide, Diagnostic, Per Microcurie | other | N/A | $8 to $60 | Low |
| Plastazote Sandal, Each | other | N/A | $8 to $60 | Low |
| Professional Service for Single Injection of Allergen | other | N/A | $8 to $95,115 | Low |
| Prostate Cancer Screening | other | N/A | $7 to $196 | High |
| Screening for Visual Sharpness | preventive | N/A | $8 to $99,173 | Low |
| Smoke Evac Pencil Push Button #0703-046 | other | N/A | $8 to $30 | Low |
| Cannula Aortic Root W/flow Guard 10/bx | other | N/A | $8 to $30 | Low |
| Algicell 4 X 4 #88044 4ea/1cs | other | N/A | $8 to $30 | Low |
| Anesthesia for Other Procedure On Esophagus, Stomach, OR Upper Small Bowel Us... | other | N/A | $2 to $731 | Low |
| Catheter Phillips Follower 14fr Lf 10ea/bx | cardiac | N/A | $8 to $31 | Low |
| Knife Orthopedic Hook Disp | other | N/A | $8 to $31 | Low |
| Dressing Ear Adult Glasscock #s | other | N/A | $8 to $31 | Low |
| Short Can Walker Xl #w1100blk | other | N/A | $8 to $31 | Low |
| Transducer Trifucated Color Coded 10ea/1cs | other | N/A | $8 to $31 | Low |
| Dressing Mepilex 4x12 Post Op Ag 5/bx 498600 | other | N/A | $8 to $31 | Low |
| Administration of Vaccine OR Toxoid Component with Counseling (18 Years OR Yo... | therapy | N/A | $8 to $90,461 | Low |
| Administration of Vaccine, Each Additional Vaccine | preventive | N/A | $8 to $90,472 | Low |
| All Potassium Hydroxide (koh) Preparations | other | N/A | $6 to $62 | Low |
| Cannula 30ga 7mm | other | N/A | $8 to $31 | Low |
| Cast Supplies, Short Arm Splint, Adult (11 Years +), Plaster | other | N/A | $8 to $62 | Low |
| Clozex Skin Closure 60mm X 50mm Cl1060l | other | N/A | $8 to $31 | Low |
| Measurement of Bilirubin | other | N/A | $5 to $88,720 | Low |
| Pathology Examination of Tissue Using a Microscope | lab | N/A | $6 to $88,302 | Low |
| Test for Ability to Detect and Repeat Spoken Words | other | N/A | $8 to $92,555 | Low |
| Tissue Fungi OR Parasites | other | N/A | $4 to $87,220 | Low |
| Total Protein Level, Urine | other | N/A | $4 to $84,156 | Low |
| Wrench Kit #5873w | other | N/A | $8 to $31 | Low |
| Wound Debridement Handpiece Vericare 6ea/1pk | other | N/A | $8 to $31 | Low |
| Pain Ease Mist Spray | other | N/A | $8 to $31 | Low |
| Vent Tube Venturi Reuter Bobbin #1070031 | other | N/A | $8 to $31 | Low |
| Lead Pacing Temp Myocardial #6500 | other | N/A | $8 to $31 | Low |
| Tubes Micron Infant Titanium #145221 | other | N/A | $8 to $31 | Low |
| Fluocinonide 0.05% Solution | other | N/A | $8 to $31 | Low |
| Boot Prevalon Heel Protector I #7305 8/cs | other | N/A | $8 to $31 | Low |
| Kwire Marked 0.9mm L70mm #agk09070m | other | N/A | $8 to $32 | Low |
| Obturator Bladeless 8mm #470359 Intuitive Sur | other | N/A | $8 to $32 | Low |
| Catheter Umbilical 3.5 Double Lumen 5ea/bx | cardiac | N/A | $8 to $32 | Low |
| Catheter Umbilical 5.0 Double Lumen 5ea/bx | cardiac | N/A | $8 to $32 | Low |
| Vac Pad Small Black 10ea/1ca | other | N/A | $8 to $32 | Low |
| Irrigation Sys W/cleaning Tip & Suction Tb | other | N/A | $8 to $32 | Low |
| Gastrostomy Tube Endovibe 20fr Rt Angle | other | N/A | $8 to $32 | Low |
| Gastrostomy Tube Repl 24fr Rt Angle | other | N/A | $8 to $32 | Low |
| Triamcinolone 0.1% Ointment | other | N/A | $8 to $32 | Low |
| Triamcinolone Acetonide 0.1 % Ex Oint | other | N/A | $8 to $32 | Low |
| Tube Vent .76mm Tiny Tylan Titanium Lf | other | N/A | $8 to $32 | Low |
| Administration of Nasal OR Oral Vaccine, Each Additional Vaccine | preventive | N/A | $9 to $90,474 | Low |
| Button Cannula 10mm Idx4 #ar-6592-10 | other | N/A | $9 to $32 | Low |
| Button Cannula 10mm Idx5 #ar-6592-10 | other | N/A | $9 to $32 | Low |
| Calcium Gluconate (antidote) 2.5 % Ex Gel | other | N/A | $9 to $32 | Low |
| Cannula Passport Button 8 X 3cm 5ea/bx | other | N/A | $9 to $32 | Low |
| Cannula Passport Button 8 X 4cm 5ea/bx | other | N/A | $9 to $32 | Low |
| Cannula Passport Button 8x2cm Ar-6592-08 | other | N/A | $9 to $32 | Low |
| Lacosamide 10 Mg/ml Solution | other | N/A | $9 to $32 | Low |
| Nepro Carb Steady Liquid | other | N/A | $9 to $32 | Low |
| Pin Drill Guide 2.4mm 6ea/bx Ar-1250l | other | N/A | $9 to $32 | Low |
| Skin Test for Tuberculosis | other | N/A | $9 to $86,580 | Low |
| Test for Allergy Using Allergenic Extract Injected Into Skin | other | N/A | $19 to $95,024 | Low |
| Test for Screening Hearing | preventive | N/A | $9 to $92,551 | Low |
| Sling Medium #mfa-1000m-m | other | N/A | $9 to $32 | Low |
| Sling Xl #mf-a1000m-xl | other | N/A | $9 to $32 | Low |
| Sling Xxlg #mf-a100m-xxlg | other | N/A | $9 to $32 | Low |
| Pillow Abduction Hip Large Disp #m60-031-l | other | N/A | $9 to $32 | Low |
| Hydroxyzine Hcl 10 Mg/5ml Po Syrp | other | N/A | $9 to $32 | Low |
| Tray Cath Surstep Lf Urin Met 18fr #a319518am | other | N/A | $9 to $32 | Low |
| Spiriva Respimat 2.5 Mcg Inh | other | N/A | $9 to $32 | Low |
| Floseal Applicator Curved #ads201815 | other | N/A | $9 to $32 | Low |
| Stirrup Air Orth Left | other | N/A | $9 to $32 | Low |
| Stirrup Air Ortho. Right | other | N/A | $9 to $32 | Low |
| Drainage Bag Aspira 1000ml#4992301 5ea/1bx | other | N/A | $9 to $32 | Low |
| Sleeve 0.9mm Microsmooth -eye | other | N/A | $9 to $32 | Low |
| Isentress 400 Mg Tablet | other | N/A | $9 to $32 | Low |
| Wrap Breast Sterile Comp Silverstein #sw001 Minimum Order 24 Each. Order Incr... | other | N/A | $9 to $32 | Low |
| Ortho Glass 2" X 15 #og-2l1 | other | N/A | $9 to $32 | Low |
| Wire Guide .025 X 40cm Fixed Core 10ea/1cs | other | N/A | $9 to $33 | Low |
| Dressing Aquacel Ag Advantage 3.5 X 14" #422607 10ea/bx | other | N/A | $9 to $33 | Low |
| Snapsecure 1-layer Foley Catheter Tray Temp Sensing 100% Silicone Urine Meter... | cardiac | N/A | $9 to $33 | Low |
| Dressing Aquacel Ag Advantage 3.5 X 12" #420606 10ea/bx | other | N/A | $9 to $33 | Low |
| Electrode Defib Radio-cmb#11996-000090 1st/1ea | other | N/A | $9 to $33 | Low |
| Tube Trach 3.5 Ped Cuffless Shiley | other | N/A | $9 to $33 | Low |
| 0.054 Wire Ws-1407st | other | N/A | $9 to $33 | Low |
| Annual, Face-to-face Intensive Behavioral Therapy for Cardiovascular Disease,... | cardiac | N/A | $9 to $66 | Low |
| Application of Electrical Stimulation | other | N/A | $9 to $97,014 | Low |
| Cast Supplies, Long Arm Cast, Pediatric (0-10 Years), Fiberglass | other | N/A | $9 to $66 | Low |
| Smear for Infectious Agents | other | N/A | $6 to $87,210 | Low |
| Wrench Kit St Jude #442 | other | N/A | $9 to $33 | Low |
| Catheter Trocar 16fr 10ea/1cs | cardiac | N/A | $9 to $33 | Low |
| Cannula Distal Rib Clr W/obturator 5.5mmx75mm | other | N/A | $9 to $33 | Low |
| Gentamicin 0.3% Eye Drop | other | N/A | $9 to $33 | Low |
| Zidovudine 50 Mg/5 Ml Syrup | other | N/A | $9 to $33 | Low |
| Micropuncture Kit 5fr #g43871 | other | N/A | $9 to $34 | Low |
| Terconazole 0.8% Cream | other | N/A | $9 to $34 | Low |
| Trach Tube Sz8 Lpc Non-fen Dct W/cannula | other | N/A | $9 to $34 | Low |
| Tube Trach Cuffless Sz 6 W/cannula #6cfs | other | N/A | $9 to $34 | Low |
| Trach Tube Sz6 Lpc Non-fen Dct W/cannula | other | N/A | $9 to $34 | Low |
| Tube Trach Cuffless Sz 8 W/cannula #8cfs | other | N/A | $9 to $34 | Low |
| Diag Catheter 6fr Barbeau 100cm #srd5897 5/bx | cardiac | N/A | $9 to $34 | Low |
| Body Fluid Ph Level | other | N/A | $4 to $83,986 | Low |
| Influenza Vaccine, Trivalent, 0.25 Ml Dosage | preventive | N/A | $9 to $90,657 | Low |
| Iron Level | other | N/A | $6 to $83,540 | Low |
| Red Blood Count, Manual Test | other | N/A | $4 to $85,044 | Low |
| Skin Test for Candida | other | N/A | $9 to $86,485 | Low |
| Tourniquet Emergency C-a-t 30 | emergency | N/A | $9 to $34 | Low |
| Butorphanol 10 Mg/ml Spray | other | N/A | $9 to $34 | Low |
| Forcep Biopsy Pediatric W/needle #m00513453 | lab | N/A | $9 to $34 | Low |
| Cannula Venous 24fr Malleable Single Stage | other | N/A | $9 to $34 | Low |
| Cannula Venous 26fr Malleable Single Stage | other | N/A | $9 to $34 | Low |
| Cannula Venous 28fr Malleable Single Stage | other | N/A | $9 to $34 | Low |
| Cannula Venous 30fr Malleable Single Stage | other | N/A | $9 to $34 | Low |
| Cannula Venous 32/40fr Two Stage #91263 | other | N/A | $9 to $34 | Low |
| Catheter Venous Return 34fr Malleable | cardiac | N/A | $9 to $34 | Low |
| Use of a Drug to Induce Depression of Consciousness By Physician Performing a... | other | N/A | $9 to $99,152 | Low |
| Collagen Dressing, Sterile, Size More Than 16 Sq. In. But Less Than OR Equal ... | other | N/A | $9 to $69 | Low |
| Clozex Skin Closure 80mm X 50mm Cl1080l | other | N/A | $9 to $35 | Low |
| Needle Accucore Biopsy 10/bx #640914 | lab | N/A | $9 to $35 | Low |
| Picc Introducer 4.5fr Micro Bard | other | N/A | $9 to $35 | Low |
| Picc Introducer 5.0fr Micro Bard | other | N/A | $9 to $35 | Low |
| Temno 18g X 6.0cm Biopsy Needle 5ea / Bx T186 | lab | N/A | $9 to $35 | Low |
| Interdry 10"x36"sheet Moist-wick Fabric 10/bx | other | N/A | $9 to $35 | Low |
| 6/7 Glidesheath Slender #50-1070 10ea/box | other | N/A | $9 to $35 | Low |
| Defib /electrode Peds Pd-2300 Zoll 6ea/1cs | other | N/A | $9 to $35 | Low |
| Cannula Viscoelastic Asp Ang 10mm 19g | other | N/A | $9 to $35 | Low |
| Cast Supplies, Short Arm Splint, Adult (11 Years +), Fiberglass | other | N/A | $9 to $70 | Low |
| Lead Pacing Temp Atrial Unipolar #6492-xf53 | other | N/A | $9 to $35 | Low |
| Lead Pacing Temp Pediatric #6491-xf53 | other | N/A | $9 to $35 | Low |
| Preparation of Tissue for Examination By Removing Any Calcium Present | other | N/A | $9 to $88,311 | Low |
| Professional Service for Multiple Injections of Allergen | other | N/A | $9 to $95,117 | Low |
| Repair of Orthotic Device, Labor Component, Per 15 Minutes | surgery | N/A | $9 to $70 | Low |
| Screening of Eye with Special Instrument Onsite Analysis | preventive | N/A | $9 to $99,177 | Low |
| See Sharp Temp Control Laparoscope Cleaning and Defogging with Long Trocar #3... | surgery | N/A | $9 to $35 | Low |
| Uric Acid Level, Blood | other | N/A | $5 to $84,550 | Low |
| Urine Pregnancy Test | other | N/A | $9 to $81,025 | Low |
| Biopsy Inst Max-core Disposable Core #mc1820 | lab | N/A | $9 to $35 | Low |
| Cefdinir 125 Mg/5 Ml Susp | other | N/A | $9 to $35 | Low |
| Defib /electrode Stat-pads Adult Zoll 12ea/cs | other | N/A | $9 to $35 | Low |
| Catheter Venous Return 36fr Malleable | cardiac | N/A | $9 to $36 | Low |
| Spinal Lumbar Puncture Adult 20gx3.5 #dynjts4301 10ea/case | other | N/A | $9 to $36 | Low |
| Dressing Mepilex 4x14 Post Op Ag 5/bx 498650 | other | N/A | $9 to $36 | Low |
| Max-core Disposable Core Biopsy Instrument 16g X 16cm #mc1616 5ea/case | lab | N/A | $10 to $36 | Low |
| Caffeine Cit 60 Mg/3 Ml Oral | other | N/A | $10 to $36 | Low |
| Spinal Tray-lumbar-infant 10ea/1cs | other | N/A | $10 to $36 | Low |
| Catheter Tray Foley Criticore 16fr Surestep | cardiac | N/A | $10 to $36 | Low |
| Interject Catheter #1836 25ga 7fr 240cm | cardiac | N/A | $10 to $36 | Low |
| Promethazine Hydrochloride, 12.5 Mg, Oral, Fda Approved Prescription Anti-eme... | other | N/A | $10 to $36 | Low |
| Tube Trach Cuffless Size 4cfn | other | N/A | $10 to $36 | Low |
| Tube Trach Cuffless Size 6cfn 1ea | other | N/A | $10 to $36 | Low |
| Tube Trach Cuffless Size 8cfn 1ea | other | N/A | $10 to $36 | Low |
| Amylase (enzyme) Level | other | N/A | $6 to $82,150 | Low |
| Bra Compression Pink Post Surgery Large #042l | surgery | N/A | $10 to $36 | Low |
| Bra Compression Pink Post Surgery Medium #042m | surgery | N/A | $10 to $36 | Low |
| Bra Post Surgery Compression 2xl #0422xl | surgery | N/A | $10 to $36 | Low |
| Bra Post Surgery Compression 3xl #0423xl | surgery | N/A | $10 to $36 | Low |
| Bra Post Surgery Compression Xl #042xl | surgery | N/A | $10 to $36 | Low |
| Cast Supplies, Short Arm Cast, Adult (11 Years +), Fiberglass | other | N/A | $10 to $72 | Low |
| Red Blood Cell Sedimentation Rate, to Detect Inflammation, Automated | other | N/A | $3 to $85,652 | Low |
| Cannula Venous 34/46fr #91246 Two-stage | other | N/A | $10 to $36 | Low |
| Breather/speech/rehab 1ea | other | N/A | $10 to $36 | Low |
| Irrigator Lap Suction Davol 12/cs #5102710 | other | N/A | $10 to $37 | Low |
| Thrombin-jmi 5,000 Units Vial | other | N/A | $10 to $37 | Low |
| Reuter-bobbin Vent Tube 1.27 Mm Lumen I.d. 1 Mm Interflange Stainless Steel 6... | other | N/A | $10 to $37 | Low |
| Softkit Black Univ Xsmall 283900010 | other | N/A | $10 to $37 | Low |
| Rapid Rhino 5.5cm Rapid-pac Rr530 #rr 530 | other | N/A | $10 to $37 | Low |
| Trach Tube Sz4 Lpc Fen Disp Dfen W/cannula | other | N/A | $10 to $37 | Low |
| Trach Tube Sz6 Lpc Fen Disp Dfen W/cannula | other | N/A | $10 to $37 | Low |
| Trach Tube Sz8 Lpc Fen Disp Dfen W/cannula | other | N/A | $10 to $37 | Low |
| Hc Dressing Aquacel Extra | other | N/A | $10 to $37 | Low |
| Dressing Jumpstart Abs | other | N/A | $10 to $37 | Low |
| Cyclogyl 2% Eye Drops | other | N/A | $10 to $37 | Low |
| Phytonadione 5 Mg Po Tabs | other | N/A | $10 to $37 | Low |
| Phytonadione 5 Mg Tablet | other | N/A | $10 to $37 | Low |
| Aortical Surgical Flat 4.0 Punch #080-401 6ea/box | surgery | N/A | $10 to $37 | Low |
| Blood Potassium Level | other | N/A | $5 to $84,132 | Low |
| Cervical OR Vaginal Cancer Screening; Pelvic and Clinical Breast Examination | preventive | N/A | $10 to $74 | Low |
| Measurement of Antibody (ige) to Allergic Substance, Crude Allergen Extract, ... | other | N/A | $5 to $86,003 | Low |
| Red Blood Count, Automated Test | other | N/A | $4 to $85,045 | Low |
| Suction Coag Tips #ps300 | other | N/A | $10 to $37 | Low |
| Syphilis Detection Test | other | N/A | $4 to $86,592 | Low |
| Urine Culture | lab | N/A | $8 to $87,088 | Low |
| Night Splint Lg #w | other | N/A | $10 to $37 | Low |
| Betamethasone Dp 0.05% Lot | other | N/A | $10 to $37 | Low |
| Softkit Black Univ Large/xlarge 283900013 | other | N/A | $10 to $37 | Low |
| Softkit Black Univ Medium 283900012 | other | N/A | $10 to $37 | Low |
| Softkit Black Univ Small 283900011 | other | N/A | $10 to $37 | Low |
| Perfusion Vavd W/specimen Trap 5/cs | surgery | N/A | $10 to $37 | Low |
| Staple Reload Ta 90mm Disposable Ta9048l 6/cs | other | N/A | $10 to $37 | Low |
| Hydrocolloid Dressing, Wound Cover, Sterile, Pad Size More Than 16 Sq. In. Bu... | other | N/A | $10 to $75 | Low |
| Shiley Tracheostomy Tube Uncuffed Id 6.5mm Od 9.4mm 62mm #4un65h | other | N/A | $10 to $38 | Low |
| Shiley Tracheostomy Tube Uncuffed Id 8.5mm Od 12.2mm 5mm | other | N/A | $10 to $38 | Low |
| Gatifloxacin 0.5 % Op Soln | other | N/A | $10 to $38 | Low |
| Carnitor 100 Mg/ml Oral Soln | other | N/A | $10 to $38 | Low |
| Levocarnitine 1 Gm/10ml Po Soln | other | N/A | $10 to $38 | Low |
| Antimicrobial Study, Mycobacteria | other | N/A | $7 to $87,190 | Low |
| Catheter Kumar Disp Ltx-free #cc | cardiac | N/A | $10 to $38 | Low |
| Clozex Skin Closure 100mm X 50mm Cl10100l | other | N/A | $10 to $38 | Low |
| Creatinine Level to Test for Kidney Function OR Muscle Injury | other | N/A | $5 to $82,570 | Low |
| Detection Test By Immunoassay Technique for Respiratory Syncytial Virus | other | N/A | $10 to $87,420 | Low |
| Endo Colon Spot Ex Tattoo #gis | other | N/A | $10 to $38 | Low |
| Professional Service for Preparation and Provision of 1 OR More Antigens | other | N/A | $3 to $95,165 | Low |
| Drop Foot Splint Standard Sm Lt #pls-ff-100l | other | N/A | $10 to $38 | Low |
| Stiff Micropuncture Introducer #h787065971045 | other | N/A | $10 to $38 | Low |
| Stylet Glidescope Adult Single Use #0270 | other | N/A | $10 to $39 | Low |
| Wound Care Set, for Negative Pressure Wound Therapy Electrical Pump, Includes... | other | N/A | $10 to $77 | Low |
| Clindamycin (pedi) 75 Mg/5 Ml | other | N/A | $10 to $39 | Low |
| Clindamycin Palmitate Hcl 75 Mg/5ml Po Solr | other | N/A | $10 to $39 | Low |
| Expanula Port 8.25 X 7cm #ar | other | N/A | $10 to $39 | Low |
| Knee Stabilizer Pad #o-tksp-a | other | N/A | $10 to $39 | Low |
| Screening Test for Mononucleosis | preventive | N/A | $5 to $86,308 | Low |
| Sleeve Scd Thigh Large Comfort #74013 3pr/1cs | other | N/A | $10 to $39 | Low |
| Vac Pad Medium Black 10ea/1ca | other | N/A | $10 to $39 | Low |
| Lotronex 0.5 Mg Tablet | other | N/A | $10 to $39 | Low |
| Temno 20g X 6.0cm Biopsy Needle 5ea / Bx T206 | lab | N/A | $10 to $39 | Low |
| Drop Foot Splint Standard Xlg Lt #pls-ff-400l | other | N/A | $10 to $39 | Low |
| Drop Foot Splint Standard Xlg Rt #pls-ff-400r | other | N/A | $10 to $39 | Low |
| Iodine I-131 Sodium Iodide Solution, Therapeutic, Per Millicurie | other | N/A | $10 to $78 | Low |
| Transfer Board W/slots 1ea | other | N/A | $10 to $39 | Low |
| Low Osmolar Contrast Material, 300-399 Mg/ml Iodine Concentration, Per Ml | other | N/A | $10 to $39 | Low |
| Commode Bedside 300lb Fixedarm Alum #cpat0002 | other | N/A | $10 to $39 | Low |
| Core Disposable Irrigation Cassette #5400-050 | other | N/A | $11 to $40 | Low |
| Flunisolide 0.025% Spray | other | N/A | $11 to $40 | Low |
| Erythromycin 2 % Ex Soln | other | N/A | $11 to $40 | Low |
| Hem-o-lok Med/lrg #544230 6ea/cartidg 14ct/bx | other | N/A | $11 to $40 | Low |
| Ligating Clip Lrg Hemolok #544240 Teleflex | other | N/A | $11 to $40 | Low |
| Surgineedle 120mm #172015 | other | N/A | $11 to $40 | Low |
| Sulfamethoxazole-tmp Susp | other | N/A | $11 to $40 | Low |
| Needle Foramen 20ga 5.0 Parylene #041829 | other | N/A | $11 to $40 | Low |
| Application of Blood Vessel Compression Device | other | N/A | $11 to $97,016 | Low |
| Blood Glucose (sugar) Level After Receiving Dose of Glucose | other | N/A | $5 to $82,950 | Low |
| Cast Supplies, Short Arm Splint, Pediatric (0-10 Years), Plaster | other | N/A | $4 to $80 | Low |
| Cast Supplies, Short Leg Cast, Adult (11 Years +), Fiberglass | other | N/A | $11 to $80 | Low |
| Cast Supplies, Short Leg Cast, Pediatric (0-10 Years), Fiberglass | other | N/A | $11 to $80 | Low |
| Complete Blood Cell Count (red Cells, White Blood Cell, Platelets), Automated... | other | N/A | $6 to $85,027 | Low |
| Drain Ep Sil 3/16" Zimmer #2540-007 | other | N/A | $11 to $40 | Low |
| Endocatch 10mm Gold Specimen Pouch #173050g | lab | N/A | $11 to $40 | Low |
| Hc Boot Cast Gelo Unna's-wch | other | N/A | $11 to $40 | Low |
| Inflation Device Encore 26 Vascular | other | N/A | $11 to $40 | Low |
| Orthotic and Prosthetic Supply, Accessory, And/or Service Component of Anothe... | other | N/A | $11 to $40 | Low |
| Specific Gravity (liquid Weight) Measurement | other | N/A | $3 to $84,315 | Low |
| Stylet | other | N/A | $11 to $40 | Low |
| Stylet #6082-52cm | other | N/A | $11 to $40 | Low |
| Stylet 45cm Gray #6091-45cm | other | N/A | $11 to $40 | Low |
| Stylet Cap & Ring Sc-4395 | other | N/A | $11 to $40 | Low |
| Stylet Gray #6082-45cm | other | N/A | $11 to $40 | Low |
| Stylet Kit with Stylet Cap M365sc4385700 #sc-4385 | other | N/A | $11 to $40 | Low |
| Surgical Boot/shoe, Each | surgery | N/A | $11 to $80 | Low |
| Granufoam Thin Dressing #m8275081/10.s 10ea/case | other | N/A | $11 to $40 | Low |
| Drop Foot Splint Standard Med Lt #pls-ff-200l | other | N/A | $11 to $40 | Low |
| Gelfoam Size 100 Sponge | other | N/A | $11 to $40 | Low |
| For Diabetics Only, Multiple Density Insert, Direct Formed, Molded to Foot Af... | other | N/A | $11 to $40 | Low |
| Phenylephrine 10% Eye Drop | other | N/A | $11 to $40 | Low |
| Knife Retrograde Dyonics Disp | other | N/A | $11 to $41 | Low |
| 5fr Sos Omni (0) 80cm H787107120085 | other | N/A | $11 to $41 | Low |
| 5fr Sos Omni (3) 80cm | other | N/A | $11 to $41 | Low |
| Reservoir Blood Collection Xres B #04259 6/cs | other | N/A | $11 to $41 | Low |
| Catheter 5fr Filiform W/spiral Tip V. Mueller Gu2075-105 10ea/bx | cardiac | N/A | $11 to $41 | Low |
| Nerve Locator/ Neuro Pulse 10/pk | other | N/A | $11 to $41 | Low |
| Bilirubin Level, Direct | other | N/A | $5 to $82,248 | Low |
| Cannula Venous T Flex Ds #trf2937o2 10ea/1cs | other | N/A | $11 to $41 | Low |
| Stool Analysis for Blood, By Peroxidase Activity | other | N/A | $4 to $82,272 | Low |
| Therapeutic Interventions That Focus On Cognitive Function (eg, Attention, Me... | other | N/A | $11 to $97,127 | Low |
| Velys Array Drill Pin 100mm X 4mm 4515-70-004 Minimum Order 10 Each | other | N/A | $11 to $41 | Low |
| **obsolete** Suture 0 Poly Prolene #833 | other | N/A | $11 to $41 | Low |
| Foley Cath 1.5cc 6fr #170003060 | other | N/A | $11 to $41 | Low |
| Stiolto Respimat Inhaler | other | N/A | $11 to $42 | Low |
| Imaging of Organ | other | N/A | $11 to $76,120 | Low |
| Magnesium Level | other | N/A | $7 to $83,735 | Low |
| Tacrolimus Level | other | N/A | $11 to $80,197 | Low |
| Thyroid Hormone Evaluation | other | N/A | $6 to $84,479 | Low |
| Total Protein Level, Blood | other | N/A | $4 to $84,155 | Low |
| Urine Calcium Level | other | N/A | $6 to $82,340 | Low |
| Detection Test By Immunoassay with Direct Visual Observation for Streptococcu... | other | N/A | $11 to $87,880 | Low |
| Evaluation of Antimicrobial Drug | other | N/A | $7 to $87,184 | Low |
| Influenza Vaccine, Trivalent, Split Virus, Preservative-free, 0.5 Ml Dosage | preventive | N/A | $12 to $90,656 | Low |
| Red Blood Cell Antibody Detection Test, Direct | other | N/A | $5 to $86,880 | Low |
| Rheumatoid Factor Level | other | N/A | $6 to $86,431 | Low |
| Special Gram OR Giemsa Stain for Microorganism | other | N/A | $4 to $87,205 | Low |
| Bleeding Time | other | N/A | $5 to $85,002 | Low |
| Screening of Eye with Special Instrument with Remote Analysis | preventive | N/A | $12 to $99,174 | Low |
| Thyroxine (thyroid Chemical), Total | other | N/A | $7 to $84,436 | Low |
| Assessment of Emotional OR Behavioral Problems | other | N/A | $12 to $96,127 | Low |
| Evaluation of Use of Breathing Device | other | N/A | $13 to $94,664 | Low |
| Pathology Examination of Tissue Using a Microscope, Moderately Low Complexity | lab | N/A | $10 to $88,304 | Low |
| Triglycerides Level | other | N/A | $6 to $84,478 | Low |
| Creatine Kinase (cardiac Enzyme) Level, Total | cardiac | N/A | $7 to $82,550 | Low |
| Haemophilus Influenzae Type B Vaccine, Prp-omp Conjugate | preventive | N/A | $13 to $90,647 | Low |
| Iron Binding Capacity | other | N/A | $9 to $83,550 | Low |
| Lipase (fat Enzyme) Level | other | N/A | $7 to $83,690 | Low |
| Red Blood Cell Concentration Measurement | other | N/A | $2 to $85,014 | Low |
| Administration of First Vaccine OR Toxoid Component with Counseling | therapy | N/A | $13 to $90,460 | Low |
| Administration of Nasal OR Oral Vaccine, 1 Vaccine | preventive | N/A | $13 to $90,473 | Low |
| Administration of Vaccine | preventive | N/A | $13 to $90,471 | Low |
| Ldl Cholesterol Level | other | N/A | $11 to $83,721 | Low |
| Adenovirus Type 4 Vaccine | preventive | N/A | $13 to $90,476 | Low |
| Detection Test By Nucleic Acid for Strep (streptococcus, Group A), Amplified ... | other | N/A | $13 to $87,651 | Low |
| Haemophilus Influenzae Type B Vaccine, Prp-t Conjugate | preventive | N/A | $13 to $90,648 | Low |
| Influenza Vaccine, Quadrivalent for Nasal Administration | preventive | N/A | $13 to $90,672 | Low |
| Lactate Dehydrogenase (enzyme) Level | other | N/A | $6 to $83,615 | Low |
| Test for Ability to Detect and Repeat Spoken Words with Speech Recognition | other | N/A | $13 to $92,556 | Low |
| Test to Assess Middle Ear Function | other | N/A | $8 to $92,567 | Low |
| Red Blood Cell Fragility Measurement, Unincubated | other | N/A | $7 to $85,555 | Low |
| Test for Hearing Various Pitches Using Earphone | other | N/A | $14 to $92,552 | Low |
| Automated White Blood Cell Count | other | N/A | $3 to $85,048 | Low |
| Bacterial Colony Count, Urine | other | N/A | $8 to $87,086 | Low |
| Pinworm Test | other | N/A | $4 to $87,172 | Low |
| Detection Test By Immunoassay with Direct Visual Observation for Influenza Virus | other | N/A | $15 to $87,804 | Low |
| Psychiatric Services Complicated By Communication Factor | therapy | N/A | $12 to $90,785 | Low |
| Sodium Level | other | N/A | $5 to $84,302 | Low |
| Test for Screening Hearing Using a Probe | preventive | N/A | $15 to $92,558 | Low |
| Blood Test | lab | N/A | $7 to $80,047 | High |
| Stool Analysis for Blood, By Fecal Hemoglobin Determination By Immunoassay | other | N/A | $15 to $82,274 | Low |
| Urine Chloride Level | other | N/A | $6 to $82,436 | Low |
| Chloride Level | other | N/A | $5 to $82,438 | Low |
| Office OR Other Outpatient Visit for the Evaluation and Management of Establi... | other | N/A | $7 to $99,211 | Low |
| Influenza Vaccine, Trivalent, Derived From Cell Cultures, Antibiotic Free, 0.... | lab | N/A | $16 to $90,661 | Low |
| Poliovirus Vaccine | preventive | N/A | $16 to $90,713 | Low |
| Service Provided in an Office During Regularly Scheduled Office Hours, Evenin... | other | N/A | $16 to $99,051 | Low |
| Blood Chloride Level | other | N/A | $5 to $82,435 | Low |
| Urine Microalbumin (protein) Level | other | N/A | $6 to $82,043 | Low |
| Blood Typing for Rh (d) Antigen | other | N/A | $3 to $86,901 | Low |
| Influenza Vaccine, Trivalent for Nasal Administration | preventive | N/A | $16 to $90,660 | Low |
| Urea Nitrogen Level to Assess Kidney Function, Urine | other | N/A | $6 to $84,540 | Low |
| Detection Test By Immunoassay Technique for Streptococcus, Group a | other | N/A | $17 to $87,430 | Low |
| Review By Radiologist of Bile And/or Pancreatic Duct Image During Surgery | surgery | N/A | $12 to $74,300 | Low |
| Education and Training for Patient Self-management, Each 30 Minutes | other | N/A | $17 to $98,960 | Low |
| Piercing of Ear | other | N/A | $17 to $69,090 | Low |
| Red Blood Cell Sickling Measurement | other | N/A | $6 to $85,660 | Low |
| Evaluation of Antimicrobial Drug (antibiotic, Antifungal, Antiviral), Microdi... | other | N/A | $9 to $87,186 | Low |
| Test to Assess Middle Ear Muscle Reflex | other | N/A | $12 to $92,568 | Low |
| Pap Test, Slides, Manual Screening | preventive | N/A | $18 to $88,164 | Low |
| Protein Test for Diagnosis and Monitoring of Bladder Cancer | other | N/A | $18 to $86,386 | Low |
| Removal of Impacted Ear Wax By Washing | surgery | N/A | $16 to $69,209 | Low |
| Check of Hearing Aid, 1 Ear | other | N/A | $18 to $92,592 | Low |
| Breast Biopsy | other | N/A | $18 to $2,890 | High |
| Special Stained Specimen Slides to Identify Organisms Including Interpretatio... | lab | N/A | $18 to $88,312 | Low |
| Immunologic Analysis Technique On Serum | other | N/A | $18 to $86,334 | Low |
| Test to Measure the Total Volume of Air That Can Be Exhaled After Inhaling | other | N/A | $18 to $94,150 | Low |
| Thyroxine (thyroid Chemical), Free | other | N/A | $9 to $84,439 | Low |
| Zinc Level | other | N/A | $11 to $84,630 | Low |
| Harvest of Vein Using an Endoscope | other | N/A | $13 to $33,508 | Low |
| Pap Test, Evaluation of Fine Needle Aspirate, Immediate, Each Additional Eval... | other | N/A | $18 to $88,177 | Low |
| Test for Abnormal Eye Movement without Stimulus | other | N/A | $18 to $92,531 | Low |
| Coagulation Function Measurement, D-dimer; Quantitative | other | N/A | $10 to $85,379 | Low |
| Concentration of Specimen for Infectious Agents | lab | N/A | $7 to $87,015 | Low |
| Hemoglobin A1C | lab | N/A | $10 to $83,036 | High |
| Influenza Vaccine, Quadrivalent Derived From Cell Cultures, Preservative and ... | lab | N/A | $19 to $90,674 | Low |
| Platelet Count, Automated Test | other | N/A | $4 to $85,049 | Low |
| Test to Measure Largest Amount of Air Breathed in an Out | other | N/A | $3 to $94,200 | Low |
| Urine Potassium Level | other | N/A | $5 to $84,133 | Low |
| Analysis for Antibody to Bartonella | other | N/A | $10 to $86,611 | Low |
| Calcium Level, Total | other | N/A | $5 to $82,310 | Low |
| Gonadotropin (reproductive Hormone) Analysis | other | N/A | $8 to $84,703 | Low |
| X-ray of Part of Lower Jaw, 1-4 Views | imaging | N/A | $9 to $70,100 | Low |
| Cryoglobulin (protein) Measurement | other | N/A | $6 to $82,595 | Low |
| Counseling for Genetic Testing Provided By a Genetic Counselor, Each 30 Minut... | therapy | N/A | $19 to $96,041 | Low |
| Examination of Archival Tissue for Genetic Analysis | other | N/A | $15 to $88,363 | Low |
| Fetal Hemoglobin OR Red Blood Cells Measurement for Assessment of Fetal-mater... | other | N/A | $9 to $85,461 | Low |
| G6pd (enzyme) Level | other | N/A | $10 to $82,955 | Low |
| Detection of Infectious Agent Antibody, Quantitative | other | N/A | $15 to $86,317 | Low |
| Single Contrast X-ray of Esophagus | imaging | N/A | $20 to $74,220 | Low |
| Ultrasonic Guidance for Blood Vessel Access | other | N/A | $13 to $76,937 | Low |
| X-ray of Joint Between Lower Spine and Hip Bone, 1-2 Views | imaging | N/A | $8 to $72,200 | Low |
| Detection Test By Immunofluorescent Technique for Legionella Pneumophila | other | N/A | $16 to $87,278 | Low |
| Flow Cytometry Technique for Dna OR Cell Analysis, 16 OR More Markers | other | N/A | $20 to $88,189 | Low |
| Influenza Vaccine, Trivalent, 0.5 Ml Dosage | preventive | N/A | $20 to $90,658 | Low |
| Smoking and Tobacco Use Intensive Counseling, More Than 10 Minutes | therapy | N/A | $20 to $99,407 | Low |
| Therapy Procedure for Nutrition Management, Each 15 Minutes | other | N/A | $20 to $97,802 | Low |
| X-ray of Spine, 1 View | imaging | N/A | $7 to $72,020 | Low |
| Creatinine Clearance Measurement to Test for Kidney Function | other | N/A | $9 to $82,575 | Low |
| Crystal Identification From Tissue OR Body Fluid | other | N/A | $7 to $89,060 | Low |
| Influenza Vaccine, Trivalent, Split Virus, Preservative-free, 0.25 Ml Dosage | preventive | N/A | $20 to $90,655 | Low |
| Special Fluorescent And/or Acid Fast Stain for Microorganism | other | N/A | $5 to $87,206 | Low |
| Mammogram | preventive | N/A | $15 to $77,052 | High |
| Therapy Procedure Using Massage, Each 15 Minutes | other | N/A | $20 to $97,124 | Low |
| X-ray of Nose Bones, Minimum of 3 Views | imaging | N/A | $8 to $70,160 | Low |
| Beta 2 Glycoprotein 1 Antibody (autoantibody) Measurement | other | N/A | $21 to $86,146 | Low |
| Blood Osmolality (concentration) Measurement | other | N/A | $7 to $83,930 | Low |
| Blood Viscosity Measurement | other | N/A | $12 to $85,810 | Low |
| Measurement C-reactive Protein for Detection of Infection OR Inflammation | other | N/A | $5 to $86,140 | Low |
| Urine Osmolality (concentration) Measurement | other | N/A | $7 to $83,935 | Low |
| Diphtheria, Tetanus, and Acellular Pertussis Vaccine | preventive | N/A | $21 to $90,715 | Low |
| Phosphatase (enzyme) Measurement, Alkaline, Isoenzymes | other | N/A | $15 to $84,080 | Low |
| Placement of Strapping to Ankle OR Foot | other | N/A | $15 to $29,540 | Low |
| Analysis for Antibody to Herpes Simplex Virus | other | N/A | $14 to $86,694 | Low |
| Coagulation Time Measurement, Activated | other | N/A | $4 to $85,347 | Low |
| Exam of Ear Using a Microscope | other | N/A | $7 to $92,504 | Low |
| Genetic Sequencing Localization, Initial Procedure | other | N/A | $21 to $88,365 | Low |
| Group Psychotherapy | therapy | N/A | $21 to $90,853 | Low |
| Pathology Examination of Specimen During Surgery, Each Additional Tissue Block | surgery | N/A | $21 to $88,332 | Low |
| Placement of Ear Probe for Computerized Measurement of Sound with Interpretat... | other | N/A | $18 to $92,587 | Low |
| Programming of Single, Dual OR Multiple Lead Implantable Defibrillator System... | surgery | N/A | $21 to $93,287 | Low |
| Screening 3d Breast Mammography | imaging | N/A | $21 to $77,063 | Low |
| Uric Acid Level | other | N/A | $5 to $84,560 | Low |
| Ferritin (blood Protein) Level | other | N/A | $14 to $82,728 | Low |
| Hepatitis B Surface Antibody Measurement | other | N/A | $11 to $86,706 | Low |
| Outpatient Heart Rehabilitation, Qualified Health Care Professional Services | cardiac | N/A | $7 to $93,797 | Low |
| Stool Culture, Additional Pathogens | lab | N/A | $9 to $87,046 | Low |
| Detection Test By Immunoassay Technique for Giardia | other | N/A | $12 to $87,329 | Low |
| Superficial And/or Low Voltage Radiation Treatment Delivery | obstetric | N/A | $22 to $77,401 | Low |
| Total Protein Level, Body Fluid | other | N/A | $4 to $84,157 | Low |
| Analysis for Antibody to Cytomegalovirus | other | N/A | $14 to $86,644 | Low |
| Blood Glucose (sugar) Tolerance Test, 3 Specimens | lab | N/A | $13 to $82,951 | Low |
| Semen Analysis Presence And/or Motility of Sperm | other | N/A | $10 to $89,300 | Low |
| X-ray of Middle Spine, 3 Views | imaging | N/A | $10 to $72,072 | Low |
| X-ray of Soft Tissue of Neck | imaging | N/A | $8 to $70,360 | Low |
| Lipoprotein (a) Level | other | N/A | $14 to $83,695 | Low |
| Pap Test | other | N/A | $22 to $88,141 | Low |
| Clotting Factor X Assessment Test, Diluted | other | N/A | $10 to $85,613 | Low |
| Dihydroxyvitamin D, 1, 25 Level | other | N/A | $23 to $82,652 | Low |
| Service Provided On an Emergency Basis in the Office | emergency | N/A | $23 to $99,058 | Low |
| Test for Detecting Genes Associated with Blood Cancer | other | N/A | $23 to $81,246 | Low |
| Aldolase (enzyme) Level | other | N/A | $10 to $82,085 | Low |
| Detection Test By Immunoassay with Direct Visual Observation for Other Organism | other | N/A | $16 to $87,899 | Low |
| Hepatitis B Core Antibody Measurement | other | N/A | $12 to $86,704 | Low |
| X-ray of Surgical Specimen | imaging | N/A | $14 to $76,098 | Low |
| Folic Acid Level, Serum | other | N/A | $15 to $82,746 | Low |
| Microscopic Genetic Analysis of Tumor, Using Computer-assisted Technology | other | N/A | $23 to $88,361 | Low |
| Analysis for Antibody to Rubella | other | N/A | $14 to $86,762 | Low |
| Hepatitis Be Antibody Measurement | other | N/A | $12 to $86,707 | Low |
| Alcohol And/or Substance Abuse Screening and Intervention, 15-30 Minutes | preventive | N/A | $23 to $99,408 | Low |
| Cell Examination of Specimen, Concentration Technique | lab | N/A | $21 to $88,108 | Low |
| Digoxin Level, Total | other | N/A | $13 to $80,162 | Low |
| Service Provided in the Office When the Office Is Normally Closed | other | N/A | $24 to $99,050 | Low |
| Analysis for Antibody to Enterovirus | other | N/A | $13 to $86,658 | Low |
| Chemical Analysis of Stone | other | N/A | $13 to $82,360 | Low |
| Cyanocobalamin (vitamin B-12) Level | other | N/A | $15 to $82,607 | Low |
| Detection Test By Immunoassay Technique for Hepatitis Be Surface Antigen | other | N/A | $12 to $87,350 | Low |
| Osteopathic Manipulative Treatment, 1-2 Body Regions | other | N/A | $19 to $98,925 | Low |
| Transferrin (iron Binding Protein) Level | other | N/A | $13 to $84,466 | Low |
| Glucose (sugar) Level On Body Fluid | other | N/A | $4 to $82,945 | Low |
| Lead Level | other | N/A | $12 to $83,655 | Low |
| Preventive Medicine Counseling, Typically 15 Minutes | therapy | N/A | $24 to $99,401 | Low |
| Ceruloplasmin (protein) Level | other | N/A | $11 to $82,390 | Low |
| X-ray of Paranasal Sinus, 1-2 Views | imaging | N/A | $8 to $70,210 | Low |
| Analysis for Antibody to Mumps Virus | other | N/A | $13 to $86,735 | Low |
| Glycated Protein Level | other | N/A | $17 to $82,985 | Low |
| Stool Fat OR Lipids Analysis, Qualitative | lab | N/A | $5 to $82,705 | Low |
| Test of Car Seat OR Bed (1 Year OR Younger), Each Additional 30 Minutes | other | N/A | $7 to $94,781 | Low |
| X-ray of Bone At Base of Skull | imaging | N/A | $25 to $70,240 | Low |
| X-ray of Infant Leg, Minimum of 2 Views | imaging | N/A | $25 to $73,592 | Low |
| Other Allergy OR Clinical Immunology Service OR Procedure | other | N/A | $25 to $95,199 | Low |
| X-ray From Nose to Rectum | imaging | N/A | $25 to $76,010 | Low |
| Blood Smear Interpretation By Physician with Written Report | other | N/A | $19 to $85,060 | Low |
| Hydroxyindolacetic Acid (product of Metabolism) Level | other | N/A | $13 to $83,497 | Low |
| X-ray of Toe, Minimum of 2 Views | imaging | N/A | $6 to $73,660 | Low |
| Check of Hearing Aid, Both Ears | other | N/A | $26 to $92,593 | Low |
| Cortisol (hormone) Measurement, Total | other | N/A | $16 to $82,533 | Low |
| PSA (prostate Specific Antigen) Measurement, Total | other | N/A | $18 to $84,153 | Low |
| Special Stained Specimen Slides to Examine Tissue, Initial Procedure | lab | N/A | $26 to $88,342 | Low |
| Analysis for Antibody to Rubeola | other | N/A | $13 to $86,765 | Low |
| Anticoagulant Management for an Outpatient Taking Warfarin, Physician Review ... | other | N/A | $26 to $99,364 | Low |
| Influenza Vaccine Split Virus, Preservative Free | preventive | N/A | $26 to $90,662 | Low |
| Lithium Level | other | N/A | $7 to $80,178 | Low |
| Preparation of Report of Patient's Psychiatric Status | therapy | N/A | $26 to $90,889 | Low |
| Primidone Level | other | N/A | $17 to $80,188 | Low |
| Screening Test for Autoimmune Disorder | preventive | N/A | $12 to $86,038 | Low |
| X-ray of Shoulder, 1 View | imaging | N/A | $7 to $73,020 | Low |
| Evaluation of Implantable Heart and Blood Vessel Monitoring System, Remote Up... | surgery | N/A | $24 to $93,297 | Low |
| Hepatitis a Vaccine Pediatric OR Adolescent Dosage | preventive | N/A | $27 to $90,633 | Low |
| Repositioning Exercises of Head for Treatment of Dizziness, Each Day | other | N/A | $27 to $95,992 | Low |
| Test to Assess Hearing Sensitivity Using Visual Aids | other | N/A | $27 to $92,579 | Low |
| Alkaloids Levels | other | N/A | $27 to $80,323 | Low |
| Carbon Dioxide (bicarbonate) Level | other | N/A | $5 to $82,374 | Low |
| Detection Test By Immunoassay Technique for Hepatitis B Surface Antigen | other | N/A | $10 to $87,340 | Low |
| Medical Management Interactions On the Patient's Behalf with Agencies, Employ... | other | N/A | $27 to $90,882 | Low |
| Thyroglobulin (thyroid Protein) Antibody Measurement | other | N/A | $16 to $86,800 | Low |
| Collection of Blood Sample From Central Venous Tube | other | N/A | $27 to $36,592 | Low |
| Extended Exam Involving Color Vision Testing | other | N/A | $8 to $92,283 | Low |
| Insulin Measurement, Total | other | N/A | $11 to $83,525 | Low |
| X-ray of Skull, 1-3 Views | imaging | N/A | $8 to $70,250 | Low |
| Copper Level | other | N/A | $12 to $82,525 | Low |
| Infrared Analysis of Stone | other | N/A | $13 to $82,365 | Low |
| Blood Group Typing | other | N/A | $3 to $86,900 | Low |
| X-ray of Heel, Minimum of 2 Views | imaging | N/A | $7 to $73,650 | Low |
| Body Fluid Cell Count | other | N/A | $5 to $89,050 | Low |
| Prealbumin (protein) Level | other | N/A | $15 to $84,134 | Low |
| PSA (prostate Specific Antigen) Measurement, Free | other | N/A | $18 to $84,154 | Low |
| Removal of Skin and Tissue, Each Additional 20.0 SQ Cm OR Less | surgery | N/A | $21 to $11,045 | Low |
| Analysis for Antibody to Ehrlichia | other | N/A | $10 to $86,666 | Low |
| Analysis for Antibody to Mycoplasma | other | N/A | $13 to $86,738 | Low |
| Haptoglobin (serum Protein) Level | other | N/A | $13 to $83,010 | Low |
| Residence Visit for Established Patient with Straightforward Medical Decision... | other | N/A | $28 to $99,347 | Low |
| Evaluation of Fine Needle Aspirate | other | N/A | $28 to $88,172 | Low |
| Gammaglobulin (immune System Protein) Measurement | other | N/A | $9 to $82,784 | Low |
| Hepatitis B Core Antibody (igm) Measurement | other | N/A | $12 to $86,705 | Low |
| Fibrinogen (factor 1) Activity Measurement | other | N/A | $10 to $85,384 | Low |
| Other Evaluation and Management Service | other | N/A | $28 to $99,499 | Low |
| Vitamin E Level | other | N/A | $14 to $84,446 | Low |
| Microsomal Antibodies (autoantibody) Measurement | other | N/A | $15 to $86,376 | Low |
| Psychiatric Evaluation of Hospital Records, Reports, Testing, OR Data for Dia... | therapy | N/A | $29 to $90,885 | Low |
| Repair Arterial Blockage | surgery | N/A | $29 to $75,962 | Low |
| X-ray of Elbow, 2 Views | imaging | N/A | $8 to $73,070 | Low |
| Lactic Acid Level | other | N/A | $12 to $83,605 | Low |
| Programming of Single, Dual, OR Multiple Lead OR Leadless Pacemaker System Be... | cardiac | N/A | $14 to $93,286 | Low |
| X-ray of Shoulder Blade | imaging | N/A | $9 to $73,010 | Low |
| Established Patient Office OR Other Outpatient Visit with Straightforward Med... | other | N/A | $29 to $99,212 | Low |
| Group Preventive Medicine Counseling, Typically 1 Hour | therapy | N/A | $29 to $99,412 | Low |
| Measurement for Strep Antibody | other | N/A | $7 to $86,060 | Low |
| Measurement of Hepatitis a Antibody | other | N/A | $11 to $86,709 | Low |
| Osteopathic Manipulative Treatment, 3-4 Body Regions | other | N/A | $29 to $98,926 | Low |
| Pathology Cytologic Examination of Specimen During Surgery, Each Additional Site | surgery | N/A | $29 to $88,334 | Low |
| X-ray of Lower Jaw, Minimum of 4 Views | imaging | N/A | $11 to $70,110 | Low |
| Analysis for Antibody to Epstein-barr Virus (mononucleosis Virus), Nuclear An... | imaging | N/A | $15 to $86,664 | Low |
| Measurement of Antibody for Rheumatoid Arthritis Assessment | other | N/A | $13 to $86,200 | Low |
| Screening Test for Pathogenic Organisms | preventive | N/A | $7 to $87,081 | Low |
| Theophylline Level | other | N/A | $14 to $80,198 | Low |
| Hepatitis C Antibody Measurement | other | N/A | $14 to $86,803 | Low |
| X-ray of Bone Behind the Ear, 1-2 Views Per Side | imaging | N/A | $30 to $70,120 | Low |
| Antibody Evaluation, Each Additional Single Antibody Stain Procedure | other | N/A | $30 to $88,350 | Low |
| Carboxyhemoglobin (protein) Level | other | N/A | $12 to $82,375 | Low |
| Ige (immune System Protein) Level | other | N/A | $16 to $82,785 | Low |
| Measurement of Complement (immune System Proteins), Antigen | other | N/A | $12 to $86,160 | Low |
| Pathology Examination of Tissue Using a Microscope, Intermediate Complexity | lab | N/A | $30 to $88,305 | Low |
| Phenytoin Level, Total | other | N/A | $13 to $80,185 | Low |
| Urine Phosphate Level | other | N/A | $6 to $84,105 | Low |
| X-ray of Infant Arm, Minimum of 2 Views | imaging | N/A | $30 to $73,092 | Low |
| Bile Acids Level, Total | other | N/A | $17 to $82,239 | Low |
| Collection of Blood Sample From Implanted Device | surgery | N/A | $28 to $36,591 | Low |
| Immunologic Analysis for Detection of Tumor Antigen, Quantitative; Ca 125 | other | N/A | $21 to $86,304 | Low |
| Insulin Antibody Measurement | other | N/A | $21 to $86,337 | Low |
| X-ray of Bone Behind the Ear, Minimum of 3 Views Per Side | imaging | N/A | $16 to $70,130 | Low |
| X-ray of Knee, 1-2 Views | imaging | N/A | $8 to $73,560 | Low |
| Ketone Bodies Analysis, Quantitative | other | N/A | $8 to $82,010 | Low |
| Test to Assess Hearing Using Pictures | other | N/A | $31 to $92,583 | Low |
| X-ray for Bone Length Assessment | imaging | N/A | $13 to $77,073 | Low |
| Analysis for Antibody to Helicobacter Pylori | other | N/A | $17 to $86,677 | Low |
| Hemoglobin Analysis and Measurement, Electrophoresis | other | N/A | $13 to $83,020 | Low |
| Removal of Tissue From Wound Gradually | surgery | N/A | $31 to $97,602 | Low |
| Tobramycin (antibiotic) Level | other | N/A | $16 to $80,200 | Low |
| Sex Hormone Binding Globulin (protein) Level | other | N/A | $22 to $84,270 | Low |
| Calcium Level, Ionized | other | N/A | $14 to $82,330 | Low |
| X-ray of Wrist, 2 Views | imaging | N/A | $8 to $73,100 | Low |
| Analysis for Antibody to Aspergillus | other | N/A | $15 to $86,606 | Low |
| Analysis for Antibody to Blastomyces | other | N/A | $13 to $86,612 | Low |
| Analysis for Antibody to Coccidioides | other | N/A | $11 to $86,635 | Low |
| Blood Gases Measurement, with O2 Saturation | other | N/A | $32 to $82,805 | Low |
| Comprehensive Hearing and Speech Recognition Test | other | N/A | $25 to $92,557 | Low |
| X-ray of Finger, Minimum of 2 Views | imaging | N/A | $6 to $73,140 | Low |
| Analysis for Antibody to Hiv-2 Virus | other | N/A | $14 to $86,702 | Low |
| Arsenic Level | other | N/A | $19 to $82,175 | Low |
| Measurement of Cold Agglutinin (protein) to Detect Infection OR Disease | other | N/A | $8 to $86,157 | Low |
| Mercury Level | other | N/A | $16 to $83,825 | Low |
| Subsequent Hospital Care with Straightforward OR Low Level of Medical Decisio... | other | N/A | $32 to $99,231 | Low |
| X-ray of Ankle, Minimum of 3 Views | imaging | N/A | $8 to $73,610 | Low |
| X-ray of Both Collar Bones Joints | imaging | N/A | $9 to $73,050 | Low |
| X-ray of Chest Bone, Minimum of 2 Views | imaging | N/A | $9 to $71,120 | Low |
| Follow-up Hospital Care of Newborn Per Day | obstetric | N/A | $32 to $99,462 | Low |
| Influenza Vaccine, Inactivated | preventive | N/A | $32 to $90,653 | Low |
| Pelvic Exam | other | N/A | $16 to $99,459 | Low |
| Valproic Acid Level, Total | other | N/A | $14 to $80,164 | Low |
| White Blood Cell Enzyme Activity Measurement | other | N/A | $19 to $85,549 | Low |
| Design and Construction of Simple Radiation Treatment Device | other | N/A | $23 to $77,332 | Low |
| X-ray of Both Knees While Standing | imaging | N/A | $8 to $73,565 | Low |
| Measurement of Antibody to Infectious Organism | other | N/A | $7 to $86,000 | Low |
| Application of Vein Wound Compression Bandages On Lower Leg, Ankle, and Foot | other | N/A | $23 to $29,581 | Low |
| Caloric Vestibular Test | other | N/A | $33 to $92,543 | Low |
| Carcinoembryonic Antigen (cea) Protein Level | other | N/A | $19 to $82,378 | Low |
| Diphtheria, Tetanus, Acellular Pertussis, Hepatitis B, and Polio Vaccine | preventive | N/A | $33 to $90,723 | Low |
| Influenza Virus Vaccine, Quadrivalent (iiv4), Split Virus, Preservative Free,... | preventive | N/A | $33 to $90,630 | Low |
| Preventive Medicine Counseling, Typically 30 Minutes | therapy | N/A | $33 to $99,402 | Low |
| X-ray of Ankle, 2 Views | imaging | N/A | $8 to $73,600 | Low |
| X-ray of Elbow, Minimum of 3 Views | imaging | N/A | $8 to $73,080 | Low |
| Ammonia Level | other | N/A | $15 to $82,140 | Low |
| Hepatitis a Vaccine Adult Dosage | preventive | N/A | $34 to $90,632 | Low |
| Hepatitis B Vaccine, Adult Dosage | preventive | N/A | $34 to $90,746 | Low |
| Test for Abnormal Eye Movement Using 3 Positions | other | N/A | $34 to $92,532 | Low |
| Training in the Use of Artificial Arm And/or Leg, Each 15 Minutes | other | N/A | $34 to $97,761 | Low |
| Analysis for Antibody to Virus | other | N/A | $13 to $86,790 | Low |
| Rotavirus Vaccine, Pentavalent | preventive | N/A | $34 to $90,680 | Low |
| X-ray of Jaw Joints On Both Sides of Mouth | imaging | N/A | $11 to $70,330 | Low |
| Irradiation of Blood Product, Each Unit | other | N/A | $34 to $86,945 | Low |
| Thyroid Hormone, T3 Measurement, Total | other | N/A | $14 to $84,480 | Low |
| X-ray of Knee, 3 Views | imaging | N/A | $9 to $73,562 | Low |
| X-ray of Ribs On Side of Body, Minimum of 3 Views | imaging | N/A | $12 to $71,101 | Low |
| Amplifed Dna OR Rna Probe Detection of Severe Acute Respiratory Syndrome Coro... | other | N/A | $35 to $87,635 | Low |
| Analysis for Antibody to Toxoplasma | other | N/A | $14 to $86,777 | Low |
| Measurement of Antibody for Assessment of Autoimmune Disorder, Any Method | other | N/A | $18 to $86,235 | Low |
| Screening Test for Red Blood Cell Antibodies | preventive | N/A | $10 to $86,850 | Low |
| X-ray of Upper Arm, Minimum of 2 Views | imaging | N/A | $8 to $73,060 | Low |
| Detection Test By Immunoassay Technique for Other Organism | other | N/A | $12 to $87,449 | Low |
| Analysis for Antibody to Cryptococcus | other | N/A | $14 to $86,641 | Low |
| Chemistry Procedures | other | N/A | $35 to $84,999 | Low |
| Confirmation Test for Antibody to Borrelia Burgdorferi | other | N/A | $15 to $86,617 | Low |
| X-ray of Face Bones, Minimum of 3 Views | imaging | N/A | $12 to $70,150 | Low |
| Zonisamide Level | other | N/A | $13 to $80,203 | Low |
| Evaluation of Cardiac Rhythm Monitor System, Remote Up to 30 Days | cardiac | N/A | $24 to $93,298 | Low |
| Limited X-ray of Body Bones | imaging | N/A | $20 to $77,074 | Low |
| Measles, Mumps, and Rubella Vaccine | preventive | N/A | $35 to $90,707 | Low |
| Phenobarbital Level | other | N/A | $15 to $80,184 | Low |
| Test for Hearing Various Pitches Using Earphone and Device Placed Against the... | other | N/A | $35 to $92,553 | Low |
| X-ray Series of Abdomen with Single X-ray of Chest | imaging | N/A | $15 to $74,022 | Low |
| Red Blood Cell Antibody Detection Test, Indirect | other | N/A | $6 to $86,885 | Low |
| Residence Visit for New Patient with Straightforward Medical Decision Making,... | other | N/A | $36 to $99,341 | Low |
| Typhoid Vaccine for Injection Into Muscle | preventive | N/A | $36 to $90,691 | Low |
| Detection Test By Immunoassay Technique for Severe Acute Respiratory Syndrome... | other | N/A | $36 to $87,428 | Low |
| Exam for Hearing Aid, Both Ears | other | N/A | $36 to $92,591 | Low |
| Application of Long Leg Splint From Thigh to Ankle OR Toe | other | N/A | $36 to $29,505 | Low |
| Application of Lower and Upper Arm Splint | other | N/A | $35 to $29,105 | Low |
| Application of Nonmoveable Finger Splint | other | N/A | $24 to $29,130 | Low |
| Application of Nonmoveable Forearm to Hand Splint | other | N/A | $36 to $29,125 | Low |
| Application of Short Leg Splint From Calf to Foot | other | N/A | $36 to $29,515 | Low |
| Comprehensive Hearing Test | other | N/A | $23 to $92,570 | Low |
| Evaluation of Lower Heart Chamber Assist Device | cardiac | N/A | $33 to $93,750 | Low |
| Immunologic Analysis for Detection of Tumor Antigen, Quantitative; Ca 19 | other | N/A | $21 to $86,301 | Low |
| Test to Assess Balance During Warm OR Cool Irrigation in Both Ears | other | N/A | $15 to $92,538 | Low |
| Analysis for Antibody | other | N/A | $17 to $86,645 | Low |
| Angiotensin L - Converting Enzyme (ace) Level | other | N/A | $15 to $82,164 | Low |
| Human Growth Hormone Level | other | N/A | $17 to $83,003 | Low |
| Test to Measure Lung Function At High Altitude | other | N/A | $36 to $94,452 | Low |
| X-ray of Middle and Lower Spine, 2 Views | imaging | N/A | $10 to $72,080 | Low |
| Smear for Parasites | other | N/A | $9 to $87,177 | Low |
| Testosterone (hormone) Level, Free | other | N/A | $25 to $84,402 | Low |
| Levetiracetam Level | other | N/A | $13 to $80,177 | Low |
| Lidocaine Level | other | N/A | $15 to $80,176 | Low |
| Removal of Impacted Ear Wax | surgery | N/A | $26 to $69,210 | Low |
| Ascorbic Acid (vitamin C) Level, Blood | other | N/A | $10 to $82,180 | Low |
| C-peptide (protein) Level | other | N/A | $21 to $84,681 | Low |
| Cardiolipin Antibody (tissue Antibody) Measurement | other | N/A | $25 to $86,147 | Low |
| Diphtheria, Tetanus, Acellular Pertussis, Polio, and Haemophilus Influenzae T... | other | N/A | $37 to $90,698 | Low |
| Erythropoietin (protein) Level | other | N/A | $19 to $82,668 | Low |
| Osteopathic Manipulative Treatment, 5-6 Body Regions | other | N/A | $37 to $98,927 | Low |
| Test for Eardrum and Muscle Function | other | N/A | $21 to $92,550 | Low |
| Training in the Use of Orthopedic Device for Arm, Leg And/or Trunk, Each 15 M... | other | N/A | $37 to $97,760 | Low |
| X-ray of Hand, 2 Views | imaging | N/A | $8 to $73,120 | Low |
| Clozapine Level | other | N/A | $20 to $80,159 | Low |
| X-ray of Shoulder, Minimum of 2 Views | imaging | N/A | $9 to $73,030 | Low |
| Removal of Foreign Body in Nose | surgery | N/A | $38 to $30,300 | Low |
| Beta-2 Microglobulin (protein) Level | other | N/A | $16 to $82,232 | Low |
| Limited Ultrasound Scan of Joint OR Other Extremity Structure Except Blood Ve... | imaging | N/A | $31 to $76,882 | Low |
| Review By Radiologist of Ultrasound of Digestive Tract Using an Endoscope | imaging | N/A | $38 to $76,975 | Low |
| X-ray of Upper Spine, 2-3 Views | imaging | N/A | $10 to $72,040 | Low |
| Bacterial Culture | lab | N/A | $9 to $87,075 | Low |
| Dilation of Stomach And/or Small Bowel Using Long Gastrointestinal Tube | other | N/A | $16 to $44,500 | Low |
| Evaluation of Implantable Heart and Blood Vessel Monitoring System | surgery | N/A | $20 to $93,290 | Low |
| Irrigation of Implanted Venous Access Drug Delivery Device | surgery | N/A | $38 to $96,523 | Low |
| Test to Assess Hearing Sensitivity Using Activity Related Feedback | other | N/A | $38 to $92,582 | Low |
| Thyroglobulin (thyroid Related Hormone) Level | other | N/A | $16 to $84,432 | Low |
| X-ray for Estimating Bone Age | imaging | N/A | $38 to $77,072 | Low |
| X-ray of Middle Spine, 2 Views | imaging | N/A | $9 to $72,070 | Low |
| Detection Test By Nucleic Acid for Clostridium Difficile, Amplified Probe Tec... | other | N/A | $37 to $87,493 | Low |
| Needle Measurement of Electrical Activity in Muscles On Side of Body | other | N/A | $38 to $95,867 | Low |
| Prolonged Outpatient Service, Each 15 Minutes of Total Time Beyond Required T... | other | N/A | $38 to $99,417 | Low |
| Psychotherapy, 30 Minutes | therapy | N/A | $38 to $90,832 | Low |
| Test to Assess Balance During Warm and Cool Irrigation in Both Ears | other | N/A | $30 to $92,537 | Low |
| Renin (kidney Enzyme) Level | other | N/A | $22 to $84,244 | Low |
| Thyroid Hormone, T3 Measurement, Free | other | N/A | $17 to $84,481 | Low |
| X-ray of Lower and Sacral Spine, 2-3 Views | imaging | N/A | $10 to $72,100 | Low |
| X-ray of Skull, Minimum of 4 Views | imaging | N/A | $13 to $70,260 | Low |
| Clotting Factor Viii Related Antigen Measurement | other | N/A | $20 to $85,244 | Low |
| Progesterone (reproductive Hormone) Level | other | N/A | $21 to $84,144 | Low |
| Topiramate Level | other | N/A | $12 to $80,201 | Low |
| Analysis for Antibody to Epstein-barr Virus (mononucleosis Virus), Early Antigen | other | N/A | $13 to $86,663 | Low |
| Application of Hinged Finger Splint | other | N/A | $29 to $29,131 | Low |
| Mycoplasma Culture | lab | N/A | $15 to $87,109 | Low |
| Nephelometry, Test Method Using Light | other | N/A | $14 to $83,883 | Low |
| Pap Test, Manual Screening | preventive | N/A | $20 to $88,142 | Low |
| Tissue Culture for Tumor Disorders of Bone Marrow and Blood Cells | lab | N/A | $39 to $88,237 | Low |
| Severe Acute Respiratory Syndrome Coronavirus 2 (covid-19) Vaccine, Recombina... | preventive | N/A | $39 to $91,304 | Low |
| Measurement of Immune Substance | other | N/A | $27 to $83,916 | Low |
| Vitamin B-1 (thiamine) Level | other | N/A | $21 to $84,425 | Low |
| X-ray of Joint Between Breast and Collar Bones, Minimum of 2 Views | imaging | N/A | $10 to $71,130 | Low |
| Diphtheria, Tetanus, Acellular Pertussis, and Polio Vaccine | preventive | N/A | $40 to $90,696 | Low |
| Family Psychotherapy without Patient, 50 Minutes | therapy | N/A | $40 to $90,846 | Low |
| Immunologic Analysis for Detection of Tumor Antigen, Quantitative; Ca 15 | other | N/A | $21 to $86,300 | Low |
| X-ray of Jaw Joint On 1 Side of Mouth | imaging | N/A | $8 to $70,328 | Low |
| Alcohols Levels, 1 OR 2 | other | N/A | $40 to $80,321 | Low |
| Barbiturates Levels | other | N/A | $40 to $80,345 | Low |
| Cannabinoids Levels, Natural | other | N/A | $40 to $80,349 | Low |
| Cocaine Level | other | N/A | $40 to $80,353 | Low |
| Opiates Levels | other | N/A | $40 to $80,361 | Low |
| Evaluation of Hearing Ringing in Ear | other | N/A | $40 to $92,625 | Low |
| Programming of Cardiac Rhythm Monitor System | cardiac | N/A | $24 to $93,285 | Low |
| X-ray of Pelvis, 1-2 Views | imaging | N/A | $8 to $72,170 | Low |
| Cell Examination of Specimen, Selective Cellular Enhancement Technique | lab | N/A | $25 to $88,112 | Low |
| Complete Ultrasound Scan of Abdomen | imaging | N/A | $36 to $76,700 | Low |
| Analysis for Antibody to Histoplasma | other | N/A | $14 to $86,698 | Low |
| Analysis for Antibody to Varicella-zoster Virus | other | N/A | $13 to $86,787 | Low |
| Aminolevulinic Acid (protein) Level | other | N/A | $16 to $82,135 | Low |
| Blood Pressure Monitoring | other | N/A | $12 to $93,790 | High |
| Folic Acid Level, Rbc | other | N/A | $18 to $82,747 | Low |
| Heart Muscle Strain Imaging | cardiac | N/A | $10 to $93,356 | Low |
| X-ray of Paranasal Sinus, Minimum of 3 Views | imaging | N/A | $10 to $70,220 | Low |
| Analysis for Antibody to Hepatitis D Virus | other | N/A | $17 to $86,692 | Low |
| Carbamazepine Level, Total | other | N/A | $15 to $80,156 | Low |
| Osteopathic Manipulative Treatment, 7-8 Body Regions | other | N/A | $41 to $98,928 | Low |
| Screening Test for Presence of Antibody | preventive | N/A | $12 to $86,403 | Low |
| Virus Isolation, Centrifuge Enhanced | other | N/A | $20 to $87,254 | Low |
| X-ray of Joint Between Lower Spine and Hip Bone, 3 OR More Views | imaging | N/A | $10 to $72,202 | Low |
| Blood Unit Compatibility Test, Antiglobulin Technique | other | N/A | $42 to $86,922 | Low |
| Design and Construction of Intermediate Radiation Treatment Device | other | N/A | $38 to $77,333 | Low |
| Microscopic Genetic Analysis of Tumor, Manual | other | N/A | $42 to $88,360 | Low |
| Amikacin (antibiotic) Level | other | N/A | $15 to $80,150 | Low |
| Vancomycin (antibiotic) Level | other | N/A | $14 to $80,202 | Low |
| Creatine Kinase (cardiac Enzyme) Level, Mb Fraction Only | cardiac | N/A | $12 to $82,553 | Low |
| Measurement C-reactive Protein for Detection of Infection OR Inflammation, Hi... | other | N/A | $13 to $86,141 | Low |
| Myoglobin (muscle Protein) Level | other | N/A | $13 to $83,874 | Low |
| Test to Determine Lung Volumes Using Gas Dilution OR Washout | other | N/A | $12 to $94,727 | Low |
| Antipsychotics Levels, 1 | other | N/A | $42 to $80,342 | Low |
| Written Consultation Report On X-ray | imaging | N/A | $42 to $76,140 | Low |
| Gabapentin Level | other | N/A | $22 to $80,171 | Low |
| Gammaglobulin (immune System Protein) Measurement, Immunoglobulin Subclasses | other | N/A | $8 to $82,787 | Low |
| X-ray of Hand, Minimum of 3 Views | imaging | N/A | $8 to $73,130 | Low |
| X-ray of Middle Spine, Minimum of 4 Views | imaging | N/A | $11 to $72,074 | Low |
| Pathology Examination of Specimen During Surgery, First Tissue Block | surgery | N/A | $43 to $88,331 | Low |
| X-ray of Sacrum and Tailbone, Minimum of 2 Views | imaging | N/A | $8 to $72,220 | Low |
| Peripheral Arterial Disease Rehabilitation, Each Session | therapy | N/A | $43 to $93,668 | Low |
| Screening Test for Antibody to Noninfectious Agent | preventive | N/A | $12 to $86,255 | Low |
| Detection Test By Immunoassay Technique for Clostridium Difficile Toxins | other | N/A | $12 to $87,324 | Low |
| Gastrin (gi Tract Hormone) Level | other | N/A | $18 to $82,941 | Low |
| Pathology Cytologic Examination of Specimen During Surgery, Initial Site | surgery | N/A | $43 to $88,333 | Low |
| Vitamin a Level | other | N/A | $12 to $84,590 | Low |
| Psychotherapy for Crisis, Each Additional 30 Minutes | therapy | N/A | $44 to $90,840 | Low |
| Test to Measure Lung Function At High Altitude with Evaluation of Oxygen Need... | other | N/A | $44 to $94,453 | Low |
| Phenylalanine, Pku (amino Acid) Level | other | N/A | $6 to $84,030 | Low |
| Evaluation of Single, Dual, Multiple Lead OR Leadless Pacemaker System OR Imp... | cardiac | N/A | $30 to $93,296 | Low |
| Gentamicin (antibiotic) Level | other | N/A | $16 to $80,170 | Low |
| Observation Care Discharge Day Management | other | N/A | $44 to $99,217 | Low |
| Needle Measurement of Electrical Activity in Arm OR Leg Muscles, Limited Study | other | N/A | $18 to $95,885 | Low |
| Detection Test By Immunoassay Technique for Hiv-1 Antigen and Hiv-1 and Hiv-2... | other | N/A | $24 to $87,389 | Low |
| Evaluation of Single, Dual, Multiple Lead OR Leadless Pacemaker System, Remot... | cardiac | N/A | $28 to $93,294 | Low |
| Protein S (clotting Inhibitor) Level | other | N/A | $12 to $85,305 | Low |
| Quantitation of Therapeutic Drug | other | N/A | $19 to $80,299 | Low |
| Review By Radiologist of 1 Arm OR Leg Vein of 1 Arm OR Leg Image | other | N/A | $45 to $75,820 | Low |
| Evaluation of Cardiac Rhythm Monitor System | cardiac | N/A | $17 to $93,291 | Low |
| Analysis for Antibody to Legionella | other | N/A | $15 to $86,713 | Low |
| Coagulation Function Analysis, Agglutination Slide, Semiquantitative | other | N/A | $7 to $85,362 | Low |
| Gene Analysis (fms-related Tyrosine Kinase 3) Internal Tandem Duplication Var... | other | N/A | $45 to $81,245 | Low |
| Residence Visit for Established Patient with Low Level of Medical Decision Ma... | other | N/A | $45 to $99,348 | Low |
| Alpha-fetoprotein (afp) Level, Serum | other | N/A | $17 to $82,105 | Low |
| Clinical Pathology Consultation; Limited, without Review of Patient's History... | lab | N/A | $45 to $80,500 | Low |
| Culture for Acid-fast Bacilli | lab | N/A | $11 to $87,116 | Low |
| Detection Test By Immunoassay Technique for Helicobacter Pylori (gi Tract Bac... | other | N/A | $14 to $87,338 | Low |
| Urine Porphyrins (metabolism Substance) Measurement | other | N/A | $15 to $84,120 | Low |
| Residence Visit for New Patient with Low Level of Medical Decision Making, Pe... | other | N/A | $46 to $99,342 | Low |
| Semen Evaluation Volume, Sperm Count, Motility and Analysis | other | N/A | $16 to $89,322 | Low |
| X-ray of Ribs On Both Sides of Body, Minimum of 4 Views | imaging | N/A | $15 to $71,111 | Low |
| Measurement of Dna Antibody, Native OR Double Stranded | other | N/A | $14 to $86,225 | Low |
| Family Psychotherapy with Patient, 50 Minutes | therapy | N/A | $47 to $90,847 | Low |
| Mycophenolate (mycophenolic Acid) Level | other | N/A | $18 to $80,180 | Low |
| Needle Measurement of Electrical Activity in Trunk OR Head Muscles | other | N/A | $36 to $95,887 | Low |
| New Patient Office OR Other Outpatient Visit with Straightforward Medical Dec... | other | N/A | $40 to $99,202 | Low |
| Rotavirus Vaccine, Human, Attenuated | preventive | N/A | $47 to $90,681 | Low |
| Protein S (clotting Inhibitor) Measurement | other | N/A | $15 to $85,306 | Low |
| Urine Vanillylmandelic Acid | other | N/A | $16 to $84,585 | Low |
| Psychotherapy with Evaluation and Management Visit, 30 Minutes | therapy | N/A | $47 to $90,833 | Low |
| Detection Test By Nucleic Acid for Multiple Types Influenza Virus | other | N/A | $47 to $87,502 | Low |
| Electronic Assessment of Bladder Emptying | other | N/A | $8 to $51,741 | Low |
| Pathology Examination of Specimen During Surgery | surgery | N/A | $27 to $88,329 | Low |
| Test for Abnormal Eye Movement with Recording | other | N/A | $20 to $92,541 | Low |
| Testosterone (hormone) Level, Total | other | N/A | $26 to $84,403 | Low |
| Psychotherapy with Evaluation and Management Visit, 45 Minutes | therapy | N/A | $48 to $90,836 | Low |
| Psychotherapy, 45 Minutes | therapy | N/A | $48 to $90,834 | Low |
| Subsequent Hospital Inpatient OR Observation Care with Moderate Level of Medi... | other | N/A | $48 to $99,232 | Low |
| Troponin (protein) Analysis, Quantitative | other | N/A | $12 to $84,484 | Low |
| Gonadotropin, Luteinizing (reproductive Hormone) Level | other | N/A | $19 to $83,002 | Low |
| X-ray of Wrist, Minimum of 3 Views | imaging | N/A | $8 to $73,110 | Low |
| Advance Care Planning, Each Additional 30 Minutes | other | N/A | $48 to $99,498 | Low |
| Blood Bank Physician Services for Cross Match And/or Evaluation and Written R... | other | N/A | $39 to $86,077 | Low |
| Blood Bank Physician Services for Investigation of Transfusion Reaction with ... | surgery | N/A | $39 to $86,078 | Low |
| Gene Analysis | other | N/A | $48 to $81,210 | Low |
| Analysis Using Chemiluminescent Technique (light and Chemical )reaction | other | N/A | $14 to $82,397 | Low |
| Clotting Factor Viii (vw Factor) Antigen | other | N/A | $23 to $85,246 | Low |
| Fungal Culture (mold OR Yeast) of Skin, Hair, OR Nail | lab | N/A | $8 to $87,101 | Low |
| Fungal Culture, Yeast | lab | N/A | $10 to $87,106 | Low |
| Meningococcal Vaccine, Serogroups A, C, W, Y, Diphtheria Toxoid Carrier Vaccine | preventive | N/A | $48 to $90,734 | Low |
| Protein Measurement, Serum | other | N/A | $11 to $84,165 | Low |
| Myelin Basic Protein (nerve Protein) Level, Spinal Fluid | other | N/A | $17 to $83,873 | Low |
| Application of Elbow to Finger Cast | other | N/A | $49 to $29,075 | Low |
| Detection Test By Nucleic Acid for Chlamydia Trachomatis, Amplified Probe Tec... | other | N/A | $35 to $87,491 | Low |
| Detection Test By Nucleic Acid for Neisseria Gonorrhoeae (gonorrhoeae Bacteri... | other | N/A | $35 to $87,591 | Low |
| Electronic Analysis of Implanted Gastric Neurostimulator Generator During Sur... | surgery | N/A | $39 to $95,980 | Low |
| Established Patient Office OR Other Outpatient Visit with Low Level of Decisi... | other | N/A | $49 to $99,213 | Low |
| Exam of Visual Field with Limited Testing | other | N/A | $15 to $92,081 | Low |
| Genetic Sequencing Localization, Each Additional Procedure | other | N/A | $49 to $88,364 | Low |
| Other Ultrasound Procedure | imaging | N/A | $49 to $76,999 | Low |
| Evaluation of Single, Dual, Multiple Lead OR Leadless Pacemaker System | cardiac | N/A | $20 to $93,288 | Low |
| Blood Culture | lab | N/A | $10 to $87,040 | Low |
| Evaluation of Fine Needle Aspirate with Interpretation and Report | other | N/A | $50 to $88,173 | Low |
| Initial Therapy Service to Facilitate Lung Function | other | N/A | $50 to $94,667 | Low |
| Calcitonin (hormone) Level | other | N/A | $27 to $82,308 | Low |
| Detection Test By Immunoassay Technique for Rotavirus | other | N/A | $12 to $87,425 | Low |
| Heparin Assay | other | N/A | $13 to $85,520 | Low |
| Needle Measurement of Electrical Activity in Muscle with Injection of Chemica... | other | N/A | $19 to $95,874 | Low |
| Amino Acid Analysis, Quantitative, Each Specimen | lab | N/A | $23 to $82,131 | Low |
| Blood Unit Compatibility Test, Immediate Spin Technique | other | N/A | $51 to $86,920 | Low |
| Estrogen Analysis, Total | other | N/A | $22 to $82,672 | Low |
| Hospital Inpatient OR Observation Discharge Day Management, 30 Minutes OR Less | other | N/A | $51 to $99,238 | Low |
| Immunologic Analysis Technique On Body Fluid | other | N/A | $23 to $86,325 | Low |
| Test of Car Seat OR Bed (1 Year OR Younger), 1 Hour | other | N/A | $20 to $94,780 | Low |
| Antidepressants Levels, 1 OR 2 | other | N/A | $51 to $80,335 | Low |
| Osteopathic Manipulative Treatment, 9-10 Body Regions | other | N/A | $51 to $98,929 | Low |
| Review By Radiologist of Previous Placed Shunt Image | other | N/A | $22 to $75,809 | Low |
| Stool Culture | lab | N/A | $9 to $87,045 | Low |
| Stool Lactoferrin (immune System Protein) Level | other | N/A | $20 to $83,631 | Low |
| Test to Determine Lung Volumes Using Sensors | other | N/A | $12 to $94,726 | Low |
| Cortisol (hormone) Measurement, Free | other | N/A | $17 to $82,530 | Low |
| Dehydroepiandrosterone (dhea-s) Hormone Level | other | N/A | $22 to $82,627 | Low |
| Measurement of Amiodarone | other | N/A | $19 to $80,151 | Low |
| Pretreatment of Red Blood Cells for Use in Red Blood Cells Antibody Analysis ... | other | N/A | $51 to $86,972 | Low |
| Hepatitis a and Hepatitis B Vaccine | preventive | N/A | $52 to $90,636 | Low |
| Application of Hand and Lower Forearm Cast | other | N/A | $52 to $29,085 | Low |
| Chg Us, Breast(s), Real Time | other | N/A | $52 to $76,645 | Low |
| Natriuretic Peptide (heart and Blood Vessel Protein) Level | cardiac | N/A | $39 to $83,880 | Low |
| Placement of Proximal OR Distal Extension Prosthesis for Endovascular Repair ... | surgery | N/A | $52 to $75,953 | Low |
| Test to Examine How Well the Lungs Exchange Gases | other | N/A | $9 to $94,729 | Low |
| Injection of Anesthetic And/or Steroid Drug Into Foot Nerve | other | N/A | $29 to $64,455 | Low |
| Obtaining Data Needed to Develop the Optimal Radiation Treatment, 1 Treatment... | other | N/A | $36 to $77,280 | Low |
| Removal of Muscle And/or Tissue, Each Additional 20.0 SQ Cm OR Less | surgery | N/A | $45 to $11,046 | Low |
| X-ray of Voice Box OR Throat | imaging | N/A | $52 to $70,370 | Low |
| Organic Acid Level | other | N/A | $21 to $83,921 | Low |
| Preventive Medicine Counseling, Typically 45 Minutes | therapy | N/A | $52 to $99,403 | Low |
| Review By Radiologist of Image From Tube Placement Into Bile and Pancreatic D... | other | N/A | $27 to $74,330 | Low |
| Measurement of Substance Using Immunoassay Technique | other | N/A | $17 to $83,520 | Low |
| X-ray of Joints, Multiple | imaging | N/A | $53 to $77,077 | Low |
| X-ray of Upper Spine, 4-5 Views | imaging | N/A | $13 to $72,050 | Low |
| Carnitine Level | other | N/A | $17 to $82,379 | Low |
| Removal of Tissue From Wound, Each Additional 20.0 SQ Cm | surgery | N/A | $21 to $97,598 | Low |
| Sputum Specimen Collection | lab | N/A | $53 to $89,220 | Low |
| Test for Abnormal Eye Movement Using 3 Positions with Recording | other | N/A | $24 to $92,542 | Low |
| Dxa Bone Density Measurement of Hip, Pelvis, Spine Including Spine Fracture A... | other | N/A | $14 to $77,085 | Low |
| Office OR Other Outpatient Consultation with Straightforward Medical Decision... | other | N/A | $54 to $99,242 | Low |
| Translocation Analysis (bcr/abl1) Major Breakpoint | other | N/A | $54 to $81,206 | Low |
| Alcohol And/or Substance Abuse Screening and Intervention, More Than 30 Minutes | preventive | N/A | $54 to $99,409 | Low |
| Application of Finger Cast | other | N/A | $44 to $29,086 | Low |
| Application of Moveable OR Hinged Forearm to Hand Splint | other | N/A | $43 to $29,126 | Low |
| Exam for Hearing Aid, 1 Ear | other | N/A | $54 to $92,590 | Low |
| Immunologic Analysis Technique, Unspecified | other | N/A | $14 to $86,329 | Low |
| Measurement of Total Estradiol | other | N/A | $28 to $82,670 | Low |
| Muscle Testing, Manual (separate Procedure) with Report; Total Evaluation of ... | other | N/A | $54 to $95,833 | Low |
| Nucleotidase 5' (enzyme) Level | other | N/A | $11 to $83,915 | Low |
| Declotting of Central Venous Tube | other | N/A | $35 to $36,593 | Low |
| Occupational Therapy | therapy | N/A | $55 to $97,168 | High |
| Physical Therapy | therapy | N/A | $43 to $97,164 | High |
| T Cells Count, Total | other | N/A | $38 to $86,359 | Low |
| X-ray Lower and Sacral Spine, Minimum of 6 Views | imaging | N/A | $14 to $72,114 | Low |
| Nuclear Medicine Study of Remaining Urine in Bladder | imaging | N/A | $8 to $78,730 | Low |
| Physician Supervision of Patient Home Health Agency Services Per Month, 15-29... | other | N/A | $55 to $99,374 | Low |
| Review By Radiologist of Urinary Bladder Image | other | N/A | $15 to $74,430 | Low |
| X-ray of Hip, Minimum of 4 Views | imaging | N/A | $13 to $73,503 | Low |
| Prolonged Monitoring and Recording of Esophageal Function Through Nasal Tube ... | other | N/A | $55 to $91,038 | Low |
| Gene Analysis (janus Kinase 2) Targeted Sequence Analysis | other | N/A | $56 to $81,279 | Low |
| Gonadotropin, Chorionic (reproductive Hormone) Level | other | N/A | $15 to $84,702 | Low |
| Inpatient OR Observation Consultation with Straightforward Medical Decision M... | other | N/A | $56 to $99,252 | Low |
| Stool Fat OR Lipids Analysis, Quantitative | lab | N/A | $17 to $82,710 | Low |
| Supervision of Interfacility Transport Care of Critical Patient, Each Additio... | other | N/A | $56 to $99,486 | Low |
| Telephone Evaluation and Management Service By a Physician OR Other Qualified... | other | N/A | $56 to $99,443 | Low |
| Oxcarbazepine Level | other | N/A | $13 to $80,183 | Low |
| Measurement of Brain Wave Activity (eeg), in Coma OR Asleep | other | N/A | $55 to $95,822 | Low |
| Measurement of Complement (immune System Proteins), Total Hemolytic | other | N/A | $20 to $86,162 | Low |
| Placement of Ear Probe for Computerized Measurement of Repeated Sounds with I... | other | N/A | $28 to $92,588 | Low |
| Review By Radiologist of Breast Artery of Breast Image | other | N/A | $52 to $75,756 | Low |
| Advance Care Planning, First 30 Minutes | other | N/A | $57 to $99,497 | Low |
| Analysis for Antibody to Rickettsia | other | N/A | $19 to $86,757 | Low |
| Electronic Analysis of Spinal Canal Drug Infusion Pump | surgery | N/A | $21 to $62,367 | Low |
| Psychotherapy, 1 Hour | therapy | N/A | $57 to $90,837 | Low |
| Cyclosporine Level | other | N/A | $18 to $80,158 | Low |
| Meningococcal Vaccine, Serogroups A, C, Y, W | preventive | N/A | $57 to $90,733 | Low |
| Removal of Antibodies From Surface of Red Blood Cell | surgery | N/A | $58 to $86,860 | Low |
| Tissue Culture Inoculation for Virus Isolation | lab | N/A | $26 to $87,252 | Low |
| Detection Test By Nucleic Acid for Herpes Simplex Virus, Amplified Probe Tech... | other | N/A | $35 to $87,529 | Low |
| Detection Test By Nucleic Acid for Human Papillomavirus (hpv), High-risk Types | other | N/A | $35 to $87,624 | Low |
| Lamotrigine Level | other | N/A | $13 to $80,175 | Low |
| Analysis of Substance Using Immunoassay Technique, Multiple Step Method | other | N/A | $12 to $83,516 | Low |
| Insertion of Probe to Widen Saliva Gland Duct | other | N/A | $50 to $42,650 | Low |
| Vitamin D-3 Level | other | N/A | $30 to $82,306 | Low |
| Subsequent Observation Care, Per Day, for the Evaluation and Management of a ... | other | N/A | $59 to $99,226 | Low |
| Vitamin B-2 (riboflavin) Level | other | N/A | $20 to $84,252 | Low |
| Antithrombin Iii Antigen (clotting Inhibitor) Activity | other | N/A | $12 to $85,300 | Low |
| Insertion of Tube Into Chest OR Arm Artery, Additional Second, Third Order an... | other | N/A | $43 to $36,218 | Low |
| Adh (antidiuretic Hormone) Level | other | N/A | $34 to $84,588 | Low |
| Bone Marrow, Smear Interpretation | other | N/A | $38 to $85,097 | Low |
| Identification of Organisms By Genetic Analysis, Amplified Probe Technique | other | N/A | $35 to $87,150 | Low |
| Needle Measurement of Electrical Activity in Arm OR Leg Muscles, Complete Study | other | N/A | $44 to $95,886 | Low |
| Programming of Single Lead Pacemaker System | cardiac | N/A | $30 to $93,279 | Low |
| Prolactin (milk Producing Hormone) Level | other | N/A | $19 to $84,146 | Low |
| Varicella Vaccine | preventive | N/A | $60 to $90,716 | Low |
| Gonadotropin, Follicle Stimulating (reproductive Hormone) Level | other | N/A | $19 to $83,001 | Low |
| Injection of Medication Into Nasal Air Passage | other | N/A | $51 to $30,200 | Low |
| Alcohols Levels | other | N/A | $61 to $80,320 | Low |
| Evaluation of Hearing Function Related to Surgically Implanted Hearing Device... | surgery | N/A | $59 to $92,626 | Low |
| Hepatitis B Vaccine (hepb), Cpg-adjuvanted, Adult Dosage, 2 Dose OR 4 Dose Sc... | preventive | N/A | $61 to $90,739 | Low |
| Complete Ultrasound Scan of Joint | imaging | N/A | $41 to $76,881 | Low |
| Electronic Analysis of Implanted Neurostimulator Generator with Simple Spinal... | surgery | N/A | $33 to $95,971 | Low |
| Human Papillomavirus Vaccine, Types 6, 11, 16, 18, Quadrivalent | preventive | N/A | $62 to $90,649 | Low |
| Blood Typing Rh Phenotyping | other | N/A | $8 to $86,906 | Low |
| Evaluation of Brain Response to Sound for Diagnosis of Nervous System Disorde... | other | N/A | $63 to $92,653 | Low |
| Home Visit for the Evaluation and Management of a New Patient, Which Requires... | other | N/A | $63 to $99,343 | Low |
| Analysis for Detection of Tumor Marker | other | N/A | $21 to $86,316 | Low |
| Chg Stereotactic Guidance Breast Bx/ Needle Place | other | N/A | $63 to $77,031 | Low |
| Preventive Medicine Counseling, Typically 1 Hour | therapy | N/A | $63 to $99,404 | Low |
| Clotting Factor Viii (ahg) Measurement | other | N/A | $18 to $85,240 | Low |
| Detection Test By Nucleic Acid for Staphylococcus Aureus, Methicillin Resista... | other | N/A | $35 to $87,641 | Low |
| Sirolimus Level | other | N/A | $14 to $80,195 | Low |
| Evaluation of Brain Response to Sound for Determination of Hearing Status wit... | other | N/A | $64 to $92,651 | Low |
| Pathology Examination of Tissue Using a Microscope, Moderately High Complexity | lab | N/A | $64 to $88,307 | Low |
| Application of Short Leg Cast | other | N/A | $53 to $29,405 | Low |
| Measurement of Substance Using Immunoassay Technique, By Radioimmunoassay | other | N/A | $18 to $83,519 | Low |
| Design and Construction of Complex Radiation Treatment Device | other | N/A | $58 to $77,334 | Low |
| Limited Ultrasound Scan of Abdomen | imaging | N/A | $27 to $76,705 | Low |
| Nuclear Medicine Study of Thyroid Function | imaging | N/A | $8 to $78,012 | Low |
| X-ray of Entire Middle and Lower Spine, Minimum of 6 Views | imaging | N/A | $19 to $72,084 | Low |
| X-ray of Infant Body Bones | imaging | N/A | $31 to $77,076 | Low |
| Review By Radiologist of Image for Repair of Descending Aorta and Subclavian ... | surgery | N/A | $66 to $75,956 | Low |
| Detection Test By Immunoassay Technique for Aspergillus | other | N/A | $12 to $87,305 | Low |
| Initial Hospital Care with Straightforward OR Low Level of Medical Decision M... | other | N/A | $66 to $99,221 | Low |
| Review By Radiologist of Both Arms and Legs Veins of Both Arms OR Legs Image | other | N/A | $65 to $75,822 | Low |
| Administration of Hormonal Anti-neoplastic Chemotherapy Under Skin OR Into Mu... | other | N/A | $67 to $96,402 | Low |
| Application of Stress By Physician for Joint Imaging | other | N/A | $55 to $77,071 | Low |
| CT Scan of Heart with Evaluation of Blood Vessel Calcium | imaging | N/A | $26 to $75,571 | Low |
| Dehydroepiandrosterone (dhea) Hormone Level | other | N/A | $25 to $82,626 | Low |
| Exam of Neurobehavioral Status, First Hour | other | N/A | $67 to $96,116 | Low |
| Tuberculosis Test, Gamma Interferon | other | N/A | $62 to $86,480 | Low |
| New Patient Office OR Other Outpatient Visit with Low Level of Medical Decisi... | other | N/A | $67 to $99,203 | Low |
| Diphtheria and Tetanus Vaccine | preventive | N/A | $67 to $90,714 | Low |
| Administration of Non-hormonal Anti-neoplastic Chemotherapy Under Skin OR Int... | other | N/A | $68 to $96,401 | Low |
| Measurement of Infliximab | other | N/A | $39 to $80,230 | Low |
| Simple Bladder Irrigation And/or Instillation | other | N/A | $25 to $51,700 | Low |
| Protein C, (clotting Inhibitor) Activity | other | N/A | $12 to $85,302 | Low |
| Testing of Autonomic (sympathetic) Nervous System Function, Heart Rate Respon... | cardiac | N/A | $44 to $95,922 | Low |
| Ultrasound Scan of Fetal Umbilical Artery Blood Flow Rate | imaging | N/A | $68 to $76,820 | Low |
| Antibody Evaluation, Initial Single Antibody Stain Procedure | other | N/A | $68 to $88,346 | Low |
| Subsequent Hospital Inpatient OR Observation Care with High Level of Medical ... | other | N/A | $68 to $99,233 | Low |
| Blood Gases Measurement | other | N/A | $26 to $82,803 | Low |
| Catecholamines (organic Nitrogen) Level | imaging | N/A | $25 to $82,384 | Low |
| Gene Rearrangement Analysis Detection Abnormal Clonal Population | other | N/A | $69 to $81,342 | Low |
| Application of On-body Injector for Under Skin Injection | other | N/A | $45 to $96,377 | Low |
| CABG (Heart Bypass Surgery) | other | N/A | $69 to $8,399 | High |
| Proinsulin (pancreatic Hormone) Level | other | N/A | $27 to $84,206 | Low |
| Residence Visit for Established Patient with Moderate Level of Medical Decisi... | other | N/A | $69 to $99,349 | Low |
| Closed Treatment of Dislocated Joint Between Toe and Foot | other | N/A | $69 to $28,630 | Low |
| Blood Typing for Red Blood Cell Antigens | other | N/A | $4 to $86,905 | Low |
| Clotting Factor Ii Prothrombin, Measurement | other | N/A | $13 to $85,210 | Low |
| Screening Test for Compatible Blood Unit, Using Reagent Serum | preventive | N/A | $6 to $86,902 | Low |
| X-ray of Upper Spine, 6 OR More Views | imaging | N/A | $14 to $72,052 | Low |
| Assessment for Hearing Aid | other | N/A | $70 to $8,400 | Low |
| Aldosterone Hormone Level | other | N/A | $41 to $82,088 | Low |
| Established Patient Office OR Other Outpatient Visit with Moderate Level of D... | other | N/A | $70 to $99,214 | Low |
| T Cell Count and Ratio, Including Ratio | other | N/A | $47 to $86,360 | Low |
| Evaluation of Single, Dual, OR Multiple Lead Implantable Defibrillator System | surgery | N/A | $35 to $93,295 | Low |
| Insertion of Probe in Esophagus for Recording Electrical Impulses to Upper an... | other | N/A | $35 to $93,615 | Low |
| Pcp Drug Level | other | N/A | $70 to $83,992 | Low |
| Evaluation of Hearing Function Brain Responses, First Hour | other | N/A | $63 to $92,620 | Low |
| Rev - Ihs-moa Clinic Visit | other | N/A | $71 to $19,250 | Low |
| Programming of Dual Lead Pacemaker System | cardiac | N/A | $36 to $93,280 | Low |
| Serotonin (hormone) Level | other | N/A | $31 to $84,260 | Low |
| Ultrasound Scan of Infant Hip | imaging | N/A | $71 to $76,886 | Low |
| Ultrasound Scan of Infant Hip During Movement | imaging | N/A | $71 to $76,885 | Low |
| Biopsy of Lip | lab | N/A | $54 to $40,490 | Low |
| Gene Analysis (hemochromatosis) Common Variants | other | N/A | $65 to $81,256 | Low |
| Review By Radiologist of Arm OR Leg Artery Image | other | N/A | $72 to $75,710 | Low |
| Fluoroscopic Guidance for Insertion OR Removal of Central Vein Access Device | surgery | N/A | $17 to $77,001 | Low |
| Individual Physician Supervision of a Patient (patient Not Present) in Home, ... | other | N/A | $72 to $99,340 | Low |
| Closed Treatment of 2 Broken Lower Leg Bones At Ankle | other | N/A | $72 to $27,808 | Low |
| Closed Treatment of Broken End of Finger OR Thumb | other | N/A | $72 to $26,750 | Low |
| Closed Treatment of Broken Finger OR Hand At Base of Finger | other | N/A | $72 to $26,740 | Low |
| Closed Treatment of Broken Hand Bone | other | N/A | $72 to $26,600 | Low |
| Closed Treatment of Broken Outside Lower Leg Bone At Ankle | other | N/A | $72 to $27,786 | Low |
| Closed Treatment of Broken Outside Lower Leg Bone At Ankle with Manipulation | other | N/A | $72 to $27,788 | Low |
| Closed Treatment of Broken Toe | other | N/A | $72 to $28,510 | Low |
| Closed Treatment of Broken Toe with Manipulation | other | N/A | $72 to $28,515 | Low |
| Closed Treatment of Inside Portion of Shin Bone At Ankle | other | N/A | $72 to $27,760 | Low |
| Evaluation of Implantable Defibrillator System | surgery | N/A | $34 to $93,261 | Low |
| Review By Radiologist of Urinary Bladder and Urethra Images with Contrast | other | N/A | $15 to $74,450 | Low |
| Dxa Bone Density Measurement of Hip, Pelvis, Spine | other | N/A | $9 to $77,080 | Low |
| Office OR Other Outpatient Consultation with Low Level of Medical Decision Ma... | other | N/A | $73 to $99,243 | Low |
| Psychotherapy for Crisis, First Hour | therapy | N/A | $73 to $90,839 | Low |
| Radioactive Drug Therapy Through a Tube Inserted in an Artery | other | N/A | $73 to $79,445 | Low |
| Respiratory Syncytial Virus Vaccine, Pref, Recombinant, Subunit, Adjuvanted, ... | preventive | N/A | $73 to $90,679 | Low |
| Diagnostic Exam of Rectum and Lower Large Bowel Using an Endoscope | other | N/A | $43 to $45,300 | Low |
| Complex Control of Nose Bleed | other | N/A | $66 to $30,903 | Low |
| Initial Control of Nose Bleed and Insertion of Packing | other | N/A | $74 to $30,905 | Low |
| Simple Control of Nose Bleed | other | N/A | $47 to $30,901 | Low |
| Fluoroscopic Guidance for Needle Placement | other | N/A | $26 to $77,002 | Low |
| Initial Evaluation and Management of Newborn Per Day | obstetric | N/A | $74 to $99,460 | Low |
| Benzodiazepines Levels, 1 | other | N/A | $75 to $80,346 | Low |
| Established Patient Periodic Preventive Medicine Examination | preventive | N/A | $75 to $99,397 | Low |
| Injection of Medication Into Palm | other | N/A | $55 to $20,527 | Low |
| Application of Walking Cast Covering Below Knee to Toe | other | N/A | $49 to $29,425 | Low |
| Metanephrines Level | other | N/A | $17 to $83,835 | Low |
| Review By Radiologist of Head OR Neck Vein System Image | other | N/A | $51 to $75,860 | Low |
| Review By Radiologist of Major Lower Body Vein Image | other | N/A | $50 to $75,825 | Low |
| X-ray of Both Hips, Minimum of 5 Views | imaging | N/A | $14 to $73,523 | Low |
| Hospital Inpatient OR Observation Discharge Day Management, More Than 30 Minutes | other | N/A | $76 to $99,239 | Low |
| Gene Analysis (mpl Proto-oncogene, Thrombopoietin Receptor) Sequence Analysis... | other | N/A | $77 to $81,339 | Low |
| Thyroid Hormone, T3 Measurement, Reverse | other | N/A | $16 to $84,482 | Low |
| Injection of Radioactive Material for X-ray Identification of Lymph Node | imaging | N/A | $26 to $38,792 | Low |
| Programming of Single Lead Implantable Defibrillator System | surgery | N/A | $39 to $93,282 | Low |
| Test to Measure Lung Airway Sensitivity | other | N/A | $28 to $94,070 | Low |
| Detection of Pancreatic Elastase (enzyme) in Stool | other | N/A | $12 to $82,656 | Low |
| Physician Attendance At Delivery and Stabilization of Newborn | obstetric | N/A | $61 to $99,464 | Low |
| Confirmation Test for Hepatitis C Antibody | other | N/A | $15 to $86,804 | Low |
| Electronic Analysis and Reprogramming of Spinal Canal Drug Infusion Pump | surgery | N/A | $28 to $62,368 | Low |
| Inpatient OR Observation Consultation with Low Level of Medical Decision Maki... | other | N/A | $78 to $99,253 | Low |
| Test to Assess Electrical Potentials Generated in the Inner Ear As a Result o... | other | N/A | $79 to $92,584 | Low |
| Application of Shoulder to Hand Cast | other | N/A | $60 to $29,065 | Low |
| Programming of Implantable Defibrillator System | surgery | N/A | $40 to $93,260 | Low |
| Special Stained Specimen Slides to Examine Tissue, Each Additional Procedure | lab | N/A | $79 to $88,341 | Low |
| Use of a Drug to Induce Depression of Consciousness By Physician Not Performi... | other | N/A | $68 to $99,156 | Low |
| Nerve Conduction, 1-2 Studies | other | N/A | $52 to $95,907 | Low |
| Physician Supervision of Patient Home Health Agency Services Per Month, 30 Mi... | other | N/A | $80 to $99,375 | Low |
| Aspiration And/or Injection of Cyst of Thyroid | other | N/A | $40 to $60,300 | Low |
| Dilation of Saliva Gland Duct and Insertion of Tube | other | N/A | $66 to $42,660 | Low |
| Work-related OR Medical Disability Examination By the Treating Physician | other | N/A | $80 to $99,455 | Low |
| Adrenocorticotropic Hormone (acth) Level | other | N/A | $39 to $82,024 | Low |
| Instillation of Anti-cancer Drug Into Bladder | other | N/A | $36 to $51,720 | Low |
| Extended Physician Standby Service, Each 30 Minutes | other | N/A | $81 to $99,360 | Low |
| Meningococcal Recombinant Protein and Outer Membrane Vesicle Vaccine, Serogro... | preventive | N/A | $81 to $90,620 | Low |
| Procalcitonin (hormone) Level | other | N/A | $27 to $84,145 | Low |
| Microscopic Genetic Analysis of Tissue, Computer-assisted Technology, Initial... | other | N/A | $81 to $88,374 | Low |
| Microscopic Genetic Analysis of Tissue, Manual, Each Additional Multiplex Sta... | other | N/A | $81 to $88,377 | Low |
| X-ray of Thigh Bone, 1 View | imaging | N/A | $82 to $73,551 | Low |
| 3d Radiographic Procedure | imaging | N/A | $24 to $76,376 | Low |
| Injection of Anesthetic OR Steroid Into Joint Between Lower Spine and Hip Bon... | other | N/A | $71 to $27,096 | Low |
| Pneumococcal Vaccine, 13-valent | preventive | N/A | $82 to $90,670 | Low |
| Evaluation of Brain Response to Sound for Determination of Hearing Threshold ... | other | N/A | $82 to $92,652 | Low |
| Removal of Foreign Body in Ear Canal | surgery | N/A | $40 to $69,200 | Low |
| Needle Measurement of Electrical Activity in Arm OR Leg Muscles, 1 Extremity | other | N/A | $50 to $95,860 | Low |
| Parathormone (parathyroid Hormone) Level | other | N/A | $41 to $83,970 | Low |
| Citrate Level | other | N/A | $28 to $82,507 | Low |
| Programming of Multiple Lead Pacemaker System | cardiac | N/A | $40 to $93,281 | Low |
| Complete X-ray of Body Bones | imaging | N/A | $25 to $77,075 | Low |
| Simple Removal of Skin Debris and Drainage of Mastoid Cavity | surgery | N/A | $42 to $69,220 | Low |
| Injection of Chemical for Paralysis of Nerve Muscles On Side of Face | other | N/A | $84 to $64,612 | Low |
| Somatomedin (growth Factor) Level | other | N/A | $21 to $84,305 | Low |
| Gene Analysis (calreticulin), Common Variants | other | N/A | $85 to $81,219 | Low |
| Initial Inpatient Hospital OR Birthing Center Same Date Care and Discharge of... | other | N/A | $85 to $99,463 | Low |
| Skin Substitute Graft to Wound 100.0 SQ Cm OR More of Trunk, Arms, OR Legs, E... | other | N/A | $37 to $15,274 | Low |
| Complete Ultrasound Scan of Pelvis | imaging | N/A | $31 to $76,856 | Low |
| Simple Drainage of Abscess of Finger | other | N/A | $85 to $26,010 | Low |
| Biopsy of Lining of Nose | lab | N/A | $58 to $30,100 | Low |
| Nuclear Medicine Study of Lymphatic System | imaging | N/A | $52 to $78,195 | Low |
| Limited OR Follow-up CT Scan | imaging | N/A | $43 to $76,380 | Low |
| Complete Ultrasound Scan Behind Abdominal Cavity | imaging | N/A | $33 to $76,770 | Low |
| Administration of Chemotherapy Into Vein, Each Additional Hour | other | N/A | $69 to $96,415 | Low |
| Flow Cytometry Technique for Dna OR Cell Analysis, First Marker | other | N/A | $87 to $88,184 | Low |
| Identification of Red Blood Cell Antibodies | other | N/A | $87 to $86,870 | Low |
| Subsequent Instillation of Agent Onto Lung Lining Using Chest Tube | other | N/A | $52 to $32,562 | Low |
| Aspiration And/or Injection of Fluid From Small Joint Using Ultrasound Guidance | imaging | N/A | $38 to $20,604 | Low |
| Aspiration And/or Injection of Fluid Large Joint Using Ultrasound Guidance | imaging | N/A | $87 to $20,611 | Low |
| Removal of Appendix During Other Major Procedure | surgery | N/A | $70 to $44,955 | Low |
| Gene Analysis (myeloid Differentiation Primary Response 88) for P.leu265pro V... | other | N/A | $88 to $81,305 | Low |
| Extended Patient Service without Direct Patient Contact, First Hour | other | N/A | $88 to $99,358 | Low |
| Removal of Foreign Body From External Eye | surgery | N/A | $29 to $65,210 | Low |
| Removal of Foreign Body in Cornea | surgery | N/A | $36 to $65,220 | Low |
| Removal of Foreign Body in Cornea Using Slit Lamp | surgery | N/A | $40 to $65,222 | Low |
| Immunologic Analysis Technique On Body Fluid, Other Fluids with Concentration | other | N/A | $29 to $86,335 | Low |
| Shingles Vaccine for Injection Under Skin | preventive | N/A | $88 to $90,736 | Low |
| Cervicovaginal Secretion of Placenta Protein | other | N/A | $89 to $84,112 | Low |
| Nerve Conduction, 5-6 Studies | other | N/A | $77 to $95,909 | Low |
| Puncture of Windpipe for Aspiration And/or Injection | other | N/A | $40 to $31,612 | Low |
| Imaging Guidance for Procedure, 60 Minutes OR Less | other | N/A | $15 to $76,000 | Low |
| Psychiatric Diagnostic Evaluation | therapy | N/A | $89 to $90,792 | Low |
| Vasoactive Intestinal Peptide (intestinal Hormone) Level | other | N/A | $35 to $84,586 | Low |
| Initial Hospital Inpatient OR Observation Care with Moderate Level of Medical... | other | N/A | $90 to $99,222 | Low |
| Other Procedure On Skin, Mucous Membrane, and Tissue | other | N/A | $90 to $17,999 | Low |
| Ultrasound of Heart Blood Flow, Valves and Chambers, Follow-up | imaging | N/A | $7 to $93,321 | Low |
| Gene Analysis (v-kit Hardy-zuckerman 4 Feline Sarcoma Viral Oncogene Homolog)... | other | N/A | $90 to $81,272 | Low |
| Injection of Anesthetic Agent And/or Steroid Into Upper Neck and Back of Head... | other | N/A | $43 to $64,405 | Low |
| Residence Visit for Established Patient with High Level of Medical Decision M... | other | N/A | $90 to $99,350 | Low |
| Diagnostic Exam of Anus Using an Endoscope | other | N/A | $38 to $46,600 | Low |
| Initial New Patient Preventive Medicine Evaluation | preventive | N/A | $92 to $99,387 | Low |
| Insertion of Probe in Esophagus for Heart Ultrasound | imaging | N/A | $10 to $93,313 | Low |
| Programming of Multiple Lead Implantable Defibrillator System | surgery | N/A | $58 to $93,284 | Low |
| Biopsy of Ear | lab | N/A | $36 to $69,100 | Low |
| Insertion of Needle OR Tube Into Vein | other | N/A | $93 to $36,000 | Low |
| Ultrasound Scan of Spinal Canal | imaging | N/A | $93 to $76,800 | Low |
| Human Papillomavirus Vaccine Types 6, 11, 16, 18, 31, 33, 45, 52, 58, Nonavalent | preventive | N/A | $93 to $90,651 | Low |
| Irrigation of Nasal Sinus | other | N/A | $93 to $31,000 | Low |
| Removal of Implanted Eardrum Tube Under Anesthesia | surgery | N/A | $53 to $69,424 | Low |
| X-ray of Chest, 1 View | imaging | N/A | $83 to $71,045 | Low |
| Screening Evaluation of Brain Response to Sound with Automated Analysis | preventive | N/A | $94 to $92,650 | Low |
| Initial Observation Care, Per Day, for the Evaluation and Management of a Pat... | other | N/A | $94 to $99,220 | Low |
| Review By Radiologist of Both Arms OR Legs Arteries Image | other | N/A | $86 to $75,716 | Low |
| Contrast Injection for X-ray Imaging Through Existing Tube in Stomach, Small ... | imaging | N/A | $95 to $49,465 | Low |
| Replacement of Stomach-to-small Bowel Tube Using Fluoroscopic Guidance with C... | surgery | N/A | $95 to $49,452 | Low |
| Drawing of Blood for a Medical Problem | other | N/A | $95 to $99,195 | Low |
| Programming of Dual Lead Implantable Defibrillator System | surgery | N/A | $53 to $93,283 | Low |
| 3d Ultrasound Imaging of Heart for Evaluation of Heart Structure Performed Du... | imaging | N/A | $20 to $93,319 | Low |
| Biopsy of Ear Canal | lab | N/A | $54 to $69,105 | Low |
| Endovascular Repair of Iliac Artery Aneurysm, Pseudoaneurysm, Arteriovenous M... | surgery | N/A | $95 to $75,954 | Low |
| Injection of Contrast for Imaging of Hip Joint | other | N/A | $55 to $27,093 | Low |
| Injection of Contrast for Imaging of Knee Joint | other | N/A | $33 to $27,369 | Low |
| Injection of Contrast for Imaging of Shoulder Joint | other | N/A | $41 to $23,350 | Low |
| Injection of Contrast for Imaging of Wrist | other | N/A | $59 to $25,246 | Low |
| Placement of Expandable Tube in Breast for Radiation Treatment Using Imaging ... | other | N/A | $77 to $19,297 | Low |
| Screening Mammography | imaging | N/A | $95 to $77,067 | Low |
| Nerve Conduction, 3-4 Studies | other | N/A | $65 to $95,908 | Low |
| X-ray of Hip, 1 View | imaging | N/A | $83 to $73,501 | Low |
| Gene Analysis (prothrombin, Coagulation Factor Ii) a Variant | other | N/A | $66 to $81,240 | Low |
| Nuclear Medicine Study of Heart Muscle with Metabolic Evaluation | imaging | N/A | $69 to $78,459 | Low |
| Residence Visit for New Patient with Moderate Level of Medical Decision Makin... | other | N/A | $96 to $99,344 | Low |
| Supervision of Interfacility Transport Care of Critical Patient, First 30 Min... | other | N/A | $96 to $99,485 | Low |
| Established Patient Synchronous Audio-only Visit with High Medical Decision M... | other | N/A | $97 to $98,015 | Low |
| Needle Biopsy of Thyroid Through Skin | lab | N/A | $63 to $60,100 | Low |
| Continuous Monitoring of Blood Sugar Level in Tissue Fluid Using Sensor Under... | other | N/A | $99 to $95,250 | Low |
| Gene Analysis (coagulation Factor V) Leiden Variant | other | N/A | $73 to $81,241 | Low |
| X-ray of Face Bones, 1-2 Views | imaging | N/A | $83 to $70,140 | Low |
| X-ray of Lower Jaws, Upper Jaws and Teeth | imaging | N/A | $83 to $70,355 | Low |
| Established Patient Office OR Other Outpatient Visit with High Level of Medic... | other | N/A | $100 to $99,215 | Low |
| Ultrasonic Guidance During Surgery | surgery | N/A | $46 to $76,998 | Low |
| Injection of Radioactive Contrast Into a Vein for Non-imaging Gamma Probe | other | N/A | $100 to $78,808 | Low |
| 3d Breast Mammography of Both Breasts | imaging | N/A | $100 to $77,062 | Low |
| Injection Procedure Through Bladder and Urethra for X-ray Imaging | imaging | N/A | $55 to $51,610 | Low |
| Administration of Prolonged Chemotherapy Into Vein | other | N/A | $101 to $96,416 | Low |
| Other Procedure On Tongue OR Floor of Mouth | other | N/A | $101 to $41,599 | Low |
| Vemp Testing of Upper and Lower Branches of Inner Ear Nerve with Interpretati... | other | N/A | $50 to $92,519 | Low |
| Nerve Conduction Study of Arm OR Leg Movement And/or Feeling with Review and ... | other | N/A | $3 to $95,905 | Low |
| Skin Substitute Graft to Wound 100.0 SQ Cm OR More of Face, Scalp, Eyelids, M... | other | N/A | $46 to $15,278 | Low |
| Bacillus Calmette-guerin Vaccine for Bladder Cancer | preventive | N/A | $102 to $90,586 | Low |
| Electronic Analysis of Implanted Neurostimulator Generator with Complex Spina... | surgery | N/A | $34 to $95,972 | Low |
| Exam of the Nose and Throat Using an Endoscope | other | N/A | $31 to $92,511 | Low |
| Simple Drainage of Abscess OR Blood Accumulation of External Ear | other | N/A | $103 to $69,000 | Low |
| Pneumococcal Conjugate Vaccine, 15 Valent (pcv15), for Intramuscular Use | preventive | N/A | $103 to $90,671 | Low |
| Radiation Treatment Management, 1-2 Treatment Sessions | other | N/A | $102 to $77,431 | Low |
| Ultrasound Scan of Pelvic Region Through Rectum | imaging | N/A | $31 to $76,872 | Low |
| Immunologic Analysis for Autoimmune Disease, A, B, OR C, Single Antigen | other | N/A | $26 to $86,812 | Low |
| Diagnostic Exam of Anus and Rectum Under Anesthesia | other | N/A | $93 to $45,990 | Low |
| Drainage of Deep Abscess OR Blood Accumulation of Leg OR Ankle | other | N/A | $103 to $27,603 | Low |
| Acute Hepatitis Panel | lab | N/A | $48 to $80,074 | Low |
| Needle Biopsy of Liver | lab | N/A | $86 to $47,001 | Low |
| Transitional Care Management Services for Problem of At Least Moderate Comple... | other | N/A | $104 to $99,495 | Low |
| Diagnostic Exam of Lower Portion of Large Bowel Using a Flexible Endoscope | other | N/A | $51 to $45,330 | Low |
| Vitamin B-6 Level | other | N/A | $28 to $84,207 | Low |
| Injection for X-ray Imaging Procedure Into Vein of Arm OR Leg | imaging | N/A | $39 to $36,005 | Low |
| New Patient Office OR Other Outpatient Visit with Moderate Level of Medical D... | other | N/A | $106 to $99,204 | Low |
| Removal of Drain (seton) From Anus | surgery | N/A | $76 to $46,030 | Low |
| Testing for Presence of Drug, Read By Instrument Assisted Observation | other | N/A | $17 to $80,306 | Low |
| 3d Breast Mammography of 1 Breast | imaging | N/A | $106 to $77,061 | Low |
| Colonoscopy | preventive | N/A | $106 to $45,383 | High |
| Psychotherapy with Evaluation and Management Visit, 1 Hour | therapy | N/A | $106 to $90,838 | Low |
| X-ray of Chest, 3 Views | imaging | N/A | $83 to $71,047 | Low |
| Review By Radiologist of Abdominal Artery Image | other | N/A | $88 to $75,726 | Low |
| Drainage of Abscess, Cyst, OR Blood Accumulation of Side of Tongue From Insid... | other | N/A | $97 to $41,000 | Low |
| Evaluation and Testing for Balance with Recording | other | N/A | $73 to $92,540 | Low |
| Application of Long Leg Cast From Thigh to Toe | other | N/A | $86 to $29,345 | Low |
| Ultrasound Scan of Brain | imaging | N/A | $100 to $76,506 | Low |
| Biopsy of Floor of Mouth | lab | N/A | $79 to $41,108 | Low |
| Closed Treatment of Broken Great Toe | other | N/A | $109 to $28,490 | Low |
| Removal of Foreign Body in Ear Canal Under Anesthesia | surgery | N/A | $83 to $69,205 | Low |
| Detection Test By Nucleic Acid for Organism, Amplified Probe Technique | other | N/A | $35 to $87,798 | Low |
| Biopsy of Roof of Mouth | lab | N/A | $96 to $42,100 | Low |
| Incision and Drainage of Abscess of Female Genital Gland | other | N/A | $94 to $56,420 | Low |
| Office OR Other Outpatient Consultation with Moderate Level of Medical Decisi... | other | N/A | $110 to $99,244 | Low |
| Administration of Additional New Drug OR Substance Into Vein, 1 Hour OR Less | other | N/A | $69 to $96,417 | Low |
| Imaging of Urinary Tract Following Injection of a Contrast Agent | other | N/A | $24 to $74,420 | Low |
| Detection Test By Nucleic Acid for Hepatitis B Virus, Quantification | other | N/A | $43 to $87,517 | Low |
| Dialysis | other | N/A | $21 to $75,791 | High |
| Manipulation of Finger for Connective Tissue Release Following Enzyme Injection | other | N/A | $69 to $26,341 | Low |
| X-ray of Collar Bone | imaging | N/A | $83 to $73,000 | Low |
| Closed Treatment of Broken Forearm (radius) Bone At the Wrist Area On the Thu... | other | N/A | $113 to $25,600 | Low |
| Closed Treatment of Broken Midpart of Forearm Bone On Small Finger Side | other | N/A | $113 to $25,530 | Low |
| Closed Treatment of Broken Midpart of Forearm Bone On Thumb Side | other | N/A | $113 to $25,500 | Low |
| Closed Treatment of Broken OR Growth Plate Separate of Forearm Bone At Wrist ... | other | N/A | $113 to $25,605 | Low |
| Administration of Additional New Drug OR Substance Into Vein Using Push Techn... | other | N/A | $69 to $96,411 | Low |
| X-ray of Foot, 2 Views | imaging | N/A | $83 to $73,620 | Low |
| X-ray of Thigh Bone, Minimum 2 Views | imaging | N/A | $83 to $73,552 | Low |
| Ultrasound Scan of Growth for Measuring Elasticity, Each Additional Growth | imaging | N/A | $57 to $76,983 | Low |
| X-ray of Hip, 2-3 Views | imaging | N/A | $83 to $73,502 | Low |
| Inpatient OR Observation Consultation with Moderate Level of Medical Decision... | other | N/A | $114 to $99,254 | Low |
| Drug Infusion OR Exercise for Heart Stimulation During Diagnostic Study | surgery | N/A | $85 to $93,464 | Low |
| Removal of Embedded Foreign Body in Eyelid | surgery | N/A | $96 to $67,938 | Low |
| Repositioning of Oral OR Nasal Feeding Tube in Small Bowel | other | N/A | $84 to $43,761 | Low |
| Surgical Pathology | lab | N/A | $116 to $88,321 | Low |
| Biopsy of Mouth | lab | N/A | $78 to $40,808 | Low |
| X-ray of Chest, 2 Views | imaging | N/A | $83 to $71,046 | Low |
| Nuclear Medicine Study, 1 Area | imaging | N/A | $29 to $78,800 | Low |
| Review By Radiologist of Placement of Long Small Bowel Tube | other | N/A | $117 to $74,340 | Low |
| Biopsy of Front 2/3 of Tongue | lab | N/A | $92 to $41,100 | Low |
| Residence Visit for New Patient with High Level of Medical Decision Making, P... | other | N/A | $117 to $99,345 | Low |
| Biopsy of Back of Throat | lab | N/A | $100 to $42,800 | Low |
| Detection Test By Nucleic Acid for Cytomegalovirus, Quantification | other | N/A | $43 to $87,497 | Low |
| Refilling and Maintenance of Portable Pump | other | N/A | $117 to $96,521 | Low |
| Therapeutic Fracture of Nasal Passages | other | N/A | $103 to $30,930 | Low |
| Enema Using Air OR Contrast | other | N/A | $119 to $74,283 | Low |
| Injection of Anesthetic Agent And/or Steroid Into Face Nerve | other | N/A | $44 to $64,400 | Low |
| Obtaining Data Needed to Develop the Optimal Radiation Treatment, 3 OR More T... | other | N/A | $79 to $77,290 | Low |
| Analysis for Antibody to Epstein-barr Virus (mononucleosis Virus), Viral Capsid | other | N/A | $18 to $86,665 | Low |
| Injection of Chemical for Paralysis of Facial and Neck Nerve Muscles On Both ... | other | N/A | $100 to $64,615 | Low |
| Sleep Study (Polysomnography) | diagnostic | N/A | $38 to $95,800 | High |
| Biopsy of Back 1/3 of Tongue | lab | N/A | $95 to $41,105 | Low |
| Ultrasonic Guidance for Pericardiocentesis, Imaging Supervision and Interpret... | other | N/A | $120 to $76,930 | Low |
| Incision, Aspiration, And/or Inflation of Eardrum | other | N/A | $104 to $69,420 | Low |
| Injection of Anesthetic Agent And/or Steroid Into Vagus Nerve | other | N/A | $37 to $64,408 | Low |
| Chemical Receptor Analysis | other | N/A | $37 to $84,238 | Low |
| Management of Oxygen Chamber Therapy | other | N/A | $104 to $99,183 | Low |
| Ultrasound of Aorta, Vena Cava, Groin Vessels OR Bypass Grafts | imaging | N/A | $22 to $93,979 | Low |
| Testing for Presence of Drug, By Chemistry Analyzers | other | N/A | $62 to $80,307 | Low |
| Simple Removal of Embedded Foreign Body in Mouth | surgery | N/A | $109 to $40,804 | Low |
| Strapping, Unna Boot | other | N/A | $123 to $29,580 | Low |
| Exam of Head, Neck, Including Ears, Nose and Throat Under General Anesthesia | other | N/A | $83 to $92,502 | Low |
| Detection Test By Nucleic Acid for Mycoplasma Pneumoniae (bacteria), Amplifie... | other | N/A | $35 to $87,581 | Low |
| Biopsies of Rectum And/or Lower Large Bowel Using a Rigid Endoscope | other | N/A | $65 to $45,305 | Low |
| Follow-up Intensive Care of Recovering Medium Birth Weight Infant Per Day | other | N/A | $98 to $99,480 | Low |
| Gene Analysis (interferon, Lambda 3) for Rs12979860 Variant | other | N/A | $73 to $81,283 | Low |
| Injection of Contrast Through Abdominal Cavity Tube for X-ray Study | imaging | N/A | $31 to $49,424 | Low |
| Ultrasound of Heart with Probe in Esophagus, with Report | imaging | N/A | $102 to $93,312 | Low |
| Application of Walking Cast Covering Thigh to Toe | other | N/A | $91 to $29,355 | Low |
| New Patient Office OR Other Outpatient Visit with a High Level of Medical Dec... | other | N/A | $126 to $99,205 | Low |
| Removal of Polyp of Outer Ear | surgery | N/A | $113 to $69,540 | Low |
| Gene Analysis (janus Kinase 2) Variant | other | N/A | $92 to $81,270 | Low |
| Limited Ultrasound Scan of 1 Breast | imaging | N/A | $83 to $76,642 | Low |
| Injection of Chemical for Paralysis of Salivary Glands On Both Sides of Mouth | other | N/A | $99 to $64,611 | Low |
| Nerve Conduction, 7-8 Studies | other | N/A | $103 to $95,910 | Low |
| Measurement of Brain Wave Activity (eeg) to Evaluate Brain Death | other | N/A | $130 to $95,824 | Low |
| Transitional Care Management Services for Problem of High Complexity | other | N/A | $130 to $99,496 | Low |
| Imaging of Lymph Nodes During Surgery | surgery | N/A | $114 to $38,900 | Low |
| Simple Drainage of Abscess of Saliva Gland | other | N/A | $131 to $42,300 | Low |
| Test to Measure Rate of Airflow | other | N/A | $131 to $94,375 | Low |
| Ultrasound Scan of Abdominal Aorta | imaging | N/A | $25 to $76,706 | Low |
| Follow-up Intensive Care of Recovering Low Birth Weight Infant Per Day | other | N/A | $102 to $99,479 | Low |
| Insertion of Needle OR Tube Into Artery of Arm OR Leg | other | N/A | $74 to $36,140 | Low |
| Release of Large Bowel From Spleen and Abdominal Wall with Partial Removal of... | surgery | N/A | $100 to $44,139 | Low |
| X-ray of Both Hips, 3-4 Views | imaging | N/A | $100 to $73,522 | Low |
| Removal of Growth of Tissue of Mouth | surgery | N/A | $108 to $40,810 | Low |
| Initial Hospital Inpatient OR Observation Care with High Level of Medical Dec... | other | N/A | $133 to $99,223 | Low |
| Administration of Chemotherapy Into Vein Using Push Technique | other | N/A | $133 to $96,409 | Low |
| Removal of Anal Polyps OR Growths Using an Endoscope with Electrical Cautery | surgery | N/A | $72 to $46,610 | Low |
| X-ray of Foot, Minimum of 3 Views | imaging | N/A | $83 to $73,630 | Low |
| X-ray of Inside of Ear Canal | imaging | N/A | $134 to $70,134 | Low |
| Removal of Single External Noncancer Growth of Anus | surgery | N/A | $112 to $46,220 | Low |
| Therapy Procedure Using a Special Bandage and Vacuum Pump, Surface Area 50.0 ... | other | N/A | $135 to $97,605 | Low |
| Delivery of Complex Radiation Treatment | obstetric | N/A | $135 to $77,412 | Low |
| Detection Test By Nucleic Acid for Digestive Tract Pathogen, Multiple Types O... | other | N/A | $135 to $87,507 | Low |
| Destruction of Soft Tissue of Nasal Passages | other | N/A | $132 to $30,801 | Low |
| Electronic Analysis Reprogramming and Refill of Spinal Canal Drug Infusion Pump | surgery | N/A | $29 to $62,369 | Low |
| Removal of Kidney Drainage Tube Using Fluoroscopic Guidance | surgery | N/A | $44 to $50,389 | Low |
| X-ray of Both Hips, 2 Views | imaging | N/A | $100 to $73,521 | Low |
| Office OR Other Outpatient Consultation with High Level of Medical Decision M... | other | N/A | $136 to $99,245 | Low |
| Ultrasound Study of Arm and Leg Arteries | imaging | N/A | $11 to $93,922 | Low |
| Insertion of Tube Into Windpipe and Airways of Lung for Aspiration of Secreti... | other | N/A | $68 to $31,725 | Low |
| Removal of Growth of Tongue without Closure | surgery | N/A | $112 to $41,110 | Low |
| Injection of Anesthetic Agent, Trigeminal Nerve Bundle | other | N/A | $90 to $64,505 | Low |
| Detection Test By Nucleic Acid for Hiv-1 Virus, Quantification | other | N/A | $85 to $87,536 | Low |
| Incision of Eardrum with Insertion of Eardrum Tube Under Local OR Topical Ane... | other | N/A | $113 to $69,433 | Low |
| Microsatellite Instability Analysis | other | N/A | $138 to $81,301 | Low |
| X-ray of Entire Middle and Lower Spine, 1 View | imaging | N/A | $83 to $72,081 | Low |
| Removal of Dental Bone Growth | surgery | N/A | $105 to $41,825 | Low |
| Detection Test By Nucleic Acid for Hepatitis C Virus, Quantification | other | N/A | $43 to $87,522 | Low |
| Diagnostic Exam of Voice Box Using a Flexible Endoscope | other | N/A | $138 to $31,575 | Low |
| Inpatient OR Observation Consultation with High Level of Medical Decision Mak... | other | N/A | $138 to $99,255 | Low |
| Nerve Conduction, 11-12 Studies | other | N/A | $139 to $95,912 | Low |
| Review By Radiologist of Ankle Joint Image | other | N/A | $139 to $73,615 | Low |
| Review By Radiologist of Hinged Joint of Upper and Lower Jaw Bones Image | other | N/A | $139 to $70,332 | Low |
| Biopsy of Anus Using an Endoscope | lab | N/A | $67 to $46,606 | Low |
| Chemical Analysis Using Chromatography Technique | other | N/A | $24 to $82,542 | Low |
| Biopsy of Lower Large Bowel Using a Flexible Endoscope | lab | N/A | $63 to $45,331 | Low |
| Simple Removal of Nasal Polyp | surgery | N/A | $113 to $30,110 | Low |
| Detection Test By Nucleic Acid for Organism, Quantification | other | N/A | $43 to $87,799 | Low |
| Follow-up Intensive Care of Recovering Very Low Birth Weight Infant Per Day | other | N/A | $113 to $99,478 | Low |
| Simple Control of Bleeding of Throat | other | N/A | $137 to $42,960 | Low |
| Radioactive Drug Therapy of Radiolabeled Monoclonal Antibody Through a Vein | other | N/A | $141 to $79,403 | Low |
| Drainage of Abscess OR Blood Accumulation of Nose | other | N/A | $104 to $30,000 | Low |
| Needle Measurement of Electrical Activity in Arm OR Leg Muscles, 3 Extremities | other | N/A | $96 to $95,863 | Low |
| Simple Biopsy of Growth of Throat Behind Nose | lab | N/A | $106 to $42,804 | Low |
| Fusion of Finger Joint, Each Additional Joint | surgery | N/A | $81 to $26,861 | Low |
| Follow-up Ultrasound Scan of Pregnant Uterus | imaging | N/A | $100 to $76,816 | Low |
| Biopsy of Prostate Gland | lab | N/A | $145 to $55,700 | Low |
| Low Dose CT Scan of Chest for Lung Cancer Screening | imaging | N/A | $48 to $71,271 | Low |
| Fetal Test | other | N/A | $146 to $59,025 | Low |
| Incision of Tissue Joining Lip and Gum | other | N/A | $27 to $40,806 | Low |
| Ultrasonic Guidance for Needle Placement | other | N/A | $30 to $76,942 | Low |
| Review By Radiologist of Salivary Structure Image | other | N/A | $147 to $70,390 | Low |
| Drainage of Abscess of Roof of Mouth | other | N/A | $94 to $42,000 | Low |
| Nuclear Medicine Study of Limited Area for Thyroid Cancer | imaging | N/A | $148 to $78,015 | Low |
| Evaluation of Sleep-disordered Breathing By Examination of Upper Airway Using... | other | N/A | $79 to $42,975 | Low |
| Injection Procedure for Imaging of Bladder During Voiding | other | N/A | $36 to $51,600 | Low |
| Needle Biopsy of Growth of Abdominal Cavity | lab | N/A | $68 to $49,180 | Low |
| Closed Treatment of Dislocated Joint Between Toe and Foot Under Anesthesia | other | N/A | $117 to $28,635 | Low |
| Instillation of Agent Onto Lung Surface Using Chest Tube | other | N/A | $65 to $32,560 | Low |
| Incision, Aspiration, and Inflation of Eardrum Under Anesthesia | other | N/A | $130 to $69,421 | Low |
| Removal of Tissue Connecting Tongue and Floor of Mouth | surgery | N/A | $126 to $41,115 | Low |
| Complex Removal of Skin Debris and Drainage of Mastoid Cavity | surgery | N/A | $119 to $69,222 | Low |
| Nerve Conduction, 9-10 Studies | other | N/A | $128 to $95,911 | Low |
| Closed Treatment of Broken Finger OR Thumb At Midportion OR Part Near Hand | other | N/A | $154 to $26,720 | Low |
| Nuclear Medicine Study of Bone And/or Joint Limited Area | imaging | N/A | $27 to $78,300 | Low |
| Simple Chemical Destruction of Growth of Anus | other | N/A | $125 to $46,900 | Low |
| Computer-assisted Surgery for Muscle and Bone Procedure | surgery | N/A | $116 to $20,985 | Low |
| Dilation of Sphincter of Anus Under Anesthesia | other | N/A | $158 to $45,905 | Low |
| Removal of Growth of Roof of Mouth | surgery | N/A | $116 to $42,104 | Low |
| Lengthening of Esophagus Using an Endoscope | other | N/A | $132 to $43,283 | Low |
| Nuclear Medicine Study of Liver and Spleen | imaging | N/A | $22 to $78,215 | Low |
| Destruction of Internal Hemorrhoids Using Heat | other | N/A | $148 to $46,930 | Low |
| Nerve Conduction, 13 OR More Studies | other | N/A | $161 to $95,913 | Low |
| Needle Biopsy of Liver Through Skin | lab | N/A | $73 to $47,000 | Low |
| Nuclear Medicine Study of Lung Ventilation | imaging | N/A | $22 to $78,579 | Low |
| Removal of Growth of Mouth with Simple Repair | surgery | N/A | $159 to $40,812 | Low |
| Nuclear Medicine Study of Thyroid | imaging | N/A | $16 to $78,013 | Low |
| Therapy Procedure Using a Special Bandage and Vacuum Pump, Surface Area More ... | other | N/A | $162 to $97,606 | Low |
| Complex Biopsy of Growth of Throat Behind Nose | lab | N/A | $121 to $42,806 | Low |
| Biopsy of Small Bowel Using an Endoscope Inserted Through Surgically Created ... | surgery | N/A | $65 to $44,382 | Low |
| X-ray of Knee, 4 OR More Views | imaging | N/A | $100 to $73,564 | Low |
| Study of Esophagus to Assess Movement | other | N/A | $65 to $91,010 | Low |
| Analysis for Antibody Borrelia Burgdorferi | other | N/A | $17 to $86,618 | Low |
| Imaging for Evaluation of Swallowing Function | other | N/A | $165 to $74,230 | Low |
| Complete Ultrasound Scan of 1 Breast | imaging | N/A | $100 to $76,641 | Low |
| Release of Nasal Scar Tissue | other | N/A | $131 to $30,560 | Low |
| Drainage of Abscess OR Blood Accumulation of Nasal Cartilage | other | N/A | $105 to $30,020 | Low |
| Destruction of Growth OR Scar of Mouth | other | N/A | $145 to $40,820 | Low |
| Radiation Treatment Management, 5 Treatment Sessions | other | N/A | $167 to $77,427 | Low |
| X-ray of Entire Middle and Lower Spine, 2-3 Views | imaging | N/A | $100 to $72,082 | Low |
| Review By Radiologist of Image for Repair of Descending Aorta with Insertion ... | surgery | N/A | $168 to $75,957 | Low |
| Review By Radiologist of Chest Aorta Serial Images | other | N/A | $50 to $75,605 | Low |
| Exam of Bile Duct During Surgery Using an Endoscope | surgery | N/A | $135 to $47,550 | Low |
| Incision of Tissue Connecting Tongue and Floor of Mouth | other | N/A | $97 to $41,010 | Low |
| Gene Analysis (t Cell Antigen Receptor Beta) Amplification Methodology | other | N/A | $169 to $81,340 | Low |
| Simple Destruction of Growth of Anus | other | N/A | $122 to $46,910 | Low |
| Removal of Lung Tissue Wedge for Diagnosis | surgery | N/A | $131 to $32,507 | Low |
| Review By Radiologist of Chest Aorta Image | other | N/A | $23 to $75,600 | Low |
| Ultrasound of One Arm Arteries OR Artery Grafts | imaging | N/A | $22 to $93,931 | Low |
| Evaluation of Heart Function Using Tilt Table | cardiac | N/A | $87 to $93,660 | Low |
| Removal of Multiple External Noncancer Growths of Anus | surgery | N/A | $156 to $46,230 | Low |
| Ultrasound of Heart, Follow-up | imaging | N/A | $24 to $93,308 | Low |
| Respiratory Syncytial Virus Antibody, 0.5 Ml Dosage for Injection Into Muscle | other | N/A | $173 to $90,380 | Low |
| Respiratory Syncytial Virus Antibody, 1.0 Ml Dosage for Injection Into Muscle | other | N/A | $173 to $90,381 | Low |
| Ultrasound and Monitoring of Heart of Fetus | imaging | N/A | $100 to $76,818 | Low |
| Ultrasound of Heart with Color-depicted Blood Flow, Rate and Valve Function | imaging | N/A | $3 to $93,325 | Low |
| Repair of Lacerated Mouth, 2.5 Cm OR Less | surgery | N/A | $131 to $40,830 | Low |
| Diagnostic Exam of Voice Box Using an Endoscope with Operating Microscope OR ... | other | N/A | $128 to $31,526 | Low |
| Simple Removal of Growth of Anus | surgery | N/A | $126 to $46,922 | Low |
| Electronic Analysis of Pacemaker to Correct Rapid Heart Rate | cardiac | N/A | $176 to $93,724 | Low |
| Removal of Tissue At Dental Edge and Cheek | surgery | N/A | $177 to $40,819 | Low |
| Hospital Inpatient OR Observation Care with Admission and Discharge On the Sa... | other | N/A | $177 to $99,236 | Low |
| Complicated Drainage of External Ear Abscess OR Blood Accumulation | other | N/A | $138 to $69,005 | Low |
| Analysis Test By Nucleic Acid for Hepatitis C Virus | other | N/A | $179 to $87,902 | Low |
| Recording of Upper Heart Chamber Rhythm | cardiac | N/A | $105 to $93,602 | Low |
| Removal OR Destruction of Growth of Throat | surgery | N/A | $140 to $42,808 | Low |
| Partial Release of Large Bowel and Partial Removal of Large Bowel Using an En... | surgery | N/A | $155 to $44,213 | Low |
| Ultrasound of Heart for Congenital Defect, Follow-up | imaging | N/A | $34 to $93,304 | Low |
| Control of Bleeding of Lower Large Bowel Using an Endoscope | other | N/A | $97 to $45,317 | Low |
| Removal of Foreign Bodies in Lower Portion of Large Bowel Using a Flexible En... | surgery | N/A | $91 to $45,332 | Low |
| Destruction of Peripheral Nerve OR Branch | other | N/A | $106 to $64,640 | Low |
| Exposure of Groin Artery for Delivery of Graft | obstetric | N/A | $102 to $34,713 | Low |
| Placement of External Device to Assist Circulation | other | N/A | $81 to $92,971 | Low |
| Removal of Dental Bone Growth with Simple Repair | surgery | N/A | $169 to $41,826 | Low |
| Destruction of Surface Soft Tissue of Nasal Passages | other | N/A | $173 to $30,802 | Low |
| Needle Measurement of Electrical Activity in Arm OR Leg Muscles, 2 Extremities | other | N/A | $78 to $95,861 | Low |
| Bypass of Diseased OR Blocked Artery with Prosthetic and Vein | other | N/A | $67 to $35,681 | Low |
| Detection Test By Nucleic Acid for Hepatitis C Virus, Amplified Probe Technique | other | N/A | $35 to $87,521 | Low |
| Removal of Lung Tissue Wedge Through Chest, Each Additional Removal | surgery | N/A | $131 to $32,506 | Low |
| Insertion of Stent Into Lower Large Bowel Using a Flexible Endoscope | cardiac | N/A | $130 to $45,347 | Low |
| Ultrasound of Abdomen and Pelvis Artery and Vein Blood Flow | imaging | N/A | $36 to $93,976 | Low |
| Medical Testimony | other | N/A | $190 to $99,075 | Low |
| Diagnostic Exam of Voice Box Using an Endoscope | other | N/A | $130 to $31,525 | Low |
| Biopsy of Voice Box Using a Flexible Endoscope | lab | N/A | $98 to $31,576 | Low |
| Nuclear Medicine Study of Thyroid and Thyroid Function | imaging | N/A | $22 to $78,014 | Low |
| Dilation of Narrowing of Rectum Under Anesthesia | other | N/A | $177 to $45,910 | Low |
| Incision of Sphincter of Anus | other | N/A | $141 to $46,080 | Low |
| X-ray of Eye Socket, Minimum of 4 Views | imaging | N/A | $100 to $70,200 | Low |
| CT Scan of Heart Structure with Contrast | imaging | N/A | $78 to $75,572 | Low |
| Removal of Polyp OR Growth of Rectum and Large Bowel Using an Endoscope with ... | surgery | N/A | $80 to $45,309 | Low |
| Fetal Fibronectin (protein) Analysis | other | N/A | $64 to $82,731 | Low |
| Manipulation of Knee Joint Under Anesthesia | other | N/A | $140 to $27,570 | Low |
| Insertion of Temporary Pacemaker Electrode for Diagnostic Lower Heart Pacing | cardiac | N/A | $148 to $93,612 | Low |
| Insertion of Implant to Close Nasal Passage | surgery | N/A | $109 to $30,220 | Low |
| Review By Radiologist of Abdominal Aorta and Both Leg Arteries Image | other | N/A | $87 to $75,630 | Low |
| Nuclear Medicine Study of Stomach to Assess Emptying | imaging | N/A | $35 to $78,264 | Low |
| Destruction of Growth OR Soft Tissue of Roof of Mouth | other | N/A | $122 to $42,160 | Low |
| Biopsy of Wedge of Lung Tissue Followed By Partial Removal of Lung | surgery | N/A | $132 to $32,668 | Low |
| Needle Biopsy of Saliva Gland | lab | N/A | $198 to $42,400 | Low |
| Removal of Growth of Front 2/3 of Tongue with Switches | surgery | N/A | $199 to $41,112 | Low |
| Removal of Indwelling Tube in Lining of Lung | surgery | N/A | $140 to $32,552 | Low |
| Nuclear Medicine Study of Liver and Bile Duct System | imaging | N/A | $33 to $78,226 | Low |
| Complete Ultrasound Study of Arm and Leg Arteries | imaging | N/A | $20 to $93,923 | Low |
| Removal of Impacted Stool OR Foreign Body in Rectum Under Anesthesia | surgery | N/A | $201 to $45,915 | Low |
| Measurement of Brain Wave Activity (eeg), 41-60 Minutes | other | N/A | $56 to $95,812 | Low |
| Aspiration of Bladder with Insertion of Bladder Tube to Skin | other | N/A | $120 to $51,102 | Low |
| Diagnostic Exam of Surgically Created Pouch of Small Bowel Using an Endoscope | surgery | N/A | $64 to $44,385 | Low |
| Removal of Foreign Bodies From Small Bowel Using an Endoscope | surgery | N/A | $162 to $44,363 | Low |
| Injection of Anesthetic Agent And/or Steroid Into Suprascapular Shoulder Nerve | other | N/A | $46 to $64,418 | Low |
| Removal of Wedge of Tissue of Lung Using an Endoscope, Each Additional Removal | surgery | N/A | $132 to $32,667 | Low |
| Imaging Guidance for Localization of Radiation Treatment | other | N/A | $35 to $77,387 | Low |
| Electronic Analysis Reprogramming and Refill of Spinal Canal Drug Infusion Pu... | surgery | N/A | $38 to $62,370 | Low |
| Nuclear Medicine Study of Kidney, Blood, Flow, and Function with Drug Adminis... | imaging | N/A | $53 to $78,708 | Low |
| Detection Test By Nucleic Acid for Multiple Types of Respiratory Virus, Multi... | other | N/A | $207 to $87,633 | Low |
| Insertion of Drain (seton) Into Anus | other | N/A | $104 to $46,020 | Low |
| Ultrasound of One Side of Head and Neck Blood Flow | imaging | N/A | $22 to $93,882 | Low |
| Repair of Nerve Using Nerve Graft, Each Additional Strand | surgery | N/A | $138 to $64,913 | Low |
| Refilling and Maintenance of Implantable Pump OR Reservoir for Drug Delivery | surgery | N/A | $204 to $96,522 | Low |
| Nuclear Medicine Study of Parathyroid | imaging | N/A | $35 to $78,070 | Low |
| Single Contrast X-ray of Small Intestine | imaging | N/A | $168 to $74,250 | Low |
| Injection of Anesthetic Agent And/or Steroid Into Rib Nerve | other | N/A | $50 to $64,420 | Low |
| Initial Repair of Anal Tear with Dilation of Anal Muscle | surgery | N/A | $129 to $46,940 | Low |
| Tying of Single Internal Hemorrhoid Group | other | N/A | $211 to $46,945 | Low |
| Injection of Local Anesthetic for Abdominal Wall Pain Control On Both Sides U... | other | N/A | $55 to $64,488 | Low |
| Injection of Local Anesthetic for Abdominal Wall Pain Control On Side Using I... | other | N/A | $47 to $64,486 | Low |
| Repair of Lacerated Roof of Mouth, 2.0 Cm OR Less | surgery | N/A | $159 to $42,180 | Low |
| Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm OR Dissection, Ra... | surgery | N/A | $212 to $75,952 | Low |
| Nuclear Medicine Study of Lung Circulation | imaging | N/A | $33 to $78,580 | Low |
| Review By Radiologist of Uterine Tube and Ovary Image | other | N/A | $213 to $74,740 | Low |
| Tying of Multiple Internal Hemorrhoid Groups | other | N/A | $214 to $46,946 | Low |
| Insertion of Lower Leg Neurostimulator Electrode | other | N/A | $25 to $64,566 | Low |
| Fluoroscopic Guidance for Spine OR Back Muscle Injection | other | N/A | $98 to $77,003 | Low |
| Nuclear Medicine Study of Bone And/or Joint Whole Body | imaging | N/A | $38 to $78,306 | Low |
| Suture of Internal Abdominal Lining Using an Endoscope | other | N/A | $157 to $49,326 | Low |
| Measurement of Brain Wave Activity (eeg), Awake and Drowsy | other | N/A | $55 to $95,816 | Low |
| X-ray of Lower and Sacral Spine, Minimum of 4 Views | imaging | N/A | $100 to $72,110 | Low |
| Control of Bleeding of Esophagus | other | N/A | $179 to $43,460 | Low |
| Review By Radiologist of Abscess OR Sinus Cavity Study | other | N/A | $217 to $76,080 | Low |
| Work-related OR Medical Disability Examination By Other Than the Treating Phy... | other | N/A | $217 to $99,456 | Low |
| Ultrasound Exam of Esophagus Using a Flexible Endoscope | imaging | N/A | $132 to $43,231 | Low |
| Balloon Dilation of Lower Large Bowel Using a Flexible Endoscope | other | N/A | $69 to $45,340 | Low |
| Biopsy of Saliva Gland | lab | N/A | $191 to $42,405 | Low |
| Delivery of Placenta | obstetric | N/A | $218 to $59,414 | Low |
| Review By Radiologist of Elbow Image | other | N/A | $218 to $73,085 | Low |
| Injection to Cause Blood Clot in Diseased OR Pseudoaneurysm of Arm OR Leg | other | N/A | $219 to $36,002 | Low |
| Primary Removal of Adenoids | surgery | N/A | $201 to $42,831 | Low |
| Control of Bleeding of Lower Large Bowel Using a Flexible Endoscope | other | N/A | $101 to $45,334 | Low |
| Aspiration of Subsequent Secretions of Lung Airway Using an Endoscope During ... | other | N/A | $124 to $31,646 | Low |
| Removal of Embedded Foreign Body in Soft Tissue of Tooth Bearing Bone | surgery | N/A | $180 to $41,805 | Low |
| Closed Treatment of Broken Middle OR Upper End of Outside Lower Leg Bone | other | N/A | $224 to $27,780 | Low |
| Exam to Assess Movement of Vocal Cord Flaps Using an Endoscope | other | N/A | $99 to $31,579 | Low |
| Injection of Agent to Destroy Nerve to Internal Sphincter of Anus | other | N/A | $225 to $46,505 | Low |
| Needle Measurement of Electrical Activity in Arm, Leg, Trunk OR Head Muscles,... | other | N/A | $19 to $95,870 | Low |
| Biopsy of Voice Box Using an Endoscope | lab | N/A | $154 to $31,535 | Low |
| Nuclear Medicine Study of Liver and Bile Duct System with Use of Drugs | imaging | N/A | $40 to $78,227 | Low |
| Nuclear Medicine Study of Bone Taken At Different Times | imaging | N/A | $45 to $78,315 | Low |
| Removal of Tube Into Artery OR Vein with Review By Radiologist | surgery | N/A | $101 to $37,214 | Low |
| CT Scan of Abdomen and Pelvis without Contrast | imaging | N/A | $77 to $74,176 | Low |
| Removal of Growth in Soft Tissue of Ear Canal | surgery | N/A | $223 to $69,145 | Low |
| Secondary Removal of Adenoids | surgery | N/A | $210 to $42,836 | Low |
| Nuclear Medicine Study of Brain and Blood Flow | imaging | N/A | $232 to $78,601 | Low |
| Double Contrast X-ray of Upper Digestive Tract | imaging | N/A | $168 to $74,246 | Low |
| Test for Exercise-induced Heart and Lung Stress | cardiac | N/A | $66 to $94,621 | Low |
| Review By Radiologist of Wrist Joint Image | other | N/A | $233 to $73,115 | Low |
| Recording of Upper Heart Rhythm | cardiac | N/A | $106 to $93,600 | Low |
| Antibody Identification Test, Platelet Antibodies | other | N/A | $18 to $86,022 | Low |
| Removal of Foreign Body in Nose Under Anesthesia | surgery | N/A | $179 to $30,310 | Low |
| Ultrasound of Leg Arteries At Rest and After Exercise | imaging | N/A | $23 to $93,924 | Low |
| Ultrasound of Heart with Probe in Esophagus to Assess Heart Pump Function | imaging | N/A | $98 to $93,318 | Low |
| Administration of Chemotherapy Into Vein, 1 Hour OR Less | other | N/A | $235 to $96,413 | Low |
| Removal of Growth of Floor of Mouth | surgery | N/A | $190 to $41,116 | Low |
| Ultrasound of Heart | imaging | N/A | $42 to $93,307 | Low |
| Heart Rhythm Recording for More Than 7 Days Up to 15 Days By Continuous Rhyth... | cardiac | N/A | $237 to $93,245 | Low |
| Removal of Lymph Nodes of Chest Cavity Using an Endoscope | surgery | N/A | $181 to $32,674 | Low |
| Measurement of Brain Wave Activity (eeg), 61-119 Minutes | other | N/A | $85 to $95,813 | Low |
| Single Contrast X-ray of Large Intestine | imaging | N/A | $168 to $74,270 | Low |
| Repair of Eardrum | surgery | N/A | $236 to $69,610 | Low |
| Review By Radiologist of Urinary Bladder and Urethra Images with Contrast and... | other | N/A | $15 to $74,455 | Low |
| Nuclear Medicine Study of Kidney, Blood Flow, and Function | imaging | N/A | $42 to $78,707 | Low |
| Ultrasound of Heart Blood Flow, Valves and Chambers | imaging | N/A | $17 to $93,320 | Low |
| Ultrasound Guided Compression Repair of Blood Vessel | imaging | N/A | $89 to $76,936 | Low |
| Conversion of Stomach Tube to Tube in Middle Small Bowel Using an Endoscope | other | N/A | $162 to $44,373 | Low |
| Incision of Eardrum with Placement of Eardrum Tube Under General Anesthesia | other | N/A | $137 to $69,436 | Low |
| Ultrasound of Heart for Congenital Defect | imaging | N/A | $59 to $93,303 | Low |
| Review By Radiologist of Abdominal Cavity Lining Image | other | N/A | $246 to $74,190 | Low |
| Biopsy OR Removal of Lymph Nodes | surgery | N/A | $228 to $38,500 | Low |
| Measurement of Brain Wave Activity (eeg), Awake and Asleep | other | N/A | $55 to $95,819 | Low |
| Injection of Anesthetic Agent And/or Steroid Into Other Nerve OR Branch | other | N/A | $37 to $64,450 | Low |
| Radioactive Drug Therapy By Mouth | other | N/A | $79 to $79,005 | Low |
| Removal of Foreign Body in Voice Box Using a Flexible Endoscope | surgery | N/A | $112 to $31,577 | Low |
| Reviving Newborn At Delivery | obstetric | N/A | $120 to $99,465 | Low |
| Injection Procedure for Imaging of Kidney and Ureter Through Already Existing... | other | N/A | $252 to $50,431 | Low |
| Injection of Blood OR Blood Clot Into Spinal Canal | other | N/A | $98 to $62,273 | Low |
| Pr Sigmoidoscopy,ablate Lesn | other | N/A | $256 to $45,339 | Low |
| Injection of Anesthetic Agent And/or Steroid Into Lower Abdomen and Groin Nerve | other | N/A | $48 to $64,425 | Low |
| Test for Detecting Nucleic Acid of Organism Causing Infection of Central Nerv... | other | N/A | $257 to $87,483 | Low |
| Removal of Biliary Drainage Tube Using Imaging Guidance with Review By Radiol... | surgery | N/A | $257 to $47,537 | Low |
| Complex Removal of Tissue and Muscle Growth of Mouth | surgery | N/A | $257 to $40,816 | Low |
| Special Radiation Treatment | other | N/A | $103 to $77,470 | Low |
| Repair of Lung Airway and Removal of Segment of Lung | surgery | N/A | $205 to $32,501 | Low |
| Ultrasound of Heart with Probe in Esophagus During Surgery On Heart OR Great ... | imaging | N/A | $186 to $93,355 | Low |
| Induction of Abnormal Heart Rhythm By Electrical Pacing | cardiac | N/A | $199 to $93,618 | Low |
| CT Scan of Leg without Contrast | imaging | N/A | $45 to $73,700 | Low |
| Complete Ultrasound of Aorta, Vena Cava, Groin Vessels OR Bypass Grafts | imaging | N/A | $36 to $93,978 | Low |
| Nuclear Medicine Study of Lung Ventilation and Blood Flow to Lung | imaging | N/A | $261 to $78,597 | Low |
| Hernia Repair | surgery | N/A | $171 to $49,623 | High |
| Single Contrast X-ray of Upper Digestive Tract | imaging | N/A | $168 to $74,240 | Low |
| Removal of Foreign Body in Voice Box Using an Endoscope | surgery | N/A | $164 to $31,530 | Low |
| Nuclear Medicine Study of Heart Muscle At Rest and with Stress and SPECT | imaging | N/A | $61 to $78,451 | Low |
| Injection Beneath Lining of Lower Large Bowel Using a Flexible Endoscope | other | N/A | $59 to $45,335 | Low |
| Removal of Growth of Back 1/3 of Tongue with Suturing | surgery | N/A | $231 to $41,113 | Low |
| Removal of Tonsils | surgery | N/A | $219 to $42,826 | Low |
| Repair of Tissue Connecting Tongue to Floor of Mouth | surgery | N/A | $217 to $41,520 | Low |
| Review By Radiologist of Additional Artery Image | other | N/A | $43 to $75,774 | Low |
| Exclusion of Appendage of Left Upper Chamber of Heart Performed During Other ... | cardiac | N/A | $109 to $33,268 | Low |
| Biopsy of Anal And/or Rectal Wall Through Anus | lab | N/A | $268 to $45,100 | Low |
| Placement and Subsequent Removal of Device to Protect Brain From Embolism Thr... | surgery | N/A | $108 to $33,370 | Low |
| Control of Bleeding of Large Bowel Using an Endoscope Inserted Through Surgic... | other | N/A | $271 to $44,391 | Low |
| Removal of Growths OR Polyps of Large Bowel By Electrical Cautery Using an En... | surgery | N/A | $271 to $44,392 | Low |
| Removal of Blood Clot and Portion of Neck Artery Following Previous Surgery | surgery | N/A | $133 to $35,390 | Low |
| Gene Analysis (tumor Protein 53) Targeted Sequence Analysis | other | N/A | $272 to $81,352 | Low |
| Double Contrast X-ray of Small Intestine | imaging | N/A | $168 to $74,251 | Low |
| Injection of Anesthetic Agent And/or Steroid Into Arm Nerve Bundle | other | N/A | $275 to $64,415 | Low |
| Injection of Anesthetic Agent And/or Steroid Into Upper Arm and Shoulder Nerve | other | N/A | $275 to $64,417 | Low |
| Review By Radiologist of Knee Joint Image | other | N/A | $276 to $73,580 | Low |
| CT Scan of Abdomen without Contrast | imaging | N/A | $53 to $74,150 | Low |
| Injection of Dilated Vein of Stomach And/or Esophagus Using a Flexible Endoscope | other | N/A | $199 to $43,243 | Low |
| Insertion of Tube Into Vein, Second Order Branch | other | N/A | $145 to $36,012 | Low |
| Injection of Anesthetic Agent Into Abdominal Sympathetic Nerve Bundle | other | N/A | $280 to $64,530 | Low |
| Ultrasound of Arm Arteries OR Artery Grafts | imaging | N/A | $36 to $93,930 | Low |
| Ultrasound of Heart During Rest, Exercise And/or Drug-induced Stress with Report | imaging | N/A | $66 to $93,350 | Low |
| Removal of Small Bowel Polyps OR Growths Using an Endoscope with Mechanical S... | surgery | N/A | $172 to $44,364 | Low |
| Initial Instillation of Agent Onto Lung Lining Using Chest Tube | other | N/A | $58 to $32,561 | Low |
| Incision and Drainage of Abscess Within Wall of Rectum Under Anesthesia | other | N/A | $285 to $46,045 | Low |
| Review By Radiologist of Upper Urinary Tract Image | other | N/A | $285 to $74,425 | Low |
| CT Scan Head OR Brain without Contrast | imaging | N/A | $38 to $70,450 | Low |
| Diagnostic Exam of Large Bowel Using a Flexible Endoscope | other | N/A | $157 to $45,378 | Low |
| Review By Radiologist of Image for Replacement of Stomach OR Large Bowel Tube | surgery | N/A | $89 to $75,984 | Low |
| Insertion of Temporary Pacemaker Electrode for Diagnostic Upper Heart Pacing | cardiac | N/A | $147 to $93,610 | Low |
| Review By Radiologist of Shoulder Joint Image | other | N/A | $291 to $73,040 | Low |
| Balloon Dilation of Vein with Review By Radiologist, Each Additional Vein | other | N/A | $121 to $37,249 | Low |
| Ultrasound Scan of Uterus and Uterine Cavity | imaging | N/A | $229 to $76,831 | Low |
| CT Scan of Face without Contrast | imaging | N/A | $38 to $70,486 | Low |
| 3d Radiographic Procedure with Computerized Image Postprocessing | imaging | N/A | $75 to $76,377 | Low |
| CT Scan of Soft Tissue of Neck without Contrast | imaging | N/A | $57 to $70,490 | Low |
| Drainage of Abscess, Cyst, OR Blood Accumulation Under Jaw Bone From Inside M... | other | N/A | $231 to $41,008 | Low |
| Needle Biopsy of Prostate Gland Using Image Guidance | lab | N/A | $194 to $55,706 | Low |
| CT Scan of Pelvis without Contrast | imaging | N/A | $48 to $72,192 | Low |
| Removal of Chronic Tear of Anus | surgery | N/A | $300 to $46,200 | Low |
| Nuclear Medicine Study of Bone Marrow Limited Area | imaging | N/A | $301 to $78,102 | Low |
| Review By Radiologist of Hip Joint Image | other | N/A | $301 to $73,525 | Low |
| Removal of Tonsils and Adenoid Glands | surgery | N/A | $258 to $42,821 | Low |
| Double Contrast X-ray of Large Intestine | imaging | N/A | $168 to $74,280 | Low |
| Removal of Polyps OR Growths of Lower Large Bowel Using a Flexible Endoscope ... | surgery | N/A | $104 to $45,338 | Low |
| Complicated Removal of Embedded Foreign Body in Mouth | surgery | N/A | $175 to $40,805 | Low |
| Removal of Multiple External Hemorrhoids | surgery | N/A | $298 to $46,250 | Low |
| Nuclear Medicine Study of Heart Pumping Function By Labeling Red Blood Cells ... | imaging | N/A | $44 to $78,472 | Low |
| CT Scan of Cranial Cavity without Contrast | imaging | N/A | $57 to $70,480 | Low |
| Other MRI Scan | imaging | N/A | $83 to $76,498 | Low |
| CT Scan of Chest without Contrast | imaging | N/A | $48 to $71,250 | Low |
| Repair Umbilical Hernia, Younger Than Age 5 Years; Reducible | surgery | N/A | $307 to $49,580 | Low |
| Contrast Injection for Imaging to Evaluate Central Venous Access Device | other | N/A | $204 to $36,598 | Low |
| Biopsy of Small Bowel Pouch Using an Endoscope | lab | N/A | $77 to $44,386 | Low |
| Dilation of Esophagus | other | N/A | $309 to $43,450 | Low |
| Exam of Kidney Using an Endoscope Inserted Through Surgically Created Opening... | surgery | N/A | $247 to $50,551 | Low |
| Ultrasound of Both Sides of Head and Neck Blood Flow | imaging | N/A | $36 to $93,880 | Low |
| Partial Removal and Reconnection of Small Bowel, Each Additional Removal and ... | surgery | N/A | $201 to $44,121 | Low |
| Removal of Growth of Roof of Mouth with Simple Closure | surgery | N/A | $142 to $42,106 | Low |
| Replacement of Stomach OR Large Bowel Tube Using Fluoroscopic Guidance with C... | surgery | N/A | $313 to $49,450 | Low |
| Bone And/or Joint Imaging; Tomographic | other | N/A | $315 to $78,320 | Low |
| Drainage of Abscess of Throat From Inside Mouth | other | N/A | $316 to $42,720 | Low |
| Ultrasound Exam of Large Bowel Using a Flexible Endoscope | imaging | N/A | $216 to $45,391 | Low |
| Stapling of Internal Hemorrhoid | other | N/A | $317 to $46,947 | Low |
| Removal of Lymph Nodes of Chest Cavity and Breast Bone | surgery | N/A | $181 to $38,746 | Low |
| Injection of Anesthetic Agent And/or Steroid Into Multiple Rib Nerves for Reg... | other | N/A | $21 to $64,421 | Low |
| Injection for Nonselective Imaging of Pulmonary Artery During Heart Catheteri... | cardiac | N/A | $38 to $93,568 | Low |
| Insertion of Feeding Tube OR Tube Into Upper Small Bowel | other | N/A | $118 to $44,015 | Low |
| Ultrasound of Leg Arteries OR Artery Grafts | imaging | N/A | $35 to $93,925 | Low |
| Ultrasound Scan of Pregnant Uterus with Detailed Fetal Anatomic Examination, ... | imaging | N/A | $229 to $76,811 | Low |
| Mediastinoscopy Incl Biopsy | lab | N/A | $325 to $39,400 | Low |
| Repair Epigastric Hernia | surgery | N/A | $325 to $49,570 | Low |
| Control of Bleeding of Throat Requiring Hospitalization | other | N/A | $326 to $42,961 | Low |
| Monitoring and Recording of Esophageal Function Through a Capsule Attached to... | other | N/A | $328 to $91,035 | Low |
| CT Scan of Abdomen with Contrast | imaging | N/A | $57 to $74,160 | Low |
| Complicated Drainage of Abscess, Cyst, OR Blood Accumulation of Mouth | other | N/A | $179 to $40,801 | Low |
| Diagnostic Exam of Small Bowel (including Lower Small Intestine) Using an End... | other | N/A | $238 to $44,376 | Low |
| Dilation of Esophagus with a Guide Wire | other | N/A | $74 to $43,453 | Low |
| CT Scan of Abdomen and Pelvis with Contrast | imaging | N/A | $81 to $74,177 | Low |
| Insertion of Tube Into Ureter Using an Endoscope Inserted Through Surgically ... | surgery | N/A | $264 to $50,553 | Low |
| Review By Radiologist of Breast Duct Image, 1 Duct | other | N/A | $229 to $77,053 | Low |
| CT Scan Head OR Brain with Contrast | imaging | N/A | $50 to $70,460 | Low |
| Control of Bleeding in Esophagus Using a Flexible Endoscope | other | N/A | $140 to $43,227 | Low |
| Second Stage Repair of Abnormal Anal Drainage Tract | surgery | N/A | $336 to $46,285 | Low |
| Complicated Removal of Saliva Gland Stone From Inside Mouth | surgery | N/A | $226 to $42,335 | Low |
| Nuclear Medicine Study to Assess Blood Loss | imaging | N/A | $337 to $78,278 | Low |
| CT Scan of Lower Spine without Contrast | imaging | N/A | $45 to $72,131 | Low |
| CT Scan of Face with Contrast | imaging | N/A | $50 to $70,487 | Low |
| Nuclear Medicine Study of Lung Ventilation and Circulation | imaging | N/A | $47 to $78,582 | Low |
| CT Scan of Middle Spine without Contrast | imaging | N/A | $45 to $72,128 | Low |
| Decompression of Twisted OR Abnormally Dilated Large Bowel Using a Flexible E... | other | N/A | $209 to $45,393 | Low |
| CT Scan of Upper Spine without Contrast | imaging | N/A | $45 to $72,125 | Low |
| CT Scan of Cranial Cavity with Contrast | imaging | N/A | $50 to $70,481 | Low |
| Extensive Destruction of Growth of Anus | other | N/A | $162 to $46,924 | Low |
| CT Scan of Chest with Contrast | imaging | N/A | $52 to $71,260 | Low |
| Removal of Single External and Internal Hemorrhoid Group and Chronic Tear in ... | surgery | N/A | $344 to $46,257 | Low |
| Needle Measurement of Electrical Activity in Arm OR Leg Muscles, 4 Extremities | other | N/A | $101 to $95,864 | Low |
| Exam with Injections of Chemical for Destruction of Bladder Using an Endoscope | other | N/A | $142 to $52,287 | Low |
| Repair of Abnormal Anal Drainage Tract | surgery | N/A | $346 to $46,270 | Low |
| Nuclear Medicine Study of Liver | imaging | N/A | $347 to $78,201 | Low |
| Removal of Growth of Dental Bone Growth with Complex Repair | surgery | N/A | $250 to $41,827 | Low |
| Removal of Congenital Skin and Tissue Cyst of Neck | surgery | N/A | $243 to $42,810 | Low |
| Follow-up Inpatient Hospital Critical Care of Newborn Per Day | obstetric | N/A | $327 to $99,469 | Low |
| CT Scan of Pelvis with Contrast | imaging | N/A | $52 to $72,193 | Low |
| Monitoring and Recording of Esophageal Function Through Nasal Tube | other | N/A | $351 to $91,034 | Low |
| Incision of Bladder with Drainage | other | N/A | $259 to $51,040 | Low |
| Repair of Lacerated Roof of Mouth, More Than 2.0 Cm | surgery | N/A | $216 to $42,182 | Low |
| Removal of Soft Tissue of Roof of Mouth | surgery | N/A | $143 to $42,140 | Low |
| Interpretation and Report of Ultrasound of Heart | imaging | N/A | $85 to $93,314 | Low |
| Ultrasound Study of Arm OR Leg Veins with Compression and Maneuvers | imaging | N/A | $31 to $93,970 | Low |
| Implantation of Nerve End Into Bone OR Muscle | surgery | N/A | $192 to $64,787 | Low |
| Radioactive Drug Therapy Through a Vein | other | N/A | $224 to $79,101 | Low |
| Removal of Abdominal Cavity Tube | surgery | N/A | $188 to $49,422 | Low |
| Fine Needle Aspiration And/or Biopsy of Large Bowel with Ultrasound Guidance ... | imaging | N/A | $254 to $45,392 | Low |
| Removal of Single External and Internal Hemorrhoid Group | surgery | N/A | $329 to $46,255 | Low |
| Simple Repair of Salivary Duct | surgery | N/A | $296 to $42,500 | Low |
| Destruction of First Division of Face Nerve Branch | other | N/A | $210 to $64,600 | Low |
| Biopsy of Small Bowel Using an Endoscope | lab | N/A | $249 to $44,377 | Low |
| Removal of Plaque with Balloon Dilation of Coronary Artery OR Branch, Each Ad... | surgery | N/A | $365 to $92,925 | Low |
| Study of Stomach to Assess Movement | other | N/A | $358 to $91,020 | Low |
| Removal OR Destruction of Growth of Tongue Lymph Node | surgery | N/A | $366 to $42,870 | Low |
| Banding of Hemorrhoids Using a Flexible Endoscope | other | N/A | $367 to $45,350 | Low |
| Destruction of Polyp OR Growth of Large Bowel Using a Flexible Endoscope | other | N/A | $367 to $45,388 | Low |
| Destruction And/or Removal of Growth of Kidney Using an Endoscope Inserted Th... | surgery | N/A | $290 to $50,557 | Low |
| Insertion of Tube Into Middle Small Bowel Using an Endoscope | other | N/A | $202 to $44,372 | Low |
| Injection Beneath Lining of Large Bowel Using a Flexible Endoscope | other | N/A | $169 to $45,381 | Low |
| Repair of Abnormal Anal Drainage Tract with Implanted Plug | surgery | N/A | $372 to $46,707 | Low |
| Insertion of Stent in Large Bowel Using a Flexible Endoscope | cardiac | N/A | $242 to $45,389 | Low |
| Removal OR Revision of a Peripheral, Sacral, OR Gastric Neurostimulator Pulse... | surgery | N/A | $199 to $64,595 | Low |
| Removal of Plaque, Insertion of Stent and Balloon Dilation of Coronary Artery... | surgery | N/A | $375 to $92,934 | Low |
| Removal of Foreign Body OR Stone in Kidney OR Ureter Using an Endoscope Inser... | surgery | N/A | $266 to $50,961 | Low |
| Replacement of Small Bowel Tube Using Fluoroscopic Guidance with Contrast | surgery | N/A | $378 to $49,451 | Low |
| Incision and Drainage of Abscess Above Pelvic Floor OR Behind Rectum | other | N/A | $378 to $45,020 | Low |
| Injection of Substance Into Lower Spine Canal Using Imaging Guidance | other | N/A | $380 to $62,323 | Low |
| Imaging of Urinary Tract with Injection of Contrast Into a Vein | other | N/A | $168 to $74,400 | Low |
| Nuclear Medicine Study of Intestine | imaging | N/A | $383 to $78,290 | Low |
| Removal of Cerebrospinal Fluid with Lower Back Spinal Tap for Diagnostic Test | surgery | N/A | $387 to $62,270 | Low |
| Partial Removal of External Ear with Simple Repair | surgery | N/A | $283 to $69,110 | Low |
| Computer-assisted Procedure Outside Membrane Covering Brain | other | N/A | $137 to $61,782 | Low |
| Biopsy of Large Bowel Using a Flexible Endoscope | lab | N/A | $169 to $45,380 | Low |
| CT Scan of Lower Spine with Contrast | imaging | N/A | $54 to $72,132 | Low |
| Complex Application of Radiation Source | other | N/A | $400 to $77,778 | Low |
| Review By Radiologist of MRI Guidance for Needle Placement | imaging | N/A | $401 to $77,021 | Low |
| Repair Umbilical Hernia, Age 5 Years OR Older; Incarcerated OR Strangulated | surgery | N/A | $404 to $49,587 | Low |
| CT Scan of Abdomen Before and After Contrast | imaging | N/A | $62 to $74,170 | Low |
| Nuclear Medicine Study, Multiple Areas | imaging | N/A | $383 to $78,801 | Low |
| CT Scan of Middle Spine with Contrast | imaging | N/A | $54 to $72,129 | Low |
| Repair Epigastric Hernia (eg, Preperitoneal Fat); Incarcerated OR Strangulated | surgery | N/A | $409 to $49,572 | Low |
| CT Scan of Upper Spine with Contrast | imaging | N/A | $54 to $72,126 | Low |
| Complete Ultrasound of Abdomen and Pelvis Artery and Vein Blood Flow | imaging | N/A | $51 to $93,975 | Low |
| CT Scan of Face Before and After Contrast | imaging | N/A | $57 to $70,488 | Low |
| Insertion of Catheters for Recording and Pacing of Right Heart Chambers Rhythm | cardiac | N/A | $353 to $93,619 | Low |
| CT Scan of Soft Tissue of Neck Before and After Contrast | imaging | N/A | $72 to $70,492 | Low |
| Diagnostic Exam of Abdomen Using an Endoscope | other | N/A | $294 to $49,320 | Low |
| CT Scan of Cranial Cavity Before and After Contrast | imaging | N/A | $56 to $70,482 | Low |
| Complex Measurement of Pressure of Urine Flow in Bladder with Voiding Pressur... | other | N/A | $100 to $51,728 | Low |
| CT Scan of Head OR Brain Before and After Contrast | imaging | N/A | $57 to $70,470 | Low |
| Insertion OR Replacement of Peripheral, Sacral, OR Gastric Neurostimulator Ge... | surgery | N/A | $253 to $64,590 | Low |
| Repair Spigelian Hernia | surgery | N/A | $428 to $49,590 | Low |
| Review By Radiologist of Image for Drainage of Fluid | other | N/A | $107 to $75,989 | Low |
| CT Scan of Pelvis Before and After Contrast | imaging | N/A | $54 to $72,194 | Low |
| Delivery of Single Session of Intraoperative Radiation Treatment with X-ray | imaging | N/A | $428 to $77,424 | Low |
| Removal of Navel and Surrounding Tissue | surgery | N/A | $432 to $49,250 | Low |
| Revision of Prosthetic Vaginal Graft | other | N/A | $423 to $57,295 | Low |
| CT Scan of Chest Before and After Contrast | imaging | N/A | $56 to $71,270 | Low |
| CT Scan of Abdomen and Pelvis Before and After Contrast | imaging | N/A | $90 to $74,178 | Low |
| CT Scan of Soft Tissue of Neck with Contrast | imaging | N/A | $62 to $70,491 | Low |
| Revision of Peripheral Neurostimulator Electrodes | other | N/A | $129 to $64,585 | Low |
| CT Scan of Blood Vessels and Grafts of Heart with Contrast | imaging | N/A | $107 to $75,574 | Low |
| Programming of Heart Rhythm Stimulation After Drug Infusion | surgery | N/A | $49 to $93,623 | Low |
| Injection for Imaging of Right Heart Chambers with Review By Radiologist | cardiac | N/A | $21 to $93,566 | Low |
| Ultrasound of Heart with Color-depicted Blood Flow, Rate, Direction and Valve... | imaging | N/A | $66 to $93,306 | Low |
| Release And/or Relocation of Hand Nerve | other | N/A | $396 to $64,721 | Low |
| Repair of Brow Paralysis | surgery | N/A | $413 to $67,900 | Low |
| CT Scan of Blood Vessels of Chest with Contrast | imaging | N/A | $81 to $71,275 | Low |
| Initial Intensive Care of Newborn Per Day | obstetric | N/A | $287 to $99,477 | Low |
| Removal of Growth of Finger OR Toe Nerve, Same Digit | surgery | N/A | $353 to $64,776 | Low |
| Therapy Using Electrical Currents | other | N/A | $471 to $90,870 | Low |
| CT Scan of Blood Vessels of Lower Leg with Contrast | imaging | N/A | $84 to $73,706 | Low |
| Nuclear Medicine Study of Parathyroid with SPECT and CT Scan | imaging | N/A | $492 to $78,072 | Low |
| CT Scan of Blood Vessels of Abdomen with Contrast | imaging | N/A | $80 to $74,175 | Low |
| Internal Shock to Heart to Regulate Heart Beat | cardiac | N/A | $201 to $92,961 | Low |
| CT Guidance for Tissue Removal | surgery | N/A | $508 to $77,013 | Low |
| External Shock to Heart to Regulate Heart Beat | cardiac | N/A | $510 to $92,960 | Low |
| Removal of Plaque, Insertion of Stent And/or Balloon Dilation of Coronary Ves... | surgery | N/A | $516 to $92,938 | Low |
| Evaluation of Single OR Dual Chamber Pacing Cardioverter-defibrillator At Tim... | other | N/A | $162 to $93,640 | Low |
| Incision of Ear Canal with Release of Scar Tissue | other | N/A | $468 to $69,450 | Low |
| Ultrasound Evaluation of Heart Blood Vessel During Diagnosis OR Treatment, Ea... | imaging | N/A | $539 to $93,572 | Low |
| Insertion of Tube in Left Heart Chamber Through Heart Septum | cardiac | N/A | $165 to $93,462 | Low |
| CT Scan of Blood Vessels of Pelvis with Contrast | imaging | N/A | $80 to $72,191 | Low |
| Nuclear Medicine Study of Cerebrospinal Fluid Flow After Injection of Contras... | imaging | N/A | $521 to $78,630 | Low |
| Programming of Pacing Cardioverter-defibrillator | other | N/A | $231 to $93,642 | Low |
| Release And/or Relocation of Wrist Nerve | other | N/A | $363 to $64,719 | Low |
| Management of Complete Single Session Course of Stereotactic Radiation Treatm... | other | N/A | $407 to $77,432 | Low |
| CT Scan of Blood Vessels of Neck with Contrast | imaging | N/A | $78 to $70,498 | Low |
| CT Scan of Blood Vessels of Head with Contrast | imaging | N/A | $78 to $70,496 | Low |
| Removal of Plaque, Insertion of Stent And/or Balloon Dilation, Each Additiona... | surgery | N/A | $566 to $92,944 | Low |
| Review By Radiologist of CT Guidance for Needle Placement | other | N/A | $117 to $77,012 | Low |
| MRI Scan of 1 Breast without Contrast | imaging | N/A | $229 to $77,046 | Low |
| Nuclear Medicine Study, SPECT Imaging, 1 Area OR Single Acquisition, Single D... | imaging | N/A | $48 to $78,803 | Low |
| Pneumococcal Conjugate Vaccine, 20 Valent (pcv20), for Intramuscular Use | preventive | N/A | $583 to $90,677 | Low |
| CT Scan of Blood Vessels of Abdomen and Pelvis with Contrast | imaging | N/A | $98 to $74,174 | Low |
| Removal of Blood Clot in Heart Artery | surgery | N/A | $76 to $92,973 | Low |
| Removal of Heart Artery Blood Clot By Dissolving Using Imaging Guidance | surgery | N/A | $634 to $92,975 | Low |
| Review By Radiologist of Image for Biopsy of Blood Vessel with Tube | lab | N/A | $640 to $75,970 | Low |
| Insertion of Tube in Pulmonary Artery for Monitoring | other | N/A | $79 to $93,503 | Low |
| Nuclear Medicine Study Limited Area with CT Scan | imaging | N/A | $661 to $78,814 | Low |
| Evaluation of Single OR Dual Chamber Pacing Cardioverter-defibrillator and Ge... | other | N/A | $282 to $93,641 | Low |
| Rabies Vaccine for Injection Into Muscle | preventive | N/A | $314 to $90,675 | Low |
| Imaging of Digestive Tract Done From the Inside of the Digestive Tract | other | N/A | $114 to $91,110 | Low |
| Initial Inpatient Hospital Critical Care of Newborn Per Day | obstetric | N/A | $757 to $99,468 | Low |
| Extreme Immaturity OR Respiratory Distress Syndrome, Neonate | other | N/A | $1,179 to $218,115 | Low |
| Abscess Drainage (I&D) | emergency | N/A | $95 to $1,917 | High |
| Acetaminophen 120 Mg Re Supp | other | N/A | $2 to $2 | Low |
| Acetylcysteine, Inhalation Solution, Fda-approved Final Product, Non-compound... | other | N/A | $1 to $1 | Low |
| Albuterol, Inhalation Solution, Fda-approved Final Product, Non-compounded, A... | other | N/A | $1 to $1 | Low |
| Allegra-d 24 Hour Tablet | other | N/A | $1 to $2 | Low |
| Allergy Testing Panel | diagnostic | N/A | $1 to $64 | High |
| Amphetamine-dextroamphet ER 15 Mg Po Cp24 | other | N/A | $1 to $1 | Low |
| Amphetamine-dextroamphetamine 10 Mg Po Tabs | other | N/A | $1 to $1 | Low |
| Amphetamine-dextroamphetamine 15 Mg Po Tabs | other | N/A | $1 to $1 | Low |
| Anesthesia for Removal of Blood Clot From Upper Arm OR Elbow Artery | surgery | N/A | $8 to $8 | Low |
| Ankle X-Ray | imaging | N/A | $8 to $242 | High |
| Annual Wellness Visit (Established) | preventive | N/A | $70 to $562 | High |
| Annual Wellness Visit (New) | preventive | N/A | $84 to $690 | High |
| Aspirin 300 Mg Suppository | other | N/A | $1 to $1 | Low |
| Asthma Management | other | N/A | $10 to $376 | High |
| Atazanavir Sulfate 200 Mg Cap | other | N/A | $1 to $1 | Low |
| Bacitracin 500 Unit/gm Ointmnt | other | N/A | $1 to $2 | Low |
| Banatrol Plus Powder Packet | other | N/A | $1 to $1 | Low |
| Basic Metabolic Panel (BMP) | lab | N/A | $8 to $110 | High |
| Blood Draw (Venipuncture) | lab | N/A | $9 to $35 | High |
| Bromocriptine 2.5 Mg Tablet | other | N/A | $1 to $1 | Low |
| Bronchoscopy | diagnostic | N/A | $473 to $1,897 | High |
| Bunionectomy | other | N/A | $438 to $5,712 | High |
| Bupropion Hcl 100 Mg Tablet | other | N/A | $1 to $1 | Low |
| Butalb-acetamin-caff 50-325 | other | N/A | $1 to $1 | Low |
| Butalbital-apap-caffeine 50-325-40 Mg Po Tabs | other | N/A | $1 to $1 | Low |
| Captopril 25 Mg Tablet | other | N/A | $1 to $1 | Low |
| Carbamazepine ER 100 Mg Cap | other | N/A | $1 to $1 | Low |
| Cardiac Ablation | other | N/A | $500 to $272,166 | High |
| Carotid Ultrasound | imaging | N/A | $36 to $2,342 | High |
| Celecoxib 200 Mg Capsule | other | N/A | $1 to $1 | Low |
| Celecoxib 200 Mg Po Caps | other | N/A | $1 to $1 | Low |
| Cell Examination of Body Fluid, Smears | other | N/A | $26 to $88,104 | Low |
| Central Line Insertion | other | N/A | $4 to $3,629 | High |
| Chest X-Ray | imaging | N/A | $83 to $452 | High |
| Chlorhexidine 0.12% 15 Ml Cup | other | N/A | $1 to $1 | Low |
| Chlorhexidine 0.12% Soln - 15 Ml - Repackaging | other | N/A | $1 to $1 | Low |
| Cholesterol Management | cardiac | N/A | $7 to $127 | High |
| Cimetidine 800 Mg Tablet | other | N/A | $1 to $1 | Low |
| Circumcision | surgery | N/A | $126 to $6,973 | High |
| Colonoscopy with Polypectomy | other | N/A | $169 to $3,490 | High |
| Complete Blood Count (CBC) | lab | N/A | $6 to $80 | High |
| Critical Care | emergency | N/A | $96 to $2,628 | High |
| CT Abdomen and Pelvis | imaging | N/A | $81 to $3,318 | High |
| CT Chest | imaging | N/A | $56 to $3,464 | High |
| CT Spine | imaging | N/A | $45 to $3,002 | High |
| Cystoscopy | diagnostic | N/A | $114 to $4,174 | High |
| Dexmethylphenidate Hcl 10 Mg Po Tabs | other | N/A | $1 to $1 | Low |
| Dextroamp-amphet ER 15 Mg Cap | other | N/A | $1 to $1 | Low |
| Dextroamphetamine 10 Mg Tab | other | N/A | $1 to $2 | Low |
| Diabetes Management | other | N/A | $69 to $524 | High |
| Diflunisal 500 Mg Po Tabs | other | N/A | $2 to $2 | Low |
| Dipyridamole 50 Mg Tablet | other | N/A | $1 to $1 | Low |
| Divalproex Sod ER 250 Mg Tab | other | N/A | $1 to $1 | Low |
| Emergency Room Visit | emergency | N/A | $1 to $3,112 | High |
| Endometrial Ablation | other | N/A | $192 to $3,332 | High |
| Endoscopy | preventive | N/A | $118 to $2,572 | High |
| Enema | other | N/A | $1 to $1 | Low |
| Epidural Steroid Injection | other | N/A | $380 to $2,024 | High |
| Exam of Chest Using an Endoscope | other | N/A | $39,401 to $39,401 | Low |
| Eye Drops 0.05% | other | N/A | $1 to $1 | Low |
| Fesoterodine ER 4 Mg Tablet | other | N/A | $1 to $1 | Low |
| Finasteride 5 Mg Po Tabs | other | N/A | $1 to $1 | Low |
| Finasteride 5 Mg Tablet | other | N/A | $1 to $1 | Low |
| First Aid Antiseptic 10% Oint | other | N/A | $1 to $1 | Low |
| Fluconazole 100 Mg Tablet | other | N/A | $1 to $1 | Low |
| Fluconazole 200 Mg Po Tabs | other | N/A | $1 to $1 | Low |
| Fluconazole 200 Mg Tablet | other | N/A | $1 to $1 | Low |
| Foot X-Ray | imaging | N/A | $7 to $501 | High |
| Glipizide ER 2.5 Mg Tablet | other | N/A | $1 to $1 | Low |
| Guaifenesin 200 Mg/10 Ml Cup | other | N/A | $1 to $2 | Low |
| Hand/Wrist X-Ray | imaging | N/A | $8 to $320 | High |
| Hernia Repair (Umbilical) | surgery | N/A | $404 to $3,036 | High |
| Hip/Pelvis X-Ray | imaging | N/A | $100 to $497 | High |
| Hospital Admission | other | N/A | $60 to $998 | High |
| Hospital Discharge | other | N/A | $38 to $572 | High |
| Hospital Follow-up Care | other | N/A | $36 to $514 | High |
| Hospital Observation | other | N/A | $37 to $1,334 | High |
| Hypertension Management | cardiac | N/A | $48 to $370 | High |
| Hysteroscopy | other | N/A | $193 to $1,037 | High |
| Incision and Drainage of Abscess of External Female Genitals | other | N/A | $56,405 to $56,405 | Low |
| Injection, Cefazolin Sodium, 500 Mg | other | N/A | $1 to $1 | Low |
| Injection, Dexamethasone Sodium Phosphate, 1 Mg | imaging | N/A | $1 to $1 | Low |
| Injection, Mepivacaine Hydrochloride, Per 10 Ml | other | N/A | $88 to $88 | Low |
| Injection, Meropenem, 100 Mg | other | N/A | $2 to $2 | Low |
| Intermediate Joint Injection | surgery | N/A | $31 to $468 | High |
| Isosorbide Dinitrate 5 Mg Po Tabs | other | N/A | $1 to $1 | Low |
| Isosorbide Dinitrate 5 Mg Tab | other | N/A | $1 to $1 | Low |
| IV Drug Infusion | therapy | N/A | $19 to $364 | High |
| IV Hydration | therapy | N/A | $8 to $182 | High |
| Knee Arthroscopy | other | N/A | $549 to $7,208 | High |
| Laceration Repair | emergency | N/A | $13 to $608 | High |
| Lactulose 10 Gm/15ml Po Soln | other | N/A | $1 to $1 | Low |
| Lactulose 20 Gm/30 Ml Soln Cup | other | N/A | $1 to $1 | Low |
| Lamotrigine ER 50 Mg Po Tb24 | other | N/A | $1 to $1 | Low |
| Lamotrigine ER 50 Mg Tablet | other | N/A | $1 to $1 | Low |
| Laryngoscopy | other | N/A | $96 to $2,641 | High |
| Lidocaine Topical 2% 15 Ml Viscous Soln Ud - Repackaging | other | N/A | $1 to $2 | Low |
| Liver Function Panel | lab | N/A | $8 to $114 | High |
| Loperamide 2 Mg Capsule | other | N/A | $1 to $1 | Low |
| Loperamide Hcl 2 Mg Po Caps | other | N/A | $1 to $1 | Low |
| Lubiprostone 24 Mcg Capsule | other | N/A | $1 to $2 | Low |
| Lubiprostone 24 Mcg Po Caps | other | N/A | $1 to $2 | Low |
| Lubiprostone 8 Mcg Capsule | other | N/A | $1 to $1 | Low |
| Lumbar Puncture (Spinal Tap) | other | N/A | $55 to $1,772 | High |
| Lumbar Spine X-Ray | imaging | N/A | $100 to $842 | High |
| Lumpectomy (Breast) | surgery | N/A | $6 to $6,438 | High |
| Mag-al Plus Xs Susp 30 Ml Cup | other | N/A | $1 to $1 | Low |
| Mct Oil | other | N/A | $1 to $1 | Low |
| Mesalamine Dr 1.2 Gm Tablet | other | N/A | $1 to $1 | Low |
| Methylphenidate Hcl 20 Mg Po Tabs | other | N/A | $1 to $1 | Low |
| Methylprednisolone Oral, Per 4 Mg | other | N/A | $1 to $1 | Low |
| Metoclopramide Hcl 10 Mg Po Tabs #2 Dispense Pack | other | N/A | $1 to $1 | Low |
| Metoprolol Succ ER 50 Mg Tab | other | N/A | $1 to $1 | Low |
| Metoprolol Succinate ER 50 Mg Po Tb24 | other | N/A | $1 to $1 | Low |
| Mineral Oil 30 Ml Cup | other | N/A | $1 to $1 | Low |
| Mineral Oil 30 Ml Ud - Repackaging | other | N/A | $1 to $1 | Low |
| Moderate Sedation | other | N/A | $5 to $310 | High |
| Mole Removal | other | N/A | $72 to $1,300 | High |
| Morphine Sulfate Ir 30 Mg Tab | other | N/A | $1 to $1 | Low |
| MRI of the Abdomen | imaging | N/A | $98 to $5,124 | High |
| MRI of the Brain | imaging | N/A | $335 to $5,245 | High |
| MRI of the Knee | imaging | N/A | $335 to $4,851 | High |
| MRI of the Shoulder | imaging | N/A | $335 to $6,843 | High |
| MRI Spine | imaging | N/A | $335 to $4,465 | High |
| Nafcillin 25 Mg/ml Ns Syringe-peds - Compounded | other | N/A | $1 to $1 | Low |
| Nateglinide 60 Mg Tablet | other | N/A | $1 to $1 | Low |
| Neomycin 500 Mg Tablet | other | N/A | $1 to $1 | Low |
| Newborn Care | obstetric | N/A | $42 to $640 | High |
| Nicotine 7 Mg/24hr Patch | other | N/A | $1 to $1 | Low |
| Nitrofurantoin Mcr 50 Mg Cap | other | N/A | $1 to $1 | Low |
| Non-needle Measurement and Recording of Electrical Activity of Muscles At Bla... | other | N/A | $2,330 to $2,330 | Low |
| Obstetric Ultrasound | imaging | N/A | $39 to $526 | High |
| Olanzapine Odt 5 Mg Tablet | other | N/A | $1 to $1 | Low |
| Oxybutynin Cl ER 5 Mg Tablet | other | N/A | $1 to $1 | Low |
| Paracentesis | diagnostic | N/A | $67 to $2,460 | High |
| Paroxetine ER 12.5 Mg Tablet | other | N/A | $1 to $1 | Low |
| Paroxetine ER 25 Mg Tablet | other | N/A | $1 to $1 | Low |
| Paroxetine Hcl ER 25 Mg Po Tb24 | other | N/A | $1 to $1 | Low |
| Pathology (Surgical Specimen) | lab | N/A | $10 to $482 | High |
| Pelvic Ultrasound | imaging | N/A | $23 to $600 | High |
| Pepto-bismol 525 Mg/30 Ml Susp | other | N/A | $1 to $1 | Low |
| PET Scan | imaging | N/A | $753 to $7,275 | High |
| Phenytoin 25 Mg Chewable Half Tablet | other | N/A | $1 to $1 | Low |
| Phenytoin 50 Mg Tablet Chew | other | N/A | $1 to $1 | Low |
| Piroxicam 10 Mg Capsule | other | N/A | $1 to $1 | Low |
| Polyethylene Glycol 3350 Powd | other | N/A | $1 to $1 | Low |
| Postpartum Care | obstetric | N/A | $149 to $968 | High |
| Prazosin 1 Mg Capsule | other | N/A | $1 to $1 | Low |
| Prenatal Care | obstetric | N/A | $361 to $2,128 | High |
| Prochlorperazine Maleate, 5 Mg, Oral, Fda Approved Prescription Anti-emetic, ... | other | N/A | $1 to $1 | Low |
| Propafenone Hcl ER 425 Mg Cap | other | N/A | $1 to $2 | Low |
| Propafenone Hcl ER 425 Mg Po Cp12 | other | N/A | $1 to $2 | Low |
| Ramelteon 8 Mg Tablet | other | N/A | $1 to $1 | Low |
| Ranolazine ER 500 Mg Tablet | other | N/A | $1 to $1 | Low |
| Rivastigmine 9.5 Mg/24hr Patch | other | N/A | $1 to $2 | Low |
| Septoplasty | surgery | N/A | $559 to $4,200 | High |
| Shoulder X-Ray | imaging | N/A | $7 to $282 | High |
| Skin Lesion Destruction | other | N/A | $59 to $550 | High |
| Skin Tag Removal | other | N/A | $12 to $1,010 | High |
| Small Joint Injection | surgery | N/A | $30 to $1,825 | High |
| Strong Iodine Solution | other | N/A | $1 to $1 | Low |
| Synthroid 200 Mcg Tablet | other | N/A | $1 to $1 | Low |
| Therapeutic Injection | preventive | N/A | $11 to $206 | High |
| Thoracentesis | other | N/A | $106 to $4,198 | High |
| Thyroid Test (TSH) | lab | N/A | $17 to $188 | High |
| Tiagabine Hcl 4 Mg Tablet | other | N/A | $1 to $2 | Low |
| Toenail Removal | surgery | N/A | $47 to $749 | High |
| Toot Sweet Sub (glucose 25%) - 1 Ml - Repackaging | other | N/A | $1 to $2 | Low |
| Tramadol Hcl ER 100 Mg Tablet | other | N/A | $1 to $2 | Low |
| Trazodone 50 Mg Tablet | other | N/A | $1 to $2 | Low |
| Trazodone Hcl 50 Mg Po Tabs | other | N/A | $1 to $2 | Low |
| Trigger Point Injection | therapy | N/A | $34 to $456 | High |
| Tubal Ligation | surgery | N/A | $313 to $6,030 | High |
| Urgent Care Visit | other | N/A | $38 to $251 | High |
| Vasectomy | surgery | N/A | $1 to $1,406 | High |
| Vision Exam | other | N/A | $1 to $4 | High |
| Vitamin D Test | lab | N/A | $30 to $438 | High |
| Voriconazole 100 Mg Half Tablet | other | N/A | $1 to $1 | Low |
| Voriconazole 200 Mg Tablet | other | N/A | $1 to $1 | Low |
| Weight Management Program | preventive | N/A | $24 to $250 | High |
| Wound Debridement | surgery | N/A | $131 to $36,578 | High |
| X-ray of Lower Leg, 2 Views | imaging | N/A | $230 to $73,590 | Low |
| X-Ray of the Knee | imaging | N/A | $9 to $617 | High |
| Zidovudine 100 Mg Capsule | other | N/A | $1 to $1 | Low |
| Zonisamide 100 Mg Capsule | other | N/A | $1 to $1 | Low |
| Zonisamide 100 Mg Po Caps | other | N/A | $1 to $1 | Low |
This hospital's pricing is published per federal mandate.
Disclosure required by 45 CFR Part 180.
Last updated: