1612 procedures with published pricing. Cash pay ranges from $25 to $63,957.
Sampson Regional Medical Center in Charlotte publishes cash-pay pricing for 1612 procedures, as required by federal law under 45 CFR Part 180. The median cash price across all published procedures is $2,636, with individual procedure prices ranging from $25 to $63,957 as of 2026-10-04. Source: Sampson Regional 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.
Sampson Regional Medical Center's cash pay prices range from $25 (Injection, Heparin Sodium (pfizer), Not Therapeutically Equivalent to J1644, ...) to $63,957 (HIV with Major Related Condition with Mcc).
| Category | Range | |||
|---|---|---|---|---|
| Injection, Heparin Sodium (pfizer), Not Therapeutically Equivalent to J1644, ... | other | $25 | $7 to $36 | Low |
| Injection, Ampicillin Sodium, 500 Mg | other | $26 | $7 to $38 | Low |
| Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm | other | $27 | $8 to $38 | Low |
| Tubersol 5t Unit/0.1 Ml Vial | other | $29 | $8 to $42 | Low |
| Guide Wire | other | $29 | $8 to $42 | Low |
| Non-covered Item OR Service | other | $31 | $9 to $44 | Low |
| Injection, Phenylephrine Hydrochloride, 20 Micrograms | other | $31 | $9 to $44 | Low |
| Injection, Piperacillin Sodium/tazobactam Sodium, 1 Gram/0.125 Grams | other | $31 | $9 to $44 | Low |
| Injection, Epinephrine (international Medication Systems), Not Therapeuticall... | other | $31 | $9 to $44 | Low |
| Benzocaine 20% 60 Ml Spray | other | $32 | $9 to $45 | Low |
| Platelet Storage Process Fee | other | $33 | $9 to $47 | Low |
| Platelets, Pheresis, Irradiated, Each Unit | other | $33 | $9 to $1,044 | Low |
| Platelets, Pheresis, Leukocytes Reduced, Each Unit | other | $33 | $9 to $563 | Low |
| Platelets, Pheresis, Leukocytes Reduced, Irradiated, Each Unit | other | $33 | $9 to $749 | Low |
| Injection, Butorphanol Tartrate, 1 Mg | other | $33 | $9 to $48 | Low |
| Dextrose 5%-0.45% Nacl IV Soln | other | $34 | $10 to $48 | Low |
| Obs ICU Nonpaid Cc 44 | other | $34 | $10 to $48 | Low |
| Obs OB Nonpaid Cc 44 | other | $34 | $10 to $48 | Low |
| Sterile Water for Injection | other | $34 | $10 to $48 | Low |
| Cholangiogram Catheter | cardiac | $34 | $10 to $48 | Low |
| Injection, Potassium Chloride, Per 2 Meq | other | $34 | $10 to $49 | Low |
| Injection, Thiamine Hcl, 100 Mg | other | $34 | $10 to $49 | Low |
| Injection, Vancomycin Hcl (mylan), Not Therapeutically Equivalent to J3370, 5... | other | $34 | $10 to $49 | Low |
| Injection, Cefepime Hydrochloride, 500 Mg | other | $35 | $10 to $50 | Low |
| Injection, Ceftazidime, Per 500 Mg | other | $35 | $10 to $50 | Low |
| Low Osmolar Contrast Material, 300-399 Mg/ml Iodine Concentration, Per Ml | other | $35 | $10 to $50 | Low |
| Injection, Acyclovir, 5 Mg | other | $37 | $10 to $53 | Low |
| Injection, Pantoprazole Sodium, 40 Mg | other | $37 | $10 to $53 | Low |
| Flector Patch | other | $38 | $11 to $54 | Low |
| Diclofenac Sodium 1% Gel | other | $38 | $11 to $55 | Low |
| Injection, Sumatriptan Succinate, 6 Mg | other | $39 | $11 to $55 | Low |
| Injection, Betamethasone Acetate 3 Mg and Betamethasone Sodium Phosphate 3 Mg | other | $39 | $11 to $55 | Low |
| Injection, Methylprednisolone Acetate, 1 Mg | other | $40 | $11 to $57 | Low |
| Sacubitril/valsartan 97/103 Mg | other | $40 | $11 to $57 | Low |
| Sacubitril/valsartan 24/26mg | other | $41 | $12 to $58 | Low |
| Injection, Succinylcholine Chloride, Up to 20 Mg | other | $41 | $12 to $58 | Low |
| Injection, Amikacin Sulfate, 100 Mg | other | $43 | $12 to $61 | Low |
| Cryoprecipitate, Each Unit | other | $43 | $12 to $79 | Low |
| Injection, Atropine Sulfate, 0.01 Mg | other | $44 | $12 to $63 | Low |
| Injection, Magnesium Sulfate, Per 500 Mg | other | $44 | $13 to $63 | Low |
| Breathing Bag OR Tube | other | $45 | $13 to $64 | Low |
| Pap Smear | preventive | $46 | $13 to $100 | High |
| Injection, Cefazolin Sodium, 500 Mg | other | $46 | $13 to $66 | Low |
| Activated Charcoal 25gm Oral | other | $47 | $13 to $67 | Low |
| Activated Charcoal; 25gm Water | other | $47 | $13 to $67 | Low |
| Nacl 0.45 500 | other | $49 | $14 to $70 | Low |
| Injection, Heparin Sodium, Per 1000 Units | other | $49 | $14 to $70 | Low |
| Injection, Hydralazine Hcl, Up to 20 Mg | other | $50 | $14 to $72 | Low |
| Injection, Clindamycin Phosphate, 300 Mg | other | $51 | $14 to $73 | Low |
| Ringers Injection-500cc | other | $52 | $15 to $74 | Low |
| Injection, Neostigmine Methylsulfate, Up to 0.5 Mg | other | $53 | $15 to $75 | Low |
| L.e.t. (lido-epineph-tetra) Ge | other | $55 | $16 to $79 | Low |
| Injection, Aminophyllin, Up to 250 Mg | other | $57 | $16 to $82 | Low |
| Cement Mixer Optivac Triple Mi | other | $58 | $16 to $82 | Low |
| Cholesterol Management | cardiac | $58 | $8 to $123 | High |
| Catheter, Intradiscal | cardiac | $60 | $17 to $86 | Low |
| D-5 Lr 500 Cc | other | $60 | $17 to $86 | Low |
| D-5- 1/2 500cc | other | $60 | $17 to $86 | Low |
| D-5- 1/4 500 Cc | other | $60 | $17 to $86 | Low |
| D-5- Lr 1000 Cc | other | $60 | $17 to $86 | Low |
| D-5-1/2 Ns 1000 Cc | other | $60 | $17 to $86 | Low |
| D-5-1/4 1000 Cc | other | $60 | $17 to $86 | Low |
| D-5-s 100o Cc | other | $60 | $17 to $86 | Low |
| D-5-s 500 Cc | other | $60 | $17 to $86 | Low |
| D-5-w 1000 Cc | other | $60 | $17 to $86 | Low |
| D-5-w 500 Cc | other | $60 | $17 to $86 | Low |
| Lactated Ringers 500 Cc | other | $60 | $17 to $86 | Low |
| Lactated Ringers-1000cc | other | $60 | $17 to $86 | Low |
| Nacl 0.45 1000 Cc | other | $60 | $17 to $86 | Low |
| Sodium Chlor(nacl)1000cc C\20m | other | $60 | $17 to $86 | Low |
| Sodium Chloride 500 Cc | other | $60 | $17 to $86 | Low |
| Injection, Glycopyrrolate, 0.1 Mg | other | $61 | $17 to $88 | Low |
| Sterile Water,irregation 250cc | other | $62 | $17 to $88 | Low |
| Technetium Tc-99m Exametazime, Diagnostic, Per Study Dose, Up to 25 Millicuries | other | $62 | $17 to $1,020 | Low |
| Abreva 2 Gm Tube | other | $62 | $18 to $89 | Low |
| Glycine Sol.1.5%-3000cc | other | $62 | $18 to $89 | Low |
| Plasmalyte-m | other | $62 | $18 to $89 | Low |
| Sodium Chloride 1000 Cc | other | $62 | $18 to $89 | Low |
| Injection, Dopamine Hcl, 40 Mg | other | $64 | $18 to $91 | Low |
| Injection, Levetiracetam, 10 Mg | other | $64 | $18 to $91 | Low |
| Ringers Injection-1000cc | other | $64 | $18 to $91 | Low |
| Sterile Water,irrigation 3000c | other | $64 | $18 to $92 | Low |
| Sodium Bicarbonate 8.4% IV | other | $65 | $18 to $93 | Low |
| Injection Fluconazole, 200 Mg | other | $65 | $19 to $93 | Low |
| Diagnostic Digital Breast Tomosynthesis, Unilateral OR Bilateral | other | $67 | $19 to $96 | Low |
| Alcohol 5%&dextr.5%in Water 10 | other | $68 | $19 to $97 | Low |
| D-10-w 500ml | other | $68 | $19 to $97 | Low |
| D-5-0.2% Sodium Chloride(250cc | other | $68 | $19 to $97 | Low |
| D-5-r 1000 Cc | other | $68 | $19 to $97 | Low |
| Dextrose 10%in Saline(d-10-s)1 | other | $68 | $19 to $97 | Low |
| Dextrose 2.5% Strength Saline | other | $68 | $19 to $97 | Low |
| Dextrose 5.5%in Salinec\20meq5 | other | $68 | $19 to $97 | Low |
| Dextrose 5.5%in Salinec\meq 10 | other | $68 | $19 to $97 | Low |
| Dextrose 5%inh2o(d5w)1000cc | other | $68 | $19 to $97 | Low |
| Dextrose 5%inwatr(d5w)500cc | other | $68 | $19 to $97 | Low |
| Dextrose 5%ring.inj.500cc | other | $68 | $19 to $97 | Low |
| Sodium Bicarbonate Sol.5%500cc | other | $68 | $19 to $97 | Low |
| Sodium Chloride 3% in Water | other | $68 | $19 to $97 | Low |
| Sodium Lactate1/6molar 500cc | other | $68 | $19 to $97 | Low |
| Sodium Lactate1/6molar1000cc | other | $68 | $19 to $97 | Low |
| Sterile Water,irrigation 1000c | other | $68 | $19 to $97 | Low |
| Injection, Methocarbamol, Up to 10 Ml | other | $69 | $20 to $99 | Low |
| Astelin | other | $70 | $20 to $100 | Low |
| Infectious Agent Detection By Nucleic Acid (dna OR Rna); Human Papillomavirus... | other | $70 | $20 to $100 | Low |
| Injection, Fentanyl Citrate, 0.1 Mg | other | $70 | $20 to $100 | Low |
| Injection, Regadenoson, 0.1 Mg | other | $70 | $20 to $100 | Low |
| Injection, Nitroglycerin, 5 Mg | other | $72 | $20 to $102 | Low |
| Flu Vaccination | preventive | $73 | $21 to $106 | High |
| Muri-lube Mineral Oil Vial | other | $73 | $21 to $104 | Low |
| Abo & Rh Blood Type | other | $74 | $21 to $106 | Low |
| Injection, Esmolol Hydrochloride, 10 Mg | other | $75 | $21 to $107 | Low |
| Injection, Ropivacaine Hydrochloride, 1 Mg | other | $76 | $22 to $109 | Low |
| Surgical Supplies | surgery | $77 | $22 to $110 | Low |
| Hemoglobin & Hematocrit | other | $77 | $22 to $110 | Low |
| Injection, Hydrocortisone Sodium Succinate, Up to 100 Mg | other | $77 | $22 to $111 | Low |
| Injection, Calcium Gluconate (wg Critical Care), Not Therapeutically Equivale... | other | $83 | $23 to $118 | Low |
| Injection, Vancomycin Hydrochloride, 10 Mg | other | $83 | $24 to $119 | Low |
| Icd-s/d/m In/cl-chec | other | $83 | $24 to $119 | Low |
| Obs W/tel ICU Nonpaid Cc 44 | other | $85 | $24 to $121 | Low |
| Obs W/tel OB Nonpaid Cc 44 | other | $85 | $24 to $121 | Low |
| Injection, Enoxaparin Sodium, 10 Mg | other | $87 | $25 to $124 | Low |
| Technetium Tc-99m Mebrofenin, Diagnostic, Per Study Dose, Up to 15 Millicuries | other | $88 | $25 to $126 | Low |
| Injection, Haloperidol Decanoate, Per 50 Mg | other | $91 | $26 to $129 | Low |
| Iodine I-123 Sodium Iodide, Diagnostic, Per Millicurie | other | $91 | $26 to $130 | Low |
| Catheter, Suprapubic/cystoscopic | cardiac | $91 | $26 to $130 | Low |
| Injection, Phenobarbital Sodium, Up to 120 Mg | other | $92 | $26 to $132 | Low |
| Parenteral Nutrition Solution, Not Otherwise Specified, 10 Grams Lipids | lab | $94 | $27 to $135 | Low |
| Initial Oxygen 30 Min | other | $95 | $27 to $135 | Low |
| Injection, Medroxyprogesterone Acetate, 1 Mg | other | $95 | $27 to $136 | Low |
| Injection, Propofol, 10 Mg | other | $98 | $28 to $140 | Low |
| Injection, Hydroxyzine Hcl, Up to 25 Mg | other | $98 | $28 to $140 | Low |
| Lokelma 10 Gm Powder Packet | other | $99 | $28 to $141 | Low |
| Impersol 1.5% 2000cc | other | $99 | $28 to $142 | Low |
| Impersol 4.25% 2000 Cc | other | $99 | $28 to $142 | Low |
| Cardiac Catheterization | cardiac | $101 | $29 to $144 | High |
| Injection, Meropenem (b. Braun), Not Therapeutically Equivalent to J2185, 100 Mg | other | $102 | $29 to $146 | Low |
| Injection, Zidovudine, 10 Mg | other | $102 | $2 to $146 | Low |
| Sodium Phosphate P-32, Therapeutic, Per Millicurie | other | $102 | $29 to $306 | Low |
| Injection, Oxytocin, Up to 10 Units | other | $104 | $29 to $148 | Low |
| Injection, Cefepime Hydrochloride (b Braun), Not Therapeutically Equivalent t... | other | $104 | $30 to $149 | Low |
| Injection, Daptomycin, 1 Mg | other | $105 | $30 to $150 | Low |
| Unclassified Drugs | other | $105 | $30 to $150 | Low |
| Injection, Methylergonovine Maleate, Up to 0.2 Mg | other | $107 | $30 to $153 | Low |
| Injection, Sodium Ferric Gluconate Complex in Sucrose Injection, 12.5 Mg | other | $111 | $32 to $159 | Low |
| Injection, Chlorpromazine Hcl, Up to 50 Mg | other | $116 | $33 to $166 | Low |
| Newborn Metabolic Screening Panel, Includes Test Kit, Postage and the Laborat... | lab | $116 | $33 to $166 | Low |
| Injection, Garamycin, Gentamicin, Up to 80 Mg | other | $117 | $33 to $167 | Low |
| Injection, Diazepam, Up to 5 Mg | other | $118 | $33 to $168 | Low |
| 3d/4d Prenatal Ultrasound | imaging | $119 | $34 to $170 | Low |
| Injection, Caffeine Citrate, 5 Mg | other | $119 | $34 to $170 | Low |
| Injection, Amiodarone Hydrochloride (nexterone), 30 Mg | other | $121 | $34 to $173 | Low |
| Injection, Insulin, Per 5 Units | other | $123 | $35 to $175 | Low |
| Introducer/sheath, Other Than Guiding, Other Than Intracardiac Electrophysiol... | cardiac | $123 | $35 to $176 | Low |
| Initial Aerosol O2 - 30 Min | other | $124 | $35 to $177 | Low |
| Injection, Acetaminophen, Not Otherwise Specified,10 Mg | other | $124 | $35 to $178 | Low |
| Injection, Aztreonam, 100 Mg | other | $126 | $36 to $180 | Low |
| Injection, Iron Dextran, 50 Mg | other | $127 | $18 to $182 | Low |
| Inhalational Anesth Ea 30min | other | $127 | $36 to $182 | Low |
| Atropine Sulf Opth Sol | other | $128 | $36 to $183 | Low |
| 17 Ketogenicsteroids | other | $131 | $37 to $187 | Low |
| Initial Oxy Hood 30 Min | other | $131 | $37 to $187 | Low |
| Technetium Tc-99m Pyrophosphate, Diagnostic, Per Study Dose, Up to 25 Millicu... | other | $131 | $37 to $187 | Low |
| Technetium Tc-99m Sulfur Colloid, Diagnostic, Per Study Dose, Up to 20 Millic... | other | $135 | $38 to $193 | Low |
| Electrical Stimulation (unattended), to One OR More Areas for Indication(s) O... | other | $137 | $12 to $195 | Low |
| Fresh Frozen Plasma (single Donor), Frozen Within 8 Hours of Collection, Each... | other | $138 | $39 to $197 | Low |
| Fresh Frozen Plasma Between 8-24 Hours of Collection, Each Unit | other | $138 | $39 to $197 | Low |
| Xenon Xe-133 Gas, Diagnostic, Per 10 Millicuries | other | $138 | $39 to $197 | Low |
| Type & Screen | other | $139 | $40 to $199 | Low |
| Prostate Cancer Screening | other | $141 | $18 to $201 | High |
| Silvasorb Gel | other | $144 | $41 to $205 | Low |
| Absorb.gelantin Sponge | other | $154 | $44 to $220 | Low |
| Injection, Acetazolamide Sodium, Up to 500 Mg | other | $154 | $44 to $220 | Low |
| Parenteral Nutrition Solution; Compounded Amino Acid and Carbohydrates with E... | other | $154 | $44 to $220 | Low |
| Unlisted Reference Lab | other | $157 | $45 to $224 | Low |
| Injection, Penicillin G Potassium, Up to 600,000 Units | other | $161 | $46 to $230 | Low |
| 3 Hour Gtt | other | $162 | $46 to $231 | Low |
| Bone Density Scan | imaging | $164 | $30 to $234 | High |
| Injection, Vancomycin Hydrochloride (mylan) Not Therapeutically Equivalent to... | other | $164 | $47 to $234 | Low |
| Prosthesis, Penile, Non-inflatable | other | $167 | $47 to $239 | Low |
| Gentran 10%-5% Dextrose | other | $168 | $48 to $240 | Low |
| Gentran 10%-saline 0.9% | other | $168 | $48 to $240 | Low |
| Injection, Phytonadione (vitamin K), Per 1 Mg | other | $171 | $49 to $245 | Low |
| Injection, Mannitol, 25% in 50 Ml | other | $176 | $50 to $251 | Low |
| Anterior Chamber Intraocular Lens | other | $179 | $51 to $255 | Low |
| Diffcult Airway-video-larygeo | other | $188 | $53 to $268 | Low |
| Drug Test(s), Definitive, Utilizing (1) Drug Identification Methods Able to I... | other | $188 | $53 to $269 | Low |
| Iodine I-131 Sodium Iodide Capsule(s), Therapeutic, Per Millicurie | other | $195 | $24 to $279 | Low |
| Technetium Tc-99m Labeled Red Blood Cells, Diagnostic, Per Study Dose, Up to ... | other | $208 | $59 to $297 | Low |
| Atb45mm Standard Artic Cutter | other | $209 | $59 to $299 | Low |
| 4 Hour Gtt | other | $209 | $59 to $299 | Low |
| Injection, Benztropine Mesylate, Per 1 Mg | other | $210 | $60 to $300 | Low |
| Anesthesia Facility Charge | other | $216 | $61 to $309 | Low |
| Tc99m Sulfur Colloid | other | $221 | $63 to $315 | Low |
| Catheter, Balloon Dilatation, Non-vascular | cardiac | $229 | $65 to $327 | Low |
| Injection, Lacosamide, 1 Mg | other | $229 | $65 to $328 | Low |
| Low Osmolar Contrast Material, 200-299 Mg/ml Iodine Concentration, Per Ml | other | $231 | $66 to $330 | Low |
| High Osmolar Contrast Material, 350-399 Mg/ml Iodine Concentration, Per Ml | other | $238 | $67 to $340 | Low |
| Monurol 3 Gm Sacet | other | $244 | $69 to $349 | Low |
| Port, Indwelling | other | $245 | $70 to $351 | Low |
| Albuterol Inhaler | other | $246 | $70 to $352 | Low |
| Levalbuterol, Inhalation Solution, Compounded Product, Administered Through D... | other | $258 | $73 to $369 | Low |
| 5 Hour Gtt | other | $259 | $74 to $370 | Low |
| Technetium Tc-99m Macroaggregated Albumin, Diagnostic, Per Study Dose, Up to ... | other | $259 | $74 to $370 | Low |
| Red Blood Cells, Each Unit | other | $260 | $74 to $372 | Low |
| Blood (whole), for Transfusion, Per Unit | surgery | $263 | $75 to $376 | Low |
| Red Blood Cells, Irradiated, Each Unit | other | $263 | $75 to $376 | Low |
| Red Blood Cells, Leukocytes Reduced, Each Unit | other | $263 | $75 to $376 | Low |
| Red Blood Cells, Leukocytes Reduced, Irradiated, Each Unit | other | $263 | $75 to $376 | Low |
| Red Cells Process/store/handle | other | $263 | $75 to $376 | Low |
| Injection, Linezolid, 200 Mg | other | $280 | $80 to $400 | Low |
| Injection, Desmopressin Acetate, Per 1 Mcg | other | $284 | $81 to $406 | Low |
| Injection, Vasopressin, 1 Unit | other | $289 | $82 to $413 | Low |
| 6 Hour Gtt | other | $304 | $86 to $434 | Low |
| Anchor/screw for Opposing Bone-to-bone OR Soft Tissue-to-bone | other | $318 | $90 to $455 | Low |
| Catheter, Intraspinal | cardiac | $320 | $91 to $457 | Low |
| Injection, Dobutamine Hydrochloride, Per 250 Mg | other | $324 | $92 to $462 | Low |
| Injection, Naloxone Hydrochloride, Not Otherwise Specified, 0.01 Mg | other | $326 | $92 to $465 | Low |
| Regional Block | other | $344 | $98 to $491 | Low |
| Injection, Nicardipine, 0.1 Mg | other | $356 | $101 to $508 | Low |
| Emergency Surgery Fee | surgery | $367 | $104 to $524 | Low |
| Injection, Cosyntropin, 0.25 Mg | other | $373 | $106 to $533 | Low |
| Injection, Epoetin Alfa, (for Non-esrd Use), 1000 Units | other | $374 | $9 to $535 | Low |
| Mesh | other | $376 | $107 to $538 | Low |
| Injection, Epinephrine (adrenalin), Not Therapeutically Equivalent to J0165, ... | other | $378 | $107 to $540 | Low |
| Injection, Methylprednisolone Sodium Succinate, 5 Mg | other | $381 | $108 to $544 | Low |
| Infusion, Albumin (human), 25%, 50 Ml | surgery | $403 | $53 to $575 | Low |
| Technetium Tc-99m Sestamibi, Diagnostic, Per Study Dose | other | $406 | $115 to $580 | Low |
| Pre Sympt Study<30 Days Hookup | other | $410 | $117 to $586 | Low |
| Catheter, Drainage | cardiac | $417 | $118 to $595 | Low |
| Injection, Esmolol Hydrochloride (wg Critical Care), Not Therapeutically Equi... | other | $418 | $119 to $598 | Low |
| Injection, Ertapenem Sodium, 500 Mg | other | $450 | $128 to $643 | Low |
| Nursery - General Classification | other | $514 | $290 to $1,800 | Low |
| Injection, Non-radioactive, Non-contrast, Visualization Adjunct (e.g., Methyl... | other | $522 | $9 to $746 | Low |
| Technetium Tc-99m Mertiatide, Diagnostic, Per Study Dose, Up to 15 Millicuries | other | $526 | $149 to $751 | Low |
| Magnetic Resonance Angiography without Contrast, Chest | imaging | $543 | $154 to $1,841 | Low |
| Injection, Methylnaltrexone, 0.1 Mg | other | $570 | $162 to $815 | Low |
| Injection, Rho(d) Immune Globulin (human), (rhophylac), Intramuscular OR Intr... | other | $583 | $166 to $833 | Low |
| 000-030 Min - Anesthesia | other | $630 | $179 to $900 | Low |
| Add'l 30 Min Anesthesia | other | $630 | $179 to $900 | Low |
| Infusion, Albumin (human), 5%, 50 Ml | surgery | $630 | $11 to $900 | Low |
| Injection, Zoledronic Acid, 1 Mg | other | $630 | $179 to $900 | Low |
| Convalescent Plasma | other | $631 | $179 to $902 | Low |
| Injection, Micafungin Sodium, 1 Mg | other | $655 | $186 to $935 | Low |
| Intensive Care Unit - General Classification | other | $687 | $388 to $4,424 | Low |
| Fine Needle Aspiration Biopsy Using Fluoroscopic Guidance, First Growth | lab | $732 | $208 to $10,007 | Low |
| Intravenous Infusion OR Subcutaneous Injection, Casirivimab and Imdevimab Inc... | surgery | $732 | $208 to $1,045 | Low |
| Intravenous Infusion, Bamlanivimab and Etesevimab, Includes Infusion and Post... | surgery | $732 | $208 to $1,045 | Low |
| Echo Limit | imaging | $750 | $213 to $1,072 | Low |
| Echocardiogram | imaging | $750 | $66 to $1,072 | High |
| Platelets, Pheresis, Each Unit | other | $799 | $227 to $1,141 | Low |
| Magnetic Resonance Angiography with Contrast, Chest | imaging | $807 | $229 to $1,841 | Low |
| Joint Device | other | $858 | $244 to $1,226 | Low |
| Injection, Tbo-filgrastim, 1 Microgram | other | $875 | $875 to $1,249 | Low |
| ICU Nursing Increment | other | $878 | $249 to $1,254 | Low |
| Fine Needle Aspiration Biopsy Using Ultrasound Guidance, First Growth | imaging | $884 | $251 to $10,005 | Low |
| Magnetic Resonance Angiography without Contrast Followed By with Contrast, Chest | imaging | $911 | $259 to $1,841 | Low |
| Magnetic Resonance Angiography without Contrast Followed By with Contrast, Sp... | imaging | $911 | $259 to $1,841 | Low |
| Injection, Epinephrine, Not Otherwise Specified, 0.1 Mg | other | $945 | $268 to $1,350 | Low |
| Tobradex Eye Ointment | other | $949 | $270 to $1,356 | Low |
| Strapping, Unna Boot | other | $955 | $155 to $29,580 | Low |
| Bronchospam Complete | other | $960 | $273 to $1,371 | Low |
| Placement of Locating Device in Breast Using X-ray with Needle Guidance, Firs... | imaging | $986 | $280 to $19,283 | Low |
| Injection, Glucagon Hydrochloride, Per 1 Mg | other | $988 | $182 to $1,411 | Low |
| Injection, Amphotericin B, 50 Mg | other | $1,114 | $316 to $1,592 | Low |
| Hemabate 250 Mcg IM | other | $1,116 | $317 to $1,595 | Low |
| Platelets, Pheresis, Pathogen-reduced, Each Unit | other | $1,126 | $320 to $1,609 | Low |
| Implantable Surgical Supplies | surgery | $1,192 | $339 to $1,703 | Low |
| Aspiration And/or Injection of Cyst of Kidney | other | $1,345 | $382 to $50,390 | Low |
| Needle Biopsy of Lining of Lung | lab | $1,345 | $382 to $32,400 | Low |
| Aspiration of Fluid From Cyst of Spinal Cord OR Fluid-filled Cavity | other | $1,428 | $406 to $62,268 | Low |
| CT Scan of Face with Contrast | imaging | $1,466 | $168 to $70,487 | Low |
| Aspiration of Fluid From Chest Cavity Using Imaging Guidance | other | $1,493 | $424 to $32,555 | Low |
| CT Scan of Chest with Contrast | imaging | $1,499 | $168 to $71,260 | Low |
| CT Scan of Chest without Contrast | imaging | $1,499 | $100 to $71,250 | Low |
| MRI Scan of Leg with Contrast | imaging | $1,538 | $333 to $73,719 | Low |
| CT Head | imaging | $1,555 | $100 to $2,222 | High |
| CT Scan Head OR Brain with Contrast | imaging | $1,555 | $168 to $70,460 | Low |
| Nuclear Medicine Study of Lung Circulation | imaging | $1,579 | $382 to $78,580 | Low |
| Nuclear Medicine Study of Lung Ventilation and Circulation | imaging | $1,580 | $449 to $78,582 | Low |
| Nuclear Medicine Study of Liver and Bile Duct System | imaging | $1,611 | $382 to $78,226 | Low |
| Nuclear Medicine Study of Liver and Bile Duct System with Use of Drugs | imaging | $1,611 | $458 to $78,227 | Low |
| CT Scan of Cranial Cavity with Contrast | imaging | $1,653 | $168 to $70,481 | Low |
| CT Scan of Cranial Cavity without Contrast | imaging | $1,653 | $100 to $70,480 | Low |
| Aspiration of Initial Secretion of Lung Airway Using an Endoscope | other | $1,662 | $472 to $31,645 | Low |
| MRI Scan of Bone of Eye Socket, Face, And/or Neck without Contrast | imaging | $1,675 | $228 to $70,540 | Low |
| Nuclear Medicine Study of Kidney and Blood Flow | imaging | $1,687 | $382 to $78,701 | Low |
| Injection, Remdesivir, 1 Mg | other | $1,715 | $7 to $2,451 | Low |
| CT Scan Head OR Brain without Contrast | imaging | $1,729 | $100 to $70,450 | Low |
| CT Scan of Arm Before and After Contrast | imaging | $1,744 | $168 to $73,202 | Low |
| Placement of Locating Device in Breast Using Imaging Guidance, First Growth | other | $1,747 | $496 to $19,281 | Low |
| MRI Scan of Blood Vessels of Head without Contrast | imaging | $1,789 | $228 to $70,544 | Low |
| MRI Scan of Blood Vessels of Neck without Contrast | imaging | $1,790 | $228 to $70,547 | Low |
| CT Scan of Blood Vessels of Arm with Contrast | imaging | $1,807 | $168 to $73,206 | Low |
| CT Scan of Blood Vessels of Lower Leg with Contrast | imaging | $1,807 | $168 to $73,706 | Low |
| Labor Room/delivery - General Classification | obstetric | $1,829 | $519 to $2,613 | Low |
| Removal of Foreskin | surgery | $1,829 | $519 to $54,161 | Low |
| Technetium Tc-99m Tilmanocept, Diagnostic, Up to 0.5 Millicuries | other | $1,835 | $521 to $2,622 | Low |
| CT Scan of Middle Spine with Contrast | imaging | $1,841 | $168 to $72,129 | Low |
| Injection, Penicillin G Benzathine, 100,000 Units | other | $1,843 | $30 to $2,632 | Low |
| MRI Scan of Blood Vessels of Head with Contrast | imaging | $1,854 | $333 to $70,545 | Low |
| MRI Scan of Blood Vessels of Neck with Contrast | imaging | $1,854 | $333 to $70,548 | Low |
| Nuclear Medicine Study of Kidney, Blood Flow, and Function | imaging | $1,875 | $519 to $78,707 | Low |
| CT Scan of Leg without Contrast | imaging | $1,904 | $100 to $73,700 | Low |
| CT Scan of Abdomen without Contrast | imaging | $1,909 | $100 to $74,150 | Low |
| CT Scan of Pelvis without Contrast | imaging | $1,909 | $100 to $72,192 | Low |
| MRI Scan of Chest without Contrast | imaging | $1,915 | $228 to $71,550 | Low |
| Injection, Tetanus Immune Globulin, Human, Up to 250 Units | other | $1,963 | $557 to $2,804 | Low |
| Lymph OR Ln Nm Scan | other | $1,966 | $558 to $2,809 | Low |
| MRI Scan of Jaw Joint | imaging | $1,978 | $228 to $70,336 | Low |
| Biopsy of Breast and Placement of Locating Device Using X-ray with Needle, Fi... | imaging | $1,987 | $564 to $19,081 | Low |
| Insertion of Stomach Tube Using Fluoroscopic Guidance with Contrast | other | $2,007 | $570 to $49,440 | Low |
| Removal of Foreskin Using Clamp OR Device | surgery | $2,013 | $572 to $54,150 | Low |
| CT Scan of Leg with Contrast Material | imaging | $2,027 | $168 to $73,701 | Low |
| Magnetic Resonance Angiography without Contrast Followed By with Contrast, Ab... | imaging | $2,055 | $333 to $2,935 | Low |
| Magnetic Resonance Angiography without Contrast Followed By with Contrast, Pe... | imaging | $2,055 | $333 to $2,935 | Low |
| MRI Scan of Middle Spinal Canal with Contrast | imaging | $2,055 | $333 to $72,147 | Low |
| Nuclear Medicine Study of Bone Taken At Different Times | imaging | $2,060 | $382 to $78,315 | Low |
| MRI Scan of Chest with Contrast | imaging | $2,071 | $588 to $71,551 | Low |
| Injection, Infliximab-abda, Biosimilar, (renflexis), 10 Mg | other | $2,109 | $27 to $3,014 | Low |
| CT Scan of Middle Spine without Contrast | imaging | $2,113 | $100 to $72,128 | Low |
| CT Scan of Abdomen with Contrast | imaging | $2,122 | $168 to $74,160 | Low |
| CT Scan of Face without Contrast | imaging | $2,122 | $100 to $70,486 | Low |
| CT Scan of Pelvis with Contrast | imaging | $2,122 | $168 to $72,193 | Low |
| CT Scan of Soft Tissue of Neck with Contrast | imaging | $2,125 | $168 to $70,491 | Low |
| Strontium Sr-89 Chloride, Therapeutic, Per Millicurie | other | $2,154 | $612 to $4,561 | Low |
| MRI Scan of Arm Joint with Contrast | imaging | $2,159 | $613 to $73,222 | Low |
| MRI Scan of Arm with Contrast | imaging | $2,159 | $333 to $73,219 | Low |
| Sleep Study (Polysomnography) | diagnostic | $2,167 | $615 to $95,811 | High |
| Rabies Immune Globulin for Injection | other | $2,170 | $280 to $90,375 | Low |
| Injection, Ferumoxytol, for Treatment of Iron Deficiency Anemia, 1 Mg | other | $2,208 | $2,208 to $3,154 | Low |
| MRI Scan of Bone of Eye Socket, Face, And/or Neck with Contrast | imaging | $2,225 | $333 to $70,542 | Low |
| MRI Scan of Pelvis with Contrast | imaging | $2,232 | $333 to $72,196 | Low |
| MRI Scan of Abdomen with Contrast | imaging | $2,237 | $333 to $74,182 | Low |
| Misc Implant | surgery | $2,244 | $637 to $3,205 | Low |
| CT Scan of Chest Before and After Contrast | imaging | $2,244 | $168 to $71,270 | Low |
| CT Scan of Soft Tissue of Neck without Contrast | imaging | $2,261 | $100 to $70,490 | Low |
| MRI Scan of Leg Before and After Contrast | imaging | $2,312 | $333 to $73,720 | Low |
| MRI Scan of Upper Spinal Canal with Contrast | imaging | $2,316 | $333 to $72,142 | Low |
| MRI Scan of Leg Joint with Contrast | imaging | $2,329 | $661 to $73,722 | Low |
| CT Scan of Blood Vessels of Neck with Contrast | imaging | $2,367 | $168 to $70,498 | Low |
| MRI Scan of Pelvis without Contrast | imaging | $2,400 | $228 to $72,195 | Low |
| CT Scan of Lower Spine with Contrast | imaging | $2,405 | $333 to $72,132 | Low |
| CT Scan of Upper Spine with Contrast | imaging | $2,405 | $333 to $72,126 | Low |
| CT Scan of Cranial Cavity Before and After Contrast | imaging | $2,412 | $168 to $70,482 | Low |
| MRI Scan of Bone of Eye Socket, Face, And/or Neck Before and After Contrast | imaging | $2,431 | $333 to $70,543 | Low |
| MRI Scan of Chest Before and After Contrast | imaging | $2,431 | $333 to $71,552 | Low |
| Other MRI Scan | imaging | $2,431 | $83 to $76,498 | Low |
| CT Scan of Blood Vessels of Head with Contrast | imaging | $2,460 | $168 to $70,496 | Low |
| MRI Scan of Leg without Contrast | imaging | $2,461 | $228 to $73,718 | Low |
| MRI Scan of Arm Before and After Contrast | imaging | $2,465 | $333 to $73,220 | Low |
| Normal Newborn | other | $2,477 | $1,469 to $7,139 | Low |
| MRI Scan of Abdomen without Contrast | imaging | $2,483 | $228 to $74,181 | Low |
| MRI Scan of Arm Joint Before and After Contrast | imaging | $2,525 | $333 to $73,223 | Low |
| MRI Scan of Lower Spinal Canal with Contrast | imaging | $2,525 | $333 to $72,149 | Low |
| Deep Biopsy of Bone Using Needle OR Trocar | lab | $2,528 | $718 to $20,225 | Low |
| MRI Scan of Pelvis Before and After Contrast | imaging | $2,553 | $333 to $72,197 | Low |
| CT Scan of Soft Tissue of Neck Before and After Contrast | imaging | $2,554 | $168 to $70,492 | Low |
| CT Scan of Head OR Brain Before and After Contrast | imaging | $2,594 | $168 to $70,470 | Low |
| MRI Scan of Leg Joint without Contrast | imaging | $2,606 | $228 to $73,721 | Low |
| MRI Scan of Brain without Contrast | imaging | $2,615 | $228 to $70,551 | Low |
| CT Scan of Abdominal Aorta and Both Leg Arteries with Contrast | imaging | $2,636 | $168 to $75,635 | Low |
| CT Scan of Blood Vessels of Abdomen with Contrast | imaging | $2,636 | $168 to $74,175 | Low |
| MRI Scan of Upper Spinal Canal without Contrast | imaging | $2,636 | $228 to $72,141 | Low |
| CT Scan of Blood Vessels of Chest with Contrast | imaging | $2,643 | $168 to $71,275 | Low |
| CT Scan of Leg Before and After Contrast | imaging | $2,645 | $168 to $73,702 | Low |
| MRI Scan of Arm Joint without Contrast | imaging | $2,645 | $228 to $73,221 | Low |
| CT Scan of Abdomen Before and After Contrast | imaging | $2,650 | $168 to $74,170 | Low |
| CT Scan of Pelvis Before and After Contrast | imaging | $2,650 | $168 to $72,194 | Low |
| MRI Scan of Arm without Contrast | imaging | $2,659 | $228 to $73,218 | Low |
| MRI Scan of Lower Spinal Canal without Contrast | imaging | $2,663 | $228 to $72,148 | Low |
| MRI Scan of Middle Spinal Canal without Contrast | imaging | $2,663 | $228 to $72,146 | Low |
| MRI Scan of Blood Vessels of Neck Before and After Contrast | imaging | $2,670 | $333 to $70,549 | Low |
| Other Male Reproductive System O.r. Procedures Except Malignancy with Cc/mcc | other | $2,700 | $2,700 to $16,967 | Low |
| Other Antepartum Diagnoses without O.r. Procedures without Cc/mcc | other | $2,738 | $1,598 to $7,023 | Low |
| CT Scan of Middle Spine Before and After Contrast | imaging | $2,750 | $168 to $72,130 | Low |
| CT Scan of Lower Spine without Contrast | imaging | $2,762 | $100 to $72,131 | Low |
| CT Scan of Face Before and After Contrast | imaging | $2,779 | $168 to $70,488 | Low |
| CT Scan of Blood Vessels of Pelvis with Contrast | imaging | $2,784 | $168 to $72,191 | Low |
| Injection, Infliximab, Excludes Biosimilar, 10 Mg | other | $2,861 | $31 to $4,087 | Low |
| Otitis Media and Uri without Mcc | other | $2,873 | $1,598 to $7,023 | Low |
| MRI Scan of Blood Vessels of Head Before and After Contrast | imaging | $2,913 | $333 to $70,546 | Low |
| Insertion of Indwelling Tube for Drainage of Lung Fluid | other | $2,925 | $831 to $32,550 | Low |
| CT Scan of Blood Vessels of Abdomen and Pelvis with Contrast | imaging | $2,968 | $333 to $74,174 | Low |
| MRI Scan of Leg Joint Before and After Contrast | imaging | $3,028 | $333 to $73,723 | Low |
| Mitomycin Pyelocalyceal Instillation, 1 Mg | other | $3,097 | $319 to $4,424 | Low |
| Prematurity without Major Problems | other | $3,125 | $3,125 to $21,981 | Low |
| MRI Scan of Abdomen Before and After Contrast | imaging | $3,143 | $333 to $74,183 | Low |
| Neonate with Other Significant Problems | other | $3,154 | $1,990 to $13,246 | Low |
| CT Scan of Upper Spine without Contrast | imaging | $3,180 | $100 to $72,125 | Low |
| MRI Scan of Brain with Contrast | imaging | $3,215 | $333 to $70,552 | Low |
| Injection, Crotalidae Immune F(ab')2 (equine), 120 Mg | other | $3,234 | $918 to $4,620 | Low |
| CT Scan of Lower Spine Before and After Contrast | imaging | $3,282 | $168 to $72,133 | Low |
| Other Antepartum Diagnoses without O.r. Procedures with Cc | other | $3,283 | $1,598 to $7,023 | Low |
| MRI Scan of Lower Spinal Canal Before and After Contrast | imaging | $3,493 | $333 to $72,158 | Low |
| MRI Scan of Middle Spinal Canal Before and After Contrast | imaging | $3,493 | $333 to $72,157 | Low |
| MRI Scan of Upper Spinal Canal Before and After Contrast | imaging | $3,493 | $333 to $72,156 | Low |
| CT Scan of Upper Spine Before and After Contrast | imaging | $3,593 | $168 to $72,127 | Low |
| Nuclear Medicine Study of Heart Muscle At Rest and with Stress and SPECT | imaging | $3,619 | $1,028 to $78,451 | Low |
| Neonates, Died OR Transferred to Another Acute Care Facility | other | $3,652 | $1,598 to $16,174 | Low |
| MRI Scan of Brain Before and After Contrast | imaging | $3,682 | $333 to $70,553 | Low |
| Prematurity with Major Problems | other | $3,812 | $3,812 to $36,428 | Low |
| Other Circulatory System Diagnoses without Cc/mcc | other | $3,892 | $1,598 to $7,023 | Low |
| Alcohol, Drug Abuse OR Dependence, Left Ama | other | $3,977 | $1,681 to $7,023 | Low |
| Abortion without D&c | other | $4,102 | $1,598 to $7,023 | Low |
| Complications of Treatment with Mcc | other | $4,181 | $1,598 to $16,431 | Low |
| CT Scan of Abdomen and Pelvis without Contrast | imaging | $4,196 | $228 to $74,176 | Low |
| CT Scan of Abdomen and Pelvis with Contrast | imaging | $4,240 | $333 to $74,177 | Low |
| Full Term Neonate with Major Problems | other | $4,467 | $4,467 to $37,421 | Low |
| Allergic Reactions with Mcc | other | $4,581 | $1,598 to $15,092 | Low |
| Major Chest Trauma without Cc/mcc | emergency | $4,671 | $1,598 to $7,059 | Low |
| Postpartum and Post Abortion Diagnoses without O.r. Procedures | obstetric | $4,683 | $1,598 to $7,023 | Low |
| Endocrine Disorders without Cc/mcc | other | $4,688 | $1,598 to $7,023 | Low |
| Vaginal Delivery | obstetric | $4,705 | $260 to $12,825 | High |
| Vaginal Delivery with OR Procedure except Sterilization/D&C | obstetric | $4,878 | $2,457 to $9,617 | Low |
| CT Scan of Abdomen and Pelvis Before and After Contrast | imaging | $5,295 | $333 to $74,178 | Low |
| Other Disorders of Nervous System without Cc/mcc | other | $5,311 | $1,598 to $7,588 | Low |
| Peripheral Vascular Disorders without Cc/mcc | other | $5,435 | $3,196 to $7,764 | Low |
| Urinary Stones without Mcc | other | $5,485 | $1,598 to $7,836 | Low |
| Bronchitis and Asthma without Cc/mcc | other | $5,630 | $3,160 to $8,042 | Low |
| Nuclear Medicine Studies of Heart Muscle At Rest and with Stress and SPECT | imaging | $5,637 | $1,237 to $78,452 | Low |
| Traumatic Injury with Mcc | emergency | $5,703 | $3,196 to $14,670 | Low |
| Other Skin, Subcutaneous Tissue and Breast Procedures without Cc/mcc | other | $5,801 | $3,600 to $12,951 | Low |
| Pneumothorax with Cc | other | $5,811 | $3,196 to $9,866 | Low |
| Kidney Stone Removal | other | $5,999 | $1,704 to $8,570 | High |
| Lithotripsy-s/w | other | $5,999 | $1,704 to $8,570 | Low |
| Heart Failure and Shock without CC/MCC | cardiac | $6,000 | $1,598 to $8,571 | Low |
| Penis Procedures with Cc/mcc | other | $6,079 | $3,600 to $20,885 | Low |
| Respiratory Infections and Inflammations without Cc/mcc | other | $6,128 | $1,598 to $8,755 | Low |
| COPD Management | other | $6,357 | $121 to $14,240 | High |
| COPD without CC/MCC | other | $6,357 | $4,627 to $9,081 | Low |
| Other Factors Influencing Health Status | other | $6,382 | $1,838 to $9,117 | Low |
| Cardiac Arrhythmia and Conduction Disorders without Cc/mcc | cardiac | $6,401 | $3,196 to $9,145 | Low |
| Major Skin Disorders without Mcc | other | $6,511 | $4,522 to $9,715 | Low |
| Other Antepartum Diagnoses with O.r. Procedures with Mcc | other | $6,587 | $1,800 to $15,149 | Low |
| Injection, Calcitonin Salmon, Up to 400 Units | other | $6,749 | $1,917 to $9,641 | Low |
| Other Antepartum Diagnoses without O.r. Procedures with Mcc | other | $6,757 | $4,794 to $10,792 | Low |
| Diabetes without Cc/mcc | other | $6,828 | $3,196 to $9,754 | Low |
| Bone Diseases and Arthropathies with Mcc | other | $6,844 | $1,598 to $11,634 | Low |
| Connective Tissue Disorders with Cc | other | $6,880 | $1,598 to $10,351 | Low |
| Fever and Inflammatory Conditions | other | $6,945 | $1,598 to $9,921 | Low |
| Acute Myocardial Infarction Discharged Alive with CC | cardiac | $7,033 | $4,794 to $10,047 | Low |
| Acute Myocardial Infarction, Expired with Mcc | other | $7,482 | $1,598 to $17,777 | Low |
| Minor Skin Disorders without Mcc | other | $7,817 | $4,794 to $11,167 | Low |
| Inflammation of the Male Reproductive System with Mcc | other | $7,822 | $1,598 to $13,309 | Low |
| Cardiac Congenital and Valvular Disorders without Mcc | cardiac | $7,949 | $1,598 to $11,355 | Low |
| Multiple Sclerosis and Cerebellar Ataxia with Cc | other | $7,988 | $6,392 to $11,411 | Low |
| Malignancy, Female Reproductive System with Cc | other | $8,269 | $3,196 to $11,813 | Low |
| Disorders of Liver Except Malignancy, Cirrhosis OR Alcoholic Hepatitis with Cc | other | $8,350 | $3,196 to $11,929 | Low |
| Dental and Oral Diseases without Cc/mcc | other | $8,430 | $3,665 to $12,043 | Low |
| Inflammation of the Male Reproductive System without Mcc | other | $8,459 | $4,647 to $12,085 | Low |
| Viral Illness without Mcc | other | $8,568 | $3,985 to $12,240 | Low |
| Dental and Oral Diseases with Cc | other | $8,709 | $4,794 to $12,441 | Low |
| HIV with Major Related Condition with Cc | other | $8,765 | $4,794 to $12,522 | Low |
| Nervous System Neoplasms with Mcc | other | $8,809 | $1,598 to $13,704 | Low |
| Non-extensive Burns | other | $8,817 | $6,392 to $18,488 | Low |
| Simple Pneumonia without CC/MCC | other | $8,923 | $3,196 to $12,747 | Low |
| Injection, Prothrombin Complex Concentrate, Human-lans, Per I.u. of Factor Ix... | other | $8,938 | $2 to $12,768 | Low |
| Prothrombin Complex Concentrate (human), Kcentra, Per I.u. of Factor Ix Activity | other | $8,938 | $2 to $12,768 | Low |
| Alcohol/Drug Abuse or Dependence without Rehabilitation without MCC | therapy | $8,959 | $2,521 to $12,799 | Low |
| Renal Failure without CC/MCC | other | $9,070 | $1,598 to $12,958 | Low |
| Inflammatory Bowel Disease without Cc/mcc | other | $9,228 | $3,196 to $13,182 | Low |
| Other Kidney and Urinary Tract Diagnoses without Cc/mcc | other | $9,255 | $3,196 to $13,221 | Low |
| C-Section (Cesarean Delivery) | obstetric | $9,266 | $3,273 to $19,997 | High |
| Gastrointestinal Obstruction without Cc/mcc | other | $9,367 | $3,538 to $13,382 | Low |
| Other Myeloproliferative Disorders OR Poorly Differentiated Neoplastic Diagno... | other | $9,446 | $4,794 to $13,494 | Low |
| Atherosclerosis without Mcc | other | $9,524 | $3,196 to $13,606 | Low |
| Bacterial and Tuberculous Infections of Nervous System without Cc/mcc | other | $9,590 | $7,023 to $23,148 | Low |
| Bone Diseases and Arthropathies without Mcc | other | $9,717 | $6,331 to $13,881 | Low |
| Trauma to the Skin, Subcutaneous Tissue and Breast without Mcc | emergency | $9,829 | $5,656 to $14,042 | Low |
| Wound Debridements for Injuries with Cc | other | $9,857 | $9,736 to $17,182 | Low |
| Acute Leukemia with Cc | other | $9,929 | $1,598 to $25,490 | Low |
| Diabetes with Cc | other | $9,950 | $5,397 to $14,214 | Low |
| COPD with MCC | other | $9,968 | $6,392 to $14,240 | Low |
| Pulmonary Embolism without MCC | other | $9,984 | $4,794 to $14,263 | Low |
| Poisoning and Toxic Effects of Drugs without MCC | emergency | $10,012 | $4,916 to $14,303 | Low |
| Septic Arthritis with Cc | other | $10,050 | $7,023 to $14,357 | Low |
| Degenerative Nervous System Disorders without Mcc | other | $10,063 | $4,794 to $14,376 | Low |
| Hypertensive Encephalopathy with Cc | other | $10,097 | $4,794 to $14,425 | Low |
| Aftercare, Musculoskeletal System and Connective Tissue with Cc | other | $10,137 | $6,392 to $14,482 | Low |
| Other Musculoskeletal System and Connective Tissue Diagnoses without Cc/mcc | other | $10,139 | $3,196 to $14,485 | Low |
| Cellulitis without Mcc | other | $10,230 | $4,556 to $14,614 | Low |
| Fractures of Hip and Pelvis without Mcc | other | $10,234 | $6,392 to $14,620 | Low |
| Sprains, Strains, and Dislocations of Hip, Pelvis and Thigh without Cc/mcc | other | $10,243 | $5,877 to $14,632 | Low |
| Respiratory Neoplasms with Cc | other | $10,320 | $1,598 to $14,743 | Low |
| Hypertension without Mcc | other | $10,488 | $5,463 to $14,982 | Low |
| Disorders of the Biliary Tract without Cc/mcc | other | $10,589 | $4,794 to $15,128 | Low |
| Other Musculoskeletal System and Connective Tissue Diagnoses with Mcc | other | $10,635 | $6,392 to $15,193 | Low |
| Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders with Mcc | other | $10,708 | $3,196 to $15,297 | Low |
| Tendonitis, Myositis and Bursitis without Mcc | other | $10,782 | $4,439 to $15,404 | Low |
| Cardiac Arrhythmia and Conduction Disorders with Cc | cardiac | $10,823 | $4,794 to $15,462 | Low |
| Pulmonary Embolism with MCC | other | $10,937 | $4,794 to $15,624 | Low |
| Endocrine Disorders with Cc | other | $11,202 | $6,164 to $16,003 | Low |
| Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes wit... | other | $11,260 | $5,326 to $16,086 | Low |
| Gastrointestinal Hemorrhage without Cc/mcc | other | $11,410 | $3,196 to $16,300 | Low |
| Cardiac Congenital and Valvular Disorders with Mcc | cardiac | $11,465 | $4,794 to $16,378 | Low |
| Malignancy of Hepatobiliary System OR Pancreas with Cc | other | $11,471 | $6,808 to $16,387 | Low |
| Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh ... | other | $11,499 | $4,794 to $16,427 | Low |
| Heart Failure and Shock with CC | cardiac | $11,503 | $4,794 to $16,433 | Low |
| Kidney and Urinary Tract Infections without MCC | other | $11,506 | $4,748 to $16,437 | Low |
| Inflammatory Bowel Disease with Cc | other | $11,512 | $4,794 to $16,446 | Low |
| Disorders of Pancreas Except Malignancy with Cc | other | $11,553 | $6,329 to $16,505 | Low |
| Cardiac Arrhythmia and Conduction Disorders with Mcc | cardiac | $11,615 | $6,392 to $16,593 | Low |
| Simple Pneumonia with CC | other | $11,748 | $5,250 to $16,783 | Low |
| Fractures of Hip and Pelvis with Mcc | other | $11,753 | $3,196 to $16,790 | Low |
| Syncope and Collapse | other | $11,757 | $4,794 to $16,796 | Low |
| Peripheral Vascular Disorders with Cc | other | $11,785 | $4,794 to $16,835 | Low |
| COPD with CC | other | $11,804 | $5,789 to $16,862 | Low |
| Kidney and Ureter Procedures for Non-neoplasm without Cc/mcc | other | $11,808 | $5,400 to $16,869 | Low |
| Major Hematological and Immunological Diagnoses Except Sickle Cell Crisis and... | other | $11,831 | $1,598 to $16,902 | Low |
| Multiple Sclerosis and Cerebellar Ataxia without Cc/mcc | other | $11,837 | $6,618 to $16,911 | Low |
| Other Injury, Poisoning and Toxic Effect Diagnoses without Mcc | other | $11,905 | $3,196 to $17,008 | Low |
| Other Musculoskeletal System and Connective Tissue O.r. Procedures with Cc | other | $11,918 | $5,400 to $18,650 | Low |
| Traumatic Injury without Mcc | emergency | $11,935 | $5,004 to $38,651 | Low |
| Renal Failure with CC | other | $11,997 | $5,571 to $17,139 | Low |
| Pulmonary Edema and Respiratory Failure | other | $12,015 | $7,023 to $17,165 | Low |
| Skin Ulcers with Cc | other | $12,064 | $7,023 to $17,234 | Low |
| Other Digestive System O.r. Procedures without Cc/mcc | other | $12,066 | $3,600 to $17,237 | Low |
| Organic Disturbances and Intellectual Disability | other | $12,076 | $7,023 to $17,251 | Low |
| Intracranial Hemorrhage or Cerebral Infarction with CC | other | $12,159 | $4,794 to $17,370 | Low |
| Bronchitis and Asthma with Cc/mcc | other | $12,251 | $3,196 to $17,501 | Low |
| Cranial and Peripheral Nerve Disorders without Mcc | other | $12,252 | $4,794 to $17,503 | Low |
| Peripheral Vascular Disorders with Mcc | other | $12,301 | $3,196 to $17,573 | Low |
| Peripheral, Cranial Nerve and Other Nervous System Procedures with Cc OR Peri... | other | $12,350 | $5,400 to $19,733 | Low |
| Acute Adjustment Reaction and Psychosocial Dysfunction | other | $12,361 | $5,043 to $17,658 | Low |
| Esophagitis and GI Disorders with MCC | other | $12,402 | $4,632 to $17,717 | Low |
| Hypertension with Mcc | other | $12,456 | $6,392 to $17,794 | Low |
| Otitis Media and Uri with Mcc | other | $12,489 | $6,801 to $17,841 | Low |
| Interstitial Lung Disease with Mcc | other | $12,613 | $6,392 to $18,018 | Low |
| Soft Tissue Procedures without Cc/mcc | other | $12,662 | $1,800 to $18,088 | Low |
| Other Ear, Nose, Mouth and Throat Diagnoses with Cc | other | $12,704 | $4,670 to $18,149 | Low |
| Disorders of the Biliary Tract with Cc | other | $12,724 | $3,196 to $18,177 | Low |
| Pneumothorax with Mcc | other | $12,726 | $4,794 to $18,181 | Low |
| Knee Procedures without Principal Diagnosis of Infection with Cc/mcc | other | $12,755 | $3,600 to $18,222 | Low |
| Disorders of Pancreas Except Malignancy without Cc/mcc | other | $12,781 | $3,196 to $18,258 | Low |
| Other Kidney and Urinary Tract Diagnoses with Cc | other | $12,810 | $6,408 to $18,300 | Low |
| Pathological Fractures and Musculoskeletal and Connective Tissue Malignancy w... | other | $12,872 | $6,392 to $18,389 | Low |
| Lymphoma and Non-acute Leukemia with Cc | other | $12,970 | $3,196 to $18,528 | Low |
| Urinary Stones with Mcc | other | $13,153 | $4,794 to $18,791 | Low |
| Gastrointestinal Obstruction with Cc | other | $13,232 | $4,794 to $18,903 | Low |
| Seizures without MCC | other | $13,300 | $4,556 to $19,000 | Low |
| Foot Procedures with Cc | other | $13,402 | $7,200 to $19,146 | Low |
| Poisoning and Toxic Effects of Drugs with MCC | emergency | $13,540 | $4,556 to $19,343 | Low |
| Benign Prostatic Hypertrophy with Mcc | other | $13,541 | $4,794 to $19,344 | Low |
| Other Disorders of Nervous System with Cc | other | $13,562 | $4,794 to $19,374 | Low |
| Inborn and Other Disorders of Metabolism | other | $13,580 | $1,598 to $19,400 | Low |
| Nervous System Neoplasms without Mcc | other | $13,626 | $5,452 to $19,466 | Low |
| Seizures with Mcc | other | $13,785 | $4,794 to $19,693 | Low |
| Respiratory Infections and Inflammations with Cc | other | $13,853 | $4,794 to $19,791 | Low |
| Other Digestive System Diagnoses with Cc | other | $13,894 | $6,022 to $19,849 | Low |
| Gastrointestinal Obstruction with Mcc | other | $13,934 | $4,794 to $19,906 | Low |
| Stomach, Esophageal and Duodenal Procedures without Cc/mcc | other | $14,094 | $6,501 to $20,134 | Low |
| Kidney and Urinary Tract Infections with MCC | other | $14,140 | $7,023 to $20,200 | Low |
| Cranial and Peripheral Nerve Disorders with Mcc | other | $14,141 | $6,392 to $20,201 | Low |
| Simple Pneumonia with MCC | other | $14,186 | $7,023 to $20,266 | Low |
| Other Digestive System Diagnoses with Mcc | other | $14,214 | $6,392 to $20,306 | Low |
| Heart Failure and Shock with MCC | cardiac | $14,229 | $7,023 to $20,328 | Low |
| Intracranial Hemorrhage or Cerebral Infarction | other | $14,259 | $6,392 to $20,369 | Low |
| Other Digestive System Diagnoses without Cc/mcc | other | $14,314 | $1,598 to $20,448 | Low |
| Amputation for Circulatory System Disorders Except Upper Limb and Toe with Cc | other | $14,395 | $7,200 to $25,582 | Low |
| Upper Limb and Toe Amputation for Circulatory System Disorders with Cc | other | $14,447 | $5,400 to $20,639 | Low |
| Other Circulatory System Diagnoses with Cc | other | $14,510 | $7,023 to $20,728 | Low |
| Acute Myocardial Infarction Discharged Alive with MCC | cardiac | $14,536 | $4,794 to $20,765 | Low |
| Major Chest Trauma with Mcc | emergency | $14,555 | $6,392 to $20,793 | Low |
| Precerebral Occlusion without Infarction with Mcc | other | $14,661 | $7,023 to $20,944 | Low |
| Acute Myocardial Infarction Discharged Alive without CC/MCC | cardiac | $14,764 | $5,762 to $21,091 | Low |
| Breast Biopsy | other | $14,772 | $54 to $21,103 | High |
| Breast Biopsy, Local Excision and Other Breast Procedures with Cc/mcc | surgery | $14,772 | $5,400 to $21,103 | Low |
| Traumatic Stupor and Coma >1 Hour with Cc | emergency | $14,798 | $3,196 to $21,140 | Low |
| Appendectomy (Laparoscopic) | surgery | $14,862 | $1,800 to $21,231 | High |
| Appendix Procedures without Cc/mcc | other | $14,891 | $1,800 to $21,272 | Low |
| Lymphoma and Non-acute Leukemia with Mcc | other | $14,933 | $4,794 to $29,032 | Low |
| Inflammatory Bowel Disease with Mcc | other | $14,987 | $7,023 to $21,410 | Low |
| Hand OR Wrist Procedures, Except Major Thumb OR Joint Procedures with Cc/mcc | other | $15,034 | $9,000 to $21,477 | Low |
| Hernia Procedures Except Inguinal and Femoral without Cc/mcc | other | $15,155 | $1,800 to $21,650 | Low |
| Benign Prostatic Hypertrophy without Mcc | other | $15,158 | $3,196 to $21,655 | Low |
| Diabetes with Mcc | other | $15,215 | $6,392 to $21,735 | Low |
| Degenerative Nervous System Disorders with Mcc | other | $15,221 | $6,392 to $24,915 | Low |
| Reticuloendothelial and Immunity Disorders with Cc | other | $15,324 | $3,196 to $21,891 | Low |
| Other Skin, Subcutaneous Tissue and Breast Procedures with Cc | other | $15,606 | $7,200 to $22,294 | Low |
| Septicemia or Severe Sepsis without Ventilator 96+ Hours without MCC | other | $15,845 | $6,440 to $22,636 | Low |
| Other Cerebrovascular Disorders without Cc/mcc | other | $15,939 | $3,196 to $22,770 | Low |
| Medical Back Problems without Mcc | other | $16,021 | $6,197 to $22,888 | Low |
| Hip and Femur Procedures except Major Joint without CC/MCC | surgery | $16,044 | $3,600 to $22,921 | Low |
| Pleural Effusion with Mcc | surgery | $16,095 | $7,023 to $22,993 | Low |
| Renal Failure with MCC | other | $16,106 | $7,023 to $23,008 | Low |
| Appendix Procedures with Cc | other | $16,235 | $3,600 to $23,193 | Low |
| Postpartum and Post Abortion Diagnoses with O.r. Procedures | obstetric | $16,351 | $5,400 to $23,358 | Low |
| Reticuloendothelial and Immunity Disorders with Mcc | other | $16,419 | $1,598 to $23,455 | Low |
| Traumatic Stupor and Coma <1 Hour with Mcc | emergency | $16,503 | $7,023 to $23,576 | Low |
| Complicated Peptic Ulcer without Cc/mcc | other | $16,572 | $4,967 to $23,674 | Low |
| Other Kidney and Urinary Tract Diagnoses with Mcc | other | $16,590 | $7,023 to $23,700 | Low |
| Skin Debridement without Cc/mcc | other | $16,640 | $6,601 to $23,771 | Low |
| Respiratory Infections with MCC | other | $16,806 | $7,023 to $24,008 | Low |
| Headaches without Mcc | other | $17,008 | $1,598 to $24,297 | Low |
| Injection, Tenecteplase, 1 Mg | other | $17,020 | $172 to $24,314 | Low |
| Nutritional and Metabolic Disorders without MCC | other | $17,046 | $6,392 to $24,352 | Low |
| Minor Small and Large Bowel Procedures without Cc/mcc | other | $17,061 | $1,800 to $24,373 | Low |
| Transient Ischemia | other | $17,156 | $3,196 to $24,508 | Low |
| Alcohol, Drug Abuse OR Dependence without Rehabilitation Therapy with Mcc | therapy | $17,249 | $6,724 to $24,641 | Low |
| Major Small and Large Bowel Procedures without CC/MCC | surgery | $17,385 | $7,200 to $24,836 | Low |
| Gallbladder Removal (Laparoscopic) | surgery | $17,432 | $3,600 to $30,072 | High |
| Laparoscopic Cholecystectomy without CC/MCC | surgery | $17,432 | $3,600 to $24,903 | Low |
| Digestive Malignancy with Cc | other | $17,560 | $3,196 to $25,086 | Low |
| Tendonitis, Myositis and Bursitis with Mcc | other | $17,563 | $7,023 to $25,090 | Low |
| Inguinal and Femoral Hernia Procedures with Cc | other | $17,630 | $3,600 to $25,185 | Low |
| Complications of Treatment with Cc | other | $17,763 | $7,023 to $25,376 | Low |
| Non-extensive O.r. Procedures Unrelated to Principal Diagnosis with Cc | other | $17,886 | $7,200 to $25,551 | Low |
| Anal and Stomal Procedures with Cc | other | $17,893 | $3,600 to $25,561 | Low |
| Nontraumatic Stupor and Coma with Mcc | emergency | $17,979 | $6,392 to $25,684 | Low |
| Prostatectomy | other | $18,200 | $7,200 to $25,999 | High |
| Transurethral Prostatectomy with Cc/mcc | other | $18,200 | $7,200 to $25,999 | Low |
| Endocrine Disorders with Mcc | other | $18,308 | $6,392 to $26,154 | Low |
| Disorders of Liver Except Malignancy, Cirrhosis OR Alcoholic Hepatitis with Mcc | other | $18,385 | $6,392 to $26,265 | Low |
| Other Cerebrovascular Disorders with Cc | other | $18,455 | $4,556 to $26,364 | Low |
| Injection, Alteplase Recombinant, 1 Mg | other | $18,481 | $94 to $26,401 | Low |
| Complicated Peptic Ulcer with Cc | other | $18,543 | $3,196 to $26,490 | Low |
| Skin Grafts and Wound Debridement for Endocrine, Nutritional and Metabolic Di... | lab | $18,573 | $9,000 to $26,532 | Low |
| Hand Procedures for Injuries | other | $18,784 | $7,200 to $26,834 | Low |
| Red Blood Cell Disorders without Mcc | other | $18,810 | $6,034 to $26,871 | Low |
| Other Musculoskeletal System and Connective Tissue Diagnoses with Cc | other | $18,909 | $7,023 to $27,013 | Low |
| Shoulder, Elbow OR Forearm Procedures, Except Major Joint Procedures without ... | other | $19,077 | $5,400 to $27,254 | Low |
| Other Multiple Significant Trauma with Cc | emergency | $19,088 | $4,794 to $27,269 | Low |
| GI Hemorrhage with CC | other | $19,116 | $6,392 to $27,308 | Low |
| Other Infectious and Parasitic Diseases Diagnoses with Mcc | other | $19,163 | $7,023 to $27,376 | Low |
| Uncomplicated Peptic Ulcer with Mcc | other | $19,198 | $5,591 to $27,426 | Low |
| Rectal Resection without Cc/mcc | other | $19,291 | $3,600 to $27,558 | Low |
| Cirrhosis and Alcoholic Hepatitis with Mcc | other | $19,369 | $7,023 to $27,670 | Low |
| Connective Tissue Disorders with Mcc | other | $19,406 | $7,023 to $27,722 | Low |
| Skin Debridement with Mcc | other | $19,409 | $9,736 to $27,728 | Low |
| Rectal Resection with Cc | other | $19,486 | $7,200 to $27,837 | Low |
| Transurethral Procedures with Mcc | other | $19,680 | $9,736 to $28,114 | Low |
| Other Circulatory System O.r. Procedures | other | $19,768 | $9,736 to $29,981 | Low |
| Other Disorders of Nervous System with Mcc | other | $19,871 | $4,556 to $28,388 | Low |
| Aftercare, Musculoskeletal System and Connective Tissue with Mcc | other | $20,013 | $7,023 to $28,590 | Low |
| Other Digestive System O.r. Procedures with Cc | other | $20,247 | $9,000 to $28,924 | Low |
| Kidney and Urinary Tract Neoplasms with Cc | other | $20,336 | $6,392 to $29,052 | Low |
| Psychoses | therapy | $20,481 | $7,023 to $29,259 | Low |
| Urethral Procedures with Cc/mcc | other | $20,592 | $5,400 to $29,417 | Low |
| Other Digestive System O.r. Procedures with Mcc | other | $20,792 | $3,600 to $39,424 | Low |
| Intracranial Hemorrhage OR Cerebral Infarction with Mcc | other | $20,942 | $6,392 to $29,917 | Low |
| Major Gastrointestinal Disorders and Peritoneal Infections with Cc | other | $20,984 | $6,358 to $29,977 | Low |
| Abortion with D&c, Aspiration Curettage OR Hysterotomy | other | $21,035 | $3,600 to $30,050 | Low |
| Laparoscopic Cholecystectomy without Common Duct with CC | surgery | $21,051 | $7,200 to $30,072 | Low |
| Major Esophageal Disorders with Cc | other | $21,186 | $4,794 to $30,266 | Low |
| Kidney and Ureter Procedures for Non-neoplasm with Cc | other | $21,400 | $7,722 to $30,572 | Low |
| Other Cerebrovascular Disorders with Mcc | other | $21,420 | $7,023 to $30,599 | Low |
| Skin Ulcers with Mcc | other | $21,587 | $7,023 to $30,839 | Low |
| Aftercare, Musculoskeletal System and Connective Tissue without Cc/mcc | other | $21,625 | $6,559 to $30,893 | Low |
| Respiratory Neoplasms with Mcc | other | $21,666 | $6,392 to $30,952 | Low |
| Upper Limb and Toe Amputation for Circulatory System Disorders with Mcc | other | $21,744 | $9,736 to $31,062 | Low |
| Soft Tissue Procedures with Cc | other | $21,998 | $9,736 to $31,426 | Low |
| Vagina, Cervix and Vulva Procedures with Cc/mcc | other | $22,585 | $8,184 to $32,264 | Low |
| Cirrhosis and Alcoholic Hepatitis with Cc | other | $22,593 | $7,023 to $32,275 | Low |
| Amputation of Lower Limb for Endocrine, Nutritional and Metabolic Disorders w... | lab | $22,740 | $9,736 to $32,485 | Low |
| Local Excision and Removal of Internal Fixation Devices of Hip and Femur with... | surgery | $23,018 | $7,200 to $32,883 | Low |
| Kidney and Urinary Tract Signs and Symptoms without Mcc | other | $23,132 | $4,496 to $33,046 | Low |
| Infectious and Parasitic Diseases with O.r. Procedures with Cc | other | $23,202 | $5,629 to $33,146 | Low |
| Amputation for Circulatory System Disorders Except Upper Limb and Toe with Mcc | other | $23,463 | $9,736 to $44,171 | Low |
| Extensive O.r. Procedures Unrelated to Principal Diagnosis without Cc/mcc | other | $23,637 | $1,800 to $33,767 | Low |
| Septicemia or Severe Sepsis without Ventilator 96+ Hours with MCC | other | $23,692 | $7,023 to $33,845 | Low |
| Biliary Tract Procedures Except Only Cholecystectomy with OR without C.d.e. w... | other | $23,883 | $7,200 to $34,119 | Low |
| Respiratory System Diagnosis with Ventilator Support <=96 Hours | other | $23,905 | $4,794 to $34,149 | Low |
| Other Circulatory System Diagnoses with Mcc | other | $23,936 | $6,392 to $34,194 | Low |
| Major Thumb OR Joint Procedures | other | $24,164 | $8,590 to $34,520 | Low |
| Wound Debridement and Skin Graft Except Hand for Musculoskeletal and Connecti... | other | $24,457 | $9,736 to $34,938 | Low |
| Other O.r. Procedures for Injuries with Cc | other | $24,466 | $9,736 to $34,952 | Low |
| Hip and Femur Procedures except Major Joint with CC | surgery | $24,599 | $9,736 to $35,142 | Low |
| Postoperative and Post-traumatic Infections with Mcc | emergency | $24,711 | $4,794 to $35,302 | Low |
| Other Endocrine, Nutritional and Metabolic O.r. Procedures with Cc | lab | $24,898 | $9,736 to $35,569 | Low |
| Malignancy, Male Reproductive System with Cc | other | $25,068 | $1,598 to $35,812 | Low |
| Postoperative OR Post-traumatic Infections with O.r. Procedures with Mcc | emergency | $25,114 | $9,000 to $40,823 | Low |
| Lower Extremity and Humerus Procedures Except Hip, Foot and Femur without Cc/mcc | other | $25,116 | $7,200 to $35,880 | Low |
| Peritoneal Adhesiolysis with Mcc | other | $25,192 | $7,200 to $35,988 | Low |
| Major Gastrointestinal Disorders and Peritoneal Infections with Mcc | other | $25,219 | $6,392 to $36,027 | Low |
| Cellulitis with Mcc | other | $25,253 | $7,023 to $36,076 | Low |
| Stomach, Esophageal and Duodenal Procedures with Mcc | other | $25,501 | $9,000 to $44,761 | Low |
| GI Hemorrhage with MCC | other | $25,831 | $7,023 to $36,901 | Low |
| Total Hip Replacement | surgery | $26,130 | $4,424 to $37,328 | High |
| Major Small and Large Bowel Procedures with MCC | surgery | $26,217 | $7,200 to $41,252 | Low |
| Hypertensive Encephalopathy with Mcc | other | $26,265 | $7,023 to $37,522 | Low |
| Other Multiple Significant Trauma without Cc/mcc | emergency | $26,312 | $5,507 to $37,588 | Low |
| Skin Debridement with Cc | other | $26,494 | $9,736 to $37,848 | Low |
| Coagulation Disorders | other | $26,588 | $7,023 to $37,983 | Low |
| Testes Procedures with Cc/mcc | other | $26,630 | $9,736 to $38,043 | Low |
| Postoperative OR Post-traumatic Infections with O.r. Procedures with Cc | emergency | $26,942 | $9,736 to $38,488 | Low |
| Fractures of Femur without Mcc | other | $26,998 | $4,765 to $38,569 | Low |
| Major Small and Large Bowel Procedures with CC | surgery | $27,241 | $9,000 to $38,916 | Low |
| Digestive Malignancy with Mcc | other | $27,710 | $4,794 to $39,586 | Low |
| Disorders of Pancreas Except Malignancy with Mcc | other | $28,282 | $7,023 to $40,403 | Low |
| Prostatectomy with Mcc | other | $28,524 | $7,200 to $40,748 | Low |
| D&c, Conization, Laparoscopy and Tubal Interruption with Cc/mcc | surgery | $28,790 | $5,400 to $41,129 | Low |
| Minor Small and Large Bowel Procedures with Cc | other | $28,869 | $8,031 to $41,241 | Low |
| Other Disorders of the Eye with Mcc OR Thrombolytic Agent | other | $29,338 | $7,023 to $41,912 | Low |
| Other Kidney and Urinary Tract Procedures with Cc | other | $29,716 | $9,736 to $42,452 | Low |
| Red Blood Cell Disorders with Mcc | other | $29,840 | $7,023 to $42,629 | Low |
| Extensive O.r. Procedures Unrelated to Principal Diagnosis with Mcc | other | $30,019 | $9,736 to $42,884 | Low |
| Soft Tissue Procedures with Mcc | other | $30,125 | $9,736 to $43,036 | Low |
| Appendix Procedures with Mcc | other | $31,075 | $7,200 to $44,393 | Low |
| Postoperative and Post-traumatic Infections without Mcc | emergency | $31,775 | $5,274 to $45,393 | Low |
| Extensive O.r. Procedures Unrelated to Principal Diagnosis with Cc | other | $32,021 | $9,736 to $45,744 | Low |
| Kidney and Ureter Procedures for Non-neoplasm with Mcc | other | $32,391 | $9,736 to $46,272 | Low |
| Other Endocrine, Nutritional and Metabolic O.r. Procedures with Mcc | lab | $33,582 | $9,736 to $47,974 | Low |
| Hip and Femur Procedures except Major Joint with MCC | surgery | $33,612 | $9,736 to $48,017 | Low |
| Osteomyelitis with Mcc | other | $33,778 | $7,023 to $48,254 | Low |
| Major Hip and Knee Joint Replacement without MCC | surgery | $34,269 | $7,200 to $48,956 | Low |
| Total Knee Replacement | surgery | $34,269 | $3,600 to $48,956 | High |
| Other Respiratory System Diagnoses with Mcc | other | $37,237 | $7,023 to $53,196 | Low |
| Infectious and Parasitic Diseases with O.r. Procedures with Mcc | other | $37,250 | $5,629 to $53,214 | Low |
| Splenic Procedures with Mcc | other | $37,543 | $9,736 to $53,634 | Low |
| Minor Bladder Procedures with Mcc | other | $38,886 | $1,800 to $55,552 | Low |
| Septicemia OR Severe Sepsis with Mv >96 Hours | other | $39,704 | $7,023 to $62,031 | Low |
| Malignancy of Hepatobiliary System OR Pancreas with Mcc | other | $40,219 | $7,023 to $57,456 | Low |
| Other Antepartum Diagnoses with O.r. Procedures with Cc | other | $40,566 | $3,600 to $57,952 | Low |
| Hernia Procedures Except Inguinal and Femoral with Cc | other | $41,397 | $9,736 to $59,138 | Low |
| Knee Procedures with Principal Diagnosis of Infection with Mcc | other | $42,530 | $9,736 to $60,757 | Low |
| Limb Reattachment, Hip and Femur Procedures for Multiple Significant Trauma | emergency | $43,246 | $9,736 to $61,779 | Low |
| Other Kidney and Urinary Tract Procedures with Mcc | other | $48,118 | $9,736 to $68,740 | Low |
| Biopsies of Musculoskeletal System and Connective Tissue with Cc | other | $48,663 | $9,736 to $69,519 | Low |
| Non-extensive O.r. Procedures Unrelated to Principal Diagnosis with Mcc | other | $52,341 | $9,736 to $74,772 | Low |
| Peritoneal Adhesiolysis with Cc | other | $52,760 | $9,736 to $75,372 | Low |
| Cervical Spinal Fusion without CC/MCC | surgery | $53,987 | $9,736 to $77,125 | Low |
| Other Skin, Subcutaneous Tissue and Breast Procedures with Mcc | other | $57,111 | $9,736 to $81,587 | Low |
| HIV with Major Related Condition with Mcc | other | $63,957 | $7,023 to $91,367 | Low |
| Albuterol, Up to 2.5 Mg and Ipratropium Bromide, Up to 0.5 Mg, Fda-approved F... | other | N/A | $1 to $2 | Low |
| Azathioprine, Oral, 50 Mg | other | N/A | $1 to $2 | Low |
| Bacitracin Oint 0.9gm | other | N/A | $1 to $2 | Low |
| Hyoscyamine Sulfate 120 Ml Dos | other | N/A | $1 to $2 | Low |
| Injection, Heparin Sodium, (heparin Lock Flush), Per 10 Units | other | N/A | $1 to $2 | Low |
| Injection, Ondansetron Hydrochloride, Per 1 Mg | other | N/A | $1 to $2 | Low |
| Injection, Triamcinolone Acetonide, Not Otherwise Specified, 10 Mg | other | N/A | $1 to $2 | Low |
| Mycophenolate Mofetil, Oral, 250 Mg | other | N/A | $1 to $2 | Low |
| Prednisone, Immediate Release OR Delayed Release, Oral, 1 Mg | other | N/A | $1 to $2 | Low |
| Prescription Drug, Oral, Chemotherapeutic, Nos | other | N/A | $1 to $2 | Low |
| Prochlorperazine Maleate, 5 Mg, Oral, Fda Approved Prescription Anti-emetic, ... | other | N/A | $1 to $2 | Low |
| Smoking Cessation Gum | other | N/A | $1 to $2 | Low |
| Sodium Chloride 0.9% 3 Ml Neb | other | N/A | $1 to $2 | Low |
| Albuterol, Inhalation Solution, Fda-approved Final Product, Non-compounded, A... | other | N/A | $1 to $2 | Low |
| Injection, Midazolam Hydrochloride, Per 1 Mg | other | N/A | $3 to $5 | Low |
| Glutose 15 Gel | other | N/A | $3 to $5 | Low |
| No Charge Item | other | N/A | $1 to $5 | Low |
| Water for Injection Vial | other | N/A | $1 to $6 | Low |
| Suture | other | N/A | $1 to $6 | Low |
| Prednisolone Oral, Per 5 Mg | other | N/A | $1 to $7 | Low |
| Vitamin D12 1.25 Mg Powder Pac | other | N/A | $1 to $7 | Low |
| Noc Drugs, Inhalation Solution Administered Through DME | other | N/A | $1 to $7 | Low |
| Methylprednisolone Oral, Per 4 Mg | other | N/A | $2 to $8 | Low |
| Injection, Lorazepam, 2 Mg | other | N/A | $2 to $9 | Low |
| Injection, Promethazine Hcl, Up to 50 Mg | other | N/A | $2 to $9 | Low |
| Sevelamer 0.8 Gm Powder Packet | other | N/A | $2 to $10 | Low |
| Injection, Metronidazole, 10 Mg | other | N/A | $2 to $10 | Low |
| Injection, Phenytoin Sodium, Per 50 Mg | other | N/A | $2 to $10 | Low |
| Tacrolimus, Immediate Release, Oral, 1 Mg | other | N/A | $2 to $10 | Low |
| Buprenorphine, Oral, 1 Mg | other | N/A | $2 to $10 | Low |
| Loperamide Hcl 1mg/7.5 Ml Ud | other | N/A | $2 to $11 | Low |
| Injection, Meperidine Hydrochloride, Per 100 Mg | other | N/A | $2 to $12 | Low |
| Injection, Morphine Sulfate (fresenius Kabi), Not Therapeutically Equivalent ... | other | N/A | $2 to $13 | Low |
| Injection, Hydromorphone, 0.1 Mg | other | N/A | $3 to $13 | Low |
| Injection, Metoclopramide Hcl, Up to 10 Mg | other | N/A | $3 to $13 | Low |
| Injection, Ziprasidone Mesylate, 10 Mg | other | N/A | $3 to $14 | Low |
| Methotrexate; Oral, 2.5 Mg | other | N/A | $3 to $14 | Low |
| Injection, Dexamethasone Sodium Phosphate, 1 Mg | imaging | N/A | $3 to $14 | Low |
| Injection, Morphine Sulfate, Up to 10 Mg | other | N/A | $3 to $15 | Low |
| Injection, Sterile Cefuroxime Sodium, Per 750 Mg | other | N/A | $3 to $15 | Low |
| Injection, Diphenhydramine Hcl, Up to 50 Mg | other | N/A | $3 to $15 | Low |
| Injection, Midazolam in 0.9% Sodium Chloride, Intravenous, Not Therapeuticall... | other | N/A | $3 to $16 | Low |
| Injection, Ciprofloxacin for Intravenous Infusion, 200 Mg | surgery | N/A | $3 to $17 | Low |
| Patient Care Supplies | other | N/A | $4 to $18 | Low |
| Ure-na 15 Gram Powder Packet | other | N/A | $4 to $18 | Low |
| Injection, Acetylcysteine, 100 Mg | other | N/A | $4 to $18 | Low |
| Viscous Lidocaine 2% 15ml Udcu | other | N/A | $4 to $19 | Low |
| Injection, Amiodarone Hydrochloride, 30 Mg | other | N/A | $4 to $19 | Low |
| 5% Dextrose and 0.45% Normal Saline, 1000 Ml | other | N/A | $4 to $20 | Low |
| Dexamethasone, Oral, 0.25 Mg | imaging | N/A | $4 to $20 | Low |
| Injection, Terbutaline Sulfate, Up to 1 Mg | other | N/A | $4 to $20 | Low |
| Injection, Labetalol Hydrochloride, 5 Mg | other | N/A | $4 to $21 | Low |
| Cryoglobulin (protein) Measurement | other | N/A | $4 to $82,595 | Low |
| Red Blood Cell Count, Automated Test | other | N/A | $3 to $85,041 | Low |
| Injection, Nalbuphine Hydrochloride, Per 10 Mg | other | N/A | $4 to $22 | Low |
| Fern Test | other | N/A | $5 to $23 | Low |
| 5% Dextrose/normal Saline | other | N/A | $5 to $24 | Low |
| Injection, Fosphenytoin, 50 Mg Phenytoin Equivalent | other | N/A | $1 to $24 | Low |
| Measurement of Antibody (ige) to Allergic Substance, Crude Allergen Extract, ... | other | N/A | $5 to $86,003 | Low |
| Urine Sulfate (acid) Level | other | N/A | $5 to $84,392 | Low |
| Infusion, Normal Saline Solution, 250 Cc | surgery | N/A | $5 to $25 | Low |
| Cerebrospinal Fluid, OR Amniotic Fluid Albumin (protein) Level | other | N/A | $5 to $82,042 | Low |
| G6pd (enzyme) Level | other | N/A | $5 to $82,955 | Low |
| Injection, Furosemide, 1 Mg | other | N/A | $5 to $25 | Low |
| Insertion of Needle Into Vein for Collection of Blood Sample | other | N/A | $5 to $36,415 | Low |
| Technetium Tc-99m Pertechnetate, Diagnostic, Per Millicurie | other | N/A | $5 to $25 | Low |
| Injection, Meropenem, 100 Mg | other | N/A | $5 to $25 | Low |
| Pantoprazole 40 Mg Inj | other | N/A | $5 to $25 | Low |
| Ringers Lactate Infusion, Up to 1000 Cc | surgery | N/A | $5 to $25 | Low |
| Cath Ua Collection | other | N/A | $5 to $26 | Low |
| Oxygen Per Hour- Subsequent | other | N/A | $5 to $26 | Low |
| Subseq Aerosol O2/hr | other | N/A | $5 to $26 | Low |
| Thrombin Time, Fibrinogen Screening Test, Plasma | preventive | N/A | $5 to $85,670 | Low |
| Injection, Lidocaine Hcl with Epinephrine, 1 Mg | other | N/A | $5 to $26 | Low |
| Injection, Droperidol, Up to 5 Mg | other | N/A | $5 to $26 | Low |
| Blocking Needle | other | N/A | $5 to $27 | Low |
| Analysis of Urine, Except Immunoassays | other | N/A | $2 to $81,005 | Low |
| Subseq Oxy Hood Q Hr | other | N/A | $5 to $27 | Low |
| Injection, Digoxin, Up to 0.5 Mg | other | N/A | $5 to $28 | Low |
| Chlorhexidine Gluconate 4% Liq | other | N/A | $5 to $28 | Low |
| Benzocaine 20 % Gel | other | N/A | $6 to $28 | Low |
| Injection, Gadolinium-based Magnetic Resonance Contrast Agent, Not Otherwise ... | other | N/A | $6 to $29 | Low |
| 5% Dextrose/water | other | N/A | $6 to $29 | Low |
| Parenteral Nutrition Solution: Carbohydrates (dextrose), 50% OR Less (500 Ml ... | other | N/A | $6 to $29 | Low |
| Ocycodone Hcl 5mg/5 Ml Soln | other | N/A | $6 to $30 | Low |
| 5% Dextrose in Lactated Ringers Infusion, Up to 1000 Cc | surgery | N/A | $6 to $30 | Low |
| Concentration of Specimen for Infectious Agents | lab | N/A | $6 to $87,015 | Low |
| Injection, Levofloxacin, 250 Mg | other | N/A | $6 to $30 | Low |
| Urine Volume Measurement | other | N/A | $4 to $81,050 | Low |
| Injection, Adenosine, 1 Mg | other | N/A | $6 to $30 | Low |
| Injection, Haloperidol, Up to 5 Mg | other | N/A | $6 to $30 | Low |
| Injection, Prochlorperazine, Up to 10 Mg | other | N/A | $6 to $30 | Low |
| Injection, Azithromycin, 500 Mg | other | N/A | $6 to $30 | Low |
| Dextrose 10%-water IV Solution | other | N/A | $6 to $32 | Low |
| Hypertonic Saline Solution, 1 Ml | other | N/A | $6 to $32 | Low |
| Lidocaine Jell Ur | other | N/A | $6 to $32 | Low |
| Chemotherapy Administration | other | N/A | $1 to $32 | High |
| Chlorpromazine Hydrochloride, 5 Mg, Oral, Fda Approved Prescription Anti-emet... | other | N/A | $6 to $32 | Low |
| Confirmation Test for Antibody to Borrelia Burgdorferi | other | N/A | $6 to $86,617 | Low |
| Therapy Procedure for Nutrition Management with Group, Each 30 Minutes | other | N/A | $6 to $97,804 | Low |
| Injection, Octreotide, Non-depot Form for Subcutaneous OR Intravenous Injecti... | other | N/A | $6 to $33 | Low |
| Injection, Ketorolac Tromethamine, Per 15 Mg | other | N/A | $23 to $33 | Low |
| Blood Potassium Level | other | N/A | $5 to $84,132 | Low |
| Injection, Bupivicaine, Not Otherwise Specified, 0.5 Mg | other | N/A | $7 to $34 | Low |
| Injection, Lidocaine Hcl in 5% Dextrose, 1 Mg | other | N/A | $7 to $34 | Low |
| Injection, Lidocaine Hydrochloride, 1 Mg | other | N/A | $7 to $34 | Low |
| Injection, Vitamin B-12 Cyanocobalamin, Up to 1000 Mcg | other | N/A | $7 to $35 | Low |
| Injection, Cefoxitin Sodium, 1 Gm | other | N/A | $7 to $35 | Low |
| Catheter, Ureteral | cardiac | N/A | $7 to $35 | Low |
| Injection, Ceftriaxone Sodium, Per 250 Mg | other | N/A | $7 to $36 | Low |
| Blood Sodium Level | other | N/A | $5 to $84,295 | Low |
| Analysis for Antibody to Brucella | other | N/A | $8 to $86,622 | Low |
| Analysis for Antibody to Coccidioides | other | N/A | $8 to $86,635 | Low |
| Detection Test By Immunoassay Technique for Histoplasma Capsulatum | other | N/A | $8 to $87,385 | Low |
| Specific Gravity (liquid Weight) Measurement | other | N/A | $3 to $84,315 | Low |
| Automated White Blood Cell Count | other | N/A | $3 to $85,048 | Low |
| Clotting Factor X Assessment Test, Diluted | other | N/A | $8 to $85,613 | Low |
| Measurement of Hepatitis a Antibody | other | N/A | $8 to $86,708 | Low |
| Thromboplastin Inhibition (circulating Anticoagulant) Measurement | other | N/A | $8 to $85,705 | Low |
| Transfusion Medicine Procedures | surgery | N/A | $8 to $86,999 | Low |
| Urinalysis | lab | N/A | $2 to $81,003 | High |
| Vitamin E Level | other | N/A | $9 to $84,446 | Low |
| EKG (Electrocardiogram) | cardiac | N/A | $22 to $93,244 | High |
| Chemical Analysis Using Spectrophotometry | other | N/A | $8 to $84,311 | Low |
| Analysis for Antibody to Histoplasma | other | N/A | $10 to $86,698 | Low |
| Detection Test By Immunoassay with Direct Visual Observation for Other Organism | other | N/A | $10 to $87,899 | Low |
| Detection Test By Immunoassay with Direct Visual Observation for Streptococcu... | other | N/A | $10 to $87,802 | Low |
| Red Blood Count, Automated Test | other | N/A | $4 to $85,045 | Low |
| Screening Test for Compatible Blood Unit, Using Patient Serum | preventive | N/A | $10 to $86,904 | Low |
| Analysis for Antibody to Aspergillus | other | N/A | $10 to $86,606 | Low |
| Analysis for Antibody to Blastomyces | other | N/A | $10 to $86,612 | Low |
| Topiramate Level | other | N/A | $11 to $80,201 | Low |
| Analysis for Antibody to Bartonella | other | N/A | $10 to $86,611 | Low |
| Urine Sodium Level | other | N/A | $5 to $84,300 | Low |
| Analysis for Antibody to Virus | other | N/A | $11 to $86,790 | Low |
| Analysis for Antibody to Zika Virus | other | N/A | $11 to $86,794 | Low |
| Detection Test By Immunoassay Technique for Helicobacter Pylori (gi Tract Bac... | other | N/A | $11 to $87,338 | Low |
| Ketone Bodies Analysis, Qualitative | other | N/A | $5 to $82,009 | Low |
| Analysis for Antibody to Hiv-1 and Hiv-2 Virus | other | N/A | $11 to $86,703 | Low |
| Bacterial Culture | lab | N/A | $8 to $87,077 | Low |
| Creatine Kinase (cardiac Enzyme) Level, Total | cardiac | N/A | $7 to $82,550 | Low |
| Hemoglobin A1C | lab | N/A | $10 to $83,036 | High |
| Analysis of Substance Using Immunoassay Technique, Multiple Step Method | other | N/A | $12 to $83,516 | Low |
| Nephelometry, Test Method Using Light | other | N/A | $12 to $83,883 | Low |
| Thyroid Hormone Evaluation | other | N/A | $6 to $84,479 | Low |
| Analysis for Antibody to Cytomegalovirus | other | N/A | $12 to $86,644 | Low |
| Lactate Dehydrogenase (enzyme) Level | other | N/A | $6 to $83,615 | Low |
| Ldl Cholesterol Level | other | N/A | $11 to $83,721 | Low |
| Analysis for Antibody to Parvovirus | other | N/A | $12 to $86,747 | Low |
| Blood Count, Hemoglobin | other | N/A | $2 to $85,018 | Low |
| Measurement of Antibody to Noninfectious Agent | other | N/A | $12 to $86,256 | Low |
| Red Blood Cell Concentration Measurement | other | N/A | $2 to $85,014 | Low |
| Culture for Acid-fast Bacilli | lab | N/A | $11 to $87,116 | Low |
| Special Fluorescent And/or Acid Fast Stain for Microorganism | other | N/A | $5 to $87,206 | Low |
| Detection Test By Immunoassay Technique for Shiga-like Toxin | other | N/A | $12 to $87,427 | Low |
| Islet Cell (pancreas) Antibody Measurement | other | N/A | $12 to $86,341 | Low |
| Nucleotidase 5' (enzyme) Level | other | N/A | $11 to $83,915 | Low |
| Therapy Procedure Reassessment for Nutrition Management, Each 15 Minutes | other | N/A | $12 to $97,803 | Low |
| Measurement of Substance Using Immunoassay Technique | other | N/A | $13 to $83,520 | Low |
| Phosphatase (enzyme) Measurement, Acid, Total | other | N/A | $8 to $84,060 | Low |
| Thyroid Hormone, T3 Measurement, Reverse | other | N/A | $13 to $84,482 | Low |
| Urea Nitrogen Level to Assess Kidney Function, Quantitative | other | N/A | $4 to $84,520 | Low |
| Organic Acids Analysis | other | N/A | $13 to $83,919 | Low |
| Virus Isolation, Centrifuge Enhanced | other | N/A | $13 to $87,254 | Low |
| Amino Acid Analysis, Quantitative, Each Specimen | lab | N/A | $13 to $82,131 | Low |
| Amino Acid Level, 6 OR More Amino Acids, Quantitative, Each Specimen | lab | N/A | $13 to $82,139 | Low |
| Bile Acids Level, Total | other | N/A | $13 to $82,239 | Low |
| Bilirubin Level, Direct | other | N/A | $5 to $82,248 | Low |
| Ige (immune System Protein) Level | other | N/A | $13 to $82,785 | Low |
| Inhibin a (reproductive Organ Hormone) Measurement | other | N/A | $13 to $86,336 | Low |
| Pap Test, Automated Thin Layer Preparation; Automated System and Manual Rescr... | other | N/A | $13 to $88,175 | Low |
| Pinworm Test | other | N/A | $4 to $87,172 | Low |
| Special Gram OR Giemsa Stain for Microorganism | other | N/A | $4 to $87,205 | Low |
| Measurement of Cold Agglutinin (protein) to Screen for Infection OR Disease | other | N/A | $8 to $86,156 | Low |
| Microscopic Examination for White Blood Cells with Manual Cell Count | other | N/A | $4 to $85,007 | Low |
| Crystal Identification From Tissue OR Body Fluid | other | N/A | $7 to $89,060 | Low |
| Cyanocobalamin (vitamin B-12) Level | other | N/A | $13 to $82,607 | Low |
| Measurement of Dna Antibody, Native OR Double Stranded | other | N/A | $13 to $86,225 | Low |
| Preparation of Tissue for Examination By Removing Any Calcium Present | other | N/A | $13 to $88,311 | Low |
| Body Fluid Cell Count | other | N/A | $5 to $89,050 | Low |
| Body Fluid Cell Count with Cell Identification | other | N/A | $6 to $89,051 | Low |
| Ceruloplasmin (protein) Level | other | N/A | $11 to $82,390 | Low |
| Fetal Hemoglobin Analysis | other | N/A | $8 to $83,033 | Low |
| Syphilis Detection Test | other | N/A | $4 to $86,592 | Low |
| Therapy Procedure for Nutrition Management, Each 15 Minutes | other | N/A | $14 to $97,802 | Low |
| Uric Acid Level, Blood | other | N/A | $5 to $84,550 | Low |
| Analysis Using Chemiluminescent Technique (light and Chemical )reaction | other | N/A | $14 to $82,397 | Low |
| Protein Measurement, Body Fluid | other | N/A | $14 to $84,166 | Low |
| Analysis for Antibody to Rubeola | other | N/A | $13 to $86,765 | Low |
| Blood Creatinine Level | other | N/A | $5 to $82,565 | Low |
| Detection Test By Immunoassay with Direct Visual Observation for Influenza Virus | other | N/A | $14 to $87,804 | Low |
| Lactic Acid Level | other | N/A | $12 to $83,605 | Low |
| Special Stain for Parasites | other | N/A | $14 to $87,209 | Low |
| Urine Phosphate Level | other | N/A | $6 to $84,105 | Low |
| Vitamin a Level | other | N/A | $12 to $84,590 | Low |
| Analysis for Antibody to Mumps Virus | other | N/A | $13 to $86,735 | Low |
| Detection Test By Immunoassay Technique for Hepatitis Be Surface Antigen | other | N/A | $12 to $87,350 | Low |
| Hemoglobin Analysis and Measurement, Chromatography | other | N/A | $15 to $83,021 | Low |
| Red Blood Cell Sickling Measurement | other | N/A | $6 to $85,660 | Low |
| Semen Analysis for Sperm Presence | other | N/A | $12 to $89,321 | Low |
| Pathology Examination of Tissue Using a Microscope, Limited Examination | lab | N/A | $15 to $88,300 | Low |
| Evaluation of Antimicrobial Drug | other | N/A | $7 to $87,184 | Low |
| Phosphatase (enzyme) Level, Alkaline | other | N/A | $5 to $84,075 | Low |
| Screening Test for Presence of Antibody | preventive | N/A | $12 to $86,403 | Low |
| Cell Examination of Specimen, Concentration Technique | lab | N/A | $16 to $88,108 | Low |
| Blood Glucose (sugar) Level | other | N/A | $4 to $82,947 | Low |
| Blood Glucose (sugar) Tolerance Test, Each Additional Beyond 3 Specimens | lab | N/A | $4 to $82,952 | Low |
| Carbon Dioxide (bicarbonate) Level | other | N/A | $5 to $82,374 | Low |
| Detection Test By Immunoassay Technique for Giardia | other | N/A | $12 to $87,329 | Low |
| Glucose (sugar) Level On Body Fluid | other | N/A | $4 to $82,945 | Low |
| Hepatitis Be Antibody Measurement | other | N/A | $12 to $86,707 | Low |
| Zinc Level | other | N/A | $11 to $84,630 | Low |
| Pap Test, Manual Screening | preventive | N/A | $16 to $88,142 | Low |
| Screening Examination of Specimen Cells, Screening and Interpretation | lab | N/A | $16 to $88,160 | Low |
| Analysis for Antibody to Toxoplasma | other | N/A | $14 to $86,777 | Low |
| Analysis for Antibody to West Nile Virus | other | N/A | $14 to $86,789 | Low |
| Folic Acid Level, Serum | other | N/A | $15 to $82,746 | Low |
| Immunologic Analysis for Detection of Tumor Antigen, Quantitative; Ca 15 | other | N/A | $16 to $86,300 | Low |
| Screening Examination of Specimen Cells, Extended Study | lab | N/A | $16 to $88,162 | Low |
| Analysis for Antibody to Mycoplasma | other | N/A | $13 to $86,738 | Low |
| Evaluation of Antimicrobial Drug (antibiotic, Antifungal, Antiviral), Microdi... | other | N/A | $9 to $87,186 | Low |
| Phospholipid Test | lab | N/A | $17 to $85,598 | Low |
| Analysis for Antibody to Salmonella | other | N/A | $13 to $86,768 | Low |
| Estrogen Analysis, Total | other | N/A | $17 to $82,672 | Low |
| Measurement C-reactive Protein for Detection of Infection OR Inflammation | other | N/A | $5 to $86,140 | Low |
| Bleeding Time | other | N/A | $5 to $85,002 | Low |
| Copper Level | other | N/A | $12 to $82,525 | Low |
| Measurement of Antibody for Assessment of Autoimmune Disorder, Any Method | other | N/A | $17 to $86,235 | Low |
| Rheumatoid Factor Analysis | other | N/A | $6 to $86,430 | Low |
| Stool Analysis for Blood, By Peroxidase Activity | other | N/A | $4 to $82,272 | Low |
| Urine Calcium Level | other | N/A | $6 to $82,340 | Low |
| Blood Osmolality (concentration) Measurement | other | N/A | $7 to $83,930 | Low |
| Testing for Presence of Drug, Read By Direct Observation | other | N/A | $13 to $80,305 | Low |
| Detection of Antimicrobial Drug | other | N/A | $5 to $87,185 | Low |
| Measurement C-reactive Protein for Detection of Infection OR Inflammation, Hi... | other | N/A | $13 to $86,141 | Low |
| Measurement of Antibody for Rheumatoid Arthritis Assessment | other | N/A | $13 to $86,200 | Low |
| Primidone Level | other | N/A | $17 to $80,188 | Low |
| Thyroid Hormone, T3 Measurement, Total | other | N/A | $14 to $84,480 | Low |
| C-peptide (protein) Level | other | N/A | $18 to $84,681 | Low |
| Cholesterol Level | other | N/A | $4 to $82,465 | Low |
| Digoxin Level, Total | other | N/A | $13 to $80,162 | Low |
| Iron Level | other | N/A | $6 to $83,540 | Low |
| Measurement of Complement Function | other | N/A | $12 to $86,161 | Low |
| Troponin (protein) Analysis, Quantitative | other | N/A | $12 to $84,484 | Low |
| Urine Analysis for Thromboxane | other | N/A | $18 to $84,431 | Low |
| Detection Test By Immunoassay Technique for Hiv-1 Antigen and Hiv-1 and Hiv-2... | other | N/A | $19 to $87,389 | Low |
| Gentamicin (antibiotic) Level | other | N/A | $16 to $80,170 | Low |
| Haloperidol Level | other | N/A | $16 to $80,173 | Low |
| Urea Nitrogen Level to Assess Kidney Function, Urine | other | N/A | $6 to $84,540 | Low |
| Analysis for Antibody (igm) to West Nile Virus | other | N/A | $17 to $86,788 | Low |
| Application of Blood Vessel Compression Device | other | N/A | $12 to $97,016 | Low |
| Chloride Level | other | N/A | $5 to $82,438 | Low |
| Detection Test By Nucleic Acid for Clostridium Difficile, Amplified Probe Tec... | other | N/A | $19 to $87,493 | Low |
| Evaluation for Wheelchair, Each 15 Minutes | other | N/A | $19 to $97,542 | Low |
| Microbial Toxin OR Antitoxin Assay | other | N/A | $19 to $87,230 | Low |
| Mammogram | preventive | N/A | $19 to $77,065 | High |
| Screening 3d Breast Mammography | imaging | N/A | $19 to $77,063 | Low |
| Beta 2 Glycoprotein 1 Antibody (autoantibody) Measurement | other | N/A | $19 to $86,146 | Low |
| Detection Test By Nucleic Acid for Chlamydia Trachomatis, Amplified Probe Tec... | other | N/A | $19 to $87,491 | Low |
| Detection Test By Nucleic Acid for Cytomegalovirus (cmv), Amplified Probe Tec... | other | N/A | $19 to $87,496 | Low |
| Detection Test By Nucleic Acid for Neisseria Gonorrhoeae (gonorrhoeae Bacteri... | other | N/A | $19 to $87,591 | Low |
| Detection Test By Nucleic Acid for Trichomonas Vaginalis (genital Parasite), ... | other | N/A | $19 to $87,661 | Low |
| Nasal Smear for Eosinophils | other | N/A | $6 to $89,190 | Low |
| Red Blood Cell Sedimentation Rate, to Detect Inflammation, Non-automated | other | N/A | $4 to $85,651 | Low |
| Albumin (protein) Level | other | N/A | $5 to $82,040 | Low |
| Analysis for Antibody to Cryptococcus | other | N/A | $14 to $86,641 | Low |
| Blood Chloride Level | other | N/A | $5 to $82,435 | Low |
| Calcium Level, Total | other | N/A | $5 to $82,310 | Low |
| Collagen Cross Links Test | other | N/A | $19 to $82,523 | Low |
| Homocysteine (amino Acid) Level | other | N/A | $18 to $83,090 | Low |
| Programming of Single Lead Pacemaker System | cardiac | N/A | $19 to $93,279 | Low |
| Protein Measurement, Serum | other | N/A | $11 to $84,165 | Low |
| Test to Measure Oxygen Level in Blood Using Ear OR Finger Device Multiple Times | other | N/A | $4 to $94,761 | Low |
| Detection Test By Nucleic Acid for Enterovirus (intestinal Virus), Amplified ... | other | N/A | $20 to $87,498 | Low |
| Platelet Count, Automated Test | other | N/A | $4 to $85,049 | Low |
| Therapy Procedure for Walking Training, Each 15 Minutes | other | N/A | $20 to $97,116 | Low |
| Urine Potassium Level | other | N/A | $5 to $84,133 | Low |
| Lamotrigine Level | other | N/A | $13 to $80,175 | Low |
| Pathology Examination of Tissue Using a Microscope | lab | N/A | $20 to $88,302 | Low |
| Phosphate Level | other | N/A | $5 to $84,100 | Low |
| Total Protein Level, Blood | other | N/A | $4 to $84,155 | Low |
| Total Protein Level, Body Fluid | other | N/A | $4 to $84,157 | Low |
| Total Protein Level, Urine | other | N/A | $4 to $84,156 | Low |
| Urine Osmolality (concentration) Measurement | other | N/A | $7 to $83,935 | Low |
| Bilirubin Level, Total | other | N/A | $5 to $82,247 | Low |
| Blood Ph Level | other | N/A | $11 to $82,800 | Low |
| Estriol (hormone) Level | other | N/A | $20 to $82,677 | Low |
| Hydroxyprogesterone, 17-d (synthetic Hormone) Level | other | N/A | $20 to $83,498 | Low |
| Magnesium Level | other | N/A | $7 to $83,735 | Low |
| Fibrinogen (factor 1) Activity Measurement | other | N/A | $10 to $85,384 | Low |
| Organic Acid Level | other | N/A | $20 to $83,921 | Low |
| Virus Isolation | other | N/A | $20 to $87,255 | Low |
| Carboxyhemoglobin (protein) Level | other | N/A | $12 to $82,375 | Low |
| Detection Test By Nucleic Acid for Chlamydia, Direct Probe Technique | other | N/A | $20 to $87,490 | Low |
| Lactate Dehydrogenase (enzyme) Measurement | other | N/A | $13 to $83,625 | Low |
| Platelet Function Test | other | N/A | $18 to $85,597 | Low |
| Test to Measure Oxygen Level in Blood Using Ear OR Finger Device | other | N/A | $4 to $94,760 | Low |
| Influenza Vaccine, Quadrivalent, Preservative Free, 0.5 Ml Dosage | preventive | N/A | $21 to $90,686 | Low |
| Creatine Kinase (cardiac Enzyme) Level, Isoenzymes | cardiac | N/A | $13 to $82,552 | Low |
| Lithium Level | other | N/A | $7 to $80,178 | Low |
| Microsomal Antibodies (autoantibody) Measurement | other | N/A | $15 to $86,376 | Low |
| Testosterone (hormone) Level, Free | other | N/A | $21 to $84,402 | Low |
| Glycated Protein Level | other | N/A | $17 to $82,985 | Low |
| Cell Examination of Body Fluid, Smears | other | N/A | $21 to $88,104 | Low |
| Therapy Procedure Using Water Pool to Exercises, Each 15 Minutes | other | N/A | $21 to $97,113 | Low |
| Urine Chloride Level | other | N/A | $6 to $82,436 | Low |
| Beta-2 Microglobulin (protein) Level | other | N/A | $16 to $82,232 | Low |
| Insulin Measurement, Total | other | N/A | $11 to $83,525 | Low |
| Liver Enzyme (sgpt), Level | other | N/A | $5 to $84,460 | Low |
| PSA (prostate Specific Antigen) Measurement, Free | other | N/A | $18 to $84,154 | Low |
| Quinidine Level | other | N/A | $15 to $80,194 | Low |
| Smear for Parasites | other | N/A | $9 to $87,177 | Low |
| Vitamin B-6 Level | other | N/A | $22 to $84,207 | Low |
| Measurement of Antibody to Infectious Organism | other | N/A | $7 to $86,000 | Low |
| Detection Test By Immunoassay Technique for Streptococcus, Group a | other | N/A | $17 to $87,430 | Low |
| Urine Culture | lab | N/A | $8 to $87,088 | Low |
| Screening Test for Mononucleosis | preventive | N/A | $5 to $86,308 | Low |
| Training for Self-care OR Home Management, Each 15 Minutes | other | N/A | $23 to $97,535 | Low |
| Uric Acid Level | other | N/A | $5 to $84,560 | Low |
| Cholinesterase (enzyme) Level, to Test for Exposure to Chemical OR Liver Disease | other | N/A | $8 to $82,480 | Low |
| Liver Enzyme (sgot), Level | other | N/A | $5 to $84,450 | Low |
| Aldolase (enzyme) Level | other | N/A | $10 to $82,085 | Low |
| Analysis for Antibody to HIV -1 Virus | other | N/A | $9 to $86,701 | Low |
| Gastrin (gi Tract Hormone) Level | other | N/A | $18 to $82,941 | Low |
| Lipoprotein Level, Quantitation of Lipoprotein Particle Number | other | N/A | $23 to $83,704 | Low |
| Smear for Infectious Agents | other | N/A | $6 to $87,210 | Low |
| Stool Culture, Additional Pathogens | lab | N/A | $9 to $87,046 | Low |
| Thyroglobulin (thyroid Protein) Antibody Measurement | other | N/A | $16 to $86,800 | Low |
| Iron Binding Capacity | other | N/A | $9 to $83,550 | Low |
| T Cell Count and Ratio | other | N/A | $24 to $86,361 | Low |
| Telephonic Rhythm Strip Evaluation of Single, Dual, Multiple Lead OR Leadless... | other | N/A | $24 to $93,293 | Low |
| Complete Blood Cell Count (red Cells, White Blood Cell, Platelets), Automated... | other | N/A | $6 to $85,027 | Low |
| Creatine Kinase (cardiac Enzyme) Level, Mb Fraction Only | cardiac | N/A | $12 to $82,553 | Low |
| Cyclosporine Level | other | N/A | $18 to $80,158 | Low |
| Detection Test By Immunoassay Technique for Other Organism | other | N/A | $12 to $87,449 | Low |
| Hdl Cholesterol Level | other | N/A | $8 to $83,718 | Low |
| Analysis for Antibody to Herpes Simplex Virus, Type 1 | other | N/A | $13 to $86,695 | Low |
| Detection Test By Nucleic Acid for Organism, Quantification | other | N/A | $25 to $87,799 | Low |
| Fetal Lung Maturity Assessment, Lecithin Sphingomyelin (l/s) Ratio | other | N/A | $22 to $83,661 | Low |
| Fine Needle Aspiration Biopsy Using Ultrasound Guidance, Each Additional Growth | imaging | N/A | $25 to $10,006 | Low |
| Phosphatidylglycerol (amniotic Fluid Organic Acid) Level | other | N/A | $17 to $84,081 | Low |
| Rheumatoid Factor Level | other | N/A | $6 to $86,431 | Low |
| Therapy Procedure in a Group Setting | other | N/A | $17 to $97,150 | Low |
| Ultrasound Measurement of Bladder Capacity After Voiding | imaging | N/A | $25 to $51,798 | Low |
| Amplifed Dna OR Rna Probe Detection of Severe Acute Respiratory Syndrome Coro... | other | N/A | $25 to $87,635 | Low |
| Analysis for Antibody to Herpes Simplex Virus, Type 2 | other | N/A | $19 to $86,696 | Low |
| Cardiolipin Antibody (tissue Antibody) Measurement | other | N/A | $25 to $86,147 | Low |
| Detection Test By Immunoassay Technique for Severe Acute Respiratory Syndrome... | other | N/A | $25 to $87,426 | Low |
| Measure of Severe Acute Respiratory Syndrome Coronavirus 2 (covid-19) Antibody | other | N/A | $25 to $86,769 | Low |
| Thyroxine (thyroid Chemical), Total | other | N/A | $7 to $84,436 | Low |
| Analysis for Antibody to Varicella-zoster Virus | other | N/A | $13 to $86,787 | Low |
| Chemical Analysis of Stone | other | N/A | $13 to $82,360 | Low |
| Hemoglobin Analysis and Measurement, Electrophoresis | other | N/A | $13 to $83,020 | Low |
| Methemoglobin (hemoglobin) Analysis, Quantitative | other | N/A | $8 to $83,050 | Low |
| Phenytoin Level, Total | other | N/A | $13 to $80,185 | Low |
| Prealbumin (protein) Level | other | N/A | $15 to $84,134 | Low |
| Ammonia Level | other | N/A | $15 to $82,140 | Low |
| Detection Test By Nucleic Acid for Hepatitis C Virus, Quantification | other | N/A | $26 to $87,522 | Low |
| Ferritin (blood Protein) Level | other | N/A | $14 to $82,728 | Low |
| Special Stain for Inclusion Bodies OR Parasites | other | N/A | $6 to $87,207 | Low |
| Stool Fat OR Lipids Analysis, Qualitative | lab | N/A | $5 to $82,705 | Low |
| Training for Community OR Work Reintegration, Each 15 Minutes | other | N/A | $26 to $97,537 | Low |
| Creatinine Level to Test for Kidney Function OR Muscle Injury | other | N/A | $5 to $82,570 | Low |
| Glutamyltransferase (liver Enzyme) Level | other | N/A | $7 to $82,977 | Low |
| Inhalation Treatment for Acute Airway Obstruction, Each Additional Hour | other | N/A | $15 to $94,645 | Low |
| Insulin Antibody Measurement | other | N/A | $21 to $86,337 | Low |
| Follow-up Therapy Service to Facilitate Lung Function | other | N/A | $26 to $94,668 | Low |
| Sex Hormone Binding Globulin (protein) Level | other | N/A | $22 to $84,270 | Low |
| Urine Porphobilinogen (metabolism Substance) Level | other | N/A | $8 to $84,110 | Low |
| Lipase (fat Enzyme) Level | other | N/A | $7 to $83,690 | Low |
| Pap Test, Slides, Manual Screening | preventive | N/A | $19 to $88,164 | Low |
| Hepatitis B Vaccine, Pediatric OR Adolescent Dosage | preventive | N/A | $27 to $90,744 | Low |
| Myoglobin (muscle Protein) Level | other | N/A | $13 to $83,874 | Low |
| Evaluation of Fine Needle Aspirate with Interpretation and Report | other | N/A | $28 to $88,173 | Low |
| Pathology Examination of Tissue Using a Microscope, Moderately Low Complexity | lab | N/A | $28 to $88,304 | Low |
| Transferrin (iron Binding Protein) Level | other | N/A | $13 to $84,466 | Low |
| Immunologic Analysis for Detection of Tumor Antigen, Quantitative; Ca 19 | other | N/A | $21 to $86,301 | Low |
| Blood Glucose (sugar) Level After Receiving Dose of Glucose | other | N/A | $5 to $82,950 | Low |
| Procainamide Level, with Metabolites | other | N/A | $17 to $80,192 | Low |
| Vitamin B-1 (thiamine) Level | other | N/A | $21 to $84,425 | Low |
| White Blood Cell Alkaline Phosphatase (enzyme) Measurement with Cell Count | other | N/A | $9 to $85,540 | Low |
| Analysis for Antibody | other | N/A | $17 to $86,645 | Low |
| Analysis for Antibody to Epstein-barr Virus (mononucleosis Virus), Early Antigen | other | N/A | $13 to $86,663 | Low |
| Analysis for Antibody to Epstein-barr Virus (mononucleosis Virus), Nuclear An... | imaging | N/A | $15 to $86,664 | Low |
| Analysis for Antibody to Epstein-barr Virus (mononucleosis Virus), Viral Capsid | other | N/A | $18 to $86,665 | Low |
| Analysis for Antibody to Rubella | other | N/A | $14 to $86,762 | Low |
| Blood Culture | lab | N/A | $20 to $87,103 | Low |
| Fungal Culture | lab | N/A | $8 to $87,102 | Low |
| Fungal Culture (mold OR Yeast) of Skin, Hair, OR Nail | lab | N/A | $8 to $87,101 | Low |
| Detection Test By Immunoassay Technique for Influenza Virus | other | N/A | $14 to $87,400 | Low |
| Detection Test By Nucleic Acid for Cytomegalovirus, Quantification | other | N/A | $29 to $87,497 | Low |
| Ketosteroids, 17 (hormone) Measurement, Total | other | N/A | $13 to $83,586 | Low |
| Lead Level | other | N/A | $12 to $83,655 | Low |
| Phosphatase, Prostatic (prostate Enzyme) Level | other | N/A | $10 to $84,066 | Low |
| Detection Test By Nucleic Acid for Organism, Amplified Probe Technique | other | N/A | $30 to $87,798 | Low |
| Detection Test By Nucleic Acid for Zika Virus, Amplified Probe Technique | other | N/A | $30 to $87,662 | Low |
| X-ray of Jaw Joint On 1 Side of Mouth | imaging | N/A | $30 to $70,328 | Low |
| Application of Hot Wax Bath | other | N/A | $6 to $97,018 | Low |
| Analysis for Antibody to Chlamydia | other | N/A | $12 to $86,631 | Low |
| Dxa Bone Density Measurement of Forearm, Finger, Hand, OR Foot | other | N/A | $30 to $77,081 | Low |
| Detection Test By Immunoassay Technique for Escherichia Coli 0157 | other | N/A | $13 to $87,335 | Low |
| Follow-up Training in the Use of Orthopedic Device OR Artificial Arm, Leg And... | other | N/A | $31 to $97,763 | Low |
| Tobramycin (antibiotic) Level | other | N/A | $16 to $80,200 | Low |
| Training in the Use of Artificial Arm And/or Leg, Each 15 Minutes | other | N/A | $31 to $97,761 | Low |
| Fracture Assessment of Spine Bones Using Dxa | other | N/A | $31 to $77,086 | Low |
| Hepatitis B Surface Antibody Measurement | other | N/A | $11 to $86,706 | Low |
| Programming of Single, Dual, OR Multiple Lead OR Leadless Pacemaker System Be... | cardiac | N/A | $31 to $93,286 | Low |
| Analysis for Antibody, Treponema Pallidum | other | N/A | $13 to $86,780 | Low |
| Immunologic Analysis Technique On Body Fluid, Other Fluids with Concentration | other | N/A | $29 to $86,335 | Low |
| Haptoglobin (serum Protein) Level | other | N/A | $13 to $83,010 | Low |
| Measurement of Range of Motion in Arm, Leg OR Each Spine Section | other | N/A | $6 to $95,851 | Low |
| X-ray of Hip, 1 View | imaging | N/A | $32 to $73,501 | Low |
| Screening Test for Pathogenic Organisms | preventive | N/A | $7 to $87,081 | Low |
| Arsenic Level | other | N/A | $19 to $82,175 | Low |
| Ascorbic Acid (vitamin C) Level, Blood | other | N/A | $10 to $82,180 | Low |
| Carotene Level | other | N/A | $9 to $82,380 | Low |
| Mercury Level | other | N/A | $16 to $83,825 | Low |
| Therapy Procedure Using Massage, Each 15 Minutes | other | N/A | $28 to $97,124 | Low |
| Amikacin (antibiotic) Level | other | N/A | $15 to $80,150 | Low |
| Urine Pregnancy Test | other | N/A | $9 to $81,025 | Low |
| Lipoprotein-associated Phospholipase A2 (enzyme) Level | other | N/A | $33 to $83,698 | Low |
| X-ray of Both Knees While Standing | imaging | N/A | $33 to $73,565 | Low |
| X-ray of Collar Bone | imaging | N/A | $33 to $73,000 | Low |
| Creatinine Clearance Measurement to Test for Kidney Function | other | N/A | $9 to $82,575 | Low |
| Detection Test By Immunoassay Technique for Respiratory Syncytial Virus | other | N/A | $14 to $87,420 | Low |
| Hydroxyindolacetic Acid (product of Metabolism) Level | other | N/A | $13 to $83,497 | Low |
| Oxalate Level | other | N/A | $14 to $83,945 | Low |
| Vancomycin (antibiotic) Level | other | N/A | $14 to $80,202 | Low |
| Detection Test By Immunoassay Technique for Hepatitis B Surface Antigen | other | N/A | $10 to $87,340 | Low |
| Amylase (enzyme) Level | other | N/A | $6 to $82,150 | Low |
| Triglycerides Level | other | N/A | $6 to $84,478 | Low |
| Detection Test By Nucleic Acid for Multiple Organisms, Direct Probe(s) Technique | other | N/A | $35 to $87,800 | Low |
| Therapy Procedure for a Range of Mental Processes, Initial 15 Minutes | other | N/A | $19 to $97,129 | Low |
| Therapy Procedure to Re-educate Brain-to-nerve-to-muscle Function, Each 15 Mi... | other | N/A | $32 to $97,112 | Low |
| Carbamazepine Level, Total | other | N/A | $15 to $80,156 | Low |
| Pathology Examination of Tissue Using a Microscope, Intermediate Complexity | lab | N/A | $35 to $88,305 | Low |
| Test OR Measurement for Functional Capacity, Each 15 Minutes | other | N/A | $32 to $97,750 | Low |
| Urine Microalbumin (protein) Level | other | N/A | $6 to $82,043 | Low |
| Application of Ultrasound, Each 15 Minutes | imaging | N/A | $14 to $97,035 | Low |
| Blood Gases Measurement | other | N/A | $26 to $82,803 | Low |
| Gammaglobulin (immune System Protein) Measurement | other | N/A | $9 to $82,784 | Low |
| Special Stained Specimen Slides to Examine Tissue, Each Additional Procedure | lab | N/A | $36 to $88,341 | Low |
| G6pd (enzyme) Screening Test | preventive | N/A | $6 to $82,960 | Low |
| Hepatitis C Antibody Measurement | other | N/A | $14 to $86,803 | Low |
| Physician Attendance At Delivery and Stabilization of Newborn | obstetric | N/A | $37 to $99,464 | Low |
| T Cells Count, Total | other | N/A | $37 to $86,359 | Low |
| Therapy Procedure Using Manual Technique, Each 15 Minutes | other | N/A | $27 to $97,140 | Low |
| Application of Mechanical Traction | other | N/A | $14 to $97,012 | Low |
| Blood Viscosity Measurement | other | N/A | $12 to $85,810 | Low |
| Measurement for Strep Antibody | other | N/A | $7 to $86,060 | Low |
| Screening Test for Autoimmune Disorder | preventive | N/A | $12 to $86,038 | Low |
| Angiotensin L - Converting Enzyme (ace) Level | other | N/A | $15 to $82,164 | Low |
| Fetal Hemoglobin OR Red Blood Cells Measurement for Assessment of Fetal-mater... | other | N/A | $9 to $85,461 | Low |
| Blood Group Typing | other | N/A | $3 to $86,900 | Low |
| Blood Typing for Rh (d) Antigen | other | N/A | $3 to $86,901 | Low |
| Blood Unit Compatibility Test, Incubation Technique | other | N/A | $38 to $86,921 | Low |
| Irradiation of Blood Product, Each Unit | other | N/A | $36 to $86,945 | Low |
| Screening Test for Red Blood Cell Antibodies | preventive | N/A | $10 to $86,850 | Low |
| Test to Examine How Well the Lungs Exchange Gases | other | N/A | $38 to $94,729 | Low |
| Gonadotropin (reproductive Hormone) Analysis | other | N/A | $8 to $84,703 | Low |
| Therapy Procedure Using Sensory Experiences | other | N/A | $39 to $97,533 | Low |
| Erythropoietin (protein) Level | other | N/A | $19 to $82,668 | Low |
| Natriuretic Peptide (heart and Blood Vessel Protein) Level | cardiac | N/A | $39 to $83,880 | Low |
| Analysis for Antibody Borrelia Burgdorferi | other | N/A | $17 to $86,618 | Low |
| Limited OR Follow-up CT Scan | imaging | N/A | $40 to $76,380 | Low |
| Vitamin D-3 Level | other | N/A | $30 to $82,306 | Low |
| PSA (prostate Specific Antigen) Measurement, Total | other | N/A | $18 to $84,153 | Low |
| Stool Culture | lab | N/A | $9 to $87,045 | Low |
| Immunologic Analysis for Detection of Tumor Antigen, Quantitative; Ca 125 | other | N/A | $21 to $86,304 | Low |
| Phenobarbital Level | other | N/A | $15 to $80,184 | Low |
| Theophylline Level | other | N/A | $14 to $80,198 | Low |
| Analysis for Antibody to Legionella | other | N/A | $15 to $86,713 | Low |
| Carcinoembryonic Antigen (cea) Protein Level | other | N/A | $19 to $82,378 | Low |
| Cortisol (hormone) Measurement, Total | other | N/A | $16 to $82,533 | Low |
| Therapy Procedure Using Exercise to Develop Strength, Endurance, Range of Mot... | other | N/A | $28 to $97,110 | Low |
| Therapy Procedure Using Functional Activities | other | N/A | $34 to $97,530 | Low |
| Ultrasonic Guidance for Removal of Amniotic Fluid | surgery | N/A | $32 to $76,946 | Low |
| X-ray of Thigh Bone, Minimum 2 Views | imaging | N/A | $42 to $73,552 | Low |
| Hepatitis B Core Antibody (igm) Measurement | other | N/A | $12 to $86,705 | Low |
| Measurement of Complement (immune System Proteins), Antigen | other | N/A | $12 to $86,160 | Low |
| Screening Test for Antibody to Noninfectious Agent | preventive | N/A | $12 to $86,255 | Low |
| Treatment of Speech, Language, Voice, Communication, And/or Hearing Processin... | other | N/A | $43 to $92,507 | Low |
| Calcium Level, Ionized | other | N/A | $14 to $82,330 | Low |
| Analysis for Antibody to Rickettsia | other | N/A | $19 to $86,757 | Low |
| Urine Vanillylmandelic Acid | other | N/A | $16 to $84,585 | Low |
| Amino Acid Analysis, Multiple Amino Acids, Qualitative, Each Specimen | lab | N/A | $14 to $82,128 | Low |
| Ketone Bodies Analysis, Quantitative | other | N/A | $8 to $82,010 | Low |
| Lidocaine Level | other | N/A | $15 to $80,176 | Low |
| Organic Acids Level | other | N/A | $24 to $83,918 | Low |
| Immunologic Analysis Technique On Body Fluid | other | N/A | $23 to $86,325 | Low |
| Application of Vein Wound Compression Bandages On Upper Arm, Forearm, Hand, a... | other | N/A | $45 to $29,584 | Low |
| Gabapentin Level | other | N/A | $22 to $80,171 | Low |
| Diphtheria, Tetanus, and Acellular Pertussis Vaccine | preventive | N/A | $45 to $90,715 | Low |
| Folic Acid Level, Rbc | other | N/A | $18 to $82,747 | Low |
| Occupational Therapy | therapy | N/A | $46 to $97,168 | High |
| Valproic Acid Level, Total | other | N/A | $14 to $80,164 | Low |
| Blood Test | lab | N/A | $7 to $85,730 | High |
| Gene Analysis (coagulation Factor V) Leiden Variant | other | N/A | $46 to $81,241 | Low |
| Vldl Cholesterol Level | other | N/A | $13 to $83,719 | Low |
| Thyroxine (thyroid Chemical), Free | other | N/A | $9 to $84,439 | Low |
| Evaluation for Work Hardening OR Conditioning, Each Additional Hour | other | N/A | $46 to $97,546 | Low |
| Dxa Bone Density Measurement of Hip, Pelvis, Spine Including Spine Fracture A... | other | N/A | $47 to $77,085 | Low |
| Ultrasound Scan of Fetal Brain Artery Blood Flow Rate | imaging | N/A | $47 to $76,821 | Low |
| Ultrasound Scan of Fetal Umbilical Artery Blood Flow Rate | imaging | N/A | $47 to $76,820 | Low |
| Limited Ultrasound Scan of Pelvis | imaging | N/A | $47 to $76,857 | Low |
| Coagulation Function Measurement, D-dimer; Quantitative | other | N/A | $10 to $85,379 | Low |
| X-ray of Finger, Minimum of 2 Views | imaging | N/A | $47 to $73,140 | Low |
| Levetiracetam Level | other | N/A | $13 to $80,177 | Low |
| Quantitation of Therapeutic Drug | other | N/A | $19 to $80,299 | Low |
| Surgical Pathology | lab | N/A | $48 to $88,325 | Low |
| Tissue Culture Inoculation for Virus Isolation | lab | N/A | $26 to $87,252 | Low |
| Aldosterone Hormone Level | other | N/A | $41 to $82,088 | Low |
| Cervicovaginal Secretion of Placenta Protein | other | N/A | $48 to $84,112 | Low |
| Application of Electrical Stimulation with Therapist Present, Each 15 Minutes | other | N/A | $14 to $97,032 | Low |
| X-ray of Hip, 2-3 Views | imaging | N/A | $48 to $73,502 | Low |
| Special Stained Specimen Slides to Examine Tissue Including Interpretation an... | lab | N/A | $49 to $88,313 | Low |
| Special Stained Specimen Slides to Identify Organisms Including Interpretatio... | lab | N/A | $49 to $88,312 | Low |
| Thyroid Stimulating Immune Globulins (thyroid Related Protein) Level | other | N/A | $49 to $84,445 | Low |
| Immunologic Analysis Technique On Serum | other | N/A | $22 to $86,334 | Low |
| Sirolimus Level | other | N/A | $14 to $80,195 | Low |
| Analysis for Antibody to Helicobacter Pylori | other | N/A | $17 to $86,677 | Low |
| Collection of Blood Sample From Implanted Device | surgery | N/A | $49 to $36,591 | Low |
| X-ray for Estimating Bone Age | imaging | N/A | $49 to $77,072 | Low |
| Blood Glucose (sugar) Tolerance Test, 3 Specimens | lab | N/A | $13 to $82,951 | Low |
| Ultrasound of Abdomen and Pelvis Artery and Vein Blood Flow | imaging | N/A | $50 to $93,976 | Low |
| Dihydroxyvitamin D, 1, 25 Level | other | N/A | $39 to $82,652 | Low |
| Hydroxycorticosteroids, 17 (adrenal Gland Hormone) Level | other | N/A | $18 to $83,491 | Low |
| Thyroid Hormone, T3 Measurement, Free | other | N/A | $17 to $84,481 | Low |
| Training in the Use of Orthopedic Device for Arm, Leg And/or Trunk, Each 15 M... | other | N/A | $44 to $97,760 | Low |
| Urine Porphyrins (metabolism Substance) Measurement | other | N/A | $15 to $84,120 | Low |
| Ultrasound of Heart with Color-depicted Blood Flow, Rate, Direction and Valve... | imaging | N/A | $66 to $93,306 | Low |
| X-ray of Eye Canal | imaging | N/A | $51 to $70,190 | Low |
| X-ray of Shoulder, 1 View | imaging | N/A | $51 to $73,020 | Low |
| Insertion of Temporary Bladder Tube | other | N/A | $51 to $51,701 | Low |
| X-ray of Toe, Minimum of 2 Views | imaging | N/A | $51 to $73,660 | Low |
| Low Dose CT Scan of Chest for Lung Cancer Screening | imaging | N/A | $51 to $71,271 | Low |
| Protein C Antigen (clotting Inhibitor) Measurement | other | N/A | $14 to $85,303 | Low |
| Protein S (clotting Inhibitor) Measurement | other | N/A | $15 to $85,306 | Low |
| X-ray of Hand, 2 Views | imaging | N/A | $51 to $73,120 | Low |
| X-ray of Spine, 1 View | imaging | N/A | $51 to $72,020 | Low |
| Antithrombin Iii Antigen (clotting Inhibitor) Level | other | N/A | $11 to $85,301 | Low |
| Application of Vein Wound Compression Bandages On Lower Leg, Ankle, and Foot | other | N/A | $52 to $29,581 | Low |
| Gonadotropin, Chorionic (reproductive Hormone) Level | other | N/A | $15 to $84,702 | Low |
| X-ray Lower and Sacral Spine, 2-3 Views Bending Views | imaging | N/A | $52 to $72,120 | Low |
| X-ray of Infant Arm, Minimum of 2 Views | imaging | N/A | $52 to $73,092 | Low |
| X-ray of Infant Body Bones | imaging | N/A | $52 to $77,076 | Low |
| X-ray of Infant Leg, Minimum of 2 Views | imaging | N/A | $52 to $73,592 | Low |
| X-ray of Middle Spine, 3 Views | imaging | N/A | $52 to $72,072 | Low |
| X-ray of Saliva Gland | imaging | N/A | $52 to $70,380 | Low |
| Application of Whirlpool Therapy | other | N/A | $15 to $97,022 | Low |
| X-ray of Joint Between Lower Spine and Hip Bone, 1-2 Views | imaging | N/A | $52 to $72,200 | Low |
| Application of Medication Using Electrical Current, Each 15 Minutes | other | N/A | $18 to $97,033 | Low |
| Single Contrast X-ray of Large Intestine | imaging | N/A | $53 to $74,270 | Low |
| Tacrolimus Level | other | N/A | $14 to $80,197 | Low |
| Injection Procedure Through Bladder and Urethra for X-ray Imaging | imaging | N/A | $53 to $51,610 | Low |
| Splitting of Blood OR Blood Products | other | N/A | $53 to $86,985 | Low |
| Cortisol (hormone) Measurement, Free | other | N/A | $17 to $82,530 | Low |
| Gene Analysis (prothrombin, Coagulation Factor Ii) a Variant | other | N/A | $53 to $81,240 | Low |
| Biopsy of Breast and Placement of Locating Device Using X-ray with Needle, Ea... | imaging | N/A | $54 to $19,082 | Low |
| Parathormone (parathyroid Hormone) Level | other | N/A | $41 to $83,970 | Low |
| Placement of Locating Device in Breast Using X-ray with Needle Guidance, Each... | imaging | N/A | $41 to $19,284 | Low |
| Review By Radiologist of Bile And/or Pancreatic Duct Image During Surgery | surgery | N/A | $54 to $74,300 | Low |
| Red Blood Cell Antibody Level | other | N/A | $5 to $86,886 | Low |
| Treatment of Swallowing and Feeding Disorder | other | N/A | $55 to $92,526 | Low |
| Drawing of Blood for a Medical Problem | other | N/A | $56 to $99,195 | Low |
| Flow Cytometry Technique for Dna OR Cell Analysis | other | N/A | $50 to $88,182 | Low |
| Chemical Analysis Using Chromatography Technique | other | N/A | $24 to $82,542 | Low |
| Antithrombin Iii Antigen (clotting Inhibitor) Activity | other | N/A | $12 to $85,300 | Low |
| Progesterone (reproductive Hormone) Level | other | N/A | $21 to $84,144 | Low |
| Renin (kidney Enzyme) Level | other | N/A | $22 to $84,244 | Low |
| Screening Mammography | imaging | N/A | $57 to $77,067 | Low |
| X-ray From Nose to Rectum | imaging | N/A | $57 to $76,010 | Low |
| X-ray of Chest Bone, Minimum of 2 Views | imaging | N/A | $57 to $71,120 | Low |
| X-ray of Elbow, 2 Views | imaging | N/A | $57 to $73,070 | Low |
| X-ray of Ankle, 2 Views | imaging | N/A | $58 to $73,600 | Low |
| X-ray of Bone Behind the Ear, Minimum of 3 Views Per Side | imaging | N/A | $58 to $70,130 | Low |
| X-ray of Face Bones, 1-2 Views | imaging | N/A | $59 to $70,140 | Low |
| X-ray of Joint Between Breast and Collar Bones, Minimum of 2 Views | imaging | N/A | $59 to $71,130 | Low |
| Tuberculosis Test, Gamma Interferon | other | N/A | $59 to $86,480 | Low |
| Gene Analysis (survival of Motor Neuron 1, Telomeric) for Dosage/deletion | other | N/A | $60 to $81,329 | Low |
| Stool Fat OR Lipids Analysis, Quantitative | lab | N/A | $17 to $82,710 | Low |
| X-ray of Chest, 1 View | imaging | N/A | $60 to $71,045 | Low |
| Dxa Bone Density Measurement of Hip, Pelvis, Spine | other | N/A | $61 to $77,080 | Low |
| X-ray of Hip, Minimum of 4 Views | imaging | N/A | $61 to $73,503 | Low |
| Evaluation for Use of Voice Artificial Device to Supplement Oral Speech | other | N/A | $61 to $92,597 | Low |
| X-ray of Abdomen, 1 View | imaging | N/A | $61 to $74,018 | Low |
| Blood Unit Compatibility Test, Antiglobulin Technique | other | N/A | $62 to $86,922 | Low |
| Blood Unit Compatibility Test, Immediate Spin Technique | other | N/A | $62 to $86,920 | Low |
| Red Blood Cell Antibody Detection Test, Direct | other | N/A | $5 to $86,880 | Low |
| Insertion of Tube Into Vena Cava | other | N/A | $62 to $36,010 | Low |
| Gonadotropin, Follicle Stimulating (reproductive Hormone) Level | other | N/A | $19 to $83,001 | Low |
| Evaluation of Speech Sound Production | other | N/A | $63 to $92,522 | Low |
| Alpha-fetoprotein (afp) Level, Serum | other | N/A | $17 to $82,105 | Low |
| Removal of Antibodies From Surface of Red Blood Cell | surgery | N/A | $64 to $86,860 | Low |
| Blood Bank Physician Services for Investigation of Transfusion Reaction with ... | surgery | N/A | $65 to $86,078 | Low |
| Special Stained Specimen Slides to Examine Tissue, Initial Procedure | lab | N/A | $65 to $88,342 | Low |
| Artery Puncture Collection of Blood Sample | other | N/A | $65 to $36,600 | Low |
| Imaging for Evaluation of Swallowing Function | other | N/A | $65 to $74,230 | Low |
| X-ray of Sacrum and Tailbone, Minimum of 2 Views | imaging | N/A | $65 to $72,220 | Low |
| Inhalation Treatment for Acute Airway Obstruction, First Hour | other | N/A | $65 to $94,644 | Low |
| Analysis of Voice and Resonance Production | other | N/A | $65 to $92,524 | Low |
| Measurement of Complement (immune System Proteins), Total Hemolytic | other | N/A | $20 to $86,162 | Low |
| X-ray of Upper Arm, Minimum of 2 Views | imaging | N/A | $65 to $73,060 | Low |
| X-ray of Heel, Minimum of 2 Views | imaging | N/A | $66 to $73,650 | Low |
| Catecholamines (organic Nitrogen) Level | imaging | N/A | $25 to $82,384 | Low |
| Use of a Drug to Induce Depression of Consciousness By Physician Performing a... | other | N/A | $11 to $99,153 | Low |
| X-ray of Wrist, 2 Views | imaging | N/A | $66 to $73,100 | Low |
| Detection Test By Immunoassay Technique for Rotavirus | other | N/A | $12 to $87,425 | Low |
| X-ray of Knee, 1-2 Views | imaging | N/A | $67 to $73,560 | Low |
| X-ray of Soft Tissue of Neck | imaging | N/A | $67 to $70,360 | Low |
| X-ray of Part of Lower Jaw, 1-4 Views | imaging | N/A | $67 to $70,100 | Low |
| Aspiration of Cyst of Breast, Each Additional Cyst | other | N/A | $17 to $19,001 | Low |
| Complete Ultrasound Scan of 1 Breast | imaging | N/A | $69 to $76,641 | Low |
| Single Contrast X-ray of Small Intestine | imaging | N/A | $69 to $74,250 | Low |
| X-ray of Foot, 2 Views | imaging | N/A | $69 to $73,620 | Low |
| Hormone Receptor Analysis | other | N/A | $69 to $84,235 | Low |
| Test to Assess the Loss of the Ability to Speak, Write, and Understand Language | other | N/A | $69 to $96,105 | Low |
| X-ray of Jaw Joints On Both Sides of Mouth | imaging | N/A | $69 to $70,330 | Low |
| Ultrasound Study of Arm and Leg Arteries | imaging | N/A | $69 to $93,922 | Low |
| X-ray of Chest, 2 Views | imaging | N/A | $69 to $71,046 | Low |
| X-ray of Shoulder Blade | imaging | N/A | $69 to $73,010 | Low |
| Gonadotropin, Luteinizing (reproductive Hormone) Level | other | N/A | $19 to $83,002 | Low |
| Culture for Chlamydia | lab | N/A | $20 to $87,110 | Low |
| Ultrasound Scan of Fetus | imaging | N/A | $70 to $76,819 | Low |
| Semen Evaluation Volume, Sperm Count, Motility and Analysis | other | N/A | $12 to $89,320 | Low |
| X-ray of Middle and Lower Spine, 2 Views | imaging | N/A | $70 to $72,080 | Low |
| X-ray of Nose Bones, Minimum of 3 Views | imaging | N/A | $70 to $70,160 | Low |
| Carnitine Level | other | N/A | $17 to $82,379 | Low |
| Limited Ultrasound Scan of 1 Breast | imaging | N/A | $72 to $76,642 | Low |
| Prolactin (milk Producing Hormone) Level | other | N/A | $19 to $84,146 | Low |
| Test to Measure Largest Amount of Air Breathed in an Out | other | N/A | $56 to $94,200 | Low |
| Detection Test By Nucleic Acid for Hiv-1 Virus, Quantification | other | N/A | $72 to $87,536 | Low |
| Antibody Identification Test, Platelet Antibodies | other | N/A | $18 to $86,022 | Low |
| X-ray of Paranasal Sinus, 1-2 Views | imaging | N/A | $73 to $70,210 | Low |
| Somatomedin (growth Factor) Level | other | N/A | $21 to $84,305 | Low |
| X-ray of Chest, 3 Views | imaging | N/A | $75 to $71,047 | Low |
| X-ray of Both Hips, Minimum of 5 Views | imaging | N/A | $75 to $73,523 | Low |
| X-ray of Pelvis, 1-2 Views | imaging | N/A | $76 to $72,170 | Low |
| Acute Hepatitis Panel | lab | N/A | $48 to $80,074 | Low |
| Immunologic Analysis for Autoimmune Disease, A, B, OR C, Single Antigen | other | N/A | $26 to $86,812 | Low |
| X-ray of Chest, Minimum of 4 Views | imaging | N/A | $76 to $71,048 | Low |
| T Cell Count and Ratio, Including Ratio | other | N/A | $47 to $86,360 | Low |
| X-ray of Forearm, 2 Views | imaging | N/A | $76 to $73,090 | Low |
| Molecular Pathology Procedure | lab | N/A | $77 to $81,479 | Low |
| Citrate Level | other | N/A | $28 to $82,507 | Low |
| Contrast Injection for X-ray Imaging Through Existing Tube in Stomach, Small ... | imaging | N/A | $77 to $49,465 | Low |
| Evaluation of Speech Continuity, Smoothness, Rate, and Effort | other | N/A | $77 to $92,521 | Low |
| Test to Assess the Ability to Complete Specific Functional Tasks Applicable t... | other | N/A | $77 to $96,125 | Low |
| X-ray of Lower Leg, 2 Views | imaging | N/A | $77 to $73,590 | Low |
| Testing for Presence of Drug, By Chemistry Analyzers | other | N/A | $62 to $80,307 | Low |
| X-ray of Eye for Detection of Foreign Body | imaging | N/A | $78 to $70,030 | Low |
| Antibody Identification Test, Platelet Associated Immunoglobulin Assay | other | N/A | $12 to $86,023 | Low |
| Limited X-ray of Body Bones | imaging | N/A | $78 to $77,074 | Low |
| Screening Evaluation of Brain Response to Sound with Automated Analysis | preventive | N/A | $78 to $92,650 | Low |
| X-ray of Ribs On Side of Body, Minimum of 3 Views | imaging | N/A | $78 to $71,101 | Low |
| Complete X-ray of Body Bones | imaging | N/A | $78 to $77,075 | Low |
| X-ray of Abdomen, 2 Views | imaging | N/A | $78 to $74,019 | Low |
| X-ray of Both Collar Bones Joints | imaging | N/A | $78 to $73,050 | Low |
| Ultrasound Scan of Brain | imaging | N/A | $79 to $76,506 | Low |
| Dehydroepiandrosterone (dhea-s) Hormone Level | other | N/A | $22 to $82,627 | Low |
| Test to Measure Expiratory Airflow and Volume | other | N/A | $79 to $94,010 | Low |
| X-ray of Elbow, Minimum of 3 Views | imaging | N/A | $79 to $73,080 | Low |
| Progesterone (reproductive Hormone) Receptor Analysis | other | N/A | $65 to $84,234 | Low |
| X-ray of Middle Spine, 2 Views | imaging | N/A | $80 to $72,070 | Low |
| Analysis for Antibody to Herpes Simplex Virus | other | N/A | $14 to $86,694 | Low |
| Fluoroscopic Guidance for Insertion OR Removal of Central Vein Access Device | surgery | N/A | $80 to $77,001 | Low |
| New Patient Office OR Other Outpatient Visit with Straightforward Medical Dec... | other | N/A | $40 to $99,202 | Low |
| Therapy Procedure Using a Special Bandage and Vacuum Pump, Surface Area 50.0 ... | other | N/A | $80 to $97,605 | Low |
| X-ray of Lower and Sacral Spine, 2-3 Views | imaging | N/A | $80 to $72,100 | Low |
| Initial Therapy Service to Facilitate Lung Function | other | N/A | $81 to $94,667 | Low |
| Physical Therapy | therapy | N/A | $46 to $97,163 | High |
| Test to Determine Lung Volumes Using Gas Dilution OR Washout | other | N/A | $81 to $94,727 | Low |
| Therapy Procedure Using a Positive Pressure Ventilator | other | N/A | $81 to $94,660 | Low |
| Aluminum Level | other | N/A | $25 to $82,108 | Low |
| Imaging of Gallbladder with Contrast | other | N/A | $82 to $74,290 | Low |
| Test to Measure Oxygen Level in Blood Using Ear OR Finger Device Continuously... | other | N/A | $82 to $94,762 | Low |
| Removal of Tissue From Wound Gradually | surgery | N/A | $83 to $97,602 | Low |
| Adrenocorticotropic Hormone (acth) Level | other | N/A | $39 to $82,024 | Low |
| Measurement of Total Estradiol | other | N/A | $28 to $82,670 | Low |
| Analysis of Female Reproductive Genetic Marker | other | N/A | $21 to $86,305 | Low |
| X-ray of Knee, 3 Views | imaging | N/A | $83 to $73,562 | Low |
| New Patient Office OR Other Outpatient Visit with Low Level of Medical Decisi... | other | N/A | $69 to $99,203 | Low |
| Testosterone (hormone) Level, Total | other | N/A | $26 to $84,403 | Low |
| Established Patient Office OR Other Outpatient Visit with Low Level of Decisi... | other | N/A | $56 to $99,213 | Low |
| X-ray of Upper Spine, 2-3 Views | imaging | N/A | $83 to $72,040 | Low |
| Evaluation of Swallowing Function | other | N/A | $57 to $92,610 | Low |
| X-ray for Bone Length Assessment | imaging | N/A | $87 to $77,073 | Low |
| Test to Measure the Total Volume of Air That Can Be Exhaled After Inhaling | other | N/A | $87 to $94,150 | Low |
| Inhalation Treatment for Airway Obstruction OR Sputum Production | other | N/A | $89 to $94,640 | Low |
| Insertion of Tube Into Airway for Aspiration of Secretions | other | N/A | $89 to $31,720 | Low |
| X-ray of Pelvis, Minimum of 3 Views | imaging | N/A | $89 to $72,190 | Low |
| Identification of Red Blood Cell Antibodies | other | N/A | $90 to $86,870 | Low |
| Pathology Examination of Tissue Using a Microscope, Moderately High Complexity | lab | N/A | $90 to $88,307 | Low |
| Evaluation and Recording of Swallowing Using an Endoscope | other | N/A | $53 to $92,612 | Low |
| Ultrasound of Heart, Follow-up | imaging | N/A | $91 to $93,308 | Low |
| X-ray of Lower Jaw, Minimum of 4 Views | imaging | N/A | $91 to $70,110 | Low |
| X-ray of Shoulder, Minimum of 2 Views | imaging | N/A | $83 to $73,030 | Low |
| Fluoroscopic Guidance for Needle Placement | other | N/A | $95 to $77,002 | Low |
| Double Contrast X-ray of Small Intestine | imaging | N/A | $95 to $74,251 | Low |
| Processing and Storage of Blood Unit OR Component, Predeposited | other | N/A | $95 to $86,890 | Low |
| Ultrasound Scan of Spinal Canal | imaging | N/A | $95 to $76,800 | Low |
| X-ray of Ankle, Minimum of 3 Views | imaging | N/A | $83 to $73,610 | Low |
| X-ray of Face Bones, Minimum of 3 Views | imaging | N/A | $96 to $70,150 | Low |
| X-ray of Foot, Minimum of 3 Views | imaging | N/A | $83 to $73,630 | Low |
| Blood Typing for Red Blood Cell Antigens | other | N/A | $4 to $86,905 | Low |
| Evaluation of Fine Needle Aspirate | other | N/A | $97 to $88,172 | Low |
| Microscopic Genetic Analysis of Tissue, Computer-assisted Technology, Initial... | other | N/A | $97 to $88,367 | Low |
| Screening Test for Compatible Blood Unit, Using Reagent Serum | preventive | N/A | $6 to $86,902 | Low |
| X-ray of Wrist, Minimum of 3 Views | imaging | N/A | $83 to $73,110 | Low |
| Complete Ultrasound of Abdomen and Pelvis Artery and Vein Blood Flow | imaging | N/A | $97 to $93,975 | Low |
| Incision of Sperm Duct for X-ray Procedure | imaging | N/A | $97 to $55,300 | Low |
| X-ray of Knee, 4 OR More Views | imaging | N/A | $97 to $73,564 | Low |
| Fluoroscopic Guidance for Spine OR Back Muscle Injection | other | N/A | $98 to $77,003 | Low |
| Imaging Guidance for Procedure, 60 Minutes OR Less | other | N/A | $98 to $76,000 | Low |
| X-ray of Hand, Minimum of 3 Views | imaging | N/A | $83 to $73,130 | Low |
| X-ray of Joint Between Lower Spine and Hip Bone, 3 OR More Views | imaging | N/A | $98 to $72,202 | Low |
| Metanephrines Level | other | N/A | $17 to $83,835 | Low |
| X-ray of Ribs On Side of Body, 2 Views | imaging | N/A | $83 to $71,100 | Low |
| Contrast Injection for Imaging to Evaluate Central Venous Access Device | other | N/A | $100 to $36,598 | Low |
| Microscopic Genetic Analysis of Tumor, Using Computer-assisted Technology | other | N/A | $101 to $88,361 | Low |
| Injection of Bladder and Ureter for Imaging | other | N/A | $59 to $50,690 | Low |
| Ultrasound of Arm Arteries OR Artery Grafts | imaging | N/A | $102 to $93,930 | Low |
| Ultrasound of Leg Arteries OR Artery Grafts | imaging | N/A | $102 to $93,925 | Low |
| Ultrasound of One Leg Arteries OR Artery Grafts | imaging | N/A | $100 to $93,926 | Low |
| Single Contrast X-ray of Esophagus | imaging | N/A | $104 to $74,220 | Low |
| Ultrasound of Both Sides of Head and Neck Blood Flow | imaging | N/A | $106 to $93,880 | Low |
| Detection Test By Nucleic Acid for Herpes Simplex Virus, Amplified Probe Tech... | other | N/A | $35 to $87,529 | Low |
| Ultrasound and Monitoring of Heart of Fetus | imaging | N/A | $100 to $76,818 | Low |
| X-ray of Ribs On Both Sides of Body, 3 Views | imaging | N/A | $100 to $71,110 | Low |
| X-ray of Paranasal Sinus, Minimum of 3 Views | imaging | N/A | $83 to $70,220 | Low |
| Detection Test By Nucleic Acid for Hiv-1 Virus, Amplified Probe Technique | other | N/A | $35 to $87,535 | Low |
| Limited Ultrasound of Pregnant Uterus | imaging | N/A | $100 to $76,815 | Low |
| X-ray of Eye Socket, Minimum of 4 Views | imaging | N/A | $100 to $70,200 | Low |
| X-ray of Skull, 1-3 Views | imaging | N/A | $100 to $70,250 | Low |
| New Patient Office OR Other Outpatient Visit with Moderate Level of Medical D... | other | N/A | $111 to $99,204 | Low |
| Ultrasound of Leg Arteries At Rest and After Exercise | imaging | N/A | $112 to $93,924 | Low |
| Injection for X-ray of Hinged Joint of Upper and Lower Jaw Bones | imaging | N/A | $37 to $21,116 | Low |
| Ultrasound Scan of Abdominal Aorta | imaging | N/A | $100 to $76,706 | Low |
| X-ray of Ribs On Both Sides of Body, Minimum of 4 Views | imaging | N/A | $100 to $71,111 | Low |
| Test to Measure Expiratory Airflow and Volume Changes Before and After Medica... | other | N/A | $116 to $94,060 | Low |
| Injection of Ureter for Imaging | other | N/A | $45 to $50,684 | Low |
| Pneumococcal Vaccine, 23-valent | preventive | N/A | $116 to $90,732 | Low |
| X-ray Series of Abdomen with Single X-ray of Chest | imaging | N/A | $100 to $74,022 | Low |
| Fetal Test | other | N/A | $119 to $59,025 | Low |
| Ultrasound Study of Arm OR Leg Veins with Compression and Maneuvers | imaging | N/A | $121 to $93,970 | Low |
| Ultrasound Study of One Arm OR Leg Veins with Compression and Maneuvers | imaging | N/A | $100 to $93,971 | Low |
| Review By Radiologist of Male Internal Genitals Image | other | N/A | $121 to $74,440 | Low |
| Tissue Culture to Identify White Blood Cell Disorders | lab | N/A | $116 to $88,230 | Low |
| Vaginal Ultrasound of Pregnant Uterus | imaging | N/A | $100 to $76,817 | Low |
| Ultrasound Scan of Pelvic Region Through Rectum | imaging | N/A | $100 to $76,872 | Low |
| Follow-up Ultrasound Scan of Pregnant Uterus | imaging | N/A | $100 to $76,816 | Low |
| Limited Ultrasound Scan of Joint OR Other Extremity Structure Except Blood Ve... | imaging | N/A | $100 to $76,882 | Low |
| Ultrasound Scan of Infant Hip During Movement | imaging | N/A | $83 to $76,885 | Low |
| CT Scan for Measuring Calcium and Other Minerals in Bone | imaging | N/A | $83 to $77,078 | Low |
| Insertion of Tube and Introduction of Contrast for X-ray of Uterus and Fallop... | imaging | N/A | $49 to $58,340 | Low |
| Ultrasound Scan of Pregnant Uterus (less Than 14 Weeks), Single OR First Fetus | imaging | N/A | $100 to $76,801 | Low |
| Evaluation of Speech Sound Production with Evaluation of Language Comprehensi... | other | N/A | $129 to $92,523 | Low |
| Review By Radiologist of Urinary Bladder Image | other | N/A | $129 to $74,430 | Low |
| Chromosome Analysis for Genetic Defects, Count 15-20 Cells | other | N/A | $125 to $88,262 | Low |
| 2d Ultrasound Scan of Eye Tissue and Structures | imaging | N/A | $100 to $76,512 | Low |
| Injection of Radioactive Material for X-ray Identification of Lymph Node | imaging | N/A | $130 to $38,792 | Low |
| Emergent Insertion of Breathing Tube Into Windpipe Using an Endoscope | other | N/A | $132 to $31,500 | Low |
| Review By Radiologist of Upper Urinary Tract Image | other | N/A | $133 to $74,425 | Low |
| X-ray of Skull, Minimum of 4 Views | imaging | N/A | $100 to $70,260 | Low |
| Complete Ultrasound Scan Behind Abdominal Cavity | imaging | N/A | $100 to $76,770 | Low |
| New Patient Office OR Other Outpatient Visit with a High Level of Medical Dec... | other | N/A | $135 to $99,205 | Low |
| Limited Ultrasound Scan Behind Abdominal Cavity | imaging | N/A | $100 to $76,775 | Low |
| Ultrasound Scan of Pregnant Uterus (less Than 14 Weeks), Each Additional Fetus | imaging | N/A | $58 to $76,802 | Low |
| Therapy Procedure Using a Special Bandage and Vacuum Pump, Surface Area More ... | other | N/A | $140 to $97,606 | Low |
| Single Contrast X-ray of Upper Digestive Tract | imaging | N/A | $141 to $74,240 | Low |
| Pathology Cytologic Examination of Specimen During Surgery, Initial Site | surgery | N/A | $143 to $88,333 | Low |
| Pathology Examination of Tissue Using a Microscope, High Complexity | lab | N/A | $143 to $88,309 | Low |
| Evaluation for Work Hardening OR Conditioning, Initial 2 Hours | other | N/A | $144 to $97,545 | Low |
| Fetal Congenital Abnormalities, Biochemical Assays of Four Analytes (afp, Ue3... | other | N/A | $145 to $81,511 | Low |
| Removal of Tissue From Wound, 20.0 SQ Cm OR Less | surgery | N/A | $145 to $97,597 | Low |
| Removal of Tissue From Wound, Each Additional 20.0 SQ Cm | surgery | N/A | $21 to $97,598 | Low |
| Ultrasound Scan of Pregnant Uterus (14 Weeks OR More), Each Additional Fetus | imaging | N/A | $84 to $76,810 | Low |
| Imaging of Urinary Tract Following Injection of a Contrast Agent | other | N/A | $146 to $74,420 | Low |
| Ultrasound Scan of Scrotum | imaging | N/A | $100 to $76,870 | Low |
| Review By Radiologist of Urinary Bladder and Urethra Images with Contrast | other | N/A | $149 to $74,450 | Low |
| X-ray of Upper Spine, 4-5 Views | imaging | N/A | $100 to $72,050 | Low |
| X-ray of Lower and Sacral Spine, Minimum of 4 Views | imaging | N/A | $100 to $72,110 | Low |
| Complete Ultrasound of Aorta, Vena Cava, Groin Vessels OR Bypass Grafts | imaging | N/A | $157 to $93,978 | Low |
| Ultrasound Scan of Head and Neck Soft Tissue | imaging | N/A | $100 to $76,536 | Low |
| X-ray Lower and Sacral Spine, Minimum of 6 Views | imaging | N/A | $100 to $72,114 | Low |
| 3d Radiographic Procedure | imaging | N/A | $24 to $76,376 | Low |
| Nuclear Medicine Study of Non-cardiac Blood Flow | imaging | N/A | $161 to $78,445 | Low |
| Review By Radiologist of Abscess OR Sinus Cavity Study | other | N/A | $161 to $76,080 | Low |
| Review By Radiologist of Urinary Bladder and Urethra Images with Contrast and... | other | N/A | $161 to $74,455 | Low |
| Review By Radiologist of Uterine Tube and Ovary Image | other | N/A | $161 to $74,740 | Low |
| Nuclear Medicine Study of Thyroid Function | imaging | N/A | $161 to $78,012 | Low |
| Double Contrast X-ray of Upper Digestive Tract | imaging | N/A | $164 to $74,246 | Low |
| Nuclear Medicine Study of Lung Ventilation | imaging | N/A | $170 to $78,579 | Low |
| Ultrasound Scan of Uterus, Ovaries, Tubes, Cervix and Pelvic Area Through Vagina | imaging | N/A | $100 to $76,830 | Low |
| Nuclear Medicine Study of Intestine | imaging | N/A | $175 to $78,290 | Low |
| X-ray of Upper Spine, 6 OR More Views | imaging | N/A | $100 to $72,052 | Low |
| Nuclear Medicine Study of Bone And/or Joint Limited Area | imaging | N/A | $179 to $78,300 | Low |
| Review By Radiologist of CT Guidance for Needle Placement | other | N/A | $117 to $77,012 | Low |
| Removal of Sample of Amniotic Fluid Surrounding Fetus for Diagnosis | surgery | N/A | $187 to $59,000 | Low |
| Complete Ultrasound Scan of Pelvis | imaging | N/A | $100 to $76,856 | Low |
| Ultrasound Scan of Pregnant Uterus (14 Weeks OR More), Single OR First Fetus | imaging | N/A | $100 to $76,805 | Low |
| Nuclear Medicine Study of Whole Body for Thyroid Cancer | imaging | N/A | $192 to $78,018 | Low |
| Limited Ultrasound Scan of Abdomen | imaging | N/A | $100 to $76,705 | Low |
| Review By Radiologist of Ultrasound of Digestive Tract Using an Endoscope | imaging | N/A | $195 to $76,975 | Low |
| Stress Test | cardiac | N/A | $193 to $59,020 | High |
| Double Contrast X-ray of Large Intestine | imaging | N/A | $168 to $74,280 | Low |
| Nuclear Medicine Study of Stomach to Assess Emptying | imaging | N/A | $201 to $78,264 | Low |
| X-ray of Body Plane | imaging | N/A | $100 to $76,100 | Low |
| Complete Ultrasound Scan of Abdomen | imaging | N/A | $100 to $76,700 | Low |
| Imaging of Urinary Tract Using Infusion Technique | surgery | N/A | $168 to $74,410 | Low |
| Imaging of Urinary Tract with Injection of Contrast Into a Vein | other | N/A | $168 to $74,400 | Low |
| Nuclear Medicine Study of Lymphatic System | imaging | N/A | $212 to $78,195 | Low |
| Nuclear Medicine Study of Testicle and Blood Flow | imaging | N/A | $212 to $78,761 | Low |
| X-ray of Surgical Specimen | imaging | N/A | $215 to $76,098 | Low |
| Nuclear Medicine Study of Lung Ventilation and Circulation and Blood Flow to ... | imaging | N/A | $218 to $78,598 | Low |
| Nuclear Medicine Study of Thyroid | imaging | N/A | $225 to $78,013 | Low |
| Nuclear Medicine Studies of Kidney, Blood Flow, and Function | imaging | N/A | $226 to $78,709 | Low |
| Nuclear Medicine Study of Kidney, Blood, Flow, and Function with Drug Adminis... | imaging | N/A | $226 to $78,708 | Low |
| Dilation of Stomach And/or Small Bowel Using Long Gastrointestinal Tube | other | N/A | $236 to $44,500 | Low |
| Bone Marrow, Smear Interpretation | other | N/A | $236 to $85,097 | Low |
| Reviving Newborn At Delivery | obstetric | N/A | $242 to $99,465 | Low |
| Nuclear Medicine Study of Thyroid and Thyroid Function | imaging | N/A | $262 to $78,014 | Low |
| Drainage of Fluid From Abdominal Cavity Using Imaging Guidance | other | N/A | $264 to $49,083 | Low |
| Nuclear Medicine Study of Liver, Spleen, and Blood Flow | imaging | N/A | $266 to $78,216 | Low |
| Nuclear Medicine Study to Assess Blood Loss | imaging | N/A | $268 to $78,278 | Low |
| Follow-up Inpatient OR Observation Ventilation Assistance and Management | other | N/A | $277 to $94,003 | Low |
| Initial Hospital Inpatient OR Observation Ventilation Assistance and Management | other | N/A | $277 to $94,002 | Low |
| Imaging of Urinary Tract Using Infusion Technique with Kidney Section Filming | surgery | N/A | $168 to $74,415 | Low |
| Radiation Therapy | other | N/A | $35 to $77,014 | High |
| Radioactive Drug Therapy By Mouth | other | N/A | $223 to $79,005 | Low |
| Dialysis | other | N/A | $100 to $90,935 | High |
| Injection of Contrast for Imaging of Lower Spinal Canal | other | N/A | $69 to $62,284 | Low |
| Nuclear Medicine Study, 1 Area | imaging | N/A | $332 to $78,800 | Low |
| Radiopharmaceutical Localization of Inflammatory Process; Whole Body | other | N/A | $332 to $78,806 | Low |
| CT Scan of Arm with Contrast | imaging | N/A | $332 to $73,201 | Low |
| Nuclear Medicine Study to Assess Urine Flow | imaging | N/A | $337 to $78,740 | Low |
| Nuclear Medicine Study, Whole Body | imaging | N/A | $344 to $78,802 | Low |
| Test for Detecting Genes Associated with Fetal Disease, Aneuploidy Genomic Se... | other | N/A | $372 to $81,420 | Low |
| CT Scan of Arm without Contrast | imaging | N/A | $100 to $73,200 | Low |
| Nuclear Medicine Study of Parathyroid | imaging | N/A | $378 to $78,070 | Low |
| Nuclear Medicine Study of Bone And/or Joint Multiple Areas | imaging | N/A | $379 to $78,305 | Low |
| Nuclear Medicine Study of Heart Pumping Function By Labeling Red Blood Cells ... | imaging | N/A | $382 to $78,472 | Low |
| Nuclear Medicine Study, SPECT Imaging, 1 Area OR Single Acquisition, Single D... | imaging | N/A | $402 to $78,803 | Low |
| Nuclear Medicine Study of Bone And/or Joint Whole Body | imaging | N/A | $382 to $78,306 | Low |
| Gene Analysis (cystic Fibrosis Transmembrane Conductance Regular) Common Vari... | other | N/A | $446 to $81,220 | Low |
| Abdominal Ultrasound | imaging | N/A | $100 to $983 | High |
| Ankle X-Ray | imaging | N/A | $58 to $290 | High |
| Asthma Management | other | N/A | $116 to $581 | High |
| Basic Metabolic Panel (BMP) | lab | N/A | $8 to $110 | High |
| Blood Draw (Venipuncture) | lab | N/A | $5 to $25 | High |
| Carotid Ultrasound | imaging | N/A | $106 to $535 | High |
| Chest X-Ray | imaging | N/A | $69 to $349 | High |
| Circumcision | surgery | N/A | $572 to $2,875 | High |
| Complete Blood Count (CBC) | lab | N/A | $6 to $123 | High |
| Cortisone Shot (Joint Injection) | surgery | N/A | $293 to $1,788 | High |
| Critical Care | emergency | N/A | $23 to $1,672 | High |
| CT Abdomen and Pelvis | imaging | N/A | $333 to $6,057 | High |
| CT Chest | imaging | N/A | $168 to $3,206 | High |
| CT Spine | imaging | N/A | $168 to $3,928 | High |
| Diabetes Management | other | N/A | $82 to $488 | High |
| Emergency Room Visit | emergency | N/A | $106 to $531 | High |
| Foot X-Ray | imaging | N/A | $69 to $345 | High |
| Hand/Wrist X-Ray | imaging | N/A | $66 to $334 | High |
| Hip/Pelvis X-Ray | imaging | N/A | $32 to $159 | High |
| Hospital Observation | other | N/A | $10 to $827 | High |
| Hypertension Management | cardiac | N/A | $56 to $422 | High |
| IV Drug Infusion | therapy | N/A | $27 to $137 | High |
| IV Hydration | therapy | N/A | $26 to $137 | High |
| Liver Function Panel | lab | N/A | $8 to $231 | High |
| Lumbar Puncture (Spinal Tap) | other | N/A | $178 to $894 | High |
| Lumbar Spine X-Ray | imaging | N/A | $80 to $404 | High |
| Moderate Sedation | other | N/A | $11 to $334 | High |
| MRI of the Abdomen | imaging | N/A | $333 to $3,547 | High |
| MRI of the Brain | imaging | N/A | $333 to $4,593 | High |
| MRI of the Knee | imaging | N/A | $333 to $3,723 | High |
| MRI of the Shoulder | imaging | N/A | $333 to $3,607 | High |
| MRI Spine | imaging | N/A | $228 to $3,607 | High |
| Obstetric Ultrasound | imaging | N/A | $34 to $624 | High |
| Paracentesis | diagnostic | N/A | $264 to $1,328 | High |
| Pathology (Surgical Specimen) | lab | N/A | $28 to $139 | High |
| Pelvic Ultrasound | imaging | N/A | $100 to $870 | High |
| Shoulder X-Ray | imaging | N/A | $51 to $254 | High |
| Therapeutic Injection | preventive | N/A | $45 to $337 | High |
| Thoracentesis | other | N/A | $424 to $2,133 | High |
| Thyroid Test (TSH) | lab | N/A | $17 to $244 | High |
| Urgent Care Visit | other | N/A | $40 to $274 | High |
| Vitamin D Test | lab | N/A | $30 to $200 | High |
| Wound Debridement | surgery | N/A | $9,736 to $26,532 | High |
| X-Ray of the Knee | imaging | N/A | $83 to $420 | High |
This hospital's pricing is published per federal mandate.
Disclosure required by 45 CFR Part 180.
Last updated: