| 27130 |
HB Arthrp Acetblr/Prox Fem Prostc Agrft/Algrft |
Peer Hospital A $13,815.01 Peer Hospital B $13,815.01 Peer Hospital C $13,815.01 |
| 93005 |
Routine electrocardiogram (ECG) using at least 12 leads with tracing |
Peer Hospital A $309.75 Peer Hospital B $309.75 Peer Hospital C $309.75 Peer Hospital D $295.00 Peer Hospital E $274.35 Peer 6 $274.35 Peer 7 $274.35 Peer 8 $250.75 Peer 9 $231.03 Peer 10 $229.18 Peer 11 $218.30 Peer 12 $213.15 Peer 13 $179.66 Peer 14 $156.18 Peer 15 $151.83 Peer 16 $149.90 Peer 17 $144.62 Peer 18 $130.03 Peer 19 $118.32 Peer 20 $105.06 Peer 21 $102.74 Peer 22 $61.60 |
| 99283 |
HB ED Visit Level 3 |
Peer Hospital A $1,382.20 Peer Hospital B $1,358.35 Peer Hospital C $1,345.80 Peer Hospital D $1,345.80 Peer Hospital E $1,317.20 Peer 6 $1,317.20 Peer 7 $1,312.00 Peer 8 $1,275.60 Peer 9 $1,215.80 Peer 10 $1,215.80 Peer 11 $1,215.80 Peer 12 $1,197.99 Peer 13 $1,197.37 Peer 14 $1,178.10 Peer 15 $1,169.20 Peer 16 $1,058.20 Peer 17 $1,040.97 Peer 18 $970.54 Peer 19 $939.15 Peer 20 $930.95 Peer 21 $696.95 Peer 22 $577.80 Peer 23 $435.60 |
| 43239 |
HB Egd Transoral Biopsy Single/Multiple |
Peer Hospital A $5,429.37 Peer Hospital B $4,896.82 Peer Hospital C $4,629.10 Peer Hospital D $4,454.33 Peer Hospital E $3,841.11 Peer 6 $3,656.99 Peer 7 $3,286.87 Peer 8 $2,528.35 Peer 9 $2,421.99 Peer 10 $1,160.69 Peer 11 $1,066.50 Peer 12 $1,006.65 |
| 99284 |
HB ED Visit Level 4 |
Peer Hospital A $2,546.54 Peer Hospital B $2,537.87 Peer Hospital C $2,364.69 Peer Hospital D $2,323.10 Peer Hospital E $2,299.94 Peer 6 $2,289.30 Peer 7 $2,289.30 Peer 8 $2,284.10 Peer 9 $2,208.85 Peer 10 $2,208.70 Peer 11 $2,208.70 Peer 12 $2,161.90 Peer 13 $2,052.70 Peer 14 $2,052.70 Peer 15 $2,050.10 Peer 16 $2,032.58 Peer 17 $1,992.90 Peer 18 $1,983.85 Peer 19 $1,782.45 Peer 20 $1,534.57 Peer 21 $1,091.40 Peer 22 $923.90 Peer 23 $822.80 |
| 71250 |
HB CT Thorax, Diagnostic W/O Dye |
Peer Hospital A $3,357.00 Peer Hospital B $2,984.00 Peer Hospital C $2,984.00 Peer Hospital D $2,797.50 Peer Hospital E $2,051.50 Peer 6 $932.79 Peer 7 $653.00 Peer 8 $653.00 Peer 9 $653.00 Peer 10 $653.00 Peer 11 $653.00 Peer 12 $653.00 Peer 13 $653.00 Peer 14 $653.00 Peer 15 $653.00 Peer 16 $653.00 Peer 17 $653.00 Peer 18 $642.09 Peer 19 $114.18 Peer 20 $114.18 |
| 70551 |
HB MRI Brain Stem W/O Dye |
Peer Hospital A $4,997.70 Peer Hospital B $4,442.40 Peer Hospital C $4,442.40 Peer Hospital D $4,164.75 Peer Hospital E $3,054.15 Peer 6 $1,302.03 Peer 7 $1,182.26 Peer 8 $1,096.00 Peer 9 $1,096.00 Peer 10 $1,096.00 Peer 11 $1,096.00 Peer 12 $1,096.00 Peer 13 $1,096.00 Peer 14 $1,096.00 Peer 15 $1,096.00 Peer 16 $1,096.00 Peer 17 $1,096.00 Peer 18 $1,096.00 Peer 19 $761.00 Peer 20 $761.00 |
| 70553 |
HB MRI Brain Stem W/O & W/Dye |
Peer Hospital A $6,923.70 Peer Hospital B $6,154.40 Peer Hospital C $6,154.40 Peer Hospital D $5,769.75 Peer Hospital E $4,231.15 Peer 6 $1,498.00 Peer 7 $1,244.23 Peer 8 $1,096.00 Peer 9 $1,096.00 Peer 10 $1,096.00 Peer 11 $1,096.00 Peer 12 $1,096.00 Peer 13 $1,096.00 Peer 14 $1,096.00 Peer 15 $1,096.00 Peer 16 $1,096.00 Peer 17 $1,096.00 Peer 18 $1,096.00 Peer 19 $761.00 Peer 20 $761.00 |
| 74177 |
HB CT Abd & Pelv W/Contrast |
Peer Hospital A $7,777.80 Peer Hospital B $6,913.60 Peer Hospital C $6,913.60 Peer Hospital D $6,481.50 Peer Hospital E $4,753.10 Peer 6 $1,095.00 Peer 7 $776.73 Peer 8 $653.00 Peer 9 $653.00 Peer 10 $653.00 Peer 11 $653.00 Peer 12 $653.00 Peer 13 $653.00 Peer 14 $653.00 Peer 15 $653.00 Peer 16 $653.00 Peer 17 $653.00 Peer 18 $653.00 Peer 19 $519.00 Peer 20 $519.00 |
| 29881 |
HB Arthroscop Knee Med and Lat |
Peer Hospital A $25,159.71 Peer Hospital B $24,400.83 Peer Hospital C $17,472.49 Peer Hospital D $15,151.45 Peer Hospital E $15,141.75 Peer 6 $9,032.19 Peer 7 $3,483.71 Peer 8 $3,483.71 Peer 9 $3,483.71 |