Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

LAKE MARTIN COMMUNITY HOSPITAL

Dadeville, AL · CCN 010052 · Rates published

1,439 distinct procedures filed
7 distinct payers
20,310 rate rows
2026-04-01 last MRF observed
Data quality

2,212 of 20,310 rate rows are consumer-grade (10.9%)

18,098 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 15,814
per-diem day rate — not a per-procedure price 1,650
exceeds 10× this hospital's gross charge — excluded from medians 468
exceeds 3× this hospital's gross charge for a DRG stay — excluded 166
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://ivycreekhealth.com/wp-content/uploads/2026/04/631282722_lake-martin-community-hospital_standardcharges.csv
Found on page https://ivycreekhealth.com/price-transparency/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-17
Content fingerprint c7113ab027535962… · 8,778,357 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
871
MS_DRG 		M Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 2 $6,500.00 $11,842.77 $9,171.39 nat. median
$19,634
outlier · 0.5×
922
MS_DRG 		M Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc 2 $6,500.00 $11,187.73 $8,843.86 nat. median
$17,445
0.5× median
193
MS_DRG 		M Simple Pneumonia And Pleurisy With Mcc 2 $6,500.00 $10,531.33 $8,515.67 nat. median
$13,648
0.6× median
551
MS_DRG 		M Medical Back Problems With Mcc 2 $6,500.00 $9,527.79 $8,013.90 nat. median
$16,881
outlier · 0.5×
291
MS_DRG 		M Heart Failure And Shock With Mcc 2 $6,500.00 $8,587.45 $7,543.73 nat. median
$13,521
0.6× median
640
MS_DRG 		M Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Wit… 2 $6,500.00 $8,471.65 $7,485.82 nat. median
$13,400
0.6× median
189
MS_DRG 		M Pulmonary Edema And Respiratory Failure 2 $6,500.00 $8,216.46 $7,358.23 nat. median
$13,017
0.6× median
689
MS_DRG 		M Kidney And Urinary Tract Infections With Mcc 2 $6,500.00 $8,091.83 $7,295.91 nat. median
$12,152
0.6× median
439
MS_DRG 		M Disorders Of Pancreas Except Malignancy With Cc 2 $6,500.00 $6,566.35 $6,533.18 nat. median
$9,521
0.7× median
0126
RC 		1 $6,500.00 $6,500.00 $6,500.00 nat. median
$927
outlier · 7.0×
72
MS_DRG 		M Other Cerebrovascular Disorders Without Cc/mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$8,633
0.8× median
557
MS_DRG 		M Tendonitis, Myositis And Bursitis With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$15,338
outlier · 0.4×
917
MS_DRG 		M Poisoning And Toxic Effects Of Drugs With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$15,271
outlier · 0.4×
0120
RC 		1 $6,500.00 $6,500.00 $6,500.00 nat. median
$1,017
outlier · 6.4×
682
MS_DRG 		M Renal Failure With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$15,223
outlier · 0.4×
438
MS_DRG 		M Disorders Of Pancreas Except Malignancy With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$16,971
outlier · 0.4×
600
MS_DRG 		M Non-malignant Breast Disorders With Cc/mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$10,799
0.6× median
436
MS_DRG 		M Malignancy Of Hepatobiliary System Or Pancreas With Cc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$12,085
0.5× median
432
MS_DRG 		M Cirrhosis And Alcoholic Hepatitis With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$19,681
outlier · 0.3×
433
MS_DRG 		M Cirrhosis And Alcoholic Hepatitis With Cc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$11,433
0.6× median
444
MS_DRG 		M Disorders Of The Biliary Tract With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$16,880
outlier · 0.4×
580
MS_DRG 		P Other Skin, Subcutaneous Tissue And Breast Procedures With Cc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$17,921
outlier · 0.4×
637
MS_DRG 		M Diabetes With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$14,787
outlier · 0.4×
388
MS_DRG 		M Gastrointestinal Obstruction With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$15,091
outlier · 0.4×
371
MS_DRG 		M Major Gastrointestinal Disorders And Peritoneal Infections With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$17,807
outlier · 0.4×
811
MS_DRG 		M Red Blood Cell Disorders With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$14,380
outlier · 0.5×
895
MS_DRG 		M Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$13,422
outlier · 0.5×
91
MS_DRG 		M Other Disorders Of Nervous System With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$17,985
outlier · 0.4×
54
MS_DRG 		M Nervous System Neoplasms With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$15,454
outlier · 0.4×
0110
RC 		1 $6,500.00 $6,500.00 $6,500.00 nat. median
$979
outlier · 6.6×
64
MS_DRG 		M Intracranial Hemorrhage Or Cerebral Infarction With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$20,254
outlier · 0.3×
177
MS_DRG 		M Respiratory Infections And Inflammations With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$16,234
outlier · 0.4×
299
MS_DRG 		M Peripheral Vascular Disorders With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$16,470
outlier · 0.4×
565
MS_DRG 		M Other Musculoskeletal System And Connective Tissue Diagnoses With Cc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$10,731
0.6× median
308
MS_DRG 		M Cardiac Arrhythmia And Conduction Disorders With Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$12,751
0.5× median
370
MS_DRG 		M Major Esophageal Disorders Without Cc/mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$8,079
0.8× median
386
MS_DRG 		M Inflammatory Bowel Disease With Cc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$10,778
0.6× median
384
MS_DRG 		M Uncomplicated Peptic Ulcer Without Mcc 1 $6,500.00 $6,500.00 $6,500.00 nat. median
$9,522
0.7× median
71
MS_DRG 		M Other Cerebrovascular Disorders With Cc 2 $6,292.07 $6,500.00 $6,396.03 nat. median
$11,209
0.6× median
65
MS_DRG 		M Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 2 $6,102.30 $6,500.00 $6,301.15 nat. median
$11,174
0.6× median
378
MS_DRG 		M Gastrointestinal Hemorrhage With Cc 2 $5,780.12 $6,500.00 $6,140.06 nat. median
$10,712
0.6× median
872
MS_DRG 		M Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 2 $5,603.62 $6,500.00 $6,051.81 nat. median
$11,103
0.5× median
194
MS_DRG 		M Simple Pneumonia And Pleurisy With Cc 2 $5,528.08 $6,500.00 $6,014.04 nat. median
$9,125
0.7× median
389
MS_DRG 		M Gastrointestinal Obstruction With Cc 2 $5,266.53 $6,500.00 $5,883.26 nat. median
$8,897
0.7× median
683
MS_DRG 		M Renal Failure With Cc 1 $5,042.63 $5,042.63 $5,042.63 nat. median
$9,664
0.5× median
440
MS_DRG 		M Disorders Of Pancreas Except Malignancy Without Cc/mcc 2 $3,042.16 $6,500.00 $4,771.08 nat. median
$7,343
0.6× median
390
MS_DRG 		M Gastrointestinal Obstruction Without Cc/mcc 1 $2,513.25 $2,513.25 $2,513.25 nat. median
$6,562
outlier · 0.4×
99285
HCPCS 		Emer Dept High Severity&threat Funcj 6 $350.00 $2,341.84 $368.75 nat. median
$1,227
outlier · 0.3×
16030
HCPCS 		Drs&/dbrdmt Prtl-thkns Burns 1st/sbsq La 6 $350.00 $375.00 $362.50 nat. median
$489
0.7× median
16025
HCPCS 		Drs&/dbrdmt Prtl-thkns Burns 1st/sbsq Me 6 $350.00 $375.00 $362.50 nat. median
$322
1.1× median

Other procedures at this hospital

Browse this hospital's 1,439 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
86038 HCPCS Antinuclear (ana) Antibody 4 2 $30.00 $22.50 25% off $8.46 $11.85 $10.16 2026-04-01
80156 HCPCS Carbamazepine 2 1 $37.00 $27.75 25% off $10.19 $10.19 $10.19 2026-04-01
83540 HCPCS Iron (reference Lab) 2 1 $16.00 $12.00 25% off $10.20 $10.20 $10.20 2026-04-01
82746 HCPCS Folate Serum (reference Lab) 2 1 $37.00 $27.75 25% off $10.29 $10.29 $10.29 2026-04-01
82550 HCPCS Ck Isoenzymes 4 2 $16.28 $12.21 25% off $4.55 $17.66 $11.11 2026-04-01
80061 HCPCS Lipid Profile 4 2 $33.00 $24.75 25% off $9.37 $13.18 $11.27 2026-04-01
80164 HCPCS Depakene 4 2 $34.00 $25.50 25% off $9.47 $13.54 $11.50 2026-04-01
87880 HCPCS Rapid Strep Screen 2 1 $42.00 $31.50 25% off $11.57 $11.57 $11.57 2026-04-01
84481 HCPCS T3 Free Assay 2 1 $42.00 $31.50 25% off $11.85 $11.85 $11.85 2026-04-01
82140 HCPCS Ammonia Ael 4 2 $37.00 $27.75 25% off $10.19 $14.28 $12.23 2026-04-01
80048 HCPCS Basic Metabolic Pa 4 2 $21.00 $15.75 25% off $8.29 $16.28 $12.29 2026-04-01
85379 HCPCS D-dimer Fdp 4 2 $25.00 $18.75 25% off $7.12 $17.50 $12.31 2026-04-01
87177 HCPCS Ova And Parasites 2 1 $22.00 $16.50 25% off $12.42 $12.42 $12.42 2026-04-01
84466 HCPCS Transferrin 2 1 $32.00 $24.00 25% off $12.50 $12.50 $12.50 2026-04-01
86235 HCPCS Rnp Antibody 2 1 $45.00 $33.75 25% off $12.55 $12.55 $12.55 2026-04-01
82607 HCPCS Vitamin B12 4 2 $38.00 $28.50 25% off $10.55 $14.78 $12.66 2026-04-01
82553 HCPCS Cpk Mb 4 2 $31.00 $23.25 25% off $8.08 $17.66 $12.87 2026-04-01
83002 HCPCS Leuteinzing Hormone 2 1 $47.00 $35.25 25% off $12.96 $12.96 $12.96 2026-04-01
83001 HCPCS Fsh 2 1 $47.00 $35.25 25% off $13.00 $13.00 $13.00 2026-04-01
Q9967 HCPCS Contrast - 50ml 4 2 $37.00 $27.75 25% off $0.15 $25.90 $13.03 2026-04-01
72220 HCPCS Xr Sacrum/coccyx 2 1 $72.00 $54.00 25% off $13.27 $13.27 $13.27 2026-04-01
87186 HCPCS Sensitivity 1 2 1 $22.00 $16.50 25% off $13.35 $13.35 $13.35 2026-04-01
87040 HCPCS Culture Blood 2 1 $25.00 $18.75 25% off $13.35 $13.35 $13.35 2026-04-01
84146 HCPCS Prolactin 2 1 $48.00 $36.00 25% off $13.56 $13.56 $13.56 2026-04-01
0270 RC — 2 1 $291.00 $218.25 25% off $13.64 $13.64 $13.64 2026-04-01
82728 HCPCS Ferritin 4 2 $34.00 $25.50 25% off $13.36 $14.80 $14.08 2026-04-01
84443 HCPCS Tsh Ael 4 2 $42.00 $31.50 25% off $11.76 $16.46 $14.11 2026-04-01
73120 HCPCS Xr Hand Pa And Lat-lt,left 4 1 $70.00 $52.50 25% off $14.52 $14.52 $14.52 2026-04-01
74018 HCPCS Xr Abdomen 1 View 2 1 $67.00 $50.25 25% off $14.97 $14.97 $14.97 2026-04-01
82672 HCPCS Estrogen, Total 2 1 $55.00 $41.25 25% off $15.19 $15.19 $15.19 2026-04-01
84484 HCPCS Troponin I 4 2 $31.00 $23.25 25% off $8.72 $21.70 $15.21 2026-04-01
73660 HCPCS Xr Toe(s)-lt,left 6 2 $65.00 $48.75 25% off $15.21 $45.50 $15.21 2026-04-01
84153 HCPCS Psa Screen 4 2 $46.00 $34.50 25% off $12.87 $18.02 $15.45 2026-04-01
87070 HCPCS Culture Nose 2 1 $22.00 $16.50 25% off $15.99 $15.99 $15.99 2026-04-01
93005 HCPCS ECG Routine ECG W/least 12 Lds Trcg ONLY,Distinct Procedural Service 4 2 $19.00 $14.25 25% off $13.30 $19.00 $16.15 2026-04-01
80184 HCPCS Phenobarbital Level 2 1 $38.00 $28.50 25% off $16.30 $16.30 $16.30 2026-04-01
73501 HCPCS Xr Hip X-table-lt,left 2 1 $73.00 $54.75 25% off $16.33 $16.33 $16.33 2026-04-01
86665 HCPCS Ebv Ab Vca Igm 4 2 $45.00 $33.75 25% off $12.69 $20.86 $16.77 2026-04-01
73130 HCPCS Xr Hand Complete-lt,left 6 2 $80.00 $60.00 25% off $16.83 $77.69 $16.83 2026-04-01
87045 HCPCS Culture Stool 2 1 $23.00 $17.25 25% off $16.87 $16.87 $16.87 2026-04-01
86318 HCPCS Mono Test (wb) 4 2 $45.00 $33.75 25% off $14.08 $20.80 $17.44 2026-04-01
0258 RC — 2 1 $54.00 $40.50 25% off $17.50 $17.50 $17.50 2026-04-01
73070 HCPCS Xr Elbow 2 View-lt,left 4 1 $65.00 $48.75 25% off $17.64 $17.64 $17.64 2026-04-01
82626 HCPCS Dhea 2 1 $63.00 $47.25 25% off $17.68 $17.68 $17.68 2026-04-01
94640 HCPCS Airway Inhalation Treatment 2 1 $40.00 $30.00 25% off $17.79 $17.79 $17.79 2026-04-01
84402 HCPCS Testosterone Free 2 1 $63.00 $47.25 25% off $17.82 $17.82 $17.82 2026-04-01
74019 HCPCS Xr Abd Flat And Upright 2 1 $83.00 $62.25 25% off $17.93 $17.93 $17.93 2026-04-01
J2919 HCPCS Solu-medrol Inj 125 Mg 8 2 $1.56 $1.17 25% off $8.40 $31.25 $18.12 2026-04-01
73090 HCPCS Xr Forearm-lt,left 4 1 $66.50 $49.88 25% off $18.20 $18.20 $18.20 2026-04-01
73030 HCPCS Xr Shoulder 2 View-lt,left 6 2 $76.00 $57.00 25% off $18.40 $73.62 $18.40 2026-04-01
73620 HCPCS Xr Foot Ap And Lat-lt,left 4 1 $64.00 $48.00 25% off $18.53 $18.53 $18.53 2026-04-01
73552 HCPCS Xr Femur-lt,left 4 1 $80.00 $60.00 25% off $18.66 $18.66 $18.66 2026-04-01
G0378 HCPCS Hospital Observation Per Hr 2 1 $25.00 $18.75 25% off $18.81 $18.81 $18.81 2026-04-01
86141 HCPCS Crp-hs (ael) 2 1 $32.00 $24.00 25% off $19.27 $19.27 $19.27 2026-04-01
73590 HCPCS Xr Tib/fib-lt,left 4 1 $70.00 $52.50 25% off $19.56 $19.56 $19.56 2026-04-01
73110 HCPCS Xr Wrist Complete-lt,left 4 1 $89.00 $66.75 25% off $20.01 $20.01 $20.01 2026-04-01
73630 HCPCS Xr Foot Complete-lt,left 4 1 $75.00 $56.25 25% off $20.01 $20.01 $20.01 2026-04-01
70160 HCPCS Xr Nasal Bones 2 1 $83.00 $62.25 25% off $20.01 $20.01 $20.01 2026-04-01
72170 HCPCS Xr Pelvis Ap 2 1 $65.00 $48.75 25% off $20.31 $20.31 $20.31 2026-04-01
87899 HCPCS Rsv Rapid Test 2 1 $40.00 $30.00 25% off $20.76 $20.76 $20.76 2026-04-01
73565 HCPCS Xr Knees Bilateral 2 1 $88.00 $66.00 25% off $21.50 $21.50 $21.50 2026-04-01
73080 HCPCS Xr Elbow Complete-lt,left 4 1 $71.00 $53.25 25% off $21.61 $21.61 $21.61 2026-04-01
72040 HCPCS Xr Cervical Spine 2 View 2 1 $88.00 $66.00 25% off $21.63 $21.63 $21.63 2026-04-01
84403 HCPCS Testosterone, Females/child 4 2 $65.00 $48.75 25% off $18.06 $25.29 $21.67 2026-04-01
73060 HCPCS Xr Humerus-lt,left 4 1 $72.00 $54.00 25% off $21.85 $21.85 $21.85 2026-04-01
J1885 HCPCS Toradol (ketorolac)inj 60mg/2ml 16 2 $27.00 $20.25 25% off $7.35 $50.00 $22.20 2026-04-01
70150 HCPCS Xr Facial Bones Complete 2 1 $105.00 $78.75 25% off $22.24 $22.24 $22.24 2026-04-01
70250 HCPCS Xr Skull Ap And Lat 2 1 $82.00 $61.50 25% off $22.41 $22.41 $22.41 2026-04-01
73560 HCPCS Xr Knee 2 View-lt,left 2 1 $77.00 $57.75 25% off $22.53 $22.53 $22.53 2026-04-01
72190 HCPCS Xr Pelvis Complete 2 1 $93.00 $69.75 25% off $22.68 $22.68 $22.68 2026-04-01
73521 HCPCS Xr Hips Bilateral 2 1 $92.00 $69.00 25% off $22.78 $22.78 $22.78 2026-04-01
72072 HCPCS Xr Thoracic Spine 4 2 $88.00 $66.00 25% off $21.36 $24.74 $23.05 2026-04-01
80185 HCPCS Dilantin 2 1 $33.00 $24.75 25% off $23.10 $23.10 $23.10 2026-04-01
73502 HCPCS Xr Hip/pelvis-lt,left 6 2 $104.00 $78.00 25% off $24.54 $77.69 $24.54 2026-04-01
87491 HCPCS Chlamydia/n.gonorrhoeae Rna, Tma 2 1 $88.00 $66.00 25% off $24.56 $24.56 $24.56 2026-04-01
82306 HCPCS Vitamin D 25 Hydroxy 4 2 $82.72 $62.04 25% off $20.72 $29.01 $24.87 2026-04-01
72050 HCPCS Xr Cervical Spine Complete 2 1 $117.00 $87.75 25% off $24.90 $24.90 $24.90 2026-04-01
72100 HCPCS Xr Lumbar Spine 2 Views 2 1 $88.00 $66.00 25% off $26.31 $26.31 $26.31 2026-04-01
71101 HCPCS Xr Ribs With Pa Chest-lt,left 6 2 $95.00 $71.25 25% off $24.64 $95.00 $27.57 2026-04-01
76536 HCPCS US Thyroid 2 1 $267.00 $200.25 25% off $28.47 $28.47 $28.47 2026-04-01
90471 HCPCS Immunization Administration Vaccine 2 1 $33.00 $24.75 25% off $29.40 $29.40 $29.40 2026-04-01
87426 HCPCS Covid Ag Sars Cov-2 - Bd (in-house) 2 1 $89.00 $66.75 25% off $34.81 $34.81 $34.81 2026-04-01
J2405 HCPCS Zofran (ondansetron) 4mg/2ml Inj 2ml Sdv 4 2 $27.00 $20.25 25% off $0.36 $75.60 $37.98 2026-04-01
83880 HCPCS Bnp Cardiac Marker 6 2 $98.00 $73.50 25% off $27.48 $38.85 $38.63 2026-04-01
83970 HCPCS Pth Intact Without Ca++ 2 1 $103.00 $77.25 25% off $40.62 $40.62 $40.62 2026-04-01
96375 HCPCS IV Push Ea Add New DRUG,Distinct Procedural Service 2 1 $31.00 $23.25 25% off $40.71 $40.71 $40.71 2026-04-01
96366 HCPCS IV Therapy Concurrent Addl Hour 2nd IV,Distinct Procedural Service 2 1 $50.50 $37.88 25% off $40.71 $40.71 $40.71 2026-04-01
96361 HCPCS IV Infusion Hydration Ea Add Hr 2 1 $31.00 $23.25 25% off $41.44 $41.44 $41.44 2026-04-01
71045 HCPCS Xr Chest Decubitus 4 2 $60.00 $45.00 25% off $8.74 $77.69 $43.22 2026-04-01
87529 HCPCS Hsv 1&2 Dna,qn Real Time Pcr (labc) 2 1 $105.27 $78.95 25% off $43.88 $43.88 $43.88 2026-04-01
71046 HCPCS Xr Chest 2 Views 4 2 $75.00 $56.25 25% off $16.14 $75.12 $45.63 2026-04-01
73610 HCPCS Xr Ankle Compl Minimum 3 VIEWS,Right 8 2 $80.00 $60.00 25% off $20.01 $79.28 $49.01 2026-04-01
76705 HCPCS US Gallbladder 4 2 $212.00 $159.00 25% off $50.03 $51.33 $50.68 2026-04-01
82805 HCPCS Arterial Blood Gas 2 1 $197.00 $147.75 25% off $57.63 $57.63 $57.63 2026-04-01
73564 HCPCS Xr Knee Complete-lt,left 8 2 $100.00 $75.00 25% off $24.82 $95.73 $60.27 2026-04-01
72110 HCPCS Xr Lumbar Spine Complete 4 2 $112.00 $84.00 25% off $30.02 $93.83 $61.92 2026-04-01
96367 HCPCS IV Drug Sequential Of New Drug 2 1 $71.00 $53.25 25% off $62.80 $62.80 $62.80 2026-04-01
J2550 HCPCS Phenergan (promethazine)inj 25 Mg Vl 6 1 $28.00 $21.00 25% off $43.03 $82.75 $66.20 2026-04-01
G0463 HCPCS Hosp Outpt Clinic Visit Assess/manage 2 1 $83.00 $62.25 25% off $68.39 $68.39 $68.39 2026-04-01
76857 HCPCS US Pelvis 4 2 $254.00 $190.50 25% off $47.45 $95.03 $71.24 2026-04-01
76770 HCPCS US Renal 4 2 $263.00 $197.25 25% off $56.35 $95.73 $76.04 2026-04-01
J0696 HCPCS Rocephin(ceftriaxone)500mg Im/iv Inj 16 2 $55.00 $41.25 25% off $0.49 $385.00 $80.50 2026-04-01
76881 HCPCS US Lower Ext Non Vascular - Lt 2 1 $181.00 $135.75 25% off $82.98 $82.98 $82.98 2026-04-01
70486 HCPCS CT Facial Without 2 1 $322.00 $241.50 25% off $88.07 $88.07 $88.07 2026-04-01
77080 HCPCS Dx Dexa (bone Density) 4 2 $90.00 $67.50 25% off $88.98 $93.83 $91.41 2026-04-01
77066 HCPCS Mg Diag Mammo With Cad - Bilateral 2 1 $391.00 $293.25 25% off $92.10 $92.10 $92.10 2026-04-01
93971 HCPCS US Lower Ext Venous - LT,Left 6 2 $280.00 $210.00 25% off $94.22 $94.42 $94.42 2026-04-01
76700 HCPCS US Abdomen Complete 2 1 $285.00 $213.75 25% off $96.40 $96.40 $96.40 2026-04-01
96360 HCPCS IV Infusion Hydration 31 Min - 1 Hr 4 2 $78.00 $58.50 25% off $39.00 $188.12 $113.56 2026-04-01
70450 HCPCS CT Head/brain Without 4 2 $268.00 $201.00 25% off $93.83 $146.82 $120.32 2026-04-01
90715 HCPCS Tetanus/redu.dipht./pertu (Tdap)0.5MLPFS 2 1 $195.00 $146.25 25% off $130.20 $130.20 $130.20 2026-04-01
71250 HCPCS CT Chest Without IV 4 2 $368.00 $276.00 25% off $95.75 $202.46 $149.11 2026-04-01
71275 HCPCS CTA Chest/abd/pelvis 2 1 $700.00 $525.00 25% off $159.28 $159.28 $159.28 2026-04-01
93925 HCPCS US Lower Ext Arterial - Bilateral 4 2 $554.00 $415.50 25% off $105.30 $215.19 $160.25 2026-04-01
74176 HCPCS CT Abd And Pelvis Without IV 4 2 $467.00 $350.25 25% off $126.84 $215.49 $171.17 2026-04-01
72125 HCPCS CT Cervical Spine Without 4 2 $360.00 $270.00 25% off $148.16 $200.34 $174.25 2026-04-01
93880 HCPCS US Carotids 4 2 $459.00 $344.25 25% off $133.48 $215.19 $174.33 2026-04-01
74170 HCPCS CT Abdomen Without And With IV 2 1 $642.00 $481.50 25% off $177.51 $177.51 $177.51 2026-04-01
96374 HCPCS IV Push, Single Or Initial Subs 2 1 $90.00 $67.50 25% off $188.12 $188.12 $188.12 2026-04-01
72131 HCPCS CT Lumbar Spine Without 4 2 $359.00 $269.25 25% off $146.82 $251.30 $199.06 2026-04-01
72128 HCPCS CT Thoracic Spine With IV 2 1 $360.00 $270.00 25% off $216.66 $216.66 $216.66 2026-04-01
93970 HCPCS US Upper Ext Venous - Bilateral 4 2 $448.00 $336.00 25% off $94.92 $354.20 $224.56 2026-04-01
74177 HCPCS CT Abd And Pelvis With IV 4 2 $755.00 $566.25 25% off $242.07 $315.13 $278.60 2026-04-01
87633 HCPCS Respiratory Viral Panel By Pcr (swab) 2 1 $1,042.00 $781.50 25% off $279.88 $279.88 $279.88 2026-04-01
93306 HCPCS US Echo 4 2 $484.00 $363.00 25% off $181.08 $485.72 $333.40 2026-04-01
78452 HCPCS Nm Multi-spec (Rest/Stress) TEST,Technical Component 2 1 $2,158.50 $1,618.88 25% off $340.82 $340.82 $340.82 2026-04-01
96365 HCPCS IV Infusion Concurrent 1st Hour 2nd IV,Distinct Procedural Service 10 3 $190.00 $142.50 25% off $186.22 $375.00 $350.00 2026-04-01
77057 HCPCS Mm Screening Mammography Bilateral 12 6 $91.00 $68.25 25% off $350.00 $350.00 $350.00 2026-04-01
77067 HCPCS Mg Mammo Screening With Cad 12 6 $317.00 $237.75 25% off $53.00 $350.00 $350.00 2026-04-01
99283 HCPCS Emer Dept Moderate Severity 12 6 $160.00 $120.00 25% off $56.88 $375.00 $356.25 2026-04-01
99282 HCPCS Emer Dept Low To Moderate Severity (pro) 12 6 $107.00 $80.25 25% off $56.88 $375.00 $356.25 2026-04-01
31603 HCPCS Tracheostomy Emergency Procedure Transtr 12 6 $790.00 $592.50 25% off $350.00 $375.00 $362.50 2026-04-01
36600 HCPCS Artl Pnxr W/drawal Bld Dx 12 6 $39.00 $29.25 25% off $350.00 $375.00 $362.50 2026-04-01
28470 HCPCS Closed Tx Metatarsal Fracture Without Manipu 12 6 $485.00 $363.75 25% off $350.00 $375.00 $362.50 2026-04-01
12053 HCPCS Repair Intermediate F/e/e/n/l/m&/muc 5.1 12 6 $522.00 $391.50 25% off $350.00 $375.00 $362.50 2026-04-01
16020 HCPCS Drs&/dbrdmt Prtl-thkns Burns 1st/sbsq Sm 12 6 $130.00 $97.50 25% off $350.00 $375.00 $362.50 2026-04-01
25600 HCPCS Cltx Dstl Radial Fx/epiphysl Sep Without Mnp 12 6 $746.00 $559.50 25% off $350.00 $375.00 $362.50 2026-04-01
26010 HCPCS Drainage Finger Abscess Simple 12 6 $330.00 $247.50 25% off $350.00 $375.00 $362.50 2026-04-01
29131 HCPCS Application Finger Splint Dynamic 12 6 $83.00 $62.25 25% off $350.00 $375.00 $362.50 2026-04-01
20525 HCPCS Rmvl Foreign Body Muscle/tendon Sheath D 12 6 $595.00 $446.25 25% off $350.00 $375.00 $362.50 2026-04-01
92960 HCPCS Cardioversion Electric Ext 12 6 $268.00 $201.00 25% off $350.00 $375.00 $362.50 2026-04-01
27520 HCPCS Closed Tx Patellar Fracture Without Manipula 12 6 $706.00 $529.50 25% off $350.00 $375.00 $362.50 2026-04-01
24560 HCPCS Cltx Humeral Epicondylar Fx Medial/lat W 12 6 $695.00 $521.25 25% off $350.00 $375.00 $362.50 2026-04-01
10140 HCPCS I&d Hematoma Seroma/fluid Collection 12 6 $286.00 $214.50 25% off $350.00 $375.00 $362.50 2026-04-01
96372 HCPCS Injection Therapeutic/each Separate Inje 4 2 $33.00 $24.75 25% off $350.00 $375.00 $362.50 2026-04-01
36425 HCPCS Vnpnxr Cutdown Age 1/> 12 6 $98.00 $73.50 25% off $350.00 $375.00 $362.50 2026-04-01
69200 HCPCS Rmvl Fb Xtrnl Aud Canal Without Anes 12 6 $115.00 $86.25 25% off $350.00 $375.00 $362.50 2026-04-01
36420 HCPCS Vnpnxr Cutdown Under Age 1 Yr 12 6 $118.00 $88.50 25% off $350.00 $375.00 $362.50 2026-04-01
32554 HCPCS Thoracentesis Pleural Cavity Without X-ray 12 6 $223.00 $167.25 25% off $350.00 $375.00 $362.50 2026-04-01
13153 HCPCS Repair Complex Eyelid/nose/ear/lip Ea 5 12 6 $340.00 $255.00 25% off $350.00 $375.00 $362.50 2026-04-01
12001 HCPCS Simple Repair Scalp/neck/ax/genit/trunk 12 6 $110.00 $82.50 25% off $77.00 $375.00 $362.50 2026-04-01
13133 HCPCS Repair Complex F/c/c/m/n/ax/g/h/f Ea 5 C 12 6 $313.00 $234.75 25% off $350.00 $375.00 $362.50 2026-04-01
13131 HCPCS Repair Complex F/c/c/m/n/ax/g/h/f 1.1 Cm 12 6 $595.00 $446.25 25% off $350.00 $375.00 $362.50 2026-04-01
23540 HCPCS Clsd Tx Acromioclavicular Dislc Without Mani 12 6 $548.00 $411.00 25% off $350.00 $375.00 $362.50 2026-04-01
26750 HCPCS Cltx Dstl Phlngl Fx Fngr/thmb Without Mnpj E 12 6 $442.00 $331.50 25% off $350.00 $375.00 $362.50 2026-04-01
99291 HCPCS Cc E/m Critically Ill/injured 1st 30-74 12 6 $542.00 $406.50 25% off $350.00 $375.00 $362.50 2026-04-01
29515 HCPCS Application Short Leg Splint Calf Foot 12 6 $120.00 $90.00 25% off $350.00 $375.00 $362.50 2026-04-01
29505 HCPCS Application Long Leg Splint Thigh Ankle/ 12 6 $122.00 $91.50 25% off $350.00 $375.00 $362.50 2026-04-01
13102 HCPCS Repair Complex Trunk Ea 5 Cm/< 12 6 $178.00 $133.50 25% off $350.00 $375.00 $362.50 2026-04-01
20520 HCPCS Removal Foreign Body Muscle/tendon Sheat 12 6 $353.00 $264.75 25% off $350.00 $375.00 $362.50 2026-04-01
13100 HCPCS Repair Complex Trunk 1.1 Cm-2.5 Cm 12 6 $490.00 $367.50 25% off $350.00 $375.00 $362.50 2026-04-01
27550 HCPCS Closed Tx Knee Dislocation Without Anesthesi 12 6 $1,160.00 $870.00 25% off $350.00 $375.00 $362.50 2026-04-01
65220 HCPCS Rmvl Fb Xtrnl Eye Crnl Without Slit Lamp 12 6 $101.00 $75.75 25% off $350.00 $375.00 $362.50 2026-04-01
12052 HCPCS Repair Intermediate F/e/e/n/l/m&/muc 2.6 12 6 $484.00 $363.00 25% off $350.00 $375.00 $362.50 2026-04-01
28400 HCPCS Closed Tx Calcaneal Fracture Without Manipul 12 6 $542.00 $406.50 25% off $350.00 $375.00 $362.50 2026-04-01
12045 HCPCS Repair Intermediate N/h/f/xtrnl Gent 12. 12 6 $650.00 $487.50 25% off $350.00 $375.00 $362.50 2026-04-01
10120 HCPCS Incision&removal Foreign Body Subq Tiss 12 6 $246.00 $184.50 25% off $350.00 $375.00 $362.50 2026-04-01
12044 HCPCS Repair Intermediate N/h/f/xtrnl Gent 7.6 12 6 $518.00 $388.50 25% off $350.00 $375.00 $362.50 2026-04-01
26700 HCPCS Cltx Mtcarphlngl Dislc 1 W/mnpj Without Anes 12 6 $186.00 $139.50 25% off $350.00 $375.00 $362.50 2026-04-01
92950 HCPCS Cardiopulmonary Resuscitation 12 6 $464.00 $348.00 25% off $350.00 $375.00 $362.50 2026-04-01
12051 HCPCS Repair Intermediate F/e/e/n/l/m&/muc 2.5 12 6 $408.00 $306.00 25% off $350.00 $375.00 $362.50 2026-04-01
28510 HCPCS Cltx Fx Phlx/phlg Oth/thn Grt Toe Without Mn 12 6 $284.00 $213.00 25% off $350.00 $375.00 $362.50 2026-04-01
28660 HCPCS Cltx Iphal Jt Dislc Without Anes 12 6 $220.00 $165.00 25% off $350.00 $375.00 $362.50 2026-04-01
12054 HCPCS Repair Intermediate F/e/e/n/l/m&/muc 7.6 12 6 $535.00 $401.25 25% off $350.00 $375.00 $362.50 2026-04-01
12055 HCPCS Repair Intermediate F/e/e/n/l/m&/muc 12. 12 6 $727.00 $545.25 25% off $350.00 $375.00 $362.50 2026-04-01
29105 HCPCS Application Long Arm Splint Shoulder Han 12 6 $103.00 $77.25 25% off $350.00 $375.00 $362.50 2026-04-01
13101 HCPCS Repair Complex Trunk 2.6 Cm-7.5 Cm 12 6 $602.00 $451.50 25% off $350.00 $375.00 $362.50 2026-04-01
69210 HCPCS Rmvl Impacted Cerumen BILATERAL,Bilateral 24 6 $82.00 $61.50 25% off $350.00 $375.00 $362.50 2026-04-01
12035 HCPCS Repair Intermediate S/a/t/e 12.6-20.0cm 12 6 $582.00 $436.50 25% off $350.00 $375.00 $362.50 2026-04-01
13121 HCPCS Repair Complex Scalp/arm/leg 2.6 Cm-7.5 12 6 $635.00 $476.25 25% off $350.00 $375.00 $362.50 2026-04-01
13122 HCPCS Repair Complex Scalp/arm/leg Ea 5 Cm/< 12 6 $205.00 $153.75 25% off $350.00 $375.00 $362.50 2026-04-01
30905 HCPCS Ctrl Nsl Hemrrg Pst Pst Nsl Packs&/caut 12 6 $260.00 $195.00 25% off $350.00 $375.00 $362.50 2026-04-01
26720 HCPCS Cltx Phlngl Fx Prox/middle Px/f/t Without Mn 12 6 $439.00 $329.25 25% off $350.00 $375.00 $362.50 2026-04-01
31600 HCPCS Tracheostomy Planned Spx 12 6 $752.00 $564.00 25% off $350.00 $375.00 $362.50 2026-04-01
31605 HCPCS Tracheostomy Emergency Cricothyroid Memb 12 6 $822.00 $616.50 25% off $350.00 $375.00 $362.50 2026-04-01
32556 HCPCS Thoracentesis Insertion Cath Without X-ray 12 6 $306.00 $229.50 25% off $350.00 $375.00 $362.50 2026-04-01
33010 HCPCS Pericardiocentesis Initial 12 6 $253.00 $189.75 25% off $350.00 $375.00 $362.50 2026-04-01
11730 HCPCS Avulsion Nail Plate Partial/complete Sim 12 6 $135.00 $101.25 25% off $350.00 $375.00 $362.50 2026-04-01
12034 HCPCS Repair Intermediate S/a/t/e 7.6-12.5 Cm 12 6 $497.00 $372.75 25% off $350.00 $375.00 $362.50 2026-04-01
28190 HCPCS Removal Foreign Body Foot Subcutaneous 12 6 $325.00 $243.75 25% off $350.00 $375.00 $362.50 2026-04-01
12032 HCPCS Repair Intermediate S/a/t/e 2.6-7.5 Cm 12 6 $350.00 $262.50 25% off $350.00 $375.00 $362.50 2026-04-01
11740 HCPCS Evacuation Subungual Hematoma 12 6 $75.00 $56.25 25% off $350.00 $375.00 $362.50 2026-04-01
36680 HCPCS Plmt Ndl Intraoss Nfs 12 6 $148.00 $111.00 25% off $350.00 $375.00 $362.50 2026-04-01
65210 HCPCS Rmvl Fb Xtrnl Eye Embedded Scjncl/scll N 12 6 $89.00 $66.75 25% off $350.00 $375.00 $362.50 2026-04-01
12016 HCPCS Simple Repair F/e/e/n/l/m 12.6cm-20.0cm 12 6 $320.00 $240.00 25% off $350.00 $375.00 $362.50 2026-04-01
11750 HCPCS Excision Nail Matrix Permanent Removal 12 6 $247.00 $185.25 25% off $350.00 $375.00 $362.50 2026-04-01
16025 HCPCS Drs&/dbrdmt Prtl-thkns Burns 1st/sbsq Me 12 6 $268.00 $201.00 25% off $350.00 $375.00 $362.50 2026-04-01
30903 HCPCS Control Nasal Hemorrhage Anterior Comple 12 6 $194.00 $145.50 25% off $350.00 $375.00 $362.50 2026-04-01
27840 HCPCS Closed Tx Ankle Dislocation Without Anesthes 12 6 $902.00 $676.50 25% off $350.00 $375.00 $362.50 2026-04-01
12014 HCPCS Simple Repair F/e/e/n/l/m 5.1cm-7.5cm 12 6 $187.00 $140.25 25% off $350.00 $375.00 $362.50 2026-04-01
13132 HCPCS Repair Complex F/c/c/m/n/ax/g/h/f 2.6 Cm 12 6 $746.00 $559.50 25% off $350.00 $375.00 $362.50 2026-04-01
12004 HCPCS Simple Rpr Scalp/neck/ax/genit/trunk 7.6 12 6 $182.00 $136.50 25% off $350.00 $375.00 $362.50 2026-04-01
12013 HCPCS Simple Repair F/e/e/n/l/m 2.6cm-5.0cm 12 6 $146.00 $109.50 25% off $350.00 $375.00 $362.50 2026-04-01
27750 HCPCS Cltx Tibl Shft Fx Without Mnpj 12 6 $760.00 $570.00 25% off $350.00 $375.00 $362.50 2026-04-01
12011 HCPCS Simple Repair F/e/e/n/l/m 2.5cm/< 12 6 $138.00 $103.50 25% off $350.00 $375.00 $362.50 2026-04-01
10060 HCPCS Incision & Drainage Abscess Simple/singl 12 6 $240.00 $180.00 25% off $177.53 $375.00 $362.50 2026-04-01
27510 HCPCS Cltx Fem Fx Dstl End Medial/lat Condyle 12 6 $1,642.00 $1,231.50 25% off $350.00 $375.00 $362.50 2026-04-01
21310 HCPCS Closed Treatment Nasal Fracture Without Mani 12 6 $68.00 $51.00 25% off $350.00 $375.00 $362.50 2026-04-01
21480 HCPCS Closed Tx Temporomandibular Dislocation 12 6 $78.00 $58.50 25% off $350.00 $375.00 $362.50 2026-04-01
31505 HCPCS Laryngoscopy Indirect Diagnostic Spx 12 6 $116.00 $87.00 25% off $350.00 $375.00 $362.50 2026-04-01
10160 HCPCS Puncture Aspiration Abscess Hematoma Bul 12 6 $227.00 $170.25 25% off $350.00 $375.00 $362.50 2026-04-01
13151 HCPCS Repair Complex Eyelid/nose/ear/lip 1.1-2 12 6 $684.00 $513.00 25% off $350.00 $375.00 $362.50 2026-04-01
31500 HCPCS Intubation Endotracheal Emergency Proced 12 6 $355.00 $266.25 25% off $350.00 $375.00 $362.50 2026-04-01
26735 HCPCS Open Tx Phalangeal Shaft Fracture Prox/m 12 6 $1,425.00 $1,068.75 25% off $350.00 $375.00 $362.50 2026-04-01
30901 HCPCS Control Nasal Hemorrhage Anterior Simple 12 6 $140.00 $105.00 25% off $350.00 $375.00 $362.50 2026-04-01
28515 HCPCS Cltx Fx Phlx/phlg Oth/thn Grt Toe W/mnpj 12 6 $340.00 $255.00 25% off $350.00 $375.00 $362.50 2026-04-01
28490 HCPCS Cltx Fx Grt Toe Phlx/phlg Without Mnpj 12 6 $294.00 $220.50 25% off $350.00 $375.00 $362.50 2026-04-01
99284 HCPCS Emer Dept Hi Severity&urgent Eval (pro) 12 6 $293.00 $219.75 25% off $104.24 $375.74 $362.50 2026-04-01
51702 HCPCS Insj Temp Ndwellg Bldr Cath Smpl 12 6 $63.00 $47.25 25% off $350.00 $375.00 $362.50 2026-04-01
23500 HCPCS Clsd Tx Clavicular Fracture Without Manipula 12 6 $532.00 $399.00 25% off $350.00 $375.00 $362.50 2026-04-01
24500 HCPCS Clsd Tx Humeral Shaft Fracture Without Manip 12 6 $782.00 $586.50 25% off $350.00 $375.00 $362.50 2026-04-01
24670 HCPCS Closed Tx Ulnar Fracture Proximal End With 12 6 $630.00 $472.50 25% off $350.00 $375.00 $362.50 2026-04-01
99281 HCPCS Op Room Charge 12 6 $55.00 $41.25 25% off $55.00 $375.00 $362.50 2026-04-01
24650 HCPCS Closed Tx Radial Head/neck Fx Without Manipu 12 6 $575.00 $431.25 25% off $350.00 $375.00 $362.50 2026-04-01
24600 HCPCS Treatment Closed Elbow Dislocation Without A 12 6 $808.00 $606.00 25% off $350.00 $375.00 $362.50 2026-04-01
92953 HCPCS Temporary Transcutaneous Pacing 12 6 $2.00 $1.50 25% off $350.00 $375.00 $362.50 2026-04-01
62270 HCPCS Spi Pnxr Lmbr Dx 12 6 $153.00 $114.75 25% off $350.00 $375.00 $362.50 2026-04-01
10061 HCPCS Incision&drainage Abscess Complicated/mu 12 6 $437.00 $327.75 25% off $350.00 $375.00 $362.50 2026-04-01
12002 HCPCS Smpl Repair Scalp/neck/ax/genit/trunk 2. 12 6 $147.00 $110.25 25% off $102.90 $375.00 $362.50 2026-04-01
23650 HCPCS Clsd Tx Shoulder Dislc W/manip Without Anest 12 6 $695.00 $521.25 25% off $350.00 $375.00 $362.50 2026-04-01
16030 HCPCS Drs&/dbrdmt Prtl-thkns Burns 1st/sbsq La 12 6 $323.00 $242.25 25% off $350.00 $375.00 $362.50 2026-04-01
12005 HCPCS Smpl Rpr Scalp/neck/ax/genit/trunk 12.6- 12 6 $238.00 $178.50 25% off $350.00 $375.00 $362.50 2026-04-01
27560 HCPCS Closed Tx Patellar Dislocation Without Anest 12 6 $820.00 $615.00 25% off $350.00 $375.00 $362.50 2026-04-01
65205 HCPCS Remove Foreign Body From Eye 12 6 $71.00 $53.25 25% off $350.00 $375.00 $362.50 2026-04-01
27760 HCPCS Cltx Medial Malls Fx Without Mnpj 12 6 $730.00 $547.50 25% off $350.00 $375.00 $362.50 2026-04-01
27780 HCPCS Cltx Prox Fibula/shft Fx Without Mnpj 12 6 $668.00 $501.00 25% off $350.00 $375.00 $362.50 2026-04-01
27786 HCPCS Cltx Dstl Fibular Fx Lat Malls Without Mnpj 12 6 $683.00 $512.25 25% off $350.00 $375.00 $362.50 2026-04-01
27808 HCPCS Closed Tx Bimalleolar Ankle Fracture Without 12 6 $719.00 $539.25 25% off $350.00 $375.00 $362.50 2026-04-01
27816 HCPCS Cltx Trimal Ankle Fx Without Mnpj 12 6 $692.00 $519.00 25% off $350.00 $375.00 $362.50 2026-04-01
13120 HCPCS Repair Complex Scalp/arm/leg 1.1 Cm-2.5 12 6 $562.00 $421.50 25% off $350.00 $375.00 $362.50 2026-04-01
12015 HCPCS Simple Repair F/e/e/n/l/m 7.6cm-12.5cm 12 6 $237.00 $177.75 25% off $350.00 $375.00 $362.50 2026-04-01
25530 HCPCS Closed Tx Ulnar Shaft Fracture Without Manip 12 6 $567.00 $425.25 25% off $350.00 $375.00 $362.50 2026-04-01
30300 HCPCS Removal Foreign Body Intranasal Office P 12 6 $268.00 $201.00 25% off $350.00 $375.00 $362.50 2026-04-01
12031 HCPCS Repair Intermediate S/a/t/e 2.5 Cm/< 12 6 $366.00 $274.50 25% off $350.00 $375.00 $362.50 2026-04-01
16000 HCPCS Initial Tx 1st Degree Burn Local Tx 12 6 $113.00 $84.75 25% off $350.00 $375.00 $362.50 2026-04-01
10121 HCPCS Incision&removal Foreign Body Subq Tiss 12 6 $448.00 $336.00 25% off $350.00 $375.00 $362.50 2026-04-01
29130 HCPCS Application Finger Splint Static 12 6 $72.00 $54.00 25% off $350.00 $375.00 $362.50 2026-04-01
28192 HCPCS Removal Foreign Body Foot Deep 12 6 $763.00 $572.25 25% off $350.00 $375.00 $362.50 2026-04-01
28193 HCPCS Removal Foreign Body Foot Complicated 12 6 $903.00 $677.25 25% off $350.00 $375.00 $362.50 2026-04-01
29125 HCPCS Application Short Arm Splint Forearm-han 12 6 $95.00 $71.25 25% off $350.00 $375.00 $362.50 2026-04-01
12042 HCPCS Repair Intermediate N/h/f/xtrnl Gent 2.6 12 6 $475.00 $356.25 25% off $350.00 $375.00 $362.50 2026-04-01
12041 HCPCS Repair Intermediate N/h/f/xtrnl Gent 2.5 12 6 $355.00 $266.25 25% off $350.00 $375.00 $362.50 2026-04-01
99285 HCPCS Emer Dept High Severity&threat Funcj 12 6 $425.00 $318.75 25% off $350.00 $2,341.84 $368.75 2026-04-01
390 MS_DRG M Gastrointestinal Obstruction Without Cc/mcc 2 1 $1,420.96 $1,065.72 25% off $2,513.25 $2,513.25 $2,513.25 2026-04-01
440 MS_DRG M Disorders Of Pancreas Except Malignancy Without Cc/mcc 4 2 $2,279.66 $1,709.75 25% off $3,042.16 $6,500.00 $4,771.08 2026-04-01
683 MS_DRG M Renal Failure With Cc 2 1 $1,854.95 $1,391.21 25% off $5,042.63 $5,042.63 $5,042.63 2026-04-01
389 MS_DRG M Gastrointestinal Obstruction With Cc 4 2 $4,028.60 $3,021.45 25% off $5,266.53 $6,500.00 $5,883.26 2026-04-01
194 MS_DRG M Simple Pneumonia And Pleurisy With Cc 4 2 $2,984.43 $2,238.32 25% off $5,528.08 $6,500.00 $6,014.04 2026-04-01
872 MS_DRG M Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 4 2 $2,810.67 $2,108.00 25% off $5,603.62 $6,500.00 $6,051.81 2026-04-01
378 MS_DRG M Gastrointestinal Hemorrhage With Cc 4 2 $2,814.17 $2,110.63 25% off $5,780.12 $6,500.00 $6,140.06 2026-04-01
65 MS_DRG M Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 4 2 $4,851.16 $3,638.37 25% off $6,102.30 $6,500.00 $6,301.15 2026-04-01
71 MS_DRG M Other Cerebrovascular Disorders With Cc 4 2 $4,088.97 $3,066.73 25% off $6,292.07 $6,500.00 $6,396.03 2026-04-01
444 MS_DRG M Disorders Of The Biliary Tract With Mcc 2 1 $3,100.07 $2,325.05 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
384 MS_DRG M Uncomplicated Peptic Ulcer Without Mcc 2 1 $2,167.75 $1,625.81 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
64 MS_DRG M Intracranial Hemorrhage Or Cerebral Infarction With Mcc 2 1 $3,301.16 $2,475.87 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
682 MS_DRG M Renal Failure With Mcc 2 1 $2,643.73 $1,982.80 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
91 MS_DRG M Other Disorders Of Nervous System With Mcc 2 1 $4,098.73 $3,074.05 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
72 MS_DRG M Other Cerebrovascular Disorders Without Cc/mcc 2 1 $2,975.14 $2,231.36 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
895 MS_DRG M Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy 2 1 $3,060.32 $2,295.24 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
433 MS_DRG M Cirrhosis And Alcoholic Hepatitis With Cc 2 1 $3,047.68 $2,285.76 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
917 MS_DRG M Poisoning And Toxic Effects Of Drugs With Mcc 2 1 $2,887.23 $2,165.42 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
438 MS_DRG M Disorders Of Pancreas Except Malignancy With Mcc 2 1 $4,354.21 $3,265.66 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
600 MS_DRG M Non-malignant Breast Disorders With Cc/mcc 2 1 $3,097.93 $2,323.45 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
299 MS_DRG M Peripheral Vascular Disorders With Mcc 2 1 — — $6,500.00 $6,500.00 $6,500.00 2026-04-01
370 MS_DRG M Major Esophageal Disorders Without Cc/mcc 2 1 $2,665.00 $1,998.75 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
432 MS_DRG M Cirrhosis And Alcoholic Hepatitis With Mcc 2 1 $6,162.64 $4,621.98 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
386 MS_DRG M Inflammatory Bowel Disease With Cc 2 1 $3,147.13 $2,360.35 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
580 MS_DRG P Other Skin, Subcutaneous Tissue And Breast Procedures With Cc 2 1 $2,882.50 $2,161.88 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
557 MS_DRG M Tendonitis, Myositis And Bursitis With Mcc 2 1 $7,357.65 $5,518.24 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
0120 RC — 2 1 $650.00 $487.50 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
388 MS_DRG M Gastrointestinal Obstruction With Mcc 2 1 $2,777.00 $2,082.75 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
811 MS_DRG M Red Blood Cell Disorders With Mcc 2 1 $2,854.45 $2,140.84 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
177 MS_DRG M Respiratory Infections And Inflammations With Mcc 2 1 $4,321.64 $3,241.23 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
436 MS_DRG M Malignancy Of Hepatobiliary System Or Pancreas With Cc 2 1 $2,282.00 $1,711.50 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
0110 RC — 2 1 $650.00 $487.50 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
0126 RC — 2 1 $650.00 $487.50 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
308 MS_DRG M Cardiac Arrhythmia And Conduction Disorders With Mcc 2 1 $2,966.12 $2,224.59 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
371 MS_DRG M Major Gastrointestinal Disorders And Peritoneal Infections With Mcc 2 1 $9,390.45 $7,042.84 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
565 MS_DRG M Other Musculoskeletal System And Connective Tissue Diagnoses With Cc 2 1 $2,639.96 $1,979.97 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
54 MS_DRG M Nervous System Neoplasms With Mcc 2 1 $2,970.50 $2,227.88 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
637 MS_DRG M Diabetes With Mcc 2 1 $4,372.32 $3,279.24 25% off $6,500.00 $6,500.00 $6,500.00 2026-04-01
439 MS_DRG M Disorders Of Pancreas Except Malignancy With Cc 4 2 $2,454.25 $1,840.69 25% off $6,500.00 $6,566.35 $6,533.18 2026-04-01
689 MS_DRG M Kidney And Urinary Tract Infections With Mcc 4 2 $3,172.98 $2,379.74 25% off $6,500.00 $8,091.83 $7,295.91 2026-04-01
189 MS_DRG M Pulmonary Edema And Respiratory Failure 4 2 $2,845.52 $2,134.14 25% off $6,500.00 $8,216.46 $7,358.23 2026-04-01
640 MS_DRG M Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Wit… 4 2 $3,531.25 $2,648.44 25% off $6,500.00 $8,471.65 $7,485.82 2026-04-01
291 MS_DRG M Heart Failure And Shock With Mcc 4 2 $3,067.97 $2,300.98 25% off $6,500.00 $8,587.45 $7,543.73 2026-04-01
551 MS_DRG M Medical Back Problems With Mcc 4 2 $3,607.39 $2,705.54 25% off $6,500.00 $9,527.79 $8,013.90 2026-04-01
193 MS_DRG M Simple Pneumonia And Pleurisy With Mcc 4 2 $3,619.99 $2,714.99 25% off $6,500.00 $10,531.33 $8,515.67 2026-04-01
922 MS_DRG M Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc 4 2 $13,968.67 $10,476.50 25% off $6,500.00 $11,187.73 $8,843.86 2026-04-01
871 MS_DRG M Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 4 2 $4,520.65 $3,390.49 25% off $6,500.00 $11,842.77 $9,171.39 2026-04-01
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