Hospital

Dewitt Hospital & Nursing Home, Inc

De Witt, AR · CCN 041314 · Rates published

1,129 distinct procedures filed

16 distinct payers

26,111 rate rows

2026-07-18 last MRF observed

Data quality

25,953 of 26,111 rate rows are consumer-grade (99.4%)

158 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 — reason	Rows
per-diem day rate — not a per-procedure price	52
percent-of-charges filed in the dollar field — excluded from medians	47
placeholder amount (≤ $0.02) — excluded from medians	35
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	15
exceeds 10× this hospital's gross charge — excluded from medians	9

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://dewitthospitalandnursinghome.pg.quadax.revenuemasters.com/cdm-files/954896822_dewitt-hospital-and-nursing-home-inc_standardcharges.csv
Found on page	https://www.dewitthealth.org/cms-hpt.txt
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-08-18
Content fingerprint	9fa5124d5060cf90… · 9,471,571 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
J1162 HCPCS	Digoxin Immune Fab Inj [3	14	$3,355.28	$11,414.56	$7,329.35	nat. median $7,100 1.0× median
J0840 HCPCS	Crofab Inj	15	$2,229.73	$8,922.10	$5,728.92	nat. median $3,427 1.7× median
19120 HCPCS	Removal Breast Growth	16	$220.21	$8,625.51	$5,538.48	nat. median $3,662 1.5× median
15273 HCPCS	Xeno Skin Sub 1st 100 Sqcm (t/a/l) (high Cost)	16	$130.19	$8,124.88	$5,217.03	nat. median $3,152 1.7× median
15110 HCPCS	Epidrm Autogrft Trnk/arm/leg	16	$408.07	$7,883.34	$5,061.93	nat. median $2,182 outlier · 2.3×
32550 HCPCS	Chest Tube Placement	16	$145.81	$7,828.81	$5,026.92	nat. median $4,071 1.2× median
26607 HCPCS	Ph Metacarpal Fx Tx W/manip	16	$203.84	$7,332.20	$4,708.04	nat. median $3,135 1.5× median
26765 HCPCS	Open Tmt Fract Fing Thumb	16	$217.98	$7,324.58	$4,703.15	nat. median $3,497 1.3× median
27532 HCPCS	Closed Tibial Prox W/wo Manip	16	$250.00	$7,324.58	$4,703.15	nat. median $3,296 1.4× median
40810 HCPCS	Excision Of Mouth Lesion	16	$50.59	$7,285.60	$4,678.12	nat. median $3,045 1.5× median
31600 HCPCS	Tracheostomy	16	$206.82	$7,285.60	$4,678.12	nat. median $3,329 1.4× median
36556 HCPCS	Central Line Placement	16	$65.09	$7,212.90	$4,631.44	nat. median $2,458 1.9× median
59409 HCPCS	Delivery Op Setting Vag Del Only	16	$250.00	$7,081.97	$4,547.37	nat. median $3,157 1.4× median
27372 HCPCS	Remve Forgn Bdy/thighknee	16	$193.80	$6,429.96	$4,128.71	nat. median $3,050 1.4× median
15115 HCPCS	Epidrm A-grft Face/nck/hf/g	16	$419.59	$4,781.63	$3,070.31	nat. median $2,165 1.4× median
81162 HCPCS	Brcavantage	13	$1,824.88	$4,334.09	$2,782.94	nat. median $1,840 1.5× median
32556 HCPCS	Indwelling Cath Fluid Rem	16	$92.99	$4,305.86	$2,764.81	nat. median $1,977 1.4× median
C5273 HCPCS	Aply Skin Sub 1st 100 Sq Cm Legs Medicar Low Cost	16	$721.01	$4,130.90	$2,652.48	nat. median $2,421 1.1× median
10140 HCPCS	I&d Hematoma	16	$58.77	$3,882.61	$2,493.05	nat. median $1,655 1.5× median
11404 HCPCS	Skin Rem Excis 3.1-4.0cm	16	$78.49	$3,668.79	$2,355.75	nat. median $1,618 1.5× median
23931 HCPCS	Incision Dr Up Arm/elbow	16	$68.44	$3,668.79	$2,355.75	nat. median $1,771 1.3× median
10121 HCPCS	Removal Foreign Body, Comp	16	$101.91	$3,668.79	$2,355.75	nat. median $1,662 1.4× median
11044 HCPCS	Debridement, Bone	16	$152.51	$3,668.79	$2,355.75	nat. median $1,751 1.3× median
20520 HCPCS	Rmve Forgn Body In Muscle Simple	16	$70.67	$3,668.79	$2,355.75	nat. median $1,545 1.5× median
26236 HCPCS	Part Excis Bone Dist Phal	16	$203.10	$3,636.91	$2,335.28	nat. median $2,065 1.1× median
26700 HCPCS	Trtmnt Of Dislo Without Manip Without Anes	16	$86.76	$3,636.91	$2,335.28	nat. median $402 outlier · 5.8×
27752 HCPCS	Closed Tibial Shaft W/manip	16	$233.23	$3,636.91	$2,335.28	nat. median $1,767 1.3× median
25605 HCPCS	Colles/smith With Manip	16	$232.48	$3,636.91	$2,335.28	nat. median $1,654 1.4× median
27781 HCPCS	Clo Prox Fibla/shft W/manip	16	$170.74	$3,636.91	$2,335.28	nat. median $1,941 1.2× median
20822 HCPCS	Replanatation Digit Complete	16	$250.00	$3,636.91	$2,335.28	nat. median $2,369 1.0× median
25565 HCPCS	Closed Radial&ulnar W/manip	16	$217.60	$3,636.91	$2,335.28	nat. median $1,655 1.4× median
24505 HCPCS	Closed Tx Brkn Upper Arm W/manip	16	$200.49	$3,636.91	$2,335.28	nat. median $1,620 1.4× median
25505 HCPCS	Closed Radial Shaft W/manip	16	$202.72	$3,636.91	$2,335.28	nat. median $1,671 1.4× median
28435 HCPCS	Closed Talus Frac W/manip	16	$131.68	$3,636.91	$2,335.28	nat. median $1,730 1.4× median
27810 HCPCS	Clo Bimallr Ankle W/manip	16	$197.89	$3,636.91	$2,335.28	nat. median $1,642 1.4× median
32551 HCPCS	Chest Tube Insertion	16	$27.23	$3,624.09	$2,327.05	nat. median $1,569 1.5× median
15275 HCPCS	Allogenic Skin Sub (f/nk/hf/g) (high Cost)	16	$68.07	$2,688.62	$1,726.38	nat. median $1,725 1.0× median
15271 HCPCS	Allogenic Graft (1st 25 Sqcm) T/a/l (high Cost)	16	$14.91	$2,688.62	$1,726.38	nat. median $1,732 1.0× median
15277 HCPCS	Xeno Sub 1st 100 Sqcm (f/nk/hf,g) (high Cost)	16	$148.79	$2,688.62	$1,726.38	nat. median $2,065 0.8× median
72159 HCPCS	MRA Spinal Canal With Contrast	14	$46.87	$2,641.00	$1,695.80	nat. median $1,107 1.5× median
73225 HCPCS	MRA Upper Ext With Contrast	14	$45.04	$2,550.75	$1,637.85	nat. median $1,215 1.3× median
74185 HCPCS	MRA Abdomen With Contrast	14	$46.87	$2,546.00	$1,634.80	nat. median $1,279 1.3× median
73725 HCPCS	MRA Lower Ext With Contrast	14	$47.39	$2,546.00	$1,634.80	nat. median $1,273 1.3× median
72198 HCPCS	MRA Pelvis With Contrast	14	$46.87	$2,541.25	$1,631.75	nat. median $1,175 1.4× median
71555 HCPCS	MRA Chest With Contrast	14	$47.12	$2,517.50	$1,616.50	nat. median $1,187 1.4× median
95810 HCPCS	Polysomnogram	14	$92.99	$2,368.40	$1,520.76	nat. median $1,777 0.9× median
95811 HCPCS	Polysomnogram C-pap Titration	14	$96.72	$2,368.40	$1,520.76	nat. median $1,923 0.8× median
11047 HCPCS	Debrid Bone Ea Addl 20 Sq Cm	14	$66.95	$2,207.32	$1,417.33	nat. median $987 1.4× median
15278 HCPCS	Xeno Sub Each Addl 100 Sqcm (f/nk/hf,g) (high Cost)	14	$37.19	$2,123.19	$1,363.31	nat. median $862 1.6× median
15274 HCPCS	Xeno Skin Sub (t/a/l) Each Add 100sqcm (high Cost)	14	$29.75	$2,123.19	$1,363.31	nat. median $818 1.7× median

Other procedures at this hospital

Browse this hospital's 1,129 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

J1162	HCPCS	Digoxin Immune Fab Inj [3	14	14	$12,015.33	$12,015.33	$3,355.28	$11,414.56	$7,329.35	2026-07-18
J0840	HCPCS	Crofab Inj	15	15	$9,391.68	$9,391.68	$2,229.73	$8,922.10	$5,728.92	2026-07-18
19120	HCPCS	Removal Breast Growth	16	16	$9,079.48	$9,079.48	$220.21	$8,625.51	$5,538.48	2026-07-18
15273	HCPCS	Xeno Skin Sub 1st 100 Sqcm (t/a/l) (high Cost)	16	16	$8,552.50	$8,552.50	$130.19	$8,124.88	$5,217.03	2026-07-18
15110	HCPCS	Epidrm Autogrft Trnk/arm/leg	16	16	$8,298.25	$8,298.25	$408.07	$7,883.34	$5,061.93	2026-07-18
32550	HCPCS	Chest Tube Placement	16	16	$8,240.85	$8,240.85	$145.81	$7,828.81	$5,026.92	2026-07-18
26607	HCPCS	Ph Metacarpal Fx Tx W/manip	27	16	$7,710.08	$7,710.08	$203.84	$7,332.20	$4,708.04	2026-07-18
27532	HCPCS	Closed Tibial Prox W/wo Manip	16	16	$7,710.08	$7,710.08	$250.00	$7,324.58	$4,703.15	2026-07-18
26765	HCPCS	Open Tmt Fract Fing Thumb	16	16	$7,710.08	$7,710.08	$217.98	$7,324.58	$4,703.15	2026-07-18
40810	HCPCS	Excision Of Mouth Lesion	16	16	$7,669.05	$7,669.05	$50.59	$7,285.60	$4,678.12	2026-07-18
31600	HCPCS	Tracheostomy	16	16	$7,669.05	$7,669.05	$206.82	$7,285.60	$4,678.12	2026-07-18
36556	HCPCS	Central Line Placement	16	16	$7,592.53	$7,592.53	$65.09	$7,212.90	$4,631.44	2026-07-18
59409	HCPCS	Delivery Op Setting Vag Del Only	16	16	$7,454.70	$7,454.70	$250.00	$7,081.97	$4,547.37	2026-07-18
27372	HCPCS	Remve Forgn Bdy/thighknee	16	16	$6,768.38	$6,768.38	$193.80	$6,429.96	$4,128.71	2026-07-18
15115	HCPCS	Epidrm A-grft Face/nck/hf/g	16	16	$5,033.29	$5,033.29	$419.59	$4,781.63	$3,070.31	2026-07-18
81162	HCPCS	Brcavantage	13	13	$4,562.20	$4,562.20	$1,824.88	$4,334.09	$2,782.94	2026-07-18
32556	HCPCS	Indwelling Cath Fluid Rem	16	16	$4,532.48	$4,532.48	$92.99	$4,305.86	$2,764.81	2026-07-18
C5273	HCPCS	Aply Skin Sub 1st 100 Sq Cm Legs Medicar Low Cost	16	16	$4,348.32	$4,348.32	$721.01	$4,130.90	$2,652.48	2026-07-18
10140	HCPCS	I&d Hematoma	29	16	$3,861.88	$3,861.88	$58.77	$3,882.61	$2,493.05	2026-07-18
23931	HCPCS	Incision Dr Up Arm/elbow	16	16	$3,861.88	$3,861.88	$68.44	$3,668.79	$2,355.75	2026-07-18
11404	HCPCS	Skin Rem Excis 3.1-4.0cm	16	16	$3,861.88	$3,861.88	$78.49	$3,668.79	$2,355.75	2026-07-18
20520	HCPCS	Rmve Forgn Body In Muscle Simple	16	16	$3,861.88	$3,861.88	$70.67	$3,668.79	$2,355.75	2026-07-18
10121	HCPCS	Removal Foreign Body, Comp	16	16	$3,861.88	$3,861.88	$101.91	$3,668.79	$2,355.75	2026-07-18
11044	HCPCS	Debridement, Bone	29	16	$3,861.88	$3,861.88	$152.51	$3,668.79	$2,355.75	2026-07-18
24505	HCPCS	Closed Tx Brkn Upper Arm W/manip	16	16	$3,828.33	$3,828.33	$200.49	$3,636.91	$2,335.28	2026-07-18
28435	HCPCS	Closed Talus Frac W/manip	16	16	$3,828.33	$3,828.33	$131.68	$3,636.91	$2,335.28	2026-07-18
25505	HCPCS	Closed Radial Shaft W/manip	16	16	$3,828.33	$3,828.33	$202.72	$3,636.91	$2,335.28	2026-07-18
27781	HCPCS	Clo Prox Fibla/shft W/manip	16	16	$3,828.33	$3,828.33	$170.74	$3,636.91	$2,335.28	2026-07-18
25565	HCPCS	Closed Radial&ulnar W/manip	16	16	$3,828.33	$3,828.33	$217.60	$3,636.91	$2,335.28	2026-07-18
27752	HCPCS	Closed Tibial Shaft W/manip	16	16	$3,828.33	$3,828.33	$233.23	$3,636.91	$2,335.28	2026-07-18
26236	HCPCS	Part Excis Bone Dist Phal	16	16	$3,828.33	$3,828.33	$203.10	$3,636.91	$2,335.28	2026-07-18
27810	HCPCS	Clo Bimallr Ankle W/manip	16	16	$3,828.33	$3,828.33	$197.89	$3,636.91	$2,335.28	2026-07-18
26700	HCPCS	Trtmnt Of Dislo Without Manip Without Anes	16	16	$3,828.33	$3,828.33	$86.76	$3,636.91	$2,335.28	2026-07-18
20822	HCPCS	Replanatation Digit Complete	16	16	$3,828.33	$3,828.33	$250.00	$3,636.91	$2,335.28	2026-07-18
25605	HCPCS	Colles/smith With Manip	16	16	$3,828.33	$3,828.33	$232.48	$3,636.91	$2,335.28	2026-07-18
32551	HCPCS	Chest Tube Insertion	18	16	$3,814.83	$3,814.83	$27.23	$3,624.09	$2,327.05	2026-07-18
15275	HCPCS	Allogenic Skin Sub (f/nk/hf/g) (high Cost)	17	16	$2,830.13	$2,830.13	$68.07	$2,688.62	$1,726.38	2026-07-18
15277	HCPCS	Xeno Sub 1st 100 Sqcm (f/nk/hf,g) (high Cost)	16	16	$2,830.13	$2,830.13	$148.79	$2,688.62	$1,726.38	2026-07-18
15271	HCPCS	Allogenic Graft (1st 25 Sqcm) T/a/l (high Cost)	18	16	$2,830.13	$2,830.13	$14.91	$2,688.62	$1,726.38	2026-07-18
72159	HCPCS	MRA Spinal Canal With Contrast	28	14	$2,780.00	$2,780.00	$46.87	$2,641.00	$1,695.80	2026-07-18
73225	HCPCS	MRA Upper Ext With Contrast	28	14	$2,685.00	$2,685.00	$45.04	$2,550.75	$1,637.85	2026-07-18
73725	HCPCS	MRA Lower Ext With Contrast	28	14	$2,680.00	$2,680.00	$47.39	$2,546.00	$1,634.80	2026-07-18
74185	HCPCS	MRA Abdomen With Contrast	28	14	$2,680.00	$2,680.00	$46.87	$2,546.00	$1,634.80	2026-07-18
72198	HCPCS	MRA Pelvis With Contrast	28	14	$2,675.00	$2,675.00	$46.87	$2,541.25	$1,631.75	2026-07-18
71555	HCPCS	MRA Chest With Contrast	28	14	$2,650.00	$2,650.00	$47.12	$2,517.50	$1,616.50	2026-07-18
95810	HCPCS	Polysomnogram	14	14	$2,493.05	$2,493.05	$92.99	$2,368.40	$1,520.76	2026-07-18
95811	HCPCS	Polysomnogram C-pap Titration	14	14	$2,493.05	$2,493.05	$96.72	$2,368.40	$1,520.76	2026-07-18
11047	HCPCS	Debrid Bone Ea Addl 20 Sq Cm	14	14	$2,323.49	$2,323.49	$66.95	$2,207.32	$1,417.33	2026-07-18
15272	HCPCS	Allogenic Graft (addt'l 25 Sqcm) T/a/l (high Cost)	15	15	$2,234.94	$2,234.94	$2.99	$2,123.19	$1,363.31	2026-07-18
15276	HCPCS	Allogenic Skin Sub (f/nk/hf/g) Add'l (high Cost)	14	14	$2,234.94	$2,234.94	$18.60	$2,123.19	$1,363.31	2026-07-18
15274	HCPCS	Xeno Skin Sub (t/a/l) Each Add 100sqcm (high Cost)	14	14	$2,234.94	$2,234.94	$29.75	$2,123.19	$1,363.31	2026-07-18
15278	HCPCS	Xeno Sub Each Addl 100 Sqcm (f/nk/hf,g) (high Cost)	14	14	$2,234.94	$2,234.94	$37.19	$2,123.19	$1,363.31	2026-07-18
49083	HCPCS	Abd Paracentesis W/imag	16	16	$2,161.48	$2,161.48	$74.39	$2,053.41	$1,318.50	2026-07-18
49082	HCPCS	Abdominal Paracentesis Without Imaging	16	16	$2,158.48	$2,158.48	$46.12	$2,050.56	$1,316.67	2026-07-18
99291	HCPCS	Critical Care 30-74 Min	15	14	$2,115.90	$2,115.90	$167.38	$2,010.11	$1,290.70	2026-07-18
90853	HCPCS	Group Psychotherapy	13	13	$1,975.00	$1,975.00	$24.17	$1,876.25	$1,204.75	2026-07-18
71551	HCPCS	MRI-chest With Contrast (	16	16	$1,909.18	$1,909.18	$45.04	$1,813.72	$1,164.60	2026-07-18
73222	HCPCS	MRI-shldr,elbow,wrist W	16	16	$1,909.18	$1,909.18	$42.18	$1,813.72	$1,164.60	2026-07-18
73722	HCPCS	MRI-hip, Knee, Ankle With	16	16	$1,909.18	$1,909.18	$42.18	$1,813.72	$1,164.60	2026-07-18
75563	HCPCS	MRI-cardiac Stress Wo & W	16	16	$1,909.18	$1,909.18	$78.11	$1,813.72	$1,164.60	2026-07-18
C7901	HCPCS	Remote Group Psych 30-60 Min	12	12	$1,875.00	$1,875.00	$750.00	$1,781.25	$1,228.12	2026-07-18
28190	HCPCS	Removal Of Foreign Body From Foot	16	16	$1,677.63	$1,677.63	$74.76	$1,593.75	$1,023.35	2026-07-18
11403	HCPCS	Skin Rem Excis 2.1-3.0cm	16	16	$1,675.90	$1,675.90	$68.44	$1,592.11	$1,022.30	2026-07-18
10080	HCPCS	Pilondial Cyst	16	16	$1,675.90	$1,675.90	$45.38	$1,592.11	$1,022.30	2026-07-18
11010	HCPCS	Debride Skin At Fx Site	16	16	$1,675.90	$1,675.90	$155.86	$1,592.11	$1,022.30	2026-07-18
64450	HCPCS	Nerve Block	16	16	$1,647.25	$1,647.25	$27.89	$1,564.89	$1,004.82	2026-07-18
62270	HCPCS	Spinal Punct Lumbar	16	16	$1,647.25	$1,647.25	$45.38	$1,564.89	$1,004.82	2026-07-18
J1670	HCPCS	Tetanus And Diphtheria To	14	14	$1,623.52	$1,623.52	$359.01	$1,542.34	$990.35	2026-07-18
C5276	HCPCS	Aply Skin Addl 25 Sq Cm Feet Low Cost	14	14	$1,580.09	$1,580.09	$395.02	$1,501.09	$963.85	2026-07-18
C5272	HCPCS	Aply Skin Sub Adl 25 Sq Cm Legs Medicare Low Cost	14	14	$1,580.09	$1,580.09	$395.02	$1,501.09	$963.85	2026-07-18
C5277	HCPCS	Aply Skin Sub 1st 100 Sq Cm Feet Medicar Low Cost	16	16	$1,580.09	$1,580.09	$220.47	$1,501.09	$963.85	2026-07-18
C5278	HCPCS	Aply Skin Sub Ea Adl 100 Sq Cm Feet Mc Low Cost	14	14	$1,580.09	$1,580.09	$395.02	$1,501.09	$963.85	2026-07-18
C5271	HCPCS	Aply Skin Sub 1st 25 Sq Cm Legs Medicare Low Cost	16	16	$1,580.09	$1,580.09	$220.47	$1,501.09	$963.85	2026-07-18
C5275	HCPCS	Aply Skin Sub 1st 25 Sq Cm Feet Medicare Low Cost	16	16	$1,580.09	$1,580.09	$220.47	$1,501.09	$963.85	2026-07-18
C5274	HCPCS	Aply Skin Sub Ea Adl 100 Sq Cm Legs Mc Low Cost	14	14	$1,580.09	$1,580.09	$395.02	$1,501.09	$963.85	2026-07-18
15004	HCPCS	Site Prep 100sq Cm (trunk/arm/leg	16	16	$1,566.98	$1,566.98	$170.36	$1,488.63	$955.86	2026-07-18
92960	HCPCS	Cardioversion Elective External	14	14	$1,550.25	$1,550.25	$74.39	$1,472.74	$945.65	2026-07-18
G0379	HCPCS	Obs-direct Refer	15	15	$1,531.58	$1,531.58	$382.90	$1,544.00	$934.26	2026-07-18
99285	HCPCS	ER-level 5 Room Fee	18	15	$1,531.58	$1,531.58	$64.71	$2,000.00	$934.26	2026-07-18
32555	HCPCS	Thorcntsis W Tube Insrtn	16	16	$1,496.38	$1,496.38	$84.43	$1,421.56	$912.79	2026-07-18
32554	HCPCS	Removal Fluid Chest Cavit	16	16	$1,496.38	$1,496.38	$67.70	$1,421.56	$912.79	2026-07-18
11043	HCPCS	Debridement To Muscle/fascia	29	16	$1,496.00	$1,496.00	$100.43	$1,556.50	$999.44	2026-07-18
12045	HCPCS	Intermed Repair 12.6-20.0cm	16	16	$1,496.00	$1,496.00	$139.48	$1,421.20	$912.56	2026-07-18
13120	HCPCS	Complex Repair 1.1-2.5cm	16	16	$1,496.00	$1,496.00	$120.14	$1,421.20	$912.56	2026-07-18
12044	HCPCS	Intermed Repair 7.6-12.5cm	16	16	$1,496.00	$1,496.00	$118.66	$1,421.20	$912.56	2026-07-18
12046	HCPCS	Intermed Repair 20.1-30.0cm	16	16	$1,496.00	$1,496.00	$159.94	$1,421.20	$912.56	2026-07-18
13152	HCPCS	Complex Repair 2.6-7.5cm	16	16	$1,496.00	$1,496.00	$198.64	$1,421.20	$912.56	2026-07-18
11000	HCPCS	Dbrdmnt Of Eczemts Skin	16	16	$1,496.00	$1,496.00	$22.31	$1,421.20	$912.56	2026-07-18
13101	HCPCS	Complex Repair 2.6-7.5cm	16	16	$1,496.00	$1,496.00	$130.19	$1,421.20	$912.56	2026-07-18
12020	HCPCS	Repair Sup Wound Dehiscence Simple	16	16	$1,496.00	$1,496.00	$99.31	$1,421.20	$912.56	2026-07-18
13121	HCPCS	Complex Repair 2.6-7.5cm	16	16	$1,496.00	$1,496.00	$148.79	$1,421.20	$912.56	2026-07-18
12036	HCPCS	Intermed Repair 20.1-30.0cm	16	16	$1,496.00	$1,496.00	$157.34	$1,421.20	$912.56	2026-07-18
13151	HCPCS	Complex Repair 1.1-2.5cm	16	16	$1,496.00	$1,496.00	$161.44	$1,421.20	$912.56	2026-07-18
13132	HCPCS	Complex Repair 2.6-7.5cm	16	16	$1,496.00	$1,496.00	$177.80	$1,421.20	$912.56	2026-07-18
94003	HCPCS	Vent Mgmt Inpat Subq Day	14	14	$1,494.25	$1,494.25	$50.96	$1,419.54	$911.49	2026-07-18
94002	HCPCS	Vent Mgmt Inpat Init Day	14	14	$1,494.25	$1,494.25	$74.01	$1,419.54	$911.49	2026-07-18
J0248	HCPCS	Remdesivir 100mg Outpatient	15	15	$1,377.50	$1,377.50	$4.71	$1,308.63	$840.28	2026-07-18
93306	HCPCS	US-echo Complete	19	15	$1,315.43	$1,315.43	$54.30	$1,249.66	$802.41	2026-07-18
75559	HCPCS	MRI-cardiac With Stress I	16	16	$1,315.43	$1,315.43	$76.81	$1,249.66	$802.41	2026-07-18
M0243	HCPCS	Regn-cov2, Inj Adm	16	16	$1,126.25	$1,126.25	$281.56	$1,069.94	$687.01	2026-07-18
99284	HCPCS	ER-level 4 Room Fee	18	15	$1,056.10	$1,056.10	$71.50	$1,200.00	$644.22	2026-07-18
87631	HCPCS	Sars Covid 19 Biofire	14	14	$1,041.95	$1,041.95	$142.63	$989.85	$635.59	2026-07-18
36430	HCPCS	Blood Transfusion	27	15	$1,034.03	$1,034.03	$26.89	$982.33	$630.76	2026-07-18
0402	RC	—	12	12	$1,001.00	$1,001.00	$400.40	$950.95	$655.65	2026-07-18
90375	HCPCS	Rabies Imm Globulin Grifols 5ml	15	15	$992.88	$992.88	$217.26	$943.24	$605.66	2026-07-18
11107	HCPCS	Incisional Biopsy Skin Ea Sep/adl Lesion	14	14	$981.93	$981.93	$20.08	$932.83	$598.98	2026-07-18
11106	HCPCS	Incisional Biopsy Skin Single Lesion	16	16	$981.93	$981.93	$37.56	$932.83	$598.98	2026-07-18
97606	HCPCS	Neg Pressure Therapy > 50 Sq Cm	14	14	$950.80	$950.80	$22.31	$903.26	$579.99	2026-07-18
10021	HCPCS	Fine Needle Aspiration	16	16	$949.90	$949.90	$38.31	$902.41	$579.44	2026-07-18
11042	HCPCS	Debridement, Subq Tissue	32	16	$949.80	$949.80	$10.75	$1,006.17	$646.07	2026-07-18
10061	HCPCS	I&d Simple Furuncle	29	16	$949.80	$949.80	$91.13	$902.31	$579.38	2026-07-18
12055	HCPCS	Intermed Repair Face 12.6-20 Cm	16	16	$949.80	$949.80	$145.50	$902.31	$579.38	2026-07-18
12054	HCPCS	Intermed Repair 7.6-12.5cm	16	16	$949.80	$949.80	$130.19	$902.31	$579.38	2026-07-18
12057	HCPCS	Intermed Repair >30.0cm	16	16	$949.80	$949.80	$145.50	$902.31	$579.38	2026-07-18
11602	HCPCS	Excise Malignant Lesion 1.1-2cm	16	16	$949.80	$949.80	$84.43	$902.31	$579.38	2026-07-18
12051	HCPCS	Intermed Repair 2.5cm Or Less	16	16	$949.80	$949.80	$86.66	$902.31	$579.38	2026-07-18
12042	HCPCS	Intermed Repair 2.6-7.5cm	16	16	$949.80	$949.80	$103.78	$902.31	$579.38	2026-07-18
12041	HCPCS	Intermed Repair 2.5cm Or Less	16	16	$949.80	$949.80	$78.11	$902.31	$579.38	2026-07-18
12035	HCPCS	Intermed Repair 12.6-20.0cm	16	16	$949.80	$949.80	$130.19	$902.31	$579.38	2026-07-18
12034	HCPCS	Intermed Repair 7.6-12.5cm	16	16	$949.80	$949.80	$110.47	$902.31	$579.38	2026-07-18
12032	HCPCS	Intermed Repair 2.6-7.5cm	16	16	$949.80	$949.80	$93.74	$902.31	$579.38	2026-07-18
12031	HCPCS	Intermed Repair 2.5cm Or Less	16	16	$949.80	$949.80	$74.39	$902.31	$579.38	2026-07-18
12017	HCPCS	Simpl Repair Face 20.1cm-30.0cm	16	16	$949.80	$949.80	$118.29	$902.31	$579.38	2026-07-18
12006	HCPCS	Simpl Repair 20.1cm-30.0cm	16	16	$949.80	$949.80	$88.90	$902.31	$579.38	2026-07-18
12005	HCPCS	Simpl Repair 12.6cm-20.0cm	16	16	$949.80	$949.80	$73.28	$902.31	$579.38	2026-07-18
10120	HCPCS	Removal Foreign Body, Sim	16	16	$949.80	$949.80	$45.38	$902.31	$579.38	2026-07-18
10160	HCPCS	Puncture Aspir Of Abscess	16	16	$949.80	$949.80	$46.49	$902.31	$579.38	2026-07-18
12053	HCPCS	Intermed Repair 5.1-7.5cm	16	16	$949.80	$949.80	$117.91	$902.31	$579.38	2026-07-18
13131	HCPCS	Complex Repair 1.1-2.5cm	16	16	$949.80	$949.80	$138.75	$902.31	$579.38	2026-07-18
12052	HCPCS	Intermed Repair 2.6-5.0cm	16	16	$949.80	$949.80	$106.75	$902.31	$579.38	2026-07-18
11750	HCPCS	Excision Nail And Matrix	29	16	$949.80	$949.80	$58.77	$902.31	$545.66	2026-07-18
16030	HCPCS	Burn Tx Large Maj >10%	29	16	$949.80	$949.80	$77.37	$902.31	$408.83	2026-07-18
65220	HCPCS	Eye: Exam/removal	14	14	$949.08	$949.08	$26.40	$901.63	$620.47	2026-07-18
41250	HCPCS	Lac Repair Tongue 2.5cm Or Less	14	14	$949.08	$949.08	$72.90	$901.63	$620.47	2026-07-18
36680	HCPCS	Placement Intraosseous Needle/ Infusion	14	14	$949.08	$949.08	$44.63	$901.63	$620.47	2026-07-18
43752	HCPCS	Placement Of Ng Tube	16	16	$949.08	$949.08	$30.13	$901.63	$578.94	2026-07-18
73201	HCPCS	CT-upper Extrem W	16	16	$917.00	$917.00	$30.20	$1,000.00	$592.18	2026-07-18
72133	HCPCS	CT-l Spine Wo/w	16	16	$917.00	$917.00	$33.07	$1,000.00	$592.18	2026-07-18
72132	HCPCS	CT-l Spine W	16	16	$917.00	$917.00	$31.77	$1,000.00	$592.18	2026-07-18
71552	HCPCS	MRI-chest Wo/w (clavicle)	16	16	$917.00	$917.00	$58.85	$871.15	$559.37	2026-07-18
74177	HCPCS	CT-abd/pelvis W	20	16	$917.00	$917.00	$47.39	$1,000.00	$559.37	2026-07-18
74178	HCPCS	CT-abd/pelvis Wo/w	19	16	$917.00	$917.00	$17.34	$1,000.00	$559.37	2026-07-18
74174	HCPCS	CTA-abd/pelvis	18	16	$917.00	$917.00	$18.95	$1,000.00	$559.37	2026-07-18
70553	HCPCS	MRI-brain Wo & W	20	16	$917.00	$917.00	$59.63	$871.15	$559.37	2026-07-18
70552	HCPCS	MRI-brain With Contrast	17	16	$917.00	$917.00	$46.34	$871.15	$559.37	2026-07-18
70548	HCPCS	MRA-neck With Contrast	16	16	$917.00	$917.00	$39.05	$871.15	$559.37	2026-07-18
70546	HCPCS	MRA-head Wo & W	16	16	$917.00	$917.00	$38.54	$871.15	$559.37	2026-07-18
70545	HCPCS	MRA-head W/contrast	16	16	$917.00	$917.00	$31.24	$871.15	$559.37	2026-07-18
70542	HCPCS	MRI-orbit, Face, Neck Wit	16	16	$917.00	$917.00	$42.18	$871.15	$559.37	2026-07-18
72126	HCPCS	CT-c Spine With	17	16	$917.00	$917.00	$10.51	$1,000.00	$559.37	2026-07-18
73223	HCPCS	MRI-shldr,elbow,wrist Wo/	16	16	$917.00	$917.00	$55.98	$871.15	$559.37	2026-07-18
70543	HCPCS	MRI-orbit, Face, Neck Wo/	16	16	$917.00	$917.00	$55.98	$871.15	$559.37	2026-07-18
73220	HCPCS	MRI-humerus, Fa, Hand Wo/	16	16	$917.00	$917.00	$55.98	$871.15	$559.37	2026-07-18
73219	HCPCS	MRI-humerus, Fa, Hand W	16	16	$917.00	$917.00	$42.18	$871.15	$559.37	2026-07-18
73723	HCPCS	MRI-hip, Knee, Ankle Wo &	16	16	$917.00	$917.00	$55.98	$871.15	$559.37	2026-07-18
70549	HCPCS	MRA-neck Without & With Contr	16	16	$917.00	$917.00	$46.87	$871.15	$559.37	2026-07-18
75561	HCPCS	MRI-cardiac For Morph Wo/	16	16	$917.00	$917.00	$67.70	$871.15	$559.37	2026-07-18
73720	HCPCS	MRI-thigh,lwleg,foot Wo/w	17	16	$917.00	$917.00	$55.98	$871.15	$559.37	2026-07-18
73719	HCPCS	MRI-thigh,lwr Leg,foot W	16	16	$917.00	$917.00	$42.18	$871.15	$559.37	2026-07-18
72197	HCPCS	MRI-pelvis Wo/with Contra	18	16	$917.00	$917.00	$57.28	$871.15	$559.37	2026-07-18
72196	HCPCS	MRI-pelvis With Contrast	16	16	$917.00	$917.00	$45.04	$871.15	$559.37	2026-07-18
74183	HCPCS	MRI-abdomen Wo/with Contr	19	16	$917.00	$917.00	$51.73	$871.15	$559.37	2026-07-18
72157	HCPCS	MRI-t-spine Wo & W	18	16	$917.00	$917.00	$19.87	$871.15	$559.37	2026-07-18
72156	HCPCS	MRI-c-spine Wo & W	16	16	$917.00	$917.00	$59.63	$871.15	$559.37	2026-07-18
72149	HCPCS	MRI-l-spine With Contrast	16	16	$917.00	$917.00	$46.34	$871.15	$559.37	2026-07-18
72147	HCPCS	MRI-t-spine With Contrast	16	16	$917.00	$917.00	$46.34	$871.15	$559.37	2026-07-18
72142	HCPCS	MRI-c-spine With Contrast	16	16	$917.00	$917.00	$46.34	$871.15	$559.37	2026-07-18
72158	HCPCS	MRI-l-spine Wo & W Contra	18	16	$917.00	$917.00	$19.87	$871.15	$559.37	2026-07-18
88184	HCPCS	Flow Cytometry	13	13	$857.08	$857.08	$342.83	$814.23	$522.82	2026-07-18
90847	HCPCS	Fam Psych With Patient Present 50min	13	13	$845.00	$845.00	$101.91	$802.75	$515.45	2026-07-18
11045	HCPCS	Debrid Subq Each Addl 20 Sq Cm	14	14	$836.43	$836.43	$18.60	$794.61	$510.22	2026-07-18
83519	HCPCS	Myasthenia Gravis Panel 2 With Reflex To Musk Antibody	13	13	$820.09	$820.09	$328.04	$779.09	$500.25	2026-07-18
11057	HCPCS	Benign Lesion Paring (4+)	16	16	$819.19	$819.19	$24.17	$778.23	$499.71	2026-07-18
37195	HCPCS	Thrombolysis Cerebral IV Infusion	26	15	$806.70	$806.70	$128.29	$766.37	$516.94	2026-07-18
92977	HCPCS	Thrmblysis Coron Int Infu	24	13	$806.70	$806.70	$67.41	$766.37	$348.84	2026-07-18
90846	HCPCS	Fam Psych Without Patient 50min	13	13	$805.00	$805.00	$97.83	$764.75	$491.05	2026-07-18
86870	HCPCS	Antibody Identification	28	14	$782.81	$782.81	$177.13	$814.23	$522.82	2026-07-18
90837	HCPCS	Psychotherapy 60 Minutes	13	13	$770.00	$770.00	$135.02	$731.50	$469.70	2026-07-18
87902	HCPCS	Hepatitis C Viral Rna, Genotype, Lipa	13	13	$769.40	$769.40	$307.76	$730.93	$469.33	2026-07-18
90834	HCPCS	Psychotherapy 45 Minutes	13	13	$755.00	$755.00	$91.13	$717.25	$460.55	2026-07-18
94060	HCPCS	Bronchodilation Responsiveness Pre/post	15	15	$748.43	$748.43	$8.18	$711.01	$456.54	2026-07-18
92950	HCPCS	Cpr	15	14	$748.43	$748.43	$75.00	$711.01	$456.54	2026-07-18
43754	HCPCS	Gastric Intubn&aspiration Diagnostic	14	14	$747.65	$747.65	$16.73	$710.27	$489.72	2026-07-18
43753	HCPCS	Gastric Intubation/asp/lavage	14	14	$747.65	$747.65	$16.73	$710.27	$489.72	2026-07-18
11046	HCPCS	Deb Muscle/fasica Addl Sqcm	14	14	$740.34	$740.34	$38.31	$703.32	$451.61	2026-07-18
81225	HCPCS	Cyp2c19 Genotype	13	13	$728.40	$728.40	$291.36	$691.98	$444.32	2026-07-18
86902	HCPCS	Antigen Scrn(reagnt Ser)	12	12	$708.53	$708.53	$283.41	$673.10	$464.09	2026-07-18
86905	HCPCS	Arc Rbc Ag Not Abo/d	13	13	$708.53	$708.53	$283.41	$673.10	$432.20	2026-07-18
20610	HCPCS	Ia Injection	16	16	$706.23	$706.23	$27.57	$670.92	$430.80	2026-07-18
20605	HCPCS	Arthrocentesis, Intermediate Joint	16	16	$706.23	$706.23	$23.21	$670.92	$430.80	2026-07-18
20600	HCPCS	Arthrocentesis, Small Joint	16	16	$706.23	$706.23	$22.39	$670.92	$430.80	2026-07-18
20550	HCPCS	Digital Block	17	16	$705.50	$705.50	$23.21	$670.23	$430.36	2026-07-18
20552	HCPCS	Injection Trigger Point	16	16	$705.50	$705.50	$22.94	$670.23	$430.36	2026-07-18
81161	HCPCS	Prothombin Factor Ii-mutn	13	13	$697.50	$697.50	$279.00	$662.63	$425.48	2026-07-18
99283	HCPCS	ER-level 3 Room Fee	19	15	$680.35	$680.35	$50.31	$1,200.00	$415.01	2026-07-18
97597	HCPCS	Deb First 20 Sq Cm Or Less	14	14	$670.73	$670.73	$28.64	$637.19	$409.15	2026-07-18
87507	HCPCS	Gi Panel	14	14	$657.48	$657.48	$262.99	$624.61	$430.65	2026-07-18
81500	HCPCS	Roma	13	13	$651.25	$651.25	$260.50	$618.69	$397.26	2026-07-18
90832	HCPCS	Psychotherapy 30 Minutes	13	13	$610.00	$610.00	$69.18	$579.50	$372.10	2026-07-18
J1610	HCPCS	Glucagon Kit (1 Mg)	15	15	$603.42	$603.42	$139.58	$573.25	$368.09	2026-07-18
17999	HCPCS	Skin Tissue Procedure	14	14	$593.85	$593.85	$148.46	$564.16	$362.25	2026-07-18
51700	HCPCS	Bladder Irrigation/lavage/instillation	16	16	$588.70	$588.70	$22.31	$662.00	$359.11	2026-07-18
43762	HCPCS	Gastric Replacement Tube	16	16	$588.70	$588.70	$27.89	$662.00	$359.11	2026-07-18
93925	HCPCS	US-arterial Extrem Bilat	18	15	$584.28	$584.28	$6.71	$555.07	$356.41	2026-07-18
93970	HCPCS	US-venous Extrem Bilat	19	15	$584.28	$584.28	$22.99	$555.07	$356.41	2026-07-18
74176	HCPCS	CT-abd/pelvis Wo	21	16	$584.28	$584.28	$45.31	$1,000.00	$356.41	2026-07-18
71550	HCPCS	MRI-chest Wo Contrast (cl	16	16	$584.28	$584.28	$38.01	$700.00	$356.41	2026-07-18
70551	HCPCS	MRI-brain Without	20	16	$584.28	$584.28	$9.06	$700.00	$356.41	2026-07-18
70547	HCPCS	MRA-neck Without Contrast	17	16	$584.28	$584.28	$31.24	$700.00	$356.41	2026-07-18
70544	HCPCS	MRA-head Wo Contrast	18	16	$584.28	$584.28	$31.24	$700.00	$356.41	2026-07-18
70540	HCPCS	MRI-orbit, Face, Neck Wo	16	16	$584.28	$584.28	$35.15	$700.00	$356.41	2026-07-18
77047	HCPCS	MRI-breast Bilateral	16	16	$584.28	$584.28	$41.66	$700.00	$356.41	2026-07-18
77084	HCPCS	MRI-bone Marrow Blood Sup	16	16	$584.28	$584.28	$41.66	$700.00	$356.41	2026-07-18
70336	HCPCS	MRI-tmj	16	16	$584.28	$584.28	$38.54	$700.00	$356.41	2026-07-18
74181	HCPCS	MRI-abdomen Without Contrast	16	16	$584.28	$584.28	$38.01	$700.00	$356.41	2026-07-18
77046	HCPCS	MRI-breast Unilateral	16	16	$584.28	$584.28	$37.75	$700.00	$356.41	2026-07-18
73218	HCPCS	MRI-humerus, Fa, Hand Wo	18	16	$584.28	$584.28	$35.15	$700.00	$356.41	2026-07-18
93880	HCPCS	US-duplex Carotid Dopp	18	15	$584.28	$584.28	$7.32	$555.07	$356.41	2026-07-18
93975	HCPCS	US-renal Artery Doppler	14	14	$584.28	$584.28	$43.15	$555.07	$356.41	2026-07-18
73721	HCPCS	MRI-hip, Knee, Ankle Wo C	19	16	$584.28	$584.28	$35.15	$700.00	$356.41	2026-07-18
73221	HCPCS	MRI-shldr,elbow,wrist Wo	20	16	$584.28	$584.28	$35.15	$700.00	$356.41	2026-07-18
75557	HCPCS	MRI-cardiac For Morph Wo	16	16	$584.28	$584.28	$61.19	$700.00	$356.41	2026-07-18
72195	HCPCS	MRI-pelvis Wo	18	16	$584.28	$584.28	$38.01	$700.00	$356.41	2026-07-18
73718	HCPCS	MRI-thigh,lwrleg,foot Wo	19	16	$584.28	$584.28	$27.96	$700.00	$356.41	2026-07-18
72148	HCPCS	MRI-l-spine Wo	19	16	$584.28	$584.28	$38.54	$700.00	$356.41	2026-07-18
72146	HCPCS	MRI-t-spine Wo Contrast	19	16	$584.28	$584.28	$38.54	$700.00	$356.41	2026-07-18
72141	HCPCS	MRI-c-spine Wo	20	16	$584.28	$584.28	$38.54	$700.00	$356.41	2026-07-18
31500	HCPCS	Endotracheal Intubation	30	16	$581.83	$581.83	$75.00	$662.00	$357.00	2026-07-18
31605	HCPCS	Emerg Open Windpipe	16	16	$581.83	$581.83	$89.05	$662.00	$354.92	2026-07-18
87484	HCPCS	Ehrlicha Chaffeensis Amp Prb	13	13	$581.51	$581.51	$232.60	$552.43	$354.72	2026-07-18
87468	HCPCS	Anaplsma Phgcytophlm Amp Prb	13	13	$581.51	$581.51	$232.60	$552.43	$354.72	2026-07-18
87478	HCPCS	Borrelia Miyamotoic Amp Prb	13	13	$581.51	$581.51	$232.60	$552.43	$354.72	2026-07-18
87469	HCPCS	Babesia Microti Amp Prb	13	13	$581.51	$581.51	$232.60	$552.43	$354.72	2026-07-18
P9019	HCPCS	Plateletapheresis Process	12	12	$576.50	$576.50	$230.60	$547.68	$377.61	2026-07-18
27762	HCPCS	Closed Distl Tibia W/manip	16	16	$561.73	$561.73	$203.47	$662.00	$410.76	2026-07-18
27750	HCPCS	Closed Tibial Shaft Without Manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
27530	HCPCS	Closed Tibial Proximal Without Manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
26770	HCPCS	Joint Disloc W/manip Without Anes	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
26725	HCPCS	Treatment Of Broken Phal W/manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
26720	HCPCS	Closed Treatment Phlange Without Manip	16	16	$561.73	$561.73	$65.46	$662.00	$342.66	2026-07-18
26670	HCPCS	Treat Hand Dislo W/manip Without Anesth	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
26641	HCPCS	Closed Reduction Thumb	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
26605	HCPCS	Closed Metacarpal W/manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
25600	HCPCS	Colles/or Smith Without Manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
25560	HCPCS	Closed Radial & Ulnar Without Manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
25535	HCPCS	Closed Ulnar Shaft W/manipu	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
25530	HCPCS	Closed Ulnar Shaft Without Manip	16	16	$561.73	$561.73	$83.32	$662.00	$342.66	2026-07-18
24670	HCPCS	Closed Red Ulnar Fracture Without Manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
25500	HCPCS	Closed Radial Shaft Without Manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
24640	HCPCS	Treat Elbow Dislocation W/manip	16	16	$561.73	$561.73	$46.49	$662.00	$342.66	2026-07-18
24600	HCPCS	Closd Elbw Disloc Wo Anes	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
24560	HCPCS	Closed Tx Upper Arm At Sh Without Manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
24530	HCPCS	Closed Treat Elbow Without Manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
23650	HCPCS	Clo Shldr Dis.w/man,wo/an	17	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
21480	HCPCS	Closed Tx Jaw Dislocation	16	16	$561.73	$561.73	$22.69	$662.00	$342.66	2026-07-18
28630	HCPCS	Closed Tx Disloc Foot Bon Without Anes	16	16	$561.73	$561.73	$65.09	$662.00	$342.66	2026-07-18
28660	HCPCS	Closed Tx Joint (toe) Without Anes	16	16	$561.73	$561.73	$47.61	$662.00	$342.66	2026-07-18
28540	HCPCS	Treat Ankle Joint Disloc W/o/anes	16	16	$561.73	$561.73	$81.45	$662.00	$342.66	2026-07-18
28515	HCPCS	Closed Tx Fx Toe-w/manip	16	16	$561.73	$561.73	$58.03	$662.00	$342.66	2026-07-18
28495	HCPCS	Closed Phalange W Manip	16	16	$561.73	$561.73	$62.49	$662.00	$342.66	2026-07-18
28490	HCPCS	Tx Broken Great Toe/phx/phl Without Man	16	16	$561.73	$561.73	$43.52	$662.00	$342.66	2026-07-18
27816	HCPCS	Treatment Ankle Fracture Without Manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
27840	HCPCS	Closed Ankle Dislocation, Without Anesth	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
27808	HCPCS	Clo Bimallr Ankle W Potts Without Manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
27788	HCPCS	Clo Distal Fibula W/manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
27786	HCPCS	Closed Distal Fibula Without Manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
27780	HCPCS	Closed Proximal Fbla/shft Without Manip	16	16	$561.73	$561.73	$86.76	$662.00	$342.66	2026-07-18
11105	HCPCS	Punch Biopsy Skin Ea Sep/add Lesion	14	14	$551.64	$551.64	$16.73	$524.06	$336.50	2026-07-18
11104	HCPCS	Punch Biospy Of Sking Single Lesion	16	16	$551.64	$551.64	$30.87	$524.06	$336.50	2026-07-18
11103	HCPCS	Tangential Biopsy Skin Ea Sep/adl Lesion	14	14	$551.64	$551.64	$14.13	$524.06	$336.50	2026-07-18
11102	HCPCS	Tangential Biopsy Of Skin Single Lesion	16	16	$551.64	$551.64	$24.54	$524.06	$336.50	2026-07-18
29580	HCPCS	Unna Boot Application - Right	29	16	$534.19	$534.19	$20.46	$711.50	$407.32	2026-07-18
11055	HCPCS	Benign Lesion Paring	14	14	$522.27	$522.27	$13.02	$496.16	$318.58	2026-07-18
96365	HCPCS	IV Drug Inf Initial Up To 1 Hr	15	15	$511.08	$511.08	$7.81	$485.53	$311.76	2026-07-18
96360	HCPCS	IV Hydration 31 Min-1 Hr	15	15	$511.08	$511.08	$6.31	$485.53	$311.76	2026-07-18
96374	HCPCS	IV Injection Initial Admin	15	15	$511.08	$511.08	$6.69	$485.53	$311.76	2026-07-18
C7900	HCPCS	Remote Ind Psychotherapy 15-29 Min	12	12	$510.00	$510.00	$204.00	$484.50	$334.05	2026-07-18
94640	HCPCS	Aerosol Treatment	14	14	$508.58	$508.58	$6.00	$483.15	$310.23	2026-07-18
94660	HCPCS	Cpap-initiation & Managme	14	14	$508.58	$508.58	$28.27	$483.15	$310.23	2026-07-18
94664	HCPCS	Cont Aerosol Initial Hr	28	14	$508.58	$508.58	$6.00	$483.15	$310.23	2026-07-18
97598	HCPCS	Slct Deb Without Anes>20sqcm Addl	14	14	$503.71	$503.71	$18.60	$478.52	$307.26	2026-07-18
97602	HCPCS	Non Select Deb Without Anesthia	14	14	$503.42	$503.42	$125.86	$478.25	$307.09	2026-07-18
81479	HCPCS	Brcavantage	13	13	$500.00	$500.00	$200.00	$475.00	$305.00	2026-07-18
0110	RC	—	2	1	$487.75	$487.75	$270.00	$607.95	$438.98	2026-07-18
31720	HCPCS	Catheter Aspiration; Nasotracheal	14	14	$478.75	$478.75	$39.42	$454.81	$292.04	2026-07-18
12013	HCPCS	Simpl Repair 2.6cm-5.0cm	14	14	$476.88	$476.88	$45.38	$662.00	$312.36	2026-07-18
16000	HCPCS	Burn Tx 1st Degree, Initial	14	14	$476.88	$476.88	$33.10	$662.00	$312.36	2026-07-18
12004	HCPCS	Simpl Repair, 7.6cm-12.5cm	14	14	$476.88	$476.88	$53.56	$662.00	$312.36	2026-07-18
12001	HCPCS	Simpl Repair 2.5cm Or Less	14	14	$476.88	$476.88	$31.25	$662.00	$312.36	2026-07-18
11730	HCPCS	Avulsion Nailplate, Singl	27	14	$476.88	$476.88	$39.05	$662.00	$291.18	2026-07-18
26010	HCPCS	I&d Abscess Finger	16	16	$476.88	$476.88	$59.14	$662.00	$290.90	2026-07-18
12015	HCPCS	Simpl Repair 7.6cm-12.5cm	16	16	$476.88	$476.88	$73.65	$662.00	$290.90	2026-07-18
16025	HCPCS	Burn Tx Dress/debrid Med 5-10%	29	16	$476.88	$476.88	$64.72	$662.00	$290.90	2026-07-18
16020	HCPCS	Burn Tx Dress/debride Sm <5%	27	14	$476.88	$476.88	$26.40	$662.00	$290.90	2026-07-18
12014	HCPCS	Simpl Repair 5.1cm-7.5cm	15	14	$476.88	$476.88	$58.40	$662.00	$290.90	2026-07-18
12011	HCPCS	Simpl Repair 2.5cm Or Less	15	15	$476.88	$476.88	$39.80	$662.00	$290.90	2026-07-18
12002	HCPCS	Simpl Repair, 2.6cm-7.5cm	16	14	$476.88	$476.88	$40.52	$662.00	$290.90	2026-07-18
10060	HCPCS	I&d Simple Abscess	32	16	$476.74	$476.74	$45.38	$662.00	$290.90	2026-07-18
0128	RC	—	1	1	$475.00	$475.00	$427.50	$427.50	$427.50	2026-07-18
75571	HCPCS	CT Coronary Calcium Scan	4	4	$100.00	$100.00	$15.10	$1,000.00	$334.21	2026-07-18

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