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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

CHICOT MEMORIAL MEDICAL CENTER

Lake Village, AR · CCN 041328 · Rates published

1,821 distinct procedures filed
9 distinct payers
42,410 rate rows
2026-03-31 last MRF observed
Data quality

41,852 of 42,410 rate rows are consumer-grade (98.7%)

558 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
placeholder amount (≤ $0.02) — excluded from medians 534
per-diem day rate — not a per-procedure price 24
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://chicotmemorial.com/mrf/383807713_CHICOT-MEMORIAL-MEDICAL-CENTER_standardcharges.csv
Found on page https://chicotmemorial.com/financial-services/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 71ab7a90d2b00ddb… · 24,167,683 bytes · first seen 2026-05-06

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
Q4341
HCPCS 		Wc-simplimax 4x4 Allograft 8 $107.12 $108,000.00 $47,040.00 nat. median
$1,474
outlier · 31.9×
C1882
HCPCS 		Aicd Othe Than Sing/dual 7 $25,284.00 $58,050.00 $26,767.50 nat. median
$27,114
1.0× median
C1721
HCPCS 		Aicd Dual Chamber 7 $22,344.00 $51,300.00 $23,655.00 nat. median
$22,213
1.1× median
Q4309
HCPCS 		Via Matrix 2x3 8 $107.12 $46,800.00 $13,870.00 nat. median
$1,750
outlier · 7.9×
37244
HCPCS 		Reboa 9 $297.00 $13,269.50 $10,509.44 nat. median
$12,234
0.9× median
Q4282
HCPCS 		Wc-cygnus Dual [2x3cm] 7 $107.12 $18,300.00 $9,721.80 nat. median
$657
outlier · 14.8×
40804
HCPCS 		Soft Tiss Fb Remov Vestibule Of Mouth 9 $179.74 $19,134.00 $8,418.96 nat. median
$943
outlier · 8.9×
J3380
HCPCS 		Vedolizumab (entyvio) Inj [300mg] 9 $17.03 $10,495.00 $8,228.08 nat. median
$280
outlier · 29.4×
J3101
HCPCS 		Tenecteplase IV Kit [50mg] 9 $41.06 $14,935.00 $7,885.00 nat. median
$5,957
1.3× median
C1785
HCPCS 		Accent Dr Rfpacemaker 7 $6,226.92 $14,296.50 $6,592.27 nat. median
$6,506
1.0× median
J2505
HCPCS 		Pegfilgrastim (neulasta Syr[6mg\0.6ml]## 9 $2,177.20 $13,709.48 $6,032.17 nat. median
$6,803
0.9× median
J1162
HCPCS 		Digoxin Immune Fab Inj [40mg] (digifab)* 9 $540.91 $14,476.54 $5,947.92 nat. median
$7,308
0.8× median
C1777
HCPCS 		Lead Aicd Endo Sing Col 7 $4,704.00 $10,800.00 $4,980.00 nat. median
$5,141
1.0× median
J0840
HCPCS 		Crotalidae Polyva Immune Fab(crofab)vial 8 $1,789.99 $5,908.62 $4,696.00 nat. median
$3,427
1.4× median
Q4196
HCPCS 		Puraply Am 25 Sq Cm 8 $107.12 $11,542.50 $4,189.70 nat. median
$286
outlier · 14.7×
J1306
HCPCS 		Inclisiran (leqvio) Inj [284mg/1.5ml] 9 $12.44 $4,875.00 $3,822.00 nat. median
$57
outlier · 67.6×
47531
HCPCS 		Xr Cholangiogram T-tube 9 $250.00 $7,969.50 $3,506.58 nat. median
$3,258
1.1× median
Q4197
HCPCS 		Puraply Xt 25 Sq Cm 8 $107.12 $6,750.00 $3,319.61 nat. median
$194
outlier · 17.2×
Q4194
HCPCS 		Wc-novachor [1.5cmx2.75cm} 7 $107.12 $4,062.50 $3,217.50 nat. median
$834
outlier · 3.9×
27087
HCPCS 		Sft Tiss Fb Remvl Lft Pelvis Or Hip Deep 9 $250.00 $6,939.90 $3,053.56 nat. median
$3,518
0.9× median
29880
HCPCS 		Knee Arthroscopy 9 $297.00 $3,855.50 $3,025.03 nat. median
$3,917
0.8× median
36555
HCPCS 		Central Line <5 Years 9 $93.28 $6,833.70 $3,006.83 nat. median
$2,693
1.1× median
59409
HCPCS 		Vaginal Delivery 9 $363.00 $6,702.30 $2,949.01 nat. median
$3,185
0.9× median
59414
HCPCS 		Delivery Of Placenta 9 $70.97 $6,702.30 $2,949.01 nat. median
$2,876
1.0× median
J3111
HCPCS 		Romosozumab (evenity) Inj [210mg/2.34ml] 9 $9.09 $3,691.06 $2,893.79 nat. median
$1,003
outlier · 2.9×
36556
HCPCS 		Pf Central Venous Line 9 $81.11 $6,833.70 $2,865.52 nat. median
$2,458
1.2× median
49560
HCPCS 		Pf Hernia Incarcer Repair 9 $363.00 $6,550.11 $2,852.94 nat. median
$3,216
0.9× median
J0630
HCPCS 		Calcitonin (miacalcin) Inj [400unit/2ml] 9 $40.46 $3,523.62 $2,790.71 nat. median
$1,885
1.5× median
19120
HCPCS 		Removal Of Breast Lesion 9 $320.00 $6,338.73 $2,760.87 nat. median
$3,650
0.8× median
0119
RC 		1 $2,719.00 $2,719.00 $2,719.00 nat. median
$853
outlier · 3.2×
0110
RC 		1 $2,719.00 $2,719.00 $2,719.00 nat. median
$979
outlier · 2.8×
0120
RC 		1 $2,719.00 $2,719.00 $2,719.00 nat. median
$1,017
outlier · 2.7×
24201
HCPCS 		Soft Tiss Fb Remvl Left Upper Arm Deep,left Side 9 $250.00 $6,092.10 $2,680.52 nat. median
$2,893
0.9× median
23333
HCPCS 		Soft Tiss Fb Remvl Lft Shldr Deep 9 $250.00 $6,092.10 $2,680.52 nat. median
$2,908
0.9× median
27086
HCPCS 		Sft Tiss Fb Removal Left Pelvis Or Hip 9 $290.08 $6,092.10 $2,680.52 nat. median
$2,773
1.0× median
58600
HCPCS 		Lap Tubal 9 $294.87 $3,349.50 $2,652.81 nat. median
$3,265
0.8× median
56740
HCPCS 		Bartholin Gland-cyst 9 $250.33 $6,029.10 $2,652.81 nat. median
$3,326
0.8× median
Q0249
HCPCS 		Tocilizumab (actemra) Inj [400mg/20ml] 9 $6.57 $3,365.00 $2,638.16 nat. median
$24
outlier · 108.5×
J3262
HCPCS 		Tocilizumab (actemra) Inj [400mg/20ml] 9 $5.07 $3,365.00 $2,638.16 nat. median
$1,425
1.9× median
20240
HCPCS 		Bone Biopsy - Excisional 9 $114.91 $3,027.00 $2,397.39 nat. median
$2,897
0.8× median
19307
HCPCS 		Pf Mast Mod Rad 9 $363.00 $7,767.00 $2,306.70 nat. median
$6,934
outlier · 0.3×
0275
RC 		7 $350.15 $8,597.25 $2,274.25 nat. median
$2,062
1.1× median
Q4160
HCPCS 		Nushield 2 Sq Cm 8 $107.12 $8,586.00 $2,243.81 nat. median
$301
outlier · 7.5×
Q4106
HCPCS 		Dermagraft 38 Sq Cm 9 $38.45 $2,812.50 $2,205.00 nat. median
$89
outlier · 24.8×
Q4159
HCPCS 		Affinity 7 Sq Cm 8 $107.12 $5,310.50 $2,115.00 nat. median
$638
outlier · 3.3×
Q5136
HCPCS 		Denosumab Bbdz (jubbonti) Inj [60mg/ml] 8 $27.67 $4,140.00 $1,840.00 nat. median
$2,897
0.6× median
64633
HCPCS 		Destroy Cerv/thor Facet J 9 $250.00 $2,242.00 $1,775.66 nat. median
$2,311
0.8× median
64635
HCPCS 		Destroy Lumb/sac Facet Jn 9 $297.00 $2,242.00 $1,775.66 nat. median
$2,352
0.8× median
12047
HCPCS 		Intmd Rpr N-hf/genit >30 Cm 9 $297.00 $3,936.60 $1,732.11 nat. median
$1,847
0.9× median
12037
HCPCS 		Intmd Rpr S/tr/ext >30 Cm 9 $250.00 $3,936.60 $1,732.11 nat. median
$1,995
0.9× median

Other procedures at this hospital

Browse this hospital's 1,821 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
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
             
Q4341 HCPCS Wc-simplimax 4x4 Allograft 17 8 $80,000.00 $80,000.00 $107.12 $108,000.00 $47,040.00 2026-03-31
C1882 HCPCS Aicd Othe Than Sing/dual 8 7 $64,500.00 $64,500.00 $25,284.00 $58,050.00 $26,767.50 2026-03-31
C1721 HCPCS Aicd Dual Chamber 8 7 $57,000.00 $57,000.00 $22,344.00 $51,300.00 $23,655.00 2026-03-31
Q4309 HCPCS Via Matrix 2x3 25 8 $34,675.00 $34,675.00 $107.12 $46,800.00 $13,870.00 2026-03-31
37244 HCPCS Reboa 10 9 $26,539.00 $26,539.00 $297.00 $13,269.50 $10,509.44 2026-03-31
Q4282 HCPCS Wc-cygnus Dual [2x3cm] 22 7 $24,550.00 $24,550.00 $107.12 $18,300.00 $9,721.80 2026-03-31
40804 HCPCS Soft Tiss Fb Remov Vestibule Of Mouth 10 9 $21,260.00 $21,260.00 $179.74 $19,134.00 $8,418.96 2026-03-31
J3380 HCPCS Vedolizumab (entyvio) Inj [300mg] 10 9 $20,990.00 $20,990.00 $17.03 $10,495.00 $8,228.08 2026-03-31
J3101 HCPCS Tenecteplase IV Kit [50mg] 20 9 $24,435.00 $24,435.00 $41.06 $14,935.00 $7,885.00 2026-03-31
C1785 HCPCS Accent Dr Rfpacemaker 8 7 $15,885.00 $15,885.00 $6,226.92 $14,296.50 $6,592.27 2026-03-31
J2505 HCPCS Pegfilgrastim (neulasta Syr[6mg\0.6ml]## 10 9 $15,232.75 $9,139.65 40% off $2,177.20 $13,709.48 $6,032.17 2026-03-31
J1162 HCPCS Digoxin Immune Fab Inj [40mg] (digifab)* 10 9 $15,020.00 $15,020.00 $540.91 $14,476.54 $5,947.92 2026-03-31
C1777 HCPCS Lead Aicd Endo Sing Col 8 7 $12,000.00 $12,000.00 $4,704.00 $10,800.00 $4,980.00 2026-03-31
J0840 HCPCS Crotalidae Polyva Immune Fab(crofab)vial 9 8 $11,740.00 $11,740.00 $1,789.99 $5,908.62 $4,696.00 2026-03-31
Q4196 HCPCS Puraply Am 25 Sq Cm 23 8 $10,688.00 $10,688.00 $107.12 $11,542.50 $4,189.70 2026-03-31
J1306 HCPCS Inclisiran (leqvio) Inj [284mg/1.5ml] 10 9 $9,750.00 $9,750.00 $12.44 $4,875.00 $3,822.00 2026-03-31
47531 HCPCS Xr Cholangiogram T-tube 20 9 $8,855.00 $8,855.00 $250.00 $7,969.50 $3,506.58 2026-03-31
Q4197 HCPCS Puraply Xt 25 Sq Cm 16 8 $13,500.00 $13,500.00 $107.12 $6,750.00 $3,319.61 2026-03-31
Q4194 HCPCS Wc-novachor [1.5cmx2.75cm} 8 7 $8,125.00 $8,125.00 $107.12 $4,062.50 $3,217.50 2026-03-31
27087 HCPCS Sft Tiss Fb Remvl Lft Pelvis Or Hip Deep 30 9 $7,711.00 $7,711.00 $250.00 $6,939.90 $3,053.56 2026-03-31
29880 HCPCS Knee Arthroscopy 10 9 $7,711.00 $7,711.00 $297.00 $3,855.50 $3,025.03 2026-03-31
36555 HCPCS Central Line <5 Years 30 9 $7,593.00 $7,593.00 $93.28 $6,833.70 $3,006.83 2026-03-31
59409 HCPCS Vaginal Delivery 10 9 $7,447.00 $7,447.00 $363.00 $6,702.30 $2,949.01 2026-03-31
59414 HCPCS Delivery Of Placenta 10 9 $7,447.00 $7,447.00 $70.97 $6,702.30 $2,949.01 2026-03-31
J3111 HCPCS Romosozumab (evenity) Inj [210mg/2.34ml] 10 9 $7,382.13 $7,382.13 $9.09 $3,691.06 $2,893.79 2026-03-31
36556 HCPCS Pf Central Venous Line 31 9 $7,310.00 $7,310.00 $81.11 $6,833.70 $2,865.52 2026-03-31
49560 HCPCS Pf Hernia Incarcer Repair 14 9 $7,277.90 $7,277.90 $363.00 $6,550.11 $2,852.94 2026-03-31
J0630 HCPCS Calcitonin (miacalcin) Inj [400unit/2ml] 10 9 $7,047.25 $7,047.25 $40.46 $3,523.62 $2,790.71 2026-03-31
19120 HCPCS Removal Of Breast Lesion 15 9 $7,043.03 $7,043.03 $320.00 $6,338.73 $2,760.87 2026-03-31
0110 RC — 1 1 $1,000.00 $1,000.00 $2,719.00 $2,719.00 $2,719.00 2026-03-31
0120 RC — 1 1 $1,000.00 $1,000.00 $2,719.00 $2,719.00 $2,719.00 2026-03-31
0119 RC — 1 1 $1,000.00 $1,000.00 $2,719.00 $2,719.00 $2,719.00 2026-03-31
23333 HCPCS Soft Tiss Fb Remvl Lft Shldr Deep 30 9 $6,769.00 $6,769.00 $250.00 $6,092.10 $2,680.52 2026-03-31
24201 HCPCS Soft Tiss Fb Remvl Left Upper Arm Deep,left Side 30 9 $6,769.00 $6,769.00 $250.00 $6,092.10 $2,680.52 2026-03-31
27086 HCPCS Sft Tiss Fb Removal Left Pelvis Or Hip 30 9 $6,769.00 $6,769.00 $290.08 $6,092.10 $2,680.52 2026-03-31
58600 HCPCS Lap Tubal 10 9 $6,699.00 $6,699.00 $294.87 $3,349.50 $2,652.81 2026-03-31
56740 HCPCS Bartholin Gland-cyst 10 9 $6,699.00 $6,699.00 $250.33 $6,029.10 $2,652.81 2026-03-31
J3262 HCPCS Tocilizumab (actemra) Inj [400mg/20ml] 10 9 $6,730.00 $6,730.00 $5.07 $3,365.00 $2,638.16 2026-03-31
Q0249 HCPCS Tocilizumab (actemra) Inj [400mg/20ml] 10 9 $6,730.00 $6,730.00 $6.57 $3,365.00 $2,638.16 2026-03-31
20240 HCPCS Bone Biopsy - Excisional 10 9 $6,054.00 $6,054.00 $114.91 $3,027.00 $2,397.39 2026-03-31
19307 HCPCS Pf Mast Mod Rad 17 9 $2,563.00 $2,563.00 $363.00 $7,767.00 $2,306.70 2026-03-31
0275 RC — 16 7 $5,222.88 $5,222.88 $350.15 $8,597.25 $2,274.25 2026-03-31
Q4160 HCPCS Nushield 2 Sq Cm 58 8 $5,562.50 $5,562.50 $107.12 $8,586.00 $2,243.81 2026-03-31
Q4106 HCPCS Dermagraft 38 Sq Cm 10 9 $5,625.00 $5,625.00 $38.45 $2,812.50 $2,205.00 2026-03-31
Q4159 HCPCS Affinity 7 Sq Cm 16 8 $10,621.00 $10,621.00 $107.12 $5,310.50 $2,115.00 2026-03-31
Q5136 HCPCS Denosumab Bbdz (jubbonti) Inj [60mg/ml] 9 8 $4,600.00 $4,600.00 $27.67 $4,140.00 $1,840.00 2026-03-31
64635 HCPCS Destroy Lumb/sac Facet Jn 10 9 $4,484.00 $4,484.00 $297.00 $2,242.00 $1,775.66 2026-03-31
64633 HCPCS Destroy Cerv/thor Facet J 10 9 $4,484.00 $4,484.00 $250.00 $2,242.00 $1,775.66 2026-03-31
12047 HCPCS Intmd Rpr N-hf/genit >30 Cm 10 9 $4,374.00 $4,374.00 $297.00 $3,936.60 $1,732.11 2026-03-31
12037 HCPCS Intmd Rpr S/tr/ext >30 Cm 10 9 $4,374.00 $4,374.00 $250.00 $3,936.60 $1,732.11 2026-03-31
G0419 HCPCS Prostate Sat Biopsy > 60 8 7 $4,125.00 $4,125.00 $1,617.00 $3,712.50 $1,711.88 2026-03-31
32551 HCPCS Chest Tube Insertion 45 9 $4,078.00 $4,078.00 $127.81 $3,670.20 $1,598.58 2026-03-31
28635 HCPCS Disloc Toe Red Metatarsophalangeal 9 8 $3,829.00 $3,829.00 $153.39 $3,446.10 $1,531.60 2026-03-31
28192 HCPCS Soft Tissue Fb Remov Left Foot Deep 30 9 $3,862.00 $3,862.00 $250.00 $3,475.80 $1,529.35 2026-03-31
19281 HCPCS Mammogram Need/local Lt 30 9 $3,862.00 $3,862.00 $204.53 $3,475.80 $1,529.35 2026-03-31
23330 HCPCS Soft Tissue Fb Removal Lft Shoulder 30 9 $3,862.00 $3,862.00 $250.00 $3,475.80 $1,529.35 2026-03-31
25071 HCPCS Excision Tumor/forearm/wrist >3cm 10 9 $3,862.00 $3,862.00 $320.00 $3,475.80 $1,529.35 2026-03-31
28193 HCPCS Soft Tissue Fb Remov Left Foot Complicat 30 9 $3,862.00 $3,862.00 $297.00 $3,475.80 $1,529.35 2026-03-31
55100 HCPCS I&d Scrotal 20 9 $3,862.00 $3,862.00 $215.67 $3,475.80 $1,529.35 2026-03-31
24200 HCPCS Soft Tiss Fb Remvl Left Upper Arm 30 9 $3,862.00 $3,862.00 $208.77 $3,475.80 $1,529.35 2026-03-31
33016 HCPCS Pericardiocentesis 9 8 $3,815.00 $3,815.00 $180.45 $3,433.50 $1,526.00 2026-03-31
27842 HCPCS Disloc Ankle Reduction Left W Sedation,left Side 30 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
23605 HCPCS Clsd Fx Red Prox Humeral 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
24605 HCPCS Elbow Disloc Red W Sedation Left 30 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
27818 HCPCS Clsd Fx Red Trimalleolar 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
27768 HCPCS Clsd Fx Red Posterior Malleolus 10 9 $3,829.00 $3,829.00 $297.00 $3,446.10 $1,516.28 2026-03-31
24505 HCPCS Cls Fx Red Humeral Shaft 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
26418 HCPCS Wound Repair Tendon - Finger 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
27510 HCPCS Clsd Fx Red Femoral 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
24655 HCPCS Clsd Fx Red Radial Head 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
27252 HCPCS Dislocated Traum Lft Hip Reduc W Anesth,left Side 30 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
27781 HCPCS Clsd Fx Red Proximal Fibular 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
24535 HCPCS Cls Fx Red Supracondylar 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
27762 HCPCS Clsd Fx Red Medial Malleolus 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
27810 HCPCS Clsd Fx Red Bimalleolar 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
25605 HCPCS Clsd Fx Red Distal Radial 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
25565 HCPCS Clsd Fx Red Rad & Ulnar Shaft 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
25505 HCPCS Clsd Fx Red Radial Shift 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
25111 HCPCS Excision Ganglion Cyst Of Wrist 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
27552 HCPCS Lft Knee Disloc Red W Sedation 30 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
23655 HCPCS Disloc Left Shlder Reduc W Sedation 30 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
23505 HCPCS Clsd Fx Reduction Clavicular 10 9 $3,829.00 $3,829.00 $297.00 $3,446.10 $1,516.28 2026-03-31
26410 HCPCS Wound Repair Tendon - Hand 10 9 $3,829.00 $3,829.00 $297.00 $3,446.10 $1,516.28 2026-03-31
27825 HCPCS Clsd Fx Red Wt Bear Articular Distal Tib 10 9 $3,829.00 $3,829.00 $297.00 $3,446.10 $1,516.28 2026-03-31
27502 HCPCS Clsd Fx Red Femoral Shaft 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
27752 HCPCS Clsd Fx Red Tibial Shaft 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
24675 HCPCS Clsd Fx Red Ulnar 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
27266 HCPCS Dislocated Hip Reduct W Sedation Post Hi 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
27257 HCPCS Dislocated Spont Lt Hip Reduc W Anesth 30 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
26705 HCPCS Dislocated Finger Red W Sedation 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
27503 HCPCS Clsd Fx Red Supracondylar 10 9 $3,829.00 $3,829.00 $250.00 $3,446.10 $1,516.28 2026-03-31
75820 HCPCS Xr Venogram Lt Ext 36 8 $3,815.00 $3,815.00 $93.95 $1,907.50 $1,495.48 2026-03-31
J0897 HCPCS Denosumab (prolia) Inj [60mg/ml] 10 9 $3,743.00 $3,743.00 $14.43 $1,871.50 $1,467.26 2026-03-31
10121 HCPCS Pf Removal Foreign Body 41 9 $3,593.00 $3,593.00 $155.02 $3,475.80 $1,437.20 2026-03-31
G0418 HCPCS Prostate Sat Biopsy 41-60 8 7 $3,435.00 $3,435.00 $1,346.52 $3,091.50 $1,425.53 2026-03-31
38221 HCPCS Bone Marrow Biospy 10 9 $3,593.00 $3,593.00 $145.12 $1,796.50 $1,422.83 2026-03-31
38220 HCPCS Bone Marrow Aspirat 10 9 $3,593.00 $3,593.00 $145.54 $1,796.50 $1,422.83 2026-03-31
20220 HCPCS Bone Biopsy - Needle 10 9 $3,593.00 $3,593.00 $193.34 $1,796.50 $1,422.83 2026-03-31
43246 HCPCS Pf Peg Tube Placement 31 9 $3,568.48 $3,568.48 $160.19 $3,211.63 $1,398.84 2026-03-31
11643 HCPCS Pf Excision Mal Le 2.1-3.0 15 9 $3,370.00 $3,370.00 $199.33 $3,033.00 $1,321.04 2026-03-31
J1301 HCPCS Edaravone (radicava) 30mg/100ml X 2 Bags 9 8 $3,044.00 $3,044.00 $1,193.25 $3,044.00 $1,308.92 2026-03-31
G0390 HCPCS Trauma Team Activation 7 6 $3,262.00 $3,262.00 $1,278.70 $1,631.00 $1,304.80 2026-03-31
43840 HCPCS Pf Repair Of Stomach Lesion 13 9 $3,090.00 $3,090.00 $682.00 $2,781.00 $1,211.28 2026-03-31
0969 RC — 7 6 $2,727.30 $2,727.30 $1,069.10 $2,454.57 $1,200.01 2026-03-31
49657 HCPCS Pf Laparscopy Incar Or Strangulation 14 9 $2,997.00 $2,997.00 $363.00 $2,697.30 $1,198.62 2026-03-31
J1561 HCPCS Immune Globulin 10% 10gm 100ml (gamunex) 17 9 $2,677.00 $2,677.00 $32.88 $2,676.50 $1,177.88 2026-03-31
C8908 HCPCS MRI Breast Bil Wo &/or W 8 7 $2,665.00 $2,665.00 $1,044.68 $2,398.50 $1,105.97 2026-03-31
49618 HCPCS Pf Rpr Ant Abd Hernia >10cm, Incar/stran 14 9 $2,788.00 $2,788.00 $363.00 $2,509.20 $1,104.05 2026-03-31
72130 HCPCS CT Spine Thoracic Wo/w 10 9 $2,760.00 $2,760.00 $171.45 $1,380.00 $1,081.92 2026-03-31
J1745 HCPCS Infliximab (remicade) [100mg] 10 9 $2,744.00 $2,744.00 $31.77 $1,372.00 $1,075.65 2026-03-31
J1459 HCPCS Immune Globulin 10% Vl [10gm] 100ml 17 9 $2,410.00 $2,410.00 $34.15 $4,820.25 $1,060.40 2026-03-31
77049 HCPCS MRI Breast Bil Wo &/or W 20 9 $2,665.00 $2,665.00 $265.63 $1,332.50 $1,044.68 2026-03-31
95811 HCPCS Pf Polysom 6/>yrs Cpap 4/>pa 18 9 $2,350.00 $2,350.00 $205.37 $1,250.00 $980.00 2026-03-31
95810 HCPCS Pf Polysom 6/>yrs 4/>param 18 9 $2,350.00 $2,350.00 $122.00 $1,245.50 $976.47 2026-03-31
0360 RC — 58 7 $2,279.80 $2,279.80 $114.52 $2,644.00 $973.04 2026-03-31
10140 HCPCS Wc Pf I&d Hematoma Seroma 29 9 $2,475.09 $2,475.09 $67.14 $3,233.70 $970.24 2026-03-31
49653 HCPCS Pf Lap Vent/abd Hern Proc Comp 21 9 $2,181.00 $2,181.00 $363.00 $6,460.00 $959.64 2026-03-31
65435 HCPCS Foreign Body Rmvl Eye Epithelium 10 9 $2,412.00 $2,412.00 $73.66 $2,170.80 $955.15 2026-03-31
47600 HCPCS Pf Cholecystectomy 13 9 $2,431.00 $2,431.00 $880.22 $2,187.90 $952.95 2026-03-31
73723 HCPCS MRI L Ext Rt W/wo Joint 30 9 $2,420.00 $2,420.00 $329.10 $1,210.00 $950.80 2026-03-31
72158 HCPCS MRI Lspine W/wo Cont 10 9 $2,420.00 $2,420.00 $276.45 $1,210.00 $948.64 2026-03-31
70553 HCPCS MRI Brain W/wo Contr 10 9 $2,420.00 $2,420.00 $275.32 $1,210.00 $948.64 2026-03-31
74182 HCPCS MRI Abdomen W/contra 10 9 $2,420.00 $2,420.00 $259.23 $1,210.00 $948.64 2026-03-31
72156 HCPCS MRI Cspine W/wo Cont 10 9 $2,420.00 $2,420.00 $276.17 $1,210.00 $948.64 2026-03-31
J2407 HCPCS Oritavancin (orbactiv) Inj 400mg 10 9 $2,380.00 $2,380.00 $25.62 $1,190.00 $932.96 2026-03-31
C8914 HCPCS MRA Lower Ext W/wo 8 7 $2,200.00 $2,200.00 $862.40 $1,980.00 $913.00 2026-03-31
C8902 HCPCS MRA Abdomen Wo Or W 8 7 $2,200.00 $2,200.00 $862.40 $1,980.00 $913.00 2026-03-31
C8920 HCPCS MRA Pelvis Wo Or W 8 7 $2,200.00 $2,200.00 $862.40 $1,980.00 $913.00 2026-03-31
73720 HCPCS MRI Lo Ext Rt W/wo Cont 20 9 $2,310.00 $2,310.00 $290.02 $1,210.00 $913.00 2026-03-31
49596 HCPCS Pf Hernia Rpr <10cm, Incar/strang Init 14 9 $2,302.00 $2,302.00 $363.00 $2,071.80 $911.59 2026-03-31
J0248 HCPCS Remdesivir Inj [100mg] 10 9 $2,285.50 $2,285.50 $5.51 $1,142.75 $895.92 2026-03-31
70487 HCPCS CT Maxillo Facial W/contr 10 9 $2,250.00 $2,250.00 $131.72 $1,125.00 $882.00 2026-03-31
72197 HCPCS MRI Pelvis W/wo Cont 10 9 $2,200.00 $2,200.00 $289.58 $1,100.00 $871.20 2026-03-31
71552 HCPCS MRI Chest W/wo Contr 10 9 $2,200.00 $2,200.00 $366.59 $1,100.00 $871.20 2026-03-31
74183 HCPCS MRI Abdomen W/wo Con 10 9 $2,200.00 $2,200.00 $290.98 $1,100.00 $871.20 2026-03-31
70543 HCPCS MRI Orbit/face/neck W/wo 10 9 $2,200.00 $2,200.00 $291.71 $1,100.00 $871.20 2026-03-31
46040 HCPCS Pf I&d Of Abscess 33 9 $2,811.00 $2,811.00 $250.00 $2,529.90 $869.40 2026-03-31
46608 HCPCS Anoscopy W Removal Fb 10 9 $2,178.00 $2,178.00 $250.00 $1,960.20 $862.49 2026-03-31
72157 HCPCS MRI Tspine W/wo Cont 10 9 $2,200.00 $2,200.00 $276.73 $1,100.00 $862.40 2026-03-31
70552 HCPCS MRI Brain W/contrast 10 9 $2,200.00 $2,200.00 $233.02 $1,100.00 $862.40 2026-03-31
72196 HCPCS MRI Pelvis W/contras 10 9 $2,200.00 $2,200.00 $232.23 $1,100.00 $862.40 2026-03-31
72142 HCPCS MRI Cspine W/contras 10 9 $2,200.00 $2,200.00 $237.02 $1,100.00 $862.40 2026-03-31
72147 HCPCS MRI Tspine W/contras 10 9 $2,200.00 $2,200.00 $234.99 $1,100.00 $862.40 2026-03-31
74185 HCPCS MRA Abdomen Wo Or W 10 9 $2,200.00 $2,200.00 $280.59 $1,100.00 $862.40 2026-03-31
73222 HCPCS MRI Lt Upper Ex Jt Wo/w 30 9 $2,200.00 $2,200.00 $269.24 $1,100.00 $862.40 2026-03-31
72149 HCPCS MRI Lspine W/contras 10 9 $2,200.00 $2,200.00 $233.59 $1,100.00 $862.40 2026-03-31
72198 HCPCS MRA Pelvis Wo Or W 10 9 $2,200.00 $2,200.00 $279.25 $1,100.00 $862.40 2026-03-31
73220 HCPCS MRI Up Rt Ext W/wo Cont 30 9 $2,200.00 $2,200.00 $350.36 $1,100.00 $862.40 2026-03-31
71551 HCPCS MRI Chest W/contrast 10 9 $2,200.00 $2,200.00 $319.12 $1,100.00 $862.40 2026-03-31
73725 HCPCS MRA Lower Ext W/wo 20 9 $2,200.00 $2,200.00 $278.91 $1,100.00 $862.40 2026-03-31
70549 HCPCS MRA Neck Wo Or W 10 9 $2,200.00 $2,200.00 $295.71 $1,100.00 $862.40 2026-03-31
70548 HCPCS MRA Neck W/contrast 10 9 $2,200.00 $2,200.00 $212.16 $1,100.00 $862.40 2026-03-31
64421 HCPCS Xr Intercostal Nerves Regional Block; Mu 10 9 $2,172.00 $2,172.00 $31.22 $1,954.80 $860.11 2026-03-31
49083 HCPCS Abdominal Paracentesis W Imag Guide 10 9 $2,160.00 $2,160.00 $245.91 $1,944.00 $855.36 2026-03-31
49084 HCPCS Peritoneal Lavage 10 9 $2,160.00 $2,160.00 $84.52 $1,944.00 $855.36 2026-03-31
64490 HCPCS Inj Paravert F Jnt CT 1le 18 9 $1,825.84 $1,825.84 $178.90 $1,954.80 $851.42 2026-03-31
49561 HCPCS Pf Hernia Repair Incar/strangulated 14 9 $2,112.00 $2,112.00 $363.00 $1,900.80 $844.75 2026-03-31
G0417 HCPCS Prostate Sat Biopsy 21-40 8 7 $2,013.00 $2,013.00 $789.10 $1,811.70 $835.39 2026-03-31
99291 HCPCS Critical Care 20 9 $2,114.00 $2,114.00 $51.00 $1,057.00 $828.69 2026-03-31
49615 HCPCS Pf Rpr Ant Abd Hernia 3-10cm, Reduc Recu 14 9 $2,112.00 $2,112.00 $363.00 $1,900.80 $827.90 2026-03-31
49613 HCPCS Pf Rpr Ant Abd Hernia <3cm, Reduc Recurr 14 9 $2,112.00 $2,112.00 $338.31 $1,900.80 $827.90 2026-03-31
49595 HCPCS Pf Hernia Rpr >10cm, Reduc Init 14 9 $2,112.00 $2,112.00 $363.00 $1,900.80 $827.90 2026-03-31
49592 HCPCS Pf Hernia Rpr <3 Cm, Incar/strang Init 14 9 $2,112.00 $2,112.00 $363.00 $1,900.80 $827.90 2026-03-31
49617 HCPCS Pf Rpr Ant Abd Hernia >10cm, Reduc Recur 14 9 $2,112.00 $2,112.00 $363.00 $1,900.80 $827.90 2026-03-31
49616 HCPCS Pf Rpr Ant Abd Hernia 3-10cm, Incar/stra 22 9 $2,112.00 $2,112.00 $363.00 $1,900.80 $827.90 2026-03-31
J0881 HCPCS Darbepoetin (aranesp] Inj [100mcg/0.5ml# 31 9 $2,168.00 $1,300.80 40% off $2.96 $2,152.25 $818.40 2026-03-31
88309 HCPCS Tissue Exam By Pathologis 10 9 $2,049.00 $2,049.00 $46.00 $1,024.50 $803.21 2026-03-31
0361 RC — 8 7 $1,997.17 $1,997.17 $250.00 $998.59 $790.88 2026-03-31
81420 HCPCS Qnatal Advanced 10 9 $1,898.00 $1,898.00 $743.87 $985.80 $787.67 2026-03-31
44960 HCPCS Pf Appendectomy Tube 13 9 $1,997.00 $1,997.00 $697.40 $1,797.30 $782.82 2026-03-31
70551 HCPCS MRI Brain Without Contra 10 9 $1,980.00 $1,980.00 $170.01 $990.00 $776.16 2026-03-31
72195 HCPCS MRI Pelvis Without Contr 10 9 $1,980.00 $1,980.00 $197.02 $990.00 $776.16 2026-03-31
72146 HCPCS MRI Tspine Without Contr 10 9 $1,980.00 $1,980.00 $165.79 $990.00 $776.16 2026-03-31
72148 HCPCS MRI Lspine Without Contr 10 9 $1,980.00 $1,980.00 $166.91 $990.00 $776.16 2026-03-31
70544 HCPCS MRA Head Without Contras 10 9 $1,980.00 $1,980.00 $185.07 $990.00 $776.16 2026-03-31
70547 HCPCS MRA Neck Without Contras 10 9 $1,980.00 $1,980.00 $185.07 $990.00 $776.16 2026-03-31
74181 HCPCS MRI Abdomen Without Cont 10 9 $1,980.00 $1,980.00 $168.62 $990.00 $776.16 2026-03-31
70336 HCPCS MRI Of Tmj's 10 9 $1,980.00 $1,980.00 $223.73 $990.00 $776.16 2026-03-31
73718 HCPCS MRI Lo Rt Ext Without Contr 30 9 $1,980.00 $1,980.00 $192.34 $990.00 $776.16 2026-03-31
44110 HCPCS Pf Ex 1 Or More Lesions Of Sm/lg Intesti 13 9 $1,935.00 $1,935.00 $698.54 $1,741.50 $774.00 2026-03-31
46050 HCPCS Pf I&d, Perianal Abscess 23 9 $1,775.00 $1,775.00 $85.76 $1,960.20 $763.25 2026-03-31
49594 HCPCS Pf Hernia Rpr 3-10cm, Incar/strang Init 22 9 $2,112.00 $2,112.00 $363.00 $1,900.80 $760.67 2026-03-31
57500 HCPCS Biopsy Of Cervix 10 9 $1,915.00 $1,915.00 $130.41 $1,723.50 $758.34 2026-03-31
C1898 HCPCS Tendril Leads U Pr 8 7 $1,800.00 $1,800.00 $705.60 $1,620.00 $747.00 2026-03-31
36561 HCPCS Pf Insert Cv Cath W/subq Port 36 9 $900.00 $900.00 $295.18 $5,608.66 $745.47 2026-03-31
27590 HCPCS Pf Amputation Above Knee 8 7 $1,875.00 $1,875.00 $630.84 $1,687.50 $742.50 2026-03-31
93306 HCPCS US Echo Complete 10 9 $1,888.95 $1,888.95 $171.26 $944.48 $740.47 2026-03-31
64493 HCPCS Inj Paravert F Jnt L/s 1l 10 9 $1,825.84 $1,825.84 $165.52 $912.92 $723.04 2026-03-31
62310 HCPCS Inj Spine Cerv/thoracic 8 7 $1,825.84 $1,825.84 $297.00 $912.92 $723.04 2026-03-31
71270 HCPCS CT Chest Wo/w Contra 10 9 $1,803.25 $1,803.25 $169.38 $901.62 $706.87 2026-03-31
70540 HCPCS MRI Orbit/face/neck Without 10 9 $1,800.00 $1,800.00 $194.03 $900.00 $705.60 2026-03-31
72141 HCPCS MRI Cspine Without Contr 10 9 $1,800.00 $1,800.00 $166.07 $900.00 $705.60 2026-03-31
71550 HCPCS MRI Chest Without Contra 10 9 $1,800.00 $1,800.00 $223.73 $900.00 $705.60 2026-03-31
73218 HCPCS MRI Up Rt Ext Without Contr 30 9 $1,800.00 $1,800.00 $223.73 $900.00 $705.60 2026-03-31
73721 HCPCS MRI Joint Lt Low Ext Without 30 9 $1,800.00 $1,800.00 $177.15 $900.00 $705.60 2026-03-31
73221 HCPCS MRI Joint Lt Up Ext Without 30 9 $1,800.00 $1,800.00 $177.72 $900.00 $705.60 2026-03-31
51860 HCPCS Cystorrhaphy, Rpr Of Bladder Wound; Simp 14 9 $1,788.78 $1,788.78 $297.00 $1,609.90 $701.20 2026-03-31
49565 HCPCS Pf Repair Incisional Hernia 14 9 $1,747.00 $1,747.00 $363.00 $1,572.30 $698.67 2026-03-31
38760 HCPCS Radical Lymphadenctomy 14 9 $1,650.00 $1,650.00 $320.00 $1,485.00 $692.39 2026-03-31
49652 HCPCS Pf Lap, Surgical, Repair, Ventral Umbili 14 9 $1,690.00 $1,690.00 $363.00 $1,521.00 $676.00 2026-03-31
85097 HCPCS Bone Marrow Interpretatio 9 8 $1,674.00 $1,674.00 $60.76 $837.00 $669.60 2026-03-31
90935 HCPCS Hemodialysis Procedu 9 8 $1,673.00 $1,673.00 $57.48 $1,505.70 $669.20 2026-03-31
28190 HCPCS Soft Tissue Fb Remov Left Foot 30 9 $1,676.00 $1,676.00 $208.28 $1,508.40 $663.69 2026-03-31
19285 HCPCS US Lt Breast Localization 20 9 $1,676.00 $1,676.00 $250.00 $1,508.40 $663.69 2026-03-31
88333 HCPCS Cytology Touch Prep Initi 10 9 $1,674.00 $1,674.00 $19.50 $837.00 $662.90 2026-03-31
88319 HCPCS Enzyme Histochemistry 10 9 $1,674.00 $1,674.00 $9.38 $837.00 $662.90 2026-03-31
88362 HCPCS Nerve Teasing Preparation 10 9 $1,674.00 $1,674.00 $75.76 $837.00 $662.90 2026-03-31
11604 HCPCS Exc Tr-ext Mal+marg 3.1-4 Cm 10 9 $1,676.00 $1,676.00 $250.00 $838.00 $658.51 2026-03-31
11642 HCPCS Pf Exc F/e/e/n/l Mal+marg 1.1-2 23 9 $1,555.00 $1,555.00 $159.36 $1,508.40 $656.99 2026-03-31
10080 HCPCS I&d Pilonidal 33 9 $1,676.00 $1,676.00 $65.83 $1,508.40 $656.99 2026-03-31
62270 HCPCS Lumbar Puncture 11 9 $1,648.00 $1,648.00 $141.13 $1,483.20 $655.31 2026-03-31
20606 HCPCS Arthrocentesis W/us Guide 20 9 $1,648.00 $1,648.00 $82.47 $1,483.20 $652.61 2026-03-31
64420 HCPCS Xr Intercostal Nerves Regional Block; Si 20 9 $1,648.00 $1,648.00 $92.96 $1,483.20 $652.61 2026-03-31
64450 HCPCS Dig Nve Block Finger/toe 20 9 $1,648.00 $1,648.00 $70.63 $1,483.20 $652.61 2026-03-31
47563 HCPCS Pf Laparo, Surg; Cholestyectomy With Chola 14 9 $1,634.00 $1,634.00 $363.00 $1,470.60 $647.07 2026-03-31
28805 HCPCS Pf Amputation Of Foot 14 9 $1,648.00 $1,648.00 $297.00 $1,483.20 $646.02 2026-03-31
56605 HCPCS Vulva Biopsy 10 9 $1,619.00 $1,619.00 $81.53 $1,457.10 $641.12 2026-03-31
27596 HCPCS Pf Reamputation Thigh Thrh Femur 8 7 $1,545.00 $1,545.00 $576.69 $1,390.50 $640.60 2026-03-31
52000 HCPCS Cystoscope 10 9 $1,628.00 $1,628.00 $186.27 $814.00 $638.18 2026-03-31
27598 HCPCS Pf Disarticulation At Knee 13 9 $1,588.00 $1,588.00 $563.66 $1,429.20 $635.20 2026-03-31
47562 HCPCS Pf Wc Lap Chole 42 9 $1,481.00 $1,481.00 $215.60 $6,872.00 $634.12 2026-03-31
73202 HCPCS CT Ext Rt Upper Wo/w 30 9 $1,600.00 $1,600.00 $162.00 $800.00 $627.20 2026-03-31
93975 HCPCS US Doppler Arterial Abd 10 9 $1,600.00 $1,600.00 $91.00 $800.00 $627.20 2026-03-31
73702 HCPCS CT Lower Lt Ext Wo/o 30 9 $1,600.00 $1,600.00 $162.00 $800.00 $627.20 2026-03-31
43830 HCPCS Pf Place Gastrostomy Tube 14 9 $1,599.00 $1,599.00 $297.00 $1,439.10 $626.81 2026-03-31
32555 HCPCS Thoracentesis W Image Guide 10 9 $1,577.00 $1,577.00 $250.00 $1,419.30 $624.49 2026-03-31
26951 HCPCS Pf Amputation Of Finger/thumb 14 9 $1,582.00 $1,582.00 $250.00 $1,423.80 $620.14 2026-03-31
92961 HCPCS Cardioversion Internal 10 9 $1,551.00 $1,551.00 $51.00 $1,395.90 $614.19 2026-03-31
92953 HCPCS Temp Transcutaneous Pacing- External Pac 10 9 $1,551.00 $1,551.00 $0.77 $1,395.90 $614.19 2026-03-31
74178 HCPCS CT Abd/pelvis W/wo 10 9 $1,550.00 $1,550.00 $272.95 $775.00 $607.60 2026-03-31
72194 HCPCS CT Pelvis Wo/w 10 9 $1,549.30 $1,549.30 $174.94 $774.65 $607.33 2026-03-31
G0379 HCPCS Observation Direct Admit 8 7 $1,530.00 $1,530.00 $520.29 $765.00 $605.88 2026-03-31
99285 HCPCS ER Level 5 Mod 25,same-day Significant, Separately Identifiable E/m Service 20 9 $1,530.00 $1,530.00 $51.00 $765.00 $599.76 2026-03-31
26990 HCPCS Pf I&d Pelvis/ Hip Joint Deep Abs 9 8 $1,485.00 $1,485.00 $297.00 $1,336.50 $594.00 2026-03-31
13120 HCPCS Cmplx Rpr S/a/l 1.1-2.5 Cm 10 9 $1,496.00 $1,496.00 $305.78 $1,346.40 $592.41 2026-03-31
13100 HCPCS Cmplx Rpr Trunk 1.1-2.5 Cm 10 9 $1,496.00 $1,496.00 $250.00 $1,346.40 $592.41 2026-03-31
12036 HCPCS Intmd Rpr S/tr/ext 20.1-30 Cm 10 9 $1,496.00 $1,496.00 $297.00 $1,346.40 $592.41 2026-03-31
12020 HCPCS Closure Of Split Wound 10 9 $1,496.00 $1,496.00 $250.00 $1,346.40 $592.41 2026-03-31
11760 HCPCS Repair Nail Bed 10 9 $1,496.00 $1,496.00 $162.38 $1,346.40 $592.41 2026-03-31
70491 HCPCS CT Neck W/c 10 9 $1,502.45 $1,502.45 $159.58 $751.22 $588.96 2026-03-31
74177 HCPCS CT Abd-pelvis W/c 10 9 $1,500.00 $1,500.00 $206.27 $750.00 $588.00 2026-03-31
74175 HCPCS CT Angio Abd 10 9 $1,500.00 $1,500.00 $174.94 $750.00 $588.00 2026-03-31
19301 HCPCS Pf Masectomy Partial 14 9 $1,498.00 $1,498.00 $320.00 $1,348.20 $587.22 2026-03-31
94002 HCPCS Vent Initial 9 8 $1,493.00 $1,493.00 $79.42 $746.50 $585.26 2026-03-31
49593 HCPCS Pf Hernia Rpr 3-10cm, Reduc Init 22 9 $2,112.00 $2,112.00 $363.00 $1,900.80 $584.37 2026-03-31
27880 HCPCS Amputation Leg Through Tibia/fibula 10 9 $1,408.00 $1,408.00 $297.00 $1,267.20 $584.32 2026-03-31
49614 HCPCS Pf Rpr Ant Abd Hernia <3cm, Incar/strang 22 9 $2,112.00 $2,112.00 $363.00 $1,900.80 $580.14 2026-03-31
49520 HCPCS Pf Hernia Repair Recurrent;any Age 22 9 $1,441.00 $1,441.00 $363.00 $1,296.90 $571.20 2026-03-31
10021 HCPCS Fna Without Imaging 10 9 $1,432.00 $1,432.00 $87.96 $1,288.80 $567.07 2026-03-31
44970 HCPCS Pf Laparoscopy, Surgical, Appendectomy 20 9 $1,369.00 $1,369.00 $363.00 $1,293.30 $566.92 2026-03-31
11772 HCPCS Pf Pilonidal Cyst Complicated 23 9 $1,314.00 $1,314.00 $320.00 $1,182.60 $565.02 2026-03-31
C8905 HCPCS MRI Breast Lt Wo &/or W C 8 7 $1,361.49 $1,361.49 $533.71 $1,225.34 $565.02 2026-03-31
92960 HCPCS Cardioversion 18 9 $1,025.45 $1,025.45 $76.00 $1,395.90 $560.36 2026-03-31
64491 HCPCS Inj Paravert Jct C/t 2lev 9 8 $1,426.70 $1,426.70 $89.74 $713.35 $559.27 2026-03-31
64492 HCPCS Inj Paravert F Jnt C/t 3l 9 8 $1,426.70 $1,426.70 $90.24 $713.35 $559.27 2026-03-31
64494 HCPCS Inj Paravert F Jnt L/s 2l 9 8 $1,426.70 $1,426.70 $84.32 $713.35 $559.27 2026-03-31
64495 HCPCS Inj Paravert F Jnt L/s 3l 9 8 $1,426.70 $1,426.70 $86.85 $713.35 $559.27 2026-03-31
71250 HCPCS CT Chest Without Con 12 9 $1,423.30 $1,423.30 $107.60 $711.65 $557.93 2026-03-31
88348 HCPCS Electron Microscopy 10 9 $1,395.00 $1,395.00 $168.00 $800.27 $552.42 2026-03-31
81220 HCPCS Cystic Fibrosis Screen 10 9 $1,392.00 $1,392.00 $372.00 $696.00 $551.23 2026-03-31
70470 HCPCS CT Head Wo/w Contras 10 9 $1,402.50 $1,402.50 $150.36 $701.25 $549.78 2026-03-31
70492 HCPCS CT Neck Wo/w 10 9 $1,402.50 $1,402.50 $142.00 $701.25 $549.78 2026-03-31
70482 HCPCS CT Post. Fossa Wo/w 10 9 $1,402.50 $1,402.50 $174.94 $701.25 $549.78 2026-03-31
70488 HCPCS CT Maxillofacial Wo/w 10 9 $1,400.00 $1,400.00 $159.64 $700.00 $548.80 2026-03-31
72133 HCPCS CT Lumbar Spine Wo/w 10 9 $1,400.00 $1,400.00 $170.32 $700.00 $548.80 2026-03-31
72132 HCPCS CT Lumbar Spine With Con 10 9 $1,400.00 $1,400.00 $146.47 $700.00 $548.80 2026-03-31
49250 HCPCS Pf Excision Of Umbilicus 14 9 $1,389.80 $1,389.80 $250.00 $1,250.82 $544.80 2026-03-31
77048 HCPCS MRI Breast Lt Wo &/or W C 30 9 $1,361.49 $1,361.49 $266.64 $680.75 $533.71 2026-03-31
Q5103 HCPCS Infliximab (inflectra) Inj [100mg] 10 9 $1,357.00 $1,357.00 $23.74 $678.50 $531.94 2026-03-31
12044 HCPCS Pf Lac Rep 7.6-12.5 Cm 23 9 $1,208.00 $1,208.00 $151.85 $1,346.40 $531.52 2026-03-31
74176 HCPCS CT Abd Pelvis Wo 10 9 $1,350.00 $1,350.00 $108.30 $675.00 $529.20 2026-03-31
45384 HCPCS Pf Colonoscope W/removal 16 9 $1,350.00 $1,350.00 $210.09 $1,215.00 $529.20 2026-03-31
49507 HCPCS Pf Inguinal Hernia Repair 14 9 $1,335.00 $1,335.00 $363.00 $1,201.50 $528.66 2026-03-31
49505 HCPCS Pf Inguinal Hernia Repair Initial 22 9 $1,500.00 $1,500.00 $363.00 $1,350.00 $528.45 2026-03-31
72131 HCPCS CT Lumbar Spine Wo 10 9 $1,335.85 $1,335.85 $107.60 $667.92 $523.65 2026-03-31
70490 HCPCS CT Neck Wo 10 9 $1,335.85 $1,335.85 $107.60 $667.92 $523.65 2026-03-31
72125 HCPCS CT Spine Cervicalw/o 10 9 $1,335.85 $1,335.85 $107.60 $667.92 $523.65 2026-03-31
71260 HCPCS CT Chest With Contra 10 9 $1,335.85 $1,335.85 $144.51 $667.92 $523.65 2026-03-31
72128 HCPCS CT Spine Thoracicw/o 10 9 $1,335.85 $1,335.85 $107.60 $667.92 $523.65 2026-03-31
70460 HCPCS CT Head With Contras 10 9 $1,333.85 $1,333.85 $128.91 $666.92 $522.87 2026-03-31
64636 HCPCS Destroy L/s Facet Jnt Add 9 8 $1,325.84 $1,325.84 $215.70 $662.92 $519.73 2026-03-31
40805 HCPCS Soft Tiss Fb Remov Vestibule Complicated 10 9 $1,311.00 $1,311.00 $250.00 $1,179.90 $519.15 2026-03-31
21931 HCPCS Excision Tumor Back Subq <3cm 22 9 $1,103.08 $1,103.08 $320.00 $3,475.80 $518.45 2026-03-31
76080 HCPCS Xr Sinus Tract 18 8 $1,315.00 $1,315.00 $51.37 $657.50 $515.48 2026-03-31
76098 HCPCS Mammo Surgical Specimen 10 9 $1,315.00 $1,315.00 $14.00 $657.50 $515.48 2026-03-31
0278 RC — 16 7 $1,222.50 $1,222.50 $52.92 $2,079.00 $513.51 2026-03-31
72193 HCPCS CT Pelvis With Contr 10 9 $1,307.75 $1,307.75 $174.94 $653.88 $512.64 2026-03-31
70498 HCPCS CTA Of Neck 10 9 $1,300.00 $1,300.00 $174.94 $650.00 $509.60 2026-03-31
70496 HCPCS CTA Of Head With Contrast 10 9 $1,300.00 $1,300.00 $174.94 $650.00 $509.60 2026-03-31
22900 HCPCS Pf Exc Abdl Tum Deep <5 Cm 14 9 $1,273.00 $1,273.00 $250.00 $1,145.70 $499.02 2026-03-31
J1410 HCPCS Estrogen Conjugated(premarin) Inj [25mg] 10 9 $1,222.00 $1,222.00 $3.68 $1,127.67 $483.91 2026-03-31
72192 HCPCS CT Pelvis Wo/contras 10 9 $1,226.40 $1,226.40 $107.60 $613.20 $480.75 2026-03-31
93307 HCPCS US Echo/2d 10 9 $1,217.00 $1,217.00 $76.00 $608.50 $477.06 2026-03-31
94003 HCPCS Vent Subsequent Day 16 8 $836.90 $836.90 $54.74 $746.50 $473.45 2026-03-31
12046 HCPCS Lac Rep 20.1-30 Cm 24 9 $480.00 $480.00 $188.16 $1,346.40 $473.06 2026-03-31
74174 HCPCS CT Angio (cta) Asb Pelvis 10 9 $1,200.00 $1,200.00 $326.58 $600.00 $470.40 2026-03-31
57421 HCPCS Colposcopy Vagina 10 9 $1,169.00 $1,169.00 $158.44 $1,052.10 $462.93 2026-03-31
J7302 HCPCS Levonorgestrel Lup, 52mg 8 7 $1,100.00 $1,100.00 $431.20 $990.00 $456.50 2026-03-31
M0249 HCPCS Adm Tocilizu Covid-19 1st Dose 8 7 $1,127.00 $1,127.00 $441.78 $563.50 $450.40 2026-03-31
M0243 HCPCS Casirivimab IV Infusion 8 7 $1,127.00 $1,127.00 $441.78 $563.50 $450.40 2026-03-31
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