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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

NELL J REDFIELD MEMORIAL HOSPITAL

Malad City, ID · CCN 131303 · Rates published

5,207 distinct procedures filed
14 distinct payers
80,718 rate rows
2026-06-10 last MRF observed
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbOneidaCounty&type=CDMWithoutLabel&fileType=CSV
Found on page https://www.oneidacountyhospital.com/cms-hpt.txt
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-13
Content fingerprint 79b60064c82d34c8… · 26,408,889 bytes · first seen 2026-08-01

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
J2350
HCPCS 		Injection, Ocrelizumab, 1 Mg 14 $37,159.75 $74,319.50 $60,198.79 nat. median
$133
outlier · 452.8×
J2327
HCPCS 		Injection, Risankizumab-rzaa, Intravenous, 1 Mg 14 $19,143.60 $38,287.20 $31,012.63 nat. median
$48
outlier · 646.4×
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 14 $15,605.85 $31,211.70 $25,281.47 nat. median
$59
outlier · 429.9×
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 14 $11,245.00 $22,490.00 $18,216.90 nat. median
$916
outlier · 19.9×
J9043
HCPCS 		Injection, Cabazitaxel, 1 Mg 14 $10,123.90 $20,247.80 $16,400.72 nat. median
$509
outlier · 32.2×
Q5108
HCPCS 		Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 14 $7,521.00 $15,042.00 $12,184.02 nat. median
$418
outlier · 29.2×
J9217
HCPCS 		Leuprolide Acetate (for Depot Suspension), 7.5 Mg 14 $6,743.40 $28,821.50 $11,704.33 nat. median
$2,144
outlier · 5.5×
04458044_1
CDM 		16 Ch Receiver Kit 3416 14 $7,189.25 $14,378.50 $11,646.58 —
J0565
HCPCS 		Injection, Bezlotoxumab, 10 Mg 14 $6,846.00 $13,692.00 $11,090.52 nat. median
$121
outlier · 92.0×
J0717
HCPCS 		Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm… 14 $6,324.25 $12,648.50 $10,245.28 nat. median
$29
outlier · 353.0×
J1306
HCPCS 		Injection, Inclisiran, 1 Mg 14 $6,003.15 $12,006.30 $9,725.10 nat. median
$25
outlier · 385.9×
90378
HCPCS 		Respiratory Syncytial Virus Antibody For Injection Into Tissue Or Muscle 14 $5,927.80 $11,855.60 $9,603.03 nat. median
$2,008
outlier · 4.8×
J9299
HCPCS 		Injection, Nivolumab, 1 Mg 14 $5,751.00 $11,502.00 $9,316.62 nat. median
$1,811
outlier · 5.1×
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 14 $167.22 $13,727.30 $9,025.70 nat. median
$498
outlier · 18.1×
81163
HCPCS 		Gene Analysis (breast Cancer 1 And 2) Of Full Sequence 14 $4,650.00 $43,524.00 $7,533.00 nat. median
$477
outlier · 15.8×
J9306
HCPCS 		Injection, Pertuzumab, 1 Mg 14 $4,445.95 $8,891.90 $7,202.44 nat. median
$43
outlier · 168.8×
C1764
HCPCS 		Event Recorder, Cardiac (implantable) 14 $3,971.25 $7,942.50 $6,433.43 nat. median
$7,993
0.8× median
J3358
HCPCS 		Ustekinumab, For Intravenous Injection, 1 Mg 14 $3,650.10 $7,300.20 $5,913.16 nat. median
$38
outlier · 155.9×
J0896
HCPCS 		Injection, Luspatercept-aamt, 0.25 Mg 13 $3,513.30 $7,026.60 $5,621.28 nat. median
$228
outlier · 24.7×
J9271
HCPCS 		Injection, Pembrolizumab, 1 Mg 14 $3,409.90 $6,819.80 $5,524.04 nat. median
$127
outlier · 43.5×
01204769_1
CDM 		Allomax Soft Tissue Graft 14 $3,307.50 $6,615.00 $5,358.15 —
J1602
HCPCS 		Injection, Golimumab, 1 Mg, For Intravenous Use 14 $3,126.40 $6,252.80 $5,064.77 nat. median
$55
outlier · 92.8×
J2426
HCPCS 		Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg 14 $3,008.15 $6,016.30 $4,873.20 nat. median
$2,528
1.9× median
E0747
HCPCS 		Osteogenesis Stimulator, Electrical, Non-invasive, Other Than Spinal Application… 14 $2,925.00 $5,733.00 $4,738.50 nat. median
$5,370
0.9× median
01204770_1
CDM 		Xenmatrix Surgical Graft 3.9x5.9 14 $2,850.00 $5,700.00 $4,617.00 —
J0875
HCPCS 		Injection, Dalbavancin, 5 Mg 14 $2,768.45 $5,536.90 $4,484.89 nat. median
$49
outlier · 90.7×
J0897
HCPCS 		Injection, Denosumab, 1 Mg 14 $33.74 $12,431.10 $4,272.80 nat. median
$86
outlier · 49.7×
J1439
HCPCS 		Injection, Ferric Carboxymaltose, 1 Mg 14 $2,532.80 $5,065.60 $4,103.14 nat. median
$5
outlier · 816.5×
J0129
HCPCS 		Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 14 $2,489.80 $4,979.60 $4,033.47 nat. median
$122
outlier · 33.0×
J1561
HCPCS 		Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liquid)… 14 $1,121.55 $10,721.30 $3,801.88 nat. median
$994
outlier · 3.8×
J2353
HCPCS 		Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg 14 $2,251.60 $6,101.10 $3,760.17 nat. median
$1,956
1.9× median
J1569
HCPCS 		Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 14 $78.55 $16,133.20 $3,637.55 nat. median
$946
outlier · 3.8×
25366301_1
CDM 		Lupron Depot 11.25mg, Kit 14 $2,221.41 $4,442.81 $3,598.68 —
J1459
HCPCS 		Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 14 $1,194.00 $9,616.00 $3,598.00 nat. median
$968
outlier · 3.7×
J1162
HCPCS 		Injection, Digoxin Immune Fab (ovine), Per Vial 14 $2,157.00 $4,314.00 $3,494.34 nat. median
$6,265
0.6× median
J9305
HCPCS 		Injection, Pemetrexed, Not Otherwise Specified, 10 Mg 14 $137.17 $5,239.00 $3,444.64 nat. median
$101
outlier · 34.2×
J3111
HCPCS 		Injection, Romosozumab-aqqg, 1 Mg 13 $2,093.50 $4,187.00 $3,349.60 nat. median
$19
outlier · 176.3×
J9177
HCPCS 		Injection, Enfortumab Vedotin-ejfv, 0.25 Mg 13 $1,939.00 $5,792.00 $3,141.18 nat. median
$112
outlier · 28.1×
J0641
HCPCS 		Injection, Levoleucovorin, Not Otherwise Specified, 0.5 Mg 14 $1,911.75 $3,823.50 $3,097.03 nat. median
$3
outlier · 1219.3×
03005070_1
CDM 		Alloderm Select Tissue 2.4+0.4 14 $1,875.00 $3,750.00 $3,037.50 —
J2357
HCPCS 		Injection, Omalizumab, 5 Mg 14 $1,846.50 $3,693.00 $2,991.33 nat. median
$682
outlier · 4.4×
J3262
HCPCS 		Injection, Tocilizumab, 1 Mg 14 $523.10 $9,572.90 $2,916.32 nat. median
$1,287
outlier · 2.3×
J1745
HCPCS 		Injection, Infliximab, Excludes Biosimilar, 10 Mg 14 $169.16 $4,224.60 $2,777.68 nat. median
$190
outlier · 14.6×
J9312
HCPCS 		Injection, Rituximab, 10 Mg 14 $973.85 $7,096.40 $2,747.95 nat. median
$739
outlier · 3.7×
J9395
HCPCS 		Injection, Fulvestrant, 25 Mg 14 $1,674.75 $3,349.50 $2,713.10 nat. median
$49
outlier · 55.3×
22510
HCPCS 		Stabilization Of Upper Spine Bone 14 $1,650.00 $3,234.00 $2,673.00 nat. median
$4,019
0.7× median
22511
HCPCS 		Stabilization Of Lower Spine Bone 14 $1,650.00 $3,234.00 $2,673.00 nat. median
$4,044
0.7× median
78452
HCPCS 		Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 14 $1,800.00 $9,000.00 $2,648.43 nat. median
$1,464
1.8× median
25990534_1
CDM 		Semaglutide (ozempic) 0.25 Or 0.5mg 14 $1,611.70 $3,223.40 $2,610.95 —
78451
HCPCS 		Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect 14 $1,700.00 $8,500.00 $2,568.43 nat. median
$1,355
1.9× median

Other procedures at this hospital

Browse this hospital's 5,207 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
             
J2350 HCPCS Injection, Ocrelizumab, 1 Mg 14 14 $74,319.50 $63,171.58 $37,159.75 $74,319.50 $60,198.79 2026-06-10
J2327 HCPCS Injection, Risankizumab-rzaa, Intravenous, 1 Mg 14 14 $38,287.20 $32,544.12 $19,143.60 $38,287.20 $31,012.63 2026-06-10
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 14 14 $31,211.70 $26,529.95 $15,605.85 $31,211.70 $25,281.47 2026-06-10
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 14 14 $22,490.00 $19,116.50 $11,245.00 $22,490.00 $18,216.90 2026-06-10
J9043 HCPCS Injection, Cabazitaxel, 1 Mg 14 14 $20,247.80 $17,210.63 $10,123.90 $20,247.80 $16,400.72 2026-06-10
Q5108 HCPCS Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 14 14 $15,042.00 $12,785.70 $7,521.00 $15,042.00 $12,184.02 2026-06-10
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 42 14 $13,769.80 $11,704.33 $6,743.40 $28,821.50 $11,704.33 2026-06-10
04458044_1 CDM 16 Ch Receiver Kit 3416 14 14 $14,378.50 $12,221.73 $7,189.25 $14,378.50 $11,646.58 2026-06-10
J0565 HCPCS Injection, Bezlotoxumab, 10 Mg 14 14 $13,692.00 $11,638.20 $6,846.00 $13,692.00 $11,090.52 2026-06-10
J0717 HCPCS Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm… 14 14 $12,648.50 $10,751.23 $6,324.25 $12,648.50 $10,245.28 2026-06-10
J1306 HCPCS Injection, Inclisiran, 1 Mg 14 14 $12,006.30 $10,205.36 $6,003.15 $12,006.30 $9,725.10 2026-06-10
90378 HCPCS Respiratory Syncytial Virus Antibody For Injection Into Tissue Or Muscle 14 14 $11,855.60 $10,077.26 $5,927.80 $11,855.60 $9,603.03 2026-06-10
J9299 HCPCS Injection, Nivolumab, 1 Mg 14 14 $11,502.00 $9,776.70 $5,751.00 $11,502.00 $9,316.62 2026-06-10
J3101 HCPCS Injection, Tenecteplase, 1 Mg 14 14 $13,727.30 $11,668.21 $167.22 $13,727.30 $9,025.70 2026-06-10
81163 HCPCS Gene Analysis (breast Cancer 1 And 2) Of Full Sequence 14 14 $9,300.00 $7,905.00 $4,650.00 $43,524.00 $7,533.00 2026-06-10
J9306 HCPCS Injection, Pertuzumab, 1 Mg 14 14 $8,891.90 $7,558.12 $4,445.95 $8,891.90 $7,202.44 2026-06-10
C1764 HCPCS Event Recorder, Cardiac (implantable) 14 14 $7,942.50 $6,751.13 $3,971.25 $7,942.50 $6,433.43 2026-06-10
J3358 HCPCS Ustekinumab, For Intravenous Injection, 1 Mg 14 14 $7,300.20 $6,205.17 $3,650.10 $7,300.20 $5,913.16 2026-06-10
J0896 HCPCS Injection, Luspatercept-aamt, 0.25 Mg 13 13 $7,026.60 $5,972.61 $3,513.30 $7,026.60 $5,621.28 2026-06-10
J9271 HCPCS Injection, Pembrolizumab, 1 Mg 14 14 $6,819.80 $5,796.83 $3,409.90 $6,819.80 $5,524.04 2026-06-10
01204769_1 CDM Allomax Soft Tissue Graft 14 14 $6,615.00 $5,622.75 $3,307.50 $6,615.00 $5,358.15 2026-06-10
J1602 HCPCS Injection, Golimumab, 1 Mg, For Intravenous Use 14 14 $6,252.80 $5,314.88 $3,126.40 $6,252.80 $5,064.77 2026-06-10
J2426 HCPCS Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg 14 14 $6,016.30 $5,113.86 $3,008.15 $6,016.30 $4,873.20 2026-06-10
E0747 HCPCS Osteogenesis Stimulator, Electrical, Non-invasive, Other Than Spinal Application… 14 14 $5,850.00 $4,972.50 $2,925.00 $5,733.00 $4,738.50 2026-06-10
01204770_1 CDM Xenmatrix Surgical Graft 3.9x5.9 14 14 $5,700.00 $4,845.00 $2,850.00 $5,700.00 $4,617.00 2026-06-10
J0875 HCPCS Injection, Dalbavancin, 5 Mg 14 14 $5,536.90 $4,706.37 $2,768.45 $5,536.90 $4,484.89 2026-06-10
J0897 HCPCS Injection, Denosumab, 1 Mg 27 14 $4,272.80 $3,631.88 $33.74 $12,431.10 $4,272.80 2026-06-10
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 14 14 $5,065.60 $4,305.76 $2,532.80 $5,065.60 $4,103.14 2026-06-10
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 14 14 $4,979.60 $4,232.66 $2,489.80 $4,979.60 $4,033.47 2026-06-10
J1561 HCPCS Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liquid)… 28 14 $6,482.20 $5,509.88 $1,121.55 $10,721.30 $3,801.88 2026-06-10
J2353 HCPCS Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg 28 14 $5,302.15 $4,506.83 $2,251.60 $6,101.10 $3,760.17 2026-06-10
J1569 HCPCS Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 70 14 $4,490.80 $3,817.18 $78.55 $16,133.20 $3,637.55 2026-06-10
25366301_1 CDM Lupron Depot 11.25mg, Kit 14 14 $4,442.81 $3,776.39 $2,221.41 $4,442.81 $3,598.68 2026-06-10
J1459 HCPCS Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 28 14 $6,002.00 $5,101.70 $1,194.00 $9,616.00 $3,598.00 2026-06-10
J1162 HCPCS Injection, Digoxin Immune Fab (ovine), Per Vial 14 14 $4,314.00 $3,666.90 $2,157.00 $4,314.00 $3,494.34 2026-06-10
J9305 HCPCS Injection, Pemetrexed, Not Otherwise Specified, 10 Mg 14 14 $5,239.00 $4,453.15 $137.17 $5,239.00 $3,444.64 2026-06-10
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 13 13 $4,187.00 $3,558.95 $2,093.50 $4,187.00 $3,349.60 2026-06-10
J9177 HCPCS Injection, Enfortumab Vedotin-ejfv, 0.25 Mg 26 13 $4,835.00 $4,109.75 $1,939.00 $5,792.00 $3,141.18 2026-06-10
J0641 HCPCS Injection, Levoleucovorin, Not Otherwise Specified, 0.5 Mg 14 14 $3,823.50 $3,249.98 $1,911.75 $3,823.50 $3,097.03 2026-06-10
03005070_1 CDM Alloderm Select Tissue 2.4+0.4 14 14 $3,750.00 $3,187.50 $1,875.00 $3,750.00 $3,037.50 2026-06-10
J2357 HCPCS Injection, Omalizumab, 5 Mg 14 14 $3,693.00 $3,139.05 $1,846.50 $3,693.00 $2,991.33 2026-06-10
J3262 HCPCS Injection, Tocilizumab, 1 Mg 28 14 $5,309.55 $4,513.12 $523.10 $9,572.90 $2,916.32 2026-06-10
J1745 HCPCS Injection, Infliximab, Excludes Biosimilar, 10 Mg 14 14 $4,224.60 $3,590.91 $169.16 $4,224.60 $2,777.68 2026-06-10
J9312 HCPCS Injection, Rituximab, 10 Mg 28 14 $4,522.05 $3,843.74 $973.85 $7,096.40 $2,747.95 2026-06-10
J9395 HCPCS Injection, Fulvestrant, 25 Mg 14 14 $3,349.50 $2,847.08 $1,674.75 $3,349.50 $2,713.10 2026-06-10
22510 HCPCS Stabilization Of Upper Spine Bone 14 14 $3,300.00 $2,805.00 $1,650.00 $3,234.00 $2,673.00 2026-06-10
22511 HCPCS Stabilization Of Lower Spine Bone 14 14 $3,300.00 $2,805.00 $1,650.00 $3,234.00 $2,673.00 2026-06-10
78452 HCPCS Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 14 14 $3,600.00 $3,060.00 $1,800.00 $9,000.00 $2,648.43 2026-06-10
25990534_1 CDM Semaglutide (ozempic) 0.25 Or 0.5mg 14 14 $3,223.40 $2,739.89 $1,611.70 $3,223.40 $2,610.95 2026-06-10
78451 HCPCS Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect 14 14 $3,400.00 $2,890.00 $1,700.00 $8,500.00 $2,568.43 2026-06-10
36475 HCPCS Destruction Of First Incompetent Vein Of Arm Or Leg Using Radiofrequency And Ima… 14 14 $3,120.00 $2,652.00 $1,560.00 $3,057.60 $2,527.20 2026-06-10
01204347_1 CDM Genesys Hta Procerva Procedure Set 14 14 $2,925.00 $2,486.25 $1,462.50 $2,925.00 $2,369.25 2026-06-10
J2997 HCPCS Injection, Alteplase Recombinant, 1 Mg 27 14 $2,363.00 $2,008.55 $122.66 $29,874.00 $2,363.00 2026-06-10
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 14 14 $3,000.00 $2,550.00 $1,500.00 $7,500.00 $2,301.06 2026-06-10
70553 HCPCS MRI Scan Of Brain Before And After Contrast 14 14 $2,950.00 $2,507.50 $1,475.00 $7,375.00 $2,281.06 2026-06-10
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 54 14 $2,800.00 $2,380.00 $1,400.00 $7,250.00 $2,240.00 2026-06-10
49654 HCPCS Laparoscopy, Surgical, Repair, Incisional Hernia (includes Mesh Insertion, When … 6 6 $3,802.00 $3,231.70 $57.25 $2,851.50 $2,210.69 2026-06-10
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 14 14 $2,750.00 $2,337.50 $1,375.00 $6,875.00 $2,201.06 2026-06-10
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 14 14 $2,750.00 $2,337.50 $1,375.00 $6,875.00 $2,201.06 2026-06-10
J0740 HCPCS Injection, Cidofovir, 375 Mg 14 14 $2,676.00 $2,274.60 $1,338.00 $2,676.00 $2,167.56 2026-06-10
J0457 HCPCS Injection, Aztreonam, 100 Mg 14 14 $2,651.20 $2,253.52 $1,325.60 $2,651.20 $2,147.47 2026-06-10
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 28 14 $2,650.00 $2,252.50 $1,325.00 $6,625.00 $2,146.50 2026-06-10
Q5114 HCPCS Injection, Trastuzumab-dkst, Biosimilar, (ogivri), 10 Mg 14 14 $2,617.90 $2,225.22 $1,308.95 $2,617.90 $2,120.50 2026-06-10
J9023 HCPCS Injection, Avelumab, 10 Mg 14 14 $2,603.90 $2,213.32 $1,301.95 $2,603.90 $2,109.16 2026-06-10
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 14 14 $2,950.00 $2,507.50 $1,475.00 $7,375.00 $2,100.65 2026-06-10
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 14 14 $2,550.00 $2,167.50 $1,275.00 $6,375.00 $2,065.50 2026-06-10
25990149_1 CDM Lacosamide (vimpat) Oral Soln 10mg/1ml 14 14 $2,547.10 $2,165.04 $1,273.55 $2,547.10 $2,063.15 2026-06-10
77049 HCPCS MRI Scan Of Both Breasts 14 14 $2,500.00 $2,125.00 $1,250.00 $6,250.00 $2,025.00 2026-06-10
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 14 14 $2,500.00 $2,125.00 $1,250.00 $6,250.00 $2,025.00 2026-06-10
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 14 14 $2,750.00 $2,337.50 $1,375.00 $6,875.00 $2,020.65 2026-06-10
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 27 14 $2,800.00 $2,380.00 $1,230.00 $7,000.00 $2,017.20 2026-06-10
73220 HCPCS MRI Scan Of Arm Before And After Contrast 28 14 $2,450.00 $2,082.50 $1,225.00 $6,125.00 $1,984.50 2026-06-10
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 14 14 $2,445.00 $2,078.25 $1,222.50 $6,112.50 $1,980.45 2026-06-10
37766 HCPCS Removal Of Varicose Veins Of Arm Or Leg, More Than 20 Incisions 28 14 $2,430.00 $2,065.50 $1,212.50 $2,386.30 $1,968.25 2026-06-10
A4264 HCPCS Permanent Implantable Contraceptive Intratubal Occlusion Device(s) And Delivery … 14 14 $2,400.00 $2,040.00 $1,200.00 $2,400.00 $1,944.00 2026-06-10
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 14 14 $2,500.00 $2,125.00 $1,250.00 $6,250.00 $1,920.65 2026-06-10
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 27 14 $3,840.00 $3,264.00 $119.15 $3,648.00 $1,920.00 2026-06-10
25990634_1 CDM Trelegy Ellipta 200-62.5-25 14 14 $2,370.20 $2,014.67 $1,185.10 $2,370.20 $1,919.86 2026-06-10
64622 HCPCS Operating Room Services - Minor Surgery 14 14 $2,370.00 $2,014.50 $1,185.00 $2,322.60 $1,919.70 2026-06-10
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 14 14 $2,500.00 $2,125.00 $1,250.00 $6,250.00 $1,896.14 2026-06-10
03098002_1 CDM Screws/wrenches For Joint Implants 14 14 $2,340.00 $1,989.00 $1,170.00 $2,340.00 $1,895.40 2026-06-10
77048 HCPCS MRI Scan Of 1 Breast 14 14 $2,300.00 $1,955.00 $1,150.00 $5,750.00 $1,863.00 2026-06-10
Q4101 HCPCS Apligraf, Per Square Centimeter 14 14 $2,271.00 $1,930.35 $1,135.50 $2,271.00 $1,839.51 2026-06-10
36478 HCPCS Laser Destruction Of Incompetent Vein Of Arm Or Leg Using Imaging Guidance 14 14 $2,255.00 $1,916.75 $1,127.50 $2,209.90 $1,826.55 2026-06-10
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 14 14 $2,300.00 $1,955.00 $1,150.00 $5,750.00 $1,816.14 2026-06-10
70552 HCPCS MRI Scan Of Brain With Contrast 14 14 $2,285.00 $1,942.25 $1,142.50 $5,712.50 $1,810.14 2026-06-10
25990514_1 CDM Trelegy Ellipta 100-62.5-25 14 14 $2,234.20 $1,899.07 $1,117.10 $2,234.20 $1,809.70 2026-06-10
73720 HCPCS MRI Scan Of Leg Before And After Contrast 54 14 $2,200.00 $1,870.00 $1,100.00 $6,250.00 $1,804.00 2026-06-10
73222 HCPCS MRI Scan Of Arm Joint With Contrast 54 14 $2,275.00 $1,933.75 $1,125.00 $5,750.00 $1,800.00 2026-06-10
71555 HCPCS MRI Scan Of Blood Vessels Of Chest 14 14 $2,250.00 $1,912.50 $1,125.00 $5,625.00 $1,799.80 2026-06-10
Q4106 HCPCS Dermagraft, Per Square Centimeter 14 14 $2,205.00 $1,874.25 $1,102.50 $2,205.00 $1,786.05 2026-06-10
90376 HCPCS Rabies Immune Globulin For Injection Beneath The Skin And/or Into Muscle, Heat-t… 14 14 $2,201.30 $1,871.11 $1,100.65 $2,201.30 $1,783.05 2026-06-10
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 14 14 $2,201.00 $1,870.85 $1,100.50 $5,502.50 $1,776.54 2026-06-10
44202 HCPCS Partial Removal And Reconnection Of Small Bowel Using An Endoscope 12 12 $3,830.00 $3,255.50 $1,163.32 $3,953.99 $1,768.24 2026-06-10
37765 HCPCS Removal Of Varicose Veins Of Arm Or Leg, 10-20 Incisions 14 14 $2,175.00 $1,848.75 $1,087.50 $2,131.50 $1,761.75 2026-06-10
78582 HCPCS Nuclear Medicine Study Of Lung Ventilation And Circulation 14 14 $2,670.00 $2,269.50 $1,229.81 $6,675.00 $1,755.53 2026-06-10
J9264 HCPCS Injection, Paclitaxel Protein-bound Particles, 1 Mg 14 14 $2,134.60 $1,814.41 $1,067.30 $2,134.60 $1,729.03 2026-06-10
C1788 HCPCS Port, Indwelling (implantable) 28 14 $3,034.50 $2,579.32 $409.50 $5,250.00 $1,722.00 2026-06-10
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 27 14 $2,145.00 $1,823.25 $1,072.50 $5,625.00 $1,716.00 2026-06-10
25022101_1 CDM Nplate 250 Mcg Vial 14 14 $2,109.20 $1,792.82 $1,054.60 $2,109.20 $1,708.45 2026-06-10
77047 HCPCS MRI Scan Of Both Breasts Without Contrast 14 14 $2,100.00 $1,785.00 $1,050.00 $5,250.00 $1,701.00 2026-06-10
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 14 14 $2,350.00 $1,997.50 $1,175.00 $5,875.00 $1,700.69 2026-06-10
27506 HCPCS Treatment Of Broken Shaft Of Thigh Bone With Implant 12 12 $4,200.00 $3,570.00 $1,116.32 $2,730.00 $1,696.81 2026-06-10
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 14 14 $2,300.00 $1,955.00 $1,150.00 $5,750.00 $1,680.69 2026-06-10
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 27 14 $3,360.00 $2,856.00 $114.89 $3,626.86 $1,680.00 2026-06-10
P_1 CDM Room & Board - Private (one Bed) - General Classification 8 8 $1,900.00 $1,615.00 $1,520.00 $1,862.00 $1,662.50 2026-06-10
IS_1 CDM Room & Board - Private (one Bed) - General Classification 8 8 $1,900.00 $1,615.00 $1,520.00 $1,862.00 $1,662.50 2026-06-10
71552 HCPCS MRI Scan Of Chest Before And After Contrast 14 14 $2,050.00 $1,742.50 $1,025.00 $5,125.00 $1,660.50 2026-06-10
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 14 14 $2,035.00 $1,729.75 $1,017.50 $5,087.50 $1,648.35 2026-06-10
70551 HCPCS MRI Scan Of Brain Without Contrast 14 14 $2,200.00 $1,870.00 $1,100.00 $5,500.00 $1,640.69 2026-06-10
77046 HCPCS MRI Scan Of 1 Breast Without Contrast 14 14 $2,000.00 $1,700.00 $1,000.00 $5,000.00 $1,620.00 2026-06-10
J9041 HCPCS Injection, Bortezomib, 0.1 Mg 14 14 $2,454.50 $2,086.33 $104.68 $2,454.50 $1,613.84 2026-06-10
74181 HCPCS MRI Scan Of Abdomen Without Contrast 14 14 $2,050.00 $1,742.50 $1,025.00 $5,125.00 $1,580.69 2026-06-10
73719 HCPCS MRI Scan Of Leg With Contrast 28 14 $1,950.00 $1,657.50 $975.00 $4,875.00 $1,579.50 2026-06-10
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 14 14 $1,950.00 $1,657.50 $975.00 $4,875.00 $1,579.50 2026-06-10
Q5115 HCPCS Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg 28 14 $2,497.90 $2,123.22 $637.00 $3,721.80 $1,567.45 2026-06-10
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 14 14 $2,000.00 $1,700.00 $1,000.00 $5,000.00 $1,560.69 2026-06-10
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 27 14 $2,000.00 $1,700.00 $975.00 $5,000.00 $1,560.00 2026-06-10
73219 HCPCS MRI Scan Of Arm With Contrast 28 14 $1,925.00 $1,636.25 $962.50 $4,812.50 $1,559.25 2026-06-10
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 14 14 $2,365.13 $2,010.36 $1,182.57 $5,912.83 $1,555.07 2026-06-10
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 14 14 $1,950.00 $1,657.50 $975.00 $4,875.00 $1,540.69 2026-06-10
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 14 14 $1,900.00 $1,615.00 $950.00 $4,750.00 $1,539.00 2026-06-10
74182 HCPCS MRI Scan Of Abdomen With Contrast 14 14 $1,900.00 $1,615.00 $950.00 $4,750.00 $1,539.00 2026-06-10
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 27 14 $1,923.00 $1,634.55 $961.50 $4,937.50 $1,538.40 2026-06-10
73722 HCPCS MRI Scan Of Leg Joint With Contrast 28 14 $1,895.00 $1,610.75 $947.50 $4,737.50 $1,534.95 2026-06-10
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 14 14 $1,890.00 $1,606.50 $945.00 $4,725.00 $1,530.90 2026-06-10
C1763 HCPCS Connective Tissue, Non-human (includes Synthetic) 70 14 $1,910.15 $1,623.63 $631.50 $4,633.50 $1,526.76 2026-06-10
J0248 HCPCS Injection, Remdesivir, 1 Mg 14 14 $1,884.00 $1,601.40 $942.00 $1,884.00 $1,526.04 2026-06-10
25990555_1 CDM Tagrisso 80 Mg Tablet 14 14 $1,882.30 $1,599.96 $941.15 $1,882.30 $1,524.66 2026-06-10
73706 HCPCS CT Scan Of Blood Vessels Of Lower Leg With Contrast 28 14 $2,300.00 $1,955.00 $1,150.00 $5,750.00 $1,523.00 2026-06-10
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 54 14 $1,950.00 $1,657.50 $950.00 $5,000.00 $1,521.38 2026-06-10
72195 HCPCS MRI Scan Of Pelvis Without Contrast 14 14 $1,900.00 $1,615.00 $950.00 $4,750.00 $1,520.69 2026-06-10
71551 HCPCS MRI Scan Of Chest With Contrast 14 14 $1,875.00 $1,593.75 $937.50 $4,687.50 $1,518.75 2026-06-10
70336 HCPCS MRI Scan Of Jaw Joint 14 14 $1,895.00 $1,610.75 $947.50 $4,737.50 $1,518.69 2026-06-10
78588 HCPCS Nm Lung Perf W/vent 14 14 $1,850.00 $1,572.50 $925.00 $4,625.00 $1,498.50 2026-06-10
73218 HCPCS MRI Scan Of Arm Without Contrast 28 14 $1,850.00 $1,572.50 $925.00 $4,625.00 $1,498.50 2026-06-10
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 14 14 $1,845.00 $1,568.25 $922.50 $4,612.50 $1,494.45 2026-06-10
LD_1 CDM Room & Board - Semi-private (two Beds) - General Classification 8 8 $1,700.00 $1,445.00 $1,360.00 $1,666.00 $1,487.50 2026-06-10
NS_1 CDM Nursery - General Classification 8 8 $1,700.00 $1,445.00 $1,360.00 $1,666.00 $1,487.50 2026-06-10
S_1 CDM Room & Board - Semi-private (two Beds) - General Classification 8 8 $1,700.00 $1,445.00 $1,360.00 $1,666.00 $1,487.50 2026-06-10
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 14 14 $2,200.00 $1,870.00 $1,100.00 $5,500.00 $1,483.00 2026-06-10
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 14 14 $1,830.00 $1,555.50 $915.00 $4,575.00 $1,482.30 2026-06-10
J9179 HCPCS Injection, Eribulin Mesylate, 0.1 Mg 14 14 $1,820.00 $1,547.00 $910.00 $1,820.00 $1,474.20 2026-06-10
L8642 HCPCS Hallux Implant 14 14 $1,820.00 $1,547.00 $910.00 $1,820.00 $1,474.20 2026-06-10
81235 HCPCS Gene Analysis (epidermal Growth Factor Receptor), Common Variants 14 14 $1,764.00 $1,499.40 $882.00 $5,725.59 $1,472.94 2026-06-10
36476 HCPCS Destruction Of Subsequent Incompetent Veins Of Arm Or Leg Using Radiofrequency A… 14 14 $1,800.00 $1,530.00 $900.00 $1,764.00 $1,458.00 2026-06-10
Q0138 HCPCS Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd … 14 14 $1,793.10 $1,524.14 $896.55 $1,793.10 $1,452.41 2026-06-10
01700390_1 CDM Trauma Response Priority 1 14 14 $1,787.34 $1,519.24 $893.67 $1,751.59 $1,447.74 2026-06-10
81219 HCPCS Gene Analysis (calreticulin), Common Variants 14 14 $1,733.76 $1,473.70 $866.88 $2,108.77 $1,447.69 2026-06-10
49560 HCPCS Repair Initial Incisional Or Ventral Hernia; Reducible 6 6 $2,229.00 $1,894.65 $57.25 $2,101.07 $1,444.67 2026-06-10
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 14 14 $1,780.00 $1,513.00 $890.00 $4,450.00 $1,441.80 2026-06-10
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 28 14 $2,050.00 $1,742.50 $1,025.00 $5,125.00 $1,423.00 2026-06-10
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 14 14 $1,750.00 $1,487.50 $875.00 $4,375.00 $1,417.50 2026-06-10
73718 HCPCS MRI Scan Of Leg Without Contrast 42 14 $1,750.00 $1,487.50 $875.00 $4,375.00 $1,417.50 2026-06-10
36479 HCPCS Laser Destruction Of Incompetent Veins Of Arm Or Leg Using Imaging Guidance, Sub… 14 14 $1,730.00 $1,470.50 $865.00 $1,695.40 $1,401.30 2026-06-10
72196 HCPCS MRI Scan Of Pelvis With Contrast 14 14 $1,720.00 $1,462.00 $860.00 $4,300.00 $1,393.20 2026-06-10
78227 HCPCS Nuclear Medicine Study Of Liver And Bile Duct System With Use Of Drugs 14 14 $1,972.00 $1,676.20 $986.00 $4,930.00 $1,390.92 2026-06-10
71270 HCPCS CT Scan Of Chest Before And After Contrast 14 14 $1,960.00 $1,666.00 $980.00 $4,900.00 $1,381.78 2026-06-10
J9171 HCPCS Injection, Docetaxel, 1 Mg 14 14 $2,099.50 $1,784.58 $15.07 $2,099.50 $1,380.42 2026-06-10
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 14 14 $1,943.00 $1,651.55 $971.50 $4,857.50 $1,380.20 2026-06-10
C8929 HCPCS Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi… 14 14 $1,700.00 $1,445.00 $850.00 $2,298.11 $1,377.00 2026-06-10
73202 HCPCS CT Scan Of Arm Before And After Contrast 28 14 $1,940.00 $1,649.00 $970.00 $4,850.00 $1,373.78 2026-06-10
J9351 HCPCS Injection, Topotecan, 0.1 Mg 14 14 $1,682.60 $1,430.21 $841.30 $1,682.60 $1,362.90 2026-06-10
C1771 HCPCS Repair Device, Urinary, Incontinence, With Sling Graft 70 14 $1,807.50 $1,536.38 $776.10 $2,111.96 $1,358.17 2026-06-10
29827 HCPCS Repair Of Shoulder Rotator Cuff Using An Endoscope 12 12 $4,600.00 $3,910.00 $893.28 $2,990.00 $1,357.79 2026-06-10
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 14 14 $1,900.00 $1,615.00 $950.00 $4,750.00 $1,357.78 2026-06-10
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 14 14 $1,895.00 $1,610.75 $947.50 $4,737.50 $1,355.78 2026-06-10
29806 HCPCS Repair Of Shoulder Joint Capsule Using An Endoscope 12 12 $3,648.00 $3,100.80 $889.48 $2,371.20 $1,352.00 2026-06-10
81404 HCPCS Molecular Pathology Procedure Level 5 Genetic Analysis 14 14 $1,650.00 $1,402.50 $381.92 $4,534.70 $1,336.50 2026-06-10
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 14 14 $1,645.00 $1,398.25 $822.50 $4,112.50 $1,332.45 2026-06-10
49002 HCPCS Reopening Of Recent Abdominal Incision 12 12 $2,696.00 $2,291.60 $878.54 $2,986.45 $1,328.65 2026-06-10
J1742 HCPCS Injection, Ibutilide Fumarate, 1 Mg 14 14 $1,640.20 $1,394.17 $820.10 $1,640.20 $1,328.56 2026-06-10
78306 HCPCS Nuclear Medicine Study Of Bone And/or Joint Whole Body 14 14 $1,988.00 $1,689.80 $994.00 $4,970.00 $1,327.93 2026-06-10
29807 HCPCS Repair Of Shoulder Socket Using An Endoscope 12 12 $4,524.00 $3,845.40 $870.24 $2,940.60 $1,322.77 2026-06-10
71550 HCPCS MRI Scan Of Chest Without Contrast 14 14 $1,630.00 $1,385.50 $815.00 $4,075.00 $1,320.30 2026-06-10
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 14 14 $1,800.00 $1,530.00 $900.00 $4,500.00 $1,317.78 2026-06-10
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 27 14 $1,600.00 $1,360.00 $800.00 $1,749.30 $1,312.00 2026-06-10
J9145 HCPCS Injection, Daratumumab, 10 Mg 28 14 $2,079.15 $1,767.28 $532.30 $3,093.70 $1,305.72 2026-06-10
Q5118 HCPCS Injection, Bevacizumab-bvzr, Biosimilar, (zirabev), 10 Mg 26 13 $1,999.70 $1,699.75 $598.45 $2,802.50 $1,299.08 2026-06-10
30465 HCPCS Repair Of Nasal Passage 12 12 $2,650.00 $2,252.50 $854.51 $2,471.88 $1,298.86 2026-06-10
78579 HCPCS Nuclear Medicine Study Of Lung Ventilation 14 14 $1,974.00 $1,677.90 $826.78 $4,935.00 $1,297.90 2026-06-10
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 14 14 $1,750.00 $1,487.50 $875.00 $4,375.00 $1,297.78 2026-06-10
70488 HCPCS CT Scan Of Face Before And After Contrast 14 14 $1,750.00 $1,487.50 $875.00 $4,375.00 $1,297.78 2026-06-10
77084 HCPCS MRI Scan Of Bone Marrow 14 14 $1,600.00 $1,360.00 $800.00 $4,000.00 $1,296.00 2026-06-10
78315 HCPCS Nuclear Medicine Study Of Bone Taken At Different Times 14 14 $1,897.00 $1,612.45 $948.50 $4,742.50 $1,291.53 2026-06-10
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 14 14 $1,675.00 $1,423.75 $837.50 $4,187.50 $1,267.78 2026-06-10
23420 HCPCS Repair Of Complete Tear Of Shoulder Rotator Cuff With Release Of Pressure On Col… 12 12 $3,745.00 $3,183.25 $827.90 $2,434.25 $1,258.41 2026-06-10
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 14 14 $1,650.00 $1,402.50 $825.00 $4,125.00 $1,257.78 2026-06-10
78226 HCPCS Nuclear Medicine Study Of Liver And Bile Duct System 14 14 $1,631.00 $1,386.35 $815.50 $4,077.50 $1,254.52 2026-06-10
71260 HCPCS CT Scan Of Chest With Contrast 14 14 $1,800.00 $1,530.00 $900.00 $4,500.00 $1,250.12 2026-06-10
73702 HCPCS CT Scan Of Leg Before And After Contrast 28 14 $1,630.00 $1,385.50 $815.00 $4,075.00 $1,249.78 2026-06-10
J0257 HCPCS Injection, Alpha 1 Proteinase Inhibitor (human), (glassia), 10 Mg 14 14 $1,542.00 $1,310.70 $771.00 $1,542.00 $1,249.02 2026-06-10
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 14 14 $1,617.00 $1,374.45 $808.50 $4,042.50 $1,244.57 2026-06-10
Q5119 HCPCS Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg 26 13 $1,975.05 $1,678.80 $506.30 $2,937.50 $1,240.67 2026-06-10
29888 HCPCS Repair Of Anterior Cruciate Ligament Of Knee Using An Endoscope 12 12 $6,750.00 $5,737.50 $814.65 $4,387.50 $1,238.27 2026-06-10
J2760 HCPCS Injection, Phentolamine Mesylate, Up To 5 Mg 14 14 $1,523.30 $1,294.81 $761.65 $1,523.30 $1,233.88 2026-06-10
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 14 14 $1,590.00 $1,351.50 $795.00 $3,975.00 $1,233.78 2026-06-10
25047103_1 CDM Chantix Starting Month Box 14 14 $1,519.20 $1,291.32 $759.60 $1,519.20 $1,230.55 2026-06-10
58572 HCPCS Removal Of Uterus Through Abdomen Using An Endoscope, More Than 250.0 G 12 12 $4,762.00 $4,047.70 $864.27 $3,095.30 $1,229.35 2026-06-10
78264 HCPCS Nuclear Medicine Study Of Stomach To Assess Emptying 14 14 $1,858.00 $1,579.30 $929.00 $4,645.00 $1,227.90 2026-06-10
J7195 HCPCS Injection, Factor Ix (antihemophilic Factor, Recombinant) Per Iu, Not Otherwise … 14 14 $1,512.00 $1,285.20 $756.00 $1,512.00 $1,224.72 2026-06-10
J3095 HCPCS Injection, Telavancin, 10 Mg 14 14 $1,495.90 $1,271.52 $747.95 $1,495.90 $1,211.68 2026-06-10
74160 HCPCS CT Scan Of Abdomen With Contrast 14 14 $1,700.00 $1,445.00 $850.00 $4,250.00 $1,210.12 2026-06-10
Q2050 HCPCS Injection, Doxorubicin Hydrochloride, Liposomal, Not Otherwise Specified, 10 Mg 14 14 $1,490.10 $1,266.59 $745.05 $1,490.10 $1,206.98 2026-06-10
58150 HCPCS Removal Of Uterus And Cervix Through Abdomen 12 12 $4,400.00 $3,740.00 $852.76 $2,860.00 $1,206.67 2026-06-10
72129 HCPCS CT Scan Of Middle Spine With Contrast 14 14 $1,687.00 $1,433.95 $843.50 $4,217.50 $1,204.92 2026-06-10
70487 HCPCS CT Scan Of Face With Contrast 14 14 $1,678.00 $1,426.30 $839.00 $4,195.00 $1,201.33 2026-06-10
01725248_1 CDM ER Physician Fb Removal From Forearm 5 5 $1,793.00 $1,524.05 $950.29 $1,434.40 $1,201.31 2026-06-10
71250 HCPCS CT Scan Of Chest Without Contrast 27 14 $1,600.00 $1,360.00 $750.00 $4,000.00 $1,200.00 2026-06-10
22513 HCPCS Treatment Of Broken Middle Spine Bone With Placement Of Stabilizing Device Using… 26 14 $2,400.00 $2,040.00 $416.38 $2,352.00 $1,200.00 2026-06-10
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 14 14 $1,650.00 $1,402.50 $825.00 $4,125.00 $1,190.12 2026-06-10
44180 HCPCS Release Of Small Bowel Scar Tissue Using An Endoscope 12 12 $3,400.00 $2,890.00 $778.46 $2,624.26 $1,183.26 2026-06-10
29828 HCPCS Release Of Tendon Connecting Biceps Muscle And Shoulder Using An Endoscope 12 12 $4,400.00 $3,740.00 $771.97 $2,860.00 $1,173.39 2026-06-10
50390 HCPCS Aspiration And/or Injection Of Cyst Of Kidney 14 14 $1,442.00 $1,225.70 $721.00 $1,413.16 $1,168.02 2026-06-10
25010061_1 CDM Spiriva Respimat 2.5 Mcg Inh 14 14 $1,434.10 $1,218.99 $717.05 $1,434.10 $1,161.62 2026-06-10
01243008_1 CDM Gastro - Intestinal (gi) Services - General Classification 14 14 $1,431.00 $1,216.35 $715.50 $1,402.38 $1,159.11 2026-06-10
22514 HCPCS Treatment Of Broken Lower Spine Bone With Placement Of Stabilizing Device 26 14 $2,300.00 $1,955.00 $389.57 $2,254.00 $1,155.75 2026-06-10
58552 HCPCS Removal Of Uterus, Tubes, And/or Ovaries Through Vagina Using An Endoscope, 250.… 12 12 $4,840.00 $4,114.00 $806.22 $3,146.00 $1,154.45 2026-06-10
25990631_1 CDM Testosterone 10 Mg Gel Pump 14 14 $1,419.00 $1,206.15 $709.50 $1,419.00 $1,149.39 2026-06-10
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 14 14 $1,530.00 $1,300.50 $765.00 $3,825.00 $1,142.12 2026-06-10
10011 HCPCS Fine Needle Aspiration Biopsy Of Growth Using MRI Guidance, First Growth 12 12 $1,400.00 $1,190.00 $700.00 $1,372.00 $1,134.00 2026-06-10
27535 HCPCS Treatment Of Broken Side Of Upper End Of Shin Bone 12 12 $2,950.00 $2,507.50 $743.96 $1,917.50 $1,130.82 2026-06-10
70460 HCPCS CT Scan Head Or Brain With Contrast 14 14 $1,500.00 $1,275.00 $750.00 $3,750.00 $1,130.12 2026-06-10
72193 HCPCS CT Scan Of Pelvis With Contrast 14 14 $1,498.00 $1,273.30 $749.00 $3,745.00 $1,129.33 2026-06-10
50435 HCPCS Replacement Of Kidney Drainage Tube Using Imaging Guidance With Review By Radiol… 14 14 $1,382.00 $1,174.70 $691.00 $1,354.36 $1,119.42 2026-06-10
J2325 HCPCS Injection, Nesiritide, 0.1 Mg 14 14 $1,379.10 $1,172.24 $689.55 $1,379.10 $1,117.07 2026-06-10
72126 HCPCS CT Scan Of Upper Spine With Contrast 14 14 $1,452.00 $1,234.20 $726.00 $3,630.00 $1,110.92 2026-06-10
04458043_1 CDM Extension #3382 14 14 $1,369.85 $1,164.37 $684.93 $1,369.85 $1,109.58 2026-06-10
72132 HCPCS CT Scan Of Lower Spine With Contrast 14 14 $1,442.00 $1,225.70 $721.00 $3,605.00 $1,106.92 2026-06-10
73701 HCPCS CT Scan Of Leg With Contrast Material 28 14 $1,425.00 $1,211.25 $712.50 $3,562.50 $1,100.12 2026-06-10
23412 HCPCS Repair Of Chronic Torn Shoulder Rotator Cuff 12 12 $3,765.00 $3,200.25 $723.37 $2,447.25 $1,099.52 2026-06-10
78223 HCPCS Nm Biliary Hida W Ef 14 14 $1,350.00 $1,147.50 $675.00 $3,375.00 $1,093.50 2026-06-10
01204310_1 CDM Harmonic Hd 1000i Shears 36cm 14 14 $1,345.25 $1,143.46 $672.63 $1,345.25 $1,089.65 2026-06-10
24800 HCPCS Fusion Of Elbow Joint Without Bone Graft From The Patient 12 12 $3,500.00 $2,975.00 $712.77 $2,275.00 $1,083.41 2026-06-10
49587 HCPCS Repair Umbilical Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated 6 6 $1,822.00 $1,548.70 $57.25 $1,366.50 $1,074.98 2026-06-10
58571 HCPCS Removal Of Uterus, Tubes, And/or Ovaries Through Abdomen Using An Endoscope, 250… 12 12 $4,200.00 $3,570.00 $757.13 $2,730.00 $1,074.42 2026-06-10
23410 HCPCS Repair Of Acute Torn Shoulder Rotator Cuff 12 12 $4,100.00 $3,485.00 $699.04 $2,665.00 $1,062.54 2026-06-10
78803 HCPCS Nuclear Medicine Study, Spect Imaging, 1 Area Or Single Acquisition, Single Day … 14 14 $1,307.00 $1,110.95 $653.50 $3,267.50 $1,058.67 2026-06-10
J9055 HCPCS Injection, Cetuximab, 10 Mg 27 14 $1,319.50 $1,121.58 $122.38 $1,954.30 $1,055.60 2026-06-10
78278 HCPCS Nuclear Medicine Study To Assess Blood Loss 14 14 $1,416.00 $1,203.60 $708.00 $3,540.00 $1,051.10 2026-06-10
25008214_1 CDM Atrovent 17 Mcg Hfa Inhaler 14 14 $1,296.20 $1,101.77 $648.10 $1,296.20 $1,049.92 2026-06-10
64635 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 52 14 $2,677.00 $2,275.45 $163.50 $3,998.40 $1,035.30 2026-06-10
73201 HCPCS CT Scan Of Arm With Contrast 28 14 $1,368.00 $1,162.80 $618.00 $3,750.00 $1,032.06 2026-06-10
20225 HCPCS Deep Biopsy Of Bone Using Needle Or Trocar 14 14 $1,264.00 $1,074.40 $632.00 $1,238.72 $1,023.84 2026-06-10
29855 HCPCS Treatment Of Broken Upper Portion Of Lower Leg Bone On Side Using An Endoscope 12 12 $2,754.00 $2,340.90 $667.21 $1,790.10 $1,014.16 2026-06-10
43251 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 14 14 $1,252.00 $1,064.20 $626.00 $1,226.96 $1,014.12 2026-06-10
01700392_1 CDM Trauma Response Priority 2 14 14 $1,247.23 $1,060.15 $623.62 $1,222.29 $1,010.25 2026-06-10
25990310_1 CDM Incruse Ellipta 62.5 Mcg Inh 14 14 $1,240.20 $1,054.17 $620.10 $1,240.20 $1,004.56 2026-06-10
01243007_1 CDM Gastro - Intestinal (gi) Services - General Classification 14 14 $1,236.00 $1,050.60 $618.00 $1,211.28 $1,001.16 2026-06-10
25091612_1 CDM Pulmicort 180 Mcg Flexhaler 14 14 $1,235.70 $1,050.35 $617.85 $1,235.70 $1,000.91 2026-06-10
25015561_1 CDM Stiolto Respimat Inhaler (60) 14 14 $1,229.90 $1,045.42 $614.95 $1,229.90 $996.22 2026-06-10
27814 HCPCS Treatment Of Both Broken Lower Leg Bones At Ankle 12 12 $3,280.00 $2,788.00 $654.49 $2,132.00 $994.82 2026-06-10
29887 HCPCS Repair Of Knee Joint With Bone Graft And Internal Stabilizing Device Using An En… 12 12 $3,268.00 $2,777.80 $648.58 $2,124.20 $985.85 2026-06-10
58260 HCPCS Removal Of Uterus Through Vagina, 250.0 G Or Less 12 12 $3,122.00 $2,653.70 $683.53 $2,029.30 $983.52 2026-06-10
72125 HCPCS CT Scan Of Upper Spine Without Contrast 14 14 $1,475.00 $1,253.75 $737.50 $3,687.50 $980.40 2026-06-10
78007 HCPCS Nm Thy Imag W Upmult 14 14 $1,203.00 $1,022.55 $601.50 $3,007.50 $974.43 2026-06-10
72131 HCPCS CT Scan Of Lower Spine Without Contrast 14 14 $1,450.00 $1,232.50 $725.00 $3,625.00 $970.40 2026-06-10
27422 HCPCS Repair Of Dislocating Kneecap With Realignment 12 12 $3,009.00 $2,557.65 $638.38 $1,955.85 $970.34 2026-06-10
23430 HCPCS Anchoring Of Biceps Tendon 12 12 $3,284.00 $2,791.40 $637.49 $2,134.60 $968.98 2026-06-10
64479 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Upper Or Middle Spine Nerve Roo… 28 14 $1,296.00 $1,101.60 $576.50 $1,410.22 $962.75 2026-06-10
72192 HCPCS CT Scan Of Pelvis Without Contrast 14 14 $1,425.00 $1,211.25 $712.50 $3,562.50 $960.40 2026-06-10
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 14 14 $1,420.00 $1,207.00 $710.00 $3,550.00 $958.40 2026-06-10
99291 HCPCS Critical Care, First 30-74 Minutes 26 14 $1,900.00 $1,615.00 $188.30 $1,862.00 $954.75 2026-06-10
58570 HCPCS Removal Of Uterus Through Abdomen Using An Endoscope, 250.0 G Or Less 12 12 $3,600.00 $3,060.00 $666.76 $2,340.00 $952.63 2026-06-10
72128 HCPCS CT Scan Of Middle Spine Without Contrast 14 14 $1,400.00 $1,190.00 $700.00 $3,500.00 $950.40 2026-06-10
01773199_1 CDM Gastro - Intestinal (gi) Services - General Classification 14 14 $1,165.84 $990.96 $582.92 $1,142.52 $944.33 2026-06-10
23515 HCPCS Treatment Of Broken Collar Bone 12 12 $2,393.00 $2,034.05 $621.00 $1,555.45 $943.92 2026-06-10
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 42 14 $1,850.00 $1,572.50 $447.50 $4,625.00 $943.50 2026-06-10
27769 HCPCS Treatment Of Broken Back Portion Of Shin Bone At Ankle 12 12 $2,235.00 $1,899.75 $618.66 $1,471.84 $940.37 2026-06-10
27829 HCPCS Treatment Of Ligament Tear At Ankle Joint 12 12 $2,640.00 $2,244.00 $617.78 $1,716.00 $939.02 2026-06-10
47563 HCPCS Removal Of Gallbladder With X-ray Study Of Bile Ducts Using An Endoscope 12 12 $3,290.00 $2,796.50 $615.61 $2,138.50 $935.73 2026-06-10
25000904_1 CDM Donnatal Elixir 14 14 $1,154.50 $981.33 $577.25 $1,154.50 $935.14 2026-06-10
25001314_1 CDM Combivent Respimat 20-100 Mcg 14 14 $1,152.20 $979.37 $576.10 $1,152.20 $933.28 2026-06-10
88309 HCPCS Pathology Examination Of Tissue Using A Microscope, High Complexity 14 14 $1,150.00 $977.50 $575.00 $1,150.00 $931.50 2026-06-10
70486 HCPCS CT Scan Of Face Without Contrast 14 14 $1,350.00 $1,147.50 $675.00 $3,375.00 $930.40 2026-06-10
64624 HCPCS Destruction Of Nerve Branches Of Knee Using Imaging Guidance 50 14 $1,850.00 $1,572.50 $125.84 $1,813.00 $925.00 2026-06-10
78708 HCPCS Nuclear Medicine Study Of Kidney, Blood, Flow, And Function With Drug Administra… 14 14 $1,139.00 $968.15 $569.50 $2,847.50 $922.59 2026-06-10
25087293_1 CDM Premarin Vaginal Cream-appl 14 14 $1,138.70 $967.90 $569.35 $1,138.70 $922.35 2026-06-10
78580 HCPCS Nuclear Medicine Study Of Lung Circulation 14 14 $1,270.00 $1,079.50 $635.00 $3,175.00 $921.39 2026-06-10
78070 HCPCS Nuclear Medicine Study Of Parathyroid 14 14 $1,377.08 $1,170.52 $688.54 $3,442.70 $919.70 2026-06-10
57260 HCPCS Plastic Repair Of Vagina And Tissue Separating Vagina, Rectum, And Bladder 12 12 $2,560.00 $2,176.00 $634.52 $1,664.00 $912.78 2026-06-10
70450 HCPCS CT Scan Head Or Brain Without Contrast 14 14 $1,300.00 $1,105.00 $650.00 $3,250.00 $910.40 2026-06-10
73700 HCPCS CT Scan Of Leg Without Contrast 28 14 $1,300.00 $1,105.00 $650.00 $3,250.00 $910.40 2026-06-10
25461001_1 CDM Mometasone/formoterol (dulera) 200/5 Inh 14 14 $1,123.30 $954.81 $561.65 $1,123.30 $909.88 2026-06-10
01700393_1 CDM Trauma Response Priority 3 14 14 $1,121.00 $952.85 $560.50 $1,098.58 $908.01 2026-06-10
10009 HCPCS Fine Needle Aspiration Biopsy Of Growth Using CT Guidance, First Growth 12 12 $1,121.00 $952.85 $560.50 $1,098.58 $908.01 2026-06-10
J0881 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 105 14 $1,126.60 $957.61 $8.15 $7,671.40 $901.28 2026-06-10
36573 HCPCS Insertion Of Tube For Infusion With Imaging Guidance And Review By Radiologist, … 14 14 $1,102.00 $936.70 $551.00 $1,079.96 $892.62 2026-06-10
74150 HCPCS CT Scan Of Abdomen Without Contrast 14 14 $1,250.00 $1,062.50 $625.00 $3,125.00 $890.40 2026-06-10
J3489 HCPCS Injection, Zoledronic Acid, 1 Mg 42 14 $1,098.60 $933.81 $32.20 $3,913.80 $889.87 2026-06-10
13160 HCPCS Extensive Or Complicated Repair Of Surface Wound Reopening 12 12 $2,084.00 $1,771.40 $681.58 $1,567.63 $889.47 2026-06-10
29824 HCPCS Partial Removal Of Collar Bone At Shoulder Using An Endoscope 12 12 $3,465.00 $2,945.25 $584.97 $2,252.25 $889.15 2026-06-10
22512 HCPCS Stabilization Of Spine Bone, Each Additional Bone 14 14 $1,095.00 $930.75 $547.50 $1,073.10 $886.95 2026-06-10
64421 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Multiple Rib Nerves For Region… 14 14 $1,093.00 $929.05 $546.50 $1,071.14 $885.33 2026-06-10
01299115_1 CDM Operating Room Services - General Classification 14 14 $1,092.00 $928.20 $546.00 $1,070.16 $884.52 2026-06-10
78300 HCPCS Nuclear Medicine Study Of Bone And/or Joint Limited Area 14 14 $1,092.00 $928.20 $546.00 $2,730.00 $884.52 2026-06-10
J2469 HCPCS Injection, Palonosetron Hcl, 25 Mcg 14 14 $1,089.10 $925.74 $544.55 $1,089.10 $882.17 2026-06-10
27509 HCPCS Treatment Of Broken Thigh Bone At Far End With Placement Of Stabilizing Device 12 12 $1,758.00 $1,494.30 $596.87 $1,372.80 $878.74 2026-06-10
57288 HCPCS Creation Of Sling Around Urethra In Female To Control Leakage 12 12 $3,775.00 $3,208.75 $613.68 $2,453.75 $877.05 2026-06-10
01243003_1 CDM Gastro - Intestinal (gi) Services - General Classification 14 14 $1,082.00 $919.70 $541.00 $1,060.36 $876.42 2026-06-10
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