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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

5,208 distinct procedures filed
14 distinct payers
81,370 rate rows
2026-06-10 last MRF observed
Data quality

80,718 of 81,370 rate rows are consumer-grade (99.2%)

652 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
template filing: same amount across many unrelated codes — excluded 391
percent-of-charges filed in the dollar field — excluded from medians 169
per-diem day rate — not a per-procedure price 57
exceeds 10× this hospital's gross charge — excluded from medians 27
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 8
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 · 2026-08-18
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
$331
outlier · 182.0×
J2327
HCPCS 		Injection, Risankizumab-rzaa, Intravenous, 1 Mg 14 $19,143.60 $38,287.20 $31,012.63 nat. median
$961
outlier · 32.3×
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 14 $15,605.85 $31,211.70 $25,281.47 nat. median
$150
outlier · 168.8×
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 14 $11,245.00 $22,490.00 $18,216.90 nat. median
$1,555
outlier · 11.7×
J9043
HCPCS 		Injection, Cabazitaxel, 1 Mg 14 $10,123.90 $20,247.80 $16,400.72 nat. median
$709
outlier · 23.1×
Q5108
HCPCS 		Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 14 $7,521.00 $15,042.00 $12,184.02 nat. median
$1,244
outlier · 9.8×
J9217
HCPCS 		Leuprolide Acetate (for Depot Suspension), 7.5 Mg 14 $6,743.40 $28,821.50 $11,704.33 nat. median
$1,518
outlier · 7.7×
04458044_1
CDM 		16 Ch Receiver Kit 3416 14 $7,189.25 $14,378.50 $11,646.58 nat. median
$11,647
1.0× median
J0565
HCPCS 		Injection, Bezlotoxumab, 10 Mg 14 $6,846.00 $13,692.00 $11,090.52 nat. median
$151
outlier · 73.3×
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
$1,187
outlier · 8.6×
J1306
HCPCS 		Injection, Inclisiran, 1 Mg 14 $6,003.15 $12,006.30 $9,725.10 nat. median
$43
outlier · 225.5×
90378
HCPCS 		Respiratory Syncytial Virus Antibody For Injection Into Tissue Or Muscle 14 $5,927.80 $11,855.60 $9,603.03 nat. median
$2,124
outlier · 4.5×
J9299
HCPCS 		Injection, Nivolumab, 1 Mg 14 $5,751.00 $11,502.00 $9,316.62 nat. median
$2,649
outlier · 3.5×
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 14 $167.22 $13,727.30 $9,025.70 nat. median
$3,475
outlier · 2.6×
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 8 $6,891.14 $8,441.65 $7,537.19 nat. median
$12,892
0.6× median
81163
HCPCS 		Gene Analysis (breast Cancer 1 And 2) Of Full Sequence 14 $4,650.00 $43,524.00 $7,533.00 nat. median
$562
outlier · 13.4×
J9306
HCPCS 		Injection, Pertuzumab, 1 Mg 14 $4,445.95 $8,891.90 $7,202.44 nat. median
$67
outlier · 108.0×
C1764
HCPCS 		Event Recorder, Cardiac (implantable) 14 $3,971.25 $7,942.50 $6,433.43 nat. median
$7,735
0.8× median
J3358
HCPCS 		Ustekinumab, For Intravenous Injection, 1 Mg 14 $3,650.10 $7,300.20 $5,913.16 nat. median
$212
outlier · 27.9×
J0896
HCPCS 		Injection, Luspatercept-aamt, 0.25 Mg 13 $3,513.30 $7,026.60 $5,621.28 nat. median
$4,503
1.2× median
J9271
HCPCS 		Injection, Pembrolizumab, 1 Mg 14 $3,409.90 $6,819.80 $5,524.04 nat. median
$254
outlier · 21.8×
01204769_1
CDM 		Allomax Soft Tissue Graft 14 $3,307.50 $6,615.00 $5,358.15 nat. median
$5,358
1.0× median
J1602
HCPCS 		Injection, Golimumab, 1 Mg, For Intravenous Use 14 $3,126.40 $6,252.80 $5,064.77 nat. median
$228
outlier · 22.3×
J2426
HCPCS 		Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg 14 $3,008.15 $6,016.30 $4,873.20 nat. median
$2,444
2.0× median
E0747
HCPCS 		Osteogenesis Stimulator, Electrical, Non-invasive, Other Than Spinal Application… 14 $2,925.00 $5,733.00 $4,738.50 nat. median
$5,581
0.8× median
01204770_1
CDM 		Xenmatrix Surgical Graft 3.9x5.9 14 $2,850.00 $5,700.00 $4,617.00 nat. median
$4,617
1.0× median
J0875
HCPCS 		Injection, Dalbavancin, 5 Mg 14 $2,768.45 $5,536.90 $4,484.89 nat. median
$371
outlier · 12.1×
J0897
HCPCS 		Injection, Denosumab, 1 Mg 14 $33.74 $12,431.10 $4,272.80 nat. median
$1,965
outlier · 2.2×
J1439
HCPCS 		Injection, Ferric Carboxymaltose, 1 Mg 14 $2,532.80 $5,065.60 $4,103.14 nat. median
$11
outlier · 377.8×
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
$842
outlier · 4.8×
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
$1,035
outlier · 3.7×
J2353
HCPCS 		Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg 14 $2,251.60 $6,101.10 $3,760.17 nat. median
$5,513
0.7× median
J1569
HCPCS 		Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 14 $78.55 $16,133.20 $3,637.55 nat. median
$1,010
outlier · 3.6×
25366301_1
CDM 		Lupron Depot 11.25mg, Kit 14 $2,221.41 $4,442.81 $3,598.68 nat. median
$3,599
1.0× median
J1459
HCPCS 		Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 14 $1,194.00 $9,616.00 $3,598.00 nat. median
$1,287
outlier · 2.8×
J1162
HCPCS 		Injection, Digoxin Immune Fab (ovine), Per Vial 14 $2,157.00 $4,314.00 $3,494.34 nat. median
$7,100
outlier · 0.5×
J9305
HCPCS 		Injection, Pemetrexed, Not Otherwise Specified, 10 Mg 14 $137.17 $5,239.00 $3,444.64 nat. median
$204
outlier · 16.9×
J3111
HCPCS 		Injection, Romosozumab-aqqg, 1 Mg 13 $2,093.50 $4,187.00 $3,349.60 nat. median
$657
outlier · 5.1×
J9177
HCPCS 		Injection, Enfortumab Vedotin-ejfv, 0.25 Mg 13 $1,939.00 $5,792.00 $3,141.18 nat. median
$2,933
1.1× median
J0641
HCPCS 		Injection, Levoleucovorin, Not Otherwise Specified, 0.5 Mg 14 $1,911.75 $3,823.50 $3,097.03 nat. median
$28
outlier · 109.6×
03005070_1
CDM 		Alloderm Select Tissue 2.4+0.4 14 $1,875.00 $3,750.00 $3,037.50 nat. median
$3,038
1.0× median
J2357
HCPCS 		Injection, Omalizumab, 5 Mg 14 $1,846.50 $3,693.00 $2,991.33 nat. median
$1,217
outlier · 2.5×
J3262
HCPCS 		Injection, Tocilizumab, 1 Mg 14 $523.10 $9,572.90 $2,916.32 nat. median
$1,375
outlier · 2.1×
J1745
HCPCS 		Injection, Infliximab, Excludes Biosimilar, 10 Mg 14 $169.16 $4,224.60 $2,777.68 nat. median
$388
outlier · 7.2×
J9312
HCPCS 		Injection, Rituximab, 10 Mg 14 $973.85 $7,096.40 $2,747.95 nat. median
$1,027
outlier · 2.7×
J9395
HCPCS 		Injection, Fulvestrant, 25 Mg 14 $1,674.75 $3,349.50 $2,713.10 nat. median
$234
outlier · 11.6×
22510
HCPCS 		Stabilization Of Upper Spine Bone 14 $1,650.00 $3,234.00 $2,673.00 nat. median
$4,216
0.6× median
22511
HCPCS 		Stabilization Of Lower Spine Bone 14 $1,650.00 $3,234.00 $2,673.00 nat. median
$4,208
0.6× 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
$1,777
1.5× median
25990534_1
CDM 		Semaglutide (ozempic) 0.25 Or 0.5mg 14 $1,611.70 $3,223.40 $2,610.95 nat. median
$2,611
1.0× median

Other procedures at this hospital

Browse this hospital's 5,208 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
             
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
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
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
23430 HCPCS Anchoring Of Biceps Tendon 12 12 $3,284.00 $2,791.40 $637.49 $2,134.60 $968.98 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
25000904_1 CDM Donnatal Elixir 14 14 $1,154.50 $981.33 $577.25 $1,154.50 $935.14 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
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
04458043_1 CDM Extension #3382 14 14 $1,369.85 $1,164.37 $684.93 $1,369.85 $1,109.58 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
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
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
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
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
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
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
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
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
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
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
L8642 HCPCS Hallux Implant 14 14 $1,820.00 $1,547.00 $910.00 $1,820.00 $1,474.20 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
J2469 HCPCS Injection, Palonosetron Hcl, 25 Mcg 14 14 $1,089.10 $925.74 $544.55 $1,089.10 $882.17 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
J3489 HCPCS Injection, Zoledronic Acid, 1 Mg 42 14 $1,098.60 $933.81 $32.20 $3,913.80 $889.87 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
C1788 HCPCS Port, Indwelling (implantable) 28 14 $3,034.50 $2,579.32 $409.50 $5,250.00 $1,722.00 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
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
189 MS_DRG Pulmonary Edema And Respiratory Failure 8 8 $8,613.93 $7,321.84 $6,891.14 $8,441.65 $7,537.19 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
01700393_1 CDM Trauma Response Priority 3 14 14 $1,121.00 $952.85 $560.50 $1,098.58 $908.01 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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