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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

SYRINGA GENERAL HOSPITAL

Grangeville, ID · CCN 131315 · Rates published

Your selected procedure

You selected 93306 (HCPCS)

Ultrasound of heart with color-depicted blood flow, rate, direction and valve function

This hospital’s price: $2,030 across 5 payers · range $1,760-$2,071

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbSGH0GRANGEVILLEID&type=CDMWithoutLabel&fileType=CSV · observed 2026-01-02

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

2,407 distinct procedures filed
5 distinct payers
13,466 rate rows
2026-01-02 last MRF observed
Data quality

13,462 of 13,466 rate rows are consumer-grade (100.0%)

4 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
percent-of-charges filed in the dollar field — excluded from medians 4
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbSGH0GRANGEVILLEID&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/Syringa_V3.aspx?sub=Patient%20Tools
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-20
Content fingerprint d84431d3872778db… · 5,542,324 bytes · first seen 2026-05-08

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
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 5 $15,480.47 $18,212.32 $17,848.07 nat. median
$155
outlier · 115.5×
21784635_1
CDM 		Template Non-formulary 1 Ea Vial 5 $8,907.81 $17,815.61 $16,924.83 nat. median
$16,925
1.0× median
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 5 $13,555.35 $15,947.47 $15,628.52 nat. median
$3,787
outlier · 4.1×
J2323
HCPCS 		Injection, Natalizumab, 1 Mg 5 $12,241.22 $14,401.43 $14,113.40 nat. median
$180
outlier · 78.5×
Q5111
HCPCS 		Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg 5 $9,456.52 $11,125.32 $10,902.81 nat. median
$1,984
outlier · 5.5×
J0517
HCPCS 		Injection, Benralizumab, 1 Mg 5 $8,978.32 $10,562.73 $10,351.48 nat. median
$919
outlier · 11.3×
J9312
HCPCS 		Injection, Rituximab, 10 Mg 5 $8,395.84 $9,877.46 $9,679.91 nat. median
$1,063
outlier · 9.1×
J2997
HCPCS 		Injection, Alteplase Recombinant, 1 Mg 5 $462.74 $17,160.79 $7,565.53 nat. median
$500
outlier · 15.1×
18615411_1
CDM 		Crofab Vial 5 $3,136.15 $6,272.30 $5,958.69 nat. median
$5,959
1.0× median
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 5 $4,908.81 $5,775.07 $5,659.57 nat. median
$1,659
outlier · 3.4×
Q5119
HCPCS 		Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg 5 $4,719.52 $5,552.38 $5,441.33 nat. median
$831
outlier · 6.6×
J9217
HCPCS 		Leuprolide Acetate (for Depot Suspension), 7.5 Mg 5 $697.90 $23,834.21 $5,390.64 nat. median
$1,573
outlier · 3.4×
23620403_1
CDM 		Synagis 100 Mg Inj [sgho] 5 $2,775.82 $5,551.63 $5,274.05 nat. median
$5,274
1.0× median
Q5115
HCPCS 		Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg 5 $4,293.43 $5,051.09 $4,950.07 nat. median
$839
outlier · 5.9×
J0897
HCPCS 		Injection, Denosumab, 1 Mg 5 $3,012.87 $4,888.49 $3,849.89 nat. median
$1,982
1.9× median
22907309_1
CDM 		Triptorelin 11.25 Mg Rec Injection 5 $1,863.18 $3,726.35 $3,540.03 nat. median
$3,540
1.0× median
J3032
HCPCS 		Injection, Eptinezumab-jjmr, 1 Mg 5 $3,059.34 $3,599.22 $3,527.24 nat. median
$73
outlier · 48.6×
44141
HCPCS 		Partial Removal Of Large Bowel With Creation Of Opening To Skin 5 $2,513.70 $5,209.19 $3,335.40 nat. median
$3,115
1.1× median
44143
HCPCS 		Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin 5 $2,292.83 $4,752.39 $3,232.75 nat. median
$3,003
1.1× median
59510
HCPCS 		Cesarean Delivery With Care Before And After Delivery 5 $2,857.78 $3,745.10 $3,220.23 nat. median
$3,631
0.9× median
70546
HCPCS 		MRI Scan Of Blood Vessels Of Head Before And After Contrast 5 $2,780.35 $3,271.00 $3,205.58 nat. median
$1,073
outlier · 3.0×
73723
HCPCS 		MRI Scan Of Leg Joint Before And After Contrast 5 $2,780.35 $3,271.00 $3,205.58 nat. median
$1,199
outlier · 2.7×
72158
HCPCS 		MRI Scan Of Lower Spinal Canal Before And After Contrast 5 $2,780.35 $3,271.00 $3,205.58 nat. median
$1,097
outlier · 2.9×
72157
HCPCS 		MRI Scan Of Middle Spinal Canal Before And After Contrast 5 $2,780.35 $3,271.00 $3,205.58 nat. median
$1,114
outlier · 2.9×
73720
HCPCS 		MRI Scan Of Leg Before And After Contrast 5 $2,780.35 $3,271.00 $3,205.58 nat. median
$1,135
outlier · 2.8×
70553
HCPCS 		MRI Scan Of Brain Before And After Contrast 5 $2,780.35 $3,271.00 $3,205.58 nat. median
$1,136
outlier · 2.8×
73223
HCPCS 		MRI Scan Of Arm Joint Before And After Contrast 5 $2,780.35 $3,271.00 $3,205.58 nat. median
$1,158
outlier · 2.8×
74183
HCPCS 		MRI Scan Of Abdomen Before And After Contrast 5 $2,780.35 $3,271.00 $3,205.58 nat. median
$1,105
outlier · 2.9×
71552
HCPCS 		MRI Scan Of Chest Before And After Contrast 5 $2,780.35 $3,271.00 $3,205.58 nat. median
$1,103
outlier · 2.9×
73220
HCPCS 		MRI Scan Of Arm Before And After Contrast 5 $2,780.35 $3,271.00 $3,205.58 nat. median
$1,136
outlier · 2.8×
70549
HCPCS 		MRI Scan Of Blood Vessels Of Neck Before And After Contrast 5 $2,780.35 $3,271.00 $3,205.58 nat. median
$1,063
outlier · 3.0×
72197
HCPCS 		MRI Scan Of Pelvis Before And After Contrast 5 $2,780.35 $3,271.00 $3,205.58 nat. median
$1,074
outlier · 3.0×
75561
HCPCS 		MRI Scan Of Heart Before And After Contrast 5 $2,780.35 $3,271.00 $3,205.58 nat. median
$766
outlier · 4.2×
43860
HCPCS 		Revision Of Surgically Created Connection Of Stomach To Small Bowel 5 $2,252.93 $4,667.46 $3,176.47 nat. median
$3,199
1.0× median
44626
HCPCS 		Closure Of Surgically Created Large Or Small Bowel Opening With Bowel Removal An… 5 $2,205.43 $4,581.98 $3,110.81 nat. median
$3,023
1.0× median
77058
HCPCS 		MRI One Breast 5 $2,662.20 $3,132.00 $3,069.36 nat. median
$1,104
outlier · 2.8×
77059
HCPCS 		MRI Both Breasts 5 $2,659.65 $3,129.00 $3,066.42 nat. median
$1,630
1.9× median
43282
HCPCS 		Repair Of Hernia Of Muscle At Esophagus And Stomach With Implantation Of Mesh US… 5 $2,391.63 $4,947.05 $3,061.70 nat. median
$10,337
outlier · 0.3×
59610
HCPCS 		Vaginal Delivery And Care Before And After Delivery After Previous Cesarean Deli… 5 $2,712.44 $3,883.65 $3,047.24 nat. median
$3,322
0.9× median
43644
HCPCS 		Bypass Of Stomach Using An Endoscope 5 $2,386.40 $4,937.73 $3,003.59 nat. median
$6,467
outlier · 0.5×
43281
HCPCS 		Repair Of Hernia Of Muscle At Esophagus And Stomach Using An Endoscope 5 $2,127.05 $4,400.37 $2,996.24 nat. median
$10,128
outlier · 0.3×
44204
HCPCS 		Partial Removal Of Large Bowel Using An Endoscope 5 $2,118.98 $4,408.90 $2,987.53 nat. median
$3,582
0.8× median
59400
HCPCS 		Vaginal Delivery With Care Before And After Delivery 5 $2,576.56 $3,394.90 $2,935.24 nat. median
$3,129
0.9× median
72156
HCPCS 		MRI Scan Of Upper Spinal Canal Before And After Contrast 5 $2,442.05 $3,271.00 $2,873.00 nat. median
$1,110
outlier · 2.6×
J0129
HCPCS 		Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 5 $2,479.65 $2,917.24 $2,858.90 nat. median
$902
outlier · 3.2×
70543
HCPCS 		MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 5 $2,465.85 $2,901.00 $2,842.98 nat. median
$1,087
outlier · 2.6×
10215383_1
CDM 		Synagis 50 Mg Inj [sgho] 5 $1,472.97 $2,945.93 $2,798.63 nat. median
$2,799
1.0× median
72159
HCPCS 		MRI Scan Of Blood Vessels Of Spinal Canal 5 $2,362.15 $2,779.00 $2,723.42 nat. median
$1,092
outlier · 2.5×
J2357
HCPCS 		Injection, Omalizumab, 5 Mg 5 $2,342.86 $2,756.30 $2,701.17 nat. median
$1,249
outlier · 2.2×
73725
HCPCS 		MRI Scan Of Blood Vessels Of Leg 5 $2,278.85 $4,021.00 $2,681.00 nat. median
$1,252
outlier · 2.1×

Other procedures at this hospital

Browse this hospital's 2,407 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
             
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 5 5 $18,212.32 $16,391.09 $15,480.47 $18,212.32 $17,848.07 2026-01-02
21784635_1 CDM Template Non-formulary 1 Ea Vial 5 5 $17,815.61 $16,034.05 $8,907.81 $17,815.61 $16,924.83 2026-01-02
J3101 HCPCS Injection, Tenecteplase, 1 Mg 5 5 $15,947.47 $14,352.72 $13,555.35 $15,947.47 $15,628.52 2026-01-02
J2323 HCPCS Injection, Natalizumab, 1 Mg 5 5 $14,401.43 $12,961.29 $12,241.22 $14,401.43 $14,113.40 2026-01-02
Q5111 HCPCS Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg 5 5 $11,125.32 $10,012.79 $9,456.52 $11,125.32 $10,902.81 2026-01-02
J0517 HCPCS Injection, Benralizumab, 1 Mg 5 5 $10,562.73 $9,506.46 $8,978.32 $10,562.73 $10,351.48 2026-01-02
J9312 HCPCS Injection, Rituximab, 10 Mg 5 5 $9,877.46 $8,889.71 $8,395.84 $9,877.46 $9,679.91 2026-01-02
J2997 HCPCS Injection, Alteplase Recombinant, 1 Mg 10 5 $8,852.59 $7,967.34 $462.74 $17,160.79 $7,565.53 2026-01-02
18615411_1 CDM Crofab Vial 5 5 $6,272.30 $5,645.07 $3,136.15 $6,272.30 $5,958.69 2026-01-02
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 5 5 $5,775.07 $5,197.56 $4,908.81 $5,775.07 $5,659.57 2026-01-02
Q5119 HCPCS Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg 5 5 $5,552.38 $4,997.14 $4,719.52 $5,552.38 $5,441.33 2026-01-02
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 20 5 $6,204.45 $5,584.01 $697.90 $23,834.21 $5,390.64 2026-01-02
23620403_1 CDM Synagis 100 Mg Inj [sgho] 5 5 $5,551.63 $4,996.47 $2,775.82 $5,551.63 $5,274.05 2026-01-02
Q5115 HCPCS Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg 5 5 $5,051.09 $4,545.98 $4,293.43 $5,051.09 $4,950.07 2026-01-02
J0897 HCPCS Injection, Denosumab, 1 Mg 10 5 $4,216.52 $3,794.87 $3,012.87 $4,888.49 $3,849.89 2026-01-02
22907309_1 CDM Triptorelin 11.25 Mg Rec Injection 5 5 $3,726.35 $3,353.72 $1,863.18 $3,726.35 $3,540.03 2026-01-02
J3032 HCPCS Injection, Eptinezumab-jjmr, 1 Mg 5 5 $3,599.22 $3,239.30 $3,059.34 $3,599.22 $3,527.24 2026-01-02
44141 HCPCS Partial Removal Of Large Bowel With Creation Of Opening To Skin 5 5 $3,924.00 $3,531.60 $2,513.70 $5,209.19 $3,335.40 2026-01-02
44143 HCPCS Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin 5 5 $3,889.00 $3,500.10 $2,292.83 $4,752.39 $3,232.75 2026-01-02
59510 HCPCS Cesarean Delivery With Care Before And After Delivery 5 5 $4,406.00 $3,965.40 $2,857.78 $3,745.10 $3,220.23 2026-01-02
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 5 5 $3,271.00 $2,943.90 $2,780.35 $3,271.00 $3,205.58 2026-01-02
75561 HCPCS MRI Scan Of Heart Before And After Contrast 5 5 $3,271.00 $2,943.90 $2,780.35 $3,271.00 $3,205.58 2026-01-02
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 5 5 $3,271.00 $2,943.90 $2,780.35 $3,271.00 $3,205.58 2026-01-02
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 5 5 $3,271.00 $2,943.90 $2,780.35 $3,271.00 $3,205.58 2026-01-02
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 5 5 $3,271.00 $2,943.90 $2,780.35 $3,271.00 $3,205.58 2026-01-02
73720 HCPCS MRI Scan Of Leg Before And After Contrast 5 5 $3,271.00 $2,943.90 $2,780.35 $3,271.00 $3,205.58 2026-01-02
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 5 5 $3,271.00 $2,943.90 $2,780.35 $3,271.00 $3,205.58 2026-01-02
73220 HCPCS MRI Scan Of Arm Before And After Contrast 5 5 $3,271.00 $2,943.90 $2,780.35 $3,271.00 $3,205.58 2026-01-02
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 5 5 $3,271.00 $2,943.90 $2,780.35 $3,271.00 $3,205.58 2026-01-02
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 5 5 $3,271.00 $2,943.90 $2,780.35 $3,271.00 $3,205.58 2026-01-02
70553 HCPCS MRI Scan Of Brain Before And After Contrast 5 5 $3,271.00 $2,943.90 $2,780.35 $3,271.00 $3,205.58 2026-01-02
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 5 5 $3,271.00 $2,943.90 $2,780.35 $3,271.00 $3,205.58 2026-01-02
71552 HCPCS MRI Scan Of Chest Before And After Contrast 5 5 $3,271.00 $2,943.90 $2,780.35 $3,271.00 $3,205.58 2026-01-02
43860 HCPCS Revision Of Surgically Created Connection Of Stomach To Small Bowel 5 5 $4,044.00 $3,639.60 $2,252.93 $4,667.46 $3,176.47 2026-01-02
44626 HCPCS Closure Of Surgically Created Large Or Small Bowel Opening With Bowel Removal An… 5 5 $3,749.00 $3,374.10 $2,205.43 $4,581.98 $3,110.81 2026-01-02
77058 HCPCS MRI One Breast 5 5 $3,132.00 $2,818.80 $2,662.20 $3,132.00 $3,069.36 2026-01-02
77059 HCPCS MRI Both Breasts 5 5 $3,129.00 $2,816.10 $2,659.65 $3,129.00 $3,066.42 2026-01-02
43282 HCPCS Repair Of Hernia Of Muscle At Esophagus And Stomach With Implantation Of Mesh Us… 5 5 $3,602.00 $3,241.80 $2,391.63 $4,947.05 $3,061.70 2026-01-02
59610 HCPCS Vaginal Delivery And Care Before And After Delivery After Previous Cesarean Deli… 5 5 $4,569.00 $4,112.10 $2,712.44 $3,883.65 $3,047.24 2026-01-02
43644 HCPCS Bypass Of Stomach Using An Endoscope 5 5 $3,493.00 $3,143.70 $2,386.40 $4,937.73 $3,003.59 2026-01-02
43281 HCPCS Repair Of Hernia Of Muscle At Esophagus And Stomach Using An Endoscope 5 5 $3,603.00 $3,242.70 $2,127.05 $4,400.37 $2,996.24 2026-01-02
44204 HCPCS Partial Removal Of Large Bowel Using An Endoscope 5 5 $3,617.00 $3,255.30 $2,118.98 $4,408.90 $2,987.53 2026-01-02
59400 HCPCS Vaginal Delivery With Care Before And After Delivery 5 5 $3,994.00 $3,594.60 $2,576.56 $3,394.90 $2,935.24 2026-01-02
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 10 5 $3,072.00 $2,764.80 $2,442.05 $3,271.00 $2,873.00 2026-01-02
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 5 5 $2,917.24 $2,625.52 $2,479.65 $2,917.24 $2,858.90 2026-01-02
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 5 5 $2,901.00 $2,610.90 $2,465.85 $2,901.00 $2,842.98 2026-01-02
10215383_1 CDM Synagis 50 Mg Inj [sgho] 5 5 $2,945.93 $2,651.34 $1,472.97 $2,945.93 $2,798.63 2026-01-02
72159 HCPCS MRI Scan Of Blood Vessels Of Spinal Canal 5 5 $2,779.00 $2,501.10 $2,362.15 $2,779.00 $2,723.42 2026-01-02
J2357 HCPCS Injection, Omalizumab, 5 Mg 5 5 $2,756.30 $2,480.67 $2,342.86 $2,756.30 $2,701.17 2026-01-02
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 15 5 $2,681.00 $2,412.90 $2,278.85 $4,021.00 $2,681.00 2026-01-02
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 10 5 $2,734.00 $2,460.60 $2,323.90 $2,734.00 $2,679.32 2026-01-02
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 10 5 $2,700.50 $2,430.45 $2,266.95 $2,734.00 $2,640.33 2026-01-02
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 10 5 $2,700.50 $2,430.45 $2,266.95 $2,734.00 $2,640.33 2026-01-02
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 5 5 $2,673.00 $2,405.70 $2,272.05 $2,673.00 $2,619.54 2026-01-02
73225 HCPCS MRI Scan Of Blood Vessels Of Arm 5 5 $2,672.00 $2,404.80 $2,271.20 $2,672.00 $2,618.56 2026-01-02
71555 HCPCS MRI Scan Of Blood Vessels Of Chest 5 5 $2,671.00 $2,403.90 $2,270.35 $2,671.00 $2,617.58 2026-01-02
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 5 5 $2,670.00 $2,403.00 $2,269.50 $2,670.00 $2,616.60 2026-01-02
73219 HCPCS MRI Scan Of Arm With Contrast 5 5 $2,662.00 $2,395.80 $2,262.70 $2,662.00 $2,608.76 2026-01-02
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 5 5 $2,662.00 $2,395.80 $2,262.70 $2,662.00 $2,608.76 2026-01-02
73722 HCPCS MRI Scan Of Leg Joint With Contrast 5 5 $2,662.00 $2,395.80 $2,262.70 $2,662.00 $2,608.76 2026-01-02
73719 HCPCS MRI Scan Of Leg With Contrast 5 5 $2,662.00 $2,395.80 $2,262.70 $2,662.00 $2,608.76 2026-01-02
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 5 5 $2,662.00 $2,395.80 $2,262.70 $2,662.00 $2,608.76 2026-01-02
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 5 5 $2,662.00 $2,395.80 $2,262.70 $2,662.00 $2,608.76 2026-01-02
72196 HCPCS MRI Scan Of Pelvis With Contrast 5 5 $2,662.00 $2,395.80 $2,262.70 $2,662.00 $2,608.76 2026-01-02
70552 HCPCS MRI Scan Of Brain With Contrast 5 5 $2,662.00 $2,395.80 $2,262.70 $2,662.00 $2,608.76 2026-01-02
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 5 5 $2,662.00 $2,395.80 $2,262.70 $2,662.00 $2,608.76 2026-01-02
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 5 5 $2,662.00 $2,395.80 $2,262.70 $2,662.00 $2,608.76 2026-01-02
74182 HCPCS MRI Scan Of Abdomen With Contrast 5 5 $2,662.00 $2,395.80 $2,262.70 $2,662.00 $2,608.76 2026-01-02
71551 HCPCS MRI Scan Of Chest With Contrast 5 5 $2,662.00 $2,395.80 $2,262.70 $2,662.00 $2,608.76 2026-01-02
73222 HCPCS MRI Scan Of Arm Joint With Contrast 5 5 $2,662.00 $2,395.80 $2,262.70 $2,662.00 $2,608.76 2026-01-02
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 5 5 $2,662.00 $2,395.80 $2,262.70 $2,662.00 $2,608.76 2026-01-02
44140 HCPCS Partial Removal Of Large Bowel With Connection 5 5 $3,617.00 $3,255.30 $1,848.70 $3,831.74 $2,604.29 2026-01-02
J2315 HCPCS Injection, Naltrexone, Depot Form, 1 Mg 5 5 $2,575.84 $2,318.26 $2,189.46 $2,575.84 $2,524.32 2026-01-02
44202 HCPCS Partial Removal And Reconnection Of Small Bowel Using An Endoscope 5 5 $2,902.00 $2,611.80 $1,906.18 $3,953.99 $2,466.70 2026-01-02
43840 HCPCS Suture Of Perforated Ulcer, Wound, Or Injury Of Stomach Or Upper Small Bowel 5 5 $2,843.00 $2,558.70 $1,873.40 $3,875.44 $2,416.55 2026-01-02
44188 HCPCS Creation Of Large Bowel Opening Using An Endoscope 5 5 $2,865.00 $2,578.50 $1,684.35 $3,500.63 $2,380.51 2026-01-02
43820 HCPCS Partial Removal Of Stomach With Attachment Of Stomach To Small Bowel 5 5 $2,486.00 $2,237.40 $1,851.08 $3,827.54 $2,328.39 2026-01-02
867367_1 CDM Room & Board - Other - Sterile Environment 4 4 $2,426.00 $2,183.40 $2,062.10 $2,377.48 $2,304.70 2026-01-02
3136237_1 CDM Labor Room/delivery - Delivery Room 5 5 $2,402.00 $2,161.80 $1,201.00 $2,402.00 $2,281.90 2026-01-02
15734 HCPCS Creation Of Muscle Graft To Trunk 5 5 $3,162.00 $2,845.80 $1,861.45 $2,687.70 $2,265.12 2026-01-02
44120 HCPCS Partial Removal Of Small Bowel With Reconnection 5 5 $2,638.00 $2,374.20 $1,685.30 $3,491.14 $2,242.30 2026-01-02
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
70551 HCPCS MRI Scan Of Brain Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
71550 HCPCS MRI Scan Of Chest Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
74181 HCPCS MRI Scan Of Abdomen Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
73718 HCPCS MRI Scan Of Leg Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
75559 HCPCS MRI Scan Of Heart Without Contrast With Stress Imaging 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
72195 HCPCS MRI Scan Of Pelvis Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
75557 HCPCS MRI Scan Of Heart Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
73218 HCPCS MRI Scan Of Arm Without Contrast 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
70336 HCPCS MRI Scan Of Jaw Joint 5 5 $2,260.00 $2,034.00 $1,921.00 $2,260.00 $2,214.80 2026-01-02
44160 HCPCS Partial Removal Of Small And Large Bowel With Attachment Of Small And Large Bowe… 5 5 $2,601.00 $2,340.90 $1,710.48 $3,548.82 $2,210.85 2026-01-02
47605 HCPCS Removal Of Gallbladder With X-ray Study Of Bile Ducts 5 5 $3,023.00 $2,720.70 $1,548.50 $3,201.39 $2,179.51 2026-01-02
867366_1 CDM Room & Board - Semi-private (two Beds) - General Classification 4 4 $2,278.00 $2,050.20 $1,936.30 $2,232.44 $2,164.10 2026-01-02
44005 HCPCS Release Of Intestinal Scar Tissue 5 5 $2,565.00 $2,308.50 $1,508.60 $3,123.21 $2,125.91 2026-01-02
1249745_1 CDM Specialty Services - Treatment Room 5 5 $2,232.00 $2,008.80 $1,116.00 $2,232.00 $2,120.40 2026-01-02
43280 HCPCS Strengthening Of Muscle Between Esophagus And Stomach By Wrapping Part Of Stomac… 5 5 $2,529.00 $2,276.10 $1,488.18 $3,078.58 $2,097.77 2026-01-02
44320 HCPCS Creation Of Opening From Large Bowel To Skin 5 5 $2,433.00 $2,189.70 $1,655.38 $3,434.63 $2,084.55 2026-01-02
Q5108 HCPCS Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 5 5 $2,121.37 $1,909.23 $1,803.16 $2,121.37 $2,078.94 2026-01-02
47600 HCPCS Removal Of Gallbladder 5 5 $2,873.00 $2,585.70 $1,471.08 $3,043.11 $2,069.63 2026-01-02
J1561 HCPCS Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liquid)… 15 5 $2,085.20 $1,876.68 $10.63 $3,857.81 $2,043.50 2026-01-02
44345 HCPCS Complicated Reconstruction Of Opening From Large Bowel To Skin 5 5 $2,476.00 $2,228.40 $1,445.90 $3,007.53 $2,042.16 2026-01-02
73706 HCPCS CT Scan Of Blood Vessels Of Lower Leg With Contrast 10 5 $2,239.00 $2,015.10 $1,522.35 $2,687.00 $2,037.47 2026-01-02
C8929 HCPCS Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi… 5 5 $2,071.00 $1,863.90 $1,760.35 $2,071.00 $2,029.58 2026-01-02
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 5 5 $2,071.00 $1,863.90 $1,760.35 $2,071.00 $2,029.58 2026-01-02
58152 HCPCS Removal Of Uterus And Cervix Through Abdomen With Repair Of Vagina 5 5 $3,389.00 $3,050.10 $1,690.53 $2,880.65 $1,996.96 2026-01-02
73202 HCPCS CT Scan Of Arm Before And After Contrast 10 5 $2,187.00 $1,968.30 $1,510.45 $2,597.00 $1,992.22 2026-01-02
3504703_1 CDM Labor Room/delivery - Labor 5 5 $2,060.00 $1,854.00 $1,030.00 $2,060.00 $1,957.00 2026-01-02
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 10 5 $1,995.00 $1,795.50 $1,674.50 $2,020.00 $1,950.30 2026-01-02
J7298 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg 5 5 $1,972.57 $1,775.31 $1,676.68 $1,972.57 $1,933.12 2026-01-02
J7300 HCPCS Intrauterine Copper Contraceptive 5 5 $1,967.70 $1,770.93 $1,672.55 $1,967.70 $1,928.35 2026-01-02
43775 HCPCS Partial Removal Of Stomach For Weight Loss Using An Endoscope 5 5 $2,230.00 $2,007.00 $1,537.10 $3,182.03 $1,916.29 2026-01-02
J0485 HCPCS Injection, Belatacept, 1 Mg 5 5 $1,947.42 $1,752.68 $1,655.31 $1,947.42 $1,908.47 2026-01-02
867361_1 CDM Room & Board - Semi-private (two Beds) - General Classification 4 4 $1,963.00 $1,766.70 $1,668.55 $1,923.74 $1,864.85 2026-01-02
49561 HCPCS Repair Initial Incisional Or Ventral Hernia; Incarcerated Or Strangulated 5 5 $2,550.00 $2,295.00 $1,279.65 $2,647.19 $1,801.63 2026-01-02
J7301 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System (skyla), 13.5 Mg 5 5 $1,834.71 $1,651.24 $1,559.50 $1,834.71 $1,798.02 2026-01-02
49653 HCPCS Laparoscopy, Surgical, Repair, Ventral, Umbilical, Spigelian Or Epigastric Herni… 5 5 $2,189.00 $1,970.10 $1,278.23 $2,642.97 $1,796.94 2026-01-02
J9202 HCPCS Goserelin Acetate Implant, Per 3.6 Mg 5 5 $1,821.00 $1,638.90 $1,547.85 $1,821.00 $1,784.58 2026-01-02
73201 HCPCS CT Scan Of Arm With Contrast 10 5 $1,944.50 $1,750.05 $1,338.75 $2,314.00 $1,770.95 2026-01-02
J7296 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System, (kyleena), 19.5 Mg 5 5 $1,804.70 $1,624.23 $1,534.00 $1,804.70 $1,768.61 2026-01-02
15830 HCPCS Removal Of Extra Skin And Tissue Of Abdomen 5 5 $2,483.00 $2,234.70 $1,454.33 $2,110.55 $1,757.08 2026-01-02
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 5 5 $1,791.00 $1,611.90 $1,522.35 $1,791.00 $1,755.18 2026-01-02
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 5 5 $1,791.00 $1,611.90 $1,522.35 $1,791.00 $1,755.18 2026-01-02
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 5 5 $1,791.00 $1,611.90 $1,522.35 $1,791.00 $1,755.18 2026-01-02
72191 HCPCS CT Scan Of Blood Vessels Of Pelvis With Contrast 5 5 $1,791.00 $1,611.90 $1,522.35 $1,791.00 $1,755.18 2026-01-02
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 10 5 $1,791.00 $1,611.90 $1,522.35 $1,791.00 $1,755.18 2026-01-02
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 5 5 $1,791.00 $1,611.90 $1,522.35 $1,791.00 $1,755.18 2026-01-02
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 5 5 $1,791.00 $1,611.90 $1,522.35 $1,791.00 $1,755.18 2026-01-02
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 5 5 $1,777.00 $1,599.30 $1,510.45 $1,777.00 $1,741.46 2026-01-02
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 5 5 $1,777.00 $1,599.30 $1,510.45 $1,777.00 $1,741.46 2026-01-02
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 5 5 $1,777.00 $1,599.30 $1,510.45 $1,777.00 $1,741.46 2026-01-02
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 5 5 $1,777.00 $1,599.30 $1,510.45 $1,777.00 $1,741.46 2026-01-02
71270 HCPCS CT Scan Of Chest Before And After Contrast 5 5 $1,777.00 $1,599.30 $1,510.45 $1,777.00 $1,741.46 2026-01-02
73702 HCPCS CT Scan Of Leg Before And After Contrast 5 5 $1,777.00 $1,599.30 $1,510.45 $1,777.00 $1,741.46 2026-01-02
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 5 5 $1,777.00 $1,599.30 $1,510.45 $1,777.00 $1,741.46 2026-01-02
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 5 5 $1,777.00 $1,599.30 $1,510.45 $1,777.00 $1,741.46 2026-01-02
70488 HCPCS CT Scan Of Face Before And After Contrast 5 5 $1,777.00 $1,599.30 $1,510.45 $1,777.00 $1,741.46 2026-01-02
1101860_1 CDM Room & Board - Semi-private (two Beds) - General Classification 4 4 $1,820.00 $1,638.00 $1,547.00 $1,783.60 $1,729.00 2026-01-02
59515 HCPCS Cesarean Delivery With Care After Delivery 5 5 $2,572.00 $2,314.80 $1,563.91 $2,186.20 $1,729.00 2026-01-02
43774 HCPCS Removal Of Stomach Reduction Device And Port Using An Endoscope 5 5 $1,999.00 $1,799.10 $1,321.45 $2,733.11 $1,699.15 2026-01-02
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 5 5 $1,733.00 $1,559.70 $1,473.05 $1,733.00 $1,698.34 2026-01-02
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 5 5 $1,733.00 $1,559.70 $1,473.05 $1,733.00 $1,698.34 2026-01-02
J0881 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 20 5 $1,833.22 $1,649.90 $1,020.63 $2,193.68 $1,679.61 2026-01-02
49654 HCPCS Laparoscopy, Surgical, Repair, Incisional Hernia (includes Mesh Insertion, When … 5 5 $1,984.00 $1,785.60 $1,163.28 $2,406.32 $1,638.82 2026-01-02
58150 HCPCS Removal Of Uterus And Cervix Through Abdomen 5 5 $2,752.00 $2,476.80 $1,382.25 $2,339.20 $1,627.96 2026-01-02
867362_1 CDM Room & Board - Semi-private (two Beds) - General Classification 4 4 $1,682.00 $1,513.80 $1,429.70 $1,648.36 $1,597.90 2026-01-02
27880 HCPCS Amputation Of Both Lower Leg Bones 5 5 $1,879.00 $1,691.10 $1,249.25 $1,834.26 $1,597.15 2026-01-02
J3315 HCPCS Injection, Triptorelin Pamoate, 3.75 Mg 5 5 $1,620.22 $1,458.20 $1,377.19 $1,620.22 $1,587.82 2026-01-02
58552 HCPCS Removal Of Uterus, Tubes, And/or Ovaries Through Vagina Using An Endoscope, 250.… 5 5 $2,668.00 $2,401.20 $1,332.38 $2,267.80 $1,578.64 2026-01-02
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 5 5 $1,575.00 $1,417.50 $1,338.75 $1,575.00 $1,543.50 2026-01-02
71260 HCPCS CT Scan Of Chest With Contrast 5 5 $1,575.00 $1,417.50 $1,338.75 $1,575.00 $1,543.50 2026-01-02
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 5 5 $1,575.00 $1,417.50 $1,338.75 $1,575.00 $1,543.50 2026-01-02
70487 HCPCS CT Scan Of Face With Contrast 5 5 $1,575.00 $1,417.50 $1,338.75 $1,575.00 $1,543.50 2026-01-02
70460 HCPCS CT Scan Head Or Brain With Contrast 5 5 $1,575.00 $1,417.50 $1,338.75 $1,575.00 $1,543.50 2026-01-02
73701 HCPCS CT Scan Of Leg With Contrast Material 5 5 $1,575.00 $1,417.50 $1,338.75 $1,575.00 $1,543.50 2026-01-02
49402 HCPCS Removal Of Foreign Body In Abdominal Cavity 5 5 $1,791.00 $1,611.90 $1,179.43 $2,441.83 $1,522.35 2026-01-02
47100 HCPCS Partial Removal Of Liver Tissue 5 5 $1,780.00 $1,602.00 $1,163.75 $2,407.15 $1,513.00 2026-01-02
72126 HCPCS CT Scan Of Upper Spine With Contrast 5 5 $1,536.00 $1,382.40 $1,305.60 $1,536.00 $1,505.28 2026-01-02
74160 HCPCS CT Scan Of Abdomen With Contrast 5 5 $1,536.00 $1,382.40 $1,305.60 $1,536.00 $1,505.28 2026-01-02
72193 HCPCS CT Scan Of Pelvis With Contrast 5 5 $1,536.00 $1,382.40 $1,305.60 $1,536.00 $1,505.28 2026-01-02
72129 HCPCS CT Scan Of Middle Spine With Contrast 5 5 $1,536.00 $1,382.40 $1,305.60 $1,536.00 $1,505.28 2026-01-02
72132 HCPCS CT Scan Of Lower Spine With Contrast 5 5 $1,536.00 $1,382.40 $1,305.60 $1,536.00 $1,505.28 2026-01-02
58262 HCPCS Removal Of Uterus, Tubes, And/or Ovaries Through Vagina, 250.0 G Or Less 5 5 $2,495.00 $2,245.50 $1,239.75 $2,120.75 $1,496.89 2026-01-02
24091807_1 CDM Remdesivir 100 Mg IV Inj [sgho] 5 5 $1,541.30 $1,387.17 $770.65 $1,541.30 $1,464.24 2026-01-02
27502 HCPCS Closed Treatment Of Broken Thigh Bone At Midportion With Manipulation 5 5 $1,796.00 $1,616.40 $1,037.88 $1,535.20 $1,462.61 2026-01-02
27252 HCPCS Closed Treatment Of Dislocated Hip Under Anesthesia 5 5 $2,021.00 $1,818.90 $1,035.50 $1,717.85 $1,459.93 2026-01-02
99291 HCPCS Critical Care, First 30-74 Minutes 10 5 $1,717.50 $1,545.75 $278.05 $2,648.00 $1,459.88 2026-01-02
3504702_1 CDM Labor Room/delivery - Labor 5 5 $1,531.00 $1,377.90 $765.50 $1,531.00 $1,454.45 2026-01-02
49652 HCPCS Laparoscopy, Surgical, Repair, Ventral, Umbilical, Spigelian Or Epigastric Herni… 5 5 $1,748.00 $1,573.20 $1,023.63 $2,116.86 $1,441.17 2026-01-02
49560 HCPCS Repair Initial Incisional Or Ventral Hernia; Reducible 5 5 $2,023.00 $1,820.70 $1,015.55 $2,101.07 $1,429.11 2026-01-02
21933 HCPCS Removal Of Growth Of Muscle Of Back Or Lower Sides, 5.0 Cm Or More 5 5 $1,738.00 $1,564.20 $1,011.28 $1,483.31 $1,425.76 2026-01-02
59410 HCPCS Vaginal Delivery With Post Delivery Care 5 5 $1,968.00 $1,771.20 $1,287.42 $1,672.80 $1,422.15 2026-01-02
1136480_1 CDM Specialty Services - Treatment Room 5 5 $1,486.00 $1,337.40 $743.00 $1,486.00 $1,411.70 2026-01-02
47563 HCPCS Removal Of Gallbladder With X-ray Study Of Bile Ducts Using An Endoscope 5 5 $1,690.00 $1,521.00 $985.63 $2,036.76 $1,384.89 2026-01-02
J1670 HCPCS Injection, Tetanus Immune Globulin, Human, Up To 250 Units 5 5 $1,401.36 $1,261.22 $1,191.16 $1,401.36 $1,373.33 2026-01-02
J1745 HCPCS Injection, Infliximab, Excludes Biosimilar, 10 Mg 5 5 $1,373.74 $1,236.37 $1,167.68 $1,373.74 $1,346.27 2026-01-02
Q5103 HCPCS Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 5 5 $1,359.21 $1,223.29 $1,155.33 $1,359.21 $1,332.03 2026-01-02
14301 HCPCS Repair Of Wound By Transferring Skin, 30.1-60.0 Sq Cm 5 5 $2,303.00 $2,072.70 $1,080.94 $1,957.55 $1,318.20 2026-01-02
3504700_1 CDM Labor Room/delivery - Labor 5 5 $1,384.00 $1,245.60 $692.00 $1,384.00 $1,314.80 2026-01-02
21554 HCPCS Removal Of Growth Of Muscle Of Neck Or Front Of Chest, 5.0 Cm Or More 5 5 $1,545.00 $1,390.50 $1,000.35 $1,472.18 $1,313.25 2026-01-02
73200 HCPCS CT Scan Of Arm Without Contrast 10 5 $1,429.50 $1,286.55 $986.85 $1,698.00 $1,302.15 2026-01-02
58700 HCPCS Removal Of Uterine Tubes 5 5 $1,711.00 $1,539.90 $1,062.58 $1,458.73 $1,285.02 2026-01-02
49594 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, 3-10 Cm In Length 2 2 $1,557.00 $1,401.30 $1,245.60 $1,323.45 $1,284.53 2026-01-02
26951 HCPCS Amputation Of Finger Or Thumb With Direct Closure 5 5 $1,507.00 $1,356.30 $874.95 $1,420.30 $1,280.95 2026-01-02
47562 HCPCS Removal Of Gallbladder Using An Endoscope 5 5 $1,769.00 $1,592.10 $905.83 $1,873.17 $1,275.68 2026-01-02
57260 HCPCS Plastic Repair Of Vagina And Tissue Separating Vagina, Rectum, And Bladder 5 5 $2,081.00 $1,872.90 $1,033.60 $1,768.85 $1,258.41 2026-01-02
23073 HCPCS Removal Of Growth Of Muscle Of Shoulder, 5.0 Cm Or More 5 5 $1,474.00 $1,326.60 $951.90 $1,398.22 $1,252.90 2026-01-02
59612 HCPCS Vaginal Delivery After Previous Cesarean Delivery 5 5 $1,715.00 $1,543.50 $1,097.17 $1,457.75 $1,251.15 2026-01-02
59514 HCPCS Cesarean Delivery 5 5 $1,718.00 $1,546.20 $1,101.44 $1,460.30 $1,250.68 2026-01-02
44950 HCPCS Removal Of Appendix 5 5 $1,729.00 $1,556.10 $884.45 $1,830.52 $1,244.86 2026-01-02
J7325 HCPCS Hyaluronan Or Derivative, Synvisc Or Synvisc-one, For Intra-articular Injection,… 5 5 $1,270.01 $1,143.01 $1,079.51 $1,270.01 $1,244.61 2026-01-02
93308 HCPCS Ultrasound Of Heart, Follow-up 5 5 $1,249.00 $1,124.10 $1,061.65 $1,249.00 $1,224.02 2026-01-02
C8924 HCPCS Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi… 5 5 $1,249.00 $1,124.10 $1,061.65 $1,249.00 $1,224.02 2026-01-02
49520 HCPCS Repair Of Groin Hernia That Is Not Trapped 5 5 $1,491.00 $1,341.90 $869.73 $1,797.94 $1,223.42 2026-01-02
J7307 HCPCS Etonogestrel (contraceptive) Implant System, Including Implant And Supplies 5 5 $1,232.91 $1,109.62 $1,047.97 $1,232.91 $1,208.25 2026-01-02
27552 HCPCS Closed Treatment Of Dislocated Knee Under Anesthesia 5 5 $1,678.00 $1,510.20 $857.38 $1,426.30 $1,200.64 2026-01-02
27378075_1 CDM Rabavert Rabies Vacc W-diluent 5 5 $1,252.33 $1,127.10 $626.17 $1,252.33 $1,189.71 2026-01-02
Q0138 HCPCS Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd … 5 5 $1,202.39 $1,082.15 $1,022.03 $1,202.39 $1,178.34 2026-01-02
44970 HCPCS Removal Of Appendix Using An Endoscope 5 5 $1,417.00 $1,275.30 $827.45 $1,711.03 $1,165.80 2026-01-02
70486 HCPCS CT Scan Of Face Without Contrast 5 5 $1,161.00 $1,044.90 $986.85 $1,161.00 $1,137.78 2026-01-02
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 5 5 $1,161.00 $1,044.90 $986.85 $1,161.00 $1,137.78 2026-01-02
73700 HCPCS CT Scan Of Leg Without Contrast 5 5 $1,161.00 $1,044.90 $986.85 $1,161.00 $1,137.78 2026-01-02
70450 HCPCS CT Scan Head Or Brain Without Contrast 5 5 $1,161.00 $1,044.90 $986.85 $1,161.00 $1,137.78 2026-01-02
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 5 5 $1,161.00 $1,044.90 $986.85 $1,161.00 $1,137.78 2026-01-02
71271 HCPCS Low Dose CT Scan Of Chest For Lung Cancer Screening 5 5 $1,161.00 $1,044.90 $986.85 $1,161.00 $1,137.78 2026-01-02
11597411_1 CDM Combivent Respimat 20-100 Mcg 5 5 $1,189.82 $1,070.84 $594.91 $1,189.82 $1,130.33 2026-01-02
44186 HCPCS Creation Of Opening From Small Bowel To Skin With Insertion Of A Tube For Decomp… 5 5 $1,319.00 $1,187.10 $895.85 $1,852.51 $1,130.21 2026-01-02
43284 HCPCS Insertion Of Magnetic Band Around Base Of Esophagus To Tighten Opening Into Stom… 5 5 $1,294.00 $1,164.60 $887.30 $1,836.90 $1,129.34 2026-01-02
1136516_1 CDM ER Procedure Level 3 Charge 5 5 $1,188.00 $1,069.20 $594.00 $1,188.00 $1,128.60 2026-01-02
71250 HCPCS CT Scan Of Chest Without Contrast 20 5 $1,146.50 $1,031.85 $949.45 $1,510.00 $1,124.50 2026-01-02
59409 HCPCS Vaginal Delivery 5 5 $1,529.00 $1,376.10 $980.38 $1,299.65 $1,110.08 2026-01-02
72131 HCPCS CT Scan Of Lower Spine Without Contrast 5 5 $1,132.00 $1,018.80 $962.20 $1,132.00 $1,109.36 2026-01-02
72125 HCPCS CT Scan Of Upper Spine Without Contrast 5 5 $1,132.00 $1,018.80 $962.20 $1,132.00 $1,109.36 2026-01-02
72192 HCPCS CT Scan Of Pelvis Without Contrast 5 5 $1,132.00 $1,018.80 $962.20 $1,132.00 $1,109.36 2026-01-02
72128 HCPCS CT Scan Of Middle Spine Without Contrast 5 5 $1,132.00 $1,018.80 $962.20 $1,132.00 $1,109.36 2026-01-02
C1781 HCPCS Mesh (implantable) 75 5 $1,159.00 $1,043.10 $109.65 $5,107.00 $1,101.05 2026-01-02
A0434 HCPCS Specialty Care Transport (sct) 5 5 $1,120.00 $1,008.00 $952.00 $1,120.00 $1,097.60 2026-01-02
1075606_1 CDM Emtricitabine/lopinavir/ritonavir/tenofovir - Kit [sgho] 5 5 $1,145.82 $1,031.24 $572.91 $1,145.82 $1,088.53 2026-01-02
27266 HCPCS Closed Treatment Of Dislocated Hip Prosthesis Under Anesthesia 5 5 $1,248.00 $1,123.20 $795.63 $1,171.60 $1,060.80 2026-01-02
58661 HCPCS Removal Of Ovaries And/or Tubes Using An Endoscope 5 5 $1,392.00 $1,252.80 $881.13 $1,215.56 $1,050.34 2026-01-02
76942 HCPCS Ultrasonic Guidance For Needle Placement 5 5 $1,058.00 $952.20 $899.30 $1,058.00 $1,036.84 2026-01-02
49507 HCPCS Repair Of Trapped Groin Hernia (5 Years Or Older) 5 5 $1,212.00 $1,090.80 $806.08 $1,666.56 $1,030.20 2026-01-02
22900 HCPCS Removal Of Growth Of Muscle Of Abdomen, Less Than 5.0 Cm 5 5 $1,194.00 $1,074.60 $771.40 $1,131.67 $1,014.90 2026-01-02
76811 HCPCS Ultrasound Scan Of Pregnant Uterus With Detailed Fetal Anatomic Examination, Sin… 5 5 $1,035.00 $931.50 $879.75 $1,035.00 $1,014.30 2026-01-02
93970 HCPCS Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 5 5 $1,035.00 $931.50 $879.75 $1,035.00 $1,014.30 2026-01-02
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 5 5 $1,035.00 $931.50 $879.75 $1,035.00 $1,014.30 2026-01-02
93930 HCPCS Ultrasound Of Arm Arteries Or Artery Grafts 5 5 $1,035.00 $931.50 $879.75 $1,035.00 $1,014.30 2026-01-02
93978 HCPCS Complete Ultrasound Of Aorta, Vena Cava, Groin Vessels Or Bypass Grafts 5 5 $1,035.00 $931.50 $879.75 $1,035.00 $1,014.30 2026-01-02
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 5 5 $1,035.00 $931.50 $879.75 $1,035.00 $1,014.30 2026-01-02
49651 HCPCS Repair Of Recurrent Groin Hernia Using An Endoscope 5 5 $1,186.00 $1,067.40 $767.13 $1,585.97 $1,008.10 2026-01-02
49505 HCPCS Repair Of Groin Hernia (5 Years Or Older) 5 5 $1,427.00 $1,284.30 $715.83 $1,480.06 $1,007.01 2026-01-02
93882 HCPCS Ultrasound Of One Side Of Head And Neck Blood Flow 10 5 $1,025.00 $922.50 $862.75 $1,035.00 $1,004.50 2026-01-02
49572 HCPCS Repair Epigastric Hernia (eg, Preperitoneal Fat); Incarcerated Or Strangulated 5 5 $1,223.00 $1,100.70 $710.13 $1,467.36 $997.63 2026-01-02
49593 HCPCS Initial Repair Of Sliding Hernia Of Abdomen, 3-10 Cm In Length 2 2 $1,197.00 $1,077.30 $957.60 $1,017.45 $987.53 2026-01-02
49614 HCPCS Repair Of Recurrent Entrapped Hernia Of Abdomen, Less Than 3 Cm In Length 2 2 $1,194.00 $1,074.60 $955.20 $1,014.90 $985.05 2026-01-02
3504701_1 CDM Labor Room/delivery - Labor 5 5 $1,031.00 $927.90 $515.50 $1,031.00 $979.45 2026-01-02
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 5 5 $1,478.00 $1,330.20 $692.08 $1,256.30 $976.86 2026-01-02
88309 HCPCS Pathology Examination Of Tissue Using A Microscope, High Complexity 5 5 $993.50 $894.15 $844.48 $993.50 $973.63 2026-01-02
59426 HCPCS Predelivery Care, 7 Or More Visits 5 5 $1,596.00 $1,436.40 $775.29 $1,356.60 $972.66 2026-01-02
49659 HCPCS Other Repair Of Hernia Using An Endoscope 3 3 $1,139.00 $1,025.10 $51.00 $1,085.12 $968.15 2026-01-02
57282 HCPCS Repair Of Pelvic Ligaments Through Vagina 5 5 $1,307.00 $1,176.30 $691.60 $1,121.85 $957.23 2026-01-02
27825 HCPCS Closed Treatment Of Broken Shin Bone At Lower Weight Bearing Joint With Manipula… 5 5 $1,177.00 $1,059.30 $675.93 $1,099.98 $953.41 2026-01-02
27842 HCPCS Closed Treatment Of Dislocated Ankle Under Anesthesia 5 5 $1,521.00 $1,368.90 $668.33 $1,292.85 $950.06 2026-01-02
27752 HCPCS Closed Treatment Of Middle Part Of Broken Shin Bone With Manipulation 5 5 $1,425.00 $1,282.50 $671.65 $1,211.25 $948.05 2026-01-02
A0433 HCPCS Advanced Life Support, Level 2 (als 2) 5 5 $964.00 $867.60 $819.40 $964.00 $944.72 2026-01-02
3504699_1 CDM Labor Room/delivery - Labor 5 5 $990.00 $891.00 $495.00 $990.00 $940.50 2026-01-02
27562 HCPCS Closed Treatment Of Dislocated Kneecap Under Anesthesia 5 5 $1,328.00 $1,195.20 $659.78 $1,128.80 $931.97 2026-01-02
25690 HCPCS Closed Treatment Of Dislocated Wrist (lunate) Bone With Manipulation 5 5 $1,186.00 $1,067.40 $658.83 $1,008.10 $925.27 2026-01-02
74150 HCPCS CT Scan Of Abdomen Without Contrast 10 5 $1,084.00 $975.60 $80.75 $1,132.00 $921.40 2026-01-02
46260 HCPCS Removal Of Multiple Hemorrhoid Groups 5 5 $1,149.00 $1,034.10 $655.03 $1,364.59 $921.25 2026-01-02
27550 HCPCS Closed Treatment Of Dislocated Knee 5 5 $1,276.00 $1,148.40 $655.98 $1,084.60 $911.87 2026-01-02
87902 HCPCS Analysis Test By Nucleic Acid For Hepatitis C Virus 5 5 $929.00 $836.10 $789.65 $929.00 $910.42 2026-01-02
21931 HCPCS Removal Of Growth Under Skin Of Back Or Lower Sides, 3.0 Cm Or More 5 5 $1,128.00 $1,015.20 $644.10 $958.80 $908.52 2026-01-02
24605 HCPCS Repair Of Dislocated Elbow Under Anesthesia 5 5 $1,252.00 $1,126.80 $645.53 $1,064.20 $904.50 2026-01-02
25565 HCPCS Closed Treatment Of Broken Midpart Of Both Forearm Bones With Manipulation 5 5 $1,407.00 $1,266.30 $629.85 $1,195.95 $893.11 2026-01-02
42971 HCPCS Control Of Bleeding Of Throat With Insertion Of Packing Requiring Hospitalizatio… 5 5 $1,219.00 $1,097.10 $619.88 $1,306.87 $871.67 2026-01-02
25505 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Thumb Side With Manipulati… 5 5 $1,366.00 $1,229.40 $618.93 $1,161.10 $871.00 2026-01-02
23308737_1 CDM Symbicort 160-4.5 Mcg Inhaler 5 5 $915.60 $824.04 $457.80 $915.60 $869.82 2026-01-02
21552 HCPCS Removal Of Growth Of Soft Tissue Under Skin Of Neck Or Front Of Chest, 3.0 Cm Or… 5 5 $1,053.00 $947.70 $610.85 $896.15 $862.29 2026-01-02
49585 HCPCS Repair Umbilical Hernia, Age 5 Years Or Older; Reducible 5 5 $1,220.00 $1,098.00 $611.33 $1,264.62 $861.62 2026-01-02
11772 HCPCS Complicated Removal Of Cyst Of Tailbone 5 5 $1,639.00 $1,475.10 $721.48 $1,393.15 $860.60 2026-01-02
24505 HCPCS Closed Treatment Of Broken Middle Part Of Upper Arm Bone With Manipulation 5 5 $1,219.00 $1,097.10 $610.85 $1,036.15 $858.94 2026-01-02
J1440 HCPCS Fecal Microbiota, Live - Jslm, 1 Ml 5 5 $876.20 $788.58 $744.77 $876.20 $858.68 2026-01-02
92950 HCPCS Manual Attempt To Restore Blood Circulation And Breathing 11 5 $989.00 $890.10 $236.63 $989.00 $840.65 2026-01-02
1101854_1 CDM Nursery - General Classification 4 4 $878.00 $790.20 $746.30 $860.44 $834.10 2026-01-02
27538 HCPCS Closed Treatment Of Broken Top Of Shin Bone At Knee 5 5 $979.00 $881.10 $606.10 $955.86 $832.15 2026-01-02
49650 HCPCS Repair Of Groin Hernia Using An Endoscope 5 5 $1,018.00 $916.20 $589.48 $1,218.86 $830.13 2026-01-02
25071 HCPCS Removal Of Growth Under Skin Of Forearm Or Wrist, 3.0 Cm Or More 5 5 $1,002.00 $901.80 $580.93 $853.85 $820.75 2026-01-02
49592 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, Less Than 3 Cm In Length 2 2 $993.00 $893.70 $794.40 $844.05 $819.22 2026-01-02
23071 HCPCS Removal Of Growth Under Skin Of Shoulder Area, 3.0 Cm Or More 5 5 $1,011.00 $909.90 $574.28 $859.35 $811.37 2026-01-02
27810 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle With Manipulation 5 5 $1,281.00 $1,152.90 $575.23 $1,088.85 $809.36 2026-01-02
27337 HCPCS Removal Of Growth Under Skin Of Thigh Or Knee, Less Than 3.0 Cm 5 5 $1,009.00 $908.10 $572.85 $857.65 $808.69 2026-01-02
46040 HCPCS Drainage Of Deep Abscess In Rectum 5 5 $1,470.00 $1,323.00 $571.90 $1,526.33 $803.33 2026-01-02
24071 HCPCS Removal Of Growth Under Skin Of Upper Arm Or Elbow, 3.0 Cm Or More 5 5 $977.00 $879.30 $555.75 $830.45 $785.24 2026-01-02
36430 HCPCS Transfusion Of Blood Or Blood Products 5 5 $800.00 $720.00 $680.00 $800.00 $784.00 2026-01-02
1136515_1 CDM ER Procedure Level 2 Charge 5 5 $814.00 $732.60 $407.00 $814.00 $773.30 2026-01-02
23655 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia 5 5 $1,104.00 $993.60 $549.58 $938.40 $771.84 2026-01-02
42961 HCPCS Control Of Bleeding Of Throat Requiring Hospitalization 5 5 $904.00 $813.60 $569.05 $1,198.85 $768.40 2026-01-02
1136479_1 CDM Specialty Services - Treatment Room 5 5 $808.00 $727.20 $404.00 $808.00 $767.60 2026-01-02
27265 HCPCS Closed Treatment Of Dislocated Hip Prosthesis 5 5 $993.00 $893.70 $547.20 $844.05 $767.15 2026-01-02
1767522_1 CDM Hemabate 250 Mcg/ml Ampul 5 5 $803.28 $722.95 $401.64 $803.28 $763.12 2026-01-02
38531 HCPCS Biopsy Or Removal Of Lymph Nodes Of Groin 5 5 $912.00 $820.80 $598.50 $775.20 $760.71 2026-01-02
23665 HCPCS Closed Treatment Of Dislocated Shoulder And Broken Upper Arm Bone At Shoulder Jo… 5 5 $1,076.00 $968.40 $539.60 $914.60 $757.77 2026-01-02
46270 HCPCS Repair Of Abnormal Anal Drainage Tract 5 5 $1,406.00 $1,265.40 $540.08 $1,459.11 $757.77 2026-01-02
14000 HCPCS Repair Of Wound Of Trunk By Transferring Skin, 10.0 Sq Cm Or Less 5 5 $1,376.00 $1,238.40 $621.60 $1,169.60 $749.84 2026-01-02
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 10 5 $876.00 $788.40 $227.13 $1,338.00 $744.60 2026-01-02
80081 HCPCS Blood Test Panel For Obstetrics ( Cbc, Differential Wbc Count, Hepatitis B, Hiv,… 5 5 $755.50 $679.95 $642.18 $755.50 $740.39 2026-01-02
38510 HCPCS Biopsy Or Removal Of Deep Lymph Nodes Of Neck 5 5 $1,428.00 $1,285.20 $573.80 $1,213.80 $732.13 2026-01-02
27315687_1 CDM Prevnar 20 Syringe 5 5 $765.03 $688.53 $382.52 $765.03 $726.78 2026-01-02
26705 HCPCS Closed Treatment Of Dislocated Hand Joint At Base Of Finger With Manipulation Un… 5 5 $1,034.00 $930.60 $519.18 $878.90 $726.28 2026-01-02
55520 HCPCS Removal Of Growth Of Sperm Cord 5 5 $965.00 $868.50 $623.20 $845.00 $724.30 2026-01-02
1057623_1 CDM Pulmicort 180 Mcg Flexhaler 5 5 $757.32 $681.59 $378.66 $757.32 $719.45 2026-01-02
J0561 HCPCS Injection, Penicillin G Benzathine, 100,000 Units 5 5 $732.79 $659.51 $622.87 $732.79 $718.13 2026-01-02
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