Price Transparencybeta Hospital negotiated rates

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

ROCHELLE COMMUNITY HOSPITAL

Rochelle, IL · CCN 141312 · 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: $2,741 across 30 payers · range $748-$4,838

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbRCHROCHELLEIL&type=CDM&fileType=CSV · observed 2026-09-28

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.

2,141 distinct procedures filed
30 distinct payers
164,478 rate rows
2026-09-28 last MRF observed
Data quality

161,605 of 164,478 rate rows are consumer-grade (98.3%)

2,873 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-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 1,530
percent-of-charges filed in the dollar field — excluded from medians 684
exceeds 10× this hospital's gross charge — excluded from medians 603
per-diem day rate — not a per-procedure price 56
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbRCHROCHELLEIL&type=CDM&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/Rochelle_V2.aspx
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-27
Content fingerprint 9bae08c55514be6a… · 30,404,856 bytes · first seen 2026-10-01

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
J1162
HCPCS 		Injection, Digoxin Immune Fab (ovine), Per Vial 29 $7,657.55 $141,247.85 $105,935.89 nat. median
$7,141
outlier · 14.8×
J2350
HCPCS 		Injection, Ocrelizumab, 1 Mg 29 $37,092.66 $117,243.80 $87,932.85 nat. median
$470
outlier · 187.2×
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 29 $7,657.55 $53,324.90 $39,993.68 nat. median
$162
outlier · 246.8×
J2323
HCPCS 		Injection, Natalizumab, 1 Mg 29 $7,657.55 $48,545.80 $36,409.35 nat. median
$197
outlier · 184.6×
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 29 $7,657.55 $47,180.95 $35,385.71 nat. median
$3,820
outlier · 9.3×
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 29 $3,092.99 $36,514.25 $27,385.69 nat. median
$1,646
outlier · 16.6×
J9312
HCPCS 		Injection, Rituximab, 10 Mg 29 $6,150.50 $26,749.20 $20,061.90 nat. median
$1,071
outlier · 18.7×
J2353
HCPCS 		Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg 29 $7,657.55 $26,287.85 $19,715.89 nat. median
$5,573
outlier · 3.5×
3600116_1
CDM 		Operating Room Services - General Classification 26 $8,301.78 $24,417.00 $19,533.60 nat. median
$19,534
1.0× median
Q5111
HCPCS 		Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg 29 $3,092.99 $23,783.05 $17,837.29 nat. median
$1,982
outlier · 9.0×
3600115_1
CDM 		Operating Room Services - General Classification 26 $6,757.16 $19,874.00 $15,899.20 nat. median
$15,899
1.0× median
122685_ERX_1
CDM 		Ryanodex 250 Mg Vial 26 $6,425.34 $18,898.05 $15,118.44 nat. median
$15,118
1.0× median
3600114_1
CDM 		Operating Room Services - General Classification 26 $5,791.90 $17,035.00 $13,628.00 nat. median
$13,628
1.0× median
J7189
HCPCS 		Factor Viia (antihemophilic Factor, Recombinant), (novoseven Rt), 1 Microgram 29 $4,831.72 $28,336.15 $12,079.31 nat. median
$3,590
outlier · 3.4×
128215_ERX_1
CDM 		Praxbind 5g Dose(2x 2.5g/50ml) 26 $4,952.58 $14,566.40 $11,653.12 nat. median
$11,653
1.0× median
47532
HCPCS 		Injection Of Bile Duct For X-ray Through New Skin Access Using Imaging Guidance… 30 $2,924.04 $11,281.00 $8,742.77 nat. median
$3,813
outlier · 2.3×
J1451
HCPCS 		Injection, Fomepizole, 15 Mg 29 $325.13 $11,437.75 $8,578.31 nat. median
$1,035
outlier · 8.3×
J1602
HCPCS 		Injection, Golimumab, 1 Mg, For Intravenous Use 29 $2,178.14 $11,433.15 $8,574.86 nat. median
$273
outlier · 31.4×
81162
HCPCS 		Gene Analysis (breast Cancer 1 And 2) Of Full Sequence And Analysis For Duplicat… 28 $3,212.32 $9,449.00 $7,558.40 nat. median
$1,825
outlier · 4.1×
J9217
HCPCS 		Leuprolide Acetate (for Depot Suspension), 7.5 Mg 29 $550.52 $73,181.20 $7,543.79 nat. median
$1,575
outlier · 4.8×
81408
HCPCS 		Molecular Pathology Procedure Level 9 Genetic Analysis 28 $3,221.50 $9,475.00 $7,343.12 nat. median
$943
outlier · 7.8×
3600113_1
CDM 		Operating Room Services - General Classification 26 $3,088.90 $9,085.00 $7,268.00 nat. median
$7,268
1.0× median
J2315
HCPCS 		Injection, Naltrexone, Depot Form, 1 Mg 29 $1,670.54 $9,680.10 $7,260.08 nat. median
$10
outlier · 713.2×
81410
HCPCS 		Test For Detecting Genes Associated With Heart Disease, Genomic Sequence Analysi… 30 $503.38 $44,352.00 $7,040.00 nat. median
$731
outlier · 9.6×
77049
HCPCS 		MRI Scan Of Both Breasts 30 $703.22 $8,995.00 $6,971.12 nat. median
$967
outlier · 7.2×
J1439
HCPCS 		Injection, Ferric Carboxymaltose, 1 Mg 29 $784.85 $8,810.85 $6,608.14 nat. median
$14
outlier · 466.2×
J0129
HCPCS 		Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 29 $2,950.28 $8,677.30 $6,507.98 nat. median
$902
outlier · 7.2×
78804
HCPCS 		Nuclear Medicine Study, Whole Body Requiring Multiple Imaging Days 30 $1,520.32 $7,880.00 $6,107.00 nat. median
$1,559
outlier · 3.9×
49407
HCPCS 		Drainage Of Fluid Collection By Tube Through Vagina Or Rectum Using Imaging Guid… 30 $1,246.30 $7,853.00 $6,086.07 nat. median
$2,059
outlier · 3.0×
49406
HCPCS 		Drainage Of Fluid Collection Of Abdominal Cavity By Tube Using Imaging Guidance 30 $1,246.30 $7,853.00 $6,086.07 nat. median
$2,185
outlier · 2.8×
19285
HCPCS 		Placement Of Locating Device In Breast Using Ultrasound Guidance, First Growth 30 $2,297.97 $7,749.00 $6,005.48 nat. median
$1,056
outlier · 5.7×
J7168
HCPCS 		Prothrombin Complex Concentrate (human), Kcentra, Per I.u. Of Factor Ix Activity 29 $2,656.06 $7,811.95 $5,858.96 nat. median
$21
outlier · 279.0×
74178
HCPCS 		CT Scan Of Abdomen And Pelvis Before And After Contrast 30 $525.09 $7,322.00 $5,674.55 nat. median
$1,024
outlier · 5.5×
J3111
HCPCS 		Injection, Romosozumab-aqqg, 1 Mg 29 $1,670.54 $7,546.60 $5,659.95 nat. median
$681
outlier · 8.3×
71555
HCPCS 		MRI Scan Of Blood Vessels Of Chest 30 $849.35 $7,217.00 $5,593.18 nat. median
$1,143
outlier · 4.9×
88344
HCPCS 		Special Stained Specimen Slides To Examine Tissue, Each Multiplex Procedure 30 $227.25 $7,187.00 $5,569.93 nat. median
$345
outlier · 16.1×
3600112_1
CDM 		Operating Room Services - General Classification 26 $2,316.76 $6,814.00 $5,451.20 nat. median
$5,451
1.0× median
J1459
HCPCS 		Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 29 $1,849.77 $42,923.95 $5,277.29 nat. median
$1,388
outlier · 3.8×
74177
HCPCS 		CT Scan Of Abdomen And Pelvis With Contrast 30 $525.09 $6,575.00 $5,095.62 nat. median
$974
outlier · 5.2×
32557
HCPCS 		Drainage Of Fluid From Chest Cavity With Insertion Of Indwelling Tube Using Imag… 30 $1,720.90 $6,555.00 $5,080.12 nat. median
$1,914
outlier · 2.7×
J1745
HCPCS 		Injection, Infliximab, Excludes Biosimilar, 10 Mg 29 $1,670.54 $6,714.25 $5,035.69 nat. median
$398
outlier · 12.7×
19083
HCPCS 		Biopsy Of Breast And Placement Of Locating Device Using Ultrasound, First Growth 30 $2,193.34 $6,451.00 $4,999.52 nat. median
$2,142
outlier · 2.3×
19084
HCPCS 		Biopsy Of Breast And Placement Of Locating Device Using Ultrasound, Each Additio… 30 $2,193.34 $6,451.00 $4,999.52 nat. median
$1,400
outlier · 3.6×
J7326
HCPCS 		Hyaluronan Or Derivative, Gel-one, For Intra-articular Injection, Per Dose 29 $325.13 $6,613.15 $4,959.86 nat. median
$767
outlier · 6.5×
J1569
HCPCS 		Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 29 $1,717.54 $29,880.90 $4,900.05 nat. median
$1,070
outlier · 4.6×
78452
HCPCS 		Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 30 $1,520.32 $6,192.00 $4,798.80 nat. median
$1,816
outlier · 2.6×
J0897
HCPCS 		Injection, Denosumab, 1 Mg 29 $1,595.24 $6,381.05 $4,785.79 nat. median
$1,972
outlier · 2.4×
32408
HCPCS 		Core Needle Biopsy Of Lung Or Center Cavity Of Chest (mediastinum), Accessed Thr… 30 $1,720.90 $6,153.00 $4,768.57 nat. median
$2,057
outlier · 2.3×
93312
HCPCS 		Ultrasound Of Heart With Probe In Esophagus, With Report 30 $748.00 $6,036.00 $4,677.90 nat. median
$937
outlier · 5.0×
74174
HCPCS 		CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 30 $641.57 $5,985.00 $4,638.38 nat. median
$988
outlier · 4.7×

Other procedures at this hospital

Browse this hospital's 2,141 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
             
J1162 HCPCS Injection, Digoxin Immune Fab (ovine), Per Vial 58 29 $141,247.85 $141,247.85 $7,657.55 $141,247.85 $105,935.89 2026-09-28
J2350 HCPCS Injection, Ocrelizumab, 1 Mg 58 29 $117,243.80 $117,243.80 $37,092.66 $117,243.80 $87,932.85 2026-09-28
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 58 29 $53,324.90 $53,324.90 $7,657.55 $53,324.90 $39,993.68 2026-09-28
J2323 HCPCS Injection, Natalizumab, 1 Mg 58 29 $48,545.80 $48,545.80 $7,657.55 $48,545.80 $36,409.35 2026-09-28
J3101 HCPCS Injection, Tenecteplase, 1 Mg 58 29 $47,180.95 $47,180.95 $7,657.55 $47,180.95 $35,385.71 2026-09-28
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 58 29 $36,514.25 $36,514.25 $3,092.99 $36,514.25 $27,385.69 2026-09-28
J9312 HCPCS Injection, Rituximab, 10 Mg 58 29 $26,749.20 $26,749.20 $6,150.50 $26,749.20 $20,061.90 2026-09-28
J2353 HCPCS Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg 58 29 $26,287.85 $26,287.85 $7,657.55 $26,287.85 $19,715.89 2026-09-28
3600116_1 CDM Operating Room Services - General Classification 52 26 $24,417.00 $24,417.00 $8,301.78 $24,417.00 $19,533.60 2026-09-28
Q5111 HCPCS Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg 58 29 $23,783.05 $23,783.05 $3,092.99 $23,783.05 $17,837.29 2026-09-28
3600115_1 CDM Operating Room Services - General Classification 52 26 $19,874.00 $19,874.00 $6,757.16 $19,874.00 $15,899.20 2026-09-28
122685_ERX_1 CDM Ryanodex 250 Mg Vial 52 26 $18,898.05 $18,898.05 $6,425.34 $18,898.05 $15,118.44 2026-09-28
3600114_1 CDM Operating Room Services - General Classification 52 26 $17,035.00 $17,035.00 $5,791.90 $17,035.00 $13,628.00 2026-09-28
J7189 HCPCS Factor Viia (antihemophilic Factor, Recombinant), (novoseven Rt), 1 Microgram 108 29 $14,210.95 $14,210.95 $4,831.72 $28,336.15 $12,079.31 2026-09-28
128215_ERX_1 CDM Praxbind 5g Dose(2x 2.5g/50ml) 52 26 $14,566.40 $14,566.40 $4,952.58 $14,566.40 $11,653.12 2026-09-28
47532 HCPCS Injection Of Bile Duct For X-ray Through New Skin Access Using Imaging Guidance … 60 30 $11,281.00 $11,281.00 $2,924.04 $11,281.00 $8,742.77 2026-09-28
J1451 HCPCS Injection, Fomepizole, 15 Mg 58 29 $11,437.75 $11,437.75 $325.13 $11,437.75 $8,578.31 2026-09-28
J1602 HCPCS Injection, Golimumab, 1 Mg, For Intravenous Use 58 29 $11,433.15 $11,433.15 $2,178.14 $11,433.15 $8,574.86 2026-09-28
81162 HCPCS Gene Analysis (breast Cancer 1 And 2) Of Full Sequence And Analysis For Duplicat… 104 28 $9,449.00 $9,449.00 $3,212.32 $9,449.00 $7,558.40 2026-09-28
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 208 29 $36,632.85 $36,632.85 $550.52 $73,181.20 $7,543.79 2026-09-28
81408 HCPCS Molecular Pathology Procedure Level 9 Genetic Analysis 56 28 $9,475.00 $9,475.00 $3,221.50 $9,475.00 $7,343.12 2026-09-28
3600113_1 CDM Operating Room Services - General Classification 52 26 $9,085.00 $9,085.00 $3,088.90 $9,085.00 $7,268.00 2026-09-28
J2315 HCPCS Injection, Naltrexone, Depot Form, 1 Mg 58 29 $9,680.10 $9,680.10 $1,670.54 $9,680.10 $7,260.08 2026-09-28
81410 HCPCS Test For Detecting Genes Associated With Heart Disease, Genomic Sequence Analysi… 60 30 $8,800.00 $8,800.00 $503.38 $44,352.00 $7,040.00 2026-09-28
77049 HCPCS MRI Scan Of Both Breasts 60 30 $8,995.00 $8,995.00 $703.22 $8,995.00 $6,971.12 2026-09-28
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 58 29 $8,810.85 $8,810.85 $784.85 $8,810.85 $6,608.14 2026-09-28
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 58 29 $8,677.30 $8,677.30 $2,950.28 $8,677.30 $6,507.98 2026-09-28
78804 HCPCS Nuclear Medicine Study, Whole Body Requiring Multiple Imaging Days 60 30 $7,880.00 $7,880.00 $1,520.32 $7,880.00 $6,107.00 2026-09-28
49407 HCPCS Drainage Of Fluid Collection By Tube Through Vagina Or Rectum Using Imaging Guid… 60 30 $7,853.00 $7,853.00 $1,246.30 $7,853.00 $6,086.07 2026-09-28
49406 HCPCS Drainage Of Fluid Collection Of Abdominal Cavity By Tube Using Imaging Guidance 60 30 $7,853.00 $7,853.00 $1,246.30 $7,853.00 $6,086.07 2026-09-28
19285 HCPCS Placement Of Locating Device In Breast Using Ultrasound Guidance, First Growth 60 30 $7,749.00 $7,749.00 $2,297.97 $7,749.00 $6,005.48 2026-09-28
J7168 HCPCS Prothrombin Complex Concentrate (human), Kcentra, Per I.u. Of Factor Ix Activity 58 29 $7,811.95 $7,811.95 $2,656.06 $7,811.95 $5,858.96 2026-09-28
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 60 30 $7,322.00 $7,322.00 $525.09 $7,322.00 $5,674.55 2026-09-28
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 58 29 $7,546.60 $7,546.60 $1,670.54 $7,546.60 $5,659.95 2026-09-28
71555 HCPCS MRI Scan Of Blood Vessels Of Chest 60 30 $7,217.00 $7,217.00 $849.35 $7,217.00 $5,593.18 2026-09-28
88344 HCPCS Special Stained Specimen Slides To Examine Tissue, Each Multiplex Procedure 60 30 $7,187.00 $7,187.00 $227.25 $7,187.00 $5,569.93 2026-09-28
3600112_1 CDM Operating Room Services - General Classification 52 26 $6,814.00 $6,814.00 $2,316.76 $6,814.00 $5,451.20 2026-09-28
J1459 HCPCS Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 108 29 $5,440.50 $5,440.50 $1,849.77 $42,923.95 $5,277.29 2026-09-28
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 60 30 $6,575.00 $6,575.00 $525.09 $6,575.00 $5,095.62 2026-09-28
32557 HCPCS Drainage Of Fluid From Chest Cavity With Insertion Of Indwelling Tube Using Imag… 60 30 $6,555.00 $6,555.00 $1,720.90 $6,555.00 $5,080.12 2026-09-28
J1745 HCPCS Injection, Infliximab, Excludes Biosimilar, 10 Mg 58 29 $6,714.25 $6,714.25 $1,670.54 $6,714.25 $5,035.69 2026-09-28
19083 HCPCS Biopsy Of Breast And Placement Of Locating Device Using Ultrasound, First Growth 60 30 $6,451.00 $6,451.00 $2,193.34 $6,451.00 $4,999.52 2026-09-28
19084 HCPCS Biopsy Of Breast And Placement Of Locating Device Using Ultrasound, Each Additio… 60 30 $6,451.00 $6,451.00 $2,193.34 $6,451.00 $4,999.52 2026-09-28
J7326 HCPCS Hyaluronan Or Derivative, Gel-one, For Intra-articular Injection, Per Dose 58 29 $6,613.15 $6,613.15 $325.13 $6,613.15 $4,959.86 2026-09-28
J1569 HCPCS Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 108 29 $5,051.60 $5,051.60 $1,717.54 $29,880.90 $4,900.05 2026-09-28
78452 HCPCS Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 60 30 $6,192.00 $6,192.00 $1,520.32 $6,192.00 $4,798.80 2026-09-28
J0897 HCPCS Injection, Denosumab, 1 Mg 58 29 $6,381.05 $6,381.05 $1,595.24 $6,381.05 $4,785.79 2026-09-28
32408 HCPCS Core Needle Biopsy Of Lung Or Center Cavity Of Chest (mediastinum), Accessed Thr… 60 30 $6,153.00 $6,153.00 $1,720.90 $6,153.00 $4,768.57 2026-09-28
93312 HCPCS Ultrasound Of Heart With Probe In Esophagus, With Report 60 30 $6,036.00 $6,036.00 $748.00 $6,036.00 $4,677.90 2026-09-28
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 60 30 $5,985.00 $5,985.00 $641.57 $5,985.00 $4,638.38 2026-09-28
J3424 HCPCS Injection, Hydroxocobalamin, Intravenous, 25 Mg 50 25 $5,762.35 $5,762.35 $1,959.20 $5,762.35 $4,609.88 2026-09-28
81229 HCPCS Genome-wide Microarray Analysis For Copy Number And Single Nucleotide Polymorphi… 56 28 $5,940.00 $5,940.00 $2,019.60 $5,940.00 $4,603.50 2026-09-28
73720 HCPCS MRI Scan Of Leg Before And After Contrast 112 30 $5,339.00 $5,339.00 $703.22 $8,545.00 $4,538.15 2026-09-28
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 112 30 $5,339.00 $5,339.00 $703.22 $8,545.00 $4,538.15 2026-09-28
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 112 30 $5,339.00 $5,339.00 $703.22 $8,545.00 $4,538.15 2026-09-28
73220 HCPCS MRI Scan Of Arm Before And After Contrast 112 30 $5,339.00 $5,339.00 $703.22 $8,545.00 $4,538.15 2026-09-28
49405 HCPCS Drainage Of Fluid Collection By Tube Through Skin Using Imaging Guidance 60 30 $5,769.00 $5,769.00 $1,246.30 $5,769.00 $4,470.98 2026-09-28
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 60 30 $5,644.00 $5,644.00 $703.22 $5,644.00 $4,374.10 2026-09-28
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 60 30 $5,644.00 $5,644.00 $703.22 $5,644.00 $4,374.10 2026-09-28
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 60 30 $5,644.00 $5,644.00 $703.22 $5,644.00 $4,374.10 2026-09-28
70553 HCPCS MRI Scan Of Brain Before And After Contrast 60 30 $5,521.00 $5,521.00 $703.22 $5,521.00 $4,278.77 2026-09-28
90377 HCPCS Rabies Immune Globulin For Injection Beneath The Skin And/or Into Muscle 112 30 $4,317.85 $4,317.85 $1,468.07 $19,402.55 $4,188.32 2026-09-28
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 60 30 $5,388.00 $5,388.00 $641.57 $5,388.00 $4,175.70 2026-09-28
71552 HCPCS MRI Scan Of Chest Before And After Contrast 60 30 $5,339.00 $5,339.00 $703.22 $5,339.00 $4,137.73 2026-09-28
Q5103 HCPCS Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 58 29 $5,456.85 $5,456.85 $1,670.54 $5,456.85 $4,092.64 2026-09-28
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 60 30 $5,264.00 $5,264.00 $525.09 $5,264.00 $4,079.60 2026-09-28
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 60 30 $5,228.00 $5,228.00 $525.09 $5,228.00 $4,051.70 2026-09-28
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 60 30 $5,181.00 $5,181.00 $703.22 $5,181.00 $4,015.28 2026-09-28
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 60 30 $5,180.00 $5,180.00 $703.22 $5,180.00 $4,014.50 2026-09-28
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 60 30 $5,024.00 $5,024.00 $849.35 $5,024.00 $3,893.60 2026-09-28
81321 HCPCS Gene Analysis (phosphatase And Tensin Homolog), Full Sequence Analysis 60 30 $4,737.00 $4,737.00 $918.57 $28,422.00 $3,789.60 2026-09-28
20206 HCPCS Needle Biopsy Of Muscle 60 30 $4,886.00 $4,886.00 $1,179.56 $4,886.00 $3,786.65 2026-09-28
73222 HCPCS MRI Scan Of Arm Joint With Contrast 112 30 $4,397.00 $4,397.00 $703.22 $7,036.00 $3,737.45 2026-09-28
73219 HCPCS MRI Scan Of Arm With Contrast 112 30 $4,397.00 $4,397.00 $703.22 $7,036.00 $3,737.45 2026-09-28
73719 HCPCS MRI Scan Of Leg With Contrast 112 30 $4,397.00 $4,397.00 $703.22 $7,036.00 $3,737.45 2026-09-28
73722 HCPCS MRI Scan Of Leg Joint With Contrast 112 30 $4,397.00 $4,397.00 $703.22 $7,036.00 $3,737.45 2026-09-28
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 60 30 $4,711.00 $4,711.00 $703.22 $4,711.00 $3,651.03 2026-09-28
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 60 30 $4,711.00 $4,711.00 $849.35 $4,711.00 $3,651.03 2026-09-28
3600111_1 CDM Operating Room Services - General Classification 52 26 $4,543.00 $4,543.00 $1,544.62 $4,543.00 $3,634.40 2026-09-28
J0717 HCPCS Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm… 58 29 $4,642.15 $4,642.15 $1,578.33 $4,642.15 $3,481.61 2026-09-28
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 60 30 $4,397.00 $4,397.00 $703.22 $4,397.00 $3,407.68 2026-09-28
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 60 30 $4,397.00 $4,397.00 $703.22 $4,397.00 $3,407.68 2026-09-28
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 60 30 $4,397.00 $4,397.00 $703.22 $4,397.00 $3,407.68 2026-09-28
70551 HCPCS MRI Scan Of Brain Without Contrast 60 30 $4,308.00 $4,308.00 $416.80 $4,308.00 $3,338.70 2026-09-28
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 112 30 $3,927.00 $3,927.00 $416.80 $6,283.00 $3,337.95 2026-09-28
73718 HCPCS MRI Scan Of Leg Without Contrast 112 30 $3,927.00 $3,927.00 $416.80 $6,283.00 $3,337.95 2026-09-28
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 112 30 $3,927.00 $3,927.00 $416.80 $6,283.00 $3,337.95 2026-09-28
73218 HCPCS MRI Scan Of Arm Without Contrast 112 30 $3,927.00 $3,927.00 $416.80 $6,283.00 $3,337.95 2026-09-28
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 60 30 $4,231.00 $4,231.00 $416.80 $4,231.00 $3,279.03 2026-09-28
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 60 30 $4,231.00 $4,231.00 $416.80 $4,231.00 $3,279.03 2026-09-28
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 60 30 $4,231.00 $4,231.00 $416.80 $4,231.00 $3,279.03 2026-09-28
99291 HCPCS Critical Care, First 30-74 Minutes 52 26 $4,072.00 $4,072.00 $1,384.48 $4,072.00 $3,257.60 2026-09-28
70552 HCPCS MRI Scan Of Brain With Contrast 60 30 $4,188.00 $4,188.00 $703.22 $4,188.00 $3,245.70 2026-09-28
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 60 30 $4,170.00 $4,170.00 $641.57 $4,170.00 $3,231.75 2026-09-28
47531 HCPCS Injection Of Bile Duct For X-ray Through Already Existing Skin Access Using Imag… 60 30 $4,134.00 $4,134.00 $1,405.56 $4,134.00 $3,203.85 2026-09-28
73706 HCPCS CT Scan Of Blood Vessels Of Lower Leg With Contrast 112 30 $3,743.00 $3,743.00 $641.57 $5,990.00 $3,181.55 2026-09-28
72196 HCPCS MRI Scan Of Pelvis With Contrast 60 30 $4,085.00 $4,085.00 $703.22 $4,085.00 $3,165.88 2026-09-28
71551 HCPCS MRI Scan Of Chest With Contrast 60 30 $4,082.00 $4,082.00 $703.22 $4,082.00 $3,163.55 2026-09-28
74182 HCPCS MRI Scan Of Abdomen With Contrast 60 30 $4,082.00 $4,082.00 $703.22 $4,082.00 $3,163.55 2026-09-28
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 60 30 $4,040.00 $4,040.00 $641.57 $4,040.00 $3,131.00 2026-09-28
0027U OTHER Gene Analysis (Janus Kinase 2) Of Targeted Sequence Exons 12-15 60 30 $3,972.00 $3,972.00 $65.25 $3,972.00 $3,078.30 2026-09-28
10009 HCPCS Fine Needle Aspiration Biopsy Of Growth Using CT Guidance, First Growth 60 30 $3,938.00 $3,938.00 $1,179.56 $3,938.00 $3,051.95 2026-09-28
72125 HCPCS CT Scan Of Upper Spine Without Contrast 60 30 $3,937.00 $3,937.00 $184.33 $3,937.00 $3,051.18 2026-09-28
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 60 30 $3,927.00 $3,927.00 $849.35 $3,927.00 $3,043.43 2026-09-28
2000001_1 CDM Intensive Care Unit - General Classification 38 19 $3,550.00 $3,550.00 $2,485.00 $3,727.50 $3,017.50 2026-09-28
3600001_1 CDM Operating Room Services - General Classification 52 26 $3,751.00 $3,751.00 $1,275.34 $3,751.00 $3,000.80 2026-09-28
93351 HCPCS Ultrasound Of Heart With Continuous Electrocardiogram (ecg) During Rest, Exercis… 60 30 $3,868.00 $3,868.00 $748.00 $3,868.00 $2,997.70 2026-09-28
72191 HCPCS CT Scan Of Blood Vessels Of Pelvis With Contrast 60 30 $3,743.00 $3,743.00 $641.57 $3,743.00 $2,900.82 2026-09-28
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 60 30 $3,743.00 $3,743.00 $641.57 $3,743.00 $2,900.82 2026-09-28
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 60 30 $3,743.00 $3,743.00 $641.57 $3,743.00 $2,900.82 2026-09-28
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 60 30 $3,736.00 $3,736.00 $525.09 $3,736.00 $2,895.40 2026-09-28
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 60 30 $3,736.00 $3,736.00 $525.09 $3,736.00 $2,895.40 2026-09-28
50200 HCPCS Needle Biopsy Of Kidney 60 30 $3,730.00 $3,730.00 $1,268.20 $3,730.00 $2,890.75 2026-09-28
76811 HCPCS Ultrasound Scan Of Pregnant Uterus With Detailed Fetal Anatomic Examination, Sin… 60 30 $3,696.00 $3,696.00 $173.91 $3,696.00 $2,864.40 2026-09-28
93303 HCPCS Ultrasound Of Heart For Congenital Defect 60 30 $3,658.00 $3,658.00 $748.00 $3,658.00 $2,834.95 2026-09-28
J1670 HCPCS Injection, Tetanus Immune Globulin, Human, Up To 250 Units 58 29 $3,770.40 $3,770.40 $325.13 $3,770.40 $2,827.80 2026-09-28
J0585 HCPCS Injection, Onabotulinumtoxina, 1 Unit 58 29 $3,752.45 $3,752.45 $784.85 $3,752.45 $2,814.34 2026-09-28
72195 HCPCS MRI Scan Of Pelvis Without Contrast 60 30 $3,616.00 $3,616.00 $416.80 $3,616.00 $2,802.40 2026-09-28
71550 HCPCS MRI Scan Of Chest Without Contrast 60 30 $3,615.00 $3,615.00 $416.80 $3,615.00 $2,801.62 2026-09-28
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 60 30 $3,615.00 $3,615.00 $849.35 $3,615.00 $2,801.62 2026-09-28
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 60 30 $3,615.00 $3,615.00 $703.22 $3,615.00 $2,801.62 2026-09-28
74181 HCPCS MRI Scan Of Abdomen Without Contrast 60 30 $3,615.00 $3,615.00 $416.80 $3,615.00 $2,801.62 2026-09-28
73702 HCPCS CT Scan Of Leg Before And After Contrast 112 30 $3,296.00 $3,296.00 $525.09 $5,274.00 $2,801.60 2026-09-28
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 60 30 $3,594.00 $3,594.00 $525.09 $3,594.00 $2,785.35 2026-09-28
72193 HCPCS CT Scan Of Pelvis With Contrast 60 30 $3,579.00 $3,579.00 $525.09 $3,579.00 $2,773.72 2026-09-28
74160 HCPCS CT Scan Of Abdomen With Contrast 60 30 $3,579.00 $3,579.00 $525.09 $3,579.00 $2,773.72 2026-09-28
J0248 HCPCS Injection, Remdesivir, 1 Mg 58 29 $3,689.15 $3,689.15 $784.85 $3,689.15 $2,766.86 2026-09-28
38792 HCPCS Injection Of Radioactive Material For X-ray Identification Of Lymph Node 60 30 $3,561.00 $3,561.00 $634.75 $3,561.00 $2,759.78 2026-09-28
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 112 30 $3,225.00 $3,225.00 $748.00 $4,838.00 $2,741.25 2026-09-28
0361U OTHER Digital Immunoassay In Plasma For Neurofilament Light Chain 60 30 $3,456.00 $3,456.00 $14.76 $3,456.00 $2,678.40 2026-09-28
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 60 30 $3,455.00 $3,455.00 $849.35 $3,455.00 $2,677.62 2026-09-28
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 60 30 $3,443.00 $3,443.00 $525.09 $3,443.00 $2,668.32 2026-09-28
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 60 30 $3,443.00 $3,443.00 $525.09 $3,443.00 $2,668.32 2026-09-28
72129 HCPCS CT Scan Of Middle Spine With Contrast 60 30 $3,443.00 $3,443.00 $525.09 $3,443.00 $2,668.32 2026-09-28
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 60 30 $3,443.00 $3,443.00 $525.09 $3,443.00 $2,668.32 2026-09-28
71270 HCPCS CT Scan Of Chest Before And After Contrast 60 30 $3,443.00 $3,443.00 $525.09 $3,443.00 $2,668.32 2026-09-28
72132 HCPCS CT Scan Of Lower Spine With Contrast 60 30 $3,443.00 $3,443.00 $525.09 $3,443.00 $2,668.32 2026-09-28
71260 HCPCS CT Scan Of Chest With Contrast 60 30 $3,434.00 $3,434.00 $525.09 $3,434.00 $2,661.35 2026-09-28
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 60 30 $3,434.00 $3,434.00 $525.09 $3,434.00 $2,661.35 2026-09-28
70460 HCPCS CT Scan Head Or Brain With Contrast 60 30 $3,434.00 $3,434.00 $525.09 $3,434.00 $2,661.35 2026-09-28
70487 HCPCS CT Scan Of Face With Contrast 112 30 $3,434.00 $3,434.00 $525.09 $3,434.00 $2,641.60 2026-09-28
94002 HCPCS Initial Hospital Inpatient Or Observation Ventilation Assistance And Management 60 30 $3,400.00 $3,400.00 $1,156.00 $3,400.00 $2,635.00 2026-09-28
59409 HCPCS Vaginal Delivery 60 30 $3,174.00 $3,174.00 $1,079.16 $3,720.29 $2,618.55 2026-09-28
74230 HCPCS Imaging For Evaluation Of Swallowing Function 60 30 $3,327.00 $3,327.00 $204.43 $3,327.00 $2,578.43 2026-09-28
73202 HCPCS CT Scan Of Arm Before And After Contrast 60 30 $3,296.00 $3,296.00 $525.09 $3,296.00 $2,554.40 2026-09-28
77012 HCPCS Review By Radiologist Of CT Guidance For Needle Placement 60 30 $3,296.00 $3,296.00 $142.28 $3,296.00 $2,554.40 2026-09-28
72128 HCPCS CT Scan Of Middle Spine Without Contrast 60 30 $3,282.00 $3,282.00 $184.33 $3,282.00 $2,543.55 2026-09-28
70488 HCPCS CT Scan Of Face Before And After Contrast 112 30 $3,296.00 $3,296.00 $525.09 $3,296.00 $2,535.20 2026-09-28
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 60 30 $3,167.00 $3,167.00 $849.35 $3,167.00 $2,454.43 2026-09-28
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 60 30 $3,143.00 $3,143.00 $525.09 $3,143.00 $2,435.82 2026-09-28
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 60 30 $3,142.00 $3,142.00 $849.35 $3,142.00 $2,435.05 2026-09-28
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 60 30 $3,142.00 $3,142.00 $416.80 $3,142.00 $2,435.05 2026-09-28
73701 HCPCS CT Scan Of Leg With Contrast Material 112 30 $2,844.00 $2,844.00 $525.09 $4,553.00 $2,417.40 2026-09-28
48102 HCPCS Needle Biopsy Of Pancreas 60 30 $3,119.00 $3,119.00 $1,060.46 $3,119.00 $2,417.22 2026-09-28
150707_ERX_1 CDM Premarin Vaginal Cream-appl 52 26 $2,933.40 $2,933.40 $997.36 $2,933.40 $2,346.72 2026-09-28
72131 HCPCS CT Scan Of Lower Spine Without Contrast 60 30 $2,986.00 $2,986.00 $184.33 $2,986.00 $2,314.15 2026-09-28
70336 HCPCS MRI Scan Of Jaw Joint 60 30 $2,983.00 $2,983.00 $416.80 $2,983.00 $2,311.82 2026-09-28
27266 HCPCS Closed Treatment Of Dislocated Hip Prosthesis Under Anesthesia 60 30 $2,974.00 $2,974.00 $1,011.16 $2,974.00 $2,304.85 2026-09-28
47000 HCPCS Needle Biopsy Of Liver Through Skin 60 30 $2,954.00 $2,954.00 $1,004.36 $2,954.00 $2,289.35 2026-09-28
78451 HCPCS Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect 60 30 $2,900.00 $2,900.00 $986.00 $2,900.00 $2,247.50 2026-09-28
10010 HCPCS Fine Needle Aspiration Biopsy Of Growth Using CT Guidance, Each Additional Growt… 60 30 $2,875.00 $2,875.00 $977.50 $2,875.00 $2,228.12 2026-09-28
3600015_1 CDM Operating Room Services - General Classification 52 26 $2,765.00 $2,765.00 $940.10 $2,765.00 $2,212.00 2026-09-28
73201 HCPCS CT Scan Of Arm With Contrast 60 30 $2,844.00 $2,844.00 $525.09 $2,844.00 $2,204.10 2026-09-28
49180 HCPCS Needle Biopsy Of Growth Of Abdominal Cavity 60 30 $2,836.00 $2,836.00 $964.24 $2,836.00 $2,197.90 2026-09-28
J9394 HCPCS Injection, Fulvestrant (fresenius Kabi) Not Therapeutically Equivalent To J9395,… 58 29 $2,910.90 $2,910.90 $214.60 $2,910.90 $2,183.18 2026-09-28
78071 HCPCS Nuclear Medicine Study Of Parathyroid With Spect 60 30 $2,812.00 $2,812.00 $634.75 $2,812.00 $2,179.30 2026-09-28
78803 HCPCS Nuclear Medicine Study, Spect Imaging, 1 Area Or Single Acquisition, Single Day … 60 30 $2,811.00 $2,811.00 $955.74 $2,811.00 $2,178.53 2026-09-28
151269_ERX_1 CDM Serevent Diskus 50 Mcg 52 26 $2,700.50 $2,700.50 $918.17 $2,700.50 $2,160.40 2026-09-28
94621 HCPCS Test For Exercise-induced Heart And Lung Stress 60 30 $2,776.00 $2,776.00 $178.26 $2,776.00 $2,151.40 2026-09-28
J2760 HCPCS Injection, Phentolamine Mesylate, Up To 5 Mg 58 29 $2,866.75 $2,866.75 $200.09 $2,866.75 $2,150.06 2026-09-28
49083 HCPCS Drainage Of Fluid From Abdominal Cavity Using Imaging Guidance 60 30 $2,752.00 $2,752.00 $935.68 $2,752.00 $2,132.80 2026-09-28
10005 HCPCS Fine Needle Aspiration Biopsy Using Ultrasound Guidance, First Growth 60 30 $2,698.00 $2,698.00 $917.32 $2,698.00 $2,090.95 2026-09-28
94003 HCPCS Follow-up Inpatient Or Observation Ventilation Assistance And Management 60 30 $2,671.00 $2,671.00 $908.14 $2,671.00 $2,070.03 2026-09-28
72192 HCPCS CT Scan Of Pelvis Without Contrast 60 30 $2,641.00 $2,641.00 $184.33 $2,641.00 $2,046.78 2026-09-28
3600006_1 CDM Operating Room Services - General Classification 52 26 $2,544.00 $2,544.00 $864.96 $2,544.00 $2,035.20 2026-09-28
3600012_1 CDM Operating Room Services - General Classification 52 26 $2,519.00 $2,519.00 $856.46 $2,519.00 $2,015.20 2026-09-28
73700 HCPCS CT Scan Of Leg Without Contrast 112 30 $2,349.00 $2,349.00 $184.33 $3,760.00 $1,996.65 2026-09-28
36573 HCPCS Insertion Of Tube For Infusion With Imaging Guidance And Review By Radiologist, … 60 30 $2,572.00 $2,572.00 $874.48 $2,572.00 $1,993.30 2026-09-28
74150 HCPCS CT Scan Of Abdomen Without Contrast 60 30 $2,547.00 $2,547.00 $184.33 $2,547.00 $1,973.92 2026-09-28
19286 HCPCS Placement Of Locating Device In Breast Using Ultrasound Guidance, Each Additiona… 60 30 $2,385.00 $2,385.00 $810.90 $2,385.00 $1,967.62 2026-09-28
71250 HCPCS CT Scan Of Chest Without Contrast 60 30 $2,493.00 $2,493.00 $184.33 $2,493.00 $1,932.08 2026-09-28
70450 HCPCS CT Scan Head Or Brain Without Contrast 60 30 $2,493.00 $2,493.00 $525.09 $2,493.00 $1,932.08 2026-09-28
62328 HCPCS Removal Of Spinal Fluid With Lower Back Spinal Tap For Diagnostic Test Using Ima… 60 30 $2,484.00 $2,484.00 $844.56 $2,484.00 $1,925.10 2026-09-28
78227 HCPCS Nuclear Medicine Study Of Liver And Bile Duct System With Use Of Drugs 60 30 $2,476.00 $2,476.00 $634.75 $2,476.00 $1,918.90 2026-09-28
70486 HCPCS CT Scan Of Face Without Contrast 112 30 $2,493.00 $2,493.00 $184.33 $2,493.00 $1,917.60 2026-09-28
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 112 30 $2,397.00 $2,397.00 $184.33 $2,493.00 $1,917.60 2026-09-28
148725_ERX_1 CDM Fluticasone-salmeterol 250-50 52 26 $2,394.05 $2,394.05 $813.98 $2,394.05 $1,915.24 2026-09-28
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 112 30 $2,246.00 $2,246.00 $641.57 $3,743.00 $1,909.10 2026-09-28
79591_ERX_1 CDM Cefixime 200 Mg/5 Ml Susp 52 26 $2,375.10 $2,375.10 $807.53 $2,375.10 $1,900.08 2026-09-28
J0666 HCPCS Injection, Bupivacaine Liposome, 1 Mg 50 25 $2,348.65 $2,348.65 $798.54 $2,348.65 $1,878.92 2026-09-28
76812 HCPCS Ultrasound Scan Of Pregnant Uterus With Detailed Fetal Anatomic Examination, Eac… 60 30 $2,419.00 $2,419.00 $173.91 $2,419.00 $1,874.72 2026-09-28
76820 HCPCS Ultrasound Scan Of Fetal Umbilical Artery Blood Flow Rate 60 30 $2,419.00 $2,419.00 $173.91 $2,419.00 $1,874.72 2026-09-28
3600005_1 CDM Operating Room Services - General Classification 52 26 $2,329.00 $2,329.00 $791.86 $2,329.00 $1,863.20 2026-09-28
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 60 30 $2,395.00 $2,395.00 $184.33 $2,395.00 $1,856.12 2026-09-28
99465 HCPCS Reviving Newborn At Delivery 60 30 $2,391.00 $2,391.00 $812.94 $2,391.00 $1,853.03 2026-09-28
92950 HCPCS Manual Attempt To Restore Blood Circulation And Breathing 112 30 $2,391.00 $2,391.00 $774.52 $2,391.00 $1,822.40 2026-09-28
73200 HCPCS CT Scan Of Arm Without Contrast 60 30 $2,349.00 $2,349.00 $184.33 $2,349.00 $1,820.47 2026-09-28
3600011_1 CDM Operating Room Services - General Classification 52 26 $2,273.00 $2,273.00 $772.82 $2,273.00 $1,818.40 2026-09-28
78306 HCPCS Nuclear Medicine Study Of Bone And/or Joint Whole Body 60 30 $2,289.00 $2,289.00 $634.75 $2,289.00 $1,773.97 2026-09-28
78708 HCPCS Nuclear Medicine Study Of Kidney, Blood, Flow, And Function With Drug Administra… 60 30 $2,289.00 $2,289.00 $634.75 $2,289.00 $1,773.97 2026-09-28
38505 HCPCS Needle Biopsy Or Removal Of Surface Lymph Nodes 60 30 $2,149.00 $2,149.00 $730.66 $2,149.00 $1,772.93 2026-09-28
P9037 HCPCS Platelets, Pheresis, Leukocytes Reduced, Irradiated, Each Unit 58 29 $2,362.00 $2,362.00 $477.08 $2,362.00 $1,771.50 2026-09-28
78226 HCPCS Nuclear Medicine Study Of Liver And Bile Duct System 60 30 $2,239.00 $2,239.00 $634.75 $2,239.00 $1,735.22 2026-09-28
87906 HCPCS Analysis Test By Nucleic Acid For HIV-1 Virus, Other Region 60 30 $2,141.00 $2,141.00 $285.68 $2,756.11 $1,712.80 2026-09-28
M0222 HCPCS Intravenous Injection, Bebtelovimab, Includes Injection And Post Administration … 50 25 $2,137.00 $2,137.00 $726.58 $2,137.00 $1,709.60 2026-09-28
M0243 HCPCS Intravenous Infusion Or Subcutaneous Injection, Casirivimab And Imdevimab Includ… 50 25 $2,137.00 $2,137.00 $726.58 $2,137.00 $1,709.60 2026-09-28
M0245 HCPCS Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Ad… 50 25 $2,137.00 $2,137.00 $726.58 $2,137.00 $1,709.60 2026-09-28
8968_ERX_1 CDM Acyclovir 5% Ointment 52 26 $2,133.05 $2,133.05 $725.24 $2,133.05 $1,706.44 2026-09-28
J0881 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 158 29 $2,721.65 $2,721.65 $626.62 $4,478.95 $1,704.78 2026-09-28
78582 HCPCS Nuclear Medicine Study Of Lung Ventilation And Circulation 60 30 $2,199.00 $2,199.00 $747.66 $2,199.00 $1,704.22 2026-09-28
64447 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Thigh Nerve (femoral Nerve) 60 30 $2,053.00 $2,053.00 $698.02 $2,210.27 $1,693.72 2026-09-28
64415 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Arm Nerve Bundle (brachial Ple… 60 30 $2,053.00 $2,053.00 $698.02 $2,210.27 $1,693.72 2026-09-28
86977 HCPCS Pretreatment Of Serum For Use In Red Blood Cell Antibody Analysis And Measuremen… 60 30 $2,184.00 $2,184.00 $146.38 $2,184.00 $1,692.60 2026-09-28
Q9957 HCPCS Injection, Perflutren Lipid Microspheres, Per Ml 50 25 $2,112.90 $2,112.90 $718.39 $2,112.90 $1,690.32 2026-09-28
81228 HCPCS Genome-wide Microarray Analysis For Copy Number Variants 60 30 $2,107.00 $2,107.00 $716.38 $18,963.00 $1,685.60 2026-09-28
93975 HCPCS Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 60 30 $2,168.00 $2,168.00 $290.89 $2,168.00 $1,680.20 2026-09-28
78315 HCPCS Nuclear Medicine Study Of Bone Taken At Different Times 60 30 $2,137.00 $2,137.00 $634.75 $2,137.00 $1,656.17 2026-09-28
78305 HCPCS Nuclear Medicine Study Of Bone And/or Joint Multiple Areas 60 30 $2,137.00 $2,137.00 $634.75 $2,137.00 $1,656.17 2026-09-28
78195 HCPCS Nuclear Medicine Study Of Lymphatic System 60 30 $2,137.00 $2,137.00 $726.58 $2,137.00 $1,656.17 2026-09-28
19081 HCPCS Biopsy Of Breast And Placement Of Locating Device Using X-ray With Needle, First… 112 30 $1,811.00 $1,811.00 $615.74 $2,897.00 $1,652.54 2026-09-28
27659 HCPCS Secondary Repair Of Tendon On Back Of Leg 60 30 $1,999.00 $1,999.00 $679.66 $12,662.72 $1,649.18 2026-09-28
3700030_1 CDM Hc General Anesthesia 1st 30 Min 52 26 $2,057.00 $2,057.00 $699.38 $2,057.00 $1,645.60 2026-09-28
60100 HCPCS Needle Biopsy Of Thyroid Through Skin 60 30 $2,112.00 $2,112.00 $718.08 $2,112.00 $1,636.80 2026-09-28
9682_ERX_1 CDM Santyl Ointment 52 26 $2,040.45 $2,040.45 $693.75 $2,040.45 $1,632.36 2026-09-28
78473 HCPCS Nuclear Medicine Studies Of Heart Pumping Function By Labeling Red Blood Cells W… 60 30 $2,083.00 $2,083.00 $634.75 $2,083.00 $1,614.33 2026-09-28
P9055 HCPCS Platelets, Leukocytes Reduced, Cmv-negative, Apheresis/pheresis, Each Unit 58 29 $2,140.00 $2,140.00 $477.08 $2,140.00 $1,605.00 2026-09-28
78802 HCPCS Nuclear Medicine Study, Whole Body 60 30 $2,068.00 $2,068.00 $703.12 $2,068.00 $1,602.70 2026-09-28
J7323 HCPCS Hyaluronan Or Derivative, Euflexxa, For Intra-articular Injection, Per Dose 58 29 $2,132.65 $2,132.65 $200.09 $2,132.65 $1,599.49 2026-09-28
64417 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Upper Arm And Shoulder Nerve (… 60 30 $2,053.00 $2,053.00 $689.08 $2,053.00 $1,591.08 2026-09-28
22953_ERX_1 CDM Brinzolamide 1% Eye Drops 52 26 $1,962.85 $1,962.85 $667.37 $1,962.85 $1,570.28 2026-09-28
78070 HCPCS Nuclear Medicine Study Of Parathyroid 60 30 $2,025.00 $2,025.00 $688.50 $2,025.00 $1,570.16 2026-09-28
31603 HCPCS Emergent Incision Of Windpipe Through Neck For Insertion Of Breathing Tube 60 30 $1,902.00 $1,902.00 $646.68 $3,551.22 $1,569.15 2026-09-28
P9035 HCPCS Platelets, Pheresis, Leukocytes Reduced, Each Unit 58 29 $2,076.00 $2,076.00 $477.08 $2,076.00 $1,557.00 2026-09-28
J0885 HCPCS Injection, Epoetin Alfa, (for Non-esrd Use), 1000 Units 108 29 $6,153.40 $6,153.40 $200.09 $6,153.40 $1,554.52 2026-09-28
78278 HCPCS Nuclear Medicine Study To Assess Blood Loss 60 30 $1,984.00 $1,984.00 $674.56 $1,984.00 $1,553.76 2026-09-28
78472 HCPCS Nuclear Medicine Study Of Heart Pumping Function By Labeling Red Blood Cells Wit… 60 30 $1,990.00 $1,990.00 $634.75 $1,990.00 $1,542.25 2026-09-28
78300 HCPCS Nuclear Medicine Study Of Bone And/or Joint Limited Area 60 30 $1,985.00 $1,985.00 $634.75 $1,985.00 $1,538.38 2026-09-28
88365 HCPCS Genetic Sequencing Localization, Initial Procedure 60 30 $1,983.00 $1,983.00 $227.25 $1,983.00 $1,536.83 2026-09-28
3600004_1 CDM Operating Room Services - General Classification 52 26 $1,876.00 $1,876.00 $637.84 $1,876.00 $1,500.80 2026-09-28
81400 HCPCS Molecular Pathology Procedure Level 1 112 30 $2,004.00 $2,004.00 $65.25 $2,004.00 $1,480.80 2026-09-28
0003M OTHER Molecular Pathology Test For Liver Disease, Including Non-alcohol Liver Disease … 112 30 $2,025.00 $2,025.00 $503.38 $2,025.00 $1,479.38 2026-09-28
81381 HCPCS Hla Class I Typing High Resolution One Allele Or Allele Group 60 30 $1,841.00 $1,841.00 $230.73 $3,127.86 $1,472.80 2026-09-28
3700031_1 CDM Hc Regional Anesth 1st 30 Min 52 26 $1,839.00 $1,839.00 $625.26 $1,839.00 $1,471.20 2026-09-28
93226 HCPCS Electrocardiogram (ecg) 2-day Continuous With Report 60 30 $1,869.00 $1,869.00 $106.68 $1,869.00 $1,448.47 2026-09-28
62270 HCPCS Removal Of Cerebrospinal Fluid With Lower Back Spinal Tap For Diagnostic Test 60 30 $1,867.00 $1,867.00 $634.78 $1,867.00 $1,446.92 2026-09-28
78481 HCPCS Nuclear Medicine Study Of Heart Pumping Function With Measurement Of Internal Bl… 60 30 $1,866.00 $1,866.00 $634.44 $1,866.00 $1,446.15 2026-09-28
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 60 30 $1,864.00 $1,864.00 $290.89 $1,864.00 $1,444.60 2026-09-28
3700032_1 CDM Hc Mac Anesth 1st 30 Min 52 26 $1,799.00 $1,799.00 $611.66 $1,799.00 $1,439.20 2026-09-28
J1453 HCPCS Injection, Fosaprepitant, 1 Mg 50 25 $1,793.25 $1,793.25 $609.71 $1,793.25 $1,434.60 2026-09-28
J3489 HCPCS Injection, Zoledronic Acid, 1 Mg 50 25 $1,792.15 $1,792.15 $609.33 $1,792.15 $1,433.72 2026-09-28
78709 HCPCS Nuclear Medicine Studies Of Kidney, Blood Flow, And Function 60 30 $1,834.00 $1,834.00 $623.56 $1,834.00 $1,421.35 2026-09-28
78707 HCPCS Nuclear Medicine Study Of Kidney, Blood Flow, And Function 60 30 $1,834.00 $1,834.00 $623.56 $1,834.00 $1,421.35 2026-09-28
90651 HCPCS Human Papillomavirus Vaccine Types 6, 11, 16, 18, 31, 33, 45, 52, 58, Nonavalent 60 30 $1,831.00 $1,831.00 $194.38 $1,831.00 $1,419.03 2026-09-28
81272 HCPCS Gene Analysis (v-kit Hardy-zuckerman 4 Feline Sarcoma Viral Oncogene Homolog), T… 60 30 $1,743.00 $1,743.00 $230.73 $5,743.36 $1,394.40 2026-09-28
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 52 26 $1,709.00 $1,709.00 $581.06 $1,709.00 $1,367.20 2026-09-28
74280 HCPCS Double Contrast X-ray Of Large Intestine 60 30 $1,764.00 $1,764.00 $204.43 $1,764.00 $1,367.10 2026-09-28
7100005_1 CDM Recovery Room - General Classification 52 26 $1,694.00 $1,694.00 $575.96 $1,694.00 $1,355.20 2026-09-28
7100003_1 CDM Recovery Room - General Classification 52 26 $1,694.00 $1,694.00 $575.96 $1,694.00 $1,355.20 2026-09-28
7100004_1 CDM Recovery Room - General Classification 52 26 $1,694.00 $1,694.00 $575.96 $1,694.00 $1,355.20 2026-09-28
59414 HCPCS Delivery Of Placenta 60 30 $1,637.00 $1,637.00 $556.58 $2,925.65 $1,350.53 2026-09-28
32551 HCPCS Removal Of Fluid From Between Lung And Chest Cavity 60 30 $1,635.00 $1,635.00 $555.90 $1,720.90 $1,348.88 2026-09-28
78801 HCPCS Nuclear Medicine Study, Multiple Areas 60 30 $1,622.00 $1,622.00 $551.48 $1,622.00 $1,338.15 2026-09-28
93304 HCPCS Ultrasound Of Heart For Congenital Defect, Follow-up 60 30 $1,719.00 $1,719.00 $584.46 $1,719.00 $1,332.22 2026-09-28
73522 HCPCS X-ray Of Both Hips, 3-4 Views 60 30 $1,718.00 $1,718.00 $97.00 $1,718.00 $1,331.45 2026-09-28
79839_ERX_1 CDM Diazepam 2.5mg Rectal Gel(2pk) 52 26 $1,656.05 $1,656.05 $563.06 $1,656.05 $1,324.84 2026-09-28
0034U OTHER Gene Analysis (thiopurine S-methyltransferase) For Common Variants 60 30 $1,704.00 $1,704.00 $503.38 $1,704.00 $1,320.60 2026-09-28
1200001_1 CDM Room & Board - Semi-private (two Beds) - General Classification 38 19 $1,550.00 $1,550.00 $1,085.00 $1,627.50 $1,317.50 2026-09-28
1100001_1 CDM Room & Board - Private (one Bed) - General Classification 38 19 $1,550.00 $1,550.00 $1,085.00 $1,627.50 $1,317.50 2026-09-28
76819 HCPCS Ultrasound Scan Of Fetus 60 30 $1,700.00 $1,700.00 $173.91 $1,700.00 $1,317.50 2026-09-28
27096 HCPCS Injection Of Anesthetic Or Steroid Into Joint Between Lower Spine And Hip Bone U… 60 30 $1,696.00 $1,696.00 $576.64 $1,696.00 $1,314.40 2026-09-28
90677 HCPCS Pneumococcal Conjugate Vaccine, 20 Valent (pcv20), For Intramuscular Use 60 30 $1,692.50 $1,692.50 $194.38 $1,692.50 $1,311.69 2026-09-28
10006 HCPCS Fine Needle Aspiration Biopsy Using Ultrasound Guidance, Each Additional Growth 60 30 $1,681.00 $1,681.00 $571.54 $1,681.00 $1,302.78 2026-09-28
94618 HCPCS Test For Exercise-induced Lung Stress 60 30 $1,664.00 $1,664.00 $99.49 $1,664.00 $1,289.60 2026-09-28
93978 HCPCS Complete Ultrasound Of Aorta, Vena Cava, Groin Vessels Or Bypass Grafts 60 30 $1,660.00 $1,660.00 $290.89 $1,660.00 $1,286.50 2026-09-28
78264 HCPCS Nuclear Medicine Study Of Stomach To Assess Emptying 60 30 $1,659.00 $1,659.00 $564.06 $1,659.00 $1,285.72 2026-09-28
1200002_1 CDM Subacute Care - General Classification 38 19 $1,500.00 $1,500.00 $1,050.00 $1,575.00 $1,275.00 2026-09-28
10003243_ERX_1 CDM Cocaine Hcl 4% Nasal Solution 52 26 $1,589.10 $1,589.10 $540.29 $1,589.10 $1,271.28 2026-09-28
19000 HCPCS Aspiration Of Cyst Of Breast, First Cyst 60 30 $1,635.00 $1,635.00 $555.90 $1,635.00 $1,267.12 2026-09-28
J1447 HCPCS Injection, Tbo-filgrastim, 1 Microgram 108 29 $1,503.95 $1,503.95 $325.13 $2,355.50 $1,263.39 2026-09-28
J1610 HCPCS Injection, Glucagon Hydrochloride, Per 1 Mg 58 29 $1,675.00 $1,675.00 $200.09 $1,675.00 $1,256.25 2026-09-28
81401 HCPCS Molecular Pathology Procedure Level 2 60 30 $1,566.00 $1,566.00 $230.73 $2,145.42 $1,252.80 2026-09-28
P9040 HCPCS Red Blood Cells, Leukocytes Reduced, Irradiated, Each Unit 58 29 $1,656.00 $1,656.00 $216.34 $1,656.00 $1,242.00 2026-09-28
J2785 HCPCS Injection, Regadenoson, 0.1 Mg 50 25 $1,548.75 $1,548.75 $526.58 $1,548.75 $1,239.00 2026-09-28
87900 HCPCS Infectious Agent Drug Susceptibility Analysis 60 30 $1,538.00 $1,538.00 $285.68 $2,004.78 $1,230.40 2026-09-28
87901 HCPCS Analysis Test By Nucleic Acid For HIV-1 Virus 60 30 $1,538.00 $1,538.00 $230.73 $3,959.58 $1,230.40 2026-09-28
31500 HCPCS Emergent Insertion Of Breathing Tube Into Windpipe Using An Endoscope 72 30 $1,635.00 $1,635.00 $555.90 $1,635.00 $1,226.25 2026-09-28
78262 HCPCS Nuclear Medicine Study Of Stomach And Esophagus To Assess Reflux 60 30 $1,572.00 $1,572.00 $534.48 $1,572.00 $1,218.30 2026-09-28
93970 HCPCS Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 60 30 $1,571.00 $1,571.00 $290.89 $1,571.00 $1,217.53 2026-09-28
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 60 30 $1,571.00 $1,571.00 $290.89 $1,571.00 $1,217.53 2026-09-28
J0630 HCPCS Injection, Calcitonin Salmon, Up To 400 Units 58 29 $1,504.75 $1,504.75 $511.62 $2,178.14 $1,203.80 2026-09-28
31605 HCPCS Emergent Incision Of Windpipe For Insertion Of Breathing Tube 60 30 $1,455.00 $1,455.00 $494.70 $3,551.22 $1,200.38 2026-09-28
93990 HCPCS Ultrasound Of Hemodialysis Access 60 30 $1,548.00 $1,548.00 $188.80 $1,548.00 $1,199.70 2026-09-28
78014 HCPCS Nuclear Medicine Study Of Thyroid And Thyroid Function 60 30 $1,527.00 $1,527.00 $519.18 $1,527.00 $1,183.42 2026-09-28
148503_ERX_1 CDM Provisc 10 Mg/ml Disp Syrng 52 26 $1,478.40 $1,478.40 $502.66 $1,478.40 $1,182.72 2026-09-28
33016 HCPCS Drainage Of Heart Sac Using Imaging Guidance 60 30 $1,430.00 $1,430.00 $486.20 $1,720.90 $1,179.75 2026-09-28
74248 HCPCS Follow-through X-ray Of Small Intestines 60 30 $1,518.00 $1,518.00 $204.43 $1,518.00 $1,176.45 2026-09-28
73040 HCPCS Review By Radiologist Of Shoulder Joint Image 60 30 $1,513.00 $1,513.00 $204.43 $1,513.00 $1,172.58 2026-09-28
62273 HCPCS Injection Of Blood Or Blood Clot Into Spinal Canal 60 30 $1,421.00 $1,421.00 $483.14 $1,421.00 $1,172.32 2026-09-28
36576_ERX_1 CDM Ciproflox-dexameth Otic Susp 52 26 $1,459.45 $1,459.45 $496.21 $1,459.45 $1,167.56 2026-09-28
76700 HCPCS Complete Ultrasound Scan Of Abdomen 60 30 $1,493.00 $1,493.00 $290.89 $1,493.00 $1,157.08 2026-09-28
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