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

FRANKLIN GENERAL HOSPITAL

Hampton, IA · CCN 161308 · 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: $1,170 across 27 payers · range $415-$2,632

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbFGHHAMPTONIA&type=CDMWithoutLabel&fileType=CSV · observed 2026-04-20

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.

2,230 distinct procedures filed
31 distinct payers
95,253 rate rows
2026-04-20 last MRF observed
Data quality

94,843 of 95,253 rate rows are consumer-grade (99.6%)

410 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 188
exceeds 10× this hospital's gross charge — excluded from medians 184
per-diem day rate — not a per-procedure price 26
percent-of-charges filed in the dollar field — excluded from medians 12
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbFGHHAMPTONIA&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/Franklin_V2.aspx
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-22
Content fingerprint 36b65c1aed60da2e… · 47,511,052 bytes · first seen 2026-05-14

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 25 $11,917.28 $28,303.55 $12,644.24 nat. median
$155
outlier · 81.8×
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 25 $5,343.76 $22,127.01 $9,642.72 nat. median
$3,787
outlier · 2.5×
J9271
HCPCS 		Injection, Pembrolizumab, 1 Mg 25 $8,141.67 $19,336.46 $8,638.31 nat. median
$275
outlier · 31.5×
J0896
HCPCS 		Injection, Luspatercept-aamt, 0.25 Mg 27 $5,098.52 $12,108.98 $6,755.53 nat. median
$4,569
1.5× median
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 25 $6,054.67 $14,379.85 $6,424.01 nat. median
$1,659
outlier · 3.9×
Q5111
HCPCS 		Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg 25 $5,879.05 $13,962.74 $6,237.67 nat. median
$1,984
outlier · 3.1×
Q5119
HCPCS 		Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg 27 $3,877.03 $9,207.95 $5,137.07 nat. median
$831
outlier · 6.2×
J7169
HCPCS 		Injection, Coagulation Factor Xa (recombinant), Inactivated-zhzo (andexxa), 10 M… 16 $125.00 $14,612.00 $4,566.25 nat. median
$278
outlier · 16.4×
J2353
HCPCS 		Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg 25 $3,786.68 $8,993.36 $4,017.66 nat. median
$5,623
0.7× median
J3262
HCPCS 		Injection, Tocilizumab, 1 Mg 25 $3,286.32 $7,805.01 $3,486.79 nat. median
$1,413
outlier · 2.5×
J0881
HCPCS 		Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 25 $3,272.26 $7,771.61 $3,471.86 nat. median
$752
outlier · 4.6×
Q0222
HCPCS 		Injection, Bebtelovimab, 175 Mg 25 $3,070.60 $7,292.68 $3,257.91 nat. median
$2,564
1.3× median
J1826
HCPCS 		Injection, Interferon Beta-1a, 30 Mcg 25 $2,804.79 $6,926.59 $3,086.70 nat. median
$2,301
1.3× median
Q5108
HCPCS 		Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 25 $2,457.77 $6,537.97 $2,913.53 nat. median
$1,244
outlier · 2.3×
J0897
HCPCS 		Injection, Denosumab, 1 Mg 25 $1,693.18 $5,991.12 $2,643.02 nat. median
$1,982
1.3× median
J1569
HCPCS 		Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 25 $653.20 $7,161.76 $2,283.42 nat. median
$1,074
outlier · 2.1×
72197
HCPCS 		MRI Scan Of Pelvis Before And After Contrast 27 $1,233.80 $5,136.65 $2,283.38 nat. median
$1,074
outlier · 2.1×
72158
HCPCS 		MRI Scan Of Lower Spinal Canal Before And After Contrast 27 $1,233.80 $5,094.85 $2,264.79 nat. median
$1,097
outlier · 2.1×
73220
HCPCS 		MRI Scan Of Arm Before And After Contrast 27 $1,233.80 $5,094.85 $2,264.79 nat. median
$1,136
2.0× median
J3111
HCPCS 		Injection, Romosozumab-aqqg, 1 Mg 27 $1,700.82 $4,359.84 $2,253.59 nat. median
$696
outlier · 3.2×
J0875
HCPCS 		Injection, Dalbavancin, 5 Mg 25 $2,070.33 $4,917.03 $2,196.62 nat. median
$435
outlier · 5.0×
74183
HCPCS 		MRI Scan Of Abdomen Before And After Contrast 27 $1,233.80 $4,891.55 $2,174.42 nat. median
$1,105
2.0× median
73720
HCPCS 		MRI Scan Of Leg Before And After Contrast 27 $1,233.80 $5,094.85 $2,145.20 nat. median
$1,135
1.9× median
73719
HCPCS 		MRI Scan Of Leg With Contrast 27 $1,233.80 $5,094.85 $2,145.20 nat. median
$965
outlier · 2.2×
74178
HCPCS 		CT Scan Of Abdomen And Pelvis Before And After Contrast 27 $1,042.22 $4,713.90 $2,095.45 nat. median
$1,027
outlier · 2.0×
73723
HCPCS 		MRI Scan Of Leg Joint Before And After Contrast 27 $1,194.00 $5,096.75 $2,089.50 nat. median
$1,199
1.7× median
J1439
HCPCS 		Injection, Ferric Carboxymaltose, 1 Mg 25 $1,951.80 $4,635.53 $2,070.86 nat. median
$14
outlier · 153.4×
73218
HCPCS 		MRI Scan Of Arm Without Contrast 27 $983.32 $5,512.85 $2,033.50 nat. median
$866
outlier · 2.3×
70543
HCPCS 		MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 27 $1,233.80 $4,558.10 $2,026.20 nat. median
$1,087
1.9× median
70553
HCPCS 		MRI Scan Of Brain Before And After Contrast 27 $1,233.80 $4,558.10 $2,026.20 nat. median
$1,136
1.8× median
71552
HCPCS 		MRI Scan Of Chest Before And After Contrast 27 $1,233.80 $4,558.10 $2,026.20 nat. median
$1,103
1.8× median
73223
HCPCS 		MRI Scan Of Arm Joint Before And After Contrast 27 $1,122.00 $4,662.60 $1,963.20 nat. median
$1,158
1.7× median
73221
HCPCS 		MRI Scan Of Arm Joint Without Contrast 27 $983.32 $5,249.70 $1,936.20 nat. median
$844
outlier · 2.3×
73718
HCPCS 		MRI Scan Of Leg Without Contrast 27 $983.32 $5,249.70 $1,936.20 nat. median
$870
outlier · 2.2×
73721
HCPCS 		MRI Scan Of Leg Joint Without Contrast 27 $983.32 $5,249.70 $1,936.20 nat. median
$856
outlier · 2.3×
74185
HCPCS 		MRI Scan Of Blood Vessels Of Abdomen 27 $675.80 $4,335.80 $1,927.38 nat. median
$1,253
1.5× median
J0129
HCPCS 		Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 25 $1,799.47 $4,273.74 $1,909.24 nat. median
$902
outlier · 2.1×
72157
HCPCS 		MRI Scan Of Middle Spinal Canal Before And After Contrast 27 $1,233.80 $4,259.80 $1,893.59 nat. median
$1,114
1.7× median
C8901
HCPCS 		Magnetic Resonance Angiography Without Contrast, Abdomen 27 $675.80 $4,134.40 $1,837.85 nat. median
$805
outlier · 2.3×
74177
HCPCS 		CT Scan Of Abdomen And Pelvis With Contrast 27 $1,042.22 $4,112.55 $1,828.14 nat. median
$976
1.9× median
73202
HCPCS 		CT Scan Of Arm Before And After Contrast 27 $1,026.40 $4,609.40 $1,796.20 nat. median
$714
outlier · 2.5×
73702
HCPCS 		CT Scan Of Leg Before And After Contrast 27 $1,026.40 $4,609.40 $1,796.20 nat. median
$708
outlier · 2.5×
J1950
HCPCS 		Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg 25 $1,692.78 $4,020.36 $1,796.04 nat. median
$3,921
outlier · 0.5×
95811
HCPCS 		Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 27 $1,115.38 $4,012.80 $1,783.80 nat. median
$1,894
0.9× median
J2794
HCPCS 		Injection, Risperidone (risperdal Consta), 0.5 Mg 25 $1,679.25 $3,988.21 $1,781.68 nat. median
$833
outlier · 2.1×
73201
HCPCS 		CT Scan Of Arm With Contrast 27 $997.60 $4,464.05 $1,745.80 nat. median
$805
outlier · 2.2×
73701
HCPCS 		CT Scan Of Leg With Contrast Material 27 $997.60 $4,464.05 $1,745.80 nat. median
$677
outlier · 2.6×
J2357
HCPCS 		Injection, Omalizumab, 5 Mg 25 $1,623.86 $3,856.67 $1,722.92 nat. median
$1,249
1.4× median
78452
HCPCS 		Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 27 $1,437.60 $3,414.30 $1,657.26 nat. median
$1,822
0.9× median
78451
HCPCS 		Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect 27 $1,176.00 $2,793.00 $1,657.26 nat. median
$1,550
1.1× median

Other procedures at this hospital

Browse this hospital's 2,230 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 25 25 $29,793.21 $26,813.89 $11,917.28 $28,303.55 $12,644.24 2026-04-20
J3101 HCPCS Injection, Tenecteplase, 1 Mg 50 25 $18,325.50 $16,492.95 $5,343.76 $22,127.01 $9,642.72 2026-04-20
J9271 HCPCS Injection, Pembrolizumab, 1 Mg 25 25 $20,354.17 $18,318.75 $8,141.67 $19,336.46 $8,638.31 2026-04-20
J0896 HCPCS Injection, Luspatercept-aamt, 0.25 Mg 27 27 $12,746.29 $11,471.66 $5,098.52 $12,108.98 $6,755.53 2026-04-20
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 25 25 $15,136.68 $13,623.01 $6,054.67 $14,379.85 $6,424.01 2026-04-20
Q5111 HCPCS Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg 25 25 $14,697.62 $13,227.86 $5,879.05 $13,962.74 $6,237.67 2026-04-20
Q5119 HCPCS Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg 27 27 $9,692.58 $8,723.32 $3,877.03 $9,207.95 $5,137.07 2026-04-20
J7169 HCPCS Injection, Coagulation Factor Xa (recombinant), Inactivated-zhzo (andexxa), 10 M… 16 16 $9,132.50 $8,219.25 $125.00 $14,612.00 $4,566.25 2026-04-20
J2353 HCPCS Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg 25 25 $9,466.69 $8,520.02 $3,786.68 $8,993.36 $4,017.66 2026-04-20
J3262 HCPCS Injection, Tocilizumab, 1 Mg 25 25 $8,215.80 $7,394.22 $3,286.32 $7,805.01 $3,486.79 2026-04-20
J0881 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 25 25 $8,180.64 $7,362.58 $3,272.26 $7,771.61 $3,471.86 2026-04-20
Q0222 HCPCS Injection, Bebtelovimab, 175 Mg 25 25 $7,676.50 $6,908.85 $3,070.60 $7,292.68 $3,257.91 2026-04-20
J1826 HCPCS Injection, Interferon Beta-1a, 30 Mcg 50 25 $7,151.56 $6,436.41 $2,804.79 $6,926.59 $3,086.70 2026-04-20
Q5108 HCPCS Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 50 25 $6,513.24 $5,861.92 $2,457.77 $6,537.97 $2,913.53 2026-04-20
J0897 HCPCS Injection, Denosumab, 1 Mg 50 25 $5,269.69 $4,742.73 $1,693.18 $5,991.12 $2,643.02 2026-04-20
J1569 HCPCS Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 50 25 $4,585.85 $4,127.26 $653.20 $7,161.76 $2,283.42 2026-04-20
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 27 27 $5,407.00 $4,866.30 $1,233.80 $5,136.65 $2,283.38 2026-04-20
73220 HCPCS MRI Scan Of Arm Before And After Contrast 81 27 $5,363.00 $4,826.70 $1,233.80 $5,094.85 $2,264.79 2026-04-20
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 27 27 $5,363.00 $4,826.70 $1,233.80 $5,094.85 $2,264.79 2026-04-20
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 54 27 $4,420.69 $3,978.61 $1,700.82 $4,359.84 $2,253.59 2026-04-20
J0875 HCPCS Injection, Dalbavancin, 5 Mg 25 25 $5,175.82 $4,658.24 $2,070.33 $4,917.03 $2,196.62 2026-04-20
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 27 27 $5,149.00 $4,634.10 $1,233.80 $4,891.55 $2,174.42 2026-04-20
73719 HCPCS MRI Scan Of Leg With Contrast 81 27 $3,192.00 $2,872.80 $1,233.80 $5,094.85 $2,145.20 2026-04-20
73720 HCPCS MRI Scan Of Leg Before And After Contrast 81 27 $3,192.00 $2,872.80 $1,233.80 $5,094.85 $2,145.20 2026-04-20
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 27 27 $4,962.00 $4,465.80 $1,042.22 $4,713.90 $2,095.45 2026-04-20
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 81 27 $2,985.00 $2,686.50 $1,194.00 $5,096.75 $2,089.50 2026-04-20
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 25 25 $4,879.51 $4,391.56 $1,951.80 $4,635.53 $2,070.86 2026-04-20
73218 HCPCS MRI Scan Of Arm Without Contrast 81 27 $2,905.00 $2,614.50 $983.32 $5,512.85 $2,033.50 2026-04-20
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 27 27 $4,798.00 $4,318.20 $1,233.80 $4,558.10 $2,026.20 2026-04-20
71552 HCPCS MRI Scan Of Chest Before And After Contrast 27 27 $4,798.00 $4,318.20 $1,233.80 $4,558.10 $2,026.20 2026-04-20
70553 HCPCS MRI Scan Of Brain Before And After Contrast 27 27 $4,798.00 $4,318.20 $1,233.80 $4,558.10 $2,026.20 2026-04-20
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 81 27 $2,805.00 $2,524.50 $1,122.00 $4,662.60 $1,963.20 2026-04-20
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 81 27 $2,766.00 $2,489.40 $983.32 $5,249.70 $1,936.20 2026-04-20
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 81 27 $2,766.00 $2,489.40 $983.32 $5,249.70 $1,936.20 2026-04-20
73718 HCPCS MRI Scan Of Leg Without Contrast 81 27 $2,766.00 $2,489.40 $983.32 $5,249.70 $1,936.20 2026-04-20
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 27 27 $4,564.00 $4,107.60 $675.80 $4,335.80 $1,927.38 2026-04-20
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 25 25 $4,498.67 $4,048.80 $1,799.47 $4,273.74 $1,909.24 2026-04-20
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 27 27 $4,484.00 $4,035.60 $1,233.80 $4,259.80 $1,893.59 2026-04-20
C8901 HCPCS Magnetic Resonance Angiography Without Contrast, Abdomen 27 27 $4,352.00 $3,916.80 $675.80 $4,134.40 $1,837.85 2026-04-20
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 27 27 $4,329.00 $3,896.10 $1,042.22 $4,112.55 $1,828.14 2026-04-20
73702 HCPCS CT Scan Of Leg Before And After Contrast 81 27 $2,566.00 $2,309.40 $1,026.40 $4,609.40 $1,796.20 2026-04-20
73202 HCPCS CT Scan Of Arm Before And After Contrast 81 27 $2,566.00 $2,309.40 $1,026.40 $4,609.40 $1,796.20 2026-04-20
J1950 HCPCS Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg 25 25 $4,231.96 $3,808.76 $1,692.78 $4,020.36 $1,796.04 2026-04-20
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 27 27 $4,224.00 $3,801.60 $1,115.38 $4,012.80 $1,783.80 2026-04-20
J2794 HCPCS Injection, Risperidone (risperdal Consta), 0.5 Mg 25 25 $4,198.12 $3,778.31 $1,679.25 $3,988.21 $1,781.68 2026-04-20
73701 HCPCS CT Scan Of Leg With Contrast Material 81 27 $2,494.00 $2,244.60 $997.60 $4,464.05 $1,745.80 2026-04-20
73201 HCPCS CT Scan Of Arm With Contrast 81 27 $2,494.00 $2,244.60 $997.60 $4,464.05 $1,745.80 2026-04-20
J2357 HCPCS Injection, Omalizumab, 5 Mg 25 25 $4,059.65 $3,653.69 $1,623.86 $3,856.67 $1,722.92 2026-04-20
78452 HCPCS Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 27 27 $3,594.00 $3,234.60 $1,437.60 $3,414.30 $1,657.26 2026-04-20
78451 HCPCS Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect 27 27 $2,940.00 $2,646.00 $1,176.00 $2,793.00 $1,657.26 2026-04-20
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 27 27 $3,867.00 $3,480.30 $1,233.80 $3,673.65 $1,633.03 2026-04-20
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 27 27 $3,796.00 $3,416.40 $1,042.22 $3,606.20 $1,603.05 2026-04-20
77001 HCPCS Fluoroscopic Guidance For Insertion Or Removal Of Central Vein Access Device 27 27 $3,789.00 $3,410.10 $655.34 $3,599.55 $1,600.09 2026-04-20
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 27 27 $3,717.00 $3,345.30 $675.80 $3,531.15 $1,569.69 2026-04-20
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 27 27 $3,696.00 $3,326.40 $1,115.38 $3,511.20 $1,560.82 2026-04-20
36556 HCPCS Insertion Of Non-tunneled Central Venous Tube For Infusion (5 Years Or Older) 27 27 $2,544.00 $2,289.60 $1,017.60 $2,416.80 $1,526.40 2026-04-20
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 27 27 $3,437.00 $3,093.30 $675.80 $3,265.15 $1,451.45 2026-04-20
73200 HCPCS CT Scan Of Arm Without Contrast 81 27 $2,063.00 $1,856.70 $480.50 $3,909.25 $1,444.10 2026-04-20
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 27 27 $3,335.00 $3,001.50 $675.80 $3,168.25 $1,408.37 2026-04-20
77075 HCPCS Complete X-ray Of Body Bones 27 27 $3,297.00 $2,967.30 $178.56 $3,132.15 $1,392.32 2026-04-20
4903011_1 CDM Room & Board - Other - Sterile Environment 14 14 $1,621.00 $1,458.90 $891.55 $1,539.95 $1,377.85 2026-04-20
73700 HCPCS CT Scan Of Leg Without Contrast 81 27 $1,965.00 $1,768.50 $480.50 $3,909.25 $1,375.50 2026-04-20
73219 HCPCS MRI Scan Of Arm With Contrast 81 27 $3,192.00 $2,872.80 $1,233.80 $3,032.40 $1,354.68 2026-04-20
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 27 27 $3,192.00 $2,872.80 $1,233.80 $3,032.40 $1,354.68 2026-04-20
J1745 HCPCS Injection, Infliximab, Excludes Biosimilar, 10 Mg 50 25 $2,432.70 $2,189.43 $649.17 $3,080.35 $1,342.28 2026-04-20
Q0138 HCPCS Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd … 50 25 $2,615.61 $2,354.06 $424.59 $3,961.26 $1,338.15 2026-04-20
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 27 27 $3,157.00 $2,841.30 $983.32 $2,999.15 $1,333.20 2026-04-20
73722 HCPCS MRI Scan Of Leg Joint With Contrast 81 27 $2,908.00 $2,617.20 $1,163.20 $2,993.45 $1,330.67 2026-04-20
4903043_1 CDM Room & Board - Semi-private (two Beds) - General Classification 14 14 $1,558.00 $1,402.20 $856.90 $1,480.10 $1,324.30 2026-04-20
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 27 27 $3,120.00 $2,808.00 $675.80 $2,964.00 $1,317.58 2026-04-20
72196 HCPCS MRI Scan Of Pelvis With Contrast 27 27 $3,095.00 $2,785.50 $1,233.80 $2,940.25 $1,313.52 2026-04-20
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 27 27 $3,094.00 $2,784.60 $1,233.80 $2,939.30 $1,313.09 2026-04-20
70552 HCPCS MRI Scan Of Brain With Contrast 27 27 $3,094.00 $2,784.60 $1,233.80 $2,939.30 $1,313.09 2026-04-20
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 27 27 $3,094.00 $2,784.60 $1,233.80 $2,939.30 $1,313.09 2026-04-20
70336 HCPCS MRI Scan Of Jaw Joint 27 27 $3,094.00 $2,784.60 $983.32 $2,939.30 $1,306.60 2026-04-20
1378483_1 CDM Operating Room Services - General Classification 27 27 $2,345.00 $2,110.50 $938.00 $2,227.75 $1,242.85 2026-04-20
49002 HCPCS Reopening Of Recent Abdominal Incision 24 24 $2,957.00 $2,661.30 $238.74 $6,661.78 $1,242.68 2026-04-20
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 27 27 $2,923.00 $2,630.70 $983.32 $2,776.85 $1,234.38 2026-04-20
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 27 27 $2,905.00 $2,614.50 $1,162.00 $2,759.75 $1,233.80 2026-04-20
73222 HCPCS MRI Scan Of Arm Joint With Contrast 81 27 $2,170.00 $1,953.00 $868.00 $2,491.85 $1,233.80 2026-04-20
74181 HCPCS MRI Scan Of Abdomen Without Contrast 27 27 $2,905.00 $2,614.50 $983.32 $2,759.75 $1,226.78 2026-04-20
71550 HCPCS MRI Scan Of Chest Without Contrast 27 27 $2,905.00 $2,614.50 $983.32 $2,759.75 $1,226.78 2026-04-20
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 27 27 $2,905.00 $2,614.50 $983.32 $2,759.75 $1,226.78 2026-04-20
72195 HCPCS MRI Scan Of Pelvis Without Contrast 27 27 $2,905.00 $2,614.50 $983.32 $2,759.75 $1,226.78 2026-04-20
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 27 27 $2,905.00 $2,614.50 $983.32 $2,759.75 $1,226.78 2026-04-20
70551 HCPCS MRI Scan Of Brain Without Contrast 27 27 $2,905.00 $2,614.50 $983.32 $2,759.75 $1,226.78 2026-04-20
A0434 HCPCS Specialty Care Transport (sct) 25 25 $2,031.00 $1,827.90 $812.40 $1,929.45 $1,218.60 2026-04-20
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 27 27 $2,866.00 $2,579.40 $1,042.22 $2,722.70 $1,210.31 2026-04-20
J1568 HCPCS Injection, Immune Globulin, (octagam), Intravenous, Non-lyophilized (e.g., Liqui… 100 25 $2,414.63 $2,173.17 $500.93 $4,502.23 $1,189.70 2026-04-20
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 27 27 $2,813.00 $2,531.70 $1,042.22 $2,672.35 $1,187.93 2026-04-20
C8929 HCPCS Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi… 27 27 $2,771.00 $2,493.90 $415.40 $2,632.45 $1,170.19 2026-04-20
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 27 27 $2,771.00 $2,493.90 $415.40 $2,632.45 $1,170.19 2026-04-20
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 27 27 $2,750.00 $2,475.00 $675.80 $2,612.50 $1,161.33 2026-04-20
72132 HCPCS CT Scan Of Lower Spine With Contrast 27 27 $2,718.00 $2,446.20 $1,042.22 $2,582.10 $1,147.81 2026-04-20
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 27 27 $2,707.00 $2,436.30 $1,042.22 $2,571.65 $1,146.44 2026-04-20
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 27 27 $2,691.00 $2,421.90 $1,042.22 $2,556.45 $1,142.06 2026-04-20
58552 HCPCS Removal Of Uterus, Tubes, And/or Ovaries Through Vagina Using An Endoscope, 250.… 24 24 $2,705.00 $2,434.50 $238.74 $10,118.83 $1,136.78 2026-04-20
72129 HCPCS CT Scan Of Middle Spine With Contrast 27 27 $2,657.00 $2,391.30 $1,042.22 $2,524.15 $1,127.63 2026-04-20
71270 HCPCS CT Scan Of Chest Before And After Contrast 27 27 $2,648.00 $2,383.20 $1,042.22 $2,515.60 $1,123.81 2026-04-20
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 27 27 $2,654.00 $2,388.60 $709.28 $2,521.30 $1,120.78 2026-04-20
78195 HCPCS Nuclear Medicine Study Of Lymphatic System 27 27 $1,862.00 $1,675.80 $744.80 $1,822.99 $1,117.20 2026-04-20
983763_1 CDM Operating Room Services - General Classification 27 27 $2,092.00 $1,882.80 $836.80 $1,987.40 $1,108.76 2026-04-20
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 27 27 $2,566.00 $2,309.40 $1,026.40 $2,437.70 $1,089.01 2026-04-20
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 27 27 $2,501.00 $2,250.90 $1,000.40 $2,375.95 $1,061.42 2026-04-20
A0433 HCPCS Advanced Life Support, Level 2 (als 2) 25 25 $1,763.00 $1,586.70 $705.20 $1,674.85 $1,057.80 2026-04-20
78709 HCPCS Nuclear Medicine Studies Of Kidney, Blood Flow, And Function 27 27 $2,500.00 $2,250.00 $879.16 $2,375.00 $1,055.75 2026-04-20
72126 HCPCS CT Scan Of Upper Spine With Contrast 27 27 $2,473.00 $2,225.70 $989.20 $2,349.35 $1,049.54 2026-04-20
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 27 27 $2,463.00 $2,216.70 $985.20 $2,339.85 $1,045.30 2026-04-20
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 27 27 $2,430.00 $2,187.00 $972.00 $2,308.50 $1,042.22 2026-04-20
74160 HCPCS CT Scan Of Abdomen With Contrast 27 27 $2,167.00 $1,950.30 $866.80 $2,058.65 $1,042.22 2026-04-20
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 27 27 $2,377.00 $2,139.30 $950.80 $2,258.15 $1,042.22 2026-04-20
70488 HCPCS CT Scan Of Face Before And After Contrast 27 27 $2,174.00 $1,956.60 $869.60 $2,065.30 $1,042.22 2026-04-20
70487 HCPCS CT Scan Of Face With Contrast 27 27 $2,028.00 $1,825.20 $811.20 $1,926.60 $1,042.22 2026-04-20
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 27 27 $2,381.00 $2,142.90 $952.40 $2,261.95 $1,042.22 2026-04-20
70450 HCPCS CT Scan Head Or Brain Without Contrast 27 27 $1,936.00 $1,742.40 $774.40 $1,839.20 $1,042.22 2026-04-20
72193 HCPCS CT Scan Of Pelvis With Contrast 27 27 $2,167.00 $1,950.30 $866.80 $2,058.65 $1,042.22 2026-04-20
70460 HCPCS CT Scan Head Or Brain With Contrast 27 27 $2,350.00 $2,115.00 $940.00 $2,232.50 $1,042.22 2026-04-20
71260 HCPCS CT Scan Of Chest With Contrast 27 27 $2,229.00 $2,006.10 $891.60 $2,117.55 $1,042.22 2026-04-20
14021 HCPCS Repair Of Wound Of Scalp, Arms, Or Legs By Transferring Skin, 10.1-30.0 Sq Cm 24 24 $2,470.00 $2,223.00 $238.74 $6,956.40 $1,038.01 2026-04-20
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 27 27 $2,442.00 $2,197.80 $709.28 $2,319.90 $1,031.26 2026-04-20
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 27 27 $2,389.00 $2,150.10 $709.28 $2,269.55 $1,008.87 2026-04-20
27252 HCPCS Closed Treatment Of Dislocated Hip Under Anesthesia 24 24 $2,365.00 $2,128.50 $238.74 $2,830.98 $993.89 2026-04-20
J0585 HCPCS Injection, Onabotulinumtoxina, 1 Unit 25 25 $2,340.26 $2,106.23 $936.10 $2,223.25 $993.21 2026-04-20
26990 HCPCS Drainage Of Deep Abscess Or Blood Accumulation Of Pelvis Or Hip Near Joint 24 24 $2,322.00 $2,089.80 $238.74 $7,381.29 $975.82 2026-04-20
78071 HCPCS Nuclear Medicine Study Of Parathyroid With Spect 27 27 $2,308.00 $2,077.20 $879.16 $2,192.60 $974.67 2026-04-20
47562 HCPCS Removal Of Gallbladder Using An Endoscope 24 24 $2,295.00 $2,065.50 $238.74 $9,126.52 $964.47 2026-04-20
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 27 27 $2,269.00 $2,042.10 $675.80 $2,155.55 $958.20 2026-04-20
90378 HCPCS Respiratory Syncytial Virus Antibody For Injection Into Tissue Or Muscle 27 27 $2,234.00 $2,010.60 $583.42 $2,122.30 $943.42 2026-04-20
14000 HCPCS Repair Of Wound Of Trunk By Transferring Skin, 10.0 Sq Cm Or Less 24 24 $2,203.00 $1,982.70 $238.74 $2,985.11 $925.81 2026-04-20
14040 HCPCS Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, Genitals, Han… 24 24 $2,141.00 $1,926.90 $238.74 $6,956.40 $899.75 2026-04-20
72128 HCPCS CT Scan Of Middle Spine Without Contrast 27 27 $2,120.00 $1,908.00 $480.50 $2,014.00 $895.28 2026-04-20
78315 HCPCS Nuclear Medicine Study Of Bone Taken At Different Times 27 27 $2,090.00 $1,881.00 $836.00 $1,985.50 $887.00 2026-04-20
J3095 HCPCS Injection, Telavancin, 10 Mg 50 25 $1,989.66 $1,790.69 $757.29 $1,981.79 $883.15 2026-04-20
78708 HCPCS Nuclear Medicine Study Of Kidney, Blood, Flow, And Function With Drug Administra… 27 27 $1,916.00 $1,724.40 $766.40 $1,820.20 $879.16 2026-04-20
78227 HCPCS Nuclear Medicine Study Of Liver And Bile Duct System With Use Of Drugs 27 27 $2,012.00 $1,810.80 $804.80 $1,911.40 $879.16 2026-04-20
78306 HCPCS Nuclear Medicine Study Of Bone And/or Joint Whole Body 27 27 $1,965.00 $1,768.50 $786.00 $1,866.75 $879.16 2026-04-20
78264 HCPCS Nuclear Medicine Study Of Stomach To Assess Emptying 27 27 $1,496.00 $1,346.40 $598.40 $1,421.20 $879.16 2026-04-20
78707 HCPCS Nuclear Medicine Study Of Kidney, Blood Flow, And Function 27 27 $1,896.00 $1,706.40 $758.40 $1,801.20 $879.16 2026-04-20
78494 HCPCS Nuclear Medicine Study Of Heart Pumping Function By Labeling Red Blood Cells Wit… 27 27 $1,802.00 $1,621.80 $720.80 $1,711.90 $879.16 2026-04-20
72125 HCPCS CT Scan Of Upper Spine Without Contrast 27 27 $2,063.00 $1,856.70 $480.50 $1,959.85 $871.20 2026-04-20
J0248 HCPCS Injection, Remdesivir, 1 Mg 25 25 $1,982.80 $1,784.52 $793.12 $1,883.66 $841.50 2026-04-20
72131 HCPCS CT Scan Of Lower Spine Without Contrast 27 27 $1,971.00 $1,773.90 $480.50 $1,872.45 $832.35 2026-04-20
74150 HCPCS CT Scan Of Abdomen Without Contrast 27 27 $1,922.00 $1,729.80 $480.50 $1,825.90 $811.66 2026-04-20
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 27 27 $1,911.00 $1,719.90 $480.50 $1,815.45 $807.02 2026-04-20
71250 HCPCS CT Scan Of Chest Without Contrast 52 27 $1,905.00 $1,714.50 $480.50 $1,809.75 $802.29 2026-04-20
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 27 27 $1,894.00 $1,704.60 $480.50 $1,799.30 $799.84 2026-04-20
Q5101 HCPCS Injection, Filgrastim-sndz, Biosimilar, (zarxio), 1 Microgram 50 25 $1,691.96 $1,522.76 $601.47 $1,786.23 $796.00 2026-04-20
14060 HCPCS Repair Of Wound Of Eyelids, Nose, Ears, Or Lips By Transferring Skin, 10.0 Sq Cm… 24 24 $1,894.00 $1,704.60 $238.74 $6,956.40 $795.96 2026-04-20
72192 HCPCS CT Scan Of Pelvis Without Contrast 27 27 $1,875.00 $1,687.50 $480.50 $1,781.25 $791.81 2026-04-20
78070 HCPCS Nuclear Medicine Study Of Parathyroid 27 27 $1,318.00 $1,186.20 $527.20 $1,822.99 $790.80 2026-04-20
J0666 HCPCS Injection, Bupivacaine Liposome, 1 Mg 27 27 $1,483.72 $1,335.35 $593.49 $1,409.53 $786.37 2026-04-20
78300 HCPCS Nuclear Medicine Study Of Bone And/or Joint Limited Area 27 27 $1,307.00 $1,176.30 $522.80 $1,241.65 $784.20 2026-04-20
94002 HCPCS Initial Hospital Inpatient Or Observation Ventilation Assistance And Management 27 27 $1,504.00 $1,353.60 $601.60 $1,428.80 $778.72 2026-04-20
49560 HCPCS Repair Initial Incisional Or Ventral Hernia; Reducible 24 24 $1,836.00 $1,652.40 $238.74 $7,398.34 $771.58 2026-04-20
8996752_1 CDM Panoptix Iol Lens 12 12 $1,090.00 $981.00 $414.20 $926.50 $763.00 2026-04-20
70486 HCPCS CT Scan Of Face Without Contrast 27 27 $1,779.00 $1,601.10 $480.50 $1,690.05 $751.27 2026-04-20
94003 HCPCS Follow-up Inpatient Or Observation Ventilation Assistance And Management 27 27 $1,250.00 $1,125.00 $500.00 $1,187.50 $750.00 2026-04-20
A0427 HCPCS Ambulance Service, Advanced Life Support, Emergency Transport, Level 1 (als 1 - … 25 25 $1,243.00 $1,118.70 $497.20 $1,180.85 $745.80 2026-04-20
78580 HCPCS Nuclear Medicine Study Of Lung Circulation 27 27 $1,219.00 $1,097.10 $487.60 $1,822.99 $731.40 2026-04-20
26951 HCPCS Amputation Of Finger Or Thumb With Direct Closure 24 24 $1,740.00 $1,566.00 $238.74 $3,526.62 $731.23 2026-04-20
Q5103 HCPCS Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 25 25 $1,701.00 $1,530.90 $680.40 $1,615.95 $721.90 2026-04-20
78701 HCPCS Nuclear Medicine Study Of Kidney And Blood Flow 27 27 $1,193.00 $1,073.70 $477.20 $1,133.35 $715.80 2026-04-20
12047 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, More Than 30.0 C… 24 24 $1,695.00 $1,525.50 $238.74 $2,985.11 $712.33 2026-04-20
78226 HCPCS Nuclear Medicine Study Of Liver And Bile Duct System 27 27 $1,183.00 $1,064.70 $473.20 $1,123.85 $709.80 2026-04-20
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 50 25 $1,646.57 $1,481.91 $647.65 $1,590.30 $708.69 2026-04-20
78579 HCPCS Nuclear Medicine Study Of Lung Ventilation 27 27 $1,174.00 $1,056.60 $469.60 $1,822.99 $704.40 2026-04-20
J1740 HCPCS Injection, Ibandronate Sodium, 1 Mg 25 25 $1,652.81 $1,487.53 $661.12 $1,570.17 $701.45 2026-04-20
J1442 HCPCS Injection, Filgrastim (g-csf), Excludes Biosimilars, 1 Microgram 50 25 $1,430.26 $1,287.24 $486.26 $1,562.63 $696.36 2026-04-20
26735 HCPCS Treatment Of Broken Finger At Midportion Or Part Near Hand 24 24 $1,646.00 $1,481.40 $238.74 $9,670.76 $691.74 2026-04-20
13132 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 24 24 $1,618.00 $1,456.20 $238.74 $1,537.10 $679.96 2026-04-20
78014 HCPCS Nuclear Medicine Study Of Thyroid And Thyroid Function 27 27 $1,125.00 $1,012.50 $450.00 $1,068.75 $675.00 2026-04-20
78215 HCPCS Nuclear Medicine Study Of Liver And Spleen 27 27 $1,114.00 $1,002.60 $445.60 $1,822.99 $668.40 2026-04-20
12056 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 20.1-… 24 24 $1,574.00 $1,416.60 $238.74 $1,495.30 $661.48 2026-04-20
59426 HCPCS Predelivery Care, 7 Or More Visits 24 24 $2,308.00 $2,077.20 $238.74 $2,192.60 $657.20 2026-04-20
78466 HCPCS Nuclear Medicine Study Of Heart Muscle Following Heart Attack 27 27 $1,094.00 $984.60 $437.60 $1,039.30 $656.40 2026-04-20
12046 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 20.1-30.0 Cm 24 24 $1,548.00 $1,393.20 $238.74 $1,470.60 $650.55 2026-04-20
7842761_1 CDM Custom Eye Pack 27 27 $1,222.00 $1,099.80 $488.80 $1,160.90 $647.66 2026-04-20
A0999 HCPCS Unlisted Ambulance Service 25 25 $1,075.00 $967.50 $430.00 $1,021.25 $645.00 2026-04-20
78013 HCPCS Nuclear Medicine Study Of Thyroid 27 27 $1,071.00 $963.90 $428.40 $1,017.45 $642.60 2026-04-20
55250 HCPCS Removal Of Sperm Duct 24 24 $1,517.00 $1,365.30 $238.74 $3,386.81 $637.52 2026-04-20
13121 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 2.6-7.5 Cm 24 24 $1,641.00 $1,476.90 $238.74 $1,558.95 $630.54 2026-04-20
24505 HCPCS Closed Treatment Of Broken Middle Part Of Upper Arm Bone With Manipulation 24 24 $1,486.00 $1,337.40 $238.74 $3,346.57 $624.50 2026-04-20
27810 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle With Manipulation 24 24 $1,483.00 $1,334.70 $238.74 $3,346.57 $623.23 2026-04-20
8996746_1 CDM Synergy Iol Lens 27 27 $1,175.00 $1,057.50 $470.00 $1,116.25 $622.75 2026-04-20
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 24 24 $1,472.00 $1,324.80 $238.74 $3,346.57 $618.61 2026-04-20
93350 HCPCS Ultrasound Of Heart During Rest, Exercise And/or Drug-induced Stress With Report 27 27 $1,456.00 $1,310.40 $415.40 $1,383.20 $614.87 2026-04-20
J7302 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System, 52 Mg 27 27 $1,157.00 $1,041.30 $462.80 $1,099.15 $613.21 2026-04-20
90375 HCPCS Rabies Immune Globulin For Injection 52 27 $1,791.57 $1,612.41 $185.20 $1,701.99 $612.59 2026-04-20
11646 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More… 24 24 $1,449.00 $1,304.10 $238.74 $3,847.84 $608.94 2026-04-20
25565 HCPCS Closed Treatment Of Broken Midpart Of Both Forearm Bones With Manipulation 24 24 $1,448.00 $1,303.20 $238.74 $3,346.57 $608.52 2026-04-20
78278 HCPCS Nuclear Medicine Study To Assess Blood Loss 27 27 $1,001.00 $900.90 $400.40 $1,822.99 $600.60 2026-04-20
26765 HCPCS Treatment Of Broken End Of Finger Or Thumb 24 24 $1,421.00 $1,278.90 $238.74 $9,670.76 $597.17 2026-04-20
99291 HCPCS Critical Care, First 30-74 Minutes 74 27 $970.00 $873.00 $186.97 $1,700.50 $582.00 2026-04-20
78803 HCPCS Nuclear Medicine Study, Spect Imaging, 1 Area Or Single Acquisition, Single Day … 52 27 $1,162.00 $1,045.80 $445.60 $1,822.99 $580.77 2026-04-20
26607 HCPCS Closed Treatment Of Broken Hand Bone With Manipulation And Placement Of External… 24 24 $1,376.00 $1,238.40 $238.74 $3,346.57 $578.26 2026-04-20
13152 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 2.6-7.5 Cm 24 24 $1,376.00 $1,238.40 $238.74 $1,307.20 $578.26 2026-04-20
8996750_1 CDM Vivity Iol Lens 27 27 $1,090.00 $981.00 $436.00 $1,035.50 $577.70 2026-04-20
21930 HCPCS Removal Of Growth Under Skin Of Back Or Lower Sides, Less Than 3.0 Cm 24 24 $1,373.00 $1,235.70 $238.74 $3,847.84 $577.01 2026-04-20
36430 HCPCS Transfusion Of Blood Or Blood Products 102 27 $1,008.00 $907.20 $329.20 $1,444.48 $574.88 2026-04-20
12055 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.6-… 24 24 $1,362.00 $1,225.80 $238.74 $1,293.90 $572.38 2026-04-20
27752 HCPCS Closed Treatment Of Middle Part Of Broken Shin Bone With Manipulation 24 24 $1,359.00 $1,223.10 $238.74 $3,346.57 $571.12 2026-04-20
27550 HCPCS Closed Treatment Of Dislocated Knee 24 24 $1,359.00 $1,223.10 $238.74 $3,346.57 $571.12 2026-04-20
23605 HCPCS Closed Treatment Of Broken Top Of Upper Arm Bone With Manipulation 24 24 $1,349.00 $1,214.10 $238.74 $3,346.57 $566.91 2026-04-20
46250 HCPCS Removal Of Multiple External Hemorrhoids 24 24 $1,349.00 $1,214.10 $238.74 $4,960.19 $566.91 2026-04-20
4021294_1 CDM 00000-0000-95 - Tpn/ppn w/Amino Acids 8% Solution (Hepatamine GEq) [fl] 27 27 $1,066.00 $959.40 $426.40 $1,012.70 $564.98 2026-04-20
M0243 HCPCS Intravenous Infusion Or Subcutaneous Injection, Casirivimab And Imdevimab Includ… 27 27 $1,062.00 $955.80 $424.80 $1,008.90 $562.86 2026-04-20
M0245 HCPCS Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Ad… 27 27 $1,062.00 $955.80 $424.80 $1,008.90 $562.86 2026-04-20
M0247 HCPCS Intravenous Infusion, Sotrovimab, Includes Infusion And Post Administration Moni… 27 27 $1,062.00 $955.80 $424.80 $1,008.90 $562.86 2026-04-20
8996748_1 CDM Symfony Iol Lens 27 27 $1,055.00 $949.50 $422.00 $1,002.25 $559.15 2026-04-20
27230 HCPCS Closed Treatment Of Broken Upper Thigh Bone 24 24 $1,307.00 $1,176.30 $238.74 $3,346.57 $549.27 2026-04-20
46255 HCPCS Removal Of Single External And Internal Hemorrhoid Group 24 24 $1,298.00 $1,168.20 $238.74 $4,960.19 $545.49 2026-04-20
11606 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 24 24 $1,290.00 $1,161.00 $238.74 $3,847.84 $542.12 2026-04-20
J7307 HCPCS Etonogestrel (contraceptive) Implant System, Including Implant And Supplies 25 25 $1,274.00 $1,146.60 $509.60 $1,210.30 $540.69 2026-04-20
J7298 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg 25 25 $1,274.00 $1,146.60 $509.60 $1,210.30 $540.69 2026-04-20
78700 HCPCS Nuclear Medicine Study Of Kidney 27 27 $888.00 $799.20 $355.20 $967.08 $532.80 2026-04-20
78761 HCPCS Nuclear Medicine Study Of Testicle And Blood Flow 27 27 $888.00 $799.20 $355.20 $967.08 $532.80 2026-04-20
25505 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Thumb Side With Manipulati… 24 24 $1,264.00 $1,137.60 $238.74 $3,346.57 $531.19 2026-04-20
52000 HCPCS Diagnostic Exam Of Bladder And Urethra Using An Endoscope 27 27 $885.00 $796.50 $354.00 $1,857.09 $531.00 2026-04-20
78305 HCPCS Nuclear Medicine Study Of Bone And/or Joint Multiple Areas 27 27 $885.00 $796.50 $354.00 $967.08 $531.00 2026-04-20
19000 HCPCS Aspiration Of Cyst Of Breast, First Cyst 78 27 $1,269.00 $1,142.10 $195.94 $1,205.55 $530.70 2026-04-20
93970 HCPCS Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 54 27 $1,255.00 $1,129.50 $302.56 $1,192.25 $529.99 2026-04-20
78230 HCPCS Nuclear Medicine Study Of Salivary Gland 27 27 $870.00 $783.00 $348.00 $967.08 $522.00 2026-04-20
12037 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, More Tha… 24 24 $1,232.00 $1,108.80 $238.74 $2,985.11 $517.75 2026-04-20
A0426 HCPCS Ambulance Service, Advanced Life Support, Non-emergency Transport, Level 1 (als … 26 25 $1,009.00 $908.10 $403.60 $958.55 $516.81 2026-04-20
24605 HCPCS Repair Of Dislocated Elbow Under Anesthesia 24 24 $1,225.00 $1,102.50 $238.74 $2,830.98 $514.81 2026-04-20
12036 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 20.1-30.… 24 24 $1,222.00 $1,099.80 $238.74 $1,160.90 $513.54 2026-04-20
13151 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 1.1-2.5 Cm 24 24 $1,212.00 $1,090.80 $238.74 $1,151.40 $509.35 2026-04-20
21337 HCPCS Closed Treatment Of Broken Bone Separating Nose Airways 24 24 $1,193.00 $1,073.70 $238.74 $6,338.51 $501.36 2026-04-20
93975 HCPCS Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 27 27 $1,176.00 $1,058.40 $302.56 $1,117.20 $496.62 2026-04-20
94621 HCPCS Test For Exercise-induced Heart And Lung Stress 27 27 $1,168.00 $1,051.20 $367.66 $1,109.60 $493.25 2026-04-20
11626 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More Tha… 24 24 $1,170.00 $1,053.00 $238.74 $3,847.84 $491.69 2026-04-20
27788 HCPCS Closed Treatment Of Broken Outside Lower Leg Bone At Ankle With Manipulation 24 24 $1,164.00 $1,047.60 $238.74 $3,346.57 $489.17 2026-04-20
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 99 27 $1,164.00 $1,047.60 $159.83 $1,358.50 $488.88 2026-04-20
90675 HCPCS Rabies Vaccine For Injection Into Muscle 152 27 $971.69 $874.52 $177.60 $1,348.14 $488.62 2026-04-20
12045 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 12.6-20.0 Cm 24 24 $1,161.00 $1,044.90 $238.74 $1,102.95 $487.91 2026-04-20
J1670 HCPCS Injection, Tetanus Immune Globulin, Human, Up To 250 Units 50 25 $878.15 $790.34 $234.00 $1,112.74 $484.36 2026-04-20
88309 HCPCS Pathology Examination Of Tissue Using A Microscope, High Complexity 27 27 $1,140.00 $1,026.00 $145.08 $1,140.00 $483.82 2026-04-20
11044 HCPCS Removal Of Bone, 20.0 Sq Cm Or Less 24 24 $1,149.00 $1,034.10 $238.74 $3,510.94 $482.87 2026-04-20
24600 HCPCS Repair Of Dislocated Elbow 24 24 $1,149.00 $1,034.10 $238.74 $3,346.57 $482.87 2026-04-20
78261 HCPCS Nuclear Medicine Study Of Stomach Lining 27 27 $803.00 $722.70 $321.20 $967.08 $481.80 2026-04-20
13101 HCPCS Complicated Repair Of Wound Of Trunk, 2.6-7.5 Cm 24 24 $1,146.00 $1,031.40 $238.74 $1,088.70 $481.61 2026-04-20
76380 HCPCS Limited Or Follow-up CT Scan 27 27 $993.00 $893.70 $397.20 $943.35 $480.50 2026-04-20
J7300 HCPCS Intrauterine Copper Contraceptive 25 25 $1,131.00 $1,017.90 $452.40 $1,074.45 $480.00 2026-04-20
23655 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia 24 24 $1,131.00 $1,017.90 $238.74 $2,830.98 $475.30 2026-04-20
24655 HCPCS Closed Treatment Of Broken Forearm Bone On Thumb Side At Elbow With Manipulation 24 24 $1,126.00 $1,013.40 $238.74 $3,346.57 $473.20 2026-04-20
J2760 HCPCS Injection, Phentolamine Mesylate, Up To 5 Mg 50 25 $872.05 $784.85 $179.07 $1,231.60 $471.94 2026-04-20
12035 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 12.6-20.… 24 24 $1,121.00 $1,008.90 $238.74 $1,064.95 $471.10 2026-04-20
76810 HCPCS Ultrasound Scan Of Pregnant Uterus (14 Weeks Or More), Each Additional Fetus 27 27 $1,113.00 $1,001.70 $169.88 $1,057.35 $470.02 2026-04-20
26645 HCPCS Closed Treatment Of Broken Thumb At Wrist With Manipulation 24 24 $1,114.00 $1,002.60 $238.74 $3,346.57 $468.15 2026-04-20
78216 HCPCS Nuclear Medicine Study Of Liver, Spleen, And Blood Flow 27 27 $778.00 $700.20 $311.20 $1,822.99 $466.80 2026-04-20
13131 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 24 24 $1,108.00 $997.20 $238.74 $1,052.60 $465.64 2026-04-20
11446 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, M… 24 24 $1,108.00 $997.20 $238.74 $3,847.84 $465.64 2026-04-20
11644 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3.1-… 24 24 $1,107.00 $996.30 $238.74 $3,847.84 $465.22 2026-04-20
A0429 HCPCS Ambulance Service, Basic Life Support, Emergency Transport (bls-emergency) 25 25 $772.00 $694.80 $308.80 $733.40 $463.20 2026-04-20
59425 HCPCS Predelivery Care, 4 To 6 Visits 24 24 $1,290.00 $1,161.00 $238.74 $1,225.50 $451.57 2026-04-20
12054 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6-1… 24 24 $1,068.00 $961.20 $238.74 $1,014.60 $448.83 2026-04-20
94660 HCPCS Therapy Procedure Using A Positive Pressure Ventilator 27 27 $744.00 $669.60 $297.60 $856.59 $446.40 2026-04-20
76377 HCPCS 3d Radiographic Procedure With Computerized Image Postprocessing 25 25 $1,045.00 $940.50 $418.00 $992.75 $443.50 2026-04-20
17286 HCPCS Destruction Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, … 24 24 $1,054.00 $948.60 $238.74 $1,001.30 $442.94 2026-04-20
92960 HCPCS External Shock To Heart To Regulate Heart Beat 49 27 $1,049.00 $944.10 $238.74 $1,506.54 $440.58 2026-04-20
12044 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 7.6-12.5 Cm 24 24 $1,040.00 $936.00 $238.74 $988.00 $437.06 2026-04-20
G0390 HCPCS Trauma Response Team Associated With Hospital Critical Care Service 25 25 $1,025.00 $922.50 $410.00 $973.75 $435.01 2026-04-20
P9016 HCPCS Red Blood Cells, Leukocytes Reduced, Each Unit 27 27 $721.00 $648.90 $288.40 $1,444.48 $432.60 2026-04-20
27530 HCPCS Closed Treatment Of Broken Shin Bone 24 24 $1,022.00 $919.80 $238.74 $3,346.57 $429.50 2026-04-20
26742 HCPCS Closed Treatment Of Broken Finger Or Hand At Base Of Finger With Manipulation 24 24 $1,022.00 $919.80 $238.74 $3,346.57 $429.50 2026-04-20
93930 HCPCS Ultrasound Of Arm Arteries Or Artery Grafts 27 27 $1,015.00 $913.50 $191.58 $964.25 $428.63 2026-04-20
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 27 27 $1,015.00 $913.50 $191.58 $964.25 $428.63 2026-04-20
81206 HCPCS Translocation Analysis (bcr/abl1) Major Breakpoint 27 27 $1,006.00 $905.40 $149.42 $1,649.44 $426.95 2026-04-20
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 27 27 $1,008.00 $907.20 $302.56 $957.60 $425.68 2026-04-20
24530 HCPCS Closed Treatment Of Upper Arm Bone Broken At Elbow 24 24 $1,009.00 $908.10 $238.74 $3,346.57 $424.03 2026-04-20
13120 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 1.1-2.5 Cm 24 24 $1,008.00 $907.20 $238.74 $957.60 $423.62 2026-04-20
76881 HCPCS Complete Ultrasound Scan Of Joint 106 27 $1,003.00 $902.70 $191.58 $952.85 $423.36 2026-04-20
74415 HCPCS Imaging Of Urinary Tract Using Infusion Technique With Kidney Section Filming 27 27 $1,001.00 $900.90 $178.56 $950.95 $422.72 2026-04-20
25111 HCPCS Removal Of First Cyst Of Wrist 24 24 $1,004.00 $903.60 $238.74 $3,526.62 $421.93 2026-04-20
12053 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1-7… 24 24 $1,000.00 $900.00 $238.74 $950.00 $420.25 2026-04-20
24576 HCPCS Closed Treatment Of Broken Elbow 24 24 $989.00 $890.10 $238.74 $3,346.57 $415.62 2026-04-20
78428 HCPCS Nuclear Medicine Study For Detecting Heart Shunt 27 27 $690.00 $621.00 $276.00 $967.08 $414.00 2026-04-20
76700 HCPCS Complete Ultrasound Scan Of Abdomen 27 27 $975.00 $877.50 $302.56 $926.25 $411.74 2026-04-20
27560 HCPCS Closed Treatment Of Dislocated Kneecap 24 24 $976.00 $878.40 $238.74 $3,346.57 $410.16 2026-04-20
23505 HCPCS Closed Treatment Of Broken Collar Bone With Manipulation 24 24 $971.00 $873.90 $238.74 $3,346.57 $408.06 2026-04-20
95070 HCPCS Test For Allergy Using Drugs 52 27 $773.00 $695.70 $309.20 $1,713.18 $407.60 2026-04-20
11624 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4.0 … 24 24 $969.00 $872.10 $238.74 $1,451.30 $407.23 2026-04-20
27824 HCPCS Closed Treatment Of Broken Shin Bone At Lower Weight Bearing Joint 24 24 $966.00 $869.40 $238.74 $3,346.57 $405.96 2026-04-20
13100 HCPCS Complicated Repair Of Wound Of Trunk, 1.1-2.5 Cm 24 24 $963.00 $866.70 $238.74 $1,060.51 $404.70 2026-04-20
88307 HCPCS Pathology Examination Of Tissue Using A Microscope, Moderately High Complexity 27 27 $952.00 $856.80 $145.08 $952.00 $404.03 2026-04-20
27808 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle 24 24 $961.00 $864.90 $238.74 $3,346.57 $403.86 2026-04-20
59812 HCPCS Treatment Of Miscarriage 24 24 $961.00 $864.90 $238.74 $3,259.28 $403.86 2026-04-20
93923 HCPCS Complete Ultrasound Study Of Arm And Leg Arteries 52 27 $953.00 $857.70 $281.48 $906.30 $403.66 2026-04-20
93017 HCPCS Exercise Or Drug-induced Heart Stress Test With Electrocardiogram (ecg) 27 27 $894.00 $804.60 $357.60 $849.30 $403.62 2026-04-20
25650 HCPCS Closed Treatment Of Broken Base Of Forearm Bone On Small Finger Side At Wrist 24 24 $955.00 $859.50 $238.74 $3,346.57 $401.34 2026-04-20
25600 HCPCS Closed Treatment Of Broken Forearm (radius) Bone At The Wrist Area On The Thumb … 24 24 $953.00 $857.70 $238.74 $3,346.57 $400.50 2026-04-20
73040 HCPCS Review By Radiologist Of Shoulder Joint Image 54 27 $938.00 $844.20 $178.56 $891.10 $396.12 2026-04-20
73580 HCPCS Review By Radiologist Of Knee Joint Image 54 27 $938.00 $844.20 $178.56 $891.10 $396.12 2026-04-20
8714924_1 CDM Gardasil 9 Vial 27 27 $740.11 $666.10 $296.04 $703.10 $392.26 2026-04-20
24560 HCPCS Closed Treatment Of Broken Outer Part Of Upper Arm Bone At Elbow 24 24 $933.00 $839.70 $238.74 $3,346.57 $392.10 2026-04-20
76885 HCPCS Ultrasound Scan Of Infant Hip During Movement 27 27 $923.00 $830.70 $191.58 $876.85 $389.78 2026-04-20
27750 HCPCS Closed Treatment Of Broken Middle Part Of Shin Bone 24 24 $925.00 $832.50 $238.74 $3,346.57 $388.74 2026-04-20
26605 HCPCS Closed Treatment Of Broken Hand Bone With Manipulation 24 24 $925.00 $832.50 $238.74 $3,346.57 $388.74 2026-04-20
27816 HCPCS Closed Treatment Of 3 Broken Lower Leg Bones At Ankle 24 24 $920.00 $828.00 $238.74 $3,346.57 $386.63 2026-04-20
26725 HCPCS Closed Treatment Of Broken Finger Or Thumb At Midportion Or Part Near Hand With … 24 24 $916.00 $824.40 $238.74 $3,346.57 $384.95 2026-04-20
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