|
27100153
|
CDM
|
Rhc Misc Implant Charge Level 32
|
13
|
13
|
$38,982.00
|
$38,982.00
|
$20,660.46
|
$35,863.44
|
$26,117.94
|
2026-03-30
|
|
27100152
|
CDM
|
Rhc Misc Implant Charge Level 31
|
13
|
13
|
$32,528.00
|
$32,528.00
|
$17,239.84
|
$29,925.76
|
$21,793.76
|
2026-03-30
|
|
27100151
|
CDM
|
Rhc Misc Implant Charge Level 30
|
13
|
13
|
$30,508.00
|
$30,508.00
|
$16,169.24
|
$28,067.36
|
$20,440.36
|
2026-03-30
|
|
27100150
|
CDM
|
Rhc Misc Implant Charge Level 29
|
13
|
13
|
$28,488.00
|
$28,488.00
|
$15,098.64
|
$26,208.96
|
$19,086.96
|
2026-03-30
|
|
J2427
|
HCPCS
|
Injection, Paliperidone Palmitate Extended Release (invega Hafyera, Or Invega Tr…
|
22
|
11
|
$27,917.50
|
$27,917.50
|
$7,981.71
|
$38,485.44
|
$18,363.50
|
2026-03-30
|
|
27100149
|
CDM
|
Rhc Misc Implant Charge Level 28
|
13
|
13
|
$26,462.00
|
$26,462.00
|
$14,024.86
|
$24,345.04
|
$17,729.54
|
2026-03-30
|
|
27100148
|
CDM
|
Rhc Misc Implant Charge Level 27
|
13
|
13
|
$24,368.00
|
$24,368.00
|
$12,915.04
|
$22,418.56
|
$16,326.56
|
2026-03-30
|
|
27100147
|
CDM
|
Rhc Misc Implant Charge Level 26
|
13
|
13
|
$22,455.00
|
$22,455.00
|
$11,901.15
|
$20,658.60
|
$15,044.85
|
2026-03-30
|
|
27100146
|
CDM
|
Rhc Misc Implant Charge Level 25
|
13
|
13
|
$20,845.00
|
$20,845.00
|
$11,047.85
|
$19,177.40
|
$13,966.15
|
2026-03-30
|
|
J2327
|
HCPCS
|
Injection, Risankizumab-rzaa, Intravenous, 1 Mg
|
11
|
11
|
$20,327.00
|
$20,327.00
|
$11,586.39
|
$18,700.84
|
$13,619.09
|
2026-03-30
|
|
27100145
|
CDM
|
Rhc Misc Implant Charge Level 24
|
13
|
13
|
$19,684.00
|
$19,684.00
|
$10,432.52
|
$18,109.28
|
$13,188.28
|
2026-03-30
|
|
27100144
|
CDM
|
Rhc Misc Implant Charge Level 23
|
13
|
13
|
$18,587.00
|
$18,587.00
|
$9,851.11
|
$17,100.04
|
$12,453.29
|
2026-03-30
|
|
27100143
|
CDM
|
Rhc Misc Implant Charge Level 22
|
13
|
13
|
$17,638.00
|
$17,638.00
|
$9,348.14
|
$16,226.96
|
$11,817.46
|
2026-03-30
|
|
27100142
|
CDM
|
Rhc Misc Implant Charge Level 21
|
13
|
13
|
$16,604.00
|
$16,604.00
|
$8,800.12
|
$15,275.68
|
$11,124.68
|
2026-03-30
|
|
27100141
|
CDM
|
Rhc Misc Implant Charge Level 20
|
13
|
13
|
$15,814.00
|
$15,814.00
|
$8,381.42
|
$14,548.88
|
$10,595.38
|
2026-03-30
|
|
27100137
|
CDM
|
Rhc Misc Implant Charge Level 16
|
13
|
13
|
$14,676.00
|
$14,676.00
|
$7,778.28
|
$13,501.92
|
$9,832.92
|
2026-03-30
|
|
27100140
|
CDM
|
Rhc Misc Implant Charge Level 19
|
13
|
13
|
$14,595.00
|
$14,595.00
|
$7,735.35
|
$13,427.40
|
$9,778.65
|
2026-03-30
|
|
J1602
|
HCPCS
|
Injection, Golimumab, 1 Mg, For Intravenous Use
|
13
|
13
|
$14,262.00
|
$14,262.00
|
$7,558.86
|
$13,121.04
|
$9,555.54
|
2026-03-30
|
|
27100139
|
CDM
|
Rhc Misc Implant Charge Level 18
|
13
|
13
|
$13,587.00
|
$13,587.00
|
$7,201.11
|
$12,500.04
|
$9,103.29
|
2026-03-30
|
|
27100138
|
CDM
|
Rhc Misc Implant Charge Level 17
|
13
|
13
|
$12,558.00
|
$12,558.00
|
$6,655.74
|
$11,553.36
|
$8,413.86
|
2026-03-30
|
|
27100136
|
CDM
|
Rhc Misc Implant Charge Level 15
|
13
|
13
|
$11,642.00
|
$11,642.00
|
$6,170.26
|
$10,710.64
|
$7,800.14
|
2026-03-30
|
|
90375
|
HCPCS
|
Rabies Immune Globulin For Injection
|
17
|
13
|
$11,615.50
|
$11,615.50
|
$306.22
|
$10,686.26
|
$7,782.39
|
2026-03-30
|
|
27100135
|
CDM
|
Rhc Misc Implant Charge Level 14
|
13
|
13
|
$9,469.00
|
$9,469.00
|
$5,018.57
|
$8,711.48
|
$6,344.23
|
2026-03-30
|
|
J1449
|
HCPCS
|
Injection, Eflapegrastim-xnst, 0.1 Mg
|
11
|
11
|
$9,087.50
|
$9,087.50
|
$5,179.88
|
$8,360.50
|
$6,088.63
|
2026-03-30
|
|
10010106
|
CDM
|
Operating Room Services - General Classification
|
12
|
12
|
$8,826.00
|
$8,826.00
|
$4,677.78
|
$8,119.92
|
$5,913.42
|
2026-03-30
|
|
27100158
|
CDM
|
Rhc Sterile Med/surg Supply Level 50
|
13
|
13
|
$8,453.00
|
$8,453.00
|
$4,480.09
|
$7,776.76
|
$5,663.51
|
2026-03-30
|
|
27100119
|
CDM
|
Rhc Misc Implant Charge Level 13
|
13
|
13
|
$8,126.00
|
$8,126.00
|
$4,306.78
|
$7,475.92
|
$5,444.42
|
2026-03-30
|
|
27100159
|
CDM
|
Rhc Sterile Med/surg Supply Level 51
|
13
|
13
|
$8,049.00
|
$8,049.00
|
$4,265.97
|
$7,405.08
|
$5,392.83
|
2026-03-30
|
|
10010105
|
CDM
|
Operating Room Services - General Classification
|
12
|
12
|
$7,314.00
|
$7,314.00
|
$3,876.42
|
$6,728.88
|
$4,900.38
|
2026-03-30
|
|
J1944
|
HCPCS
|
Injection, Aripiprazole Lauroxil, (aristada), 1 Mg
|
22
|
11
|
$6,904.00
|
$6,904.00
|
$3,571.91
|
$6,938.18
|
$4,870.08
|
2026-03-30
|
|
27100118
|
CDM
|
Rhc Misc Implant Charge Level 12
|
13
|
13
|
$7,214.00
|
$7,214.00
|
$3,823.42
|
$6,636.88
|
$4,833.38
|
2026-03-30
|
|
27100157
|
CDM
|
Rhc Sterile Med/surg Supply Level 49
|
13
|
13
|
$7,112.00
|
$7,112.00
|
$3,769.36
|
$6,543.04
|
$4,765.04
|
2026-03-30
|
|
J2426
|
HCPCS
|
Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg
|
13
|
13
|
$7,045.00
|
$7,045.00
|
$3,733.85
|
$6,481.40
|
$4,720.15
|
2026-03-30
|
|
J1569
|
HCPCS
|
Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),…
|
13
|
13
|
$6,868.50
|
$6,868.50
|
$3,640.31
|
$6,319.02
|
$4,601.90
|
2026-03-30
|
|
27100117
|
CDM
|
Rhc Misc Implant Charge Level 11
|
13
|
13
|
$6,364.00
|
$6,364.00
|
$3,372.92
|
$5,854.88
|
$4,263.88
|
2026-03-30
|
|
27100156
|
CDM
|
Rhc Sterile Med/surg Supply Level 48
|
13
|
13
|
$6,069.00
|
$6,069.00
|
$3,216.57
|
$5,583.48
|
$4,066.23
|
2026-03-30
|
|
10010104
|
CDM
|
Operating Room Services - General Classification
|
12
|
12
|
$5,875.00
|
$5,875.00
|
$3,113.75
|
$5,405.00
|
$3,936.25
|
2026-03-30
|
|
J0401
|
HCPCS
|
Injection, Aripiprazole (abilify Maintena), 1 Mg
|
13
|
13
|
$5,727.50
|
$5,727.50
|
$3,035.58
|
$5,269.30
|
$3,837.43
|
2026-03-30
|
|
J2357
|
HCPCS
|
Injection, Omalizumab, 5 Mg
|
13
|
13
|
$5,627.50
|
$5,627.50
|
$2,982.58
|
$5,177.30
|
$3,770.43
|
2026-03-30
|
|
J3101
|
HCPCS
|
Injection, Tenecteplase, 1 Mg
|
13
|
13
|
$5,567.00
|
$5,567.00
|
$2,950.51
|
$5,121.64
|
$3,729.89
|
2026-03-30
|
|
74178
|
HCPCS
|
CT Scan Of Abdomen And Pelvis Before And After Contrast
|
13
|
13
|
$5,328.00
|
$5,328.00
|
$1,042.22
|
$4,901.76
|
$3,569.76
|
2026-03-30
|
|
27100116
|
CDM
|
Rhc Misc Implant Charge Level 10
|
13
|
13
|
$5,133.00
|
$5,133.00
|
$2,720.49
|
$4,722.36
|
$3,439.11
|
2026-03-30
|
|
J3111
|
HCPCS
|
Injection, Romosozumab-aqqg, 1 Mg
|
11
|
11
|
$5,095.00
|
$5,095.00
|
$2,904.15
|
$4,687.40
|
$3,413.65
|
2026-03-30
|
|
27100155
|
CDM
|
Rhc Sterile Med/surg Supply Level 47
|
13
|
13
|
$4,896.00
|
$4,896.00
|
$2,594.88
|
$4,504.32
|
$3,280.32
|
2026-03-30
|
|
40000027
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
12
|
12
|
$4,801.00
|
$4,801.00
|
$2,544.53
|
$4,416.92
|
$3,216.67
|
2026-03-30
|
|
27100133
|
CDM
|
Rhc Med/surg Supply Level 47
|
13
|
13
|
$4,732.00
|
$4,732.00
|
$2,507.96
|
$4,353.44
|
$3,170.44
|
2026-03-30
|
|
Q5104
|
HCPCS
|
Injection, Infliximab-abda, Biosimilar, (renflexis), 10 Mg
|
13
|
13
|
$4,608.00
|
$4,608.00
|
$2,442.24
|
$4,239.36
|
$3,087.36
|
2026-03-30
|
|
27100045
|
CDM
|
Rhc Med/surg Supply Level 45
|
13
|
13
|
$4,558.00
|
$4,558.00
|
$2,415.74
|
$4,193.36
|
$3,053.86
|
2026-03-30
|
|
10010103
|
CDM
|
Operating Room Services - General Classification
|
12
|
12
|
$4,549.00
|
$4,549.00
|
$2,410.97
|
$4,185.08
|
$3,047.83
|
2026-03-30
|
|
73220
|
HCPCS
|
MRI Scan Of Arm Before And After Contrast
|
13
|
13
|
$4,475.00
|
$4,475.00
|
$1,233.80
|
$4,117.00
|
$2,998.25
|
2026-03-30
|
|
27100168
|
CDM
|
Rhc Med/surg Supply Level 56
|
13
|
13
|
$4,425.00
|
$4,425.00
|
$2,345.25
|
$4,071.00
|
$2,964.75
|
2026-03-30
|
|
70553
|
HCPCS
|
MRI Scan Of Brain Before And After Contrast
|
13
|
13
|
$4,422.00
|
$4,422.00
|
$1,233.80
|
$4,068.24
|
$2,962.74
|
2026-03-30
|
|
27100132
|
CDM
|
Rhc Med/surg Supply Level 46
|
13
|
13
|
$4,392.00
|
$4,392.00
|
$2,327.76
|
$4,040.64
|
$2,942.64
|
2026-03-30
|
|
J7327
|
HCPCS
|
Hyaluronan Or Derivative, Monovisc, For Intra-articular Injection, Per Dose
|
13
|
13
|
$4,382.00
|
$4,382.00
|
$2,322.46
|
$4,031.44
|
$2,935.94
|
2026-03-30
|
|
72158
|
HCPCS
|
MRI Scan Of Lower Spinal Canal Before And After Contrast
|
13
|
13
|
$4,359.00
|
$4,359.00
|
$1,233.80
|
$4,010.28
|
$2,920.53
|
2026-03-30
|
|
27100115
|
CDM
|
Rhc Misc Implant Charge Level 9
|
13
|
13
|
$4,358.00
|
$4,358.00
|
$2,309.74
|
$4,009.36
|
$2,919.86
|
2026-03-30
|
|
27100044
|
CDM
|
Rhc Med/surg Supply Level 44
|
13
|
13
|
$4,335.00
|
$4,335.00
|
$2,297.55
|
$3,988.20
|
$2,904.45
|
2026-03-30
|
|
27100167
|
CDM
|
Rhc Med/surg Supply Level 55
|
13
|
13
|
$4,275.00
|
$4,275.00
|
$2,265.75
|
$3,933.00
|
$2,864.25
|
2026-03-30
|
|
Q5108
|
HCPCS
|
Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg
|
13
|
13
|
$4,263.00
|
$4,263.00
|
$2,259.39
|
$3,921.96
|
$2,856.21
|
2026-03-30
|
|
72157
|
HCPCS
|
MRI Scan Of Middle Spinal Canal Before And After Contrast
|
13
|
13
|
$4,240.00
|
$4,240.00
|
$1,233.80
|
$3,900.80
|
$2,840.80
|
2026-03-30
|
|
40000036
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
12
|
12
|
$4,237.00
|
$4,237.00
|
$2,245.61
|
$3,898.04
|
$2,838.79
|
2026-03-30
|
|
74183
|
HCPCS
|
MRI Scan Of Abdomen Before And After Contrast
|
13
|
13
|
$4,178.00
|
$4,178.00
|
$1,233.80
|
$3,843.76
|
$2,799.26
|
2026-03-30
|
|
27100154
|
CDM
|
Rhc Sterile Med/surg Supply Level 46
|
13
|
13
|
$4,178.00
|
$4,178.00
|
$2,214.34
|
$3,843.76
|
$2,799.26
|
2026-03-30
|
|
73720
|
HCPCS
|
MRI Scan Of Leg Before And After Contrast
|
13
|
13
|
$4,175.00
|
$4,175.00
|
$1,233.80
|
$3,841.00
|
$2,797.25
|
2026-03-30
|
|
27100090
|
CDM
|
Rhc Sterile Med/surg Supply Level 45
|
13
|
13
|
$4,161.00
|
$4,161.00
|
$2,205.33
|
$3,828.12
|
$2,787.87
|
2026-03-30
|
|
27100166
|
CDM
|
Rhc Med/surg Supply Level 54
|
13
|
13
|
$4,125.00
|
$4,125.00
|
$2,186.25
|
$3,795.00
|
$2,763.75
|
2026-03-30
|
|
40000026
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
12
|
12
|
$4,056.00
|
$4,056.00
|
$2,149.68
|
$3,731.52
|
$2,717.52
|
2026-03-30
|
|
27100043
|
CDM
|
Rhc Med/surg Supply Level 43
|
13
|
13
|
$4,025.00
|
$4,025.00
|
$2,133.25
|
$3,703.00
|
$2,696.75
|
2026-03-30
|
|
71552
|
HCPCS
|
MRI Scan Of Chest Before And After Contrast
|
13
|
13
|
$3,979.00
|
$3,979.00
|
$1,233.80
|
$3,660.68
|
$2,665.93
|
2026-03-30
|
|
27100165
|
CDM
|
Rhc Med/surg Supply Level 53
|
13
|
13
|
$3,975.00
|
$3,975.00
|
$2,106.75
|
$3,657.00
|
$2,663.25
|
2026-03-30
|
|
27100089
|
CDM
|
Rhc Sterile Med/surg Supply Level 44
|
13
|
13
|
$3,959.00
|
$3,959.00
|
$2,098.27
|
$3,642.28
|
$2,652.53
|
2026-03-30
|
|
95811
|
HCPCS
|
Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older)
|
13
|
13
|
$3,934.00
|
$3,934.00
|
$1,115.38
|
$3,619.28
|
$2,635.78
|
2026-03-30
|
|
40000025
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
12
|
12
|
$3,907.00
|
$3,907.00
|
$2,070.71
|
$3,594.44
|
$2,617.69
|
2026-03-30
|
|
27100042
|
CDM
|
Rhc Med/surg Supply Level 42
|
13
|
13
|
$3,902.00
|
$3,902.00
|
$2,068.06
|
$3,589.84
|
$2,614.34
|
2026-03-30
|
|
27100169
|
CDM
|
Rhc Med/surg Supply Level 57
|
13
|
13
|
$3,875.00
|
$3,875.00
|
$2,053.75
|
$3,565.00
|
$2,596.25
|
2026-03-30
|
|
73223
|
HCPCS
|
MRI Scan Of Arm Joint Before And After Contrast
|
13
|
13
|
$3,847.00
|
$3,847.00
|
$1,233.80
|
$3,539.24
|
$2,577.49
|
2026-03-30
|
|
72156
|
HCPCS
|
MRI Scan Of Upper Spinal Canal Before And After Contrast
|
13
|
13
|
$3,840.00
|
$3,840.00
|
$1,233.80
|
$3,532.80
|
$2,572.80
|
2026-03-30
|
|
27100164
|
CDM
|
Rhc Med/surg Supply Level 52
|
13
|
13
|
$3,825.00
|
$3,825.00
|
$2,027.25
|
$3,519.00
|
$2,562.75
|
2026-03-30
|
|
70543
|
HCPCS
|
MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast
|
13
|
13
|
$3,799.00
|
$3,799.00
|
$1,233.80
|
$3,495.08
|
$2,545.33
|
2026-03-30
|
|
27100088
|
CDM
|
Rhc Sterile Med/surg Supply Level 43
|
13
|
13
|
$3,751.00
|
$3,751.00
|
$1,988.03
|
$3,450.92
|
$2,513.17
|
2026-03-30
|
|
40000040
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
12
|
12
|
$3,700.00
|
$3,700.00
|
$1,961.00
|
$3,404.00
|
$2,479.00
|
2026-03-30
|
|
74177
|
HCPCS
|
CT Scan Of Abdomen And Pelvis With Contrast
|
13
|
13
|
$3,694.00
|
$3,694.00
|
$1,042.22
|
$3,398.48
|
$2,474.98
|
2026-03-30
|
|
27100041
|
CDM
|
Rhc Med/surg Supply Level 41
|
13
|
13
|
$3,676.00
|
$3,676.00
|
$1,948.28
|
$3,381.92
|
$2,462.92
|
2026-03-30
|
|
27100163
|
CDM
|
Rhc Med/surg Supply Level 51
|
13
|
13
|
$3,675.00
|
$3,675.00
|
$1,947.75
|
$3,381.00
|
$2,462.25
|
2026-03-30
|
|
27100087
|
CDM
|
Rhc Sterile Med/surg Supply Level 42
|
13
|
13
|
$3,601.00
|
$3,601.00
|
$1,908.53
|
$3,312.92
|
$2,412.67
|
2026-03-30
|
|
70549
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck Before And After Contrast
|
13
|
13
|
$3,588.00
|
$3,588.00
|
$675.80
|
$3,300.96
|
$2,403.96
|
2026-03-30
|
|
73723
|
HCPCS
|
MRI Scan Of Leg Joint Before And After Contrast
|
13
|
13
|
$3,571.00
|
$3,571.00
|
$1,233.80
|
$3,285.32
|
$2,392.57
|
2026-03-30
|
|
27100162
|
CDM
|
Rhc Med/surg Supply Level 50
|
13
|
13
|
$3,525.00
|
$3,525.00
|
$1,868.25
|
$3,243.00
|
$2,361.75
|
2026-03-30
|
|
95810
|
HCPCS
|
Sleep Study In Sleep Lab (6 Years Or Older)
|
13
|
13
|
$3,523.00
|
$3,523.00
|
$1,115.38
|
$3,241.16
|
$2,360.41
|
2026-03-30
|
|
J0897
|
HCPCS
|
Injection, Denosumab, 1 Mg
|
18
|
14
|
$3,660.00
|
$3,660.00
|
$19.70
|
$3,367.20
|
$2,340.57
|
2026-03-30
|
|
27100040
|
CDM
|
Rhc Med/surg Supply Level 40
|
13
|
13
|
$3,473.00
|
$3,473.00
|
$1,840.69
|
$3,195.16
|
$2,326.91
|
2026-03-30
|
|
40000035
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
12
|
12
|
$3,451.00
|
$3,451.00
|
$1,829.03
|
$3,174.92
|
$2,312.17
|
2026-03-30
|
|
40000024
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
12
|
12
|
$3,444.00
|
$3,444.00
|
$1,825.32
|
$3,168.48
|
$2,307.48
|
2026-03-30
|
|
78452
|
HCPCS
|
Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect
|
13
|
13
|
$3,439.00
|
$3,439.00
|
$1,657.26
|
$3,163.88
|
$2,304.13
|
2026-03-30
|
|
27100086
|
CDM
|
Rhc Sterile Med/surg Supply Level 41
|
13
|
13
|
$3,381.00
|
$3,381.00
|
$1,791.93
|
$3,110.52
|
$2,265.27
|
2026-03-30
|
|
27100161
|
CDM
|
Rhc Med/surg Supply Level 49
|
13
|
13
|
$3,375.00
|
$3,375.00
|
$1,788.75
|
$3,105.00
|
$2,261.25
|
2026-03-30
|
|
27100114
|
CDM
|
Rhc Misc Implant Charge Level 8
|
13
|
13
|
$3,256.00
|
$3,256.00
|
$1,725.68
|
$2,995.52
|
$2,181.52
|
2026-03-30
|
|
27100039
|
CDM
|
Rhc Med/surg Supply Level 39
|
13
|
13
|
$3,237.00
|
$3,237.00
|
$1,715.61
|
$2,978.04
|
$2,168.79
|
2026-03-30
|
|
27100160
|
CDM
|
Rhc Med/surg Supply Level 48
|
13
|
13
|
$3,225.00
|
$3,225.00
|
$1,709.25
|
$2,967.00
|
$2,160.75
|
2026-03-30
|
|
40000039
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
12
|
12
|
$3,219.00
|
$3,219.00
|
$1,706.07
|
$2,961.48
|
$2,156.73
|
2026-03-30
|
|
J0881
|
HCPCS
|
Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use)
|
13
|
13
|
$3,183.50
|
$3,183.50
|
$1,687.26
|
$2,928.82
|
$2,132.95
|
2026-03-30
|
|
73218
|
HCPCS
|
MRI Scan Of Arm Without Contrast
|
13
|
13
|
$3,175.00
|
$3,175.00
|
$983.32
|
$2,921.00
|
$2,127.25
|
2026-03-30
|
|
10010102
|
CDM
|
Operating Room Services - General Classification
|
12
|
12
|
$3,159.00
|
$3,159.00
|
$1,674.27
|
$2,906.28
|
$2,116.53
|
2026-03-30
|
|
72149
|
HCPCS
|
MRI Scan Of Lower Spinal Canal With Contrast
|
13
|
13
|
$3,150.00
|
$3,150.00
|
$1,233.80
|
$2,898.00
|
$2,110.50
|
2026-03-30
|
|
27100085
|
CDM
|
Rhc Sterile Med/surg Supply Level 40
|
13
|
13
|
$3,148.00
|
$3,148.00
|
$1,668.44
|
$2,896.16
|
$2,109.16
|
2026-03-30
|
|
70552
|
HCPCS
|
MRI Scan Of Brain With Contrast
|
13
|
13
|
$3,092.00
|
$3,092.00
|
$1,233.80
|
$2,844.64
|
$2,071.64
|
2026-03-30
|
|
72148
|
HCPCS
|
MRI Scan Of Lower Spinal Canal Without Contrast
|
13
|
13
|
$3,092.00
|
$3,092.00
|
$983.32
|
$2,844.64
|
$2,071.64
|
2026-03-30
|
|
72197
|
HCPCS
|
MRI Scan Of Pelvis Before And After Contrast
|
13
|
13
|
$3,073.00
|
$3,073.00
|
$1,233.80
|
$2,827.16
|
$2,058.91
|
2026-03-30
|
|
74176
|
HCPCS
|
CT Scan Of Abdomen And Pelvis Without Contrast
|
13
|
13
|
$3,031.00
|
$3,031.00
|
$1,042.22
|
$2,788.52
|
$2,030.77
|
2026-03-30
|
|
27100038
|
CDM
|
Rhc Med/surg Supply Level 38
|
13
|
13
|
$2,973.00
|
$2,973.00
|
$1,575.69
|
$2,735.16
|
$1,991.91
|
2026-03-30
|
|
J7324
|
HCPCS
|
Hyaluronan Or Derivative, Orthovisc, For Intra-articular Injection, Per Dose
|
13
|
13
|
$2,970.00
|
$2,970.00
|
$1,574.10
|
$2,732.40
|
$1,989.90
|
2026-03-30
|
|
J1439
|
HCPCS
|
Injection, Ferric Carboxymaltose, 1 Mg
|
13
|
13
|
$2,947.00
|
$2,947.00
|
$1,561.91
|
$2,711.24
|
$1,974.49
|
2026-03-30
|
|
72147
|
HCPCS
|
MRI Scan Of Middle Spinal Canal With Contrast
|
13
|
13
|
$2,936.00
|
$2,936.00
|
$1,233.80
|
$2,701.12
|
$1,967.12
|
2026-03-30
|
|
27100084
|
CDM
|
Rhc Sterile Med/surg Supply Level 39
|
13
|
13
|
$2,928.00
|
$2,928.00
|
$1,551.84
|
$2,693.76
|
$1,961.76
|
2026-03-30
|
|
74174
|
HCPCS
|
CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast
|
13
|
13
|
$2,925.00
|
$2,925.00
|
$709.28
|
$2,691.00
|
$1,959.75
|
2026-03-30
|
|
74185
|
HCPCS
|
MRI Scan Of Blood Vessels Of Abdomen
|
13
|
13
|
$2,887.00
|
$2,887.00
|
$675.80
|
$2,656.04
|
$1,934.29
|
2026-03-30
|
|
72146
|
HCPCS
|
MRI Scan Of Middle Spinal Canal Without Contrast
|
13
|
13
|
$2,870.00
|
$2,870.00
|
$983.32
|
$2,640.40
|
$1,922.90
|
2026-03-30
|
|
70545
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head With Contrast
|
13
|
13
|
$2,869.00
|
$2,869.00
|
$675.80
|
$2,639.48
|
$1,922.23
|
2026-03-30
|
|
73725
|
HCPCS
|
MRI Scan Of Blood Vessels Of Leg
|
13
|
13
|
$2,868.00
|
$2,868.00
|
$675.80
|
$2,638.56
|
$1,921.56
|
2026-03-30
|
|
73719
|
HCPCS
|
MRI Scan Of Leg With Contrast
|
13
|
13
|
$2,815.00
|
$2,815.00
|
$1,233.80
|
$2,589.80
|
$1,886.05
|
2026-03-30
|
|
40000034
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
12
|
12
|
$2,765.00
|
$2,765.00
|
$1,465.45
|
$2,543.80
|
$1,852.55
|
2026-03-30
|
|
27100037
|
CDM
|
Rhc Med/surg Supply Level 37
|
13
|
13
|
$2,746.00
|
$2,746.00
|
$1,455.38
|
$2,526.32
|
$1,839.82
|
2026-03-30
|
|
40000038
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
12
|
12
|
$2,737.00
|
$2,737.00
|
$1,450.61
|
$2,518.04
|
$1,833.79
|
2026-03-30
|
|
70548
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck With Contrast
|
13
|
13
|
$2,723.00
|
$2,723.00
|
$675.80
|
$2,505.16
|
$1,824.41
|
2026-03-30
|
|
27100083
|
CDM
|
Rhc Sterile Med/surg Supply Level 38
|
13
|
13
|
$2,709.00
|
$2,709.00
|
$1,435.77
|
$2,492.28
|
$1,815.03
|
2026-03-30
|
|
72142
|
HCPCS
|
MRI Scan Of Upper Spinal Canal With Contrast
|
13
|
13
|
$2,695.00
|
$2,695.00
|
$1,233.80
|
$2,479.40
|
$1,805.65
|
2026-03-30
|
|
90378
|
HCPCS
|
Respiratory Syncytial Virus Antibody For Injection Into Tissue Or Muscle
|
4
|
4
|
$1,838.00
|
$1,838.00
|
$1,699.08
|
$2,437.56
|
$1,771.52
|
2026-03-30
|
|
71275
|
HCPCS
|
CT Scan Of Blood Vessels Of Chest With Contrast
|
13
|
13
|
$2,631.00
|
$2,631.00
|
$709.28
|
$2,420.52
|
$1,762.77
|
2026-03-30
|
|
73718
|
HCPCS
|
MRI Scan Of Leg Without Contrast
|
13
|
13
|
$2,601.00
|
$2,601.00
|
$983.32
|
$2,392.92
|
$1,742.67
|
2026-03-30
|
|
72196
|
HCPCS
|
MRI Scan Of Pelvis With Contrast
|
13
|
13
|
$2,599.00
|
$2,599.00
|
$1,233.80
|
$2,391.08
|
$1,741.33
|
2026-03-30
|
|
72141
|
HCPCS
|
MRI Scan Of Upper Spinal Canal Without Contrast
|
13
|
13
|
$2,585.00
|
$2,585.00
|
$983.32
|
$2,378.20
|
$1,731.95
|
2026-03-30
|
|
70551
|
HCPCS
|
MRI Scan Of Brain Without Contrast
|
13
|
13
|
$2,585.00
|
$2,585.00
|
$983.32
|
$2,378.20
|
$1,731.95
|
2026-03-30
|
|
70336
|
HCPCS
|
MRI Scan Of Jaw Joint
|
13
|
13
|
$2,584.00
|
$2,584.00
|
$983.32
|
$2,377.28
|
$1,731.28
|
2026-03-30
|
|
70544
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head Without Contrast
|
13
|
13
|
$2,584.00
|
$2,584.00
|
$675.80
|
$2,377.28
|
$1,731.28
|
2026-03-30
|
|
27100036
|
CDM
|
Rhc Med/surg Supply Level 36
|
13
|
13
|
$2,575.00
|
$2,575.00
|
$1,364.75
|
$2,369.00
|
$1,725.25
|
2026-03-30
|
|
71550
|
HCPCS
|
MRI Scan Of Chest Without Contrast
|
13
|
13
|
$2,567.00
|
$2,567.00
|
$983.32
|
$2,361.64
|
$1,719.89
|
2026-03-30
|
|
74181
|
HCPCS
|
MRI Scan Of Abdomen Without Contrast
|
13
|
13
|
$2,567.00
|
$2,567.00
|
$983.32
|
$2,361.64
|
$1,719.89
|
2026-03-30
|
|
73222
|
HCPCS
|
MRI Scan Of Arm Joint With Contrast
|
13
|
13
|
$2,556.00
|
$2,556.00
|
$1,233.80
|
$2,351.52
|
$1,712.52
|
2026-03-30
|
|
70540
|
HCPCS
|
MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast
|
13
|
13
|
$2,555.70
|
$2,555.70
|
$983.32
|
$2,351.24
|
$1,712.32
|
2026-03-30
|
|
73721
|
HCPCS
|
MRI Scan Of Leg Joint Without Contrast
|
13
|
13
|
$2,539.00
|
$2,539.00
|
$983.32
|
$2,335.88
|
$1,701.13
|
2026-03-30
|
|
27100082
|
CDM
|
Rhc Sterile Med/surg Supply Level 37
|
13
|
13
|
$2,489.00
|
$2,489.00
|
$1,319.17
|
$2,289.88
|
$1,667.63
|
2026-03-30
|
|
J0248
|
HCPCS
|
Injection, Remdesivir, 1 Mg
|
11
|
11
|
$2,485.50
|
$2,485.50
|
$1,416.74
|
$2,286.66
|
$1,665.29
|
2026-03-30
|
|
73221
|
HCPCS
|
MRI Scan Of Arm Joint Without Contrast
|
13
|
13
|
$2,472.00
|
$2,472.00
|
$983.32
|
$2,274.24
|
$1,656.24
|
2026-03-30
|
|
27100035
|
CDM
|
Rhc Med/surg Supply Level 35
|
13
|
13
|
$2,457.00
|
$2,457.00
|
$1,302.21
|
$2,260.44
|
$1,646.19
|
2026-03-30
|
|
74170
|
HCPCS
|
CT Scan Of Abdomen Before And After Contrast
|
13
|
13
|
$2,425.00
|
$2,425.00
|
$1,042.22
|
$2,231.00
|
$1,624.75
|
2026-03-30
|
|
74175
|
HCPCS
|
CT Scan Of Blood Vessels Of Abdomen With Contrast
|
13
|
13
|
$2,418.00
|
$2,418.00
|
$709.28
|
$2,224.56
|
$1,620.06
|
2026-03-30
|
|
Q0138
|
HCPCS
|
Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd …
|
13
|
13
|
$2,405.50
|
$2,405.50
|
$1,274.92
|
$2,213.06
|
$1,611.69
|
2026-03-30
|
|
64635
|
HCPCS
|
Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,…
|
34
|
13
|
$2,394.00
|
$2,394.00
|
$162.49
|
$3,811.56
|
$1,603.98
|
2026-03-30
|
|
70496
|
HCPCS
|
CT Scan Of Blood Vessels Of Head With Contrast
|
13
|
13
|
$2,385.00
|
$2,385.00
|
$709.28
|
$2,194.20
|
$1,597.95
|
2026-03-30
|
|
73225
|
HCPCS
|
MRI Scan Of Blood Vessels Of Arm
|
35
|
13
|
$2,384.00
|
$2,384.00
|
$675.80
|
$2,377.28
|
$1,597.28
|
2026-03-30
|
|
J7307
|
HCPCS
|
Etonogestrel (contraceptive) Implant System, Including Implant And Supplies
|
17
|
13
|
$2,363.00
|
$2,363.00
|
$1,009.61
|
$2,173.96
|
$1,583.21
|
2026-03-30
|
|
40000037
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
12
|
12
|
$2,355.00
|
$2,355.00
|
$1,248.15
|
$2,166.60
|
$1,577.85
|
2026-03-30
|
|
72191
|
HCPCS
|
CT Scan Of Blood Vessels Of Pelvis With Contrast
|
13
|
13
|
$2,346.00
|
$2,346.00
|
$709.28
|
$2,158.32
|
$1,571.82
|
2026-03-30
|
|
27100034
|
CDM
|
Rhc Med/surg Supply Level 34
|
13
|
13
|
$2,328.00
|
$2,328.00
|
$1,233.84
|
$2,141.76
|
$1,559.76
|
2026-03-30
|
|
70547
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck Without Contrast
|
13
|
13
|
$2,301.00
|
$2,301.00
|
$675.80
|
$2,116.92
|
$1,541.67
|
2026-03-30
|
|
40000033
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
12
|
12
|
$2,294.00
|
$2,294.00
|
$1,215.82
|
$2,110.48
|
$1,536.98
|
2026-03-30
|
|
70498
|
HCPCS
|
CT Scan Of Blood Vessels Of Neck With Contrast
|
13
|
13
|
$2,290.00
|
$2,290.00
|
$709.28
|
$2,106.80
|
$1,534.30
|
2026-03-30
|
|
J1950
|
HCPCS
|
Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg
|
4
|
4
|
$3,474.00
|
$3,474.00
|
$1,323.76
|
$1,764.73
|
$1,530.53
|
2026-03-30
|
|
70470
|
HCPCS
|
CT Scan Of Head Or Brain Before And After Contrast
|
13
|
13
|
$2,254.00
|
$2,254.00
|
$1,042.22
|
$2,073.68
|
$1,510.18
|
2026-03-30
|
|
72195
|
HCPCS
|
MRI Scan Of Pelvis Without Contrast
|
13
|
13
|
$2,252.00
|
$2,252.00
|
$983.32
|
$2,071.84
|
$1,508.84
|
2026-03-30
|
|
72194
|
HCPCS
|
CT Scan Of Pelvis Before And After Contrast
|
13
|
13
|
$2,246.00
|
$2,246.00
|
$1,042.22
|
$2,066.32
|
$1,504.82
|
2026-03-30
|
|
71270
|
HCPCS
|
CT Scan Of Chest Before And After Contrast
|
13
|
13
|
$2,235.00
|
$2,235.00
|
$1,042.22
|
$2,056.20
|
$1,497.45
|
2026-03-30
|
|
27100081
|
CDM
|
Rhc Sterile Med/surg Supply Level 36
|
13
|
13
|
$2,230.00
|
$2,230.00
|
$1,181.90
|
$2,051.60
|
$1,494.10
|
2026-03-30
|
|
93306
|
HCPCS
|
Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu…
|
13
|
13
|
$2,228.00
|
$2,228.00
|
$415.40
|
$2,049.76
|
$1,492.76
|
2026-03-30
|
|
72130
|
HCPCS
|
CT Scan Of Middle Spine Before And After Contrast
|
13
|
13
|
$2,204.00
|
$2,204.00
|
$1,042.22
|
$2,027.68
|
$1,476.68
|
2026-03-30
|
|
72127
|
HCPCS
|
CT Scan Of Upper Spine Before And After Contrast
|
13
|
13
|
$2,204.00
|
$2,204.00
|
$1,042.22
|
$2,027.68
|
$1,476.68
|
2026-03-30
|
|
72133
|
HCPCS
|
CT Scan Of Lower Spine Before And After Contrast
|
13
|
13
|
$2,204.00
|
$2,204.00
|
$1,042.22
|
$2,027.68
|
$1,476.68
|
2026-03-30
|
|
27100033
|
CDM
|
Rhc Med/surg Supply Level 33
|
13
|
13
|
$2,196.00
|
$2,196.00
|
$1,163.88
|
$2,020.32
|
$1,471.32
|
2026-03-30
|
|
27100080
|
CDM
|
Rhc Sterile Med/surg Supply Level 35
|
13
|
13
|
$2,193.00
|
$2,193.00
|
$1,162.29
|
$2,017.56
|
$1,469.31
|
2026-03-30
|
|
72193
|
HCPCS
|
CT Scan Of Pelvis With Contrast
|
13
|
13
|
$2,192.00
|
$2,192.00
|
$1,042.22
|
$2,016.64
|
$1,468.64
|
2026-03-30
|
|
27100113
|
CDM
|
Rhc Misc Implant Charge Level 7
|
13
|
13
|
$2,170.00
|
$2,170.00
|
$1,150.10
|
$1,996.40
|
$1,453.90
|
2026-03-30
|
|
74160
|
HCPCS
|
CT Scan Of Abdomen With Contrast
|
13
|
13
|
$2,147.00
|
$2,147.00
|
$1,042.22
|
$1,975.24
|
$1,438.49
|
2026-03-30
|
|
70488
|
HCPCS
|
CT Scan Of Face Before And After Contrast
|
13
|
13
|
$2,131.00
|
$2,131.00
|
$1,042.22
|
$1,960.52
|
$1,427.77
|
2026-03-30
|
|
50050064
|
CDM
|
Room & Board - Semi-private (two Beds) - General Classification
|
7
|
7
|
$1,709.00
|
$1,709.00
|
$939.95
|
$2,528.98
|
$1,411.63
|
2026-03-30
|
|
27100032
|
CDM
|
Rhc Med/surg Supply Level 32
|
13
|
13
|
$2,068.00
|
$2,068.00
|
$1,096.04
|
$1,902.56
|
$1,385.56
|
2026-03-30
|
|
27100079
|
CDM
|
Rhc Sterile Med/surg Supply Level 34
|
13
|
13
|
$2,042.00
|
$2,042.00
|
$1,082.26
|
$1,878.64
|
$1,368.14
|
2026-03-30
|
|
64633
|
HCPCS
|
Destruction Of Upper Or Middle Spinal Facet Joint Nerves Using Imaging Guidance,…
|
22
|
13
|
$2,415.00
|
$2,415.00
|
$162.01
|
$2,221.80
|
$1,364.38
|
2026-03-30
|
|
70460
|
HCPCS
|
CT Scan Head Or Brain With Contrast
|
13
|
13
|
$1,978.00
|
$1,978.00
|
$1,042.22
|
$1,819.76
|
$1,325.26
|
2026-03-30
|
|
27100031
|
CDM
|
Rhc Med/surg Supply Level 31
|
13
|
13
|
$1,944.00
|
$1,944.00
|
$1,030.32
|
$1,788.48
|
$1,302.48
|
2026-03-30
|
|
73202
|
HCPCS
|
CT Scan Of Arm Before And After Contrast
|
13
|
13
|
$1,898.00
|
$1,898.00
|
$1,042.22
|
$1,746.16
|
$1,271.66
|
2026-03-30
|
|
70482
|
HCPCS
|
CT Scan Of Cranial Cavity Before And After Contrast
|
13
|
13
|
$1,897.00
|
$1,897.00
|
$1,042.22
|
$1,745.24
|
$1,270.99
|
2026-03-30
|
|
73702
|
HCPCS
|
CT Scan Of Leg Before And After Contrast
|
13
|
13
|
$1,897.00
|
$1,897.00
|
$1,042.22
|
$1,745.24
|
$1,270.99
|
2026-03-30
|
|
70492
|
HCPCS
|
CT Scan Of Soft Tissue Of Neck Before And After Contrast
|
13
|
13
|
$1,897.00
|
$1,897.00
|
$1,042.22
|
$1,745.24
|
$1,270.99
|
2026-03-30
|
|
27138
|
HCPCS
|
Revision Of Thigh Bone Prosthesis
|
10
|
10
|
$4,604.00
|
$4,604.00
|
$1,231.73
|
$4,604.00
|
$1,244.05
|
2026-03-30
|
|
70487
|
HCPCS
|
CT Scan Of Face With Contrast
|
13
|
13
|
$1,846.00
|
$1,846.00
|
$1,042.22
|
$1,698.32
|
$1,236.82
|
2026-03-30
|
|
27100078
|
CDM
|
Rhc Sterile Med/surg Supply Level 33
|
13
|
13
|
$1,834.00
|
$1,834.00
|
$972.02
|
$1,687.28
|
$1,228.78
|
2026-03-30
|
|
71260
|
HCPCS
|
CT Scan Of Chest With Contrast
|
13
|
13
|
$1,833.00
|
$1,833.00
|
$1,042.22
|
$1,686.36
|
$1,228.11
|
2026-03-30
|
|
72132
|
HCPCS
|
CT Scan Of Lower Spine With Contrast
|
13
|
13
|
$1,825.00
|
$1,825.00
|
$1,040.25
|
$1,679.00
|
$1,222.75
|
2026-03-30
|
|
72129
|
HCPCS
|
CT Scan Of Middle Spine With Contrast
|
13
|
13
|
$1,825.00
|
$1,825.00
|
$1,040.25
|
$1,679.00
|
$1,222.75
|
2026-03-30
|
|
72126
|
HCPCS
|
CT Scan Of Upper Spine With Contrast
|
13
|
13
|
$1,825.00
|
$1,825.00
|
$1,040.25
|
$1,679.00
|
$1,222.75
|
2026-03-30
|
|
27100030
|
CDM
|
Rhc Med/surg Supply Level 30
|
13
|
13
|
$1,822.00
|
$1,822.00
|
$965.66
|
$1,676.24
|
$1,220.74
|
2026-03-30
|
|
10010101
|
CDM
|
Operating Room Services - General Classification
|
12
|
12
|
$1,801.00
|
$1,801.00
|
$954.53
|
$1,656.92
|
$1,206.67
|
2026-03-30
|
|
27100077
|
CDM
|
Rhc Sterile Med/surg Supply Level 32
|
13
|
13
|
$1,781.00
|
$1,781.00
|
$943.93
|
$1,638.52
|
$1,193.27
|
2026-03-30
|
|
J0485
|
HCPCS
|
Injection, Belatacept, 1 Mg
|
13
|
13
|
$1,736.50
|
$1,736.50
|
$920.35
|
$1,597.58
|
$1,163.46
|
2026-03-30
|
|
27486
|
HCPCS
|
Revision Of Component Of Total Knee Joint Prosthesis
|
10
|
10
|
$4,064.00
|
$4,064.00
|
$1,149.74
|
$4,064.00
|
$1,161.24
|
2026-03-30
|
|
27100029
|
CDM
|
Rhc Med/surg Supply Level 29
|
13
|
13
|
$1,709.00
|
$1,709.00
|
$905.77
|
$1,572.28
|
$1,145.03
|
2026-03-30
|
|
27828
|
HCPCS
|
Treatment Of Broken Lower Weight Bearing Joint Of Both Lower Leg Bones
|
10
|
10
|
$3,853.00
|
$3,853.00
|
$1,113.63
|
$3,853.00
|
$1,124.77
|
2026-03-30
|
|
72192
|
HCPCS
|
CT Scan Of Pelvis Without Contrast
|
13
|
13
|
$1,676.00
|
$1,676.00
|
$480.50
|
$1,541.92
|
$1,122.92
|
2026-03-30
|
|
27100076
|
CDM
|
Rhc Sterile Med/surg Supply Level 31
|
13
|
13
|
$1,673.00
|
$1,673.00
|
$886.69
|
$1,539.16
|
$1,120.91
|
2026-03-30
|
|
36569
|
HCPCS
|
Insertion Of Tube For Infusion (5 Years Or Older)
|
22
|
13
|
$1,736.00
|
$1,736.00
|
$78.39
|
$2,271.06
|
$1,110.17
|
2026-03-30
|
|
78227
|
HCPCS
|
Nuclear Medicine Study Of Liver And Bile Duct System With Use Of Drugs
|
13
|
13
|
$1,649.00
|
$1,649.00
|
$879.16
|
$1,517.08
|
$1,104.83
|
2026-03-30
|
|
78014
|
HCPCS
|
Nuclear Medicine Study Of Thyroid And Thyroid Function
|
13
|
13
|
$1,638.00
|
$1,638.00
|
$879.16
|
$1,506.96
|
$1,097.46
|
2026-03-30
|
|
72128
|
HCPCS
|
CT Scan Of Middle Spine Without Contrast
|
13
|
13
|
$1,632.00
|
$1,632.00
|
$480.50
|
$1,501.44
|
$1,093.44
|
2026-03-30
|
|
72131
|
HCPCS
|
CT Scan Of Lower Spine Without Contrast
|
13
|
13
|
$1,632.00
|
$1,632.00
|
$480.50
|
$1,501.44
|
$1,093.44
|
2026-03-30
|
|
72125
|
HCPCS
|
CT Scan Of Upper Spine Without Contrast
|
13
|
13
|
$1,632.00
|
$1,632.00
|
$480.50
|
$1,501.44
|
$1,093.44
|
2026-03-30
|
|
74150
|
HCPCS
|
CT Scan Of Abdomen Without Contrast
|
13
|
13
|
$1,625.00
|
$1,625.00
|
$480.50
|
$1,495.00
|
$1,088.75
|
2026-03-30
|
|
27100028
|
CDM
|
Rhc Med/surg Supply Level 28
|
13
|
13
|
$1,625.00
|
$1,625.00
|
$861.25
|
$1,495.00
|
$1,088.75
|
2026-03-30
|
|
J7298
|
HCPCS
|
Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg
|
4
|
4
|
$991.00
|
$991.00
|
$1,029.79
|
$1,535.37
|
$1,072.80
|
2026-03-30
|
|
27130
|
HCPCS
|
Replacement Of Thigh Bone And Hip Joint With Prosthesis
|
11
|
11
|
$3,746.00
|
$3,746.00
|
$1,047.43
|
$3,746.00
|
$1,068.38
|
2026-03-30
|
|
27447
|
HCPCS
|
Replacement Of Knee Joint, Both Sides Of Knee
|
11
|
11
|
$4,106.00
|
$4,106.00
|
$1,045.50
|
$4,106.00
|
$1,066.41
|
2026-03-30
|
|
27100075
|
CDM
|
Rhc Sterile Med/surg Supply Level 30
|
13
|
13
|
$1,589.00
|
$1,589.00
|
$842.17
|
$1,461.88
|
$1,064.63
|
2026-03-30
|
|
70491
|
HCPCS
|
CT Scan Of Soft Tissue Of Neck With Contrast
|
13
|
13
|
$1,588.00
|
$1,588.00
|
$905.16
|
$1,460.96
|
$1,063.96
|
2026-03-30
|
|
70481
|
HCPCS
|
CT Scan Of Cranial Cavity With Contrast
|
13
|
13
|
$1,587.00
|
$1,587.00
|
$904.59
|
$1,460.04
|
$1,063.29
|
2026-03-30
|
|
71250
|
HCPCS
|
CT Scan Of Chest Without Contrast
|
13
|
13
|
$1,570.00
|
$1,570.00
|
$480.50
|
$1,444.40
|
$1,051.90
|
2026-03-30
|
|
73201
|
HCPCS
|
CT Scan Of Arm With Contrast
|
13
|
13
|
$1,570.00
|
$1,570.00
|
$894.90
|
$1,444.40
|
$1,051.90
|
2026-03-30
|
|
73701
|
HCPCS
|
CT Scan Of Leg With Contrast Material
|
13
|
13
|
$1,569.00
|
$1,569.00
|
$894.33
|
$1,443.48
|
$1,051.23
|
2026-03-30
|
|
27100027
|
CDM
|
Rhc Med/surg Supply Level 27
|
13
|
13
|
$1,562.00
|
$1,562.00
|
$827.86
|
$1,437.04
|
$1,046.54
|
2026-03-30
|
|
70486
|
HCPCS
|
CT Scan Of Face Without Contrast
|
13
|
13
|
$1,561.00
|
$1,561.00
|
$480.50
|
$1,436.12
|
$1,045.87
|
2026-03-30
|
|
J7300
|
HCPCS
|
Intrauterine Copper Contraceptive
|
4
|
4
|
$815.00
|
$815.00
|
$955.26
|
$1,853.18
|
$1,027.08
|
2026-03-30
|
|
50050051
|
CDM
|
Room & Board - Semi-private (two Beds) - Hospice
|
7
|
7
|
$1,242.00
|
$1,242.00
|
$683.10
|
$1,837.91
|
$1,025.89
|
2026-03-30
|
|
50050093
|
CDM
|
Room & Board - Semi-private (two Beds) - General Classification
|
7
|
7
|
$1,242.00
|
$1,242.00
|
$683.10
|
$1,837.91
|
$1,025.89
|
2026-03-30
|
|
50050012
|
CDM
|
Room & Board - Semi-private (two Beds) - General Classification
|
7
|
7
|
$1,242.00
|
$1,242.00
|
$683.10
|
$1,837.91
|
$1,025.89
|
2026-03-30
|
|
27244
|
HCPCS
|
Treatment Of Broken Neck Of Thigh Bone With Plate/screw Implant
|
10
|
10
|
$3,683.00
|
$3,683.00
|
$1,011.42
|
$3,683.00
|
$1,021.54
|
2026-03-30
|
|
27100026
|
CDM
|
Rhc Med/surg Supply Level 26
|
13
|
13
|
$1,522.00
|
$1,522.00
|
$806.66
|
$1,400.24
|
$1,019.74
|
2026-03-30
|
|
27245
|
HCPCS
|
Treatment Of Broken Neck Of Thigh Bone With Bone Implant
|
10
|
10
|
$3,898.00
|
$3,898.00
|
$1,009.36
|
$3,898.00
|
$1,019.45
|
2026-03-30
|
|
70450
|
HCPCS
|
CT Scan Head Or Brain Without Contrast
|
13
|
13
|
$1,511.00
|
$1,511.00
|
$861.27
|
$1,390.12
|
$1,012.37
|
2026-03-30
|
|
19307
|
HCPCS
|
Removal Of Breast And Underarm Lymph Nodes
|
10
|
10
|
$3,304.00
|
$3,304.00
|
$1,002.27
|
$3,304.00
|
$1,012.30
|
2026-03-30
|
|
64624
|
HCPCS
|
Destruction Of Nerve Branches Of Knee Using Imaging Guidance
|
20
|
13
|
$1,707.00
|
$1,707.00
|
$125.06
|
$1,570.44
|
$1,006.27
|
2026-03-30
|
|
27488
|
HCPCS
|
Removal Of Total Knee Joint Prosthesis
|
10
|
10
|
$3,679.00
|
$3,679.00
|
$992.31
|
$3,679.00
|
$1,002.23
|
2026-03-30
|
|
27100074
|
CDM
|
Rhc Sterile Med/surg Supply Level 29
|
13
|
13
|
$1,485.00
|
$1,485.00
|
$787.05
|
$1,366.20
|
$994.95
|
2026-03-30
|
|
27236
|
HCPCS
|
Treatment Of Upper End Of Broken Thigh Bone With Placement Of Stabilizing Device…
|
10
|
10
|
$3,462.00
|
$3,462.00
|
$983.52
|
$3,462.00
|
$993.36
|
2026-03-30
|
|
78315
|
HCPCS
|
Nuclear Medicine Study Of Bone Taken At Different Times
|
13
|
13
|
$1,465.00
|
$1,465.00
|
$835.05
|
$1,347.80
|
$981.55
|
2026-03-30
|
|
27100025
|
CDM
|
Rhc Med/surg Supply Level 25
|
13
|
13
|
$1,459.00
|
$1,459.00
|
$773.27
|
$1,342.28
|
$977.53
|
2026-03-30
|
|
78278
|
HCPCS
|
Nuclear Medicine Study To Assess Blood Loss
|
13
|
13
|
$1,448.00
|
$1,448.00
|
$825.36
|
$1,822.99
|
$970.16
|
2026-03-30
|
|
78803
|
HCPCS
|
Nuclear Medicine Study, Spect Imaging, 1 Area Or Single Acquisition, Single Day …
|
13
|
13
|
$1,441.00
|
$1,441.00
|
$821.37
|
$1,822.99
|
$965.47
|
2026-03-30
|
|
78708
|
HCPCS
|
Nuclear Medicine Study Of Kidney, Blood, Flow, And Function With Drug Administra…
|
13
|
13
|
$1,424.00
|
$1,424.00
|
$811.68
|
$1,310.08
|
$954.08
|
2026-03-30
|
|
62321
|
HCPCS
|
Injection Of Substance Into Middle Or Upper Spine Canal Using Imaging Guidance
|
23
|
14
|
$1,660.00
|
$1,660.00
|
$89.69
|
$1,527.20
|
$946.20
|
2026-03-30
|
|
64483
|
HCPCS
|
Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I…
|
23
|
14
|
$1,657.00
|
$1,657.00
|
$93.39
|
$1,524.44
|
$944.49
|
2026-03-30
|
|
78013
|
HCPCS
|
Nuclear Medicine Study Of Thyroid
|
13
|
13
|
$1,408.00
|
$1,408.00
|
$802.56
|
$1,295.36
|
$943.36
|
2026-03-30
|
|
78709
|
HCPCS
|
Nuclear Medicine Studies Of Kidney, Blood Flow, And Function
|
13
|
13
|
$1,405.00
|
$1,405.00
|
$800.85
|
$1,292.60
|
$941.35
|
2026-03-30
|
|
99291
|
HCPCS
|
Critical Care, First 30-74 Minutes
|
23
|
14
|
$1,761.00
|
$1,761.00
|
$186.97
|
$1,620.12
|
$933.33
|
2026-03-30
|
|
27100024
|
CDM
|
Rhc Med/surg Supply Level 24
|
13
|
13
|
$1,391.00
|
$1,391.00
|
$737.23
|
$1,279.72
|
$931.97
|
2026-03-30
|
|
J1670
|
HCPCS
|
Injection, Tetanus Immune Globulin, Human, Up To 250 Units
|
13
|
13
|
$1,386.00
|
$1,386.00
|
$734.58
|
$1,275.12
|
$928.62
|
2026-03-30
|
|
27100073
|
CDM
|
Rhc Sterile Med/surg Supply Level 28
|
13
|
13
|
$1,372.00
|
$1,372.00
|
$727.16
|
$1,262.24
|
$919.24
|
2026-03-30
|
|
78582
|
HCPCS
|
Nuclear Medicine Study Of Lung Ventilation And Circulation
|
13
|
13
|
$1,370.00
|
$1,370.00
|
$780.90
|
$1,822.99
|
$917.90
|
2026-03-30
|
|
70490
|
HCPCS
|
CT Scan Of Soft Tissue Of Neck Without Contrast
|
13
|
13
|
$1,366.00
|
$1,366.00
|
$480.50
|
$1,256.72
|
$915.22
|
2026-03-30
|
|
70480
|
HCPCS
|
CT Scan Of Cranial Cavity Without Contrast
|
13
|
13
|
$1,366.00
|
$1,366.00
|
$480.50
|
$1,256.72
|
$915.22
|
2026-03-30
|
|
78018
|
HCPCS
|
Nuclear Medicine Study Of Whole Body For Thyroid Cancer
|
13
|
13
|
$1,356.00
|
$1,356.00
|
$772.92
|
$1,247.52
|
$908.52
|
2026-03-30
|
|
27100112
|
CDM
|
Rhc Misc Implant Charge Level 6
|
13
|
13
|
$1,352.00
|
$1,352.00
|
$716.56
|
$1,243.84
|
$905.84
|
2026-03-30
|
|
73200
|
HCPCS
|
CT Scan Of Arm Without Contrast
|
13
|
13
|
$1,351.00
|
$1,351.00
|
$480.50
|
$1,242.92
|
$905.17
|
2026-03-30
|
|
73700
|
HCPCS
|
CT Scan Of Leg Without Contrast
|
13
|
13
|
$1,351.00
|
$1,351.00
|
$480.50
|
$1,242.92
|
$905.17
|
2026-03-30
|
|
64415
|
HCPCS
|
Injection Of Anesthetic Agent And/or Steroid Into Arm Nerve Bundle (brachial Ple…
|
12
|
12
|
$1,336.00
|
$1,336.00
|
$761.52
|
$1,560.42
|
$904.07
|
2026-03-30
|
|
62323
|
HCPCS
|
Injection Of Substance Into Lower Spine Canal Using Imaging Guidance
|
23
|
14
|
$1,584.00
|
$1,584.00
|
$83.66
|
$1,487.44
|
$902.88
|
2026-03-30
|
|
29827
|
HCPCS
|
Repair Of Shoulder Rotator Cuff Using An Endoscope
|
11
|
11
|
$3,190.00
|
$3,190.00
|
$883.71
|
$3,190.00
|
$901.38
|
2026-03-30
|
|
J7301
|
HCPCS
|
Levonorgestrel-releasing Intrauterine Contraceptive System (skyla), 13.5 Mg
|
4
|
4
|
$743.00
|
$743.00
|
$857.48
|
$1,278.56
|
$893.29
|
2026-03-30
|
|
J0561
|
HCPCS
|
Injection, Penicillin G Benzathine, 100,000 Units
|
17
|
13
|
$1,307.50
|
$1,307.50
|
$14.09
|
$1,202.90
|
$876.03
|
2026-03-30
|
|
78264
|
HCPCS
|
Nuclear Medicine Study Of Stomach To Assess Emptying
|
13
|
13
|
$1,302.00
|
$1,302.00
|
$742.14
|
$1,197.84
|
$872.34
|
2026-03-30
|
|
27100023
|
CDM
|
Rhc Med/surg Supply Level 23
|
13
|
13
|
$1,295.00
|
$1,295.00
|
$686.35
|
$1,191.40
|
$867.65
|
2026-03-30
|
|
27100072
|
CDM
|
Rhc Sterile Med/surg Supply Level 27
|
13
|
13
|
$1,294.00
|
$1,294.00
|
$685.82
|
$1,190.48
|
$866.98
|
2026-03-30
|
|
27100071
|
CDM
|
Rhc Sterile Med/surg Supply Level 26
|
13
|
13
|
$1,289.00
|
$1,289.00
|
$683.17
|
$1,185.88
|
$863.63
|
2026-03-30
|
|
78012
|
HCPCS
|
Nuclear Medicine Study Of Thyroid Function
|
13
|
13
|
$1,289.00
|
$1,289.00
|
$734.73
|
$1,185.88
|
$863.63
|
2026-03-30
|
|
64490
|
HCPCS
|
Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Single Le…
|
22
|
13
|
$1,462.00
|
$1,462.00
|
$88.27
|
$1,487.44
|
$861.85
|
2026-03-30
|
|
78226
|
HCPCS
|
Nuclear Medicine Study Of Liver And Bile Duct System
|
13
|
13
|
$1,269.00
|
$1,269.00
|
$723.33
|
$1,167.48
|
$850.23
|
2026-03-30
|
|
93880
|
HCPCS
|
Ultrasound Of Both Sides Of Head And Neck Blood Flow
|
13
|
13
|
$1,247.00
|
$1,247.00
|
$191.58
|
$1,147.24
|
$835.49
|
2026-03-30
|
|
27100070
|
CDM
|
Rhc Sterile Med/surg Supply Level 25
|
13
|
13
|
$1,245.00
|
$1,245.00
|
$659.85
|
$1,145.40
|
$834.15
|
2026-03-30
|
|
27100022
|
CDM
|
Rhc Med/surg Supply Level 22
|
13
|
13
|
$1,244.00
|
$1,244.00
|
$659.32
|
$1,144.48
|
$833.48
|
2026-03-30
|
|
47531
|
HCPCS
|
Injection Of Bile Duct For X-ray Through Already Existing Skin Access Using Imag…
|
12
|
12
|
$1,223.00
|
$1,223.00
|
$697.11
|
$2,423.15
|
$827.61
|
2026-03-30
|
|
29888
|
HCPCS
|
Repair Of Anterior Cruciate Ligament Of Knee Using An Endoscope
|
11
|
11
|
$2,830.00
|
$2,830.00
|
$806.03
|
$2,830.00
|
$822.15
|
2026-03-30
|
|
93350
|
HCPCS
|
Ultrasound Of Heart During Rest, Exercise And/or Drug-induced Stress With Report
|
13
|
13
|
$1,226.00
|
$1,226.00
|
$415.40
|
$1,127.92
|
$821.42
|
2026-03-30
|
|
78306
|
HCPCS
|
Nuclear Medicine Study Of Bone And/or Joint Whole Body
|
13
|
13
|
$1,225.00
|
$1,225.00
|
$698.25
|
$1,127.00
|
$820.75
|
2026-03-30
|
|
27240
|
HCPCS
|
Closed Treatment Of Broken Below Neck Of Thigh Bone With Manipulation
|
10
|
10
|
$3,061.00
|
$3,061.00
|
$809.33
|
$3,061.00
|
$817.42
|
2026-03-30
|
|
25415
|
HCPCS
|
Treatment Of Both Nonhealed Broken Forearm Bones
|
10
|
10
|
$2,938.00
|
$2,938.00
|
$807.92
|
$2,938.00
|
$816.00
|
2026-03-30
|
|
64493
|
HCPCS
|
Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Le…
|
44
|
13
|
$1,209.00
|
$1,209.00
|
$76.35
|
$2,224.56
|
$810.03
|
2026-03-30
|
|
64447
|
HCPCS
|
Injection Of Anesthetic Agent And/or Steroid Into Thigh Nerve (femoral Nerve)
|
12
|
12
|
$1,203.00
|
$1,203.00
|
$639.22
|
$1,106.76
|
$806.01
|
2026-03-30
|
|
27100069
|
CDM
|
Rhc Sterile Med/surg Supply Level 24
|
13
|
13
|
$1,188.00
|
$1,188.00
|
$629.64
|
$1,092.96
|
$795.96
|
2026-03-30
|
|
78472
|
HCPCS
|
Nuclear Medicine Study Of Heart Pumping Function By Labeling Red Blood Cells Wit…
|
13
|
13
|
$1,176.00
|
$1,176.00
|
$670.32
|
$1,081.92
|
$787.92
|
2026-03-30
|
|
64634
|
HCPCS
|
Destruction Of Upper Or Middle Spinal Facet Joint Nerves Using Imaging Guidance,…
|
23
|
13
|
$1,282.00
|
$1,282.00
|
$54.46
|
$1,487.44
|
$780.74
|
2026-03-30
|
|
29828
|
HCPCS
|
Release Of Tendon Connecting Biceps Muscle And Shoulder Using An Endoscope
|
10
|
10
|
$2,996.00
|
$2,996.00
|
$763.78
|
$2,996.00
|
$771.42
|
2026-03-30
|
|
27235
|
HCPCS
|
Placement Of Stabilizing Device For Upper End Of Broken Thigh Bone
|
10
|
10
|
$2,895.00
|
$2,895.00
|
$755.59
|
$2,895.00
|
$763.14
|
2026-03-30
|
|
20020106
|
CDM
|
Operating Room Services - General Classification
|
12
|
12
|
$1,133.00
|
$1,133.00
|
$600.49
|
$1,042.36
|
$759.11
|
2026-03-30
|
|
27100021
|
CDM
|
Rhc Med/surg Supply Level 21
|
13
|
13
|
$1,131.00
|
$1,131.00
|
$599.43
|
$1,040.52
|
$757.77
|
2026-03-30
|
|
27822
|
HCPCS
|
Treatment Of 3 Broken Lower Leg Bones At Ankle
|
10
|
10
|
$2,812.00
|
$2,812.00
|
$750.11
|
$2,812.00
|
$757.61
|
2026-03-30
|
|
27100068
|
CDM
|
Rhc Sterile Med/surg Supply Level 23
|
13
|
13
|
$1,122.00
|
$1,122.00
|
$594.66
|
$1,032.24
|
$751.74
|
2026-03-30
|
|
27100111
|
CDM
|
Rhc Misc Implant Charge Level 5
|
13
|
13
|
$1,115.00
|
$1,115.00
|
$590.95
|
$1,025.80
|
$747.05
|
2026-03-30
|
|
93307
|
HCPCS
|
Ultrasound Of Heart
|
13
|
13
|
$1,114.00
|
$1,114.00
|
$415.40
|
$1,024.88
|
$746.38
|
2026-03-30
|
|
70070005
|
CDM
|
Recovery Room - General Classification
|
13
|
13
|
$1,095.00
|
$1,095.00
|
$580.35
|
$1,007.40
|
$733.65
|
2026-03-30
|
|
64636
|
HCPCS
|
Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,…
|
23
|
13
|
$1,203.00
|
$1,203.00
|
$47.76
|
$1,487.44
|
$732.63
|
2026-03-30
|
|
27100020
|
CDM
|
Rhc Med/surg Supply Level 20
|
13
|
13
|
$1,088.00
|
$1,088.00
|
$576.64
|
$1,000.96
|
$728.96
|
2026-03-30
|
|
66986
|
HCPCS
|
Exchange Of Prosthetic Lens
|
10
|
10
|
$2,675.00
|
$2,675.00
|
$716.74
|
$2,675.00
|
$723.90
|
2026-03-30
|
|
27100067
|
CDM
|
Rhc Sterile Med/surg Supply Level 22
|
13
|
13
|
$1,062.00
|
$1,062.00
|
$562.86
|
$977.04
|
$711.54
|
2026-03-30
|
|
78305
|
HCPCS
|
Nuclear Medicine Study Of Bone And/or Joint Multiple Areas
|
13
|
13
|
$1,054.00
|
$1,054.00
|
$600.78
|
$969.68
|
$706.18
|
2026-03-30
|
|
62273
|
HCPCS
|
Injection Of Blood Or Blood Clot Into Spinal Canal
|
22
|
13
|
$1,163.00
|
$1,163.00
|
$95.85
|
$1,487.44
|
$685.59
|
2026-03-30
|
|
93970
|
HCPCS
|
Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers
|
13
|
13
|
$1,022.00
|
$1,022.00
|
$302.56
|
$940.24
|
$684.74
|
2026-03-30
|
|
93978
|
HCPCS
|
Complete Ultrasound Of Aorta, Vena Cava, Groin Vessels Or Bypass Grafts
|
13
|
13
|
$1,019.00
|
$1,019.00
|
$302.56
|
$937.48
|
$682.73
|
2026-03-30
|
|
27100019
|
CDM
|
Rhc Med/surg Supply Level 19
|
13
|
13
|
$1,013.00
|
$1,013.00
|
$536.89
|
$931.96
|
$678.71
|
2026-03-30
|
|
66989
|
HCPCS
|
Complex Extracapsular Removal Of Cataract With Insertion Of Artificial Lens And …
|
8
|
8
|
$2,533.00
|
$2,533.00
|
$675.36
|
$2,533.00
|
$675.36
|
2026-03-30
|
|
78761
|
HCPCS
|
Nuclear Medicine Study Of Testicle And Blood Flow
|
13
|
13
|
$1,006.00
|
$1,006.00
|
$573.42
|
$967.08
|
$674.02
|
2026-03-30
|
|
28725
|
HCPCS
|
Fusion Of Foot Below Ankle
|
10
|
10
|
$2,378.00
|
$2,378.00
|
$666.22
|
$2,378.00
|
$672.88
|
2026-03-30
|
|
27100066
|
CDM
|
Rhc Sterile Med/surg Supply Level 21
|
13
|
13
|
$993.00
|
$993.00
|
$526.29
|
$913.56
|
$665.31
|
2026-03-30
|
|
78701
|
HCPCS
|
Nuclear Medicine Study Of Kidney And Blood Flow
|
13
|
13
|
$984.00
|
$984.00
|
$560.88
|
$967.08
|
$659.28
|
2026-03-30
|