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Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

GUTHRIE COUNTY HOSPITAL

Guthrie Center, IA · CCN 161314 · Rates published

1,413 distinct procedures filed
14 distinct payers
19,456 rate rows
2026-09-21 last MRF observed
Data quality

18,998 of 19,456 rate rows are consumer-grade (97.6%)

458 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 210
per-diem day rate — not a per-procedure price 149
exceeds 3× this hospital's gross charge for a DRG stay — excluded 79
percent-of-charges filed in the dollar field — excluded from medians 13
exceeds 10× this hospital's gross charge — excluded from medians 7
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbGCHGUTHRIECENTERIA&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/Guthrie_V2.aspx
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-08
Content fingerprint 5d1808841f5660a9… · 9,094,995 bytes · first seen 2026-09-22

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
630
MS_DRG 		Other Endocrine, Nutritional And Metabolic O.r. Procedures Without Cc/mcc 4 $44,666.30 $96,573.00 $96,573.00 nat. median
$10,400
outlier · 9.3×
468
MS_DRG 		Revision Of Hip Or Knee Replacement Without Cc/mcc 1 $73,112.63 $73,112.63 $73,112.63 nat. median
$19,904
outlier · 3.7×
522
MS_DRG 		Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 1 $71,885.53 $71,885.53 $71,885.53 nat. median
$15,839
outlier · 4.5×
481
MS_DRG 		Hip And Femur Procedures Except Major Joint With Cc 1 $69,217.79 $69,217.79 $69,217.79 nat. median
$15,706
outlier · 4.4×
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 3 $49,319.71 $64,796.00 $64,796.00 nat. median
$14,442
outlier · 4.5×
195
MS_DRG 		Simple Pneumonia And Pleurisy Without Cc/mcc 4 $16,841.50 $38,554.50 $38,554.50 nat. median
$4,710
outlier · 8.2×
193
MS_DRG 		Simple Pneumonia And Pleurisy With Mcc 1 $34,932.40 $34,932.40 $34,932.40 nat. median
$9,802
outlier · 3.6×
65
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 1 $31,812.07 $31,812.07 $31,812.07 nat. median
$7,677
outlier · 4.1×
872
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 1 $27,420.02 $27,420.02 $27,420.02 nat. median
$7,744
outlier · 3.5×
178
MS_DRG 		Respiratory Infections And Inflammations With Cc 1 $26,833.57 $26,833.57 $26,833.57 nat. median
$7,418
outlier · 3.6×
27100153
CDM 		Rhc Misc Implant Charge Level 32 13 $20,660.46 $35,863.44 $26,117.94 nat. median
$26,118
1.0× median
603
MS_DRG 		Cellulitis Without Mcc 1 $25,861.45 $25,861.45 $25,861.45 nat. median
$6,621
outlier · 3.9×
194
MS_DRG 		Simple Pneumonia And Pleurisy With Cc 1 $25,246.31 $25,246.31 $25,246.31 nat. median
$6,156
outlier · 4.1×
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 3 $24,771.56 $24,771.56 $24,771.56 nat. median
$9,470
outlier · 2.6×
292
MS_DRG 		Heart Failure And Shock With Cc 1 $24,082.96 $24,082.96 $24,082.96 nat. median
$6,415
outlier · 3.8×
638
MS_DRG 		Diabetes With Cc 1 $23,604.87 $23,604.87 $23,604.87 nat. median
$6,741
outlier · 3.5×
27100152
CDM 		Rhc Misc Implant Charge Level 31 13 $17,239.84 $29,925.76 $21,793.76 nat. median
$21,794
1.0× median
948
MS_DRG 		Signs And Symptoms Without Mcc 1 $21,306.85 $21,306.85 $21,306.85 nat. median
$5,562
outlier · 3.8×
27100151
CDM 		Rhc Misc Implant Charge Level 30 13 $16,169.24 $28,067.36 $20,440.36 nat. median
$20,440
1.0× median
641
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 1 $19,649.48 $19,649.48 $19,649.48 nat. median
$5,850
outlier · 3.4×
728
MS_DRG 		Inflammation Of The Male Reproductive System Without Mcc 1 $19,410.43 $19,410.43 $19,410.43 nat. median
$5,965
outlier · 3.3×
27100150
CDM 		Rhc Misc Implant Charge Level 29 13 $15,098.64 $26,208.96 $19,086.96 nat. median
$19,087
1.0× median
886
MS_DRG 		Behavioral And Developmental Disorders 1 $18,961.03 $18,961.03 $18,961.03 nat. median
$2,736
outlier · 6.9×
J2427
HCPCS 		Injection, Paliperidone Palmitate Extended Release (invega Hafyera, Or Invega Tr… 11 $7,981.71 $38,485.44 $18,363.50 nat. median
$17
outlier · 1109.6×
285
MS_DRG 		Acute Myocardial Infarction, Expired Without Cc/mcc 1 $17,890.11 $17,890.11 $17,890.11 nat. median
$4,212
outlier · 4.2×
27100149
CDM 		Rhc Misc Implant Charge Level 28 13 $14,024.86 $24,345.04 $17,729.54 nat. median
$17,730
1.0× median
556
MS_DRG 		Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 1 $16,372.97 $16,372.97 $16,372.97 nat. median
$6,105
outlier · 2.7×
27100148
CDM 		Rhc Misc Implant Charge Level 27 13 $12,915.04 $22,418.56 $16,326.56 nat. median
$16,327
1.0× median
390
MS_DRG 		Gastrointestinal Obstruction Without Cc/mcc 1 $16,140.30 $16,140.30 $16,140.30 nat. median
$4,287
outlier · 3.8×
191
MS_DRG 		Chronic Obstructive Pulmonary Disease With Cc 3 $15,531.50 $15,531.50 $15,531.50 nat. median
$6,349
outlier · 2.4×
27100147
CDM 		Rhc Misc Implant Charge Level 26 13 $11,901.15 $20,658.60 $15,044.85 nat. median
$15,045
1.0× median
87
MS_DRG 		Traumatic Stupor And Coma <1 Hour Without Cc/mcc 1 $14,578.54 $14,578.54 $14,578.54 nat. median
$6,636
outlier · 2.2×
27100146
CDM 		Rhc Misc Implant Charge Level 25 13 $11,047.85 $19,177.40 $13,966.15 nat. median
$13,966
1.0× median
J2327
HCPCS 		Injection, Risankizumab-rzaa, Intravenous, 1 Mg 11 $11,586.39 $18,700.84 $13,619.09 nat. median
$48
outlier · 283.9×
27100145
CDM 		Rhc Misc Implant Charge Level 24 13 $10,432.52 $18,109.28 $13,188.28 nat. median
$13,188
1.0× median
916
MS_DRG 		Allergic Reactions Without Mcc 3 $12,861.00 $12,861.00 $12,861.00 nat. median
$4,945
outlier · 2.6×
27100144
CDM 		Rhc Misc Implant Charge Level 23 13 $9,851.11 $17,100.04 $12,453.29 nat. median
$12,453
1.0× median
27100143
CDM 		Rhc Misc Implant Charge Level 22 13 $9,348.14 $16,226.96 $11,817.46 nat. median
$11,817
1.0× median
27100142
CDM 		Rhc Misc Implant Charge Level 21 13 $8,800.12 $15,275.68 $11,124.68 nat. median
$11,125
1.0× median
27100141
CDM 		Rhc Misc Implant Charge Level 20 13 $8,381.42 $14,548.88 $10,595.38 nat. median
$10,595
1.0× median
27100137
CDM 		Rhc Misc Implant Charge Level 16 13 $7,778.28 $13,501.92 $9,832.92 nat. median
$9,833
1.0× median
27100140
CDM 		Rhc Misc Implant Charge Level 19 13 $7,735.35 $13,427.40 $9,778.65 nat. median
$9,779
1.0× median
293
MS_DRG 		Heart Failure And Shock Without Cc/mcc 1 $9,673.34 $9,673.34 $9,673.34 nat. median
$4,186
outlier · 2.3×
J1602
HCPCS 		Injection, Golimumab, 1 Mg, For Intravenous Use 13 $7,558.86 $13,121.04 $9,555.54 nat. median
$55
outlier · 175.0×
27100139
CDM 		Rhc Misc Implant Charge Level 18 13 $7,201.11 $12,500.04 $9,103.29 nat. median
$9,103
1.0× median
27100138
CDM 		Rhc Misc Implant Charge Level 17 13 $6,655.74 $11,553.36 $8,413.86 nat. median
$8,414
1.0× median
27100136
CDM 		Rhc Misc Implant Charge Level 15 13 $6,170.26 $10,710.64 $7,800.14 nat. median
$7,800
1.0× median
90375
HCPCS 		Rabies Immune Globulin For Injection 13 $306.22 $10,686.26 $7,782.39 nat. median
$789
outlier · 9.9×
27100135
CDM 		Rhc Misc Implant Charge Level 14 13 $5,018.57 $8,711.48 $6,344.23 nat. median
$6,344
1.0× median
J1449
HCPCS 		Injection, Eflapegrastim-xnst, 0.1 Mg 11 $5,179.88 $8,360.50 $6,088.63 nat. median
$39
outlier · 156.3×

Other procedures at this hospital

Browse this hospital's 1,413 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
             
630 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures Without Cc/mcc 4 4 $47,205.00 $47,205.00 $44,666.30 $96,573.00 $96,573.00 2026-09-21
468 MS_DRG Revision Of Hip Or Knee Replacement Without Cc/mcc 1 1 $81,446.00 $81,446.00 $73,112.63 $73,112.63 $73,112.63 2026-09-21
522 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 1 1 $57,552.50 $57,552.50 $71,885.53 $71,885.53 $71,885.53 2026-09-21
481 MS_DRG Hip And Femur Procedures Except Major Joint With Cc 1 1 $69,094.17 $69,094.17 $69,217.79 $69,217.79 $69,217.79 2026-09-21
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 3 3 $23,656.00 $23,656.00 $49,319.71 $64,796.00 $64,796.00 2026-09-21
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/mcc 4 4 $13,870.50 $13,870.50 $16,841.50 $38,554.50 $38,554.50 2026-09-21
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 1 1 $16,743.00 $16,743.00 $34,932.40 $34,932.40 $34,932.40 2026-09-21
65 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 1 1 $11,941.00 $11,941.00 $31,812.07 $31,812.07 $31,812.07 2026-09-21
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 1 1 $9,981.67 $9,981.67 $27,420.02 $27,420.02 $27,420.02 2026-09-21
178 MS_DRG Respiratory Infections And Inflammations With Cc 1 1 $19,535.50 $19,535.50 $26,833.57 $26,833.57 $26,833.57 2026-09-21
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 2026-09-21
603 MS_DRG Cellulitis Without Mcc 1 1 $12,031.25 $12,031.25 $25,861.45 $25,861.45 $25,861.45 2026-09-21
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 1 1 $11,026.25 $11,026.25 $25,246.31 $25,246.31 $25,246.31 2026-09-21
189 MS_DRG Pulmonary Edema And Respiratory Failure 3 3 $8,315.56 $8,315.56 $24,771.56 $24,771.56 $24,771.56 2026-09-21
292 MS_DRG Heart Failure And Shock With Cc 1 1 $16,107.67 $16,107.67 $24,082.96 $24,082.96 $24,082.96 2026-09-21
638 MS_DRG Diabetes With Cc 1 1 $17,120.00 $17,120.00 $23,604.87 $23,604.87 $23,604.87 2026-09-21
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 2026-09-21
948 MS_DRG Signs And Symptoms Without Mcc 1 1 $11,323.00 $11,323.00 $21,306.85 $21,306.85 $21,306.85 2026-09-21
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 2026-09-21
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 1 1 $12,024.50 $12,024.50 $19,649.48 $19,649.48 $19,649.48 2026-09-21
728 MS_DRG Inflammation Of The Male Reproductive System Without Mcc 1 1 $9,239.00 $9,239.00 $19,410.43 $19,410.43 $19,410.43 2026-09-21
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 2026-09-21
886 MS_DRG Behavioral And Developmental Disorders 1 1 $7,006.50 $7,006.50 $18,961.03 $18,961.03 $18,961.03 2026-09-21
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 2026-09-21
285 MS_DRG Acute Myocardial Infarction, Expired Without Cc/mcc 1 1 $8,968.00 $8,968.00 $17,890.11 $17,890.11 $17,890.11 2026-09-21
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 2026-09-21
556 MS_DRG Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 1 1 $15,070.50 $15,070.50 $16,372.97 $16,372.97 $16,372.97 2026-09-21
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 2026-09-21
390 MS_DRG Gastrointestinal Obstruction Without Cc/mcc 1 1 $9,547.00 $9,547.00 $16,140.30 $16,140.30 $16,140.30 2026-09-21
191 MS_DRG Chronic Obstructive Pulmonary Disease With Cc 3 3 $7,303.50 $7,303.50 $15,531.50 $15,531.50 $15,531.50 2026-09-21
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 2026-09-21
87 MS_DRG Traumatic Stupor And Coma <1 Hour Without Cc/mcc 1 1 $8,560.50 $8,560.50 $14,578.54 $14,578.54 $14,578.54 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
916 MS_DRG Allergic Reactions Without Mcc 3 3 $4,633.00 $4,633.00 $12,861.00 $12,861.00 $12,861.00 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
293 MS_DRG Heart Failure And Shock Without Cc/mcc 1 1 $9,514.00 $9,514.00 $9,673.34 $9,673.34 $9,673.34 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
90375 HCPCS Rabies Immune Globulin For Injection 17 13 $11,615.50 $11,615.50 $306.22 $10,686.26 $7,782.39 2026-09-21
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 2026-09-21
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 2026-09-21
10010106 CDM Operating Room Services - General Classification 12 12 $8,826.00 $8,826.00 $4,677.78 $8,119.92 $5,913.42 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
10010105 CDM Operating Room Services - General Classification 12 12 $7,314.00 $7,314.00 $3,876.42 $6,728.88 $4,900.38 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
10010104 CDM Operating Room Services - General Classification 12 12 $5,875.00 $5,875.00 $3,113.75 $5,405.00 $3,936.25 2026-09-21
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 2026-09-21
J2357 HCPCS Injection, Omalizumab, 5 Mg 13 13 $5,627.50 $5,627.50 $2,982.58 $5,177.30 $3,770.43 2026-09-21
J3101 HCPCS Injection, Tenecteplase, 1 Mg 13 13 $5,567.00 $5,567.00 $2,950.51 $5,121.64 $3,729.89 2026-09-21
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 2026-09-21
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 2026-09-21
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 11 11 $5,095.00 $5,095.00 $2,904.15 $4,687.40 $3,413.65 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
10010103 CDM Operating Room Services - General Classification 12 12 $4,549.00 $4,549.00 $2,410.97 $4,185.08 $3,047.83 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
J0897 HCPCS Injection, Denosumab, 1 Mg 18 14 $3,660.00 $3,660.00 $19.70 $3,367.20 $2,340.57 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
73218 HCPCS MRI Scan Of Arm Without Contrast 13 13 $3,175.00 $3,175.00 $983.32 $2,921.00 $2,127.25 2026-09-21
10010102 CDM Operating Room Services - General Classification 12 12 $3,159.00 $3,159.00 $1,674.27 $2,906.28 $2,116.53 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 13 13 $2,947.00 $2,947.00 $1,561.91 $2,711.24 $1,974.49 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
73718 HCPCS MRI Scan Of Leg Without Contrast 13 13 $2,601.00 $2,601.00 $983.32 $2,392.92 $1,742.67 2026-09-21
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 2026-09-21
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 2026-09-21
70551 HCPCS MRI Scan Of Brain Without Contrast 13 13 $2,585.00 $2,585.00 $983.32 $2,378.20 $1,731.95 2026-09-21
70336 HCPCS MRI Scan Of Jaw Joint 13 13 $2,584.00 $2,584.00 $983.32 $2,377.28 $1,731.28 2026-09-21
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 2026-09-21
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 2026-09-21
74181 HCPCS MRI Scan Of Abdomen Without Contrast 13 13 $2,567.00 $2,567.00 $983.32 $2,361.64 $1,719.89 2026-09-21
71550 HCPCS MRI Scan Of Chest Without Contrast 13 13 $2,567.00 $2,567.00 $983.32 $2,361.64 $1,719.89 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
J0248 HCPCS Injection, Remdesivir, 1 Mg 11 11 $2,485.50 $2,485.50 $1,416.74 $2,286.66 $1,665.29 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
72195 HCPCS MRI Scan Of Pelvis Without Contrast 13 13 $2,252.00 $2,252.00 $983.32 $2,071.84 $1,508.84 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
27138 HCPCS Revision Of Thigh Bone Prosthesis 10 10 $4,604.00 $4,604.00 $1,231.73 $4,604.00 $1,244.05 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
27100030 CDM Rhc Med/surg Supply Level 30 13 13 $1,822.00 $1,822.00 $965.66 $1,676.24 $1,220.74 2026-09-21
10010101 CDM Operating Room Services - General Classification 12 12 $1,801.00 $1,801.00 $954.53 $1,656.92 $1,206.67 2026-09-21
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 2026-09-21
J0485 HCPCS Injection, Belatacept, 1 Mg 13 13 $1,736.50 $1,736.50 $920.35 $1,597.58 $1,163.46 2026-09-21
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 2026-09-21
27100029 CDM Rhc Med/surg Supply Level 29 13 13 $1,709.00 $1,709.00 $905.77 $1,572.28 $1,145.03 2026-09-21
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 2026-09-21
72192 HCPCS CT Scan Of Pelvis Without Contrast 13 13 $1,676.00 $1,676.00 $480.50 $1,541.92 $1,122.92 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
74150 HCPCS CT Scan Of Abdomen Without Contrast 13 13 $1,625.00 $1,625.00 $480.50 $1,495.00 $1,088.75 2026-09-21
27100028 CDM Rhc Med/surg Supply Level 28 13 13 $1,625.00 $1,625.00 $861.25 $1,495.00 $1,088.75 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
71250 HCPCS CT Scan Of Chest Without Contrast 13 13 $1,570.00 $1,570.00 $480.50 $1,444.40 $1,051.90 2026-09-21
73201 HCPCS CT Scan Of Arm With Contrast 13 13 $1,570.00 $1,570.00 $894.90 $1,444.40 $1,051.90 2026-09-21
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 2026-09-21
27100027 CDM Rhc Med/surg Supply Level 27 13 13 $1,562.00 $1,562.00 $827.86 $1,437.04 $1,046.54 2026-09-21
70486 HCPCS CT Scan Of Face Without Contrast 13 13 $1,561.00 $1,561.00 $480.50 $1,436.12 $1,045.87 2026-09-21
J7300 HCPCS Intrauterine Copper Contraceptive 4 4 $815.00 $815.00 $955.26 $1,853.18 $1,027.08 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
27100026 CDM Rhc Med/surg Supply Level 26 13 13 $1,522.00 $1,522.00 $806.66 $1,400.24 $1,019.74 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
27488 HCPCS Removal Of Total Knee Joint Prosthesis 10 10 $3,679.00 $3,679.00 $992.31 $3,679.00 $1,002.23 2026-09-21
27100074 CDM Rhc Sterile Med/surg Supply Level 29 13 13 $1,485.00 $1,485.00 $787.05 $1,366.20 $994.95 2026-09-21
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 2026-09-21
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 2026-09-21
27100025 CDM Rhc Med/surg Supply Level 25 13 13 $1,459.00 $1,459.00 $773.27 $1,342.28 $977.53 2026-09-21
78278 HCPCS Nuclear Medicine Study To Assess Blood Loss 13 13 $1,448.00 $1,448.00 $825.36 $1,822.99 $970.16 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
78013 HCPCS Nuclear Medicine Study Of Thyroid 13 13 $1,408.00 $1,408.00 $802.56 $1,295.36 $943.36 2026-09-21
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 2026-09-21
99291 HCPCS Critical Care, First 30-74 Minutes 23 14 $1,761.00 $1,761.00 $186.97 $1,620.12 $933.33 2026-09-21
27100024 CDM Rhc Med/surg Supply Level 24 13 13 $1,391.00 $1,391.00 $737.23 $1,279.72 $931.97 2026-09-21
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 2026-09-21
27100073 CDM Rhc Sterile Med/surg Supply Level 28 13 13 $1,372.00 $1,372.00 $727.16 $1,262.24 $919.24 2026-09-21
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 2026-09-21
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 2026-09-21
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 13 13 $1,366.00 $1,366.00 $480.50 $1,256.72 $915.22 2026-09-21
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 2026-09-21
27100112 CDM Rhc Misc Implant Charge Level 6 13 13 $1,352.00 $1,352.00 $716.56 $1,243.84 $905.84 2026-09-21
73200 HCPCS CT Scan Of Arm Without Contrast 13 13 $1,351.00 $1,351.00 $480.50 $1,242.92 $905.17 2026-09-21
73700 HCPCS CT Scan Of Leg Without Contrast 13 13 $1,351.00 $1,351.00 $480.50 $1,242.92 $905.17 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
J7301 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System (skyla), 13.5 Mg 4 4 $743.00 $743.00 $857.48 $1,278.56 $893.29 2026-09-21
J0561 HCPCS Injection, Penicillin G Benzathine, 100,000 Units 17 13 $1,307.50 $1,307.50 $14.09 $1,202.90 $876.03 2026-09-21
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 2026-09-21
27100023 CDM Rhc Med/surg Supply Level 23 13 13 $1,295.00 $1,295.00 $686.35 $1,191.40 $867.65 2026-09-21
27100072 CDM Rhc Sterile Med/surg Supply Level 27 13 13 $1,294.00 $1,294.00 $685.82 $1,190.48 $866.98 2026-09-21
78012 HCPCS Nuclear Medicine Study Of Thyroid Function 13 13 $1,289.00 $1,289.00 $734.73 $1,185.88 $863.63 2026-09-21
27100071 CDM Rhc Sterile Med/surg Supply Level 26 13 13 $1,289.00 $1,289.00 $683.17 $1,185.88 $863.63 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
27100070 CDM Rhc Sterile Med/surg Supply Level 25 13 13 $1,245.00 $1,245.00 $659.85 $1,145.40 $834.15 2026-09-21
27100022 CDM Rhc Med/surg Supply Level 22 13 13 $1,244.00 $1,244.00 $659.32 $1,144.48 $833.48 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
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 2026-09-21
25415 HCPCS Treatment Of Both Nonhealed Broken Forearm Bones 10 10 $2,938.00 $2,938.00 $807.92 $2,938.00 $816.00 2026-09-21
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 2026-09-21
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 2026-09-21
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