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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

Your selected procedure

You selected 93350 (HCPCS)

Ultrasound of heart during rest, exercise and/or drug-induced stress with report

This hospital’s price: $821 across 13 payers · range $415-$1,128

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbGCHGUTHRIECENTERIA&type=CDMWithoutLabel&fileType=CSV · observed 2026-09-21

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.

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 · 2026-10-20
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
$14,543
outlier · 6.6×
468
MS_DRG 		Revision Of Hip Or Knee Replacement Without Cc/mcc 1 $73,112.63 $73,112.63 $73,112.63 nat. median
$25,679
outlier · 2.8×
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
$20,545
outlier · 3.5×
481
MS_DRG 		Hip And Femur Procedures Except Major Joint With Cc 1 $69,217.79 $69,217.79 $69,217.79 nat. median
$20,312
outlier · 3.4×
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
$18,659
outlier · 3.5×
195
MS_DRG 		Simple Pneumonia And Pleurisy Without Cc/mcc 4 $16,841.50 $38,554.50 $38,554.50 nat. median
$6,821
outlier · 5.7×
193
MS_DRG 		Simple Pneumonia And Pleurisy With Mcc 1 $34,932.40 $34,932.40 $34,932.40 nat. median
$12,877
outlier · 2.7×
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
$10,477
outlier · 3.0×
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
$10,410
outlier · 2.6×
178
MS_DRG 		Respiratory Infections And Inflammations With Cc 1 $26,833.57 $26,833.57 $26,833.57 nat. median
$10,207
outlier · 2.6×
27100153
CDM 		Rhc Misc Implant Charge Level 32 13 $20,660.46 $35,863.44 $26,117.94 nat. median
$40
outlier · 654.4×
603
MS_DRG 		Cellulitis Without Mcc 1 $25,861.45 $25,861.45 $25,861.45 nat. median
$8,991
outlier · 2.9×
194
MS_DRG 		Simple Pneumonia And Pleurisy With Cc 1 $25,246.31 $25,246.31 $25,246.31 nat. median
$8,522
outlier · 3.0×
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 3 $24,771.56 $24,771.56 $24,771.56 nat. median
$12,282
outlier · 2.0×
292
MS_DRG 		Heart Failure And Shock With Cc 1 $24,082.96 $24,082.96 $24,082.96 nat. median
$8,955
outlier · 2.7×
638
MS_DRG 		Diabetes With Cc 1 $23,604.87 $23,604.87 $23,604.87 nat. median
$9,230
outlier · 2.6×
27100152
CDM 		Rhc Misc Implant Charge Level 31 13 $17,239.84 $29,925.76 $21,793.76 nat. median
$71
outlier · 308.5×
948
MS_DRG 		Signs And Symptoms Without Mcc 1 $21,306.85 $21,306.85 $21,306.85 nat. median
$7,971
outlier · 2.7×
27100151
CDM 		Rhc Misc Implant Charge Level 30 13 $16,169.24 $28,067.36 $20,440.36 nat. median
$80
outlier · 256.0×
641
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 1 $19,649.48 $19,649.48 $19,649.48 nat. median
$8,119
outlier · 2.4×
728
MS_DRG 		Inflammation Of The Male Reproductive System Without Mcc 1 $19,410.43 $19,410.43 $19,410.43 nat. median
$8,518
outlier · 2.3×
27100150
CDM 		Rhc Misc Implant Charge Level 29 13 $15,098.64 $26,208.96 $19,086.96 nat. median
$102
outlier · 186.4×
886
MS_DRG 		Behavioral And Developmental Disorders 1 $18,961.03 $18,961.03 $18,961.03 nat. median
$16,734
1.1× median
J2427
HCPCS 		Injection, Paliperidone Palmitate Extended Release (invega Hafyera, Or Invega Tr… 11 $7,981.71 $38,485.44 $18,363.50 nat. median
$2,836
outlier · 6.5×
285
MS_DRG 		Acute Myocardial Infarction, Expired Without Cc/mcc 1 $17,890.11 $17,890.11 $17,890.11 nat. median
$6,516
outlier · 2.7×
27100149
CDM 		Rhc Misc Implant Charge Level 28 13 $14,024.86 $24,345.04 $17,729.54 nat. median
$170
outlier · 104.3×
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
$8,636
1.9× median
27100148
CDM 		Rhc Misc Implant Charge Level 27 13 $12,915.04 $22,418.56 $16,326.56 nat. median
$64
outlier · 257.0×
390
MS_DRG 		Gastrointestinal Obstruction Without Cc/mcc 1 $16,140.30 $16,140.30 $16,140.30 nat. median
$6,125
outlier · 2.6×
191
MS_DRG 		Chronic Obstructive Pulmonary Disease With Cc 3 $15,531.50 $15,531.50 $15,531.50 nat. median
$8,851
1.8× median
27100147
CDM 		Rhc Misc Implant Charge Level 26 13 $11,901.15 $20,658.60 $15,044.85 nat. median
$76
outlier · 197.5×
87
MS_DRG 		Traumatic Stupor And Coma <1 Hour Without Cc/mcc 1 $14,578.54 $14,578.54 $14,578.54 nat. median
$9,333
1.6× median
27100146
CDM 		Rhc Misc Implant Charge Level 25 13 $11,047.85 $19,177.40 $13,966.15 nat. median
$1
J2327
HCPCS 		Injection, Risankizumab-rzaa, Intravenous, 1 Mg 11 $11,586.39 $18,700.84 $13,619.09 nat. median
$1,767
outlier · 7.7×
27100145
CDM 		Rhc Misc Implant Charge Level 24 13 $10,432.52 $18,109.28 $13,188.28 nat. median
$140
outlier · 94.4×
916
MS_DRG 		Allergic Reactions Without Mcc 3 $12,861.00 $12,861.00 $12,861.00 nat. median
$7,164
1.8× median
27100144
CDM 		Rhc Misc Implant Charge Level 23 13 $9,851.11 $17,100.04 $12,453.29 nat. median
$59
outlier · 211.5×
27100143
CDM 		Rhc Misc Implant Charge Level 22 13 $9,348.14 $16,226.96 $11,817.46 nat. median
$49
outlier · 239.7×
27100142
CDM 		Rhc Misc Implant Charge Level 21 13 $8,800.12 $15,275.68 $11,124.68 nat. median
$104
outlier · 106.5×
27100141
CDM 		Rhc Misc Implant Charge Level 20 13 $8,381.42 $14,548.88 $10,595.38 nat. median
$66
outlier · 161.0×
27100137
CDM 		Rhc Misc Implant Charge Level 16 13 $7,778.28 $13,501.92 $9,832.92 nat. median
$63
outlier · 156.6×
27100140
CDM 		Rhc Misc Implant Charge Level 19 13 $7,735.35 $13,427.40 $9,778.65 nat. median
$51
outlier · 192.7×
293
MS_DRG 		Heart Failure And Shock Without Cc/mcc 1 $9,673.34 $9,673.34 $9,673.34 nat. median
$6,358
1.5× median
J1602
HCPCS 		Injection, Golimumab, 1 Mg, For Intravenous Use 13 $7,558.86 $13,121.04 $9,555.54 nat. median
$261
outlier · 36.6×
27100139
CDM 		Rhc Misc Implant Charge Level 18 13 $7,201.11 $12,500.04 $9,103.29 nat. median
$25
outlier · 369.1×
27100138
CDM 		Rhc Misc Implant Charge Level 17 13 $6,655.74 $11,553.36 $8,413.86 nat. median
$41
outlier · 204.0×
27100136
CDM 		Rhc Misc Implant Charge Level 15 13 $6,170.26 $10,710.64 $7,800.14 nat. median
$4,195
1.9× median
90375
HCPCS 		Rabies Immune Globulin For Injection 13 $306.22 $10,686.26 $7,782.39 nat. median
$1,052
outlier · 7.4×
27100135
CDM 		Rhc Misc Implant Charge Level 14 13 $5,018.57 $8,711.48 $6,344.23 nat. median
$11
outlier · 603.1×
J1449
HCPCS 		Injection, Eflapegrastim-xnst, 0.1 Mg 11 $5,179.88 $8,360.50 $6,088.63 nat. median
$30
outlier · 203.0×

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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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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