Price Transparencybeta Hospital negotiated rates

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

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Hospital

AUDUBON COUNTY MEMORIAL HOSPITAL

Audubon, IA · CCN 161330 · Rates published

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You selected 29806 (HCPCS)

Repair of shoulder joint capsule using an endoscope

This hospital’s price: $2,192 across 8 payers · range $880-$2,678

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbACMHAUDUBONIA&type=CDMWithoutLabel&fileType=CSV · observed 2026-09-14

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

2,659 distinct procedures filed
14 distinct payers
27,298 rate rows
2026-09-14 last MRF observed
Data quality

26,445 of 27,298 rate rows are consumer-grade (96.9%)

853 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-charges filed in the dollar field — excluded from medians 279
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 205
exceeds 10× this hospital's gross charge — excluded from medians 125
template filing: same amount across many unrelated codes — excluded 110
per-diem day rate — not a per-procedure price 98
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 20
exceeds 3× this hospital's gross charge for a DRG stay — excluded 16
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbACMHAUDUBONIA&type=CDMWithoutLabel&fileType=CSV
Found on page https://www.acmhhosp.org/price-transparency/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-11-09
Content fingerprint 2bc8728ad591b4bb… · 9,302,920 bytes · first seen 2026-11-06

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
J2350
HCPCS 		Injection, Ocrelizumab, 1 Mg 8 $33,448.44 $45,527.04 $41,810.54 nat. median
$714
outlier · 58.6×
561
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc 3 $11,432.83 $26,222.55 $25,223.59 nat. median
$8,641
outlier · 2.9×
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc 3 $18,241.90 $24,550.07 $23,614.83 nat. median
$15,338
1.5× median
J2329
HCPCS 		Injection, Ublituximab-xiiy, 1mg 8 $18,008.28 $24,511.27 $22,510.35 nat. median
$176
outlier · 127.6×
J9042
HCPCS 		Injection, Brentuximab Vedotin, 1 Mg 8 $17,140.68 $23,330.37 $21,425.85 nat. median
$1,041
outlier · 20.6×
J9022
HCPCS 		Injection, Atezolizumab, 10 Mg 8 $15,809.44 $21,518.40 $19,761.80 nat. median
$7,244
outlier · 2.7×
175
MS_DRG 		Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 3 $9,167.80 $20,516.36 $19,734.78 nat. median
$13,705
1.4× median
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 8 $15,173.14 $20,652.32 $18,966.42 nat. median
$204
outlier · 93.1×
291
MS_DRG 		Heart Failure And Shock With Mcc 3 $8,031.36 $19,571.86 $18,826.27 nat. median
$12,730
1.5× median
J9144
HCPCS 		Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj 8 $14,854.78 $20,219.01 $18,568.48 nat. median
$231
outlier · 80.5×
54
MS_DRG 		Nervous System Neoplasms With Mcc 3 $9,952.94 $19,188.27 $18,457.29 nat. median
$14,730
1.3× median
565
MS_DRG 		Other Musculoskeletal System And Connective Tissue Diagnoses With Cc 3 $9,322.72 $18,818.31 $18,101.42 nat. median
$10,076
1.8× median
J1932
HCPCS 		Injection, Lanreotide, (cipla), 1 Mg 8 $14,416.19 $19,622.04 $18,020.24 nat. median
$112
outlier · 160.6×
193
MS_DRG 		Simple Pneumonia And Pleurisy With Mcc 3 $6,705.25 $18,685.33 $17,973.51 nat. median
$12,837
1.4× median
J9301
HCPCS 		Injection, Obinutuzumab, 10 Mg 8 $12,104.14 $16,475.07 $15,130.17 nat. median
$299
outlier · 50.6×
280
MS_DRG 		Acute Myocardial Infarction, Discharged Alive With Mcc 2 $7,623.38 $22,627.60 $15,125.49 nat. median
$15,615
1.0× median
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 3 $14,553.06 $15,280.71 $14,698.59 nat. median
$12,249
1.2× median
J0896
HCPCS 		Injection, Luspatercept-aamt, 0.25 Mg 8 $6,542.71 $26,688.54 $14,256.63 nat. median
$4,571
outlier · 3.1×
872
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 3 $5,245.40 $14,666.96 $14,108.22 nat. median
$10,374
1.4× median
552
MS_DRG 		Medical Back Problems Without Mcc 3 $9,954.05 $14,532.28 $13,978.67 nat. median
$9,816
1.4× median
J9217
HCPCS 		Leuprolide Acetate (for Depot Suspension), 7.5 Mg 8 $3,487.10 $28,409.69 $13,918.10 nat. median
$1,581
outlier · 8.8×
178
MS_DRG 		Respiratory Infections And Inflammations With Cc 3 $7,487.03 $14,353.27 $13,806.48 nat. median
$10,168
1.4× median
439
MS_DRG 		Disorders Of Pancreas Except Malignancy With Cc 3 $13,635.68 $14,317.47 $13,772.04 nat. median
$8,912
1.5× median
86
MS_DRG 		Traumatic Stupor And Coma <1 Hour With Cc 3 $13,301.20 $13,966.26 $13,434.22 nat. median
$12,840
1.0× median
J9311
HCPCS 		Injection, Rituximab 10 Mg And Hyaluronidase 8 $10,664.14 $14,515.08 $13,330.18 nat. median
$2,842
outlier · 4.7×
603
MS_DRG 		Cellulitis Without Mcc 3 $6,678.78 $13,833.28 $13,306.30 nat. median
$8,967
1.5× median
557
MS_DRG 		Tendonitis, Myositis And Bursitis With Mcc 3 $4,810.93 $13,829.87 $13,303.02 nat. median
$14,464
0.9× median
551
MS_DRG 		Medical Back Problems With Mcc 2 $6,736.37 $19,759.38 $13,247.88 nat. median
$16,070
0.8× median
389
MS_DRG 		Gastrointestinal Obstruction With Cc 3 $12,995.95 $13,645.75 $13,125.91 nat. median
$8,333
1.6× median
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 8 $10,407.23 $14,165.39 $13,009.03 nat. median
$1,662
outlier · 7.8×
89
MS_DRG 		Concussion With Cc 3 $12,564.95 $13,357.63 $12,848.76 nat. median
$11,095
1.2× median
563
MS_DRG 		Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 3 $10,955.03 $13,321.82 $12,814.33 nat. median
$9,132
1.4× median
536
MS_DRG 		Fractures Of Hip And Pelvis Without Mcc 3 $7,722.24 $13,212.71 $12,709.37 nat. median
$8,421
1.5× median
690
MS_DRG 		Kidney And Urinary Tract Infections Without Mcc 3 $8,681.90 $12,885.38 $12,394.51 nat. median
$8,366
1.5× median
292
MS_DRG 		Heart Failure And Shock With Cc 3 $8,778.24 $12,881.97 $12,391.23 nat. median
$8,935
1.4× median
683
MS_DRG 		Renal Failure With Cc 3 $7,798.53 $12,704.66 $12,220.68 nat. median
$9,083
1.3× median
638
MS_DRG 		Diabetes With Cc 3 $8,990.61 $12,626.24 $12,145.24 nat. median
$9,200
1.3× median
J9306
HCPCS 		Injection, Pertuzumab, 1 Mg 8 $9,587.85 $13,050.13 $11,984.81 nat. median
$91
outlier · 131.7×
312
MS_DRG 		Syncope And Collapse 3 $6,467.92 $12,148.88 $11,686.06 nat. median
$8,930
1.3× median
66
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc 3 $10,789.37 $11,328.84 $10,897.26 nat. median
$7,555
1.4× median
28800
HCPCS 		Amputation Of Midfoot Bone 10 $8,640.00 $13,337.14 $10,854.00 nat. median
$3,411
outlier · 3.2×
558
MS_DRG 		Tendonitis, Myositis And Bursitis Without Mcc 3 $7,496.91 $10,846.36 $10,433.16 nat. median
$9,050
1.2× median
J9271
HCPCS 		Injection, Pembrolizumab, 1 Mg 8 $8,292.28 $11,286.71 $10,365.35 nat. median
$323
outlier · 32.1×
641
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 3 $7,233.88 $10,510.50 $10,110.10 nat. median
$8,082
1.3× median
J1449
HCPCS 		Injection, Eflapegrastim-xnst, 0.1 Mg 8 $7,300.08 $9,936.22 $9,125.10 nat. median
$31
outlier · 294.2×
684
MS_DRG 		Renal Failure Without Cc/mcc 3 $9,017.93 $9,468.83 $9,108.11 nat. median
$6,639
1.4× median
195
MS_DRG 		Simple Pneumonia And Pleurisy Without Cc/mcc 3 $6,031.08 $9,008.51 $8,665.33 nat. median
$6,810
1.3× median
440
MS_DRG 		Disorders Of Pancreas Except Malignancy Without Cc/mcc 2 $4,105.91 $12,271.51 $8,188.71 nat. median
$6,860
1.2× median
Q5120
HCPCS 		Injection, Pegfilgrastim-bmez (ziextenzo), Biosimilar, 0.5 Mg 8 $6,369.44 $8,669.51 $7,961.80 nat. median
$374
outlier · 21.3×
Q5122
HCPCS 		Injection, Pegfilgrastim-apgf (nyvepria), Biosimilar, 0.5 Mg 8 $6,368.58 $8,668.35 $7,960.73 nat. median
$637
outlier · 12.5×

Other procedures at this hospital

Browse this hospital's 2,659 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
             
J2350 HCPCS Injection, Ocrelizumab, 1 Mg 8 8 $46,456.16 $46,456.16 $33,448.44 $45,527.04 $41,810.54 2026-09-14
561 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc 3 3 $11,432.83 $11,432.83 $11,432.83 $26,222.55 $25,223.59 2026-09-14
177 MS_DRG Respiratory Infections And Inflammations With Mcc 3 3 $18,241.90 $18,241.90 $18,241.90 $24,550.07 $23,614.83 2026-09-14
J2329 HCPCS Injection, Ublituximab-xiiy, 1mg 8 8 $25,011.50 $25,011.50 $18,008.28 $24,511.27 $22,510.35 2026-09-14
J9042 HCPCS Injection, Brentuximab Vedotin, 1 Mg 8 8 $23,806.50 $23,806.50 $17,140.68 $23,330.37 $21,425.85 2026-09-14
J9022 HCPCS Injection, Atezolizumab, 10 Mg 8 8 $21,957.55 $21,957.55 $15,809.44 $21,518.40 $19,761.80 2026-09-14
175 MS_DRG Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 3 3 $9,167.80 $9,167.80 $9,167.80 $20,516.36 $19,734.78 2026-09-14
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 8 8 $21,073.80 $21,073.80 $15,173.14 $20,652.32 $18,966.42 2026-09-14
291 MS_DRG Heart Failure And Shock With Mcc 3 3 $8,031.36 $8,031.36 $8,031.36 $19,571.86 $18,826.27 2026-09-14
J9144 HCPCS Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj 8 8 $20,631.64 $20,631.64 $14,854.78 $20,219.01 $18,568.48 2026-09-14
54 MS_DRG Nervous System Neoplasms With Mcc 3 3 $9,952.94 $9,952.94 $9,952.94 $19,188.27 $18,457.29 2026-09-14
565 MS_DRG Other Musculoskeletal System And Connective Tissue Diagnoses With Cc 3 3 $9,322.72 $9,322.72 $9,322.72 $18,818.31 $18,101.42 2026-09-14
J1932 HCPCS Injection, Lanreotide, (cipla), 1 Mg 8 8 $20,022.49 $20,022.49 $14,416.19 $19,622.04 $18,020.24 2026-09-14
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 3 3 $6,705.25 $6,705.25 $6,705.25 $18,685.33 $17,973.51 2026-09-14
J9301 HCPCS Injection, Obinutuzumab, 10 Mg 8 8 $16,811.30 $16,811.30 $12,104.14 $16,475.07 $15,130.17 2026-09-14
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 2 2 $7,623.38 $7,623.38 $7,623.38 $22,627.60 $15,125.49 2026-09-14
189 MS_DRG Pulmonary Edema And Respiratory Failure 3 3 $16,504.22 $16,504.22 $14,553.06 $15,280.71 $14,698.59 2026-09-14
J0896 HCPCS Injection, Luspatercept-aamt, 0.25 Mg 16 8 $18,160.15 $18,160.15 $6,542.71 $26,688.54 $14,256.63 2026-09-14
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 3 3 $5,245.40 $5,245.40 $5,245.40 $14,666.96 $14,108.22 2026-09-14
552 MS_DRG Medical Back Problems Without Mcc 3 3 $9,954.05 $9,954.05 $9,954.05 $14,532.28 $13,978.67 2026-09-14
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 32 8 $16,916.09 $16,916.09 $3,487.10 $28,409.69 $13,918.10 2026-09-14
178 MS_DRG Respiratory Infections And Inflammations With Cc 3 3 $7,487.03 $7,487.03 $7,487.03 $14,353.27 $13,806.48 2026-09-14
439 MS_DRG Disorders Of Pancreas Except Malignancy With Cc 3 3 $17,111.63 $17,111.63 $13,635.68 $14,317.47 $13,772.04 2026-09-14
86 MS_DRG Traumatic Stupor And Coma <1 Hour With Cc 3 3 $13,556.85 $13,556.85 $13,301.20 $13,966.26 $13,434.22 2026-09-14
J9311 HCPCS Injection, Rituximab 10 Mg And Hyaluronidase 8 8 $14,811.31 $14,811.31 $10,664.14 $14,515.08 $13,330.18 2026-09-14
603 MS_DRG Cellulitis Without Mcc 3 3 $6,678.78 $6,678.78 $6,678.78 $13,833.28 $13,306.30 2026-09-14
557 MS_DRG Tendonitis, Myositis And Bursitis With Mcc 3 3 $4,810.93 $4,810.93 $4,810.93 $13,829.87 $13,303.02 2026-09-14
551 MS_DRG Medical Back Problems With Mcc 2 2 $6,736.37 $6,736.37 $6,736.37 $19,759.38 $13,247.88 2026-09-14
389 MS_DRG Gastrointestinal Obstruction With Cc 3 3 $19,425.74 $19,425.74 $12,995.95 $13,645.75 $13,125.91 2026-09-14
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 8 8 $14,454.48 $14,454.48 $10,407.23 $14,165.39 $13,009.03 2026-09-14
89 MS_DRG Concussion With Cc 3 3 $12,564.95 $12,564.95 $12,564.95 $13,357.63 $12,848.76 2026-09-14
563 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 3 3 $10,955.03 $10,955.03 $10,955.03 $13,321.82 $12,814.33 2026-09-14
536 MS_DRG Fractures Of Hip And Pelvis Without Mcc 3 3 $7,722.24 $7,722.24 $7,722.24 $13,212.71 $12,709.37 2026-09-14
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 3 3 $8,681.90 $8,681.90 $8,681.90 $12,885.38 $12,394.51 2026-09-14
292 MS_DRG Heart Failure And Shock With Cc 3 3 $8,778.24 $8,778.24 $8,778.24 $12,881.97 $12,391.23 2026-09-14
683 MS_DRG Renal Failure With Cc 3 3 $7,798.53 $7,798.53 $7,798.53 $12,704.66 $12,220.68 2026-09-14
638 MS_DRG Diabetes With Cc 3 3 $8,990.61 $8,990.61 $8,990.61 $12,626.24 $12,145.24 2026-09-14
J9306 HCPCS Injection, Pertuzumab, 1 Mg 8 8 $13,316.46 $13,316.46 $9,587.85 $13,050.13 $11,984.81 2026-09-14
312 MS_DRG Syncope And Collapse 3 3 $6,467.92 $6,467.92 $6,467.92 $12,148.88 $11,686.06 2026-09-14
66 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc 3 3 $14,719.16 $14,719.16 $10,789.37 $11,328.84 $10,897.26 2026-09-14
28800 HCPCS Amputation Of Midfoot Bone 10 10 $12,000.00 $12,000.00 $8,640.00 $13,337.14 $10,854.00 2026-09-14
558 MS_DRG Tendonitis, Myositis And Bursitis Without Mcc 3 3 $7,496.91 $7,496.91 $7,496.91 $10,846.36 $10,433.16 2026-09-14
J9271 HCPCS Injection, Pembrolizumab, 1 Mg 8 8 $11,517.05 $11,517.05 $8,292.28 $11,286.71 $10,365.35 2026-09-14
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 3 3 $7,233.88 $7,233.88 $7,233.88 $10,510.50 $10,110.10 2026-09-14
J1449 HCPCS Injection, Eflapegrastim-xnst, 0.1 Mg 8 8 $10,139.00 $10,139.00 $7,300.08 $9,936.22 $9,125.10 2026-09-14
684 MS_DRG Renal Failure Without Cc/mcc 3 3 $11,092.01 $11,092.01 $9,017.93 $9,468.83 $9,108.11 2026-09-14
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/mcc 3 3 $6,031.08 $6,031.08 $6,031.08 $9,008.51 $8,665.33 2026-09-14
440 MS_DRG Disorders Of Pancreas Except Malignancy Without Cc/mcc 2 2 $4,105.91 $4,105.91 $4,105.91 $12,271.51 $8,188.71 2026-09-14
Q5120 HCPCS Injection, Pegfilgrastim-bmez (ziextenzo), Biosimilar, 0.5 Mg 8 8 $8,846.44 $8,846.44 $6,369.44 $8,669.51 $7,961.80 2026-09-14
Q5122 HCPCS Injection, Pegfilgrastim-apgf (nyvepria), Biosimilar, 0.5 Mg 8 8 $8,845.25 $8,845.25 $6,368.58 $8,668.35 $7,960.73 2026-09-14
27536 HCPCS Treatment Of Broken Shin Bone On Both Sides Of Upper End 18 10 $11,000.00 $11,000.00 $984.01 $10,780.00 $7,920.00 2026-09-14
J2802 HCPCS Injection, Romiplostim, 1 Microgram 16 8 $9,305.42 $9,305.42 $4,469.98 $12,154.50 $7,506.99 2026-09-14
951 MS_DRG Other Factors Influencing Health Status 3 3 $3,392.02 $3,392.02 $3,392.02 $7,801.47 $7,504.27 2026-09-14
379 MS_DRG Gastrointestinal Hemorrhage Without Cc/mcc 3 3 $3,792.04 $3,792.04 $3,792.04 $7,734.98 $7,440.31 2026-09-14
J9173 HCPCS Injection, Durvalumab, 10 Mg 8 8 $8,226.88 $8,226.88 $5,923.35 $8,062.34 $7,404.19 2026-09-14
J9305 HCPCS Injection, Pemetrexed, Not Otherwise Specified, 10 Mg 8 8 $7,900.35 $7,900.35 $5,688.25 $7,742.34 $7,110.32 2026-09-14
90375 HCPCS Rabies Immune Globulin For Injection 8 8 $7,671.29 $7,671.29 $5,523.33 $7,517.86 $6,904.16 2026-09-14
Rx42367054032 CDM Ryanodex 250 Mg Vial 8 8 $7,471.31 $7,471.31 $5,379.34 $7,321.88 $6,724.18 2026-09-14
J9299 HCPCS Injection, Nivolumab, 1 Mg 16 8 $8,874.59 $8,874.59 $1,834.12 $14,897.75 $6,720.86 2026-09-14
49572 HCPCS Repair Epigastric Hernia (eg, Preperitoneal Fat); Incarcerated Or Strangulated 15 10 $7,700.00 $7,700.00 $991.00 $9,789.05 $6,545.00 2026-09-14
J1950 HCPCS Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg 16 8 $8,119.04 $8,119.04 $2,927.88 $11,928.15 $6,374.36 2026-09-14
J9047 HCPCS Injection, Carfilzomib, 1 Mg 8 8 $6,914.02 $6,914.02 $4,978.09 $6,775.74 $6,222.62 2026-09-14
444 MS_DRG Disorders Of The Biliary Tract With Mcc 1 1 $6,059.94 $6,059.94 $6,059.94 $6,059.94 $6,059.94 2026-09-14
390 MS_DRG Gastrointestinal Obstruction Without Cc/mcc 2 2 $2,824.86 $2,824.86 $2,824.86 $8,304.55 $5,564.70 2026-09-14
22514 HCPCS Treatment Of Broken Lower Spine Bone With Placement Of Stabilizing Device 8 8 $15,000.00 $15,000.00 $385.34 $15,750.00 $5,458.85 2026-09-14
78815 HCPCS Nuclear Medicine Study From Skull Base To Mid-thigh With CT Scan 10 10 $6,600.00 $6,600.00 $3,625.12 $6,468.00 $5,346.00 2026-09-14
78816 HCPCS Nuclear Medicine Study Whole Body With CT Scan 10 10 $6,600.00 $6,600.00 $3,625.12 $6,468.00 $5,346.00 2026-09-14
J0897 HCPCS Injection, Denosumab, 1 Mg 16 8 $6,004.82 $6,004.82 $3,048.28 $7,620.40 $4,873.85 2026-09-14
J9312 HCPCS Injection, Rituximab, 10 Mg 16 8 $6,355.76 $6,355.76 $1,532.10 $10,371.93 $4,852.77 2026-09-14
J2426 HCPCS Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg 24 8 $5,367.85 $5,367.85 $2,901.05 $7,883.70 $4,831.07 2026-09-14
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 1 1 $4,443.20 $4,443.20 $4,443.20 $4,443.20 $4,443.20 2026-09-14
J9034 HCPCS Injection, Bendamustine Hcl (bendeka), 1 Mg 8 8 $4,840.41 $4,840.41 $3,485.10 $4,743.60 $4,356.37 2026-09-14
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 1 1 $4,278.43 $4,278.43 $4,278.43 $4,278.43 $4,278.43 2026-09-14
Q5108 HCPCS Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 8 8 $4,710.88 $4,710.88 $3,391.83 $4,616.66 $4,239.79 2026-09-14
J3145 HCPCS Injection, Testosterone Undecanoate, 1 Mg 8 8 $4,677.08 $4,677.08 $3,367.50 $4,583.54 $4,209.37 2026-09-14
543 MS_DRG Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 1 1 $4,054.58 $4,054.58 $4,054.58 $4,054.58 $4,054.58 2026-09-14
90691 HCPCS Typhoid Vaccine For Injection Into Muscle 10 10 $4,573.18 $4,573.18 $80.12 $4,481.72 $4,001.53 2026-09-14
33285 HCPCS Insertion Of Heart Rhythm Monitor Under Skin 8 8 $11,000.00 $11,000.00 $67.38 $11,550.00 $3,841.31 2026-09-14
J3032 HCPCS Injection, Eptinezumab-jjmr, 1 Mg 8 8 $4,262.34 $4,262.34 $3,068.88 $4,177.09 $3,836.11 2026-09-14
Q5119 HCPCS Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg 16 8 $4,852.40 $4,852.40 $1,171.30 $7,916.44 $3,705.21 2026-09-14
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 10 10 $4,400.00 $4,400.00 $1,013.16 $4,312.00 $3,564.00 2026-09-14
73720 HCPCS MRI Scan Of Leg Before And After Contrast 10 10 $4,400.00 $4,400.00 $1,013.16 $4,312.00 $3,564.00 2026-09-14
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 10 10 $4,400.00 $4,400.00 $1,013.16 $4,312.00 $3,564.00 2026-09-14
J9330 HCPCS Injection, Temsirolimus, 1 Mg 8 8 $3,917.12 $3,917.12 $2,820.33 $3,838.78 $3,525.41 2026-09-14
J2315 HCPCS Injection, Naltrexone, Depot Form, 1 Mg 8 8 $3,817.27 $3,817.27 $2,748.43 $3,740.92 $3,435.54 2026-09-14
52647 HCPCS Complete Laser Destruction Of Prostate Including Control Of Bleeding Using An En… 6 6 $4,400.00 $4,400.00 $1,218.40 $4,620.00 $3,426.24 2026-09-14
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 10 10 $4,100.00 $4,100.00 $1,013.16 $4,018.00 $3,321.00 2026-09-14
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 10 10 $4,100.00 $4,100.00 $1,013.16 $4,018.00 $3,321.00 2026-09-14
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 10 10 $4,100.00 $4,100.00 $1,013.16 $4,018.00 $3,321.00 2026-09-14
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 10 10 $4,100.00 $4,100.00 $1,013.16 $4,018.00 $3,321.00 2026-09-14
49321 HCPCS Biopsy Of Abdomen Using An Endoscope 18 10 $4,500.00 $4,500.00 $294.59 $7,454.65 $3,240.00 2026-09-14
192 MS_DRG Chronic Obstructive Pulmonary Disease Without Cc/mcc 1 1 $3,203.86 $3,203.86 $3,203.86 $3,203.86 $3,203.86 2026-09-14
373 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/mcc 1 1 $3,086.90 $3,086.90 $3,086.90 $3,086.90 $3,086.90 2026-09-14
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 10 10 $3,800.00 $3,800.00 $1,013.16 $3,724.00 $3,078.00 2026-09-14
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 8 8 $3,419.76 $3,419.76 $2,462.23 $3,351.36 $3,077.78 2026-09-14
J7327 HCPCS Hyaluronan Or Derivative, Monovisc, For Intra-articular Injection, Per Dose 8 8 $3,389.00 $3,389.00 $2,440.08 $3,321.22 $3,050.10 2026-09-14
J9145 HCPCS Injection, Daratumumab, 10 Mg 16 8 $3,914.01 $3,914.01 $1,268.40 $5,945.01 $3,047.10 2026-09-14
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 8 8 $3,327.34 $3,327.34 $2,395.68 $3,260.79 $2,994.61 2026-09-14
027211525 CDM Hb Acmh Avaflex 10g 20mm Balloon 8 8 $3,325.00 $3,325.00 $2,394.00 $3,258.50 $2,992.50 2026-09-14
47379 HCPCS Other Procedure On Liver Using An Endoscope 3 3 $2,950.00 $2,950.00 $2,950.00 $3,097.50 $2,979.50 2026-09-14
J1561 HCPCS Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liquid)… 24 8 $3,299.00 $3,299.00 $601.38 $12,890.92 $2,969.10 2026-09-14
38531 HCPCS Biopsy Or Removal Of Lymph Nodes Of Groin 18 10 $4,100.00 $4,100.00 $386.23 $5,032.76 $2,952.00 2026-09-14
J9264 HCPCS Injection, Paclitaxel Protein-bound Particles, 1 Mg 8 8 $3,212.49 $3,212.49 $2,312.99 $3,148.24 $2,891.24 2026-09-14
63267 HCPCS Removal Of Growth Of Lower Spine Bone Outside Spine Membrane 8 8 $3,500.00 $3,500.00 $1,147.98 $3,675.00 $2,845.50 2026-09-14
69706 HCPCS Dilation Of Canal Between Middle Ear And Throat (eustachian Tube) On Both Sides … 8 8 $7,235.00 $7,235.00 $189.38 $7,596.75 $2,841.53 2026-09-14
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 10 10 $3,500.00 $3,500.00 $832.37 $3,430.00 $2,835.00 2026-09-14
J7325 HCPCS Hyaluronan Or Derivative, Synvisc Or Synvisc-one, For Intra-articular Injection,… 8 8 $3,095.65 $3,095.65 $2,228.87 $3,033.74 $2,786.09 2026-09-14
J9355 HCPCS Injection, Trastuzumab, Excludes Biosimilar, 10 Mg 8 8 $3,055.42 $3,055.42 $2,199.90 $2,994.31 $2,749.88 2026-09-14
J3262 HCPCS Injection, Tocilizumab, 1 Mg 16 8 $3,599.36 $3,599.36 $870.56 $5,869.81 $2,748.72 2026-09-14
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 10 10 $3,000.00 $3,000.00 $2,160.00 $2,940.00 $2,700.00 2026-09-14
027211531 CDM Hb Acmh Het Bipolar Forceps 8 8 $2,975.00 $2,975.00 $2,142.00 $2,915.50 $2,677.50 2026-09-14
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 8 8 $2,971.53 $2,971.53 $2,139.50 $2,912.10 $2,674.38 2026-09-14
27447 HCPCS Replacement Of Knee Joint, Both Sides Of Knee 8 8 $3,000.00 $3,000.00 $1,045.50 $3,150.00 $2,640.15 2026-09-14
49655 HCPCS Laparoscopy, Surgical, Repair, Incisional Hernia (includes Mesh Insertion, When … 5 5 $2,600.00 $2,600.00 $1,886.00 $2,730.00 $2,600.00 2026-09-14
J1459 HCPCS Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 16 8 $3,191.23 $3,191.23 $1,535.15 $4,165.29 $2,574.86 2026-09-14
72195 HCPCS MRI Scan Of Pelvis Without Contrast 10 10 $3,170.00 $3,170.00 $724.60 $3,106.60 $2,567.70 2026-09-14
70551 HCPCS MRI Scan Of Brain Without Contrast 10 10 $3,150.00 $3,150.00 $724.60 $3,087.00 $2,551.50 2026-09-14
51725 HCPCS Simple Measurement Of Pressure Of Urine Flow In Bladder 10 10 $2,890.00 $2,890.00 $684.89 $2,832.20 $2,528.75 2026-09-14
73218 HCPCS MRI Scan Of Arm Without Contrast 10 10 $3,100.00 $3,100.00 $724.60 $3,038.00 $2,511.00 2026-09-14
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 10 10 $3,100.00 $3,100.00 $652.99 $3,038.00 $2,511.00 2026-09-14
49653 HCPCS Laparoscopy, Surgical, Repair, Ventral, Umbilical, Spigelian Or Epigastric Herni… 5 5 $2,500.00 $2,500.00 $1,699.00 $2,625.00 $2,500.00 2026-09-14
49652 HCPCS Laparoscopy, Surgical, Repair, Ventral, Umbilical, Spigelian Or Epigastric Herni… 5 5 $2,500.00 $2,500.00 $1,356.00 $2,625.00 $2,500.00 2026-09-14
J7296 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System, (kyleena), 19.5 Mg 8 8 $2,744.42 $2,744.42 $1,975.98 $2,689.53 $2,469.98 2026-09-14
J7307 HCPCS Etonogestrel (contraceptive) Implant System, Including Implant And Supplies 8 8 $2,744.42 $2,744.42 $1,975.98 $2,689.53 $2,469.98 2026-09-14
Q0138 HCPCS Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd … 8 8 $2,699.65 $2,699.65 $1,943.75 $2,645.66 $2,429.69 2026-09-14
Q5118 HCPCS Injection, Bevacizumab-bvzr, Biosimilar, (zirabev), 10 Mg 16 8 $3,098.84 $3,098.84 $1,005.59 $4,705.00 $2,412.73 2026-09-14
25448 HCPCS Replacement Of Joint Between Wrist And Fingers Using Tendon Or Stitches 5 5 $2,400.00 $2,400.00 $744.41 $2,520.00 $2,400.00 2026-09-14
J1569 HCPCS Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 48 8 $2,960.55 $2,960.55 $292.95 $11,564.18 $2,388.78 2026-09-14
J1745 HCPCS Injection, Infliximab, Excludes Biosimilar, 10 Mg 8 8 $2,641.60 $2,641.60 $1,901.95 $2,588.77 $2,377.44 2026-09-14
19307 HCPCS Removal Of Breast And Underarm Lymph Nodes 8 8 $3,100.00 $3,100.00 $1,002.27 $3,255.00 $2,351.20 2026-09-14
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 10 10 $2,900.00 $2,900.00 $724.60 $2,842.00 $2,349.00 2026-09-14
74181 HCPCS MRI Scan Of Abdomen Without Contrast 10 10 $2,900.00 $2,900.00 $724.60 $2,842.00 $2,349.00 2026-09-14
73718 HCPCS MRI Scan Of Leg Without Contrast 10 10 $2,900.00 $2,900.00 $724.60 $2,842.00 $2,349.00 2026-09-14
J7300 HCPCS Intrauterine Copper Contraceptive 8 8 $2,574.25 $2,574.25 $1,853.46 $2,522.77 $2,316.83 2026-09-14
49656 HCPCS Laparoscopy, Surgical, Repair, Recurrent Incisional Hernia (includes Mesh Insert… 5 5 $2,300.00 $2,300.00 $1,672.00 $2,415.00 $2,300.00 2026-09-14
63047 HCPCS Partial Removal Of Spine Bone With Release Of Lower Spinal Cord And/or Nerves, 1… 8 8 $2,800.00 $2,800.00 $933.05 $2,940.00 $2,291.30 2026-09-14
26433 HCPCS Repair Of Tendon On Upper Side Of End Of Finger 10 10 $2,500.00 $2,500.00 $1,800.00 $3,486.38 $2,261.25 2026-09-14
29827 HCPCS Repair Of Shoulder Rotator Cuff Using An Endoscope 8 8 $2,850.00 $2,850.00 $883.71 $2,992.50 $2,208.20 2026-09-14
29806 HCPCS Repair Of Shoulder Joint Capsule Using An Endoscope 8 8 $2,550.00 $2,550.00 $879.92 $2,677.50 $2,191.80 2026-09-14
25609 HCPCS Treatment Of 3 Or More Broken Lower Forearm Bone Pieces On Thumb Side Inside Wri… 8 8 $2,800.00 $2,800.00 $878.21 $2,940.00 $2,186.30 2026-09-14
29807 HCPCS Repair Of Shoulder Socket Using An Endoscope 8 8 $2,650.00 $2,650.00 $860.92 $2,782.50 $2,140.45 2026-09-14
J0881 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 48 8 $2,626.25 $2,626.25 $511.63 $8,547.07 $2,119.12 2026-09-14
027211627 CDM Hb Acmh Hand Wrist Internal Brace Lig Aug Repair 8 8 $2,300.00 $2,300.00 $1,656.00 $2,254.00 $2,070.00 2026-09-14
25320 HCPCS Reconstruction Of Wrist Joint 8 8 $2,750.00 $2,750.00 $842.29 $2,887.50 $2,062.40 2026-09-14
J7301 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System (skyla), 13.5 Mg 8 8 $2,287.11 $2,287.11 $1,646.72 $2,241.37 $2,058.40 2026-09-14
A9697 HCPCS Injection, Carboxydextran-coated Superparamagnetic Iron Oxide, Per Study Dose 8 8 $2,263.78 $2,263.78 $1,629.92 $2,218.50 $2,037.40 2026-09-14
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 10 10 $2,250.00 $2,250.00 $1,620.00 $2,900.63 $2,035.12 2026-09-14
52648 HCPCS Complete Laser Vaporization Of Prostate Including Control Of Bleeding Using An E… 8 8 $4,600.00 $4,600.00 $489.34 $4,830.00 $2,029.03 2026-09-14
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 10 10 $2,500.00 $2,500.00 $684.19 $2,450.00 $2,025.00 2026-09-14
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 10 10 $2,500.00 $2,500.00 $684.19 $2,450.00 $2,025.00 2026-09-14
22010 HCPCS Drainage Of Abscess Of Deep Tissue Of Upper Or Middle Spine 8 8 $2,800.00 $2,800.00 $836.35 $2,940.00 $2,022.70 2026-09-14
49594 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, 3-10 Cm In Length 5 5 $2,000.00 $2,000.00 $601.94 $2,100.00 $2,000.00 2026-09-14
49565 HCPCS Repair Recurrent Incisional Or Ventral Hernia; Reducible 5 5 $2,000.00 $2,000.00 $1,462.00 $2,100.00 $2,000.00 2026-09-14
35206 HCPCS Repair Of Blood Vessel Of Arm 18 10 $2,200.00 $2,200.00 $646.73 $4,183.04 $1,980.00 2026-09-14
23420 HCPCS Repair Of Complete Tear Of Shoulder Rotator Cuff With Release Of Pressure On Col… 8 8 $2,100.00 $2,100.00 $819.00 $2,205.00 $1,978.70 2026-09-14
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 10 10 $2,400.00 $2,400.00 $684.19 $2,352.00 $1,944.00 2026-09-14
Q5103 HCPCS Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 8 8 $2,143.13 $2,143.13 $1,543.05 $2,100.27 $1,928.82 2026-09-14
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 10 10 $2,375.00 $2,375.00 $684.19 $2,327.50 $1,923.75 2026-09-14
19303 HCPCS Simple Complete Removal Of Breast 8 8 $2,500.00 $2,500.00 $814.66 $2,625.00 $1,910.05 2026-09-14
63030 HCPCS Partial Removal Of Spine Bone With Release Of Lower Spinal Cord Or Nerves And/or… 8 8 $2,450.00 $2,450.00 $788.59 $2,572.50 $1,898.60 2026-09-14
29828 HCPCS Release Of Tendon Connecting Biceps Muscle And Shoulder Using An Endoscope 8 8 $2,500.00 $2,500.00 $763.78 $2,625.00 $1,896.75 2026-09-14
J0207 HCPCS Injection, Amifostine, 500 Mg 8 8 $2,105.74 $2,105.74 $1,516.13 $2,063.63 $1,895.17 2026-09-14
70553 HCPCS MRI Scan Of Brain Before And After Contrast 10 10 $2,300.00 $2,300.00 $1,013.16 $2,254.00 $1,863.00 2026-09-14
66989 HCPCS Complex Extracapsular Removal Of Cataract With Insertion Of Artificial Lens And … 8 8 $2,050.00 $2,050.00 $1,476.00 $2,009.00 $1,845.00 2026-09-14
19302 HCPCS Partial Removal Of Breast And Underarm Lymph Nodes 8 8 $2,400.00 $2,400.00 $771.69 $2,520.00 $1,809.50 2026-09-14
29883 HCPCS Repair Of Inside And Outside Knee Joint Cartilage Using An Endoscope 8 8 $2,200.00 $2,200.00 $710.02 $2,310.00 $1,749.55 2026-09-14
26123 HCPCS Removal Of Connective Tissue Of Palm And Release Of Finger, First Digit 8 8 $3,000.00 $3,000.00 $710.01 $3,150.00 $1,748.25 2026-09-14
25447 HCPCS Replacement Of Joint Between Wrist And Fingers Using Tissue 8 8 $2,100.00 $2,100.00 $675.77 $2,205.00 $1,733.15 2026-09-14
25608 HCPCS Treatment Of 2 Broken Lower Forearm Bone Pieces On Thumb Side Inside Wrist Joint… 8 8 $2,250.00 $2,250.00 $699.37 $2,362.50 $1,727.00 2026-09-14
78452 HCPCS Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 10 10 $1,900.00 $1,900.00 $1,140.00 $2,167.28 $1,718.55 2026-09-14
26596 HCPCS Removal Of Constricting Ring Of Skin Of Finger 8 8 $2,500.00 $2,500.00 $717.48 $2,625.00 $1,702.35 2026-09-14
55700 HCPCS Biopsy Of Prostate Gland 10 10 $1,875.00 $1,875.00 $1,350.00 $3,221.63 $1,695.94 2026-09-14
64835 HCPCS Suture Of Hand Median Motor Nerve 8 8 $2,300.00 $2,300.00 $681.27 $2,415.00 $1,683.20 2026-09-14
73220 HCPCS MRI Scan Of Arm Before And After Contrast 10 10 $2,060.00 $2,060.00 $1,013.16 $2,018.80 $1,668.60 2026-09-14
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 10 10 $2,050.00 $2,050.00 $1,013.16 $2,009.00 $1,660.50 2026-09-14
26480 HCPCS Transfer Of Tendon To Back Of Hand 8 8 $2,070.00 $2,070.00 $607.44 $2,173.50 $1,633.90 2026-09-14
J9035 HCPCS Injection, Bevacizumab, 10 Mg 8 8 $1,809.62 $1,809.62 $1,302.93 $1,773.43 $1,628.66 2026-09-14
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 10 10 $2,000.00 $2,000.00 $832.37 $1,960.00 $1,620.00 2026-09-14
15110 HCPCS Outer Layer Self Skin Graft Of Trunk, Arms, Or Legs, 100.0 Sq Cm Or 1% Body Area… 18 10 $1,800.00 $1,800.00 $606.78 $3,434.06 $1,620.00 2026-09-14
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 10 10 $2,000.00 $2,000.00 $724.60 $1,960.00 $1,620.00 2026-09-14
26841 HCPCS Fusion Of Thumb At Wrist 8 8 $2,000.00 $2,000.00 $683.30 $2,100.00 $1,614.75 2026-09-14
27814 HCPCS Treatment Of Both Broken Lower Leg Bones At Ankle 8 8 $2,000.00 $2,000.00 $647.81 $2,100.00 $1,587.40 2026-09-14
15240 HCPCS Full Thickness Skin Graft To Forehead, Cheeks, Chin, Mouth, Neck, Underarms, Gen… 8 8 $2,450.00 $2,450.00 $644.55 $2,572.50 $1,582.00 2026-09-14
27524 HCPCS Treatment Of Broken Kneecap With Placement Of Stabilizing Device And/or Removal … 8 8 $2,300.00 $2,300.00 $637.36 $2,415.00 $1,566.85 2026-09-14
23430 HCPCS Anchoring Of Biceps Tendon 8 8 $2,040.00 $2,040.00 $630.95 $2,142.00 $1,549.00 2026-09-14
25607 HCPCS Treatment Of Broken Forearm Bone On Thumb Side Of Wrist, Above Wrist, With Place… 8 8 $1,950.00 $1,950.00 $632.06 $2,047.50 $1,546.95 2026-09-14
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 10 10 $1,900.00 $1,900.00 $832.37 $1,862.00 $1,539.00 2026-09-14
25020 HCPCS Incision Of Tissue Of Forearm And/or Wrist Muscle Compartment On One Side Of The… 8 8 $2,075.00 $2,075.00 $657.50 $2,178.75 $1,533.95 2026-09-14
21933 HCPCS Removal Of Growth Of Muscle Of Back Or Lower Sides, 5.0 Cm Or More 8 8 $2,000.00 $2,000.00 $625.70 $2,100.00 $1,525.75 2026-09-14
21554 HCPCS Removal Of Growth Of Muscle Of Neck Or Front Of Chest, 5.0 Cm Or More 8 8 $2,250.00 $2,250.00 $612.30 $2,362.50 $1,512.75 2026-09-14
47563 HCPCS Removal Of Gallbladder With X-ray Study Of Bile Ducts Using An Endoscope 8 8 $1,800.00 $1,800.00 $607.09 $1,890.00 $1,509.95 2026-09-14
49521 HCPCS Repair Of Trapped Or Strangulated Groin Hernia 8 8 $2,000.00 $2,000.00 $608.07 $2,100.00 $1,507.85 2026-09-14
24343 HCPCS Repair Of Ligament Of Thumb Side Of Elbow 8 8 $2,000.00 $2,000.00 $613.74 $2,100.00 $1,492.85 2026-09-14
J1212 HCPCS Injection, Dmso, Dimethyl Sulfoxide, 50%, 50 Ml 8 8 $1,650.94 $1,650.94 $1,188.68 $1,617.92 $1,485.85 2026-09-14
26951 HCPCS Amputation Of Finger Or Thumb With Direct Closure 8 8 $2,100.00 $2,100.00 $636.44 $2,205.00 $1,464.85 2026-09-14
24140 HCPCS Partial Removal Of Infected Upper Arm Bone 8 8 $1,825.00 $1,825.00 $593.62 $1,916.25 $1,464.85 2026-09-14
71260 HCPCS CT Scan Of Chest With Contrast 10 10 $1,800.00 $1,800.00 $832.37 $1,764.00 $1,458.00 2026-09-14
23073 HCPCS Removal Of Growth Of Muscle Of Shoulder, 5.0 Cm Or More 8 8 $1,700.00 $1,700.00 $591.45 $1,785.00 $1,444.30 2026-09-14
27598 HCPCS Removal Of Leg At Knee Joint 8 8 $1,715.00 $1,715.00 $575.32 $1,800.75 $1,423.10 2026-09-14
29824 HCPCS Partial Removal Of Collar Bone At Shoulder Using An Endoscope 8 8 $1,800.00 $1,800.00 $579.07 $1,890.00 $1,409.40 2026-09-14
49592 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, Less Than 3 Cm In Length 5 5 $1,400.00 $1,400.00 $385.80 $1,470.00 $1,400.00 2026-09-14
30520 HCPCS Reshaping Of Nasal Cartilage 8 8 $1,850.00 $1,850.00 $563.03 $1,942.50 $1,398.40 2026-09-14
027211584 CDM Hb Acmh Ligasure Impact 8 8 $1,550.00 $1,550.00 $1,116.00 $1,519.00 $1,395.00 2026-09-14
47562 HCPCS Removal Of Gallbladder Using An Endoscope 8 8 $1,650.00 $1,650.00 $561.02 $1,732.50 $1,389.35 2026-09-14
24359 HCPCS Incision And Repair Of Elbow Tendon With Removal Of Tissue Or Bone 8 8 $1,750.00 $1,750.00 $559.24 $1,837.50 $1,385.45 2026-09-14
027211623 CDM Hb Acmh Hernia Tacker 8 8 $1,535.00 $1,535.00 $1,105.20 $1,504.30 $1,381.50 2026-09-14
J3304 HCPCS Injection, Triamcinolone Acetonide, Preservative-free, Extended-release, Microsp… 8 8 $1,530.52 $1,530.52 $1,101.97 $1,499.91 $1,377.47 2026-09-14
29879 HCPCS Repair Of Knee Joint With Drilling And Or Scraping Of Joint Using An Endoscope 8 8 $1,875.00 $1,875.00 $563.69 $1,968.75 $1,377.20 2026-09-14
23180 HCPCS Partial Removal Of Infected Collar Bone 8 8 $1,900.00 $1,900.00 $592.03 $1,995.00 $1,377.20 2026-09-14
78227 HCPCS Nuclear Medicine Study Of Liver And Bile Duct System With Use Of Drugs 10 10 $1,700.00 $1,700.00 $903.27 $1,666.00 $1,377.00 2026-09-14
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 10 10 $1,700.00 $1,700.00 $724.60 $1,666.00 $1,377.00 2026-09-14
25820 HCPCS Fusion Of Part Of Wrist Joint 8 8 $1,700.00 $1,700.00 $559.01 $1,785.00 $1,354.65 2026-09-14
26440 HCPCS Release Of Tendon Of Palm Or Finger 8 8 $1,750.00 $1,750.00 $585.68 $1,837.50 $1,353.95 2026-09-14
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 18 10 $1,500.00 $1,500.00 $496.33 $2,009.51 $1,350.00 2026-09-14
44950 HCPCS Removal Of Appendix 8 8 $1,900.00 $1,900.00 $538.28 $1,995.00 $1,347.45 2026-09-14
27792 HCPCS Treatment Of Broken Outer Lower Leg Bone At Ankle 8 8 $2,100.00 $2,100.00 $552.59 $2,205.00 $1,343.00 2026-09-14
74160 HCPCS CT Scan Of Abdomen With Contrast 10 10 $1,650.00 $1,650.00 $832.37 $1,617.00 $1,336.50 2026-09-14
27886 HCPCS Re-amputation Of Lower Leg 8 8 $1,600.00 $1,600.00 $537.63 $1,680.00 $1,332.75 2026-09-14
027211603 CDM Hb Acmh Sorbafix 8 8 $1,480.00 $1,480.00 $1,065.60 $1,450.40 $1,332.00 2026-09-14
26531 HCPCS Repair Of Joint Between Hand And Finger Bones With Prosthesis 8 8 $1,600.00 $1,600.00 $534.93 $1,680.00 $1,321.10 2026-09-14
J0585 HCPCS Injection, Onabotulinumtoxina, 1 Unit 24 8 $1,467.50 $1,467.50 $596.52 $2,862.58 $1,320.75 2026-09-14
19301 HCPCS Partial Removal Of Breast 8 8 $1,740.00 $1,740.00 $562.94 $1,827.00 $1,318.10 2026-09-14
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 10 10 $1,500.00 $1,500.00 $901.85 $1,470.00 $1,312.50 2026-09-14
27752 HCPCS Closed Treatment Of Middle Part Of Broken Shin Bone With Manipulation 18 10 $1,450.00 $1,450.00 $452.28 $2,009.51 $1,305.00 2026-09-14
26418 HCPCS Repair Of Tendon On Top Side Of Finger 8 8 $2,100.00 $2,100.00 $571.93 $2,205.00 $1,303.30 2026-09-14
J0248 HCPCS Injection, Remdesivir, 1 Mg 8 8 $1,442.41 $1,442.41 $1,038.54 $1,413.56 $1,298.17 2026-09-14
70487 HCPCS CT Scan Of Face With Contrast 10 10 $1,600.00 $1,600.00 $832.37 $1,568.00 $1,296.00 2026-09-14
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 10 10 $1,600.00 $1,600.00 $724.60 $1,568.00 $1,296.00 2026-09-14
23130 HCPCS Partial Removal Or Repair Of Shoulder Bone Near Collar Bone 8 8 $1,700.00 $1,700.00 $534.65 $1,785.00 $1,293.05 2026-09-14
64635 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 18 10 $1,700.00 $1,700.00 $162.49 $2,560.12 $1,287.50 2026-09-14
11772 HCPCS Complicated Removal Of Cyst Of Tailbone 18 10 $1,425.00 $1,425.00 $515.69 $5,511.52 $1,282.50 2026-09-14
44970 HCPCS Removal Of Appendix Using An Endoscope 8 8 $1,600.00 $1,600.00 $514.00 $1,680.00 $1,268.00 2026-09-14
24605 HCPCS Repair Of Dislocated Elbow Under Anesthesia 18 10 $1,400.00 $1,400.00 $433.42 $2,696.01 $1,260.00 2026-09-14
26445 HCPCS Release Of Tendon Of Top Of Hand Or Finger 8 8 $1,700.00 $1,700.00 $551.44 $1,785.00 $1,258.10 2026-09-14
72132 HCPCS CT Scan Of Lower Spine With Contrast 10 10 $1,550.00 $1,550.00 $832.37 $1,519.00 $1,255.50 2026-09-14
64718 HCPCS Release And/or Relocation Of Elbow Nerve 8 8 $1,800.00 $1,800.00 $521.63 $1,890.00 $1,255.05 2026-09-14
26121 HCPCS Removal Of Connective Tissue Of Palm 8 8 $2,200.00 $2,200.00 $510.54 $2,310.00 $1,254.70 2026-09-14
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 10 10 $1,545.00 $1,545.00 $724.60 $1,514.10 $1,251.45 2026-09-14
24620 HCPCS Closed Treatment Of Broken And Dislocated Forearm Bones At Elbow With Manipulati… 8 8 $1,790.00 $1,790.00 $513.76 $1,879.50 $1,238.30 2026-09-14
23120 HCPCS Partial Removal Of Collar Bone 8 8 $1,700.00 $1,700.00 $511.66 $1,785.00 $1,232.10 2026-09-14
64490 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Single Le… 18 10 $1,700.00 $1,700.00 $88.27 $1,679.15 $1,224.00 2026-09-14
62323 HCPCS Injection Of Substance Into Lower Spine Canal Using Imaging Guidance 18 10 $1,700.00 $1,700.00 $83.66 $1,679.15 $1,224.00 2026-09-14
64483 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 18 10 $1,700.00 $1,700.00 $93.39 $1,679.15 $1,224.00 2026-09-14
29819 HCPCS Removal Of Loose Or Foreign Body In Shoulder Joint Using An Endoscope 8 8 $1,550.00 $1,550.00 $498.98 $1,627.50 $1,223.20 2026-09-14
78582 HCPCS Nuclear Medicine Study Of Lung Ventilation And Circulation 10 10 $1,350.00 $1,350.00 $810.00 $2,167.28 $1,221.08 2026-09-14
71250 HCPCS CT Scan Of Chest Without Contrast 10 10 $1,500.00 $1,500.00 $312.67 $1,470.00 $1,215.00 2026-09-14
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 10 10 $1,500.00 $1,500.00 $832.37 $1,470.00 $1,215.00 2026-09-14
72125 HCPCS CT Scan Of Upper Spine Without Contrast 10 10 $1,500.00 $1,500.00 $312.67 $1,470.00 $1,215.00 2026-09-14
78306 HCPCS Nuclear Medicine Study Of Bone And/or Joint Whole Body 10 10 $1,500.00 $1,500.00 $900.00 $1,470.00 $1,215.00 2026-09-14
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 10 10 $1,500.00 $1,500.00 $652.99 $1,470.00 $1,215.00 2026-09-14
70486 HCPCS CT Scan Of Face Without Contrast 10 10 $1,500.00 $1,500.00 $312.67 $1,470.00 $1,215.00 2026-09-14
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 10 10 $1,500.00 $1,500.00 $652.99 $1,470.00 $1,215.00 2026-09-14
49329 HCPCS Other Procedure On Abdomen Using An Endoscope 3 3 $1,200.00 $1,200.00 $1,200.00 $1,260.00 $1,212.00 2026-09-14
49585 HCPCS Repair Umbilical Hernia, Age 5 Years Or Older; Reducible 5 5 $1,200.00 $1,200.00 $854.00 $1,260.00 $1,200.00 2026-09-14
50590 HCPCS Shock Wave Crushing Of Kidney Stones 8 8 $2,200.00 $2,200.00 $482.54 $2,310.00 $1,196.85 2026-09-14
49651 HCPCS Repair Of Recurrent Groin Hernia Using An Endoscope 8 8 $3,000.00 $3,000.00 $489.35 $3,150.00 $1,194.00 2026-09-14
36561 HCPCS Insertion Of Central Venous Tube With Port (5 Years Or Older) 8 8 $2,650.00 $2,650.00 $274.05 $2,782.50 $1,179.40 2026-09-14
28485 HCPCS Treatment Of Broken Midportion Of Foot 8 8 $1,600.00 $1,600.00 $498.95 $1,680.00 $1,173.25 2026-09-14
29880 HCPCS Removal Of Both Knee Cartilages Using An Endoscope 8 8 $1,500.00 $1,500.00 $482.80 $1,575.00 $1,171.85 2026-09-14
24505 HCPCS Closed Treatment Of Broken Middle Part Of Upper Arm Bone With Manipulation 18 10 $1,300.00 $1,300.00 $427.71 $2,009.51 $1,170.00 2026-09-14
21931 HCPCS Removal Of Growth Under Skin Of Back Or Lower Sides, 3.0 Cm Or More 18 10 $1,300.00 $1,300.00 $405.36 $4,029.18 $1,170.00 2026-09-14
21552 HCPCS Removal Of Growth Of Soft Tissue Under Skin Of Neck Or Front Of Chest, 3.0 Cm Or… 18 10 $1,300.00 $1,300.00 $384.74 $4,222.87 $1,170.00 2026-09-14
J9293 HCPCS Injection, Mitoxantrone Hydrochloride, Per 5 Mg 8 8 $1,283.81 $1,283.81 $924.34 $1,258.13 $1,155.43 2026-09-14
44640 HCPCS Closure Of Abnormal Drainage Tract From Small Bowel To Skin 8 8 $3,600.00 $3,600.00 $75.00 $3,140.40 $1,147.85 2026-09-14
19125 HCPCS Removal Of Growth Of Breast Identified By X-ray Marker, First Growth 18 10 $1,275.00 $1,275.00 $403.56 $2,997.48 $1,147.50 2026-09-14
J7298 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg 16 8 $1,534.71 $1,534.71 $234.00 $2,689.53 $1,147.24 2026-09-14
78226 HCPCS Nuclear Medicine Study Of Liver And Bile Duct System 10 10 $1,410.00 $1,410.00 $846.00 $1,381.80 $1,142.10 2026-09-14
90380 HCPCS Respiratory Syncytial Virus Antibody, 0.5 Ml Dosage For Injection Into Muscle 16 8 $1,265.30 $1,265.30 $911.01 $1,239.99 $1,138.76 2026-09-14
90381 HCPCS Respiratory Syncytial Virus Antibody, 1.0 Ml Dosage For Injection Into Muscle 16 8 $1,265.30 $1,265.30 $911.01 $1,239.99 $1,138.76 2026-09-14
70450 HCPCS CT Scan Head Or Brain Without Contrast 10 10 $1,400.00 $1,400.00 $832.37 $1,372.00 $1,134.00 2026-09-14
78070 HCPCS Nuclear Medicine Study Of Parathyroid 10 10 $1,250.00 $1,250.00 $750.00 $2,167.28 $1,130.62 2026-09-14
29881 HCPCS Removal Of Knee Cartilage Using An Endoscope 8 8 $1,475.00 $1,475.00 $467.10 $1,548.75 $1,129.40 2026-09-14
29822 HCPCS Limited Removal Of Abnormal Shoulder Joint Tissue Using Endoscope 8 8 $1,500.00 $1,500.00 $467.23 $1,575.00 $1,129.40 2026-09-14
25071 HCPCS Removal Of Growth Under Skin Of Forearm Or Wrist, 3.0 Cm Or More 18 10 $1,250.00 $1,250.00 $364.31 $4,391.56 $1,125.00 2026-09-14
23605 HCPCS Closed Treatment Of Broken Top Of Upper Arm Bone With Manipulation 18 10 $1,250.00 $1,250.00 $398.73 $2,009.51 $1,125.00 2026-09-14
46040 HCPCS Drainage Of Deep Abscess In Rectum 18 10 $1,250.00 $1,250.00 $392.03 $4,161.95 $1,125.00 2026-09-14
23655 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia 18 10 $1,245.00 $1,245.00 $378.77 $2,696.01 $1,120.50 2026-09-14
25073 HCPCS Removal Of Growth Of Muscle Of Forearm Or Wrist, 3.0 Cm Or More 8 8 $1,500.00 $1,500.00 $459.14 $1,575.00 $1,117.80 2026-09-14
29999 HCPCS Other Procedure On Joint Using An Endoscope 3 3 $1,100.00 $1,100.00 $1,100.00 $1,155.00 $1,111.00 2026-09-14
24358 HCPCS Incision Of Elbow Tendon With Removal Of Tissue 8 8 $1,575.00 $1,575.00 $453.79 $1,653.75 $1,110.95 2026-09-14
29820 HCPCS Partial Removal Of Shoulder Joint Lining Using An Endoscope 8 8 $1,500.00 $1,500.00 $455.64 $1,575.00 $1,110.95 2026-09-14
21556 HCPCS Removal Of Growth Of Muscle Of Neck Or Front Of Chest, Less Than 5.0 Cm 8 8 $1,300.00 $1,300.00 $445.17 $1,365.00 $1,097.95 2026-09-14
J0885 HCPCS Injection, Epoetin Alfa, (for Non-esrd Use), 1000 Units 24 8 $1,216.63 $1,216.63 $443.02 $2,370.87 $1,094.97 2026-09-14
69620 HCPCS Repair Of Defect Or Tear Of Eardrum 8 8 $1,970.00 $1,970.00 $415.14 $2,068.50 $1,091.20 2026-09-14
27810 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle With Manipulation 26 10 $1,260.00 $1,260.00 $419.30 $2,009.51 $1,085.40 2026-09-14
25076 HCPCS Removal Of Growth Of Muscle Of Forearm Or Wrist, Less Than 3.0 Cm 8 8 $1,500.00 $1,500.00 $445.42 $1,575.00 $1,084.25 2026-09-14
29848 HCPCS Release Of Wrist Ligament Using An Endoscope 8 8 $2,500.00 $2,500.00 $441.12 $2,625.00 $1,073.30 2026-09-14
28238 HCPCS Reconstruction Of Ankle Tendon With Removal Of Extra Ankle Joint Bone 8 8 $1,825.00 $1,825.00 $425.82 $1,916.25 $1,059.69 2026-09-14
25120 HCPCS Removal Of Cyst Or Growth Of Lower Forearm Bone 8 8 $1,500.00 $1,500.00 $431.48 $1,575.00 $1,053.45 2026-09-14
73201 HCPCS CT Scan Of Arm With Contrast 10 10 $1,300.00 $1,300.00 $780.00 $1,274.00 $1,053.00 2026-09-14
26230 HCPCS Partial Removal Of Hand Bone 8 8 $1,400.00 $1,400.00 $428.34 $1,470.00 $1,047.95 2026-09-14
47610 HCPCS Removal Of Gallbladder With Exploration Of Common Bile Duct 8 8 $3,400.00 $3,400.00 $75.00 $2,825.20 $1,040.16 2026-09-14
78264 HCPCS Nuclear Medicine Study Of Stomach To Assess Emptying 10 10 $1,200.00 $1,200.00 $720.00 $1,176.00 $1,037.49 2026-09-14
25210 HCPCS Removal Of Wrist Bone 8 8 $1,500.00 $1,500.00 $424.61 $1,575.00 $1,036.35 2026-09-14
73722 HCPCS MRI Scan Of Leg Joint With Contrast 10 10 $1,150.00 $1,150.00 $690.00 $1,127.00 $1,035.00 2026-09-14
73222 HCPCS MRI Scan Of Arm Joint With Contrast 10 10 $1,150.00 $1,150.00 $690.00 $1,127.00 $1,035.00 2026-09-14
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 10 10 $1,275.00 $1,275.00 $312.67 $1,249.50 $1,032.75 2026-09-14
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 10 10 $1,275.00 $1,275.00 $765.00 $1,249.50 $1,032.75 2026-09-14
Rx00597002402 CDM Combivent Respimat 20-100 Mcg 8 8 $1,143.05 $1,143.05 $823.00 $1,120.19 $1,028.75 2026-09-14
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 10 10 $1,175.00 $1,175.00 $375.06 $1,151.50 $1,028.12 2026-09-14
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