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

GRISELL MEMORIAL HOSPITAL

Ransom, KS · CCN 171300 · Rates published

1,460 distinct procedures filed
6 distinct payers
10,972 rate rows
2026-03-03 last MRF observed
Data quality

4,738 of 10,972 rate rows are consumer-grade (43.2%)

6,234 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-charges methodology — not a negotiated dollar; shown as context only 6,199
exceeds 10× this hospital's gross charge — excluded from medians 23
per-diem day rate — not a per-procedure price 10
placeholder amount (≤ $0.02) — excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbGMHDRANSOMKS&type=CDMWithoutLabel
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 9874dad21f3fe7df… · 5,561,889 bytes · first seen 2026-05-04

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
J2997
HCPCS 		Injection, Alteplase Recombinant, 1 Mg 6 $107.24 $15,650.57 $13,647.30 nat. median
$545
outlier · 25.0×
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 6 $153.82 $11,818.10 $10,305.39 nat. median
$5,957
1.7× median
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 6 $5,394.62 $7,250.83 $6,888.29 nat. median
$2,076
outlier · 3.3×
J2182
HCPCS 		Injection, Mepolizumab, 1 Mg 6 $35.80 $6,560.23 $5,720.52 nat. median
$3,087
1.9× median
J0840
HCPCS 		Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 6 $3,710.95 $5,420.81 $4,726.94 nat. median
$3,427
1.4× median
J0897
HCPCS 		Injection, Denosumab, 1 Mg 6 $23.34 $3,967.31 $3,206.66 nat. median
$2,502
1.3× median
74174
HCPCS 		CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 6 $1,602.92 $2,827.18 $2,465.30 nat. median
$959
outlier · 2.6×
93306
HCPCS 		Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 6 $1,441.15 $2,541.87 $2,216.51 nat. median
$1,008
outlier · 2.2×
12036
HCPCS 		Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 20.1-30.… 6 $315.83 $3,657.81 $2,073.85 nat. median
$883
outlier · 2.3×
C8929
HCPCS 		Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi… 6 $1,441.15 $2,280.00 $1,988.16 nat. median
$1,362
1.5× median
73206
HCPCS 		CT Scan Of Blood Vessels Of Arm With Contrast 6 $1,361.52 $1,903.24 $1,771.46 nat. median
$697
outlier · 2.5×
87633
HCPCS 		Detection Test By Nucleic Acid For Multiple Types Of Respiratory Virus, Multiple… 6 $1,315.75 $8,463.18 $1,770.69 nat. median
$563
outlier · 3.1×
12035
HCPCS 		Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 12.6-20.… 6 $678.53 $3,026.12 $1,715.70 nat. median
$661
outlier · 2.6×
71275
HCPCS 		CT Scan Of Blood Vessels Of Chest With Contrast 6 $1,075.89 $1,830.00 $1,595.76 nat. median
$736
outlier · 2.2×
70496
HCPCS 		CT Scan Of Blood Vessels Of Head With Contrast 6 $1,089.88 $1,830.00 $1,595.76 nat. median
$729
outlier · 2.2×
70498
HCPCS 		CT Scan Of Blood Vessels Of Neck With Contrast 6 $1,090.75 $1,830.00 $1,595.76 nat. median
$722
outlier · 2.2×
26011
HCPCS 		Complicated Drainage Of Abscess In Finger 6 $999.40 $1,762.72 $1,537.09 nat. median
$1,701
0.9× median
13152
HCPCS 		Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 2.6-7.5 Cm 6 $315.83 $2,684.30 $1,521.90 nat. median
$918
1.7× median
74270
HCPCS 		Single Contrast X-ray Of Large Intestine 6 $947.15 $1,670.56 $1,456.73 nat. median
$324
outlier · 4.5×
12034
HCPCS 		Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 7.6-12.5… 6 $315.83 $2,568.68 $1,456.35 nat. median
$591
outlier · 2.5×
12055
HCPCS 		Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.6-… 6 $315.83 $2,262.05 $1,282.50 nat. median
$652
2.0× median
12047
HCPCS 		Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, More Than 30.0 C… 5 $315.83 $1,446.85 $1,195.20 nat. median
$1,847
0.6× median
2120839_1
CDM 		Room & Board - Private (one Bed) - General Classification 2 $959.76 $1,290.00 $1,124.88 nat. median
$1,266
0.9× median
10140
HCPCS 		Drainage Of Blood Or Fluid Accumulation 6 $342.98 $1,968.82 $1,116.25 nat. median
$1,654
0.7× median
2120840_1
CDM 		Room & Board - Semi-private (two Beds) - General Classification 2 $937.44 $1,260.00 $1,098.72 nat. median
$1,188
0.9× median
12037
HCPCS 		Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, More Tha… 5 $315.83 $2,451.95 $1,096.80 nat. median
$1,995
0.5× median
12045
HCPCS 		Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 12.6-20.0 Cm 6 $315.83 $1,802.93 $1,022.20 nat. median
$833
1.2× median
99285
HCPCS 		Emergency Department Visit With High Level Of Medical Decision Making 6 $98.48 $1,792.62 $1,016.35 nat. median
$1,227
0.8× median
87799
HCPCS 		Detection Test By Nucleic Acid For Organism, Quantification 6 $236.64 $1,732.80 $1,015.77 nat. median
$177
outlier · 5.8×
10120
HCPCS 		Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Simple 6 $102.67 $1,784.50 $1,011.75 nat. median
$450
outlier · 2.2×
12054
HCPCS 		Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6-1… 6 $315.83 $1,759.37 $997.50 nat. median
$625
1.6× median
11624
HCPCS 		Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4.0… 5 $315.83 $1,086.00 $993.60 nat. median
$1,710
0.6× median
27750
HCPCS 		Closed Treatment Of Broken Middle Part Of Shin Bone 6 $735.82 $1,368.00 $989.00 nat. median
$486
outlier · 2.0×
11426
HCPCS 		Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More… 5 $315.83 $1,770.80 $979.20 nat. median
$2,748
outlier · 0.4×
26725
HCPCS 		Closed Treatment Of Broken Finger Or Thumb At Midportion Or Part Near Hand With… 6 $315.83 $1,069.70 $978.00 nat. median
$442
outlier · 2.2×
J0248
HCPCS 		Injection, Remdesivir, 1 Mg 6 $765.32 $1,028.66 $977.23 nat. median
$588
1.7× median
12017
HCPCS 		Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 20.… 6 $315.83 $2,551.92 $977.00 nat. median
$520
1.9× median
12007
HCPCS 		Simple Repair Of Surface Wound To Scalp, Neck, Underarms, Trunk, Arms, Or Legs,… 6 $500.71 $2,551.92 $971.00 nat. median
$404
outlier · 2.4×
36589
HCPCS 		Removal Of Tunneled Central Venous Tube 6 $771.38 $1,036.80 $969.17 nat. median
$962
1.0× median
27301
HCPCS 		Drainage Of Deep Abscess Or Blood Accumulation Of Thigh Or Knee 6 $315.83 $3,451.35 $950.62 nat. median
$2,968
outlier · 0.3×
13132
HCPCS 		Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 6 $315.83 $1,673.91 $949.05 nat. median
$877
1.1× median
27808
HCPCS 		Closed Treatment Of 2 Broken Lower Leg Bones At Ankle 5 $315.83 $1,368.00 $948.00 nat. median
$452
outlier · 2.1×
4441947_1
CDM 		Room & Board - Private (one Bed) - General Classification 2 $803.52 $1,080.00 $941.76 nat. median
$1,015
0.9× median
74183
HCPCS 		MRI Scan Of Abdomen Before And After Contrast 6 $494.95 $1,080.00 $941.76 nat. median
$1,102
0.9× median
70450
HCPCS 		CT Scan Head Or Brain Without Contrast 6 $430.35 $1,080.00 $941.76 nat. median
$454
outlier · 2.1×
A0433
HCPCS 		Advanced Life Support, Level 2 (als 2) 6 $736.56 $990.00 $940.50 nat. median
$1,173
0.8× median
28505
HCPCS 		Treatment Of Broken Great Toe 6 $315.83 $2,029.20 $935.04 nat. median
$3,632
outlier · 0.3×
74182
HCPCS 		MRI Scan Of Abdomen With Contrast 6 $494.95 $1,068.00 $931.30 nat. median
$991
0.9× median
23600
HCPCS 		Closed Treatment Of Broken Top Of Upper Arm Bone 6 $315.83 $1,368.00 $923.00 nat. median
$448
outlier · 2.1×
27760
HCPCS 		Closed Treatment Of Inside Portion Of Shin Bone At Ankle 6 $682.25 $1,368.00 $917.00 nat. median
$443
outlier · 2.1×

Other procedures at this hospital

Browse this hospital's 1,460 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
             
10060 HCPCS Simple Or Single Drainage Of Skin Abscess 11 6 $329.00 $312.55 $244.78 $1,224.60 $745.75 2026-03-03
10061 HCPCS Complicated Or Multiple Drainage Of Skin Abscess 7 6 $556.00 $528.20 $315.83 $1,396.50 $556.00 2026-03-03
10120 HCPCS Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Simple 11 6 $138.00 $131.10 $102.67 $1,784.50 $1,011.75 2026-03-03
10121 HCPCS Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Complex 7 6 $778.00 $739.10 $315.83 $1,426.90 $778.00 2026-03-03
10140 HCPCS Drainage Of Blood Or Fluid Accumulation 10 6 $461.00 $437.95 $342.98 $1,968.82 $1,116.25 2026-03-03
11401 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 0.6-1.0 Cm 7 6 $426.00 $404.70 $315.83 $787.55 $426.00 2026-03-03
11402 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 1.1-2.0 Cm 7 6 $475.00 $451.25 $315.83 $835.05 $475.00 2026-03-03
11403 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm 5 5 $547.00 $519.65 $315.83 $1,241.65 $547.00 2026-03-03
11404 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 3.1-4.0 Cm 5 5 $622.00 $590.90 $315.83 $1,424.05 $622.00 2026-03-03
11406 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 7 6 $893.00 $848.35 $315.83 $1,954.15 $893.00 2026-03-03
11421 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 0.6-1… 5 5 $452.00 $429.40 $315.83 $1,152.35 $452.00 2026-03-03
11422 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 1.1-2… 5 5 $504.00 $478.80 $315.83 $1,287.25 $504.00 2026-03-03
11423 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 2.1-3… 7 6 $589.00 $559.55 $315.83 $1,542.80 $589.00 2026-03-03
11426 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More … 5 5 $979.20 $930.24 $315.83 $1,770.80 $979.20 2026-03-03
11441 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 0… 5 5 $485.00 $460.75 $315.83 $1,092.50 $485.00 2026-03-03
11442 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 1… 5 5 $546.00 $518.70 $315.83 $1,153.30 $546.00 2026-03-03
11444 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3… 5 5 $480.00 $456.00 $315.83 $1,805.00 $480.00 2026-03-03
11600 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 0.5 Cm Or Less 5 5 $404.00 $383.80 $300.58 $608.95 $404.00 2026-03-03
11601 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 0.6-1.0 Cm 5 5 $661.00 $627.95 $315.83 $774.25 $661.00 2026-03-03
11602 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 1.1-2.0 Cm 7 6 $725.00 $688.75 $315.83 $850.25 $725.00 2026-03-03
11603 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm 5 5 $420.00 $399.00 $312.48 $1,054.50 $420.00 2026-03-03
11621 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 0.6-1.0 … 5 5 $668.00 $634.60 $496.99 $668.00 $624.00 2026-03-03
11622 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 1.1-2.0 … 5 5 $993.60 $943.92 $315.83 $993.60 $723.00 2026-03-03
11624 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4.0 … 5 5 $993.60 $943.92 $315.83 $1,086.00 $993.60 2026-03-03
11640 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 0.5 … 5 5 $571.00 $542.45 $315.83 $571.00 $475.95 2026-03-03
11641 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 0.6-… 5 5 $698.00 $663.10 $519.31 $698.00 $618.45 2026-03-03
11642 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 1.1-… 5 5 $804.00 $763.80 $598.18 $804.00 $746.70 2026-03-03
11750 HCPCS Permanent Removal Fingernail Or Toenail 7 6 $641.00 $608.95 $315.83 $641.00 $485.45 2026-03-03
11765 HCPCS Removal Of Skin Of Fingernail Or Toenail 5 5 $390.00 $370.50 $290.16 $651.70 $390.00 2026-03-03
12002 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 13 6 $478.00 $454.10 $246.26 $759.04 $430.35 2026-03-03
12004 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 13 6 $560.00 $532.00 $284.95 $958.44 $543.40 2026-03-03
12005 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 13 6 $698.00 $663.10 $315.83 $1,342.15 $698.00 2026-03-03
12006 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 13 6 $865.00 $821.75 $315.83 $2,551.92 $865.00 2026-03-03
12007 HCPCS Simple Repair Of Surface Wound To Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 13 6 $971.00 $922.45 $500.71 $2,551.92 $971.00 2026-03-03
12011 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5… 11 6 $476.00 $452.20 $315.83 $789.20 $476.00 2026-03-03
12013 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.6… 13 6 $526.00 $499.70 $270.82 $789.20 $447.45 2026-03-03
12014 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1… 13 6 $617.00 $586.15 $315.83 $789.20 $447.45 2026-03-03
12015 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6… 13 6 $773.00 $734.35 $315.83 $1,342.15 $760.95 2026-03-03
12016 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.… 13 6 $923.00 $876.85 $315.83 $1,342.15 $760.95 2026-03-03
12017 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 20.… 13 6 $977.00 $928.15 $315.83 $2,551.92 $977.00 2026-03-03
12018 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, Mor… 7 5 $977.00 $928.15 $315.83 $1,446.85 $726.89 2026-03-03
12031 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 2.5 Cm O… 13 6 $713.00 $677.35 $367.54 $980.40 $713.00 2026-03-03
12032 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 2.6-7.5 … 13 6 $748.49 $711.07 $315.83 $1,235.95 $674.06 2026-03-03
12034 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 7.6-12.5… 19 6 $2,568.68 $2,440.25 $315.83 $2,568.68 $1,456.35 2026-03-03
12035 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 12.6-20.… 10 6 $912.00 $866.40 $678.53 $3,026.12 $1,715.70 2026-03-03
12036 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 20.1-30.… 11 6 $998.40 $948.48 $315.83 $3,657.81 $2,073.85 2026-03-03
12037 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, More Tha… 5 5 $1,096.80 $1,041.96 $315.83 $2,451.95 $1,096.80 2026-03-03
12041 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 2.5 Cm Or Less 13 6 $746.00 $708.70 $315.83 $883.04 $518.00 2026-03-03
12042 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 2.6-7.5 Cm 15 6 $863.00 $819.85 $315.83 $1,172.91 $642.07 2026-03-03
12044 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 7.6-12.5 Cm 11 6 $840.00 $798.00 $315.83 $1,342.15 $840.00 2026-03-03
12045 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 12.6-20.0 Cm 11 6 $916.80 $870.96 $315.83 $1,802.93 $1,022.20 2026-03-03
12046 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 20.1-30.0 Cm 5 5 $707.27 $671.91 $315.83 $1,446.85 $707.27 2026-03-03
12047 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, More Than 30.0 C… 5 5 $1,195.20 $1,135.44 $315.83 $1,446.85 $1,195.20 2026-03-03
12051 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 C… 13 6 $794.00 $754.30 $339.26 $1,186.32 $672.60 2026-03-03
12052 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.6-5… 13 6 $748.49 $711.07 $468.72 $907.00 $748.49 2026-03-03
12053 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1-7… 13 6 $998.00 $948.10 $315.83 $1,615.27 $915.80 2026-03-03
12054 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6-1… 11 6 $880.80 $836.76 $315.83 $1,759.37 $997.50 2026-03-03
12055 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.6-… 11 6 $1,058.40 $1,005.48 $315.83 $2,262.05 $1,282.50 2026-03-03
13100 HCPCS Complicated Repair Of Wound Of Trunk, 1.1-2.5 Cm 13 6 $650.00 $617.50 $291.65 $937.00 $514.41 2026-03-03
13101 HCPCS Complicated Repair Of Wound Of Trunk, 2.6-7.5 Cm 5 5 $987.60 $938.22 $315.83 $987.60 $507.30 2026-03-03
13120 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 1.1-2.5 Cm 9 6 $973.00 $924.35 $291.65 $973.00 $676.00 2026-03-03
13121 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 2.6-7.5 Cm 11 6 $1,099.20 $1,044.24 $315.83 $1,099.20 $894.77 2026-03-03
13131 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 11 6 $895.20 $850.44 $315.83 $1,306.96 $895.20 2026-03-03
13132 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 11 6 $720.00 $684.00 $315.83 $1,673.91 $949.05 2026-03-03
13151 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 1.1-2.5 Cm 13 6 $722.00 $685.90 $315.83 $2,181.62 $722.00 2026-03-03
13152 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 2.6-7.5 Cm 11 6 $1,032.00 $980.40 $315.83 $2,684.30 $1,521.90 2026-03-03
16030 HCPCS Dressing Change Or Removal Of Burn Tissue, More Than 10% Of Total Body Surface 7 6 $533.00 $506.35 $315.83 $533.00 $396.55 2026-03-03
17004 HCPCS Destruction Of Precancer Skin Growth, 15 Or More Growths 5 5 $523.00 $496.85 $315.83 $760.95 $523.00 2026-03-03
17111 HCPCS Destruction Of Skin Growth, 15 Or More Growths 5 5 $396.00 $376.20 $294.62 $1,692.90 $396.00 2026-03-03
2120839_1 CDM Room & Board - Private (one Bed) - General Classification 2 2 $1,290.00 $1,225.50 $959.76 $1,290.00 $1,124.88 2026-03-03
2120840_1 CDM Room & Board - Semi-private (two Beds) - General Classification 2 2 $1,260.00 $1,197.00 $937.44 $1,260.00 $1,098.72 2026-03-03
21315 HCPCS Closed Treatment Of Broken Nose Bone With Manipulation 9 6 $700.00 $665.00 $315.83 $1,839.20 $785.00 2026-03-03
21320 HCPCS Closed Treatment Of Broken Nose Bone With Placement Of Stabilizing Device 5 5 $746.00 $708.70 $315.83 $1,854.40 $746.00 2026-03-03
21820 HCPCS Closed Treatment Of Broken Chest Bone 5 5 $555.60 $527.82 $315.83 $555.60 $472.26 2026-03-03
23500 HCPCS Closed Treatment Of Broken Collar Bone 6 6 $622.00 $590.90 $462.77 $760.95 $622.00 2026-03-03
23520 HCPCS Closed Treatment Of Dislocated Joint Between Collar And Chest Bone 5 5 $648.00 $615.60 $315.83 $760.95 $648.00 2026-03-03
23570 HCPCS Closed Treatment Of Broken Shoulder Blade 5 5 $661.00 $627.95 $315.83 $760.95 $661.00 2026-03-03
23600 HCPCS Closed Treatment Of Broken Top Of Upper Arm Bone 7 6 $923.00 $876.85 $315.83 $1,368.00 $923.00 2026-03-03
23650 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation 7 6 $874.00 $830.30 $315.83 $874.00 $844.55 2026-03-03
24560 HCPCS Closed Treatment Of Broken Outer Part Of Upper Arm Bone At Elbow 5 5 $907.00 $861.65 $315.83 $1,368.00 $907.00 2026-03-03
24640 HCPCS Closed Treatment Of Dislocated Forearm Bone On Thumb Side At Elbow With Manipula… 6 6 $430.80 $409.26 $320.52 $760.95 $430.80 2026-03-03
24650 HCPCS Closed Treatment Of Broken Forearm Bone On Thumb Side At Elbow 6 6 $734.00 $697.30 $546.10 $760.95 $734.00 2026-03-03
24670 HCPCS Closed Treatment Of Broken Forearm Bone On Small Finger Side At Elbow 7 6 $823.00 $781.85 $315.83 $1,368.00 $823.00 2026-03-03
25500 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Thumb Side 7 6 $757.00 $719.15 $315.83 $1,368.00 $757.00 2026-03-03
25530 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Small Finger Side 6 6 $732.00 $695.40 $544.61 $1,368.00 $732.00 2026-03-03
25560 HCPCS Closed Treatment Of Broken Midpart Of Both Forearm Bones 7 6 $769.00 $730.55 $315.83 $1,368.00 $769.00 2026-03-03
25600 HCPCS Closed Treatment Of Broken Forearm (radius) Bone At The Wrist Area On The Thumb … 7 6 $830.00 $788.50 $315.83 $1,368.00 $830.00 2026-03-03
25622 HCPCS Closed Treatment Of Broken Wrist Bone Near Base Of Thumb 5 5 $856.00 $813.20 $636.86 $1,368.00 $856.00 2026-03-03
25630 HCPCS Closed Treatment Of Other Broken Wrist Bone 5 5 $872.00 $828.40 $315.83 $872.00 $509.20 2026-03-03
25650 HCPCS Closed Treatment Of Broken Base Of Forearm Bone On Small Finger Side At Wrist 5 5 $912.00 $866.40 $315.83 $1,368.00 $912.00 2026-03-03
26011 HCPCS Complicated Drainage Of Abscess In Finger 6 6 $1,762.72 $1,674.58 $999.40 $1,762.72 $1,537.09 2026-03-03
26070 HCPCS Incision Of Wrist Joint At Finger For Exploration, Fluid Drainage, Or Removal Of… 7 6 $598.00 $568.10 $315.83 $1,368.00 $598.00 2026-03-03
26160 HCPCS Removal Of Growth Of Tendon Finger Or Hand 5 5 $881.62 $837.54 $315.83 $1,951.30 $881.62 2026-03-03
26600 HCPCS Closed Treatment Of Broken Hand Bone 6 6 $811.00 $770.45 $406.60 $811.00 $707.19 2026-03-03
26605 HCPCS Closed Treatment Of Broken Hand Bone With Manipulation 7 6 $914.00 $868.30 $315.83 $914.00 $760.95 2026-03-03
26720 HCPCS Closed Treatment Of Broken Finger Or Thumb At Midportion Or Part Near Hand 6 6 $553.00 $525.35 $411.43 $760.95 $553.00 2026-03-03
26725 HCPCS Closed Treatment Of Broken Finger Or Thumb At Midportion Or Part Near Hand With … 7 6 $978.00 $929.10 $315.83 $1,069.70 $978.00 2026-03-03
26750 HCPCS Closed Treatment Of Broken End Of Finger Or Thumb 6 6 $518.00 $492.10 $385.39 $518.00 $462.30 2026-03-03
26755 HCPCS Closed Treatment Of Broken End Of Finger Or Thumb With Manipulation 7 6 $902.00 $856.90 $315.83 $902.00 $671.09 2026-03-03
26770 HCPCS Closed Treatment Of Dislocated Finger Joint With Manipulation 7 6 $782.00 $742.90 $315.83 $782.00 $760.95 2026-03-03
27250 HCPCS Closed Treatment Of Dislocated Hip 7 6 $678.00 $644.10 $315.83 $678.00 $509.20 2026-03-03
27301 HCPCS Drainage Of Deep Abscess Or Blood Accumulation Of Thigh Or Knee 7 6 $950.62 $903.09 $315.83 $3,451.35 $950.62 2026-03-03
27520 HCPCS Closed Treatment Of Broken Kneecap 7 6 $917.00 $871.15 $315.83 $1,368.00 $917.00 2026-03-03
27560 HCPCS Closed Treatment Of Dislocated Kneecap 7 6 $404.00 $383.80 $300.58 $760.95 $404.00 2026-03-03
27750 HCPCS Closed Treatment Of Broken Middle Part Of Shin Bone 6 6 $989.00 $939.55 $735.82 $1,368.00 $989.00 2026-03-03
27760 HCPCS Closed Treatment Of Inside Portion Of Shin Bone At Ankle 6 6 $917.00 $871.15 $682.25 $1,368.00 $917.00 2026-03-03
27780 HCPCS Closed Treatment Of Broken Middle Or Upper End Of Outside Lower Leg Bone 6 6 $862.00 $818.90 $641.33 $1,368.00 $862.00 2026-03-03
27786 HCPCS Closed Treatment Of Broken Outside Lower Leg Bone At Ankle 6 6 $635.00 $603.25 $472.44 $1,368.00 $635.00 2026-03-03
27808 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle 5 5 $948.00 $900.60 $315.83 $1,368.00 $948.00 2026-03-03
27840 HCPCS Closed Treatment Of Dislocated Ankle 5 5 $562.00 $533.90 $418.13 $760.95 $562.00 2026-03-03
28192 HCPCS Removal Of Foreign Body Of Foot Tissue, Deep 7 6 $406.00 $385.70 $302.06 $1,172.30 $406.00 2026-03-03
28193 HCPCS Complicated Removal Of Foreign Body In Foot 5 5 $674.00 $640.30 $315.83 $1,446.85 $674.00 2026-03-03
28400 HCPCS Closed Treatment Of Broken Heel Bone 5 5 $714.00 $678.30 $315.83 $714.00 $606.90 2026-03-03
28430 HCPCS Closed Treatment Of Broken Ankle Joint Bone 5 5 $624.00 $592.80 $315.83 $1,368.00 $624.00 2026-03-03
28450 HCPCS Treatment Of Broken Foot Bone At Ankle 5 5 $619.00 $588.05 $315.83 $1,368.00 $619.00 2026-03-03
28470 HCPCS Closed Treatment Of Broken Bone In Forefoot Or Midfoot 9 6 $811.00 $770.45 $456.07 $1,368.00 $613.00 2026-03-03
28475 HCPCS Closed Treatment Of Broken Foot With Manipulation 7 6 $883.20 $839.04 $315.83 $1,520.95 $883.20 2026-03-03
28490 HCPCS Closed Treatment Of Broken Great Toe 7 6 $403.00 $382.85 $299.83 $1,368.00 $403.00 2026-03-03
28495 HCPCS Closed Treatment Of Broken Great Toe With Manipulation 7 6 $617.00 $586.15 $315.83 $1,520.95 $617.00 2026-03-03
28505 HCPCS Treatment Of Broken Great Toe 7 6 $935.04 $888.29 $315.83 $2,029.20 $935.04 2026-03-03
28515 HCPCS Closed Treatment Of Broken Toe With Manipulation 7 6 $520.00 $494.00 $315.83 $520.00 $406.60 2026-03-03
28525 HCPCS Treatment Of Broken Toe 5 5 $805.15 $764.89 $315.83 $2,029.20 $805.15 2026-03-03
29065 HCPCS Application Of Shoulder To Hand Cast 5 5 $513.60 $487.92 $315.83 $513.60 $406.60 2026-03-03
29260 HCPCS Placement Of Strapping To Elbow Or Wrist 6 6 $460.79 $437.75 $261.25 $460.79 $401.81 2026-03-03
30901 HCPCS Simple Control Of Nose Bleed 10 6 $316.00 $300.20 $235.10 $810.99 $459.80 2026-03-03
30903 HCPCS Complex Control Of Nose Bleed 7 6 $577.00 $548.15 $315.83 $577.00 $558.60 2026-03-03
30905 HCPCS Initial Control Of Nose Bleed And Insertion Of Packing 11 6 $719.00 $683.05 $315.83 $862.80 $719.00 2026-03-03
36589 HCPCS Removal Of Tunneled Central Venous Tube 6 6 $1,036.80 $984.96 $771.38 $1,036.80 $969.17 2026-03-03
4441941_1 CDM Room & Board - Semi-private (two Beds) - General Classification 2 2 $1,020.00 $969.00 $758.88 $1,020.00 $889.44 2026-03-03
4441947_1 CDM Room & Board - Private (one Bed) - General Classification 2 2 $1,080.00 $1,026.00 $803.52 $1,080.00 $941.76 2026-03-03
45005 HCPCS Drainage Of Superficial Rectal Abscess 5 5 $457.75 $434.86 $315.83 $457.75 $389.09 2026-03-03
46320 HCPCS Removal Of External Hemorrhoid With Blood Clot 5 5 $506.40 $481.08 $315.83 $1,591.25 $506.40 2026-03-03
4866766_1 CDM Nitroprusside 25 mg/mL IV Sol 2 Ml [grks] 5 5 $571.08 $542.53 $424.88 $571.08 $513.97 2026-03-03
4984401_2 CDM Rev - Fs-rural/clinic 4 4 $540.00 $513.00 $315.83 $486.00 $430.38 2026-03-03
5189194_2 CDM Rev - Fs-rural/clinic 4 4 $540.00 $513.00 $315.83 $486.00 $430.38 2026-03-03
5189195_2 CDM Rev - Fs-rural/clinic 4 4 $810.00 $769.50 $315.83 $729.00 $645.57 2026-03-03
53060 HCPCS Drainage Of Abscess Or Cyst Of Skene's Glands 6 6 $558.42 $530.50 $415.46 $558.42 $530.50 2026-03-03
54056 HCPCS Simple Destruction Of Growth Of Penis Using Freezing 5 5 $483.60 $459.42 $315.83 $483.60 $411.06 2026-03-03
56501 HCPCS Simple Destruction Of Growth Of External Female Genitals 5 5 $483.60 $459.42 $315.83 $483.60 $411.06 2026-03-03
5709484_2 CDM Rev - Fs-rural/clinic 4 4 $660.00 $627.00 $315.83 $594.00 $526.02 2026-03-03
5982858_2 CDM Rev - Fs-rural/clinic 4 4 $540.00 $513.00 $315.83 $486.00 $430.38 2026-03-03
6008485_2 CDM Rev - Fs-rural/clinic 4 4 $570.00 $541.50 $315.83 $513.00 $454.29 2026-03-03
6044775_1 CDM Tr M0247 Intravenous Infusion, Sotrovimab, Includes Infusion And Post Administra… 1 1 $540.00 $513.00 $393.71 $393.71 $393.71 2026-03-03
6044776_1 CDM ER M0247 Intravenous Infusion, Sotrovimab, Includes Infusion And Post Administra… 1 1 $540.00 $513.00 $393.71 $393.71 $393.71 2026-03-03
6437408_1 CDM Hypertet 250 Unit/ml Syringe 5 5 $903.56 $858.38 $672.25 $903.56 $813.20 2026-03-03
65222 HCPCS Removal Of Foreign Body In Cornea Using Slit Lamp 6 6 $865.53 $822.25 $413.25 $865.53 $754.74 2026-03-03
6553479_1 CDM Airsupra 90-80 Mcg Inhaler 5 5 $621.22 $590.16 $462.19 $621.22 $559.10 2026-03-03
70336 HCPCS MRI Scan Of Jaw Joint 6 6 $872.98 $829.33 $494.95 $872.98 $761.24 2026-03-03
70450 HCPCS CT Scan Head Or Brain Without Contrast 6 6 $1,080.00 $1,026.00 $430.35 $1,080.00 $941.76 2026-03-03
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 6 6 $960.00 $912.00 $430.35 $960.00 $837.12 2026-03-03
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 6 6 $936.00 $889.20 $430.35 $936.00 $816.19 2026-03-03
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 6 6 $948.00 $900.60 $430.35 $948.00 $826.65 2026-03-03
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 6 6 $960.00 $912.00 $430.35 $960.00 $837.12 2026-03-03
70486 HCPCS CT Scan Of Face Without Contrast 6 6 $936.00 $889.20 $430.35 $936.00 $816.19 2026-03-03
70487 HCPCS CT Scan Of Face With Contrast 6 6 $948.00 $900.60 $430.35 $948.00 $826.65 2026-03-03
70488 HCPCS CT Scan Of Face Before And After Contrast 6 6 $960.00 $912.00 $430.35 $960.00 $837.12 2026-03-03
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 6 6 $936.00 $889.20 $430.35 $936.00 $816.19 2026-03-03
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 6 6 $948.00 $900.60 $430.35 $948.00 $826.65 2026-03-03
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 6 6 $960.00 $912.00 $430.35 $960.00 $837.12 2026-03-03
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 6 6 $1,830.00 $1,738.50 $1,089.88 $1,830.00 $1,595.76 2026-03-03
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 6 6 $1,830.00 $1,738.50 $1,090.75 $1,830.00 $1,595.76 2026-03-03
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 6 6 $936.00 $889.20 $494.95 $936.00 $816.19 2026-03-03
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 6 6 $948.00 $900.60 $494.95 $948.00 $826.65 2026-03-03
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 6 6 $960.00 $912.00 $494.95 $960.00 $837.12 2026-03-03
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 6 6 $1,050.59 $998.06 $595.65 $1,050.59 $916.12 2026-03-03
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 6 6 $1,050.59 $998.06 $595.65 $1,050.59 $916.12 2026-03-03
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 6 6 $1,050.59 $998.06 $595.65 $1,050.59 $916.12 2026-03-03
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 6 6 $1,050.59 $998.06 $595.65 $1,050.59 $916.12 2026-03-03
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 6 6 $1,050.59 $998.06 $595.65 $1,050.59 $916.12 2026-03-03
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 6 6 $1,050.59 $998.06 $595.65 $1,050.59 $916.12 2026-03-03
70551 HCPCS MRI Scan Of Brain Without Contrast 6 6 $876.00 $832.20 $494.95 $876.00 $763.87 2026-03-03
70552 HCPCS MRI Scan Of Brain With Contrast 6 6 $888.00 $843.60 $494.95 $888.00 $774.34 2026-03-03
70553 HCPCS MRI Scan Of Brain Before And After Contrast 6 6 $900.00 $855.00 $494.95 $900.00 $784.80 2026-03-03
71250 HCPCS CT Scan Of Chest Without Contrast 6 6 $936.00 $889.20 $430.35 $936.00 $816.19 2026-03-03
71260 HCPCS CT Scan Of Chest With Contrast 6 6 $948.00 $900.60 $430.35 $948.00 $826.65 2026-03-03
71270 HCPCS CT Scan Of Chest Before And After Contrast 6 6 $960.00 $912.00 $430.35 $960.00 $837.12 2026-03-03
71271 HCPCS Low Dose CT Scan Of Chest For Lung Cancer Screening 6 6 $759.04 $721.09 $564.73 $759.04 $721.09 2026-03-03
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 6 6 $1,830.00 $1,738.50 $1,075.89 $1,830.00 $1,595.76 2026-03-03
71550 HCPCS MRI Scan Of Chest Without Contrast 6 6 $840.00 $798.00 $494.95 $840.00 $732.48 2026-03-03
71551 HCPCS MRI Scan Of Chest With Contrast 6 6 $872.98 $829.33 $494.95 $872.98 $761.24 2026-03-03
71552 HCPCS MRI Scan Of Chest Before And After Contrast 6 6 $864.00 $820.80 $494.95 $864.00 $753.41 2026-03-03
71555 HCPCS MRI Scan Of Blood Vessels Of Chest 6 6 $1,050.59 $998.06 $595.65 $1,050.59 $916.12 2026-03-03
72052 HCPCS X-ray Of Upper Spine, 6 Or More Views 6 6 $450.14 $427.63 $255.21 $450.14 $392.52 2026-03-03
72082 HCPCS X-ray Of Entire Middle And Lower Spine, 2-3 Views 6 6 $462.00 $438.90 $343.73 $462.00 $438.90 2026-03-03
72125 HCPCS CT Scan Of Upper Spine Without Contrast 6 6 $948.00 $900.60 $430.35 $948.00 $826.65 2026-03-03
72126 HCPCS CT Scan Of Upper Spine With Contrast 6 6 $960.00 $912.00 $430.35 $960.00 $837.12 2026-03-03
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 6 6 $990.00 $940.50 $430.35 $990.00 $863.28 2026-03-03
72128 HCPCS CT Scan Of Middle Spine Without Contrast 6 6 $936.00 $889.20 $430.35 $936.00 $816.19 2026-03-03
72129 HCPCS CT Scan Of Middle Spine With Contrast 6 6 $948.00 $900.60 $430.35 $948.00 $826.65 2026-03-03
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 6 6 $960.00 $912.00 $430.35 $960.00 $837.12 2026-03-03
72131 HCPCS CT Scan Of Lower Spine Without Contrast 6 6 $936.00 $889.20 $430.35 $936.00 $816.19 2026-03-03
72132 HCPCS CT Scan Of Lower Spine With Contrast 6 6 $948.00 $900.60 $430.35 $948.00 $826.65 2026-03-03
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 6 6 $960.00 $912.00 $430.35 $960.00 $837.12 2026-03-03
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 6 6 $876.00 $832.20 $494.95 $876.00 $763.87 2026-03-03
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 6 6 $888.00 $843.60 $494.95 $888.00 $774.34 2026-03-03
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 6 6 $936.00 $889.20 $494.95 $936.00 $816.19 2026-03-03
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 6 6 $948.00 $900.60 $494.95 $948.00 $826.65 2026-03-03
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 6 6 $936.00 $889.20 $494.95 $936.00 $816.19 2026-03-03
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 6 6 $948.00 $900.60 $494.95 $948.00 $826.65 2026-03-03
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 6 6 $900.00 $855.00 $494.95 $900.00 $784.80 2026-03-03
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 6 6 $960.00 $912.00 $494.95 $960.00 $837.12 2026-03-03
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 6 6 $960.00 $912.00 $494.95 $960.00 $837.12 2026-03-03
72159 HCPCS MRI Scan Of Blood Vessels Of Spinal Canal 6 6 $1,050.59 $998.06 $595.65 $1,050.59 $916.12 2026-03-03
72192 HCPCS CT Scan Of Pelvis Without Contrast 6 6 $936.00 $889.20 $430.35 $936.00 $816.19 2026-03-03
72193 HCPCS CT Scan Of Pelvis With Contrast 6 6 $948.00 $900.60 $430.35 $948.00 $826.65 2026-03-03
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 6 6 $960.00 $912.00 $430.35 $960.00 $837.12 2026-03-03
72195 HCPCS MRI Scan Of Pelvis Without Contrast 6 6 $936.00 $889.20 $494.95 $936.00 $816.19 2026-03-03
72196 HCPCS MRI Scan Of Pelvis With Contrast 6 6 $948.00 $900.60 $494.95 $948.00 $826.65 2026-03-03
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 6 6 $960.00 $912.00 $494.95 $960.00 $837.12 2026-03-03
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 6 6 $1,050.59 $998.06 $595.65 $1,050.59 $916.12 2026-03-03
73200 HCPCS CT Scan Of Arm Without Contrast 26 6 $870.00 $826.50 $430.35 $960.00 $870.00 2026-03-03
73201 HCPCS CT Scan Of Arm With Contrast 18 6 $900.00 $855.00 $430.35 $900.00 $784.80 2026-03-03
73202 HCPCS CT Scan Of Arm Before And After Contrast 18 6 $960.00 $912.00 $430.35 $960.00 $837.12 2026-03-03
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 12 6 $1,866.62 $1,773.29 $1,361.52 $1,903.24 $1,771.46 2026-03-03
73218 HCPCS MRI Scan Of Arm Without Contrast 18 6 $876.00 $832.20 $494.95 $876.00 $763.87 2026-03-03
73219 HCPCS MRI Scan Of Arm With Contrast 18 6 $900.00 $855.00 $494.95 $900.00 $784.80 2026-03-03
73220 HCPCS MRI Scan Of Arm Before And After Contrast 18 6 $960.00 $912.00 $494.95 $960.00 $837.12 2026-03-03
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 18 6 $888.00 $843.60 $494.95 $888.00 $774.34 2026-03-03
73222 HCPCS MRI Scan Of Arm Joint With Contrast 18 6 $960.00 $912.00 $494.95 $960.00 $837.12 2026-03-03
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 18 6 $960.00 $912.00 $494.95 $960.00 $837.12 2026-03-03
73225 HCPCS MRI Scan Of Blood Vessels Of Arm 6 6 $1,050.59 $998.06 $595.65 $1,050.59 $916.12 2026-03-03
73700 HCPCS CT Scan Of Leg Without Contrast 18 6 $936.00 $889.20 $430.35 $936.00 $816.19 2026-03-03
73701 HCPCS CT Scan Of Leg With Contrast Material 18 6 $960.00 $912.00 $430.35 $960.00 $837.12 2026-03-03
73702 HCPCS CT Scan Of Leg Before And After Contrast 18 6 $960.00 $912.00 $430.35 $960.00 $837.12 2026-03-03
73718 HCPCS MRI Scan Of Leg Without Contrast 18 6 $876.00 $832.20 $494.95 $876.00 $763.87 2026-03-03
73719 HCPCS MRI Scan Of Leg With Contrast 18 6 $888.00 $843.60 $494.95 $888.00 $774.34 2026-03-03
73720 HCPCS MRI Scan Of Leg Before And After Contrast 18 6 $960.00 $912.00 $494.95 $960.00 $837.12 2026-03-03
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 18 6 $876.00 $832.20 $494.95 $876.00 $763.87 2026-03-03
73722 HCPCS MRI Scan Of Leg Joint With Contrast 18 6 $900.00 $855.00 $494.95 $900.00 $784.80 2026-03-03
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 18 6 $960.00 $912.00 $494.95 $960.00 $837.12 2026-03-03
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 18 6 $1,050.59 $998.06 $595.65 $1,050.59 $916.12 2026-03-03
74150 HCPCS CT Scan Of Abdomen Without Contrast 6 6 $936.00 $889.20 $430.35 $936.00 $816.19 2026-03-03
74160 HCPCS CT Scan Of Abdomen With Contrast 6 6 $948.00 $900.60 $430.35 $948.00 $826.65 2026-03-03
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 6 6 $960.00 $912.00 $430.35 $960.00 $837.12 2026-03-03
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 6 6 $2,827.18 $2,685.82 $1,602.92 $2,827.18 $2,465.30 2026-03-03
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 6 6 $759.04 $721.09 $430.35 $759.04 $661.88 2026-03-03
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 6 6 $759.04 $721.09 $430.35 $759.04 $661.88 2026-03-03
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 6 6 $759.04 $721.09 $430.35 $759.04 $661.88 2026-03-03
74181 HCPCS MRI Scan Of Abdomen Without Contrast 6 6 $872.98 $829.33 $494.95 $872.98 $761.24 2026-03-03
74182 HCPCS MRI Scan Of Abdomen With Contrast 6 6 $1,068.00 $1,014.60 $494.95 $1,068.00 $931.30 2026-03-03
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 6 6 $1,080.00 $1,026.00 $494.95 $1,080.00 $941.76 2026-03-03
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 6 6 $1,050.59 $998.06 $595.65 $1,050.59 $916.12 2026-03-03
74220 HCPCS Single Contrast X-ray Of Esophagus 6 6 $448.59 $426.16 $254.33 $448.59 $391.17 2026-03-03
74246 HCPCS Double Contrast X-ray Of Upper Digestive Tract 6 6 $601.20 $571.14 $334.74 $601.20 $524.25 2026-03-03
74250 HCPCS Single Contrast X-ray Of Small Intestine 6 6 $517.20 $491.34 $292.79 $517.20 $451.00 2026-03-03
74270 HCPCS Single Contrast X-ray Of Large Intestine 6 6 $1,670.56 $1,587.03 $947.15 $1,670.56 $1,456.73 2026-03-03
74400 HCPCS Imaging Of Urinary Tract With Injection Of Contrast Into A Vein 6 6 $798.53 $758.60 $452.73 $798.53 $696.32 2026-03-03
75557 HCPCS MRI Scan Of Heart Without Contrast 6 6 $872.98 $829.33 $494.95 $872.98 $761.24 2026-03-03
75561 HCPCS MRI Scan Of Heart Before And After Contrast 6 6 $872.98 $829.33 $494.95 $872.98 $761.24 2026-03-03
76536 HCPCS Ultrasound Scan Of Head And Neck Soft Tissue 6 6 $797.58 $757.70 $452.20 $797.58 $695.49 2026-03-03
77075 HCPCS Complete X-ray Of Body Bones 6 6 $900.00 $855.00 $476.33 $900.00 $784.80 2026-03-03
77084 HCPCS MRI Scan Of Bone Marrow 6 6 $840.00 $798.00 $494.95 $840.00 $732.48 2026-03-03
80204 HCPCS Measurement Of Methotrexate 6 6 $512.00 $486.40 $197.48 $512.00 $448.00 2026-03-03
80280 HCPCS Measurement Of Vedolizumab 6 6 $460.00 $437.00 $177.42 $460.00 $402.50 2026-03-03
84445 HCPCS Thyroid Stimulating Immune Globulins (thyroid Related Protein) Level 6 6 $1,092.00 $1,037.40 $441.95 $1,092.00 $683.92 2026-03-03
87506 HCPCS Detection Test By Nucleic Acid For Digestive Tract Pathogen, Multiple Types Or S… 6 6 $942.00 $894.90 $438.06 $2,477.37 $821.42 2026-03-03
87633 HCPCS Detection Test By Nucleic Acid For Multiple Types Of Respiratory Virus, Multiple… 6 6 $2,030.61 $1,929.08 $1,315.75 $8,463.18 $1,770.69 2026-03-03
87799 HCPCS Detection Test By Nucleic Acid For Organism, Quantification 6 6 $1,732.80 $1,646.16 $236.64 $1,732.80 $1,015.77 2026-03-03
87902 HCPCS Analysis Test By Nucleic Acid For Hepatitis C Virus 6 6 $739.20 $702.24 $519.61 $1,903.07 $644.58 2026-03-03
88184 HCPCS Flow Cytometry Technique For DNA Or Cell Analysis, First Marker 6 6 $525.60 $499.32 $164.13 $525.60 $458.33 2026-03-03
92950 HCPCS Manual Attempt To Restore Blood Circulation And Breathing 6 6 $513.44 $487.77 $291.11 $513.44 $447.72 2026-03-03
93017 HCPCS Exercise Or Drug-induced Heart Stress Test With Electrocardiogram (ecg) 6 6 $772.80 $734.16 $335.20 $772.80 $673.88 2026-03-03
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 6 6 $2,541.87 $2,414.78 $1,441.15 $2,541.87 $2,216.51 2026-03-03
93307 HCPCS Ultrasound Of Heart 6 6 $955.09 $907.34 $541.50 $955.09 $832.84 2026-03-03
93308 HCPCS Ultrasound Of Heart, Follow-up 6 6 $955.09 $907.34 $541.50 $955.09 $832.84 2026-03-03
93325 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate And Valve Function 6 6 $720.00 $684.00 $452.20 $720.00 $627.84 2026-03-03
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 6 6 $797.58 $757.70 $452.20 $797.58 $695.49 2026-03-03
93882 HCPCS Ultrasound Of One Side Of Head And Neck Blood Flow 6 6 $797.58 $757.70 $452.20 $797.58 $695.49 2026-03-03
93922 HCPCS Ultrasound Study Of Arm And Leg Arteries 6 6 $996.00 $946.20 $452.20 $996.00 $868.51 2026-03-03
93923 HCPCS Complete Ultrasound Study Of Arm And Leg Arteries 6 6 $900.00 $855.00 $452.20 $900.00 $784.80 2026-03-03
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 6 6 $900.00 $855.00 $452.20 $900.00 $784.80 2026-03-03
93926 HCPCS Ultrasound Of One Leg Arteries Or Artery Grafts 6 6 $720.00 $684.00 $452.20 $720.00 $627.84 2026-03-03
93931 HCPCS Ultrasound Of One Arm Arteries Or Artery Grafts 6 6 $797.58 $757.70 $452.20 $797.58 $695.49 2026-03-03
93970 HCPCS Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 6 6 $900.00 $855.00 $452.20 $900.00 $784.80 2026-03-03
93971 HCPCS Ultrasound Study Of One Arm Or Leg Veins With Compression And Maneuvers 6 6 $797.58 $757.70 $452.20 $797.58 $695.49 2026-03-03
93975 HCPCS Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 6 6 $996.00 $946.20 $452.20 $996.00 $868.51 2026-03-03
93976 HCPCS Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 6 6 $576.64 $547.81 $429.02 $576.64 $514.42 2026-03-03
93978 HCPCS Complete Ultrasound Of Aorta, Vena Cava, Groin Vessels Or Bypass Grafts 6 6 $996.00 $946.20 $452.20 $996.00 $868.51 2026-03-03
99283 HCPCS Emergency Department Visit With Low Level Of Medical Decision Making 18 6 $676.52 $642.69 $40.48 $676.52 $383.56 2026-03-03
99284 HCPCS Emergency Department Visit With Moderate Level Of Medical Decision Making 18 6 $1,153.40 $1,095.73 $98.48 $1,153.40 $653.94 2026-03-03
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 18 6 $1,792.62 $1,702.99 $98.48 $1,792.62 $1,016.35 2026-03-03
99291 HCPCS Critical Care, First 30-74 Minutes 12 6 $1,162.58 $1,104.45 $122.27 $1,695.15 $710.21 2026-03-03
A0426 HCPCS Ambulance Service, Advanced Life Support, Non-emergency Transport, Level 1 (als … 6 6 $660.00 $627.00 $491.04 $660.00 $627.00 2026-03-03
A0427 HCPCS Ambulance Service, Advanced Life Support, Emergency Transport, Level 1 (als 1 - … 6 6 $786.00 $746.70 $584.78 $786.00 $746.70 2026-03-03
A0428 HCPCS Ambulance Service, Basic Life Support, Non-emergency Transport, (bls) 6 6 $540.00 $513.00 $401.76 $540.00 $513.00 2026-03-03
A0429 HCPCS Ambulance Service, Basic Life Support, Emergency Transport (bls-emergency) 6 6 $660.00 $627.00 $491.04 $660.00 $627.00 2026-03-03
A0433 HCPCS Advanced Life Support, Level 2 (als 2) 6 6 $990.00 $940.50 $736.56 $990.00 $940.50 2026-03-03
C8929 HCPCS Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi… 6 6 $2,280.00 $2,166.00 $1,441.15 $2,280.00 $1,988.16 2026-03-03
J0248 HCPCS Injection, Remdesivir, 1 Mg 6 6 $1,028.66 $977.23 $765.32 $1,028.66 $977.23 2026-03-03
J0840 HCPCS Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 6 6 $5,420.81 $5,149.77 $3,710.95 $5,420.81 $4,726.94 2026-03-03
J0897 HCPCS Injection, Denosumab, 1 Mg 10 6 $3,206.66 $3,046.33 $23.34 $3,967.31 $3,206.66 2026-03-03
J1610 HCPCS Injection, Glucagon Hydrochloride, Per 1 Mg 14 6 $534.54 $507.81 $163.58 $562.00 $407.91 2026-03-03
J1670 HCPCS Injection, Tetanus Immune Globulin, Human, Up To 250 Units 10 6 $778.44 $739.52 $528.74 $903.56 $778.44 2026-03-03
J2182 HCPCS Injection, Mepolizumab, 1 Mg 6 6 $6,560.23 $6,232.22 $35.80 $6,560.23 $5,720.52 2026-03-03
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 6 6 $7,250.83 $6,888.29 $5,394.62 $7,250.83 $6,888.29 2026-03-03
J2997 HCPCS Injection, Alteplase Recombinant, 1 Mg 6 6 $15,650.57 $14,868.04 $107.24 $15,650.57 $13,647.30 2026-03-03
J3101 HCPCS Injection, Tenecteplase, 1 Mg 6 6 $11,818.10 $11,227.20 $153.82 $11,818.10 $10,305.39 2026-03-03
M0220 HCPCS Injection, Tixagevimab And Cilgavimab, For The Pre-exposure Prophylaxis Only, Fo… 6 6 $600.00 $570.00 $446.40 $600.00 $570.00 2026-03-03
P9021 HCPCS Red Blood Cells, Each Unit 6 6 $736.80 $699.96 $548.18 $736.80 $699.96 2026-03-03
Q0138 HCPCS Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd … 6 6 $578.00 $549.10 $1.30 $578.00 $504.01 2026-03-03
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