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

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Hospital

ELLINWOOD DISTRICT HOSPITAL

Ellinwood, KS · CCN 171301 · Rates published

Your selected procedure

You selected 93306 (HCPCS)

Ultrasound of heart with color-depicted blood flow, rate, direction and valve function

This hospital’s price: $1,390 across 5 payers

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbEDHELLINWOODKS&type=CDMWithoutLabel&fileType=CSV · observed 2026-03-03

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

1,722 distinct procedures filed
5 distinct payers
31,066 rate rows
2026-03-03 last MRF observed
Data quality

30,846 of 31,066 rate rows are consumer-grade (99.3%)

220 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 220
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbEDHELLINWOODKS&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/Ellinwood_V2.aspx
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-17
Content fingerprint 2bb7584e08e5cd60… · 7,780,786 bytes · first seen 2026-05-09

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
4441253_1
CDM 		Praxbind 5g Dose(2x 2.5g/50ml) 5 $116,865.00 $116,865.00 $116,865.00 nat. median
$116,865
1.0× median
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 5 $9,356.82 $9,356.82 $9,356.82 nat. median
$3,787
outlier · 2.5×
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 5 $9,168.55 $9,168.55 $9,168.55 nat. median
$155
outlier · 59.3×
J0717
HCPCS 		Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm… 5 $7,468.57 $7,468.57 $7,468.57 nat. median
$1,635
outlier · 4.6×
57288
HCPCS 		Creation Of Sling Around Urethra In Female To Control Leakage 5 $6,268.50 $6,268.50 $6,268.50 nat. median
$5,177
1.2× median
47562
HCPCS 		Removal Of Gallbladder Using An Endoscope 5 $6,209.00 $6,209.00 $6,209.00 nat. median
$5,988
1.0× median
J0491
HCPCS 		Injection, Anifrolumab-fnia, 1 Mg 5 $5,883.60 $5,883.60 $5,883.60 nat. median
$62
outlier · 94.4×
J2997
HCPCS 		Injection, Alteplase Recombinant, 1 Mg 5 $197.03 $10,534.04 $5,365.53 nat. median
$500
outlier · 10.7×
J1306
HCPCS 		Injection, Inclisiran, 1 Mg 5 $4,294.51 $4,294.51 $4,294.51 nat. median
$44
outlier · 98.2×
55500
HCPCS 		Removal Of Fluid Collection In Sperm Cord 5 $3,857.00 $3,857.00 $3,857.00 nat. median
$3,587
1.1× median
49505
HCPCS 		Repair Of Groin Hernia (5 Years Or Older) 5 $3,629.50 $3,629.50 $3,629.50 nat. median
$3,855
0.9× median
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 5 $3,615.79 $3,615.79 $3,615.79 nat. median
$1,659
outlier · 2.2×
52601
HCPCS 		Removal Of Prostate Gland Using An Electrocautery Knife Through Urethra With Con… 5 $3,454.50 $3,454.50 $3,454.50 nat. median
$5,338
0.6× median
J0897
HCPCS 		Injection, Denosumab, 1 Mg 5 $2,244.66 $4,121.10 $3,182.88 nat. median
$1,982
1.6× median
J3262
HCPCS 		Injection, Tocilizumab, 1 Mg 5 $2,905.31 $2,905.31 $2,905.31 nat. median
$1,413
outlier · 2.1×
J3247
HCPCS 		Injection, Secukinumab, Intravenous, 1 Mg 5 $2,739.56 $2,739.56 $2,739.56 nat. median
$50
outlier · 55.1×
54161
HCPCS 		Removal Of Foreskin (older Than 28 Days) 5 $2,625.00 $2,625.00 $2,625.00 nat. median
$2,292
1.1× median
52320
HCPCS 		Removal Of Stone In Ureter Using An Endoscope 5 $2,450.00 $2,450.00 $2,450.00 nat. median
$3,744
0.7× median
J3032
HCPCS 		Injection, Eptinezumab-jjmr, 1 Mg 5 $2,415.15 $2,415.15 $2,415.15 nat. median
$73
outlier · 33.2×
J1602
HCPCS 		Injection, Golimumab, 1 Mg, For Intravenous Use 5 $2,387.31 $2,387.31 $2,387.31 nat. median
$261
outlier · 9.1×
J0401
HCPCS 		Injection, Aripiprazole (abilify Maintena), 1 Mg 5 $2,349.30 $2,349.30 $2,349.30 nat. median
$1,912
1.2× median
55060
HCPCS 		Repair Of Fluid Collection In Testicle And Sperm Reservoir 5 $2,327.50 $2,327.50 $2,327.50 nat. median
$3,601
0.6× median
55041
HCPCS 		Removal Of Fluid Collection In Both Testicles And Sperm Reservoirs 5 $2,310.00 $2,310.00 $2,310.00 nat. median
$3,911
0.6× median
55040
HCPCS 		Removal Of Fluid Collection In Testicle And Sperm Reservoir 5 $2,310.00 $2,310.00 $2,310.00 nat. median
$3,679
0.6× median
27562
HCPCS 		Closed Treatment Of Dislocated Kneecap Under Anesthesia 5 $2,240.00 $2,240.00 $2,240.00 nat. median
$660
outlier · 3.4×
55250
HCPCS 		Removal Of Sperm Duct 5 $2,138.50 $2,138.50 $2,138.50 nat. median
$2,136
1.0× median
54150
HCPCS 		Removal Of Foreskin Using Clamp Or Device 5 $2,138.50 $2,138.50 $2,138.50 nat. median
$1,707
1.3× median
J2315
HCPCS 		Injection, Naltrexone, Depot Form, 1 Mg 5 $2,023.34 $2,023.34 $2,023.34 nat. median
$10
outlier · 195.3×
70471
HCPCS 		Computed Tomographic Angiography (cta), Head And Neck, With Contrast Material(s)… 5 $2,016.00 $2,016.00 $2,016.00 nat. median
$815
outlier · 2.5×
81229
HCPCS 		Genome-wide Microarray Analysis For Copy Number And Single Nucleotide Polymorphi… 5 $2,006.55 $2,006.55 $2,006.55 nat. median
$1,323
1.5× median
28090
HCPCS 		Removal Of Growth Of Tendon Covering Or Joint Capsule Of Foot 5 $1,995.00 $1,995.00 $1,995.00 nat. median
$2,008
1.0× median
52287
HCPCS 		Exam With Injections Of Chemical For Destruction Of Bladder Using An Endoscope 5 $1,960.00 $1,960.00 $1,960.00 nat. median
$2,264
0.9× median
52250
HCPCS 		Insertion Of Radioactive Substance Of Bladder And Urethra Using An Endoscope 5 $1,750.00 $2,135.00 $1,942.50 nat. median
$3,704
0.5× median
Q5108
HCPCS 		Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 5 $1,918.10 $1,918.10 $1,918.10 nat. median
$1,244
1.5× median
52310
HCPCS 		Simple Removal Of Foreign Body, Stone, Or Stent In Urethra Or Bladder Using An E… 5 $1,750.00 $1,750.00 $1,750.00 nat. median
$2,232
0.8× median
88185
HCPCS 		Flow Cytometry Technique For DNA Or Cell Analysis, Each Additional Marker 5 $1,705.20 $1,705.20 $1,705.20 nat. median
$64
outlier · 26.8×
J3111
HCPCS 		Injection, Romosozumab-aqqg, 1 Mg 5 $1,636.35 $1,636.35 $1,636.35 nat. median
$696
outlier · 2.4×
J0129
HCPCS 		Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 5 $1,386.13 $1,855.35 $1,620.74 nat. median
$902
1.8× median
46320
HCPCS 		Removal Of External Hemorrhoid With Blood Clot 5 $1,617.00 $1,617.00 $1,617.00 nat. median
$1,319
1.2× median
J0490
HCPCS 		Injection, Belimumab, 10 Mg 5 $742.80 $2,475.87 $1,609.34 nat. median
$1,026
1.6× median
78264
HCPCS 		Nuclear Medicine Study Of Stomach To Assess Emptying 5 $1,543.50 $1,543.50 $1,543.50 nat. median
$716
outlier · 2.2×
74174
HCPCS 		CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 5 $1,540.00 $1,540.00 $1,540.00 nat. median
$998
1.5× median
59409
HCPCS 		Vaginal Delivery 5 $1,540.00 $1,540.00 $1,540.00 nat. median
$3,148
outlier · 0.5×
46221
HCPCS 		Removal Of External Hemorrhoids By Rubber Banding 5 $1,473.50 $1,540.00 $1,506.75 nat. median
$1,043
1.4× median
43246
HCPCS 		Insertion Of Stomach Tube Using A Flexible Endoscope 5 $1,494.50 $1,494.50 $1,494.50 nat. median
$2,129
0.7× median
54162
HCPCS 		Removal Of Scar Tissue After Foreskin Removal 5 $1,400.00 $1,400.00 $1,400.00 nat. median
$2,199
0.6× median
54001
HCPCS 		Incision Of Foreskin 5 $1,400.00 $1,400.00 $1,400.00 nat. median
$2,324
0.6× median
54840
HCPCS 		Removal Of Fluid Accumulation In Sperm Reservoir 5 $1,400.00 $1,400.00 $1,400.00 nat. median
$2,358
0.6× median
52281
HCPCS 		Dilation Of Urethra Using An Endoscope 5 $1,400.00 $1,400.00 $1,400.00 nat. median
$2,224
0.6× median
93306
HCPCS 		Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 5 $1,389.50 $1,389.50 $1,389.50 nat. median
$993
1.4× median

Other procedures at this hospital

Browse this hospital's 1,722 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
4441253_1 CDM Praxbind 5g Dose(2x 2.5g/50ml) 10 5 $166,950.00 $141,907.50 $116,865.00 $116,865.00 $116,865.00 2026-03-03
J3101 HCPCS Injection, Tenecteplase, 1 Mg 10 5 $13,366.89 $11,361.86 $9,356.82 $9,356.82 $9,356.82 2026-03-03
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 10 5 $13,097.93 $11,133.24 $9,168.55 $9,168.55 $9,168.55 2026-03-03
J0717 HCPCS Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm… 10 5 $10,669.39 $9,068.98 $7,468.57 $7,468.57 $7,468.57 2026-03-03
57288 HCPCS Creation Of Sling Around Urethra In Female To Control Leakage 10 5 $8,955.00 $7,611.75 $6,268.50 $6,268.50 $6,268.50 2026-03-03
47562 HCPCS Removal Of Gallbladder Using An Endoscope 10 5 $8,870.00 $7,539.50 $6,209.00 $6,209.00 $6,209.00 2026-03-03
J0491 HCPCS Injection, Anifrolumab-fnia, 1 Mg 10 5 $8,405.14 $7,144.37 $5,883.60 $5,883.60 $5,883.60 2026-03-03
J2997 HCPCS Injection, Alteplase Recombinant, 1 Mg 20 5 $7,665.05 $6,515.30 $197.03 $10,534.04 $5,365.53 2026-03-03
J1306 HCPCS Injection, Inclisiran, 1 Mg 10 5 $6,135.02 $5,214.77 $4,294.51 $4,294.51 $4,294.51 2026-03-03
55500 HCPCS Removal Of Fluid Collection In Sperm Cord 10 5 $5,510.00 $4,683.50 $3,857.00 $3,857.00 $3,857.00 2026-03-03
49505 HCPCS Repair Of Groin Hernia (5 Years Or Older) 10 5 $5,185.00 $4,407.25 $3,629.50 $3,629.50 $3,629.50 2026-03-03
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 10 5 $5,165.42 $4,390.61 $3,615.79 $3,615.79 $3,615.79 2026-03-03
52601 HCPCS Removal Of Prostate Gland Using An Electrocautery Knife Through Urethra With Con… 10 5 $4,935.00 $4,194.75 $3,454.50 $3,454.50 $3,454.50 2026-03-03
J0897 HCPCS Injection, Denosumab, 1 Mg 20 5 $4,546.98 $3,864.93 $2,244.66 $4,121.10 $3,182.88 2026-03-03
J3262 HCPCS Injection, Tocilizumab, 1 Mg 10 5 $4,150.44 $3,527.87 $2,905.31 $2,905.31 $2,905.31 2026-03-03
J3247 HCPCS Injection, Secukinumab, Intravenous, 1 Mg 10 5 $3,913.65 $3,326.60 $2,739.56 $2,739.56 $2,739.56 2026-03-03
54161 HCPCS Removal Of Foreskin (older Than 28 Days) 10 5 $3,750.00 $3,187.50 $2,625.00 $2,625.00 $2,625.00 2026-03-03
52320 HCPCS Removal Of Stone In Ureter Using An Endoscope 10 5 $3,500.00 $2,975.00 $2,450.00 $2,450.00 $2,450.00 2026-03-03
J3032 HCPCS Injection, Eptinezumab-jjmr, 1 Mg 10 5 $3,450.22 $2,932.69 $2,415.15 $2,415.15 $2,415.15 2026-03-03
J1602 HCPCS Injection, Golimumab, 1 Mg, For Intravenous Use 10 5 $3,410.44 $2,898.87 $2,387.31 $2,387.31 $2,387.31 2026-03-03
J0401 HCPCS Injection, Aripiprazole (abilify Maintena), 1 Mg 10 5 $3,356.14 $2,852.72 $2,349.30 $2,349.30 $2,349.30 2026-03-03
55060 HCPCS Repair Of Fluid Collection In Testicle And Sperm Reservoir 10 5 $3,325.00 $2,826.25 $2,327.50 $2,327.50 $2,327.50 2026-03-03
55040 HCPCS Removal Of Fluid Collection In Testicle And Sperm Reservoir 10 5 $3,300.00 $2,805.00 $2,310.00 $2,310.00 $2,310.00 2026-03-03
55041 HCPCS Removal Of Fluid Collection In Both Testicles And Sperm Reservoirs 10 5 $3,300.00 $2,805.00 $2,310.00 $2,310.00 $2,310.00 2026-03-03
27562 HCPCS Closed Treatment Of Dislocated Kneecap Under Anesthesia 10 5 $3,200.00 $2,720.00 $2,240.00 $2,240.00 $2,240.00 2026-03-03
55250 HCPCS Removal Of Sperm Duct 10 5 $3,055.00 $2,596.75 $2,138.50 $2,138.50 $2,138.50 2026-03-03
54150 HCPCS Removal Of Foreskin Using Clamp Or Device 10 5 $3,055.00 $2,596.75 $2,138.50 $2,138.50 $2,138.50 2026-03-03
J2315 HCPCS Injection, Naltrexone, Depot Form, 1 Mg 10 5 $2,890.49 $2,456.92 $2,023.34 $2,023.34 $2,023.34 2026-03-03
70471 HCPCS Computed Tomographic Angiography (cta), Head And Neck, With Contrast Material(s)… 10 5 $2,880.00 $2,448.00 $2,016.00 $2,016.00 $2,016.00 2026-03-03
81229 HCPCS Genome-wide Microarray Analysis For Copy Number And Single Nucleotide Polymorphi… 10 5 $2,866.50 $2,436.53 $2,006.55 $2,006.55 $2,006.55 2026-03-03
28090 HCPCS Removal Of Growth Of Tendon Covering Or Joint Capsule Of Foot 10 5 $2,850.00 $2,422.50 $1,995.00 $1,995.00 $1,995.00 2026-03-03
52287 HCPCS Exam With Injections Of Chemical For Destruction Of Bladder Using An Endoscope 10 5 $2,800.00 $2,380.00 $1,960.00 $1,960.00 $1,960.00 2026-03-03
52250 HCPCS Insertion Of Radioactive Substance Of Bladder And Urethra Using An Endoscope 20 5 $2,775.00 $2,358.75 $1,750.00 $2,135.00 $1,942.50 2026-03-03
Q5108 HCPCS Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 10 5 $2,740.14 $2,329.12 $1,918.10 $1,918.10 $1,918.10 2026-03-03
52310 HCPCS Simple Removal Of Foreign Body, Stone, Or Stent In Urethra Or Bladder Using An E… 10 5 $2,500.00 $2,125.00 $1,750.00 $1,750.00 $1,750.00 2026-03-03
88185 HCPCS Flow Cytometry Technique For DNA Or Cell Analysis, Each Additional Marker 10 5 $2,436.00 $2,070.60 $1,705.20 $1,705.20 $1,705.20 2026-03-03
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 10 5 $2,337.64 $1,986.99 $1,636.35 $1,636.35 $1,636.35 2026-03-03
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 20 5 $2,315.34 $1,968.04 $1,386.13 $1,855.35 $1,620.74 2026-03-03
46320 HCPCS Removal Of External Hemorrhoid With Blood Clot 10 5 $2,310.00 $1,963.50 $1,617.00 $1,617.00 $1,617.00 2026-03-03
J0490 HCPCS Injection, Belimumab, 10 Mg 20 5 $2,299.05 $1,954.19 $742.80 $2,475.87 $1,609.34 2026-03-03
78264 HCPCS Nuclear Medicine Study Of Stomach To Assess Emptying 10 5 $2,205.00 $1,874.25 $1,543.50 $1,543.50 $1,543.50 2026-03-03
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 10 5 $2,200.00 $1,870.00 $1,540.00 $1,540.00 $1,540.00 2026-03-03
59409 HCPCS Vaginal Delivery 10 5 $2,200.00 $1,870.00 $1,540.00 $1,540.00 $1,540.00 2026-03-03
46221 HCPCS Removal Of External Hemorrhoids By Rubber Banding 20 5 $2,152.50 $1,829.62 $1,473.50 $1,540.00 $1,506.75 2026-03-03
43246 HCPCS Insertion Of Stomach Tube Using A Flexible Endoscope 10 5 $2,135.00 $1,814.75 $1,494.50 $1,494.50 $1,494.50 2026-03-03
52281 HCPCS Dilation Of Urethra Using An Endoscope 10 5 $2,000.00 $1,700.00 $1,400.00 $1,400.00 $1,400.00 2026-03-03
54162 HCPCS Removal Of Scar Tissue After Foreskin Removal 10 5 $2,000.00 $1,700.00 $1,400.00 $1,400.00 $1,400.00 2026-03-03
54840 HCPCS Removal Of Fluid Accumulation In Sperm Reservoir 10 5 $2,000.00 $1,700.00 $1,400.00 $1,400.00 $1,400.00 2026-03-03
54001 HCPCS Incision Of Foreskin 10 5 $2,000.00 $1,700.00 $1,400.00 $1,400.00 $1,400.00 2026-03-03
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 10 5 $1,985.00 $1,687.25 $1,389.50 $1,389.50 $1,389.50 2026-03-03
10121 HCPCS Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Complex 10 5 $1,975.00 $1,678.75 $1,382.50 $1,382.50 $1,382.50 2026-03-03
J0881 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 40 5 $1,963.40 $1,668.89 $316.83 $1,782.21 $1,374.38 2026-03-03
12035 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 12.6-20.… 20 5 $1,915.00 $1,627.75 $406.00 $2,275.00 $1,340.50 2026-03-03
45385 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S… 22 5 $1,894.00 $1,609.90 $490.00 $1,325.80 $1,325.80 2026-03-03
52332 HCPCS Insertion Of Stent In Ureter Using An Endoscope 20 5 $1,845.00 $1,568.25 $133.00 $2,450.00 $1,291.50 2026-03-03
12037 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, More Tha… 10 5 $1,800.00 $1,530.00 $1,260.00 $1,260.00 $1,260.00 2026-03-03
11626 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More Tha… 20 5 $1,800.00 $1,530.00 $504.00 $2,016.00 $1,260.00 2026-03-03
59300 HCPCS Episiotomy Or Repair Of Vagina 10 5 $1,785.00 $1,517.25 $1,249.50 $1,249.50 $1,249.50 2026-03-03
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 10 5 $1,653.98 $1,405.88 $1,157.79 $1,157.79 $1,157.79 2026-03-03
J2357 HCPCS Injection, Omalizumab, 5 Mg 30 5 $1,626.99 $1,382.94 $916.71 $3,666.85 $1,138.89 2026-03-03
54163 HCPCS Repair Of Incomplete Removal Of Foreskin 10 5 $1,580.00 $1,343.00 $1,106.00 $1,106.00 $1,106.00 2026-03-03
11606 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 20 5 $1,505.00 $1,279.25 $427.00 $1,680.00 $1,053.50 2026-03-03
70371 HCPCS Imaging Of Voice Box With Speech Evaluation 10 5 $1,478.20 $1,256.47 $1,034.74 $1,034.74 $1,034.74 2026-03-03
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 10 5 $1,475.00 $1,253.75 $1,032.50 $1,032.50 $1,032.50 2026-03-03
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 10 5 $1,440.00 $1,224.00 $1,008.00 $1,008.00 $1,008.00 2026-03-03
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 10 5 $1,440.00 $1,224.00 $1,008.00 $1,008.00 $1,008.00 2026-03-03
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 10 5 $1,440.00 $1,224.00 $1,008.00 $1,008.00 $1,008.00 2026-03-03
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 10 5 $1,440.00 $1,224.00 $1,008.00 $1,008.00 $1,008.00 2026-03-03
P9037 HCPCS Platelets, Pheresis, Leukocytes Reduced, Irradiated, Each Unit 10 5 $1,419.00 $1,206.15 $993.30 $993.30 $993.30 2026-03-03
81479 HCPCS Molecular Pathology Procedure 20 5 $1,409.96 $1,198.47 $928.90 $1,045.04 $986.97 2026-03-03
73706 HCPCS CT Scan Of Blood Vessels Of Lower Leg With Contrast 20 5 $1,400.00 $1,190.00 $980.00 $980.00 $980.00 2026-03-03
44360 HCPCS Diagnostic Exam Of Small Bowel (excluding Lower Small Intestine) Using An Endosc… 10 5 $1,350.00 $1,147.50 $945.00 $945.00 $945.00 2026-03-03
44361 HCPCS Biopsy Of Small Bowel (except Ileum) Using An Endoscope 12 5 $1,350.00 $1,147.50 $945.00 $945.00 $945.00 2026-03-03
44388 HCPCS Diagnostic Exam Of Large Bowel Using An Endoscope Inserted Through Surgically Cr… 10 5 $1,350.00 $1,147.50 $945.00 $945.00 $945.00 2026-03-03
J1745 HCPCS Injection, Infliximab, Excludes Biosimilar, 10 Mg 20 5 $1,348.62 $1,146.34 $488.24 $1,399.83 $944.03 2026-03-03
52204 HCPCS Biopsy Of Bladder Using An Endoscope 20 5 $1,335.00 $1,134.75 $119.00 $1,750.00 $934.50 2026-03-03
28190 HCPCS Removal Of Foreign Body Of Foot Tissue, Accessed Beneath The Skin 20 5 $1,335.00 $1,134.75 $73.50 $1,795.50 $934.50 2026-03-03
4337499_1 CDM Transport - Observation Charge 10 5 $1,333.00 $1,133.05 $933.10 $933.10 $933.10 2026-03-03
46040 HCPCS Drainage Of Deep Abscess In Rectum 20 5 $1,267.50 $1,077.38 $591.50 $1,183.00 $887.25 2026-03-03
87507 HCPCS Detection Test By Nucleic Acid For Digestive Tract Pathogen, Multiple Types Or S… 10 5 $1,260.00 $1,071.00 $882.00 $882.00 $882.00 2026-03-03
12053 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1-7… 10 5 $1,255.00 $1,066.75 $878.50 $878.50 $878.50 2026-03-03
36573 HCPCS Insertion Of Tube For Infusion With Imaging Guidance And Review By Radiologist, … 10 5 $1,235.00 $1,049.75 $864.50 $864.50 $864.50 2026-03-03
45380 HCPCS Biopsy Of Large Bowel Using A Flexible Endoscope 20 5 $1,192.50 $1,013.62 $455.00 $1,214.50 $834.75 2026-03-03
45384 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using A Flexible Endoscope With Elec… 20 5 $1,165.50 $990.67 $455.00 $1,176.70 $815.85 2026-03-03
5483752_1 CDM Room & Board - Semi-private (two Beds) - General Classification 10 5 $1,150.00 $977.50 $805.00 $805.00 $805.00 2026-03-03
45378 HCPCS Diagnostic Exam Of Large Bowel Using A Flexible Endoscope 20 5 $1,140.50 $969.42 $420.00 $1,176.70 $798.35 2026-03-03
43251 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 20 5 $1,136.00 $965.60 $385.00 $1,205.40 $795.20 2026-03-03
81222 HCPCS Gene Analysis (cystic Fibrosis Transmembrane Conductance Regular) Duplication Or… 10 5 $1,114.00 $946.90 $779.80 $779.80 $779.80 2026-03-03
4474176_1 CDM Operating Room Services - General Classification 10 5 $1,112.50 $945.63 $778.75 $778.75 $778.75 2026-03-03
12055 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.6-… 10 5 $1,100.00 $935.00 $770.00 $770.00 $770.00 2026-03-03
25600 HCPCS Closed Treatment Of Broken Forearm (radius) Bone At The Wrist Area On The Thumb … 20 5 $1,087.50 $924.38 $332.50 $1,190.00 $761.25 2026-03-03
12054 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6-1… 20 5 $1,083.00 $920.55 $560.70 $955.50 $758.10 2026-03-03
6462950_1 CDM Ozempic 0.25-0.5 Mg/dose Pen 10 5 $1,077.37 $915.76 $754.16 $754.16 $754.16 2026-03-03
12034 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 7.6-12.5… 20 5 $1,060.00 $901.00 $91.00 $1,393.00 $742.00 2026-03-03
J0248 HCPCS Injection, Remdesivir, 1 Mg 20 5 $1,046.63 $889.63 $655.20 $810.08 $732.64 2026-03-03
27560 HCPCS Closed Treatment Of Dislocated Kneecap 10 5 $1,045.00 $888.25 $731.50 $731.50 $731.50 2026-03-03
64635 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 20 5 $1,035.00 $879.75 $161.00 $1,288.00 $724.50 2026-03-03
64633 HCPCS Destruction Of Upper Or Middle Spinal Facet Joint Nerves Using Imaging Guidance,… 20 5 $1,035.00 $879.75 $161.00 $1,288.00 $724.50 2026-03-03
43250 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 20 5 $1,007.50 $856.38 $367.50 $1,043.00 $705.25 2026-03-03
43239 HCPCS Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop… 20 5 $1,007.50 $856.38 $385.00 $1,025.50 $705.25 2026-03-03
81206 HCPCS Translocation Analysis (bcr/abl1) Major Breakpoint 20 5 $995.25 $845.97 $464.45 $928.90 $696.67 2026-03-03
64624 HCPCS Destruction Of Nerve Branches Of Knee Using Imaging Guidance 20 5 $987.50 $839.38 $122.50 $1,260.00 $691.25 2026-03-03
64495 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Third And… 20 5 $987.50 $839.38 $45.50 $1,337.00 $691.25 2026-03-03
12006 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 20 5 $971.50 $825.77 $294.00 $1,066.10 $680.05 2026-03-03
93799 HCPCS Other Cardiovascular Service Or Procedure 10 5 $960.00 $816.00 $672.00 $672.00 $672.00 2026-03-03
G0105 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual At High Risk 20 5 $951.00 $808.35 $437.50 $893.90 $665.70 2026-03-03
2120839_1 CDM Room & Board - Private (one Bed) - General Classification 10 5 $950.00 $807.50 $665.00 $665.00 $665.00 2026-03-03
2120847_1 CDM Room & Board - Semi-private (two Beds) - General Classification 10 5 $950.00 $807.50 $665.00 $665.00 $665.00 2026-03-03
5404220_1 CDM Room & Board - Semi-private (two Beds) - General Classification 10 5 $950.00 $807.50 $665.00 $665.00 $665.00 2026-03-03
G0121 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual Not Meeting Criteria For … 20 5 $938.50 $797.73 $420.00 $893.90 $656.95 2026-03-03
12016 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.… 20 5 $925.00 $786.25 $563.50 $731.50 $647.50 2026-03-03
43235 HCPCS Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible… 20 5 $917.50 $779.88 $367.50 $917.00 $642.25 2026-03-03
J1459 HCPCS Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 20 5 $917.28 $779.69 $395.14 $889.06 $642.10 2026-03-03
5483751_1 CDM Room & Board - Semi-private (two Beds) - General Classification 10 5 $900.00 $765.00 $630.00 $630.00 $630.00 2026-03-03
45990 HCPCS Diagnostic Exam Of Anus And Rectum Under Anesthesia 10 5 $880.00 $748.00 $616.00 $616.00 $616.00 2026-03-03
77075 HCPCS Complete X-ray Of Body Bones 10 5 $880.00 $748.00 $616.00 $616.00 $616.00 2026-03-03
12031 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 2.5 Cm O… 20 5 $877.00 $745.45 $210.00 $1,017.80 $613.90 2026-03-03
93229 HCPCS Electrocardiogram (ecg) Up To 30 Days Continuous With Transmission Of Patient Tr… 10 5 $876.00 $744.60 $613.20 $613.20 $613.20 2026-03-03
11106 HCPCS Incision Biopsy, First Skin Growth 10 5 $875.00 $743.75 $612.50 $612.50 $612.50 2026-03-03
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 20 5 $875.00 $743.75 $280.00 $945.00 $612.50 2026-03-03
55700 HCPCS Biopsy Of Prostate Gland 20 5 $865.00 $735.25 $108.50 $1,102.50 $605.50 2026-03-03
62321 HCPCS Injection Of Substance Into Middle Or Upper Spine Canal Using Imaging Guidance 20 5 $842.50 $716.12 $91.00 $1,088.50 $589.75 2026-03-03
J1569 HCPCS Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 20 5 $839.30 $713.40 $95.93 $1,079.10 $587.51 2026-03-03
62323 HCPCS Injection Of Substance Into Lower Spine Canal Using Imaging Guidance 20 5 $837.50 $711.88 $84.00 $1,088.50 $586.25 2026-03-03
P9040 HCPCS Red Blood Cells, Leukocytes Reduced, Irradiated, Each Unit 10 5 $808.50 $687.23 $565.95 $565.95 $565.95 2026-03-03
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 10 5 $805.00 $684.25 $563.50 $563.50 $563.50 2026-03-03
52000 HCPCS Diagnostic Exam Of Bladder And Urethra Using An Endoscope 10 5 $800.00 $680.00 $560.00 $560.00 $560.00 2026-03-03
27301 HCPCS Drainage Of Deep Abscess Or Blood Accumulation Of Thigh Or Knee 10 5 $800.00 $680.00 $560.00 $560.00 $560.00 2026-03-03
99291 HCPCS Critical Care, First 30-74 Minutes 20 5 $800.00 $680.00 $227.50 $892.50 $560.00 2026-03-03
12045 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 12.6-20.0 Cm 10 5 $793.00 $674.05 $555.10 $555.10 $555.10 2026-03-03
6563912_1 CDM Surgery Plamsa Button 10 5 $792.80 $673.88 $554.96 $554.96 $554.96 2026-03-03
64493 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Le… 30 5 $760.00 $646.00 $77.00 $661.50 $532.00 2026-03-03
81340 HCPCS Gene Analysis (t Cell Antigen Receptor Beta) Amplification Methodology 10 5 $757.90 $644.22 $530.53 $530.53 $530.53 2026-03-03
81342 HCPCS Gene Rearrangement Analysis Detection Abnormal Clonal Population (t Cell Antigen… 10 5 $757.90 $644.22 $530.53 $530.53 $530.53 2026-03-03
S9485 HCPCS Crisis Intervention Mental Health Services, Per Diem 10 5 $750.00 $637.50 $525.00 $525.00 $525.00 2026-03-03
70553 HCPCS MRI Scan Of Brain Before And After Contrast 10 5 $750.00 $637.50 $525.00 $525.00 $525.00 2026-03-03
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 10 5 $750.00 $637.50 $525.00 $525.00 $525.00 2026-03-03
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 10 5 $750.00 $637.50 $525.00 $525.00 $525.00 2026-03-03
2120840_1 CDM Room & Board - Semi-private (two Beds) - General Classification 10 5 $750.00 $637.50 $525.00 $525.00 $525.00 2026-03-03
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 10 5 $750.00 $637.50 $525.00 $525.00 $525.00 2026-03-03
5404217_1 CDM Room & Board - Semi-private (two Beds) - General Classification 10 5 $750.00 $637.50 $525.00 $525.00 $525.00 2026-03-03
12015 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6… 20 5 $747.50 $635.38 $315.00 $731.50 $523.25 2026-03-03
70552 HCPCS MRI Scan Of Brain With Contrast 10 5 $725.00 $616.25 $507.50 $507.50 $507.50 2026-03-03
12052 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.6-5… 20 5 $717.50 $609.88 $210.00 $794.50 $502.25 2026-03-03
J1442 HCPCS Injection, Filgrastim (g-csf), Excludes Biosimilars, 1 Microgram 20 5 $716.98 $609.43 $284.05 $719.71 $501.88 2026-03-03
P9016 HCPCS Red Blood Cells, Leukocytes Reduced, Each Unit 10 5 $704.00 $598.40 $492.80 $492.80 $492.80 2026-03-03
64494 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Second Le… 20 5 $702.50 $597.12 $45.50 $938.00 $491.75 2026-03-03
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 10 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
70488 HCPCS CT Scan Of Face Before And After Contrast 10 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 10 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 10 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 10 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
73202 HCPCS CT Scan Of Arm Before And After Contrast 20 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
73702 HCPCS CT Scan Of Leg Before And After Contrast 20 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
71270 HCPCS CT Scan Of Chest Before And After Contrast 10 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 10 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 10 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 10 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
10160 HCPCS Aspiration Of Abscess, Blood, Or Cyst 20 5 $700.00 $595.00 $126.00 $854.00 $490.00 2026-03-03
5404221_1 CDM Room & Board - Semi-private (two Beds) - General Classification 10 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 10 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
11642 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 1.1-… 10 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 10 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
5404238_1 CDM Room & Board - Semi-private (two Beds) - General Classification 10 5 $700.00 $595.00 $490.00 $490.00 $490.00 2026-03-03
J9155 HCPCS Injection, Degarelix, 1 Mg 10 5 $696.82 $592.30 $487.77 $487.77 $487.77 2026-03-03
23650 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation 20 5 $695.00 $590.75 $378.00 $595.00 $486.50 2026-03-03
6519532_1 CDM Surgery Ventralex Mesh 4.3cm 10 5 $688.80 $585.48 $482.16 $482.16 $482.16 2026-03-03
94660 HCPCS Therapy Procedure Using A Positive Pressure Ventilator 20 5 $686.12 $583.20 $136.50 $824.08 $480.29 2026-03-03
43450 HCPCS Dilation Of Esophagus 20 5 $685.00 $582.25 $217.00 $742.00 $479.50 2026-03-03
82139 HCPCS Amino Acid Level, 6 Or More Amino Acids, Quantitative, Each Specimen 10 5 $683.00 $580.55 $478.10 $478.10 $478.10 2026-03-03
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 10 5 $680.00 $578.00 $476.00 $476.00 $476.00 2026-03-03
70551 HCPCS MRI Scan Of Brain Without Contrast 10 5 $680.00 $578.00 $476.00 $476.00 $476.00 2026-03-03
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 20 5 $680.00 $578.00 $476.00 $476.00 $476.00 2026-03-03
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 10 5 $680.00 $578.00 $476.00 $476.00 $476.00 2026-03-03
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 10 5 $680.00 $578.00 $476.00 $476.00 $476.00 2026-03-03
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 20 5 $680.00 $578.00 $476.00 $476.00 $476.00 2026-03-03
6563911_1 CDM Surgery Plasma Loop 10 5 $671.50 $570.78 $470.05 $470.05 $470.05 2026-03-03
45331 HCPCS Biopsy Of Lower Large Bowel Using A Flexible Endoscope 20 5 $667.50 $567.38 $234.50 $700.00 $467.25 2026-03-03
81207 HCPCS Translocation Analysis (bcr/abl1) Minor Breakpoint 10 5 $663.50 $563.98 $464.45 $464.45 $464.45 2026-03-03
41250 HCPCS Repair Of Lacerated Floor Of Mouth And/or Tongue, 2.5 Cm Or Less 10 5 $660.00 $561.00 $462.00 $462.00 $462.00 2026-03-03
30300 HCPCS Removal Of Foreign Body In Nose 20 5 $660.00 $561.00 $140.00 $784.00 $462.00 2026-03-03
64450 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Other Nerve Or Branch 20 5 $660.00 $561.00 $147.00 $777.00 $462.00 2026-03-03
70487 HCPCS CT Scan Of Face With Contrast 10 5 $645.00 $548.25 $451.50 $451.50 $451.50 2026-03-03
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 10 5 $645.00 $548.25 $451.50 $451.50 $451.50 2026-03-03
72193 HCPCS CT Scan Of Pelvis With Contrast 10 5 $645.00 $548.25 $451.50 $451.50 $451.50 2026-03-03
72126 HCPCS CT Scan Of Upper Spine With Contrast 10 5 $645.00 $548.25 $451.50 $451.50 $451.50 2026-03-03
73701 HCPCS CT Scan Of Leg With Contrast Material 20 5 $645.00 $548.25 $451.50 $451.50 $451.50 2026-03-03
73201 HCPCS CT Scan Of Arm With Contrast 20 5 $645.00 $548.25 $451.50 $451.50 $451.50 2026-03-03
74160 HCPCS CT Scan Of Abdomen With Contrast 10 5 $645.00 $548.25 $451.50 $451.50 $451.50 2026-03-03
70460 HCPCS CT Scan Head Or Brain With Contrast 10 5 $645.00 $548.25 $451.50 $451.50 $451.50 2026-03-03
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 10 5 $645.00 $548.25 $451.50 $451.50 $451.50 2026-03-03
72129 HCPCS CT Scan Of Middle Spine With Contrast 10 5 $645.00 $548.25 $451.50 $451.50 $451.50 2026-03-03
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 20 5 $645.00 $548.25 $413.00 $490.00 $451.50 2026-03-03
72132 HCPCS CT Scan Of Lower Spine With Contrast 10 5 $645.00 $548.25 $451.50 $451.50 $451.50 2026-03-03
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 10 5 $640.00 $544.00 $448.00 $448.00 $448.00 2026-03-03
6519533_1 CDM Surgery Ventralex Mesh 6.4 Cm 10 5 $638.40 $542.64 $446.88 $446.88 $446.88 2026-03-03
6519534_1 CDM Surgery Ventralex Mesh 8.0 10 5 $638.40 $542.64 $446.88 $446.88 $446.88 2026-03-03
45330 HCPCS Diagnostic Exam Of Lower Portion Of Large Bowel Using A Flexible Endoscope 20 5 $635.00 $539.75 $189.00 $700.00 $444.50 2026-03-03
13131 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 20 5 $632.50 $537.62 $224.00 $661.50 $442.75 2026-03-03
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 10 5 $632.00 $537.20 $442.40 $442.40 $442.40 2026-03-03
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 10 5 $632.00 $537.20 $442.40 $442.40 $442.40 2026-03-03
71555 HCPCS MRI Scan Of Blood Vessels Of Chest 10 5 $632.00 $537.20 $442.40 $442.40 $442.40 2026-03-03
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 10 5 $630.00 $535.50 $441.00 $441.00 $441.00 2026-03-03
76536 HCPCS Ultrasound Scan Of Head And Neck Soft Tissue 10 5 $630.00 $535.50 $441.00 $441.00 $441.00 2026-03-03
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 10 5 $630.00 $535.50 $441.00 $441.00 $441.00 2026-03-03
93926 HCPCS Ultrasound Of One Leg Arteries Or Artery Grafts 20 5 $630.00 $535.50 $441.00 $441.00 $441.00 2026-03-03
93922 HCPCS Ultrasound Study Of Arm And Leg Arteries 10 5 $630.00 $535.50 $441.00 $441.00 $441.00 2026-03-03
12051 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 C… 20 5 $630.00 $535.50 $238.00 $644.00 $441.00 2026-03-03
93976 HCPCS Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 10 5 $630.00 $535.50 $441.00 $441.00 $441.00 2026-03-03
93931 HCPCS Ultrasound Of One Arm Arteries Or Artery Grafts 20 5 $630.00 $535.50 $441.00 $441.00 $441.00 2026-03-03
93970 HCPCS Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 10 5 $630.00 $535.50 $441.00 $441.00 $441.00 2026-03-03
93971 HCPCS Ultrasound Study Of One Arm Or Leg Veins With Compression And Maneuvers 20 5 $630.00 $535.50 $441.00 $441.00 $441.00 2026-03-03
93930 HCPCS Ultrasound Of Arm Arteries Or Artery Grafts 10 5 $630.00 $535.50 $441.00 $441.00 $441.00 2026-03-03
93975 HCPCS Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 10 5 $630.00 $535.50 $441.00 $441.00 $441.00 2026-03-03
45379 HCPCS Removal Of Foreign Bodies In Large Bowel Using A Flexible Endoscope 10 5 $625.00 $531.25 $437.50 $437.50 $437.50 2026-03-03
46606 HCPCS Biopsy Of Anus Using An Endoscope 20 5 $620.00 $527.00 $136.50 $731.50 $434.00 2026-03-03
45300 HCPCS Diagnostic Exam Of Rectum And Lower Large Bowel Using An Endoscope 20 5 $620.00 $527.00 $136.50 $731.50 $434.00 2026-03-03
J2770 HCPCS Injection, Quinupristin/dalfopristin, 500 Mg (150/350) 10 5 $617.77 $525.10 $432.44 $432.44 $432.44 2026-03-03
26770 HCPCS Closed Treatment Of Dislocated Finger Joint With Manipulation 20 5 $617.50 $524.88 $189.00 $675.50 $432.25 2026-03-03
70450 HCPCS CT Scan Head Or Brain Without Contrast 20 5 $617.50 $524.88 $413.00 $451.50 $432.25 2026-03-03
4441389_1 CDM Dakin's 0.25% Solution 10 5 $603.93 $513.34 $422.75 $422.75 $422.75 2026-03-03
43762 HCPCS Replacement Of Stomach Stoma Tube 10 5 $600.00 $510.00 $420.00 $420.00 $420.00 2026-03-03
36569 HCPCS Insertion Of Tube For Infusion (5 Years Or Older) 10 5 $600.00 $510.00 $420.00 $420.00 $420.00 2026-03-03
27530 HCPCS Closed Treatment Of Broken Shin Bone 10 5 $600.00 $510.00 $420.00 $420.00 $420.00 2026-03-03
6519536_1 CDM Surgery Articulating Endoscopic Linear Cutter 10 5 $600.00 $510.00 $420.00 $420.00 $420.00 2026-03-03
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
73200 HCPCS CT Scan Of Arm Without Contrast 20 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
72125 HCPCS CT Scan Of Upper Spine Without Contrast 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
6044776_1 CDM ER M0247 Intravenous Infusion, Sotrovimab, Includes Infusion And Post Administra… 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
75571 HCPCS CT Scan Of Heart With Evaluation Of Blood Vessel Calcium 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
72131 HCPCS CT Scan Of Lower Spine Without Contrast 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
72128 HCPCS CT Scan Of Middle Spine Without Contrast 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
73700 HCPCS CT Scan Of Leg Without Contrast 20 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
74150 HCPCS CT Scan Of Abdomen Without Contrast 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
6044775_1 CDM Tr M0247 Intravenous Infusion, Sotrovimab, Includes Infusion And Post Administra… 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
71250 HCPCS CT Scan Of Chest Without Contrast 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
71271 HCPCS Low Dose CT Scan Of Chest For Lung Cancer Screening 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
70486 HCPCS CT Scan Of Face Without Contrast 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
72192 HCPCS CT Scan Of Pelvis Without Contrast 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
71260 HCPCS CT Scan Of Chest With Contrast 10 5 $590.00 $501.50 $413.00 $413.00 $413.00 2026-03-03
13121 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 2.6-7.5 Cm 20 5 $577.50 $490.88 $353.50 $455.00 $404.25 2026-03-03
99284 HCPCS Emergency Department Visit With Moderate Level Of Medical Decision Making 20 5 $572.50 $486.62 $189.00 $612.50 $400.75 2026-03-03
11644 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3.1-… 10 5 $570.00 $484.50 $399.00 $399.00 $399.00 2026-03-03
Q5106 HCPCS Injection, Epoetin Alfa-epbx, Biosimilar, (retacrit) (for Non-esrd Use), 1000 Un… 10 5 $563.44 $478.92 $394.41 $394.41 $394.41 2026-03-03
94002 HCPCS Initial Hospital Inpatient Or Observation Ventilation Assistance And Management 10 5 $560.00 $476.00 $392.00 $392.00 $392.00 2026-03-03
90377 HCPCS Rabies Immune Globulin For Injection Beneath The Skin And/or Into Muscle 10 5 $558.72 $474.91 $391.10 $391.10 $391.10 2026-03-03
90651 HCPCS Human Papillomavirus Vaccine Types 6, 11, 16, 18, 31, 33, 45, 52, 58, Nonavalent 20 5 $553.56 $470.52 $310.00 $464.99 $387.50 2026-03-03
27750 HCPCS Closed Treatment Of Broken Middle Part Of Shin Bone 10 5 $550.00 $467.50 $385.00 $385.00 $385.00 2026-03-03
24640 HCPCS Closed Treatment Of Dislocated Forearm Bone On Thumb Side At Elbow With Manipula… 10 5 $550.00 $467.50 $385.00 $385.00 $385.00 2026-03-03
13132 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 20 5 $548.00 $465.80 $280.00 $487.20 $383.60 2026-03-03
11604 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 3.1-4.0 Cm 20 5 $545.00 $463.25 $280.00 $483.00 $381.50 2026-03-03
20206 HCPCS Needle Biopsy Of Muscle 20 5 $545.00 $463.25 $220.50 $542.50 $381.50 2026-03-03
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 10 5 $540.00 $459.00 $378.00 $378.00 $378.00 2026-03-03
5782115_1 CDM Cetacaine Spray 10 5 $538.23 $457.50 $376.76 $376.76 $376.76 2026-03-03
4441493_1 CDM Benzocaine-butamben-tetracaine Top Aerosol 56 Gm [elks] 10 5 $537.60 $456.96 $376.32 $376.32 $376.32 2026-03-03
27096 HCPCS Injection Of Anesthetic Or Steroid Into Joint Between Lower Spine And Hip Bone U… 40 5 $537.50 $456.88 $70.00 $1,050.00 $376.25 2026-03-03
30903 HCPCS Complex Control Of Nose Bleed 20 5 $535.00 $454.75 $252.00 $497.00 $374.50 2026-03-03
64483 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 20 5 $535.00 $454.75 $91.00 $658.00 $374.50 2026-03-03
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 10 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
73222 HCPCS MRI Scan Of Arm Joint With Contrast 20 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
72196 HCPCS MRI Scan Of Pelvis With Contrast 10 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
73220 HCPCS MRI Scan Of Arm Before And After Contrast 20 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
73720 HCPCS MRI Scan Of Leg Before And After Contrast 20 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 20 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 10 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
73218 HCPCS MRI Scan Of Arm Without Contrast 20 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
71551 HCPCS MRI Scan Of Chest With Contrast 10 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 20 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
74181 HCPCS MRI Scan Of Abdomen Without Contrast 10 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
71552 HCPCS MRI Scan Of Chest Before And After Contrast 10 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
73718 HCPCS MRI Scan Of Leg Without Contrast 20 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 10 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
73719 HCPCS MRI Scan Of Leg With Contrast 20 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
72195 HCPCS MRI Scan Of Pelvis Without Contrast 10 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 10 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 10 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
73722 HCPCS MRI Scan Of Leg Joint With Contrast 20 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 10 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
74182 HCPCS MRI Scan Of Abdomen With Contrast 10 5 $532.00 $452.20 $372.40 $372.40 $372.40 2026-03-03
11440 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 0… 20 5 $522.50 $444.12 $154.00 $577.50 $365.75 2026-03-03
5463307_1 CDM Rev Medical Speech Therapy Visit 10 5 $515.00 $437.75 $360.50 $360.50 $360.50 2026-03-03
92612 HCPCS Evaluation And Recording Of Swallowing Using An Endoscope 10 5 $515.00 $437.75 $360.50 $360.50 $360.50 2026-03-03
11102 HCPCS Biopsy Of Related Skin Growth, First Growth 20 5 $510.00 $433.50 $136.50 $577.50 $357.00 2026-03-03
77002 HCPCS Fluoroscopic Guidance For Needle Placement 10 5 $510.00 $433.50 $357.00 $357.00 $357.00 2026-03-03
87517 HCPCS Detection Test By Nucleic Acid For Hepatitis B Virus, Quantification 20 5 $504.70 $429.00 $209.00 $497.58 $353.29 2026-03-03
44140 HCPCS Partial Removal Of Large Bowel With Connection 10 5 $502.00 $426.70 $351.40 $351.40 $351.40 2026-03-03
17282 HCPCS Destruction Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, … 10 5 $501.00 $425.85 $350.70 $350.70 $350.70 2026-03-03
36430 HCPCS Transfusion Of Blood Or Blood Products 70 5 $500.00 $425.00 $56.00 $490.00 $350.00 2026-03-03
4441942_1 CDM Room & Board - Semi-private (two Beds) - General Classification 10 5 $500.00 $425.00 $350.00 $350.00 $350.00 2026-03-03
M0222 HCPCS Intravenous Injection, Bebtelovimab, Includes Injection And Post Administration … 10 5 $500.00 $425.00 $350.00 $350.00 $350.00 2026-03-03
27786 HCPCS Closed Treatment Of Broken Outside Lower Leg Bone At Ankle 10 5 $500.00 $425.00 $350.00 $350.00 $350.00 2026-03-03
11603 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm 20 5 $495.00 $420.75 $252.00 $441.00 $346.50 2026-03-03
86360 HCPCS T Cell Count And Ratio, Including Ratio 10 5 $495.00 $420.75 $346.50 $346.50 $346.50 2026-03-03
12014 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1… 20 5 $491.00 $417.35 $245.00 $442.40 $343.70 2026-03-03
81256 HCPCS Gene Analysis (hemochromatosis) Common Variants 10 5 $488.00 $414.80 $341.60 $341.60 $341.60 2026-03-03
12005 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 20 5 $487.50 $414.38 $262.50 $420.00 $341.25 2026-03-03
11104 HCPCS Punch Biopsy, First Skin Growth 20 5 $482.50 $410.12 $98.00 $577.50 $337.75 2026-03-03
11313 HCPCS Shaving Of Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More Than 2… 10 5 $480.00 $408.00 $336.00 $336.00 $336.00 2026-03-03
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