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

LANE COUNTY HOSPITAL

Dighton, KS · CCN 171303 · 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: $2,248 across 9 payers · range $2,023-$3,372

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbLCHDIGHTONKS&type=CDMWithoutLabel&fileType=CSV · observed 2026-03-04

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.

1,224 distinct procedures filed
10 distinct payers
16,937 rate rows
2026-03-04 last MRF observed
Data quality

16,782 of 16,937 rate rows are consumer-grade (99.1%)

155 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 105
exceeds 10× this hospital's gross charge — excluded from medians 36
per-diem day rate — not a per-procedure price 14
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbLCHDIGHTONKS&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/LaneCounty_V2.aspx
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-19
Content fingerprint 398eb996bdfa51ed… · 8,559,026 bytes · first seen 2026-05-08

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
J1439
HCPCS 		Injection, Ferric Carboxymaltose, 1 Mg 9 $17,828.26 $32,685.15 $29,713.77 nat. median
$14
outlier · 2201.0×
J9217
HCPCS 		Leuprolide Acetate (for Depot Suspension), 7.5 Mg 9 $12,583.64 $23,070.01 $20,972.74 nat. median
$1,573
outlier · 13.3×
J0517
HCPCS 		Injection, Benralizumab, 1 Mg 9 $6,314.81 $11,577.16 $10,524.69 nat. median
$919
outlier · 11.5×
J2997
HCPCS 		Injection, Alteplase Recombinant, 1 Mg 9 $4,458.98 $16,553.49 $8,601.99 nat. median
$500
outlier · 17.2×
J1561
HCPCS 		Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liquid)… 9 $5,084.64 $9,321.84 $8,474.40 nat. median
$1,094
outlier · 7.7×
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 9 $4,411.80 $8,088.30 $7,353.00 nat. median
$1,659
outlier · 4.4×
Q4196
HCPCS 		Puraply Am, Per Square Centimeter 9 $4,155.00 $7,617.50 $6,925.00 nat. median
$311
outlier · 22.2×
J2356
HCPCS 		Injection, Tezepelumab-ekko, 1 Mg 9 $3,923.64 $7,193.34 $6,539.40 nat. median
$76
outlier · 86.4×
15275
HCPCS 		Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 10 $1,500.00 $9,000.00 $6,000.00 nat. median
$1,713
outlier · 3.5×
10180
HCPCS 		Complex Drainage Of Wound Infection After Surgery 9 $4,500.00 $7,500.00 $5,000.00 nat. median
$2,862
1.7× median
15271
HCPCS 		Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C… 10 $1,007.50 $6,045.00 $4,030.00 nat. median
$1,725
outlier · 2.3×
Q4159
HCPCS 		Affinity, Per Square Centimeter 9 $2,190.00 $4,015.00 $3,650.00 nat. median
$643
outlier · 5.7×
J3358
HCPCS 		Ustekinumab, For Intravenous Injection, 1 Mg 9 $2,186.48 $4,008.54 $3,644.13 nat. median
$264
outlier · 13.8×
J2182
HCPCS 		Injection, Mepolizumab, 1 Mg 9 $1,593.58 $7,522.99 $3,512.51 nat. median
$2,791
1.3× median
15273
HCPCS 		Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.… 10 $826.25 $4,957.50 $3,305.00 nat. median
$3,119
1.1× median
Q5108
HCPCS 		Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 9 $1,737.45 $3,185.33 $2,895.75 nat. median
$1,244
outlier · 2.3×
64624
HCPCS 		Destruction Of Nerve Branches Of Knee Using Imaging Guidance 10 $125.36 $4,556.25 $2,733.75 nat. median
$2,300
1.2× median
74174
HCPCS 		CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 9 $2,404.80 $4,008.00 $2,672.00 nat. median
$998
outlier · 2.7×
27818
HCPCS 		Closed Treatment Of 3 Broken Lower Leg Bones At Ankle With Manipulation 9 $2,353.50 $3,922.50 $2,615.00 nat. median
$1,668
1.6× median
70498
HCPCS 		CT Scan Of Blood Vessels Of Neck With Contrast 9 $2,230.65 $3,717.75 $2,478.50 nat. median
$744
outlier · 3.3×
70496
HCPCS 		CT Scan Of Blood Vessels Of Head With Contrast 9 $2,230.65 $3,717.75 $2,478.50 nat. median
$752
outlier · 3.3×
64430
HCPCS 		Injection Of Anesthetic Agent And/or Steroid Into External Genitals And Anus Ner… 10 $45.76 $8,235.00 $2,470.50 nat. median
$1,171
outlier · 2.1×
12036
HCPCS 		Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 20.1-30.… 9 $235.36 $3,820.50 $2,292.30 nat. median
$857
outlier · 2.7×
11444
HCPCS 		Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3… 10 $235.36 $3,750.00 $2,250.00 nat. median
$1,624
1.4× median
93306
HCPCS 		Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 9 $2,023.20 $3,372.00 $2,248.00 nat. median
$993
outlier · 2.3×
C8929
HCPCS 		Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi… 9 $2,023.20 $3,372.00 $2,248.00 nat. median
$1,358
1.7× median
93303
HCPCS 		Ultrasound Of Heart For Congenital Defect 9 $1,890.00 $3,150.00 $2,100.00 nat. median
$792
outlier · 2.7×
64633
HCPCS 		Destruction Of Upper Or Middle Spinal Facet Joint Nerves Using Imaging Guidance,… 10 $162.49 $6,682.50 $2,004.75 nat. median
$2,325
0.9× median
12006
HCPCS 		Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs,… 9 $1,800.00 $3,000.00 $2,000.00 nat. median
$529
outlier · 3.8×
12042
HCPCS 		Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 2.6-7.5 Cm 9 $235.36 $3,264.00 $1,958.40 nat. median
$541
outlier · 3.6×
28430
HCPCS 		Closed Treatment Of Broken Ankle Joint Bone 10 $486.25 $2,917.50 $1,945.00 nat. median
$425
outlier · 4.6×
74175
HCPCS 		CT Scan Of Blood Vessels Of Abdomen With Contrast 9 $1,730.70 $2,884.50 $1,923.00 nat. median
$718
outlier · 2.7×
73206
HCPCS 		CT Scan Of Blood Vessels Of Arm With Contrast 9 $1,730.70 $2,884.50 $1,923.00 nat. median
$694
outlier · 2.8×
73706
HCPCS 		CT Scan Of Blood Vessels Of Lower Leg With Contrast 9 $1,573.23 $2,884.50 $1,922.83 nat. median
$752
outlier · 2.6×
12034
HCPCS 		Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 7.6-12.5… 10 $235.36 $3,105.00 $1,863.00 nat. median
$582
outlier · 3.2×
71275
HCPCS 		CT Scan Of Blood Vessels Of Chest With Contrast 9 $1,674.90 $2,791.50 $1,861.00 nat. median
$759
outlier · 2.5×
10061
HCPCS 		Complicated Or Multiple Drainage Of Skin Abscess 10 $235.36 $2,977.50 $1,845.38 nat. median
$501
outlier · 3.7×
64495
HCPCS 		Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Third And… 9 $42.84 $5,925.00 $1,826.88 nat. median
$752
outlier · 2.4×
75635
HCPCS 		CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 9 $1,503.44 $3,024.00 $1,825.97 nat. median
$727
outlier · 2.5×
64517
HCPCS 		Injection Of Anesthetic Agent Into Sacral Nerve Bundle 10 $37.76 $3,037.50 $1,822.50 nat. median
$1,285
1.4× median
64640
HCPCS 		Destruction Of Peripheral Nerve Or Branch 10 $104.10 $3,037.50 $1,822.50 nat. median
$1,194
1.5× median
64635
HCPCS 		Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 10 $162.92 $6,075.00 $1,822.50 nat. median
$2,392
0.8× median
73702
HCPCS 		CT Scan Of Leg Before And After Contrast 9 $990.00 $3,300.00 $1,815.00 nat. median
$708
outlier · 2.6×
72191
HCPCS 		CT Scan Of Blood Vessels Of Pelvis With Contrast 9 $1,573.23 $2,622.05 $1,748.03 nat. median
$640
outlier · 2.7×
15002
HCPCS 		Preparation Of Skin Graft Site Of Trunk, Arms, Or Legs, 100.0 Sq Cm Or 1% Body A… 10 $434.38 $2,606.30 $1,737.53 nat. median
$1,700
1.0× median
27750
HCPCS 		Closed Treatment Of Broken Middle Part Of Shin Bone 9 $235.36 $2,700.00 $1,620.00 nat. median
$474
outlier · 3.4×
93970
HCPCS 		Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 9 $1,337.40 $2,229.00 $1,486.00 nat. median
$565
outlier · 2.6×
93925
HCPCS 		Ultrasound Of Leg Arteries Or Artery Grafts 9 $1,337.40 $2,229.00 $1,486.00 nat. median
$524
outlier · 2.8×
93930
HCPCS 		Ultrasound Of Arm Arteries Or Artery Grafts 9 $1,337.40 $2,229.00 $1,486.00 nat. median
$482
outlier · 3.1×
64505
HCPCS 		Injection Of Anesthetic Agent, Trigeminal Nerve Bundle 10 $87.36 $4,931.25 $1,479.38 nat. median
$463
outlier · 3.2×

Other procedures at this hospital

Browse this hospital's 1,224 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
             
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 9 9 $29,713.77 $29,713.77 $17,828.26 $32,685.15 $29,713.77 2026-03-04
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 9 9 $20,972.74 $20,972.74 $12,583.64 $23,070.01 $20,972.74 2026-03-04
J0517 HCPCS Injection, Benralizumab, 1 Mg 9 9 $10,524.69 $10,524.69 $6,314.81 $11,577.16 $10,524.69 2026-03-04
J2997 HCPCS Injection, Alteplase Recombinant, 1 Mg 18 9 $11,240.14 $11,240.14 $4,458.98 $16,553.49 $8,601.99 2026-03-04
J1561 HCPCS Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liquid)… 9 9 $8,474.40 $8,474.40 $5,084.64 $9,321.84 $8,474.40 2026-03-04
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 9 9 $7,353.00 $7,353.00 $4,411.80 $8,088.30 $7,353.00 2026-03-04
Q4196 HCPCS Puraply Am, Per Square Centimeter 9 9 $6,925.00 $6,925.00 $4,155.00 $7,617.50 $6,925.00 2026-03-04
J2356 HCPCS Injection, Tezepelumab-ekko, 1 Mg 9 9 $6,539.40 $6,539.40 $3,923.64 $7,193.34 $6,539.40 2026-03-04
15275 HCPCS Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 10 10 $6,000.00 $6,000.00 $1,500.00 $9,000.00 $6,000.00 2026-03-04
10180 HCPCS Complex Drainage Of Wound Infection After Surgery 9 9 $5,000.00 $5,000.00 $4,500.00 $7,500.00 $5,000.00 2026-03-04
15271 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C… 10 10 $4,030.00 $4,030.00 $1,007.50 $6,045.00 $4,030.00 2026-03-04
Q4159 HCPCS Affinity, Per Square Centimeter 9 9 $3,650.00 $3,650.00 $2,190.00 $4,015.00 $3,650.00 2026-03-04
J3358 HCPCS Ustekinumab, For Intravenous Injection, 1 Mg 9 9 $3,644.13 $3,644.13 $2,186.48 $4,008.54 $3,644.13 2026-03-04
J2182 HCPCS Injection, Mepolizumab, 1 Mg 18 9 $4,747.52 $4,747.52 $1,593.58 $7,522.99 $3,512.51 2026-03-04
15273 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.… 10 10 $3,305.00 $3,305.00 $826.25 $4,957.50 $3,305.00 2026-03-04
Q5108 HCPCS Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 9 9 $2,895.75 $2,895.75 $1,737.45 $3,185.33 $2,895.75 2026-03-04
64624 HCPCS Destruction Of Nerve Branches Of Knee Using Imaging Guidance 17 10 $3,037.50 $3,037.50 $125.36 $4,556.25 $2,733.75 2026-03-04
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 9 9 $2,672.00 $2,672.00 $2,404.80 $4,008.00 $2,672.00 2026-03-04
27818 HCPCS Closed Treatment Of 3 Broken Lower Leg Bones At Ankle With Manipulation 9 9 $2,615.00 $2,615.00 $2,353.50 $3,922.50 $2,615.00 2026-03-04
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 9 9 $2,478.50 $2,478.50 $2,230.65 $3,717.75 $2,478.50 2026-03-04
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 9 9 $2,478.50 $2,478.50 $2,230.65 $3,717.75 $2,478.50 2026-03-04
64430 HCPCS Injection Of Anesthetic Agent And/or Steroid Into External Genitals And Anus Ner… 34 10 $2,745.00 $2,745.00 $45.76 $8,235.00 $2,470.50 2026-03-04
12036 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 20.1-30.… 16 9 $2,547.00 $2,547.00 $235.36 $3,820.50 $2,292.30 2026-03-04
11444 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3… 17 10 $2,500.00 $2,500.00 $235.36 $3,750.00 $2,250.00 2026-03-04
C8929 HCPCS Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi… 9 9 $2,248.00 $2,248.00 $2,023.20 $3,372.00 $2,248.00 2026-03-04
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 9 9 $2,248.00 $2,248.00 $2,023.20 $3,372.00 $2,248.00 2026-03-04
93303 HCPCS Ultrasound Of Heart For Congenital Defect 9 9 $2,100.00 $2,100.00 $1,890.00 $3,150.00 $2,100.00 2026-03-04
64633 HCPCS Destruction Of Upper Or Middle Spinal Facet Joint Nerves Using Imaging Guidance,… 34 10 $2,227.50 $2,227.50 $162.49 $6,682.50 $2,004.75 2026-03-04
12006 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 9 9 $2,000.00 $2,000.00 $1,800.00 $3,000.00 $2,000.00 2026-03-04
12042 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 2.6-7.5 Cm 16 9 $2,176.00 $2,176.00 $235.36 $3,264.00 $1,958.40 2026-03-04
28430 HCPCS Closed Treatment Of Broken Ankle Joint Bone 19 10 $1,945.00 $1,945.00 $486.25 $2,917.50 $1,945.00 2026-03-04
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 9 9 $1,923.00 $1,923.00 $1,730.70 $2,884.50 $1,923.00 2026-03-04
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 18 9 $1,923.00 $1,923.00 $1,730.70 $2,884.50 $1,923.00 2026-03-04
73706 HCPCS CT Scan Of Blood Vessels Of Lower Leg With Contrast 27 9 $1,923.00 $1,923.00 $1,573.23 $2,884.50 $1,922.83 2026-03-04
12034 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 7.6-12.5… 17 10 $2,070.00 $2,070.00 $235.36 $3,105.00 $1,863.00 2026-03-04
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 9 9 $1,861.00 $1,861.00 $1,674.90 $2,791.50 $1,861.00 2026-03-04
10061 HCPCS Complicated Or Multiple Drainage Of Skin Abscess 26 10 $1,900.00 $1,900.00 $235.36 $2,977.50 $1,845.38 2026-03-04
64495 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Third And… 32 9 $1,975.00 $1,975.00 $42.84 $5,925.00 $1,826.88 2026-03-04
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 18 9 $1,843.24 $1,843.24 $1,503.44 $3,024.00 $1,825.97 2026-03-04
64635 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 34 10 $2,025.00 $2,025.00 $162.92 $6,075.00 $1,822.50 2026-03-04
64640 HCPCS Destruction Of Peripheral Nerve Or Branch 44 10 $2,025.00 $2,025.00 $104.10 $3,037.50 $1,822.50 2026-03-04
64517 HCPCS Injection Of Anesthetic Agent Into Sacral Nerve Bundle 17 10 $2,025.00 $2,025.00 $37.76 $3,037.50 $1,822.50 2026-03-04
73702 HCPCS CT Scan Of Leg Before And After Contrast 36 9 $1,650.00 $1,650.00 $990.00 $3,300.00 $1,815.00 2026-03-04
72191 HCPCS CT Scan Of Blood Vessels Of Pelvis With Contrast 9 9 $1,748.03 $1,748.03 $1,573.23 $2,622.05 $1,748.03 2026-03-04
15002 HCPCS Preparation Of Skin Graft Site Of Trunk, Arms, Or Legs, 100.0 Sq Cm Or 1% Body A… 10 10 $1,737.53 $1,737.53 $434.38 $2,606.30 $1,737.53 2026-03-04
27750 HCPCS Closed Treatment Of Broken Middle Part Of Shin Bone 16 9 $1,800.00 $1,800.00 $235.36 $2,700.00 $1,620.00 2026-03-04
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 9 9 $1,486.00 $1,486.00 $1,337.40 $2,229.00 $1,486.00 2026-03-04
93970 HCPCS Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 9 9 $1,486.00 $1,486.00 $1,337.40 $2,229.00 $1,486.00 2026-03-04
93930 HCPCS Ultrasound Of Arm Arteries Or Artery Grafts 9 9 $1,486.00 $1,486.00 $1,337.40 $2,229.00 $1,486.00 2026-03-04
64505 HCPCS Injection Of Anesthetic Agent, Trigeminal Nerve Bundle 34 10 $1,643.75 $1,643.75 $87.36 $4,931.25 $1,479.38 2026-03-04
62323 HCPCS Injection Of Substance Into Lower Spine Canal Using Imaging Guidance 17 10 $1,606.25 $1,606.25 $83.99 $2,409.38 $1,445.63 2026-03-04
62321 HCPCS Injection Of Substance Into Middle Or Upper Spine Canal Using Imaging Guidance 17 10 $1,606.25 $1,606.25 $90.04 $2,409.38 $1,445.63 2026-03-04
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 9 9 $1,445.00 $1,445.00 $1,300.50 $2,167.50 $1,445.00 2026-03-04
64484 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 16 9 $1,572.50 $1,572.50 $41.63 $2,358.75 $1,415.25 2026-03-04
64492 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Third And… 32 9 $1,530.00 $1,530.00 $48.62 $4,590.00 $1,415.25 2026-03-04
12032 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 2.6-7.5 … 16 9 $1,561.20 $1,561.20 $235.36 $2,341.80 $1,405.08 2026-03-04
12005 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 16 9 $1,550.00 $1,550.00 $235.36 $2,325.00 $1,395.00 2026-03-04
99291 HCPCS Critical Care, First 30-74 Minutes 9 9 $1,365.00 $1,365.00 $1,228.50 $2,047.50 $1,365.00 2026-03-04
77075 HCPCS Complete X-ray Of Body Bones 9 9 $1,331.00 $1,331.00 $1,197.90 $1,996.50 $1,331.00 2026-03-04
6599655_1 CDM Kionex 15 Gm/60 Ml Suspension 9 9 $1,396.15 $1,396.15 $349.04 $1,535.77 $1,326.34 2026-03-04
24200 HCPCS Removal Of Foreign Body Of Upper Arm Or Elbow Area, Accessed Beneath The Skin 10 10 $1,300.00 $1,300.00 $325.00 $1,950.00 $1,300.00 2026-03-04
64450 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Other Nerve Or Branch 17 10 $1,436.25 $1,436.25 $36.13 $2,154.38 $1,292.63 2026-03-04
2120840_1 CDM Room & Board - Semi-private (two Beds) - General Classification 5 5 $1,350.00 $1,350.00 $1,215.00 $2,042.01 $1,282.50 2026-03-04
64494 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Second Le… 32 9 $1,385.00 $1,385.00 $41.63 $4,155.00 $1,281.12 2026-03-04
64451 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Spine And Pelvis Nerve Using I… 17 10 $1,411.25 $1,411.25 $68.40 $2,116.88 $1,270.13 2026-03-04
64510 HCPCS Injection Of Anesthetic Agent Into Sympathetic Nerve Bundle 17 10 $1,382.50 $1,382.50 $57.75 $2,073.75 $1,244.25 2026-03-04
87507 HCPCS Detection Test By Nucleic Acid For Digestive Tract Pathogen, Multiple Types Or S… 9 9 $1,220.00 $1,220.00 $1,098.00 $1,830.00 $1,220.00 2026-03-04
4441941_1 CDM Room & Board - Semi-private (two Beds) - General Classification 5 5 $1,250.00 $1,250.00 $1,125.00 $1,890.75 $1,187.50 2026-03-04
64491 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Second Le… 32 9 $1,278.75 $1,278.75 $48.05 $3,836.25 $1,182.85 2026-03-04
64454 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Knee Nerve Branch Using Imagin… 17 10 $1,286.25 $1,286.25 $69.13 $1,929.38 $1,157.63 2026-03-04
64634 HCPCS Destruction Of Upper Or Middle Spinal Facet Joint Nerves Using Imaging Guidance,… 41 9 $1,215.00 $1,215.00 $54.77 $1,822.50 $1,154.25 2026-03-04
10120 HCPCS Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Simple 16 9 $1,278.00 $1,278.00 $235.36 $1,917.00 $1,150.20 2026-03-04
12051 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 C… 16 9 $1,271.86 $1,271.86 $235.36 $1,907.79 $1,144.67 2026-03-04
64421 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Multiple Rib Nerves For Region… 17 10 $1,266.25 $1,266.25 $20.53 $1,899.38 $1,139.63 2026-03-04
12052 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.6-5… 19 10 $1,130.00 $1,130.00 $282.50 $1,695.00 $1,130.00 2026-03-04
30300 HCPCS Removal Of Foreign Body In Nose 16 9 $1,250.00 $1,250.00 $235.36 $1,875.00 $1,125.00 2026-03-04
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 9 9 $1,100.00 $1,100.00 $990.00 $1,650.00 $1,100.00 2026-03-04
70488 HCPCS CT Scan Of Face Before And After Contrast 9 9 $1,100.00 $1,100.00 $990.00 $1,650.00 $1,100.00 2026-03-04
73202 HCPCS CT Scan Of Arm Before And After Contrast 18 9 $1,100.00 $1,100.00 $990.00 $1,650.00 $1,100.00 2026-03-04
72132 HCPCS CT Scan Of Lower Spine With Contrast 9 9 $1,100.00 $1,100.00 $990.00 $1,650.00 $1,100.00 2026-03-04
71270 HCPCS CT Scan Of Chest Before And After Contrast 9 9 $1,100.00 $1,100.00 $990.00 $1,650.00 $1,100.00 2026-03-04
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 9 9 $1,100.00 $1,100.00 $990.00 $1,650.00 $1,100.00 2026-03-04
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 9 9 $1,100.00 $1,100.00 $990.00 $1,650.00 $1,100.00 2026-03-04
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 9 9 $1,100.00 $1,100.00 $990.00 $1,650.00 $1,100.00 2026-03-04
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 9 9 $1,100.00 $1,100.00 $990.00 $1,650.00 $1,100.00 2026-03-04
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 9 9 $1,100.00 $1,100.00 $990.00 $1,650.00 $1,100.00 2026-03-04
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 9 9 $1,100.00 $1,100.00 $990.00 $1,650.00 $1,100.00 2026-03-04
15277 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout… 10 10 $1,082.00 $1,082.00 $270.50 $1,623.00 $1,082.00 2026-03-04
23650 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation 16 9 $1,200.00 $1,200.00 $235.36 $1,800.00 $1,080.00 2026-03-04
10080 HCPCS Simple Drainage Of Cyst Of Tailbone 16 9 $1,168.00 $1,168.00 $235.36 $1,752.00 $1,051.20 2026-03-04
Q5103 HCPCS Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 9 9 $1,044.16 $1,044.16 $626.50 $1,148.58 $1,044.16 2026-03-04
27096 HCPCS Injection Of Anesthetic Or Steroid Into Joint Between Lower Spine And Hip Bone U… 32 9 $1,128.75 $1,128.75 $69.48 $3,386.25 $1,044.10 2026-03-04
64530 HCPCS Injection Of Anesthetic Agent Into Abdominal Sympathetic Nerve Bundle 17 10 $1,142.50 $1,142.50 $80.23 $1,713.75 $1,028.25 2026-03-04
73701 HCPCS CT Scan Of Leg With Contrast Material 18 9 $1,025.00 $1,025.00 $922.50 $1,537.50 $1,025.00 2026-03-04
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 9 9 $1,025.00 $1,025.00 $922.50 $1,537.50 $1,025.00 2026-03-04
70487 HCPCS CT Scan Of Face With Contrast 9 9 $1,025.00 $1,025.00 $922.50 $1,537.50 $1,025.00 2026-03-04
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 9 9 $1,025.00 $1,025.00 $922.50 $1,537.50 $1,025.00 2026-03-04
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 9 9 $1,025.00 $1,025.00 $922.50 $1,537.50 $1,025.00 2026-03-04
70460 HCPCS CT Scan Head Or Brain With Contrast 9 9 $1,025.00 $1,025.00 $922.50 $1,537.50 $1,025.00 2026-03-04
74160 HCPCS CT Scan Of Abdomen With Contrast 9 9 $1,025.00 $1,025.00 $922.50 $1,537.50 $1,025.00 2026-03-04
73201 HCPCS CT Scan Of Arm With Contrast 18 9 $1,025.00 $1,025.00 $922.50 $1,537.50 $1,025.00 2026-03-04
71260 HCPCS CT Scan Of Chest With Contrast 9 9 $1,025.00 $1,025.00 $922.50 $1,537.50 $1,025.00 2026-03-04
72193 HCPCS CT Scan Of Pelvis With Contrast 9 9 $1,025.00 $1,025.00 $922.50 $1,537.50 $1,025.00 2026-03-04
72131 HCPCS CT Scan Of Lower Spine Without Contrast 9 9 $1,025.00 $1,025.00 $922.50 $1,537.50 $1,025.00 2026-03-04
72126 HCPCS CT Scan Of Upper Spine With Contrast 9 9 $1,025.00 $1,025.00 $922.50 $1,537.50 $1,025.00 2026-03-04
72129 HCPCS CT Scan Of Middle Spine With Contrast 9 9 $1,025.00 $1,025.00 $922.50 $1,537.50 $1,025.00 2026-03-04
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 9 9 $1,012.00 $1,012.00 $910.80 $1,518.00 $1,012.00 2026-03-04
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 9 9 $1,012.00 $1,012.00 $910.80 $1,518.00 $1,012.00 2026-03-04
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 9 9 $1,012.00 $1,012.00 $910.80 $1,518.00 $1,012.00 2026-03-04
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 9 9 $1,012.00 $1,012.00 $910.80 $1,518.00 $1,012.00 2026-03-04
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 9 9 $1,012.00 $1,012.00 $910.80 $1,518.00 $1,012.00 2026-03-04
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 9 9 $1,012.00 $1,012.00 $910.80 $1,518.00 $1,012.00 2026-03-04
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 9 9 $1,012.00 $1,012.00 $910.80 $1,518.00 $1,012.00 2026-03-04
73225 HCPCS MRI Scan Of Blood Vessels Of Arm 9 9 $1,012.00 $1,012.00 $910.80 $1,518.00 $1,012.00 2026-03-04
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 18 9 $1,012.00 $1,012.00 $910.80 $1,518.00 $1,012.00 2026-03-04
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 9 9 $1,012.00 $1,012.00 $910.80 $1,518.00 $1,012.00 2026-03-04
72159 HCPCS MRI Scan Of Blood Vessels Of Spinal Canal 9 9 $1,012.00 $1,012.00 $910.80 $1,518.00 $1,012.00 2026-03-04
71555 HCPCS MRI Scan Of Blood Vessels Of Chest 9 9 $1,012.00 $1,012.00 $910.80 $1,518.00 $1,012.00 2026-03-04
62329 HCPCS Removal Of Cerebrospinal Fluid With Lower Back Spinal Tap Using Imaging Guidance 17 10 $1,116.25 $1,116.25 $85.61 $1,674.38 $1,004.63 2026-03-04
62328 HCPCS Removal Of Spinal Fluid With Lower Back Spinal Tap For Diagnostic Test Using Ima… 17 10 $1,116.25 $1,116.25 $69.44 $1,674.38 $1,004.63 2026-03-04
15276 HCPCS Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 9 9 $1,000.00 $1,000.00 $900.00 $1,500.00 $1,000.00 2026-03-04
12015 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6… 16 9 $1,081.00 $1,081.00 $235.36 $1,621.50 $972.90 2026-03-04
93307 HCPCS Ultrasound Of Heart 9 9 $970.00 $970.00 $873.00 $1,455.00 $970.00 2026-03-04
93308 HCPCS Ultrasound Of Heart, Follow-up 9 9 $970.00 $970.00 $873.00 $1,455.00 $970.00 2026-03-04
64636 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 41 9 $1,012.50 $1,012.50 $48.05 $1,518.75 $961.88 2026-03-04
71271 HCPCS Low Dose CT Scan Of Chest For Lung Cancer Screening 9 9 $950.00 $950.00 $855.00 $1,425.00 $950.00 2026-03-04
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 9 9 $950.00 $950.00 $855.00 $1,425.00 $950.00 2026-03-04
70486 HCPCS CT Scan Of Face Without Contrast 9 9 $950.00 $950.00 $855.00 $1,425.00 $950.00 2026-03-04
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 9 9 $950.00 $950.00 $855.00 $1,425.00 $950.00 2026-03-04
70450 HCPCS CT Scan Head Or Brain Without Contrast 9 9 $950.00 $950.00 $855.00 $1,425.00 $950.00 2026-03-04
73200 HCPCS CT Scan Of Arm Without Contrast 18 9 $950.00 $950.00 $855.00 $1,425.00 $950.00 2026-03-04
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 9 9 $950.00 $950.00 $855.00 $1,425.00 $950.00 2026-03-04
74150 HCPCS CT Scan Of Abdomen Without Contrast 9 9 $950.00 $950.00 $855.00 $1,425.00 $950.00 2026-03-04
73700 HCPCS CT Scan Of Leg Without Contrast 18 9 $950.00 $950.00 $855.00 $1,425.00 $950.00 2026-03-04
71250 HCPCS CT Scan Of Chest Without Contrast 9 9 $950.00 $950.00 $855.00 $1,425.00 $950.00 2026-03-04
72192 HCPCS CT Scan Of Pelvis Without Contrast 9 9 $950.00 $950.00 $855.00 $1,425.00 $950.00 2026-03-04
72128 HCPCS CT Scan Of Middle Spine Without Contrast 9 9 $950.00 $950.00 $855.00 $1,425.00 $950.00 2026-03-04
72125 HCPCS CT Scan Of Upper Spine Without Contrast 9 9 $950.00 $950.00 $855.00 $1,425.00 $950.00 2026-03-04
76380 HCPCS Limited Or Follow-up CT Scan 9 9 $950.00 $950.00 $855.00 $1,425.00 $950.00 2026-03-04
99284 HCPCS Emergency Department Visit With Moderate Level Of Medical Decision Making 9 9 $930.00 $930.00 $837.00 $1,395.00 $930.00 2026-03-04
J0248 HCPCS Injection, Remdesivir, 1 Mg 18 9 $926.64 $926.64 $550.37 $1,029.60 $917.28 2026-03-04
J3262 HCPCS Injection, Tocilizumab, 1 Mg 9 9 $908.30 $908.30 $544.98 $999.13 $908.30 2026-03-04
64400 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Face Nerve 17 10 $1,003.75 $1,003.75 $42.41 $1,505.63 $903.38 2026-03-04
15272 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, Each Addi… 9 9 $887.09 $887.09 $798.38 $1,330.64 $887.09 2026-03-04
64493 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Le… 34 10 $973.75 $973.75 $76.55 $2,921.25 $876.38 2026-03-04
71550 HCPCS MRI Scan Of Chest Without Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
72196 HCPCS MRI Scan Of Pelvis With Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 18 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
70553 HCPCS MRI Scan Of Brain Before And After Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
70551 HCPCS MRI Scan Of Brain Without Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
73719 HCPCS MRI Scan Of Leg With Contrast 18 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 18 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
77048 HCPCS MRI Scan Of 1 Breast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
70336 HCPCS MRI Scan Of Jaw Joint 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
70552 HCPCS MRI Scan Of Brain With Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
74181 HCPCS MRI Scan Of Abdomen Without Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
73722 HCPCS MRI Scan Of Leg Joint With Contrast 18 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 18 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
77049 HCPCS MRI Scan Of Both Breasts 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
73222 HCPCS MRI Scan Of Arm Joint With Contrast 18 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
73218 HCPCS MRI Scan Of Arm Without Contrast 18 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
73720 HCPCS MRI Scan Of Leg Before And After Contrast 27 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
73219 HCPCS MRI Scan Of Arm With Contrast 18 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
71551 HCPCS MRI Scan Of Chest With Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
73220 HCPCS MRI Scan Of Arm Before And After Contrast 18 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
73718 HCPCS MRI Scan Of Leg Without Contrast 18 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
77084 HCPCS MRI Scan Of Bone Marrow 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
75561 HCPCS MRI Scan Of Heart Before And After Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
74182 HCPCS MRI Scan Of Abdomen With Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
72195 HCPCS MRI Scan Of Pelvis Without Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 18 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
75557 HCPCS MRI Scan Of Heart Without Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
71552 HCPCS MRI Scan Of Chest Before And After Contrast 9 9 $875.00 $875.00 $787.50 $1,312.50 $875.00 2026-03-04
20611 HCPCS Aspiration And/or Injection Of Fluid Large Joint Using Ultrasound Guidance 51 10 $970.00 $970.00 $46.85 $2,850.00 $873.00 2026-03-04
64483 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 34 10 $968.75 $968.75 $93.64 $2,906.25 $871.88 2026-03-04
26770 HCPCS Closed Treatment Of Dislocated Finger Joint With Manipulation 16 9 $961.00 $961.00 $235.36 $1,441.50 $864.90 2026-03-04
93926 HCPCS Ultrasound Of One Leg Arteries Or Artery Grafts 18 9 $843.00 $843.00 $758.70 $1,264.50 $843.00 2026-03-04
93320 HCPCS Ultrasound Of Heart Blood Flow, Valves And Chambers 9 9 $843.00 $843.00 $758.70 $1,264.50 $843.00 2026-03-04
76536 HCPCS Ultrasound Scan Of Head And Neck Soft Tissue 9 9 $843.00 $843.00 $758.70 $1,264.50 $843.00 2026-03-04
93931 HCPCS Ultrasound Of One Arm Arteries Or Artery Grafts 18 9 $843.00 $843.00 $758.70 $1,264.50 $843.00 2026-03-04
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 9 9 $843.00 $843.00 $758.70 $1,264.50 $843.00 2026-03-04
93922 HCPCS Ultrasound Study Of Arm And Leg Arteries 9 9 $843.00 $843.00 $758.70 $1,264.50 $843.00 2026-03-04
93325 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate And Valve Function 9 9 $843.00 $843.00 $758.70 $1,264.50 $843.00 2026-03-04
93971 HCPCS Ultrasound Study Of One Arm Or Leg Veins With Compression And Maneuvers 18 9 $843.00 $843.00 $758.70 $1,264.50 $843.00 2026-03-04
93978 HCPCS Complete Ultrasound Of Aorta, Vena Cava, Groin Vessels Or Bypass Grafts 9 9 $843.00 $843.00 $758.70 $1,264.50 $843.00 2026-03-04
93975 HCPCS Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 9 9 $843.00 $843.00 $758.70 $1,264.50 $843.00 2026-03-04
93976 HCPCS Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 9 9 $843.00 $843.00 $758.70 $1,264.50 $843.00 2026-03-04
12014 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1… 16 9 $921.60 $921.60 $235.36 $1,382.40 $829.44 2026-03-04
20520 HCPCS Removal Of Foreign Body In Muscle Or Tendon 19 10 $820.00 $820.00 $205.00 $1,230.00 $820.00 2026-03-04
30903 HCPCS Complex Control Of Nose Bleed 9 9 $810.00 $810.00 $729.00 $1,215.00 $810.00 2026-03-04
11765 HCPCS Removal Of Skin Of Fingernail Or Toenail 16 9 $892.00 $892.00 $234.00 $1,338.00 $802.80 2026-03-04
L1833 HCPCS Knee Orthosis, Adjustable Knee Joints (unicentric Or Polycentric), Positional Or… 9 9 $775.00 $775.00 $697.50 $1,162.50 $775.00 2026-03-04
5926951_1 CDM Cetacaine Spray 9 9 $814.46 $814.46 $203.62 $895.91 $773.74 2026-03-04
J1670 HCPCS Injection, Tetanus Immune Globulin, Human, Up To 250 Units 9 9 $755.00 $755.00 $453.00 $830.50 $755.00 2026-03-04
10060 HCPCS Simple Or Single Drainage Of Skin Abscess 16 9 $800.00 $800.00 $182.70 $1,200.00 $720.00 2026-03-04
64520 HCPCS Injection Of Anesthetic Agent Into Middle Or Lower Spine Sympathetic Nerve 17 10 $791.25 $791.25 $72.08 $1,186.88 $712.13 2026-03-04
74400 HCPCS Imaging Of Urinary Tract With Injection Of Contrast Into A Vein 9 9 $707.30 $707.30 $636.57 $1,060.95 $707.30 2026-03-04
12004 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 16 9 $772.00 $772.00 $235.36 $1,158.00 $694.80 2026-03-04
6570090_1 CDM Azithromycin 200 Mg/5 Ml Susp 9 9 $726.60 $726.60 $181.65 $799.26 $690.27 2026-03-04
11750 HCPCS Permanent Removal Fingernail Or Toenail 9 9 $690.00 $690.00 $621.00 $1,035.00 $690.00 2026-03-04
12035 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 12.6-20.… 7 7 $761.00 $761.00 $235.36 $1,141.50 $684.90 2026-03-04
64490 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Single Le… 34 10 $785.62 $785.62 $88.55 $2,261.25 $678.38 2026-03-04
65220 HCPCS Removal Of Foreign Body In Cornea 16 9 $730.00 $730.00 $73.80 $1,095.00 $657.00 2026-03-04
26755 HCPCS Closed Treatment Of Broken End Of Finger Or Thumb With Manipulation 16 9 $724.00 $724.00 $235.36 $1,086.00 $651.60 2026-03-04
62272 HCPCS Removal Of Cerebrospinal Fluid With Lower Back Spinal Tap 17 10 $723.75 $723.75 $75.35 $1,085.63 $651.38 2026-03-04
62270 HCPCS Removal Of Cerebrospinal Fluid With Lower Back Spinal Tap For Diagnostic Test 17 10 $723.75 $723.75 $53.08 $1,085.63 $651.38 2026-03-04
74280 HCPCS Double Contrast X-ray Of Large Intestine 9 9 $638.00 $638.00 $574.20 $957.00 $638.00 2026-03-04
80285 HCPCS Measurement Of Voriconazole 9 9 $595.00 $595.00 $535.50 $892.50 $595.00 2026-03-04
16020 HCPCS Dressing Change Or Removal Of Burn Tissue, Less Than 5% Of Total Body Surface 16 9 $661.00 $661.00 $76.50 $991.50 $594.90 2026-03-04
28515 HCPCS Closed Treatment Of Broken Toe With Manipulation 9 9 $590.00 $590.00 $531.00 $885.00 $590.00 2026-03-04
64418 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Suprascapular Shoulder Nerve 34 10 $643.75 $643.75 $45.44 $1,927.50 $578.25 2026-03-04
29085 HCPCS Application Of Hand And Lower Forearm Cast 19 10 $578.00 $578.00 $144.50 $892.50 $578.00 2026-03-04
84445 HCPCS Thyroid Stimulating Immune Globulins (thyroid Related Protein) Level 9 9 $550.00 $550.00 $495.00 $825.00 $550.00 2026-03-04
29075 HCPCS Application Of Elbow To Finger Cast 26 10 $578.00 $578.00 $144.50 $867.00 $549.10 2026-03-04
29065 HCPCS Application Of Shoulder To Hand Cast 26 10 $577.00 $577.00 $144.50 $867.00 $548.62 2026-03-04
77002 HCPCS Fluoroscopic Guidance For Needle Placement 9 9 $547.80 $547.80 $493.02 $821.70 $547.80 2026-03-04
99283 HCPCS Emergency Department Visit With Low Level Of Medical Decision Making 9 9 $545.00 $545.00 $490.50 $817.50 $545.00 2026-03-04
74230 HCPCS Imaging For Evaluation Of Swallowing Function 9 9 $539.00 $539.00 $485.10 $808.50 $539.00 2026-03-04
G0480 HCPCS Drug Test(s), Definitive, Utilizing (1) Drug Identification Methods Able To Iden… 9 9 $530.00 $530.00 $477.00 $795.00 $530.00 2026-03-04
11406 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 7 7 $585.00 $585.00 $235.36 $877.50 $526.50 2026-03-04
12013 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.6… 16 9 $575.00 $575.00 $235.36 $862.50 $517.50 2026-03-04
81256 HCPCS Gene Analysis (hemochromatosis) Common Variants 9 9 $515.00 $515.00 $463.50 $772.50 $515.00 2026-03-04
24670 HCPCS Closed Treatment Of Broken Forearm Bone On Small Finger Side At Elbow 7 7 $572.00 $572.00 $235.36 $858.00 $514.80 2026-03-04
26600 HCPCS Closed Treatment Of Broken Hand Bone 16 9 $513.60 $513.60 $235.36 $844.50 $513.60 2026-03-04
74246 HCPCS Double Contrast X-ray Of Upper Digestive Tract 9 9 $503.00 $503.00 $452.70 $754.50 $503.00 2026-03-04
76811 HCPCS Ultrasound Scan Of Pregnant Uterus With Detailed Fetal Anatomic Examination, Sin… 9 9 $502.90 $502.90 $452.61 $754.35 $502.90 2026-03-04
15274 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, Each… 9 9 $500.00 $500.00 $450.00 $750.00 $500.00 2026-03-04
25600 HCPCS Closed Treatment Of Broken Forearm (radius) Bone At The Wrist Area On The Thumb … 7 7 $555.00 $555.00 $235.36 $832.50 $499.50 2026-03-04
29260 HCPCS Placement Of Strapping To Elbow Or Wrist 9 9 $495.00 $495.00 $445.50 $742.50 $495.00 2026-03-04
27786 HCPCS Closed Treatment Of Broken Outside Lower Leg Bone At Ankle 7 7 $547.00 $547.00 $235.36 $820.50 $492.30 2026-03-04
74270 HCPCS Single Contrast X-ray Of Large Intestine 9 9 $481.80 $481.80 $433.62 $722.70 $481.80 2026-03-04
64405 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Upper Neck And Back Of Head Ne… 34 10 $533.75 $533.75 $41.81 $1,601.25 $480.38 2026-03-04
23655 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia 7 7 $521.00 $521.00 $235.36 $781.50 $468.90 2026-03-04
64455 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Foot Nerve 17 10 $517.50 $517.50 $12.19 $776.25 $465.75 2026-03-04
64445 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Lower Back And Leg Nerve (scia… 17 10 $517.50 $517.50 $62.14 $776.25 $465.75 2026-03-04
64420 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Rib Nerve 17 10 $517.50 $517.50 $49.57 $776.25 $465.75 2026-03-04
64417 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Upper Arm And Shoulder Nerve (… 17 10 $517.50 $517.50 $57.93 $776.25 $465.75 2026-03-04
12011 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5… 16 9 $500.00 $500.00 $235.36 $750.00 $460.50 2026-03-04
24650 HCPCS Closed Treatment Of Broken Forearm Bone On Thumb Side At Elbow 7 7 $510.00 $510.00 $235.36 $765.00 $459.00 2026-03-04
74250 HCPCS Single Contrast X-ray Of Small Intestine 9 9 $457.60 $457.60 $411.84 $686.40 $457.60 2026-03-04
11602 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 1.1-2.0 Cm 7 7 $503.00 $503.00 $235.36 $754.50 $452.70 2026-03-04
P9040 HCPCS Red Blood Cells, Leukocytes Reduced, Irradiated, Each Unit 9 9 $450.00 $450.00 $405.00 $675.00 $450.00 2026-03-04
76700 HCPCS Complete Ultrasound Scan Of Abdomen 9 9 $450.00 $450.00 $405.00 $675.00 $450.00 2026-03-04
76770 HCPCS Complete Ultrasound Scan Behind Abdominal Cavity 9 9 $450.00 $450.00 $405.00 $675.00 $450.00 2026-03-04
J1442 HCPCS Injection, Filgrastim (g-csf), Excludes Biosimilars, 1 Microgram 36 9 $493.60 $493.60 $159.47 $1,012.52 $446.52 2026-03-04
25622 HCPCS Closed Treatment Of Broken Wrist Bone Near Base Of Thumb 7 7 $496.00 $496.00 $235.36 $744.00 $446.40 2026-03-04
J1610 HCPCS Injection, Glucagon Hydrochloride, Per 1 Mg 18 9 $470.72 $470.72 $266.81 $546.43 $445.88 2026-03-04
73521 HCPCS X-ray Of Both Hips, 2 Views 9 9 $435.60 $435.60 $392.04 $653.40 $435.60 2026-03-04
25530 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Small Finger Side 7 7 $483.00 $483.00 $235.36 $724.50 $434.70 2026-03-04
84433 HCPCS Evaluation Of Thiopurine S-methyltransferase (tpmt) 9 9 $430.00 $430.00 $387.00 $645.00 $430.00 2026-03-04
20605 HCPCS Aspiration And/or Injection Of Fluid From Medium Joint 67 10 $450.00 $450.00 $30.03 $1,822.50 $427.50 2026-03-04
G0378 HCPCS Hospital Observation Service, Per Hour 18 9 $466.00 $466.00 $17.10 $1,369.50 $425.10 2026-03-04
76376 HCPCS 3d Radiographic Procedure 9 9 $425.00 $425.00 $382.50 $637.50 $425.00 2026-03-04
76856 HCPCS Complete Ultrasound Scan Of Pelvis 9 9 $425.00 $425.00 $382.50 $637.50 $425.00 2026-03-04
92950 HCPCS Manual Attempt To Restore Blood Circulation And Breathing 9 9 $425.00 $425.00 $382.50 $637.50 $425.00 2026-03-04
81206 HCPCS Translocation Analysis (bcr/abl1) Major Breakpoint 9 9 $420.00 $420.00 $378.00 $630.00 $420.00 2026-03-04
11603 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm 7 7 $463.00 $463.00 $235.36 $694.50 $416.70 2026-03-04
11601 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 0.6-1.0 Cm 7 7 $463.00 $463.00 $235.36 $694.50 $416.70 2026-03-04
L1832 HCPCS Knee Orthosis, Adjustable Knee Joints (unicentric Or Polycentric), Positional Or… 9 9 $415.60 $415.60 $374.04 $623.40 $415.60 2026-03-04
87799 HCPCS Detection Test By Nucleic Acid For Organism, Quantification 18 9 $401.50 $401.50 $310.50 $687.00 $412.20 2026-03-04
11443 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2… 7 7 $455.00 $455.00 $235.36 $682.50 $409.50 2026-03-04
72190 HCPCS X-ray Of Pelvis, Minimum Of 3 Views 9 9 $405.90 $405.90 $365.31 $608.85 $405.90 2026-03-04
76805 HCPCS Ultrasound Scan Of Pregnant Uterus (14 Weeks Or More), Single Or First Fetus 9 9 $405.00 $405.00 $364.50 $607.50 $405.00 2026-03-04
76801 HCPCS Ultrasound Scan Of Pregnant Uterus (less Than 14 Weeks), Single Or First Fetus 9 9 $405.00 $405.00 $364.50 $607.50 $405.00 2026-03-04
74220 HCPCS Single Contrast X-ray Of Esophagus 9 9 $401.50 $401.50 $361.35 $602.25 $401.50 2026-03-04
94010 HCPCS Test To Measure Expiratory Airflow And Volume 9 9 $400.00 $400.00 $360.00 $600.00 $400.00 2026-03-04
12001 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 25 9 $400.00 $400.00 $235.36 $600.00 $400.00 2026-03-04
87522 HCPCS Detection Test By Nucleic Acid For Hepatitis C Virus, Quantification 27 9 $400.00 $400.00 $184.50 $957.00 $400.00 2026-03-04
6599663_1 CDM Amoxicillin 250 Mg/5 Ml Susp 9 9 $418.25 $418.25 $104.56 $460.08 $397.34 2026-03-04
88342 HCPCS Special Stained Specimen Slides To Examine Tissue, Initial Procedure 9 9 $395.00 $395.00 $355.50 $592.50 $395.00 2026-03-04
88341 HCPCS Special Stained Specimen Slides To Examine Tissue, Each Additional Procedure 9 9 $395.00 $395.00 $355.50 $592.50 $395.00 2026-03-04
76706 HCPCS Ultrasound Scan Of Abdominal Aorta 9 9 $395.00 $395.00 $355.50 $592.50 $395.00 2026-03-04
6599662_1 CDM Amoxicillin 125 Mg/5 Ml Susp 9 9 $414.75 $414.75 $103.69 $456.23 $394.01 2026-03-04
J0881 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 9 9 $393.76 $393.76 $236.26 $433.14 $393.76 2026-03-04
27780 HCPCS Closed Treatment Of Broken Middle Or Upper End Of Outside Lower Leg Bone 7 7 $435.00 $435.00 $235.36 $652.50 $391.50 2026-03-04
92611 HCPCS Evaluation Of Swallowing Function Image 9 9 $390.00 $390.00 $351.00 $585.00 $390.00 2026-03-04
76816 HCPCS Follow-up Ultrasound Scan Of Pregnant Uterus 9 9 $389.00 $389.00 $350.10 $583.50 $389.00 2026-03-04
76817 HCPCS Vaginal Ultrasound Of Pregnant Uterus 9 9 $389.00 $389.00 $350.10 $583.50 $389.00 2026-03-04
76810 HCPCS Ultrasound Scan Of Pregnant Uterus (14 Weeks Or More), Each Additional Fetus 9 9 $389.00 $389.00 $350.10 $583.50 $389.00 2026-03-04
74022 HCPCS X-ray Series Of Abdomen With Single X-ray Of Chest 9 9 $388.30 $388.30 $349.47 $582.45 $388.30 2026-03-04
12031 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 2.5 Cm O… 16 9 $385.00 $385.00 $235.36 $642.00 $385.00 2026-03-04
76705 HCPCS Limited Ultrasound Scan Of Abdomen 9 9 $380.00 $380.00 $342.00 $570.00 $380.00 2026-03-04
29425 HCPCS Application Of Walking Cast Covering Below Knee To Toe 9 9 $380.00 $380.00 $342.00 $570.00 $380.00 2026-03-04
71111 HCPCS X-ray Of Ribs On Both Sides Of Body, Minimum Of 4 Views 9 9 $377.30 $377.30 $339.57 $565.95 $377.30 2026-03-04
28470 HCPCS Closed Treatment Of Broken Bone In Forefoot Or Midfoot 7 7 $417.00 $417.00 $235.36 $625.50 $375.30 2026-03-04
76857 HCPCS Limited Ultrasound Scan Of Pelvis 9 9 $375.00 $375.00 $337.50 $562.50 $375.00 2026-03-04
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