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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

ELLSWORTH COUNTY MEDICAL CENTER

Ellsworth, KS · CCN 171327 · Rates published

1,947 distinct procedures filed
20 distinct payers
172,183 rate rows
2026-05-11 last MRF observed
Data quality

171,587 of 172,183 rate rows are consumer-grade (99.7%)

596 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
exceeds 10× this hospital's gross charge — excluded from medians 291
percent-of-charges filed in the dollar field — excluded from medians 156
per-diem day rate — not a per-procedure price 143
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 6
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbECMCELLSWORTHKS&type=CDMWithoutLabel
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-12
Content fingerprint c56628bebec5404e… · 25,240,882 bytes · first seen 2026-07-17

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
J2350
HCPCS 		Injection, Ocrelizumab, 1 Mg 20 $66.98 $30,589.90 $27,530.91 nat. median
$133
outlier · 207.1×
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 20 $23.66 $23,119.00 $20,807.10 nat. median
$59
outlier · 353.8×
6565928_1
CDM 		Tnkase 50 Mg Vial 15 $8,802.63 $17,792.55 $15,919.65 —
27823
HCPCS 		Treatment Of 3 Broken Lower Leg Bones At Ankle With Fixation Of Posterior Lip 20 $6,638.75 $21,187.50 $12,712.50 nat. median
$6,708
1.9× median
15274
HCPCS 		Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, Each… 18 $4,824.77 $15,398.19 $9,752.19 nat. median
$549
outlier · 17.8×
J2356
HCPCS 		Injection, Tezepelumab-ekko, 1 Mg 18 $4,829.92 $10,276.42 $9,248.78 nat. median
$43
outlier · 213.6×
15273
HCPCS 		Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.… 20 $2,324.65 $15,398.19 $9,238.91 nat. median
$2,471
outlier · 3.7×
J1306
HCPCS 		Injection, Inclisiran, 1 Mg 18 $3,935.92 $8,374.30 $7,536.87 nat. median
$25
outlier · 299.1×
J2182
HCPCS 		Injection, Mepolizumab, 1 Mg 20 $35.80 $8,009.08 $7,208.17 nat. median
$80
outlier · 90.5×
Q4194
HCPCS 		Novachor, Per Square Centimeter 18 $3,525.00 $11,250.00 $7,125.00 nat. median
$770
outlier · 9.3×
25295
HCPCS 		Removal Of Scar Tissue To Release Tendon Of Forearm Or Wrist 20 $3,391.52 $10,824.00 $6,494.40 nat. median
$3,245
outlier · 2.0×
28820
HCPCS 		Amputation Of Toe At Joint Between Forefoot And Toes 20 $3,273.08 $10,446.00 $6,267.60 nat. median
$3,343
1.9× median
41805
HCPCS 		Removal Of Embedded Foreign Body In Soft Tissue Of Tooth Bearing Bone 18 $2,923.40 $9,330.00 $5,909.00 nat. median
$1,673
outlier · 3.5×
27514
HCPCS 		Treatment Of Broken Side Of Lower End Of Thigh Bone 20 $2,923.40 $9,330.00 $5,598.00 nat. median
$6,142
0.9× median
26785
HCPCS 		Treatment Of Dislocated Finger Joint 20 $2,923.40 $9,330.00 $5,598.00 nat. median
$3,345
1.7× median
38525
HCPCS 		Biopsy Or Removal Of Deep Lymph Nodes Of Underarm 20 $2,875.93 $9,178.50 $5,507.10 nat. median
$4,639
1.2× median
27301
HCPCS 		Drainage Of Deep Abscess Or Blood Accumulation Of Thigh Or Knee 20 $2,794.15 $8,917.50 $5,350.50 nat. median
$2,895
1.8× median
26735
HCPCS 		Treatment Of Broken Finger At Midportion Or Part Near Hand 20 $2,769.71 $8,839.50 $5,303.70 nat. median
$3,473
1.5× median
26951
HCPCS 		Amputation Of Finger Or Thumb With Direct Closure 20 $1,970.30 $8,736.00 $5,241.60 nat. median
$3,337
1.6× median
J2802
HCPCS 		Injection, Romiplostim, 1 Microgram 18 $2,646.22 $5,630.25 $5,067.23 nat. median
$43
outlier · 117.4×
Q4197
HCPCS 		Puraply Xt, Per Square Centimeter 18 $2,350.00 $13,921.88 $5,000.00 nat. median
$191
outlier · 26.2×
15278
HCPCS 		Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout… 18 $2,452.46 $7,826.99 $4,957.09 nat. median
$573
outlier · 8.7×
15272
HCPCS 		Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, Each Addi… 18 $2,452.46 $7,826.99 $4,957.09 nat. median
$158
outlier · 31.4×
15276
HCPCS 		Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 18 $2,452.46 $7,826.99 $4,957.09 nat. median
$161
outlier · 30.7×
27345
HCPCS 		Removal Of Cyst Of Back Of Knee 20 $2,498.99 $7,975.50 $4,785.30 nat. median
$3,352
1.4× median
15277
HCPCS 		Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout… 20 $760.95 $7,826.99 $4,696.19 nat. median
$1,927
outlier · 2.4×
J1602
HCPCS 		Injection, Golimumab, 1 Mg, For Intravenous Use 20 $24.65 $4,772.68 $4,295.41 nat. median
$55
outlier · 78.7×
27310
HCPCS 		Incision Of Knee Joint For Exploration, Fluid Drainage, Or Removal Of Foreign Bo… 20 $2,181.74 $6,963.00 $4,177.80 nat. median
$3,417
1.2× median
28092
HCPCS 		Removal Of Growth Of Tendon Covering Or Joint Capsule Of Toes 20 $2,181.74 $6,963.00 $4,177.80 nat. median
$1,858
outlier · 2.2×
J0897
HCPCS 		Injection, Denosumab, 1 Mg 20 $23.34 $4,453.70 $4,008.33 nat. median
$86
outlier · 46.6×
J7336
HCPCS 		Capsaicin 8% Patch, Per Square Centimeter 20 $3.97 $8,975.38 $3,940.41 nat. median
$5
outlier · 852.9×
26742
HCPCS 		Closed Treatment Of Broken Finger Or Hand At Base Of Finger With Manipulation 20 $1,915.25 $6,112.50 $3,667.50 nat. median
$1,543
outlier · 2.4×
38589
HCPCS 		Other Procedure On Lymphatic System Using An Endoscope 20 $1,786.00 $5,700.00 $3,610.00 nat. median
$6,608
0.5× median
J2357
HCPCS 		Injection, Omalizumab, 5 Mg 20 $45.30 $3,837.80 $3,454.02 nat. median
$682
outlier · 5.1×
Q5108
HCPCS 		Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 20 $375.81 $3,830.13 $3,447.12 nat. median
$418
outlier · 8.3×
27630
HCPCS 		Removal Of Growth Of Leg And/or Ankle Tendon Lining Or Capsule 20 $1,793.99 $5,725.50 $3,435.30 nat. median
$3,184
1.1× median
J0129
HCPCS 		Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 20 $65.92 $3,810.10 $3,429.09 nat. median
$122
outlier · 28.1×
27524
HCPCS 		Treatment Of Broken Kneecap With Placement Of Stabilizing Device And/or Removal… 20 $257.53 $10,870.50 $3,406.09 nat. median
$7,141
outlier · 0.5×
28505
HCPCS 		Treatment Of Broken Great Toe 20 $1,642.18 $5,241.00 $3,144.60 nat. median
$3,385
0.9× median
26765
HCPCS 		Treatment Of Broken End Of Finger Or Thumb 20 $1,595.18 $5,091.00 $3,054.60 nat. median
$3,201
1.0× median
26952
HCPCS 		Amputation Of Finger Or Thumb With Tissue Flap 20 $1,595.18 $5,091.00 $3,054.60 nat. median
$3,254
0.9× median
J3262
HCPCS 		Injection, Tocilizumab, 1 Mg 20 $6.20 $6,343.45 $3,013.14 nat. median
$1,287
outlier · 2.3×
J0585
HCPCS 		Injection, Onabotulinumtoxina, 1 Unit 20 $7.49 $3,255.00 $2,929.50 nat. median
$21
outlier · 142.6×
J3111
HCPCS 		Injection, Romosozumab-aqqg, 1 Mg 18 $1,525.96 $3,246.73 $2,922.06 nat. median
$19
outlier · 153.8×
45338
HCPCS 		Removal Of Polyps Or Growths Of Lower Large Bowel Using A Flexible Endoscope Wit… 20 $1,072.55 $4,763.57 $2,858.14 nat. median
$1,350
outlier · 2.1×
27818
HCPCS 		Closed Treatment Of 3 Broken Lower Leg Bones At Ankle With Manipulation 20 $1,458.88 $4,656.00 $2,793.60 nat. median
$1,691
1.7× median
14060
HCPCS 		Repair Of Wound Of Eyelids, Nose, Ears, Or Lips By Transferring Skin, 10.0 Sq Cm… 20 $1,452.77 $4,636.50 $2,781.90 nat. median
$2,256
1.2× median
Q4160
HCPCS 		Nushield, Per Square Centimeter 18 $401.85 $10,012.50 $2,670.00 nat. median
$320
outlier · 8.4×
45020
HCPCS 		Incision And Drainage Of Abscess Above Pelvic Floor Or Behind Rectum 18 $1,284.04 $4,098.00 $2,595.40 nat. median
$2,800
0.9× median
14040
HCPCS 		Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, Genitals, Han… 20 $1,354.07 $4,321.50 $2,592.90 nat. median
$2,206
1.2× median

Other procedures at this hospital

Browse this hospital's 1,947 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
J2350 HCPCS Injection, Ocrelizumab, 1 Mg 55 20 $30,589.90 $30,589.90 $66.98 $30,589.90 $27,530.91 2026-05-11
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 55 20 $23,119.00 $23,119.00 $23.66 $23,119.00 $20,807.10 2026-05-11
6565928_1 CDM Tnkase 50 Mg Vial 41 15 $18,729.00 $18,729.00 $8,802.63 $17,792.55 $15,919.65 2026-05-11
27823 HCPCS Treatment Of 3 Broken Lower Leg Bones At Ankle With Fixation Of Posterior Lip 55 20 $14,125.00 $14,125.00 $6,638.75 $21,187.50 $12,712.50 2026-05-11
15274 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, Each… 49 18 $10,265.46 $10,265.46 $4,824.77 $15,398.19 $9,752.19 2026-05-11
J2356 HCPCS Injection, Tezepelumab-ekko, 1 Mg 49 18 $10,276.42 $10,276.42 $4,829.92 $10,276.42 $9,248.78 2026-05-11
15273 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.… 55 20 $10,265.46 $10,265.46 $2,324.65 $15,398.19 $9,238.91 2026-05-11
J1306 HCPCS Injection, Inclisiran, 1 Mg 49 18 $8,374.30 $8,374.30 $3,935.92 $8,374.30 $7,536.87 2026-05-11
J2182 HCPCS Injection, Mepolizumab, 1 Mg 55 20 $8,009.08 $8,009.08 $35.80 $8,009.08 $7,208.17 2026-05-11
Q4194 HCPCS Novachor, Per Square Centimeter 49 18 $7,500.00 $7,500.00 $3,525.00 $11,250.00 $7,125.00 2026-05-11
25295 HCPCS Removal Of Scar Tissue To Release Tendon Of Forearm Or Wrist 55 20 $7,216.00 $7,216.00 $3,391.52 $10,824.00 $6,494.40 2026-05-11
28820 HCPCS Amputation Of Toe At Joint Between Forefoot And Toes 55 20 $6,964.00 $6,964.00 $3,273.08 $10,446.00 $6,267.60 2026-05-11
41805 HCPCS Removal Of Embedded Foreign Body In Soft Tissue Of Tooth Bearing Bone 49 18 $6,220.00 $6,220.00 $2,923.40 $9,330.00 $5,909.00 2026-05-11
26785 HCPCS Treatment Of Dislocated Finger Joint 55 20 $6,220.00 $6,220.00 $2,923.40 $9,330.00 $5,598.00 2026-05-11
27514 HCPCS Treatment Of Broken Side Of Lower End Of Thigh Bone 55 20 $6,220.00 $6,220.00 $2,923.40 $9,330.00 $5,598.00 2026-05-11
38525 HCPCS Biopsy Or Removal Of Deep Lymph Nodes Of Underarm 55 20 $6,119.00 $6,119.00 $2,875.93 $9,178.50 $5,507.10 2026-05-11
27301 HCPCS Drainage Of Deep Abscess Or Blood Accumulation Of Thigh Or Knee 55 20 $5,945.00 $5,945.00 $2,794.15 $8,917.50 $5,350.50 2026-05-11
26735 HCPCS Treatment Of Broken Finger At Midportion Or Part Near Hand 55 20 $5,893.00 $5,893.00 $2,769.71 $8,839.50 $5,303.70 2026-05-11
26951 HCPCS Amputation Of Finger Or Thumb With Direct Closure 55 20 $5,824.00 $5,824.00 $1,970.30 $8,736.00 $5,241.60 2026-05-11
J2802 HCPCS Injection, Romiplostim, 1 Microgram 49 18 $5,630.25 $5,630.25 $2,646.22 $5,630.25 $5,067.23 2026-05-11
Q4197 HCPCS Puraply Xt, Per Square Centimeter 98 18 $7,140.62 $7,140.62 $2,350.00 $13,921.88 $5,000.00 2026-05-11
15276 HCPCS Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 49 18 $5,217.99 $5,217.99 $2,452.46 $7,826.99 $4,957.09 2026-05-11
15272 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, Each Addi… 49 18 $5,217.99 $5,217.99 $2,452.46 $7,826.99 $4,957.09 2026-05-11
15278 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout… 49 18 $5,217.99 $5,217.99 $2,452.46 $7,826.99 $4,957.09 2026-05-11
27345 HCPCS Removal Of Cyst Of Back Of Knee 55 20 $5,317.00 $5,317.00 $2,498.99 $7,975.50 $4,785.30 2026-05-11
15277 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout… 55 20 $5,217.99 $5,217.99 $760.95 $7,826.99 $4,696.19 2026-05-11
J1602 HCPCS Injection, Golimumab, 1 Mg, For Intravenous Use 55 20 $4,772.68 $4,772.68 $24.65 $4,772.68 $4,295.41 2026-05-11
27310 HCPCS Incision Of Knee Joint For Exploration, Fluid Drainage, Or Removal Of Foreign Bo… 55 20 $4,642.00 $4,642.00 $2,181.74 $6,963.00 $4,177.80 2026-05-11
28092 HCPCS Removal Of Growth Of Tendon Covering Or Joint Capsule Of Toes 55 20 $4,642.00 $4,642.00 $2,181.74 $6,963.00 $4,177.80 2026-05-11
J0897 HCPCS Injection, Denosumab, 1 Mg 55 20 $4,453.70 $4,453.70 $23.34 $4,453.70 $4,008.33 2026-05-11
J7336 HCPCS Capsaicin 8% Patch, Per Square Centimeter 153 20 $4,378.23 $4,378.23 $3.97 $8,975.38 $3,940.41 2026-05-11
26742 HCPCS Closed Treatment Of Broken Finger Or Hand At Base Of Finger With Manipulation 55 20 $4,075.00 $4,075.00 $1,915.25 $6,112.50 $3,667.50 2026-05-11
38589 HCPCS Other Procedure On Lymphatic System Using An Endoscope 55 20 $3,800.00 $3,800.00 $1,786.00 $5,700.00 $3,610.00 2026-05-11
J2357 HCPCS Injection, Omalizumab, 5 Mg 55 20 $3,837.80 $3,837.80 $45.30 $3,837.80 $3,454.02 2026-05-11
Q5108 HCPCS Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 55 20 $3,830.13 $3,830.13 $375.81 $3,830.13 $3,447.12 2026-05-11
27630 HCPCS Removal Of Growth Of Leg And/or Ankle Tendon Lining Or Capsule 55 20 $3,817.00 $3,817.00 $1,793.99 $5,725.50 $3,435.30 2026-05-11
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 55 20 $3,810.10 $3,810.10 $65.92 $3,810.10 $3,429.09 2026-05-11
27524 HCPCS Treatment Of Broken Kneecap With Placement Of Stabilizing Device And/or Removal … 104 20 $1,360.00 $1,360.00 $257.53 $10,870.50 $3,406.09 2026-05-11
28505 HCPCS Treatment Of Broken Great Toe 55 20 $3,494.00 $3,494.00 $1,642.18 $5,241.00 $3,144.60 2026-05-11
26952 HCPCS Amputation Of Finger Or Thumb With Tissue Flap 55 20 $3,394.00 $3,394.00 $1,595.18 $5,091.00 $3,054.60 2026-05-11
26765 HCPCS Treatment Of Broken End Of Finger Or Thumb 55 20 $3,394.00 $3,394.00 $1,595.18 $5,091.00 $3,054.60 2026-05-11
J3262 HCPCS Injection, Tocilizumab, 1 Mg 104 20 $3,171.73 $3,171.73 $6.20 $6,343.45 $3,013.14 2026-05-11
J0585 HCPCS Injection, Onabotulinumtoxina, 1 Unit 55 20 $3,255.00 $3,255.00 $7.49 $3,255.00 $2,929.50 2026-05-11
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 49 18 $3,246.73 $3,246.73 $1,525.96 $3,246.73 $2,922.06 2026-05-11
45338 HCPCS Removal Of Polyps Or Growths Of Lower Large Bowel Using A Flexible Endoscope Wit… 55 20 $3,175.71 $3,175.71 $1,072.55 $4,763.57 $2,858.14 2026-05-11
27818 HCPCS Closed Treatment Of 3 Broken Lower Leg Bones At Ankle With Manipulation 55 20 $3,104.00 $3,104.00 $1,458.88 $4,656.00 $2,793.60 2026-05-11
14060 HCPCS Repair Of Wound Of Eyelids, Nose, Ears, Or Lips By Transferring Skin, 10.0 Sq Cm… 55 20 $3,091.00 $3,091.00 $1,452.77 $4,636.50 $2,781.90 2026-05-11
Q4160 HCPCS Nushield, Per Square Centimeter 245 18 $3,825.00 $3,825.00 $401.85 $10,012.50 $2,670.00 2026-05-11
45020 HCPCS Incision And Drainage Of Abscess Above Pelvic Floor Or Behind Rectum 49 18 $2,732.00 $2,732.00 $1,284.04 $4,098.00 $2,595.40 2026-05-11
14040 HCPCS Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, Genitals, Han… 55 20 $2,881.00 $2,881.00 $1,354.07 $4,321.50 $2,592.90 2026-05-11
70471 HCPCS Computed Tomographic Angiography (cta), Head And Neck, With Contrast Material(s)… 55 20 $2,875.00 $2,875.00 $1,351.25 $4,312.50 $2,587.50 2026-05-11
43246 HCPCS Insertion Of Stomach Tube Using A Flexible Endoscope 104 20 $2,694.08 $2,694.08 $1,266.22 $5,185.50 $2,559.38 2026-05-11
44365 HCPCS Removal Of Small Bowel Polyps Or Growths Using An Endoscope With Electrical Caut… 55 20 $2,769.16 $2,769.16 $947.15 $4,153.74 $2,492.24 2026-05-11
15275 HCPCS Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 101 20 $5,217.99 $5,217.99 $79.13 $7,826.99 $2,452.46 2026-05-11
15271 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C… 101 20 $5,217.99 $5,217.99 $69.81 $7,826.99 $2,452.46 2026-05-11
Q4101 HCPCS Apligraf, Per Square Centimeter 98 18 $2,869.00 $2,869.00 $1,198.50 $3,825.00 $2,422.50 2026-05-11
13152 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 2.6-7.5 Cm 55 20 $2,621.00 $2,621.00 $1,231.87 $3,931.50 $2,358.90 2026-05-11
28495 HCPCS Closed Treatment Of Broken Great Toe With Manipulation 55 20 $2,620.00 $2,620.00 $1,231.40 $3,930.00 $2,358.00 2026-05-11
28475 HCPCS Closed Treatment Of Broken Foot With Manipulation 55 20 $2,620.00 $2,620.00 $1,231.40 $3,930.00 $2,358.00 2026-05-11
6564107_1 CDM Kcentra 500 Unit Vial 41 15 $2,725.68 $2,725.68 $1,281.07 $2,589.40 $2,316.83 2026-05-11
11044 HCPCS Removal Of Bone, 20.0 Sq Cm Or Less 104 20 $2,924.00 $2,924.00 $262.20 $4,386.00 $2,315.15 2026-05-11
46930 HCPCS Destruction Of Internal Hemorrhoids Using Heat 55 20 $2,553.83 $2,553.83 $1,200.30 $3,830.75 $2,298.45 2026-05-11
Q4159 HCPCS Affinity, Per Square Centimeter 147 18 $2,550.00 $2,550.00 $1,081.00 $3,825.00 $2,295.00 2026-05-11
Q4199 HCPCS Cygnus Matrix, Per Square Centimeter 294 18 $3,025.00 $3,025.00 $251.96 $7,826.49 $2,295.00 2026-05-11
43255 HCPCS Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flex… 55 20 $2,500.00 $2,500.00 $1,077.30 $3,750.00 $2,250.00 2026-05-11
12007 HCPCS Simple Repair Of Surface Wound To Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 55 20 $2,492.00 $2,492.00 $1,171.24 $3,738.00 $2,242.80 2026-05-11
23660 HCPCS Treatment Of Dislocated Shoulder 55 20 $2,356.00 $2,356.00 $1,107.32 $3,534.00 $2,238.20 2026-05-11
11626 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More Tha… 104 20 $727.00 $727.00 $257.53 $7,495.50 $2,160.60 2026-05-11
25260 HCPCS Primary Repair Of Tendon Or Muscle Of Palm Side Of Forearm Or Wrist 49 18 $2,272.00 $2,272.00 $1,067.84 $3,408.00 $2,158.40 2026-05-11
28208 HCPCS Repair Of Tendon Of Top Side Of Foot 49 18 $2,272.00 $2,272.00 $1,067.84 $3,408.00 $2,158.40 2026-05-11
27532 HCPCS Closed Treatment Of Broken Shin Bone With Traction 55 20 $2,356.00 $2,356.00 $1,107.32 $3,534.00 $2,120.40 2026-05-11
27502 HCPCS Closed Treatment Of Broken Thigh Bone At Midportion With Manipulation 55 20 $2,356.00 $2,356.00 $1,107.32 $3,534.00 $2,120.40 2026-05-11
26080 HCPCS Incision Of Finger Joint For Exploration, Fluid Drainage, Or Removal Of Foreign … 55 20 $2,356.00 $2,356.00 $1,107.32 $3,534.00 $2,120.40 2026-05-11
27810 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle With Manipulation 55 20 $2,356.00 $2,356.00 $1,107.32 $3,534.00 $2,120.40 2026-05-11
26075 HCPCS Incision Of Lower Finger Joint For Exploration, Fluid Drainage, Or Removal Of Fo… 55 20 $2,356.00 $2,356.00 $1,107.32 $3,534.00 $2,120.40 2026-05-11
23600 HCPCS Closed Treatment Of Broken Top Of Upper Arm Bone 55 20 $2,356.00 $2,356.00 $1,107.32 $3,534.00 $2,120.40 2026-05-11
27762 HCPCS Closed Treatment Of Inside Portion Of Shin Bone At Ankle With Manipulation 55 20 $2,356.00 $2,356.00 $1,107.32 $3,534.00 $2,120.40 2026-05-11
27752 HCPCS Closed Treatment Of Middle Part Of Broken Shin Bone With Manipulation 55 20 $2,356.00 $2,356.00 $1,107.32 $3,534.00 $2,120.40 2026-05-11
28022 HCPCS Incision Of Midfoot Joint For Exploration, Fluid Drainage, Or Removal Of Foreign… 55 20 $2,356.00 $2,356.00 $1,107.32 $3,534.00 $2,120.40 2026-05-11
27808 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle 55 20 $2,356.00 $2,356.00 $1,107.32 $3,534.00 $2,120.40 2026-05-11
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 55 20 $2,330.00 $2,330.00 $1,095.10 $3,495.00 $2,097.00 2026-05-11
J9395 HCPCS Injection, Fulvestrant, 25 Mg 55 20 $2,272.72 $2,272.72 $141.80 $2,272.72 $2,045.45 2026-05-11
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 55 20 $2,200.00 $2,200.00 $1,034.00 $3,300.00 $1,980.00 2026-05-11
43251 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 55 20 $2,192.00 $2,192.00 $1,030.24 $3,288.00 $1,972.80 2026-05-11
J7300 HCPCS Intrauterine Copper Contraceptive 55 20 $2,170.00 $2,170.00 $1,019.90 $2,170.00 $1,953.00 2026-05-11
J7298 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg 55 20 $2,098.00 $2,098.00 $986.06 $2,098.00 $1,888.20 2026-05-11
J7297 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System (liletta), 52 Mg 55 20 $2,098.00 $2,098.00 $986.06 $2,098.00 $1,888.20 2026-05-11
46221 HCPCS Removal Of External Hemorrhoids By Rubber Banding 55 20 $2,060.40 $2,060.40 $968.39 $3,090.60 $1,854.36 2026-05-11
28192 HCPCS Removal Of Foreign Body Of Foot Tissue, Deep 55 20 $2,020.00 $2,020.00 $949.40 $3,030.00 $1,818.00 2026-05-11
43249 HCPCS Balloon Dilation Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexibl… 55 20 $1,977.53 $1,977.53 $929.44 $2,966.30 $1,779.78 2026-05-11
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 55 20 $1,975.00 $1,975.00 $928.25 $2,962.50 $1,777.50 2026-05-11
45398 HCPCS Banding Of Hemorrhoids Using A Flexible Endoscope (colonoscope) 55 20 $1,950.00 $1,950.00 $916.50 $2,925.00 $1,755.00 2026-05-11
65290 HCPCS Repair Of Wound Of Eye Muscle Or Tendon 49 18 $1,800.00 $1,800.00 $846.00 $2,700.00 $1,710.00 2026-05-11
6600322_1 CDM Bildyos 60 Mg/ml Syringe 41 15 $1,989.20 $1,989.20 $934.92 $1,889.74 $1,690.82 2026-05-11
45385 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S… 55 20 $1,876.80 $1,876.80 $882.10 $2,815.20 $1,689.12 2026-05-11
J7296 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System, (kyleena), 19.5 Mg 55 20 $1,875.00 $1,875.00 $881.25 $1,875.00 $1,687.50 2026-05-11
12036 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 20.1-30.… 104 20 $755.00 $755.00 $257.53 $5,358.00 $1,678.84 2026-05-11
J1459 HCPCS Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 202 20 $1,764.00 $1,764.00 $49.76 $7,056.00 $1,675.80 2026-05-11
45386 HCPCS Balloon Dilation Of Large Bowel Using A Flexible Endoscope 55 20 $1,836.00 $1,836.00 $862.92 $2,754.00 $1,652.40 2026-05-11
Q4196 HCPCS Puraply Am, Per Square Centimeter 588 18 $2,350.00 $2,350.00 $188.00 $10,260.00 $1,625.00 2026-05-11
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 55 20 $1,805.00 $1,805.00 $430.35 $2,707.50 $1,624.50 2026-05-11
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 55 20 $1,790.00 $1,790.00 $430.35 $2,685.00 $1,611.00 2026-05-11
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 55 20 $1,770.00 $1,770.00 $430.35 $2,655.00 $1,593.00 2026-05-11
J7301 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System (skyla), 13.5 Mg 55 20 $1,747.00 $1,747.00 $821.09 $1,747.00 $1,572.30 2026-05-11
45380 HCPCS Biopsy Of Large Bowel Using A Flexible Endoscope 55 20 $1,721.25 $1,721.25 $808.99 $2,581.88 $1,549.13 2026-05-11
26011 HCPCS Complicated Drainage Of Abscess In Finger 55 20 $1,721.00 $1,721.00 $808.87 $2,581.50 $1,548.90 2026-05-11
11606 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 104 20 $798.00 $798.00 $257.53 $4,857.00 $1,521.86 2026-05-11
28190 HCPCS Removal Of Foreign Body Of Foot Tissue, Accessed Beneath The Skin 104 20 $464.00 $464.00 $257.53 $4,840.50 $1,516.69 2026-05-11
59409 HCPCS Vaginal Delivery 98 18 $2,177.50 $2,177.50 $257.53 $4,275.00 $1,505.00 2026-05-11
45378 HCPCS Diagnostic Exam Of Large Bowel Using A Flexible Endoscope 55 20 $1,667.70 $1,667.70 $783.82 $2,501.55 $1,500.93 2026-05-11
45381 HCPCS Injection Beneath Lining Of Large Bowel Using A Flexible Endoscope 55 20 $1,667.70 $1,667.70 $783.82 $2,501.55 $1,500.93 2026-05-11
45384 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using A Flexible Endoscope With Elec… 55 20 $1,667.70 $1,667.70 $783.82 $2,501.55 $1,500.93 2026-05-11
45390 HCPCS Removal Of Large Bowel Tissue Using A Flexible Endoscope 55 20 $1,667.00 $1,667.00 $783.49 $2,500.50 $1,500.30 2026-05-11
12034 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 7.6-12.5… 104 20 $551.00 $551.00 $257.53 $36,000.00 $1,494.67 2026-05-11
L0457 HCPCS Tlso, Flexible, Provides Trunk Support, Thoracic Region, Rigid Posterior Panel A… 49 18 $1,556.10 $1,556.10 $731.37 $2,334.15 $1,478.30 2026-05-11
28043 HCPCS Removal (less Than 1.5 Centimeters) Tissue Growth Beneath The Skin Of Foot Or To… 55 20 $1,637.00 $1,637.00 $769.39 $2,455.50 $1,473.30 2026-05-11
J0248 HCPCS Injection, Remdesivir, 1 Mg 49 18 $1,607.30 $1,607.30 $755.43 $1,607.30 $1,446.57 2026-05-11
11646 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More… 104 20 $919.00 $919.00 $257.53 $4,609.50 $1,444.31 2026-05-11
11426 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More … 104 20 $592.00 $592.00 $257.53 $4,575.00 $1,433.50 2026-05-11
90375 HCPCS Rabies Immune Globulin For Injection 55 20 $1,583.47 $1,583.47 $342.97 $1,583.47 $1,425.12 2026-05-11
37618 HCPCS Tying Of Major Arm Or Leg Artery 49 18 $1,500.00 $1,500.00 $705.00 $2,250.00 $1,425.00 2026-05-11
43250 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 104 20 $1,900.00 $1,900.00 $695.73 $2,850.00 $1,406.27 2026-05-11
J0875 HCPCS Injection, Dalbavancin, 5 Mg 104 20 $4,015.95 $4,015.95 $18.27 $4,015.95 $1,399.50 2026-05-11
13160 HCPCS Extensive Or Complicated Repair Of Surface Wound Reopening 55 20 $1,466.00 $1,466.00 $257.53 $2,199.00 $1,392.70 2026-05-11
12035 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 12.6-20.… 104 20 $685.00 $685.00 $257.53 $4,431.00 $1,388.38 2026-05-11
59300 HCPCS Episiotomy Or Repair Of Vagina 49 18 $1,450.00 $1,450.00 $681.50 $2,175.00 $1,377.50 2026-05-11
4634665_1 CDM Room & Board - Semi-private (two Beds) - General Classification 32 12 $1,430.00 $1,430.00 $1,215.50 $1,430.00 $1,358.50 2026-05-11
2120839_1 CDM Room & Board - Private (one Bed) - General Classification 32 12 $1,430.00 $1,430.00 $1,215.50 $1,430.00 $1,358.50 2026-05-11
2120840_1 CDM Room & Board - Private (one Bed) - General Classification 32 12 $1,430.00 $1,430.00 $1,215.50 $1,430.00 $1,358.50 2026-05-11
35190 HCPCS Repair Of Abnormal Artery-vein Connection In Arm Or Leg 49 18 $1,411.00 $1,411.00 $257.53 $2,116.50 $1,340.45 2026-05-11
43215 HCPCS Removal Of Foreign Bodies In Esophagus Using A Flexible Endoscope 55 20 $1,481.00 $1,481.00 $696.07 $2,221.50 $1,332.90 2026-05-11
43241 HCPCS Insertion Of Tube Or Tube In Esophagus, Stomach, And/or Upper Small Bowel Using … 55 20 $1,481.00 $1,481.00 $696.07 $2,221.50 $1,332.90 2026-05-11
43239 HCPCS Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop… 55 20 $1,456.05 $1,456.05 $684.34 $2,184.08 $1,310.45 2026-05-11
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 55 20 $1,438.00 $1,438.00 $675.86 $2,157.00 $1,294.20 2026-05-11
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 55 20 $1,437.00 $1,437.00 $675.39 $2,155.50 $1,293.30 2026-05-11
46320 HCPCS Removal Of External Hemorrhoid With Blood Clot 104 20 $344.00 $344.00 $257.53 $4,111.50 $1,288.27 2026-05-11
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 55 20 $1,418.50 $1,418.50 $666.70 $2,127.75 $1,276.65 2026-05-11
44377 HCPCS Biopsy Of Small Bowel Using An Endoscope 55 20 $1,415.00 $1,415.00 $665.05 $2,122.50 $1,273.50 2026-05-11
P9053 HCPCS Platelets, Pheresis, Leukocytes Reduced, Cmv-negative, Irradiated, Each Unit 49 18 $1,315.00 $1,315.00 $618.05 $1,972.50 $1,249.25 2026-05-11
11423 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 2.1-3… 104 20 $358.00 $358.00 $257.53 $3,985.50 $1,248.79 2026-05-11
43248 HCPCS Insertion Of Guide Wire With Dilation Of Esophagus Using A Flexible Endoscope 55 20 $1,377.00 $1,377.00 $647.19 $2,065.50 $1,239.30 2026-05-11
27265 HCPCS Closed Treatment Of Dislocated Hip Prosthesis 55 20 $1,361.00 $1,361.00 $639.67 $2,041.50 $1,224.90 2026-05-11
64483 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 227 20 $2,590.00 $2,590.00 $36.10 $7,770.00 $1,217.30 2026-05-11
43220 HCPCS Balloon Dilation Of Esophagus Using A Flexible Endoscope, Less Than 3.0 Cm 55 20 $1,336.20 $1,336.20 $628.01 $2,004.30 $1,202.58 2026-05-11
27603 HCPCS Drainage Of Deep Abscess Or Blood Accumulation Of Leg Or Ankle 55 20 $1,325.00 $1,325.00 $622.75 $1,987.50 $1,192.50 2026-05-11
57200 HCPCS Suture Of Nonobstetrical Injury Of Vagina 49 18 $1,250.00 $1,250.00 $587.50 $1,875.00 $1,187.50 2026-05-11
27550 HCPCS Closed Treatment Of Dislocated Knee 55 20 $1,310.00 $1,310.00 $615.70 $1,965.00 $1,179.00 2026-05-11
27041 HCPCS Biopsy Of Deep Tissue Of Pelvis And Hip 55 20 $1,310.00 $1,310.00 $615.70 $1,965.00 $1,179.00 2026-05-11
26740 HCPCS Closed Treatment Of Broken Finger Or Hand At Base Of Finger 55 20 $1,310.00 $1,310.00 $615.70 $1,965.00 $1,179.00 2026-05-11
26670 HCPCS Closed Treatment Of Dislocated Hand Bone At Wrist Joint With Manipulation 55 20 $1,310.00 $1,310.00 $615.70 $1,965.00 $1,179.00 2026-05-11
25675 HCPCS Closed Treatment Of Dislocated Forearm Bone At Wrist With Manipulation 55 20 $1,310.00 $1,310.00 $615.70 $1,965.00 $1,179.00 2026-05-11
27560 HCPCS Closed Treatment Of Dislocated Kneecap 55 20 $1,310.00 $1,310.00 $615.70 $1,965.00 $1,179.00 2026-05-11
46604 HCPCS Dilation Of Anus Using An Endoscope 55 20 $1,309.00 $1,309.00 $615.23 $1,963.50 $1,178.10 2026-05-11
45382 HCPCS Control Of Bleeding Of Upper Large Bowel Using A Flexible Endoscope 153 20 $1,667.70 $1,667.70 $552.25 $3,210.00 $1,175.00 2026-05-11
43235 HCPCS Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible… 55 20 $1,304.33 $1,304.33 $613.04 $1,956.50 $1,173.90 2026-05-11
93799 HCPCS Other Cardiovascular Service Or Procedure 98 18 $1,373.51 $1,373.51 $564.94 $2,317.53 $1,171.95 2026-05-11
12017 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 20.… 104 20 $460.00 $460.00 $257.53 $3,738.00 $1,171.24 2026-05-11
12006 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 104 20 $457.00 $457.00 $257.53 $3,738.00 $1,171.24 2026-05-11
45910 HCPCS Dilation Of Narrowing Of Rectum Under Anesthesia 49 18 $1,225.00 $1,225.00 $575.75 $1,837.50 $1,163.75 2026-05-11
10121 HCPCS Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Complex 104 20 $489.00 $489.00 $257.53 $3,687.00 $1,155.26 2026-05-11
G0105 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual At High Risk 55 20 $1,271.18 $1,271.18 $597.45 $1,906.77 $1,144.06 2026-05-11
G0121 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual Not Meeting Criteria For … 55 20 $1,271.18 $1,271.18 $597.45 $1,906.77 $1,144.06 2026-05-11
44378 HCPCS Control Of Bleeding Of Small Bowel Using An Endoscope 55 20 $1,271.18 $1,271.18 $597.45 $1,906.77 $1,144.06 2026-05-11
44370 HCPCS Insertion Of Small Bowel Stent Above Lower Small Bowel Using An Endoscope 55 20 $1,271.18 $1,271.18 $597.45 $1,906.77 $1,144.06 2026-05-11
44388 HCPCS Diagnostic Exam Of Large Bowel Using An Endoscope Inserted Through Surgically Cr… 55 20 $1,271.18 $1,271.18 $597.45 $1,906.77 $1,144.06 2026-05-11
10061 HCPCS Complicated Or Multiple Drainage Of Skin Abscess 104 20 $375.00 $375.00 $257.53 $3,607.50 $1,130.35 2026-05-11
P9037 HCPCS Platelets, Pheresis, Leukocytes Reduced, Irradiated, Each Unit 49 18 $1,185.00 $1,185.00 $556.95 $1,777.50 $1,125.75 2026-05-11
27786 HCPCS Closed Treatment Of Broken Outside Lower Leg Bone At Ankle 104 20 $568.00 $568.00 $257.53 $3,534.00 $1,107.32 2026-05-11
27780 HCPCS Closed Treatment Of Broken Middle Or Upper End Of Outside Lower Leg Bone 104 20 $549.00 $549.00 $257.53 $3,534.00 $1,107.32 2026-05-11
27760 HCPCS Closed Treatment Of Inside Portion Of Shin Bone At Ankle 104 20 $600.00 $600.00 $257.53 $3,534.00 $1,107.32 2026-05-11
27750 HCPCS Closed Treatment Of Broken Middle Part Of Shin Bone 104 20 $621.00 $621.00 $257.53 $3,534.00 $1,107.32 2026-05-11
27530 HCPCS Closed Treatment Of Broken Shin Bone 104 20 $541.00 $541.00 $257.53 $3,534.00 $1,107.32 2026-05-11
27520 HCPCS Closed Treatment Of Broken Kneecap 104 20 $579.00 $579.00 $257.53 $3,534.00 $1,107.32 2026-05-11
26070 HCPCS Incision Of Wrist Joint At Finger For Exploration, Fluid Drainage, Or Removal Of… 104 20 $882.00 $882.00 $257.53 $3,534.00 $1,107.32 2026-05-11
25530 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Small Finger Side 104 20 $467.00 $467.00 $257.53 $3,534.00 $1,107.32 2026-05-11
25500 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Thumb Side 104 20 $486.00 $486.00 $257.53 $3,534.00 $1,107.32 2026-05-11
24670 HCPCS Closed Treatment Of Broken Forearm Bone On Small Finger Side At Elbow 104 20 $520.00 $520.00 $257.53 $3,534.00 $1,107.32 2026-05-11
24576 HCPCS Closed Treatment Of Broken Elbow 104 20 $606.00 $606.00 $257.53 $3,534.00 $1,107.32 2026-05-11
24500 HCPCS Closed Treatment Of Broken Middle Part Of Upper Arm Bone 104 20 $639.00 $639.00 $257.53 $3,534.00 $1,107.32 2026-05-11
28490 HCPCS Closed Treatment Of Broken Great Toe 104 20 $261.00 $261.00 $234.90 $3,534.00 $1,107.32 2026-05-11
28470 HCPCS Closed Treatment Of Broken Bone In Forefoot Or Midfoot 104 20 $398.00 $398.00 $257.53 $3,534.00 $1,107.32 2026-05-11
25560 HCPCS Closed Treatment Of Broken Midpart Of Both Forearm Bones 104 20 $499.00 $499.00 $257.53 $3,534.00 $1,107.32 2026-05-11
P9035 HCPCS Platelets, Pheresis, Leukocytes Reduced, Each Unit 49 18 $1,163.00 $1,163.00 $546.61 $1,744.50 $1,104.85 2026-05-11
73706 HCPCS CT Scan Of Blood Vessels Of Lower Leg With Contrast 49 18 $1,150.00 $1,150.00 $540.50 $1,725.00 $1,092.50 2026-05-11
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 55 20 $1,150.00 $1,150.00 $540.50 $1,725.00 $1,092.50 2026-05-11
72191 HCPCS CT Scan Of Blood Vessels Of Pelvis With Contrast 49 18 $1,150.00 $1,150.00 $540.50 $1,725.00 $1,092.50 2026-05-11
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 147 18 $1,150.00 $1,150.00 $540.50 $1,725.00 $1,092.50 2026-05-11
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 104 20 $984.00 $984.00 $257.53 $3,484.50 $1,091.81 2026-05-11
57460 HCPCS Biopsy Of Cervix Using An Endoscope With Loop Electrode 104 20 $507.00 $507.00 $257.53 $3,441.00 $1,078.18 2026-05-11
11443 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2… 104 20 $397.00 $397.00 $257.53 $3,421.50 $1,072.07 2026-05-11
12051 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 C… 104 20 $848.00 $848.00 $257.53 $5,415.00 $1,060.00 2026-05-11
37195 HCPCS Infusion Of Drug To Dissolve Blood Clot In Brain 49 18 $1,115.00 $1,115.00 $524.05 $1,672.50 $1,059.25 2026-05-11
64454 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Knee Nerve Branch Using Imagin… 144 20 $2,880.00 $2,880.00 $36.10 $4,320.00 $1,056.40 2026-05-11
49083 HCPCS Drainage Of Fluid From Abdominal Cavity Using Imaging Guidance 159 20 $1,748.00 $1,748.00 $199.75 $3,370.41 $1,056.06 2026-05-11
36556 HCPCS Insertion Of Non-tunneled Central Venous Tube For Infusion (5 Years Or Older) 55 20 $1,100.00 $1,100.00 $517.00 $2,640.00 $1,045.00 2026-05-11
43270 HCPCS Destruction Of Polyp Or Growth Of Esophagus, Stomach, And/or Upper Small Bowel U… 55 20 $1,153.88 $1,153.88 $542.32 $1,730.82 $1,038.49 2026-05-11
12055 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.6-… 104 20 $652.00 $652.00 $257.53 $3,313.50 $1,038.23 2026-05-11
27372 HCPCS Removal Of Foreign Body Deep In Tissue Of Thigh Or Knee 55 20 $1,090.00 $1,090.00 $257.53 $4,707.00 $1,035.50 2026-05-11
44382 HCPCS Biopsy Of Small Bowel Using An Endoscope Inserted Through Surgically Created Ope… 55 20 $1,148.78 $1,148.78 $539.93 $1,723.17 $1,033.90 2026-05-11
44380 HCPCS Diagnostic Exam Of Small Bowel Using An Endoscope Inserted Through Surgically Cr… 55 20 $1,148.78 $1,148.78 $539.93 $1,723.17 $1,033.90 2026-05-11
25600 HCPCS Closed Treatment Of Broken Forearm (radius) Bone At The Wrist Area On The Thumb … 104 20 $6,151.00 $6,151.00 $257.53 $9,226.50 $1,030.00 2026-05-11
70553 HCPCS MRI Scan Of Brain Before And After Contrast 55 20 $1,142.50 $1,142.50 $494.95 $1,713.75 $1,028.25 2026-05-11
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 55 20 $1,142.50 $1,142.50 $494.95 $1,713.75 $1,028.25 2026-05-11
74182 HCPCS MRI Scan Of Abdomen With Contrast 55 20 $1,142.50 $1,142.50 $494.95 $1,713.75 $1,028.25 2026-05-11
71552 HCPCS MRI Scan Of Chest Before And After Contrast 55 20 $1,142.50 $1,142.50 $494.95 $1,713.75 $1,028.25 2026-05-11
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 55 20 $1,142.50 $1,142.50 $494.95 $1,713.75 $1,028.25 2026-05-11
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 55 20 $1,142.50 $1,142.50 $494.95 $1,713.75 $1,028.25 2026-05-11
73720 HCPCS MRI Scan Of Leg Before And After Contrast 165 20 $1,142.50 $1,142.50 $494.95 $1,713.75 $1,028.25 2026-05-11
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 55 20 $1,142.50 $1,142.50 $494.95 $1,713.75 $1,028.25 2026-05-11
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 55 20 $1,142.00 $1,142.00 $536.74 $1,713.00 $1,027.80 2026-05-11
71555 HCPCS MRI Scan Of Blood Vessels Of Chest 55 20 $1,142.00 $1,142.00 $536.74 $1,713.00 $1,027.80 2026-05-11
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 165 20 $1,142.00 $1,142.00 $536.74 $1,713.00 $1,027.80 2026-05-11
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 55 20 $1,142.00 $1,142.00 $536.74 $1,713.00 $1,027.80 2026-05-11
73220 HCPCS MRI Scan Of Arm Before And After Contrast 165 20 $1,142.00 $1,142.00 $494.95 $1,713.00 $1,027.80 2026-05-11
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 55 20 $1,142.00 $1,142.00 $536.74 $1,713.00 $1,027.80 2026-05-11
70552 HCPCS MRI Scan Of Brain With Contrast 55 20 $1,142.00 $1,142.00 $494.95 $1,713.00 $1,027.80 2026-05-11
11403 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm 104 20 $338.00 $338.00 $257.53 $3,232.23 $1,012.77 2026-05-11
62321 HCPCS Injection Of Substance Into Middle Or Upper Spine Canal Using Imaging Guidance 130 20 $2,100.00 $2,100.00 $36.10 $3,150.00 $987.00 2026-05-11
27096 HCPCS Injection Of Anesthetic Or Steroid Into Joint Between Lower Spine And Hip Bone U… 300 20 $1,920.00 $1,920.00 $36.10 $5,760.00 $984.60 2026-05-11
43450 HCPCS Dilation Of Esophagus 104 20 $1,035.30 $1,035.30 $486.59 $1,992.00 $983.54 2026-05-11
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 55 20 $1,067.00 $1,067.00 $494.95 $1,600.50 $960.30 2026-05-11
Q5103 HCPCS Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 55 20 $1,060.65 $1,060.65 $58.38 $1,060.65 $954.59 2026-05-11
J7325 HCPCS Hyaluronan Or Derivative, Synvisc Or Synvisc-one, For Intra-articular Injection,… 55 20 $1,050.95 $1,050.95 $13.47 $1,050.95 $945.86 2026-05-11
62323 HCPCS Injection Of Substance Into Lower Spine Canal Using Imaging Guidance 126 20 $2,000.00 $2,000.00 $36.10 $3,000.00 $940.00 2026-05-11
28193 HCPCS Complicated Removal Of Foreign Body In Foot 55 20 $968.00 $968.00 $257.53 $1,523.00 $919.60 2026-05-11
45350 HCPCS Banding Of Hemorrhoids Using A Flexible Endoscope (sigmoidoscope) 55 20 $1,020.00 $1,020.00 $479.40 $1,530.00 $918.00 2026-05-11
46040 HCPCS Drainage Of Deep Abscess In Rectum 55 20 $952.00 $952.00 $257.53 $2,306.00 $904.40 2026-05-11
10140 HCPCS Drainage Of Blood Or Fluid Accumulation 104 20 $290.00 $290.00 $257.53 $2,883.00 $903.34 2026-05-11
31730 HCPCS Insertion Of Needle Wire Dilator Or Indwelling Tube For Oxygen Therapy 49 18 $950.00 $950.00 $446.50 $1,425.00 $902.50 2026-05-11
71270 HCPCS CT Scan Of Chest Before And After Contrast 55 20 $1,000.00 $1,000.00 $430.35 $1,500.00 $900.00 2026-05-11
27508 HCPCS Closed Treatment Of Broken Inside Or Outside Portion Of Lower End Of Thigh Bone 55 20 $946.00 $946.00 $257.53 $1,440.00 $898.70 2026-05-11
70450 HCPCS CT Scan Head Or Brain Without Contrast 55 20 $990.00 $990.00 $430.35 $1,485.00 $891.00 2026-05-11
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 55 20 $985.00 $985.00 $430.35 $1,477.50 $886.50 2026-05-11
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 55 20 $985.00 $985.00 $430.35 $1,477.50 $886.50 2026-05-11
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 55 20 $985.00 $985.00 $430.35 $1,477.50 $886.50 2026-05-11
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 55 20 $985.00 $985.00 $430.35 $1,477.50 $886.50 2026-05-11
25565 HCPCS Closed Treatment Of Broken Midpart Of Both Forearm Bones With Manipulation 55 20 $931.00 $931.00 $257.53 $1,440.00 $884.45 2026-05-11
41252 HCPCS Repair Of Lacerated Tongue Or Floor Of Mouth, More Than 2.6 Cm 49 18 $917.00 $917.00 $257.53 $1,375.50 $871.15 2026-05-11
64624 HCPCS Destruction Of Nerve Branches Of Knee Using Imaging Guidance 144 20 $1,848.00 $1,848.00 $36.10 $2,772.00 $868.56 2026-05-11
73219 HCPCS MRI Scan Of Arm With Contrast 165 20 $963.00 $963.00 $452.61 $1,444.50 $866.70 2026-05-11
73222 HCPCS MRI Scan Of Arm Joint With Contrast 165 20 $963.00 $963.00 $452.61 $1,444.50 $866.70 2026-05-11
73719 HCPCS MRI Scan Of Leg With Contrast 55 20 $963.00 $963.00 $452.61 $1,444.50 $866.70 2026-05-11
30903 HCPCS Complex Control Of Nose Bleed 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
70551 HCPCS MRI Scan Of Brain Without Contrast 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
72196 HCPCS MRI Scan Of Pelvis With Contrast 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
72195 HCPCS MRI Scan Of Pelvis Without Contrast 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
71550 HCPCS MRI Scan Of Chest Without Contrast 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
71551 HCPCS MRI Scan Of Chest With Contrast 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
70336 HCPCS MRI Scan Of Jaw Joint 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 55 20 $962.00 $962.00 $452.14 $1,443.00 $865.80 2026-05-11
4441948_1 CDM Room & Board - Semi-private (two Beds) - General Classification 32 12 $910.00 $910.00 $773.50 $910.00 $864.50 2026-05-11
28045 HCPCS Removal Of Growth Of Muscle Of Foot Or Toe, Less Than 1.5 Cm 55 20 $902.00 $902.00 $257.53 $1,695.00 $856.90 2026-05-11
27562 HCPCS Closed Treatment Of Dislocated Kneecap Under Anesthesia 55 20 $900.00 $900.00 $423.00 $2,501.00 $855.00 2026-05-11
27266 HCPCS Closed Treatment Of Dislocated Hip Prosthesis Under Anesthesia 55 20 $900.00 $900.00 $423.00 $1,350.00 $855.00 2026-05-11
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 55 20 $950.00 $950.00 $430.35 $1,425.00 $855.00 2026-05-11
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 55 20 $950.00 $950.00 $430.35 $1,425.00 $855.00 2026-05-11
71260 HCPCS CT Scan Of Chest With Contrast 55 20 $950.00 $950.00 $430.35 $1,425.00 $855.00 2026-05-11
51102 HCPCS Aspiration Of Bladder With Insertion Of Bladder Tube To Skin 49 18 $900.00 $900.00 $423.00 $1,350.00 $855.00 2026-05-11
72125 HCPCS CT Scan Of Upper Spine Without Contrast 55 20 $945.00 $945.00 $430.35 $1,417.50 $850.50 2026-05-11
72131 HCPCS CT Scan Of Lower Spine Without Contrast 55 20 $945.00 $945.00 $430.35 $1,417.50 $850.50 2026-05-11
64615 HCPCS Injection Of Chemical For Paralysis Of Facial And Neck Nerve Muscles On Both Sid… 107 20 $1,800.00 $1,800.00 $27.44 $2,700.00 $846.00 2026-05-11
64635 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 233 20 $1,800.00 $1,800.00 $36.10 $2,913.00 $846.00 2026-05-11
72193 HCPCS CT Scan Of Pelvis With Contrast 55 20 $940.00 $940.00 $430.35 $1,410.00 $846.00 2026-05-11
13132 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 104 20 $841.00 $841.00 $257.53 $2,451.00 $841.00 2026-05-11
19120 HCPCS Removal Of Growth And Tissue Of Breast, Duct, Or Nipple 55 20 $879.00 $879.00 $257.53 $2,355.00 $835.05 2026-05-11
64494 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Second Le… 233 20 $1,750.00 $1,750.00 $36.10 $5,250.00 $822.50 2026-05-11
64495 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Third And… 214 20 $1,750.00 $1,750.00 $36.10 $5,250.00 $822.50 2026-05-11
10120 HCPCS Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Simple 104 20 $270.00 $270.00 $243.00 $2,613.00 $818.74 2026-05-11
36010 HCPCS Insertion Of Tube Into Vena Cava 55 20 $903.00 $903.00 $257.53 $1,354.50 $812.70 2026-05-11
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 55 20 $899.00 $899.00 $422.53 $1,348.50 $809.10 2026-05-11
12037 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, More Tha… 55 20 $849.00 $849.00 $257.53 $2,581.00 $806.55 2026-05-11
64620 HCPCS Injection Of Agent To Destroy Rib Nerve 55 20 $890.29 $890.29 $36.10 $1,335.44 $801.26 2026-05-11
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 55 20 $890.00 $890.00 $418.30 $1,335.00 $801.00 2026-05-11
38510 HCPCS Biopsy Or Removal Of Deep Lymph Nodes Of Neck 104 20 $940.00 $940.00 $257.53 $3,920.00 $800.00 2026-05-11
74150 HCPCS CT Scan Of Abdomen Without Contrast 55 20 $885.00 $885.00 $415.95 $1,327.50 $796.50 2026-05-11
72192 HCPCS CT Scan Of Pelvis Without Contrast 55 20 $885.00 $885.00 $415.95 $1,327.50 $796.50 2026-05-11
27614 HCPCS Biopsy Of Deep Tissue Of Leg Or Ankle 55 20 $877.00 $877.00 $412.19 $1,315.50 $789.30 2026-05-11
27250 HCPCS Closed Treatment Of Dislocated Hip 55 20 $877.00 $877.00 $412.19 $1,315.50 $789.30 2026-05-11
26755 HCPCS Closed Treatment Of Broken End Of Finger Or Thumb With Manipulation 55 20 $877.00 $877.00 $412.19 $1,315.50 $789.30 2026-05-11
11643 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.1-… 104 20 $569.00 $569.00 $257.53 $2,518.50 $789.13 2026-05-11
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 101 20 $1,675.00 $1,675.00 $98.48 $2,512.50 $787.25 2026-05-11
6485190_1 CDM Revonto 20 Mg Vial 41 15 $925.00 $925.00 $434.75 $878.75 $786.25 2026-05-11
36589 HCPCS Removal Of Tunneled Central Venous Tube 104 20 $1,553.00 $1,553.00 $368.48 $2,329.50 $784.00 2026-05-11
64484 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 328 20 $1,665.00 $1,665.00 $36.10 $2,497.50 $782.55 2026-05-11
70488 HCPCS CT Scan Of Face Before And After Contrast 55 20 $868.00 $868.00 $407.96 $1,302.00 $781.20 2026-05-11
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 165 20 $864.00 $864.00 $406.08 $1,296.00 $777.60 2026-05-11
73718 HCPCS MRI Scan Of Leg Without Contrast 165 20 $864.00 $864.00 $406.08 $1,296.00 $777.60 2026-05-11
73218 HCPCS MRI Scan Of Arm Without Contrast 165 20 $864.00 $864.00 $406.08 $1,296.00 $777.60 2026-05-11
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 165 20 $864.00 $864.00 $406.08 $1,296.00 $777.60 2026-05-11
43247 HCPCS Removal Of Foreign Bodies Of Esophagus, Stomach, And/or Upper Small Bowel Using … 110 20 $1,192.20 $1,192.20 $257.53 $2,478.60 $776.63 2026-05-11
72132 HCPCS CT Scan Of Lower Spine With Contrast 55 20 $850.00 $850.00 $399.50 $1,275.00 $765.00 2026-05-11
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