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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

OTTAWA COUNTY HEALTH CENTER

Minneapolis, KS · CCN 171328 · Rates published

1,586 distinct procedures filed
15 distinct payers
25,073 rate rows
2026-03-09 last MRF observed
Data quality

24,503 of 25,073 rate rows are consumer-grade (97.7%)

570 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
template filing: same amount across many unrelated codes — excluded 208
percent-of-charges filed in the dollar field — excluded from medians 173
per-diem day rate — not a per-procedure price 133
exceeds 10× this hospital's gross charge — excluded from medians 52
placeholder amount (≤ $0.02) — excluded from medians 4
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbOttawaCounty&type=CDMWithoutLabel&fileType=CSV
Found on page https://www.ottawacountyhealthcenter.org/cms-hpt.txt
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-19
Content fingerprint 231499d530a7c135… · 11,521,665 bytes · first seen 2026-05-17

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
Q4309
HCPCS 		Via Matrix, Per Square Centimeter 10 $9,923.10 $25,000.00 $15,500.00 nat. median
$1,750
outlier · 8.9×
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 12 $187.12 $13,531.18 $8,389.33 nat. median
$5,957
1.4× median
15275
HCPCS 		Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 10 $3,722.67 $6,190.00 $4,549.65 nat. median
$1,737
outlier · 2.6×
J1306
HCPCS 		Injection, Inclisiran, 1 Mg 10 $3,689.61 $6,135.03 $4,509.25 nat. median
$57
outlier · 79.8×
15271
HCPCS 		Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C… 10 $2,504.83 $4,165.00 $3,061.28 nat. median
$1,748
1.8× median
36558
HCPCS 		Insertion Of Tunneled Central Venous Tube For Infusion (5 Years Or Older) 12 $2,555.95 $4,250.00 $2,990.68 nat. median
$3,479
0.9× median
72157
HCPCS 		MRI Scan Of Middle Spinal Canal Before And After Contrast 12 $524.89 $4,305.20 $2,669.22 nat. median
$1,094
outlier · 2.4×
70553
HCPCS 		MRI Scan Of Brain Before And After Contrast 12 $524.89 $4,115.20 $2,551.42 nat. median
$1,122
outlier · 2.3×
2120839_1
CDM 		Room & Board - Private (one Bed) - General Classification 2 $2,100.00 $3,000.00 $2,550.00 nat. median
$1,266
outlier · 2.0×
15273
HCPCS 		Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.… 10 $2,053.78 $3,415.00 $2,510.03 nat. median
$3,195
0.8× median
15276
HCPCS 		Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 10 $1,861.33 $3,095.00 $2,274.82 nat. median
$454
outlier · 5.0×
59510
HCPCS 		Cesarean Delivery With Care Before And After Delivery 12 $68.24 $3,299.00 $2,193.84 nat. median
$3,677
0.6× median
4441947_1
CDM 		Room & Board - Private (one Bed) - General Classification 2 $1,750.00 $2,500.00 $2,125.00 nat. median
$1,015
outlier · 2.1×
J1602
HCPCS 		Injection, Golimumab, 1 Mg, For Intravenous Use 12 $13.79 $3,416.90 $2,118.48 nat. median
$505
outlier · 4.2×
19120
HCPCS 		Removal Of Growth And Tissue Of Breast, Duct, Or Nipple 15 $12.00 $5,750.00 $2,071.53 nat. median
$3,650
0.6× median
26765
HCPCS 		Treatment Of Broken End Of Finger Or Thumb 12 $1,750.07 $2,910.00 $2,042.37 nat. median
$3,497
0.6× median
28190
HCPCS 		Removal Of Foreign Body Of Foot Tissue, Accessed Beneath The Skin 10 $1,656.86 $2,755.00 $2,024.92 nat. median
$892
outlier · 2.3×
J0897
HCPCS 		Injection, Denosumab, 1 Mg 12 $30.80 $3,206.99 $1,988.33 nat. median
$2,502
0.8× median
59400
HCPCS 		Vaginal Delivery With Care Before And After Delivery 12 $61.53 $2,984.00 $1,979.71 nat. median
$3,198
0.6× median
78582
HCPCS 		Nuclear Medicine Study Of Lung Ventilation And Circulation 12 $658.52 $2,851.00 $1,767.62 nat. median
$856
outlier · 2.1×
36573
HCPCS 		Insertion Of Tube For Infusion With Imaging Guidance And Review By Radiologist,… 10 $1,419.30 $2,360.00 $1,734.60 nat. median
$2,044
0.8× median
74174
HCPCS 		CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 12 $1,473.43 $2,450.00 $1,661.55 nat. median
$959
1.7× median
15272
HCPCS 		Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, Each Addi… 10 $1,253.92 $2,085.00 $1,532.47 nat. median
$485
outlier · 3.2×
43249
HCPCS 		Balloon Dilation Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexibl… 12 $1,312.86 $2,183.00 $1,527.35 nat. median
$2,133
0.7× median
93306
HCPCS 		Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 12 $1,274.97 $2,120.00 $1,493.87 nat. median
$1,008
1.5× median
45385
HCPCS 		Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S… 12 $1,142.66 $1,900.00 $1,449.55 nat. median
$1,686
0.9× median
J3111
HCPCS 		Injection, Romosozumab-aqqg, 1 Mg 12 $13.11 $2,337.64 $1,449.34 nat. median
$1,003
1.4× median
72148
HCPCS 		MRI Scan Of Lower Spinal Canal Without Contrast 12 $524.89 $2,272.00 $1,408.64 nat. median
$770
1.8× median
87636
HCPCS 		Detection Test By Multiplex Amplified Probe Technique For Severe Acute Respirato… 12 $72.76 $2,220.00 $1,376.40 nat. median
$165
outlier · 8.3×
73718
HCPCS 		MRI Scan Of Leg Without Contrast 12 $524.89 $2,190.00 $1,357.80 nat. median
$917
1.5× median
73721
HCPCS 		MRI Scan Of Leg Joint Without Contrast 12 $524.89 $2,190.00 $1,357.80 nat. median
$899
1.5× median
45380
HCPCS 		Biopsy Of Large Bowel Using A Flexible Endoscope 12 $1,139.65 $1,895.00 $1,329.41 nat. median
$1,566
0.8× median
43251
HCPCS 		Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 12 $1,134.24 $1,886.00 $1,319.57 nat. median
$2,145
0.6× median
45384
HCPCS 		Removal Of Polyps Or Growths Of Large Bowel Using A Flexible Endoscope With Elec… 12 $1,112.59 $1,850.00 $1,288.05 nat. median
$1,676
0.8× median
45378
HCPCS 		Diagnostic Exam Of Large Bowel Using A Flexible Endoscope 12 $1,112.59 $1,850.00 $1,288.05 nat. median
$1,331
1.0× median
73706
HCPCS 		CT Scan Of Blood Vessels Of Lower Leg With Contrast 10 $1,052.45 $1,750.00 $1,286.25 nat. median
$760
1.7× median
73206
HCPCS 		CT Scan Of Blood Vessels Of Arm With Contrast 10 $1,052.45 $1,750.00 $1,286.25 nat. median
$697
1.8× median
72191
HCPCS 		CT Scan Of Blood Vessels Of Pelvis With Contrast 10 $1,052.45 $1,750.00 $1,286.25 nat. median
$602
outlier · 2.1×
J2357
HCPCS 		Injection, Omalizumab, 5 Mg 12 $44.98 $2,619.16 $1,284.40 nat. median
$1,302
1.0× median
J7307
HCPCS 		Etonogestrel (contraceptive) Implant System, Including Implant And Supplies 12 $3.01 $2,095.00 $1,279.41 nat. median
$1,689
0.8× median
43247
HCPCS 		Removal Of Foreign Bodies Of Esophagus, Stomach, And/or Upper Small Bowel Using… 12 $1,094.55 $1,820.00 $1,276.24 nat. median
$1,481
0.9× median
15274
HCPCS 		Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, Each… 10 $1,028.39 $1,710.00 $1,256.85 nat. median
$921
1.4× median
28192
HCPCS 		Removal Of Foreign Body Of Foot Tissue, Deep 12 $1,043.43 $1,735.00 $1,215.18 nat. median
$1,917
0.6× median
J2407
HCPCS 		Injection, Oritavancin (orbactiv), 10 Mg 12 $33.73 $1,920.53 $1,190.73 nat. median
$65
outlier · 18.2×
59426
HCPCS 		Predelivery Care, 7 Or More Visits 9 $139.00 $1,365.00 $1,160.25 nat. median
$1,440
0.8× median
74175
HCPCS 		CT Scan Of Blood Vessels Of Abdomen With Contrast 12 $1,067.49 $1,775.00 $1,156.92 nat. median
$710
1.6× median
43250
HCPCS 		Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 12 $984.49 $1,637.00 $1,143.30 nat. median
$2,087
0.5× median
43239
HCPCS 		Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop… 12 $1,094.55 $1,820.00 $1,140.91 nat. median
$1,377
0.8× median
70498
HCPCS 		CT Scan Of Blood Vessels Of Neck With Contrast 12 $1,052.45 $1,750.00 $1,130.65 nat. median
$722
1.6× median
75635
HCPCS 		CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 12 $481.12 $1,850.00 $1,129.80 nat. median
$706
1.6× median

Other procedures at this hospital

Browse this hospital's 1,586 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
             
J7307 HCPCS Etonogestrel (contraceptive) Implant System, Including Implant And Supplies 22 12 $5.00 $5.00 $3.01 $2,095.00 $1,279.41 2026-03-09
11424 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4… 22 13 $330.00 $330.00 $5.11 $2,490.00 $283.50 2026-03-09
59430 HCPCS Post Delivery Care 9 9 $360.00 $360.00 $139.00 $360.00 $306.00 2026-03-09
10180 HCPCS Complex Drainage Of Wound Infection After Surgery 22 13 $365.00 $365.00 $5.11 $5,230.00 $274.56 2026-03-09
11044 HCPCS Removal Of Bone, 20.0 Sq Cm Or Less 22 13 $370.00 $370.00 $6.56 $2,500.00 $382.73 2026-03-09
11642 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 1.1-… 22 13 $375.00 $375.00 $5.22 $2,000.00 $333.50 2026-03-09
78278 HCPCS Nuclear Medicine Study To Assess Blood Loss 10 10 $379.00 $379.00 $227.93 $379.00 $278.56 2026-03-09
36680 HCPCS Insertion Of Needle For Infusion Into Bone 20 10 $379.00 $379.00 $227.93 $379.00 $278.56 2026-03-09
11603 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm 22 13 $390.00 $390.00 $5.54 $1,085.00 $289.34 2026-03-09
29581 HCPCS Application Of Vein Wound Compression Bandages On Lower Leg, Ankle, And Foot 10 10 $390.00 $390.00 $234.55 $390.00 $286.65 2026-03-09
72084 HCPCS X-ray Of Entire Middle And Lower Spine, Minimum Of 6 Views 10 10 $391.00 $391.00 $235.15 $391.00 $287.38 2026-03-09
72083 HCPCS X-ray Of Entire Middle And Lower Spine, 4-5 Views 10 10 $391.00 $391.00 $235.15 $391.00 $287.38 2026-03-09
73522 HCPCS X-ray Of Both Hips, 3-4 Views 10 10 $391.00 $391.00 $235.15 $391.00 $287.38 2026-03-09
73523 HCPCS X-ray Of Both Hips, Minimum Of 5 Views 10 10 $391.00 $391.00 $235.15 $391.00 $287.38 2026-03-09
72082 HCPCS X-ray Of Entire Middle And Lower Spine, 2-3 Views 10 10 $391.00 $391.00 $235.15 $391.00 $287.38 2026-03-09
78580 HCPCS Nuclear Medicine Study Of Lung Circulation 10 10 $393.00 $393.00 $236.35 $393.00 $288.86 2026-03-09
11042 HCPCS Removal Of Skin And Tissue, 20.0 Sq Cm Or Less 24 15 $394.50 $394.50 $1.75 $630.00 $278.44 2026-03-09
11444 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3… 22 13 $395.00 $395.00 $6.49 $2,655.00 $320.81 2026-03-09
12002 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 24 15 $400.00 $400.00 $1.73 $640.00 $310.95 2026-03-09
97607 HCPCS Therapy Procedure Using A Special Bandage, Vacuum Pump And Disposable Medical Eq… 10 10 $400.00 $400.00 $240.56 $400.00 $294.00 2026-03-09
37195 HCPCS Infusion Of Drug To Dissolve Blood Clot In Brain 10 10 $400.00 $400.00 $240.56 $400.00 $294.00 2026-03-09
78701 HCPCS Nuclear Medicine Study Of Kidney And Blood Flow 10 10 $403.00 $403.00 $242.36 $403.00 $296.21 2026-03-09
78216 HCPCS Nuclear Medicine Study Of Liver, Spleen, And Blood Flow 10 10 $403.00 $403.00 $242.36 $403.00 $296.21 2026-03-09
78215 HCPCS Nuclear Medicine Study Of Liver And Spleen 10 10 $403.00 $403.00 $242.36 $403.00 $296.21 2026-03-09
90377 HCPCS Rabies Immune Globulin For Injection Beneath The Skin And/or Into Muscle 12 12 $407.93 $407.93 $245.33 $407.93 $340.38 2026-03-09
11623 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 2.1-3.0 … 22 13 $410.00 $410.00 $6.03 $2,495.00 $353.00 2026-03-09
P9040 HCPCS Red Blood Cells, Leukocytes Reduced, Irradiated, Each Unit 10 10 $410.00 $410.00 $246.57 $410.00 $301.35 2026-03-09
12011 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5… 24 15 $412.50 $412.50 $1.63 $665.00 $317.47 2026-03-09
12013 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.6… 24 15 $415.00 $415.00 $1.72 $665.00 $328.97 2026-03-09
10120 HCPCS Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Simple 34 15 $415.00 $415.00 $2.94 $1,495.00 $305.02 2026-03-09
26600 HCPCS Closed Treatment Of Broken Hand Bone 12 12 $420.00 $420.00 $8.06 $407.00 $273.35 2026-03-09
97608 HCPCS Therapy Procedure Using A Special Bandage, Vacuum Pump And Disposable Medical Eq… 10 10 $425.00 $425.00 $255.60 $425.00 $312.38 2026-03-09
11604 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 3.1-4.0 Cm 22 13 $430.00 $430.00 $6.12 $1,085.00 $326.85 2026-03-09
99292 HCPCS Critical Care, Each Additional 30 Minutes 12 12 $430.00 $430.00 $258.60 $430.00 $295.71 2026-03-09
11643 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.1-… 22 13 $435.00 $435.00 $6.55 $1,435.00 $334.69 2026-03-09
72114 HCPCS X-ray Lower And Sacral Spine, Minimum Of 6 Views 12 12 $437.00 $437.00 $262.81 $437.00 $291.72 2026-03-09
11406 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 22 13 $440.00 $440.00 $7.09 $2,870.00 $351.44 2026-03-09
97606 HCPCS Therapy Procedure Using A Special Bandage And Vacuum Pump, Surface Area More Tha… 10 10 $440.00 $440.00 $264.62 $440.00 $323.40 2026-03-09
92960 HCPCS External Shock To Heart To Regulate Heart Beat 24 15 $445.00 $445.00 $3.12 $675.00 $412.23 2026-03-09
74250 HCPCS Single Contrast X-ray Of Small Intestine 12 12 $448.00 $448.00 $269.43 $448.00 $303.50 2026-03-09
25111 HCPCS Removal Of First Cyst Of Wrist 12 12 $450.00 $450.00 $9.24 $494.00 $296.19 2026-03-09
74230 HCPCS Imaging For Evaluation Of Swallowing Function 12 12 $453.00 $453.00 $272.43 $453.00 $304.40 2026-03-09
30901 HCPCS Simple Control Of Nose Bleed 24 15 $457.50 $457.50 $1.64 $690.00 $319.99 2026-03-09
20610 HCPCS Aspiration And/or Injection Of Fluid From Large Joint 54 15 $458.00 $458.00 $1.32 $531.00 $314.34 2026-03-09
20103 HCPCS Exploration Of Wound Of Arm Or Leg 12 12 $458.00 $458.00 $275.44 $458.00 $302.32 2026-03-09
11426 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More … 22 13 $460.00 $460.00 $7.89 $2,605.00 $371.62 2026-03-09
11624 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4.0 … 22 13 $465.00 $465.00 $6.85 $2,495.00 $351.52 2026-03-09
26605 HCPCS Closed Treatment Of Broken Hand Bone With Manipulation 12 12 $465.00 $465.00 $8.45 $451.00 $283.33 2026-03-09
6460876_1 CDM Repatha 140 Mg/ml Sureclick 9 9 $466.82 $466.82 $280.75 $443.48 $289.43 2026-03-09
Q5101 HCPCS Injection, Filgrastim-sndz, Biosimilar, (zarxio), 1 Microgram 12 12 $469.17 $469.17 $0.54 $469.17 $290.89 2026-03-09
26700 HCPCS Closed Treatment Of Dislocated Hand Joint At Base Of Finger With Manipulation 12 12 $470.00 $470.00 $8.86 $453.00 $313.76 2026-03-09
26725 HCPCS Closed Treatment Of Broken Finger Or Thumb At Midportion Or Part Near Hand With … 12 12 $475.00 $475.00 $8.73 $495.00 $296.16 2026-03-09
25110 HCPCS Removal Of Growth Of Tendon Covering Of Forearm Or Wrist 12 12 $480.00 $480.00 $9.84 $661.00 $307.48 2026-03-09
P9058 HCPCS Red Blood Cells, Leukocytes Reduced, Cmv-negative, Irradiated, Each Unit 10 10 $481.00 $481.00 $289.27 $481.00 $353.54 2026-03-09
78300 HCPCS Nuclear Medicine Study Of Bone And/or Joint Limited Area 12 12 $485.00 $485.00 $291.68 $485.00 $335.21 2026-03-09
26670 HCPCS Closed Treatment Of Dislocated Hand Bone At Wrist Joint With Manipulation 12 12 $485.00 $485.00 $8.87 $482.00 $318.58 2026-03-09
57220 HCPCS Plastic Repair Of Muscles At Urinary Opening Through Vagina 12 12 $485.00 $485.00 $9.67 $522.00 $286.06 2026-03-09
86581 HCPCS Test For Streptococcus Pneumonia Antibody 20 10 $487.50 $487.50 $39.09 $910.00 $306.13 2026-03-09
73040 HCPCS Review By Radiologist Of Shoulder Joint Image 12 12 $490.00 $490.00 $294.69 $490.00 $338.83 2026-03-09
12004 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 24 15 $495.00 $495.00 $2.15 $805.00 $380.56 2026-03-09
96413 HCPCS Administration Of Chemotherapy Into Vein, 1 Hour Or Less 12 12 $500.00 $500.00 $300.70 $500.00 $349.25 2026-03-09
64490 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Single Le… 24 15 $512.50 $512.50 $3.04 $750.00 $361.52 2026-03-09
88309 HCPCS Pathology Examination Of Tissue Using A Microscope, High Complexity 12 12 $515.00 $515.00 $309.72 $515.00 $357.67 2026-03-09
16020 HCPCS Dressing Change Or Removal Of Burn Tissue, Less Than 5% Of Total Body Surface 12 12 $520.00 $520.00 $312.73 $520.00 $362.39 2026-03-09
26742 HCPCS Closed Treatment Of Broken Finger Or Hand At Base Of Finger With Manipulation 12 12 $520.00 $520.00 $9.64 $541.00 $309.77 2026-03-09
12032 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 2.6-7.5 … 24 15 $525.00 $525.00 $5.46 $630.00 $384.74 2026-03-09
12014 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1… 24 15 $525.50 $525.50 $2.20 $846.00 $378.96 2026-03-09
11446 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, M… 22 13 $535.00 $535.00 $9.26 $4,000.00 $494.00 2026-03-09
11644 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3.1-… 22 13 $535.00 $535.00 $8.14 $1,820.00 $416.99 2026-03-09
4986070_1 CDM Cetacaine Spray 9 9 $541.81 $541.81 $325.84 $514.72 $335.92 2026-03-09
16030 HCPCS Dressing Change Or Removal Of Burn Tissue, More Than 10% Of Total Body Surface 22 12 $542.00 $542.00 $312.73 $542.00 $362.39 2026-03-09
16025 HCPCS Dressing Change Or Removal Of Burn Tissue, 5-10% Of Total Body Surface 22 12 $542.00 $542.00 $312.73 $542.00 $362.39 2026-03-09
M0222 HCPCS Intravenous Injection, Bebtelovimab, Includes Injection And Post Administration … 10 10 $545.00 $545.00 $327.76 $545.00 $400.57 2026-03-09
92950 HCPCS Manual Attempt To Restore Blood Circulation And Breathing 24 15 $548.50 $548.50 $5.36 $563.00 $301.75 2026-03-09
Q9967 HCPCS Low Osmolar Contrast Material, 300-399 Mg/ml Iodine Concentration, Per Ml 22 12 $550.00 $550.00 $4.80 $550.00 $341.00 2026-03-09
78306 HCPCS Nuclear Medicine Study Of Bone And/or Joint Whole Body 12 12 $551.00 $551.00 $331.37 $551.00 $390.48 2026-03-09
11626 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More Tha… 22 13 $560.00 $560.00 $8.44 $4,260.00 $431.00 2026-03-09
15278 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout… 10 10 $560.00 $560.00 $336.78 $560.00 $411.60 2026-03-09
12041 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 2.5 Cm Or Less 24 15 $560.00 $560.00 $4.22 $750.00 $392.52 2026-03-09
64719 HCPCS Release And/or Relocation Of Wrist Nerve 12 12 $560.00 $560.00 $11.59 $586.00 $374.22 2026-03-09
90675 HCPCS Rabies Vaccine For Injection Into Muscle 12 12 $563.99 $563.99 $339.18 $591.06 $507.59 2026-03-09
99283 HCPCS Emergency Department Visit With Low Level Of Medical Decision Making 12 12 $570.00 $570.00 $342.80 $570.00 $397.60 2026-03-09
6044775_1 CDM Tr M0247 Intravenous Infusion, Sotrovimab, Includes Infusion And Post Administra… 3 3 $576.00 $576.00 $345.60 $489.60 $403.20 2026-03-09
25248 HCPCS Removal Of Deep Foreign Body In Forearm Or Wrist 12 12 $580.00 $580.00 $11.97 $822.00 $370.62 2026-03-09
30903 HCPCS Complex Control Of Nose Bleed 24 15 $590.00 $590.00 $2.28 $830.00 $417.58 2026-03-09
26705 HCPCS Closed Treatment Of Dislocated Hand Joint At Base Of Finger With Manipulation Un… 12 12 $590.00 $590.00 $11.02 $585.00 $359.94 2026-03-09
81528 HCPCS Gene Analysis (colorectal Cancer) 9 9 $595.00 $595.00 $139.00 $595.00 $505.75 2026-03-09
87637 HCPCS Detection Test By Multiplex Amplified Probe Technique For Severe Acute Respirato… 12 12 $600.00 $600.00 $227.95 $600.00 $372.00 2026-03-09
26645 HCPCS Closed Treatment Of Broken Thumb At Wrist With Manipulation 12 12 $600.00 $600.00 $11.32 $590.00 $355.69 2026-03-09
26755 HCPCS Closed Treatment Of Broken End Of Finger Or Thumb With Manipulation 24 15 $600.50 $600.50 $7.87 $756.00 $455.33 2026-03-09
64493 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Le… 24 15 $610.00 $610.00 $2.58 $970.00 $413.18 2026-03-09
11606 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 22 13 $615.00 $615.00 $9.15 $2,765.00 $476.12 2026-03-09
26210 HCPCS Removal Of Cyst Or Growth Of Finger Bone 12 12 $620.00 $620.00 $12.78 $656.00 $390.68 2026-03-09
84445 HCPCS Thyroid Stimulating Immune Globulins (thyroid Related Protein) Level 12 12 $645.00 $645.00 $387.90 $645.00 $458.12 2026-03-09
19020 HCPCS Drainage Of Abscess Of Breast 12 12 $645.00 $645.00 $8.93 $657.00 $293.08 2026-03-09
13101 HCPCS Complicated Repair Of Wound Of Trunk, 2.6-7.5 Cm 24 15 $652.50 $652.50 $7.14 $750.00 $458.02 2026-03-09
90670 HCPCS Pneumococcal Vaccine, 13-valent 12 12 $655.30 $655.30 $307.01 $655.30 $481.65 2026-03-09
P9035 HCPCS Platelets, Pheresis, Leukocytes Reduced, Each Unit 10 10 $662.00 $662.00 $398.13 $662.00 $486.57 2026-03-09
93978 HCPCS Complete Ultrasound Of Aorta, Vena Cava, Groin Vessels Or Bypass Grafts 12 12 $665.00 $665.00 $399.93 $665.00 $468.74 2026-03-09
12037 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, More Tha… 12 12 $665.00 $665.00 $9.53 $657.00 $296.30 2026-03-09
13121 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 2.6-7.5 Cm 24 15 $670.00 $670.00 $7.50 $750.00 $458.02 2026-03-09
93975 HCPCS Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 12 12 $675.00 $675.00 $405.95 $675.00 $468.74 2026-03-09
93923 HCPCS Complete Ultrasound Study Of Arm And Leg Arteries 12 12 $675.00 $675.00 $405.95 $675.00 $468.74 2026-03-09
93926 HCPCS Ultrasound Of One Leg Arteries Or Artery Grafts 12 12 $675.00 $675.00 $405.95 $675.00 $468.74 2026-03-09
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 12 12 $675.00 $675.00 $405.95 $675.00 $468.74 2026-03-09
93976 HCPCS Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 12 12 $675.00 $675.00 $405.95 $675.00 $468.74 2026-03-09
93971 HCPCS Ultrasound Study Of One Arm Or Leg Veins With Compression And Maneuvers 12 12 $675.00 $675.00 $405.95 $675.00 $468.74 2026-03-09
76536 HCPCS Ultrasound Scan Of Head And Neck Soft Tissue 12 12 $675.00 $675.00 $405.95 $675.00 $468.74 2026-03-09
93922 HCPCS Ultrasound Study Of Arm And Leg Arteries 12 12 $675.00 $675.00 $405.95 $675.00 $468.74 2026-03-09
93970 HCPCS Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 12 12 $675.00 $675.00 $405.95 $675.00 $468.74 2026-03-09
93931 HCPCS Ultrasound Of One Arm Arteries Or Artery Grafts 12 12 $675.00 $675.00 $405.95 $675.00 $468.74 2026-03-09
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 12 12 $675.00 $675.00 $405.95 $675.00 $468.74 2026-03-09
93882 HCPCS Ultrasound Of One Side Of Head And Neck Blood Flow 12 12 $675.00 $675.00 $405.95 $675.00 $468.74 2026-03-09
12015 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6… 24 15 $685.00 $685.00 $2.78 $1,130.00 $532.29 2026-03-09
12046 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 20.1-30.0 Cm 12 12 $685.00 $685.00 $9.08 $737.00 $293.05 2026-03-09
12052 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.6-5… 24 15 $690.00 $690.00 $5.74 $630.00 $384.74 2026-03-09
12005 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 24 15 $692.00 $692.00 $2.80 $1,139.00 $515.50 2026-03-09
11646 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More… 22 13 $695.00 $695.00 $11.28 $2,625.00 $560.23 2026-03-09
12055 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.6-… 12 12 $695.00 $695.00 $8.66 $653.00 $277.90 2026-03-09
73720 HCPCS MRI Scan Of Leg Before And After Contrast 12 12 $700.00 $700.00 $420.98 $700.00 $538.70 2026-03-09
26607 HCPCS Closed Treatment Of Broken Hand Bone With Manipulation And Placement Of External… 12 12 $705.00 $705.00 $13.97 $719.00 $451.49 2026-03-09
12042 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 2.6-7.5 Cm 24 15 $710.00 $710.00 $5.64 $985.00 $491.19 2026-03-09
25076 HCPCS Removal Of Growth Of Muscle Of Forearm Or Wrist, Less Than 3.0 Cm 12 12 $710.00 $710.00 $14.91 $866.00 $447.56 2026-03-09
25075 HCPCS Removal Of Growth Under Skin Of Forearm Or Wrist, Less Than 3.0 Cm 12 12 $720.00 $720.00 $9.09 $666.00 $292.76 2026-03-09
12016 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.… 24 15 $722.00 $722.00 $3.77 $1,139.00 $571.00 2026-03-09
77075 HCPCS Complete X-ray Of Body Bones 12 12 $731.00 $731.00 $439.62 $731.00 $493.75 2026-03-09
90677 HCPCS Pneumococcal Conjugate Vaccine, 20 Valent (pcv20), For Intramuscular Use 12 12 $734.95 $734.95 $354.72 $734.95 $455.67 2026-03-09
57120 HCPCS Suture Closure Of Vagina And Vaginal Opening 12 12 $735.00 $735.00 $15.11 $870.00 $436.26 2026-03-09
P9016 HCPCS Red Blood Cells, Leukocytes Reduced, Each Unit 12 12 $745.00 $745.00 $448.04 $745.00 $520.98 2026-03-09
59425 HCPCS Predelivery Care, 4 To 6 Visits 9 9 $750.00 $750.00 $139.00 $750.00 $637.50 2026-03-09
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 12 12 $750.00 $750.00 $451.05 $750.00 $538.70 2026-03-09
10160 HCPCS Aspiration Of Abscess, Blood, Or Cyst 24 15 $750.00 $750.00 $2.71 $1,315.00 $481.92 2026-03-09
12047 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, More Than 30.0 C… 12 12 $750.00 $750.00 $10.13 $810.00 $324.19 2026-03-09
11471 HCPCS Removal Of Skin And Tissue Of Anus Or Navel For Inflamed Sweat Glands With Compl… 12 12 $750.00 $750.00 $10.02 $713.00 $320.08 2026-03-09
64494 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Second Le… 24 15 $752.50 $752.50 $1.49 $1,370.00 $472.96 2026-03-09
4986365_1 CDM Collagenase Top 250 Units/g Oint [otks] 9 9 $758.16 $758.16 $455.96 $720.25 $470.06 2026-03-09
90651 HCPCS Human Papillomavirus Vaccine Types 6, 11, 16, 18, 31, 33, 45, 52, 58, Nonavalent 12 12 $762.13 $762.13 $389.90 $762.13 $472.52 2026-03-09
26770 HCPCS Closed Treatment Of Dislocated Finger Joint With Manipulation 24 15 $762.50 $762.50 $7.41 $1,125.00 $533.29 2026-03-09
Q5103 HCPCS Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 12 12 $763.67 $763.67 $42.72 $763.67 $473.48 2026-03-09
73218 HCPCS MRI Scan Of Arm Without Contrast 12 12 $770.00 $770.00 $463.08 $770.00 $538.70 2026-03-09
27250 HCPCS Closed Treatment Of Dislocated Hip 12 12 $773.00 $773.00 $464.88 $773.00 $527.83 2026-03-09
12056 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 20.1-… 12 12 $795.00 $795.00 $11.10 $754.00 $343.11 2026-03-09
12051 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 C… 24 15 $798.50 $798.50 $4.85 $1,202.00 $518.66 2026-03-09
86366 HCPCS Test For Muscle-specific Kinase Antibody 10 10 $800.00 $800.00 $481.12 $800.00 $588.00 2026-03-09
30300 HCPCS Removal Of Foreign Body In Nose 24 15 $800.00 $800.00 $3.23 $1,305.00 $553.91 2026-03-09
73722 HCPCS MRI Scan Of Leg Joint With Contrast 12 12 $800.00 $800.00 $481.12 $800.00 $538.70 2026-03-09
70486 HCPCS CT Scan Of Face Without Contrast 12 12 $800.00 $800.00 $456.39 $800.00 $496.00 2026-03-09
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 12 12 $800.00 $800.00 $456.39 $800.00 $496.00 2026-03-09
72128 HCPCS CT Scan Of Middle Spine Without Contrast 12 12 $800.00 $800.00 $456.39 $800.00 $496.00 2026-03-09
74160 HCPCS CT Scan Of Abdomen With Contrast 12 12 $800.00 $800.00 $456.39 $800.00 $496.00 2026-03-09
73200 HCPCS CT Scan Of Arm Without Contrast 36 12 $800.00 $800.00 $456.39 $800.00 $496.00 2026-03-09
72192 HCPCS CT Scan Of Pelvis Without Contrast 12 12 $800.00 $800.00 $456.39 $800.00 $496.00 2026-03-09
71271 HCPCS Low Dose CT Scan Of Chest For Lung Cancer Screening 12 12 $800.00 $800.00 $456.39 $800.00 $496.00 2026-03-09
71250 HCPCS CT Scan Of Chest Without Contrast 12 12 $800.00 $800.00 $456.39 $800.00 $496.00 2026-03-09
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 12 12 $800.00 $800.00 $456.39 $800.00 $496.00 2026-03-09
73700 HCPCS CT Scan Of Leg Without Contrast 36 12 $800.00 $800.00 $456.39 $800.00 $496.00 2026-03-09
72131 HCPCS CT Scan Of Lower Spine Without Contrast 12 12 $800.00 $800.00 $456.39 $800.00 $496.00 2026-03-09
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 12 12 $800.00 $800.00 $456.39 $800.00 $496.00 2026-03-09
72125 HCPCS CT Scan Of Upper Spine Without Contrast 12 12 $800.00 $800.00 $456.39 $800.00 $496.00 2026-03-09
70450 HCPCS CT Scan Head Or Brain Without Contrast 12 12 $800.00 $800.00 $456.39 $800.00 $496.00 2026-03-09
69209 HCPCS Removal Of Impacted Ear Wax By Washing 34 15 $815.00 $815.00 $0.40 $820.00 $505.30 2026-03-09
13131 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 24 15 $817.50 $817.50 $7.04 $1,095.00 $595.26 2026-03-09
12057 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More … 12 12 $840.00 $840.00 $12.28 $835.00 $375.51 2026-03-09
20520 HCPCS Removal Of Foreign Body In Muscle Or Tendon 12 12 $845.00 $845.00 $508.18 $845.00 $590.85 2026-03-09
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 32 12 $850.00 $850.00 $456.39 $900.00 $558.00 2026-03-09
72193 HCPCS CT Scan Of Pelvis With Contrast 12 12 $850.00 $850.00 $456.39 $850.00 $527.00 2026-03-09
72132 HCPCS CT Scan Of Lower Spine With Contrast 12 12 $850.00 $850.00 $456.39 $850.00 $527.00 2026-03-09
73201 HCPCS CT Scan Of Arm With Contrast 36 12 $850.00 $850.00 $456.39 $850.00 $527.00 2026-03-09
74150 HCPCS CT Scan Of Abdomen Without Contrast 12 12 $850.00 $850.00 $456.39 $850.00 $527.00 2026-03-09
72126 HCPCS CT Scan Of Upper Spine With Contrast 12 12 $850.00 $850.00 $456.39 $850.00 $527.00 2026-03-09
70460 HCPCS CT Scan Head Or Brain With Contrast 12 12 $850.00 $850.00 $456.39 $850.00 $527.00 2026-03-09
73701 HCPCS CT Scan Of Leg With Contrast Material 36 12 $850.00 $850.00 $456.39 $850.00 $527.00 2026-03-09
71260 HCPCS CT Scan Of Chest With Contrast 12 12 $850.00 $850.00 $456.39 $850.00 $527.00 2026-03-09
70487 HCPCS CT Scan Of Face With Contrast 12 12 $850.00 $850.00 $456.39 $850.00 $527.00 2026-03-09
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 12 12 $850.00 $850.00 $456.39 $850.00 $527.00 2026-03-09
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 12 12 $850.00 $850.00 $456.39 $850.00 $527.00 2026-03-09
72129 HCPCS CT Scan Of Middle Spine With Contrast 12 12 $850.00 $850.00 $456.39 $850.00 $527.00 2026-03-09
26641 HCPCS Closed Treatment Of Dislocated Thumb At Wrist With Manipulation 24 15 $852.50 $852.50 $9.97 $1,125.00 $624.29 2026-03-09
26160 HCPCS Removal Of Growth Of Tendon Finger Or Hand 12 12 $855.00 $855.00 $9.04 $900.00 $295.01 2026-03-09
81479 HCPCS Molecular Pathology Procedure 12 12 $860.00 $860.00 $84.80 $860.00 $533.20 2026-03-09
10080 HCPCS Simple Drainage Of Cyst Of Tailbone 24 15 $865.00 $865.00 $2.95 $1,370.00 $582.96 2026-03-09
5232507_1 CDM Santyl Ointment 9 9 $884.52 $884.52 $531.95 $840.29 $548.40 2026-03-09
19301 HCPCS Partial Removal Of Breast 12 12 $895.00 $895.00 $19.06 $909.00 $569.63 2026-03-09
19125 HCPCS Removal Of Growth Of Breast Identified By X-ray Marker, First Growth 12 12 $895.00 $895.00 $13.33 $761.00 $426.97 2026-03-09
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 12 12 $900.00 $900.00 $456.39 $900.00 $558.00 2026-03-09
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 12 12 $900.00 $900.00 $456.39 $900.00 $558.00 2026-03-09
73702 HCPCS CT Scan Of Leg Before And After Contrast 36 12 $900.00 $900.00 $456.39 $900.00 $558.00 2026-03-09
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 22 12 $900.00 $900.00 $456.39 $900.00 $558.00 2026-03-09
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 12 12 $900.00 $900.00 $456.39 $900.00 $558.00 2026-03-09
70488 HCPCS CT Scan Of Face Before And After Contrast 12 12 $900.00 $900.00 $456.39 $900.00 $558.00 2026-03-09
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 12 12 $900.00 $900.00 $456.39 $900.00 $558.00 2026-03-09
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 12 12 $900.00 $900.00 $456.39 $900.00 $558.00 2026-03-09
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 12 12 $900.00 $900.00 $456.39 $900.00 $558.00 2026-03-09
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 12 12 $900.00 $900.00 $456.39 $900.00 $558.00 2026-03-09
71270 HCPCS CT Scan Of Chest Before And After Contrast 12 12 $900.00 $900.00 $456.39 $900.00 $558.00 2026-03-09
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 12 12 $900.00 $900.00 $456.39 $900.00 $558.00 2026-03-09
76380 HCPCS Limited Or Follow-up CT Scan 12 12 $900.00 $900.00 $456.39 $900.00 $558.00 2026-03-09
73202 HCPCS CT Scan Of Arm Before And After Contrast 36 12 $900.00 $900.00 $456.39 $900.00 $558.00 2026-03-09
12053 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1-7… 24 15 $930.00 $930.00 $6.20 $1,355.00 $646.45 2026-03-09
6571599_1 CDM Santyl Ointment 9 9 $940.46 $940.46 $565.59 $893.44 $583.09 2026-03-09
78305 HCPCS Nuclear Medicine Study Of Bone And/or Joint Multiple Areas 10 10 $946.00 $946.00 $568.92 $946.00 $695.31 2026-03-09
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 12 12 $950.00 $950.00 $571.33 $950.00 $648.30 2026-03-09
51845 HCPCS Repair Of Bladder Neck In Female 12 12 $955.00 $955.00 $16.80 $1,169.00 $495.10 2026-03-09
31720 HCPCS Insertion Of Tube Into Airway For Aspiration Of Secretions 12 12 $965.00 $965.00 $580.35 $965.00 $675.54 2026-03-09
99284 HCPCS Emergency Department Visit With Moderate Level Of Medical Decision Making 12 12 $970.00 $970.00 $583.36 $970.00 $677.86 2026-03-09
12031 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 2.5 Cm O… 24 15 $986.50 $986.50 $4.36 $1,603.00 $394.81 2026-03-09
12054 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6-1… 24 15 $992.50 $992.50 $6.35 $1,450.00 $691.51 2026-03-09
13132 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 24 15 $1,030.00 $1,030.00 $8.81 $1,405.00 $817.49 2026-03-09
93799 HCPCS Other Cardiovascular Service Or Procedure 10 10 $1,035.00 $1,035.00 $622.45 $1,035.00 $760.73 2026-03-09
64495 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Third And… 24 15 $1,042.50 $1,042.50 $1.51 $1,950.00 $647.87 2026-03-09
J7298 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg 12 12 $1,045.00 $1,045.00 $628.46 $1,651.90 $940.50 2026-03-09
99468 HCPCS Initial Inpatient Hospital Critical Care Of Newborn Per Day (28 Days Or Younger) 9 9 $1,055.00 $1,055.00 $139.00 $1,055.00 $896.75 2026-03-09
11772 HCPCS Complicated Removal Of Cyst Of Tailbone 12 12 $1,065.00 $1,065.00 $16.68 $1,063.00 $518.72 2026-03-09
J0248 HCPCS Injection, Remdesivir, 1 Mg 10 10 $1,066.12 $1,066.12 $641.16 $1,066.12 $783.60 2026-03-09
11600 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 0.5 Cm Or Less 34 15 $1,085.00 $1,085.00 $3.46 $2,000.00 $708.55 2026-03-09
11402 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 1.1-2.0 Cm 34 15 $1,085.00 $1,085.00 $3.27 $1,095.00 $672.70 2026-03-09
11403 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm 34 15 $1,085.00 $1,085.00 $4.23 $1,095.00 $672.70 2026-03-09
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 12 12 $1,087.00 $1,087.00 $524.89 $1,087.00 $673.94 2026-03-09
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 12 12 $1,087.00 $1,087.00 $524.89 $1,087.00 $673.94 2026-03-09
11400 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 0.5 Cm Or Less 34 15 $1,090.00 $1,090.00 $2.33 $1,090.00 $675.80 2026-03-09
11422 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 1.1-2… 34 15 $1,095.00 $1,095.00 $3.88 $2,495.00 $804.83 2026-03-09
33956 HCPCS Insertion Of Tube Through The Chest For Ecmo External Blood Circulation In Heart… 12 12 $1,100.00 $1,100.00 $24.23 $1,190.00 $683.39 2026-03-09
15277 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout… 10 10 $1,120.00 $1,120.00 $673.57 $1,120.00 $823.20 2026-03-09
27550 HCPCS Closed Treatment Of Dislocated Knee 12 12 $1,125.00 $1,125.00 $676.58 $1,125.00 $788.78 2026-03-09
24600 HCPCS Repair Of Dislocated Elbow 12 12 $1,125.00 $1,125.00 $676.58 $1,125.00 $788.78 2026-03-09
26775 HCPCS Closed Treatment Of Dislocated Finger Joint With Manipulation Under Anesthesia 12 12 $1,125.00 $1,125.00 $676.58 $1,125.00 $788.78 2026-03-09
45330 HCPCS Diagnostic Exam Of Lower Portion Of Large Bowel Using A Flexible Endoscope 12 12 $1,125.00 $1,125.00 $676.58 $1,125.00 $787.80 2026-03-09
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 12 12 $1,131.00 $1,131.00 $524.89 $1,131.00 $701.22 2026-03-09
23655 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia 12 12 $1,139.00 $1,139.00 $684.99 $1,139.00 $788.78 2026-03-09
24640 HCPCS Closed Treatment Of Dislocated Forearm Bone On Thumb Side At Elbow With Manipula… 12 12 $1,139.00 $1,139.00 $684.99 $1,139.00 $788.78 2026-03-09
M0220 HCPCS Injection, Tixagevimab And Cilgavimab, For The Pre-exposure Prophylaxis Only, Fo… 10 10 $1,155.00 $1,155.00 $694.62 $1,155.00 $848.92 2026-03-09
12006 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 24 15 $1,215.00 $1,215.00 $3.43 $2,140.00 $859.00 2026-03-09
51800 HCPCS Repair Of Bladder And/or Urethra 12 12 $1,225.00 $1,225.00 $30.12 $1,676.00 $876.25 2026-03-09
23650 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation 12 12 $1,250.00 $1,250.00 $751.75 $1,250.00 $875.44 2026-03-09
19303 HCPCS Simple Complete Removal Of Breast 12 12 $1,285.00 $1,285.00 $27.84 $1,409.00 $824.74 2026-03-09
J2357 HCPCS Injection, Omalizumab, 5 Mg 42 12 $1,309.58 $1,309.58 $44.98 $2,619.16 $1,284.40 2026-03-09
12034 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 7.6-12.5… 24 15 $1,310.00 $1,310.00 $5.91 $2,155.00 $863.51 2026-03-09
36589 HCPCS Removal Of Tunneled Central Venous Tube 12 12 $1,335.00 $1,335.00 $802.87 $1,335.00 $934.53 2026-03-09
59426 HCPCS Predelivery Care, 7 Or More Visits 9 9 $1,365.00 $1,365.00 $139.00 $1,365.00 $1,160.25 2026-03-09
51840 HCPCS Simple Suture Of Bladder Neck To Vaginal Wall And Pubic Bone With Urethra Suspen… 12 12 $1,415.00 $1,415.00 $19.70 $1,152.00 $577.07 2026-03-09
99291 HCPCS Critical Care, First 30-74 Minutes 12 12 $1,420.00 $1,420.00 $853.99 $1,420.00 $996.25 2026-03-09
43233 HCPCS Balloon Dilation Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexibl… 12 12 $1,423.00 $1,423.00 $855.79 $1,423.00 $995.58 2026-03-09
43235 HCPCS Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible… 12 12 $1,435.00 $1,435.00 $863.01 $1,435.00 $1,007.40 2026-03-09
13152 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 2.6-7.5 Cm 24 15 $1,470.00 $1,470.00 $9.74 $2,250.00 $1,061.58 2026-03-09
G0105 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual At High Risk 12 12 $1,475.00 $1,475.00 $887.07 $1,475.00 $981.80 2026-03-09
G0121 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual Not Meeting Criteria For … 23 13 $1,475.00 $1,475.00 $139.00 $1,475.00 $914.50 2026-03-09
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 12 12 $1,510.00 $1,510.00 $908.11 $1,510.00 $1,053.53 2026-03-09
12035 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 12.6-20.… 24 15 $1,537.50 $1,537.50 $6.94 $2,540.00 $1,031.78 2026-03-09
43250 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 12 12 $1,637.00 $1,637.00 $984.49 $1,637.00 $1,143.30 2026-03-09
10140 HCPCS Drainage Of Blood Or Fluid Accumulation 34 15 $1,645.00 $1,645.00 $3.41 $1,650.00 $1,019.90 2026-03-09
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 32 12 $1,650.00 $1,650.00 $962.24 $1,750.00 $1,115.26 2026-03-09
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 12 12 $1,692.58 $1,692.58 $1.33 $1,692.58 $1,049.40 2026-03-09
15274 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, Each… 10 10 $1,710.00 $1,710.00 $1,028.39 $1,710.00 $1,256.85 2026-03-09
36430 HCPCS Transfusion Of Blood Or Blood Products 22 12 $1,733.00 $1,733.00 $489.91 $1,733.00 $1,074.46 2026-03-09
28192 HCPCS Removal Of Foreign Body Of Foot Tissue, Deep 12 12 $1,735.00 $1,735.00 $1,043.43 $1,735.00 $1,215.18 2026-03-09
73706 HCPCS CT Scan Of Blood Vessels Of Lower Leg With Contrast 10 10 $1,750.00 $1,750.00 $1,052.45 $1,750.00 $1,286.25 2026-03-09
72191 HCPCS CT Scan Of Blood Vessels Of Pelvis With Contrast 10 10 $1,750.00 $1,750.00 $1,052.45 $1,750.00 $1,286.25 2026-03-09
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 30 10 $1,750.00 $1,750.00 $1,052.45 $1,750.00 $1,286.25 2026-03-09
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 12 12 $1,750.00 $1,750.00 $1,052.45 $1,750.00 $1,130.65 2026-03-09
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 12 12 $1,750.00 $1,750.00 $1,052.45 $1,750.00 $1,129.74 2026-03-09
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 12 12 $1,775.00 $1,775.00 $1,067.49 $1,775.00 $1,156.92 2026-03-09
43247 HCPCS Removal Of Foreign Bodies Of Esophagus, Stomach, And/or Upper Small Bowel Using … 12 12 $1,820.00 $1,820.00 $1,094.55 $1,820.00 $1,276.24 2026-03-09
43239 HCPCS Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop… 12 12 $1,820.00 $1,820.00 $1,094.55 $1,820.00 $1,140.91 2026-03-09
45384 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using A Flexible Endoscope With Elec… 12 12 $1,850.00 $1,850.00 $1,112.59 $1,850.00 $1,288.05 2026-03-09
45378 HCPCS Diagnostic Exam Of Large Bowel Using A Flexible Endoscope 12 12 $1,850.00 $1,850.00 $1,112.59 $1,850.00 $1,288.05 2026-03-09
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 22 12 $1,850.00 $1,850.00 $481.12 $1,850.00 $1,129.80 2026-03-09
43251 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 12 12 $1,886.00 $1,886.00 $1,134.24 $1,886.00 $1,319.57 2026-03-09
45380 HCPCS Biopsy Of Large Bowel Using A Flexible Endoscope 12 12 $1,895.00 $1,895.00 $1,139.65 $1,895.00 $1,329.41 2026-03-09
45385 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S… 12 12 $1,900.00 $1,900.00 $1,142.66 $1,900.00 $1,449.55 2026-03-09
J2407 HCPCS Injection, Oritavancin (orbactiv), 10 Mg 12 12 $1,920.53 $1,920.53 $33.73 $1,920.53 $1,190.73 2026-03-09
15272 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, Each Addi… 10 10 $2,085.00 $2,085.00 $1,253.92 $2,085.00 $1,532.47 2026-03-09
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 12 12 $2,120.00 $2,120.00 $1,274.97 $2,120.00 $1,493.87 2026-03-09
43249 HCPCS Balloon Dilation Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexibl… 12 12 $2,183.00 $2,183.00 $1,312.86 $2,183.00 $1,527.35 2026-03-09
73718 HCPCS MRI Scan Of Leg Without Contrast 12 12 $2,190.00 $2,190.00 $524.89 $2,190.00 $1,357.80 2026-03-09
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 36 12 $2,190.00 $2,190.00 $524.89 $2,190.00 $1,357.80 2026-03-09
87636 HCPCS Detection Test By Multiplex Amplified Probe Technique For Severe Acute Respirato… 12 12 $2,220.00 $2,220.00 $72.76 $2,220.00 $1,376.40 2026-03-09
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 12 12 $2,272.00 $2,272.00 $524.89 $2,272.00 $1,408.64 2026-03-09
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 12 12 $2,337.64 $2,337.64 $13.11 $2,337.64 $1,449.34 2026-03-09
36573 HCPCS Insertion Of Tube For Infusion With Imaging Guidance And Review By Radiologist, … 10 10 $2,360.00 $2,360.00 $1,419.30 $2,360.00 $1,734.60 2026-03-09
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 12 12 $2,450.00 $2,450.00 $1,473.43 $2,450.00 $1,661.55 2026-03-09
4441947_1 CDM Room & Board - Private (one Bed) - General Classification 2 2 $2,500.00 $2,500.00 $1,750.00 $2,500.00 $2,125.00 2026-03-09
28190 HCPCS Removal Of Foreign Body Of Foot Tissue, Accessed Beneath The Skin 10 10 $2,755.00 $2,755.00 $1,656.86 $2,755.00 $2,024.92 2026-03-09
78582 HCPCS Nuclear Medicine Study Of Lung Ventilation And Circulation 12 12 $2,851.00 $2,851.00 $658.52 $2,851.00 $1,767.62 2026-03-09
26765 HCPCS Treatment Of Broken End Of Finger Or Thumb 12 12 $2,910.00 $2,910.00 $1,750.07 $2,910.00 $2,042.37 2026-03-09
2120839_1 CDM Room & Board - Private (one Bed) - General Classification 2 2 $3,000.00 $3,000.00 $2,100.00 $3,000.00 $2,550.00 2026-03-09
J0897 HCPCS Injection, Denosumab, 1 Mg 22 12 $3,054.28 $3,054.28 $30.80 $3,206.99 $1,988.33 2026-03-09
15276 HCPCS Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 10 10 $3,095.00 $3,095.00 $1,861.33 $3,095.00 $2,274.82 2026-03-09
59400 HCPCS Vaginal Delivery With Care Before And After Delivery 12 12 $3,175.00 $3,175.00 $61.53 $2,984.00 $1,979.71 2026-03-09
19120 HCPCS Removal Of Growth And Tissue Of Breast, Duct, Or Nipple 24 15 $3,230.00 $3,230.00 $12.00 $5,750.00 $2,071.53 2026-03-09
15273 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.… 10 10 $3,415.00 $3,415.00 $2,053.78 $3,415.00 $2,510.03 2026-03-09
J1602 HCPCS Injection, Golimumab, 1 Mg, For Intravenous Use 12 12 $3,416.90 $3,416.90 $13.79 $3,416.90 $2,118.48 2026-03-09
59510 HCPCS Cesarean Delivery With Care Before And After Delivery 12 12 $3,480.00 $3,480.00 $68.24 $3,299.00 $2,193.84 2026-03-09
70553 HCPCS MRI Scan Of Brain Before And After Contrast 12 12 $4,115.20 $4,115.20 $524.89 $4,115.20 $2,551.42 2026-03-09
15271 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C… 10 10 $4,165.00 $4,165.00 $2,504.83 $4,165.00 $3,061.28 2026-03-09
36558 HCPCS Insertion Of Tunneled Central Venous Tube For Infusion (5 Years Or Older) 12 12 $4,250.00 $4,250.00 $2,555.95 $4,250.00 $2,990.68 2026-03-09
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 12 12 $4,305.20 $4,305.20 $524.89 $4,305.20 $2,669.22 2026-03-09
J1306 HCPCS Injection, Inclisiran, 1 Mg 10 10 $6,135.03 $6,135.03 $3,689.61 $6,135.03 $4,509.25 2026-03-09
15275 HCPCS Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 10 10 $6,190.00 $6,190.00 $3,722.67 $6,190.00 $4,549.65 2026-03-09
J3101 HCPCS Injection, Tenecteplase, 1 Mg 12 12 $13,531.18 $13,531.18 $187.12 $13,531.18 $8,389.33 2026-03-09
Q4309 HCPCS Via Matrix, Per Square Centimeter 20 10 $20,750.00 $20,750.00 $9,923.10 $25,000.00 $15,500.00 2026-03-09
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