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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

MEDICINE LODGE MEMORIAL HOSPITAL

Medicine Lodge, KS · CCN 171334 · Rates published

1,648 distinct procedures filed
9 distinct payers
28,198 rate rows
2026-03-04 last MRF observed
Data quality

7,075 of 28,198 rate rows are consumer-grade (25.1%)

21,123 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
percent-of-billed-charges methodology — not a negotiated dollar; shown as context only 21,075
percent-of-charges filed in the dollar field — excluded from medians 29
per-diem day rate — not a per-procedure price 15
exceeds 10× this hospital's gross charge — 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=dbMLMHMEDICINELODGEKS&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/Medicine_Lodge_V2.aspx
Discovered viaDiscovered by HANK
Last fetch success · 2026-05-15
Content fingerprint 5fe8b3e73eef9055… · 13,887,406 bytes · first seen 2026-05-04

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
J2350
HCPCS 		Injection, Ocrelizumab, 1 Mg 9 $29,395.72 $36,707.94 $34,872.54 nat. median
$683
outlier · 51.1×
27882
HCPCS 		Amputation Of Both Lower Leg Bones Leaving Wound 9 $24,024.00 $30,000.00 $28,500.00 nat. median
$3,585
outlier · 8.0×
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 9 $13,329.86 $16,645.68 $15,813.40 nat. median
$280
outlier · 56.4×
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 9 $8,411.03 $13,782.10 $10,503.29 nat. median
$5,957
1.8× median
47562
HCPCS 		Removal Of Gallbladder Using An Endoscope 9 $7,647.64 $9,550.00 $9,072.50 nat. median
$5,956
1.5× median
49650
HCPCS 		Repair Of Groin Hernia Using An Endoscope 9 $7,527.52 $9,400.00 $8,930.00 nat. median
$5,742
1.6× median
19303
HCPCS 		Simple Complete Removal Of Breast 9 $7,207.20 $9,000.00 $8,550.00 nat. median
$6,217
1.4× median
63650
HCPCS 		Insertion Of Spinal Neurostimulator Electrode Array Through Skin 9 $92.29 $9,222.11 $8,392.12 nat. median
$7,241
1.2× median
57240
HCPCS 		Repair Of Bladder Hernia Into Vaginal Wall 9 $364.86 $8,700.00 $7,917.00 nat. median
$4,828
1.6× median
58150
HCPCS 		Removal Of Uterus And Cervix Through Abdomen 9 $6,166.16 $7,700.00 $7,315.00 nat. median
$3,282
outlier · 2.2×
55100
HCPCS 		Drainage Of Abscess Of Scrotum 9 $6,096.37 $7,612.85 $7,232.21 nat. median
$1,664
outlier · 4.3×
J1306
HCPCS 		Injection, Inclisiran, 1 Mg 9 $5,109.44 $6,380.42 $6,061.40 nat. median
$57
outlier · 107.2×
20205
HCPCS 		Deep Biopsy Of Muscle 9 $4,898.49 $6,117.00 $5,811.15 nat. median
$2,945
2.0× median
58661
HCPCS 		Removal Of Ovaries And/or Tubes Using An Endoscope 9 $4,703.90 $5,874.00 $5,580.30 nat. median
$5,899
0.9× median
44955
HCPCS 		Removal Of Appendix During Other Major Procedure 9 $4,681.48 $5,846.00 $5,553.70 nat. median
$1,433
outlier · 3.9×
J2426
HCPCS 		Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg 9 $4,677.20 $5,840.66 $5,548.63 nat. median
$2,742
outlier · 2.0×
21554
HCPCS 		Removal Of Growth Of Muscle Of Neck Or Front Of Chest, 5.0 Cm Or More 9 $164.43 $6,880.00 $5,509.50 nat. median
$3,251
1.7× median
59151
HCPCS 		Removal Of Ovarian Or Tubal Pregnancy With Removal Of Ovary And/or Tube Using An… 9 $4,570.17 $5,707.00 $5,421.65 nat. median
$6,222
0.9× median
44005
HCPCS 		Release Of Intestinal Scar Tissue 9 $4,329.93 $5,407.00 $5,136.65 nat. median
$2,702
1.9× median
49591
HCPCS 		Initial Repair Of Sliding Hernia Of Abdomen, Less Than 3 Cm In Length 9 $4,244.24 $5,300.00 $5,035.00 nat. median
$3,788
1.3× median
49592
HCPCS 		Initial Repair Of Entrapped Hernia Of Abdomen, Less Than 3 Cm In Length 9 $4,236.54 $5,290.38 $5,025.86 nat. median
$5,742
0.9× median
17250
HCPCS 		Application Of Chemical To Stop Tissue Regrowth In Wound 9 $4,204.14 $5,249.92 $4,987.42 nat. median
$258
outlier · 19.3×
49505
HCPCS 		Repair Of Groin Hernia (5 Years Or Older) 9 $4,124.12 $5,150.00 $4,892.50 nat. median
$3,829
1.3× median
57520
HCPCS 		Removal Or Destruction Of Cervix With Cold Knife Or Laser 9 $3,809.41 $4,757.00 $4,519.15 nat. median
$3,224
1.4× median
58552
HCPCS 		Removal Of Uterus, Tubes, And/or Ovaries Through Vagina Using An Endoscope, 250.… 9 $3,523.52 $4,400.00 $4,180.00 nat. median
$9,808
outlier · 0.4×
10180
HCPCS 		Complex Drainage Of Wound Infection After Surgery 9 $164.43 $5,109.03 $4,091.31 nat. median
$2,867
1.4× median
36561
HCPCS 		Insertion Of Central Venous Tube With Port (5 Years Or Older) 9 $164.43 $5,010.00 $4,012.01 nat. median
$3,693
1.1× median
19300
HCPCS 		Removal Of Extra Breast Tissue In Male 9 $3,274.07 $4,088.50 $3,884.08 nat. median
$3,890
1.0× median
24120
HCPCS 		Removal Of Cyst Or Growth Of Elbow Or Upper Forearm Bone 9 $164.43 $4,770.70 $3,820.38 nat. median
$3,497
1.1× median
J0897
HCPCS 		Injection, Denosumab, 1 Mg 9 $2,568.16 $5,472.29 $3,794.60 nat. median
$2,502
1.5× median
J3262
HCPCS 		Injection, Tocilizumab, 1 Mg 9 $3,097.08 $3,867.48 $3,674.11 nat. median
$1,425
outlier · 2.6×
6566116_1
CDM 		Vasopressin 20 Unit/100 Ml-ns 7 $3,008.29 $3,643.90 $3,568.77 nat. median
$3,569
1.0× median
15271
HCPCS 		Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C… 9 $61.43 $3,500.00 $3,185.00 nat. median
$1,748
1.8× median
54522
HCPCS 		Partial Removal Of Testicle 9 $2,574.57 $3,215.00 $3,054.25 nat. median
$3,675
0.8× median
46040
HCPCS 		Drainage Of Deep Abscess In Rectum 9 $2,559.86 $3,196.63 $3,036.80 nat. median
$1,775
1.7× median
44143
HCPCS 		Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin 9 $2,554.55 $3,190.00 $3,030.50 nat. median
$3,062
1.0× median
49594
HCPCS 		Initial Repair Of Entrapped Hernia Of Abdomen, 3-10 Cm In Length 9 $2,520.92 $3,148.00 $2,990.60 nat. median
$5,863
0.5× median
25111
HCPCS 		Removal Of First Cyst Of Wrist 9 $164.43 $3,230.70 $2,988.40 nat. median
$2,034
1.5× median
24105
HCPCS 		Removal Of Fluid-filled Sac Of Elbow 9 $164.43 $3,626.70 $2,904.26 nat. median
$3,333
0.9× median
Q5108
HCPCS 		Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 9 $2,434.50 $3,040.09 $2,888.09 nat. median
$1,257
outlier · 2.3×
54161
HCPCS 		Removal Of Foreskin (older Than 28 Days) 9 $164.43 $3,600.00 $2,882.88 nat. median
$2,316
1.2× median
46255
HCPCS 		Removal Of Single External And Internal Hemorrhoid Group 9 $2,378.38 $2,970.00 $2,821.50 nat. median
$2,859
1.0× median
21931
HCPCS 		Removal Of Growth Under Skin Of Back Or Lower Sides, 3.0 Cm Or More 9 $2,198.20 $2,745.00 $2,607.75 nat. median
$2,063
1.3× median
J2997
HCPCS 		Injection, Alteplase Recombinant, 1 Mg 9 $425.45 $5,767.20 $2,574.82 nat. median
$545
outlier · 4.7×
46930
HCPCS 		Destruction Of Internal Hemorrhoids Using Heat 9 $2,114.11 $2,640.00 $2,508.00 nat. median
$1,346
1.9× median
J0840
HCPCS 		Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 9 $2,111.49 $2,636.72 $2,504.88 nat. median
$3,427
0.7× median
55040
HCPCS 		Removal Of Fluid Collection In Testicle And Sperm Reservoir 9 $164.43 $3,000.00 $2,402.40 nat. median
$3,651
0.7× median
26951
HCPCS 		Amputation Of Finger Or Thumb With Direct Closure 9 $495.76 $2,600.00 $2,366.00 nat. median
$3,343
0.7× median
44620
HCPCS 		Closure Of Surgically Created Large Or Small Bowel Opening 9 $1,961.96 $2,450.00 $2,327.50 nat. median
$2,358
1.0× median
J0129
HCPCS 		Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 9 $1,959.45 $2,446.87 $2,324.53 nat. median
$1,082
outlier · 2.1×

Other procedures at this hospital

Browse this hospital's 1,648 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
             
44141 HCPCS Partial Removal Of Large Bowel With Creation Of Opening To Skin 6 6 $2,700.00 $2,700.00 $1,064.97 $2,565.00 $1,396.82 2026-03-04
2120839_1 CDM Room & Board - Private (one Bed) - General Classification 6 6 $1,425.00 $1,425.00 $1,318.13 $1,425.00 $1,353.75 2026-03-04
2120840_1 CDM Room & Board - Semi-private (two Beds) - General Classification 6 6 $1,375.00 $1,375.00 $1,271.88 $1,375.00 $1,306.25 2026-03-04
4441947_1 CDM Room & Board - Private (one Bed) - General Classification 6 6 $1,325.00 $1,325.00 $1,225.63 $1,325.00 $1,258.75 2026-03-04
4441941_1 CDM Room & Board - Semi-private (two Beds) - General Classification 6 6 $1,275.00 $1,275.00 $1,179.38 $1,275.00 $1,211.25 2026-03-04
44140 HCPCS Partial Removal Of Large Bowel With Connection 6 6 $1,681.00 $1,681.00 $993.23 $1,596.95 $1,078.77 2026-03-04
63655 HCPCS Removal Of Spine Bone For Insertion Of Neurostimulator Electrode Plate In Spine 6 6 $1,141.00 $1,141.00 $171.47 $1,083.95 $678.16 2026-03-04
6566116_1 CDM Vasopressin 20 Unit/100 Ml-ns 7 7 $3,756.60 $3,756.60 $3,008.29 $3,643.90 $3,568.77 2026-03-04
5463807_1 CDM Rev - Ihs-moa Clinic Visit 7 7 $2,000.00 $2,000.00 $1,601.60 $1,940.00 $1,900.00 2026-03-04
6017892_1 CDM Ozempic 0.25-0.5 Mg/dose Pen 7 7 $1,506.64 $1,506.64 $1,206.52 $1,461.44 $1,431.31 2026-03-04
5463792_1 CDM Rev - Ihs-moa Clinic Visit 7 7 $1,500.00 $1,500.00 $1,201.20 $1,455.00 $1,425.00 2026-03-04
5463824_1 CDM Rev - Ihs-moa Clinic Visit 7 7 $1,100.00 $1,100.00 $880.88 $1,067.00 $1,045.00 2026-03-04
5463793_1 CDM Rev - Ihs-moa Clinic Visit 7 7 $890.00 $890.00 $712.71 $863.30 $845.50 2026-03-04
5463760_1 CDM Rev - Ihs-moa Clinic Visit 7 7 $890.00 $890.00 $712.71 $863.30 $845.50 2026-03-04
5463776_1 CDM Rev - Ihs-moa Clinic Visit 7 7 $800.00 $800.00 $640.64 $776.00 $760.00 2026-03-04
5296035_1 CDM Santyl Ointment 7 7 $744.01 $744.01 $595.80 $721.69 $706.81 2026-03-04
5463819_1 CDM Rev - Ihs-moa Clinic Visit 7 7 $740.00 $740.00 $592.59 $717.80 $703.00 2026-03-04
5463758_1 CDM Rev - Ihs-moa Clinic Visit 7 7 $725.00 $725.00 $580.58 $703.25 $688.75 2026-03-04
5463738_1 CDM Rev - Ihs-moa Clinic Visit 7 7 $650.00 $650.00 $520.52 $630.50 $617.50 2026-03-04
36571 HCPCS Insertion Of Central Venous Tube With Port For Infusion (5 Years Or Older) 8 8 $1,607.00 $1,607.00 $164.43 $1,607.00 $836.67 2026-03-04
J2350 HCPCS Injection, Ocrelizumab, 1 Mg 9 9 $36,707.94 $36,707.94 $29,395.72 $36,707.94 $34,872.54 2026-03-04
27882 HCPCS Amputation Of Both Lower Leg Bones Leaving Wound 9 9 $30,000.00 $30,000.00 $24,024.00 $30,000.00 $28,500.00 2026-03-04
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 9 9 $16,645.68 $16,645.68 $13,329.86 $16,645.68 $15,813.40 2026-03-04
J3101 HCPCS Injection, Tenecteplase, 1 Mg 27 9 $11,008.69 $11,008.69 $8,411.03 $13,782.10 $10,503.29 2026-03-04
47562 HCPCS Removal Of Gallbladder Using An Endoscope 9 9 $9,550.00 $9,550.00 $7,647.64 $9,550.00 $9,072.50 2026-03-04
49650 HCPCS Repair Of Groin Hernia Using An Endoscope 9 9 $9,400.00 $9,400.00 $7,527.52 $9,400.00 $8,930.00 2026-03-04
19303 HCPCS Simple Complete Removal Of Breast 9 9 $9,000.00 $9,000.00 $7,207.20 $9,000.00 $8,550.00 2026-03-04
63650 HCPCS Insertion Of Spinal Neurostimulator Electrode Array Through Skin 15 9 $9,222.11 $9,222.11 $92.29 $9,222.11 $8,392.12 2026-03-04
57240 HCPCS Repair Of Bladder Hernia Into Vaginal Wall 15 9 $8,700.00 $8,700.00 $364.86 $8,700.00 $7,917.00 2026-03-04
58150 HCPCS Removal Of Uterus And Cervix Through Abdomen 9 9 $7,700.00 $7,700.00 $6,166.16 $7,700.00 $7,315.00 2026-03-04
55100 HCPCS Drainage Of Abscess Of Scrotum 9 9 $7,612.85 $7,612.85 $6,096.37 $7,612.85 $7,232.21 2026-03-04
J1306 HCPCS Injection, Inclisiran, 1 Mg 9 9 $6,380.42 $6,380.42 $5,109.44 $6,380.42 $6,061.40 2026-03-04
20205 HCPCS Deep Biopsy Of Muscle 9 9 $6,117.00 $6,117.00 $4,898.49 $6,117.00 $5,811.15 2026-03-04
58661 HCPCS Removal Of Ovaries And/or Tubes Using An Endoscope 9 9 $5,874.00 $5,874.00 $4,703.90 $5,874.00 $5,580.30 2026-03-04
44955 HCPCS Removal Of Appendix During Other Major Procedure 9 9 $5,846.00 $5,846.00 $4,681.48 $5,846.00 $5,553.70 2026-03-04
J2426 HCPCS Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg 9 9 $5,840.66 $5,840.66 $4,677.20 $5,840.66 $5,548.63 2026-03-04
21554 HCPCS Removal Of Growth Of Muscle Of Neck Or Front Of Chest, 5.0 Cm Or More 17 9 $6,880.00 $6,880.00 $164.43 $6,880.00 $5,509.50 2026-03-04
59151 HCPCS Removal Of Ovarian Or Tubal Pregnancy With Removal Of Ovary And/or Tube Using An… 9 9 $5,707.00 $5,707.00 $4,570.17 $5,707.00 $5,421.65 2026-03-04
44005 HCPCS Release Of Intestinal Scar Tissue 9 9 $5,407.00 $5,407.00 $4,329.93 $5,407.00 $5,136.65 2026-03-04
49591 HCPCS Initial Repair Of Sliding Hernia Of Abdomen, Less Than 3 Cm In Length 9 9 $5,300.00 $5,300.00 $4,244.24 $5,300.00 $5,035.00 2026-03-04
49592 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, Less Than 3 Cm In Length 9 9 $5,290.38 $5,290.38 $4,236.54 $5,290.38 $5,025.86 2026-03-04
17250 HCPCS Application Of Chemical To Stop Tissue Regrowth In Wound 9 9 $5,249.92 $5,249.92 $4,204.14 $5,249.92 $4,987.42 2026-03-04
49505 HCPCS Repair Of Groin Hernia (5 Years Or Older) 9 9 $5,150.00 $5,150.00 $4,124.12 $5,150.00 $4,892.50 2026-03-04
57520 HCPCS Removal Or Destruction Of Cervix With Cold Knife Or Laser 9 9 $4,757.00 $4,757.00 $3,809.41 $4,757.00 $4,519.15 2026-03-04
58552 HCPCS Removal Of Uterus, Tubes, And/or Ovaries Through Vagina Using An Endoscope, 250.… 9 9 $4,400.00 $4,400.00 $3,523.52 $4,400.00 $4,180.00 2026-03-04
10180 HCPCS Complex Drainage Of Wound Infection After Surgery 17 9 $5,109.03 $5,109.03 $164.43 $5,109.03 $4,091.31 2026-03-04
36561 HCPCS Insertion Of Central Venous Tube With Port (5 Years Or Older) 17 9 $5,010.00 $5,010.00 $164.43 $5,010.00 $4,012.01 2026-03-04
19300 HCPCS Removal Of Extra Breast Tissue In Male 9 9 $4,088.50 $4,088.50 $3,274.07 $4,088.50 $3,884.08 2026-03-04
24120 HCPCS Removal Of Cyst Or Growth Of Elbow Or Upper Forearm Bone 17 9 $4,770.70 $4,770.70 $164.43 $4,770.70 $3,820.38 2026-03-04
J0897 HCPCS Injection, Denosumab, 1 Mg 18 9 $4,339.64 $4,339.64 $2,568.16 $5,472.29 $3,794.60 2026-03-04
J3262 HCPCS Injection, Tocilizumab, 1 Mg 9 9 $3,867.48 $3,867.48 $3,097.08 $3,867.48 $3,674.11 2026-03-04
15271 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C… 15 9 $3,500.00 $3,500.00 $61.43 $3,500.00 $3,185.00 2026-03-04
54522 HCPCS Partial Removal Of Testicle 9 9 $3,215.00 $3,215.00 $2,574.57 $3,215.00 $3,054.25 2026-03-04
46040 HCPCS Drainage Of Deep Abscess In Rectum 9 9 $3,196.63 $3,196.63 $2,559.86 $3,196.63 $3,036.80 2026-03-04
44143 HCPCS Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin 9 9 $3,190.00 $3,190.00 $2,554.55 $3,190.00 $3,030.50 2026-03-04
49594 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, 3-10 Cm In Length 9 9 $3,148.00 $3,148.00 $2,520.92 $3,148.00 $2,990.60 2026-03-04
25111 HCPCS Removal Of First Cyst Of Wrist 26 9 $3,230.70 $3,230.70 $164.43 $3,230.70 $2,988.40 2026-03-04
24105 HCPCS Removal Of Fluid-filled Sac Of Elbow 17 9 $3,626.70 $3,626.70 $164.43 $3,626.70 $2,904.26 2026-03-04
Q5108 HCPCS Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 9 9 $3,040.09 $3,040.09 $2,434.50 $3,040.09 $2,888.09 2026-03-04
54161 HCPCS Removal Of Foreskin (older Than 28 Days) 17 9 $3,600.00 $3,600.00 $164.43 $3,600.00 $2,882.88 2026-03-04
46255 HCPCS Removal Of Single External And Internal Hemorrhoid Group 9 9 $2,970.00 $2,970.00 $2,378.38 $2,970.00 $2,821.50 2026-03-04
21931 HCPCS Removal Of Growth Under Skin Of Back Or Lower Sides, 3.0 Cm Or More 9 9 $2,745.00 $2,745.00 $2,198.20 $2,745.00 $2,607.75 2026-03-04
J2997 HCPCS Injection, Alteplase Recombinant, 1 Mg 18 9 $3,149.24 $3,149.24 $425.45 $5,767.20 $2,574.82 2026-03-04
46930 HCPCS Destruction Of Internal Hemorrhoids Using Heat 9 9 $2,640.00 $2,640.00 $2,114.11 $2,640.00 $2,508.00 2026-03-04
J0840 HCPCS Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 9 9 $2,636.72 $2,636.72 $2,111.49 $2,636.72 $2,504.88 2026-03-04
55040 HCPCS Removal Of Fluid Collection In Testicle And Sperm Reservoir 17 9 $3,000.00 $3,000.00 $164.43 $3,000.00 $2,402.40 2026-03-04
26951 HCPCS Amputation Of Finger Or Thumb With Direct Closure 15 9 $2,600.00 $2,600.00 $495.76 $2,600.00 $2,366.00 2026-03-04
44620 HCPCS Closure Of Surgically Created Large Or Small Bowel Opening 9 9 $2,450.00 $2,450.00 $1,961.96 $2,450.00 $2,327.50 2026-03-04
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 9 9 $2,446.87 $2,446.87 $1,959.45 $2,446.87 $2,324.53 2026-03-04
64635 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 15 9 $2,500.00 $2,500.00 $143.37 $2,500.00 $2,275.00 2026-03-04
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 9 9 $2,355.99 $2,355.99 $1,886.68 $2,355.99 $2,238.19 2026-03-04
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 9 9 $2,352.50 $2,352.50 $1,883.88 $2,352.50 $2,234.88 2026-03-04
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 9 9 $2,337.64 $2,337.64 $1,871.98 $2,337.64 $2,220.76 2026-03-04
44204 HCPCS Partial Removal Of Large Bowel Using An Endoscope 9 9 $2,310.00 $2,310.00 $1,849.85 $2,310.00 $2,194.50 2026-03-04
11772 HCPCS Complicated Removal Of Cyst Of Tailbone 17 9 $2,740.00 $2,740.00 $164.43 $2,740.00 $2,194.19 2026-03-04
27043 HCPCS Removal Of Growth Under Skin Of Pelvis And Hip, 3.0 Cm Or More 9 9 $2,300.00 $2,300.00 $1,841.84 $2,300.00 $2,185.00 2026-03-04
28190 HCPCS Removal Of Foreign Body Of Foot Tissue, Accessed Beneath The Skin 17 9 $2,688.82 $2,688.82 $164.43 $2,688.82 $2,153.21 2026-03-04
36590 HCPCS Removal Of Central Venous Tube With Port Or Pump 9 9 $2,266.00 $2,266.00 $1,814.61 $2,266.00 $2,152.70 2026-03-04
36573 HCPCS Insertion Of Tube For Infusion With Imaging Guidance And Review By Radiologist, … 9 9 $2,250.00 $2,250.00 $1,801.80 $2,250.00 $2,137.50 2026-03-04
11406 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 17 9 $2,620.00 $2,620.00 $164.43 $2,620.00 $2,098.10 2026-03-04
11606 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 17 9 $2,613.00 $2,613.00 $164.43 $2,613.00 $2,092.49 2026-03-04
J7298 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg 18 9 $2,394.00 $2,394.00 $1,369.37 $3,078.00 $2,087.43 2026-03-04
64633 HCPCS Destruction Of Upper Or Middle Spinal Facet Joint Nerves Using Imaging Guidance,… 17 9 $2,500.00 $2,500.00 $164.43 $2,500.00 $2,002.00 2026-03-04
59812 HCPCS Treatment Of Miscarriage 9 9 $2,097.70 $2,097.70 $1,679.84 $2,097.70 $1,992.82 2026-03-04
11426 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More … 17 9 $2,485.00 $2,485.00 $164.43 $2,485.00 $1,989.99 2026-03-04
55700 HCPCS Biopsy Of Prostate Gland 9 9 $2,068.43 $2,068.43 $1,656.40 $2,068.43 $1,965.01 2026-03-04
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 27 9 $2,002.44 $2,002.44 $1,603.55 $2,118.23 $1,927.59 2026-03-04
26236 HCPCS Partial Removal Of Finger Bone At End Of Finger 17 9 $2,400.00 $2,400.00 $164.43 $2,400.00 $1,921.92 2026-03-04
58100 HCPCS Biopsy Of Lining Of Uterus 9 9 $2,009.70 $2,009.70 $1,609.37 $2,009.70 $1,909.22 2026-03-04
26160 HCPCS Removal Of Growth Of Tendon Finger Or Hand 17 9 $2,325.40 $2,325.40 $164.43 $2,325.40 $1,862.18 2026-03-04
44970 HCPCS Removal Of Appendix Using An Endoscope 9 9 $1,947.00 $1,947.00 $1,559.16 $1,947.00 $1,849.65 2026-03-04
46947 HCPCS Stapling Of Internal Hemorrhoid 9 9 $1,940.00 $1,940.00 $1,553.55 $1,940.00 $1,843.00 2026-03-04
58353 HCPCS Destruction Of Lining Of Uterus 9 9 $1,925.00 $1,925.00 $1,541.54 $1,925.00 $1,828.75 2026-03-04
19020 HCPCS Drainage Of Abscess Of Breast 18 9 $2,052.84 $2,052.84 $1,439.04 $2,308.68 $1,822.89 2026-03-04
64495 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Third And… 15 9 $1,964.56 $1,964.56 $37.70 $1,964.56 $1,787.75 2026-03-04
58670 HCPCS Destruction Of Fallopian Tubes Using An Endoscope 9 9 $1,870.00 $1,870.00 $1,497.50 $1,870.00 $1,776.50 2026-03-04
J7307 HCPCS Etonogestrel (contraceptive) Implant System, Including Implant And Supplies 9 9 $1,850.20 $1,850.20 $1,481.64 $1,850.20 $1,757.69 2026-03-04
54700 HCPCS Incision And Drainage Of Sperm Reservoir, Testis, And/or Scrotal Area 9 9 $1,845.00 $1,845.00 $1,477.48 $1,845.00 $1,752.75 2026-03-04
43251 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 15 9 $1,880.00 $1,880.00 $142.59 $1,880.00 $1,710.80 2026-03-04
J7296 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System, (kyleena), 19.5 Mg 18 9 $1,791.82 $1,791.82 $1,357.36 $1,888.63 $1,695.00 2026-03-04
45378 HCPCS Diagnostic Exam Of Large Bowel Using A Flexible Endoscope 18 9 $1,780.78 $1,780.78 $1,382.63 $1,835.00 $1,686.07 2026-03-04
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 9 9 $1,764.00 $1,764.00 $1,412.61 $1,764.00 $1,675.80 2026-03-04
45384 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using A Flexible Endoscope With Elec… 18 9 $1,759.35 $1,759.35 $1,336.30 $1,850.00 $1,668.70 2026-03-04
45385 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S… 18 9 $1,866.85 $1,866.85 $1,336.30 $2,065.00 $1,668.70 2026-03-04
45381 HCPCS Injection Beneath Lining Of Large Bowel Using A Flexible Endoscope 9 9 $1,735.00 $1,735.00 $1,389.39 $1,735.00 $1,648.25 2026-03-04
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 9 9 $1,727.81 $1,727.81 $1,383.63 $1,727.81 $1,641.42 2026-03-04
36556 HCPCS Insertion Of Non-tunneled Central Venous Tube For Infusion (5 Years Or Older) 17 9 $2,040.00 $2,040.00 $164.43 $2,040.00 $1,633.63 2026-03-04
47563 HCPCS Removal Of Gallbladder With X-ray Study Of Bile Ducts Using An Endoscope 9 9 $1,700.00 $1,700.00 $1,361.36 $1,700.00 $1,615.00 2026-03-04
59409 HCPCS Vaginal Delivery 9 9 $1,696.00 $1,696.00 $1,358.16 $1,696.00 $1,611.20 2026-03-04
10061 HCPCS Complicated Or Multiple Drainage Of Skin Abscess 17 9 $2,004.35 $2,004.35 $164.43 $2,004.35 $1,605.08 2026-03-04
58301 HCPCS Removal Of IUD 17 9 $2,000.00 $2,000.00 $118.40 $2,000.00 $1,601.60 2026-03-04
J7300 HCPCS Intrauterine Copper Contraceptive 9 9 $1,667.25 $1,667.25 $1,335.13 $1,667.25 $1,583.89 2026-03-04
25535 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Small Finger Side With Man… 9 9 $1,634.00 $1,634.00 $1,308.51 $1,634.00 $1,552.30 2026-03-04
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 9 9 $1,603.20 $1,603.20 $1,283.84 $1,603.20 $1,523.04 2026-03-04
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 9 9 $1,601.63 $1,601.63 $1,282.59 $1,601.63 $1,521.55 2026-03-04
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 18 9 $1,581.37 $1,581.37 $1,266.36 $1,581.37 $1,502.30 2026-03-04
49255 HCPCS Removal Of Lining Covering Abdominal Organs 9 9 $1,560.00 $1,560.00 $1,249.25 $1,560.00 $1,482.00 2026-03-04
45380 HCPCS Biopsy Of Large Bowel Using A Flexible Endoscope 18 9 $1,665.00 $1,665.00 $1,145.14 $1,900.00 $1,475.76 2026-03-04
11443 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2… 17 9 $1,840.00 $1,840.00 $164.43 $1,840.00 $1,473.47 2026-03-04
11047 HCPCS Removal Of Bone, Each Additional 20.0 Sq Cm Or Less 9 9 $1,544.75 $1,544.75 $1,237.04 $1,544.75 $1,467.51 2026-03-04
20225 HCPCS Deep Biopsy Of Bone Using Needle Or Trocar 9 9 $1,544.75 $1,544.75 $1,237.04 $1,544.75 $1,467.51 2026-03-04
20220 HCPCS Biopsy Of Bone Using Needle Or Trocar 9 9 $1,544.75 $1,544.75 $1,237.04 $1,544.75 $1,467.51 2026-03-04
J3489 HCPCS Injection, Zoledronic Acid, 1 Mg 27 9 $1,585.19 $1,585.19 $67.72 $1,585.20 $1,466.30 2026-03-04
62321 HCPCS Injection Of Substance Into Middle Or Upper Spine Canal Using Imaging Guidance 15 9 $1,600.00 $1,600.00 $79.24 $1,600.00 $1,456.00 2026-03-04
62323 HCPCS Injection Of Substance Into Lower Spine Canal Using Imaging Guidance 15 9 $1,600.00 $1,600.00 $73.91 $1,600.00 $1,456.00 2026-03-04
43239 HCPCS Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop… 24 9 $1,507.44 $1,507.44 $101.71 $1,600.00 $1,432.07 2026-03-04
55250 HCPCS Removal Of Sperm Duct 26 9 $1,500.00 $1,500.00 $164.43 $1,700.00 $1,425.00 2026-03-04
49083 HCPCS Drainage Of Fluid From Abdominal Cavity Using Imaging Guidance 9 9 $1,500.00 $1,500.00 $1,201.20 $1,500.00 $1,425.00 2026-03-04
C1781 HCPCS Mesh (implantable) 36 9 $1,659.35 $1,659.35 $108.11 $3,574.20 $1,423.00 2026-03-04
64492 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Third And… 15 9 $1,522.95 $1,522.95 $42.79 $1,522.95 $1,385.88 2026-03-04
G0121 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual Not Meeting Criteria For … 18 9 $1,548.35 $1,548.35 $1,010.37 $1,835.00 $1,365.59 2026-03-04
J1442 HCPCS Injection, Filgrastim (g-csf), Excludes Biosimilars, 1 Microgram 18 9 $1,430.34 $1,430.34 $1,084.88 $1,505.92 $1,354.75 2026-03-04
26725 HCPCS Closed Treatment Of Broken Finger Or Thumb At Midportion Or Part Near Hand With … 9 9 $1,420.00 $1,420.00 $1,137.14 $1,420.00 $1,349.00 2026-03-04
52000 HCPCS Diagnostic Exam Of Bladder And Urethra Using An Endoscope 9 9 $1,411.30 $1,411.30 $1,130.17 $1,411.30 $1,340.74 2026-03-04
11403 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm 17 9 $1,665.00 $1,665.00 $164.43 $1,665.00 $1,333.33 2026-03-04
12007 HCPCS Simple Repair Of Surface Wound To Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 9 9 $1,400.00 $1,400.00 $1,121.12 $1,400.00 $1,330.00 2026-03-04
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 9 9 $1,390.00 $1,390.00 $1,113.11 $1,390.00 $1,320.50 2026-03-04
63685 HCPCS Insertion Or Replacement Of Spinal Neurostimulator Generator Or Receiver 9 9 $1,380.23 $1,380.23 $1,105.29 $1,380.23 $1,311.22 2026-03-04
10140 HCPCS Drainage Of Blood Or Fluid Accumulation 35 9 $1,600.00 $1,600.00 $164.43 $1,602.11 $1,281.28 2026-03-04
12036 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 20.1-30.… 17 9 $1,600.00 $1,600.00 $164.43 $1,600.00 $1,281.28 2026-03-04
11404 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 3.1-4.0 Cm 17 9 $1,590.00 $1,590.00 $164.43 $1,590.00 $1,273.27 2026-03-04
G0105 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual At High Risk 18 9 $1,333.05 $1,333.05 $1,013.89 $1,400.00 $1,266.10 2026-03-04
64494 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Second Le… 15 9 $1,378.55 $1,378.55 $36.63 $1,378.55 $1,254.48 2026-03-04
44180 HCPCS Release Of Small Bowel Scar Tissue Using An Endoscope 9 9 $1,320.00 $1,320.00 $1,057.06 $1,320.00 $1,254.00 2026-03-04
44950 HCPCS Removal Of Appendix 9 9 $1,320.00 $1,320.00 $1,057.06 $1,320.00 $1,254.00 2026-03-04
64721 HCPCS Release And/or Relocation Of Hand Nerve 9 9 $1,320.00 $1,320.00 $1,057.06 $1,320.00 $1,254.00 2026-03-04
Q5103 HCPCS Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 9 9 $1,305.73 $1,305.73 $1,045.63 $1,305.73 $1,240.44 2026-03-04
87507 HCPCS Detection Test By Nucleic Acid For Digestive Tract Pathogen, Multiple Types Or S… 9 9 $1,273.26 $1,273.26 $1,019.63 $1,273.26 $1,209.60 2026-03-04
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 27 9 $1,265.30 $1,265.30 $1,013.25 $1,265.30 $1,202.04 2026-03-04
73706 HCPCS CT Scan Of Blood Vessels Of Lower Leg With Contrast 18 9 $1,265.30 $1,265.30 $1,013.25 $1,265.30 $1,202.04 2026-03-04
64484 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 15 9 $1,317.85 $1,317.85 $36.63 $1,317.85 $1,199.24 2026-03-04
99291 HCPCS Critical Care, First 30-74 Minutes 17 9 $1,470.00 $1,470.00 $164.43 $1,470.00 $1,177.18 2026-03-04
52281 HCPCS Dilation Of Urethra Using An Endoscope 9 9 $1,232.00 $1,232.00 $986.59 $1,232.00 $1,170.40 2026-03-04
43246 HCPCS Insertion Of Stomach Tube Using A Flexible Endoscope 24 9 $1,145.10 $1,145.10 $145.45 $2,965.00 $1,099.30 2026-03-04
58120 HCPCS Dilation And Scraping Of Uterus 9 9 $1,155.00 $1,155.00 $924.92 $1,155.00 $1,097.25 2026-03-04
12045 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 12.6-20.0 Cm 17 9 $1,370.00 $1,370.00 $164.43 $1,370.00 $1,097.10 2026-03-04
45305 HCPCS Biopsies Of Rectum And/or Lower Large Bowel Using A Rigid Endoscope 9 9 $1,148.00 $1,148.00 $919.32 $1,148.00 $1,090.60 2026-03-04
90375 HCPCS Rabies Immune Globulin For Injection 9 9 $1,140.10 $1,140.10 $912.99 $1,140.10 $1,083.10 2026-03-04
45300 HCPCS Diagnostic Exam Of Rectum And Lower Large Bowel Using An Endoscope 9 9 $1,135.00 $1,135.00 $908.91 $1,135.00 $1,078.25 2026-03-04
23650 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation 18 9 $1,132.79 $1,132.79 $874.55 $1,173.48 $1,076.67 2026-03-04
C1897 HCPCS Lead, Neurostimulator Test Kit (implantable) 9 9 $1,125.00 $1,125.00 $900.90 $1,125.00 $1,068.75 2026-03-04
J1459 HCPCS Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 18 9 $1,184.33 $1,184.33 $853.22 $1,303.20 $1,065.46 2026-03-04
63190 HCPCS Removal Of Spine Bone With Severing Of Nerve Roots, More Than 2 Segments 15 9 $1,120.00 $1,120.00 $896.90 $1,451.60 $1,064.00 2026-03-04
63185 HCPCS Removal Of Spine Bone With Severing Of Nerve Roots, 1-2 Segments 15 9 $1,120.00 $1,120.00 $853.43 $1,323.35 $1,064.00 2026-03-04
11402 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 1.1-2.0 Cm 26 9 $1,120.00 $1,120.00 $164.43 $1,160.28 $1,059.92 2026-03-04
52204 HCPCS Biopsy Of Bladder Using An Endoscope 9 9 $1,100.00 $1,100.00 $880.88 $1,100.00 $1,045.00 2026-03-04
10160 HCPCS Aspiration Of Abscess, Blood, Or Cyst 17 9 $1,278.96 $1,278.96 $150.78 $1,278.96 $1,024.19 2026-03-04
45330 HCPCS Diagnostic Exam Of Lower Portion Of Large Bowel Using A Flexible Endoscope 18 9 $1,123.50 $1,123.50 $810.41 $1,235.00 $1,012.00 2026-03-04
45333 HCPCS Removal Of Polyps Or Growths Of Lower Large Bowel Using A Flexible Endoscope Wit… 9 9 $1,065.00 $1,065.00 $852.85 $1,065.00 $1,011.75 2026-03-04
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 9 9 $1,060.90 $1,060.90 $849.57 $1,060.90 $1,007.86 2026-03-04
70487 HCPCS CT Scan Of Face With Contrast 9 9 $1,060.90 $1,060.90 $849.57 $1,060.90 $1,007.86 2026-03-04
45335 HCPCS Injection Beneath Lining Of Lower Large Bowel Using A Flexible Endoscope 9 9 $1,056.00 $1,056.00 $845.64 $1,056.00 $1,003.20 2026-03-04
36589 HCPCS Removal Of Tunneled Central Venous Tube 17 9 $1,252.68 $1,252.68 $164.43 $1,252.68 $1,003.15 2026-03-04
90377 HCPCS Rabies Immune Globulin For Injection Beneath The Skin And/or Into Muscle 9 9 $1,054.58 $1,054.58 $844.51 $1,054.58 $1,001.85 2026-03-04
73702 HCPCS CT Scan Of Leg Before And After Contrast 27 9 $1,043.30 $1,043.30 $835.47 $1,043.30 $991.14 2026-03-04
64491 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Second Le… 15 9 $1,071.81 $1,071.81 $42.28 $1,071.81 $975.35 2026-03-04
23076 HCPCS Removal Of Growth Of Muscle Of Shoulder, Less Than 5.0 Cm 9 9 $1,020.00 $1,020.00 $816.82 $1,020.00 $969.00 2026-03-04
21552 HCPCS Removal Of Growth Of Soft Tissue Under Skin Of Neck Or Front Of Chest, 3.0 Cm Or… 17 9 $1,206.70 $1,206.70 $164.43 $1,206.70 $966.33 2026-03-04
14040 HCPCS Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, Genitals, Han… 17 9 $1,206.70 $1,206.70 $164.43 $1,206.70 $966.33 2026-03-04
12006 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 17 9 $1,200.00 $1,200.00 $164.43 $1,200.00 $960.96 2026-03-04
43249 HCPCS Balloon Dilation Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexibl… 24 9 $1,500.00 $1,500.00 $112.22 $2,175.00 $942.64 2026-03-04
J0248 HCPCS Injection, Remdesivir, 1 Mg 18 9 $1,001.06 $1,001.06 $749.55 $1,066.12 $936.00 2026-03-04
99284 HCPCS Emergency Department Visit With Moderate Level Of Medical Decision Making 9 9 $973.00 $973.00 $779.18 $973.00 $924.35 2026-03-04
12016 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.… 9 9 $971.00 $971.00 $777.58 $971.00 $922.45 2026-03-04
15260 HCPCS Full Thickness Skin Graft To Nose, Ears, Eyelids, Or Lips, 20.0 Sq Cm Or Less 9 9 $970.00 $970.00 $776.78 $970.00 $921.50 2026-03-04
43247 HCPCS Removal Of Foreign Bodies Of Esophagus, Stomach, And/or Upper Small Bowel Using … 24 9 $957.00 $957.00 $129.23 $1,820.00 $918.72 2026-03-04
43215 HCPCS Removal Of Foreign Bodies In Esophagus Using A Flexible Endoscope 18 9 $1,037.30 $1,037.30 $704.70 $1,194.60 $918.32 2026-03-04
32555 HCPCS Aspiration Of Fluid From Chest Cavity Using Imaging Guidance 17 9 $1,080.20 $1,080.20 $164.43 $1,080.20 $910.00 2026-03-04
78701 HCPCS Nuclear Medicine Study Of Kidney And Blood Flow 9 9 $957.00 $957.00 $766.37 $957.00 $909.15 2026-03-04
43235 HCPCS Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible… 24 9 $935.00 $935.00 $90.89 $1,435.00 $897.60 2026-03-04
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 17 9 $1,107.00 $1,107.00 $164.43 $1,107.00 $886.49 2026-03-04
77075 HCPCS Complete X-ray Of Body Bones 9 9 $929.45 $929.45 $744.30 $929.45 $882.98 2026-03-04
64493 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Le… 15 9 $968.84 $968.84 $67.36 $968.84 $881.64 2026-03-04
90675 HCPCS Rabies Vaccine For Injection Into Muscle 18 9 $993.89 $993.89 $665.21 $1,157.11 $878.64 2026-03-04
64483 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 15 9 $963.80 $963.80 $82.40 $963.80 $877.06 2026-03-04
57300 HCPCS Closure Of Abnormal Drainage Tract From Rectum To Vagina Through Vagina Or Anus 9 9 $907.00 $907.00 $726.33 $907.00 $861.65 2026-03-04
27096 HCPCS Injection Of Anesthetic Or Steroid Into Joint Between Lower Spine And Hip Bone U… 15 9 $945.97 $945.97 $61.14 $945.97 $860.83 2026-03-04
11401 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 0.6-1.0 Cm 17 9 $1,055.00 $1,055.00 $164.43 $1,055.00 $844.84 2026-03-04
12005 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 17 9 $1,050.00 $1,050.00 $164.43 $1,050.00 $840.84 2026-03-04
24071 HCPCS Removal Of Growth Under Skin Of Upper Arm Or Elbow, 3.0 Cm Or More 9 9 $880.00 $880.00 $704.70 $880.00 $836.00 2026-03-04
47000 HCPCS Needle Biopsy Of Liver Through Skin 9 9 $880.00 $880.00 $704.70 $880.00 $836.00 2026-03-04
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 9 9 $875.50 $875.50 $701.10 $875.50 $831.73 2026-03-04
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 9 9 $875.50 $875.50 $701.10 $875.50 $831.73 2026-03-04
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 9 9 $875.50 $875.50 $701.10 $875.50 $831.73 2026-03-04
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 9 9 $875.50 $875.50 $701.10 $875.50 $831.73 2026-03-04
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 9 9 $875.50 $875.50 $701.10 $875.50 $831.73 2026-03-04
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 9 9 $875.50 $875.50 $701.10 $875.50 $831.73 2026-03-04
23655 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia 18 9 $936.16 $936.16 $652.65 $1,057.32 $830.85 2026-03-04
64636 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 15 9 $900.00 $900.00 $42.28 $900.00 $819.00 2026-03-04
28660 HCPCS Closed Treatment Of Dislocated Joint In Toe 17 9 $1,012.00 $1,012.00 $107.30 $1,012.00 $810.41 2026-03-04
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 27 9 $875.50 $875.50 $544.54 $875.50 $809.84 2026-03-04
12044 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 7.6-12.5 Cm 17 9 $1,011.00 $1,011.00 $164.43 $1,011.00 $809.61 2026-03-04
72128 HCPCS CT Scan Of Middle Spine Without Contrast 9 9 $851.60 $851.60 $681.96 $851.60 $809.02 2026-03-04
62322 HCPCS Injection Of Substance Into Lower Spine Canal 9 9 $850.00 $850.00 $680.68 $850.00 $807.50 2026-03-04
78700 HCPCS Nuclear Medicine Study Of Kidney 9 9 $842.00 $842.00 $674.27 $842.00 $799.90 2026-03-04
72125 HCPCS CT Scan Of Upper Spine Without Contrast 9 9 $838.76 $838.76 $671.68 $838.76 $796.82 2026-03-04
24600 HCPCS Repair Of Dislocated Elbow 26 9 $815.00 $815.00 $164.43 $1,057.32 $774.25 2026-03-04
20200 HCPCS Biopsy Of Muscle 9 9 $807.84 $807.84 $646.92 $807.84 $767.45 2026-03-04
74160 HCPCS CT Scan Of Abdomen With Contrast 9 9 $806.25 $806.25 $645.65 $806.25 $765.94 2026-03-04
11400 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 0.5 Cm Or Less 26 9 $800.00 $800.00 $144.30 $1,620.00 $760.00 2026-03-04
37195 HCPCS Infusion Of Drug To Dissolve Blood Clot In Brain 9 9 $800.00 $800.00 $640.64 $800.00 $760.00 2026-03-04
93799 HCPCS Other Cardiovascular Service Or Procedure 9 9 $800.00 $800.00 $640.64 $800.00 $760.00 2026-03-04
20520 HCPCS Removal Of Foreign Body In Muscle Or Tendon 9 9 $799.92 $799.92 $640.58 $799.92 $759.92 2026-03-04
74150 HCPCS CT Scan Of Abdomen Without Contrast 9 9 $798.50 $798.50 $639.44 $798.50 $758.58 2026-03-04
J7325 HCPCS Hyaluronan Or Derivative, Synvisc Or Synvisc-one, For Intra-articular Injection,… 9 9 $797.00 $797.00 $638.24 $797.00 $757.15 2026-03-04
J1610 HCPCS Injection, Glucagon Hydrochloride, Per 1 Mg 27 9 $784.14 $784.14 $612.47 $795.71 $744.93 2026-03-04
32554 HCPCS Aspiration Of Fluid From Chest Cavity 17 9 $929.50 $929.50 $163.73 $929.50 $744.34 2026-03-04
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 9 9 $779.16 $779.16 $623.95 $779.16 $740.20 2026-03-04
72193 HCPCS CT Scan Of Pelvis With Contrast 9 9 $778.85 $778.85 $623.70 $778.85 $739.91 2026-03-04
P9040 HCPCS Red Blood Cells, Leukocytes Reduced, Irradiated, Each Unit 9 9 $777.28 $777.28 $622.45 $777.28 $738.42 2026-03-04
70488 HCPCS CT Scan Of Face Before And After Contrast 9 9 $758.65 $758.65 $607.53 $758.65 $720.72 2026-03-04
64634 HCPCS Destruction Of Upper Or Middle Spinal Facet Joint Nerves Using Imaging Guidance,… 17 9 $900.00 $900.00 $164.43 $900.00 $720.72 2026-03-04
32551 HCPCS Removal Of Fluid From Between Lung And Chest Cavity 17 9 $900.00 $900.00 $164.43 $900.00 $720.72 2026-03-04
93307 HCPCS Ultrasound Of Heart 9 9 $752.40 $752.40 $602.52 $752.40 $714.78 2026-03-04
64454 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Knee Nerve Branch Using Imagin… 15 9 $780.00 $780.00 $60.83 $780.00 $709.80 2026-03-04
82139 HCPCS Amino Acid Level, 6 Or More Amino Acids, Quantitative, Each Specimen 9 9 $743.02 $743.02 $595.01 $743.02 $705.87 2026-03-04
P9016 HCPCS Red Blood Cells, Leukocytes Reduced, Each Unit 9 9 $738.73 $738.73 $591.58 $738.73 $701.79 2026-03-04
71270 HCPCS CT Scan Of Chest Before And After Contrast 9 9 $731.12 $731.12 $585.48 $731.12 $694.56 2026-03-04
11107 HCPCS Incision Biopsy, Each Additional Skin Growth 17 9 $863.10 $863.10 $57.35 $863.10 $691.17 2026-03-04
11106 HCPCS Incision Biopsy, First Skin Growth 17 9 $863.10 $863.10 $126.73 $863.10 $691.17 2026-03-04
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
70552 HCPCS MRI Scan Of Brain With Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
74181 HCPCS MRI Scan Of Abdomen Without Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
74182 HCPCS MRI Scan Of Abdomen With Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
73722 HCPCS MRI Scan Of Leg Joint With Contrast 27 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
70553 HCPCS MRI Scan Of Brain Before And After Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 18 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 18 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
70551 HCPCS MRI Scan Of Brain Without Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
73220 HCPCS MRI Scan Of Arm Before And After Contrast 18 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
73222 HCPCS MRI Scan Of Arm Joint With Contrast 18 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
72195 HCPCS MRI Scan Of Pelvis Without Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
72196 HCPCS MRI Scan Of Pelvis With Contrast 9 9 $727.49 $727.49 $582.57 $727.49 $691.12 2026-03-04
20611 HCPCS Aspiration And/or Injection Of Fluid Large Joint Using Ultrasound Guidance 15 9 $759.00 $759.00 $31.18 $759.00 $690.69 2026-03-04
64490 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Single Le… 15 9 $750.55 $750.55 $77.92 $750.55 $683.00 2026-03-04
73218 HCPCS MRI Scan Of Arm Without Contrast 36 9 $727.39 $727.39 $518.04 $727.49 $681.93 2026-03-04
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 9 9 $716.64 $716.64 $573.89 $716.64 $680.81 2026-03-04
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 27 9 $727.49 $727.49 $544.54 $727.49 $680.00 2026-03-04
73720 HCPCS MRI Scan Of Leg Before And After Contrast 27 9 $727.49 $727.49 $544.54 $727.49 $680.00 2026-03-04
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 9 9 $709.20 $709.20 $567.93 $709.20 $673.74 2026-03-04
73718 HCPCS MRI Scan Of Leg Without Contrast 27 9 $727.49 $727.49 $518.04 $727.59 $672.93 2026-03-04
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 27 9 $727.49 $727.49 $518.04 $727.49 $672.93 2026-03-04
76536 HCPCS Ultrasound Scan Of Head And Neck Soft Tissue 9 9 $707.85 $707.85 $566.85 $707.85 $672.46 2026-03-04
90677 HCPCS Pneumococcal Conjugate Vaccine, 20 Valent (pcv20), For Intramuscular Use 27 9 $707.71 $707.71 $393.46 $739.08 $672.32 2026-03-04
L2114 HCPCS Ankle Foot Orthosis, Fracture Orthosis, Tibial Fracture Orthosis, Semi-rigid, Pr… 9 9 $704.00 $704.00 $563.76 $704.00 $668.80 2026-03-04
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 9 9 $700.00 $700.00 $560.56 $700.00 $665.00 2026-03-04
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 9 9 $686.00 $686.00 $549.35 $686.00 $651.70 2026-03-04
94660 HCPCS Therapy Procedure Using A Positive Pressure Ventilator 18 9 $770.00 $770.00 $246.65 $1,232.00 $647.30 2026-03-04
27560 HCPCS Closed Treatment Of Dislocated Kneecap 17 9 $801.00 $801.00 $164.43 $801.00 $641.44 2026-03-04
27840 HCPCS Closed Treatment Of Dislocated Ankle 9 9 $670.00 $670.00 $536.54 $670.00 $636.50 2026-03-04
27810 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle With Manipulation 9 9 $670.00 $670.00 $536.54 $670.00 $636.50 2026-03-04
12053 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1-7… 17 9 $721.00 $721.00 $164.43 $721.00 $635.00 2026-03-04
93975 HCPCS Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 9 9 $664.65 $664.65 $532.25 $664.65 $631.42 2026-03-04
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 9 9 $664.65 $664.65 $532.25 $664.65 $631.42 2026-03-04
93970 HCPCS Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 18 9 $664.65 $664.65 $532.25 $664.65 $631.42 2026-03-04
93926 HCPCS Ultrasound Of One Leg Arteries Or Artery Grafts 18 9 $664.65 $664.65 $532.25 $664.65 $631.42 2026-03-04
93922 HCPCS Ultrasound Study Of Arm And Leg Arteries 9 9 $664.65 $664.65 $532.25 $664.65 $631.42 2026-03-04
93971 HCPCS Ultrasound Study Of One Arm Or Leg Veins With Compression And Maneuvers 27 9 $664.65 $664.65 $532.25 $664.65 $631.42 2026-03-04
93931 HCPCS Ultrasound Of One Arm Arteries Or Artery Grafts 18 9 $664.65 $664.65 $532.25 $664.65 $631.42 2026-03-04
93978 HCPCS Complete Ultrasound Of Aorta, Vena Cava, Groin Vessels Or Bypass Grafts 9 9 $664.65 $664.65 $532.25 $664.65 $631.42 2026-03-04
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 9 9 $664.65 $664.65 $532.25 $664.65 $631.42 2026-03-04
93930 HCPCS Ultrasound Of Arm Arteries Or Artery Grafts 9 9 $664.65 $664.65 $532.25 $664.65 $631.42 2026-03-04
12004 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 17 9 $780.00 $780.00 $164.43 $780.00 $624.62 2026-03-04
71250 HCPCS CT Scan Of Chest Without Contrast 9 9 $650.40 $650.40 $520.84 $650.40 $617.88 2026-03-04
36430 HCPCS Transfusion Of Blood Or Blood Products 72 9 $649.00 $649.00 $73.67 $900.00 $615.60 2026-03-04
71260 HCPCS CT Scan Of Chest With Contrast 9 9 $647.92 $647.92 $518.85 $647.92 $615.52 2026-03-04
36680 HCPCS Insertion Of Needle For Infusion Into Bone 9 9 $640.00 $640.00 $512.51 $640.00 $608.00 2026-03-04
90649 HCPCS Human Papillomavirus Vaccine, Types 6, 11, 16, 18, Quadrivalent 9 9 $633.45 $633.45 $507.27 $633.45 $601.78 2026-03-04
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