Price Transparencybeta Hospital negotiated rates

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

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Hospital

Rush County Memorial Hospital

La Crosse, KS · CCN 171342 · Rates published

1,970 distinct procedures filed
10 distinct payers
5,836 rate rows
2025-04-25 last MRF observed · ⚠ 18 mo old
Data quality

5,733 of 5,836 rate rows are consumer-grade (98.2%)

103 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
per-diem day rate — not a per-procedure price 48
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 24
percent-of-charges filed in the dollar field — excluded from medians 20
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 9
exceeds 10× this hospital's gross charge — excluded from medians 2

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 18 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbRCMHLACROSSEKS&type=CDMWithoutLabel&fileType=CSV
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-10-14
Content fingerprint 170e6e8dd13a8085… · 2,199,573 bytes · first seen 2026-08-01

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
2597755
CDM 		Neulasta Onpro 6 Mg/0.6 Ml Kit 2 $8,959.65 $10,540.77 $9,750.21 —
637
MS_DRG 		Diabetes With Mcc 1 $5,509.40 $5,509.40 $5,509.40 nat. median
$10,515
0.5× median
154
MS_DRG 		Other Ear, Nose, Mouth And Throat Diagnoses With Mcc 1 $4,803.63 $4,803.63 $4,803.63 nat. median
$11,032
outlier · 0.4×
603
MS_DRG 		Cellulitis Without Mcc 1 $4,337.52 $4,337.52 $4,337.52 nat. median
$6,621
0.7× median
872
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 1 $4,335.80 $4,335.80 $4,335.80 nat. median
$7,744
0.6× median
195
MS_DRG 		Simple Pneumonia And Pleurisy Without Cc/mcc 1 $4,205.40 $4,205.40 $4,205.40 nat. median
$4,710
0.9× median
2519892
CDM 		Xgeva 120 Mg/1.7 Ml Vial 2 $3,858.43 $4,539.32 $4,198.88 —
184
MS_DRG 		Major Chest Trauma With Cc 1 $4,042.40 $4,042.40 $4,042.40 nat. median
$7,947
0.5× median
69
MS_DRG 		Transient Ischemia Without Thrombolytic 1 $4,006.00 $4,006.00 $4,006.00 nat. median
$6,174
0.6× median
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 1 $3,709.74 $3,709.74 $3,709.74 nat. median
$9,470
outlier · 0.4×
948
MS_DRG 		Signs And Symptoms Without Mcc 1 $3,700.81 $3,700.81 $3,700.81 nat. median
$5,562
0.7× median
638
MS_DRG 		Diabetes With Cc 1 $3,553.40 $3,553.40 $3,553.40 nat. median
$6,741
0.5× median
200
MS_DRG 		Pneumothorax With Cc 1 $3,460.68 $3,460.68 $3,460.68 nat. median
$8,043
outlier · 0.4×
536
MS_DRG 		Fractures Of Hip And Pelvis Without Mcc 1 $3,325.20 $3,325.20 $3,325.20 nat. median
$6,111
0.5× median
728
MS_DRG 		Inflammation Of The Male Reproductive System Without Mcc 1 $2,640.60 $2,640.60 $2,640.60 nat. median
$5,965
outlier · 0.4×
179
MS_DRG 		Respiratory Infections And Inflammations Without Cc/mcc 1 $2,518.05 $2,518.05 $2,518.05 nat. median
$5,691
outlier · 0.4×
293
MS_DRG 		Heart Failure And Shock Without Cc/mcc 1 $2,510.20 $2,510.20 $2,510.20 nat. median
$4,186
0.6× median
310
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 1 $2,445.00 $2,445.00 $2,445.00 nat. median
$4,383
0.6× median
25073
HCPCS 		Removal Of Growth Of Muscle Of Forearm Or Wrist, 3.0 Cm Or More 4 $317.71 $3,001.50 $2,414.25 nat. median
$3,060
0.8× median
178
MS_DRG 		Respiratory Infections And Inflammations With Cc 1 $2,355.23 $2,355.23 $2,355.23 nat. median
$7,418
outlier · 0.3×
2516530
CDM 		Remicade 100 Mg Vial 2 $2,050.94 $2,412.88 $2,231.91 —
156
MS_DRG 		Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/mcc 1 $2,184.20 $2,184.20 $2,184.20 nat. median
$5,048
outlier · 0.4×
309
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders With Cc 1 $2,176.12 $2,176.12 $2,176.12 nat. median
$5,574
outlier · 0.4×
2517681
CDM 		Prolia 60 Mg/ml Syringe 2 $1,947.80 $2,291.53 $2,119.66 —
2518724
CDM 		Fulvestrant 250 Mg/5 Ml 2 $1,904.77 $2,240.90 $2,072.84 —
194
MS_DRG 		Simple Pneumonia And Pleurisy With Cc 1 $1,918.59 $1,918.59 $1,918.59 nat. median
$6,156
outlier · 0.3×
2520053
CDM 		Zoledronic Acid 5 Mg/100 Ml 2 $1,752.36 $2,061.60 $1,906.98 —
25075
HCPCS 		Removal Of Growth Under Skin Of Forearm Or Wrist, Less Than 3.0 Cm 4 $329.18 $2,507.00 $1,853.00 nat. median
$1,849
1.0× median
897
MS_DRG 		Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc 1 $1,624.11 $1,624.11 $1,624.11 nat. median
$5,898
outlier · 0.3×
76060
HCPCS 		Operating Room Services - Minor Surgery 3 $1,253.75 $2,500.00 $1,475.00 —
11424
HCPCS 		Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4… 3 $1,248.74 $2,490.00 $1,469.10 nat. median
$1,708
0.9× median
74174
HCPCS 		CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 3 $1,133.39 $2,260.00 $1,333.40 nat. median
$549
outlier · 2.4×
76050
HCPCS 		Operating Room Services - Minor Surgery 3 $1,028.08 $2,050.00 $1,209.50 —
95810
HCPCS 		Sleep Study In Sleep Lab (6 Years Or Older) 3 $1,023.06 $2,040.00 $1,203.60 nat. median
$1,446
0.8× median
95805
HCPCS 		Sleep Study, Multiple Trials 3 $1,023.06 $2,040.00 $1,203.60 nat. median
$1,061
1.1× median
95811
HCPCS 		Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 3 $1,023.06 $2,040.00 $1,203.60 nat. median
$1,412
0.9× median
87900
HCPCS 		Infectious Agent Drug Susceptibility Analysis 3 $1,020.55 $2,035.00 $1,200.65 nat. median
$149
outlier · 8.0×
93306
HCPCS 		Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 3 $1,000.49 $1,995.00 $1,177.05 nat. median
$804
1.5× median
2598894
CDM 		Filgrastim 480 Mcg/0.8 Ml 2 $1,071.69 $1,260.81 $1,166.25 —
20103
HCPCS 		Exploration Of Wound Of Arm Or Leg 4 $450.00 $1,437.50 $1,156.25 nat. median
$1,633
0.7× median
36571
HCPCS 		Insertion Of Central Venous Tube With Port For Infusion (5 Years Or Older) 4 $386.75 $4,980.00 $1,133.78 nat. median
$3,733
outlier · 0.3×
11646
HCPCS 		Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More… 4 $300.00 $1,208.70 $1,096.12 nat. median
$2,549
outlier · 0.4×
22004
HCPCS 		Room & Board - Semi-private (two Beds) - General Classification 1 $1,000.00 $1,000.00 $1,000.00 —
43245
HCPCS 		Dilation Of Stomach Outlet Using A Flexible Endoscope 3 $824.97 $1,645.00 $970.55 nat. median
$2,031
outlier · 0.5×
2518114
CDM 		Hypertet 250 Unit/ml Syringe 2 $874.89 $1,029.28 $952.09 —
14060
HCPCS 		Repair Of Wound Of Eyelids, Nose, Ears, Or Lips By Transferring Skin, 10.0 Sq Cm… 4 $300.00 $1,575.00 $929.25 nat. median
$2,256
outlier · 0.4×
71275
HCPCS 		CT Scan Of Blood Vessels Of Chest With Contrast 3 $789.86 $1,575.00 $929.25 nat. median
$365
outlier · 2.5×
14040
HCPCS 		Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, Genitals, Han… 4 $300.00 $1,575.00 $900.00 nat. median
$2,206
outlier · 0.4×
11104
HCPCS 		Punch Biopsy, First Skin Growth 4 $73.39 $984.30 $892.62 nat. median
$406
outlier · 2.2×
27045
HCPCS 		Removal Of Growth Of Muscle Of Pelvis And Hip, 5.0 Cm Or More 4 $609.00 $1,092.50 $878.75 nat. median
$3,009
outlier · 0.3×

Other procedures at this hospital

Browse this hospital's 1,970 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
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
             
2597755 CDM Neulasta Onpro 6 Mg/0.6 Ml Kit 2 2 $17,865.71 $16,079.14 $8,959.65 $10,540.77 $9,750.21 2025-04-25
637 MS_DRG Diabetes With Mcc 1 1 $7,358.40 $6,622.56 $5,509.40 $5,509.40 $5,509.40 2025-04-25
154 MS_DRG Other Ear, Nose, Mouth And Throat Diagnoses With Mcc 1 1 $4,803.63 $4,323.27 $4,803.63 $4,803.63 $4,803.63 2025-04-25
603 MS_DRG Cellulitis Without Mcc 1 1 $4,337.52 $3,903.77 $4,337.52 $4,337.52 $4,337.52 2025-04-25
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 1 1 $5,741.92 $5,167.73 $4,335.80 $4,335.80 $4,335.80 2025-04-25
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/mcc 1 1 $4,464.16 $4,017.74 $4,205.40 $4,205.40 $4,205.40 2025-04-25
2519892 CDM Xgeva 120 Mg/1.7 Ml Vial 2 2 $7,693.77 $6,924.39 $3,858.43 $4,539.32 $4,198.88 2025-04-25
184 MS_DRG Major Chest Trauma With Cc 1 1 $4,676.99 $4,209.29 $4,042.40 $4,042.40 $4,042.40 2025-04-25
69 MS_DRG Transient Ischemia Without Thrombolytic 1 1 $4,006.00 $3,605.40 $4,006.00 $4,006.00 $4,006.00 2025-04-25
189 MS_DRG Pulmonary Edema And Respiratory Failure 1 1 $3,709.74 $3,338.77 $3,709.74 $3,709.74 $3,709.74 2025-04-25
948 MS_DRG Signs And Symptoms Without Mcc 1 1 $3,700.81 $3,330.73 $3,700.81 $3,700.81 $3,700.81 2025-04-25
638 MS_DRG Diabetes With Cc 1 1 $5,325.36 $4,792.82 $3,553.40 $3,553.40 $3,553.40 2025-04-25
200 MS_DRG Pneumothorax With Cc 1 1 $3,460.68 $3,114.61 $3,460.68 $3,460.68 $3,460.68 2025-04-25
536 MS_DRG Fractures Of Hip And Pelvis Without Mcc 1 1 $8,820.02 $7,938.02 $3,325.20 $3,325.20 $3,325.20 2025-04-25
728 MS_DRG Inflammation Of The Male Reproductive System Without Mcc 1 1 $3,567.00 $3,210.30 $2,640.60 $2,640.60 $2,640.60 2025-04-25
179 MS_DRG Respiratory Infections And Inflammations Without Cc/mcc 1 1 $2,518.05 $2,266.25 $2,518.05 $2,518.05 $2,518.05 2025-04-25
293 MS_DRG Heart Failure And Shock Without Cc/mcc 1 1 $4,786.80 $4,308.12 $2,510.20 $2,510.20 $2,510.20 2025-04-25
310 MS_DRG Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 1 1 $2,670.54 $2,403.49 $2,445.00 $2,445.00 $2,445.00 2025-04-25
25073 HCPCS Removal Of Growth Of Muscle Of Forearm Or Wrist, 3.0 Cm Or More 4 4 $2,610.00 $2,349.00 $317.71 $3,001.50 $2,414.25 2025-04-25
178 MS_DRG Respiratory Infections And Inflammations With Cc 1 1 $2,355.23 $2,119.71 $2,355.23 $2,355.23 $2,355.23 2025-04-25
2516530 CDM Remicade 100 Mg Vial 2 2 $4,089.62 $3,680.66 $2,050.94 $2,412.88 $2,231.91 2025-04-25
156 MS_DRG Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/mcc 1 1 $2,634.00 $2,370.60 $2,184.20 $2,184.20 $2,184.20 2025-04-25
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 1 1 $2,176.12 $1,958.51 $2,176.12 $2,176.12 $2,176.12 2025-04-25
2517681 CDM Prolia 60 Mg/ml Syringe 2 2 $3,883.95 $3,495.56 $1,947.80 $2,291.53 $2,119.66 2025-04-25
2518724 CDM Fulvestrant 250 Mg/5 Ml 2 2 $3,798.14 $3,418.33 $1,904.77 $2,240.90 $2,072.84 2025-04-25
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 1 1 $1,918.59 $1,726.73 $1,918.59 $1,918.59 $1,918.59 2025-04-25
2520053 CDM Zoledronic Acid 5 Mg/100 Ml 2 2 $3,494.23 $3,144.81 $1,752.36 $2,061.60 $1,906.98 2025-04-25
25075 HCPCS Removal Of Growth Under Skin Of Forearm Or Wrist, Less Than 3.0 Cm 7 4 $2,180.00 $1,962.00 $329.18 $2,507.00 $1,853.00 2025-04-25
897 MS_DRG Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc 1 1 $1,624.11 $1,461.70 $1,624.11 $1,624.11 $1,624.11 2025-04-25
76060 HCPCS Operating Room Services - Minor Surgery 3 3 $2,500.00 $2,250.00 $1,253.75 $2,500.00 $1,475.00 2025-04-25
11424 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4… 3 3 $2,490.00 $2,241.00 $1,248.74 $2,490.00 $1,469.10 2025-04-25
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 3 3 $2,260.00 $2,034.00 $1,133.39 $2,260.00 $1,333.40 2025-04-25
76050 HCPCS Operating Room Services - Minor Surgery 3 3 $2,050.00 $1,845.00 $1,028.08 $2,050.00 $1,209.50 2025-04-25
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 3 3 $2,040.00 $1,836.00 $1,023.06 $2,040.00 $1,203.60 2025-04-25
95805 HCPCS Sleep Study, Multiple Trials 3 3 $2,040.00 $1,836.00 $1,023.06 $2,040.00 $1,203.60 2025-04-25
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 3 3 $2,040.00 $1,836.00 $1,023.06 $2,040.00 $1,203.60 2025-04-25
87900 HCPCS Infectious Agent Drug Susceptibility Analysis 3 3 $2,035.00 $1,831.50 $1,020.55 $2,035.00 $1,200.65 2025-04-25
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 3 3 $1,995.00 $1,795.50 $1,000.49 $1,995.00 $1,177.05 2025-04-25
2598894 CDM Filgrastim 480 Mcg/0.8 Ml 2 2 $2,136.96 $1,923.26 $1,071.69 $1,260.81 $1,166.25 2025-04-25
20103 HCPCS Exploration Of Wound Of Arm Or Leg 4 4 $1,250.00 $1,125.00 $450.00 $1,437.50 $1,156.25 2025-04-25
36571 HCPCS Insertion Of Central Venous Tube With Port For Infusion (5 Years Or Older) 7 4 $455.00 $409.50 $386.75 $4,980.00 $1,133.78 2025-04-25
11646 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More… 4 4 $1,185.00 $1,066.50 $300.00 $1,208.70 $1,096.12 2025-04-25
22004 HCPCS Room & Board - Semi-private (two Beds) - General Classification 1 1 $1,000.00 $900.00 $1,000.00 $1,000.00 $1,000.00 2025-04-25
43245 HCPCS Dilation Of Stomach Outlet Using A Flexible Endoscope 3 3 $1,645.00 $1,480.50 $824.97 $1,645.00 $970.55 2025-04-25
2518114 CDM Hypertet 250 Unit/ml Syringe 2 2 $1,744.55 $1,570.10 $874.89 $1,029.28 $952.09 2025-04-25
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 3 3 $1,575.00 $1,417.50 $789.86 $1,575.00 $929.25 2025-04-25
14060 HCPCS Repair Of Wound Of Eyelids, Nose, Ears, Or Lips By Transferring Skin, 10.0 Sq Cm… 7 4 $975.00 $877.50 $300.00 $1,575.00 $929.25 2025-04-25
14040 HCPCS Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, Genitals, Han… 7 4 $900.00 $810.00 $300.00 $1,575.00 $900.00 2025-04-25
11104 HCPCS Punch Biopsy, First Skin Growth 4 4 $965.00 $868.50 $73.39 $984.30 $892.62 2025-04-25
27045 HCPCS Removal Of Growth Of Muscle Of Pelvis And Hip, 5.0 Cm Or More 4 4 $950.00 $855.00 $609.00 $1,092.50 $878.75 2025-04-25
2518399 CDM Daptomycin 500 Mg Vial 2 2 $1,592.64 $1,433.38 $798.71 $939.66 $869.18 2025-04-25
11606 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 4 4 $930.00 $837.00 $263.39 $948.60 $860.25 2025-04-25
76040 HCPCS Operating Room Services - Minor Surgery 3 3 $1,450.00 $1,305.00 $727.18 $1,450.00 $855.50 2025-04-25
11644 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3.1-… 4 4 $899.00 $809.10 $300.00 $916.98 $831.58 2025-04-25
G0121 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual Not Meeting Criteria For … 3 3 $1,365.00 $1,228.50 $684.55 $1,365.00 $805.35 2025-04-25
G0105 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual At High Risk 3 3 $1,365.00 $1,228.50 $684.55 $1,365.00 $805.35 2025-04-25
76030 HCPCS Operating Room Services - Minor Surgery 3 3 $1,350.00 $1,215.00 $677.03 $1,350.00 $796.50 2025-04-25
87507 HCPCS Detection Test By Nucleic Acid For Digestive Tract Pathogen, Multiple Types Or S… 3 3 $1,341.00 $1,206.90 $672.51 $1,341.00 $791.19 2025-04-25
99291 HCPCS Critical Care, First 30-74 Minutes 7 4 $770.00 $693.00 $122.27 $1,330.00 $770.00 2025-04-25
2550424 CDM Combivent Inhaler 4gm 1 Inh Aero.powd 2 2 $1,405.99 $1,265.39 $705.10 $829.53 $767.32 2025-04-25
84125 HCPCS Myositis Ab Panel 3 3 $1,300.00 $1,170.00 $651.95 $1,300.00 $767.00 2025-04-25
11426 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More … 4 4 $800.00 $720.00 $252.71 $816.00 $740.00 2025-04-25
P9035 HCPCS Platelets, Pheresis, Leukocytes Reduced, Each Unit 3 3 $1,215.00 $1,093.50 $609.32 $1,215.00 $716.85 2025-04-25
36589 HCPCS Removal Of Tunneled Central Venous Tube 3 3 $1,205.00 $1,084.50 $604.31 $1,205.00 $710.95 2025-04-25
2507929 CDM Filgrastim 300 Mcg/ml Vial 2 2 $1,266.05 $1,139.45 $634.92 $746.97 $690.94 2025-04-25
12037 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, More Tha… 7 4 $1,075.00 $967.50 $343.53 $1,096.50 $685.00 2025-04-25
11406 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 4 4 $723.00 $650.70 $200.93 $737.46 $668.77 2025-04-25
52001 HCPCS Irrigation And Removal Of Multiple Blood Clots From Bladder And Urethra Using An… 1 1 $660.00 $594.00 $660.00 $660.00 $660.00 2025-04-25
21552 HCPCS Removal Of Growth Of Soft Tissue Under Skin Of Neck Or Front Of Chest, 3.0 Cm Or… 4 4 $700.00 $630.00 $262.70 $805.00 $647.50 2025-04-25
13152 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 2.6-7.5 Cm 7 4 $1,175.00 $1,057.50 $323.47 $1,198.50 $645.00 2025-04-25
13132 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 7 4 $1,485.00 $1,336.50 $250.00 $1,514.70 $645.00 2025-04-25
13121 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 2.6-7.5 Cm 7 4 $964.00 $867.60 $323.47 $983.28 $645.00 2025-04-25
2503473 CDM Linezolid 600 Mg Tablet 2 2 $1,179.15 $1,061.24 $591.34 $695.70 $643.52 2025-04-25
11604 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 3.1-4.0 Cm 4 4 $693.00 $623.70 $194.76 $706.86 $641.02 2025-04-25
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 3 3 $1,080.00 $972.00 $541.62 $1,080.00 $637.20 2025-04-25
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 3 3 $1,080.00 $972.00 $541.62 $1,080.00 $637.20 2025-04-25
71555 HCPCS MRI Scan Of Blood Vessels Of Chest 3 3 $1,080.00 $972.00 $541.62 $1,080.00 $637.20 2025-04-25
72159 HCPCS MRI Scan Of Blood Vessels Of Spinal Canal 3 3 $1,080.00 $972.00 $541.62 $1,080.00 $637.20 2025-04-25
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 3 3 $1,080.00 $972.00 $541.62 $1,080.00 $637.20 2025-04-25
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 3 3 $1,080.00 $972.00 $541.62 $1,080.00 $637.20 2025-04-25
73225 HCPCS MRI Scan Of Blood Vessels Of Arm 3 3 $1,080.00 $972.00 $541.62 $1,080.00 $637.20 2025-04-25
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 3 3 $1,080.00 $972.00 $541.62 $1,080.00 $637.20 2025-04-25
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 3 3 $1,080.00 $972.00 $541.62 $1,080.00 $637.20 2025-04-25
13131 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 7 4 $1,214.00 $1,092.60 $275.78 $1,238.28 $630.00 2025-04-25
12036 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 20.1-30.… 7 4 $930.00 $837.00 $315.95 $948.60 $630.00 2025-04-25
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 6 3 $1,052.50 $947.25 $514.04 $1,080.00 $620.98 2025-04-25
11444 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3… 4 4 $659.00 $593.10 $226.57 $672.18 $609.58 2025-04-25
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 3 3 $1,025.00 $922.50 $514.04 $1,025.00 $604.75 2025-04-25
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 3 3 $1,025.00 $922.50 $514.04 $1,025.00 $604.75 2025-04-25
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 3 3 $1,025.00 $922.50 $514.04 $1,025.00 $604.75 2025-04-25
70553 HCPCS MRI Scan Of Brain Before And After Contrast 3 3 $1,025.00 $922.50 $514.04 $1,025.00 $604.75 2025-04-25
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 3 3 $1,025.00 $922.50 $514.04 $1,025.00 $604.75 2025-04-25
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 3 3 $1,025.00 $922.50 $514.04 $1,025.00 $604.75 2025-04-25
73720 HCPCS MRI Scan Of Leg Before And After Contrast 3 3 $1,025.00 $922.50 $514.04 $1,025.00 $604.75 2025-04-25
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 3 3 $1,025.00 $922.50 $514.04 $1,025.00 $604.75 2025-04-25
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 3 3 $1,025.00 $922.50 $514.04 $1,025.00 $604.75 2025-04-25
21501 HCPCS Drainage Of Deep Abscess Or Blood Accumulation In Soft Tissue Of Neck Or Chest 3 3 $1,000.00 $900.00 $501.50 $1,000.00 $590.00 2025-04-25
36430 HCPCS Transfusion Of Blood Or Blood Products 3 3 $1,000.00 $900.00 $501.50 $1,000.00 $590.00 2025-04-25
73220 HCPCS MRI Scan Of Arm Before And After Contrast 6 3 $1,000.00 $900.00 $488.96 $1,025.00 $590.00 2025-04-25
12035 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 12.6-20.… 7 4 $860.00 $774.00 $290.87 $877.20 $580.00 2025-04-25
12055 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.6-… 7 4 $1,086.00 $977.40 $290.87 $1,107.72 $580.00 2025-04-25
12045 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 12.6-20.0 Cm 7 4 $930.00 $837.00 $250.00 $948.60 $580.00 2025-04-25
11603 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm 4 4 $621.00 $558.90 $177.02 $633.42 $574.42 2025-04-25
12044 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 7.6-12.5 Cm 7 4 $790.00 $711.00 $224.82 $805.80 $565.00 2025-04-25
12054 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6-1… 7 4 $1,245.00 $1,120.50 $240.31 $1,269.90 $565.00 2025-04-25
12034 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 7.6-12.5… 7 4 $990.00 $891.00 $250.00 $1,009.80 $565.00 2025-04-25
11010 HCPCS Removal Of Foreign Material From Skin And Tissue At Open Broken And/or Dislocate… 4 4 $600.00 $540.00 $96.49 $612.00 $555.00 2025-04-25
13151 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 1.1-2.5 Cm 7 4 $980.00 $882.00 $275.83 $999.60 $550.00 2025-04-25
11642 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 1.1-… 4 4 $585.00 $526.50 $202.15 $596.70 $541.12 2025-04-25
12052 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.6-5… 7 4 $956.00 $860.40 $202.42 $975.12 $540.00 2025-04-25
12042 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 2.6-7.5 Cm 7 4 $935.00 $841.50 $250.00 $953.70 $540.00 2025-04-25
12032 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 2.6-7.5 … 7 4 $902.00 $811.80 $250.00 $920.04 $540.00 2025-04-25
28810 HCPCS Amputation Of Toe And Midfoot Bone 4 4 $565.00 $508.50 $379.98 $649.75 $522.62 2025-04-25
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 3 3 $870.00 $783.00 $436.31 $870.00 $513.30 2025-04-25
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 3 3 $870.00 $783.00 $436.31 $870.00 $513.30 2025-04-25
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 3 3 $870.00 $783.00 $436.31 $870.00 $513.30 2025-04-25
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 3 3 $870.00 $783.00 $436.31 $870.00 $513.30 2025-04-25
71270 HCPCS CT Scan Of Chest Before And After Contrast 3 3 $870.00 $783.00 $436.31 $870.00 $513.30 2025-04-25
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 3 3 $870.00 $783.00 $436.31 $870.00 $513.30 2025-04-25
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 3 3 $870.00 $783.00 $436.31 $870.00 $513.30 2025-04-25
76020 HCPCS Operating Room Services - Minor Surgery 3 3 $850.00 $765.00 $426.28 $850.00 $501.50 2025-04-25
45383 HCPCS Colonoscopy Splenic Flx;lesion Forc 4 4 $500.00 $450.00 $425.00 $530.00 $500.00 2025-04-25
2520989 CDM Ciprofloxacin/hydrocortisone 10 Ml Drops.susp 2 2 $913.71 $822.34 $458.23 $539.09 $498.66 2025-04-25
11404 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 3.1-4.0 Cm 7 4 $485.00 $436.50 $162.21 $1,670.00 $494.70 2025-04-25
11602 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 1.1-2.0 Cm 4 4 $530.00 $477.00 $159.77 $540.60 $490.25 2025-04-25
12007 HCPCS Simple Repair Of Surface Wound To Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 4 4 $530.00 $477.00 $220.50 $540.60 $490.25 2025-04-25
45385 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S… 7 4 $455.00 $409.50 $386.75 $1,950.00 $482.30 2025-04-25
72195 HCPCS MRI Scan Of Pelvis Without Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
72126 HCPCS CT Scan Of Upper Spine With Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
71260 HCPCS CT Scan Of Chest With Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
72129 HCPCS CT Scan Of Middle Spine With Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
70336 HCPCS MRI Scan Of Jaw Joint 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
70551 HCPCS MRI Scan Of Brain Without Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
70504 HCPCS MRI Orbits/face/neck Without Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
70487 HCPCS CT Scan Of Face With Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
70460 HCPCS CT Scan Head Or Brain With Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
73701 HCPCS CT Scan Of Leg With Contrast Material 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
82132 HCPCS CT Lumbar Spine With Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
73218 HCPCS MRI Scan Of Arm Without Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
74181 HCPCS MRI Scan Of Abdomen Without Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
73718 HCPCS MRI Scan Of Leg Without Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
73201 HCPCS CT Scan Of Arm With Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 3 3 $815.00 $733.50 $408.72 $815.00 $480.85 2025-04-25
28190 HCPCS Removal Of Foreign Body Of Foot Tissue, Accessed Beneath The Skin 4 4 $515.00 $463.50 $180.35 $592.25 $476.38 2025-04-25
12015 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6… 7 4 $735.00 $661.50 $199.57 $749.70 $475.00 2025-04-25
2590149 CDM Epipen 2-pak 0.3 Mg Auto-injct 2 2 $866.50 $779.85 $434.55 $511.24 $472.89 2025-04-25
92612 HCPCS Evaluation And Recording Of Swallowing Using An Endoscope 3 3 $790.00 $711.00 $396.19 $790.00 $466.10 2025-04-25
11443 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2… 4 4 $502.00 $451.80 $177.11 $512.04 $464.35 2025-04-25
99306 HCPCS Initial Nursing Facility Care With High Level Of Medical Decision Making, Per Da… 4 4 $520.00 $468.00 $109.73 $520.00 $455.00 2025-04-25
72191 HCPCS CT Scan Of Blood Vessels Of Pelvis With Contrast 3 3 $765.00 $688.50 $383.65 $765.00 $451.35 2025-04-25
72131 HCPCS CT Scan Of Lower Spine Without Contrast 3 3 $765.00 $688.50 $383.65 $765.00 $451.35 2025-04-25
72128 HCPCS CT Scan Of Middle Spine Without Contrast 3 3 $765.00 $688.50 $383.65 $765.00 $451.35 2025-04-25
72125 HCPCS CT Scan Of Upper Spine Without Contrast 3 3 $765.00 $688.50 $383.65 $765.00 $451.35 2025-04-25
71250 HCPCS CT Scan Of Chest Without Contrast 3 3 $765.00 $688.50 $383.65 $765.00 $451.35 2025-04-25
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 3 3 $765.00 $688.50 $383.65 $765.00 $451.35 2025-04-25
70486 HCPCS CT Scan Of Face Without Contrast 3 3 $765.00 $688.50 $383.65 $765.00 $451.35 2025-04-25
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 3 3 $765.00 $688.50 $383.65 $765.00 $451.35 2025-04-25
70450 HCPCS CT Scan Head Or Brain Without Contrast 3 3 $765.00 $688.50 $383.65 $765.00 $451.35 2025-04-25
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 3 3 $765.00 $688.50 $383.65 $765.00 $451.35 2025-04-25
74150 HCPCS CT Scan Of Abdomen Without Contrast 3 3 $765.00 $688.50 $383.65 $765.00 $451.35 2025-04-25
73700 HCPCS CT Scan Of Leg Without Contrast 3 3 $765.00 $688.50 $383.65 $765.00 $451.35 2025-04-25
73200 HCPCS CT Scan Of Arm Without Contrast 3 3 $765.00 $688.50 $383.65 $765.00 $451.35 2025-04-25
2513294 CDM Mometasone Furoate Nasal 17 Gm Naspr 2 2 $825.09 $742.58 $413.78 $486.80 $450.29 2025-04-25
11601 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 0.6-1.0 Cm 4 4 $485.00 $436.50 $150.75 $494.70 $448.62 2025-04-25
2509834 CDM Calcitonin-salmon 200 Unit Spr 2 2 $816.56 $734.90 $409.50 $481.77 $445.63 2025-04-25
12031 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 2.5 Cm O… 7 4 $910.00 $819.00 $154.58 $928.20 $445.00 2025-04-25
12051 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 C… 7 4 $808.00 $727.20 $194.14 $824.16 $445.00 2025-04-25
12041 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 2.5 Cm Or Less 7 4 $735.00 $661.50 $167.70 $749.70 $445.00 2025-04-25
12016 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.… 4 4 $481.00 $432.90 $237.05 $490.62 $444.93 2025-04-25
25248 HCPCS Removal Of Deep Foreign Body In Forearm Or Wrist 4 4 $455.00 $409.50 $386.75 $523.25 $440.61 2025-04-25
27603 HCPCS Drainage Of Deep Abscess Or Blood Accumulation Of Leg Or Ankle 4 4 $445.00 $400.50 $378.25 $511.75 $435.52 2025-04-25
12013 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.6… 7 4 $625.00 $562.50 $133.62 $637.50 $435.00 2025-04-25
11640 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 0.5 … 4 4 $470.00 $423.00 $133.02 $479.40 $434.75 2025-04-25
75574 HCPCS CT Scan Of Blood Vessels And Grafts Of Heart With Contrast 3 3 $735.00 $661.50 $368.60 $735.00 $433.65 2025-04-25
2714725 CDM Brace - Back Flex/elas/rigid 2 2 $788.00 $709.20 $395.18 $464.92 $430.05 2025-04-25
45384 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using A Flexible Endoscope With Elec… 7 4 $400.00 $360.00 $340.00 $1,735.00 $424.00 2025-04-25
P9016 HCPCS Red Blood Cells, Leukocytes Reduced, Each Unit 3 3 $715.00 $643.50 $358.57 $715.00 $421.85 2025-04-25
12002 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 4 4 $455.00 $409.50 $122.62 $464.10 $420.88 2025-04-25
11423 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 2.1-3… 4 4 $452.00 $406.80 $156.47 $461.04 $418.10 2025-04-25
2513840 CDM Salmeterol Xinaf/fluticasone 500/50 1 Ea Disk 2 2 $762.34 $686.11 $382.31 $449.78 $416.04 2025-04-25
30903 HCPCS Complex Control Of Nose Bleed 7 4 $415.00 $373.50 $142.21 $775.00 $415.00 2025-04-25
2515530 CDM Spiriva Handihaler 18 Mcg Cap 2 2 $749.81 $674.83 $376.03 $442.39 $409.21 2025-04-25
2518867 CDM Darbepoetin Alfa In Polysorbat 25 Mcg/ml Ml 2 2 $744.66 $670.19 $373.45 $439.35 $406.40 2025-04-25
87902 HCPCS Analysis Test By Nucleic Acid For Hepatitis C Virus 3 3 $683.00 $614.70 $342.52 $683.00 $402.97 2025-04-25
45380 HCPCS Biopsy Of Large Bowel Using A Flexible Endoscope 7 4 $380.00 $342.00 $225.00 $1,840.00 $402.80 2025-04-25
11403 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm 4 4 $425.00 $382.50 $142.05 $433.50 $393.12 2025-04-25
11422 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 1.1-2… 7 4 $385.00 $346.50 $131.79 $1,810.00 $392.70 2025-04-25
77075 HCPCS Complete X-ray Of Body Bones 3 3 $659.00 $593.10 $330.49 $659.00 $388.81 2025-04-25
17272 HCPCS Destruction Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 1.1-… 4 4 $410.00 $369.00 $300.00 $418.20 $379.25 2025-04-25
12014 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1… 7 4 $446.00 $401.40 $158.56 $460.00 $379.10 2025-04-25
11442 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 1… 4 4 $409.00 $368.10 $225.00 $417.18 $378.32 2025-04-25
16030 HCPCS Dressing Change Or Removal Of Burn Tissue, More Than 10% Of Total Body Surface 7 4 $445.00 $400.50 $243.23 $485.00 $378.25 2025-04-25
2520841 CDM Ferric Subsulfate 8 Ml Sol.w.appl 2 2 $693.00 $623.70 $347.54 $408.87 $378.21 2025-04-25
J1670 HCPCS Injection, Tetanus Immune Globulin, Human, Up To 250 Units 4 4 $375.97 $338.37 $319.57 $572.07 $375.97 2025-04-25
84445 HCPCS Thyroid Stimulating Immune Globulins (thyroid Related Protein) Level 3 3 $625.00 $562.50 $313.44 $625.00 $368.75 2025-04-25
93931 HCPCS Ultrasound Of One Arm Arteries Or Artery Grafts 3 3 $625.00 $562.50 $313.44 $625.00 $368.75 2025-04-25
93976 HCPCS Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 3 3 $625.00 $562.50 $313.44 $625.00 $368.75 2025-04-25
93975 HCPCS Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 3 3 $625.00 $562.50 $313.44 $625.00 $368.75 2025-04-25
93926 HCPCS Ultrasound Of One Leg Arteries Or Artery Grafts 3 3 $625.00 $562.50 $313.44 $625.00 $368.75 2025-04-25
76536 HCPCS Ultrasound Scan Of Head And Neck Soft Tissue 3 3 $625.00 $562.50 $313.44 $625.00 $368.75 2025-04-25
93922 HCPCS Ultrasound Study Of Arm And Leg Arteries 3 3 $625.00 $562.50 $313.44 $625.00 $368.75 2025-04-25
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 3 3 $625.00 $562.50 $313.44 $625.00 $368.75 2025-04-25
93930 HCPCS Ultrasound Of Arm Arteries Or Artery Grafts 3 3 $625.00 $562.50 $313.44 $625.00 $368.75 2025-04-25
93970 HCPCS Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 3 3 $625.00 $562.50 $313.44 $625.00 $368.75 2025-04-25
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 3 3 $625.00 $562.50 $313.44 $625.00 $368.75 2025-04-25
93971 HCPCS Ultrasound Study Of One Arm Or Leg Veins With Compression And Maneuvers 3 3 $625.00 $562.50 $313.44 $625.00 $368.75 2025-04-25
12006 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 10 4 $525.00 $472.50 $220.50 $580.00 $361.50 2025-04-25
99223 HCPCS Initial Hospital Inpatient Or Observation Care With High Level Of Medical Decisi… 7 4 $346.50 $311.85 $140.93 $648.90 $356.90 2025-04-25
19020 HCPCS Drainage Of Abscess Of Breast 4 4 $370.00 $333.00 $314.50 $377.40 $352.13 2025-04-25
12053 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1-7… 7 4 $765.00 $688.50 $175.53 $780.30 $350.00 2025-04-25
99305 HCPCS Initial Nursing Facility Care With Moderate Level Of Medical Decision Making, Pe… 4 4 $400.00 $360.00 $80.23 $400.00 $350.00 2025-04-25
11765 HCPCS Removal Of Skin Of Fingernail Or Toenail 4 4 $375.00 $337.50 $200.00 $382.50 $346.88 2025-04-25
20520 HCPCS Removal Of Foreign Body In Muscle Or Tendon 4 4 $373.50 $336.15 $300.00 $429.53 $345.49 2025-04-25
11441 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 0… 4 4 $373.00 $335.70 $128.22 $380.46 $345.02 2025-04-25
16025 HCPCS Dressing Change Or Removal Of Burn Tissue, 5-10% Of Total Body Surface 4 4 $370.00 $333.00 $165.90 $377.40 $342.25 2025-04-25
12011 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5… 7 4 $423.00 $380.70 $60.00 $431.46 $340.00 2025-04-25
45378 HCPCS Diagnostic Exam Of Large Bowel Using A Flexible Endoscope 7 4 $315.00 $283.50 $267.75 $1,735.00 $333.90 2025-04-25
99236 HCPCS Hospital Inpatient Or Observation Care With Admission And Discharge On The Same … 4 4 $360.00 $324.00 $149.16 $370.80 $333.00 2025-04-25
11402 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 1.1-2.0 Cm 4 4 $355.00 $319.50 $125.85 $362.10 $328.38 2025-04-25
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 7 4 $325.00 $292.50 $90.35 $630.00 $325.00 2025-04-25
11042 HCPCS Removal Of Skin And Tissue, 20.0 Sq Cm Or Less 4 4 $350.00 $315.00 $76.21 $357.00 $323.75 2025-04-25
12005 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 7 4 $375.00 $337.50 $179.58 $475.00 $318.75 2025-04-25
11421 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 0.6-1… 4 4 $342.00 $307.80 $117.71 $348.84 $316.35 2025-04-25
2597906 CDM Prevnar 13 Syringe 2 2 $571.54 $514.39 $286.63 $337.21 $311.92 2025-04-25
2590156 CDM Epipen Jr 2-pak 0.15 Mg Injctr 2 2 $562.63 $506.37 $282.16 $331.95 $307.06 2025-04-25
29105 HCPCS Application Of Lower And Upper Arm Splint 7 4 $372.00 $334.80 $71.95 $427.80 $300.00 2025-04-25
2510568 CDM Glucagon 1 Mg Emergency Kit 2 2 $549.60 $494.64 $275.62 $324.26 $299.94 2025-04-25
29065 HCPCS Application Of Shoulder To Hand Cast 7 4 $298.00 $268.20 $200.00 $565.00 $298.00 2025-04-25
2540276 CDM Latanoprost 2.5 Ml Drops 2 2 $545.16 $490.64 $273.40 $321.64 $297.52 2025-04-25
92950 HCPCS Manual Attempt To Restore Blood Circulation And Breathing 7 4 $350.00 $315.00 $203.11 $434.00 $297.50 2025-04-25
99245 HCPCS Office Or Other Outpatient Consultation With High Level Of Medical Decision Maki… 4 4 $320.00 $288.00 $151.44 $329.60 $296.00 2025-04-25
11401 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 0.6-1.0 Cm 4 4 $320.00 $288.00 $109.93 $326.40 $296.00 2025-04-25
25111 HCPCS Removal Of First Cyst Of Wrist 4 4 $310.00 $279.00 $263.50 $356.50 $294.53 2025-04-25
2515040 CDM Fluticasone/salmeterol 250/50 2 2 $539.45 $485.51 $270.53 $318.28 $294.40 2025-04-25
2507754 CDM Sumatriptan Succinate 6 Mg/0.5 Ml Vial 2 2 $536.38 $482.74 $268.99 $316.46 $292.73 2025-04-25
99221 HCPCS Initial Hospital Care With Straightforward Or Low Level Of Medical Decision Maki… 4 4 $315.00 $283.50 $60.97 $324.45 $291.38 2025-04-25
12020 HCPCS Simple Closure Of Surface Wound Reopening 7 4 $917.00 $825.30 $145.44 $935.34 $290.00 2025-04-25
12021 HCPCS Repair Of Separation Of Wound Closure With Insertion Of Packing 7 4 $425.00 $382.50 $145.44 $433.50 $290.00 2025-04-25
2581594 CDM Teflaro 600 Mg Vial 2 2 $530.67 $477.60 $266.13 $313.10 $289.62 2025-04-25
11312 HCPCS Shaving Of Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 1.1-2.0 Cm 4 4 $311.00 $279.90 $91.56 $317.22 $287.68 2025-04-25
62270 HCPCS Removal Of Cerebrospinal Fluid With Lower Back Spinal Tap For Diagnostic Test 4 4 $310.00 $279.00 $130.75 $365.80 $286.75 2025-04-25
43239 HCPCS Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop… 7 4 $245.00 $220.50 $208.25 $1,575.00 $284.80 2025-04-25
2590065 CDM Lovenox 150 Mg/ml Syringe 2 2 $521.72 $469.55 $261.64 $307.81 $284.73 2025-04-25
56405 HCPCS Incision And Drainage Of Abscess Of External Female Genitals 4 4 $307.00 $276.30 $96.48 $353.05 $283.98 2025-04-25
29075 HCPCS Application Of Elbow To Finger Cast 7 4 $275.00 $247.50 $69.61 $565.00 $283.35 2025-04-25
81256 HCPCS Gene Analysis (hemochromatosis) Common Variants 3 3 $480.00 $432.00 $240.72 $480.00 $283.20 2025-04-25
88309 HCPCS Pathology Examination Of Tissue Using A Microscope, High Complexity 3 3 $477.00 $429.30 $239.22 $477.00 $281.43 2025-04-25
43235 HCPCS Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible… 7 4 $265.00 $238.50 $225.00 $1,470.00 $280.90 2025-04-25
12018 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, Mor… 7 4 $275.00 $247.50 $233.75 $580.00 $280.50 2025-04-25
29405 HCPCS Application Of Short Leg Cast 7 4 $330.00 $297.00 $71.81 $379.50 $280.50 2025-04-25
93015 HCPCS Exercise Or Drug-induced Heart Stress Test With Electrocardiogram (ecg) With Sup… 3 3 $475.00 $427.50 $238.21 $475.00 $280.25 2025-04-25
19101 HCPCS Biopsy Of Breast Through Incision 4 4 $275.00 $247.50 $233.75 $450.00 $277.75 2025-04-25
11440 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 0… 4 4 $300.00 $270.00 $108.06 $306.00 $277.50 2025-04-25
12001 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 10 4 $351.00 $315.90 $115.26 $435.00 $277.50 2025-04-25
11450 HCPCS Removal Of Skin And Tissue Of Underarms For Inflamed Sweat Glands With Simple Or… 4 4 $275.00 $247.50 $233.75 $280.50 $268.25 2025-04-25
2523090 CDM Acyclovir 5% Ointment 2 2 $491.32 $442.19 $246.40 $289.88 $268.14 2025-04-25
11420 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 0.5 C… 4 4 $283.75 $255.38 $91.83 $289.43 $262.47 2025-04-25
2500470 CDM Neomyc-polym-dexameth Eye Drop 2 2 $480.69 $432.62 $241.07 $283.61 $262.34 2025-04-25
2522241 CDM Fluocinonide 0.05% Ointment 2 2 $475.44 $427.90 $238.43 $280.51 $259.47 2025-04-25
2515766 CDM Neomycin-poly-hc Eye Drops 2 2 $475.36 $427.82 $238.39 $280.46 $259.42 2025-04-25
99284 HCPCS Emergency Department Visit With Moderate Level Of Medical Decision Making 10 4 $440.00 $396.00 $143.48 $475.00 $259.23 2025-04-25
99235 HCPCS Hospital Inpatient Or Observation Care With Admission And Discharge On The Same … 4 4 $280.00 $252.00 $115.51 $288.40 $259.00 2025-04-25
10061 HCPCS Complicated Or Multiple Drainage Of Skin Abscess 4 4 $280.00 $252.00 $148.21 $285.60 $259.00 2025-04-25
30901 HCPCS Simple Control Of Nose Bleed 10 4 $275.00 $247.50 $91.35 $640.00 $254.38 2025-04-25
99304 HCPCS Initial Nursing Facility Care With Straightforward Or Low Level Of Medical Decis… 4 4 $290.00 $261.00 $58.87 $290.00 $253.75 2025-04-25
G0438 HCPCS Annual Wellness Visit; Includes A Personalized Prevention Plan Of Service (pps),… 3 3 $295.00 $265.50 $147.50 $295.00 $250.75 2025-04-25
G0402 HCPCS Initial Preventive Physical Examination; Face-to-face Visit, Services Limited To… 3 3 $295.00 $265.50 $147.50 $295.00 $250.75 2025-04-25
13120 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 1.1-2.5 Cm 7 4 $815.00 $733.50 $122.87 $831.30 $250.00 2025-04-25
99205 HCPCS New Patient Office Or Other Outpatient Visit With A High Level Of Medical Decisi… 4 4 $270.00 $243.00 $153.38 $278.10 $249.75 2025-04-25
17111 HCPCS Destruction Of Skin Growth, 15 Or More Growths 4 4 $269.00 $242.10 $85.60 $274.38 $248.82 2025-04-25
12004 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 7 4 $420.00 $378.00 $122.87 $428.40 $245.00 2025-04-25
13100 HCPCS Complicated Repair Of Wound Of Trunk, 1.1-2.5 Cm 7 4 $754.00 $678.60 $122.87 $769.08 $245.00 2025-04-25
2501857 CDM Advair 100-50 Diskus 2 2 $442.30 $398.07 $221.81 $260.96 $241.38 2025-04-25
99244 HCPCS Office Or Other Outpatient Consultation With Moderate Level Of Medical Decision … 4 4 $260.00 $234.00 $120.56 $267.80 $240.50 2025-04-25
29125 HCPCS Application Of Nonmoveable Forearm To Hand Splint 7 4 $280.00 $252.00 $54.28 $322.00 $238.00 2025-04-25
11301 HCPCS Shaving Of Skin Growth Of Body, Arms, Or Legs, 0.6-1.0 Cm 4 4 $257.00 $231.30 $71.40 $262.14 $237.72 2025-04-25
99309 HCPCS Subsequent Nursing Facility Care With Moderate Level Of Medical Decision Making,… 4 4 $270.00 $243.00 $70.95 $270.00 $236.25 2025-04-25
64550 HCPCS Appl Surface Neurostimulator 6 3 $400.00 $360.00 $198.09 $405.00 $236.00 2025-04-25
11400 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 0.5 Cm Or Less 4 4 $245.00 $220.50 $208.25 $249.90 $235.00 2025-04-25
96003 HCPCS Dynamic Fine Wire Electromyography, During Walking Or Other Functional Activitie… 3 3 $394.00 $354.60 $197.59 $394.00 $232.46 2025-04-25
88644 HCPCS Immunocytochemistry, Each Antibody 3 3 $394.00 $354.60 $197.59 $394.00 $232.46 2025-04-25
88342 HCPCS Special Stained Specimen Slides To Examine Tissue, Initial Procedure 3 3 $394.00 $354.60 $197.59 $394.00 $232.46 2025-04-25
99343 HCPCS Home Visit For The Evaluation And Management Of A New Patient, Which Requires Th… 4 4 $250.00 $225.00 $99.69 $257.50 $231.25 2025-04-25
72114 HCPCS X-ray Lower And Sacral Spine, Minimum Of 6 Views 3 3 $389.00 $350.10 $195.08 $389.00 $229.51 2025-04-25
12017 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 20.… 7 4 $225.00 $202.50 $191.25 $555.00 $229.50 2025-04-25
88341 HCPCS Special Stained Specimen Slides To Examine Tissue, Each Additional Procedure 3 3 $384.00 $345.60 $192.58 $384.00 $226.56 2025-04-25
20610 HCPCS Aspiration And/or Injection Of Fluid From Large Joint 7 4 $153.00 $137.70 $130.05 $545.00 $225.00 2025-04-25
11730 HCPCS Simple Separation Of Fingernail Or Toenail From Nail Bed, First Nail 4 4 $243.00 $218.70 $75.46 $247.86 $224.78 2025-04-25
76080 HCPCS Review By Radiologist Of Abscess Or Sinus Cavity Study 3 3 $373.00 $335.70 $187.06 $373.00 $220.07 2025-04-25
2589976 CDM Albuked-25 Vial 2 2 $403.20 $362.88 $202.20 $237.89 $220.04 2025-04-25
99234 HCPCS Hospital Inpatient Or Observation Care With Admission And Discharge On The Same … 7 4 $235.00 $211.50 $90.15 $242.05 $220.00 2025-04-25
9931S OTHER Phys Nursing Fac Dc 30 Mins < 4 4 $220.00 $198.00 $187.00 $272.80 $220.00 2025-04-25
69100 HCPCS Biopsy Of Ear 4 4 $205.00 $184.50 $174.25 $350.00 $219.35 2025-04-25
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