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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

STANTON COUNTY HOSPITAL

Johnson, KS · CCN 171343 · Rates published

3,170 distinct procedures filed
9 distinct payers
15,715 rate rows
2026-08-07 last MRF observed
Data quality

15,511 of 15,715 rate rows are consumer-grade (98.7%)

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

Excluded — reasonRows
exceeds 10× this hospital's gross charge — excluded from medians 158
per-diem day rate — not a per-procedure price 30
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 12
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=dbSCHJOHNSONKS&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/Stanton_County.aspx
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-12
Content fingerprint 3448fc54ad380608… · 5,736,758 bytes · first seen 2026-08-11

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
03060702
CDM 		Ivpb Crotalidae/ns : 4 Gm/250 Ml 3 $14,349.60 $15,625.12 $15,156.37 —
03065855
CDM 		Lupron Depot 45 Mg 6 Month Kit 3 $11,479.81 $12,500.23 $12,125.23 —
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 6 $187.12 $7,741.65 $7,163.35 nat. median
$498
outlier · 14.4×
03066132
CDM 		Uzedy ER 200 Mg/0.56 Ml Syring 3 $5,766.30 $6,278.86 $6,090.49 —
J2997
HCPCS 		Injection, Alteplase Recombinant, 1 Mg 6 $107.24 $5,720.24 $5,292.94 nat. median
$428
outlier · 12.4×
03066342
CDM 		Tezspire 210 Mg/1.91 Ml Syring 3 $4,088.93 $4,452.39 $4,318.82 —
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 4 $3,685.50 $4,095.00 $3,952.90 nat. median
$916
outlier · 4.3×
95811
HCPCS 		Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 6 $1,003.64 $4,200.00 $3,886.26 nat. median
$1,412
outlier · 2.8×
95810
HCPCS 		Sleep Study In Sleep Lab (6 Years Or Older) 6 $1,003.64 $3,990.00 $3,691.94 nat. median
$1,446
outlier · 2.6×
95805
HCPCS 		Sleep Study, Multiple Trials 6 $1,003.64 $3,990.00 $3,691.94 nat. median
$1,061
outlier · 3.5×
J0840
HCPCS 		Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 6 $2,314.35 $3,982.00 $3,684.55 nat. median
$3,496
1.1× median
03099996
CDM 		Scopolamine 1 Mg/3 Day Patch 3 $3,447.63 $3,754.09 $3,641.46 —
J2182
HCPCS 		Injection, Mepolizumab, 1 Mg 6 $37.00 $3,895.00 $3,604.05 nat. median
$80
outlier · 45.2×
03066156
CDM 		Aranesp 300 Mcg/0.6 Ml Syringe 3 $3,260.70 $3,550.54 $3,444.02 —
03066197
CDM 		Aranesp 300 Mcg/0.6 Ml Syringe 3 $3,260.70 $3,550.54 $3,444.02 —
J0882
HCPCS 		Injection, Darbepoetin Alfa, 1 Microgram (for Esrd On Dialysis) 6 $3.58 $3,019.00 $2,793.48 nat. median
$6
outlier · 453.9×
03065864
CDM 		Dalvance 500 Mg Vial 3 $2,471.00 $2,690.65 $2,609.93 —
72158
HCPCS 		MRI Scan Of Lower Spinal Canal Before And After Contrast 6 $524.89 $2,625.00 $2,428.91 nat. median
$616
outlier · 3.9×
73723
HCPCS 		MRI Scan Of Leg Joint Before And After Contrast 6 $524.89 $2,625.00 $2,428.91 nat. median
$756
outlier · 3.2×
73720
HCPCS 		MRI Scan Of Leg Before And After Contrast 6 $524.89 $2,625.00 $2,428.91 nat. median
$754
outlier · 3.2×
73223
HCPCS 		MRI Scan Of Arm Joint Before And After Contrast 6 $524.89 $2,625.00 $2,428.91 nat. median
$757
outlier · 3.2×
72156
HCPCS 		MRI Scan Of Upper Spinal Canal Before And After Contrast 6 $524.89 $2,625.00 $2,428.91 nat. median
$625
outlier · 3.9×
26952
HCPCS 		Amputation Of Finger Or Thumb With Tissue Flap 6 $1,990.00 $2,625.00 $2,428.91 nat. median
$3,254
0.7× median
71552
HCPCS 		MRI Scan Of Chest Before And After Contrast 6 $524.89 $2,625.00 $2,428.91 nat. median
$691
outlier · 3.5×
73220
HCPCS 		MRI Scan Of Arm Before And After Contrast 6 $524.89 $2,625.00 $2,428.91 nat. median
$737
outlier · 3.3×
74183
HCPCS 		MRI Scan Of Abdomen Before And After Contrast 6 $524.89 $2,625.00 $2,428.91 nat. median
$611
outlier · 4.0×
70553
HCPCS 		MRI Scan Of Brain Before And After Contrast 6 $524.89 $2,625.00 $2,428.91 nat. median
$616
outlier · 3.9×
72197
HCPCS 		MRI Scan Of Pelvis Before And After Contrast 6 $524.89 $2,625.00 $2,428.91 nat. median
$606
outlier · 4.0×
70549
HCPCS 		MRI Scan Of Blood Vessels Of Neck Before And After Contrast 6 $631.68 $2,625.00 $2,428.91 nat. median
$606
outlier · 4.0×
72157
HCPCS 		MRI Scan Of Middle Spinal Canal Before And After Contrast 6 $524.89 $2,625.00 $2,428.91 nat. median
$624
outlier · 3.9×
70543
HCPCS 		MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 6 $524.89 $2,625.00 $2,428.91 nat. median
$605
outlier · 4.0×
00100020
CDM 		Room & Board - Semi-private (two Beds) - Obstetrics (ob) 2 $2,250.00 $2,500.00 $2,375.00 —
10
CDM 		Room & Board - Semi-private (two Beds) - Obstetrics (ob) 2 $2,250.00 $2,500.00 $2,375.00 nat. median
$1,173
outlier · 2.0×
62321
HCPCS 		Injection Of Substance Into Middle Or Upper Spine Canal Using Imaging Guidance 6 $1,084.71 $2,499.00 $2,312.32 nat. median
$885
outlier · 2.6×
74178
HCPCS 		CT Scan Of Abdomen And Pelvis Before And After Contrast 6 $456.39 $2,467.50 $2,283.18 nat. median
$539
outlier · 4.2×
70552
HCPCS 		MRI Scan Of Brain With Contrast 6 $524.89 $2,467.50 $2,283.18 nat. median
$597
outlier · 3.8×
64484
HCPCS 		Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 6 $894.25 $2,446.50 $2,263.74 nat. median
$608
outlier · 3.7×
73722
HCPCS 		MRI Scan Of Leg Joint With Contrast 6 $524.89 $2,415.00 $2,234.60 nat. median
$1,003
outlier · 2.2×
72196
HCPCS 		MRI Scan Of Pelvis With Contrast 6 $524.89 $2,415.00 $2,234.60 nat. median
$562
outlier · 4.0×
73719
HCPCS 		MRI Scan Of Leg With Contrast 6 $524.89 $2,415.00 $2,234.60 nat. median
$575
outlier · 3.9×
72147
HCPCS 		MRI Scan Of Middle Spinal Canal With Contrast 6 $524.89 $2,415.00 $2,234.60 nat. median
$576
outlier · 3.9×
72149
HCPCS 		MRI Scan Of Lower Spinal Canal With Contrast 6 $524.89 $2,415.00 $2,234.60 nat. median
$549
outlier · 4.1×
73222
HCPCS 		MRI Scan Of Arm Joint With Contrast 6 $524.89 $2,415.00 $2,234.60 nat. median
$1,026
outlier · 2.2×
74182
HCPCS 		MRI Scan Of Abdomen With Contrast 6 $524.89 $2,415.00 $2,234.60 nat. median
$580
outlier · 3.9×
72142
HCPCS 		MRI Scan Of Upper Spinal Canal With Contrast 6 $524.89 $2,415.00 $2,234.60 nat. median
$541
outlier · 4.1×
73219
HCPCS 		MRI Scan Of Arm With Contrast 6 $524.89 $2,415.00 $2,234.60 nat. median
$622
outlier · 3.6×
70546
HCPCS 		MRI Scan Of Blood Vessels Of Head Before And After Contrast 6 $631.68 $2,399.25 $2,220.03 nat. median
$625
outlier · 3.6×
73225
HCPCS 		MRI Scan Of Blood Vessels Of Arm 6 $631.68 $2,383.50 $2,205.45 nat. median
$943
outlier · 2.3×
71275
HCPCS 		CT Scan Of Blood Vessels Of Chest With Contrast 6 $1,086.66 $2,378.25 $2,200.60 nat. median
$365
outlier · 6.0×
72133
HCPCS 		CT Scan Of Lower Spine Before And After Contrast 6 $456.39 $2,362.50 $2,186.02 nat. median
$346
outlier · 6.3×

Other procedures at this hospital

Browse this hospital's 3,170 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
             
03060702 CDM Ivpb Crotalidae/ns : 4 Gm/250 Ml 3 3 $15,944.00 $15,944.00 $14,349.60 $15,625.12 $15,156.37 2026-08-07
03065855 CDM Lupron Depot 45 Mg 6 Month Kit 3 3 $12,755.34 $12,755.34 $11,479.81 $12,500.23 $12,125.23 2026-08-07
J3101 HCPCS Injection, Tenecteplase, 1 Mg 6 6 $7,741.65 $7,741.65 $187.12 $7,741.65 $7,163.35 2026-08-07
03066132 CDM Uzedy ER 200 Mg/0.56 Ml Syring 3 3 $6,407.00 $6,407.00 $5,766.30 $6,278.86 $6,090.49 2026-08-07
J2997 HCPCS Injection, Alteplase Recombinant, 1 Mg 6 6 $5,720.24 $5,720.24 $107.24 $5,720.24 $5,292.94 2026-08-07
03066342 CDM Tezspire 210 Mg/1.91 Ml Syring 3 3 $4,543.26 $4,543.26 $4,088.93 $4,452.39 $4,318.82 2026-08-07
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 4 4 $4,095.00 $4,095.00 $3,685.50 $4,095.00 $3,952.90 2026-08-07
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 6 6 $4,200.00 $4,200.00 $1,003.64 $4,200.00 $3,886.26 2026-08-07
95805 HCPCS Sleep Study, Multiple Trials 6 6 $3,990.00 $3,990.00 $1,003.64 $3,990.00 $3,691.94 2026-08-07
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 6 6 $3,990.00 $3,990.00 $1,003.64 $3,990.00 $3,691.94 2026-08-07
J0840 HCPCS Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 6 6 $3,982.00 $3,982.00 $2,314.35 $3,982.00 $3,684.55 2026-08-07
03099996 CDM Scopolamine 1 Mg/3 Day Patch 3 3 $3,830.70 $3,830.70 $3,447.63 $3,754.09 $3,641.46 2026-08-07
J2182 HCPCS Injection, Mepolizumab, 1 Mg 6 6 $3,895.00 $3,895.00 $37.00 $3,895.00 $3,604.05 2026-08-07
03066156 CDM Aranesp 300 Mcg/0.6 Ml Syringe 3 3 $3,623.00 $3,623.00 $3,260.70 $3,550.54 $3,444.02 2026-08-07
03066197 CDM Aranesp 300 Mcg/0.6 Ml Syringe 3 3 $3,623.00 $3,623.00 $3,260.70 $3,550.54 $3,444.02 2026-08-07
J0882 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (for Esrd On Dialysis) 6 6 $3,019.00 $3,019.00 $3.58 $3,019.00 $2,793.48 2026-08-07
03065864 CDM Dalvance 500 Mg Vial 3 3 $2,745.56 $2,745.56 $2,471.00 $2,690.65 $2,609.93 2026-08-07
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 12 6 $2,625.00 $2,625.00 $524.89 $2,625.00 $2,428.91 2026-08-07
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 6 6 $2,625.00 $2,625.00 $631.68 $2,625.00 $2,428.91 2026-08-07
26952 HCPCS Amputation Of Finger Or Thumb With Tissue Flap 6 6 $2,625.00 $2,625.00 $1,990.00 $2,625.00 $2,428.91 2026-08-07
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 6 6 $2,625.00 $2,625.00 $524.89 $2,625.00 $2,428.91 2026-08-07
71552 HCPCS MRI Scan Of Chest Before And After Contrast 6 6 $2,625.00 $2,625.00 $524.89 $2,625.00 $2,428.91 2026-08-07
73220 HCPCS MRI Scan Of Arm Before And After Contrast 12 6 $2,625.00 $2,625.00 $524.89 $2,625.00 $2,428.91 2026-08-07
70553 HCPCS MRI Scan Of Brain Before And After Contrast 6 6 $2,625.00 $2,625.00 $524.89 $2,625.00 $2,428.91 2026-08-07
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 6 6 $2,625.00 $2,625.00 $524.89 $2,625.00 $2,428.91 2026-08-07
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 6 6 $2,625.00 $2,625.00 $524.89 $2,625.00 $2,428.91 2026-08-07
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 12 6 $2,625.00 $2,625.00 $524.89 $2,625.00 $2,428.91 2026-08-07
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 6 6 $2,625.00 $2,625.00 $524.89 $2,625.00 $2,428.91 2026-08-07
73720 HCPCS MRI Scan Of Leg Before And After Contrast 12 6 $2,625.00 $2,625.00 $524.89 $2,625.00 $2,428.91 2026-08-07
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 6 6 $2,625.00 $2,625.00 $524.89 $2,625.00 $2,428.91 2026-08-07
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 6 6 $2,625.00 $2,625.00 $524.89 $2,625.00 $2,428.91 2026-08-07
00100020 CDM Room & Board - Semi-private (two Beds) - Obstetrics (ob) 2 2 $2,500.00 $2,500.00 $2,250.00 $2,500.00 $2,375.00 2026-08-07
10 CDM Room & Board - Semi-private (two Beds) - Obstetrics (ob) 2 2 $2,500.00 $2,500.00 $2,250.00 $2,500.00 $2,375.00 2026-08-07
62321 HCPCS Injection Of Substance Into Middle Or Upper Spine Canal Using Imaging Guidance 6 6 $2,499.00 $2,499.00 $1,084.71 $2,499.00 $2,312.32 2026-08-07
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 6 6 $2,467.50 $2,467.50 $456.39 $2,467.50 $2,283.18 2026-08-07
70552 HCPCS MRI Scan Of Brain With Contrast 6 6 $2,467.50 $2,467.50 $524.89 $2,467.50 $2,283.18 2026-08-07
64484 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 6 6 $2,446.50 $2,446.50 $894.25 $2,446.50 $2,263.74 2026-08-07
73719 HCPCS MRI Scan Of Leg With Contrast 12 6 $2,415.00 $2,415.00 $524.89 $2,415.00 $2,234.60 2026-08-07
73722 HCPCS MRI Scan Of Leg Joint With Contrast 12 6 $2,415.00 $2,415.00 $524.89 $2,415.00 $2,234.60 2026-08-07
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 6 6 $2,415.00 $2,415.00 $524.89 $2,415.00 $2,234.60 2026-08-07
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 6 6 $2,415.00 $2,415.00 $524.89 $2,415.00 $2,234.60 2026-08-07
73222 HCPCS MRI Scan Of Arm Joint With Contrast 12 6 $2,415.00 $2,415.00 $524.89 $2,415.00 $2,234.60 2026-08-07
73219 HCPCS MRI Scan Of Arm With Contrast 12 6 $2,415.00 $2,415.00 $524.89 $2,415.00 $2,234.60 2026-08-07
72196 HCPCS MRI Scan Of Pelvis With Contrast 6 6 $2,415.00 $2,415.00 $524.89 $2,415.00 $2,234.60 2026-08-07
74182 HCPCS MRI Scan Of Abdomen With Contrast 6 6 $2,415.00 $2,415.00 $524.89 $2,415.00 $2,234.60 2026-08-07
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 6 6 $2,415.00 $2,415.00 $524.89 $2,415.00 $2,234.60 2026-08-07
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 6 6 $2,399.25 $2,399.25 $631.68 $2,399.25 $2,220.03 2026-08-07
73225 HCPCS MRI Scan Of Blood Vessels Of Arm 12 6 $2,383.50 $2,383.50 $631.68 $2,383.50 $2,205.45 2026-08-07
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 6 6 $2,378.25 $2,378.25 $1,086.66 $2,378.25 $2,200.60 2026-08-07
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 6 6 $2,362.50 $2,362.50 $456.39 $2,362.50 $2,186.02 2026-08-07
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 6 6 $2,362.50 $2,362.50 $524.89 $2,362.50 $2,186.02 2026-08-07
71551 HCPCS MRI Scan Of Chest With Contrast 6 6 $2,357.25 $2,357.25 $524.89 $2,357.25 $2,181.16 2026-08-07
03065942 CDM Orencia 250 Mg Vial 3 3 $2,282.00 $2,282.00 $2,053.80 $2,236.36 $2,169.27 2026-08-07
77084 HCPCS MRI Scan Of Bone Marrow 6 6 $2,341.50 $2,341.50 $524.89 $2,341.50 $2,166.59 2026-08-07
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 6 6 $2,325.75 $2,325.75 $631.68 $2,325.75 $2,152.02 2026-08-07
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 6 6 $2,310.00 $2,310.00 $456.39 $2,310.00 $2,137.44 2026-08-07
03065824 CDM Orencia 250 Mg Vial 3 3 $2,227.99 $2,227.99 $2,005.19 $2,183.43 $2,117.93 2026-08-07
71270 HCPCS CT Scan Of Chest Before And After Contrast 6 6 $2,231.25 $2,231.25 $456.39 $2,231.25 $2,064.58 2026-08-07
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 6 6 $2,205.00 $2,205.00 $456.39 $2,205.00 $2,040.29 2026-08-07
73718 HCPCS MRI Scan Of Leg Without Contrast 12 6 $2,257.50 $2,257.50 $524.89 $2,415.00 $2,027.13 2026-08-07
00800020 CDM Room & Board - Semi-private (two Beds) - Obstetrics (ob) 2 2 $2,100.00 $2,100.00 $1,890.00 $2,100.00 $1,995.00 2026-08-07
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 12 6 $2,100.00 $2,100.00 $524.89 $2,100.00 $1,943.13 2026-08-07
72193 HCPCS CT Scan Of Pelvis With Contrast 6 6 $2,100.00 $2,100.00 $456.39 $2,100.00 $1,943.13 2026-08-07
74181 HCPCS MRI Scan Of Abdomen Without Contrast 6 6 $2,100.00 $2,100.00 $524.89 $2,100.00 $1,943.13 2026-08-07
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 6 6 $2,100.00 $2,100.00 $524.89 $2,100.00 $1,943.13 2026-08-07
72195 HCPCS MRI Scan Of Pelvis Without Contrast 6 6 $2,100.00 $2,100.00 $524.89 $2,100.00 $1,943.13 2026-08-07
73218 HCPCS MRI Scan Of Arm Without Contrast 12 6 $2,100.00 $2,100.00 $524.89 $2,100.00 $1,943.13 2026-08-07
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 6 6 $2,100.00 $2,100.00 $524.89 $2,100.00 $1,943.13 2026-08-07
73702 HCPCS CT Scan Of Leg Before And After Contrast 12 6 $2,100.00 $2,100.00 $456.39 $2,100.00 $1,943.13 2026-08-07
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 6 6 $2,100.00 $2,100.00 $524.89 $2,100.00 $1,943.13 2026-08-07
72159 HCPCS MRI Scan Of Blood Vessels Of Spinal Canal 6 6 $2,089.50 $2,089.50 $631.68 $2,089.50 $1,933.41 2026-08-07
73202 HCPCS CT Scan Of Arm Before And After Contrast 12 6 $2,073.75 $2,073.75 $456.39 $2,073.75 $1,918.85 2026-08-07
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 6 6 $2,073.75 $2,073.75 $456.39 $2,073.75 $1,918.85 2026-08-07
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 6 6 $2,073.75 $2,073.75 $456.39 $2,073.75 $1,918.85 2026-08-07
70488 HCPCS CT Scan Of Face Before And After Contrast 6 6 $2,047.50 $2,047.50 $456.39 $2,047.50 $1,894.55 2026-08-07
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 6 6 $2,047.50 $2,047.50 $631.68 $2,047.50 $1,894.55 2026-08-07
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 6 6 $2,047.50 $2,047.50 $456.39 $2,047.50 $1,894.55 2026-08-07
71550 HCPCS MRI Scan Of Chest Without Contrast 6 6 $1,995.00 $1,995.00 $524.89 $1,995.00 $1,845.97 2026-08-07
70551 HCPCS MRI Scan Of Brain Without Contrast 6 6 $1,995.00 $1,995.00 $524.89 $1,995.00 $1,845.97 2026-08-07
64491 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Second Le… 6 6 $1,989.75 $1,989.75 $727.30 $1,989.75 $1,841.12 2026-08-07
74160 HCPCS CT Scan Of Abdomen With Contrast 6 6 $1,968.75 $1,968.75 $456.39 $1,968.75 $1,821.68 2026-08-07
J0897 HCPCS Injection, Denosumab, 1 Mg 10 6 $1,817.55 $1,817.55 $30.80 $2,760.45 $1,799.38 2026-08-07
00807030 CDM Labor Room/delivery - Delivery Room 3 3 $1,890.00 $1,890.00 $1,701.00 $1,852.20 $1,796.63 2026-08-07
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 6 6 $1,916.25 $1,916.25 $456.39 $1,916.25 $1,773.11 2026-08-07
71260 HCPCS CT Scan Of Chest With Contrast 6 6 $1,916.25 $1,916.25 $456.39 $1,916.25 $1,773.11 2026-08-07
72132 HCPCS CT Scan Of Lower Spine With Contrast 6 6 $1,916.25 $1,916.25 $456.39 $1,916.25 $1,773.11 2026-08-07
72129 HCPCS CT Scan Of Middle Spine With Contrast 6 6 $1,916.25 $1,916.25 $456.39 $1,916.25 $1,773.11 2026-08-07
72126 HCPCS CT Scan Of Upper Spine With Contrast 6 6 $1,916.25 $1,916.25 $456.39 $1,916.25 $1,773.11 2026-08-07
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 6 6 $1,890.00 $1,890.00 $631.68 $1,890.00 $1,748.82 2026-08-07
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 6 6 $1,890.00 $1,890.00 $524.89 $1,890.00 $1,748.82 2026-08-07
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 6 6 $1,879.50 $1,879.50 $456.39 $1,879.50 $1,739.10 2026-08-07
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 6 6 $1,837.50 $1,837.50 $456.39 $1,837.50 $1,700.24 2026-08-07
74150 HCPCS CT Scan Of Abdomen Without Contrast 6 6 $1,837.50 $1,837.50 $456.39 $1,837.50 $1,700.24 2026-08-07
70336 HCPCS MRI Scan Of Jaw Joint 6 6 $1,837.50 $1,837.50 $524.89 $1,837.50 $1,700.24 2026-08-07
72192 HCPCS CT Scan Of Pelvis Without Contrast 6 6 $1,837.50 $1,837.50 $456.39 $1,837.50 $1,700.24 2026-08-07
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 6 6 $1,837.50 $1,837.50 $631.68 $1,837.50 $1,700.24 2026-08-07
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 6 6 $1,837.50 $1,837.50 $631.68 $1,837.50 $1,700.24 2026-08-07
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 6 6 $1,837.50 $1,837.50 $456.39 $1,837.50 $1,700.24 2026-08-07
J1745 HCPCS Injection, Infliximab, Excludes Biosimilar, 10 Mg 6 6 $1,821.00 $1,821.00 $37.59 $1,821.00 $1,684.97 2026-08-07
J1438 HCPCS Injection, Etanercept, 25 Mg (code May Be Used For Medicare When Drug Administer… 6 6 $1,814.40 $1,814.40 $1,066.89 $1,814.40 $1,678.87 2026-08-07
71250 HCPCS CT Scan Of Chest Without Contrast 6 6 $1,779.75 $1,779.75 $456.39 $1,779.75 $1,646.80 2026-08-07
03065719 CDM Nf Nirmatrelvir-ritonavir Tab [150-100mg 3 3 $1,722.80 $1,722.80 $1,550.52 $1,688.34 $1,637.69 2026-08-07
03066080 CDM Paxlovid 300-100 Mg Dose Pack 3 3 $1,722.80 $1,722.80 $1,550.52 $1,688.34 $1,637.69 2026-08-07
03065722 CDM Nf Nirmatrelvir-ritonavir Tab [300-100mg 3 3 $1,722.80 $1,722.80 $1,550.52 $1,688.34 $1,637.69 2026-08-07
03065718 CDM Nirmatrelvir-ritonavir Tab [150-100 Mg] 3 3 $1,722.80 $1,722.80 $1,550.52 $1,688.34 $1,637.69 2026-08-07
72131 HCPCS CT Scan Of Lower Spine Without Contrast 6 6 $1,758.75 $1,758.75 $456.39 $1,758.75 $1,627.38 2026-08-07
72125 HCPCS CT Scan Of Upper Spine Without Contrast 6 6 $1,758.75 $1,758.75 $456.39 $1,758.75 $1,627.38 2026-08-07
70487 HCPCS CT Scan Of Face With Contrast 6 6 $1,758.75 $1,758.75 $456.39 $1,758.75 $1,627.38 2026-08-07
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 6 6 $1,758.75 $1,758.75 $456.39 $1,758.75 $1,627.38 2026-08-07
62323 HCPCS Injection Of Substance Into Lower Spine Canal Using Imaging Guidance 6 6 $1,749.30 $1,749.30 $1,084.71 $1,749.30 $1,618.62 2026-08-07
70460 HCPCS CT Scan Head Or Brain With Contrast 6 6 $1,732.50 $1,732.50 $456.39 $1,732.50 $1,603.08 2026-08-07
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 6 6 $1,716.75 $1,716.75 $456.39 $1,716.75 $1,588.51 2026-08-07
72128 HCPCS CT Scan Of Middle Spine Without Contrast 6 6 $1,706.25 $1,706.25 $456.39 $1,706.25 $1,578.80 2026-08-07
73701 HCPCS CT Scan Of Leg With Contrast Material 12 6 $1,706.25 $1,706.25 $456.39 $1,706.25 $1,578.80 2026-08-07
73201 HCPCS CT Scan Of Arm With Contrast 12 6 $1,680.00 $1,680.00 $456.39 $1,680.00 $1,554.51 2026-08-07
70486 HCPCS CT Scan Of Face Without Contrast 6 6 $1,669.50 $1,669.50 $456.39 $1,669.50 $1,544.79 2026-08-07
70450 HCPCS CT Scan Head Or Brain Without Contrast 6 6 $1,669.50 $1,669.50 $456.39 $1,669.50 $1,544.79 2026-08-07
03060717 CDM Ivpb Infliximab/ns : 100 Mg/250 Ml 3 3 $1,606.97 $1,606.97 $1,446.27 $1,574.83 $1,527.59 2026-08-07
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 6 6 $1,575.00 $1,575.00 $1,417.50 $1,575.00 $1,514.68 2026-08-07
10061 HCPCS Complicated Or Multiple Drainage Of Skin Abscess 9 6 $2,037.42 $2,037.42 $207.18 $2,037.42 $1,484.70 2026-08-07
64479 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Upper Or Middle Spine Nerve Roo… 6 6 $1,590.75 $1,590.75 $690.47 $1,590.75 $1,471.93 2026-08-07
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 6 6 $1,585.50 $1,585.50 $631.68 $1,585.50 $1,467.07 2026-08-07
87633 HCPCS Detection Test By Nucleic Acid For Multiple Types Of Respiratory Virus, Multiple… 6 6 $1,575.00 $1,575.00 $1,328.91 $1,575.00 $1,457.35 2026-08-07
73700 HCPCS CT Scan Of Leg Without Contrast 12 6 $1,575.00 $1,575.00 $456.39 $1,575.00 $1,457.35 2026-08-07
73200 HCPCS CT Scan Of Arm Without Contrast 12 6 $1,575.00 $1,575.00 $456.39 $1,575.00 $1,457.35 2026-08-07
03066111 CDM Skyrizi 600 Mg/10 Ml Vial 3 3 $1,530.00 $1,530.00 $1,377.00 $1,499.40 $1,454.42 2026-08-07
03066009 CDM Skyrizi 600 Mg/10 Ml Vial 3 3 $1,529.72 $1,529.72 $1,376.75 $1,499.13 $1,454.15 2026-08-07
03065999 CDM Ozempic 1 Mg/dose (4 Mg/3 Ml) 3 3 $1,511.00 $1,511.00 $1,359.90 $1,480.78 $1,436.36 2026-08-07
02 CDM Room & Board - Semi-private (two Beds) - General Classification 2 2 $1,500.00 $1,500.00 $1,350.00 $1,500.00 $1,425.00 2026-08-07
00100010 CDM Room & Board - Semi-private (two Beds) - General Classification 2 2 $1,500.00 $1,500.00 $1,350.00 $1,500.00 $1,425.00 2026-08-07
62320 HCPCS Injection Of Substance Into Middle Or Upper Spine Canal 6 6 $1,530.38 $1,530.38 $559.39 $1,530.38 $1,416.06 2026-08-07
64483 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 6 6 $1,506.75 $1,506.75 $654.01 $1,506.75 $1,394.20 2026-08-07
77058 HCPCS MRI One Breast 8 4 $1,417.50 $1,417.50 $1,275.75 $1,417.50 $1,368.32 2026-08-07
03065933 CDM Hyperrab 300 Unit/ml Vial 3 3 $1,411.54 $1,411.54 $1,270.39 $1,383.31 $1,341.81 2026-08-07
03065934 CDM Hyperrab 300 Unit/ml Vial 3 3 $1,411.54 $1,411.54 $1,270.39 $1,383.31 $1,341.81 2026-08-07
90376 HCPCS Rabies Immune Globulin For Injection Beneath The Skin And/or Into Muscle, Heat-t… 6 6 $1,439.55 $1,439.55 $352.47 $1,439.55 $1,332.02 2026-08-07
45384 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using A Flexible Endoscope With Elec… 6 6 $1,373.40 $1,373.40 $1,236.06 $1,373.40 $1,313.32 2026-08-07
86015 HCPCS Measurement Of Actin (smooth Muscle) Antibody 4 4 $1,346.10 $1,346.10 $1,211.49 $1,346.10 $1,299.39 2026-08-07
45380 HCPCS Biopsy Of Large Bowel Using A Flexible Endoscope 9 6 $1,417.50 $1,417.50 $207.18 $1,417.50 $1,295.33 2026-08-07
77059 HCPCS MRI Both Breasts 4 4 $1,312.50 $1,312.50 $1,181.25 $1,312.50 $1,266.95 2026-08-07
78315 HCPCS Nuclear Medicine Study Of Bone Taken At Different Times 6 6 $1,359.75 $1,359.75 $330.14 $1,359.75 $1,258.18 2026-08-07
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 20 6 $2,100.00 $2,100.00 $524.89 $2,100.00 $1,247.40 2026-08-07
78306 HCPCS Nuclear Medicine Study Of Bone And/or Joint Whole Body 6 6 $1,302.00 $1,302.00 $380.47 $1,302.00 $1,204.74 2026-08-07
71555 HCPCS MRI Scan Of Blood Vessels Of Chest 6 6 $1,286.25 $1,286.25 $631.68 $1,286.25 $1,190.17 2026-08-07
64493 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Le… 6 6 $1,281.00 $1,281.00 $657.43 $1,281.00 $1,185.31 2026-08-07
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 12 6 $1,260.00 $1,260.00 $631.68 $1,260.00 $1,165.88 2026-08-07
Q5104 HCPCS Injection, Infliximab-abda, Biosimilar, (renflexis), 10 Mg 6 6 $1,253.00 $1,253.00 $37.37 $1,253.00 $1,159.40 2026-08-07
J0256 HCPCS Injection, Alpha 1 Proteinase Inhibitor (human), Not Otherwise Specified, 10 Mg 6 6 $1,250.21 $1,250.21 $5.71 $1,250.21 $1,156.82 2026-08-07
83698 HCPCS Lipoprotein-associated Phospholipase A2 (enzyme) Level 6 6 $1,249.40 $1,249.40 $193.94 $1,249.40 $1,156.07 2026-08-07
43239 HCPCS Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop… 9 6 $1,411.20 $1,411.20 $207.18 $1,411.20 $1,153.42 2026-08-07
Q5103 HCPCS Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 6 6 $1,213.00 $1,213.00 $42.72 $1,213.00 $1,122.39 2026-08-07
64490 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Single Le… 6 6 $1,173.38 $1,173.38 $509.30 $1,173.38 $1,085.73 2026-08-07
03066091 CDM Mounjaro 7.5 Mg/0.5 Ml Pen 3 3 $1,112.00 $1,112.00 $1,000.80 $1,089.76 $1,057.07 2026-08-07
03066093 CDM Mounjaro 7.5 Mg/0.5 Ml Pen 3 3 $1,112.00 $1,112.00 $1,000.80 $1,089.76 $1,057.07 2026-08-07
03066163 CDM Mounjaro 2.5 Mg/0.5 Ml Pen 3 3 $1,112.00 $1,112.00 $1,000.80 $1,089.76 $1,057.07 2026-08-07
12016 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.… 6 6 $1,127.70 $1,127.70 $768.56 $1,127.70 $1,043.46 2026-08-07
43235 HCPCS Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible… 14 6 $1,081.50 $1,081.50 $250.43 $1,286.25 $1,030.65 2026-08-07
45378 HCPCS Diagnostic Exam Of Large Bowel Using A Flexible Endoscope 17 6 $1,081.50 $1,081.50 $207.18 $1,321.08 $1,028.07 2026-08-07
26725 HCPCS Closed Treatment Of Broken Finger Or Thumb At Midportion Or Part Near Hand With … 10 6 $236.25 $236.25 $212.63 $1,137.26 $985.16 2026-08-07
12006 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 9 6 $1,023.75 $1,023.75 $207.18 $1,538.23 $973.18 2026-08-07
SB CDM Room & Board - Semi-private (two Beds) - Other 2 2 $1,000.00 $1,000.00 $900.00 $1,000.00 $950.00 2026-08-07
00350060 CDM Room & Board - Semi-private (two Beds) - Other 2 2 $1,000.00 $1,000.00 $900.00 $1,000.00 $950.00 2026-08-07
27 CDM Room & Board - Semi-private (two Beds) - Other 2 2 $1,000.00 $1,000.00 $900.00 $1,000.00 $950.00 2026-08-07
25565 HCPCS Closed Treatment Of Broken Midpart Of Both Forearm Bones With Manipulation 6 6 $892.50 $892.50 $803.25 $1,454.40 $883.58 2026-08-07
J2760 HCPCS Injection, Phentolamine Mesylate, Up To 5 Mg 6 6 $947.10 $947.10 $550.36 $947.10 $876.35 2026-08-07
93970 HCPCS Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 6 6 $945.00 $945.00 $456.72 $945.00 $874.41 2026-08-07
25600 HCPCS Closed Treatment Of Broken Forearm (radius) Bone At The Wrist Area On The Thumb … 12 6 $945.00 $945.00 $237.29 $945.00 $874.41 2026-08-07
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 6 6 $918.75 $918.75 $456.72 $918.75 $850.12 2026-08-07
23650 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation 12 6 $855.75 $855.75 $770.18 $897.89 $845.82 2026-08-07
J1441 HCPCS Nivestym 480 Mcg/1.6 Ml Vial 4 4 $875.70 $875.70 $788.13 $875.70 $845.32 2026-08-07
23655 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia 12 6 $887.25 $887.25 $768.56 $887.25 $826.21 2026-08-07
93975 HCPCS Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 6 6 $892.50 $892.50 $456.72 $892.50 $825.83 2026-08-07
36430 HCPCS Transfusion Of Blood Or Blood Products 6 6 $892.50 $892.50 $489.91 $892.50 $825.83 2026-08-07
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 6 6 $866.25 $866.25 $456.72 $866.25 $801.55 2026-08-07
05100654 CDM US Upper Extremity Venous Bilateral 3 3 $840.00 $840.00 $756.00 $823.20 $798.50 2026-08-07
12044 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 7.6-12.5 Cm 9 6 $884.10 $884.10 $207.18 $884.10 $795.69 2026-08-07
MS200 OTHER Dantrium 20 Mg Vial 4 4 $812.00 $812.00 $730.80 $812.00 $783.83 2026-08-07
93930 HCPCS Ultrasound Of Arm Arteries Or Artery Grafts 6 6 $840.00 $840.00 $456.72 $840.00 $777.25 2026-08-07
95806 HCPCS Sleep Study Including Heart Rate, Breathing, Airflow, And Effort 6 6 $840.00 $840.00 $195.74 $840.00 $777.25 2026-08-07
26770 HCPCS Closed Treatment Of Dislocated Finger Joint With Manipulation 17 6 $802.20 $802.20 $207.18 $809.01 $768.56 2026-08-07
26075 HCPCS Incision Of Lower Finger Joint For Exploration, Fluid Drainage, Or Removal Of Fo… 6 6 $761.25 $761.25 $685.13 $1,454.40 $753.64 2026-08-07
93017 HCPCS Exercise Or Drug-induced Heart Stress Test With Electrocardiogram (ecg) 6 6 $813.75 $813.75 $338.55 $813.75 $752.96 2026-08-07
00400070 CDM Room & Board - Semi-private (two Beds) - Other 2 2 $787.50 $787.50 $708.75 $787.50 $748.12 2026-08-07
28190 HCPCS Removal Of Foreign Body Of Foot Tissue, Accessed Beneath The Skin 17 6 $761.25 $761.25 $207.18 $1,991.72 $746.03 2026-08-07
03060850 CDM Fleet Mineral Oil Enema 3 3 $779.00 $779.00 $701.10 $763.42 $740.52 2026-08-07
P9016 HCPCS Red Blood Cells, Leukocytes Reduced, Each Unit 6 6 $787.50 $787.50 $507.62 $787.50 $728.67 2026-08-07
76700 HCPCS Complete Ultrasound Scan Of Abdomen 6 6 $787.50 $787.50 $143.93 $787.50 $728.67 2026-08-07
62322 HCPCS Injection Of Substance Into Lower Spine Canal 13 6 $780.15 $780.15 $207.18 $1,530.38 $698.69 2026-08-07
81315 HCPCS Translocation Analysis (pml-rara Regulated Adaptor Molecule 1) Common Breakpoint 6 6 $750.75 $750.75 $189.67 $750.75 $694.67 2026-08-07
76001 HCPCS Fluoroscope Exam Extensive 4 4 $714.00 $714.00 $642.60 $714.00 $689.23 2026-08-07
27096 HCPCS Injection Of Anesthetic Or Steroid Into Joint Between Lower Spine And Hip Bone U… 6 6 $719.25 $719.25 $641.91 $719.25 $679.71 2026-08-07
20 CDM Nursery - General Classification 2 2 $700.00 $700.00 $630.00 $700.00 $665.00 2026-08-07
03060004 CDM Atrovent 17 Mcg Hfa Inhaler 3 3 $681.45 $681.45 $613.31 $667.82 $647.79 2026-08-07
86832 HCPCS Assessment Of Antibody To Human Leukocyte Antigens (hla) With High Definition Qu… 6 6 $691.37 $691.37 $361.02 $691.37 $639.73 2026-08-07
02400022 CDM Operating Room Services - General Classification 3 3 $664.65 $664.65 $598.19 $651.36 $631.82 2026-08-07
02400021 CDM Operating Room Services - General Classification 3 3 $664.65 $664.65 $598.19 $651.36 $631.82 2026-08-07
76506 HCPCS Ultrasound Scan Of Brain 6 6 $661.50 $661.50 $456.72 $661.50 $612.09 2026-08-07
93971 HCPCS Ultrasound Study Of One Arm Or Leg Veins With Compression And Maneuvers 12 6 $656.25 $656.25 $456.72 $656.25 $607.23 2026-08-07
93976 HCPCS Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 6 6 $656.25 $656.25 $456.72 $656.25 $607.23 2026-08-07
76856 HCPCS Complete Ultrasound Scan Of Pelvis 6 6 $656.25 $656.25 $117.06 $656.25 $607.23 2026-08-07
64480 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Upper Or Middle Spine Nerve Roo… 6 6 $651.00 $651.00 $428.90 $651.00 $602.37 2026-08-07
74230 HCPCS Imaging For Evaluation Of Swallowing Function 6 6 $649.15 $649.15 $296.60 $649.15 $600.66 2026-08-07
02500243 CDM Cre Dialator 45fr Balloon 3 3 $628.11 $628.11 $565.30 $615.55 $597.08 2026-08-07
03066169 CDM Fluticasone-salmeterol 232-14 3 3 $628.00 $628.00 $565.20 $615.44 $596.98 2026-08-07
76706 HCPCS Ultrasound Scan Of Abdominal Aorta 6 6 $640.50 $640.50 $143.93 $640.50 $592.65 2026-08-07
81401 HCPCS Molecular Pathology Procedure Level 2 6 6 $630.00 $630.00 $270.12 $630.00 $582.94 2026-08-07
71271 HCPCS Low Dose CT Scan Of Chest For Lung Cancer Screening 6 6 $630.00 $630.00 $456.39 $630.00 $582.94 2026-08-07
20611 HCPCS Aspiration And/or Injection Of Fluid Large Joint Using Ultrasound Guidance 6 6 $630.00 $630.00 $314.00 $630.00 $582.94 2026-08-07
00301011 CDM Ambulance Charge 3 3 $611.21 $611.21 $550.09 $598.99 $581.02 2026-08-07
21310 HCPCS Closed Treatment Of Nasal Bone Fracture Without Manipulation 4 4 $583.80 $583.80 $525.42 $583.80 $563.54 2026-08-07
93926 HCPCS Ultrasound Of One Leg Arteries Or Artery Grafts 12 6 $603.75 $603.75 $456.72 $603.75 $558.65 2026-08-07
76870 HCPCS Ultrasound Scan Of Scrotum 6 6 $603.75 $603.75 $117.06 $603.75 $558.65 2026-08-07
87902 HCPCS Analysis Test By Nucleic Acid For Hepatitis C Virus 9 6 $756.00 $756.00 $207.18 $756.00 $552.43 2026-08-07
03061376 CDM E.e.s. 200 Mg/5 Ml Suspension 3 3 $574.35 $574.35 $516.92 $562.86 $545.98 2026-08-07
80305 HCPCS Testing For Presence Of Drug, Read By Direct Observation 6 6 $588.00 $588.00 $26.74 $588.00 $544.08 2026-08-07
93931 HCPCS Ultrasound Of One Arm Arteries Or Artery Grafts 12 6 $588.00 $588.00 $456.72 $588.00 $544.08 2026-08-07
77001 HCPCS Fluoroscopic Guidance For Insertion Or Removal Of Central Vein Access Device 4 4 $561.75 $561.75 $505.58 $561.75 $542.26 2026-08-07
13121 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 2.6-7.5 Cm 9 6 $1,121.40 $1,121.40 $207.18 $1,121.40 $539.34 2026-08-07
02500247 CDM Hemostatic Clip 3 3 $564.38 $564.38 $507.94 $553.09 $536.50 2026-08-07
80320 HCPCS Alcohols Levels 6 6 $577.50 $577.50 $57.60 $577.50 $534.36 2026-08-07
76872 HCPCS Ultrasound Scan Of Pelvic Region Through Rectum 6 6 $577.50 $577.50 $95.95 $577.50 $534.36 2026-08-07
76818 HCPCS Ultrasound And Monitoring Of Heart Of Fetus 6 6 $577.50 $577.50 $134.43 $577.50 $534.36 2026-08-07
77002 HCPCS Fluoroscopic Guidance For Needle Placement 6 6 $572.25 $572.25 $353.98 $572.25 $529.50 2026-08-07
27250 HCPCS Closed Treatment Of Dislocated Hip 12 6 $540.75 $540.75 $486.68 $541.36 $522.12 2026-08-07
72052 HCPCS X-ray Of Upper Spine, 6 Or More Views 6 6 $561.75 $561.75 $257.76 $561.75 $519.79 2026-08-07
04001618 CDM Drug Screen 3 3 $546.00 $546.00 $491.40 $535.08 $519.03 2026-08-07
03060246 CDM Combivent Respimat 20-100 Mcg 3 3 $540.75 $540.75 $486.68 $529.94 $514.04 2026-08-07
76830 HCPCS Ultrasound Scan Of Uterus, Ovaries, Tubes, Cervix And Pelvic Area Through Vagina 6 6 $551.25 $551.25 $117.06 $551.25 $510.07 2026-08-07
64494 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Second Le… 6 6 $514.50 $514.50 $463.05 $984.68 $509.36 2026-08-07
03066171 CDM Calquence 100 Mg Tablet 3 3 $533.00 $533.00 $479.70 $522.34 $506.67 2026-08-07
72110 HCPCS X-ray Of Lower And Sacral Spine, Minimum Of 4 Views 6 6 $546.00 $546.00 $235.70 $546.00 $505.21 2026-08-07
00600040 CDM Nursery - General Classification 2 2 $525.00 $525.00 $472.50 $525.00 $498.75 2026-08-07
76000 HCPCS Imaging Guidance For Procedure, 60 Minutes Or Less 6 6 $535.50 $535.50 $222.45 $535.50 $495.50 2026-08-07
92960 HCPCS External Shock To Heart To Regulate Heart Beat 6 6 $532.35 $532.35 $457.83 $532.35 $493.99 2026-08-07
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 12 6 $498.75 $498.75 $448.88 $1,434.20 $493.76 2026-08-07
76770 HCPCS Complete Ultrasound Scan Behind Abdominal Cavity 16 6 $511.35 $511.35 $143.93 $640.50 $493.61 2026-08-07
71111 HCPCS X-ray Of Ribs On Both Sides Of Body, Minimum Of 4 Views 6 6 $525.00 $525.00 $233.04 $525.00 $485.78 2026-08-07
13160 HCPCS Extensive Or Complicated Repair Of Surface Wound Reopening 6 6 $476.70 $476.70 $429.03 $2,038.18 $471.94 2026-08-07
72050 HCPCS X-ray Of Upper Spine, 4-5 Views 6 6 $509.25 $509.25 $218.92 $509.25 $471.21 2026-08-07
76536 HCPCS Ultrasound Scan Of Head And Neck Soft Tissue 10 6 $551.25 $551.25 $206.44 $551.25 $468.74 2026-08-07
64495 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Third And… 6 6 $472.50 $472.50 $425.25 $1,403.26 $467.77 2026-08-07
M0247 HCPCS Intravenous Infusion, Sotrovimab, Includes Infusion And Post Administration Moni… 6 6 $472.50 $472.50 $425.25 $497.56 $467.77 2026-08-07
13152 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 2.6-7.5 Cm 6 6 $472.50 $472.50 $425.25 $1,618.02 $467.77 2026-08-07
12057 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More … 6 6 $472.50 $472.50 $425.25 $1,818.00 $467.77 2026-08-07
28193 HCPCS Complicated Removal Of Foreign Body In Foot 12 6 $472.50 $472.50 $425.25 $1,538.23 $467.77 2026-08-07
86794 HCPCS Analysis For Antibody To Zika Virus 6 6 $505.31 $505.31 $35.92 $505.31 $467.56 2026-08-07
02500586 CDM Dress Sm Granufoam 3 3 $491.30 $491.30 $442.17 $481.47 $467.03 2026-08-07
30901 HCPCS Simple Control Of Nose Bleed 9 6 $508.20 $508.20 $207.18 $508.20 $464.40 2026-08-07
02500587 CDM Canister W/gel 500ml 3 3 $487.18 $487.18 $438.46 $477.44 $463.11 2026-08-07
93320 HCPCS Ultrasound Of Heart Blood Flow, Valves And Chambers 10 6 $498.75 $498.75 $417.69 $498.75 $460.41 2026-08-07
03060424 CDM Cipro Hc Otic Suspension 3 3 $484.05 $484.05 $435.65 $474.37 $460.14 2026-08-07
03061500 CDM Cipro Hc Otic Suspension 3 3 $484.05 $484.05 $435.65 $474.37 $460.14 2026-08-07
03061293 CDM Tiotropium 18 Mcg Cap-inhaler 3 3 $479.99 $479.99 $431.99 $470.39 $456.28 2026-08-07
12051 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 C… 6 6 $459.90 $459.90 $413.91 $715.08 $455.30 2026-08-07
74022 HCPCS X-ray Series Of Abdomen With Single X-ray Of Chest 6 6 $488.25 $488.25 $250.70 $488.25 $451.78 2026-08-07
70260 HCPCS X-ray Of Skull, Minimum Of 4 Views 6 6 $488.25 $488.25 $200.38 $488.25 $451.78 2026-08-07
11042 HCPCS Removal Of Skin And Tissue, 20.0 Sq Cm Or Less 9 6 $765.45 $765.45 $207.18 $765.45 $451.17 2026-08-07
05100578 CDM US Unlisted US Procedure 3 3 $472.50 $472.50 $425.25 $463.05 $449.16 2026-08-07
02500145 CDM Chest Drain Valve 3 3 $466.74 $466.74 $420.07 $457.41 $443.68 2026-08-07
12056 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 20.1-… 6 6 $446.25 $446.25 $401.63 $1,605.90 $441.79 2026-08-07
80081 HCPCS Blood Test Panel For Obstetrics ( Cbc, Differential Wbc Count, Hepatitis B, Hiv,… 6 6 $477.00 $477.00 $145.29 $477.00 $441.37 2026-08-07
12052 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.6-5… 12 6 $484.05 $484.05 $36.46 $525.00 $438.67 2026-08-07
M0245 HCPCS Intravenous Infusion, Bamlanivimab And Etesevimab, Includes Infusion And Post Ad… 6 6 $472.50 $472.50 $325.20 $472.50 $437.21 2026-08-07
M0240 HCPCS Intravenous Infusion Or Subcutaneous Injection, Casirivimab And Imdevimab Includ… 6 6 $472.50 $472.50 $325.20 $472.50 $437.21 2026-08-07
77080 HCPCS Dxa Bone Density Measurement Of Hip, Pelvis, Spine 6 6 $472.50 $472.50 $188.06 $472.50 $437.21 2026-08-07
M0243 HCPCS Intravenous Infusion Or Subcutaneous Injection, Casirivimab And Imdevimab Includ… 6 6 $472.50 $472.50 $325.20 $472.50 $437.21 2026-08-07
76817 HCPCS Vaginal Ultrasound Of Pregnant Uterus 6 6 $472.50 $472.50 $134.43 $472.50 $437.21 2026-08-07
76604 HCPCS Ultrasound Scan Of Chest 6 6 $472.50 $472.50 $105.55 $472.50 $437.21 2026-08-07
03066311 CDM Imovax Rabies Vaccine Vial 3 3 $459.41 $459.41 $413.47 $450.22 $436.72 2026-08-07
25660 HCPCS Closed Treatment Of Dislocated Wrist Bones With Manipulation 6 6 $441.00 $441.00 $396.90 $1,454.40 $436.59 2026-08-07
62270 HCPCS Removal Of Cerebrospinal Fluid With Lower Back Spinal Tap For Diagnostic Test 6 6 $458.33 $458.33 $411.63 $458.33 $434.49 2026-08-07
12014 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1… 9 6 $456.75 $456.75 $207.18 $475.71 $434.19 2026-08-07
76645 HCPCS US Breast(l) 8 4 $446.25 $446.25 $401.63 $446.25 $430.77 2026-08-07
11750 HCPCS Permanent Removal Fingernail Or Toenail 9 6 $456.75 $456.75 $207.18 $456.75 $428.61 2026-08-07
12018 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, Mor… 6 6 $430.50 $430.50 $387.45 $1,538.23 $426.19 2026-08-07
90675 HCPCS Rabies Vaccine For Injection Into Muscle 6 6 $429.40 $429.40 $386.46 $591.06 $425.11 2026-08-07
03065970 CDM Zarxio 480 Mcg/0.8 Ml 3 3 $446.41 $446.41 $401.77 $437.48 $424.36 2026-08-07
03065967 CDM Filgrastim-sndz Inj [480 Mcg/0.8 Ml] 3 3 $446.41 $446.41 $401.77 $437.48 $424.36 2026-08-07
03099997 CDM Zarxio 480 Mcg/0.8 Ml 3 3 $446.41 $446.41 $401.77 $437.48 $424.36 2026-08-07
03066152 CDM Zarxio 480 Mcg/0.8 Ml 3 3 $446.41 $446.41 $401.77 $437.48 $424.36 2026-08-07
93922 HCPCS Ultrasound Study Of Arm And Leg Arteries 6 6 $420.00 $420.00 $378.00 $480.76 $415.80 2026-08-07
76641 HCPCS Complete Ultrasound Scan Of 1 Breast 12 6 $446.25 $446.25 $90.19 $446.25 $412.92 2026-08-07
29085 HCPCS Application Of Hand And Lower Forearm Cast 26 6 $63.00 $63.00 $56.70 $470.40 $410.67 2026-08-07
10120 HCPCS Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Simple 9 6 $429.45 $429.45 $207.18 $1,075.65 $408.24 2026-08-07
26670 HCPCS Closed Treatment Of Dislocated Hand Bone At Wrist Joint With Manipulation 6 6 $409.50 $409.50 $368.55 $809.01 $405.40 2026-08-07
03066117 CDM Clin Vac Zoster Inj [0.5 Ml] 3 3 $426.00 $426.00 $383.40 $417.48 $404.96 2026-08-07
92611 HCPCS Evaluation Of Swallowing Function Image 12 6 $435.75 $435.75 $169.31 $435.75 $403.20 2026-08-07
16030 HCPCS Dressing Change Or Removal Of Burn Tissue, More Than 10% Of Total Body Surface 6 6 $433.65 $433.65 $353.10 $433.65 $401.26 2026-08-07
81270 HCPCS Gene Analysis (Janus Kinase 2) Variant 6 6 $430.50 $430.50 $150.31 $430.50 $398.34 2026-08-07
71110 HCPCS X-ray Of Ribs On Both Sides Of Body, 3 Views 6 6 $430.50 $430.50 $127.99 $430.50 $398.34 2026-08-07
12042 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 2.6-7.5 Cm 9 6 $417.90 $417.90 $207.18 $707.00 $397.26 2026-08-07
77003 HCPCS Fluoroscopic Guidance For Spine Or Back Muscle Injection 10 6 $399.00 $399.00 $223.34 $567.00 $395.01 2026-08-07
92950 HCPCS Manual Attempt To Restore Blood Circulation And Breathing 6 6 $425.50 $425.50 $294.02 $425.50 $393.72 2026-08-07
70150 HCPCS X-ray Of Face Bones, Minimum Of 3 Views 6 6 $425.25 $425.25 $180.08 $425.25 $393.49 2026-08-07
73564 HCPCS X-ray Of Knee, 4 Or More Views 12 6 $425.25 $425.25 $205.68 $425.25 $393.49 2026-08-07
72082 HCPCS X-ray Of Entire Middle And Lower Spine, 2-3 Views 8 4 $417.38 $417.38 $302.40 $498.75 $392.44 2026-08-07
12047 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, More Than 30.0 C… 6 6 $393.75 $393.75 $354.38 $1,538.23 $389.81 2026-08-07
12037 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, More Tha… 6 6 $393.75 $393.75 $354.38 $2,606.81 $389.81 2026-08-07
70220 HCPCS X-ray Of Paranasal Sinus, Minimum Of 3 Views 6 6 $420.00 $420.00 $184.49 $420.00 $388.62 2026-08-07
88307 HCPCS Pathology Examination Of Tissue Using A Microscope, Moderately High Complexity 6 6 $420.00 $420.00 $258.22 $420.00 $388.62 2026-08-07
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