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

SHERIDAN COUNTY HOSPITAL

Hoxie, KS · CCN 171347 · Rates published

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You selected 93306 (HCPCS)

CARD ECHOCARDIOGRAM WITHOUT

This hospital’s price: $2,111 across 3 payers · range $1,849-$2,903

Source: https://ambermed.com/480579744_sheridan-county-hospital_standardcharges.csv · observed 2026-07-15

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

1,432 distinct procedures filed
3 distinct payers
6,649 rate rows
2026-07-15 last MRF observed
Data quality

6,645 of 6,649 rate rows are consumer-grade (99.9%)

4 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 2
placeholder amount (≤ $0.02) — excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://ambermed.com/480579744_sheridan-county-hospital_standardcharges.csv
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-10-22
Content fingerprint 703c9423ab7430c1… · 823,767 bytes · first seen 2026-05-13

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
J3380
HCPCS 		Entyvio 300mg IV 20mL Sdv 3 $7,812.00 $17,274.80 $11,001.32 nat. median
$162
outlier · 67.9×
Q5115
HCPCS 		Truxima 500mg (rituximab-abbs) IV Sdv 3 $6,698.56 $11,072.00 $10,518.40 nat. median
$840
outlier · 12.5×
J3101
HCPCS 		Tenecteplase (TNKase) Kit 50mg 3 $8,073.72 $12,677.75 $10,447.50 nat. median
$3,820
outlier · 2.7×
J2506
HCPCS 		Pegfligrastim (Neulasta)6mg Inj Syr 3 $147.54 $16,001.80 $10,190.62 nat. median
$1,646
outlier · 6.2×
58670
HCPCS 		Laparoscopy Fulg Of Oviducts 3 $5,684.58 $10,046.04 $8,926.20 nat. median
$5,670
1.6× median
Q5119
HCPCS 		Ruxience (rituximab) 500 Mg Inj Sdv 50mL 3 $5,269.55 $8,710.00 $8,274.50 nat. median
$826
outlier · 10.0×
J9217
HCPCS 		Eligard 225mg(3mo)/pfs 3 $1,935.40 $28,793.55 $7,345.00 nat. median
$1,575
outlier · 4.7×
Q5111
HCPCS 		Udenyca (pegfilgrastim-cbqv) 6mg/06mL 3 $1,262.76 $10,732.15 $6,834.68 nat. median
$1,982
outlier · 3.4×
Q5108
HCPCS 		Fulphila (pegfilgrastim) 6mg/06ml Syr 3 $909.30 $10,087.10 $6,423.89 nat. median
$1,244
outlier · 5.2×
15275
HCPCS 		Epi Fix/cord Skn Subs Fce Sclp Eyeld Mth 3 $5,108.62 $8,021.80 $6,175.87 nat. median
$1,713
outlier · 3.6×
J2997
HCPCS 		Alteplase (Activase) Inj 100mg Vial 3 $235.00 $19,301.15 $6,087.32 nat. median
$500
outlier · 12.2×
J0739
HCPCS 		Apretude 600mg IM Kit 3ml 3 $5,322.00 $8,902.45 $5,669.46 nat. median
$14
outlier · 414.1×
J2356
HCPCS 		Tezspire 210mg/191mL Syringe 3 $4,809.00 $8,852.10 $5,637.39 nat. median
$81
outlier · 69.3×
Q4278
HCPCS 		EpiEffect 1x2 Cm 3 $1,102.07 $14,601.50 $5,533.20 nat. median
$351
outlier · 15.8×
28825
HCPCS 		Amputation Toe/interphalangeal Joint 3 $4,701.46 $7,382.45 $5,459.36 nat. median
$3,334
1.6× median
J2182
HCPCS 		Nucala (mepolizumab) 100mg/ml Syringe 3 $3,895.00 $8,473.05 $5,396.00 nat. median
$2,791
1.9× median
J0840
HCPCS 		Antivenin ovine(CroFab) Vial IV 3 $2,189.78 $8,228.90 $5,240.51 nat. median
$3,445
1.5× median
Q4145
HCPCS 		EpiFix Micronized 100mg 3 $3,114.54 $8,521.50 $5,158.73 nat. median
$238
outlier · 21.6×
J1306
HCPCS 		Leqvio 284 Mg Syringe 15mL 3 $4,407.68 $7,695.00 $4,900.50 nat. median
$44
outlier · 111.0×
15271
HCPCS 		Epi Fix/cord Skn Grft Sub Trnk Arms Legs 3 $3,430.96 $5,387.45 $4,152.96 nat. median
$1,725
outlier · 2.4×
J0875
HCPCS 		Dalvance (dalbavancin) 500mg Inj Sdv 3 $2,599.08 $4,296.00 $4,081.20 nat. median
$390
outlier · 10.5×
12035
HCPCS 		Wound Int Rep 126 Cm To 20 Cm S A T E 3 $2,512.64 $6,183.55 $3,937.94 nat. median
$644
outlier · 6.1×
J3262
HCPCS 		Actemra 400mg/20mL Sdv 3 $2,896.00 $6,138.90 $3,909.51 nat. median
$1,416
outlier · 2.8×
J0881
HCPCS 		Darbepoetin (aranesp)non-esrd 150mcg Inj 3 $3.82 $8,603.20 $3,810.29 nat. median
$752
outlier · 5.1×
J3111
HCPCS 		Evenity 210mg (2X105mg) Inj Syringe 3 $3,103.80 $5,843.45 $3,721.36 nat. median
$681
outlier · 5.5×
Q4186
HCPCS 		EpiFix 4cm X 4cm Patch 3 $260.17 $18,450.90 $3,705.02 nat. median
$448
outlier · 8.3×
Q5130
HCPCS 		Fylnetra 6mg/06mL Inj Syringe 3 $1,267.02 $5,779.80 $3,680.82 nat. median
$353
outlier · 10.4×
J0129
HCPCS 		Orencia 250mg Sdv 3 $2,159.85 $3,570.00 $3,391.50 nat. median
$902
outlier · 3.8×
81408
HCPCS 		Rl Full Gene Sequence (81408) 3 $2,093.90 $3,461.00 $3,287.95 nat. median
$943
outlier · 3.5×
43249
HCPCS 		Egd W Dilation Less Than 30 Mm 3 $1,995.29 $3,266.38 $3,133.10 nat. median
$2,120
1.5× median
28286
HCPCS 		Correction, Cock-up Fifth Toe, With Plas 3 $1,967.46 $5,586.81 $3,089.40 nat. median
$3,396
0.9× median
26607
HCPCS 		Clsd Trt Met Carp Fra W Manip W Ext Fix 3 $2,220.96 $3,487.45 $3,066.37 nat. median
$3,111
1.0× median
J1745
HCPCS 		Remicade (inFLIXimab) 100mg Vial Sdv 3 $1,925.72 $3,183.00 $3,023.85 nat. median
$398
outlier · 7.6×
J0897
HCPCS 		Denosumab (Prolia) 60mg/ml Syringe 3 $1,749.06 $4,746.20 $3,022.58 nat. median
$1,972
1.5× median
28124
HCPCS 		Partial Excision Bone Phalanx Toe 3 $2,537.98 $3,985.25 $2,971.76 nat. median
$3,324
0.9× median
J1602
HCPCS 		Simponi Aria 50mg/4ml Sdv 3 $663.00 $4,628.40 $2,947.56 nat. median
$273
outlier · 10.8×
22902
HCPCS 		Excision Tmr Sft Tiss Abdom Subcu >3 Cm 3 $1,441.72 $3,661.30 $2,788.76 nat. median
$1,880
1.5× median
21315
HCPCS 		Clsd Trt Of Nasal Bone Fracture Wo Man 3 $1,706.10 $2,693.51 $2,679.00 nat. median
$1,683
1.6× median
36590
HCPCS 		Removal Of Cent Line W/subcut 3 $1,782.33 $2,798.70 $2,674.83 nat. median
$1,775
1.5× median
J3240
HCPCS 		Thyrogen 09mg Inj Sdv 3 $2,667.12 $4,196.15 $2,672.28 nat. median
$2,980
0.9× median
36573
HCPCS 		Picc Line Insertion With Image Guidance 3 $1,635.92 $2,674.83 $2,568.80 nat. median
$2,034
1.3× median
J1568
HCPCS 		Octagam 5% (10grams In 200ml) Ivig 3 $630.20 $3,984.30 $2,537.37 nat. median
$710
outlier · 3.6×
J1459
HCPCS 		Privigen (igg) 10gm (10%) IV Sdv 3 $309.80 $12,877.25 $2,474.61 nat. median
$1,388
1.8× median
12051
HCPCS 		Wound Int Rep 25 Cm Or Less F E E N L 3 $985.02 $3,819.95 $2,432.70 nat. median
$513
outlier · 4.7×
J9395
HCPCS 		fulvestrant(Faslodex) 250mg Inj Syr 3 $1,646.20 $2,721.00 $2,401.22 nat. median
$236
outlier · 10.2×
J7168
HCPCS 		KCENTRA(prothrombin Complex Conc):500un 3 $3.62 $3,757.25 $2,392.78 nat. median
$21
outlier · 113.9×
74174
HCPCS 		CTA Abdomen/pelvis With 3 $1,671.01 $2,623.90 $2,347.47 nat. median
$988
outlier · 2.4×
46221
HCPCS 		Hemorrhoidectomy Internal Rub Band Ligat 3 $1,601.44 $2,514.65 $2,248.30 nat. median
$1,043
outlier · 2.2×
43237
HCPCS 		Esophagogastroduodenoscopy 3 $1,418.72 $3,266.38 $2,227.75 nat. median
$2,262
1.0× median
43246
HCPCS 		Egd W Peg 3 $1,418.72 $3,266.38 $2,227.75 nat. median
$2,130
1.0× median

Other procedures at this hospital

Browse this hospital's 1,432 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
             
J3380 HCPCS Entyvio 300mg IV 20mL Sdv 3 3 $18,184.00 $18,184.00 $7,812.00 $17,274.80 $11,001.32 2026-07-15
Q5115 HCPCS Truxima 500mg (rituximab-abbs) IV Sdv 3 3 $11,072.00 $11,072.00 $6,698.56 $11,072.00 $10,518.40 2026-07-15
J3101 HCPCS Tenecteplase (TNKase) Kit 50mg 3 3 $13,345.00 $13,345.00 $8,073.72 $12,677.75 $10,447.50 2026-07-15
J2506 HCPCS Pegfligrastim (Neulasta)6mg Inj Syr 3 3 $16,844.00 $16,844.00 $147.54 $16,001.80 $10,190.62 2026-07-15
58670 HCPCS Laparoscopy Fulg Of Oviducts 3 3 $9,396.00 $9,396.00 $5,684.58 $10,046.04 $8,926.20 2026-07-15
Q5119 HCPCS Ruxience (rituximab) 500 Mg Inj Sdv 50mL 3 3 $8,710.00 $8,710.00 $5,269.55 $8,710.00 $8,274.50 2026-07-15
J9217 HCPCS Eligard 225mg(3mo)/pfs 15 3 $13,504.00 $13,504.00 $1,935.40 $28,793.55 $7,345.00 2026-07-15
Q5111 HCPCS Udenyca (pegfilgrastim-cbqv) 6mg/06mL 3 3 $11,297.00 $11,297.00 $1,262.76 $10,732.15 $6,834.68 2026-07-15
Q5108 HCPCS Fulphila (pegfilgrastim) 6mg/06ml Syr 5 3 $10,618.00 $10,618.00 $909.30 $10,087.10 $6,423.89 2026-07-15
15275 HCPCS Epi Fix/cord Skn Subs Fce Sclp Eyeld Mth 3 3 $8,444.00 $8,444.00 $5,108.62 $8,021.80 $6,175.87 2026-07-15
J2997 HCPCS Alteplase (Activase) Inj 100mg Vial 6 3 $10,382.00 $10,382.00 $235.00 $19,301.15 $6,087.32 2026-07-15
J0739 HCPCS Apretude 600mg IM Kit 3ml 3 3 $9,371.00 $9,371.00 $5,322.00 $8,902.45 $5,669.46 2026-07-15
J2356 HCPCS Tezspire 210mg/191mL Syringe 3 3 $9,318.00 $9,318.00 $4,809.00 $8,852.10 $5,637.39 2026-07-15
Q4278 HCPCS EpiEffect 1x2 Cm 9 3 $6,148.00 $6,148.00 $1,102.07 $14,601.50 $5,533.20 2026-07-15
28825 HCPCS Amputation Toe/interphalangeal Joint 3 3 $7,771.00 $7,771.00 $4,701.46 $7,382.45 $5,459.36 2026-07-15
J2182 HCPCS Nucala (mepolizumab) 100mg/ml Syringe 3 3 $8,919.00 $8,919.00 $3,895.00 $8,473.05 $5,396.00 2026-07-15
J0840 HCPCS Antivenin ovine(CroFab) Vial IV 3 3 $8,662.00 $8,662.00 $2,189.78 $8,228.90 $5,240.51 2026-07-15
Q4145 HCPCS EpiFix Micronized 100mg 6 3 $7,059.00 $7,059.00 $3,114.54 $8,521.50 $5,158.73 2026-07-15
J1306 HCPCS Leqvio 284 Mg Syringe 15mL 3 3 $8,100.00 $8,100.00 $4,407.68 $7,695.00 $4,900.50 2026-07-15
15271 HCPCS Epi Fix/cord Skn Grft Sub Trnk Arms Legs 3 3 $5,671.00 $5,671.00 $3,430.96 $5,387.45 $4,152.96 2026-07-15
J0875 HCPCS Dalvance (dalbavancin) 500mg Inj Sdv 3 3 $4,296.00 $4,296.00 $2,599.08 $4,296.00 $4,081.20 2026-07-15
12035 HCPCS Wound Int Rep 126 Cm To 20 Cm S A T E 3 3 $6,509.00 $6,509.00 $2,512.64 $6,183.55 $3,937.94 2026-07-15
J3262 HCPCS Actemra 400mg/20mL Sdv 3 3 $6,462.00 $6,462.00 $2,896.00 $6,138.90 $3,909.51 2026-07-15
J0881 HCPCS Darbepoetin (aranesp)non-esrd 150mcg Inj 11 3 $6,298.00 $6,298.00 $3.82 $8,603.20 $3,810.29 2026-07-15
J3111 HCPCS Evenity 210mg (2X105mg) Inj Syringe 3 3 $6,151.00 $6,151.00 $3,103.80 $5,843.45 $3,721.36 2026-07-15
Q4186 HCPCS EpiFix 4cm X 4cm Patch 13 3 $6,124.00 $6,124.00 $260.17 $18,450.90 $3,705.02 2026-07-15
Q5130 HCPCS Fylnetra 6mg/06mL Inj Syringe 3 3 $6,084.00 $6,084.00 $1,267.02 $5,779.80 $3,680.82 2026-07-15
J0129 HCPCS Orencia 250mg Sdv 3 3 $3,570.00 $3,570.00 $2,159.85 $3,570.00 $3,391.50 2026-07-15
81408 HCPCS Rl Full Gene Sequence (81408) 3 3 $3,461.00 $3,461.00 $2,093.90 $3,461.00 $3,287.95 2026-07-15
43249 HCPCS Egd W Dilation Less Than 30 Mm 3 3 $3,298.00 $3,298.00 $1,995.29 $3,266.38 $3,133.10 2026-07-15
28286 HCPCS Correction, Cock-up Fifth Toe, With Plas 3 3 $3,252.00 $3,252.00 $1,967.46 $5,586.81 $3,089.40 2026-07-15
26607 HCPCS Clsd Trt Met Carp Fra W Manip W Ext Fix 3 3 $3,671.00 $3,671.00 $2,220.96 $3,487.45 $3,066.37 2026-07-15
J1745 HCPCS Remicade (inFLIXimab) 100mg Vial Sdv 3 3 $3,183.00 $3,183.00 $1,925.72 $3,183.00 $3,023.85 2026-07-15
J0897 HCPCS Denosumab (Prolia) 60mg/ml Syringe 7 3 $4,417.00 $4,417.00 $1,749.06 $4,746.20 $3,022.58 2026-07-15
28124 HCPCS Partial Excision Bone Phalanx Toe 3 3 $4,195.00 $4,195.00 $2,537.98 $3,985.25 $2,971.76 2026-07-15
J1602 HCPCS Simponi Aria 50mg/4ml Sdv 3 3 $4,872.00 $4,872.00 $663.00 $4,628.40 $2,947.56 2026-07-15
22902 HCPCS Excision Tmr Sft Tiss Abdom Subcu >3 Cm 4 3 $3,854.00 $3,854.00 $1,441.72 $3,661.30 $2,788.76 2026-07-15
21315 HCPCS Clsd Trt Of Nasal Bone Fracture Wo Man 3 3 $2,820.00 $2,820.00 $1,706.10 $2,693.51 $2,679.00 2026-07-15
36590 HCPCS Removal Of Cent Line W/subcut 3 3 $2,946.00 $2,946.00 $1,782.33 $2,798.70 $2,674.83 2026-07-15
J3240 HCPCS Thyrogen 09mg Inj Sdv 3 3 $4,417.00 $4,417.00 $2,667.12 $4,196.15 $2,672.28 2026-07-15
36573 HCPCS Picc Line Insertion With Image Guidance 3 3 $2,704.00 $2,704.00 $1,635.92 $2,674.83 $2,568.80 2026-07-15
J1568 HCPCS Octagam 5% (10grams In 200ml) Ivig 3 3 $4,194.00 $4,194.00 $630.20 $3,984.30 $2,537.37 2026-07-15
J1459 HCPCS Privigen (igg) 10gm (10%) IV Sdv 12 3 $5,430.50 $5,430.50 $309.80 $12,877.25 $2,474.61 2026-07-15
12051 HCPCS Wound Int Rep 25 Cm Or Less F E E N L 3 3 $4,021.00 $4,021.00 $985.02 $3,819.95 $2,432.70 2026-07-15
J9395 HCPCS fulvestrant(Faslodex) 250mg Inj Syr 4 3 $2,721.00 $2,721.00 $1,646.20 $2,721.00 $2,401.22 2026-07-15
J7168 HCPCS KCENTRA(prothrombin Complex Conc):500un 3 3 $3,955.00 $3,955.00 $3.62 $3,757.25 $2,392.78 2026-07-15
74174 HCPCS CTA Abdomen/pelvis With 3 3 $2,762.00 $2,762.00 $1,671.01 $2,623.90 $2,347.47 2026-07-15
46221 HCPCS Hemorrhoidectomy Internal Rub Band Ligat 3 3 $2,647.00 $2,647.00 $1,601.44 $2,514.65 $2,248.30 2026-07-15
43237 HCPCS Esophagogastroduodenoscopy 3 3 $2,345.00 $2,345.00 $1,418.72 $3,266.38 $2,227.75 2026-07-15
43246 HCPCS Egd W Peg 3 3 $2,345.00 $2,345.00 $1,418.72 $3,266.38 $2,227.75 2026-07-15
45378 HCPCS Colonoscopy Dx W Specimen 3 3 $3,671.00 $3,671.00 $1,819.79 $3,487.45 $2,220.96 2026-07-15
25605 HCPCS Clsd Trt Dist Rad Frac Epiphys Sep W Man 3 3 $2,336.00 $2,336.00 $1,413.28 $2,755.70 $2,219.20 2026-07-15
Q5103 HCPCS Inflectra (infliximab-dyyb) 100mg Vial 3 3 $2,252.00 $2,252.00 $1,362.46 $2,252.00 $2,139.40 2026-07-15
27500 HCPCS Closed Treat Femoral Shaft & Fract W/out 3 3 $2,370.00 $2,370.00 $1,433.85 $2,251.50 $2,133.00 2026-07-15
12034 HCPCS Repair Intermediate S/a/t/e 76-125 Cm 3 3 $2,394.00 $2,394.00 $1,448.37 $2,274.30 $2,132.82 2026-07-15
12018 HCPCS Wound Repair Over 30 Cm F E E N L 3 3 $3,068.00 $3,068.00 $1,856.14 $2,914.60 $2,118.91 2026-07-15
12006 HCPCS Wound Repair 201 Cm To 30 Cm S N A Eg 3 3 $3,068.00 $3,068.00 $1,856.14 $2,914.60 $2,118.91 2026-07-15
12007 HCPCS Wound Repair Over 30 Cm S N A Eg 3 3 $3,068.00 $3,068.00 $1,856.14 $2,914.60 $2,118.91 2026-07-15
12017 HCPCS Wound Repair 201 Cm To 30 Cm F E E N L 3 3 $3,068.00 $3,068.00 $1,856.14 $2,914.60 $2,118.91 2026-07-15
25565 HCPCS Clsd Trt Rad & Uln Shaft Frac Sep W Man 3 3 $2,225.00 $2,225.00 $1,346.12 $2,755.70 $2,113.75 2026-07-15
93306 HCPCS Card Echocardiogram Without 3 3 $3,056.00 $3,056.00 $1,848.88 $2,903.20 $2,110.56 2026-07-15
C8929 HCPCS Card Echocardiogram With 3 3 $3,198.00 $3,198.00 $1,934.79 $3,038.10 $2,110.56 2026-07-15
45388 HCPCS Colonoscopy W Ablation (dx) 3 3 $2,902.00 $2,902.00 $1,755.71 $2,756.90 $2,030.23 2026-07-15
45384 HCPCS Colonoscopy W Hot Biopsy (sn-dx) 3 3 $2,637.00 $2,637.00 $1,595.38 $2,505.15 $2,030.23 2026-07-15
45385 HCPCS Colonoscopy W Snare (sn-dx) 5 3 $3,391.00 $3,391.00 $1,598.41 $3,221.45 $2,030.23 2026-07-15
45381 HCPCS Colonscpy W Submucosal Inj (add On Chrg) 3 3 $2,637.00 $2,637.00 $1,595.38 $2,505.15 $2,030.23 2026-07-15
45380 HCPCS Colonoscopy Sn-dx W Biopsy 3 3 $2,637.00 $2,637.00 $1,595.38 $2,505.15 $2,030.23 2026-07-15
78452 HCPCS Nuc Myocardial Spect Multi Ef Wm 3 3 $2,730.00 $2,730.00 $1,651.65 $2,593.50 $2,022.28 2026-07-15
27786 HCPCS Clsd Treat Dist Fib Frac Lat Mall W/out 3 3 $2,370.00 $2,370.00 $1,433.85 $2,251.50 $2,003.44 2026-07-15
27760 HCPCS Applications Fiber Glass Splint Splint 3 3 $2,437.00 $2,437.00 $1,474.38 $2,315.15 $2,003.44 2026-07-15
28470 HCPCS Closed Treatment Of Metatarsal Fract Wo 3 3 $2,818.00 $2,818.00 $1,704.89 $2,677.10 $2,003.44 2026-07-15
J0882 HCPCS Darbepoetin (Aranesp)ESRD*150mcg Inj Syr 3 3 $3,166.00 $3,166.00 $3.82 $3,007.70 $1,915.43 2026-07-15
28190 HCPCS Foreign Body Rem Foot-subcuta 5 3 $352.00 $352.00 $212.96 $2,961.15 $1,885.78 2026-07-15
J0885 HCPCS epoetin(Procrit)10,000unit/1ml*SPEC Ord* 9 3 $2,917.00 $2,917.00 $892.98 $3,038.00 $1,837.99 2026-07-15
J1439 HCPCS Injectafer 750mg Inj 15ml Sdv 3 3 $3,019.00 $3,019.00 $1,087.50 $2,868.05 $1,826.50 2026-07-15
36575 HCPCS Picc Line Repair 3 3 $2,456.00 $2,456.00 $1,485.88 $2,333.20 $1,819.79 2026-07-15
Q0138 HCPCS Feraheme (ferumoxytol) 510mg Sdv 17mL 5 3 $2,921.00 $2,921.00 $214.20 $2,774.95 $1,767.20 2026-07-15
Q4187 HCPCS EpiCord 3cm X 5cm Patch 7 3 $2,649.00 $2,649.00 $260.17 $6,269.05 $1,763.20 2026-07-15
95810 HCPCS Polysomnograpyy 6or Older Sleep Staging 3 3 $2,085.00 $2,085.00 $1,261.42 $1,980.75 $1,751.82 2026-07-15
95811 HCPCS Polysomnography Age 6or Older 4+add Para 3 3 $2,318.00 $2,318.00 $1,402.39 $2,202.10 $1,751.82 2026-07-15
75635 HCPCS CTA Abdomen/pelvis With Runoffs 3 3 $2,028.00 $2,028.00 $1,226.94 $1,926.60 $1,721.56 2026-07-15
26055 HCPCS Trigger Finger Release 3 3 $1,774.00 $1,774.00 $1,073.27 $2,755.70 $1,685.30 2026-07-15
11403 HCPCS Removal Of Lesion 21 To 30cm 3 3 $2,745.00 $2,745.00 $1,211.50 $2,607.75 $1,660.72 2026-07-15
36569 HCPCS Picc Line Insertion W/out Image Guidance 3 3 $2,704.00 $2,704.00 $1,066.14 $2,568.80 $1,635.92 2026-07-15
43239 HCPCS Gastroscope W/biopsy 3 3 $2,345.00 $2,345.00 $1,418.72 $2,227.75 $1,614.36 2026-07-15
43235 HCPCS Egd/gastroscope 3 3 $2,345.00 $2,345.00 $1,418.72 $2,227.75 $1,614.36 2026-07-15
J2357 HCPCS Xolair (omalizumab) 150mg/1mL Sub-q Syr 6 3 $2,230.00 $2,230.00 $801.62 $3,135.00 $1,610.84 2026-07-15
70498 HCPCS CTA Neck With 3 3 $1,881.00 $1,881.00 $1,138.00 $1,786.95 $1,597.40 2026-07-15
70471 HCPCS CTA Head/neck With 3 3 $2,348.00 $2,348.00 $1,420.54 $2,230.60 $1,597.40 2026-07-15
70496 HCPCS CTA Head With 3 3 $1,821.00 $1,821.00 $1,101.70 $1,729.95 $1,596.12 2026-07-15
71275 HCPCS CTA Chest With 5 3 $1,856.00 $1,856.00 $1,122.88 $1,786.00 $1,575.65 2026-07-15
45333 HCPCS Sigmoidscopy Flex W Removal 3 3 $1,672.00 $1,672.00 $1,011.56 $1,588.40 $1,569.85 2026-07-15
45330 HCPCS Sigmoidscopy Diag W Spec By Brush 3 3 $1,661.00 $1,661.00 $1,004.90 $1,577.95 $1,569.85 2026-07-15
G0105 HCPCS Colonoscopy Screen High Risk 3 3 $2,011.00 $2,011.00 $1,216.66 $1,910.45 $1,569.85 2026-07-15
G0121 HCPCS Colonoscopy Screening 3 3 $2,011.00 $2,011.00 $1,216.66 $1,910.45 $1,569.85 2026-07-15
26725 HCPCS Cltx Phlngl Fx Prox/mid PX/F/T,Surgical Care Only 3 3 $1,787.00 $1,787.00 $1,081.14 $1,697.65 $1,566.58 2026-07-15
32551 HCPCS Chest Tube Insertion 3 3 $1,642.00 $1,642.00 $993.41 $2,674.83 $1,559.90 2026-07-15
24605 HCPCS Clsd Elbow Disloc With Anesthes 3 3 $1,986.00 $1,986.00 $1,201.53 $1,886.70 $1,538.75 2026-07-15
G0104 HCPCS Sigmoidoscopy Colorect Scrn Flexible 3 3 $1,617.00 $1,617.00 $978.28 $1,569.85 $1,536.15 2026-07-15
64495 HCPCS Injec Para Vert W Img Guid Lv 3 5 3 $1,999.00 $1,999.00 $376.92 $1,899.05 $1,532.96 2026-07-15
74175 HCPCS CTA Abdomen With 3 3 $1,592.00 $1,592.00 $963.16 $1,592.00 $1,512.40 2026-07-15
99285 HCPCS Emergency Room - Critical Care 6 3 $2,073.50 $2,073.50 $1,174.30 $2,095.70 $1,488.44 2026-07-15
27842 HCPCS Closed Treat Ankle Disloc W Anesthesia 3 3 $1,747.00 $1,747.00 $1,056.94 $1,659.65 $1,484.49 2026-07-15
27552 HCPCS Closed Tx Knee Disloc W Anesthesia 3 3 $1,746.00 $1,746.00 $1,056.33 $1,658.70 $1,484.49 2026-07-15
10120 HCPCS Incisn & Removal/foreign Body 3 3 $1,774.00 $1,774.00 $1,073.27 $1,685.30 $1,481.71 2026-07-15
20670 HCPCS Removal Of Implant Superficial 3 3 $1,544.00 $1,544.00 $934.12 $2,789.85 $1,466.80 2026-07-15
0360 RC — 3 3 $1,603.00 $1,603.00 $969.82 $1,522.85 $1,442.70 2026-07-15
12032 HCPCS Repair Interm Wound Scalp Axillae Trunk 3 3 $2,347.00 $2,347.00 $621.49 $2,229.65 $1,419.94 2026-07-15
99291 HCPCS ER Critical CARE,Emergency Services 3 3 $2,206.00 $2,206.00 $1,334.63 $2,095.70 $1,407.52 2026-07-15
78451 HCPCS Nuc Myocardial Spect Single 3 3 $1,878.00 $1,878.00 $1,136.19 $1,784.10 $1,391.28 2026-07-15
55100 HCPCS Drainage Scrotal Wall Abscessabcess 3 3 $1,444.00 $1,444.00 $873.62 $2,789.85 $1,371.80 2026-07-15
25600 HCPCS Immobilization Of L Lower Arm Using 3 3 $2,241.00 $2,241.00 $413.04 $2,128.95 $1,355.80 2026-07-15
10080 HCPCS Inc Drain Pilonidal Cyst Simple 3 3 $1,558.00 $1,558.00 $942.59 $1,480.10 $1,353.71 2026-07-15
12053 HCPCS Wound Int Rep 51cm To 75cm S N A Eg 3 3 $1,448.00 $1,448.00 $876.04 $1,375.60 $1,341.19 2026-07-15
43213 HCPCS Dilation Of Esophagus 3 3 $1,586.00 $1,586.00 $959.53 $1,506.70 $1,327.28 2026-07-15
J1569 HCPCS Gammagard (igg) 25gm/25ml Inj Sdv 12 3 $4,897.00 $4,897.00 $145.12 $11,701.15 $1,319.12 2026-07-15
12031 HCPCS Suture Int Rep 25 Cm Or Less S A T E 5 3 $2,167.00 $2,167.00 $621.49 $2,058.65 $1,311.04 2026-07-15
10160 HCPCS Pncture Aspir Abcess Hematoma Bulla Cyst 5 3 $1,978.00 $1,978.00 $894.19 $1,879.10 $1,305.02 2026-07-15
64484 HCPCS Njx Aa&/strd Tfrml Epi Lumbar/sacral Ea 5 3 $1,437.00 $1,437.00 $316.42 $1,365.15 $1,296.67 2026-07-15
30300 HCPCS Removal Of Foreign Body Intranasal 3 3 $1,510.00 $1,510.00 $913.55 $1,434.50 $1,292.49 2026-07-15
87507 HCPCS Gastrointestinal Panel Torch 3 3 $1,475.00 $1,475.00 $892.38 $1,401.25 $1,252.79 2026-07-15
23650 HCPCS Clsd Tx Shoulder Dis W/manip Without Aneseth 3 3 $1,410.00 $1,410.00 $853.05 $1,339.50 $1,236.84 2026-07-15
69000 HCPCS Drainage Ext Ear Abscess Hematoma Simple 3 3 $1,320.00 $1,320.00 $798.60 $1,254.00 $1,211.50 2026-07-15
26700 HCPCS Clsdmetacarp Dislocation, Single W Man W 3 3 $1,986.00 $1,986.00 $1,114.41 $1,886.70 $1,201.53 2026-07-15
32555 HCPCS US Thoracentesis With Guidance 3 3 $1,825.00 $1,825.00 $1,104.12 $1,733.75 $1,188.15 2026-07-15
64450 HCPCS Peripheral Nerve Block W Ultrasound 5 3 $1,426.00 $1,426.00 $316.42 $1,354.70 $1,183.98 2026-07-15
J2760 HCPCS Phentolamine Mesylate 5 Mg/ml Vial 3 3 $1,237.00 $1,237.00 $748.38 $1,237.00 $1,175.15 2026-07-15
43450 HCPCS Esophageal Dillitation 3 3 $1,234.00 $1,234.00 $746.57 $1,614.36 $1,172.30 2026-07-15
J2770 HCPCS quinupristin/dalfopr(Synercid)500mg 3 3 $1,232.00 $1,232.00 $745.36 $1,232.00 $1,170.40 2026-07-15
64491 HCPCS Injec Paravert Facet W Image Guid Lv 2,Bilateral Procedure 7 3 $1,222.00 $1,222.00 $268.02 $1,532.96 $1,160.90 2026-07-15
78708 HCPCS Nuc Renal Flow & Function Single W Lasix 3 3 $1,343.00 $1,343.00 $812.52 $1,275.85 $1,157.10 2026-07-15
49083 HCPCS US Paracentesis W Guidance 3 3 $1,204.00 $1,204.00 $728.42 $1,614.36 $1,143.80 2026-07-15
94003 HCPCS Rt Vent Ast Mng Init Pres Vol Preset Sub 3 3 $1,299.00 $1,299.00 $785.90 $1,234.05 $1,138.34 2026-07-15
64492 HCPCS Injec Paravert Facet Cerv /thor Level 3 4 3 $948.50 $948.50 $263.18 $1,532.96 $1,136.70 2026-07-15
P9053 HCPCS Bb Platelets Pher Leukred Irradiated 3 3 $1,260.00 $1,260.00 $762.30 $1,197.00 $1,134.00 2026-07-15
49082 HCPCS Abdominal Parancentesis Without Guidance 3 3 $1,180.00 $1,180.00 $713.90 $1,614.36 $1,121.00 2026-07-15
28660 HCPCS Clsd Trt Of Interphalangeal Jnt Wo Anes 3 3 $1,249.00 $1,249.00 $755.64 $1,186.55 $1,114.41 2026-07-15
27840 HCPCS Clsd Treat Of Ankel Disloc Without Anesthes 3 3 $1,328.00 $1,328.00 $803.44 $1,261.60 $1,114.41 2026-07-15
27560 HCPCS Closed Treat Patellar Dislocation W/out 3 3 $1,280.00 $1,280.00 $774.40 $1,216.00 $1,114.41 2026-07-15
27550 HCPCS Clsd Tx Knee Disloc Without Anesthes 3 3 $1,314.00 $1,314.00 $794.97 $1,248.30 $1,114.41 2026-07-15
26770 HCPCS Clsd Trt Interphalang Joint Dis Sgl W/ma 3 3 $1,310.00 $1,310.00 $792.55 $1,244.50 $1,114.41 2026-07-15
26605 HCPCS Clsd Trt Met Carp Fra W Manip Ea 3 3 $1,443.00 $1,443.00 $873.02 $1,370.85 $1,114.41 2026-07-15
25675 HCPCS Clsd Treat Distalradioulnar Disloc W Man 3 3 $1,323.00 $1,323.00 $800.42 $1,256.85 $1,114.41 2026-07-15
12016 HCPCS Wound Repair 126 Cm To 20 Cm F E E N L 3 3 $1,615.00 $1,615.00 $977.08 $1,534.25 $1,114.41 2026-07-15
24640 HCPCS Dislocation Of Elbow Treatment Nursemaid 3 3 $1,615.00 $1,615.00 $977.08 $1,534.25 $1,114.41 2026-07-15
12015 HCPCS Wound Repair 76 Cm To 125cm F E E N L 3 3 $1,615.00 $1,615.00 $977.08 $1,534.25 $1,114.41 2026-07-15
24600 HCPCS Dislocation Of Elbow Treatment 3 3 $1,615.00 $1,615.00 $977.08 $1,534.25 $1,114.41 2026-07-15
12005 HCPCS Wound Repair 126 Cm To 20 Cm S N A Eg 3 3 $1,615.00 $1,615.00 $977.08 $1,534.25 $1,114.41 2026-07-15
37609 HCPCS Ligation Or Biopsy Temporal Artery 3 3 $1,444.00 $1,444.00 $873.62 $1,371.80 $1,103.38 2026-07-15
64494 HCPCS Injection Para Vertebral W Img Guid Lv2 4 3 $1,405.00 $1,405.00 $255.92 $1,532.96 $1,092.38 2026-07-15
13131 HCPCS Repair Cmplx 11 To 25 Cm 3 3 $1,237.00 $1,237.00 $748.38 $1,175.15 $1,085.19 2026-07-15
P9037 HCPCS Bb Platelets Pheresis Leukoreduce 3 3 $1,159.00 $1,159.00 $701.20 $1,101.05 $1,043.10 2026-07-15
36010 HCPCS Central Line Insertion 3 3 $1,693.00 $1,693.00 $908.50 $1,608.35 $1,024.26 2026-07-15
32554 HCPCS Thoracentesis Procedure Without Guidance 3 3 $1,482.00 $1,482.00 $896.61 $1,407.90 $1,022.59 2026-07-15
41800 HCPCS Drainage Abscess/cyst/hematoma Dentoalv 3 3 $1,681.00 $1,681.00 $221.96 $1,596.95 $1,017.00 2026-07-15
28010 HCPCS Tenotomy, Percutaneous, Toe; Single Tend 3 3 $1,658.00 $1,658.00 $218.20 $1,575.10 $1,003.09 2026-07-15
64510 HCPCS Stellate Ganglion Block Under Fluoro 3 3 $1,204.00 $1,204.00 $728.42 $1,143.80 $985.02 2026-07-15
17110 HCPCS Destruction Benign Lesion <=14 Less 3 3 $1,622.00 $1,622.00 $342.14 $1,540.90 $981.31 2026-07-15
73206 HCPCS CTA Upper Extremity Bilateral With 3 3 $1,616.00 $1,616.00 $306.54 $1,535.20 $977.68 2026-07-15
73706 HCPCS CTA Lower Extremity With Left 3 3 $1,616.00 $1,616.00 $306.54 $1,535.20 $977.68 2026-07-15
12042 HCPCS Wound Int Repair 26 To 75cm N H F Ext 3 3 $1,080.00 $1,080.00 $653.40 $1,026.00 $973.89 2026-07-15
62323 HCPCS Lumbar Epidur Steroid Inj W/fluoro 5 3 $1,603.00 $1,603.00 $521.51 $1,572.83 $969.82 2026-07-15
J0248 HCPCS Remdesivir (Veklury) 100mg Inj Sdv 3 3 $1,600.00 $1,600.00 $818.00 $1,520.00 $968.00 2026-07-15
99284 HCPCS ER - Level 4 3 3 $1,292.00 $1,292.00 $781.66 $1,227.40 $957.69 2026-07-15
11765 HCPCS Wedge Excision Skin Nail Fold 3 3 $1,113.00 $1,113.00 $673.36 $1,057.35 $954.41 2026-07-15
31720 HCPCS Catheter Aspiration Nasotracheal (spx) 5 3 $1,404.00 $1,404.00 $659.45 $1,333.80 $954.41 2026-07-15
78227 HCPCS Nuc Hepatoductal System (gb) 3 3 $1,004.00 $1,004.00 $607.42 $953.80 $940.61 2026-07-15
90940 HCPCS US Post Av Fistula Evaluation 3 3 $1,043.00 $1,043.00 $631.02 $990.85 $938.70 2026-07-15
20680 HCPCS Removal Of Implant Deep 3 3 $987.00 $987.00 $597.14 $4,928.09 $937.65 2026-07-15
72191 HCPCS CTA Pelvis With 3 3 $1,534.00 $1,534.00 $306.54 $1,457.30 $928.07 2026-07-15
27096 HCPCS Sacroiliac Joint Injection W Fluoro 5 3 $1,128.00 $1,128.00 $559.02 $1,071.60 $924.00 2026-07-15
36680 HCPCS Intraosseous Injection 3 3 $1,521.00 $1,521.00 $687.10 $1,444.95 $920.20 2026-07-15
70549 HCPCS MRA Neck With/without 3 3 $1,265.00 $1,265.00 $765.32 $1,201.75 $915.94 2026-07-15
70546 HCPCS MRA Head With/without 3 3 $1,265.00 $1,265.00 $765.32 $1,201.75 $915.94 2026-07-15
70545 HCPCS MRA Head With 3 3 $1,265.00 $1,265.00 $765.32 $1,201.75 $915.94 2026-07-15
70544 HCPCS MRA Head Without 3 3 $1,265.00 $1,265.00 $765.32 $1,201.75 $915.94 2026-07-15
74185 HCPCS MRA Abdomen With/without 3 3 $1,265.00 $1,265.00 $765.32 $1,201.75 $915.94 2026-07-15
72198 HCPCS MRA Pelvis With/without 3 3 $1,265.00 $1,265.00 $765.32 $1,201.75 $915.94 2026-07-15
11400 HCPCS Removal Of Lesion 05 Cm Or Less 3 3 $960.00 $960.00 $580.80 $1,211.50 $912.00 2026-07-15
13160 HCPCS Secondary Closure Of Wound 3 3 $956.00 $956.00 $578.38 $2,807.59 $908.20 2026-07-15
19000 HCPCS Aspiration Of Cyst Of Breast 3 3 $956.00 $956.00 $578.38 $1,211.50 $908.20 2026-07-15
64493 HCPCS Injec Paravert Facet W Image Guidance 9 3 $988.00 $988.00 $443.46 $1,532.96 $885.12 2026-07-15
62321 HCPCS Thoracic Epid Ster Inj W/fluoroscopy 7 3 $877.00 $877.00 $530.58 $1,572.83 $877.00 2026-07-15
20103 HCPCS Exploration Of Penetrating Wound 3 3 $1,444.00 $1,444.00 $427.12 $1,371.80 $873.62 2026-07-15
64483 HCPCS Lumbar Transforaminal Inj With Fluoro 7 3 $956.00 $956.00 $552.36 $1,532.96 $867.35 2026-07-15
12052 HCPCS Repair Intermed F/e/e/n/l&/muc 26-50cm 3 3 $1,386.00 $1,386.00 $621.49 $1,316.70 $838.53 2026-07-15
87632 HCPCS Pneumonia Virus Panel (87632) 3 3 $1,126.00 $1,126.00 $681.23 $1,069.70 $833.99 2026-07-15
62322 HCPCS Injection Single-non Ind Cath 3 3 $1,176.00 $1,176.00 $711.48 $1,117.20 $811.11 2026-07-15
88230 HCPCS Rl Chromosome Blood Culture 3 3 $908.00 $908.00 $549.34 $862.60 $810.84 2026-07-15
C8924 HCPCS Card Echocardiogram Limited With 3 3 $1,333.00 $1,333.00 $798.59 $1,266.35 $806.46 2026-07-15
94002 HCPCS Respir Ventilation Less 24 Consec Hrs 6 3 $1,059.00 $1,059.00 $495.50 $1,234.05 $802.45 2026-07-15
93350 HCPCS Card Dobutamine Stress Echocardiogram 3 3 $1,158.00 $1,158.00 $700.59 $1,100.10 $798.59 2026-07-15
64479 HCPCS Thoracic Transforaminal Inj W Fluoro 4 3 $1,027.00 $1,027.00 $263.18 $1,532.96 $798.50 2026-07-15
12004 HCPCS Wound Repair 76 Cm To 125 Cm S N A Eg 3 3 $858.00 $858.00 $519.09 $815.10 $795.81 2026-07-15
93308 HCPCS Card Echocardiogram Limited Without 3 3 $1,149.00 $1,149.00 $695.14 $1,091.55 $793.03 2026-07-15
64454 HCPCS Inj Aa&/strd Genic Nrv Brnch W Img Guide 3 3 $833.00 $833.00 $503.96 $1,134.55 $791.35 2026-07-15
10021 HCPCS Fn Needle Asp Biop Without Img Guid1stlesion 3 3 $1,305.00 $1,305.00 $687.94 $1,239.75 $789.52 2026-07-15
69209 HCPCS Rem Impacted Earwax By Irrigation/lavage 3 3 $831.00 $831.00 $502.76 $807.89 $789.45 2026-07-15
11104 HCPCS Punch Biop Skin Sngl Lesion Simple Close 3 3 $1,291.00 $1,291.00 $687.94 $1,226.45 $781.06 2026-07-15
74182 HCPCS MRI Abdomen With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-07-15
74181 HCPCS MRI Abdomen Without 5 3 $1,049.00 $1,049.00 $516.67 $996.55 $761.10 2026-07-15
73718 HCPCS MRI Femur Without Left 3 3 $1,049.00 $1,049.00 $634.64 $996.55 $761.10 2026-07-15
70553 HCPCS MRI Brain (head) With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-07-15
70552 HCPCS MRI Brain (head) With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-07-15
70551 HCPCS MRI Brain (head) Without 3 3 $854.00 $854.00 $516.67 $811.30 $761.10 2026-07-15
70543 HCPCS MRI Orbits With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-07-15
70542 HCPCS MRI Orbits With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-07-15
70540 HCPCS MRI Orbits Without 3 3 $1,049.00 $1,049.00 $634.64 $996.55 $761.10 2026-07-15
72156 HCPCS MRI Cervical Spine With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-07-15
73223 HCPCS MRI Elbow With/without Left 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-07-15
73221 HCPCS MRI Elbow Without Left 5 3 $1,049.00 $1,049.00 $516.67 $996.55 $761.10 2026-07-15
73719 HCPCS MRI Femur With Left 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-07-15
73720 HCPCS MRI Femur With/without Left 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-07-15
72196 HCPCS MRI Pelvis With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-07-15
73222 HCPCS MRI Elbow With Left 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-07-15
72146 HCPCS MRI Thoracic Spine Without 3 3 $1,049.00 $1,049.00 $634.64 $996.55 $761.10 2026-07-15
72195 HCPCS MRI Pelvis Without 3 3 $1,049.00 $1,049.00 $634.64 $996.55 $761.10 2026-07-15
73721 HCPCS MRI Ankle Without Left 3 3 $1,049.00 $1,049.00 $634.64 $996.55 $761.10 2026-07-15
72157 HCPCS MRI Thoracic Spine With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-07-15
72158 HCPCS MRI Lumbar Spine With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-07-15
72149 HCPCS MRI Lumbar Spine With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-07-15
72148 HCPCS MRI Lumbar Spine Without 3 3 $854.00 $854.00 $516.67 $811.30 $761.10 2026-07-15
72147 HCPCS MRI Thoracic Spine With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-07-15
72142 HCPCS MRI Cervical Spine With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-07-15
72141 HCPCS MRI Cervical Spine Without 3 3 $854.00 $854.00 $516.67 $811.30 $761.10 2026-07-15
73722 HCPCS MRI Ankle With Left 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-07-15
73218 HCPCS MRI Forearm Without Left 3 3 $1,049.00 $1,049.00 $634.64 $996.55 $761.10 2026-07-15
73723 HCPCS MRI Ankle With/without Left 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-07-15
73220 HCPCS MRI Forearm With/without Left 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-07-15
73219 HCPCS MRI Forearm With Left 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-07-15
74183 HCPCS MRI Abdomen With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-07-15
71552 HCPCS MRI Chest With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-07-15
71551 HCPCS MRI Chest With 3 3 $1,153.00 $1,153.00 $697.56 $1,095.35 $761.10 2026-07-15
71550 HCPCS MRI Chest Without 3 3 $1,049.00 $1,049.00 $634.64 $996.55 $761.10 2026-07-15
72197 HCPCS MRI Pelvis With/without 3 3 $1,185.00 $1,185.00 $716.92 $1,125.75 $761.10 2026-07-15
26755 HCPCS Treat Finger Fracture W/manip 3 3 $1,246.00 $1,246.00 $745.72 $1,183.70 $753.83 2026-07-15
81219 HCPCS Rl Calreticulin (calr) Mutation Analysis 3 3 $1,236.00 $1,236.00 $345.71 $1,174.20 $747.78 2026-07-15
65220 HCPCS Removal Foreign Body Ext Eye, Corneal 3 3 $864.00 $864.00 $522.72 $820.80 $745.72 2026-07-15
27250 HCPCS Clsd Hip Disloc Traumatic Without Anesthes 3 3 $833.00 $833.00 $503.96 $791.35 $745.72 2026-07-15
13121 HCPCS Wound Repair 26 Cm To 75 Cm S A L 3 3 $907.00 $907.00 $548.74 $861.65 $742.94 2026-07-15
P9016 HCPCS Bb Red Blood Cells Per Unit 3 3 $835.00 $835.00 $505.18 $793.25 $736.05 2026-07-15
12041 HCPCS Repair Intermed N/h/f/xtrn Gent 25 Cm/< 3 3 $817.00 $817.00 $494.28 $776.15 $733.20 2026-07-15
82139 HCPCS Rl Amino Acids Quant, Plasma 3 3 $1,060.00 $1,060.00 $641.30 $1,007.00 $731.08 2026-07-15
0120 RC — 4 2 $1,458.50 $1,458.50 $174.06 $1,490.55 $730.64 2026-07-15
S8037 HCPCS MRI Cholangiopancreatography 3 3 $854.00 $854.00 $516.67 $811.30 $724.85 2026-07-15
88262 HCPCS Rl Chromosome Analysis Blood 3 3 $810.00 $810.00 $490.05 $769.50 $722.55 2026-07-15
46500 HCPCS Injection Into Hemorrhoids 3 3 $799.00 $799.00 $483.40 $759.05 $719.10 2026-07-15
36430 HCPCS Blood Administration 3 3 $812.00 $812.00 $491.26 $771.40 $710.36 2026-07-15
78472 HCPCS Nuc Muga Scan 3 3 $975.00 $975.00 $589.88 $926.25 $698.86 2026-07-15
77075 HCPCS Xr Skeletal Survey >12 Months 3 3 $941.00 $941.00 $569.30 $893.95 $697.58 2026-07-15
78264 HCPCS Nuc Gastric Emptying Study 3 3 $789.00 $789.00 $477.34 $749.55 $691.90 2026-07-15
78306 HCPCS Nuc Bone Scan Total Body 3 3 $878.00 $878.00 $531.19 $834.10 $691.90 2026-07-15
11750 HCPCS Excision Nail Matrix Permanent Removal 3 3 $958.00 $958.00 $579.59 $910.10 $687.94 2026-07-15
10061 HCPCS Incision & Drainage Of Abcess Comp Or Mu 5 3 $620.00 $620.00 $375.10 $2,914.60 $687.94 2026-07-15
78013 HCPCS Nuc Thyroid Imaging 3 3 $712.00 $712.00 $430.76 $691.90 $676.40 2026-07-15
74178 HCPCS CT Abdomen/pelvis With/without 3 3 $1,115.00 $1,115.00 $661.76 $1,059.25 $674.58 2026-07-15
30901 HCPCS Nose Bleedltd Cautery And Packing 3 3 $754.00 $754.00 $456.17 $716.30 $673.38 2026-07-15
78315 HCPCS Nuc 3-phase Bone Scan 3 3 $708.00 $708.00 $428.34 $691.90 $672.60 2026-07-15
78278 HCPCS Nuc Gastrointestinal Bleed 3 3 $702.00 $702.00 $424.71 $691.90 $666.90 2026-07-15
92960 HCPCS Cardioversion External 3 3 $1,068.00 $1,068.00 $646.14 $1,014.60 $663.86 2026-07-15
74400 HCPCS Xr Intravenous Pyelogram 3 3 $894.00 $894.00 $540.87 $849.30 $663.03 2026-07-15
93882 HCPCS US Carotid Doppler Unilateral Right 3 3 $782.00 $782.00 $473.11 $742.90 $662.25 2026-07-15
93880 HCPCS US Carotid Doppler 3 3 $782.00 $782.00 $473.11 $742.90 $662.25 2026-07-15
93970 HCPCS US Venous Upper Extremity Bilateral 5 3 $958.00 $958.00 $533.00 $910.10 $662.25 2026-07-15
93971 HCPCS US Venous Lower Extremity LEFT,Left Side 10 3 $752.00 $752.00 $454.96 $910.10 $662.25 2026-07-15
93926 HCPCS US Arterial Lower Extremity LEFT,Left Side 6 3 $958.00 $958.00 $579.59 $910.10 $662.25 2026-07-15
93925 HCPCS US Arterial Lower Extremity Bilateral 3 3 $782.00 $782.00 $473.11 $742.90 $662.25 2026-07-15
93976 HCPCS US Ovarian Doppler 3 3 $958.00 $958.00 $579.59 $910.10 $662.25 2026-07-15
93922 HCPCS US Ankle Brachial Index 3 3 $782.00 $782.00 $473.11 $742.90 $662.25 2026-07-15
93975 HCPCS US Renal Doppler 3 3 $958.00 $958.00 $579.59 $910.10 $662.25 2026-07-15
93979 HCPCS US Aorta-iliac Bypass Unilateral 3 3 $958.00 $958.00 $579.59 $910.10 $662.25 2026-07-15
93930 HCPCS US Arterial Upper Extremity Bilateral 3 3 $1,028.00 $1,028.00 $621.94 $976.60 $662.25 2026-07-15
93990 HCPCS US Av Fistula Mapping 3 3 $782.00 $782.00 $473.11 $742.90 $662.25 2026-07-15
76536 HCPCS US Neck Soft Tissue 3 3 $782.00 $782.00 $473.11 $742.90 $662.25 2026-07-15
93931 HCPCS US Arterial Upper Extremity LEFT,Left Side 6 3 $958.00 $958.00 $579.59 $910.10 $662.25 2026-07-15
93978 HCPCS US Aorta-iliac Bypass Bilateral 3 3 $1,028.00 $1,028.00 $621.94 $976.60 $662.25 2026-07-15
74160 HCPCS CT Abdomen With 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
73702 HCPCS CT Ankle With/without Left 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
70492 HCPCS CT Neck (soft Tissue) With/without 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
70491 HCPCS CT Neck (soft Tissue) With 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
70490 HCPCS CT Neck (soft Tissue) Without 3 3 $914.00 $914.00 $552.97 $868.30 $661.76 2026-07-15
70488 HCPCS CT Sinus With/without 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
70487 HCPCS CT Sinus With 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
70486 HCPCS CT Mandible Without 3 3 $914.00 $914.00 $552.97 $868.30 $661.76 2026-07-15
70482 HCPCS CT Iac With/without 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
70481 HCPCS CT Iac With 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
70480 HCPCS CT Iac Without 3 3 $914.00 $914.00 $552.97 $868.30 $661.76 2026-07-15
70470 HCPCS CT Head (brain) With/without 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
70460 HCPCS CT Head (brain) With 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
70450 HCPCS CT Head (brain) Without 3 3 $758.00 $758.00 $458.59 $720.10 $661.76 2026-07-15
73201 HCPCS CT Elbow With Left 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
73200 HCPCS CT Elbow Without Left 3 3 $914.00 $914.00 $552.97 $868.30 $661.76 2026-07-15
74177 HCPCS CT Abdomen/pelvis With 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
73202 HCPCS CT Elbow With/without Left 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
73700 HCPCS CT Ankle Without Left 3 3 $914.00 $914.00 $552.97 $868.30 $661.76 2026-07-15
74150 HCPCS CT Abdomen Without 3 3 $914.00 $914.00 $552.97 $868.30 $661.76 2026-07-15
74176 HCPCS CT Renal Stone 3 3 $981.00 $981.00 $593.50 $931.95 $661.76 2026-07-15
72194 HCPCS CT Pelvis With/without 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
72133 HCPCS CT Lumbar Spine With/without 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
72132 HCPCS CT Lumbar Spine With 3 3 $1,046.00 $1,046.00 $632.83 $993.70 $661.76 2026-07-15
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