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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

TREGO COUNTY LEMKE MEMORIAL HOSPITAL

Wakeeney, KS · CCN 171355 · Rates published

Your selected procedure

You selected 93306 (HCPCS)

Ultrasound of heart with color-depicted blood flow, rate, direction and valve function

This hospital’s price: $2,095 across 15 payers · range $1,396-$2,850

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbTCLMWAKEENEYKS&type=CDMWithoutLabel · observed 2026-03-11

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.

1,508 distinct procedures filed
15 distinct payers
38,840 rate rows
2026-03-11 last MRF observed
Data quality

38,658 of 38,840 rate rows are consumer-grade (99.5%)

182 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 90
per-diem day rate — not a per-procedure price 54
percent-of-charges filed in the dollar field — excluded from medians 37
placeholder amount (≤ $0.02) — excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbTCLMWAKEENEYKS&type=CDMWithoutLabel
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-19
Content fingerprint c7b7a7d41497cbc9… · 16,852,413 bytes · first seen 2026-05-08

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
J2327
HCPCS 		Injection, Risankizumab-rzaa, Intravenous, 1 Mg 14 $9,675.29 $19,745.48 $15,125.04 nat. median
$1,767
outlier · 8.6×
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 15 $196.97 $15,336.66 $10,459.60 nat. median
$3,787
outlier · 2.8×
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 15 $35.07 $13,993.52 $9,543.58 nat. median
$155
outlier · 61.7×
J2353
HCPCS 		Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg 15 $259.42 $13,002.52 $8,867.72 nat. median
$5,623
1.6× median
22513
HCPCS 		Treatment Of Broken Middle Spine Bone With Placement Of Stabilizing Device Using… 15 $4,299.75 $11,489.12 $7,458.75 nat. median
$8,377
0.9× median
J2356
HCPCS 		Injection, Tezepelumab-ekko, 1 Mg 14 $4,230.21 $8,633.08 $6,612.94 nat. median
$76
outlier · 87.3×
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 14 $3,953.15 $8,067.66 $6,179.83 nat. median
$1,659
outlier · 3.7×
15275
HCPCS 		Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 15 $3,038.00 $6,200.00 $5,270.00 nat. median
$1,713
outlier · 3.1×
J2182
HCPCS 		Injection, Mepolizumab, 1 Mg 15 $38.95 $7,582.88 $5,171.52 nat. median
$2,791
1.9× median
19301
HCPCS 		Partial Removal Of Breast 15 $2,940.00 $7,655.85 $5,100.00 nat. median
$3,992
1.3× median
63650
HCPCS 		Insertion Of Spinal Neurostimulator Electrode Array Through Skin 15 $2,940.00 $9,008.02 $5,100.00 nat. median
$7,298
0.7× median
22515
HCPCS 		Treatment Of Broken Spine Bone With Stabilizing Device, Each Additional Segment 14 $3,075.83 $6,277.20 $4,808.34 nat. median
$5,281
0.9× median
49592
HCPCS 		Initial Repair Of Entrapped Hernia Of Abdomen, Less Than 3 Cm In Length 14 $2,837.10 $5,790.00 $4,435.14 nat. median
$5,879
0.8× median
49594
HCPCS 		Initial Repair Of Entrapped Hernia Of Abdomen, 3-10 Cm In Length 14 $2,837.10 $5,790.00 $4,435.14 nat. median
$5,991
0.7× median
49505
HCPCS 		Repair Of Groin Hernia (5 Years Or Older) 15 $2,450.00 $5,634.69 $4,250.00 nat. median
$3,855
1.1× median
49591
HCPCS 		Initial Repair Of Sliding Hernia Of Abdomen, Less Than 3 Cm In Length 14 $2,450.00 $5,000.00 $3,830.00 nat. median
$3,840
1.0× median
55500
HCPCS 		Removal Of Fluid Collection In Sperm Cord 15 $307.04 $6,095.00 $3,778.90 nat. median
$3,587
1.1× median
24102
HCPCS 		Removal Of Elbow Joint Lining 15 $2,107.00 $4,300.00 $3,655.00 nat. median
$3,546
1.0× median
55520
HCPCS 		Removal Of Growth Of Sperm Cord 15 $2,082.50 $5,405.92 $3,612.50 nat. median
$3,524
1.0× median
15271
HCPCS 		Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C… 15 $2,058.00 $4,200.00 $3,570.00 nat. median
$1,725
outlier · 2.1×
21552
HCPCS 		Removal Of Growth Of Soft Tissue Under Skin Of Neck Or Front Of Chest, 3.0 Cm Or… 15 $2,058.00 $4,211.20 $3,570.00 nat. median
$3,005
1.2× median
15276
HCPCS 		Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 14 $2,278.50 $4,650.00 $3,561.90 nat. median
$373
outlier · 9.5×
12036
HCPCS 		Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 20.1-30.… 15 $2,479.40 $5,060.00 $3,450.92 nat. median
$857
outlier · 4.0×
J3262
HCPCS 		Injection, Tocilizumab, 1 Mg 15 $7.44 $5,046.06 $3,441.41 nat. median
$1,413
outlier · 2.4×
55040
HCPCS 		Removal Of Fluid Collection In Testicle And Sperm Reservoir 15 $2,455.88 $5,012.00 $3,418.18 nat. median
$3,679
0.9× median
J3247
HCPCS 		Injection, Secukinumab, Intravenous, 1 Mg 14 $2,130.77 $4,348.52 $3,330.97 nat. median
$50
outlier · 67.0×
11446
HCPCS 		Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, M… 15 $1,911.00 $3,952.92 $3,315.00 nat. median
$2,812
1.2× median
12035
HCPCS 		Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 12.6-20.… 15 $2,254.00 $4,600.00 $3,137.20 nat. median
$643
outlier · 4.9×
4865570_1
CDM 		Praxbind 5g Dose(2x 2.5g/50ml) 11 $2,457.83 $4,765.18 $3,109.91 nat. median
$3,110
1.0× median
70471
HCPCS 		Computed Tomographic Angiography (cta), Head And Neck, With Contrast Material(s)… 14 $1,945.30 $3,970.00 $3,041.02 nat. median
$815
outlier · 3.7×
46040
HCPCS 		Drainage Of Deep Abscess In Rectum 15 $1,606.71 $3,279.00 $2,787.15 nat. median
$1,690
1.6× median
36561
HCPCS 		Insertion Of Central Venous Tube With Port (5 Years Or Older) 15 $276.57 $4,903.12 $2,749.70 nat. median
$3,751
0.7× median
J3358
HCPCS 		Ustekinumab, For Intravenous Injection, 1 Mg 15 $15.59 $4,000.44 $2,728.30 nat. median
$264
outlier · 10.3×
95810
HCPCS 		Sleep Study In Sleep Lab (6 Years Or Older) 15 $1,444.71 $3,880.00 $2,646.16 nat. median
$1,827
1.4× median
95811
HCPCS 		Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 15 $1,444.71 $3,880.00 $2,646.16 nat. median
$1,894
1.4× median
21931
HCPCS 		Removal Of Growth Under Skin Of Back Or Lower Sides, 3.0 Cm Or More 15 $1,506.75 $3,075.00 $2,613.75 nat. median
$1,983
1.3× median
J1602
HCPCS 		Injection, Golimumab, 1 Mg, For Intravenous Use 15 $14.52 $3,803.76 $2,594.16 nat. median
$261
outlier · 9.9×
11444
HCPCS 		Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3… 15 $1,494.50 $3,050.00 $2,592.50 nat. median
$1,624
1.6× median
95805
HCPCS 		Sleep Study, Multiple Trials 15 $1,444.71 $3,800.00 $2,591.60 nat. median
$1,233
outlier · 2.1×
28820
HCPCS 		Amputation Of Toe At Joint Between Forefoot And Toes 15 $1,470.00 $5,878.28 $2,550.00 nat. median
$3,394
0.8× median
19120
HCPCS 		Removal Of Growth And Tissue Of Breast, Duct, Or Nipple 15 $1,442.56 $5,665.54 $2,502.40 nat. median
$3,667
0.7× median
11406
HCPCS 		Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 15 $1,438.15 $2,935.00 $2,494.75 nat. median
$1,750
1.4× median
59409
HCPCS 		Vaginal Delivery 14 $1,592.50 $3,250.00 $2,489.50 nat. median
$3,148
0.8× median
27337
HCPCS 		Removal Of Growth Under Skin Of Thigh Or Knee, Less Than 3.0 Cm 15 $246.74 $4,010.00 $2,486.20 nat. median
$3,019
0.8× median
J0897
HCPCS 		Injection, Denosumab, 1 Mg 15 $32.42 $3,562.96 $2,429.94 nat. median
$1,982
1.2× median
23071
HCPCS 		Removal Of Growth Under Skin Of Shoulder Area, 3.0 Cm Or More 15 $1,396.50 $2,850.00 $2,422.50 nat. median
$1,906
1.3× median
15272
HCPCS 		Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, Each Addi… 14 $1,543.50 $3,150.00 $2,412.90 nat. median
$404
outlier · 6.0×
22903
HCPCS 		Removal Of Growth Of Soft Tissue Of Abdominal Wall, 3.0 Cm Or More 15 $1,372.00 $3,222.28 $2,380.00 nat. median
$2,993
0.8× median
64624
HCPCS 		Destruction Of Nerve Branches Of Knee Using Imaging Guidance 14 $125.36 $3,812.00 $2,363.44 nat. median
$2,300
1.0× median
24071
HCPCS 		Removal Of Growth Under Skin Of Upper Arm Or Elbow, 3.0 Cm Or More 15 $1,396.50 $2,850.00 $2,361.81 nat. median
$2,987
0.8× median

Other procedures at this hospital

Browse this hospital's 1,508 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
             
J2327 HCPCS Injection, Risankizumab-rzaa, Intravenous, 1 Mg 14 14 $19,745.48 $16,783.66 $9,675.29 $19,745.48 $15,125.04 2026-03-11
J3101 HCPCS Injection, Tenecteplase, 1 Mg 15 15 $15,336.66 $13,036.16 $196.97 $15,336.66 $10,459.60 2026-03-11
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 15 15 $13,993.52 $11,894.49 $35.07 $13,993.52 $9,543.58 2026-03-11
J2353 HCPCS Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg 15 15 $13,002.52 $11,052.14 $259.42 $13,002.52 $8,867.72 2026-03-11
22513 HCPCS Treatment Of Broken Middle Spine Bone With Placement Of Stabilizing Device Using… 15 15 $8,775.00 $7,458.75 $4,299.75 $11,489.12 $7,458.75 2026-03-11
J2356 HCPCS Injection, Tezepelumab-ekko, 1 Mg 14 14 $8,633.08 $7,338.12 $4,230.21 $8,633.08 $6,612.94 2026-03-11
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 14 14 $8,067.66 $6,857.51 $3,953.15 $8,067.66 $6,179.83 2026-03-11
15275 HCPCS Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 15 15 $6,200.00 $5,270.00 $3,038.00 $6,200.00 $5,270.00 2026-03-11
J2182 HCPCS Injection, Mepolizumab, 1 Mg 15 15 $7,582.88 $6,445.45 $38.95 $7,582.88 $5,171.52 2026-03-11
63650 HCPCS Insertion Of Spinal Neurostimulator Electrode Array Through Skin 15 15 $6,000.00 $5,100.00 $2,940.00 $9,008.02 $5,100.00 2026-03-11
19301 HCPCS Partial Removal Of Breast 15 15 $6,000.00 $5,100.00 $2,940.00 $7,655.85 $5,100.00 2026-03-11
22515 HCPCS Treatment Of Broken Spine Bone With Stabilizing Device, Each Additional Segment 14 14 $6,277.20 $5,335.62 $3,075.83 $6,277.20 $4,808.34 2026-03-11
49594 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, 3-10 Cm In Length 14 14 $5,790.00 $4,921.50 $2,837.10 $5,790.00 $4,435.14 2026-03-11
49592 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, Less Than 3 Cm In Length 14 14 $5,790.00 $4,921.50 $2,837.10 $5,790.00 $4,435.14 2026-03-11
49505 HCPCS Repair Of Groin Hernia (5 Years Or Older) 15 15 $5,000.00 $4,250.00 $2,450.00 $5,634.69 $4,250.00 2026-03-11
49591 HCPCS Initial Repair Of Sliding Hernia Of Abdomen, Less Than 3 Cm In Length 14 14 $5,000.00 $4,250.00 $2,450.00 $5,000.00 $3,830.00 2026-03-11
55500 HCPCS Removal Of Fluid Collection In Sperm Cord 24 15 $6,095.00 $5,180.75 $307.04 $6,095.00 $3,778.90 2026-03-11
24102 HCPCS Removal Of Elbow Joint Lining 15 15 $4,300.00 $3,655.00 $2,107.00 $4,300.00 $3,655.00 2026-03-11
55520 HCPCS Removal Of Growth Of Sperm Cord 15 15 $4,250.00 $3,612.50 $2,082.50 $5,405.92 $3,612.50 2026-03-11
15271 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C… 15 15 $4,200.00 $3,570.00 $2,058.00 $4,200.00 $3,570.00 2026-03-11
21552 HCPCS Removal Of Growth Of Soft Tissue Under Skin Of Neck Or Front Of Chest, 3.0 Cm Or… 15 15 $4,200.00 $3,570.00 $2,058.00 $4,211.20 $3,570.00 2026-03-11
15276 HCPCS Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 14 14 $4,650.00 $3,952.50 $2,278.50 $4,650.00 $3,561.90 2026-03-11
12036 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 20.1-30.… 15 15 $5,060.00 $4,301.00 $2,479.40 $5,060.00 $3,450.92 2026-03-11
J3262 HCPCS Injection, Tocilizumab, 1 Mg 15 15 $5,046.06 $4,289.15 $7.44 $5,046.06 $3,441.41 2026-03-11
55040 HCPCS Removal Of Fluid Collection In Testicle And Sperm Reservoir 15 15 $5,012.00 $4,260.20 $2,455.88 $5,012.00 $3,418.18 2026-03-11
J3247 HCPCS Injection, Secukinumab, Intravenous, 1 Mg 14 14 $4,348.52 $3,696.24 $2,130.77 $4,348.52 $3,330.97 2026-03-11
11446 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, M… 15 15 $3,900.00 $3,315.00 $1,911.00 $3,952.92 $3,315.00 2026-03-11
12035 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 12.6-20.… 15 15 $4,600.00 $3,910.00 $2,254.00 $4,600.00 $3,137.20 2026-03-11
4865570_1 CDM Praxbind 5g Dose(2x 2.5g/50ml) 11 11 $5,015.98 $4,263.58 $2,457.83 $4,765.18 $3,109.91 2026-03-11
70471 HCPCS Computed Tomographic Angiography (cta), Head And Neck, With Contrast Material(s)… 14 14 $3,970.00 $3,374.50 $1,945.30 $3,970.00 $3,041.02 2026-03-11
46040 HCPCS Drainage Of Deep Abscess In Rectum 15 15 $3,279.00 $2,787.15 $1,606.71 $3,279.00 $2,787.15 2026-03-11
36561 HCPCS Insertion Of Central Venous Tube With Port (5 Years Or Older) 21 15 $4,435.00 $3,769.75 $276.57 $4,903.12 $2,749.70 2026-03-11
J3358 HCPCS Ustekinumab, For Intravenous Injection, 1 Mg 15 15 $4,000.44 $3,400.37 $15.59 $4,000.44 $2,728.30 2026-03-11
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 15 15 $3,880.00 $3,298.00 $1,444.71 $3,880.00 $2,646.16 2026-03-11
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 15 15 $3,880.00 $3,298.00 $1,444.71 $3,880.00 $2,646.16 2026-03-11
21931 HCPCS Removal Of Growth Under Skin Of Back Or Lower Sides, 3.0 Cm Or More 15 15 $3,075.00 $2,613.75 $1,506.75 $3,075.00 $2,613.75 2026-03-11
J1602 HCPCS Injection, Golimumab, 1 Mg, For Intravenous Use 15 15 $3,803.76 $3,233.20 $14.52 $3,803.76 $2,594.16 2026-03-11
11444 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3… 15 15 $3,050.00 $2,592.50 $1,494.50 $3,050.00 $2,592.50 2026-03-11
95805 HCPCS Sleep Study, Multiple Trials 15 15 $3,800.00 $3,230.00 $1,444.71 $3,800.00 $2,591.60 2026-03-11
28820 HCPCS Amputation Of Toe At Joint Between Forefoot And Toes 15 15 $3,000.00 $2,550.00 $1,470.00 $5,878.28 $2,550.00 2026-03-11
19120 HCPCS Removal Of Growth And Tissue Of Breast, Duct, Or Nipple 15 15 $2,944.00 $2,502.40 $1,442.56 $5,665.54 $2,502.40 2026-03-11
11406 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 15 15 $2,935.00 $2,494.75 $1,438.15 $2,935.00 $2,494.75 2026-03-11
59409 HCPCS Vaginal Delivery 14 14 $3,250.00 $2,762.50 $1,592.50 $3,250.00 $2,489.50 2026-03-11
27337 HCPCS Removal Of Growth Under Skin Of Thigh Or Knee, Less Than 3.0 Cm 24 15 $4,010.00 $3,408.50 $246.74 $4,010.00 $2,486.20 2026-03-11
J0897 HCPCS Injection, Denosumab, 1 Mg 15 15 $3,562.96 $3,028.52 $32.42 $3,562.96 $2,429.94 2026-03-11
23071 HCPCS Removal Of Growth Under Skin Of Shoulder Area, 3.0 Cm Or More 15 15 $2,850.00 $2,422.50 $1,396.50 $2,850.00 $2,422.50 2026-03-11
15272 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, Each Addi… 14 14 $3,150.00 $2,677.50 $1,543.50 $3,150.00 $2,412.90 2026-03-11
22903 HCPCS Removal Of Growth Of Soft Tissue Of Abdominal Wall, 3.0 Cm Or More 15 15 $2,800.00 $2,380.00 $1,372.00 $3,222.28 $2,380.00 2026-03-11
64624 HCPCS Destruction Of Nerve Branches Of Knee Using Imaging Guidance 23 14 $3,812.00 $3,240.20 $125.36 $3,812.00 $2,363.44 2026-03-11
24071 HCPCS Removal Of Growth Under Skin Of Upper Arm Or Elbow, 3.0 Cm Or More 15 15 $2,850.00 $2,422.50 $1,396.50 $2,850.00 $2,361.81 2026-03-11
11626 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More Tha… 15 15 $2,770.00 $2,354.50 $1,357.30 $4,218.12 $2,354.50 2026-03-11
11646 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More… 15 15 $2,770.00 $2,354.50 $1,357.30 $2,770.00 $2,354.50 2026-03-11
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 15 15 $2,885.00 $2,452.25 $1,413.65 $2,885.00 $2,330.43 2026-03-11
11426 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More … 15 15 $2,665.00 $2,265.25 $1,305.85 $2,665.00 $2,265.25 2026-03-11
35206 HCPCS Repair Of Blood Vessel Of Arm 15 15 $3,275.00 $2,783.75 $1,604.75 $3,275.00 $2,233.55 2026-03-11
36582 HCPCS Replacement Of Tunneled Central Venous Tube With Port 15 15 $3,275.00 $2,783.75 $1,604.75 $3,275.00 $2,233.55 2026-03-11
59612 HCPCS Vaginal Delivery After Previous Cesarean Delivery 14 14 $2,900.00 $2,465.00 $1,421.00 $2,900.00 $2,221.40 2026-03-11
11606 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 15 15 $2,600.00 $2,210.00 $1,274.00 $2,733.35 $2,210.00 2026-03-11
J0875 HCPCS Injection, Dalbavancin, 5 Mg 15 15 $3,201.56 $2,721.33 $19.65 $3,201.56 $2,183.46 2026-03-11
Q5108 HCPCS Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 15 15 $3,116.76 $2,649.25 $220.19 $3,116.76 $2,125.63 2026-03-11
36558 HCPCS Insertion Of Tunneled Central Venous Tube For Infusion (5 Years Or Older) 15 15 $2,481.50 $2,109.28 $1,215.94 $4,194.63 $2,109.28 2026-03-11
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 15 15 $2,850.00 $2,422.50 $1,396.50 $2,850.00 $2,095.24 2026-03-11
11462 HCPCS Removal Of Skin And Tissue Of Groin For Inflamed Sweat Glands With Simple Or Int… 15 15 $2,400.00 $2,040.00 $1,176.00 $4,218.12 $2,040.00 2026-03-11
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 15 15 $2,945.00 $2,503.25 $53.11 $2,945.00 $2,008.49 2026-03-11
J0840 HCPCS Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 15 15 $2,335.31 $1,985.01 $1,144.30 $2,436.16 $1,985.01 2026-03-11
11423 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 2.1-3… 15 15 $2,320.00 $1,972.00 $1,136.80 $2,320.00 $1,972.00 2026-03-11
46221 HCPCS Removal Of External Hemorrhoids By Rubber Banding 15 15 $2,310.00 $1,963.50 $1,131.90 $2,310.00 $1,963.50 2026-03-11
12006 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 15 15 $2,300.00 $1,955.00 $1,127.00 $2,300.00 $1,955.00 2026-03-11
26160 HCPCS Removal Of Growth Of Tendon Finger Or Hand 15 15 $2,290.00 $1,946.50 $1,122.10 $2,836.93 $1,946.50 2026-03-11
46280 HCPCS Repair Of Abnormal Drainage Tract Around Anal Sphincter 15 15 $2,825.00 $2,401.25 $1,104.94 $2,825.00 $1,926.65 2026-03-11
Q4205 HCPCS Membrane Graft Or Membrane Wrap, Per Square Centimeter 14 14 $2,500.00 $2,125.00 $1,225.00 $2,500.00 $1,915.00 2026-03-11
21930 HCPCS Removal Of Growth Under Skin Of Back Or Lower Sides, Less Than 3.0 Cm 30 15 $2,200.00 $1,870.00 $1,078.00 $2,200.00 $1,870.00 2026-03-11
J2357 HCPCS Injection, Omalizumab, 5 Mg 43 15 $2,736.70 $2,326.20 $47.35 $5,820.38 $1,866.43 2026-03-11
36573 HCPCS Insertion Of Tube For Infusion With Imaging Guidance And Review By Radiologist, … 23 14 $3,000.00 $2,550.00 $68.14 $3,000.00 $1,860.00 2026-03-11
36571 HCPCS Insertion Of Central Venous Tube With Port For Infusion (5 Years Or Older) 21 15 $3,000.00 $2,550.00 $267.32 $5,238.80 $1,860.00 2026-03-11
78452 HCPCS Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 15 15 $2,175.00 $1,848.75 $1,065.75 $2,175.00 $1,848.75 2026-03-11
64772 HCPCS Incision Or Removal Of Spinal Nerve 15 15 $2,100.00 $1,785.00 $1,029.00 $2,220.93 $1,785.00 2026-03-11
26350 HCPCS Repair Of Finger Tendon Of Under Side Of Hand Other Than Upper Most Part Of Palm… 15 15 $2,100.00 $1,785.00 $1,029.00 $2,100.00 $1,785.00 2026-03-11
24560 HCPCS Closed Treatment Of Broken Outer Part Of Upper Arm Bone At Elbow 15 15 $2,100.00 $1,785.00 $1,029.00 $2,100.00 $1,785.00 2026-03-11
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 15 15 $2,597.38 $2,207.77 $13.80 $2,597.38 $1,771.41 2026-03-11
11424 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4… 15 15 $2,075.00 $1,763.75 $1,016.75 $2,464.02 $1,763.75 2026-03-11
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 15 15 $2,065.00 $1,755.25 $1,011.85 $2,065.00 $1,709.06 2026-03-11
45384 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using A Flexible Endoscope With Elec… 15 15 $2,000.00 $1,700.00 $980.00 $2,000.00 $1,700.00 2026-03-11
36590 HCPCS Removal Of Central Venous Tube With Port Or Pump 29 15 $2,000.00 $1,700.00 $980.00 $2,607.66 $1,700.00 2026-03-11
21012 HCPCS Removal Of Growth Under Skin Of Face Or Scalp, 2.0 Cm Or More 15 15 $1,990.00 $1,691.50 $975.10 $1,990.00 $1,691.50 2026-03-11
43249 HCPCS Balloon Dilation Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexibl… 15 15 $1,969.80 $1,674.33 $965.20 $2,142.20 $1,674.33 2026-03-11
64635 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 46 14 $2,700.00 $2,295.00 $162.92 $3,750.00 $1,674.00 2026-03-11
43245 HCPCS Dilation Of Stomach Outlet Using A Flexible Endoscope 15 15 $1,956.25 $1,662.81 $958.56 $2,161.54 $1,662.81 2026-03-11
12034 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 7.6-12.5… 30 15 $2,200.00 $1,870.00 $931.00 $2,500.00 $1,660.00 2026-03-11
64633 HCPCS Destruction Of Upper Or Middle Spinal Facet Joint Nerves Using Imaging Guidance,… 46 14 $2,675.00 $2,273.75 $162.49 $4,680.00 $1,658.50 2026-03-11
46320 HCPCS Removal Of External Hemorrhoid With Blood Clot 30 15 $2,187.50 $1,859.38 $918.75 $2,500.00 $1,640.62 2026-03-11
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 15 15 $2,010.00 $1,708.50 $984.90 $2,010.00 $1,622.66 2026-03-11
35207 HCPCS Repair Of Blood Vessel Of Hand Or Finger 15 15 $1,904.00 $1,618.40 $932.96 $2,103.53 $1,618.40 2026-03-11
11624 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4.0 … 15 15 $1,900.00 $1,615.00 $931.00 $2,468.93 $1,615.00 2026-03-11
11404 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 3.1-4.0 Cm 15 15 $1,900.00 $1,615.00 $931.00 $2,070.38 $1,615.00 2026-03-11
J1459 HCPCS Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 57 15 $1,587.60 $1,349.46 $61.96 $5,696.56 $1,587.60 2026-03-11
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 15 15 $1,965.00 $1,670.25 $962.85 $1,965.00 $1,585.81 2026-03-11
45381 HCPCS Injection Beneath Lining Of Large Bowel Using A Flexible Endoscope 15 15 $1,865.00 $1,585.25 $913.85 $1,865.00 $1,585.25 2026-03-11
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 15 15 $1,965.00 $1,670.25 $962.85 $1,965.00 $1,584.54 2026-03-11
11644 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3.1-… 15 15 $1,860.00 $1,581.00 $911.40 $1,860.00 $1,581.00 2026-03-11
32551 HCPCS Removal Of Fluid From Between Lung And Chest Cavity 14 14 $2,050.00 $1,742.50 $1,004.50 $2,050.00 $1,570.30 2026-03-11
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 15 15 $1,940.00 $1,649.00 $950.60 $1,940.00 $1,564.21 2026-03-11
11442 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 1… 15 15 $1,800.00 $1,530.00 $882.00 $1,800.00 $1,530.00 2026-03-11
64721 HCPCS Release And/or Relocation Of Hand Nerve 15 15 $1,800.00 $1,530.00 $882.00 $2,220.93 $1,530.00 2026-03-11
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 15 15 $1,790.00 $1,521.50 $877.10 $1,961.27 $1,521.50 2026-03-11
45388 HCPCS Destruction Of Polyp Or Growth Of Large Bowel Using A Flexible Endoscope 15 15 $1,785.00 $1,517.25 $874.65 $1,988.89 $1,517.25 2026-03-11
11443 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2… 30 15 $1,771.50 $1,505.78 $854.07 $1,925.36 $1,481.55 2026-03-11
12005 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 15 15 $2,150.00 $1,827.50 $1,053.50 $2,150.00 $1,466.30 2026-03-11
J2407 HCPCS Injection, Oritavancin (orbactiv), 10 Mg 15 15 $2,141.33 $1,820.13 $35.50 $2,141.33 $1,460.39 2026-03-11
43251 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 15 15 $1,717.00 $1,459.45 $841.33 $1,850.77 $1,459.45 2026-03-11
43246 HCPCS Insertion Of Stomach Tube Using A Flexible Endoscope 30 15 $1,975.00 $1,678.75 $808.50 $2,918.42 $1,455.50 2026-03-11
Q4256 HCPCS Mlg-complete, Per Square Centimeter 14 14 $1,900.00 $1,615.00 $931.00 $1,900.00 $1,455.40 2026-03-11
11422 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 1.1-2… 15 15 $1,700.00 $1,445.00 $833.00 $2,468.93 $1,445.00 2026-03-11
10121 HCPCS Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Complex 15 15 $1,700.00 $1,445.00 $833.00 $2,074.52 $1,445.00 2026-03-11
11643 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.1-… 15 15 $1,900.00 $1,615.00 $931.00 $1,900.00 $1,417.09 2026-03-11
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 15 15 $2,075.32 $1,764.02 $1.40 $2,075.32 $1,415.37 2026-03-11
99291 HCPCS Critical Care, First 30-74 Minutes 15 15 $1,760.00 $1,496.00 $862.40 $1,760.00 $1,397.30 2026-03-11
44388 HCPCS Diagnostic Exam Of Large Bowel Using An Endoscope Inserted Through Surgically Cr… 15 15 $2,000.00 $1,700.00 $980.00 $2,000.00 $1,377.03 2026-03-11
12042 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 2.6-7.5 Cm 15 15 $2,008.80 $1,707.48 $966.82 $2,008.80 $1,370.00 2026-03-11
43255 HCPCS Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flex… 15 15 $1,600.00 $1,360.00 $784.00 $2,871.91 $1,360.00 2026-03-11
43248 HCPCS Insertion Of Guide Wire With Dilation Of Esophagus Using A Flexible Endoscope 15 15 $1,600.00 $1,360.00 $784.00 $1,600.00 $1,360.00 2026-03-11
27842 HCPCS Closed Treatment Of Dislocated Ankle Under Anesthesia 15 15 $1,570.00 $1,334.50 $769.30 $1,570.00 $1,334.50 2026-03-11
43247 HCPCS Removal Of Foreign Bodies Of Esophagus, Stomach, And/or Upper Small Bowel Using … 15 15 $1,562.50 $1,328.13 $765.63 $1,790.00 $1,328.13 2026-03-11
G0105 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual At High Risk 15 15 $1,562.50 $1,328.13 $765.63 $1,562.50 $1,328.13 2026-03-11
G0121 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual Not Meeting Criteria For … 15 15 $1,562.50 $1,328.13 $765.63 $1,562.50 $1,328.13 2026-03-11
62327 HCPCS Insertion Of Tube And Injection Of Substance Into Lower Spine Canal Using Imagin… 15 15 $1,550.00 $1,317.50 $759.50 $1,550.00 $1,314.88 2026-03-11
J1561 HCPCS Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liquid)… 29 15 $4,631.48 $3,936.76 $63.59 $4,631.48 $1,302.62 2026-03-11
Q4170 HCPCS Cygnus, Per Square Centimeter 14 14 $1,700.00 $1,445.00 $833.00 $1,700.00 $1,302.20 2026-03-11
45385 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S… 24 15 $2,100.00 $1,785.00 $209.49 $2,100.00 $1,302.00 2026-03-11
11642 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 1.1-… 15 15 $1,900.00 $1,615.00 $931.00 $1,900.00 $1,295.80 2026-03-11
47000 HCPCS Needle Biopsy Of Liver Through Skin 15 15 $1,500.00 $1,275.00 $735.00 $1,500.00 $1,275.00 2026-03-11
36589 HCPCS Removal Of Tunneled Central Venous Tube 15 15 $1,500.00 $1,275.00 $735.00 $1,500.00 $1,275.00 2026-03-11
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 57 15 $8,689.50 $7,386.08 $238.83 $24,468.20 $1,269.00 2026-03-11
45990 HCPCS Diagnostic Exam Of Anus And Rectum Under Anesthesia 14 14 $1,650.00 $1,402.50 $808.50 $1,650.00 $1,263.90 2026-03-11
45380 HCPCS Biopsy Of Large Bowel Using A Flexible Endoscope 24 15 $2,000.00 $1,700.00 $166.15 $2,000.00 $1,240.00 2026-03-11
11603 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm 15 15 $1,800.00 $1,530.00 $882.00 $1,800.00 $1,227.60 2026-03-11
56420 HCPCS Incision And Drainage Of Abscess Of Female Genital Gland 14 14 $1,565.00 $1,330.25 $766.85 $1,565.00 $1,198.79 2026-03-11
26725 HCPCS Closed Treatment Of Broken Finger Or Thumb At Midportion Or Part Near Hand With … 15 15 $1,400.00 $1,190.00 $686.00 $1,555.20 $1,190.00 2026-03-11
45378 HCPCS Diagnostic Exam Of Large Bowel Using A Flexible Endoscope 24 15 $1,900.00 $1,615.00 $153.58 $1,900.00 $1,178.00 2026-03-11
10080 HCPCS Simple Drainage Of Cyst Of Tailbone 15 15 $1,384.00 $1,176.40 $678.16 $1,384.00 $1,176.40 2026-03-11
43250 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 15 15 $1,380.00 $1,173.00 $676.20 $1,603.54 $1,173.00 2026-03-11
5404236_1 CDM Room & Board - Semi-private (two Beds) - General Classification 9 9 $1,300.00 $1,105.00 $637.00 $1,300.00 $1,170.00 2026-03-11
6421069_1 CDM Tr C5276 Low Cost Skin Substitute App 1 1 $4,650.00 $3,952.50 $1,162.50 $1,162.50 $1,162.50 2026-03-11
11441 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 0… 15 15 $1,700.00 $1,445.00 $833.00 $1,700.00 $1,159.40 2026-03-11
11403 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm 15 15 $1,700.00 $1,445.00 $833.00 $1,700.00 $1,159.40 2026-03-11
78708 HCPCS Nuclear Medicine Study Of Kidney, Blood, Flow, And Function With Drug Administra… 15 15 $1,425.00 $1,211.25 $698.25 $1,425.00 $1,148.70 2026-03-11
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 30 15 $1,387.50 $1,179.38 $661.50 $1,477.64 $1,147.50 2026-03-11
2120839_1 CDM Room & Board - Private (one Bed) - General Classification 9 9 $1,269.00 $1,078.65 $621.81 $1,269.00 $1,142.10 2026-03-11
78803 HCPCS Nuclear Medicine Study, Spect Imaging, 1 Area Or Single Acquisition, Single Day … 14 14 $1,490.00 $1,266.50 $730.10 $1,490.00 $1,141.34 2026-03-11
10140 HCPCS Drainage Of Blood Or Fluid Accumulation 44 15 $1,500.00 $1,275.00 $52.48 $1,622.88 $1,134.12 2026-03-11
12054 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6-1… 15 15 $1,313.00 $1,116.05 $643.37 $1,450.23 $1,116.05 2026-03-11
2120840_1 CDM Room & Board - Semi-private (two Beds) - General Classification 9 9 $1,240.00 $1,054.00 $607.60 $1,240.00 $1,116.00 2026-03-11
23665 HCPCS Closed Treatment Of Dislocated Shoulder And Broken Upper Arm Bone At Shoulder Jo… 15 15 $1,375.00 $1,168.75 $673.75 $1,375.00 $1,106.32 2026-03-11
37609 HCPCS Tying Or Biopsy Of Artery On Side Of Skull 15 15 $1,525.00 $1,296.25 $747.25 $1,525.00 $1,095.37 2026-03-11
11421 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 0.6-1… 15 15 $1,500.00 $1,275.00 $735.00 $1,500.00 $1,071.53 2026-03-11
C1788 HCPCS Port, Indwelling (implantable) 28 14 $1,402.80 $1,192.38 $668.21 $1,441.90 $1,071.27 2026-03-11
11402 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 1.1-2.0 Cm 15 15 $1,255.00 $1,066.75 $614.95 $1,255.00 $1,066.75 2026-03-11
36569 HCPCS Insertion Of Tube For Infusion (5 Years Or Older) 39 15 $1,710.00 $1,453.50 $79.42 $1,710.00 $1,060.20 2026-03-11
10120 HCPCS Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Simple 30 15 $1,400.00 $1,190.00 $539.00 $1,700.00 $1,054.00 2026-03-11
91110 HCPCS Imaging Of Digestive Tract Done From The Inside Of The Digestive Tract 14 14 $1,375.00 $1,168.75 $673.75 $1,375.00 $1,053.25 2026-03-11
12032 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 2.6-7.5 … 30 15 $1,395.65 $1,186.30 $539.00 $1,691.30 $1,046.80 2026-03-11
44376 HCPCS Diagnostic Exam Of Small Bowel (including Lower Small Intestine) Using An Endosc… 24 15 $1,675.00 $1,423.75 $233.53 $1,675.00 $1,038.50 2026-03-11
J2515 HCPCS Injection, Pentobarbital Sodium, Per 50 Mg 29 15 $1,519.74 $1,291.78 $64.12 $1,519.74 $1,036.46 2026-03-11
64495 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Third And… 63 15 $1,665.00 $1,415.25 $42.84 $1,918.96 $1,032.30 2026-03-11
12053 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1-7… 15 15 $1,205.00 $1,024.25 $590.45 $1,331.45 $1,024.25 2026-03-11
45350 HCPCS Banding Of Hemorrhoids Using A Flexible Endoscope (sigmoidoscope) 15 15 $1,195.00 $1,015.75 $585.55 $1,195.00 $1,015.75 2026-03-11
12015 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6… 15 15 $1,183.00 $1,005.55 $579.67 $1,183.00 $1,005.55 2026-03-11
J9155 HCPCS Injection, Degarelix, 1 Mg 29 15 $1,607.03 $1,365.98 $5.60 $1,607.03 $996.36 2026-03-11
P9037 HCPCS Platelets, Pheresis, Leukocytes Reduced, Irradiated, Each Unit 14 14 $1,300.00 $1,105.00 $637.00 $1,300.00 $995.80 2026-03-11
4441939_1 CDM Room & Board - Private (one Bed) - General Classification 9 9 $1,088.00 $924.80 $533.12 $1,088.00 $979.20 2026-03-11
J0248 HCPCS Injection, Remdesivir, 1 Mg 28 14 $1,290.64 $1,097.05 $573.30 $1,411.29 $978.50 2026-03-11
45331 HCPCS Biopsy Of Lower Large Bowel Using A Flexible Endoscope 15 15 $1,150.00 $977.50 $563.50 $1,150.00 $977.50 2026-03-11
27265 HCPCS Closed Treatment Of Dislocated Hip Prosthesis 15 15 $1,150.00 $977.50 $563.50 $1,150.00 $977.50 2026-03-11
24600 HCPCS Repair Of Dislocated Elbow 15 15 $1,150.00 $977.50 $563.50 $1,150.00 $977.50 2026-03-11
12044 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 7.6-12.5 Cm 15 15 $1,144.00 $972.40 $560.56 $1,144.00 $972.40 2026-03-11
24640 HCPCS Closed Treatment Of Dislocated Forearm Bone On Thumb Side At Elbow With Manipula… 15 15 $1,144.00 $972.40 $560.56 $1,144.00 $972.40 2026-03-11
45333 HCPCS Removal Of Polyps Or Growths Of Lower Large Bowel Using A Flexible Endoscope Wit… 15 15 $1,140.00 $969.00 $558.60 $1,140.00 $969.00 2026-03-11
26770 HCPCS Closed Treatment Of Dislocated Finger Joint With Manipulation 15 15 $1,140.00 $969.00 $558.60 $1,140.00 $969.00 2026-03-11
43239 HCPCS Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop… 39 15 $1,370.40 $1,164.84 $115.58 $1,577.30 $968.75 2026-03-11
64494 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Second Le… 63 15 $1,400.00 $1,190.00 $41.63 $1,945.00 $954.80 2026-03-11
2120841_1 CDM Room & Board - Semi-private (two Beds) - General Classification 9 9 $1,058.00 $899.30 $518.42 $1,058.00 $952.20 2026-03-11
78582 HCPCS Nuclear Medicine Study Of Lung Ventilation And Circulation 15 15 $1,175.00 $998.75 $575.75 $1,175.00 $947.92 2026-03-11
31720 HCPCS Insertion Of Tube Into Airway For Aspiration Of Secretions 15 15 $1,115.00 $947.75 $546.35 $1,115.00 $947.49 2026-03-11
45330 HCPCS Diagnostic Exam Of Lower Portion Of Large Bowel Using A Flexible Endoscope 15 15 $1,100.00 $935.00 $539.00 $1,104.94 $935.00 2026-03-11
44377 HCPCS Biopsy Of Small Bowel Using An Endoscope 15 15 $1,100.00 $935.00 $539.00 $1,377.03 $935.00 2026-03-11
13132 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 15 15 $1,100.00 $935.00 $539.00 $1,379.79 $935.00 2026-03-11
93312 HCPCS Ultrasound Of Heart With Probe In Esophagus, With Report 15 15 $1,275.00 $1,083.75 $624.75 $1,275.00 $934.86 2026-03-11
64490 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Single Le… 48 15 $1,500.00 $1,275.00 $88.55 $3,000.00 $930.00 2026-03-11
43235 HCPCS Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible… 24 15 $1,500.00 $1,275.00 $103.28 $1,500.00 $930.00 2026-03-11
4441947_1 CDM Room & Board - Private (one Bed) - General Classification 9 9 $1,028.00 $873.80 $503.72 $1,028.00 $925.20 2026-03-11
26605 HCPCS Closed Treatment Of Broken Hand Bone With Manipulation 15 15 $1,087.00 $923.95 $532.63 $1,106.32 $923.95 2026-03-11
64454 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Knee Nerve Branch Using Imagin… 48 15 $1,400.00 $1,190.00 $69.13 $3,130.00 $911.40 2026-03-11
32555 HCPCS Aspiration Of Fluid From Chest Cavity Using Imaging Guidance 29 15 $1,100.00 $935.00 $523.32 $1,179.52 $907.80 2026-03-11
11420 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 0.5 C… 15 15 $1,062.00 $902.70 $520.38 $2,468.93 $902.70 2026-03-11
78598 HCPCS Nuclear Medicine Study Of Lung Ventilation And Circulation And Blood Flow To Lun… 14 14 $1,175.00 $998.75 $575.75 $1,175.00 $900.05 2026-03-11
27096 HCPCS Injection Of Anesthetic Or Steroid Into Joint Between Lower Spine And Hip Bone U… 53 15 $1,200.00 $1,020.00 $69.48 $1,740.00 $900.00 2026-03-11
4441941_1 CDM Room & Board - Semi-private (two Beds) - General Classification 9 9 $998.00 $848.30 $489.02 $998.00 $898.20 2026-03-11
43450 HCPCS Dilation Of Esophagus 15 15 $1,050.00 $892.50 $514.50 $1,121.51 $892.50 2026-03-11
11623 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 2.1-3.0 … 29 15 $1,800.00 $1,530.00 $47.14 $2,468.93 $882.00 2026-03-11
92511 HCPCS Exam Of The Nose And Throat Using An Endoscope 14 14 $1,150.00 $977.50 $563.50 $1,150.00 $880.90 2026-03-11
5318310_1 CDM Transport - Ultrasound 11 11 $1,403.72 $1,193.16 $687.82 $1,333.53 $870.31 2026-03-11
93308 HCPCS Ultrasound Of Heart, Follow-up 15 15 $1,275.00 $1,083.75 $624.75 $1,275.00 $869.55 2026-03-11
93307 HCPCS Ultrasound Of Heart 15 15 $1,275.00 $1,083.75 $624.75 $1,275.00 $869.55 2026-03-11
11107 HCPCS Incision Biopsy, Each Additional Skin Growth 15 15 $1,023.00 $869.55 $501.27 $1,023.00 $869.55 2026-03-11
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 15 15 $1,020.00 $867.00 $499.80 $1,020.00 $867.00 2026-03-11
27840 HCPCS Closed Treatment Of Dislocated Ankle 15 15 $1,009.00 $857.65 $494.41 $1,106.32 $857.65 2026-03-11
26720 HCPCS Closed Treatment Of Broken Finger Or Thumb At Midportion Or Part Near Hand 15 15 $1,001.25 $851.06 $490.61 $1,106.32 $851.06 2026-03-11
45335 HCPCS Injection Beneath Lining Of Lower Large Bowel Using A Flexible Endoscope 15 15 $1,000.00 $850.00 $490.00 $1,373.38 $850.00 2026-03-11
13131 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 15 15 $1,000.00 $850.00 $490.00 $1,077.32 $850.00 2026-03-11
12051 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 C… 15 15 $1,000.00 $850.00 $490.00 $1,000.00 $850.00 2026-03-11
32554 HCPCS Aspiration Of Fluid From Chest Cavity 15 15 $1,000.00 $850.00 $490.00 $1,015.16 $850.00 2026-03-11
64636 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 23 14 $1,370.00 $1,164.50 $48.05 $1,370.00 $849.40 2026-03-11
62323 HCPCS Injection Of Substance Into Lower Spine Canal Using Imaging Guidance 62 15 $1,190.00 $1,011.50 $52.48 $1,860.00 $840.10 2026-03-11
62321 HCPCS Injection Of Substance Into Middle Or Upper Spine Canal Using Imaging Guidance 24 15 $1,355.00 $1,151.75 $90.04 $1,561.41 $840.10 2026-03-11
64634 HCPCS Destruction Of Upper Or Middle Spinal Facet Joint Nerves Using Imaging Guidance,… 23 14 $1,340.00 $1,139.00 $54.77 $1,340.00 $830.80 2026-03-11
99284 HCPCS Emergency Department Visit With Moderate Level Of Medical Decision Making 30 15 $975.00 $828.75 $477.75 $975.00 $828.75 2026-03-11
64484 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 24 15 $1,330.00 $1,130.50 $41.63 $1,330.00 $824.60 2026-03-11
64999 HCPCS Other Procedure On Nervous System 15 14 $1,200.00 $1,020.00 $105.00 $1,200.00 $818.40 2026-03-11
J0585 HCPCS Injection, Onabotulinumtoxina, 1 Unit 29 15 $2,604.00 $2,213.40 $8.13 $2,604.00 $814.50 2026-03-11
J1670 HCPCS Injection, Tetanus Immune Globulin, Human, Up To 250 Units 15 15 $1,186.02 $1,008.12 $581.15 $1,186.02 $808.87 2026-03-11
93799 HCPCS Other Cardiovascular Service Or Procedure 14 14 $1,045.00 $888.25 $512.05 $1,045.00 $800.47 2026-03-11
64492 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Third And… 24 15 $1,290.00 $1,096.50 $48.62 $1,487.59 $799.80 2026-03-11
11200 HCPCS Removal Of Skin Tag, 1-15 Skin Tags 30 15 $1,346.00 $1,144.10 $297.72 $1,900.00 $792.00 2026-03-11
28899 HCPCS Other Procedure On Foot Or Toes 44 14 $1,080.00 $918.00 $100.00 $1,200.00 $781.20 2026-03-11
11400 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 0.5 Cm Or Less 30 15 $1,088.75 $925.44 $380.98 $1,400.00 $777.50 2026-03-11
88230 HCPCS Tissue Culture To Identify White Blood Cell Disorders 15 15 $911.00 $774.35 $446.39 $1,061.22 $774.35 2026-03-11
46600 HCPCS Diagnostic Exam Of Anus Using An Endoscope 15 15 $1,135.00 $964.75 $192.13 $1,135.00 $774.07 2026-03-11
49083 HCPCS Drainage Of Fluid From Abdominal Cavity Using Imaging Guidance 15 15 $900.00 $765.00 $441.00 $1,476.37 $765.00 2026-03-11
88120 HCPCS Cell Examination Of Urine, Manual 15 15 $900.00 $765.00 $441.00 $1,641.00 $765.00 2026-03-11
12004 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 15 15 $900.00 $765.00 $441.00 $900.00 $765.00 2026-03-11
64479 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Upper Or Middle Spine Nerve Roo… 15 15 $900.00 $765.00 $441.00 $993.91 $765.00 2026-03-11
P9035 HCPCS Platelets, Pheresis, Leukocytes Reduced, Each Unit 14 14 $995.00 $845.75 $487.55 $995.00 $762.17 2026-03-11
Q4309 HCPCS Via Matrix, Per Square Centimeter 14 14 $995.00 $845.75 $487.55 $995.00 $762.17 2026-03-11
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
71550 HCPCS MRI Scan Of Chest Without Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
70553 HCPCS MRI Scan Of Brain Before And After Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
73218 HCPCS MRI Scan Of Arm Without Contrast 45 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
70552 HCPCS MRI Scan Of Brain With Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
73722 HCPCS MRI Scan Of Leg Joint With Contrast 45 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
74181 HCPCS MRI Scan Of Abdomen Without Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
73718 HCPCS MRI Scan Of Leg Without Contrast 45 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
77084 HCPCS MRI Scan Of Bone Marrow 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
70551 HCPCS MRI Scan Of Brain Without Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
73720 HCPCS MRI Scan Of Leg Before And After Contrast 45 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 45 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 45 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
73719 HCPCS MRI Scan Of Leg With Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
72195 HCPCS MRI Scan Of Pelvis Without Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
75557 HCPCS MRI Scan Of Heart Without Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
70336 HCPCS MRI Scan Of Jaw Joint 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
72196 HCPCS MRI Scan Of Pelvis With Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
73220 HCPCS MRI Scan Of Arm Before And After Contrast 15 15 $925.00 $786.25 $453.25 $925.00 $755.57 2026-03-11
23650 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation 29 15 $1,520.00 $1,292.00 $355.25 $1,520.00 $744.80 2026-03-11
45300 HCPCS Diagnostic Exam Of Rectum And Lower Large Bowel Using An Endoscope 24 15 $1,200.00 $1,020.00 $41.53 $1,200.00 $744.00 2026-03-11
64449 HCPCS Injection By Continuous Infusion Of Anesthetic Agent Into Lower Back Nerve Bundl… 23 14 $1,200.00 $1,020.00 $33.83 $1,200.00 $744.00 2026-03-11
12041 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 2.5 Cm Or Less 15 15 $900.00 $765.00 $441.00 $900.00 $727.88 2026-03-11
87902 HCPCS Analysis Test By Nucleic Acid For Hepatitis C Virus 15 15 $855.00 $726.75 $418.95 $2,201.20 $726.75 2026-03-11
93320 HCPCS Ultrasound Of Heart Blood Flow, Valves And Chambers 15 15 $1,065.00 $905.25 $521.85 $1,065.00 $726.33 2026-03-11
93325 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate And Valve Function 15 15 $1,065.00 $905.25 $521.85 $1,065.00 $726.33 2026-03-11
78227 HCPCS Nuclear Medicine Study Of Liver And Bile Duct System With Use Of Drugs 15 15 $900.00 $765.00 $441.00 $900.00 $724.28 2026-03-11
78226 HCPCS Nuclear Medicine Study Of Liver And Bile Duct System 15 15 $900.00 $765.00 $441.00 $900.00 $724.28 2026-03-11
27250 HCPCS Closed Treatment Of Dislocated Hip 15 15 $850.00 $722.50 $416.50 $850.00 $722.50 2026-03-11
64450 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Other Nerve Or Branch 38 15 $850.00 $722.50 $36.13 $1,200.00 $722.50 2026-03-11
81263 HCPCS Gene Rearrangement Analysis (immunoglobulin Heavy Chain Locus), Variable Region … 15 15 $848.50 $721.23 $415.77 $2,499.00 $721.23 2026-03-11
12052 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.6-5… 15 15 $1,047.60 $890.46 $513.32 $1,047.60 $714.46 2026-03-11
90375 HCPCS Rabies Immune Globulin For Injection 15 15 $1,041.10 $884.94 $398.51 $1,041.10 $710.03 2026-03-11
64491 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Second Le… 48 15 $1,089.00 $925.65 $48.05 $1,887.00 $701.78 2026-03-11
64421 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Multiple Rib Nerves For Region… 24 15 $1,120.00 $952.00 $20.53 $1,120.00 $694.40 2026-03-11
77075 HCPCS Complete X-ray Of Body Bones 15 15 $835.00 $709.75 $409.15 $835.00 $692.52 2026-03-11
30300 HCPCS Removal Of Foreign Body In Nose 15 15 $800.00 $680.00 $392.00 $1,283.11 $680.00 2026-03-11
72159 HCPCS MRI Scan Of Blood Vessels Of Spinal Canal 15 15 $790.00 $671.50 $387.10 $909.29 $671.50 2026-03-11
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 15 15 $790.00 $671.50 $387.10 $909.29 $671.50 2026-03-11
71555 HCPCS MRI Scan Of Blood Vessels Of Chest 15 15 $790.00 $671.50 $387.10 $909.29 $671.50 2026-03-11
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 15 15 $790.00 $671.50 $387.10 $909.29 $671.50 2026-03-11
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 15 15 $790.00 $671.50 $387.10 $909.29 $671.50 2026-03-11
73225 HCPCS MRI Scan Of Blood Vessels Of Arm 15 15 $790.00 $671.50 $387.10 $909.29 $671.50 2026-03-11
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 15 15 $790.00 $671.50 $387.10 $909.29 $671.50 2026-03-11
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 15 15 $790.00 $671.50 $387.10 $909.29 $671.50 2026-03-11
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 15 15 $790.00 $671.50 $387.10 $909.29 $671.50 2026-03-11
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 45 15 $790.00 $671.50 $387.10 $909.29 $671.50 2026-03-11
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 15 15 $790.00 $671.50 $387.10 $909.29 $671.50 2026-03-11
10060 HCPCS Simple Or Single Drainage Of Skin Abscess 44 15 $900.00 $765.00 $297.73 $1,025.00 $667.27 2026-03-11
30901 HCPCS Simple Control Of Nose Bleed 15 15 $785.00 $667.25 $384.65 $785.00 $667.25 2026-03-11
J1745 HCPCS Injection, Infliximab, Excludes Biosimilar, 10 Mg 15 15 $971.12 $825.45 $39.57 $971.12 $662.30 2026-03-11
74400 HCPCS Imaging Of Urinary Tract With Injection Of Contrast Into A Vein 15 15 $795.00 $675.75 $389.55 $795.00 $658.22 2026-03-11
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