Price Transparency 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

MITCHELL COUNTY HOSPITAL HEALTH SYSTEMS

Beloit, KS · CCN 171375 · Rates published

5,277 distinct procedures filed
13 distinct payers
75,740 rate rows
2026-03-21 last MRF observed
Data quality

75,298 of 75,740 rate rows are consumer-grade (99.4%)

442 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
template filing: same amount across many unrelated codes — excluded 270
percent-of-charges filed in the dollar field — excluded from medians 147
per-diem day rate — not a per-procedure price 17
exceeds 10× this hospital's gross charge — excluded from medians 6
placeholder amount (≤ $0.02) — excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbMCHHSBELOITKS&type=CDMWithoutLabel
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint b8f8e94d2b7499ae… · 31,926,386 bytes · first seen 2026-05-07

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
J3357
HCPCS 		Ustekinumab, For Subcutaneous Injection, 1 Mg 12 $190.72 $34,617.36 $32,886.49 nat. median
$14,306
outlier · 2.3×
J9334
HCPCS 		Injection, Efgartigimod Alfa, 2 Mg And Hyaluronidase-qvfc 12 $33.89 $20,266.64 $19,253.31 nat. median
$73
outlier · 262.4×
25765486_5
CDM 		Graft Xenmatrix Surg 19cmx28cm Antibac* 10 $15,261.75 $17,775.45 $17,057.25 nat. median
$17,057
1.0× median
J2350
HCPCS 		Injection, Ocrelizumab, 1 Mg 13 $59.41 $15,617.44 $14,836.57 nat. median
$712
outlier · 20.8×
J0896
HCPCS 		Injection, Luspatercept-aamt, 0.25 Mg 13 $41.98 $15,239.13 $14,477.17 nat. median
$4,612
outlier · 3.1×
25765940_5
CDM 		Graft Xenmatrix Surg 20cmx20cm* 10 $11,711.94 $13,640.96 $13,089.81 nat. median
$13,090
1.0× median
25766037_5
CDM 		Mesh Phasix 10"x12"* 10 $10,994.75 $12,805.65 $12,288.25 nat. median
$12,288
1.0× median
J2327
HCPCS 		Injection, Risankizumab-rzaa, Intravenous, 1 Mg 12 $14.94 $12,632.30 $12,000.69 nat. median
$2,241
outlier · 5.4×
25765485_5
CDM 		Graft Xenmatrix Surg 15cmx20cm Antibac* 10 $9,282.00 $10,810.80 $10,374.00 nat. median
$10,374
1.0× median
27091376_5
CDM 		Meshed Bilayer Wound Matrix 4x5 10 $8,991.39 $10,472.32 $10,049.20 nat. median
$10,049
1.0× median
27535763_5
CDM 		Mesh Xen Matrix Ab 15cm X 20cm* 10 $8,414.58 $9,800.51 $9,404.53 nat. median
$9,405
1.0× median
25768576_5
CDM 		Mesh Surgimend 20CMx20CMx2MM 2017* 10 $8,398.00 $9,781.20 $9,386.00 nat. median
$9,386
1.0× median
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 13 $172.22 $34,490.81 $8,820.03 nat. median
$5,949
1.5× median
J2353
HCPCS 		Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg 13 $203.58 $8,451.64 $8,029.06 nat. median
$5,975
1.3× median
25765454_5
CDM 		Alrua Pacemaker Generator* 10 $6,792.44 $7,911.19 $7,591.55 nat. median
$7,592
1.0× median
25765453_5
CDM 		Adapta Dr Pacemaker Generator* 10 $6,109.55 $7,115.82 $6,828.32 nat. median
$6,828
1.0× median
27372
HCPCS 		Removal Of Foreign Body Deep In Tissue Of Thigh Or Knee 13 $2,967.63 $7,131.00 $6,417.90 nat. median
$3,130
outlier · 2.1×
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 13 $21.31 $6,696.34 $6,361.52 nat. median
$288
outlier · 22.1×
J7192
HCPCS 		Factor Viii (antihemophilic Factor, Recombinant) Per I.u., Not Otherwise Specifi… 13 $1.61 $6,513.47 $6,187.80 nat. median
$10
outlier · 593.8×
31525
HCPCS 		Diagnostic Exam Of Voice Box Using An Endoscope 13 $1,818.45 $6,701.00 $6,030.90 nat. median
$2,020
outlier · 3.0×
J7202
HCPCS 		Injection, Factor Ix, Albumin Fusion Protein, (recombinant), Idelvion, 1 I.u. 13 $5.32 $6,284.88 $5,970.64 nat. median
$7
outlier · 822.4×
27749219_5
CDM 		Graft Skin Mesh Derm Regenerating 2x2" * 10 $5,265.09 $6,132.28 $5,884.51 nat. median
$5,885
1.0× median
25765858_5
CDM 		Reveal Xt Monitor Pacemaker* 10 $5,236.00 $6,098.40 $5,852.00 nat. median
$5,852
1.0× median
J1162
HCPCS 		Injection, Digoxin Immune Fab (ovine), Per Vial 13 $4,974.80 $5,913.56 $5,560.07 nat. median
$7,316
0.8× median
31530
HCPCS 		Removal Of Foreign Body In Voice Box Using An Endoscope 13 $160.17 $6,236.00 $5,550.04 nat. median
$2,041
outlier · 2.7×
25575
HCPCS 		Treatment Of Broken Midpart Of Both Forearm Bones With Placement Of Stabilizing… 13 $3,839.01 $7,413.38 $5,471.05 nat. median
$7,293
0.8× median
27784
HCPCS 		Treatment Of Broken Upper Or Middle Part Of Outer Lower Leg Bone 13 $3,839.01 $7,413.38 $5,471.05 nat. median
$6,889
0.8× median
27244
HCPCS 		Treatment Of Broken Neck Of Thigh Bone With Plate/screw Implant 13 $3,839.01 $7,413.38 $5,471.05 nat. median
$4,919
1.1× median
Q9996
HCPCS 		Injection, Ustekinumab-ttwe (pyzchiva), Subcutaneous, 1 Mg 11 $4,721.45 $5,554.65 $5,276.92 nat. median
$988
outlier · 5.3×
28492690_5
CDM 		Template Derm Regen 2in X 2in* (2023) 10 $4,655.28 $5,422.03 $5,202.96 nat. median
$5,203
1.0× median
26727
HCPCS 		Placement Of Stabilizing Device For Broken Finger Or Thumb At Midportion Or Part… 13 $3,342.87 $5,759.00 $5,183.10 nat. median
$3,550
1.5× median
26785
HCPCS 		Treatment Of Dislocated Finger Joint 13 $281.27 $5,759.00 $5,125.51 nat. median
$3,500
1.5× median
J0517
HCPCS 		Injection, Benralizumab, 1 Mg 13 $164.59 $5,206.88 $4,946.54 nat. median
$919
outlier · 5.4×
26735
HCPCS 		Treatment Of Broken Finger At Midportion Or Part Near Hand 13 $374.28 $5,457.00 $4,856.73 nat. median
$3,781
1.3× median
J0881
HCPCS 		Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 13 $2.93 $4,855.40 $4,612.63 nat. median
$751
outlier · 6.1×
25767469_5
CDM 		Mesh Lg Ventral Coated 22 X 26 Cm (consign) 2017* 10 $3,986.50 $4,643.10 $4,455.50 nat. median
$4,456
1.0× median
25766043_5
CDM 		Pleurx Pleural Cath Kit Complete W/discharge Pk* 10 $3,966.51 $4,619.82 $4,433.16 nat. median
$4,433
1.0× median
25765488_5
CDM 		Graft Allomax Surg 10cmx10cm* 10 $3,856.79 $4,492.03 $4,310.53 nat. median
$4,311
1.0× median
J2182
HCPCS 		Injection, Mepolizumab, 1 Mg 13 $31.27 $4,485.08 $4,260.83 nat. median
$3,098
1.4× median
25765893_5
CDM 		Kyphopak Express Tray 10/2 First Fracture* 10 $3,751.71 $4,369.64 $4,193.09 nat. median
$4,193
1.0× median
27502111_5
CDM 		Stent Colonic 22 Dm X 9 Cm 10 $3,730.65 $4,345.11 $4,169.55 nat. median
$4,170
1.0× median
11012
HCPCS 		Removal Of Foreign Material From Skin, Tissue, Muscle, And Bone At Open Broken A… 13 $2,967.63 $4,627.00 $4,164.30 nat. median
$2,818
1.5× median
74178
HCPCS 		CT Scan Of Abdomen And Pelvis Before And After Contrast 13 $356.43 $4,354.00 $4,136.30 nat. median
$977
outlier · 4.2×
26309839_5
CDM 		Mesh Ventral Coated 15x22CM* 10 $3,629.50 $4,227.30 $4,056.50 nat. median
$4,056
1.0× median
25765749_5
CDM 		Graftjacket 4cmx8cm **needs Abn Signed*** 10 $3,615.31 $4,210.78 $4,040.64 nat. median
$4,041
1.0× median
27383446_5
CDM 		Mesh Phasix Hernia 10cm X 15cm 10 $3,598.32 $4,190.99 $4,021.65 nat. median
$4,022
1.0× median
23605
HCPCS 		Closed Treatment Of Broken Top Of Upper Arm Bone With Manipulation 13 $1,642.82 $4,172.00 $3,754.80 nat. median
$1,955
1.9× median
74177
HCPCS 		CT Scan Of Abdomen And Pelvis With Contrast 13 $356.43 $3,916.00 $3,720.20 nat. median
$928
outlier · 4.0×
25765355_5
CDM 		Mesh C-qur Edge 12"x18"* 10 $3,308.20 $3,853.08 $3,697.40 nat. median
$3,697
1.0× median
70471
HCPCS 		Computed Tomographic Angiography (cta), Head And Neck, With Contrast Material(s)… 12 $356.43 $3,826.00 $3,634.70 nat. median
$729
outlier · 5.0×

Other procedures at this hospital

Browse this hospital's 5,277 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
             
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 35 13 $2,766.00 $2,489.40 $307.09 $2,948.00 $2,585.00 2026-03-21
J1459 HCPCS Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 35 13 $2,399.04 $2,159.14 $50.74 $3,951.36 $2,279.09 2026-03-21
Q4133 HCPCS Grafix Prime, Grafixpl Prime, Stravix And Stravixpl, Per Square Centimeter 35 13 $1,976.25 $1,778.63 $115.04 $3,906.00 $1,877.44 2026-03-21
36482 HCPCS Chemical Destruction Of First Incompetent Vein Of Arm Or Leg Using Imaging Guida… 34 12 $2,798.00 $2,518.20 $595.00 $5,685.01 $2,658.10 2026-03-21
36466 HCPCS Injection Of Chemical Agent Into Multiple Incompetent Veins Of Same Leg Using Ul… 34 12 $2,432.00 $2,188.80 $516.80 $3,040.00 $2,249.60 2026-03-21
36465 HCPCS Injection Of Chemical Agent Into Single Incompetent Vein Of Leg Using Ultrasound… 34 12 $2,206.00 $1,985.40 $469.20 $2,758.00 $2,095.70 2026-03-21
73720 HCPCS MRI Scan Of Leg Before And After Contrast 26 13 $2,493.00 $2,243.70 $356.43 $2,493.00 $2,368.35 2026-03-21
73220 HCPCS MRI Scan Of Arm Before And After Contrast 26 13 $2,189.00 $1,970.10 $356.43 $2,189.00 $2,079.55 2026-03-21
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 26 13 $2,189.00 $1,970.10 $356.43 $2,189.00 $2,079.55 2026-03-21
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 26 13 $2,189.00 $1,970.10 $356.43 $2,189.00 $2,079.55 2026-03-21
73718 HCPCS MRI Scan Of Leg Without Contrast 26 13 $2,128.00 $1,915.20 $243.77 $2,128.00 $2,021.60 2026-03-21
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 26 13 $2,128.00 $1,915.20 $243.77 $2,128.00 $2,021.60 2026-03-21
73219 HCPCS MRI Scan Of Arm With Contrast 26 13 $2,007.00 $1,806.30 $356.43 $2,007.00 $1,906.65 2026-03-21
73719 HCPCS MRI Scan Of Leg With Contrast 26 13 $2,007.00 $1,806.30 $356.43 $2,007.00 $1,906.65 2026-03-21
73222 HCPCS MRI Scan Of Arm Joint With Contrast 26 13 $2,007.00 $1,806.30 $526.21 $2,007.00 $1,906.65 2026-03-21
73722 HCPCS MRI Scan Of Leg Joint With Contrast 26 13 $2,007.00 $1,806.30 $526.21 $2,007.00 $1,906.65 2026-03-21
J3101 HCPCS Injection, Tenecteplase, 1 Mg 24 13 $8,864.35 $7,977.92 $172.22 $34,490.81 $8,820.03 2026-03-21
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 24 13 $2,604.51 $2,344.06 $12.07 $2,665.84 $2,474.28 2026-03-21
J3262 HCPCS Injection, Tocilizumab, 1 Mg 24 13 $3,458.70 $3,112.83 $5.71 $3,458.70 $1,950.13 2026-03-21
J7168 HCPCS Prothrombin Complex Concentrate (human), Kcentra, Per I.u. Of Factor Ix Activity 24 13 $3,605.63 $3,245.07 $2.14 $3,605.63 $1,853.01 2026-03-21
C1783 HCPCS Ocular Implant, Aqueous Drainage Assist Device 22 11 $2,840.00 $2,556.00 $2,380.00 $2,880.00 $2,660.00 2026-03-21
47000 HCPCS Needle Biopsy Of Liver Through Skin 20 13 $3,038.00 $2,734.20 $72.04 $3,038.00 $2,643.06 2026-03-21
36590 HCPCS Removal Of Central Venous Tube With Port Or Pump 20 13 $2,860.00 $2,574.00 $158.71 $2,860.00 $2,488.20 2026-03-21
38792 HCPCS Injection Of Radioactive Material For X-ray Identification Of Lymph Node 20 13 $2,045.00 $1,840.50 $25.84 $4,751.04 $1,830.28 2026-03-21
31530 HCPCS Removal Of Foreign Body In Voice Box Using An Endoscope 19 13 $6,236.00 $5,612.40 $160.17 $6,236.00 $5,550.04 2026-03-21
26785 HCPCS Treatment Of Dislocated Finger Joint 19 13 $5,759.00 $5,183.10 $281.27 $5,759.00 $5,125.51 2026-03-21
26735 HCPCS Treatment Of Broken Finger At Midportion Or Part Near Hand 19 13 $5,457.00 $4,911.30 $374.28 $5,457.00 $4,856.73 2026-03-21
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 19 13 $4,002.00 $3,601.80 $118.70 $4,002.00 $3,601.80 2026-03-21
36556 HCPCS Insertion Of Non-tunneled Central Venous Tube For Infusion (5 Years Or Older) 19 13 $4,000.00 $3,600.00 $72.46 $4,000.00 $3,560.00 2026-03-21
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 19 13 $3,627.00 $3,264.30 $114.45 $3,627.00 $3,264.30 2026-03-21
12036 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 20.1-30.… 19 13 $3,307.00 $2,976.30 $245.46 $3,307.00 $2,943.23 2026-03-21
28505 HCPCS Treatment Of Broken Great Toe 19 13 $3,236.00 $2,912.40 $367.40 $3,342.87 $2,912.40 2026-03-21
26765 HCPCS Treatment Of Broken End Of Finger Or Thumb 19 13 $3,142.00 $2,827.80 $275.53 $3,342.87 $2,827.80 2026-03-21
12035 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 12.6-20.… 19 13 $2,736.00 $2,462.40 $205.56 $2,736.00 $2,435.04 2026-03-21
31625 HCPCS Biopsy Of Lung Airway Using An Endoscope 19 13 $2,594.00 $2,334.60 $132.83 $2,594.00 $2,308.66 2026-03-21
13152 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 2.6-7.5 Cm 19 13 $2,427.00 $2,184.30 $260.38 $2,427.00 $2,160.03 2026-03-21
12006 HCPCS Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 19 13 $2,307.00 $2,076.30 $99.39 $2,307.00 $2,053.23 2026-03-21
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 19 13 $2,189.00 $1,970.10 $79.09 $2,189.00 $1,970.10 2026-03-21
31622 HCPCS Diagnostic Exam Of Lung Airway Using An Endoscope 19 13 $2,192.00 $1,972.80 $112.61 $2,192.00 $1,950.88 2026-03-21
72295 HCPCS Review By Radiologist Of Disc Of Lower Spine Image 18 12 $2,258.00 $2,032.20 $38.60 $2,258.00 $2,032.20 2026-03-21
64625 HCPCS Destruction Of Nerves Supplying Joint Between Spine And Pelvis Using Imaging Gui… 18 12 $2,258.00 $2,032.20 $123.68 $2,258.00 $2,020.91 2026-03-21
64635 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 18 12 $2,258.00 $2,032.20 $101.65 $2,258.00 $2,020.91 2026-03-21
64624 HCPCS Destruction Of Nerve Branches Of Knee Using Imaging Guidance 18 12 $2,258.00 $2,032.20 $93.47 $2,258.00 $2,020.91 2026-03-21
64633 HCPCS Destruction Of Upper Or Middle Spinal Facet Joint Nerves Using Imaging Guidance,… 18 12 $2,258.00 $2,032.20 $103.73 $2,258.00 $2,020.91 2026-03-21
72285 HCPCS Review By Radiologist Of Disc Of Upper Or Middle Spine Image 17 12 $2,258.00 $2,032.20 $54.72 $2,258.00 $2,032.20 2026-03-21
J2350 HCPCS Injection, Ocrelizumab, 1 Mg 13 13 $15,617.44 $14,055.70 $59.41 $15,617.44 $14,836.57 2026-03-21
J0896 HCPCS Injection, Luspatercept-aamt, 0.25 Mg 13 13 $15,239.13 $13,715.22 $41.98 $15,239.13 $14,477.17 2026-03-21
J2353 HCPCS Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg 13 13 $8,451.64 $7,606.48 $203.58 $8,451.64 $8,029.06 2026-03-21
27372 HCPCS Removal Of Foreign Body Deep In Tissue Of Thigh Or Knee 13 13 $7,131.00 $6,417.90 $2,967.63 $7,131.00 $6,417.90 2026-03-21
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 13 13 $6,696.34 $6,026.71 $21.31 $6,696.34 $6,361.52 2026-03-21
J7192 HCPCS Factor Viii (antihemophilic Factor, Recombinant) Per I.u., Not Otherwise Specifi… 13 13 $6,513.47 $5,862.12 $1.61 $6,513.47 $6,187.80 2026-03-21
31525 HCPCS Diagnostic Exam Of Voice Box Using An Endoscope 13 13 $6,701.00 $6,030.90 $1,818.45 $6,701.00 $6,030.90 2026-03-21
J7202 HCPCS Injection, Factor Ix, Albumin Fusion Protein, (recombinant), Idelvion, 1 I.u. 13 13 $6,284.88 $5,656.39 $5.32 $6,284.88 $5,970.64 2026-03-21
J1162 HCPCS Injection, Digoxin Immune Fab (ovine), Per Vial 13 13 $5,852.70 $5,267.43 $4,974.80 $5,913.56 $5,560.07 2026-03-21
27244 HCPCS Treatment Of Broken Neck Of Thigh Bone With Plate/screw Implant 13 13 $5,759.00 $5,183.10 $3,839.01 $7,413.38 $5,471.05 2026-03-21
25575 HCPCS Treatment Of Broken Midpart Of Both Forearm Bones With Placement Of Stabilizing … 13 13 $5,759.00 $5,183.10 $3,839.01 $7,413.38 $5,471.05 2026-03-21
27784 HCPCS Treatment Of Broken Upper Or Middle Part Of Outer Lower Leg Bone 13 13 $5,759.00 $5,183.10 $3,839.01 $7,413.38 $5,471.05 2026-03-21
26727 HCPCS Placement Of Stabilizing Device For Broken Finger Or Thumb At Midportion Or Part… 13 13 $5,759.00 $5,183.10 $3,342.87 $5,759.00 $5,183.10 2026-03-21
J0517 HCPCS Injection, Benralizumab, 1 Mg 13 13 $5,206.88 $4,686.19 $164.59 $5,206.88 $4,946.54 2026-03-21
J0881 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 13 13 $4,855.40 $4,369.86 $2.93 $4,855.40 $4,612.63 2026-03-21
J2182 HCPCS Injection, Mepolizumab, 1 Mg 13 13 $4,485.08 $4,036.57 $31.27 $4,485.08 $4,260.83 2026-03-21
11012 HCPCS Removal Of Foreign Material From Skin, Tissue, Muscle, And Bone At Open Broken A… 13 13 $4,627.00 $4,164.30 $2,967.63 $4,627.00 $4,164.30 2026-03-21
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 13 13 $4,354.00 $3,918.60 $356.43 $4,354.00 $4,136.30 2026-03-21
23605 HCPCS Closed Treatment Of Broken Top Of Upper Arm Bone With Manipulation 13 13 $4,172.00 $3,754.80 $1,642.82 $4,172.00 $3,754.80 2026-03-21
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 13 13 $3,916.00 $3,524.40 $356.43 $3,916.00 $3,720.20 2026-03-21
12037 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, More Tha… 13 13 $3,910.00 $3,519.00 $2,107.97 $3,910.00 $3,519.00 2026-03-21
72265 HCPCS Review By Radiologist Of Lower Spinal Canal Image 13 13 $3,699.00 $3,329.10 $800.90 $3,699.00 $3,514.05 2026-03-21
27562 HCPCS Closed Treatment Of Dislocated Kneecap Under Anesthesia 13 13 $3,789.00 $3,410.10 $252.01 $3,789.00 $3,410.10 2026-03-21
26742 HCPCS Closed Treatment Of Broken Finger Or Hand At Base Of Finger With Manipulation 13 13 $3,774.00 $3,396.60 $1,642.82 $3,774.00 $3,396.60 2026-03-21
26756 HCPCS Placement Of Stabilizing Device For Broken End Of Finger Or Thumb 13 13 $3,615.00 $3,253.50 $2,409.86 $3,615.00 $3,342.87 2026-03-21
72240 HCPCS Review By Radiologist Of Upper Spinal Canal Image 13 13 $3,506.00 $3,155.40 $800.90 $3,506.00 $3,330.70 2026-03-21
72255 HCPCS Review By Radiologist Of Middle Spinal Canal Image 13 13 $3,506.00 $3,155.40 $800.90 $3,506.00 $3,330.70 2026-03-21
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 13 13 $3,456.00 $3,110.40 $243.77 $3,456.00 $3,283.20 2026-03-21
81420 HCPCS Test For Detecting Genes Associated With Fetal Disease, Aneuploidy Genomic Seque… 13 13 $3,451.17 $3,106.05 $759.05 $3,451.17 $3,278.61 2026-03-21
20525 HCPCS Complicated Removal Of Foreign Body In Deep Muscle Or Tendon 13 13 $3,433.00 $3,089.70 $2,288.66 $3,433.00 $3,089.70 2026-03-21
28525 HCPCS Treatment Of Broken Toe 13 13 $3,236.00 $2,912.40 $2,157.36 $3,342.87 $3,074.20 2026-03-21
27509 HCPCS Treatment Of Broken Thigh Bone At Far End With Placement Of Stabilizing Device 13 13 $3,142.00 $2,827.80 $2,094.74 $7,413.38 $2,984.90 2026-03-21
J3358 HCPCS Ustekinumab, For Intravenous Injection, 1 Mg 13 13 $3,048.03 $2,743.23 $12.99 $3,048.03 $2,895.63 2026-03-21
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 13 13 $3,040.00 $2,736.00 $356.43 $3,040.00 $2,888.00 2026-03-21
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 13 13 $3,040.00 $2,736.00 $356.43 $3,040.00 $2,888.00 2026-03-21
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 13 13 $3,040.00 $2,736.00 $356.43 $3,040.00 $2,888.00 2026-03-21
70553 HCPCS MRI Scan Of Brain Before And After Contrast 13 13 $3,040.00 $2,736.00 $356.43 $3,040.00 $2,888.00 2026-03-21
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 13 13 $3,040.00 $2,736.00 $356.43 $3,040.00 $2,888.00 2026-03-21
78452 HCPCS Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 13 13 $3,034.00 $2,730.60 $1,322.69 $3,034.00 $2,882.30 2026-03-21
J1602 HCPCS Injection, Golimumab, 1 Mg, For Intravenous Use 13 13 $2,995.06 $2,695.55 $11.04 $2,995.06 $2,845.31 2026-03-21
24620 HCPCS Closed Treatment Of Broken And Dislocated Forearm Bones At Elbow With Manipulati… 13 13 $3,151.00 $2,835.90 $1,642.82 $3,151.00 $2,835.90 2026-03-21
21320 HCPCS Closed Treatment Of Broken Nose Bone With Placement Of Stabilizing Device 13 13 $2,957.00 $2,661.30 $1,971.52 $3,387.27 $2,809.15 2026-03-21
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 13 13 $2,948.00 $2,653.20 $356.43 $2,948.00 $2,800.60 2026-03-21
40650 HCPCS Repair Of Lip And Border 13 13 $3,013.00 $2,711.70 $551.01 $3,013.00 $2,711.70 2026-03-21
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 13 13 $2,797.00 $2,517.30 $356.43 $2,797.00 $2,657.15 2026-03-21
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 13 13 $2,797.00 $2,517.30 $356.43 $2,797.00 $2,657.15 2026-03-21
21315 HCPCS Closed Treatment Of Broken Nose Bone With Manipulation 13 13 $2,933.00 $2,639.70 $1,585.19 $2,933.00 $2,639.70 2026-03-21
72196 HCPCS MRI Scan Of Pelvis With Contrast 13 13 $2,766.00 $2,489.40 $356.43 $2,766.00 $2,627.70 2026-03-21
74182 HCPCS MRI Scan Of Abdomen With Contrast 13 13 $2,766.00 $2,489.40 $356.43 $2,766.00 $2,627.70 2026-03-21
27818 HCPCS Closed Treatment Of 3 Broken Lower Leg Bones At Ankle With Manipulation 13 13 $2,874.00 $2,586.60 $1,642.82 $2,874.00 $2,586.60 2026-03-21
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 13 13 $2,675.00 $2,407.50 $243.77 $2,675.00 $2,541.25 2026-03-21
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 13 13 $2,675.00 $2,407.50 $243.77 $2,675.00 $2,541.25 2026-03-21
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 13 13 $2,675.00 $2,407.50 $243.77 $2,675.00 $2,541.25 2026-03-21
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 13 13 $2,675.00 $2,407.50 $243.77 $2,675.00 $2,541.25 2026-03-21
70551 HCPCS MRI Scan Of Brain Without Contrast 13 13 $2,675.00 $2,407.50 $243.77 $2,675.00 $2,541.25 2026-03-21
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 13 13 $2,675.00 $2,407.50 $356.43 $2,675.00 $2,541.25 2026-03-21
72195 HCPCS MRI Scan Of Pelvis Without Contrast 13 13 $2,675.00 $2,407.50 $243.77 $2,675.00 $2,541.25 2026-03-21
J9330 HCPCS Injection, Temsirolimus, 1 Mg 13 13 $2,674.50 $2,407.05 $26.71 $2,674.50 $2,540.78 2026-03-21
J3240 HCPCS Injection, Thyrotropin Alpha, 0.9 Mg, Provided In 1.1 Mg Vial 13 13 $2,651.88 $2,386.69 $2,116.32 $2,651.88 $2,519.29 2026-03-21
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 13 13 $2,644.00 $2,379.60 $356.43 $2,644.00 $2,511.80 2026-03-21
J1561 HCPCS Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liquid)… 13 13 $2,626.18 $2,363.56 $48.96 $2,626.18 $2,494.87 2026-03-21
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 13 13 $2,614.00 $2,352.60 $356.43 $2,614.00 $2,483.30 2026-03-21
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 13 13 $2,614.00 $2,352.60 $356.43 $2,614.00 $2,483.30 2026-03-21
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 13 13 $2,614.00 $2,352.60 $356.43 $2,614.00 $2,483.30 2026-03-21
70552 HCPCS MRI Scan Of Brain With Contrast 13 13 $2,614.00 $2,352.60 $356.43 $2,614.00 $2,483.30 2026-03-21
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 13 13 $2,614.00 $2,352.60 $356.43 $2,614.00 $2,483.30 2026-03-21
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 13 13 $2,614.00 $2,352.60 $356.43 $2,614.00 $2,483.30 2026-03-21
74181 HCPCS MRI Scan Of Abdomen Without Contrast 13 13 $2,585.00 $2,326.50 $243.77 $2,585.00 $2,455.75 2026-03-21
12057 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More … 13 13 $2,727.00 $2,454.30 $415.32 $2,727.00 $2,454.30 2026-03-21
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 13 13 $2,553.00 $2,297.70 $179.20 $2,553.00 $2,425.35 2026-03-21
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 13 13 $2,553.00 $2,297.70 $179.20 $2,553.00 $2,425.35 2026-03-21
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 13 13 $2,529.00 $2,276.10 $356.43 $2,529.00 $2,402.55 2026-03-21
Q5108 HCPCS Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 13 13 $2,460.64 $2,214.58 $99.13 $2,460.64 $2,337.61 2026-03-21
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 13 13 $2,432.00 $2,188.80 $179.20 $2,432.00 $2,310.40 2026-03-21
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 13 13 $2,432.00 $2,188.80 $243.77 $2,432.00 $2,310.40 2026-03-21
52281 HCPCS Dilation Of Urethra Using An Endoscope 13 13 $2,503.00 $2,252.70 $1,668.52 $2,503.00 $2,252.70 2026-03-21
28475 HCPCS Closed Treatment Of Broken Foot With Manipulation 13 13 $2,425.00 $2,182.50 $252.01 $2,425.00 $2,182.50 2026-03-21
28435 HCPCS Closed Treatment Of Broken Ankle Joint Bone With Manipulation 13 13 $2,425.00 $2,182.50 $1,617.01 $2,425.00 $2,182.50 2026-03-21
28455 HCPCS Treatment Of Broken Foot Bone At Ankle With Manipulation 13 13 $2,425.00 $2,182.50 $1,617.01 $2,425.00 $2,182.50 2026-03-21
28495 HCPCS Closed Treatment Of Broken Great Toe With Manipulation 13 13 $2,425.00 $2,182.50 $252.01 $2,425.00 $2,182.50 2026-03-21
27825 HCPCS Closed Treatment Of Broken Shin Bone At Lower Weight Bearing Joint With Manipula… 13 13 $2,409.00 $2,168.10 $1,605.90 $2,409.00 $2,168.10 2026-03-21
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 13 13 $2,281.00 $2,052.90 $243.77 $2,281.00 $2,166.95 2026-03-21
78451 HCPCS Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect 13 13 $2,249.00 $2,024.10 $1,010.00 $2,249.00 $2,136.55 2026-03-21
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 13 13 $2,245.00 $2,020.50 $307.66 $2,245.00 $2,132.75 2026-03-21
12047 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, More Than 30.0 C… 13 13 $2,307.00 $2,076.30 $1,538.23 $2,307.00 $2,107.97 2026-03-21
71270 HCPCS CT Scan Of Chest Before And After Contrast 13 13 $2,189.00 $1,970.10 $179.20 $2,189.00 $2,079.55 2026-03-21
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 13 13 $2,189.00 $1,970.10 $179.20 $2,189.00 $2,079.55 2026-03-21
28193 HCPCS Complicated Removal Of Foreign Body In Foot 13 13 $2,307.00 $2,076.30 $1,538.23 $2,307.00 $2,076.30 2026-03-21
12046 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 20.1-30.0 Cm 13 13 $2,307.00 $2,076.30 $755.08 $2,307.00 $2,076.30 2026-03-21
12018 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, Mor… 13 13 $2,307.00 $2,076.30 $204.98 $2,307.00 $2,076.30 2026-03-21
12017 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 20.… 13 13 $2,307.00 $2,076.30 $415.32 $2,307.00 $2,076.30 2026-03-21
12007 HCPCS Simple Repair Of Surface Wound To Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 13 13 $2,307.00 $2,076.30 $204.98 $2,307.00 $2,076.30 2026-03-21
27532 HCPCS Closed Treatment Of Broken Shin Bone With Traction 13 13 $2,182.00 $1,963.80 $1,454.40 $3,342.87 $2,072.90 2026-03-21
26665 HCPCS Treatment Of Broken Thumb At Wrist 13 13 $2,182.00 $1,963.80 $1,454.40 $3,342.87 $2,072.90 2026-03-21
27752 HCPCS Closed Treatment Of Middle Part Of Broken Shin Bone With Manipulation 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
25624 HCPCS Closed Treatment Of Broken Wrist Bone Near Base Of Thumb With Manipulation 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
24530 HCPCS Closed Treatment Of Upper Arm Bone Broken At Elbow 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
24577 HCPCS Closed Treatment Of Broken Elbow With Manipulation 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
25565 HCPCS Closed Treatment Of Broken Midpart Of Both Forearm Bones With Manipulation 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
27520 HCPCS Closed Treatment Of Broken Kneecap 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
28490 HCPCS Closed Treatment Of Broken Great Toe 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
25530 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Small Finger Side 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
25660 HCPCS Closed Treatment Of Dislocated Wrist Bones With Manipulation 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
27760 HCPCS Closed Treatment Of Inside Portion Of Shin Bone At Ankle 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
24505 HCPCS Closed Treatment Of Broken Middle Part Of Upper Arm Bone With Manipulation 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
27808 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
24535 HCPCS Closed Treatment Of Upper Arm Bone Broken At Elbow With Manipulation 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
25650 HCPCS Closed Treatment Of Broken Base Of Forearm Bone On Small Finger Side At Wrist 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
27508 HCPCS Closed Treatment Of Broken Inside Or Outside Portion Of Lower End Of Thigh Bone 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
23625 HCPCS Closed Treatment Of Upper Arm Bone Broken At Shoulder Joint With Manipulation 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
27538 HCPCS Closed Treatment Of Broken Top Of Shin Bone At Knee 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
27786 HCPCS Closed Treatment Of Broken Outside Lower Leg Bone At Ankle 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
24560 HCPCS Closed Treatment Of Broken Outer Part Of Upper Arm Bone At Elbow 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
27530 HCPCS Closed Treatment Of Broken Shin Bone 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
24670 HCPCS Closed Treatment Of Broken Forearm Bone On Small Finger Side At Elbow 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
28470 HCPCS Closed Treatment Of Broken Bone In Forefoot Or Midfoot 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
27780 HCPCS Closed Treatment Of Broken Middle Or Upper End Of Outside Lower Leg Bone 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
24675 HCPCS Closed Treatment Of Broken Forearm Bone On Small Finger Side At Elbow With Manip… 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
27788 HCPCS Closed Treatment Of Broken Outside Lower Leg Bone At Ankle With Manipulation 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
25505 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Thumb Side With Manipulati… 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
28450 HCPCS Treatment Of Broken Foot Bone At Ankle 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
27781 HCPCS Closed Treatment Of Broken Middle Or Upper End Of Outside Lower Leg Bone With Ma… 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
24565 HCPCS Closed Treatment Of Broken Outer Part Of Upper Arm Bone At Elbow With Manipulati… 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
27810 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle With Manipulation 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
27750 HCPCS Closed Treatment Of Broken Middle Part Of Shin Bone 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
27510 HCPCS Closed Treatment Of Broken Thigh Bone At Knee Area With Manipulation 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
25500 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Thumb Side 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
24576 HCPCS Closed Treatment Of Broken Elbow 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
27503 HCPCS Closed Treatment Of Broken Thigh Bone At Far End With Manipulation 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
24500 HCPCS Closed Treatment Of Broken Middle Part Of Upper Arm Bone 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
28001 HCPCS Drainage Of Fluid Filled Sac In Foot 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
25520 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Thumb Side And Dislocated … 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
28530 HCPCS Closed Treatment Of Broken Small Bone In Tendon Attached To Great Toe 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
27762 HCPCS Closed Treatment Of Inside Portion Of Shin Bone At Ankle With Manipulation 13 13 $2,182.00 $1,963.80 $1,454.40 $2,182.00 $1,963.80 2026-03-21
23600 HCPCS Closed Treatment Of Broken Top Of Upper Arm Bone 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
27816 HCPCS Closed Treatment Of 3 Broken Lower Leg Bones At Ankle 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
27824 HCPCS Closed Treatment Of Broken Shin Bone At Lower Weight Bearing Joint 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
25560 HCPCS Closed Treatment Of Broken Midpart Of Both Forearm Bones 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
28430 HCPCS Closed Treatment Of Broken Ankle Joint Bone 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
23620 HCPCS Closed Treatment Of Upper Arm Bone Broken At Shoulder Joint 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
25622 HCPCS Closed Treatment Of Broken Wrist Bone Near Base Of Thumb 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
25535 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Small Finger Side With Man… 13 13 $2,182.00 $1,963.80 $252.01 $2,182.00 $1,963.80 2026-03-21
74160 HCPCS CT Scan Of Abdomen With Contrast 13 13 $2,066.00 $1,859.40 $179.20 $2,066.00 $1,962.70 2026-03-21
21325 HCPCS Treatment Of Broken Nose Bone 13 13 $2,038.00 $1,834.20 $1,358.45 $3,387.27 $1,936.10 2026-03-21
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 13 13 $2,151.00 $1,935.90 $1,434.20 $2,151.00 $1,935.90 2026-03-21
71260 HCPCS CT Scan Of Chest With Contrast 13 13 $2,037.00 $1,833.30 $179.20 $2,037.00 $1,935.15 2026-03-21
72193 HCPCS CT Scan Of Pelvis With Contrast 13 13 $2,037.00 $1,833.30 $179.20 $2,037.00 $1,935.15 2026-03-21
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 13 13 $2,037.00 $1,833.30 $179.20 $2,037.00 $1,935.15 2026-03-21
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 13 13 $2,007.00 $1,806.30 $179.20 $2,007.00 $1,906.65 2026-03-21
Q5115 HCPCS Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg 13 13 $1,988.44 $1,789.60 $29.38 $1,988.44 $1,889.02 2026-03-21
12056 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 20.1-… 13 13 $2,049.00 $1,844.10 $415.32 $2,049.00 $1,844.10 2026-03-21
J3357 HCPCS Ustekinumab, For Subcutaneous Injection, 1 Mg 12 12 $34,617.36 $31,155.62 $190.72 $34,617.36 $32,886.49 2026-03-21
J9334 HCPCS Injection, Efgartigimod Alfa, 2 Mg And Hyaluronidase-qvfc 12 12 $20,266.64 $18,239.98 $33.89 $20,266.64 $19,253.31 2026-03-21
J2327 HCPCS Injection, Risankizumab-rzaa, Intravenous, 1 Mg 12 12 $12,632.30 $11,369.07 $14.94 $12,632.30 $12,000.69 2026-03-21
70471 HCPCS Computed Tomographic Angiography (cta), Head And Neck, With Contrast Material(s)… 12 12 $3,826.00 $3,443.40 $356.43 $3,826.00 $3,634.70 2026-03-21
J1306 HCPCS Injection, Inclisiran, 1 Mg 12 12 $3,470.24 $3,123.22 $12.32 $3,470.24 $3,296.73 2026-03-21
78071 HCPCS Nuclear Medicine Study Of Parathyroid With Spect 12 12 $2,500.00 $2,250.00 $408.43 $2,500.00 $2,375.00 2026-03-21
27767 HCPCS Closed Treatment Of Back Portion Of Shin Bone At Ankle 12 12 $2,182.00 $1,963.80 $252.01 $2,182.00 $2,018.35 2026-03-21
Q9996 HCPCS Injection, Ustekinumab-ttwe (pyzchiva), Subcutaneous, 1 Mg 11 11 $5,554.65 $4,999.19 $4,721.45 $5,554.65 $5,276.92 2026-03-21
J0139 HCPCS Injection, Adalimumab, 1 Mg 11 11 $3,629.65 $3,266.69 $3,085.20 $3,629.65 $3,448.17 2026-03-21
Q0222 HCPCS Injection, Bebtelovimab, 175 Mg 11 11 $3,150.00 $2,835.00 $2,677.50 $3,150.00 $2,992.50 2026-03-21
25765486_5 CDM Graft Xenmatrix Surg 19cmx28cm Antibac* 10 10 $17,955.00 $16,159.50 $15,261.75 $17,775.45 $17,057.25 2026-03-21
25765940_5 CDM Graft Xenmatrix Surg 20cmx20cm* 10 10 $13,778.75 $12,400.88 $11,711.94 $13,640.96 $13,089.81 2026-03-21
25766037_5 CDM Mesh Phasix 10"x12"* 10 10 $12,935.00 $11,641.50 $10,994.75 $12,805.65 $12,288.25 2026-03-21
25765485_5 CDM Graft Xenmatrix Surg 15cmx20cm Antibac* 10 10 $10,920.00 $9,828.00 $9,282.00 $10,810.80 $10,374.00 2026-03-21
27091376_5 CDM Meshed Bilayer Wound Matrix 4x5 10 10 $10,578.10 $9,520.29 $8,991.39 $10,472.32 $10,049.20 2026-03-21
27535763_5 CDM Mesh Xen Matrix Ab 15cm X 20cm* 10 10 $9,899.50 $8,909.55 $8,414.58 $9,800.51 $9,404.53 2026-03-21
25768576_5 CDM Mesh Surgimend 20CMx20CMx2MM 2017* 10 10 $9,880.00 $8,892.00 $8,398.00 $9,781.20 $9,386.00 2026-03-21
25765454_5 CDM Alrua Pacemaker Generator* 10 10 $7,991.10 $7,191.99 $6,792.44 $7,911.19 $7,591.55 2026-03-21
25765453_5 CDM Adapta Dr Pacemaker Generator* 10 10 $7,187.70 $6,468.93 $6,109.55 $7,115.82 $6,828.32 2026-03-21
27749219_5 CDM Graft Skin Mesh Derm Regenerating 2x2" * 10 10 $6,194.22 $5,574.80 $5,265.09 $6,132.28 $5,884.51 2026-03-21
25765858_5 CDM Reveal Xt Monitor Pacemaker* 10 10 $6,160.00 $5,544.00 $5,236.00 $6,098.40 $5,852.00 2026-03-21
28492690_5 CDM Template Derm Regen 2in X 2in* (2023) 10 10 $5,476.80 $4,929.12 $4,655.28 $5,422.03 $5,202.96 2026-03-21
25767469_5 CDM Mesh Lg Ventral Coated 22 X 26 Cm (consign) 2017* 10 10 $4,690.00 $4,221.00 $3,986.50 $4,643.10 $4,455.50 2026-03-21
25766043_5 CDM Pleurx Pleural Cath Kit Complete W/discharge Pk* 10 10 $4,666.48 $4,199.83 $3,966.51 $4,619.82 $4,433.16 2026-03-21
25765488_5 CDM Graft Allomax Surg 10cmx10cm* 10 10 $4,537.40 $4,083.66 $3,856.79 $4,492.03 $4,310.53 2026-03-21
25765893_5 CDM Kyphopak Express Tray 10/2 First Fracture* 10 10 $4,413.78 $3,972.40 $3,751.71 $4,369.64 $4,193.09 2026-03-21
27502111_5 CDM Stent Colonic 22 Dm X 9 Cm 10 10 $4,389.00 $3,950.10 $3,730.65 $4,345.11 $4,169.55 2026-03-21
26309839_5 CDM Mesh Ventral Coated 15x22CM* 10 10 $4,270.00 $3,843.00 $3,629.50 $4,227.30 $4,056.50 2026-03-21
25765749_5 CDM Graftjacket 4cmx8cm **needs Abn Signed*** 10 10 $4,253.31 $3,827.98 $3,615.31 $4,210.78 $4,040.64 2026-03-21
27383446_5 CDM Mesh Phasix Hernia 10cm X 15cm 10 10 $4,233.32 $3,809.99 $3,598.32 $4,190.99 $4,021.65 2026-03-21
25765355_5 CDM Mesh C-qur Edge 12"x18"* 10 10 $3,892.00 $3,502.80 $3,308.20 $3,853.08 $3,697.40 2026-03-21
25765802_5 CDM Matristem Powder 1gm **needs Abn Signed *** 10 10 $3,780.00 $3,402.00 $3,213.00 $3,742.20 $3,591.00 2026-03-21
667719_1 CDM Misc Supplies & Materials Charge 10 10 $3,612.34 $3,251.11 $3,070.49 $3,576.22 $3,431.72 2026-03-21
25765933_5 CDM Mesh Ventralight 10"x13"* 10 10 $3,442.50 $3,098.25 $2,926.13 $3,408.08 $3,270.38 2026-03-21
26309841_5 CDM Mesh Ventral Coated 30x30CM 10 10 $3,382.50 $3,044.25 $2,875.13 $3,348.68 $3,213.38 2026-03-21
25765738_5 CDM Mesh Composix L/p 10.2x14.2* 10 10 $3,375.00 $3,037.50 $2,868.75 $3,341.25 $3,206.25 2026-03-21
25764890_5 CDM Mesh Composix Ellipse 10x13* 10 10 $3,333.00 $2,999.70 $2,833.05 $3,299.67 $3,166.35 2026-03-21
27091372_5 CDM Valvulotome 1.5mm Hydro* 10 10 $3,298.50 $2,968.65 $2,803.73 $3,265.52 $3,133.58 2026-03-21
25765967_5 CDM Mesh Composix L/p 10.2x13.2* 10 10 $3,252.00 $2,926.80 $2,764.20 $3,219.48 $3,089.40 2026-03-21
27502113_5 CDM Mesh Surgical Phasix St 4" X 4" 10 10 $3,200.01 $2,880.01 $2,720.01 $3,168.01 $3,040.01 2026-03-21
25766137_5 CDM Sling Obtryx Cvd Single Syst System Device* 10 10 $3,184.00 $2,865.60 $2,706.40 $3,152.16 $3,024.80 2026-03-21
25766026_5 CDM Graft Mini Cuff Bypass 6 X 70 Distaflo 6mm X 70cm * 10 10 $3,166.40 $2,849.76 $2,691.44 $3,134.74 $3,008.08 2026-03-21
26309837_5 CDM Mesh Ventral Coated 14x15CM* 10 10 $3,120.00 $2,808.00 $2,652.00 $3,088.80 $2,964.00 2026-03-21
27579779_5 CDM Mesh Ventral 15cm* (consign) 10 10 $3,120.00 $2,808.00 $2,652.00 $3,088.80 $2,964.00 2026-03-21
25765803_5 CDM Matristem Sheets **needs Abn Signed*** 10 10 $3,116.80 $2,805.12 $2,649.28 $3,085.63 $2,960.96 2026-03-21
25765742_5 CDM Graftjacket 2cc Xpress Flow **needs Abn Signed*** 10 10 $3,097.60 $2,787.84 $2,632.96 $3,066.62 $2,942.72 2026-03-21
27383448_5 CDM Mesh Phasix Hernia 10cm X 10cm 10 10 $3,009.44 $2,708.50 $2,558.02 $2,979.35 $2,858.97 2026-03-21
25766114_5 CDM Graft Allomax Surg 1mm 7x10CM* 10 10 $2,998.40 $2,698.56 $2,548.64 $2,968.42 $2,848.48 2026-03-21
25769407_5 CDM Thunderbeat Transducer 10 10 $2,960.00 $2,664.00 $2,516.00 $2,930.40 $2,812.00 2026-03-21
25684266_5 CDM Labor Room/delivery - General Classification 10 10 $2,940.00 $2,646.00 $2,499.00 $2,910.60 $2,793.00 2026-03-21
25765781_5 CDM Mesh Ventrio St 8.7x10.7 Hernia Patch * 10 10 $2,928.00 $2,635.20 $2,488.80 $2,898.72 $2,781.60 2026-03-21
25765354_5 CDM Mesh C-qur 10"x14"* 10 10 $2,872.00 $2,584.80 $2,441.20 $2,843.28 $2,728.40 2026-03-21
9259111_5 CDM Intensive Care Unit - General Classification 10 10 $2,819.00 $2,537.10 $2,396.15 $2,819.00 $2,678.05 2026-03-21
28833263_5 CDM Ryanodex 250 Mg Vial 10 10 $2,769.10 $2,492.19 $2,353.74 $2,741.41 $2,630.65 2026-03-21
25765966_5 CDM Mesh Composix L/p 8.2x10.2* 10 10 $2,720.00 $2,448.00 $2,312.00 $2,692.80 $2,584.00 2026-03-21
25765487_5 CDM Graft Allomax Surg 7cmx10cm* 10 10 $2,656.69 $2,391.02 $2,258.19 $2,630.12 $2,523.86 2026-03-21
25765875_5 CDM Mesh Hiatal Hernia 7cmx10cm Biodesign* 10 10 $2,645.40 $2,380.86 $2,248.59 $2,618.95 $2,513.13 2026-03-21
25766129_5 CDM Mesh Skirted Oval 10 X 15 2016 10 10 $2,640.00 $2,376.00 $2,244.00 $2,613.60 $2,508.00 2026-03-21
25910805_5 CDM Mchb Indium Per Dose 10 10 $2,621.00 $2,358.90 $2,227.85 $2,594.79 $2,489.95 2026-03-21
25910792_5 CDM Mchb Ceretec/ 25 Mci 10 10 $2,621.00 $2,358.90 $2,227.85 $2,594.79 $2,489.95 2026-03-21
26152980_5 CDM Cypass Micro Stent Eye (2017)* 10 10 $2,552.00 $2,296.80 $2,169.20 $2,526.48 $2,424.40 2026-03-21
25765323_5 CDM Filter Vena Cava Celect Uni* 10 10 $2,550.01 $2,295.01 $2,167.51 $2,524.51 $2,422.51 2026-03-21
25765741_5 CDM Graftjacket 4cmx4cm **needs Abn Signed*** 10 10 $2,550.01 $2,295.01 $2,167.51 $2,524.51 $2,422.51 2026-03-21
25766027_5 CDM Valvulotome* 10 10 $2,550.01 $2,295.01 $2,167.51 $2,524.51 $2,422.51 2026-03-21
25764677_5 CDM Blade Scope Endo Carpal Tunnel* 10 10 $2,533.00 $2,279.70 $2,153.05 $2,507.67 $2,406.35 2026-03-21
25764942_5 CDM Mesh Sepra 8 X 12* 10 10 $2,490.50 $2,241.45 $2,116.93 $2,465.60 $2,365.98 2026-03-21
25765464_5 CDM Gynecare Tvt Secur-tension* 10 10 $2,482.00 $2,233.80 $2,109.70 $2,457.18 $2,357.90 2026-03-21
27692621_5 CDM Room & Board - Semi-private (two Beds) - General Classification 10 10 $2,478.00 $2,230.20 $2,106.30 $2,478.00 $2,354.10 2026-03-21
25765397_5 CDM Mesh Surgimesh 14x15 Rectangle* 10 10 $2,473.50 $2,226.15 $2,102.48 $2,448.77 $2,349.83 2026-03-21
29003506_5 CDM Catheter "jada" Hemorrhage Control* (2025) 10 10 $2,465.00 $2,218.50 $2,095.25 $2,440.35 $2,341.75 2026-03-21
25768723_5 CDM Set Fistula Plug - 0.4cm Cook 2017 10 10 $2,334.10 $2,100.69 $1,983.99 $2,310.76 $2,217.40 2026-03-21
1251733_5 CDM Operating Room Services - General Classification 10 10 $2,305.00 $2,074.50 $1,959.25 $2,281.95 $2,189.75 2026-03-21
25766062_5 CDM Introducer Needle Bone* 10 10 $2,244.00 $2,019.60 $1,907.40 $2,221.56 $2,131.80 2026-03-21
27502107_5 CDM Dermaclose System - Greater Than 11cm 10 10 $2,208.30 $1,987.47 $1,877.06 $2,186.22 $2,097.89 2026-03-21
25765255_5 CDM Endometrial Ablation Instrument With Suresound* 10 10 $2,150.50 $1,935.45 $1,827.93 $2,129.00 $2,042.98 2026-03-21
27579777_5 CDM Mesh Ventral 10cm* (consign) 10 10 $2,125.00 $1,912.50 $1,806.25 $2,103.75 $2,018.75 2026-03-21
25765681_5 CDM Coseal Surgical Sealant 8ml* 10 10 $2,121.09 $1,908.98 $1,802.93 $2,099.88 $2,015.04 2026-03-21
25764893_5 CDM Mesh Marlex Composix 8"x10"* 10 10 $2,108.00 $1,897.20 $1,791.80 $2,086.92 $2,002.60 2026-03-21
28292434_5 CDM Sealer Open Curved Large Jaw* (2022) 10 10 $1,988.01 $1,789.21 $1,689.81 $1,968.13 $1,888.61 2026-03-21
25765862_5 CDM Vena Cava Filter Sys Opt Elite* 10 10 $1,955.00 $1,759.50 $1,661.75 $1,935.45 $1,857.25 2026-03-21
25765664_5 CDM Catheter Thermal Chc Endometrial Ablation* 10 10 $1,944.80 $1,750.32 $1,653.08 $1,925.35 $1,847.56 2026-03-21
25765955_5 CDM Mesh Ventralite 4.5" Circle* 10 10 $1,938.00 $1,744.20 $1,647.30 $1,918.62 $1,841.10 2026-03-21
25765740_5 CDM Mesh Composix L/p 6.2x8.2* 10 10 $1,929.50 $1,736.55 $1,640.08 $1,910.21 $1,833.03 2026-03-21
44204 HCPCS Partial Removal Of Large Bowel Using An Endoscope 7 7 $2,963.00 $2,666.70 $1,168.28 $2,814.85 $2,506.70 2026-03-21
43282 HCPCS Repair Of Hernia Of Muscle At Esophagus And Stomach With Implantation Of Mesh Us… 7 7 $2,549.00 $2,294.10 $886.49 $2,421.55 $2,156.45 2026-03-21
44145 HCPCS Partial Removal Of Large Bowel And Reattachment To Rectum 7 7 $2,407.00 $2,166.30 $1,240.11 $2,392.00 $2,036.32 2026-03-21
47120 HCPCS Partial Removal Of Liver Lobe 6 6 $3,094.00 $2,784.60 $1,689.98 $2,939.30 $2,617.52 2026-03-21
44141 HCPCS Partial Removal Of Large Bowel With Creation Of Opening To Skin 6 6 $3,021.00 $2,718.90 $977.04 $2,869.95 $2,555.77 2026-03-21
44207 HCPCS Partial Removal Of Large Bowel And Reattachment To Rectum Using An Endoscope 6 6 $2,996.00 $2,696.40 $1,384.41 $2,846.20 $2,534.62 2026-03-21
44146 HCPCS Partial Removal Of Large Bowel And Reattachment To Rectum And Creation Of Large … 6 6 $2,709.00 $2,438.10 $1,337.86 $2,573.55 $2,291.81 2026-03-21
43632 HCPCS Removal Of Lower Part Of Stomach With Reattachment Of Remaining Stomach To Secon… 6 6 $2,603.00 $2,342.70 $1,062.30 $2,472.85 $2,202.14 2026-03-21
44140 HCPCS Partial Removal Of Large Bowel With Connection 6 6 $2,580.00 $2,322.00 $989.70 $2,451.00 $2,182.68 2026-03-21
43633 HCPCS Removal Of Lower Portion Of Stomach With Reattachment Of Upper Portion Of Remain… 6 6 $2,552.00 $2,296.80 $1,085.31 $2,424.40 $2,158.99 2026-03-21
15734 HCPCS Creation Of Muscle Graft To Trunk 6 6 $2,513.00 $2,261.70 $1,153.65 $2,387.35 $2,126.00 2026-03-21
44206 HCPCS Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin… 6 6 $2,475.00 $2,227.50 $1,275.70 $2,351.25 $2,093.85 2026-03-21
44626 HCPCS Closure Of Surgically Created Large Or Small Bowel Opening With Bowel Removal An… 6 6 $2,404.00 $2,163.60 $1,177.10 $2,283.80 $2,033.78 2026-03-21
43631 HCPCS Removal Of Lower Part Of Stomach With Reattachment Of Remaining Stomach To First… 6 6 $2,395.00 $2,155.50 $1,062.30 $2,275.25 $2,026.17 2026-03-21
38724 HCPCS Removal Of Lymph Nodes, Muscle, And Tissue Of Neck 6 6 $2,213.00 $1,991.70 $781.28 $2,102.35 $1,872.20 2026-03-21
44205 HCPCS Partial Removal Of Small And Large Bowel With Attachment Of Small And Large Bowe… 6 6 $2,212.00 $1,990.80 $1,036.20 $2,101.40 $1,871.35 2026-03-21
58554 HCPCS Removal Of Uterus, Tubes, And/or Ovaries Through Vagina Using An Endoscope, More… 6 6 $2,200.00 $1,980.00 $1,061.87 $2,090.00 $1,861.20 2026-03-21
60254 HCPCS Removal Of Thyroid And Surrounding Lymph Nodes With Extensive Neck Removal 6 6 $2,184.00 $1,965.60 $1,338.05 $2,074.80 $1,847.66 2026-03-21
44227 HCPCS Closure Of Opening From Large Or Small Bowel To Skin Using An Endoscope 6 6 $2,175.00 $1,957.50 $1,240.99 $2,066.25 $1,840.05 2026-03-21
44143 HCPCS Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin 6 6 $2,170.00 $1,953.00 $1,120.22 $2,061.50 $1,835.82 2026-03-21
49618 HCPCS Repair Of Recurrent Entrapped Hernia Of Abdomen, More Than 10 Cm In Length 5 5 $2,325.00 $2,092.50 $1,017.83 $2,208.75 $1,966.95 2026-03-21
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