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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

SMITH COUNTY MEMORIAL HOSPITAL

Smith Center, KS · CCN 171377 · Rates published

2,135 distinct procedures filed
9 distinct payers
32,499 rate rows
2026-06-09 last MRF observed
Data quality

32,396 of 32,499 rate rows are consumer-grade (99.7%)

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

Excluded — reasonRows
percent-of-charges filed in the dollar field — excluded from medians 78
per-diem day rate — not a per-procedure price 22
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 1
exceeds 10× this hospital's gross charge — excluded from medians 1
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=dbSCMHSMITHCENTERKS&type=CDMWithoutLabel&fileType=CSV
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-13
Content fingerprint c09e70276a578730… · 16,479,170 bytes · first seen 2026-07-17

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 9 $228.58 $37,699.18 $35,437.23 nat. median
$20,264
1.7× median
6107010_1
CDM 		Nutrilipid 20% IV Fat Emulsion 8 $4,314.38 $16,394.63 $15,876.90 —
29807
HCPCS 		Repair Of Shoulder Socket Using An Endoscope 9 $9,239.00 $15,200.00 $14,288.00 nat. median
$7,073
outlier · 2.0×
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 9 $24.91 $14,540.22 $13,667.81 nat. median
$59
outlier · 232.4×
28750
HCPCS 		Fusion Of Big Toe At Joint With Foot 9 $8,455.00 $14,032.00 $13,190.08 nat. median
$7,165
1.8× median
29828
HCPCS 		Release Of Tendon Connecting Biceps Muscle And Shoulder Using An Endoscope 9 $7,870.99 $13,064.00 $12,280.16 nat. median
$7,292
1.7× median
J9299
HCPCS 		Injection, Nivolumab, 1 Mg 9 $34.65 $13,050.24 $12,267.23 nat. median
$1,811
outlier · 6.8×
29827
HCPCS 		Repair Of Shoulder Rotator Cuff Using An Endoscope 9 $7,870.99 $13,000.00 $12,220.00 nat. median
$7,413
1.6× median
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 9 $161.92 $13,605.86 $11,983.02 nat. median
$498
outlier · 24.1×
J0896
HCPCS 		Injection, Luspatercept-aamt, 0.25 Mg 8 $5,120.37 $21,944.34 $11,337.93 nat. median
$228
outlier · 49.8×
49651
HCPCS 		Repair Of Recurrent Groin Hernia Using An Endoscope 9 $8,330.00 $11,900.00 $11,186.00 nat. median
$6,367
1.8× median
29806
HCPCS 		Repair Of Shoulder Joint Capsule Using An Endoscope 9 $7,173.00 $11,800.00 $11,092.00 nat. median
$7,073
1.6× median
47563
HCPCS 		Removal Of Gallbladder With X-ray Study Of Bile Ducts Using An Endoscope 9 $5,828.00 $11,600.00 $10,904.00 nat. median
$6,246
1.7× median
49650
HCPCS 		Repair Of Groin Hernia Using An Endoscope 9 $7,124.00 $11,049.32 $10,386.36 nat. median
$5,726
1.8× median
57288
HCPCS 		Creation Of Sling Around Urethra In Female To Control Leakage 9 $6,516.00 $10,740.00 $10,095.60 nat. median
$5,561
1.8× median
57135
HCPCS 		Removal Of Cyst Or Growth Of Vaginal 9 $6,586.00 $10,214.89 $9,602.00 nat. median
$3,216
outlier · 3.0×
J0517
HCPCS 		Injection, Benralizumab, 1 Mg 9 $206.27 $10,094.81 $9,489.12 nat. median
$404
outlier · 23.5×
47564
HCPCS 		Removal Of Gallbladder With Exploration Of Common Bile Duct Using An Endoscope 9 $6,790.00 $9,700.00 $9,118.00 nat. median
$8,650
1.1× median
J0717
HCPCS 		Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm… 9 $10.21 $9,604.37 $9,028.11 nat. median
$29
outlier · 311.1×
58661
HCPCS 		Removal Of Ovaries And/or Tubes Using An Endoscope 9 $6,188.00 $9,597.59 $9,021.73 nat. median
$5,852
1.5× median
58150
HCPCS 		Removal Of Uterus And Cervix Through Abdomen 8 $6,300.00 $9,000.00 $8,505.00 nat. median
$3,499
outlier · 2.4×
58262
HCPCS 		Removal Of Uterus, Tubes, And/or Ovaries Through Vagina, 250.0 G Or Less 9 $5,988.00 $9,000.00 $8,460.00 nat. median
$5,192
1.6× median
J1950
HCPCS 		Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg 9 $1,635.13 $19,437.39 $8,365.30 nat. median
$3,343
outlier · 2.5×
J9271
HCPCS 		Injection, Pembrolizumab, 1 Mg 9 $60.73 $10,081.19 $8,191.24 nat. median
$127
outlier · 64.5×
J1162
HCPCS 		Injection, Digoxin Immune Fab (ovine), Per Vial 9 $4,862.89 $7,938.74 $7,462.42 nat. median
$6,265
1.2× median
J2356
HCPCS 		Injection, Tezepelumab-ekko, 1 Mg 8 $5,438.29 $7,768.99 $7,341.69 nat. median
$43
outlier · 169.6×
36571
HCPCS 		Insertion Of Central Venous Tube With Port For Infusion (5 Years Or Older) 9 $3,793.00 $7,600.00 $7,144.00 nat. median
$3,733
1.9× median
47562
HCPCS 		Removal Of Gallbladder Using An Endoscope 9 $4,826.00 $7,485.13 $7,036.02 nat. median
$6,043
1.2× median
49521
HCPCS 		Repair Of Trapped Or Strangulated Groin Hernia 9 $5,180.00 $7,400.00 $6,956.00 nat. median
$6,223
1.1× median
58260
HCPCS 		Removal Of Uterus Through Vagina, 250.0 G Or Less 9 $4,744.00 $7,357.94 $6,916.46 nat. median
$5,217
1.3× median
15275
HCPCS 		Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 9 $38.00 $6,884.89 $6,471.80 nat. median
$1,689
outlier · 3.8×
29822
HCPCS 		Limited Removal Of Abnormal Shoulder Joint Tissue Using Endoscope 9 $4,126.00 $6,800.00 $6,392.00 nat. median
$3,489
1.8× median
15734
HCPCS 		Creation Of Muscle Graft To Trunk 9 $3,917.48 $6,480.00 $6,091.20 nat. median
$3,867
1.6× median
28122
HCPCS 		Partial Removal Of Foot Or Heel Bone 9 $3,897.00 $6,470.00 $6,081.80 nat. median
$3,388
1.8× median
28825
HCPCS 		Amputation Of Toe At Toe Joint 9 $3,924.00 $6,465.00 $6,077.10 nat. median
$3,245
1.9× median
55520
HCPCS 		Removal Of Growth Of Sperm Cord 9 $3,914.00 $6,450.00 $6,063.00 nat. median
$3,424
1.8× median
49592
HCPCS 		Initial Repair Of Entrapped Hernia Of Abdomen, Less Than 3 Cm In Length 8 $4,480.00 $6,400.00 $6,048.00 nat. median
$6,267
1.0× median
49594
HCPCS 		Initial Repair Of Entrapped Hernia Of Abdomen, 3-10 Cm In Length 8 $4,474.40 $6,392.00 $6,040.44 nat. median
$6,255
1.0× median
49321
HCPCS 		Biopsy Of Abdomen Using An Endoscope 9 $4,490.50 $6,415.00 $6,030.10 nat. median
$6,112
1.0× median
J2182
HCPCS 		Injection, Mepolizumab, 1 Mg 9 $37.68 $6,369.16 $5,987.01 nat. median
$80
outlier · 75.1×
29877
HCPCS 		Removal Or Shaving Of Knee Joint Cartilage Using An Endoscope 9 $3,801.00 $6,300.00 $5,922.00 nat. median
$3,605
1.6× median
29826
HCPCS 		Shaving Of Part Of Shoulder Bone And Repair Of Ligament Using An Endoscope 9 $3,807.00 $6,270.00 $5,893.80 nat. median
$3,950
1.5× median
58565
HCPCS 		Placement Of Implants To Block Fallopian Tubes Using An Endoscope 9 $4,378.50 $6,255.00 $5,879.70 nat. median
$5,181
1.1× median
49593
HCPCS 		Initial Repair Of Sliding Hernia Of Abdomen, 3-10 Cm In Length 8 $4,352.60 $6,218.00 $5,876.01 nat. median
$6,490
0.9× median
58294
HCPCS 		Removal Of Uterus With Repair Of Herniated Bowel Through Vagina. 250.0 G Or More 9 $4,347.00 $6,210.00 $5,837.40 nat. median
$5,111
1.1× median
J2353
HCPCS 		Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg 9 $251.86 $10,799.00 $5,812.34 nat. median
$1,956
outlier · 3.0×
21552
HCPCS 		Removal Of Growth Of Soft Tissue Under Skin Of Neck Or Front Of Chest, 3.0 Cm Or… 9 $3,049.00 $6,100.00 $5,734.00 nat. median
$2,904
2.0× median
52310
HCPCS 		Simple Removal Of Foreign Body, Stone, Or Stent In Urethra Or Bladder Using An E… 9 $4,200.00 $6,000.00 $5,640.00 nat. median
$2,192
outlier · 2.6×
J2426
HCPCS 		Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg 9 $14.90 $5,981.20 $5,622.33 nat. median
$2,528
outlier · 2.2×
29823
HCPCS 		Removal Of Extensive Shoulder Joint Tissue Using An Endoscope 9 $3,622.00 $5,970.00 $5,611.80 nat. median
$3,808
1.5× median

Other procedures at this hospital

Browse this hospital's 2,135 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
             
J3357 HCPCS Ustekinumab, For Subcutaneous Injection, 1 Mg 9 9 $37,699.18 $37,699.18 $228.58 $37,699.18 $35,437.23 2026-06-09
6107010_1 CDM Nutrilipid 20% IV Fat Emulsion 8 8 $17,257.50 $17,257.50 $4,314.38 $16,394.63 $15,876.90 2026-06-09
29807 HCPCS Repair Of Shoulder Socket Using An Endoscope 9 9 $15,200.00 $15,200.00 $9,239.00 $15,200.00 $14,288.00 2026-06-09
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 9 9 $14,540.22 $14,540.22 $24.91 $14,540.22 $13,667.81 2026-06-09
28750 HCPCS Fusion Of Big Toe At Joint With Foot 9 9 $14,032.00 $14,032.00 $8,455.00 $14,032.00 $13,190.08 2026-06-09
29828 HCPCS Release Of Tendon Connecting Biceps Muscle And Shoulder Using An Endoscope 9 9 $13,064.00 $13,064.00 $7,870.99 $13,064.00 $12,280.16 2026-06-09
J9299 HCPCS Injection, Nivolumab, 1 Mg 9 9 $13,050.24 $13,050.24 $34.65 $13,050.24 $12,267.23 2026-06-09
29827 HCPCS Repair Of Shoulder Rotator Cuff Using An Endoscope 9 9 $13,000.00 $13,000.00 $7,870.99 $13,000.00 $12,220.00 2026-06-09
J3101 HCPCS Injection, Tenecteplase, 1 Mg 17 9 $12,613.70 $12,613.70 $161.92 $13,605.86 $11,983.02 2026-06-09
J0896 HCPCS Injection, Luspatercept-aamt, 0.25 Mg 16 8 $14,629.58 $14,629.58 $5,120.37 $21,944.34 $11,337.93 2026-06-09
49651 HCPCS Repair Of Recurrent Groin Hernia Using An Endoscope 9 9 $11,900.00 $11,900.00 $8,330.00 $11,900.00 $11,186.00 2026-06-09
29806 HCPCS Repair Of Shoulder Joint Capsule Using An Endoscope 9 9 $11,800.00 $11,800.00 $7,173.00 $11,800.00 $11,092.00 2026-06-09
47563 HCPCS Removal Of Gallbladder With X-ray Study Of Bile Ducts Using An Endoscope 9 9 $11,600.00 $11,600.00 $5,828.00 $11,600.00 $10,904.00 2026-06-09
49650 HCPCS Repair Of Groin Hernia Using An Endoscope 9 9 $11,049.32 $11,049.32 $7,124.00 $11,049.32 $10,386.36 2026-06-09
57288 HCPCS Creation Of Sling Around Urethra In Female To Control Leakage 9 9 $10,740.00 $10,740.00 $6,516.00 $10,740.00 $10,095.60 2026-06-09
57135 HCPCS Removal Of Cyst Or Growth Of Vaginal 9 9 $10,214.89 $10,214.89 $6,586.00 $10,214.89 $9,602.00 2026-06-09
J0517 HCPCS Injection, Benralizumab, 1 Mg 9 9 $10,094.81 $10,094.81 $206.27 $10,094.81 $9,489.12 2026-06-09
47564 HCPCS Removal Of Gallbladder With Exploration Of Common Bile Duct Using An Endoscope 9 9 $9,700.00 $9,700.00 $6,790.00 $9,700.00 $9,118.00 2026-06-09
J0717 HCPCS Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm… 9 9 $9,604.37 $9,604.37 $10.21 $9,604.37 $9,028.11 2026-06-09
58661 HCPCS Removal Of Ovaries And/or Tubes Using An Endoscope 9 9 $9,597.59 $9,597.59 $6,188.00 $9,597.59 $9,021.73 2026-06-09
58150 HCPCS Removal Of Uterus And Cervix Through Abdomen 8 8 $9,000.00 $9,000.00 $6,300.00 $9,000.00 $8,505.00 2026-06-09
58262 HCPCS Removal Of Uterus, Tubes, And/or Ovaries Through Vagina, 250.0 G Or Less 9 9 $9,000.00 $9,000.00 $5,988.00 $9,000.00 $8,460.00 2026-06-09
J1950 HCPCS Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg 25 9 $8,899.25 $8,899.25 $1,635.13 $19,437.39 $8,365.30 2026-06-09
J9271 HCPCS Injection, Pembrolizumab, 1 Mg 17 9 $8,622.36 $8,622.36 $60.73 $10,081.19 $8,191.24 2026-06-09
J1162 HCPCS Injection, Digoxin Immune Fab (ovine), Per Vial 9 9 $7,938.74 $7,938.74 $4,862.89 $7,938.74 $7,462.42 2026-06-09
J2356 HCPCS Injection, Tezepelumab-ekko, 1 Mg 8 8 $7,768.99 $7,768.99 $5,438.29 $7,768.99 $7,341.69 2026-06-09
36571 HCPCS Insertion Of Central Venous Tube With Port For Infusion (5 Years Or Older) 9 9 $7,600.00 $7,600.00 $3,793.00 $7,600.00 $7,144.00 2026-06-09
47562 HCPCS Removal Of Gallbladder Using An Endoscope 9 9 $7,485.13 $7,485.13 $4,826.00 $7,485.13 $7,036.02 2026-06-09
49521 HCPCS Repair Of Trapped Or Strangulated Groin Hernia 9 9 $7,400.00 $7,400.00 $5,180.00 $7,400.00 $6,956.00 2026-06-09
58260 HCPCS Removal Of Uterus Through Vagina, 250.0 G Or Less 9 9 $7,357.94 $7,357.94 $4,744.00 $7,357.94 $6,916.46 2026-06-09
15275 HCPCS Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 9 9 $6,884.89 $6,884.89 $38.00 $6,884.89 $6,471.80 2026-06-09
29822 HCPCS Limited Removal Of Abnormal Shoulder Joint Tissue Using Endoscope 9 9 $6,800.00 $6,800.00 $4,126.00 $6,800.00 $6,392.00 2026-06-09
15734 HCPCS Creation Of Muscle Graft To Trunk 9 9 $6,480.00 $6,480.00 $3,917.48 $6,480.00 $6,091.20 2026-06-09
28122 HCPCS Partial Removal Of Foot Or Heel Bone 9 9 $6,470.00 $6,470.00 $3,897.00 $6,470.00 $6,081.80 2026-06-09
28825 HCPCS Amputation Of Toe At Toe Joint 9 9 $6,465.00 $6,465.00 $3,924.00 $6,465.00 $6,077.10 2026-06-09
55520 HCPCS Removal Of Growth Of Sperm Cord 9 9 $6,450.00 $6,450.00 $3,914.00 $6,450.00 $6,063.00 2026-06-09
49592 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, Less Than 3 Cm In Length 8 8 $6,400.00 $6,400.00 $4,480.00 $6,400.00 $6,048.00 2026-06-09
49594 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, 3-10 Cm In Length 8 8 $6,392.00 $6,392.00 $4,474.40 $6,392.00 $6,040.44 2026-06-09
49321 HCPCS Biopsy Of Abdomen Using An Endoscope 9 9 $6,415.00 $6,415.00 $4,490.50 $6,415.00 $6,030.10 2026-06-09
J2182 HCPCS Injection, Mepolizumab, 1 Mg 9 9 $6,369.16 $6,369.16 $37.68 $6,369.16 $5,987.01 2026-06-09
29877 HCPCS Removal Or Shaving Of Knee Joint Cartilage Using An Endoscope 9 9 $6,300.00 $6,300.00 $3,801.00 $6,300.00 $5,922.00 2026-06-09
29826 HCPCS Shaving Of Part Of Shoulder Bone And Repair Of Ligament Using An Endoscope 9 9 $6,270.00 $6,270.00 $3,807.00 $6,270.00 $5,893.80 2026-06-09
58565 HCPCS Placement Of Implants To Block Fallopian Tubes Using An Endoscope 9 9 $6,255.00 $6,255.00 $4,378.50 $6,255.00 $5,879.70 2026-06-09
49593 HCPCS Initial Repair Of Sliding Hernia Of Abdomen, 3-10 Cm In Length 8 8 $6,218.00 $6,218.00 $4,352.60 $6,218.00 $5,876.01 2026-06-09
58294 HCPCS Removal Of Uterus With Repair Of Herniated Bowel Through Vagina. 250.0 G Or More 9 9 $6,210.00 $6,210.00 $4,347.00 $6,210.00 $5,837.40 2026-06-09
J2353 HCPCS Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg 33 9 $6,118.25 $6,118.25 $251.86 $10,799.00 $5,812.34 2026-06-09
21552 HCPCS Removal Of Growth Of Soft Tissue Under Skin Of Neck Or Front Of Chest, 3.0 Cm Or… 9 9 $6,100.00 $6,100.00 $3,049.00 $6,100.00 $5,734.00 2026-06-09
52310 HCPCS Simple Removal Of Foreign Body, Stone, Or Stent In Urethra Or Bladder Using An E… 9 9 $6,000.00 $6,000.00 $4,200.00 $6,000.00 $5,640.00 2026-06-09
J2426 HCPCS Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg 9 9 $5,981.20 $5,981.20 $14.90 $5,981.20 $5,622.33 2026-06-09
29823 HCPCS Removal Of Extensive Shoulder Joint Tissue Using An Endoscope 9 9 $5,970.00 $5,970.00 $3,622.00 $5,970.00 $5,611.80 2026-06-09
J1306 HCPCS Injection, Inclisiran, 1 Mg 8 8 $5,925.20 $5,925.20 $4,147.64 $5,925.20 $5,599.31 2026-06-09
28285 HCPCS Correction Of Toe Joint Deformity 9 9 $5,907.00 $5,907.00 $2,385.00 $5,907.00 $5,552.58 2026-06-09
29805 HCPCS Diagnostic Exam Of Shoulder Using An Endoscope 9 9 $5,860.00 $5,860.00 $3,557.00 $5,860.00 $5,508.40 2026-06-09
49505 HCPCS Repair Of Groin Hernia (5 Years Or Older) 9 9 $5,853.47 $5,853.47 $3,774.00 $5,853.47 $5,502.26 2026-06-09
29876 HCPCS Removal Of Joint Lining From Multiple Knee Joint Compartments Using An Endoscope 9 9 $5,780.00 $5,780.00 $3,801.00 $5,780.00 $5,433.20 2026-06-09
25448 HCPCS Replacement Of Joint Between Wrist And Fingers Using Tendon Or Stitches 8 8 $5,720.00 $5,720.00 $4,004.00 $5,720.00 $5,405.40 2026-06-09
44970 HCPCS Removal Of Appendix Using An Endoscope 9 9 $5,750.00 $5,750.00 $4,025.00 $5,750.00 $5,405.00 2026-06-09
49520 HCPCS Repair Of Groin Hernia That Is Not Trapped 9 9 $5,750.00 $5,750.00 $4,025.00 $5,750.00 $5,405.00 2026-06-09
46946 HCPCS Tying Of Multiple Internal Hemorrhoid Groups 9 9 $5,750.00 $5,750.00 $3,467.00 $5,750.00 $5,405.00 2026-06-09
25447 HCPCS Replacement Of Joint Between Wrist And Fingers Using Tissue 9 9 $5,719.00 $5,719.00 $3,446.00 $5,719.00 $5,375.86 2026-06-09
29824 HCPCS Partial Removal Of Collar Bone At Shoulder Using An Endoscope 9 9 $5,600.00 $5,600.00 $3,406.00 $5,600.00 $5,264.00 2026-06-09
36561 HCPCS Insertion Of Central Venous Tube With Port (5 Years Or Older) 9 9 $5,580.00 $5,580.00 $3,108.00 $5,580.00 $5,245.20 2026-06-09
J0139 HCPCS Injection, Adalimumab, 1 Mg 8 8 $5,540.29 $5,540.29 $3,878.20 $5,540.29 $5,235.57 2026-06-09
52234 HCPCS Destruction And/or Removal Of Growth Of Bladder And Urethra Using An Endoscope, … 9 9 $5,500.00 $5,500.00 $3,313.00 $5,500.00 $5,170.00 2026-06-09
58670 HCPCS Destruction Of Fallopian Tubes Using An Endoscope 9 9 $5,500.00 $5,500.00 $3,850.00 $5,500.00 $5,170.00 2026-06-09
43236 HCPCS Injection Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endos… 9 9 $5,462.62 $5,462.62 $3,522.00 $5,462.62 $5,134.86 2026-06-09
58600 HCPCS Tying Or Incision Of Fallopian Tubes 9 9 $5,400.00 $5,400.00 $3,397.00 $5,400.00 $5,076.00 2026-06-09
27435 HCPCS Incision Of Back Portion Of Knee Joint Capsule 9 9 $5,350.00 $5,350.00 $3,740.00 $5,350.00 $5,029.00 2026-06-09
49320 HCPCS Diagnostic Exam Of Abdomen Using An Endoscope 9 9 $5,304.42 $5,304.42 $3,420.00 $5,304.42 $4,986.15 2026-06-09
29825 HCPCS Removal Of Shoulder Scar Tissue Using An Endoscope 9 9 $5,293.00 $5,293.00 $3,213.00 $5,293.00 $4,975.42 2026-06-09
57250 HCPCS Repair Of Herniated Rectum Into Vaginal Wall 8 8 $5,175.00 $5,175.00 $3,622.50 $5,175.00 $4,890.38 2026-06-09
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 8 8 $5,165.42 $5,165.42 $3,615.79 $5,165.42 $4,881.32 2026-06-09
Q4196 HCPCS Puraply Am, Per Square Centimeter 72 8 $4,940.00 $4,940.00 $598.50 $24,320.00 $4,668.30 2026-06-09
42960 HCPCS Simple Control Of Bleeding Of Throat 9 9 $4,880.00 $4,880.00 $2,711.00 $4,880.00 $4,587.20 2026-06-09
64625 HCPCS Destruction Of Nerves Supplying Joint Between Spine And Pelvis Using Imaging Gui… 12 8 $5,696.00 $5,696.00 $165.93 $5,696.00 $4,559.40 2026-06-09
29881 HCPCS Removal Of Knee Cartilage Using An Endoscope 9 9 $4,850.00 $4,850.00 $3,395.00 $4,850.00 $4,559.00 2026-06-09
29880 HCPCS Removal Of Both Knee Cartilages Using An Endoscope 9 9 $4,850.00 $4,850.00 $3,395.00 $4,850.00 $4,559.00 2026-06-09
49591 HCPCS Initial Repair Of Sliding Hernia Of Abdomen, Less Than 3 Cm In Length 8 8 $4,800.00 $4,800.00 $3,360.00 $4,800.00 $4,536.00 2026-06-09
52214 HCPCS Destruction Of Tissue Of Bladder, Urethra, Or Surrounding Glands Using An Endosc… 9 9 $4,800.00 $4,800.00 $2,897.00 $4,800.00 $4,512.00 2026-06-09
54161 HCPCS Removal Of Foreskin (older Than 28 Days) 18 9 $4,767.00 $4,767.00 $2,724.00 $4,767.00 $4,480.98 2026-06-09
46260 HCPCS Removal Of Multiple Hemorrhoid Groups 9 9 $4,680.00 $4,680.00 $2,841.00 $4,680.00 $4,399.20 2026-06-09
15271 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C… 9 9 $4,629.74 $4,629.74 $38.00 $4,629.74 $4,351.96 2026-06-09
59514 HCPCS Cesarean Delivery 8 8 $4,600.00 $4,600.00 $3,220.00 $4,600.00 $4,347.00 2026-06-09
27337 HCPCS Removal Of Growth Under Skin Of Thigh Or Knee, Less Than 3.0 Cm 9 9 $4,381.58 $4,381.58 $2,825.00 $4,381.58 $4,118.69 2026-06-09
52287 HCPCS Exam With Injections Of Chemical For Destruction Of Bladder Using An Endoscope 9 9 $4,359.86 $4,359.86 $2,811.00 $4,359.86 $4,098.27 2026-06-09
26951 HCPCS Amputation Of Finger Or Thumb With Direct Closure 9 9 $4,148.00 $4,148.00 $2,074.00 $4,148.00 $3,899.12 2026-06-09
64718 HCPCS Release And/or Relocation Of Elbow Nerve 9 9 $4,100.00 $4,100.00 $2,455.00 $4,100.00 $3,854.00 2026-06-09
6521026_1 CDM Cygnus Dual, Amniotic Allograft, 4x6 3 3 $15,390.00 $15,390.00 $3,847.50 $13,851.00 $3,847.50 2026-06-09
58558 HCPCS Biopsy Of Lining Of Uterus And/or Removal Of Polyp Using An Endoscope 9 9 $4,082.23 $4,082.23 $2,632.00 $4,082.23 $3,837.30 2026-06-09
57260 HCPCS Plastic Repair Of Vagina And Tissue Separating Vagina, Rectum, And Bladder 8 8 $4,000.00 $4,000.00 $2,800.00 $4,000.00 $3,780.00 2026-06-09
21931 HCPCS Removal Of Growth Under Skin Of Back Or Lower Sides, 3.0 Cm Or More 9 9 $4,000.00 $4,000.00 $2,064.00 $4,000.00 $3,760.00 2026-06-09
36558 HCPCS Insertion Of Tunneled Central Venous Tube For Infusion (5 Years Or Older) 9 9 $3,950.00 $3,950.00 $2,765.00 $3,950.00 $3,713.00 2026-06-09
4490377_1 CDM Labor Room/delivery - General Classification 8 8 $4,025.00 $4,025.00 $1,006.25 $3,823.75 $3,703.00 2026-06-09
25111 HCPCS Removal Of First Cyst Of Wrist 9 9 $3,800.00 $3,800.00 $2,307.00 $3,800.00 $3,572.00 2026-06-09
15273 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.… 9 9 $3,795.30 $3,795.30 $38.00 $3,795.30 $3,567.58 2026-06-09
52224 HCPCS Destruction Of Growth Of Bladder And Urethra Using An Endoscope, Less Than 0.5 C… 9 9 $3,750.00 $3,750.00 $2,625.00 $3,750.00 $3,525.00 2026-06-09
81420 HCPCS Test For Detecting Genes Associated With Fetal Disease, Aneuploidy Genomic Seque… 9 9 $3,730.70 $3,730.70 $2,278.00 $3,730.70 $3,506.86 2026-06-09
19120 HCPCS Removal Of Growth And Tissue Of Breast, Duct, Or Nipple 9 9 $3,652.61 $3,652.61 $2,355.00 $3,652.61 $3,433.45 2026-06-09
64624 HCPCS Destruction Of Nerve Branches Of Knee Using Imaging Guidance 24 8 $4,554.00 $4,554.00 $125.36 $7,175.00 $3,408.60 2026-06-09
58611 HCPCS Tying Or Incision Of Fallopian Tubes During Cesarean Delivery Or Other Abdominal… 9 9 $3,618.48 $3,618.48 $2,333.00 $3,618.48 $3,401.37 2026-06-09
28060 HCPCS Partial Removal Of Connective Tissue At Sole Of Foot 9 9 $3,550.00 $3,550.00 $2,485.00 $3,550.00 $3,337.00 2026-06-09
28112 HCPCS Removal Of Toe Bone At Second, Third, Or Fourth Joints 9 9 $3,544.00 $3,544.00 $2,136.00 $3,544.00 $3,331.36 2026-06-09
4318785_1 CDM Praxbind 5g Dose(2x 2.5g/50ml) 8 8 $3,606.00 $3,606.00 $901.50 $3,425.70 $3,317.52 2026-06-09
29819 HCPCS Removal Of Loose Or Foreign Body In Shoulder Joint Using An Endoscope 9 9 $3,520.00 $3,520.00 $2,136.00 $3,520.00 $3,308.80 2026-06-09
29821 HCPCS Removal Of Entire Shoulder Joint Lining Using An Endoscope 9 9 $3,520.00 $3,520.00 $2,136.00 $3,520.00 $3,308.80 2026-06-09
29820 HCPCS Partial Removal Of Shoulder Joint Lining Using An Endoscope 9 9 $3,520.00 $3,520.00 $2,136.00 $3,520.00 $3,308.80 2026-06-09
Q4159 HCPCS Affinity, Per Square Centimeter 16 8 $4,203.75 $4,203.75 $1,695.75 $5,985.00 $3,306.00 2026-06-09
22900 HCPCS Removal Of Growth Of Muscle Of Abdomen, Less Than 5.0 Cm 9 9 $3,500.00 $3,500.00 $496.00 $3,500.00 $3,290.00 2026-06-09
29848 HCPCS Release Of Wrist Ligament Using An Endoscope 9 9 $3,500.00 $3,500.00 $2,450.00 $3,500.00 $3,290.00 2026-06-09
29875 HCPCS Partial Removal Of Knee Joint Lining Using An Endoscope 9 9 $3,480.00 $3,480.00 $2,293.00 $3,480.00 $3,271.20 2026-06-09
26121 HCPCS Removal Of Connective Tissue Of Palm 9 9 $3,470.00 $3,470.00 $2,104.00 $3,470.00 $3,261.80 2026-06-09
J3032 HCPCS Injection, Eptinezumab-jjmr, 1 Mg 8 8 $3,450.22 $3,450.22 $2,415.15 $3,450.22 $3,260.46 2026-06-09
J3358 HCPCS Ustekinumab, For Intravenous Injection, 1 Mg 9 9 $3,428.95 $3,428.95 $14.79 $3,428.95 $3,223.21 2026-06-09
J1602 HCPCS Injection, Golimumab, 1 Mg, For Intravenous Use 9 9 $3,416.90 $3,416.90 $25.95 $3,416.90 $3,211.89 2026-06-09
11446 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, M… 9 9 $3,400.00 $3,400.00 $38.00 $3,400.00 $3,196.00 2026-06-09
78816 HCPCS Nuclear Medicine Study Whole Body With CT Scan 9 9 $3,360.00 $3,360.00 $1,300.00 $3,360.00 $3,158.40 2026-06-09
55040 HCPCS Removal Of Fluid Collection In Testicle And Sperm Reservoir 8 8 $3,300.00 $3,300.00 $2,310.00 $3,300.00 $3,118.50 2026-06-09
28080 HCPCS Removal Of Fibrous Nerve Growth From Between Toes 9 9 $3,300.00 $3,300.00 $2,011.00 $3,300.00 $3,102.00 2026-06-09
46270 HCPCS Repair Of Abnormal Anal Drainage Tract 9 9 $3,300.00 $3,300.00 $2,290.00 $3,300.00 $3,102.00 2026-06-09
55060 HCPCS Repair Of Fluid Collection In Testicle And Sperm Reservoir 8 8 $3,200.00 $3,200.00 $2,240.00 $3,200.00 $3,024.00 2026-06-09
11444 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3… 9 9 $3,125.00 $3,125.00 $1,900.00 $3,125.00 $2,937.50 2026-06-09
64451 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Spine And Pelvis Nerve Using I… 12 8 $3,640.00 $3,640.00 $68.40 $3,640.00 $2,912.00 2026-06-09
58555 HCPCS Diagnostic Exam Of Uterus Using An Endoscope 9 9 $3,025.00 $3,025.00 $2,117.50 $3,025.00 $2,843.50 2026-06-09
11606 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 10 9 $3,069.43 $3,069.43 $38.00 $3,069.43 $2,823.88 2026-06-09
64635 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 24 8 $3,203.50 $3,203.50 $162.92 $5,160.00 $2,818.65 2026-06-09
81220 HCPCS Gene Analysis (cystic Fibrosis Transmembrane Conductance Regular) Common Variant… 17 9 $2,935.00 $2,935.00 $2,054.50 $3,641.38 $2,788.25 2026-06-09
J0875 HCPCS Injection, Dalbavancin, 5 Mg 9 9 $2,951.50 $2,951.50 $19.23 $2,951.50 $2,774.41 2026-06-09
22903 HCPCS Removal Of Growth Of Soft Tissue Of Abdominal Wall, 3.0 Cm Or More 9 9 $2,916.00 $2,916.00 $2,041.20 $2,916.00 $2,741.04 2026-06-09
Q5108 HCPCS Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 9 9 $2,907.00 $2,907.00 $395.59 $2,907.00 $2,732.58 2026-06-09
57456 HCPCS Scraping Of Cervix Using An Endoscope 9 9 $2,900.00 $2,900.00 $1,523.00 $2,900.00 $2,726.00 2026-06-09
45171 HCPCS Removal Of Growth Of Rectum Through Anus 8 8 $2,875.00 $2,875.00 $2,012.50 $2,875.00 $2,716.88 2026-06-09
J0897 HCPCS Injection, Denosumab, 1 Mg 17 9 $2,777.98 $2,777.98 $24.57 $3,206.66 $2,639.08 2026-06-09
J3240 HCPCS Injection, Thyrotropin Alpha, 0.9 Mg, Provided In 1.1 Mg Vial 9 9 $2,804.33 $2,804.33 $1,963.03 $2,804.33 $2,636.07 2026-06-09
52204 HCPCS Biopsy Of Bladder Using An Endoscope 9 9 $2,800.00 $2,800.00 $1,960.00 $2,800.00 $2,632.00 2026-06-09
57421 HCPCS Biopsy Of Vagina And Cervix Using An Endoscope 18 9 $2,750.00 $2,750.00 $1,523.00 $2,750.00 $2,585.00 2026-06-09
25000 HCPCS Incision Or The Tendon Covering On The Top Side Of The Wrist 9 9 $2,750.00 $2,750.00 $1,925.00 $2,750.00 $2,585.00 2026-06-09
25071 HCPCS Removal Of Growth Under Skin Of Forearm Or Wrist, 3.0 Cm Or More 9 9 $2,749.92 $2,749.92 $1,773.00 $2,749.92 $2,584.92 2026-06-09
J0881 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 33 9 $6,611.09 $6,611.09 $4.97 $6,611.10 $2,546.01 2026-06-09
19083 HCPCS Biopsy Of Breast And Placement Of Locating Device Using Ultrasound, First Growth 9 9 $2,700.00 $2,700.00 $1,624.00 $2,700.00 $2,538.00 2026-06-09
6521025_1 CDM Cygnus Dual, Amniotic Allograft, 4x4 3 3 $10,070.00 $10,070.00 $2,517.50 $9,063.00 $2,517.50 2026-06-09
57420 HCPCS Exam Of Vagina And Cervix Using An Endoscope 18 9 $2,665.00 $2,665.00 $1,523.00 $2,665.00 $2,505.10 2026-06-09
59160 HCPCS Scraping Of Lining Of Uterus After Delivery 9 9 $2,665.00 $2,665.00 $1,523.00 $2,665.00 $2,505.10 2026-06-09
64721 HCPCS Release And/or Relocation Of Hand Nerve 9 9 $2,650.00 $2,650.00 $1,608.00 $2,650.00 $2,491.00 2026-06-09
J0840 HCPCS Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 9 9 $2,622.04 $2,622.04 $1,835.43 $3,906.26 $2,490.94 2026-06-09
64454 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Knee Nerve Branch Using Imagin… 24 8 $2,900.00 $2,900.00 $69.13 $5,200.00 $2,470.00 2026-06-09
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 9 9 $2,616.97 $2,616.97 $1,687.28 $2,616.97 $2,459.95 2026-06-09
21555 HCPCS Removal Of Growth Under Skin Of Neck Or Front Of Chest, Less Than 3.0 Cm 9 9 $2,605.00 $2,605.00 $38.00 $2,605.00 $2,448.70 2026-06-09
64483 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 26 9 $2,775.00 $2,775.00 $93.64 $5,181.00 $2,447.55 2026-06-09
49525 HCPCS Repair Of Sliding Groin Hernia 9 9 $2,600.00 $2,600.00 $1,820.00 $2,600.00 $2,444.00 2026-06-09
11643 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.1-… 27 9 $2,903.00 $2,903.00 $38.00 $3,483.00 $2,438.10 2026-06-09
64640 HCPCS Destruction Of Peripheral Nerve Or Branch 28 8 $2,580.00 $2,580.00 $104.10 $2,580.00 $2,425.20 2026-06-09
78815 HCPCS Nuclear Medicine Study From Skull Base To Mid-thigh With CT Scan 9 9 $2,550.00 $2,550.00 $1,300.00 $2,550.00 $2,397.00 2026-06-09
11423 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 2.1-3… 18 9 $2,596.91 $2,596.91 $38.00 $2,675.00 $2,392.88 2026-06-09
64633 HCPCS Destruction Of Upper Or Middle Spinal Facet Joint Nerves Using Imaging Guidance,… 24 8 $2,520.00 $2,520.00 $162.49 $5,040.00 $2,381.40 2026-06-09
6521313_1 CDM Diclofenac Sodium 1% Gel 8 8 $2,588.40 $2,588.40 $647.10 $2,458.98 $2,381.33 2026-06-09
57455 HCPCS Biopsy Of Cervix Using An Endoscope 27 9 $2,900.00 $2,900.00 $38.00 $3,153.18 $2,375.00 2026-06-09
28190 HCPCS Removal Of Foreign Body Of Foot Tissue, Accessed Beneath The Skin 17 9 $2,495.00 $2,495.00 $1,746.50 $2,600.00 $2,370.25 2026-06-09
57410 HCPCS Pelvic Exam Under Anesthesia 9 9 $2,510.00 $2,510.00 $1,523.00 $2,510.00 $2,359.40 2026-06-09
46612 HCPCS Removal Of Multiple Anal Polyps Or Growths Using An Endoscope With Electrical Ca… 9 9 $2,500.00 $2,500.00 $800.00 $2,500.00 $2,350.00 2026-06-09
46255 HCPCS Removal Of Single External And Internal Hemorrhoid Group 9 9 $2,500.00 $2,500.00 $1,750.00 $2,500.00 $2,350.00 2026-06-09
58120 HCPCS Dilation And Scraping Of Uterus 9 9 $2,500.00 $2,500.00 $1,750.00 $2,500.00 $2,350.00 2026-06-09
64772 HCPCS Incision Or Removal Of Spinal Nerve 9 9 $2,494.01 $2,494.01 $1,608.00 $2,494.01 $2,344.37 2026-06-09
J7168 HCPCS Prothrombin Complex Concentrate (human), Kcentra, Per I.u. Of Factor Ix Activity 16 8 $2,920.24 $2,920.24 $1,277.14 $4,016.00 $2,317.84 2026-06-09
27043 HCPCS Removal Of Growth Under Skin Of Pelvis And Hip, 3.0 Cm Or More 10 9 $2,500.00 $2,500.00 $38.00 $2,500.00 $2,300.00 2026-06-09
11626 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More Tha… 27 9 $2,500.00 $2,500.00 $38.00 $3,324.00 $2,300.00 2026-06-09
Q4101 HCPCS Apligraf, Per Square Centimeter 8 8 $2,422.50 $2,422.50 $1,695.75 $2,422.50 $2,289.27 2026-06-09
23071 HCPCS Removal Of Growth Under Skin Of Shoulder Area, 3.0 Cm Or More 18 9 $2,548.00 $2,548.00 $38.00 $2,700.00 $2,276.20 2026-06-09
43249 HCPCS Balloon Dilation Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexibl… 9 9 $2,405.60 $2,405.60 $1,551.00 $2,405.60 $2,261.26 2026-06-09
11771 HCPCS Extensive Removal Of Cyst Of Tailbone 9 9 $2,378.00 $2,378.00 $1,664.60 $3,038.00 $2,259.10 2026-06-09
59820 HCPCS Treatment Of Miscarriage During First Trimester 9 9 $2,390.00 $2,390.00 $1,673.00 $2,390.00 $2,246.60 2026-06-09
43200 HCPCS Diagnostic Exam Of Esophagus Using A Flexible Endoscope Through Mouth 9 9 $2,385.00 $2,385.00 $1,363.00 $2,385.00 $2,241.90 2026-06-09
57800 HCPCS Dilation Of Cervical Canal 9 9 $2,362.17 $2,362.17 $1,523.00 $2,362.17 $2,220.44 2026-06-09
11406 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 18 9 $2,745.20 $2,745.20 $38.00 $3,190.41 $2,209.14 2026-06-09
27339 HCPCS Removal Of Growth Of Muscle Of Thigh Or Knee, 5.0 Cm Or More 9 9 $2,350.00 $2,350.00 $1,067.00 $2,350.00 $2,209.00 2026-06-09
12035 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 12.6-20.… 9 9 $2,350.00 $2,350.00 $1,645.00 $2,350.00 $2,209.00 2026-06-09
43245 HCPCS Dilation Of Stomach Outlet Using A Flexible Endoscope 9 9 $2,347.00 $2,347.00 $1,565.00 $2,347.00 $2,206.18 2026-06-09
55250 HCPCS Removal Of Sperm Duct 9 9 $2,311.00 $2,311.00 $1,321.00 $2,311.00 $2,172.34 2026-06-09
19020 HCPCS Drainage Of Abscess Of Breast 9 9 $2,300.00 $2,300.00 $38.00 $2,300.00 $2,162.00 2026-06-09
J1744 HCPCS Injection, Icatibant, 1 Mg 9 9 $2,295.72 $2,295.72 $205.67 $2,295.72 $2,157.98 2026-06-09
45385 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S… 9 9 $2,283.07 $2,283.07 $1,472.00 $2,283.07 $2,146.09 2026-06-09
Q4186 HCPCS Epifix, Per Square Centimeter 32 8 $2,345.55 $2,345.55 $911.05 $2,565.00 $2,143.82 2026-06-09
6437085_1 CDM Silver Sulfadiazine 1% Cream 8 8 $2,324.07 $2,324.07 $581.02 $2,207.87 $2,138.14 2026-06-09
64620 HCPCS Injection Of Agent To Destroy Rib Nerve 12 8 $2,670.00 $2,670.00 $155.51 $2,670.00 $2,136.00 2026-06-09
Q4160 HCPCS Nushield, Per Square Centimeter 56 8 $2,612.50 $2,612.50 $525.35 $4,731.00 $2,123.25 2026-06-09
24071 HCPCS Removal Of Growth Under Skin Of Upper Arm Or Elbow, 3.0 Cm Or More 9 9 $2,250.00 $2,250.00 $1,575.00 $2,250.00 $2,115.00 2026-06-09
43246 HCPCS Insertion Of Stomach Tube Using A Flexible Endoscope 27 9 $2,700.00 $2,700.00 $38.00 $2,700.00 $2,113.00 2026-06-09
Q4106 HCPCS Dermagraft, Per Square Centimeter 8 8 $2,232.50 $2,232.50 $1,562.75 $2,232.50 $2,109.72 2026-06-09
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 16 8 $2,275.78 $2,275.78 $1,549.86 $2,337.48 $2,103.38 2026-06-09
11470 HCPCS Removal Of Skin And Tissue Of Anus Or Navel For Inflamed Sweat Glands With Simpl… 9 9 $2,233.00 $2,233.00 $1,276.00 $2,233.00 $2,099.02 2026-06-09
57240 HCPCS Repair Of Bladder Hernia Into Vaginal Wall 8 8 $2,200.00 $2,200.00 $1,540.00 $2,200.00 $2,079.00 2026-06-09
52281 HCPCS Dilation Of Urethra Using An Endoscope 9 9 $2,200.00 $2,200.00 $1,540.00 $2,200.00 $2,068.00 2026-06-09
64632 HCPCS Destruction Of Foot Nerve 12 8 $2,580.00 $2,580.00 $22.27 $2,580.00 $2,064.00 2026-06-09
64517 HCPCS Injection Of Anesthetic Agent Into Sacral Nerve Bundle 12 8 $2,580.00 $2,580.00 $37.76 $2,580.00 $2,064.00 2026-06-09
64490 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Single Le… 26 9 $2,325.00 $2,325.00 $88.55 $4,341.00 $2,050.65 2026-06-09
J1459 HCPCS Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 17 9 $2,008.40 $2,008.40 $52.38 $5,140.80 $2,008.40 2026-06-09
J2357 HCPCS Injection, Omalizumab, 5 Mg 25 9 $2,463.03 $2,463.03 $47.68 $2,518.79 $1,991.45 2026-06-09
6446301_1 CDM Diclofenac Sodium 1% Gel 8 8 $2,151.00 $2,151.00 $537.75 $2,043.45 $1,978.92 2026-06-09
46221 HCPCS Removal Of External Hemorrhoids By Rubber Banding 9 9 $2,100.00 $2,100.00 $1,470.00 $2,100.00 $1,974.00 2026-06-09
45380 HCPCS Biopsy Of Large Bowel Using A Flexible Endoscope 9 9 $2,093.85 $2,093.85 $1,350.00 $2,093.85 $1,968.22 2026-06-09
J7307 HCPCS Etonogestrel (contraceptive) Implant System, Including Implant And Supplies 9 9 $2,081.30 $2,081.30 $1,271.35 $2,081.30 $1,956.42 2026-06-09
27096 HCPCS Injection Of Anesthetic Or Steroid Into Joint Between Lower Spine And Hip Bone U… 26 9 $2,100.00 $2,100.00 $69.48 $3,360.00 $1,932.00 2026-06-09
L8699 HCPCS Prosthetic Implant, Not Otherwise Specified 8 8 $2,042.50 $2,042.50 $1,429.75 $2,042.50 $1,930.16 2026-06-09
45381 HCPCS Injection Beneath Lining Of Large Bowel Using A Flexible Endoscope 9 9 $2,028.71 $2,028.71 $1,308.00 $2,028.71 $1,906.99 2026-06-09
45382 HCPCS Control Of Bleeding Of Upper Large Bowel Using A Flexible Endoscope 9 9 $2,028.71 $2,028.71 $1,308.00 $2,028.71 $1,906.99 2026-06-09
45378 HCPCS Diagnostic Exam Of Large Bowel Using A Flexible Endoscope 9 9 $2,028.71 $2,028.71 $1,308.00 $2,028.71 $1,906.99 2026-06-09
52441 HCPCS Insertion Of Implant In Urethra Within Prostate Gland Using An Endoscope, 1 Impl… 8 8 $2,012.50 $2,012.50 $1,408.75 $2,012.50 $1,901.82 2026-06-09
4634656_1 CDM Room & Board - Private (one Bed) - General Classification 5 5 $2,000.00 $2,000.00 $1,800.00 $2,000.00 $1,900.00 2026-06-09
4634667_1 CDM Nursery - Newborn - Level Iii 5 5 $2,000.00 $2,000.00 $1,800.00 $2,000.00 $1,900.00 2026-06-09
J1745 HCPCS Injection, Infliximab, Excludes Biosimilar, 10 Mg 9 9 $2,018.68 $2,018.68 $68.53 $2,018.68 $1,897.56 2026-06-09
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 13 9 $2,705.00 $2,705.00 $118.70 $2,705.00 $1,893.50 2026-06-09
36590 HCPCS Removal Of Central Venous Tube With Port Or Pump 17 9 $1,600.00 $1,600.00 $1,120.00 $2,928.29 $1,888.00 2026-06-09
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 17 9 $2,352.87 $2,352.87 $1,382.50 $2,352.87 $1,876.25 2026-06-09
45560 HCPCS Repair Of Bulging Of Rectum Into Vagina 8 8 $1,975.00 $1,975.00 $1,382.50 $1,975.00 $1,866.38 2026-06-09
70471 HCPCS Computed Tomographic Angiography (cta), Head And Neck, With Contrast Material(s)… 8 8 $1,950.00 $1,950.00 $1,365.00 $1,950.00 $1,842.75 2026-06-09
26055 HCPCS Incision Of Tendon Covering Of Finger 9 9 $1,950.00 $1,950.00 $1,365.00 $1,950.00 $1,833.00 2026-06-09
64493 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Le… 26 9 $2,107.00 $2,107.00 $76.55 $3,869.00 $1,827.63 2026-06-09
57452 HCPCS Exam Of Cervix And Upper Part Of Vagina Using An Endoscope 27 9 $2,025.00 $2,025.00 $38.00 $2,665.00 $1,822.50 2026-06-09
64510 HCPCS Injection Of Anesthetic Agent Into Sympathetic Nerve Bundle 13 9 $2,580.00 $2,580.00 $65.45 $2,580.00 $1,806.00 2026-06-09
64530 HCPCS Injection Of Anesthetic Agent Into Abdominal Sympathetic Nerve Bundle 13 9 $2,580.00 $2,580.00 $80.23 $2,580.00 $1,806.00 2026-06-09
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 9 9 $1,919.21 $1,919.21 $1,237.40 $1,919.21 $1,804.06 2026-06-09
54162 HCPCS Removal Of Scar Tissue After Foreskin Removal 8 8 $1,900.00 $1,900.00 $1,330.00 $1,900.00 $1,795.50 2026-06-09
12017 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 20.… 9 9 $1,904.00 $1,904.00 $1,332.80 $1,904.00 $1,789.76 2026-06-09
26116 HCPCS Removal Of Growth Of Muscle Of Hand Or Finger, Less Than 1.5 Cm 9 9 $1,904.00 $1,904.00 $38.00 $1,904.00 $1,789.76 2026-06-09
44389 HCPCS Biopsy Of Large Bowel Using An Endoscope Inserted Through Surgically Created Ope… 9 9 $1,899.98 $1,899.98 $1,225.00 $1,899.98 $1,785.98 2026-06-09
10121 HCPCS Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Complex 17 9 $2,400.00 $2,400.00 $1,314.60 $2,400.00 $1,784.10 2026-06-09
10160 HCPCS Aspiration Of Abscess, Blood, Or Cyst 9 9 $1,880.00 $1,880.00 $38.00 $1,880.00 $1,767.20 2026-06-09
45386 HCPCS Balloon Dilation Of Large Bowel Using A Flexible Endoscope 9 9 $1,875.00 $1,875.00 $1,312.50 $1,875.00 $1,762.50 2026-06-09
45379 HCPCS Removal Of Foreign Bodies In Large Bowel Using A Flexible Endoscope 9 9 $1,875.00 $1,875.00 $1,308.00 $1,875.00 $1,762.50 2026-06-09
58100 HCPCS Biopsy Of Lining Of Uterus 18 9 $2,108.59 $2,108.59 $38.00 $2,362.17 $1,762.25 2026-06-09
27818 HCPCS Closed Treatment Of 3 Broken Lower Leg Bones At Ankle With Manipulation 9 9 $1,850.00 $1,850.00 $1,295.00 $1,897.00 $1,757.50 2026-06-09
44640 HCPCS Closure Of Abnormal Drainage Tract From Small Bowel To Skin 8 8 $1,850.00 $1,850.00 $1,295.00 $1,850.00 $1,748.25 2026-06-09
45384 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using A Flexible Endoscope With Elec… 9 9 $1,850.00 $1,850.00 $1,295.00 $1,850.00 $1,739.00 2026-06-09
25075 HCPCS Removal Of Growth Under Skin Of Forearm Or Wrist, Less Than 3.0 Cm 9 9 $1,842.59 $1,842.59 $1,188.00 $1,842.59 $1,732.03 2026-06-09
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 9 9 $1,822.18 $1,822.18 $1,174.84 $1,822.18 $1,712.85 2026-06-09
11426 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More … 27 9 $1,900.00 $1,900.00 $38.00 $1,900.00 $1,710.00 2026-06-09
26040 HCPCS Release Of Tissue Of Palm 8 8 $1,800.00 $1,800.00 $1,260.00 $1,800.00 $1,701.00 2026-06-09
32551 HCPCS Removal Of Fluid From Between Lung And Chest Cavity 8 8 $1,800.00 $1,800.00 $1,260.00 $1,800.00 $1,701.00 2026-06-09
45398 HCPCS Banding Of Hemorrhoids Using A Flexible Endoscope (colonoscope) 9 9 $1,801.00 $1,801.00 $1,260.70 $1,801.00 $1,692.94 2026-06-09
11644 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3.1-… 9 9 $1,800.00 $1,800.00 $38.00 $1,800.00 $1,692.00 2026-06-09
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 9 9 $1,800.00 $1,800.00 $1,260.00 $1,800.00 $1,692.00 2026-06-09
25505 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Thumb Side With Manipulati… 9 9 $1,800.00 $1,800.00 $1,260.00 $1,800.00 $1,692.00 2026-06-09
13152 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 2.6-7.5 Cm 9 9 $1,800.00 $1,800.00 $1,260.00 $1,800.00 $1,692.00 2026-06-09
J9312 HCPCS Injection, Rituximab, 10 Mg 17 9 $1,691.14 $1,691.14 $117.81 $8,354.21 $1,691.14 2026-06-09
2120839_1 CDM Room & Board - Private (one Bed) - General Classification 5 5 $1,770.00 $1,770.00 $1,593.00 $1,770.00 $1,681.50 2026-06-09
2120840_1 CDM Room & Board - Semi-private (two Beds) - General Classification 5 5 $1,770.00 $1,770.00 $1,593.00 $1,770.00 $1,681.50 2026-06-09
4441947_1 CDM Room & Board - Private (one Bed) - General Classification 5 5 $1,770.00 $1,770.00 $1,593.00 $1,770.00 $1,681.50 2026-06-09
4441941_1 CDM Room & Board - Semi-private (two Beds) - General Classification 5 5 $1,770.00 $1,770.00 $1,593.00 $1,770.00 $1,681.50 2026-06-09
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 14 9 $2,402.00 $2,402.00 $114.45 $2,402.00 $1,681.40 2026-06-09
64400 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Face Nerve 13 9 $2,400.00 $2,400.00 $42.41 $2,400.00 $1,680.00 2026-06-09
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 9 9 $1,779.37 $1,779.37 $1,147.24 $1,779.37 $1,672.61 2026-06-09
43239 HCPCS Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop… 9 9 $1,771.24 $1,771.24 $1,142.00 $1,771.24 $1,664.97 2026-06-09
62323 HCPCS Injection Of Substance Into Lower Spine Canal Using Imaging Guidance 22 9 $1,750.00 $1,750.00 $83.99 $3,500.00 $1,662.50 2026-06-09
43255 HCPCS Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flex… 9 9 $1,758.83 $1,758.83 $1,134.00 $1,758.83 $1,653.30 2026-06-09
45338 HCPCS Removal Of Polyps Or Growths Of Lower Large Bowel Using A Flexible Endoscope Wit… 9 9 $1,751.08 $1,751.08 $1,129.00 $1,751.08 $1,646.02 2026-06-09
87633 HCPCS Detection Test By Nucleic Acid For Multiple Types Of Respiratory Virus, Multiple… 17 9 $1,731.25 $1,731.25 $1,211.88 $2,148.14 $1,644.69 2026-06-09
54001 HCPCS Incision Of Foreskin 8 8 $1,740.00 $1,740.00 $1,218.00 $1,740.00 $1,644.30 2026-06-09
J0485 HCPCS Injection, Belatacept, 1 Mg 9 9 $1,745.78 $1,745.78 $4.88 $1,745.78 $1,641.03 2026-06-09
4634655_1 CDM Nursery - Newborn - Level Ii 5 5 $1,725.00 $1,725.00 $1,552.50 $1,725.00 $1,638.75 2026-06-09
52000 HCPCS Diagnostic Exam Of Bladder And Urethra Using An Endoscope 9 9 $1,730.92 $1,730.92 $1,116.00 $1,730.92 $1,627.06 2026-06-09
11603 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm 18 9 $1,721.61 $1,721.61 $38.00 $1,721.61 $1,618.31 2026-06-09
J2407 HCPCS Injection, Oritavancin (orbactiv), 10 Mg 17 9 $1,701.82 $1,701.82 $30.43 $1,728.58 $1,616.73 2026-06-09
J7298 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg 9 9 $1,716.32 $1,716.32 $1,201.42 $1,716.32 $1,613.34 2026-06-09
27510 HCPCS Closed Treatment Of Broken Thigh Bone At Knee Area With Manipulation 9 9 $1,700.00 $1,700.00 $1,190.00 $1,700.00 $1,598.00 2026-06-09
5966597_1 CDM Curosurf 240 Mg/3 Ml Vial 8 8 $1,733.63 $1,733.63 $433.41 $1,646.95 $1,594.94 2026-06-09
Q4199 HCPCS Cygnus Matrix, Per Square Centimeter 24 8 $1,657.50 $1,657.50 $682.50 $2,275.00 $1,566.34 2026-06-09
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 9 9 $1,659.32 $1,659.32 $1,069.84 $1,659.32 $1,559.76 2026-06-09
28043 HCPCS Removal (less Than 1.5 Centimeters) Tissue Growth Beneath The Skin Of Foot Or To… 9 9 $1,656.00 $1,656.00 $1,000.00 $1,656.00 $1,556.64 2026-06-09
11403 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm 19 9 $2,027.16 $2,027.16 $38.00 $2,027.16 $1,552.30 2026-06-09
11404 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 3.1-4.0 Cm 18 9 $2,015.00 $2,015.00 $38.00 $2,470.00 $1,529.50 2026-06-09
11443 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2… 27 9 $1,800.00 $1,800.00 $38.00 $2,162.09 $1,520.00 2026-06-09
38221 HCPCS Biopsy Of Bone Marrow 8 8 $1,600.00 $1,600.00 $1,120.00 $1,600.00 $1,512.00 2026-06-09
46280 HCPCS Repair Of Abnormal Drainage Tract Around Anal Sphincter 9 9 $1,600.00 $1,600.00 $800.00 $1,600.00 $1,504.00 2026-06-09
25600 HCPCS Closed Treatment Of Broken Forearm (radius) Bone At The Wrist Area On The Thumb … 9 9 $1,600.00 $1,600.00 $1,120.00 $1,600.00 $1,504.00 2026-06-09
44394 HCPCS Removal Of Growths Or Polyps Of Large Bowel By Mechanical Snare Using An Endosco… 9 9 $1,600.00 $1,600.00 $997.00 $1,600.00 $1,504.00 2026-06-09
15277 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout… 9 9 $1,600.00 $1,600.00 $38.00 $1,600.00 $1,504.00 2026-06-09
78452 HCPCS Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 18 9 $1,600.00 $1,600.00 $1,000.00 $1,600.00 $1,504.00 2026-06-09
43235 HCPCS Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible… 9 9 $1,586.67 $1,586.67 $1,023.00 $1,586.67 $1,491.47 2026-06-09
78598 HCPCS Nuclear Medicine Study Of Lung Ventilation And Circulation And Blood Flow To Lun… 8 8 $1,570.00 $1,570.00 $1,099.00 $1,570.00 $1,483.65 2026-06-09
43220 HCPCS Balloon Dilation Of Esophagus Using A Flexible Endoscope, Less Than 3.0 Cm 9 9 $1,572.00 $1,572.00 $1,048.00 $1,572.00 $1,477.68 2026-06-09
99291 HCPCS Critical Care, First 30-74 Minutes 9 9 $1,569.10 $1,569.10 $1,011.67 $1,569.10 $1,474.95 2026-06-09
11646 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More… 18 9 $1,503.00 $1,503.00 $634.20 $2,100.00 $1,470.00 2026-06-09
62321 HCPCS Injection Of Substance Into Middle Or Upper Spine Canal Using Imaging Guidance 13 9 $2,100.00 $2,100.00 $90.04 $2,100.00 $1,470.00 2026-06-09
78451 HCPCS Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect 9 9 $1,551.00 $1,551.00 $1,000.00 $1,551.00 $1,457.94 2026-06-09
G0105 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual At High Risk 9 9 $1,546.35 $1,546.35 $997.00 $1,546.35 $1,453.57 2026-06-09
G0121 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual Not Meeting Criteria For … 9 9 $1,546.35 $1,546.35 $997.00 $1,546.35 $1,453.57 2026-06-09
11422 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 1.1-2… 18 9 $1,800.81 $1,800.81 $38.00 $2,101.61 $1,448.07 2026-06-09
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 17 9 $1,756.54 $1,756.54 $1,050.00 $1,756.54 $1,425.00 2026-06-09
11424 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4… 9 9 $1,500.00 $1,500.00 $1,050.00 $1,784.00 $1,425.00 2026-06-09
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 17 9 $1,780.80 $1,780.80 $1,050.00 $1,780.80 $1,425.00 2026-06-09
91110 HCPCS Imaging Of Digestive Tract Done From The Inside Of The Digestive Tract 8 8 $1,500.00 $1,500.00 $1,050.00 $1,500.00 $1,417.50 2026-06-09
27257 HCPCS Treatment Of Spontaneous Dislocated Hip Under Anesthesia 16 8 $1,500.00 $1,500.00 $1,050.00 $1,500.00 $1,417.50 2026-06-09
72191 HCPCS CT Scan Of Blood Vessels Of Pelvis With Contrast 8 8 $1,500.00 $1,500.00 $1,050.00 $1,500.00 $1,417.50 2026-06-09
21011 HCPCS Removal Of Growth Under Skin Of Face Or Scalp, Less Than 2.0 Cm 9 9 $1,500.00 $1,500.00 $897.00 $1,500.00 $1,410.00 2026-06-09
43247 HCPCS Removal Of Foreign Bodies Of Esophagus, Stomach, And/or Upper Small Bowel Using … 9 9 $1,500.00 $1,500.00 $1,050.00 $1,500.00 $1,410.00 2026-06-09
43248 HCPCS Insertion Of Guide Wire With Dilation Of Esophagus Using A Flexible Endoscope 9 9 $1,500.00 $1,500.00 $1,050.00 $1,500.00 $1,410.00 2026-06-09
78582 HCPCS Nuclear Medicine Study Of Lung Ventilation And Circulation 9 9 $1,500.00 $1,500.00 $686.32 $1,500.00 $1,410.00 2026-06-09
88120 HCPCS Cell Examination Of Urine, Manual 9 9 $1,486.00 $1,486.00 $1,040.20 $1,486.00 $1,396.84 2026-06-09
64430 HCPCS Injection Of Anesthetic Agent And/or Steroid Into External Genitals And Anus Ner… 26 9 $1,575.00 $1,575.00 $45.76 $2,941.00 $1,396.50 2026-06-09
12034 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 7.6-12.5… 17 9 $1,050.00 $1,050.00 $735.00 $1,980.00 $1,386.00 2026-06-09
36589 HCPCS Removal Of Tunneled Central Venous Tube 9 9 $1,471.90 $1,471.90 $949.00 $1,471.90 $1,383.59 2026-06-09
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