Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

LARNED STATE HOSPITAL

Larned, KS · CCN 174006 · Rates published

2,268 distinct procedures filed
1 distinct payers
2,281 rate rows
2026-07-31 last MRF observed
Data quality

2,268 of 2,281 rate rows are consumer-grade (99.4%)

13 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
placeholder amount (≤ $0.02) — excluded from medians 9
percent-of-charges filed in the dollar field — excluded from medians 4
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.kdads.ks.gov/home/showpublisheddocument/1768/638581901446870000
Found on page https://www.kdads.ks.gov/state-hospitals/larned-state-hospital-lsh/lsh-business-services-patient-accounts
Discovered viaDiscovered by HANK (automated)
Last fetch success · 2026-08-01
Content fingerprint 7e5a413df3e05bc6… · 284,859 bytes · first seen 2026-05-18

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
586041
OTHER 		Invega Trinza 273 Mg/0.875 Ml Intramuscular Syringe 1 $6,026.53 $6,026.53 $6,026.53 nat. median
$6,027
1.0× median
158017
OTHER 		Neomycin-polymyxin-hydrocort 3.5 Mg/ml-10,000 Unit/ml-1 % Ear Solution 1 $5,109.24 $5,109.24 $5,109.24 nat. median
$5,109
1.0× median
609666
OTHER 		Paxlovid 300 Mg (150 Mg X 2)-100 Mg Tablet (eua) 1 $4,687.68 $4,687.68 $4,687.68 nat. median
$4,688
1.0× median
559008
OTHER 		Invega Sustenna 156 mg/mL Intramuscular Syringe 1 $4,174.44 $4,174.44 $4,174.44 nat. median
$4,174
1.0× median
D5212
HCPCS 		Partial Denture-lower 1 $4,002.75 $4,002.75 $4,002.75 nat. median
$866
outlier · 4.6×
290519
OTHER 		Hibiclens 4 % Topical Liquid 1 $3,845.90 $3,845.90 $3,845.90 nat. median
$3,846
1.0× median
577284
OTHER 		Abilify Maintena 300 Mg Intramuscular Suspension,extended Release 1 $3,383.81 $3,383.81 $3,383.81 nat. median
$3,384
1.0× median
559004
OTHER 		Invega Sustenna 78 Mg/0.5 Ml Intramuscular Syringe 1 $3,366.42 $3,366.42 $3,366.42 nat. median
$3,366
1.0× median
162237
OTHER 		Effer-k 25 mEq Effervescent Tablet 1 $3,252.16 $3,252.16 $3,252.16 nat. median
$3,252
1.0× median
559005
OTHER 		Invega Sustenna 117 Mg/0.75 Ml Intramuscular Syringe 1 $2,783.03 $2,783.03 $2,783.03 nat. median
$2,783
1.0× median
474911
OTHER 		A.e.r. Witch Hazel 12.5 %-50 % Topical Pads 1 $2,477.30 $2,477.30 $2,477.30 nat. median
$2,477
1.0× median
296048
OTHER 		Progesterone Micronized 100 Mg Capsule 1 $2,083.00 $2,083.00 $2,083.00 nat. median
$2,083
1.0× median
249746
OTHER 		Indomethacin 25 Mg Capsule 1 $2,008.85 $2,008.85 $2,008.85 nat. median
$2,009
1.0× median
D5130
HCPCS 		Immediate Upperis 1 $1,977.67 $1,977.67 $1,977.67 nat. median
$1,129
1.8× median
D5110
HCPCS 		Complete Upper Denture 1 $1,813.80 $1,813.80 $1,813.80 nat. median
$1,050
1.7× median
D5120
HCPCS 		Complete Lower Denture 1 $1,813.80 $1,813.80 $1,813.80 nat. median
$1,062
1.7× median
D7440
HCPCS 		Excision Malignant Tumor 1 $1,571.36 $1,571.36 $1,571.36 nat. median
$3,439
outlier · 0.5×
D5211
HCPCS 		Partial Denture-upper 1 $1,532.08 $1,532.08 $1,532.08 nat. median
$830
1.8× median
D2740
HCPCS 		Crown-porcelain/ceramic Substrate 1 $1,487.18 $1,487.18 $1,487.18 nat. median
$980
1.5× median
453139
OTHER 		Risperdal Consta 37.5 Mg/2 Ml Intramuscular Susp,extended Release 1 $1,475.05 $1,475.05 $1,475.05 nat. median
$1,475
1.0× median
D2750
HCPCS 		Crown-porcelain Fused To High Noble 1 $1,465.85 $1,465.85 $1,465.85 nat. median
$1,435
1.0× median
D7473
HCPCS 		Removal Of Torus Mandibularis 1 $1,378.31 $1,378.31 $1,378.31 nat. median
$1,442
1.0× median
D2751
HCPCS 		Crown Porcelin 1 $1,365.96 $1,365.96 $1,365.96 nat. median
$1,397
1.0× median
D7911
HCPCS 		Suture 1 $1,354.74 $1,354.74 $1,354.74 nat. median
$778
1.7× median
D2791
HCPCS 		Crown Full Cast Base Metal 1 $1,339.02 $1,339.02 $1,339.02 nat. median
$1,424
0.9× median
D3330
HCPCS 		Root Canal Molar 1 $1,282.90 $1,282.90 $1,282.90 nat. median
$1,180
1.1× median
D6710
HCPCS 		Fixed Partial Denture 1 $1,242.50 $1,242.50 $1,242.50 nat. median
$617
outlier · 2.0×
D7471
HCPCS 		Removal Of Lateral Exostosis 1 $1,229.03 $1,229.03 $1,229.03 nat. median
$3,330
outlier · 0.4×
453140
OTHER 		Risperdal Consta 25 Mg/2 Ml Intramuscular Susp,extended Release 1 $1,106.26 $1,106.26 $1,106.26 nat. median
$1,106
1.0× median
D2961
HCPCS 		Resin Veneer/lab-fabricated 1 $1,089.85 $1,089.85 $1,089.85 nat. median
$1,437
0.8× median
D7980
HCPCS 		Sialolithotomy 1 $1,042.71 $1,042.71 $1,042.71 nat. median
$1,275
0.8× median
D3320
HCPCS 		Root Canel Pre-molar 1 $1,033.73 $1,033.73 $1,033.73 nat. median
$1,097
0.9× median
D7410
HCPCS 		Excision Of Benign Lesion To 1.25 C 1 $993.32 $993.32 $993.32 nat. median
$1,637
0.6× median
D7450
HCPCS 		Removal Of Cyst 1 $993.32 $993.32 $993.32 nat. median
$3,357
outlier · 0.3×
D7820
HCPCS 		Closed Reduction Of Dislocation 1 $977.61 $977.61 $977.61 nat. median
$790
1.2× median
D3410
HCPCS 		Apicoectomy-anterior 1 $951.80 $951.80 $951.80 nat. median
$1,114
0.9× median
88230
OTHER 		Tissue Culture Non-neoplastic 1 $930.48 $930.48 $930.48 nat. median
$441
outlier · 2.1×
RM183
OTHER 		LOA/Therapeutic 1 $877.00 $877.00 $877.00 nat. median
$877
1.0× median
RM180
OTHER 		Room & Board (Non Cov.) 1 $877.00 $877.00 $877.00 nat. median
$877
1.0× median
RM124
OTHER 		Room & Board (Regular) 1 $877.00 $877.00 $877.00 nat. median
$877
1.0× median
RM189
OTHER 		LOA/Hospital Leave 1 $877.00 $877.00 $877.00 nat. median
$877
1.0× median
D6205
HCPCS 		Pontic-indirect Resin Based 1 $859.76 $859.76 $859.76 nat. median
$540
1.6× median
D3310
HCPCS 		Root Canel- Anterior 1 $844.04 $844.04 $844.04 nat. median
$1,072
0.8× median
88262
OTHER 		Count 15-20 Cells,2karyotypes W 1 $829.19 $829.19 $829.19 nat. median
$205
outlier · 4.0×
D7241
HCPCS 		Extract Impacted Tooth Complete 1 $785.68 $785.68 $785.68 nat. median
$1,530
0.5× median
257008
OTHER 		Breathe Right Strips 1 $774.17 $774.17 $774.17 nat. median
$774
1.0× median
D2393
HCPCS 		Composite - 3 Surface Posterior 1 $747.53 $747.53 $747.53 nat. median
$992
0.8× median
D4210
HCPCS 		Gingivectomy Per Qua 1 $744.15 $744.15 $744.15 nat. median
$3,378
outlier · 0.2×
213638
OTHER 		Risperdal 1 mg/mL Oral Solution 1 $737.47 $737.47 $737.47 nat. median
$737
1.0× median
95819
OTHER 		EEG/awake&asleep With Hyper.photic 1 $733.81 $733.81 $733.81 nat. median
$309
outlier · 2.4×

Other procedures at this hospital

Browse this hospital's 2,268 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
             
10061 OTHER Drainage Of Abcess Complicated 1 1 $171.45 $171.45 $171.45 $171.45 $171.45 2026-07-31
11044 OTHER Debridement,bone Includes 1 1 $222.46 $222.46 $222.46 $222.46 $222.46 2026-07-31
11424 OTHER Excision Benign Les Incl. Mar 3.1 T 1 1 $181.98 $181.98 $181.98 $181.98 $181.98 2026-07-31
11426 OTHER Excision,lesion,excised Diam. Over 1 1 $260.28 $260.28 $260.28 $260.28 $260.28 2026-07-31
11443 OTHER Excision, Other Benign Lesion Inclu 1 1 $170.12 $170.12 $170.12 $170.12 $170.12 2026-07-31
11446 OTHER Excision,other Benign Lesion,face, 1 1 $294.14 $294.14 $294.14 $294.14 $294.14 2026-07-31
11762 OTHER Reconstruction Of Nail Bed 1 1 $175.92 $175.92 $175.92 $175.92 $175.92 2026-07-31
150973 OTHER Refresh Tears 0.5 % Eye Drops 1 1 $330.29 $330.29 $330.29 $330.29 $330.29 2026-07-31
158017 OTHER Neomycin-polymyxin-hydrocort 3.5 Mg/ml-10,000 Unit/ml-1 % Ear Solution 1 1 $5,109.24 $5,109.24 $5,109.24 $5,109.24 $5,109.24 2026-07-31
158361 OTHER Fluticasone 250 Mcg-salmeterol 50 Mcg/dose Blistr Powdr For Inhalation 1 1 $590.63 $590.63 $590.63 $590.63 $590.63 2026-07-31
162237 OTHER Effer-k 25 mEq Effervescent Tablet 1 1 $3,252.16 $3,252.16 $3,252.16 $3,252.16 $3,252.16 2026-07-31
162880 OTHER Paroxetine 10 Mg Tablet 1 1 $268.35 $268.35 $268.35 $268.35 $268.35 2026-07-31
163803 OTHER Trandolapril 4 Mg Tablet 1 1 $206.85 $206.85 $206.85 $206.85 $206.85 2026-07-31
164619 OTHER Ketoconazole 2 % Shampoo 1 1 $208.44 $208.44 $208.44 $208.44 $208.44 2026-07-31
165351 OTHER Haloperidol 5 Mg Tab 1 1 $258.00 $258.00 $258.00 $258.00 $258.00 2026-07-31
166370 OTHER Fluphenazine 2.5 Mg Tab 1 1 $230.48 $230.48 $230.48 $230.48 $230.48 2026-07-31
169434.1 OTHER Trazodone 50 Mg Tablet 1 1 $306.50 $306.50 $306.50 $306.50 $306.50 2026-07-31
177407 OTHER Risperidone 4 Mg Tablet 1 1 $368.77 $368.77 $368.77 $368.77 $368.77 2026-07-31
177791 OTHER Ocuvite Lutein Capsule 1 1 $308.56 $308.56 $308.56 $308.56 $308.56 2026-07-31
178251 OTHER Sotalol 80 Mg Tablet 1 1 $614.44 $614.44 $614.44 $614.44 $614.44 2026-07-31
178786.1 OTHER Fluticasone Propionate 0.05 % Topical Cream 1 1 $312.17 $312.17 $312.17 $312.17 $312.17 2026-07-31
181913 OTHER Surgilube Topical Gel 1 1 $578.88 $578.88 $578.88 $578.88 $578.88 2026-07-31
183150 OTHER Metronidazole 0.75 % Vaginal Gel 1 1 $213.00 $213.00 $213.00 $213.00 $213.00 2026-07-31
191281 OTHER Glipizide ER 5 Mg Tablet, Extended Release 24 Hr 1 1 $336.96 $336.96 $336.96 $336.96 $336.96 2026-07-31
192623 OTHER Clobetasol 0.05 % Topical Cream 1 1 $258.75 $258.75 $258.75 $258.75 $258.75 2026-07-31
199638 OTHER Tropicamide 1 % Eye Drops 1 1 $293.23 $293.23 $293.23 $293.23 $293.23 2026-07-31
199810 OTHER Oxcarbazepine 300 Mg Tablet 1 1 $284.70 $284.70 $284.70 $284.70 $284.70 2026-07-31
208877 OTHER Quinapril 40 Mg Tablet 1 1 $228.25 $228.25 $228.25 $228.25 $228.25 2026-07-31
213638 OTHER Risperdal 1 mg/mL Oral Solution 1 1 $737.47 $737.47 $737.47 $737.47 $737.47 2026-07-31
214879 OTHER Cyclopentolate 1 % Eye Drops 1 1 $367.99 $367.99 $367.99 $367.99 $367.99 2026-07-31
21555 OTHER Excision,tumor,soft Tissue Of Neck 1 1 $287.26 $287.26 $287.26 $287.26 $287.26 2026-07-31
220871 OTHER Water For Irrigation, Sterile Solution 1 1 $404.50 $404.50 $404.50 $404.50 $404.50 2026-07-31
222280 OTHER DuoNeb 0.5 Mg-3 Mg(2.5 Mg Base)/3 Ml Solution For Nebulization 1 1 $236.16 $236.16 $236.16 $236.16 $236.16 2026-07-31
231269 OTHER Fluphenazine Decanoate 25 mg/mL Injection Solution 1 1 $364.44 $364.44 $364.44 $364.44 $364.44 2026-07-31
232452 OTHER Ciprofloxacin 0.3 % Eye Drops 1 1 $210.00 $210.00 $210.00 $210.00 $210.00 2026-07-31
233006 OTHER Imiquimod 5 % Topical Cream Packet 1 1 $330.68 $330.68 $330.68 $330.68 $330.68 2026-07-31
23930 OTHER Incision And Drainage, Upper Arm Or 1 1 $206.06 $206.06 $206.06 $206.06 $206.06 2026-07-31
244696 OTHER Vicks Vaporub Topical Ointment 1 1 $368.71 $368.71 $368.71 $368.71 $368.71 2026-07-31
249746 OTHER Indomethacin 25 Mg Capsule 1 1 $2,008.85 $2,008.85 $2,008.85 $2,008.85 $2,008.85 2026-07-31
251929 OTHER Metoprolol Tartrate 50 Mg Tablet 1 1 $247.14 $247.14 $247.14 $247.14 $247.14 2026-07-31
257008 OTHER Breathe Right Strips 1 1 $774.17 $774.17 $774.17 $774.17 $774.17 2026-07-31
266383 OTHER Replens Vaginal Gel 1 1 $351.35 $351.35 $351.35 $351.35 $351.35 2026-07-31
268991 OTHER Fluphenazine 5 mg/mL Oral Concentrate 1 1 $185.96 $185.96 $185.96 $185.96 $185.96 2026-07-31
269442 OTHER Mometasone 0.1 % Topical Ointment 1 1 $256.25 $256.25 $256.25 $256.25 $256.25 2026-07-31
274265 OTHER Zaleplon 5 Mg Capsule 1 1 $272.35 $272.35 $272.35 $272.35 $272.35 2026-07-31
275579 OTHER Fluticasone 100 Mcg-salmeterol 50 Mcg/dose Blistr Powdr For Inhalation 1 1 $449.08 $449.08 $449.08 $449.08 $449.08 2026-07-31
278509 OTHER Letrozole 2.5 Mg Tablet 1 1 $310.00 $310.00 $310.00 $310.00 $310.00 2026-07-31
280154 OTHER Pilocarpine 2 % Eye Drops 1 1 $284.95 $284.95 $284.95 $284.95 $284.95 2026-07-31
287768 OTHER Sertraline 50 Mg Tab 1 1 $220.09 $220.09 $220.09 $220.09 $220.09 2026-07-31
288051 OTHER Fludrocortisone 0.1 Mg Tablet 1 1 $182.19 $182.19 $182.19 $182.19 $182.19 2026-07-31
290519 OTHER Hibiclens 4 % Topical Liquid 1 1 $3,845.90 $3,845.90 $3,845.90 $3,845.90 $3,845.90 2026-07-31
292133 OTHER Fluphenazine 5 Mg Tab 1 1 $376.51 $376.51 $376.51 $376.51 $376.51 2026-07-31
293640 OTHER Fluticasone Propionate 110 Mcg/actuation Hfa Aerosol Inhaler 1 1 $233.18 $233.18 $233.18 $233.18 $233.18 2026-07-31
296048 OTHER Progesterone Micronized 100 Mg Capsule 1 1 $2,083.00 $2,083.00 $2,083.00 $2,083.00 $2,083.00 2026-07-31
298903 OTHER Tobramycin 0.3 %-dexamethasone 0.1 % Eye Drops,suspension 1 1 $273.85 $273.85 $273.85 $273.85 $273.85 2026-07-31
440148 OTHER TobraDex 0.3 %-0.1 % Eye Drops,suspension 1 1 $273.85 $273.85 $273.85 $273.85 $273.85 2026-07-31
446327 OTHER Saline Nasal 0.65 % Spray Aerosol 1 1 $329.10 $329.10 $329.10 $329.10 $329.10 2026-07-31
449856 OTHER Levofloxacin 750 Mg/150 Ml In 5 % Dextrose Intravenous Piggyback 1 1 $179.00 $179.00 $179.00 $179.00 $179.00 2026-07-31
453062 OTHER Daptomycin 500 Mg Intravenous Solution 1 1 $179.00 $179.00 $179.00 $179.00 $179.00 2026-07-31
453139 OTHER Risperdal Consta 37.5 Mg/2 Ml Intramuscular Susp,extended Release 1 1 $1,475.05 $1,475.05 $1,475.05 $1,475.05 $1,475.05 2026-07-31
453140 OTHER Risperdal Consta 25 Mg/2 Ml Intramuscular Susp,extended Release 1 1 $1,106.26 $1,106.26 $1,106.26 $1,106.26 $1,106.26 2026-07-31
465462 OTHER H-r Lubricating Jelly Topical 1 1 $489.50 $489.50 $489.50 $489.50 $489.50 2026-07-31
474911 OTHER A.e.r. Witch Hazel 12.5 %-50 % Topical Pads 1 1 $2,477.30 $2,477.30 $2,477.30 $2,477.30 $2,477.30 2026-07-31
551033 OTHER Symbicort 160 Mcg-4.5 Mcg/actuation Hfa Aerosol Inhaler 1 1 $352.52 $352.52 $352.52 $352.52 $352.52 2026-07-31
552563 OTHER Swim Ear 95 %-5 % Drops 1 1 $402.96 $402.96 $402.96 $402.96 $402.96 2026-07-31
554412 OTHER Seasonale (91) 0.15 Mg-30 Mcg Tablets,3 Month Dose Pack 1 1 $338.83 $338.83 $338.83 $338.83 $338.83 2026-07-31
557061 OTHER Lipo-flavonoid Plus 200 Mg-100 Mg Tablet 1 1 $446.72 $446.72 $446.72 $446.72 $446.72 2026-07-31
559004 OTHER Invega Sustenna 78 Mg/0.5 Ml Intramuscular Syringe 1 1 $3,366.42 $3,366.42 $3,366.42 $3,366.42 $3,366.42 2026-07-31
559005 OTHER Invega Sustenna 117 Mg/0.75 Ml Intramuscular Syringe 1 1 $2,783.03 $2,783.03 $2,783.03 $2,783.03 $2,783.03 2026-07-31
559007 OTHER Invega Sustenna 234 Mg/1.5 Ml Intramuscular Syringe 1 1 $707.98 $707.98 $707.98 $707.98 $707.98 2026-07-31
559008 OTHER Invega Sustenna 156 mg/mL Intramuscular Syringe 1 1 $4,174.44 $4,174.44 $4,174.44 $4,174.44 $4,174.44 2026-07-31
577284 OTHER Abilify Maintena 300 Mg Intramuscular Suspension,extended Release 1 1 $3,383.81 $3,383.81 $3,383.81 $3,383.81 $3,383.81 2026-07-31
577537 OTHER Estarylla 0.25 Mg-35 Mcg Tablet 1 1 $339.68 $339.68 $339.68 $339.68 $339.68 2026-07-31
580407 OTHER Preparation H(phenyleph,cocoa Buttr) 0.25 %-88.44 % Rectal Suppository 1 1 $304.78 $304.78 $304.78 $304.78 $304.78 2026-07-31
582683 OTHER Trulicity 0.75 Mg/0.5 Ml Subcutaneous Pen Injector 1 1 $293.23 $293.23 $293.23 $293.23 $293.23 2026-07-31
582684 OTHER Trulicity 1.5 Mg/0.5 Ml Subcutaneous Pen Injector 1 1 $293.23 $293.23 $293.23 $293.23 $293.23 2026-07-31
586041 OTHER Invega Trinza 273 Mg/0.875 Ml Intramuscular Syringe 1 1 $6,026.53 $6,026.53 $6,026.53 $6,026.53 $6,026.53 2026-07-31
586524 OTHER Entresto 49 Mg-51 Mg Tablet 1 1 $187.50 $187.50 $187.50 $187.50 $187.50 2026-07-31
594631 OTHER Qvar RediHaler 80 Mcg/actuation Hfa Breath Activated Aerosol 1 1 $198.00 $198.00 $198.00 $198.00 $198.00 2026-07-31
594632 OTHER Qvar RediHaler 40 Mcg/actuation Hfa Breath Activated Aerosol 1 1 $320.89 $320.89 $320.89 $320.89 $320.89 2026-07-31
595451 OTHER Biktarvy 50 Mg-200 Mg-25 Mg Tablet 1 1 $180.02 $180.02 $180.02 $180.02 $180.02 2026-07-31
598899 OTHER Wixela Inhub 100 Mcg-50 Mcg/dose Powder For Inhalation 1 1 $449.08 $449.08 $449.08 $449.08 $449.08 2026-07-31
598900 OTHER Wixela Inhub 250 Mcg-50 Mcg/dose Powder For Inhalation 1 1 $590.63 $590.63 $590.63 $590.63 $590.63 2026-07-31
599807 OTHER Acthar 80 unit/mL Injection Gel 1 1 $398.80 $398.80 $398.80 $398.80 $398.80 2026-07-31
604202 OTHER Trulicity 3 Mg/0.5 Ml Subcutaneous Pen Injector 1 1 $293.23 $293.23 $293.23 $293.23 $293.23 2026-07-31
606782 OTHER Wegovy 1 Mg/0.5 Ml Subcutaneous Pen Injector 1 1 $404.50 $404.50 $404.50 $404.50 $404.50 2026-07-31
606784 OTHER Wegovy 1.7 Mg/0.75 Ml Subcutaneous Pen Injector 1 1 $404.50 $404.50 $404.50 $404.50 $404.50 2026-07-31
606785 OTHER Wegovy 2.4 Mg/0.75 Ml Subcutaneous Pen Injector 1 1 $364.44 $364.44 $364.44 $364.44 $364.44 2026-07-31
609666 OTHER Paxlovid 300 Mg (150 Mg X 2)-100 Mg Tablet (eua) 1 1 $4,687.68 $4,687.68 $4,687.68 $4,687.68 $4,687.68 2026-07-31
7522 OTHER Hepatitus C Pcr 1 1 $200.00 $200.00 $200.00 $200.00 $200.00 2026-07-31
76536 OTHER Echo Soft Tissue Head & Neck 1 1 $192.03 $192.03 $192.03 $192.03 $192.03 2026-07-31
76641 OTHER Ultrasound,breast,unilateral W/imag 1 1 $176.99 $176.99 $176.99 $176.99 $176.99 2026-07-31
76700 OTHER Echo Abdomen Complete 1 1 $201.86 $201.86 $201.86 $201.86 $201.86 2026-07-31
76770 OTHER Echo Abdomen Retroperitoneal 1 1 $186.82 $186.82 $186.82 $186.82 $186.82 2026-07-31
76856 OTHER Echo Pelvic (non Ob) 1 1 $181.62 $181.62 $181.62 $181.62 $181.62 2026-07-31
80050 OTHER General Health Panel 1 1 $184.25 $184.25 $184.25 $184.25 $184.25 2026-07-31
80102 OTHER Lsd Reflex For Confirmation 1 1 $231.01 $231.01 $231.01 $231.01 $231.01 2026-07-31
80154-A OTHER Ativan (Loranzepam) 1 1 $172.28 $172.28 $172.28 $172.28 $172.28 2026-07-31
80154-B OTHER Klonopin (Clonazepam) 1 1 $172.28 $172.28 $172.28 $172.28 $172.28 2026-07-31
80154-C OTHER Valium (Diazepam) 1 1 $172.28 $172.28 $172.28 $172.28 $172.28 2026-07-31
80154-D OTHER Zyprexa (Olanzapine) 1 1 $172.28 $172.28 $172.28 $172.28 $172.28 2026-07-31
80174 OTHER Imipramine 1 1 $200.74 $200.74 $200.74 $200.74 $200.74 2026-07-31
80197 OTHER Prograf 1 1 $189.68 $189.68 $189.68 $189.68 $189.68 2026-07-31
80201 OTHER Topiramate 1 1 $189.68 $189.68 $189.68 $189.68 $189.68 2026-07-31
81381 OTHER Hla One Allele Or Allele Group 1 1 $169.90 $169.90 $169.90 $169.90 $169.90 2026-07-31
81528 OTHER Cologuard - Colorectal Screening 1 1 $508.87 $508.87 $508.87 $508.87 $508.87 2026-07-31
82024 OTHER Adrenocorticotropic Hormone 1 1 $274.70 $274.70 $274.70 $274.70 $274.70 2026-07-31
82088-S OTHER Aldosterone-serum 1 1 $285.90 $285.90 $285.90 $285.90 $285.90 2026-07-31
82088-U OTHER Aldosterone Urine 1 1 $285.90 $285.90 $285.90 $285.90 $285.90 2026-07-31
82131 OTHER Anemia Panel 1 1 $700.10 $700.10 $700.10 $700.10 $700.10 2026-07-31
82157 OTHER Androstenedione 1 1 $291.73 $291.73 $291.73 $291.73 $291.73 2026-07-31
82240 OTHER Cholylglycine 1 1 $226.11 $226.11 $226.11 $226.11 $226.11 2026-07-31
82300 OTHER Cadmium 1 1 $180.35 $180.35 $180.35 $180.35 $180.35 2026-07-31
82308 OTHER Calcitonin 1 1 $250.54 $250.54 $250.54 $250.54 $250.54 2026-07-31
82382 OTHER Catecholamine Total Urune 1 1 $194.35 $194.35 $194.35 $194.35 $194.35 2026-07-31
82542 OTHER Tiagabine 1 1 $487.74 $487.74 $487.74 $487.74 $487.74 2026-07-31
82542-A OTHER Risperdal (Risperidone) 1 1 $487.74 $487.74 $487.74 $487.74 $487.74 2026-07-31
82542-B OTHER Dexamethasone Suppression 1 1 $487.74 $487.74 $487.74 $487.74 $487.74 2026-07-31
82542-C OTHER Ziprasidone 1 1 $487.74 $487.74 $487.74 $487.74 $487.74 2026-07-31
82542-E OTHER Keppra/Levetiracetam 1 1 $487.74 $487.74 $487.74 $487.74 $487.74 2026-07-31
82626 OTHER Dhea 1 1 $212.35 $212.35 $212.35 $212.35 $212.35 2026-07-31
82668 OTHER Erythropoietin 1 1 $189.45 $189.45 $189.45 $189.45 $189.45 2026-07-31
82670 OTHER Estradiol 1 1 $306.64 $306.64 $306.64 $306.64 $306.64 2026-07-31
82672 OTHER Estrogen Total 1 1 $238.03 $238.03 $238.03 $238.03 $238.03 2026-07-31
83015 OTHER Heavy Metal Screen 1 1 $380.61 $380.61 $380.61 $380.61 $380.61 2026-07-31
83498 OTHER Hydroxyprogesterone, 17-d 1 1 $203.28 $203.28 $203.28 $203.28 $203.28 2026-07-31
83516-C OTHER Anti Glaia Antibodies 1 1 $337.18 $337.18 $337.18 $337.18 $337.18 2026-07-31
83516-E OTHER Ttg Immunoglobulin 1 1 $337.18 $337.18 $337.18 $337.18 $337.18 2026-07-31
83812 OTHER Hla-b-27 1 1 $221.31 $221.31 $221.31 $221.31 $221.31 2026-07-31
83900 OTHER Molecular Diagnostics,amplification 1 1 $268.72 $268.72 $268.72 $268.72 $268.72 2026-07-31
83909 OTHER Separation And Id By High Resolutio 1 1 $290.42 $290.42 $290.42 $290.42 $290.42 2026-07-31
84144 OTHER Progesterone 1 1 $191.42 $191.42 $191.42 $191.42 $191.42 2026-07-31
84146-A OTHER Macroprolactin 1 1 $194.48 $194.48 $194.48 $194.48 $194.48 2026-07-31
84182 OTHER Botulinium 1 1 $468.45 $468.45 $468.45 $468.45 $468.45 2026-07-31
84207 OTHER Vitamin B-6 1 1 $344.16 $344.16 $344.16 $344.16 $344.16 2026-07-31
84233 OTHER Receptor Assay Estrogen 1 1 $251.41 $251.41 $251.41 $251.41 $251.41 2026-07-31
84244 OTHER Renin 1 1 $186.51 $186.51 $186.51 $186.51 $186.51 2026-07-31
84260 OTHER Seratonin 1 1 $302.88 $302.88 $302.88 $302.88 $302.88 2026-07-31
84305 OTHER Somatomedin 1 1 $295.70 $295.70 $295.70 $295.70 $295.70 2026-07-31
84311 OTHER Spectrophometry Analyte Not 1 1 $465.70 $465.70 $465.70 $465.70 $465.70 2026-07-31
84377 OTHER Reducing Substances 1 1 $249.97 $249.97 $249.97 $249.97 $249.97 2026-07-31
84445 OTHER Thyroid Stimulating Immunoglobulins 1 1 $625.74 $625.74 $625.74 $625.74 $625.74 2026-07-31
84466 OTHER Transferritin-serum 1 1 $190.90 $190.90 $190.90 $190.90 $190.90 2026-07-31
84482 OTHER Triiodothyronine Reverse 1 1 $203.10 $203.10 $203.10 $203.10 $203.10 2026-07-31
84588 OTHER Vasopressin (antiduretic) 1 1 $298.19 $298.19 $298.19 $298.19 $298.19 2026-07-31
85240 OTHER Factor V111 1 1 $221.31 $221.31 $221.31 $221.31 $221.31 2026-07-31
85244 OTHER Factor V111 Related Antigen 1 1 $242.03 $242.03 $242.03 $242.03 $242.03 2026-07-31
85250 OTHER Factor Ix Ptc 1 1 $269.35 $269.35 $269.35 $269.35 $269.35 2026-07-31
85305 OTHER Protein S Functional, 1 1 $195.17 $195.17 $195.17 $195.17 $195.17 2026-07-31
85520 OTHER Anti-xa 1 1 $251.54 $251.54 $251.54 $251.54 $251.54 2026-07-31
86023 OTHER Platlet ASSN,IgG 1 1 $327.94 $327.94 $327.94 $327.94 $327.94 2026-07-31
86320 OTHER Immunoelectrophesis 1 1 $204.03 $204.03 $204.03 $204.03 $204.03 2026-07-31
86331 OTHER Immuno-gel Diffusion 1 1 $196.16 $196.16 $196.16 $196.16 $196.16 2026-07-31
86337 OTHER Insulin Autoantiboldies 1 1 $206.05 $206.05 $206.05 $206.05 $206.05 2026-07-31
86355 OTHER B Cells, Total Count 1 1 $407.44 $407.44 $407.44 $407.44 $407.44 2026-07-31
86357 OTHER Nk Cells, Total Count 1 1 $407.44 $407.44 $407.44 $407.44 $407.44 2026-07-31
86359 OTHER T Cells;total Count (differential) 1 1 $182.06 $182.06 $182.06 $182.06 $182.06 2026-07-31
86618 OTHER Borrelia Burgdorferi Lyme Screen 1 1 $187.81 $187.81 $187.81 $187.81 $187.81 2026-07-31
86644 OTHER Cytomegalovirus IgG 1 1 $176.61 $176.61 $176.61 $176.61 $176.61 2026-07-31
86689 OTHER Htlv Or HIV Antibody (eg Western 1 1 $585.74 $585.74 $585.74 $585.74 $585.74 2026-07-31
86804 OTHER Riba-hepatitis C Antibody Positive 1 1 $351.34 $351.34 $351.34 $351.34 $351.34 2026-07-31
86822 OTHER Lymphocyte Culture Ptimed 1 1 $542.00 $542.00 $542.00 $542.00 $542.00 2026-07-31
87110 OTHER Clamydia 1 1 $186.27 $186.27 $186.27 $186.27 $186.27 2026-07-31
87117 OTHER Acid Fast Culture 1 1 $188.56 $188.56 $188.56 $188.56 $188.56 2026-07-31
87252 OTHER 3 Virus Culture 1 1 $227.82 $227.82 $227.82 $227.82 $227.82 2026-07-31
87517 OTHER Hbv Qnt Pcr 1 1 $585.30 $585.30 $585.30 $585.30 $585.30 2026-07-31
87521 OTHER Hepatitis C, Amplified Probe 1 1 $345.87 $345.87 $345.87 $345.87 $345.87 2026-07-31
87535 OTHER HIV-1 1 1 $439.28 $439.28 $439.28 $439.28 $439.28 2026-07-31
87901 OTHER HIV-1 Reverse Trans And Protease 1 1 $257.45 $257.45 $257.45 $257.45 $257.45 2026-07-31
87902 OTHER Hepatitis C Virus 1 1 $645.27 $645.27 $645.27 $645.27 $645.27 2026-07-31
88112 OTHER Cytopathology,except Cervical Or 1 1 $421.62 $421.62 $421.62 $421.62 $421.62 2026-07-31
88160 OTHER Cytopathy Any Oth Source Scr And In 1 1 $316.58 $316.58 $316.58 $316.58 $316.58 2026-07-31
88173 OTHER Needla Aspiration 1 1 $686.34 $686.34 $686.34 $686.34 $686.34 2026-07-31
88189 OTHER Flow Cytometry 16 Or More Markers 1 1 $364.83 $364.83 $364.83 $364.83 $364.83 2026-07-31
88230 OTHER Tissue Culture Non-neoplastic 1 1 $930.48 $930.48 $930.48 $930.48 $930.48 2026-07-31
88260 OTHER Chromosom Analysis 1 1 $244.90 $244.90 $244.90 $244.90 $244.90 2026-07-31
88262 OTHER Count 15-20 Cells,2karyotypes W 1 1 $829.19 $829.19 $829.19 $829.19 $829.19 2026-07-31
88289 OTHER Additional High Resolution Study 1 1 $669.07 $669.07 $669.07 $669.07 $669.07 2026-07-31
88291 OTHER CytogeneticsMolecularCytogeneticsIn 1 1 $278.93 $278.93 $278.93 $278.93 $278.93 2026-07-31
88304 OTHER Surgical Tissue Gross & Micro 1 1 $294.05 $294.05 $294.05 $294.05 $294.05 2026-07-31
88305 OTHER Level IV Surg Path,gross & 1 1 $494.69 $494.69 $494.69 $494.69 $494.69 2026-07-31
88309 OTHER Tissue Pathology 1 1 $272.54 $272.54 $272.54 $272.54 $272.54 2026-07-31
88312 OTHER Special Stains 1 1 $285.57 $285.57 $285.57 $285.57 $285.57 2026-07-31
88321 OTHER Consultation 1 1 $283.98 $283.98 $283.98 $283.98 $283.98 2026-07-31
89160 OTHER Special Stain 1 1 $182.67 $182.67 $182.67 $182.67 $182.67 2026-07-31
93306 OTHER Echocardiogram 1 1 $183.61 $183.61 $183.61 $183.61 $183.61 2026-07-31
93880 OTHER Duplex Scan Of Extrac Arteries Dup 1 1 $177.12 $177.12 $177.12 $177.12 $177.12 2026-07-31
9388051 OTHER Duplex Scan Of Extrac Arteries Dup 1 1 $177.12 $177.12 $177.12 $177.12 $177.12 2026-07-31
93886TC OTHER Echo, Doppler Intracranial Arteries 1 1 $206.91 $206.91 $206.91 $206.91 $206.91 2026-07-31
93925 OTHER Duplex Scan Lower Ext Bil Study 1 1 $222.44 $222.44 $222.44 $222.44 $222.44 2026-07-31
93925TC OTHER Duplex Scan Lower Ext Bil Study 1 1 $186.93 $186.93 $186.93 $186.93 $186.93 2026-07-31
93975 OTHER Vasular Study 1 1 $246.99 $246.99 $246.99 $246.99 $246.99 2026-07-31
93975TC OTHER Renal Artery-doppler 1 1 $194.31 $194.31 $194.31 $194.31 $194.31 2026-07-31
95812 OTHER EEG Extended Monitoring < 1hr. 1 1 $559.68 $559.68 $559.68 $559.68 $559.68 2026-07-31
95812TC OTHER EEG Extended Monitoring, Up To 1 Hr 1 1 $559.68 $559.68 $559.68 $559.68 $559.68 2026-07-31
95816 OTHER EEG Awake, Drowsy With Hv&photic 1 1 $631.16 $631.16 $631.16 $631.16 $631.16 2026-07-31
95816TC OTHER EEG Recording Awake & Drowsy 1 1 $319.49 $319.49 $319.49 $319.49 $319.49 2026-07-31
95819 OTHER EEG/awake&asleep With Hyper.photic 1 1 $733.81 $733.81 $733.81 $733.81 $733.81 2026-07-31
95819TC OTHER EEG Recording Awake & Asleep 1 1 $733.81 $733.81 $733.81 $733.81 $733.81 2026-07-31
95830 OTHER EEG Physician Insertion Sphen 1 1 $406.32 $406.32 $406.32 $406.32 $406.32 2026-07-31
95950QB OTHER EEG 24hr.ambulatory W/interpretatio 1 1 $594.50 $594.50 $594.50 $594.50 $594.50 2026-07-31
99205 OTHER Office Or Other Outpt Visit 60-74 1 1 $169.79 $169.79 $169.79 $169.79 $169.79 2026-07-31
9920525 OTHER Office Or Other Oupt Visit 60-74 1 1 $169.79 $169.79 $169.79 $169.79 $169.79 2026-07-31
99205AI OTHER Office Or Other Oupt Visit 60-74 1 1 $169.79 $169.79 $169.79 $169.79 $169.79 2026-07-31
99236 OTHER Hospital Inpt Or Observ Care 85 1 1 $195.94 $195.94 $195.94 $195.94 $195.94 2026-07-31
9923625 OTHER Hospital Inpt Or Observ Care 85 1 1 $195.94 $195.94 $195.94 $195.94 $195.94 2026-07-31
99236AQ OTHER Hospital Inpt Or Observ Care 85 1 1 $195.94 $195.94 $195.94 $195.94 $195.94 2026-07-31
99255 OTHER Inpatient Consult. Typically 80 1 1 $193.05 $193.05 $193.05 $193.05 $193.05 2026-07-31
99291 OTHER Critical Care - Lst Hour 1 1 $255.66 $255.66 $255.66 $255.66 $255.66 2026-07-31
D0140 HCPCS Limited Oral Eval- Problem Focused 1 1 $214.65 $214.65 $214.65 $214.65 $214.65 2026-07-31
D0150 HCPCS Initial Exam 1 1 $222.24 $222.24 $222.24 $222.24 $222.24 2026-07-31
D0210 HCPCS Intraoral-complete With B.w.s. 1 1 $245.81 $245.81 $245.81 $245.81 $245.81 2026-07-31
D0574 HCPCS Resin-based Composite-two Surfaces 1 1 $306.00 $306.00 $306.00 $306.00 $306.00 2026-07-31
D1110 HCPCS Prophylaxis, Adults 1 1 $262.65 $262.65 $262.65 $262.65 $262.65 2026-07-31
D1510 HCPCS Space Maintain R-unilateral Fixed 1 1 $414.17 $414.17 $414.17 $414.17 $414.17 2026-07-31
D2330 HCPCS Composite -1 Surface Anterior 1 1 $391.44 $391.44 $391.44 $391.44 $391.44 2026-07-31
D2331 HCPCS Composite - 2 Surface Anterior 1 1 $373.34 $373.34 $373.34 $373.34 $373.34 2026-07-31
D2332 HCPCS Composite - 3 Surface Anterior 1 1 $608.63 $608.63 $608.63 $608.63 $608.63 2026-07-31
D2335 HCPCS Composite - 4 Or More Surface 1 1 $321.01 $321.01 $321.01 $321.01 $321.01 2026-07-31
D2390 HCPCS Composite Crown - Anterior 1 1 $355.80 $355.80 $355.80 $355.80 $355.80 2026-07-31
D2391 HCPCS Composite - 1 Surface Posterior 1 1 $457.10 $457.10 $457.10 $457.10 $457.10 2026-07-31
D2392 HCPCS Composite - 2 Surface Posterior 1 1 $598.53 $598.53 $598.53 $598.53 $598.53 2026-07-31
D2393 HCPCS Composite - 3 Surface Posterior 1 1 $747.53 $747.53 $747.53 $747.53 $747.53 2026-07-31
D2394 HCPCS Composite - 4 Or More Surface 1 1 $404.06 $404.06 $404.06 $404.06 $404.06 2026-07-31
D2710 HCPCS Crown-resin-based Composite 1 1 $587.02 $587.02 $587.02 $587.02 $587.02 2026-07-31
D2712 HCPCS Crown 3/4 Resin-based Composite 1 1 $587.02 $587.02 $587.02 $587.02 $587.02 2026-07-31
D2740 HCPCS Crown-porcelain/ceramic Substrate 1 1 $1,487.18 $1,487.18 $1,487.18 $1,487.18 $1,487.18 2026-07-31
D2750 HCPCS Crown-porcelain Fused To High Noble 1 1 $1,465.85 $1,465.85 $1,465.85 $1,465.85 $1,465.85 2026-07-31
D2751 HCPCS Crown Porcelin 1 1 $1,365.96 $1,365.96 $1,365.96 $1,365.96 $1,365.96 2026-07-31
D2791 HCPCS Crown Full Cast Base Metal 1 1 $1,339.02 $1,339.02 $1,339.02 $1,339.02 $1,339.02 2026-07-31
D2920 HCPCS Recement Crowns 1 1 $272.75 $272.75 $272.75 $272.75 $272.75 2026-07-31
D2930 HCPCS Prefab Stainless Steel Crown Primar 1 1 $329.99 $329.99 $329.99 $329.99 $329.99 2026-07-31
D2931 HCPCS Prefab Stainless Steel Crown 1 1 $371.55 $371.55 $371.55 $371.55 $371.55 2026-07-31
D2950 HCPCS Crown Build Up Including Any Pins 1 1 $704.60 $704.60 $704.60 $704.60 $704.60 2026-07-31
D2954 HCPCS Prefabricated Post And Core With 1 1 $397.33 $397.33 $397.33 $397.33 $397.33 2026-07-31
D2961 HCPCS Resin Veneer/lab-fabricated 1 1 $1,089.85 $1,089.85 $1,089.85 $1,089.85 $1,089.85 2026-07-31
D3220 HCPCS Pulpotomy 1 1 $203.15 $203.15 $203.15 $203.15 $203.15 2026-07-31
D3221 HCPCS Pulpal Debridement And Permanent 1 1 $223.36 $223.36 $223.36 $223.36 $223.36 2026-07-31
D3240 HCPCS Resorbable Filling Post, Prime Toot 1 1 $596.01 $596.01 $596.01 $596.01 $596.01 2026-07-31
D3310 HCPCS Root Canel- Anterior 1 1 $844.04 $844.04 $844.04 $844.04 $844.04 2026-07-31
D3320 HCPCS Root Canel Pre-molar 1 1 $1,033.73 $1,033.73 $1,033.73 $1,033.73 $1,033.73 2026-07-31
D3330 HCPCS Root Canal Molar 1 1 $1,282.90 $1,282.90 $1,282.90 $1,282.90 $1,282.90 2026-07-31
D3410 HCPCS Apicoectomy-anterior 1 1 $951.80 $951.80 $951.80 $951.80 $951.80 2026-07-31
D4210 HCPCS Gingivectomy Per Qua 1 1 $744.15 $744.15 $744.15 $744.15 $744.15 2026-07-31
D4341 HCPCS Peridontal Scaling Per Quad 1 1 $313.15 $313.15 $313.15 $313.15 $313.15 2026-07-31
D4342 HCPCS Prdontal Scaling& Root Planing 1-3 1 1 $409.13 $409.13 $409.13 $409.13 $409.13 2026-07-31
D4355 HCPCS Full Mouth Debridement For 1 1 $482.36 $482.36 $482.36 $482.36 $482.36 2026-07-31
D5110 HCPCS Complete Upper Denture 1 1 $1,813.80 $1,813.80 $1,813.80 $1,813.80 $1,813.80 2026-07-31
D5120 HCPCS Complete Lower Denture 1 1 $1,813.80 $1,813.80 $1,813.80 $1,813.80 $1,813.80 2026-07-31
D5130 HCPCS Immediate Upperis 1 1 $1,977.67 $1,977.67 $1,977.67 $1,977.67 $1,977.67 2026-07-31
D5211 HCPCS Partial Denture-upper 1 1 $1,532.08 $1,532.08 $1,532.08 $1,532.08 $1,532.08 2026-07-31
D5212 HCPCS Partial Denture-lower 1 1 $4,002.75 $4,002.75 $4,002.75 $4,002.75 $4,002.75 2026-07-31
D5410 HCPCS Complete Upper Denture Adjustment 1 1 $222.24 $222.24 $222.24 $222.24 $222.24 2026-07-31
D5630 HCPCS Replace Additional Tooth 1 1 $280.60 $280.60 $280.60 $280.60 $280.60 2026-07-31
D5640 HCPCS Replace Broken Tooth-denture 1 1 $409.13 $409.13 $409.13 $409.13 $409.13 2026-07-31
D5650 HCPCS Add Tooth To Existing Partial 1 1 $558.12 $558.12 $558.12 $558.12 $558.12 2026-07-31
D5660 HCPCS Adding Clasp To Partial 1 1 $297.44 $297.44 $297.44 $297.44 $297.44 2026-07-31
D5670 HCPCS Reattaching Damaged Claspal 1 1 $728.44 $728.44 $728.44 $728.44 $728.44 2026-07-31
D5730 HCPCS Reline comp.U/dent.(chairside) 1 1 $415.29 $415.29 $415.29 $415.29 $415.29 2026-07-31
D5731 HCPCS Reline comp.L/dent.(chairside) 1 1 $415.29 $415.29 $415.29 $415.29 $415.29 2026-07-31
D5750 HCPCS Relining Denture-max.-lab 1 1 $554.47 $554.47 $554.47 $554.47 $554.47 2026-07-31
D5751 HCPCS Reline comp.L/dent.(Lab) 1 1 $554.47 $554.47 $554.47 $554.47 $554.47 2026-07-31
D5760 HCPCS Relining Partial-max.-lab 1 1 $546.61 $546.61 $546.61 $546.61 $546.61 2026-07-31
D5761 HCPCS Reline comp.U/part.(Lab) 1 1 $546.61 $546.61 $546.61 $546.61 $546.61 2026-07-31
D5850 HCPCS Tissue Reconditioning-max. 1 1 $173.97 $173.97 $173.97 $173.97 $173.97 2026-07-31
D5851 HCPCS Tissue conditioning/Mand. 1 1 $173.97 $173.97 $173.97 $173.97 $173.97 2026-07-31
D5999 HCPCS Unspecified Maxillofacial Prosthesi 1 1 $184.71 $184.71 $184.71 $184.71 $184.71 2026-07-31
D6205 HCPCS Pontic-indirect Resin Based 1 1 $859.76 $859.76 $859.76 $859.76 $859.76 2026-07-31
D6710 HCPCS Fixed Partial Denture 1 1 $1,242.50 $1,242.50 $1,242.50 $1,242.50 $1,242.50 2026-07-31
D6930 HCPCS Recement Fixed Partial Denture 1 1 $173.97 $173.97 $173.97 $173.97 $173.97 2026-07-31
D7140 HCPCS Extraction-erupted Tooth Or Exposed 1 1 $404.06 $404.06 $404.06 $404.06 $404.06 2026-07-31
D7210 HCPCS Surgery-erupted Tooth 1 1 $719.73 $719.73 $719.73 $719.73 $719.73 2026-07-31
D7220 HCPCS Surgery-impaction-soft Tissue 1 1 $400.70 $400.70 $400.70 $400.70 $400.70 2026-07-31
D7230 HCPCS Surgery Impacted-partial Boney 1 1 $533.14 $533.14 $533.14 $533.14 $533.14 2026-07-31
D7240 HCPCS Complicated Impaction -comp. Boney 1 1 $624.05 $624.05 $624.05 $624.05 $624.05 2026-07-31
D7241 HCPCS Extract Impacted Tooth Complete 1 1 $785.68 $785.68 $785.68 $785.68 $785.68 2026-07-31
D7250 HCPCS Root Recovery-with Cutting 1 1 $336.72 $336.72 $336.72 $336.72 $336.72 2026-07-31
D7270 HCPCS Tooth Re-implantation And/or 1 1 $620.69 $620.69 $620.69 $620.69 $620.69 2026-07-31
D7311 HCPCS Alveoloplasty In Conj W Extractions 1 1 $289.58 $289.58 $289.58 $289.58 $289.58 2026-07-31
D7320 HCPCS Alveoloplasty 1 1 $537.63 $537.63 $537.63 $537.63 $537.63 2026-07-31
D7410 HCPCS Excision Of Benign Lesion To 1.25 C 1 1 $993.32 $993.32 $993.32 $993.32 $993.32 2026-07-31
D7440 HCPCS Excision Malignant Tumor 1 1 $1,571.36 $1,571.36 $1,571.36 $1,571.36 $1,571.36 2026-07-31
D7450 HCPCS Removal Of Cyst 1 1 $993.32 $993.32 $993.32 $993.32 $993.32 2026-07-31
D7471 HCPCS Removal Of Lateral Exostosis 1 1 $1,229.03 $1,229.03 $1,229.03 $1,229.03 $1,229.03 2026-07-31
D7473 HCPCS Removal Of Torus Mandibularis 1 1 $1,378.31 $1,378.31 $1,378.31 $1,378.31 $1,378.31 2026-07-31
D7510 HCPCS Drainage Of Abscess 1 1 $355.80 $355.80 $355.80 $355.80 $355.80 2026-07-31
D7530 HCPCS Removal Foreign Body 1 1 $610.59 $610.59 $610.59 $610.59 $610.59 2026-07-31
D7820 HCPCS Closed Reduction Of Dislocation 1 1 $977.61 $977.61 $977.61 $977.61 $977.61 2026-07-31
D7910 HCPCS Suture Of Recent Small Wounds Up To 1 1 $543.24 $543.24 $543.24 $543.24 $543.24 2026-07-31
D7911 HCPCS Suture 1 1 $1,354.74 $1,354.74 $1,354.74 $1,354.74 $1,354.74 2026-07-31
D7980 HCPCS Sialolithotomy 1 1 $1,042.71 $1,042.71 $1,042.71 $1,042.71 $1,042.71 2026-07-31
D8210 HCPCS Remove A Corrective Device 1 1 $547.00 $547.00 $547.00 $547.00 $547.00 2026-07-31
D9310 HCPCS Consultation 1 1 $264.89 $264.89 $264.89 $264.89 $264.89 2026-07-31
D9944 HCPCS Occlusal Guard-hard Appliance,full 1 1 $190.83 $190.83 $190.83 $190.83 $190.83 2026-07-31
D9945 HCPCS Occlusal Guard-soft Appliance,full 1 1 $429.38 $429.38 $429.38 $429.38 $429.38 2026-07-31
D9946 HCPCS Occlusal Guard-hard 1 1 $190.83 $190.83 $190.83 $190.83 $190.83 2026-07-31
RM124 OTHER Room & Board (Regular) 1 1 $877.00 $877.00 $877.00 $877.00 $877.00 2026-07-31
RM180 OTHER Room & Board (Non Cov.) 1 1 $877.00 $877.00 $877.00 $877.00 $877.00 2026-07-31
RM183 OTHER LOA/Therapeutic 1 1 $877.00 $877.00 $877.00 $877.00 $877.00 2026-07-31
RM189 OTHER LOA/Hospital Leave 1 1 $877.00 $877.00 $877.00 $877.00 $877.00 2026-07-31
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