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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

NORTH VALLEY HEALTH CENTER

Warren, MN · CCN 241337 · Rates published

2,030 distinct procedures filed
14 distinct payers
30,783 rate rows
2025-09-15 last MRF observed
Data quality

29,848 of 30,783 rate rows are consumer-grade (97.0%)

935 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 520
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 204
per-diem day rate — not a per-procedure price 184
exceeds 10× this hospital's gross charge — excluded from medians 23
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 4
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbNVHCWARRENMN&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/North_Valley_V2.aspx
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-08-14
Content fingerprint 5fc15ff8693680f5… · 10,999,543 bytes · first seen 2026-05-08

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
445
MS_DRG 		Disorders Of The Biliary Tract With Cc 8 $4,169.66 $47,825.85 $35,695.71 nat. median
$11,531
outlier · 3.1×
698
MS_DRG 		Other Kidney And Urinary Tract Diagnoses With Mcc 8 $6,303.26 $44,873.73 $35,603.45 nat. median
$16,480
outlier · 2.2×
292
MS_DRG 		Heart Failure And Shock With Cc 8 $3,234.69 $36,175.53 $27,174.24 nat. median
$9,526
outlier · 2.9×
J3357
HCPCS 		Ustekinumab, For Subcutaneous Injection, 1 Mg 13 $8,137.67 $46,459.04 $26,897.34 nat. median
$12,959
outlier · 2.1×
683
MS_DRG 		Renal Failure With Cc 8 $3,336.80 $34,962.85 $26,601.03 nat. median
$9,596
outlier · 2.8×
178
MS_DRG 		Respiratory Infections And Inflammations With Cc 8 $3,718.56 $31,051.58 $23,175.92 nat. median
$10,806
outlier · 2.1×
193
MS_DRG 		Simple Pneumonia And Pleurisy With Mcc 8 $5,007.86 $30,906.43 $23,067.58 nat. median
$13,455
1.7× median
640
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 8 $4,681.29 $26,726.11 $22,707.65 nat. median
$13,243
1.7× median
872
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 8 $3,898.77 $28,664.11 $22,184.49 nat. median
$11,029
outlier · 2.0×
202
MS_DRG 		Bronchitis And Asthma With Cc/mcc 8 $3,700.27 $22,404.56 $17,786.46 nat. median
$10,254
1.7× median
534
MS_DRG 		Fractures Of Femur Without Mcc 8 $3,071.24 $23,468.92 $17,516.46 nat. median
$8,911
2.0× median
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 8 $3,880.28 $22,153.05 $16,534.33 nat. median
$19,136
0.9× median
556
MS_DRG 		Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 8 $3,164.59 $19,530.58 $16,427.97 nat. median
$9,097
1.8× median
194
MS_DRG 		Simple Pneumonia And Pleurisy With Cc 8 $3,070.48 $20,217.03 $15,313.21 nat. median
$9,038
1.7× median
280
MS_DRG 		Acute Myocardial Infarction, Discharged Alive With Mcc 8 $2,985.67 $17,045.61 $15,253.36 nat. median
$16,417
0.9× median
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 8 $3,039.13 $17,350.80 $13,958.39 nat. median
$12,892
1.1× median
179
MS_DRG 		Respiratory Infections And Inflammations Without Cc/mcc 8 $2,876.55 $16,858.11 $13,725.50 nat. median
$8,650
1.6× median
948
MS_DRG 		Signs And Symptoms Without Mcc 8 $2,801.23 $15,992.62 $13,316.40 nat. median
$8,463
1.6× median
291
MS_DRG 		Heart Failure And Shock With Mcc 8 $2,963.79 $16,920.69 $12,629.07 nat. median
$13,359
0.9× median
812
MS_DRG 		Red Blood Cell Disorders Without Mcc 8 $2,324.11 $13,268.65 $12,028.82 nat. median
$9,785
1.2× median
389
MS_DRG 		Gastrointestinal Obstruction With Cc 8 $2,723.05 $15,546.28 $11,666.18 nat. median
$8,854
1.3× median
91
MS_DRG 		Other Disorders Of Nervous System With Mcc 8 $2,691.69 $15,367.20 $11,581.54 nat. median
$17,843
0.6× median
190
MS_DRG 		Chronic Obstructive Pulmonary Disease With Mcc 8 $2,599.92 $14,843.28 $11,333.89 nat. median
$11,661
1.0× median
602
MS_DRG 		Cellulitis With Mcc 8 $2,421.45 $13,824.40 $10,852.28 nat. median
$14,706
0.7× median
191
MS_DRG 		Chronic Obstructive Pulmonary Disease With Cc 8 $1,935.61 $11,513.88 $10,638.27 nat. median
$9,352
1.1× median
641
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 8 $2,320.37 $13,247.32 $10,579.51 nat. median
$8,588
1.2× median
536
MS_DRG 		Fractures Of Hip And Pelvis Without Mcc 8 $1,816.76 $11,513.88 $9,985.06 nat. median
$8,921
1.1× median
552
MS_DRG 		Medical Back Problems Without Mcc 8 $1,790.67 $11,513.88 $9,841.70 nat. median
$10,356
1.0× median
684
MS_DRG 		Renal Failure Without Cc/mcc 8 $1,941.47 $11,084.13 $8,272.84 nat. median
$7,026
1.2× median
690
MS_DRG 		Kidney And Urinary Tract Infections Without Mcc 8 $1,883.65 $10,754.04 $8,026.48 nat. median
$8,869
0.9× median
689
MS_DRG 		Kidney And Urinary Tract Infections With Mcc 8 $1,879.65 $10,731.20 $8,009.43 nat. median
$12,008
0.7× median
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 13 $2,186.16 $12,481.10 $7,225.90 nat. median
$3,475
outlier · 2.1×
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 13 $2,096.10 $11,966.91 $6,928.21 nat. median
$1,555
outlier · 4.5×
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc 8 $1,459.87 $8,334.59 $6,916.58 nat. median
$16,167
outlier · 0.4×
RX12652
CDM 		Dificid 200 Mg Tablet 13 $1,881.73 $10,743.08 $6,219.68 nat. median
$6,220
1.0× median
391
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 8 $860.54 $4,912.93 $4,729.60 nat. median
$13,072
outlier · 0.4×
439
MS_DRG 		Disorders Of Pancreas Except Malignancy With Cc 8 $995.36 $5,682.66 $4,288.59 nat. median
$9,456
outlier · 0.5×
J0565
HCPCS 		Injection, Bezlotoxumab, 10 Mg 13 $1,264.64 $7,220.00 $4,180.00 nat. median
$151
outlier · 27.6×
69666
HCPCS 		Repair Of Opening Of Middle To Inner Ear 13 $310.58 $6,611.05 $3,827.45 nat. median
$3,559
1.1× median
Q5111
HCPCS 		Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg 13 $1,095.49 $6,254.33 $3,620.93 nat. median
$1,862
1.9× median
J1569
HCPCS 		Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 13 $715.48 $5,884.30 $3,406.70 nat. median
$1,010
outlier · 3.4×
RX12558
CDM 		Xarelto 10 Mg Tablet 13 $969.28 $5,533.75 $3,203.75 nat. median
$3,204
1.0× median
38555
HCPCS 		Removal Of Congenital Defect Of Lymph Nodes At Underarm Or Neck With Deep Neurov… 5 $310.58 $5,381.75 $3,059.10 nat. median
$6,263
outlier · 0.5×
1210010
CDM 		Room & Board - Semi-private (two Beds) - Medical/surgical/gyn 7 $500.86 $2,878.47 $2,802.31 nat. median
$85
outlier · 32.9×
93
MS_DRG 		Other Disorders Of Nervous System Without Cc/mcc 8 $459.26 $3,033.90 $2,595.78 nat. median
$8,905
outlier · 0.3×
70546
HCPCS 		MRI Scan Of Blood Vessels Of Head Before And After Contrast 13 $31.62 $4,397.55 $2,534.38 nat. median
$1,051
outlier · 2.4×
RX22261
CDM 		Eliquis 2.5 Mg Tablet 13 $760.53 $4,341.98 $2,513.78 nat. median
$2,514
1.0× median
58150
HCPCS 		Removal Of Uterus And Cervix Through Abdomen 13 $310.58 $4,207.55 $2,435.95 nat. median
$3,086
0.8× median
70549
HCPCS 		MRI Scan Of Blood Vessels Of Neck Before And After Contrast 13 $38.44 $4,167.65 $2,401.89 nat. median
$1,063
outlier · 2.3×
71552
HCPCS 		MRI Scan Of Chest Before And After Contrast 13 $47.92 $4,106.85 $2,366.85 nat. median
$1,103
outlier · 2.1×

Other procedures at this hospital

Browse this hospital's 2,030 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
             
445 MS_DRG Disorders Of The Biliary Tract With Cc 8 8 $50,343.00 $50,343.00 $4,169.66 $47,825.85 $35,695.71 2025-09-15
698 MS_DRG Other Kidney And Urinary Tract Diagnoses With Mcc 8 8 $47,235.50 $47,235.50 $6,303.26 $44,873.73 $35,603.45 2025-09-15
292 MS_DRG Heart Failure And Shock With Cc 8 8 $38,079.50 $38,079.50 $3,234.69 $36,175.53 $27,174.24 2025-09-15
J3357 HCPCS Ustekinumab, For Subcutaneous Injection, 1 Mg 13 13 $48,904.25 $48,904.25 $8,137.67 $46,459.04 $26,897.34 2025-09-15
683 MS_DRG Renal Failure With Cc 8 8 $36,803.00 $36,803.00 $3,336.80 $34,962.85 $26,601.03 2025-09-15
178 MS_DRG Respiratory Infections And Inflammations With Cc 8 8 $32,685.87 $32,685.87 $3,718.56 $31,051.58 $23,175.92 2025-09-15
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 8 8 $32,533.08 $32,533.08 $5,007.86 $30,906.43 $23,067.58 2025-09-15
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 8 8 $28,132.75 $28,132.75 $4,681.29 $26,726.11 $22,707.65 2025-09-15
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 8 8 $30,172.75 $30,172.75 $3,898.77 $28,664.11 $22,184.49 2025-09-15
202 MS_DRG Bronchitis And Asthma With Cc/mcc 8 8 $23,583.75 $23,583.75 $3,700.27 $22,404.56 $17,786.46 2025-09-15
534 MS_DRG Fractures Of Femur Without Mcc 8 8 $24,704.13 $24,704.13 $3,071.24 $23,468.92 $17,516.46 2025-09-15
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 8 8 $23,319.00 $23,319.00 $3,880.28 $22,153.05 $16,534.33 2025-09-15
556 MS_DRG Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 8 8 $20,558.50 $20,558.50 $3,164.59 $19,530.58 $16,427.97 2025-09-15
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 8 8 $21,281.08 $21,281.08 $3,070.48 $20,217.03 $15,313.21 2025-09-15
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 8 8 $17,942.75 $17,942.75 $2,985.67 $17,045.61 $15,253.36 2025-09-15
189 MS_DRG Pulmonary Edema And Respiratory Failure 8 8 $18,264.00 $18,264.00 $3,039.13 $17,350.80 $13,958.39 2025-09-15
179 MS_DRG Respiratory Infections And Inflammations Without Cc/mcc 8 8 $17,745.38 $17,745.38 $2,876.55 $16,858.11 $13,725.50 2025-09-15
948 MS_DRG Signs And Symptoms Without Mcc 8 8 $16,834.33 $16,834.33 $2,801.23 $15,992.62 $13,316.40 2025-09-15
291 MS_DRG Heart Failure And Shock With Mcc 8 8 $17,811.25 $17,811.25 $2,963.79 $16,920.69 $12,629.07 2025-09-15
812 MS_DRG Red Blood Cell Disorders Without Mcc 8 8 $13,967.00 $13,967.00 $2,324.11 $13,268.65 $12,028.82 2025-09-15
389 MS_DRG Gastrointestinal Obstruction With Cc 8 8 $16,364.50 $16,364.50 $2,723.05 $15,546.28 $11,666.18 2025-09-15
91 MS_DRG Other Disorders Of Nervous System With Mcc 8 8 $16,176.00 $16,176.00 $2,691.69 $15,367.20 $11,581.54 2025-09-15
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 8 8 $15,624.50 $15,624.50 $2,599.92 $14,843.28 $11,333.89 2025-09-15
602 MS_DRG Cellulitis With Mcc 8 8 $14,552.00 $14,552.00 $2,421.45 $13,824.40 $10,852.28 2025-09-15
191 MS_DRG Chronic Obstructive Pulmonary Disease With Cc 8 8 $11,632.25 $11,632.25 $1,935.61 $11,513.88 $10,638.27 2025-09-15
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 8 8 $13,944.55 $13,944.55 $2,320.37 $13,247.32 $10,579.51 2025-09-15
536 MS_DRG Fractures Of Hip And Pelvis Without Mcc 8 8 $10,918.00 $10,918.00 $1,816.76 $11,513.88 $9,985.06 2025-09-15
552 MS_DRG Medical Back Problems Without Mcc 8 8 $10,761.25 $10,761.25 $1,790.67 $11,513.88 $9,841.70 2025-09-15
684 MS_DRG Renal Failure Without Cc/mcc 8 8 $11,667.50 $11,667.50 $1,941.47 $11,084.13 $8,272.84 2025-09-15
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 8 8 $11,320.04 $11,320.04 $1,883.65 $10,754.04 $8,026.48 2025-09-15
689 MS_DRG Kidney And Urinary Tract Infections With Mcc 8 8 $11,296.00 $11,296.00 $1,879.65 $10,731.20 $8,009.43 2025-09-15
J3101 HCPCS Injection, Tenecteplase, 1 Mg 13 13 $13,138.00 $13,138.00 $2,186.16 $12,481.10 $7,225.90 2025-09-15
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 13 13 $12,596.75 $12,596.75 $2,096.10 $11,966.91 $6,928.21 2025-09-15
177 MS_DRG Respiratory Infections And Inflammations With Mcc 8 8 $8,773.25 $8,773.25 $1,459.87 $8,334.59 $6,916.58 2025-09-15
RX12652 CDM Dificid 200 Mg Tablet 13 13 $11,308.50 $11,308.50 $1,881.73 $10,743.08 $6,219.68 2025-09-15
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 8 8 $5,171.50 $5,171.50 $860.54 $4,912.93 $4,729.60 2025-09-15
439 MS_DRG Disorders Of Pancreas Except Malignancy With Cc 8 8 $5,981.75 $5,981.75 $995.36 $5,682.66 $4,288.59 2025-09-15
J0565 HCPCS Injection, Bezlotoxumab, 10 Mg 13 13 $7,600.00 $7,600.00 $1,264.64 $7,220.00 $4,180.00 2025-09-15
69666 HCPCS Repair Of Opening Of Middle To Inner Ear 18 13 $6,959.00 $6,959.00 $310.58 $6,611.05 $3,827.45 2025-09-15
Q5111 HCPCS Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg 13 13 $6,583.50 $6,583.50 $1,095.49 $6,254.33 $3,620.93 2025-09-15
J1569 HCPCS Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 26 13 $5,246.88 $5,246.88 $715.48 $5,884.30 $3,406.70 2025-09-15
RX12558 CDM Xarelto 10 Mg Tablet 13 13 $5,825.00 $5,825.00 $969.28 $5,533.75 $3,203.75 2025-09-15
38555 HCPCS Removal Of Congenital Defect Of Lymph Nodes At Underarm Or Neck With Deep Neurov… 5 5 $5,665.00 $5,665.00 $310.58 $5,381.75 $3,059.10 2025-09-15
1210010 CDM Room & Board - Semi-private (two Beds) - Medical/surgical/gyn 7 7 $3,010.00 $3,010.00 $500.86 $2,878.47 $2,802.31 2025-09-15
93 MS_DRG Other Disorders Of Nervous System Without Cc/mcc 8 8 $2,760.00 $2,760.00 $459.26 $3,033.90 $2,595.78 2025-09-15
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 18 13 $4,629.00 $4,629.00 $31.62 $4,397.55 $2,534.38 2025-09-15
RX22261 CDM Eliquis 2.5 Mg Tablet 13 13 $4,570.50 $4,570.50 $760.53 $4,341.98 $2,513.78 2025-09-15
58150 HCPCS Removal Of Uterus And Cervix Through Abdomen 18 13 $4,429.00 $4,429.00 $310.58 $4,207.55 $2,435.95 2025-09-15
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 18 13 $4,387.00 $4,387.00 $38.44 $4,167.65 $2,401.89 2025-09-15
71552 HCPCS MRI Scan Of Chest Before And After Contrast 18 13 $4,323.00 $4,323.00 $47.92 $4,106.85 $2,366.85 2025-09-15
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 13 13 $4,225.00 $4,225.00 $703.04 $4,013.75 $2,323.75 2025-09-15
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 20 13 $4,202.00 $4,202.00 $96.24 $3,991.90 $2,279.59 2025-09-15
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 13 13 $4,125.00 $4,125.00 $686.40 $3,918.75 $2,268.75 2025-09-15
73720 HCPCS MRI Scan Of Leg Before And After Contrast 20 13 $4,167.00 $4,167.00 $96.57 $3,958.65 $2,260.60 2025-09-15
73220 HCPCS MRI Scan Of Arm Before And After Contrast 20 13 $4,167.00 $4,167.00 $96.57 $3,958.65 $2,260.60 2025-09-15
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 20 13 $4,138.00 $4,138.00 $102.85 $3,931.10 $2,244.86 2025-09-15
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 20 13 $4,138.00 $4,138.00 $98.52 $3,931.10 $2,244.86 2025-09-15
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 20 13 $4,138.00 $4,138.00 $102.85 $3,931.10 $2,244.86 2025-09-15
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 18 13 $4,074.00 $4,074.00 $45.26 $3,870.30 $2,230.51 2025-09-15
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 18 13 $4,074.00 $4,074.00 $45.26 $3,870.30 $2,230.51 2025-09-15
95807 HCPCS Sleep Study Including Heart Rate And Breathing Attended By Technician 13 13 $4,050.00 $4,050.00 $673.92 $3,847.50 $2,227.50 2025-09-15
70553 HCPCS MRI Scan Of Brain Before And After Contrast 20 13 $4,103.00 $4,103.00 $102.52 $3,897.85 $2,225.88 2025-09-15
J3262 HCPCS Injection, Tocilizumab, 1 Mg 26 13 $3,496.12 $3,496.12 $387.84 $4,428.43 $2,214.21 2025-09-15
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 20 13 $4,074.00 $4,074.00 $102.85 $3,870.30 $2,210.14 2025-09-15
95805 HCPCS Sleep Study, Multiple Trials 13 13 $4,000.00 $4,000.00 $665.60 $3,800.00 $2,200.00 2025-09-15
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 20 13 $4,039.00 $4,039.00 $98.52 $3,837.05 $2,191.16 2025-09-15
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 18 13 $3,953.00 $3,953.00 $36.77 $3,755.35 $2,164.27 2025-09-15
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 18 13 $3,953.00 $3,953.00 $36.77 $3,755.35 $2,164.27 2025-09-15
44310 HCPCS Creation Of Opening From Small Bowel To Skin 5 5 $3,991.00 $3,991.00 $310.58 $3,791.45 $2,155.14 2025-09-15
71551 HCPCS MRI Scan Of Chest With Contrast 18 13 $3,853.00 $3,853.00 $36.77 $3,660.35 $2,109.52 2025-09-15
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 18 13 $3,817.00 $3,817.00 $49.59 $3,626.15 $2,089.81 2025-09-15
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 18 13 $3,802.00 $3,802.00 $37.61 $3,611.90 $2,081.60 2025-09-15
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 18 13 $3,797.00 $3,797.00 $38.44 $3,607.15 $2,078.86 2025-09-15
73706 HCPCS CT Scan Of Blood Vessels Of Lower Leg With Contrast 18 13 $3,767.00 $3,767.00 $39.27 $3,578.65 $2,062.43 2025-09-15
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 18 13 $3,762.00 $3,762.00 $34.28 $3,573.90 $2,059.69 2025-09-15
72196 HCPCS MRI Scan Of Pelvis With Contrast 18 13 $3,762.00 $3,762.00 $36.77 $3,573.90 $2,059.69 2025-09-15
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 20 13 $3,792.00 $3,792.00 $67.10 $3,602.40 $2,057.16 2025-09-15
J3358 HCPCS Ustekinumab, For Intravenous Injection, 1 Mg 13 13 $3,706.25 $3,706.25 $616.72 $3,520.94 $2,038.44 2025-09-15
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 20 13 $3,732.00 $3,732.00 $81.39 $3,545.40 $2,024.61 2025-09-15
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 18 13 $3,697.00 $3,697.00 $25.63 $3,512.15 $2,024.11 2025-09-15
74182 HCPCS MRI Scan Of Abdomen With Contrast 18 13 $3,697.00 $3,697.00 $36.77 $3,512.15 $2,024.11 2025-09-15
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 20 13 $3,727.00 $3,727.00 $79.75 $3,540.65 $2,021.90 2025-09-15
1210000 CDM Room & Board - Semi-private (two Beds) - Medical/surgical/gyn 7 7 $2,160.00 $2,160.00 $359.42 $2,878.47 $2,010.96 2025-09-15
72191 HCPCS CT Scan Of Blood Vessels Of Pelvis With Contrast 18 13 $3,669.00 $3,669.00 $37.61 $3,485.55 $2,008.78 2025-09-15
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 20 13 $3,697.00 $3,697.00 $53.89 $3,512.15 $2,005.62 2025-09-15
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 20 13 $3,697.00 $3,697.00 $53.56 $3,512.15 $2,005.62 2025-09-15
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 18 13 $3,635.00 $3,635.00 $37.61 $3,453.25 $1,990.16 2025-09-15
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 20 13 $3,635.00 $3,635.00 $80.43 $3,453.25 $1,971.99 2025-09-15
70552 HCPCS MRI Scan Of Brain With Contrast 20 13 $3,607.00 $3,607.00 $79.90 $3,426.65 $1,956.80 2025-09-15
73719 HCPCS MRI Scan Of Leg With Contrast 18 13 $3,572.00 $3,572.00 $34.28 $3,393.40 $1,955.67 2025-09-15
73219 HCPCS MRI Scan Of Arm With Contrast 20 13 $3,572.00 $3,572.00 $72.64 $3,393.40 $1,937.81 2025-09-15
36011 HCPCS Insertion Of Tube Into Vein, First Order Branch 18 13 $3,512.00 $3,512.00 $310.58 $3,336.40 $1,931.60 2025-09-15
71550 HCPCS MRI Scan Of Chest Without Contrast 20 13 $3,542.00 $3,542.00 $65.48 $3,364.90 $1,921.54 2025-09-15
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 18 13 $3,507.00 $3,507.00 $37.61 $3,331.65 $1,920.09 2025-09-15
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 18 13 $3,485.00 $3,485.00 $37.61 $3,310.75 $1,908.04 2025-09-15
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 20 13 $3,485.00 $3,485.00 $89.86 $3,310.75 $1,890.62 2025-09-15
73222 HCPCS MRI Scan Of Arm Joint With Contrast 18 13 $3,450.00 $3,450.00 $34.28 $3,277.50 $1,888.88 2025-09-15
73722 HCPCS MRI Scan Of Leg Joint With Contrast 18 13 $3,450.00 $3,450.00 $34.28 $3,277.50 $1,888.88 2025-09-15
24000 HCPCS Incision Of Elbow Joint For Exploration, Fluid Drainage, Or Removal Of Foreign B… 18 13 $3,425.00 $3,425.00 $310.58 $3,253.75 $1,883.75 2025-09-15
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 20 13 $3,472.00 $3,472.00 $81.72 $3,298.40 $1,883.56 2025-09-15
21451 HCPCS Closed Treatment Of Broken Lower Jaw Bone With Manipulation 18 13 $3,349.00 $3,349.00 $310.58 $3,181.55 $1,841.95 2025-09-15
65260 HCPCS Removal Of Foreign Body In Eye With A Magnet 5 5 $3,357.00 $3,357.00 $310.58 $3,189.15 $1,812.78 2025-09-15
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 20 13 $3,293.00 $3,293.00 $62.44 $3,128.35 $1,786.45 2025-09-15
73218 HCPCS MRI Scan Of Arm Without Contrast 20 13 $3,293.00 $3,293.00 $60.83 $3,128.35 $1,786.45 2025-09-15
70551 HCPCS MRI Scan Of Brain Without Contrast 20 13 $3,293.00 $3,293.00 $66.12 $3,128.35 $1,786.45 2025-09-15
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 18 13 $3,258.00 $3,258.00 $28.12 $3,095.10 $1,783.76 2025-09-15
72195 HCPCS MRI Scan Of Pelvis Without Contrast 20 13 $3,258.00 $3,258.00 $65.48 $3,095.10 $1,767.46 2025-09-15
73718 HCPCS MRI Scan Of Leg Without Contrast 20 13 $3,258.00 $3,258.00 $60.50 $3,095.10 $1,767.46 2025-09-15
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 20 13 $3,230.00 $3,230.00 $60.83 $3,068.50 $1,752.28 2025-09-15
26910 HCPCS Amputation Of Finger Or Thumb 13 13 $3,174.00 $3,174.00 $528.15 $3,015.30 $1,745.70 2025-09-15
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 20 13 $3,132.00 $3,132.00 $66.46 $2,975.40 $1,699.11 2025-09-15
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 20 13 $3,132.00 $3,132.00 $60.83 $2,975.40 $1,699.11 2025-09-15
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 20 13 $3,132.00 $3,132.00 $66.46 $2,975.40 $1,699.11 2025-09-15
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 20 13 $3,132.00 $3,132.00 $66.46 $2,975.40 $1,699.11 2025-09-15
74181 HCPCS MRI Scan Of Abdomen Without Contrast 20 13 $3,103.00 $3,103.00 $65.15 $2,947.85 $1,683.38 2025-09-15
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 20 13 $3,079.00 $3,079.00 $56.58 $2,925.05 $1,670.36 2025-09-15
RX42594 CDM Pancrelipase (lip-prot-amyl) 15000-47000 Units Po Cpep 13 13 $2,988.00 $2,988.00 $497.20 $2,838.60 $1,643.40 2025-09-15
J0897 HCPCS Injection, Denosumab, 1 Mg 26 13 $2,835.50 $2,835.50 $450.69 $2,814.38 $1,629.38 2025-09-15
RX22294 CDM Eliquis 5 Mg Tablet 13 13 $2,940.50 $2,940.50 $489.30 $2,793.48 $1,617.28 2025-09-15
43249 HCPCS Balloon Dilation Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexibl… 18 13 $2,891.00 $2,891.00 $224.47 $2,746.45 $1,582.82 2025-09-15
71270 HCPCS CT Scan Of Chest Before And After Contrast 20 13 $2,911.00 $2,911.00 $55.94 $2,765.45 $1,579.22 2025-09-15
78452 HCPCS Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 20 13 $2,894.00 $2,894.00 $71.45 $2,749.30 $1,569.99 2025-09-15
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 20 13 $2,894.00 $2,894.00 $77.95 $2,749.30 $1,569.99 2025-09-15
73202 HCPCS CT Scan Of Arm Before And After Contrast 18 13 $2,848.00 $2,848.00 $25.63 $2,705.60 $1,559.28 2025-09-15
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 18 13 $2,848.00 $2,848.00 $27.29 $2,705.60 $1,559.28 2025-09-15
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 18 13 $2,848.00 $2,848.00 $27.29 $2,705.60 $1,559.28 2025-09-15
73702 HCPCS CT Scan Of Leg Before And After Contrast 18 13 $2,848.00 $2,848.00 $25.63 $2,705.60 $1,559.28 2025-09-15
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 18 13 $2,848.00 $2,848.00 $26.46 $2,705.60 $1,559.28 2025-09-15
99291 HCPCS Critical Care, First 30-74 Minutes 18 13 $2,832.00 $2,832.00 $225.00 $2,690.40 $1,557.60 2025-09-15
70488 HCPCS CT Scan Of Face Before And After Contrast 20 13 $2,848.00 $2,848.00 $56.58 $2,705.60 $1,545.04 2025-09-15
43270 HCPCS Destruction Of Polyp Or Growth Of Esophagus, Stomach, And/or Upper Small Bowel U… 20 13 $2,827.00 $2,827.00 $205.51 $2,685.65 $1,533.65 2025-09-15
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 20 13 $2,820.00 $2,820.00 $54.54 $2,679.00 $1,529.85 2025-09-15
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 20 13 $2,785.00 $2,785.00 $72.31 $2,645.75 $1,510.87 2025-09-15
RX23456 CDM Invokana 100 Mg Tablet 13 13 $2,745.00 $2,745.00 $456.77 $2,607.75 $1,509.75 2025-09-15
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 20 13 $2,692.00 $2,692.00 $50.63 $2,557.40 $1,460.41 2025-09-15
23182 HCPCS Partial Removal Of Infected Shoulder Blade 5 5 $2,678.00 $2,678.00 $310.58 $2,544.10 $1,446.12 2025-09-15
12057 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More … 18 13 $2,629.00 $2,629.00 $310.58 $2,497.55 $1,445.95 2025-09-15
25520 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Thumb Side And Dislocated … 18 13 $2,553.00 $2,553.00 $310.58 $2,425.35 $1,404.15 2025-09-15
72132 HCPCS CT Scan Of Lower Spine With Contrast 18 13 $2,519.00 $2,519.00 $25.63 $2,393.05 $1,379.15 2025-09-15
72126 HCPCS CT Scan Of Upper Spine With Contrast 18 13 $2,519.00 $2,519.00 $25.63 $2,393.05 $1,379.15 2025-09-15
72129 HCPCS CT Scan Of Middle Spine With Contrast 18 13 $2,519.00 $2,519.00 $25.63 $2,393.05 $1,379.15 2025-09-15
74160 HCPCS CT Scan Of Abdomen With Contrast 20 13 $2,535.00 $2,535.00 $56.91 $2,408.25 $1,375.24 2025-09-15
43266 HCPCS Placement Of Stent In Esophagus, Stomach, And/or Upper Small Bowel Using A Flexi… 20 13 $2,520.00 $2,520.00 $152.99 $2,394.00 $1,367.10 2025-09-15
43246 HCPCS Insertion Of Stomach Tube Using A Flexible Endoscope 20 13 $2,520.00 $2,520.00 $139.72 $2,394.00 $1,367.10 2025-09-15
RX38943 CDM Linzess 72 Mcg Capsule 13 13 $2,475.00 $2,475.00 $411.84 $2,351.25 $1,361.25 2025-09-15
45382 HCPCS Control Of Bleeding Of Upper Large Bowel Using A Flexible Endoscope 18 13 $2,441.00 $2,441.00 $168.73 $2,318.95 $1,336.45 2025-09-15
27301 HCPCS Drainage Of Deep Abscess Or Blood Accumulation Of Thigh Or Knee 18 13 $2,411.00 $2,411.00 $310.58 $2,290.45 $1,326.05 2025-09-15
RX29061 CDM Empagliflozin 10 Mg Po Tabs 13 13 $2,383.50 $2,383.50 $396.61 $2,264.33 $1,310.93 2025-09-15
45379 HCPCS Removal Of Foreign Bodies In Large Bowel Using A Flexible Endoscope 18 13 $2,388.00 $2,388.00 $124.13 $2,268.60 $1,307.43 2025-09-15
43245 HCPCS Dilation Of Stomach Outlet Using A Flexible Endoscope 18 13 $2,388.00 $2,388.00 $152.42 $2,268.60 $1,307.43 2025-09-15
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 20 13 $2,409.00 $2,409.00 $57.57 $2,288.55 $1,306.88 2025-09-15
70487 HCPCS CT Scan Of Face With Contrast 20 13 $2,379.00 $2,379.00 $50.63 $2,260.05 $1,290.61 2025-09-15
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 20 13 $2,379.00 $2,379.00 $56.91 $2,260.05 $1,290.61 2025-09-15
71260 HCPCS CT Scan Of Chest With Contrast 20 13 $2,379.00 $2,379.00 $52.26 $2,260.05 $1,290.61 2025-09-15
12056 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 20.1-… 18 13 $2,335.00 $2,335.00 $310.58 $2,218.25 $1,284.25 2025-09-15
64479 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Upper Or Middle Spine Nerve Roo… 13 13 $2,314.00 $2,314.00 $385.05 $2,198.30 $1,272.70 2025-09-15
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 20 13 $2,315.00 $2,315.00 $61.80 $2,199.25 $1,255.89 2025-09-15
RX33175 CDM Brilinta 60 Mg Tablet 13 13 $2,270.50 $2,270.50 $377.81 $2,156.98 $1,248.78 2025-09-15
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 13 13 $2,266.00 $2,266.00 $377.06 $2,152.70 $1,246.30 2025-09-15
43242 HCPCS Ultrasound Guided Needle Aspiration Or Biopsy Of Esophagus, Stomach, And/or Uppe… 18 13 $2,266.00 $2,266.00 $85.70 $2,152.70 $1,240.63 2025-09-15
43238 HCPCS Ultrasound Guided Needle Aspiration Or Biopsy Of Esophagus Using A Flexible Endo… 18 13 $2,266.00 $2,266.00 $73.55 $2,152.70 $1,240.63 2025-09-15
RX09464 CDM Pradaxa 75 Mg Capsule 13 13 $2,252.25 $2,252.25 $374.77 $2,139.64 $1,238.74 2025-09-15
73201 HCPCS CT Scan Of Arm With Contrast 20 13 $2,281.00 $2,281.00 $51.93 $2,166.95 $1,237.45 2025-09-15
73701 HCPCS CT Scan Of Leg With Contrast Material 20 13 $2,281.00 $2,281.00 $51.93 $2,166.95 $1,237.45 2025-09-15
51045 HCPCS Incision Of Bladder With Insertion Of Tube Or Stent In Ureter 5 5 $2,291.00 $2,291.00 $310.58 $2,176.45 $1,237.14 2025-09-15
45385 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S… 20 13 $2,272.00 $2,272.00 $232.17 $2,158.40 $1,232.56 2025-09-15
43255 HCPCS Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flex… 20 13 $2,272.00 $2,272.00 $183.88 $2,158.40 $1,232.56 2025-09-15
43253 HCPCS Injection Of Diagnostic Or Therapeutic Substance Or Marker In Esophagus, Stomach… 20 13 $2,270.00 $2,270.00 $185.54 $2,156.50 $1,231.47 2025-09-15
27372 HCPCS Removal Of Foreign Body Deep In Tissue Of Thigh Or Knee 18 13 $2,225.00 $2,225.00 $310.58 $2,113.75 $1,223.75 2025-09-15
72193 HCPCS CT Scan Of Pelvis With Contrast 20 13 $2,252.00 $2,252.00 $51.93 $2,139.40 $1,221.71 2025-09-15
12047 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, More Than 30.0 C… 18 13 $2,192.00 $2,192.00 $310.58 $2,082.40 $1,205.60 2025-09-15
11646 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More… 18 13 $2,192.00 $2,192.00 $310.58 $2,082.40 $1,205.60 2025-09-15
64483 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 13 13 $2,181.00 $2,181.00 $362.92 $2,071.95 $1,199.55 2025-09-15
62273 HCPCS Injection Of Blood Or Blood Clot Into Spinal Canal 13 13 $2,181.00 $2,181.00 $362.92 $2,071.95 $1,199.55 2025-09-15
43251 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 20 13 $2,203.00 $2,203.00 $179.41 $2,092.85 $1,195.13 2025-09-15
49550 HCPCS Repair Of Femoral Groin Hernia 18 13 $2,160.00 $2,160.00 $310.58 $2,052.00 $1,188.00 2025-09-15
J1561 HCPCS Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liquid)… 13 13 $2,150.00 $2,150.00 $357.76 $2,042.50 $1,182.50 2025-09-15
J1451 HCPCS Injection, Fomepizole, 15 Mg 13 13 $2,143.00 $2,143.00 $356.60 $2,035.85 $1,178.65 2025-09-15
43259 HCPCS Ultrasound Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible… 18 13 $2,139.00 $2,139.00 $73.55 $2,032.05 $1,171.11 2025-09-15
43244 HCPCS Tying Of Dilated Veins Of Stomach And/or Esophagus Using A Flexible Endoscope 18 13 $2,139.00 $2,139.00 $79.54 $2,032.05 $1,171.11 2025-09-15
43237 HCPCS Ultrasound Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible… 18 13 $2,139.00 $2,139.00 $66.73 $2,032.05 $1,171.11 2025-09-15
43233 HCPCS Balloon Dilation Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexibl… 18 13 $2,139.00 $2,139.00 $73.55 $2,032.05 $1,171.11 2025-09-15
J7168 HCPCS Prothrombin Complex Concentrate (human), Kcentra, Per I.u. Of Factor Ix Activity 13 13 $2,128.50 $2,128.50 $354.18 $2,022.08 $1,170.68 2025-09-15
64490 HCPCS Injection Of Upper Or Middle Spine Facet Joint Using Imaging Guidance, Single Le… 13 13 $2,117.00 $2,117.00 $352.27 $2,011.15 $1,164.35 2025-09-15
11010 HCPCS Removal Of Foreign Material From Skin And Tissue At Open Broken And/or Dislocate… 18 13 $2,116.00 $2,116.00 $308.51 $2,010.20 $1,163.80 2025-09-15
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 13 13 $2,113.25 $2,113.25 $351.64 $2,007.59 $1,162.29 2025-09-15
72128 HCPCS CT Scan Of Middle Spine Without Contrast 20 13 $2,142.00 $2,142.00 $44.67 $2,034.90 $1,162.04 2025-09-15
72131 HCPCS CT Scan Of Lower Spine Without Contrast 20 13 $2,142.00 $2,142.00 $44.67 $2,034.90 $1,162.04 2025-09-15
72125 HCPCS CT Scan Of Upper Spine Without Contrast 20 13 $2,142.00 $2,142.00 $44.67 $2,034.90 $1,162.04 2025-09-15
45380 HCPCS Biopsy Of Large Bowel Using A Flexible Endoscope 20 13 $2,139.00 $2,139.00 $183.70 $2,032.05 $1,160.41 2025-09-15
45378 HCPCS Diagnostic Exam Of Large Bowel Using A Flexible Endoscope 20 13 $2,139.00 $2,139.00 $168.97 $2,032.05 $1,160.41 2025-09-15
43247 HCPCS Removal Of Foreign Bodies Of Esophagus, Stomach, And/or Upper Small Bowel Using … 20 13 $2,139.00 $2,139.00 $161.51 $2,032.05 $1,160.41 2025-09-15
43250 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 18 13 $2,086.00 $2,086.00 $126.80 $1,981.70 $1,142.09 2025-09-15
G0105 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual At High Risk 18 13 $2,085.00 $2,085.00 $100.17 $1,980.75 $1,141.54 2025-09-15
G0121 HCPCS Colorectal Cancer Screening; Colonoscopy On Individual Not Meeting Criteria For … 18 13 $2,085.00 $2,085.00 $100.17 $1,980.75 $1,141.54 2025-09-15
43240 HCPCS Drainage Of Fluid Collection Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 18 13 $2,084.00 $2,084.00 $120.81 $1,979.80 $1,140.99 2025-09-15
26075 HCPCS Incision Of Lower Finger Joint For Exploration, Fluid Drainage, Or Removal Of Fo… 18 13 $2,072.00 $2,072.00 $303.35 $1,968.40 $1,139.60 2025-09-15
45381 HCPCS Injection Beneath Lining Of Large Bowel Using A Flexible Endoscope 18 13 $2,081.00 $2,081.00 $124.13 $1,976.95 $1,139.35 2025-09-15
RX19992 CDM Myrbetriq ER 25 Mg Tablet 13 13 $2,068.50 $2,068.50 $344.20 $1,965.08 $1,137.68 2025-09-15
P9035 HCPCS Platelets, Pheresis, Leukocytes Reduced, Each Unit 13 13 $2,060.00 $2,060.00 $342.78 $1,957.00 $1,133.00 2025-09-15
64493 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Le… 13 13 $2,060.00 $2,060.00 $342.78 $1,957.00 $1,133.00 2025-09-15
78315 HCPCS Nuclear Medicine Study Of Bone Taken At Different Times 20 13 $2,084.00 $2,084.00 $44.99 $1,979.80 $1,130.57 2025-09-15
Q5103 HCPCS Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 13 13 $2,050.50 $2,050.50 $341.20 $1,947.98 $1,127.78 2025-09-15
20525 HCPCS Complicated Removal Of Foreign Body In Deep Muscle Or Tendon 18 13 $2,040.00 $2,040.00 $291.37 $1,938.00 $1,122.00 2025-09-15
12055 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.6-… 18 13 $2,040.00 $2,040.00 $297.36 $1,938.00 $1,122.00 2025-09-15
26160 HCPCS Removal Of Growth Of Tendon Finger Or Hand 18 13 $2,040.00 $2,040.00 $310.58 $1,938.00 $1,122.00 2025-09-15
26070 HCPCS Incision Of Wrist Joint At Finger For Exploration, Fluid Drainage, Or Removal Of… 18 13 $2,040.00 $2,040.00 $295.53 $1,938.00 $1,122.00 2025-09-15
25680 HCPCS Closed Treatment Of Broken And Dislocated Wrist Bones With Manipulation 18 13 $2,040.00 $2,040.00 $295.53 $1,938.00 $1,122.00 2025-09-15
55500 HCPCS Removal Of Fluid Collection In Sperm Cord 18 13 $2,040.00 $2,040.00 $295.53 $1,938.00 $1,122.00 2025-09-15
P9037 HCPCS Platelets, Pheresis, Leukocytes Reduced, Irradiated, Each Unit 13 13 $2,000.00 $2,000.00 $332.80 $1,900.00 $1,100.00 2025-09-15
71250 HCPCS CT Scan Of Chest Without Contrast 20 13 $2,027.00 $2,027.00 $48.35 $1,925.65 $1,099.65 2025-09-15
43248 HCPCS Insertion Of Guide Wire With Dilation Of Esophagus Using A Flexible Endoscope 18 13 $2,007.00 $2,007.00 $121.64 $1,906.65 $1,098.84 2025-09-15
43243 HCPCS Injection Of Dilated Vein Of Stomach And/or Esophagus Using A Flexible Endoscope 18 13 $2,007.00 $2,007.00 $77.04 $1,906.65 $1,098.84 2025-09-15
43239 HCPCS Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop… 18 13 $2,007.00 $2,007.00 $115.65 $1,906.65 $1,098.84 2025-09-15
45384 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using A Flexible Endoscope With Elec… 20 13 $2,007.00 $2,007.00 $206.39 $1,906.65 $1,088.80 2025-09-15
43235 HCPCS Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible… 20 13 $2,007.00 $2,007.00 $112.99 $1,906.65 $1,088.80 2025-09-15
70486 HCPCS CT Scan Of Face Without Contrast 20 13 $1,997.00 $1,997.00 $38.49 $1,897.15 $1,083.38 2025-09-15
12037 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, More Tha… 18 13 $1,963.00 $1,963.00 $287.04 $1,864.85 $1,079.65 2025-09-15
78227 HCPCS Nuclear Medicine Study Of Liver And Bile Duct System With Use Of Drugs 20 13 $1,982.00 $1,982.00 $39.78 $1,882.90 $1,075.24 2025-09-15
62323 HCPCS Injection Of Substance Into Lower Spine Canal Using Imaging Guidance 13 13 $1,933.00 $1,933.00 $321.65 $1,836.35 $1,063.15 2025-09-15
62321 HCPCS Injection Of Substance Into Middle Or Upper Spine Canal Using Imaging Guidance 13 13 $1,933.00 $1,933.00 $321.65 $1,836.35 $1,063.15 2025-09-15
13121 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 2.6-7.5 Cm 18 13 $1,932.00 $1,932.00 $281.88 $1,835.40 $1,062.60 2025-09-15
45331 HCPCS Biopsy Of Lower Large Bowel Using A Flexible Endoscope 20 13 $1,953.00 $1,953.00 $67.27 $1,855.35 $1,059.51 2025-09-15
43252 HCPCS Microscopic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexibl… 20 13 $1,952.00 $1,952.00 $154.28 $1,854.40 $1,058.96 2025-09-15
28022 HCPCS Incision Of Midfoot Joint For Exploration, Fluid Drainage, Or Removal Of Foreign… 18 13 $1,909.00 $1,909.00 $287.04 $1,813.55 $1,049.95 2025-09-15
27810 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle With Manipulation 13 13 $1,909.00 $1,909.00 $317.66 $1,813.55 $1,049.95 2025-09-15
27762 HCPCS Closed Treatment Of Inside Portion Of Shin Bone At Ankle With Manipulation 13 13 $1,909.00 $1,909.00 $317.66 $1,813.55 $1,049.95 2025-09-15
J1459 HCPCS Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 26 13 $1,602.12 $1,602.12 $183.16 $1,998.33 $1,045.71 2025-09-15
12046 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 20.1-30.0 Cm 18 13 $1,899.00 $1,899.00 $276.72 $1,804.05 $1,044.45 2025-09-15
43236 HCPCS Injection Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endos… 18 13 $1,890.00 $1,890.00 $118.14 $1,795.50 $1,034.78 2025-09-15
93350 HCPCS Ultrasound Of Heart During Rest, Exercise And/or Drug-induced Stress With Report 13 13 $1,879.00 $1,879.00 $312.67 $1,785.05 $1,033.45 2025-09-15
43257 HCPCS Heat Delivery To Muscle At Esophagus And/or Stomach To Treat Gastric Reflux Usin… 18 13 $1,886.00 $1,886.00 $75.38 $1,791.70 $1,032.59 2025-09-15
43241 HCPCS Insertion Of Tube Or Tube In Esophagus, Stomach, And/or Upper Small Bowel Using … 18 13 $1,886.00 $1,886.00 $48.76 $1,791.70 $1,032.59 2025-09-15
11606 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 18 13 $1,876.00 $1,876.00 $274.23 $1,782.20 $1,031.80 2025-09-15
74150 HCPCS CT Scan Of Abdomen Without Contrast 20 13 $1,900.00 $1,900.00 $53.23 $1,805.00 $1,030.75 2025-09-15
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 20 13 $1,900.00 $1,900.00 $57.57 $1,805.00 $1,030.75 2025-09-15
73200 HCPCS CT Scan Of Arm Without Contrast 20 13 $1,900.00 $1,900.00 $44.67 $1,805.00 $1,030.75 2025-09-15
70460 HCPCS CT Scan Head Or Brain With Contrast 20 13 $1,900.00 $1,900.00 $50.63 $1,805.00 $1,030.75 2025-09-15
86711 HCPCS Analysis For Antibody To John Cunningham Virus 13 13 $1,866.00 $1,866.00 $310.50 $1,772.70 $1,026.30 2025-09-15
13132 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 13 13 $1,855.00 $1,855.00 $308.67 $1,762.25 $1,020.25 2025-09-15
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 13 13 $1,854.50 $1,854.50 $308.59 $1,761.78 $1,019.98 2025-09-15
73700 HCPCS CT Scan Of Leg Without Contrast 20 13 $1,870.00 $1,870.00 $44.67 $1,776.50 $1,014.47 2025-09-15
72192 HCPCS CT Scan Of Pelvis Without Contrast 20 13 $1,870.00 $1,870.00 $48.67 $1,776.50 $1,014.47 2025-09-15
27230 HCPCS Closed Treatment Of Broken Upper Thigh Bone 18 13 $1,843.00 $1,843.00 $293.86 $1,750.85 $1,013.65 2025-09-15
11446 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, M… 18 13 $1,823.00 $1,823.00 $265.57 $1,731.85 $1,002.65 2025-09-15
12036 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 20.1-30.… 18 13 $1,823.00 $1,823.00 $265.57 $1,731.85 $1,002.65 2025-09-15
Q0138 HCPCS Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd … 13 13 $1,809.00 $1,809.00 $301.02 $1,718.55 $994.95 2025-09-15
RX12094 CDM Daliresp 500 Mcg Tablet 13 13 $1,803.00 $1,803.00 $300.02 $1,712.85 $991.65 2025-09-15
11626 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More Tha… 18 13 $1,757.00 $1,757.00 $257.09 $1,669.15 $966.35 2025-09-15
38500 HCPCS Biopsy Or Removal Of Lymph Nodes 20 13 $1,757.00 $1,757.00 $232.59 $1,669.15 $953.17 2025-09-15
A0429 HCPCS Ambulance Service, Basic Life Support, Emergency Transport (bls-emergency) 13 13 $1,725.00 $1,725.00 $287.04 $1,638.75 $948.75 2025-09-15
43254 HCPCS Removal Of Tissue Lining Of Esophagus, Stomach, And/or Upper Small Bowel Using A… 18 13 $1,705.00 $1,705.00 $87.36 $1,619.75 $933.49 2025-09-15
12054 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6-1… 18 13 $1,680.00 $1,680.00 $244.94 $1,596.00 $924.00 2025-09-15
12045 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 12.6-20.0 Cm 18 13 $1,680.00 $1,680.00 $244.94 $1,596.00 $924.00 2025-09-15
11644 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3.1-… 18 13 $1,680.00 $1,680.00 $248.44 $1,596.00 $924.00 2025-09-15
52270 HCPCS Incision Of Urethra In Female Using An Endoscope 5 5 $1,699.00 $1,699.00 $282.71 $1,614.05 $917.46 2025-09-15
64421 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Multiple Rib Nerves For Region… 13 13 $1,657.00 $1,657.00 $275.72 $1,574.15 $911.35 2025-09-15
70450 HCPCS CT Scan Head Or Brain Without Contrast 20 13 $1,679.00 $1,679.00 $38.16 $1,595.05 $910.86 2025-09-15
78226 HCPCS Nuclear Medicine Study Of Liver And Bile Duct System 20 13 $1,679.00 $1,679.00 $32.61 $1,595.05 $910.86 2025-09-15
P9036 HCPCS Platelets, Pheresis, Irradiated, Each Unit 13 13 $1,650.00 $1,650.00 $274.56 $1,567.50 $907.50 2025-09-15
93268 HCPCS Electrocardiogram (ecg) Up To 30 Days Continuous With Symptom Monitoring And Rev… 13 13 $1,648.00 $1,648.00 $274.23 $1,565.60 $906.40 2025-09-15
93247 HCPCS Heart Rhythm Analysis And Report Of Continuous External EKG Over 8-15 Days 13 13 $1,648.00 $1,648.00 $274.23 $1,565.60 $906.40 2025-09-15
54161 HCPCS Removal Of Foreskin (older Than 28 Days) 20 13 $1,669.00 $1,669.00 $143.47 $1,585.55 $905.43 2025-09-15
RX0587 CDM Metolazone 2.5 Mg Tablet 13 13 $1,620.00 $1,620.00 $269.57 $1,539.00 $891.00 2025-09-15
11426 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More … 18 13 $1,615.00 $1,615.00 $231.30 $1,534.25 $888.25 2025-09-15
78472 HCPCS Nuclear Medicine Study Of Heart Pumping Function By Labeling Red Blood Cells Wit… 20 13 $1,621.00 $1,621.00 $43.03 $1,539.95 $879.39 2025-09-15
11624 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4.0 … 18 13 $1,571.00 $1,571.00 $231.30 $1,492.45 $864.05 2025-09-15
RX0724 CDM Nitrofurantoin Mono-mcr 100 Mg 13 13 $1,566.00 $1,566.00 $260.58 $1,487.70 $861.30 2025-09-15
RX_78310 CDM Mesalamine Dr 1.2 Gm Tablet 13 13 $1,562.75 $1,562.75 $260.04 $1,484.61 $859.51 2025-09-15
23655 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia 13 13 $1,527.00 $1,527.00 $254.09 $1,450.65 $839.85 2025-09-15
76380 HCPCS Limited Or Follow-up CT Scan 20 13 $1,540.00 $1,540.00 $42.46 $1,463.00 $835.45 2025-09-15
12035 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 12.6-20.… 18 13 $1,517.00 $1,517.00 $229.63 $1,441.15 $834.35 2025-09-15
78306 HCPCS Nuclear Medicine Study Of Bone And/or Joint Whole Body 20 13 $1,534.00 $1,534.00 $37.82 $1,457.30 $832.19 2025-09-15
11604 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 3.1-4.0 Cm 18 13 $1,462.00 $1,462.00 $214.16 $1,388.90 $804.10 2025-09-15
11406 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 18 13 $1,462.00 $1,462.00 $222.81 $1,388.90 $804.10 2025-09-15
11643 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.1-… 18 13 $1,462.00 $1,462.00 $214.16 $1,388.90 $804.10 2025-09-15
78801 HCPCS Nuclear Medicine Study, Multiple Areas 18 13 $1,465.00 $1,465.00 $15.31 $1,391.75 $802.09 2025-09-15
12053 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1-7… 18 13 $1,440.00 $1,440.00 $219.32 $1,368.00 $792.00 2025-09-15
27096 HCPCS Injection Of Anesthetic Or Steroid Into Joint Between Lower Spine And Hip Bone U… 13 13 $1,440.00 $1,440.00 $239.62 $1,368.00 $792.00 2025-09-15
L1846 HCPCS Knee Orthosis, Double Upright, Thigh And Calf, With Adjustable Flexion And Exten… 13 13 $1,430.00 $1,430.00 $237.95 $1,358.50 $786.50 2025-09-15
78305 HCPCS Nuclear Medicine Study Of Bone And/or Joint Multiple Areas 20 13 $1,448.00 $1,448.00 $36.85 $1,375.60 $785.54 2025-09-15
64420 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Rib Nerve 13 13 $1,409.00 $1,409.00 $234.46 $1,338.55 $774.95 2025-09-15
93246 HCPCS Heart Rhythm Recording Of Continuous External EKG Over 8-15 Days 13 13 $1,390.00 $1,390.00 $231.30 $1,320.50 $764.50 2025-09-15
78800 HCPCS Nuclear Medicine Study, 1 Area 18 13 $1,390.00 $1,390.00 $13.64 $1,320.50 $761.02 2025-09-15
45330 HCPCS Diagnostic Exam Of Lower Portion Of Large Bowel Using A Flexible Endoscope 20 13 $1,397.00 $1,397.00 $52.97 $1,327.15 $757.88 2025-09-15
62322 HCPCS Injection Of Substance Into Lower Spine Canal 13 13 $1,377.00 $1,377.00 $229.13 $1,308.15 $757.35 2025-09-15
62320 HCPCS Injection Of Substance Into Middle Or Upper Spine Canal 13 13 $1,377.00 $1,377.00 $229.13 $1,308.15 $757.35 2025-09-15
87633 HCPCS Detection Test By Nucleic Acid For Multiple Types Of Respiratory Virus, Multiple… 13 13 $1,375.00 $1,375.00 $228.80 $1,306.25 $756.25 2025-09-15
13120 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 1.1-2.5 Cm 18 13 $1,364.00 $1,364.00 $214.16 $1,295.80 $750.20 2025-09-15
93270 HCPCS Electrocardiogram (ecg) Up To 30 Days Continuous With Symptom Monitoring 13 13 $1,364.00 $1,364.00 $226.97 $1,295.80 $750.20 2025-09-15
43450 HCPCS Dilation Of Esophagus 18 13 $1,360.00 $1,360.00 $59.90 $1,292.00 $744.60 2025-09-15
12007 HCPCS Simple Repair Of Surface Wound To Scalp, Neck, Underarms, Trunk, Arms, Or Legs, … 18 13 $1,353.00 $1,353.00 $201.34 $1,285.35 $744.15 2025-09-15
27560 HCPCS Closed Treatment Of Dislocated Kneecap 18 13 $1,353.00 $1,353.00 $197.02 $1,285.35 $744.15 2025-09-15
P9034 HCPCS Platelets, Pheresis, Each Unit 13 13 $1,328.00 $1,328.00 $220.98 $1,261.60 $730.40 2025-09-15
11623 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 2.1-3.0 … 18 13 $1,320.00 $1,320.00 $192.69 $1,254.00 $726.00 2025-09-15
11444 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3… 18 13 $1,320.00 $1,320.00 $197.02 $1,254.00 $726.00 2025-09-15
12017 HCPCS Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 20.… 18 13 $1,320.00 $1,320.00 $191.03 $1,254.00 $726.00 2025-09-15
25600 HCPCS Closed Treatment Of Broken Forearm (radius) Bone At The Wrist Area On The Thumb … 18 13 $1,320.00 $1,320.00 $190.20 $1,254.00 $726.00 2025-09-15
12044 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 7.6-12.5 Cm 18 13 $1,298.00 $1,298.00 $212.49 $1,233.10 $713.90 2025-09-15
78215 HCPCS Nuclear Medicine Study Of Liver And Spleen 20 13 $1,281.00 $1,281.00 $21.68 $1,216.95 $694.94 2025-09-15
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