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

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 · ⚠ 13 mo old
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

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 13 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

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 · 2026-10-16
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
J3357
HCPCS 		Ustekinumab, For Subcutaneous Injection, 1 Mg 13 $8,137.67 $46,459.04 $26,897.34 nat. median
$20,264
1.3× median
698
MS_DRG 		Other Kidney And Urinary Tract Diagnoses With Mcc 2 $6,303.26 $28,784.70 $17,543.98 nat. median
$12,136
1.4× median
640
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 2 $5,088.64 $20,149.29 $12,618.97 nat. median
$9,697
1.3× median
683
MS_DRG 		Renal Failure With Cc 2 $3,336.80 $20,149.29 $11,743.05 nat. median
$6,692
1.8× median
292
MS_DRG 		Heart Failure And Shock With Cc 2 $3,234.69 $20,149.29 $11,691.99 nat. median
$6,415
1.8× median
445
MS_DRG 		Disorders Of The Biliary Tract With Cc 2 $4,169.66 $17,270.82 $10,720.24 nat. median
$8,125
1.3× median
872
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 2 $3,898.77 $17,270.82 $10,584.80 nat. median
$7,744
1.4× median
280
MS_DRG 		Acute Myocardial Infarction, Discharged Alive With Mcc 2 $6,111.62 $14,392.35 $10,251.99 nat. median
$11,829
0.9× median
193
MS_DRG 		Simple Pneumonia And Pleurisy With Mcc 2 $5,007.86 $14,392.35 $9,700.10 nat. median
$9,802
1.0× median
178
MS_DRG 		Respiratory Infections And Inflammations With Cc 2 $3,718.56 $14,392.35 $9,055.45 nat. median
$7,418
1.2× median
202
MS_DRG 		Bronchitis And Asthma With Cc/mcc 2 $3,700.27 $14,392.35 $9,046.31 nat. median
$7,228
1.3× median
556
MS_DRG 		Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 2 $3,164.59 $14,392.35 $8,778.47 nat. median
$6,105
1.4× median
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 2 $4,706.87 $11,513.88 $8,110.38 nat. median
$9,470
0.9× median
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 2 $7,400.93 $8,635.41 $8,018.17 nat. median
$14,442
0.6× median
91
MS_DRG 		Other Disorders Of Nervous System With Mcc 2 $6,691.12 $8,635.41 $7,663.26 nat. median
$12,760
0.6× median
552
MS_DRG 		Medical Back Problems Without Mcc 2 $3,662.55 $11,513.88 $7,588.22 nat. median
$7,205
1.1× median
812
MS_DRG 		Red Blood Cell Disorders Without Mcc 2 $3,498.34 $11,513.88 $7,506.11 nat. median
$6,771
1.1× median
191
MS_DRG 		Chronic Obstructive Pulmonary Disease With Cc 2 $3,211.83 $11,513.88 $7,362.85 nat. median
$6,349
1.2× median
536
MS_DRG 		Fractures Of Hip And Pelvis Without Mcc 2 $3,076.96 $11,513.88 $7,295.42 nat. median
$6,111
1.2× median
534
MS_DRG 		Fractures Of Femur Without Mcc 2 $3,071.24 $11,513.88 $7,292.56 nat. median
$5,924
1.2× median
194
MS_DRG 		Simple Pneumonia And Pleurisy With Cc 2 $3,070.48 $11,513.88 $7,292.18 nat. median
$6,156
1.2× median
948
MS_DRG 		Signs And Symptoms Without Mcc 2 $3,049.91 $11,513.88 $7,281.89 nat. median
$5,562
1.3× median
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 13 $2,186.16 $12,481.10 $7,225.90 nat. median
$498
outlier · 14.5×
179
MS_DRG 		Respiratory Infections And Inflammations Without Cc/mcc 2 $2,876.55 $11,513.88 $7,195.21 nat. median
$5,691
1.3× median
602
MS_DRG 		Cellulitis With Mcc 2 $5,415.15 $8,635.41 $7,025.28 nat. median
$10,595
0.7× median
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 13 $2,096.10 $11,966.91 $6,928.21 nat. median
$916
outlier · 7.6×
291
MS_DRG 		Heart Failure And Shock With Mcc 2 $4,891.28 $8,635.41 $6,763.34 nat. median
$9,572
0.7× median
190
MS_DRG 		Chronic Obstructive Pulmonary Disease With Mcc 2 $4,220.34 $8,635.41 $6,427.88 nat. median
$8,303
0.8× median
RX12652
CDM 		Dificid 200 Mg Tablet 13 $1,881.73 $10,743.08 $6,219.68 —
389
MS_DRG 		Gastrointestinal Obstruction With Cc 2 $3,009.14 $8,635.41 $5,822.27 nat. median
$5,994
1.0× median
641
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 2 $2,964.94 $8,635.41 $5,800.17 nat. median
$5,850
1.0× median
689
MS_DRG 		Kidney And Urinary Tract Infections With Mcc 2 $4,420.74 $5,756.94 $5,088.84 nat. median
$8,710
0.6× median
690
MS_DRG 		Kidney And Urinary Tract Infections Without Mcc 2 $3,084.20 $5,756.94 $4,420.57 nat. median
$6,107
0.7× median
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc 2 $2,878.47 $5,953.89 $4,416.18 nat. median
$11,701
outlier · 0.4×
J0565
HCPCS 		Injection, Bezlotoxumab, 10 Mg 13 $1,264.64 $7,220.00 $4,180.00 nat. median
$121
outlier · 34.7×
684
MS_DRG 		Renal Failure Without Cc/mcc 2 $2,287.14 $5,756.94 $4,022.04 nat. median
$4,560
0.9× median
391
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 2 $2,878.47 $4,832.22 $3,855.35 nat. median
$9,511
outlier · 0.4×
69666
HCPCS 		Repair Of Opening Of Middle To Inner Ear 13 $310.58 $6,611.05 $3,827.45 nat. median
$3,484
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
$665
outlier · 5.4×
J1569
HCPCS 		Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 13 $715.48 $5,884.30 $3,406.70 nat. median
$946
outlier · 3.6×
RX12558
CDM 		Xarelto 10 Mg Tablet 13 $969.28 $5,533.75 $3,203.75 —
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×
439
MS_DRG 		Disorders Of Pancreas Except Malignancy With Cc 2 $2,878.47 $3,204.97 $3,041.72 nat. median
$6,417
outlier · 0.5×
93
MS_DRG 		Other Disorders Of Nervous System Without Cc/mcc 2 $2,878.47 $3,033.90 $2,956.18 nat. median
$5,925
outlier · 0.5×
1210010
CDM 		Room & Board - Semi-private (two Beds) - Medical/surgical/gyn 7 $500.86 $2,878.47 $2,802.31 —
70546
HCPCS 		MRI Scan Of Blood Vessels Of Head Before And After Contrast 13 $31.62 $4,397.55 $2,534.38 nat. median
$625
outlier · 4.1×
RX22261
CDM 		Eliquis 2.5 Mg Tablet 13 $760.53 $4,341.98 $2,513.78 —
58150
HCPCS 		Removal Of Uterus And Cervix Through Abdomen 13 $310.58 $4,207.55 $2,435.95 nat. median
$3,499
0.7× 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
$606
outlier · 4.0×
71552
HCPCS 		MRI Scan Of Chest Before And After Contrast 13 $47.92 $4,106.85 $2,366.85 nat. median
$691
outlier · 3.4×

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.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
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
698 MS_DRG Other Kidney And Urinary Tract Diagnoses With Mcc 2 2 $47,235.50 $47,235.50 $6,303.26 $28,784.70 $17,543.98 2025-09-15
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 2 2 $28,132.75 $28,132.75 $5,088.64 $20,149.29 $12,618.97 2025-09-15
683 MS_DRG Renal Failure With Cc 2 2 $36,803.00 $36,803.00 $3,336.80 $20,149.29 $11,743.05 2025-09-15
292 MS_DRG Heart Failure And Shock With Cc 2 2 $38,079.50 $38,079.50 $3,234.69 $20,149.29 $11,691.99 2025-09-15
445 MS_DRG Disorders Of The Biliary Tract With Cc 2 2 $50,343.00 $50,343.00 $4,169.66 $17,270.82 $10,720.24 2025-09-15
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 2 2 $30,172.75 $30,172.75 $3,898.77 $17,270.82 $10,584.80 2025-09-15
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 2 2 $17,942.75 $17,942.75 $6,111.62 $14,392.35 $10,251.99 2025-09-15
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 2 2 $32,533.08 $32,533.08 $5,007.86 $14,392.35 $9,700.10 2025-09-15
178 MS_DRG Respiratory Infections And Inflammations With Cc 2 2 $32,685.87 $32,685.87 $3,718.56 $14,392.35 $9,055.45 2025-09-15
202 MS_DRG Bronchitis And Asthma With Cc/mcc 2 2 $23,583.75 $23,583.75 $3,700.27 $14,392.35 $9,046.31 2025-09-15
556 MS_DRG Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 2 2 $20,558.50 $20,558.50 $3,164.59 $14,392.35 $8,778.47 2025-09-15
189 MS_DRG Pulmonary Edema And Respiratory Failure 2 2 $18,264.00 $18,264.00 $4,706.87 $11,513.88 $8,110.38 2025-09-15
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 2 2 $23,319.00 $23,319.00 $7,400.93 $8,635.41 $8,018.17 2025-09-15
91 MS_DRG Other Disorders Of Nervous System With Mcc 2 2 $16,176.00 $16,176.00 $6,691.12 $8,635.41 $7,663.26 2025-09-15
552 MS_DRG Medical Back Problems Without Mcc 2 2 $10,761.25 $10,761.25 $3,662.55 $11,513.88 $7,588.22 2025-09-15
812 MS_DRG Red Blood Cell Disorders Without Mcc 2 2 $13,967.00 $13,967.00 $3,498.34 $11,513.88 $7,506.11 2025-09-15
191 MS_DRG Chronic Obstructive Pulmonary Disease With Cc 2 2 $11,632.25 $11,632.25 $3,211.83 $11,513.88 $7,362.85 2025-09-15
536 MS_DRG Fractures Of Hip And Pelvis Without Mcc 2 2 $10,918.00 $10,918.00 $3,076.96 $11,513.88 $7,295.42 2025-09-15
534 MS_DRG Fractures Of Femur Without Mcc 2 2 $24,704.13 $24,704.13 $3,071.24 $11,513.88 $7,292.56 2025-09-15
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 2 2 $21,281.08 $21,281.08 $3,070.48 $11,513.88 $7,292.18 2025-09-15
948 MS_DRG Signs And Symptoms Without Mcc 2 2 $16,834.33 $16,834.33 $3,049.91 $11,513.88 $7,281.89 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
179 MS_DRG Respiratory Infections And Inflammations Without Cc/mcc 2 2 $17,745.38 $17,745.38 $2,876.55 $11,513.88 $7,195.21 2025-09-15
602 MS_DRG Cellulitis With Mcc 2 2 $14,552.00 $14,552.00 $5,415.15 $8,635.41 $7,025.28 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
291 MS_DRG Heart Failure And Shock With Mcc 2 2 $17,811.25 $17,811.25 $4,891.28 $8,635.41 $6,763.34 2025-09-15
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 2 2 $15,624.50 $15,624.50 $4,220.34 $8,635.41 $6,427.88 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
389 MS_DRG Gastrointestinal Obstruction With Cc 2 2 $16,364.50 $16,364.50 $3,009.14 $8,635.41 $5,822.27 2025-09-15
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 2 2 $13,944.55 $13,944.55 $2,964.94 $8,635.41 $5,800.17 2025-09-15
689 MS_DRG Kidney And Urinary Tract Infections With Mcc 2 2 $11,296.00 $11,296.00 $4,420.74 $5,756.94 $5,088.84 2025-09-15
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 2 2 $11,320.04 $11,320.04 $3,084.20 $5,756.94 $4,420.57 2025-09-15
177 MS_DRG Respiratory Infections And Inflammations With Mcc 2 2 $8,773.25 $8,773.25 $2,878.47 $5,953.89 $4,416.18 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
684 MS_DRG Renal Failure Without Cc/mcc 2 2 $11,667.50 $11,667.50 $2,287.14 $5,756.94 $4,022.04 2025-09-15
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 2 2 $5,171.50 $5,171.50 $2,878.47 $4,832.22 $3,855.35 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
439 MS_DRG Disorders Of Pancreas Except Malignancy With Cc 2 2 $5,981.75 $5,981.75 $2,878.47 $3,204.97 $3,041.72 2025-09-15
93 MS_DRG Other Disorders Of Nervous System Without Cc/mcc 2 2 $2,760.00 $2,760.00 $2,878.47 $3,033.90 $2,956.18 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
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
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
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
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
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
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
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
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
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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