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

SULLIVAN COUNTY MEMORIAL HOSPITAL

Milan, MO · CCN 261306 · Rates published

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You selected 93306 (HCPCS)

PV ECHO 2D&M/CARD. DOP/COLOR

This hospital’s price: $492 across 3 payers · range $394-$680

Source: https://scmhospital.org/446005595_sullivan-county-memorial-hospital_standardcharges.csv · observed 2026-07-27

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

2,713 distinct procedures filed
6 distinct payers
9,162 rate rows
2026-07-27 last MRF observed
Data quality

887 of 9,162 rate rows are consumer-grade (9.7%)

8,275 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 8,263
per-diem day rate — not a per-procedure price 11
exceeds 10× this hospital's gross charge — excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://scmhospital.org/wp-content/uploads/2022/04/SCMH_Chargemaster_updated_April_2_2021.csv
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-10-03
Content fingerprint 69d378b639273da4… · 220,987 bytes · first seen 2026-05-13

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
J3262
HCPCS 		Tocilizumab (actemra) 80mg/4ml Inj 1 $2,220.00 $2,220.00 $2,220.00 nat. median
$1,413
1.6× median
0120
RC 		1 $1,972.50 $1,972.50 $1,972.50 nat. median
$986
outlier · 2.0×
72158
HCPCS 		MRI Lumbar With & Without Contrast 1 $1,525.59 $1,525.59 $1,525.59 nat. median
$1,097
1.4× median
0160
RC 		1 $1,321.00 $1,321.00 $1,321.00 nat. median
$858
1.5× median
0110
RC 		1 $1,220.00 $1,220.00 $1,220.00 nat. median
$961
1.3× median
74177
HCPCS 		CT Abd & Pelvis With Contrast 2 $884.40 $1,525.59 $1,204.99 nat. median
$976
1.2× median
74178
HCPCS 		CT Abd & Pelvis With & Without 2 $884.40 $1,525.59 $1,204.99 nat. median
$1,027
1.2× median
73221
HCPCS 		MRI Up. Left Extrem. Joint Without Contrast,left 1 $1,120.80 $1,120.80 $1,120.80 nat. median
$844
1.3× median
73721
HCPCS 		MRI Low Lt Extrem Any Joint Without Contrast,left 1 $1,120.80 $1,120.80 $1,120.80 nat. median
$856
1.3× median
72146
HCPCS 		MRI Thoracic Spine Without Contrast 1 $1,120.80 $1,120.80 $1,120.80 nat. median
$800
1.4× median
74176
HCPCS 		CT Abd & Pelvis Without Contrast 3 $956.23 $1,120.80 $1,088.58 nat. median
$694
1.6× median
64640
HCPCS 		Peripheral Nerve/branch 2nd Inj Pro FEE,Distinct Procedural Service, Professiona… 1 $1,035.59 $1,035.59 $1,035.59 nat. median
$1,194
0.9× median
99285
HCPCS 		ER Major With Procedure,separate Service 3 $181.64 $1,315.20 $978.18 nat. median
$1,187
0.8× median
99291
HCPCS 		ER Physician Fee - Critical 2 $219.09 $1,453.65 $921.20 nat. median
$1,530
0.6× median
12042
HCPCS 		Intermed Repair Super 2.6-7.5cm Pro 1 $895.20 $895.20 $895.20 nat. median
$541
1.7× median
73201
HCPCS 		CT Upper Left Extremity With,left 1 $884.40 $884.40 $884.40 nat. median
$805
1.1× median
74183
HCPCS 		MRI Abdomenwith And Without Contrast 1 $884.40 $884.40 $884.40 nat. median
$1,105
0.8× median
70487
HCPCS 		CT Maxillofacial With 1 $865.60 $865.60 $865.60 nat. median
$611
1.4× median
70492
HCPCS 		CT Soft Tissueneck W & Wo 1 $865.60 $865.60 $865.60 nat. median
$650
1.3× median
70498
HCPCS 		CTA Neck W Contrast & Imaging Postproces 1 $865.60 $865.60 $865.60 nat. median
$744
1.2× median
70496
HCPCS 		CTA Brain W Contrast & Imaging Postproce 1 $865.60 $865.60 $865.60 nat. median
$752
1.2× median
36430
HCPCS 		Bb Blood Administration 1 $843.87 $843.87 $843.87 nat. median
$708
1.2× median
71270
HCPCS 		CT Chest With & Without 2 $746.58 $865.60 $806.09 nat. median
$684
1.2× median
99284
HCPCS 		ER Physician Fee - Urgent 4 $125.14 $1,283.20 $767.61 nat. median
$754
1.0× median
70551
HCPCS 		MRI Brain Without Contrast 2 $560.40 $966.69 $763.55 nat. median
$787
1.0× median
72141
HCPCS 		MRI Cervical Spine Without Contrast 2 $560.40 $939.23 $749.82 nat. median
$785
1.0× median
70491
HCPCS 		CT Neck Soft Tissue With Contrast 1 $746.58 $746.58 $746.58 nat. median
$632
1.2× median
71275
HCPCS 		CT Chest Angiography (non Coronary) 3 $541.00 $865.60 $746.58 nat. median
$759
1.0× median
73701
HCPCS 		CT Lower Left Extremity With,left 1 $746.58 $746.58 $746.58 nat. median
$677
1.1× median
C1897
HCPCS 		Tourniquet Trauma 1 $690.00 $690.00 $690.00 nat. median
$1,179
0.6× median
J0897
HCPCS 		Denosumab (prolia) 60mg/1ml Inj 1 $680.00 $680.00 $680.00 nat. median
$1,982
outlier · 0.3×
20611
HCPCS 		Artho Major Joint/inject With US 3 $60.35 $1,035.00 $675.00 nat. median
$487
1.4× median
72148
HCPCS 		MRI Lumbar Spine Without Contrast 3 $560.40 $966.69 $630.20 nat. median
$807
0.8× median
64635
HCPCS 		Desctr. Lumb\sac W Fluro Procedure Room 2 $194.47 $1,035.00 $600.00 nat. median
$2,392
outlier · 0.3×
64490
HCPCS 		Cerv/thor W Fluro 1 Lev Procedure Room 1 $600.00 $600.00 $600.00 nat. median
$1,287
outlier · 0.5×
64633
HCPCS 		Desctr. F\c\t W Fluro Procedure Room 1 $600.00 $600.00 $600.00 nat. median
$2,325
outlier · 0.3×
12001
HCPCS 		Simp Repair Superfical 2.5or Less Cm Pro 2 $433.60 $747.96 $590.78 nat. median
$282
outlier · 2.1×
71260
HCPCS 		CT Chest With 2 $432.80 $746.58 $589.69 nat. median
$651
0.9× median
29240
HCPCS 		Strapping Shoulder 2 $240.12 $893.20 $566.66 nat. median
$167
outlier · 3.4×
64454
HCPCS 		Genicular Nerve Branch Pro Fee,professional Component 1 $83.86 $1,038.97 $561.41 nat. median
$990
0.6× median
72195
HCPCS 		MRI Pelvis W/out Contrast 1 $560.40 $560.40 $560.40 nat. median
$811
0.7× median
74181
HCPCS 		MRI Abdomen Without Contrast 1 $560.40 $560.40 $560.40 nat. median
$820
0.7× median
99283
HCPCS 		ER Moderate With Procedure,separate Service 4 $74.92 $1,131.20 $547.58 nat. median
$460
1.2× median
25605
HCPCS 		Closed Tx Fracture Radius With Manip Pro 1 $524.19 $524.19 $524.19 nat. median
$1,667
outlier · 0.3×
93306
HCPCS 		Pv Echo 2d&m/card. Dop/color 3 $394.00 $679.65 $492.50 nat. median
$993
outlier · 0.5×
70486
HCPCS 		CT Screening Sinuses Without Contrast 2 $442.29 $512.80 $477.54 nat. median
$481
1.0× median
12034
HCPCS 		Repair Interm S/a/te 7.6-12.5cm Pro 1 $205.99 $706.31 $456.15 nat. median
$582
0.8× median
64450
HCPCS 		Nerve Block Other Peripheral Pro 2 $40.67 $1,200.00 $450.00 nat. median
$800
0.6× median
12032
HCPCS 		Repair Interm S/a/t/e 2.6 -7.5 Cm Pro 1 $447.60 $447.60 $447.60 nat. median
$546
0.8× median
73700
HCPCS 		CT Lower Left Extremity Without,left 2 $256.40 $512.80 $442.29 nat. median
$505
0.9× median

Other procedures at this hospital

Browse this hospital's 2,713 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
             
J3262 HCPCS Tocilizumab (actemra) 80mg/4ml Inj 1 1 $1,250.00 $1,250.00 $2,220.00 $2,220.00 $2,220.00 2026-07-27
0120 RC — 1 1 $139.00 $139.00 $1,972.50 $1,972.50 $1,972.50 2026-07-27
72158 HCPCS MRI Lumbar With & Without Contrast 1 1 $2,211.00 $2,211.00 $1,525.59 $1,525.59 $1,525.59 2026-07-27
0160 RC — 1 1 $1,000.00 $1,000.00 $1,321.00 $1,321.00 $1,321.00 2026-07-27
0110 RC — 1 1 $1,100.00 $1,100.00 $1,220.00 $1,220.00 $1,220.00 2026-07-27
74177 HCPCS CT Abd & Pelvis With Contrast 2 2 $2,211.00 $2,211.00 $884.40 $1,525.59 $1,204.99 2026-07-27
74178 HCPCS CT Abd & Pelvis With & Without 2 2 $2,211.00 $2,211.00 $884.40 $1,525.59 $1,204.99 2026-07-27
73221 HCPCS MRI Up. Left Extrem. Joint Without Contrast,left 2 1 $1,401.00 $1,401.00 $1,120.80 $1,120.80 $1,120.80 2026-07-27
73721 HCPCS MRI Low Lt Extrem Any Joint Without Contrast,left 2 1 $1,401.00 $1,401.00 $1,120.80 $1,120.80 $1,120.80 2026-07-27
72146 HCPCS MRI Thoracic Spine Without Contrast 1 1 $1,401.00 $1,401.00 $1,120.80 $1,120.80 $1,120.80 2026-07-27
74176 HCPCS CT Abd & Pelvis Without Contrast 3 3 $1,401.00 $1,401.00 $956.23 $1,120.80 $1,088.58 2026-07-27
64640 HCPCS Peripheral Nerve/branch 2nd Inj Pro FEE,Distinct Procedural Service, Professiona… 1 1 $291.50 $291.50 $1,035.59 $1,035.59 $1,035.59 2026-07-27
99285 HCPCS ER Major With Procedure,separate Service 6 3 $1,644.00 $1,644.00 $181.64 $1,315.20 $978.18 2026-07-27
99291 HCPCS ER Physician Fee - Critical 3 2 $880.00 $880.00 $219.09 $1,453.65 $921.20 2026-07-27
12042 HCPCS Intermed Repair Super 2.6-7.5cm Pro 1 1 $382.00 $382.00 $895.20 $895.20 $895.20 2026-07-27
74183 HCPCS MRI Abdomenwith And Without Contrast 1 1 $2,211.00 $2,211.00 $884.40 $884.40 $884.40 2026-07-27
73201 HCPCS CT Upper Left Extremity With,left 1 1 $2,211.00 $2,211.00 $884.40 $884.40 $884.40 2026-07-27
70496 HCPCS CTA Brain W Contrast & Imaging Postproce 1 1 $1,082.00 $1,082.00 $865.60 $865.60 $865.60 2026-07-27
70492 HCPCS CT Soft Tissueneck W & Wo 1 1 $1,082.00 $1,082.00 $865.60 $865.60 $865.60 2026-07-27
70487 HCPCS CT Maxillofacial With 1 1 $1,082.00 $1,082.00 $865.60 $865.60 $865.60 2026-07-27
70498 HCPCS CTA Neck W Contrast & Imaging Postproces 1 1 $1,082.00 $1,082.00 $865.60 $865.60 $865.60 2026-07-27
36430 HCPCS Bb Blood Administration 1 1 $1,223.00 $1,223.00 $843.87 $843.87 $843.87 2026-07-27
71270 HCPCS CT Chest With & Without 2 2 $1,082.00 $1,082.00 $746.58 $865.60 $806.09 2026-07-27
99284 HCPCS ER Physician Fee - Urgent 7 4 $1,145.00 $1,145.00 $125.14 $1,283.20 $767.61 2026-07-27
70551 HCPCS MRI Brain Without Contrast 2 2 $1,401.00 $1,401.00 $560.40 $966.69 $763.55 2026-07-27
72141 HCPCS MRI Cervical Spine Without Contrast 2 2 $1,401.00 $1,401.00 $560.40 $939.23 $749.82 2026-07-27
73701 HCPCS CT Lower Left Extremity With,left 1 1 $1,082.00 $1,082.00 $746.58 $746.58 $746.58 2026-07-27
70491 HCPCS CT Neck Soft Tissue With Contrast 1 1 $1,082.00 $1,082.00 $746.58 $746.58 $746.58 2026-07-27
71275 HCPCS CT Chest Angiography (non Coronary) 3 3 $1,082.00 $1,082.00 $541.00 $865.60 $746.58 2026-07-27
C1897 HCPCS Tourniquet Trauma 1 1 $65.00 $65.00 $690.00 $690.00 $690.00 2026-07-27
J0897 HCPCS Denosumab (prolia) 60mg/1ml Inj 1 1 $1,700.00 $1,700.00 $680.00 $680.00 $680.00 2026-07-27
20611 HCPCS Artho Major Joint/inject With US 4 3 $816.00 $816.00 $60.35 $1,035.00 $675.00 2026-07-27
72148 HCPCS MRI Lumbar Spine Without Contrast 3 3 $1,401.00 $1,401.00 $560.40 $966.69 $630.20 2026-07-27
64635 HCPCS Desctr. Lumb\sac W Fluro Procedure Room 3 2 $1,069.00 $1,069.00 $194.47 $1,035.00 $600.00 2026-07-27
64633 HCPCS Desctr. F\c\t W Fluro Procedure Room 1 1 $1,073.50 $1,073.50 $600.00 $600.00 $600.00 2026-07-27
64490 HCPCS Cerv/thor W Fluro 1 Lev Procedure Room 1 1 $1,500.00 $1,500.00 $600.00 $600.00 $600.00 2026-07-27
12001 HCPCS Simp Repair Superfical 2.5or Less Cm Pro 2 2 $204.00 $204.00 $433.60 $747.96 $590.78 2026-07-27
71260 HCPCS CT Chest With 2 2 $1,082.00 $1,082.00 $432.80 $746.58 $589.69 2026-07-27
29240 HCPCS Strapping Shoulder 2 2 $348.00 $348.00 $240.12 $893.20 $566.66 2026-07-27
64454 HCPCS Genicular Nerve Branch Pro Fee,professional Component 2 1 $950.00 $950.00 $83.86 $1,038.97 $561.41 2026-07-27
74181 HCPCS MRI Abdomen Without Contrast 1 1 $1,401.00 $1,401.00 $560.40 $560.40 $560.40 2026-07-27
72195 HCPCS MRI Pelvis W/out Contrast 1 1 $1,401.00 $1,401.00 $560.40 $560.40 $560.40 2026-07-27
99283 HCPCS ER Moderate With Procedure,separate Service 8 4 $735.00 $735.00 $74.92 $1,131.20 $547.58 2026-07-27
25605 HCPCS Closed Tx Fracture Radius With Manip Pro 1 1 $1,276.00 $1,276.00 $524.19 $524.19 $524.19 2026-07-27
93306 HCPCS Pv Echo 2d&m/card. Dop/color 3 3 $985.00 $985.00 $394.00 $679.65 $492.50 2026-07-27
70486 HCPCS CT Screening Sinuses Without Contrast 2 2 $641.00 $641.00 $442.29 $512.80 $477.54 2026-07-27
12034 HCPCS Repair Interm S/a/te 7.6-12.5cm Pro 2 1 $497.00 $497.00 $205.99 $706.31 $456.15 2026-07-27
64450 HCPCS Nerve Block Other Peripheral Pro 8 2 $300.00 $300.00 $40.67 $1,200.00 $450.00 2026-07-27
12032 HCPCS Repair Interm S/a/t/e 2.6 -7.5 Cm Pro 1 1 $280.00 $280.00 $447.60 $447.60 $447.60 2026-07-27
73700 HCPCS CT Lower Left Extremity Without,left 4 2 $641.00 $641.00 $256.40 $512.80 $442.29 2026-07-27
74150 HCPCS CT Abdomen Without 1 1 $641.00 $641.00 $442.29 $442.29 $442.29 2026-07-27
12002 HCPCS Simp Repair Superfical 2.6cm- 7.5cm Pro 2 2 $251.00 $251.00 $433.60 $447.15 $440.38 2026-07-27
10060 HCPCS I & O Abcess Simple Single 1 1 $269.00 $269.00 $433.60 $433.60 $433.60 2026-07-27
71250 HCPCS CT Chest Without 3 3 $641.00 $641.00 $256.40 $498.06 $429.73 2026-07-27
73200 HCPCS CT Upper Extremity Without Lt,left 4 2 $641.00 $641.00 $256.40 $512.80 $404.60 2026-07-27
P9016 HCPCS Bb Red Blood Cells, Leukoreduced, Ea 1 1 $568.00 $568.00 $391.92 $391.92 $391.92 2026-07-27
76830 HCPCS US Transvaginal Non OB Pelvis 2 2 $428.00 $428.00 $342.40 $428.00 $385.20 2026-07-27
29540 HCPCS Strapping Ankle And Or Foot 1 1 $437.00 $437.00 $349.60 $349.60 $349.60 2026-07-27
29505 HCPCS Splint Long Leg 1 1 $437.00 $437.00 $349.60 $349.60 $349.60 2026-07-27
72125 HCPCS CT Cervical Spine Without 2 2 $641.00 $641.00 $256.40 $442.29 $349.35 2026-07-27
72192 HCPCS CT Pelvis Without 2 2 $641.00 $641.00 $256.40 $442.29 $349.35 2026-07-27
76805 HCPCS US Preg Comp>14 Weeks 1st Baby 1 1 $428.00 $428.00 $342.40 $342.40 $342.40 2026-07-27
76801 HCPCS US Preg Complete < 14 Weeks 1st B 1 1 $428.00 $428.00 $342.40 $342.40 $342.40 2026-07-27
76817 HCPCS US Transvaginal Pregnancy 1 1 $428.00 $428.00 $342.40 $342.40 $342.40 2026-07-27
76870 HCPCS US Scrotum 1 1 $428.00 $428.00 $342.40 $342.40 $342.40 2026-07-27
76857 HCPCS US Urinary Bladder 1 1 $428.00 $428.00 $342.40 $342.40 $342.40 2026-07-27
76881 HCPCS US Extremity Nonvasc With Image Doc Comple 1 1 $428.00 $428.00 $342.40 $342.40 $342.40 2026-07-27
76856 HCPCS US Pelvic 3 3 $428.00 $428.00 $270.15 $342.40 $332.56 2026-07-27
72128 HCPCS CT Thoracic Spine Without 2 2 $641.00 $641.00 $256.40 $404.60 $330.50 2026-07-27
72131 HCPCS CT Lumbar Spine Without 2 2 $641.00 $641.00 $256.40 $404.60 $330.50 2026-07-27
86920 HCPCS .bb Crossmatch Immediate Spin 1 1 $472.00 $472.00 $325.68 $325.68 $325.68 2026-07-27
86921 HCPCS .bb Crossmatch Incubation 1 1 $472.00 $472.00 $325.68 $325.68 $325.68 2026-07-27
84597 HCPCS Vitamin K 1 1 $514.00 $514.00 $322.38 $322.38 $322.38 2026-07-27
70450 HCPCS CT Head Without 3 3 $641.00 $641.00 $256.40 $404.60 $320.50 2026-07-27
76700 HCPCS US Abdomen Complete 2 2 $428.00 $428.00 $295.32 $342.40 $318.86 2026-07-27
76770 HCPCS US Renal Bilat 2 2 $428.00 $428.00 $295.32 $342.40 $318.86 2026-07-27
93971 HCPCS Pv Uni Venous Doppler Lt,left 3 2 $460.00 $460.00 $290.35 $368.00 $317.40 2026-07-27
76536 HCPCS US Parotid 2 2 $428.00 $428.00 $286.93 $342.40 $314.66 2026-07-27
82656 HCPCS Pancreatic Elastase-1 1 1 $400.00 $400.00 $310.80 $310.80 $310.80 2026-07-27
76882 HCPCS US Extrem Nonvasc With Image Doc Limit Ana 2 2 $428.00 $428.00 $270.15 $342.40 $306.27 2026-07-27
99215 HCPCS Op Treatment Room Level 5 1 1 $376.00 $376.00 $300.80 $300.80 $300.80 2026-07-27
99282 HCPCS ER Low/ Procedure,separate Service 4 2 $419.00 $419.00 $43.35 $335.20 $299.84 2026-07-27
76705 HCPCS US Liver 3 3 $428.00 $428.00 $171.20 $332.56 $295.32 2026-07-27
29130 HCPCS Application Of Finger Splint Pro Fee 1 1 $50.00 $50.00 $278.40 $278.40 $278.40 2026-07-27
93970 HCPCS Pv Bilateral Venous Doppler 1 1 $690.00 $690.00 $276.00 $276.00 $276.00 2026-07-27
93975 HCPCS Pv Renal Artery Doppler 1 1 $380.00 $380.00 $262.20 $262.20 $262.20 2026-07-27
72202 HCPCS Xr Sacroiliac Joints 3v 1 1 $321.00 $321.00 $256.80 $256.80 $256.80 2026-07-27
70250 HCPCS Xr Skull 1/2/3 Views 1 1 $321.00 $321.00 $256.80 $256.80 $256.80 2026-07-27
71271 HCPCS CT Low Dose Lung Screen Wo Contrast 2 2 $500.00 $500.00 $200.00 $313.60 $256.80 2026-07-27
71101 HCPCS Xr Ribs With Chest Unilateral Lt,left 2 2 $321.00 $321.00 $249.42 $256.80 $253.11 2026-07-27
87902 HCPCS Hepatitis C Virus RNA Genotype 1 1 $538.00 $538.00 $252.30 $252.30 $252.30 2026-07-27
87800 HCPCS Bacterial Vaginosis Vaginitis Panel 2 2 $576.00 $576.00 $42.80 $460.80 $251.80 2026-07-27
84433 HCPCS Tpmt Activity 1 1 $356.00 $356.00 $244.22 $244.22 $244.22 2026-07-27
29125 HCPCS Splint Short Arm 3 2 $348.00 $348.00 $40.48 $278.40 $240.12 2026-07-27
83993 HCPCS Calprotectin, Stool 1 1 $350.00 $350.00 $240.10 $240.10 $240.10 2026-07-27
83789 HCPCS Tramadol & Metabolite 1 1 $185.00 $185.00 $240.00 $240.00 $240.00 2026-07-27
74019 HCPCS Xr Abdomen W/upright 2 View 2 2 $321.00 $321.00 $221.87 $256.80 $239.34 2026-07-27
72170 HCPCS Xr Pelvis Ap 2 2 $321.00 $321.00 $221.49 $256.80 $239.15 2026-07-27
72110 HCPCS Xr Lumbar W/obliques 2 2 $321.00 $321.00 $221.49 $256.80 $239.15 2026-07-27
72114 HCPCS Xr Lumbar Complete With Bending View 2 2 $321.00 $321.00 $221.49 $256.80 $239.15 2026-07-27
86900 HCPCS .bb Blood Group A B O 1 1 $348.00 $348.00 $238.73 $238.73 $238.73 2026-07-27
72100 HCPCS Xr Lumbar 2v 2 2 $321.00 $321.00 $218.34 $256.80 $237.57 2026-07-27
72070 HCPCS Xr Thoracic Spine 2 View 2 2 $321.00 $321.00 $202.62 $256.80 $229.71 2026-07-27
71110 HCPCS Xr Ribs Bilateral 1 1 $321.00 $321.00 $221.49 $221.49 $221.49 2026-07-27
72052 HCPCS Xr Cervical Flex/ext 1 1 $321.00 $321.00 $221.49 $221.49 $221.49 2026-07-27
72050 HCPCS Xr Cervical 5 View 3 3 $321.00 $321.00 $160.50 $256.80 $221.49 2026-07-27
70110 HCPCS Xr Mandible 4 View 1 1 $321.00 $321.00 $221.49 $221.49 $221.49 2026-07-27
76706 HCPCS US Abdominal Aorta Screening 2 2 $428.00 $428.00 $171.20 $268.44 $219.82 2026-07-27
12013 HCPCS Simple Repair Superfical 2.6-5.0 Cm Pro 1 1 $276.00 $276.00 $216.80 $216.80 $216.80 2026-07-27
G0480 HCPCS Methanol ,urine 3 3 $167.00 $167.00 $171.50 $274.40 $215.13 2026-07-27
73070 HCPCS Xr Elbow Left 2 View,left 1 1 $261.00 $261.00 $208.80 $208.80 $208.80 2026-07-27
73610 HCPCS Xr Ankle L 3 View,left 4 3 $261.00 $261.00 $164.74 $208.80 $205.80 2026-07-27
71120 HCPCS Xr Sternum 1 1 $261.00 $261.00 $202.80 $202.80 $202.80 2026-07-27
77075 HCPCS Xr Complete Skeletal Survey 1 1 $321.00 $321.00 $202.62 $202.62 $202.62 2026-07-27
86644 HCPCS Cytomegolorvirus Antibodies IgG 1 1 $246.00 $246.00 $196.80 $196.80 $196.80 2026-07-27
93880 HCPCS Pv Carotid Bilateral 2 2 $380.00 $380.00 $152.00 $239.86 $195.93 2026-07-27
73130 HCPCS Xr Hand 3 View Left,left 4 2 $261.00 $261.00 $180.09 $208.80 $194.44 2026-07-27
74018 HCPCS Xr Abdomen Ap 2 2 $261.00 $261.00 $180.09 $208.80 $194.44 2026-07-27
71100 HCPCS Xr Ribs Left,left 4 2 $261.00 $261.00 $164.74 $208.80 $194.44 2026-07-27
93922 HCPCS Pv Arterial Doppler Limited 2 2 $215.00 $215.00 $142.00 $246.10 $194.05 2026-07-27
72040 HCPCS Xr Cervical 2 View 2 2 $261.00 $261.00 $174.97 $208.80 $191.88 2026-07-27
83090 HCPCS Homocysteine Quantitative 2 2 $258.00 $258.00 $176.99 $206.40 $191.69 2026-07-27
71046 HCPCS Xr Chest 2 View 4 4 $261.00 $261.00 $94.45 $208.80 $191.44 2026-07-27
73120 HCPCS Xr Hand 2 V Left,left 4 3 $321.00 $321.00 $160.50 $256.80 $191.00 2026-07-27
86645 HCPCS Cytomegolorvirus Antibody IgM 1 1 $232.00 $232.00 $185.60 $185.60 $185.60 2026-07-27
83519 HCPCS Gad Antibodies Quantitative 1 1 $322.00 $322.00 $185.22 $185.22 $185.22 2026-07-27
93925 HCPCS Pv Bilat Arterial Duplex Dop Extrem Low 2 2 $355.00 $355.00 $142.00 $224.08 $183.04 2026-07-27
82670 HCPCS Estradiol 2 2 $245.00 $245.00 $168.07 $196.00 $182.03 2026-07-27
87338 HCPCS Helicobacter Pylori Stool 2 2 $245.00 $245.00 $168.07 $196.00 $182.03 2026-07-27
84402 HCPCS Testosterone Free Test 1 3 3 $265.00 $265.00 $132.50 $212.00 $181.79 2026-07-27
73080 HCPCS Xr Elbow Left 3 View,left 3 2 $261.00 $261.00 $104.40 $208.80 $180.09 2026-07-27
73600 HCPCS Xr Ankle L 2 View,left 3 3 $261.00 $261.00 $104.40 $202.80 $180.09 2026-07-27
73560 HCPCS Xr Knee 2v Left,left 5 3 $261.00 $261.00 $104.40 $215.33 $180.09 2026-07-27
73620 HCPCS Xr Foot 2 View Left,left 5 3 $261.00 $261.00 $104.40 $208.80 $180.09 2026-07-27
73590 HCPCS Xr Tibia - Fibula Left 2v,left 3 2 $261.00 $261.00 $164.74 $208.80 $180.09 2026-07-27
73630 HCPCS Xr Foot Left 3 View,left 5 3 $261.00 $261.00 $104.40 $208.80 $180.09 2026-07-27
73552 HCPCS Xr Femur Left 2v,left 3 2 $261.00 $261.00 $164.74 $208.80 $180.09 2026-07-27
73110 HCPCS Xr Wrist 3 View Left,left 5 3 $261.00 $261.00 $130.50 $208.80 $180.09 2026-07-27
73090 HCPCS Xr Forearm Left 2 View,left 3 2 $261.00 $261.00 $104.40 $208.80 $180.09 2026-07-27
73030 HCPCS Xr Shoulder Left 2 V Or More,left 7 4 $261.00 $261.00 $108.44 $208.80 $180.09 2026-07-27
71045 HCPCS Xr Chest 1 View 3 3 $261.00 $261.00 $104.40 $215.33 $180.09 2026-07-27
71111 HCPCS Xr Ribs Bilat W 1 View Chest 2 2 $321.00 $321.00 $157.29 $202.62 $179.95 2026-07-27
73502 HCPCS Xr Hip Left 2v,left 5 3 $261.00 $261.00 $104.40 $202.80 $179.00 2026-07-27
83880 HCPCS Brain Natriuretic Peptide 3 3 $259.00 $259.00 $103.60 $213.68 $177.67 2026-07-27
73562 HCPCS Xr Knee Left 3 View,left 5 3 $261.00 $261.00 $104.40 $208.80 $177.53 2026-07-27
73140 HCPCS Xr Finger Left First INDEX,Left Second DigitFinger 3 2 $261.00 $261.00 $104.40 $208.80 $174.97 2026-07-27
84207 HCPCS Vitamin B-6 (pridoxine) 1 1 $278.00 $278.00 $174.36 $174.36 $174.36 2026-07-27
73523 HCPCS Xr Hip Bilateral With Ap Pelvis 2 2 $321.00 $321.00 $128.40 $218.34 $173.37 2026-07-27
73100 HCPCS Xr Wrist 2v Left,left 2 1 $261.00 $261.00 $164.74 $180.09 $172.42 2026-07-27
93926 HCPCS Pv Unilat Art Duplex Dop Extrem Lower Lt,left 1 1 $215.00 $215.00 $172.00 $172.00 $172.00 2026-07-27
86480 HCPCS Quantiferon-TB Gold 2 2 $160.00 $160.00 $132.00 $206.98 $169.49 2026-07-27
J1756 HCPCS Iron Sucrose (venofer) 100mg/5ml Inj 1 1 $210.00 $210.00 $168.00 $168.00 $168.00 2026-07-27
82652 HCPCS Vitamin D Panel 2 2 $305.00 $305.00 $122.00 $209.23 $165.62 2026-07-27
87493 HCPCS C Diff Toxin B R-time Pcr 1 1 $238.00 $238.00 $163.27 $163.27 $163.27 2026-07-27
94640 HCPCS Updraft Per Treatment 1 1 $204.00 $204.00 $163.20 $163.20 $163.20 2026-07-27
83921 HCPCS Methylmalonic Acid 2 2 $310.00 $310.00 $124.00 $194.43 $159.22 2026-07-27
87426 HCPCS Rapid Sars CoV2 Fia 2 2 $250.00 $250.00 $155.40 $160.00 $157.70 2026-07-27
82523 HCPCS Collagen Type I C-telopeptide 2 2 $278.00 $278.00 $111.20 $190.71 $150.96 2026-07-27
87427 HCPCS Sugar Toxin - E.coli 3 3 $192.00 $192.00 $120.42 $153.60 $149.18 2026-07-27
86200 HCPCS Cyclic Citrullinated Peptide AbIgG 3 3 $200.00 $200.00 $88.40 $171.72 $148.58 2026-07-27
64624 HCPCS Lt Destr Nerve Branch Pro Fee,left, Professional Component 2 1 $905.00 $905.00 $148.48 $148.48 $148.48 2026-07-27
72220 HCPCS Xr Coccyx/sacrum 2 2 $261.00 $261.00 $104.40 $180.09 $142.25 2026-07-27
96360 HCPCS IV Infusion Hydration 1st Hr 3 3 $205.00 $205.00 $82.00 $159.29 $141.45 2026-07-27
76942 HCPCS Ultrasound Guidance For Placement 3 2 $150.00 $150.00 $31.03 $160.00 $138.00 2026-07-27
83883 HCPCS Kappa Light Chain, Free Blood 2 2 $288.00 $288.00 $120.00 $150.53 $135.26 2026-07-27
87661 HCPCS Trichomonas Vaginalis RNA Qualitative Tm 1 1 $168.00 $168.00 $134.40 $134.40 $134.40 2026-07-27
99222 HCPCS Obs Init Care Moderate - Prof Fee 1 1 $393.00 $393.00 $132.72 $132.72 $132.72 2026-07-27
94664 HCPCS Updraft Initial Treatment 2 2 $204.00 $204.00 $102.00 $163.20 $132.60 2026-07-27
73060 HCPCS Xr Humerus Left 2 View,left 3 3 $261.00 $261.00 $104.40 $180.09 $130.50 2026-07-27
73564 HCPCS Xr Knee And Patella Left,left 3 2 $321.00 $321.00 $128.40 $224.70 $128.40 2026-07-27
80307 HCPCS Cocaine Metabolites Qualitative 1 1 $67.00 $67.00 $128.00 $128.00 $128.00 2026-07-27
88175 HCPCS Thin Prep Pap Smear Screening & Review 2 2 $142.00 $142.00 $113.60 $142.00 $127.80 2026-07-27
99214 HCPCS Est Pain Man Patient Level 4 PRO,Professional Component 2 2 $229.00 $229.00 $80.00 $175.47 $127.73 2026-07-27
99281 HCPCS ER Minor With Procedure,separate Service 4 3 $225.00 $225.00 $90.00 $180.00 $127.26 2026-07-27
90715 HCPCS Adacel(prefill Syr) Tdap 1 1 $158.00 $158.00 $126.40 $126.40 $126.40 2026-07-27
82306 HCPCS Vitamin D (25 Hydroxy) 3 3 $249.00 $249.00 $99.60 $156.17 $124.50 2026-07-27
80074 HCPCS Hepatitis Panel, Acute With Reflex 2 2 $171.00 $171.00 $107.25 $136.80 $122.03 2026-07-27
96374 HCPCS IV Push Inj.initial 4 3 $205.00 $205.00 $82.00 $164.00 $121.97 2026-07-27
96365 HCPCS IV Infusion Therapy 1st Hr 4 3 $205.00 $205.00 $82.00 $164.00 $121.97 2026-07-27
83615 HCPCS Ldh Body Fluid 1 1 $192.00 $192.00 $120.42 $120.42 $120.42 2026-07-27
87389 HCPCS HIV-1ag With HIV-1 & HIV-2 Ab 1 1 $150.00 $150.00 $120.00 $120.00 $120.00 2026-07-27
64636 HCPCS Desct Lum\sac Ea Add Joint W Fluro Proc 3 2 $236.50 $236.50 $60.19 $207.00 $120.00 2026-07-27
64634 HCPCS Desctr F\c\t Ea Add Joint W Fluro Proc R 1 1 $249.00 $249.00 $120.00 $120.00 $120.00 2026-07-27
64491 HCPCS Cerv/thor W Fluro 2 Lev Procedure Room 1 1 $237.50 $237.50 $120.00 $120.00 $120.00 2026-07-27
86812 HCPCS Hla-b27 Antigen 2 2 $150.00 $150.00 $116.55 $120.00 $118.28 2026-07-27
80235 HCPCS Lacosamide 1 1 $170.00 $170.00 $116.62 $116.62 $116.62 2026-07-27
99239 HCPCS Obs Discharge More Than 30 Min Prof Fee 1 1 $308.00 $308.00 $112.75 $112.75 $112.75 2026-07-27
99213 HCPCS Est Pain Man Patient Level 3 PRO,Professional Component 2 2 $163.00 $163.00 $82.40 $142.14 $112.27 2026-07-27
64483 HCPCS Lumbar Level 1 Procedure Room 1 1 $911.00 $911.00 $112.13 $112.13 $112.13 2026-07-27
99292 HCPCS ER Physician Fee - Critical Ea Add 30 Mi 1 1 $440.00 $440.00 $109.50 $109.50 $109.50 2026-07-27
86880 HCPCS Bb Coombs Direct 1 1 $172.00 $172.00 $107.88 $107.88 $107.88 2026-07-27
83970 HCPCS Parathyroid Hormone, Intact Without Calcium 2 2 $196.00 $196.00 $78.40 $131.77 $105.09 2026-07-27
73660 HCPCS Xr Toe Left First,left Second Digit Toe 3 1 $261.00 $261.00 $104.40 $208.80 $104.40 2026-07-27
70160 HCPCS Xr Nasal 3 View 1 1 $261.00 $261.00 $104.40 $104.40 $104.40 2026-07-27
86850 HCPCS Tentanus Antitoxoid Antibody 1 1 $160.00 $160.00 $102.90 $102.90 $102.90 2026-07-27
84153 HCPCS Psa Total (diagnostic 2 2 $190.00 $190.00 $76.00 $127.73 $101.87 2026-07-27
36600 HCPCS Arterial Puncture 3 3 $147.00 $147.00 $58.80 $121.28 $101.43 2026-07-27
62323 HCPCS Lesi W Fluro Procedure Room 1 1 $893.50 $893.50 $100.66 $100.66 $100.66 2026-07-27
84443 HCPCS Tsh With Reflex To Free T4 4 4 $150.00 $150.00 $56.40 $140.77 $99.00 2026-07-27
86666 HCPCS Ehrlichia Chaffeensis IgG Or IgM 1 1 $174.00 $174.00 $98.16 $98.16 $98.16 2026-07-27
82172 HCPCS Apolipoprotein B 1 1 $38.00 $38.00 $97.20 $97.20 $97.20 2026-07-27
97167 HCPCS Ot Occupational Therapy Eval 60 Min,occupational Therapy 1 1 $240.00 $240.00 $96.00 $96.00 $96.00 2026-07-27
82365 HCPCS Stone Analysis 1 1 $118.00 $118.00 $94.40 $94.40 $94.40 2026-07-27
84403 HCPCS Testosterone Total 3 3 $150.00 $150.00 $75.00 $120.00 $94.08 2026-07-27
90732 HCPCS Pneumococcal Vaccine 2 2 $347.00 $347.00 $54.88 $130.81 $92.84 2026-07-27
86780 HCPCS Treponema Pallidum Antibody, Immunassay 1 1 $116.00 $116.00 $92.80 $92.80 $92.80 2026-07-27
64493 HCPCS Lumbar W Fluro Level 1 Procedure Room 1 1 $880.00 $880.00 $91.86 $91.86 $91.86 2026-07-27
86769 HCPCS Sars CoV2 Ab (IgG) Immunoassay 1 1 $114.00 $114.00 $89.18 $89.18 $89.18 2026-07-27
86364 HCPCS Tissue Transglutami (tTG) Antibody (IgA) 1 1 $225.00 $225.00 $86.24 $86.24 $86.24 2026-07-27
80185 HCPCS Anticonvulsant 2 Dilantin Phen 1 1 $93.00 $93.00 $85.06 $85.06 $85.06 2026-07-27
27096 HCPCS Injection With US - Sacroiliac Joint 1 1 $369.00 $369.00 $84.57 $84.57 $84.57 2026-07-27
80201 HCPCS Topiramate (topamax Level) 1 1 $120.00 $120.00 $82.32 $82.32 $82.32 2026-07-27
99238 HCPCS Obs Discharge Less Than 30 Min Prof Fee 1 1 $208.00 $208.00 $82.10 $82.10 $82.10 2026-07-27
99212 HCPCS Est Pain Man Patient Level 2 PRO,Professional Component 2 2 $105.00 $105.00 $60.00 $103.50 $81.75 2026-07-27
80061 HCPCS Lipid Profile 4 4 $113.00 $113.00 $45.20 $112.18 $81.55 2026-07-27
93005 HCPCS EKG Hook Up & Connect 6 4 $115.00 $115.00 $46.00 $92.00 $79.35 2026-07-27
87624 HCPCS Hpv High-risk Types 2 2 $88.00 $88.00 $70.40 $88.00 $79.20 2026-07-27
51702 HCPCS Op Insertion Temporary Bladder Cath 3 2 $189.00 $189.00 $25.37 $91.20 $78.66 2026-07-27
87804 HCPCS Influenza Antigen A 3 3 $126.00 $126.00 $69.29 $80.80 $78.48 2026-07-27
83002 HCPCS Lh Luteinizing Hormone 2 2 $105.00 $105.00 $72.03 $84.00 $78.02 2026-07-27
51701 HCPCS Op Insertion Non-indwelling Bladder Cath 2 2 $141.00 $141.00 $56.40 $97.29 $76.84 2026-07-27
86753 HCPCS Babesia Duncani Wa1 Antibody IgG Ifa 1 1 $160.00 $160.00 $74.43 $74.43 $74.43 2026-07-27
83937 HCPCS Osteocalcin N-mid 1 1 $106.00 $106.00 $72.72 $72.72 $72.72 2026-07-27
84482 HCPCS T3 Reverse 2 2 $132.00 $132.00 $52.80 $90.55 $71.67 2026-07-27
87045 HCPCS Culture Stool 3 3 $92.00 $92.00 $57.70 $73.60 $71.48 2026-07-27
0710 RC — 4 4 $120.00 $120.00 $48.00 $92.40 $71.40 2026-07-27
81596 HCPCS Liver Fibrosis Fibro Test-acti Test Pane 1 1 $433.00 $433.00 $70.75 $70.75 $70.75 2026-07-27
80177 HCPCS Levetiracetam/keppra Level 2 2 $130.00 $130.00 $52.00 $89.18 $70.59 2026-07-27
G0103 HCPCS Psa Screening 4 4 $97.00 $97.00 $38.80 $97.00 $70.00 2026-07-27
86901 HCPCS .bb Rho D&du 1 1 $102.00 $102.00 $69.97 $69.97 $69.97 2026-07-27
80164 HCPCS Valproic Acid (depakene) 2 2 $136.00 $136.00 $54.40 $85.30 $69.85 2026-07-27
51798 HCPCS Bladder Scan 3 2 $92.00 $92.00 $36.80 $118.68 $68.80 2026-07-27
29260 HCPCS Strapping Elbow Or Wrist 1 1 $172.00 $172.00 $68.80 $68.80 $68.80 2026-07-27
Q9967 HCPCS Opti Ray Contrast 300-100ml 3 3 $135.00 $135.00 $54.00 $103.95 $67.50 2026-07-27
87591 HCPCS Gonorrhoeae Amplified DNA 1 1 $150.00 $150.00 $67.20 $67.20 $67.20 2026-07-27
87491 HCPCS C Trachomatis Amplified DNA 1 1 $150.00 $150.00 $67.20 $67.20 $67.20 2026-07-27
J2357 HCPCS Xolair 150mg Inj 1 1 $2,900.00 $2,900.00 $66.70 $66.70 $66.70 2026-07-27
82803 HCPCS Arterial Blood Gas Study 3 3 $97.00 $97.00 $38.80 $80.03 $66.54 2026-07-27
87420 HCPCS Rsv Antigen By Eia 3 3 $83.00 $83.00 $56.94 $68.48 $66.40 2026-07-27
84425 HCPCS Vitamin B-1 (thiamine) 2 2 $88.00 $88.00 $60.37 $70.40 $65.39 2026-07-27
86334 HCPCS Urine Conc For Immunoelectro 1 1 $80.00 $80.00 $65.17 $65.17 $65.17 2026-07-27
86664 HCPCS Epstein Barr Virus Ag Ebna 2 2 $91.00 $91.00 $57.08 $72.80 $64.94 2026-07-27
86021 HCPCS Anca Antineutrophil Cytoplasmic Ab Test1 2 2 $306.00 $306.00 $57.60 $72.00 $64.80 2026-07-27
87329 HCPCS Giardia Lamblia Antigen 2 2 $92.00 $92.00 $57.70 $71.48 $64.59 2026-07-27
84146 HCPCS Prolactin By Ria 2 2 $125.00 $125.00 $50.00 $78.40 $64.20 2026-07-27
J2360 HCPCS Orphenadrine (norflex) 60mg/2ml Inj 1 1 $78.00 $78.00 $62.40 $62.40 $62.40 2026-07-27
83605 HCPCS Lactic Acid - Plasma 3 3 $90.00 $90.00 $36.00 $69.93 $61.74 2026-07-27
82607 HCPCS Vitamin B-12 4 4 $87.00 $87.00 $34.80 $87.00 $61.08 2026-07-27
82679 HCPCS Estrone 1 1 $76.00 $76.00 $60.80 $60.80 $60.80 2026-07-27
J2543 HCPCS Piperacillin/tazo (zosyn) 4.5gm Inj 1 1 $27.00 $27.00 $60.80 $60.80 $60.80 2026-07-27
87040 HCPCS Culture Blood 3 3 $120.00 $120.00 $48.00 $82.32 $60.00 2026-07-27
96368 HCPCS IV Infusion Concurrent 1 1 $74.00 $74.00 $59.20 $59.20 $59.20 2026-07-27
83036 HCPCS Glycohemoglobin (Hb A1c) 4 4 $82.00 $82.00 $32.80 $81.30 $59.17 2026-07-27
87186 HCPCS Culture Sensitivity 3 3 $93.00 $93.00 $37.20 $72.45 $58.33 2026-07-27
87077 HCPCS Culture Aerobic Identification 4 4 $77.00 $77.00 $30.80 $77.00 $57.97 2026-07-27
82787 HCPCS Immunoglobulin G Subclass 4 2 2 $74.00 $74.00 $56.45 $59.20 $57.83 2026-07-27
82542 HCPCS Cannabinoids Quantitative 3 3 $198.00 $198.00 $36.80 $71.48 $57.70 2026-07-27
99211 HCPCS Op Treatment Room Level 1 2 2 $80.00 $80.00 $50.50 $64.00 $57.25 2026-07-27
86665 HCPCS Epstein Barr Virus Vca IgG Ab 2 2 $130.00 $130.00 $52.00 $61.15 $56.58 2026-07-27
84481 HCPCS Free T3 3 3 $90.00 $90.00 $36.00 $69.93 $56.45 2026-07-27
90471 HCPCS Immunization Inj (1st Inj) 1 1 $70.00 $70.00 $56.00 $56.00 $56.00 2026-07-27
82105 HCPCS Alpha-fetoprotein 1 1 $87.00 $87.00 $54.57 $54.57 $54.57 2026-07-27
88305 HCPCS Level 4 Surg Path Gross & Micro Exam,technical Component 2 2 $89.00 $89.00 $40.00 $69.00 $54.50 2026-07-27
84446 HCPCS Vitamin E (alph-tocopherol) 1 1 $86.00 $86.00 $53.94 $53.94 $53.94 2026-07-27
96376 HCPCS IV Push Inj. Same Drug-30min Later 3 2 $78.00 $78.00 $31.20 $62.40 $53.82 2026-07-27
84439 HCPCS T-4 (free Thyroxine) 4 4 $76.00 $76.00 $30.40 $75.52 $53.36 2026-07-27
93798 HCPCS Cardiac Rehab W ECG Monitoring 1 1 $132.00 $132.00 $52.80 $52.80 $52.80 2026-07-27
96367 HCPCS IV Infusion Add Sequential 2 2 $96.00 $96.00 $38.40 $66.24 $52.32 2026-07-27
80053 HCPCS Comprehensive Metabolic Panel 4 4 $89.00 $89.00 $35.60 $88.50 $52.16 2026-07-27
64494 HCPCS Lumbar W Fluro Level 2 Procedure Room 1 1 $237.50 $237.50 $51.96 $51.96 $51.96 2026-07-27
64484 HCPCS Injection Foramen Epidural Pro Fee,professional Component 1 1 $294.00 $294.00 $51.57 $51.57 $51.57 2026-07-27
87046 HCPCS Culture Stool Additional Pathogens 3 3 $63.00 $63.00 $39.51 $58.28 $50.40 2026-07-27
96375 HCPCS IV Push Inj. Each Add.push Dif Drug 4 2 $78.00 $78.00 $31.20 $53.82 $50.23 2026-07-27
J0780 HCPCS Prochlorperazine 5mg IV 1 1 $2.00 $2.00 $49.23 $49.23 $49.23 2026-07-27
90661 HCPCS Influenza Vaccine Flucelvax 25-26 0.5ml 2 2 $40.00 $40.00 $48.51 $48.51 $48.51 2026-07-27
96372 HCPCS IM Antibiotic Inj Each 3 2 $70.00 $70.00 $28.00 $56.00 $48.30 2026-07-27
82785 HCPCS Immunoglobulin IgE 1 1 $60.00 $60.00 $48.00 $48.00 $48.00 2026-07-27
82728 HCPCS Ferritin 4 4 $84.00 $84.00 $33.60 $84.00 $47.34 2026-07-27
96366 HCPCS IV Infusion/therapy Ea. Addl. Hr. 3 2 $68.00 $68.00 $27.20 $54.40 $46.92 2026-07-27
82330 HCPCS Ionized Calcium 1 1 $68.00 $68.00 $46.65 $46.65 $46.65 2026-07-27
80299 HCPCS Pemoline (cylert) 1 1 $129.00 $129.00 $46.41 $46.41 $46.41 2026-07-27
86140 HCPCS Comprehensive Anemia Profile Test 6 4 4 $72.00 $72.00 $28.80 $55.94 $46.38 2026-07-27
87088 HCPCS Culture Urine Routine 4 4 $89.00 $89.00 $35.60 $55.82 $45.59 2026-07-27
84484 HCPCS Troponin -i Quantitative 3 3 $75.00 $75.00 $37.50 $51.45 $45.57 2026-07-27
86255 HCPCS Anti Smooth Muscle Antibody 1 1 $66.00 $66.00 $45.28 $45.28 $45.28 2026-07-27
86235 HCPCS Arthritis Panel #3 Test 3 1 1 $32.00 $32.00 $45.20 $45.20 $45.20 2026-07-27
86618 HCPCS Lyme Disease Ab W Reflex To Blot IgG,IgM 1 1 $72.00 $72.00 $45.16 $45.16 $45.16 2026-07-27
86300 HCPCS Cancer Antigen 15 3 Breast An 1 1 $88.00 $88.00 $44.53 $44.53 $44.53 2026-07-27
86800 HCPCS Thyroid Sutoantibodies Test 1 1 1 $32.00 $32.00 $43.20 $43.20 $43.20 2026-07-27
82164 HCPCS Angiotensin Convert Enz 1 1 $54.00 $54.00 $43.20 $43.20 $43.20 2026-07-27
82746 HCPCS Folate-serum Folic Acid 2 2 $84.00 $84.00 $33.60 $52.68 $43.14 2026-07-27
20553 HCPCS Trigger Point 3 Or More Muscle Proc Room 1 1 $905.00 $905.00 $42.94 $42.94 $42.94 2026-07-27
20610 HCPCS Injection Of Major Joint 1 1 $144.00 $144.00 $42.40 $42.40 $42.40 2026-07-27
80048 HCPCS Basic Metabolic Panel 4 4 $71.00 $71.00 $28.40 $70.85 $42.11 2026-07-27
87522 HCPCS Hepatitis C V RNA Quantitative R-t Pcr 1 1 $717.00 $717.00 $41.98 $41.98 $41.98 2026-07-27
85379 HCPCS D-dimer 3 3 $61.00 $61.00 $30.50 $48.80 $41.85 2026-07-27
81025 HCPCS Urine Preg Test Hcg Qualitative 1 1 $52.00 $52.00 $41.60 $41.60 $41.60 2026-07-27
85730 HCPCS Ptt Lupus Anticoagulant 4 4 $54.00 $54.00 $34.99 $50.31 $41.44 2026-07-27
94761 HCPCS Six Minute Walk Multiple Pulse Oximetry 3 2 $75.00 $75.00 $30.00 $48.00 $41.40 2026-07-27
J0360 HCPCS Hydralazine (apresoline) Inj 20mg/ml 1 1 $51.00 $51.00 $40.80 $40.80 $40.80 2026-07-27
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