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

RUBY VALLEY MEDICAL CENTER

Sheridan, MT · CCN 271319 · Rates published

1,810 distinct procedures filed
6 distinct payers
39,384 rate rows
2026-02-27 last MRF observed
Data quality

35,280 of 39,384 rate rows are consumer-grade (89.6%)

4,104 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
professional (physician) fee — not the facility price 4,104
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://pricetransparency.healthcare/ruby-valley-medical-center/charges/export/
Found on page https://rvmc.org/cms-hpt.txt
Discovered viaCMS hospital list
Last fetch success · 2026-11-05
Content fingerprint a33a6527254249cf… · 17,146,276 bytes · first seen 2026-05-17

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
Q4282
HCPCS 		Cygnus Dual- 2x3 Sq Centimeter 6 $10,500.00 $262,500.00 $41,000.00 nat. median
$625
outlier · 65.6×
90197083
CDM 		Siemens Exl Service Contract 6 $12,250.00 $17,500.00 $16,625.00 nat. median
$16,625
1.0× median
J3101
HCPCS 		Tenecteplase Inj [50 Mg] 6 $8,554.70 $12,221.00 $11,609.95 nat. median
$4,042
outlier · 2.9×
J2506
HCPCS 		Pegfilgrastim Syr [6 Mg/0.6 Ml] Spec Ord 6 $7,547.40 $10,782.00 $10,242.90 nat. median
$1,662
outlier · 6.2×
90197134
CDM 		Id Now Influenza Bundle 6 $5,594.02 $7,991.45 $7,591.88 nat. median
$7,592
1.0× median
J2997
HCPCS 		Alteplase Inj [2 Mg/2 Ml] 6 $513.10 $15,524.00 $5,799.90 nat. median
$504
outlier · 11.5×
90197114
CDM 		Id Now Strep Bundle 6 $4,154.19 $5,934.55 $5,637.82 nat. median
$5,638
1.0× median
90197016
CDM 		Cepheid Genexpert Service Agreement 6 $3,899.70 $5,571.00 $5,292.45 nat. median
$5,292
1.0× median
J1459
HCPCS 		Immune Globulin [20 G] 10% 200ml Sdv 6 $1,005.90 $24,332.00 $5,039.26 nat. median
$1,409
outlier · 3.6×
J7168
HCPCS 		Prothrombin Complex 1000iu (kcentra) 6 $3,659.60 $5,228.00 $4,966.60 nat. median
$22
outlier · 224.4×
36561
HCPCS 		Insert Device Central Venous W/port >5yr 6 $3,580.50 $5,115.00 $4,859.25 nat. median
$3,733
1.3× median
64625
HCPCS 		Profee Rf Abltj Nrv Nrvtg Si Jt W/i 6 $3,537.10 $5,053.00 $4,800.35 nat. median
$2,466
1.9× median
64624
HCPCS 		Destruction Neurolytic Agt Genicular Ne 6 $3,331.30 $4,759.00 $4,521.05 nat. median
$2,287
2.0× median
1500213
CDM 		Pain Room Facility Level 3 6 $3,156.30 $4,509.00 $4,283.55 nat. median
$4,058
1.1× median
90197108
CDM 		Cepheid Ctng Startpak 6 $3,010.00 $4,300.00 $4,085.00 nat. median
$4,085
1.0× median
90197126
CDM 		Pathfast Service Contract 6 $2,796.50 $3,995.00 $3,795.25 nat. median
$3,795
1.0× median
G0390
HCPCS 		Trauma Activation 6 $2,755.20 $3,936.00 $3,739.20 nat. median
$3,222
1.2× median
20525
HCPCS 		ER Remove Fb Deep Or Comlicated 6 $2,654.40 $3,792.00 $3,602.40 nat. median
$2,884
1.2× median
72156
HCPCS 		Mr Cervical Spine W Wo Contrast 6 $2,576.00 $3,680.00 $3,496.00 nat. median
$1,096
outlier · 3.2×
72157
HCPCS 		Mr Thoracic Spine W Wo Contrast 6 $2,576.00 $3,680.00 $3,496.00 nat. median
$1,099
outlier · 3.2×
72158
HCPCS 		Mr Lumbar Spine W Wo Contrast 6 $2,576.00 $3,680.00 $3,496.00 nat. median
$1,083
outlier · 3.2×
74178
HCPCS 		CT Abdomen Pelvis W Wo Contrast 6 $2,491.30 $3,559.00 $3,381.05 nat. median
$1,023
outlier · 3.3×
1500212
CDM 		Pain Room Facility Level 2 6 $2,489.90 $3,557.00 $3,379.15 nat. median
$3,201
1.1× median
74183
HCPCS 		Mr Abdomen W Wo Contrast 6 $2,463.30 $3,519.00 $3,343.05 nat. median
$1,096
outlier · 3.1×
Q5108
HCPCS 		Pegfilgrastim Syr [6 Mg/0.6 Ml] Spec Ord 6 $2,455.60 $3,508.00 $3,332.60 nat. median
$1,244
outlier · 2.7×
73723
HCPCS 		Mr Hip Lt W Wo Contrast 6 $2,434.60 $3,478.00 $3,304.10 nat. median
$1,191
outlier · 2.8×
Q4186
HCPCS 		Epifix, 18 Mm Q4186 6 $1,919.40 $5,436.00 $3,273.60 nat. median
$449
outlier · 7.3×
Q9992
HCPCS 		Buprenorphine Inj [300 Mg/1.5 Ml] Sp Ord 6 $2,410.80 $3,444.00 $3,271.80 nat. median
$2,570
1.3× median
72197
HCPCS 		Mr Pelvis W Wo Contrast 6 $2,398.20 $3,426.00 $3,254.70 nat. median
$1,058
outlier · 3.1×
73223
HCPCS 		Mr Shoulder Lt W Wo Contrast 6 $2,377.90 $3,397.00 $3,227.15 nat. median
$1,166
outlier · 2.8×
71552
HCPCS 		Mr Chest W Wo Contrast 6 $2,342.90 $3,347.00 $3,179.65 nat. median
$1,089
outlier · 2.9×
70543
HCPCS 		Mr Orbit Face Neck W Wo Contrast 6 $2,296.70 $3,281.00 $3,116.95 nat. median
$1,080
outlier · 2.9×
74177
HCPCS 		CT Abdomen Pelvis W Contrast 6 $2,244.90 $3,207.00 $3,046.65 nat. median
$970
outlier · 3.1×
73220
HCPCS 		Mr Forearm Lt W Wo Contrast 6 $2,220.40 $3,172.00 $3,013.40 nat. median
$1,122
outlier · 2.7×
73720
HCPCS 		Mr Femur Lt W Wo Contrast 6 $2,216.90 $3,167.00 $3,008.65 nat. median
$1,123
outlier · 2.7×
45380
HCPCS 		Colonoscopy With Biopsy 45380 6 $2,198.70 $3,141.00 $2,983.95 nat. median
$1,558
1.9× median
70546
HCPCS 		MRA Head W Wo Contrast 6 $2,132.90 $3,047.00 $2,894.65 nat. median
$1,055
outlier · 2.7×
70549
HCPCS 		MRA Neck W Wo Contrast 6 $2,132.90 $3,047.00 $2,894.65 nat. median
$1,042
outlier · 2.8×
74174
HCPCS 		CTA Abdomen Pelvis W Contrast 6 $2,082.50 $2,975.00 $2,826.25 nat. median
$980
outlier · 2.9×
45378
HCPCS 		Colonoscopy 6 $2,074.10 $2,963.00 $2,814.85 nat. median
$1,342
outlier · 2.1×
45381
HCPCS 		Colonoscopy W/directed Submuc Inj 45381 6 $2,074.10 $2,963.00 $2,814.85 nat. median
$1,563
1.8× median
70553
HCPCS 		Mr Brain And Pituitary W Wo Contrast 6 $1,997.80 $3,657.00 $2,811.19 nat. median
$1,122
outlier · 2.5×
72147
HCPCS 		Mr Thoracic Spine W Contrast 6 $2,045.40 $2,922.00 $2,775.90 nat. median
$954
outlier · 2.9×
72149
HCPCS 		Mr Lumbar Spine W Contrast 6 $2,045.40 $2,922.00 $2,775.90 nat. median
$974
outlier · 2.9×
72142
HCPCS 		Mr Cervical Spine W Contrast 6 $2,045.40 $2,922.00 $2,775.90 nat. median
$965
outlier · 2.9×
43239
HCPCS 		Egd With Biopsy 43239 6 $2,044.70 $2,921.00 $2,774.95 nat. median
$1,370
outlier · 2.0×
73219
HCPCS 		Mr Humerus Lt W Contrast 6 $2,041.90 $2,917.00 $2,771.15 nat. median
$960
outlier · 2.9×
45384
HCPCS 		Colonoscopy W/remvl-hot Bpsy Fcps 45384 6 $2,018.10 $2,883.00 $2,738.85 nat. median
$1,584
1.7× median
45385
HCPCS 		Colonoscopy W/rmvl-snare Technq 45385 6 $2,017.40 $2,882.00 $2,737.90 nat. median
$1,666
1.6× median
70552
HCPCS 		Mr Brain W Contrast 6 $1,997.80 $2,854.00 $2,711.30 nat. median
$956
outlier · 2.8×

Other procedures at this hospital

Browse this hospital's 1,810 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
             
00731 HCPCS Anesthesia Endo 00731 16 6 $866.00 $779.40 $606.20 $866.00 $822.70 2026-02-27
00811 HCPCS Anesthesia Colonoscopy 00811 16 6 $867.00 $780.30 $606.90 $867.00 $823.65 2026-02-27
00812 HCPCS Anesthesia Colonoscopy 00812 16 6 $827.00 $744.30 $578.90 $827.00 $785.65 2026-02-27
00813 HCPCS Anesthesia Colon& Egd 00813 16 6 $833.00 $749.70 $583.10 $833.00 $791.35 2026-02-27
0202U OTHER Respiratory Panel, Nad Rvmc 16 6 $613.00 $551.70 $429.10 $613.00 $582.35 2026-02-27
100001 CDM Private Room 16 6 $1,736.00 $1,562.40 $1,215.20 $1,736.00 $1,649.20 2026-02-27
100002 CDM Private Room Isolation 16 6 $1,875.00 $1,687.50 $1,312.50 $1,875.00 $1,781.25 2026-02-27
1099999 CDM ER Miscellaneous 16 6 $914.00 $822.60 $639.80 $914.00 $868.30 2026-02-27
12032 HCPCS ER Repair Int S/a/t/e 2.6-7.5cm 16 6 $649.00 $584.10 $454.30 $649.00 $616.55 2026-02-27
12034 HCPCS ER Repair Int S/a/t/e 7.6-12cm 16 6 $731.00 $657.90 $511.70 $731.00 $694.45 2026-02-27
12035 HCPCS ER Repair Int S/a/t/e 12.6-20cm 16 6 $805.00 $724.50 $563.50 $805.00 $764.75 2026-02-27
12054 HCPCS ER Repair Int F/e/e/n/l 7.6-12.5cm 16 6 $660.00 $594.00 $462.00 $660.00 $627.00 2026-02-27
13120 HCPCS ER Repair Complex 1.1cm To 2.5 Scalp, Ar 16 6 $714.00 $642.60 $499.80 $714.00 $678.30 2026-02-27
13121 HCPCS ER Repair Complex 2.6cm To 7.5cm 16 6 $899.00 $809.10 $629.30 $899.00 $854.05 2026-02-27
13122 HCPCS ER Repair Complex Ea Addtl 5cm Or Less 16 6 $899.00 $809.10 $629.30 $899.00 $854.05 2026-02-27
13131 HCPCS ER Repair Complex 1.1-2.5 Cm 16 6 $734.00 $660.60 $513.80 $734.00 $697.30 2026-02-27
13132 HCPCS ER Repair Complex Fc/hn 2.6 To 7.5cm 16 6 $981.00 $882.90 $686.70 $981.00 $931.95 2026-02-27
1500212 CDM Pain Room Facility Level 2 16 6 $3,557.00 $3,201.30 $2,489.90 $3,557.00 $3,379.15 2026-02-27
1500213 CDM Pain Room Facility Level 3 16 6 $4,509.00 $4,058.10 $3,156.30 $4,509.00 $4,283.55 2026-02-27
15271 HCPCS Skin Subs Applic T,a,l 1-25 Sqcm 15271 16 6 $1,752.00 $1,576.80 $1,226.40 $1,752.00 $1,664.40 2026-02-27
15273 HCPCS Skin Subs Applic T,a,l 1st100 Sqcm 15273 16 6 $1,914.00 $1,722.60 $1,339.80 $1,914.00 $1,818.30 2026-02-27
15274 HCPCS Skin Subs Applic T,a,l Ea100+ Sqcm 15274 16 6 $815.00 $733.50 $570.50 $815.00 $774.25 2026-02-27
15275 HCPCS Skin Subs Applic H,ft,fc, 1-25sqcm 15275 16 6 $1,855.00 $1,669.50 $1,298.50 $1,855.00 $1,762.25 2026-02-27
15277 HCPCS Skin Sub Applic H,ft,fc 1st100sqcm 15277 16 6 $1,960.00 $1,764.00 $1,372.00 $1,960.00 $1,862.00 2026-02-27
15278 HCPCS Skin Subs App H,ft,fc Ea 100+ Sqcm 15278 16 6 $1,315.00 $1,183.50 $920.50 $1,315.00 $1,249.25 2026-02-27
20520 HCPCS ER Remove Fb Muscle/tendon Sheath Simple 16 6 $1,847.00 $1,662.30 $1,292.90 $1,847.00 $1,754.65 2026-02-27
20525 HCPCS ER Remove Fb Deep Or Comlicated 16 6 $3,792.00 $3,412.80 $2,654.40 $3,792.00 $3,602.40 2026-02-27
20605 HCPCS Inj And/or Aspir Jnt Intrmd Without US 20605 16 6 $672.00 $604.80 $470.40 $672.00 $638.40 2026-02-27
20610 HCPCS Op Major Joint Inj Without US 20610 16 6 $984.00 $885.60 $688.80 $984.00 $934.80 2026-02-27
20611 HCPCS Op Inj Major Joint W/us 20611 16 6 $1,042.00 $937.80 $729.40 $1,042.00 $989.90 2026-02-27
21315 HCPCS ER Closed Tx Nose Fx Without Stab 16 6 $1,042.00 $937.80 $729.40 $1,042.00 $989.90 2026-02-27
23655 HCPCS ER Treat Shoulder Dislocation 16 6 $1,195.00 $1,075.50 $836.50 $1,195.00 $1,135.25 2026-02-27
24200 HCPCS ER Remove Fb Upper Arm Elbow Area 16 6 $1,304.00 $1,173.60 $912.80 $1,304.00 $1,238.80 2026-02-27
24650 HCPCS Closed Treat Radial Head Without Mani 16 6 $652.00 $586.80 $456.40 $652.00 $619.40 2026-02-27
25505 HCPCS ER Closed Fx Wrist With Manipulation 16 6 $722.00 $649.80 $505.40 $722.00 $685.90 2026-02-27
25565 HCPCS Treat Fracture Radius & Ulna W/mani 16 6 $773.00 $695.70 $541.10 $773.00 $734.35 2026-02-27
25605 HCPCS Fx Closed Distal Radial With Manipul 16 6 $930.00 $837.00 $651.00 $930.00 $883.50 2026-02-27
26770 HCPCS ER Tx Disloc(i-p)jt Without Anes W/manip Clo 16 6 $724.00 $651.60 $506.80 $724.00 $687.80 2026-02-27
29581 HCPCS Ot Apply Multlay Comprs Lwr Leg 16 6 $664.00 $597.60 $464.80 $664.00 $630.80 2026-02-27
29584 HCPCS Ot Apply Multlay Comprs Upr Arm 16 6 $664.00 $597.60 $464.80 $664.00 $630.80 2026-02-27
300003 CDM Swing Bed 16 6 $1,447.00 $1,302.30 $1,012.90 $1,447.00 $1,374.65 2026-02-27
3007134 CDM Flutic/umeclid/vilan 100/62.5/25mcg Nf 16 6 $1,139.00 $1,025.10 $797.30 $1,139.00 $1,082.05 2026-02-27
3007191 CDM D/c Budesonide-formoterol Inh 80-4.5mcg 16 6 $756.20 $680.58 $529.34 $756.20 $718.39 2026-02-27
3007217 CDM Xx Tresiba 100u/1ml Inj 10ml 16 6 $726.00 $653.40 $508.20 $726.00 $689.70 2026-02-27
3007241 CDM Budesonide Formoterol 80/4.5 Inh Nf 16 6 $670.00 $603.00 $469.00 $670.00 $636.50 2026-02-27
3007247 CDM Netarsudil 0.02% Solution 2.5 Ml-nf 16 6 $677.40 $609.66 $474.18 $677.40 $643.53 2026-02-27
3007249 CDM Levemir 100u/ml 10ml Vial-nf 16 6 $702.60 $632.34 $491.82 $702.60 $667.47 2026-02-27
3007257 CDM Naltrexone 380mg Susp-inj-nf 16 6 $2,520.35 $2,268.32 $1,764.24 $2,520.35 $2,394.33 2026-02-27
3007262 CDM Brimonidine/timolol [0.2%/0.5%] 5ml Nf 16 6 $617.00 $555.30 $431.90 $617.00 $586.15 2026-02-27
3007298 CDM Ipratropium Hfa Inh (17 Mcg) Nf 16 6 $700.00 $630.00 $490.00 $700.00 $665.00 2026-02-27
3007386 CDM Mometasone Furoate 100mcg/5mcg Inh 16 6 $640.10 $576.09 $448.07 $640.10 $608.10 2026-02-27
3007393 CDM Xx Semaglutide Subq [0.68mg/ml] 16 6 $1,628.00 $1,465.20 $1,139.60 $1,628.00 $1,546.60 2026-02-27
3007411 CDM Xx Semaglutide Inj. 2.68mg/ml 16 6 $1,572.10 $1,414.89 $1,100.47 $1,572.10 $1,493.49 2026-02-27
3007581 CDM Omnipod 5 [10 Pod] Kit 16 6 $1,045.00 $940.50 $731.50 $1,045.00 $992.75 2026-02-27
31500 HCPCS ER Intubation, Endotracheal 31500 16 6 $641.00 $576.90 $448.70 $641.00 $608.95 2026-02-27
32551 HCPCS ER Insertion Of Chest Tube 16 6 $1,253.00 $1,127.70 $877.10 $1,253.00 $1,190.35 2026-02-27
32556 HCPCS Pleural Drng, Perc,w/ins Of Cath-without Ima 16 6 $2,196.00 $1,976.40 $1,537.20 $2,196.00 $2,086.20 2026-02-27
36430 HCPCS Bb Administration Blood/day 16 6 $668.00 $601.20 $467.60 $668.00 $634.60 2026-02-27
36556 HCPCS Treatment Rm 16 6 $1,649.00 $1,484.10 $1,154.30 $1,649.00 $1,566.55 2026-02-27
36561 HCPCS Insert Device Central Venous W/port >5yr 16 6 $5,115.00 $4,603.50 $3,580.50 $5,115.00 $4,859.25 2026-02-27
36569 HCPCS Insertion Of Picc Line 16 6 $1,970.00 $1,773.00 $1,379.00 $1,970.00 $1,871.50 2026-02-27
43235 HCPCS Egd 43235 16 6 $2,843.00 $2,558.70 $1,990.10 $2,843.00 $2,700.85 2026-02-27
43239 HCPCS Egd With Biopsy 43239 16 6 $2,921.00 $2,628.90 $2,044.70 $2,921.00 $2,774.95 2026-02-27
43246 HCPCS Tr Gi Services General 16 6 $2,499.00 $2,249.10 $1,749.30 $2,499.00 $2,374.05 2026-02-27
43248 HCPCS Egd With Dilitation 43248 16 6 $2,756.00 $2,480.40 $1,929.20 $2,756.00 $2,618.20 2026-02-27
45330 HCPCS Sigmoidoscopy 45330 16 6 $2,460.00 $2,214.00 $1,722.00 $2,460.00 $2,337.00 2026-02-27
45378 HCPCS Colonoscopy 16 6 $2,963.00 $2,666.70 $2,074.10 $2,963.00 $2,814.85 2026-02-27
45380 HCPCS Colonoscopy With Biopsy 45380 16 6 $3,141.00 $2,826.90 $2,198.70 $3,141.00 $2,983.95 2026-02-27
45381 HCPCS Colonoscopy W/directed Submuc Inj 45381 16 6 $2,963.00 $2,666.70 $2,074.10 $2,963.00 $2,814.85 2026-02-27
45382 HCPCS Colonoscopy W/control Of Bleedng 45382 16 6 $2,779.00 $2,501.10 $1,945.30 $2,779.00 $2,640.05 2026-02-27
45384 HCPCS Colonoscopy W/remvl-hot Bpsy Fcps 45384 16 6 $2,883.00 $2,594.70 $2,018.10 $2,883.00 $2,738.85 2026-02-27
45385 HCPCS Colonoscopy W/rmvl-snare Technq 45385 16 6 $2,882.00 $2,593.80 $2,017.40 $2,882.00 $2,737.90 2026-02-27
45388 HCPCS Colonoscopy W/ablation Guide Wire 45388 16 6 $2,630.00 $2,367.00 $1,841.00 $2,630.00 $2,498.50 2026-02-27
45900 HCPCS ER Reduction Of Rectal Prolapse 16 6 $863.00 $776.70 $604.10 $863.00 $819.85 2026-02-27
46040 HCPCS ER Incision Of Rectal Abscess 16 6 $1,042.00 $937.80 $729.40 $1,042.00 $989.90 2026-02-27
62270 HCPCS Tr Lumbar Puncture 16 6 $2,028.00 $1,825.20 $1,419.60 $2,028.00 $1,926.60 2026-02-27
62321 HCPCS Outpatient Injection Intrlam C-t 62321 16 6 $2,422.00 $2,179.80 $1,695.40 $2,422.00 $2,300.90 2026-02-27
62323 HCPCS Op Inj Intrlamin Lumab W/ima 62323 16 6 $2,349.00 $2,114.10 $1,644.30 $2,349.00 $2,231.55 2026-02-27
64405 HCPCS Op Inj Grter Occipt Nerve Block 64405 16 6 $669.00 $602.10 $468.30 $669.00 $635.55 2026-02-27
64415 HCPCS Op Inj Brachial Plexus W/imaging 64415 16 6 $669.00 $602.10 $468.30 $669.00 $635.55 2026-02-27
64417 HCPCS Op Inj Ane Agen Axillary Nerve 16 6 $1,768.00 $1,591.20 $1,237.60 $1,768.00 $1,679.60 2026-02-27
64418 HCPCS Op Inj Suprascapular Nerve 64418 16 6 $848.00 $763.20 $593.60 $848.00 $805.60 2026-02-27
64420 HCPCS Op Inj Intrcost Nerve Block Single 64420 16 6 $848.00 $763.20 $593.60 $848.00 $805.60 2026-02-27
64421 HCPCS Op Ij Intercostal Nrve Blk Ea Add 64421 16 6 $2,257.00 $2,031.30 $1,579.90 $2,257.00 $2,144.15 2026-02-27
64425 HCPCS Op Inj Ilioing/iliohypog Nv Block 64425 16 6 $822.00 $739.80 $575.40 $822.00 $780.90 2026-02-27
64445 HCPCS Op Inj Sciatic Nerve Block 64445 16 6 $1,935.00 $1,741.50 $1,354.50 $1,935.00 $1,838.25 2026-02-27
64447 HCPCS Op Inj Femoral Nerve Block 64447 16 6 $2,006.00 $1,805.40 $1,404.20 $2,006.00 $1,905.70 2026-02-27
64450 HCPCS ER N Block Of Peripheral Branch 32 6 $1,190.50 $1,071.45 $632.80 $1,477.00 $968.95 2026-02-27
64451 HCPCS Njx Aa&/strd Nrv Nrvtg Si Jt 64451 16 6 $1,413.00 $1,271.70 $989.10 $1,413.00 $1,342.35 2026-02-27
64454 HCPCS Op Into/inj Genicular Nerve Branch 64454 16 6 $695.00 $625.50 $486.50 $695.00 $660.25 2026-02-27
64461 HCPCS Pro Fee Pvb Thoracic 1st Level 16 6 $1,852.00 $1,666.80 $1,296.40 $1,852.00 $1,759.40 2026-02-27
64462 HCPCS Pro Fee Pvb Thoracic Add On Level 16 6 $975.00 $877.50 $682.50 $975.00 $926.25 2026-02-27
64479 HCPCS Op Inj Transfor C/t 1st 64479 16 6 $1,732.00 $1,558.80 $1,212.40 $1,732.00 $1,645.40 2026-02-27
64480 HCPCS Op Inj Op Inj Tranfor C/t Addtl 64480 16 6 $948.00 $853.20 $663.60 $948.00 $900.60 2026-02-27
64483 HCPCS Op Inj Op Inj Transfora L/s 1 64483 16 6 $2,485.00 $2,236.50 $1,739.50 $2,485.00 $2,360.75 2026-02-27
64484 HCPCS Op Inj Transfor L/s Add 64484 16 6 $840.00 $756.00 $588.00 $840.00 $798.00 2026-02-27
64490 HCPCS Op Inj Facet Jnt C/t 1l W/ima 64490 16 6 $1,588.00 $1,429.20 $1,111.60 $1,588.00 $1,508.60 2026-02-27
64491 HCPCS Op Inj Facet Jnt C/t 2nd Level 64491 16 6 $755.00 $679.50 $528.50 $755.00 $717.25 2026-02-27
64492 HCPCS Op Inj Facet Jnt C/t 3rdl Wim 64492 16 6 $771.00 $693.90 $539.70 $771.00 $732.45 2026-02-27
64493 HCPCS Op Inj Facet Jnt L/s 1l 64493 16 6 $1,615.00 $1,453.50 $1,130.50 $1,615.00 $1,534.25 2026-02-27
64494 HCPCS Op Inj Facet Jnt L/s 2 L 64494 16 6 $785.00 $706.50 $549.50 $785.00 $745.75 2026-02-27
64495 HCPCS Op Inj Facet Jnt L/s 3l + 64495 16 6 $748.00 $673.20 $523.60 $748.00 $710.60 2026-02-27
64505 HCPCS Op Inj Sphenopalgang Bloc 64505 16 6 $651.00 $585.90 $455.70 $651.00 $618.45 2026-02-27
64510 HCPCS Op Inj Stellate Gang Block 64510 16 6 $1,381.00 $1,242.90 $966.70 $1,381.00 $1,311.95 2026-02-27
64517 HCPCS Op Inj Sup Hypogstrc Plx Bl 64517 16 6 $1,317.00 $1,185.30 $921.90 $1,317.00 $1,251.15 2026-02-27
64520 HCPCS Op Inj Paravert Symp Block T/l 64520 16 6 $1,703.00 $1,532.70 $1,192.10 $1,703.00 $1,617.85 2026-02-27
64530 HCPCS Op Inj Celiac Plex Block 64530 16 6 $1,838.00 $1,654.20 $1,286.60 $1,838.00 $1,746.10 2026-02-27
64612 HCPCS Op Inj Destruction Of Facial Nerve 64612 16 6 $631.00 $567.90 $441.70 $631.00 $599.45 2026-02-27
64624 HCPCS Destruction Neurolytic Agt Genicular Ne 16 6 $4,759.00 $4,283.10 $3,331.30 $4,759.00 $4,521.05 2026-02-27
64625 HCPCS Profee Rf Abltj Nrv Nrvtg Si Jt W/i 16 6 $5,053.00 $4,547.70 $3,537.10 $5,053.00 $4,800.35 2026-02-27
64630 HCPCS Op Inj Destr Nero Agt, Pudendal Nv 64630 16 6 $1,762.00 $1,585.80 $1,233.40 $1,762.00 $1,673.90 2026-02-27
64633 HCPCS Op Inj Rfa C/t 1st Joint 64633 16 6 $2,330.00 $2,097.00 $1,631.00 $2,330.00 $2,213.50 2026-02-27
64634 HCPCS Op Inj Rfa C/t Ea Add On Jt 64634 16 6 $924.00 $831.60 $646.80 $924.00 $877.80 2026-02-27
64635 HCPCS Op Inj Rfa L/s 1st Joint 64635 16 6 $2,587.00 $2,328.30 $1,810.90 $2,587.00 $2,457.65 2026-02-27
64636 HCPCS Op Inj Rfa L/s Eadd Joint 64636 16 6 $1,294.00 $1,164.60 $905.80 $1,294.00 $1,229.30 2026-02-27
64640 HCPCS Op Ij Rfa Rfa Perph Nv/supscap 64640 16 6 $1,643.00 $1,478.70 $1,150.10 $1,643.00 $1,560.85 2026-02-27
64999 HCPCS Pro Fee Op Unlisted Procedure 64999 16 6 $1,588.00 $1,429.20 $1,111.60 $1,588.00 $1,508.60 2026-02-27
70336 HCPCS Mr Tmj 16 6 $2,113.00 $1,901.70 $1,479.10 $2,113.00 $2,007.35 2026-02-27
70450 HCPCS CT Head Wo Contrast 16 6 $1,518.00 $1,366.20 $1,062.60 $1,518.00 $1,442.10 2026-02-27
70460 HCPCS CT Head W Contrast 16 6 $1,769.00 $1,592.10 $1,238.30 $1,769.00 $1,680.55 2026-02-27
70470 HCPCS CT Head W Wo Contrast 16 6 $2,233.00 $2,009.70 $1,563.10 $2,233.00 $2,121.35 2026-02-27
70480 HCPCS CT Limited Orbits For MRI 32 6 $1,239.00 $1,115.10 $676.20 $1,512.00 $1,012.20 2026-02-27
70481 HCPCS CTA Orbit Ear Fossa W Contrast 32 6 $1,995.50 $1,795.95 $1,314.60 $2,113.00 $1,849.83 2026-02-27
70486 HCPCS CT Facial Bones Wo Contrast 16 6 $1,522.00 $1,369.80 $1,065.40 $1,522.00 $1,445.90 2026-02-27
70487 HCPCS CT Facial Bones W Contrast 16 6 $1,846.00 $1,661.40 $1,292.20 $1,846.00 $1,753.70 2026-02-27
70488 HCPCS CT Facial Bones W Wo Contrast 16 6 $2,124.00 $1,911.60 $1,486.80 $2,124.00 $2,017.80 2026-02-27
70490 HCPCS CT Soft Tissue Neck Wo Contrast 16 6 $1,539.00 $1,385.10 $1,077.30 $1,539.00 $1,462.05 2026-02-27
70491 HCPCS CT Soft Tissue Neck W Contrast 16 6 $1,957.00 $1,761.30 $1,369.90 $1,957.00 $1,859.15 2026-02-27
70492 HCPCS CT Soft Tissue Neck W Wo Contrast 16 6 $2,064.00 $1,857.60 $1,444.80 $2,064.00 $1,960.80 2026-02-27
70496 HCPCS CTA Head Circle Of Willis 16 6 $2,315.00 $2,083.50 $1,620.50 $2,315.00 $2,199.25 2026-02-27
70498 HCPCS CTA Neck 16 6 $2,297.00 $2,067.30 $1,607.90 $2,297.00 $2,182.15 2026-02-27
70540 HCPCS Mr Orbit Face Neck Wo Contrast 16 6 $2,298.00 $2,068.20 $1,608.60 $2,298.00 $2,183.10 2026-02-27
70542 HCPCS Mr Orbit Face Neck W Contrast 16 6 $2,651.00 $2,385.90 $1,855.70 $2,651.00 $2,518.45 2026-02-27
70543 HCPCS Mr Orbit Face Neck W Wo Contrast 16 6 $3,281.00 $2,952.90 $2,296.70 $3,281.00 $3,116.95 2026-02-27
70544 HCPCS MRA Head Wo Contrast 16 6 $2,292.00 $2,062.80 $1,604.40 $2,292.00 $2,177.40 2026-02-27
70545 HCPCS MRA Head W Contrast 16 6 $2,489.00 $2,240.10 $1,742.30 $2,489.00 $2,364.55 2026-02-27
70546 HCPCS MRA Head W Wo Contrast 16 6 $3,047.00 $2,742.30 $2,132.90 $3,047.00 $2,894.65 2026-02-27
70547 HCPCS MRA Neck Wo Contrast 16 6 $2,146.00 $1,931.40 $1,502.20 $2,146.00 $2,038.70 2026-02-27
70548 HCPCS MRA Neck W Contrast 16 6 $2,558.00 $2,302.20 $1,790.60 $2,558.00 $2,430.10 2026-02-27
70549 HCPCS MRA Neck W Wo Contrast 16 6 $3,047.00 $2,742.30 $2,132.90 $3,047.00 $2,894.65 2026-02-27
70551 HCPCS Mr Brain Wo Contrast 16 6 $2,460.00 $2,214.00 $1,722.00 $2,460.00 $2,337.00 2026-02-27
70552 HCPCS Mr Brain W Contrast 16 6 $2,854.00 $2,568.60 $1,997.80 $2,854.00 $2,711.30 2026-02-27
70553 HCPCS Mr Brain And Pituitary W Wo Contrast 32 6 $3,255.50 $2,929.95 $1,997.80 $3,657.00 $2,811.19 2026-02-27
71250 HCPCS CT Chest Wo Contrast 32 6 $1,044.50 $940.05 $344.40 $1,597.00 $804.95 2026-02-27
71260 HCPCS CT Chest W Contrast 16 6 $1,988.00 $1,789.20 $1,391.60 $1,988.00 $1,888.60 2026-02-27
71270 HCPCS CT Chest W Wo Contrast 16 6 $2,321.00 $2,088.90 $1,624.70 $2,321.00 $2,204.95 2026-02-27
71275 HCPCS CTA Chest Pe Study 16 6 $2,420.00 $2,178.00 $1,694.00 $2,420.00 $2,299.00 2026-02-27
71550 HCPCS Mr Chest Wo Contrast 16 6 $2,276.00 $2,048.40 $1,593.20 $2,276.00 $2,162.20 2026-02-27
71551 HCPCS Mr Chest W Contrast 16 6 $2,732.00 $2,458.80 $1,912.40 $2,732.00 $2,595.40 2026-02-27
71552 HCPCS Mr Chest W Wo Contrast 16 6 $3,347.00 $3,012.30 $2,342.90 $3,347.00 $3,179.65 2026-02-27
71555 HCPCS MRA Chest W Wo Contrast 16 6 $1,812.00 $1,630.80 $1,268.40 $1,812.00 $1,721.40 2026-02-27
72125 HCPCS CT Cervical Spine Wo Contrast 16 6 $1,708.00 $1,537.20 $1,195.60 $1,708.00 $1,622.60 2026-02-27
72126 HCPCS CT Cervical Spine W Contrast 16 6 $2,141.00 $1,926.90 $1,498.70 $2,141.00 $2,033.95 2026-02-27
72127 HCPCS CT Cervical Spine W Wo Contrast 16 6 $2,261.00 $2,034.90 $1,582.70 $2,261.00 $2,147.95 2026-02-27
72128 HCPCS CT Thoracic Spine Wo Contrast 16 6 $1,611.00 $1,449.90 $1,127.70 $1,611.00 $1,530.45 2026-02-27
72129 HCPCS CT Thoracic Spine W Contrast 16 6 $2,003.00 $1,802.70 $1,402.10 $2,003.00 $1,902.85 2026-02-27
72130 HCPCS CT Thoracic Spine W Wo Contrast 16 6 $2,288.00 $2,059.20 $1,601.60 $2,288.00 $2,173.60 2026-02-27
72131 HCPCS CT Lumbar Spine Wo Contrast 16 6 $1,616.00 $1,454.40 $1,131.20 $1,616.00 $1,535.20 2026-02-27
72132 HCPCS CT Lumbar Spine W Contrast 16 6 $2,165.00 $1,948.50 $1,515.50 $2,165.00 $2,056.75 2026-02-27
72133 HCPCS CT Lumbar Spine W Wo Contrast 16 6 $2,343.00 $2,108.70 $1,640.10 $2,343.00 $2,225.85 2026-02-27
72141 HCPCS Mr Cervical Spine Wo Contrast 16 6 $2,375.00 $2,137.50 $1,662.50 $2,375.00 $2,256.25 2026-02-27
72142 HCPCS Mr Cervical Spine W Contrast 16 6 $2,922.00 $2,629.80 $2,045.40 $2,922.00 $2,775.90 2026-02-27
72146 HCPCS Mr Thoracic Spine Wo Contrast 16 6 $2,518.00 $2,266.20 $1,762.60 $2,518.00 $2,392.10 2026-02-27
72147 HCPCS Mr Thoracic Spine W Contrast 16 6 $2,922.00 $2,629.80 $2,045.40 $2,922.00 $2,775.90 2026-02-27
72148 HCPCS Mr Lumbar Spine Wo Contrast 16 6 $2,375.00 $2,137.50 $1,662.50 $2,375.00 $2,256.25 2026-02-27
72149 HCPCS Mr Lumbar Spine W Contrast 16 6 $2,922.00 $2,629.80 $2,045.40 $2,922.00 $2,775.90 2026-02-27
72156 HCPCS Mr Cervical Spine W Wo Contrast 16 6 $3,680.00 $3,312.00 $2,576.00 $3,680.00 $3,496.00 2026-02-27
72157 HCPCS Mr Thoracic Spine W Wo Contrast 16 6 $3,680.00 $3,312.00 $2,576.00 $3,680.00 $3,496.00 2026-02-27
72158 HCPCS Mr Lumbar Spine W Wo Contrast 16 6 $3,680.00 $3,312.00 $2,576.00 $3,680.00 $3,496.00 2026-02-27
72191 HCPCS CTA Pelvis 16 6 $2,031.00 $1,827.90 $1,421.70 $2,031.00 $1,929.45 2026-02-27
72192 HCPCS CT Pelvis Wo Contrast 16 6 $1,546.00 $1,391.40 $1,082.20 $1,546.00 $1,468.70 2026-02-27
72193 HCPCS CT Pelvis W Contrast 16 6 $1,966.00 $1,769.40 $1,376.20 $1,966.00 $1,867.70 2026-02-27
72194 HCPCS CT Pelvis W Wo Contrast 16 6 $2,222.00 $1,999.80 $1,555.40 $2,222.00 $2,110.90 2026-02-27
72195 HCPCS Mr Pelvis Wo Contrast 16 6 $2,425.00 $2,182.50 $1,697.50 $2,425.00 $2,303.75 2026-02-27
72196 HCPCS Mr Pelvis W Contrast 16 6 $2,697.00 $2,427.30 $1,887.90 $2,697.00 $2,562.15 2026-02-27
72197 HCPCS Mr Pelvis W Wo Contrast 16 6 $3,426.00 $3,083.40 $2,398.20 $3,426.00 $3,254.70 2026-02-27
73030 HCPCS Xr Shoulder Lt 2-3 Views 80 6 $713.00 $641.70 $475.30 $1,019.00 $650.50 2026-02-27
73200 HCPCS CT Upper Extremity Lt Wo Contrast 32 6 $1,534.00 $1,380.60 $1,073.80 $1,534.00 $1,457.30 2026-02-27
73201 HCPCS CT Upper Extremity Lt W Contrast 32 6 $1,841.00 $1,656.90 $1,288.70 $1,841.00 $1,748.95 2026-02-27
73202 HCPCS CT Upper Extremity Lt W Wo Contrast 32 6 $1,878.00 $1,690.20 $1,314.60 $1,878.00 $1,784.10 2026-02-27
73206 HCPCS CTA Upper Extremity Lt W Wo 32 6 $2,025.00 $1,822.50 $1,417.50 $2,025.00 $1,923.75 2026-02-27
73218 HCPCS Mr Humerus Lt Wo Contrast 32 6 $2,222.00 $1,999.80 $1,555.40 $2,222.00 $2,110.90 2026-02-27
73219 HCPCS Mr Humerus Lt W Contrast 32 6 $2,917.00 $2,625.30 $2,041.90 $2,917.00 $2,771.15 2026-02-27
73220 HCPCS Mr Forearm Lt W Wo Contrast 32 6 $3,172.00 $2,854.80 $2,220.40 $3,172.00 $3,013.40 2026-02-27
73221 HCPCS Mr Shoulder Lt Wo Contrast 32 6 $2,249.00 $2,024.10 $1,574.30 $2,249.00 $2,136.55 2026-02-27
73222 HCPCS Mr Shoulder Lt W Contrast 32 6 $2,709.00 $2,438.10 $1,896.30 $2,709.00 $2,573.55 2026-02-27
73223 HCPCS Mr Shoulder Lt W Wo Contrast 32 6 $3,397.00 $3,057.30 $2,377.90 $3,397.00 $3,227.15 2026-02-27
73700 HCPCS CT Lower Extremity Lt Wo Contrast 32 6 $1,474.00 $1,326.60 $1,031.80 $1,474.00 $1,400.30 2026-02-27
73701 HCPCS CT Lower Extremity Lt W Contrast 32 6 $1,928.00 $1,735.20 $1,349.60 $1,928.00 $1,831.60 2026-02-27
73702 HCPCS CT Lower Extremity Lt W Wo Contrast 32 6 $2,115.50 $1,903.95 $1,444.80 $2,167.00 $1,960.80 2026-02-27
73706 HCPCS CTA Lower Extremity Bilat W Wo Contrast 16 6 $2,092.00 $1,882.80 $1,464.40 $2,092.00 $1,987.40 2026-02-27
73718 HCPCS Mr Femur Lt Wo Contrast 32 6 $2,255.00 $2,029.50 $1,578.50 $2,255.00 $2,142.25 2026-02-27
73719 HCPCS Mr Femur Lt W Contrast 32 6 $2,645.00 $2,380.50 $1,851.50 $2,645.00 $2,512.75 2026-02-27
73720 HCPCS Mr Femur Lt W Wo Contrast 32 6 $3,167.00 $2,850.30 $2,216.90 $3,167.00 $3,008.65 2026-02-27
73721 HCPCS Mr Hip Lt Wo Contrast 32 6 $2,413.00 $2,171.70 $1,689.10 $2,413.00 $2,292.35 2026-02-27
73722 HCPCS Mr Hip Lt W Contrast 32 6 $2,725.00 $2,452.50 $1,907.50 $2,725.00 $2,588.75 2026-02-27
73723 HCPCS Mr Hip Lt W Wo Contrast 32 6 $3,478.00 $3,130.20 $2,434.60 $3,478.00 $3,304.10 2026-02-27
74150 HCPCS CT Abdomen Wo Contrast 16 6 $1,631.00 $1,467.90 $1,141.70 $1,631.00 $1,549.45 2026-02-27
74160 HCPCS CT Abdomen W Contrast 16 6 $2,084.00 $1,875.60 $1,458.80 $2,084.00 $1,979.80 2026-02-27
74170 HCPCS CT Abdomen W Wo Contrast 16 6 $2,454.00 $2,208.60 $1,717.80 $2,454.00 $2,331.30 2026-02-27
74174 HCPCS CTA Abdomen Pelvis W Contrast 16 6 $2,975.00 $2,677.50 $2,082.50 $2,975.00 $2,826.25 2026-02-27
74176 HCPCS CT Abdomen Pelvis Wo Contrast 16 6 $2,519.00 $2,267.10 $1,763.30 $2,519.00 $2,393.05 2026-02-27
74177 HCPCS CT Abdomen Pelvis W Contrast 16 6 $3,207.00 $2,886.30 $2,244.90 $3,207.00 $3,046.65 2026-02-27
74178 HCPCS CT Abdomen Pelvis W Wo Contrast 16 6 $3,559.00 $3,203.10 $2,491.30 $3,559.00 $3,381.05 2026-02-27
74181 HCPCS Mr Abdomen Wo Contrast 16 6 $2,331.00 $2,097.90 $1,631.70 $2,331.00 $2,214.45 2026-02-27
74182 HCPCS Mr Abdomen W Contrast 16 6 $2,610.00 $2,349.00 $1,827.00 $2,610.00 $2,479.50 2026-02-27
74183 HCPCS Mr Abdomen W Wo Contrast 16 6 $3,519.00 $3,167.10 $2,463.30 $3,519.00 $3,343.05 2026-02-27
74185 HCPCS MRA Abdomen W Wo Contrast 16 6 $2,610.00 $2,349.00 $1,827.00 $2,610.00 $2,479.50 2026-02-27
74230 HCPCS Xr Cine/video Throat/esoph 16 6 $675.00 $607.50 $472.50 $675.00 $641.25 2026-02-27
75635 HCPCS CTA Aorta Iliac Runoff 32 6 $2,780.50 $2,502.45 $1,653.40 $3,199.00 $2,326.57 2026-02-27
75989 HCPCS US Radiologl Guidance Prq DRG W/plmt Cat 16 6 $1,673.00 $1,505.70 $1,171.10 $1,673.00 $1,589.35 2026-02-27
76377 HCPCS US 3d Render W/interp&postproc Diff Work 16 6 $885.00 $796.50 $619.50 $885.00 $840.75 2026-02-27
76380 HCPCS CT Limited Follow-up 16 6 $737.00 $663.30 $515.90 $737.00 $700.15 2026-02-27
76506 HCPCS Echoencephalography Real Time Imaging 16 6 $668.00 $601.20 $467.60 $668.00 $634.60 2026-02-27
76776 HCPCS US Trnsplnt Kidney Real Time W/image Doc 16 6 $847.00 $762.30 $592.90 $847.00 $804.65 2026-02-27
76819 HCPCS US Fetal Biophys Prof Without Non Stress Tes 16 6 $673.00 $605.70 $471.10 $673.00 $639.35 2026-02-27
76825 HCPCS Echo Exam Of Fetal Heart 16 6 $1,451.00 $1,305.90 $1,015.70 $1,451.00 $1,378.45 2026-02-27
76942 HCPCS Xr Ultrasound Needle Guid 76942 16 6 $1,194.00 $1,074.60 $835.80 $1,194.00 $1,134.30 2026-02-27
81219 HCPCS Calr Mutation (myeloproliferative Analy 16 6 $970.00 $873.00 $679.00 $970.00 $921.50 2026-02-27
81220 HCPCS Lab Cftr Gene Com Variants 16 6 $649.00 $584.10 $454.30 $649.00 $616.55 2026-02-27
8126770 CDM Tx Disloc Jt Without Anes W/manip Clo 16 6 $642.00 $577.80 $449.40 $642.00 $609.90 2026-02-27
81339 HCPCS Mpl Exon 10 Mutation Code 16 6 $950.00 $855.00 $665.00 $950.00 $902.50 2026-02-27
86041 HCPCS Anti Musk Antibody 16 6 $850.00 $765.00 $595.00 $850.00 $807.50 2026-02-27
87150 HCPCS Lab Dna/rna Amplified Probe Id 16 6 $1,123.00 $1,010.70 $786.10 $1,123.00 $1,066.85 2026-02-27
87507 HCPCS Biofire Gi Panel Rvmc 32 6 $910.50 $819.45 $554.40 $1,029.00 $780.12 2026-02-27
87536 HCPCS HIV-1 RNA Quantitative, Pcr (550880) 16 6 $1,154.00 $1,038.60 $807.80 $1,154.00 $1,096.30 2026-02-27
87633 HCPCS Lab Comp Respiratory Panel 16 6 $739.00 $665.10 $517.30 $739.00 $702.05 2026-02-27
87799 HCPCS Ebv, Quantitative, Pcr (138230) 16 6 $630.00 $567.00 $441.00 $630.00 $598.50 2026-02-27
87901 HCPCS Lab HIV-1 Genotype 16 6 $770.00 $693.00 $539.00 $770.00 $731.50 2026-02-27
88262 HCPCS Lab Chromosone Routine 16 6 $687.00 $618.30 $480.90 $687.00 $652.65 2026-02-27
90197016 CDM Cepheid Genexpert Service Agreement 16 6 $5,571.00 $5,013.90 $3,899.70 $5,571.00 $5,292.45 2026-02-27
90197024 CDM Pathfast Ntprobnp(60tests/bx) D/s 16 6 $1,584.74 $1,426.27 $1,109.32 $1,584.74 $1,505.50 2026-02-27
90197025 CDM Pathfast D-dimer(60tests/bx) D/s 16 6 $620.10 $558.09 $434.07 $620.10 $589.10 2026-02-27
90197081 CDM Cepheid Vaginal Mvp Panel 16 6 $1,104.41 $993.97 $773.09 $1,104.41 $1,049.19 2026-02-27
90197083 CDM Siemens Exl Service Contract 16 6 $17,500.00 $15,750.00 $12,250.00 $17,500.00 $16,625.00 2026-02-27
90197091 CDM Procalcitonin Assay 16 6 $2,800.00 $2,520.00 $1,960.00 $2,800.00 $2,660.00 2026-02-27
90197094 CDM Vitamin D Assay 16 6 $1,250.00 $1,125.00 $875.00 $1,250.00 $1,187.50 2026-02-27
90197108 CDM Cepheid Ctng Startpak 16 6 $4,300.00 $3,870.00 $3,010.00 $4,300.00 $4,085.00 2026-02-27
90197113 CDM Millipore Repair 16 6 $2,787.43 $2,508.69 $1,951.20 $2,787.43 $2,648.06 2026-02-27
90197114 CDM Id Now Strep Bundle 16 6 $5,934.55 $5,341.10 $4,154.19 $5,934.55 $5,637.82 2026-02-27
90197126 CDM Pathfast Service Contract 16 6 $3,995.00 $3,595.50 $2,796.50 $3,995.00 $3,795.25 2026-02-27
90197134 CDM Id Now Influenza Bundle 16 6 $7,991.45 $7,192.31 $5,594.02 $7,991.45 $7,591.88 2026-02-27
90375 HCPCS Rabies Immune Globulin [150iu/ml] 2ml 16 6 $1,253.00 $1,127.70 $877.10 $1,253.00 $1,190.35 2026-02-27
90675 HCPCS Vac - Rabies Vaccine 16 6 $845.00 $760.50 $591.50 $845.00 $802.75 2026-02-27
92610 HCPCS St Eval Of Oral&pharyngeal Swallowing F 16 6 $677.00 $609.30 $473.90 $677.00 $643.15 2026-02-27
92611 HCPCS St Video Study Motion Fluoroscopic Eval 16 6 $796.00 $716.40 $557.20 $796.00 $756.20 2026-02-27
92950 HCPCS ER Cardiopulmonary Resuscitation 16 6 $875.00 $787.50 $612.50 $875.00 $831.25 2026-02-27
92960 HCPCS ER Cardioversion Elective External(defib 16 6 $1,537.00 $1,383.30 $1,075.90 $1,537.00 $1,460.15 2026-02-27
93017 HCPCS Cardiovascular Stress Test 16 6 $1,372.00 $1,234.80 $960.40 $1,372.00 $1,303.40 2026-02-27
93303 HCPCS US Complete Tthrc Echo Congeni Cardiac A 16 6 $631.00 $567.90 $441.70 $631.00 $599.45 2026-02-27
93306 HCPCS Echo Complete 16 6 $1,906.00 $1,715.40 $1,334.20 $1,906.00 $1,810.70 2026-02-27
93308 HCPCS Echo Limited 16 6 $783.00 $704.70 $548.10 $783.00 $743.85 2026-02-27
93325 HCPCS US Doppler Color Flow Add-on 16 6 $941.00 $846.90 $658.70 $941.00 $893.95 2026-02-27
93350 HCPCS (do Not Use) Stress Echo With Contrast 32 6 $2,401.00 $2,160.90 $1,514.10 $2,639.00 $2,130.56 2026-02-27
93880 HCPCS US Carotid Bilateral 16 6 $694.00 $624.60 $485.80 $694.00 $659.30 2026-02-27
93886 HCPCS US Transcranial Doppler Stdy Intracran A 16 6 $1,303.00 $1,172.70 $912.10 $1,303.00 $1,237.85 2026-02-27
93888 HCPCS US Transcranial Doppler Stdy Intracranil 16 6 $757.00 $681.30 $529.90 $757.00 $719.15 2026-02-27
93892 HCPCS US Transcranl Doppler Intracran Art Embo 16 6 $781.00 $702.90 $546.70 $781.00 $741.95 2026-02-27
93893 HCPCS US Transcran Dopl Intracran Art Microbub 16 6 $709.00 $638.10 $496.30 $709.00 $673.55 2026-02-27
93925 HCPCS US Lower Ext Arterial Duplex Bilateral 16 6 $668.00 $601.20 $467.60 $668.00 $634.60 2026-02-27
93930 HCPCS US Upper Ext Arterial Duplex Bilateral 16 6 $945.00 $850.50 $661.50 $945.00 $897.75 2026-02-27
93970 HCPCS US Venous Dopp Lower Ext Biilateral 16 6 $735.00 $661.50 $514.50 $735.00 $698.25 2026-02-27
93975 HCPCS US Dup-scan Artl Flo Abd/pel/scro/rpr Or 16 6 $708.00 $637.20 $495.60 $708.00 $672.60 2026-02-27
96413 HCPCS Initial Hour Of Chemo Infusion 16 6 $890.00 $801.00 $623.00 $890.00 $845.50 2026-02-27
97167 HCPCS Ot Eval High Complex 16 6 $609.00 $548.10 $426.30 $609.00 $578.55 2026-02-27
99283 HCPCS ER Room/op Room Intermediate 99283 16 6 $758.00 $682.20 $530.60 $758.00 $720.10 2026-02-27
99284 HCPCS ER Room/op Room Extended 99284 16 6 $1,221.00 $1,098.90 $854.70 $1,221.00 $1,159.95 2026-02-27
99285 HCPCS ER Room/op Room Comprehensive 99285 16 6 $1,823.00 $1,640.70 $1,276.10 $1,823.00 $1,731.85 2026-02-27
99291 HCPCS Critical Care 1st Hour 16 6 $2,639.00 $2,375.10 $1,847.30 $2,639.00 $2,507.05 2026-02-27
99292 HCPCS Critical Care (ea 1/2 Hr) 16 6 $628.00 $565.20 $439.60 $628.00 $596.60 2026-02-27
A0426 HCPCS Ambulance Als Non Emergent 16 6 $1,703.00 $1,532.70 $1,192.10 $1,703.00 $1,617.85 2026-02-27
A0427 HCPCS Ambulance Als Emergent 16 6 $2,260.00 $2,034.00 $1,582.00 $2,260.00 $2,147.00 2026-02-27
A0428 HCPCS Ambulance Bls Non Emergent 16 6 $1,058.00 $952.20 $740.60 $1,058.00 $1,005.10 2026-02-27
A0429 HCPCS Ambulance Bls Emergent 16 6 $1,481.00 $1,332.90 $1,036.70 $1,481.00 $1,406.95 2026-02-27
A0433 HCPCS Ambulance Als 2 Emergent 32 6 $1,475.00 $1,327.50 $116.90 $2,783.00 $1,057.55 2026-02-27
G0105 HCPCS Colonoscopy Screen-pt High Risk G0105 16 6 $2,822.00 $2,539.80 $1,975.40 $2,822.00 $2,680.90 2026-02-27
G0121 HCPCS Colonoscopy Scrn-not Mtg High Risk G0121 16 6 $2,795.00 $2,515.50 $1,956.50 $2,795.00 $2,655.25 2026-02-27
G0390 HCPCS Trauma Activation 16 6 $3,936.00 $3,542.40 $2,755.20 $3,936.00 $3,739.20 2026-02-27
J0132 HCPCS Acetylcysteine Inj (200mg/ml) 30ml 16 6 $665.00 $598.50 $465.50 $665.00 $631.75 2026-02-27
J0561 HCPCS Penicillin G Benz Inj [1,200,000 U/2 Ml] 16 6 $633.00 $569.70 $443.10 $633.00 $601.35 2026-02-27
J0585 HCPCS Botulinum Toxin 100un Vial 16 6 $1,065.20 $958.68 $745.64 $1,065.20 $1,011.94 2026-02-27
J0841 HCPCS Crotalidae Immune Fab2 Vial 16 6 $2,218.00 $1,996.20 $1,552.60 $2,218.00 $2,107.10 2026-02-27
J0881 HCPCS Darbepoetin Alfa [40 Mcg/ Ml] Pfs Sp Ord 16 6 $706.00 $635.40 $494.20 $706.00 $670.70 2026-02-27
J0885 HCPCS Epoetin Alfa Inj [10,000 U/ml] Spec Ord 16 6 $640.00 $576.00 $448.00 $640.00 $608.00 2026-02-27
J0897 HCPCS Denosumab Inj [60 Mg/ml] Spec Order 16 6 $2,530.00 $2,277.00 $1,771.00 $2,530.00 $2,403.50 2026-02-27
J1442 HCPCS Filgrastim Inj [480 Mcg/0.8 Ml] 16 6 $893.00 $803.70 $625.10 $893.00 $848.35 2026-02-27
J1447 HCPCS Filgrastim Inj [480 Mcg/0.8 Ml] Pfs 16 6 $893.00 $803.70 $625.10 $893.00 $848.35 2026-02-27
J1459 HCPCS Immune Globulin [20 G] 10% 200ml Sdv 96 6 $5,426.00 $4,883.40 $1,005.90 $24,332.00 $5,039.26 2026-02-27
J1670 HCPCS Tetanus Immune Globulin Syr. 250 Units 16 6 $1,058.90 $953.01 $741.23 $1,058.90 $1,005.96 2026-02-27
J2506 HCPCS Pegfilgrastim Syr [6 Mg/0.6 Ml] Spec Ord 16 6 $10,782.00 $9,703.80 $7,547.40 $10,782.00 $10,242.90 2026-02-27
J2997 HCPCS Alteplase Inj [2 Mg/2 Ml] 32 6 $8,128.50 $7,315.65 $513.10 $15,524.00 $5,799.90 2026-02-27
J3101 HCPCS Tenecteplase Inj [50 Mg] 16 6 $12,221.00 $10,998.90 $8,554.70 $12,221.00 $11,609.95 2026-02-27
J3590 HCPCS Semaglutide Sq Inj [1 Mg/0.75 Ml] Sp Ord 32 6 $1,146.00 $1,031.40 $431.20 $1,676.00 $894.60 2026-02-27
J7168 HCPCS Prothrombin Complex 1000iu (kcentra) 16 6 $5,228.00 $4,705.20 $3,659.60 $5,228.00 $4,966.60 2026-02-27
P9016 HCPCS Bb Blood Packed Cells 16 6 $699.00 $629.10 $489.30 $699.00 $664.05 2026-02-27
Q4186 HCPCS Epifix, 18 Mm Q4186 32 6 $4,089.00 $3,680.10 $1,919.40 $5,436.00 $3,273.60 2026-02-27
Q4282 HCPCS Cygnus Dual- 2x3 Sq Centimeter 64 6 $50,000.00 $45,000.00 $10,500.00 $262,500.00 $41,000.00 2026-02-27
Q5108 HCPCS Pegfilgrastim Syr [6 Mg/0.6 Ml] Spec Ord 16 6 $3,508.00 $3,157.20 $2,455.60 $3,508.00 $3,332.60 2026-02-27
Q5125 HCPCS Filgrastim Inj [300 Mcg/0.5 Ml] Spec Ord 16 6 $611.00 $549.90 $427.70 $611.00 $580.45 2026-02-27
Q9992 HCPCS Buprenorphine Inj [300 Mg/1.5 Ml] Sp Ord 16 6 $3,444.00 $3,099.60 $2,410.80 $3,444.00 $3,271.80 2026-02-27
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