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

PONDERA MEDICAL CENTER

Conrad, MT · CCN 271324 · Rates published

Your selected procedure

You selected 93306 (HCPCS)

Ultrasound of heart with color-depicted blood flow, rate, direction and valve function

This hospital’s price: $1,949 across 8 payers · range $220-$2,052

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbPonderaConradMT&type=CDMWithoutLabel&fileType=CSV · observed 2024-02-08

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.

2,344 distinct procedures filed
38 distinct payers
36,526 rate rows
2024-12-01 last MRF observed · ⚠ 22 mo old
Data quality

32,217 of 36,526 rate rows are consumer-grade (88.2%)

4,309 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 3,956
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 353

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 22 months old.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://hospitalpricedisclosure.com/Download.aspx?pi=7Ibd9esQPMReZy5CCZbmTw*-*
Found on page https://hospitalpricedisclosure.com/Default.aspx?pi=7Ibd9esQPMReZy5CCZbmTw*-*
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-20
Content fingerprint b242f3341f9ba682… · 792,013 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
Q2043
HCPCS 		Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 8 $39,369.04 $57,500.00 $54,625.00 nat. median
$65,720
0.8× median
Q4105
HCPCS 		Integra Dermal Regeneration Template (drt) Or Integra Omnigraft Dermal Regenerat… 8 $32,575.40 $38,324.00 $36,791.04 nat. median
$198
outlier · 185.9×
J2323
HCPCS 		Injection, Natalizumab, 1 Mg 8 $16.84 $24,631.17 $23,399.61 nat. median
$180
outlier · 130.2×
J3380
HCPCS 		Injection, Vedolizumab, 1 Mg 8 $18,818.28 $22,139.15 $21,253.58 nat. median
$155
outlier · 137.5×
436
MS_DRG 		Malignancy Of Hepatobiliary System Or Pancreas With Cc 1 $12,865.44 $12,865.44 $12,865.44 nat. median
$11,448
1.1× median
387
MS_DRG 		Inflammatory Bowel Disease Without Cc/Mcc 1 $12,501.47 $12,501.47 $12,501.47 nat. median
$7,478
1.7× median
C1783
HCPCS 		Ocular Implant, Aqueous Drainage Assist Device 8 $9,286.25 $13,537.50 $10,925.00 nat. median
$2,321
outlier · 4.7×
J1602
HCPCS 		Injection, Golimumab, 1 Mg, For Intravenous Use 8 $27.08 $11,427.13 $10,855.77 nat. median
$261
outlier · 41.6×
J7168
HCPCS 		Prothrombin Complex Concentrate (human), Kcentra, Per I.u. Of Factor Ix Activity 8 $8,499.15 $9,999.00 $9,599.04 nat. median
$20
outlier · 471.9×
205
MS_DRG 		Other Respiratory System Diagnoses With Mcc 2 $9,300.28 $9,300.28 $9,300.28 nat. median
$17,357
0.5× median
194
MS_DRG 		Simple Pneumonia And Pleurisy With Cc 1 $9,249.24 $9,249.24 $9,249.24 nat. median
$8,522
1.1× median
66
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc 1 $9,249.24 $9,249.24 $9,249.24 nat. median
$7,567
1.2× median
897
MS_DRG 		Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc 1 $8,444.60 $8,444.60 $8,444.60 nat. median
$8,362
1.0× median
Q4104
HCPCS 		Integra Bilayer Matrix Wound Dressing (bmwd), Per Square Centimeter 8 $7,003.15 $8,239.00 $7,909.44 nat. median
$329
outlier · 24.0×
392
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 1 $7,504.48 $7,504.48 $7,504.48 nat. median
$8,186
0.9× median
193
MS_DRG 		Simple Pneumonia And Pleurisy With Mcc 2 $5,592.81 $5,592.81 $5,592.81 nat. median
$12,877
outlier · 0.4×
390
MS_DRG 		Gastrointestinal Obstruction Without Cc/mcc 1 $5,559.75 $5,559.75 $5,559.75 nat. median
$6,125
0.9× median
Q5103
HCPCS 		Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 8 $94.28 $5,374.10 $5,105.40 nat. median
$285
outlier · 17.9×
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 1 $5,087.79 $5,087.79 $5,087.79 nat. median
$18,659
outlier · 0.3×
64856
HCPCS 		Suture And Relocation Of Arm Or Leg Peripheral Nerve 8 $3,933.80 $4,628.00 $4,442.88 nat. median
$6,196
0.7× median
81439
HCPCS 		Test For Detecting Genes Associated With Inherited Disease Of Heart Muscle 8 $789.62 $4,735.75 $4,174.00 nat. median
$1,053
outlier · 4.0×
59618
HCPCS 		Cesarean Delivery And Care Before And After Delivery Following Attempted Vaginal… 8 $3,939.84 $10,944.00 $4,051.81 nat. median
$3,504
1.2× median
64
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Mcc 1 $4,047.86 $4,047.86 $4,047.86 nat. median
$19,268
outlier · 0.2×
59510
HCPCS 		Cesarean Delivery With Care Before And After Delivery 8 $3,889.68 $10,830.40 $4,000.23 nat. median
$3,631
1.1× median
74183
HCPCS 		MRI Scan Of Abdomen Before And After Contrast 8 $461.31 $4,180.00 $3,971.00 nat. median
$1,105
outlier · 3.6×
59610
HCPCS 		Vaginal Delivery And Care Before And After Delivery After Previous Cesarean Deli… 8 $3,690.18 $10,256.00 $3,795.06 nat. median
$3,322
1.1× median
81410
HCPCS 		Test For Detecting Genes Associated With Heart Disease, Genomic Sequence Analysi… 8 $680.40 $3,948.25 $3,750.84 nat. median
$737
outlier · 5.1×
21337
HCPCS 		Closed Treatment Of Broken Bone Separating Nose Airways 8 $3,291.20 $3,872.00 $3,717.12 nat. median
$3,235
1.1× median
74182
HCPCS 		MRI Scan Of Abdomen With Contrast 8 $433.90 $3,823.00 $3,631.85 nat. median
$976
outlier · 3.7×
70553
HCPCS 		MRI Scan Of Brain Before And After Contrast 8 $409.41 $3,810.00 $3,619.50 nat. median
$1,136
outlier · 3.2×
59400
HCPCS 		Vaginal Delivery With Care Before And After Delivery 8 $3,507.21 $9,809.60 $3,606.89 nat. median
$3,129
1.2× median
49618
HCPCS 		Repair Of Recurrent Entrapped Hernia Of Abdomen, More Than 10 Cm In Length 8 $2,184.70 $4,993.60 $3,589.15 nat. median
$4,647
0.8× median
81448
HCPCS 		Gene Analysis Panel For Hereditary Disorders Of The Peripheral Nervous System 8 $789.62 $3,705.00 $3,519.75 nat. median
$1,053
outlier · 3.3×
71552
HCPCS 		MRI Scan Of Chest Before And After Contrast 8 $723.17 $3,687.00 $3,502.65 nat. median
$1,103
outlier · 3.2×
72197
HCPCS 		MRI Scan Of Pelvis Before And After Contrast 8 $460.14 $3,684.00 $3,499.80 nat. median
$1,074
outlier · 3.3×
43632
HCPCS 		Removal Of Lower Part Of Stomach With Reattachment Of Remaining Stomach To Secon… 8 $3,382.95 $8,350.40 $3,479.10 nat. median
$3,244
1.1× median
74178
HCPCS 		CT Scan Of Abdomen And Pelvis Before And After Contrast 8 $437.98 $3,625.00 $3,443.75 nat. median
$1,027
outlier · 3.4×
74174
HCPCS 		CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 8 $484.06 $3,606.00 $3,425.70 nat. median
$998
outlier · 3.4×
72156
HCPCS 		MRI Scan Of Upper Spinal Canal Before And After Contrast 8 $414.07 $3,570.00 $3,391.50 nat. median
$1,110
outlier · 3.1×
26951
HCPCS 		Amputation Of Finger Or Thumb With Direct Closure 8 $1,091.55 $4,706.00 $3,388.00 nat. median
$3,320
1.0× median
C1889
HCPCS 		Implantable/insertable Device, Not Otherwise Classified 8 $2,996.25 $3,525.00 $3,384.00 nat. median
$2,362
1.4× median
72158
HCPCS 		MRI Scan Of Lower Spinal Canal Before And After Contrast 8 $412.91 $3,527.00 $3,350.65 nat. median
$1,097
outlier · 3.1×
73723
HCPCS 		MRI Scan Of Leg Joint Before And After Contrast 8 $563.37 $3,509.00 $3,333.55 nat. median
$1,199
outlier · 2.8×
44147
HCPCS 		Partial Removal Of Large Bowel Through Abdomen And Anus 8 $3,214.80 $7,905.60 $3,306.17 nat. median
$3,323
1.0× median
72157
HCPCS 		MRI Scan Of Middle Spinal Canal Before And After Contrast 8 $415.24 $3,468.00 $3,294.60 nat. median
$1,114
outlier · 3.0×
90378
HCPCS 		Respiratory Syncytial Virus Antibody For Injection Into Tissue Or Muscle 8 $1,375.01 $3,438.00 $3,266.10 nat. median
$2,117
1.5× median
66986
HCPCS 		Exchange Of Prosthetic Lens 8 $2,890.00 $3,400.00 $3,264.00 nat. median
$2,898
1.1× median
73720
HCPCS 		MRI Scan Of Leg Before And After Contrast 8 $463.64 $3,364.00 $3,195.80 nat. median
$1,135
outlier · 2.8×
45382
HCPCS 		Control Of Bleeding Of Upper Large Bowel Using A Flexible Endoscope 8 $426.36 $4,121.00 $3,175.43 nat. median
$1,744
1.8× median
44150
HCPCS 		Removal Of Large Bowel With Attachment Of Small Bowel To Rectum Or Creation Of O… 8 $3,087.12 $7,598.40 $3,174.86 nat. median
$3,333
1.0× median

Other procedures at this hospital

Browse this hospital's 2,344 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
Q2043 HCPCS Sipuleucel-t, Minimum Of 50 Million Autologous Cd54+ Cells Activated With Pap-gm… 11 8 $57,500.00 $48,875.00 $39,369.04 $57,500.00 $54,625.00 2024-02-08
Q4105 HCPCS Integra Dermal Regeneration Template (drt) Or Integra Omnigraft Dermal Regenerat… 8 8 $38,324.00 $32,575.40 $32,575.40 $38,324.00 $36,791.04 2024-02-08
J2323 HCPCS Injection, Natalizumab, 1 Mg 11 8 $24,631.17 $20,936.49 $16.84 $24,631.17 $23,399.61 2024-02-08
J3380 HCPCS Injection, Vedolizumab, 1 Mg 8 8 $22,139.15 $18,818.28 $18,818.28 $22,139.15 $21,253.58 2024-02-08
436 MS_DRG Malignancy Of Hepatobiliary System Or Pancreas With Cc 1 1 — — $12,865.44 $12,865.44 $12,865.44 2024-12-01
387 MS_DRG Inflammatory Bowel Disease Without Cc/Mcc 1 1 — — $12,501.47 $12,501.47 $12,501.47 2024-12-01
C1783 HCPCS Ocular Implant, Aqueous Drainage Assist Device 15 8 $10,925.00 $9,286.25 $9,286.25 $13,537.50 $10,925.00 2024-02-08
J1602 HCPCS Injection, Golimumab, 1 Mg, For Intravenous Use 11 8 $11,427.13 $9,713.06 $27.08 $11,427.13 $10,855.77 2024-02-08
J7168 HCPCS Prothrombin Complex Concentrate (human), Kcentra, Per I.u. Of Factor Ix Activity 8 8 $9,999.00 $8,499.15 $8,499.15 $9,999.00 $9,599.04 2024-02-08
205 MS_DRG Other Respiratory System Diagnoses With Mcc 2 2 — — $9,300.28 $9,300.28 $9,300.28 2024-12-01
66 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc 1 1 — — $9,249.24 $9,249.24 $9,249.24 2024-12-01
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 1 1 — — $9,249.24 $9,249.24 $9,249.24 2024-12-01
897 MS_DRG Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc 1 1 — — $8,444.60 $8,444.60 $8,444.60 2024-12-01
Q4104 HCPCS Integra Bilayer Matrix Wound Dressing (bmwd), Per Square Centimeter 8 8 $8,239.00 $7,003.15 $7,003.15 $8,239.00 $7,909.44 2024-02-08
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 1 1 — — $7,504.48 $7,504.48 $7,504.48 2024-12-01
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 2 2 — — $5,592.81 $5,592.81 $5,592.81 2024-12-01
390 MS_DRG Gastrointestinal Obstruction Without Cc/mcc 1 1 — — $5,559.75 $5,559.75 $5,559.75 2024-12-01
Q5103 HCPCS Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 11 8 $5,374.10 $4,567.99 $94.28 $5,374.10 $5,105.40 2024-02-08
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 1 1 — — $5,087.79 $5,087.79 $5,087.79 2024-12-01
64856 HCPCS Suture And Relocation Of Arm Or Leg Peripheral Nerve 8 8 $4,628.00 $3,933.80 $3,933.80 $4,628.00 $4,442.88 2024-02-08
81439 HCPCS Test For Detecting Genes Associated With Inherited Disease Of Heart Muscle 35 8 $4,415.00 $3,752.75 $789.62 $4,735.75 $4,174.00 2024-02-08
59618 HCPCS Cesarean Delivery And Care Before And After Delivery Following Attempted Vaginal… 8 8 $6,840.00 $5,814.00 $3,939.84 $10,944.00 $4,051.81 2024-02-08
64 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Mcc 1 1 — — $4,047.86 $4,047.86 $4,047.86 2024-12-01
59510 HCPCS Cesarean Delivery With Care Before And After Delivery 8 8 $6,769.00 $5,753.65 $3,889.68 $10,830.40 $4,000.23 2024-02-08
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 11 8 $4,180.00 $3,553.00 $461.31 $4,180.00 $3,971.00 2024-02-08
59610 HCPCS Vaginal Delivery And Care Before And After Delivery After Previous Cesarean Deli… 8 8 $6,410.00 $5,448.50 $3,690.18 $10,256.00 $3,795.06 2024-02-08
81410 HCPCS Test For Detecting Genes Associated With Heart Disease, Genomic Sequence Analysi… 11 8 $3,948.25 $3,356.01 $680.40 $3,948.25 $3,750.84 2024-02-08
21337 HCPCS Closed Treatment Of Broken Bone Separating Nose Airways 8 8 $3,872.00 $3,291.20 $3,291.20 $3,872.00 $3,717.12 2024-02-08
74182 HCPCS MRI Scan Of Abdomen With Contrast 11 8 $3,823.00 $3,249.55 $433.90 $3,823.00 $3,631.85 2024-02-08
70553 HCPCS MRI Scan Of Brain Before And After Contrast 11 8 $3,810.00 $3,238.50 $409.41 $3,810.00 $3,619.50 2024-02-08
59400 HCPCS Vaginal Delivery With Care Before And After Delivery 8 8 $6,131.00 $5,211.35 $3,507.21 $9,809.60 $3,606.89 2024-02-08
49618 HCPCS Repair Of Recurrent Entrapped Hernia Of Abdomen, More Than 10 Cm In Length 8 8 $3,121.00 $2,652.85 $2,184.70 $4,993.60 $3,589.15 2024-02-08
81448 HCPCS Gene Analysis Panel For Hereditary Disorders Of The Peripheral Nervous System 11 8 $3,705.00 $3,149.25 $789.62 $3,705.00 $3,519.75 2024-02-08
71552 HCPCS MRI Scan Of Chest Before And After Contrast 11 8 $3,687.00 $3,133.95 $723.17 $3,687.00 $3,502.65 2024-02-08
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 11 8 $3,684.00 $3,131.40 $460.14 $3,684.00 $3,499.80 2024-02-08
43632 HCPCS Removal Of Lower Part Of Stomach With Reattachment Of Remaining Stomach To Secon… 8 8 $5,219.00 $4,436.15 $3,382.95 $8,350.40 $3,479.10 2024-02-08
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 11 8 $3,625.00 $3,081.25 $437.98 $3,625.00 $3,443.75 2024-02-08
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 11 8 $3,606.00 $3,065.10 $484.06 $3,606.00 $3,425.70 2024-02-08
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 11 8 $3,570.00 $3,034.50 $414.07 $3,570.00 $3,391.50 2024-02-08
26951 HCPCS Amputation Of Finger Or Thumb With Direct Closure 18 8 $2,406.00 $2,045.10 $1,091.55 $4,706.00 $3,388.00 2024-02-08
C1889 HCPCS Implantable/insertable Device, Not Otherwise Classified 8 8 $3,525.00 $2,996.25 $2,996.25 $3,525.00 $3,384.00 2024-02-08
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 11 8 $3,527.00 $2,997.95 $412.91 $3,527.00 $3,350.65 2024-02-08
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 11 8 $3,509.00 $2,982.65 $563.37 $3,509.00 $3,333.55 2024-02-08
44147 HCPCS Partial Removal Of Large Bowel Through Abdomen And Anus 8 8 $4,941.00 $4,199.85 $3,214.80 $7,905.60 $3,306.17 2024-02-08
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 11 8 $3,468.00 $2,947.80 $415.24 $3,468.00 $3,294.60 2024-02-08
90378 HCPCS Respiratory Syncytial Virus Antibody For Injection Into Tissue Or Muscle 11 8 $3,438.00 $2,922.30 $1,375.01 $3,438.00 $3,266.10 2024-02-08
66986 HCPCS Exchange Of Prosthetic Lens 8 8 $3,400.00 $2,890.00 $2,890.00 $3,400.00 $3,264.00 2024-02-08
73720 HCPCS MRI Scan Of Leg Before And After Contrast 11 8 $3,364.00 $2,859.40 $463.64 $3,364.00 $3,195.80 2024-02-08
45382 HCPCS Control Of Bleeding Of Upper Large Bowel Using A Flexible Endoscope 16 8 $2,950.50 $2,507.93 $426.36 $4,121.00 $3,175.43 2024-02-08
44150 HCPCS Removal Of Large Bowel With Attachment Of Small Bowel To Rectum Or Creation Of O… 8 8 $4,749.00 $4,036.65 $3,087.12 $7,598.40 $3,174.86 2024-02-08
66982 HCPCS Complex Removal Of Cataract With Insertion Of Prosthetic Lens 8 8 $3,300.00 $2,805.00 $2,805.00 $3,300.00 $3,168.00 2024-02-08
45112 HCPCS Removal Of Rectum And Suturing Of Large Bowel To Anus Through Incision Of Abdome… 8 8 $4,706.00 $4,000.10 $3,075.15 $7,529.60 $3,162.55 2024-02-08
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 11 8 $3,295.00 $2,800.75 $386.08 $3,295.00 $3,130.25 2024-02-08
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 11 8 $3,292.00 $2,798.20 $462.48 $3,292.00 $3,127.40 2024-02-08
73220 HCPCS MRI Scan Of Arm Before And After Contrast 11 8 $3,248.00 $2,760.80 $608.86 $3,248.00 $3,085.60 2024-02-08
81457 HCPCS Solid Organ Neoplasm, Genomic Sequence Analysis Panel, Interrogation For Sequenc… 16 8 $3,375.97 $2,869.58 $2,132.43 $4,243.21 $3,057.73 2024-02-08
43270 HCPCS Destruction Of Polyp Or Growth Of Esophagus, Stomach, And/or Upper Small Bowel U… 8 8 $3,175.00 $2,698.75 $2,698.75 $3,175.00 $3,048.00 2024-02-08
26418 HCPCS Repair Of Tendon On Top Side Of Finger 18 8 $2,142.00 $1,820.70 $970.71 $4,559.00 $3,025.60 2024-02-08
81450 HCPCS Targeted Genomic Sequence Analysis Panel Of DNA Or Combine DNA And RNA Of 5-50 G… 11 8 $3,150.00 $2,677.50 $1,025.37 $3,150.00 $2,992.50 2024-02-08
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 11 8 $3,122.00 $2,653.70 $564.54 $3,122.00 $2,965.90 2024-02-08
49596 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, More Than 10 Cm In Length 8 8 $2,576.00 $2,189.60 $1,803.20 $4,121.60 $2,962.40 2024-02-08
948 MS_DRG Signs And Symptoms Without Mcc 1 1 — — $2,918.02 $2,918.02 $2,918.02 2024-12-01
27266 HCPCS Closed Treatment Of Dislocated Hip Prosthesis Under Anesthesia 16 8 $2,583.50 $2,195.98 $957.60 $3,298.00 $2,896.85 2024-02-08
44143 HCPCS Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin 8 8 $4,248.00 $3,610.80 $2,759.37 $6,796.80 $2,837.79 2024-02-08
2143003010 CDM Coronary Care Unit - Intermediate Ccu 8 8 $2,948.00 $2,505.80 $2,505.80 $2,948.00 $2,830.08 2024-02-08
44145 HCPCS Partial Removal Of Large Bowel And Reattachment To Rectum 8 8 $4,218.00 $3,585.30 $2,739.42 $6,748.80 $2,817.28 2024-02-08
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 11 8 $2,900.00 $2,465.00 $327.18 $2,900.00 $2,755.00 2024-02-08
49020 HCPCS Drainage Of Abdominal Abscess Or Infection 8 8 $4,093.00 $3,479.05 $2,642.52 $6,548.80 $2,717.62 2024-02-08
45378 HCPCS Diagnostic Exam Of Large Bowel Using A Flexible Endoscope 32 8 $2,899.50 $2,464.57 $304.95 $3,175.00 $2,685.11 2024-02-08
74181 HCPCS MRI Scan Of Abdomen Without Contrast 11 8 $2,801.00 $2,380.85 $248.44 $2,801.00 $2,660.95 2024-02-08
832 MS_DRG Other Antepartum Diagnoses Without O.r. Procedures With Cc 1 1 — — $2,641.58 $2,641.58 $2,641.58 2024-12-01
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 11 8 $2,780.00 $2,363.00 $486.97 $2,780.00 $2,641.00 2024-02-08
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 11 8 $2,761.00 $2,346.85 $533.04 $2,761.00 $2,622.95 2024-02-08
A0434 HCPCS Specialty Care Transport (sct) 8 8 $2,723.00 $2,314.55 $2,314.55 $2,723.00 $2,614.08 2024-02-08
A0433 HCPCS Advanced Life Support, Level 2 (als 2) 8 8 $2,723.00 $2,314.55 $2,314.55 $2,723.00 $2,614.08 2024-02-08
43255 HCPCS Control Of Bleeding Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flex… 16 8 $2,302.50 $1,957.12 $330.03 $2,920.00 $2,589.00 2024-02-08
70552 HCPCS MRI Scan Of Brain With Contrast 11 8 $2,715.00 $2,307.75 $359.25 $2,715.00 $2,579.25 2024-02-08
72196 HCPCS MRI Scan Of Pelvis With Contrast 11 8 $2,700.00 $2,295.00 $366.25 $2,700.00 $2,565.00 2024-02-08
71551 HCPCS MRI Scan Of Chest With Contrast 11 8 $2,700.00 $2,295.00 $575.04 $2,700.00 $2,565.00 2024-02-08
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 11 8 $2,700.00 $2,295.00 $369.75 $2,700.00 $2,565.00 2024-02-08
5313 OTHER Level 3 Lower Gi Procedures 2 2 — — $2,563.08 $2,563.08 $2,563.08 2024-12-01
49617 HCPCS Repair Of Recurrent Sliding Hernia Of Abdomen, More Than 10 Cm In Length 8 8 $2,228.00 $1,893.80 $1,559.60 $3,564.80 $2,562.20 2024-02-08
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 11 8 $2,697.00 $2,292.45 $347.00 $2,697.00 $2,562.15 2024-02-08
26410 HCPCS Repair Of Tendon On Top Of Hand 16 8 $2,315.00 $1,967.75 $943.92 $3,049.00 $2,560.62 2024-02-08
70488 HCPCS CT Scan Of Face Before And After Contrast 11 8 $2,691.00 $2,287.35 $229.20 $2,691.00 $2,556.45 2024-02-08
43249 HCPCS Balloon Dilation Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexibl… 16 8 $2,815.00 $2,392.75 $251.94 $4,720.00 $2,526.75 2024-02-08
70554 HCPCS Functional MRI Scan Of Brain 11 8 $2,639.00 $2,243.15 $534.79 $2,639.00 $2,507.05 2024-02-08
49616 HCPCS Repair Of Recurrent Entrapped Hernia Of Abdomen, 3-10 Cm In Length 8 8 $2,163.00 $1,838.55 $1,514.10 $3,460.80 $2,487.45 2024-02-08
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 11 8 $2,614.00 $2,221.90 $366.83 $2,614.00 $2,483.30 2024-02-08
43631 HCPCS Removal Of Lower Part Of Stomach With Reattachment Of Remaining Stomach To First… 8 8 $3,726.00 $3,167.10 $2,411.10 $5,961.60 $2,479.63 2024-02-08
45380 HCPCS Biopsy Of Large Bowel Using A Flexible Endoscope 16 8 $2,405.50 $2,044.67 $330.03 $3,661.00 $2,475.93 2024-02-08
45385 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S… 16 8 $2,385.00 $2,027.25 $418.95 $3,575.00 $2,475.38 2024-02-08
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 11 8 $2,600.00 $2,210.00 $321.34 $2,600.00 $2,470.00 2024-02-08
73202 HCPCS CT Scan Of Arm Before And After Contrast 11 8 $2,585.00 $2,197.25 $355.17 $2,585.00 $2,455.75 2024-02-08
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 11 8 $2,584.00 $2,196.40 $362.17 $2,584.00 $2,454.80 2024-02-08
66984 HCPCS Removal Of Cataract With Insertion Of Prosthetic Lens 8 8 $2,546.00 $2,164.10 $2,164.10 $2,546.00 $2,444.16 2024-02-08
5442 OTHER Level 2 Nerve Injections 8 8 — — $2,439.36 $2,439.36 $2,439.36 2024-12-01
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 11 8 $2,563.00 $2,178.55 $373.83 $2,563.00 $2,434.85 2024-02-08
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 11 8 $2,521.00 $2,142.85 $341.76 $2,521.00 $2,394.95 2024-02-08
73222 HCPCS MRI Scan Of Arm Joint With Contrast 11 8 $2,512.00 $2,135.20 $464.81 $2,512.00 $2,386.40 2024-02-08
12037 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, More Tha… 16 8 $2,254.50 $1,916.32 $543.21 $3,257.00 $2,385.82 2024-02-08
44640 HCPCS Closure Of Abnormal Drainage Tract From Small Bowel To Skin 8 8 $3,577.00 $3,040.45 $2,319.33 $5,723.20 $2,385.25 2024-02-08
25028 HCPCS Drainage Of Deep Abscess Or Blood Accumulation Of Forearm Or Wrist 16 8 $2,237.00 $1,901.45 $972.99 $2,924.80 $2,381.40 2024-02-08
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 11 8 $2,506.00 $2,130.10 $345.84 $2,506.00 $2,380.70 2024-02-08
73719 HCPCS MRI Scan Of Leg With Contrast 11 8 $2,500.00 $2,125.00 $365.67 $2,500.00 $2,375.00 2024-02-08
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 11 8 $2,500.00 $2,125.00 $273.52 $2,500.00 $2,375.00 2024-02-08
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 11 8 $2,500.00 $2,125.00 $272.94 $2,500.00 $2,375.00 2024-02-08
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 11 8 $2,493.00 $2,119.05 $380.83 $2,493.00 $2,368.35 2024-02-08
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 11 8 $2,489.00 $2,115.65 $233.28 $2,489.00 $2,364.55 2024-02-08
43215 HCPCS Removal Of Foreign Bodies In Esophagus Using A Flexible Endoscope 16 8 $2,297.50 $1,952.88 $232.56 $3,545.00 $2,346.62 2024-02-08
43251 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 16 8 $2,170.00 $1,844.50 $322.62 $3,016.00 $2,341.00 2024-02-08
C8929 HCPCS Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi… 11 8 $2,443.00 $2,076.55 $434.07 $2,443.00 $2,320.85 2024-02-08
C8930 HCPCS Transthoracic Echocardiography, With Contrast, Or Without Contrast Followed By W… 8 8 $2,414.00 $2,051.90 $2,051.90 $2,414.00 $2,317.44 2024-02-08
71550 HCPCS MRI Scan Of Chest Without Contrast 11 8 $2,430.00 $2,065.50 $529.55 $2,430.00 $2,308.50 2024-02-08
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 11 8 $2,425.00 $2,061.25 $303.26 $2,425.00 $2,303.75 2024-02-08
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 11 8 $2,423.00 $2,059.55 $341.76 $2,423.00 $2,301.85 2024-02-08
43820 HCPCS Partial Removal Of Stomach With Attachment Of Stomach To Small Bowel 8 8 $3,457.00 $2,938.45 $2,233.26 $5,531.20 $2,296.73 2024-02-08
71270 HCPCS CT Scan Of Chest Before And After Contrast 11 8 $2,415.00 $2,052.75 $267.11 $2,415.00 $2,294.25 2024-02-08
44140 HCPCS Partial Removal Of Large Bowel With Connection 8 8 $3,444.00 $2,927.40 $2,226.99 $5,510.40 $2,290.28 2024-02-08
70551 HCPCS MRI Scan Of Brain Without Contrast 11 8 $2,406.00 $2,045.10 $243.19 $2,406.00 $2,285.70 2024-02-08
72195 HCPCS MRI Scan Of Pelvis Without Contrast 11 8 $2,401.00 $2,040.85 $315.51 $2,401.00 $2,280.95 2024-02-08
73722 HCPCS MRI Scan Of Leg Joint With Contrast 11 8 $2,400.00 $2,040.00 $465.98 $2,400.00 $2,280.00 2024-02-08
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 11 8 $2,397.00 $2,037.45 $208.79 $2,397.00 $2,277.15 2024-02-08
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 11 8 $2,393.00 $2,034.05 $342.34 $2,393.00 $2,273.35 2024-02-08
45384 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using A Flexible Endoscope With Elec… 16 8 $2,093.00 $1,779.05 $376.20 $2,892.00 $2,264.30 2024-02-08
43247 HCPCS Removal Of Foreign Bodies Of Esophagus, Stomach, And/or Upper Small Bowel Using … 16 8 $2,197.50 $1,867.88 $291.27 $3,379.00 $2,248.88 2024-02-08
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 11 8 $2,351.00 $1,998.35 $390.74 $2,351.00 $2,233.45 2024-02-08
49595 HCPCS Initial Repair Of Sliding Hernia Of Abdomen, More Than 10 Cm In Length 8 8 $1,940.00 $1,649.00 $1,358.00 $3,104.00 $2,231.00 2024-02-08
81229 HCPCS Genome-wide Microarray Analysis For Copy Number And Single Nucleotide Polymorphi… 19 8 $2,275.50 $1,934.18 $1,566.00 $3,100.50 $2,229.99 2024-02-08
43246 HCPCS Insertion Of Stomach Tube Using A Flexible Endoscope 18 8 $1,788.00 $1,519.80 $330.60 $3,420.00 $2,228.25 2024-02-08
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 11 8 $2,308.00 $1,961.80 $233.28 $2,308.00 $2,192.60 2024-02-08
G0390 HCPCS Trauma Response Team Associated With Hospital Critical Care Service 8 8 $2,272.00 $1,931.20 $1,931.20 $2,272.00 $2,181.12 2024-02-08
72129 HCPCS CT Scan Of Middle Spine With Contrast 11 8 $2,290.00 $1,946.50 $222.20 $2,290.00 $2,175.50 2024-02-08
59515 HCPCS Cesarean Delivery With Care After Delivery 8 8 $3,332.00 $2,832.20 $2,102.73 $5,331.20 $2,162.49 2024-02-08
49594 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, 3-10 Cm In Length 8 8 $1,879.00 $1,597.15 $1,315.30 $3,006.40 $2,160.85 2024-02-08
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 11 8 $2,273.00 $1,932.05 $267.11 $2,273.00 $2,159.35 2024-02-08
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 11 8 $2,271.00 $1,930.35 $271.77 $2,271.00 $2,157.45 2024-02-08
37799 HCPCS Other Procedure On Blood Vessel 8 8 $1,873.00 $1,592.05 $1,311.10 $2,996.80 $2,153.95 2024-02-08
47610 HCPCS Removal Of Gallbladder With Exploration Of Common Bile Duct 8 8 $3,232.00 $2,747.20 $2,087.34 $5,171.20 $2,146.66 2024-02-08
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 11 8 $2,248.00 $1,910.80 $233.86 $2,248.00 $2,135.60 2024-02-08
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 11 8 $2,247.00 $1,909.95 $184.29 $2,247.00 $2,134.65 2024-02-08
72126 HCPCS CT Scan Of Upper Spine With Contrast 11 8 $2,219.00 $1,886.15 $219.87 $2,219.00 $2,108.05 2024-02-08
74160 HCPCS CT Scan Of Abdomen With Contrast 11 8 $2,214.00 $1,881.90 $300.35 $2,214.00 $2,103.30 2024-02-08
95805 HCPCS Sleep Study, Multiple Trials 11 8 $2,207.00 $1,875.95 $584.95 $2,207.00 $2,096.65 2024-02-08
73219 HCPCS MRI Scan Of Arm With Contrast 11 8 $2,200.00 $1,870.00 $505.05 $2,200.00 $2,090.00 2024-02-08
44120 HCPCS Partial Removal Of Small Bowel With Reconnection 8 8 $3,136.00 $2,665.60 $2,030.91 $5,017.60 $2,088.63 2024-02-08
73580 HCPCS Review By Radiologist Of Knee Joint Image 11 8 $2,192.00 $1,863.20 $176.13 $2,192.00 $2,082.40 2024-02-08
J3240 HCPCS Injection, Thyrotropin Alpha, 0.9 Mg, Provided In 1.1 Mg Vial 11 8 $2,186.00 $1,858.10 $1,819.54 $2,186.00 $2,076.70 2024-02-08
72191 HCPCS CT Scan Of Blood Vessels Of Pelvis With Contrast 11 8 $2,179.00 $1,852.15 $381.41 $2,179.00 $2,070.05 2024-02-08
72132 HCPCS CT Scan Of Lower Spine With Contrast 11 8 $2,168.00 $1,842.80 $220.45 $2,168.00 $2,059.60 2024-02-08
44320 HCPCS Creation Of Opening From Large Bowel To Skin 8 8 $3,077.00 $2,615.45 $1,989.87 $4,923.20 $2,046.42 2024-02-08
71260 HCPCS CT Scan Of Chest With Contrast 11 8 $2,150.00 $1,827.50 $218.70 $2,150.00 $2,042.50 2024-02-08
73718 HCPCS MRI Scan Of Leg Without Contrast 11 8 $2,146.00 $1,824.10 $311.43 $2,146.00 $2,038.70 2024-02-08
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 11 8 $2,134.00 $1,813.90 $263.61 $2,134.00 $2,027.30 2024-02-08
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 11 8 $2,123.00 $1,804.55 $317.26 $2,123.00 $2,016.85 2024-02-08
812 MS_DRG Red Blood Cell Disorders Without Mcc 1 1 — — $2,016.84 $2,016.84 $2,016.84 2024-12-01
923 MS_DRG Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc 1 1 — — $2,016.84 $2,016.84 $2,016.84 2024-12-01
43640 HCPCS Severing Of Vagus Nerve To Stomach 8 8 $3,071.00 $2,610.35 $1,957.95 $4,913.60 $2,013.60 2024-02-08
38100 HCPCS Removal Of Spleen 8 8 $2,954.00 $2,510.90 $1,914.63 $4,726.40 $1,969.05 2024-02-08
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 11 8 $2,069.00 $1,758.65 $263.61 $2,069.00 $1,965.55 2024-02-08
72193 HCPCS CT Scan Of Pelvis With Contrast 11 8 $2,061.00 $1,751.85 $301.51 $2,061.00 $1,957.95 2024-02-08
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 11 8 $2,052.00 $1,744.20 $220.45 $2,052.00 $1,949.40 2024-02-08
45334 HCPCS Control Of Bleeding Of Lower Large Bowel Using A Flexible Endoscope 8 8 $2,030.00 $1,725.50 $1,725.50 $2,030.00 $1,948.80 2024-02-08
1233110010 CDM Room & Board - Semi-private (two Beds) - Pediatric 8 8 $2,025.00 $1,721.25 $1,721.25 $2,025.00 $1,944.00 2024-02-08
59614 HCPCS Vaginal Delivery And Care After Delivery After Prior Cesarean Delivery 8 8 $2,921.00 $2,482.85 $1,883.85 $4,673.60 $1,937.39 2024-02-08
47605 HCPCS Removal Of Gallbladder With X-ray Study Of Bile Ducts 8 8 $2,906.00 $2,470.10 $1,869.60 $4,649.60 $1,922.74 2024-02-08
43239 HCPCS Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop… 16 8 $1,809.50 $1,538.08 $227.43 $2,613.00 $1,915.33 2024-02-08
73702 HCPCS CT Scan Of Leg Before And After Contrast 11 8 $2,008.00 $1,706.80 $282.27 $2,008.00 $1,907.60 2024-02-08
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 11 8 $2,006.00 $1,705.10 $302.10 $2,006.00 $1,905.70 2024-02-08
49060 HCPCS Drainage Of Abscess Behind Abdominal Cavity 8 8 $2,820.00 $2,397.00 $1,825.14 $4,512.00 $1,877.01 2024-02-08
1203001010 CDM Room & Board - Semi-private (two Beds) - General Classification 8 8 $1,953.00 $1,660.05 $1,660.05 $1,953.00 $1,874.88 2024-02-08
1203100010 CDM Room & Board - Semi-private (two Beds) - General Classification 8 8 $1,953.00 $1,660.05 $1,660.05 $1,953.00 $1,874.88 2024-02-08
44005 HCPCS Release Of Intestinal Scar Tissue 8 8 $2,807.00 $2,385.95 $1,815.45 $4,491.20 $1,867.05 2024-02-08
81407 HCPCS Molecular Pathology Procedure Level 8 11 8 $1,965.25 $1,670.46 $1,142.46 $1,965.25 $1,866.99 2024-02-08
49615 HCPCS Repair Of Recurrent Sliding Hernia Of Abdomen, 3-10 Cm In Length 8 8 $1,610.00 $1,368.50 $1,127.00 $2,576.00 $1,851.50 2024-02-08
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 11 8 $1,946.00 $1,654.10 $218.12 $1,946.00 $1,848.70 2024-02-08
45111 HCPCS Partial Removal Of Rectum Through Abdomen 8 8 $2,783.00 $2,365.55 $1,795.50 $4,452.80 $1,846.53 2024-02-08
43250 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 8 8 $1,915.00 $1,627.75 $1,627.75 $1,915.00 $1,838.40 2024-02-08
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 19 8 $2,956.00 $2,512.60 $204.06 $3,454.40 $1,835.15 2024-02-08
47600 HCPCS Removal Of Gallbladder 8 8 $2,754.00 $2,340.90 $1,776.69 $4,406.40 $1,827.19 2024-02-08
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 11 8 $1,901.00 $1,615.85 $488.72 $1,901.00 $1,805.95 2024-02-08
70460 HCPCS CT Scan Head Or Brain With Contrast 11 8 $1,900.00 $1,615.00 $174.38 $1,900.00 $1,805.00 2024-02-08
44604 HCPCS Suture Of Tear Or Hole In Large Bowel 8 8 $2,701.00 $2,295.85 $1,754.46 $4,321.60 $1,804.32 2024-02-08
73201 HCPCS CT Scan Of Arm With Contrast 11 8 $1,898.00 $1,613.30 $269.44 $1,898.00 $1,803.10 2024-02-08
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 19 8 $2,095.00 $1,780.75 $196.65 $3,403.20 $1,799.92 2024-02-08
81235 HCPCS Gene Analysis (epidermal Growth Factor Receptor), Common Variants 11 8 $1,890.25 $1,606.71 $438.18 $1,890.25 $1,795.74 2024-02-08
P9055 HCPCS Platelets, Leukocytes Reduced, Cmv-negative, Apheresis/pheresis, Each Unit 8 8 $1,869.50 $1,589.08 $1,589.08 $1,869.50 $1,794.72 2024-02-08
93350 HCPCS Ultrasound Of Heart During Rest, Exercise And/or Drug-induced Stress With Report 11 8 $1,889.00 $1,605.65 $194.79 $1,889.00 $1,794.55 2024-02-08
73701 HCPCS CT Scan Of Leg With Contrast Material 11 8 $1,889.00 $1,605.65 $222.20 $1,889.00 $1,794.55 2024-02-08
73218 HCPCS MRI Scan Of Arm Without Contrast 11 8 $1,887.00 $1,603.95 $467.14 $1,887.00 $1,792.65 2024-02-08
49002 HCPCS Reopening Of Recent Abdominal Incision 8 8 $2,679.00 $2,277.15 $1,735.08 $4,286.40 $1,784.39 2024-02-08
23605 HCPCS Closed Treatment Of Broken Top Of Upper Arm Bone With Manipulation 16 8 $1,678.50 $1,426.72 $698.82 $2,201.60 $1,782.90 2024-02-08
N901 OTHER Anesthesia, Bundled 8 8 — — $1,780.70 $1,780.70 $1,780.70 2024-12-01
50220 HCPCS Removal Of Kidney And Partial Removal Of Ureter 8 8 $2,670.00 $2,269.50 $1,727.67 $4,272.00 $1,776.77 2024-02-08
59410 HCPCS Vaginal Delivery With Post Delivery Care 8 8 $2,705.00 $2,299.25 $1,726.53 $4,328.00 $1,775.60 2024-02-08
45331 HCPCS Biopsy Of Lower Large Bowel Using A Flexible Endoscope 16 8 $1,742.00 $1,480.70 $117.42 $2,719.00 $1,767.58 2024-02-08
23655 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia 18 8 $1,148.00 $975.80 $663.48 $3,801.00 $1,766.40 2024-02-08
72128 HCPCS CT Scan Of Middle Spine Without Contrast 11 8 $1,859.00 $1,580.15 $172.63 $1,859.00 $1,766.05 2024-02-08
72125 HCPCS CT Scan Of Upper Spine Without Contrast 11 8 $1,856.00 $1,577.60 $172.63 $1,856.00 $1,763.20 2024-02-08
72131 HCPCS CT Scan Of Lower Spine Without Contrast 11 8 $1,855.00 $1,576.75 $171.46 $1,855.00 $1,762.25 2024-02-08
31510 HCPCS Biopsy Of Voice Box Using An Endoscope With Mirror 16 8 $1,741.00 $1,479.85 $196.65 $2,741.00 $1,757.72 2024-02-08
93351 HCPCS Ultrasound Of Heart With Continuous Electrocardiogram (ecg) During Rest, Exercis… 11 8 $1,829.00 $1,554.65 $245.53 $1,829.00 $1,737.55 2024-02-08
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 11 8 $1,823.00 $1,549.55 $273.52 $1,823.00 $1,731.85 2024-02-08
27252 HCPCS Closed Treatment Of Dislocated Hip Under Anesthesia 8 8 $1,794.00 $1,524.90 $1,524.90 $1,794.00 $1,722.24 2024-02-08
58150 HCPCS Removal Of Uterus And Cervix Through Abdomen 8 8 $2,595.00 $2,205.75 $1,667.25 $4,152.00 $1,714.64 2024-02-08
43235 HCPCS Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible… 16 8 $1,642.50 $1,396.12 $201.78 $2,499.00 $1,690.88 2024-02-08
70487 HCPCS CT Scan Of Face With Contrast 11 8 $1,778.00 $1,511.30 $180.79 $1,778.00 $1,689.10 2024-02-08
71250 HCPCS CT Scan Of Chest Without Contrast 11 8 $1,776.00 $1,509.60 $163.88 $1,776.00 $1,687.20 2024-02-08
25520 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Thumb Side And Dislocated … 16 8 $1,653.50 $1,405.47 $887.49 $2,360.00 $1,682.07 2024-02-08
43610 HCPCS Removal Of Stomach Ulcer Or Growth 8 8 $2,520.00 $2,142.00 $1,629.06 $4,032.00 $1,675.36 2024-02-08
49593 HCPCS Initial Repair Of Sliding Hernia Of Abdomen, 3-10 Cm In Length 8 8 $1,443.00 $1,226.55 $1,010.10 $2,308.80 $1,659.45 2024-02-08
49614 HCPCS Repair Of Recurrent Entrapped Hernia Of Abdomen, Less Than 3 Cm In Length 8 8 $1,440.00 $1,224.00 $1,008.00 $2,304.00 $1,656.00 2024-02-08
72192 HCPCS CT Scan Of Pelvis Without Contrast 11 8 $1,737.00 $1,476.45 $148.72 $1,737.00 $1,650.15 2024-02-08
J7327 HCPCS Hyaluronan Or Derivative, Monovisc, For Intra-articular Injection, Per Dose 11 8 $1,728.00 $1,468.80 $1,258.79 $1,728.00 $1,641.60 2024-02-08
27810 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle With Manipulation 18 8 $1,568.00 $1,332.80 $695.40 $2,508.80 $1,634.67 2024-02-08
46040 HCPCS Drainage Of Deep Abscess In Rectum 16 8 $1,629.50 $1,385.08 $693.12 $2,320.00 $1,628.10 2024-02-08
P9052 HCPCS Platelets, Hla-matched Leukocytes Reduced, Apheresis/pheresis, Each Unit 11 8 $1,709.75 $1,453.29 $902.79 $1,709.75 $1,624.26 2024-02-08
59620 HCPCS Cesarean Delivery Following Vaginal Delivery Attempt After Previous Cesarean Del… 8 8 $2,390.00 $2,031.50 $1,570.35 $3,824.00 $1,614.98 2024-02-08
564 MS_DRG Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc 1 1 — — $1,600.00 $1,600.00 $1,600.00 2024-12-01
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 18 8 $1,668.00 $1,417.80 $839.61 $2,668.80 $1,598.85 2024-02-08
C1776 HCPCS Joint Device (implantable) 11 8 $1,625.00 $1,381.25 $1,381.25 $6,590.70 $1,592.50 2024-02-08
74150 HCPCS CT Scan Of Abdomen Without Contrast 11 8 $1,669.00 $1,418.65 $146.38 $1,669.00 $1,585.55 2024-02-08
291 MS_DRG Heart Failure And Shock With Mcc 1 1 — — $1,579.67 $1,579.67 $1,579.67 2024-12-01
81420 HCPCS Test For Detecting Genes Associated With Fetal Disease, Aneuploidy Genomic Seque… 11 8 $1,662.50 $1,413.13 $1,024.72 $1,662.50 $1,579.38 2024-02-08
A0427 HCPCS Ambulance Service, Advanced Life Support, Emergency Transport, Level 1 (als 1 - … 8 8 $1,645.00 $1,398.25 $1,398.25 $1,645.00 $1,579.20 2024-02-08
49010 HCPCS Exploration Behind Abdominal Cavity 8 8 $2,368.00 $2,012.80 $1,532.73 $3,788.80 $1,576.29 2024-02-08
59514 HCPCS Cesarean Delivery 8 8 $2,312.00 $1,965.20 $1,515.63 $3,699.20 $1,558.71 2024-02-08
59612 HCPCS Vaginal Delivery After Previous Cesarean Delivery 8 8 $2,309.00 $1,962.65 $1,515.63 $3,694.40 $1,558.71 2024-02-08
73700 HCPCS CT Scan Of Leg Without Contrast 11 8 $1,632.00 $1,387.20 $171.46 $1,632.00 $1,550.40 2024-02-08
94002 HCPCS Initial Hospital Inpatient Or Observation Ventilation Assistance And Management 8 8 $1,610.00 $1,368.50 $1,368.50 $1,610.00 $1,545.60 2024-02-08
73200 HCPCS CT Scan Of Arm Without Contrast 11 8 $1,623.00 $1,379.55 $210.54 $1,623.00 $1,541.85 2024-02-08
20103 HCPCS Exploration Of Wound Of Arm Or Leg 8 8 $1,603.00 $1,362.55 $1,362.55 $1,603.00 $1,538.88 2024-02-08
45381 HCPCS Injection Beneath Lining Of Large Bowel Using A Flexible Endoscope 16 8 $1,436.50 $1,221.03 $330.03 $1,876.80 $1,530.00 2024-02-08
58740 HCPCS Removal Of Scar Tissue Of Ovaries Or Fallopian Tubes 8 8 $2,317.00 $1,969.45 $1,479.72 $3,707.20 $1,521.78 2024-02-08
M0244 HCPCS Intravenous Infusion Or Subcutaneous Injection, Casirivimab And Imdevimab Includ… 8 8 $1,575.00 $1,338.75 $1,338.75 $1,575.00 $1,512.00 2024-02-08
44960 HCPCS Removal Of Ruptured Infected Appendix 8 8 $2,263.00 $1,923.55 $1,456.92 $3,620.80 $1,498.33 2024-02-08
26591 HCPCS Repair Of Hand Muscle 16 8 $1,547.00 $1,314.95 $400.35 $2,623.00 $1,496.97 2024-02-08
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 11 8 $1,575.00 $1,338.75 $163.88 $1,575.00 $1,496.25 2024-02-08
24605 HCPCS Repair Of Dislocated Elbow Under Anesthesia 18 8 $1,238.00 $1,052.30 $777.48 $1,980.80 $1,491.80 2024-02-08
27818 HCPCS Closed Treatment Of 3 Broken Lower Leg Bones At Ankle With Manipulation 8 8 $1,553.00 $1,320.05 $1,320.05 $1,553.00 $1,490.88 2024-02-08
25505 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Thumb Side With Manipulati… 16 8 $1,374.50 $1,168.32 $752.97 $1,748.80 $1,490.40 2024-02-08
70486 HCPCS CT Scan Of Face Without Contrast 11 8 $1,551.00 $1,318.35 $157.46 $1,551.00 $1,473.45 2024-02-08
12020 HCPCS Simple Closure Of Surface Wound Reopening 16 8 $1,422.00 $1,208.70 $309.51 $2,145.00 $1,470.83 2024-02-08
V2788 HCPCS Presbyopia Correcting Function Of Intraocular Lens 15 8 $1,492.50 $1,268.63 $1,268.63 $1,522.50 $1,447.73 2024-02-08
47100 HCPCS Partial Removal Of Liver Tissue 8 8 $2,190.00 $1,861.50 $1,404.48 $3,504.00 $1,444.40 2024-02-08
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 11 8 $1,515.00 $1,287.75 $223.37 $1,515.00 $1,439.25 2024-02-08
44300 HCPCS Insertion Of Tube Into Small Bowel 8 8 $2,166.00 $1,841.10 $1,398.78 $3,465.60 $1,438.53 2024-02-08
70450 HCPCS CT Scan Head Or Brain Without Contrast 11 8 $1,505.00 $1,279.25 $118.97 $1,505.00 $1,429.75 2024-02-08
43243 HCPCS Injection Of Dilated Vein Of Stomach And/or Esophagus Using A Flexible Endoscope 8 8 $1,483.00 $1,260.55 $1,260.55 $1,483.00 $1,423.68 2024-02-08
43241 HCPCS Insertion Of Tube Or Tube In Esophagus, Stomach, And/or Upper Small Bowel Using … 8 8 $1,483.00 $1,260.55 $1,260.55 $1,483.00 $1,423.68 2024-02-08
64415 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Arm Nerve Bundle (brachial Ple… 16 8 $1,443.50 $1,226.97 $104.31 $2,719.00 $1,413.58 2024-02-08
77049 HCPCS MRI Scan Of Both Breasts 11 8 $1,485.00 $1,262.25 $280.52 $1,485.00 $1,410.75 2024-02-08
43200 HCPCS Diagnostic Exam Of Esophagus Using A Flexible Endoscope Through Mouth 16 8 $1,349.50 $1,147.08 $143.64 $2,002.00 $1,408.45 2024-02-08
C2625 HCPCS Stent, Non-coronary, Temporary, With Delivery System 11 8 $1,471.00 $1,250.35 $102.22 $1,471.00 $1,397.45 2024-02-08
32551 HCPCS Removal Of Fluid From Between Lung And Chest Cavity 17 8 $1,638.00 $1,392.30 $259.92 $2,620.80 $1,392.30 2024-02-08
P9053 HCPCS Platelets, Pheresis, Leukocytes Reduced, Cmv-negative, Irradiated, Each Unit 11 8 $1,465.50 $1,245.68 $943.74 $1,465.50 $1,392.23 2024-02-08
62273 HCPCS Injection Of Blood Or Blood Clot Into Spinal Canal 8 8 $1,440.00 $1,224.00 $1,224.00 $1,440.00 $1,382.40 2024-02-08
59409 HCPCS Vaginal Delivery 8 8 $2,046.00 $1,739.10 $1,341.21 $3,273.60 $1,379.33 2024-02-08
49592 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, Less Than 3 Cm In Length 8 8 $1,198.00 $1,018.30 $838.60 $1,916.80 $1,377.70 2024-02-08
93975 HCPCS Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 11 8 $1,443.00 $1,226.55 $361.58 $1,443.00 $1,370.85 2024-02-08
49255 HCPCS Removal Of Lining Covering Abdominal Organs 8 8 $2,030.00 $1,725.50 $1,303.02 $3,248.00 $1,340.05 2024-02-08
A0426 HCPCS Ambulance Service, Advanced Life Support, Non-emergency Transport, Level 1 (als … 8 8 $1,391.00 $1,182.35 $1,182.35 $1,391.00 $1,335.36 2024-02-08
24505 HCPCS Closed Treatment Of Broken Middle Part Of Upper Arm Bone With Manipulation 16 8 $1,196.50 $1,017.02 $714.00 $1,553.00 $1,332.03 2024-02-08
13132 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 18 8 $1,216.00 $1,033.60 $502.17 $1,945.60 $1,332.00 2024-02-08
27552 HCPCS Closed Treatment Of Dislocated Knee Under Anesthesia 16 8 $1,243.00 $1,056.55 $890.80 $1,676.80 $1,324.95 2024-02-08
J7326 HCPCS Hyaluronan Or Derivative, Gel-one, For Intra-articular Injection, Per Dose 11 8 $1,394.00 $1,184.90 $638.33 $1,394.00 $1,324.30 2024-02-08
69205 HCPCS Removal Of Foreign Body In Ear Canal Under Anesthesia 8 8 $1,376.00 $1,169.60 $1,169.60 $1,376.00 $1,320.96 2024-02-08
25565 HCPCS Closed Treatment Of Broken Midpart Of Both Forearm Bones With Manipulation 18 8 $1,349.00 $1,146.65 $762.66 $2,158.40 $1,319.49 2024-02-08
49000 HCPCS Exploration Of Abdominal Cavity 8 8 $1,977.00 $1,680.45 $1,275.66 $3,163.20 $1,311.92 2024-02-08
44800 HCPCS Repair Of Congenital Bowel Defect 8 8 $1,984.00 $1,686.40 $1,275.09 $3,174.40 $1,311.33 2024-02-08
59151 HCPCS Removal Of Ovarian Or Tubal Pregnancy With Removal Of Ovary And/or Tube Using An… 8 8 $1,992.00 $1,693.20 $1,268.25 $3,187.20 $1,304.30 2024-02-08
58925 HCPCS Removal Of Cysts Of Ovaries 8 8 $1,976.00 $1,679.60 $1,252.86 $3,161.60 $1,288.47 2024-02-08
P9073 HCPCS Platelets, Pheresis, Pathogen-reduced, Each Unit 8 8 $1,328.25 $1,129.01 $1,129.01 $1,328.25 $1,275.12 2024-02-08
58720 HCPCS Removal Of Uterine Tubes And Ovaries 8 8 $1,949.00 $1,656.65 $1,229.49 $3,118.40 $1,264.43 2024-02-08
51860 HCPCS Suture Of Simple Wound, Injury, Or Rupture Of Bladder 8 8 $1,897.00 $1,612.45 $1,228.35 $3,035.20 $1,263.26 2024-02-08
81223 HCPCS Gene Analysis (cystic Fibrosis Transmembrane Conductance Regular) Full Gene Sequ… 11 8 $1,321.00 $1,122.85 $673.65 $1,321.00 $1,254.95 2024-02-08
45379 HCPCS Removal Of Foreign Bodies In Large Bowel Using A Flexible Endoscope 16 8 $1,267.50 $1,077.38 $393.87 $1,832.00 $1,251.00 2024-02-08
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 11 8 $1,314.00 $1,116.90 $353.42 $1,314.00 $1,248.30 2024-02-08
86366 HCPCS Muscle-specific Kinase (musk) Antibody 8 8 $1,290.75 $1,097.14 $1,097.14 $1,290.75 $1,239.12 2024-02-08
31603 HCPCS Emergent Incision Of Windpipe Through Neck For Insertion Of Breathing Tube 8 8 $1,279.00 $1,087.15 $1,087.15 $1,279.00 $1,227.84 2024-02-08
49521 HCPCS Repair Of Trapped Or Strangulated Groin Hernia 8 8 $1,848.00 $1,570.80 $1,190.73 $2,956.80 $1,224.57 2024-02-08
47563 HCPCS Removal Of Gallbladder With X-ray Study Of Bile Ducts Using An Endoscope 8 8 $1,854.00 $1,575.90 $1,190.73 $2,966.40 $1,224.57 2024-02-08
28805 HCPCS Amputation Of Foot Across Instep 8 8 $1,809.00 $1,537.65 $1,189.02 $2,894.40 $1,222.81 2024-02-08
49613 HCPCS Repair Of Recurrent Sliding Hernia Of Abdomen, Less Than 3 Cm In Length 8 8 $1,062.00 $902.70 $743.40 $1,699.20 $1,221.30 2024-02-08
C8933 HCPCS Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Spina… 8 8 $1,271.00 $1,080.35 $1,080.35 $1,271.00 $1,220.16 2024-02-08
26742 HCPCS Closed Treatment Of Broken Finger Or Hand At Base Of Finger With Manipulation 16 8 $1,113.50 $946.48 $549.48 $1,403.20 $1,215.00 2024-02-08
43870 HCPCS Closure Of Surgically Created Opening From Stomach To Skin 8 8 $1,830.00 $1,555.50 $1,178.76 $2,928.00 $1,212.26 2024-02-08
21485 HCPCS Complicated Repair Of Dislocated Jaw Joint With Placement Of Stabilizing Device 16 8 $1,027.00 $872.95 $658.75 $1,279.00 $1,211.61 2024-02-08
58662 HCPCS Destruction Or Removal Of Ovary Or Growth Of Pelvis Using An Endoscope 8 8 $1,826.00 $1,552.10 $1,175.91 $2,921.60 $1,209.33 2024-02-08
1203001020 CDM Room & Board - Semi-private (two Beds) - General Classification 8 8 $1,250.00 $1,062.50 $1,062.50 $1,250.00 $1,200.00 2024-02-08
43830 HCPCS Insertion Of Stomach Feeding Tube 8 8 $1,814.00 $1,541.90 $1,165.08 $2,902.40 $1,198.19 2024-02-08
A0429 HCPCS Ambulance Service, Basic Life Support, Emergency Transport (bls-emergency) 8 8 $1,246.00 $1,059.10 $1,059.10 $1,246.00 $1,196.16 2024-02-08
93307 HCPCS Ultrasound Of Heart 11 8 $1,248.00 $1,060.80 $158.05 $1,248.00 $1,185.60 2024-02-08
C8934 HCPCS Magnetic Resonance Angiography With Contrast, Upper Extremity 11 8 $1,248.00 $1,060.80 $532.86 $1,248.00 $1,185.60 2024-02-08
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 11 8 $1,246.00 $1,059.10 $263.02 $1,246.00 $1,183.70 2024-02-08
87633 HCPCS Detection Test By Nucleic Acid For Multiple Types Of Respiratory Virus, Multiple… 11 8 $1,243.50 $1,056.98 $746.10 $1,243.50 $1,181.33 2024-02-08
G0416 HCPCS Surgical Pathology, Gross And Microscopic Examinations, For Prostate Needle Biop… 11 8 $1,240.75 $1,054.64 $262.44 $1,240.75 $1,178.71 2024-02-08
7203102220 CDM Labor Room/delivery - General Classification 8 8 $1,227.00 $1,042.95 $1,042.95 $1,227.00 $1,177.92 2024-02-08
73040 HCPCS Review By Radiologist Of Shoulder Joint Image 11 8 $1,233.00 $1,048.05 $152.22 $1,233.00 $1,171.35 2024-02-08
M0247 HCPCS Intravenous Infusion, Sotrovimab, Includes Infusion And Post Administration Moni… 8 8 $1,215.00 $1,032.75 $1,032.75 $1,215.00 $1,166.40 2024-02-08
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