|
918
|
MS_DRG
|
Poisoning And Toxic Effects Of Drugs Without Mcc
|
60
|
60
|
$30,076.00
|
$30,076.00
|
$22,557.00
|
$73,011.20
|
$28,572.20
|
2025-12-19
|
|
811
|
MS_DRG
|
Red Blood Cell Disorders With Mcc
|
60
|
60
|
$28,119.55
|
$28,119.55
|
$21,089.66
|
$58,787.55
|
$26,713.57
|
2025-12-19
|
|
641
|
MS_DRG
|
Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…
|
60
|
60
|
$27,317.50
|
$27,317.50
|
$20,488.13
|
$64,119.10
|
$25,951.63
|
2025-12-19
|
|
291
|
MS_DRG
|
Heart Failure And Shock With Mcc
|
58
|
58
|
$25,410.93
|
$25,410.93
|
$19,058.20
|
$25,410.93
|
$24,140.39
|
2025-12-19
|
|
371
|
MS_DRG
|
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc
|
60
|
60
|
$25,182.32
|
$25,182.32
|
$18,886.74
|
$61,983.92
|
$23,923.20
|
2025-12-19
|
|
179
|
MS_DRG
|
Respiratory Infections And Inflammations Without Cc/mcc
|
58
|
58
|
$17,799.66
|
$17,799.66
|
$13,349.75
|
$17,799.66
|
$16,909.68
|
2025-12-19
|
|
372
|
MS_DRG
|
Major Gastrointestinal Disorders And Peritoneal Infections With Cc
|
60
|
60
|
$15,916.45
|
$15,916.45
|
$11,937.34
|
$40,450.85
|
$15,120.63
|
2025-12-19
|
|
897
|
MS_DRG
|
Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc
|
60
|
60
|
$15,839.01
|
$15,839.01
|
$11,879.25
|
$46,507.01
|
$15,047.05
|
2025-12-19
|
|
193
|
MS_DRG
|
Simple Pneumonia And Pleurisy With Mcc
|
60
|
60
|
$14,096.89
|
$14,096.89
|
$10,572.67
|
$38,631.29
|
$13,392.04
|
2025-12-19
|
|
951
|
MS_DRG
|
Other Factors Influencing Health Status
|
60
|
60
|
$12,978.81
|
$12,978.81
|
$9,734.11
|
$37,513.21
|
$12,329.87
|
2025-12-19
|
|
871
|
MS_DRG
|
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc
|
58
|
58
|
$12,404.00
|
$12,404.00
|
$9,303.00
|
$12,404.00
|
$11,783.80
|
2025-12-19
|
|
690
|
MS_DRG
|
Kidney And Urinary Tract Infections Without Mcc
|
60
|
60
|
$11,908.50
|
$11,908.50
|
$8,931.38
|
$30,309.30
|
$11,313.08
|
2025-12-19
|
|
534
|
MS_DRG
|
Fractures Of Femur Without Mcc
|
60
|
60
|
$11,848.00
|
$11,848.00
|
$8,886.00
|
$30,248.80
|
$11,255.60
|
2025-12-19
|
|
948
|
MS_DRG
|
Signs And Symptoms Without Mcc
|
60
|
60
|
$11,848.00
|
$11,848.00
|
$8,886.00
|
$30,248.80
|
$11,255.60
|
2025-12-19
|
|
872
|
MS_DRG
|
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc
|
59
|
59
|
$11,622.47
|
$11,622.47
|
$8,716.85
|
$23,889.67
|
$11,041.34
|
2025-12-19
|
|
543
|
MS_DRG
|
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With…
|
60
|
60
|
$10,960.17
|
$10,960.17
|
$8,220.13
|
$29,360.97
|
$10,412.16
|
2025-12-19
|
|
683
|
MS_DRG
|
Renal Failure With Cc
|
60
|
60
|
$10,643.14
|
$10,643.14
|
$7,982.36
|
$29,043.94
|
$10,110.98
|
2025-12-19
|
|
603
|
MS_DRG
|
Cellulitis Without Mcc
|
60
|
60
|
$10,610.00
|
$10,610.00
|
$7,957.50
|
$29,010.80
|
$10,079.50
|
2025-12-19
|
|
177
|
MS_DRG
|
Respiratory Infections And Inflammations With Mcc
|
60
|
60
|
$10,392.61
|
$10,392.61
|
$7,794.46
|
$22,659.81
|
$9,872.98
|
2025-12-19
|
|
J9332
|
HCPCS
|
Injection, Efgartigimod Alfa-fcab, 2mg
|
64
|
64
|
$9,838.00
|
$9,838.00
|
$6,689.84
|
$13,773.20
|
$9,346.10
|
2025-12-19
|
|
689
|
MS_DRG
|
Kidney And Urinary Tract Infections With Mcc
|
60
|
60
|
$8,772.00
|
$8,772.00
|
$6,579.00
|
$21,039.20
|
$8,333.40
|
2025-12-19
|
|
66
|
MS_DRG
|
Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc
|
60
|
60
|
$8,458.00
|
$8,458.00
|
$6,343.50
|
$20,725.20
|
$8,035.10
|
2025-12-19
|
|
189
|
MS_DRG
|
Pulmonary Edema And Respiratory Failure
|
60
|
60
|
$8,093.00
|
$8,093.00
|
$6,069.75
|
$20,360.20
|
$7,688.35
|
2025-12-19
|
|
195
|
MS_DRG
|
Simple Pneumonia And Pleurisy Without Cc/mcc
|
60
|
60
|
$7,990.88
|
$7,990.88
|
$5,993.16
|
$20,258.08
|
$7,591.34
|
2025-12-19
|
|
187
|
MS_DRG
|
Pleural Effusion With Cc
|
60
|
60
|
$7,957.00
|
$7,957.00
|
$5,967.75
|
$20,224.20
|
$7,559.15
|
2025-12-19
|
|
175
|
MS_DRG
|
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale
|
58
|
58
|
$7,552.00
|
$7,552.00
|
$5,664.00
|
$7,552.00
|
$7,174.40
|
2025-12-19
|
|
919
|
MS_DRG
|
Complications Of Treatment With Mcc
|
58
|
58
|
$7,456.89
|
$7,456.89
|
$5,592.67
|
$7,456.89
|
$7,084.05
|
2025-12-19
|
|
186
|
MS_DRG
|
Pleural Effusion With Mcc
|
60
|
60
|
$7,261.09
|
$7,261.09
|
$5,445.82
|
$19,528.29
|
$6,898.04
|
2025-12-19
|
|
J2506
|
HCPCS
|
Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg
|
64
|
64
|
$7,219.00
|
$7,219.00
|
$4,908.92
|
$10,106.60
|
$6,858.05
|
2025-12-19
|
|
81162
|
HCPCS
|
Gene Analysis (breast Cancer 1 And 2) Of Full Sequence And Analysis For Duplicat…
|
64
|
64
|
$6,475.00
|
$6,475.00
|
$3,695.39
|
$9,065.00
|
$6,151.25
|
2025-12-19
|
|
190
|
MS_DRG
|
Chronic Obstructive Pulmonary Disease With Mcc
|
60
|
60
|
$5,273.00
|
$5,273.00
|
$3,954.75
|
$11,406.60
|
$5,009.35
|
2025-12-19
|
|
65
|
MS_DRG
|
Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours
|
60
|
60
|
$5,163.00
|
$5,163.00
|
$3,872.25
|
$11,296.60
|
$4,904.85
|
2025-12-19
|
|
392
|
MS_DRG
|
Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc
|
60
|
60
|
$4,503.00
|
$4,503.00
|
$3,377.25
|
$10,636.60
|
$4,277.85
|
2025-12-19
|
|
310
|
MS_DRG
|
Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc
|
60
|
60
|
$4,030.00
|
$4,030.00
|
$3,022.50
|
$10,163.60
|
$3,828.50
|
2025-12-19
|
|
G0390
|
HCPCS
|
Trauma Response Team Associated With Hospital Critical Care Service
|
64
|
64
|
$3,949.00
|
$3,949.00
|
$2,685.32
|
$5,528.60
|
$3,751.55
|
2026-07-30
|
|
314
|
MS_DRG
|
Other Circulatory System Diagnoses With Mcc
|
60
|
60
|
$3,742.72
|
$3,742.72
|
$2,807.04
|
$9,876.32
|
$3,555.58
|
2025-12-19
|
|
Q4199
|
HCPCS
|
Cygnus Matrix, Per Square Centimeter
|
192
|
64
|
$3,720.00
|
$3,720.00
|
$1,081.20
|
$7,280.00
|
$3,534.00
|
2025-12-19
|
|
8028141_1
|
CDM
|
Coronary Care Unit - General Classification
|
58
|
58
|
$3,682.00
|
$3,682.00
|
$2,761.50
|
$3,682.00
|
$3,497.90
|
2025-12-19
|
|
74177
|
HCPCS
|
CT Scan Of Abdomen And Pelvis With Contrast
|
192
|
64
|
$3,617.00
|
$3,617.00
|
$81.71
|
$5,063.80
|
$3,436.15
|
2025-12-19
|
|
90378
|
HCPCS
|
Respiratory Syncytial Virus Antibody For Injection Into Tissue Or Muscle
|
128
|
64
|
$4,211.50
|
$4,211.50
|
$2,062.52
|
$7,028.00
|
$3,300.91
|
2025-12-19
|
|
8028202_1
|
CDM
|
Room & Board - Other - Sterile Environment
|
58
|
58
|
$3,341.00
|
$3,341.00
|
$2,505.75
|
$3,341.00
|
$3,173.95
|
2025-12-19
|
|
8028232_1
|
CDM
|
Coronary Care Unit - General Classification
|
58
|
58
|
$3,314.00
|
$3,314.00
|
$2,485.50
|
$3,314.00
|
$3,148.30
|
2025-12-19
|
|
81229
|
HCPCS
|
Genome-wide Microarray Analysis For Copy Number And Single Nucleotide Polymorphi…
|
64
|
64
|
$3,263.00
|
$3,263.00
|
$2,218.84
|
$4,568.20
|
$3,099.85
|
2025-12-19
|
|
812
|
MS_DRG
|
Red Blood Cell Disorders Without Mcc
|
60
|
60
|
$3,221.00
|
$3,221.00
|
$2,415.75
|
$9,354.60
|
$3,059.95
|
2025-12-19
|
|
8028231_1
|
CDM
|
Room & Board - Other - Sterile Environment
|
58
|
58
|
$3,169.00
|
$3,169.00
|
$2,376.75
|
$3,169.00
|
$3,010.55
|
2025-12-19
|
|
8028230_1
|
CDM
|
Room & Board - Other - Other
|
58
|
58
|
$3,142.00
|
$3,142.00
|
$2,356.50
|
$3,142.00
|
$2,984.90
|
2025-12-19
|
|
8028201_1
|
CDM
|
Room & Board - Private (one Bed) - General Classification
|
58
|
58
|
$2,973.00
|
$2,973.00
|
$2,229.75
|
$2,973.00
|
$2,824.35
|
2025-12-19
|
|
74183
|
HCPCS
|
MRI Scan Of Abdomen Before And After Contrast
|
192
|
64
|
$2,900.00
|
$2,900.00
|
$98.50
|
$4,060.00
|
$2,755.00
|
2025-12-19
|
|
59409
|
HCPCS
|
Vaginal Delivery
|
128
|
64
|
$3,024.50
|
$3,024.50
|
$773.25
|
$4,155.20
|
$2,705.51
|
2025-12-19
|
|
8028229_1
|
CDM
|
Room & Board - Other - Other
|
58
|
58
|
$2,800.00
|
$2,800.00
|
$2,100.00
|
$2,800.00
|
$2,660.00
|
2025-12-19
|
|
Q4159
|
HCPCS
|
Affinity, Per Square Centimeter
|
128
|
64
|
$3,150.00
|
$3,150.00
|
$1,836.00
|
$5,040.00
|
$2,619.00
|
2025-12-19
|
|
J0897
|
HCPCS
|
Injection, Denosumab, 1 Mg
|
64
|
64
|
$2,690.00
|
$2,690.00
|
$24.93
|
$3,766.00
|
$2,555.50
|
2025-12-19
|
|
Q4101
|
HCPCS
|
Apligraf, Per Square Centimeter
|
64
|
64
|
$2,590.00
|
$2,590.00
|
$1,761.20
|
$3,626.00
|
$2,460.50
|
2025-12-19
|
|
C1052
|
HCPCS
|
Hemostatic Agent, Gastrointestinal, Topical
|
64
|
64
|
$2,400.00
|
$2,400.00
|
$1,632.00
|
$3,360.00
|
$2,280.00
|
2025-12-19
|
|
74174
|
HCPCS
|
CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast
|
192
|
64
|
$2,388.00
|
$2,388.00
|
$98.18
|
$3,343.20
|
$2,268.60
|
2025-12-19
|
|
J7307
|
HCPCS
|
Etonogestrel (contraceptive) Implant System, Including Implant And Supplies
|
64
|
64
|
$2,221.00
|
$2,221.00
|
$1,450.31
|
$3,109.40
|
$2,109.95
|
2025-12-19
|
|
93306
|
HCPCS
|
Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu…
|
64
|
64
|
$2,131.00
|
$2,131.00
|
$330.68
|
$2,983.40
|
$2,024.45
|
2025-12-19
|
|
C8929
|
HCPCS
|
Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi…
|
64
|
64
|
$2,131.00
|
$2,131.00
|
$651.11
|
$2,983.40
|
$2,024.45
|
2025-12-19
|
|
Q4196
|
HCPCS
|
Puraply Am, Per Square Centimeter
|
320
|
64
|
$2,100.00
|
$2,100.00
|
$612.00
|
$4,838.40
|
$1,995.00
|
2025-12-19
|
|
73720
|
HCPCS
|
MRI Scan Of Leg Before And After Contrast
|
576
|
64
|
$2,891.00
|
$2,891.00
|
$96.60
|
$4,047.40
|
$1,985.54
|
2025-12-19
|
|
J7298
|
HCPCS
|
Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg
|
64
|
64
|
$2,056.00
|
$2,056.00
|
$1,398.08
|
$2,878.40
|
$1,953.20
|
2025-12-19
|
|
J7296
|
HCPCS
|
Levonorgestrel-releasing Intrauterine Contraceptive System, (kyleena), 19.5 Mg
|
64
|
64
|
$1,960.00
|
$1,960.00
|
$1,332.80
|
$2,744.00
|
$1,862.00
|
2025-12-19
|
|
C8909
|
HCPCS
|
Magnetic Resonance Angiography With Contrast, Chest (excluding Myocardium)
|
64
|
64
|
$1,934.00
|
$1,934.00
|
$764.12
|
$2,707.60
|
$1,837.30
|
2025-12-19
|
|
C8911
|
HCPCS
|
Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Chest…
|
64
|
64
|
$1,934.00
|
$1,934.00
|
$1,315.12
|
$2,707.60
|
$1,837.30
|
2025-12-19
|
|
C8910
|
HCPCS
|
Magnetic Resonance Angiography Without Contrast, Chest (excluding Myocardium)
|
64
|
64
|
$1,934.00
|
$1,934.00
|
$764.12
|
$2,707.60
|
$1,837.30
|
2025-12-19
|
|
C8900
|
HCPCS
|
Magnetic Resonance Angiography With Contrast, Abdomen
|
64
|
64
|
$1,919.00
|
$1,919.00
|
$776.42
|
$2,686.60
|
$1,823.05
|
2025-12-19
|
|
C8902
|
HCPCS
|
Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Abdom…
|
64
|
64
|
$1,919.00
|
$1,919.00
|
$1,304.92
|
$2,686.60
|
$1,823.05
|
2025-12-19
|
|
C8901
|
HCPCS
|
Magnetic Resonance Angiography Without Contrast, Abdomen
|
64
|
64
|
$1,919.00
|
$1,919.00
|
$776.42
|
$2,686.60
|
$1,823.05
|
2025-12-19
|
|
74178
|
HCPCS
|
CT Scan Of Abdomen And Pelvis Before And After Contrast
|
192
|
64
|
$1,902.00
|
$1,902.00
|
$89.64
|
$2,662.80
|
$1,806.90
|
2025-12-19
|
|
Q4160
|
HCPCS
|
Nushield, Per Square Centimeter
|
320
|
64
|
$1,900.00
|
$1,900.00
|
$537.20
|
$5,208.00
|
$1,805.00
|
2025-12-19
|
|
74160
|
HCPCS
|
CT Scan Of Abdomen With Contrast
|
192
|
64
|
$1,898.00
|
$1,898.00
|
$56.70
|
$2,657.20
|
$1,803.10
|
2025-12-19
|
|
74182
|
HCPCS
|
MRI Scan Of Abdomen With Contrast
|
320
|
64
|
$2,031.00
|
$2,031.00
|
$76.98
|
$2,843.40
|
$1,766.97
|
2025-12-19
|
|
81220
|
HCPCS
|
Gene Analysis (cystic Fibrosis Transmembrane Conductance Regular) Common Variant…
|
64
|
64
|
$1,767.00
|
$1,767.00
|
$1,127.12
|
$2,473.80
|
$1,678.65
|
2025-12-19
|
|
86711
|
HCPCS
|
Analysis For Antibody To John Cunningham Virus
|
64
|
64
|
$1,718.00
|
$1,718.00
|
$34.20
|
$2,405.20
|
$1,632.10
|
2025-12-19
|
|
72125
|
HCPCS
|
CT Scan Of Upper Spine Without Contrast
|
192
|
64
|
$1,713.00
|
$1,713.00
|
$44.35
|
$2,398.20
|
$1,627.35
|
2025-12-19
|
|
74150
|
HCPCS
|
CT Scan Of Abdomen Without Contrast
|
192
|
64
|
$1,712.00
|
$1,712.00
|
$52.90
|
$2,396.80
|
$1,626.40
|
2025-12-19
|
|
90380
|
HCPCS
|
Respiratory Syncytial Virus Antibody, 0.5 Ml Dosage For Injection Into Muscle
|
64
|
64
|
$1,621.00
|
$1,621.00
|
$1,102.28
|
$2,269.40
|
$1,539.95
|
2025-12-19
|
|
90381
|
HCPCS
|
Respiratory Syncytial Virus Antibody, 1.0 Ml Dosage For Injection Into Muscle
|
64
|
64
|
$1,621.00
|
$1,621.00
|
$1,102.28
|
$2,269.40
|
$1,539.95
|
2025-12-19
|
|
G0121
|
HCPCS
|
Colorectal Cancer Screening; Colonoscopy On Individual Not Meeting Criteria For …
|
128
|
64
|
$1,857.00
|
$1,857.00
|
$177.27
|
$2,931.60
|
$1,539.00
|
2025-12-19
|
|
74175
|
HCPCS
|
CT Scan Of Blood Vessels Of Abdomen With Contrast
|
192
|
64
|
$1,610.00
|
$1,610.00
|
$81.09
|
$2,254.00
|
$1,529.50
|
2025-12-19
|
|
C8933
|
HCPCS
|
Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Spina…
|
64
|
64
|
$1,603.00
|
$1,603.00
|
$1,090.04
|
$2,244.20
|
$1,522.85
|
2025-12-19
|
|
C8931
|
HCPCS
|
Magnetic Resonance Angiography With Contrast, Spinal Canal And Contents
|
64
|
64
|
$1,603.00
|
$1,603.00
|
$806.33
|
$2,244.20
|
$1,522.85
|
2025-12-19
|
|
C8932
|
HCPCS
|
Magnetic Resonance Angiography Without Contrast, Spinal Canal And Contents
|
64
|
64
|
$1,603.00
|
$1,603.00
|
$806.33
|
$2,244.20
|
$1,522.85
|
2025-12-19
|
|
C8934
|
HCPCS
|
Magnetic Resonance Angiography With Contrast, Upper Extremity
|
128
|
64
|
$1,584.00
|
$1,584.00
|
$799.29
|
$2,217.60
|
$1,504.80
|
2025-12-19
|
|
C8936
|
HCPCS
|
Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Upper…
|
128
|
64
|
$1,584.00
|
$1,584.00
|
$1,077.12
|
$2,217.60
|
$1,504.80
|
2025-12-19
|
|
C8935
|
HCPCS
|
Magnetic Resonance Angiography Without Contrast, Upper Extremity
|
128
|
64
|
$1,584.00
|
$1,584.00
|
$799.29
|
$2,217.60
|
$1,504.80
|
2025-12-19
|
|
45378
|
HCPCS
|
Diagnostic Exam Of Large Bowel Using A Flexible Endoscope
|
128
|
64
|
$1,689.00
|
$1,689.00
|
$176.95
|
$2,511.60
|
$1,504.80
|
2025-12-19
|
|
J0248
|
HCPCS
|
Injection, Remdesivir, 1 Mg
|
64
|
64
|
$1,578.00
|
$1,578.00
|
$1,073.04
|
$2,209.20
|
$1,499.10
|
2025-12-19
|
|
71271
|
HCPCS
|
Low Dose CT Scan Of Chest For Lung Cancer Screening
|
100
|
64
|
$1,530.00
|
$1,530.00
|
$48.15
|
$2,142.00
|
$1,453.50
|
2025-12-19
|
|
G0105
|
HCPCS
|
Colorectal Cancer Screening; Colonoscopy On Individual At High Risk
|
128
|
64
|
$1,802.50
|
$1,802.50
|
$176.95
|
$2,931.60
|
$1,451.91
|
2025-12-19
|
|
81222
|
HCPCS
|
Gene Analysis (cystic Fibrosis Transmembrane Conductance Regular) Duplication Or…
|
64
|
64
|
$1,520.00
|
$1,520.00
|
$881.01
|
$2,128.00
|
$1,444.00
|
2025-12-19
|
|
45388
|
HCPCS
|
Destruction Of Polyp Or Growth Of Large Bowel Using A Flexible Endoscope
|
128
|
64
|
$1,831.50
|
$1,831.50
|
$258.00
|
$3,822.00
|
$1,380.70
|
2025-12-19
|
|
70498
|
HCPCS
|
CT Scan Of Blood Vessels Of Neck With Contrast
|
192
|
64
|
$1,452.00
|
$1,452.00
|
$77.93
|
$2,032.80
|
$1,379.40
|
2025-12-19
|
|
C8920
|
HCPCS
|
Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Pelvi…
|
64
|
64
|
$1,433.00
|
$1,433.00
|
$974.44
|
$2,006.20
|
$1,361.35
|
2025-12-19
|
|
45381
|
HCPCS
|
Injection Beneath Lining Of Large Bowel Using A Flexible Endoscope
|
128
|
64
|
$1,612.50
|
$1,612.50
|
$192.45
|
$2,511.60
|
$1,359.45
|
2025-12-19
|
|
63661
|
HCPCS
|
Insertion Of Spinal Neurostimulator Electrode Array Using Fluoroscopic Guidance
|
128
|
64
|
$1,722.50
|
$1,722.50
|
$323.07
|
$3,302.60
|
$1,328.77
|
2025-12-19
|
|
74181
|
HCPCS
|
MRI Scan Of Abdomen Without Contrast
|
320
|
64
|
$1,486.00
|
$1,486.00
|
$64.93
|
$2,080.40
|
$1,292.82
|
2025-12-19
|
|
10121
|
HCPCS
|
Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Complex
|
128
|
64
|
$1,594.00
|
$1,594.00
|
$179.25
|
$2,703.40
|
$1,266.18
|
2025-12-19
|
|
59812
|
HCPCS
|
Treatment Of Miscarriage
|
128
|
64
|
$1,704.50
|
$1,704.50
|
$300.84
|
$3,957.80
|
$1,262.02
|
2025-12-19
|
|
45382
|
HCPCS
|
Control Of Bleeding Of Upper Large Bowel Using A Flexible Endoscope
|
128
|
64
|
$1,662.00
|
$1,662.00
|
$247.05
|
$3,382.40
|
$1,261.82
|
2025-12-19
|
|
21555
|
HCPCS
|
Removal Of Growth Under Skin Of Neck Or Front Of Chest, Less Than 3.0 Cm
|
64
|
64
|
$1,240.00
|
$1,240.00
|
$843.20
|
$1,736.00
|
$1,178.00
|
2025-12-19
|
|
45385
|
HCPCS
|
Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S…
|
128
|
64
|
$1,415.50
|
$1,415.50
|
$242.52
|
$2,511.60
|
$1,112.90
|
2025-12-19
|
|
11606
|
HCPCS
|
Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm
|
55
|
55
|
$1,158.00
|
$1,158.00
|
$787.44
|
$1,621.20
|
$1,100.10
|
2025-12-19
|
|
23655
|
HCPCS
|
Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia
|
128
|
64
|
$1,404.50
|
$1,404.50
|
$409.79
|
$2,758.00
|
$1,079.59
|
2025-12-19
|
|
74176
|
HCPCS
|
CT Scan Of Abdomen And Pelvis Without Contrast
|
192
|
64
|
$1,129.00
|
$1,129.00
|
$77.61
|
$1,580.60
|
$1,072.55
|
2025-12-19
|
|
45380
|
HCPCS
|
Biopsy Of Large Bowel Using A Flexible Endoscope
|
128
|
64
|
$1,347.00
|
$1,347.00
|
$192.45
|
$2,511.60
|
$1,046.46
|
2025-12-19
|
|
C8914
|
HCPCS
|
Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Lower…
|
236
|
64
|
$1,433.00
|
$1,433.00
|
$52.00
|
$2,006.20
|
$1,038.92
|
2025-12-19
|
|
25605
|
HCPCS
|
Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit…
|
128
|
64
|
$1,281.00
|
$1,281.00
|
$514.38
|
$2,109.80
|
$1,024.76
|
2025-12-19
|
|
45384
|
HCPCS
|
Removal Of Polyps Or Growths Of Large Bowel Using A Flexible Endoscope With Elec…
|
128
|
64
|
$1,305.00
|
$1,305.00
|
$218.54
|
$2,511.60
|
$1,005.72
|
2025-12-19
|
|
8891465_1
|
CDM
|
Snare Expro Elite 25mm__stw
|
63
|
63
|
$1,040.00
|
$1,040.00
|
$707.20
|
$1,456.00
|
$988.00
|
2025-12-19
|
|
25565
|
HCPCS
|
Closed Treatment Of Broken Midpart Of Both Forearm Bones With Manipulation
|
128
|
64
|
$1,235.00
|
$1,235.00
|
$467.54
|
$2,109.80
|
$979.92
|
2025-12-19
|
|
C8913
|
HCPCS
|
Magnetic Resonance Angiography Without Contrast, Lower Extremity
|
236
|
64
|
$1,433.00
|
$1,433.00
|
$52.00
|
$2,006.20
|
$974.44
|
2025-12-19
|
|
C8918
|
HCPCS
|
Magnetic Resonance Angiography With Contrast, Pelvis
|
118
|
64
|
$1,433.00
|
$1,433.00
|
$52.00
|
$2,006.20
|
$974.44
|
2025-12-19
|
|
C8919
|
HCPCS
|
Magnetic Resonance Angiography Without Contrast, Pelvis
|
118
|
64
|
$1,433.00
|
$1,433.00
|
$52.00
|
$2,006.20
|
$974.44
|
2025-12-19
|
|
C8912
|
HCPCS
|
Magnetic Resonance Angiography With Contrast, Lower Extremity
|
236
|
64
|
$1,433.00
|
$1,433.00
|
$52.00
|
$2,006.20
|
$974.44
|
2025-12-19
|
|
99291
|
HCPCS
|
Critical Care, First 30-74 Minutes
|
128
|
64
|
$1,270.50
|
$1,270.50
|
$205.41
|
$2,587.20
|
$964.43
|
2025-12-19
|
|
28001
|
HCPCS
|
Drainage Of Fluid Filled Sac In Foot
|
128
|
64
|
$1,293.00
|
$1,293.00
|
$93.04
|
$2,835.00
|
$960.59
|
2025-12-19
|
|
87507
|
HCPCS
|
Detection Test By Nucleic Acid For Digestive Tract Pathogen, Multiple Types Or S…
|
184
|
64
|
$1,010.00
|
$1,010.00
|
$570.52
|
$1,576.40
|
$959.50
|
2025-12-19
|
|
27818
|
HCPCS
|
Closed Treatment Of 3 Broken Lower Leg Bones At Ankle With Manipulation
|
128
|
64
|
$1,206.50
|
$1,206.50
|
$443.62
|
$2,109.80
|
$956.00
|
2025-12-19
|
|
12044
|
HCPCS
|
Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 7.6-12.5 Cm
|
128
|
64
|
$1,061.50
|
$1,061.50
|
$209.59
|
$1,470.00
|
$955.35
|
2025-12-19
|
|
44389
|
HCPCS
|
Biopsy Of Large Bowel Using An Endoscope Inserted Through Surgically Created Ope…
|
128
|
64
|
$1,246.00
|
$1,246.00
|
$164.67
|
$2,511.60
|
$948.49
|
2025-12-19
|
|
27810
|
HCPCS
|
Closed Treatment Of 2 Broken Lower Leg Bones At Ankle With Manipulation
|
128
|
64
|
$1,194.50
|
$1,194.50
|
$431.39
|
$2,109.80
|
$943.77
|
2025-12-19
|
|
36430
|
HCPCS
|
Transfusion Of Blood Or Blood Products
|
64
|
64
|
$975.00
|
$975.00
|
$663.00
|
$1,365.00
|
$926.25
|
2025-12-19
|
|
87633
|
HCPCS
|
Detection Test By Nucleic Acid For Multiple Types Of Respiratory Virus, Multiple…
|
64
|
64
|
$964.00
|
$964.00
|
$655.52
|
$1,349.60
|
$915.80
|
2025-12-19
|
|
43249
|
HCPCS
|
Balloon Dilation Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexibl…
|
128
|
64
|
$1,253.00
|
$1,253.00
|
$146.93
|
$2,900.80
|
$914.97
|
2025-12-19
|
|
44394
|
HCPCS
|
Removal Of Growths Or Polyps Of Large Bowel By Mechanical Snare Using An Endosco…
|
128
|
64
|
$1,202.50
|
$1,202.50
|
$215.37
|
$2,479.40
|
$909.63
|
2025-12-19
|
|
43251
|
HCPCS
|
Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi…
|
128
|
64
|
$1,191.50
|
$1,191.50
|
$187.30
|
$2,560.60
|
$890.55
|
2025-12-19
|
|
11624
|
HCPCS
|
Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4.0 …
|
55
|
55
|
$935.00
|
$935.00
|
$635.80
|
$1,309.00
|
$888.25
|
2025-12-19
|
|
93303
|
HCPCS
|
Ultrasound Of Heart For Congenital Defect
|
64
|
64
|
$923.00
|
$923.00
|
$417.29
|
$1,292.20
|
$876.85
|
2025-12-19
|
|
27842
|
HCPCS
|
Closed Treatment Of Dislocated Ankle Under Anesthesia
|
64
|
64
|
$1,938.00
|
$1,938.00
|
$491.75
|
$1,879.86
|
$831.23
|
2025-12-19
|
|
76811
|
HCPCS
|
Ultrasound Scan Of Pregnant Uterus With Detailed Fetal Anatomic Examination, Sin…
|
64
|
64
|
$872.00
|
$872.00
|
$203.84
|
$1,220.80
|
$828.40
|
2025-12-19
|
|
32551
|
HCPCS
|
Removal Of Fluid From Between Lung And Chest Cavity
|
128
|
64
|
$1,076.50
|
$1,076.50
|
$148.74
|
$2,186.80
|
$817.72
|
2025-12-19
|
|
J2002
|
HCPCS
|
Injection, Lidocaine Hcl In 5% Dextrose, 1 Mg
|
64
|
64
|
$856.00
|
$856.00
|
$582.08
|
$1,198.40
|
$813.20
|
2025-12-19
|
|
71552
|
HCPCS
|
MRI Scan Of Chest Before And After Contrast
|
256
|
64
|
$1,715.50
|
$1,715.50
|
$101.35
|
$4,022.20
|
$813.01
|
2025-12-19
|
|
92950
|
HCPCS
|
Manual Attempt To Restore Blood Circulation And Breathing
|
128
|
64
|
$981.00
|
$981.00
|
$175.36
|
$1,194.20
|
$810.35
|
2025-12-19
|
|
86366
|
HCPCS
|
Test For Muscle-specific Kinase Antibody
|
64
|
64
|
$852.00
|
$852.00
|
$579.36
|
$1,192.80
|
$809.40
|
2025-12-19
|
|
5799034_1
|
CDM
|
43760 Ed Proc Gastrostomy Tube Chng-hospital
|
63
|
63
|
$840.00
|
$840.00
|
$571.20
|
$1,176.00
|
$798.00
|
2025-12-19
|
|
99285
|
HCPCS
|
Emergency Department Visit With High Level Of Medical Decision Making
|
128
|
64
|
$1,024.50
|
$1,024.50
|
$168.54
|
$2,072.00
|
$779.16
|
2025-12-19
|
|
28232
|
HCPCS
|
Incision To Lengthen Toe Tendon
|
128
|
64
|
$895.00
|
$895.00
|
$237.86
|
$1,377.60
|
$765.70
|
2025-12-19
|
|
44392
|
HCPCS
|
Removal Of Growths Or Polyps Of Large Bowel By Electrical Cautery Using An Endos…
|
128
|
64
|
$1,001.00
|
$1,001.00
|
$191.71
|
$1,990.80
|
$764.78
|
2025-12-19
|
|
87899
|
HCPCS
|
Detection Test By Immunoassay With Direct Visual Observation For Other Organism
|
188
|
64
|
$791.00
|
$791.00
|
$23.80
|
$1,107.40
|
$751.45
|
2025-12-19
|
|
Q5125
|
HCPCS
|
Injection, Filgrastim-ayow, Biosimilar, (releuko), 1 Microgram
|
64
|
64
|
$784.00
|
$784.00
|
$533.12
|
$1,097.60
|
$744.80
|
2025-12-19
|
|
25622
|
HCPCS
|
Closed Treatment Of Broken Wrist Bone Near Base Of Thumb
|
128
|
64
|
$815.00
|
$815.00
|
$291.71
|
$1,068.20
|
$722.23
|
2025-12-19
|
|
73220
|
HCPCS
|
MRI Scan Of Arm Before And After Contrast
|
512
|
64
|
$1,710.00
|
$1,710.00
|
$96.60
|
$4,047.40
|
$713.21
|
2025-12-19
|
|
46040
|
HCPCS
|
Drainage Of Deep Abscess In Rectum
|
64
|
64
|
$1,877.00
|
$1,877.00
|
$421.63
|
$1,820.69
|
$702.85
|
2025-12-19
|
|
81514
|
HCPCS
|
Measurement Of DNA Of Bacteria In Vaginal Fluid Specimen
|
64
|
64
|
$735.00
|
$735.00
|
$499.80
|
$1,029.00
|
$698.25
|
2025-12-19
|
|
25660
|
HCPCS
|
Closed Treatment Of Dislocated Wrist Bones With Manipulation
|
64
|
64
|
$1,465.00
|
$1,465.00
|
$454.71
|
$1,421.05
|
$695.82
|
2025-12-19
|
|
93976
|
HCPCS
|
Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow
|
192
|
64
|
$732.00
|
$732.00
|
$36.20
|
$1,024.80
|
$695.40
|
2025-12-19
|
|
26600
|
HCPCS
|
Closed Treatment Of Broken Hand Bone
|
55
|
55
|
$726.00
|
$726.00
|
$493.68
|
$1,016.40
|
$689.70
|
2025-12-19
|
|
75635
|
HCPCS
|
CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast
|
128
|
64
|
$1,098.50
|
$1,098.50
|
$105.78
|
$2,254.00
|
$684.47
|
2025-12-19
|
|
73223
|
HCPCS
|
MRI Scan Of Arm Joint Before And After Contrast
|
512
|
64
|
$1,711.00
|
$1,711.00
|
$96.60
|
$4,047.40
|
$680.94
|
2025-12-19
|
|
25530
|
HCPCS
|
Closed Treatment Of Broken Midpart Of Forearm Bone On Small Finger Side
|
142
|
64
|
$740.00
|
$740.00
|
$251.34
|
$1,002.40
|
$680.20
|
2025-12-19
|
|
73723
|
HCPCS
|
MRI Scan Of Leg Joint Before And After Contrast
|
512
|
64
|
$1,710.00
|
$1,710.00
|
$96.60
|
$4,047.40
|
$679.10
|
2025-12-19
|
|
0202U
|
OTHER
|
Test For Detection Of Respiratory Disease-causing Organisms From Back Of Nose An…
|
124
|
64
|
$804.00
|
$804.00
|
$150.00
|
$1,125.60
|
$645.05
|
2025-12-19
|
|
8028192_1
|
CDM
|
Room & Board - Other - Sterile Environment
|
58
|
58
|
$674.00
|
$674.00
|
$505.50
|
$674.00
|
$640.30
|
2025-12-19
|
|
71551
|
HCPCS
|
MRI Scan Of Chest With Contrast
|
256
|
64
|
$986.50
|
$986.50
|
$76.98
|
$2,165.80
|
$637.89
|
2025-12-19
|
|
12055
|
HCPCS
|
Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.6-…
|
128
|
64
|
$845.50
|
$845.50
|
$293.45
|
$996.19
|
$630.80
|
2025-12-19
|
|
63688
|
HCPCS
|
Removal Or Revision Of Spinal Neurostimulator Generator Or Receiver
|
64
|
64
|
$1,775.00
|
$1,775.00
|
$293.66
|
$1,721.75
|
$628.73
|
2025-12-19
|
|
11424
|
HCPCS
|
Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4…
|
55
|
55
|
$658.00
|
$658.00
|
$447.44
|
$921.20
|
$625.10
|
2025-12-19
|
|
11602
|
HCPCS
|
Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 1.1-2.0 Cm
|
55
|
55
|
$655.00
|
$655.00
|
$445.40
|
$917.00
|
$622.25
|
2025-12-19
|
|
26755
|
HCPCS
|
Closed Treatment Of Broken End Of Finger Or Thumb With Manipulation
|
142
|
64
|
$1,062.00
|
$1,062.00
|
$281.93
|
$1,184.37
|
$612.75
|
2025-12-19
|
|
87154
|
HCPCS
|
Amplifed Nucleic Acid Probe Typing Of Disease Agent In Blood Culture Specimen
|
64
|
64
|
$643.00
|
$643.00
|
$437.24
|
$900.20
|
$610.85
|
2025-12-19
|
|
70543
|
HCPCS
|
MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast
|
128
|
64
|
$1,748.00
|
$1,748.00
|
$96.29
|
$4,155.20
|
$602.94
|
2025-12-19
|
|
92960
|
HCPCS
|
External Shock To Heart To Regulate Heart Beat
|
128
|
64
|
$695.50
|
$695.50
|
$103.72
|
$1,061.20
|
$601.35
|
2025-12-19
|
|
11603
|
HCPCS
|
Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm
|
55
|
55
|
$630.00
|
$630.00
|
$428.40
|
$882.00
|
$598.50
|
2025-12-19
|
|
13121
|
HCPCS
|
Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 2.6-7.5 Cm
|
142
|
64
|
$631.00
|
$631.00
|
$250.34
|
$1,358.97
|
$597.55
|
2025-12-19
|
|
72159
|
HCPCS
|
MRI Scan Of Blood Vessels Of Spinal Canal
|
128
|
64
|
$1,024.00
|
$1,024.00
|
$80.14
|
$2,244.20
|
$594.62
|
2025-12-19
|
|
26641
|
HCPCS
|
Closed Treatment Of Dislocated Thumb At Wrist With Manipulation
|
64
|
64
|
$1,408.00
|
$1,408.00
|
$389.18
|
$1,365.76
|
$583.86
|
2025-12-19
|
|
26700
|
HCPCS
|
Closed Treatment Of Dislocated Hand Joint At Base Of Finger With Manipulation
|
142
|
64
|
$1,122.00
|
$1,122.00
|
$320.34
|
$1,251.30
|
$583.30
|
2025-12-19
|
|
70549
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck Before And After Contrast
|
128
|
64
|
$1,882.00
|
$1,882.00
|
$80.14
|
$4,649.40
|
$582.71
|
2025-12-19
|
|
70553
|
HCPCS
|
MRI Scan Of Brain Before And After Contrast
|
256
|
64
|
$1,793.00
|
$1,793.00
|
$102.62
|
$4,230.80
|
$580.60
|
2025-12-19
|
|
70546
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head Before And After Contrast
|
128
|
64
|
$1,882.00
|
$1,882.00
|
$65.89
|
$4,649.40
|
$580.09
|
2025-12-19
|
|
74185
|
HCPCS
|
MRI Scan Of Blood Vessels Of Abdomen
|
128
|
64
|
$1,179.50
|
$1,179.50
|
$79.81
|
$2,686.60
|
$579.94
|
2025-12-19
|
|
13132
|
HCPCS
|
Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G…
|
128
|
64
|
$937.50
|
$937.50
|
$292.67
|
$1,227.05
|
$579.50
|
2025-12-19
|
|
72198
|
HCPCS
|
MRI Scan Of Blood Vessels Of Pelvis
|
256
|
64
|
$936.50
|
$936.50
|
$80.13
|
$2,006.20
|
$578.20
|
2025-12-19
|
|
27840
|
HCPCS
|
Closed Treatment Of Dislocated Ankle
|
128
|
64
|
$696.00
|
$696.00
|
$390.38
|
$831.60
|
$576.18
|
2025-12-19
|
|
6912560_1
|
CDM
|
Tubing Irr W Back Flow 100130__stw
|
63
|
63
|
$605.00
|
$605.00
|
$411.40
|
$847.00
|
$574.75
|
2025-12-19
|
|
11404
|
HCPCS
|
Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 3.1-4.0 Cm
|
55
|
55
|
$603.00
|
$603.00
|
$410.04
|
$844.20
|
$572.85
|
2025-12-19
|
|
71550
|
HCPCS
|
MRI Scan Of Chest Without Contrast
|
256
|
64
|
$1,111.50
|
$1,111.50
|
$65.25
|
$2,611.00
|
$570.80
|
2025-12-19
|
|
25650
|
HCPCS
|
Closed Treatment Of Broken Base Of Forearm Bone On Small Finger Side At Wrist
|
142
|
64
|
$1,056.00
|
$1,056.00
|
$312.99
|
$1,178.55
|
$569.05
|
2025-12-19
|
|
P9016
|
HCPCS
|
Red Blood Cells, Leukocytes Reduced, Each Unit
|
64
|
64
|
$592.00
|
$592.00
|
$377.06
|
$828.80
|
$562.40
|
2026-07-30
|
|
99245
|
HCPCS
|
Office Or Other Outpatient Consultation With High Level Of Medical Decision Maki…
|
64
|
64
|
$588.00
|
$588.00
|
$399.84
|
$823.20
|
$558.60
|
2025-12-19
|
|
31500
|
HCPCS
|
Emergent Insertion Of Breathing Tube Into Windpipe Using An Endoscope
|
122
|
64
|
$615.00
|
$615.00
|
$136.49
|
$861.00
|
$557.65
|
2025-12-19
|
|
23075
|
HCPCS
|
Removal Of Growth Under Skin Of Shoulder Area, Less Than 3.0 Cm
|
64
|
64
|
$2,243.00
|
$2,243.00
|
$326.39
|
$2,175.71
|
$552.79
|
2025-12-19
|
|
11622
|
HCPCS
|
Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 1.1-2.0 …
|
55
|
55
|
$581.00
|
$581.00
|
$395.08
|
$813.40
|
$551.95
|
2025-12-19
|
|
0219U
|
OTHER
|
Gene Analysis Of Human Immunodeficiency Virus Targeted Sequence Analysis For Res…
|
64
|
64
|
$579.00
|
$579.00
|
$393.72
|
$810.60
|
$550.05
|
2025-12-19
|
|
87522
|
HCPCS
|
Detection Test By Nucleic Acid For Hepatitis C Virus, Quantification
|
124
|
64
|
$605.00
|
$605.00
|
$86.75
|
$847.00
|
$547.08
|
2025-12-19
|
|
73706
|
HCPCS
|
CT Scan Of Blood Vessels Of Lower Leg With Contrast
|
256
|
64
|
$971.00
|
$971.00
|
$84.25
|
$2,066.40
|
$547.07
|
2025-12-19
|
|
G0379
|
HCPCS
|
Direct Admission Of Patient For Hospital Observation Care
|
64
|
64
|
$575.00
|
$575.00
|
$391.00
|
$805.00
|
$546.25
|
2025-12-19
|
|
88307
|
HCPCS
|
Pathology Examination Of Tissue Using A Microscope, Moderately High Complexity
|
64
|
64
|
$574.00
|
$574.00
|
$390.32
|
$803.60
|
$545.30
|
2025-12-19
|
|
23650
|
HCPCS
|
Closed Treatment Of Dislocated Shoulder With Manipulation
|
128
|
64
|
$598.50
|
$598.50
|
$307.10
|
$805.00
|
$543.69
|
2025-12-19
|
|
73722
|
HCPCS
|
MRI Scan Of Leg Joint With Contrast
|
512
|
64
|
$851.00
|
$851.00
|
$72.54
|
$1,822.80
|
$543.49
|
2025-12-19
|
|
73222
|
HCPCS
|
MRI Scan Of Arm Joint With Contrast
|
512
|
64
|
$1,065.50
|
$1,065.50
|
$72.54
|
$2,423.40
|
$542.61
|
2025-12-19
|
|
46320
|
HCPCS
|
Removal Of External Hemorrhoid With Blood Clot
|
55
|
55
|
$571.00
|
$571.00
|
$388.28
|
$799.40
|
$542.45
|
2025-12-19
|
|
10080
|
HCPCS
|
Simple Drainage Of Cyst Of Tailbone
|
128
|
64
|
$625.50
|
$625.50
|
$103.04
|
$953.40
|
$541.50
|
2025-12-19
|
|
81256
|
HCPCS
|
Gene Analysis (hemochromatosis) Common Variants
|
64
|
64
|
$568.00
|
$568.00
|
$132.36
|
$795.20
|
$539.60
|
2025-12-19
|
|
81219
|
HCPCS
|
Gene Analysis (calreticulin), Common Variants
|
64
|
64
|
$567.00
|
$567.00
|
$246.30
|
$793.80
|
$538.65
|
2025-12-19
|
|
13131
|
HCPCS
|
Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G…
|
128
|
64
|
$594.50
|
$594.50
|
$235.14
|
$824.60
|
$535.05
|
2025-12-19
|
|
88309
|
HCPCS
|
Pathology Examination Of Tissue Using A Microscope, High Complexity
|
188
|
64
|
$559.00
|
$559.00
|
$226.44
|
$1,142.40
|
$531.05
|
2025-12-19
|
|
27265
|
HCPCS
|
Closed Treatment Of Dislocated Hip Prosthesis
|
128
|
64
|
$935.00
|
$935.00
|
$369.24
|
$1,287.19
|
$526.71
|
2025-12-19
|
|
27786
|
HCPCS
|
Closed Treatment Of Broken Outside Lower Leg Bone At Ankle
|
183
|
64
|
$865.00
|
$865.00
|
$291.71
|
$1,391.60
|
$524.40
|
2025-12-19
|
|
87902
|
HCPCS
|
Analysis Test By Nucleic Acid For Hepatitis C Virus
|
124
|
64
|
$907.00
|
$907.00
|
$67.32
|
$1,269.80
|
$521.34
|
2025-12-19
|
|
25600
|
HCPCS
|
Closed Treatment Of Broken Forearm (radius) Bone At The Wrist Area On The Thumb …
|
183
|
64
|
$969.00
|
$969.00
|
$333.76
|
$1,551.20
|
$520.55
|
2025-12-19
|
|
11423
|
HCPCS
|
Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 2.1-3…
|
55
|
55
|
$547.00
|
$547.00
|
$371.96
|
$765.80
|
$519.65
|
2025-12-19
|
|
15271
|
HCPCS
|
Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C…
|
64
|
64
|
$546.00
|
$546.00
|
$371.28
|
$764.40
|
$518.70
|
2025-12-19
|
|
76830
|
HCPCS
|
Ultrasound Scan Of Uterus, Ovaries, Tubes, Cervix And Pelvic Area Through Vagina
|
192
|
64
|
$545.00
|
$545.00
|
$31.05
|
$763.00
|
$517.75
|
2025-12-19
|
|
92610
|
HCPCS
|
Evaluation Of Swallowing Function
|
64
|
64
|
$545.00
|
$545.00
|
$370.60
|
$763.00
|
$517.75
|
2025-12-19
|
|
71275
|
HCPCS
|
CT Scan Of Blood Vessels Of Chest With Contrast
|
128
|
64
|
$1,500.00
|
$1,500.00
|
$81.40
|
$3,460.80
|
$516.33
|
2025-12-19
|
|
23600
|
HCPCS
|
Closed Treatment Of Broken Top Of Upper Arm Bone
|
64
|
64
|
$939.00
|
$939.00
|
$324.33
|
$910.83
|
$515.27
|
2025-12-19
|
|
81292
|
HCPCS
|
Gene Analysis (mutL Homolog 1, Colon Cancer, Nonpolyposis Type 2) Full Sequence …
|
64
|
64
|
$540.00
|
$540.00
|
$367.20
|
$1,367.69
|
$513.00
|
2025-12-19
|
|
88269
|
HCPCS
|
Chromosome Analysis Of Amniotic Fluid For Genetic Defects
|
64
|
64
|
$540.00
|
$540.00
|
$351.66
|
$756.00
|
$513.00
|
2025-12-19
|
|
73218
|
HCPCS
|
MRI Scan Of Arm Without Contrast
|
640
|
64
|
$1,019.50
|
$1,019.50
|
$60.51
|
$2,385.60
|
$512.83
|
2025-12-19
|
|
27824
|
HCPCS
|
Closed Treatment Of Broken Shin Bone At Lower Weight Bearing Joint
|
64
|
64
|
$1,065.00
|
$1,065.00
|
$311.37
|
$1,033.05
|
$511.75
|
2025-12-19
|
|
99284
|
HCPCS
|
Emergency Department Visit With Moderate Level Of Medical Decision Making
|
128
|
64
|
$665.00
|
$665.00
|
$116.24
|
$1,309.00
|
$509.47
|
2025-12-19
|
|
27760
|
HCPCS
|
Closed Treatment Of Inside Portion Of Shin Bone At Ankle
|
64
|
64
|
$864.00
|
$864.00
|
$314.64
|
$838.08
|
$509.41
|
2025-12-19
|
|
81381
|
HCPCS
|
Hla Class I Typing High Resolution One Allele Or Allele Group
|
64
|
64
|
$536.00
|
$536.00
|
$344.06
|
$750.40
|
$509.20
|
2025-12-19
|
|
73206
|
HCPCS
|
CT Scan Of Blood Vessels Of Arm With Contrast
|
256
|
64
|
$958.50
|
$958.50
|
$80.13
|
$2,066.40
|
$506.94
|
2025-12-19
|
|
80305
|
HCPCS
|
Testing For Presence Of Drug, Read By Direct Observation
|
64
|
64
|
$532.00
|
$532.00
|
$25.52
|
$744.80
|
$505.40
|
2025-12-19
|
|
26725
|
HCPCS
|
Closed Treatment Of Broken Finger Or Thumb At Midportion Or Part Near Hand With …
|
128
|
64
|
$855.50
|
$855.50
|
$311.02
|
$1,147.51
|
$504.41
|
2025-12-19
|
|
11042
|
HCPCS
|
Removal Of Skin And Tissue, 20.0 Sq Cm Or Less
|
220
|
64
|
$530.00
|
$530.00
|
$58.78
|
$1,281.00
|
$503.50
|
2025-12-19
|
|
72191
|
HCPCS
|
CT Scan Of Blood Vessels Of Pelvis With Contrast
|
128
|
64
|
$1,027.50
|
$1,027.50
|
$80.13
|
$2,254.00
|
$501.88
|
2025-12-19
|
|
92523
|
HCPCS
|
Evaluation Of Speech Sound Production With Evaluation Of Language Comprehension …
|
64
|
64
|
$527.00
|
$527.00
|
$358.36
|
$737.80
|
$500.65
|
2025-12-19
|
|
11626
|
HCPCS
|
Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More Tha…
|
64
|
64
|
$1,124.00
|
$1,124.00
|
$282.48
|
$1,090.28
|
$496.51
|
2025-12-19
|
|
26605
|
HCPCS
|
Closed Treatment Of Broken Hand Bone With Manipulation
|
64
|
64
|
$847.00
|
$847.00
|
$303.95
|
$821.59
|
$490.65
|
2025-12-19
|
|
81375
|
HCPCS
|
Hla Class Ii Typing Low Resolution Hla-drb1/3/4/5 And -dqb1
|
64
|
64
|
$515.00
|
$515.00
|
$350.20
|
$721.00
|
$489.25
|
2025-12-19
|
|
81298
|
HCPCS
|
Gene Analysis (mutS Homolog 6 [e Coli]) Full Sequence Analysis
|
64
|
64
|
$513.00
|
$513.00
|
$348.84
|
$1,299.75
|
$487.35
|
2025-12-19
|
|
27520
|
HCPCS
|
Closed Treatment Of Broken Kneecap
|
128
|
64
|
$698.00
|
$698.00
|
$307.84
|
$867.18
|
$486.94
|
2025-12-19
|
|
12032
|
HCPCS
|
Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 2.6-7.5 …
|
183
|
64
|
$509.00
|
$509.00
|
$185.79
|
$924.00
|
$483.55
|
2025-12-19
|
|
12031
|
HCPCS
|
Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 2.5 Cm O…
|
183
|
64
|
$509.00
|
$509.00
|
$147.65
|
$788.20
|
$483.55
|
2025-12-19
|
|
72196
|
HCPCS
|
MRI Scan Of Pelvis With Contrast
|
256
|
64
|
$898.00
|
$898.00
|
$76.98
|
$1,916.60
|
$481.78
|
2025-12-19
|
|
43239
|
HCPCS
|
Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop…
|
128
|
64
|
$623.50
|
$623.50
|
$132.41
|
$1,212.40
|
$479.23
|
2025-12-19
|
|
27780
|
HCPCS
|
Closed Treatment Of Broken Middle Or Upper End Of Outside Lower Leg Bone
|
128
|
64
|
$674.50
|
$674.50
|
$291.70
|
$819.65
|
$478.80
|
2025-12-19
|
|
11442
|
HCPCS
|
Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 1…
|
55
|
55
|
$501.00
|
$501.00
|
$340.68
|
$701.40
|
$475.95
|
2025-12-19
|
|
70542
|
HCPCS
|
MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast
|
128
|
64
|
$1,133.00
|
$1,133.00
|
$72.23
|
$2,612.40
|
$474.38
|
2025-12-19
|
|
11403
|
HCPCS
|
Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 2.1-3.0 Cm
|
55
|
55
|
$499.00
|
$499.00
|
$339.32
|
$698.60
|
$474.05
|
2025-12-19
|
|
81263
|
HCPCS
|
Gene Rearrangement Analysis (immunoglobulin Heavy Chain Locus), Variable Region …
|
64
|
64
|
$498.00
|
$498.00
|
$338.64
|
$697.20
|
$473.10
|
2025-12-19
|
|
85302
|
HCPCS
|
Protein C, (clotting Inhibitor) Activity
|
64
|
64
|
$497.00
|
$497.00
|
$24.32
|
$695.80
|
$472.15
|
2025-12-19
|
|
25630
|
HCPCS
|
Closed Treatment Of Other Broken Wrist Bone
|
64
|
64
|
$1,101.00
|
$1,101.00
|
$291.99
|
$1,067.97
|
$470.72
|
2025-12-19
|
|
28490
|
HCPCS
|
Closed Treatment Of Broken Great Toe
|
55
|
55
|
$495.00
|
$495.00
|
$336.60
|
$693.00
|
$470.25
|
2025-12-19
|
|
84378
|
HCPCS
|
Carbohydrate Analysis, Single Quantitative
|
64
|
64
|
$494.00
|
$494.00
|
$23.36
|
$691.60
|
$469.30
|
2025-12-19
|
|
72156
|
HCPCS
|
MRI Scan Of Upper Spinal Canal Before And After Contrast
|
320
|
64
|
$564.00
|
$564.00
|
$102.93
|
$4,230.80
|
$468.12
|
2025-12-19
|
|
72157
|
HCPCS
|
MRI Scan Of Middle Spinal Canal Before And After Contrast
|
320
|
64
|
$564.00
|
$564.00
|
$102.93
|
$4,120.20
|
$468.12
|
2025-12-19
|
|
72158
|
HCPCS
|
MRI Scan Of Lower Spinal Canal Before And After Contrast
|
320
|
64
|
$564.00
|
$564.00
|
$102.93
|
$4,120.20
|
$468.12
|
2025-12-19
|
|
99496
|
HCPCS
|
Transitional Care Management Services For Problem Of High Complexity
|
119
|
64
|
$562.00
|
$562.00
|
$182.26
|
$819.00
|
$466.46
|
2025-12-19
|
|
74170
|
HCPCS
|
CT Scan Of Abdomen Before And After Contrast
|
128
|
64
|
$1,031.00
|
$1,031.00
|
$62.09
|
$2,280.60
|
$466.32
|
2025-12-19
|
|
70496
|
HCPCS
|
CT Scan Of Blood Vessels Of Head With Contrast
|
128
|
64
|
$942.00
|
$942.00
|
$77.93
|
$2,032.80
|
$466.27
|
2025-12-19
|
|
64405
|
HCPCS
|
Injection Of Anesthetic Agent And/or Steroid Into Upper Neck And Back Of Head Ne…
|
55
|
55
|
$488.00
|
$488.00
|
$331.84
|
$683.20
|
$463.60
|
2025-12-19
|
|
70336
|
HCPCS
|
MRI Scan Of Jaw Joint
|
128
|
64
|
$723.50
|
$723.50
|
$65.57
|
$1,519.00
|
$463.38
|
2025-12-19
|
|
72197
|
HCPCS
|
MRI Scan Of Pelvis Before And After Contrast
|
320
|
64
|
$558.00
|
$558.00
|
$98.50
|
$4,060.00
|
$463.14
|
2025-12-19
|
|
G0438
|
HCPCS
|
Annual Wellness Visit; Includes A Personalized Prevention Plan Of Service (pps),…
|
55
|
55
|
$486.00
|
$486.00
|
$330.48
|
$680.40
|
$461.70
|
2025-12-19
|
|
11601
|
HCPCS
|
Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 0.6-1.0 Cm
|
55
|
55
|
$486.00
|
$486.00
|
$330.48
|
$680.40
|
$461.70
|
2025-12-19
|
|
81218
|
HCPCS
|
Gene Analysis (ccaat/enhancer Binding Protein [c/ebp], Alpha) Full Gene Sequence
|
64
|
64
|
$485.00
|
$485.00
|
$329.80
|
$679.00
|
$460.75
|
2025-12-19
|
|
70482
|
HCPCS
|
CT Scan Of Cranial Cavity Before And After Contrast
|
128
|
64
|
$1,362.00
|
$1,362.00
|
$56.38
|
$3,151.40
|
$455.98
|
2025-12-19
|
|
87497
|
HCPCS
|
Detection Test By Nucleic Acid For Cytomegalovirus, Quantification
|
64
|
64
|
$479.00
|
$479.00
|
$86.75
|
$670.60
|
$455.05
|
2025-12-19
|
|
88235
|
HCPCS
|
Tissue Culture For Disorders Of Amniotic Fluid Or Placenta Cells
|
64
|
64
|
$478.00
|
$478.00
|
$304.37
|
$669.20
|
$454.10
|
2025-12-19
|
|
12051
|
HCPCS
|
Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 C…
|
183
|
64
|
$478.00
|
$478.00
|
$164.76
|
$1,076.60
|
$454.10
|
2025-12-19
|
|
88233
|
HCPCS
|
Tissue Culture To Identify Skin Disorders
|
64
|
64
|
$476.00
|
$476.00
|
$284.99
|
$666.40
|
$452.20
|
2025-12-19
|
|
25535
|
HCPCS
|
Closed Treatment Of Broken Midpart Of Forearm Bone On Small Finger Side With Man…
|
64
|
64
|
$475.00
|
$475.00
|
$323.00
|
$665.00
|
$451.25
|
2025-12-19
|
|
96365
|
HCPCS
|
Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less
|
64
|
64
|
$475.00
|
$475.00
|
$323.00
|
$665.00
|
$451.25
|
2025-12-19
|
|
76801
|
HCPCS
|
Ultrasound Scan Of Pregnant Uterus (less Than 14 Weeks), Single Or First Fetus
|
192
|
64
|
$474.00
|
$474.00
|
$44.35
|
$663.60
|
$450.30
|
2025-12-19
|
|
0027U
|
OTHER
|
Gene Analysis (Janus Kinase 2) Of Targeted Sequence Exons 12-15
|
64
|
64
|
$471.00
|
$471.00
|
$320.28
|
$659.40
|
$447.45
|
2025-12-19
|
|
70492
|
HCPCS
|
CT Scan Of Soft Tissue Of Neck Before And After Contrast
|
128
|
64
|
$1,458.50
|
$1,458.50
|
$71.91
|
$3,431.40
|
$447.36
|
2025-12-19
|
|
82139
|
HCPCS
|
Amino Acid Level, 6 Or More Amino Acids, Quantitative, Each Specimen
|
184
|
64
|
$468.00
|
$468.00
|
$34.16
|
$694.40
|
$444.60
|
2025-12-19
|
|
15275
|
HCPCS
|
Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne…
|
64
|
64
|
$466.00
|
$466.00
|
$316.88
|
$652.40
|
$442.70
|
2025-12-19
|
|
72127
|
HCPCS
|
CT Scan Of Upper Spine Before And After Contrast
|
128
|
64
|
$1,463.00
|
$1,463.00
|
$56.38
|
$3,456.60
|
$438.72
|
2025-12-19
|
|
99244
|
HCPCS
|
Office Or Other Outpatient Consultation With Moderate Level Of Medical Decision …
|
64
|
64
|
$460.00
|
$460.00
|
$312.80
|
$644.00
|
$437.00
|
2025-12-19
|
|
26770
|
HCPCS
|
Closed Treatment Of Dislocated Finger Joint With Manipulation
|
142
|
64
|
$545.00
|
$545.00
|
$269.97
|
$919.56
|
$437.00
|
2025-12-19
|
|
6972624_1
|
CDM
|
Cath Pyloric/colonic 5848 Bl__stw
|
63
|
63
|
$459.00
|
$459.00
|
$312.12
|
$642.60
|
$436.05
|
2025-12-19
|
|
6972625_1
|
CDM
|
Cath Pyloric/colonic 5847 Bln__stw
|
63
|
63
|
$459.00
|
$459.00
|
$312.12
|
$642.60
|
$436.05
|
2025-12-19
|
|
6972626_1
|
CDM
|
Cath Pyloric/colonic 5846 Bln__stw
|
63
|
63
|
$459.00
|
$459.00
|
$312.12
|
$642.60
|
$436.05
|
2025-12-19
|
|
90678
|
HCPCS
|
Respiratory Syncytial Virus Vaccine, preF, Subunit, Bivalent, For Intramuscular …
|
64
|
64
|
$457.00
|
$457.00
|
$310.76
|
$639.80
|
$434.15
|
2025-12-19
|
|
73202
|
HCPCS
|
CT Scan Of Arm Before And After Contrast
|
256
|
64
|
$1,091.50
|
$1,091.50
|
$53.85
|
$2,573.20
|
$433.70
|
2025-12-19
|
|
23500
|
HCPCS
|
Closed Treatment Of Broken Collar Bone
|
183
|
64
|
$476.00
|
$476.00
|
$230.30
|
$879.20
|
$433.20
|
2025-12-19
|
|
70481
|
HCPCS
|
CT Scan Of Cranial Cavity With Contrast
|
128
|
64
|
$1,165.50
|
$1,165.50
|
$50.37
|
$2,632.00
|
$432.96
|
2025-12-19
|
|
70545
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head With Contrast
|
128
|
64
|
$1,236.00
|
$1,236.00
|
$53.22
|
$2,907.80
|
$432.58
|
2025-12-19
|
|
85280
|
HCPCS
|
Clotting Factor Xii (Hageman) Measurement
|
64
|
64
|
$455.00
|
$455.00
|
$39.18
|
$637.00
|
$432.25
|
2025-12-19
|
|
85210
|
HCPCS
|
Clotting Factor Ii Prothrombin, Measurement
|
64
|
64
|
$455.00
|
$455.00
|
$26.28
|
$637.00
|
$432.25
|
2025-12-19
|
|
27250
|
HCPCS
|
Closed Treatment Of Dislocated Hip
|
128
|
64
|
$500.00
|
$500.00
|
$173.78
|
$631.40
|
$428.45
|
2025-12-19
|
|
70491
|
HCPCS
|
CT Scan Of Soft Tissue Of Neck With Contrast
|
128
|
64
|
$1,214.50
|
$1,214.50
|
$61.46
|
$2,776.20
|
$428.16
|
2025-12-19
|
|
45330
|
HCPCS
|
Diagnostic Exam Of Lower Portion Of Large Bowel Using A Flexible Endoscope
|
142
|
64
|
$457.00
|
$457.00
|
$55.22
|
$2,511.60
|
$428.05
|
2025-12-19
|
|
10140
|
HCPCS
|
Drainage Of Blood Or Fluid Accumulation
|
142
|
64
|
$462.00
|
$462.00
|
$116.30
|
$2,373.00
|
$427.35
|
2025-12-19
|
|
70480
|
HCPCS
|
CT Scan Of Cranial Cavity Without Contrast
|
128
|
64
|
$1,074.00
|
$1,074.00
|
$57.33
|
$2,387.00
|
$425.28
|
2025-12-19
|
|
17004
|
HCPCS
|
Destruction Of Precancer Skin Growth, 15 Or More Growths
|
55
|
55
|
$446.00
|
$446.00
|
$303.28
|
$624.40
|
$423.70
|
2025-12-19
|
|
88374
|
HCPCS
|
Microscopic Genetic Analysis Of Tissue, Computer-assisted Technology, Initial Pr…
|
64
|
64
|
$443.00
|
$443.00
|
$301.24
|
$732.21
|
$420.85
|
2025-12-19
|
|
25500
|
HCPCS
|
Closed Treatment Of Broken Midpart Of Forearm Bone On Thumb Side
|
64
|
64
|
$922.00
|
$922.00
|
$265.53
|
$894.34
|
$419.72
|
2025-12-19
|
|
70490
|
HCPCS
|
CT Scan Of Soft Tissue Of Neck Without Contrast
|
128
|
64
|
$889.50
|
$889.50
|
$57.33
|
$1,878.80
|
$419.52
|
2025-12-19
|
|
88237
|
HCPCS
|
Tissue Culture For Tumor Disorders Of Bone Marrow And Blood Cells
|
184
|
64
|
$441.00
|
$441.00
|
$99.28
|
$646.80
|
$418.95
|
2025-12-19
|
|
81279
|
HCPCS
|
Gene Analysis (Janus Kinase 2) Targeted Sequence Analysis
|
64
|
64
|
$441.00
|
$441.00
|
$299.88
|
$617.40
|
$418.95
|
2025-12-19
|
|
88377
|
HCPCS
|
Microscopic Genetic Analysis Of Tissue, Manual, Each Additional Multiplex Stain …
|
64
|
64
|
$441.00
|
$441.00
|
$299.88
|
$834.56
|
$418.95
|
2025-12-19
|
|
87523
|
HCPCS
|
Detection Of Hepatitis D (delta)
|
64
|
64
|
$440.00
|
$440.00
|
$299.20
|
$616.00
|
$418.00
|
2025-12-19
|
|
11406
|
HCPCS
|
Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm
|
64
|
64
|
$900.00
|
$900.00
|
$243.76
|
$873.00
|
$416.79
|
2025-12-19
|
|
43235
|
HCPCS
|
Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible…
|
128
|
64
|
$554.50
|
$554.50
|
$117.87
|
$1,212.40
|
$412.31
|
2025-12-19
|
|
96360
|
HCPCS
|
Infusion Into A Vein For Hydration, 31-60 Minutes
|
64
|
64
|
$434.00
|
$434.00
|
$295.12
|
$607.60
|
$412.30
|
2025-12-19
|
|
71270
|
HCPCS
|
CT Scan Of Chest Before And After Contrast
|
128
|
64
|
$1,396.00
|
$1,396.00
|
$55.75
|
$3,308.20
|
$411.84
|
2025-12-19
|
|
86053
|
HCPCS
|
Flow Cytometry Detection Of Aquaporin-4 (neuromyelitis Optica [nmo]) Antibody
|
192
|
64
|
$433.00
|
$433.00
|
$64.60
|
$655.20
|
$411.35
|
2025-12-19
|
|
86363
|
HCPCS
|
Flow Cytometry Detection Of Myelin Oligodendrocyte Glycoprotein (mog-igg1) Antib…
|
128
|
64
|
$433.00
|
$433.00
|
$294.44
|
$606.20
|
$411.35
|
2025-12-19
|
|
85598
|
HCPCS
|
Phospholipid Test
|
64
|
64
|
$432.00
|
$432.00
|
$36.41
|
$604.80
|
$410.40
|
2025-12-19
|
|
93975
|
HCPCS
|
Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow
|
128
|
64
|
$596.50
|
$596.50
|
$52.34
|
$1,268.40
|
$410.38
|
2025-12-19
|
|
8935743_1
|
CDM
|
Clip Hemo 360 Resolution M0052__stw
|
63
|
63
|
$431.00
|
$431.00
|
$293.08
|
$603.40
|
$409.45
|
2025-12-19
|
|
12053
|
HCPCS
|
Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1-7…
|
128
|
64
|
$449.00
|
$449.00
|
$209.65
|
$621.60
|
$408.54
|
2025-12-19
|