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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

ROUNDUP MEMORIAL HEALTHCARE

Roundup, MT · CCN 271346 · Rates published

2,360 distinct procedures filed
15 distinct payers
39,489 rate rows
2026-05-05 last MRF observed
Data quality

39,033 of 39,489 rate rows are consumer-grade (98.8%)

456 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
percent-of-charges filed in the dollar field — excluded from medians 395
exceeds 10× this hospital's gross charge — excluded from medians 37
per-diem day rate — not a per-procedure price 24
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbRMHRoundupMT&type=CDMWithoutLabel&fileType=CSV
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-16
Content fingerprint 0ef39e8c4f4e50fa… · 17,046,361 bytes · first seen 2026-07-17

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
60006523781_1
CDM 		Propranolol 40mg Tablet 15 $7,911.66 $16,146.25 $15,338.94 —
J1250
HCPCS 		Injection, Dobutamine Hydrochloride, Per 250 Mg 15 $7,026.36 $35,848.75 $13,909.32 nat. median
$30
outlier · 463.8×
60006574131_1
CDM 		Pristiq ER 100 Mg Tablet 15 $7,138.57 $14,568.50 $13,840.08 —
J0840
HCPCS 		Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 15 $2,879.73 $14,692.50 $5,700.69 nat. median
$3,496
1.6× median
60006526875_1
CDM 		Triamcinolone 0.1% Cream 15 $2,879.73 $5,877.00 $5,583.15 —
74178
HCPCS 		CT Scan Of Abdomen And Pelvis Before And After Contrast 15 $2,832.20 $5,780.00 $5,491.00 nat. median
$539
outlier · 10.2×
74170
HCPCS 		CT Scan Of Abdomen Before And After Contrast 15 $2,832.20 $5,780.00 $5,491.00 nat. median
$366
outlier · 15.0×
60006591507_1
CDM 		Farxiga 10 Mg Tablet 15 $2,567.23 $5,239.25 $4,977.29 —
60006566020_1
CDM 		Ferrous Sulf 300 Mg/5 Ml Cup 15 $2,545.06 $5,194.00 $4,934.30 —
74177
HCPCS 		CT Scan Of Abdomen And Pelvis With Contrast 15 $2,497.53 $5,097.00 $4,842.15 nat. median
$501
outlier · 9.7×
74174
HCPCS 		CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 15 $2,306.92 $4,708.00 $4,472.60 nat. median
$549
outlier · 8.1×
32557
HCPCS 		Drainage Of Fluid From Chest Cavity With Insertion Of Indwelling Tube Using Imag… 15 $2,150.61 $4,389.00 $4,169.55 nat. median
$1,722
outlier · 2.4×
60006587927_1
CDM 		Senna 8.6mg Tab 15 $1,982.05 $4,045.00 $3,842.75 —
J0295
HCPCS 		Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm 15 $1,916.64 $9,778.75 $3,794.16 nat. median
$24
outlier · 159.0×
74176
HCPCS 		CT Scan Of Abdomen And Pelvis Without Contrast 15 $1,891.40 $3,860.00 $3,667.00 nat. median
$333
outlier · 11.0×
30700005ISO_1
CDM 		Room & Board - Other - Sterile Environment 12 $2,965.94 $3,617.00 $3,562.74 —
60006567978_1
CDM 		Protonix Dr 20 Mg Tablet 15 $1,804.06 $3,681.75 $3,497.66 —
71275
HCPCS 		CT Scan Of Blood Vessels Of Chest With Contrast 15 $1,798.30 $3,670.00 $3,486.50 nat. median
$365
outlier · 9.6×
30700002_1
CDM 		Room & Board - Other - Sterile Environment 12 $2,663.36 $3,248.00 $3,199.28 —
75635
HCPCS 		CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 15 $1,638.07 $3,343.00 $3,175.85 nat. median
$355
outlier · 8.9×
71270
HCPCS 		CT Scan Of Chest Before And After Contrast 15 $1,580.25 $3,225.00 $3,063.75 nat. median
$348
outlier · 8.8×
G0390
HCPCS 		Trauma Response Team Associated With Hospital Critical Care Service 15 $1,519.98 $3,102.00 $2,946.90 nat. median
$3,280
0.9× median
71260
HCPCS 		CT Scan Of Chest With Contrast 15 $1,448.93 $2,957.00 $2,809.15 nat. median
$327
outlier · 8.6×
60006591298_1
CDM 		Diphenhydramine 12.5 Mg/5 Ml 15 $1,432.03 $2,922.50 $2,776.38 —
60006591298_1{2}
CDM 		Diphenhydramine 12.5 Mg/5 Ml 15 $1,432.03 $2,922.50 $2,776.38 —
72127
HCPCS 		CT Scan Of Upper Spine Before And After Contrast 15 $1,422.47 $2,903.00 $2,757.85 nat. median
$346
outlier · 8.0×
60006565576_1
CDM 		Fentanyl 12 Mcg/hr Patch 15 $1,413.65 $2,885.00 $2,740.75 —
73706
HCPCS 		CT Scan Of Blood Vessels Of Lower Leg With Contrast 15 $1,402.87 $2,863.00 $2,719.85 nat. median
$416
outlier · 6.5×
74160
HCPCS 		CT Scan Of Abdomen With Contrast 15 $1,396.99 $2,851.00 $2,708.45 nat. median
$330
outlier · 8.2×
72126
HCPCS 		CT Scan Of Upper Spine With Contrast 15 $1,396.99 $2,851.00 $2,708.45 nat. median
$475
outlier · 5.7×
70492
HCPCS 		CT Scan Of Soft Tissue Of Neck Before And After Contrast 15 $1,396.99 $2,851.00 $2,708.45 nat. median
$337
outlier · 8.0×
71250
HCPCS 		CT Scan Of Chest Without Contrast 15 $1,360.73 $2,777.00 $2,638.15 nat. median
$230
outlier · 11.5×
70470
HCPCS 		CT Scan Of Head Or Brain Before And After Contrast 15 $1,360.73 $2,777.00 $2,638.15 nat. median
$330
outlier · 8.0×
73202
HCPCS 		CT Scan Of Arm Before And After Contrast 15 $1,350.93 $2,757.00 $2,619.15 nat. median
$399
outlier · 6.6×
73702
HCPCS 		CT Scan Of Leg Before And After Contrast 15 $1,350.93 $2,757.00 $2,619.15 nat. median
$369
outlier · 7.1×
72130
HCPCS 		CT Scan Of Middle Spine Before And After Contrast 15 $1,347.99 $2,751.00 $2,613.45 nat. median
$318
outlier · 8.2×
72193
HCPCS 		CT Scan Of Pelvis With Contrast 15 $1,333.29 $2,721.00 $2,584.95 nat. median
$323
outlier · 8.0×
74175
HCPCS 		CT Scan Of Blood Vessels Of Abdomen With Contrast 15 $1,319.57 $2,693.00 $2,558.35 nat. median
$355
outlier · 7.2×
30700005_1
CDM 		Coronary Care Unit - General Classification 12 $2,121.34 $2,587.00 $2,548.19 —
J3111
HCPCS 		Injection, Romosozumab-aqqg, 1 Mg 15 $1,282.12 $6,541.45 $2,538.08 nat. median
$19
outlier · 133.6×
70496
HCPCS 		CT Scan Of Blood Vessels Of Head With Contrast 15 $1,305.85 $2,665.00 $2,531.75 nat. median
$364
outlier · 6.9×
70498
HCPCS 		CT Scan Of Blood Vessels Of Neck With Contrast 15 $1,305.85 $2,665.00 $2,531.75 nat. median
$355
outlier · 7.1×
70491
HCPCS 		CT Scan Of Soft Tissue Of Neck With Contrast 15 $1,293.60 $2,640.00 $2,508.00 nat. median
$327
outlier · 7.7×
70488
HCPCS 		CT Scan Of Face Before And After Contrast 15 $1,292.62 $2,638.00 $2,506.10 nat. median
$314
outlier · 8.0×
72194
HCPCS 		CT Scan Of Pelvis Before And After Contrast 15 $1,257.83 $2,567.00 $2,438.65 nat. median
$337
outlier · 7.2×
70482
HCPCS 		CT Scan Of Cranial Cavity Before And After Contrast 15 $1,254.40 $2,560.00 $2,432.00 nat. median
$355
outlier · 6.9×
60006558472_1
CDM 		Ezetimibe 10 Mg Tablet 15 $1,251.46 $2,554.00 $2,426.30 —
72129
HCPCS 		CT Scan Of Middle Spine With Contrast 15 $1,216.67 $2,483.00 $2,358.85 nat. median
$318
outlier · 7.4×
72133
HCPCS 		CT Scan Of Lower Spine Before And After Contrast 15 $1,216.67 $2,483.00 $2,358.85 nat. median
$346
outlier · 6.8×
72192
HCPCS 		CT Scan Of Pelvis Without Contrast 15 $1,216.67 $2,483.00 $2,358.85 nat. median
$205
outlier · 11.5×

Other procedures at this hospital

Browse this hospital's 2,360 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
60006523781_1 CDM Propranolol 40mg Tablet 15 15 $16,146.25 $16,146.25 $7,911.66 $16,146.25 $15,338.94 2026-05-05
J1250 HCPCS Injection, Dobutamine Hydrochloride, Per 250 Mg 15 15 $14,339.50 $14,339.50 $7,026.36 $35,848.75 $13,909.32 2026-05-05
60006574131_1 CDM Pristiq ER 100 Mg Tablet 15 15 $14,568.50 $14,568.50 $7,138.57 $14,568.50 $13,840.08 2026-05-05
J0840 HCPCS Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 15 15 $5,877.00 $5,877.00 $2,879.73 $14,692.50 $5,700.69 2026-05-05
60006526875_1 CDM Triamcinolone 0.1% Cream 15 15 $5,877.00 $5,877.00 $2,879.73 $5,877.00 $5,583.15 2026-05-05
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 15 15 $5,780.00 $5,780.00 $2,832.20 $5,780.00 $5,491.00 2026-05-05
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 15 15 $5,780.00 $5,780.00 $2,832.20 $5,780.00 $5,491.00 2026-05-05
60006591507_1 CDM Farxiga 10 Mg Tablet 15 15 $5,239.25 $5,239.25 $2,567.23 $5,239.25 $4,977.29 2026-05-05
60006566020_1 CDM Ferrous Sulf 300 Mg/5 Ml Cup 15 15 $5,194.00 $5,194.00 $2,545.06 $5,194.00 $4,934.30 2026-05-05
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 15 15 $5,097.00 $5,097.00 $2,497.53 $5,097.00 $4,842.15 2026-05-05
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 15 15 $4,708.00 $4,708.00 $2,306.92 $4,708.00 $4,472.60 2026-05-05
32557 HCPCS Drainage Of Fluid From Chest Cavity With Insertion Of Indwelling Tube Using Imag… 15 15 $4,389.00 $4,389.00 $2,150.61 $4,389.00 $4,169.55 2026-05-05
60006587927_1 CDM Senna 8.6mg Tab 15 15 $4,045.00 $4,045.00 $1,982.05 $4,045.00 $3,842.75 2026-05-05
J0295 HCPCS Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm 15 15 $3,911.50 $3,911.50 $1,916.64 $9,778.75 $3,794.16 2026-05-05
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 15 15 $3,860.00 $3,860.00 $1,891.40 $3,860.00 $3,667.00 2026-05-05
30700005ISO_1 CDM Room & Board - Other - Sterile Environment 12 12 $3,617.00 $3,617.00 $2,965.94 $3,617.00 $3,562.74 2026-05-05
60006567978_1 CDM Protonix Dr 20 Mg Tablet 15 15 $3,681.75 $3,681.75 $1,804.06 $3,681.75 $3,497.66 2026-05-05
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 15 15 $3,670.00 $3,670.00 $1,798.30 $3,670.00 $3,486.50 2026-05-05
30700002_1 CDM Room & Board - Other - Sterile Environment 12 12 $3,248.00 $3,248.00 $2,663.36 $3,248.00 $3,199.28 2026-05-05
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 15 15 $3,343.00 $3,343.00 $1,638.07 $3,343.00 $3,175.85 2026-05-05
71270 HCPCS CT Scan Of Chest Before And After Contrast 15 15 $3,225.00 $3,225.00 $1,580.25 $3,225.00 $3,063.75 2026-05-05
G0390 HCPCS Trauma Response Team Associated With Hospital Critical Care Service 15 15 $3,102.00 $3,102.00 $1,519.98 $3,102.00 $2,946.90 2026-05-05
71260 HCPCS CT Scan Of Chest With Contrast 15 15 $2,957.00 $2,957.00 $1,448.93 $2,957.00 $2,809.15 2026-05-05
60006591298_1 CDM Diphenhydramine 12.5 Mg/5 Ml 15 15 $2,922.50 $2,922.50 $1,432.03 $2,922.50 $2,776.38 2026-05-05
60006591298_1{2} CDM Diphenhydramine 12.5 Mg/5 Ml 15 15 $2,922.50 $2,922.50 $1,432.03 $2,922.50 $2,776.38 2026-05-05
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 15 15 $2,903.00 $2,903.00 $1,422.47 $2,903.00 $2,757.85 2026-05-05
60006565576_1 CDM Fentanyl 12 Mcg/hr Patch 15 15 $2,885.00 $2,885.00 $1,413.65 $2,885.00 $2,740.75 2026-05-05
73706 HCPCS CT Scan Of Blood Vessels Of Lower Leg With Contrast 15 15 $2,863.00 $2,863.00 $1,402.87 $2,863.00 $2,719.85 2026-05-05
72126 HCPCS CT Scan Of Upper Spine With Contrast 15 15 $2,851.00 $2,851.00 $1,396.99 $2,851.00 $2,708.45 2026-05-05
74160 HCPCS CT Scan Of Abdomen With Contrast 15 15 $2,851.00 $2,851.00 $1,396.99 $2,851.00 $2,708.45 2026-05-05
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 15 15 $2,851.00 $2,851.00 $1,396.99 $2,851.00 $2,708.45 2026-05-05
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 15 15 $2,777.00 $2,777.00 $1,360.73 $2,777.00 $2,638.15 2026-05-05
71250 HCPCS CT Scan Of Chest Without Contrast 15 15 $2,777.00 $2,777.00 $1,360.73 $2,777.00 $2,638.15 2026-05-05
73702 HCPCS CT Scan Of Leg Before And After Contrast 15 15 $2,757.00 $2,757.00 $1,350.93 $2,757.00 $2,619.15 2026-05-05
73202 HCPCS CT Scan Of Arm Before And After Contrast 15 15 $2,757.00 $2,757.00 $1,350.93 $2,757.00 $2,619.15 2026-05-05
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 15 15 $2,751.00 $2,751.00 $1,347.99 $2,751.00 $2,613.45 2026-05-05
72193 HCPCS CT Scan Of Pelvis With Contrast 15 15 $2,721.00 $2,721.00 $1,333.29 $2,721.00 $2,584.95 2026-05-05
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 15 15 $2,693.00 $2,693.00 $1,319.57 $2,693.00 $2,558.35 2026-05-05
30700005_1 CDM Coronary Care Unit - General Classification 12 12 $2,587.00 $2,587.00 $2,121.34 $2,587.00 $2,548.19 2026-05-05
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 15 15 $2,616.58 $2,616.58 $1,282.12 $6,541.45 $2,538.08 2026-05-05
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 15 15 $2,665.00 $2,665.00 $1,305.85 $2,665.00 $2,531.75 2026-05-05
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 15 15 $2,665.00 $2,665.00 $1,305.85 $2,665.00 $2,531.75 2026-05-05
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 15 15 $2,640.00 $2,640.00 $1,293.60 $2,640.00 $2,508.00 2026-05-05
70488 HCPCS CT Scan Of Face Before And After Contrast 15 15 $2,638.00 $2,638.00 $1,292.62 $2,638.00 $2,506.10 2026-05-05
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 15 15 $2,567.00 $2,567.00 $1,257.83 $2,567.00 $2,438.65 2026-05-05
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 15 15 $2,560.00 $2,560.00 $1,254.40 $2,560.00 $2,432.00 2026-05-05
60006558472_1 CDM Ezetimibe 10 Mg Tablet 15 15 $2,554.00 $2,554.00 $1,251.46 $2,554.00 $2,426.30 2026-05-05
72192 HCPCS CT Scan Of Pelvis Without Contrast 15 15 $2,483.00 $2,483.00 $1,216.67 $2,483.00 $2,358.85 2026-05-05
72125 HCPCS CT Scan Of Upper Spine Without Contrast 15 15 $2,483.00 $2,483.00 $1,216.67 $2,483.00 $2,358.85 2026-05-05
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 15 15 $2,483.00 $2,483.00 $1,216.67 $2,483.00 $2,358.85 2026-05-05
72129 HCPCS CT Scan Of Middle Spine With Contrast 15 15 $2,483.00 $2,483.00 $1,216.67 $2,483.00 $2,358.85 2026-05-05
72191 HCPCS CT Scan Of Blood Vessels Of Pelvis With Contrast 15 15 $2,480.00 $2,480.00 $1,215.20 $2,480.00 $2,356.00 2026-05-05
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 15 15 $2,470.00 $2,470.00 $1,210.30 $2,470.00 $2,346.50 2026-05-05
72132 HCPCS CT Scan Of Lower Spine With Contrast 15 15 $2,433.00 $2,433.00 $1,192.17 $2,433.00 $2,311.35 2026-05-05
74150 HCPCS CT Scan Of Abdomen Without Contrast 15 15 $2,415.00 $2,415.00 $1,183.35 $2,415.00 $2,294.25 2026-05-05
72131 HCPCS CT Scan Of Lower Spine Without Contrast 15 15 $2,358.00 $2,358.00 $1,155.42 $2,358.00 $2,240.10 2026-05-05
30700001_1 CDM Room & Board - Private (one Bed) - General Classification 12 12 $2,218.00 $2,218.00 $1,818.76 $2,218.00 $2,184.73 2026-05-05
59426 HCPCS Predelivery Care, 7 Or More Visits 14 14 $2,272.00 $2,272.00 $252.68 $2,272.00 $2,181.12 2026-05-05
60006593174_1 CDM Cyclobenzaprine 10 Mg Tablet 15 15 $2,253.25 $2,253.25 $1,104.09 $2,253.25 $2,140.59 2026-05-05
73701 HCPCS CT Scan Of Leg With Contrast Material 15 15 $2,239.00 $2,239.00 $1,097.11 $2,239.00 $2,127.05 2026-05-05
73201 HCPCS CT Scan Of Arm With Contrast 15 15 $2,226.00 $2,226.00 $1,090.74 $2,226.00 $2,114.70 2026-05-05
72128 HCPCS CT Scan Of Middle Spine Without Contrast 15 15 $2,201.00 $2,201.00 $1,078.49 $2,201.00 $2,090.95 2026-05-05
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 15 15 $2,177.00 $2,177.00 $1,066.73 $2,177.00 $2,068.15 2026-05-05
70460 HCPCS CT Scan Head Or Brain With Contrast 15 15 $2,177.00 $2,177.00 $1,066.73 $2,177.00 $2,068.15 2026-05-05
70487 HCPCS CT Scan Of Face With Contrast 15 15 $2,177.00 $2,177.00 $1,066.73 $2,177.00 $2,068.15 2026-05-05
73200 HCPCS CT Scan Of Arm Without Contrast 15 15 $2,177.00 $2,177.00 $1,066.73 $2,177.00 $2,068.15 2026-05-05
70486 HCPCS CT Scan Of Face Without Contrast 15 15 $2,148.00 $2,148.00 $1,052.52 $2,148.00 $2,040.60 2026-05-05
70450 HCPCS CT Scan Head Or Brain Without Contrast 15 15 $2,140.00 $2,140.00 $1,048.60 $2,140.00 $2,033.00 2026-05-05
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 15 15 $2,083.00 $2,083.00 $1,020.67 $2,083.00 $1,978.85 2026-05-05
73700 HCPCS CT Scan Of Leg Without Contrast 15 15 $2,083.00 $2,083.00 $1,020.67 $2,083.00 $1,978.85 2026-05-05
33000006ISO_1 CDM Room & Board - Other - Sterile Environment 12 12 $2,000.00 $2,000.00 $1,640.00 $2,000.00 $1,970.00 2026-05-05
90732 HCPCS Pneumococcal Vaccine, 23-valent 15 15 $2,015.00 $2,015.00 $987.35 $2,015.00 $1,954.55 2026-05-05
J0461 HCPCS Injection, Atropine Sulfate, 0.01 Mg 15 15 $2,015.00 $2,015.00 $987.35 $5,037.50 $1,954.55 2026-05-05
60006591659_1 CDM Acidophilus 175 Mg Capsule 15 15 $2,015.00 $2,015.00 $987.35 $2,015.00 $1,914.25 2026-05-05
60006591377_1 CDM Nitrofurantoin Mcr 50 Mg Cap 15 15 $2,015.00 $2,015.00 $987.35 $2,015.00 $1,914.25 2026-05-05
60006548150_1 CDM Carvedilol 3.125 Mg Tablet 15 15 $2,015.00 $2,015.00 $987.35 $2,015.00 $1,914.25 2026-05-05
60006568760_1 CDM Nystatin 500,000 Unit/5 Ml Cup 15 15 $2,015.00 $2,015.00 $987.35 $2,015.00 $1,914.25 2026-05-05
60006540934_1 CDM Acetaminophen-oxycodone 325-5mg Tab 15 15 $2,015.00 $2,015.00 $987.35 $2,015.00 $1,914.25 2026-05-05
90375 HCPCS Rabies Immune Globulin For Injection 15 15 $2,015.00 $2,015.00 $987.35 $2,015.00 $1,914.25 2026-05-05
60006566004_1 CDM Child Diphenhydramin 12.5 Mg/5 15 15 $2,015.00 $2,015.00 $987.35 $2,015.00 $1,914.25 2026-05-05
J1670 HCPCS Injection, Tetanus Immune Globulin, Human, Up To 250 Units 15 15 $1,951.25 $1,951.25 $956.11 $4,878.13 $1,892.71 2026-05-05
60006538078_1 CDM Nicotine 21 Mg/24hr Patch 15 15 $1,974.75 $1,974.75 $967.63 $1,974.75 $1,876.01 2026-05-05
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 15 15 $1,886.00 $1,886.00 $924.14 $1,886.00 $1,791.70 2026-05-05
11011 HCPCS Removal Of Foreign Material From Skin, Tissue, And Muscle At Open Broken And/or … 14 14 $1,846.00 $1,846.00 $252.68 $1,846.00 $1,772.16 2026-05-05
43239 HCPCS Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop… 14 14 $1,753.00 $1,753.00 $252.68 $1,753.00 $1,682.88 2026-05-05
45380 HCPCS Biopsy Of Large Bowel Using A Flexible Endoscope 14 14 $1,747.00 $1,747.00 $252.68 $1,747.00 $1,677.12 2026-05-05
19120 HCPCS Removal Of Growth And Tissue Of Breast, Duct, Or Nipple 14 14 $1,677.00 $1,677.00 $252.68 $1,677.00 $1,609.92 2026-05-05
30700041ISO_1 CDM Room & Board - Other - Sterile Environment 12 12 $1,617.00 $1,617.00 $1,325.94 $1,617.00 $1,592.74 2026-05-05
37609 HCPCS Tying Or Biopsy Of Artery On Side Of Skull 14 14 $3,348.00 $3,348.00 $188.00 $3,348.00 $1,552.98 2026-05-05
27810 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle With Manipulation 28 15 $1,636.00 $1,636.00 $252.68 $2,719.90 $1,513.30 2026-05-05
27530 HCPCS Closed Treatment Of Broken Shin Bone 14 14 $1,576.00 $1,576.00 $252.68 $1,576.00 $1,512.96 2026-05-05
27818 HCPCS Closed Treatment Of 3 Broken Lower Leg Bones At Ankle With Manipulation 28 15 $1,677.00 $1,677.00 $252.68 $1,677.00 $1,509.30 2026-05-05
J3490 HCPCS Unclassified Drugs 15 15 $1,538.75 $1,538.75 $753.99 $3,846.88 $1,492.59 2026-05-05
35206 HCPCS Repair Of Blood Vessel Of Arm 14 14 $1,900.00 $1,900.00 $33.04 $1,900.00 $1,464.50 2026-05-05
60006591372_1 CDM Quetiapine ER 200 Mg Tablet 15 15 $1,513.50 $1,513.50 $741.62 $1,513.50 $1,437.83 2026-05-05
60006591473_1 CDM Cefuroxime Axetil 250 Mg Tab 15 15 $1,481.25 $1,481.25 $725.81 $1,481.25 $1,407.19 2026-05-05
32555 HCPCS Aspiration Of Fluid From Chest Cavity Using Imaging Guidance 14 14 $1,589.00 $1,589.00 $93.84 $4,826.20 $1,366.54 2026-05-05
74400 HCPCS Imaging Of Urinary Tract With Injection Of Contrast Into A Vein 15 15 $1,431.00 $1,431.00 $701.19 $1,431.00 $1,359.45 2026-05-05
60006588388_1 CDM Ubiquinone 100mg Capsule 15 15 $1,413.50 $1,413.50 $692.62 $1,413.50 $1,342.83 2026-05-05
11646 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More… 14 14 $1,364.00 $1,364.00 $252.68 $1,364.00 $1,309.44 2026-05-05
59409 HCPCS Vaginal Delivery 28 15 $1,342.00 $1,342.00 $252.68 $6,080.54 $1,301.74 2026-05-05
87633 HCPCS Detection Test By Nucleic Acid For Multiple Types Of Respiratory Virus, Multiple… 15 15 $1,318.00 $1,318.00 $416.78 $1,318.00 $1,252.10 2026-05-05
93970 HCPCS Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 15 15 $1,317.00 $1,317.00 $645.33 $1,317.00 $1,251.15 2026-05-05
59425 HCPCS Predelivery Care, 4 To 6 Visits 14 14 $1,274.00 $1,274.00 $252.68 $1,274.00 $1,223.04 2026-05-05
36430 HCPCS Transfusion Of Blood Or Blood Products 30 15 $1,297.00 $1,297.00 $609.07 $1,351.00 $1,210.81 2026-05-05
P9035 HCPCS Platelets, Pheresis, Leukocytes Reduced, Each Unit 15 15 $1,243.00 $1,243.00 $609.07 $3,107.50 $1,205.71 2026-05-05
60006591327_1 CDM Ventolin Hfa 90 Mcg Inhaler 15 15 $1,268.00 $1,268.00 $621.32 $1,268.00 $1,204.60 2026-05-05
93308 HCPCS Ultrasound Of Heart, Follow-up 15 15 $1,238.00 $1,238.00 $606.62 $1,238.00 $1,176.10 2026-05-05
93971 HCPCS Ultrasound Study Of One Arm Or Leg Veins With Compression And Maneuvers 15 15 $1,218.00 $1,218.00 $596.82 $1,218.00 $1,157.10 2026-05-05
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 15 15 $1,217.00 $1,217.00 $596.33 $1,217.00 $1,156.15 2026-05-05
11644 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3.1-… 14 14 $1,186.00 $1,186.00 $252.68 $1,186.00 $1,138.56 2026-05-05
27750 HCPCS Closed Treatment Of Broken Middle Part Of Shin Bone 14 14 $1,180.00 $1,180.00 $252.68 $1,180.00 $1,132.80 2026-05-05
76770 HCPCS Complete Ultrasound Scan Behind Abdominal Cavity 15 15 $1,189.00 $1,189.00 $582.61 $1,189.00 $1,129.55 2026-05-05
76706 HCPCS Ultrasound Scan Of Abdominal Aorta 15 15 $1,189.00 $1,189.00 $582.61 $1,189.00 $1,129.55 2026-05-05
81207 HCPCS Translocation Analysis (bcr/abl1) Minor Breakpoint 15 15 $1,182.00 $1,182.00 $144.84 $1,182.00 $1,122.90 2026-05-05
60006588222_1 CDM Combivent Respimat 20-100 Mcg 15 15 $1,166.50 $1,166.50 $571.59 $1,166.50 $1,108.18 2026-05-05
76497 HCPCS Other CT Scan 15 15 $1,156.00 $1,156.00 $566.44 $1,156.00 $1,098.20 2026-05-05
76380 HCPCS Limited Or Follow-up CT Scan 15 15 $1,156.00 $1,156.00 $566.44 $1,156.00 $1,098.20 2026-05-05
27808 HCPCS Closed Treatment Of 2 Broken Lower Leg Bones At Ankle 14 14 $1,139.00 $1,139.00 $252.68 $1,139.00 $1,093.44 2026-05-05
60006546543_1 CDM buPROPion Sr 150mg/12hr Tablet 15 15 $1,140.75 $1,140.75 $558.97 $1,140.75 $1,083.71 2026-05-05
99291 HCPCS Critical Care, First 30-74 Minutes 29 15 $1,731.00 $1,731.00 $65.00 $1,731.00 $1,037.00 2026-05-05
60006568935_1 CDM Chld Acetaminophen 160 Mg/5 Ml 15 15 $1,089.50 $1,089.50 $533.86 $1,089.50 $1,035.03 2026-05-05
27816 HCPCS Closed Treatment Of 3 Broken Lower Leg Bones At Ankle 14 14 $1,078.00 $1,078.00 $252.68 $1,078.00 $1,034.88 2026-05-05
93976 HCPCS Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 15 15 $1,073.00 $1,073.00 $525.77 $1,073.00 $1,019.35 2026-05-05
11406 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 14 14 $1,061.00 $1,061.00 $252.68 $1,061.00 $1,018.56 2026-05-05
93978 HCPCS Complete Ultrasound Of Aorta, Vena Cava, Groin Vessels Or Bypass Grafts 15 15 $1,071.00 $1,071.00 $524.79 $1,071.00 $1,017.45 2026-05-05
31603 HCPCS Emergent Incision Of Windpipe Through Neck For Insertion Of Breathing Tube 15 15 $1,061.00 $1,061.00 $519.89 $1,061.00 $1,007.95 2026-05-05
86366 HCPCS Test For Muscle-specific Kinase Antibody 15 15 $1,057.00 $1,057.00 $18.40 $1,057.00 $1,004.15 2026-05-05
11626 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More Tha… 14 14 $1,042.00 $1,042.00 $252.68 $1,042.00 $1,000.32 2026-05-05
25630 HCPCS Closed Treatment Of Other Broken Wrist Bone 14 14 $1,042.00 $1,042.00 $252.68 $1,042.00 $1,000.32 2026-05-05
11643 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.1-… 14 14 $1,042.00 $1,042.00 $252.68 $1,042.00 $1,000.32 2026-05-05
60006541783_1 CDM metFORMIN 500mg Tablet 15 15 $1,044.50 $1,044.50 $511.81 $1,044.50 $992.28 2026-05-05
33000006_1 CDM Room & Board - Semi-private (two Beds) - Other 12 12 $970.00 $970.00 $795.40 $970.00 $955.45 2026-05-05
25565 HCPCS Closed Treatment Of Broken Midpart Of Both Forearm Bones With Manipulation 28 15 $1,024.50 $1,024.50 $252.68 $1,177.05 $946.90 2026-05-05
25650 HCPCS Closed Treatment Of Broken Base Of Forearm Bone On Small Finger Side At Wrist 28 15 $1,011.50 $1,011.50 $119.77 $1,042.00 $937.80 2026-05-05
87507 HCPCS Detection Test By Nucleic Acid For Digestive Tract Pathogen, Multiple Types Or S… 29 15 $1,100.00 $1,100.00 $416.78 $1,100.00 $926.00 2026-05-05
27372 HCPCS Removal Of Foreign Body Deep In Tissue Of Thigh Or Knee 14 14 $955.00 $955.00 $252.68 $955.00 $916.80 2026-05-05
27323 HCPCS Biopsy Of Surface Tissue Of Thigh Or Knee 14 14 $949.00 $949.00 $252.68 $949.00 $911.04 2026-05-05
20103 HCPCS Exploration Of Wound Of Arm Or Leg 14 14 $941.00 $941.00 $252.68 $941.00 $903.36 2026-05-05
43235 HCPCS Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible… 14 14 $1,700.00 $1,700.00 $110.54 $1,700.00 $895.54 2026-05-05
46230 HCPCS Removal Of Multiple External Noncancer Growths Of Anus 14 14 $925.00 $925.00 $252.68 $925.00 $888.00 2026-05-05
J0897 HCPCS Injection, Denosumab, 1 Mg 15 15 $915.00 $915.00 $448.35 $2,287.50 $887.55 2026-05-05
J7325 HCPCS Hyaluronan Or Derivative, Synvisc Or Synvisc-one, For Intra-articular Injection,… 15 15 $915.00 $915.00 $448.35 $2,287.50 $887.55 2026-05-05
Q5125 HCPCS Injection, Filgrastim-ayow, Biosimilar, (releuko), 1 Microgram 15 15 $915.00 $915.00 $448.35 $2,287.50 $887.55 2026-05-05
60006520688_1 CDM Nystatin 100,000 Unit/gm Cream 15 15 $915.00 $915.00 $448.35 $915.00 $869.25 2026-05-05
60006593371_1 CDM Vaccine Pneumococcal 20-valent Refused 15 15 $915.00 $915.00 $448.35 $915.00 $869.25 2026-05-05
46221 HCPCS Removal Of External Hemorrhoids By Rubber Banding 14 14 $898.00 $898.00 $252.68 $898.00 $862.08 2026-05-05
45378 HCPCS Diagnostic Exam Of Large Bowel Using A Flexible Endoscope 14 14 $1,700.00 $1,700.00 $164.64 $1,700.00 $859.00 2026-05-05
27613 HCPCS Biopsy Of Surface Tissue Of Leg Or Ankle 14 14 $883.00 $883.00 $252.68 $883.00 $847.68 2026-05-05
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 29 15 $1,725.00 $1,725.00 $65.00 $1,725.00 $845.25 2026-05-05
25530 HCPCS Closed Treatment Of Broken Midpart Of Forearm Bone On Small Finger Side 14 14 $878.00 $878.00 $252.68 $878.00 $842.88 2026-05-05
60006509517_1 CDM Clonidine Hcl 0.1 Mg Tablet 15 15 $883.75 $883.75 $433.04 $883.75 $839.56 2026-05-05
11624 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4.0 … 14 14 $873.00 $873.00 $252.68 $873.00 $838.08 2026-05-05
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 28 15 $1,096.00 $1,096.00 $252.68 $1,356.00 $836.00 2026-05-05
11426 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More … 14 14 $864.00 $864.00 $252.68 $864.00 $829.44 2026-05-05
28400 HCPCS Closed Treatment Of Broken Heel Bone 14 14 $855.00 $855.00 $252.68 $855.00 $820.80 2026-05-05
60006562839_1{5} CDM Miscellaneous Medication 15 15 $856.75 $856.75 $419.81 $856.75 $813.91 2026-05-05
60006562839_1{4} CDM Miscellaneous Medication 15 15 $856.75 $856.75 $419.81 $856.75 $813.91 2026-05-05
60006562839_1 CDM Nonformulary Chemo Injection 15 15 $856.75 $856.75 $419.81 $856.75 $813.91 2026-05-05
60006562839_1{3} CDM Nonformulary Injectable Medication 15 15 $856.75 $856.75 $419.81 $856.75 $813.91 2026-05-05
60006562839_1{2} CDM Nonformulary Injectable Medication 15 15 $856.75 $856.75 $419.81 $856.75 $813.91 2026-05-05
11642 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 1.1-… 14 14 $838.00 $838.00 $252.68 $838.00 $804.48 2026-05-05
60006591662_1 CDM Perforomist 20 Mcg/2 Ml Soln 15 15 $829.25 $829.25 $406.33 $829.25 $787.79 2026-05-05
13132 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 28 15 $848.50 $848.50 $65.00 $873.00 $785.70 2026-05-05
62272 HCPCS Removal Of Cerebrospinal Fluid With Lower Back Spinal Tap 15 15 $810.00 $810.00 $396.90 $810.00 $769.50 2026-05-05
31500 HCPCS Emergent Insertion Of Breathing Tube Into Windpipe Using An Endoscope 15 15 $796.00 $796.00 $390.04 $796.00 $756.20 2026-05-05
54700 HCPCS Incision And Drainage Of Sperm Reservoir, Testis, And/or Scrotal Area 14 14 $786.00 $786.00 $252.68 $786.00 $754.56 2026-05-05
11424 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 3.1-4… 14 14 $786.00 $786.00 $252.68 $786.00 $754.56 2026-05-05
11423 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 2.1-3… 14 14 $786.00 $786.00 $252.68 $786.00 $754.56 2026-05-05
J0558 HCPCS Injection, Penicillin G Benzathine And Penicillin G Procaine, 100,000 Units 15 15 $769.75 $769.75 $377.18 $1,924.38 $746.66 2026-05-05
76700 HCPCS Complete Ultrasound Scan Of Abdomen 15 15 $784.00 $784.00 $384.16 $784.00 $744.80 2026-05-05
32554 HCPCS Aspiration Of Fluid From Chest Cavity 29 15 $1,516.00 $1,516.00 $252.68 $1,516.00 $742.84 2026-05-05
0202U OTHER Test For Detection Of Respiratory Disease-causing Organisms From Back Of Nose An… 15 15 $780.00 $780.00 $382.20 $780.00 $741.00 2026-05-05
60006509558_1 CDM Clotrimazole 1% Topical Cream 15 15 $769.75 $769.75 $377.18 $769.75 $731.26 2026-05-05
41500046_2{5} CDM CT Chest Tube Placement 12 12 $830.00 $830.00 $207.50 $830.00 $726.25 2026-05-05
41500046_2 CDM CT Chest/Abd Angiography 12 12 $830.00 $830.00 $207.50 $830.00 $726.25 2026-05-05
41500046_2{4} CDM CT Chest Angiography 12 12 $830.00 $830.00 $207.50 $830.00 $726.25 2026-05-05
41500046_2{3} CDM CT Chest Angio Pe Protocol 12 12 $830.00 $830.00 $207.50 $830.00 $726.25 2026-05-05
41500046_2{2} CDM CT Chest/Abd/Pelvis Angiography 12 12 $830.00 $830.00 $207.50 $830.00 $726.25 2026-05-05
76817 HCPCS Vaginal Ultrasound Of Pregnant Uterus 15 15 $758.00 $758.00 $371.42 $758.00 $720.10 2026-05-05
J1920 HCPCS Injection, Labetalol Hydrochloride, 5 Mg 15 15 $738.50 $738.50 $361.87 $1,846.25 $716.35 2026-05-05
23500 HCPCS Closed Treatment Of Broken Collar Bone 14 14 $746.00 $746.00 $252.68 $746.00 $716.16 2026-05-05
13152 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 2.6-7.5 Cm 14 14 $1,018.00 $1,018.00 $65.00 $1,018.00 $710.78 2026-05-05
93979 HCPCS Ultrasound Of Aorta, Vena Cava, Groin Vessels Or Bypass Grafts 15 15 $743.00 $743.00 $364.07 $743.00 $705.85 2026-05-05
11623 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 2.1-3.0 … 14 14 $734.00 $734.00 $252.68 $734.00 $704.64 2026-05-05
99255 HCPCS Inpatient Or Observation Consultation With High Level Of Medical Decision Making… 13 13 $855.00 $855.00 $65.00 $855.00 $701.10 2026-05-05
74022 HCPCS X-ray Series Of Abdomen With Single X-ray Of Chest 15 15 $732.00 $732.00 $358.68 $732.00 $695.40 2026-05-05
76830 HCPCS Ultrasound Scan Of Uterus, Ovaries, Tubes, Cervix And Pelvic Area Through Vagina 15 15 $730.00 $730.00 $357.70 $730.00 $693.50 2026-05-05
76705 HCPCS Limited Ultrasound Scan Of Abdomen 15 15 $730.00 $730.00 $357.70 $730.00 $693.50 2026-05-05
76856 HCPCS Complete Ultrasound Scan Of Pelvis 15 15 $730.00 $730.00 $357.70 $730.00 $693.50 2026-05-05
76775 HCPCS Limited Ultrasound Scan Behind Abdominal Cavity 15 15 $730.00 $730.00 $357.70 $730.00 $693.50 2026-05-05
76870 HCPCS Ultrasound Scan Of Scrotum 15 15 $730.00 $730.00 $357.70 $730.00 $693.50 2026-05-05
76776 HCPCS Ultrasound Scan Of Transplanted Kidney 15 15 $726.00 $726.00 $355.74 $726.00 $689.70 2026-05-05
76536 HCPCS Ultrasound Scan Of Head And Neck Soft Tissue 15 15 $726.00 $726.00 $355.74 $726.00 $689.70 2026-05-05
99205 HCPCS New Patient Office Or Other Outpatient Visit With A High Level Of Medical Decisi… 14 14 $705.00 $705.00 $252.68 $705.00 $676.80 2026-05-05
72052 HCPCS X-ray Of Upper Spine, 6 Or More Views 15 15 $710.00 $710.00 $347.90 $710.00 $674.50 2026-05-05
49083 HCPCS Drainage Of Fluid From Abdominal Cavity Using Imaging Guidance 29 15 $1,350.00 $1,350.00 $92.84 $1,350.00 $661.50 2026-05-05
74019 HCPCS X-ray Of Abdomen, 2 Views 15 15 $691.00 $691.00 $338.59 $691.00 $656.45 2026-05-05
20520 HCPCS Removal Of Foreign Body In Muscle Or Tendon 14 14 $683.00 $683.00 $252.68 $683.00 $655.68 2026-05-05
23650 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation 28 15 $725.00 $725.00 $65.00 $725.00 $652.50 2026-05-05
92950 HCPCS Manual Attempt To Restore Blood Circulation And Breathing 15 15 $684.00 $684.00 $335.16 $684.00 $649.80 2026-05-05
92610 HCPCS Evaluation Of Swallowing Function 15 15 $682.00 $682.00 $334.18 $682.00 $647.90 2026-05-05
11983 HCPCS Removal With Reinsertion Of Drug Delivery Implant Into Tissue 14 14 $674.00 $674.00 $252.68 $674.00 $647.04 2026-05-05
72050 HCPCS X-ray Of Upper Spine, 4-5 Views 15 15 $676.00 $676.00 $331.24 $676.00 $642.20 2026-05-05
11641 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 0.6-… 14 14 $668.00 $668.00 $252.68 $668.00 $641.28 2026-05-05
60006593175_1 CDM Hydrocodone-acetamin 5-325 Mg 15 15 $675.00 $675.00 $330.75 $675.00 $641.25 2026-05-05
87154 HCPCS Amplifed Nucleic Acid Probe Typing Of Disease Agent In Blood Culture Specimen 30 15 $674.67 $674.67 $218.06 $674.67 $640.94 2026-05-05
99306 HCPCS Initial Nursing Facility Care With High Level Of Medical Decision Making, Per Da… 14 14 $656.00 $656.00 $321.44 $656.00 $629.76 2026-05-05
24600 HCPCS Repair Of Dislocated Elbow 28 15 $696.00 $696.00 $251.93 $696.00 $626.40 2026-05-05
70260 HCPCS X-ray Of Skull, Minimum Of 4 Views 15 15 $659.00 $659.00 $322.91 $659.00 $626.05 2026-05-05
32551 HCPCS Removal Of Fluid From Between Lung And Chest Cavity 29 15 $1,247.00 $1,247.00 $252.68 $1,247.00 $626.00 2026-05-05
99387 HCPCS Initial New Patient Preventive Medicine Evaluation (65 Years Or Older) 14 14 $650.00 $650.00 $252.68 $650.00 $624.00 2026-05-05
G0438 HCPCS Annual Wellness Visit; Includes A Personalized Prevention Plan Of Service (pps),… 14 14 $650.00 $650.00 $252.68 $650.00 $624.00 2026-05-05
19101 HCPCS Biopsy Of Breast Through Incision 14 14 $644.00 $644.00 $252.68 $644.00 $618.24 2026-05-05
J7626 HCPCS Budesonide, Inhalation Solution, Fda-approved Final Product, Non-compounded, Adm… 15 15 $637.00 $637.00 $312.13 $1,592.50 $617.89 2026-05-05
46050 HCPCS Drainage Of Superficial Rectal Abscess Surrounding Anus 28 15 $659.00 $659.00 $103.53 $1,186.49 $609.58 2026-05-05
99350 HCPCS Residence Visit For Established Patient With High Level Of Medical Decision Maki… 28 14 $658.50 $658.50 $252.68 $709.00 $608.00 2026-05-05
60006564934_1 CDM Pregabalin 75 Mg Capsule 15 15 $633.75 $633.75 $310.54 $633.75 $602.06 2026-05-05
G0439 HCPCS Annual Wellness Visit, Includes A Personalized Prevention Plan Of Service (pps),… 14 14 $623.00 $623.00 $252.68 $623.00 $598.08 2026-05-05
41500056_2 CDM CT Abdomen/Pelvis Angiography 12 12 $679.00 $679.00 $169.75 $679.00 $594.12 2026-05-05
74018 HCPCS X-ray Of Abdomen, 1 View 15 15 $623.00 $623.00 $305.27 $623.00 $591.85 2026-05-05
73050 HCPCS X-ray Of Both Collar Bones Joints 15 15 $623.00 $623.00 $305.27 $623.00 $591.85 2026-05-05
96360 HCPCS Infusion Into A Vein For Hydration, 31-60 Minutes 15 15 $622.00 $622.00 $304.78 $622.00 $590.90 2026-05-05
96365 HCPCS Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less 15 15 $622.00 $622.00 $304.78 $622.00 $590.90 2026-05-05
60006548077_1 CDM Quetiapine Fumarate 25 Mg Tab 15 15 $616.25 $616.25 $301.96 $616.25 $585.44 2026-05-05
25248 HCPCS Removal Of Deep Foreign Body In Forearm Or Wrist 14 14 $608.00 $608.00 $252.68 $608.00 $583.68 2026-05-05
40503760_1 CDM 43760 Ed Proc Gastrostomy Tube Chng-hospital 15 15 $612.00 $612.00 $299.88 $612.00 $581.40 2026-05-05
99284 HCPCS Emergency Department Visit With Moderate Level Of Medical Decision Making 29 15 $1,186.00 $1,186.00 $65.00 $1,186.00 $581.14 2026-05-05
72110 HCPCS X-ray Of Lower And Sacral Spine, Minimum Of 4 Views 15 15 $611.00 $611.00 $299.39 $611.00 $580.45 2026-05-05
93882 HCPCS Ultrasound Of One Side Of Head And Neck Blood Flow 15 15 $611.00 $611.00 $299.39 $611.00 $580.45 2026-05-05
73592 HCPCS X-ray Of Infant Leg, Minimum Of 2 Views 15 15 $611.00 $611.00 $299.39 $611.00 $580.45 2026-05-05
60006563571_1 CDM Metoprolol 25mg Tablet 15 15 $609.50 $609.50 $298.66 $609.50 $579.03 2026-05-05
90675 HCPCS Rabies Vaccine For Injection Into Muscle 15 15 $609.50 $609.50 $298.66 $609.50 $579.03 2026-05-05
30700041_1 CDM Room & Board - Semi-private (two Beds) - Hospice 12 12 $587.00 $587.00 $481.34 $587.00 $578.19 2026-05-05
P9016 HCPCS Red Blood Cells, Leukocytes Reduced, Each Unit 15 15 $593.00 $593.00 $290.57 $1,482.50 $575.21 2026-05-05
11622 HCPCS Removal Of Cancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, 1.1-2.0 … 14 14 $598.00 $598.00 $252.68 $598.00 $574.08 2026-05-05
13121 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 2.6-7.5 Cm 28 15 $631.00 $631.00 $65.00 $632.00 $568.80 2026-05-05
12036 HCPCS Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 20.1-30.… 28 15 $612.50 $612.50 $65.00 $631.00 $567.90 2026-05-05
11446 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, M… 14 14 $587.00 $587.00 $252.68 $587.00 $563.52 2026-05-05
99236 HCPCS Hospital Inpatient Or Observation Care With Admission And Discharge On The Same … 14 14 $922.00 $922.00 $23.60 $922.00 $562.52 2026-05-05
24655 HCPCS Closed Treatment Of Broken Forearm Bone On Thumb Side At Elbow With Manipulation 14 14 $592.00 $592.00 $307.98 $714.00 $562.40 2026-05-05
27786 HCPCS Closed Treatment Of Broken Outside Lower Leg Bone At Ankle 14 14 $582.00 $582.00 $252.68 $582.00 $558.72 2026-05-05
87522 HCPCS Detection Test By Nucleic Acid For Hepatitis C Virus, Quantification 15 15 $587.00 $587.00 $42.84 $587.00 $557.65 2026-05-05
J7060 HCPCS 5% Dextrose/water (500 Ml = 1 Unit) 45 15 $574.50 $574.50 $4.53 $5,037.50 $557.27 2026-05-05
77085 HCPCS Dxa Bone Density Measurement Of Hip, Pelvis, Spine Including Spine Fracture Asse… 15 15 $583.00 $583.00 $285.67 $583.00 $553.85 2026-05-05
60006593415_1 CDM Dextrose 10%-water IV Solution 15 15 $574.50 $574.50 $281.51 $574.50 $545.78 2026-05-05
11606 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 14 14 $566.00 $566.00 $252.68 $566.00 $543.36 2026-05-05
99204 HCPCS New Patient Office Or Other Outpatient Visit With Moderate Level Of Medical Deci… 14 14 $566.00 $566.00 $252.68 $566.00 $543.36 2026-05-05
99483 HCPCS Assessment Of And Care Planning For Patient With Impaired Thought Processing, Ty… 14 14 $565.00 $565.00 $252.68 $565.00 $542.40 2026-05-05
70200 HCPCS X-ray Of Eye Socket, Minimum Of 4 Views 15 15 $566.00 $566.00 $277.34 $566.00 $537.70 2026-05-05
70150 HCPCS X-ray Of Face Bones, Minimum Of 3 Views 15 15 $566.00 $566.00 $277.34 $566.00 $537.70 2026-05-05
76857 HCPCS Limited Ultrasound Scan Of Pelvis 15 15 $565.00 $565.00 $276.85 $565.00 $536.75 2026-05-05
60006591470_1 CDM Calcium 600 Mg-vit D3 10mcg TB 15 15 $565.00 $565.00 $276.85 $565.00 $536.75 2026-05-05
70110 HCPCS X-ray Of Lower Jaw, Minimum Of 4 Views 15 15 $562.00 $562.00 $275.38 $562.00 $533.90 2026-05-05
11981 HCPCS Insertion Of Drug Delivery Implant Into Tissue 14 14 $553.00 $553.00 $252.68 $553.00 $531.04 2026-05-05
77075 HCPCS Complete X-ray Of Body Bones 15 15 $558.00 $558.00 $273.42 $558.00 $530.10 2026-05-05
77076 HCPCS X-ray Of Infant Body Bones 15 15 $558.00 $558.00 $273.42 $558.00 $530.10 2026-05-05
76805 HCPCS Ultrasound Scan Of Pregnant Uterus (14 Weeks Or More), Single Or First Fetus 15 15 $553.00 $553.00 $270.97 $553.00 $525.35 2026-05-05
23505 HCPCS Closed Treatment Of Broken Collar Bone With Manipulation 14 14 $552.00 $552.00 $314.47 $593.40 $524.40 2026-05-05
71111 HCPCS X-ray Of Ribs On Both Sides Of Body, Minimum Of 4 Views 15 15 $551.00 $551.00 $269.99 $551.00 $523.45 2026-05-05
99254 HCPCS Inpatient Or Observation Consultation With Moderate Level Of Medical Decision Ma… 13 13 $637.00 $637.00 $65.00 $637.00 $522.34 2026-05-05
27840 HCPCS Closed Treatment Of Dislocated Ankle 14 14 $537.00 $537.00 $252.68 $537.00 $520.89 2026-05-05
10021 HCPCS Fine Needle Aspiration Biopsy, First Growth 28 15 $556.00 $556.00 $46.08 $571.00 $519.79 2026-05-05
99292 HCPCS Critical Care, Each Additional 30 Minutes 29 15 $749.00 $749.00 $65.00 $749.00 $518.00 2026-05-05
84445 HCPCS Thyroid Stimulating Immune Globulins (thyroid Related Protein) Level 15 15 $545.00 $545.00 $50.86 $545.00 $517.75 2026-05-05
12053 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1-7… 14 14 $527.00 $527.00 $252.68 $527.00 $511.19 2026-05-05
99396 HCPCS Established Patient Periodic Preventive Medicine Examination (40-64 Years) 14 14 $527.00 $527.00 $252.68 $527.00 $511.19 2026-05-05
60006520407_1 CDM Nitroglycerin 0.4mg Sl Tab 15 15 $537.75 $537.75 $263.50 $537.75 $510.86 2026-05-05
42308028_1 CDM 99144 Ed Proc Mod Cs By Same Phys > 5 Yrs 15 15 $537.00 $537.00 $263.13 $537.00 $510.15 2026-05-05
99215 HCPCS Established Patient Office Or Other Outpatient Visit With High Level Of Medical … 43 15 $566.00 $566.00 $136.22 $566.00 $509.40 2026-05-05
99305 HCPCS Initial Nursing Facility Care With Moderate Level Of Medical Decision Making, Pe… 14 14 $527.00 $527.00 $258.23 $527.00 $505.92 2026-05-05
99397 HCPCS Established Patient Periodic Preventive Medicine Examination (65 Year Old Or Old… 14 14 $518.00 $518.00 $252.68 $525.68 $502.46 2026-05-05
13151 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 1.1-2.5 Cm 14 14 $630.00 $630.00 $65.00 $630.00 $501.60 2026-05-05
49082 HCPCS Drainage Of Fluid From Abdominal Cavity 43 15 $527.00 $527.00 $71.13 $1,935.20 $500.65 2026-05-05
77073 HCPCS X-ray For Bone Length Assessment 15 15 $525.00 $525.00 $257.25 $525.00 $498.75 2026-05-05
94060 HCPCS Test To Measure Expiratory Airflow And Volume Changes Before And After Medicatio… 15 15 $524.00 $524.00 $256.76 $524.00 $497.80 2026-05-05
12054 HCPCS Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6-1… 28 15 $551.00 $551.00 $65.00 $605.00 $497.00 2026-05-05
25600 HCPCS Closed Treatment Of Broken Forearm (radius) Bone At The Wrist Area On The Thumb … 28 15 $512.00 $512.00 $156.35 $572.40 $497.00 2026-05-05
72170 HCPCS X-ray Of Pelvis, 1-2 Views 15 15 $523.00 $523.00 $256.27 $523.00 $496.85 2026-05-05
12045 HCPCS Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 12.6-20.0 Cm 28 15 $523.00 $523.00 $65.00 $539.00 $496.05 2026-05-05
77080 HCPCS Dxa Bone Density Measurement Of Hip, Pelvis, Spine 15 15 $518.00 $518.00 $253.82 $518.00 $492.10 2026-05-05
11640 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 0.5 … 14 14 $505.00 $505.00 $252.68 $525.68 $489.85 2026-05-05
11604 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, 3.1-4.0 Cm 14 14 $505.00 $505.00 $252.68 $525.68 $489.85 2026-05-05
99384 HCPCS Initial New Patient Preventive Medicine Evaluation (12-17 Years) 14 14 $505.00 $505.00 $252.68 $525.68 $489.85 2026-05-05
99386 HCPCS Initial New Patient Preventive Medicine Evaluation (40-64 Years) 14 14 $503.00 $503.00 $252.68 $525.68 $487.91 2026-05-05
25560 HCPCS Closed Treatment Of Broken Midpart Of Both Forearm Bones 28 15 $535.00 $535.00 $252.68 $565.00 $484.80 2026-05-05
40830 HCPCS Repair Of Lacerated Mouth, 2.5 Cm Or Less 14 14 $826.00 $826.00 $138.60 $826.00 $484.46 2026-05-05
L0650 HCPCS Lumbar-sacral Orthosis, Sagittal-coronal Control, With Rigid Anterior And Poster… 15 15 $498.00 $498.00 $244.02 $1,245.00 $483.06 2026-05-05
40500134_1 CDM Zoll Adult Electrode__8900-0214-01 15 15 $507.00 $507.00 $248.43 $507.00 $481.65 2026-05-05
40500134_1{2} CDM Zoll Adult Pads 15 15 $507.00 $507.00 $248.43 $507.00 $481.65 2026-05-05
85306 HCPCS Protein S (clotting Inhibitor) Measurement 29 15 $499.00 $499.00 $15.32 $503.00 $477.85 2026-05-05
28090 HCPCS Removal Of Growth Of Tendon Covering Or Joint Capsule Of Foot 14 14 $492.00 $492.00 $252.68 $525.68 $477.24 2026-05-05
99385 HCPCS Initial New Patient Preventive Medicine Evaluation (18-39 Years) 14 14 $491.00 $491.00 $252.68 $525.68 $476.27 2026-05-05
60006586341_1 CDM Vitamin D3 5,000 Unit Softgel 15 15 $501.25 $501.25 $245.61 $501.25 $476.19 2026-05-05
28475 HCPCS Closed Treatment Of Broken Foot With Manipulation 14 14 $490.00 $490.00 $252.68 $525.68 $475.30 2026-05-05
11444 HCPCS Removal Of Noncancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 3… 14 14 $490.00 $490.00 $252.68 $525.68 $475.30 2026-05-05
71110 HCPCS X-ray Of Ribs On Both Sides Of Body, 3 Views 15 15 $500.00 $500.00 $245.00 $500.00 $475.00 2026-05-05
93227 HCPCS Electrocardiogram (ecg) 2-day Continuous With Review By Health Care Professional 15 15 $499.00 $499.00 $244.51 $499.00 $474.05 2026-05-05
72114 HCPCS X-ray Lower And Sacral Spine, Minimum Of 6 Views 15 15 $499.00 $499.00 $244.51 $499.00 $474.05 2026-05-05
70330 HCPCS X-ray Of Jaw Joints On Both Sides Of Mouth 15 15 $497.00 $497.00 $243.53 $497.00 $472.15 2026-05-05
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