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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 · 2026-10-17
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 nat. median
$15,339
1.0× median
J1250
HCPCS 		Injection, Dobutamine Hydrochloride, Per 250 Mg 15 $7,026.36 $35,848.75 $13,909.32 nat. median
$42
outlier · 332.0×
60006574131_1
CDM 		Pristiq ER 100 Mg Tablet 15 $7,138.57 $14,568.50 $13,840.08 nat. median
$13,840
1.0× median
J0840
HCPCS 		Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 15 $2,879.73 $14,692.50 $5,700.69 nat. median
$3,452
1.7× median
60006526875_1
CDM 		Triamcinolone 0.1% Cream 15 $2,879.73 $5,877.00 $5,583.15 nat. median
$5,583
1.0× median
74178
HCPCS 		CT Scan Of Abdomen And Pelvis Before And After Contrast 15 $2,832.20 $5,780.00 $5,491.00 nat. median
$1,027
outlier · 5.3×
74170
HCPCS 		CT Scan Of Abdomen Before And After Contrast 15 $2,832.20 $5,780.00 $5,491.00 nat. median
$714
outlier · 7.7×
60006591507_1
CDM 		Farxiga 10 Mg Tablet 15 $2,567.23 $5,239.25 $4,977.29 nat. median
$4,977
1.0× median
60006566020_1
CDM 		Ferrous Sulf 300 Mg/5 Ml Cup 15 $2,545.06 $5,194.00 $4,934.30 nat. median
$4,934
1.0× median
74177
HCPCS 		CT Scan Of Abdomen And Pelvis With Contrast 15 $2,497.53 $5,097.00 $4,842.15 nat. median
$976
outlier · 5.0×
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
$998
outlier · 4.5×
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
$1,917
outlier · 2.2×
60006587927_1
CDM 		Senna 8.6mg Tab 15 $1,982.05 $4,045.00 $3,842.75 nat. median
$3,843
1.0× median
J0295
HCPCS 		Injection, Ampicillin Sodium/sulbactam Sodium, Per 1.5 Gm 15 $1,916.64 $9,778.75 $3,794.16 nat. median
$26
outlier · 147.5×
74176
HCPCS 		CT Scan Of Abdomen And Pelvis Without Contrast 15 $1,891.40 $3,860.00 $3,667.00 nat. median
$694
outlier · 5.3×
30700005ISO_1
CDM 		Room & Board - Other - Sterile Environment 12 $2,965.94 $3,617.00 $3,562.74 nat. median
$3,563
1.0× median
60006567978_1
CDM 		Protonix Dr 20 Mg Tablet 15 $1,804.06 $3,681.75 $3,497.66 nat. median
$3,498
1.0× median
71275
HCPCS 		CT Scan Of Blood Vessels Of Chest With Contrast 15 $1,798.30 $3,670.00 $3,486.50 nat. median
$759
outlier · 4.6×
30700002_1
CDM 		Room & Board - Other - Sterile Environment 12 $2,663.36 $3,248.00 $3,199.28 nat. median
$3,199
1.0× median
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
$727
outlier · 4.4×
71270
HCPCS 		CT Scan Of Chest Before And After Contrast 15 $1,580.25 $3,225.00 $3,063.75 nat. median
$684
outlier · 4.5×
G0390
HCPCS 		Trauma Response Team Associated With Hospital Critical Care Service 15 $1,519.98 $3,102.00 $2,946.90 nat. median
$3,197
0.9× median
71260
HCPCS 		CT Scan Of Chest With Contrast 15 $1,448.93 $2,957.00 $2,809.15 nat. median
$651
outlier · 4.3×
60006591298_1
CDM 		Diphenhydramine 12.5 Mg/5 Ml 15 $1,432.03 $2,922.50 $2,776.38 nat. median
$2,776
1.0× median
60006591298_1{2}
CDM 		Diphenhydramine 12.5 Mg/5 Ml 15 $1,432.03 $2,922.50 $2,776.38 nat. median
$2,776
1.0× median
72127
HCPCS 		CT Scan Of Upper Spine Before And After Contrast 15 $1,422.47 $2,903.00 $2,757.85 nat. median
$617
outlier · 4.5×
60006565576_1
CDM 		Fentanyl 12 Mcg/hr Patch 15 $1,413.65 $2,885.00 $2,740.75 nat. median
$2,741
1.0× median
73706
HCPCS 		CT Scan Of Blood Vessels Of Lower Leg With Contrast 15 $1,402.87 $2,863.00 $2,719.85 nat. median
$752
outlier · 3.6×
74160
HCPCS 		CT Scan Of Abdomen With Contrast 15 $1,396.99 $2,851.00 $2,708.45 nat. median
$655
outlier · 4.1×
72126
HCPCS 		CT Scan Of Upper Spine With Contrast 15 $1,396.99 $2,851.00 $2,708.45 nat. median
$758
outlier · 3.6×
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
$650
outlier · 4.2×
71250
HCPCS 		CT Scan Of Chest Without Contrast 15 $1,360.73 $2,777.00 $2,638.15 nat. median
$469
outlier · 5.6×
70470
HCPCS 		CT Scan Of Head Or Brain Before And After Contrast 15 $1,360.73 $2,777.00 $2,638.15 nat. median
$629
outlier · 4.2×
73202
HCPCS 		CT Scan Of Arm Before And After Contrast 15 $1,350.93 $2,757.00 $2,619.15 nat. median
$714
outlier · 3.7×
73702
HCPCS 		CT Scan Of Leg Before And After Contrast 15 $1,350.93 $2,757.00 $2,619.15 nat. median
$708
outlier · 3.7×
72130
HCPCS 		CT Scan Of Middle Spine Before And After Contrast 15 $1,347.99 $2,751.00 $2,613.45 nat. median
$604
outlier · 4.3×
72193
HCPCS 		CT Scan Of Pelvis With Contrast 15 $1,333.29 $2,721.00 $2,584.95 nat. median
$643
outlier · 4.0×
74175
HCPCS 		CT Scan Of Blood Vessels Of Abdomen With Contrast 15 $1,319.57 $2,693.00 $2,558.35 nat. median
$718
outlier · 3.6×
30700005_1
CDM 		Coronary Care Unit - General Classification 12 $2,121.34 $2,587.00 $2,548.19 nat. median
$2,548
1.0× median
J3111
HCPCS 		Injection, Romosozumab-aqqg, 1 Mg 15 $1,282.12 $6,541.45 $2,538.08 nat. median
$696
outlier · 3.6×
70496
HCPCS 		CT Scan Of Blood Vessels Of Head With Contrast 15 $1,305.85 $2,665.00 $2,531.75 nat. median
$752
outlier · 3.4×
70498
HCPCS 		CT Scan Of Blood Vessels Of Neck With Contrast 15 $1,305.85 $2,665.00 $2,531.75 nat. median
$744
outlier · 3.4×
70491
HCPCS 		CT Scan Of Soft Tissue Of Neck With Contrast 15 $1,293.60 $2,640.00 $2,508.00 nat. median
$632
outlier · 4.0×
70488
HCPCS 		CT Scan Of Face Before And After Contrast 15 $1,292.62 $2,638.00 $2,506.10 nat. median
$639
outlier · 3.9×
72194
HCPCS 		CT Scan Of Pelvis Before And After Contrast 15 $1,257.83 $2,567.00 $2,438.65 nat. median
$672
outlier · 3.6×
70482
HCPCS 		CT Scan Of Cranial Cavity Before And After Contrast 15 $1,254.40 $2,560.00 $2,432.00 nat. median
$663
outlier · 3.7×
60006558472_1
CDM 		Ezetimibe 10 Mg Tablet 15 $1,251.46 $2,554.00 $2,426.30 nat. median
$2,426
1.0× median
72129
HCPCS 		CT Scan Of Middle Spine With Contrast 15 $1,216.67 $2,483.00 $2,358.85 nat. median
$585
outlier · 4.0×
72133
HCPCS 		CT Scan Of Lower Spine Before And After Contrast 15 $1,216.67 $2,483.00 $2,358.85 nat. median
$637
outlier · 3.7×
72192
HCPCS 		CT Scan Of Pelvis Without Contrast 15 $1,216.67 $2,483.00 $2,358.85 nat. median
$463
outlier · 5.1×

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.

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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
             
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
10021 HCPCS Fine Needle Aspiration Biopsy, First Growth 28 15 $556.00 $556.00 $46.08 $571.00 $519.79 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
11981 HCPCS Insertion Of Drug Delivery Implant Into Tissue 14 14 $553.00 $553.00 $252.68 $553.00 $531.04 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
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
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
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
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
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
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
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
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
19101 HCPCS Biopsy Of Breast Through Incision 14 14 $644.00 $644.00 $252.68 $644.00 $618.24 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
20103 HCPCS Exploration Of Wound Of Arm Or Leg 14 14 $941.00 $941.00 $252.68 $941.00 $903.36 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
23500 HCPCS Closed Treatment Of Broken Collar Bone 14 14 $746.00 $746.00 $252.68 $746.00 $716.16 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
23650 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation 28 15 $725.00 $725.00 $65.00 $725.00 $652.50 2026-05-05
24600 HCPCS Repair Of Dislocated Elbow 28 15 $696.00 $696.00 $251.93 $696.00 $626.40 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
27840 HCPCS Closed Treatment Of Dislocated Ankle 14 14 $537.00 $537.00 $252.68 $537.00 $520.89 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
28400 HCPCS Closed Treatment Of Broken Heel Bone 14 14 $855.00 $855.00 $252.68 $855.00 $820.80 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
41500046_2 CDM CT Chest/Abd Angiography 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
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{4} CDM CT Chest Angiography 12 12 $830.00 $830.00 $207.50 $830.00 $726.25 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
41500056_2 CDM CT Abdomen/Pelvis Angiography 12 12 $679.00 $679.00 $169.75 $679.00 $594.12 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
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
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
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
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
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
46221 HCPCS Removal Of External Hemorrhoids By Rubber Banding 14 14 $898.00 $898.00 $252.68 $898.00 $862.08 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
49082 HCPCS Drainage Of Fluid From Abdominal Cavity 43 15 $527.00 $527.00 $71.13 $1,935.20 $500.65 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
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
59409 HCPCS Vaginal Delivery 28 15 $1,342.00 $1,342.00 $252.68 $6,080.54 $1,301.74 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
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
60006509517_1 CDM Clonidine Hcl 0.1 Mg Tablet 15 15 $883.75 $883.75 $433.04 $883.75 $839.56 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
60006520407_1 CDM Nitroglycerin 0.4mg Sl Tab 15 15 $537.75 $537.75 $263.50 $537.75 $510.86 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
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
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
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
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
60006541783_1 CDM metFORMIN 500mg Tablet 15 15 $1,044.50 $1,044.50 $511.81 $1,044.50 $992.28 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
60006548077_1 CDM Quetiapine Fumarate 25 Mg Tab 15 15 $616.25 $616.25 $301.96 $616.25 $585.44 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
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
60006562839_1 CDM Nonformulary Chemo Injection 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
60006562839_1{3} CDM Nonformulary Injectable 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{5} CDM Miscellaneous Medication 15 15 $856.75 $856.75 $419.81 $856.75 $813.91 2026-05-05
60006563571_1 CDM Metoprolol 25mg Tablet 15 15 $609.50 $609.50 $298.66 $609.50 $579.03 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
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
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
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
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
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
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
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
60006586341_1 CDM Vitamin D3 5,000 Unit Softgel 15 15 $501.25 $501.25 $245.61 $501.25 $476.19 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
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
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
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
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
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
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
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
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
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
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
60006591662_1 CDM Perforomist 20 Mcg/2 Ml Soln 15 15 $829.25 $829.25 $406.33 $829.25 $787.79 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
60006593175_1 CDM Hydrocodone-acetamin 5-325 Mg 15 15 $675.00 $675.00 $330.75 $675.00 $641.25 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
60006593415_1 CDM Dextrose 10%-water IV Solution 15 15 $574.50 $574.50 $281.51 $574.50 $545.78 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
72170 HCPCS X-ray Of Pelvis, 1-2 Views 15 15 $523.00 $523.00 $256.27 $523.00 $496.85 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
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
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
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
73050 HCPCS X-ray Of Both Collar Bones Joints 15 15 $623.00 $623.00 $305.27 $623.00 $591.85 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
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
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
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
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
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
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
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
74018 HCPCS X-ray Of Abdomen, 1 View 15 15 $623.00 $623.00 $305.27 $623.00 $591.85 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
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
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
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
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
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
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
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
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
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
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
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
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
76497 HCPCS Other CT Scan 15 15 $1,156.00 $1,156.00 $566.44 $1,156.00 $1,098.20 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
76700 HCPCS Complete Ultrasound Scan Of Abdomen 15 15 $784.00 $784.00 $384.16 $784.00 $744.80 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
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
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
76775 HCPCS Limited Ultrasound Scan Behind Abdominal Cavity 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
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
76817 HCPCS Vaginal Ultrasound Of Pregnant Uterus 15 15 $758.00 $758.00 $371.42 $758.00 $720.10 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
76856 HCPCS Complete Ultrasound Scan Of Pelvis 15 15 $730.00 $730.00 $357.70 $730.00 $693.50 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
76870 HCPCS Ultrasound Scan Of Scrotum 15 15 $730.00 $730.00 $357.70 $730.00 $693.50 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
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
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
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
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
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
85306 HCPCS Protein S (clotting Inhibitor) Measurement 29 15 $499.00 $499.00 $15.32 $503.00 $477.85 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
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
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
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
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
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
90675 HCPCS Rabies Vaccine For Injection Into Muscle 15 15 $609.50 $609.50 $298.66 $609.50 $579.03 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
92610 HCPCS Evaluation Of Swallowing Function 15 15 $682.00 $682.00 $334.18 $682.00 $647.90 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
99292 HCPCS Critical Care, Each Additional 30 Minutes 29 15 $749.00 $749.00 $65.00 $749.00 $518.00 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
J0897 HCPCS Injection, Denosumab, 1 Mg 15 15 $915.00 $915.00 $448.35 $2,287.50 $887.55 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
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
J1920 HCPCS Injection, Labetalol Hydrochloride, 5 Mg 15 15 $738.50 $738.50 $361.87 $1,846.25 $716.35 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
J3490 HCPCS Unclassified Drugs 15 15 $1,538.75 $1,538.75 $753.99 $3,846.88 $1,492.59 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
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
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
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
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
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
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
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