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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

OSMOND GENERAL HOSPITAL

Osmond, NE · CCN 281347 · Rates published

1,690 distinct procedures filed
15 distinct payers
40,969 rate rows
2026-03-09 last MRF observed
Data quality

3,707 of 40,969 rate rows are consumer-grade (9.0%)

37,262 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-billed-charges methodology — not a negotiated dollar; shown as context only 36,994
percent-of-charges filed in the dollar field — excluded from medians 150
exceeds 10× this hospital's gross charge — excluded from medians 73
per-diem day rate — not a per-procedure price 45
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbOGHOSMONDNE&type=CDMWithoutLabel
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/Osmond_V3.aspx
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 1daf56d26188c6b2… · 19,405,834 bytes · first seen 2026-05-07

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
J3241
HCPCS 		Injection, Teprotumumab-trbw, 10 Mg 15 $16,390.42 $30,259.23 $23,009.62 nat. median
$704
outlier · 32.7×
4983143_1
CDM 		Nithiodote 300 Mg-12.5 Gram 15 $9,547.20 $17,625.60 $13,402.80 nat. median
$13,403
1.0× median
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 15 $6,294.87 $11,621.30 $8,837.03 nat. median
$5,957
1.5× median
J9217
HCPCS 		Leuprolide Acetate (for Depot Suspension), 7.5 Mg 15 $527.90 $18,606.07 $7,290.40 nat. median
$1,521
outlier · 4.8×
J1950
HCPCS 		Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg 15 $4,228.67 $7,806.78 $5,936.40 nat. median
$4,344
1.4× median
J2182
HCPCS 		Injection, Mepolizumab, 1 Mg 15 $3,591.88 $6,631.16 $5,042.45 nat. median
$3,087
1.6× median
J2997
HCPCS 		Injection, Alteplase Recombinant, 1 Mg 15 $802.39 $15,207.02 $4,859.24 nat. median
$545
outlier · 8.9×
74174
HCPCS 		CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 15 $1,222.00 $6,174.72 $4,695.36 nat. median
$959
outlier · 4.9×
74177
HCPCS 		CT Scan Of Abdomen And Pelvis With Contrast 15 $1,222.00 $6,048.00 $4,599.00 nat. median
$928
outlier · 5.0×
J1162
HCPCS 		Injection, Digoxin Immune Fab (ovine), Per Vial 15 $3,241.94 $5,985.12 $4,551.19 nat. median
$7,308
0.6× median
J1306
HCPCS 		Injection, Inclisiran, 1 Mg 15 $3,164.38 $5,841.93 $4,442.30 nat. median
$57
outlier · 78.6×
74178
HCPCS 		CT Scan Of Abdomen And Pelvis Before And After Contrast 15 $1,222.00 $5,703.84 $4,337.30 nat. median
$979
outlier · 4.4×
78452
HCPCS 		Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 15 $2,313.38 $5,328.00 $4,051.50 nat. median
$1,767
outlier · 2.3×
Q5120
HCPCS 		Injection, Pegfilgrastim-bmez (ziextenzo), Biosimilar, 0.5 Mg 15 $2,875.24 $5,308.13 $4,036.39 nat. median
$361
outlier · 11.2×
43251
HCPCS 		Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 15 $2,670.20 $4,929.60 $3,748.55 nat. median
$2,145
1.7× median
74176
HCPCS 		CT Scan Of Abdomen And Pelvis Without Contrast 15 $1,222.00 $4,800.00 $3,650.00 nat. median
$685
outlier · 5.3×
15120
HCPCS 		Partial Thickness Self Skin Graft To Face, Scalp, Eyelids, Mouth, Neck, Ears, Ar… 15 $563.35 $10,560.00 $3,634.11 nat. median
$3,667
1.0× median
C9482
HCPCS 		Injection, Sotalol Hydrochloride, 1 Mg 15 $2,559.02 $4,724.35 $3,592.48 nat. median
$41
outlier · 86.8×
45385
HCPCS 		Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S… 15 $2,509.00 $4,632.00 $3,522.25 nat. median
$1,686
outlier · 2.1×
74170
HCPCS 		CT Scan Of Abdomen Before And After Contrast 15 $1,222.00 $4,518.72 $3,436.11 nat. median
$703
outlier · 4.9×
72148
HCPCS 		MRI Scan Of Lower Spinal Canal Without Contrast 15 $1,915.80 $4,512.00 $3,431.00 nat. median
$770
outlier · 4.5×
73725
HCPCS 		MRI Scan Of Blood Vessels Of Leg 15 $2,040.00 $4,476.00 $3,403.63 nat. median
$1,228
outlier · 2.8×
74185
HCPCS 		MRI Scan Of Blood Vessels Of Abdomen 15 $2,040.00 $4,476.00 $3,403.63 nat. median
$1,240
outlier · 2.7×
74183
HCPCS 		MRI Scan Of Abdomen Before And After Contrast 15 $2,040.00 $4,476.00 $3,403.63 nat. median
$1,102
outlier · 3.1×
70543
HCPCS 		MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 15 $2,040.00 $4,451.52 $3,385.01 nat. median
$1,079
outlier · 3.1×
70552
HCPCS 		MRI Scan Of Brain With Contrast 15 $2,040.00 $4,451.52 $3,385.01 nat. median
$960
outlier · 3.5×
72157
HCPCS 		MRI Scan Of Middle Spinal Canal Before And After Contrast 15 $2,040.00 $4,451.52 $3,385.01 nat. median
$1,094
outlier · 3.1×
72197
HCPCS 		MRI Scan Of Pelvis Before And After Contrast 15 $2,040.00 $4,451.52 $3,385.01 nat. median
$1,065
outlier · 3.2×
72156
HCPCS 		MRI Scan Of Upper Spinal Canal Before And After Contrast 15 $2,040.00 $4,451.52 $3,385.01 nat. median
$1,092
outlier · 3.1×
72158
HCPCS 		MRI Scan Of Lower Spinal Canal Before And After Contrast 15 $2,040.00 $4,381.44 $3,331.72 nat. median
$1,081
outlier · 3.1×
70553
HCPCS 		MRI Scan Of Brain Before And After Contrast 15 $2,040.00 $4,381.44 $3,331.72 nat. median
$1,122
outlier · 3.0×
71275
HCPCS 		CT Scan Of Blood Vessels Of Chest With Contrast 15 $1,222.00 $4,320.00 $3,285.00 nat. median
$736
outlier · 4.5×
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 15 $2,326.01 $4,294.18 $3,265.36 nat. median
$2,076
1.6× median
74181
HCPCS 		MRI Scan Of Abdomen Without Contrast 15 $2,040.00 $4,197.12 $3,191.56 nat. median
$820
outlier · 3.9×
72142
HCPCS 		MRI Scan Of Upper Spinal Canal With Contrast 15 $2,040.00 $4,172.16 $3,172.58 nat. median
$959
outlier · 3.3×
72149
HCPCS 		MRI Scan Of Lower Spinal Canal With Contrast 15 $2,040.00 $4,172.16 $3,172.58 nat. median
$970
outlier · 3.3×
72147
HCPCS 		MRI Scan Of Middle Spinal Canal With Contrast 15 $2,040.00 $4,172.16 $3,172.58 nat. median
$965
outlier · 3.3×
Q5108
HCPCS 		Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 15 $2,227.45 $4,112.21 $3,126.99 nat. median
$1,257
outlier · 2.5×
70549
HCPCS 		MRI Scan Of Blood Vessels Of Neck Before And After Contrast 15 $2,040.00 $4,093.44 $3,112.72 nat. median
$1,051
outlier · 3.0×
15273
HCPCS 		Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.… 15 $155.95 $10,560.00 $3,084.62 nat. median
$3,195
1.0× median
70551
HCPCS 		MRI Scan Of Brain Without Contrast 15 $2,040.00 $4,032.00 $3,066.00 nat. median
$772
outlier · 4.0×
73223
HCPCS 		MRI Scan Of Arm Joint Before And After Contrast 15 $2,040.00 $4,007.52 $3,047.39 nat. median
$1,225
outlier · 2.5×
15274
HCPCS 		Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, Each… 15 $34.98 $10,560.00 $2,910.50 nat. median
$921
outlier · 3.2×
93351
HCPCS 		Ultrasound Of Heart With Continuous Electrocardiogram (ecg) During Rest, Exercis… 15 $2,054.00 $3,792.00 $2,883.50 nat. median
$856
outlier · 3.4×
J0897
HCPCS 		Injection, Denosumab, 1 Mg 15 $1,588.23 $5,316.29 $2,879.66 nat. median
$2,502
1.2× median
72141
HCPCS 		MRI Scan Of Upper Spinal Canal Without Contrast 15 $2,028.00 $3,744.00 $2,847.00 nat. median
$766
outlier · 3.7×
Q5103
HCPCS 		Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 15 $2,027.02 $3,742.20 $2,845.63 nat. median
$335
outlier · 8.5×
70542
HCPCS 		MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 15 $2,002.00 $3,696.00 $2,810.50 nat. median
$905
outlier · 3.1×
72133
HCPCS 		CT Scan Of Lower Spine Before And After Contrast 15 $1,222.00 $3,639.36 $2,767.43 nat. median
$616
outlier · 4.5×
72146
HCPCS 		MRI Scan Of Middle Spinal Canal Without Contrast 15 $1,970.28 $3,637.44 $2,765.97 nat. median
$772
outlier · 3.6×

Other procedures at this hospital

Browse this hospital's 1,690 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
             
J3241 HCPCS Injection, Teprotumumab-trbw, 10 Mg 15 15 $31,520.03 $31,520.03 $16,390.42 $30,259.23 $23,009.62 2026-03-09
4983143_1 CDM Nithiodote 300 Mg-12.5 Gram 15 15 $18,360.00 $18,360.00 $9,547.20 $17,625.60 $13,402.80 2026-03-09
J3101 HCPCS Injection, Tenecteplase, 1 Mg 15 15 $12,105.52 $12,105.52 $6,294.87 $11,621.30 $8,837.03 2026-03-09
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 45 15 $9,986.85 $9,986.85 $527.90 $18,606.07 $7,290.40 2026-03-09
J1950 HCPCS Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg 15 15 $8,132.06 $8,132.06 $4,228.67 $7,806.78 $5,936.40 2026-03-09
J2182 HCPCS Injection, Mepolizumab, 1 Mg 15 15 $6,907.46 $6,907.46 $3,591.88 $6,631.16 $5,042.45 2026-03-09
J2997 HCPCS Injection, Alteplase Recombinant, 1 Mg 30 15 $8,691.85 $8,691.85 $802.39 $15,207.02 $4,859.24 2026-03-09
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 15 15 $6,432.00 $6,432.00 $1,222.00 $6,174.72 $4,695.36 2026-03-09
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 15 15 $6,300.00 $6,300.00 $1,222.00 $6,048.00 $4,599.00 2026-03-09
J1162 HCPCS Injection, Digoxin Immune Fab (ovine), Per Vial 15 15 $6,234.50 $6,234.50 $3,241.94 $5,985.12 $4,551.19 2026-03-09
J1306 HCPCS Injection, Inclisiran, 1 Mg 15 15 $6,085.34 $6,085.34 $3,164.38 $5,841.93 $4,442.30 2026-03-09
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 15 15 $5,941.50 $5,941.50 $1,222.00 $5,703.84 $4,337.30 2026-03-09
78452 HCPCS Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 15 15 $5,550.00 $5,550.00 $2,313.38 $5,328.00 $4,051.50 2026-03-09
Q5120 HCPCS Injection, Pegfilgrastim-bmez (ziextenzo), Biosimilar, 0.5 Mg 15 15 $5,529.30 $5,529.30 $2,875.24 $5,308.13 $4,036.39 2026-03-09
43251 HCPCS Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi… 15 15 $5,135.00 $5,135.00 $2,670.20 $4,929.60 $3,748.55 2026-03-09
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 15 15 $5,000.00 $5,000.00 $1,222.00 $4,800.00 $3,650.00 2026-03-09
15120 HCPCS Partial Thickness Self Skin Graft To Face, Scalp, Eyelids, Mouth, Neck, Ears, Ar… 30 15 $6,308.50 $6,308.50 $563.35 $10,560.00 $3,634.11 2026-03-09
C9482 HCPCS Injection, Sotalol Hydrochloride, 1 Mg 15 15 $4,921.20 $4,921.20 $2,559.02 $4,724.35 $3,592.48 2026-03-09
45385 HCPCS Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S… 15 15 $4,825.00 $4,825.00 $2,509.00 $4,632.00 $3,522.25 2026-03-09
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 15 15 $4,707.00 $4,707.00 $1,222.00 $4,518.72 $3,436.11 2026-03-09
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 15 15 $4,700.00 $4,700.00 $1,915.80 $4,512.00 $3,431.00 2026-03-09
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 15 15 $4,662.50 $4,662.50 $2,040.00 $4,476.00 $3,403.63 2026-03-09
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 15 15 $4,662.50 $4,662.50 $2,040.00 $4,476.00 $3,403.63 2026-03-09
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 45 15 $4,662.50 $4,662.50 $2,040.00 $4,476.00 $3,403.63 2026-03-09
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 15 15 $4,637.00 $4,637.00 $2,040.00 $4,451.52 $3,385.01 2026-03-09
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 15 15 $4,637.00 $4,637.00 $2,040.00 $4,451.52 $3,385.01 2026-03-09
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 15 15 $4,637.00 $4,637.00 $2,040.00 $4,451.52 $3,385.01 2026-03-09
70552 HCPCS MRI Scan Of Brain With Contrast 15 15 $4,637.00 $4,637.00 $2,040.00 $4,451.52 $3,385.01 2026-03-09
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 15 15 $4,637.00 $4,637.00 $2,040.00 $4,451.52 $3,385.01 2026-03-09
70553 HCPCS MRI Scan Of Brain Before And After Contrast 15 15 $4,564.00 $4,564.00 $2,040.00 $4,381.44 $3,331.72 2026-03-09
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 15 15 $4,564.00 $4,564.00 $2,040.00 $4,381.44 $3,331.72 2026-03-09
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 15 15 $4,500.00 $4,500.00 $1,222.00 $4,320.00 $3,285.00 2026-03-09
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 15 15 $4,473.10 $4,473.10 $2,326.01 $4,294.18 $3,265.36 2026-03-09
74181 HCPCS MRI Scan Of Abdomen Without Contrast 15 15 $4,372.00 $4,372.00 $2,040.00 $4,197.12 $3,191.56 2026-03-09
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 15 15 $4,346.00 $4,346.00 $2,040.00 $4,172.16 $3,172.58 2026-03-09
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 15 15 $4,346.00 $4,346.00 $2,040.00 $4,172.16 $3,172.58 2026-03-09
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 15 15 $4,346.00 $4,346.00 $2,040.00 $4,172.16 $3,172.58 2026-03-09
Q5108 HCPCS Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 15 15 $4,283.55 $4,283.55 $2,227.45 $4,112.21 $3,126.99 2026-03-09
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 15 15 $4,264.00 $4,264.00 $2,040.00 $4,093.44 $3,112.72 2026-03-09
15273 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.… 30 15 $5,796.00 $5,796.00 $155.95 $10,560.00 $3,084.62 2026-03-09
70551 HCPCS MRI Scan Of Brain Without Contrast 15 15 $4,200.00 $4,200.00 $2,040.00 $4,032.00 $3,066.00 2026-03-09
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 15 15 $4,174.50 $4,174.50 $2,040.00 $4,007.52 $3,047.39 2026-03-09
15274 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, Each… 30 15 $5,578.50 $5,578.50 $34.98 $10,560.00 $2,910.50 2026-03-09
93351 HCPCS Ultrasound Of Heart With Continuous Electrocardiogram (ecg) During Rest, Exercis… 15 15 $3,950.00 $3,950.00 $2,054.00 $3,792.00 $2,883.50 2026-03-09
J0897 HCPCS Injection, Denosumab, 1 Mg 45 15 $3,496.95 $3,496.95 $1,588.23 $5,316.29 $2,879.66 2026-03-09
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 15 15 $3,900.00 $3,900.00 $2,028.00 $3,744.00 $2,847.00 2026-03-09
Q5103 HCPCS Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 15 15 $3,898.12 $3,898.12 $2,027.02 $3,742.20 $2,845.63 2026-03-09
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 15 15 $3,850.00 $3,850.00 $2,002.00 $3,696.00 $2,810.50 2026-03-09
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 15 15 $3,791.00 $3,791.00 $1,222.00 $3,639.36 $2,767.43 2026-03-09
71550 HCPCS MRI Scan Of Chest Without Contrast 15 15 $3,789.00 $3,789.00 $1,970.28 $3,637.44 $2,765.97 2026-03-09
72195 HCPCS MRI Scan Of Pelvis Without Contrast 15 15 $3,789.00 $3,789.00 $1,970.28 $3,637.44 $2,765.97 2026-03-09
73220 HCPCS MRI Scan Of Arm Before And After Contrast 15 15 $3,789.00 $3,789.00 $1,970.28 $3,637.44 $2,765.97 2026-03-09
73720 HCPCS MRI Scan Of Leg Before And After Contrast 45 15 $3,789.00 $3,789.00 $1,970.28 $3,637.44 $2,765.97 2026-03-09
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 15 15 $3,789.00 $3,789.00 $1,970.28 $3,637.44 $2,765.97 2026-03-09
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 15 15 $3,789.00 $3,789.00 $1,970.28 $3,637.44 $2,765.97 2026-03-09
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 45 15 $3,789.00 $3,789.00 $1,970.28 $3,637.44 $2,765.97 2026-03-09
J1602 HCPCS Injection, Golimumab, 1 Mg, For Intravenous Use 15 15 $3,726.22 $3,726.22 $1,937.63 $3,577.17 $2,720.14 2026-03-09
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 15 15 $3,705.00 $3,705.00 $1,926.60 $3,556.80 $2,704.65 2026-03-09
71270 HCPCS CT Scan Of Chest Before And After Contrast 15 15 $3,686.50 $3,686.50 $1,222.00 $3,539.04 $2,691.15 2026-03-09
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 15 15 $3,644.50 $3,644.50 $1,895.14 $3,498.72 $2,660.49 2026-03-09
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 15 15 $3,637.00 $3,637.00 $1,222.00 $3,491.52 $2,655.01 2026-03-09
74160 HCPCS CT Scan Of Abdomen With Contrast 15 15 $3,637.00 $3,637.00 $1,222.00 $3,491.52 $2,655.01 2026-03-09
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 15 15 $3,637.00 $3,637.00 $1,222.00 $3,491.52 $2,655.01 2026-03-09
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 15 15 $3,637.00 $3,637.00 $1,222.00 $3,491.52 $2,655.01 2026-03-09
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 15 15 $3,603.50 $3,603.50 $1,873.82 $3,459.36 $2,630.56 2026-03-09
71260 HCPCS CT Scan Of Chest With Contrast 43 15 $3,600.00 $3,600.00 $1,222.00 $3,456.00 $2,628.00 2026-03-09
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 15 15 $3,544.00 $3,544.00 $1,222.00 $3,402.24 $2,587.12 2026-03-09
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 15 15 $3,527.50 $3,527.50 $1,222.00 $3,386.40 $2,575.08 2026-03-09
90651 HCPCS Human Papillomavirus Vaccine Types 6, 11, 16, 18, 31, 33, 45, 52, 58, Nonavalent 45 15 $3,520.21 $3,520.21 $257.40 $3,993.76 $2,569.75 2026-03-09
73218 HCPCS MRI Scan Of Arm Without Contrast 45 15 $3,517.50 $3,517.50 $1,829.10 $3,376.80 $2,567.78 2026-03-09
J1447 HCPCS Injection, Tbo-filgrastim, 1 Microgram 15 15 $3,496.68 $3,496.68 $1,818.27 $3,356.81 $2,552.58 2026-03-09
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 15 15 $3,479.50 $3,479.50 $1,222.00 $3,340.32 $2,540.04 2026-03-09
J3358 HCPCS Ustekinumab, For Intravenous Injection, 1 Mg 15 15 $3,470.69 $3,470.69 $1,804.76 $3,331.86 $2,533.60 2026-03-09
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 15 15 $3,457.50 $3,457.50 $1,797.90 $3,319.20 $2,523.98 2026-03-09
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 15 15 $3,450.00 $3,450.00 $1,794.00 $3,312.00 $2,518.50 2026-03-09
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 15 15 $3,400.00 $3,400.00 $1,768.00 $3,264.00 $2,482.00 2026-03-09
J3032 HCPCS Injection, Eptinezumab-jjmr, 1 Mg 15 15 $3,398.67 $3,398.67 $1,767.31 $3,262.72 $2,481.03 2026-03-09
70488 HCPCS CT Scan Of Face Before And After Contrast 15 15 $3,394.00 $3,394.00 $1,222.00 $3,258.24 $2,477.62 2026-03-09
72126 HCPCS CT Scan Of Upper Spine With Contrast 15 15 $3,389.50 $3,389.50 $1,222.00 $3,253.92 $2,474.34 2026-03-09
72129 HCPCS CT Scan Of Middle Spine With Contrast 15 15 $3,389.50 $3,389.50 $1,222.00 $3,253.92 $2,474.34 2026-03-09
72132 HCPCS CT Scan Of Lower Spine With Contrast 15 15 $3,389.50 $3,389.50 $1,222.00 $3,253.92 $2,474.34 2026-03-09
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 15 15 $3,389.50 $3,389.50 $1,222.00 $3,253.92 $2,474.34 2026-03-09
72193 HCPCS CT Scan Of Pelvis With Contrast 15 15 $3,389.50 $3,389.50 $1,222.00 $3,253.92 $2,474.34 2026-03-09
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 15 15 $3,374.50 $3,374.50 $1,222.00 $3,239.52 $2,463.39 2026-03-09
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 15 15 $3,325.50 $3,325.50 $1,222.00 $3,192.48 $2,427.62 2026-03-09
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 30 15 $3,325.00 $3,325.00 $1,729.00 $3,192.00 $2,427.25 2026-03-09
73718 HCPCS MRI Scan Of Leg Without Contrast 45 15 $3,306.00 $3,306.00 $1,719.12 $3,173.76 $2,413.38 2026-03-09
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 29 15 $2,900.00 $2,900.00 $1,222.00 $3,152.64 $2,397.32 2026-03-09
J2212 HCPCS Injection, Methylnaltrexone, 0.1 Mg 15 15 $3,236.80 $3,236.80 $1,683.14 $3,107.33 $2,362.86 2026-03-09
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 15 15 $3,228.00 $3,228.00 $1,222.00 $3,098.88 $2,356.44 2026-03-09
70336 HCPCS MRI Scan Of Jaw Joint 15 15 $3,206.50 $3,206.50 $1,667.38 $3,078.24 $2,340.75 2026-03-09
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 45 15 $3,206.50 $3,206.50 $1,455.39 $3,078.24 $2,340.75 2026-03-09
72125 HCPCS CT Scan Of Upper Spine Without Contrast 15 15 $3,149.50 $3,149.50 $1,222.00 $3,023.52 $2,299.14 2026-03-09
73700 HCPCS CT Scan Of Leg Without Contrast 15 15 $3,049.00 $3,049.00 $1,222.00 $2,927.04 $2,225.77 2026-03-09
90675 HCPCS Rabies Vaccine For Injection Into Muscle 45 15 $2,760.89 $2,760.89 $1,312.22 $2,963.52 $2,220.68 2026-03-09
15100 HCPCS Partial Thickness Self Skin Graft To Trunk, Arms, Or Legs, 100.0 Sq Cm Or 1% Bod… 30 15 $3,575.50 $3,575.50 $363.52 $5,280.00 $2,218.82 2026-03-09
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 15 15 $3,029.00 $3,029.00 $1,222.00 $2,907.84 $2,211.17 2026-03-09
74150 HCPCS CT Scan Of Abdomen Without Contrast 15 15 $3,022.00 $3,022.00 $1,222.00 $2,901.12 $2,206.06 2026-03-09
15115 HCPCS Outer Layer Self Skin Graft Of Face, Scalp, Eyelids, Mouth, Neck, Ears, Around E… 30 15 $3,517.50 $3,517.50 $594.38 $5,280.00 $2,200.56 2026-03-09
15110 HCPCS Outer Layer Self Skin Graft Of Trunk, Arms, Or Legs, 100.0 Sq Cm Or 1% Body Area… 30 15 $3,540.50 $3,540.50 $607.32 $5,280.00 $2,196.09 2026-03-09
43239 HCPCS Biopsy Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible Endoscop… 15 15 $3,000.00 $3,000.00 $1,560.00 $2,955.00 $2,190.00 2026-03-09
45380 HCPCS Biopsy Of Large Bowel Using A Flexible Endoscope 15 15 $3,000.00 $3,000.00 $1,560.00 $2,955.00 $2,190.00 2026-03-09
71250 HCPCS CT Scan Of Chest Without Contrast 15 15 $2,991.50 $2,991.50 $1,222.00 $2,871.84 $2,183.80 2026-03-09
70487 HCPCS CT Scan Of Face With Contrast 15 15 $2,983.00 $2,983.00 $1,222.00 $2,863.68 $2,177.59 2026-03-09
72128 HCPCS CT Scan Of Middle Spine Without Contrast 15 15 $2,910.50 $2,910.50 $1,222.00 $2,794.08 $2,124.67 2026-03-09
70450 HCPCS CT Scan Head Or Brain Without Contrast 15 15 $2,900.00 $2,900.00 $1,222.00 $2,784.00 $2,117.00 2026-03-09
70460 HCPCS CT Scan Head Or Brain With Contrast 15 15 $2,894.50 $2,894.50 $1,222.00 $2,778.72 $2,112.99 2026-03-09
72131 HCPCS CT Scan Of Lower Spine Without Contrast 15 15 $2,850.00 $2,850.00 $1,222.00 $2,736.00 $2,080.50 2026-03-09
72192 HCPCS CT Scan Of Pelvis Without Contrast 15 15 $2,825.50 $2,825.50 $1,222.00 $2,712.48 $2,062.62 2026-03-09
43235 HCPCS Diagnostic Exam Of Esophagus, Stomach, And/or Upper Small Bowel Using A Flexible… 15 15 $2,800.00 $2,800.00 $1,456.00 $2,955.00 $2,044.00 2026-03-09
J1442 HCPCS Injection, Filgrastim (g-csf), Excludes Biosimilars, 1 Microgram 45 15 $2,783.72 $2,783.72 $527.59 $3,408.05 $2,032.12 2026-03-09
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 15 15 $2,730.00 $2,730.00 $1,419.60 $2,620.80 $1,992.90 2026-03-09
4983102_1 CDM Ipol Vial 15 15 $2,658.86 $2,658.86 $1,382.61 $2,552.51 $1,940.97 2026-03-09
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 15 15 $2,650.50 $2,650.50 $1,378.26 $2,544.48 $1,934.87 2026-03-09
73200 HCPCS CT Scan Of Arm Without Contrast 15 15 $2,614.00 $2,614.00 $1,222.00 $2,509.44 $1,908.22 2026-03-09
45378 HCPCS Diagnostic Exam Of Large Bowel Using A Flexible Endoscope 15 15 $2,535.00 $2,535.00 $1,318.20 $2,955.00 $1,850.55 2026-03-09
70486 HCPCS CT Scan Of Face Without Contrast 15 15 $2,524.50 $2,524.50 $1,222.00 $2,423.52 $1,842.89 2026-03-09
71271 HCPCS Low Dose CT Scan Of Chest For Lung Cancer Screening 15 15 $2,400.00 $2,400.00 $1,222.00 $2,304.00 $1,752.00 2026-03-09
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 30 15 $2,278.47 $2,278.47 $1,139.27 $2,271.39 $1,727.20 2026-03-09
64493 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Le… 15 15 $2,340.00 $2,340.00 $1,216.80 $2,468.00 $1,708.20 2026-03-09
15277 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout… 30 15 $3,078.50 $3,078.50 $179.31 $5,280.00 $1,684.57 2026-03-09
4350901_1 CDM US Echo 2d Comp Without Color Flow Doppler 15 15 $2,305.00 $2,305.00 $1,198.60 $2,212.80 $1,682.65 2026-03-09
5884592_1 CDM Cl 93307 Echo Transthorac R-t 2d W/wo M-mode Rec Comp 15 15 $2,305.00 $2,305.00 $1,198.60 $2,212.80 $1,682.65 2026-03-09
55250 HCPCS Removal Of Sperm Duct 15 15 $2,300.00 $2,300.00 $1,196.00 $6,468.00 $1,679.00 2026-03-09
43248 HCPCS Insertion Of Guide Wire With Dilation Of Esophagus Using A Flexible Endoscope 15 15 $2,300.00 $2,300.00 $1,196.00 $2,955.00 $1,679.00 2026-03-09
36589 HCPCS Removal Of Tunneled Central Venous Tube 15 15 $2,185.00 $2,185.00 $1,136.20 $2,097.60 $1,595.05 2026-03-09
J0881 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 120 15 $2,287.75 $2,287.75 $426.57 $6,172.07 $1,574.91 2026-03-09
81539 HCPCS Measurement Of Proteins Associated With Prostate Cancer 15 15 $2,110.00 $2,110.00 $1,097.20 $2,025.60 $1,540.30 2026-03-09
15275 HCPCS Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 30 15 $2,904.00 $2,904.00 $78.63 $5,280.00 $1,539.03 2026-03-09
52310 HCPCS Simple Removal Of Foreign Body, Stone, Or Stent In Urethra Or Bladder Using An E… 15 15 $2,105.00 $2,105.00 $1,094.60 $2,020.80 $1,536.65 2026-03-09
15271 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C… 30 15 $2,897.50 $2,897.50 $69.30 $5,280.00 $1,524.56 2026-03-09
11044 HCPCS Removal Of Bone, 20.0 Sq Cm Or Less 30 15 $2,733.00 $2,733.00 $184.23 $4,680.00 $1,523.19 2026-03-09
6157014_1 CDM Proquad Vial 15 15 $2,079.61 $2,079.61 $1,081.40 $1,996.43 $1,518.12 2026-03-09
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 15 15 $2,075.22 $2,075.22 $1,079.11 $1,992.21 $1,514.91 2026-03-09
32555 HCPCS Aspiration Of Fluid From Chest Cavity Using Imaging Guidance 15 15 $2,065.00 $2,065.00 $1,073.80 $1,982.40 $1,507.45 2026-03-09
15278 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout… 30 15 $2,841.00 $2,841.00 $43.89 $5,280.00 $1,493.34 2026-03-09
J2426 HCPCS Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg 15 15 $2,043.52 $2,043.52 $1,062.63 $1,961.78 $1,491.77 2026-03-09
6437518_1 CDM Prevnar 20 Syringe 15 15 $2,038.54 $2,038.54 $1,060.04 $1,957.00 $1,488.13 2026-03-09
78227 HCPCS Nuclear Medicine Study Of Liver And Bile Duct System With Use Of Drugs 30 15 $1,821.50 $1,821.50 $854.36 $1,920.00 $1,460.00 2026-03-09
15276 HCPCS Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 30 15 $2,781.50 $2,781.50 $20.33 $5,280.00 $1,458.79 2026-03-09
15272 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, Each Addi… 30 15 $2,773.50 $2,773.50 $13.48 $5,280.00 $1,449.45 2026-03-09
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 15 15 $1,925.00 $1,925.00 $1,001.00 $1,848.00 $1,405.25 2026-03-09
64454 HCPCS Injection Of Anesthetic Agent And/or Steroid Into Knee Nerve Branch Using Imagin… 15 15 $1,900.00 $1,900.00 $988.00 $2,468.00 $1,387.00 2026-03-09
Q9968 HCPCS Injection, Non-radioactive, Non-contrast, Visualization Adjunct (e.g., Methylene… 15 15 $1,893.92 $1,893.92 $984.84 $1,818.16 $1,382.56 2026-03-09
11047 HCPCS Removal Of Bone, Each Additional 20.0 Sq Cm Or Less 30 15 $2,551.00 $2,551.00 $76.77 $4,680.00 $1,376.64 2026-03-09
93350 HCPCS Ultrasound Of Heart During Rest, Exercise And/or Drug-induced Stress With Report 45 15 $1,800.00 $1,800.00 $780.00 $1,728.00 $1,314.00 2026-03-09
J1745 HCPCS Injection, Infliximab, Excludes Biosimilar, 10 Mg 15 15 $1,681.66 $1,681.66 $874.46 $1,614.39 $1,227.61 2026-03-09
93970 HCPCS Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 15 15 $1,669.50 $1,669.50 $868.14 $1,602.72 $1,218.74 2026-03-09
23065 HCPCS Biopsy Of Surface Tissue Of Shoulder 15 15 $1,650.00 $1,650.00 $858.00 $1,584.00 $1,204.50 2026-03-09
27096 HCPCS Injection Of Anesthetic Or Steroid Into Joint Between Lower Spine And Hip Bone U… 15 15 $1,640.00 $1,640.00 $852.80 $1,658.00 $1,197.20 2026-03-09
62323 HCPCS Injection Of Substance Into Lower Spine Canal Using Imaging Guidance 15 15 $1,635.00 $1,635.00 $850.20 $2,468.00 $1,193.55 2026-03-09
93971 HCPCS Ultrasound Study Of One Arm Or Leg Veins With Compression And Maneuvers 15 15 $1,630.00 $1,630.00 $847.60 $1,564.80 $1,189.90 2026-03-09
J2786 HCPCS Injection, Reslizumab, 1 Mg 15 15 $1,584.00 $1,584.00 $823.68 $1,520.64 $1,156.32 2026-03-09
Q5101 HCPCS Injection, Filgrastim-sndz, Biosimilar, (zarxio), 1 Microgram 30 15 $1,712.00 $1,712.00 $598.64 $2,181.85 $1,143.51 2026-03-09
J2248 HCPCS Injection, Micafungin Sodium, 1 Mg 30 15 $1,557.99 $1,557.99 $808.31 $1,499.07 $1,139.92 2026-03-09
P9073 HCPCS Platelets, Pheresis, Pathogen-reduced, Each Unit 15 15 $1,550.00 $1,550.00 $806.00 $1,488.00 $1,131.50 2026-03-09
93926 HCPCS Ultrasound Of One Leg Arteries Or Artery Grafts 15 15 $1,550.00 $1,550.00 $806.00 $1,488.00 $1,131.50 2026-03-09
93017 HCPCS Exercise Or Drug-induced Heart Stress Test With Electrocardiogram (ecg) 30 15 $1,500.00 $1,500.00 $780.00 $1,440.00 $1,095.00 2026-03-09
52281 HCPCS Dilation Of Urethra Using An Endoscope 15 15 $1,500.00 $1,500.00 $780.00 $1,440.00 $1,095.00 2026-03-09
93315 HCPCS Ultrasound Of Heart With Probe In Esophagus For Congenital Defect, With Report 15 15 $1,500.00 $1,500.00 $780.00 $1,440.00 $1,095.00 2026-03-09
J7307 HCPCS Etonogestrel (contraceptive) Implant System, Including Implant And Supplies 15 15 $1,496.00 $1,496.00 $777.92 $1,436.16 $1,092.08 2026-03-09
J1740 HCPCS Injection, Ibandronate Sodium, 1 Mg 15 15 $1,464.11 $1,464.11 $761.34 $1,405.55 $1,068.80 2026-03-09
P9037 HCPCS Platelets, Pheresis, Leukocytes Reduced, Irradiated, Each Unit 15 15 $1,425.00 $1,425.00 $741.00 $1,368.00 $1,040.25 2026-03-09
52000 HCPCS Diagnostic Exam Of Bladder And Urethra Using An Endoscope 15 15 $1,400.00 $1,400.00 $728.00 $1,344.00 $1,022.00 2026-03-09
P9035 HCPCS Platelets, Pheresis, Leukocytes Reduced, Each Unit 15 15 $1,400.00 $1,400.00 $728.00 $1,344.00 $1,022.00 2026-03-09
93930 HCPCS Ultrasound Of Arm Arteries Or Artery Grafts 30 15 $1,381.50 $1,381.50 $718.38 $1,326.24 $1,008.50 2026-03-09
J0885 HCPCS Injection, Epoetin Alfa, (for Non-esrd Use), 1000 Units 15 15 $1,380.83 $1,380.83 $718.03 $1,325.60 $1,008.01 2026-03-09
36590 HCPCS Removal Of Central Venous Tube With Port Or Pump 15 15 $1,375.00 $1,375.00 $715.00 $1,320.00 $1,003.75 2026-03-09
92960 HCPCS External Shock To Heart To Regulate Heart Beat 15 15 $1,350.00 $1,350.00 $702.00 $1,296.00 $985.50 2026-03-09
87633 HCPCS Detection Test By Nucleic Acid For Multiple Types Of Respiratory Virus, Multiple… 15 15 $1,331.50 $1,331.50 $692.38 $1,278.24 $972.00 2026-03-09
J9030 HCPCS Bcg Live Intravesical Instillation, 1 Mg 15 15 $1,312.50 $1,312.50 $682.50 $1,260.00 $958.13 2026-03-09
J1610 HCPCS Injection, Glucagon Hydrochloride, Per 1 Mg 45 15 $1,118.42 $1,118.42 $511.70 $1,382.80 $908.26 2026-03-09
4982954_1 CDM M-m-r Ii Vaccine Vial 15 15 $1,233.40 $1,233.40 $641.37 $1,184.06 $900.38 2026-03-09
64483 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 15 15 $1,200.00 $1,200.00 $624.00 $2,468.00 $876.00 2026-03-09
76700 HCPCS Complete Ultrasound Scan Of Abdomen 15 15 $1,200.00 $1,200.00 $624.00 $1,152.00 $876.00 2026-03-09
93308 HCPCS Ultrasound Of Heart, Follow-up 30 15 $1,292.50 $1,292.50 $468.00 $1,617.60 $870.10 2026-03-09
99291 HCPCS Critical Care, First 30-74 Minutes 30 15 $1,574.00 $1,574.00 $160.84 $4,077.00 $866.44 2026-03-09
76770 HCPCS Complete Ultrasound Scan Behind Abdominal Cavity 15 15 $1,170.00 $1,170.00 $608.40 $1,123.20 $854.10 2026-03-09
5546634_1 CDM Santyl Ointment 15 15 $1,143.31 $1,143.31 $594.52 $1,097.58 $834.62 2026-03-09
J0248 HCPCS Injection, Remdesivir, 1 Mg 30 15 $1,039.37 $1,039.37 $486.72 $1,097.02 $834.19 2026-03-09
Q9957 HCPCS Injection, Perflutren Lipid Microspheres, Per Ml 15 15 $1,131.73 $1,131.73 $588.50 $1,086.46 $826.16 2026-03-09
76801 HCPCS Ultrasound Scan Of Pregnant Uterus (less Than 14 Weeks), Single Or First Fetus 15 15 $1,121.00 $1,121.00 $582.92 $1,076.16 $818.33 2026-03-09
76805 HCPCS Ultrasound Scan Of Pregnant Uterus (14 Weeks Or More), Single Or First Fetus 15 15 $1,121.00 $1,121.00 $582.92 $1,076.16 $818.33 2026-03-09
76856 HCPCS Complete Ultrasound Scan Of Pelvis 15 15 $1,100.00 $1,100.00 $572.00 $1,056.00 $803.00 2026-03-09
90716 HCPCS Varicella Vaccine 30 15 $1,348.11 $1,348.11 $105.56 $2,393.48 $745.68 2026-03-09
36430 HCPCS Transfusion Of Blood Or Blood Products 60 15 $925.00 $925.00 $455.00 $1,248.00 $731.75 2026-03-09
15002 HCPCS Preparation Of Skin Graft Site Of Trunk, Arms, Or Legs, 100.0 Sq Cm Or 1% Body A… 30 15 $1,254.50 $1,254.50 $150.20 $1,776.00 $730.69 2026-03-09
93320 HCPCS Ultrasound Of Heart Blood Flow, Valves And Chambers 15 15 $995.00 $995.00 $517.40 $955.20 $726.35 2026-03-09
90677 HCPCS Pneumococcal Conjugate Vaccine, 20 Valent (pcv20), For Intramuscular Use 30 15 $1,226.88 $1,226.88 $200.20 $1,986.01 $722.68 2026-03-09
64494 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Second Le… 15 15 $984.00 $984.00 $511.68 $1,658.00 $718.32 2026-03-09
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 30 15 $1,309.00 $1,309.00 $159.70 $4,077.00 $696.02 2026-03-09
93931 HCPCS Ultrasound Of One Arm Arteries Or Artery Grafts 30 15 $950.00 $950.00 $494.00 $912.00 $693.50 2026-03-09
55700 HCPCS Biopsy Of Prostate Gland 15 15 $950.00 $950.00 $494.00 $912.00 $693.50 2026-03-09
96413 HCPCS Administration Of Chemotherapy Into Vein, 1 Hour Or Less 15 15 $950.00 $950.00 $494.00 $912.00 $693.50 2026-03-09
76942 HCPCS Ultrasonic Guidance For Needle Placement 15 15 $950.00 $950.00 $494.00 $912.00 $693.50 2026-03-09
92611 HCPCS Evaluation Of Swallowing Function Image 15 15 $944.00 $944.00 $490.88 $906.24 $689.12 2026-03-09
76870 HCPCS Ultrasound Scan Of Scrotum 15 15 $925.00 $925.00 $481.00 $888.00 $675.25 2026-03-09
6033282_1 CDM Pneumovax 23 Syringe 15 15 $922.25 $922.25 $479.57 $885.36 $673.24 2026-03-09
76705 HCPCS Limited Ultrasound Scan Of Abdomen 15 15 $900.00 $900.00 $468.00 $864.00 $657.00 2026-03-09
36680 HCPCS Insertion Of Needle For Infusion Into Bone 15 15 $900.00 $900.00 $468.00 $864.00 $657.00 2026-03-09
97608 HCPCS Therapy Procedure Using A Special Bandage, Vacuum Pump And Disposable Medical Eq… 30 15 $944.00 $944.00 $19.74 $1,152.00 $656.00 2026-03-09
97607 HCPCS Therapy Procedure Using A Special Bandage, Vacuum Pump And Disposable Medical Eq… 30 15 $943.00 $943.00 $17.20 $1,152.00 $655.00 2026-03-09
11043 HCPCS Removal Of Muscle And/or Tissue, 20.0 Sq Cm Or Less 30 15 $1,147.00 $1,147.00 $126.75 $1,776.00 $654.56 2026-03-09
J2805 HCPCS Injection, Sincalide, 5 Micrograms 15 15 $884.70 $884.70 $460.04 $849.31 $645.83 2026-03-09
4983034_1 CDM Bridion 200 Mg/2 Ml Vial 15 15 $880.95 $880.95 $458.09 $845.71 $643.09 2026-03-09
76830 HCPCS Ultrasound Scan Of Uterus, Ovaries, Tubes, Cervix And Pelvic Area Through Vagina 15 15 $865.00 $865.00 $449.80 $830.40 $631.45 2026-03-09
76817 HCPCS Vaginal Ultrasound Of Pregnant Uterus 15 15 $865.00 $865.00 $449.80 $830.40 $631.45 2026-03-09
76706 HCPCS Ultrasound Scan Of Abdominal Aorta 15 15 $850.00 $850.00 $442.00 $816.00 $620.50 2026-03-09
72202 HCPCS X-ray Of Joint Between Lower Spine And Hip Bone, 3 Or More Views 15 15 $850.00 $850.00 $442.00 $816.00 $620.50 2026-03-09
73502 HCPCS X-ray Of Hip, 2-3 Views 15 15 $846.50 $846.50 $440.18 $812.64 $617.95 2026-03-09
76000 HCPCS Imaging Guidance For Procedure, 60 Minutes Or Less 15 15 $842.00 $842.00 $437.84 $808.32 $614.66 2026-03-09
76536 HCPCS Ultrasound Scan Of Head And Neck Soft Tissue 15 15 $825.00 $825.00 $429.00 $792.00 $602.25 2026-03-09
76872 HCPCS Ultrasound Scan Of Pelvic Region Through Rectum 15 15 $825.00 $825.00 $429.00 $792.00 $602.25 2026-03-09
76604 HCPCS Ultrasound Scan Of Chest 15 15 $820.00 $820.00 $426.40 $787.20 $598.60 2026-03-09
72050 HCPCS X-ray Of Upper Spine, 4-5 Views 15 15 $804.50 $804.50 $418.34 $772.32 $587.29 2026-03-09
76775 HCPCS Limited Ultrasound Scan Behind Abdominal Cavity 15 15 $793.50 $793.50 $412.62 $761.76 $579.26 2026-03-09
26418 HCPCS Repair Of Tendon On Top Side Of Finger 15 15 $1,650.00 $1,650.00 $308.75 $1,257.17 $575.02 2026-03-09
76641 HCPCS Complete Ultrasound Scan Of 1 Breast 30 15 $850.00 $850.00 $312.00 $1,056.00 $572.00 2026-03-09
71111 HCPCS X-ray Of Ribs On Both Sides Of Body, Minimum Of 4 Views 15 15 $764.50 $764.50 $397.54 $733.92 $558.09 2026-03-09
0097U HCPCS Gastrointestinal Pathogen, Multiplex Reverse Transcription And Multiplex Amplifi… 15 15 $712.00 $712.00 $370.24 $683.52 $519.76 2026-03-09
72081 HCPCS X-ray Of Entire Middle And Lower Spine, 1 View 15 15 $700.00 $700.00 $364.00 $672.00 $511.00 2026-03-09
P9016 HCPCS Red Blood Cells, Leukocytes Reduced, Each Unit 15 15 $700.00 $700.00 $364.00 $672.00 $511.00 2026-03-09
51720 HCPCS Instillation Of Anti-cancer Drug Into Bladder 15 15 $700.00 $700.00 $364.00 $672.00 $511.00 2026-03-09
4631398_1 CDM Recovery Room - General Classification 15 15 $700.00 $700.00 $364.00 $672.00 $511.00 2026-03-09
72070 HCPCS X-ray Of Middle Spine, 2 Views 15 15 $697.50 $697.50 $362.70 $669.60 $509.18 2026-03-09
76816 HCPCS Follow-up Ultrasound Scan Of Pregnant Uterus 15 15 $684.00 $684.00 $355.68 $656.64 $499.32 2026-03-09
73501 HCPCS X-ray Of Hip, 1 View 15 15 $675.00 $675.00 $351.00 $648.00 $492.75 2026-03-09
93225 HCPCS Electrocardiogram (ecg) 2-day Continuous 15 15 $655.00 $655.00 $340.60 $628.80 $478.15 2026-03-09
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 15 15 $650.00 $650.00 $338.00 $624.00 $474.50 2026-03-09
81270 HCPCS Gene Analysis (Janus Kinase 2) Variant 15 15 $650.00 $650.00 $338.00 $624.00 $474.50 2026-03-09
81279 HCPCS Gene Analysis (Janus Kinase 2) Targeted Sequence Analysis 15 15 $650.00 $650.00 $338.00 $624.00 $474.50 2026-03-09
G0177 HCPCS Training And Educational Services Related To The Care And Treatment Of Patient's… 15 15 $650.00 $650.00 $338.00 $624.00 $474.50 2026-03-09
93922 HCPCS Ultrasound Study Of Arm And Leg Arteries 15 15 $650.00 $650.00 $338.00 $624.00 $474.50 2026-03-09
94660 HCPCS Therapy Procedure Using A Positive Pressure Ventilator 15 15 $650.00 $650.00 $338.00 $624.00 $474.50 2026-03-09
94060 HCPCS Test To Measure Expiratory Airflow And Volume Changes Before And After Medicatio… 15 15 $650.00 $650.00 $338.00 $624.00 $474.50 2026-03-09
73521 HCPCS X-ray Of Both Hips, 2 Views 15 15 $648.00 $648.00 $336.96 $622.08 $473.04 2026-03-09
70110 HCPCS X-ray Of Lower Jaw, Minimum Of 4 Views 15 15 $647.00 $647.00 $336.44 $621.12 $472.31 2026-03-09
70150 HCPCS X-ray Of Face Bones, Minimum Of 3 Views 15 15 $643.00 $643.00 $334.36 $617.28 $469.39 2026-03-09
16030 HCPCS Dressing Change Or Removal Of Burn Tissue, More Than 10% Of Total Body Surface 30 15 $787.00 $787.00 $93.61 $1,152.00 $459.94 2026-03-09
77003 HCPCS Fluoroscopic Guidance For Spine Or Back Muscle Injection 15 15 $625.00 $625.00 $325.00 $600.00 $456.25 2026-03-09
96360 HCPCS Infusion Into A Vein For Hydration, 31-60 Minutes 15 15 $625.00 $625.00 $325.00 $600.00 $456.25 2026-03-09
87154 HCPCS Amplifed Nucleic Acid Probe Typing Of Disease Agent In Blood Culture Specimen 15 15 $620.00 $620.00 $322.40 $595.20 $452.60 2026-03-09
96365 HCPCS Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, 1 Hour Or Less 34 15 $625.00 $625.00 $260.00 $600.00 $448.12 2026-03-09
6557304_1 CDM Fluad 2025-2026 Syringe 15 15 $604.63 $604.63 $314.41 $580.44 $441.38 2026-03-09
72100 HCPCS X-ray Of Lower And Sacral Spine, 2-3 Views 15 15 $600.00 $600.00 $312.00 $576.00 $438.00 2026-03-09
93246 HCPCS Heart Rhythm Recording Of Continuous External EKG Over 8-15 Days 15 15 $600.00 $600.00 $312.00 $576.00 $438.00 2026-03-09
76882 HCPCS Limited Ultrasound Scan Of Joint Or Other Extremity Structure Except Blood Vesse… 45 15 $600.00 $600.00 $312.00 $576.00 $438.00 2026-03-09
93242 HCPCS Heart Rhythm Recording Continuous External EKG Over More Than 48 Hours Up To 7 D… 15 15 $600.00 $600.00 $312.00 $576.00 $438.00 2026-03-09
0202U HCPCS Test For Detection Of Respiratory Disease-causing Organisms From Back Of Nose An… 15 15 $592.50 $592.50 $308.10 $568.80 $432.53 2026-03-09
99284 HCPCS Emergency Department Visit With Moderate Level Of Medical Decision Making 30 15 $799.50 $799.50 $109.81 $2,280.00 $427.50 2026-03-09
74019 HCPCS X-ray Of Abdomen, 2 Views 15 15 $575.00 $575.00 $299.00 $552.00 $419.75 2026-03-09
71110 HCPCS X-ray Of Ribs On Both Sides Of Body, 3 Views 15 15 $575.00 $575.00 $299.00 $552.00 $419.75 2026-03-09
92507 HCPCS Treatment Of Speech, Language, Voice, Communication, And/or Hearing Processing D… 15 15 $575.00 $575.00 $299.00 $552.00 $419.75 2026-03-09
72110 HCPCS X-ray Of Lower And Sacral Spine, Minimum Of 4 Views 15 15 $571.50 $571.50 $297.18 $548.64 $417.20 2026-03-09
5695053_1 CDM Esophageal Dilator 18-20 15 15 $570.00 $570.00 $296.40 $547.20 $416.10 2026-03-09
5695052_1 CDM Esophageal Dilator 15-18 15 15 $570.00 $570.00 $296.40 $547.20 $416.10 2026-03-09
80145 HCPCS Measurement Of Adalimumab 15 15 $570.00 $570.00 $296.40 $547.20 $416.10 2026-03-09
92522 HCPCS Evaluation Of Speech Sound Production 15 15 $563.00 $563.00 $292.76 $540.48 $410.99 2026-03-09
92523 HCPCS Evaluation Of Speech Sound Production With Evaluation Of Language Comprehension … 15 15 $563.00 $563.00 $292.76 $540.48 $410.99 2026-03-09
92521 HCPCS Evaluation Of Speech Continuity, Smoothness, Rate, And Effort 15 15 $563.00 $563.00 $292.76 $540.48 $410.99 2026-03-09
92524 HCPCS Analysis Of Voice And Resonance Production 15 15 $563.00 $563.00 $292.76 $540.48 $410.99 2026-03-09
11426 HCPCS Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More … 15 15 $790.00 $790.00 $258.94 $790.00 $410.80 2026-03-09
10061 HCPCS Complicated Or Multiple Drainage Of Skin Abscess 45 15 $511.00 $511.00 $115.15 $1,152.00 $404.95 2026-03-09
76857 HCPCS Limited Ultrasound Scan Of Pelvis 15 15 $550.00 $550.00 $286.00 $528.00 $401.50 2026-03-09
86355 HCPCS Total Cell Count For B Cells (white Blood Cells) 15 15 $550.00 $550.00 $286.00 $528.00 $401.50 2026-03-09
94726 HCPCS Test To Determine Lung Volumes Using Sensors 15 15 $550.00 $550.00 $286.00 $528.00 $401.50 2026-03-09
4983212_1 CDM Revonto 20 Mg Vial 15 15 $539.58 $539.58 $280.58 $518.00 $393.89 2026-03-09
73562 HCPCS X-ray Of Knee, 3 Views 15 15 $531.50 $531.50 $257.00 $510.24 $388.00 2026-03-09
71101 HCPCS X-ray Of Ribs On Side Of Body, Minimum Of 3 Views 15 15 $530.00 $530.00 $275.60 $508.80 $386.90 2026-03-09
64495 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Third And… 15 15 $521.00 $521.00 $270.92 $1,658.00 $380.33 2026-03-09
64484 HCPCS Injection Of Anesthetic And/or Steroid Drug Into Sacral Spine Nerve Root Using I… 15 15 $521.00 $521.00 $270.92 $1,658.00 $380.33 2026-03-09
70220 HCPCS X-ray Of Paranasal Sinus, Minimum Of 3 Views 15 15 $517.50 $517.50 $269.10 $496.80 $377.78 2026-03-09
70260 HCPCS X-ray Of Skull, Minimum Of 4 Views 15 15 $512.50 $512.50 $266.50 $492.00 $374.13 2026-03-09
11046 HCPCS Removal Of Muscle And/or Tissue, Each Additional 20.0 Sq Cm Or Less 30 15 $669.00 $669.00 $43.20 $1,152.00 $374.01 2026-03-09
5960256_1 CDM Engerix-b 20 Mcg/ml Syrn 15 15 $511.44 $511.44 $265.95 $490.98 $373.35 2026-03-09
5830764_1 CDM Cpr-d-padz-adult Defib 15 15 $500.01 $500.01 $260.01 $480.01 $365.01 2026-03-09
6034420_1 CDM Power Picc 5fr 15 15 $500.01 $500.01 $260.01 $480.01 $365.01 2026-03-09
94729 HCPCS Test To Examine How Well The Lungs Exchange Gases 15 15 $500.00 $500.00 $260.00 $480.00 $365.00 2026-03-09
51705 HCPCS Simple Change Of Bladder Tube 15 15 $500.00 $500.00 $260.00 $480.00 $365.00 2026-03-09
93798 HCPCS Outpatient Heart Rehabilitation With Electrocardiogram (ecg) Monitoring, Quality… 15 15 $500.00 $500.00 $260.00 $480.00 $365.00 2026-03-09
51700 HCPCS Simple Bladder Irrigation And/or Instillation 19 15 $500.00 $500.00 $260.00 $480.00 $365.00 2026-03-09
99292 HCPCS Critical Care, Each Additional 30 Minutes 30 15 $662.50 $662.50 $94.09 $960.00 $363.24 2026-03-09
92526 HCPCS Treatment Of Swallowing And Feeding Disorder 15 15 $497.00 $497.00 $258.44 $477.12 $362.81 2026-03-09
J1364 HCPCS Injection, Erythromycin Lactobionate, Per 500 Mg 15 15 $493.85 $493.85 $256.80 $474.10 $360.51 2026-03-09
11404 HCPCS Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, 3.1-4.0 Cm 45 15 $533.00 $533.00 $94.10 $720.00 $359.68 2026-03-09
73610 HCPCS X-ray Of Ankle, Minimum Of 3 Views 15 15 $485.00 $485.00 $240.00 $465.60 $354.05 2026-03-09
73030 HCPCS X-ray Of Shoulder, Minimum Of 2 Views 15 15 $476.50 $476.50 $247.78 $457.44 $347.85 2026-03-09
29580 HCPCS Strapping, Unna Boot 90 15 $475.00 $475.00 $21.69 $912.00 $346.75 2026-03-09
73080 HCPCS X-ray Of Elbow, Minimum Of 3 Views 15 15 $471.50 $471.50 $245.18 $452.64 $344.20 2026-03-09
C7901 HCPCS Service For Diagnosis, Evaluation, Or Treatment Of A Mental Health Or Substance … 12 12 $755.00 $755.00 $392.60 $724.80 $551.15 2026-03-09
90853 HCPCS Group Psychotherapy 12 12 $735.00 $735.00 $382.20 $705.60 $536.55 2026-03-09
G0410 HCPCS Group Psychotherapy Other Than Of A Multiple-family Group, In A Partial Hospital… 12 12 $735.00 $735.00 $382.20 $705.60 $536.55 2026-03-09
C7903 HCPCS Group Psychotherapy Service For Diagnosis, Evaluation, Or Treatment Of A Mental … 12 12 $735.00 $735.00 $382.20 $705.60 $536.55 2026-03-09
G0176 HCPCS Activity Therapy, Such As Music, Dance, Art Or Play Therapies Not For Recreation… 12 12 $650.00 $650.00 $338.00 $624.00 $474.50 2026-03-09
C7900 HCPCS Service For Diagnosis, Evaluation, Or Treatment Of A Mental Health Or Substance… 12 12 $625.00 $625.00 $325.00 $600.00 $456.25 2026-03-09
4634665_1 CDM Room & Board - Private (one Bed) - General Classification 6 6 $2,650.00 $2,650.00 $2,332.00 $2,544.00 $2,491.00 2026-03-09
2120840_1 CDM Room & Board - Semi-private (two Beds) - General Classification 6 6 $2,100.00 $2,100.00 $1,848.00 $2,016.00 $1,974.00 2026-03-09
4441941_1 CDM Room & Board - Semi-private (two Beds) - General Classification 6 6 $2,100.00 $2,100.00 $1,848.00 $2,016.00 $1,974.00 2026-03-09
4441947_1 CDM Room & Board - Private (one Bed) - General Classification 6 6 $2,100.00 $2,100.00 $1,848.00 $2,016.00 $1,974.00 2026-03-09
2120839_1 CDM Room & Board - Private (one Bed) - General Classification 6 6 $2,100.00 $2,100.00 $1,848.00 $2,016.00 $1,974.00 2026-03-09
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