Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

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.

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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
             
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
29580 HCPCS Strapping, Unna Boot 90 15 $475.00 $475.00 $21.69 $912.00 $346.75 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
J0248 HCPCS Injection, Remdesivir, 1 Mg 30 15 $1,039.37 $1,039.37 $486.72 $1,097.02 $834.19 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
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
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
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
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
76641 HCPCS Complete Ultrasound Scan Of 1 Breast 30 15 $850.00 $850.00 $312.00 $1,056.00 $572.00 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
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
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
99292 HCPCS Critical Care, Each Additional 30 Minutes 30 15 $662.50 $662.50 $94.09 $960.00 $363.24 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
51700 HCPCS Simple Bladder Irrigation And/or Instillation 19 15 $500.00 $500.00 $260.00 $480.00 $365.00 2026-03-09
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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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