Hospital

INCLINE VILLAGE COMMUNITY HOSPITAL

Incline Village, NV · CCN 291301 · Rates published

Your selected procedure

You selected 93306 (HCPCS)

Ultrasound of heart with color-depicted blood flow, rate, direction and valve function

This hospital’s price: $290 across 19 payers · range $88-$4,485

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbIVHINCLNEVILLAGENV&type=CDMWithoutLabel&fileType=CSV · observed 2025-09-04

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

6,789 distinct procedures filed

22 distinct payers

199,482 rate rows

2025-09-04 last MRF observed · ⚠ 13 mo old

Data quality

199,111 of 199,482 rate rows are consumer-grade (99.8%)

371 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 — reason	Rows
percent-of-charges filed in the dollar field — excluded from medians	289
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	51
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	18
placeholder amount (≤ $0.02) — excluded from medians	9
exceeds 10× this hospital's gross charge — excluded from medians	4

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 13 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbIVHINCLNEVILLAGENV&type=CDMWithoutLabel&fileType=CSV
Found on page	https://www.tfhd.com/shoppable-services/
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-10-17
Content fingerprint	c3182397e7991fa5… · 68,880,402 bytes · first seen 2026-05-08

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
J9266 HCPCS	Injection, Pegaspargase, Per Single Dose Vial	19	$16,681.04	$93,054.60	$82,107.00	nat. median $33,238 outlier · 2.5×
77371 HCPCS	Complete Single Session Course Of Cranial Lesion Surgery Using Radiation	19	$1,078.50	$77,623.02	$68,490.90	nat. median $9,378 outlier · 7.3×
J2350 HCPCS	Injection, Ocrelizumab, 1 Mg	19	$62.81	$74,455.41	$65,695.95	nat. median $414 outlier · 158.5×
J3241 HCPCS	Injection, Teprotumumab-trbw, 10 Mg	18	$54,802.44	$63,521.01	$56,047.95	nat. median $718 outlier · 78.0×
J9298 HCPCS	Injection, Nivolumab And Relatlimab-rmbw, 3 Mg/1 Mg	18	$49,428.28	$57,291.87	$50,551.65	nat. median $559 outlier · 90.4×
J9307 HCPCS	Injection, Pralatrexate, 1 Mg	19	$295.35	$52,223.49	$46,079.55	nat. median $897 outlier · 51.3×
J9043 HCPCS	Injection, Cabazitaxel, 1 Mg	19	$180.59	$47,432.04	$41,851.80	nat. median $735 outlier · 57.0×
J9316 HCPCS	Injection, Pertuzumab, Trastuzumab, And Hyaluronidase-zzxf, Per 10 Mg	18	$30,575.60	$53,161.89	$40,652.53	nat. median $384 outlier · 106.0×
J0222 HCPCS	Injection, Patisiran, 0.1 Mg	18	$35,318.36	$40,937.19	$36,121.05	nat. median $157 outlier · 230.2×
J9042 HCPCS	Injection, Brentuximab Vedotin, 1 Mg	19	$170.04	$40,581.72	$35,807.40	nat. median $962 outlier · 37.2×
J9228 HCPCS	Injection, Ipilimumab, 1 Mg	19	$159.88	$131,913.03	$32,978.64	nat. median $8,966 outlier · 3.7×
J1930 HCPCS	Injection, Lanreotide, 1 Mg	19	$68.69	$36,632.28	$32,322.60	nat. median $5,088 outlier · 6.4×
J9144 HCPCS	Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj	18	$30,197.20	$35,001.30	$30,883.50	nat. median $211 outlier · 146.1×
J2323 HCPCS	Injection, Natalizumab, 1 Mg	19	$25.12	$32,866.44	$28,999.80	nat. median $180 outlier · 161.4×
J9022 HCPCS	Injection, Atezolizumab, 10 Mg	19	$82.86	$41,203.41	$28,842.54	nat. median $6,720 outlier · 4.3×
J3380 HCPCS	Injection, Vedolizumab, Intravenous, 1 Mg	19	$24.96	$32,269.74	$28,473.30	nat. median $155 outlier · 184.2×
J9311 HCPCS	Injection, Rituximab 10 Mg And Hyaluronidase	19	$49.51	$31,444.56	$27,128.64	nat. median $2,428 outlier · 11.2×
J9301 HCPCS	Injection, Obinutuzumab, 10 Mg	19	$68.82	$29,799.30	$26,293.50	nat. median $286 outlier · 91.8×
J9308 HCPCS	Injection, Ramucirumab, 5 Mg	19	$63.79	$27,067.74	$23,883.30	nat. median $1,489 outlier · 16.0×
47135 HCPCS	Transplantation Of Donor Liver	19	$6,855.86	$24,197.46	$21,350.70	nat. median $6,167 outlier · 3.5×
J9306 HCPCS	Injection, Pertuzumab, 1 Mg	19	$16.96	$24,177.57	$21,333.15	nat. median $75 outlier · 284.1×
J9271 HCPCS	Injection, Pembrolizumab, 1 Mg	19	$54.85	$21,480.69	$18,953.55	nat. median $275 outlier · 69.0×
J0717 HCPCS	Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm…	19	$12.78	$21,335.34	$18,825.30	nat. median $1,635 outlier · 11.5×
J9356 HCPCS	Injection, Trastuzumab, 10 Mg And Hyaluronidase-oysk	19	$85.99	$19,559.52	$17,258.40	nat. median $139 outlier · 124.2×
J2353 HCPCS	Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg	19	$212.29	$26,717.37	$15,743.25	nat. median $5,623 outlier · 2.8×
690 MS_DRG	Kidney And Urinary Tract Infections Without Mcc	1	$15,589.89	$15,589.89	$15,589.89	nat. median $8,379 1.9× median
J9204 HCPCS	Injection, Mogamulizumab-kpkc, 1 Mg	18	$14,736.92	$17,081.43	$15,071.85	nat. median $431 outlier · 35.0×
J3101 HCPCS	Injection, Tenecteplase, 1 Mg	18	$13,690.60	$17,163.03	$14,949.05	nat. median $3,787 outlier · 3.9×
J2506 HCPCS	Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg	18	$14,128.84	$16,376.61	$14,449.95	nat. median $1,659 outlier · 8.7×
J9354 HCPCS	Injection, Ado-trastuzumab Emtansine, 1 Mg	19	$36.29	$23,059.14	$14,412.09	nat. median $4,219 outlier · 3.4×
J9304 HCPCS	Injection, Pemetrexed (pemfexy), 10 Mg	18	$13,886.84	$16,096.11	$14,202.45	nat. median $66 outlier · 215.6×
Q5117 HCPCS	Injection, Trastuzumab-anns, Biosimilar, (kanjinti), 10 Mg	18	$13,745.60	$15,932.40	$14,058.00	nat. median $802 outlier · 17.5×
J9173 HCPCS	Injection, Durvalumab, 10 Mg	19	$80.51	$15,796.74	$13,938.30	nat. median $1,119 outlier · 12.5×
J0896 HCPCS	Injection, Luspatercept-aamt, 0.25 Mg	18	$12,988.36	$15,054.69	$13,283.55	nat. median $4,569 outlier · 2.9×
Q5119 HCPCS	Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg	18	$12,936.44	$14,994.51	$13,230.45	nat. median $831 outlier · 15.9×
41155 HCPCS	Removal Of Tongue, Floor Of Mouth, Jaw Bone, Tissue, And Lymph Nodes	19	$3,835.03	$14,066.82	$12,411.90	nat. median $4,146 outlier · 3.0×
J2182 HCPCS	Injection, Mepolizumab, 1 Mg	19	$35.02	$13,912.29	$12,275.55	nat. median $2,791 outlier · 4.4×
J0775 HCPCS	Injection, Collagenase, Clostridium Histolyticum, 0.01 Mg	19	$52.32	$13,876.08	$12,243.60	nat. median $114 outlier · 107.5×
400048553 CDM	Hchg Tfh Dressing Incision Prevena Kci	17	$11,938.96	$13,159.99	$12,210.30	nat. median $12,210 1.0× median
A9592 HCPCS	Copper Cu-64, Dotatate, Diagnostic, 1 Millicurie	18	$11,873.84	$13,762.86	$12,143.70	nat. median $1,712 outlier · 7.1×
J9319 HCPCS	Injection, Romidepsin, Lyophilized, 0.1 Mg	18	$11,545.60	$13,382.40	$11,808.00	nat. median $102 outlier · 116.3×
J9035 HCPCS	Injection, Bevacizumab, 10 Mg	19	$87.03	$13,336.50	$11,767.50	nat. median $727 outlier · 16.2×
J9352 HCPCS	Injection, Trabectedin, 0.1 Mg	19	$320.03	$13,217.16	$11,662.20	nat. median $1,097 outlier · 10.6×
J9061 HCPCS	Injection, Amivantamab-vmjw, 2 Mg	18	$11,361.68	$13,169.22	$11,619.90	nat. median $68 outlier · 171.5×
Q2050 HCPCS	Injection, Doxorubicin Hydrochloride, Liposomal, Not Otherwise Specified, 10 Mg	19	$359.07	$13,063.14	$11,526.30	nat. median $717 outlier · 16.1×
77372 HCPCS	Complete Single Session Course Of Cranial Lesion Surgery Using Radiation And A M…	19	$818.30	$13,057.02	$11,520.90	nat. median $9,194 1.3× median
20956 HCPCS	Bone Graft Of Pelvic Bone With Microvascular Connection	19	$3,418.23	$12,505.20	$11,034.00	nat. median $6,769 1.6× median
650001651 CDM	Hchg Tf Hearing Aid Binaural Level 6	17	$10,755.36	$11,855.34	$10,999.80	nat. median $11,000 1.0× median
500001108 CDM	Gastro - Intestinal (gi) Services - General Classification	17	$10,603.12	$11,687.53	$10,844.10	nat. median $10,844 1.0× median
J9299 HCPCS	Injection, Nivolumab, 1 Mg	19	$32.74	$28,929.75	$10,636.20	nat. median $2,849 outlier · 3.7×

Other procedures at this hospital

Browse this hospital's 6,789 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

J9266	HCPCS	Injection, Pegaspargase, Per Single Dose Vial	19	19	$91,230.00	$91,230.00	$16,681.04	$93,054.60	$82,107.00	2025-09-04
77371	HCPCS	Complete Single Session Course Of Cranial Lesion Surgery Using Radiation	19	19	$76,101.00	$76,101.00	$1,078.50	$77,623.02	$68,490.90	2025-09-04
J2350	HCPCS	Injection, Ocrelizumab, 1 Mg	19	19	$72,995.50	$72,995.50	$62.81	$74,455.41	$65,695.95	2025-09-04
J3241	HCPCS	Injection, Teprotumumab-trbw, 10 Mg	18	18	$62,275.50	$62,275.50	$54,802.44	$63,521.01	$56,047.95	2025-09-04
J9298	HCPCS	Injection, Nivolumab And Relatlimab-rmbw, 3 Mg/1 Mg	18	18	$56,168.50	$56,168.50	$49,428.28	$57,291.87	$50,551.65	2025-09-04
J9307	HCPCS	Injection, Pralatrexate, 1 Mg	19	19	$51,199.50	$51,199.50	$295.35	$52,223.49	$46,079.55	2025-09-04
J9043	HCPCS	Injection, Cabazitaxel, 1 Mg	19	19	$46,502.00	$46,502.00	$180.59	$47,432.04	$41,851.80	2025-09-04
J9316	HCPCS	Injection, Pertuzumab, Trastuzumab, And Hyaluronidase-zzxf, Per 10 Mg	36	18	$43,432.25	$43,432.25	$30,575.60	$53,161.89	$40,652.53	2025-09-04
J0222	HCPCS	Injection, Patisiran, 0.1 Mg	18	18	$40,134.50	$40,134.50	$35,318.36	$40,937.19	$36,121.05	2025-09-04
J9042	HCPCS	Injection, Brentuximab Vedotin, 1 Mg	19	19	$39,786.00	$39,786.00	$170.04	$40,581.72	$35,807.40	2025-09-04
J9228	HCPCS	Injection, Ipilimumab, 1 Mg	37	19	$32,332.00	$32,332.00	$159.88	$131,913.03	$32,978.64	2025-09-04
J1930	HCPCS	Injection, Lanreotide, 1 Mg	19	19	$35,914.00	$35,914.00	$68.69	$36,632.28	$32,322.60	2025-09-04
J9144	HCPCS	Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj	18	18	$34,315.00	$34,315.00	$30,197.20	$35,001.30	$30,883.50	2025-09-04
J2323	HCPCS	Injection, Natalizumab, 1 Mg	19	19	$32,222.00	$32,222.00	$25.12	$32,866.44	$28,999.80	2025-09-04
J9022	HCPCS	Injection, Atezolizumab, 10 Mg	37	19	$40,395.50	$40,395.50	$82.86	$41,203.41	$28,842.54	2025-09-04
J3380	HCPCS	Injection, Vedolizumab, Intravenous, 1 Mg	19	19	$31,637.00	$31,637.00	$24.96	$32,269.74	$28,473.30	2025-09-04
J9311	HCPCS	Injection, Rituximab 10 Mg And Hyaluronidase	37	19	$26,975.00	$26,975.00	$49.51	$31,444.56	$27,128.64	2025-09-04
J9301	HCPCS	Injection, Obinutuzumab, 10 Mg	19	19	$29,215.00	$29,215.00	$68.82	$29,799.30	$26,293.50	2025-09-04
J9308	HCPCS	Injection, Ramucirumab, 5 Mg	19	19	$26,537.00	$26,537.00	$63.79	$27,067.74	$23,883.30	2025-09-04
47135	HCPCS	Transplantation Of Donor Liver	38	19	$23,723.00	$23,723.00	$6,855.86	$24,197.46	$21,350.70	2025-09-04
J9306	HCPCS	Injection, Pertuzumab, 1 Mg	19	19	$23,703.50	$23,703.50	$16.96	$24,177.57	$21,333.15	2025-09-04
J9271	HCPCS	Injection, Pembrolizumab, 1 Mg	19	19	$21,059.50	$21,059.50	$54.85	$21,480.69	$18,953.55	2025-09-04
J0717	HCPCS	Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm…	19	19	$20,917.00	$20,917.00	$12.78	$21,335.34	$18,825.30	2025-09-04
J9356	HCPCS	Injection, Trastuzumab, 10 Mg And Hyaluronidase-oysk	19	19	$19,176.00	$19,176.00	$85.99	$19,559.52	$17,258.40	2025-09-04
J2353	HCPCS	Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg	55	19	$17,492.50	$17,492.50	$212.29	$26,717.37	$15,743.25	2025-09-04
690	MS_DRG	Kidney And Urinary Tract Infections Without Mcc	1	1	$10,618.50	$10,618.50	$15,589.89	$15,589.89	$15,589.89	2025-09-04
J9204	HCPCS	Injection, Mogamulizumab-kpkc, 1 Mg	18	18	$16,746.50	$16,746.50	$14,736.92	$17,081.43	$15,071.85	2025-09-04
J3101	HCPCS	Injection, Tenecteplase, 1 Mg	36	18	$16,192.00	$16,192.00	$13,690.60	$17,163.03	$14,949.05	2025-09-04
J2506	HCPCS	Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg	18	18	$16,055.50	$16,055.50	$14,128.84	$16,376.61	$14,449.95	2025-09-04
J9354	HCPCS	Injection, Ado-trastuzumab Emtansine, 1 Mg	37	19	$14,129.50	$14,129.50	$36.29	$23,059.14	$14,412.09	2025-09-04
J9304	HCPCS	Injection, Pemetrexed (pemfexy), 10 Mg	18	18	$15,780.50	$15,780.50	$13,886.84	$16,096.11	$14,202.45	2025-09-04
Q5117	HCPCS	Injection, Trastuzumab-anns, Biosimilar, (kanjinti), 10 Mg	18	18	$15,620.00	$15,620.00	$13,745.60	$15,932.40	$14,058.00	2025-09-04
J9173	HCPCS	Injection, Durvalumab, 10 Mg	19	19	$15,487.00	$15,487.00	$80.51	$15,796.74	$13,938.30	2025-09-04
J0896	HCPCS	Injection, Luspatercept-aamt, 0.25 Mg	18	18	$14,759.50	$14,759.50	$12,988.36	$15,054.69	$13,283.55	2025-09-04
Q5119	HCPCS	Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg	18	18	$14,700.50	$14,700.50	$12,936.44	$14,994.51	$13,230.45	2025-09-04
41155	HCPCS	Removal Of Tongue, Floor Of Mouth, Jaw Bone, Tissue, And Lymph Nodes	38	19	$13,791.00	$13,791.00	$3,835.03	$14,066.82	$12,411.90	2025-09-04
J2182	HCPCS	Injection, Mepolizumab, 1 Mg	19	19	$13,639.50	$13,639.50	$35.02	$13,912.29	$12,275.55	2025-09-04
J0775	HCPCS	Injection, Collagenase, Clostridium Histolyticum, 0.01 Mg	19	19	$13,604.00	$13,604.00	$52.32	$13,876.08	$12,243.60	2025-09-04
400048553	CDM	Hchg Tfh Dressing Incision Prevena Kci	17	17	$13,567.00	$13,567.00	$11,938.96	$13,159.99	$12,210.30	2025-09-04
A9592	HCPCS	Copper Cu-64, Dotatate, Diagnostic, 1 Millicurie	18	18	$13,493.00	$13,493.00	$11,873.84	$13,762.86	$12,143.70	2025-09-04
J9319	HCPCS	Injection, Romidepsin, Lyophilized, 0.1 Mg	18	18	$13,120.00	$13,120.00	$11,545.60	$13,382.40	$11,808.00	2025-09-04
J9035	HCPCS	Injection, Bevacizumab, 10 Mg	19	19	$13,075.00	$13,075.00	$87.03	$13,336.50	$11,767.50	2025-09-04
J9352	HCPCS	Injection, Trabectedin, 0.1 Mg	19	19	$12,958.00	$12,958.00	$320.03	$13,217.16	$11,662.20	2025-09-04
J9061	HCPCS	Injection, Amivantamab-vmjw, 2 Mg	18	18	$12,911.00	$12,911.00	$11,361.68	$13,169.22	$11,619.90	2025-09-04
Q2050	HCPCS	Injection, Doxorubicin Hydrochloride, Liposomal, Not Otherwise Specified, 10 Mg	19	19	$12,807.00	$12,807.00	$359.07	$13,063.14	$11,526.30	2025-09-04
77372	HCPCS	Complete Single Session Course Of Cranial Lesion Surgery Using Radiation And A M…	19	19	$12,801.00	$12,801.00	$818.30	$13,057.02	$11,520.90	2025-09-04
20956	HCPCS	Bone Graft Of Pelvic Bone With Microvascular Connection	38	19	$12,260.00	$12,260.00	$3,418.23	$12,505.20	$11,034.00	2025-09-04
650001651	CDM	Hchg Tf Hearing Aid Binaural Level 6	17	17	$12,222.00	$12,222.00	$10,755.36	$11,855.34	$10,999.80	2025-09-04
500001108	CDM	Gastro - Intestinal (gi) Services - General Classification	17	17	$12,049.00	$12,049.00	$10,603.12	$11,687.53	$10,844.10	2025-09-04
J9299	HCPCS	Injection, Nivolumab, 1 Mg	55	19	$11,818.00	$11,818.00	$32.74	$28,929.75	$10,636.20	2025-09-04
31365	HCPCS	Complete Removal Of Voice Box With Extensive Dissection Of Neck	38	19	$11,636.00	$11,636.00	$3,285.20	$11,868.72	$10,472.40	2025-09-04
500002645	CDM	Operating Room Services - General Classification	17	17	$11,393.00	$11,393.00	$10,025.84	$11,051.21	$10,253.70	2025-09-04
140000008	CDM	Intensive Care Unit - General Classification	19	19	$11,331.00	$11,331.00	$4,192.47	$10,991.07	$10,197.90	2025-09-04
400048857	CDM	Hchg Tfh Novasure Device Disp	17	17	$11,304.00	$11,304.00	$9,947.52	$10,964.88	$10,173.60	2025-09-04
31368	HCPCS	Removal Of Voice Box With Extensive Dissection Of Neck	38	19	$11,158.00	$11,158.00	$3,110.93	$11,381.16	$10,042.20	2025-09-04
500001029	CDM	Operating Room Services - General Classification	17	17	$11,075.00	$11,075.00	$9,746.00	$10,742.75	$9,967.50	2025-09-04
650001650	CDM	Hchg Tf Hearing Aid Binaural Level 5	17	17	$10,869.00	$10,869.00	$9,564.72	$10,542.93	$9,782.10	2025-09-04
44126	HCPCS	Partial Removal Of Small Bowel And Reconnection To Correct Congenital Defect	38	19	$10,866.00	$10,866.00	$2,328.00	$10,540.02	$9,779.40	2025-09-04
400066450	CDM	Hchg Tfh Pack Procedure Pack Tx3	17	17	$10,864.00	$10,864.00	$9,560.32	$10,538.08	$9,777.60	2025-09-04
J7169	HCPCS	Injection, Coagulation Factor Xa (recombinant), Inactivated-zhzo (andexxa), 10 M…	36	18	$10,319.25	$10,319.25	$6,053.96	$14,034.18	$9,562.51	2025-09-04
J9205	HCPCS	Injection, Irinotecan Liposome, 1 Mg	19	19	$10,594.50	$10,594.50	$55.06	$10,806.39	$9,535.05	2025-09-04
C1880	HCPCS	Vena Cava Filter	18	18	$10,593.00	$10,593.00	$9,321.84	$10,804.86	$9,533.70	2025-09-04
Q5111	HCPCS	Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg	19	19	$10,444.50	$10,444.50	$369.13	$10,653.39	$9,400.05	2025-09-04
J9034	HCPCS	Injection, Bendamustine Hcl (bendeka), 1 Mg	19	19	$10,147.00	$10,147.00	$28.68	$10,349.94	$9,132.30	2025-09-04
J9285	HCPCS	Injection, Olaratumab, 10 Mg	19	19	$10,074.00	$10,074.00	$57.37	$10,275.48	$9,066.60	2025-09-04
41140	HCPCS	Complete Removal Of Tongue	38	19	$10,046.00	$10,046.00	$2,808.49	$10,246.92	$9,041.40	2025-09-04
31367	HCPCS	Removal Of Voice Box	38	19	$10,042.00	$10,042.00	$2,816.73	$10,242.84	$9,037.80	2025-09-04
A9572	HCPCS	Indium In-111 Pentetreotide, Diagnostic, Per Study Dose, Up To 6 Millicuries	18	18	$10,031.00	$10,031.00	$8,827.28	$10,231.62	$9,027.90	2025-09-04
400063167	CDM	Hchg Tfh System Control Hemorrhage Jada 2.0	17	17	$10,030.00	$10,030.00	$8,826.40	$9,729.10	$9,027.00	2025-09-04
500002643	CDM	Operating Room Services - General Classification	17	17	$9,983.00	$9,983.00	$8,785.04	$9,683.51	$8,984.70	2025-09-04
J9358	HCPCS	Injection, Fam-trastuzumab Deruxtecan-nxki, 1 Mg	18	18	$9,944.50	$9,944.50	$8,751.16	$10,143.39	$8,950.05	2025-09-04
500001027	CDM	Operating Room Services - General Classification	17	17	$9,706.00	$9,706.00	$8,541.28	$9,414.82	$8,735.40	2025-09-04
J9177	HCPCS	Injection, Enfortumab Vedotin-ejfv, 0.25 Mg	18	18	$9,700.50	$9,700.50	$8,536.44	$9,894.51	$8,730.45	2025-09-04
31370	HCPCS	Partial Removal Of Voice Box	38	19	$9,471.00	$9,471.00	$2,643.18	$9,660.42	$8,523.90	2025-09-04
31360	HCPCS	Complete Removal Of Voice Box	38	19	$9,467.00	$9,467.00	$2,662.35	$9,656.34	$8,520.30	2025-09-04
J9176	HCPCS	Injection, Elotuzumab, 1 Mg	37	19	$8,329.00	$8,329.00	$11.11	$11,327.61	$8,495.58	2025-09-04
200003567	CDM	Hchg Ed Multi Proc Level 5	17	17	$9,387.00	$9,387.00	$8,260.56	$9,105.39	$8,448.30	2025-09-04
35216	HCPCS	Repair Of Blood Vessel Of Chest	38	19	$9,078.00	$9,078.00	$2,632.82	$9,259.56	$8,170.20	2025-09-04
J9317	HCPCS	Injection, Sacituzumab Govitecan-hziy, 2.5 Mg	18	18	$8,976.50	$8,976.50	$7,899.32	$9,156.03	$8,078.85	2025-09-04
100001600	CDM	Labor Room/delivery - General Classification	17	17	$8,845.00	$8,845.00	$7,783.60	$8,579.65	$7,960.50	2025-09-04
44208	HCPCS	Partial Removal Of Large Bowel And Reattachment To Rectum And Creation Of Openin…	38	19	$8,680.00	$8,680.00	$2,519.44	$8,853.60	$7,812.00	2025-09-04
44147	HCPCS	Partial Removal Of Large Bowel Through Abdomen And Anus	38	19	$8,609.00	$8,609.00	$2,480.79	$8,781.18	$7,748.10	2025-09-04
35820	HCPCS	Exploration Of Chest For Bleeding, Blood Clot, Or Infection After Surgery	38	19	$8,605.00	$8,605.00	$2,538.66	$8,777.10	$7,744.50	2025-09-04
140000046	CDM	Intensive Care Unit - Intermediate ICU	19	19	$8,528.00	$8,528.00	$3,155.36	$8,272.16	$7,675.20	2025-09-04
100001596	CDM	Labor Room/delivery - General Classification	17	17	$8,403.00	$8,403.00	$7,394.64	$8,150.91	$7,562.70	2025-09-04
90375	HCPCS	Rabies Immune Globulin For Injection	19	19	$8,386.00	$8,386.00	$310.78	$8,553.72	$7,547.40	2025-09-04
400065151	CDM	Hchg Tfh Pillow Fetal	17	17	$8,349.00	$8,349.00	$7,347.12	$8,098.53	$7,514.10	2025-09-04
32652	HCPCS	Removal Of Chest Cavity Lining And Lung Lining Using An Endoscope	76	19	$11,313.00	$11,313.00	$2,104.93	$15,386.70	$7,427.89	2025-09-04
27132	HCPCS	Total Hip Replacement After Previous Hip Surgery	76	19	$11,309.00	$11,309.00	$2,171.70	$15,380.58	$7,425.91	2025-09-04
27590	HCPCS	Amputation Of Thigh Through Thigh Bone	38	19	$8,247.00	$8,247.00	$1,001.57	$8,411.94	$7,422.30	2025-09-04
27228	HCPCS	Treatment Of Broken Bones Of Front And Back Column Or Wall Of Hip Socket With Pl…	38	19	$8,217.00	$8,217.00	$2,436.47	$8,381.34	$7,395.30	2025-09-04
650001649	CDM	Hchg Tf Hearing Aid Binaural Level 4	17	17	$8,167.00	$8,167.00	$7,186.96	$7,921.99	$7,350.30	2025-09-04
44141	HCPCS	Partial Removal Of Large Bowel With Creation Of Opening To Skin	38	19	$8,132.00	$8,132.00	$2,322.65	$8,294.64	$7,318.80	2025-09-04
J1306	HCPCS	Injection, Inclisiran, 1 Mg	18	18	$8,130.50	$8,130.50	$7,154.84	$8,293.11	$7,317.45	2025-09-04
44207	HCPCS	Partial Removal Of Large Bowel And Reattachment To Rectum Using An Endoscope	38	19	$8,121.00	$8,121.00	$2,316.72	$8,283.42	$7,308.90	2025-09-04
44603	HCPCS	Suture Of Multiple Tears Or Holes In Small Bowel	76	19	$11,118.00	$11,118.00	$2,074.55	$15,121.50	$7,299.84	2025-09-04
100001599	CDM	Labor Room/delivery - General Classification	17	17	$8,109.00	$8,109.00	$7,135.92	$7,865.73	$7,298.10	2025-09-04
59510	HCPCS	Cesarean Delivery With Care Before And After Delivery	38	19	$8,101.00	$8,101.00	$3,315.85	$8,263.02	$7,290.90	2025-09-04
27134	HCPCS	Revision Of Thigh Bone And Hip Joint Prosthesis	38	19	$8,073.00	$8,073.00	$2,467.13	$8,234.46	$7,265.70	2025-09-04
45110	HCPCS	Removal Of Rectum With Creation Of Opening From Large Bowel To Skin Through Abdo…	38	19	$8,018.00	$8,018.00	$2,329.64	$8,178.36	$7,216.20	2025-09-04
44144	HCPCS	Partial Removal Of Large Bowel With Creation Of 2 Openings From Small Or Large B…	38	19	$7,914.00	$7,914.00	$2,262.05	$8,072.28	$7,122.60	2025-09-04
23474	HCPCS	Revision Of Total Shoulder Repair, Total Shoulder	38	19	$7,895.00	$7,895.00	$2,255.01	$8,052.90	$7,105.50	2025-09-04
44206	HCPCS	Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin…	38	19	$7,800.00	$7,800.00	$2,226.69	$7,956.00	$7,020.00	2025-09-04
200004110	CDM	Tfh Trauma Act Lvl3 Without Cc Full Ems	17	17	$7,785.00	$7,785.00	$6,850.80	$7,551.45	$7,006.50	2025-09-04
200004109	CDM	Tfh Trauma Act Lvl3 Without Cc Full	17	17	$7,785.00	$7,785.00	$6,850.80	$7,551.45	$7,006.50	2025-09-04
500001107	CDM	Gastro - Intestinal (gi) Services - General Classification	17	17	$7,739.00	$7,739.00	$6,810.32	$7,506.83	$6,965.10	2025-09-04
100001592	CDM	Labor Room/delivery - General Classification	17	17	$7,665.00	$7,665.00	$6,745.20	$7,435.05	$6,898.50	2025-09-04
100001595	CDM	Labor Room/delivery - General Classification	17	17	$7,665.00	$7,665.00	$6,745.20	$7,435.05	$6,898.50	2025-09-04
43282	HCPCS	Repair Of Hernia Of Muscle At Esophagus And Stomach With Implantation Of Mesh Us…	38	19	$7,664.00	$7,664.00	$2,217.69	$7,817.28	$6,897.60	2025-09-04
J3358	HCPCS	Ustekinumab, For Intravenous Injection, 1 Mg	19	19	$7,604.50	$7,604.50	$16.71	$7,756.59	$6,844.05	2025-09-04
J3240	HCPCS	Injection, Thyrotropin Alpha, 0.9 Mg, Provided In 1.1 Mg Vial	19	19	$7,535.50	$7,535.50	$1,720.18	$7,686.21	$6,781.95	2025-09-04
C8910	HCPCS	Magnetic Resonance Angiography Without Contrast, Chest (excluding Myocardium)	18	18	$7,521.00	$7,521.00	$6,618.48	$7,671.42	$6,768.90	2025-09-04
C8909	HCPCS	Magnetic Resonance Angiography With Contrast, Chest (excluding Myocardium)	18	18	$7,521.00	$7,521.00	$6,618.48	$7,671.42	$6,768.90	2025-09-04
C8900	HCPCS	Magnetic Resonance Angiography With Contrast, Abdomen	18	18	$7,521.00	$7,521.00	$6,618.48	$7,671.42	$6,768.90	2025-09-04
C8901	HCPCS	Magnetic Resonance Angiography Without Contrast, Abdomen	18	18	$7,521.00	$7,521.00	$6,618.48	$7,671.42	$6,768.90	2025-09-04
C8911	HCPCS	Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Chest…	18	18	$7,521.00	$7,521.00	$6,618.48	$7,671.42	$6,768.90	2025-09-04
C8902	HCPCS	Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Abdom…	18	18	$7,521.00	$7,521.00	$6,618.48	$7,671.42	$6,768.90	2025-09-04
J9400	HCPCS	Injection, Ziv-aflibercept, 1 Mg	37	19	$6,563.00	$6,563.00	$13.07	$13,388.01	$6,694.26	2025-09-04
J2783	HCPCS	Injection, Rasburicase, 0.5 Mg	36	18	$7,398.75	$7,398.75	$2,170.52	$12,577.62	$6,683.56	2025-09-04
27487	HCPCS	Revision Of Thigh And Lower Leg Bone Components Of Total Knee Joint Prosthesis	38	19	$7,407.00	$7,407.00	$2,276.79	$7,555.14	$6,666.30	2025-09-04
60254	HCPCS	Removal Of Thyroid And Surrounding Lymph Nodes With Extensive Neck Removal	38	19	$7,406.00	$7,406.00	$2,151.40	$7,554.12	$6,665.40	2025-09-04
44143	HCPCS	Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin	38	19	$7,400.00	$7,400.00	$2,117.41	$7,548.00	$6,660.00	2025-09-04
44227	HCPCS	Closure Of Opening From Large Or Small Bowel To Skin Using An Endoscope	38	19	$7,400.00	$7,400.00	$2,122.28	$7,548.00	$6,660.00	2025-09-04
44145	HCPCS	Partial Removal Of Large Bowel And Reattachment To Rectum	38	19	$7,374.00	$7,374.00	$2,116.31	$7,521.48	$6,636.60	2025-09-04
100001588	CDM	Labor Room/delivery - General Classification	17	17	$7,370.00	$7,370.00	$6,485.60	$7,148.90	$6,633.00	2025-09-04
100001598	CDM	Labor Room/delivery - General Classification	17	17	$7,370.00	$7,370.00	$6,485.60	$7,148.90	$6,633.00	2025-09-04
59400	HCPCS	Vaginal Delivery With Care Before And After Delivery	38	19	$7,308.00	$7,308.00	$2,990.41	$7,454.16	$6,577.20	2025-09-04
49020	HCPCS	Drainage Of Abdominal Abscess Or Infection	38	19	$7,289.00	$7,289.00	$2,054.25	$7,434.78	$6,560.10	2025-09-04
J9330	HCPCS	Injection, Temsirolimus, 1 Mg	19	19	$7,258.50	$7,258.50	$63.33	$7,403.67	$6,532.65	2025-09-04
J1950	HCPCS	Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg	37	19	$19,145.00	$19,145.00	$1,291.31	$19,527.90	$6,509.64	2025-09-04
27227	HCPCS	Treatment Of Broken Bones Of Front Or Back Column Of Hip Socket Or Across Hip So…	38	19	$7,204.00	$7,204.00	$2,147.73	$7,348.08	$6,483.60	2025-09-04
140000091	CDM	Room & Board - Private (one Bed) - General Classification	19	19	$7,186.00	$7,186.00	$2,658.82	$6,970.42	$6,467.40	2025-09-04
27091	HCPCS	Removal Of Hip Prosthesis, Complicated	38	19	$7,186.00	$7,186.00	$2,072.24	$7,329.72	$6,467.40	2025-09-04
140000110	CDM	Room & Board - Private (one Bed) - Pediatric	19	19	$7,186.00	$7,186.00	$2,658.82	$6,970.42	$6,467.40	2025-09-04
500002641	CDM	Operating Room Services - General Classification	17	17	$7,136.00	$7,136.00	$6,279.68	$6,921.92	$6,422.40	2025-09-04
44626	HCPCS	Closure Of Surgically Created Large Or Small Bowel Opening With Bowel Removal An…	38	19	$7,106.00	$7,106.00	$1,521.45	$6,892.82	$6,395.40	2025-09-04
400066449	CDM	Hchg Tfh Pack Procedure Pack Tx2	17	17	$7,090.00	$7,090.00	$6,239.20	$6,877.30	$6,381.00	2025-09-04
500001106	CDM	Gastro - Intestinal (gi) Services - General Classification	17	17	$6,967.00	$6,967.00	$6,130.96	$6,757.99	$6,270.30	2025-09-04
500001025	CDM	Operating Room Services - General Classification	17	17	$6,938.00	$6,938.00	$6,105.44	$6,729.86	$6,244.20	2025-09-04
100001594	CDM	Labor Room/delivery - General Classification	17	17	$6,928.00	$6,928.00	$6,096.64	$6,720.16	$6,235.20	2025-09-04
100001591	CDM	Labor Room/delivery - General Classification	17	17	$6,928.00	$6,928.00	$6,096.64	$6,720.16	$6,235.20	2025-09-04
C8920	HCPCS	Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Pelvi…	18	18	$6,918.00	$6,918.00	$6,087.84	$7,056.36	$6,226.20	2025-09-04
27412	HCPCS	Implantation Of Self Cartilage Into Knee Joint	38	19	$6,917.00	$6,917.00	$2,147.97	$7,055.34	$6,225.30	2025-09-04
44661	HCPCS	Closure Of Abnormal Drainage Tract From Small Bowel To Urinary Bladder With Rese…	38	19	$6,913.00	$6,913.00	$1,980.91	$7,051.26	$6,221.70	2025-09-04
44204	HCPCS	Partial Removal Of Large Bowel Using An Endoscope	38	19	$6,897.00	$6,897.00	$1,970.23	$7,034.94	$6,207.30	2025-09-04
27138	HCPCS	Revision Of Thigh Bone Prosthesis	38	19	$6,886.00	$6,886.00	$1,977.99	$7,023.72	$6,197.40	2025-09-04
23473	HCPCS	Revision Of Total Shoulder Repair	38	19	$6,871.00	$6,871.00	$2,089.95	$7,008.42	$6,183.90	2025-09-04
30462	HCPCS	Revision Of Congenital Nasal Defect With Lengthening Of Tip Of Nose	38	19	$6,845.00	$6,845.00	$2,069.40	$6,981.90	$6,160.50	2025-09-04
217529_ERX	CDM	Triamcinolone Acet 40 Mg/ml Vl	17	17	$6,822.50	$6,822.50	$6,003.80	$6,617.83	$6,140.25	2025-09-04
43281	HCPCS	Repair Of Hernia Of Muscle At Esophagus And Stomach Using An Endoscope	38	19	$6,822.00	$6,822.00	$1,967.85	$6,958.44	$6,139.80	2025-09-04
C8914	HCPCS	Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Lower…	54	18	$6,458.00	$6,458.00	$5,683.04	$13,172.28	$6,135.10	2025-09-04
29999	HCPCS	Other Procedure On Joint Using An Endoscope	17	17	$6,806.00	$6,806.00	$5,989.28	$6,942.12	$6,125.40	2025-09-04
J7168	HCPCS	Prothrombin Complex Concentrate (human), Kcentra, Per I.u. Of Factor Ix Activity	18	18	$6,804.50	$6,804.50	$5,987.96	$6,940.59	$6,124.05	2025-09-04
50543	HCPCS	Partial Removal Of Kidney Using An Endoscope	38	19	$6,801.00	$6,801.00	$1,921.47	$6,937.02	$6,120.90	2025-09-04
43840	HCPCS	Suture Of Perforated Ulcer, Wound, Or Injury Of Stomach Or Upper Small Bowel	76	19	$9,321.00	$9,321.00	$1,753.91	$12,677.58	$6,119.81	2025-09-04
27447	HCPCS	Replacement Of Knee Joint, Both Sides Of Knee	76	19	$9,194.00	$9,194.00	$1,670.69	$12,503.16	$6,038.05	2025-09-04
J9303	HCPCS	Injection, Panitumumab, 10 Mg	37	19	$5,902.00	$5,902.00	$124.05	$24,078.63	$6,020.04	2025-09-04
J0897	HCPCS	Injection, Denosumab, 1 Mg	37	19	$5,882.50	$5,882.50	$23.91	$11,036.91	$6,000.15	2025-09-04
100001597	CDM	Labor Room/delivery - General Classification	17	17	$6,635.00	$6,635.00	$5,838.80	$6,435.95	$5,971.50	2025-09-04
100001587	CDM	Labor Room/delivery - General Classification	17	17	$6,635.00	$6,635.00	$5,838.80	$6,435.95	$5,971.50	2025-09-04
27580	HCPCS	Fusion Of Knee Joint	38	19	$6,628.00	$6,628.00	$1,921.28	$6,760.56	$5,965.20	2025-09-04
44055	HCPCS	Correction Of Abnormal Rotation Of Small Bowel	38	19	$6,595.00	$6,595.00	$1,919.96	$6,726.90	$5,935.50	2025-09-04
47741	HCPCS	Creation Of Drainage Tract From Gallbladder To Small Bowel Using Roux-en-y Conne…	38	19	$6,545.00	$6,545.00	$1,900.31	$6,675.90	$5,890.50	2025-09-04
500002646	CDM	Operating Room Services - General Classification	17	17	$6,539.00	$6,539.00	$5,754.32	$6,342.83	$5,885.10	2025-09-04
38724	HCPCS	Removal Of Lymph Nodes, Muscle, And Tissue Of Neck	38	19	$6,484.00	$6,484.00	$1,885.33	$6,613.68	$5,835.60	2025-09-04
J9264	HCPCS	Injection, Paclitaxel Protein-bound Particles, 1 Mg	19	19	$6,481.00	$6,481.00	$17.01	$6,610.62	$5,832.90	2025-09-04
23472	HCPCS	Prosthetic Repair Of Shoulder Joint, Total Shoulder	57	19	$6,313.00	$6,313.00	$1,880.47	$12,877.50	$5,807.96	2025-09-04
27130	HCPCS	Replacement Of Thigh Bone And Hip Joint With Prosthesis	76	19	$8,830.50	$8,830.50	$1,672.81	$12,009.48	$5,798.69	2025-09-04
J3032	HCPCS	Injection, Eptinezumab-jjmr, 1 Mg	18	18	$6,442.50	$6,442.50	$5,669.40	$6,571.35	$5,798.25	2025-09-04
400066448	CDM	Hchg Tfh Pack Procedure Pack Tx1	17	17	$6,418.00	$6,418.00	$5,647.84	$6,225.46	$5,776.20	2025-09-04
G0390	HCPCS	Trauma Response Team Associated With Hospital Critical Care Service	36	18	$6,189.50	$6,189.50	$4,042.72	$7,940.70	$5,768.34	2025-09-04
500001130	CDM	Gastro - Intestinal (gi) Services - General Classification	17	17	$6,407.00	$6,407.00	$5,638.16	$6,214.79	$5,766.30	2025-09-04
44376	HCPCS	Diagnostic Exam Of Small Bowel (including Lower Small Intestine) Using An Endosc…	19	19	$6,407.00	$6,407.00	$256.21	$6,535.14	$5,766.30	2025-09-04
J9355	HCPCS	Injection, Trastuzumab, Excludes Biosimilar, 10 Mg	19	19	$6,392.50	$6,392.50	$113.11	$6,520.35	$5,753.25	2025-09-04
27486	HCPCS	Revision Of Component Of Total Knee Joint Prosthesis	38	19	$6,369.00	$6,369.00	$1,830.95	$6,496.38	$5,732.10	2025-09-04
500001030	CDM	Operating Room Services - General Classification	17	17	$6,358.00	$6,358.00	$5,595.04	$6,167.26	$5,722.20	2025-09-04
77373	HCPCS	Delivery Of Radiation Therapy Per Dose To 1 Or More Lesions Not To Exceed 5 Dose…	19	19	$6,314.00	$6,314.00	$1,265.75	$6,440.28	$5,682.60	2025-09-04
77778	HCPCS	Complex Application Of Radiation Source	19	19	$6,304.00	$6,304.00	$745.61	$6,430.08	$5,673.60	2025-09-04
V5258	HCPCS	Hearing Aid, Digital, Binaural, Cic	144	18	$6,033.00	$6,033.00	$3,429.36	$10,252.02	$5,671.15	2025-09-04
V5261	HCPCS	Hearing Aid, Digital, Binaural, Bte	180	18	$6,033.00	$6,033.00	$3,429.36	$10,252.02	$5,671.15	2025-09-04
J9217	HCPCS	Leuprolide Acetate (for Depot Suspension), 7.5 Mg	73	19	$22,814.00	$22,814.00	$237.49	$31,026.87	$5,669.16	2025-09-04
C1764	HCPCS	Event Recorder, Cardiac (implantable)	18	18	$6,272.00	$6,272.00	$5,519.36	$6,397.44	$5,644.80	2025-09-04
55845	HCPCS	Removal Of Prostate Gland And Surrounding Lymph Nodes On Both Sides Of Pelvis Th…	38	19	$6,234.00	$6,234.00	$1,756.66	$6,358.68	$5,610.60	2025-09-04
44602	HCPCS	Suture Of Tear Of Hole In Small Bowel	38	19	$6,233.00	$6,233.00	$1,801.25	$6,357.66	$5,609.70	2025-09-04
27137	HCPCS	Revision Of Hip Socket Part Of Hip Prosthesis	38	19	$6,198.00	$6,198.00	$1,904.69	$6,321.96	$5,578.20	2025-09-04
100001593	CDM	Labor Room/delivery - General Classification	17	17	$6,192.00	$6,192.00	$5,448.96	$6,006.24	$5,572.80	2025-09-04
200003566	CDM	Hchg Ed Multi Proc Level 4	17	17	$6,192.00	$6,192.00	$5,448.96	$6,006.24	$5,572.80	2025-09-04
500001105	CDM	Gastro - Intestinal (gi) Services - General Classification	17	17	$6,192.00	$6,192.00	$5,448.96	$6,006.24	$5,572.80	2025-09-04
100001590	CDM	Labor Room/delivery - General Classification	17	17	$6,192.00	$6,192.00	$5,448.96	$6,006.24	$5,572.80	2025-09-04
44202	HCPCS	Partial Removal And Reconnection Of Small Bowel Using An Endoscope	38	19	$6,150.00	$6,150.00	$1,784.05	$6,273.00	$5,535.00	2025-09-04
27415	HCPCS	Implantation Of Donor Cartilage Cells Into Knee Joint	38	19	$6,139.00	$6,139.00	$1,795.27	$6,261.78	$5,525.10	2025-09-04
41130	HCPCS	Partial Removal Of Tongue	38	19	$6,122.00	$6,122.00	$1,695.60	$6,244.44	$5,509.80	2025-09-04
50545	HCPCS	Removal Of Kidney And Lymph Nodes Using An Endoscope	38	19	$6,115.00	$6,115.00	$1,719.18	$6,237.30	$5,503.50	2025-09-04
650001645	CDM	Hchg Tf Hearing Aid Monaural Level 6	17	17	$6,110.00	$6,110.00	$5,376.80	$5,926.70	$5,499.00	2025-09-04
500001219	CDM	Gastro - Intestinal (gi) Services - General Classification	17	17	$6,094.00	$6,094.00	$5,362.72	$5,911.18	$5,484.60	2025-09-04
60600	HCPCS	Removal Of Growth Of Carotid Artery	38	19	$6,082.00	$6,082.00	$1,723.44	$6,203.64	$5,473.80	2025-09-04
50240	HCPCS	Partial Removal Of Kidney	38	19	$6,049.00	$6,049.00	$1,715.46	$6,169.98	$5,444.10	2025-09-04
42426	HCPCS	Removal Of Growth Of Saliva Gland Or Saliva Gland, And Surrounding Lymph Nodes O…	38	19	$6,027.00	$6,027.00	$1,368.17	$5,846.19	$5,424.30	2025-09-04
650001648	CDM	Hchg Tf Hearing Aid Binaural Level 3	17	17	$6,023.00	$6,023.00	$5,300.24	$5,842.31	$5,420.70	2025-09-04
69644	HCPCS	Repair Of Eardrum, Ear Canal, And Bones With Removal Of Mastoid Bone, With Intac…	38	19	$6,010.00	$6,010.00	$1,960.78	$6,130.20	$5,409.00	2025-09-04
38720	HCPCS	Removal Of Lymph Nodes Of Neck	38	19	$5,996.00	$5,996.00	$1,745.85	$6,115.92	$5,396.40	2025-09-04
44205	HCPCS	Partial Removal Of Small And Large Bowel With Attachment Of Small And Large Bowe…	38	19	$5,962.00	$5,962.00	$1,712.23	$6,081.24	$5,365.80	2025-09-04
28420	HCPCS	Treatment Of Broken Heel Bone With Graft	38	19	$5,955.00	$5,955.00	$1,697.06	$6,074.10	$5,359.50	2025-09-04
30420	HCPCS	Reshaping Of Bony Cartilage Dividing Nasal Passages	38	19	$5,924.00	$5,924.00	$1,872.25	$6,042.48	$5,331.60	2025-09-04
47610	HCPCS	Removal Of Gallbladder With Exploration Of Common Bile Duct	38	19	$5,905.00	$5,905.00	$1,617.71	$6,023.10	$5,314.50	2025-09-04
100001586	CDM	Labor Room/delivery - General Classification	17	17	$5,897.00	$5,897.00	$5,189.36	$5,720.09	$5,307.30	2025-09-04
58554	HCPCS	Removal Of Uterus, Tubes, And/or Ovaries Through Vagina Using An Endoscope, More…	38	19	$5,888.00	$5,888.00	$1,685.38	$6,005.76	$5,299.20	2025-09-04
31300	HCPCS	Removal Of Vocal Cord Growth Or Cartilage Attachment	38	19	$5,881.00	$5,881.00	$1,624.86	$5,998.62	$5,292.90	2025-09-04
50230	HCPCS	Removal Of Kidney, Lymph Nodes, And/or Blood Clot From Major Vein With Partial R…	38	19	$5,840.00	$5,840.00	$1,648.32	$5,956.80	$5,256.00	2025-09-04
50948	HCPCS	Repositioning Of Ureter Using An Endoscope	38	19	$5,824.00	$5,824.00	$1,645.35	$5,940.48	$5,241.60	2025-09-04
30410	HCPCS	Reshaping Of Bone, Cartilage, And/or Tip Of Nose	38	19	$5,793.00	$5,793.00	$1,835.38	$5,908.86	$5,213.70	2025-09-04
32654	HCPCS	Control Of Traumatic Bleeding In Chest Using An Endoscope	76	19	$7,923.50	$7,923.50	$1,522.44	$10,775.28	$5,203.76	2025-09-04
58573	HCPCS	Removal Of Uterus, Tubes, And/or Ovaries Through Abdomen Using An Endoscope, Mor…	38	19	$5,774.00	$5,774.00	$1,578.03	$5,889.48	$5,196.60	2025-09-04
28705	HCPCS	Fusion Of All Bones Of Ankle And Hindfoot	38	19	$5,768.00	$5,768.00	$1,593.46	$5,883.36	$5,191.20	2025-09-04
23335	HCPCS	Removal Of Ball And Socket Prosthesis From Shoulder	38	19	$5,765.00	$5,765.00	$1,652.37	$5,880.30	$5,188.50	2025-09-04
44140	HCPCS	Partial Removal Of Large Bowel With Connection	38	19	$5,741.00	$5,741.00	$1,727.41	$5,855.82	$5,166.90	2025-09-04
J0630	HCPCS	Injection, Calcitonin Salmon, Up To 400 Units	19	19	$5,712.50	$5,712.50	$2,691.50	$5,826.75	$5,141.25	2025-09-04
37617	HCPCS	Tying Of Major Artery Of The Abdomen	38	19	$5,687.00	$5,687.00	$1,682.82	$5,800.74	$5,118.30	2025-09-04
500002639	CDM	Operating Room Services - General Classification	17	17	$5,683.00	$5,683.00	$5,001.04	$5,512.51	$5,114.70	2025-09-04
100001521	CDM	Hchg Care High Risk Antenatal Or Postpartal	17	17	$5,681.00	$5,681.00	$4,999.28	$5,510.57	$5,112.90	2025-09-04
27828	HCPCS	Treatment Of Broken Lower Weight Bearing Joint Of Both Lower Leg Bones	38	19	$5,622.00	$5,622.00	$1,729.96	$5,734.44	$5,059.80	2025-09-04
27506	HCPCS	Treatment Of Broken Shaft Of Thigh Bone With Implant	38	19	$5,616.00	$5,616.00	$1,748.43	$5,728.32	$5,054.40	2025-09-04
J9047	HCPCS	Injection, Carfilzomib, 1 Mg	55	19	$5,601.50	$5,601.50	$42.34	$11,427.06	$5,041.35	2025-09-04
100001589	CDM	Labor Room/delivery - General Classification	17	17	$5,601.00	$5,601.00	$4,928.88	$5,432.97	$5,040.90	2025-09-04
23616	HCPCS	Treatment Of Broken Upper Arm Bone With Replacement	38	19	$5,590.00	$5,590.00	$1,612.24	$5,701.80	$5,031.00	2025-09-04
58152	HCPCS	Removal Of Uterus And Cervix Through Abdomen With Repair Of Vagina	38	19	$5,559.00	$5,559.00	$1,599.08	$5,670.18	$5,003.10	2025-09-04
58291	HCPCS	Removal Of Uterus, Tubes, And/or Ovaries Through Vagina, More Than 250.0 G	38	19	$5,537.00	$5,537.00	$1,605.42	$5,647.74	$4,983.30	2025-09-04
29889	HCPCS	Repair Of Posterior Cruciate Ligament Of Knee Using An Endoscope	38	19	$5,532.00	$5,532.00	$1,606.45	$5,642.64	$4,978.80	2025-09-04
140000135	CDM	Nursery - Newborn - Level Iii	19	19	$5,529.00	$5,529.00	$2,045.73	$5,363.13	$4,976.10	2025-09-04
140000003	CDM	Room & Board - Private (one Bed) - Pediatric	19	19	$5,529.00	$5,529.00	$2,045.73	$5,363.13	$4,976.10	2025-09-04
140000065	CDM	Room & Board - Private (one Bed) - Obstetrics (ob)	19	19	$5,529.00	$5,529.00	$2,045.73	$5,363.13	$4,976.10	2025-09-04
140000000	CDM	Room & Board - Private (one Bed) - General Classification	19	19	$5,529.00	$5,529.00	$2,045.73	$5,363.13	$4,976.10	2025-09-04
140000118	CDM	Room & Board - Private (one Bed) - General Classification	19	19	$5,529.00	$5,529.00	$2,045.73	$5,363.13	$4,976.10	2025-09-04
500001023	CDM	Operating Room Services - General Classification	17	17	$5,525.00	$5,525.00	$4,862.00	$5,359.25	$4,972.50	2025-09-04
59515	HCPCS	Cesarean Delivery With Care After Delivery	38	19	$5,516.00	$5,516.00	$1,713.22	$5,626.32	$4,964.40	2025-09-04
27466	HCPCS	Lengthening Of Thigh Bone	38	19	$5,510.00	$5,510.00	$1,549.37	$5,620.20	$4,959.00	2025-09-04
44188	HCPCS	Creation Of Large Bowel Opening Using An Endoscope	38	19	$5,496.00	$5,496.00	$1,560.80	$5,605.92	$4,946.40	2025-09-04
27724	HCPCS	Repair Of Nonhealed Broken Shin Bone With Self Graft From Hip Or Other Bone	38	19	$5,489.00	$5,489.00	$1,632.88	$5,598.78	$4,940.10	2025-09-04
27470	HCPCS	Repair Of Nonhealed Broken Thigh Bone	38	19	$5,478.00	$5,478.00	$1,543.47	$5,587.56	$4,930.20	2025-09-04
27472	HCPCS	Repair Of Nonhealed Broken Thigh Bone With Self Bone Graft	38	19	$5,477.00	$5,477.00	$1,651.77	$5,586.54	$4,929.30	2025-09-04
J2802	HCPCS	Injection, Romiplostim, 1 Microgram	18	18	$5,470.00	$5,470.00	$4,813.60	$5,579.40	$4,923.00	2025-09-04
21470	HCPCS	Complicated Treatment Of Broken Lower Jaw Bone With Placement Of Stabilizing Dev…	38	19	$5,462.00	$5,462.00	$1,521.46	$5,571.24	$4,915.80	2025-09-04
25025	HCPCS	Incision To Relieve Pressure In Top And Palm Side Of Wrist Compartment With Remo…	38	19	$5,455.00	$5,455.00	$1,605.62	$5,564.10	$4,909.50	2025-09-04
650001644	CDM	Hchg Tf Hearing Aid Monaural Level 5	17	17	$5,436.00	$5,436.00	$4,783.68	$5,272.92	$4,892.40	2025-09-04
38100	HCPCS	Removal Of Spleen	38	19	$5,430.00	$5,430.00	$1,480.91	$5,538.60	$4,887.00	2025-09-04
24149	HCPCS	Extensive Removal Of Bony Growth And Tissue From Elbow To Increase Elbow Motion	38	19	$5,421.00	$5,421.00	$1,553.70	$5,529.42	$4,878.90	2025-09-04
27709	HCPCS	Incision Or Partial Removal Of Shin And Outer Lower Leg Bones	38	19	$5,390.00	$5,390.00	$1,490.99	$5,497.80	$4,851.00	2025-09-04
27513	HCPCS	Treatment Of Broken Thigh Bone In Knee Area	38	19	$5,388.00	$5,388.00	$1,603.62	$5,495.76	$4,849.20	2025-09-04
21601	HCPCS	Removal Of Growth Of Chest Wall And Rib	38	19	$5,366.00	$5,366.00	$1,475.46	$5,473.32	$4,829.40	2025-09-04
55840	HCPCS	Removal Of Prostate	38	19	$5,362.00	$5,362.00	$1,513.08	$5,469.24	$4,825.80	2025-09-04
30435	HCPCS	Revision To Reshape Nasal Bones After Previous Repair	38	19	$5,355.00	$5,355.00	$1,625.28	$5,462.10	$4,819.50	2025-09-04
44320	HCPCS	Creation Of Opening From Large Bowel To Skin	38	19	$5,352.00	$5,352.00	$1,547.75	$5,459.04	$4,816.80	2025-09-04
27244	HCPCS	Treatment Of Broken Neck Of Thigh Bone With Plate/screw Implant	38	19	$5,351.00	$5,351.00	$1,603.73	$5,458.02	$4,815.90	2025-09-04
27245	HCPCS	Treatment Of Broken Neck Of Thigh Bone With Bone Implant	38	19	$5,334.00	$5,334.00	$1,601.69	$5,440.68	$4,800.60	2025-09-04
19307	HCPCS	Removal Of Breast And Underarm Lymph Nodes	38	19	$5,312.00	$5,312.00	$1,528.73	$5,418.24	$4,780.80	2025-09-04
42420	HCPCS	Removal Of Growth Of Saliva Gland Or Saliva Gland With Release Of Facial Nerve	38	19	$5,304.00	$5,304.00	$1,543.75	$5,410.08	$4,773.60	2025-09-04
35840	HCPCS	Exploration Of Abdomen For Bleeding, Blood Clot, Or Infection After Surgery	38	19	$5,301.00	$5,301.00	$1,559.75	$5,407.02	$4,770.90	2025-09-04
400000002	CDM	Hchg Miscellaneous Sup Implants Rev Cd 278	17	17	$5,300.06	$5,300.06	$4,664.05	$5,141.06	$4,770.05	2025-09-04
50400	HCPCS	Simple Reconstruction Of Neck Of Kidney	38	19	$5,292.00	$5,292.00	$1,491.72	$5,397.84	$4,762.80	2025-09-04
27429	HCPCS	Reconstruction Of Ligaments Inside And Outside Knee Joint	38	19	$5,288.00	$5,288.00	$1,656.32	$5,393.76	$4,759.20	2025-09-04
44346	HCPCS	Revision Of Opening From Large Bowel To Skin With Repair Of Hernia	38	19	$5,284.00	$5,284.00	$1,525.92	$5,389.68	$4,755.60	2025-09-04
27269	HCPCS	Treatment Of Broken Head Of Thigh Bone	38	19	$5,275.00	$5,275.00	$1,616.92	$5,380.50	$4,747.50	2025-09-04
58146	HCPCS	Removal Of 5 Or More Growths Of Uterus Through Abdomen	38	19	$5,272.00	$5,272.00	$1,491.53	$5,377.44	$4,744.80	2025-09-04
29867	HCPCS	Repair Of Knee Cartilage And Bone With Donor Cartilage Graft Using An Endoscope	38	19	$5,266.00	$5,266.00	$1,675.24	$5,371.32	$4,739.40	2025-09-04
44120	HCPCS	Partial Removal Of Small Bowel With Reconnection	38	19	$5,230.00	$5,230.00	$1,572.84	$5,334.60	$4,707.00	2025-09-04
J9179	HCPCS	Injection, Eribulin Mesylate, 0.1 Mg	19	19	$5,225.50	$5,225.50	$122.02	$5,330.01	$4,702.95	2025-09-04
27488	HCPCS	Removal Of Total Knee Joint Prosthesis	38	19	$5,216.00	$5,216.00	$1,569.55	$5,320.32	$4,694.40	2025-09-04
44160	HCPCS	Partial Removal Of Small And Large Bowel With Attachment Of Small And Large Bowe…	38	19	$5,201.00	$5,201.00	$1,599.24	$5,305.02	$4,680.90	2025-09-04
V5259	HCPCS	Hearing Aid, Digital, Binaural, Itc	90	18	$5,173.00	$5,173.00	$3,687.20	$9,249.36	$4,655.70	2025-09-04
V5260	HCPCS	Hearing Aid, Digital, Binaural, Ite	162	18	$5,173.00	$5,173.00	$3,429.36	$10,252.02	$4,655.70	2025-09-04
27558	HCPCS	Treatment Of Dislocated Knee With Ligament Repair And Reconstruction	38	19	$5,167.00	$5,167.00	$1,544.68	$5,270.34	$4,650.30	2025-09-04
27536	HCPCS	Treatment Of Broken Shin Bone On Both Sides Of Upper End	38	19	$5,161.00	$5,161.00	$1,553.74	$5,264.22	$4,644.90	2025-09-04
100001585	CDM	Labor Room/delivery - General Classification	17	17	$5,160.00	$5,160.00	$4,540.80	$5,005.20	$4,644.00	2025-09-04
27236	HCPCS	Treatment Of Upper End Of Broken Thigh Bone With Placement Of Stabilizing Device…	38	19	$5,157.00	$5,157.00	$1,558.85	$5,260.14	$4,641.30	2025-09-04
43332	HCPCS	Repair Of Paraesophageal Hernia Through Abdomen	38	19	$5,133.00	$5,133.00	$1,471.96	$5,235.66	$4,619.70	2025-09-04
49618	HCPCS	Repair Of Recurrent Entrapped Hernia Of Abdomen, More Than 10 Cm In Length	36	18	$5,116.00	$5,116.00	$1,596.27	$5,218.32	$4,604.40	2025-09-04
58290	HCPCS	Removal Of Uterus Through Vagina, More Than 250.0 G	38	19	$5,101.00	$5,101.00	$1,486.80	$5,203.02	$4,590.90	2025-09-04
V5254	HCPCS	Hearing Aid, Digital, Monaural, Cic	396	18	$4,985.00	$4,985.00	$1,827.76	$10,252.02	$4,590.08	2025-09-04
28415	HCPCS	Treatment Of Broken Heel Bone	38	19	$5,084.00	$5,084.00	$1,468.84	$5,185.68	$4,575.60	2025-09-04
23466	HCPCS	Repair And Tightening Of Shoulder Joint Capsule	38	19	$5,077.00	$5,077.00	$1,468.11	$5,178.54	$4,569.30	2025-09-04
J9349	HCPCS	Injection, Tafasitamab-cxix, 2 Mg	18	18	$5,071.00	$5,071.00	$4,462.48	$5,172.42	$4,563.90	2025-09-04
30400	HCPCS	Reshaping Of Tip Of Nose	38	19	$5,065.00	$5,065.00	$1,459.68	$5,166.30	$4,558.50	2025-09-04
27428	HCPCS	Reconstruction Ligaments Inside Knee Joint	38	19	$5,045.00	$5,045.00	$1,469.22	$5,145.90	$4,540.50	2025-09-04
27446	HCPCS	Replacement Of Knee Joint On Side Of Knee	38	19	$5,039.00	$5,039.00	$1,499.05	$5,139.78	$4,535.10	2025-09-04
23465	HCPCS	Repair Of Shoulder Joint Capsule In The Back Of The Joint	38	19	$5,033.00	$5,033.00	$1,463.40	$5,133.66	$4,529.70	2025-09-04
21365	HCPCS	Treatment Of Complicated Broken Cheek Bone With Placement Of Internal Stabilizin…	38	19	$5,032.00	$5,032.00	$1,415.18	$5,132.64	$4,528.80	2025-09-04
45400	HCPCS	Repair Of Rectal Prolapse Using An Endoscope	38	19	$5,027.00	$5,027.00	$1,457.89	$5,127.54	$4,524.30	2025-09-04
90396	HCPCS	Varicella (chicken Pox) Zoster Immune Globulin For Injection Into Muscle	18	18	$5,014.00	$5,014.00	$4,412.32	$5,114.28	$4,512.60	2025-09-04
45562	HCPCS	Repair Of Rectal Wound	38	19	$5,011.00	$5,011.00	$1,513.77	$5,111.22	$4,509.90	2025-09-04
58553	HCPCS	Removal Of Uterus Through Vagina Using An Endoscope, More Than 250.0	38	19	$5,007.00	$5,007.00	$1,446.53	$5,107.14	$4,506.30	2025-09-04
41120	HCPCS	Removal Of Less Than Half Of Tongue	38	19	$5,004.00	$5,004.00	$1,371.99	$5,104.08	$4,503.60	2025-09-04
500002644	CDM	Operating Room Services - General Classification	17	17	$4,995.00	$4,995.00	$4,395.60	$4,845.15	$4,495.50	2025-09-04
58546	HCPCS	Removal Of Growth Of Uterus Using An Endoscope, More Than 250.0 G	38	19	$4,980.00	$4,980.00	$1,438.44	$5,079.60	$4,482.00	2025-09-04
77385	HCPCS	Delivery Of Simple High Precision Radiation Treatment	19	19	$4,951.00	$4,951.00	$322.57	$5,050.02	$4,455.90	2025-09-04
77386	HCPCS	Delivery Of Complex High Precision Radiation Treatment	19	19	$4,951.00	$4,951.00	$387.08	$5,050.02	$4,455.90	2025-09-04
650001647	CDM	Hchg Tf Hearing Aid Binaural Level 2	17	17	$4,941.00	$4,941.00	$4,348.08	$4,792.77	$4,446.90	2025-09-04
47564	HCPCS	Removal Of Gallbladder With Exploration Of Common Bile Duct Using An Endoscope	38	19	$4,940.00	$4,940.00	$1,448.24	$5,038.80	$4,446.00	2025-09-04
64857	HCPCS	Suture Of Arm Or Leg Peripheral Nerve	38	19	$4,939.00	$4,939.00	$1,365.93	$5,037.78	$4,445.10	2025-09-04
23470	HCPCS	Partial Replacement Of Shoulder Joint	38	19	$4,930.00	$4,930.00	$1,563.48	$5,028.60	$4,437.00	2025-09-04
27125	HCPCS	Partial Replacement Of Thigh Bone At Hip Joint With Prosthesis	38	19	$4,926.00	$4,926.00	$1,479.59	$5,024.52	$4,433.40	2025-09-04

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