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

ASHLEY MEDICAL CENTER

Ashley, ND · CCN 351322 · Rates published

1,091 distinct procedures filed
14 distinct payers
23,799 rate rows
2026-03-16 last MRF observed
Data quality

1,428 of 23,799 rate rows are consumer-grade (6.0%)

22,371 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 — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 20,283
per-diem day rate — not a per-procedure price 1,941
exceeds 10× this hospital's gross charge — excluded from medians 147
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://irp.cdn-website.com/5b245649/files/uploaded/450255914_ashley-medical-center_standardcharges.csv
Found on page https://www.amctoday.org/financial
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-18
Content fingerprint 2233ebc9a38aa694… · 13,204,865 bytes · first seen 2026-05-09

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
0120
RC 		8 $4,765.90 $4,765.90 $4,765.90 nat. median
$1,017
outlier · 4.7×
0110
RC 		8 $4,765.90 $4,765.90 $4,765.90 nat. median
$979
outlier · 4.9×
70543
HCPCS 		MRI Orbit/face/neck W&without Contrast 2 $3,286.83 $4,540.00 $3,913.41 nat. median
$1,079
outlier · 3.6×
72158
HCPCS 		MRI L Spine W&without - Lumbar 1 $3,462.45 $3,462.45 $3,462.45 nat. median
$1,081
outlier · 3.2×
70553
HCPCS 		MRI Brain W&without Contrast 4 $3,324.65 $4,624.00 $3,462.45 nat. median
$1,122
outlier · 3.1×
74183
HCPCS 		MRI Abdomen W&without 3 $2,606.03 $4,556.00 $3,404.67 nat. median
$1,102
outlier · 3.1×
73723
HCPCS 		MRI Ext Lower Lt Joint W&W/O,Left 1 $3,399.55 $3,399.55 $3,399.55 nat. median
$1,264
outlier · 2.7×
72157
HCPCS 		MRI T Spine W & Without - Thoracic 1 $3,305.97 $3,305.97 $3,305.97 nat. median
$1,094
outlier · 3.0×
72197
HCPCS 		MRI Pelvis W&without 1 $3,297.17 $3,297.17 $3,297.17 nat. median
$1,065
outlier · 3.1×
73720
HCPCS 		MRI Ext Lower Lt Non-joint W&W/O,Left 1 $3,285.59 $3,285.59 $3,285.59 nat. median
$1,190
outlier · 2.8×
72156
HCPCS 		MRI C Spine W&without - Cervical 2 $3,091.64 $3,181.79 $3,136.72 nat. median
$1,092
outlier · 2.9×
0360
RC 		1 $2,874.40 $2,874.40 $2,874.40 nat. median
$2,181
1.3× median
70547
HCPCS 		MRA Neck Without Contrast 1 $2,720.69 $2,720.69 $2,720.69 nat. median
$751
outlier · 3.6×
70544
HCPCS 		MRA Head Without Contrast 1 $2,593.84 $2,593.84 $2,593.84 nat. median
$817
outlier · 3.2×
45384
HCPCS 		Colonoscopy W Lesion Removal Hot Snare 1 $2,583.37 $2,583.37 $2,583.37 nat. median
$1,676
1.5× median
72195
HCPCS 		MRI Pelvis Without Contrast 1 $2,562.39 $2,562.39 $2,562.39 nat. median
$787
outlier · 3.3×
73718
HCPCS 		MRI Ext Lower Lt Non-joint WO,Left 3 $2,446.76 $2,548.17 $2,534.55 nat. median
$917
outlier · 2.8×
74181
HCPCS 		MRI Abdomen Without Contrast 2 $2,198.45 $2,857.00 $2,527.72 nat. median
$820
outlier · 3.1×
74174
HCPCS 		CT Angio Abd/pel W 2 $2,456.96 $2,475.63 $2,466.30 nat. median
$959
outlier · 2.6×
73218
HCPCS 		MRI Ext Upper Lt Non-joint WO,Left 1 $2,395.42 $2,395.42 $2,395.42 nat. median
$896
outlier · 2.7×
45378
HCPCS 		Colonoscopy Dx 3 $188.95 $3,259.00 $2,343.23 nat. median
$1,331
1.8× median
73721
HCPCS 		MRI Ext Lower Lt Joint W/O,Left 4 $2,086.53 $2,902.00 $2,173.02 nat. median
$899
outlier · 2.4×
74178
HCPCS 		CT Abd/pel W&without Cont 3 $2,064.96 $2,150.55 $2,143.57 nat. median
$979
outlier · 2.2×
70551
HCPCS 		MRI Brain Without Contrast 3 $2,029.25 $2,099.64 $2,088.42 nat. median
$772
outlier · 2.7×
73221
HCPCS 		MRI Ext Upper Lt Joint W/O,Left 4 $1,915.17 $2,829.00 $2,047.34 nat. median
$880
outlier · 2.3×
72141
HCPCS 		MRI C Spine Without - Cervical 4 $1,830.68 $2,695.00 $2,011.74 nat. median
$766
outlier · 2.6×
70498
HCPCS 		CT Angio Neck W 2 $1,807.07 $1,869.75 $1,838.41 nat. median
$722
outlier · 2.5×
74177
HCPCS 		CT Abd/pel W Cont 4 $1,696.60 $2,001.60 $1,836.22 nat. median
$928
2.0× median
72146
HCPCS 		MRI T Spine Without - Thoracic 3 $1,821.07 $2,439.00 $1,826.32 nat. median
$772
outlier · 2.4×
72148
HCPCS 		MRI L Spine Without - Lumbar 4 $1,752.20 $2,437.00 $1,824.83 nat. median
$770
outlier · 2.4×
71275
HCPCS 		CT Angio Chest W 2 $1,733.98 $1,794.12 $1,764.05 nat. median
$736
outlier · 2.4×
73702
HCPCS 		CT Low Ext Lt W&without CONT,Left 1 $1,744.29 $1,744.29 $1,744.29 nat. median
$710
outlier · 2.5×
70496
HCPCS 		CT Angio Head W 2 $1,688.39 $1,746.95 $1,717.67 nat. median
$729
outlier · 2.4×
11420
HCPCS 		Exc B9 + Marg 0.5 1 $43.69 $3,314.94 $1,679.32 nat. median
$1,519
1.1× median
G0121
HCPCS 		Colonoscopy (screening) 1 $192.39 $2,676.07 $1,434.23 nat. median
$1,368
1.0× median
G0105
HCPCS 		Colonoscopy (screen Hi Risk) 1 $192.20 $2,676.07 $1,434.14 nat. median
$1,410
1.0× median
71260
HCPCS 		CT Chest W Cont 3 $1,370.68 $1,418.23 $1,417.15 nat. median
$646
outlier · 2.2×
73701
HCPCS 		CT Low Ext Lt W CONT,Left 2 $1,368.98 $1,425.72 $1,401.82 nat. median
$710
2.0× median
45380
HCPCS 		Colonoscopy W/biopsy 1 $205.24 $2,542.32 $1,373.78 nat. median
$1,566
0.9× median
70491
HCPCS 		CT Neck W Contrast 2 $1,277.13 $1,360.55 $1,318.84 nat. median
$617
outlier · 2.1×
43239
HCPCS 		Egd/gastroscopy 2 $141.10 $2,041.24 $1,138.78 nat. median
$1,377
0.8× median
43235
HCPCS 		Egd Dx Brush Wash 1 $125.42 $2,125.84 $1,125.63 nat. median
$1,340
0.8× median
72125
HCPCS 		CT Cervical Spine Without 5 $1,025.95 $1,489.00 $1,113.51 nat. median
$469
outlier · 2.4×
72128
HCPCS 		CT Thoracic Spine Without 3 $1,109.72 $1,482.00 $1,110.29 nat. median
$449
outlier · 2.5×
72131
HCPCS 		CT Lumbar Spine Without 4 $1,059.80 $1,474.00 $1,103.73 nat. median
$449
outlier · 2.5×
99285
HCPCS 		ER Significant THREAT,same Day As Other Service 2 $151.81 $1,146.41 $1,100.78 nat. median
$1,227
0.9× median
71250
HCPCS 		CT Chest Without Cont 4 $838.43 $1,466.00 $1,098.06 nat. median
$473
outlier · 2.3×
73700
HCPCS 		CT Low Ext Lt Without CONT,Left 2 $1,059.81 $1,103.73 $1,081.77 nat. median
$555
1.9× median
73200
HCPCS 		CT Upp Ext Lt Without CONT,Left 1 $1,067.79 $1,067.79 $1,067.79 nat. median
$548
1.9× median
70486
HCPCS 		CT Face/sin/jaw Without 4 $932.84 $1,289.00 $998.20 nat. median
$463
outlier · 2.2×

Other procedures at this hospital

Browse this hospital's 1,091 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
0110 RC — 8 8 $8.00 $8.00 $4,765.90 $4,765.90 $4,765.90 2026-03-16
0120 RC — 8 8 $414.00 $414.00 $4,765.90 $4,765.90 $4,765.90 2026-03-16
0360 RC — 1 1 $777.74 $777.74 $2,874.40 $2,874.40 $2,874.40 2026-03-16
0710 RC — 5 4 $321.00 $321.00 $141.65 $654.55 $227.37 2026-03-16
10060 HCPCS I & D (fnp),np Or Pa 1 1 $343.00 $343.00 $279.56 $279.56 $279.56 2026-03-16
10080 HCPCS I & D Pilonidal Cyst 1 1 $998.00 $998.00 $205.24 $205.24 $205.24 2026-03-16
10120 HCPCS Removal Forgein Body (fnp),np Or Pa 1 1 $411.50 $411.50 $205.24 $205.24 $205.24 2026-03-16
10140 HCPCS I & D Fluid 1 1 $462.50 $462.50 $205.24 $205.24 $205.24 2026-03-16
11000 HCPCS Debride Infected Skin 1 1 $819.00 $819.00 $205.24 $205.24 $205.24 2026-03-16
11055 HCPCS Paring Lesion 2 2 $190.50 $190.50 $205.24 $290.82 $248.03 2026-03-16
11102 HCPCS Biopsy Skin Lesion 8 5 $101.50 $101.50 $33.04 $310.00 $228.56 2026-03-16
11106 HCPCS Skin Biopsy 1 1 $534.00 $534.00 $383.94 $383.94 $383.94 2026-03-16
11200 HCPCS Removal Of Skin Tags<w15 3 2 $211.50 $211.50 $83.54 $215.70 $205.24 2026-03-16
11201 HCPCS Removal Addtl Skin Tags 1 1 $43.50 $43.50 $205.24 $205.24 $205.24 2026-03-16
11401 HCPCS Excision Benign Lesion .6-1.0 (phy),np Or Pa 4 2 $424.00 $424.00 $94.89 $620.72 $303.22 2026-03-16
11402 HCPCS Excision Extremity 1.1-2cm 7 3 $392.00 $392.00 $92.67 $1,183.27 $205.24 2026-03-16
11403 HCPCS Excision Extremity 2.1-3 Cm 1 1 $536.00 $536.00 $205.24 $205.24 $205.24 2026-03-16
11420 HCPCS Exc B9 + Marg 0.5 2 1 $228.00 $228.00 $43.69 $3,314.94 $1,679.32 2026-03-16
11421 HCPCS Exc Hd-face .6-1cm (fnp),np Or Pa 1 1 $300.50 $300.50 $706.05 $706.05 $706.05 2026-03-16
11602 HCPCS Excision Mal 1.1-2.0 Cm 2 1 $442.50 $442.50 $169.23 $399.86 $284.55 2026-03-16
11604 HCPCS Excision Mal Extremity 3.1-4.0 2 1 $982.00 $982.00 $221.01 $1,333.12 $777.06 2026-03-16
11606 HCPCS Excise Malignant Marg >4cm 1 1 $2,329.00 $2,329.00 $323.88 $323.88 $323.88 2026-03-16
11642 HCPCS Exc Malignant Lesion (fnp),np Or Pa 2 1 $500.00 $500.00 $189.58 $735.32 $462.45 2026-03-16
11719 HCPCS Trimming Nails 1 1 $39.00 $39.00 $205.24 $205.24 $205.24 2026-03-16
11730 HCPCS Removal Of Nail Plate 3 2 $311.00 $311.00 $57.28 $332.93 $205.24 2026-03-16
11750 HCPCS Removal Of Nail Bed 1 1 $551.00 $551.00 $205.24 $205.24 $205.24 2026-03-16
11760 HCPCS Repair Of Nailbed 1 1 $844.00 $844.00 $205.24 $205.24 $205.24 2026-03-16
11982 HCPCS Remove Drug Implant Device 1 1 $300.50 $300.50 $205.24 $205.24 $205.24 2026-03-16
12001 HCPCS Repair Trunk 2.5cm 7 4 $278.00 $278.00 $38.24 $300.00 $231.95 2026-03-16
12004 HCPCS Repair .6-12.5 Cm (fnp),np Or Pa 1 1 $359.50 $359.50 $205.24 $205.24 $205.24 2026-03-16
12005 HCPCS Repair Of Trunk 12.6-20.0cm 1 1 $478.50 $478.50 $205.24 $205.24 $205.24 2026-03-16
12013 HCPCS Repair Lacerations 2.6-5.0 Cm 3 2 $309.00 $309.00 $58.84 $208.74 $205.24 2026-03-16
12014 HCPCS Laceration Repair 5.0- 7.5 Cm 1 1 $385.50 $385.50 $205.24 $205.24 $205.24 2026-03-16
12015 HCPCS Laceration Repair Face 7.5-12cm 1 1 $306.00 $306.00 $205.24 $205.24 $205.24 2026-03-16
12016 HCPCS Repair Laceration > 12.6 Cm 1 1 $602.00 $602.00 $205.24 $205.24 $205.24 2026-03-16
12017 HCPCS Repair Of Face 20-30cm 1 1 $580.00 $580.00 $205.24 $205.24 $205.24 2026-03-16
12020 HCPCS Repair Wound Dehiscence 1 1 $815.50 $815.50 $205.24 $205.24 $205.24 2026-03-16
12031 HCPCS Intermediate Repair 2.5 Cm 1 1 $551.00 $551.00 $205.24 $205.24 $205.24 2026-03-16
12032 HCPCS Intermediate Repair 2.6-7.5cm 3 2 $542.50 $542.50 $169.91 $412.59 $205.24 2026-03-16
12034 HCPCS Intermediate Repair (fnp),np Or Pa 1 1 $562.00 $562.00 $205.24 $205.24 $205.24 2026-03-16
12041 HCPCS Interm Repair 0-2.5cm 1 1 $551.00 $551.00 $205.24 $205.24 $205.24 2026-03-16
12042 HCPCS Intermediate Repair 2.6-7.5 Cm 1 1 $551.00 $551.00 $205.24 $205.24 $205.24 2026-03-16
12051 HCPCS Interm Repair 1 1 $551.00 $551.00 $205.24 $205.24 $205.24 2026-03-16
12052 HCPCS Facial Wound Repair (fnp),np Or Pa 1 1 $551.00 $551.00 $205.24 $205.24 $205.24 2026-03-16
17000 HCPCS Destruct Premalignant Lesion (fnp),np Or Pa 3 3 $186.00 $186.00 $140.16 $290.82 $205.24 2026-03-16
17110 HCPCS Destruct Lesion 1-14 2 2 $300.00 $300.00 $237.78 $243.15 $240.47 2026-03-16
17111 HCPCS Wart Destruction 1 1 $362.50 $362.50 $205.24 $205.24 $205.24 2026-03-16
17250 HCPCS Cauterization Tissue 1 1 $424.00 $424.00 $205.24 $205.24 $205.24 2026-03-16
17340 HCPCS Crytherapy 1 1 $144.50 $144.50 $205.24 $205.24 $205.24 2026-03-16
19120 HCPCS Remove Breast Lesion 1 1 $5,051.00 $5,051.00 $205.24 $205.24 $205.24 2026-03-16
1999 HCPCS Anesthesia 8 7 $146.00 $146.00 $205.24 $205.24 $205.24 2026-03-16
20550 HCPCS Inj Tendon Sheath 1 1 $159.00 $159.00 $205.24 $205.24 $205.24 2026-03-16
20552 HCPCS Muscle Injection 1 1 $130.00 $130.00 $205.24 $205.24 $205.24 2026-03-16
20553 HCPCS Joint Injection Trigger Point 1 1 $463.00 $463.00 $205.24 $205.24 $205.24 2026-03-16
20600 HCPCS Arthocentesis Asp/inj Joint 1 1 $147.00 $147.00 $205.24 $205.24 $205.24 2026-03-16
20605 HCPCS Apiration/injection Of Joint 1 1 $149.00 $149.00 $205.24 $205.24 $205.24 2026-03-16
20610 HCPCS Joint Injection 1 1 $400.00 $400.00 $205.24 $205.24 $205.24 2026-03-16
21931 HCPCS Exc Back Lesion 3cm> 1 1 $2,491.00 $2,491.00 $205.24 $205.24 $205.24 2026-03-16
24071 HCPCS Escision Arm/elbow 1 1 $4,306.00 $4,306.00 $205.24 $205.24 $205.24 2026-03-16
24600 HCPCS Elbow Reduction 1 1 $420.00 $420.00 $205.24 $205.24 $205.24 2026-03-16
25600 HCPCS Distal Radial Fracture 1 1 $978.00 $978.00 $205.24 $205.24 $205.24 2026-03-16
29065 HCPCS Application Of Long Arm Cast 1 1 $461.00 $461.00 $205.24 $205.24 $205.24 2026-03-16
29075 HCPCS Application Of Forearm Cast (fnp),np Or Pa 1 1 $241.00 $241.00 $205.24 $205.24 $205.24 2026-03-16
29085 HCPCS Apply Hand/wrist Cast 1 1 $252.00 $252.00 $205.24 $205.24 $205.24 2026-03-16
29086 HCPCS Apply Finger Cast 1 1 $219.00 $219.00 $205.24 $205.24 $205.24 2026-03-16
29125 HCPCS Apply Shortarm Splint 1 1 $183.50 $183.50 $205.24 $205.24 $205.24 2026-03-16
29126 HCPCS Apply Short Arm Splint Dyn 1 1 $222.50 $222.50 $205.24 $205.24 $205.24 2026-03-16
29130 HCPCS Finger Splint 1 1 $118.00 $118.00 $205.24 $205.24 $205.24 2026-03-16
29131 HCPCS Application Of Finger Splint 1 1 $106.00 $106.00 $205.24 $205.24 $205.24 2026-03-16
29345 HCPCS Long Leg Cast 1 1 $381.50 $381.50 $205.24 $205.24 $205.24 2026-03-16
29355 HCPCS Long Leg Casting Walker 1 1 $398.00 $398.00 $205.24 $205.24 $205.24 2026-03-16
29405 HCPCS Short Leg Cast 1 1 $440.00 $440.00 $205.24 $205.24 $205.24 2026-03-16
29440 HCPCS Add Walker To Cast 1 1 $120.00 $120.00 $205.24 $205.24 $205.24 2026-03-16
29580 HCPCS Unna Boot 1 1 $171.50 $171.50 $205.24 $205.24 $205.24 2026-03-16
36430 HCPCS Blood Adm 1 Unit 2 2 $1,070.00 $1,070.00 $801.22 $915.62 $858.42 2026-03-16
36680 HCPCS Intraosseous Needle Placement 1 1 $899.00 $899.00 $205.24 $205.24 $205.24 2026-03-16
43235 HCPCS Egd Dx Brush Wash 2 1 $2,839.00 $2,839.00 $125.42 $2,125.84 $1,125.63 2026-03-16
43239 HCPCS Egd/gastroscopy 4 2 $2,839.00 $2,839.00 $141.10 $2,041.24 $1,138.78 2026-03-16
43249 HCPCS Egd Dilation <30mm 1 1 $2,775.00 $2,775.00 $205.24 $205.24 $205.24 2026-03-16
45305 HCPCS Procto With Biopsy 1 1 $484.00 $484.00 $205.24 $205.24 $205.24 2026-03-16
45307 HCPCS Proctoscope Foreign Body 1 1 $575.00 $575.00 $205.24 $205.24 $205.24 2026-03-16
45378 HCPCS Colonoscopy Dx 7 3 $3,259.00 $3,259.00 $188.95 $3,259.00 $2,343.23 2026-03-16
45380 HCPCS Colonoscopy W/biopsy 2 1 $852.75 $852.75 $205.24 $2,542.32 $1,373.78 2026-03-16
45384 HCPCS Colonoscopy W Lesion Removal Hot Snare 1 1 $3,593.00 $3,593.00 $2,583.37 $2,583.37 $2,583.37 2026-03-16
45385 HCPCS Colonoscopy W Lesion Removal 3 2 $3,593.00 $3,593.00 $205.24 $2,055.13 $259.45 2026-03-16
49505 HCPCS Hernia Repair 1 1 $5,348.00 $5,348.00 $205.24 $205.24 $205.24 2026-03-16
49560 HCPCS Repair Vental Hernia Reducibl 1 1 $1,898.00 $1,898.00 $205.24 $205.24 $205.24 2026-03-16
49561 HCPCS Hernia Repair Init Block 1 1 $5,624.00 $5,624.00 $205.24 $205.24 $205.24 2026-03-16
49587 HCPCS Repair Umbilical Hernia 1 1 $5,624.00 $5,624.00 $205.24 $205.24 $205.24 2026-03-16
51702 HCPCS Foley Cath Insertion 2 2 $319.00 $319.00 $238.87 $240.02 $239.44 2026-03-16
54056 HCPCS Cyrotherapy Lesions 1 1 $401.50 $401.50 $205.24 $205.24 $205.24 2026-03-16
55250 HCPCS Vasectomy 1 1 $3,120.00 $3,120.00 $205.24 $205.24 $205.24 2026-03-16
58301 HCPCS IUD Removal 1 1 $298.00 $298.00 $205.24 $205.24 $205.24 2026-03-16
65205 HCPCS Remove Forgein Body Eye 2 2 $236.00 $236.00 $188.80 $205.24 $197.02 2026-03-16
65210 HCPCS Removal Forgein Body Eye 1 1 $102.00 $102.00 $205.24 $205.24 $205.24 2026-03-16
69200 HCPCS Removal Forgein Body Ear Canal 1 1 $229.00 $229.00 $205.24 $205.24 $205.24 2026-03-16
69210 HCPCS Removal Impacted Ear Wax(unilateral) 1 1 $163.00 $163.00 $205.24 $205.24 $205.24 2026-03-16
70450 HCPCS CT Head Without Cont 5 4 $1,014.00 $1,014.00 $686.87 $1,014.00 $729.06 2026-03-16
70486 HCPCS CT Face/sin/jaw Without 4 4 $1,289.00 $1,289.00 $932.84 $1,289.00 $998.20 2026-03-16
70487 HCPCS CT Face/sin/jaw W Cont 2 2 $1,579.00 $1,579.00 $903.24 $1,072.79 $988.01 2026-03-16
70490 HCPCS CT Neck Without Contrast 1 1 $1,459.00 $1,459.00 $834.31 $834.31 $834.31 2026-03-16
70491 HCPCS CT Neck W Contrast 2 2 $1,880.00 $1,880.00 $1,277.13 $1,360.55 $1,318.84 2026-03-16
70496 HCPCS CT Angio Head W 2 2 $2,333.00 $2,333.00 $1,688.39 $1,746.95 $1,717.67 2026-03-16
70498 HCPCS CT Angio Neck W 2 2 $2,497.00 $2,497.00 $1,807.07 $1,869.75 $1,838.41 2026-03-16
70543 HCPCS MRI Orbit/face/neck W&without Contrast 2 2 $4,540.00 $4,540.00 $3,286.83 $4,540.00 $3,913.41 2026-03-16
70544 HCPCS MRA Head Without Contrast 1 1 $3,464.00 $3,464.00 $2,593.84 $2,593.84 $2,593.84 2026-03-16
70547 HCPCS MRA Neck Without Contrast 1 1 $3,784.00 $3,784.00 $2,720.69 $2,720.69 $2,720.69 2026-03-16
70551 HCPCS MRI Brain Without Contrast 3 3 $2,804.00 $2,804.00 $2,029.25 $2,099.64 $2,088.42 2026-03-16
70553 HCPCS MRI Brain W&without Contrast 5 4 $4,624.00 $4,624.00 $3,324.65 $4,624.00 $3,462.45 2026-03-16
71250 HCPCS CT Chest Without Cont 4 4 $1,466.00 $1,466.00 $838.43 $1,466.00 $1,098.06 2026-03-16
71260 HCPCS CT Chest W Cont 3 3 $1,894.00 $1,894.00 $1,370.68 $1,418.23 $1,417.15 2026-03-16
71271 HCPCS CT Low Dose Chest Without Screening 3 2 $689.00 $689.00 $495.39 $689.00 $513.17 2026-03-16
71275 HCPCS CT Angio Chest W 2 2 $2,396.00 $2,396.00 $1,733.98 $1,794.12 $1,764.05 2026-03-16
72125 HCPCS CT Cervical Spine Without 5 5 $1,489.00 $1,489.00 $1,025.95 $1,489.00 $1,113.51 2026-03-16
72128 HCPCS CT Thoracic Spine Without 3 3 $1,482.00 $1,482.00 $1,109.72 $1,482.00 $1,110.29 2026-03-16
72131 HCPCS CT Lumbar Spine Without 5 4 $1,474.00 $1,474.00 $1,059.80 $1,474.00 $1,103.73 2026-03-16
72141 HCPCS MRI C Spine Without - Cervical 5 4 $2,695.00 $2,695.00 $1,830.68 $2,695.00 $2,011.74 2026-03-16
72146 HCPCS MRI T Spine Without - Thoracic 3 3 $2,439.00 $2,439.00 $1,821.07 $2,439.00 $1,826.32 2026-03-16
72148 HCPCS MRI L Spine Without - Lumbar 5 4 $2,437.00 $2,437.00 $1,752.20 $2,437.00 $1,824.83 2026-03-16
72156 HCPCS MRI C Spine W&without - Cervical 2 2 $4,272.00 $4,272.00 $3,091.64 $3,181.79 $3,136.72 2026-03-16
72157 HCPCS MRI T Spine W & Without - Thoracic 1 1 $4,598.00 $4,598.00 $3,305.97 $3,305.97 $3,305.97 2026-03-16
72158 HCPCS MRI L Spine W&without - Lumbar 1 1 $4,624.00 $4,624.00 $3,462.45 $3,462.45 $3,462.45 2026-03-16
72192 HCPCS CT Pelvic Without Cont 2 2 $1,260.00 $1,260.00 $868.33 $943.49 $905.91 2026-03-16
72195 HCPCS MRI Pelvis Without Contrast 1 1 $3,422.00 $3,422.00 $2,562.39 $2,562.39 $2,562.39 2026-03-16
72197 HCPCS MRI Pelvis W&without 1 1 $4,556.00 $4,556.00 $3,297.17 $3,297.17 $3,297.17 2026-03-16
73200 HCPCS CT Upp Ext Lt Without CONT,Left 1 1 $1,469.00 $1,469.00 $1,067.79 $1,067.79 $1,067.79 2026-03-16
73218 HCPCS MRI Ext Upper Lt Non-joint WO,Left 1 1 $3,526.00 $3,526.00 $2,395.42 $2,395.42 $2,395.42 2026-03-16
73221 HCPCS MRI Ext Upper Lt Joint W/O,Left 5 4 $2,829.00 $2,829.00 $1,915.17 $2,829.00 $2,047.34 2026-03-16
73521 HCPCS Xr Hip Bil 2v - Pelvis 1 1 $255.00 $255.00 $190.94 $190.94 $190.94 2026-03-16
73700 HCPCS CT Low Ext Lt Without CONT,Left 2 2 $1,474.00 $1,474.00 $1,059.81 $1,103.73 $1,081.77 2026-03-16
73701 HCPCS CT Low Ext Lt W CONT,Left 4 2 $1,904.00 $1,904.00 $1,368.98 $1,425.72 $1,401.82 2026-03-16
73702 HCPCS CT Low Ext Lt W&without CONT,Left 1 1 $2,426.00 $2,426.00 $1,744.29 $1,744.29 $1,744.29 2026-03-16
73718 HCPCS MRI Ext Lower Lt Non-joint WO,Left 5 3 $3,403.00 $3,403.00 $2,446.76 $2,548.17 $2,534.55 2026-03-16
73720 HCPCS MRI Ext Lower Lt Non-joint W&W/O,Left 1 1 $4,540.00 $4,540.00 $3,285.59 $3,285.59 $3,285.59 2026-03-16
73721 HCPCS MRI Ext Lower Lt Joint W/O,Left 7 4 $2,902.00 $2,902.00 $2,086.53 $2,902.00 $2,173.02 2026-03-16
73723 HCPCS MRI Ext Lower Lt Joint W&W/O,Left 1 1 $4,540.00 $4,540.00 $3,399.55 $3,399.55 $3,399.55 2026-03-16
74150 HCPCS CT Abd Without Cont 1 1 $1,221.00 $1,221.00 $877.89 $877.89 $877.89 2026-03-16
74174 HCPCS CT Angio Abd/pel W 2 2 $3,395.00 $3,395.00 $2,456.96 $2,475.63 $2,466.30 2026-03-16
74176 HCPCS CT Abd/pel Without Contrast 3 3 $1,321.00 $1,321.00 $949.79 $1,321.00 $989.16 2026-03-16
74177 HCPCS CT Abd/pel W Cont 4 4 $2,502.00 $2,502.00 $1,696.60 $2,001.60 $1,836.22 2026-03-16
74178 HCPCS CT Abd/pel W&without Cont 3 3 $2,872.00 $2,872.00 $2,064.96 $2,150.55 $2,143.57 2026-03-16
74181 HCPCS MRI Abdomen Without Contrast 2 2 $2,943.00 $2,943.00 $2,198.45 $2,857.00 $2,527.72 2026-03-16
74183 HCPCS MRI Abdomen W&without 4 3 $4,556.00 $4,556.00 $2,606.03 $4,556.00 $3,404.67 2026-03-16
76536 HCPCS US Thyroid B-scan 3 3 $604.00 $604.00 $434.27 $452.28 $436.75 2026-03-16
76642 HCPCS US B-scan Lt Limited - Breast SCAN,Left 2 2 $373.00 $373.00 $277.81 $279.30 $278.56 2026-03-16
76700 HCPCS US Abd Complete - Abdominal 4 3 $615.00 $615.00 $415.69 $615.00 $445.32 2026-03-16
76705 HCPCS US Abd Limited - Abdominal 2 2 $473.00 $473.00 $340.08 $354.18 $347.13 2026-03-16
76770 HCPCS US Renal/aorta/nodes 2 2 $603.00 $603.00 $436.39 $451.53 $443.96 2026-03-16
76856 HCPCS US Pelvic Complete 2 2 $521.00 $521.00 $374.59 $390.12 $382.36 2026-03-16
76870 HCPCS US Scrotum 1 1 $527.00 $527.00 $378.92 $378.92 $378.92 2026-03-16
76881 HCPCS US Ext Nonvas Complete 1 1 $570.00 $570.00 $409.83 $409.83 $409.83 2026-03-16
77067 HCPCS Ma Mammo Bilat Screening 4 4 $541.00 $541.00 $87.65 $432.80 $395.96 2026-03-16
77080 HCPCS Bd Bone Density 4 3 $482.00 $482.00 $346.55 $462.33 $353.40 2026-03-16
80050 HCPCS General Health Plan Panel 3 2 $299.00 $299.00 $50.13 $296.01 $221.81 2026-03-16
80074 HCPCS Hepatitis Panel ACUTE,Ref Lab 1 1 $396.50 $396.50 $286.94 $286.94 $286.94 2026-03-16
80307 HCPCS Drug Screen 9 Panel Serum Or PLASMA,Ref Lab 2 2 $598.50 $598.50 $62.14 $430.32 $246.23 2026-03-16
82024 HCPCS Adrenocorticotropic HORMONE,Ref Lab 3 2 $337.00 $337.00 $242.30 $337.00 $251.00 2026-03-16
82088 HCPCS Aldosterone SERUM,Ref Lab 1 1 $355.00 $355.00 $264.40 $264.40 $264.40 2026-03-16
82166 HCPCS Anti-mullerian HORMONE,Ref Lab 1 1 $386.00 $386.00 $277.53 $277.53 $277.53 2026-03-16
82306 HCPCS Vitamin D 25-hydrox ( D2 & D3),Ref Lab 4 3 $258.50 $258.50 $185.86 $258.50 $192.53 2026-03-16
82626 HCPCS DHEA,Ref Lab 2 1 $221.50 $221.50 $159.25 $212.85 $186.05 2026-03-16
82962 HCPCS Glucoscan 1 1 $9.00 $9.00 $205.24 $205.24 $205.24 2026-03-16
83026 HCPCS Hemoglobulin Electrophoresis 1 1 $11.00 $11.00 $205.24 $205.24 $205.24 2026-03-16
83880 HCPCS B-type Natriuret Peptide (npl) Send OUT,Ref Lab 4 4 $296.00 $296.00 $39.26 $220.46 $216.64 2026-03-16
83970 HCPCS Parathyroid H Intact Wo/ CA,Ref Lab 4 3 $359.50 $359.50 $41.28 $359.50 $263.12 2026-03-16
86335 HCPCS Other Fluid W CONCENTRATION,Ref Lab 1 1 $255.50 $255.50 $190.30 $190.30 $190.30 2026-03-16
86581 HCPCS Streptococcus Pneumoniae Ab IGG,Ref Lab 1 1 $290.00 $290.00 $208.51 $208.51 $208.51 2026-03-16
86923 HCPCS Crossmatch, ELECTRONIC,Ref Lab 1 1 $271.00 $271.00 $201.84 $201.84 $201.84 2026-03-16
87491 HCPCS Chlamydia AMPLIFIED,Ref Lab 1 1 $305.50 $305.50 $219.66 $219.66 $219.66 2026-03-16
87493 HCPCS C Difficile Toxin By PCR,Ref Lab 4 4 $305.50 $305.50 $37.27 $244.40 $223.59 2026-03-16
87591 HCPCS Gonorrhoeae AMPLIFIED,Ref Lab 1 1 $305.50 $305.50 $219.66 $219.66 $219.66 2026-03-16
87799 HCPCS Bk Virus Quantitative Naat, PLASMA,Ref Lab 1 1 $442.50 $442.50 $329.57 $329.57 $329.57 2026-03-16
88142 HCPCS Cytopath Cervical Or Vaginal 1 1 $61.00 $61.00 $205.24 $205.24 $205.24 2026-03-16
88305 HCPCS Level 4 PATHOLOGY,Ref Lab 2 2 $269.50 $269.50 $201.80 $201.97 $201.88 2026-03-16
88342 HCPCS IMMUNOCYTOCHEMISTRY,Ref Lab 1 1 $280.00 $280.00 $195.94 $195.94 $195.94 2026-03-16
90670 HCPCS Snf-prevnar 13 (pneumo) 0.5 Ml Vial 1 1 $587.48 $587.48 $205.24 $205.24 $205.24 2026-03-16
90675 HCPCS Rabies Vaccine Intradermal US 1 1 $413.50 $413.50 $205.24 $205.24 $205.24 2026-03-16
90677 HCPCS Cln - Prevnar 20 2 2 $327.50 $327.50 $306.64 $890.62 $598.63 2026-03-16
90685 HCPCS Flu Vac No Prsv 4 Val 6-35 1 1 $24.50 $24.50 $205.24 $205.24 $205.24 2026-03-16
90688 HCPCS Cln - Fluzone Quadrivalent 1 1 $23.50 $23.50 $205.24 $205.24 $205.24 2026-03-16
90700 HCPCS Immunization; Dtap 1 1 $38.00 $38.00 $205.24 $205.24 $205.24 2026-03-16
90732 HCPCS Snf Prevnar 23 (pneumo) 0.5 Ml Vial 1 1 $151.00 $151.00 $205.24 $205.24 $205.24 2026-03-16
90740 HCPCS Hepatitis B Vaccine 3 Shots 1 1 $241.00 $241.00 $205.24 $205.24 $205.24 2026-03-16
90744 HCPCS Immunization; Hepatitis B 1 1 $36.00 $36.00 $205.24 $205.24 $205.24 2026-03-16
90746 HCPCS Cln - Engerix-b 1 1 $80.00 $80.00 $205.24 $205.24 $205.24 2026-03-16
90750 HCPCS Cln - Shingrix 1 1 $236.50 $236.50 $236.50 $236.50 $236.50 2026-03-16
90792 HCPCS Psych Diag Eval W/med Srvcs 4 3 $527.50 $527.50 $268.57 $420.24 $337.02 2026-03-16
91320 HCPCS Snf Comirnaty Covid Booster 2025-26 1 1 $385.00 $385.00 $373.53 $373.53 $373.53 2026-03-16
93244 HCPCS Cln - Epatch Interpretation 1 1 $62.00 $62.00 $205.24 $205.24 $205.24 2026-03-16
93270 HCPCS Mcot Live Holter Monitor Hook-up &Record 1 1 $75.00 $75.00 $205.24 $205.24 $205.24 2026-03-16
93272 HCPCS Cln - Mcot Interpretation 1 1 $64.50 $64.50 $205.24 $205.24 $205.24 2026-03-16
93306 HCPCS US Echocardiogram 4 4 $1,194.00 $1,194.00 $858.48 $1,194.00 $893.93 2026-03-16
93880 HCPCS US Carotid Duplex Bilateral 2 2 $1,174.00 $1,174.00 $844.10 $879.09 $861.60 2026-03-16
93970 HCPCS US Venous Dopp Bilat - Doppler Ven 1 1 $1,232.00 $1,232.00 $922.52 $922.52 $922.52 2026-03-16
93971 HCPCS US Venous Dopp Lt Unilat - DOPPLER,Left 2 2 $814.00 $814.00 $609.52 $814.00 $711.76 2026-03-16
94640 HCPCS Nebulizer Treatment 1 1 $22.00 $22.00 $205.24 $205.24 $205.24 2026-03-16
95115 HCPCS Allergan Immunotherapt 1 1 $29.00 $29.00 $205.24 $205.24 $205.24 2026-03-16
96360 HCPCS IV Hydration 1st Hr 3 3 $525.00 $525.00 $380.39 $525.00 $508.00 2026-03-16
96365 HCPCS ER IV Therapy 1st Hr 4 3 $508.00 $508.00 $365.25 $508.00 $444.19 2026-03-16
96374 HCPCS ER Ivp Infusion 2 2 $508.00 $508.00 $367.63 $445.78 $406.70 2026-03-16
97161 HCPCS Pt Evaluation,physical Therapist Service 6 5 $429.00 $429.00 $308.14 $442.00 $342.29 2026-03-16
97597 HCPCS Rmvl Devital Tis 20 Cm/< 1 1 $271.50 $271.50 $205.24 $205.24 $205.24 2026-03-16
97750 HCPCS Pt Physical Performance Test 1 1 $279.00 $279.00 $205.24 $205.24 $205.24 2026-03-16
99000 HCPCS Collection/conveyance To Lab 1 1 $21.00 $21.00 $205.24 $205.24 $205.24 2026-03-16
99100 HCPCS Anesthesia Extreme Age 1 1 $52.00 $52.00 $205.24 $205.24 $205.24 2026-03-16
99140 HCPCS Anesthesia ER Conditions 1 1 $52.00 $52.00 $205.24 $205.24 $205.24 2026-03-16
99202 HCPCS Office Visit-new Patient 1 1 $166.50 $166.50 $205.24 $205.24 $205.24 2026-03-16
99203 HCPCS Office Visit-new Patient 3 3 $260.00 $260.00 $205.82 $269.61 $232.20 2026-03-16
99204 HCPCS Office Visit-new Patient 3 3 $389.50 $389.50 $264.32 $327.24 $308.42 2026-03-16
99212 HCPCS Op Visit Estab Pt (phy) 3 3 $81.00 $81.00 $103.82 $290.82 $269.61 2026-03-16
99213 HCPCS Office O/p Est Low 20-29 Min 5 4 $212.00 $212.00 $108.17 $290.82 $186.87 2026-03-16
99214 HCPCS Office O/p Est Mod 30-39 Min 5 4 $298.50 $298.50 $152.54 $290.82 $251.06 2026-03-16
99215 HCPCS Office O/p Est Hi 40-54 Min 5 4 $419.00 $419.00 $214.74 $351.75 $290.82 2026-03-16
99217 HCPCS Op Obser D/c (fnp) 1 1 $189.00 $189.00 $205.24 $205.24 $205.24 2026-03-16
99218 HCPCS Initial Obser Visit Lc (fnp) 1 1 $259.00 $259.00 $205.24 $205.24 $205.24 2026-03-16
99219 HCPCS Initial Obser Visit Mc (fnp) 1 1 $351.00 $351.00 $205.24 $205.24 $205.24 2026-03-16
99220 HCPCS Initial Obser Visit Hc (fnp) 1 1 $480.00 $480.00 $205.24 $205.24 $205.24 2026-03-16
99223 HCPCS Initial Care High (phy) 2 2 $460.50 $460.50 $152.49 $373.94 $263.22 2026-03-16
99224 HCPCS Subsequent Obser Care Low (fnp) 1 1 $103.00 $103.00 $205.24 $205.24 $205.24 2026-03-16
99225 HCPCS Subsequent Obser Care Moderate (fnp) 1 1 $189.00 $189.00 $205.24 $205.24 $205.24 2026-03-16
99233 HCPCS Subsequent Care-h C 2 2 $319.50 $319.50 $211.97 $254.60 $233.28 2026-03-16
99234 HCPCS Hospital Care Low (fnp),np Or Pa 1 1 $263.50 $263.50 $205.24 $205.24 $205.24 2026-03-16
99235 HCPCS Hospital Care Mod (phy) 1 1 $428.50 $428.50 $205.24 $205.24 $205.24 2026-03-16
99236 HCPCS Hospital Care Hi (phy) 3 3 $560.50 $560.50 $182.04 $391.12 $205.24 2026-03-16
99239 HCPCS Hospital Discharge-high 1 1 $310.50 $310.50 $205.24 $205.24 $205.24 2026-03-16
99241 HCPCS Consult Op Level I (phy) 1 1 $84.00 $84.00 $205.24 $205.24 $205.24 2026-03-16
99242 HCPCS Consult Op Level Ii 1 1 $177.00 $177.00 $205.24 $205.24 $205.24 2026-03-16
99243 HCPCS Consulation Op-level 3 1 1 $307.50 $307.50 $205.24 $205.24 $205.24 2026-03-16
99244 HCPCS Consulation Op-level 4 1 1 $460.50 $460.50 $205.24 $205.24 $205.24 2026-03-16
99245 HCPCS Consulation Op-level 5 1 1 $561.00 $561.00 $205.24 $205.24 $205.24 2026-03-16
99251 HCPCS Ip Consult 1 1 $122.50 $122.50 $205.24 $205.24 $205.24 2026-03-16
99252 HCPCS Inpatient Consultation 1 1 $187.00 $187.00 $205.24 $205.24 $205.24 2026-03-16
99253 HCPCS Ip Consulation 1 1 $287.00 $287.00 $205.24 $205.24 $205.24 2026-03-16
99254 HCPCS Ip Consulation 1 1 $415.50 $415.50 $205.24 $205.24 $205.24 2026-03-16
99255 HCPCS Inpatient Consultation 1 1 $501.00 $501.00 $205.24 $205.24 $205.24 2026-03-16
99282 HCPCS ER Low SEVERITY,same Day As Other Service 6 5 $115.25 $115.25 $264.59 $368.00 $285.35 2026-03-16
99283 HCPCS ER Moderate SEVERITY,same Day As Other Service 10 5 $195.75 $195.75 $61.56 $696.00 $472.80 2026-03-16
99284 HCPCS ER High SEVERITY,same Day As Other Service 9 5 $332.00 $332.00 $104.80 $1,090.00 $783.71 2026-03-16
99285 HCPCS ER Significant THREAT,same Day As Other Service 3 2 $481.00 $481.00 $151.81 $1,146.41 $1,100.78 2026-03-16
99291 HCPCS Critical Care 30-74 Min 2 1 $733.00 $733.00 $205.24 $250.00 $227.62 2026-03-16
99292 HCPCS Critical Care Ea Add 30 Min 1 1 $324.50 $324.50 $205.24 $205.24 $205.24 2026-03-16
99304 HCPCS Nursing Facility Care Initial 1 1 $218.00 $218.00 $205.24 $205.24 $205.24 2026-03-16
99305 HCPCS Nursing Facility Care Initial 3 3 $360.50 $360.50 $205.24 $290.82 $269.61 2026-03-16
99307 HCPCS Nursing Facility Subs Care 2 2 $108.00 $108.00 $205.24 $264.32 $234.78 2026-03-16
99308 HCPCS Nursing Facility Subs Care 3 3 $201.50 $201.50 $205.24 $290.82 $264.32 2026-03-16
99309 HCPCS Nursing Facility Subs Care 3 3 $292.50 $292.50 $205.24 $290.82 $269.61 2026-03-16
99315 HCPCS Nursing Home Discharge 2 2 $220.50 $220.50 $205.24 $290.82 $248.03 2026-03-16
99316 HCPCS Discharge 1 1 $353.50 $353.50 $205.24 $205.24 $205.24 2026-03-16
99318 HCPCS Annual Nursing Fac Assessment 1 1 $245.00 $245.00 $205.24 $205.24 $205.24 2026-03-16
99341 HCPCS Home Visit-new Patient 1 1 $133.50 $133.50 $205.24 $205.24 $205.24 2026-03-16
99343 HCPCS Home Visit-new Patient 1 1 $321.50 $321.50 $205.24 $205.24 $205.24 2026-03-16
99345 HCPCS Home Visit-new Patient 1 1 $544.00 $544.00 $205.24 $205.24 $205.24 2026-03-16
99347 HCPCS Home Visit-estab Patient 1 1 $122.50 $122.50 $205.24 $205.24 $205.24 2026-03-16
99348 HCPCS Home Visit-estab Patient 2 2 $208.00 $208.00 $205.24 $290.82 $248.03 2026-03-16
99349 HCPCS Home Visit-estab Patient 2 2 $344.00 $344.00 $205.24 $290.82 $248.03 2026-03-16
99350 HCPCS Home Visit-estab Patient 1 1 $499.50 $499.50 $205.24 $205.24 $205.24 2026-03-16
99381 HCPCS Newborn Evaluation 1 1 $298.00 $298.00 $205.24 $205.24 $205.24 2026-03-16
99382 HCPCS Prev Med Early Child 1-4 2 2 $312.50 $312.50 $205.24 $234.99 $220.11 2026-03-16
99383 HCPCS Prev Med Late Child 5-11 1 1 $324.50 $324.50 $205.24 $205.24 $205.24 2026-03-16
99384 HCPCS Prev Med Adolescent 12-17 1 1 $364.00 $364.00 $205.24 $205.24 $205.24 2026-03-16
99385 HCPCS Prev Med Adolescent 18-39 1 1 $354.00 $354.00 $205.24 $205.24 $205.24 2026-03-16
99386 HCPCS Prev Med Visit New Pt 40-64 Yr 1 1 $408.00 $408.00 $205.24 $205.24 $205.24 2026-03-16
99387 HCPCS Prev Med New Pt; 65+ 1 1 $443.00 $443.00 $205.24 $205.24 $205.24 2026-03-16
99391 HCPCS Prev Med Visit Under 1 Yr 2 2 $267.00 $267.00 $208.42 $269.61 $239.01 2026-03-16
99392 HCPCS Prev Med Early Child Age 1-4 3 3 $284.50 $284.50 $205.24 $269.61 $216.16 2026-03-16
99393 HCPCS Well Child Exam 5-11 Yrs 2 2 $284.50 $284.50 $226.40 $269.61 $248.00 2026-03-16
99394 HCPCS Prev Med Exam 12-17 Yrs 2 2 $310.50 $310.50 $247.38 $269.61 $258.50 2026-03-16
99395 HCPCS Prev Med; 18-39 2 1 $319.50 $319.50 $138.27 $254.60 $196.44 2026-03-16
99396 HCPCS Prev Med Eval 40-64 Yrs 2 2 $339.50 $339.50 $242.45 $270.52 $256.49 2026-03-16
99397 HCPCS Prev Med Eval > 65 Yr 2 2 $366.00 $366.00 $261.66 $291.49 $276.58 2026-03-16
A4565 HCPCS Sling Cradle Arm 1 1 $14.00 $14.00 $205.24 $205.24 $205.24 2026-03-16
E0114 HCPCS Crutches Underarm Not Wood 1 1 $87.00 $87.00 $205.24 $205.24 $205.24 2026-03-16
G0101 HCPCS Cx/vag Ca Screen Pelvic 1 1 $106.50 $106.50 $205.24 $205.24 $205.24 2026-03-16
G0105 HCPCS Colonoscopy (screen Hi Risk) 2 1 $3,593.00 $3,593.00 $192.20 $2,676.07 $1,434.14 2026-03-16
G0121 HCPCS Colonoscopy (screening) 2 1 $3,593.00 $3,593.00 $192.39 $2,676.07 $1,434.23 2026-03-16
G0379 HCPCS Direct Admit 1 1 $1,069.00 $1,069.00 $800.47 $800.47 $800.47 2026-03-16
G0402 HCPCS Welcome To Medicare 1 1 $451.50 $451.50 $205.24 $205.24 $205.24 2026-03-16
G0438 HCPCS Annual Wellness Exam 2 2 $450.50 $450.50 $205.24 $290.82 $248.03 2026-03-16
G0439 HCPCS Annual Wellness Subsequent 2 2 $355.00 $355.00 $205.24 $290.82 $248.03 2026-03-16
J0171 HCPCS Cln - Epinephrine Hcl 1 Mg/10 Ml 1 1 $2.00 $2.00 $205.24 $205.24 $205.24 2026-03-16
J0698 HCPCS Cefotaxime Sodium Inj 1 1 $12.50 $12.50 $205.24 $205.24 $205.24 2026-03-16
J1010 HCPCS Depo-medrol(methylprednisolon)40 Mg/1 Ml 1 1 $30.00 $30.00 $205.24 $205.24 $205.24 2026-03-16
J1160 HCPCS Digoxin 500 Mcg/2 Ml Ivp 1 1 $30.00 $30.00 $205.24 $205.24 $205.24 2026-03-16
J1940 HCPCS Cln - Furosemide 40 Mg/4 Ml 8 7 $2.00 $2.00 $205.24 $205.24 $205.24 2026-03-16
J2001 HCPCS Cln - Lidocaine Hcl 1% 8 7 $2.00 $2.00 $205.24 $205.24 $205.24 2026-03-16
J2730 HCPCS Cln - Lidocaine Hcl 2% 8 7 $109.00 $109.00 $205.24 $205.24 $205.24 2026-03-16
J2930 HCPCS Methyprednisolone Inj 8 7 $7.00 $7.00 $205.24 $205.24 $205.24 2026-03-16
J3360 HCPCS Valium (diazepam) 5 Mg/ml Vial 1 1 $135.73 $135.73 $205.24 $205.24 $205.24 2026-03-16
J7325 HCPCS Synvisc Or Synvisc One 1 1 $12.00 $12.00 $205.24 $205.24 $205.24 2026-03-16
J7620 HCPCS Cln - Albuterol Sulfate 2.5 Mg/3 Ml 1 1 $2.00 $2.00 $205.24 $205.24 $205.24 2026-03-16
J7644 HCPCS Inhalation Ipratr Bromid 1 1 $2.00 $2.00 $205.24 $205.24 $205.24 2026-03-16
L1810 HCPCS Knee Orthosis Elastic W Joint 1 1 $150.00 $150.00 $205.24 $205.24 $205.24 2026-03-16
L1830 HCPCS Knee Immob Canvas Long Pre Ots 1 1 $89.50 $89.50 $205.24 $205.24 $205.24 2026-03-16
L3908 HCPCS Wrist Splint With Ctrl Cock-up 1 1 $87.00 $87.00 $205.24 $205.24 $205.24 2026-03-16
L4387 HCPCS Cam Walker 1 1 $255.00 $255.00 $205.24 $205.24 $205.24 2026-03-16
P9016 HCPCS Leukocyte Poor Blood 2 2 $902.00 $902.00 $516.14 $675.42 $595.78 2026-03-16
Q3014 HCPCS Telehealth Site Fee 1 1 $102.00 $102.00 $205.24 $205.24 $205.24 2026-03-16
Q5108 HCPCS Fulphila Subcutaneous Solution 6mg/0. 2 2 $7,469.00 $7,469.00 $366.73 $466.07 $416.40 2026-03-16
S9981 HCPCS Mr Copying Fee Pg 1-25 1 1 $20.00 $20.00 $205.24 $205.24 $205.24 2026-03-16
S9982 HCPCS Mr Copying Fee Per Page 1 1 $0.75 $0.75 $205.24 $205.24 $205.24 2026-03-16
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