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 →

Export CSV
Hospital

PRAGUE REGIONAL MEMORIAL HOSPITAL

Prague, OK · CCN 371301 · 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: $1,086 across 21 payers · range $500-$1,781

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbPMHPRAGUEOK&type=CDMWithoutLabel&fileType=CSV · observed 2026-03-30

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.

2,476 distinct procedures filed
21 distinct payers
47,761 rate rows
2026-03-30 last MRF observed
Data quality

46,159 of 47,761 rate rows are consumer-grade (96.6%)

1,602 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
per-diem day rate — not a per-procedure price 972
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 392
exceeds 10× this hospital's gross charge — excluded from medians 133
percent-of-charges filed in the dollar field — excluded from medians 103
exceeds 3× this hospital's gross charge for a DRG stay — excluded 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbPMHPRAGUEOK&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/Prague.aspx
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-19
Content fingerprint 6c04075200d2618e… · 16,678,063 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
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 21 $114.53 $38,278.50 $23,349.89 nat. median
$3,787
outlier · 6.2×
264
MS_DRG 		Other Circulatory System O.r. Procedures 8 $18,281.52 $36,990.46 $22,518.98 nat. median
$31,243
0.7× median
570
MS_DRG 		Skin Debridement With Mcc 8 $19,163.68 $32,566.80 $19,825.96 nat. median
$28,050
0.7× median
867
MS_DRG 		Other Infectious And Parasitic Diseases Diagnoses With Mcc 8 $14,110.26 $23,178.00 $18,716.36 nat. median
$20,269
0.9× median
64
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Mcc 8 $13,556.15 $22,267.80 $14,513.23 nat. median
$19,268
0.8× median
374
MS_DRG 		Digestive Malignancy With Mcc 8 $10,672.99 $23,681.83 $14,416.98 nat. median
$20,165
0.7× median
539
MS_DRG 		Osteomyelitis With Mcc 8 $13,277.75 $21,810.49 $13,620.49 nat. median
$18,853
0.7× median
100
MS_DRG 		Seizures With Mcc 8 $9,364.74 $21,446.19 $13,055.97 nat. median
$18,371
0.7× median
592
MS_DRG 		Skin Ulcers With Mcc 8 $11,002.65 $21,429.58 $13,045.86 nat. median
$18,752
0.7× median
91
MS_DRG 		Other Disorders Of Nervous System With Mcc 8 $10,117.03 $19,446.40 $11,838.54 nat. median
$17,070
0.7× median
70
MS_DRG 		Other Cerebrovascular Disorders With Mcc 8 $10,922.93 $18,434.33 $11,222.42 nat. median
$16,327
0.7× median
280
MS_DRG 		Acute Myocardial Infarction, Discharged Alive With Mcc 8 $7,228.43 $17,762.20 $10,813.24 nat. median
$15,670
0.7× median
393
MS_DRG 		Other Digestive System Diagnoses With Mcc 8 $9,549.42 $17,709.05 $10,780.88 nat. median
$15,626
0.7× median
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc 8 $7,236.55 $17,303.78 $10,534.16 nat. median
$15,405
0.7× median
186
MS_DRG 		Pleural Effusion With Mcc 8 $8,371.82 $17,257.27 $10,505.85 nat. median
$15,136
0.7× median
964
MS_DRG 		Other Multiple Significant Trauma With Cc 8 $9,648.19 $16,970.48 $10,331.26 nat. median
$14,949
0.7× median
682
MS_DRG 		Renal Failure With Mcc 8 $7,008.47 $16,399.11 $9,983.42 nat. median
$14,443
0.7× median
388
MS_DRG 		Gastrointestinal Obstruction With Mcc 8 $6,419.92 $16,352.61 $9,955.11 nat. median
$14,325
0.7× median
604
MS_DRG 		Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc 8 $9,290.31 $16,300.56 $9,923.43 nat. median
$14,413
0.7× median
637
MS_DRG 		Diabetes With Mcc 8 $6,707.39 $15,908.58 $9,684.79 nat. median
$13,970
0.7× median
757
MS_DRG 		Infections, Female Reproductive System With Mcc 8 $5,476.88 $15,855.43 $9,652.44 nat. median
$14,027
0.7× median
602
MS_DRG 		Cellulitis With Mcc 8 $6,718.75 $15,738.05 $9,580.98 nat. median
$14,036
0.7× median
811
MS_DRG 		Red Blood Cell Disorders With Mcc 8 $6,884.67 $15,549.81 $9,466.39 nat. median
$13,626
0.7× median
885
MS_DRG 		Psychoses 8 $2,570.65 $15,466.77 $9,415.83 nat. median
$12,315
0.8× median
858
MS_DRG 		Postoperative Or Post-traumatic Infections With O.r. Procedures Without Cc/mcc 8 $8,567.87 $15,423.58 $9,389.54 nat. median
$13,563
0.7× median
175
MS_DRG 		Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 8 $7,135.95 $15,209.87 $9,259.44 nat. median
$13,735
0.7× median
640
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 8 $5,777.19 $14,789.10 $9,003.28 nat. median
$12,851
0.7× median
291
MS_DRG 		Heart Failure And Shock With Mcc 8 $8,654.10 $14,215.52 $8,883.41 nat. median
$12,775
0.7× median
193
MS_DRG 		Simple Pneumonia And Pleurisy With Mcc 8 $5,107.65 $14,554.35 $8,860.37 nat. median
$12,877
0.7× median
86
MS_DRG 		Traumatic Stupor And Coma <1 Hour With Cc 8 $6,629.86 $14,424.80 $8,781.50 nat. median
$12,867
0.7× median
540
MS_DRG 		Osteomyelitis With Cc 8 $6,622.52 $14,353.93 $8,738.36 nat. median
$12,776
0.7× median
57
MS_DRG 		Degenerative Nervous System Disorders Without Mcc 8 $6,083.85 $14,346.18 $8,733.64 nat. median
$12,550
0.7× median
947
MS_DRG 		Signs And Symptoms With Mcc 8 $6,258.73 $14,056.07 $8,557.03 nat. median
$12,113
0.7× median
391
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 8 $6,167.09 $14,043.89 $8,549.61 nat. median
$12,544
0.7× median
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 8 $5,563.72 $13,679.58 $8,327.83 nat. median
$12,282
0.7× median
375
MS_DRG 		Digestive Malignancy With Cc 8 $5,985.37 $13,393.90 $8,153.91 nat. median
$12,163
0.7× median
302
MS_DRG 		Atherosclerosis With Mcc 8 $6,615.05 $13,249.95 $8,066.28 nat. median
$11,867
0.7× median
304
MS_DRG 		Hypertension With Mcc 8 $5,608.59 $13,176.87 $8,021.79 nat. median
$11,839
0.7× median
689
MS_DRG 		Kidney And Urinary Tract Infections With Mcc 8 $5,732.74 $12,848.00 $7,821.58 nat. median
$11,515
0.7× median
Q4197
HCPCS 		Puraply Xt, Per Square Centimeter 16 $6,375.00 $12,750.00 $7,777.50 nat. median
$211
outlier · 36.9×
436
MS_DRG 		Malignancy Of Hepatobiliary System Or Pancreas With Cc 8 $7,314.15 $12,524.67 $7,624.75 nat. median
$11,448
0.7× median
300
MS_DRG 		Peripheral Vascular Disorders With Cc 8 $4,936.58 $11,820.43 $7,196.02 nat. median
$10,846
0.7× median
433
MS_DRG 		Cirrhosis And Alcoholic Hepatitis With Cc 8 $5,768.79 $11,695.30 $7,119.84 nat. median
$10,769
0.7× median
71
MS_DRG 		Other Cerebrovascular Disorders With Cc 8 $5,561.67 $11,360.90 $6,916.27 nat. median
$10,562
0.7× median
644
MS_DRG 		Endocrine Disorders With Cc 8 $4,194.66 $11,349.83 $6,909.53 nat. median
$10,451
0.7× median
872
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 8 $4,344.99 $11,331.00 $6,898.07 nat. median
$10,410
0.7× median
92
MS_DRG 		Other Disorders Of Nervous System With Cc 8 $5,475.75 $11,327.68 $6,896.04 nat. median
$10,613
0.6× median
372
MS_DRG 		Major Gastrointestinal Disorders And Peritoneal Infections With Cc 8 $4,520.50 $11,305.53 $6,882.56 nat. median
$10,422
0.7× median
699
MS_DRG 		Other Kidney And Urinary Tract Diagnoses With Cc 8 $4,920.21 $11,239.10 $6,842.12 nat. median
$10,325
0.7× median
65
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 8 $6,176.54 $11,187.05 $6,810.43 nat. median
$10,477
0.7× median

Other procedures at this hospital

Browse this hospital's 2,476 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
             
J3101 HCPCS Injection, Tenecteplase, 1 Mg 21 21 $38,278.50 $38,278.50 $114.53 $38,278.50 $23,349.89 2026-03-30
264 MS_DRG Other Circulatory System O.r. Procedures 8 8 $339,798.77 — $18,281.52 $36,990.46 $22,518.98 2026-03-30
570 MS_DRG Skin Debridement With Mcc 8 8 $692,957.93 — $19,163.68 $32,566.80 $19,825.96 2026-03-30
867 MS_DRG Other Infectious And Parasitic Diseases Diagnoses With Mcc 8 8 $30,079.82 $1,226,354.26 $14,110.26 $23,178.00 $18,716.36 2026-03-30
64 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Mcc 8 8 $162,151.94 — $13,556.15 $22,267.80 $14,513.23 2026-03-30
374 MS_DRG Digestive Malignancy With Mcc 8 8 $411,302.46 — $10,672.99 $23,681.83 $14,416.98 2026-03-30
539 MS_DRG Osteomyelitis With Mcc 8 8 $253,654.99 — $13,277.75 $21,810.49 $13,620.49 2026-03-30
100 MS_DRG Seizures With Mcc 8 8 $23,894.99 $974,198.74 $9,364.74 $21,446.19 $13,055.97 2026-03-30
592 MS_DRG Skin Ulcers With Mcc 8 8 $362,517.02 — $11,002.65 $21,429.58 $13,045.86 2026-03-30
91 MS_DRG Other Disorders Of Nervous System With Mcc 8 8 $190,030.18 — $10,117.03 $19,446.40 $11,838.54 2026-03-30
70 MS_DRG Other Cerebrovascular Disorders With Mcc 8 8 $85,467.84 $3,484,523.84 $10,922.93 $18,434.33 $11,222.42 2026-03-30
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 8 8 $12,301.69 $501,539.90 $7,228.43 $17,762.20 $10,813.24 2026-03-30
393 MS_DRG Other Digestive System Diagnoses With Mcc 8 8 $43,829.45 $1,786,926.68 $9,549.42 $17,709.05 $10,780.88 2026-03-30
177 MS_DRG Respiratory Infections And Inflammations With Mcc 8 8 $137,839.78 — $7,236.55 $17,303.78 $10,534.16 2026-03-30
186 MS_DRG Pleural Effusion With Mcc 8 8 $104,919.31 $4,277,560.06 $8,371.82 $17,257.27 $10,505.85 2026-03-30
964 MS_DRG Other Multiple Significant Trauma With Cc 8 8 $286,845.82 — $9,648.19 $16,970.48 $10,331.26 2026-03-30
682 MS_DRG Renal Failure With Mcc 8 8 $284,527.17 — $7,008.47 $16,399.11 $9,983.42 2026-03-30
388 MS_DRG Gastrointestinal Obstruction With Mcc 8 8 $203,303.00 — $6,419.92 $16,352.61 $9,955.11 2026-03-30
604 MS_DRG Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc 8 8 $38,316.15 $1,562,149.44 $9,290.31 $16,300.56 $9,923.43 2026-03-30
637 MS_DRG Diabetes With Mcc 8 8 $37,529.13 $1,530,062.63 $6,707.39 $15,908.58 $9,684.79 2026-03-30
757 MS_DRG Infections, Female Reproductive System With Mcc 8 8 $303,312.22 — $5,476.88 $15,855.43 $9,652.44 2026-03-30
602 MS_DRG Cellulitis With Mcc 8 8 $343,136.53 — $6,718.75 $15,738.05 $9,580.98 2026-03-30
811 MS_DRG Red Blood Cell Disorders With Mcc 8 8 $89,369.49 $3,643,594.11 $6,884.67 $15,549.81 $9,466.39 2026-03-30
885 MS_DRG Psychoses 8 8 $60,608.00 $2,470,988.16 $2,570.65 $15,466.77 $9,415.83 2026-03-30
858 MS_DRG Postoperative Or Post-traumatic Infections With O.r. Procedures Without Cc/mcc 8 8 $328,879.94 — $8,567.87 $15,423.58 $9,389.54 2026-03-30
175 MS_DRG Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 8 8 $255,614.20 — $7,135.95 $15,209.87 $9,259.44 2026-03-30
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 8 8 $151,882.08 — $5,777.19 $14,789.10 $9,003.28 2026-03-30
291 MS_DRG Heart Failure And Shock With Mcc 8 8 $597,054.67 — $8,654.10 $14,215.52 $8,883.41 2026-03-30
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 8 8 $23,141.69 $943,486.70 $5,107.65 $14,554.35 $8,860.37 2026-03-30
86 MS_DRG Traumatic Stupor And Coma <1 Hour With Cc 8 8 $420,324.75 — $6,629.86 $14,424.80 $8,781.50 2026-03-30
540 MS_DRG Osteomyelitis With Cc 8 8 $102,902.52 $4,195,335.74 $6,622.52 $14,353.93 $8,738.36 2026-03-30
57 MS_DRG Degenerative Nervous System Disorders Without Mcc 8 8 $123,467.30 — $6,083.85 $14,346.18 $8,733.64 2026-03-30
947 MS_DRG Signs And Symptoms With Mcc 8 8 $86,295.04 $3,518,248.78 $6,258.73 $14,056.07 $8,557.03 2026-03-30
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 8 8 $14,920.16 $608,294.92 $6,167.09 $14,043.89 $8,549.61 2026-03-30
189 MS_DRG Pulmonary Edema And Respiratory Failure 8 8 $182,001.38 — $5,563.72 $13,679.58 $8,327.83 2026-03-30
375 MS_DRG Digestive Malignancy With Cc 8 8 $55,099.57 $2,246,409.27 $5,985.37 $13,393.90 $8,153.91 2026-03-30
302 MS_DRG Atherosclerosis With Mcc 8 8 $11,478.35 $467,972.33 $6,615.05 $13,249.95 $8,066.28 2026-03-30
304 MS_DRG Hypertension With Mcc 8 8 $73,464.74 $2,995,157.45 $5,608.59 $13,176.87 $8,021.79 2026-03-30
689 MS_DRG Kidney And Urinary Tract Infections With Mcc 8 8 $32,119.74 $1,309,521.90 $5,732.74 $12,848.00 $7,821.58 2026-03-30
Q4197 HCPCS Puraply Xt, Per Square Centimeter 16 16 $12,750.00 $12,750.00 $6,375.00 $12,750.00 $7,777.50 2026-03-30
436 MS_DRG Malignancy Of Hepatobiliary System Or Pancreas With Cc 8 8 $46,846.85 $1,909,946.07 $7,314.15 $12,524.67 $7,624.75 2026-03-30
300 MS_DRG Peripheral Vascular Disorders With Cc 8 8 $28,109.97 $1,146,043.27 $4,936.58 $11,820.43 $7,196.02 2026-03-30
433 MS_DRG Cirrhosis And Alcoholic Hepatitis With Cc 8 8 $61,210.79 $2,495,563.91 $5,768.79 $11,695.30 $7,119.84 2026-03-30
71 MS_DRG Other Cerebrovascular Disorders With Cc 8 8 $100,178.06 $4,084,259.51 $5,561.67 $11,360.90 $6,916.27 2026-03-30
644 MS_DRG Endocrine Disorders With Cc 8 8 $99,349.28 $4,050,470.15 $4,194.66 $11,349.83 $6,909.53 2026-03-30
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 8 8 $7,483.72 $305,111.26 $4,344.99 $11,331.00 $6,898.07 2026-03-30
92 MS_DRG Other Disorders Of Nervous System With Cc 8 8 $99,134.10 $4,041,697.26 $5,475.75 $11,327.68 $6,896.04 2026-03-30
372 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Cc 8 8 $67,202.22 $2,739,834.51 $4,520.50 $11,305.53 $6,882.56 2026-03-30
699 MS_DRG Other Kidney And Urinary Tract Diagnoses With Cc 8 8 $75,456.89 $3,076,377.41 $4,920.21 $11,239.10 $6,842.12 2026-03-30
65 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 8 8 $193,598.44 — $6,176.54 $11,187.05 $6,810.43 2026-03-30
187 MS_DRG Pleural Effusion With Cc 8 8 $121,459.94 $4,951,921.75 $5,400.55 $10,952.30 $6,667.52 2026-03-30
178 MS_DRG Respiratory Infections And Inflammations With Cc 8 8 $273,294.68 — $5,013.33 $10,807.25 $6,579.22 2026-03-30
552 MS_DRG Medical Back Problems Without Mcc 8 8 $45,269.08 $1,845,620.39 $4,934.32 $10,644.47 $6,480.12 2026-03-30
394 MS_DRG Other Digestive System Diagnoses With Cc 8 8 $22,299.30 $909,142.46 $4,758.17 $10,361.01 $6,307.55 2026-03-30
376 MS_DRG Digestive Malignancy Without Cc/mcc 8 8 $17,934.95 $731,207.91 $5,754.83 $10,234.77 $6,230.71 2026-03-30
60 MS_DRG Multiple Sclerosis And Cerebellar Ataxia Without Cc/mcc 8 8 $194,675.63 — $4,839.15 $10,184.95 $6,200.37 2026-03-30
281 MS_DRG Acute Myocardial Infarction, Discharged Alive With Cc 8 8 $78,934.95 $3,218,177.91 $5,391.52 $10,177.19 $6,195.65 2026-03-30
638 MS_DRG Diabetes With Cc 8 8 $63,283.12 $2,580,052.80 $4,036.78 $9,923.62 $6,041.28 2026-03-30
558 MS_DRG Tendonitis, Myositis And Bursitis Without Mcc 8 8 $113,100.16 $4,611,093.52 $3,568.50 $9,890.40 $6,021.06 2026-03-30
914 MS_DRG Traumatic Injury Without Mcc 8 8 $210,081.89 — $4,171.10 $9,805.14 $5,969.16 2026-03-30
Q4194 HCPCS Novachor, Per Square Centimeter 16 16 $9,750.00 $9,750.00 $4,875.00 $9,750.00 $5,947.50 2026-03-30
J0840 HCPCS Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 21 21 $9,745.00 $9,745.00 $2,442.86 $9,745.00 $5,944.45 2026-03-30
683 MS_DRG Renal Failure With Cc 8 8 $79,901.70 $3,257,592.21 $3,940.77 $9,697.73 $5,903.77 2026-03-30
312 MS_DRG Syncope And Collapse 8 8 $43,879.92 $1,788,984.34 $4,143.87 $9,651.23 $5,875.46 2026-03-30
603 MS_DRG Cellulitis Without Mcc 8 8 $235,938.88 — $3,895.20 $9,643.48 $5,870.74 2026-03-30
594 MS_DRG Skin Ulcers Without Cc/mcc 8 8 $46,916.64 $1,912,791.41 $5,396.81 $9,598.08 $5,843.10 2026-03-30
292 MS_DRG Heart Failure And Shock With Cc 8 8 $95,516.75 $3,894,217.72 $4,300.83 $9,400.98 $5,723.11 2026-03-30
191 MS_DRG Chronic Obstructive Pulmonary Disease With Cc 8 8 $191,197.35 — $4,294.48 $9,334.54 $5,682.66 2026-03-30
556 MS_DRG Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 8 8 $83,396.72 $3,400,084.07 $4,052.79 $9,197.23 $5,599.07 2026-03-30
869 MS_DRG Other Infectious And Parasitic Diseases Diagnoses Without Cc/mcc 8 8 $61,118.83 $2,491,814.70 $4,918.91 $8,079.97 $5,531.97 2026-03-30
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 8 8 $54,284.74 $2,213,188.81 $3,537.18 $8,963.59 $5,456.84 2026-03-30
536 MS_DRG Fractures Of Hip And Pelvis Without Mcc 8 8 $122,738.40 — $4,884.80 $8,942.55 $5,444.03 2026-03-30
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 8 8 $26,279.05 $1,071,397.02 $4,158.75 $8,923.73 $5,432.57 2026-03-30
176 MS_DRG Pulmonary Embolism Without Mcc 8 8 $313,790.27 — $4,362.63 $8,913.77 $5,426.51 2026-03-30
561 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc 8 8 $199,387.72 — $4,301.32 $8,901.58 $5,419.09 2026-03-30
948 MS_DRG Signs And Symptoms Without Mcc 8 8 $87,083.36 $3,550,388.49 $4,301.75 $8,863.94 $5,396.17 2026-03-30
93 MS_DRG Other Disorders Of Nervous System Without Cc/mcc 8 8 $354,122.85 — $4,172.08 $8,817.43 $5,367.86 2026-03-30
36556 HCPCS Insertion Of Non-tunneled Central Venous Tube For Infusion (5 Years Or Older) 21 21 $8,771.00 $8,771.00 $882.00 $8,771.00 $5,350.31 2026-03-30
15002 HCPCS Preparation Of Skin Graft Site Of Trunk, Arms, Or Legs, 100.0 Sq Cm Or 1% Body A… 21 21 $8,746.30 $8,746.30 $1,154.00 $8,746.30 $5,335.24 2026-03-30
66 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc 8 8 $47,871.47 $1,951,719.83 $4,613.54 $7,578.36 $5,317.52 2026-03-30
185 MS_DRG Major Chest Trauma Without Cc/mcc 8 8 $79,596.95 $3,245,167.65 $4,896.86 $8,708.91 $5,301.80 2026-03-30
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 8 8 $145,876.54 — $3,373.09 $8,632.51 $5,255.28 2026-03-30
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 8 8 $96,001.92 $3,913,998.36 $3,194.05 $8,617.01 $5,245.85 2026-03-30
645 MS_DRG Endocrine Disorders Without Cc/mcc 8 8 $16,990.17 $692,689.23 $3,284.35 $8,507.39 $5,179.11 2026-03-30
305 MS_DRG Hypertension Without Mcc 8 8 $37,593.75 $1,532,697.30 $3,985.49 $8,361.22 $5,090.13 2026-03-30
179 MS_DRG Respiratory Infections And Inflammations Without Cc/mcc 8 8 $65,465.18 $2,669,015.18 $3,640.81 $8,360.12 $5,089.46 2026-03-30
544 MS_DRG Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 8 8 $46,804.90 $1,908,235.77 $4,698.21 $8,355.69 $5,086.76 2026-03-30
182 MS_DRG Respiratory Neoplasms Without Cc/mcc 8 8 $18,443.94 $751,959.43 $4,632.25 $8,238.31 $5,015.30 2026-03-30
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 8 8 $49,080.57 $2,001,014.94 $3,639.33 $8,146.41 $4,959.35 2026-03-30
373 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/mcc 8 8 $187,090.79 — $3,623.39 $8,054.50 $4,903.40 2026-03-30
538 MS_DRG Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/mcc 8 8 $4,570.74 $186,349.07 $4,484.67 $7,975.88 $4,855.54 2026-03-30
284 MS_DRG Acute Myocardial Infarction, Expired With Cc 8 8 $69,330.98 $2,826,624.05 $4,309.72 $7,664.73 $4,666.12 2026-03-30
921 MS_DRG Complications Of Treatment Without Cc/mcc 8 8 $70,304.93 $2,866,332.00 $3,042.73 $7,622.65 $4,640.50 2026-03-30
72 MS_DRG Other Cerebrovascular Disorders Without Cc/mcc 6 6 $2,195.91 $89,527.25 $2,195.91 $6,188.74 $4,628.50 2026-03-30
303 MS_DRG Atherosclerosis Without Mcc 8 8 $80,639.75 $3,287,682.61 $3,539.23 $7,454.34 $4,538.04 2026-03-30
203 MS_DRG Bronchitis And Asthma Without Cc/mcc 8 8 $9,194.65 $374,865.88 $1,983.08 $7,418.91 $4,516.47 2026-03-30
192 MS_DRG Chronic Obstructive Pulmonary Disease Without Cc/mcc 8 8 $52,219.67 $2,128,995.95 $3,735.41 $7,108.87 $4,327.72 2026-03-30
816 MS_DRG Reticuloendothelial And Immunity Disorders Without Cc/mcc 8 8 $60,293.12 $2,458,150.50 $2,956.60 $6,998.14 $4,260.31 2026-03-30
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/mcc 8 8 $72,396.47 $2,951,603.99 $3,130.84 $6,959.38 $4,236.72 2026-03-30
05500595 CDM Scrotal Support Small 13 13 $6,945.00 — $3,472.50 $6,778.32 $4,236.45 2026-03-30
440 MS_DRG Disorders Of Pancreas Except Malignancy Without Cc/mcc 8 8 $12,506.00 $509,869.62 $3,184.53 $6,880.76 $4,188.86 2026-03-30
639 MS_DRG Diabetes Without Cc/mcc 8 8 $173,564.55 — $3,160.97 $6,878.55 $4,187.51 2026-03-30
684 MS_DRG Renal Failure Without Cc/mcc 8 8 $76,765.66 $3,129,735.75 $2,587.37 $6,647.12 $4,046.62 2026-03-30
310 MS_DRG Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 8 8 $34,347.75 $1,400,357.74 $3,264.03 $6,268.43 $3,816.08 2026-03-30
293 MS_DRG Heart Failure And Shock Without Cc/mcc 8 8 $63,757.68 $2,599,400.61 $3,368.93 $6,267.32 $3,815.41 2026-03-30
15277 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout… 38 21 $8,746.30 $8,746.30 $187.46 $8,746.30 $3,620.18 2026-03-30
15275 HCPCS Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 38 21 $8,746.30 $8,746.30 $80.75 $8,746.30 $3,620.18 2026-03-30
15274 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, Each… 38 21 $8,990.00 $8,990.00 $37.03 $8,990.00 $3,620.18 2026-03-30
15273 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.… 38 21 $17,981.10 $17,981.10 $163.10 $17,981.10 $3,620.18 2026-03-30
27372 HCPCS Removal Of Foreign Body Deep In Tissue Of Thigh Or Knee 21 21 $4,621.00 $4,621.00 $2,541.55 $5,989.48 $3,465.75 2026-03-30
15271 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C… 38 21 $5,982.89 $5,982.89 $71.52 $5,982.89 $3,440.16 2026-03-30
Q4160 HCPCS Nushield, Per Square Centimeter 128 16 $4,842.82 $4,842.82 $592.50 $10,650.00 $3,220.69 2026-03-30
05601064 CDM Ozempic 1 Mg/dose (4 Mg/3 Ml) 13 13 $4,748.10 — $2,374.05 $4,634.15 $2,896.34 2026-03-30
Q4196 HCPCS Puraply Am, Per Square Centimeter 112 16 $3,960.00 $3,960.00 $675.00 $17,820.00 $2,815.80 2026-03-30
27257 HCPCS Treatment Of Spontaneous Dislocated Hip Under Anesthesia 21 21 $4,268.00 $4,268.00 $1,456.00 $4,268.00 $2,603.48 2026-03-30
59409 HCPCS Vaginal Delivery 38 21 $5,919.00 $5,919.00 $680.34 $5,919.00 $2,565.00 2026-03-30
15278 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout… 38 21 $4,373.15 $4,373.15 $46.27 $5,948.95 $2,514.56 2026-03-30
15276 HCPCS Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne… 38 21 $4,373.15 $4,373.15 $21.17 $5,948.95 $2,514.56 2026-03-30
Q4159 HCPCS Affinity, Per Square Centimeter 16 16 $4,050.00 $4,050.00 $2,025.00 $4,050.00 $2,470.50 2026-03-30
11 CDM Room & Board - Private (one Bed) - Medical/surgical/gyn 7 7 $3,800.00 $4,077.00 $2,090.00 $3,420.00 $2,395.14 2026-03-30
94002 HCPCS Initial Hospital Inpatient Or Observation Ventilation Assistance And Management 21 21 $3,918.25 $3,918.25 $296.86 $3,918.25 $2,390.13 2026-03-30
21501 HCPCS Drainage Of Deep Abscess Or Blood Accumulation In Soft Tissue Of Neck Or Chest 21 21 $3,907.00 $3,907.00 $1,124.50 $3,907.00 $2,383.27 2026-03-30
Q4101 HCPCS Apligraf, Per Square Centimeter 16 16 $3,884.76 $3,884.76 $1,942.38 $3,884.76 $2,369.70 2026-03-30
J3590 HCPCS Unclassified Biologics 21 21 $3,600.00 $3,600.00 $0.19 $3,600.00 $2,196.00 2026-03-30
70552 HCPCS MRI Scan Of Brain With Contrast 21 21 $3,524.00 $3,524.00 $700.00 $3,524.00 $2,149.64 2026-03-30
05500594 CDM Scrotal Support Xl 13 13 $3,480.00 — $1,740.00 $3,396.48 $2,122.80 2026-03-30
Q4195 HCPCS Puraply, Per Square Centimeter 48 16 $3,480.00 $3,480.00 $382.50 $6,945.00 $2,122.80 2026-03-30
74182 HCPCS MRI Scan Of Abdomen With Contrast 21 21 $3,451.00 $3,451.00 $700.00 $3,451.00 $2,105.11 2026-03-30
74181 HCPCS MRI Scan Of Abdomen Without Contrast 21 21 $3,451.00 $3,451.00 $700.00 $3,451.00 $2,105.11 2026-03-30
11047 HCPCS Removal Of Bone, Each Additional 20.0 Sq Cm Or Less 38 21 $3,592.50 $3,592.50 $80.99 $6,234.72 $2,065.69 2026-03-30
71270 HCPCS CT Scan Of Chest Before And After Contrast 21 21 $3,350.00 $3,350.00 $468.45 $3,350.00 $2,043.50 2026-03-30
54 CDM Coronary Care Unit - Myocardial Infarction 7 7 $3,200.00 $4,077.00 $1,760.00 $2,880.00 $2,016.96 2026-03-30
12 CDM Room & Board - Private (one Bed) - Medical/surgical/gyn 7 7 $3,200.00 $4,077.00 $1,760.00 $2,880.00 $2,016.96 2026-03-30
71550 HCPCS MRI Scan Of Chest Without Contrast 21 21 $3,224.00 $3,224.00 $700.00 $3,224.00 $1,966.64 2026-03-30
06 CDM Room & Board - Private (one Bed) - Medical/surgical/gyn 7 7 $3,015.00 $4,077.00 $1,658.25 $2,713.50 $1,900.35 2026-03-30
40 CDM Room & Board - Private (one Bed) - Pediatric 7 7 $3,000.00 $4,077.00 $1,650.00 $2,700.00 $1,890.90 2026-03-30
53 CDM Coronary Care Unit - Myocardial Infarction 7 7 $3,000.00 $4,077.00 $1,650.00 $2,700.00 $1,890.90 2026-03-30
52 CDM Coronary Care Unit - Myocardial Infarction 7 7 $3,000.00 $4,077.00 $1,650.00 $2,700.00 $1,890.90 2026-03-30
22 CDM Room & Board - Semi-private (two Beds) - Medical/surgical/gyn 7 7 $3,000.00 $4,077.00 $1,650.00 $2,700.00 $1,890.90 2026-03-30
11044 HCPCS Removal Of Bone, 20.0 Sq Cm Or Less 38 21 $7,184.95 $7,184.95 $191.37 $7,184.95 $1,862.57 2026-03-30
90947 HCPCS Dialysis Procedure Requiring Repeat Evaluation 20 20 $3,000.00 $3,000.00 $379.68 $3,000.00 $1,830.00 2026-03-30
90940 HCPCS Hemodialysis Access Blood Flow Study 20 20 $3,000.00 $3,000.00 $496.09 $3,000.00 $1,830.00 2026-03-30
90935 HCPCS Hemodialysis Procedure With Physician Evaluation 20 20 $3,000.00 $3,000.00 $571.16 $3,000.00 $1,830.00 2026-03-30
90989 HCPCS Dialysis Training Completed 15 15 $3,000.00 $3,000.00 $1,650.00 $3,000.00 $1,830.00 2026-03-30
90997 HCPCS Removal Of Toxins From Blood 20 20 $3,000.00 $3,000.00 $571.16 $3,000.00 $1,830.00 2026-03-30
90993 HCPCS Dialysis Training Not Completed 20 20 $3,000.00 $3,000.00 $164.35 $3,000.00 $1,830.00 2026-03-30
90937 HCPCS Hemodialysis Procedure Requiring Repeated Evaluation 20 20 $3,000.00 $3,000.00 $571.16 $3,000.00 $1,830.00 2026-03-30
90999 HCPCS Other Inpatient Or Outpatient Dialysis Procedure 20 20 $3,000.00 $3,000.00 $379.68 $3,000.00 $1,830.00 2026-03-30
27562 HCPCS Closed Treatment Of Dislocated Kneecap Under Anesthesia 38 21 $3,152.00 $3,152.00 $222.13 $3,384.79 $1,812.40 2026-03-30
09 CDM Room & Board - Semi-private (two Beds) - Medical/surgical/gyn 7 7 $2,820.00 $4,077.00 $1,551.00 $2,538.00 $1,777.45 2026-03-30
23330 HCPCS Removal Of Foreign Body Of Shoulder Joint, Accessed Beneath The Skin 38 21 $5,042.00 $5,042.00 $144.59 $5,042.00 $1,765.85 2026-03-30
51 CDM Room & Board - Semi-private (two Beds) - Medical/surgical/gyn 7 7 $2,800.00 $4,077.00 $1,540.00 $2,520.00 $1,764.84 2026-03-30
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 21 21 $2,840.00 $2,840.00 $500.00 $2,840.00 $1,732.40 2026-03-30
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 21 21 $2,758.00 $2,758.00 $500.00 $2,758.00 $1,682.38 2026-03-30
J0248 HCPCS Injection, Remdesivir, 1 Mg 16 16 $2,755.00 $2,755.00 $1,377.50 $2,755.00 $1,680.55 2026-03-30
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 21 21 $2,740.00 $2,740.00 $445.09 $2,740.00 $1,671.40 2026-03-30
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 21 21 $2,740.00 $2,740.00 $445.09 $2,740.00 $1,671.40 2026-03-30
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 21 21 $2,705.00 $2,705.00 $700.00 $2,705.00 $1,650.05 2026-03-30
73218 HCPCS MRI Scan Of Arm Without Contrast 21 21 $2,705.00 $2,705.00 $700.00 $2,705.00 $1,650.05 2026-03-30
72195 HCPCS MRI Scan Of Pelvis Without Contrast 21 21 $2,705.00 $2,705.00 $700.00 $2,705.00 $1,650.05 2026-03-30
71552 HCPCS MRI Scan Of Chest Before And After Contrast 21 21 $2,693.00 $2,693.00 $700.00 $2,693.00 $1,642.73 2026-03-30
70553 HCPCS MRI Scan Of Brain Before And After Contrast 21 21 $2,693.00 $2,693.00 $700.00 $2,693.00 $1,642.73 2026-03-30
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 21 21 $2,692.00 $2,692.00 $445.09 $2,692.00 $1,642.12 2026-03-30
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 21 21 $2,683.00 $2,683.00 $700.00 $2,683.00 $1,636.63 2026-03-30
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 21 21 $2,683.00 $2,683.00 $700.00 $2,683.00 $1,636.63 2026-03-30
73720 HCPCS MRI Scan Of Leg Before And After Contrast 21 21 $2,661.00 $2,661.00 $700.00 $2,661.00 $1,623.21 2026-03-30
73220 HCPCS MRI Scan Of Arm Before And After Contrast 21 21 $2,661.00 $2,661.00 $700.00 $2,661.00 $1,623.21 2026-03-30
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 21 21 $2,660.00 $2,660.00 $700.00 $2,660.00 $1,622.60 2026-03-30
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 21 21 $2,652.00 $2,652.00 $500.00 $2,652.00 $1,617.72 2026-03-30
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 21 21 $2,634.00 $2,634.00 $222.17 $2,634.00 $1,606.74 2026-03-30
94660 HCPCS Therapy Procedure Using A Positive Pressure Ventilator 21 21 $2,620.01 $2,620.01 $296.86 $2,620.01 $1,598.21 2026-03-30
71260 HCPCS CT Scan Of Chest With Contrast 21 21 $2,603.00 $2,603.00 $468.45 $2,603.00 $1,587.83 2026-03-30
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 21 21 $2,586.00 $2,586.00 $700.00 $2,586.00 $1,577.46 2026-03-30
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 21 21 $2,586.00 $2,586.00 $700.00 $2,586.00 $1,577.46 2026-03-30
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 21 21 $2,553.00 $2,553.00 $500.00 $2,553.00 $1,557.33 2026-03-30
05601032 CDM Xiidra 5% Eye Drops 13 13 $2,517.56 — $1,258.78 $2,457.14 $1,535.71 2026-03-30
20103 HCPCS Exploration Of Wound Of Arm Or Leg 21 21 $2,517.00 $2,517.00 $882.00 $2,517.00 $1,535.37 2026-03-30
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 21 21 $2,507.00 $2,507.00 $500.00 $2,507.00 $1,529.27 2026-03-30
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 21 21 $2,499.00 $2,499.00 $500.00 $2,499.00 $1,524.39 2026-03-30
11010 HCPCS Removal Of Foreign Material From Skin And Tissue At Open Broken And/or Dislocate… 38 21 $2,542.16 $2,542.16 $234.52 $5,989.48 $1,461.74 2026-03-30
72193 HCPCS CT Scan Of Pelvis With Contrast 21 21 $2,390.00 $2,390.00 $500.00 $2,390.00 $1,457.90 2026-03-30
72132 HCPCS CT Scan Of Lower Spine With Contrast 21 21 $2,353.00 $2,353.00 $389.43 $2,353.00 $1,435.33 2026-03-30
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 21 21 $2,353.00 $2,353.00 $389.43 $2,353.00 $1,435.33 2026-03-30
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 21 21 $2,353.00 $2,353.00 $468.45 $2,353.00 $1,435.33 2026-03-30
36569 HCPCS Insertion Of Tube For Infusion (5 Years Or Older) 38 21 $4,308.48 $4,308.48 $82.29 $4,308.48 $1,417.53 2026-03-30
87902 HCPCS Analysis Test By Nucleic Acid For Hepatitis C Virus 21 21 $2,317.00 $2,317.00 $77.08 $5,965.12 $1,413.37 2026-03-30
P9036 HCPCS Platelets, Pheresis, Irradiated, Each Unit 21 21 $1,852.83 $1,852.83 $926.42 $2,922.51 $1,389.62 2026-03-30
71271 HCPCS Low Dose CT Scan Of Chest For Lung Cancer Screening 16 16 $2,255.00 $2,255.00 $500.00 $2,255.00 $1,375.55 2026-03-30
71250 HCPCS CT Scan Of Chest Without Contrast 21 21 $2,255.00 $2,255.00 $468.45 $2,255.00 $1,375.55 2026-03-30
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 21 21 $2,250.00 $2,250.00 $502.48 $2,250.00 $1,372.50 2026-03-30
73201 HCPCS CT Scan Of Arm With Contrast 21 21 $2,243.00 $2,243.00 $468.45 $2,243.00 $1,368.23 2026-03-30
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 21 21 $2,243.00 $2,243.00 $468.45 $2,243.00 $1,368.23 2026-03-30
70486 HCPCS CT Scan Of Face Without Contrast 21 21 $2,243.00 $2,243.00 $468.45 $2,243.00 $1,368.23 2026-03-30
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 21 21 $2,243.00 $2,243.00 $468.45 $2,243.00 $1,368.23 2026-03-30
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 21 21 $2,237.00 $2,237.00 $445.09 $2,237.00 $1,364.57 2026-03-30
J2760 HCPCS Injection, Phentolamine Mesylate, Up To 5 Mg 21 21 $2,233.99 $2,233.99 $114.53 $2,233.99 $1,362.73 2026-03-30
94003 HCPCS Follow-up Inpatient Or Observation Ventilation Assistance And Management 21 21 $2,226.88 $2,226.88 $296.86 $2,226.88 $1,358.40 2026-03-30
73701 HCPCS CT Scan Of Leg With Contrast Material 21 21 $2,193.00 $2,193.00 $468.45 $2,193.00 $1,337.73 2026-03-30
70460 HCPCS CT Scan Head Or Brain With Contrast 21 21 $2,193.00 $2,193.00 $222.17 $2,193.00 $1,337.73 2026-03-30
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 21 21 $2,157.00 $2,157.00 $445.09 $2,157.00 $1,315.77 2026-03-30
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 21 21 $2,156.00 $2,156.00 $445.09 $2,156.00 $1,315.16 2026-03-30
74160 HCPCS CT Scan Of Abdomen With Contrast 21 21 $2,150.00 $2,150.00 $500.00 $2,150.00 $1,311.50 2026-03-30
72192 HCPCS CT Scan Of Pelvis Without Contrast 21 21 $2,139.00 $2,139.00 $500.00 $2,139.00 $1,304.79 2026-03-30
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 21 21 $2,126.00 $2,126.00 $445.09 $2,126.00 $1,296.86 2026-03-30
72196 HCPCS MRI Scan Of Pelvis With Contrast 21 21 $2,120.00 $2,120.00 $700.00 $2,120.00 $1,293.20 2026-03-30
73722 HCPCS MRI Scan Of Leg Joint With Contrast 21 21 $2,095.00 $2,095.00 $502.48 $2,095.00 $1,277.95 2026-03-30
73219 HCPCS MRI Scan Of Arm With Contrast 21 21 $2,095.00 $2,095.00 $700.00 $2,095.00 $1,277.95 2026-03-30
73719 HCPCS MRI Scan Of Leg With Contrast 21 21 $2,094.00 $2,094.00 $700.00 $2,094.00 $1,277.34 2026-03-30
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 21 21 $2,094.00 $2,094.00 $700.00 $2,094.00 $1,277.34 2026-03-30
73222 HCPCS MRI Scan Of Arm Joint With Contrast 21 21 $2,094.00 $2,094.00 $502.48 $2,094.00 $1,277.34 2026-03-30
40650 HCPCS Repair Of Lip And Border 38 21 $2,096.92 $2,096.92 $322.30 $5,189.68 $1,268.63 2026-03-30
73200 HCPCS CT Scan Of Arm Without Contrast 36 21 $2,193.00 $2,193.00 $468.45 $2,193.00 $1,260.97 2026-03-30
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 38 21 $2,785.00 $2,785.00 $473.41 $2,785.00 $1,220.93 2026-03-30
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 21 21 $1,995.00 $1,995.00 $700.00 $1,995.00 $1,216.95 2026-03-30
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 21 21 $1,995.00 $1,995.00 $700.00 $1,995.00 $1,216.95 2026-03-30
36589 HCPCS Removal Of Tunneled Central Venous Tube 53 21 $1,960.00 $1,960.00 $118.43 $2,552.00 $1,195.60 2026-03-30
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 21 21 $1,898.00 $1,898.00 $468.45 $1,898.00 $1,157.78 2026-03-30
92960 HCPCS External Shock To Heart To Regulate Heart Beat 38 21 $2,004.00 $2,004.00 $91.10 $2,228.01 $1,152.30 2026-03-30
70551 HCPCS MRI Scan Of Brain Without Contrast 21 21 $1,877.00 $1,877.00 $700.00 $1,877.00 $1,144.97 2026-03-30
74150 HCPCS CT Scan Of Abdomen Without Contrast 21 21 $1,871.00 $1,871.00 $500.00 $1,871.00 $1,141.31 2026-03-30
73718 HCPCS MRI Scan Of Leg Without Contrast 21 21 $1,847.00 $1,847.00 $700.00 $1,847.00 $1,126.67 2026-03-30
99291 HCPCS Critical Care, First 30-74 Minutes 52 21 $1,846.00 $1,846.00 $39.00 $1,878.00 $1,126.06 2026-03-30
70450 HCPCS CT Scan Head Or Brain Without Contrast 21 21 $1,844.00 $1,844.00 $222.17 $1,844.00 $1,124.84 2026-03-30
90945 HCPCS Dialysis Procedure Including 1 Evaluation 20 20 $1,800.00 $1,800.00 $379.68 $1,800.00 $1,098.00 2026-03-30
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 21 21 $1,781.00 $1,781.00 $499.64 $1,781.00 $1,086.41 2026-03-30
77084 HCPCS MRI Scan Of Bone Marrow 21 21 $1,768.00 $1,768.00 $700.00 $1,768.00 $1,078.48 2026-03-30
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 21 21 $1,763.00 $1,763.00 $445.09 $1,763.00 $1,075.43 2026-03-30
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 21 21 $1,763.00 $1,763.00 $445.09 $1,763.00 $1,075.43 2026-03-30
05500465 CDM Fecal Managment System 13 13 $1,742.00 — $871.00 $1,700.19 $1,062.62 2026-03-30
70336 HCPCS MRI Scan Of Jaw Joint 21 21 $1,738.00 $1,738.00 $502.48 $1,738.00 $1,060.18 2026-03-30
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 21 21 $1,712.00 $1,712.00 $502.48 $1,712.00 $1,044.32 2026-03-30
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 21 21 $1,712.00 $1,712.00 $502.48 $1,712.00 $1,044.32 2026-03-30
72125 HCPCS CT Scan Of Upper Spine Without Contrast 21 21 $1,703.00 $1,703.00 $389.43 $1,703.00 $1,038.83 2026-03-30
31500 HCPCS Emergent Insertion Of Breathing Tube Into Windpipe Using An Endoscope 38 21 $1,781.57 $1,781.57 $122.94 $2,717.45 $1,024.40 2026-03-30
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 21 21 $1,675.00 $1,675.00 $700.00 $1,675.00 $1,021.75 2026-03-30
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 21 21 $1,674.00 $1,674.00 $700.00 $1,674.00 $1,021.14 2026-03-30
70488 HCPCS CT Scan Of Face Before And After Contrast 36 21 $1,619.00 $1,619.00 $468.45 $1,667.00 $1,016.87 2026-03-30
10061 HCPCS Complicated Or Multiple Drainage Of Skin Abscess 36 21 $1,765.00 $1,765.00 $566.67 $1,765.00 $1,014.88 2026-03-30
92950 HCPCS Manual Attempt To Restore Blood Circulation And Breathing 54 21 $1,536.00 $1,462.00 $158.79 $2,717.45 $998.25 2026-03-30
05500672 CDM Ez-10 Needle 45mm Yellow 13 13 $1,598.75 — $799.38 $1,560.38 $975.24 2026-03-30
05601467 CDM Ozempic 2 Mg/dose (8 Mg/3 Ml) 13 13 $1,560.00 — $780.00 $1,522.56 $951.60 2026-03-30
93975 HCPCS Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 21 21 $1,541.00 $1,541.00 $210.18 $1,541.00 $940.01 2026-03-30
73700 HCPCS CT Scan Of Leg Without Contrast 21 21 $1,525.00 $1,525.00 $468.45 $1,525.00 $930.25 2026-03-30
72128 HCPCS CT Scan Of Middle Spine Without Contrast 21 21 $1,525.00 $1,525.00 $389.43 $1,525.00 $930.25 2026-03-30
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 21 21 $1,525.00 $1,525.00 $468.45 $1,525.00 $930.25 2026-03-30
70487 HCPCS CT Scan Of Face With Contrast 21 21 $1,498.00 $1,498.00 $468.45 $1,498.00 $913.78 2026-03-30
72131 HCPCS CT Scan Of Lower Spine Without Contrast 21 21 $1,492.00 $1,492.00 $389.43 $1,492.00 $910.12 2026-03-30
J2997 HCPCS Injection, Alteplase Recombinant, 1 Mg 37 21 $44,487.00 $44,487.00 $57.26 $44,487.00 $890.00 2026-03-30
86005 HCPCS Measurement Of Antibody (IgE) To Allergic Substance, Multiallergen Screen 21 21 $1,454.60 $1,454.60 $23.75 $1,454.60 $887.31 2026-03-30
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 21 21 $1,439.00 $1,439.00 $349.40 $1,439.00 $877.79 2026-03-30
11043 HCPCS Removal Of Muscle And/or Tissue, 20.0 Sq Cm Or Less 38 21 $5,115.49 $5,115.49 $131.26 $5,115.49 $870.79 2026-03-30
26770 HCPCS Closed Treatment Of Dislocated Finger Joint With Manipulation 38 21 $1,660.00 $1,660.00 $234.50 $1,660.00 $862.57 2026-03-30
97607 HCPCS Therapy Procedure Using A Special Bandage, Vacuum Pump And Disposable Medical Eq… 21 21 $1,412.00 $1,412.00 $523.13 $1,412.00 $861.32 2026-03-30
97608 HCPCS Therapy Procedure Using A Special Bandage, Vacuum Pump And Disposable Medical Eq… 21 21 $1,412.00 $1,412.00 $523.13 $1,412.00 $861.32 2026-03-30
05500660 CDM Wounds Vac Large Whitefoam Dressing Kit 13 13 $1,396.45 — $698.23 $1,362.94 $851.83 2026-03-30
26720 HCPCS Closed Treatment Of Broken Finger Or Thumb At Midportion Or Part Near Hand 38 21 $1,528.00 $1,528.00 $178.77 $1,528.00 $832.77 2026-03-30
A2001 HCPCS Innovamatrix Ac, Per Square Centimeter 48 16 $1,360.00 $1,360.00 $408.00 $3,405.00 $829.60 2026-03-30
12020 HCPCS Simple Closure Of Surface Wound Reopening 38 21 $1,341.00 $1,341.00 $162.15 $2,284.99 $811.31 2026-03-30
26775 HCPCS Closed Treatment Of Dislocated Finger Joint With Manipulation Under Anesthesia 21 21 $1,071.00 $1,071.00 $589.05 $3,384.79 $803.25 2026-03-30
99285 HCPCS Emergency Department Visit With High Level Of Medical Decision Making 52 21 $1,289.00 $1,289.00 $39.00 $1,301.00 $786.29 2026-03-30
05500676 CDM Ez-io 15 Mm Needle 13 13 $1,275.00 — $637.50 $1,244.40 $777.75 2026-03-30
23655 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia 53 21 $1,001.25 $1,001.25 $386.66 $3,384.79 $777.34 2026-03-30
05500659 CDM Wound Vac Small Whitefoam Dressing 13 13 $1,207.55 — $603.78 $1,178.57 $736.61 2026-03-30
93880 HCPCS Ultrasound Of Both Sides Of Head And Neck Blood Flow 21 21 $1,176.00 $1,176.00 $210.18 $1,176.00 $717.36 2026-03-30
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 36 21 $2,353.00 $2,353.00 $387.75 $2,353.00 $705.00 2026-03-30
93970 HCPCS Ultrasound Study Of Arm Or Leg Veins With Compression And Maneuvers 21 21 $1,150.00 $1,150.00 $349.40 $1,150.00 $701.50 2026-03-30
28190 HCPCS Removal Of Foreign Body Of Foot Tissue, Accessed Beneath The Skin 38 21 $1,140.00 $1,140.00 $120.13 $2,901.78 $689.70 2026-03-30
P9016 HCPCS Red Blood Cells, Leukocytes Reduced, Each Unit 21 21 $896.00 $896.00 $448.00 $2,922.51 $672.00 2026-03-30
80307 HCPCS Testing For Presence Of Drug, By Chemistry Analyzers 21 21 $1,094.31 $1,094.31 $82.59 $1,094.31 $667.53 2026-03-30
20605 HCPCS Aspiration And/or Injection Of Fluid From Medium Joint 38 21 $1,067.32 $1,067.32 $30.68 $1,169.14 $645.73 2026-03-30
49083 HCPCS Drainage Of Fluid From Abdominal Cavity Using Imaging Guidance 21 21 $860.00 $860.00 $473.00 $2,453.66 $645.00 2026-03-30
81514 HCPCS Measurement Of DNA Of Bacteria In Vaginal Fluid Specimen 16 16 $1,051.96 $1,051.96 $578.58 $2,766.55 $641.70 2026-03-30
10160 HCPCS Aspiration Of Abscess, Blood, Or Cyst 38 21 $1,765.00 $1,765.00 $85.47 $1,765.00 $626.98 2026-03-30
10140 HCPCS Drainage Of Blood Or Fluid Accumulation 38 21 $2,486.70 $2,486.70 $101.87 $2,486.70 $626.98 2026-03-30
J0712 HCPCS Injection, Ceftaroline Fosamil, 10 Mg 21 21 $1,018.00 $1,018.00 $1.15 $1,018.00 $620.98 2026-03-30
23650 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation 53 21 $819.00 $819.00 $266.58 $1,355.93 $611.19 2026-03-30
87507 HCPCS Detection Test By Nucleic Acid For Digestive Tract Pathogen, Multiple Types Or S… 21 21 $1,000.00 $1,000.00 $77.08 $4,167.80 $610.00 2026-03-30
87483 HCPCS Test For Detecting Nucleic Acid Of Organism Causing Infection Of Central Nervous… 21 21 $1,000.00 $1,000.00 $77.08 $4,167.80 $610.00 2026-03-30
87633 HCPCS Detection Test By Nucleic Acid For Multiple Types Of Respiratory Virus, Multiple… 21 21 $1,000.00 $1,000.00 $77.08 $4,167.80 $610.00 2026-03-30
05500736 CDM Bivona Trache 5mm 13 13 $1,000.00 — $500.00 $976.00 $610.00 2026-03-30
05500739 CDM Versett External Cath 13 13 $1,000.00 — $500.00 $976.00 $610.00 2026-03-30
05500738 CDM Cloth Measuring Tape 13 13 $1,000.00 — $500.00 $976.00 $610.00 2026-03-30
05500737 CDM Bivona Trache 5mm 13 13 $1,000.00 — $500.00 $976.00 $610.00 2026-03-30
05500735 CDM Bivona Trache 6mm 13 13 $1,000.00 — $500.00 $976.00 $610.00 2026-03-30
J0171 HCPCS Injection, Adrenalin, Epinephrine, 0.1 Mg 21 21 $998.00 $998.00 $0.51 $998.00 $608.78 2026-03-30
87522 HCPCS Detection Test By Nucleic Acid For Hepatitis C Virus, Quantification 21 21 $985.00 $985.00 $77.08 $985.00 $600.85 2026-03-30
05601034 CDM Incruse Ellipta 62.5 Mcg Inh 13 13 $973.60 — $486.80 $950.23 $593.90 2026-03-30
97606 HCPCS Therapy Procedure Using A Special Bandage And Vacuum Pump, Surface Area More Tha… 69 21 $735.00 $735.00 $18.12 $1,412.00 $589.87 2026-03-30
25600 HCPCS Closed Treatment Of Broken Forearm (radius) Bone At The Wrist Area On The Thumb … 38 21 $972.00 $972.00 $286.65 $1,813.33 $588.06 2026-03-30
80000154 CDM Tri-lumen Cvc Cath, 7fr 13 13 $962.49 — $481.25 $939.39 $587.12 2026-03-30
J0699 HCPCS Injection, Cefiderocol, 10 Mg 16 16 $960.00 $960.00 $480.00 $960.00 $585.60 2026-03-30
94669 HCPCS Therapy Procedure To Clear Airway Using An Inflatable Vest 21 21 $957.50 $957.50 $40.70 $957.50 $584.08 2026-03-30
81206 HCPCS Translocation Analysis (bcr/abl1) Major Breakpoint 21 21 $953.00 $953.00 $448.47 $1,562.54 $581.33 2026-03-30
27265 HCPCS Closed Treatment Of Dislocated Hip Prosthesis 38 21 $959.52 $959.52 $365.77 $1,813.33 $580.51 2026-03-30
05601008 CDM Dificid 200 Mg Tablet 13 13 $950.00 — $475.00 $927.20 $579.50 2026-03-30
05601006 CDM Dificid 200 Mg Tablet 13 13 $950.00 — $475.00 $927.20 $579.50 2026-03-30
13121 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 2.6-7.5 Cm 38 21 $2,323.80 $2,323.80 $204.62 $2,323.80 $578.81 2026-03-30
J1610 HCPCS Injection, Glucagon Hydrochloride, Per 1 Mg 21 21 $941.50 $941.50 $114.53 $941.50 $574.32 2026-03-30
93976 HCPCS Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 21 21 $939.00 $939.00 $210.18 $939.00 $572.79 2026-03-30
42000 HCPCS Drainage Of Abscess Of Roof Of Mouth 38 21 $967.92 $967.92 $92.36 $1,154.00 $566.67 2026-03-30
See an error in this hospital's data? Submit a correction