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

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Hospital

MOBRIDGE REGIONAL HOSPITAL - CAH

Mobridge, SD · CCN 431325 · Rates published

4,048 distinct procedures filed
17 distinct payers
49,215 rate rows
2026-07-16 last MRF observed
Data quality

49,104 of 49,215 rate rows are consumer-grade (99.8%)

111 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 51
percent-of-charges filed in the dollar field — excluded from medians 36
per-diem day rate — not a per-procedure price 22
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbMRHMOBRIDGESD&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/Mobridge_Regional.aspx
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-17
Content fingerprint bcff5ee4f448cbd2… · 18,746,887 bytes · first seen 2026-07-31

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
J3245
HCPCS 		Injection, Tildrakizumab, 1 Mg 9 $14,977.66 $38,232.46 $30,743.63 nat. median
$256
outlier · 120.0×
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 9 $7,909.62 $20,190.36 $16,235.54 nat. median
$155
outlier · 105.0×
C1786
HCPCS 		Pacemaker, Single Chamber, Rate-responsive (implantable) 9 $6,874.96 $17,549.24 $14,111.76 nat. median
$7,842
1.8× median
C1785
HCPCS 		Pacemaker, Dual Chamber, Rate-responsive (implantable) 9 $6,874.96 $17,549.24 $14,111.76 nat. median
$6,717
outlier · 2.1×
49605
HCPCS 		Repair Of Large Defect Of Abdominal Wall At Navel 9 $213.78 $13,791.25 $10,411.92 nat. median
$5,152
outlier · 2.0×
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 9 $3,683.98 $19,330.57 $7,951.44 nat. median
$3,787
outlier · 2.1×
Q5115
HCPCS 		Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg 9 $3,861.41 $9,856.75 $7,926.05 nat. median
$839
outlier · 9.4×
C1726
HCPCS 		Catheter, Balloon Dilatation, Non-vascular 9 $3,668.90 $9,365.35 $7,530.90 nat. median
$591
outlier · 12.7×
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 9 $3,517.63 $11,691.41 $7,400.90 nat. median
$1,659
outlier · 4.5×
C9363
HCPCS 		Skin Substitute, Integra Meshed Bilayer Wound Matrix, Per Square Centimeter 9 $3,464.84 $8,844.46 $7,112.04 nat. median
$1,474
outlier · 4.8×
27939262_1
CDM 		Amnio Graft 10.0x5.0 9 $3,282.82 $8,379.83 $6,738.42 nat. median
$6,738
1.0× median
J1437
HCPCS 		Injection, Ferric Derisomaltose, 10 Mg 9 $3,208.38 $8,189.81 $6,585.62 nat. median
$45
outlier · 145.8×
27813206_1
CDM 		Trilliant Sterile SUPPLY(modify Per Patient) 9 $3,104.22 $7,923.93 $6,371.82 nat. median
$6,372
1.0× median
J1306
HCPCS 		Injection, Inclisiran, 1 Mg 9 $3,082.25 $7,867.85 $6,326.73 nat. median
$44
outlier · 144.7×
78452
HCPCS 		Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 9 $2,695.72 $6,881.18 $5,533.32 nat. median
$1,822
outlier · 3.0×
C8911
HCPCS 		Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Chest… 9 $2,451.38 $7,585.40 $5,157.57 nat. median
$1,027
outlier · 5.0×
J1951
HCPCS 		Injection, Leuprolide Acetate For Depot Suspension (fensolvi), 0.25 Mg 9 $2,477.34 $6,323.74 $5,085.07 nat. median
$173
outlier · 29.3×
72159
HCPCS 		MRI Scan Of Blood Vessels Of Spinal Canal 9 $2,451.38 $6,257.47 $5,031.78 nat. median
$1,092
outlier · 4.6×
Q5127
HCPCS 		Injection, Pegfilgrastim-fpgk (stimufend), Biosimilar, 0.5 Mg 9 $2,358.80 $6,021.14 $4,841.74 nat. median
$401
outlier · 12.1×
74178
HCPCS 		CT Scan Of Abdomen And Pelvis Before And After Contrast 9 $2,328.26 $5,943.19 $4,779.06 nat. median
$1,027
outlier · 4.7×
C8908
HCPCS 		Magnetic Resonance Imaging Without Contrast Followed By With Contrast, Breast; B… 9 $2,318.76 $5,918.94 $4,759.56 nat. median
$1,023
outlier · 4.7×
Q5122
HCPCS 		Injection, Pegfilgrastim-apgf (nyvepria), Biosimilar, 0.5 Mg 9 $2,153.46 $5,496.99 $4,420.26 nat. median
$561
outlier · 7.9×
35221
HCPCS 		Repair Of Blood Vessel Of Abdomen 9 $63.72 $7,708.65 $4,303.57 nat. median
$3,095
1.4× median
20816
HCPCS 		Reattachment Of Cutoff Finger 9 $89.52 $7,024.40 $4,289.76 nat. median
$3,784
1.1× median
70546
HCPCS 		MRI Scan Of Blood Vessels Of Head Before And After Contrast 9 $2,083.92 $5,319.48 $4,277.52 nat. median
$1,073
outlier · 4.0×
70549
HCPCS 		MRI Scan Of Blood Vessels Of Neck Before And After Contrast 9 $2,083.92 $5,319.48 $4,277.52 nat. median
$1,063
outlier · 4.0×
43324
HCPCS 		43324 Pf Esoph. Fundoplasty 6 $1,458.75 $4,959.75 $4,230.38 nat. median
$4,012
1.1× median
J0401
HCPCS 		Injection, Aripiprazole (abilify Maintena), 1 Mg 9 $1,992.34 $6,776.09 $4,191.78 nat. median
$1,912
outlier · 2.2×
70336
HCPCS 		MRI Scan Of Jaw Joint 9 $2,004.12 $5,115.78 $4,113.72 nat. median
$756
outlier · 5.4×
C8909
HCPCS 		Magnetic Resonance Angiography With Contrast, Chest (excluding Myocardium) 9 $1,982.46 $5,060.49 $4,069.26 nat. median
$887
outlier · 4.6×
2976532_1
CDM 		Assisted Living Double Charge 9 $1,962.32 $5,009.08 $4,027.92 nat. median
$4,028
1.0× median
C8914
HCPCS 		Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Lower… 9 $1,960.80 $5,005.20 $4,024.80 nat. median
$1,180
outlier · 3.4×
C8902
HCPCS 		Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Abdom… 9 $1,960.80 $5,005.20 $4,024.80 nat. median
$1,044
outlier · 3.9×
70545
HCPCS 		MRI Scan Of Blood Vessels Of Head With Contrast 9 $1,960.80 $5,005.20 $4,024.80 nat. median
$893
outlier · 4.5×
70543
HCPCS 		MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 9 $1,960.80 $5,005.20 $4,024.80 nat. median
$1,087
outlier · 3.7×
73225
HCPCS 		MRI Scan Of Blood Vessels Of Arm 9 $1,960.80 $5,005.20 $4,024.80 nat. median
$1,211
outlier · 3.3×
72198
HCPCS 		MRI Scan Of Blood Vessels Of Pelvis 9 $1,960.80 $5,005.20 $4,024.80 nat. median
$1,136
outlier · 3.5×
70553
HCPCS 		MRI Scan Of Brain Before And After Contrast 9 $1,960.80 $5,005.20 $4,024.80 nat. median
$1,136
outlier · 3.5×
C8910
HCPCS 		Magnetic Resonance Angiography Without Contrast, Chest (excluding Myocardium) 9 $1,930.78 $4,928.57 $3,963.18 nat. median
$734
outlier · 5.4×
27939261_1
CDM 		Amnio Graft 5.0x5.0 9 $1,877.20 $4,791.80 $3,853.20 nat. median
$3,853
1.0× median
45110
HCPCS 		Removal Of Rectum With Creation Of Opening From Large Bowel To Skin Through Abdo… 9 $80.00 $5,992.50 $3,825.36 nat. median
$3,177
1.2× median
44141
HCPCS 		Partial Removal Of Large Bowel With Creation Of Opening To Skin 9 $79.38 $4,920.65 $3,818.88 nat. median
$3,115
1.2× median
44207
HCPCS 		Partial Removal Of Large Bowel And Reattachment To Rectum Using An Endoscope 9 $79.02 $5,207.95 $3,793.68 nat. median
$3,919
1.0× median
70552
HCPCS 		MRI Scan Of Brain With Contrast 9 $1,838.44 $4,692.86 $3,773.64 nat. median
$965
outlier · 3.9×
70544
HCPCS 		MRI Scan Of Blood Vessels Of Head Without Contrast 9 $1,838.44 $4,692.86 $3,773.64 nat. median
$829
outlier · 4.6×
70542
HCPCS 		MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 9 $1,838.44 $4,692.86 $3,773.64 nat. median
$923
outlier · 4.1×
74183
HCPCS 		MRI Scan Of Abdomen Before And After Contrast 9 $1,838.44 $4,692.86 $3,773.64 nat. median
$1,105
outlier · 3.4×
70547
HCPCS 		MRI Scan Of Blood Vessels Of Neck Without Contrast 9 $1,838.44 $4,692.86 $3,773.64 nat. median
$764
outlier · 4.9×
75635
HCPCS 		CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 9 $1,838.44 $4,692.86 $3,773.64 nat. median
$727
outlier · 5.2×
81229
HCPCS 		Genome-wide Microarray Analysis For Copy Number And Single Nucleotide Polymorphi… 9 $1,811.08 $4,623.02 $3,717.48 nat. median
$1,323
outlier · 2.8×

Other procedures at this hospital

Browse this hospital's 4,048 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
0191T OTHER Insertion Of Anterior Segment Aqueous Drainage Device, Without Extraocular Reser… 9 9 $3,883.00 $3,883.00 $1,475.54 $3,766.51 $3,028.74 2026-07-16
1101859_1 CDM Intensive Care Unit - General Classification 7 7 $3,460.00 $3,460.00 $1,380.54 $3,356.20 $2,833.74 2026-07-16
1101859_3 CDM Room/bed: Intensive Care Unit 9 9 $3,377.50 $3,377.50 $1,283.45 $3,276.18 $2,634.45 2026-07-16
1101862_1 CDM Room & Board - Semi-private (two Beds) - Obstetrics (ob) 7 7 $3,408.00 $3,408.00 $1,359.79 $3,305.76 $2,791.15 2026-07-16
1101862_3 CDM Room/bed: Obstetrics 9 9 $3,329.98 $3,329.98 $1,265.39 $3,230.08 $2,597.39 2026-07-16
15002 HCPCS Preparation Of Skin Graft Site Of Trunk, Arms, Or Legs, 100.0 Sq Cm Or 1% Body A… 18 9 $3,686.50 $3,686.50 $9.71 $5,988.78 $1,682.63 2026-07-16
15100 HCPCS Partial Thickness Self Skin Graft To Trunk, Arms, Or Legs, 100.0 Sq Cm Or 1% Bod… 18 9 $4,450.00 $4,450.00 $30.80 $5,988.78 $2,331.61 2026-07-16
15110 HCPCS Outer Layer Self Skin Graft Of Trunk, Arms, Or Legs, 100.0 Sq Cm Or 1% Body Area… 18 9 $4,416.50 $4,416.50 $29.73 $5,988.78 $2,303.14 2026-07-16
15115 HCPCS Outer Layer Self Skin Graft Of Face, Scalp, Eyelids, Mouth, Neck, Ears, Around E… 18 9 $4,782.00 $4,782.00 $29.51 $5,988.78 $2,463.43 2026-07-16
15120 HCPCS Partial Thickness Self Skin Graft To Face, Scalp, Eyelids, Mouth, Neck, Ears, Ar… 18 9 $6,938.00 $6,938.00 $30.02 $10,697.16 $3,305.72 2026-07-16
15240 HCPCS Full Thickness Skin Graft To Forehead, Cheeks, Chin, Mouth, Neck, Underarms, Gen… 9 9 $2,908.00 $2,908.00 $34.52 $2,471.80 $1,637.28 2026-07-16
15260 HCPCS Full Thickness Skin Graft To Nose, Ears, Eyelids, Or Lips, 20.0 Sq Cm Or Less 9 9 $3,242.00 $3,242.00 $36.98 $2,755.70 $1,740.96 2026-07-16
15574 HCPCS Creation Of Flap Graft To Forehead, Cheeks, Chin, Mouth, Neck, Underarms, Genita… 9 9 $3,549.00 $3,549.00 $32.69 $3,016.65 $1,556.64 2026-07-16
15839 HCPCS Removal Of Extra Skin And Tissue Of Other Area 9 9 $1,861.00 $1,861.00 $31.73 $1,627.80 $1,529.28 2026-07-16
15944 HCPCS Removal Of Pressure Sore Tissue Of Lower Pelvic Bone With Skin Graft 16 9 $3,573.00 $3,573.00 $38.75 $3,465.81 $1,974.72 2026-07-16
19302 HCPCS Partial Removal Of Breast And Underarm Lymph Nodes 9 9 $1,835.00 $1,835.00 $38.96 $1,994.10 $1,559.75 2026-07-16
19303 HCPCS Simple Complete Removal Of Breast 9 9 $5,168.00 $5,168.00 $41.54 $4,392.80 $2,004.48 2026-07-16
19307 HCPCS Removal Of Breast And Underarm Lymph Nodes 9 9 $4,701.00 $4,701.00 $51.92 $3,995.85 $2,518.56 2026-07-16
20816 HCPCS Reattachment Of Cutoff Finger 9 9 $8,264.00 $8,264.00 $89.52 $7,024.40 $4,289.76 2026-07-16
21933 HCPCS Removal Of Growth Of Muscle Of Back Or Lower Sides, 5.0 Cm Or More 9 9 $2,520.00 $2,520.00 $31.94 $2,142.00 $1,539.36 2026-07-16
24341 HCPCS Repair Of Tendon Or Muscle Of Upper Arm Or Elbow 9 9 $3,160.00 $3,160.00 $32.13 $2,686.00 $1,545.84 2026-07-16
24495 HCPCS Incision Of Tissue Of Forearm Muscle With Exploration Of Artery 9 9 $3,628.00 $3,628.00 $31.91 $3,083.80 $1,686.24 2026-07-16
25024 HCPCS Incision Of Tissue Of Forearm And/or Wrist Muscle Compartment On Both Sides Of T… 9 9 $6,096.00 $6,096.00 $33.68 $5,181.60 $1,625.04 2026-07-16
25265 HCPCS Repair Of Forearm And/or Wrist Tendon Or Muscle On The Underside Of The Wrist (f… 9 9 $2,996.00 $2,996.00 $32.21 $2,546.60 $1,554.48 2026-07-16
26973880_1 CDM Solyx Sis System 9 9 $2,874.00 $2,874.00 $1,092.12 $2,787.78 $2,241.72 2026-07-16
27045 HCPCS Removal Of Growth Of Muscle Of Pelvis And Hip, 5.0 Cm Or More 16 9 $5,181.00 $5,181.00 $32.07 $5,025.57 $2,067.22 2026-07-16
27252 HCPCS Closed Treatment Of Dislocated Hip Under Anesthesia 9 9 $2,236.00 $2,236.00 $32.70 $1,900.60 $1,571.04 2026-07-16
27502 HCPCS Closed Treatment Of Broken Thigh Bone At Midportion With Manipulation 9 9 $3,648.00 $3,648.00 $32.78 $3,100.80 $1,579.68 2026-07-16
27590 HCPCS Amputation Of Thigh Through Thigh Bone 9 9 $3,645.00 $3,645.00 $34.43 $3,098.25 $1,657.44 2026-07-16
27725434_1 CDM Ib Kit, Bc, W/cc Ft And Jumpstart 9 9 $3,700.00 $3,700.00 $1,406.00 $3,589.00 $2,886.00 2026-07-16
27813206_1 CDM Trilliant Sterile SUPPLY(modify Per Patient) 9 9 $8,169.00 $8,169.00 $3,104.22 $7,923.93 $6,371.82 2026-07-16
27880 HCPCS Amputation Of Both Lower Leg Bones 9 9 $4,106.00 $4,106.00 $39.45 $3,490.10 $1,897.20 2026-07-16
27939257_1 CDM Amnio Graft 1.5x1.0 9 9 $2,131.00 $2,131.00 $809.78 $2,067.07 $1,662.18 2026-07-16
27939258_1 CDM Amnio Graft 2.0x1.5 9 9 $2,431.00 $2,431.00 $923.78 $2,358.07 $1,896.18 2026-07-16
27939259_1 CDM Amnio Graft 2.5x2.0 9 9 $2,705.00 $2,705.00 $1,027.90 $2,623.85 $2,109.90 2026-07-16
27939260_1 CDM Amnio Graft 3.5x3.5 9 9 $2,745.00 $2,745.00 $1,043.10 $2,662.65 $2,141.10 2026-07-16
27939261_1 CDM Amnio Graft 5.0x5.0 9 9 $4,940.00 $4,940.00 $1,877.20 $4,791.80 $3,853.20 2026-07-16
27939262_1 CDM Amnio Graft 10.0x5.0 9 9 $8,639.00 $8,639.00 $3,282.82 $8,379.83 $6,738.42 2026-07-16
28296333_1 CDM Broad Straight Plate 6 Holes (t10) 9 9 $3,798.00 $3,798.00 $1,443.24 $3,684.06 $2,962.44 2026-07-16
28480037_1 CDM Surgical Outreach 9 9 $3,600.00 $3,600.00 $1,368.00 $3,492.00 $2,808.00 2026-07-16
28499496_1 CDM Staple Nitinol 10x10 Fuseforce 9 9 $3,876.00 $3,876.00 $1,472.88 $3,759.72 $3,023.28 2026-07-16
2850140_2 CDM Endobronchial TB Track Left Sterile 37fr 6 6 $3,608.00 $3,608.00 $902.00 $3,066.80 $2,615.80 2026-07-16
2867603_1 CDM Gore-tex Stretch Vascular Graft Twl(thinwall Limbs) 9 9 $2,783.00 $2,783.00 $1,057.54 $2,699.51 $2,170.74 2026-07-16
2867822_1 CDM Closure Fast Cath 100cm 9 9 $2,654.00 $2,654.00 $1,008.52 $2,574.38 $2,070.12 2026-07-16
2867834_1 CDM Harmonic Lap Shear 5mm 36m 9 9 $2,935.00 $2,935.00 $1,115.30 $2,846.95 $2,289.30 2026-07-16
2867852_1 CDM Anesthesia Mask Sz 2 Infant 9 9 $3,259.00 $3,259.00 $1,238.42 $3,161.23 $2,542.02 2026-07-16
2867872_1 CDM Intering Str 6mm 40cm Rs X 40 Vascular Graft 9 9 $2,693.00 $2,693.00 $1,023.34 $2,612.21 $2,100.54 2026-07-16
2867873_1 CDM Intering Str 8mm 40cm Rs X 40 Vascular Graft 9 9 $2,482.00 $2,482.00 $943.16 $2,407.54 $1,935.96 2026-07-16
2867873_2 CDM Intering Str 8mm 40cm Rs X 40 Vascular Graft 6 6 $2,772.00 $2,772.00 $693.00 $2,356.20 $2,009.70 2026-07-16
2973030_2 CDM 43258 Pf Oper Upper Gi Endoscopy 6 6 $2,575.00 $2,575.00 $643.75 $2,188.75 $1,866.88 2026-07-16
2976529_1 CDM Rent/Month - VisionCare Charge 9 9 $3,461.89 $3,461.89 $1,315.52 $3,358.03 $2,700.27 2026-07-16
2976530_1 CDM Rent/Month - Othopedic Surgery Specialists 9 9 $2,691.00 $2,691.00 $1,022.58 $2,610.27 $2,098.98 2026-07-16
2976532_1 CDM Assisted Living Double Charge 9 9 $5,164.00 $5,164.00 $1,962.32 $5,009.08 $4,027.92 2026-07-16
2976534_1 CDM Senior Living Single Charge 9 9 $1,976.00 $1,976.00 $750.88 $1,916.72 $1,541.28 2026-07-16
2976535_1 CDM Senior Living Double Charge 9 9 $2,931.00 $2,931.00 $1,113.78 $2,843.07 $2,286.18 2026-07-16
2978818_1 CDM Multifocal Zma00 9 9 $2,940.00 $2,940.00 $1,117.20 $2,851.80 $2,293.20 2026-07-16
35206 HCPCS Repair Of Blood Vessel Of Arm 9 9 $4,514.00 $4,514.00 $34.01 $3,836.90 $1,632.96 2026-07-16
35207 HCPCS Repair Of Blood Vessel Of Hand Or Finger 9 9 $6,246.00 $6,246.00 $32.64 $5,309.10 $1,566.72 2026-07-16
35221 HCPCS Repair Of Blood Vessel Of Abdomen 12 9 $9,069.00 $9,069.00 $63.72 $7,708.65 $4,303.57 2026-07-16
35606 HCPCS Bypass Of Diseased Or Blocked Neck To Chest Artery With Other Than Vein 9 9 $3,513.00 $3,513.00 $51.02 $2,986.05 $2,454.48 2026-07-16
37618 HCPCS Tying Of Major Arm Or Leg Artery 16 9 $7,765.00 $7,765.00 $16.67 $7,532.05 $3,098.24 2026-07-16
38724 HCPCS Removal Of Lymph Nodes, Muscle, And Tissue Of Neck 9 9 $5,733.00 $5,733.00 $62.51 $4,873.05 $2,991.60 2026-07-16
38745 HCPCS Removal Of Lymph Nodes Of Underarm 9 9 $2,705.00 $2,705.00 $38.16 $2,299.25 $1,839.60 2026-07-16
38760 HCPCS Removal Of Lymph Nodes Of Groin 9 9 $2,509.00 $2,509.00 $36.56 $2,132.65 $1,748.88 2026-07-16
39501 HCPCS Repair Of Muscle Tissue Separating Chest And Abdominal Cavities 9 9 $2,244.00 $2,244.00 $36.98 $2,011.70 $1,784.16 2026-07-16
42420 HCPCS Removal Of Growth Of Saliva Gland Or Saliva Gland With Release Of Facial Nerve 9 9 $5,622.00 $5,622.00 $51.09 $4,778.70 $2,447.28 2026-07-16
43324 HCPCS 43324 Pf Esoph. Fundoplasty 6 6 $5,835.00 $5,835.00 $1,458.75 $4,959.75 $4,230.38 2026-07-16
43500 HCPCS Exploration Of Stomach Or Removal Of Foreign Body In Stomach 9 9 $1,871.00 $1,871.00 $34.11 $1,873.50 $1,590.35 2026-07-16
43502 HCPCS Suture Of Lacerated Stomach 9 9 $4,385.00 $4,385.00 $66.00 $3,727.25 $3,204.72 2026-07-16
43610 HCPCS Removal Of Stomach Ulcer Or Growth 9 9 $3,877.00 $3,877.00 $42.77 $3,295.45 $2,057.76 2026-07-16
43631 HCPCS Removal Of Lower Part Of Stomach With Reattachment Of Remaining Stomach To First… 9 9 $6,544.00 $6,544.00 $63.14 $5,562.40 $3,045.60 2026-07-16
43640 HCPCS Severing Of Vagus Nerve To Stomach 9 9 $4,630.00 $4,630.00 $51.29 $3,935.50 $2,473.20 2026-07-16
43840 HCPCS Suture Of Perforated Ulcer, Wound, Or Injury Of Stomach Or Upper Small Bowel 9 9 $4,025.00 $4,025.00 $59.16 $3,421.25 $2,856.24 2026-07-16
43860 HCPCS Revision Of Surgically Created Connection Of Stomach To Small Bowel 9 9 $5,488.00 $5,488.00 $71.15 $4,664.80 $3,435.84 2026-07-16
44005 HCPCS Release Of Intestinal Scar Tissue 9 9 $5,220.00 $5,220.00 $47.64 $4,437.00 $2,293.20 2026-07-16
44050 HCPCS Repair Of Twisted Or Herniated Small Bowel 9 9 $3,570.00 $3,570.00 $40.68 $3,034.50 $1,962.00 2026-07-16
44110 HCPCS Removal Of Growth Of Small Or Large Bowels 9 9 $3,314.00 $3,314.00 $36.95 $2,816.90 $1,766.88 2026-07-16
44120 HCPCS Partial Removal Of Small Bowel With Reconnection 9 9 $5,456.00 $5,456.00 $53.22 $4,637.60 $2,565.36 2026-07-16
44130 HCPCS Creation Of Connection Between 2 Segments Of Small Bowel 16 9 $2,415.00 $2,415.00 $57.18 $3,115.70 $1,968.22 2026-07-16
44140 HCPCS Partial Removal Of Large Bowel With Connection 9 9 $6,050.00 $6,050.00 $58.38 $5,142.50 $2,813.04 2026-07-16
44141 HCPCS Partial Removal Of Large Bowel With Creation Of Opening To Skin 9 9 $5,789.00 $5,789.00 $79.38 $4,920.65 $3,818.88 2026-07-16
44143 HCPCS Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin 9 9 $6,603.00 $6,603.00 $72.41 $5,612.55 $3,485.52 2026-07-16
44144 HCPCS Partial Removal Of Large Bowel With Creation Of 2 Openings From Small Or Large B… 9 9 $6,521.00 $6,521.00 $77.01 $5,542.85 $3,702.96 2026-07-16
44160 HCPCS Partial Removal Of Small And Large Bowel With Attachment Of Small And Large Bowe… 9 9 $6,064.00 $6,064.00 $54.02 $5,154.40 $2,602.08 2026-07-16
44180 HCPCS Release Of Small Bowel Scar Tissue Using An Endoscope 9 9 $2,702.00 $2,702.00 $40.01 $2,296.70 $1,928.88 2026-07-16
44202 HCPCS Partial Removal And Reconnection Of Small Bowel Using An Endoscope 9 9 $6,636.00 $6,636.00 $60.20 $5,640.60 $2,904.48 2026-07-16
44204 HCPCS Partial Removal Of Large Bowel Using An Endoscope 9 9 $6,715.00 $6,715.00 $66.92 $5,707.75 $3,218.40 2026-07-16
44205 HCPCS Partial Removal Of Small And Large Bowel With Attachment Of Small And Large Bowe… 9 9 $5,299.00 $5,299.00 $58.14 $4,504.15 $2,795.04 2026-07-16
44207 HCPCS Partial Removal Of Large Bowel And Reattachment To Rectum Using An Endoscope 9 9 $6,127.00 $6,127.00 $79.02 $5,207.95 $3,793.68 2026-07-16
44310 HCPCS Creation Of Opening From Small Bowel To Skin 9 9 $4,225.00 $4,225.00 $45.36 $3,591.25 $2,178.72 2026-07-16
44320 HCPCS Creation Of Opening From Large Bowel To Skin 9 9 $3,263.00 $3,263.00 $52.28 $2,836.90 $2,513.52 2026-07-16
44346 HCPCS Revision Of Opening From Large Bowel To Skin With Repair Of Hernia 9 9 $3,785.00 $3,785.00 $51.41 $3,217.25 $2,473.92 2026-07-16
44602 HCPCS Suture Of Tear Of Hole In Small Bowel 9 9 $3,978.00 $3,978.00 $61.44 $3,381.30 $2,958.48 2026-07-16
44603 HCPCS Suture Of Multiple Tears Or Holes In Small Bowel 9 9 $5,674.00 $5,674.00 $70.52 $4,822.90 $3,394.80 2026-07-16
44604 HCPCS Suture Of Tear Or Hole In Large Bowel 9 9 $3,629.00 $3,629.00 $46.07 $3,084.65 $2,216.16 2026-07-16
44620 HCPCS Closure Of Surgically Created Large Or Small Bowel Opening 9 9 $3,410.00 $3,410.00 $37.71 $2,898.50 $1,811.52 2026-07-16
44625 HCPCS Closure Of Surgically Created Large Or Small Bowel Opening With Bowel Removal An… 9 9 $5,211.00 $5,211.00 $44.15 $4,429.35 $2,115.36 2026-07-16
44626 HCPCS Closure Of Surgically Created Large Or Small Bowel Opening With Bowel Removal An… 9 9 $3,627.00 $3,627.00 $69.65 $3,736.00 $3,082.95 2026-07-16
44960 HCPCS Removal Of Ruptured Infected Appendix 9 9 $3,040.00 $3,040.00 $38.12 $2,584.00 $1,840.32 2026-07-16
45110 HCPCS Removal Of Rectum With Creation Of Opening From Large Bowel To Skin Through Abdo… 9 9 $7,050.00 $7,050.00 $80.00 $5,992.50 $3,825.36 2026-07-16
45550 HCPCS Suture Of Rectum To Sacrum With Removal Of Large Bowel 9 9 $5,129.00 $5,129.00 $63.62 $4,359.65 $3,051.36 2026-07-16
47350 HCPCS Suture Of Simple Liver Wound To Control Bleeding 9 9 $3,255.00 $3,255.00 $59.55 $3,220.10 $2,766.75 2026-07-16
47600 HCPCS Removal Of Gallbladder 9 9 $4,362.00 $4,362.00 $46.46 $3,707.70 $2,244.24 2026-07-16
47605 HCPCS Removal Of Gallbladder With X-ray Study Of Bile Ducts 9 9 $4,960.00 $4,960.00 $48.90 $4,216.00 $2,361.60 2026-07-16
47610 HCPCS Removal Of Gallbladder With Exploration Of Common Bile Duct 9 9 $5,124.00 $5,124.00 $54.59 $4,355.40 $2,636.64 2026-07-16
49000 HCPCS Exploration Of Abdominal Cavity 18 9 $3,755.50 $3,755.50 $33.48 $3,653.02 $1,718.88 2026-07-16
49002 HCPCS Reopening Of Recent Abdominal Incision 9 9 $1,960.00 $1,960.00 $45.51 $2,467.10 $1,666.00 2026-07-16
49010 HCPCS Exploration Behind Abdominal Cavity 9 9 $3,871.00 $3,871.00 $40.35 $3,290.35 $1,936.08 2026-07-16
49020 HCPCS Drainage Of Abdominal Abscess Or Infection 9 9 $4,653.00 $4,653.00 $69.20 $3,955.05 $3,337.92 2026-07-16
49255 HCPCS Removal Of Lining Covering Abdominal Organs 9 9 $2,020.00 $2,020.00 $34.40 $1,887.60 $1,645.92 2026-07-16
49402 HCPCS Removal Of Foreign Body In Abdominal Cavity 9 9 $3,713.00 $3,713.00 $37.25 $3,156.05 $1,794.96 2026-07-16
49594 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, 3-10 Cm In Length 7 7 $2,444.00 $2,444.00 $605.87 $2,077.40 $1,762.00 2026-07-16
49595 HCPCS Initial Repair Of Sliding Hernia Of Abdomen, More Than 10 Cm In Length 7 7 $2,938.00 $2,938.00 $627.47 $2,497.30 $1,826.40 2026-07-16
49596 HCPCS Initial Repair Of Entrapped Hernia Of Abdomen, More Than 10 Cm In Length 7 7 $2,676.00 $2,676.00 $831.66 $2,424.70 $2,274.60 2026-07-16
49605 HCPCS Repair Of Large Defect Of Abdominal Wall At Navel 9 9 $16,225.00 $16,225.00 $213.78 $13,791.25 $10,411.92 2026-07-16
49606 HCPCS Repair Of Defect Of Abdominal Wall At Navel With Removal Of Prosthesis 9 9 $4,110.00 $4,110.00 $49.37 $3,493.50 $2,383.20 2026-07-16
49616 HCPCS Repair Of Recurrent Entrapped Hernia Of Abdomen, 3-10 Cm In Length 7 7 $3,875.00 $3,875.00 $695.65 $3,293.75 $2,027.40 2026-07-16
49652 HCPCS Laparoscopy, Surgical, Repair, Ventral, Umbilical, Spigelian Or Epigastric Herni… 16 9 $2,659.00 $2,659.00 $32.33 $2,579.23 $1,817.85 2026-07-16
49653 HCPCS Laparoscopy, Surgical, Repair, Ventral, Umbilical, Spigelian Or Epigastric Herni… 7 7 $3,612.00 $3,612.00 $40.37 $3,070.20 $1,949.76 2026-07-16
49659 HCPCS Other Repair Of Hernia Using An Endoscope 6 6 $4,262.00 $4,262.00 $1,065.50 $3,622.70 $3,089.95 2026-07-16
49900 HCPCS Suture Of Postsurgical Opening In Abdominal Wall 9 9 $3,302.00 $3,302.00 $35.46 $2,806.70 $1,710.00 2026-07-16
51860 HCPCS Suture Of Simple Wound, Injury, Or Rupture Of Bladder 9 9 $2,148.00 $2,148.00 $32.33 $1,825.80 $1,551.60 2026-07-16
57260 HCPCS Plastic Repair Of Vagina And Tissue Separating Vagina, Rectum, And Bladder 9 9 $2,027.00 $2,027.00 $32.64 $1,808.10 $1,614.96 2026-07-16
57270 HCPCS Repair Of Protrusion Of Intestine Into Rectum Or Vagina Through Abdomen 9 9 $3,094.00 $3,094.00 $34.55 $2,629.90 $1,687.68 2026-07-16
58140 HCPCS Removal Of Growth Of Uterus Through Abdomen, 1-4 Growths 9 9 $2,133.00 $2,133.00 $39.27 $2,137.50 $1,813.05 2026-07-16
58150 HCPCS Removal Of Uterus And Cervix Through Abdomen 9 9 $5,598.00 $5,598.00 $43.65 $4,758.30 $2,106.00 2026-07-16
58152 HCPCS Removal Of Uterus And Cervix Through Abdomen With Repair Of Vagina 9 9 $6,446.00 $6,446.00 $53.39 $5,479.10 $2,616.48 2026-07-16
58180 HCPCS Removal Of Uterus Through Abdomen 9 9 $2,931.00 $2,931.00 $41.09 $2,491.35 $2,004.48 2026-07-16
58200 HCPCS Removal Of Uterus Through Abdomen With Partial Removal Of Vagina 9 9 $6,111.00 $6,111.00 $59.57 $5,194.35 $2,810.16 2026-07-16
58260 HCPCS Removal Of Uterus Through Vagina, 250.0 G Or Less 9 9 $5,412.00 $5,412.00 $35.22 $4,600.20 $1,742.40 2026-07-16
58262 HCPCS Removal Of Uterus, Tubes, And/or Ovaries Through Vagina, 250.0 G Or Less 9 9 $3,612.00 $3,612.00 $39.15 $3,070.20 $1,934.64 2026-07-16
58673 HCPCS Repair Of Uterine Tube Using An Endoscope 9 9 $3,354.00 $3,354.00 $33.66 $2,850.90 $1,666.80 2026-07-16
58700 HCPCS Removal Of Uterine Tubes 9 9 $2,826.00 $2,826.00 $33.56 $2,402.10 $1,648.80 2026-07-16
58720 HCPCS Removal Of Uterine Tubes And Ovaries 9 9 $3,913.00 $3,913.00 $31.98 $3,326.05 $1,553.04 2026-07-16
58925 HCPCS Removal Of Cysts Of Ovaries 9 9 $3,636.00 $3,636.00 $32.19 $3,090.60 $1,582.56 2026-07-16
58960 HCPCS Exam Of Abdominal Cavity With Removal Or Biopsy Of Abdominal Lining Or Lymph Nod… 9 9 $4,372.00 $4,372.00 $42.39 $3,716.20 $2,015.28 2026-07-16
59100 HCPCS Incision Of Uterus 9 9 $3,872.00 $3,872.00 $36.29 $3,291.20 $1,775.52 2026-07-16
59120 HCPCS Removal Of Ovarian Or Tubal Pregnancy With Removal Of Ovaries 9 9 $3,075.00 $3,075.00 $34.56 $2,613.75 $1,691.28 2026-07-16
59400 HCPCS Vaginal Delivery With Care Before And After Delivery 9 9 $3,675.00 $3,675.00 $90.65 $4,430.16 $3,123.75 2026-07-16
59410 HCPCS Vaginal Delivery With Post Delivery Care 9 9 $3,060.00 $3,060.00 $44.91 $2,601.00 $1,655.70 2026-07-16
59515 HCPCS Cesarean Delivery With Care After Delivery 9 9 $4,112.00 $4,112.00 $54.60 $3,495.20 $2,053.70 2026-07-16
59614 HCPCS Vaginal Delivery And Care After Delivery After Prior Cesarean Delivery 9 9 $2,991.00 $2,991.00 $48.99 $2,542.35 $1,790.70 2026-07-16
66830 HCPCS Removal Of Recurring Cataract In Lens Capsule With Sectioning Of Cornea And Scle… 9 9 $2,977.00 $2,977.00 $1,131.26 $2,887.69 $2,322.06 2026-07-16
66984 HCPCS Removal Of Cataract With Insertion Of Prosthetic Lens 9 9 $4,204.00 $4,204.00 $1,597.52 $4,077.88 $3,279.12 2026-07-16
66985 HCPCS Insertion Of Prosthetic Lens 9 9 $2,977.00 $2,977.00 $1,131.26 $2,887.69 $2,322.06 2026-07-16
70336 HCPCS MRI Scan Of Jaw Joint 9 9 $5,274.00 $5,274.00 $2,004.12 $5,115.78 $4,113.72 2026-07-16
70450 HCPCS CT Scan Head Or Brain Without Contrast 9 9 $2,260.00 $2,260.00 $858.80 $2,192.20 $1,762.80 2026-07-16
70460 HCPCS CT Scan Head Or Brain With Contrast 9 9 $2,582.00 $2,582.00 $981.16 $2,504.54 $2,013.96 2026-07-16
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 9 9 $2,905.00 $2,905.00 $1,103.90 $2,817.85 $2,265.90 2026-07-16
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 9 9 $2,260.00 $2,260.00 $858.80 $2,192.20 $1,762.80 2026-07-16
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 18 9 $2,359.50 $2,359.50 $812.06 $2,504.54 $1,708.53 2026-07-16
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 18 9 $2,733.00 $2,733.00 $973.18 $2,817.85 $2,047.52 2026-07-16
70486 HCPCS CT Scan Of Face Without Contrast 9 9 $2,260.00 $2,260.00 $858.80 $2,192.20 $1,762.80 2026-07-16
70487 HCPCS CT Scan Of Face With Contrast 9 9 $2,582.00 $2,582.00 $981.16 $2,504.54 $2,013.96 2026-07-16
70488 HCPCS CT Scan Of Face Before And After Contrast 9 9 $2,905.00 $2,905.00 $1,103.90 $2,817.85 $2,265.90 2026-07-16
70490 HCPCS CT Scan Of Soft Tissue Of Neck Without Contrast 9 9 $2,260.00 $2,260.00 $858.80 $2,192.20 $1,762.80 2026-07-16
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 9 9 $2,582.00 $2,582.00 $981.16 $2,504.54 $2,013.96 2026-07-16
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 9 9 $2,905.00 $2,905.00 $1,103.90 $2,817.85 $2,265.90 2026-07-16
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 9 9 $3,872.00 $3,872.00 $1,471.36 $3,755.84 $3,020.16 2026-07-16
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 9 9 $3,872.00 $3,872.00 $1,471.36 $3,755.84 $3,020.16 2026-07-16
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 9 9 $4,515.00 $4,515.00 $1,715.70 $4,379.55 $3,521.70 2026-07-16
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 9 9 $4,838.00 $4,838.00 $1,838.44 $4,692.86 $3,773.64 2026-07-16
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 9 9 $5,160.00 $5,160.00 $1,960.80 $5,005.20 $4,024.80 2026-07-16
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 9 9 $4,838.00 $4,838.00 $1,838.44 $4,692.86 $3,773.64 2026-07-16
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 9 9 $5,160.00 $5,160.00 $1,960.80 $5,005.20 $4,024.80 2026-07-16
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 9 9 $5,484.00 $5,484.00 $2,083.92 $5,319.48 $4,277.52 2026-07-16
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 9 9 $4,838.00 $4,838.00 $1,838.44 $4,692.86 $3,773.64 2026-07-16
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 9 9 $3,332.00 $3,332.00 $1,266.16 $3,232.04 $2,598.96 2026-07-16
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 9 9 $5,484.00 $5,484.00 $2,083.92 $5,319.48 $4,277.52 2026-07-16
70551 HCPCS MRI Scan Of Brain Without Contrast 9 9 $4,515.00 $4,515.00 $1,715.70 $4,379.55 $3,521.70 2026-07-16
70552 HCPCS MRI Scan Of Brain With Contrast 9 9 $4,838.00 $4,838.00 $1,838.44 $4,692.86 $3,773.64 2026-07-16
70553 HCPCS MRI Scan Of Brain Before And After Contrast 9 9 $5,160.00 $5,160.00 $1,960.80 $5,005.20 $4,024.80 2026-07-16
71250 HCPCS CT Scan Of Chest Without Contrast 9 9 $2,582.00 $2,582.00 $981.16 $2,504.54 $2,013.96 2026-07-16
71260 HCPCS CT Scan Of Chest With Contrast 9 9 $2,905.00 $2,905.00 $1,103.90 $2,817.85 $2,265.90 2026-07-16
71270 HCPCS CT Scan Of Chest Before And After Contrast 9 9 $3,227.00 $3,227.00 $1,226.26 $3,130.19 $2,517.06 2026-07-16
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 18 9 $4,239.50 $4,239.50 $1,471.36 $4,468.79 $3,095.66 2026-07-16
71550 HCPCS MRI Scan Of Chest Without Contrast 9 9 $3,872.00 $3,872.00 $1,471.36 $3,755.84 $3,020.16 2026-07-16
71551 HCPCS MRI Scan Of Chest With Contrast 10 9 $4,133.00 $4,133.00 $1,570.54 $4,009.01 $2,436.40 2026-07-16
71552 HCPCS MRI Scan Of Chest Before And After Contrast 10 9 $4,515.00 $4,515.00 $1,715.70 $4,379.55 $2,661.59 2026-07-16
72125 HCPCS CT Scan Of Upper Spine Without Contrast 9 9 $2,905.00 $2,905.00 $1,103.90 $2,817.85 $2,265.90 2026-07-16
72126 HCPCS CT Scan Of Upper Spine With Contrast 9 9 $3,227.00 $3,227.00 $1,226.26 $3,130.19 $2,517.06 2026-07-16
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 9 9 $3,548.00 $3,548.00 $1,348.24 $3,441.56 $2,767.44 2026-07-16
72128 HCPCS CT Scan Of Middle Spine Without Contrast 9 9 $2,905.00 $2,905.00 $1,103.90 $2,817.85 $2,265.90 2026-07-16
72129 HCPCS CT Scan Of Middle Spine With Contrast 9 9 $3,227.00 $3,227.00 $1,226.26 $3,130.19 $2,517.06 2026-07-16
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 9 9 $3,548.00 $3,548.00 $1,348.24 $3,441.56 $2,767.44 2026-07-16
72131 HCPCS CT Scan Of Lower Spine Without Contrast 9 9 $2,905.00 $2,905.00 $1,103.90 $2,817.85 $2,265.90 2026-07-16
72132 HCPCS CT Scan Of Lower Spine With Contrast 9 9 $3,227.00 $3,227.00 $1,226.26 $3,130.19 $2,517.06 2026-07-16
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 9 9 $3,548.00 $3,548.00 $1,348.24 $3,441.56 $2,767.44 2026-07-16
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 9 9 $3,872.00 $3,872.00 $1,471.36 $3,755.84 $3,020.16 2026-07-16
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 9 9 $4,195.00 $4,195.00 $1,594.10 $4,069.15 $3,272.10 2026-07-16
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 9 9 $3,872.00 $3,872.00 $1,471.36 $3,755.84 $3,020.16 2026-07-16
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 9 9 $4,195.00 $4,195.00 $1,594.10 $4,069.15 $3,272.10 2026-07-16
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 9 9 $3,872.00 $3,872.00 $1,471.36 $3,755.84 $3,020.16 2026-07-16
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 9 9 $4,195.00 $4,195.00 $1,594.10 $4,069.15 $3,272.10 2026-07-16
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 9 9 $4,515.00 $4,515.00 $1,715.70 $4,379.55 $3,521.70 2026-07-16
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 9 9 $4,515.00 $4,515.00 $1,715.70 $4,379.55 $3,521.70 2026-07-16
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 9 9 $4,515.00 $4,515.00 $1,715.70 $4,379.55 $3,521.70 2026-07-16
72159 HCPCS MRI Scan Of Blood Vessels Of Spinal Canal 9 9 $6,451.00 $6,451.00 $2,451.38 $6,257.47 $5,031.78 2026-07-16
72192 HCPCS CT Scan Of Pelvis Without Contrast 9 9 $2,905.00 $2,905.00 $1,103.90 $2,817.85 $2,265.90 2026-07-16
72193 HCPCS CT Scan Of Pelvis With Contrast 9 9 $3,227.00 $3,227.00 $1,226.26 $3,130.19 $2,517.06 2026-07-16
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 9 9 $3,548.00 $3,548.00 $1,348.24 $3,441.56 $2,767.44 2026-07-16
72195 HCPCS MRI Scan Of Pelvis Without Contrast 9 9 $3,872.00 $3,872.00 $1,471.36 $3,755.84 $3,020.16 2026-07-16
72196 HCPCS MRI Scan Of Pelvis With Contrast 9 9 $4,195.00 $4,195.00 $1,594.10 $4,069.15 $3,272.10 2026-07-16
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 9 9 $4,515.00 $4,515.00 $1,715.70 $4,379.55 $3,521.70 2026-07-16
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 9 9 $5,160.00 $5,160.00 $1,960.80 $5,005.20 $4,024.80 2026-07-16
73200 HCPCS CT Scan Of Arm Without Contrast 9 9 $2,582.00 $2,582.00 $981.16 $2,504.54 $2,013.96 2026-07-16
73201 HCPCS CT Scan Of Arm With Contrast 9 9 $2,905.00 $2,905.00 $1,103.90 $2,817.85 $2,265.90 2026-07-16
73202 HCPCS CT Scan Of Arm Before And After Contrast 9 9 $3,227.00 $3,227.00 $1,226.26 $3,130.19 $2,517.06 2026-07-16
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 18 9 $2,151.00 $2,151.00 $769.12 $2,209.66 $1,618.19 2026-07-16
73218 HCPCS MRI Scan Of Arm Without Contrast 9 9 $3,872.00 $3,872.00 $1,471.36 $3,755.84 $3,020.16 2026-07-16
73219 HCPCS MRI Scan Of Arm With Contrast 9 9 $4,195.00 $4,195.00 $1,594.10 $4,069.15 $3,272.10 2026-07-16
73220 HCPCS MRI Scan Of Arm Before And After Contrast 9 9 $4,515.00 $4,515.00 $1,715.70 $4,379.55 $3,521.70 2026-07-16
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 9 9 $3,872.00 $3,872.00 $1,471.36 $3,755.84 $3,020.16 2026-07-16
73222 HCPCS MRI Scan Of Arm Joint With Contrast 9 9 $4,195.00 $4,195.00 $1,594.10 $4,069.15 $3,272.10 2026-07-16
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 9 9 $4,515.00 $4,515.00 $1,715.70 $4,379.55 $3,521.70 2026-07-16
73225 HCPCS MRI Scan Of Blood Vessels Of Arm 9 9 $5,160.00 $5,160.00 $1,960.80 $5,005.20 $4,024.80 2026-07-16
73700 HCPCS CT Scan Of Leg Without Contrast 9 9 $2,582.00 $2,582.00 $981.16 $2,504.54 $2,013.96 2026-07-16
73701 HCPCS CT Scan Of Leg With Contrast Material 9 9 $2,905.00 $2,905.00 $1,103.90 $2,817.85 $2,265.90 2026-07-16
73702 HCPCS CT Scan Of Leg Before And After Contrast 9 9 $3,227.00 $3,227.00 $1,226.26 $3,130.19 $2,517.06 2026-07-16
73718 HCPCS MRI Scan Of Leg Without Contrast 9 9 $3,872.00 $3,872.00 $1,471.36 $3,755.84 $3,020.16 2026-07-16
73719 HCPCS MRI Scan Of Leg With Contrast 9 9 $4,195.00 $4,195.00 $1,594.10 $4,069.15 $3,272.10 2026-07-16
73720 HCPCS MRI Scan Of Leg Before And After Contrast 9 9 $4,515.00 $4,515.00 $1,715.70 $4,379.55 $3,521.70 2026-07-16
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 9 9 $3,872.00 $3,872.00 $1,471.36 $3,755.84 $3,020.16 2026-07-16
73722 HCPCS MRI Scan Of Leg Joint With Contrast 9 9 $4,195.00 $4,195.00 $1,594.10 $4,069.15 $3,272.10 2026-07-16
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 9 9 $4,515.00 $4,515.00 $1,715.70 $4,379.55 $3,521.70 2026-07-16
74150 HCPCS CT Scan Of Abdomen Without Contrast 9 9 $2,582.00 $2,582.00 $981.16 $2,504.54 $2,013.96 2026-07-16
74160 HCPCS CT Scan Of Abdomen With Contrast 27 9 $2,430.00 $2,430.00 $765.32 $2,817.85 $1,649.47 2026-07-16
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 9 9 $3,227.00 $3,227.00 $1,226.26 $3,130.19 $2,517.06 2026-07-16
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 18 9 $4,722.50 $4,722.50 $1,750.66 $4,692.86 $3,683.30 2026-07-16
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 9 9 $4,195.00 $4,195.00 $1,594.10 $4,069.15 $3,272.10 2026-07-16
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 27 9 $4,149.00 $4,149.00 $805.60 $5,005.20 $2,056.40 2026-07-16
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 20 9 $5,484.00 $5,484.00 $765.32 $5,319.48 $2,083.92 2026-07-16
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 9 9 $6,127.00 $6,127.00 $2,328.26 $5,943.19 $4,779.06 2026-07-16
74181 HCPCS MRI Scan Of Abdomen Without Contrast 9 9 $4,195.00 $4,195.00 $1,594.10 $4,069.15 $3,272.10 2026-07-16
74182 HCPCS MRI Scan Of Abdomen With Contrast 9 9 $4,515.00 $4,515.00 $1,715.70 $4,379.55 $3,521.70 2026-07-16
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 9 9 $4,838.00 $4,838.00 $1,838.44 $4,692.86 $3,773.64 2026-07-16
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 9 9 $4,838.00 $4,838.00 $1,838.44 $4,692.86 $3,773.64 2026-07-16
76400 HCPCS MRI Bone Marrow Blood Supply 9 9 $2,779.00 $2,779.00 $1,056.02 $2,695.63 $2,167.62 2026-07-16
77046 HCPCS MRI Scan Of 1 Breast Without Contrast 9 9 $2,644.00 $2,644.00 $1,004.72 $2,564.68 $2,062.32 2026-07-16
77047 HCPCS MRI Scan Of Both Breasts Without Contrast 9 9 $3,935.00 $3,935.00 $1,495.30 $3,816.95 $3,069.30 2026-07-16
78315 HCPCS Nuclear Medicine Study Of Bone Taken At Different Times 9 9 $2,324.00 $2,324.00 $883.12 $2,254.28 $1,812.72 2026-07-16
78451 HCPCS Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect 10 9 $5,160.00 $5,160.00 $1,960.80 $5,005.20 $3,041.82 2026-07-16
78452 HCPCS Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 9 9 $7,094.00 $7,094.00 $2,695.72 $6,881.18 $5,533.32 2026-07-16
78582 HCPCS Nuclear Medicine Study Of Lung Ventilation And Circulation 9 9 $2,970.00 $2,970.00 $1,128.60 $2,880.90 $2,316.60 2026-07-16
81208 HCPCS Translocation Analysis (bcr/abl1) Other Breakpoint 9 9 $2,348.00 $2,348.00 $892.24 $2,277.56 $1,831.44 2026-07-16
81229 HCPCS Genome-wide Microarray Analysis For Copy Number And Single Nucleotide Polymorphi… 9 9 $4,766.00 $4,766.00 $1,811.08 $4,623.02 $3,717.48 2026-07-16
81408 HCPCS Molecular Pathology Procedure Level 9 Genetic Analysis 9 9 $4,755.00 $4,755.00 $1,806.90 $4,612.35 $3,708.90 2026-07-16
82710 HCPCS Stool Fat Or Lipids Analysis, Quantitative 9 9 $3,213.00 $3,213.00 $1,220.94 $3,116.61 $2,506.14 2026-07-16
90378 HCPCS Respiratory Syncytial Virus Antibody For Injection Into Tissue Or Muscle 9 9 $3,756.00 $3,756.00 $1,427.28 $3,643.32 $2,929.68 2026-07-16
90396 HCPCS Varicella (chicken Pox) Zoster Immune Globulin For Injection Into Muscle 7 7 $2,737.00 $2,737.00 $1,040.06 $2,654.89 $2,134.86 2026-07-16
94003 HCPCS Follow-up Inpatient Or Observation Ventilation Assistance And Management 9 9 $2,258.00 $2,258.00 $858.04 $2,190.26 $1,761.24 2026-07-16
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 18 9 $3,374.50 $3,374.50 $1,250.96 $3,353.29 $2,631.95 2026-07-16
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 9 9 $3,894.00 $3,894.00 $1,479.72 $3,777.18 $3,037.32 2026-07-16
A0427 HCPCS Ambulance Service, Advanced Life Support, Emergency Transport, Level 1 (als 1 - … 9 9 $2,600.00 $2,600.00 $988.00 $2,522.00 $2,028.00 2026-07-16
A0433 HCPCS Advanced Life Support, Level 2 (als 2) 9 9 $2,947.00 $2,947.00 $1,119.86 $2,858.59 $2,298.66 2026-07-16
A9697 HCPCS Injection, Carboxydextran-coated Superparamagnetic Iron Oxide, Per Study Dose 9 9 $2,015.00 $2,015.00 $765.70 $1,954.55 $1,571.70 2026-07-16
C1726 HCPCS Catheter, Balloon Dilatation, Non-vascular 9 9 $9,655.00 $9,655.00 $3,668.90 $9,365.35 $7,530.90 2026-07-16
C1785 HCPCS Pacemaker, Dual Chamber, Rate-responsive (implantable) 9 9 $18,092.00 $18,092.00 $6,874.96 $17,549.24 $14,111.76 2026-07-16
C1786 HCPCS Pacemaker, Single Chamber, Rate-responsive (implantable) 9 9 $18,092.00 $18,092.00 $6,874.96 $17,549.24 $14,111.76 2026-07-16
C8900 HCPCS Magnetic Resonance Angiography With Contrast, Abdomen 9 9 $3,998.00 $3,998.00 $1,519.24 $3,878.06 $3,118.44 2026-07-16
C8901 HCPCS Magnetic Resonance Angiography Without Contrast, Abdomen 9 9 $3,864.00 $3,864.00 $1,468.32 $3,748.08 $3,013.92 2026-07-16
C8902 HCPCS Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Abdom… 9 9 $5,160.00 $5,160.00 $1,960.80 $5,005.20 $4,024.80 2026-07-16
C8903 HCPCS Magnetic Resonance Imaging With Contrast, Breast; Unilateral 9 9 $2,779.00 $2,779.00 $1,056.02 $2,695.63 $2,167.62 2026-07-16
C8905 HCPCS Magnetic Resonance Imaging Without Contrast Followed By With Contrast, Breast; U… 9 9 $4,167.00 $4,167.00 $1,583.46 $4,041.99 $3,250.26 2026-07-16
C8906 HCPCS Magnetic Resonance Imaging With Contrast, Breast; Bilateral 9 9 $4,070.00 $4,070.00 $1,546.60 $3,947.90 $3,174.60 2026-07-16
C8908 HCPCS Magnetic Resonance Imaging Without Contrast Followed By With Contrast, Breast; B… 9 9 $6,102.00 $6,102.00 $2,318.76 $5,918.94 $4,759.56 2026-07-16
C8909 HCPCS Magnetic Resonance Angiography With Contrast, Chest (excluding Myocardium) 9 9 $5,217.00 $5,217.00 $1,982.46 $5,060.49 $4,069.26 2026-07-16
C8910 HCPCS Magnetic Resonance Angiography Without Contrast, Chest (excluding Myocardium) 9 9 $5,081.00 $5,081.00 $1,930.78 $4,928.57 $3,963.18 2026-07-16
C8911 HCPCS Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Chest… 18 9 $7,135.50 $7,135.50 $2,451.38 $7,585.40 $5,157.57 2026-07-16
C8914 HCPCS Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Lower… 9 9 $5,160.00 $5,160.00 $1,960.80 $5,005.20 $4,024.80 2026-07-16
C9363 HCPCS Skin Substitute, Integra Meshed Bilayer Wound Matrix, Per Square Centimeter 9 9 $9,118.00 $9,118.00 $3,464.84 $8,844.46 $7,112.04 2026-07-16
J0401 HCPCS Injection, Aripiprazole (abilify Maintena), 1 Mg 18 9 $6,114.33 $6,114.33 $1,992.34 $6,776.09 $4,191.78 2026-07-16
J0490 HCPCS Injection, Belimumab, 10 Mg 18 9 $3,381.55 $3,381.55 $596.17 $5,038.40 $1,747.81 2026-07-16
J0897 HCPCS Injection, Denosumab, 1 Mg 45 9 $4,175.92 $4,175.92 $20.52 $7,451.19 $1,666.19 2026-07-16
J1306 HCPCS Injection, Inclisiran, 1 Mg 9 9 $8,111.19 $8,111.19 $3,082.25 $7,867.85 $6,326.73 2026-07-16
J1437 HCPCS Injection, Ferric Derisomaltose, 10 Mg 9 9 $8,443.10 $8,443.10 $3,208.38 $8,189.81 $6,585.62 2026-07-16
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 9 9 $3,485.14 $3,485.14 $1,324.35 $3,380.59 $2,718.41 2026-07-16
J1561 HCPCS Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liquid)… 36 9 $4,086.84 $4,086.84 $446.47 $9,009.70 $2,813.44 2026-07-16
J1602 HCPCS Injection, Golimumab, 1 Mg, For Intravenous Use 9 9 $4,119.48 $4,119.48 $1,565.40 $3,995.89 $3,213.19 2026-07-16
J1950 HCPCS Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg 18 9 $6,957.30 $6,957.30 $588.62 $11,994.63 $3,100.73 2026-07-16
J1951 HCPCS Injection, Leuprolide Acetate For Depot Suspension (fensolvi), 0.25 Mg 9 9 $6,519.32 $6,519.32 $2,477.34 $6,323.74 $5,085.07 2026-07-16
J2315 HCPCS Injection, Naltrexone, Depot Form, 1 Mg 9 9 $4,071.82 $4,071.82 $1,547.29 $3,949.67 $3,176.02 2026-07-16
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 18 9 $10,654.95 $10,654.95 $3,517.63 $11,691.41 $7,400.90 2026-07-16
J3101 HCPCS Injection, Tenecteplase, 1 Mg 18 9 $14,811.55 $14,811.55 $3,683.98 $19,330.57 $7,951.44 2026-07-16
J3240 HCPCS Injection, Thyrotropin Alpha, 0.9 Mg, Provided In 1.1 Mg Vial 9 9 $3,829.00 $3,829.00 $1,455.02 $3,714.13 $2,986.62 2026-07-16
J3245 HCPCS Injection, Tildrakizumab, 1 Mg 9 9 $39,414.91 $39,414.91 $14,977.66 $38,232.46 $30,743.63 2026-07-16
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 9 9 $20,814.80 $20,814.80 $7,909.62 $20,190.36 $16,235.54 2026-07-16
J3590 HCPCS Unclassified Biologics 9 9 $2,411.02 $2,411.02 $916.19 $2,338.69 $1,880.60 2026-07-16
J7298 HCPCS Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg 9 9 $2,240.00 $2,240.00 $851.20 $2,172.80 $1,747.20 2026-07-16
J7307 HCPCS Etonogestrel (contraceptive) Implant System, Including Implant And Supplies 9 9 $2,551.00 $2,551.00 $969.38 $2,474.47 $1,989.78 2026-07-16
J9202 HCPCS Goserelin Acetate Implant, Per 3.6 Mg 9 9 $2,286.46 $2,286.46 $868.85 $2,217.87 $1,783.44 2026-07-16
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 27 9 $3,267.17 $3,267.17 $95.00 $14,290.53 $2,548.39 2026-07-16
J9312 HCPCS Injection, Rituximab, 10 Mg 18 9 $6,271.62 $6,271.62 $476.52 $10,950.56 $2,753.14 2026-07-16
P9034 HCPCS Platelets, Pheresis, Each Unit 18 9 $2,399.50 $2,399.50 $847.78 $2,490.96 $1,783.68 2026-07-16
Q0138 HCPCS Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd … 18 9 $2,492.05 $2,492.05 $831.38 $2,712.36 $1,749.18 2026-07-16
Q5103 HCPCS Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 9 9 $2,286.08 $2,286.08 $868.71 $2,217.50 $1,783.14 2026-07-16
Q5115 HCPCS Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg 9 9 $10,161.60 $10,161.60 $3,861.41 $9,856.75 $7,926.05 2026-07-16
Q5122 HCPCS Injection, Pegfilgrastim-apgf (nyvepria), Biosimilar, 0.5 Mg 9 9 $5,667.00 $5,667.00 $2,153.46 $5,496.99 $4,420.26 2026-07-16
Q5127 HCPCS Injection, Pegfilgrastim-fpgk (stimufend), Biosimilar, 0.5 Mg 9 9 $6,207.36 $6,207.36 $2,358.80 $6,021.14 $4,841.74 2026-07-16
T2031 HCPCS Assisted Living; Waiver, Per Diem 9 9 $2,977.00 $2,977.00 $1,131.26 $2,887.69 $2,322.06 2026-07-16
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