Hospital

QUINCY VALLEY MEDICAL CENTER

Quincy, WA · CCN 501320 · Rates published

5,102 distinct procedures filed

15 distinct payers

64,412 rate rows

2026-03-12 last MRF observed

Data quality

64,278 of 64,412 rate rows are consumer-grade (99.8%)

134 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reason	Rows
percent-of-charges filed in the dollar field — excluded from medians	86
exceeds 10× this hospital's gross charge — excluded from medians	19
per-diem day rate — not a per-procedure price	17
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	12

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

Source MRF file	https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbQVMCQUINCYWA&type=CDMWithoutLabel
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-05-15
Content fingerprint	cdbf18506d273279… · 21,120,509 bytes · first seen 2026-05-06

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	11	$13,042.48	$23,386.85	$20,925.08	nat. median $5,957 outlier · 3.5×
600095 CDM	Amniofix 9x9	11	$8,504.08	$15,248.93	$13,643.78	nat. median $908 outlier · 15.0×
600107 CDM	Amnioeffect 6x8	11	$6,866.21	$12,312.00	$11,016.00	nat. median $786 outlier · 14.0×
600099 CDM	Amniofix 6x10	11	$6,509.39	$11,672.18	$10,443.53	nat. median $8 outlier · 1299.8×
999865 CDM	Misc Item Personnel	11	$3,584.03	$6,426.63	$5,750.14	nat. median $402 outlier · 14.3×
600091 CDM	Amniofix 4cm X 6cm Sheet	11	$3,495.89	$6,268.58	$5,608.73	nat. median $9,241 0.6× median
600106 CDM	Axiofill 1000mg	11	$3,482.38	$6,244.35	$5,587.05	nat. median $972 outlier · 5.7×
600108 CDM	Amnioeffect 4x6 Cm	11	$3,433.10	$6,156.00	$5,508.00	nat. median $652 outlier · 8.4×
600090 CDM	Amniofix 160 Mg Micronized	11	$3,171.65	$5,687.18	$5,088.53	nat. median $91 outlier · 55.8×
600096 CDM	Aminocord 3x5cm	11	$2,853.77	$5,117.18	$4,578.53	nat. median $899 outlier · 5.1×
600109 CDM	Amnioeffect 3x5 Cm	11	$2,852.97	$5,115.75	$4,577.25	nat. median $1,036 outlier · 4.4×
500328 CDM	Omm Step Lps Plate	11	$2,549.40	$4,571.41	$4,090.21	nat. median $3,413 1.2× median
A2007 HCPCS	Restrata, Per Square Centimeter	11	$1,088.10	$8,977.50	$4,016.25	nat. median $292 outlier · 13.8×
C1849 HCPCS	Skin Substitute, Synthetic, Resorbable, Per Square Centimeter	11	$2,384.10	$4,275.00	$3,825.00	nat. median $1,437 outlier · 2.7×
600092 CDM	Amniofix 4x4 Sheet	11	$2,225.95	$3,991.43	$3,571.28	nat. median $129 outlier · 27.7×
600093 CDM	Amniofix Wrap 2x4	11	$2,059.07	$3,692.18	$3,303.53	nat. median $170 outlier · 19.4×
500240 CDM	Right Lapidus Plate	11	$2,007.94	$3,600.50	$3,221.50	nat. median $229 outlier · 14.1×
26952 HCPCS	Amputation Of Finger Or Thumb With Tissue Flap	11	$1,854.79	$3,325.88	$2,975.79	nat. median $3,390 0.9× median
600089 CDM	Amniofill 500 Mg	11	$1,827.81	$3,277.50	$2,932.50	nat. median $248 outlier · 11.8×
600105 CDM	Axiofill 500mg	11	$1,740.39	$3,120.75	$2,792.25	nat. median $15 outlier · 183.5×
Q4196 HCPCS	Puraply Am, Per Square Centimeter	11	$1,192.05	$4,924.80	$2,422.50	nat. median $286 outlier · 8.5×
59409 HCPCS	Vaginal Delivery	11	$701.64	$3,603.68	$2,218.73	nat. median $3,185 0.7× median
600098 CDM	Amniocord 2x3	11	$1,351.78	$2,423.93	$2,168.78	nat. median $165 outlier · 13.2×
600115 CDM	Amnioeffect 2x3	11	$1,350.99	$2,422.50	$2,167.50	nat. median $18 outlier · 118.7×
95808 HCPCS	Sleep Study In Sleep Lab	11	$82.86	$3,457.88	$2,128.96	nat. median $1,142 1.9× median
95810 HCPCS	Sleep Study In Sleep Lab (6 Years Or Older)	11	$121.58	$3,457.88	$2,128.96	nat. median $1,870 1.1× median
95811 HCPCS	Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older)	11	$126.02	$3,457.88	$2,128.96	nat. median $2,026 1.1× median
95805 HCPCS	Sleep Study, Multiple Trials	11	$58.80	$3,457.88	$2,128.96	nat. median $1,268 1.7× median
70546 HCPCS	MRI Scan Of Blood Vessels Of Head Before And After Contrast	11	$68.69	$3,378.84	$2,080.30	nat. median $1,043 2.0× median
1200071 CDM	MRI Cardiac MRI Limited Study	11	$1,271.83	$2,280.55	$2,040.49	nat. median $933 outlier · 2.2×
1200070 CDM	MRI Cardiac MRI Function	11	$1,260.50	$2,260.24	$2,022.32	nat. median $1,006 outlier · 2.0×
730011 CDM	Room & Board - Private (one Bed) - General Classification	8	$1,504.91	$6,669.08	$1,996.90	nat. median $190 outlier · 10.5×
730013 CDM	Room & Board - Private (one Bed) - Medical/surgical/gyn	8	$1,504.91	$6,669.08	$1,996.90	nat. median $1,997 1.0× median
600100 CDM	Amniofix 2x3cm	11	$1,208.74	$2,167.43	$1,939.28	nat. median $1,782 1.1× median
24505 HCPCS	Closed Treatment Of Broken Middle Part Of Upper Arm Bone With Manipulation	11	$1,201.59	$2,154.60	$1,927.80	nat. median $1,641 1.2× median
1200069 CDM	MRI Myocardium With Contrast	11	$1,198.58	$2,149.21	$1,922.98	nat. median $2,036 0.9× median
730004 CDM	Room & Board - Private (one Bed) - General Classification	8	$1,418.92	$6,287.99	$1,882.80	nat. median $1,883 1.0× median
600094 CDM	Amniofix 2x2	11	$1,153.11	$2,067.68	$1,850.03	nat. median $955 1.9× median
70553 HCPCS	MRI Scan Of Brain Before And After Contrast	11	$106.54	$2,946.40	$1,814.05	nat. median $1,122 1.6× median
1200000 CDM	MRI Myocardium	11	$1,098.70	$1,970.11	$1,762.73	nat. median $480 outlier · 3.7×
730010 CDM	Room & Board - Semi-private (two Beds) - Medical/surgical/gyn	8	$1,326.10	$5,876.65	$1,759.63	nat. median $145 outlier · 12.2×
14020 HCPCS	Repair Of Wound Of Scalp, Arms, Or Legs By Transferring Skin, 10.0 Sq Cm Or Less	11	$1,085.56	$1,946.55	$1,741.65	nat. median $2,316 0.8× median
71551 HCPCS	MRI Scan Of Chest With Contrast	11	$80.57	$2,827.91	$1,741.10	nat. median $1,144 1.5× median
21450 HCPCS	Closed Treatment Of Broken Lower Jaw Bone	11	$302.04	$2,814.85	$1,733.06	nat. median $929 1.9× median
27818 HCPCS	Closed Treatment Of 3 Broken Lower Leg Bones At Ankle With Manipulation	11	$279.67	$2,634.72	$1,622.15	nat. median $1,679 1.0× median
505112 CDM	Mesh Plug&patch Lrg Hernia	11	$1,010.83	$1,812.55	$1,621.76	nat. median $1,622 1.0× median
1706280 CDM	Veklury 100 Mg Vial	11	$1,008.32	$1,808.04	$1,617.72	nat. median $1,618 1.0× median
73723 HCPCS	MRI Scan Of Leg Joint Before And After Contrast	11	$100.48	$2,377.55	$1,601.72	nat. median $1,264 1.3× median
23605 HCPCS	Closed Treatment Of Broken Top Of Upper Arm Bone With Manipulation	11	$272.99	$2,599.20	$1,600.28	nat. median $1,955 0.8× median
72156 HCPCS	MRI Scan Of Upper Spinal Canal Before And After Contrast	11	$106.89	$2,513.70	$1,547.64	nat. median $1,092 1.4× median

Other procedures at this hospital

Browse this hospital's 5,102 published procedures. Use the slice to choose what to show, then sort or filter any column.

Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code	Type	Description	Rate rows	Payers	Gross	Cash	Min $	Max $	Avg median	Last observed

J3101	HCPCS	Injection, Tenecteplase, 1 Mg	11	11	$24,617.74	$24,617.74	$13,042.48	$23,386.85	$20,925.08	2026-03-12
600095	CDM	Amniofix 9x9	11	11	$16,051.50	$16,051.50	$8,504.08	$15,248.93	$13,643.78	2026-03-12
600107	CDM	Amnioeffect 6x8	11	11	$12,960.00	$12,960.00	$6,866.21	$12,312.00	$11,016.00	2026-03-12
600099	CDM	Amniofix 6x10	11	11	$12,286.50	$12,286.50	$6,509.39	$11,672.18	$10,443.53	2026-03-12
999865	CDM	Misc Item Personnel	11	11	$6,764.87	$6,764.87	$3,584.03	$6,426.63	$5,750.14	2026-03-12
600091	CDM	Amniofix 4cm X 6cm Sheet	11	11	$6,598.50	$6,598.50	$3,495.89	$6,268.58	$5,608.73	2026-03-12
600106	CDM	Axiofill 1000mg	11	11	$6,573.00	$6,573.00	$3,482.38	$6,244.35	$5,587.05	2026-03-12
600108	CDM	Amnioeffect 4x6 Cm	11	11	$6,480.00	$6,480.00	$3,433.10	$6,156.00	$5,508.00	2026-03-12
600090	CDM	Amniofix 160 Mg Micronized	11	11	$5,986.50	$5,986.50	$3,171.65	$5,687.18	$5,088.53	2026-03-12
600096	CDM	Aminocord 3x5cm	11	11	$5,386.50	$5,386.50	$2,853.77	$5,117.18	$4,578.53	2026-03-12
600109	CDM	Amnioeffect 3x5 Cm	11	11	$5,385.00	$5,385.00	$2,852.97	$5,115.75	$4,577.25	2026-03-12
500328	CDM	Omm Step Lps Plate	11	11	$4,812.01	$4,812.01	$2,549.40	$4,571.41	$4,090.21	2026-03-12
A2007	HCPCS	Restrata, Per Square Centimeter	66	11	$5,302.50	$5,302.50	$1,088.10	$8,977.50	$4,016.25	2026-03-12
C1849	HCPCS	Skin Substitute, Synthetic, Resorbable, Per Square Centimeter	11	11	$4,500.00	$4,500.00	$2,384.10	$4,275.00	$3,825.00	2026-03-12
600092	CDM	Amniofix 4x4 Sheet	11	11	$4,201.50	$4,201.50	$2,225.95	$3,991.43	$3,571.28	2026-03-12
600093	CDM	Amniofix Wrap 2x4	11	11	$3,886.50	$3,886.50	$2,059.07	$3,692.18	$3,303.53	2026-03-12
500240	CDM	Right Lapidus Plate	11	11	$3,790.00	$3,790.00	$2,007.94	$3,600.50	$3,221.50	2026-03-12
26952	HCPCS	Amputation Of Finger Or Thumb With Tissue Flap	11	11	$3,500.93	$3,500.93	$1,854.79	$3,325.88	$2,975.79	2026-03-12
600089	CDM	Amniofill 500 Mg	11	11	$3,450.00	$3,450.00	$1,827.81	$3,277.50	$2,932.50	2026-03-12
600105	CDM	Axiofill 500mg	11	11	$3,285.00	$3,285.00	$1,740.39	$3,120.75	$2,792.25	2026-03-12
Q4196	HCPCS	Puraply Am, Per Square Centimeter	33	11	$2,850.00	$2,850.00	$1,192.05	$4,924.80	$2,422.50	2026-03-12
59409	HCPCS	Vaginal Delivery	20	11	$3,793.35	$3,793.35	$701.64	$3,603.68	$2,218.73	2026-03-12
600098	CDM	Amniocord 2x3	11	11	$2,551.50	$2,551.50	$1,351.78	$2,423.93	$2,168.78	2026-03-12
600115	CDM	Amnioeffect 2x3	11	11	$2,550.00	$2,550.00	$1,350.99	$2,422.50	$2,167.50	2026-03-12
95808	HCPCS	Sleep Study In Sleep Lab	20	11	$3,639.87	$3,639.87	$82.86	$3,457.88	$2,128.96	2026-03-12
95810	HCPCS	Sleep Study In Sleep Lab (6 Years Or Older)	20	11	$3,639.87	$3,639.87	$121.58	$3,457.88	$2,128.96	2026-03-12
95811	HCPCS	Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older)	20	11	$3,639.87	$3,639.87	$126.02	$3,457.88	$2,128.96	2026-03-12
95805	HCPCS	Sleep Study, Multiple Trials	20	11	$3,639.87	$3,639.87	$58.80	$3,457.88	$2,128.96	2026-03-12
70546	HCPCS	MRI Scan Of Blood Vessels Of Head Before And After Contrast	20	11	$3,556.67	$3,556.67	$68.69	$3,378.84	$2,080.30	2026-03-12
1200071	CDM	MRI Cardiac MRI Limited Study	11	11	$2,400.58	$2,400.58	$1,271.83	$2,280.55	$2,040.49	2026-03-12
1200070	CDM	MRI Cardiac MRI Function	11	11	$2,379.20	$2,379.20	$1,260.50	$2,260.24	$2,022.32	2026-03-12
730011	CDM	Room & Board - Private (one Bed) - General Classification	8	8	$2,315.25	$2,315.25	$1,504.91	$6,669.08	$1,996.90	2026-03-12
730013	CDM	Room & Board - Private (one Bed) - Medical/surgical/gyn	8	8	$2,315.25	$2,315.25	$1,504.91	$6,669.08	$1,996.90	2026-03-12
600100	CDM	Amniofix 2x3cm	11	11	$2,281.50	$2,281.50	$1,208.74	$2,167.43	$1,939.28	2026-03-12
24505	HCPCS	Closed Treatment Of Broken Middle Part Of Upper Arm Bone With Manipulation	11	11	$2,268.00	$2,268.00	$1,201.59	$2,154.60	$1,927.80	2026-03-12
1200069	CDM	MRI Myocardium With Contrast	11	11	$2,262.33	$2,262.33	$1,198.58	$2,149.21	$1,922.98	2026-03-12
730004	CDM	Room & Board - Private (one Bed) - General Classification	8	8	$2,182.95	$2,182.95	$1,418.92	$6,287.99	$1,882.80	2026-03-12
600094	CDM	Amniofix 2x2	11	11	$2,176.50	$2,176.50	$1,153.11	$2,067.68	$1,850.03	2026-03-12
70553	HCPCS	MRI Scan Of Brain Before And After Contrast	20	11	$3,101.47	$3,101.47	$106.54	$2,946.40	$1,814.05	2026-03-12
1200000	CDM	MRI Myocardium	11	11	$2,073.80	$2,073.80	$1,098.70	$1,970.11	$1,762.73	2026-03-12
730010	CDM	Room & Board - Semi-private (two Beds) - Medical/surgical/gyn	8	8	$2,040.15	$2,040.15	$1,326.10	$5,876.65	$1,759.63	2026-03-12
14020	HCPCS	Repair Of Wound Of Scalp, Arms, Or Legs By Transferring Skin, 10.0 Sq Cm Or Less	11	11	$2,049.00	$2,049.00	$1,085.56	$1,946.55	$1,741.65	2026-03-12
71551	HCPCS	MRI Scan Of Chest With Contrast	20	11	$2,976.75	$2,976.75	$80.57	$2,827.91	$1,741.10	2026-03-12
21450	HCPCS	Closed Treatment Of Broken Lower Jaw Bone	20	11	$2,963.00	$2,963.00	$302.04	$2,814.85	$1,733.06	2026-03-12
27818	HCPCS	Closed Treatment Of 3 Broken Lower Leg Bones At Ankle With Manipulation	20	11	$2,773.39	$2,773.39	$279.67	$2,634.72	$1,622.15	2026-03-12
505112	CDM	Mesh Plug&patch Lrg Hernia	11	11	$1,907.95	$1,907.95	$1,010.83	$1,812.55	$1,621.76	2026-03-12
1706280	CDM	Veklury 100 Mg Vial	11	11	$1,903.20	$1,903.20	$1,008.32	$1,808.04	$1,617.72	2026-03-12
73723	HCPCS	MRI Scan Of Leg Joint Before And After Contrast	31	11	$2,304.23	$2,304.23	$100.48	$2,377.55	$1,601.72	2026-03-12
23605	HCPCS	Closed Treatment Of Broken Top Of Upper Arm Bone With Manipulation	20	11	$2,736.00	$2,736.00	$272.99	$2,599.20	$1,600.28	2026-03-12
72156	HCPCS	MRI Scan Of Upper Spinal Canal Before And After Contrast	20	11	$2,646.00	$2,646.00	$106.89	$2,513.70	$1,547.64	2026-03-12
72157	HCPCS	MRI Scan Of Middle Spinal Canal Before And After Contrast	20	11	$2,601.90	$2,601.90	$106.89	$2,471.81	$1,521.86	2026-03-12
72159	HCPCS	MRI Scan Of Blood Vessels Of Spinal Canal	20	11	$2,590.88	$2,590.88	$83.64	$2,461.34	$1,515.41	2026-03-12
41252	HCPCS	Repair Of Lacerated Tongue Or Floor Of Mouth, More Than 2.6 Cm	11	11	$1,764.00	$1,764.00	$934.57	$1,675.80	$1,499.40	2026-03-12
72158	HCPCS	MRI Scan Of Lower Spinal Canal Before And After Contrast	20	11	$2,546.78	$2,546.78	$106.89	$2,419.44	$1,489.61	2026-03-12
71552	HCPCS	MRI Scan Of Chest Before And After Contrast	20	11	$2,535.75	$2,535.75	$105.18	$2,408.96	$1,483.16	2026-03-12
74183	HCPCS	MRI Scan Of Abdomen Before And After Contrast	20	11	$2,513.70	$2,513.70	$102.78	$2,388.02	$1,470.26	2026-03-12
J7298	HCPCS	Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg	11	11	$1,716.00	$1,716.00	$909.14	$1,630.20	$1,458.60	2026-03-12
70551	HCPCS	MRI Scan Of Brain Without Contrast	42	11	$1,786.05	$1,786.05	$68.69	$3,161.36	$1,452.55	2026-03-12
72148	HCPCS	MRI Scan Of Lower Spinal Canal Without Contrast	20	11	$2,449.23	$2,449.23	$69.40	$2,326.77	$1,432.55	2026-03-12
95807	HCPCS	Sleep Study Including Heart Rate And Breathing Attended By Technician	11	11	$1,685.21	$1,685.21	$892.82	$1,600.95	$1,432.43	2026-03-12
73221	HCPCS	MRI Scan Of Arm Joint Without Contrast	31	11	$1,797.08	$1,797.08	$64.03	$2,061.22	$1,388.61	2026-03-12
73721	HCPCS	MRI Scan Of Leg Joint Without Contrast	31	11	$1,797.08	$1,797.08	$63.68	$2,061.22	$1,388.61	2026-03-12
70336	HCPCS	MRI Scan Of Jaw Joint	31	11	$1,813.61	$1,813.61	$67.74	$2,005.73	$1,351.23	2026-03-12
73223	HCPCS	MRI Scan Of Arm Joint Before And After Contrast	40	11	$2,304.23	$2,304.23	$100.83	$2,189.02	$1,347.74	2026-03-12
503678	CDM	Device Tvt Disposable	11	11	$1,550.00	$1,550.00	$821.19	$1,472.50	$1,317.50	2026-03-12
71275	HCPCS	CT Scan Of Blood Vessels Of Chest With Contrast	31	11	$1,730.43	$1,730.43	$84.49	$1,932.22	$1,301.71	2026-03-12
73222	HCPCS	MRI Scan Of Arm Joint With Contrast	42	11	$1,786.05	$1,786.05	$76.24	$1,696.75	$1,294.49	2026-03-12
72146	HCPCS	MRI Scan Of Middle Spinal Canal Without Contrast	20	11	$2,209.63	$2,209.63	$69.05	$2,099.15	$1,292.41	2026-03-12
27197	HCPCS	Closed Treatment Of Broken And/or Dislocated Pelvis And/or Sacrum	20	11	$2,208.44	$2,208.44	$82.43	$2,098.02	$1,291.72	2026-03-12
70498	HCPCS	CT Scan Of Blood Vessels Of Neck With Contrast	20	11	$2,196.63	$2,196.63	$81.25	$2,086.80	$1,284.80	2026-03-12
70496	HCPCS	CT Scan Of Blood Vessels Of Head With Contrast	20	11	$2,196.63	$2,196.63	$81.25	$2,086.80	$1,284.80	2026-03-12
730009	CDM	Room & Board - Semi-private (two Beds) - General Classification	8	8	$1,488.90	$1,488.90	$967.79	$4,288.78	$1,284.18	2026-03-12
27752	HCPCS	Closed Treatment Of Middle Part Of Broken Shin Bone With Manipulation	11	11	$1,502.52	$1,502.52	$796.04	$1,427.39	$1,277.14	2026-03-12
Q4278	HCPCS	Epieffect, Per Square Centimeter	11	11	$1,500.00	$1,500.00	$794.70	$1,425.00	$1,275.00	2026-03-12
70552	HCPCS	MRI Scan Of Brain With Contrast	20	11	$2,149.88	$2,149.88	$82.97	$2,042.39	$1,257.47	2026-03-12
70549	HCPCS	MRI Scan Of Blood Vessels Of Neck Before And After Contrast	20	11	$2,133.34	$2,133.34	$83.64	$2,026.67	$1,247.79	2026-03-12
72195	HCPCS	MRI Scan Of Pelvis Without Contrast	20	11	$2,103.14	$2,103.14	$67.76	$1,997.98	$1,230.12	2026-03-12
72149	HCPCS	MRI Scan Of Lower Spinal Canal With Contrast	20	11	$2,094.75	$2,094.75	$83.32	$1,990.01	$1,225.22	2026-03-12
504908	CDM	Port A Cath	11	11	$1,429.12	$1,429.12	$757.15	$1,357.66	$1,214.75	2026-03-12
25675	HCPCS	Closed Treatment Of Dislocated Forearm Bone At Wrist With Manipulation	20	11	$2,067.77	$2,067.77	$265.93	$1,964.38	$1,209.43	2026-03-12
13132	HCPCS	Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G…	20	11	$2,040.37	$2,040.37	$253.29	$1,938.35	$1,193.41	2026-03-12
504763	CDM	Dst Eea 28	11	11	$1,400.00	$1,400.00	$741.72	$1,330.00	$1,190.00	2026-03-12
504762	CDM	Dst Eea 25	11	11	$1,400.00	$1,400.00	$741.72	$1,330.00	$1,190.00	2026-03-12
72147	HCPCS	MRI Scan Of Middle Spinal Canal With Contrast	20	11	$2,028.60	$2,028.60	$83.32	$1,927.17	$1,186.53	2026-03-12
13151	HCPCS	Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 1.1-2.5 Cm	11	11	$1,378.17	$1,378.17	$730.15	$1,309.26	$1,171.44	2026-03-12
504764	CDM	Dst Eea 31	11	11	$1,370.00	$1,370.00	$725.83	$1,301.50	$1,164.50	2026-03-12
70548	HCPCS	MRI Scan Of Blood Vessels Of Neck With Contrast	20	11	$1,981.19	$1,981.19	$69.72	$1,882.13	$1,158.80	2026-03-12
70547	HCPCS	MRI Scan Of Blood Vessels Of Neck Without Contrast	20	11	$1,951.43	$1,951.43	$55.79	$1,853.86	$1,141.39	2026-03-12
70545	HCPCS	MRI Scan Of Blood Vessels Of Head With Contrast	20	11	$1,948.12	$1,948.12	$55.79	$1,850.71	$1,139.45	2026-03-12
26725	HCPCS	Closed Treatment Of Broken Finger Or Thumb At Midportion Or Part Near Hand With …	20	11	$1,938.66	$1,938.66	$222.76	$1,841.73	$1,133.92	2026-03-12
59414	HCPCS	Delivery Of Placenta	20	11	$1,937.74	$1,937.74	$79.49	$1,840.85	$1,133.38	2026-03-12
71555	HCPCS	MRI Scan Of Blood Vessels Of Chest	20	11	$1,930.48	$1,930.48	$83.64	$1,833.96	$1,129.14	2026-03-12
G0390	HCPCS	Trauma Response Team Associated With Hospital Critical Care Service	11	11	$1,323.00	$1,323.00	$700.93	$1,256.85	$1,124.55	2026-03-12
25535	HCPCS	Closed Treatment Of Broken Midpart Of Forearm Bone On Small Finger Side With Man…	20	11	$1,850.00	$1,850.00	$318.33	$1,757.50	$1,082.07	2026-03-12
13152	HCPCS	Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 2.6-7.5 Cm	20	11	$1,848.05	$1,848.05	$203.52	$1,755.65	$1,080.92	2026-03-12
25600	HCPCS	Closed Treatment Of Broken Forearm (radius) Bone At The Wrist Area On The Thumb …	20	11	$1,841.34	$1,841.34	$214.32	$1,749.27	$1,077.00	2026-03-12
99291	HCPCS	Critical Care, First 30-74 Minutes	20	11	$1,836.08	$1,836.08	$166.82	$1,744.28	$1,073.92	2026-03-12
72141	HCPCS	MRI Scan Of Upper Spinal Canal Without Contrast	20	11	$1,819.13	$1,819.13	$69.05	$1,728.17	$1,064.01	2026-03-12
74177	HCPCS	CT Scan Of Abdomen And Pelvis With Contrast	20	11	$1,812.05	$1,812.05	$84.84	$1,721.45	$1,059.87	2026-03-12
24530	HCPCS	Closed Treatment Of Upper Arm Bone Broken At Elbow	20	11	$1,802.63	$1,802.63	$250.04	$1,712.50	$1,054.36	2026-03-12
73722	HCPCS	MRI Scan Of Leg Joint With Contrast	20	11	$1,786.05	$1,786.05	$76.24	$1,696.75	$1,044.66	2026-03-12
504563	CDM	Grasping Forceps	11	11	$1,227.84	$1,227.84	$650.51	$1,166.45	$1,043.66	2026-03-12
71550	HCPCS	MRI Scan Of Chest Without Contrast	20	11	$1,775.03	$1,775.03	$67.41	$1,686.28	$1,038.21	2026-03-12
74176	HCPCS	CT Scan Of Abdomen And Pelvis Without Contrast	20	11	$1,771.77	$1,771.77	$80.91	$1,683.18	$1,036.31	2026-03-12
J7296	HCPCS	Levonorgestrel-releasing Intrauterine Contraceptive System, (kyleena), 19.5 Mg	11	11	$1,199.14	$1,199.14	$635.30	$1,139.18	$1,019.27	2026-03-12
J7300	HCPCS	Intrauterine Copper Contraceptive	11	11	$1,196.00	$1,196.00	$633.64	$1,136.20	$1,016.60	2026-03-12
24600	HCPCS	Repair Of Dislocated Elbow	20	11	$1,735.76	$1,735.76	$219.61	$1,648.97	$1,015.25	2026-03-12
L8641	HCPCS	Metatarsal Joint Implant	11	11	$1,194.00	$1,194.00	$632.58	$1,134.30	$1,014.90	2026-03-12
500563	CDM	Arthrez 1.1mm Disposable Implant	11	11	$1,194.00	$1,194.00	$632.58	$1,134.30	$1,014.90	2026-03-12
70487	HCPCS	CT Scan Of Face With Contrast	20	11	$1,734.43	$1,734.43	$52.71	$1,647.71	$1,014.47	2026-03-12
2300524	CDM	Complex Repair 1.0 Or Less - Facility	11	11	$1,186.25	$1,186.25	$628.48	$1,126.94	$1,008.31	2026-03-12
J7307	HCPCS	Etonogestrel (contraceptive) Implant System, Including Implant And Supplies	11	11	$1,177.87	$1,177.87	$624.04	$1,118.98	$1,001.19	2026-03-12
75635	HCPCS	CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast	20	11	$1,700.06	$1,700.06	$110.77	$1,615.06	$994.37	2026-03-12
74181	HCPCS	MRI Scan Of Abdomen Without Contrast	20	11	$1,697.85	$1,697.85	$67.41	$1,612.96	$993.07	2026-03-12
24500	HCPCS	Closed Treatment Of Broken Middle Part Of Upper Arm Bone	20	11	$1,691.15	$1,691.15	$217.84	$1,606.59	$989.15	2026-03-12
74175	HCPCS	CT Scan Of Blood Vessels Of Abdomen With Contrast	20	11	$1,684.62	$1,684.62	$84.14	$1,600.39	$985.34	2026-03-12
74174	HCPCS	CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast	20	11	$1,684.62	$1,684.62	$102.08	$1,600.39	$985.34	2026-03-12
49083	HCPCS	Drainage Of Fluid From Abdominal Cavity Using Imaging Guidance	20	11	$1,673.60	$1,673.60	$93.12	$1,589.92	$978.88	2026-03-12
74185	HCPCS	MRI Scan Of Blood Vessels Of Abdomen	20	11	$1,664.78	$1,664.78	$83.45	$1,581.54	$973.73	2026-03-12
70450	HCPCS	CT Scan Head Or Brain Without Contrast	20	11	$1,654.84	$1,654.84	$39.91	$1,572.10	$967.91	2026-03-12
74182	HCPCS	MRI Scan Of Abdomen With Contrast	20	11	$1,653.75	$1,653.75	$80.22	$1,571.06	$967.28	2026-03-12
27750	HCPCS	Closed Treatment Of Broken Middle Part Of Shin Bone	20	11	$1,645.51	$1,645.51	$209.60	$1,563.23	$962.46	2026-03-12
71250	HCPCS	CT Scan Of Chest Without Contrast	42	11	$1,453.53	$1,453.53	$50.07	$1,491.32	$935.23	2026-03-12
27808	HCPCS	Closed Treatment Of 2 Broken Lower Leg Bones At Ankle	20	11	$1,594.61	$1,594.61	$220.01	$1,514.88	$932.68	2026-03-12
27760	HCPCS	Closed Treatment Of Inside Portion Of Shin Bone At Ankle	20	11	$1,593.64	$1,593.64	$218.24	$1,513.96	$932.12	2026-03-12
J1610	HCPCS	Injection, Glucagon Hydrochloride, Per 1 Mg	11	11	$1,077.22	$1,077.22	$570.71	$1,023.36	$915.64	2026-03-12
74178	HCPCS	CT Scan Of Abdomen And Pelvis Before And After Contrast	20	11	$1,564.05	$1,564.05	$93.99	$1,485.85	$914.81	2026-03-12
72125	HCPCS	CT Scan Of Upper Spine Without Contrast	20	11	$1,560.76	$1,560.76	$46.99	$1,482.72	$912.89	2026-03-12
13131	HCPCS	Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G…	20	11	$1,540.28	$1,540.28	$147.78	$1,463.27	$900.91	2026-03-12
23600	HCPCS	Closed Treatment Of Broken Top Of Upper Arm Bone	20	11	$1,540.11	$1,540.11	$207.45	$1,463.10	$900.81	2026-03-12
26605	HCPCS	Closed Treatment Of Broken Hand Bone With Manipulation	20	11	$1,531.07	$1,531.07	$193.90	$1,454.52	$895.52	2026-03-12
72126	HCPCS	CT Scan Of Upper Spine With Contrast	20	11	$1,523.05	$1,523.05	$56.81	$1,446.90	$890.83	2026-03-12
72142	HCPCS	MRI Scan Of Upper Spinal Canal With Contrast	20	11	$1,521.45	$1,521.45	$83.83	$1,445.38	$889.89	2026-03-12
70544	HCPCS	MRI Scan Of Blood Vessels Of Head Without Contrast	20	11	$1,521.45	$1,521.45	$55.79	$1,445.38	$889.89	2026-03-12
84182	HCPCS	Protein Measurement, Immunological Probe For Band Identification	11	11	$1,044.54	$1,044.54	$553.40	$992.31	$887.86	2026-03-12
27816	HCPCS	Closed Treatment Of 3 Broken Lower Leg Bones At Ankle	20	11	$1,514.00	$1,514.00	$216.47	$1,438.30	$885.54	2026-03-12
27786	HCPCS	Closed Treatment Of Broken Outside Lower Leg Bone At Ankle	20	11	$1,508.00	$1,508.00	$186.05	$1,432.60	$882.03	2026-03-12
71260	HCPCS	CT Scan Of Chest With Contrast	20	11	$1,506.14	$1,506.14	$54.43	$1,430.83	$880.94	2026-03-12
25565	HCPCS	Closed Treatment Of Broken Midpart Of Both Forearm Bones With Manipulation	20	11	$1,442.82	$1,442.82	$333.44	$1,370.68	$874.75	2026-03-12
27552	HCPCS	Closed Treatment Of Dislocated Knee Under Anesthesia	20	11	$1,214.45	$1,214.45	$398.40	$1,153.73	$874.35	2026-03-12
2300114	CDM	Transcatheter Therapy, Infusion Throm	11	11	$1,026.43	$1,026.43	$543.80	$975.11	$872.47	2026-03-12
504785	CDM	Gia 100 3.8	11	11	$1,018.50	$1,018.50	$539.60	$967.58	$865.73	2026-03-12
504578	CDM	Grasping Forceps Alligator Jaw	11	11	$1,017.46	$1,017.46	$539.05	$966.59	$864.84	2026-03-12
74170	HCPCS	CT Scan Of Abdomen Before And After Contrast	20	11	$1,472.50	$1,472.50	$65.02	$1,398.88	$861.26	2026-03-12
99285	HCPCS	Emergency Department Visit With High Level Of Medical Decision Making	31	11	$1,309.12	$1,309.12	$103.62	$1,243.71	$850.93	2026-03-12
25630	HCPCS	Closed Treatment Of Other Broken Wrist Bone	20	11	$1,450.37	$1,450.37	$200.57	$1,377.85	$848.33	2026-03-12
25622	HCPCS	Closed Treatment Of Broken Wrist Bone Near Base Of Thumb	20	11	$1,445.96	$1,445.96	$186.45	$1,373.66	$845.74	2026-03-12
27560	HCPCS	Closed Treatment Of Dislocated Kneecap	20	11	$1,442.82	$1,442.82	$219.02	$1,370.68	$843.90	2026-03-12
72193	HCPCS	CT Scan Of Pelvis With Contrast	20	11	$1,442.65	$1,442.65	$54.08	$1,370.52	$843.81	2026-03-12
36430	HCPCS	Transfusion Of Blood Or Blood Products	110	11	$1,060.05	$1,060.05	$278.15	$1,995.00	$831.45	2026-03-12
505062	CDM	Infaltion Handle	11	11	$958.00	$958.00	$507.55	$910.10	$814.30	2026-03-12
1700866	CDM	Santyl Ointment	11	11	$955.99	$955.99	$506.48	$908.19	$812.59	2026-03-12
504784	CDM	Gia 80-3.8	11	11	$950.12	$950.12	$503.37	$902.61	$807.60	2026-03-12
72194	HCPCS	CT Scan Of Pelvis Before And After Contrast	20	11	$1,377.02	$1,377.02	$56.81	$1,308.17	$805.42	2026-03-12
70492	HCPCS	CT Scan Of Soft Tissue Of Neck Before And After Contrast	20	11	$1,365.89	$1,365.89	$74.84	$1,297.60	$798.91	2026-03-12
87481	HCPCS	Detection Test For Candida Species (yeast), Amplified Probe Technique	11	11	$937.50	$937.50	$496.69	$890.63	$796.88	2026-03-12
70488	HCPCS	CT Scan Of Face Before And After Contrast	20	11	$1,358.84	$1,358.84	$59.21	$1,290.90	$794.78	2026-03-12
0002M	HCPCS	Molecular Pathology Test For Liver Disease, Including Alcohol Liver Disease (ash…	11	11	$931.80	$931.80	$493.67	$885.21	$792.03	2026-03-12
90001530	CDM	Lma Classic Size 1.5	11	11	$926.25	$926.25	$490.73	$879.94	$787.31	2026-03-12
90001532	CDM	Lma Classic Size 3	11	11	$926.25	$926.25	$490.73	$879.94	$787.31	2026-03-12
90001531	CDM	Lma Classic Size 2.5	11	11	$926.25	$926.25	$490.73	$879.94	$787.31	2026-03-12
90001529	CDM	Lma Classic Size 1	11	11	$926.25	$926.25	$490.73	$879.94	$787.31	2026-03-12
505176	CDM	Power Port	11	11	$920.00	$920.00	$487.42	$874.00	$782.00	2026-03-12
69000	HCPCS	Simple Drainage Of Abscess Or Blood Accumulation Of External Ear	11	11	$910.00	$910.00	$482.12	$864.50	$773.50	2026-03-12
70470	HCPCS	CT Scan Of Head Or Brain Before And After Contrast	20	11	$1,321.90	$1,321.90	$59.21	$1,255.81	$773.18	2026-03-12
82139	HCPCS	Amino Acid Level, 6 Or More Amino Acids, Quantitative, Each Specimen	11	11	$907.75	$907.75	$480.93	$862.36	$771.59	2026-03-12
502389	CDM	Tray Peg Tube	11	11	$907.02	$907.02	$480.54	$861.67	$770.97	2026-03-12
24605	HCPCS	Repair Of Dislocated Elbow Under Anesthesia	11	11	$903.50	$903.50	$478.67	$858.33	$767.98	2026-03-12
24620	HCPCS	Closed Treatment Of Broken And Dislocated Forearm Bones At Elbow With Manipulati…	20	11	$897.44	$897.44	$372.50	$918.35	$758.69	2026-03-12
504668	CDM	Oropharyngeal Airway Size 5	11	11	$892.00	$892.00	$472.58	$847.40	$758.20	2026-03-12
504667	CDM	Oropharyngeal Airway Size 4	11	11	$892.00	$892.00	$472.58	$847.40	$758.20	2026-03-12
73700	HCPCS	CT Scan Of Leg Without Contrast	53	11	$946.06	$946.06	$46.99	$1,106.73	$757.24	2026-03-12
70490	HCPCS	CT Scan Of Soft Tissue Of Neck Without Contrast	20	11	$1,290.54	$1,290.54	$59.90	$1,226.01	$754.84	2026-03-12
72128	HCPCS	CT Scan Of Middle Spine Without Contrast	20	11	$1,289.83	$1,289.83	$46.99	$1,225.34	$754.42	2026-03-12
72131	HCPCS	CT Scan Of Lower Spine Without Contrast	20	11	$1,289.57	$1,289.57	$46.99	$1,225.09	$754.27	2026-03-12
25500	HCPCS	Closed Treatment Of Broken Midpart Of Forearm Bone On Thumb Side	20	11	$1,283.79	$1,283.79	$187.81	$1,219.60	$750.89	2026-03-12
26785	HCPCS	Treatment Of Dislocated Finger Joint	20	11	$911.99	$911.99	$348.16	$866.39	$749.76	2026-03-12
504666	CDM	Oropharyngeal Airway Size 3	11	11	$882.00	$882.00	$467.28	$837.90	$749.70	2026-03-12
13153	HCPCS	Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, Each Additional 5.0 …	11	11	$880.10	$880.10	$466.28	$836.10	$748.09	2026-03-12
25605	HCPCS	Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit…	20	11	$1,155.60	$1,155.60	$325.20	$1,097.82	$739.58	2026-03-12
74160	HCPCS	CT Scan Of Abdomen With Contrast	20	11	$1,263.80	$1,263.80	$59.21	$1,200.61	$739.19	2026-03-12
72129	HCPCS	CT Scan Of Middle Spine With Contrast	20	11	$1,261.26	$1,261.26	$56.81	$1,198.20	$737.72	2026-03-12
72192	HCPCS	CT Scan Of Pelvis Without Contrast	20	11	$1,251.24	$1,251.24	$50.40	$1,188.68	$731.85	2026-03-12
86258	HCPCS	Detection Of Gliadin (deamidated) (dgp) Antibody	11	11	$859.00	$859.00	$455.10	$816.05	$730.15	2026-03-12
25530	HCPCS	Closed Treatment Of Broken Midpart Of Forearm Bone On Small Finger Side	20	11	$1,244.94	$1,244.94	$160.93	$1,182.69	$728.16	2026-03-12
24650	HCPCS	Closed Treatment Of Broken Forearm Bone On Thumb Side At Elbow	20	11	$1,243.80	$1,243.80	$162.50	$1,181.61	$727.50	2026-03-12
1702045	CDM	Truvada 200 Mg-300 Mg Tablet	11	11	$850.50	$850.50	$450.59	$807.98	$722.93	2026-03-12
27840	HCPCS	Closed Treatment Of Dislocated Ankle	20	11	$1,129.04	$1,129.04	$246.70	$1,072.59	$722.59	2026-03-12
13101	HCPCS	Complicated Repair Of Wound Of Trunk, 2.6-7.5 Cm	20	11	$1,233.92	$1,233.92	$151.12	$1,172.22	$721.72	2026-03-12
1700189	CDM	Metronidazole Topical 1% Gel	11	11	$845.64	$845.64	$448.02	$803.36	$718.79	2026-03-12
13121	HCPCS	Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 2.6-7.5 Cm	31	11	$1,062.51	$1,062.51	$157.40	$1,345.84	$718.61	2026-03-12
26700	HCPCS	Closed Treatment Of Dislocated Hand Joint At Base Of Finger With Manipulation	20	11	$1,222.01	$1,222.01	$220.98	$1,160.91	$714.75	2026-03-12
90001394	CDM	Acl Probe Block Needle	11	11	$831.80	$831.80	$440.69	$790.21	$707.03	2026-03-12
503949	CDM	Suction Containers Intermi	11	11	$828.00	$828.00	$438.67	$786.60	$703.80	2026-03-12
28400	HCPCS	Closed Treatment Of Broken Heel Bone	20	11	$1,190.84	$1,190.84	$149.15	$1,131.30	$696.52	2026-03-12
508114	CDM	Pico 7 6x6"	11	11	$818.72	$818.72	$433.76	$777.78	$695.91	2026-03-12
508115	CDM	Pico 7 6x8	11	11	$818.72	$818.72	$433.76	$777.78	$695.91	2026-03-12
26765	HCPCS	Treatment Of Broken End Of Finger Or Thumb	9	9	$1,550.23	$1,550.23	$319.90	$790.22	$684.95	2026-03-12
27825	HCPCS	Closed Treatment Of Broken Shin Bone At Lower Weight Bearing Joint With Manipula…	9	9	$1,626.30	$1,626.30	$347.96	$771.97	$676.88	2026-03-12
92960	HCPCS	External Shock To Heart To Regulate Heart Beat	20	11	$1,151.82	$1,151.82	$94.21	$1,094.23	$673.69	2026-03-12
87799	HCPCS	Detection Test By Nucleic Acid For Organism, Quantification	11	11	$791.05	$791.05	$419.10	$751.50	$672.39	2026-03-12
504769	CDM	Endoclip 5 Mm	11	11	$784.42	$784.42	$415.59	$745.20	$666.76	2026-03-12
27562	HCPCS	Closed Treatment Of Dislocated Kneecap Under Anesthesia	9	9	$1,164.24	$1,164.24	$311.66	$770.50	$665.48	2026-03-12
12007	HCPCS	Simple Repair Of Surface Wound To Scalp, Neck, Underarms, Trunk, Arms, Or Legs, …	20	11	$1,130.50	$1,130.50	$131.21	$1,073.98	$661.23	2026-03-12
730002	CDM	Room & Board - Semi-private (two Beds) - Hospice	8	8	$766.40	$766.40	$498.16	$2,207.62	$661.02	2026-03-12
23655	HCPCS	Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia	20	11	$1,032.16	$1,032.16	$259.64	$980.55	$660.58	2026-03-12
28430	HCPCS	Closed Treatment Of Broken Ankle Joint Bone	20	11	$1,124.79	$1,124.79	$155.83	$1,068.55	$657.89	2026-03-12
27550	HCPCS	Closed Treatment Of Dislocated Knee	9	9	$1,448.75	$1,448.75	$298.12	$848.03	$652.20	2026-03-12
504815	CDM	Basket Lithotriptor	11	11	$762.20	$762.20	$403.81	$724.09	$647.87	2026-03-12
81400	HCPCS	Molecular Pathology Procedure Level 1	11	11	$760.31	$760.31	$402.81	$722.29	$646.26	2026-03-12
1702248	CDM	Epinephrine 0.15 Mg Auto-injct	11	11	$759.38	$759.38	$402.32	$721.41	$645.47	2026-03-12
26770	HCPCS	Closed Treatment Of Dislocated Finger Joint With Manipulation	20	11	$1,099.94	$1,099.94	$188.80	$1,044.94	$643.36	2026-03-12
23570	HCPCS	Closed Treatment Of Broken Shoulder Blade	20	11	$1,094.43	$1,094.43	$154.07	$1,039.71	$640.13	2026-03-12
70460	HCPCS	CT Scan Head Or Brain With Contrast	20	11	$1,090.93	$1,090.93	$52.71	$1,036.38	$638.09	2026-03-12
505111	CDM	Mesh Keyhole Lrg Surgimesh	11	11	$750.00	$750.00	$397.35	$712.50	$637.50	2026-03-12
70491	HCPCS	CT Scan Of Soft Tissue Of Neck With Contrast	20	11	$1,083.98	$1,083.98	$64.34	$1,029.78	$634.02	2026-03-12
85307	HCPCS	Activated Protein Resistance Assay	11	11	$745.29	$745.29	$394.85	$708.03	$633.50	2026-03-12
70486	HCPCS	CT Scan Of Face Without Contrast	40	11	$982.62	$982.62	$40.26	$1,253.35	$628.88	2026-03-12
13120	HCPCS	Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 1.1-2.5 Cm	20	11	$1,060.87	$1,060.87	$141.50	$1,007.83	$620.50	2026-03-12
504779	CDM	Rotic 45 White	11	11	$729.56	$729.56	$386.52	$693.08	$620.13	2026-03-12
85245	HCPCS	Clotting Factor Viii (vw Factor) Measurement	11	11	$727.20	$727.20	$385.27	$690.84	$618.12	2026-03-12
90001901	CDM	Linearity Xpand Psa	11	11	$725.00	$725.00	$384.11	$688.75	$616.25	2026-03-12
20525	HCPCS	Complicated Removal Of Foreign Body In Deep Muscle Or Tendon	22	11	$943.24	$943.24	$286.88	$1,277.73	$613.50	2026-03-12
73200	HCPCS	CT Scan Of Arm Without Contrast	31	11	$943.52	$943.52	$46.99	$896.34	$613.29	2026-03-12
19020	HCPCS	Drainage Of Abscess Of Breast	20	11	$1,047.38	$1,047.38	$194.10	$995.01	$612.61	2026-03-12
12016	HCPCS	Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 12.…	20	11	$1,044.99	$1,044.99	$74.77	$992.74	$611.21	2026-03-12
12036	HCPCS	Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 20.1-30.…	20	11	$1,044.07	$1,044.07	$269.07	$991.87	$610.67	2026-03-12
74150	HCPCS	CT Scan Of Abdomen Without Contrast	20	11	$1,041.54	$1,041.54	$55.45	$989.46	$609.20	2026-03-12
81329	HCPCS	Gene Analysis (survival Of Motor Neuron 1, Telomeric) For Dosage/deletion	11	11	$715.00	$715.00	$378.81	$679.25	$607.75	2026-03-12
28450	HCPCS	Treatment Of Broken Foot Bone At Ankle	20	11	$1,038.91	$1,038.91	$124.04	$986.96	$607.65	2026-03-12
99284	HCPCS	Emergency Department Visit With Moderate Level Of Medical Decision Making	40	11	$1,024.84	$1,024.84	$71.63	$973.60	$599.43	2026-03-12
96369	HCPCS	Infusion Into Tissue For Therapy Or Prevention, 1 Hour Or Less	11	11	$704.67	$704.67	$373.33	$669.44	$598.97	2026-03-12
28540	HCPCS	Closed Treatment Of Dislocated Ankle Joint Bone	11	11	$700.00	$700.00	$370.86	$665.00	$595.00	2026-03-12
12032	HCPCS	Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 2.6-7.5 …	20	11	$1,016.16	$1,016.16	$167.92	$965.35	$594.35	2026-03-12
13100	HCPCS	Complicated Repair Of Wound Of Trunk, 1.1-2.5 Cm	20	11	$1,012.27	$1,012.27	$173.00	$961.66	$592.08	2026-03-12
88261	HCPCS	Chromosome Analysis For Genetic Defects, Count 5 Cells	11	11	$695.27	$695.27	$368.35	$660.51	$590.98	2026-03-12
26670	HCPCS	Closed Treatment Of Dislocated Hand Bone At Wrist Joint With Manipulation	20	11	$928.28	$928.28	$203.91	$881.87	$587.42	2026-03-12
23545	HCPCS	Closed Treatment Of Dislocated Joint Between Collar Bone And Shoulder With Manip…	20	11	$914.37	$914.37	$210.39	$868.65	$585.20	2026-03-12
90001183	CDM	Mouthpiece Acapella Dm Blue	11	11	$686.87	$686.87	$363.90	$652.53	$583.84	2026-03-12
90001509	CDM	Lamp For Xenon Lgt.source	11	11	$685.56	$685.56	$363.21	$651.28	$582.73	2026-03-12
87517	HCPCS	Detection Test By Nucleic Acid For Hepatitis B Virus, Quantification	11	11	$685.22	$685.22	$363.03	$650.96	$582.44	2026-03-12
83993	HCPCS	Stool Calprotectin (protein) Level	11	11	$683.00	$683.00	$361.85	$648.85	$580.55	2026-03-12
27810	HCPCS	Closed Treatment Of 2 Broken Lower Leg Bones At Ankle With Manipulation	9	9	$1,409.22	$1,409.22	$272.60	$752.85	$579.18	2026-03-12
70480	HCPCS	CT Scan Of Cranial Cavity Without Contrast	20	11	$989.72	$989.72	$59.90	$940.23	$578.88	2026-03-12
999002	CDM	Misc Item Surgery	11	11	$679.77	$679.77	$360.14	$645.78	$577.80	2026-03-12
23650	HCPCS	Closed Treatment Of Dislocated Shoulder With Manipulation	20	11	$898.54	$898.54	$194.69	$853.61	$575.07	2026-03-12
27265	HCPCS	Closed Treatment Of Dislocated Hip Prosthesis	20	11	$757.92	$757.92	$264.95	$801.04	$571.69	2026-03-12
12054	HCPCS	Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6-1…	20	11	$977.08	$977.08	$197.98	$928.23	$571.50	2026-03-12
12006	HCPCS	Simple Repair Of Surface Wound Of Scalp, Neck, Underarms, Trunk, Arms, Or Legs, …	20	11	$976.59	$976.59	$106.92	$927.76	$571.21	2026-03-12
7200310	CDM	Repair Complex 1.1-2.5 - Professional	2	2	$1,033.63	$1,033.63	$516.82	$620.18	$568.50	2026-03-12
1702044	CDM	Isentress 400 Mg Tablet	11	11	$666.67	$666.67	$353.20	$633.34	$566.67	2026-03-12
500405	CDM	Tube Sengstaken Blakemore	11	11	$665.34	$665.34	$352.50	$632.07	$565.54	2026-03-12
90001362	CDM	Linearity Xpand Gc1	11	11	$663.00	$663.00	$351.26	$629.85	$563.55	2026-03-12
2300113	CDM	Treatment Room	11	11	$656.38	$656.38	$347.75	$623.56	$557.92	2026-03-12
86331	HCPCS	Immunologic Analysis For Detection Of Antigen Or Antibody	22	11	$829.29	$829.29	$293.72	$1,048.96	$555.84	2026-03-12
504770	CDM	Endoclip Ii 10mm	11	11	$649.44	$649.44	$344.07	$616.97	$552.02	2026-03-12
28525	HCPCS	Treatment Of Broken Toe	9	9	$732.50	$732.50	$349.15	$627.49	$551.48	2026-03-12
93922	HCPCS	Ultrasound Study Of Arm And Leg Arteries	11	11	$646.07	$646.07	$342.29	$613.77	$549.16	2026-03-12
12052	HCPCS	Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.6-5…	20	11	$938.81	$938.81	$122.86	$891.87	$549.11	2026-03-12
504789	CDM	Gia 100-3.8 Reload	11	11	$643.61	$643.61	$340.98	$611.43	$547.07	2026-03-12
51703	HCPCS	Complicated Insertion Of Bladder Tube	11	11	$643.06	$643.06	$340.69	$610.91	$546.60	2026-03-12
Q4187	HCPCS	Epicord, Per Square Centimeter	33	11	$624.75	$624.75	$330.64	$1,236.19	$546.08	2026-03-12
12053	HCPCS	Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1-7…	20	11	$930.59	$930.59	$189.03	$884.06	$544.31	2026-03-12
504778	CDM	Endogia Universal	11	11	$635.96	$635.96	$336.93	$604.16	$540.57	2026-03-12
84145	HCPCS	Procalcitonin (hormone) Level	11	11	$631.97	$631.97	$334.82	$600.37	$537.17	2026-03-12
23540	HCPCS	Closed Treatment Of Dislocated Joint Between Collar Bone And Shoulder	20	11	$914.37	$914.37	$154.26	$868.65	$534.82	2026-03-12
37618	HCPCS	Tying Of Major Arm Or Leg Artery	20	11	$780.43	$780.43	$234.53	$741.41	$534.74	2026-03-12
18600045	CDM	Specialty Services - Treatment Room	11	11	$625.12	$625.12	$331.19	$593.86	$531.35	2026-03-12
27788	HCPCS	Closed Treatment Of Broken Outside Lower Leg Bone At Ankle With Manipulation	9	9	$950.44	$950.44	$246.30	$672.69	$526.71	2026-03-12
12014	HCPCS	Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 5.1…	20	11	$899.41	$899.41	$70.41	$854.44	$526.07	2026-03-12
86757	HCPCS	Analysis For Antibody To Rickettsia (bacteria)	11	11	$608.19	$608.19	$322.22	$577.78	$516.96	2026-03-12
504790	CDM	Ta 45-3.5	11	11	$607.13	$607.13	$321.66	$576.77	$516.06	2026-03-12
12034	HCPCS	Intermediate Repair Of Wound Of Scalp, Underarms, Trunk, Arms, Or Legs, 7.6-12.5…	20	11	$875.39	$875.39	$126.19	$831.62	$512.01	2026-03-12
C1781	HCPCS	Mesh (implantable)	11	11	$597.00	$597.00	$316.29	$567.15	$507.45	2026-03-12
12042	HCPCS	Intermediate Repair Of Wound Of Neck, Hands, Feet, Or Genitals, 2.6-7.5 Cm	20	11	$858.85	$858.85	$170.70	$815.91	$502.34	2026-03-12
90000316	CDM	Mat Suction Surgery	11	11	$590.38	$590.38	$312.78	$560.86	$501.82	2026-03-12
28495	HCPCS	Closed Treatment Of Broken Great Toe With Manipulation	20	11	$855.06	$855.06	$97.15	$812.31	$500.12	2026-03-12
92977	HCPCS	Removal Of Heart Artery Blood Clot By Dissolving	17	11	$778.68	$778.68	$34.27	$739.75	$498.36	2026-03-12
12015	HCPCS	Simple Repair Of Surface Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 7.6…	20	11	$848.00	$848.00	$88.09	$805.60	$496.00	2026-03-12
1700136	CDM	Cetacaine Spray	11	11	$578.34	$578.34	$306.40	$549.42	$491.59	2026-03-12
76942	HCPCS	Ultrasonic Guidance For Needle Placement	11	11	$577.71	$577.71	$306.07	$548.82	$491.05	2026-03-12
7200042	CDM	Repair Complex 1.0 Or Less - Prof	2	2	$889.69	$889.69	$444.85	$533.81	$489.33	2026-03-12
504781	CDM	Rotic 45 Green	11	11	$572.50	$572.50	$303.31	$543.88	$486.63	2026-03-12
90000997	CDM	Blood Bank Anti D	11	11	$570.48	$570.48	$302.24	$541.96	$484.91	2026-03-12
J1335	HCPCS	Injection, Ertapenem Sodium, 500 Mg	11	11	$568.94	$568.94	$301.42	$540.49	$483.60	2026-03-12
87498	HCPCS	Detection Test By Nucleic Acid For Enterovirus (intestinal Virus), Amplified Pro…	11	11	$568.44	$568.44	$301.16	$540.02	$483.17	2026-03-12
10121	HCPCS	Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Complex	20	11	$825.30	$825.30	$112.84	$784.04	$482.72	2026-03-12
11765	HCPCS	Removal Of Skin Of Fingernail Or Toenail	20	11	$819.16	$819.16	$91.44	$778.20	$479.12	2026-03-12
26641	HCPCS	Closed Treatment Of Dislocated Thumb At Wrist With Manipulation	9	9	$1,027.57	$1,027.57	$272.60	$625.12	$477.19	2026-03-12
90000994	CDM	Blood Bank Anti A	11	11	$559.94	$559.94	$296.66	$531.94	$475.95	2026-03-12
90000995	CDM	Blood Bank Anti B	11	11	$559.94	$559.94	$296.66	$531.94	$475.95	2026-03-12
504869	CDM	Autotome 39	11	11	$558.00	$558.00	$295.63	$530.10	$474.30	2026-03-12
26775	HCPCS	Closed Treatment Of Dislocated Finger Joint With Manipulation Under Anesthesia	9	9	$585.76	$585.76	$229.81	$582.14	$473.10	2026-03-12
13133	HCPCS	Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G…	20	11	$794.06	$794.06	$102.13	$754.36	$464.44	2026-03-12
505172	CDM	Mesh Fish Oil 3 X 6	11	11	$546.00	$546.00	$289.27	$518.70	$464.10	2026-03-12
504780	CDM	Rotic 45 Blue	11	11	$545.22	$545.22	$288.86	$517.96	$463.44	2026-03-12
Q4186	HCPCS	Epifix, Per Square Centimeter	77	11	$552.57	$552.57	$255.40	$2,851.43	$461.47	2026-03-12
12051	HCPCS	Intermediate Repair Of Wound Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 2.5 C…	20	11	$784.90	$784.90	$151.35	$745.66	$459.09	2026-03-12
1300071	CDM	CT Coronal Sagittal Oblique	11	11	$540.00	$540.00	$286.09	$513.00	$459.00	2026-03-12
20103	HCPCS	Exploration Of Wound Of Arm Or Leg	20	11	$539.12	$539.12	$285.63	$512.16	$458.25	2026-03-12

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