Price Transparencybeta Hospital negotiated rates

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

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Hospital

SEARHC WRANGELL MEDICAL CENTER & LTC

Wrangell, AK · CCN 021305 · Rates published

3,907 distinct procedures filed
9 distinct payers
71,236 rate rows
2024-12-09 last MRF observed · ⚠ 22 mo old
Data quality

68,914 of 71,236 rate rows are consumer-grade (96.7%)

2,322 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 1,659
per-diem day rate — not a per-procedure price 520
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 124
exceeds 10× this hospital's gross charge — excluded from medians 19

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 22 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbSARHCSITKAAK&type=CDMWithoutLabel&fileType=CSV
Found on page https://searhc.org/patient-support/price-transparency/para-price-transparency/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-12
Content fingerprint 4b69ccf800e6436d… · 31,011,317 bytes · first seen 2026-05-05

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
J9022
HCPCS 		Injection, Atezolizumab, 10 Mg 9 $60,286.89 $71,635.01 $67,379.46 nat. median
$1,229
outlier · 54.8×
J2350
HCPCS 		Injection, Ocrelizumab, 1 Mg 9 $59,912.45 $66,960.97 $65,551.26 nat. median
$133
outlier · 493.0×
J9144
HCPCS 		Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj 9 $51,214.24 $60,854.57 $57,239.45 nat. median
$114
outlier · 500.0×
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 9 $51.98 $56,106.31 $47,218.18 nat. median
$59
outlier · 803.0×
J9271
HCPCS 		Injection, Pembrolizumab, 1 Mg 9 $32,054.95 $38,088.82 $35,826.12 nat. median
$127
outlier · 282.1×
J9356
HCPCS 		Injection, Trastuzumab, 10 Mg And Hyaluronidase-oysk 9 $28,625.66 $34,014.02 $31,993.39 nat. median
$117
outlier · 273.9×
J9312
HCPCS 		Injection, Rituximab, 10 Mg 9 $28,755.91 $32,138.96 $31,462.35 nat. median
$739
outlier · 42.6×
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 9 $24,604.10 $29,235.46 $27,498.70 nat. median
$916
outlier · 30.0×
J9173
HCPCS 		Injection, Durvalumab, 10 Mg 9 $23,112.16 $27,462.69 $25,831.24 nat. median
$588
outlier · 43.9×
Q5119
HCPCS 		Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg 9 $216.64 $24,521.92 $21,940.67 nat. median
$318
outlier · 69.0×
27447
HCPCS 		Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compartments With Or… 9 $72.00 $24,422.17 $20,859.32 nat. median
$12,374
1.7× median
27130
HCPCS 		Arthroplasty, Acetabular And Proximal Femoral Prosthetic Replacement (total Hip… 9 $72.00 $21,322.43 $19,476.18 nat. median
$12,734
1.5× median
43282
HCPCS 		Laparoscopy, Surgical, Repair Of Paraesophageal Hernia, Includes Fundoplasty, Wh… 9 $72.00 $25,160.51 $18,971.39 nat. median
$10,473
1.8× median
21613660_1
CDM 		Rev - Ihs-moa Clinic Visit 9 $16,566.25 $19,684.60 $18,515.22 —
58150
HCPCS 		Total Abdominal Hysterectomy (corpus And Cervix), With Or Without Removal Of Tub… 9 $72.00 $25,281.76 $18,185.65 nat. median
$3,499
outlier · 5.2×
2504932_1
CDM 		Rev - Ihs-moa Clinic Visit 9 $15,753.06 $18,718.34 $17,606.36 —
27245
HCPCS 		Treatment Of Intertrochanteric, Peritrochanteric, Or Subtrochanteric Femoral Fra… 9 $72.00 $17,946.24 $15,476.74 nat. median
$5,566
outlier · 2.8×
23515
HCPCS 		Open Treatment Of Clavicular Fracture, Includes Internal Fixation, When Performe… 9 $72.00 $23,393.25 $15,021.02 nat. median
$7,165
outlier · 2.1×
27822
HCPCS 		Open Treatment Of Trimalleolar Ankle Fracture, Includes Internal Fixation, When… 9 $72.00 $20,279.12 $14,689.99 nat. median
$7,082
outlier · 2.1×
27524
HCPCS 		Open Treatment Of Patellar Fracture, With Internal Fixation And/or Partial Or Co… 9 $72.00 $20,722.50 $14,142.27 nat. median
$7,141
2.0× median
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 9 $207.92 $15,554.64 $13,771.67 nat. median
$498
outlier · 27.7×
59514
HCPCS 		Cesarean Delivery Only 9 $72.00 $15,534.03 $13,762.58 nat. median
$2,304
outlier · 6.0×
60210
HCPCS 		Partial Thyroid Lobectomy, Unilateral; With Or Without Isthmusectomy 9 $72.00 $19,824.30 $13,544.19 nat. median
$5,609
outlier · 2.4×
24342
HCPCS 		Reinsertion Of Ruptured Biceps Or Triceps Tendon, Distal, With Or Without Tendon… 9 $72.00 $18,188.83 $13,258.48 nat. median
$7,073
1.9× median
25607
HCPCS 		Open Treatment Of Distal Radial Extra-articular Fracture Or Epiphyseal Separatio… 9 $72.00 $17,874.90 $13,255.11 nat. median
$7,280
1.8× median
59151
HCPCS 		Laparoscopic Treatment Of Ectopic Pregnancy; With Salpingectomy And/or Oophorect… 9 $72.00 $16,551.76 $12,881.26 nat. median
$6,218
outlier · 2.1×
21012
HCPCS 		Excision, Tumor, Soft Tissue Of Face Or Scalp, Subcutaneous; 2 Cm Or Greater 9 $72.00 $43,746.45 $12,394.83 nat. median
$1,761
outlier · 7.0×
J1459
HCPCS 		Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 9 $4,988.44 $47,309.86 $11,839.22 nat. median
$968
outlier · 12.2×
29835
HCPCS 		Arthroscopy, Elbow, Surgical; Synovectomy, Partial 9 $72.00 $17,168.57 $11,284.42 nat. median
$3,694
outlier · 3.1×
27650
HCPCS 		Repair, Primary, Open Or Percutaneous, Ruptured Achilles Tendon 9 $72.00 $15,370.72 $11,250.99 nat. median
$6,837
1.6× median
59510
HCPCS 		Routine Obstetric Care Including Antepartum Care, Cesarean Delivery, And Postpar… 9 $72.00 $39,603.09 $11,220.88 nat. median
$3,349
outlier · 3.4×
25447
HCPCS 		Arthroplasty, Intercarpal Or Carpometacarpal Joints; Interposition (eg, Tendon) 9 $72.00 $12,768.66 $11,061.96 nat. median
$3,534
outlier · 3.1×
47563
HCPCS 		Laparoscopy, Surgical; Cholecystectomy With Cholangiography 9 $72.00 $13,760.14 $11,035.66 nat. median
$6,246
1.8× median
29891
HCPCS 		Arthroscopy, Ankle, Surgical, Excision Of Osteochondral Defect Of Talus And/or T… 9 $72.00 $13,967.80 $10,782.03 nat. median
$3,859
outlier · 2.8×
44950
HCPCS 		Appendectomy 9 $72.00 $14,043.64 $10,646.54 nat. median
$5,001
outlier · 2.1×
25515
HCPCS 		Open Treatment Of Radial Shaft Fracture, Includes Internal Fixation, When Perfor… 9 $72.00 $15,651.20 $10,549.61 nat. median
$6,837
1.5× median
26123
HCPCS 		Fasciectomy, Partial Palmar With Release Of Single Digit Including Proximal Inte… 9 $72.00 $12,159.74 $10,534.44 nat. median
$3,670
outlier · 2.9×
Q5113
HCPCS 		Injection, Trastuzumab-pkrb, Biosimilar, (herzuma), 10 Mg 9 $9,541.59 $10,664.13 $10,439.62 nat. median
$291
outlier · 35.9×
29882
HCPCS 		Arthroscopy, Knee, Surgical; With Meniscus Repair (medial Or Lateral) 9 $72.00 $12,077.92 $10,137.16 nat. median
$3,592
outlier · 2.8×
59400
HCPCS 		Routine Obstetric Care Including Antepartum Care, Vaginal Delivery (with Or With… 9 $72.00 $35,705.91 $10,116.67 nat. median
$2,933
outlier · 3.4×
43632
HCPCS 		Gastrectomy, Partial, Distal; With Gastrojejunostomy 9 $72.00 $30,304.86 $10,101.62 nat. median
$4,034
outlier · 2.5×
44379
HCPCS 		Small Intestinal Endoscopy, Enteroscopy Beyond Second Portion Of Duodenum, Inclu… 9 $72.00 $15,235.95 $9,978.83 nat. median
$6,015
1.7× median
44970
HCPCS 		Laparoscopy, Surgical, Appendectomy 9 $72.00 $13,104.05 $9,915.31 nat. median
$6,065
1.6× median
26735
HCPCS 		Open Treatment Of Phalangeal Shaft Fracture, Proximal Or Middle Phalanx, Finger… 9 $72.00 $13,005.84 $9,717.20 nat. median
$3,473
outlier · 2.8×
59610
HCPCS 		Routine Obstetric Care Including Antepartum Care, Vaginal Delivery (with Or With… 9 $72.00 $31,937.88 $9,711.00 nat. median
$3,150
outlier · 3.1×
23294613_1
CDM 		Lapiplasty Mini-incision System 9 $8,709.79 $9,734.47 $9,529.53 —
27355
HCPCS 		Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Femur 9 $72.00 $11,439.59 $9,136.30 nat. median
$3,417
outlier · 2.7×
44207
HCPCS 		Laparoscopy, Surgical; Colectomy, Partial, With Anastomosis, With Coloproctostom… 9 $72.00 $27,392.34 $9,130.78 nat. median
$4,397
outlier · 2.1×
19303
HCPCS 		Mastectomy, Simple, Complete 9 $72.00 $14,731.38 $8,978.78 nat. median
$6,248
1.4× median
59150
HCPCS 		Laparoscopic Treatment Of Ectopic Pregnancy; Without Salpingectomy And/or Oophor… 9 $72.00 $11,241.66 $8,944.85 nat. median
$6,140
1.5× median

Other procedures at this hospital

Browse this hospital's 3,907 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
             
16804258_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $4,882.07 $4,882.07 $4,149.76 $4,637.97 $4,637.97 2024-12-09
1307792_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $4,882.07 $4,882.07 $4,149.76 $4,637.97 $4,637.97 2024-12-09
18609203_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $4,882.07 $4,882.07 $4,149.76 $4,637.97 $4,637.97 2024-12-09
1307796_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $4,882.07 $4,882.07 $4,149.76 $4,637.97 $4,637.97 2024-12-09
16804266_1 CDM Room & Board - Semi-private (two Beds) - Obstetrics (ob) 7 7 $4,882.07 $4,882.07 $4,149.76 $4,637.97 $4,637.97 2024-12-09
1307801_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $4,882.07 $4,882.07 $4,149.76 $4,637.97 $4,637.97 2024-12-09
1307794_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $4,882.07 $4,882.07 $4,149.76 $4,637.97 $4,637.97 2024-12-09
18609204_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $4,882.07 $4,882.07 $4,149.76 $4,637.97 $4,637.97 2024-12-09
1307798_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $4,882.07 $4,882.07 $4,149.76 $4,637.97 $4,637.97 2024-12-09
1307800_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $4,882.07 $4,882.07 $4,149.76 $4,637.97 $4,637.97 2024-12-09
16804259_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $4,882.07 $4,882.07 $4,149.76 $4,637.97 $4,637.97 2024-12-09
18609205_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $4,882.07 $4,882.07 $4,149.76 $4,637.97 $4,637.97 2024-12-09
81162 HCPCS Brca1 (brca1, DNA Repair Associated), Brca2 (brca2, DNA Repair Associated) (eg, … 8 8 $5,035.58 $5,035.58 $4,280.24 $5,085.94 $4,783.80 2024-12-09
16804257_1 CDM Room & Board - Private (one Bed) - General Classification 7 7 $5,422.66 $5,422.66 $4,609.26 $5,151.53 $5,151.53 2024-12-09
81229 HCPCS Cytogenomic (genome-wide) Analysis For Constitutional Chromosomal Abnormalities;… 7 7 $5,316.69 $5,316.69 $4,519.19 $5,369.86 $5,050.86 2024-12-09
42299 HCPCS Unlisted Procedure, Palate, Uvula 9 9 $5,318.46 $5,318.46 $4,520.69 $5,371.64 $5,052.54 2024-12-09
70545 HCPCS Magnetic Resonance Angiography, Head; With Contrast Material(s) 18 9 $3,498.51 $3,498.51 $72.00 $5,375.42 $4,656.92 2024-12-09
99291 HCPCS Critical Care, Evaluation And Management Of The Critically Ill Or Critically Inj… 29 9 $5,415.59 $5,415.59 $72.00 $5,469.75 $5,036.50 2024-12-09
1307795_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $5,769.71 $5,769.71 $4,904.25 $5,481.22 $5,481.22 2024-12-09
1307793_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $5,769.71 $5,769.71 $4,904.25 $5,481.22 $5,481.22 2024-12-09
1307799_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $5,769.71 $5,769.71 $4,904.25 $5,481.22 $5,481.22 2024-12-09
1307797_1 CDM Room & Board - Semi-private (two Beds) - General Classification 7 7 $5,769.71 $5,769.71 $4,904.25 $5,481.22 $5,481.22 2024-12-09
70543 HCPCS Magnetic Resonance (eg, Proton) Imaging, Orbit, Face, And/or Neck; Without Contr… 18 9 $3,627.57 $3,627.57 $72.00 $5,517.09 $4,739.09 2024-12-09
27696 HCPCS Repair, Primary, Disrupted Ligament, Ankle; Both Collateral Ligaments 18 9 $3,788.49 $3,788.49 $72.00 $5,545.50 $5,012.41 2024-12-09
11443 HCPCS Excision, Other Benign Lesion Including Margins, Except Skin Tag (unless Listed … 19 9 $5,532.59 $5,532.59 $72.00 $5,587.92 $4,702.70 2024-12-09
73719 HCPCS Magnetic Resonance (eg, Proton) Imaging, Lower Extremity Other Than Joint; With … 40 9 $5,627.65 $5,627.65 $72.00 $5,683.93 $5,064.89 2024-12-09
46999 HCPCS Unlisted Procedure, Anus 9 9 $6,052.28 $6,052.28 $5,144.44 $5,749.67 $5,628.62 2024-12-09
66999 HCPCS Unlisted Procedure, Anterior Segment Of Eye 9 9 $6,055.92 $6,055.92 $5,147.53 $5,753.12 $5,632.01 2024-12-09
70552 HCPCS Magnetic Resonance (eg, Proton) Imaging, Brain (including Brain Stem); With Cont… 18 9 $3,754.19 $3,754.19 $72.00 $5,784.34 $4,717.13 2024-12-09
72196 HCPCS Magnetic Resonance (eg, Proton) Imaging, Pelvis; With Contrast Material(s) 18 9 $3,792.67 $3,792.67 $72.00 $5,849.78 $5,067.88 2024-12-09
24071 HCPCS Excision, Tumor, Soft Tissue Of Upper Arm Or Elbow Area, Subcutaneous; 3 Cm Or G… 18 9 $3,842.23 $3,842.23 $72.00 $5,850.93 $5,017.38 2024-12-09
11646 HCPCS Excision, Malignant Lesion Including Margins, Face, Ears, Eyelids, Nose, Lips; E… 18 9 $3,721.90 $3,721.90 $72.00 $5,857.80 $4,804.80 2024-12-09
72142 HCPCS Magnetic Resonance (eg, Proton) Imaging, Spinal Canal And Contents, Cervical; Wi… 18 9 $3,663.40 $3,663.40 $72.00 $5,945.37 $4,662.22 2024-12-09
74182 HCPCS Magnetic Resonance (eg, Proton) Imaging, Abdomen; With Contrast Material(s) 18 9 $3,955.18 $3,955.18 $72.00 $5,993.27 $5,192.19 2024-12-09
54150 HCPCS Circumcision, Using Clamp Or Other Device With Regional Dorsal Penile Or Ring Bl… 19 9 $6,081.82 $6,081.82 $72.00 $6,142.64 $5,169.55 2024-12-09
59821 HCPCS Treatment Of Missed Abortion, Completed Surgically; Second Trimester 18 9 $3,901.24 $3,901.24 $72.00 $6,148.62 $5,159.41 2024-12-09
26020 HCPCS Drainage Of Tendon Sheath, Digit And/or Palm, Each 18 9 $3,799.80 $3,799.80 $72.00 $6,173.55 $4,849.02 2024-12-09
24120 HCPCS Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Head Or Neck Of Radius Or … 18 9 $4,053.66 $4,053.66 $72.00 $6,210.91 $5,380.74 2024-12-09
74178 HCPCS Computed Tomography, Abdomen And Pelvis; Without Contrast Material In One Or Bot… 19 9 $6,194.86 $6,194.86 $72.00 $6,256.81 $5,265.63 2024-12-09
46045 HCPCS Incision And Drainage Of Intramural, Intramuscular, Or Submucosal Abscess, Trans… 18 9 $3,717.28 $3,717.28 $72.00 $6,266.22 $4,677.58 2024-12-09
59830 HCPCS Treatment Of Septic Abortion, Completed Surgically 18 9 $3,852.06 $3,852.06 $72.00 $6,335.79 $4,893.16 2024-12-09
22903 HCPCS Excision, Tumor, Soft Tissue Of Abdominal Wall, Subcutaneous; 3 Cm Or Greater 18 9 $3,974.00 $3,974.00 $72.00 $6,352.02 $5,101.83 2024-12-09
30130 HCPCS Excision Inferior Turbinate, Partial Or Complete, Any Method 18 9 $4,234.31 $4,234.31 $72.00 $6,387.22 $5,475.27 2024-12-09
70542 HCPCS Magnetic Resonance (eg, Proton) Imaging, Orbit, Face, And/or Neck; With Contrast… 18 9 $3,908.06 $3,908.06 $72.00 $6,387.69 $4,925.40 2024-12-09
43240 HCPCS Esophagogastroduodenoscopy, Flexible, Transoral; With Transmural Drainage Of Pse… 18 9 $4,188.13 $4,188.13 $72.00 $6,416.37 $5,558.74 2024-12-09
11644 HCPCS Excision, Malignant Lesion Including Margins, Face, Ears, Eyelids, Nose, Lips; E… 18 9 $3,883.67 $3,883.67 $72.00 $6,431.07 $4,806.06 2024-12-09
64721 HCPCS Neuroplasty And/or Transposition; Median Nerve At Carpal Tunnel 18 9 $4,401.48 $4,401.48 $72.00 $6,455.39 $5,899.67 2024-12-09
37618 HCPCS Ligation, Major Artery (eg, Post-traumatic, Rupture); Extremity 18 9 $4,086.84 $4,086.84 $72.00 $6,465.74 $5,378.66 2024-12-09
21337 HCPCS Closed Treatment Of Nasal Septal Fracture, With Or Without Stabilization 18 9 $3,905.61 $3,905.61 $72.00 $6,478.87 $4,821.02 2024-12-09
43242 HCPCS Esophagogastroduodenoscopy, Flexible, Transoral; With Transendoscopic Ultrasound… 18 9 $4,103.78 $4,103.78 $72.00 $6,511.71 $4,942.85 2024-12-09
15823 HCPCS Blepharoplasty, Upper Eyelid; With Excessive Skin Weighting Down Lid 18 9 $4,250.29 $4,250.29 $72.00 $6,555.97 $5,679.67 2024-12-09
27899 HCPCS Unlisted Procedure, Leg Or Ankle 17 9 $3,958.30 $3,958.30 $72.00 $6,663.11 $5,607.57 2024-12-09
44378 HCPCS Small Intestinal Endoscopy, Enteroscopy Beyond Second Portion Of Duodenum, Inclu… 18 9 $4,310.33 $4,310.33 $72.00 $6,701.55 $5,798.15 2024-12-09
43278 HCPCS Endoscopic Retrograde Cholangiopancreatography (ercp); With Ablation Of Tumor(s)… 18 9 $4,283.24 $4,283.24 $72.00 $6,705.18 $5,539.99 2024-12-09
54160 HCPCS Circumcision, Surgical Excision Other Than Clamp, Device, Or Dorsal Slit; Neonat… 19 9 $6,685.85 $6,685.85 $72.00 $6,752.71 $5,682.97 2024-12-09
26320 HCPCS Removal Of Implant From Finger Or Hand 18 9 $4,384.33 $4,384.33 $72.00 $6,776.99 $5,484.28 2024-12-09
69110 HCPCS Excision External Ear; Partial, Simple Repair 18 9 $4,184.34 $4,184.34 $72.00 $6,822.25 $5,291.72 2024-12-09
C1889 HCPCS Implantable/insertable Device, Not Otherwise Classified 9 9 $6,799.00 $6,799.00 $5,779.15 $6,866.99 $6,459.05 2024-12-09
21932 HCPCS Excision, Tumor, Soft Tissue Of Back Or Flank, Subfascial (eg, Intramuscular); L… 18 9 $4,714.77 $4,714.77 $72.00 $6,882.48 $6,339.13 2024-12-09
Q5103 HCPCS Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg 9 9 $6,817.13 $6,817.13 $5,794.56 $6,885.30 $6,476.27 2024-12-09
43261 HCPCS Endoscopic Retrograde Cholangiopancreatography (ercp); With Biopsy, Single Or Mu… 18 9 $4,292.91 $4,292.91 $72.00 $6,908.38 $5,525.76 2024-12-09
74174 HCPCS Computed Tomographic Angiography, Abdomen And Pelvis, With Contrast Material(s),… 18 9 $4,288.75 $4,288.75 $72.00 $6,920.04 $5,500.86 2024-12-09
37785 HCPCS Ligation, Division, And/or Excision Of Varicose Vein Cluster(s), 1 Leg 18 9 $4,332.33 $4,332.33 $72.00 $7,021.22 $5,051.92 2024-12-09
25270 HCPCS Repair, Tendon Or Muscle, Extensor, Forearm And/or Wrist; Primary, Single, Each … 18 9 $4,129.64 $4,129.64 $72.00 $7,046.22 $5,171.72 2024-12-09
11606 HCPCS Excision, Malignant Lesion Including Margins, Trunk, Arms, Or Legs; Excised Diam… 18 9 $4,297.80 $4,297.80 $72.00 $7,091.46 $5,345.56 2024-12-09
43213 HCPCS Esophagoscopy, Flexible, Transoral; With Dilation Of Esophagus, By Balloon Or Di… 18 9 $4,177.89 $4,177.89 $72.00 $7,101.97 $4,974.64 2024-12-09
J2795 HCPCS Injection, Ropivacaine Hydrochloride, 1 Mg 9 9 $7,041.60 $7,041.60 $5,985.36 $7,112.02 $6,689.52 2024-12-09
46040 HCPCS Incision And Drainage Of Ischiorectal And/or Perirectal Abscess (separate Proced… 19 9 $7,050.99 $7,050.99 $72.00 $7,121.50 $5,993.34 2024-12-09
53040 HCPCS Drainage Of Deep Periurethral Abscess 18 9 $4,533.88 $4,533.88 $72.00 $7,167.40 $5,972.97 2024-12-09
43274 HCPCS Endoscopic Retrograde Cholangiopancreatography (ercp); With Placement Of Endosco… 18 9 $4,275.44 $4,275.44 $72.00 $7,170.06 $5,390.75 2024-12-09
56501 HCPCS Destruction Of Lesion(s), Vulva; Simple (eg, Laser Surgery, Electrosurgery, Cryo… 20 9 $7,114.54 $7,114.54 $72.00 $7,185.69 $6,225.23 2024-12-09
43257 HCPCS Esophagogastroduodenoscopy, Flexible, Transoral; With Delivery Of Thermal Energy… 18 9 $4,181.22 $4,181.22 $72.00 $7,243.77 $4,833.69 2024-12-09
20926 HCPCS Tissue Grafts, Other (eg, Paratenon, Fat, Dermis) 17 9 $4,853.21 $4,853.21 $72.00 $7,276.91 $6,510.92 2024-12-09
43277 HCPCS Endoscopic Retrograde Cholangiopancreatography (ercp); With Trans-endoscopic Bal… 18 9 $4,581.05 $4,581.05 $72.00 $7,280.85 $5,993.72 2024-12-09
42831 HCPCS Adenoidectomy, Primary; Age 12 Or Over 18 9 $4,148.24 $4,148.24 $72.00 $7,293.24 $4,682.13 2024-12-09
73706 HCPCS Computed Tomographic Angiography, Lower Extremity, With Contrast Material(s), In… 36 9 $4,459.06 $4,459.06 $72.00 $7,419.19 $5,480.51 2024-12-09
43263 HCPCS Endoscopic Retrograde Cholangiopancreatography (ercp); With Pressure Measurement… 18 9 $4,606.32 $4,606.32 $72.00 $7,442.08 $5,897.91 2024-12-09
49594 HCPCS Repair Of Anterior Abdominal Hernia(s) (ie, Epigastric, Incisional, Ventral, Umb… 9 9 $2,486.72 $2,486.72 $2,113.71 $7,460.16 $4,786.94 2024-12-09
31648 HCPCS Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed… 18 9 $4,202.53 $4,202.53 $72.00 $7,470.97 $4,655.83 2024-12-09
27619 HCPCS Excision, Tumor, Soft Tissue Of Leg Or Ankle Area, Subfascial (eg, Intramuscular… 18 9 $4,534.14 $4,534.14 $72.00 $7,484.63 $5,636.11 2024-12-09
49621 HCPCS Repair Of Parastomal Hernia, Any Approach (ie, Open, Laparoscopic, Robotic), Ini… 9 9 $2,497.38 $2,497.38 $2,122.77 $7,492.14 $4,807.45 2024-12-09
35207 HCPCS Repair Blood Vessel, Direct; Hand, Finger 18 9 $4,091.48 $4,091.48 $72.00 $7,494.33 $4,974.24 2024-12-09
71552 HCPCS Magnetic Resonance (eg, Proton) Imaging, Chest (eg, For Evaluation Of Hilar And … 18 9 $4,747.24 $4,747.24 $72.00 $7,567.86 $6,100.37 2024-12-09
57023 HCPCS Incision And Drainage Of Vaginal Hematoma; Non-obstetrical (eg, Post-trauma, Spo… 18 9 $4,520.57 $4,520.57 $72.00 $7,583.05 $5,490.64 2024-12-09
32601 HCPCS Thoracoscopy, Diagnostic (separate Procedure); Lungs, Pericardial Sac, Mediastin… 18 9 $4,555.40 $4,555.40 $72.00 $7,648.80 $5,525.16 2024-12-09
11626 HCPCS Excision, Malignant Lesion Including Margins, Scalp, Neck, Hands, Feet, Genitali… 18 9 $4,514.64 $4,514.64 $72.00 $7,656.26 $5,394.93 2024-12-09
43238 HCPCS Esophagogastroduodenoscopy, Flexible, Transoral; With Transendoscopic Ultrasound… 18 9 $4,407.67 $4,407.67 $72.00 $7,695.02 $5,032.78 2024-12-09
49595 HCPCS Repair Of Anterior Abdominal Hernia(s) (ie, Epigastric, Incisional, Ventral, Umb… 9 9 $2,571.66 $2,571.66 $2,185.91 $7,714.98 $4,950.44 2024-12-09
11446 HCPCS Excision, Other Benign Lesion Including Margins, Except Skin Tag (unless Listed … 19 9 $7,641.19 $7,641.19 $72.00 $7,717.60 $6,495.01 2024-12-09
31237 HCPCS Nasal/sinus Endoscopy, Surgical; With Biopsy, Polypectomy Or Debridement (separa… 19 9 $7,649.72 $7,649.72 $72.00 $7,726.22 $6,502.26 2024-12-09
46270 HCPCS Surgical Treatment Of Anal Fistula (fistulectomy/fistulotomy); Subcutaneous 18 9 $4,815.72 $4,815.72 $72.00 $7,844.60 $6,097.71 2024-12-09
29881 HCPCS Arthroscopy, Knee, Surgical; With Meniscectomy (medial Or Lateral, Including Any… 18 9 $5,432.60 $5,432.60 $72.00 $7,865.56 $7,244.60 2024-12-09
43265 HCPCS Endoscopic Retrograde Cholangiopancreatography (ercp); With Destruction Of Calcu… 18 9 $5,035.37 $5,035.37 $72.00 $7,912.04 $6,684.89 2024-12-09
29826 HCPCS Arthroscopy, Shoulder, Surgical; Decompression Of Subacromial Space With Partial… 18 9 $4,354.84 $4,354.84 $72.00 $7,912.24 $4,643.08 2024-12-09
27422 HCPCS Reconstruction Of Dislocating Patella; With Extensor Realignment And/or Muscle A… 18 9 $5,338.36 $5,338.36 $72.00 $7,915.12 $7,058.52 2024-12-09
31647 HCPCS Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed… 18 9 $4,495.30 $4,495.30 $72.00 $7,980.52 $4,991.77 2024-12-09
26952 HCPCS Amputation, Finger Or Thumb, Primary Or Secondary, Any Joint Or Phalanx, Single,… 18 9 $4,517.86 $4,517.86 $72.00 $7,984.08 $5,577.57 2024-12-09
59812 HCPCS Treatment Of Incomplete Abortion, Any Trimester, Completed Surgically 18 9 $4,690.40 $4,690.40 $72.00 $8,031.36 $5,522.97 2024-12-09
21552 HCPCS Excision, Tumor, Soft Tissue Of Neck Or Anterior Thorax, Subcutaneous; 3 Cm Or G… 18 9 $5,061.94 $5,061.94 $72.00 $8,037.35 $6,631.22 2024-12-09
59820 HCPCS Treatment Of Missed Abortion, Completed Surgically; First Trimester 20 9 $7,965.15 $7,965.15 $72.00 $8,044.80 $6,969.51 2024-12-09
43229 HCPCS Esophagoscopy, Flexible, Transoral; With Ablation Of Tumor(s), Polyp(s), Or Othe… 18 9 $4,762.84 $4,762.84 $72.00 $8,089.65 $5,134.44 2024-12-09
2504922_1 CDM Rev - Ihs-moa Clinic Visit 9 9 $8,010.60 $8,010.60 $6,809.01 $8,090.71 $7,610.07 2024-12-09
46924 HCPCS Destruction Of Lesion(s), Anus (eg, Condyloma, Papilloma, Molluscum Contagiosum,… 18 9 $4,714.17 $4,714.17 $72.00 $8,100.91 $4,975.68 2024-12-09
38500 HCPCS Biopsy Or Excision Of Lymph Node(s); Open, Superficial 18 9 $4,631.27 $4,631.27 $72.00 $8,110.66 $5,261.19 2024-12-09
43194 HCPCS Esophagoscopy, Rigid, Transoral; With Removal Of Foreign Body(s) 18 9 $4,512.19 $4,512.19 $72.00 $8,126.94 $4,886.62 2024-12-09
2504915_1 CDM Rev - Ihs-moa Clinic Visit 9 9 $8,066.45 $8,066.45 $6,856.48 $8,147.11 $7,663.13 2024-12-09
29822 HCPCS Arthroscopy, Shoulder, Surgical; Debridement, Limited, 1 Or 2 Discrete Structure… 18 9 $5,033.08 $5,033.08 $72.00 $8,182.83 $6,421.24 2024-12-09
46250 HCPCS Hemorrhoidectomy, External, 2 Or More Columns/groups 18 9 $4,818.94 $4,818.94 $72.00 $8,205.41 $5,723.35 2024-12-09
69610 HCPCS Tympanic Membrane Repair, With Or Without Site Preparation Of Perforation For Cl… 18 9 $4,777.97 $4,777.97 $72.00 $8,210.66 $5,594.84 2024-12-09
19125 HCPCS Excision Of Breast Lesion Identified By Preoperative Placement Of Radiological M… 18 9 $4,982.52 $4,982.52 $72.00 $8,216.33 $6,202.47 2024-12-09
11426 HCPCS Excision, Benign Lesion Including Margins, Except Skin Tag (unless Listed Elsewh… 18 9 $4,751.14 $4,751.14 $72.00 $8,246.69 $5,475.98 2024-12-09
56515 HCPCS Destruction Of Lesion(s), Vulva; Extensive (eg, Laser Surgery, Electrosurgery, C… 18 9 $4,600.65 $4,600.65 $72.00 $8,299.52 $4,968.28 2024-12-09
23120 HCPCS Claviculectomy; Partial 18 9 $5,115.66 $5,115.66 $72.00 $8,331.33 $6,522.42 2024-12-09
29825 HCPCS Arthroscopy, Shoulder, Surgical; With Lysis And Resection Of Adhesions, With Or … 18 9 $4,748.80 $4,748.80 $72.00 $8,335.71 $5,879.15 2024-12-09
46946 HCPCS Hemorrhoidectomy, Internal, By Ligation Other Than Rubber Band; 2 Or More Hemorr… 18 9 $4,662.43 $4,662.43 $72.00 $8,340.60 $5,109.90 2024-12-09
31631 HCPCS Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed… 18 9 $4,986.69 $4,986.69 $72.00 $8,362.63 $5,497.11 2024-12-09
31630 HCPCS Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed… 18 9 $4,915.40 $4,915.40 $72.00 $8,366.18 $5,279.22 2024-12-09
2505525_1 CDM Rev - Ihs-moa Clinic Visit 9 9 $8,309.08 $8,309.08 $7,062.72 $8,392.17 $7,893.63 2024-12-09
58558 HCPCS Hysteroscopy, Surgical; With Sampling (biopsy) Of Endometrium And/or Polypectomy… 18 9 $4,744.01 $4,744.01 $72.00 $8,392.17 $5,299.77 2024-12-09
43260 HCPCS Endoscopic Retrograde Cholangiopancreatography (ercp); Diagnostic, Including Col… 18 9 $4,993.15 $4,993.15 $72.00 $8,407.93 $6,030.40 2024-12-09
43266 HCPCS Esophagogastroduodenoscopy, Flexible, Transoral; With Placement Of Endoscopic St… 18 9 $4,723.62 $4,723.62 $72.00 $8,410.87 $5,218.72 2024-12-09
14041 HCPCS Adjacent Tissue Transfer Or Rearrangement, Forehead, Cheeks, Chin, Mouth, Neck, … 18 9 $4,733.24 $4,733.24 $72.00 $8,477.34 $5,810.61 2024-12-09
31636 HCPCS Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed… 18 9 $4,793.47 $4,793.47 $72.00 $8,536.39 $5,294.64 2024-12-09
43276 HCPCS Endoscopic Retrograde Cholangiopancreatography (ercp); With Removal And Exchange… 18 9 $5,491.77 $5,491.77 $72.00 $8,579.46 $7,343.71 2024-12-09
49616 HCPCS Repair Of Anterior Abdominal Hernia(s) (ie, Epigastric, Incisional, Ventral, Umb… 9 9 $2,864.56 $2,864.56 $2,434.88 $8,593.68 $5,514.28 2024-12-09
46020 HCPCS Placement Of Seton 18 9 $4,814.99 $4,814.99 $72.00 $8,594.69 $5,297.16 2024-12-09
46257 HCPCS Hemorrhoidectomy, Internal And External, Single Column/group; With Fissurectomy 18 9 $5,274.99 $5,274.99 $72.00 $8,608.98 $6,661.93 2024-12-09
31640 HCPCS Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed… 18 9 $4,912.55 $4,912.55 $72.00 $8,609.82 $5,573.72 2024-12-09
23130 HCPCS Acromioplasty Or Acromionectomy, Partial, With Or Without Coracoacromial Ligamen… 18 9 $4,806.05 $4,806.05 $72.00 $8,692.32 $5,875.32 2024-12-09
90378 HCPCS Respiratory Syncytial Virus, Monoclonal Antibody, Recombinant, For Intramuscular… 20 9 $8,643.44 $8,643.44 $330.31 $8,729.87 $7,563.01 2024-12-09
19120 HCPCS Excision Of Cyst, Fibroadenoma, Or Other Benign Or Malignant Tumor, Aberrant Bre… 18 9 $5,317.10 $5,317.10 $72.00 $8,736.49 $6,652.57 2024-12-09
30520 HCPCS Septoplasty Or Submucous Resection, With Or Without Cartilage Scoring, Contourin… 18 9 $4,835.32 $4,835.32 $72.00 $8,738.82 $5,912.99 2024-12-09
14060 HCPCS Adjacent Tissue Transfer Or Rearrangement, Eyelids, Nose, Ears And/or Lips; Defe… 18 9 $5,240.09 $5,240.09 $72.00 $8,785.29 $6,607.78 2024-12-09
58561 HCPCS Hysteroscopy, Surgical; With Removal Of Leiomyomata 19 9 $8,746.10 $8,746.10 $72.00 $8,833.56 $7,434.19 2024-12-09
42826 HCPCS Tonsillectomy, Primary Or Secondary; Age 12 Or Over 18 9 $4,994.44 $4,994.44 $72.00 $8,855.40 $5,558.03 2024-12-09
25111 HCPCS Excision Of Ganglion, Wrist (dorsal Or Volar); Primary 18 9 $5,135.26 $5,135.26 $72.00 $8,860.65 $5,974.89 2024-12-09
49617 HCPCS Repair Of Anterior Abdominal Hernia(s) (ie, Epigastric, Incisional, Ventral, Umb… 9 9 $2,956.10 $2,956.10 $2,512.69 $8,868.30 $5,690.49 2024-12-09
26951 HCPCS Amputation, Finger Or Thumb, Primary Or Secondary, Any Joint Or Phalanx, Single,… 18 9 $4,377.67 $4,377.67 $72.00 $8,896.98 $5,065.97 2024-12-09
31641 HCPCS Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed… 18 9 $5,068.81 $5,068.81 $72.00 $8,897.41 $5,736.40 2024-12-09
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 9 9 $9,378.23 $9,378.23 $7,971.50 $8,909.32 $8,721.75 2024-12-09
26746 HCPCS Open Treatment Of Articular Fracture, Involving Metacarpophalangeal Or Interphal… 18 9 $5,725.98 $5,725.98 $72.00 $8,915.17 $7,689.02 2024-12-09
29999 HCPCS Unlisted Procedure, Arthroscopy 9 9 $8,831.89 $8,831.89 $7,507.11 $8,920.21 $8,390.30 2024-12-09
29823 HCPCS Arthroscopy, Shoulder, Surgical; Debridement, Extensive, 3 Or More Discrete Stru… 18 9 $5,546.94 $5,546.94 $72.00 $8,937.87 $7,100.27 2024-12-09
23405 HCPCS Tenotomy, Shoulder Area; Single Tendon 18 9 $5,149.61 $5,149.61 $72.00 $8,975.94 $6,393.84 2024-12-09
44370 HCPCS Small Intestinal Endoscopy, Enteroscopy Beyond Second Portion Of Duodenum, Not I… 18 9 $5,137.49 $5,137.49 $72.00 $8,999.51 $5,833.80 2024-12-09
42808 HCPCS Excision Or Destruction Of Lesion Of Pharynx, Any Method 18 9 $4,903.34 $4,903.34 $72.00 $9,103.08 $5,021.10 2024-12-09
59841 HCPCS Induced Abortion, By Dilation And Evacuation 18 9 $5,386.52 $5,386.52 $72.00 $9,108.64 $6,464.72 2024-12-09
51715 HCPCS Endoscopic Injection Of Implant Material Into The Submucosal Tissues Of The Uret… 18 9 $5,033.96 $5,033.96 $72.00 $9,137.01 $5,376.85 2024-12-09
26113 HCPCS Excision, Tumor, Soft Tissue, Or Vascular Malformation, Of Hand Or Finger, Subfa… 18 9 $5,838.82 $5,838.82 $72.00 $9,147.10 $7,780.69 2024-12-09
46610 HCPCS Anoscopy; With Removal Of Single Tumor, Polyp, Or Other Lesion By Hot Biopsy For… 18 9 $5,063.76 $5,063.76 $72.00 $9,240.76 $4,734.62 2024-12-09
66984 HCPCS Extracapsular Cataract Removal With Insertion Of Intraocular Lens Prosthesis (1 … 18 9 $4,690.87 $4,690.87 $72.00 $9,251.43 $5,510.69 2024-12-09
49622 HCPCS Repair Of Parastomal Hernia, Any Approach (ie, Open, Laparoscopic, Robotic), Ini… 9 9 $3,087.06 $3,087.06 $2,624.00 $9,261.18 $5,942.59 2024-12-09
31638 HCPCS Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed… 18 9 $5,261.26 $5,261.26 $72.00 $9,323.88 $5,859.84 2024-12-09
25628 HCPCS Open Treatment Of Carpal Scaphoid (navicular) Fracture, Includes Internal Fixati… 18 9 $6,062.36 $6,062.36 $72.00 $9,350.94 $7,881.78 2024-12-09
58565 HCPCS Hysteroscopy, Surgical; With Bilateral Fallopian Tube Cannulation To Induce Occl… 18 9 $6,015.83 $6,015.83 $72.00 $9,396.77 $7,414.30 2024-12-09
Q5111 HCPCS Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg 9 9 $9,378.72 $9,378.72 $7,971.91 $9,472.51 $8,909.78 2024-12-09
24358 HCPCS Tenotomy, Elbow, Lateral Or Medial (eg, Epicondylitis, Tennis Elbow, Golfer's El… 18 9 $6,237.34 $6,237.34 $72.00 $9,488.85 $7,974.66 2024-12-09
46262 HCPCS Hemorrhoidectomy, Internal And External, 2 Or More Columns/groups; With Fistulec… 18 9 $6,048.69 $6,048.69 $72.00 $9,505.70 $8,028.62 2024-12-09
43212 HCPCS Esophagoscopy, Flexible, Transoral; With Placement Of Endoscopic Stent (includes… 18 9 $5,217.47 $5,217.47 $72.00 $9,562.84 $5,474.14 2024-12-09
54161 HCPCS Circumcision, Surgical Excision Other Than Clamp, Device, Or Dorsal Slit; Older … 18 9 $5,249.40 $5,249.40 $72.00 $9,604.76 $5,525.32 2024-12-09
29824 HCPCS Arthroscopy, Shoulder, Surgical; Distal Claviculectomy Including Distal Articula… 18 9 $5,253.76 $5,253.76 $72.00 $9,628.62 $6,385.74 2024-12-09
47562 HCPCS Laparoscopy, Surgical; Cholecystectomy 18 9 $4,586.14 $4,586.14 $72.00 $9,650.46 $5,211.02 2024-12-09
23294613_1 CDM Lapiplasty Mini-incision System 9 9 $10,246.81 $10,246.81 $8,709.79 $9,734.47 $9,529.53 2024-12-09
27301 HCPCS Incision And Drainage, Deep Abscess, Bursa, Or Hematoma, Thigh Or Knee Region 18 9 $6,046.41 $6,046.41 $72.00 $9,955.62 $7,677.49 2024-12-09
45320 HCPCS Proctosigmoidoscopy, Rigid; With Ablation Of Tumor(s), Polyp(s), Or Other Lesion… 18 9 $5,651.93 $5,651.93 $72.00 $10,251.29 $5,355.65 2024-12-09
49596 HCPCS Repair Of Anterior Abdominal Hernia(s) (ie, Epigastric, Incisional, Ventral, Umb… 9 9 $3,420.85 $3,420.85 $2,907.72 $10,262.55 $6,585.14 2024-12-09
26727 HCPCS Percutaneous Skeletal Fixation Of Unstable Phalangeal Shaft Fracture, Proximal O… 18 9 $6,221.18 $6,221.18 $72.00 $10,340.14 $7,657.94 2024-12-09
46261 HCPCS Hemorrhoidectomy, Internal And External, 2 Or More Columns/groups; With Fissurec… 18 9 $6,394.34 $6,394.34 $72.00 $10,344.34 $8,172.94 2024-12-09
46260 HCPCS Hemorrhoidectomy, Internal And External, 2 Or More Columns/groups 18 9 $6,357.36 $6,357.36 $72.00 $10,520.71 $7,874.31 2024-12-09
46947 HCPCS Hemorrhoidopexy (eg, For Prolapsing Internal Hemorrhoids) By Stapling 18 9 $6,177.13 $6,177.13 $72.00 $10,608.83 $7,239.81 2024-12-09
24341 HCPCS Repair, Tendon Or Muscle, Upper Arm Or Elbow, Each Tendon Or Muscle, Primary Or … 18 9 $6,333.08 $6,333.08 $72.00 $10,652.31 $7,975.97 2024-12-09
Q5113 HCPCS Injection, Trastuzumab-pkrb, Biosimilar, (herzuma), 10 Mg 9 9 $11,225.40 $11,225.40 $9,541.59 $10,664.13 $10,439.62 2024-12-09
G0390 HCPCS Trauma Response Team Associated With Hospital Critical Care Service 18 9 $7,465.23 $7,465.23 $3,714.39 $10,666.19 $6,695.03 2024-12-09
23430 HCPCS Tenodesis Of Long Tendon Of Biceps 18 9 $6,019.67 $6,019.67 $72.00 $10,738.11 $7,402.48 2024-12-09
31661 HCPCS Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed… 18 9 $6,299.86 $6,299.86 $72.00 $10,941.31 $6,518.60 2024-12-09
29856 HCPCS Arthroscopically Aided Treatment Of Tibial Fracture, Proximal (plateau); Bicondy… 18 9 $5,448.51 $5,448.51 $72.00 $10,990.83 $6,329.23 2024-12-09
J1930 HCPCS Injection, Lanreotide, 1 Mg 18 9 $5,635.78 $5,635.78 $226.41 $11,115.25 $4,811.72 2024-12-09
29884 HCPCS Arthroscopy, Knee, Surgical; With Lysis Of Adhesions, With Or Without Manipulati… 18 9 $6,540.68 $6,540.68 $72.00 $11,161.55 $7,742.17 2024-12-09
59150 HCPCS Laparoscopic Treatment Of Ectopic Pregnancy; Without Salpingectomy And/or Oophor… 18 9 $6,984.95 $6,984.95 $72.00 $11,241.66 $8,944.85 2024-12-09
28725 HCPCS Arthrodesis; Subtalar 18 9 $6,790.47 $6,790.47 $72.00 $11,359.92 $8,570.01 2024-12-09
46258 HCPCS Hemorrhoidectomy, Internal And External, Single Column/group; With Fistulectomy,… 18 9 $6,750.17 $6,750.17 $72.00 $11,391.16 $8,126.25 2024-12-09
27355 HCPCS Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Femur 18 9 $7,104.03 $7,104.03 $72.00 $11,439.59 $9,136.30 2024-12-09
27425 HCPCS Lateral Retinacular Release, Open 18 9 $7,111.52 $7,111.52 $72.00 $11,504.37 $8,316.46 2024-12-09
11005 HCPCS Debridement Of Skin, Subcutaneous Tissue, Muscle And Fascia For Necrotizing Soft… 18 9 $5,889.16 $5,889.16 $72.00 $11,726.22 $6,885.88 2024-12-09
21931 HCPCS Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater 18 9 $7,387.17 $7,387.17 $72.00 $11,878.52 $8,720.02 2024-12-09
29882 HCPCS Arthroscopy, Knee, Surgical; With Meniscus Repair (medial Or Lateral) 18 9 $7,664.12 $7,664.12 $72.00 $12,077.92 $10,137.16 2024-12-09
26123 HCPCS Fasciectomy, Partial Palmar With Release Of Single Digit Including Proximal Inte… 18 9 $8,012.52 $8,012.52 $72.00 $12,159.74 $10,534.44 2024-12-09
49618 HCPCS Repair Of Anterior Abdominal Hernia(s) (ie, Epigastric, Incisional, Ventral, Umb… 9 9 $4,145.00 $4,145.00 $3,523.25 $12,435.00 $7,979.12 2024-12-09
25447 HCPCS Arthroplasty, Intercarpal Or Carpometacarpal Joints; Interposition (eg, Tendon) 18 9 $8,308.35 $8,308.35 $72.00 $12,768.66 $11,061.96 2024-12-09
26735 HCPCS Open Treatment Of Phalangeal Shaft Fracture, Proximal Or Middle Phalanx, Finger … 18 9 $7,853.35 $7,853.35 $72.00 $13,005.84 $9,717.20 2024-12-09
44970 HCPCS Laparoscopy, Surgical, Appendectomy 18 9 $7,954.23 $7,954.23 $72.00 $13,104.05 $9,915.31 2024-12-09
29828 HCPCS Arthroscopy, Shoulder, Surgical; Biceps Tenodesis 18 9 $6,675.30 $6,675.30 $72.00 $13,277.79 $7,809.07 2024-12-09
47563 HCPCS Laparoscopy, Surgical; Cholecystectomy With Cholangiography 18 9 $8,560.45 $8,560.45 $72.00 $13,760.14 $11,035.66 2024-12-09
45308 HCPCS Proctosigmoidoscopy, Rigid; With Removal Of Single Tumor, Polyp, Or Other Lesion… 18 9 $7,024.62 $7,024.62 $72.00 $13,775.05 $6,412.32 2024-12-09
29891 HCPCS Arthroscopy, Ankle, Surgical, Excision Of Osteochondral Defect Of Talus And/or T… 18 9 $8,549.58 $8,549.58 $72.00 $13,967.80 $10,782.03 2024-12-09
43772 HCPCS Laparoscopy, Surgical, Gastric Restrictive Procedure; Removal Of Adjustable Gast… 9 9 $4,666.79 $4,666.79 $72.00 $14,000.37 $4,666.79 2024-12-09
29915 HCPCS Arthroscopy, Hip, Surgical; With Acetabuloplasty (ie, Treatment Of Pincer Lesion… 9 9 $4,677.19 $4,677.19 $72.00 $14,031.57 $4,677.19 2024-12-09
44950 HCPCS Appendectomy 18 9 $8,531.33 $8,531.33 $72.00 $14,043.64 $10,646.54 2024-12-09
44604 HCPCS Suture Of Large Intestine (colorrhaphy) For Perforated Ulcer, Diverticulum, Woun… 9 9 $4,723.89 $4,723.89 $72.00 $14,171.67 $4,723.89 2024-12-09
27514 HCPCS Open Treatment Of Femoral Fracture, Distal End, Medial Or Lateral Condyle, Inclu… 9 9 $4,735.74 $4,735.74 $72.00 $14,207.22 $4,735.74 2024-12-09
27870 HCPCS Arthrodesis, Ankle, Open 9 9 $4,744.90 $4,744.90 $72.00 $14,234.70 $4,744.90 2024-12-09
27507 HCPCS Open Treatment Of Femoral Shaft Fracture With Plate/screws, With Or Without Cerc… 9 9 $4,754.46 $4,754.46 $72.00 $14,263.38 $4,754.46 2024-12-09
44625 HCPCS Closure Of Enterostomy, Large Or Small Intestine; With Resection And Anastomosis… 9 9 $4,769.96 $4,769.96 $72.00 $14,309.88 $4,769.96 2024-12-09
29888 HCPCS Arthroscopically Aided Anterior Cruciate Ligament Repair/augmentation Or Reconst… 9 9 $4,777.03 $4,777.03 $72.00 $14,331.09 $4,777.03 2024-12-09
37617 HCPCS Ligation, Major Artery (eg, Post-traumatic, Rupture); Abdomen 9 9 $4,798.77 $4,798.77 $72.00 $14,396.31 $4,798.77 2024-12-09
29914 HCPCS Arthroscopy, Hip, Surgical; With Femoroplasty (ie, Treatment Of Cam Lesion) 9 9 $4,824.77 $4,824.77 $72.00 $14,474.31 $4,824.77 2024-12-09
27759 HCPCS Treatment Of Tibial Shaft Fracture (with Or Without Fibular Fracture) By Intrame… 9 9 $4,835.17 $4,835.17 $72.00 $14,505.51 $4,835.17 2024-12-09
23462 HCPCS Capsulorrhaphy, Anterior, Any Type; With Coracoid Process Transfer 9 9 $4,880.82 $4,880.82 $72.00 $14,642.46 $4,880.82 2024-12-09
27450 HCPCS Osteotomy, Femur, Shaft Or Supracondylar; With Fixation 9 9 $4,896.22 $4,896.22 $72.00 $14,688.66 $4,896.22 2024-12-09
19303 HCPCS Mastectomy, Simple, Complete 18 9 $7,585.97 $7,585.97 $72.00 $14,731.38 $8,978.78 2024-12-09
29916 HCPCS Arthroscopy, Hip, Surgical; With Labral Repair 9 9 $4,972.24 $4,972.24 $72.00 $14,916.72 $4,972.24 2024-12-09
43280 HCPCS Laparoscopy, Surgical, Esophagogastric Fundoplasty (eg, Nissen, Toupet Procedure… 9 9 $5,027.98 $5,027.98 $72.00 $15,083.94 $5,027.98 2024-12-09
29807 HCPCS Arthroscopy, Shoulder, Surgical; Repair Of Slap Lesion 9 9 $5,031.83 $5,031.83 $72.00 $15,095.49 $5,031.83 2024-12-09
44055 HCPCS Correction Of Malrotation By Lysis Of Duodenal Bands And/or Reduction Of Midgut … 9 9 $5,057.05 $5,057.05 $72.00 $15,171.15 $5,057.05 2024-12-09
25609 HCPCS Open Treatment Of Distal Radial Intra-articular Fracture Or Epiphyseal Separatio… 9 9 $5,069.90 $5,069.90 $72.00 $15,209.70 $5,069.90 2024-12-09
44379 HCPCS Small Intestinal Endoscopy, Enteroscopy Beyond Second Portion Of Duodenum, Inclu… 18 9 $9,073.17 $9,073.17 $72.00 $15,235.95 $9,978.83 2024-12-09
27650 HCPCS Repair, Primary, Open Or Percutaneous, Ruptured Achilles Tendon 18 9 $9,203.64 $9,203.64 $72.00 $15,370.72 $11,250.99 2024-12-09
15830 HCPCS Excision, Excessive Skin And Subcutaneous Tissue (includes Lipectomy); Abdomen, … 9 9 $5,127.41 $5,127.41 $72.00 $15,382.23 $5,127.41 2024-12-09
29827 HCPCS Arthroscopy, Shoulder, Surgical; With Rotator Cuff Repair 18 9 $7,007.52 $7,007.52 $72.00 $15,444.00 $7,758.66 2024-12-09
29806 HCPCS Arthroscopy, Shoulder, Surgical; Capsulorrhaphy 9 9 $5,157.05 $5,157.05 $72.00 $15,471.15 $5,157.05 2024-12-09
49002 HCPCS Reopening Of Recent Laparotomy 9 9 $5,164.43 $5,164.43 $72.00 $15,493.29 $5,164.43 2024-12-09
59514 HCPCS Cesarean Delivery Only 18 9 $10,446.85 $10,446.85 $72.00 $15,534.03 $13,762.58 2024-12-09
J3101 HCPCS Injection, Tenecteplase, 1 Mg 27 9 $14,808.25 $14,808.25 $207.92 $15,554.64 $13,771.67 2024-12-09
27429 HCPCS Ligamentous Reconstruction (augmentation), Knee; Intra-articular (open) And Extr… 9 9 $5,189.08 $5,189.08 $72.00 $15,567.24 $5,189.08 2024-12-09
44202 HCPCS Laparoscopy, Surgical; Enterectomy, Resection Of Small Intestine, Single Resecti… 9 9 $5,194.80 $5,194.80 $72.00 $15,584.40 $5,194.80 2024-12-09
44310 HCPCS Ileostomy Or Jejunostomy, Non-tube 9 9 $5,197.50 $5,197.50 $72.00 $15,592.50 $5,197.50 2024-12-09
47605 HCPCS Cholecystectomy; With Cholangiography 9 9 $5,211.13 $5,211.13 $72.00 $15,633.39 $5,211.13 2024-12-09
25515 HCPCS Open Treatment Of Radial Shaft Fracture, Includes Internal Fixation, When Perfor… 18 9 $9,420.06 $9,420.06 $72.00 $15,651.20 $10,549.61 2024-12-09
47600 HCPCS Cholecystectomy 9 9 $5,243.47 $5,243.47 $72.00 $15,730.41 $5,243.47 2024-12-09
44602 HCPCS Suture Of Small Intestine (enterorrhaphy) For Perforated Ulcer, Diverticulum, Wo… 9 9 $5,303.69 $5,303.69 $72.00 $15,911.07 $5,303.69 2024-12-09
45327 HCPCS Proctosigmoidoscopy, Rigid; With Transendoscopic Stent Placement (includes Predi… 18 9 $8,304.45 $8,304.45 $72.00 $16,198.22 $7,672.67 2024-12-09
44005 HCPCS Enterolysis (freeing Of Intestinal Adhesion) (separate Procedure) 9 9 $5,428.90 $5,428.90 $72.00 $16,286.70 $5,428.90 2024-12-09
27488 HCPCS Removal Of Prosthesis, Including Total Knee Prosthesis, Methylmethacrylate With … 9 9 $5,507.84 $5,507.84 $72.00 $16,523.52 $5,507.84 2024-12-09
59151 HCPCS Laparoscopic Treatment Of Ectopic Pregnancy; With Salpingectomy And/or Oophorect… 18 9 $10,536.97 $10,536.97 $72.00 $16,551.76 $12,881.26 2024-12-09
29867 HCPCS Arthroscopy, Knee, Surgical; Osteochondral Allograft (eg, Mosaicplasty) 9 9 $5,581.47 $5,581.47 $72.00 $16,744.41 $5,581.47 2024-12-09
J1950 HCPCS Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg 68 9 $7,495.23 $7,495.23 $39.15 $16,761.52 $6,711.80 2024-12-09
44320 HCPCS Colostomy Or Skin Level Cecostomy 9 9 $5,596.24 $5,596.24 $72.00 $16,788.72 $5,596.24 2024-12-09
44650 HCPCS Closure Of Enteroenteric Or Enterocolic Fistula 9 9 $5,606.43 $5,606.43 $72.00 $16,819.29 $5,606.43 2024-12-09
27446 HCPCS Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral Compartment 9 9 $5,651.67 $5,651.67 $72.00 $16,955.01 $5,651.67 2024-12-09
58615 HCPCS Occlusion Of Fallopian Tube(s) By Device (eg, Band, Clip, Falope Ring) Vaginal O… 18 9 $8,928.61 $8,928.61 $72.00 $17,070.47 $8,616.76 2024-12-09
29835 HCPCS Arthroscopy, Elbow, Surgical; Synovectomy, Partial 18 9 $10,237.34 $10,237.34 $72.00 $17,168.57 $11,284.42 2024-12-09
23474 HCPCS Revision Of Total Shoulder Arthroplasty, Including Allograft When Performed; Hum… 18 9 $7,796.29 $7,796.29 $72.00 $17,271.69 $8,853.41 2024-12-09
44125 HCPCS Enterectomy, Resection Of Small Intestine; With Enterostomy 9 9 $5,788.02 $5,788.02 $72.00 $17,364.06 $5,788.02 2024-12-09
27236 HCPCS Open Treatment Of Femoral Fracture, Proximal End, Neck, Internal Fixation Or Pro… 9 9 $5,810.58 $5,810.58 $72.00 $17,431.74 $5,810.58 2024-12-09
25607 HCPCS Open Treatment Of Distal Radial Extra-articular Fracture Or Epiphyseal Separatio… 18 9 $11,160.65 $11,160.65 $72.00 $17,874.90 $13,255.11 2024-12-09
49020 HCPCS Drainage Of Peritoneal Abscess Or Localized Peritonitis, Exclusive Of Appendicea… 14 9 $5,976.78 $5,976.78 $72.00 $17,930.34 $5,746.83 2024-12-09
27245 HCPCS Treatment Of Intertrochanteric, Peritrochanteric, Or Subtrochanteric Femoral Fra… 18 9 $11,834.89 $11,834.89 $72.00 $17,946.24 $15,476.74 2024-12-09
27244 HCPCS Treatment Of Intertrochanteric, Peritrochanteric, Or Subtrochanteric Femoral Fra… 9 9 $6,014.84 $6,014.84 $72.00 $18,044.52 $6,014.84 2024-12-09
44661 HCPCS Closure Of Enterovesical Fistula; With Intestine And/or Bladder Resection 9 9 $6,030.65 $6,030.65 $72.00 $18,091.95 $6,030.65 2024-12-09
44120 HCPCS Enterectomy, Resection Of Small Intestine; Single Resection And Anastomosis 9 9 $6,051.66 $6,051.66 $72.00 $18,154.98 $6,051.66 2024-12-09
24342 HCPCS Reinsertion Of Ruptured Biceps Or Triceps Tendon, Distal, With Or Without Tendon… 18 9 $10,872.62 $10,872.62 $72.00 $18,188.83 $13,258.48 2024-12-09
44160 HCPCS Colectomy, Partial, With Removal Of Terminal Ileum With Ileocolostomy 9 9 $6,138.91 $6,138.91 $72.00 $18,416.73 $6,138.91 2024-12-09
2504932_1 CDM Rev - Ihs-moa Clinic Visit 9 9 $18,533.01 $18,533.01 $15,753.06 $18,718.34 $17,606.36 2024-12-09
58563 HCPCS Hysteroscopy, Surgical; With Endometrial Ablation (eg, Endometrial Resection, El… 20 9 $8,052.00 $8,052.00 $72.00 $19,114.38 $7,246.80 2024-12-09
21613660_1 CDM Rev - Ihs-moa Clinic Visit 9 9 $19,489.70 $19,489.70 $16,566.25 $19,684.60 $18,515.22 2024-12-09
44206 HCPCS Laparoscopy, Surgical; Colectomy, Partial, With End Colostomy And Closure Of Dis… 9 9 $6,567.08 $6,567.08 $72.00 $19,701.24 $6,567.08 2024-12-09
27506 HCPCS Open Treatment Of Femoral Shaft Fracture, With Or Without External Fixation, Wit… 9 9 $6,569.06 $6,569.06 $72.00 $19,707.18 $6,569.06 2024-12-09
60210 HCPCS Partial Thyroid Lobectomy, Unilateral; With Or Without Isthmusectomy 18 9 $11,548.10 $11,548.10 $72.00 $19,824.30 $13,544.19 2024-12-09
44140 HCPCS Colectomy, Partial; With Anastomosis 9 9 $6,655.69 $6,655.69 $72.00 $19,967.07 $6,655.69 2024-12-09
43840 HCPCS Gastrorrhaphy, Suture Of Perforated Duodenal Or Gastric Ulcer, Wound, Or Injury 9 9 $6,702.38 $6,702.38 $72.00 $20,107.14 $6,702.38 2024-12-09
44238 HCPCS Unlisted Laparoscopy Procedure, Intestine (except Rectum) 8 8 $6,702.38 $6,702.38 $72.00 $20,107.14 $6,032.14 2024-12-09
27822 HCPCS Open Treatment Of Trimalleolar Ankle Fracture, Includes Internal Fixation, When … 18 9 $12,091.40 $12,091.40 $72.00 $20,279.12 $14,689.99 2024-12-09
27486 HCPCS Revision Of Total Knee Arthroplasty, With Or Without Allograft; 1 Component 9 9 $6,855.16 $6,855.16 $72.00 $20,565.48 $6,855.16 2024-12-09
27524 HCPCS Open Treatment Of Patellar Fracture, With Internal Fixation And/or Partial Or Co… 18 9 $12,066.14 $12,066.14 $72.00 $20,722.50 $14,142.27 2024-12-09
44145 HCPCS Colectomy, Partial; With Coloproctostomy (low Pelvic Anastomosis) 9 9 $7,048.29 $7,048.29 $72.00 $21,144.87 $7,048.29 2024-12-09
44227 HCPCS Laparoscopy, Surgical, Closure Of Enterostomy, Large Or Small Intestine, With Re… 9 9 $7,081.88 $7,081.88 $72.00 $21,245.64 $7,081.88 2024-12-09
27130 HCPCS Arthroplasty, Acetabular And Proximal Femoral Prosthetic Replacement (total Hip … 18 9 $14,534.73 $14,534.73 $72.00 $21,322.43 $19,476.18 2024-12-09
23472 HCPCS Arthroplasty, Glenohumeral Joint; Total Shoulder (glenoid And Proximal Humeral R… 9 9 $7,146.57 $7,146.57 $72.00 $21,439.71 $7,146.57 2024-12-09
44204 HCPCS Laparoscopy, Surgical; Colectomy, Partial, With Anastomosis 9 9 $7,214.38 $7,214.38 $72.00 $21,643.14 $7,214.38 2024-12-09
43281 HCPCS Laparoscopy, Surgical, Repair Of Paraesophageal Hernia, Includes Fundoplasty, Wh… 9 9 $7,222.70 $7,222.70 $72.00 $21,668.10 $7,222.70 2024-12-09
44146 HCPCS Colectomy, Partial; With Coloproctostomy (low Pelvic Anastomosis), With Colostom… 9 9 $7,563.82 $7,563.82 $72.00 $22,691.46 $7,563.82 2024-12-09
44188 HCPCS Laparoscopy, Surgical, Colostomy Or Skin Level Cecostomy 9 9 $7,571.72 $7,571.72 $72.00 $22,715.16 $6,435.96 2024-12-09
44208 HCPCS Laparoscopy, Surgical; Colectomy, Partial, With Anastomosis, With Coloproctostom… 9 9 $7,675.82 $7,675.82 $72.00 $23,027.46 $7,675.82 2024-12-09
23515 HCPCS Open Treatment Of Clavicular Fracture, Includes Internal Fixation, When Performe… 18 9 $13,306.59 $13,306.59 $72.00 $23,393.25 $15,021.02 2024-12-09
44626 HCPCS Closure Of Enterostomy, Large Or Small Intestine; With Resection And Colorectal … 9 9 $7,972.22 $7,972.22 $72.00 $23,916.66 $7,972.22 2024-12-09
44141 HCPCS Colectomy, Partial; With Skin Level Cecostomy Or Colostomy 9 9 $8,088.39 $8,088.39 $72.00 $24,265.17 $8,088.39 2024-12-09
27447 HCPCS Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral Compartments With Or… 18 9 $16,164.98 $16,164.98 $72.00 $24,422.17 $20,859.32 2024-12-09
44143 HCPCS Colectomy, Partial; With End Colostomy And Closure Of Distal Segment (hartmann T… 9 9 $8,144.14 $8,144.14 $72.00 $24,432.42 $8,144.14 2024-12-09
Q5119 HCPCS Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg 17 9 $25,812.55 $25,812.55 $216.64 $24,521.92 $21,940.67 2024-12-09
59618 HCPCS Routine Obstetric Care Including Antepartum Care, Cesarean Delivery, And Postpar… 9 9 $8,174.08 $8,174.08 $72.00 $24,522.24 $8,174.08 2024-12-09
43282 HCPCS Laparoscopy, Surgical, Repair Of Paraesophageal Hernia, Includes Fundoplasty, Wh… 18 9 $15,250.38 $15,250.38 $72.00 $25,160.51 $18,971.39 2024-12-09
58150 HCPCS Total Abdominal Hysterectomy (corpus And Cervix), With Or Without Removal Of Tub… 18 9 $15,031.49 $15,031.49 $72.00 $25,281.76 $18,185.65 2024-12-09
27487 HCPCS Revision Of Total Knee Arthroplasty, With Or Without Allograft; Femoral And Enti… 9 9 $8,649.26 $8,649.26 $72.00 $25,947.78 $8,649.26 2024-12-09
J2426 HCPCS Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg 71 9 $7,280.83 $7,280.83 $21.22 $26,587.73 $6,188.71 2024-12-09
44207 HCPCS Laparoscopy, Surgical; Colectomy, Partial, With Anastomosis, With Coloproctostom… 9 9 $9,130.78 $9,130.78 $72.00 $27,392.34 $9,130.78 2024-12-09
J9173 HCPCS Injection, Durvalumab, 10 Mg 9 9 $27,190.78 $27,190.78 $23,112.16 $27,462.69 $25,831.24 2024-12-09
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 9 9 $28,946.00 $28,946.00 $24,604.10 $29,235.46 $27,498.70 2024-12-09
43632 HCPCS Gastrectomy, Partial, Distal; With Gastrojejunostomy 9 9 $10,101.62 $10,101.62 $72.00 $30,304.86 $10,101.62 2024-12-09
59610 HCPCS Routine Obstetric Care Including Antepartum Care, Vaginal Delivery (with Or With… 9 9 $10,645.96 $10,645.96 $72.00 $31,937.88 $9,711.00 2024-12-09
J9312 HCPCS Injection, Rituximab, 10 Mg 9 9 $33,830.48 $33,830.48 $28,755.91 $32,138.96 $31,462.35 2024-12-09
J9356 HCPCS Injection, Trastuzumab, 10 Mg And Hyaluronidase-oysk 9 9 $33,677.25 $33,677.25 $28,625.66 $34,014.02 $31,993.39 2024-12-09
59400 HCPCS Routine Obstetric Care Including Antepartum Care, Vaginal Delivery (with Or With… 9 9 $11,901.97 $11,901.97 $72.00 $35,705.91 $10,116.67 2024-12-09
J9271 HCPCS Injection, Pembrolizumab, 1 Mg 9 9 $37,711.70 $37,711.70 $32,054.95 $38,088.82 $35,826.12 2024-12-09
59510 HCPCS Routine Obstetric Care Including Antepartum Care, Cesarean Delivery, And Postpar… 9 9 $13,201.03 $13,201.03 $72.00 $39,603.09 $11,220.88 2024-12-09
21012 HCPCS Excision, Tumor, Soft Tissue Of Face Or Scalp, Subcutaneous; 2 Cm Or Greater 9 9 $14,582.15 $14,582.15 $72.00 $43,746.45 $12,394.83 2024-12-09
J1459 HCPCS Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 34 9 $11,722.00 $11,722.00 $4,988.44 $47,309.86 $11,839.22 2024-12-09
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 17 9 $55,550.80 $55,550.80 $51.98 $56,106.31 $47,218.18 2024-12-09
J9144 HCPCS Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj 9 9 $60,252.05 $60,252.05 $51,214.24 $60,854.57 $57,239.45 2024-12-09
J2350 HCPCS Injection, Ocrelizumab, 1 Mg 9 9 $70,485.23 $70,485.23 $59,912.45 $66,960.97 $65,551.26 2024-12-09
J9022 HCPCS Injection, Atezolizumab, 10 Mg 9 9 $70,925.75 $70,925.75 $60,286.89 $71,635.01 $67,379.46 2024-12-09
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