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

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Hospital

ARKANSAS CHILDREN'S NORTHWEST, INC

Springdale, AR · CCN 043301 · Rates published

13,243 distinct procedures filed
30 distinct payers
391,694 rate rows
2026-05-09 last MRF observed
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apim.services.craneware.com/api-pricing-transparency/api/public/eb18b2f68dd86a27732870abb762237f/charges/mrf
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-10-13
Content fingerprint b1ffdddd241fd471… · 81,156,288 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
67979-0002-01
OTHER 		Supprelin La 30 $43,185.34 $86,927.59 $65,056.46 —
0571T
CPT 		Insj/rplcmt Icds Ss Eltrd 30 $29,296.07 $29,296.07 $29,296.07 nat. median
$32,945
0.9× median
L5856
HCPCS 		Elec Knee-shin Swing/stance 30 $28,851.23 $28,851.23 $28,851.23 nat. median
$29,004
1.0× median
L6880
HCPCS 		Elec Hand Ind Art Digits 30 $28,715.00 $28,715.00 $28,715.00 nat. median
$28,867
1.0× median
33289
OTHER 		Tcat Impl Wrls P-art Prs Snr 7 $947.50 $26,770.94 $26,770.94 —
L5858
HCPCS 		Stance Phase Only 30 $22,336.47 $22,336.47 $22,336.47 nat. median
$22,455
1.0× median
33902
OTHER 		Perq P-art Revsc 1 Abnor Uni 26 $17,109.41 $24,982.37 $21,045.89 —
93654
OTHER 		Compre Ep Eval Tx Vt 30 $2,011.32 $34,150.19 $18,080.76 —
61624
OTHER 		Tcat Perm Occls/embolj Cns 25 $17,109.41 $17,109.41 $17,109.41 —
33264
OTHER 		Rmvl & Rplcmt Dfb Gen Mlt Ld 8 $1,375.77 $46,650.45 $15,711.62 —
33231
OTHER 		Insrt Pulse Gen W/mult Leads 8 $1,375.77 $46,650.45 $15,711.62 —
33270
OTHER 		Ins/rep Subq Defibrillator 8 $1,125.63 $46,650.45 $15,518.25 —
33249
OTHER 		Insj/rplcmt Defib W/lead(s) 8 $1,125.63 $46,650.45 $15,518.25 —
93581
OTHER 		Transcath Closure Of Vsd 30 $5,033.04 $24,982.37 $15,007.70 —
93580
OTHER 		Transcath Closure Of Asd 30 $3,763.77 $24,982.37 $14,373.07 —
33221
OTHER 		Insert Pulse Gen Mult Leads 30 $1,375.77 $27,155.79 $14,265.78 —
33229
OTHER 		Remv&replc Pm Gen Mult Leads 30 $1,375.77 $27,155.79 $14,265.78 —
93582
OTHER 		Perq Transcath Closure Pda 30 $3,451.14 $24,982.37 $14,216.75 —
93591
OTHER 		Perq Transcath Cls Aortic 30 $3,412.25 $24,982.37 $14,197.31 —
93653
OTHER 		Compre Ep Eval Tx Svt 8 $1,507.59 $34,150.19 $13,363.07 —
92997
OTHER 		Pul Art Balloon Repr Percut 30 $10,774.50 $15,438.47 $13,106.49 —
33903
OTHER 		Perq P-art Revsc 1 Abnor Bi 26 $10,774.50 $15,438.47 $13,106.49 —
33214
OTHER 		Upgrade Of Pacemaker System 26 $9,755.13 $15,021.74 $12,388.43 —
81416
OTHER 		Test For Detecting Exome; Sequence Analysis; Each Comparator Exome 30 $2,084.78 $12,000.00 $12,000.00 —
33262
OTHER 		Rmvl& Replc Pulse Gen 1 Lead 8 $1,375.77 $33,186.01 $11,443.85 —
33263
OTHER 		Rmvl & Rplcmt Dfb Gen 2 Lead 8 $1,375.77 $33,186.01 $11,443.85 —
33230
OTHER 		Insrt Pulse Gen W/dual Leads 8 $1,375.77 $33,186.01 $11,443.85 —
33900
OTHER 		Perq P-art Revsc 1 Nm Nt Uni 26 $10,774.50 $10,774.50 $10,774.50 —
33901
OTHER 		Perq P-art Revsc 1 Nm Nt Bi 26 $10,774.50 $10,774.50 $10,774.50 —
L6925
HCPCS 		Wrist Disart Myoelectronic C 30 $10,417.12 $10,417.12 $10,417.12 nat. median
$10,759
1.0× median
L5857
HCPCS 		Elec Knee-shin Swing Only 30 $10,237.55 $10,237.55 $10,237.55 nat. median
$10,299
1.0× median
25365
OTHER 		Incision Or Partial Removal Of Both Forearm Bones 30 $1,125.63 $18,976.59 $10,051.11 —
24575
OTHER 		Treatment Of Broken Outer Part Of Upper Arm Bone At Elbow 30 $1,125.63 $18,976.59 $10,051.11 —
24579
OTHER 		Treatment Of Broken Elbow 30 $1,125.63 $18,976.59 $10,051.11 —
24545
OTHER 		Treatment Of Upper Arm Bone Broken At Elbow 30 $1,125.63 $18,976.59 $10,051.11 —
24435
OTHER 		Repair Of Nonhealed Broken Upper Arm Bone With Self Bone Graft 30 $1,125.63 $18,976.59 $10,051.11 —
27428
OTHER 		Reconstruction Ligaments Inside Knee Joint 30 $1,125.63 $18,976.59 $10,051.11 —
27828
OTHER 		Treatment Of Broken Lower Weight Bearing Joint Of Both Lower Leg Bones 30 $1,125.63 $18,976.59 $10,051.11 —
24515
OTHER 		Treatment Of Broken Middle Part Of Upper Arm Bone With Placement Of Stabilizing… 30 $1,125.63 $18,976.59 $10,051.11 —
27759
OTHER 		Treatment Of Broken Part Of Shin Bone With Rod 30 $1,125.63 $18,976.59 $10,051.11 —
27827
OTHER 		Treatment Of Broken Shin Bone At Lower Weight Bearing Joint 30 $1,125.63 $18,976.59 $10,051.11 —
27758
OTHER 		Treatment Broken Middle Part Of Shin Bone With Plate Or Screws 30 $1,125.63 $18,976.59 $10,051.11 —
33274
OTHER 		Tcat Insj/rpl Perm Ldls Pm 8 $947.50 $24,982.37 $9,721.23 —
37182
OTHER 		Insert Hepatic Shunt (tips) 29 $1,375.77 $17,109.41 $9,242.59 —
37184
OTHER 		Prim Art M-thrmbc 1st Vsl 30 $1,375.77 $17,109.41 $9,242.59 —
37242
OTHER 		Vasc Embolize/occlude Artery 30 $1,125.63 $17,109.41 $9,117.52 —
92990
OTHER 		Revision Of Pulmonary Valve 30 $2,449.29 $15,438.47 $8,943.88 —
20982
OTHER 		Ablate Bone Tumor(s) Perq 30 $1,125.63 $16,364.78 $8,745.20 —
L5987
HCPCS 		Shank Ft W Vert Load Pylon 30 $8,645.73 $8,645.73 $8,645.73 nat. median
$8,684
1.0× median
37238
OTHER 		Open/perq Place Stent Same 30 $1,375.77 $15,438.47 $8,407.12 —

Other procedures at this hospital

Browse this hospital's 13,243 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
67979-0002-01 OTHER Supprelin La 31 30 $187,277.56 $168,549.80 $43,185.34 $86,927.59 $65,056.46 2026-05-09
0571T CPT Insj/rplcmt Icds Ss Eltrd 31 30 $52,748.59 $47,473.73 $29,296.07 $29,296.07 $29,296.07 2026-05-09
L5856 HCPCS Elec Knee-shin Swing/stance 31 30 $39,796.43 $35,816.79 $28,851.23 $28,851.23 $28,851.23 2026-05-09
L6880 HCPCS Elec Hand Ind Art Digits 31 30 $42,732.68 $38,459.41 $28,715.00 $28,715.00 $28,715.00 2026-05-09
33289 OTHER Tcat Impl Wrls P-art Prs Snr 11 7 $47,737.51 $42,963.76 $947.50 $26,770.94 $26,770.94 2026-05-09
L5858 HCPCS Stance Phase Only 31 30 $27,063.01 $24,356.71 $22,336.47 $22,336.47 $22,336.47 2026-05-09
33902 OTHER Perq P-art Revsc 1 Abnor Uni 27 26 $11,501.41 $10,351.27 $17,109.41 $24,982.37 $21,045.89 2026-05-09
93654 OTHER Compre Ep Eval Tx Vt 31 30 $39,067.82 $35,161.04 $2,011.32 $34,150.19 $18,080.76 2026-05-09
61624 OTHER Tcat Perm Occls/embolj Cns 26 25 $2,451.94 $2,206.75 $17,109.41 $17,109.41 $17,109.41 2026-05-09
33264 OTHER Rmvl & Rplcmt Dfb Gen Mlt Ld 8 8 $5,081.04 $4,572.94 $1,375.77 $46,650.45 $15,711.62 2026-05-09
33231 OTHER Insrt Pulse Gen W/mult Leads 8 8 $4,983.33 $4,485.00 $1,375.77 $46,650.45 $15,711.62 2026-05-09
33249 OTHER Insj/rplcmt Defib W/lead(s) 8 8 $53,368.12 $48,031.31 $1,125.63 $46,650.45 $15,518.25 2026-05-09
33270 OTHER Ins/rep Subq Defibrillator 8 8 $53,368.12 $48,031.31 $1,125.63 $46,650.45 $15,518.25 2026-05-09
93581 OTHER Transcath Closure Of Vsd 31 30 $5,209.15 $4,688.24 $5,033.04 $24,982.37 $15,007.70 2026-05-09
93580 OTHER Transcath Closure Of Asd 31 30 $24,136.99 $21,723.29 $3,763.77 $24,982.37 $14,373.07 2026-05-09
33221 OTHER Insert Pulse Gen Mult Leads 31 30 $29,871.37 $26,884.23 $1,375.77 $27,155.79 $14,265.78 2026-05-09
33229 OTHER Remv&replc Pm Gen Mult Leads 31 30 $4,885.57 $4,397.01 $1,375.77 $27,155.79 $14,265.78 2026-05-09
93582 OTHER Perq Transcath Closure Pda 31 30 $24,136.99 $21,723.29 $3,451.14 $24,982.37 $14,216.75 2026-05-09
93591 OTHER Perq Transcath Cls Aortic 31 30 $28,579.83 $25,721.85 $3,412.25 $24,982.37 $14,197.31 2026-05-09
93653 OTHER Compre Ep Eval Tx Svt 8 8 $39,067.82 $35,161.04 $1,507.59 $34,150.19 $13,363.07 2026-05-09
92997 OTHER Pul Art Balloon Repr Percut 31 30 $15,034.24 $13,530.82 $10,774.50 $15,438.47 $13,106.49 2026-05-09
33903 OTHER Perq P-art Revsc 1 Abnor Bi 27 26 $11,501.41 $10,351.27 $10,774.50 $15,438.47 $13,106.49 2026-05-09
33214 OTHER Upgrade Of Pacemaker System 27 26 $4,935.43 $4,441.89 $9,755.13 $15,021.74 $12,388.43 2026-05-09
81416 OTHER Test For Detecting Exome; Sequence Analysis; Each Comparator Exome 57 30 $2,605.98 $2,345.38 $2,084.78 $12,000.00 $12,000.00 2026-05-09
33263 OTHER Rmvl & Rplcmt Dfb Gen 2 Lead 8 8 $37,964.78 $34,168.30 $1,375.77 $33,186.01 $11,443.85 2026-05-09
33262 OTHER Rmvl& Replc Pulse Gen 1 Lead 8 8 $7,549.15 $6,794.24 $1,375.77 $33,186.01 $11,443.85 2026-05-09
33230 OTHER Insrt Pulse Gen W/dual Leads 8 8 $4,791.61 $4,312.45 $1,375.77 $33,186.01 $11,443.85 2026-05-09
33900 OTHER Perq P-art Revsc 1 Nm Nt Uni 27 26 $11,280.22 $10,152.20 $10,774.50 $10,774.50 $10,774.50 2026-05-09
33901 OTHER Perq P-art Revsc 1 Nm Nt Bi 27 26 $11,280.22 $10,152.20 $10,774.50 $10,774.50 $10,774.50 2026-05-09
L6925 HCPCS Wrist Disart Myoelectronic C 31 30 $18,871.18 $16,984.06 $10,417.12 $10,417.12 $10,417.12 2026-05-09
L5857 HCPCS Elec Knee-shin Swing Only 31 30 $12,403.85 $11,163.47 $10,237.55 $10,237.55 $10,237.55 2026-05-09
27827 OTHER Treatment Of Broken Shin Bone At Lower Weight Bearing Joint 62 30 $6,170.75 $5,553.68 $1,125.63 $18,976.59 $10,051.11 2026-05-09
24575 OTHER Treatment Of Broken Outer Part Of Upper Arm Bone At Elbow 93 30 $11,181.80 $10,063.62 $1,125.63 $18,976.59 $10,051.11 2026-05-09
27759 OTHER Treatment Of Broken Part Of Shin Bone With Rod 62 30 $18,158.00 $16,342.19 $1,125.63 $18,976.59 $10,051.11 2026-05-09
24579 OTHER Treatment Of Broken Elbow 93 30 $7,719.34 $6,947.41 $1,125.63 $18,976.59 $10,051.11 2026-05-09
24545 OTHER Treatment Of Upper Arm Bone Broken At Elbow 31 30 $15,673.53 $14,106.18 $1,125.63 $18,976.59 $10,051.11 2026-05-09
27758 OTHER Treatment Broken Middle Part Of Shin Bone With Plate Or Screws 31 30 $12,812.09 $11,530.88 $1,125.63 $18,976.59 $10,051.11 2026-05-09
27828 OTHER Treatment Of Broken Lower Weight Bearing Joint Of Both Lower Leg Bones 62 30 $14,385.55 $12,946.99 $1,125.63 $18,976.59 $10,051.11 2026-05-09
24515 OTHER Treatment Of Broken Middle Part Of Upper Arm Bone With Placement Of Stabilizing … 31 30 $12,372.89 $11,135.60 $1,125.63 $18,976.59 $10,051.11 2026-05-09
25365 OTHER Incision Or Partial Removal Of Both Forearm Bones 31 30 $31,616.01 $28,454.41 $1,125.63 $18,976.59 $10,051.11 2026-05-09
24435 OTHER Repair Of Nonhealed Broken Upper Arm Bone With Self Bone Graft 31 30 $8,759.56 $7,883.60 $1,125.63 $18,976.59 $10,051.11 2026-05-09
27428 OTHER Reconstruction Ligaments Inside Knee Joint 31 30 $18,351.34 $16,516.21 $1,125.63 $18,976.59 $10,051.11 2026-05-09
33274 OTHER Tcat Insj/rpl Perm Ldls Pm 8 8 $7,260.32 $6,534.29 $947.50 $24,982.37 $9,721.23 2026-05-09
37182 OTHER Insert Hepatic Shunt (tips) 30 29 $11,340.03 $10,206.03 $1,375.77 $17,109.41 $9,242.59 2026-05-09
37184 OTHER Prim Art M-thrmbc 1st Vsl 31 30 $5,373.77 $4,836.39 $1,375.77 $17,109.41 $9,242.59 2026-05-09
37242 OTHER Vasc Embolize/occlude Artery 31 30 $14,889.68 $13,400.71 $1,125.63 $17,109.41 $9,117.52 2026-05-09
92990 OTHER Revision Of Pulmonary Valve 31 30 $15,034.24 $13,530.82 $2,449.29 $15,438.47 $8,943.88 2026-05-09
20982 OTHER Ablate Bone Tumor(s) Perq 31 30 $4,578.68 $4,120.81 $1,125.63 $16,364.78 $8,745.20 2026-05-09
L5987 HCPCS Shank Ft W Vert Load Pylon 31 30 $15,831.48 $14,248.33 $8,645.73 $8,645.73 $8,645.73 2026-05-09
37236 OTHER Open/perq Place Stent 1st 31 30 $14,745.12 $13,270.61 $1,375.77 $15,438.47 $8,407.12 2026-05-09
37238 OTHER Open/perq Place Stent Same 31 30 $16,746.06 $15,071.45 $1,375.77 $15,438.47 $8,407.12 2026-05-09
61623 OTHER Endovasc Tempory Vessel Occl 31 30 $16,219.66 $14,597.69 $1,375.77 $15,438.47 $8,407.12 2026-05-09
37187 OTHER Venous Mech Thrombectomy 31 30 $8,132.20 $7,318.98 $1,375.77 $15,438.47 $8,407.12 2026-05-09
37221 OTHER Iliac Revasc W/stent 31 30 $8,927.71 $8,034.94 $1,375.77 $15,438.47 $8,407.12 2026-05-09
92928 OTHER Prq Tcat Plmt Ntrac St 1 Les 31 30 $18,420.66 $16,578.59 $1,212.80 $15,438.47 $8,325.64 2026-05-09
61626 OTHER Tcat Perm Occls/embol Noncns 31 30 $16,266.09 $14,639.48 $1,125.63 $15,438.47 $8,282.05 2026-05-09
37244 OTHER Vasc Embolize/occlude Bleed 31 30 $16,266.09 $14,639.48 $1,125.63 $15,438.47 $8,282.05 2026-05-09
37241 OTHER Vasc Embolize/occlude Venous 31 30 $16,585.04 $14,926.54 $1,125.63 $15,438.47 $8,282.05 2026-05-09
37243 OTHER Vasc Embolize/occlude Organ 31 30 $7,567.83 $6,811.05 $1,125.63 $15,438.47 $8,282.05 2026-05-09
33213 OTHER Insert Pulse Gen Dual Leads 31 30 $16,523.91 $14,871.52 $1,375.77 $15,021.74 $8,198.75 2026-05-09
33228 OTHER Remv&replc Pm Gen Dual Lead 31 30 $17,326.37 $15,593.73 $1,375.77 $15,021.74 $8,198.75 2026-05-09
27415 OTHER Implantation Of Donor Cartilage Cells Into Knee Joint 8 8 $19,248.12 $17,323.31 $1,125.63 $25,174.75 $6,861.55 2026-05-09
33227 OTHER Remove&replace Pm Gen Singl 31 30 $12,667.57 $11,400.81 $1,375.77 $11,871.59 $6,623.68 2026-05-09
47579 OTHER Other Procedure On Bile Duct Using An Endoscope 27 26 $1,477.32 $1,329.59 $5,642.45 $7,580.33 $6,611.39 2026-05-09
43659 OTHER Other Procedure On Stomach Using An Endoscope 27 26 $5,758.28 $5,182.45 $5,642.45 $7,580.33 $6,611.39 2026-05-09
33210 OTHER Insert Electrd/pm Cath Sngl 31 30 $12,915.96 $11,624.36 $1,212.80 $11,871.59 $6,542.19 2026-05-09
33212 OTHER Insert Pulse Gen Sngl Lead 31 30 $4,935.43 $4,441.89 $1,125.63 $11,871.59 $6,498.61 2026-05-09
33285 OTHER Insj Subq Car Rhythm Mntr 31 30 $12,915.96 $11,624.36 $1,125.63 $11,871.59 $6,498.61 2026-05-09
33216 OTHER Insert 1 Electrode Pm-defib 31 30 $4,935.43 $4,441.89 $1,125.63 $11,871.59 $6,498.61 2026-05-09
33233 OTHER Removal Of Pm Generator 31 30 $4,983.35 $4,485.02 $947.50 $11,871.59 $6,409.55 2026-05-09
L5230 HCPCS Fem Focal Defic Constant Fri 31 30 $6,001.47 $5,401.32 $6,209.65 $6,209.65 $6,209.65 2026-05-09
L6300 HCPCS Shlder Disart Int Lock Elbow 31 30 $8,817.86 $7,936.07 $6,081.45 $6,081.45 $6,081.45 2026-05-09
93620 OTHER Comp Ep Evl R At Ven Pac&rec 31 30 $11,201.86 $10,081.67 $2,001.88 $9,791.84 $5,896.86 2026-05-09
50590 OTHER Shock Wave Crushing Of Kidney Stones 31 30 $8,386.72 $7,548.05 $3,289.96 $8,386.72 $5,838.34 2026-05-09
93650 OTHER Icar Cath Abltj Av Node Func 31 30 $11,201.86 $10,081.67 $1,650.20 $9,791.84 $5,721.02 2026-05-09
43265 OTHER Ercp Lithotripsy Calculi 31 30 $5,591.33 $5,032.20 $5,666.13 $5,666.13 $5,666.13 2026-05-09
93619 OTHER Comprehensive Ep Evaluation 31 30 $11,201.86 $10,081.67 $1,451.57 $9,791.84 $5,621.70 2026-05-09
33206 OTHER Insert Heart Pm Atrial 31 30 $17,159.77 $15,443.79 $1,375.77 $9,755.13 $5,565.45 2026-05-09
L5701 HCPCS Replace Socket Above Knee 31 30 $7,626.21 $6,863.59 $5,550.13 $5,550.13 $5,550.13 2026-05-09
40700 OTHER Primary Plastic Repair Of Deformity Present At Birth On 1 Side Of Nose And/or Li… 4 4 $0.01 — $5,525.14 $7,765.79 $5,525.14 2026-05-09
33207 OTHER Insert Heart Pm Ventricular 31 30 $17,159.77 $15,443.79 $1,212.80 $9,755.13 $5,483.97 2026-05-09
0212U CPT Rare Ds Gen DNA Alys Proband 30 29 $3,125.00 $2,812.50 $5,475.20 $5,475.20 $5,475.20 2026-05-09
33208 OTHER Insrt Heart Pm Atrial & Vent 31 30 $17,326.37 $15,593.73 $1,125.63 $9,755.13 $5,440.38 2026-05-09
27814 OTHER Treatment Of Both Broken Lower Leg Bones At Ankle 93 30 $8,504.51 $7,654.06 $1,125.63 $9,620.04 $5,372.84 2026-05-09
28750 OTHER Fusion Of Big Toe At Joint With Foot 31 30 $1.00 $0.90 $1,125.63 $9,620.04 $5,372.84 2026-05-09
24635 OTHER Treatment Of Broken And Dislocated Forearm Bones At Elbow 62 30 $13,305.68 $11,975.11 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27437 OTHER Repair Of Kneecap 31 30 $5,670.21 $5,103.19 $1,125.63 $9,620.04 $5,372.84 2026-05-09
23515 OTHER Treatment Of Broken Collar Bone 31 30 $13,157.36 $11,841.62 $1,125.63 $9,620.04 $5,372.84 2026-05-09
23156 OTHER Removal Of Cyst Or Growth Of Top Of Upper Arm Bone With Donor Bone Graft 31 30 $4,555.39 $4,099.85 $1,125.63 $9,620.04 $5,372.84 2026-05-09
25545 OTHER Treatment Of Broken Midpart Of Forearm Bone On Small Finger Side 91 30 $0.01 $10,886.58 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27418 OTHER Repair Of Upper End Of Shin Bone At Knee Joint 31 30 $0.01 — $1,125.63 $9,620.04 $5,372.84 2026-05-09
27475 OTHER Removal Of Growth Plate At Lower End Of Thigh Bone 31 30 $7,521.59 $6,769.43 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27422 OTHER Repair Of Dislocating Kneecap With Realignment 31 30 $9,620.04 $8,658.04 $1,125.63 $9,620.04 $5,372.84 2026-05-09
25574 OTHER Treatment Of Broken Midpart Of Both Forearm Bones With Placement Of Stabilizing … 31 30 $6,267.83 $5,641.05 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27695 OTHER Primary Repair Of Disrupted Ankle Ligament 62 30 $8,336.89 $7,503.20 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27829 OTHER Treatment Of Ligament Tear At Ankle Joint 93 30 $6,466.72 $5,820.05 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27509 OTHER Treatment Of Broken Thigh Bone At Far End With Placement Of Stabilizing Device 31 30 $6,668.92 $6,002.03 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27485 OTHER Removal Of Growth Plate Of Leg Or Thigh Bones 124 30 $9,043.10 $8,138.79 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27792 OTHER Treatment Of Broken Outer Lower Leg Bone At Ankle 93 30 $11,341.42 $12,725.14 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27766 OTHER Treatment Of Inside Portion Of Broken Shin Bone At Ankle 62 30 $4,465.13 $8,037.23 $947.50 $9,620.04 $5,372.84 2026-05-09
27427 OTHER Reconstruction Of Ligaments Outside Knee Joint 124 30 $13,971.18 $12,574.07 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27756 OTHER Placement Of Stabilizing Device For Broken Middle Part Of Shin Bone 31 30 $11,411.80 $10,270.62 $1,125.63 $9,620.04 $5,372.84 2026-05-09
29888 OTHER Repair Of Anterior Cruciate Ligament Of Knee Using An Endoscope 90 30 $9,670.61 $9,644.73 $1,125.63 $15,702.32 $5,372.84 2026-05-09
28485 OTHER Treatment Of Broken Midportion Of Foot 89 30 $11,573.26 $10,415.93 $1,125.63 $9,620.04 $5,372.84 2026-05-09
28755 OTHER Fusion Of Big Toe Between Toe Joints 31 30 $14,643.53 $13,179.18 $1,125.63 $9,620.04 $5,372.84 2026-05-09
28300 OTHER Incision Or Partial Removal Of Heel Bone 62 30 $4,810.03 $8,658.04 $1,125.63 $9,620.04 $5,372.84 2026-05-09
29887 OTHER Repair Of Knee Joint With Bone Graft And Internal Stabilizing Device Using An En… 31 30 $25,173.48 $22,656.13 $1,125.63 $9,620.04 $5,372.84 2026-05-09
29806 OTHER Repair Of Shoulder Joint Capsule Using An Endoscope 31 30 $16,690.37 $15,021.33 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27705 OTHER Incision Or Partial Removal Of Shin Bone 62 30 $8,805.04 $7,924.54 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27784 OTHER Treatment Of Broken Upper Or Middle Part Of Outer Lower Leg Bone 31 30 $9,620.04 $8,658.04 $1,125.63 $9,620.04 $5,372.84 2026-05-09
28304 OTHER Incision Or Partial Removal Of Foot Bone 31 30 $10,196.64 $9,176.98 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27690 OTHER Transfer Of Tendon And Muscle Rerouting At Lower Leg Or Ankle 31 30 $1,396.79 $1,257.11 $1,125.63 $9,620.04 $5,372.84 2026-05-09
25405 OTHER Repair Non-healed Fracture Of Forearm Bone With Patient-derived Bone Graft 31 30 $15,321.13 $13,789.02 $1,125.63 $9,620.04 $5,372.84 2026-05-09
24665 OTHER Treatment Of Broken Forearm Bone On Thumb Side At Elbow 62 30 $10,499.91 $9,449.92 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27393 OTHER Lengthening Of Hamstring Tendon 31 30 $14,385.78 $12,947.20 $1,125.63 $9,620.04 $5,372.84 2026-05-09
20900 OTHER Harvest Of Graft From Small Bone 31 30 $9,620.04 $8,658.04 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27691 OTHER Transfer Of Deep Tendon Of Foot With Muscle Rerouting 62 30 $8,340.99 $7,506.89 $1,125.63 $9,620.04 $5,372.84 2026-05-09
28305 OTHER Incision Or Partial Removal Of Foot Bone With Bone Graft 61 30 $5,837.87 $10,508.16 $1,125.63 $9,620.04 $5,372.84 2026-05-09
25607 OTHER Treatment Of Broken Forearm Bone On Thumb Side Of Wrist; Above Wrist; With Place… 31 30 $18,677.46 $16,809.71 $1,125.63 $9,620.04 $5,372.84 2026-05-09
25360 OTHER Incision Or Partial Removal Of Forearm Bone On Small Finger Side 31 30 $16,115.83 $14,504.25 $1,125.63 $9,620.04 $5,372.84 2026-05-09
25608 OTHER Treatment Of 2 Broken Lower Forearm Bone Pieces On Thumb Side Inside Wrist Joint… 31 30 $18,237.96 $16,414.16 $1,125.63 $9,620.04 $5,372.84 2026-05-09
24538 OTHER Placement Of Stabilizing Device To Upper Arm Broken At Elbow 100 30 $6,095.71 $5,486.14 $1,125.63 $9,620.04 $5,372.84 2026-05-09
20983 OTHER Ablate Bone Tumor(s) Perq 31 30 $10,899.50 $9,809.55 $1,125.63 $9,620.04 $5,372.84 2026-05-09
25652 OTHER Treatment Of Broken Base Of Forearm Bone On Small Finger Side At Wrist 30 29 $0.01 — $1,125.63 $9,620.04 $5,372.84 2026-05-09
28238 OTHER Reconstruction Of Ankle Tendon With Removal Of Extra Ankle Joint Bone 35 30 $10,550.59 $9,495.53 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27524 OTHER Treatment Of Broken Kneecap With Placement Of Stabilizing Device And/or Removal … 31 30 $4,580.47 $4,122.42 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27477 OTHER Removal Of Growth Plate Of Both Lower Leg Bones 31 30 $13,883.54 $12,495.19 $1,125.63 $9,620.04 $5,372.84 2026-05-09
27405 OTHER Primary Repair Of Torn Ligament Or Joint Capsule At Outside Part Of Knee 30 29 $0.01 — $1,125.63 $9,620.04 $5,372.84 2026-05-09
24116 OTHER Removal Of Cyst Or Growth Of Upper Arm Bone And Donor Bone Graft 31 30 $10,203.53 $9,183.18 $1,125.63 $9,620.04 $5,372.84 2026-05-09
24341 OTHER Repair Of Tendon Or Muscle Of Upper Arm Or Elbow 62 30 $10,774.11 $9,696.70 $1,125.63 $9,620.04 $5,372.84 2026-05-09
24582 OTHER Placement Of Stabilizing Device For Broken Elbow With Manipulation 62 30 $7,987.86 $7,189.08 $1,125.63 $9,620.04 $5,372.84 2026-05-09
24685 OTHER Treatment Of Broken Forearm Bone On Small Finger Side At Elbow 31 30 $8,444.63 $7,600.17 $1,125.63 $9,620.04 $5,372.84 2026-05-09
25515 OTHER Treatment Of Broken Midpart Of Forearm Bone On Thumb Side 62 30 $6,275.49 $5,647.93 $1,125.63 $9,620.04 $5,372.84 2026-05-09
25575 OTHER Treatment Of Broken Midpart Of Both Forearm Bones With Placement Of Stabilizing … 62 30 $8,534.70 $7,681.23 $1,125.63 $9,620.04 $5,372.84 2026-05-09
L5321 HCPCS Ak Open End Sach 31 30 $6,308.21 $5,677.39 $5,364.98 $5,364.98 $5,364.98 2026-05-09
92986 OTHER Revision Of Aortic Valve 31 30 $8,372.16 $7,534.94 $3,121.33 $7,585.06 $5,353.19 2026-05-09
28306 OTHER Incision Or Partial Removal Of Big Toe Bone To Straighten Toe 62 30 $9,443.61 $8,499.25 $947.50 $9,620.04 $5,328.30 2026-05-09
42210 OTHER Repair Of Cleft Palate With Bone Graft 36 30 $136.08 $122.47 $947.50 $7,765.79 $5,264.18 2026-05-09
0214U CPT Rare Ds Xom DNA Alys Proband 30 29 $1,876.25 $1,688.63 $5,224.60 $5,224.60 $5,224.60 2026-05-09
75736 OTHER Artery X-rays Pelvis 30 29 $6,026.51 $5,423.86 $5,193.48 $5,193.48 $5,193.48 2026-05-09
75705 OTHER Artery X-rays Spine 30 29 $2,003.66 $1,803.29 $5,193.48 $5,193.48 $5,193.48 2026-05-09
75893 OTHER Venous Sampling By Catheter 30 29 $6,026.51 $5,423.86 $5,193.48 $5,193.48 $5,193.48 2026-05-09
75605 OTHER Contrast Exam Thoracic Aorta 30 29 $4,105.98 $3,695.38 $5,193.48 $5,193.48 $5,193.48 2026-05-09
75726 OTHER Artery X-rays Abdomen 30 29 $6,026.51 $5,423.86 $5,193.48 $5,193.48 $5,193.48 2026-05-09
L5980 HCPCS Flex Foot System 31 30 $7,430.73 $6,687.66 $5,166.71 $5,166.71 $5,166.71 2026-05-09
64910 OTHER Repair Of Nerve With Graft 31 30 $11,957.46 $10,761.71 $1,212.80 $8,985.96 $5,099.38 2026-05-09
31255 OTHER Removal Of Nasal Sinus Using An Endoscope 62 30 $4,449.28 $8,008.69 $1,125.63 $8,998.22 $5,061.93 2026-05-09
31259 OTHER Removal Of Tissue From Sphenoid Sinus Using An Endoscope 30 30 $0.01 — $1,125.63 $8,998.22 $5,061.93 2026-05-09
31292 OTHER Decompression Of Medial Or Inferior Wall Of Eye Socket Using An Endoscope 31 30 $4,499.11 $4,049.20 $1,125.63 $8,998.22 $5,061.93 2026-05-09
31276 OTHER Exploration Of Nasal Sinus Using An Endoscope 93 30 $0.01 $8,098.40 $1,125.63 $8,998.22 $5,061.93 2026-05-09
31257 OTHER Exam Of Nose And Sinus With Removal Of Nasal Sinus Using An Endoscope 62 30 $8,102.06 $7,291.86 $1,125.63 $8,998.22 $5,061.93 2026-05-09
31254 OTHER Partial Removal Of Nasal Sinus Using An Endoscope 31 30 $5,778.92 $5,201.03 $1,125.63 $8,998.22 $5,061.93 2026-05-09
31267 OTHER Removal Of Nasal Sinus Tissue Using An Endoscope 124 30 $3,602.96 $7,291.86 $1,125.63 $8,998.22 $5,061.93 2026-05-09
81425 OTHER Test For Detecting Genes Associated With Disease; Genome Sequence Analysis 61 30 $5,500.00 $4,950.00 $3,125.00 $5,031.20 $5,031.20 2026-05-09
54660 OTHER Insertion Of Testicular Implant 31 30 $9,654.34 $8,688.91 $5,004.31 $5,004.31 $5,004.31 2026-05-09
54344 OTHER Repair Of Complication Of Urinary Outlet Of Penis At Underside Of Penis With Mob… 31 30 $7,792.20 $7,012.98 $1,125.63 $8,835.30 $4,980.47 2026-05-09
31561 OTHER Removal Of Voice Box Cartilage Using An Endoscope With Operating Microscope Or T… 31 30 $8,998.22 $8,098.40 $947.50 $8,998.22 $4,972.86 2026-05-09
81455 OTHER So/hl 51/>gsap Dna/dna&rna 42 29 $6,983.75 $6,285.38 $2,455.16 $6,983.75 $4,951.68 2026-05-09
L2005 HCPCS Kafo Sng/dbl Mechanical Act 31 30 $8,052.03 $7,246.83 $4,915.21 $4,915.21 $4,915.21 2026-05-09
L6881 HCPCS Term Dev Auto Grasp Feature 31 30 $8,997.13 $8,097.42 $4,913.43 $4,913.43 $4,913.43 2026-05-09
L5200 HCPCS Kne Sing Axis Fric Shin Sach 31 30 $8,091.18 $7,282.06 $4,913.09 $4,913.09 $4,913.09 2026-05-09
19318 OTHER Breast Reduction 93 30 $8,643.48 $7,779.13 $1,125.63 $9,827.99 $4,884.56 2026-05-09
L5312 HCPCS Knee Disart, Sach Ft, Endo 31 30 $6,987.94 $6,289.15 $4,823.95 $4,823.95 $4,823.95 2026-05-09
81415 OTHER Test For Detecting Exome; Sequence Analysis 57 30 $519.02 $467.12 $415.22 $4,780.00 $4,780.00 2026-05-09
42820 OTHER Removal Of Tonsils And Adenoid Glands (younger Than 12 Years) 63 30 $2,169.82 $1,952.84 $1,375.77 $7,765.79 $4,696.76 2026-05-09
42825 OTHER Removal Of Tonsils (younger Than 12 Years) 31 30 $3,514.74 $3,163.27 $1,375.77 $7,765.79 $4,570.78 2026-05-09
30600 OTHER Repair Of Abnormal Drainage Tract Between Mouth And Nasal Cavity 31 30 $15,410.21 $13,869.19 $1,375.77 $7,765.79 $4,570.78 2026-05-09
30460 OTHER Revision Of Congenital Nasal Defect To Lengthen Tip Of Nose 31 30 $10,806.67 $9,726.00 $1,375.77 $8,645.35 $4,570.78 2026-05-09
42220 OTHER Repair Of Cleft Palate With Palate Lengthening 31 30 $8,260.08 $7,434.07 $1,212.80 $7,765.79 $4,489.30 2026-05-09
42200 OTHER Repair Of Defect Of Soft And/or Hard Tissue Of Roof Of Mouth For Cleft Palate 62 30 $8,608.90 $7,748.01 $1,125.63 $7,765.79 $4,489.30 2026-05-09
37248 OTHER Trluml Balo Angiop 1st Vein 31 30 $8,291.65 $7,462.49 $1,375.77 $7,585.06 $4,480.41 2026-05-09
37246 OTHER Trluml Balo Angiop 1st Art 31 30 $8,372.16 $7,534.94 $1,375.77 $7,585.06 $4,480.41 2026-05-09
37220 OTHER Iliac Revasc 31 30 $6,054.96 $5,449.46 $1,375.77 $7,585.06 $4,480.41 2026-05-09
37183 OTHER Revision Tips 31 30 $8,593.88 $7,734.49 $1,375.77 $7,585.06 $4,480.41 2026-05-09
L5828 HCPCS Endo Knee-shin Fluid Swg/sta 31 30 $4,494.93 $4,045.44 $4,478.35 $4,478.35 $4,478.35 2026-05-09
49592 OTHER Repair Of Anterior Abdominal Hernia(s) (ie; Epigastric; Incisional; Ventral; Umb… 31 30 $8,450.36 $7,605.32 $1,375.77 $7,580.33 $4,478.05 2026-05-09
49491 OTHER Repair Of Groin Hernia In Preterm Infant Younger Than 37 Weeks Gestation Perform… 31 30 $4,164.63 $3,748.17 $1,375.77 $7,580.33 $4,478.05 2026-05-09
44970 OTHER Removal Of Appendix Using An Endoscope 35 30 $7,580.33 $6,822.30 $1,375.77 $7,580.33 $4,478.05 2026-05-09
L5700 HCPCS Replace Socket Below Knee 31 30 $6,350.33 $5,715.30 $4,470.21 $4,470.21 $4,470.21 2026-05-09
69642 OTHER Repair Of Eardrum; Ear Canal; And Bones With Removal Of Middle Ear Bone 62 30 $8,512.08 $7,660.88 $1,125.63 $7,765.79 $4,445.71 2026-05-09
69635 OTHER Repair Of Eardrum And Ear Canal With Incision Of Middle Ear Bone 31 30 $7,580.38 $6,822.34 $1,125.63 $7,765.79 $4,445.71 2026-05-09
69641 OTHER Complex Repair Of Eardrum And Ear Canal With Removal Of Mastoid Bone 61 30 $3,882.90 $6,989.21 $1,125.63 $7,765.79 $4,445.71 2026-05-09
69631 OTHER Repair Of Eardrum And Ear Canal With Opening To Ear Bones 154 30 $0.01 $5,810.32 $1,125.63 $7,765.79 $4,445.71 2026-05-09
69633 OTHER Repair Of Eardrum; Ear Canal; And Bones With Insertion Of Prosthesis 62 30 $6,347.80 $5,713.02 $1,125.63 $7,765.79 $4,445.71 2026-05-09
42870 OTHER Removal Or Destruction Of Growth Of Tongue Lymph Node 31 30 $12,521.48 $11,269.33 $1,125.63 $7,765.79 $4,445.71 2026-05-09
42215 OTHER Revision Of Prior Cleft Palate Repair 31 30 $6,172.21 $5,554.99 $1,125.63 $7,765.79 $4,445.71 2026-05-09
42410 OTHER Removal Of Growth Of Saliva Gland Or Saliva Gland; Lateral Lobe 31 30 $10,031.74 $9,028.57 $1,125.63 $8,025.39 $4,445.71 2026-05-09
42415 OTHER Removal Of Growth Of Saliva Gland With Release Of Facial Nerve 31 30 $14,367.97 $12,931.17 $1,125.63 $7,765.79 $4,445.71 2026-05-09
42815 OTHER Removal Of Congenital Cyst Or Abnormal Drainage Tract Of Neck And/or Throat 31 30 $5,775.76 $5,198.18 $1,125.63 $7,765.79 $4,445.71 2026-05-09
21048 OTHER Removal Of Growth Or Cyst Of Upper Jaw Bone Through Mouth 31 30 $9,453.02 $8,507.72 $1,125.63 $7,765.79 $4,445.71 2026-05-09
21235 OTHER Obtaining Ear Cartilage For Grafting 121 30 $7,486.06 $6,737.45 $947.50 $7,765.79 $4,445.71 2026-05-09
37191 OTHER Ins Endovas Vena Cava Filtr 31 30 $10,059.96 $9,053.96 $1,375.77 $7,475.04 $4,425.40 2026-05-09
81529 OTHER Onc Cutan Mlnma Mrna 31 Gene 30 29 $1,605.72 $1,445.15 $1,605.72 $7,193.00 $4,399.36 2026-05-09
92920 OTHER Prq Trluml C Angiop 1art&/br 31 30 $9,209.38 $8,288.44 $1,212.80 $7,585.06 $4,398.93 2026-05-09
60240 OTHER Removal Of Thyroid 31 30 $10,955.43 $9,859.89 $1,212.80 $9,859.89 $4,396.56 2026-05-09
60280 OTHER Removal Of Cyst Of Thyroid Or Drainage Of Thyroid Gland Duct 31 30 $9,883.15 $8,894.84 $1,212.80 $7,580.33 $4,396.56 2026-05-09
L6250 HCPCS Elbow Inter Loc Elbow Forarm 31 30 $7,322.57 $6,590.31 $4,383.37 $4,383.37 $4,383.37 2026-05-09
30462 OTHER Revision Of Congenital Nasal Defect With Lengthening Of Tip Of Nose 31 30 $7,237.77 $6,513.99 $947.50 $7,765.79 $4,356.65 2026-05-09
36902 OTHER Intro Cath Dialysis Circuit 31 30 $2,163.48 $1,947.13 $1,125.63 $7,585.06 $4,355.35 2026-05-09
58661 OTHER Removal Of Ovaries And/or Tubes Using An Endoscope 31 30 $8,617.49 $7,755.74 $1,125.63 $7,580.33 $4,352.98 2026-05-09
54692 OTHER Removal Of Congenital Malpositioned Testicle Using An Endoscope 62 30 $5,178.40 $4,660.56 $1,125.63 $7,580.33 $4,352.98 2026-05-09
58662 OTHER Destruction Or Removal Of Ovary Or Growth Of Pelvis Using An Endoscope 93 30 $4,590.45 $8,532.30 $1,125.63 $7,580.33 $4,352.98 2026-05-09
54690 OTHER Removal Of Testicles Using An Endoscope 31 30 $3,372.70 $3,035.43 $1,125.63 $7,580.33 $4,352.98 2026-05-09
49651 OTHER Repair Of Recurrent Groin Hernia Using An Endoscope 62 30 $3,814.24 $3,432.81 $1,125.63 $7,580.33 $4,352.98 2026-05-09
49650 OTHER Repair Of Groin Hernia Using An Endoscope 155 30 $5,642.12 $5,571.98 $1,125.63 $7,580.33 $4,352.98 2026-05-09
51500 OTHER Repair Of Congenital Defect Of Bladder 62 30 $4,594.86 $4,135.37 $1,125.63 $7,580.33 $4,352.98 2026-05-09
47562 OTHER Removal Of Gallbladder Using An Endoscope 62 30 $7,670.68 $6,903.61 $1,125.63 $7,580.33 $4,352.98 2026-05-09
47539 OTHER Perq Plmt Bile Duct Stent 31 30 $4,592.97 $4,133.67 $1,125.63 $7,580.33 $4,352.98 2026-05-09
44238 OTHER Other Procedure On Bowel Using An Endoscope 30 30 $13,632.08 $12,268.87 $1,125.63 $7,580.33 $4,352.98 2026-05-09
49320 OTHER Diagnostic Exam Of Abdomen Using An Endoscope 35 30 $6,955.12 $6,259.61 $267.53 $7,580.33 $4,352.98 2026-05-09
43653 OTHER Creation Of Surgical Opening From Stomach To Skin Using An Endoscope 93 30 $7,580.33 $6,822.30 $1,125.63 $7,580.33 $4,352.98 2026-05-09
44180 OTHER Release Of Small Bowel Scar Tissue Using An Endoscope 31 30 $7,580.33 $6,822.30 $1,125.63 $7,580.33 $4,352.98 2026-05-09
49322 OTHER Aspiration Of Abdominal Cavity Or Cyst Using An Endoscope 31 30 $4,034.45 $3,631.01 $1,125.63 $7,580.33 $4,352.98 2026-05-09
10223020104 OTHER Cetacaine 23 23 $213.24 $191.92 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10019095616 OTHER cycloPHOSphamide 23 23 $1,897.82 $1,708.04 $4,272.00 $4,272.00 $4,272.00 2026-05-09
115168301 OTHER Dexmethylphenidate HCl 23 23 $1,993.85 $1,794.47 $4,272.00 $4,272.00 $4,272.00 2026-05-09
Q5104 HCPCS Injection, Renflexis 23 23 $2,903.89 $2,613.50 $4,272.00 $4,272.00 $4,272.00 2026-05-09
S0028 HCPCS Injection, Famotidine, 20 Mg 23 23 $60.64 $54.58 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10019093901 OTHER cycloPHOSphamide Novaplus 23 23 $586.91 $528.22 $4,272.00 $4,272.00 $4,272.00 2026-05-09
115191101 OTHER riMANTAdine HCl 23 23 $713.14 $641.83 $4,272.00 $4,272.00 $4,272.00 2026-05-09
108058980041501YN1080SUPPOSITORY [44] OTHER Bisacodyl 10 Mg Rect Supp 23 23 $6.84 $6.16 $4,272.00 $4,272.00 $4,272.00 2026-05-09
P9041 HCPCS Albumin (human),5%, 50ml 23 23 $49.22 $44.30 $4,272.00 $4,272.00 $4,272.00 2026-05-09
1134951645085110YN11349ORAL SOLIDS [42] OTHER Sennosides 8.6 Mg Oral Tab 23 23 $43.21 $38.89 $4,272.00 $4,272.00 $4,272.00 2026-05-09
Q2009 HCPCS Fosphenytoin Inj Pe 23 23 $28.40 $25.56 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10100030174 OTHER Hc Base Dly Care- Lev E-4k Hem (3gold) 23 23 $6,845.82 $6,161.24 $4,272.00 $4,272.00 $4,272.00 2026-05-09
115148801 OTHER Mixed Amphetamine Salt 23 23 $1,344.51 $1,210.06 $4,272.00 $4,272.00 $4,272.00 2026-05-09
115169449 OTHER EPINEPHrine 23 23 $1,591.71 $1,432.54 $4,272.00 $4,272.00 $4,272.00 2026-05-09
1157363323056301YN11573INJ [19] OTHER Tranexamic Acid 1,000 Mg/10 Ml (100 Mg/ml) IV Soln 23 23 $778.87 $700.98 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2001 HCPCS Lidocaine Injection 23 23 $8.93 $8.04 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1951 HCPCS Inj Fensolvi 0.25 Mg 24 24 $86,710.39 $78,039.35 $4,272.00 $4,272.00 $4,272.00 2026-05-09
100679854010011YN1006ACH CAM ORAL [51] OTHER Beta Carotene 7,500 Mcg (25,000 Unit) Oral Cap 23 23 $12.40 $11.16 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10100020 OTHER Hc Base Dly Care- Lev F- Med/surg(brn) 23 23 $4,793.00 $4,313.70 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1950 HCPCS Leuprolide Acetate /3.75 Mg 23 23 $5,373.82 $4,836.44 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1644 HCPCS Inj Heparin Sodium Per 1000u 23 23 $274.68 $247.21 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10006070028 OTHER Magnesium Oxide 23 23 $20.88 $18.79 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1953 HCPCS Levetiracetam Injection 23 23 $336.85 $303.17 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1642 HCPCS Inj Heparin Sodium Per 10 U 23 23 $7.43 $6.69 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2002 HCPCS Inj, Lidocaine In D5w, 1 Mg 23 23 $45.00 $40.50 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2250 HCPCS Inj Midazolam Hydrochloride 23 23 $33.91 $30.52 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2260 HCPCS Inj Milrinone Lactate / 5 Mg 23 23 $45.00 $40.50 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2274 HCPCS Inj Morphine Pf Epid Ithc 23 23 $122.07 $109.86 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2312 HCPCS Inj Naloxone Hcl Nos, 0.01mg 23 23 $86.79 $78.11 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2371 HCPCS Inj Phenylephrine Hcl 20 Mcg 23 23 $162.23 $146.01 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2440 HCPCS Papaverin Hcl Injection 23 23 $154.87 $139.38 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2543 HCPCS Piperacillin/tazobactam 23 23 $50.43 $45.39 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2545 HCPCS Pentamidine Non-comp Unit 23 23 $381.40 $343.26 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2597 HCPCS Inj Desmopressin Acetate 23 23 $257.83 $232.05 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2690 HCPCS Procainamide Hcl Injection 23 23 $757.24 $681.52 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2710 HCPCS Neostigmine Methylslfte Inj 23 23 $68.47 $61.62 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2783 HCPCS Rasburicase 23 23 $4,261.73 $3,835.56 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2795 HCPCS Ropivacaine Hcl Injection 23 23 $98.04 $88.24 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J2997 HCPCS Alteplase Recombinant 23 23 $33,804.15 $30,423.74 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J3230 HCPCS Chlorpromazine Hcl Injection 23 23 $129.12 $116.21 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J3316 HCPCS Inj., Triptorelin Xr 3.75 Mg 24 24 $71,959.29 $64,763.36 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1580 HCPCS Garamycin Gentamicin Inj 23 23 $39.79 $35.81 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10006073038 OTHER Magnesium Oxide 23 23 $13.78 $12.40 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10100031174 OTHER Hc Base Dly Care- Lev F-4k Hem (3gold) 23 23 $9,308.10 $8,377.29 $4,272.00 $4,272.00 $4,272.00 2026-05-09
1114400713052606YN11144SUPPOSITORY [44] OTHER Promethazine 25 Mg Rect Supp 23 23 $50.12 $45.11 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1569 HCPCS Gammagard Liquid Injection 23 23 $681.27 $613.14 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1566 HCPCS Immune Globulin, Powder 23 23 $8,291.07 $7,461.96 $4,272.00 $4,272.00 $4,272.00 2026-05-09
1037568084045711NN10375ACH CAM ORAL [51] OTHER Labetalol 300 Mg Oral Tab 23 23 $90.50 $81.45 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1308 HCPCS Inj, Famotidine, 0.25 Mg 23 23 $97.27 $87.54 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1265 HCPCS Dopamine Injection 23 23 $45.00 $40.50 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10100027174 OTHER Hc Base Dly Care- Lev B-4k Hem (3gold) 23 23 $2,832.90 $2,549.61 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10702017001 OTHER Desmopressin Acetate 23 23 $1,669.29 $1,502.36 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1250 HCPCS Inj Dobutamine Hcl/250 Mg 23 23 $45.00 $40.50 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1190 HCPCS Dexrazoxane Hcl Injection 23 23 $2,117.15 $1,905.44 $4,272.00 $4,272.00 $4,272.00 2026-05-09
00019-0862-07 OTHER Cysto-conray Ii 23 23 $41.36 $37.22 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1171 HCPCS Inj, Hydromorphone, 0.1 Mg 23 23 $26.81 $24.13 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1120 HCPCS Acetazolamid Sodium Injectio 23 23 $199.90 $179.91 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10100019 OTHER Hc Base Dly Care- Lev E- Med/surg(brn) 23 23 $3,894.00 $3,504.60 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10702001801 OTHER oxyCODONE HCl 23 23 $59.60 $53.64 $4,272.00 $4,272.00 $4,272.00 2026-05-09
113006510 OTHER Good Sense Nasal Spray 23 23 $7.33 $6.60 $4,272.00 $4,272.00 $4,272.00 2026-05-09
113095828 OTHER Good Sense Children's Cough Dm 23 23 $30.05 $27.05 $4,272.00 $4,272.00 $4,272.00 2026-05-09
116400530 OTHER Lactulose 23 23 $7.33 $6.60 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1100 HCPCS Dexamethasone Sodium Phos 23 23 $8.75 $7.88 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1050 HCPCS Medroxyprogesterone Acetate 23 23 $118.59 $106.73 $4,272.00 $4,272.00 $4,272.00 2026-05-09
Q9958 HCPCS High Osmolar Contrast Material; Up To 149 Mg/ml Iodine Concentration; Per Ml 23 23 $41.36 $37.22 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J1030 HCPCS Methylprednisolone 40 Mg Inj 23 23 $9.09 $8.18 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J0895 HCPCS Deferoxamine Mesylate Inj 23 23 $133.95 $120.56 $4,272.00 $4,272.00 $4,272.00 2026-05-09
103 OTHER Headaches Without Comorbity 24 24 — — $4,272.00 $13,856.40 $4,272.00 2026-05-09
J0840 HCPCS Crotalidae Poly Immune Fab 23 23 $12,291.19 $11,062.07 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J0739 HCPCS HIV Prep, Inj, Cabotegravir 23 23 $5,661.76 $5,095.58 $4,272.00 $4,272.00 $4,272.00 2026-05-09
Q9963 HCPCS High Osmolar Contrast Material; 350-399 Mg/ml Iodine Concentration; Per Ml 23 23 $36.56 $32.90 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J0714 HCPCS Ceftazidime And Avibactam 23 23 $541.69 $487.52 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J0713 HCPCS Inj Ceftazidime Per 500 Mg 23 23 $27.00 $24.30 $4,272.00 $4,272.00 $4,272.00 2026-05-09
00019-4816-04 OTHER Md-gastroview 23 23 $36.56 $32.90 $4,272.00 $4,272.00 $4,272.00 2026-05-09
113006134 OTHER GoodSense Tussin Mucus + Chest Congestion 23 23 $13.16 $11.84 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J0706 HCPCS Caffeine Citrate Injection 23 23 $49.27 $44.34 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J0698 HCPCS Cefotaxime Sodium Injection 23 23 $86.25 $77.63 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10019092501 OTHER Ifosfamide 23 23 $236.09 $212.48 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J0696 HCPCS Ceftriaxone Sodium Injection 23 23 $87.67 $78.90 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10019055390 OTHER Transderm Scop 23 23 $31.06 $27.95 $4,272.00 $4,272.00 $4,272.00 2026-05-09
1.01E+13 OTHER Hc Base Dly Care- Lev G-4k Hem (3gold) 23 23 $9,308.00 $8,377.20 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10420863323049603YN104208ACH CAM OUTPATIENT INJECTION [78] OTHER Lidocaine (pf) 20 Mg/ml (2 %) Inj Soln 23 23 $15.49 $13.94 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J0612 HCPCS Inj, Calcium Gluconate, Nos 23 23 $32.50 $29.25 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J0583 HCPCS Bivalirudin 23 23 $365.60 $329.04 $4,272.00 $4,272.00 $4,272.00 2026-05-09
10122032510 OTHER Cardene 23 23 $800.80 $720.72 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J0567 HCPCS Inj., Cerliponase Alfa 1 Mg 24 24 $53,943.67 $48,549.30 $4,272.00 $4,272.00 $4,272.00 2026-05-09
J0476 HCPCS Baclofen Intrathecal Trial 23 23 $137.48 $123.73 $4,272.00 $4,272.00 $4,272.00 2026-05-09
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