Hospital

DONALSONVILLE HOSPITAL INC

Donalsonville, GA · CCN 110194 · Rates published

1,922 distinct procedures filed

7 distinct payers

25,482 rate rows

2026-07-15 last MRF observed

Data quality

25,437 of 25,482 rate rows are consumer-grade (99.8%)

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

Excluded — reason	Rows
percent-of-charges filed in the dollar field — excluded from medians	23
exceeds 10× this hospital's gross charge — excluded from medians	12
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	5
placeholder amount (≤ $0.02) — excluded from medians	4
per-diem day rate — not a per-procedure price	1

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

Source MRF file	https://donalsonvillehospital.org/wp-content/uploads/2025/08/standardcharges.csv
Found on page	https://donalsonvillehospital.org/billing/hospital-pricing-transparency/
Discovered via	Discovered by HANK
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-09-21
Content fingerprint	403b967a476cd671… · 12,973,657 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
J0129 HCPCS	Orencia (abatacept)250mg/ns 100ml	7	$130.00	$34,663.85	$24,256.08	nat. median $122 outlier · 198.7×
C1781 HCPCS	V-patch 31201	7	$130.00	$64,017.84	$12,113.28	nat. median $1,566 outlier · 7.7×
J2997 HCPCS	Tpa-activase (alteplase) 100mg Inj	7	$130.00	$15,002.50	$9,903.80	nat. median $428 outlier · 23.1×
J3101 HCPCS	Tnkase (tenecteplase) 50mg Kit	7	$130.00	$9,955.20	$6,993.66	nat. median $498 outlier · 14.0×
C1776 HCPCS	Hip Joint 51mm	7	$130.00	$10,442.25	$5,578.20	nat. median $3,543 1.6× median
S0122 HCPCS	Repronex (menotropins) 75u Inj	7	$130.00	$7,716.30	$5,429.48	nat. median $262 outlier · 20.8×
36475 HCPCS	Endovenous Radio Frequency Ablation 1st	7	$130.00	$7,285.35	$5,128.40	nat. median $3,662 1.4× median
36478 HCPCS	Laser Ablation 1st Vein	7	$130.00	$7,285.35	$5,128.40	nat. median $3,367 1.5× median
J1745 HCPCS	Remicade (infliximab) 100mg/20ml Inj	7	$130.00	$7,268.35	$5,116.52	nat. median $190 outlier · 26.9×
278 RC	Uriglow Stent R57412	7	$130.00	$22,809.75	$4,924.64	—
72158 HCPCS	MRI Lumbar Spine W & Without	7	$130.00	$5,893.05	$4,733.31	nat. median $616 outlier · 7.7×
J0139 HCPCS	Humira (adalimumab) 40mg/0.8ml Syringe	7	$130.00	$9,582.05	$4,650.86	nat. median $7,034 0.7× median
70543 HCPCS	MRI Soft Tissue Neck W Without Contrast	7	$130.00	$5,951.70	$4,196.66	nat. median $605 outlier · 6.9×
14300 HCPCS	Adjacent Tissue Transfer More Than 30sqc	7	$130.00	$5,688.20	$4,012.57	nat. median $3,124 1.3× median
26121 HCPCS	Release Of Palmar Contractive	7	$130.00	$5,585.35	$3,940.71	nat. median $3,494 1.1× median
73720 HCPCS	MRI Lower Extremity Non Joint W&without	7	$130.00	$5,585.35	$3,940.71	nat. median $754 outlier · 5.2×
72197 HCPCS	MRI Pelvis W & Without Contrast	7	$130.00	$5,440.85	$3,839.76	nat. median $606 outlier · 6.3×
J2799 HCPCS	Uzedy (risperidone) 100mg Syringe	7	$130.00	$5,436.60	$3,836.79	nat. median $3,164 1.2× median
J3380 HCPCS	Entyvio (vedolizumab) 300mg Inj	7	$130.00	$5,392.40	$3,805.91	nat. median $59 outlier · 64.7×
14061 HCPCS	Adjacent Tissue Defect 10.1 To 30.0 Sqcm	7	$130.00	$5,338.85	$3,768.50	nat. median $2,265 1.7× median
J1162 HCPCS	Digibind (digoxin Immune Fab) Inj	7	$130.00	$5,303.15	$3,743.56	nat. median $6,265 0.6× median
C1726 HCPCS	X-view Round Oms-xb1	7	$130.00	$5,032.00	$3,554.12	nat. median $819 outlier · 4.3×
70553 HCPCS	MRI Brain W & Without	7	$130.00	$5,999.30	$3,510.76	nat. median $616 outlier · 5.7×
90675 HCPCS	Rabies Vaccine	7	$130.00	$4,794.85	$3,388.44	nat. median $550 outlier · 6.2×
73723 HCPCS	MRI Lower Extremity W& Without Contrast	7	$130.00	$4,660.55	$3,294.61	nat. median $756 outlier · 4.4×
72156 HCPCS	MRI Cervical W & Without	7	$130.00	$4,648.65	$3,286.30	nat. median $625 outlier · 5.3×
14060 HCPCS	Adjacent Tissue Transfer 1osqcm Eyelids	7	$130.00	$4,618.05	$3,264.92	nat. median $2,256 1.4× median
71552 HCPCS	MRI Chest W & Without Contrast	7	$130.00	$4,601.05	$3,253.04	nat. median $691 outlier · 4.7×
72148 HCPCS	MRI L Spine Without Contrast	7	$130.00	$4,326.50	$3,248.38	nat. median $408 outlier · 8.0×
74183 HCPCS	MRI Abdomen W & Without Contrast	7	$130.00	$4,438.70	$3,186.25	nat. median $611 outlier · 5.2×
J1944 HCPCS	Aristada (aripoprazole) 882mg Inj	7	$130.00	$4,431.90	$3,134.87	nat. median $894 outlier · 3.5×
J0630 HCPCS	Miacalcin (calcitonin Sal)400iu/2ml Inj	7	$130.00	$4,431.90	$3,134.87	nat. median $1,663 1.9× median
14040 HCPCS	Adjacent Tissue Transfer Forehead Cks 10	7	$130.00	$3,746.80	$3,072.63	nat. median $2,206 1.4× median
81420 HCPCS	Maternit21 Plus Core	7	$130.00	$3,995.00	$3,060.50	nat. median $789 outlier · 3.9×
J0840 HCPCS	Crofab (antivenin Crotalidae Po) 1gm Inj	7	$130.00	$4,280.60	$3,029.16	nat. median $3,496 0.9× median
72146 HCPCS	MRI Thoracic Spine Without Sc	7	$130.00	$4,254.25	$3,010.75	nat. median $421 outlier · 7.2×
72195 HCPCS	MRI Pelvis Without	7	$130.00	$4,181.15	$2,959.68	nat. median $437 outlier · 6.8×
81162 HCPCS	Brcassure Brca1 And Brca2 Comp Analysis	7	$130.00	$4,154.80	$2,941.28	nat. median $1,880 1.6× median
14041 HCPCS	Adjacent Tissue Defect 10.1 To 30.0 Sqcm	7	$130.00	$4,122.50	$2,918.71	nat. median $2,416 1.2× median
36558 HCPCS	Insertion Of Central Line	7	$130.00	$4,056.20	$2,872.39	nat. median $3,467 0.8× median
C9003 HCPCS	Synagis (palivizumab)100mg Inj	7	$130.00	$4,039.20	$2,860.51	nat. median $200 outlier · 14.3×
73220 HCPCS	MRI Upper Extremity Oth/ Thn Joinc-/c+	7	$130.00	$3,998.40	$2,832.01	nat. median $737 outlier · 3.8×
71275 HCPCS	CT Angiography Chest W & W/0	7	$130.00	$4,317.15	$2,825.96	nat. median $365 outlier · 7.7×
88233 HCPCS	Chromosome Study Tissue	7	$130.00	$3,405.95	$2,779.22	nat. median $177 outlier · 15.7×
74181 HCPCS	MRI Abdomen Wo	7	$130.00	$4,312.05	$2,727.95	nat. median $428 outlier · 6.4×
J2426 HCPCS	Invega Sustenna (paliperidone) 234mg Inj	7	$130.00	$3,825.00	$2,717.56	nat. median $2,528 1.1× median
70552 HCPCS	MRI Brain W Contrast	7	$130.00	$3,794.40	$2,689.49	nat. median $597 outlier · 4.5×
36570 HCPCS	Ins Pr Picc Line < 5years W Sub Port	7	$130.00	$3,756.15	$2,662.76	nat. median $3,414 0.8× median
36571 HCPCS	Ins Pr Picc Line > 5years W Sub Port	7	$130.00	$3,756.15	$2,662.76	nat. median $3,733 0.7× median
27786 HCPCS	Treatment Of Ankle Fracture	7	$130.00	$3,721.30	$2,638.42	nat. median $402 outlier · 6.6×

Other procedures at this hospital

Browse this hospital's 1,922 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

J0129	HCPCS	Orencia (abatacept)250mg/ns 100ml	7	7	$40,781.00	$34,663.85	$130.00	$34,663.85	$24,256.08	2026-07-15
C1781	HCPCS	V-patch 31201	277	7	$75,315.11	$64,017.84	$130.00	$64,017.84	$12,113.28	2026-07-15
J2997	HCPCS	Tpa-activase (alteplase) 100mg Inj	12	7	$17,650.00	$15,002.50	$130.00	$15,002.50	$9,903.80	2026-07-15
J3101	HCPCS	Tnkase (tenecteplase) 50mg Kit	7	7	$11,712.00	$9,955.20	$130.00	$9,955.20	$6,993.66	2026-07-15
C1776	HCPCS	Hip Joint 51mm	12	7	$12,285.00	$10,442.25	$130.00	$10,442.25	$5,578.20	2026-07-15
S0122	HCPCS	Repronex (menotropins) 75u Inj	7	7	$9,078.00	$7,716.30	$130.00	$7,716.30	$5,429.48	2026-07-15
36475	HCPCS	Endovenous Radio Frequency Ablation 1st	7	7	$8,571.00	$7,285.35	$130.00	$7,285.35	$5,128.40	2026-07-15
36478	HCPCS	Laser Ablation 1st Vein	7	7	$8,571.00	$7,285.35	$130.00	$7,285.35	$5,128.40	2026-07-15
J1745	HCPCS	Remicade (infliximab) 100mg/20ml Inj	7	7	$8,551.00	$7,268.35	$130.00	$7,268.35	$5,116.52	2026-07-15
278	RC	Uriglow Stent R57412	76	7	$26,835.00	$22,809.75	$130.00	$22,809.75	$4,924.64	2026-07-15
72158	HCPCS	MRI Lumbar Spine W & Without	12	7	$6,933.00	$5,893.05	$130.00	$5,893.05	$4,733.31	2026-07-15
J0139	HCPCS	Humira (adalimumab) 40mg/0.8ml Syringe	12	7	$11,273.00	$9,582.05	$130.00	$9,582.05	$4,650.86	2026-07-15
70543	HCPCS	MRI Soft Tissue Neck W Without Contrast	7	7	$7,002.00	$5,951.70	$130.00	$5,951.70	$4,196.66	2026-07-15
14300	HCPCS	Adjacent Tissue Transfer More Than 30sqc	7	7	$6,692.00	$5,688.20	$130.00	$5,688.20	$4,012.57	2026-07-15
73720	HCPCS	MRI Lower Extremity Non Joint W&without	7	7	$6,571.00	$5,585.35	$130.00	$5,585.35	$3,940.71	2026-07-15
26121	HCPCS	Release Of Palmar Contractive	7	7	$6,571.00	$5,585.35	$130.00	$5,585.35	$3,940.71	2026-07-15
72197	HCPCS	MRI Pelvis W & Without Contrast	7	7	$6,401.00	$5,440.85	$130.00	$5,440.85	$3,839.76	2026-07-15
J2799	HCPCS	Uzedy (risperidone) 100mg Syringe	7	7	$6,396.00	$5,436.60	$130.00	$5,436.60	$3,836.79	2026-07-15
J3380	HCPCS	Entyvio (vedolizumab) 300mg Inj	7	7	$6,344.00	$5,392.40	$130.00	$5,392.40	$3,805.91	2026-07-15
14061	HCPCS	Adjacent Tissue Defect 10.1 To 30.0 Sqcm	7	7	$6,281.00	$5,338.85	$130.00	$5,338.85	$3,768.50	2026-07-15
J1162	HCPCS	Digibind (digoxin Immune Fab) Inj	7	7	$6,239.00	$5,303.15	$130.00	$5,303.15	$3,743.56	2026-07-15
C1726	HCPCS	X-view Round Oms-xb1	7	7	$5,920.00	$5,032.00	$130.00	$5,032.00	$3,554.12	2026-07-15
70553	HCPCS	MRI Brain W & Without	7	7	$7,058.00	$5,999.30	$130.00	$5,999.30	$3,510.76	2026-07-15
90675	HCPCS	Rabies Vaccine	7	7	$5,641.00	$4,794.85	$130.00	$4,794.85	$3,388.44	2026-07-15
73723	HCPCS	MRI Lower Extremity W& Without Contrast	7	7	$5,483.00	$4,660.55	$130.00	$4,660.55	$3,294.61	2026-07-15
72156	HCPCS	MRI Cervical W & Without	7	7	$5,469.00	$4,648.65	$130.00	$4,648.65	$3,286.30	2026-07-15
14060	HCPCS	Adjacent Tissue Transfer 1osqcm Eyelids	7	7	$5,433.00	$4,618.05	$130.00	$4,618.05	$3,264.92	2026-07-15
71552	HCPCS	MRI Chest W & Without Contrast	7	7	$5,413.00	$4,601.05	$130.00	$4,601.05	$3,253.04	2026-07-15
72148	HCPCS	MRI L Spine Without Contrast	16	7	$5,090.00	$4,326.50	$130.00	$4,326.50	$3,248.38	2026-07-15
74183	HCPCS	MRI Abdomen W & Without Contrast	12	7	$5,222.00	$4,438.70	$130.00	$4,438.70	$3,186.25	2026-07-15
J0630	HCPCS	Miacalcin (calcitonin Sal)400iu/2ml Inj	7	7	$5,214.00	$4,431.90	$130.00	$4,431.90	$3,134.87	2026-07-15
J1944	HCPCS	Aristada (aripoprazole) 882mg Inj	7	7	$5,214.00	$4,431.90	$130.00	$4,431.90	$3,134.87	2026-07-15
14040	HCPCS	Adjacent Tissue Transfer Forehead Cks 10	12	7	$4,408.00	$3,746.80	$130.00	$3,746.80	$3,072.63	2026-07-15
81420	HCPCS	Maternit21 Plus Core	12	7	$4,700.00	$3,995.00	$130.00	$3,995.00	$3,060.50	2026-07-15
J0840	HCPCS	Crofab (antivenin Crotalidae Po) 1gm Inj	7	7	$5,036.00	$4,280.60	$130.00	$4,280.60	$3,029.16	2026-07-15
72146	HCPCS	MRI Thoracic Spine Without Sc	7	7	$5,005.00	$4,254.25	$130.00	$4,254.25	$3,010.75	2026-07-15
72195	HCPCS	MRI Pelvis Without	7	7	$4,919.00	$4,181.15	$130.00	$4,181.15	$2,959.68	2026-07-15
81162	HCPCS	Brcassure Brca1 And Brca2 Comp Analysis	7	7	$4,888.00	$4,154.80	$130.00	$4,154.80	$2,941.28	2026-07-15
14041	HCPCS	Adjacent Tissue Defect 10.1 To 30.0 Sqcm	7	7	$4,850.00	$4,122.50	$130.00	$4,122.50	$2,918.71	2026-07-15
36558	HCPCS	Insertion Of Central Line	7	7	$4,772.00	$4,056.20	$130.00	$4,056.20	$2,872.39	2026-07-15
C9003	HCPCS	Synagis (palivizumab)100mg Inj	7	7	$4,752.00	$4,039.20	$130.00	$4,039.20	$2,860.51	2026-07-15
73220	HCPCS	MRI Upper Extremity Oth/ Thn Joinc-/c+	7	7	$4,704.00	$3,998.40	$130.00	$3,998.40	$2,832.01	2026-07-15
71275	HCPCS	CT Angiography Chest W & W/0	11	7	$5,079.00	$4,317.15	$130.00	$4,317.15	$2,825.96	2026-07-15
88233	HCPCS	Chromosome Study Tissue	12	7	$4,007.00	$3,405.95	$130.00	$3,405.95	$2,779.22	2026-07-15
74181	HCPCS	MRI Abdomen Wo	12	7	$5,073.00	$4,312.05	$130.00	$4,312.05	$2,727.95	2026-07-15
J2426	HCPCS	Invega Sustenna (paliperidone) 234mg Inj	12	7	$4,500.00	$3,825.00	$130.00	$3,825.00	$2,717.56	2026-07-15
70552	HCPCS	MRI Brain W Contrast	7	7	$4,464.00	$3,794.40	$130.00	$3,794.40	$2,689.49	2026-07-15
36570	HCPCS	Ins Pr Picc Line < 5years W Sub Port	7	7	$4,419.00	$3,756.15	$130.00	$3,756.15	$2,662.76	2026-07-15
36571	HCPCS	Ins Pr Picc Line > 5years W Sub Port	7	7	$4,419.00	$3,756.15	$130.00	$3,756.15	$2,662.76	2026-07-15
27786	HCPCS	Treatment Of Ankle Fracture	7	7	$4,378.00	$3,721.30	$130.00	$3,721.30	$2,638.42	2026-07-15
J1573	HCPCS	Immune Globulin-hepatitis B 5ml	27	7	$9,962.00	$8,467.70	$130.00	$8,467.70	$2,616.99	2026-07-15
72196	HCPCS	MRI Pelvis W Contrast	7	7	$4,337.00	$3,686.45	$130.00	$3,686.45	$2,614.07	2026-07-15
70551	HCPCS	MRI Brain Without Contrast	10	7	$4,850.00	$4,122.50	$130.00	$4,122.50	$2,569.85	2026-07-15
81408	HCPCS	Marfan Syndrome Fbn1(full Gene Sequence)	7	7	$4,230.00	$3,595.50	$130.00	$3,595.50	$2,550.53	2026-07-15
72142	HCPCS	MRI Spinal Canal Cervical W	7	7	$4,223.00	$3,589.55	$130.00	$3,589.55	$2,546.37	2026-07-15
73718	HCPCS	MRI Tib/fib Femur Without Contrast	12	7	$3,880.00	$3,298.00	$130.00	$3,298.00	$2,442.51	2026-07-15
73223	HCPCS	MRI Upper Extremity Any Joint W & Without	7	7	$4,004.00	$3,403.40	$130.00	$3,403.40	$2,416.32	2026-07-15
Q4081	HCPCS	Epogen (epoetin) 10mu/ml Inj	7	7	$3,942.00	$3,350.70	$130.00	$3,350.70	$2,379.50	2026-07-15
J0401	HCPCS	Abilify Maintena(aripiprazole) 400mg Inj	7	7	$3,911.00	$3,324.35	$130.00	$3,324.35	$2,361.09	2026-07-15
71550	HCPCS	MRI Chest Without Contrast	7	7	$3,857.00	$3,278.45	$130.00	$3,278.45	$2,329.02	2026-07-15
72191	HCPCS	CTA Pelvis W Contrast	12	7	$3,569.00	$3,033.65	$130.00	$3,033.65	$2,325.77	2026-07-15
J2212	HCPCS	Relistor(methylnaltr Bro)12mg/0.6ml Inj	7	7	$3,808.00	$3,236.80	$130.00	$3,236.80	$2,299.93	2026-07-15
78226	HCPCS	Nm Hepatobiliary Includin Gall Bladder	7	7	$3,806.00	$3,235.10	$130.00	$3,235.10	$2,298.74	2026-07-15
81229	HCPCS	Snp Microarray-pediatric (reveal)	12	7	$3,966.00	$3,371.10	$130.00	$3,371.10	$2,276.58	2026-07-15
36476	HCPCS	Endovenous Radio Frequency Ablation 2nd	7	7	$3,761.00	$3,196.85	$130.00	$3,196.85	$2,272.01	2026-07-15
36479	HCPCS	Laser Ablation 2nd Vein	7	7	$3,761.00	$3,196.85	$130.00	$3,196.85	$2,272.01	2026-07-15
J2993	HCPCS	Retavase Kit	12	7	$6,175.00	$5,248.75	$130.00	$5,248.75	$2,256.49	2026-07-15
72157	HCPCS	MRI T Spine W & Without Contrast	7	7	$3,729.00	$3,169.65	$130.00	$3,169.65	$2,253.01	2026-07-15
70491	HCPCS	CT Neck W Contrast Soft Tissue	7	7	$3,713.00	$3,156.05	$130.00	$3,156.05	$2,243.51	2026-07-15
J1459	HCPCS	Privigen (immune Globulin) 40gm/400ml	17	7	$4,640.00	$3,944.00	$130.00	$3,944.00	$2,220.26	2026-07-15
J9218	HCPCS	Lupron(leuprolide Acetate) 1mg/0.2ml Inj	7	7	$3,673.00	$3,122.05	$130.00	$3,122.05	$2,219.76	2026-07-15
73221	HCPCS	MRI Any Joint Upper Extre Wo	12	7	$4,322.00	$3,673.70	$130.00	$3,673.70	$2,198.64	2026-07-15
74178	HCPCS	CT Urogram	12	7	$3,254.00	$2,765.90	$130.00	$2,765.90	$2,197.60	2026-07-15
31603	HCPCS	Tracheostomy Emergency	7	7	$3,598.00	$3,058.30	$130.00	$3,058.30	$2,175.22	2026-07-15
C1751	HCPCS	Power Port 08fr 1708000 Discontinued	37	7	$3,743.75	$3,182.19	$130.00	$3,182.19	$2,168.86	2026-07-15
72147	HCPCS	MRI T Spine W Contrast	7	7	$3,545.00	$3,013.25	$130.00	$3,013.25	$2,143.74	2026-07-15
36572	HCPCS	US Ins Picc < 5 W Image	12	7	$3,305.00	$2,809.25	$130.00	$2,809.25	$2,124.16	2026-07-15
74174	HCPCS	CTA Abd&plvis W/wo	7	7	$3,510.00	$2,983.50	$130.00	$2,983.50	$2,122.96	2026-07-15
73219	HCPCS	MRI Upper Extremity Other Than Joint W	7	7	$3,504.00	$2,978.40	$130.00	$2,978.40	$2,119.40	2026-07-15
15240	HCPCS	Skin Full Graft	7	7	$3,466.00	$2,946.10	$130.00	$2,946.10	$2,096.83	2026-07-15
J2941	HCPCS	Genotropin (somatropin) 1.4mg Injection	7	7	$3,397.00	$2,887.45	$130.00	$2,887.45	$2,055.86	2026-07-15
14350	HCPCS	Filleted Finger Or Toe Flap	7	7	$3,394.00	$2,884.90	$130.00	$2,884.90	$2,054.07	2026-07-15
70547	HCPCS	MRA Neck Wo Contrast	7	7	$3,352.00	$2,849.20	$130.00	$2,849.20	$2,029.13	2026-07-15
14000	HCPCS	Adjacent Tissue Transter Truck 10sqcm	7	7	$3,289.00	$2,795.65	$130.00	$2,795.65	$1,991.72	2026-07-15
81443	HCPCS	Geneseq Neuro Malignant Hyperthermia Pan	12	7	$3,120.00	$2,652.00	$130.00	$2,652.00	$1,985.60	2026-07-15
71270	HCPCS	CT Chest W & Without Contrast	17	7	$4,013.00	$3,411.05	$112.02	$3,411.05	$1,976.72	2026-07-15
C1729	HCPCS	Pleurx 50-9000b	72	7	$17,590.00	$14,951.50	$69.63	$14,951.50	$1,960.61	2026-07-15
72141	HCPCS	MRI C Spine	15	7	$4,974.00	$4,227.90	$130.00	$4,227.90	$1,949.51	2026-07-15
25260	HCPCS	Repair Forearm Tendon	7	7	$3,202.00	$2,721.70	$130.00	$2,721.70	$1,940.06	2026-07-15
72128	HCPCS	CT T Spine Without Contrast	7	7	$3,183.00	$2,705.55	$130.00	$2,705.55	$1,928.77	2026-07-15
74175	HCPCS	CT Abdomen W/wo	12	7	$3,762.00	$3,197.70	$130.00	$3,197.70	$1,912.85	2026-07-15
70549	HCPCS	MRA Neck W/wo	7	7	$3,155.00	$2,681.75	$130.00	$2,681.75	$1,912.15	2026-07-15
73721	HCPCS	MRI Knee	11	7	$4,905.00	$4,169.25	$114.75	$4,169.25	$1,907.30	2026-07-15
37765	HCPCS	Phlebectomy 10 - 20 Incisions	7	7	$3,135.00	$2,664.75	$130.00	$2,664.75	$1,900.27	2026-07-15
74182	HCPCS	MRI Abdomen W	12	7	$3,378.00	$2,871.30	$130.00	$2,871.30	$1,899.51	2026-07-15
72149	HCPCS	MRI Lumbar W/con	17	7	$4,263.00	$3,623.55	$130.00	$3,623.55	$1,892.84	2026-07-15
27825	HCPCS	Tx Lower Leg Fracture	7	7	$3,119.00	$2,651.15	$130.00	$2,651.15	$1,890.77	2026-07-15
J1952	HCPCS	Lupron Depot(leuprolide Ac) 11.25mg Inj.	7	7	$3,092.00	$2,628.20	$130.00	$2,628.20	$1,874.73	2026-07-15
14020	HCPCS	Skin Tissue Rearrangement	12	7	$3,039.00	$2,583.15	$130.00	$2,583.15	$1,833.87	2026-07-15
J0875	HCPCS	Dalvance (dalbavancin) 500mg Vial	7	7	$3,012.00	$2,560.20	$130.00	$2,560.20	$1,827.23	2026-07-15
37766	HCPCS	Phlebectomy 20 + Incisions	7	7	$3,009.00	$2,557.65	$130.00	$2,557.65	$1,825.44	2026-07-15
J9280	HCPCS	Mutamycin 20mg Vial	7	7	$2,980.00	$2,533.00	$130.00	$2,533.00	$1,808.22	2026-07-15
70544	HCPCS	MRA Brain Without Contrast	7	7	$2,963.00	$2,518.55	$130.00	$2,518.55	$1,798.13	2026-07-15
21931	HCPCS	Exc Tumor Soft Tis Back/flank 3 Cm >	7	7	$2,938.00	$2,497.30	$130.00	$2,497.30	$1,783.28	2026-07-15
87900	HCPCS	HIV-1 Phenosense Gt Plus Integrase	7	7	$2,897.00	$2,462.45	$130.00	$2,462.45	$1,758.93	2026-07-15
73706	HCPCS	CT Angiography Lower Extremity Lt	12	7	$2,548.00	$2,165.80	$130.00	$2,165.80	$1,756.27	2026-07-15
73206	HCPCS	CT Angiography Upper Extremity Rt	7	7	$2,856.00	$2,427.60	$130.00	$2,427.60	$1,734.59	2026-07-15
J7169	HCPCS	Andexxa 200mg Inj	7	7	$2,839.00	$2,413.15	$130.00	$2,413.15	$1,724.49	2026-07-15
14021	HCPCS	Adjacent Tissue Defect 10.1 To 30.0 Sqc	7	7	$2,817.00	$2,394.45	$130.00	$2,394.45	$1,711.43	2026-07-15
11646	HCPCS	Excision Lesion 4.0 Cm Face Ear Eyelid	7	7	$2,814.00	$2,391.90	$130.00	$2,391.90	$1,709.65	2026-07-15
J2802	HCPCS	Nplate (romiplostim) 250mcg Inj	7	7	$2,812.00	$2,390.20	$130.00	$2,390.20	$1,708.46	2026-07-15
70498	HCPCS	CT Angiography Neck W & W/0	12	7	$3,158.00	$2,684.30	$130.00	$2,684.30	$1,703.62	2026-07-15
27752	HCPCS	Tr Of Tibia Fx	7	7	$2,798.00	$2,378.30	$130.00	$2,378.30	$1,700.14	2026-07-15
34421	HCPCS	Excision Thrombolitic Mass	7	7	$2,782.00	$2,364.70	$130.00	$2,364.70	$1,690.64	2026-07-15
J1327	HCPCS	Integrilin (eptifibatide)2mg/ml 10ml Inj	7	7	$2,763.00	$2,348.55	$130.00	$2,348.55	$1,679.36	2026-07-15
70486	HCPCS	CT Sinus Without Contrast	7	7	$2,759.00	$2,345.15	$130.00	$2,345.15	$1,665.79	2026-07-15
23605	HCPCS	Treatment Humerus Fx	7	7	$2,726.00	$2,317.10	$130.00	$2,317.10	$1,657.39	2026-07-15
23655	HCPCS	Treatment Shoulder Dislocation	12	7	$2,513.00	$2,136.05	$130.00	$2,136.05	$1,633.30	2026-07-15
24075	HCPCS	Ex Tumor Soft Tissue Upperarm/elbow <3	7	7	$2,670.00	$2,269.50	$130.00	$2,269.50	$1,624.13	2026-07-15
J3240	HCPCS	Thyrogen 1.1mg Inj W/diluent	7	7	$2,631.00	$2,236.35	$130.00	$2,236.35	$1,600.97	2026-07-15
70496	HCPCS	CT Angiography Head W & W/0	12	7	$3,161.00	$2,686.85	$130.00	$2,686.85	$1,591.73	2026-07-15
25075	HCPCS	Ex Tumor Soft Tissue Forearm/wrist <3	7	7	$2,599.00	$2,209.15	$130.00	$2,209.15	$1,581.97	2026-07-15
25660	HCPCS	Cl Tx Rdcrpl Dislc 1/> Bones W/manu	7	7	$2,550.00	$2,167.50	$130.00	$2,167.50	$1,552.87	2026-07-15
S0157	HCPCS	Regranex (becaplermin) 0.01% 15gm Gel	7	7	$2,540.00	$2,159.00	$130.00	$2,159.00	$1,546.93	2026-07-15
J2730	HCPCS	Protopam (pralidoxime Chloride) 1gm Inj	7	7	$2,537.00	$2,156.45	$130.00	$2,156.45	$1,545.15	2026-07-15
37799	HCPCS	Phlebectomy Less Than 10	7	7	$2,510.00	$2,133.50	$130.00	$2,133.50	$1,529.12	2026-07-15
J1569	HCPCS	Immune Globulin (human)gammar 5gm/50ml	37	7	$5,073.00	$4,312.05	$130.00	$4,312.05	$1,506.81	2026-07-15
124	RC	Semi Private Room Rate Bhu	7	7	$1,612.00	$1,370.20	$130.00	$4,508.63	$1,475.68	2026-07-15
15120	HCPCS	Skin Split Graft	12	7	$4,113.00	$3,496.05	$52.23	$3,496.05	$1,471.18	2026-07-15
J0897	HCPCS	Prolia (denosumab) 60mg/ml 1ml Injection	7	7	$2,400.00	$2,040.00	$130.00	$2,040.00	$1,463.79	2026-07-15
90375	HCPCS	Rabies Immune Globulin 300i.u. Injection	7	7	$2,388.00	$2,029.80	$130.00	$2,029.80	$1,456.67	2026-07-15
270	RC	Xeroform 5x9	426	7	$29,071.25	$24,710.56	$5.10	$24,710.56	$1,454.98	2026-07-15
88262	HCPCS	Chromosome W/binding CT 15-20 Cell	12	7	$3,951.00	$3,358.35	$130.00	$3,358.35	$1,454.43	2026-07-15
78227	HCPCS	Nm Hidda Hepatobiliary Imaging	7	7	$2,380.00	$2,023.00	$130.00	$2,023.00	$1,451.92	2026-07-15
81404	HCPCS	Vistaseq Men 1 Comprehensive Analysis	7	7	$2,376.00	$2,019.60	$130.00	$2,019.60	$1,449.54	2026-07-15
25565	HCPCS	Closed Tx Radial/ulnar Shaft Fx W/manj	7	7	$2,694.00	$2,289.90	$130.00	$2,005.15	$1,439.45	2026-07-15
73218	HCPCS	MRI Upper Extremity Other Than Joint Without	7	7	$2,354.00	$2,000.90	$130.00	$2,000.90	$1,436.48	2026-07-15
J3262	HCPCS	Actemra (tocilizumab): 80mg Vial	17	7	$3,447.00	$2,929.95	$130.00	$2,929.95	$1,434.61	2026-07-15
360	RC	Recovery Room-first Hour	47	7	$5,481.00	$4,658.85	$130.00	$29,006.35	$1,434.27	2026-07-15
78195	HCPCS	Nm Lymphatics & Lymph Node Img	12	7	$2,116.00	$1,798.60	$130.00	$1,798.60	$1,419.22	2026-07-15
21011	HCPCS	Exc Tumor Soft Tiss Face/scalp Subq <2cm	7	7	$2,323.00	$1,974.55	$130.00	$1,974.55	$1,418.07	2026-07-15
J3358	HCPCS	Stelara(ustekinumab) 5mg/ml 26ml Inj	7	7	$2,321.00	$1,972.85	$130.00	$1,972.85	$1,416.88	2026-07-15
70542	HCPCS	MRI Orbit/face/neck W Contrast	7	7	$2,301.00	$1,955.85	$130.00	$1,955.85	$1,405.00	2026-07-15
272	RC	Xray Sponges	67	7	$10,978.00	$9,331.30	$12.75	$9,331.30	$1,380.46	2026-07-15
11463	HCPCS	Excision With Complex Repair	7	7	$2,244.00	$1,907.40	$130.00	$1,907.40	$1,371.15	2026-07-15
11451	HCPCS	Excision Of Skin With Complex Repair	7	7	$2,244.00	$1,907.40	$130.00	$1,907.40	$1,371.15	2026-07-15
11470	HCPCS	Excision With Simple Or Inter Repair	7	7	$2,244.00	$1,907.40	$130.00	$1,907.40	$1,371.15	2026-07-15
14001	HCPCS	Adjacent Tissue Defect 10.1 To 30.0 Sqcm	7	7	$2,227.00	$1,892.95	$130.00	$1,892.95	$1,361.06	2026-07-15
19125	HCPCS	Exc Breast Local Device 1st Les Without U	7	7	$2,216.00	$1,883.60	$130.00	$1,883.60	$1,354.53	2026-07-15
74177	HCPCS	CT Abd & Pelvis W Contrast	7	7	$2,229.00	$1,894.65	$130.00	$1,894.65	$1,341.30	2026-07-15
26765	HCPCS	Repair Fx Finger Each	7	7	$2,191.00	$1,862.35	$130.00	$1,862.35	$1,339.68	2026-07-15
J1380	HCPCS	Estradiol Valerate 20mg/ml Inj	12	7	$2,802.00	$2,381.70	$130.00	$2,381.70	$1,333.65	2026-07-15
70546	HCPCS	MRA Brain W & Without Contrast	7	7	$2,160.00	$1,836.00	$130.00	$1,836.00	$1,321.27	2026-07-15
36568	HCPCS	Ins Pr Picc Line < 5years Without Sub Port	7	7	$2,124.00	$1,805.40	$130.00	$1,805.40	$1,299.89	2026-07-15
P9034	HCPCS	Platelet Apheresis	7	7	$2,121.00	$1,802.85	$130.00	$1,802.85	$1,298.11	2026-07-15
74170	HCPCS	CT Abdomen W&without Contrast Addtl Sections	12	7	$3,514.00	$2,986.90	$121.10	$2,986.90	$1,295.20	2026-07-15
11406	HCPCS	Excision Lesion Over 4.0 Cm	7	7	$2,104.00	$1,788.40	$130.00	$1,788.40	$1,288.02	2026-07-15
J1742	HCPCS	Corvert (ibutilide Fumarate)0.1mg/ml Inj	7	7	$2,089.00	$1,775.65	$130.00	$1,775.65	$1,279.11	2026-07-15
21552	HCPCS	Exc Tumor Soft Tis Neck/ant Subq 3 Cm/>	7	7	$2,078.00	$1,766.30	$130.00	$1,766.30	$1,272.58	2026-07-15
11644	HCPCS	Excision Lesion 3.1 To 4.0 Cm Face Ear	7	7	$2,076.00	$1,764.60	$130.00	$1,764.60	$1,271.39	2026-07-15
64445	HCPCS	US Inj Aa&strd Sciatic Nerve W/img Gdn	7	7	$2,096.00	$1,781.60	$130.00	$1,781.60	$1,270.55	2026-07-15
21930	HCPCS	Remove Lesion Back/flank	7	7	$2,073.00	$1,762.05	$130.00	$1,762.05	$1,269.61	2026-07-15
11462	HCPCS	Excision Skin With Simple Or Inter Repai	7	7	$2,039.00	$1,733.15	$130.00	$1,733.15	$1,249.42	2026-07-15
11643	HCPCS	Excision Lesion 2.1 To 3.0 Cm Face Ear	7	7	$2,039.00	$1,733.15	$130.00	$1,733.15	$1,249.42	2026-07-15
70481	HCPCS	CT Orbit W Contrast (skull)	7	7	$2,034.00	$1,728.90	$130.00	$1,728.90	$1,246.45	2026-07-15
73719	HCPCS	MRI Tib/fib Femur W Contrast	7	7	$2,034.00	$1,728.90	$130.00	$1,728.90	$1,246.45	2026-07-15
70540	HCPCS	MRI Face Neck Without Contrast	7	7	$2,034.00	$1,728.90	$130.00	$1,728.90	$1,246.45	2026-07-15
J1438	HCPCS	Enbrel Sureclick (etanercept)50mg/ml Inj	7	7	$2,034.00	$1,728.90	$130.00	$1,728.90	$1,246.45	2026-07-15
74176	HCPCS	CT Abd & Pelvis Without Contrast	7	7	$1,967.00	$1,671.95	$130.00	$2,117.92	$1,234.39	2026-07-15
74185	HCPCS	MRA Abdomen W & Without	7	7	$1,970.00	$1,674.50	$130.00	$1,674.50	$1,208.44	2026-07-15
70545	HCPCS	MRA Brain W Contrast	7	7	$1,970.00	$1,674.50	$130.00	$1,674.50	$1,208.44	2026-07-15
72126	HCPCS	CT Cervical Spine W Contrast	7	7	$1,965.00	$1,670.25	$130.00	$1,670.25	$1,205.47	2026-07-15
70482	HCPCS	CT Orbit W & Without Contrast (skull)	7	7	$1,948.00	$1,655.80	$130.00	$1,655.80	$1,195.38	2026-07-15
75635	HCPCS	CTA Abd Aorta Run Off W & Without	7	7	$1,944.00	$1,652.40	$130.00	$1,652.40	$1,193.00	2026-07-15
81406	HCPCS	Notch3 (cadasil) Sequencing Test	17	7	$1,929.00	$1,639.65	$130.00	$1,639.65	$1,186.66	2026-07-15
13152	HCPCS	Repair 2.6 - 7.5 Cm Complex Eyelid/nose/	7	7	$1,925.00	$1,636.25	$130.00	$1,636.25	$1,181.72	2026-07-15
80500	HCPCS	Lupus Anticoag Confirm Consult	7	7	$1,908.00	$1,621.80	$130.00	$1,621.80	$1,171.62	2026-07-15
78264	HCPCS	Nm Gastric Emptying Study	7	7	$1,902.00	$1,616.70	$130.00	$1,616.70	$1,168.06	2026-07-15
11624	HCPCS	Excision Lesion 3.1 To 4.0 Cm	7	7	$1,900.00	$1,615.00	$130.00	$1,615.00	$1,166.87	2026-07-15
72193	HCPCS	CT Pelvis W Contrast	12	7	$3,140.00	$2,669.00	$102.18	$2,669.00	$1,156.99	2026-07-15
70492	HCPCS	CT Neck W & Without Contrast Soft Tissue	7	7	$1,871.00	$1,590.35	$130.00	$1,590.35	$1,149.65	2026-07-15
71260	HCPCS	CT Chest W Contrast	16	7	$3,500.00	$2,975.00	$112.02	$2,975.00	$1,142.28	2026-07-15
J1572	HCPCS	Immune Globulin (human)flgamma20gm/400ml	7	7	$1,858.00	$1,579.30	$130.00	$1,579.30	$1,141.93	2026-07-15
J1568	HCPCS	Octagam (immune Globulin) 10% 5gm/50ml	12	7	$2,545.00	$2,163.25	$130.00	$2,163.25	$1,141.05	2026-07-15
11471	HCPCS	Excision With Complex Repair Perianal Pe	7	7	$1,844.00	$1,567.40	$130.00	$1,567.40	$1,133.62	2026-07-15
J1439	HCPCS	Injectafer (ferr Carbox)50mg/ml 15ml Inj	7	7	$1,837.00	$1,561.45	$130.00	$1,561.45	$1,129.46	2026-07-15
11450	HCPCS	Excision Of Skin And Tissue With Sim Rep	7	7	$1,834.00	$1,558.90	$130.00	$1,558.90	$1,127.68	2026-07-15
49561	HCPCS	Repair Incision Hernia	7	7	$1,834.00	$1,558.90	$130.00	$1,558.90	$1,127.68	2026-07-15
74160	HCPCS	CT Abdomen W Contrast	12	7	$3,343.00	$2,841.55	$121.10	$2,841.55	$1,126.60	2026-07-15
12057	HCPCS	Repair > 30.0 Cm Intermed F/e/e/n/l&muc	7	7	$1,831.00	$1,556.35	$130.00	$1,556.35	$1,125.90	2026-07-15
11606	HCPCS	Exc Lesion Trunk/arm/leg >4.0 Cm	12	7	$2,009.00	$1,707.65	$130.00	$1,707.65	$1,125.46	2026-07-15
73200	HCPCS	CT Shoulder Without Contrast Right,right	22	7	$1,911.00	$1,624.35	$130.00	$1,624.35	$1,122.89	2026-07-15
J1561	HCPCS	Gamunex (immune Globulin) 10% 5gm/50ml	12	7	$2,485.00	$2,112.25	$130.00	$2,112.25	$1,120.27	2026-07-15
27043	HCPCS	Excis Tumor Soft Tiss Pelvis/hip 3cm/>	7	7	$1,820.00	$1,547.00	$130.00	$1,547.00	$1,119.37	2026-07-15
70480	HCPCS	CT Orbit Without Contrast (skull)	7	7	$1,812.00	$1,540.20	$130.00	$1,540.20	$1,114.61	2026-07-15
J1559	HCPCS	Hizentra (immune Globulin) 20% 10gm/50ml	7	7	$1,808.00	$1,536.80	$130.00	$1,536.80	$1,112.24	2026-07-15
25605	HCPCS	Closed Reduction Of Distal Radius/ulna	7	7	$2,227.00	$1,892.95	$130.00	$1,533.40	$1,109.86	2026-07-15
637	RC	Zyvox (linezolid) 600mg Tab	3,607	7	$97,018.00	$82,465.30	$0.76	$82,465.30	$1,098.38	2026-07-15
78070	HCPCS	Nm Parathyroid Imaging	7	7	$1,783.00	$1,515.55	$130.00	$1,515.55	$1,097.39	2026-07-15
72130	HCPCS	CT T Spine Without & W Contrast	7	7	$1,780.00	$1,513.00	$130.00	$1,513.00	$1,095.61	2026-07-15
J0515	HCPCS	Cogentin (benztropine Mes) 2mg/2cc Inj	7	7	$1,778.00	$1,511.30	$130.00	$1,511.30	$1,094.42	2026-07-15
11446	HCPCS	Removal Skin Lesion Ear 3 Cm	12	7	$1,781.00	$1,513.85	$130.00	$1,513.85	$1,089.09	2026-07-15
78315	HCPCS	Nm Bone Imaging, 3 Phase	7	7	$1,766.00	$1,501.10	$130.00	$1,501.10	$1,087.30	2026-07-15
710	RC	Recovery Room	7	7	$1,819.00	$1,546.15	$130.00	$1,546.15	$1,080.96	2026-07-15
70450	HCPCS	CT Head Without Contrast	15	7	$2,589.00	$2,200.65	$119.00	$2,200.65	$1,077.34	2026-07-15
72194	HCPCS	CT Pelvis W & Without Contrast	12	7	$2,850.00	$2,422.50	$130.00	$2,422.50	$1,073.85	2026-07-15
90632	HCPCS	Hepatitis A (havrix) Vaccine 1ml Inj	7	7	$1,737.00	$1,476.45	$130.00	$1,476.45	$1,070.08	2026-07-15
11626	HCPCS	Excision Lesion Over 4.0	7	7	$1,731.00	$1,471.35	$130.00	$1,471.35	$1,066.51	2026-07-15
93307	HCPCS	Echo 2-d/mode W/interp	7	7	$1,725.00	$1,466.25	$130.00	$1,466.25	$1,062.95	2026-07-15
12037	HCPCS	Repair > 30.0 Cm Intermed S/a/t/e	7	7	$1,716.00	$1,458.60	$130.00	$1,458.60	$1,057.61	2026-07-15
J7325	HCPCS	Synvisc(hyaluronate Sodium)8mg/ml Inj	7	7	$1,713.00	$1,456.05	$130.00	$1,456.05	$1,055.82	2026-07-15
12018	HCPCS	Repair > 30.0 Cm Simple Repair F/e/e/n/l	7	7	$1,701.00	$1,445.85	$130.00	$1,445.85	$1,048.70	2026-07-15
84182	HCPCS	Myositis Extended Panel	7	7	$1,686.00	$1,433.10	$130.00	$1,433.10	$1,039.79	2026-07-15
11424	HCPCS	Exc Lesion Mrg S/n/h/f/g 3.1 -4.0 Cm	17	7	$1,487.00	$1,263.95	$130.00	$1,263.95	$1,038.24	2026-07-15
J2794	HCPCS	Risperdal Consta (risperidone) 50mg Inj	17	7	$1,716.00	$1,458.60	$130.00	$1,458.60	$1,025.28	2026-07-15
36573	HCPCS	US Ins Picc > 5 W Image	12	7	$2,644.00	$2,247.40	$130.00	$2,247.40	$1,013.86	2026-07-15
81377	HCPCS	Celiac Hla Dq Association (167652)	17	7	$2,325.00	$1,976.25	$130.00	$1,976.25	$1,013.05	2026-07-15
72125	HCPCS	Tomography C Spine Without Contrast	17	7	$2,238.00	$1,902.30	$117.32	$1,902.30	$1,008.37	2026-07-15
88230	HCPCS	Chromosome Tissue Culture	22	7	$2,884.00	$2,451.40	$130.00	$2,451.40	$1,006.34	2026-07-15
93970	HCPCS	Venous Doppler Bilateral Duplex	17	7	$1,968.00	$1,672.80	$130.00	$1,672.80	$1,001.94	2026-07-15
73702	HCPCS	CT Lower Extremity W & Without Contrast	7	7	$1,606.00	$1,365.10	$130.00	$1,365.10	$992.28	2026-07-15
12056	HCPCS	Repair 20.1 - 30 Cm Intermed F/e/e/n/l&m	7	7	$1,598.00	$1,358.30	$130.00	$1,358.30	$987.53	2026-07-15
36576	HCPCS	Repair Port/pic Line	7	7	$1,598.00	$1,358.30	$130.00	$1,358.30	$987.53	2026-07-15
74740	HCPCS	Hysterosalpingogram	7	7	$1,593.00	$1,354.05	$130.00	$1,354.05	$984.56	2026-07-15
93306	HCPCS	Echo Cardio Trans W Doppler/colorflow	7	7	$1,647.00	$1,399.95	$130.00	$1,399.95	$980.85	2026-07-15
J2430	HCPCS	Aredia (pamidronate) 90mg 10ml Inj	12	7	$2,672.00	$2,271.20	$60.55	$2,271.20	$975.82	2026-07-15
30905	HCPCS	Tx Epistaxis Epistaxis Posterior	7	7	$1,576.00	$1,339.60	$130.00	$1,339.60	$974.47	2026-07-15
87507	HCPCS	Gi Panel Stool Pcr	15	7	$1,640.00	$1,394.00	$130.00	$1,394.00	$968.26	2026-07-15
73201	HCPCS	Tomo Ex Upper With Contrast Lt,left	14	7	$2,006.00	$1,705.10	$130.00	$1,705.10	$968.23	2026-07-15
J2247	HCPCS	Micafungin 100mg/ns 100ml	7	7	$1,560.00	$1,326.00	$130.00	$1,326.00	$964.97	2026-07-15
71250	HCPCS	CT Chest W/0 Contrast	17	7	$2,336.00	$1,985.60	$112.02	$1,985.60	$964.04	2026-07-15
72133	HCPCS	CT L Spine W & Without Contrast	7	7	$1,531.00	$1,301.35	$130.00	$1,301.35	$947.74	2026-07-15
19285	HCPCS	US Breast Local Device 1st Les Without U Pe	7	7	$1,518.00	$1,290.30	$130.00	$1,290.30	$940.02	2026-07-15
Q5101	HCPCS	Neupogen 480mcg/1.6ml Inj	7	7	$1,516.00	$1,288.60	$130.00	$1,288.60	$938.84	2026-07-15
10005	HCPCS	Fine Needle Aspiration Bx W US Gdn 1 Les	12	7	$2,178.00	$1,851.30	$130.00	$1,851.30	$935.98	2026-07-15
23650	HCPCS	Treat Shoulder Dislocation	7	7	$1,479.00	$1,257.15	$130.00	$1,257.15	$916.87	2026-07-15
11604	HCPCS	Excision Mal Lesion 3.1-4.0 Cm Trunk/arm	12	7	$1,395.00	$1,185.75	$130.00	$1,185.75	$904.11	2026-07-15
J2010	HCPCS	Lincocin (lincomycin) 300mg/ml 2ml Inj	12	7	$1,790.00	$1,521.50	$130.00	$1,521.50	$901.68	2026-07-15
49083	HCPCS	US Guided Paracentesis	22	7	$1,881.00	$1,598.85	$113.54	$1,598.85	$893.91	2026-07-15
11426	HCPCS	Lesion Over 4.0 Cm Dia	12	7	$1,259.00	$1,070.15	$130.00	$1,070.15	$891.99	2026-07-15
L4386	HCPCS	Moonboot Sm	15	7	$1,232.00	$1,047.20	$130.00	$1,047.20	$886.81	2026-07-15
47531	HCPCS	Cholangio W/image Exisitng Access	7	7	$1,406.00	$1,195.10	$130.00	$1,195.10	$873.51	2026-07-15
J0725	HCPCS	Novarel (chorionic Gon)10,000 Units Inj	7	7	$1,404.00	$1,193.40	$130.00	$1,193.40	$872.33	2026-07-15
12053	HCPCS	Repair 5.1 - 7.5 Cm Intermed F/e/e/n/l&m	7	7	$1,460.00	$1,241.00	$130.00	$1,193.40	$872.33	2026-07-15
26742	HCPCS	Tx Finger Fracture	7	7	$1,754.00	$1,490.90	$130.00	$1,190.85	$870.55	2026-07-15
72131	HCPCS	CT Lumbar Spine	12	7	$2,307.00	$1,960.95	$115.05	$1,960.95	$868.89	2026-07-15
93975	HCPCS	US Duplex Scan Artl Flo Abd/pel/rpr Org	12	7	$1,628.00	$1,383.80	$130.00	$1,383.80	$867.39	2026-07-15
43762	HCPCS	Replacement Of G Tube Without Image Guidance	7	7	$1,395.00	$1,185.75	$130.00	$1,185.75	$866.98	2026-07-15
J1212	HCPCS	Rimso-50 (dimethyl Sulfo) 50ml Solution	7	7	$1,385.00	$1,177.25	$130.00	$1,177.25	$861.04	2026-07-15
J3424	HCPCS	Cyanide Antidote Kit	7	7	$1,361.00	$1,156.85	$130.00	$1,156.85	$846.79	2026-07-15
70488	HCPCS	CT Maxillo Facial W & Without Contrast	7	7	$1,355.00	$1,151.75	$130.00	$1,151.75	$843.23	2026-07-15
P9045	HCPCS	Albumin 5% 250ml Inj	7	7	$1,354.00	$1,150.90	$130.00	$1,150.90	$842.63	2026-07-15
78582	HCPCS	Nm Pulmonary Scan Perfusion & Ventilatio	7	7	$1,353.00	$1,150.05	$130.00	$1,150.05	$842.04	2026-07-15
11622	HCPCS	Excision Mal Lesion 1.1-2.0 Cm S/n/h/f	12	7	$1,222.00	$1,038.70	$130.00	$1,038.70	$836.91	2026-07-15
13151	HCPCS	Repair 1 2.5 Cm	7	7	$1,344.00	$1,142.40	$130.00	$1,142.40	$836.70	2026-07-15
93268	HCPCS	Event Monitoring	7	7	$1,321.00	$1,122.85	$130.00	$1,122.85	$823.04	2026-07-15
40650	HCPCS	Vermillion Lip	7	7	$1,307.00	$1,110.95	$130.00	$1,110.95	$814.72	2026-07-15
J1071	HCPCS	Testosterone Cypionaye Inj 100mg/ml	12	7	$1,918.00	$1,630.30	$130.00	$1,630.30	$813.70	2026-07-15
J0714	HCPCS	Avycaz (ceftaz/avibac) 2.5gm Inj	7	7	$1,297.00	$1,102.45	$130.00	$1,102.45	$808.79	2026-07-15
93882	HCPCS	US Carotid Unilateral	12	7	$1,610.00	$1,368.50	$130.00	$1,368.50	$806.08	2026-07-15
76830	HCPCS	US Transvaginal Pelvic Non Obstetrical	7	7	$1,291.00	$1,097.35	$130.00	$1,097.35	$799.99	2026-07-15
36569	HCPCS	US Ins Picc Line > 5 Years Without Image	12	7	$1,415.00	$1,202.75	$130.00	$1,202.75	$797.76	2026-07-15
11642	HCPCS	Excision Lesion 1.1 To 2.0 Cm Face Ear	7	7	$1,276.00	$1,084.60	$130.00	$1,084.60	$796.31	2026-07-15
10008	HCPCS	Needle Aspiration Bx W/fluor Ea Addl	7	7	$1,272.00	$1,081.20	$130.00	$1,081.20	$793.94	2026-07-15
12055	HCPCS	Repair 12.6 - 20 Cm Intermediate F/e/e/n	7	7	$1,251.00	$1,063.35	$130.00	$1,063.35	$781.47	2026-07-15
12047	HCPCS	Repair > 30.0 Cm Intermed N/h/f/xtrnl	7	7	$1,251.00	$1,063.35	$130.00	$1,063.35	$781.47	2026-07-15
78761	HCPCS	Nm Testicular Imaging W Vascular Flow	7	7	$1,242.00	$1,055.70	$130.00	$1,055.70	$776.12	2026-07-15
J1756	HCPCS	Venofer (iron Sucrose) 20mg/ml 5ml Inj	7	7	$1,507.00	$1,280.95	$10.98	$1,280.95	$772.11	2026-07-15
70460	HCPCS	CT Head W Contrast	12	7	$2,012.00	$1,710.20	$102.18	$1,710.20	$766.24	2026-07-15
11443	HCPCS	Exc Lesion Mrg F/e/n/l/m/2.1 - 3.0	12	7	$1,185.00	$1,007.25	$130.00	$1,007.25	$762.08	2026-07-15
87633	HCPCS	Respiratory Virus Profile (rvp), Pcr	15	7	$1,850.00	$1,572.50	$130.00	$1,572.50	$757.43	2026-07-15
J2312	HCPCS	Narcan (naloxone) 0.4mg/ml 1ml Inj	12	7	$1,562.00	$1,327.70	$130.00	$1,327.70	$754.81	2026-07-15
81272	HCPCS	C-kit Mutation Analysis	7	7	$1,206.00	$1,025.10	$130.00	$1,025.10	$754.75	2026-07-15
J1950	HCPCS	Lupron Depot(leuprolide Acet) 7.5mg Inj.	7	7	$1,199.00	$1,019.15	$130.00	$1,019.15	$750.59	2026-07-15
36471	HCPCS	Inj Sclerosing Sol Multi Veins Same Leg	7	7	$1,196.00	$1,016.60	$130.00	$1,016.60	$748.81	2026-07-15
94762	HCPCS	Pulse Oximeter Cont	7	7	$1,191.00	$1,012.35	$130.00	$1,012.35	$745.84	2026-07-15
72192	HCPCS	CT Pelvis Without Contrast	12	7	$2,173.00	$1,847.05	$102.18	$1,847.05	$743.23	2026-07-15
84433	HCPCS	Thiopurine Methyltransferase	7	7	$1,185.00	$1,007.25	$130.00	$1,007.25	$742.28	2026-07-15
32555	HCPCS	Thoracentesis Needle/cath Pleura W/imagi	7	7	$1,182.00	$1,004.70	$130.00	$1,004.70	$740.49	2026-07-15
J1335	HCPCS	Invanz 1gm/ns 100ml	7	7	$1,178.00	$1,001.30	$130.00	$1,001.30	$738.12	2026-07-15
86341	HCPCS	Znt8 Antibody	19	7	$4,433.00	$3,768.05	$117.30	$3,768.05	$737.89	2026-07-15
J2597	HCPCS	Desmopressin(ddavp)4mcg/ml 10ml Inj	7	7	$1,173.00	$997.05	$130.00	$997.05	$735.15	2026-07-15
J2690	HCPCS	Pronestyl 500mg Inj	17	7	$2,009.00	$1,707.65	$130.00	$1,707.65	$732.34	2026-07-15
88184	HCPCS	Leukocyte Adhesion Deficiency Eval	17	7	$1,862.00	$1,582.70	$130.00	$1,582.70	$730.62	2026-07-15
93971	HCPCS	Venous Doppler Unilateral Duplex	26	7	$1,349.00	$1,146.65	$130.00	$1,146.65	$728.06	2026-07-15
88342	HCPCS	Lab Pathology	7	7	$1,146.00	$974.10	$130.00	$974.10	$719.12	2026-07-15
75822	HCPCS	Venogram (extremity) Bilateral	7	7	$1,145.00	$973.25	$130.00	$973.25	$718.52	2026-07-15
12046	HCPCS	Repair 20.1 - 30 Cm Intermed N/h/f/xtrnl	7	7	$1,137.00	$966.45	$130.00	$966.45	$713.77	2026-07-15
76770	HCPCS	US Renal Complete	10	7	$1,350.00	$1,147.50	$130.00	$1,147.50	$712.83	2026-07-15
74150	HCPCS	CT Abdomen Without Contrast	12	7	$2,206.00	$1,875.10	$95.09	$1,875.10	$710.88	2026-07-15
12042	HCPCS	Repair Intermediate N/h/f/xtrnl 2.6 - 7.	12	7	$1,098.00	$933.30	$130.00	$933.30	$709.08	2026-07-15
62273	HCPCS	Inj Epidural Blood/clot Patch	7	7	$1,127.00	$957.95	$130.00	$957.95	$707.83	2026-07-15
81401	HCPCS	Spinal Muscular Atrophy (sma) Carrier	12	7	$1,222.00	$1,038.70	$130.00	$1,038.70	$705.62	2026-07-15
78306	HCPCS	Nm Bone Imaging Whole Body	7	7	$1,114.00	$946.90	$130.00	$946.90	$700.11	2026-07-15
11444	HCPCS	Removal Skin Lesion	17	7	$1,565.00	$1,330.25	$80.99	$1,330.25	$698.59	2026-07-15
99204	HCPCS	Office/op New 45 Minutes	12	7	$1,387.00	$1,178.95	$130.00	$1,178.95	$698.34	2026-07-15
25600	HCPCS	Closed Tx Fx Radius	7	7	$1,109.00	$942.65	$130.00	$942.65	$697.14	2026-07-15
11404	HCPCS	Exc Lesmrg T/a/l 3.1 -4.0 Cm	12	7	$990.00	$841.50	$130.00	$841.50	$694.53	2026-07-15
11621	HCPCS	Excision Lesion 0.6 To 1.0cm	7	7	$1,094.00	$929.90	$130.00	$929.90	$688.24	2026-07-15
13132	HCPCS	Repair Of Wound Or Lesion	22	7	$1,730.00	$1,470.50	$59.04	$1,470.50	$687.39	2026-07-15

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