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://www.donalsonvillehospital.org/docs/580973772_donalsonville-hospital_standardcharges.csv
Found on page	https://www.donalsonvillehospital.org/getpage.php
Discovered via	Discovered by HANK
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-10-10

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	$34,663.85	nat. median $122 outlier · 283.9×
J3101 HCPCS	Tnkase (tenecteplase) 50mg Kit	7	$130.00	$9,955.20	$9,955.20	nat. median $498 outlier · 20.0×
J2997 HCPCS	Tpa-activase (alteplase) 100mg Inj	7	$130.00	$15,002.50	$9,243.75	nat. median $428 outlier · 21.6×
C1781 HCPCS	Mesh Vicryl 12x12 Vwml	7	$130.00	$64,017.84	$9,135.80	nat. median $1,566 outlier · 5.8×
S0122 HCPCS	Repronex (menotropins) 75u Inj	7	$130.00	$7,716.30	$7,716.30	nat. median $262 outlier · 29.5×
36478 HCPCS	Laser Ablation 1st Vein	7	$130.00	$7,285.35	$7,285.35	nat. median $3,367 outlier · 2.2×
36475 HCPCS	Endovenous Radio Frequency Ablation 1st	7	$130.00	$7,285.35	$7,285.35	nat. median $3,662 2.0× median
J1745 HCPCS	Remicade (infliximab) 100mg/20ml Inj	7	$130.00	$7,268.35	$7,268.35	nat. median $190 outlier · 38.3×
70553 HCPCS	MRI Brain W & Without	7	$130.00	$5,999.30	$5,999.30	nat. median $616 outlier · 9.7×
70543 HCPCS	MRI Soft Tissue Neck W Without Contrast	7	$130.00	$5,951.70	$5,951.70	nat. median $605 outlier · 9.8×
14300 HCPCS	Adjacent Tissue Transfer More Than 30sqc	7	$130.00	$5,688.20	$5,688.20	nat. median $3,124 1.8× median
72158 HCPCS	MRI Lumbar Spine W & Without	7	$130.00	$5,893.05	$5,666.10	nat. median $616 outlier · 9.2×
26121 HCPCS	Release Of Palmar Contractive	7	$130.00	$5,585.35	$5,585.35	nat. median $3,494 1.6× median
73720 HCPCS	MRI Lower Extremity Non Joint W&without	7	$130.00	$5,585.35	$5,585.35	nat. median $754 outlier · 7.4×
72197 HCPCS	MRI Pelvis W & Without Contrast	7	$130.00	$5,440.85	$5,440.85	nat. median $606 outlier · 9.0×
J2799 HCPCS	Uzedy (risperidone) 100mg Syringe	7	$130.00	$5,436.60	$5,436.60	nat. median $3,164 1.7× median
J3380 HCPCS	Entyvio (vedolizumab) 300mg Inj	7	$130.00	$5,392.40	$5,392.40	nat. median $59 outlier · 91.7×
14061 HCPCS	Adjacent Tissue Defect 10.1 To 30.0 Sqcm	7	$130.00	$5,338.85	$5,338.85	nat. median $2,265 outlier · 2.4×
J1162 HCPCS	Digibind (digoxin Immune Fab) Inj	7	$130.00	$5,303.15	$5,303.15	nat. median $6,265 0.8× median
C1726 HCPCS	X-view Round Oms-xb1	7	$130.00	$5,032.00	$5,032.00	nat. median $819 outlier · 6.1×
90675 HCPCS	Rabies Vaccine	7	$130.00	$4,794.85	$4,794.85	nat. median $550 outlier · 8.7×
73723 HCPCS	MRI Lower Extremity W& Without Contrast	7	$130.00	$4,660.55	$4,660.55	nat. median $756 outlier · 6.2×
72156 HCPCS	MRI Cervical W & Without	7	$130.00	$4,648.65	$4,648.65	nat. median $625 outlier · 7.4×
14060 HCPCS	Adjacent Tissue Transfer 1osqcm Eyelids	7	$130.00	$4,618.05	$4,618.05	nat. median $2,256 outlier · 2.0×
71552 HCPCS	MRI Chest W & Without Contrast	7	$130.00	$4,601.05	$4,601.05	nat. median $691 outlier · 6.7×
J0630 HCPCS	Miacalcin (calcitonin Sal)400iu/2ml Inj	7	$130.00	$4,431.90	$4,431.90	nat. median $1,663 outlier · 2.7×
J1944 HCPCS	Aristada (aripoprazole) 882mg Inj	7	$130.00	$4,431.90	$4,431.90	nat. median $894 outlier · 5.0×
J0840 HCPCS	Crofab (antivenin Crotalidae Po) 1gm Inj	7	$130.00	$4,280.60	$4,280.60	nat. median $3,496 1.2× median
72146 HCPCS	MRI Thoracic Spine Without Sc	7	$130.00	$4,254.25	$4,254.25	nat. median $421 outlier · 10.1×
72195 HCPCS	MRI Pelvis Without	7	$130.00	$4,181.15	$4,181.15	nat. median $437 outlier · 9.6×
81162 HCPCS	Brcassure Brca1 And Brca2 Comp Analysis	7	$130.00	$4,154.80	$4,154.80	nat. median $1,880 outlier · 2.2×
14041 HCPCS	Adjacent Tissue Defect 10.1 To 30.0 Sqcm	7	$130.00	$4,122.50	$4,122.50	nat. median $2,416 1.7× median
36558 HCPCS	Insertion Of Central Line	7	$130.00	$4,056.20	$4,056.20	nat. median $3,467 1.2× median
C9003 HCPCS	Synagis (palivizumab)100mg Inj	7	$130.00	$4,039.20	$4,039.20	nat. median $200 outlier · 20.2×
72148 HCPCS	MRI Basic Lumbar Without Contrast	7	$130.00	$4,326.50	$4,000.10	nat. median $408 outlier · 9.8×
73220 HCPCS	MRI Upper Extremity Oth/ Thn Joinc-/c+	7	$130.00	$3,998.40	$3,998.40	nat. median $737 outlier · 5.4×
70552 HCPCS	MRI Brain W Contrast	7	$130.00	$3,794.40	$3,794.40	nat. median $597 outlier · 6.4×
36571 HCPCS	Ins Pr Picc Line > 5years W Sub Port	7	$130.00	$3,756.15	$3,756.15	nat. median $3,733 1.0× median
36570 HCPCS	Ins Pr Picc Line < 5years W Sub Port	7	$130.00	$3,756.15	$3,756.15	nat. median $3,414 1.1× median
14040 HCPCS	Adjacent Tissue Transfer Forehead Cks 10	7	$130.00	$3,746.80	$3,737.45	nat. median $2,206 1.7× median
27786 HCPCS	Treatment Of Ankle Fracture	7	$130.00	$3,721.30	$3,721.30	nat. median $402 outlier · 9.3×
72196 HCPCS	MRI Pelvis W Contrast	7	$130.00	$3,686.45	$3,686.45	nat. median $562 outlier · 6.6×
81408 HCPCS	Marfan Syndrome Fbn1(full Gene Sequence)	7	$130.00	$3,595.50	$3,595.50	nat. median $2,000 1.8× median
72142 HCPCS	MRI Spinal Canal Cervical W	7	$130.00	$3,589.55	$3,589.55	nat. median $541 outlier · 6.6×
81420 HCPCS	Maternit21 Plus Core	7	$130.00	$3,995.00	$3,459.50	nat. median $789 outlier · 4.4×
73223 HCPCS	MRI Upper Extremity Any Joint W & Without	7	$130.00	$3,403.40	$3,403.40	nat. median $757 outlier · 4.5×
88233 HCPCS	Chromosome Study Tissue	7	$130.00	$3,405.95	$3,358.35	nat. median $177 outlier · 18.9×
Q4081 HCPCS	Epogen (epoetin) 10mu/ml Inj	7	$130.00	$3,350.70	$3,350.70	nat. median $171 outlier · 19.6×
74183 HCPCS	Mrcp Without & W Contrast	7	$130.00	$4,438.70	$3,324.35	nat. median $611 outlier · 5.4×
J0401 HCPCS	Abilify Maintena(aripiprazole) 400mg Inj	7	$130.00	$3,324.35	$3,324.35	nat. median $22 outlier · 148.0×

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	$34,663.85	2026-07-15
J2997	HCPCS	Tpa-activase (alteplase) 100mg Inj	12	7	$17,650.00	$15,002.50	$130.00	$15,002.50	$9,243.75	2026-07-15
C1776	HCPCS	Hip Joint 51mm	12	7	$12,285.00	$10,442.25	$130.00	$10,442.25	$3,190.05	2026-07-15
J3101	HCPCS	Tnkase (tenecteplase) 50mg Kit	7	7	$11,712.00	$9,955.20	$130.00	$9,955.20	$9,955.20	2026-07-15
C1781	HCPCS	Mesh Vicryl 12x12 Vwml	277	7	$11,435.00	$9,719.75	$130.00	$64,017.84	$9,135.80	2026-07-15
S0122	HCPCS	Repronex (menotropins) 75u Inj	7	7	$9,078.00	$7,716.30	$130.00	$7,716.30	$7,716.30	2026-07-15
36478	HCPCS	Laser Ablation 1st Vein	7	7	$8,571.00	$7,285.35	$130.00	$7,285.35	$7,285.35	2026-07-15
36475	HCPCS	Endovenous Radio Frequency Ablation 1st	7	7	$8,571.00	$7,285.35	$130.00	$7,285.35	$7,285.35	2026-07-15
J1745	HCPCS	Remicade (infliximab) 100mg/20ml Inj	7	7	$8,551.00	$7,268.35	$130.00	$7,268.35	$7,268.35	2026-07-15
70553	HCPCS	MRI Brain W & Without	7	7	$7,058.00	$5,999.30	$130.00	$5,999.30	$5,999.30	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	$5,951.70	2026-07-15
14300	HCPCS	Adjacent Tissue Transfer More Than 30sqc	7	7	$6,692.00	$5,688.20	$130.00	$5,688.20	$5,688.20	2026-07-15
72158	HCPCS	MRI Lumbar Spine W & Without	12	7	$6,666.00	$5,666.10	$130.00	$5,893.05	$5,666.10	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	$5,585.35	2026-07-15
26121	HCPCS	Release Of Palmar Contractive	7	7	$6,571.00	$5,585.35	$130.00	$5,585.35	$5,585.35	2026-07-15
72197	HCPCS	MRI Pelvis W & Without Contrast	7	7	$6,401.00	$5,440.85	$130.00	$5,440.85	$5,440.85	2026-07-15
J2799	HCPCS	Uzedy (risperidone) 100mg Syringe	7	7	$6,396.00	$5,436.60	$130.00	$5,436.60	$5,436.60	2026-07-15
J3380	HCPCS	Entyvio (vedolizumab) 300mg Inj	7	7	$6,344.00	$5,392.40	$130.00	$5,392.40	$5,392.40	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	$5,338.85	2026-07-15
J1162	HCPCS	Digibind (digoxin Immune Fab) Inj	7	7	$6,239.00	$5,303.15	$130.00	$5,303.15	$5,303.15	2026-07-15
C1726	HCPCS	X-view Round Oms-xb1	7	7	$5,920.00	$5,032.00	$130.00	$5,032.00	$5,032.00	2026-07-15
90675	HCPCS	Rabies Vaccine	7	7	$5,641.00	$4,794.85	$130.00	$4,794.85	$4,794.85	2026-07-15
73723	HCPCS	MRI Lower Extremity W& Without Contrast	7	7	$5,483.00	$4,660.55	$130.00	$4,660.55	$4,660.55	2026-07-15
72156	HCPCS	MRI Cervical W & Without	7	7	$5,469.00	$4,648.65	$130.00	$4,648.65	$4,648.65	2026-07-15
14060	HCPCS	Adjacent Tissue Transfer 1osqcm Eyelids	7	7	$5,433.00	$4,618.05	$130.00	$4,618.05	$4,618.05	2026-07-15
71552	HCPCS	MRI Chest W & Without Contrast	7	7	$5,413.00	$4,601.05	$130.00	$4,601.05	$4,601.05	2026-07-15
J0630	HCPCS	Miacalcin (calcitonin Sal)400iu/2ml Inj	7	7	$5,214.00	$4,431.90	$130.00	$4,431.90	$4,431.90	2026-07-15
J1944	HCPCS	Aristada (aripoprazole) 882mg Inj	7	7	$5,214.00	$4,431.90	$130.00	$4,431.90	$4,431.90	2026-07-15
74181	HCPCS	MRI Abdomen Wo	12	7	$5,073.00	$4,312.05	$130.00	$4,312.05	$2,326.45	2026-07-15
J0840	HCPCS	Crofab (antivenin Crotalidae Po) 1gm Inj	7	7	$5,036.00	$4,280.60	$130.00	$4,280.60	$4,280.60	2026-07-15
72146	HCPCS	MRI Thoracic Spine Without Sc	7	7	$5,005.00	$4,254.25	$130.00	$4,254.25	$4,254.25	2026-07-15
72195	HCPCS	MRI Pelvis Without	7	7	$4,919.00	$4,181.15	$130.00	$4,181.15	$4,181.15	2026-07-15
81162	HCPCS	Brcassure Brca1 And Brca2 Comp Analysis	7	7	$4,888.00	$4,154.80	$130.00	$4,154.80	$4,154.80	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	$4,122.50	2026-07-15
70551	HCPCS	MRI Brain Without Contrast	10	7	$4,850.00	$4,122.50	$130.00	$4,122.50	$2,702.05	2026-07-15
36558	HCPCS	Insertion Of Central Line	7	7	$4,772.00	$4,056.20	$130.00	$4,056.20	$4,056.20	2026-07-15
C9003	HCPCS	Synagis (palivizumab)100mg Inj	7	7	$4,752.00	$4,039.20	$130.00	$4,039.20	$4,039.20	2026-07-15
72148	HCPCS	MRI Basic Lumbar Without Contrast	16	7	$4,706.00	$4,000.10	$130.00	$4,326.50	$4,000.10	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	$3,998.40	2026-07-15
81420	HCPCS	Maternit21 Plus Core	12	7	$4,700.00	$3,995.00	$130.00	$3,995.00	$3,459.50	2026-07-15
70552	HCPCS	MRI Brain W Contrast	7	7	$4,464.00	$3,794.40	$130.00	$3,794.40	$3,794.40	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	$3,756.15	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	$3,756.15	2026-07-15
14040	HCPCS	Adjacent Tissue Transfer Forehead Cks 10	12	7	$4,397.00	$3,737.45	$130.00	$3,746.80	$3,737.45	2026-07-15
27786	HCPCS	Treatment Of Ankle Fracture	7	7	$4,378.00	$3,721.30	$130.00	$3,721.30	$3,721.30	2026-07-15
72196	HCPCS	MRI Pelvis W Contrast	7	7	$4,337.00	$3,686.45	$130.00	$3,686.45	$3,686.45	2026-07-15
81408	HCPCS	Marfan Syndrome Fbn1(full Gene Sequence)	7	7	$4,230.00	$3,595.50	$130.00	$3,595.50	$3,595.50	2026-07-15
72142	HCPCS	MRI Spinal Canal Cervical W	7	7	$4,223.00	$3,589.55	$130.00	$3,589.55	$3,589.55	2026-07-15
88233	HCPCS	Chromosome Study Tissue	12	7	$4,007.00	$3,405.95	$130.00	$3,405.95	$3,358.35	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	$3,403.40	2026-07-15
Q4081	HCPCS	Epogen (epoetin) 10mu/ml Inj	7	7	$3,942.00	$3,350.70	$130.00	$3,350.70	$3,350.70	2026-07-15
J0401	HCPCS	Abilify Maintena(aripiprazole) 400mg Inj	7	7	$3,911.00	$3,324.35	$130.00	$3,324.35	$3,324.35	2026-07-15
74183	HCPCS	Mrcp Without & W Contrast	12	7	$3,911.00	$3,324.35	$130.00	$4,438.70	$3,324.35	2026-07-15
73718	HCPCS	MRI Tib/fib Femur Without Contrast	12	7	$3,880.00	$3,298.00	$130.00	$3,298.00	$2,640.10	2026-07-15
71270	HCPCS	CT Chest W & Without Contrast	17	7	$3,858.00	$3,279.30	$112.02	$3,411.05	$3,037.44	2026-07-15
71550	HCPCS	MRI Chest Without Contrast	7	7	$3,857.00	$3,278.45	$130.00	$3,278.45	$3,278.45	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	$3,236.80	2026-07-15
78226	HCPCS	Nm Hepatobiliary Includin Gall Bladder	7	7	$3,806.00	$3,235.10	$130.00	$3,235.10	$3,235.10	2026-07-15
74175	HCPCS	CT Abdomen W/wo	12	7	$3,762.00	$3,197.70	$130.00	$3,197.70	$1,440.75	2026-07-15
36479	HCPCS	Laser Ablation 2nd Vein	7	7	$3,761.00	$3,196.85	$130.00	$3,196.85	$3,196.85	2026-07-15
36476	HCPCS	Endovenous Radio Frequency Ablation 2nd	7	7	$3,761.00	$3,196.85	$130.00	$3,196.85	$3,196.85	2026-07-15
72157	HCPCS	MRI T Spine W & Without Contrast	7	7	$3,729.00	$3,169.65	$130.00	$3,169.65	$3,169.65	2026-07-15
J1459	HCPCS	Privigen (immune Globulin) 20gm/200ml	17	7	$3,718.00	$3,160.30	$130.00	$3,944.00	$3,160.30	2026-07-15
70491	HCPCS	CT Neck W Contrast Soft Tissue	7	7	$3,713.00	$3,156.05	$130.00	$3,156.05	$3,156.05	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	$3,122.05	2026-07-15
31603	HCPCS	Tracheostomy Emergency	7	7	$3,598.00	$3,058.30	$130.00	$3,058.30	$3,058.30	2026-07-15
72191	HCPCS	CTA Pelvis W Contrast	12	7	$3,569.00	$3,033.65	$130.00	$3,033.65	$2,618.00	2026-07-15
72147	HCPCS	MRI T Spine W Contrast	7	7	$3,545.00	$3,013.25	$130.00	$3,013.25	$3,013.25	2026-07-15
74174	HCPCS	CTA Abd&plvis W/wo	7	7	$3,510.00	$2,983.50	$130.00	$2,983.50	$2,983.50	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	$2,978.40	2026-07-15
15240	HCPCS	Skin Full Graft	7	7	$3,466.00	$2,946.10	$130.00	$2,946.10	$2,946.10	2026-07-15
J2941	HCPCS	Genotropin (somatropin) 1.4mg Injection	7	7	$3,397.00	$2,887.45	$130.00	$2,887.45	$2,887.45	2026-07-15
14350	HCPCS	Filleted Finger Or Toe Flap	7	7	$3,394.00	$2,884.90	$130.00	$2,884.90	$2,884.90	2026-07-15
70547	HCPCS	MRA Neck Wo Contrast	7	7	$3,352.00	$2,849.20	$130.00	$2,849.20	$2,849.20	2026-07-15
0278	RC	—	76	7	$3,334.00	$2,833.90	$130.00	$22,809.75	$2,833.90	2026-07-15
36572	HCPCS	Ins Picc W/rs&i 5 Yr/>	12	7	$3,305.00	$2,809.25	$130.00	$2,809.25	$2,347.70	2026-07-15
14000	HCPCS	Adjacent Tissue Transter Truck 10sqcm	7	7	$3,289.00	$2,795.65	$130.00	$2,795.65	$2,795.65	2026-07-15
J2426	HCPCS	Invega Sustenna (paliperidone) 117mg Inj	12	7	$3,280.00	$2,788.00	$130.00	$3,825.00	$2,788.00	2026-07-15
74178	HCPCS	CT Urogram	12	7	$3,254.00	$2,765.90	$130.00	$2,765.90	$2,571.25	2026-07-15
72149	HCPCS	MRI Lumbar W/con	17	7	$3,238.00	$2,752.30	$130.00	$3,623.55	$2,752.30	2026-07-15
25260	HCPCS	Repair Forearm Tendon	7	7	$3,202.00	$2,721.70	$130.00	$2,721.70	$2,721.70	2026-07-15
72128	HCPCS	CT T Spine Without Contrast	7	7	$3,183.00	$2,705.55	$130.00	$2,705.55	$2,705.55	2026-07-15
70496	HCPCS	CT Angiography Head W & W/0	12	7	$3,161.00	$2,686.85	$130.00	$2,686.85	$1,163.65	2026-07-15
70498	HCPCS	CT Angiography Neck W & W/0	12	7	$3,158.00	$2,684.30	$130.00	$2,684.30	$1,440.75	2026-07-15
70549	HCPCS	MRA Neck W/wo	7	7	$3,155.00	$2,681.75	$130.00	$2,681.75	$2,681.75	2026-07-15
37765	HCPCS	Phlebectomy 10 - 20 Incisions	7	7	$3,135.00	$2,664.75	$130.00	$2,664.75	$2,664.75	2026-07-15
81443	HCPCS	Geneseq Neuro Malignant Hyperthermia Pan	12	7	$3,120.00	$2,652.00	$130.00	$2,652.00	$2,164.95	2026-07-15
27825	HCPCS	Tx Lower Leg Fracture	7	7	$3,119.00	$2,651.15	$130.00	$2,651.15	$2,651.15	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	$2,628.20	2026-07-15
C1751	HCPCS	Picc 5fr 7918508	37	7	$3,060.00	$2,601.00	$130.00	$3,182.19	$2,489.44	2026-07-15
14020	HCPCS	Adjacent Tissue Transfer 10sqcm Scalp Ar	12	7	$3,039.00	$2,583.15	$130.00	$2,583.15	$1,861.50	2026-07-15
J0875	HCPCS	Dalvance (dalbavancin) 500mg Vial	7	7	$3,012.00	$2,560.20	$130.00	$2,560.20	$2,560.20	2026-07-15
37766	HCPCS	Phlebectomy 20 + Incisions	7	7	$3,009.00	$2,557.65	$130.00	$2,557.65	$2,557.65	2026-07-15
71275	HCPCS	CT Angiography Chest W & W/0	11	7	$3,000.00	$2,550.00	$130.00	$4,317.15	$2,550.00	2026-07-15
J9280	HCPCS	Mutamycin 20mg Vial	7	7	$2,980.00	$2,533.00	$130.00	$2,533.00	$2,533.00	2026-07-15
70544	HCPCS	MRA Brain Without Contrast	7	7	$2,963.00	$2,518.55	$130.00	$2,518.55	$2,518.55	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	$2,497.30	2026-07-15
87900	HCPCS	HIV-1 Phenosense Gt Plus Integrase	7	7	$2,897.00	$2,462.45	$130.00	$2,462.45	$2,462.45	2026-07-15
73206	HCPCS	CT Angiography Upper Extremity Rt	7	7	$2,856.00	$2,427.60	$130.00	$2,427.60	$2,427.60	2026-07-15
J7169	HCPCS	Andexxa 200mg Inj	7	7	$2,839.00	$2,413.15	$130.00	$2,413.15	$2,413.15	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	$2,394.45	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	$2,391.90	2026-07-15
J2802	HCPCS	Nplate (romiplostim) 250mcg Inj	7	7	$2,812.00	$2,390.20	$130.00	$2,390.20	$2,390.20	2026-07-15
27752	HCPCS	Tr Of Tibia Fx	7	7	$2,798.00	$2,378.30	$130.00	$2,378.30	$2,378.30	2026-07-15
34421	HCPCS	Excision Thrombolitic Mass	7	7	$2,782.00	$2,364.70	$130.00	$2,364.70	$2,364.70	2026-07-15
J1327	HCPCS	Integrilin (eptifibatide)2mg/ml 10ml Inj	7	7	$2,763.00	$2,348.55	$130.00	$2,348.55	$2,348.55	2026-07-15
70486	HCPCS	CT Sinus Without Contrast	7	7	$2,759.00	$2,345.15	$130.00	$2,345.15	$2,345.15	2026-07-15
23605	HCPCS	Treatment Humerus Fx	7	7	$2,726.00	$2,317.10	$130.00	$2,317.10	$2,317.10	2026-07-15
24075	HCPCS	Exc Tumor Soft Tiss Up Arm/elbow Subq<3c	7	7	$2,670.00	$2,269.50	$130.00	$2,269.50	$2,269.50	2026-07-15
J3240	HCPCS	Thyrogen 1.1mg Inj W/diluent	7	7	$2,631.00	$2,236.35	$130.00	$2,236.35	$2,236.35	2026-07-15
25075	HCPCS	Exc Tum Soft Tiss Forearm/wrist Subq< 3c	7	7	$2,599.00	$2,209.15	$130.00	$2,209.15	$2,209.15	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	$2,167.50	2026-07-15
81229	HCPCS	Poc/tissue Microarray Test:510110	12	7	$2,541.00	$2,159.85	$130.00	$3,371.10	$2,159.85	2026-07-15
S0157	HCPCS	Regranex (becaplermin) 0.01% 15gm Gel	7	7	$2,540.00	$2,159.00	$130.00	$2,159.00	$2,159.00	2026-07-15
J2730	HCPCS	Protopam (pralidoxime Chloride) 1gm Inj	7	7	$2,537.00	$2,156.45	$130.00	$2,156.45	$2,156.45	2026-07-15
23655	HCPCS	Clsd Tx Shoulder Dislc W/man Req Anes	12	7	$2,513.00	$2,136.05	$130.00	$2,136.05	$1,816.45	2026-07-15
37799	HCPCS	Phlebectomy Less Than 10	7	7	$2,510.00	$2,133.50	$130.00	$2,133.50	$2,133.50	2026-07-15
73706	HCPCS	CT Angiography Lower Extremity	12	7	$2,457.00	$2,088.45	$130.00	$2,165.80	$2,088.45	2026-07-15
J0897	HCPCS	Prolia (denosumab) 60mg/ml 1ml Injection	7	7	$2,400.00	$2,040.00	$130.00	$2,040.00	$2,040.00	2026-07-15
90375	HCPCS	Rabies Immune Globulin 300i.u. Injection	7	7	$2,388.00	$2,029.80	$130.00	$2,029.80	$2,029.80	2026-07-15
78227	HCPCS	Nm Hidda Hepatobiliary Imaging	7	7	$2,380.00	$2,023.00	$130.00	$2,023.00	$2,023.00	2026-07-15
81404	HCPCS	Vistaseq Men 1 Comprehensive Analysis	7	7	$2,376.00	$2,019.60	$130.00	$2,019.60	$2,019.60	2026-07-15
25565	HCPCS	Closed Fx Reduction -radius	7	7	$2,359.00	$2,005.15	$130.00	$2,005.15	$2,005.15	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	$2,000.90	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	$1,974.55	2026-07-15
J3358	HCPCS	Stelara(ustekinumab) 5mg/ml 26ml Inj	7	7	$2,321.00	$1,972.85	$130.00	$1,972.85	$1,972.85	2026-07-15
70542	HCPCS	MRI Orbit/face/neck W Contrast	7	7	$2,301.00	$1,955.85	$130.00	$1,955.85	$1,955.85	2026-07-15
11451	HCPCS	Excision Of Skin With Complex Repair	7	7	$2,244.00	$1,907.40	$130.00	$1,907.40	$1,907.40	2026-07-15
11470	HCPCS	Excision With Simple Or Inter Repair	7	7	$2,244.00	$1,907.40	$130.00	$1,907.40	$1,907.40	2026-07-15
11463	HCPCS	Excision With Complex Repair	7	7	$2,244.00	$1,907.40	$130.00	$1,907.40	$1,907.40	2026-07-15
74177	HCPCS	CT Abd & Pelvis W Contrast	7	7	$2,229.00	$1,894.65	$130.00	$1,894.65	$1,800.12	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	$1,892.95	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	$1,883.60	2026-07-15
26765	HCPCS	Repair Fx Finger Each	7	7	$2,191.00	$1,862.35	$130.00	$1,862.35	$1,862.35	2026-07-15
70546	HCPCS	MRA Brain W & Without Contrast	7	7	$2,160.00	$1,836.00	$130.00	$1,836.00	$1,836.00	2026-07-15
72141	HCPCS	MRI Cervical Wo	15	7	$2,145.00	$1,823.25	$130.00	$4,227.90	$1,823.25	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	$1,805.40	2026-07-15
P9034	HCPCS	Platelet Apheresis	7	7	$2,121.00	$1,802.85	$130.00	$1,802.85	$1,802.85	2026-07-15
11406	HCPCS	Excision Lesion Over 4.0 Cm	7	7	$2,104.00	$1,788.40	$130.00	$1,788.40	$1,788.40	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	$1,692.60	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	$1,775.65	2026-07-15
J0139	HCPCS	Humira (adalimumab) 40mg/0.8ml Syringe	12	7	$2,088.00	$1,774.80	$130.00	$9,582.05	$1,774.80	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	$1,766.30	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	$1,764.60	2026-07-15
21930	HCPCS	Remove Lesion Back/flank	7	7	$2,073.00	$1,762.05	$130.00	$1,762.05	$1,762.05	2026-07-15
74182	HCPCS	MRI Abdomen W	12	7	$2,040.00	$1,734.00	$130.00	$2,871.30	$1,734.00	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	$1,733.15	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	$1,733.15	2026-07-15
J1569	HCPCS	Immune Globulin (human) Gammar 2ml Inj	37	7	$2,039.00	$1,733.15	$130.00	$4,312.05	$1,640.20	2026-07-15
70540	HCPCS	MRI Face Neck Without Contrast	7	7	$2,034.00	$1,728.90	$130.00	$1,728.90	$1,728.90	2026-07-15
70481	HCPCS	CT Orbit W Contrast (skull)	7	7	$2,034.00	$1,728.90	$130.00	$1,728.90	$1,728.90	2026-07-15
J1438	HCPCS	Enbrel Sureclick (etanercept)50mg/ml Inj	7	7	$2,034.00	$1,728.90	$130.00	$1,728.90	$1,728.90	2026-07-15
73719	HCPCS	MRI Tib/fib Femur W Contrast	7	7	$2,034.00	$1,728.90	$130.00	$1,728.90	$1,728.90	2026-07-15
74185	HCPCS	MRA Abdomen W & Without	7	7	$1,970.00	$1,674.50	$130.00	$1,674.50	$1,674.50	2026-07-15
70545	HCPCS	MRA Brain W Contrast	7	7	$1,970.00	$1,674.50	$130.00	$1,674.50	$1,674.50	2026-07-15
74176	HCPCS	CT Abd & Pelvis Without Contrast	7	7	$1,967.00	$1,671.95	$130.00	$2,117.92	$1,588.44	2026-07-15
72126	HCPCS	CT Cervical Spine W Contrast	7	7	$1,965.00	$1,670.25	$130.00	$1,670.25	$1,670.25	2026-07-15
73221	HCPCS	MRI Any Joint Upper Extre Wo	12	7	$1,960.00	$1,666.00	$130.00	$3,673.70	$1,666.00	2026-07-15
70482	HCPCS	CT Orbit W & Without Contrast (skull)	7	7	$1,948.00	$1,655.80	$130.00	$1,655.80	$1,655.80	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	$1,652.40	2026-07-15
13152	HCPCS	Lac Complex 2.6 - 7.5 Cm	7	7	$1,925.00	$1,636.25	$130.00	$1,636.25	$1,636.25	2026-07-15
78195	HCPCS	Nm Lymphatics & Lymph Node Img	12	7	$1,916.00	$1,628.60	$130.00	$1,798.60	$1,628.60	2026-07-15
73200	HCPCS	CT Extremity Upper Wo Contrast Left,left	22	7	$1,911.00	$1,624.35	$130.00	$1,624.35	$1,372.30	2026-07-15
80500	HCPCS	Lupus Anticoag Confirm Consult	7	7	$1,908.00	$1,621.80	$130.00	$1,621.80	$1,621.80	2026-07-15
78264	HCPCS	Nm Gastric Emptying Study	7	7	$1,902.00	$1,616.70	$130.00	$1,616.70	$1,616.70	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	$1,615.00	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	$1,590.35	2026-07-15
J1572	HCPCS	Immune Globulin (human)flgamma20gm/400ml	7	7	$1,858.00	$1,579.30	$130.00	$1,579.30	$1,579.30	2026-07-15
11471	HCPCS	Excision With Complex Repair Perianal Pe	7	7	$1,844.00	$1,567.40	$130.00	$1,567.40	$1,567.40	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	$1,561.45	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	$1,558.90	2026-07-15
49561	HCPCS	Repair Incision Hernia	7	7	$1,834.00	$1,558.90	$130.00	$1,558.90	$1,558.90	2026-07-15
12057	HCPCS	Lac Intermed > 30cm	7	7	$1,831.00	$1,556.35	$130.00	$1,556.35	$1,556.35	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	$1,547.00	2026-07-15
0710	RC	—	7	7	$1,819.00	$1,546.15	$130.00	$1,546.15	$1,469.16	2026-07-15
70480	HCPCS	CT Orbit Without Contrast (skull)	7	7	$1,812.00	$1,540.20	$130.00	$1,540.20	$1,540.20	2026-07-15
J1559	HCPCS	Hizentra (immune Globulin) 20% 10gm/50ml	7	7	$1,808.00	$1,536.80	$130.00	$1,536.80	$1,536.80	2026-07-15
25605	HCPCS	Closed Reduction Of Distal Radius/ulna	7	7	$1,804.00	$1,533.40	$130.00	$1,533.40	$1,533.40	2026-07-15
72125	HCPCS	CT C Spine Without Contr	17	7	$1,790.00	$1,521.50	$117.32	$1,902.30	$1,354.85	2026-07-15
78070	HCPCS	Nm Parathyroid Imaging	7	7	$1,783.00	$1,515.55	$130.00	$1,515.55	$1,515.55	2026-07-15
11446	HCPCS	Excision Lesion Over 4.0 Cm	12	7	$1,781.00	$1,513.85	$130.00	$1,513.85	$1,103.30	2026-07-15
72130	HCPCS	CT T Spine Without & W Contrast	7	7	$1,780.00	$1,513.00	$130.00	$1,513.00	$1,513.00	2026-07-15
J0515	HCPCS	Cogentin (benztropine Mes) 2mg/2cc Inj	7	7	$1,778.00	$1,511.30	$130.00	$1,511.30	$1,511.30	2026-07-15
78315	HCPCS	Nm Bone Imaging, 3 Phase	7	7	$1,766.00	$1,501.10	$130.00	$1,501.10	$1,501.10	2026-07-15
90632	HCPCS	Hepatitis A (havrix) Vaccine 1ml Inj	7	7	$1,737.00	$1,476.45	$130.00	$1,476.45	$1,476.45	2026-07-15
11626	HCPCS	Excision Lesion Over 4.0	7	7	$1,731.00	$1,471.35	$130.00	$1,471.35	$1,471.35	2026-07-15
93307	HCPCS	Echo 2-d/mode W/interp	7	7	$1,725.00	$1,466.25	$130.00	$1,466.25	$1,466.25	2026-07-15
12037	HCPCS	Lac Intermed > 30cm	7	7	$1,716.00	$1,458.60	$130.00	$1,458.60	$1,458.60	2026-07-15
J7325	HCPCS	Synvisc(hyaluronate Sodium)8mg/ml Inj	7	7	$1,713.00	$1,456.05	$130.00	$1,456.05	$1,456.05	2026-07-15
12018	HCPCS	Lac Simple > 30cm	7	7	$1,701.00	$1,445.85	$130.00	$1,445.85	$1,445.85	2026-07-15
84182	HCPCS	Myositis Extended Panel	7	7	$1,686.00	$1,433.10	$130.00	$1,433.10	$1,433.10	2026-07-15
J3262	HCPCS	Actemra (tocilizumab): 80mg Vial	17	7	$1,666.00	$1,416.10	$130.00	$2,929.95	$1,416.10	2026-07-15
93306	HCPCS	Echo Cardio Trans W Doppler/colorflow	7	7	$1,647.00	$1,399.95	$130.00	$1,399.95	$1,329.72	2026-07-15
70450	HCPCS	CT Head Wo Cont Outside Facility	15	7	$1,620.00	$1,377.00	$119.00	$2,200.65	$1,307.88	2026-07-15
0124	RC	—	6	6	$1,612.00	$1,370.20	$130.00	$4,508.63	$1,260.47	2026-07-15
73702	HCPCS	CT Lower Extremity W & Without Contrast	7	7	$1,606.00	$1,365.10	$130.00	$1,365.10	$1,365.10	2026-07-15
12056	HCPCS	Lac Intermed 20.1 - 30cm	7	7	$1,598.00	$1,358.30	$130.00	$1,358.30	$1,358.30	2026-07-15
36576	HCPCS	Repair Port/pic Line	7	7	$1,598.00	$1,358.30	$130.00	$1,358.30	$1,358.30	2026-07-15
81406	HCPCS	Galactosemia (galt)	17	7	$1,596.00	$1,356.60	$130.00	$1,639.65	$1,356.60	2026-07-15
74740	HCPCS	Hysterosalpingogram	7	7	$1,593.00	$1,354.05	$130.00	$1,354.05	$1,354.05	2026-07-15
30905	HCPCS	Tx Epistaxis Epistaxis Posterior	7	7	$1,576.00	$1,339.60	$130.00	$1,339.60	$1,339.60	2026-07-15
87507	HCPCS	Gastrointestinal Profile Stool Pcr	15	7	$1,567.00	$1,331.95	$130.00	$1,394.00	$1,331.95	2026-07-15
73201	HCPCS	CT Upper Extrem W Contrast	14	7	$1,565.50	$1,330.67	$130.00	$1,705.10	$956.25	2026-07-15
J2247	HCPCS	Micafungin 100mg/ns 100ml	7	7	$1,560.00	$1,326.00	$130.00	$1,326.00	$1,326.00	2026-07-15
93970	HCPCS	Venous Doppler Bilateral Duplex	17	7	$1,554.00	$1,320.90	$130.00	$1,672.80	$1,254.96	2026-07-15
71250	HCPCS	CT Chest Abd Pelvis Without Contrast	17	7	$1,545.00	$1,313.25	$112.02	$1,985.60	$1,169.41	2026-07-15
72133	HCPCS	CT L Spine W & Without Contrast	7	7	$1,531.00	$1,301.35	$130.00	$1,301.35	$1,301.35	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	$1,290.30	2026-07-15
Q5101	HCPCS	Neupogen 480mcg/1.6ml Inj	7	7	$1,516.00	$1,288.60	$130.00	$1,288.60	$1,288.60	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	$1,280.95	2026-07-15
23650	HCPCS	Treatment Shoulder Dislocation	7	7	$1,479.00	$1,257.15	$130.00	$1,257.15	$1,257.15	2026-07-15
11424	HCPCS	Excis B9 Lesions/n/h/f/3.1 - 4 Cm	17	7	$1,479.00	$1,257.15	$130.00	$1,263.95	$1,125.51	2026-07-15
47531	HCPCS	Cholangio W/image Exisitng Access	7	7	$1,406.00	$1,195.10	$130.00	$1,195.10	$1,195.10	2026-07-15
12053	HCPCS	Lac Intermed 5.1 - 7.5 Cm	7	7	$1,404.00	$1,193.40	$130.00	$1,193.40	$1,193.40	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	$1,193.40	2026-07-15
26742	HCPCS	Treatment Finger Fracture Each	7	7	$1,401.00	$1,190.85	$130.00	$1,190.85	$1,190.85	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	$1,185.75	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	$977.50	2026-07-15
J1212	HCPCS	Rimso-50 (dimethyl Sulfo) 50ml Solution	7	7	$1,385.00	$1,177.25	$130.00	$1,177.25	$1,177.25	2026-07-15
J3424	HCPCS	Cyanide Antidote Kit	7	7	$1,361.00	$1,156.85	$130.00	$1,156.85	$1,156.85	2026-07-15
70488	HCPCS	CT Maxillo Facial W & Without Contrast	7	7	$1,355.00	$1,151.75	$130.00	$1,151.75	$1,151.75	2026-07-15
P9045	HCPCS	Albumin 5% 250ml Inj	7	7	$1,354.00	$1,150.90	$130.00	$1,150.90	$1,150.90	2026-07-15
78582	HCPCS	Nm Pulmonary Scan Perfusion & Ventilatio	7	7	$1,353.00	$1,150.05	$130.00	$1,150.05	$1,150.05	2026-07-15
93971	HCPCS	US Extremity Venous Lt Unilateral,left	26	7	$1,349.00	$1,146.65	$130.00	$1,146.65	$996.73	2026-07-15
13151	HCPCS	Lac Complex 1 - 2.5 Cm	7	7	$1,344.00	$1,142.40	$130.00	$1,142.40	$1,142.40	2026-07-15
93268	HCPCS	Event Monitoring	7	7	$1,321.00	$1,122.85	$130.00	$1,122.85	$1,122.85	2026-07-15
40650	HCPCS	Lac Mouth Vermillion Lip	7	7	$1,307.00	$1,110.95	$130.00	$1,110.95	$1,110.95	2026-07-15
J0714	HCPCS	Avycaz (ceftaz/avibac) 2.5gm Inj	7	7	$1,297.00	$1,102.45	$130.00	$1,102.45	$1,102.45	2026-07-15
76830	HCPCS	US Transvaginal Pelvic Non Obstetrical	7	7	$1,291.00	$1,097.35	$130.00	$1,097.35	$1,097.35	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	$1,084.60	2026-07-15
J2794	HCPCS	Risperdal Consta (risperidone) 25mg Inj	17	7	$1,272.00	$1,081.20	$130.00	$1,458.60	$1,081.20	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	$1,081.20	2026-07-15
J1573	HCPCS	Immune Globulin-hepatitis B 5ml	27	7	$1,264.00	$1,074.40	$130.00	$8,467.70	$1,074.40	2026-07-15
11426	HCPCS	Lesion Over 4.0 Cm Dia	12	7	$1,259.00	$1,070.15	$130.00	$1,070.15	$1,063.35	2026-07-15
12055	HCPCS	Lac Intermed 12.6 - 20 Cm	7	7	$1,251.00	$1,063.35	$130.00	$1,063.35	$1,063.35	2026-07-15
12047	HCPCS	Lac Intermed >30cm	7	7	$1,251.00	$1,063.35	$130.00	$1,063.35	$1,063.35	2026-07-15
78761	HCPCS	Nm Testicular Imaging W Vascular Flow	7	7	$1,242.00	$1,055.70	$130.00	$1,055.70	$1,055.70	2026-07-15
L4386	HCPCS	Moonboot Lg	15	7	$1,227.00	$1,042.95	$130.00	$1,047.20	$1,042.95	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	$959.65	2026-07-15
81272	HCPCS	C-kit Mutation Analysis	7	7	$1,206.00	$1,025.10	$130.00	$1,025.10	$1,025.10	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	$1,019.15	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	$1,016.60	2026-07-15
94762	HCPCS	Pulse Oximeter Cont	7	7	$1,191.00	$1,012.35	$130.00	$1,012.35	$1,012.35	2026-07-15
84433	HCPCS	Thiopurine Methyltransferase	7	7	$1,185.00	$1,007.25	$130.00	$1,007.25	$1,007.25	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	$807.50	2026-07-15
32555	HCPCS	Thoracentesis Needle/cath Pleura W/imagi	7	7	$1,182.00	$1,004.70	$130.00	$1,004.70	$1,004.70	2026-07-15
J1335	HCPCS	Invanz 1gm/ns 100ml	7	7	$1,178.00	$1,001.30	$130.00	$1,001.30	$1,001.30	2026-07-15
11606	HCPCS	Exc Lesion Trunk/arm/leg >4.0 Cm	12	7	$1,175.00	$998.75	$130.00	$1,707.65	$998.75	2026-07-15
J2597	HCPCS	Desmopressin(ddavp)4mcg/ml 10ml Inj	7	7	$1,173.00	$997.05	$130.00	$997.05	$997.05	2026-07-15
88342	HCPCS	Lab Pathology	7	7	$1,146.00	$974.10	$130.00	$974.10	$974.10	2026-07-15
75822	HCPCS	Venogram (extremity) Bilateral	7	7	$1,145.00	$973.25	$130.00	$973.25	$973.25	2026-07-15
12046	HCPCS	Lac Intermed 20.1 - 30cm	7	7	$1,137.00	$966.45	$130.00	$966.45	$966.45	2026-07-15
62273	HCPCS	Inj Epidural Blood/clot Patch	7	7	$1,127.00	$957.95	$130.00	$957.95	$957.95	2026-07-15
11444	HCPCS	Removal Skin Lesion	17	7	$1,120.00	$952.00	$80.99	$1,330.25	$952.00	2026-07-15
78306	HCPCS	Nm Bone Imaging Whole Body	7	7	$1,114.00	$946.90	$130.00	$946.90	$946.90	2026-07-15
25600	HCPCS	Closed Tx Fx Radius	7	7	$1,109.00	$942.65	$130.00	$942.65	$942.65	2026-07-15
0410	RC	—	7	7	$1,108.00	$941.80	$130.00	$941.80	$941.80	2026-07-15
93925	HCPCS	US Arterial Bil Lower Extremity	7	7	$1,100.00	$935.00	$130.00	$935.00	$935.00	2026-07-15
11621	HCPCS	Excision Lesion 0.6 To 1.0cm	7	7	$1,094.00	$929.90	$130.00	$929.90	$929.90	2026-07-15
12017	HCPCS	Lac Simple 20 - 30 Cm	7	7	$1,092.00	$928.20	$130.00	$928.20	$928.20	2026-07-15
77012	HCPCS	CT Guidance Needle Placement	7	7	$1,089.00	$925.65	$130.00	$925.65	$925.65	2026-07-15
70487	HCPCS	CT Maxillo Facial W Contrast	7	7	$1,088.00	$924.80	$130.00	$924.80	$924.80	2026-07-15
19286	HCPCS	US Breast Local Device Ea Les Without U Pe	7	7	$1,086.00	$923.10	$130.00	$923.10	$923.10	2026-07-15
J2675	HCPCS	Progesterone 50mg/ml 10ml Mdv Inj	7	7	$1,085.00	$922.25	$130.00	$922.25	$922.25	2026-07-15
76873	HCPCS	US Prostate	7	7	$1,079.00	$917.15	$130.00	$917.15	$917.15	2026-07-15
21550	HCPCS	Biopsy Soft Tissue Neck/thorax	7	7	$1,079.00	$917.15	$130.00	$917.15	$917.15	2026-07-15
94002	HCPCS	Vent Assist & Mgmt Ip/obs 1st Day	7	7	$1,068.00	$907.80	$130.00	$907.80	$907.80	2026-07-15
13101	HCPCS	Lac Complex 2.6 - 7.5 Cm	7	7	$1,064.00	$904.40	$130.00	$904.40	$904.40	2026-07-15
70490	HCPCS	CT Neck Without Contrast Soft Tissue	7	7	$1,064.00	$904.40	$130.00	$904.40	$904.40	2026-07-15
88230	HCPCS	Chromosome Tissue Culture	22	7	$1,063.00	$903.55	$130.00	$2,451.40	$903.55	2026-07-15
0111	RC	—	7	7	$1,050.00	$892.50	$40.73	$1,505.13	$892.50	2026-07-15
J1726	HCPCS	Makena (hydrox Prog) 250mg/ml 5ml Inj	7	7	$1,047.00	$889.95	$130.00	$889.95	$889.95	2026-07-15
J1808	HCPCS	Folic Acid 5mg/ml 10ml Inj	7	7	$1,038.00	$882.30	$130.00	$882.30	$882.30	2026-07-15
12036	HCPCS	Lac Intermed	7	7	$1,035.00	$879.75	$130.00	$879.75	$879.75	2026-07-15
12035	HCPCS	Lac Intermed 12.6 - 20 Cm	7	7	$1,035.00	$879.75	$130.00	$879.75	$879.75	2026-07-15
78014	HCPCS	Nm Thyroid Image Single/multi	7	7	$1,024.00	$870.40	$130.00	$870.40	$870.40	2026-07-15
87901	HCPCS	HIV 1 Genosure Mg Genotyping	7	7	$1,020.00	$867.00	$130.00	$867.00	$867.00	2026-07-15
90670	HCPCS	Pneumovax 2.5mcg/0.5ml(2.5ml-mdv)vaccine	7	7	$1,018.00	$865.30	$130.00	$865.30	$865.30	2026-07-15
92960	HCPCS	Cardioversion Emergency	7	7	$1,016.00	$863.60	$130.00	$863.60	$863.60	2026-07-15
93320	HCPCS	Echo Cardiac Doppler	7	7	$1,012.00	$860.20	$130.00	$860.20	$860.20	2026-07-15
12054	HCPCS	Lac Intermed 7.6 - 12.5 Cm	7	7	$1,006.00	$855.10	$130.00	$855.10	$855.10	2026-07-15
81377	HCPCS	Celiac Disease Dq Association	17	7	$992.00	$843.20	$130.00	$1,976.25	$843.20	2026-07-15
19126	HCPCS	Exc Breast Local Device Without US Ea Add	7	7	$986.00	$838.10	$130.00	$838.10	$838.10	2026-07-15
78278	HCPCS	Nm Gi Bleed Scan Image	7	7	$985.00	$837.25	$130.00	$837.25	$837.25	2026-07-15
11308	HCPCS	Shaving Of Lesion 2.0 Cm	7	7	$984.00	$836.40	$130.00	$836.40	$836.40	2026-07-15
J1380	HCPCS	Delestrogen (estradiol Vale) 20mg/ml Inj	12	7	$983.00	$835.55	$130.00	$2,381.70	$835.55	2026-07-15
J0120	HCPCS	Pontocaine (tetracaine) 1% 2ml Inj	7	7	$980.00	$833.00	$130.00	$833.00	$833.00	2026-07-15
11603	HCPCS	Excision Lesion 2.1 To 3.0 Cm	7	7	$975.00	$828.75	$130.00	$828.75	$828.75	2026-07-15
96413	HCPCS	IV Infusion Chemo 1st Hour	7	7	$967.00	$821.95	$130.00	$821.95	$821.95	2026-07-15
J2280	HCPCS	Avelox (moxifloxacin) 400mg/250ml Premix	7	7	$960.00	$816.00	$130.00	$816.00	$816.00	2026-07-15
11404	HCPCS	Exc Lesmrg T/a/l 3.1 -4.0 Cm	12	7	$950.00	$807.50	$130.00	$841.50	$807.50	2026-07-15
78215	HCPCS	Nm Liver & Spleen Image	7	7	$943.00	$801.55	$130.00	$801.55	$801.55	2026-07-15
11044	HCPCS	Cleaning Tissue/muscle/bone	7	7	$943.00	$801.55	$130.00	$801.55	$801.55	2026-07-15
93930	HCPCS	US Arterial Upper Li Arterail Bil Comple	7	7	$941.00	$799.85	$130.00	$799.85	$799.85	2026-07-15
12007	HCPCS	Lac Simple > 30	7	7	$940.00	$799.00	$130.00	$799.00	$799.00	2026-07-15
27380	HCPCS	Repair Of Kneecap Tendon	7	7	$932.00	$792.20	$130.00	$792.20	$792.20	2026-07-15
26705	HCPCS	Tr Knuckle Dislocation	7	7	$931.00	$791.35	$130.00	$791.35	$791.35	2026-07-15
11641	HCPCS	Excision Lesion 0.6 To 1.0 Cm Face Ear E	7	7	$926.00	$787.10	$130.00	$787.10	$787.10	2026-07-15
76881	HCPCS	US Extremity Non Vasc Complete	7	7	$921.00	$782.85	$130.00	$782.85	$782.85	2026-07-15
20520	HCPCS	Remove Fb Muscle Simple	7	7	$920.00	$782.00	$130.00	$782.00	$782.00	2026-07-15

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