|
01204770_1
|
CDM
|
Xenmatrix Surgical Graft 3.9x5.9
|
14
|
14
|
$5,700.00
|
$4,845.00
|
$2,850.00
|
$5,700.00
|
$4,617.00
|
2026-06-10
|
|
J3358
|
HCPCS
|
Ustekinumab, For Intravenous Injection, 1 Mg
|
14
|
14
|
$7,300.20
|
$6,205.17
|
$3,650.10
|
$7,300.20
|
$5,913.16
|
2026-06-10
|
|
93306
|
HCPCS
|
Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu…
|
27
|
14
|
$1,600.00
|
$1,360.00
|
$800.00
|
$1,749.30
|
$1,312.00
|
2026-06-10
|
|
25990634_1
|
CDM
|
Trelegy Ellipta 200-62.5-25
|
14
|
14
|
$2,370.20
|
$2,014.67
|
$1,185.10
|
$2,370.20
|
$1,919.86
|
2026-06-10
|
|
25990514_1
|
CDM
|
Trelegy Ellipta 100-62.5-25
|
14
|
14
|
$2,234.20
|
$1,899.07
|
$1,117.10
|
$2,234.20
|
$1,809.70
|
2026-06-10
|
|
27829
|
HCPCS
|
Treatment Of Ligament Tear At Ankle Joint
|
12
|
12
|
$2,640.00
|
$2,244.00
|
$617.78
|
$1,716.00
|
$939.02
|
2026-06-10
|
|
29855
|
HCPCS
|
Treatment Of Broken Upper Portion Of Lower Leg Bone On Side Using An Endoscope
|
12
|
12
|
$2,754.00
|
$2,340.90
|
$667.21
|
$1,790.10
|
$1,014.16
|
2026-06-10
|
|
27509
|
HCPCS
|
Treatment Of Broken Thigh Bone At Far End With Placement Of Stabilizing Device
|
12
|
12
|
$1,758.00
|
$1,494.30
|
$596.87
|
$1,372.80
|
$878.74
|
2026-06-10
|
|
27535
|
HCPCS
|
Treatment Of Broken Side Of Upper End Of Shin Bone
|
12
|
12
|
$2,950.00
|
$2,507.50
|
$743.96
|
$1,917.50
|
$1,130.82
|
2026-06-10
|
|
27506
|
HCPCS
|
Treatment Of Broken Shaft Of Thigh Bone With Implant
|
12
|
12
|
$4,200.00
|
$3,570.00
|
$1,116.32
|
$2,730.00
|
$1,696.81
|
2026-06-10
|
|
22513
|
HCPCS
|
Treatment Of Broken Middle Spine Bone With Placement Of Stabilizing Device Using…
|
26
|
14
|
$2,400.00
|
$2,040.00
|
$416.38
|
$2,352.00
|
$1,200.00
|
2026-06-10
|
|
22514
|
HCPCS
|
Treatment Of Broken Lower Spine Bone With Placement Of Stabilizing Device
|
26
|
14
|
$2,300.00
|
$1,955.00
|
$389.57
|
$2,254.00
|
$1,155.75
|
2026-06-10
|
|
23515
|
HCPCS
|
Treatment Of Broken Collar Bone
|
12
|
12
|
$2,393.00
|
$2,034.05
|
$621.00
|
$1,555.45
|
$943.92
|
2026-06-10
|
|
27769
|
HCPCS
|
Treatment Of Broken Back Portion Of Shin Bone At Ankle
|
12
|
12
|
$2,235.00
|
$1,899.75
|
$618.66
|
$1,471.84
|
$940.37
|
2026-06-10
|
|
27814
|
HCPCS
|
Treatment Of Both Broken Lower Leg Bones At Ankle
|
12
|
12
|
$3,280.00
|
$2,788.00
|
$654.49
|
$2,132.00
|
$994.82
|
2026-06-10
|
|
01700393_1
|
CDM
|
Trauma Response Priority 3
|
14
|
14
|
$1,121.00
|
$952.85
|
$560.50
|
$1,098.58
|
$908.01
|
2026-06-10
|
|
01700392_1
|
CDM
|
Trauma Response Priority 2
|
14
|
14
|
$1,247.23
|
$1,060.15
|
$623.62
|
$1,222.29
|
$1,010.25
|
2026-06-10
|
|
01700390_1
|
CDM
|
Trauma Response Priority 1
|
14
|
14
|
$1,787.34
|
$1,519.24
|
$893.67
|
$1,751.59
|
$1,447.74
|
2026-06-10
|
|
C8929
|
HCPCS
|
Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi…
|
14
|
14
|
$1,700.00
|
$1,445.00
|
$850.00
|
$2,298.11
|
$1,377.00
|
2026-06-10
|
|
25990631_1
|
CDM
|
Testosterone 10 Mg Gel Pump
|
14
|
14
|
$1,419.00
|
$1,206.15
|
$709.50
|
$1,419.00
|
$1,149.39
|
2026-06-10
|
|
25990555_1
|
CDM
|
Tagrisso 80 Mg Tablet
|
14
|
14
|
$1,882.30
|
$1,599.96
|
$941.15
|
$1,882.30
|
$1,524.66
|
2026-06-10
|
|
25015561_1
|
CDM
|
Stiolto Respimat Inhaler (60)
|
14
|
14
|
$1,229.90
|
$1,045.42
|
$614.95
|
$1,229.90
|
$996.22
|
2026-06-10
|
|
22510
|
HCPCS
|
Stabilization Of Upper Spine Bone
|
14
|
14
|
$3,300.00
|
$2,805.00
|
$1,650.00
|
$3,234.00
|
$2,673.00
|
2026-06-10
|
|
22512
|
HCPCS
|
Stabilization Of Spine Bone, Each Additional Bone
|
14
|
14
|
$1,095.00
|
$930.75
|
$547.50
|
$1,073.10
|
$886.95
|
2026-06-10
|
|
22511
|
HCPCS
|
Stabilization Of Lower Spine Bone
|
14
|
14
|
$3,300.00
|
$2,805.00
|
$1,650.00
|
$3,234.00
|
$2,673.00
|
2026-06-10
|
|
25010061_1
|
CDM
|
Spiriva Respimat 2.5 Mcg Inh
|
14
|
14
|
$1,434.10
|
$1,218.99
|
$717.05
|
$1,434.10
|
$1,161.62
|
2026-06-10
|
|
95811
|
HCPCS
|
Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older)
|
27
|
14
|
$3,840.00
|
$3,264.00
|
$119.15
|
$3,648.00
|
$1,920.00
|
2026-06-10
|
|
95810
|
HCPCS
|
Sleep Study In Sleep Lab (6 Years Or Older)
|
27
|
14
|
$3,360.00
|
$2,856.00
|
$114.89
|
$3,626.86
|
$1,680.00
|
2026-06-10
|
|
25990534_1
|
CDM
|
Semaglutide (ozempic) 0.25 Or 0.5mg
|
14
|
14
|
$3,223.40
|
$2,739.89
|
$1,611.70
|
$3,223.40
|
$2,610.95
|
2026-06-10
|
|
03098002_1
|
CDM
|
Screws/wrenches For Joint Implants
|
14
|
14
|
$2,340.00
|
$1,989.00
|
$1,170.00
|
$2,340.00
|
$1,895.40
|
2026-06-10
|
|
S_1
|
CDM
|
Room & Board - Semi-private (two Beds) - General Classification
|
8
|
8
|
$1,700.00
|
$1,445.00
|
$1,360.00
|
$1,666.00
|
$1,487.50
|
2026-06-10
|
|
LD_1
|
CDM
|
Room & Board - Semi-private (two Beds) - General Classification
|
8
|
8
|
$1,700.00
|
$1,445.00
|
$1,360.00
|
$1,666.00
|
$1,487.50
|
2026-06-10
|
|
IS_1
|
CDM
|
Room & Board - Private (one Bed) - General Classification
|
8
|
8
|
$1,900.00
|
$1,615.00
|
$1,520.00
|
$1,862.00
|
$1,662.50
|
2026-06-10
|
|
P_1
|
CDM
|
Room & Board - Private (one Bed) - General Classification
|
8
|
8
|
$1,900.00
|
$1,615.00
|
$1,520.00
|
$1,862.00
|
$1,662.50
|
2026-06-10
|
|
90378
|
HCPCS
|
Respiratory Syncytial Virus Antibody For Injection Into Tissue Or Muscle
|
14
|
14
|
$11,855.60
|
$10,077.26
|
$5,927.80
|
$11,855.60
|
$9,603.03
|
2026-06-10
|
|
50435
|
HCPCS
|
Replacement Of Kidney Drainage Tube Using Imaging Guidance With Review By Radiol…
|
14
|
14
|
$1,382.00
|
$1,174.70
|
$691.00
|
$1,354.36
|
$1,119.42
|
2026-06-10
|
|
49587
|
HCPCS
|
Repair Umbilical Hernia, Age 5 Years Or Older; Incarcerated Or Strangulated
|
6
|
6
|
$1,822.00
|
$1,548.70
|
$57.25
|
$1,366.50
|
$1,074.98
|
2026-06-10
|
|
29807
|
HCPCS
|
Repair Of Shoulder Socket Using An Endoscope
|
12
|
12
|
$4,524.00
|
$3,845.40
|
$870.24
|
$2,940.60
|
$1,322.77
|
2026-06-10
|
|
29827
|
HCPCS
|
Repair Of Shoulder Rotator Cuff Using An Endoscope
|
12
|
12
|
$4,600.00
|
$3,910.00
|
$893.28
|
$2,990.00
|
$1,357.79
|
2026-06-10
|
|
29806
|
HCPCS
|
Repair Of Shoulder Joint Capsule Using An Endoscope
|
12
|
12
|
$3,648.00
|
$3,100.80
|
$889.48
|
$2,371.20
|
$1,352.00
|
2026-06-10
|
|
30465
|
HCPCS
|
Repair Of Nasal Passage
|
12
|
12
|
$2,650.00
|
$2,252.50
|
$854.51
|
$2,471.88
|
$1,298.86
|
2026-06-10
|
|
29887
|
HCPCS
|
Repair Of Knee Joint With Bone Graft And Internal Stabilizing Device Using An En…
|
12
|
12
|
$3,268.00
|
$2,777.80
|
$648.58
|
$2,124.20
|
$985.85
|
2026-06-10
|
|
27422
|
HCPCS
|
Repair Of Dislocating Kneecap With Realignment
|
12
|
12
|
$3,009.00
|
$2,557.65
|
$638.38
|
$1,955.85
|
$970.34
|
2026-06-10
|
|
23420
|
HCPCS
|
Repair Of Complete Tear Of Shoulder Rotator Cuff With Release Of Pressure On Col…
|
12
|
12
|
$3,745.00
|
$3,183.25
|
$827.90
|
$2,434.25
|
$1,258.41
|
2026-06-10
|
|
23412
|
HCPCS
|
Repair Of Chronic Torn Shoulder Rotator Cuff
|
12
|
12
|
$3,765.00
|
$3,200.25
|
$723.37
|
$2,447.25
|
$1,099.52
|
2026-06-10
|
|
29888
|
HCPCS
|
Repair Of Anterior Cruciate Ligament Of Knee Using An Endoscope
|
12
|
12
|
$6,750.00
|
$5,737.50
|
$814.65
|
$4,387.50
|
$1,238.27
|
2026-06-10
|
|
23410
|
HCPCS
|
Repair Of Acute Torn Shoulder Rotator Cuff
|
12
|
12
|
$4,100.00
|
$3,485.00
|
$699.04
|
$2,665.00
|
$1,062.54
|
2026-06-10
|
|
49560
|
HCPCS
|
Repair Initial Incisional Or Ventral Hernia; Reducible
|
6
|
6
|
$2,229.00
|
$1,894.65
|
$57.25
|
$2,101.07
|
$1,444.67
|
2026-06-10
|
|
C1771
|
HCPCS
|
Repair Device, Urinary, Incontinence, With Sling Graft
|
70
|
14
|
$1,807.50
|
$1,536.38
|
$776.10
|
$2,111.96
|
$1,358.17
|
2026-06-10
|
|
49002
|
HCPCS
|
Reopening Of Recent Abdominal Incision
|
12
|
12
|
$2,696.00
|
$2,291.60
|
$878.54
|
$2,986.45
|
$1,328.65
|
2026-06-10
|
|
37766
|
HCPCS
|
Removal Of Varicose Veins Of Arm Or Leg, More Than 20 Incisions
|
28
|
14
|
$2,430.00
|
$2,065.50
|
$1,212.50
|
$2,386.30
|
$1,968.25
|
2026-06-10
|
|
37765
|
HCPCS
|
Removal Of Varicose Veins Of Arm Or Leg, 10-20 Incisions
|
14
|
14
|
$2,175.00
|
$1,848.75
|
$1,087.50
|
$2,131.50
|
$1,761.75
|
2026-06-10
|
|
58552
|
HCPCS
|
Removal Of Uterus, Tubes, And/or Ovaries Through Vagina Using An Endoscope, 250.…
|
12
|
12
|
$4,840.00
|
$4,114.00
|
$806.22
|
$3,146.00
|
$1,154.45
|
2026-06-10
|
|
58571
|
HCPCS
|
Removal Of Uterus, Tubes, And/or Ovaries Through Abdomen Using An Endoscope, 250…
|
12
|
12
|
$4,200.00
|
$3,570.00
|
$757.13
|
$2,730.00
|
$1,074.42
|
2026-06-10
|
|
58260
|
HCPCS
|
Removal Of Uterus Through Vagina, 250.0 G Or Less
|
12
|
12
|
$3,122.00
|
$2,653.70
|
$683.53
|
$2,029.30
|
$983.52
|
2026-06-10
|
|
58572
|
HCPCS
|
Removal Of Uterus Through Abdomen Using An Endoscope, More Than 250.0 G
|
12
|
12
|
$4,762.00
|
$4,047.70
|
$864.27
|
$3,095.30
|
$1,229.35
|
2026-06-10
|
|
58570
|
HCPCS
|
Removal Of Uterus Through Abdomen Using An Endoscope, 250.0 G Or Less
|
12
|
12
|
$3,600.00
|
$3,060.00
|
$666.76
|
$2,340.00
|
$952.63
|
2026-06-10
|
|
58150
|
HCPCS
|
Removal Of Uterus And Cervix Through Abdomen
|
12
|
12
|
$4,400.00
|
$3,740.00
|
$852.76
|
$2,860.00
|
$1,206.67
|
2026-06-10
|
|
43251
|
HCPCS
|
Removal Of Polyps Or Growths Of Esophagus, Stomach, And/or Upper Small Bowel Usi…
|
14
|
14
|
$1,252.00
|
$1,064.20
|
$626.00
|
$1,226.96
|
$1,014.12
|
2026-06-10
|
|
47563
|
HCPCS
|
Removal Of Gallbladder With X-ray Study Of Bile Ducts Using An Endoscope
|
12
|
12
|
$3,290.00
|
$2,796.50
|
$615.61
|
$2,138.50
|
$935.73
|
2026-06-10
|
|
29828
|
HCPCS
|
Release Of Tendon Connecting Biceps Muscle And Shoulder Using An Endoscope
|
12
|
12
|
$4,400.00
|
$3,740.00
|
$771.97
|
$2,860.00
|
$1,173.39
|
2026-06-10
|
|
44180
|
HCPCS
|
Release Of Small Bowel Scar Tissue Using An Endoscope
|
12
|
12
|
$3,400.00
|
$2,890.00
|
$778.46
|
$2,624.26
|
$1,183.26
|
2026-06-10
|
|
90376
|
HCPCS
|
Rabies Immune Globulin For Injection Beneath The Skin And/or Into Muscle, Heat-t…
|
14
|
14
|
$2,201.30
|
$1,871.11
|
$1,100.65
|
$2,201.30
|
$1,783.05
|
2026-06-10
|
|
189
|
MS_DRG
|
Pulmonary Edema And Respiratory Failure
|
8
|
8
|
$8,613.93
|
$7,321.84
|
$6,891.14
|
$8,441.65
|
$7,537.19
|
2026-06-10
|
|
25091612_1
|
CDM
|
Pulmicort 180 Mcg Flexhaler
|
14
|
14
|
$1,235.70
|
$1,050.35
|
$617.85
|
$1,235.70
|
$1,000.91
|
2026-06-10
|
|
25087293_1
|
CDM
|
Premarin Vaginal Cream-appl
|
14
|
14
|
$1,138.70
|
$967.90
|
$569.35
|
$1,138.70
|
$922.35
|
2026-06-10
|
|
C1788
|
HCPCS
|
Port, Indwelling (implantable)
|
28
|
14
|
$3,034.50
|
$2,579.32
|
$409.50
|
$5,250.00
|
$1,722.00
|
2026-06-10
|
|
57260
|
HCPCS
|
Plastic Repair Of Vagina And Tissue Separating Vagina, Rectum, And Bladder
|
12
|
12
|
$2,560.00
|
$2,176.00
|
$634.52
|
$1,664.00
|
$912.78
|
2026-06-10
|
|
A4264
|
HCPCS
|
Permanent Implantable Contraceptive Intratubal Occlusion Device(s) And Delivery …
|
14
|
14
|
$2,400.00
|
$2,040.00
|
$1,200.00
|
$2,400.00
|
$1,944.00
|
2026-06-10
|
|
88309
|
HCPCS
|
Pathology Examination Of Tissue Using A Microscope, High Complexity
|
14
|
14
|
$1,150.00
|
$977.50
|
$575.00
|
$1,150.00
|
$931.50
|
2026-06-10
|
|
29824
|
HCPCS
|
Partial Removal Of Collar Bone At Shoulder Using An Endoscope
|
12
|
12
|
$3,465.00
|
$2,945.25
|
$584.97
|
$2,252.25
|
$889.15
|
2026-06-10
|
|
44202
|
HCPCS
|
Partial Removal And Reconnection Of Small Bowel Using An Endoscope
|
12
|
12
|
$3,830.00
|
$3,255.50
|
$1,163.32
|
$3,953.99
|
$1,768.24
|
2026-06-10
|
|
E0747
|
HCPCS
|
Osteogenesis Stimulator, Electrical, Non-invasive, Other Than Spinal Application…
|
14
|
14
|
$5,850.00
|
$4,972.50
|
$2,925.00
|
$5,733.00
|
$4,738.50
|
2026-06-10
|
|
64622
|
HCPCS
|
Operating Room Services - Minor Surgery
|
14
|
14
|
$2,370.00
|
$2,014.50
|
$1,185.00
|
$2,322.60
|
$1,919.70
|
2026-06-10
|
|
01299115_1
|
CDM
|
Operating Room Services - General Classification
|
14
|
14
|
$1,092.00
|
$928.20
|
$546.00
|
$1,070.16
|
$884.52
|
2026-06-10
|
|
NS_1
|
CDM
|
Nursery - General Classification
|
8
|
8
|
$1,700.00
|
$1,445.00
|
$1,360.00
|
$1,666.00
|
$1,487.50
|
2026-06-10
|
|
78803
|
HCPCS
|
Nuclear Medicine Study, Spect Imaging, 1 Area Or Single Acquisition, Single Day …
|
14
|
14
|
$1,307.00
|
$1,110.95
|
$653.50
|
$3,267.50
|
$1,058.67
|
2026-06-10
|
|
78278
|
HCPCS
|
Nuclear Medicine Study To Assess Blood Loss
|
14
|
14
|
$1,416.00
|
$1,203.60
|
$708.00
|
$3,540.00
|
$1,051.10
|
2026-06-10
|
|
78264
|
HCPCS
|
Nuclear Medicine Study Of Stomach To Assess Emptying
|
14
|
14
|
$1,858.00
|
$1,579.30
|
$929.00
|
$4,645.00
|
$1,227.90
|
2026-06-10
|
|
78070
|
HCPCS
|
Nuclear Medicine Study Of Parathyroid
|
14
|
14
|
$1,377.08
|
$1,170.52
|
$688.54
|
$3,442.70
|
$919.70
|
2026-06-10
|
|
78582
|
HCPCS
|
Nuclear Medicine Study Of Lung Ventilation And Circulation
|
14
|
14
|
$2,670.00
|
$2,269.50
|
$1,229.81
|
$6,675.00
|
$1,755.53
|
2026-06-10
|
|
78579
|
HCPCS
|
Nuclear Medicine Study Of Lung Ventilation
|
14
|
14
|
$1,974.00
|
$1,677.90
|
$826.78
|
$4,935.00
|
$1,297.90
|
2026-06-10
|
|
78580
|
HCPCS
|
Nuclear Medicine Study Of Lung Circulation
|
14
|
14
|
$1,270.00
|
$1,079.50
|
$635.00
|
$3,175.00
|
$921.39
|
2026-06-10
|
|
78227
|
HCPCS
|
Nuclear Medicine Study Of Liver And Bile Duct System With Use Of Drugs
|
14
|
14
|
$1,972.00
|
$1,676.20
|
$986.00
|
$4,930.00
|
$1,390.92
|
2026-06-10
|
|
78226
|
HCPCS
|
Nuclear Medicine Study Of Liver And Bile Duct System
|
14
|
14
|
$1,631.00
|
$1,386.35
|
$815.50
|
$4,077.50
|
$1,254.52
|
2026-06-10
|
|
78708
|
HCPCS
|
Nuclear Medicine Study Of Kidney, Blood, Flow, And Function With Drug Administra…
|
14
|
14
|
$1,139.00
|
$968.15
|
$569.50
|
$2,847.50
|
$922.59
|
2026-06-10
|
|
78451
|
HCPCS
|
Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect
|
14
|
14
|
$3,400.00
|
$2,890.00
|
$1,700.00
|
$8,500.00
|
$2,568.43
|
2026-06-10
|
|
78315
|
HCPCS
|
Nuclear Medicine Study Of Bone Taken At Different Times
|
14
|
14
|
$1,897.00
|
$1,612.45
|
$948.50
|
$4,742.50
|
$1,291.53
|
2026-06-10
|
|
78306
|
HCPCS
|
Nuclear Medicine Study Of Bone And/or Joint Whole Body
|
14
|
14
|
$1,988.00
|
$1,689.80
|
$994.00
|
$4,970.00
|
$1,327.93
|
2026-06-10
|
|
78300
|
HCPCS
|
Nuclear Medicine Study Of Bone And/or Joint Limited Area
|
14
|
14
|
$1,092.00
|
$928.20
|
$546.00
|
$2,730.00
|
$884.52
|
2026-06-10
|
|
78452
|
HCPCS
|
Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect
|
14
|
14
|
$3,600.00
|
$3,060.00
|
$1,800.00
|
$9,000.00
|
$2,648.43
|
2026-06-10
|
|
25022101_1
|
CDM
|
Nplate 250 Mcg Vial
|
14
|
14
|
$2,109.20
|
$1,792.82
|
$1,054.60
|
$2,109.20
|
$1,708.45
|
2026-06-10
|
|
78007
|
HCPCS
|
Nm Thy Imag W Upmult
|
14
|
14
|
$1,203.00
|
$1,022.55
|
$601.50
|
$3,007.50
|
$974.43
|
2026-06-10
|
|
78588
|
HCPCS
|
Nm Lung Perf W/vent
|
14
|
14
|
$1,850.00
|
$1,572.50
|
$925.00
|
$4,625.00
|
$1,498.50
|
2026-06-10
|
|
78223
|
HCPCS
|
Nm Biliary Hida W Ef
|
14
|
14
|
$1,350.00
|
$1,147.50
|
$675.00
|
$3,375.00
|
$1,093.50
|
2026-06-10
|
|
72141
|
HCPCS
|
MRI Scan Of Upper Spinal Canal Without Contrast
|
14
|
14
|
$2,300.00
|
$1,955.00
|
$1,150.00
|
$5,750.00
|
$1,680.69
|
2026-06-10
|
|
72142
|
HCPCS
|
MRI Scan Of Upper Spinal Canal With Contrast
|
14
|
14
|
$2,500.00
|
$2,125.00
|
$1,250.00
|
$6,250.00
|
$1,896.14
|
2026-06-10
|
|
72156
|
HCPCS
|
MRI Scan Of Upper Spinal Canal Before And After Contrast
|
14
|
14
|
$2,750.00
|
$2,337.50
|
$1,375.00
|
$6,875.00
|
$2,201.06
|
2026-06-10
|
|
72195
|
HCPCS
|
MRI Scan Of Pelvis Without Contrast
|
14
|
14
|
$1,900.00
|
$1,615.00
|
$950.00
|
$4,750.00
|
$1,520.69
|
2026-06-10
|
|
72196
|
HCPCS
|
MRI Scan Of Pelvis With Contrast
|
14
|
14
|
$1,720.00
|
$1,462.00
|
$860.00
|
$4,300.00
|
$1,393.20
|
2026-06-10
|
|
72197
|
HCPCS
|
MRI Scan Of Pelvis Before And After Contrast
|
14
|
14
|
$2,550.00
|
$2,167.50
|
$1,275.00
|
$6,375.00
|
$2,065.50
|
2026-06-10
|
|
72146
|
HCPCS
|
MRI Scan Of Middle Spinal Canal Without Contrast
|
14
|
14
|
$2,350.00
|
$1,997.50
|
$1,175.00
|
$5,875.00
|
$1,700.69
|
2026-06-10
|
|
72147
|
HCPCS
|
MRI Scan Of Middle Spinal Canal With Contrast
|
14
|
14
|
$2,201.00
|
$1,870.85
|
$1,100.50
|
$5,502.50
|
$1,776.54
|
2026-06-10
|
|
72157
|
HCPCS
|
MRI Scan Of Middle Spinal Canal Before And After Contrast
|
14
|
14
|
$2,750.00
|
$2,337.50
|
$1,375.00
|
$6,875.00
|
$2,201.06
|
2026-06-10
|
|
72148
|
HCPCS
|
MRI Scan Of Lower Spinal Canal Without Contrast
|
14
|
14
|
$2,000.00
|
$1,700.00
|
$1,000.00
|
$5,000.00
|
$1,560.69
|
2026-06-10
|
|
72149
|
HCPCS
|
MRI Scan Of Lower Spinal Canal With Contrast
|
14
|
14
|
$2,300.00
|
$1,955.00
|
$1,150.00
|
$5,750.00
|
$1,816.14
|
2026-06-10
|
|
72158
|
HCPCS
|
MRI Scan Of Lower Spinal Canal Before And After Contrast
|
14
|
14
|
$3,000.00
|
$2,550.00
|
$1,500.00
|
$7,500.00
|
$2,301.06
|
2026-06-10
|
|
73718
|
HCPCS
|
MRI Scan Of Leg Without Contrast
|
42
|
14
|
$1,750.00
|
$1,487.50
|
$875.00
|
$4,375.00
|
$1,417.50
|
2026-06-10
|
|
73719
|
HCPCS
|
MRI Scan Of Leg With Contrast
|
28
|
14
|
$1,950.00
|
$1,657.50
|
$975.00
|
$4,875.00
|
$1,579.50
|
2026-06-10
|
|
73721
|
HCPCS
|
MRI Scan Of Leg Joint Without Contrast
|
42
|
14
|
$1,850.00
|
$1,572.50
|
$447.50
|
$4,625.00
|
$943.50
|
2026-06-10
|
|
73722
|
HCPCS
|
MRI Scan Of Leg Joint With Contrast
|
28
|
14
|
$1,895.00
|
$1,610.75
|
$947.50
|
$4,737.50
|
$1,534.95
|
2026-06-10
|
|
73723
|
HCPCS
|
MRI Scan Of Leg Joint Before And After Contrast
|
54
|
14
|
$2,800.00
|
$2,380.00
|
$1,400.00
|
$7,250.00
|
$2,240.00
|
2026-06-10
|
|
73720
|
HCPCS
|
MRI Scan Of Leg Before And After Contrast
|
54
|
14
|
$2,200.00
|
$1,870.00
|
$1,100.00
|
$6,250.00
|
$1,804.00
|
2026-06-10
|
|
70336
|
HCPCS
|
MRI Scan Of Jaw Joint
|
14
|
14
|
$1,895.00
|
$1,610.75
|
$947.50
|
$4,737.50
|
$1,518.69
|
2026-06-10
|
|
71550
|
HCPCS
|
MRI Scan Of Chest Without Contrast
|
14
|
14
|
$1,630.00
|
$1,385.50
|
$815.00
|
$4,075.00
|
$1,320.30
|
2026-06-10
|
|
71551
|
HCPCS
|
MRI Scan Of Chest With Contrast
|
14
|
14
|
$1,875.00
|
$1,593.75
|
$937.50
|
$4,687.50
|
$1,518.75
|
2026-06-10
|
|
71552
|
HCPCS
|
MRI Scan Of Chest Before And After Contrast
|
14
|
14
|
$2,050.00
|
$1,742.50
|
$1,025.00
|
$5,125.00
|
$1,660.50
|
2026-06-10
|
|
70551
|
HCPCS
|
MRI Scan Of Brain Without Contrast
|
14
|
14
|
$2,200.00
|
$1,870.00
|
$1,100.00
|
$5,500.00
|
$1,640.69
|
2026-06-10
|
|
70552
|
HCPCS
|
MRI Scan Of Brain With Contrast
|
14
|
14
|
$2,285.00
|
$1,942.25
|
$1,142.50
|
$5,712.50
|
$1,810.14
|
2026-06-10
|
|
70553
|
HCPCS
|
MRI Scan Of Brain Before And After Contrast
|
14
|
14
|
$2,950.00
|
$2,507.50
|
$1,475.00
|
$7,375.00
|
$2,281.06
|
2026-06-10
|
|
77047
|
HCPCS
|
MRI Scan Of Both Breasts Without Contrast
|
14
|
14
|
$2,100.00
|
$1,785.00
|
$1,050.00
|
$5,250.00
|
$1,701.00
|
2026-06-10
|
|
77049
|
HCPCS
|
MRI Scan Of Both Breasts
|
14
|
14
|
$2,500.00
|
$2,125.00
|
$1,250.00
|
$6,250.00
|
$2,025.00
|
2026-06-10
|
|
70540
|
HCPCS
|
MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast
|
14
|
14
|
$1,830.00
|
$1,555.50
|
$915.00
|
$4,575.00
|
$1,482.30
|
2026-06-10
|
|
70542
|
HCPCS
|
MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast
|
14
|
14
|
$1,950.00
|
$1,657.50
|
$975.00
|
$4,875.00
|
$1,579.50
|
2026-06-10
|
|
70543
|
HCPCS
|
MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast
|
27
|
14
|
$2,800.00
|
$2,380.00
|
$1,230.00
|
$7,000.00
|
$2,017.20
|
2026-06-10
|
|
77084
|
HCPCS
|
MRI Scan Of Bone Marrow
|
14
|
14
|
$1,600.00
|
$1,360.00
|
$800.00
|
$4,000.00
|
$1,296.00
|
2026-06-10
|
|
72198
|
HCPCS
|
MRI Scan Of Blood Vessels Of Pelvis
|
14
|
14
|
$1,845.00
|
$1,568.25
|
$922.50
|
$4,612.50
|
$1,494.45
|
2026-06-10
|
|
70547
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck Without Contrast
|
14
|
14
|
$1,645.00
|
$1,398.25
|
$822.50
|
$4,112.50
|
$1,332.45
|
2026-06-10
|
|
70548
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck With Contrast
|
14
|
14
|
$1,750.00
|
$1,487.50
|
$875.00
|
$4,375.00
|
$1,417.50
|
2026-06-10
|
|
70549
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck Before And After Contrast
|
14
|
14
|
$1,780.00
|
$1,513.00
|
$890.00
|
$4,450.00
|
$1,441.80
|
2026-06-10
|
|
73725
|
HCPCS
|
MRI Scan Of Blood Vessels Of Leg
|
14
|
14
|
$1,900.00
|
$1,615.00
|
$950.00
|
$4,750.00
|
$1,539.00
|
2026-06-10
|
|
70544
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head Without Contrast
|
14
|
14
|
$1,950.00
|
$1,657.50
|
$975.00
|
$4,875.00
|
$1,540.69
|
2026-06-10
|
|
70545
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head With Contrast
|
14
|
14
|
$1,890.00
|
$1,606.50
|
$945.00
|
$4,725.00
|
$1,530.90
|
2026-06-10
|
|
70546
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head Before And After Contrast
|
14
|
14
|
$2,445.00
|
$2,078.25
|
$1,222.50
|
$6,112.50
|
$1,980.45
|
2026-06-10
|
|
71555
|
HCPCS
|
MRI Scan Of Blood Vessels Of Chest
|
14
|
14
|
$2,250.00
|
$1,912.50
|
$1,125.00
|
$5,625.00
|
$1,799.80
|
2026-06-10
|
|
74185
|
HCPCS
|
MRI Scan Of Blood Vessels Of Abdomen
|
14
|
14
|
$2,035.00
|
$1,729.75
|
$1,017.50
|
$5,087.50
|
$1,648.35
|
2026-06-10
|
|
73218
|
HCPCS
|
MRI Scan Of Arm Without Contrast
|
28
|
14
|
$1,850.00
|
$1,572.50
|
$925.00
|
$4,625.00
|
$1,498.50
|
2026-06-10
|
|
73219
|
HCPCS
|
MRI Scan Of Arm With Contrast
|
28
|
14
|
$1,925.00
|
$1,636.25
|
$962.50
|
$4,812.50
|
$1,559.25
|
2026-06-10
|
|
73221
|
HCPCS
|
MRI Scan Of Arm Joint Without Contrast
|
54
|
14
|
$1,950.00
|
$1,657.50
|
$950.00
|
$5,000.00
|
$1,521.38
|
2026-06-10
|
|
73222
|
HCPCS
|
MRI Scan Of Arm Joint With Contrast
|
54
|
14
|
$2,275.00
|
$1,933.75
|
$1,125.00
|
$5,750.00
|
$1,800.00
|
2026-06-10
|
|
73223
|
HCPCS
|
MRI Scan Of Arm Joint Before And After Contrast
|
28
|
14
|
$2,650.00
|
$2,252.50
|
$1,325.00
|
$6,625.00
|
$2,146.50
|
2026-06-10
|
|
73220
|
HCPCS
|
MRI Scan Of Arm Before And After Contrast
|
28
|
14
|
$2,450.00
|
$2,082.50
|
$1,225.00
|
$6,125.00
|
$1,984.50
|
2026-06-10
|
|
74181
|
HCPCS
|
MRI Scan Of Abdomen Without Contrast
|
14
|
14
|
$2,050.00
|
$1,742.50
|
$1,025.00
|
$5,125.00
|
$1,580.69
|
2026-06-10
|
|
74182
|
HCPCS
|
MRI Scan Of Abdomen With Contrast
|
14
|
14
|
$1,900.00
|
$1,615.00
|
$950.00
|
$4,750.00
|
$1,539.00
|
2026-06-10
|
|
74183
|
HCPCS
|
MRI Scan Of Abdomen Before And After Contrast
|
14
|
14
|
$2,500.00
|
$2,125.00
|
$1,250.00
|
$6,250.00
|
$2,025.00
|
2026-06-10
|
|
77046
|
HCPCS
|
MRI Scan Of 1 Breast Without Contrast
|
14
|
14
|
$2,000.00
|
$1,700.00
|
$1,000.00
|
$5,000.00
|
$1,620.00
|
2026-06-10
|
|
77048
|
HCPCS
|
MRI Scan Of 1 Breast
|
14
|
14
|
$2,300.00
|
$1,955.00
|
$1,150.00
|
$5,750.00
|
$1,863.00
|
2026-06-10
|
|
25461001_1
|
CDM
|
Mometasone/formoterol (dulera) 200/5 Inh
|
14
|
14
|
$1,123.30
|
$954.81
|
$561.65
|
$1,123.30
|
$909.88
|
2026-06-10
|
|
81404
|
HCPCS
|
Molecular Pathology Procedure Level 5 Genetic Analysis
|
14
|
14
|
$1,650.00
|
$1,402.50
|
$381.92
|
$4,534.70
|
$1,336.50
|
2026-06-10
|
|
25366301_1
|
CDM
|
Lupron Depot 11.25mg, Kit
|
14
|
14
|
$4,442.81
|
$3,776.39
|
$2,221.41
|
$4,442.81
|
$3,598.68
|
2026-06-10
|
|
J9217
|
HCPCS
|
Leuprolide Acetate (for Depot Suspension), 7.5 Mg
|
42
|
14
|
$13,769.80
|
$11,704.33
|
$6,743.40
|
$28,821.50
|
$11,704.33
|
2026-06-10
|
|
36479
|
HCPCS
|
Laser Destruction Of Incompetent Veins Of Arm Or Leg Using Imaging Guidance, Sub…
|
14
|
14
|
$1,730.00
|
$1,470.50
|
$865.00
|
$1,695.40
|
$1,401.30
|
2026-06-10
|
|
36478
|
HCPCS
|
Laser Destruction Of Incompetent Vein Of Arm Or Leg Using Imaging Guidance
|
14
|
14
|
$2,255.00
|
$1,916.75
|
$1,127.50
|
$2,209.90
|
$1,826.55
|
2026-06-10
|
|
49654
|
HCPCS
|
Laparoscopy, Surgical, Repair, Incisional Hernia (includes Mesh Insertion, When …
|
6
|
6
|
$3,802.00
|
$3,231.70
|
$57.25
|
$2,851.50
|
$2,210.69
|
2026-06-10
|
|
25990149_1
|
CDM
|
Lacosamide (vimpat) Oral Soln 10mg/1ml
|
14
|
14
|
$2,547.10
|
$2,165.04
|
$1,273.55
|
$2,547.10
|
$2,063.15
|
2026-06-10
|
|
36573
|
HCPCS
|
Insertion Of Tube For Infusion With Imaging Guidance And Review By Radiologist, …
|
14
|
14
|
$1,102.00
|
$936.70
|
$551.00
|
$1,079.96
|
$892.62
|
2026-06-10
|
|
J3489
|
HCPCS
|
Injection, Zoledronic Acid, 1 Mg
|
42
|
14
|
$1,098.60
|
$933.81
|
$32.20
|
$3,913.80
|
$889.87
|
2026-06-10
|
|
J3380
|
HCPCS
|
Injection, Vedolizumab, Intravenous, 1 Mg
|
14
|
14
|
$31,211.70
|
$26,529.95
|
$15,605.85
|
$31,211.70
|
$25,281.47
|
2026-06-10
|
|
Q5114
|
HCPCS
|
Injection, Trastuzumab-dkst, Biosimilar, (ogivri), 10 Mg
|
14
|
14
|
$2,617.90
|
$2,225.22
|
$1,308.95
|
$2,617.90
|
$2,120.50
|
2026-06-10
|
|
J9351
|
HCPCS
|
Injection, Topotecan, 0.1 Mg
|
14
|
14
|
$1,682.60
|
$1,430.21
|
$841.30
|
$1,682.60
|
$1,362.90
|
2026-06-10
|
|
J3262
|
HCPCS
|
Injection, Tocilizumab, 1 Mg
|
28
|
14
|
$5,309.55
|
$4,513.12
|
$523.10
|
$9,572.90
|
$2,916.32
|
2026-06-10
|
|
J3101
|
HCPCS
|
Injection, Tenecteplase, 1 Mg
|
14
|
14
|
$13,727.30
|
$11,668.21
|
$167.22
|
$13,727.30
|
$9,025.70
|
2026-06-10
|
|
J3095
|
HCPCS
|
Injection, Telavancin, 10 Mg
|
14
|
14
|
$1,495.90
|
$1,271.52
|
$747.95
|
$1,495.90
|
$1,211.68
|
2026-06-10
|
|
J3111
|
HCPCS
|
Injection, Romosozumab-aqqg, 1 Mg
|
13
|
13
|
$4,187.00
|
$3,558.95
|
$2,093.50
|
$4,187.00
|
$3,349.60
|
2026-06-10
|
|
Q5119
|
HCPCS
|
Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg
|
26
|
13
|
$1,975.05
|
$1,678.80
|
$506.30
|
$2,937.50
|
$1,240.67
|
2026-06-10
|
|
Q5115
|
HCPCS
|
Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg
|
28
|
14
|
$2,497.90
|
$2,123.22
|
$637.00
|
$3,721.80
|
$1,567.45
|
2026-06-10
|
|
J9312
|
HCPCS
|
Injection, Rituximab, 10 Mg
|
28
|
14
|
$4,522.05
|
$3,843.74
|
$973.85
|
$7,096.40
|
$2,747.95
|
2026-06-10
|
|
J2327
|
HCPCS
|
Injection, Risankizumab-rzaa, Intravenous, 1 Mg
|
14
|
14
|
$38,287.20
|
$32,544.12
|
$19,143.60
|
$38,287.20
|
$31,012.63
|
2026-06-10
|
|
J0248
|
HCPCS
|
Injection, Remdesivir, 1 Mg
|
14
|
14
|
$1,884.00
|
$1,601.40
|
$942.00
|
$1,884.00
|
$1,526.04
|
2026-06-10
|
|
J2760
|
HCPCS
|
Injection, Phentolamine Mesylate, Up To 5 Mg
|
14
|
14
|
$1,523.30
|
$1,294.81
|
$761.65
|
$1,523.30
|
$1,233.88
|
2026-06-10
|
|
J9306
|
HCPCS
|
Injection, Pertuzumab, 1 Mg
|
14
|
14
|
$8,891.90
|
$7,558.12
|
$4,445.95
|
$8,891.90
|
$7,202.44
|
2026-06-10
|
|
J9305
|
HCPCS
|
Injection, Pemetrexed, Not Otherwise Specified, 10 Mg
|
14
|
14
|
$5,239.00
|
$4,453.15
|
$137.17
|
$5,239.00
|
$3,444.64
|
2026-06-10
|
|
J9271
|
HCPCS
|
Injection, Pembrolizumab, 1 Mg
|
14
|
14
|
$6,819.80
|
$5,796.83
|
$3,409.90
|
$6,819.80
|
$5,524.04
|
2026-06-10
|
|
Q5108
|
HCPCS
|
Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg
|
14
|
14
|
$15,042.00
|
$12,785.70
|
$7,521.00
|
$15,042.00
|
$12,184.02
|
2026-06-10
|
|
J2506
|
HCPCS
|
Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg
|
14
|
14
|
$22,490.00
|
$19,116.50
|
$11,245.00
|
$22,490.00
|
$18,216.90
|
2026-06-10
|
|
J2469
|
HCPCS
|
Injection, Palonosetron Hcl, 25 Mcg
|
14
|
14
|
$1,089.10
|
$925.74
|
$544.55
|
$1,089.10
|
$882.17
|
2026-06-10
|
|
J2426
|
HCPCS
|
Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg
|
14
|
14
|
$6,016.30
|
$5,113.86
|
$3,008.15
|
$6,016.30
|
$4,873.20
|
2026-06-10
|
|
J9264
|
HCPCS
|
Injection, Paclitaxel Protein-bound Particles, 1 Mg
|
14
|
14
|
$2,134.60
|
$1,814.41
|
$1,067.30
|
$2,134.60
|
$1,729.03
|
2026-06-10
|
|
J2357
|
HCPCS
|
Injection, Omalizumab, 5 Mg
|
14
|
14
|
$3,693.00
|
$3,139.05
|
$1,846.50
|
$3,693.00
|
$2,991.33
|
2026-06-10
|
|
J2353
|
HCPCS
|
Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg
|
28
|
14
|
$5,302.15
|
$4,506.83
|
$2,251.60
|
$6,101.10
|
$3,760.17
|
2026-06-10
|
|
J2350
|
HCPCS
|
Injection, Ocrelizumab, 1 Mg
|
14
|
14
|
$74,319.50
|
$63,171.58
|
$37,159.75
|
$74,319.50
|
$60,198.79
|
2026-06-10
|
|
J9299
|
HCPCS
|
Injection, Nivolumab, 1 Mg
|
14
|
14
|
$11,502.00
|
$9,776.70
|
$5,751.00
|
$11,502.00
|
$9,316.62
|
2026-06-10
|
|
J2325
|
HCPCS
|
Injection, Nesiritide, 0.1 Mg
|
14
|
14
|
$1,379.10
|
$1,172.24
|
$689.55
|
$1,379.10
|
$1,117.07
|
2026-06-10
|
|
J0896
|
HCPCS
|
Injection, Luspatercept-aamt, 0.25 Mg
|
13
|
13
|
$7,026.60
|
$5,972.61
|
$3,513.30
|
$7,026.60
|
$5,621.28
|
2026-06-10
|
|
J0641
|
HCPCS
|
Injection, Levoleucovorin, Not Otherwise Specified, 0.5 Mg
|
14
|
14
|
$3,823.50
|
$3,249.98
|
$1,911.75
|
$3,823.50
|
$3,097.03
|
2026-06-10
|
|
J1745
|
HCPCS
|
Injection, Infliximab, Excludes Biosimilar, 10 Mg
|
14
|
14
|
$4,224.60
|
$3,590.91
|
$169.16
|
$4,224.60
|
$2,777.68
|
2026-06-10
|
|
J1306
|
HCPCS
|
Injection, Inclisiran, 1 Mg
|
14
|
14
|
$12,006.30
|
$10,205.36
|
$6,003.15
|
$12,006.30
|
$9,725.10
|
2026-06-10
|
|
J1561
|
HCPCS
|
Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liquid)…
|
28
|
14
|
$6,482.20
|
$5,509.88
|
$1,121.55
|
$10,721.30
|
$3,801.88
|
2026-06-10
|
|
J1569
|
HCPCS
|
Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),…
|
70
|
14
|
$4,490.80
|
$3,817.18
|
$78.55
|
$16,133.20
|
$3,637.55
|
2026-06-10
|
|
J1459
|
HCPCS
|
Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui…
|
28
|
14
|
$6,002.00
|
$5,101.70
|
$1,194.00
|
$9,616.00
|
$3,598.00
|
2026-06-10
|
|
J1742
|
HCPCS
|
Injection, Ibutilide Fumarate, 1 Mg
|
14
|
14
|
$1,640.20
|
$1,394.17
|
$820.10
|
$1,640.20
|
$1,328.56
|
2026-06-10
|
|
J1602
|
HCPCS
|
Injection, Golimumab, 1 Mg, For Intravenous Use
|
14
|
14
|
$6,252.80
|
$5,314.88
|
$3,126.40
|
$6,252.80
|
$5,064.77
|
2026-06-10
|
|
J9395
|
HCPCS
|
Injection, Fulvestrant, 25 Mg
|
14
|
14
|
$3,349.50
|
$2,847.08
|
$1,674.75
|
$3,349.50
|
$2,713.10
|
2026-06-10
|
|
Q0138
|
HCPCS
|
Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd …
|
14
|
14
|
$1,793.10
|
$1,524.14
|
$896.55
|
$1,793.10
|
$1,452.41
|
2026-06-10
|
|
J1439
|
HCPCS
|
Injection, Ferric Carboxymaltose, 1 Mg
|
14
|
14
|
$5,065.60
|
$4,305.76
|
$2,532.80
|
$5,065.60
|
$4,103.14
|
2026-06-10
|
|
J7195
|
HCPCS
|
Injection, Factor Ix (antihemophilic Factor, Recombinant) Per Iu, Not Otherwise …
|
14
|
14
|
$1,512.00
|
$1,285.20
|
$756.00
|
$1,512.00
|
$1,224.72
|
2026-06-10
|
|
J9179
|
HCPCS
|
Injection, Eribulin Mesylate, 0.1 Mg
|
14
|
14
|
$1,820.00
|
$1,547.00
|
$910.00
|
$1,820.00
|
$1,474.20
|
2026-06-10
|
|
J9177
|
HCPCS
|
Injection, Enfortumab Vedotin-ejfv, 0.25 Mg
|
26
|
13
|
$4,835.00
|
$4,109.75
|
$1,939.00
|
$5,792.00
|
$3,141.18
|
2026-06-10
|
|
Q2050
|
HCPCS
|
Injection, Doxorubicin Hydrochloride, Liposomal, Not Otherwise Specified, 10 Mg
|
14
|
14
|
$1,490.10
|
$1,266.59
|
$745.05
|
$1,490.10
|
$1,206.98
|
2026-06-10
|
|
J9171
|
HCPCS
|
Injection, Docetaxel, 1 Mg
|
14
|
14
|
$2,099.50
|
$1,784.58
|
$15.07
|
$2,099.50
|
$1,380.42
|
2026-06-10
|
|
J1162
|
HCPCS
|
Injection, Digoxin Immune Fab (ovine), Per Vial
|
14
|
14
|
$4,314.00
|
$3,666.90
|
$2,157.00
|
$4,314.00
|
$3,494.34
|
2026-06-10
|
|
J0897
|
HCPCS
|
Injection, Denosumab, 1 Mg
|
27
|
14
|
$4,272.80
|
$3,631.88
|
$33.74
|
$12,431.10
|
$4,272.80
|
2026-06-10
|
|
J0881
|
HCPCS
|
Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use)
|
105
|
14
|
$1,126.60
|
$957.61
|
$8.15
|
$7,671.40
|
$901.28
|
2026-06-10
|
|
J9145
|
HCPCS
|
Injection, Daratumumab, 10 Mg
|
28
|
14
|
$2,079.15
|
$1,767.28
|
$532.30
|
$3,093.70
|
$1,305.72
|
2026-06-10
|
|
J0875
|
HCPCS
|
Injection, Dalbavancin, 5 Mg
|
14
|
14
|
$5,536.90
|
$4,706.37
|
$2,768.45
|
$5,536.90
|
$4,484.89
|
2026-06-10
|
|
J0740
|
HCPCS
|
Injection, Cidofovir, 375 Mg
|
14
|
14
|
$2,676.00
|
$2,274.60
|
$1,338.00
|
$2,676.00
|
$2,167.56
|
2026-06-10
|
|
J9055
|
HCPCS
|
Injection, Cetuximab, 10 Mg
|
27
|
14
|
$1,319.50
|
$1,121.58
|
$122.38
|
$1,954.30
|
$1,055.60
|
2026-06-10
|
|
J0717
|
HCPCS
|
Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm…
|
14
|
14
|
$12,648.50
|
$10,751.23
|
$6,324.25
|
$12,648.50
|
$10,245.28
|
2026-06-10
|
|
J9043
|
HCPCS
|
Injection, Cabazitaxel, 1 Mg
|
14
|
14
|
$20,247.80
|
$17,210.63
|
$10,123.90
|
$20,247.80
|
$16,400.72
|
2026-06-10
|
|
J9041
|
HCPCS
|
Injection, Bortezomib, 0.1 Mg
|
14
|
14
|
$2,454.50
|
$2,086.33
|
$104.68
|
$2,454.50
|
$1,613.84
|
2026-06-10
|
|
J0565
|
HCPCS
|
Injection, Bezlotoxumab, 10 Mg
|
14
|
14
|
$13,692.00
|
$11,638.20
|
$6,846.00
|
$13,692.00
|
$11,090.52
|
2026-06-10
|
|
Q5118
|
HCPCS
|
Injection, Bevacizumab-bvzr, Biosimilar, (zirabev), 10 Mg
|
26
|
13
|
$1,999.70
|
$1,699.75
|
$598.45
|
$2,802.50
|
$1,299.08
|
2026-06-10
|
|
J0457
|
HCPCS
|
Injection, Aztreonam, 100 Mg
|
14
|
14
|
$2,651.20
|
$2,253.52
|
$1,325.60
|
$2,651.20
|
$2,147.47
|
2026-06-10
|
|
J9023
|
HCPCS
|
Injection, Avelumab, 10 Mg
|
14
|
14
|
$2,603.90
|
$2,213.32
|
$1,301.95
|
$2,603.90
|
$2,109.16
|
2026-06-10
|
|
J2997
|
HCPCS
|
Injection, Alteplase Recombinant, 1 Mg
|
27
|
14
|
$2,363.00
|
$2,008.55
|
$122.66
|
$29,874.00
|
$2,363.00
|
2026-06-10
|
|
J0257
|
HCPCS
|
Injection, Alpha 1 Proteinase Inhibitor (human), (glassia), 10 Mg
|
14
|
14
|
$1,542.00
|
$1,310.70
|
$771.00
|
$1,542.00
|
$1,249.02
|
2026-06-10
|
|
J0129
|
HCPCS
|
Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere…
|
14
|
14
|
$4,979.60
|
$4,232.66
|
$2,489.80
|
$4,979.60
|
$4,033.47
|
2026-06-10
|
|
64479
|
HCPCS
|
Injection Of Anesthetic And/or Steroid Drug Into Upper Or Middle Spine Nerve Roo…
|
28
|
14
|
$1,296.00
|
$1,101.60
|
$576.50
|
$1,410.22
|
$962.75
|
2026-06-10
|
|
64421
|
HCPCS
|
Injection Of Anesthetic Agent And/or Steroid Into Multiple Rib Nerves For Region…
|
14
|
14
|
$1,093.00
|
$929.05
|
$546.50
|
$1,071.14
|
$885.33
|
2026-06-10
|
|
25990310_1
|
CDM
|
Incruse Ellipta 62.5 Mcg Inh
|
14
|
14
|
$1,240.20
|
$1,054.17
|
$620.10
|
$1,240.20
|
$1,004.56
|
2026-06-10
|
|
01204310_1
|
CDM
|
Harmonic Hd 1000i Shears 36cm
|
14
|
14
|
$1,345.25
|
$1,143.46
|
$672.63
|
$1,345.25
|
$1,089.65
|
2026-06-10
|
|
L8642
|
HCPCS
|
Hallux Implant
|
14
|
14
|
$1,820.00
|
$1,547.00
|
$910.00
|
$1,820.00
|
$1,474.20
|
2026-06-10
|
|
01204347_1
|
CDM
|
Genesys Hta Procerva Procedure Set
|
14
|
14
|
$2,925.00
|
$2,486.25
|
$1,462.50
|
$2,925.00
|
$2,369.25
|
2026-06-10
|
|
81235
|
HCPCS
|
Gene Analysis (epidermal Growth Factor Receptor), Common Variants
|
14
|
14
|
$1,764.00
|
$1,499.40
|
$882.00
|
$5,725.59
|
$1,472.94
|
2026-06-10
|
|
81219
|
HCPCS
|
Gene Analysis (calreticulin), Common Variants
|
14
|
14
|
$1,733.76
|
$1,473.70
|
$866.88
|
$2,108.77
|
$1,447.69
|
2026-06-10
|
|
81163
|
HCPCS
|
Gene Analysis (breast Cancer 1 And 2) Of Full Sequence
|
14
|
14
|
$9,300.00
|
$7,905.00
|
$4,650.00
|
$43,524.00
|
$7,533.00
|
2026-06-10
|
|
01243008_1
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
14
|
14
|
$1,431.00
|
$1,216.35
|
$715.50
|
$1,402.38
|
$1,159.11
|
2026-06-10
|
|
01243007_1
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
14
|
14
|
$1,236.00
|
$1,050.60
|
$618.00
|
$1,211.28
|
$1,001.16
|
2026-06-10
|
|
01773199_1
|
CDM
|
Gastro - Intestinal (gi) Services - General Classification
|
14
|
14
|
$1,165.84
|
$990.96
|
$582.92
|
$1,142.52
|
$944.33
|
2026-06-10
|
|
24800
|
HCPCS
|
Fusion Of Elbow Joint Without Bone Graft From The Patient
|
12
|
12
|
$3,500.00
|
$2,975.00
|
$712.77
|
$2,275.00
|
$1,083.41
|
2026-06-10
|
|
10011
|
HCPCS
|
Fine Needle Aspiration Biopsy Of Growth Using MRI Guidance, First Growth
|
12
|
12
|
$1,400.00
|
$1,190.00
|
$700.00
|
$1,372.00
|
$1,134.00
|
2026-06-10
|
|
10009
|
HCPCS
|
Fine Needle Aspiration Biopsy Of Growth Using CT Guidance, First Growth
|
12
|
12
|
$1,121.00
|
$952.85
|
$560.50
|
$1,098.58
|
$908.01
|
2026-06-10
|
|
13160
|
HCPCS
|
Extensive Or Complicated Repair Of Surface Wound Reopening
|
12
|
12
|
$2,084.00
|
$1,771.40
|
$681.58
|
$1,567.63
|
$889.47
|
2026-06-10
|
|
04458043_1
|
CDM
|
Extension #3382
|
14
|
14
|
$1,369.85
|
$1,164.37
|
$684.93
|
$1,369.85
|
$1,109.58
|
2026-06-10
|
|
C1764
|
HCPCS
|
Event Recorder, Cardiac (implantable)
|
14
|
14
|
$7,942.50
|
$6,751.13
|
$3,971.25
|
$7,942.50
|
$6,433.43
|
2026-06-10
|
|
01725248_1
|
CDM
|
ER Physician Fb Removal From Forearm
|
5
|
5
|
$1,793.00
|
$1,524.05
|
$950.29
|
$1,434.40
|
$1,201.31
|
2026-06-10
|
|
25000904_1
|
CDM
|
Donnatal Elixir
|
14
|
14
|
$1,154.50
|
$981.33
|
$577.25
|
$1,154.50
|
$935.14
|
2026-06-10
|
|
36476
|
HCPCS
|
Destruction Of Subsequent Incompetent Veins Of Arm Or Leg Using Radiofrequency A…
|
14
|
14
|
$1,800.00
|
$1,530.00
|
$900.00
|
$1,764.00
|
$1,458.00
|
2026-06-10
|
|
64624
|
HCPCS
|
Destruction Of Nerve Branches Of Knee Using Imaging Guidance
|
50
|
14
|
$1,850.00
|
$1,572.50
|
$125.84
|
$1,813.00
|
$925.00
|
2026-06-10
|
|
64635
|
HCPCS
|
Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,…
|
52
|
14
|
$2,677.00
|
$2,275.45
|
$163.50
|
$3,998.40
|
$1,035.30
|
2026-06-10
|
|
36475
|
HCPCS
|
Destruction Of First Incompetent Vein Of Arm Or Leg Using Radiofrequency And Ima…
|
14
|
14
|
$3,120.00
|
$2,652.00
|
$1,560.00
|
$3,057.60
|
$2,527.20
|
2026-06-10
|
|
Q4106
|
HCPCS
|
Dermagraft, Per Square Centimeter
|
14
|
14
|
$2,205.00
|
$1,874.25
|
$1,102.50
|
$2,205.00
|
$1,786.05
|
2026-06-10
|
|
20225
|
HCPCS
|
Deep Biopsy Of Bone Using Needle Or Trocar
|
14
|
14
|
$1,264.00
|
$1,074.40
|
$632.00
|
$1,238.72
|
$1,023.84
|
2026-06-10
|
|
72125
|
HCPCS
|
CT Scan Of Upper Spine Without Contrast
|
14
|
14
|
$1,475.00
|
$1,253.75
|
$737.50
|
$3,687.50
|
$980.40
|
2026-06-10
|
|
72126
|
HCPCS
|
CT Scan Of Upper Spine With Contrast
|
14
|
14
|
$1,452.00
|
$1,234.20
|
$726.00
|
$3,630.00
|
$1,110.92
|
2026-06-10
|
|
72127
|
HCPCS
|
CT Scan Of Upper Spine Before And After Contrast
|
14
|
14
|
$1,617.00
|
$1,374.45
|
$808.50
|
$4,042.50
|
$1,244.57
|
2026-06-10
|
|
70491
|
HCPCS
|
CT Scan Of Soft Tissue Of Neck With Contrast
|
14
|
14
|
$1,650.00
|
$1,402.50
|
$825.00
|
$4,125.00
|
$1,190.12
|
2026-06-10
|
|
70492
|
HCPCS
|
CT Scan Of Soft Tissue Of Neck Before And After Contrast
|
14
|
14
|
$1,750.00
|
$1,487.50
|
$875.00
|
$4,375.00
|
$1,297.78
|
2026-06-10
|
|
72192
|
HCPCS
|
CT Scan Of Pelvis Without Contrast
|
14
|
14
|
$1,425.00
|
$1,211.25
|
$712.50
|
$3,562.50
|
$960.40
|
2026-06-10
|
|
72193
|
HCPCS
|
CT Scan Of Pelvis With Contrast
|
14
|
14
|
$1,498.00
|
$1,273.30
|
$749.00
|
$3,745.00
|
$1,129.33
|
2026-06-10
|
|
72194
|
HCPCS
|
CT Scan Of Pelvis Before And After Contrast
|
14
|
14
|
$1,800.00
|
$1,530.00
|
$900.00
|
$4,500.00
|
$1,317.78
|
2026-06-10
|
|
72128
|
HCPCS
|
CT Scan Of Middle Spine Without Contrast
|
14
|
14
|
$1,400.00
|
$1,190.00
|
$700.00
|
$3,500.00
|
$950.40
|
2026-06-10
|
|
72129
|
HCPCS
|
CT Scan Of Middle Spine With Contrast
|
14
|
14
|
$1,687.00
|
$1,433.95
|
$843.50
|
$4,217.50
|
$1,204.92
|
2026-06-10
|
|
72130
|
HCPCS
|
CT Scan Of Middle Spine Before And After Contrast
|
14
|
14
|
$1,895.00
|
$1,610.75
|
$947.50
|
$4,737.50
|
$1,355.78
|
2026-06-10
|
|
72131
|
HCPCS
|
CT Scan Of Lower Spine Without Contrast
|
14
|
14
|
$1,450.00
|
$1,232.50
|
$725.00
|
$3,625.00
|
$970.40
|
2026-06-10
|
|
72132
|
HCPCS
|
CT Scan Of Lower Spine With Contrast
|
14
|
14
|
$1,442.00
|
$1,225.70
|
$721.00
|
$3,605.00
|
$1,106.92
|
2026-06-10
|
|
72133
|
HCPCS
|
CT Scan Of Lower Spine Before And After Contrast
|
14
|
14
|
$1,590.00
|
$1,351.50
|
$795.00
|
$3,975.00
|
$1,233.78
|
2026-06-10
|
|
73700
|
HCPCS
|
CT Scan Of Leg Without Contrast
|
28
|
14
|
$1,300.00
|
$1,105.00
|
$650.00
|
$3,250.00
|
$910.40
|
2026-06-10
|
|
73701
|
HCPCS
|
CT Scan Of Leg With Contrast Material
|
28
|
14
|
$1,425.00
|
$1,211.25
|
$712.50
|
$3,562.50
|
$1,100.12
|
2026-06-10
|
|
73702
|
HCPCS
|
CT Scan Of Leg Before And After Contrast
|
28
|
14
|
$1,630.00
|
$1,385.50
|
$815.00
|
$4,075.00
|
$1,249.78
|
2026-06-10
|
|
70470
|
HCPCS
|
CT Scan Of Head Or Brain Before And After Contrast
|
14
|
14
|
$1,650.00
|
$1,402.50
|
$825.00
|
$4,125.00
|
$1,257.78
|
2026-06-10
|
|
70486
|
HCPCS
|
CT Scan Of Face Without Contrast
|
14
|
14
|
$1,350.00
|
$1,147.50
|
$675.00
|
$3,375.00
|
$930.40
|
2026-06-10
|
|
70487
|
HCPCS
|
CT Scan Of Face With Contrast
|
14
|
14
|
$1,678.00
|
$1,426.30
|
$839.00
|
$4,195.00
|
$1,201.33
|
2026-06-10
|
|
70488
|
HCPCS
|
CT Scan Of Face Before And After Contrast
|
14
|
14
|
$1,750.00
|
$1,487.50
|
$875.00
|
$4,375.00
|
$1,297.78
|
2026-06-10
|
|
70480
|
HCPCS
|
CT Scan Of Cranial Cavity Without Contrast
|
14
|
14
|
$1,420.00
|
$1,207.00
|
$710.00
|
$3,550.00
|
$958.40
|
2026-06-10
|
|
70481
|
HCPCS
|
CT Scan Of Cranial Cavity With Contrast
|
14
|
14
|
$1,530.00
|
$1,300.50
|
$765.00
|
$3,825.00
|
$1,142.12
|
2026-06-10
|
|
70482
|
HCPCS
|
CT Scan Of Cranial Cavity Before And After Contrast
|
14
|
14
|
$1,675.00
|
$1,423.75
|
$837.50
|
$4,187.50
|
$1,267.78
|
2026-06-10
|
|
71250
|
HCPCS
|
CT Scan Of Chest Without Contrast
|
27
|
14
|
$1,600.00
|
$1,360.00
|
$750.00
|
$4,000.00
|
$1,200.00
|
2026-06-10
|
|
71260
|
HCPCS
|
CT Scan Of Chest With Contrast
|
14
|
14
|
$1,800.00
|
$1,530.00
|
$900.00
|
$4,500.00
|
$1,250.12
|
2026-06-10
|
|
71270
|
HCPCS
|
CT Scan Of Chest Before And After Contrast
|
14
|
14
|
$1,960.00
|
$1,666.00
|
$980.00
|
$4,900.00
|
$1,381.78
|
2026-06-10
|
|
70498
|
HCPCS
|
CT Scan Of Blood Vessels Of Neck With Contrast
|
27
|
14
|
$1,923.00
|
$1,634.55
|
$961.50
|
$4,937.50
|
$1,538.40
|
2026-06-10
|
|
73706
|
HCPCS
|
CT Scan Of Blood Vessels Of Lower Leg With Contrast
|
28
|
14
|
$2,300.00
|
$1,955.00
|
$1,150.00
|
$5,750.00
|
$1,523.00
|
2026-06-10
|
|
70496
|
HCPCS
|
CT Scan Of Blood Vessels Of Head With Contrast
|
14
|
14
|
$1,943.00
|
$1,651.55
|
$971.50
|
$4,857.50
|
$1,380.20
|
2026-06-10
|
|
71275
|
HCPCS
|
CT Scan Of Blood Vessels Of Chest With Contrast
|
27
|
14
|
$2,000.00
|
$1,700.00
|
$975.00
|
$5,000.00
|
$1,560.00
|
2026-06-10
|
|
73206
|
HCPCS
|
CT Scan Of Blood Vessels Of Arm With Contrast
|
28
|
14
|
$2,050.00
|
$1,742.50
|
$1,025.00
|
$5,125.00
|
$1,423.00
|
2026-06-10
|
|
74175
|
HCPCS
|
CT Scan Of Blood Vessels Of Abdomen With Contrast
|
14
|
14
|
$2,200.00
|
$1,870.00
|
$1,100.00
|
$5,500.00
|
$1,483.00
|
2026-06-10
|
|
74174
|
HCPCS
|
CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast
|
14
|
14
|
$2,500.00
|
$2,125.00
|
$1,250.00
|
$6,250.00
|
$1,920.65
|
2026-06-10
|
|
73201
|
HCPCS
|
CT Scan Of Arm With Contrast
|
28
|
14
|
$1,368.00
|
$1,162.80
|
$618.00
|
$3,750.00
|
$1,032.06
|
2026-06-10
|
|
73202
|
HCPCS
|
CT Scan Of Arm Before And After Contrast
|
28
|
14
|
$1,940.00
|
$1,649.00
|
$970.00
|
$4,850.00
|
$1,373.78
|
2026-06-10
|
|
75635
|
HCPCS
|
CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast
|
14
|
14
|
$2,365.13
|
$2,010.36
|
$1,182.57
|
$5,912.83
|
$1,555.07
|
2026-06-10
|
|
74150
|
HCPCS
|
CT Scan Of Abdomen Without Contrast
|
14
|
14
|
$1,250.00
|
$1,062.50
|
$625.00
|
$3,125.00
|
$890.40
|
2026-06-10
|
|
74160
|
HCPCS
|
CT Scan Of Abdomen With Contrast
|
14
|
14
|
$1,700.00
|
$1,445.00
|
$850.00
|
$4,250.00
|
$1,210.12
|
2026-06-10
|
|
74170
|
HCPCS
|
CT Scan Of Abdomen Before And After Contrast
|
14
|
14
|
$1,900.00
|
$1,615.00
|
$950.00
|
$4,750.00
|
$1,357.78
|
2026-06-10
|
|
74176
|
HCPCS
|
CT Scan Of Abdomen And Pelvis Without Contrast
|
27
|
14
|
$2,145.00
|
$1,823.25
|
$1,072.50
|
$5,625.00
|
$1,716.00
|
2026-06-10
|
|
74177
|
HCPCS
|
CT Scan Of Abdomen And Pelvis With Contrast
|
14
|
14
|
$2,750.00
|
$2,337.50
|
$1,375.00
|
$6,875.00
|
$2,020.65
|
2026-06-10
|
|
74178
|
HCPCS
|
CT Scan Of Abdomen And Pelvis Before And After Contrast
|
14
|
14
|
$2,950.00
|
$2,507.50
|
$1,475.00
|
$7,375.00
|
$2,100.65
|
2026-06-10
|
|
70450
|
HCPCS
|
CT Scan Head Or Brain Without Contrast
|
14
|
14
|
$1,300.00
|
$1,105.00
|
$650.00
|
$3,250.00
|
$910.40
|
2026-06-10
|
|
70460
|
HCPCS
|
CT Scan Head Or Brain With Contrast
|
14
|
14
|
$1,500.00
|
$1,275.00
|
$750.00
|
$3,750.00
|
$1,130.12
|
2026-06-10
|
|
99291
|
HCPCS
|
Critical Care, First 30-74 Minutes
|
26
|
14
|
$1,900.00
|
$1,615.00
|
$188.30
|
$1,862.00
|
$954.75
|
2026-06-10
|
|
57288
|
HCPCS
|
Creation Of Sling Around Urethra In Female To Control Leakage
|
12
|
12
|
$3,775.00
|
$3,208.75
|
$613.68
|
$2,453.75
|
$877.05
|
2026-06-10
|
|
C1763
|
HCPCS
|
Connective Tissue, Non-human (includes Synthetic)
|
70
|
14
|
$1,910.15
|
$1,623.63
|
$631.50
|
$4,633.50
|
$1,526.76
|
2026-06-10
|
|
25001314_1
|
CDM
|
Combivent Respimat 20-100 Mcg
|
14
|
14
|
$1,152.20
|
$979.37
|
$576.10
|
$1,152.20
|
$933.28
|
2026-06-10
|
|
25047103_1
|
CDM
|
Chantix Starting Month Box
|
14
|
14
|
$1,519.20
|
$1,291.32
|
$759.60
|
$1,519.20
|
$1,230.55
|
2026-06-10
|
|
25008214_1
|
CDM
|
Atrovent 17 Mcg Hfa Inhaler
|
14
|
14
|
$1,296.20
|
$1,101.77
|
$648.10
|
$1,296.20
|
$1,049.92
|
2026-06-10
|
|
50390
|
HCPCS
|
Aspiration And/or Injection Of Cyst Of Kidney
|
14
|
14
|
$1,442.00
|
$1,225.70
|
$721.00
|
$1,413.16
|
$1,168.02
|
2026-06-10
|
|
Q4101
|
HCPCS
|
Apligraf, Per Square Centimeter
|
14
|
14
|
$2,271.00
|
$1,930.35
|
$1,135.50
|
$2,271.00
|
$1,839.51
|
2026-06-10
|
|
23430
|
HCPCS
|
Anchoring Of Biceps Tendon
|
12
|
12
|
$3,284.00
|
$2,791.40
|
$637.49
|
$2,134.60
|
$968.98
|
2026-06-10
|
|
01204769_1
|
CDM
|
Allomax Soft Tissue Graft
|
14
|
14
|
$6,615.00
|
$5,622.75
|
$3,307.50
|
$6,615.00
|
$5,358.15
|
2026-06-10
|
|
03005070_1
|
CDM
|
Alloderm Select Tissue 2.4+0.4
|
14
|
14
|
$3,750.00
|
$3,187.50
|
$1,875.00
|
$3,750.00
|
$3,037.50
|
2026-06-10
|
|
04458044_1
|
CDM
|
16 Ch Receiver Kit 3416
|
14
|
14
|
$14,378.50
|
$12,221.73
|
$7,189.25
|
$14,378.50
|
$11,646.58
|
2026-06-10
|