Hospital

PENOBSCOT VALLEY HOSPITAL

Lincoln, ME · CCN 201303 · Rates published

5,795 distinct procedures filed

17 distinct payers

212,948 rate rows

2026-05-09 last MRF observed

Data quality

209,344 of 212,948 rate rows are consumer-grade (98.3%)

3,604 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
placeholder amount (≤ $0.02) — excluded from medians	3,394
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	166
per-diem day rate — not a per-procedure price	44

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

Source MRF file	https://pvhme.org/files/price-transparency/010545327_penobscot-valley-hospital_standardcharges.csv
Found on page	https://pvhme.org/patient-resources/price-transparency/
Discovered via	CMS hospital list
Last fetch	success · 2026-06-08
Content fingerprint	ac66df12aa2d01c3… · 67,734,186 bytes · first seen 2026-06-08

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
J2507 OTHER	Nf-pegloticase 8mg/1ml Vial(krystexxa	10	$3,240.90	$39,362.36	$20,091.21	nat. median $3,771 outlier · 5.3×
J2507 HCPCS	Nf-pegloticase 8mg/1ml Vial(krystexxa	11	$3,240.90	$39,362.36	$19,271.16	nat. median $8,536 outlier · 2.3×
J2350 OTHER	Nf-ocrevus 300mg/10ml Vial	10	$15,295.08	$31,214.43	$16,777.08	nat. median $65 outlier · 258.6×
J2350 HCPCS	Nf-ocrevus 300mg/10ml Vial	11	$14,670.79	$31,214.43	$16,455.57	nat. median $683 outlier · 24.1×
J3101 HCPCS	Tnk 50mg Inj Syr(tenectepl)	11	$7,501.70	$16,812.62	$8,231.18	nat. median $5,957 1.4× median
J3101 OTHER	Tnk 50mg Inj Syr(tenectepl)	10	$7,501.70	$15,869.43	$8,100.02	nat. median $195 outlier · 41.5×
J3380 OTHER	Vedolizumab 300mg Inj Vial(entyvio)-nf	10	$6,555.02	$14,882.84	$7,596.45	nat. median $24 outlier · 321.9×
J3380 HCPCS	Vedolizumab 300mg Inj Vial(entyvio)-nf	11	$6,555.02	$14,882.84	$7,286.39	nat. median $280 outlier · 26.0×
J3590 OTHER	Nf-taltz Subcutaneous Solution 80 mg/1mL	10	$6,018.79	$12,032.56	$6,199.35	nat. median $836 outlier · 7.4×
J3590 HCPCS	Nf-taltz Subcutaneous Solution 80 mg/1mL	10	$5,773.12	$12,032.56	$5,918.63	nat. median $683 outlier · 8.7×
J1162 HCPCS	Digoxin Immune Fab 40mg Inj (digibind)	11	$4,650.00	$9,893.62	$4,789.50	nat. median $7,308 0.7× median
J2506 OTHER	Nf-neulasta Onpro Kit 6 Mg/0.6 Ml	10	$440.70	$9,079.95	$4,634.56	nat. median $124 outlier · 37.4×
J0517 OTHER	Nf-benralizumab 30mg/ml Inj	10	$167.15	$8,878.71	$4,531.84	nat. median $174 outlier · 26.0×
J2506 HCPCS	Nf-neulasta Onpro Kit 6 Mg/0.6 Ml	11	$440.70	$9,079.95	$4,445.39	nat. median $2,076 outlier · 2.1×
J3240 HCPCS	Thyrotropin Alfa 0.9 Mg/ml Inj Vial-nf	11	$1,971.03	$8,934.07	$4,373.97	nat. median $2,976 1.5× median
J0517 HCPCS	Nf-benralizumab 30mg/ml Inj	11	$167.15	$8,878.71	$4,346.87	nat. median $914 outlier · 4.8×
Q5111 HCPCS	Pegfilgrastim-cbqv 6mg/0.6ml(udenyca)	11	$147.76	$8,748.17	$4,282.96	nat. median $2,102 outlier · 2.0×
50590 OTHER	Lithotripsy	10	$521.60	$8,407.62	$4,205.56	nat. median $3,608 1.2× median
31582 OTHER	Laryngoplasty Rem Web 2 Stage W Keel Ins	9	$2,646.45	$5,184.87	$3,915.66	nat. median $6,848 0.6× median
J1162 OTHER	Digoxin Immune Fab 40mg Inj (digibind)	10	$3,754.01	$7,661.25	$3,866.63	nat. median $5,270 0.7× median
31582 HCPCS	Laryngoplasty Rem Web 2 Stage W Keel Ins	9	$2,538.43	$5,184.87	$3,861.65	nat. median $5,366 0.7× median
61608 HCPCS	Resection Excision Lesion Parasellar Int	11	$2,790.13	$9,092.70	$3,829.28	nat. median $4,160 0.9× median
61585 HCPCS	Orbitocranial App Ant Cran Fos Extr W/ex	11	$2,872.73	$8,403.10	$3,808.88	nat. median $4,160 0.9× median
61592 HCPCS	Orbitocranial Zygomatic App Mid Cran Fos	11	$2,687.72	$8,782.66	$3,704.04	nat. median $4,160 0.9× median
41155 HCPCS	Glossectomy Commando Type Com Res Fl Mo	11	$2,406.42	$8,396.28	$3,628.00	nat. median $4,087 0.9× median
61591 HCPCS	Infratemporal Post Auricular Mid Cran Fo	11	$2,516.11	$8,955.71	$3,566.80	nat. median $4,160 0.9× median
61582 HCPCS	Craniofacial Approach Anterior Fossa	11	$2,732.47	$7,907.27	$3,544.39	nat. median $4,081 0.9× median
0360 RC		10	$327.79	$36,399.37	$3,542.39	nat. median $2,181 1.6× median
Q5122 OTHER	Nf-pegfilgrastim-apgf 6mg/0.6ml(nyvepria	10	$523.20	$6,937.47	$3,541.00	nat. median $146 outlier · 24.2×
31395 HCPCS	Pharyngolaryngectomy W Rad Nk Dis Recon	11	$2,353.81	$8,489.10	$3,533.33	nat. median $4,142 0.9× median
61590 HCPCS	Infratemporal Pre Auricular Mid Cran Fos	11	$2,434.07	$8,890.73	$3,528.38	nat. median $4,160 0.8× median
20970 HCPCS	Free Ostecutaneous Flap W/micro Ana Ilia	11	$2,314.10	$8,271.92	$3,493.28	nat. median $6,009 0.6× median
61606 HCPCS	Resection Excision Lesion Infra Foss Int	11	$2,429.85	$8,327.64	$3,429.15	nat. median $4,036 0.8× median
360 OTHER	Op Minor Surgery	10	$328.59	$34,999.39	$3,398.56	nat. median $7,392 outlier · 0.5×
Q5122 HCPCS	Nf-pegfilgrastim-apgf 6mg/0.6ml(nyvepria	11	$523.20	$6,937.47	$3,396.47	nat. median $439 outlier · 7.7×
61583 HCPCS	Craniofacial Approach Ant Fossa Intradur	11	$2,584.28	$8,059.35	$3,370.73	nat. median $4,037 0.8× median
75635 OTHER	CT Angiography Abd. Aorta W/le Runoff	10	$367.26	$6,595.65	$3,366.53	nat. median $318 outlier · 10.6×
75635 HCPCS	CT Angiography Abd. Aorta W/le Runoff	11	$374.88	$6,859.48	$3,358.29	nat. median $706 outlier · 4.8×
61584 HCPCS	Orbitocranial Approach Ant Cran Fos Extr	11	$2,509.17	$7,867.15	$3,349.92	nat. median $4,063 0.8× median
31390 HCPCS	Pharyngolaryngectomy W Radical Neck Diss	11	$2,241.24	$7,946.36	$3,348.53	nat. median $4,071 0.8× median
61608 OTHER	Resection Excision Lesion Parasellar Int	10	$2,847.61	$8,742.98	$3,341.58	nat. median $4,266 0.8× median
61585 OTHER	Orbitocranial App Ant Cran Fos Extr W/ex	10	$2,842.24	$8,079.91	$3,335.28	nat. median $4,773 0.7× median
44238 HCPCS	Laparoscopy Procedure Intestine	10	$2,145.72	$4,472.20	$3,330.86	nat. median $6,688 outlier · 0.5×
20969 HCPCS	Free Ostecutaneous Flap W/micro Ana Othe	11	$2,143.30	$8,321.64	$3,323.44	nat. median $6,254 0.5× median
52648 OTHER	Greenlight Photoselective Vap Of Prostat	10	$631.23	$6,523.15	$3,262.94	nat. median $5,188 0.6× median
44238 OTHER	Laparoscopy Procedure Intestine	9	$2,194.89	$4,300.20	$3,247.55	nat. median $6,256 0.5× median
20956 HCPCS	Bone Graft Iliac Crest	11	$2,145.10	$7,846.50	$3,240.38	nat. median $6,673 outlier · 0.5×
61592 OTHER	Orbitocranial Zygomatic App Mid Cran Fos	10	$2,754.17	$8,444.86	$3,231.94	nat. median $4,606 0.7× median
61591 OTHER	Infratemporal Post Auricular Mid Cran Fo	10	$2,724.73	$8,611.26	$3,197.39	nat. median $4,490 0.7× median
J1944 OTHER	Aripiprazole Lauroxil ER 1064mg/3.9ml-nf	10	$1,341.91	$7,567.73	$3,184.63	nat. median $3 outlier · 938.0×

Other procedures at this hospital

Browse this hospital's 5,795 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

0360	RC	—	900	10	$5,792.85	$4,634.28 20% off	$327.79	$36,399.37	$3,542.39	2026-04-24
15756	HCPCS	Free Muscle Flap W/microvas Anastamosis	21	11	$7,127.53	$5,702.02 20% off	$1,805.78	$6,842.43	$2,411.81	2026-04-24
15756	OTHER	Free Muscle Flap W/microvas Anastamosis	11	10	$6,853.39	$5,482.71 20% off	$2,033.21	$6,579.25	$2,385.91	2026-05-09
15757	HCPCS	Free Skin Flap W/micro Anastomosis	21	11	$7,118.60	$5,694.88 20% off	$1,793.30	$6,833.86	$2,386.31	2026-04-24
15757	OTHER	Free Skin Flap W/micro Anastomosis	11	10	$6,844.81	$5,475.85	$2,022.59	$6,571.02	$2,373.45	2026-05-09
15758	OTHER	Free Fascia Flap W/micro Anatomosis	11	10	$3,652.27	$2,921.82	$1,789.61	$3,506.18	$2,339.95	2026-05-09
15758	HCPCS	Free Fascia Flap W/micro Anatomosis	21	11	$3,798.36	$3,038.69	$1,749.53	$3,646.43	$2,077.42	2026-04-24
200	OTHER	ICU Room & Board	6	6	$3,150.00	$2,520.00 20% off	$2,279.97	$3,024.00	$2,879.11	2026-05-09
20696	HCPCS	Application Multiplane Uni Ext Fix W/com	21	11	$3,376.15	$2,700.92 20% off	$972.81	$3,241.10	$1,453.46	2026-04-24
20955	HCPCS	Bone Graft W/micro Anastomosis Fibula	21	11	$7,765.83	$6,212.66 20% off	$2,076.34	$7,455.20	$3,021.95	2026-04-24
20955	OTHER	Bone Graft W/micro Anastomosis Fibula	11	10	$7,467.14	$5,973.71 20% off	$2,180.14	$7,168.45	$2,558.32	2026-05-09
20956	HCPCS	Bone Graft Iliac Crest	21	11	$8,173.44	$6,538.75 20% off	$2,145.10	$7,846.50	$3,240.38	2026-04-24
20956	OTHER	Bone Graft Iliac Crest	11	10	$7,859.08	$6,287.26 20% off	$2,346.92	$7,544.72	$2,754.04	2026-05-09
20969	HCPCS	Free Ostecutaneous Flap W/micro Ana Othe	21	11	$8,668.37	$6,934.70	$2,143.30	$8,321.64	$3,323.44	2026-04-24
20969	OTHER	Free Ostecutaneous Flap W/micro Ana Othe	11	10	$8,334.97	$6,667.98	$2,422.84	$8,001.57	$2,843.13	2026-05-09
20970	HCPCS	Free Ostecutaneous Flap W/micro Ana Ilia	21	11	$8,616.58	$6,893.26 20% off	$2,314.10	$8,271.92	$3,493.28	2026-04-24
20970	OTHER	Free Ostecutaneous Flap W/micro Ana Ilia	11	10	$8,285.17	$6,628.14	$2,532.71	$7,953.76	$2,972.06	2026-05-09
21045	HCPCS	Excision Malignant Tumor Mandible Rad Re	21	11	$3,692.85	$2,954.28	$977.20	$3,545.14	$1,471.32	2026-04-24
22999	HCPCS	Abdomen Surgery Procedure Unlisted	13	10	$2,701.46	$2,161.17	$1,244.30	$2,593.40	$1,931.55	2026-04-24
22999	OTHER	Abdomen Surgery Procedure Unlisted	10	9	$2,597.56	$2,078.05	$1,272.80	$2,493.66	$1,883.23	2026-05-09
23470	HCPCS	Shoulder Hemiarthroplasty	21	11	$3,641.46	$2,913.17	$991.76	$3,495.80	$1,476.30	2026-04-24
23472	HCPCS	Total Shoulder Arthroplasty	21	11	$4,513.27	$3,610.62	$1,186.33	$4,332.74	$1,778.62	2026-04-24
23472	OTHER	Total Shoulder Arthroplasty	11	10	$4,339.68	$3,471.74 20% off	$1,290.76	$4,166.09	$1,514.67	2026-05-09
27245	HCPCS	Txt Intertrochameric W Intramedullary IM	21	11	$3,724.67	$2,979.74	$1,018.46	$3,575.68	$1,509.53	2026-04-24
30410	HCPCS	Rhinoplasty Primary Complete Ext Parts	21	11	$3,794.77	$3,035.82	$1,232.20	$3,642.98	$1,462.89	2026-04-24
30410	OTHER	Rhinoplasty Primary Complete Ext Parts	11	10	$3,648.82	$2,919.06	$1,245.27	$3,502.87	$1,461.28	2026-05-09
30420	HCPCS	Rhinoplasty Primary Inc Maj Scent Repair	21	11	$4,148.84	$3,319.07 20% off	$1,201.96	$3,982.89	$1,611.71	2026-04-24
30420	OTHER	Rhinoplasty Primary Inc Maj Scent Repair	11	10	$3,989.27	$3,191.42	$1,278.04	$3,829.70	$1,499.74	2026-05-09
31225	HCPCS	Maxillectomy Wo Orbital Exenteration	21	11	$5,455.39	$4,364.31 20% off	$1,453.39	$5,237.17	$2,158.76	2026-04-24
31225	OTHER	Maxillectomy Wo Orbital Exenteration	11	10	$5,245.57	$4,196.46	$1,606.84	$5,035.75	$1,885.57	2026-05-09
31230	HCPCS	Maxillectomy W Orbital Exenteration En B	21	11	$6,154.31	$4,923.45	$1,608.84	$5,908.14	$2,385.67	2026-04-24
31230	OTHER	Maxillectomy W Orbital Exenteration En B	11	10	$5,917.61	$4,734.09	$1,793.00	$5,680.91	$2,104.03	2026-05-09
31291	HCPCS	Nasal Sin End Surg W Rep Cereb Leak Sphe	21	11	$3,794.77	$3,035.82	$985.02	$3,642.98	$1,428.95	2026-04-24
31360	HCPCS	Laryngectomy Total Wo Radical Neck Disse	21	11	$5,880.66	$4,704.53	$1,662.39	$5,645.43	$2,444.96	2026-04-24
31360	OTHER	Laryngectomy Total Wo Radical Neck Disse	11	10	$5,654.48	$4,523.58 20% off	$1,830.31	$5,428.30	$2,147.81	2026-05-09
31365	HCPCS	Laryngectomy Total W Radical Neck Disse	21	11	$7,391.27	$5,913.02	$2,041.66	$7,095.62	$3,018.17	2026-04-24
31365	OTHER	Laryngectomy Total W Radical Neck Disse	11	10	$7,106.99	$5,685.59 20% off	$2,262.85	$6,822.71	$2,655.38	2026-05-09
31367	HCPCS	Laryngectomy Subtot Supragiotic Wo Rad	21	11	$6,808.58	$5,446.86 20% off	$1,768.50	$6,536.24	$2,585.20	2026-04-24
31367	OTHER	Laryngectomy Subtot Supragiotic Wo Rad	11	10	$6,546.71	$5,237.37	$1,934.33	$6,284.84	$2,269.88	2026-05-09
31368	HCPCS	Laryngectomy Subtot Supragiotic W Rad	21	11	$7,262.57	$5,810.06	$1,949.95	$6,972.07	$2,871.40	2026-04-24
31368	OTHER	Laryngectomy Subtot Supragiotic W Rad	11	10	$6,983.24	$5,586.59 20% off	$2,137.28	$6,703.91	$2,508.04	2026-05-09
31370	HCPCS	Partial Laryngetomy Horizontal	21	11	$6,089.72	$4,871.78	$1,666.45	$5,846.13	$2,431.06	2026-04-24
31370	OTHER	Partial Laryngetomy Horizontal	11	10	$5,855.50	$4,684.40 20% off	$1,812.64	$5,621.28	$2,127.07	2026-05-09
31375	HCPCS	Partial Laryngetomy Laterovertical	21	11	$5,726.35	$4,581.08 20% off	$1,586.78	$5,497.30	$2,303.49	2026-04-24
31375	OTHER	Partial Laryngetomy Laterovertical	11	10	$5,506.11	$4,404.89	$1,723.80	$5,285.87	$2,022.83	2026-05-09
31380	HCPCS	Partial Laryngetomy Anterovertical	21	11	$5,663.94	$4,531.15 20% off	$1,565.70	$5,437.38	$2,274.06	2026-04-24
31380	OTHER	Partial Laryngetomy Anterovertical	11	10	$5,446.10	$4,356.88 20% off	$1,699.56	$5,228.26	$1,994.39	2026-05-09
31382	HCPCS	Partial Laryngetomy Anter Latero Vertica	21	11	$6,198.04	$4,958.43 20% off	$1,708.61	$5,950.12	$2,494.84	2026-04-24
31382	OTHER	Partial Laryngetomy Anter Latero Vertica	11	10	$5,959.65	$4,767.72	$1,861.03	$5,721.26	$2,183.86	2026-05-09
31390	HCPCS	Pharyngolaryngectomy W Radical Neck Diss	21	11	$8,277.46	$6,621.97	$2,241.24	$7,946.36	$3,348.53	2026-04-24
31390	OTHER	Pharyngolaryngectomy W Radical Neck Diss	11	10	$7,959.10	$6,367.28 20% off	$2,489.92	$7,640.74	$2,921.84	2026-05-09
31395	HCPCS	Pharyngolaryngectomy W Rad Nk Dis Recon	21	11	$8,842.81	$7,074.25	$2,353.81	$8,489.10	$3,533.33	2026-04-24
31395	OTHER	Pharyngolaryngectomy W Rad Nk Dis Recon	11	10	$8,502.70	$6,802.16 20% off	$2,608.36	$8,162.59	$3,060.83	2026-05-09
31582	OTHER	Laryngoplasty Rem Web 2 Stage W Keel Ins	10	9	$5,400.91	$4,320.73	$2,646.45	$5,184.87	$3,915.66	2026-05-09
31582	HCPCS	Laryngoplasty Rem Web 2 Stage W Keel Ins	9	9	$5,400.91	$4,320.73	$2,538.43	$5,184.87	$3,861.65	2026-04-24
360	OTHER	Op Minor Surgery	901	10	$5,570.05	$4,456.04 20% off	$328.59	$34,999.39	$3,398.56	2026-05-09
37617	HCPCS	Ligation Major Artery Abdomen	21	11	$3,766.37	$3,013.10	$1,093.12	$3,615.72	$1,613.76	2026-04-24
38720	HCPCS	Cervical Lymphadenectomy Complete	21	11	$3,850.50	$3,080.40 20% off	$1,096.37	$3,696.48	$1,532.03	2026-04-24
38724	HCPCS	Cervical Lymphadenectomy Mod Rad Nk Diss	21	11	$4,199.36	$3,359.49	$1,163.47	$4,031.39	$1,653.89	2026-04-24
38724	OTHER	Cervical Lymphadenectomy Mod Rad Nk Diss	11	10	$4,037.85	$3,230.28	$1,301.49	$3,876.34	$1,527.26	2026-05-09
41130	HCPCS	Glossectomy Hemiglossectomy	21	11	$3,874.62	$3,099.70	$1,086.10	$3,719.64	$1,584.21	2026-04-24
41135	HCPCS	Glossectomy Partial W Uni Rad Nk Dissect	21	11	$6,452.12	$5,161.70	$1,762.69	$6,194.04	$2,616.91	2026-04-24
41135	OTHER	Glossectomy Partial W Uni Rad Nk Dissect	11	10	$6,203.96	$4,963.17	$1,916.16	$5,955.80	$2,248.56	2026-05-09
41150	HCPCS	Glossectomy Composite Wo Rad Nk Dissect	21	11	$6,582.10	$5,265.68 20% off	$1,785.33	$6,318.82	$2,641.87	2026-04-24
41150	OTHER	Glossectomy Composite Wo Rad Nk Dissect	11	10	$6,328.94	$5,063.15 20% off	$1,941.68	$6,075.78	$2,278.51	2026-05-09
41155	HCPCS	Glossectomy Commando Type Com Res Fl Mo	21	11	$8,746.12	$6,996.90	$2,406.42	$8,396.28	$3,628.00	2026-04-24
41155	OTHER	Glossectomy Commando Type Com Res Fl Mo	11	10	$8,409.73	$6,727.78 20% off	$2,640.22	$8,073.34	$3,098.22	2026-05-09
42426	HCPCS	Excision Parotid Tumor Tot W Uni Rad Nk	21	11	$3,260.73	$2,608.58 20% off	$1,075.19	$3,130.30	$1,501.89	2026-04-24
42426	OTHER	Excision Parotid Tumor Tot W Uni Rad Nk	11	10	$3,135.32	$2,508.26	$1,211.07	$3,009.91	$1,421.16	2026-05-09
42890	HCPCS	Limited Pharyngectomy	21	11	$4,130.02	$3,304.02	$1,153.61	$3,964.82	$1,716.47	2026-04-24
42890	OTHER	Limited Pharyngectomy	11	10	$3,971.17	$3,176.94	$1,256.55	$3,812.32	$1,474.52	2026-05-09
42892	HCPCS	Resection Lateral Pharyngeal Wall Direct	21	11	$5,391.41	$4,313.13	$1,510.18	$5,175.75	$2,252.99	2026-04-24
42892	OTHER	Resection Lateral Pharyngeal Wall Direct	11	10	$5,184.05	$4,147.24 20% off	$1,652.20	$4,976.69	$1,938.81	2026-05-09
42894	HCPCS	Resection Of Pharyngeal Wall W Clos W Fl	21	11	$6,933.11	$5,546.49	$1,907.97	$6,655.79	$2,851.07	2026-04-24
42894	OTHER	Resection Of Pharyngeal Wall W Clos W Fl	11	10	$6,666.45	$5,333.16 20% off	$2,097.09	$6,399.79	$2,460.87	2026-05-09
43281	HCPCS	Laproscopic Fundoplasty Repair Without Mesh	25	11	$4,176.82	$3,341.46	$1,286.76	$4,009.75	$1,900.46	2026-04-24
43281	OTHER	Laproscopic Fundoplasty Repair Without Mesh	11	10	$4,016.17	$3,212.94	$1,352.21	$3,855.52	$1,586.78	2026-05-09
43282	HCPCS	Laproscopic Paraesophageal Hernia Repair	21	11	$5,570.84	$4,456.67 20% off	$1,446.03	$5,348.01	$2,094.11	2026-04-24
43282	OTHER	Laproscopic Paraesophageal Hernia Repair	11	10	$5,356.58	$4,285.26 20% off	$1,524.05	$5,142.32	$1,788.42	2026-05-09
43310	HCPCS	Repair Esophagoplasty	21	11	$4,067.77	$3,254.22	$1,266.90	$3,905.06	$1,785.09	2026-04-24
43310	OTHER	Repair Esophagoplasty	11	10	$3,911.32	$3,129.06	$1,293.12	$3,754.87	$1,517.44	2026-05-09
43336	OTHER	Repair Combined Thoracoabd W/dial Strict	11	10	$2,568.73	$2,054.98 20% off	$1,258.68	$2,465.98	$1,465.37	2026-05-09
43336	HCPCS	Repair Combined Thoracoabd W/dial Strict	21	11	$2,671.48	$2,137.18 20% off	$1,230.49	$2,564.62	$1,433.18	2026-04-24
43820	HCPCS	Gastrojejunostomy Wo Vagotomy	21	11	$3,819.71	$3,055.77	$1,136.39	$3,666.92	$1,620.81	2026-04-24
43860	HCPCS	Revision Gastrojejunostomy W/reconstruct	25	11	$5,117.89	$4,094.31 20% off	$1,370.69	$4,913.17	$2,098.65	2026-04-24
43860	OTHER	Revision Gastrojejunostomy W/reconstruct	11	10	$4,921.05	$3,936.84 20% off	$1,446.47	$4,724.21	$1,697.39	2026-05-09
44120	HCPCS	Enterectomy Resec Sml Intest Single Anas	36	11	$3,419.02	$2,735.22	$1,027.90	$3,413.55	$1,490.71	2026-04-24
44140	HCPCS	Colectomy Partial With Anastomosis	25	11	$4,403.12	$3,522.50	$1,132.19	$4,227.00	$1,720.38	2026-04-24
44141	OTHER	Colectomy Partial With Skin Level Cecost	11	10	$2,874.77	$2,299.82	$1,408.64	$2,759.78	$1,853.03	2026-05-09
44141	HCPCS	Colectomy Partial With Skin Level Cecost	25	11	$2,989.76	$2,391.81	$1,351.14	$2,870.17	$1,796.82	2026-04-24
44145	OTHER	Colectomy With Coloproctostomy	11	10	$3,201.28	$2,561.02 20% off	$1,458.51	$3,073.23	$1,694.07	2026-05-09
44145	HCPCS	Colectomy With Coloproctostomy	25	11	$3,329.33	$2,663.46 20% off	$1,379.08	$3,196.16	$1,618.30	2026-04-24
44160	OTHER	Colectomy Partial With Rem Ileum	15	10	$3,373.98	$2,699.18 20% off	$1,099.23	$3,304.67	$1,653.25	2026-05-09
44160	HCPCS	Colectomy Partial W/rem Ileum W/ileoco	25	11	$3,580.05	$2,864.04 20% off	$1,049.00	$3,436.85	$1,585.77	2026-04-24
44204	HCPCS	Laparoscopy Colectomy Partial	50	11	$4,419.50	$3,535.60 20% off	$205.68	$4,242.72	$1,961.02	2026-04-24
44204	OTHER	Laparoscopy Colectomy Partial	22	10	$4,249.52	$3,399.62	$217.13	$4,079.54	$1,568.44	2026-05-09
44205	HCPCS	Laparoscopy Colectomy Partial	40	11	$3,566.21	$2,852.97	$178.79	$3,560.51	$1,659.27	2026-04-24
44206	HCPCS	Lap Part Colectomy W/stoma	21	11	$4,573.03	$3,658.42 20% off	$1,455.15	$4,390.11	$2,106.33	2026-04-24
44206	OTHER	Lap Part Colectomy W/stoma	11	10	$4,397.14	$3,517.71 20% off	$1,533.47	$4,221.25	$1,799.49	2026-05-09
44207	OTHER	Colectomy Partial With End Colostomy	22	10	$4,246.40	$3,397.12	$255.93	$4,760.08	$1,839.50	2026-05-09
44207	HCPCS	Colectomy Partial With End Colostomy	46	11	$3,675.74	$2,940.59 20% off	$241.04	$4,950.49	$1,767.83	2026-04-24
44210	HCPCS	Laparoscopy Colectomy Total	21	11	$4,624.99	$3,699.99 20% off	$1,490.35	$4,439.99	$2,130.28	2026-04-24
44210	OTHER	Laparoscopy Colectomy Total	11	10	$4,447.11	$3,557.69	$1,565.72	$4,269.23	$1,837.32	2026-05-09
44238	HCPCS	Laparoscopy Procedure Intestine	13	10	$4,658.54	$3,726.83 20% off	$2,145.72	$4,472.20	$3,330.86	2026-04-24
44238	OTHER	Laparoscopy Procedure Intestine	10	9	$4,479.37	$3,583.50	$2,194.89	$4,300.20	$3,247.55	2026-05-09
44320	HCPCS	Colostomy Or Skin Level Cecostomy	36	11	$4,062.67	$3,250.14	$1,018.47	$4,056.17	$1,464.24	2026-04-24
44602	OTHER	Suture Repair Of Small Intest Perf Ulcer	11	10	$2,669.38	$2,135.50 20% off	$1,239.67	$2,562.60	$1,439.88	2026-05-09
44603	OTHER	Suture Repair Of Small Intestine Multipl	11	10	$2,667.60	$2,134.08 20% off	$1,307.12	$2,560.90	$1,658.39	2026-05-09
44603	HCPCS	Suture Repair Of Small Intestine Multipl	25	11	$2,774.30	$2,219.44 20% off	$1,253.77	$2,663.33	$1,578.57	2026-04-24
44626	HCPCS	Closure Of Enterostomy With Resection	21	11	$4,505.52	$3,604.42	$1,323.54	$4,325.30	$1,931.08	2026-04-24
44626	OTHER	Closure Of Enterostomy With Resection	11	10	$4,332.23	$3,465.78 20% off	$1,403.06	$4,158.94	$1,646.44	2026-05-09
44640	OTHER	Closure Intestinal Cuntaneous Fistula	11	10	$2,704.18	$2,163.34 20% off	$1,232.68	$2,596.01	$1,431.77	2026-05-09
44650	HCPCS	Closure Enteroenteric/enterocolic Fistul	21	11	$4,075.73	$3,260.58 20% off	$1,203.61	$3,912.70	$1,741.42	2026-04-24
44650	OTHER	Closure Enteroenteric/enterocolic Fistul	11	10	$3,918.97	$3,135.18	$1,270.58	$3,762.21	$1,490.99	2026-05-09
44899	HCPCS	Unlisted Procedure Meckels Diverticulum	13	10	$2,131.17	$1,704.94	$981.62	$2,045.92	$1,523.79	2026-04-24
44899	OTHER	Unlisted Procedure Meckels Diverticulum	10	9	$2,049.20	$1,639.36 20% off	$1,004.11	$1,967.23	$1,485.67	2026-05-09
45110	HCPCS	Protectomy Complete With Colostomy	21	11	$5,204.60	$4,163.68 20% off	$1,532.42	$4,996.42	$2,218.06	2026-04-24
45110	OTHER	Protectomy Complete With Colostomy	11	10	$5,004.42	$4,003.54	$1,608.25	$4,804.24	$1,887.23	2026-05-09
47350	HCPCS	Management Liver Hemorrhage Simple	25	11	$3,831.46	$3,065.17	$1,164.44	$3,678.20	$1,731.53	2026-04-24
48140	OTHER	Pancreatectomy Distal Subtotal	22	10	$4,236.95	$3,389.56 20% off	$221.61	$4,067.47	$1,600.78	2026-05-09
48140	HCPCS	Pancreatectomy Distal Subtotal	32	11	$4,406.43	$3,525.14 20% off	$210.83	$4,230.17	$1,553.50	2026-04-24
49020	OTHER	Incision Drainage Of Peritoneal Abscess	11	10	$3,177.24	$2,541.79 20% off	$1,411.36	$3,050.15	$1,639.29	2026-05-09
49020	HCPCS	Incision Drainage Of Peritoneal Abscess	21	11	$3,304.33	$2,643.46 20% off	$1,347.83	$3,172.16	$1,565.51	2026-04-24
49657	OTHER	Laparascopy Surg Rep Incar Strang Hern	15	10	$3,340.85	$2,672.68 20% off	$1,229.41	$3,207.22	$1,574.06	2026-05-09
49657	HCPCS	Laparascopy Surg Rep Incar Strang Hern	15	11	$3,340.85	$2,672.68 20% off	$1,229.41	$3,207.22	$1,509.81	2026-04-24
49659	OTHER	Unlisted Laparoscopy Procedure Hemioplas	10	9	$2,323.57	$1,858.86	$1,138.55	$2,230.63	$1,684.59	2026-05-09
49659	HCPCS	Unlisted Laparoscopy Procedure Hemioplas	17	10	$2,323.57	$1,858.86	$1,092.08	$2,319.85	$1,661.36	2026-04-24
50590	OTHER	Lithotripsy	23	10	$8,757.94	$7,006.35 20% off	$521.60	$8,407.62	$4,205.56	2026-05-09
52648	OTHER	Greenlight Photoselective Vap Of Prostat	23	10	$6,794.95	$5,435.96 20% off	$631.23	$6,523.15	$3,262.94	2026-05-09
52648	HCPCS	Laser Vaporation Of Prostate	33	11	$1,956.67	$1,565.34	$489.69	$6,784.08	$1,878.40	2026-04-24
59510	OTHER	Cesarean Delivery Incl Ante/del/post Car	11	10	$4,361.04	$3,488.83 20% off	$2,136.91	$4,186.60	$2,731.57	2026-05-09
59510	HCPCS	Cesarean Delivery Incl Ante/del/post Car	25	11	$4,535.48	$3,628.38 20% off	$2,049.69	$4,354.06	$2,567.66	2026-04-24
60252	HCPCS	Thyroidectomy Mal W/limited Neck Dissect	21	11	$3,944.93	$3,155.94 20% off	$1,077.27	$3,787.13	$1,520.57	2026-04-24
60254	HCPCS	Thyroidectomy Mal W/radical Neck Dissect	21	11	$5,127.72	$4,102.18	$1,354.59	$4,922.61	$1,925.30	2026-04-24
60254	OTHER	Thyroidectomy Mal W/radical Neck Dissect	11	10	$4,930.50	$3,944.40 20% off	$1,483.12	$4,733.28	$1,740.40	2026-05-09
60502	HCPCS	Parathyroidectomy Or Re-exploration	21	11	$3,796.41	$3,037.13	$1,090.91	$3,644.55	$1,491.36	2026-04-24
61575	HCPCS	Transoral Approach	21	11	$6,938.94	$5,551.15 20% off	$2,122.00	$6,661.38	$2,945.78	2026-04-24
61575	OTHER	Transoral Approach	11	10	$6,672.06	$5,337.65	$2,187.66	$6,405.18	$2,567.16	2026-05-09
61580	HCPCS	Craniofacial Anterior Cranial Fossa Wo M	21	11	$7,307.50	$5,846.00 20% off	$2,019.83	$7,015.20	$2,816.54	2026-04-24
61580	OTHER	Craniofacial Anterior Cranial Fossa Wo M	11	10	$7,026.44	$5,621.15 20% off	$2,198.35	$6,745.38	$2,579.69	2026-05-09
61581	HCPCS	Craniofacial Anterior Cranial Fossa Inc	21	11	$8,067.29	$6,453.83 20% off	$2,173.14	$7,744.60	$3,047.42	2026-04-24
61581	OTHER	Craniofacial Anterior Cranial Fossa Inc	11	10	$7,757.01	$6,205.61	$2,403.93	$7,446.73	$2,820.94	2026-05-09
61582	HCPCS	Craniofacial Approach Anterior Fossa	21	11	$8,236.74	$6,589.39 20% off	$2,732.47	$7,907.27	$3,544.39	2026-04-24
61582	OTHER	Craniofacial Approach Anterior Fossa	11	10	$7,919.94	$6,335.95 20% off	$2,649.18	$7,603.14	$3,108.74	2026-05-09
61583	HCPCS	Craniofacial Approach Ant Fossa Intradur	21	11	$8,395.16	$6,716.13	$2,584.28	$8,059.35	$3,370.73	2026-04-24
61583	OTHER	Craniofacial Approach Ant Fossa Intradur	11	10	$8,072.27	$6,457.82	$2,556.14	$7,749.38	$2,999.56	2026-05-09
61584	HCPCS	Orbitocranial Approach Ant Cran Fos Extr	21	11	$8,194.95	$6,555.96 20% off	$2,509.17	$7,867.15	$3,349.92	2026-04-24
61584	OTHER	Orbitocranial Approach Ant Cran Fos Extr	11	10	$7,879.76	$6,303.81	$2,509.24	$7,564.57	$2,944.52	2026-05-09
61585	HCPCS	Orbitocranial App Ant Cran Fos Extr W/ex	21	11	$8,753.23	$7,002.58 20% off	$2,872.73	$8,403.10	$3,808.88	2026-04-24
61585	OTHER	Orbitocranial App Ant Cran Fos Extr W/ex	11	10	$8,416.57	$6,733.26	$2,842.24	$8,079.91	$3,335.28	2026-05-09
61586	HCPCS	Bicoronal Trans +/- Lefort I Osteotomy	21	11	$6,342.61	$5,074.09	$2,339.36	$6,088.91	$2,822.55	2026-04-24
61586	OTHER	Bicoronal Trans +/- Lefort I Osteotomy	11	10	$6,098.66	$4,878.93	$2,191.77	$5,854.71	$2,571.98	2026-05-09
61590	HCPCS	Infratemporal Pre Auricular Mid Cran Fos	21	11	$9,261.18	$7,408.94 20% off	$2,434.07	$8,890.73	$3,528.38	2026-04-24
61590	OTHER	Infratemporal Pre Auricular Mid Cran Fos	11	10	$8,904.98	$7,123.98 20% off	$2,673.39	$8,548.78	$3,137.14	2026-05-09
61591	HCPCS	Infratemporal Post Auricular Mid Cran Fo	21	11	$9,328.86	$7,463.09	$2,516.11	$8,955.71	$3,566.80	2026-04-24
61591	OTHER	Infratemporal Post Auricular Mid Cran Fo	11	10	$8,970.06	$7,176.05	$2,724.73	$8,611.26	$3,197.39	2026-05-09
61592	HCPCS	Orbitocranial Zygomatic App Mid Cran Fos	21	11	$9,148.60	$7,318.88 20% off	$2,687.72	$8,782.66	$3,704.04	2026-04-24
61592	OTHER	Orbitocranial Zygomatic App Mid Cran Fos	11	10	$8,796.73	$7,037.38 20% off	$2,754.17	$8,444.86	$3,231.94	2026-05-09
61600	HCPCS	Resection Excision Lesion Cran Foss Extr	21	11	$6,261.21	$5,008.97	$1,739.76	$6,010.76	$2,464.02	2026-04-24
61600	OTHER	Resection Excision Lesion Cran Foss Extr	11	10	$6,020.39	$4,816.31 20% off	$1,869.31	$5,779.57	$2,193.58	2026-05-09
61601	HCPCS	Resection Excision Lesion Cran Foss Intr	21	11	$6,822.26	$5,457.81	$2,127.25	$6,549.37	$2,804.94	2026-04-24
61601	OTHER	Resection Excision Lesion Cran Foss Intr	11	10	$6,559.87	$5,247.90	$2,107.69	$6,297.48	$2,473.31	2026-05-09
61605	OTHER	Resection Excision Lesion Infra Foss Ext	11	10	$3,606.89	$2,885.51 20% off	$1,767.38	$3,462.61	$2,243.69	2026-05-09
61605	HCPCS	Resection Excision Lesion Infra Foss Ext	21	11	$3,751.17	$3,000.94	$1,727.79	$3,601.12	$2,036.31	2026-04-24
61606	HCPCS	Resection Excision Lesion Infra Foss Int	21	11	$8,674.62	$6,939.70	$2,429.85	$8,327.64	$3,429.15	2026-04-24
61606	OTHER	Resection Excision Lesion Infra Foss Int	11	10	$8,340.98	$6,672.78 20% off	$2,545.58	$8,007.34	$2,987.16	2026-05-09
61607	HCPCS	Resection Excision Lesion Parasellar Ext	21	11	$8,133.20	$6,506.56	$2,242.41	$7,807.87	$3,114.24	2026-04-24
61607	OTHER	Resection Excision Lesion Parasellar Ext	11	10	$7,820.38	$6,256.30 20% off	$2,639.17	$7,507.56	$3,096.98	2026-05-09
61608	HCPCS	Resection Excision Lesion Parasellar Int	21	11	$9,471.56	$7,577.25	$2,790.13	$9,092.70	$3,829.28	2026-04-24
61608	OTHER	Resection Excision Lesion Parasellar Int	11	10	$9,107.27	$7,285.82	$2,847.61	$8,742.98	$3,341.58	2026-05-09
61618	HCPCS	Sec Rep Dura Csf Ant Mid Post Cran Fossa	21	11	$3,775.06	$3,020.05	$1,086.98	$3,624.06	$1,502.90	2026-04-24
61619	HCPCS	Sec Rep Dura Local/reg Vasc Ped/myoc Fla	21	11	$4,387.95	$3,510.36	$1,379.03	$4,212.43	$1,656.15	2026-04-24
61619	OTHER	Sec Rep Dura Local/reg Vasc Ped/myoc Fla	11	10	$4,219.18	$3,375.34 20% off	$1,264.40	$4,050.41	$1,483.73	2026-05-09
64886	HCPCS	Nerve Graft Inc Obt Grt Head Neck > 4 Cm	21	11	$4,092.69	$3,274.15 20% off	$1,029.68	$3,928.98	$1,491.70	2026-04-24
64999	HCPCS	Unlisted Procedure Nervous System	13	10	$2,595.29	$2,076.23 20% off	$1,195.39	$2,491.48	$1,855.63	2026-04-24
64999	OTHER	Unlisted Procedure Nervous System	10	9	$2,495.47	$1,996.38	$1,222.78	$2,395.65	$1,809.21	2026-05-09
70482	OTHER	CT Orbit/sella/ear With & Without Contrast	13	10	$3,329.00	$2,663.20 20% off	$187.78	$3,195.84	$1,631.21	2026-05-09
70482	HCPCS	CT Orbit/sella/ear With & Without Contrast	13	11	$3,462.16	$2,769.73	$190.88	$3,323.67	$1,627.22	2026-04-24
70488	OTHER	CT Maxillofacial/sinus W & Without Contrast	13	10	$3,329.00	$2,663.20 20% off	$164.90	$3,195.84	$1,631.21	2026-05-09
70488	HCPCS	CT Maxillofacial/sinus W & Without Contrast	13	11	$3,462.16	$2,769.73	$168.30	$3,323.67	$1,627.22	2026-04-24
70543	OTHER	MRI Orbit/face/neck W/wo Contrast	13	10	$4,047.16	$3,237.73	$303.06	$3,885.27	$1,983.11	2026-05-09
70543	HCPCS	MRI Orbit/face/neck W/wo Contrast	13	11	$4,209.05	$3,367.24 20% off	$307.89	$4,040.69	$1,978.25	2026-04-24
70546	OTHER	MRA Brain W/wo Contrast	13	10	$4,596.35	$3,677.08 20% off	$293.74	$4,412.50	$2,252.21	2026-05-09
70546	HCPCS	MRA Brain W/wo Contrast	13	11	$4,780.20	$3,824.16 20% off	$298.02	$4,588.99	$2,246.69	2026-04-24
70549	OTHER	MRA Neck With And Without Contrast	25	10	$4,596.35	$3,677.08 20% off	$308.43	$4,692.14	$2,394.95	2026-05-09
70549	HCPCS	MRA Neck With And Without Contrast	25	11	$4,780.20	$3,824.16 20% off	$312.91	$4,879.83	$2,389.09	2026-04-24
70553	OTHER	MRI Head W/wo Contrast	13	10	$3,843.84	$3,075.07 20% off	$286.00	$3,690.09	$1,883.48	2026-05-09
70553	HCPCS	MRI Head W/wo Contrast	13	11	$3,997.59	$3,198.07 20% off	$290.06	$3,837.69	$1,878.87	2026-04-24
71270	OTHER	CT Scan Thorax W&without Contrast	13	10	$3,310.21	$2,648.17	$175.57	$3,177.80	$1,622.00	2026-05-09
71270	HCPCS	CT Scan Thorax W&without Contrast	13	11	$3,442.62	$2,754.10	$178.79	$3,304.92	$1,618.03	2026-04-24
71550	OTHER	MRI Chest Wo Contrast	13	10	$2,900.83	$2,320.66 20% off	$298.11	$2,784.80	$1,421.41	2026-05-09
71550	HCPCS	MRI Chest Wo Contrast	13	11	$3,016.86	$2,413.49	$302.99	$2,896.19	$1,417.92	2026-04-24
71551	OTHER	MRI Chest W/contrast	13	10	$2,900.83	$2,320.66 20% off	$332.34	$2,784.80	$1,421.41	2026-05-09
71551	HCPCS	MRI Chest W/contrast	13	11	$3,016.86	$2,413.49	$338.13	$2,896.19	$1,417.92	2026-04-24
71552	OTHER	MRI Chest W/wo Contrast	13	10	$2,900.83	$2,320.66 20% off	$417.81	$2,784.80	$1,421.41	2026-05-09
71552	HCPCS	MRI Chest W/wo Contrast	13	11	$3,016.86	$2,413.49	$424.19	$2,896.19	$1,417.92	2026-04-24
72127	OTHER	CT Scan Cervical Spine W&wo Contrast	13	10	$3,985.62	$3,188.50	$175.91	$3,826.20	$1,952.95	2026-05-09
72127	HCPCS	CT Scan Cervical Spine W&wo Contrast	13	11	$4,145.04	$3,316.03 20% off	$179.14	$3,979.24	$1,948.17	2026-04-24
72132	OTHER	CT Scan Lumbar Spine W/contrast	13	10	$3,193.72	$2,554.98	$151.83	$3,065.97	$1,564.92	2026-05-09
72132	HCPCS	CT Scan Lumbar Spine W/contrast	13	11	$3,321.47	$2,657.18	$154.31	$3,188.61	$1,561.09	2026-04-24
72133	OTHER	CT Scan Lumbar Spine W&without Contrast	13	10	$3,872.86	$3,098.29	$176.19	$3,717.95	$1,897.70	2026-05-09
72133	HCPCS	CT Scan Lumbar Spine W&without Contrast	13	11	$4,027.77	$3,222.22	$179.74	$3,866.66	$1,893.05	2026-04-24
72157	OTHER	MRI Thoracic Spine W/wo Contrast	13	10	$4,392.86	$3,514.29	$287.45	$4,217.15	$2,152.50	2026-05-09
72157	HCPCS	MRI Thoracic Spine W/wo Contrast	13	11	$4,568.57	$3,654.86	$291.57	$4,385.83	$2,147.23	2026-04-24
72158	OTHER	MRI Lumbar Spine W/wo Contrast	13	10	$3,983.72	$3,186.98	$286.30	$3,824.37	$1,952.02	2026-05-09
72158	HCPCS	MRI Lumbar Spine W/wo Contrast	13	11	$4,143.07	$3,314.46	$291.27	$3,977.35	$1,947.24	2026-04-24
72194	OTHER	CT Scan Pelvis W&without Contrast	13	10	$3,699.40	$2,959.52 20% off	$223.31	$3,551.42	$1,812.71	2026-05-09
72194	HCPCS	CT Scan Pelvis W&without Contrast	13	11	$3,847.38	$3,077.90 20% off	$228.10	$3,693.48	$1,808.27	2026-04-24
72197	OTHER	MRI Pelvis W/wo Contrast	13	10	$4,641.53	$3,713.22 20% off	$301.18	$4,455.87	$2,274.35	2026-05-09
72197	HCPCS	MRI Pelvis W/wo Contrast	13	11	$4,827.19	$3,861.75 20% off	$305.52	$4,634.10	$2,268.78	2026-04-24
72198	OTHER	MRA Pelvis W/wo Contrast	13	10	$4,641.53	$3,713.22 20% off	$301.90	$4,455.87	$2,274.35	2026-05-09
72198	HCPCS	MRA Pelvis W/wo Contrast	13	11	$4,827.19	$3,861.75 20% off	$306.29	$4,634.10	$2,268.78	2026-04-24
73202	OTHER	CT Scan Upper Extremity W&without Contrast	13	10	$3,338.07	$2,670.46	$219.47	$3,204.55	$1,635.65	2026-05-09
73202	HCPCS	CT Scan Upper Extremity W&without Contrast	13	11	$3,471.59	$2,777.27 20% off	$224.18	$3,332.73	$1,631.65	2026-04-24
73223	OTHER	MRI Upper Extremity Joint W/wo Contrast	13	10	$4,490.42	$3,592.34	$343.29	$4,310.80	$2,200.31	2026-05-09
73223	HCPCS	MRI Upper Extremity Joint W/wo Contrast	13	11	$4,670.04	$3,736.03 20% off	$349.45	$4,483.24	$2,194.92	2026-04-24
73225	OTHER	MRA Upper Extremity W/wo Contrast	13	10	$4,490.42	$3,592.34	$290.58	$4,310.80	$2,200.31	2026-05-09
73225	HCPCS	MRA Upper Extremity W/wo Contrast	13	11	$4,670.04	$3,736.03 20% off	$294.77	$4,483.24	$2,194.92	2026-04-24
73702	OTHER	CT Scan Lower Extremity W&without Contrast	13	10	$3,323.85	$2,659.08 20% off	$174.69	$3,190.90	$1,628.69	2026-05-09
73702	HCPCS	CT Scan Lower Extremity W&without Contrast	13	11	$3,456.80	$2,765.44 20% off	$177.80	$3,318.53	$1,624.70	2026-04-24
73720	OTHER	MRI Lower Extremity Not Joint W/wocontra	13	10	$4,637.29	$3,709.83 20% off	$301.33	$4,451.80	$2,272.27	2026-05-09
73720	HCPCS	MRI Lower Extremity Not Joint W/wocontra	13	11	$4,822.78	$3,858.22 20% off	$306.08	$4,629.87	$2,266.71	2026-04-24
73723	OTHER	MRI Lower Extremity Joint W/wo Contrast	13	10	$4,488.28	$3,590.62 20% off	$342.43	$4,308.75	$2,199.26	2026-05-09
73723	HCPCS	MRI Lower Extremity Joint W/wo Contrast	13	11	$4,667.81	$3,734.25	$347.94	$4,481.10	$2,193.87	2026-04-24
73725	OTHER	MRA Lower Ext With Or Without Contrast	13	10	$4,637.29	$3,709.83 20% off	$300.51	$4,451.80	$2,272.27	2026-05-09
73725	HCPCS	MRA Lower Ext With Or Without Contrast	13	11	$4,822.78	$3,858.22 20% off	$307.02	$4,629.87	$2,266.71	2026-04-24
74170	OTHER	CT Scan Abd W&w/ocon	13	10	$3,218.77	$2,575.02	$231.54	$3,090.02	$1,577.20	2026-05-09
74170	HCPCS	CT Scan Abd W&w/ocon	13	11	$3,347.52	$2,678.02	$236.09	$3,213.62	$1,573.33	2026-04-24
74176	OTHER	CT Scan Abdomen/pelvis Without Contrast	13	10	$3,204.42	$2,563.54	$165.75	$3,076.24	$1,570.17	2026-05-09
74176	HCPCS	CT Scan Abdomen/pelvis Without Contrast	13	11	$3,332.60	$2,666.08 20% off	$168.40	$3,199.30	$1,566.32	2026-04-24
74177	OTHER	CT Scan Abdomen/pelvis W/contrast	13	10	$4,166.24	$3,332.99 20% off	$269.99	$3,999.59	$2,041.46	2026-05-09
74177	HCPCS	CT Scan Abdomen/pelvis W/contrast	13	11	$4,332.89	$3,466.31 20% off	$274.10	$4,159.57	$2,036.46	2026-04-24
74178	OTHER	CT Scan Abdomen/pelvis W&without Contrast	13	10	$4,996.16	$3,996.93	$302.27	$4,796.31	$2,448.12	2026-05-09
74178	HCPCS	CT Scan Abdomen/pelvis W&without Contrast	13	11	$5,196.01	$4,156.81	$308.43	$4,988.17	$2,442.12	2026-04-24
74183	OTHER	MRI Abdomen W/wo Contrast	13	10	$4,413.24	$3,530.59 20% off	$302.34	$4,236.71	$2,162.49	2026-05-09
74183	HCPCS	MRI Abdomen W/wo Contrast	13	11	$4,589.77	$3,671.82	$307.01	$4,406.18	$2,157.19	2026-04-24
75635	OTHER	CT Angiography Abd. Aorta W/le Runoff	13	10	$6,870.47	$5,496.38	$367.26	$6,595.65	$3,366.53	2026-05-09
75635	HCPCS	CT Angiography Abd. Aorta W/le Runoff	13	11	$7,145.29	$5,716.23 20% off	$374.88	$6,859.48	$3,358.29	2026-04-24
78451	OTHER	Nm Spect Single Study Rest Or Stress	13	10	$2,943.65	$2,354.92 20% off	$268.82	$2,825.90	$1,442.39	2026-05-09
78451	HCPCS	Nm Spect Single Study Rest Or Stress	13	11	$3,061.40	$2,449.12 20% off	$283.22	$2,938.94	$1,438.86	2026-04-24
78452	OTHER	Nm Spect Multiple Study Rest Or Stress	13	10	$3,354.73	$2,683.78 20% off	$369.29	$3,220.54	$1,643.82	2026-05-09
78452	HCPCS	Nm Spect Multiple Study Rest Or Stress	13	11	$3,488.92	$2,791.14	$388.63	$3,349.36	$1,639.79	2026-04-24
78465	OTHER	Nm Spect Multiple Study Rest Or Stress	13	10	$2,888.31	$2,310.65	$1,386.96	$2,772.78	$1,428.58	2026-05-09
78597	OTHER	Nm Pulmonary Quan Dif Func Ven/per Study	13	10	$3,234.18	$2,587.34 20% off	$159.01	$3,104.81	$1,584.75	2026-05-09
78597	HCPCS	Nm Pulmonary Quan Dif Func Ven/per Study	13	11	$3,234.18	$2,587.34 20% off	$163.64	$3,104.81	$1,520.06	2026-04-24
90378	OTHER	Nf-palivizumab 100mg/1ml (synagis) Vial	13	10	$6,236.85	$4,989.48 20% off	$2,994.94	$5,987.38	$3,084.79	2026-05-09
90378	HCPCS	Nf-palivizumab 100mg/1ml (synagis) Vial	12	10	$6,236.85	$4,989.48 20% off	$2,872.69	$5,987.38	$2,945.10	2026-04-24
J0490	OTHER	Belimumab 120mg Inj Vial(benlysta)-nf	26	10	$3,282.49	$2,625.99 20% off	$50.93	$4,571.63	$2,032.08	2026-05-09
J0490	HCPCS	Belimumab 120mg Inj Vial(benlysta)-nf	26	11	$3,375.50	$2,700.40 20% off	$50.93	$4,753.92	$2,029.20	2026-04-24
J0517	OTHER	Nf-benralizumab 30mg/ml Inj	13	10	$9,248.66	$7,398.93	$167.15	$8,878.71	$4,531.84	2026-05-09
J0517	HCPCS	Nf-benralizumab 30mg/ml Inj	13	11	$9,248.66	$7,398.93	$167.15	$8,878.71	$4,346.87	2026-04-24
J0630	OTHER	Nf-calcitonin Salmon 400units/2ml Inj	13	10	$4,832.73	$3,866.18 20% off	$2,320.68	$4,736.08	$2,390.30	2026-05-09
J0630	HCPCS	Nf-calcitonin Salmon 400units/2ml Inj	13	11	$4,832.73	$3,866.18 20% off	$2,225.95	$4,736.08	$2,292.73	2026-04-24
J0875	OTHER	Nf-dalvance IV 500mg Vial	13	10	$3,060.39	$2,448.31 20% off	$1,469.60	$2,999.18	$1,513.69	2026-05-09
J0875	HCPCS	Nf-dalvance IV 500mg Vial	13	11	$3,060.39	$2,448.31 20% off	$1,409.61	$2,999.18	$1,451.90	2026-04-24
J0881	OTHER	Darbepoetin 60mcg Inj Syr (aranesp)	109	10	$2,551.20	$2,040.96	$2.88	$7,667.72	$1,635.60	2026-05-09
J0881	HCPCS	Darbepoetin 60mcg Inj Syr (aranesp)	109	11	$2,551.20	$2,040.96	$2.88	$7,667.72	$1,584.53	2026-04-24
J0897	OTHER	Denosumab 60mg/ml Syr(prolia)-nf	26	10	$3,928.61	$3,142.89	$23.74	$3,921.79	$1,991.54	2026-05-09
J0897	HCPCS	Denosumab 60mg/ml Syr(prolia)-nf	26	11	$4,025.87	$3,220.69 20% off	$23.74	$3,921.79	$1,910.25	2026-04-24
J1162	HCPCS	Digoxin Immune Fab 40mg Inj (digibind)	13	11	$10,095.53	$8,076.42 20% off	$4,650.00	$9,893.62	$4,789.50	2026-04-24
J1162	OTHER	Digoxin Immune Fab 40mg Inj (digibind)	13	10	$7,817.60	$6,254.08 20% off	$3,754.01	$7,661.25	$3,866.63	2026-05-09
J1561	OTHER	Nf-immune Globulin 20gm/200ml (gamunex)	13	10	$3,792.13	$3,033.70 20% off	$1,820.98	$3,716.29	$1,875.60	2026-05-09
J1561	HCPCS	Nf-immune Globulin 20gm/200ml (gamunex)	13	11	$3,792.13	$3,033.70 20% off	$1,746.65	$3,716.29	$1,799.05	2026-04-24
J1944	HCPCS	Aripiprazole Lauroxil ER 1064mg/3.9ml-nf	26	11	$5,572.57	$4,458.06 20% off	$1,341.91	$7,567.73	$3,184.63	2026-04-24
J1944	OTHER	Aripiprazole Lauroxil ER 1064mg/3.9ml-nf	26	10	$5,572.57	$4,458.06 20% off	$1,341.91	$7,567.73	$3,184.63	2026-05-09
J2350	OTHER	Nf-ocrevus 300mg/10ml Vial	14	10	$31,851.46	$25,481.17	$15,295.08	$31,214.43	$16,777.08	2026-05-09
J2350	HCPCS	Nf-ocrevus 300mg/10ml Vial	14	11	$31,851.46	$25,481.17	$14,670.79	$31,214.43	$16,455.57	2026-04-24
J2357	OTHER	Omalizumab 300 Mg/ 2 Ml Syringe-nf	13	10	$5,320.69	$4,256.55 20% off	$2,555.00	$5,214.28	$2,631.64	2026-05-09
J2357	HCPCS	Omalizumab 300 Mg/ 2 Ml Syringe-nf	13	11	$5,320.69	$4,256.55 20% off	$2,450.71	$5,214.28	$2,524.23	2026-04-24
J2426	OTHER	Nf-paliperidone Palmitate 117mg/0.75ml	13	10	$2,928.74	$2,342.99 20% off	$1,406.38	$2,811.59	$1,448.57	2026-05-09
J2506	OTHER	Nf-neulasta Onpro Kit 6 Mg/0.6 Ml	13	10	$9,458.28	$7,566.62 20% off	$440.70	$9,079.95	$4,634.56	2026-05-09
J2506	HCPCS	Nf-neulasta Onpro Kit 6 Mg/0.6 Ml	13	11	$9,458.28	$7,566.62 20% off	$440.70	$9,079.95	$4,445.39	2026-04-24
J2507	OTHER	Nf-pegloticase 8mg/1ml Vial(krystexxa	13	10	$41,002.46	$32,801.97	$3,240.90	$39,362.36	$20,091.21	2026-05-09
J2507	HCPCS	Nf-pegloticase 8mg/1ml Vial(krystexxa	13	11	$41,002.46	$32,801.97	$3,240.90	$39,362.36	$19,271.16	2026-04-24
J3032	OTHER	Nf-eptinezumab IV Solution 100 Mg/1 Ml	13	10	$3,351.88	$2,681.50 20% off	$1,609.57	$3,217.80	$1,657.86	2026-05-09
J3032	HCPCS	Nf-eptinezumab IV Solution 100 Mg/1 Ml	13	11	$3,351.88	$2,681.50 20% off	$1,543.87	$3,217.80	$1,590.19	2026-04-24
J3101	HCPCS	Tnk 50mg Inj Syr(tenectepl)	13	11	$17,513.15	$14,010.52 20% off	$7,501.70	$16,812.62	$8,231.18	2026-04-24
J3101	OTHER	Tnk 50mg Inj Syr(tenectepl)	13	10	$16,530.66	$13,224.53	$7,501.70	$15,869.43	$8,100.02	2026-05-09
J3240	HCPCS	Thyrotropin Alfa 0.9 Mg/ml Inj Vial-nf	13	11	$9,306.32	$7,445.06	$1,971.03	$8,934.07	$4,373.97	2026-04-24
J3262	HCPCS	Tocilizumab 200mg/10ml Sdpfv-nf	39	11	$2,920.87	$2,336.70	$485.14	$5,608.06	$1,561.87	2026-04-24
J3262	OTHER	Tocilizumab 200mg/10ml Sdpfv-nf	39	10	$2,791.84	$2,233.47 20% off	$485.14	$4,107.11	$1,433.33	2026-05-09
J3358	OTHER	Ustekinumab 130mg Inj Vial (stelara)- Nf	26	10	$4,274.78	$3,419.83	$1,607.66	$4,368.84	$2,229.93	2026-05-09
J3358	HCPCS	Ustekinumab 130mg Inj Vial (stelara)- Nf	26	11	$4,274.78	$3,419.83	$1,607.66	$4,368.84	$2,138.91	2026-04-24
J3380	OTHER	Vedolizumab 300mg Inj Vial(entyvio)-nf	13	10	$15,502.96	$12,402.37	$6,555.02	$14,882.84	$7,596.45	2026-05-09
J3380	HCPCS	Vedolizumab 300mg Inj Vial(entyvio)-nf	13	11	$15,502.96	$12,402.37	$6,555.02	$14,882.84	$7,286.39	2026-04-24
J3590	OTHER	Nf-taltz Subcutaneous Solution 80 mg/1mL	13	10	$12,533.92	$10,027.14	$6,018.79	$12,032.56	$6,199.35	2026-05-09
J3590	HCPCS	Nf-taltz Subcutaneous Solution 80 mg/1mL	12	10	$12,533.92	$10,027.14	$5,773.12	$12,032.56	$5,918.63	2026-04-24
J8499	OTHER	Nf-sofosbuvir 400mg Tab(sovaldi)	13	10	$3,885.92	$3,108.74	$1,866.02	$3,730.48	$1,922.00	2026-05-09
J8499	HCPCS	Nf-sofosbuvir 400mg Tab(sovaldi)	12	10	$3,885.92	$3,108.74	$1,789.85	$3,730.48	$1,834.97	2026-04-24
J9217	OTHER	Leuprolide 45mg Syr(lupron Depot)	52	10	$5,032.68	$4,026.14 20% off	$779.94	$22,625.71	$3,178.28	2026-05-09
J9217	HCPCS	Leuprolide 45mg Syr(lupron Depot)	52	11	$5,032.68	$4,026.14 20% off	$748.10	$22,625.71	$3,109.50	2026-04-24
Q5108	OTHER	Pegfilgrastim-jmdb 6mg/0.6ml(fulphilia)	13	10	$4,256.24	$3,404.99 20% off	$567.20	$4,085.99	$2,085.56	2026-05-09
Q5108	HCPCS	Pegfilgrastim-jmdb 6mg/0.6ml(fulphilia)	13	11	$4,256.24	$3,404.99 20% off	$567.20	$4,085.99	$2,000.43	2026-04-24
Q5111	HCPCS	Pegfilgrastim-cbqv 6mg/0.6ml(udenyca)	13	11	$9,112.68	$7,290.14 20% off	$147.76	$8,748.17	$4,282.96	2026-04-24
Q5122	OTHER	Nf-pegfilgrastim-apgf 6mg/0.6ml(nyvepria	13	10	$7,226.53	$5,781.22 20% off	$523.20	$6,937.47	$3,541.00	2026-05-09
Q5122	HCPCS	Nf-pegfilgrastim-apgf 6mg/0.6ml(nyvepria	13	11	$7,226.53	$5,781.22 20% off	$523.20	$6,937.47	$3,396.47	2026-04-24
Q9991	HCPCS	Sublocade 100mg Subq Soln ER 100mg/0.5ml	13	11	$4,759.53	$3,807.62 20% off	$2,192.24	$4,664.34	$2,258.01	2026-04-24
Q9991	OTHER	Sublocade 100mg Subq Soln ER 100mg/0.5ml	13	10	$3,480.66	$2,784.53	$1,671.41	$3,411.05	$1,721.56	2026-05-09
Q9992	OTHER	Sublocade 300mg Subq Soln ER 300mg/1.5ml	13	10	$3,654.16	$2,923.33	$1,754.73	$3,581.08	$1,807.37	2026-05-09
Q9992	HCPCS	Sublocade 300mg Subq Soln ER 300mg/1.5ml	13	11	$3,654.16	$2,923.33	$1,683.11	$3,581.08	$1,733.60	2026-04-24

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