Price Transparencybeta Hospital negotiated rates

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

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Hospital

ADVENTIST HEALTHCARE WHITE OAK MEDICAL CENTER

Silver Spring, MD · CCN 210016 · Rates published

4,458 distinct procedures filed
1 distinct payers
16,800 rate rows
2025-12-31 last MRF observed
Data quality

16,797 of 16,800 rate rows are consumer-grade (100.0%)

3 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 — reasonRows
placeholder amount (≤ $0.02) — excluded from medians 2
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.adventisthealthcare.com/app/files/public/91919297-0df2-4ab4-b788-71160672291c/84-2670875_AdventistHealthCareFortWashingtonMedicalCenter_StandardCharges.csv
Found on page https://www.adventisthealthcare.com/patients-visitors/billing-financial/price-transparency/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-07-31
Content fingerprint b84a0da436947d20… · 1,519,171 bytes · first seen 2026-05-08

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
50242-0085-27
NDC 		Alteplase 100 Mg Inj Soln 1 $23,778.92 $23,778.92 $23,778.92 nat. median
$30,625
0.8× median
50242-0120-47
NDC 		Tenecteplase 50 Mg Inj Soln 1 $22,419.53 $22,419.53 $22,419.53 nat. median
$15,569
1.4× median
50242-0176-01
NDC 		Tenecteplase 50 Mg Inj Soln 1 $22,419.53 $22,419.53 $22,419.53 nat. median
$28,874
0.8× median
44206-0439-40
NDC 		Immune Globulin (ivig) 10%, 40 G/400 Ml (Privigen) Inj Soln 1 $20,349.60 $20,349.60 $20,349.60 nat. median
$12,001
1.7× median
00169-7205-01
NDC 		Coagulation Factor VIIa 5,000 Mcg Inj 1 $20,152.72 $20,152.72 $20,152.72 nat. median
$5
outlier · 4297.0×
00002-7678-01
NDC 		Ramucirumab 500 Mg/50 Ml Inj Soln 1 $19,878.34 $19,878.34 $19,878.34 nat. median
$22,179
0.9× median
50242-0120-01
NDC 		Tenecteplase 50 Mg Inj Soln 1 $18,174.35 $18,174.35 $18,174.35 nat. median
$23,407
0.8× median
78816
CPT 		PET Image-whole Body 1 $15,527.78 $15,527.78 $15,527.78 nat. median
$2,751
outlier · 5.6×
78813
CPT 		PET Tumor Image Whole Body Mod-q0 1 $14,116.17 $14,116.17 $14,116.17 nat. median
$1,853
outlier · 7.6×
78815
CPT 		PET Image-w/ct-skull To Mid-thigh 1 $13,645.63 $13,645.63 $13,645.63 nat. median
$2,791
outlier · 4.9×
73607-0011-11
NDC 		Artesunate 110 Mg Inj Soln 1 $13,456.16 $13,456.16 $13,456.16 nat. median
$60
outlier · 224.5×
50633-0120-11
NDC 		Digoxin Immune Fab 40 Mg Inj Soln 1 $13,439.95 $13,439.95 $13,439.95 nat. median
$9,660
1.4× median
50242-0044-13
NDC 		Alteplase 50 Mg Inj Soln 1 $11,889.47 $11,889.47 $11,889.47 nat. median
$5,549
outlier · 2.1×
63459-0104-50
NDC 		Rituximab-abbs 500 Mg/50 Ml Inj Soln 1 $11,423.55 $11,423.55 $11,423.55 nat. median
$12,303
0.9× median
78609
CPT 		PET Brain Imaging Perfusion Evaluation 1 $11,292.93 $11,292.93 $11,292.93 nat. median
$1,650
outlier · 6.8×
78608
CPT 		PET Brain Imaging Metabolic Evaluation 1 $11,292.93 $11,292.93 $11,292.93 nat. median
$2,413
outlier · 4.7×
78814
CPT 		PET Image-w/ct-limited Area 1 $11,292.93 $11,292.93 $11,292.93 nat. median
$2,317
outlier · 4.9×
78812
CPT 		PET Image-skull To Mid-thigh 1 $11,292.93 $11,292.93 $11,292.93 nat. median
$1,853
outlier · 6.1×
00002-7623-01
NDC 		PEMEtrexed 500 Mg Inj Soln 1 $10,924.35 $10,924.35 $10,924.35 nat. median
$8,265
1.3× median
44206-0438-20
NDC 		Immune Globulin (ivig) 10%, 20 G/200 Ml (Privigen) Inj Soln 1 $10,174.80 $10,174.80 $10,174.80 nat. median
$4,897
outlier · 2.1×
0211U
CPT 		Mi Cancer Seek 1 $9,883.48 $9,883.48 $9,883.48 nat. median
$8,455
1.2× median
60505-6066-00
NDC 		PEMEtrexed 500 Mg Inj Soln 1 $9,639.03 $9,639.03 $9,639.03 nat. median
$11,027
0.9× median
68001-0544-41
NDC 		PEMEtrexed 500 Mg Inj Soln 1 $9,639.03 $9,639.03 $9,639.03 nat. median
$11,027
0.9× median
50458-0564-01
NDC 		Paliperidone 234 Mg/1.5 Ml IM Susp 1 $9,399.59 $9,399.59 $9,399.59 nat. median
$9,152
1.0× median
13533-0318-05
NDC 		Rabies Immune Glob, Human 1,500 Intl_Units/5 Ml Inj Soln 1 $9,057.80 $9,057.80 $9,057.80 nat. median
$7,890
1.1× median
00169-7202-01
NDC 		Coagulation Factor VIIa 2,000 Mcg Inj 1 $9,006.80 $9,006.80 $9,006.80 nat. median
$5
outlier · 1920.4×
71225-0120-01
NDC 		Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 $8,845.76 $8,845.76 $8,845.76 nat. median
$10,119
0.9× median
0279
RC 		1 $187.14 $15,654.35 $8,814.76 nat. median
$215
outlier · 40.9×
60505-6228-00
NDC 		Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 $8,672.31 $8,672.31 $8,672.31 nat. median
$9,921
0.9× median
50633-0110-12
NDC 		Antivenin (crotalidae-snake Ovine) Polyvalent Inj 1 $8,641.12 $8,641.12 $8,641.12 nat. median
$4,547
1.9× median
78811
CPT 		PET Image-limited Area 1 $8,469.70 $8,469.70 $8,469.70 nat. median
$1,661
outlier · 5.1×
63833-0617-02
NDC 		Antihemophilic Factor Viii (human)-vwf 2,400 Units (vwf:RCo) Inj Soln 1 $8,214.20 $8,214.20 $8,214.20 nat. median
$18,352
outlier · 0.4×
50242-0037-06
NDC 		Tenecteplase 50 Mg Inj Soln 1 $7,948.50 $7,948.50 $7,948.50 nat. median
$10,237
0.8× median
59148-0019-71
NDC 		ARIPiprazole (Abilify Maintena Depot) 400 Mg Inj Susp 1 $7,847.92 $7,847.92 $7,847.92 nat. median
$8,978
0.9× median
59148-0072-80
NDC 		ARIPiprazole (Abilify Maintena Depot) 400 Mg Inj Susp 1 $7,847.92 $7,847.92 $7,847.92 nat. median
$5,729
1.4× median
00944-2844-10
NDC 		Antihemophilic Factor Viii (recombinant) ~1500 Intl_units Inj Soln 1 $7,700.81 $7,700.81 $7,700.81 nat. median
$7,701
1.0× median
43598-0051-11
NDC 		Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 $7,191.07 $7,191.07 $7,191.07 nat. median
$9,262
0.8× median
50242-0137-01
NDC 		Tocilizumab 400 Mg/20 Ml Inj Soln 1 $7,176.13 $7,176.13 $7,176.13 nat. median
$4,876
1.5× median
42367-0521-25
NDC 		Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 $7,025.30 $7,025.30 $7,025.30 nat. median
$8,037
0.9× median
00597-0197-05
NDC 		idaruCIZUmab 2.5 G/ 50 Ml Inj Soln 1 $6,893.46 $6,893.46 $6,893.46 nat. median
$2,449
outlier · 2.8×
0720
RC 		1 $720.93 $21,988.35 $6,848.83 nat. median
$912
outlier · 7.5×
33947
CPT 		Ecmo Per Day Initial 1 $6,835.78 $6,835.78 $6,835.78 nat. median
$3,783
1.8× median
77301
CPT 		Imrt Planning 1 $6,745.03 $6,745.03 $6,745.03 nat. median
$2,755
outlier · 2.4×
63459-0348-04
NDC 		Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 $6,684.31 $6,684.31 $6,684.31 nat. median
$3,934
1.7× median
00069-0342-01
NDC 		Bevacizumab-bvzr 400 Mg/16 Ml Inj Soln 1 $6,629.73 $6,629.73 $6,629.73 nat. median
$3,939
1.7× median
0275
RC 		1 $61.26 $33,486.83 $6,439.75 nat. median
$9,836
0.7× median
10019-0079-01
NDC 		Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 $6,322.77 $6,322.77 $6,322.77 nat. median
$7,233
0.9× median
50458-0563-01
NDC 		Paliperidone 156 mg/mL IM Susp 1 $6,266.54 $6,266.54 $6,266.54 nat. median
$6,102
1.0× median
0277
RC 		1 $6,087.11 $6,087.11 $6,087.11 nat. median
$51
outlier · 119.3×
77373
CPT 		Sbrt 1 $5,983.24 $5,983.24 $5,983.24 nat. median
$3,665
1.6× median

Other procedures at this hospital

Browse this hospital's 4,458 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
00002-7623-01 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $10,924.35 $10,705.86 $10,924.35 $10,924.35 $10,924.35 2025-12-31
00002-7640-01 NDC PEMEtrexed 100 Mg Inj Soln 1 1 $2,184.87 $2,141.17 $2,184.87 $2,184.87 $2,184.87 2025-12-31
00002-7678-01 NDC Ramucirumab 500 Mg/50 Ml Inj Soln 1 1 $19,878.34 $19,480.77 $19,878.34 $19,878.34 $19,878.34 2025-12-31
00009-3794-01 NDC Ibutilide 1 Mg/10 Ml Inj Soln 1 1 $1,483.01 $1,453.35 $1,483.01 $1,483.01 $1,483.01 2025-12-31
00023-1145-01 NDC onabotulinumtoxinA 100 Units Inj Soln 1 1 $1,759.03 $1,723.85 $1,759.03 $1,759.03 $1,759.03 2025-12-31
00024-5150-10 NDC Rasburicase 1.5 Mg Inj Soln 1 1 $2,991.14 $2,931.32 $2,991.14 $2,991.14 $2,991.14 2025-12-31
00069-0315-01 NDC Bevacizumab-bvzr 100 Mg/4 Ml Inj Soln 1 1 $1,657.43 $1,624.28 $1,657.43 $1,657.43 $1,657.43 2025-12-31
00069-0342-01 NDC Bevacizumab-bvzr 400 Mg/16 Ml Inj Soln 1 1 $6,629.73 $6,497.14 $6,629.73 $6,629.73 $6,629.73 2025-12-31
00069-0809-01 NDC Infliximab-dyyb 100 Mg Inj Soln 1 1 $2,556.90 $2,505.76 $2,556.90 $2,556.90 $2,556.90 2025-12-31
00069-1309-04 NDC Epoetin Alfa-epbx 40,000 units/mL (non-esrd) Inj Soln 1 1 $1,192.14 $1,168.30 $1,192.14 $1,192.14 $1,192.14 2025-12-31
00069-1309-04A NDC Epoetin Alfa-epbx 40,000 units/mL (esrd And On Dialysis) Inj Soln 1 1 $1,192.14 $1,168.30 $1,192.14 $1,192.14 $1,192.14 2025-12-31
00074-2108-03 NDC Leuprolide Depot 7.5 Mg/month Inj Susp 1 1 $5,854.65 $5,737.56 $5,854.65 $5,854.65 $5,854.65 2025-12-31
00074-3642-03 NDC Leuprolide Depot 7.5 Mg/month Inj Susp 1 1 $5,799.42 $5,683.43 $5,799.42 $5,799.42 $5,799.42 2025-12-31
00078-0435-61 NDC Zoledronic Acid 5 Mg/ Sw 100 Ml Inj Soln 1 1 $2,928.56 $2,869.99 $2,928.56 $2,928.56 $2,928.56 2025-12-31
00143-9279-01 NDC mitoMYcin 20 Mg Inj Soln 1 1 $1,378.04 $1,350.48 $1,378.04 $1,378.04 $1,378.04 2025-12-31
00143-9564-01 NDC Phentolamine 5 Mg Inj Soln 1 1 $1,204.61 $1,180.52 $1,204.61 $1,204.61 $1,204.61 2025-12-31
00143-9564-10 NDC Phentolamine 5 Mg Inj Soln 1 1 $1,323.90 $1,297.42 $1,323.90 $1,323.90 $1,323.90 2025-12-31
00143-9674-01A NDC Argatroban 250 Mg/2.5 Ml Inj Soln (for Impella Purge) 1 1 $1,351.02 $1,324.00 $1,351.02 $1,351.02 $1,351.02 2025-12-31
00169-7201-01 NDC Coagulation Factor VIIa 1,000 Mcg Inj 1 1 $4,030.54 $3,949.93 $4,030.54 $4,030.54 $4,030.54 2025-12-31
00169-7202-01 NDC Coagulation Factor VIIa 2,000 Mcg Inj 1 1 $9,006.80 $8,826.66 $9,006.80 $9,006.80 $9,006.80 2025-12-31
00169-7205-01 NDC Coagulation Factor VIIa 5,000 Mcg Inj 1 1 $20,152.72 $19,749.67 $20,152.72 $20,152.72 $20,152.72 2025-12-31
0037U CPT Trgt Gen Seq DNA 324 Genes 1 1 $4,654.80 $4,561.71 $4,654.80 $4,654.80 $4,654.80 2025-12-31
00409-1061-01 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $1,345.19 $1,318.29 $1,345.19 $1,345.19 $1,345.19 2025-12-31
00456-2700-10 NDC Ceftazidime-avibactam 2.5 G (2g-0.5g) Inj Soln 1 1 $1,122.33 $1,099.88 $1,122.33 $1,122.33 $1,122.33 2025-12-31
00517-0710-01 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $4,678.87 $4,585.29 $4,678.87 $4,678.87 $4,678.87 2025-12-31
00517-4300-01 NDC PACLitaxel (protein-bound) 100 Mg Inj Soln 1 1 $4,428.55 $4,339.98 $4,428.55 $4,428.55 $4,428.55 2025-12-31
00597-0197-05 NDC idaruCIZUmab 2.5 G/ 50 Ml Inj Soln 1 1 $6,893.46 $6,755.59 $6,893.46 $6,893.46 $6,893.46 2025-12-31
00781-3158-95 NDC Bivalirudin 250 Mg Inj Soln 1 1 $2,560.79 $2,509.57 $2,560.79 $2,560.79 $2,560.79 2025-12-31
00781-3182-73 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $3,073.23 $3,011.77 $3,073.23 $3,073.23 $3,073.23 2025-12-31
00781-3182-84 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $3,073.23 $3,011.77 $3,073.23 $3,073.23 $3,073.23 2025-12-31
00781-3244-94 NDC cycloPHOSphamide Lyophilized 1,000 Mg Inj 1 1 $1,855.54 $1,818.43 $1,855.54 $1,855.54 $1,855.54 2025-12-31
00781-3531-91 NDC PACLitaxel (protein-bound) 100 Mg Inj Soln 1 1 $3,842.44 $3,765.59 $3,842.44 $3,842.44 $3,842.44 2025-12-31
00944-2842-10 NDC Antihemophilic Factor Viii (recombinant) ~500 Intl_units Inj Soln 1 1 $1,801.36 $1,765.33 $1,801.36 $1,801.36 $1,801.36 2025-12-31
00944-2843-10 NDC Antihemophilic Factor Viii (recombinant) ~1,000 Intl_units Inj Soln 1 1 $3,557.69 $3,486.54 $3,557.69 $3,557.69 $3,557.69 2025-12-31
00944-2844-10 NDC Antihemophilic Factor Viii (recombinant) ~1500 Intl_units Inj Soln 1 1 $7,700.81 $7,546.79 $7,700.81 $7,700.81 $7,700.81 2025-12-31
0121 RC — 3 1 $1,562.75 $1,531.49 $357.46 $1,661.48 $1,562.75 2025-12-31
0122 RC — 1 1 $2,514.39 $2,464.11 $2,514.39 $2,514.39 $2,514.39 2025-12-31
0123 RC — 1 1 $1,562.75 $1,531.49 $1,562.75 $1,562.75 $1,562.75 2025-12-31
0152U CPT Infectious Disease DNA Pcr Ngs 1 1 $2,572.65 $2,521.20 $2,572.65 $2,572.65 $2,572.65 2025-12-31
0202 RC — 1 1 $2,754.54 $2,699.45 $2,754.54 $2,754.54 $2,754.54 2025-12-31
0206 RC — 1 1 $1,661.48 $1,628.25 $1,661.48 $1,661.48 $1,661.48 2025-12-31
0210 RC — 1 1 $2,754.54 $2,699.45 $2,754.54 $2,754.54 $2,754.54 2025-12-31
0211U CPT Mi Cancer Seek 1 1 $9,883.48 $9,685.81 $9,883.48 $9,883.48 $9,883.48 2025-12-31
0244U CPT 0244u Oncotype Map Pan-cancer Tissue Test 1 1 $3,671.36 $3,597.93 $3,671.36 $3,671.36 $3,671.36 2025-12-31
0273 RC — 1 1 $1,629.52 $1,596.93 $1,629.52 $1,629.52 $1,629.52 2025-12-31
0274 RC — 1 1 $2,240.66 $2,195.85 $2,240.66 $2,240.66 $2,240.66 2025-12-31
0275 RC — 189 1 $6,439.75 $6,310.96 $61.26 $33,486.83 $6,439.75 2025-12-31
0277 RC — 1 1 $6,087.11 $5,965.37 $6,087.11 $6,087.11 $6,087.11 2025-12-31
0278 RC — 5,016 1 $1,486.28 $1,456.55 $4.91 $49,471.52 $1,486.28 2025-12-31
0279 RC — 9 1 $8,814.76 $8,638.46 $187.14 $15,654.35 $8,814.76 2025-12-31
0636 RC — 47 1 $1,631.66 $1,599.03 $3.20 $35,731.87 $1,631.66 2025-12-31
0710 RC — 1 1 $1,415.23 $1,386.93 $1,415.23 $1,415.23 $1,415.23 2025-12-31
0720 RC — 27 1 $6,848.83 $6,711.85 $720.93 $21,988.35 $6,848.83 2025-12-31
10019-0079-01 NDC Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 1 $6,322.77 $6,196.31 $6,322.77 $6,322.77 $6,322.77 2025-12-31
10019-0670-10 NDC Pm Esmolol 2,500 Mg/ Ns 250 Ml IV 1 1 $1,263.68 $1,238.41 $1,263.68 $1,263.68 $1,263.68 2025-12-31
10019-0956-01 NDC cycloPHOSphamide Lyophilized 1,000 Mg Inj 1 1 $1,268.56 $1,243.19 $1,268.56 $1,268.56 $1,268.56 2025-12-31
10122-0510-01 NDC Poractant 120 Mg/1.5 Ml Intra-tracheal Susp 1 1 $1,618.41 $1,586.04 $1,618.41 $1,618.41 $1,618.41 2025-12-31
10122-0510-03 NDC Poractant 240 Mg/3 Ml Intra-tracheal Susp 1 1 $3,191.33 $3,127.50 $3,191.33 $3,191.33 $3,191.33 2025-12-31
10122-0620-10 NDC Cangrelor 50 Mg Inj Soln 1 1 $2,705.28 $2,651.17 $2,705.28 $2,705.28 $2,705.28 2025-12-31
11042 CPT Debridement, Sub-q Tissue 1 1 $1,223.75 $1,199.28 $1,223.75 $1,223.75 $1,223.75 2025-12-31
11043 CPT Debridement, Sub-q Tissue, Muscle 1 1 $1,295.74 $1,269.82 $1,295.74 $1,295.74 $1,295.74 2025-12-31
11044 CPT Debridement, Sub-q Tissue, Muscle, Bone 1 1 $1,511.69 $1,481.46 $1,511.69 $1,511.69 $1,511.69 2025-12-31
11047 CPT Debridement, Bone, Ea Adl 20 Sq Cm Or Part Of 1 1 $1,223.75 $1,199.28 $1,223.75 $1,223.75 $1,223.75 2025-12-31
11057 CPT Paring Of Benign Lesion, >4 1 1 $1,295.74 $1,269.82 $1,295.74 $1,295.74 $1,295.74 2025-12-31
13160 CPT Seconday Closure Of Surgical Wound 1 1 $1,295.74 $1,269.82 $1,295.74 $1,295.74 $1,295.74 2025-12-31
13533-0318-01 NDC Rabies Immune Glob, Human 300 Intl_Units/mL Inj Soln 1 1 $1,918.76 $1,880.38 $1,918.76 $1,918.76 $1,918.76 2025-12-31
13533-0318-03 NDC Rabies Immune Glob, Human 900 Intl_Units/3 Ml Inj Soln 1 1 $5,434.66 $5,325.97 $5,434.66 $5,434.66 $5,434.66 2025-12-31
13533-0318-05 NDC Rabies Immune Glob, Human 1,500 Intl_Units/5 Ml Inj Soln 1 1 $9,057.80 $8,876.64 $9,057.80 $9,057.80 $9,057.80 2025-12-31
13533-0602-50 NDC Antithrombin Iii (human) 500 Intl_Units Inj Soln 1 1 $3,051.05 $2,990.03 $3,051.05 $3,051.05 $3,051.05 2025-12-31
13533-0603-20 NDC Antithrombin Iii (human) 500 Intl_Units Inj Soln 1 1 $3,051.05 $2,990.03 $3,051.05 $3,051.05 $3,051.05 2025-12-31
13533-0606-12 NDC Antithrombin Iii (human) 500 Intl_Units Inj Soln 1 1 $5,404.08 $5,296.00 $5,404.08 $5,404.08 $5,404.08 2025-12-31
13533-0634-02 NDC Tetanus Immune Globulin 250 units/mL Inj Soln 1 1 $1,503.42 $1,473.35 $1,503.42 $1,503.42 $1,503.42 2025-12-31
14789-0015-05 NDC Isoproterenol 1 Mg/5 Ml Inj Soln 1 1 $1,621.22 $1,588.80 $1,621.22 $1,621.22 $1,621.22 2025-12-31
14789-0901-10 NDC Procainamide 1000 Mg/10 Ml (mdv) Inj Soln 1 1 $1,621.22 $1,588.80 $1,621.22 $1,621.22 $1,621.22 2025-12-31
16714-0815-01 NDC Zoledronic Acid 4 Mg/5 Ml Inj Soln 1 1 $1,323.14 $1,296.68 $1,323.14 $1,323.14 $1,323.14 2025-12-31
16714-0857-01 NDC cycloPHOSphamide Lyophilized 1,000 Mg Inj 1 1 $1,858.98 $1,821.80 $1,858.98 $1,858.98 $1,858.98 2025-12-31
16714-0892-01 NDC DAPTOmycin 500 Mg Inj 1 1 $1,115.97 $1,093.65 $1,115.97 $1,115.97 $1,115.97 2025-12-31
16729-0108-11 NDC mitoMYcin 20 Mg Inj Soln 1 1 $1,593.80 $1,561.92 $1,593.80 $1,593.80 $1,593.80 2025-12-31
16729-0230-11 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $1,230.67 $1,206.06 $1,230.67 $1,230.67 $1,230.67 2025-12-31
16729-0242-31 NDC Zoledronic Acid 4 Mg/5 Ml Inj Soln 1 1 $1,887.58 $1,849.83 $1,887.58 $1,887.58 $1,887.58 2025-12-31
16729-0435-05 NDC DAPTOmycin 500 Mg Inj 1 1 $1,203.62 $1,179.55 $1,203.62 $1,203.62 $1,203.62 2025-12-31
24201-0400-02 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $2,161.63 $2,118.40 $2,161.63 $2,161.63 $2,161.63 2025-12-31
25021-0251-50 NDC mitoMYcin 20 Mg Inj Soln 1 1 $1,707.64 $1,673.49 $1,707.64 $1,707.64 $1,707.64 2025-12-31
31722-0102-10 NDC DAPTOmycin 500 Mg Inj 1 1 $1,203.62 $1,179.55 $1,203.62 $1,203.62 $1,203.62 2025-12-31
33947 CPT Ecmo Per Day Initial 1 1 $6,835.78 $6,699.07 $6,835.78 $6,835.78 $6,835.78 2025-12-31
33949 CPT Ecmo Per Day Subsequent 1 1 $5,408.53 $5,300.36 $5,408.53 $5,408.53 $5,408.53 2025-12-31
36511 CPT Apheresis Wbc Therapeutic 1 1 $1,529.52 $1,498.93 $1,529.52 $1,529.52 $1,529.52 2025-12-31
36512 CPT Apheresis Rbc Exchange Transfusion 1 1 $1,529.52 $1,498.93 $1,529.52 $1,529.52 $1,529.52 2025-12-31
36513 CPT Apheresis Platelets Therapeutic 1 1 $1,529.52 $1,498.93 $1,529.52 $1,529.52 $1,529.52 2025-12-31
42023-0182-01 NDC Argatroban 250 Mg/2.5 Ml Inj Soln 1 1 $1,378.04 $1,350.48 $1,378.04 $1,378.04 $1,378.04 2025-12-31
42023-0182-89 NDC Argatroban 250 Mg/2.5 Ml Inj Soln 1 1 $1,378.04 $1,350.48 $1,378.04 $1,378.04 $1,378.04 2025-12-31
42023-0205-01 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $2,161.63 $2,118.40 $2,161.63 $2,161.63 $2,161.63 2025-12-31
42367-0521-25 NDC Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 1 $7,025.30 $6,884.79 $7,025.30 $7,025.30 $7,025.30 2025-12-31
43598-0051-11 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $7,191.07 $7,047.25 $7,191.07 $7,191.07 $7,191.07 2025-12-31
43598-0387-11 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $2,142.72 $2,099.87 $2,142.72 $2,142.72 $2,142.72 2025-12-31
43598-0865-60 NDC Bortezomib 3.5 Mg Inj Soln 1 1 $4,331.33 $4,244.70 $4,331.33 $4,331.33 $4,331.33 2025-12-31
44206-0436-05 NDC Immune Globulin (ivig) 10%, 5 G/50 Ml (Privigen) Inj Soln 1 1 $2,543.70 $2,492.83 $2,543.70 $2,543.70 $2,543.70 2025-12-31
44206-0437-10 NDC Immune Globulin (ivig) 10%, 10 G/100 Ml (Privigen) Inj Soln 1 1 $5,087.40 $4,985.65 $5,087.40 $5,087.40 $5,087.40 2025-12-31
44206-0438-20 NDC Immune Globulin (ivig) 10%, 20 G/200 Ml (Privigen) Inj Soln 1 1 $10,174.80 $9,971.30 $10,174.80 $10,174.80 $10,174.80 2025-12-31
44206-0439-40 NDC Immune Globulin (ivig) 10%, 40 G/400 Ml (Privigen) Inj Soln 1 1 $20,349.60 $19,942.61 $20,349.60 $20,349.60 $20,349.60 2025-12-31
49281-0252-51 NDC Rabies Vaccine, Human Diploid Cell 2.5 Intl_Units/mL Inj Soln 1 1 $1,219.05 $1,194.67 $1,219.05 $1,219.05 $1,219.05 2025-12-31
49281-0575-15 NDC Nirsevimab-alip 50 Mg/0.5 Ml Inj Syringe 1 1 $1,502.69 $1,472.64 $1,502.69 $1,502.69 $1,502.69 2025-12-31
50242-0037-06 NDC Tenecteplase 50 Mg Inj Soln 1 1 $7,948.50 $7,789.53 $7,948.50 $7,948.50 $7,948.50 2025-12-31
50242-0044-13 NDC Alteplase 50 Mg Inj Soln 1 1 $11,889.47 $11,651.68 $11,889.47 $11,889.47 $11,889.47 2025-12-31
50242-0085-27 NDC Alteplase 100 Mg Inj Soln 1 1 $23,778.92 $23,303.34 $23,778.92 $23,778.92 $23,778.92 2025-12-31
50242-0120-01 NDC Tenecteplase 50 Mg Inj Soln 1 1 $18,174.35 $17,810.86 $18,174.35 $18,174.35 $18,174.35 2025-12-31
50242-0120-47 NDC Tenecteplase 50 Mg Inj Soln 1 1 $22,419.53 $21,971.14 $22,419.53 $22,419.53 $22,419.53 2025-12-31
50242-0135-01 NDC Tocilizumab 80 Mg/4 Ml Inj Soln 1 1 $1,435.22 $1,406.52 $1,435.22 $1,435.22 $1,435.22 2025-12-31
50242-0136-01 NDC Tocilizumab 200 Mg/10 Ml Inj Soln 1 1 $3,588.07 $3,516.31 $3,588.07 $3,588.07 $3,588.07 2025-12-31
50242-0137-01 NDC Tocilizumab 400 Mg/20 Ml Inj Soln 1 1 $7,176.13 $7,032.61 $7,176.13 $7,176.13 $7,176.13 2025-12-31
50242-0176-01 NDC Tenecteplase 50 Mg Inj Soln 1 1 $22,419.53 $21,971.14 $22,419.53 $22,419.53 $22,419.53 2025-12-31
50458-0563-01 NDC Paliperidone 156 mg/mL IM Susp 1 1 $6,266.54 $6,141.21 $6,266.54 $6,266.54 $6,266.54 2025-12-31
50458-0564-01 NDC Paliperidone 234 Mg/1.5 Ml IM Susp 1 1 $9,399.59 $9,211.60 $9,399.59 $9,399.59 $9,399.59 2025-12-31
50590 CPT Extracorporeal Shock Wave Lithotripsy 1 1 $4,958.41 $4,859.25 $4,958.41 $4,958.41 $4,958.41 2025-12-31
50632-0010-01 NDC Rabies Vaccine, Purified Chick Embryo 2.5 Int_Unit/mL Inj Soln 1 1 $1,174.33 $1,150.84 $1,174.33 $1,174.33 $1,174.33 2025-12-31
50633-0110-12 NDC Antivenin (crotalidae-snake Ovine) Polyvalent Inj 1 1 $8,641.12 $8,468.30 $8,641.12 $8,641.12 $8,641.12 2025-12-31
50633-0120-11 NDC Digoxin Immune Fab 40 Mg Inj Soln 1 1 $13,439.95 $13,171.15 $13,439.95 $13,439.95 $13,439.95 2025-12-31
50742-0431-08 NDC DOCEtaxel 80 Mg/8 Ml (mdv) Inj Soln 1 1 $3,418.46 $3,350.09 $3,418.46 $3,418.46 $3,418.46 2025-12-31
54288-0105-15 NDC Ethanol 99%, 5 Ml 1 1 $2,688.53 $2,634.76 $2,688.53 $2,688.53 $2,688.53 2025-12-31
55150-0240-05 NDC Isosulfan Blue 50 Mg/5 Ml Inj Soln 1 1 $2,758.33 $2,703.16 $2,758.33 $2,758.33 $2,758.33 2025-12-31
55150-0317-10 NDC Isoproterenol 1 Mg/5 Ml Inj Soln 1 1 $1,472.61 $1,443.16 $1,472.61 $1,472.61 $1,472.61 2025-12-31
55150-0382-01 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $1,351.02 $1,324.00 $1,351.02 $1,351.02 $1,351.02 2025-12-31
55566-2300-00 NDC Desmopressin 40 Mcg/10 Ml (mdv) Inj Soln 1 1 $2,219.75 $2,175.36 $2,219.75 $2,219.75 $2,219.75 2025-12-31
55566-2800-01 NDC Dinoprostone 10 Mg (vaginal) Supp 1 1 $1,486.62 $1,456.89 $1,486.62 $1,486.62 $1,486.62 2025-12-31
57970-0100-01 NDC Dalbavancin 500 Mg Inj Soln 1 1 $4,807.28 $4,711.13 $4,807.28 $4,807.28 $4,807.28 2025-12-31
59148-0018-71 NDC ARIPiprazole (Abilify Maintena Depot) 300 Mg Inj Susp 1 1 $5,885.94 $5,768.22 $5,885.94 $5,885.94 $5,885.94 2025-12-31
59148-0019-71 NDC ARIPiprazole (Abilify Maintena Depot) 400 Mg Inj Susp 1 1 $7,847.92 $7,690.96 $7,847.92 $7,847.92 $7,847.92 2025-12-31
59148-0045-80 NDC ARIPiprazole (Abilify Maintena Depot) 300 Mg Inj Susp 1 1 $5,885.94 $5,768.22 $5,885.94 $5,885.94 $5,885.94 2025-12-31
59148-0072-80 NDC ARIPiprazole (Abilify Maintena Depot) 400 Mg Inj Susp 1 1 $7,847.92 $7,690.96 $7,847.92 $7,847.92 $7,847.92 2025-12-31
59676-0320-04 NDC Epoetin Alfa 20,000 units/mL Inj Soln (esrd And On Dialysis) (mdv) 1 1 $1,444.24 $1,415.36 $1,444.24 $1,444.24 $1,444.24 2025-12-31
60505-6065-00 NDC PEMEtrexed 100 Mg Inj Soln 1 1 $1,927.82 $1,889.26 $1,927.82 $1,927.82 $1,927.82 2025-12-31
60505-6066-00 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $9,639.03 $9,446.25 $9,639.03 $9,639.03 $9,639.03 2025-12-31
60505-6110-00 NDC Zoledronic Acid 4 Mg/5 Ml Inj Soln 1 1 $2,177.96 $2,134.40 $2,177.96 $2,177.96 $2,177.96 2025-12-31
60505-6228-00 NDC Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 1 $8,672.31 $8,498.86 $8,672.31 $8,672.31 $8,672.31 2025-12-31
60505-6229-04 NDC DAPTOmycin 500 Mg Inj 1 1 $1,203.62 $1,179.55 $1,203.62 $1,203.62 $1,203.62 2025-12-31
60505-6230-04 NDC PACLitaxel (protein-bound) 100 Mg Inj Soln 1 1 $4,055.92 $3,974.80 $4,055.92 $4,055.92 $4,055.92 2025-12-31
61958-2901-02 NDC Remdesivir 100 Mg Inj Soln 1 1 $1,715.39 $1,681.08 $1,715.39 $1,715.39 $1,715.39 2025-12-31
61958-2901-02A NDC Remdesivir 100 Mg Inj Soln (from Pharmacy) 1 1 $1,405.06 $1,376.96 $1,405.06 $1,405.06 $1,405.06 2025-12-31
62332-0678-08 NDC DOCEtaxel 80 Mg/8 Ml (mdv) Inj Soln 1 1 $3,418.44 $3,350.07 $3,418.44 $3,418.44 $3,418.44 2025-12-31
62756-0529-40 NDC Desmopressin 40 Mcg/10 Ml (mdv) Inj Soln 1 1 $1,606.00 $1,573.88 $1,606.00 $1,606.00 $1,606.00 2025-12-31
63020-0049-01 NDC Bortezomib 3.5 Mg Inj Soln 1 1 $4,331.37 $4,244.74 $4,331.37 $4,331.37 $4,331.37 2025-12-31
63261-0250-21 NDC Isosulfan Blue 50 Mg/5 Ml Inj Soln 1 1 $1,713.99 $1,679.71 $1,713.99 $1,713.99 $1,713.99 2025-12-31
63323-0371-19 NDC DAPTOmycin 500 Mg Inj 1 1 $1,203.71 $1,179.64 $1,203.71 $1,203.71 $1,203.71 2025-12-31
63323-0450-50 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $1,603.91 $1,571.83 $1,603.91 $1,603.91 $1,603.91 2025-12-31
63323-0721-10 NDC Bortezomib 3.5 Mg Inj Soln 1 1 $4,331.33 $4,244.70 $4,331.33 $4,331.33 $4,331.33 2025-12-31
63323-0865-02 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $2,161.63 $2,118.40 $2,161.63 $2,161.63 $2,161.63 2025-12-31
63459-0103-10 NDC Rituximab-abbs 100 Mg/10 Ml Inj Soln 1 1 $2,284.71 $2,239.02 $2,284.71 $2,284.71 $2,284.71 2025-12-31
63459-0104-50 NDC Rituximab-abbs 500 Mg/50 Ml Inj Soln 1 1 $11,423.55 $11,195.08 $11,423.55 $11,423.55 $11,423.55 2025-12-31
63459-0348-04 NDC Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 1 $6,684.31 $6,550.62 $6,684.31 $6,684.31 $6,684.31 2025-12-31
63833-0386-02 NDC Prothrombin Complex Concentrate (human) 500 Units (range) Inj Soln 1 1 $4,983.91 $4,884.23 $4,983.91 $4,983.91 $4,983.91 2025-12-31
63833-0615-02 NDC Antihemophilic Factor Viii (human)-vwf 600 Units (vwf:RCo) Inj Soln 1 1 $2,702.04 $2,648.00 $2,702.04 $2,702.04 $2,702.04 2025-12-31
63833-0616-02 NDC Antihemophilic Factor Viii (human)-vwf 1,200 Units (vwf:RCo) Inj Soln 1 1 $4,107.10 $4,024.96 $4,107.10 $4,107.10 $4,107.10 2025-12-31
63833-0617-02 NDC Antihemophilic Factor Viii (human)-vwf 2,400 Units (vwf:RCo) Inj Soln 1 1 $8,214.20 $8,049.92 $8,214.20 $8,214.20 $8,214.20 2025-12-31
65219-0566-20 NDC mitoMYcin 20 Mg Inj Soln 1 1 $1,707.64 $1,673.49 $1,707.64 $1,707.64 $1,707.64 2025-12-31
65757-0300-01 NDC Naltrexone (depot) 380 Mg Inj Susp 1 1 $4,567.37 $4,476.02 $4,567.37 $4,567.37 $4,567.37 2025-12-31
66758-0050-02 NDC DOCEtaxel 80 Mg/8 Ml (mdv) Inj Soln 1 1 $3,418.46 $3,350.09 $3,418.46 $3,418.46 $3,418.46 2025-12-31
66758-0950-03 NDC DOCEtaxel 80 Mg/8 Ml (mdv) Inj Soln 1 1 $3,418.46 $3,350.09 $3,418.46 $3,418.46 $3,418.46 2025-12-31
67457-0211-02 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $2,774.45 $2,718.96 $2,774.45 $2,774.45 $2,774.45 2025-12-31
67457-0212-02 NDC Argatroban 250 Mg/2.5 Ml Inj Soln 1 1 $1,378.04 $1,350.48 $1,378.04 $1,378.04 $1,378.04 2025-12-31
67457-0220-05 NDC Isosulfan Blue 50 Mg/5 Ml Inj Soln 1 1 $3,280.79 $3,215.17 $3,280.79 $3,280.79 $3,280.79 2025-12-31
67457-0256-10 NDC Bivalirudin 250 Mg Inj Soln 1 1 $2,560.79 $2,509.57 $2,560.79 $2,560.79 $2,560.79 2025-12-31
67457-0519-20 NDC mitoMYcin 20 Mg Inj Soln 1 1 $1,593.80 $1,561.92 $1,593.80 $1,593.80 $1,593.80 2025-12-31
67457-0586-05 NDC Isosulfan Blue 50 Mg/5 Ml Inj Soln 1 1 $3,009.90 $2,949.70 $3,009.90 $3,009.90 $3,009.90 2025-12-31
67457-0657-25 NDC Pm Esmolol 2,500 Mg/ Ns 250 Ml IV 1 1 $1,136.07 $1,113.35 $1,136.07 $1,136.07 $1,136.07 2025-12-31
67457-0675-02 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $2,702.04 $2,648.00 $2,702.04 $2,702.04 $2,702.04 2025-12-31
68001-0536-41 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $1,351.02 $1,324.00 $1,351.02 $1,351.02 $1,351.02 2025-12-31
68001-0539-41 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $2,161.63 $2,118.40 $2,161.63 $2,161.63 $2,161.63 2025-12-31
68001-0543-41 NDC PEMEtrexed 100 Mg Inj Soln 1 1 $1,927.82 $1,889.26 $1,927.82 $1,927.82 $1,927.82 2025-12-31
68001-0544-41 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $9,639.03 $9,446.25 $9,639.03 $9,639.03 $9,639.03 2025-12-31
68094-0101-20 NDC Phentolamine 5 Mg Inj Soln 1 1 $1,134.32 $1,111.63 $1,134.32 $1,134.32 $1,134.32 2025-12-31
68547-0501-02 NDC Angiotensin Ii 2.5 mg/mL Inj Soln 1 1 $4,769.10 $4,673.72 $4,769.10 $4,769.10 $4,769.10 2025-12-31
68682-0433-05 NDC Isoproterenol 1 Mg/5 Ml Inj Soln 1 1 $1,324.00 $1,297.52 $1,324.00 $1,324.00 $1,324.00 2025-12-31
68817-0134-50 NDC PACLitaxel (protein-bound) 100 Mg Inj Soln 1 1 $4,269.39 $4,184.00 $4,269.39 $4,269.39 $4,269.39 2025-12-31
69097-0522-35 NDC Isoproterenol 1 Mg/5 Ml Inj Soln 1 1 $1,324.00 $1,297.52 $1,324.00 $1,324.00 $1,324.00 2025-12-31
70095-0031-01 NDC Desmopressin 40 Mcg/10 Ml (mdv) Inj Soln 1 1 $1,606.00 $1,573.88 $1,606.00 $1,606.00 $1,606.00 2025-12-31
70377-0093-91 NDC DAPTOmycin 500 Mg Inj 1 1 $1,202.41 $1,178.36 $1,202.41 $1,202.41 $1,202.41 2025-12-31
70700-0175-22 NDC DOCEtaxel 80 Mg/8 Ml (mdv) Inj Soln 1 1 $3,418.46 $3,350.09 $3,418.46 $3,418.46 $3,418.46 2025-12-31
70710-1478-01 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $4,053.06 $3,972.00 $4,053.06 $4,053.06 $4,053.06 2025-12-31
70710-1655-01 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $2,677.54 $2,623.99 $2,677.54 $2,677.54 $2,677.54 2025-12-31
70860-0203-50 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $2,229.18 $2,184.60 $2,229.18 $2,229.18 $2,229.18 2025-12-31
70860-0454-10 NDC Desmopressin 40 Mcg/10 Ml (mdv) Inj Soln 1 1 $1,418.57 $1,390.20 $1,418.57 $1,418.57 $1,418.57 2025-12-31
71225-0120-01 NDC Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 1 $8,845.76 $8,668.84 $8,845.76 $8,845.76 $8,845.76 2025-12-31
71288-0138-50 NDC mitoMYcin 20 Mg Inj Soln 1 1 $1,215.92 $1,191.60 $1,215.92 $1,215.92 $1,215.92 2025-12-31
71839-0107-01 NDC DAPTOmycin 500 Mg Inj 1 1 $1,203.62 $1,179.55 $1,203.62 $1,203.62 $1,203.62 2025-12-31
72603-0152-01 NDC DAPTOmycin 500 Mg Inj 1 1 $1,115.97 $1,093.65 $1,115.97 $1,115.97 $1,115.97 2025-12-31
73607-0011-11 NDC Artesunate 110 Mg Inj Soln 1 1 $13,456.16 $13,187.04 $13,456.16 $13,456.16 $13,456.16 2025-12-31
76329-3399-05 NDC Procainamide 1000 Mg/10 Ml (mdv) Inj Soln 1 1 $1,148.37 $1,125.40 $1,148.37 $1,148.37 $1,148.37 2025-12-31
77285 CPT Simulation/Intermediate 1 1 $1,650.55 $1,617.54 $1,650.55 $1,650.55 $1,650.55 2025-12-31
77290 CPT Simulation/Complex 1 1 $1,904.48 $1,866.39 $1,904.48 $1,904.48 $1,904.48 2025-12-31
77293 CPT Respiratory Motion Mgmt Simulation 1 1 $1,602.94 $1,570.88 $1,602.94 $1,602.94 $1,602.94 2025-12-31
77295 CPT Simulation Three Dimensional 1 1 $1,174.43 $1,150.94 $1,174.43 $1,174.43 $1,174.43 2025-12-31
77301 CPT Imrt Planning 1 1 $6,745.03 $6,610.13 $6,745.03 $6,745.03 $6,745.03 2025-12-31
77338 CPT Mlc For Irmt Design & Const 1 1 $1,253.78 $1,228.71 $1,253.78 $1,253.78 $1,253.78 2025-12-31
77373 CPT Sbrt 1 1 $5,983.24 $5,863.58 $5,983.24 $5,983.24 $5,983.24 2025-12-31
77385 CPT Imrt Includes Guidance And Tracking, When Performed; Simple 1 1 $1,777.52 $1,741.96 $1,777.52 $1,777.52 $1,777.52 2025-12-31
77386 CPT Imrt Includes Guidance And Tracking, When Performed; Complex 1 1 $1,777.52 $1,741.96 $1,777.52 $1,777.52 $1,777.52 2025-12-31
77407 CPT Radiation Treatment/Delivery > 1MeV; Intermediate 77407 1 1 $1,142.69 $1,119.83 $1,142.69 $1,142.69 $1,142.69 2025-12-31
77412 CPT Radiation Treatment/Complex 0-5 Mev 1 1 $1,222.04 $1,197.60 $1,222.04 $1,222.04 $1,222.04 2025-12-31
77763 CPT Brachy Intracavitary Complex 1 1 $1,253.78 $1,228.71 $1,253.78 $1,253.78 $1,253.78 2025-12-31
77767 CPT Brachy Dose Lesion Up To 2cm Or 1 Channel-77767 1 1 $1,428.36 $1,399.79 $1,428.36 $1,428.36 $1,428.36 2025-12-31
77768 CPT Brachy Dose Lesion Over 2m Or 2 Or More Channels-77768 1 1 $2,332.99 $2,286.33 $2,332.99 $2,332.99 $2,332.99 2025-12-31
77771 CPT Hi Dose Therapy 2-12 Channels 1 1 $1,428.36 $1,399.79 $1,428.36 $1,428.36 $1,428.36 2025-12-31
77772 CPT Hi Inten Brach Tx > 12 Ch 1 1 $2,332.99 $2,286.33 $2,332.99 $2,332.99 $2,332.99 2025-12-31
77778 CPT Interstitial Radioactive Application/Complex 1 1 $1,269.65 $1,244.26 $1,269.65 $1,269.65 $1,269.65 2025-12-31
78013 CPT Nm Thyroid Imaging Only 1 1 $1,568.46 $1,537.09 $1,568.46 $1,568.46 $1,568.46 2025-12-31
78014 CPT Nm Thyroid Imaging With Uptake Multiple 1 1 $1,976.26 $1,936.74 $1,976.26 $1,976.26 $1,976.26 2025-12-31
78018 CPT Nm Thyroid Ca Met Imaging-body 1 1 $2,478.17 $2,428.61 $2,478.17 $2,478.17 $2,478.17 2025-12-31
78070 CPT Nm Parathyroid Spect Imaging 1 1 $2,384.06 $2,336.38 $2,384.06 $2,384.06 $2,384.06 2025-12-31
78071 CPT Nm Parathyroid Planar Imaging W/spect 1 1 $2,729.13 $2,674.54 $2,729.13 $2,729.13 $2,729.13 2025-12-31
78075 CPT Nm Adrenal Imaging 1 1 $3,732.94 $3,658.28 $3,732.94 $3,732.94 $3,732.94 2025-12-31
78102 CPT Nm Bone Marrow Imaging Limited 1 1 $1,317.51 $1,291.16 $1,317.51 $1,317.51 $1,317.51 2025-12-31
78103 CPT Nm Bone Marrow Imaging Multiple Areas 1 1 $1,693.94 $1,660.06 $1,693.94 $1,693.94 $1,693.94 2025-12-31
78104 CPT Nm Bone Marrow Imaging Whole Body 1 1 $1,913.52 $1,875.25 $1,913.52 $1,913.52 $1,913.52 2025-12-31
78185 CPT Nm Spleen Imaging With Or Without Flow 1 1 $1,756.68 $1,721.55 $1,756.68 $1,756.68 $1,756.68 2025-12-31
78195 CPT Nm Lymphatic Imaging 1 1 $2,729.13 $2,674.54 $2,729.13 $2,729.13 $2,729.13 2025-12-31
78201 CPT Nm Liver Imaging Static Only 1 1 $1,537.09 $1,506.35 $1,537.09 $1,537.09 $1,537.09 2025-12-31
78215 CPT Nm Liver Spleen Scan 1 1 $1,568.46 $1,537.09 $1,568.46 $1,568.46 $1,568.46 2025-12-31
78226 CPT Nm Hida Scan Without Intervention 1 1 $2,697.76 $2,643.80 $2,697.76 $2,697.76 $2,697.76 2025-12-31
78227 CPT Nm Hida Scan With Intervention 1 1 $3,701.57 $3,627.54 $3,701.57 $3,701.57 $3,701.57 2025-12-31
78230 CPT Nm Salivary Gland Imaging 1 1 $1,380.25 $1,352.64 $1,380.25 $1,380.25 $1,380.25 2025-12-31
78262 CPT Nm Gastroesophageal Reflux Exam 1 1 $1,913.52 $1,875.25 $1,913.52 $1,913.52 $1,913.52 2025-12-31
78264 CPT Nm Gastric Emptying Study, Solid, Liquid Or Both 1 1 $2,729.13 $2,674.54 $2,729.13 $2,729.13 $2,729.13 2025-12-31
78265 CPT Nm Gastric Emptying Study W/small Bowel Transit 1 1 $3,199.66 $3,135.67 $3,199.66 $3,199.66 $3,199.66 2025-12-31
78266 CPT Nm Gastric Emptying Study W/small Bowel&colon Transit Multi Days 1 1 $3,858.42 $3,781.25 $3,858.42 $3,858.42 $3,858.42 2025-12-31
78278 CPT Nm Bleeding Scan-gi 1 1 $2,760.50 $2,705.29 $2,760.50 $2,760.50 $2,760.50 2025-12-31
78290 CPT Nm Meckel's Scan 1 1 $2,729.13 $2,674.54 $2,729.13 $2,729.13 $2,729.13 2025-12-31
78291 CPT Nm Peritoneal-venous Shunt Patency 1 1 $1,944.89 $1,906.00 $1,944.89 $1,944.89 $1,944.89 2025-12-31
78300 CPT Nm Bone Imaging Limited 1 1 $1,380.25 $1,352.64 $1,380.25 $1,380.25 $1,380.25 2025-12-31
78305 CPT Nm Bone Imaging Limited Multiple Areas 1 1 $1,756.68 $1,721.55 $1,756.68 $1,756.68 $1,756.68 2025-12-31
78306 CPT Nm Bone Imaging Whole Body 1 1 $1,913.52 $1,875.25 $1,913.52 $1,913.52 $1,913.52 2025-12-31
78315 CPT Nm Bone Three Phase Study 1 1 $2,729.13 $2,674.54 $2,729.13 $2,729.13 $2,729.13 2025-12-31
78451 CPT Nm Heart Muscle Spect Single 1 1 $2,509.54 $2,459.35 $2,509.54 $2,509.54 $2,509.54 2025-12-31
78452 CPT Nm Heart Muscle Spect Multiple 1 1 $3,607.47 $3,535.32 $3,607.47 $3,607.47 $3,607.47 2025-12-31
78469 CPT Nm Myo Infarct Spect 1 1 $1,662.57 $1,629.32 $1,662.57 $1,662.57 $1,662.57 2025-12-31
78472 CPT Nm Cardiac Blood Pool Gated Single 1 1 $1,662.57 $1,629.32 $1,662.57 $1,662.57 $1,662.57 2025-12-31
78483 CPT Nm Cardiac Blood Pool Multi Rest/Stress 1 1 $1,568.46 $1,537.09 $1,568.46 $1,568.46 $1,568.46 2025-12-31
78579 CPT Nm Lung Scan Vent Only 1 1 $1,474.36 $1,444.87 $1,474.36 $1,474.36 $1,474.36 2025-12-31
78580 CPT Nm Differential Lung Scan 1 1 $1,850.79 $1,813.77 $1,850.79 $1,850.79 $1,850.79 2025-12-31
78582 CPT Nm Vq Scan Complete 1 1 $2,572.28 $2,520.83 $2,572.28 $2,572.28 $2,572.28 2025-12-31
78597 CPT Nm Quantitative Lung Perfusion Only 1 1 $1,537.09 $1,506.35 $1,537.09 $1,537.09 $1,537.09 2025-12-31
78598 CPT Nm Quantitative Lung Complete 1 1 $2,415.43 $2,367.12 $2,415.43 $2,415.43 $2,415.43 2025-12-31
78600 CPT Nm Brain Imaging < 4 Views 1 1 $1,505.72 $1,475.61 $1,505.72 $1,505.72 $1,505.72 2025-12-31
78601 CPT Nm Brain Imaging Ltd Static With Vascular 1 1 $1,725.31 $1,690.80 $1,725.31 $1,725.31 $1,725.31 2025-12-31
78605 CPT Nm Brain Imaging Complete Study Static 1 1 $1,599.83 $1,567.84 $1,599.83 $1,599.83 $1,599.83 2025-12-31
78606 CPT Nm Brain Imaging Comp With Vascular Flow 1 1 $2,729.13 $2,674.54 $2,729.13 $2,729.13 $2,729.13 2025-12-31
78608 CPT PET Brain Imaging Metabolic Evaluation 2 1 $11,292.93 $11,067.08 $11,292.93 $11,292.93 $11,292.93 2025-12-31
78609 CPT PET Brain Imaging Perfusion Evaluation 1 1 $11,292.93 $11,067.08 $11,292.93 $11,292.93 $11,292.93 2025-12-31
78610 CPT Nm Brain Imaging Vascular Flow Only 1 1 $1,474.36 $1,444.87 $1,474.36 $1,474.36 $1,474.36 2025-12-31
78630 CPT Nm Cisternography/Cerebrospinal 1 1 $2,791.86 $2,736.03 $2,791.86 $2,791.86 $2,791.86 2025-12-31
78645 CPT Nm Cerebro Fluid Flow Shunt Evaluation 1 1 $2,729.13 $2,674.54 $2,729.13 $2,729.13 $2,729.13 2025-12-31
78650 CPT Nm Cerebrospinal Fluid Leakage Detection 1 1 $2,760.50 $2,705.29 $2,760.50 $2,760.50 $2,760.50 2025-12-31
78700 CPT Nm DMSA/Kidney Static Imaging 1 1 $1,380.25 $1,352.64 $1,380.25 $1,380.25 $1,380.25 2025-12-31
78701 CPT Nm Kidney Imaging With Flow 1 1 $1,725.31 $1,690.80 $1,725.31 $1,725.31 $1,725.31 2025-12-31
78707 CPT Nm Kidney Imaging With Flow Without Pharm 1 1 $1,693.94 $1,660.06 $1,693.94 $1,693.94 $1,693.94 2025-12-31
78709 CPT Nm Kidney Imaging With Flow With + Without Pharm 1 1 $2,729.13 $2,674.54 $2,729.13 $2,729.13 $2,729.13 2025-12-31
78740 CPT Nm Ureteral Reflux Study 1 1 $1,756.68 $1,721.55 $1,756.68 $1,756.68 $1,756.68 2025-12-31
78761 CPT Nm Testicular Scan With Vascular Flow 1 1 $1,631.20 $1,598.58 $1,631.20 $1,631.20 $1,631.20 2025-12-31
78800 CPT Nm Abscess Imaging Limited Area 1 1 $1,442.99 $1,414.13 $1,442.99 $1,442.99 $1,442.99 2025-12-31
78801 CPT Nm Octreoscan 1 1 $2,039.00 $1,998.22 $2,039.00 $2,039.00 $2,039.00 2025-12-31
78802 CPT Nm Abscess Imaging Whole Body 1 1 $2,572.28 $2,520.83 $2,572.28 $2,572.28 $2,572.28 2025-12-31
78803 CPT Nm Abscess Imaging Spect 1 1 $2,666.39 $2,613.06 $2,666.39 $2,666.39 $2,666.39 2025-12-31
78804 CPT Nm Octreoscan Whole Body 2day 1 1 $4,705.39 $4,611.28 $4,705.39 $4,705.39 $4,705.39 2025-12-31
78811 CPT PET Image-limited Area 1 1 $8,469.70 $8,300.31 $8,469.70 $8,469.70 $8,469.70 2025-12-31
78812 CPT PET Image-skull To Mid-thigh 2 1 $11,292.93 $11,067.08 $11,292.93 $11,292.93 $11,292.93 2025-12-31
78813 CPT PET Tumor Image Whole Body Mod-q0 2 1 $14,116.17 $13,833.84 $14,116.17 $14,116.17 $14,116.17 2025-12-31
78814 CPT PET Image-w/ct-limited Area 2 1 $11,292.93 $11,067.08 $11,292.93 $11,292.93 $11,292.93 2025-12-31
78815 CPT PET Image-w/ct-skull To Mid-thigh 1 1 $13,645.63 $13,372.72 $13,645.63 $13,645.63 $13,645.63 2025-12-31
78816 CPT PET Image-whole Body 2 1 $15,527.78 $15,217.23 $15,527.78 $15,527.78 $15,527.78 2025-12-31
78831 CPT Nm Octreo Scan Spect 1 1 $5,583.73 $5,472.05 $5,583.73 $5,583.73 $5,583.73 2025-12-31
81220 CPT Cystic Fibrosis Screen(XCYFIB) 6120010 1 1 $1,113.42 $1,091.16 $1,113.42 $1,113.42 $1,113.42 2025-12-31
81229 CPT Interrogation Of Genomic Regions, Etc 6220003 1 1 $2,908.64 $2,850.47 $2,908.64 $2,908.64 $2,908.64 2025-12-31
81352 CPT 81352 Tp53 Mutation Analysis 1 1 $1,223.79 $1,199.31 $1,223.79 $1,223.79 $1,223.79 2025-12-31
81401 CPT Molecular Pathology Procedure, Level 2 (eg, 2-10) 1 1 $1,356.22 $1,329.10 $1,356.22 $1,356.22 $1,356.22 2025-12-31
81405 CPT Molecular Pathology Procedure, Level 6 1 1 $1,258.12 $1,232.96 $1,258.12 $1,258.12 $1,258.12 2025-12-31
81420 CPT Fetal Aneupoidy Genomic Sequence 1 1 $3,752.29 $3,677.24 $3,752.29 $3,752.29 $3,752.29 2025-12-31
81455 CPT 81455 Targeted Genomic Sequence Analysis Panel, DNA Analysis 1 1 $2,925.81 $2,867.29 $2,925.81 $2,925.81 $2,925.81 2025-12-31
81519 CPT Oncotype Dx Breast Cancer Assay 1 1 $4,946.65 $4,847.71 $4,946.65 $4,946.65 $4,946.65 2025-12-31
81525 CPT 81525 Oncotype Dx Colon 1 1 $5,427.33 $5,318.79 $5,427.33 $5,427.33 $5,427.33 2025-12-31
81540 CPT 81540 Oncology, Mrna, Gene Expression Profiling By Real0time Rt-pcr Of 92 Genes 1 1 $5,667.67 $5,554.32 $5,667.67 $5,667.67 $5,667.67 2025-12-31
88249 CPT Chromosome Analysis 100 6128250 1 1 $1,140.40 $1,117.59 $1,140.40 $1,140.40 $1,140.40 2025-12-31
90935 CPT Ip Dialysis Hemo 1 1 $1,421.68 $1,393.25 $1,421.68 $1,421.68 $1,421.68 2025-12-31
91010 CPT $Esophageal Motility Charges -> $Esophageal Motility Study Of Esophagus 2 1 $2,291.57 $2,245.73 $863.83 $3,719.30 $2,291.57 2025-12-31
92506 CPT Slp-kx Speech Language Eval Chrg Min -> 15 Minutes 6 1 $1,510.94 $1,480.72 $431.70 $2,590.18 $1,510.94 2025-12-31
92612 CPT Slp Fiberoptic Endoscopic Eval -> 30 Minutes Fiberoptic Endoscopic Eval 1 1 $1,654.84 $1,621.74 $1,654.84 $1,654.84 $1,654.84 2025-12-31
93886 CPT US Transcranial Doppler Complete 1 1 $1,414.48 $1,386.19 $1,414.48 $1,414.48 $1,414.48 2025-12-31
93925 CPT US Arterial Duplex Le Bilateral 1 1 $1,349.19 $1,322.21 $1,349.19 $1,349.19 $1,349.19 2025-12-31
93975 CPT US Art/Vein Abd/Pelvic Complete - Vas 1 1 $1,370.95 $1,343.53 $1,370.95 $1,370.95 $1,370.95 2025-12-31
95708 CPT EEG Monitoring 12-26 Hrs 1 1 $1,448.65 $1,419.68 $1,448.65 $1,448.65 $1,448.65 2025-12-31
95714 CPT Veeg Monitoring 12-26 Hrs 1 1 $1,448.65 $1,419.68 $1,448.65 $1,448.65 $1,448.65 2025-12-31
95808 CPT Polysomnography 1-3 Par Attended 1 1 $1,320.83 $1,294.42 $1,320.83 $1,320.83 $1,320.83 2025-12-31
95810 CPT Polysomnography 4+ Par Attended 1 1 $1,193.01 $1,169.15 $1,193.01 $1,193.01 $1,193.01 2025-12-31
95811 CPT Polysom 4+ Attended With Cpap 1 1 $1,261.18 $1,235.96 $1,261.18 $1,261.18 $1,261.18 2025-12-31
99999-6603-00 NDC Tpn Pediatric - Peripheral Line 1 1 $1,351.02 $1,324.00 $1,351.02 $1,351.02 $1,351.02 2025-12-31
99999-6603-02 NDC Tpn Pediatric - Central Line 1 1 $1,351.02 $1,324.00 $1,351.02 $1,351.02 $1,351.02 2025-12-31
G0257 HCPCS Dialysis Out-pt Emerg Basis 1 1 $1,421.68 $1,393.25 $1,421.68 $1,421.68 $1,421.68 2025-12-31
G6013 HCPCS Radtrmtdel 3/more Trmt Custblck Tnl Prt Wdg 1 1 $1,110.95 $1,088.73 $1,110.95 $1,110.95 $1,110.95 2025-12-31
P9035 HCPCS Plate Pheres-leuko Reducd/unit 6816393 1 1 $1,226.24 $1,201.71 $1,226.24 $1,226.24 $1,226.24 2025-12-31
P9037 HCPCS Platelets Pheresis Lr Irr Each 6819037 1 1 $1,422.44 $1,393.99 $1,422.44 $1,422.44 $1,422.44 2025-12-31
P9052 HCPCS Platelets Hla-m L/r Unit 6822000 1 1 $1,532.80 $1,502.14 $1,532.80 $1,532.80 $1,532.80 2025-12-31
P9073 HCPCS Platelets, Pheresis, Pathogen Reduced, Each Unit. 1 1 $1,471.49 $1,442.06 $1,471.49 $1,471.49 $1,471.49 2025-12-31
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