Price Transparency 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

4,616 distinct procedures filed
3 distinct payers
22,945 rate rows
2025-12-31 last MRF observed
Data quality

22,928 of 22,945 rate rows are consumer-grade (99.9%)

17 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 15
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 2
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 · 2026-05-15
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 $36,644.69 $30,211.81 nat. median
$30,625
1.0× median
50242-0176-01
NDC 		Tenecteplase 50 Mg Inj Soln 1 $22,419.53 $34,549.79 $28,484.66 nat. median
$28,874
1.0× median
50242-0120-47
NDC 		Tenecteplase 50 Mg Inj Soln 1 $22,419.53 $34,549.79 $28,484.66 nat. median
$241
outlier · 118.0×
44206-0439-40
NDC 		Immune Globulin (ivig) 10%, 40 G/400 Ml (Privigen) Inj Soln 1 $20,349.60 $31,359.92 $25,854.76 nat. median
$26,209
1.0× median
50242-0120-01
NDC 		Tenecteplase 50 Mg Inj Soln 1 $18,174.35 $28,007.73 $23,091.04 nat. median
$23,407
1.0× 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
$19,878
1.0× median
50633-0120-11
NDC 		Digoxin Immune Fab 40 Mg Inj Soln 1 $13,439.95 $20,711.74 $17,075.85 nat. median
$10,060
1.7× median
78816
CPT 		PET Image-whole Body 1 $15,527.78 $15,527.78 $15,527.78 nat. median
$2,707
outlier · 5.7×
50242-0044-13
NDC 		Alteplase 50 Mg Inj Soln 1 $11,889.47 $18,322.36 $15,105.92 nat. median
$195
outlier · 77.4×
78813
CPT 		PET Tumor Image Whole Body Mod-q0 1 $14,116.17 $14,116.17 $14,116.17 nat. median
$1,855
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
$2,794
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×
44206-0438-20
NDC 		Immune Globulin (ivig) 10%, 20 G/200 Ml (Privigen) Inj Soln 1 $10,174.80 $15,679.96 $12,927.38 nat. median
$13,104
1.0× median
13533-0318-05
NDC 		Rabies Immune Glob, Human 1,500 Intl_Units/5 Ml Inj Soln 1 $9,057.80 $13,958.60 $11,508.20 nat. median
$11,666
1.0× median
63459-0104-50
NDC 		Rituximab-abbs 500 Mg/50 Ml Inj Soln 1 $11,423.55 $11,423.55 $11,423.55 nat. median
$52
outlier · 217.7×
78608
CPT 		PET Brain Imaging Metabolic Evaluation 1 $11,292.93 $11,292.93 $11,292.93 nat. median
$2,352
outlier · 4.8×
78812
CPT 		PET Image-skull To Mid-thigh 1 $11,292.93 $11,292.93 $11,292.93 nat. median
$1,862
outlier · 6.1×
78814
CPT 		PET Image-w/ct-limited Area 1 $11,292.93 $11,292.93 $11,292.93 nat. median
$2,306
outlier · 4.9×
78609
CPT 		PET Brain Imaging Perfusion Evaluation 1 $11,292.93 $11,292.93 $11,292.93 nat. median
$1,553
outlier · 7.3×
50633-0110-12
NDC 		Antivenin (crotalidae-snake Ovine) Polyvalent Inj 1 $8,641.12 $13,316.47 $10,978.80 nat. median
$4,547
outlier · 2.4×
00002-7623-01
NDC 		PEMEtrexed 500 Mg Inj Soln 1 $10,924.35 $10,924.35 $10,924.35 nat. median
$9
outlier · 1156.6×
50242-0037-06
NDC 		Tenecteplase 50 Mg Inj Soln 1 $7,948.50 $12,249.10 $10,098.80 nat. median
$10,237
1.0× median
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
$17,381
0.5× median
43598-0051-11
NDC 		Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 $7,191.07 $11,081.86 $9,136.47 nat. median
$9,262
1.0× median
50242-0137-01
NDC 		Tocilizumab 400 Mg/20 Ml Inj Soln 1 $7,176.13 $11,058.83 $9,117.48 nat. median
$14
outlier · 672.9×
78831
CPT 		Nm Octreo Scan Spect 1 $5,583.73 $12,519.45 $9,051.59 nat. median
$1,665
outlier · 5.4×
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
$191
outlier · 46.2×
00597-0197-05
NDC 		idaruCIZUmab 2.5 G/ 50 Ml Inj Soln 1 $6,893.46 $10,623.22 $8,758.34 nat. median
$11,875
0.7× median
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
78811
CPT 		PET Image-limited Area 1 $8,469.70 $8,469.70 $8,469.70 nat. median
$1,668
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
$2
outlier · 3634.6×
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
$8,978
0.9× 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
78804
CPT 		Nm Octreoscan Whole Body 2day 1 $4,705.39 $10,550.10 $7,627.75 nat. median
$1,550
outlier · 4.9×
81540
CPT 		81540 Oncology, Mrna, Gene Expression Profiling By Real0time Rt-pcr Of 92 Genes 1 $5,667.67 $8,416.29 $7,041.98 nat. median
$3,975
1.8× 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
0720
RC 		1 $720.93 $21,988.35 $6,848.83 nat. median
$1,188
outlier · 5.8×
33947
CPT 		Ecmo Per Day Initial 1 $6,835.78 $6,835.78 $6,835.78 nat. median
$3,791
1.8× median
77301
CPT 		Imrt Planning 1 $6,745.03 $6,745.03 $6,745.03 nat. median
$2,773
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
$7,647
0.9× 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
$31
outlier · 212.4×
44206-0437-10
NDC 		Immune Globulin (ivig) 10%, 10 G/100 Ml (Privigen) Inj Soln 1 $5,087.40 $7,839.98 $6,463.69 nat. median
$6,552
1.0× median
0275
RC 		1 $61.26 $33,486.83 $6,422.02 nat. median
$2,062
outlier · 3.1×

Other procedures at this hospital

Browse this hospital's 4,616 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
             
50242-0085-27 NDC Alteplase 100 Mg Inj Soln 2 1 $30,211.81 $29,607.57 $23,778.92 $36,644.69 $30,211.81 2025-12-31
50242-0176-01 NDC Tenecteplase 50 Mg Inj Soln 2 1 $28,484.66 $27,914.97 $22,419.53 $34,549.79 $28,484.66 2025-12-31
50242-0120-47 NDC Tenecteplase 50 Mg Inj Soln 2 1 $28,484.66 $27,914.97 $22,419.53 $34,549.79 $28,484.66 2025-12-31
44206-0439-40 NDC Immune Globulin (ivig) 10%, 40 G/400 Ml (Privigen) Inj Soln 2 1 $25,854.76 $25,337.67 $20,349.60 $31,359.92 $25,854.76 2025-12-31
50242-0120-01 NDC Tenecteplase 50 Mg Inj Soln 2 1 $23,091.04 $22,629.22 $18,174.35 $28,007.73 $23,091.04 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
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
50633-0120-11 NDC Digoxin Immune Fab 40 Mg Inj Soln 2 1 $17,075.85 $16,734.33 $13,439.95 $20,711.74 $17,075.85 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
50242-0044-13 NDC Alteplase 50 Mg Inj Soln 2 1 $15,105.92 $14,803.80 $11,889.47 $18,322.36 $15,105.92 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
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
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
44206-0438-20 NDC Immune Globulin (ivig) 10%, 20 G/200 Ml (Privigen) Inj Soln 2 1 $12,927.38 $12,668.83 $10,174.80 $15,679.96 $12,927.38 2025-12-31
13533-0318-05 NDC Rabies Immune Glob, Human 1,500 Intl_Units/5 Ml Inj Soln 2 1 $11,508.20 $11,278.03 $9,057.80 $13,958.60 $11,508.20 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
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
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
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
50633-0110-12 NDC Antivenin (crotalidae-snake Ovine) Polyvalent Inj 2 1 $10,978.80 $10,759.22 $8,641.12 $13,316.47 $10,978.80 2025-12-31
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
50242-0037-06 NDC Tenecteplase 50 Mg Inj Soln 2 1 $10,098.80 $9,896.83 $7,948.50 $12,249.10 $10,098.80 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
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
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
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
43598-0051-11 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 2 1 $9,136.47 $8,953.74 $7,191.07 $11,081.86 $9,136.47 2025-12-31
50242-0137-01 NDC Tocilizumab 400 Mg/20 Ml Inj Soln 2 1 $9,117.48 $8,935.13 $7,176.13 $11,058.83 $9,117.48 2025-12-31
78831 CPT Nm Octreo Scan Spect 2 1 $9,051.59 $8,870.56 $5,583.73 $12,519.45 $9,051.59 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
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
0279 RC — 11 1 $8,814.76 $8,638.46 $187.14 $15,654.35 $8,814.76 2025-12-31
00597-0197-05 NDC idaruCIZUmab 2.5 G/ 50 Ml Inj Soln 2 1 $8,758.34 $8,583.17 $6,893.46 $10,623.22 $8,758.34 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
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
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
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
59148-0072-80 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
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
78804 CPT Nm Octreoscan Whole Body 2day 2 1 $7,627.75 $7,475.19 $4,705.39 $10,550.10 $7,627.75 2025-12-31
81540 CPT 81540 Oncology, Mrna, Gene Expression Profiling By Real0time Rt-pcr Of 92 Genes 2 1 $7,041.98 $6,901.14 $5,667.67 $8,416.29 $7,041.98 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
0720 RC — 27 1 $6,848.83 $6,711.85 $720.93 $21,988.35 $6,848.83 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
77301 CPT Imrt Planning 1 1 $6,745.03 $6,610.13 $6,745.03 $6,745.03 $6,745.03 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
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
44206-0437-10 NDC Immune Globulin (ivig) 10%, 10 G/100 Ml (Privigen) Inj Soln 2 1 $6,463.69 $6,334.41 $5,087.40 $7,839.98 $6,463.69 2025-12-31
0275 RC — 192 1 $6,422.02 $6,293.58 $61.26 $33,486.83 $6,422.02 2025-12-31
63833-0386-02 NDC Prothrombin Complex Concentrate (human) 500 Units (range) Inj Soln 2 1 $6,332.20 $6,205.56 $4,983.91 $7,680.50 $6,332.20 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
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
78266 CPT Nm Gastric Emptying Study W/small Bowel&colon Transit Multi Days 2 1 $6,254.75 $6,129.65 $3,858.42 $8,651.08 $6,254.75 2025-12-31
81519 CPT Oncotype Dx Breast Cancer Assay 2 1 $6,146.12 $6,023.19 $4,946.65 $7,345.59 $6,146.12 2025-12-31
A9572 HCPCS In-111 Octreoscan / 6mCi 1 1 $6,095.41 $5,973.50 $6,095.41 $6,095.41 $6,095.41 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
78075 CPT Nm Adrenal Imaging 2 1 $6,051.34 $5,930.32 $3,732.94 $8,369.75 $6,051.34 2025-12-31
78227 CPT Nm Hida Scan With Intervention 2 1 $6,000.49 $5,880.49 $3,701.57 $8,299.41 $6,000.49 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
00517-0710-01 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 2 1 $5,944.65 $5,825.75 $4,678.87 $7,210.42 $5,944.65 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
59148-0045-80 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
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
78452 CPT Nm Heart Muscle Spect Multiple 2 1 $5,847.94 $5,730.98 $3,607.47 $8,088.41 $5,847.94 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
0037U CPT Trgt Gen Seq DNA 324 Genes 2 1 $5,783.51 $5,667.84 $4,654.80 $6,912.21 $5,783.51 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
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
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
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
78265 CPT Nm Gastric Emptying Study W/small Bowel Transit 2 1 $5,186.86 $5,083.13 $3,199.66 $7,174.07 $5,186.86 2025-12-31
77046 CPT Fwmc Mr Charges -> Fwmc MRI Breast W/wo Contrast Left 2 1 $5,171.90 $5,068.46 $5,171.90 $5,171.90 $5,171.90 2025-12-31
70710-1478-01 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 2 1 $5,149.53 $5,046.54 $4,053.06 $6,246.00 $5,149.53 2025-12-31
77047 CPT Fwmc Mr Charges -> Fwmc MRI Breast W/wo Contrast Bilat 1 1 $5,131.80 $5,029.17 $5,131.80 $5,131.80 $5,131.80 2025-12-31
50590 CPT Extracorporeal Shock Wave Lithotripsy 2 1 $4,935.67 $4,836.96 $4,912.93 $4,958.41 $4,935.67 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
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
81420 CPT Fetal Aneupoidy Genomic Sequence 2 1 $4,662.15 $4,568.90 $3,752.29 $5,572.01 $4,662.15 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
0244U CPT 0244u Oncotype Map Pan-cancer Tissue Test 2 1 $4,561.60 $4,470.36 $3,671.36 $5,451.83 $4,561.60 2025-12-31
78630 CPT Nm Cisternography/Cerebrospinal 2 1 $4,525.80 $4,435.28 $2,791.86 $6,259.73 $4,525.80 2025-12-31
78278 CPT Nm Bleeding Scan-gi 2 1 $4,474.94 $4,385.45 $2,760.50 $6,189.39 $4,474.94 2025-12-31
78650 CPT Nm Cerebrospinal Fluid Leakage Detection 2 1 $4,474.94 $4,385.45 $2,760.50 $6,189.39 $4,474.94 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
78315 CPT Nm Bone Three Phase Study 2 1 $4,424.10 $4,335.61 $2,729.13 $6,119.06 $4,424.10 2025-12-31
78290 CPT Nm Meckel's Scan 2 1 $4,424.10 $4,335.61 $2,729.13 $6,119.06 $4,424.10 2025-12-31
78709 CPT Nm Kidney Imaging With Flow With + Without Pharm 2 1 $4,424.10 $4,335.61 $2,729.13 $6,119.06 $4,424.10 2025-12-31
78195 CPT Nm Lymphatic Imaging 2 1 $4,424.10 $4,335.61 $2,729.13 $6,119.06 $4,424.10 2025-12-31
78264 CPT Nm Gastric Emptying Study, Solid, Liquid Or Both 2 1 $4,424.10 $4,335.61 $2,729.13 $6,119.06 $4,424.10 2025-12-31
78645 CPT Nm Cerebro Fluid Flow Shunt Evaluation 2 1 $4,424.10 $4,335.61 $2,729.13 $6,119.06 $4,424.10 2025-12-31
78071 CPT Nm Parathyroid Planar Imaging W/spect 2 1 $4,424.10 $4,335.61 $2,729.13 $6,119.06 $4,424.10 2025-12-31
78606 CPT Nm Brain Imaging Comp With Vascular Flow 2 1 $4,424.10 $4,335.61 $2,729.13 $6,119.06 $4,424.10 2025-12-31
73220 CPT Fwmc Mr Charges -> Fwmc Mr Upper Ext Bilateral 5 1 $4,410.14 $4,321.94 $663.16 $4,410.14 $4,410.14 2025-12-31
78226 CPT Nm Hida Scan Without Intervention 2 1 $4,373.24 $4,285.77 $2,697.76 $6,048.73 $4,373.24 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
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
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
78803 CPT Nm Abscess Imaging Spect 2 1 $4,322.39 $4,235.94 $2,666.39 $5,978.39 $4,322.39 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
78582 CPT Nm Vq Scan Complete 2 1 $4,169.84 $4,086.43 $2,572.28 $5,767.39 $4,169.84 2025-12-31
78802 CPT Nm Abscess Imaging Whole Body 2 1 $4,169.84 $4,086.43 $2,572.28 $5,767.39 $4,169.84 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
78451 CPT Nm Heart Muscle Spect Single 2 1 $4,068.13 $3,986.77 $2,509.54 $5,626.72 $4,068.13 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
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
78018 CPT Nm Thyroid Ca Met Imaging-body 2 1 $4,017.28 $3,936.94 $2,478.17 $5,556.39 $4,017.28 2025-12-31
78598 CPT Nm Quantitative Lung Complete 2 1 $3,915.57 $3,837.26 $2,415.43 $5,415.72 $3,915.57 2025-12-31
00781-3182-84 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 2 1 $3,904.63 $3,826.54 $3,073.23 $4,736.03 $3,904.63 2025-12-31
00781-3182-73 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 2 1 $3,904.63 $3,826.54 $3,073.23 $4,736.03 $3,904.63 2025-12-31
78070 CPT Nm Parathyroid Spect Imaging 2 1 $3,864.72 $3,787.43 $2,384.06 $5,345.38 $3,864.72 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
91010 CPT $Esophageal Motility Charges -> $Esophageal Motility Study Of Esophagus 3 1 $3,719.30 $3,644.91 $863.83 $5,264.16 $3,719.30 2025-12-31
73225 CPT Fwmc Mr Charges -> Fwmc MRA Upper Ext W/wo Contrast Bilateral 5 1 $3,648.39 $3,575.42 $548.61 $3,648.39 $3,648.39 2025-12-31
81455 CPT 81455 Targeted Genomic Sequence Analysis Panel, DNA Analysis 2 1 $3,635.26 $3,562.55 $2,925.81 $4,344.71 $3,635.26 2025-12-31
81229 CPT Interrogation Of Genomic Regions, Etc 6220003 2 1 $3,613.93 $3,541.65 $2,908.64 $4,319.22 $3,613.93 2025-12-31
73219 CPT Fwmc Mr Charges -> Fwmc MRI Upper Ext w/Contrast Bilateral 5 1 $3,608.30 $3,536.13 $542.58 $3,608.30 $3,608.30 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
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
74185 CPT Fwmc Mr Charges -> Fwmc MRA Abdomen W/wo Contrast 1 1 $3,528.12 $3,457.55 $3,528.12 $3,528.12 $3,528.12 2025-12-31
72198 CPT Fwmc Mr Charges -> Fwmc MRA Pelvis W/wo Contrast 1 1 $3,528.12 $3,457.55 $3,528.12 $3,528.12 $3,528.12 2025-12-31
67457-0211-02 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 2 1 $3,525.03 $3,454.53 $2,774.45 $4,275.60 $3,525.03 2025-12-31
77084 CPT Fwmc Mr Charges -> Fwmc MRI Bone Marrow 1 1 $3,488.02 $3,418.26 $3,488.02 $3,488.02 $3,488.02 2025-12-31
71555 CPT Fwmc Mr Charges -> Fwmc MRA Chest (Excl Myocard) W/wo Contrast 1 1 $3,488.02 $3,418.26 $3,488.02 $3,488.02 $3,488.02 2025-12-31
73725 CPT Fwmc Mr Charges -> Fwmc MRA Lower Extremity W/wo Contrast 1 1 $3,488.02 $3,418.26 $3,488.02 $3,488.02 $3,488.02 2025-12-31
10122-0620-10 NDC Cangrelor 50 Mg Inj Soln 2 1 $3,437.14 $3,368.39 $2,705.28 $4,168.99 $3,437.14 2025-12-31
67457-0675-02 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 2 1 $3,433.02 $3,364.36 $2,702.04 $4,164.00 $3,433.02 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
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
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
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
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
70549 CPT Fwmc Mr Charges -> Fwmc MRA Neck W/wo Contrast 2 1 $3,320.70 $3,254.29 $868.13 $5,773.28 $3,320.70 2025-12-31
78801 CPT Nm Octreoscan 2 1 $3,305.36 $3,239.25 $2,039.00 $4,571.71 $3,305.36 2025-12-31
70546 CPT Fwmc Mr Charges -> Fwmc MRA Head W/wo Contrast 2 1 $3,297.65 $3,231.69 $862.11 $5,733.19 $3,297.65 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
44206-0436-05 NDC Immune Globulin (ivig) 10%, 5 G/50 Ml (Privigen) Inj Soln 2 1 $3,231.84 $3,167.21 $2,543.70 $3,919.99 $3,231.84 2025-12-31
78014 CPT Nm Thyroid Imaging With Uptake Multiple 2 1 $3,203.65 $3,139.58 $1,976.26 $4,431.04 $3,203.65 2025-12-31
0152U CPT Infectious Disease DNA Pcr Ngs 2 1 $3,196.47 $3,132.54 $2,572.65 $3,820.29 $3,196.47 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
78291 CPT Nm Peritoneal-venous Shunt Patency 2 1 $3,152.80 $3,089.74 $1,944.89 $4,360.71 $3,152.80 2025-12-31
A0428 HCPCS Ambulance Base Charge 1 1 $3,127.10 $3,064.56 $3,127.10 $3,127.10 $3,127.10 2025-12-31
78104 CPT Nm Bone Marrow Imaging Whole Body 2 1 $3,101.94 $3,039.91 $1,913.52 $4,290.37 $3,101.94 2025-12-31
78306 CPT Nm Bone Imaging Whole Body 2 1 $3,101.94 $3,039.91 $1,913.52 $4,290.37 $3,101.94 2025-12-31
78262 CPT Nm Gastroesophageal Reflux Exam 2 1 $3,101.94 $3,039.91 $1,913.52 $4,290.37 $3,101.94 2025-12-31
A9570 HCPCS In-111 Wbc / Per Study 1 1 $3,060.57 $2,999.36 $3,060.57 $3,060.57 $3,060.57 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
13533-0602-50 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
71552 CPT Fwmc Mr Charges -> Fwmc MRI Chest W/wo Contrast 2 1 $3,020.92 $2,960.51 $789.76 $5,252.08 $3,020.92 2025-12-31
0202 RC — 2 1 $3,019.74 $2,959.35 $2,754.54 $3,284.95 $3,019.74 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
78580 CPT Nm Differential Lung Scan 2 1 $3,000.25 $2,940.24 $1,850.79 $4,149.71 $3,000.25 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
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
A9548 HCPCS In-111 Dtpa Cister / 0.5mCi 1 1 $2,874.47 $2,816.98 $2,874.47 $2,874.47 $2,874.47 2025-12-31
78185 CPT Nm Spleen Imaging With Or Without Flow 2 1 $2,847.69 $2,790.74 $1,756.68 $3,938.70 $2,847.69 2025-12-31
78305 CPT Nm Bone Imaging Limited Multiple Areas 2 1 $2,847.69 $2,790.74 $1,756.68 $3,938.70 $2,847.69 2025-12-31
78740 CPT Nm Ureteral Reflux Study 2 1 $2,847.69 $2,790.74 $1,756.68 $3,938.70 $2,847.69 2025-12-31
78701 CPT Nm Kidney Imaging With Flow 2 1 $2,796.84 $2,740.90 $1,725.31 $3,868.37 $2,796.84 2025-12-31
78601 CPT Nm Brain Imaging Ltd Static With Vascular 2 1 $2,796.84 $2,740.90 $1,725.31 $3,868.37 $2,796.84 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
0210 RC — 1 1 $2,754.54 $2,699.45 $2,754.54 $2,754.54 $2,754.54 2025-12-31
24201-0400-02 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 2 1 $2,746.41 $2,691.49 $2,161.63 $3,331.20 $2,746.41 2025-12-31
63323-0865-02 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 2 1 $2,746.41 $2,691.49 $2,161.63 $3,331.20 $2,746.41 2025-12-31
42023-0205-01 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 2 1 $2,746.41 $2,691.49 $2,161.63 $3,331.20 $2,746.41 2025-12-31
78707 CPT Nm Kidney Imaging With Flow Without Pharm 2 1 $2,745.99 $2,691.07 $1,693.94 $3,798.04 $2,745.99 2025-12-31
78103 CPT Nm Bone Marrow Imaging Multiple Areas 2 1 $2,745.99 $2,691.07 $1,693.94 $3,798.04 $2,745.99 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
78469 CPT Nm Myo Infarct Spect 2 1 $2,695.14 $2,641.24 $1,662.57 $3,727.70 $2,695.14 2025-12-31
78472 CPT Nm Cardiac Blood Pool Gated Single 2 1 $2,695.14 $2,641.24 $1,662.57 $3,727.70 $2,695.14 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
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
78761 CPT Nm Testicular Scan With Vascular Flow 2 1 $2,644.28 $2,591.40 $1,631.20 $3,657.37 $2,644.28 2025-12-31
78605 CPT Nm Brain Imaging Complete Study Static 2 1 $2,593.43 $2,541.57 $1,599.83 $3,587.03 $2,593.43 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
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
74183 CPT Fwmc Mr Charges -> Fwmc MRI Abdomen W/wo Contrast 2 1 $2,559.72 $2,508.51 $669.19 $4,450.24 $2,559.72 2025-12-31
73720 CPT Fwmc Mr Charges -> Fwmc Mr Lower Ext W/wo Contrast Left 4 1 $2,559.72 $2,508.51 $669.19 $4,450.24 $2,559.72 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
78215 CPT Nm Liver Spleen Scan 2 1 $2,542.58 $2,491.73 $1,568.46 $3,516.70 $2,542.58 2025-12-31
78483 CPT Nm Cardiac Blood Pool Multi Rest/Stress 2 1 $2,542.58 $2,491.73 $1,568.46 $3,516.70 $2,542.58 2025-12-31
78013 CPT Nm Thyroid Imaging Only 2 1 $2,542.58 $2,491.73 $1,568.46 $3,516.70 $2,542.58 2025-12-31
72197 CPT Fwmc Mr Charges -> Fwmc MRI Pelvis W/wo Contrast 2 1 $2,536.65 $2,485.92 $663.16 $4,410.14 $2,536.65 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
78201 CPT Nm Liver Imaging Static Only 2 1 $2,491.73 $2,441.89 $1,537.09 $3,446.37 $2,491.73 2025-12-31
78597 CPT Nm Quantitative Lung Perfusion Only 2 1 $2,491.73 $2,441.89 $1,537.09 $3,446.37 $2,491.73 2025-12-31
13533-0318-01 NDC Rabies Immune Glob, Human 300 Intl_Units/mL Inj Soln 2 1 $2,437.84 $2,389.09 $1,918.76 $2,956.93 $2,437.84 2025-12-31
71551 CPT Fwmc Mr Charges -> Fwmc MRI Chest With Contrast 2 1 $2,421.35 $2,372.92 $633.01 $4,209.68 $2,421.35 2025-12-31
78579 CPT Nm Lung Scan Vent Only 2 1 $2,390.03 $2,342.22 $1,474.36 $3,305.70 $2,390.03 2025-12-31
78610 CPT Nm Brain Imaging Vascular Flow Only 2 1 $2,390.03 $2,342.22 $1,474.36 $3,305.70 $2,390.03 2025-12-31
74182 CPT Fwmc Mr Charges -> Fwmc MRI Abdomen With Contrast 2 1 $2,375.23 $2,327.72 $620.96 $4,129.50 $2,375.23 2025-12-31
73723 CPT Fwmc Mr Charges -> Fwmc MRI Joint Lower Ext W/wo Contrast Left 4 1 $2,352.17 $2,305.12 $614.93 $4,089.41 $2,352.17 2025-12-31
73223 CPT Fwmc Mr Charges -> Fwmc MRI Joint Upper Ext W/wo Contrast Left 4 1 $2,352.17 $2,305.12 $614.93 $4,089.41 $2,352.17 2025-12-31
78800 CPT Nm Abscess Imaging Limited Area 2 1 $2,339.18 $2,292.39 $1,442.99 $3,235.36 $2,339.18 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
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
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
70548 CPT Fwmc Mr Charges -> Fwmc MRA Neck With Contrast 2 1 $2,282.99 $2,237.33 $596.84 $3,969.13 $2,282.99 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
78300 CPT Nm Bone Imaging Limited 2 1 $2,237.47 $2,192.72 $1,380.25 $3,094.70 $2,237.47 2025-12-31
78700 CPT Nm DMSA/Kidney Static Imaging 2 1 $2,237.47 $2,192.72 $1,380.25 $3,094.70 $2,237.47 2025-12-31
78230 CPT Nm Salivary Gland Imaging 2 1 $2,237.47 $2,192.72 $1,380.25 $3,094.70 $2,237.47 2025-12-31
00023-1145-01 NDC onabotulinumtoxinA 100 Units Inj Soln 2 1 $2,234.89 $2,190.19 $1,759.03 $2,710.76 $2,234.89 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
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
71550 CPT Fwmc Mr Charges -> Fwmc Mr Chest 2 1 $2,213.81 $2,169.53 $578.76 $3,848.85 $2,213.81 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
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
70547 CPT Fwmc Mr Charges -> Fwmc MRA Neck Without Contrast 2 1 $2,167.69 $2,124.32 $566.70 $3,768.67 $2,167.69 2025-12-31
61958-2901-02 NDC Remdesivir 100 Mg Inj Soln 3 1 $2,165.28 $2,121.97 $1,715.39 $2,643.52 $2,165.28 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
70544 CPT Fwmc Mr Charges -> Fwmc MRA Head Without Contrast 2 1 $2,144.62 $2,101.73 $560.67 $3,728.58 $2,144.62 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
78102 CPT Nm Bone Marrow Imaging Limited 2 1 $2,135.77 $2,093.05 $1,317.51 $2,954.03 $2,135.77 2025-12-31
A9569 HCPCS Tc-99m Ceretec Wbc / Per Study 1 1 $2,127.19 $2,084.65 $2,127.19 $2,127.19 $2,127.19 2025-12-31
72159 CPT Fwmc Mr Charges -> Fwmc MRA Spinal Canal And Contents W/wo Contrast 2 1 $2,121.56 $2,079.13 $554.64 $3,688.48 $2,121.56 2025-12-31
A9521 HCPCS Tc-99m Ceretec / 25mCi 1 1 $2,085.41 $2,043.70 $2,085.41 $2,085.41 $2,085.41 2025-12-31
14789-0015-05 NDC Isoproterenol 1 Mg/5 Ml Inj Soln 2 1 $2,059.81 $2,018.61 $1,621.22 $2,498.40 $2,059.81 2025-12-31
70543 CPT Fwmc Mr Charges -> Fwmc MRI Orbit,Face,Neck W/wo Contrast 2 1 $2,006.26 $1,966.13 $524.50 $3,488.02 $2,006.26 2025-12-31
72195 CPT Fwmc Mr Charges -> Fwmc MRI Pelvis Without Contrast 2 1 $1,960.14 $1,920.93 $512.44 $3,407.84 $1,960.14 2025-12-31
0636 RC — 50 1 $1,948.66 $1,909.69 $3.20 $35,731.87 $1,948.66 2025-12-31
73722 CPT Fwmc Mr Charges -> Fwmc MRI Joint Lower Ext Without Contrast Left 4 1 $1,937.08 $1,898.33 $506.41 $3,367.75 $1,937.08 2025-12-31
73218 CPT Fwmc Mr Charges -> Fwmc MRI Upper Ext Without Contrast Bilateral 6 1 $1,937.08 $1,898.33 $506.41 $3,367.75 $1,937.08 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
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
75561 CPT Fwmc Mr Charges -> Fwmc MRI Cardiac W/wo Contrast 2 1 $1,914.01 $1,875.74 $500.38 $3,327.65 $1,914.01 2025-12-31
73222 CPT Fwmc Mr Charges -> Fwmc MRI Joint Upper Ext With Contrast Left 4 1 $1,914.01 $1,875.74 $500.38 $3,327.65 $1,914.01 2025-12-31
93886 CPT US Transcranial Doppler Complete 2 1 $1,911.50 $1,873.27 $1,414.48 $2,408.52 $1,911.50 2025-12-31
13533-0634-02 NDC Tetanus Immune Globulin 250 units/mL Inj Soln 2 1 $1,910.13 $1,871.93 $1,503.42 $2,316.85 $1,910.13 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
P9052 HCPCS Platelets Hla-m L/r Unit 6822000 2 1 $1,904.47 $1,866.39 $1,532.80 $2,276.15 $1,904.47 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
73721 CPT Fwmc Mr Charges -> Fwmc Mr Any Joint Upper Ext Bilateral 5 1 $1,884.33 $1,846.65 $283.35 $1,884.33 $1,884.33 2025-12-31
55150-0317-10 NDC Isoproterenol 1 Mg/5 Ml Inj Soln 2 1 $1,870.99 $1,833.57 $1,472.61 $2,269.38 $1,870.99 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
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
93975 CPT US Art/Vein Abd/Pelvic Complete - Vas 2 1 $1,852.68 $1,815.63 $1,370.95 $2,334.41 $1,852.68 2025-12-31
90935 CPT Ip Dialysis Hemo 2 1 $1,838.28 $1,801.52 $1,421.68 $2,254.88 $1,838.28 2025-12-31
G0257 HCPCS Dialysis Out-pt Emerg Basis 2 1 $1,838.28 $1,801.52 $1,421.68 $2,254.88 $1,838.28 2025-12-31
P9073 HCPCS Platelets, Pheresis, Pathogen Reduced, Each Unit. 2 1 $1,828.30 $1,791.73 $1,471.49 $2,185.10 $1,828.30 2025-12-31
93925 CPT US Arterial Duplex Le Bilateral 2 1 $1,823.28 $1,786.81 $1,349.19 $2,297.36 $1,823.28 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
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
P9037 HCPCS Platelets Pheresis Lr Irr Each 6819037 2 1 $1,767.36 $1,732.01 $1,422.44 $2,112.27 $1,767.36 2025-12-31
67457-0212-02 NDC Argatroban 250 Mg/2.5 Ml Inj Soln 2 1 $1,750.84 $1,715.83 $1,378.04 $2,123.64 $1,750.84 2025-12-31
42023-0182-89 NDC Argatroban 250 Mg/2.5 Ml Inj Soln 2 1 $1,750.84 $1,715.83 $1,378.04 $2,123.64 $1,750.84 2025-12-31
42023-0182-01 NDC Argatroban 250 Mg/2.5 Ml Inj Soln 2 1 $1,750.84 $1,715.83 $1,378.04 $2,123.64 $1,750.84 2025-12-31
72157 CPT Fwmc Mr Charges -> Fwmc MRI Thoracic W/wo Contrast 2 1 $1,729.53 $1,694.95 $452.15 $3,006.92 $1,729.53 2025-12-31
78708 CPT Nm Kidney Imaging With Flow With Pharm 2 1 $1,728.95 $1,694.38 $1,066.55 $2,391.36 $1,728.95 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
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
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
72158 CPT Fwmc Mr Charges -> Fwmc MRI Lumbar W/wo Contrast 2 1 $1,706.47 $1,672.35 $446.12 $2,966.82 $1,706.47 2025-12-31
72156 CPT Fwmc Mr Charges -> Fwmc MRI Spinal Canal W/wo Contrast 2 1 $1,706.47 $1,672.35 $446.12 $2,966.82 $1,706.47 2025-12-31
70553 CPT Fwmc Mr Charges -> Fwmc MRI Brain W/wo Contrast 2 1 $1,706.47 $1,672.35 $446.12 $2,966.82 $1,706.47 2025-12-31
81401 CPT Molecular Pathology Procedure, Level 2 (eg, 2-10) 2 1 $1,685.08 $1,651.38 $1,356.22 $2,013.94 $1,685.08 2025-12-31
74181 CPT Fwmc Mr Charges -> Fwmc Mr Abdomen 2 1 $1,683.41 $1,649.74 $440.10 $2,926.73 $1,683.41 2025-12-31
69097-0522-35 NDC Isoproterenol 1 Mg/5 Ml Inj Soln 2 1 $1,682.18 $1,648.53 $1,324.00 $2,040.36 $1,682.18 2025-12-31
68682-0433-05 NDC Isoproterenol 1 Mg/5 Ml Inj Soln 2 1 $1,682.18 $1,648.53 $1,324.00 $2,040.36 $1,682.18 2025-12-31
00143-9564-10 NDC Phentolamine 5 Mg Inj Soln 2 1 $1,682.05 $1,648.41 $1,323.90 $2,040.20 $1,682.05 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
70542 CPT Fwmc Mr Charges -> Fwmc MRI Orbit,Face,Neck With Contrast 2 1 $1,660.35 $1,627.15 $434.07 $2,886.64 $1,660.35 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
77285 CPT Simulation/Intermediate 1 1 $1,650.55 $1,617.54 $1,650.55 $1,650.55 $1,650.55 2025-12-31
00456-2700-10 NDC Ceftazidime-avibactam 2.5 G (2g-0.5g) Inj Soln 3 1 $1,647.22 $1,614.28 $1,122.33 $1,729.58 $1,647.22 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
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
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
70336 CPT Fwmc Mr Charges -> Fwmc MRA Head With Contrast 2 1 $1,614.23 $1,581.95 $422.01 $2,806.46 $1,614.23 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
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
10019-0670-10 NDC Pm Esmolol 2,500 Mg/ Ns 250 Ml IV 2 1 $1,605.54 $1,573.43 $1,263.68 $1,947.40 $1,605.54 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
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
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
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
81405 CPT Molecular Pathology Procedure, Level 6 2 1 $1,563.19 $1,531.93 $1,258.12 $1,868.26 $1,563.19 2025-12-31
0278 RC — 5,829 1 $1,538.74 $1,507.97 $4.91 $59,666.31 $1,538.74 2025-12-31
00143-9564-01 NDC Phentolamine 5 Mg Inj Soln 2 1 $1,530.49 $1,499.88 $1,204.61 $1,856.38 $1,530.49 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
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
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
63323-0371-19 NDC DAPTOmycin 500 Mg Inj 2 1 $1,529.35 $1,498.77 $1,203.71 $1,854.99 $1,529.35 2025-12-31
16729-0435-05 NDC DAPTOmycin 500 Mg Inj 2 1 $1,529.23 $1,498.65 $1,203.62 $1,854.85 $1,529.23 2025-12-31
31722-0102-10 NDC DAPTOmycin 500 Mg Inj 2 1 $1,529.23 $1,498.65 $1,203.62 $1,854.85 $1,529.23 2025-12-31
71839-0107-01 NDC DAPTOmycin 500 Mg Inj 2 1 $1,529.23 $1,498.65 $1,203.62 $1,854.85 $1,529.23 2025-12-31
60505-6229-04 NDC DAPTOmycin 500 Mg Inj 2 1 $1,529.23 $1,498.65 $1,203.62 $1,854.85 $1,529.23 2025-12-31
70377-0093-91 NDC DAPTOmycin 500 Mg Inj 2 1 $1,527.70 $1,497.14 $1,202.41 $1,852.98 $1,527.70 2025-12-31
78231 CPT Nm Salivary Gland Imaging/Flow 2 1 $1,525.55 $1,495.04 $941.08 $2,110.02 $1,525.55 2025-12-31
P9035 HCPCS Plate Pheres-leuko Reducd/unit 6816393 2 1 $1,523.58 $1,493.11 $1,226.24 $1,820.92 $1,523.58 2025-12-31
72147 CPT Fwmc Mr Charges -> Fwmc MRI Spinal Thoracic With Contrast 2 1 $1,521.99 $1,491.55 $397.89 $2,646.09 $1,521.99 2025-12-31
72142 CPT Fwmc Mr Charges -> Fwmc MRI Cervical Spine With Contrast 2 1 $1,521.99 $1,491.55 $397.89 $2,646.09 $1,521.99 2025-12-31
70540 CPT Fwmc Mr Charges -> Fwmc Mr Orbit Face Neck 2 1 $1,521.99 $1,491.55 $397.89 $2,646.09 $1,521.99 2025-12-31
81352 CPT 81352 Tp53 Mutation Analysis 2 1 $1,520.53 $1,490.12 $1,223.79 $1,817.28 $1,520.53 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
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
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
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
0123 RC — 2 1 $1,500.34 $1,470.33 $1,437.92 $1,562.75 $1,500.34 2025-12-31
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