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 FORT WASHINGTON MEDICAL CTR

Fort Washington, MD · CCN 210060 · Rates published

3,182 distinct procedures filed
3 distinct payers
6,145 rate rows
2025-12-31 last MRF observed
Data quality

6,130 of 6,145 rate rows are consumer-grade (99.8%)

15 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 13
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/FWMC-Billing-StandardCharges.csv
Found on page https://www.adventisthealthcare.com/patients-visitors/billing-financial/price-transparency/
Discovered viaDiscovered by HANK
Last fetch success · 2026-09-21
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 $36,644.69 $36,644.69 $36,644.69 nat. median
$27,202
1.3× median
50242-0176-01
NDC 		Tenecteplase 50 Mg Inj Soln 1 $34,549.79 $34,549.79 $34,549.79 nat. median
$25,647
1.3× median
50242-0120-47
NDC 		Tenecteplase 50 Mg Inj Soln 1 $34,549.79 $34,549.79 $34,549.79 nat. median
$25,647
1.3× median
44206-0439-40
NDC 		Immune Globulin (ivig) 10%, 40 G/400 Ml (Privigen) Inj Soln 1 $31,359.92 $31,359.92 $31,359.92 nat. median
$23,279
1.3× median
50242-0120-01
NDC 		Tenecteplase 50 Mg Inj Soln 1 $28,007.73 $28,007.73 $28,007.73 nat. median
$20,791
1.3× median
50633-0120-11
NDC 		Digoxin Immune Fab 40 Mg Inj Soln 1 $20,711.74 $20,711.74 $20,711.74 nat. median
$15,375
1.3× median
50242-0044-13
NDC 		Alteplase 50 Mg Inj Soln 1 $18,322.36 $18,322.36 $18,322.36 nat. median
$13,601
1.3× median
44206-0438-20
NDC 		Immune Globulin (ivig) 10%, 20 G/200 Ml (Privigen) Inj Soln 1 $15,679.96 $15,679.96 $15,679.96 nat. median
$11,640
1.3× median
13533-0318-05
NDC 		Rabies Immune Glob, Human 1,500 Intl_Units/5 Ml Inj Soln 1 $13,958.60 $13,958.60 $13,958.60 nat. median
$10,362
1.3× median
50633-0110-12
NDC 		Antivenin (crotalidae-snake Ovine) Polyvalent Inj 1 $13,316.47 $13,316.47 $13,316.47 nat. median
$9,885
1.3× median
78831
CPT 		Nm Octreo Scan Spect 1 $12,519.45 $12,519.45 $12,519.45 nat. median
$1,341
outlier · 9.3×
50242-0037-06
NDC 		Tenecteplase 50 Mg Inj Soln 1 $12,249.10 $12,249.10 $12,249.10 nat. median
$9,093
1.3× median
636
RC 		Graft Matrx 7.3x14.7cm Perf Regen Contr 77sqcm Sm 1 $4,771.07 $21,419.13 $11,765.96 —
43598-0051-11
NDC 		Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 $11,081.86 $11,081.86 $11,081.86 nat. median
$8,226
1.3× median
50242-0137-01
NDC 		Tocilizumab 400 Mg/20 Ml Inj Soln 1 $11,058.83 $11,058.83 $11,058.83 nat. median
$8,209
1.3× median
00597-0197-05
NDC 		idaruCIZUmab 2.5 G/ 50 Ml Inj Soln 1 $10,623.22 $10,623.22 $10,623.22 nat. median
$7,886
1.3× median
78804
CPT 		Nm Tumor Localization/Whole Body 2+ Days 1 $10,550.10 $10,550.10 $10,550.10 nat. median
$893
outlier · 11.8×
78266
CPT 		Nm Gastric Emptying Study W/small Bowel&colon Transit Multi Days 1 $8,651.08 $8,651.08 $8,651.08 nat. median
$554
outlier · 15.6×
81540
CPT 		81540 Oncology, Mrna, Gene Expression Profiling By Real0time Rt-pcr Of 92 Genes 1 $8,416.29 $8,416.29 $8,416.29 nat. median
$3,769
outlier · 2.2×
78075
CPT 		Nm Adrenal Imaging 1 $8,369.75 $8,369.75 $8,369.75 nat. median
$1,285
outlier · 6.5×
78227
CPT 		Nm Hida Scan With Intervention 1 $8,299.41 $8,299.41 $8,299.41 nat. median
$675
outlier · 12.3×
78452
CPT 		Nm Heart Muscle Spect Multiple 1 $8,088.41 $8,088.41 $8,088.41 nat. median
$1,464
outlier · 5.5×
44206-0437-10
NDC 		Immune Globulin (ivig) 10%, 10 G/100 Ml (Privigen) Inj Soln 1 $7,839.98 $7,839.98 $7,839.98 nat. median
$5,820
1.3× median
63833-0386-02
NDC 		Prothrombin Complex Concentrate (human) 500 Units (range) Inj Soln 1 $7,680.50 $7,680.50 $7,680.50 nat. median
$5,701
1.3× median
81519
CPT 		Oncotype Dx Breast Cancer Assay 1 $7,345.59 $7,345.59 $7,345.59 nat. median
$3,875
1.9× median
00517-0710-01
NDC 		Fomepizole 1.5 G/1.5 Ml Inj Soln 1 $7,210.42 $7,210.42 $7,210.42 nat. median
$5,352
1.3× median
78265
CPT 		Nm Gastric Emptying Study W/small Bowel Transit 1 $7,174.07 $7,174.07 $7,174.07 nat. median
$413
outlier · 17.4×
0037U
CPT 		Trgt Gen Seq DNA 324 Genes 1 $6,912.21 $6,912.21 $6,912.21 nat. median
$3,570
1.9× median
78630
CPT 		Nm Cisternography/Cerebrospinal 1 $6,259.73 $6,259.73 $6,259.73 nat. median
$587
outlier · 10.7×
70710-1478-01
NDC 		Fomepizole 1.5 G/1.5 Ml Inj Soln 1 $6,246.00 $6,246.00 $6,246.00 nat. median
$4,637
1.3× median
78278
CPT 		Nm Bleeding Scan-gi 1 $6,189.39 $6,189.39 $6,189.39 nat. median
$505
outlier · 12.2×
78650
CPT 		Nm Cerebrospinal Fluid Leakage Detection 1 $6,189.39 $6,189.39 $6,189.39 nat. median
$1,311
outlier · 4.7×
78264
CPT 		Nm Gastric Emptying Study, Solid, Liquid Or Both 1 $6,119.06 $6,119.06 $6,119.06 nat. median
$506
outlier · 12.1×
78071
CPT 		Nm Parathyroid Planar Imaging W/spect 1 $6,119.06 $6,119.06 $6,119.06 nat. median
$449
outlier · 13.6×
78290
CPT 		Nm Meckel's Scan 1 $6,119.06 $6,119.06 $6,119.06 nat. median
$486
outlier · 12.6×
78645
CPT 		Nm Cerebro Fluid Flow Shunt Evaluation 1 $6,119.06 $6,119.06 $6,119.06 nat. median
$568
outlier · 10.8×
78709
CPT 		Nm Kidney Imaging With Flow With + Without Pharm 1 $6,119.06 $6,119.06 $6,119.06 nat. median
$577
outlier · 10.6×
78606
CPT 		Nm Brain Imaging Comp With Vascular Flow 1 $6,119.06 $6,119.06 $6,119.06 nat. median
$582
outlier · 10.5×
78315
CPT 		Nm Bone Three Phase Study 1 $6,119.06 $6,119.06 $6,119.06 nat. median
$512
outlier · 12.0×
78195
CPT 		Nm Lymphatic Imaging 1 $6,119.06 $6,119.06 $6,119.06 nat. median
$632
outlier · 9.7×
A9572
HCPCS 		In-111 Octreoscan / 6mCi 1 $6,095.41 $6,095.41 $6,095.41 nat. median
$3,702
1.6× median
78226
CPT 		Nm Hida Scan Without Intervention 1 $6,048.73 $6,048.73 $6,048.73 nat. median
$512
outlier · 11.8×
78803
CPT 		Nm Abscess Imaging Spect 1 $5,978.39 $5,978.39 $5,978.39 nat. median
$900
outlier · 6.6×
70549
CPT 		Fwmc Mr Charges -> Fwmc MRA Neck W/wo Contrast 1 $5,773.28 $5,773.28 $5,773.28 nat. median
$606
outlier · 9.5×
78582
CPT 		Nm Vq Scan Complete 1 $5,767.39 $5,767.39 $5,767.39 nat. median
$632
outlier · 9.1×
78802
CPT 		Nm Abscess Imaging Whole Body 1 $5,767.39 $5,767.39 $5,767.39 nat. median
$741
outlier · 7.8×
70546
CPT 		Fwmc Mr Charges -> Fwmc MRA Head W/wo Contrast 1 $5,733.19 $5,733.19 $5,733.19 nat. median
$625
outlier · 9.2×
78451
CPT 		Nm Heart Muscle Spect Single 1 $5,626.72 $5,626.72 $5,626.72 nat. median
$1,355
outlier · 4.2×
81420
CPT 		Fetal Aneupoidy Genomic Sequence 1 $5,572.01 $5,572.01 $5,572.01 nat. median
$789
outlier · 7.1×
78018
CPT 		Nm Thyroid Ca Met Imaging-body 1 $5,556.39 $5,556.39 $5,556.39 nat. median
$578
outlier · 9.6×

Other procedures at this hospital

Browse this hospital's 3,182 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
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 1 1 $36,644.69 $35,911.80 $36,644.69 $36,644.69 $36,644.69 2025-12-31
50242-0120-47 NDC Tenecteplase 50 Mg Inj Soln 1 1 $34,549.79 $33,858.79 $34,549.79 $34,549.79 $34,549.79 2025-12-31
50242-0176-01 NDC Tenecteplase 50 Mg Inj Soln 1 1 $34,549.79 $33,858.79 $34,549.79 $34,549.79 $34,549.79 2025-12-31
44206-0439-40 NDC Immune Globulin (ivig) 10%, 40 G/400 Ml (Privigen) Inj Soln 1 1 $31,359.92 $30,732.72 $31,359.92 $31,359.92 $31,359.92 2025-12-31
50242-0120-01 NDC Tenecteplase 50 Mg Inj Soln 1 1 $28,007.73 $27,447.58 $28,007.73 $28,007.73 $28,007.73 2025-12-31
50633-0120-11 NDC Digoxin Immune Fab 40 Mg Inj Soln 1 1 $20,711.74 $20,297.51 $20,711.74 $20,711.74 $20,711.74 2025-12-31
50242-0044-13 NDC Alteplase 50 Mg Inj Soln 1 1 $18,322.36 $17,955.91 $18,322.36 $18,322.36 $18,322.36 2025-12-31
44206-0438-20 NDC Immune Globulin (ivig) 10%, 20 G/200 Ml (Privigen) Inj Soln 1 1 $15,679.96 $15,366.36 $15,679.96 $15,679.96 $15,679.96 2025-12-31
13533-0318-05 NDC Rabies Immune Glob, Human 1,500 Intl_Units/5 Ml Inj Soln 1 1 $13,958.60 $13,679.43 $13,958.60 $13,958.60 $13,958.60 2025-12-31
50633-0110-12 NDC Antivenin (crotalidae-snake Ovine) Polyvalent Inj 1 1 $13,316.47 $13,050.14 $13,316.47 $13,316.47 $13,316.47 2025-12-31
78831 CPT Nm Octreo Scan Spect 1 1 $12,519.45 $12,269.07 $12,519.45 $12,519.45 $12,519.45 2025-12-31
50242-0037-06 NDC Tenecteplase 50 Mg Inj Soln 1 1 $12,249.10 $12,004.12 $12,249.10 $12,249.10 $12,249.10 2025-12-31
636 RC Graft Matrx 7.3x14.7cm Perf Regen Contr 77sqcm Sm 3 1 $21,419.13 $20,990.75 $4,771.07 $21,419.13 $11,765.96 2025-12-31
43598-0051-11 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $11,081.86 $10,860.22 $11,081.86 $11,081.86 $11,081.86 2025-12-31
50242-0137-01 NDC Tocilizumab 400 Mg/20 Ml Inj Soln 1 1 $11,058.83 $10,837.65 $11,058.83 $11,058.83 $11,058.83 2025-12-31
00597-0197-05 NDC idaruCIZUmab 2.5 G/ 50 Ml Inj Soln 1 1 $10,623.22 $10,410.76 $10,623.22 $10,623.22 $10,623.22 2025-12-31
78804 CPT Nm Tumor Localization/Whole Body 2+ Days 1 1 $10,550.10 $10,339.10 $10,550.10 $10,550.10 $10,550.10 2025-12-31
78266 CPT Nm Gastric Emptying Study W/small Bowel&colon Transit Multi Days 1 1 $8,651.08 $8,478.06 $8,651.08 $8,651.08 $8,651.08 2025-12-31
81540 CPT 81540 Oncology, Mrna, Gene Expression Profiling By Real0time Rt-pcr Of 92 Genes 1 1 $8,416.29 $8,247.96 $8,416.29 $8,416.29 $8,416.29 2025-12-31
78075 CPT Nm Adrenal Imaging 1 1 $8,369.75 $8,202.35 $8,369.75 $8,369.75 $8,369.75 2025-12-31
78227 CPT Nm Hida Scan With Intervention 1 1 $8,299.41 $8,133.43 $8,299.41 $8,299.41 $8,299.41 2025-12-31
78452 CPT Nm Heart Muscle Spect Multiple 1 1 $8,088.41 $7,926.64 $8,088.41 $8,088.41 $8,088.41 2025-12-31
44206-0437-10 NDC Immune Globulin (ivig) 10%, 10 G/100 Ml (Privigen) Inj Soln 1 1 $7,839.98 $7,683.18 $7,839.98 $7,839.98 $7,839.98 2025-12-31
63833-0386-02 NDC Prothrombin Complex Concentrate (human) 500 Units (range) Inj Soln 1 1 $7,680.50 $7,526.89 $7,680.50 $7,680.50 $7,680.50 2025-12-31
81519 CPT Oncotype Dx Breast Cancer Assay 1 1 $7,345.59 $7,198.68 $7,345.59 $7,345.59 $7,345.59 2025-12-31
00517-0710-01 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $7,210.42 $7,066.21 $7,210.42 $7,210.42 $7,210.42 2025-12-31
78265 CPT Nm Gastric Emptying Study W/small Bowel Transit 1 1 $7,174.07 $7,030.59 $7,174.07 $7,174.07 $7,174.07 2025-12-31
0037U CPT Trgt Gen Seq DNA 324 Genes 1 1 $6,912.21 $6,773.97 $6,912.21 $6,912.21 $6,912.21 2025-12-31
78630 CPT Nm Cisternography/Cerebrospinal 1 1 $6,259.73 $6,134.53 $6,259.73 $6,259.73 $6,259.73 2025-12-31
70710-1478-01 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $6,246.00 $6,121.08 $6,246.00 $6,246.00 $6,246.00 2025-12-31
78650 CPT Nm Cerebrospinal Fluid Leakage Detection 1 1 $6,189.39 $6,065.61 $6,189.39 $6,189.39 $6,189.39 2025-12-31
78278 CPT Nm Bleeding Scan-gi 1 1 $6,189.39 $6,065.61 $6,189.39 $6,189.39 $6,189.39 2025-12-31
78071 CPT Nm Parathyroid Planar Imaging W/spect 1 1 $6,119.06 $5,996.68 $6,119.06 $6,119.06 $6,119.06 2025-12-31
78315 CPT Nm Bone Three Phase Study 1 1 $6,119.06 $5,996.68 $6,119.06 $6,119.06 $6,119.06 2025-12-31
78606 CPT Nm Brain Imaging Comp With Vascular Flow 1 1 $6,119.06 $5,996.68 $6,119.06 $6,119.06 $6,119.06 2025-12-31
78709 CPT Nm Kidney Imaging With Flow With + Without Pharm 1 1 $6,119.06 $5,996.68 $6,119.06 $6,119.06 $6,119.06 2025-12-31
78645 CPT Nm Cerebro Fluid Flow Shunt Evaluation 1 1 $6,119.06 $5,996.68 $6,119.06 $6,119.06 $6,119.06 2025-12-31
78290 CPT Nm Meckel's Scan 1 1 $6,119.06 $5,996.68 $6,119.06 $6,119.06 $6,119.06 2025-12-31
78195 CPT Nm Lymphatic Imaging 1 1 $6,119.06 $5,996.68 $6,119.06 $6,119.06 $6,119.06 2025-12-31
78264 CPT Nm Gastric Emptying Study, Solid, Liquid Or Both 1 1 $6,119.06 $5,996.68 $6,119.06 $6,119.06 $6,119.06 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
78226 CPT Nm Hida Scan Without Intervention 1 1 $6,048.73 $5,927.75 $6,048.73 $6,048.73 $6,048.73 2025-12-31
78803 CPT Nm Abscess Imaging Spect 1 1 $5,978.39 $5,858.82 $5,978.39 $5,978.39 $5,978.39 2025-12-31
70549 CPT Fwmc Mr Charges -> Fwmc MRA Neck W/wo Contrast 1 1 $5,773.28 $5,657.81 $5,773.28 $5,773.28 $5,773.28 2025-12-31
78802 CPT Nm Abscess Imaging Whole Body 1 1 $5,767.39 $5,652.04 $5,767.39 $5,767.39 $5,767.39 2025-12-31
78582 CPT Nm Vq Scan Complete 1 1 $5,767.39 $5,652.04 $5,767.39 $5,767.39 $5,767.39 2025-12-31
70546 CPT Fwmc Mr Charges -> Fwmc MRA Head W/wo Contrast 1 1 $5,733.19 $5,618.52 $5,733.19 $5,733.19 $5,733.19 2025-12-31
78451 CPT Nm Heart Muscle Spect Single 1 1 $5,626.72 $5,514.19 $5,626.72 $5,626.72 $5,626.72 2025-12-31
81420 CPT Fetal Aneupoidy Genomic Sequence 1 1 $5,572.01 $5,460.57 $5,572.01 $5,572.01 $5,572.01 2025-12-31
78018 CPT Nm Thyroid Ca Met Imaging-body 1 1 $5,556.39 $5,445.26 $5,556.39 $5,556.39 $5,556.39 2025-12-31
0244U CPT 0244u Oncotype Map Pan-cancer Tissue Test 1 1 $5,451.83 $5,342.80 $5,451.83 $5,451.83 $5,451.83 2025-12-31
78598 CPT Nm Quantitative Lung Complete 1 1 $5,415.72 $5,307.40 $5,415.72 $5,415.72 $5,415.72 2025-12-31
78070 CPT Nm Parathyroid Study 1 1 $5,345.38 $5,238.48 $5,345.38 $5,345.38 $5,345.38 2025-12-31
91010 CPT Esophageal Motility Study Of Esophagus 1 1 $5,264.16 $5,158.88 $5,264.16 $5,264.16 $5,264.16 2025-12-31
71552 CPT Fwmc Mr Charges -> Fwmc MRI Chest W/wo Contrast 1 1 $5,252.08 $5,147.04 $5,252.08 $5,252.08 $5,252.08 2025-12-31
77046 CPT Fwmc Mr Charges -> Fwmc MRI Breast W/wo Contrast Right 2 1 $5,171.90 $5,068.46 $5,171.90 $5,171.90 $5,171.90 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 1 1 $4,912.93 $4,814.67 $4,912.93 $4,912.93 $4,912.93 2025-12-31
00781-3182-84 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $4,736.03 $4,641.31 $4,736.03 $4,736.03 $4,736.03 2025-12-31
00781-3182-73 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $4,736.03 $4,641.31 $4,736.03 $4,736.03 $4,736.03 2025-12-31
279 RC Screw Bone Axs 17x4mm 2 1 $8,937.45 $8,758.70 $213.75 $8,937.45 $4,575.60 2025-12-31
78801 CPT Nm Octreoscan 1 1 $4,571.71 $4,480.28 $4,571.71 $4,571.71 $4,571.71 2025-12-31
74183 CPT Fwmc Mr Charges -> Fwmc MRI Abdomen W/wo Contrast 1 1 $4,450.24 $4,361.23 $4,450.24 $4,450.24 $4,450.24 2025-12-31
73720 CPT Fwmc Mr Charges -> Fwmc Mr Lower Ext W/wo Contrast Right 2 1 $4,450.24 $4,361.23 $4,450.24 $4,450.24 $4,450.24 2025-12-31
78014 CPT Nm Thyroid Imaging With Uptake Multiple 1 1 $4,431.04 $4,342.42 $4,431.04 $4,431.04 $4,431.04 2025-12-31
73220 CPT Fwmc Mr Charges -> Fwmc Mr Upper Ext Right 3 1 $4,410.14 $4,321.94 $4,410.14 $4,410.14 $4,410.14 2025-12-31
72197 CPT Fwmc Mr Charges -> Fwmc MRI Pelvis W/wo Contrast 1 1 $4,410.14 $4,321.94 $4,410.14 $4,410.14 $4,410.14 2025-12-31
78291 CPT Nm Peritoneal-venous Shunt Patency 1 1 $4,360.71 $4,273.49 $4,360.71 $4,360.71 $4,360.71 2025-12-31
81455 CPT 81455 Targeted Genomic Sequence Analysis Panel, DNA Analysis 1 1 $4,344.71 $4,257.82 $4,344.71 $4,344.71 $4,344.71 2025-12-31
81229 CPT Interrogation Of Genomic Regions, Etc 6220003 1 1 $4,319.22 $4,232.84 $4,319.22 $4,319.22 $4,319.22 2025-12-31
78104 CPT Nm Bone Marrow Imaging Whole Body 1 1 $4,290.37 $4,204.57 $4,290.37 $4,290.37 $4,290.37 2025-12-31
78306 CPT Nm Bone Imaging Whole Body 1 1 $4,290.37 $4,204.57 $4,290.37 $4,290.37 $4,290.37 2025-12-31
78262 CPT Nm Gastroesophageal Reflux Exam 1 1 $4,290.37 $4,204.57 $4,290.37 $4,290.37 $4,290.37 2025-12-31
67457-0211-02 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $4,275.60 $4,190.09 $4,275.60 $4,275.60 $4,275.60 2025-12-31
71551 CPT Fwmc Mr Charges -> Fwmc MRI Chest With Contrast 1 1 $4,209.68 $4,125.49 $4,209.68 $4,209.68 $4,209.68 2025-12-31
10122-0620-10 NDC Cangrelor 50 Mg Inj Soln 1 1 $4,168.99 $4,085.61 $4,168.99 $4,168.99 $4,168.99 2025-12-31
67457-0675-02 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $4,164.00 $4,080.72 $4,164.00 $4,164.00 $4,164.00 2025-12-31
78580 CPT Nm Lung Perfusion Imaging 1 1 $4,149.71 $4,066.71 $4,149.71 $4,149.71 $4,149.71 2025-12-31
74182 CPT Fwmc Mr Charges -> Fwmc MRI Abdomen With Contrast 1 1 $4,129.50 $4,046.91 $4,129.50 $4,129.50 $4,129.50 2025-12-31
73223 CPT Fwmc Mr Charges -> Fwmc MRI Joint Upper Ext W/wo Contrast Right 2 1 $4,089.41 $4,007.62 $4,089.41 $4,089.41 $4,089.41 2025-12-31
73723 CPT Fwmc Mr Charges -> Fwmc MRI Joint Lower Ext W/wo Contrast Right 2 1 $4,089.41 $4,007.62 $4,089.41 $4,089.41 $4,089.41 2025-12-31
278 RC Y Plate 18hl Wd 1.4mm 813 1 $59,666.31 $58,472.98 $24.45 $59,666.31 $4,042.35 2025-12-31
70548 CPT Fwmc Mr Charges -> Fwmc MRA Neck With Contrast 1 1 $3,969.13 $3,889.75 $3,969.13 $3,969.13 $3,969.13 2025-12-31
78305 CPT Nm Bone Imaging Limited Multiple Areas 1 1 $3,938.70 $3,859.93 $3,938.70 $3,938.70 $3,938.70 2025-12-31
78185 CPT Nm Spleen Imaging With Or Without Flow 1 1 $3,938.70 $3,859.93 $3,938.70 $3,938.70 $3,938.70 2025-12-31
78740 CPT Nm Ureteral Reflux Study 1 1 $3,938.70 $3,859.93 $3,938.70 $3,938.70 $3,938.70 2025-12-31
44206-0436-05 NDC Immune Globulin (ivig) 10%, 5 G/50 Ml (Privigen) Inj Soln 1 1 $3,919.99 $3,841.59 $3,919.99 $3,919.99 $3,919.99 2025-12-31
78601 CPT Nm Brain Imaging Ltd Static With Vascular 1 1 $3,868.37 $3,791.00 $3,868.37 $3,868.37 $3,868.37 2025-12-31
78701 CPT Nm Kidney Imaging With Flow 1 1 $3,868.37 $3,791.00 $3,868.37 $3,868.37 $3,868.37 2025-12-31
71550 CPT Fwmc Mr Charges -> Fwmc Mr Chest 1 1 $3,848.85 $3,771.88 $3,848.85 $3,848.85 $3,848.85 2025-12-31
0152U CPT Infectious Disease DNA Pcr Ngs 1 1 $3,820.29 $3,743.88 $3,820.29 $3,820.29 $3,820.29 2025-12-31
78707 CPT Nm Kidney Imaging With Flow Without Pharm 1 1 $3,798.04 $3,722.08 $3,798.04 $3,798.04 $3,798.04 2025-12-31
78103 CPT Nm Bone Marrow Imaging Multiple Areas 1 1 $3,798.04 $3,722.08 $3,798.04 $3,798.04 $3,798.04 2025-12-31
70547 CPT Fwmc Mr Charges -> Fwmc MRA Neck Without Contrast 1 1 $3,768.67 $3,693.29 $3,768.67 $3,768.67 $3,768.67 2025-12-31
70544 CPT Fwmc Mr Charges -> Fwmc MRA Head Without Contrast 1 1 $3,728.58 $3,654.00 $3,728.58 $3,728.58 $3,728.58 2025-12-31
78469 CPT Nm Myo Infarct Spect 1 1 $3,727.70 $3,653.15 $3,727.70 $3,727.70 $3,727.70 2025-12-31
78472 CPT Nm Cardiac Blood Pool Gated Single 1 1 $3,727.70 $3,653.15 $3,727.70 $3,727.70 $3,727.70 2025-12-31
72159 CPT Fwmc Mr Charges -> Fwmc MRA Spinal Canal And Contents W/wo Contrast 1 1 $3,688.48 $3,614.71 $3,688.48 $3,688.48 $3,688.48 2025-12-31
78761 CPT Nm Testicular Scan With Vascular Flow 1 1 $3,657.37 $3,584.22 $3,657.37 $3,657.37 $3,657.37 2025-12-31
72196 CPT Fwmc Mr Charges -> Fwmc Mr Pelvis 1 1 $3,648.39 $3,575.42 $3,648.39 $3,648.39 $3,648.39 2025-12-31
73225 CPT Fwmc Mr Charges -> Fwmc MRA Upper Ext W/wo Contrast Right 3 1 $3,648.39 $3,575.42 $3,648.39 $3,648.39 $3,648.39 2025-12-31
73219 CPT Fwmc Mr Charges -> Fwmc MRI Upper Ext With Contrast Right 3 1 $3,608.30 $3,536.13 $3,608.30 $3,608.30 $3,608.30 2025-12-31
78605 CPT Nm Brain Imaging Complete Study Static 1 1 $3,587.03 $3,515.29 $3,587.03 $3,587.03 $3,587.03 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
78215 CPT Nm Liver Spleen Scan 1 1 $3,516.70 $3,446.37 $3,516.70 $3,516.70 $3,516.70 2025-12-31
78013 CPT Nm Thyroid Imaging Only 1 1 $3,516.70 $3,446.37 $3,516.70 $3,516.70 $3,516.70 2025-12-31
78483 CPT Nm Cardiac Blood Pool Multi Rest/Stress 1 1 $3,516.70 $3,446.37 $3,516.70 $3,516.70 $3,516.70 2025-12-31
70543 CPT Fwmc Mr Charges -> Fwmc MRI Orbit,Face,Neck W/wo Contrast 1 1 $3,488.02 $3,418.26 $3,488.02 $3,488.02 $3,488.02 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
78597 CPT Nm Quantitative Lung Perfusion Only 1 1 $3,446.37 $3,377.44 $3,446.37 $3,446.37 $3,446.37 2025-12-31
78201 CPT Nm Liver Imaging Static Only 1 1 $3,446.37 $3,377.44 $3,446.37 $3,446.37 $3,446.37 2025-12-31
72195 CPT Fwmc Mr Charges -> Fwmc MRI Pelvis Without Contrast 1 1 $3,407.84 $3,339.68 $3,407.84 $3,407.84 $3,407.84 2025-12-31
73218 CPT Fwmc Mr Charges -> Fwmc MRI Upper Ext Without Contrast Right 3 1 $3,367.75 $3,300.39 $3,367.75 $3,367.75 $3,367.75 2025-12-31
73722 CPT Fwmc Mr Charges -> Fwmc MRI Joint Lower Ext Without Contrast Right 2 1 $3,367.75 $3,300.39 $3,367.75 $3,367.75 $3,367.75 2025-12-31
63323-0865-02 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $3,331.20 $3,264.58 $3,331.20 $3,331.20 $3,331.20 2025-12-31
24201-0400-02 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $3,331.20 $3,264.58 $3,331.20 $3,331.20 $3,331.20 2025-12-31
42023-0205-01 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $3,331.20 $3,264.58 $3,331.20 $3,331.20 $3,331.20 2025-12-31
73718 CPT Fwmc Mr Charges -> Fwmc MRI Lower Ext Without Contrast Right 2 1 $3,327.65 $3,261.10 $3,327.65 $3,327.65 $3,327.65 2025-12-31
73222 CPT Fwmc Mr Charges -> Fwmc MRI Joint Upper Ext With Contrast Right 2 1 $3,327.65 $3,261.10 $3,327.65 $3,327.65 $3,327.65 2025-12-31
75561 CPT Fwmc Mr Charges -> Fwmc MRI Cardiac W/wo Contrast 1 1 $3,327.65 $3,261.10 $3,327.65 $3,327.65 $3,327.65 2025-12-31
78610 CPT Nm Brain Imaging Vascular Flow Only 1 1 $3,305.70 $3,239.58 $3,305.70 $3,305.70 $3,305.70 2025-12-31
78579 CPT Nm Lung Scan Vent Only 1 1 $3,305.70 $3,239.58 $3,305.70 $3,305.70 $3,305.70 2025-12-31
202 RC Room/bed: ICU 1 1 $3,284.95 $3,219.25 $3,284.95 $3,284.95 $3,284.95 2025-12-31
78800 CPT Nm Abscess Imaging Limited Area 1 1 $3,235.36 $3,170.66 $3,235.36 $3,235.36 $3,235.36 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
78300 CPT Nm Bone Imaging Limited 1 1 $3,094.70 $3,032.80 $3,094.70 $3,094.70 $3,094.70 2025-12-31
78700 CPT Nm DMSA/Kidney Static Imaging 1 1 $3,094.70 $3,032.80 $3,094.70 $3,094.70 $3,094.70 2025-12-31
78230 CPT Nm Salivary Gland Imaging 1 1 $3,094.70 $3,032.80 $3,094.70 $3,094.70 $3,094.70 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
72157 CPT Fwmc Mr Charges -> Fwmc MRI Thoracic W/wo Contrast 1 1 $3,006.92 $2,946.78 $3,006.92 $3,006.92 $3,006.92 2025-12-31
70553 CPT Fwmc Mr Charges -> Fwmc MRI Brain W/wo Contrast 1 1 $2,966.82 $2,907.49 $2,966.82 $2,966.82 $2,966.82 2025-12-31
72158 CPT Fwmc Mr Charges -> Fwmc MRI Lumbar W/wo Contrast 1 1 $2,966.82 $2,907.49 $2,966.82 $2,966.82 $2,966.82 2025-12-31
72156 CPT Fwmc Mr Charges -> Fwmc MRI Spinal Canal W/wo Contrast 1 1 $2,966.82 $2,907.49 $2,966.82 $2,966.82 $2,966.82 2025-12-31
13533-0318-01 NDC Rabies Immune Glob, Human 300 Intl_Units/mL Inj Soln 1 1 $2,956.93 $2,897.79 $2,956.93 $2,956.93 $2,956.93 2025-12-31
78102 CPT Nm Bone Marrow Imaging Limited 1 1 $2,954.03 $2,894.95 $2,954.03 $2,954.03 $2,954.03 2025-12-31
74181 CPT Fwmc Mr Charges -> Fwmc Mr Abdomen 1 1 $2,926.73 $2,868.20 $2,926.73 $2,926.73 $2,926.73 2025-12-31
70542 CPT Fwmc Mr Charges -> Fwmc MRI Orbit,Face,Neck With Contrast 1 1 $2,886.64 $2,828.91 $2,886.64 $2,886.64 $2,886.64 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
70336 CPT Fwmc Mr Charges -> Fwmc MRA Head With Contrast 1 1 $2,806.46 $2,750.33 $2,806.46 $2,806.46 $2,806.46 2025-12-31
00023-1145-01 NDC onabotulinumtoxinA 100 Units Inj Soln 1 1 $2,710.76 $2,656.54 $2,710.76 $2,710.76 $2,710.76 2025-12-31
70540 CPT Fwmc Mr Charges -> Fwmc Mr Orbit Face Neck 1 1 $2,646.09 $2,593.16 $2,646.09 $2,646.09 $2,646.09 2025-12-31
72147 CPT Fwmc Mr Charges -> Fwmc MRI Spinal Thoracic With Contrast 1 1 $2,646.09 $2,593.16 $2,646.09 $2,646.09 $2,646.09 2025-12-31
72142 CPT Fwmc Mr Charges -> Fwmc MRI Cervical Spine With Contrast 1 1 $2,646.09 $2,593.16 $2,646.09 $2,646.09 $2,646.09 2025-12-31
72149 CPT Fwmc Mr Charges -> Fwmc MRI Spinal Lumbar With Contrast 1 1 $2,605.99 $2,553.87 $2,605.99 $2,605.99 $2,605.99 2025-12-31
70552 CPT Fwmc Mr Charges -> Fwmc MRI Brain With Contrast 1 1 $2,605.99 $2,553.87 $2,605.99 $2,605.99 $2,605.99 2025-12-31
14789-0015-05 NDC Isoproterenol 1 Mg/5 Ml Inj Soln 1 1 $2,498.40 $2,448.43 $2,498.40 $2,498.40 $2,498.40 2025-12-31
93886 CPT US Transcranial Doppler Complete 1 1 $2,408.52 $2,360.35 $2,408.52 $2,408.52 $2,408.52 2025-12-31
61958-2901-02 NDC Remdesivir 100 Mg Inj Soln (from Pharmacy) 2 1 $2,643.52 $2,590.65 $2,165.28 $2,643.52 $2,404.40 2025-12-31
78708 CPT Nm Kidney Imaging With Flow With Pharm 1 1 $2,391.36 $2,343.53 $2,391.36 $2,391.36 $2,391.36 2025-12-31
93975 CPT US Art/Vein Abd/Pelvic Complete - Vas 1 1 $2,334.41 $2,287.73 $2,334.41 $2,334.41 $2,334.41 2025-12-31
13533-0634-02 NDC Tetanus Immune Globulin 250 units/mL Inj Soln 1 1 $2,316.85 $2,270.51 $2,316.85 $2,316.85 $2,316.85 2025-12-31
93925 CPT US Arterial Duplex Le Bilateral 1 1 $2,297.36 $2,251.41 $2,297.36 $2,297.36 $2,297.36 2025-12-31
75557 CPT Fwmc Mr Charges -> Fwmc MRI Cardiac Without Contrast 1 1 $2,285.26 $2,239.55 $2,285.26 $2,285.26 $2,285.26 2025-12-31
P9052 HCPCS Platelets Hla-m L/r Unit 6822000 1 1 $2,276.15 $2,230.63 $2,276.15 $2,276.15 $2,276.15 2025-12-31
55150-0317-10 NDC Isoproterenol 1 Mg/5 Ml Inj Soln 1 1 $2,269.38 $2,223.99 $2,269.38 $2,269.38 $2,269.38 2025-12-31
G0257 HCPCS Dialysis Out-pt Emerg Basis 1 1 $2,254.88 $2,209.78 $2,254.88 $2,254.88 $2,254.88 2025-12-31
90935 CPT Ip Dialysis Hemo 1 1 $2,254.88 $2,209.78 $2,254.88 $2,254.88 $2,254.88 2025-12-31
84999 CPT Handling Charge 6119900 3 1 $6,624.50 $6,492.01 $36.42 $6,624.50 $2,237.30 2025-12-31
P9073 HCPCS Platelets, Pheresis, Pathogen Reduced, Each Unit. 1 1 $2,185.10 $2,141.40 $2,185.10 $2,185.10 $2,185.10 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
67457-0212-02 NDC Argatroban 250 Mg/2.5 Ml Inj Soln 1 1 $2,123.64 $2,081.17 $2,123.64 $2,123.64 $2,123.64 2025-12-31
42023-0182-01 NDC Argatroban 250 Mg/2.5 Ml Inj Soln 1 1 $2,123.64 $2,081.17 $2,123.64 $2,123.64 $2,123.64 2025-12-31
42023-0182-89 NDC Argatroban 250 Mg/2.5 Ml Inj Soln 1 1 $2,123.64 $2,081.17 $2,123.64 $2,123.64 $2,123.64 2025-12-31
P9037 HCPCS Platelets Pheresis Lr Irr Each 6819037 1 1 $2,112.27 $2,070.02 $2,112.27 $2,112.27 $2,112.27 2025-12-31
78231 CPT Nm Salivary Gland Imaging/Flow 1 1 $2,110.02 $2,067.82 $2,110.02 $2,110.02 $2,110.02 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
300 RC Unlisted Molecular Pathology Procedure 1 1 $2,062.86 $2,021.60 $2,062.86 $2,062.86 $2,062.86 2025-12-31
69097-0522-35 NDC Isoproterenol 1 Mg/5 Ml Inj Soln 1 1 $2,040.36 $1,999.55 $2,040.36 $2,040.36 $2,040.36 2025-12-31
68682-0433-05 NDC Isoproterenol 1 Mg/5 Ml Inj Soln 1 1 $2,040.36 $1,999.55 $2,040.36 $2,040.36 $2,040.36 2025-12-31
00143-9564-10 NDC Phentolamine 5 Mg Inj Soln 1 1 $2,040.20 $1,999.40 $2,040.20 $2,040.20 $2,040.20 2025-12-31
78216 CPT Nm Liver/Spleen Image With Flow 1 1 $2,039.69 $1,998.89 $2,039.69 $2,039.69 $2,039.69 2025-12-31
81401 CPT Molecular Pathology Procedure, Level 2 (eg, 2-10) 1 1 $2,013.94 $1,973.66 $2,013.94 $2,013.94 $2,013.94 2025-12-31
10019-0670-10 NDC Pm Esmolol 2,500 Mg/ Ns 250 Ml IV 1 1 $1,947.40 $1,908.45 $1,947.40 $1,947.40 $1,947.40 2025-12-31
94640 CPT Aerosol Sputum Induction Chrg -> Initial Treatment: Outpatient 2 1 $3,513.36 $3,443.10 $292.78 $3,513.36 $1,903.07 2025-12-31
73221 CPT Fwmc Mr Charges -> Fwmc Mr Any Joint Lower Ext Right 3 1 $1,884.33 $1,846.65 $1,884.33 $1,884.33 $1,884.33 2025-12-31
73721 CPT Fwmc Mr Charges -> Fwmc Mr Any Joint Upper Ext Right 3 1 $1,884.33 $1,846.65 $1,884.33 $1,884.33 $1,884.33 2025-12-31
81405 CPT Molecular Pathology Procedure, Level 6 1 1 $1,868.26 $1,830.90 $1,868.26 $1,868.26 $1,868.26 2025-12-31
00143-9564-01 NDC Phentolamine 5 Mg Inj Soln 1 1 $1,856.38 $1,819.25 $1,856.38 $1,856.38 $1,856.38 2025-12-31
63323-0371-19 NDC DAPTOmycin 500 Mg Inj 1 1 $1,854.99 $1,817.89 $1,854.99 $1,854.99 $1,854.99 2025-12-31
60505-6229-04 NDC DAPTOmycin 500 Mg Inj 1 1 $1,854.85 $1,817.75 $1,854.85 $1,854.85 $1,854.85 2025-12-31
16729-0435-05 NDC DAPTOmycin 500 Mg Inj 1 1 $1,854.85 $1,817.75 $1,854.85 $1,854.85 $1,854.85 2025-12-31
31722-0102-10 NDC DAPTOmycin 500 Mg Inj 1 1 $1,854.85 $1,817.75 $1,854.85 $1,854.85 $1,854.85 2025-12-31
71839-0107-01 NDC DAPTOmycin 500 Mg Inj 1 1 $1,854.85 $1,817.75 $1,854.85 $1,854.85 $1,854.85 2025-12-31
70377-0093-91 NDC DAPTOmycin 500 Mg Inj 1 1 $1,852.98 $1,815.92 $1,852.98 $1,852.98 $1,852.98 2025-12-31
94002 CPT Vent Mgmt Adult/Peds Chrg -> Initial 1 1 $1,829.88 $1,793.28 $1,829.88 $1,829.88 $1,829.88 2025-12-31
94003 CPT Vent Mgmt Adult/Peds Chrg -> Subsequent 1 1 $1,829.88 $1,793.28 $1,829.88 $1,829.88 $1,829.88 2025-12-31
P9035 HCPCS Plate Pheres-leuko Reducd/unit 6816393 1 1 $1,820.92 $1,784.50 $1,820.92 $1,820.92 $1,820.92 2025-12-31
81352 CPT 81352 Tp53 Mutation Analysis 1 1 $1,817.28 $1,780.93 $1,817.28 $1,817.28 $1,817.28 2025-12-31
50632-0010-01 NDC Rabies Vaccine, Purified Chick Embryo 2.5 Int_Unit/mL Inj Soln 1 1 $1,809.71 $1,773.52 $1,809.71 $1,809.71 $1,809.71 2025-12-31
70551 CPT Fwmc Mr Charges -> Fwmc MRI Brain Without Contrast 1 1 $1,764.06 $1,728.78 $1,764.06 $1,764.06 $1,764.06 2025-12-31
67457-0657-25 NDC Pm Esmolol 2,500 Mg/ Ns 250 Ml IV 1 1 $1,750.75 $1,715.74 $1,750.75 $1,750.75 $1,750.75 2025-12-31
68094-0101-20 NDC Phentolamine 5 Mg Inj Soln 1 1 $1,748.05 $1,713.09 $1,748.05 $1,748.05 $1,748.05 2025-12-31
93930 CPT US Arterial Duplex Ue Bilateral 1 1 $1,741.55 $1,706.72 $1,741.55 $1,741.55 $1,741.55 2025-12-31
16714-0892-01 NDC DAPTOmycin 500 Mg Inj 1 1 $1,719.77 $1,685.37 $1,719.77 $1,719.77 $1,719.77 2025-12-31
72603-0152-01 NDC DAPTOmycin 500 Mg Inj 1 1 $1,719.77 $1,685.37 $1,719.77 $1,719.77 $1,719.77 2025-12-31
93970 CPT US Vein Mapping Bilateral 1 1 $1,704.49 $1,670.40 $1,704.49 $1,704.49 $1,704.49 2025-12-31
74280 CPT Xr Barium Enema With Air Complete 1 1 $1,704.49 $1,670.40 $1,704.49 $1,704.49 $1,704.49 2025-12-31
93880 CPT US Carotid Duplex Bilateral 1 1 $1,704.49 $1,670.40 $1,704.49 $1,704.49 $1,704.49 2025-12-31
88249 CPT Chromosome Analysis 100 6128250 1 1 $1,693.45 $1,659.59 $1,693.45 $1,693.45 $1,693.45 2025-12-31
00456-2700-10 NDC Ceftazidime-avibactam 2.5 G (2g-0.5g) Inj Soln (from Pharmacy) 2 1 $1,729.58 $1,694.99 $1,647.22 $1,729.58 $1,688.40 2025-12-31
72148 CPT Fwmc Mr Charges -> Fwmc MRI Lumbar Without Contrast 1 1 $1,683.87 $1,650.20 $1,683.87 $1,683.87 $1,683.87 2025-12-31
72141 CPT Fwmc Mr Charges -> Fwmc MRI Cervical Spine Without Contrast 1 1 $1,683.87 $1,650.20 $1,683.87 $1,683.87 $1,683.87 2025-12-31
72146 CPT Fwmc Mr Charges -> Fwmc Mr Thoracic Spine 1 1 $1,683.87 $1,650.20 $1,683.87 $1,683.87 $1,683.87 2025-12-31
81220 CPT Cystic Fibrosis Screen(XCYFIB) 6120010 1 1 $1,653.39 $1,620.33 $1,653.39 $1,653.39 $1,653.39 2025-12-31
79403 CPT Nm Rp/tx Radiolbld Monoclonal IV 1 1 $1,617.68 $1,585.33 $1,617.68 $1,617.68 $1,617.68 2025-12-31
78232 CPT Nm Salivary Gland Function 1 1 $1,617.68 $1,585.33 $1,617.68 $1,617.68 $1,617.68 2025-12-31
93978 CPT US Aorta Duplex Complete 1 1 $1,593.33 $1,561.46 $1,593.33 $1,593.33 $1,593.33 2025-12-31
58160-0964-12 NDC Rabies Vaccine, Purified Chick Embryo 2.5 Int_Unit/mL Inj Soln 1 1 $1,578.33 $1,546.76 $1,578.33 $1,578.33 $1,578.33 2025-12-31
88380 CPT Microdisection Bio Ther 1 6420023 1 1 $1,565.99 $1,534.67 $1,565.99 $1,565.99 $1,565.99 2025-12-31
60793-0701-10 NDC Penicillin G Benzathine 1,200,000 Units/2 Ml Inj Susp 1 1 $1,536.67 $1,505.94 $1,536.67 $1,536.67 $1,536.67 2025-12-31
93924 CPT US Pvr W/stress-lower Extremity 1 1 $1,519.22 $1,488.84 $1,519.22 $1,519.22 $1,519.22 2025-12-31
78012 CPT Nm Thyroid Single Uptake 1 1 $1,477.01 $1,447.47 $1,477.01 $1,477.01 $1,477.01 2025-12-31
70121-1605-07 NDC Isoproterenol 1 Mg/5 Ml Inj Soln 1 1 $1,468.43 $1,439.06 $1,468.43 $1,468.43 $1,468.43 2025-12-31
00006-3823-10 NDC Caspofungin 70 Mg Inj Soln 1 1 $1,461.08 $1,431.86 $1,461.08 $1,461.08 $1,461.08 2025-12-31
88264 CPT Chromosome Analysis Bone Marrow Quest 1 1 1 $1,456.74 $1,427.60 $1,456.74 $1,456.74 $1,456.74 2025-12-31
88348 CPT Cp Electron Microscopy Lab6428348 1 1 $1,456.74 $1,427.60 $1,456.74 $1,456.74 $1,456.74 2025-12-31
88263 CPT Mosaic Study Quest 1 1 $1,456.74 $1,427.60 $1,456.74 $1,456.74 $1,456.74 2025-12-31
121 RC Room/bed: Med Surg 1 1 $1,437.92 $1,409.16 $1,437.92 $1,437.92 $1,437.92 2025-12-31
123 RC Room/bed: Pediatrics Wah 1 1 $1,437.92 $1,409.16 $1,437.92 $1,437.92 $1,437.92 2025-12-31
710 RC Fw Postoperative 1 1 $1,416.84 $1,388.50 $1,416.84 $1,416.84 $1,416.84 2025-12-31
00006-3822-10 NDC Caspofungin 50 Mg Inj Soln 1 1 $1,406.22 $1,378.10 $1,406.22 $1,406.22 $1,406.22 2025-12-31
63323-0356-10 NDC Caspofungin 50 Mg Inj Soln 1 1 $1,403.27 $1,375.20 $1,403.27 $1,403.27 $1,403.27 2025-12-31
63323-0526-03 NDC Argatroban 250 Mg/2.5 Ml Inj Soln 1 1 $1,344.97 $1,318.07 $1,344.97 $1,344.97 $1,344.97 2025-12-31
81272 CPT 81272 Kit Gene Analysis, Targeted Dequence Analysis 1 1 $1,343.84 $1,316.96 $1,343.84 $1,343.84 $1,343.84 2025-12-31
93926 CPT US Arterial Duplex Le Right 2 1 $1,333.95 $1,307.27 $1,333.95 $1,333.95 $1,333.95 2025-12-31
90940 CPT US Hemodialysis Access Patency Study 1 1 $1,333.95 $1,307.27 $1,333.95 $1,333.95 $1,333.95 2025-12-31
93976 CPT US Abdomen Limited - Vascular 1 1 $1,296.90 $1,270.96 $1,296.90 $1,296.90 $1,296.90 2025-12-31
00169-7065-15 NDC Glucagon Recombinant 1 Mg Inj 1 1 $1,281.26 $1,255.63 $1,281.26 $1,281.26 $1,281.26 2025-12-31
76776 CPT US Kidney Transplant Right 3 1 $1,259.84 $1,234.65 $1,259.84 $1,259.84 $1,259.84 2025-12-31
81270 CPT Jak2 V617F,Qual w/rfl(XJAKQ) 6120017 1 1 $1,252.79 $1,227.74 $1,252.79 $1,252.79 $1,252.79 2025-12-31
87900 CPT HIV 1 Susceptibility 1 1 $1,238.23 $1,213.46 $1,238.23 $1,238.23 $1,238.23 2025-12-31
87901 CPT HIV 1 Genotyping Pr Rt Quest 1 1 $1,238.23 $1,213.46 $1,238.23 $1,238.23 $1,238.23 2025-12-31
87902 CPT Hepatitis C Genotyping Quest 1 1 $1,238.23 $1,213.46 $1,238.23 $1,238.23 $1,238.23 2025-12-31
74270 CPT Xr Defecogram Colon W/modifer 52 2 1 $1,185.73 $1,162.02 $1,185.73 $1,185.73 $1,185.73 2025-12-31
93923 CPT Transcutaneous O2 Tension M 2 1 1 $1,185.73 $1,162.02 $1,185.73 $1,185.73 $1,185.73 2025-12-31
00005-2000-02 NDC Pneumococcal 20-valent Conjugate Vaccine, 0.5 Ml Inj Susp 1 1 $1,176.16 $1,152.64 $1,176.16 $1,176.16 $1,176.16 2025-12-31
00548-5850-00 NDC Glucagon Recombinant 1 Mg Inj 1 1 $1,165.92 $1,142.60 $1,165.92 $1,165.92 $1,165.92 2025-12-31
88365 CPT Cp Tissue Situ Hybrid Inter&rpt Lab6428365 1 1 $1,165.39 $1,142.08 $1,165.39 $1,165.39 $1,165.39 2025-12-31
88262 CPT Chromosome Analalysis Blood No Growth Quest 1 1 $1,165.39 $1,142.08 $1,165.39 $1,165.39 $1,165.39 2025-12-31
63323-0582-82 NDC Glucagon Recombinant 1 Mg Inj 1 1 $1,165.09 $1,141.79 $1,165.09 $1,165.09 $1,165.09 2025-12-31
76885 CPT US Hips Infant Dynamic 1 1 $1,148.68 $1,125.71 $1,148.68 $1,148.68 $1,148.68 2025-12-31
74415 CPT Xr Urography With Nephrotomography 1 1 $1,148.68 $1,125.71 $1,148.68 $1,148.68 $1,148.68 2025-12-31
08065-1831-50 NDC Chondroitin-hyaluronate 1.05 Ml Oph Inj Kit 1 1 $1,147.63 $1,124.68 $1,147.63 $1,147.63 $1,147.63 2025-12-31
63851-0501-02 NDC Rabies Vaccine, Purified Chick Embryo 2.5 Int_Unit/mL Inj Soln 1 1 $1,147.28 $1,124.33 $1,147.28 $1,147.28 $1,147.28 2025-12-31
92612 CPT Fees - 15 Minutes 1 1 $1,143.52 $1,120.65 $1,143.52 $1,143.52 $1,143.52 2025-12-31
00005-2000-10 NDC Pneumococcal 20-valent Conjugate Vaccine, 0.5 Ml Inj Susp 1 1 $1,140.32 $1,117.51 $1,140.32 $1,140.32 $1,140.32 2025-12-31
00409-3670-10 NDC Cisatracurium 200 Mg/20 Ml Inj Soln 1 1 $1,137.63 $1,114.88 $1,137.63 $1,137.63 $1,137.63 2025-12-31
00409-1103-01 NDC Cisatracurium 200 Mg/20 Ml Inj Soln 1 1 $1,137.63 $1,114.88 $1,137.63 $1,137.63 $1,137.63 2025-12-31
00409-1140-01 NDC Argatroban 250 Mg/2.5 Ml Inj Soln 1 1 $1,131.32 $1,108.69 $1,131.32 $1,131.32 $1,131.32 2025-12-31
63323-0418-20 NDC Cisatracurium 200 Mg/20 Ml Inj Soln 1 1 $1,126.36 $1,103.83 $1,126.36 $1,126.36 $1,126.36 2025-12-31
00703-2045-03 NDC Cisatracurium 200 Mg/20 Ml Inj Soln 1 1 $1,126.36 $1,103.83 $1,126.36 $1,126.36 $1,126.36 2025-12-31
70069-0151-10 NDC Cisatracurium 200 Mg/20 Ml Inj Soln 1 1 $1,126.36 $1,103.83 $1,126.36 $1,126.36 $1,126.36 2025-12-31
78020 CPT Nm Thyroid Mets Uptake - Bill Only 1 1 $1,125.34 $1,102.84 $1,125.34 $1,125.34 $1,125.34 2025-12-31
86362 CPT Myelin Oligodendrocyte Glycoprotein 1 1 $1,125.33 $1,102.82 $1,125.33 $1,125.33 $1,125.33 2025-12-31
81511 CPT Alpha Fetoprotein Quad Screen Prof Quest 1 1 $1,118.04 $1,095.68 $1,118.04 $1,118.04 $1,118.04 2025-12-31
74283 CPT Xr Barium Enema Therapeutic 1 1 $1,111.63 $1,089.39 $1,111.63 $1,111.63 $1,111.63 2025-12-31
88269 CPT Chromosome Analysis Amniotic Fluid Quest 1 1 1 $1,092.55 $1,070.70 $1,092.55 $1,092.55 $1,092.55 2025-12-31
93931 CPT US Arterial Duplex Ue Right 2 1 $1,074.57 $1,053.08 $1,074.57 $1,074.57 $1,074.57 2025-12-31
00469-6501-89 NDC Regadenoson 0.4 Mg/5 Ml Inj Soln 1 1 $1,073.31 $1,051.84 $1,073.31 $1,073.31 $1,073.31 2025-12-31
70121-1570-07 NDC Filgrastim-ayow 480 Mcg/0.8 Ml Inj Soln 1 1 $1,059.32 $1,038.13 $1,059.32 $1,059.32 $1,059.32 2025-12-31
63323-0596-13 NDC Glucagon Recombinant 1 Mg Inj 1 1 $1,052.16 $1,031.12 $1,052.16 $1,052.16 $1,052.16 2025-12-31
63323-0593-03 NDC Glucagon Recombinant 1 Mg Inj 1 1 $1,052.16 $1,031.12 $1,052.16 $1,052.16 $1,052.16 2025-12-31
16729-0477-31 NDC Regadenoson 0.4 Mg/5 Ml Inj Soln 1 1 $1,042.04 $1,021.20 $1,042.04 $1,042.04 $1,042.04 2025-12-31
93990 CPT US Hemodialysis Access 1 1 $1,037.52 $1,016.77 $1,037.52 $1,037.52 $1,037.52 2025-12-31
74230 CPT Xr Modified Barium Swallow W/video 1 1 $1,037.52 $1,016.77 $1,037.52 $1,037.52 $1,037.52 2025-12-31
93971 CPT US Venous Duplex Le Right 3 1 $1,037.52 $1,016.77 $1,037.52 $1,037.52 $1,037.52 2025-12-31
08065-1830-85 NDC Sodium Hyaluronate 10 mg/mL, 0.85 Ml Oph Inj 1 1 $1,021.67 $1,001.24 $1,021.67 $1,021.67 $1,021.67 2025-12-31
70860-0107-10 NDC Caspofungin 70 Mg Inj Soln 1 1 $1,020.18 $999.78 $1,020.18 $1,020.18 $1,020.18 2025-12-31
55150-0241-10 NDC Pm Argatroban 50 Mg/ NaCl 50 Ml IV 1 1 $1,014.97 $994.67 $1,014.97 $1,014.97 $1,014.97 2025-12-31
53276-1010-02 NDC Collagen Hemostat Flour, 1 G 1 1 $1,006.30 $986.17 $1,006.30 $1,006.30 $1,006.30 2025-12-31
93979 CPT US Aorta Duplex Limited 1 1 $1,000.46 $980.45 $1,000.46 $1,000.46 $1,000.46 2025-12-31
00143-9288-01 NDC Argatroban 250 Mg/2.5 Ml Inj Soln 1 1 $995.58 $975.67 $995.58 $995.58 $995.58 2025-12-31
79101 CPT Nm Therapy IV Admin 1 1 $984.68 $964.98 $984.68 $984.68 $984.68 2025-12-31
79005 CPT Nm Radionuc Ablat Glnd/thyr 1 1 $984.68 $964.98 $984.68 $984.68 $984.68 2025-12-31
00517-0374-05 NDC Methylene Blue 50 Mg/10 Ml Inj Soln 1 1 $976.00 $956.48 $976.00 $976.00 $976.00 2025-12-31
00517-0381-05 NDC Methylene Blue 50 Mg/10 Ml Inj Soln 1 1 $976.00 $956.48 $976.00 $976.00 $976.00 2025-12-31
70710-1838-05 NDC Methylene Blue 50 Mg/10 Ml Inj Soln 1 1 $975.99 $956.47 $975.99 $975.99 $975.99 2025-12-31
74246 CPT Xr Upper Gi With Small Bowel 1 1 $963.41 $944.14 $963.41 $963.41 $963.41 2025-12-31
76805 CPT US OB/Pregnancy After 1st Tri (> 14 Wks) 1 1 $963.41 $944.14 $963.41 $963.41 $963.41 2025-12-31
71288-0713-21 NDC Cisatracurium 200 Mg/20 Ml Inj Soln 1 1 $957.72 $938.57 $957.72 $957.72 $957.72 2025-12-31
95819 CPT EEG Awake And Asleep 1 1 $953.44 $934.37 $953.44 $953.44 $953.44 2025-12-31
76881 CPT US Soft Tissue Groin 4 1 $926.35 $907.83 $926.35 $926.35 $926.35 2025-12-31
76536 CPT US Node Mapping 1 1 $926.35 $907.83 $926.35 $926.35 $926.35 2025-12-31
76830 CPT US Transvaginal Non-OB 1 1 $926.35 $907.83 $926.35 $926.35 $926.35 2025-12-31
00069-1311-10 NDC Epoetin Alfa-epbx 20,000 units/mL (esrd And On Dialysis) Inj Soln (mdv) 1 1 $918.58 $900.21 $918.58 $918.58 $918.58 2025-12-31
88239 CPT Tissue Cult-tumor/neoplas Eval 6228239 1 1 $910.46 $892.25 $910.46 $910.46 $910.46 2025-12-31
81314 CPT 81314 PDGFRa Mutation Analysis 1 1 $910.46 $892.25 $910.46 $910.46 $910.46 2025-12-31
81372 CPT Hla-a,b,c Class I Dna(xhlai) 6120015 1 1 $895.89 $877.97 $895.89 $895.89 $895.89 2025-12-31
74410 CPT Xr Urography With Infusion Without Tomography 1 1 $889.30 $871.51 $889.30 $889.30 $889.30 2025-12-31
76506 CPT US Neonatal Head 1 1 $889.30 $871.51 $889.30 $889.30 $889.30 2025-12-31
70100-0725-01 NDC Indocyanine Green 25 Mg Inj Kit 1 1 $883.76 $866.08 $883.76 $883.76 $883.76 2025-12-31
70100-0424-02 NDC Indocyanine Green 25 Mg Inj Kit 1 1 $883.76 $866.08 $883.76 $883.76 $883.76 2025-12-31
94660 CPT Cpap /Day Chrg 1 1 $878.34 $860.77 $878.34 $878.34 $878.34 2025-12-31
00781-3204-95 NDC niCARdipine 25 Mg/ 10 Ml Inj Soln 1 1 $877.70 $860.15 $877.70 $877.70 $877.70 2025-12-31
00781-3204-70 NDC niCARdipine 25 Mg/ 10 Ml Inj Soln 1 1 $877.70 $860.15 $877.70 $877.70 $877.70 2025-12-31
G0416 HCPCS Surgical Path Gross And Micro Ex For Prostate Biop Any Meth Any Number Spec 6420… 1 1 $874.04 $856.56 $874.04 $874.04 $874.04 2025-12-31
81445 CPT 81445 Targeted Genomic Sequence Analysis Panel, Solid Organ Neoplasm 1 1 $863.12 $845.85 $863.12 $863.12 $863.12 2025-12-31
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