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

COREWELL HEALTH REED CITY HOSPITAL

Reed City, MI · CCN 231323 · Rates published

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This hospital’s price: $630 across 1 payer · range $529-$780

Source: https://assets.contentstack.io/v3/assets/blt3055f692fe7bf193/blt3be61430bc83a1ee/382770076_corewell-health-reed-city-hospital_standardcharges.csv · observed 2026-04-01

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

4,427 distinct procedures filed
21 distinct payers
32,514 rate rows
2026-04-01 last MRF observed
Data quality

10,664 of 32,514 rate rows are consumer-grade (32.8%)

21,850 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 21,704
placeholder amount (≤ $0.02) — excluded from medians 125
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 15
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 6
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://assets.contentstack.io/v3/assets/blt3055f692fe7bf193/blt3be61430bc83a1ee/382770076_corewell-health-reed-city-hospital_standardcharges.csv
Found on page https://corewellhealth.org/cms-hpt.txt
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-10-23
Content fingerprint a4d832333ed73a9c… · 7,454,347 bytes · first seen 2026-05-17

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
A9543
HCPCS 		Y90 Ibritumomab, Rx 1 $68,140.74 $78,361.85 $68,140.74 nat. median
$63,643
1.1× median
J7330
HCPCS 		Cultured Chondrocytes Implnt 1 $67,138.44 $77,209.21 $67,138.44 nat. median
$75,037
0.9× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 1 $59,168.69 $68,043.99 $59,168.69 nat. median
$65,720
0.9× median
9355
OTHER 		Inj. Teprotumumab-trbw 10 Mg 1 $52,310.98 $52,310.98 $52,310.98 nat. median
$369
outlier · 141.6×
9236
OTHER 		Eculizumab Injection 1 $49,685.76 $49,685.76 $49,685.76 nat. median
$231
outlier · 214.7×
90288
HCPCS 		Botulism Ig IV 1 $48,705.00 $56,010.75 $48,705.00 nat. median
$51,570
0.9× median
J9226
HCPCS 		Supprelin La Implant 1 $47,279.65 $54,371.60 $47,279.65 nat. median
$55,159
0.9× median
9284
OTHER 		Ipilimumab Injection 2 $19,726.08 $48,284.42 $34,005.25 nat. median
$189
outlier · 180.1×
J9266
HCPCS 		Pegaspargase Injection 1 $29,496.67 $33,921.17 $29,496.67 nat. median
$33,238
0.9× median
9287
OTHER 		Brentuximab Vedotin Inj 1 $26,707.53 $26,707.53 $26,707.53 nat. median
$268
outlier · 99.5×
5626
OTHER 		Level 6 Radiation Therapy 5 $6,263.77 $49,481.34 $24,553.53 nat. median
$1,954
outlier · 12.6×
J9600
HCPCS 		Porfimer Sodium Injection 1 $23,789.46 $27,357.88 $23,789.46 nat. median
$30,131
0.8× median
470
MS_DRG 		Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without… 1 $17,246.34 $25,427.29 $22,110.69 nat. median
$18,831
1.2× median
7046
OTHER 		Doxorubicin Inj 10mg 1 $20,379.37 $20,379.37 $20,379.37 nat. median
$116
outlier · 176.4×
27130
HCPCS 		Total Hip Arthroplasty 1 $19,463.58 $22,383.12 $19,463.58 nat. median
$13,091
1.5× median
27447
HCPCS 		Total Knee Arthroplasty 1 $19,463.58 $22,383.12 $19,463.58 nat. median
$12,739
1.5× median
786
MS_DRG 		Cesarean Section Without Sterilization With Mcc 1 $14,627.84 $21,566.69 $18,753.64 nat. median
$14,846
1.3× median
9276
OTHER 		Cabazitaxel Injection 1 $17,686.77 $17,686.77 $17,686.77 nat. median
$232
outlier · 76.4×
A9604
HCPCS 		Sm 153 Lexidronam 1 $16,608.54 $19,099.82 $16,608.54 nat. median
$12,749
1.3× median
9347
OTHER 		Inj Luspatercept-aamt 0.25mg 1 $16,566.79 $16,566.79 $16,566.79 nat. median
$44
outlier · 379.7×
J7310
HCPCS 		Ganciclovir Long Act Implant 1 $16,320.00 $18,768.00 $16,320.00 nat. median
$18,387
0.9× median
699
MS_DRG 		Other Kidney And Urinary Tract Diagnoses With Cc 1 $14,590.72 $14,590.72 $14,590.72 nat. median
$10,325
1.4× median
841
MS_DRG 		Lymphoma And Non-acute Leukemia With Cc 1 $13,209.42 $13,209.42 $13,209.42 nat. median
$15,885
0.8× median
787
MS_DRG 		Cesarean Section Without Sterilization With Cc 1 $9,903.83 $14,601.80 $12,697.22 nat. median
$10,913
1.2× median
698
MS_DRG 		Other Kidney And Urinary Tract Diagnoses With Mcc 3 $4,156.77 $14,343.28 $12,271.97 nat. median
$15,915
0.8× median
552
MS_DRG 		Medical Back Problems Without Mcc 1 $11,921.55 $11,921.55 $11,921.55 nat. median
$9,833
1.2× median
58571
HCPCS 		Tlh W/t/o 250 G Or Less 1 $11,515.26 $13,242.55 $11,515.26 nat. median
$9,885
1.2× median
81416
HCPCS 		Exome Sequence Analysis 1 $11,400.00 $11,400.00 $11,400.00 nat. median
$12,000
0.9× median
1207
OTHER 		Octreotide Injection, Depot 2 $4,494.61 $18,229.16 $11,361.88 nat. median
$215
outlier · 52.9×
308
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders With Mcc 1 $10,929.49 $10,929.49 $10,929.49 nat. median
$11,997
0.9× median
788
MS_DRG 		Cesarean Section Without Sterilization Without Cc/Mcc 1 $8,502.69 $12,536.01 $10,900.88 nat. median
$9,600
1.1× median
640
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 4 $2,725.57 $21,744.00 $10,678.64 nat. median
$12,851
0.8× median
682
MS_DRG 		Renal Failure With Mcc 1 $5,784.94 $15,471.26 $10,628.10 nat. median
$14,443
0.7× median
29888
HCPCS 		Knee Arthroscopy/surgery 1 $10,133.39 $11,653.40 $10,133.39 nat. median
$7,336
1.4× median
564
MS_DRG 		Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc 1 $9,625.56 $9,625.56 $9,625.56 nat. median
$15,007
0.6× median
43770
HCPCS 		Lap Place Gastr Adj Device 1 $9,404.66 $10,815.36 $9,404.66 nat. median
$10,690
0.9× median
291
MS_DRG 		Heart Failure And Shock With Mcc 4 $850.14 $11,712.96 $9,251.02 nat. median
$12,775
0.7× median
809
MS_DRG 		Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 1 $8,880.73 $8,880.73 $8,880.73 nat. median
$12,522
0.7× median
J9216
HCPCS 		Interferon Gamma 1-b Inj 1 $8,628.84 $9,923.17 $8,628.84 nat. median
$9,517
0.9× median
29827
HCPCS 		Arthroscop Rotator Cuff Repr 1 $8,627.98 $9,922.18 $8,627.98 nat. median
$7,187
1.2× median
58563
HCPCS 		Hysteroscopy Ablation 1 $8,577.11 $9,863.68 $8,577.11 nat. median
$5,216
1.6× median
690
MS_DRG 		Kidney And Urinary Tract Infections Without Mcc 2 $6,056.46 $10,719.60 $8,388.03 nat. median
$8,379
1.0× median
872
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 7 $3,176.63 $22,441.17 $8,295.55 nat. median
$10,410
0.8× median
441
MS_DRG 		Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc 1 $8,285.70 $8,285.70 $8,285.70 nat. median
$17,437
outlier · 0.5×
807
MS_DRG 		Vaginal Delivery Without Sterilization Or D&c Without Cc/Mcc 1 $6,297.33 $9,284.53 $8,073.50 nat. median
$6,991
1.2× median
58280
HCPCS 		Hysterectomy/revise Vagina 1 $7,951.69 $9,144.44 $7,951.69 nat. median
$4,142
1.9× median
58263
HCPCS 		Vag Hyst W/t/o & Vag Repair 1 $7,951.69 $9,144.44 $7,951.69 nat. median
$5,277
1.5× median
58270
HCPCS 		Vag Hyst W/enterocele Repair 1 $7,951.69 $9,144.44 $7,951.69 nat. median
$5,318
1.5× median
58275
HCPCS 		Hysterectomy/revise Vagina 1 $7,951.69 $9,144.44 $7,951.69 nat. median
$3,727
outlier · 2.1×
58262
HCPCS 		Vag Hyst Including T/o 1 $7,951.69 $9,144.44 $7,951.69 nat. median
$5,363
1.5× median

Other procedures at this hospital

Browse this hospital's 4,427 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
             
A9543 HCPCS Y90 Ibritumomab, Rx 4 1 — — $68,140.74 $78,361.85 $68,140.74 2026-04-01
J7330 HCPCS Cultured Chondrocytes Implnt 4 1 — — $67,138.44 $77,209.21 $67,138.44 2026-04-01
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 4 1 — — $59,168.69 $68,043.99 $59,168.69 2026-04-01
9355 OTHER Inj. Teprotumumab-trbw 10 Mg 1 1 — — $52,310.98 $52,310.98 $52,310.98 2025-01-01
9236 OTHER Eculizumab Injection 1 1 — — $49,685.76 $49,685.76 $49,685.76 2025-01-01
90288 HCPCS Botulism Ig IV 4 1 — — $48,705.00 $56,010.75 $48,705.00 2026-04-01
J9226 HCPCS Supprelin La Implant 4 1 — — $47,279.65 $54,371.60 $47,279.65 2026-04-01
9284 OTHER Ipilimumab Injection 2 2 — — $19,726.08 $48,284.42 $34,005.25 2025-01-01
J9266 HCPCS Pegaspargase Injection 4 1 — — $29,496.67 $33,921.17 $29,496.67 2026-04-01
9287 OTHER Brentuximab Vedotin Inj 1 1 — — $26,707.53 $26,707.53 $26,707.53 2025-01-01
5626 OTHER Level 6 Radiation Therapy 8 5 — — $6,263.77 $49,481.34 $24,553.53 2026-04-01
J9600 HCPCS Porfimer Sodium Injection 4 1 — — $23,789.46 $27,357.88 $23,789.46 2026-04-01
470 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without … 4 1 — — $17,246.34 $25,427.29 $22,110.69 2026-04-01
7046 OTHER Doxorubicin Inj 10mg 1 1 — — $20,379.37 $20,379.37 $20,379.37 2025-01-01
27130 HCPCS Total Hip Arthroplasty 4 1 — — $19,463.58 $22,383.12 $19,463.58 2026-04-01
27447 HCPCS Total Knee Arthroplasty 4 1 — — $19,463.58 $22,383.12 $19,463.58 2026-04-01
786 MS_DRG Cesarean Section Without Sterilization With Mcc 4 1 — — $14,627.84 $21,566.69 $18,753.64 2026-04-01
9276 OTHER Cabazitaxel Injection 1 1 — — $17,686.77 $17,686.77 $17,686.77 2025-01-01
A9604 HCPCS Sm 153 Lexidronam 4 1 — — $16,608.54 $19,099.82 $16,608.54 2026-04-01
9347 OTHER Inj Luspatercept-aamt 0.25mg 1 1 — — $16,566.79 $16,566.79 $16,566.79 2025-01-01
J7310 HCPCS Ganciclovir Long Act Implant 4 1 — — $16,320.00 $18,768.00 $16,320.00 2026-04-01
699 MS_DRG Other Kidney And Urinary Tract Diagnoses With Cc 1 1 — — $14,590.72 $14,590.72 $14,590.72 2026-04-01
841 MS_DRG Lymphoma And Non-acute Leukemia With Cc 1 1 — — $13,209.42 $13,209.42 $13,209.42 2026-04-01
787 MS_DRG Cesarean Section Without Sterilization With Cc 4 1 — — $9,903.83 $14,601.80 $12,697.22 2026-04-01
698 MS_DRG Other Kidney And Urinary Tract Diagnoses With Mcc 4 3 — — $4,156.77 $14,343.28 $12,271.97 2026-04-01
552 MS_DRG Medical Back Problems Without Mcc 1 1 — — $11,921.55 $11,921.55 $11,921.55 2026-04-01
58571 HCPCS Tlh W/t/o 250 G Or Less 4 1 — — $11,515.26 $13,242.55 $11,515.26 2026-04-01
81416 HCPCS Exome Sequence Analysis 1 1 — — $11,400.00 $11,400.00 $11,400.00 2026-04-01
1207 OTHER Octreotide Injection, Depot 2 2 — — $4,494.61 $18,229.16 $11,361.88 2025-01-01
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 1 1 — — $10,929.49 $10,929.49 $10,929.49 2026-04-01
788 MS_DRG Cesarean Section Without Sterilization Without Cc/Mcc 4 1 — — $8,502.69 $12,536.01 $10,900.88 2026-04-01
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 5 4 — — $2,725.57 $21,744.00 $10,678.64 2026-04-01
682 MS_DRG Renal Failure With Mcc 2 1 — — $5,784.94 $15,471.26 $10,628.10 2026-04-01
29888 HCPCS Knee Arthroscopy/surgery 4 1 — — $10,133.39 $11,653.40 $10,133.39 2026-04-01
564 MS_DRG Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc 1 1 — — $9,625.56 $9,625.56 $9,625.56 2026-04-01
43770 HCPCS Lap Place Gastr Adj Device 4 1 — — $9,404.66 $10,815.36 $9,404.66 2026-04-01
291 MS_DRG Heart Failure And Shock With Mcc 6 4 — — $850.14 $11,712.96 $9,251.02 2026-04-01
809 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 1 1 — — $8,880.73 $8,880.73 $8,880.73 2026-04-01
J9216 HCPCS Interferon Gamma 1-b Inj 4 1 — — $8,628.84 $9,923.17 $8,628.84 2026-04-01
29827 HCPCS Arthroscop Rotator Cuff Repr 4 1 — — $8,627.98 $9,922.18 $8,627.98 2026-04-01
58563 HCPCS Hysteroscopy Ablation 4 1 — — $8,577.11 $9,863.68 $8,577.11 2026-04-01
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 2 2 — — $6,056.46 $10,719.60 $8,388.03 2026-04-01
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 12 7 — — $3,176.63 $22,441.17 $8,295.55 2026-04-01
441 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc 1 1 — — $8,285.70 $8,285.70 $8,285.70 2026-04-01
807 MS_DRG Vaginal Delivery Without Sterilization Or D&c Without Cc/Mcc 4 1 — — $6,297.33 $9,284.53 $8,073.50 2026-04-01
58280 HCPCS Hysterectomy/revise Vagina 4 1 — — $7,951.69 $9,144.44 $7,951.69 2026-04-01
58263 HCPCS Vag Hyst W/t/o & Vag Repair 4 1 — — $7,951.69 $9,144.44 $7,951.69 2026-04-01
58262 HCPCS Vag Hyst Including T/o 4 1 — — $7,951.69 $9,144.44 $7,951.69 2026-04-01
58270 HCPCS Vag Hyst W/enterocele Repair 4 1 — — $7,951.69 $9,144.44 $7,951.69 2026-04-01
58275 HCPCS Hysterectomy/revise Vagina 4 1 — — $7,951.69 $9,144.44 $7,951.69 2026-04-01
683 MS_DRG Renal Failure With Cc 4 4 — — $1,855.93 $11,929.60 $7,931.67 2026-04-01
177 MS_DRG Respiratory Infections And Inflammations With Mcc 3 2 — — $1,020.00 $15,534.96 $7,899.73 2026-04-01
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 1 1 — — $7,899.73 $7,899.73 $7,899.73 2026-04-01
390 MS_DRG Gastrointestinal Obstruction Without Cc/Mcc 1 1 — — $7,899.73 $7,899.73 $7,899.73 2026-04-01
58260 HCPCS Vaginal Hysterectomy 4 1 — — $7,673.61 $8,824.65 $7,673.61 2026-04-01
5623 OTHER Level 3 Radiation Therapy 26 15 — — $1,084.51 $56,547.92 $7,581.68 2026-04-01
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 3 3 — — $2,897.03 $8,366.40 $7,579.63 2026-04-01
81552 HCPCS Onc Uveal Mlnma Mrna 15 Gene 1 1 — — $7,387.20 $7,387.20 $7,387.20 2026-04-01
65 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 1 1 — — $7,159.90 $7,159.90 $7,159.90 2026-04-01
394 MS_DRG Other Digestive System Diagnoses With Cc 1 1 — — $7,154.12 $7,154.12 $7,154.12 2026-04-01
44970 HCPCS Laparoscopy Appendectomy 4 1 — — $7,051.11 $8,108.78 $7,051.11 2026-04-01
58670 HCPCS Laparoscopy Tubal Cautery 4 1 — — $6,957.86 $8,001.54 $6,957.86 2026-04-01
58662 HCPCS Laparoscopy Excise Lesions 4 1 — — $6,957.86 $8,001.54 $6,957.86 2026-04-01
49650 HCPCS Lap Ing Hernia Repair Init 4 1 — — $6,957.86 $8,001.54 $6,957.86 2026-04-01
81529 HCPCS Onc Cutan Mlnma Mrna 31 Gene 1 1 — — $6,833.35 $6,833.35 $6,833.35 2026-04-01
9436 OTHER Inj Pegfilgrast Ex Bio 0.5mg 2 2 — — $807.45 $12,716.84 $6,762.14 2025-01-01
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 14 8 — — $1,857.17 $11,900.70 $6,744.85 2026-04-01
J0600 HCPCS Edetate Calcium Disodium Inj 4 1 — — $6,698.14 $7,702.86 $6,698.14 2026-04-01
191 MS_DRG Chronic Obstructive Pulmonary Disease With Cc 2 2 — — $3,983.90 $9,360.96 $6,672.43 2026-04-01
432 MS_DRG Cirrhosis And Alcoholic Hepatitis With Mcc 1 1 — — $6,515.04 $6,515.04 $6,515.04 2026-04-01
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 1 1 — — $6,514.86 $6,514.86 $6,514.86 2026-04-01
Q0224 HCPCS Inj, Pemivibart, 4500 Mg 4 1 — — $6,477.18 $7,448.76 $6,477.18 2026-04-01
29819 HCPCS Shoulder Arthroscopy/surgery 4 1 — — $6,365.93 $7,320.82 $6,365.93 2026-04-01
29821 HCPCS Shoulder Arthroscopy/surgery 4 1 — — $6,365.93 $7,320.82 $6,365.93 2026-04-01
29806 HCPCS Shoulder Arthroscopy/surgery 4 1 — — $6,365.93 $7,320.82 $6,365.93 2026-04-01
29822 HCPCS Shoulder Arthroscopy/surgery 4 1 — — $6,365.93 $7,320.82 $6,365.93 2026-04-01
29826 HCPCS Shoulder Arthroscopy/surgery 4 1 — — $6,365.93 $7,320.82 $6,365.93 2026-04-01
29823 HCPCS Shoulder Arthroscopy/surgery 4 1 — — $6,365.93 $7,320.82 $6,365.93 2026-04-01
29820 HCPCS Shoulder Arthroscopy/surgery 4 1 — — $6,365.93 $7,320.82 $6,365.93 2026-04-01
29807 HCPCS Shoulder Arthroscopy/surgery 4 1 — — $6,365.93 $7,320.82 $6,365.93 2026-04-01
644 MS_DRG Endocrine Disorders With Cc 1 1 — — $6,258.47 $6,258.47 $6,258.47 2026-04-01
J9015 HCPCS Aldesleukin Injection 4 1 — — $6,181.20 $7,108.38 $6,181.20 2026-04-01
603 MS_DRG Cellulitis Without Mcc 1 1 — — $6,122.73 $6,122.73 $6,122.73 2026-04-01
29824 HCPCS Shoulder Arthroscopy/surgery 4 1 — — $5,778.23 $6,644.96 $5,778.23 2026-04-01
9133 OTHER Rabies Ig, Im/sc 2 2 — — $119.16 $11,436.62 $5,777.89 2025-01-01
47562 HCPCS Laparoscopic Cholecystectomy 4 1 — — $5,534.79 $6,365.01 $5,534.79 2026-04-01
30420 HCPCS Reconstruction Of Nose 4 1 — — $5,446.37 $6,263.33 $5,446.37 2026-04-01
42820 HCPCS Remove Tonsils And Adenoids 4 1 — — $5,446.37 $6,263.33 $5,446.37 2026-04-01
602 MS_DRG Cellulitis With Mcc 1 1 — — $5,424.47 $5,424.47 $5,424.47 2026-04-01
52332 HCPCS Cystoscopy And Treatment 4 1 — — $5,396.72 $6,206.23 $5,396.72 2026-04-01
J0716 HCPCS Centruroides Immune F(ab) 4 1 — — $5,351.02 $6,153.67 $5,351.02 2026-04-01
5613 OTHER Level 3 Therapeutic Radiation Treatment Preparation 13 10 — — $1,684.76 $22,179.27 $5,332.36 2026-04-01
81554 HCPCS Pulm Ds Ipf Mrna 190 Gen Alg 1 1 — — $5,244.00 $5,244.00 $5,244.00 2026-04-01
52235 HCPCS Cystoscopy And Treatment 4 1 — — $5,242.92 $6,029.36 $5,242.92 2026-04-01
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 4 3 — — $3,611.52 $7,895.73 $5,230.62 2026-04-01
A9582 HCPCS Iodine I-123 Iobenguane 4 1 — — $5,210.58 $5,992.17 $5,210.58 2026-04-01
J7504 HCPCS Lymphocyte Immune Globulin 4 1 — — $5,202.28 $5,982.62 $5,202.28 2026-04-01
J0225 HCPCS Inj, Vutrisiran, 1 Mg 4 1 — — $5,171.93 $5,947.72 $5,171.93 2026-04-01
9245 OTHER Romiplostim Injection 1 1 — — $5,165.79 $5,165.79 $5,165.79 2025-01-01
J1162 HCPCS Digoxin Immune Fab (ovine) 4 1 — — $5,156.07 $5,929.48 $5,156.07 2026-04-01
A9515 HCPCS Choline C-11 4 1 — — $5,100.00 $5,865.00 $5,100.00 2026-04-01
47570 HCPCS Laparo Cholecystoenterostomy 4 1 — — $5,068.58 $5,828.87 $5,068.58 2026-04-01
47563 HCPCS Laparo Cholecystectomy/graph 4 1 — — $5,068.58 $5,828.87 $5,068.58 2026-04-01
0800 RC Leuprolide Acetate 3 3 — — $4,643.70 $10,706.10 $5,048.12 2025-01-01
30410 HCPCS Reconstruction Of Nose 4 1 — — $5,002.84 $5,753.27 $5,002.84 2026-04-01
30620 HCPCS Intranasal Reconstruction 4 1 — — $5,002.84 $5,753.27 $5,002.84 2026-04-01
30400 HCPCS Reconstruction Of Nose 4 1 — — $5,002.84 $5,753.27 $5,002.84 2026-04-01
30630 HCPCS Repair Nasal Septum Defect 4 1 — — $5,002.84 $5,753.27 $5,002.84 2026-04-01
30600 HCPCS Repair Mouth/nose Fistula 4 1 — — $5,002.84 $5,753.27 $5,002.84 2026-04-01
30580 HCPCS Repair Upper Jaw Fistula 4 1 — — $5,002.84 $5,753.27 $5,002.84 2026-04-01
J9219 HCPCS Leuprolide Acetate Implant 4 1 — — $5,001.70 $5,751.96 $5,001.70 2026-04-01
J9225 HCPCS Vantas Implant 4 1 — — $4,971.34 $5,717.04 $4,971.34 2026-04-01
42830 HCPCS Removal Of Adenoids 4 1 — — $4,914.70 $5,651.91 $4,914.70 2026-04-01
J0480 HCPCS Basiliximab 4 1 — — $4,848.79 $5,576.11 $4,848.79 2026-04-01
30520 HCPCS Repair Of Nasal Septum 4 1 — — $4,827.49 $5,551.61 $4,827.49 2026-04-01
9466 OTHER Inj., Benralizumab, 1 Mg 1 1 — — $4,793.76 $4,793.76 $4,793.76 2025-01-01
393 MS_DRG Other Digestive System Diagnoses With Mcc 1 1 — — $4,659.90 $4,659.90 $4,659.90 2026-04-01
5622 OTHER Level 2 Radiation Therapy 18 11 — — $284.38 $38,323.50 $4,556.91 2026-04-01
81415 HCPCS Exome Sequence Analysis 1 1 — — $4,541.00 $4,541.00 $4,541.00 2026-04-01
A9507 HCPCS In111 Capromab 4 1 — — $4,483.93 $5,156.52 $4,483.93 2026-04-01
50590 HCPCS Fragmenting Of Kidney Stone 4 1 — — $4,431.46 $5,096.18 $4,431.46 2026-04-01
J0801 HCPCS Inj. Acthar Gel To 40 Units 4 1 — — $4,345.44 $4,997.26 $4,345.44 2026-04-01
282 MS_DRG Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc 1 1 — — $4,299.35 $4,299.35 $4,299.35 2026-04-01
A9570 HCPCS Indium In-111 Auto Wbc 4 1 — — $4,294.16 $4,938.28 $4,294.16 2026-04-01
A9571 HCPCS Indium In-111 Auto Platelet 4 1 — — $4,294.16 $4,938.28 $4,294.16 2026-04-01
J9200 HCPCS Floxuridine Injection 4 1 — — $4,281.23 $4,923.41 $4,281.23 2026-04-01
202 MS_DRG Bronchitis And Asthma With Cc/Mcc 3 3 — — $3,036.83 $9,439.36 $4,101.62 2026-04-01
A9572 HCPCS Indium In-111 Pentetreotide 4 1 — — $3,947.40 $4,539.51 $3,947.40 2026-04-01
Q4204 HCPCS Xwrap 1 Sq Cm 4 1 — — $3,917.22 $4,504.80 $3,917.22 2026-04-01
J3316 HCPCS Inj., Triptorelin Xr 3.75 Mg 4 1 — — $3,915.22 $4,502.50 $3,915.22 2026-04-01
638 MS_DRG Diabetes With Cc 2 2 — — $2,578.38 $5,173.78 $3,876.08 2026-04-01
A9600 HCPCS Sr89 Strontium 4 1 — — $3,825.00 $4,398.75 $3,825.00 2026-04-01
58558 HCPCS Hysteroscopy Biopsy 4 1 — — $3,784.74 $4,352.45 $3,784.74 2026-04-01
J2507 HCPCS Pegloticase Injection 4 1 — — $3,776.18 $4,342.61 $3,776.18 2026-04-01
1508 OTHER New Technology - Level 8 ($601 - $700) 12 9 — — $760.70 $15,029.96 $3,748.82 2026-04-01
A9557 HCPCS Tc99m Bicisate 4 1 — — $3,739.65 $4,300.60 $3,739.65 2026-04-01
J0802 HCPCS Inj. (ani), Up To 40 Units 4 1 — — $3,681.18 $4,233.36 $3,681.18 2026-04-01
81518 HCPCS Onc Brst Mrna 11 Genes 1 1 — — $3,679.35 $3,679.35 $3,679.35 2026-04-01
81523 HCPCS Onc Brst Mrna 70 Cnt 31 Gene 1 1 — — $3,679.35 $3,679.35 $3,679.35 2026-04-01
81522 HCPCS Onc Breast Mrna 12 Genes 1 1 — — $3,679.35 $3,679.35 $3,679.35 2026-04-01
81541 HCPCS Onc Prostate Mrna 46 Genes 1 1 — — $3,679.35 $3,679.35 $3,679.35 2026-04-01
81521 HCPCS Onc Breast Mrna 70 Genes 1 1 — — $3,679.35 $3,679.35 $3,679.35 2026-04-01
81519 HCPCS Oncology Breast Mrna 1 1 — — $3,679.35 $3,679.35 $3,679.35 2026-04-01
81542 HCPCS Onc Prostate Mrna 22 Cnt Gen 1 1 — — $3,679.35 $3,679.35 $3,679.35 2026-04-01
5112 OTHER Level 2 Musculoskeletal Procedures 7 5 — — $1,157.10 $9,822.89 $3,675.97 2026-04-01
439 MS_DRG Disorders Of Pancreas Except Malignancy With Cc 3 3 — — $2,739.63 $13,097.68 $3,578.00 2026-04-01
A9542 HCPCS In111 Ibritumomab, Dx 4 1 — — $3,570.00 $4,105.50 $3,570.00 2026-04-01
81540 HCPCS Oncology Tum Unknown Origin 1 1 — — $3,562.50 $3,562.50 $3,562.50 2026-04-01
Q9983 HCPCS Florbetaben F18 Diagnostic 4 1 — — $3,468.00 $3,988.20 $3,468.00 2026-04-01
81546 HCPCS Onc Thyr Mrna 10,196 Gen Alg 1 1 — — $3,420.00 $3,420.00 $3,420.00 2026-04-01
8011 OTHER Comprehensive Observation Services 11 9 — — $1,608.00 $9,096.44 $3,387.90 2025-01-01
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 1 1 — — $3,284.55 $3,284.55 $3,284.55 2026-04-01
Q9982 HCPCS Flutemetamol F18 Diagnostic 4 1 — — $3,264.00 $3,753.60 $3,264.00 2026-04-01
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 3 3 — — $3,180.90 $7,122.64 $3,257.52 2026-04-01
J7352 HCPCS Afamelanotide Implant, 1 Mg 4 1 — — $3,213.59 $3,695.63 $3,213.59 2026-04-01
29881 HCPCS Knee Arthroscopy/surgery 4 1 — — $3,186.45 $3,664.42 $3,186.45 2026-04-01
81440 HCPCS Mitochondrial Gene 1 1 — — $3,157.80 $3,157.80 $3,157.80 2026-04-01
J2993 HCPCS Reteplase Injection 4 1 — — $3,081.45 $3,543.67 $3,081.45 2026-04-01
81595 HCPCS Cardiology Hrt Trnspl Mrna 1 1 — — $3,078.00 $3,078.00 $3,078.00 2026-04-01
5694 OTHER Level 4 Drug Administration 29 15 — — $366.34 $38,748.84 $3,033.15 2026-04-01
897 MS_DRG Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc 1 1 — — $3,002.72 $3,002.72 $3,002.72 2026-04-01
19120 HCPCS Removal Of Breast Lesion 4 1 — — $2,978.37 $3,425.13 $2,978.37 2026-04-01
19086 HCPCS Bx Breast Add Lesion Mr Imag 4 1 — — $2,978.37 $3,425.13 $2,978.37 2026-04-01
19081 HCPCS Bx Breast 1st Lesion Strtctc 4 1 — — $2,978.37 $3,425.13 $2,978.37 2026-04-01
19085 HCPCS Bx Breast 1st Lesion Mr Imag 4 1 — — $2,978.37 $3,425.13 $2,978.37 2026-04-01
19084 HCPCS Bx Breast Add Lesion US Imag 4 1 — — $2,978.37 $3,425.13 $2,978.37 2026-04-01
19125 HCPCS Excision Breast Lesion 4 1 — — $2,978.37 $3,425.13 $2,978.37 2026-04-01
19082 HCPCS Bx Breast Add Lesion Strtctc 4 1 — — $2,978.37 $3,425.13 $2,978.37 2026-04-01
81525 HCPCS Oncology Colon Mrna 1 1 — — $2,960.20 $2,960.20 $2,960.20 2026-04-01
A9586 HCPCS Florbetapir F18 4 1 — — $2,914.55 $3,351.73 $2,914.55 2026-04-01
29886 HCPCS Knee Arthroscopy/surgery 4 1 — — $2,885.79 $3,318.66 $2,885.79 2026-04-01
29884 HCPCS Knee Arthroscopy/surgery 4 1 — — $2,885.79 $3,318.66 $2,885.79 2026-04-01
29882 HCPCS Knee Arthroscopy/surgery 4 1 — — $2,885.79 $3,318.66 $2,885.79 2026-04-01
29879 HCPCS Knee Arthroscopy/surgery 4 1 — — $2,885.79 $3,318.66 $2,885.79 2026-04-01
29880 HCPCS Knee Arthroscopy/surgery 4 1 — — $2,885.79 $3,318.66 $2,885.79 2026-04-01
29876 HCPCS Knee Arthroscopy/surgery 4 1 — — $2,885.79 $3,318.66 $2,885.79 2026-04-01
29877 HCPCS Knee Arthroscopy/surgery 4 1 — — $2,885.79 $3,318.66 $2,885.79 2026-04-01
29875 HCPCS Knee Arthroscopy/surgery 4 1 — — $2,885.79 $3,318.66 $2,885.79 2026-04-01
29850 HCPCS Knee Arthroscopy/surgery 4 1 — — $2,885.79 $3,318.66 $2,885.79 2026-04-01
29891 HCPCS Ankle Arthroscopy/surgery 4 1 — — $2,885.79 $3,318.66 $2,885.79 2026-04-01
19083 HCPCS Bx Breast 1st Lesion US Imag 4 1 — — $2,875.19 $3,306.47 $2,875.19 2026-04-01
J9286 HCPCS Inj Glofitamab Gxbm, 2.5 Mg 4 1 — — $2,875.12 $3,306.39 $2,875.12 2026-04-01
189 MS_DRG Pulmonary Edema And Respiratory Failure 5 3 — — $1,608.01 $7,259.53 $2,873.65 2026-04-01
880 MS_DRG Acute Adjustment Reaction And Psychosocial Dysfunction 1 1 — — $2,860.51 $2,860.51 $2,860.51 2026-04-01
296 MS_DRG Cardiac Arrest, Unexplained With Mcc 1 1 — — $2,849.84 $2,849.84 $2,849.84 2026-04-01
J9229 HCPCS Inj Inotuzumab Ozogam 0.1 Mg 4 1 — — $2,799.87 $3,219.85 $2,799.87 2026-04-01
81456 HCPCS Hc Sarcoma Genomic Seq Panel 1 1 — — $2,773.62 $2,773.62 $2,773.62 2026-04-01
81455 HCPCS Hc Gene Solid Tumor Analysis 1 1 — — $2,773.62 $2,773.62 $2,773.62 2026-04-01
5594 OTHER Level 4 Nuclear Medicine And Related Services 27 14 — — $1,054.56 $8,332.76 $2,740.28 2026-04-01
81538 HCPCS Oncology Lung 1 1 — — $2,727.45 $2,727.45 $2,727.45 2026-04-01
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 1 1 — — $2,697.94 $2,697.94 $2,697.94 2026-04-01
5041 OTHER Critical Care 24 14 — — $774.67 $11,995.21 $2,694.23 2026-04-01
A9584 HCPCS Iodine I-123 Ioflupane 4 1 — — $2,643.84 $3,040.42 $2,643.84 2026-04-01
J9268 HCPCS Pentostatin Injection 4 1 — — $2,639.89 $3,035.87 $2,639.89 2026-04-01
43260 HCPCS Ercp W/specimen Collection 4 1 — — $2,618.81 $3,011.63 $2,618.81 2026-04-01
43248 HCPCS Egd Guide Wire Insertion 4 1 — — $2,618.81 $3,011.63 $2,618.81 2026-04-01
43238 HCPCS Egd US Fine Needle Bx/aspir 4 1 — — $2,618.81 $3,011.63 $2,618.81 2026-04-01
42826 HCPCS Removal Of Tonsils 4 1 — — $2,609.41 $3,000.82 $2,609.41 2026-04-01
42821 HCPCS Remove Tonsils And Adenoids 4 1 — — $2,609.41 $3,000.82 $2,609.41 2026-04-01
43240 HCPCS Egd W/transmural Drain Cyst 4 1 — — $2,567.82 $2,952.99 $2,567.82 2026-04-01
5781 OTHER Resuscitation And Cardioversion 8 5 — — $966.68 $5,692.10 $2,545.93 2026-04-01
Q2017 HCPCS Teniposide, 50 Mg 4 1 — — $2,545.87 $2,927.75 $2,545.87 2026-04-01
J0202 HCPCS Injection, Alemtuzumab 4 1 — — $2,532.80 $2,912.72 $2,532.80 2026-04-01
J7294 HCPCS Seg Acet And Eth Estr Yearly 4 1 — — $2,468.96 $2,839.30 $2,468.96 2026-04-01
Q4206 HCPCS Fluid Flow Or Fluid Gf 1 Cc 4 1 — — $2,448.00 $2,815.20 $2,448.00 2026-04-01
9501 OTHER Platelet Pheres Leukoreduced 1 1 — — $2,447.62 $2,447.62 $2,447.62 2025-01-01
J0350 HCPCS Injection Anistreplase 30 U 4 1 — — $2,410.24 $2,771.78 $2,410.24 2026-04-01
81520 HCPCS Onc Breast Mrna 58 Genes 1 1 — — $2,384.70 $2,384.70 $2,384.70 2026-04-01
66985 HCPCS Insert Lens Prosthesis 4 1 — — $2,350.48 $2,703.05 $2,350.48 2026-04-01
66852 HCPCS Removal Of Lens Material 4 1 — — $2,350.48 $2,703.05 $2,350.48 2026-04-01
66983 HCPCS Cataract Surg W/iol 1 Stage 4 1 — — $2,350.48 $2,703.05 $2,350.48 2026-04-01
66940 HCPCS Extraction Of Lens 4 1 — — $2,350.48 $2,703.05 $2,350.48 2026-04-01
66930 HCPCS Extraction Of Lens 4 1 — — $2,350.48 $2,703.05 $2,350.48 2026-04-01
66920 HCPCS Extraction Of Lens 4 1 — — $2,350.48 $2,703.05 $2,350.48 2026-04-01
66850 HCPCS Removal Of Lens Material 4 1 — — $2,350.48 $2,703.05 $2,350.48 2026-04-01
66840 HCPCS Removal Of Lens Material 4 1 — — $2,350.48 $2,703.05 $2,350.48 2026-04-01
66830 HCPCS Removal Of Lens Lesion 4 1 — — $2,350.48 $2,703.05 $2,350.48 2026-04-01
90396 HCPCS Varicella-zoster Ig IM 4 1 — — $2,326.37 $2,675.33 $2,326.37 2026-04-01
81443 HCPCS Genetic Tstg Severe Inh Cond 1 1 — — $2,326.13 $2,326.13 $2,326.13 2026-04-01
81419 HCPCS Epilepsy Gen Seq Alys Panel 1 1 — — $2,326.13 $2,326.13 $2,326.13 2026-04-01
81441 HCPCS Ibmfs Seq Alys Pnl 30 Genes 1 1 — — $2,326.13 $2,326.13 $2,326.13 2026-04-01
81412 HCPCS Ashkenazi Jewish Assoc Dis 1 1 — — $2,326.13 $2,326.13 $2,326.13 2026-04-01
J2787 HCPCS Riboflavin 5?phos Opth<=3ml 4 1 — — $2,325.60 $2,674.44 $2,325.60 2026-04-01
66984 HCPCS Cataract Surg W/iol 1 Stage 4 1 — — $2,322.92 $2,671.36 $2,322.92 2026-04-01
5045 OTHER Trauma Response With Critical Care 7 7 — — $1,777.44 $14,272.48 $2,307.53 2026-04-01
Q4169 HCPCS Artacent Wound, Per Sq Cm 4 1 — — $2,304.37 $2,650.03 $2,304.37 2026-04-01
5183 OTHER Level 3 Vascular Procedures 5 5 — — $2,244.21 $7,690.91 $2,260.59 2025-01-01
J1826 HCPCS Interferon Beta-1a Inj 4 1 — — $2,202.64 $2,533.04 $2,202.64 2026-04-01
J3240 HCPCS Thyrotropin Injection 4 1 — — $2,192.98 $2,521.93 $2,192.98 2026-04-01
0810 RC Goserelin Acetate Implant 2 2 — — $903.18 $3,413.32 $2,158.25 2025-01-01
A9547 HCPCS In111 Oxyquinoline 4 1 — — $2,147.08 $2,469.14 $2,147.08 2026-04-01
64721 HCPCS Carpal Tunnel Surgery 4 1 — — $2,062.53 $2,371.91 $2,062.53 2026-04-01
Q9992 HCPCS Buprenorphine Xr Over 100 Mg 4 1 — — $2,051.14 $2,358.81 $2,051.14 2026-04-01
Q9991 HCPCS Buprenorph Xr 100 Mg Or Less 4 1 — — $2,051.14 $2,358.81 $2,051.14 2026-04-01
81442 HCPCS Noonan Spectrum Disorders 1 1 — — $2,036.42 $2,036.42 $2,036.42 2026-04-01
Q4221 HCPCS Amniowrap2 Per Sq Cm 4 1 — — $2,035.00 $2,340.25 $2,035.00 2026-04-01
J0840 HCPCS Crotalidae Poly Immune Fab 4 1 — — $1,931.36 $2,221.06 $1,931.36 2026-04-01
81551 HCPCS Onc Prostate 3 Genes 1 1 — — $1,928.50 $1,928.50 $1,928.50 2026-04-01
81408 HCPCS Mopath Procedure Level 9 1 1 — — $1,900.00 $1,900.00 $1,900.00 2026-04-01
J0850 HCPCS Cytomegalovirus Imm IV /vial 4 1 — — $1,877.72 $2,159.38 $1,877.72 2026-04-01
Q4162 HCPCS Amnio Bio And Woundex Flow 4 1 — — $1,870.00 $2,150.50 $1,870.00 2026-04-01
69436 HCPCS Create Eardrum Opening 4 1 — — $1,862.15 $2,141.47 $1,862.15 2026-04-01
90378 HCPCS Rsv Mab IM 50mg 4 1 — — $1,857.07 $2,135.63 $1,857.07 2026-04-01
A9509 HCPCS Iodine I-123 Sod Iodide Mil 4 1 — — $1,844.67 $2,121.37 $1,844.67 2026-04-01
5025 OTHER Level 5 Type A Ed Visits 38 17 — — $635.76 $8,536.10 $1,825.78 2026-04-01
J1950 HCPCS Leuprolide Acetate /3.75 Mg 4 1 — — $1,802.65 $2,073.05 $1,802.65 2026-04-01
90291 HCPCS Cmv Ig IV 4 1 — — $1,791.99 $2,060.79 $1,791.99 2026-04-01
5691 OTHER Level 1 Drug Administration 6 5 — — $943.15 $10,806.61 $1,785.37 2026-04-01
Q4193 HCPCS Coll-e-derm 1 Sq Cm 4 1 — — $1,777.83 $2,044.50 $1,777.83 2026-04-01
9173 OTHER Injection, Fulphila 2 2 — — $1,602.45 $1,951.88 $1,777.16 2025-01-01
J0578 HCPCS Inj Brixadi, More Than 7 Day 4 1 — — $1,755.13 $2,018.40 $1,755.13 2026-04-01
A9569 HCPCS Technetium Tc-99m Auto Wbc 4 1 — — $1,748.25 $2,010.49 $1,748.25 2026-04-01
A9521 HCPCS Tc99m Exametazime 4 1 — — $1,748.25 $2,010.49 $1,748.25 2026-04-01
81162 HCPCS Brca1&2 Seq & Full Dup/del 1 1 — — $1,733.64 $1,733.64 $1,733.64 2026-04-01
Q4161 HCPCS Bio-connekt Per Square Cm 4 1 — — $1,716.22 $1,973.65 $1,716.22 2026-04-01
Q4164 HCPCS Helicoll, Per Square Cm 4 1 — — $1,702.85 $1,958.28 $1,702.85 2026-04-01
8008 OTHER MRI And MRA With Contrast Composite 13 9 — — $613.61 $6,868.94 $1,682.67 2025-01-01
43239 HCPCS Egd Biopsy Single/multiple 4 1 — — $1,677.40 $1,929.01 $1,677.40 2026-04-01
43235 HCPCS Egd Diagnostic Brush Wash 4 1 — — $1,677.40 $1,929.01 $1,677.40 2026-04-01
9530 OTHER Plate Pheres Leukoredu Irrad 1 1 — — $1,663.32 $1,663.32 $1,663.32 2025-01-01
J9026 HCPCS Inj, Tarlatamab-dlle, 1 Mg 4 1 — — $1,626.64 $1,870.64 $1,626.64 2026-04-01
5181 OTHER Level 1 Vascular Procedures 1 1 — — $1,621.91 $1,621.91 $1,621.91 2025-01-01
5501 OTHER Level 1 Extraocular, Repair, And Plastic Eye Procedures 1 1 — — $1,614.70 $1,614.70 $1,614.70 2026-04-01
95811 HCPCS Polysom 6/>yrs Cpap 4/> Parm 4 1 — — $1,352.86 $1,994.61 $1,611.73 2026-04-01
440 MS_DRG Disorders Of Pancreas Except Malignancy Without Cc/Mcc 1 1 — — $1,608.00 $1,608.00 $1,608.00 2026-04-01
Q4114 HCPCS Integra Flowable Wound Matri 4 1 — — $1,600.44 $1,840.51 $1,600.44 2026-04-01
64483 HCPCS Inj Foramen Epidural L/s 4 1 — — $1,586.56 $1,824.54 $1,586.56 2026-04-01
95810 HCPCS Polysom 6/> Yrs 4/> Param 4 1 — — $1,331.04 $1,962.43 $1,585.73 2026-04-01
81430 HCPCS Hearing Loss Sequence Analys 1 1 — — $1,543.75 $1,543.75 $1,543.75 2026-04-01
78452 HCPCS Ht Muscle Image Spect Mult 4 1 — — $1,281.82 $1,889.86 $1,527.09 2026-04-01
5442 OTHER Level 2 Nerve Injections 9 6 — — $542.45 $6,319.22 $1,504.37 2026-04-01
5612 OTHER Level 2 Therapeutic Radiation Treatment Preparation 20 13 — — $259.81 $19,962.29 $1,499.53 2026-04-01
5373 OTHER Level 3 Urology And Related Services 1 1 — — $1,481.07 $1,481.07 $1,481.07 2026-04-01
A9589 HCPCS Insti Hexaminolevulinate Hcl 4 1 — — $1,478.08 $1,699.79 $1,478.08 2026-04-01
J9357 HCPCS Valrubicin Injection 4 1 — — $1,428.74 $1,643.05 $1,428.74 2026-04-01
A4642 HCPCS In111 Satumomab 4 1 — — $1,423.75 $1,637.31 $1,423.75 2026-04-01
81509 HCPCS Ftl Cgen Abnor 3 Proteins 1 1 — — $1,413.00 $1,413.00 $1,413.00 2026-04-01
J0130 HCPCS Abciximab Injection 4 1 — — $1,375.15 $1,581.42 $1,375.15 2026-04-01
5302 OTHER Level 2 Upper Gi Procedures 20 11 — — $492.42 $3,569.60 $1,371.52 2026-04-01
J9320 HCPCS Streptozocin Injection 4 1 — — $1,326.00 $1,524.90 $1,326.00 2026-04-01
81411 HCPCS Aortic Dysfunction/dilation 1 1 — — $1,282.68 $1,282.68 $1,282.68 2026-04-01
Q4174 HCPCS Palingen Or Promatrx 4 1 — — $1,269.90 $1,460.39 $1,269.90 2026-04-01
90999 HCPCS Dialysis Procedure 4 1 — — $1,065.55 $1,571.00 $1,269.44 2026-04-01
9195 OTHER Injection, Udenyca 0.5 Mg 1 1 — — $1,254.02 $1,254.02 $1,254.02 2025-01-01
J2326 HCPCS Inj, Nusinersen, 0.1mg 4 1 — — $1,243.54 $1,430.07 $1,243.54 2026-04-01
J7298 HCPCS Mirena, 52 Mg 4 1 — — $1,238.93 $1,424.77 $1,238.93 2026-04-01
J7307 HCPCS Etonogestrel Implant System 4 1 — — $1,238.93 $1,424.77 $1,238.93 2026-04-01
J7296 HCPCS Kyleena, 19.5 Mg 4 1 — — $1,238.93 $1,424.77 $1,238.93 2026-04-01
Q4205 HCPCS Membrane Graft Or Wrap Sq Cm 4 1 — — $1,235.36 $1,420.66 $1,235.36 2026-04-01
Q4226 HCPCS Myown Harv Prep Proc Sq Cm 4 1 — — $1,224.00 $1,407.60 $1,224.00 2026-04-01
81460 HCPCS Whole Mitochondrial Genome 1 1 — — $1,222.65 $1,222.65 $1,222.65 2026-04-01
Q4227 HCPCS Amniocore Per Sq Cm 4 1 — — $1,209.36 $1,390.76 $1,209.36 2026-04-01
A9536 HCPCS Tc99m Depreotide 4 1 — — $1,190.00 $1,368.50 $1,190.00 2026-04-01
75561 HCPCS Cardiac MRI For Morph With Contrast 4 1 — — $996.63 $1,469.39 $1,187.33 2026-04-01
8006 OTHER CT And CTA With Contrast Composite 18 12 — — $315.57 $6,908.29 $1,181.70 2025-01-01
5072 OTHER Level 2 Excision/ Biopsy/ Incision And Drainage 5 5 — — $917.86 $2,196.67 $1,171.43 2026-04-01
J7300 HCPCS Intraut Copper Contraceptive 4 1 — — $1,161.10 $1,335.27 $1,161.10 2026-04-01
C8905 HCPCS MRI Without Fol W/cont, Brst, Un 4 1 — — $961.74 $1,417.95 $1,145.76 2026-04-01
S0145 HCPCS Pegylated Interferon Alfa-2a, 180 Mcg/ Ml 4 1 — — $1,135.69 $1,306.04 $1,135.69 2026-04-01
Q4180 HCPCS Revita, Per Sq Cm 4 1 — — $1,131.20 $1,300.88 $1,131.20 2026-04-01
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