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

ELY - BLOOMENSON COMMUNITY HOSPITAL

Ely, MN · CCN 241318 · Rates published

2,592 distinct procedures filed
8 distinct payers
74,440 rate rows
2024-07-01 last MRF observed · ⚠ 23 mo old
Data quality

52,885 of 74,440 rate rows are consumer-grade (71.0%)

21,555 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
exceeds 10× this hospital's gross charge — excluded from medians 8,474
professional (physician) fee — not the facility price 8,034
per-diem day rate — not a per-procedure price 3,498
template filing: same amount across many unrelated codes — excluded 1,423
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 60
placeholder amount (≤ $0.02) — excluded from medians 36
percent-of-charges filed in the dollar field — excluded from medians 30

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 23 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.ebch.org/price-transparency/410808719_Ely-Bloomenson-Community-Hospital_standardcharges.csv
Found on page https://www.ebch.org/price-transparency
Discovered viaCMS hospital list
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-05-18

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
J2507
HCPCS 		Pegloticase 8 Mg/ml Solution 1 Ml Vial 8 $3,090.93 $47,400.03 $23,820.93 nat. median
$8,558
outlier · 2.8×
J2350
HCPCS 		Ocrelizumab 300 Mg/10ml Solution 10 Ml Vial 8 $49.47 $32,487.00 $16,243.50 nat. median
$712
outlier · 22.8×
J9043
HCPCS 		Cabazitaxel 60 Mg/1.5ml Solution 6 Ml Vial 8 $192.96 $27,727.21 $13,934.33 nat. median
$739
outlier · 18.9×
J9119
HCPCS 		Cemiplimab-rwlc 350 Mg/7ml Solution 7 Ml Vial 8 $23.75 $18,834.93 $9,465.51 nat. median
$91
outlier · 103.7×
J2323
HCPCS 		Natalizumab 300 Mg/15ml Concentrate 15 Ml Vial 8 $22.42 $14,922.00 $7,499.07 nat. median
$201
outlier · 37.4×
J9173
HCPCS 		Durvalumab 120 Mg/2.4ml Solution 2.4 Ml Vial 8 $62.48 $21,336.46 $7,436.99 nat. median
$1,153
outlier · 6.4×
96377
CPT 		Appl On-body Injector For Timed Subq Injection 8 $41.50 $12,831.14 $6,448.30 nat. median
$88
outlier · 73.4×
J2506
HCPCS 		Pegfilgrastim 6 Mg/0.6ml Prefilled Syringe Kit 0.6 Ml Syringe 8 $46.46 $12,830.85 $6,415.42 nat. median
$2,076
outlier · 3.1×
Q4180
HCPCS 		Revita Placental Membrane 2x3cm 6sqcm 7 $1,027.70 $19,396.16 $6,166.20 nat. median
$660
outlier · 9.3×
J3380
HCPCS 		Vedolizumab 300 Mg Recon Soln 1 Each Vial 8 $14.66 $12,190.26 $6,095.13 nat. median
$288
outlier · 21.2×
1392
CPT 		Anesth Knee Area Surgery 6 $32.04 $5,740.93 $5,740.93 —
1380
CPT 		Anesth Knee Joint Procedure 6 $32.04 $5,740.93 $5,740.93 —
1202
CPT 		Anesth Arthroscopy Of Hip 6 $32.04 $5,740.93 $5,740.93 —
1220
CPT 		Anesth Procedure On Femur 6 $32.04 $5,740.93 $5,740.93 —
1340
CPT 		Anesth Knee Area Procedure 6 $32.04 $5,740.93 $5,740.93 —
1390
CPT 		Anesth Knee Area Procedure 6 $32.04 $5,740.93 $5,740.93 —
1402
CPT 		Anesth Knee Arthroplasty 6 $32.04 $5,740.93 $5,740.93 —
142
CPT 		Anesth Lens Surgery 6 $32.04 $5,740.93 $5,740.93 —
1272
CPT 		Anesth Femoral Artery Surg 6 $32.04 $5,740.93 $5,740.93 —
1232
CPT 		Anesth Amputation Of Femur 6 $32.04 $5,740.93 $5,740.93 —
140
CPT 		Anesth Procedures On Eye 6 $32.04 $5,740.93 $5,740.93 —
1400
CPT 		Anesth Knee Joint Surgery 6 $32.04 $5,740.93 $5,740.93 —
1270
CPT 		Anesth Thigh Arteries Surg 6 $32.04 $5,740.93 $5,740.93 —
1234
CPT 		Anesth Radical Femur Surg 6 $32.04 $5,740.93 $5,740.93 —
102
CPT 		Anesth Repair Of Cleft Lip 6 $32.04 $5,740.93 $5,740.93 —
126
CPT 		Anesth Tympanotomy 6 $32.04 $5,740.93 $5,740.93 —
103
CPT 		Anesth Blepharoplasty 6 $32.04 $5,740.93 $5,740.93 —
1112
CPT 		Anesth Bone Aspirate/Bx 6 $32.04 $5,740.93 $5,740.93 —
1120
CPT 		Anesth Pelvis Surgery 6 $32.04 $5,740.93 $5,740.93 —
104
CPT 		Anesth Electroshock 6 $32.04 $5,740.93 $5,740.93 —
1430
CPT 		Anesth Knee Veins Surgery 6 $32.04 $5,740.93 $5,740.93 —
1432
CPT 		Anesth Knee Vessel Surg 6 $32.04 $5,740.93 $5,740.93 —
1382
CPT 		Anesth Dx Knee Arthroscopy 6 $32.04 $5,740.93 $5,740.93 —
1180
CPT 		Anesth Pelvis Nerve Removal 6 $32.04 $5,740.93 $5,740.93 —
1320
CPT 		Anesth Knee Area Surgery 6 $32.04 $5,740.93 $5,740.93 —
1404
CPT 		Anesth Amputation At Knee 6 $32.04 $5,740.93 $5,740.93 —
1215
CPT 		Anesth Revise Hip Repair 6 $32.04 $5,740.93 $5,740.93 —
1360
CPT 		Anesth Knee Area Surgery 6 $32.04 $5,740.93 $5,740.93 —
1214
CPT 		Anesth Hip Arthroplasty 6 $32.04 $5,740.93 $5,740.93 —
1210
CPT 		Anesth Hip Joint Surgery 6 $32.04 $5,740.93 $5,740.93 —
1260
CPT 		Anesth Upper Leg Veins Surg 6 $32.04 $5,740.93 $5,740.93 —
1212
CPT 		Anesth Hip Disarticulation 6 $32.04 $5,740.93 $5,740.93 —
1250
CPT 		Anesth Upper Leg Surgery 6 $32.04 $5,740.93 $5,740.93 —
1170
CPT 		Anesth Pelvis Surgery 6 $32.04 $5,740.93 $5,740.93 —
1190
CPT 		Anesth Pelvis Nerve Removal 6 $32.04 $5,740.93 $5,740.93 —
1274
CPT 		Anesth Femoral Embolectomy 6 $32.04 $5,740.93 $5,740.93 —
124
CPT 		Anesth Ear Exam 6 $32.04 $5,740.93 $5,740.93 —
1150
CPT 		Anesth Pelvic Tumor Surgery 6 $32.04 $5,740.93 $5,740.93 —
1160
CPT 		Anesth Pelvis Procedure 6 $32.04 $5,740.93 $5,740.93 —
1420
CPT 		Anesth Knee Joint Casting 6 $32.04 $5,740.93 $5,740.93 —

Other procedures at this hospital

Browse this hospital's 2,592 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
             
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 3 2 — — $5,225.00 $10,200.00 $5,356.00 2024-07-01
10 MS_DRG Pancreas Transplant 3 2 — — $5,225.00 $10,200.00 $5,356.00 2024-07-01
100 CPT Anesth Salivary Gland 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
100 MS_DRG Seizures With Mcc 3 2 — — $5,225.00 $10,200.00 $5,356.00 2024-07-01
101 MS_DRG Seizures Without Mcc 3 2 — — $5,225.00 $10,200.00 $5,356.00 2024-07-01
102 CPT Anesth Repair Of Cleft Lip 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
102 MS_DRG Headaches With Mcc 3 2 — — $5,225.00 $10,200.00 $5,356.00 2024-07-01
103 CPT Anesth Blepharoplasty 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
103 MS_DRG Headaches Without Mcc 3 2 — — $5,225.00 $10,200.00 $5,356.00 2024-07-01
104 CPT Anesth Electroshock 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 3 2 — — $5,225.00 $10,200.00 $5,356.00 2024-07-01
1112 CPT Anesth Bone Aspirate/Bx 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1120 CPT Anesth Pelvis Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
113 MS_DRG Orbital Procedures With Cc/mcc 3 2 — — $5,225.00 $10,200.00 $5,356.00 2024-07-01
1130 CPT Anesth Body Cast Procedure 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
114 MS_DRG Orbital Procedures Without Cc/mcc 3 2 — — $5,225.00 $10,200.00 $5,356.00 2024-07-01
1140 CPT Anesth Amputation At Pelvis 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
115 MS_DRG Extraocular Procedures Except Orbit 3 2 — — $5,225.00 $10,200.00 $5,356.00 2024-07-01
1150 CPT Anesth Pelvic Tumor Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1160 CPT Anesth Pelvis Procedure 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1170 CPT Anesth Pelvis Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1173 CPT Anesth Fx Repair Pelvis 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1180 CPT Anesth Pelvis Nerve Removal 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1190 CPT Anesth Pelvis Nerve Removal 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
120 CPT Anesth Ear Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1200 CPT Anesth Hip Joint Procedure 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1202 CPT Anesth Arthroscopy Of Hip 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1210 CPT Anesth Hip Joint Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1212 CPT Anesth Hip Disarticulation 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1214 CPT Anesth Hip Arthroplasty 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1215 CPT Anesth Revise Hip Repair 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1220 CPT Anesth Procedure On Femur 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1230 CPT Anesth Surgery Of Femur 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1232 CPT Anesth Amputation Of Femur 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1234 CPT Anesth Radical Femur Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
124 CPT Anesth Ear Exam 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1250 CPT Anesth Upper Leg Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
126 CPT Anesth Tympanotomy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1260 CPT Anesth Upper Leg Veins Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1270 CPT Anesth Thigh Arteries Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1272 CPT Anesth Femoral Artery Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1274 CPT Anesth Femoral Embolectomy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1320 CPT Anesth Knee Area Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1340 CPT Anesth Knee Area Procedure 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1360 CPT Anesth Knee Area Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1380 CPT Anesth Knee Joint Procedure 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1382 CPT Anesth Dx Knee Arthroscopy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1390 CPT Anesth Knee Area Procedure 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1392 CPT Anesth Knee Area Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
140 CPT Anesth Procedures On Eye 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1400 CPT Anesth Knee Joint Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1402 CPT Anesth Knee Arthroplasty 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1404 CPT Anesth Amputation At Knee 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
142 CPT Anesth Lens Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1420 CPT Anesth Knee Joint Casting 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1430 CPT Anesth Knee Veins Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1432 CPT Anesth Knee Vessel Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
144 CPT Anesth Corneal Transplant 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1440 CPT Anesth Knee Arteries Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1442 CPT Anesth Knee Artery Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1444 CPT Anesth Knee Artery Repair 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
145 CPT Anesth Vitreoretinal Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1462 CPT Anesth Lower Leg Procedure 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1464 CPT Anesth Ankle/Ft Arthroscopy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
147 CPT Anesth Iridectomy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1470 CPT Anesth Lower Leg Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1472 CPT Anesth Achilles Tendon Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1474 CPT Anesth Lower Leg Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
148 CPT Anesth Eye Exam 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1480 CPT Anesth Lower Leg Bone Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1482 CPT Anesth Radical Leg Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1484 CPT Anesth Lower Leg Revision 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1486 CPT Anesth Ankle Replacement 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1490 CPT Anesth Lower Leg Casting 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1500 CPT Anesth Leg Arteries Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1502 CPT Anesth Lwr Leg Embolectomy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1520 CPT Anesth Lower Leg Vein Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1522 CPT Anesth Lower Leg Vein Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
160 CPT Anesth Nose/Sinus Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1610 CPT Anesth Surgery Of Shoulder 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
162 CPT Anesth Nose/Sinus Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1620 CPT Anesth Shoulder Procedure 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1622 CPT Anes Dx Shoulder Arthroscopy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1630 CPT Anesth Surgery Of Shoulder 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1634 CPT Anesth Shoulder Joint Amput 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1636 CPT Anesth Forequarter Amput 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1638 CPT Anesth Shoulder Replacement 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
164 CPT Anesth Biopsy Of Nose 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1650 CPT Anesth Shoulder Artery Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1652 CPT Anesth Shoulder Vessel Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1654 CPT Anesth Shoulder Vessel Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1656 CPT Anesth Arm-leg Vessel Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1670 CPT Anesth Shoulder Vein Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1680 CPT Anesth Shoulder Casting 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1682 CPT Anesth Airplane Cast 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
170 CPT Anesth Procedure On Mouth 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1710 CPT Anesth Elbow Area Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1712 CPT Anesth Uppr Arm Tendon Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1714 CPT Anesth Uppr Arm Tendon Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1716 CPT Anesth Biceps Tendon Repair 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
172 CPT Anesth Cleft Palate Repair 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1730 CPT Anesth Uppr Arm Procedure 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1732 CPT Anesth Dx Elbow Arthroscopy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
174 CPT Anesth Pharyngeal Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1740 CPT Anesth Upper Arm Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1742 CPT Anesth Humerus Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1744 CPT Anesth Humerus Repair 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1756 CPT Anesth Radical Humerus Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1758 CPT Anesth Humeral Lesion Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
176 CPT Anesth Pharyngeal Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1760 CPT Anesth Elbow Replacement 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1770 CPT Anesth Uppr Arm Artery Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1772 CPT Anesth Uppr Arm Embolectomy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1780 CPT Anesth Upper Arm Vein Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1782 CPT Anesth Uppr Arm Vein Repair 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1810 CPT Anesth Lower Arm Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1820 CPT Anesth Lower Arm Procedure 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1829 CPT Anesth Dx Wrist Arthroscopy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1830 CPT Anesth Lower Arm Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1832 CPT Anesth Wrist Replacement 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1840 CPT Anesth Lwr Arm Artery Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1842 CPT Anesth Lwr Arm Embolectomy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1844 CPT Anesth Vascular Shunt Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1850 CPT Anesth Lower Arm Vein Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1852 CPT Anesth Lwr Arm Vein Repair 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1860 CPT Anesth Lower Arm Casting 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
190 CPT Anesth Face/Skull Bone Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1916 CPT Anesth Dx Arteriography 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
192 CPT Anesth Facial Bone Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1920 CPT Anesth Catheterize Heart 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1922 CPT Anesth Cat Or MRI Scan 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1924 CPT Anes Ther Interven Rad Art 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1925 CPT Anes Ther Interven Rad Car 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1926 CPT Anes Tx Interv Rad Hrt/Cran 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1930 CPT Anes Ther Interven Rad Vei 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1931 CPT Anes Ther Interven Rad Tip 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1932 CPT Anes Tx Interv Rad Th Vein 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1933 CPT Anes Tx Interv Rad Cran V 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1935 CPT Anesth Perc Img Dx Sp Proc 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1936 CPT Anesth Perc Img Tx Sp Proc 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1951 CPT Anesth Burn Less 4 Percent 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1952 CPT Anesth Burn 4-9 Percent 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1953 CPT Anesth Burn Each 9 Percent 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1958 CPT Anesth Antepartum Manipul 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1960 CPT Anesth Vaginal Delivery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1961 CPT Anesth Cs Delivery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1962 CPT Anesth Emer Hysterectomy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1963 CPT Anesth Cs Hysterectomy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1965 CPT Anesth Inc/Missed Ab Proc 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1966 CPT Anesth Induced Ab Procedure 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1967 CPT Anesth/Analg Vag Delivery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1968 CPT Anes/Analg Cs Deliver Add-on 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1969 CPT Anesth/Analg Cs Hyst Add-on 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1990 CPT Support For Organ Donor 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1991 CPT Anesth Nerve Block/Inj 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1992 CPT Anesth N Block/Inj Prone 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1996 CPT Hosp Manage Cont Drug Admin 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
1999 CPT Unlisted Anesth Procedure 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
210 CPT Anesth Cranial Surg Nos 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
211 CPT Anesth Cran Surg Hemotoma 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
212 CPT Anesth Skull Drainage 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
214 CPT Anesth Skull Drainage 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
215 CPT Anesth Skull Repair/Fract 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
216 CPT Anesth Head Vessel Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
218 CPT Anesth Special Head Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
220 CPT Anesth Intrcrn Nerve 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
222 CPT Anesth Head Nerve Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
300 CPT Anesth Head/Neck/Ptrunk 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
320 CPT Anesth Neck Organ 1 & Over 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
322 CPT Anesth Biopsy Of Thyroid 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
326 CPT Anesth Larynx/Trach < 1 Yr 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
350 CPT Anesth Neck Vessel Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
352 CPT Anesth Neck Vessel Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
400 CPT Anesth Skin Ext/per/Atrunk 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
402 CPT Anesth Surgery Of Breast 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
404 CPT Anesth Surgery Of Breast 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
406 CPT Anesth Surgery Of Breast 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
410 CPT Anesth Correct Heart Rhythm 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
450 CPT Anesth Surgery Of Shoulder 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
452 CPT Anesth Surgery Of Shoulder 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
454 CPT Anesth Collar Bone Biopsy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
470 CPT Anesth Removal Of Rib 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
472 CPT Anesth Chest Wall Repair 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
474 CPT Anesth Surgery Of Rib(S) 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
500 CPT Anesth Esophageal Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
520 CPT Anesth Chest Procedure 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
522 CPT Anesth Chest Lining Biopsy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
524 CPT Anesth Chest Drainage 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
528 CPT Anesth Chest Partition View 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
529 CPT Anesth Chest Partition View 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
530 CPT Anesth Pacemaker Insertion 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
532 CPT Anesth Vascular Access 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
534 CPT Anesth Cardioverter/Defib 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
537 CPT Anesth Cardiac Electrophys 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
539 CPT Anesth Trach-bronch Reconst 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
540 CPT Anesth Chest Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
541 CPT Anesth One Lung Ventilation 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
542 CPT Anesth Release Of Lung 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
546 CPT Anesth Lung Chest Wall Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
548 CPT Anesth Trachea Bronchi Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
550 CPT Anesth Sternal Debridement 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
560 CPT Anesth Heart Surg Without Pump 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
561 CPT Anesth Heart Surg < 1 Yr 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
562 CPT Anesth Hrt Surg W/Pmp Age 1+ 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
563 CPT Anesth Heart Surg W/Arrest 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
566 CPT Anesth Cabg Without Pump 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
567 CPT Anesth Cabg W/Pump 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
580 CPT Anesth Heart/Lung Transplnt 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
600 CPT Anesth Spine Cord Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
604 CPT Anesth Sitting Procedure 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
620 CPT Anesth Spine Cord Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
622 CPT Anesth Removal Of Nerves 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
625 CPT Anes Spine Tranthor Without Vent 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
626 CPT Anes Spine Transthor W/Vent 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
630 CPT Anesth Spine Cord Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
632 CPT Anesth Removal Of Nerves 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
634 CPT Anesth For Chemonucleolysis 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
635 CPT Anesth Lumbar Puncture 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
640 CPT Anesth Spine Manipulation 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
670 CPT Anesth Spine Cord Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
700 CPT Anesth Abdominal Wall Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
702 CPT Anesth For Liver Biopsy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
730 CPT Anesth Abdominal Wall Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
731 CPT Anes Upper Gi Endoscopic Px Nos 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
732 CPT Anes Upper Gi Endoscopic Px Ercp 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
740 CPT Anesth Upper Gi Visualize 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
750 CPT Anesth Repair Of Hernia 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
752 CPT Anesth Repair Of Hernia 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
754 CPT Anesth Repair Of Hernia 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
756 CPT Anesth Repair Of Hernia 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
770 CPT Anesth Blood Vessel Repair 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
790 CPT Anesth Surg Upper Abdomen 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
792 CPT Anesth Hemorr/Excise Liver 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
794 CPT Anesth Pancreas Removal 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
796 CPT Anesth For Liver Transplant 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
797 CPT Anesth Surgery For Obesity 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
800 CPT Anesth Abdominal Wall Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
802 CPT Anesth Fat Layer Removal 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
810 CPT Anesth Low Intestine Scope 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
811 CPT Anes Lower Intestinal Endoscopic Px Nos 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
812 CPT Anes Lower Intestinal Screening Colonoscopy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
813 CPT Anes Upper/Lower Gi Endoscopic Px 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
820 CPT Anesth Abdominal Wall Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
830 CPT Anesth Repair Of Hernia 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
832 CPT Anesth Repair Of Hernia 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
834 CPT Anesth Hernia Repair < 1 Yr 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
836 CPT Anesth Hernia Repair Preemie 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
840 CPT Anesth Surg Lower Abdomen 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
842 CPT Anesth Amniocentesis 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
844 CPT Anesth Pelvis Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
846 CPT Anesth Hysterectomy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
848 CPT Anesth Pelvic Organ Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
851 CPT Anesth Tubal Ligation 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
860 CPT Anesth Surgery Of Abdomen 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
862 CPT Anesth Kidney/Ureter Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
864 CPT Anesth Removal Of Bladder 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
865 CPT Anesth Removal Of Prostate 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
866 CPT Anesth Removal Of Adrenal 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
868 CPT Anesth Kidney Transplant 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
870 CPT Anesth Bladder Stone Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
872 CPT Anesth Kidney Stone Destruct 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
873 CPT Anesth Kidney Stone Destruct 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
880 CPT Anesth Abdomen Vessel Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
882 CPT Anesth Major Vein Ligation 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
902 CPT Anesth Anorectal Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
904 CPT Anesth Perineal Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
906 CPT Anesth Removal Of Vulva 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
908 CPT Anesth Removal Of Prostate 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
910 CPT Anesth Bladder Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
912 CPT Anesth Bladder Tumor Surg 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
914 CPT Anesth Trans Resect Of Prostate 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
916 CPT Anesth Bleeding Control 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
918 CPT Anesth Stone Removal 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
920 CPT Anesth Genitalia Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
921 CPT Anesth Vasectomy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
922 CPT Anesth Sperm Duct Surgery 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
924 CPT Anesth Testis Exploration 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
926 CPT Anesth Removal Of Testis 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
928 CPT Anesth Removal Of Testis 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
930 CPT Anesth Testis Suspension 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
932 CPT Anesth Amputation Of Penis 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
934 CPT Anesth Penis Nodes Removal 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
936 CPT Anesth Penis Nodes Removal 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
938 CPT Anesth Insert Penis Device 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
940 CPT Anesth Vaginal Procedures 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
942 CPT Anesth Surg On Vag/Urethral 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
944 CPT Anesth Vaginal Hysterectomy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
948 CPT Anesth Repair Of Cervix 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
950 CPT Anesth Vaginal Endoscopy 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
952 CPT Anesth Hysteroscope/Graph 9 6 $36.00 — $32.04 $5,740.93 $5,740.93 2024-07-01
96377 CPT Appl On-body Injector For Timed Subq Injection 16 8 $13,093.00 — $41.50 $12,831.14 $6,448.30 2024-07-01
J2323 HCPCS Natalizumab 300 Mg/15ml Concentrate 15 Ml Vial 16 8 $15,226.53 — $22.42 $14,922.00 $7,499.07 2024-07-01
J2350 HCPCS Ocrelizumab 300 Mg/10ml Solution 10 Ml Vial 16 8 $33,150.00 — $49.47 $32,487.00 $16,243.50 2024-07-01
J2506 HCPCS Pegfilgrastim 6 Mg/0.6ml Prefilled Syringe Kit 0.6 Ml Syringe 31 8 $13,092.70 — $46.46 $12,830.85 $6,415.42 2024-07-01
J2507 HCPCS Pegloticase 8 Mg/ml Solution 1 Ml Vial 16 8 $48,367.38 — $3,090.93 $47,400.03 $23,820.93 2024-07-01
J3380 HCPCS Vedolizumab 300 Mg Recon Soln 1 Each Vial 16 8 $12,439.04 — $14.66 $12,190.26 $6,095.13 2024-07-01
J9043 HCPCS Cabazitaxel 60 Mg/1.5ml Solution 6 Ml Vial 16 8 $28,293.07 — $192.96 $27,727.21 $13,934.33 2024-07-01
J9119 HCPCS Cemiplimab-rwlc 350 Mg/7ml Solution 7 Ml Vial 16 8 $19,219.32 — $23.75 $18,834.93 $9,465.51 2024-07-01
J9173 HCPCS Durvalumab 120 Mg/2.4ml Solution 2.4 Ml Vial 31 8 $21,771.90 — $62.48 $21,336.46 $7,436.99 2024-07-01
Q4180 HCPCS Revita Placental Membrane 2x3cm 6sqcm 75 7 $9,896.00 — $1,027.70 $19,396.16 $6,166.20 2024-07-01
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