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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

RIVER'S EDGE HOSPITAL & CLINIC

St Peter, MN · CCN 241334 · Rates published

11,906 distinct procedures filed
24 distinct payers
338,237 rate rows
2026-05-21 last MRF observed
Data quality

168,090 of 338,237 rate rows are consumer-grade (49.7%)

170,147 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
professional (physician) fee — not the facility price 166,609
placeholder amount (≤ $0.02) — excluded from medians 1,645
per-diem day rate — not a per-procedure price 887
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 784
exceeds 10× this hospital's gross charge — excluded from medians 168
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 30
percent-of-charges filed in the dollar field — excluded from medians 24
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/100229/416006852-1407849367_city-of-st-peter_standardcharges.csv
Found on page https://search.hospitalpriceindex.com/hpi2/machineReadable/RiversEdgeHospitalandClinic/100229
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-11
Content fingerprint d6c87d3f80743e5a… · 268,512,946 bytes · first seen 2026-08-06

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
J1414
HCPCS 		Inj, Beqvez, Per Tx Dose 1 $3,500,000.00 $3,500,000.00 $3,500,000.00 nat. median
$3,508,750
1.0× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 1 $3,500,000.00 $3,500,000.00 $3,500,000.00 nat. median
$3,685,267
0.9× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 1 $3,200,000.00 $3,200,000.00 $3,200,000.00 nat. median
$3,325,455
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 1 $3,100,000.00 $3,100,000.00 $3,100,000.00 nat. median
$3,248,446
1.0× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 1 $2,800,000.00 $2,800,000.00 $2,800,000.00 nat. median
$2,968,000
0.9× median
J3399
HCPCS 		Inj Onase Abepar-xioi Treat 1 $2,391,705.69 $2,391,705.69 $2,391,705.69 nat. median
$2,455,111
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 1 $2,200,000.00 $2,200,000.00 $2,200,000.00 nat. median
$2,332,000
0.9× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 1 $531,350.40 $531,350.40 $531,350.40 nat. median
$579,571
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 1 $528,312.43 $528,312.43 $528,312.43 nat. median
$574,037
0.9× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 1 $522,055.50 $522,055.50 $522,055.50 nat. median
$599,737
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 1 $503,580.00 $503,580.00 $503,580.00 nat. median
$562,501
0.9× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 1 $462,000.00 $462,000.00 $462,000.00 nat. median
$513,770
0.9× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 1 $62,602.52 $62,602.52 $62,602.52 nat. median
$63,499
1.0× median
90288
CPT 		Botulism Ig IV 1 $48,705.00 $73,057.50 $60,881.25 nat. median
$43,548
1.4× median
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 1 $60,000.00 $60,000.00 $60,000.00 nat. median
$66,211
0.9× median
J9226
HCPCS 		Supprelin La Implant 1 $47,524.89 $71,287.34 $59,406.11 nat. median
$57,036
1.0× median
J9266
HCPCS 		Pegaspargase Injection 1 $28,424.06 $42,636.09 $35,530.07 nat. median
$31,084
1.1× median
37277
CPT 		Rvsc Evsc Fpvt St Athr Cpx 1 1 $32,752.29 $32,752.29 $32,752.29 nat. median
$19,143
1.7× median
37294
CPT 		Rvsc Evsc Tpvt St Athr Cpx 1 1 $32,280.54 $32,280.54 $32,280.54 nat. median
$19,143
1.7× median
J9600
HCPCS 		Porfimer Sodium Injection 1 $23,789.46 $35,684.19 $29,736.83 nat. median
$26,416
1.1× median
37273
CPT 		Revsc Evsc Fpvt Athrc Cplx 1 1 $28,095.79 $28,095.79 $28,095.79 nat. median
$18,862
1.5× median
37269
CPT 		Revsc Evasc Fpvt St Cplx 1st 1 $24,538.15 $24,538.15 $24,538.15 nat. median
$12,666
1.9× median
37290
CPT 		Revsc Evsc Tpvt Athrc Cplx 1 1 $22,611.42 $22,611.42 $22,611.42 nat. median
$18,837
1.2× median
37271
CPT 		Revsc Evsc Fpvt Athrc Sf 1st 1 $22,434.07 $22,434.07 $22,434.07 nat. median
$18,795
1.2× median
37286
CPT 		Revsc Evasc Tpvt St Cplx 1st 1 $22,016.23 $22,016.23 $22,016.23 nat. median
$19,143
1.2× median
37275
CPT 		Rvsc Evsc Fpvt St Athrc Sf 1 1 $21,824.69 $21,824.69 $21,824.69 nat. median
$19,143
1.1× median
37292
CPT 		Rvsc Evsc Tpvt St Athrc Sf 1 1 $21,731.05 $21,731.05 $21,731.05 nat. median
$19,143
1.1× median
J7310
HCPCS 		Outpatient Services 1 $16,960.00 $25,440.00 $21,200.00 nat. median
$13,629
1.6× median
55882
CPT 		Ablt Trurl Prst8 Tis Trnsdcr 1 $19,310.58 $19,310.58 $19,310.58 nat. median
$13,479
1.4× median
55881
CPT 		Ablt Trurl Prst8 Tis Thrm US 1 $18,660.77 $18,660.77 $18,660.77 nat. median
$2,168
outlier · 8.6×
37231
CPT 		Professional Services 2 $12,867.00 $23,238.53 $18,052.76 nat. median
$19,288
0.9× median
37260
CPT 		Revsc Evasc Ivt St Cplx 1st 1 $17,912.35 $17,912.35 $17,912.35 nat. median
$12,440
1.4× median
37227
CPT 		Professional Services 2 $12,867.00 $22,130.44 $17,498.72 nat. median
$19,510
0.9× median
37288
CPT 		Revsc Evsc Tpvt Athrc Sf 1st 1 $16,557.40 $16,557.40 $16,557.40 nat. median
$19,143
0.9× median
27278
CPT 		Arthrd Si Jt Plmt Iartic Dev 2 $4,926.00 $25,890.26 $15,408.13 nat. median
$17,914
0.9× median
0414T
CPT 		Rmvl & Rpl Car Modulj Pls Gn 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$24,700
0.6× median
0614T
CPT 		Rmvl&rplcmt Ss Impl Dfb Pg 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$24,111
0.6× median
0515T
CPT 		Insj Wcs Lv Compl Sys 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$22,512
0.7× median
0571T
CPT 		Insj/rplcmt Icds Ss Eltrd 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$32,945
outlier · 0.5×
0100T
CPT 		Prosth Retina Receive&gen 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$11,456
1.3× median
0520T
CPT 		Rmv&rplcmt Pg Wcs Lv Battery 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$11,241
1.4× median
0409T
CPT 		Insj/rplc Car Modulj Pls Gn 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$24,700
0.6× median
C9760
HCPCS 		Non-blind Interatrial Shunt 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$28,845
0.5× median
0408T
CPT 		Insj/rplc Cardiac Modulj Sys 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$31,369
outlier · 0.5×
37265
CPT 		Revsc Evsc Fpvt Angio Cplx 1 1 $14,502.26 $14,502.26 $14,502.26 nat. median
$6,982
outlier · 2.1×
37282
CPT 		Rvsc Evsc Tpvt Angio Cplx 1 1 $12,952.23 $12,952.23 $12,952.23 nat. median
$12,568
1.0× median
0308T
CPT 		Insj Ocular Telescope Prosth 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$16,465
0.8× median
C9758
HCPCS 		Blind Interatrial Shunt Ide 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$18,540
0.7× median
0266T
CPT 		Outpatient Surgical Services 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$41,318
outlier · 0.3×
C9782
HCPCS 		Blind Myocar Trpl Bon Marrow 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$18,540
0.7× median

Other procedures at this hospital

Browse this hospital's 11,906 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
             
0100T CPT Prosth Retina Receive&gen 1 1 — — $15,319.00 $15,319.00 $15,319.00 2026-05-21
0234T CPT Trluml Perip Athrc Renal Art 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0236T CPT Trluml Perip Athrc Abd Aorta 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0237T CPT Trluml Perip Athrc Brchiocph 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0238T CPT Trluml Perip Athrc Iliac Art 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0266T CPT Outpatient Surgical Services 1 1 — — $12,867.00 $12,867.00 $12,867.00 2026-05-21
0268T CPT Outpatient Surgical Services 1 1 — — $12,867.00 $12,867.00 $12,867.00 2026-05-21
0308T CPT Insj Ocular Telescope Prosth 1 1 — — $12,867.00 $12,867.00 $12,867.00 2026-05-21
0398T CPT Professional Services 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0408T CPT Insj/rplc Cardiac Modulj Sys 1 1 — — $15,319.00 $15,319.00 $15,319.00 2026-05-21
0409T CPT Insj/rplc Car Modulj Pls Gn 1 1 — — $15,319.00 $15,319.00 $15,319.00 2026-05-21
0410T CPT Insj/rplc Car Modulj Atr Elt 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0411T CPT Insj/rplc Car Modulj Vnt Elt 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0414T CPT Rmvl & Rpl Car Modulj Pls Gn 1 1 — — $15,319.00 $15,319.00 $15,319.00 2026-05-21
0505T CPT Ev Fempop Artl Revsc 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0515T CPT Insj Wcs Lv Compl Sys 1 1 — — $15,319.00 $15,319.00 $15,319.00 2026-05-21
0516T CPT Insj Wcs Lv Eltrd Only 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0517T CPT Insj Wcs Lv Both Compnt Pg 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0520T CPT Rmv&rplcmt Pg Wcs Lv Battery 1 1 — — $15,319.00 $15,319.00 $15,319.00 2026-05-21
0525T CPT Insj/rplcmt Compl Iims 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0526T CPT Insj/rplcmt Iims Eltrd Only 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0527T CPT Insj/rplcmt Iims Implt Mntr 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0571T CPT Insj/rplcmt Icds Ss Eltrd 1 1 — — $15,319.00 $15,319.00 $15,319.00 2026-05-21
0572T CPT Insertion Ss Dfb Electrode 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0614T CPT Rmvl&rplcmt Ss Impl Dfb Pg 1 1 — — $15,319.00 $15,319.00 $15,319.00 2026-05-21
0620T CPT Evasc Ven Artlz Tibl/prnl Vn 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0632T CPT Perq Tcat US Abltj Nrv P-art 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0645T CPT Tcat Impltj C Sins Rdctj Dev 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0784T CPT Ins/rplmt Eltrd Ra Spi Nstim 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0786T CPT Insj/rplcmt Prq Ra Sac Nstim 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0793T CPT Prq Tcat Thrm Ablt Nrv P-art 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0795T CPT Tcat Ins 2chmbr Ldls Pm Cmpl 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0796T CPT Tcat Ins 2chmbr Ldls Pm Ra 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0797T CPT Tcat Ins 2chmbr Ldls Pm Rv 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0801T CPT Tcat Rmv&rpl 2chmbr Ldls Pm 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0802T CPT Tcat Rmv&rpl2chmb Ldls Pm Ra 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0803T CPT Tcat Rmv&rpl2chmb Ldls Pm Rv 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0816T CPT Opn Insj/rplcmt Ins Ptn Subq 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0817T CPT Opn Insj/rplcmt Ins Ptn Subf 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0823T CPT Tcat Ins 1chmbr Ldls Pm Ra 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
0825T CPT Tcat Rmv&rpl1chmb Ldls Pm Ra 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
19296 CPT Place Po Breast Cath For Rad 2 2 — — $2,794.00 $7,340.16 $5,067.08 2026-05-21
20802 CPT Pr Replantation Arm Complete Amputation 17 16 $13,077.75 $10,462.20 $2,880.96 $12,031.53 $4,926.00 2026-05-21
20805 CPT Pr Replantation Forearm Complete Amputation 17 16 $15,790.50 $12,632.40 20% off $3,413.92 $14,527.26 $4,926.00 2026-05-21
20808 CPT Pr Replantation Hand Complete Amputation 17 16 $19,358.75 $15,487.00 20% off $4,108.67 $17,810.05 $4,926.00 2026-05-21
20838 CPT Pr Replantation Foot Complete Amputation 17 16 $13,157.50 $10,526.00 20% off $2,926.28 $12,104.90 $4,926.00 2026-05-21
21127 CPT Augmentation Mndblr B1 Grf 2 2 — — $2,206.00 $8,321.26 $5,263.63 2026-05-21
21160 CPT Rcnst Mdfc Lfrtiii Advm W/i 2 2 — — $2,206.00 $5,963.93 $4,084.97 2026-05-21
21215 CPT Lower Jaw Bone Graft 2 2 — — $2,206.00 $8,497.90 $5,351.95 2026-05-21
22548 CPT Pr Arthrd Ant Transorl/xtroral C1-c2 W/wo Exc Odntd 17 16 $8,303.50 $6,642.80 20% off $1,972.31 $7,639.22 $4,104.06 2026-05-21
22586 CPT Pr Arthrodesis Presacral Intrbdy W/instrument L5-s1 17 16 $8,629.00 $6,903.20 20% off $2,038.16 $7,938.68 $4,264.92 2026-05-21
22802 CPT Pr Arthrodesis Posterior Spinal Dfrm 7-12 Vrt Seg 17 16 $9,853.25 $7,882.60 $2,179.20 $9,064.99 $4,532.36 2026-05-21
22804 CPT Pr Arthrodesis Posterior Spinal Dfrm 13/> Vrt Seg 17 16 $11,507.50 $9,206.00 20% off $2,498.77 $10,586.90 $4,926.00 2026-05-21
22810 CPT Pr Arthrodesis Anterior Spinal Dfrm 4-7 Vrt Seg 17 16 $9,666.25 $7,733.00 20% off $2,109.42 $8,892.95 $4,304.64 2026-05-21
22812 CPT Pr Arthrodesis Anterior Spinal Dfrm 8/> Vrt Seg 17 16 $10,509.50 $8,407.60 $2,313.58 $9,668.74 $4,717.51 2026-05-21
22818 CPT Pr Kyphectomy Single Or Two Segments 17 16 $10,534.75 $8,427.80 20% off $2,251.44 $9,691.97 $4,602.59 2026-05-21
22819 CPT Pr Kyphectomy 3 Or More Segments 17 16 $12,084.00 $9,667.20 $2,592.57 $11,117.28 $4,926.00 2026-05-21
22861 CPT Pr Revj Rplcmt Disc Arthroplasty Ant 1 Ntrspc Crv 17 16 $10,236.50 $8,189.20 20% off $2,301.20 $9,417.58 $4,926.00 2026-05-21
22862 CPT Pr Revj Rplcmt Disc Arthroplasty Ant 1 Ntrspc Lmbr 17 16 $10,012.75 $8,010.20 20% off $2,311.96 $9,211.73 $4,926.00 2026-05-21
27218 CPT Pr Optx Post Pel Bone Fx&/dislc Int Fixj If Pfrmd 17 16 $6,421.75 $5,137.40 20% off $711.00 $5,908.01 $4,540.99 2026-05-21
27278 CPT Arthrd Si Jt Plmt Iartic Dev 2 2 — — $4,926.00 $25,890.26 $15,408.13 2026-05-21
32445 CPT Removal Of Lung Extrapleural 2 2 — — $711.00 $7,396.91 $4,053.95 2026-05-21
32652 CPT Thoracoscopy Rem Totl Cortex 2 2 — — $3,497.34 $4,926.00 $4,211.67 2026-05-21
32852 CPT Lung Transplant With Bypass 2 2 — — $711.00 $7,391.95 $4,051.47 2026-05-21
32853 CPT Lung Transplant Double 2 2 — — $711.00 $9,605.99 $5,158.49 2026-05-21
32854 CPT Lung Transplant With Bypass 2 2 — — $711.00 $10,152.93 $5,431.97 2026-05-21
32994 CPT Ablate Pulm Tumor Perq Crybl 2 2 — — $2,794.00 $9,772.69 $6,283.35 2026-05-21
32998 CPT Ablate Pulm Tumor Perq Rf 2 2 — — $2,794.00 $6,249.10 $4,521.55 2026-05-21
33208 CPT Insrt Heart Pm Atrial & Vent 2 2 — — $1,085.38 $7,671.00 $4,378.19 2026-05-21
33214 CPT Upgrade Of Pacemaker System 2 2 — — $1,006.64 $7,671.00 $4,338.82 2026-05-21
33224 CPT Insert Pacing Lead & Connect 2 2 — — $1,066.94 $7,671.00 $4,368.97 2026-05-21
33225 CPT L Ventric Pacing Lead Add-on 2 2 — — $961.95 $7,671.00 $4,316.48 2026-05-21
33230 CPT Insrt Pulse Gen W/dual Leads 2 2 — — $785.31 $15,319.00 $8,052.16 2026-05-21
33231 CPT Insrt Pulse Gen W/mult Leads 2 2 — — $841.35 $15,319.00 $8,080.18 2026-05-21
33240 CPT Insrt Pulse Gen W/singl Lead 2 2 — — $756.22 $15,319.00 $8,037.61 2026-05-21
33249 CPT Insj/rplcmt Defib W/lead(s) 2 2 — — $1,909.70 $15,319.00 $8,614.35 2026-05-21
33262 CPT Rmvl& Replc Pulse Gen 1 Lead 2 2 — — $781.76 $15,319.00 $8,050.38 2026-05-21
33263 CPT Rmvl & Rplcmt Dfb Gen 2 Lead 2 2 — — $812.97 $15,319.00 $8,065.99 2026-05-21
33264 CPT Rmvl & Rplcmt Dfb Gen Mlt Ld 2 2 — — $847.02 $15,319.00 $8,083.01 2026-05-21
33270 CPT Ins/rep Subq Defibrillator 2 2 — — $1,174.77 $15,319.00 $8,246.89 2026-05-21
33274 CPT Tcat Insj/rpl Perm Ldls Pm 2 2 — — $1,000.96 $12,867.00 $6,933.98 2026-05-21
33276 CPT Insj Phrnc Nrv Stim Sys 2 2 — — $1,217.33 $15,319.00 $8,268.17 2026-05-21
33285 CPT Insj Subq Car Rhythm Mntr 2 2 — — $4,926.00 $8,343.25 $6,634.62 2026-05-21
33287 CPT Rmv&rplcmt Phrnc Nrv Stim Pg 2 2 — — $819.36 $12,867.00 $6,843.18 2026-05-21
33289 CPT Tcat Impl Wrls P-art Prs Snr 2 2 — — $697.34 $15,319.00 $8,008.17 2026-05-21
33305 CPT Repair Of Heart Wound 2 2 — — $711.00 $8,529.12 $4,620.06 2026-05-21
33820 CPT Repair Pda By Ligation 2 2 — — $2,042.36 $7,671.00 $4,856.68 2026-05-21
33824 CPT Repair Pda Div 18 Yrs&older 2 2 — — $2,494.96 $7,671.00 $5,082.98 2026-05-21
33877 CPT Thoracoabdominal Graft 2 2 — — $711.00 $7,510.42 $4,110.71 2026-05-21
33916 CPT Surgery Of Great Vessel 2 2 — — $711.00 $8,710.01 $4,710.51 2026-05-21
33935 CPT Transplantation Heart/lung 2 2 — — $711.00 $10,264.31 $5,487.65 2026-05-21
33945 CPT Transplantation Of Heart 2 2 — — $711.00 $10,159.32 $5,435.16 2026-05-21
33967 CPT Insert I-aort Percut Device 2 2 — — $538.43 $12,867.00 $6,702.72 2026-05-21
33968 CPT Remove Aortic Assist Device 2 2 — — $70.94 $12,867.00 $6,468.97 2026-05-21
36566 CPT Insert Tunneled Cv Cath 2 2 — — $2,794.00 $8,234.72 $5,514.36 2026-05-21
36836 CPT Prq Av Fstl Crtj Uxtr 1 Acs 2 2 — — $4,926.00 $16,189.22 $10,557.61 2026-05-21
36837 CPT Prq Av Fstl Crt Uxtr Sep Acs 2 2 — — $4,926.00 $19,226.16 $12,076.08 2026-05-21
36903 CPT Intro Cath Dialysis Circuit 2 2 — — $4,926.00 $8,431.93 $6,678.97 2026-05-21
36905 CPT Thrmbc/nfs Dialysis Circuit 2 2 — — $4,577.76 $4,926.00 $4,751.88 2026-05-21
36906 CPT Thrmbc/nfs Dialysis Circuit 2 2 — — $10,756.63 $12,867.00 $11,811.81 2026-05-21
37183 CPT Revision Tips 2 2 — — $4,926.00 $11,612.88 $8,269.44 2026-05-21
37221 CPT Professional Services 2 2 — — $4,926.00 $6,142.69 $5,534.34 2026-05-21
37224 CPT Professional Services 2 2 — — $2,794.00 $5,818.50 $4,306.25 2026-05-21
37225 CPT Professional Services 2 2 — — $4,926.00 $17,327.80 $11,126.90 2026-05-21
37226 CPT Professional Services 2 2 — — $4,926.00 $16,036.70 $10,481.35 2026-05-21
37227 CPT Professional Services 2 2 — — $12,867.00 $22,130.44 $17,498.72 2026-05-21
37228 CPT Professional Services 2 2 — — $2,794.00 $8,229.04 $5,511.52 2026-05-21
37229 CPT Professional Services 2 2 — — $4,926.00 $17,699.53 $11,312.76 2026-05-21
37230 CPT Professional Services 2 2 — — $4,926.00 $17,711.59 $11,318.80 2026-05-21
37231 CPT Professional Services 2 2 — — $12,867.00 $23,238.53 $18,052.76 2026-05-21
37234 CPT Professional Services 2 2 — — $2,794.00 $7,201.12 $4,997.56 2026-05-21
37235 CPT Professional Services 2 2 — — $2,794.00 $7,980.04 $5,387.02 2026-05-21
37236 CPT Open/perq Place Stent 1st 2 2 — — $4,926.00 $5,495.01 $5,210.51 2026-05-21
37238 CPT Open/perq Place Stent Same 2 2 — — $4,926.00 $6,879.76 $5,902.88 2026-05-21
37241 CPT Vasc Embolize/occlude Venous 2 2 — — $4,926.00 $9,206.59 $7,066.30 2026-05-21
37242 CPT Vasc Embolize/occlude Artery 2 2 — — $4,926.00 $14,181.62 $9,553.81 2026-05-21
37243 CPT Vasc Embolize/occlude Organ 2 2 — — $4,926.00 $17,196.57 $11,061.28 2026-05-21
37244 CPT Vasc Embolize/occlude Bleed 2 2 — — $4,926.00 $13,143.05 $9,034.52 2026-05-21
37254 CPT Revsc Evasc Ivt Angio Sf 1st 1 1 — — $4,401.83 $4,401.83 $4,401.83 2026-05-21
37256 CPT Revsc Evasc Ivt Angio Cplx 1 1 1 — — $5,161.59 $5,161.59 $5,161.59 2026-05-21
37258 CPT Revsc Evasc Ivt Stent Sf 1st 1 1 — — $7,565.75 $7,565.75 $7,565.75 2026-05-21
37260 CPT Revsc Evasc Ivt St Cplx 1st 1 1 — — $17,912.35 $17,912.35 $17,912.35 2026-05-21
37261 CPT Revsc Evasc Ivt St Cplx Ea 1 1 — — $7,139.40 $7,139.40 $7,139.40 2026-05-21
37262 CPT IV Lithotrp Ivt W/in Sm Art 1 1 — — $7,240.85 $7,240.85 $7,240.85 2026-05-21
37263 CPT Revsc Evasc Fpvt Angio Sf 1 1 1 — — $11,532.01 $11,532.01 $11,532.01 2026-05-21
37264 CPT Revsc Evasc Fpvt Angio Sf Ea 1 1 — — $4,637.35 $4,637.35 $4,637.35 2026-05-21
37265 CPT Revsc Evsc Fpvt Angio Cplx 1 1 1 — — $14,502.26 $14,502.26 $14,502.26 2026-05-21
37266 CPT Rvsc Evsc Fpvt Angio Cplx Ea 1 1 — — $5,184.30 $5,184.30 $5,184.30 2026-05-21
37267 CPT Revsc Evsc Fpvt Stent Sf 1st 1 1 — — $11,062.38 $11,062.38 $11,062.38 2026-05-21
37268 CPT Revsc Evasc Fpvt Stent Sf Ea 1 1 — — $7,136.56 $7,136.56 $7,136.56 2026-05-21
37269 CPT Revsc Evasc Fpvt St Cplx 1st 1 1 — — $24,538.15 $24,538.15 $24,538.15 2026-05-21
37270 CPT Revsc Evasc Fpvt St Cplx Ea 1 1 — — $7,424.58 $7,424.58 $7,424.58 2026-05-21
37271 CPT Revsc Evsc Fpvt Athrc Sf 1st 1 1 — — $22,434.07 $22,434.07 $22,434.07 2026-05-21
37272 CPT Revsc Evsc Fpvt Athrc Sf Ea 1 1 — — $4,963.67 $4,963.67 $4,963.67 2026-05-21
37273 CPT Revsc Evsc Fpvt Athrc Cplx 1 1 1 — — $28,095.79 $28,095.79 $28,095.79 2026-05-21
37274 CPT Rvsc Evsc Fpvt Athrc Cplx Ea 1 1 — — $5,281.48 $5,281.48 $5,281.48 2026-05-21
37275 CPT Rvsc Evsc Fpvt St Athrc Sf 1 1 1 — — $21,824.69 $21,824.69 $21,824.69 2026-05-21
37276 CPT Rvsc Evsc Fpvt St Athr Sf Ea 1 1 — — $7,345.84 $7,345.84 $7,345.84 2026-05-21
37277 CPT Rvsc Evsc Fpvt St Athr Cpx 1 1 1 — — $32,752.29 $32,752.29 $32,752.29 2026-05-21
37278 CPT Rvsc Evsc Fpvt St Ath Cpx Ea 1 1 — — $8,228.33 $8,228.33 $8,228.33 2026-05-21
37279 CPT IV Lithotrp Fpvt W/in Sm Art 1 1 — — $9,846.47 $9,846.47 $9,846.47 2026-05-21
37280 CPT Revsc Evsc Tpvt Angio Sf 1st 1 1 — — $5,728.41 $5,728.41 $5,728.41 2026-05-21
37282 CPT Rvsc Evsc Tpvt Angio Cplx 1 1 1 — — $12,952.23 $12,952.23 $12,952.23 2026-05-21
37284 CPT Revsc Evasc Tpvt St Sf 1st 1 1 — — $11,959.77 $11,959.77 $11,959.77 2026-05-21
37285 CPT Revsc Evasc Tpvt St Sf Ea 1 1 — — $5,921.36 $5,921.36 $5,921.36 2026-05-21
37286 CPT Revsc Evasc Tpvt St Cplx 1st 1 1 — — $22,016.23 $22,016.23 $22,016.23 2026-05-21
37287 CPT Revsc Evasc Tpvt St Cplx Ea 1 1 — — $10,492.74 $10,492.74 $10,492.74 2026-05-21
37288 CPT Revsc Evsc Tpvt Athrc Sf 1st 1 1 — — $16,557.40 $16,557.40 $16,557.40 2026-05-21
37290 CPT Revsc Evsc Tpvt Athrc Cplx 1 1 1 — — $22,611.42 $22,611.42 $22,611.42 2026-05-21
37292 CPT Rvsc Evsc Tpvt St Athrc Sf 1 1 1 — — $21,731.05 $21,731.05 $21,731.05 2026-05-21
37293 CPT Rvsc Evsc Tpvt St Athr Sf Ea 1 1 — — $7,452.96 $7,452.96 $7,452.96 2026-05-21
37294 CPT Rvsc Evsc Tpvt St Athr Cpx 1 1 1 — — $32,280.54 $32,280.54 $32,280.54 2026-05-21
37295 CPT Rvsc Evsc Tpvt St Ath Cpx Ea 1 1 — — $12,747.21 $12,747.21 $12,747.21 2026-05-21
37296 CPT Revsc Evasc Imvt Angio Sf 1 1 1 — — $6,442.06 $6,442.06 $6,442.06 2026-05-21
37298 CPT Revsc Evsc Imvt Angio Cplx 1 1 1 — — $7,243.68 $7,243.68 $7,243.68 2026-05-21
39503 CPT Repair Of Diaphragm Hernia 2 2 — — $711.00 $12,150.60 $6,430.80 2026-05-21
43108 CPT Removal Of Esophagus 2 2 — — $711.00 $9,292.43 $5,001.72 2026-05-21
43113 CPT Removal Of Esophagus 2 2 — — $711.00 $9,098.06 $4,904.53 2026-05-21
43116 CPT Partial Removal Of Esophagus 2 2 — — $711.00 $10,385.62 $5,548.31 2026-05-21
43118 CPT Partial Removal Of Esophagus 2 2 — — $711.00 $7,584.90 $4,147.95 2026-05-21
43123 CPT Partial Removal Of Esophagus 2 2 — — $711.00 $9,429.34 $5,070.17 2026-05-21
43124 CPT Removal Of Esophagus 2 2 — — $711.00 $7,985.72 $4,348.36 2026-05-21
43287 CPT Esphg Dstl 2/3 W/laps Moblj 2 2 — — $711.00 $7,469.27 $4,090.14 2026-05-21
43288 CPT Esphg Thrsc Moblj 2 2 — — $711.00 $7,885.69 $4,298.34 2026-05-21
43647 CPT Lap Impl Electrode Antrum 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
46744 CPT Repair Of Cloacal Anomaly 2 2 — — $711.00 $7,554.40 $4,132.70 2026-05-21
46746 CPT Repair Of Cloacal Anomaly 2 2 — — $711.00 $8,314.88 $4,512.94 2026-05-21
46748 CPT Repair Of Cloacal Anomaly 2 2 — — $711.00 $9,005.83 $4,858.41 2026-05-21
47135 CPT Transplantation Of Liver 2 2 — — $711.00 $11,535.55 $6,123.27 2026-05-21
47140 CPT Partial Removal Donor Liver 2 2 — — $711.00 $7,642.37 $4,176.68 2026-05-21
47141 CPT Partial Removal Donor Liver 2 2 — — $711.00 $9,124.30 $4,917.65 2026-05-21
47142 CPT Partial Removal Donor Liver 2 2 — — $711.00 $10,043.69 $5,377.35 2026-05-21
47382 CPT Percut Ablate Liver Rf 2 2 — — $2,794.00 $7,390.53 $5,092.26 2026-05-21
47383 CPT Perq Abltj Lvr Cryoablation 2 2 — — $2,794.00 $11,993.83 $7,393.91 2026-05-21
47538 CPT Perq Plmt Bile Duct Stent 2 2 — — $2,794.00 $7,513.26 $5,153.63 2026-05-21
47539 CPT Perq Plmt Bile Duct Stent 2 2 — — $2,794.00 $8,391.49 $5,592.74 2026-05-21
47540 CPT Perq Plmt Bile Duct Stent 2 2 — — $2,794.00 $8,488.68 $5,641.34 2026-05-21
48150 CPT Partial Removal Of Pancreas 1 1 — — $6,637.86 $6,637.86 $6,637.86 2026-05-21
49188 CPT Opn Exc/dst Ntra-abd 10.1-20 1 1 — — $4,279.10 $4,279.10 $4,279.10 2026-05-21
49189 CPT Opn Exc/dst Ntra-abd 20.1-30 1 1 — — $4,977.86 $4,977.86 $4,977.86 2026-05-21
49190 CPT Opn Exc/dstr Ntra-abd >30 Cm 1 1 — — $6,136.31 $6,136.31 $6,136.31 2026-05-21
49605 CPT Repair Umbilical Lesion 2 2 — — $711.00 $10,450.88 $5,580.94 2026-05-21
50592 CPT Perc Rf Ablate Renal Tumor 2 2 — — $2,794.00 $5,635.47 $4,214.74 2026-05-21
50593 CPT Perc Cryo Ablate Renal Tum 2 2 — — $2,794.00 $7,562.91 $5,178.45 2026-05-21
52443 CPT Cysto 1st Trurl Prst8 Comis 1 1 — — $12,540.06 $12,540.06 $12,540.06 2026-05-21
53445 CPT Insert Uro/ves Nck Sphincter 2 2 — — $1,618.14 $7,671.00 $4,644.57 2026-05-21
53447 CPT Remove/replace Ur Sphincter 2 2 — — $1,718.88 $7,671.00 $4,694.94 2026-05-21
53451 CPT Tprnl Balo Cntnc Dev Bi 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
53865 CPT Cysto Insj Dev Ischmc Rmdlg 1 1 — — $6,241.30 $6,241.30 $6,241.30 2026-05-21
54401 CPT Insert Self-contd Prosthesis 2 2 — — $1,430.15 $7,671.00 $4,550.58 2026-05-21
54405 CPT Insert Multi-comp Penis Pros 2 2 — — $1,723.84 $7,671.00 $4,697.42 2026-05-21
54410 CPT Remove/replace Penis Prosth 2 2 — — $1,843.02 $7,671.00 $4,757.01 2026-05-21
54416 CPT Remv/repl Penis Contain Pros 2 2 — — $1,534.43 $7,671.00 $4,602.72 2026-05-21
55873 CPT Cryoablate Prostate 2 2 — — $4,926.00 $11,565.35 $8,245.67 2026-05-21
55874 CPT Tprnl Plmt Biodegrdabl Matrl 2 2 — — $2,794.00 $5,802.18 $4,298.09 2026-05-21
55881 CPT Ablt Trurl Prst8 Tis Thrm US 1 1 — — $18,660.77 $18,660.77 $18,660.77 2026-05-21
55882 CPT Ablt Trurl Prst8 Tis Trnsdcr 1 1 — — $19,310.58 $19,310.58 $19,310.58 2026-05-21
56637 CPT Vlvctmy Rad Comp Bi Lymphad 2 2 — — $3,258.98 $4,926.00 $4,092.49 2026-05-21
60660 CPT Abltj 1/+thyr Ndul 1lobe Prq 1 1 — — $5,243.88 $5,243.88 $5,243.88 2026-05-21
61520 CPT Removal Of Brain Lesion 2 2 — — $711.00 $8,028.28 $4,369.64 2026-05-21
61576 CPT Skull Base/brainstem Surgery 2 2 — — $711.00 $9,030.66 $4,870.83 2026-05-21
61682 CPT Intracranial Vessel Surgery 2 2 — — $711.00 $8,918.58 $4,814.79 2026-05-21
61686 CPT Intracranial Vessel Surgery 2 2 — — $711.00 $9,676.22 $5,193.61 2026-05-21
61692 CPT Intracranial Vessel Surgery 2 2 — — $711.00 $7,869.37 $4,290.18 2026-05-21
61697 CPT Brain Aneurysm Repr Complx 1 1 — — $9,092.38 $9,092.38 $9,092.38 2026-05-21
61698 CPT Brain Aneurysm Repr Complx 2 2 — — $711.00 $9,962.10 $5,336.55 2026-05-21
61702 CPT Inner Skull Vessel Surgery 1 1 — — $8,668.87 $8,668.87 $8,668.87 2026-05-21
61885 CPT Insrt/redo Neurostim 1 Array 2 2 — — $1,157.03 $12,867.00 $7,012.01 2026-05-21
61886 CPT Implant Neurostim Arrays 2 2 — — $1,929.57 $15,319.00 $8,624.28 2026-05-21
62361 CPT Implant Spine Infusion Pump 2 2 — — $954.85 $12,867.00 $6,910.93 2026-05-21
62362 CPT Implant Spine Infusion Pump 2 2 — — $832.84 $12,867.00 $6,849.92 2026-05-21
63252 CPT Pr Lam Exc/occlusion Avm Spi Cord Thoracolumbar 17 16 $13,694.75 $10,955.80 20% off $2,989.31 $12,599.17 $4,926.00 2026-05-21
63272 CPT Pr Lam Exc Ispi Les Oth/thn Neo Idrl Lumbar 17 16 $8,438.75 $6,751.00 20% off $1,894.65 $7,763.65 $4,088.27 2026-05-21
63282 CPT Pr Lam Bx/exc Ispi Neo Idrl Xmed Lumbar 17 16 $8,637.75 $6,910.20 20% off $1,982.65 $7,946.73 $4,269.25 2026-05-21
63287 CPT Pr Lam Bx/exc Ispi Neo Idrl Imed Thoracolmbr 17 16 $12,298.25 $9,838.60 20% off $2,713.24 $11,314.39 $4,926.00 2026-05-21
63290 CPT Pr Lam Bx/exc Ispi Neo Xdrl-idrl Les Any Lvl 17 16 $12,525.50 $10,020.40 20% off $2,758.23 $11,523.46 $4,926.00 2026-05-21
63685 CPT Ins/rplc Spi Npg/rcvr Pocket 2 2 — — $729.26 $12,867.00 $6,798.13 2026-05-21
64568 CPT Opn Impltj Crnl Nrv Nea&pg 2 2 — — $1,301.75 $15,319.00 $8,310.38 2026-05-21
64582 CPT Opn Mpltj Hpglsl Nstm Ary Pg 2 2 — — $1,789.11 $12,867.00 $7,328.05 2026-05-21
64596 CPT Ins/rplcmt Prq Eltrd Ra Pn 1 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
69930 CPT Implant Cochlear Device 2 2 — — $2,580.80 $15,319.00 $8,949.90 2026-05-21
70546 CPT Rad MRI Angio Head Brain Wwo 41 12 $6,707.75 $5,366.20 20% off $687.84 $6,506.52 $4,151.43 2026-05-21
78815 CPT PET Image W/ct Skull-thigh 1 1 — — $5,385.57 $5,385.57 $5,385.57 2026-05-21
78816 CPT PET Image W/ct Full Body 1 1 — — $5,341.72 $5,341.72 $5,341.72 2026-05-21
90288 CPT Botulism Ig IV 2 1 — — $48,705.00 $73,057.50 $60,881.25 2026-05-21
92925 CPT Outpatient Surgical Services 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
93580 CPT Transcath Closure Of Asd 2 2 — — $1,742.69 $7,671.00 $4,706.84 2026-05-21
93581 CPT Transcath Closure Of Vsd 2 2 — — $2,367.74 $7,671.00 $5,019.37 2026-05-21
93582 CPT Perq Transcath Closure Pda 2 2 — — $1,181.73 $7,671.00 $4,426.36 2026-05-21
93590 CPT Perq Transcath Cls Mitral 2 2 — — $1,912.99 $12,867.00 $7,389.99 2026-05-21
93591 CPT Perq Transcath Cls Aortic 2 2 — — $1,585.82 $12,867.00 $7,226.41 2026-05-21
93653 CPT Compre Ep Eval Tx Svt 2 2 — — $1,493.04 $7,671.00 $4,582.02 2026-05-21
93654 CPT Compre Ep Eval Tx Vt 2 2 — — $1,799.46 $7,671.00 $4,735.23 2026-05-21
93656 CPT Compre Ep Eval Abltj Atr Fib 2 2 — — $1,692.03 $7,671.00 $4,681.52 2026-05-21
A9591 HCPCS Fluoroestradiol F 18 2 1 — — $4,707.30 $7,060.95 $5,884.12 2026-05-21
A9593 HCPCS Gallium Ga-68 Psma-11 Ucsf 2 1 — — $5,495.88 $8,243.82 $6,869.85 2026-05-21
A9594 HCPCS Gallium Ga-68 Psma-11, Ucla 2 1 — — $5,495.88 $8,243.82 $6,869.85 2026-05-21
A9601 HCPCS Flortaucipir Inj 1 Millicuri 2 1 — — $3,570.00 $5,355.00 $4,462.50 2026-05-21
A9608 HCPCS Flotufolastat F18 Diag 1 Mci 2 1 — — $5,016.62 $7,524.93 $6,270.77 2026-05-21
C9600 HCPCS Perc Drug-el Cor Stent Sing 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
C9602 HCPCS Perc D-e Cor Stent Ather S 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
C9604 HCPCS Perc D-e Cor Revasc T Cabg S 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
C9607 HCPCS Perc D-e Cor Revasc Chro Sin 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
C9758 HCPCS Blind Interatrial Shunt Ide 1 1 — — $12,867.00 $12,867.00 $12,867.00 2026-05-21
C9760 HCPCS Non-blind Interatrial Shunt 1 1 — — $15,319.00 $15,319.00 $15,319.00 2026-05-21
C9765 HCPCS Revasc Intra Lithotrip-stent 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
C9766 HCPCS Revasc Intra Lithotrip-ather 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
C9767 HCPCS Revasc Lithotrip-stent-ather 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
C9772 HCPCS Revasc Lithotrip Tibi/perone 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
C9773 HCPCS Revasc Lithotr-stent Tib/per 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
C9774 HCPCS Revasc Lithotr-ather Tib/per 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
C9775 HCPCS Revasc Lith-sten-ath Tib/per 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
C9780 HCPCS Insert Cv Cath Inf & Sup App 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
C9782 HCPCS Blind Myocar Trpl Bon Marrow 1 1 — — $12,867.00 $12,867.00 $12,867.00 2026-05-21
C9783 HCPCS Blind Cor Sinus Reducer Impl 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
C9792 HCPCS Blind/nonblind Trans Atrial 1 1 — — $4,926.00 $4,926.00 $4,926.00 2026-05-21
J0225 HCPCS Inj, Vutrisiran, 1 Mg 2 1 — — $4,774.04 $4,774.04 $4,774.04 2026-05-21
J0480 HCPCS Basiliximab 2 1 — — $4,657.58 $6,986.37 $5,821.98 2026-05-21
J0600 HCPCS Edetate Calcium Disodium Inj 2 1 — — $6,084.10 $9,126.15 $7,605.12 2026-05-21
J0716 HCPCS Centruroides Immune F(ab) 2 1 — — $5,351.02 $8,026.53 $6,688.77 2026-05-21
J0801 HCPCS Inj. Acthar Gel To 40 Units 2 1 — — $3,827.83 $5,741.75 $4,784.79 2026-05-21
J0802 HCPCS Inj. (ani), Up To 40 Units 2 1 — — $3,468.85 $5,203.28 $4,336.06 2026-05-21
J1162 HCPCS Digoxin Immune Fab (ovine) 2 1 — — $5,069.98 $7,604.97 $6,337.48 2026-05-21
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 2 1 — — $3,500,000.00 $3,500,000.00 $3,500,000.00 2026-05-21
J1412 HCPCS Inj Roctavian Ml 2x10^13vc G 2 1 — — $11,668.13 $11,668.13 $11,668.13 2026-05-21
J1413 HCPCS Inj Delandistrogene Mox Rokl 2 1 — — $3,200,000.00 $3,200,000.00 $3,200,000.00 2026-05-21
J1414 HCPCS Inj, Beqvez, Per Tx Dose 2 1 — — $3,500,000.00 $3,500,000.00 $3,500,000.00 2026-05-21
J2323 HCPCS Natalizumab 300 Mg/15 Ml Soln 15 Ml Vial 40 12 $10,132.60 $8,106.08 20% off $23.88 $9,828.62 $6,428.63 2026-05-21
J2327 HCPCS Risankizumab-rzaa 60 mg/mL Soln 10 Ml Vial 40 12 $12,433.81 $9,947.05 $15.08 $12,060.80 $7,888.64 2026-05-21
J2507 HCPCS Pegloticase Injection 2 1 — — $3,550.05 $7,100.10 $5,325.08 2026-05-21
J3101 HCPCS Tenecteplase 50 Mg/10 Ml (5 mg/mL) Solr 1 Each Vial 64 12 $9,752.95 $7,802.36 20% off $162.43 $9,460.36 $6,154.96 2026-05-21
J3316 HCPCS Inj., Triptorelin Xr 3.75 Mg 2 1 — — $3,790.60 $5,685.90 $4,738.25 2026-05-21
J3380 HCPCS Vedolizumab 300 Mg Solr 1 Each Vial 39 12 $11,534.22 $9,227.38 $21.67 $11,188.19 $7,497.24 2026-05-21
J3392 HCPCS Inj, Exagamglogene Autotem 2 1 — — $2,200,000.00 $2,200,000.00 $2,200,000.00 2026-05-21
J3393 HCPCS Inj, Betibeglogene Autotemce 2 1 — — $2,800,000.00 $2,800,000.00 $2,800,000.00 2026-05-21
J3394 HCPCS Inj, Lovotibeglogene Autotem 2 1 — — $3,100,000.00 $3,100,000.00 $3,100,000.00 2026-05-21
J3399 HCPCS Inj Onase Abepar-xioi Treat 2 1 — — $2,391,705.69 $2,391,705.69 $2,391,705.69 2026-05-21
J7310 HCPCS Outpatient Services 2 1 — — $16,960.00 $25,440.00 $21,200.00 2026-05-21
J7504 HCPCS Lymphocyte Immune Globulin 2 1 — — $4,355.73 $6,533.60 $5,444.66 2026-05-21
J9015 HCPCS Aldesleukin Injection 2 1 — — $5,662.50 $8,493.75 $7,078.12 2026-05-21
J9029 HCPCS Instill Adstiladrin, Tx Dose 2 1 — — $60,000.00 $60,000.00 $60,000.00 2026-05-21
J9200 HCPCS Floxuridine Injection 2 1 — — $4,189.12 $6,283.68 $5,236.40 2026-05-21
J9216 HCPCS Interferon Gamma 1-b Inj 2 1 — — $8,628.85 $12,943.28 $10,786.07 2026-05-21
J9219 HCPCS Leuprolide Acetate Implant 2 1 — — $5,398.20 $8,097.30 $6,747.75 2026-05-21
J9225 HCPCS Vantas Implant 2 1 — — $4,971.34 $7,457.01 $6,214.18 2026-05-21
J9226 HCPCS Supprelin La Implant 2 1 — — $47,524.89 $71,287.34 $59,406.11 2026-05-21
J9266 HCPCS Pegaspargase Injection 2 1 — — $28,424.06 $42,636.09 $35,530.07 2026-05-21
J9600 HCPCS Porfimer Sodium Injection 2 1 — — $23,789.46 $35,684.19 $29,736.83 2026-05-21
Q0224 HCPCS Inj, Pemivibart, 4500 Mg 2 1 — — $6,583.50 $9,875.25 $8,229.38 2026-05-21
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 2 1 — — $503,580.00 $503,580.00 $503,580.00 2026-05-21
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 2 1 — — $62,602.52 $62,602.52 $62,602.52 2026-05-21
Q2053 HCPCS Brexucabtagene Car Pos T 2 1 — — $462,000.00 $462,000.00 $462,000.00 2026-05-21
Q2054 HCPCS Lisocabtagene Mara Car Pos T 2 1 — — $531,350.40 $531,350.40 $531,350.40 2026-05-21
Q2055 HCPCS Idecabtagene Vicleucel Car 2 1 — — $528,312.43 $528,312.43 $528,312.43 2026-05-21
Q2056 HCPCS Ciltacabtagene Car-pos T 2 1 — — $522,055.50 $522,055.50 $522,055.50 2026-05-21
Q4303 HCPCS Complete Aa, Per Sq Cm 2 1 — — $3,412.79 $5,119.19 $4,265.99 2026-05-21
Q4342 HCPCS Theramend, Per Sq Cm 2 1 — — $3,570.00 $5,355.00 $4,462.50 2026-05-21
Q4346 HCPCS Shelter Dm Matrix Per Sq Cm 2 1 — — $3,570.00 $5,355.00 $4,462.50 2026-05-21
Q4350 HCPCS Palisade Dm Matrix Per Sq Cm 2 1 — — $3,570.00 $5,355.00 $4,462.50 2026-05-21
Q4351 HCPCS Enclose Tl Matrix, Per Sq Cm 2 1 — — $3,825.00 $5,737.50 $4,781.25 2026-05-21
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