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

ORTONVILLE AREA HEALTH SERVICES

Ortonville, MN · CCN 241342 · Rates published

Your selected procedure

You selected 93306 (CPT)

ECHO (2D) COMPLETE W DOPPLER & COLOR

This hospital’s price: $1,216 across 12 payers · range $727-$2,105

Source: https://sthpiprd.blob.core.windows.net/machine-readable-files/8030/411369442_ortonville-area-health-services_standardcharges.csv · observed 2025-07-07

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.

8,863 distinct procedures filed
12 distinct payers
205,372 rate rows
2025-07-07 last MRF observed · ⚠ 15 mo old
Data quality

200,120 of 205,372 rate rows are consumer-grade (97.4%)

5,252 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
per-diem day rate — not a per-procedure price 4,692
percent-of-charges filed in the dollar field — excluded from medians 458
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 68
placeholder amount (≤ $0.02) — excluded from medians 34

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 15 months old.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://sthpiprd.blob.core.windows.net/machine-readable-files/8030/411369442_ortonville-area-health-services_standardcharges.csv
Found on page https://search.hospitalpriceindex.com/hpi2/machineReadable/OrtonvilleAreaHealth/8030
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-21
Content fingerprint fe1e6095f43ee366… · 83,514,904 bytes · first seen 2026-05-09

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
$3,710,000
0.9× median
J1411
HCPCS 		Inj, Hemgenix, Per Tx Dose 1 $3,500,000.00 $3,500,000.00 $3,500,000.00 nat. median
$3,705,478
0.9× median
J1413
HCPCS 		Inj Delandistrogene Mox Rokl 1 $3,200,000.00 $3,200,000.00 $3,200,000.00 nat. median
$3,324,572
1.0× median
J3394
HCPCS 		Inj, Lovotibeglogene Autotem 1 $3,100,000.00 $3,100,000.00 $3,100,000.00 nat. median
$3,286,000
0.9× median
J3393
HCPCS 		Inj, Betibeglogene Autotemce 1 $2,800,000.00 $2,800,000.00 $2,800,000.00 nat. median
$2,994,107
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
$2,467,386
1.0× median
J3392
HCPCS 		Inj, Exagamglogene Autotem 1 $2,200,000.00 $2,200,000.00 $2,200,000.00 nat. median
$2,401,965
0.9× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 1 $531,350.40 $531,350.40 $531,350.40 nat. median
$640,950
0.8× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 1 $528,312.43 $528,312.43 $528,312.43 nat. median
$622,450
0.8× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 1 $522,055.50 $522,055.50 $522,055.50 nat. median
$646,415
0.8× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 1 $503,580.00 $503,580.00 $503,580.00 nat. median
$608,239
0.8× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 1 $462,000.00 $462,000.00 $462,000.00 nat. median
$591,721
0.8× median
J7330
HCPCS 		Allo Carticel Implt Genz*nlu* 12 $37,599.79 $101,170.03 $69,384.91 nat. median
$75,000
0.9× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 1 $62,602.52 $62,602.52 $62,602.52 nat. median
$65,720
1.0× median
90288
CPT 		Botulism Ig IV 1 $48,705.00 $73,057.50 $60,881.25 nat. median
$51,570
1.2× median
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 1 $60,000.00 $60,000.00 $60,000.00 nat. median
$68,423
0.9× median
J9226
HCPCS 		Supprelin La Implant 1 $47,524.89 $71,287.34 $59,406.11 nat. median
$55,159
1.1× median
J9266
HCPCS 		Pegaspargase Injection 1 $28,424.06 $42,636.09 $35,530.07 nat. median
$33,233
1.1× median
J9600
HCPCS 		Porfimer Sodium Injection 1 $23,789.46 $35,684.19 $29,736.83 nat. median
$30,131
1.0× median
J3357
HCPCS 		Ustekinumab 90 Mg/ml Subcut Sosy 12 $155.88 $34,336.45 $23,548.78 nat. median
$14,744
1.6× median
J9274
HCPCS 		Tebentafusp-tebn 100 Mcg/0.5ml IV Soln 12 $225.49 $31,061.27 $21,302.59 nat. median
$418
outlier · 51.0×
J7310
HCPCS 		Outpatient Services 1 $16,960.00 $25,440.00 $21,200.00 nat. median
$18,387
1.2× median
J2350
HCPCS 		Ocrelizumab 300 Mg/10ml IV Soln 12 $58.77 $30,705.74 $21,058.76 nat. median
$470
outlier · 44.8×
61886
CPT 		Implant Neurostim Arrays 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$27,176
0.6× median
0100T
CPT 		Prosth Retina Receive&gen 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$11,291
1.4× median
C9760
HCPCS 		Non-blind Interatrial Shunt 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$27,860
0.5× median
0571T
CPT 		Insj/rplcmt Icds Ss Eltrd 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$32,221
outlier · 0.5×
0520T
CPT 		Rmv&rplcmt Pg Wcs Lv Battery 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$13,297
1.2× median
0515T
CPT 		Insj Wcs Lv Compl Sys 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$22,690
0.7× median
0408T
CPT 		Insj/rplc Cardiac Modulj Sys 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$32,041
outlier · 0.5×
64568
CPT 		Opn Impltj Crnl Nrv Nea&pg 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$27,694
0.6× median
0409T
CPT 		Insj/rplc Car Modulj Pls Gn 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$23,398
0.7× median
0414T
CPT 		Rmvl & Rpl Car Modulj Pls Gn 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$23,398
0.7× median
33262
CPT 		Rmvl& Replc Pulse Gen 1 Lead 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$23,311
0.7× median
33264
CPT 		Rmvl & Rplcmt Dfb Gen Mlt Ld 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$31,574
outlier · 0.5×
33240
CPT 		Insrt Pulse Gen W/singl Lead 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$22,117
0.7× median
0614T
CPT 		Rmvl&rplcmt Ss Impl Dfb Pg 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$23,432
0.7× median
33263
CPT 		Rmvl & Rplcmt Dfb Gen 2 Lead 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$23,376
0.7× median
33249
CPT 		Insj/rplcmt Defib W/lead(s) 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$31,620
outlier · 0.5×
33270
CPT 		Ins/rep Subq Defibrillator 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$32,114
outlier · 0.5×
33230
CPT 		Insrt Pulse Gen W/dual Leads 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$22,483
0.7× median
33289
CPT 		Tcat Impl Wrls P-art Prs Snr 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$27,731
0.6× median
33231
CPT 		Insrt Pulse Gen W/mult Leads 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$30,121
0.5× median
0424T
CPT 		Outpatient Surgical Group Procedures - Cpt/hcpcs 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$22,771
0.7× median
69930
CPT 		Implant Cochlear Device 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$29,189
0.5× median
J3245
HCPCS 		Tildrakizumab-asmn 100 Mg/ml Subcut Sosy 12 $133.18 $20,165.94 $13,830.30 nat. median
$256
outlier · 54.0×
61885
CPT 		Insrt/redo Neurostim 1 Array 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$19,863
0.6× median
0427T
CPT 		Outpatient Surgical Group Procedures - Cpt/hcpcs 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$15,162
0.8× median
62361
CPT 		Implant Spine Infusion Pump 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$16,404
0.8× median
C9782
HCPCS 		Blind Myocar Trpl Bon Marrow 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$18,376
0.7× median

Other procedures at this hospital

Browse this hospital's 8,863 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
             
J1411 HCPCS Inj, Hemgenix, Per Tx Dose 4 1 — — $3,500,000.00 $3,500,000.00 $3,500,000.00 2025-07-07
J1414 HCPCS Inj, Beqvez, Per Tx Dose 4 1 — — $3,500,000.00 $3,500,000.00 $3,500,000.00 2025-07-07
J1413 HCPCS Inj Delandistrogene Mox Rokl 4 1 — — $3,200,000.00 $3,200,000.00 $3,200,000.00 2025-07-07
J3394 HCPCS Inj, Lovotibeglogene Autotem 4 1 — — $3,100,000.00 $3,100,000.00 $3,100,000.00 2025-07-07
J3393 HCPCS Inj, Betibeglogene Autotemce 4 1 — — $2,800,000.00 $2,800,000.00 $2,800,000.00 2025-07-07
J3399 HCPCS Inj Onase Abepar-xioi Treat 4 1 — — $2,391,705.69 $2,391,705.69 $2,391,705.69 2025-07-07
J3392 HCPCS Inj, Exagamglogene Autotem 4 1 — — $2,200,000.00 $2,200,000.00 $2,200,000.00 2025-07-07
Q2054 HCPCS Lisocabtagene Mara Car Pos T 4 1 — — $531,350.40 $531,350.40 $531,350.40 2025-07-07
Q2055 HCPCS Idecabtagene Vicleucel Car 4 1 — — $528,312.43 $528,312.43 $528,312.43 2025-07-07
Q2056 HCPCS Ciltacabtagene Car-pos T 4 1 — — $522,055.50 $522,055.50 $522,055.50 2025-07-07
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 4 1 — — $503,580.00 $503,580.00 $503,580.00 2025-07-07
Q2053 HCPCS Brexucabtagene Car Pos T 4 1 — — $462,000.00 $462,000.00 $462,000.00 2025-07-07
J7330 HCPCS Allo Carticel Implt Genz*nlu* 50 12 $104,299.00 $88,654.15 $37,599.79 $101,170.03 $69,384.91 2025-07-07
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 4 1 — — $62,602.52 $62,602.52 $62,602.52 2025-07-07
90288 CPT Botulism Ig IV 4 1 — — $48,705.00 $73,057.50 $60,881.25 2025-07-07
J9029 HCPCS Instill Adstiladrin, Tx Dose 4 1 — — $60,000.00 $60,000.00 $60,000.00 2025-07-07
J9226 HCPCS Supprelin La Implant 4 1 — — $47,524.89 $71,287.34 $59,406.11 2025-07-07
J9266 HCPCS Pegaspargase Injection 4 1 — — $28,424.06 $42,636.09 $35,530.07 2025-07-07
J9600 HCPCS Porfimer Sodium Injection 4 1 — — $23,789.46 $35,684.19 $29,736.83 2025-07-07
J3357 HCPCS Ustekinumab 90 Mg/ml Subcut Sosy 54 12 $35,398.40 $30,088.64 $155.88 $34,336.45 $23,548.78 2025-07-07
J9274 HCPCS Tebentafusp-tebn 100 Mcg/0.5ml IV Soln 54 12 $32,021.93 $27,218.65 $225.49 $31,061.27 $21,302.59 2025-07-07
J7310 HCPCS Outpatient Services 4 1 — — $16,960.00 $25,440.00 $21,200.00 2025-07-07
J2350 HCPCS Ocrelizumab 300 Mg/10ml IV Soln 54 12 $31,655.40 $26,907.09 $58.77 $30,705.74 $21,058.76 2025-07-07
33264 CPT Rmvl & Rplcmt Dfb Gen Mlt Ld 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
0409T CPT Insj/rplc Car Modulj Pls Gn 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
33231 CPT Insrt Pulse Gen W/mult Leads 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
64568 CPT Opn Impltj Crnl Nrv Nea&pg 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
33240 CPT Insrt Pulse Gen W/singl Lead 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
0520T CPT Rmv&rplcmt Pg Wcs Lv Battery 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
0515T CPT Insj Wcs Lv Compl Sys 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
0571T CPT Insj/rplcmt Icds Ss Eltrd 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
33289 CPT Tcat Impl Wrls P-art Prs Snr 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
33263 CPT Rmvl & Rplcmt Dfb Gen 2 Lead 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
0100T CPT Prosth Retina Receive&gen 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
69930 CPT Implant Cochlear Device 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
0614T CPT Rmvl&rplcmt Ss Impl Dfb Pg 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
33270 CPT Ins/rep Subq Defibrillator 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
33249 CPT Insj/rplcmt Defib W/lead(s) 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
33230 CPT Insrt Pulse Gen W/dual Leads 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
0408T CPT Insj/rplc Cardiac Modulj Sys 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
0424T CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
33262 CPT Rmvl& Replc Pulse Gen 1 Lead 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
0414T CPT Rmvl & Rpl Car Modulj Pls Gn 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
C9760 HCPCS Non-blind Interatrial Shunt 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
61886 CPT Implant Neurostim Arrays 2 1 — — $15,319.00 $15,319.00 $15,319.00 2025-07-07
J3245 HCPCS Tildrakizumab-asmn 100 Mg/ml Subcut Sosy 54 12 $20,789.63 $17,671.19 $133.18 $20,165.94 $13,830.30 2025-07-07
33967 CPT Insert I-aort Percut Device 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
61885 CPT Insrt/redo Neurostim 1 Array 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
62362 CPT Implant Spine Infusion Pump 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
62361 CPT Implant Spine Infusion Pump 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
0431T CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
C9758 HCPCS Blind Interatrial Shunt Ide 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
33968 CPT Remove Aortic Assist Device 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
33274 CPT Tcat Insj/rpl Perm Ldls Pm 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
37231 CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
0268T CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
0308T CPT Insj Ocular Telescope Prosth 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
63685 CPT Ins/rplc Spi Npg/rcvr Pocket 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
64590 CPT Ins/rpl Prph Sac/gstr Npg/r 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
93591 CPT Perq Transcath Cls Aortic 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
64582 CPT Opn Mpltj Hpglsl Nstm Ary Pg 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
C9782 HCPCS Blind Myocar Trpl Bon Marrow 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
0266T CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
93590 CPT Perq Transcath Cls Mitral 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
0427T CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
37227 CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
36906 CPT Thrmbc/nfs Dialysis Circuit 2 1 — — $12,867.00 $12,867.00 $12,867.00 2025-07-07
J1412 HCPCS Inj Roctavian Ml 2x10^13vc G 4 1 — — $11,668.13 $11,668.13 $11,668.13 2025-07-07
J9216 HCPCS Interferon Gamma 1-b Inj 4 1 — — $8,628.85 $12,943.28 $10,786.07 2025-07-07
Q4104 HCPCS Drsg Mtx Bilyr 4x5=130sqcm 54 12 $16,167.00 $13,741.95 $52.40 $15,681.99 $10,755.09 2025-07-07
J9119 HCPCS Cemiplimab-rwlc 350 Mg/7ml IV Soln 54 12 $16,110.23 $13,693.70 $29.62 $15,626.92 $10,717.33 2025-07-07
J1930 HCPCS Lanreotide Acetate 120 Mg/0.5ml Subcut Soln 54 12 $16,038.69 $13,632.89 $44.98 $15,557.53 $10,669.74 2025-07-07
J3380 HCPCS Vedolizumab 300 Mg IV Solr 54 12 $14,629.20 $12,434.82 $21.67 $14,190.32 $9,732.08 2025-07-07
J0896 HCPCS Luspatercept-aamt 75 Mg Subcut Solr 88 12 $19,749.33 $16,786.94 $41.28 $19,156.85 $9,479.68 2025-07-07
J9228 HCPCS Ipilimumab 50 Mg/10ml IV Soln 54 12 $13,940.91 $11,849.78 $189.05 $13,522.68 $9,274.19 2025-07-07
J9043 HCPCS Cabazitaxel 60 Mg/1.5ml IV Soln 54 12 $13,643.10 $11,596.64 $235.29 $13,233.81 $9,076.08 2025-07-07
J0870 HCPCS Imetelstat Sodium 188 Mg IV Solr 88 12 $17,168.25 $14,593.02 $55.23 $16,653.20 $8,240.76 2025-07-07
J9223 HCPCS Lurbinectedin 4 Mg IV Solr 54 12 $12,248.25 $10,411.02 $215.14 $11,880.80 $8,148.15 2025-07-07
J1932 HCPCS Lanreotide Acetate 120 Mg/0.5ml Subcut Soln 54 12 $12,195.69 $10,366.34 $30.68 $11,829.82 $8,113.19 2025-07-07
J9022 HCPCS Atezolizumab 840 Mg/14ml IV Soln 88 12 $12,036.57 $10,231.09 $92.63 $15,974.30 $8,007.32 2025-07-07
33214 CPT Upgrade Of Pacemaker System 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
54410 CPT Remove/replace Penis Prosth 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
93656 CPT Compre Ep Eval Abltj Atr Fib 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
93582 CPT Perq Transcath Closure Pda 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
22633 CPT Arthrd Cmbn 1ntrspc Lumbar 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
93653 CPT Compre Ep Eval Tx Svt 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
93580 CPT Transcath Closure Of Asd 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
93654 CPT Compre Ep Eval Tx Vt 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
93581 CPT Transcath Closure Of Vsd 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
54416 CPT Remv/repl Penis Contain Pros 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
54405 CPT Insert Multi-comp Penis Pros 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
53447 CPT Remove/replace Ur Sphincter 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
54401 CPT Insert Self-contd Prosthesis 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
53445 CPT Insert Uro/ves Nck Sphincter 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
33225 CPT L Ventric Pacing Lead Add-on 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
33208 CPT Insrt Heart Pm Atrial & Vent 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
33224 CPT Insert Pacing Lead & Connect 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
33820 CPT Repair Pda By Ligation 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
33824 CPT Repair Pda Div 18 Yrs&older 2 1 — — $7,671.00 $7,671.00 $7,671.00 2025-07-07
J0600 HCPCS Edetate Calcium Disodium Inj 4 1 — — $6,084.10 $9,126.15 $7,605.12 2025-07-07
J9144 HCPCS Daratumumab-hyaluronidase-fihj 1800-30000 Mg-ut/15ml Subcut Soln 54 12 $10,881.00 $9,248.85 $53.96 $10,554.57 $7,238.59 2025-07-07
J9015 HCPCS Aldesleukin Injection 4 1 — — $5,662.50 $8,493.75 $7,078.12 2025-07-07
37224 CPT Surg 37224 Revsc Opn/prg Fem/pop W/angioplasty Uni 50 12 $10,565.00 $8,980.25 $2,794.00 $10,248.05 $7,028.36 2025-07-07
J9306 HCPCS Pertuzumab 420 Mg/14ml IV Soln 54 12 $10,537.80 $8,957.13 $17.00 $10,221.67 $7,010.27 2025-07-07
J3101 HCPCS Tenecteplase 50 Mg IV Kit 54 12 $10,359.87 $8,805.89 $162.43 $10,049.07 $6,891.90 2025-07-07
A9594 HCPCS Gallium Ga-68 Psma-11, Ucla 4 1 — — $5,495.88 $8,243.82 $6,869.85 2025-07-07
A9593 HCPCS Gallium Ga-68 Psma-11 Ucsf 4 1 — — $5,495.88 $8,243.82 $6,869.85 2025-07-07
J9219 HCPCS Leuprolide Acetate Implant 4 1 — — $5,398.20 $8,097.30 $6,747.75 2025-07-07
J0716 HCPCS Centruroides Immune F(ab) 4 1 — — $5,351.02 $8,026.53 $6,688.77 2025-07-07
J1162 HCPCS Digoxin Immune Fab (ovine) 4 1 — — $5,069.98 $7,604.97 $6,337.48 2025-07-07
A9608 HCPCS Flotufolastat F18 Diag 1 Mci 4 1 — — $5,016.62 $7,524.93 $6,270.77 2025-07-07
J9225 HCPCS Vantas Implant 4 1 — — $4,971.34 $7,457.01 $6,214.18 2025-07-07
V2790 HCPCS Allo Mtx Viaflow Placental 2cc 186 12 $10,020.00 $8,517.00 $1,314.02 $16,358.08 $6,072.00 2025-07-07
J9271 HCPCS Pembrolizumab 100 Mg/4ml IV Soln 88 12 $9,551.31 $8,118.62 $60.48 $9,264.77 $6,066.27 2025-07-07
J9301 HCPCS Obinutuzumab 1000 Mg/40ml IV Soln 54 12 $9,075.75 $7,714.39 $78.57 $8,803.48 $6,037.65 2025-07-07
J0717 HCPCS Certolizumab Pegol 200 Mg/ml Subcut Pskt 54 12 $9,042.15 $7,685.83 $3.90 $8,770.89 $6,015.30 2025-07-07
A9591 HCPCS Fluoroestradiol F 18 4 1 — — $4,707.30 $7,060.95 $5,884.12 2025-07-07
J0480 HCPCS Basiliximab 4 1 — — $4,657.58 $6,986.37 $5,821.98 2025-07-07
J9356 HCPCS Trastuzumab-hyaluronidase-oysk 600-10000 Mg-unt/5ml Subcut Soln 54 12 $8,708.55 $7,402.27 $66.22 $8,447.29 $5,793.36 2025-07-07
J2506 HCPCS Pegfilgrastim 6 Mg/0.6ml Subcut Pskt 88 12 $8,902.13 $7,566.82 $19.98 $8,635.07 $5,653.97 2025-07-07
36475 CPT Surg 36475 Endoven Abltj Incmptnt Vein Xtr Rf 1st Vein 50 12 $8,481.00 $7,208.85 $1,471.00 $8,226.57 $5,641.98 2025-07-07
Q4196 HCPCS Drsgwndpuraplyam4.91x4.91=25sq 54 12 $8,475.00 $7,203.75 $105.69 $8,220.75 $5,637.99 2025-07-07
J7504 HCPCS Lymphocyte Immune Globulin 4 1 — — $4,355.73 $6,533.60 $5,444.66 2025-07-07
J2507 HCPCS Pegloticase Injection 4 1 — — $3,550.05 $7,100.10 $5,325.08 2025-07-07
Q4107 HCPCS Allo Graftjacket1 5x10cm*nlu* 292 12 $9,111.00 $7,744.35 $85.96 $11,267.52 $5,285.56 2025-07-07
J9200 HCPCS Floxuridine Injection 4 1 — — $4,189.12 $6,283.68 $5,236.40 2025-07-07
37700 CPT Surg 37700 Lig&div Long Saph Vein Saphfem Junct/interruption 50 12 $7,801.00 $6,630.85 $1,471.00 $7,566.97 $5,189.61 2025-07-07
J2353 HCPCS Octreotide Acetate 20 Mg IM Kit 88 12 $7,675.77 $6,524.41 $218.37 $10,330.88 $5,112.19 2025-07-07
C1734 HCPCS Scaf Bone Kt Aug 1.5cc*nlu* 84 12 $5,685.00 $4,832.25 $2,049.44 $10,175.30 $5,035.20 2025-07-07
27487 CPT Revise/replace Knee Joint 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27486 CPT Revise/replace Knee Joint 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0411T CPT Insj/rplc Car Modulj Vnt Elt 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0236T CPT Trluml Perip Athrc Abd Aorta 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0410T CPT Insj/rplc Car Modulj Atr Elt 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0527T CPT Insj/rplcmt Iims Implt Mntr 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27447 CPT Total Knee Arthroplasty 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0526T CPT Insj/rplcmt Iims Eltrd Only 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0525T CPT Insj/rplcmt Compl Iims 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27295 CPT Amputation Of Leg At Hip 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27284 CPT Arthrodesis Hip Joint 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0234T CPT Trluml Perip Athrc Renal Art 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27286 CPT Arthrd Hip Jt Sbtrchc Osteot 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0398T CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0775T CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27280 CPT Arthr Si Jt Opn B1grf Instrm 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0516T CPT Insj Wcs Lv Eltrd Only 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27446 CPT Revision Of Knee Joint 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0426T CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
C9783 HCPCS Blind Cor Sinus Reducer Impl 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
C9780 HCPCS Insert Cv Cath Inf & Sup App 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
C9767 HCPCS Revasc Lithotrip-stent-ather 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
C9773 HCPCS Revasc Lithotr-stent Tib/per 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
37244 CPT Vasc Embolize/occlude Bleed 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27137 CPT Revise Hip Joint Replacement 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27138 CPT Revise Hip Joint Replacement 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
C9765 HCPCS Revasc Intra Lithotrip-stent 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
C9604 HCPCS Perc D-e Cor Revasc T Cabg S 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
C9600 HCPCS Perc Drug-el Cor Stent Sing 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
C9602 HCPCS Perc D-e Cor Stent Ather S 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
C9766 HCPCS Revasc Intra Lithotrip-ather 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
37242 CPT Vasc Embolize/occlude Artery 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22862 CPT Rev Rplcm Rthrp 1ntrspc Lmbr 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22861 CPT Rev Rplcm Arthrp 1ntrspc Crv 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
23470 CPT Reconstruct Shoulder Joint 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
92925 CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
92924 CPT Prq Trluml C Athrc 1 Art&/br 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
20838 CPT Replantation Foot Complete 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22857 CPT Tot Disc Arthrp 1ntrspc Lmbr 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
37233 CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22819 CPT Kyphectomy 3 Or More 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22818 CPT Kyphectomy 1-2 Segments 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22810 CPT Arthrd Ant Dfrm 4-7 Vrt Sgm 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22812 CPT Arthrd Ant Dfrm 8+ Vrt Sgm 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
64583 CPT Rev/rplct Hpglsl Nstm Ary Pg 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
69714 CPT Impl Oi Implt Skull Perq Esp 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22802 CPT Arthrd Pst Dfrm 7-12 Vrt Sgm 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
64575 CPT Opn Impltj Nea Perph Nerve 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22804 CPT Arthrd Pst Dfrm 13+ Vrt Sgm 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
64580 CPT Opn Impltj Nea Neuromuscular 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
20808 CPT Replantation Hand Complete 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22630 CPT Arthrd Pst Tq 1ntrspc Lum 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22800 CPT Arthrd Pst Dfrm<6 Vrt Sgm 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
63290 CPT Bx/exc Xdrl/idrl Lsn Any Lvl 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22808 CPT Arthrd Ant Dfrm 2-3 Vrt Sgm 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
63287 CPT Bx/exc Idrl Imed Lesn Thrlmb 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
20805 CPT Replant Forearm Complete 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
63655 CPT Implant Neuroelectrodes 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
64581 CPT Opn Impltj Nea Sacral Nerve 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
63200 CPT Release Spinal Cord Lumbar 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
20802 CPT Replantation Arm Complete 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
63191 CPT Incise Spine Accessory Nerve 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
63252 CPT Revise Spine Cord Vsl Thrlmb 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22595 CPT Arthrd Pst Tq Atlas-axis 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22600 CPT Arthrd Pst Tq 1ntrspc Crv 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
63190 CPT Incise Spine Nrv >2 Segmnts 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
63272 CPT Excise Intrspinl Lesion Lmbr 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0645T CPT Tcat Impltj C Sins Rdctj Dev 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22610 CPT Arthrd Pst Tq 1ntrspc Thrc 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0632T CPT Perq Tcat US Abltj Nrv P-art 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22590 CPT Arthrd Pst Tq Craniocervical 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
63185 CPT Incise Spine Nrv Half Segmnt 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
63277 CPT Bx/exc Xdrl Spine Lesn Lmbr 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22558 CPT Arthrd Ant Ntrbd Min Dsc Lum 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
61626 CPT Tcat Perm Occls/embol Noncns 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
25446 CPT Arthrp W/prostc Dst Rds&crps 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22556 CPT Arthrd Ant Ntrbd Min Dsc Thc 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
61624 CPT Tcat Perm Occls/embolj Cns 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
56634 CPT Vlvctmy Rad Comp Uni Lymphad 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22586 CPT Arthrd Pre-sac Ntrbdy L5-s1 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
C9607 HCPCS Perc D-e Cor Revasc Chro Sin 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27132 CPT Total Hip Arthroplasty 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27130 CPT Total Hip Arthroplasty 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0505T CPT Ev Fempop Artl Revsc 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27134 CPT Revise Hip Joint Replacement 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
56637 CPT Vlvctmy Rad Comp Bi Lymphad 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
C9772 HCPCS Revasc Lithotrip Tibi/perone 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
C9774 HCPCS Revasc Lithotr-ather Tib/per 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
C9775 HCPCS Revasc Lith-sten-ath Tib/per 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0620T CPT Evasc Ven Artlz Tibl/prnl Vn 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
56633 CPT Vulvectomy Radical Complete 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
61623 CPT Evasc Temp Balo Artl Occ H/n 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
63282 CPT Bx/exc Idrl Spine Lesn Lmbr 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22532 CPT Arthrd Lat Xtrcvtry Tq Thrc 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
55866 CPT Laps Surg Prst8ect Rpbic Rad 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
53451 CPT Tprnl Balo Cntnc Dev Bi 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
54400 CPT Insert Semi-rigid Prosthesis 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
53444 CPT Insert Tandem Cuff 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0517T CPT Insj Wcs Lv Both Compnt Pg 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22533 CPT Arthrd Lat Xtrcvtry Tq Lmbr 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27279 CPT Arthrd Si Jt Plmt Tartclr Dv 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
55873 CPT Cryoablate Prostate 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
47370 CPT Laparo Ablate Liver Tumor Rf 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
43774 CPT Lap Rmvl Gastr Adj All Parts 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27290 CPT Amputation Of Leg At Hip 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
47371 CPT Laparo Ablate Liver Cryosurg 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
43647 CPT Lap Impl Electrode Antrum 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
37243 CPT Vasc Embolize/occlude Organ 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
50542 CPT Laparo Ablate Renal Mass 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
53440 CPT Male Sling Procedure 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
37236 CPT Open/perq Place Stent 1st 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
37230 CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
37238 CPT Open/perq Place Stent Same 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
37225 CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
37221 CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
37226 CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
37241 CPT Vasc Embolize/occlude Venous 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
56631 CPT Vlvctmy Rad Prtl Uni Lymphad 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
56632 CPT Vlvctmy Rad Prtl Bi Lymphad 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
36903 CPT Intro Cath Dialysis Circuit 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
36905 CPT Thrmbc/nfs Dialysis Circuit 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33902 CPT Perq P-art Revsc 1 Abnor Uni 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
24370 CPT Revise Reconst Elbow Joint 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33900 CPT Perq P-art Revsc 1 Nm Nt Uni 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33903 CPT Perq P-art Revsc 1 Abnor Bi 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33285 CPT Insj Subq Car Rhythm Mntr 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0572T CPT Insertion Ss Dfb Electrode 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33271 CPT Insj Subq Impltbl Dfb Elctrd 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
24366 CPT Reconstruct Head Of Radius 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
24361 CPT Reconstruct Elbow Joint 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33822 CPT Repair Pda Div<18 Years 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
37182 CPT Insert Hepatic Shunt (tips) 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33228 CPT Remv&replc Pm Gen Dual Lead 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0238T CPT Trluml Perip Athrc Iliac Art 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33227 CPT Remove&replace Pm Gen Singl 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33213 CPT Insert Pulse Gen Dual Leads 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33221 CPT Insert Pulse Gen Mult Leads 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33212 CPT Insert Pulse Gen Sngl Lead 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
32655 CPT Thoracoscopy Resect Bullae 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
32652 CPT Thoracoscopy Rem Totl Cortex 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33229 CPT Remv&replc Pm Gen Mult Leads 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
32656 CPT Thoracoscopy W/pleurectomy 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
32650 CPT Thoracoscopy W/pleurodesis 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27880 CPT Amputation Of Lower Leg 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
32651 CPT Thoracoscopy Remove Cortex 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33206 CPT Insert Heart Pm Atrial 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
24363 CPT Replace Elbow Joint 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22849 CPT Reinsert Spinal Fixation 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
23472 CPT Reconstruct Shoulder Joint 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27591 CPT Amputate Leg At Thigh 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
25442 CPT Arthrp W/prostc Dstl Ulna 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
24371 CPT Revise Reconst Elbow Joint 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33901 CPT Perq P-art Revsc 1 Nm Nt Bi 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
0237T CPT Trluml Perip Athrc Brchiocph 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27590 CPT Amputate Leg At Thigh 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
36836 CPT Prq Av Fstl Crtj Uxtr 1 Acs 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
36837 CPT Prq Av Fstl Crt Uxtr Sep Acs 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
27592 CPT Amputate Leg At Thigh 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
25441 CPT Arthrp W/prostc Dstl Rds 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
33207 CPT Insert Heart Pm Ventricular 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
22548 CPT Arthrd Ant Toral/xoral C1-c2 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
37183 CPT Revision Tips 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
37229 CPT Outpatient Surgical Group Procedures - Cpt/hcpcs 2 1 — — $4,926.00 $4,926.00 $4,926.00 2025-07-07
J0565 HCPCS Bezlotoxumab 1000 Mg/40ml IV Soln 54 12 $7,366.59 $6,261.61 $39.87 $7,145.59 $4,900.62 2025-07-07
J9354 HCPCS Ado-trastuzumab Emtansine 160 Mg IV Solr 88 12 $10,128.63 $8,609.34 $43.02 $9,824.77 $4,861.74 2025-07-07
J0801 HCPCS Inj. Acthar Gel To 40 Units 4 1 — — $3,827.83 $5,741.75 $4,784.79 2025-07-07
Q4351 HCPCS Enclose Tl Matrix, Per Sq Cm 4 1 — — $3,825.00 $5,737.50 $4,781.25 2025-07-07
J0225 HCPCS Inj, Vutrisiran, 1 Mg 4 1 — — $4,774.04 $4,774.04 $4,774.04 2025-07-07
J3316 HCPCS Inj., Triptorelin Xr 3.75 Mg 4 1 — — $3,790.60 $5,685.90 $4,738.25 2025-07-07
Q5111 HCPCS Pegfilgrastim-cbqv 6 Mg/0.6ml Subcut Sosy 54 12 $6,813.78 $5,791.72 $135.55 $6,609.37 $4,532.87 2025-07-07
Q4342 HCPCS Theramend, Per Sq Cm 4 1 — — $3,570.00 $5,355.00 $4,462.50 2025-07-07
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