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

UNITED HOSPITAL DISTRICT

Blue Earth, MN · CCN 241369 · Rates published

9,083 distinct procedures filed
3 distinct payers
116,245 rate rows
2026-02-12 last MRF observed
Data quality

75,801 of 116,245 rate rows are consumer-grade (65.2%)

40,444 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 37,929
per-diem day rate — not a per-procedure price 2,316
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 98
percent-of-charges filed in the dollar field — excluded from medians 55
placeholder amount (≤ $0.02) — excluded from medians 46
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/8132/454165628-1952307688_united-hospital-district%2C-inc_standardcharges.csv
Found on page https://www.uhd.org/cms-hpt.txt
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-12
Content fingerprint 30d81064e26873a0… · 80,512,101 bytes · first seen 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
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
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
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
J9600
HCPCS 		Porfimer Sodium Injection 1 $23,789.46 $35,684.19 $29,736.83 nat. median
$26,416
1.1× median
J7310
HCPCS 		Op Carveout Services 1 $16,960.00 $25,440.00 $21,200.00 nat. median
$13,629
1.6× median
C1767
HCPCS 		Stim Nerve Ipg Inspire 3150 3 $5,757.78 $26,892.00 $17,019.65 nat. median
$25,172
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×
33264
CPT 		Rmvl & Rplcmt Dfb Gen Mlt Ld 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$32,779
outlier · 0.5×
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
69930
CPT 		Implant Cochlear Device 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$23,645
0.6× median
33263
CPT 		Rmvl & Rplcmt Dfb Gen 2 Lead 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$23,924
0.6× median
0424T
CPT 		Outpatient Surgery 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$14,841
1.0× median
C9760
HCPCS 		Non-blind Interatrial Shunt 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$28,845
0.5× median
33289
CPT 		Tcat Impl Wrls P-art Prs Snr 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$28,889
0.5× median
33270
CPT 		Ins/rep Subq Defibrillator 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$32,475
outlier · 0.5×
0515T
CPT 		Insj Wcs Lv Compl Sys 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$22,512
0.7× 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
33249
CPT 		Insj/rplcmt Defib W/lead(s) 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$32,069
outlier · 0.5×
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
0408T
CPT 		Insj/rplc Cardiac Modulj Sys 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$31,369
outlier · 0.5×
33230
CPT 		Insrt Pulse Gen W/dual Leads 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$23,060
0.7× median
33231
CPT 		Insrt Pulse Gen W/mult Leads 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$31,377
outlier · 0.5×
33240
CPT 		Insrt Pulse Gen W/singl Lead 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
$23,514
0.7× median
0100T
CPT 		Prosth Retina Receive&gen 1 $15,319.00 $15,319.00 $15,319.00 nat. median
$11,456
1.3× median
62362
CPT 		Implant Spine Infusion Pump 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$15,917
0.8× median
63685
CPT 		Ins/rplc Spi Npg/rcvr Pocket 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$21,812
0.6× median
61885
CPT 		Insrt/redo Neurostim 1 Array 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$18,802
0.7× median
0427T
CPT 		Outpatient Surgery 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$14,385
0.9× median
62361
CPT 		Implant Spine Infusion Pump 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$16,517
0.8× median
64590
CPT 		Ins/rpl Prph Sac/gstr Npg/r 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$18,089
0.7× median
0431T
CPT 		Outpatient Surgery 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$14,159
0.9× median
0308T
CPT 		Insj Ocular Telescope Prosth 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$16,465
0.8× median
33967
CPT 		Insert I-aort Percut Device 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$1,569
outlier · 8.2×
33968
CPT 		Remove Aortic Assist Device 1 $12,867.00 $12,867.00 $12,867.00 nat. median
$258
outlier · 49.8×

Other procedures at this hospital

Browse this hospital's 9,083 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 2 1 — — $3,500,000.00 $3,500,000.00 $3,500,000.00 2026-02-12
J1414 HCPCS Inj, Beqvez, Per Tx Dose 2 1 — — $3,500,000.00 $3,500,000.00 $3,500,000.00 2026-02-12
J1413 HCPCS Inj Delandistrogene Mox Rokl 2 1 — — $3,200,000.00 $3,200,000.00 $3,200,000.00 2026-02-12
J3394 HCPCS Inj, Lovotibeglogene Autotem 2 1 — — $3,100,000.00 $3,100,000.00 $3,100,000.00 2026-02-12
J3393 HCPCS Inj, Betibeglogene Autotemce 2 1 — — $2,800,000.00 $2,800,000.00 $2,800,000.00 2026-02-12
J3399 HCPCS Inj Onase Abepar-xioi Treat 2 1 — — $2,391,705.69 $2,391,705.69 $2,391,705.69 2026-02-12
J3392 HCPCS Inj, Exagamglogene Autotem 2 1 — — $2,200,000.00 $2,200,000.00 $2,200,000.00 2026-02-12
Q2054 HCPCS Lisocabtagene Mara Car Pos T 2 1 — — $531,350.40 $531,350.40 $531,350.40 2026-02-12
Q2055 HCPCS Idecabtagene Vicleucel Car 2 1 — — $528,312.43 $528,312.43 $528,312.43 2026-02-12
Q2056 HCPCS Ciltacabtagene Car-pos T 2 1 — — $522,055.50 $522,055.50 $522,055.50 2026-02-12
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 2 1 — — $503,580.00 $503,580.00 $503,580.00 2026-02-12
Q2053 HCPCS Brexucabtagene Car Pos T 2 1 — — $462,000.00 $462,000.00 $462,000.00 2026-02-12
90288 CPT Botulism Ig IV 2 1 — — $48,705.00 $73,057.50 $60,881.25 2026-02-12
J9226 HCPCS Supprelin La Implant 2 1 — — $47,524.89 $71,287.34 $59,406.11 2026-02-12
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 2 1 — — $62,602.52 $62,602.52 $62,602.52 2026-02-12
J9029 HCPCS Instill Adstiladrin, Tx Dose 2 1 — — $60,000.00 $60,000.00 $60,000.00 2026-02-12
J9266 HCPCS Pegaspargase Injection 2 1 — — $28,424.06 $42,636.09 $35,530.07 2026-02-12
J9600 HCPCS Porfimer Sodium Injection 2 1 — — $23,789.46 $35,684.19 $29,736.83 2026-02-12
C1767 HCPCS Stim Nerve Ipg Inspire 3150 21 3 $29,880.00 $25,398.00 $5,757.78 $26,892.00 $17,019.65 2026-02-12
J7310 HCPCS Op Carveout Services 2 1 — — $16,960.00 $25,440.00 $21,200.00 2026-02-12
0424T CPT Outpatient Surgery 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
33240 CPT Insrt Pulse Gen W/singl Lead 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
0409T CPT Insj/rplc Car Modulj Pls Gn 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
0408T CPT Insj/rplc Cardiac Modulj Sys 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
0571T CPT Insj/rplcmt Icds Ss Eltrd 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
33262 CPT Rmvl& Replc Pulse Gen 1 Lead 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
33270 CPT Ins/rep Subq Defibrillator 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
33289 CPT Tcat Impl Wrls P-art Prs Snr 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
33249 CPT Insj/rplcmt Defib W/lead(s) 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
C9760 HCPCS Non-blind Interatrial Shunt 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
0515T CPT Insj Wcs Lv Compl Sys 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
33264 CPT Rmvl & Rplcmt Dfb Gen Mlt Ld 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
0414T CPT Rmvl & Rpl Car Modulj Pls Gn 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
0614T CPT Rmvl&rplcmt Ss Impl Dfb Pg 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
69930 CPT Implant Cochlear Device 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
0100T CPT Prosth Retina Receive&gen 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
33263 CPT Rmvl & Rplcmt Dfb Gen 2 Lead 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
33231 CPT Insrt Pulse Gen W/mult Leads 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
33230 CPT Insrt Pulse Gen W/dual Leads 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
0520T CPT Rmv&rplcmt Pg Wcs Lv Battery 3 1 — — $15,319.00 $15,319.00 $15,319.00 2026-02-12
J9216 HCPCS Interferon Gamma 1-b Inj 2 1 — — $8,628.85 $12,943.28 $10,786.07 2026-02-12
33274 CPT Tcat Insj/rpl Perm Ldls Pm 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
0268T CPT Outpatient Surgery 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
93591 CPT Perq Transcath Cls Aortic 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
62361 CPT Implant Spine Infusion Pump 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
33967 CPT Insert I-aort Percut Device 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
64590 CPT Ins/rpl Prph Sac/gstr Npg/r 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
0431T CPT Outpatient Surgery 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
62362 CPT Implant Spine Infusion Pump 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
0308T CPT Insj Ocular Telescope Prosth 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
93590 CPT Perq Transcath Cls Mitral 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
C9782 HCPCS Blind Myocar Trpl Bon Marrow 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
C9758 HCPCS Blind Interatrial Shunt Ide 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
63685 CPT Ins/rplc Spi Npg/rcvr Pocket 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
36906 CPT Thrmbc/nfs Dialysis Circuit 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
33968 CPT Remove Aortic Assist Device 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
37231 CPT Outpatient Surgery 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
0427T CPT Outpatient Surgery 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
37227 CPT Outpatient Surgery 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
61885 CPT Insrt/redo Neurostim 1 Array 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
0266T CPT Outpatient Surgery 3 1 — — $12,867.00 $12,867.00 $12,867.00 2026-02-12
J3380 HCPCS Vedolizumab For IV Solution 300 Mg 15 3 $12,996.90 $11,047.37 $21.67 $11,697.21 $7,403.03 2026-02-12
J1412 HCPCS Inj Roctavian Ml 2x10^13vc G 2 1 — — $11,668.13 $11,668.13 $11,668.13 2026-02-12
J3101 HCPCS Tenecteplase For IV Soln Kit 50 Mg 15 3 $12,036.00 $10,230.60 $162.43 $10,832.40 $6,855.70 2026-02-12
Q0224 HCPCS Inj, Pemivibart, 4500 Mg 2 1 — — $6,583.50 $9,875.25 $8,229.38 2026-02-12
J0600 HCPCS Edetate Calcium Disodium Inj 2 1 — — $6,084.10 $9,126.15 $7,605.12 2026-02-12
27130 CPT Arthroplasty Acetabular Proximal Femoral Prosthetic Replace Wwo Autog 14 3 $9,509.00 $8,082.65 $1,592.12 $8,558.10 $5,416.32 2026-02-12
J9015 HCPCS Aldesleukin Injection 2 1 — — $5,662.50 $8,493.75 $7,078.12 2026-02-12
J0517 HCPCS Benralizumab Subcutaneous Soln Prefilled Syringe 30 Mg/ml 15 3 $9,214.62 $7,832.43 $165.89 $8,293.16 $5,248.65 2026-02-12
A9594 HCPCS Gallium Ga-68 Psma-11, Ucla 2 1 — — $5,495.88 $8,243.82 $6,869.85 2026-02-12
A9593 HCPCS Gallium Ga-68 Psma-11 Ucsf 2 1 — — $5,495.88 $8,243.82 $6,869.85 2026-02-12
J9219 HCPCS Leuprolide Acetate Implant 2 1 — — $5,398.20 $8,097.30 $6,747.75 2026-02-12
J0716 HCPCS Centruroides Immune F(ab) 2 1 — — $5,351.02 $8,026.53 $6,688.77 2026-02-12
J2506 HCPCS Pegfilgrastim Soln Prefilled Syringe 6 Mg/0.6ml 15 3 $8,887.50 $7,554.38 $19.98 $7,998.75 $5,062.32 2026-02-12
43282 CPT Lap Paraesoph Hernia W Mesh 14 3 $8,598.00 $7,308.30 $1,439.51 $7,738.20 $4,897.42 2026-02-12
33208 CPT Insrt Heart Pm Atrial & Vent 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
54416 CPT Remv/repl Penis Contain Pros 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
93656 CPT Compre Ep Eval Abltj Atr Fib 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
33225 CPT L Ventric Pacing Lead Add-on 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
22633 CPT Arthrd Cmbn 1ntrspc Lumbar 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
33820 CPT Repair Pda By Ligation 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
54401 CPT Insert Self-contd Prosthesis 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
93653 CPT Compre Ep Eval Tx Svt 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
93581 CPT Transcath Closure Of Vsd 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
93580 CPT Transcath Closure Of Asd 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
93582 CPT Perq Transcath Closure Pda 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
93654 CPT Compre Ep Eval Tx Vt 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
33214 CPT Upgrade Of Pacemaker System 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
54410 CPT Remove/replace Penis Prosth 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
53445 CPT Insert Uro/ves Nck Sphincter 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
53447 CPT Remove/replace Ur Sphincter 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
54405 CPT Insert Multi-comp Penis Pros 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
33824 CPT Repair Pda Div 18 Yrs&older 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
33224 CPT Insert Pacing Lead & Connect 3 1 — — $7,671.00 $7,671.00 $7,671.00 2026-02-12
J1162 HCPCS Digoxin Immune Fab (ovine) 2 1 — — $5,069.98 $7,604.97 $6,337.48 2026-02-12
J9225 HCPCS Vantas Implant 2 1 — — $4,971.34 $7,457.01 $6,214.18 2026-02-12
59510 CPT Routine Obstetric Care Wantepartum Care Cesarean Delivery & Postpartu 16 3 $5,717.00 $4,859.45 $741.83 $7,350.30 $3,256.41 2026-02-12
J1459 HCPCS Immune Globulin (Human) IV Soln 40 Gm/400ml 23 3 $7,928.00 $6,738.80 $49.28 $7,135.20 $3,353.54 2026-02-12
J2507 HCPCS Pegloticase Injection 2 1 — — $3,550.05 $7,100.10 $5,325.08 2026-02-12
A9591 HCPCS Fluoroestradiol F 18 2 1 — — $4,707.30 $7,060.95 $5,884.12 2026-02-12
J0480 HCPCS Basiliximab 2 1 — — $4,657.58 $6,986.37 $5,821.98 2026-02-12
Q5111 HCPCS Pegfilgrastim-cbqv Soln Prefilled Syringe 6 Mg/0.6ml 15 3 $7,634.38 $6,489.23 $135.55 $6,870.94 $4,348.54 2026-02-12
44204 CPT Laparoscopy Surgical Colectomy Partial Wanastomosis 14 3 $7,523.00 $6,394.55 $1,259.63 $6,770.70 $4,285.10 2026-02-12
J7504 HCPCS Lymphocyte Immune Globulin 2 1 — — $4,355.73 $6,533.60 $5,444.66 2026-02-12
J9200 HCPCS Floxuridine Injection 2 1 — — $4,189.12 $6,283.68 $5,236.40 2026-02-12
27447 CPT Arthroplasty Knee Condyle & Plateau Medial & Lat Compartments Wwo Pat 11 3 $6,960.00 $5,916.00 $1,664.83 $6,264.00 $3,964.41 2026-02-12
44141 CPT Colectomy Partial Wskin Level Cecostomy Colostomy 14 3 $6,717.00 $5,709.45 $711.00 $6,045.30 $3,826.01 2026-02-12
44206 CPT Lap Surg Colectomy Partial Wend Colostomy & Closure Distal Seg 14 3 $6,470.00 $5,499.50 $711.00 $5,823.00 $3,685.31 2026-02-12
44140 CPT Colectomy Partial Wanastomosis 14 3 $6,380.00 $5,423.00 $711.00 $5,742.00 $3,634.05 2026-02-12
J0801 HCPCS Inj. Acthar Gel To 40 Units 2 1 — — $3,827.83 $5,741.75 $4,784.79 2026-02-12
Q4351 HCPCS Enclose Tl Matrix, Per Sq Cm 2 1 — — $3,825.00 $5,737.50 $4,781.25 2026-02-12
J3316 HCPCS Inj., Triptorelin Xr 3.75 Mg 2 1 — — $3,790.60 $5,685.90 $4,738.25 2026-02-12
Q4342 HCPCS Theramend, Per Sq Cm 2 1 — — $3,570.00 $5,355.00 $4,462.50 2026-02-12
A9601 HCPCS Flortaucipir Inj 1 Millicuri 2 1 — — $3,570.00 $5,355.00 $4,462.50 2026-02-12
Q4346 HCPCS Shelter Dm Matrix Per Sq Cm 2 1 — — $3,570.00 $5,355.00 $4,462.50 2026-02-12
Q4350 HCPCS Palisade Dm Matrix Per Sq Cm 2 1 — — $3,570.00 $5,355.00 $4,462.50 2026-02-12
J0802 HCPCS Inj. (ani), Up To 40 Units 2 1 — — $3,468.85 $5,203.28 $4,336.06 2026-02-12
Q4303 HCPCS Complete Aa, Per Sq Cm 2 1 — — $3,412.79 $5,119.19 $4,265.99 2026-02-12
27814 CPT Open Treat Bimalleolar Ankle Fx Wwo Int Ext Fixn 14 3 $5,683.00 $4,830.55 $951.54 $5,114.70 $3,237.03 2026-02-12
95811 CPT Sleep Study Splt Nght 95811 13 3 $5,656.00 $4,807.60 $1,056.88 $5,090.40 $3,221.66 2026-02-12
29888 CPT Arthroscopically Aided Anterior Cruciate Lig Rpr Augmentatn Reconstrct 11 3 $5,588.00 $4,749.80 $1,336.65 $5,029.20 $3,182.93 2026-02-12
21555 CPT Exc Tumor Soft Tissue Neck Thorax Subq 14 3 $5,579.00 $4,742.15 $711.00 $5,021.10 $3,177.80 2026-02-12
23410 CPT Rpr Ruptured Musculotendinous Cuff Open Acute 14 3 $5,537.00 $4,706.45 $552.83 $4,983.30 $3,153.88 2026-02-12
43774 CPT Lap Gastric Restrictive Remove Band Port 14 3 $5,530.00 $4,700.50 $925.94 $4,977.00 $3,248.38 2026-02-12
27592 CPT Amputate Leg At Thigh 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0411T CPT Insj/rplc Car Modulj Vnt Elt 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
36837 CPT Prq Av Fstl Crt Uxtr Sep Acs 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0410T CPT Insj/rplc Car Modulj Atr Elt 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0527T CPT Insj/rplcmt Iims Implt Mntr 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0234T CPT Trluml Perip Athrc Renal Art 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22857 CPT Tot Disc Arthrp 1ntrspc Lmbr 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22861 CPT Rev Rplcm Arthrp 1ntrspc Crv 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33901 CPT Perq P-art Revsc 1 Nm Nt Bi 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
27446 CPT Revision Of Knee Joint 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0398T CPT Outpatient Surgery 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0517T CPT Insj Wcs Lv Both Compnt Pg 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22862 CPT Rev Rplcm Rthrp 1ntrspc Lmbr 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
50542 CPT Laparo Ablate Renal Mass 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
32656 CPT Thoracoscopy W/pleurectomy 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
37236 CPT Open/perq Place Stent 1st 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0525T CPT Insj/rplcmt Compl Iims 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0526T CPT Insj/rplcmt Iims Eltrd Only 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
32650 CPT Thoracoscopy W/pleurodesis 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
27286 CPT Arthrd Hip Jt Sbtrchc Osteot 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
27487 CPT Revise/replace Knee Joint 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
27486 CPT Revise/replace Knee Joint 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22818 CPT Kyphectomy 1-2 Segments 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
47371 CPT Laparo Ablate Liver Cryosurg 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
27290 CPT Amputation Of Leg At Hip 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
27590 CPT Amputate Leg At Thigh 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
27295 CPT Amputation Of Leg At Hip 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22812 CPT Arthrd Ant Dfrm 8+ Vrt Sgm 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22819 CPT Kyphectomy 3 Or More 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
27280 CPT Arthr Si Jt Opn B1grf Instrm 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
C9783 HCPCS Blind Cor Sinus Reducer Impl 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
C9780 HCPCS Insert Cv Cath Inf & Sup App 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
C9775 HCPCS Revasc Lith-sten-ath Tib/per 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
C9773 HCPCS Revasc Lithotr-stent Tib/per 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22810 CPT Arthrd Ant Dfrm 4-7 Vrt Sgm 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
C9766 HCPCS Revasc Intra Lithotrip-ather 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
C9767 HCPCS Revasc Lithotrip-stent-ather 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
C9774 HCPCS Revasc Lithotr-ather Tib/per 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
C9607 HCPCS Perc D-e Cor Revasc Chro Sin 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
C9600 HCPCS Perc Drug-el Cor Stent Sing 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22802 CPT Arthrd Pst Dfrm 7-12 Vrt Sgm 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22804 CPT Arthrd Pst Dfrm 13+ Vrt Sgm 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22800 CPT Arthrd Pst Dfrm<6 Vrt Sgm 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
24371 CPT Revise Reconst Elbow Joint 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22610 CPT Arthrd Pst Tq 1ntrspc Thrc 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22630 CPT Arthrd Pst Tq 1ntrspc Lum 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
C9765 HCPCS Revasc Intra Lithotrip-stent 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
27137 CPT Revise Hip Joint Replacement 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
27134 CPT Revise Hip Joint Replacement 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22808 CPT Arthrd Ant Dfrm 2-3 Vrt Sgm 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
92925 CPT Outpatient Surgery 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22590 CPT Arthrd Pst Tq Craniocervical 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
37230 CPT Outpatient Surgery 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22586 CPT Arthrd Pre-sac Ntrbdy L5-s1 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22595 CPT Arthrd Pst Tq Atlas-axis 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
36903 CPT Intro Cath Dialysis Circuit 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
69714 CPT Impl Oi Implt Skull Perq Esp 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22558 CPT Arthrd Ant Ntrbd Min Dsc Lum 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
64581 CPT Opn Impltj Nea Sacral Nerve 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
64575 CPT Opn Impltj Nea Perph Nerve 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
63290 CPT Bx/exc Xdrl/idrl Lsn Any Lvl 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
63287 CPT Bx/exc Idrl Imed Lesn Thrlmb 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
63655 CPT Implant Neuroelectrodes 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
64580 CPT Opn Impltj Nea Neuromuscular 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
63252 CPT Revise Spine Cord Vsl Thrlmb 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
63185 CPT Incise Spine Nrv Half Segmnt 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
63191 CPT Incise Spine Accessory Nerve 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
63272 CPT Excise Intrspinl Lesion Lmbr 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22532 CPT Arthrd Lat Xtrcvtry Tq Thrc 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
61624 CPT Tcat Perm Occls/embolj Cns 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0645T CPT Tcat Impltj C Sins Rdctj Dev 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
63190 CPT Incise Spine Nrv >2 Segmnts 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
63200 CPT Release Spinal Cord Lumbar 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
20838 CPT Replantation Foot Complete 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
61626 CPT Tcat Perm Occls/embol Noncns 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
63277 CPT Bx/exc Xdrl Spine Lesn Lmbr 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22548 CPT Arthrd Ant Toral/xoral C1-c2 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
56637 CPT Vlvctmy Rad Comp Bi Lymphad 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
56634 CPT Vlvctmy Rad Comp Uni Lymphad 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22556 CPT Arthrd Ant Ntrbd Min Dsc Thc 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
61623 CPT Evasc Temp Balo Artl Occ H/n 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0632T CPT Perq Tcat US Abltj Nrv P-art 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
56633 CPT Vulvectomy Radical Complete 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
55873 CPT Cryoablate Prostate 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
20802 CPT Replantation Arm Complete 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
20805 CPT Replant Forearm Complete 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22533 CPT Arthrd Lat Xtrcvtry Tq Lmbr 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
92924 CPT Prq Trluml C Athrc 1 Art&/br 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
56631 CPT Vlvctmy Rad Prtl Uni Lymphad 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
20808 CPT Replantation Hand Complete 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
55866 CPT Laps Surg Prst8ect Rpbic Rad 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
56632 CPT Vlvctmy Rad Prtl Bi Lymphad 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
63282 CPT Bx/exc Idrl Spine Lesn Lmbr 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
37242 CPT Vasc Embolize/occlude Artery 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0620T CPT Evasc Ven Artlz Tibl/prnl Vn 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
54400 CPT Insert Semi-rigid Prosthesis 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
25446 CPT Arthrp W/prostc Dst Rds&crps 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
53451 CPT Tprnl Balo Cntnc Dev Bi 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
25441 CPT Arthrp W/prostc Dstl Rds 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
25442 CPT Arthrp W/prostc Dstl Ulna 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
53440 CPT Male Sling Procedure 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
53444 CPT Insert Tandem Cuff 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
47370 CPT Laparo Ablate Liver Tumor Rf 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
37226 CPT Outpatient Surgery 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
C9602 HCPCS Perc D-e Cor Stent Ather S 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
C9604 HCPCS Perc D-e Cor Revasc T Cabg S 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33902 CPT Perq P-art Revsc 1 Abnor Uni 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
37241 CPT Vasc Embolize/occlude Venous 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0505T CPT Ev Fempop Artl Revsc 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
C9772 HCPCS Revasc Lithotrip Tibi/perone 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
43647 CPT Lap Impl Electrode Antrum 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
37243 CPT Vasc Embolize/occlude Organ 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
37238 CPT Open/perq Place Stent Same 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
37244 CPT Vasc Embolize/occlude Bleed 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
37229 CPT Outpatient Surgery 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
37225 CPT Outpatient Surgery 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0775T CPT Outpatient Surgery 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
27279 CPT Arthrd Si Jt Plmt Tartclr Dv 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
37233 CPT Outpatient Surgery 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
24366 CPT Reconstruct Head Of Radius 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0516T CPT Insj Wcs Lv Eltrd Only 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
27284 CPT Arthrodesis Hip Joint 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
36905 CPT Thrmbc/nfs Dialysis Circuit 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22849 CPT Reinsert Spinal Fixation 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
36836 CPT Prq Av Fstl Crtj Uxtr 1 Acs 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33903 CPT Perq P-art Revsc 1 Abnor Bi 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33822 CPT Repair Pda Div<18 Years 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33900 CPT Perq P-art Revsc 1 Nm Nt Uni 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
37182 CPT Insert Hepatic Shunt (tips) 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33285 CPT Insj Subq Car Rhythm Mntr 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
24363 CPT Replace Elbow Joint 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
24370 CPT Revise Reconst Elbow Joint 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
22600 CPT Arthrd Pst Tq 1ntrspc Crv 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
24361 CPT Reconstruct Elbow Joint 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0238T CPT Trluml Perip Athrc Iliac Art 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33271 CPT Insj Subq Impltbl Dfb Elctrd 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
37183 CPT Revision Tips 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0572T CPT Insertion Ss Dfb Electrode 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33228 CPT Remv&replc Pm Gen Dual Lead 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33229 CPT Remv&replc Pm Gen Mult Leads 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33221 CPT Insert Pulse Gen Mult Leads 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33213 CPT Insert Pulse Gen Dual Leads 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0237T CPT Trluml Perip Athrc Brchiocph 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33227 CPT Remove&replace Pm Gen Singl 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33207 CPT Insert Heart Pm Ventricular 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
32652 CPT Thoracoscopy Rem Totl Cortex 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
32655 CPT Thoracoscopy Resect Bullae 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0236T CPT Trluml Perip Athrc Abd Aorta 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
32651 CPT Thoracoscopy Remove Cortex 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33212 CPT Insert Pulse Gen Sngl Lead 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
37221 CPT Outpatient Surgery 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
0426T CPT Outpatient Surgery 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
33206 CPT Insert Heart Pm Atrial 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
27591 CPT Amputate Leg At Thigh 3 1 — — $4,926.00 $4,926.00 $4,926.00 2026-02-12
J7352 HCPCS Afamelanotide Implant, 1 Mg 2 1 — — $3,213.58 $4,820.37 $4,016.97 2026-02-12
J0225 HCPCS Inj, Vutrisiran, 1 Mg 2 1 — — $4,774.04 $4,774.04 $4,774.04 2026-02-12
90396 CPT Varicella-zoster Ig IM 2 1 — — $2,326.37 $4,652.74 $3,489.55 2026-02-12
C9067 HCPCS Gallium Ga-68 Dotatoc 2 1 — — $3,092.23 $4,638.35 $3,865.29 2026-02-12
J2993 HCPCS Reteplase Injection 2 1 — — $3,081.45 $4,622.18 $3,851.82 2026-02-12
Q4353 HCPCS Xceed Tl Matrix Per Sq Cm 2 1 — — $3,009.00 $4,513.50 $3,761.25 2026-02-12
Q4341 HCPCS Simplimax, Per Sq Cm 2 1 — — $2,996.46 $4,494.69 $3,745.57 2026-02-12
Q4313 HCPCS Dermabind Fm, Per Sq Cm 2 1 — — $2,932.50 $4,398.75 $3,665.62 2026-02-12
A9586 HCPCS Florbetapir F18 2 1 — — $2,914.55 $4,371.83 $3,643.19 2026-02-12
J9286 HCPCS Inj Glofitamab Gxbm, 2.5 Mg 2 1 — — $2,909.46 $4,364.19 $3,636.82 2026-02-12
Q4204 HCPCS Xwrap 1 Sq Cm 2 1 — — $2,907.00 $4,360.50 $3,633.75 2026-02-12
J9268 HCPCS Pentostatin Injection 2 1 — — $2,869.16 $4,303.74 $3,586.45 2026-02-12
Q4169 HCPCS Artacent Wound, Per Sq Cm 2 1 — — $2,825.40 $4,238.10 $3,531.75 2026-02-12
J9229 HCPCS Inj Inotuzumab Ozogam 0.1 Mg 2 1 — — $2,791.04 $4,186.56 $3,488.80 2026-02-12
Q4264 HCPCS Cocoon Membrane, Per Sq Cm 2 1 — — $2,754.00 $4,131.00 $3,442.50 2026-02-12
Q4246 HCPCS Coretext Or Protext, Per Cc 2 1 — — $2,737.00 $4,105.50 $3,421.25 2026-02-12
Q4344 HCPCS Tri Membrane Wrap, Per Sq Cm 2 1 — — $2,601.00 $3,901.50 $3,251.25 2026-02-12
Q4294 HCPCS Amnio Quad-core, Per Sq Cm 2 1 — — $2,550.00 $3,825.00 $3,187.50 2026-02-12
Q4161 HCPCS Bio-connekt Per Square Cm 2 1 — — $2,550.00 $3,825.00 $3,187.50 2026-02-12
Q2017 HCPCS Op Carveout Services 2 1 — — $2,545.87 $3,818.81 $3,182.34 2026-02-12
A9584 HCPCS Iodine I-123 Ioflupane 2 1 — — $2,517.36 $3,776.04 $3,146.70 2026-02-12
Q4299 HCPCS Amniocore Pro+, Per Sq Cm 2 1 — — $2,499.00 $3,748.50 $3,123.75 2026-02-12
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