Hospital

PRAIRIE RIDGE HOSPITAL AND HEALTH SERVICES

Elbow Lake, MN · CCN 241379 · Rates published

Your selected procedure

You selected 93306 (CPT)

ECHO (2D) COMPLETE W DOPPLER & COLOR

This hospital’s price: $1,077 across 15 payers · range $363-$2,143

Source: https://sthpiprd.blob.core.windows.net/machine-readable-files/10082/411763968-1407838329_prairie-ridge-hospital-and-health-services_standardcharges.csv · observed 2026-03-17

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.

15,620 distinct procedures filed

16 distinct payers

302,800 rate rows

2026-07-30 last MRF observed

Data quality

67,697 of 302,800 rate rows are consumer-grade (22.4%)

235,103 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 — reason	Rows
professional (physician) fee — not the facility price	227,921
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	6,820
per-diem day rate — not a per-procedure price	155
percent-of-charges filed in the dollar field — excluded from medians	136
placeholder amount (≤ $0.02) — excluded from medians	39
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	29
exceeds 10× this hospital's gross charge — excluded from medians	3

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://sthpiprd.blob.core.windows.net/machine-readable-files/10082/411763968-1407838329_prairie-ridge-hospital-and-health-services_standardcharges.csv
Found on page	https://www.lrhc.org/cms-hpt.txt
Discovered via	Discovered by HANK (automated)
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-10-12
Content fingerprint	a1cff27bcb0e765f… · 81,821,742 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	$2,672,250.00	$3,563,000.00	$3,117,625.00	nat. median $3,703,693 0.8× median
J1414 HCPCS	Inj, Beqvez, Per Tx Dose	1	$2,672,250.00	$3,563,000.00	$3,117,625.00	nat. median $3,710,000 0.8× median
J1413 HCPCS	Inj Delandistrogene Mox Rokl	1	$2,443,200.00	$3,257,600.00	$2,850,400.00	nat. median $3,324,572 0.9× median
J3394 HCPCS	Inj, Lovotibeglogene Autotem	1	$2,366,850.00	$3,155,800.00	$2,761,325.00	nat. median $3,286,000 0.8× median
J3393 HCPCS	Inj, Betibeglogene Autotemce	1	$2,137,800.00	$2,850,400.00	$2,494,100.00	nat. median $2,994,107 0.8× median
J3399 HCPCS	Inj Onase Abepar-xioi Treat	1	$1,826,067.30	$2,434,756.39	$2,130,411.85	nat. median $2,466,282 0.9× median
J3392 HCPCS	Inj, Exagamglogene Autotem	1	$1,679,700.00	$2,239,600.00	$1,959,650.00	nat. median $2,401,960 0.8× median
Q2054 HCPCS	Lisocabtagene Mara Car Pos T	1	$405,686.03	$540,914.71	$473,300.37	nat. median $640,950 0.7× median
Q2055 HCPCS	Idecabtagene Vicleucel Car	1	$403,366.54	$537,822.05	$470,594.30	nat. median $622,245 0.8× median
Q2056 HCPCS	Ciltacabtagene Car-pos T	1	$398,589.38	$531,452.50	$465,020.94	nat. median $646,415 0.7× median
Q2041 HCPCS	Axicabtagene Ciloleucel Car+	1	$384,483.33	$512,644.44	$448,563.89	nat. median $608,101 0.7× median
Q2053 HCPCS	Brexucabtagene Car Pos T	1	$352,737.00	$470,316.00	$411,526.50	nat. median $591,650 0.7× median
90288 CPT	Botulism Ig IV	1	$37,186.27	$74,372.54	$55,779.40	nat. median $51,570 1.1× median
Q2043 HCPCS	Sipuleucel-t Auto Cd54+	1	$47,797.02	$63,729.37	$55,763.19	nat. median $65,720 0.8× median
J9226 HCPCS	Supprelin La Implant	1	$36,285.26	$72,570.51	$54,427.88	nat. median $55,159 1.0× median
J9029 HCPCS	Instill Adstiladrin, Tx Dose	1	$45,810.00	$61,080.00	$53,445.00	nat. median $68,423 0.8× median
J9266 HCPCS	Pegaspargase Injection	1	$21,701.77	$43,403.54	$32,552.65	nat. median $33,238 1.0× median
J9600 HCPCS	Porfimer Sodium Injection	1	$18,163.26	$36,326.51	$27,244.89	nat. median $30,131 0.9× median
J7310 HCPCS	All Outpatient	1	$12,948.96	$25,897.92	$19,423.44	nat. median $18,387 1.1× median
61886 CPT	Implant Neurostim Arrays	1	$15,564.00	$15,564.00	$15,564.00	nat. median $27,176 0.6× median
64568 CPT	Opn Impltj Crnl Nrv Nea&pg	1	$15,564.00	$15,564.00	$15,564.00	nat. median $27,679 0.6× median
0571T CPT	Insj/rplcmt Icds Ss Eltrd	1	$15,564.00	$15,564.00	$15,564.00	nat. median $32,221 outlier · 0.5×
0408T CPT	Insj/rplc Cardiac Modulj Sys	1	$15,564.00	$15,564.00	$15,564.00	nat. median $32,041 outlier · 0.5×
0409T CPT	Insj/rplc Car Modulj Pls Gn	1	$15,564.00	$15,564.00	$15,564.00	nat. median $23,240 0.7× median
33289 CPT	Tcat Impl Wrls P-art Prs Snr	1	$15,564.00	$15,564.00	$15,564.00	nat. median $27,726 0.6× median
0424T CPT	Op Surgery	1	$15,564.00	$15,564.00	$15,564.00	nat. median $22,810 0.7× median
0515T CPT	Insj Wcs Lv Compl Sys	1	$15,564.00	$15,564.00	$15,564.00	nat. median $22,680 0.7× median
0414T CPT	Rmvl & Rpl Car Modulj Pls Gn	1	$15,564.00	$15,564.00	$15,564.00	nat. median $23,236 0.7× median
33270 CPT	Ins/rep Subq Defibrillator	1	$15,564.00	$15,564.00	$15,564.00	nat. median $32,113 outlier · 0.5×
33264 CPT	Pf 33264 Rmvl & Replc Defib Gen Mult Leads	1	$15,564.00	$15,564.00	$15,564.00	nat. median $31,564 outlier · 0.5×
33263 CPT	Pf 33263 Rmvl & Replc Defib Gen Dual Leads	1	$15,564.00	$15,564.00	$15,564.00	nat. median $23,346 0.7× median
33231 CPT	Insrt Pulse Gen W/mult Leads	1	$15,564.00	$15,564.00	$15,564.00	nat. median $30,121 0.5× median
0614T CPT	Rmvl&rplcmt Ss Impl Dfb Pg	1	$15,564.00	$15,564.00	$15,564.00	nat. median $23,432 0.7× median
33230 CPT	Insrt Pulse Gen W/dual Leads	1	$15,564.00	$15,564.00	$15,564.00	nat. median $22,483 0.7× median
33249 CPT	Pf 33249 Insertion Perm Implant Defibrillator Single Or Dual	1	$15,564.00	$15,564.00	$15,564.00	nat. median $31,584 outlier · 0.5×
C9760 HCPCS	Non-blind Interatrial Shunt	1	$15,564.00	$15,564.00	$15,564.00	nat. median $27,848 0.6× median
0520T CPT	Rmv&rplcmt Pg Wcs Lv Battery	1	$15,564.00	$15,564.00	$15,564.00	nat. median $13,297 1.2× median
33240 CPT	Insrt Pulse Gen W/singl Lead	1	$15,564.00	$15,564.00	$15,564.00	nat. median $22,094 0.7× median
33262 CPT	Pf 33262 Remvl & Replc Defib Gen Single Lead	1	$15,564.00	$15,564.00	$15,564.00	nat. median $23,239 0.7× median
0100T CPT	Prosth Retina Receive&gen	1	$15,564.00	$15,564.00	$15,564.00	nat. median $11,267 1.4× median
69930 CPT	Implant Cochlear Device	1	$15,564.00	$15,564.00	$15,564.00	nat. median $29,205 0.5× median
62361 CPT	Implant Spine Infusion Pump	1	$13,073.00	$13,073.00	$13,073.00	nat. median $16,404 0.8× median
62362 CPT	Implant Spine Infusion Pump	1	$13,073.00	$13,073.00	$13,073.00	nat. median $16,426 0.8× median
63685 CPT	Ins/rplc Spi Npg/rcvr Pocket	1	$13,073.00	$13,073.00	$13,073.00	nat. median $21,040 0.6× median
61885 CPT	Insrt/redo Neurostim 1 Array	1	$13,073.00	$13,073.00	$13,073.00	nat. median $19,858 0.7× median
C9782 HCPCS	Blind Myocar Trpl Bon Marrow	1	$13,073.00	$13,073.00	$13,073.00	nat. median $18,356 0.7× median
0427T CPT	Op Surgery	1	$13,073.00	$13,073.00	$13,073.00	nat. median $15,162 0.9× median
0308T CPT	Insj Ocular Telescope Prosth	1	$13,073.00	$13,073.00	$13,073.00	nat. median $16,353 0.8× median
37231 CPT	All Other Professional	1	$13,073.00	$13,073.00	$13,073.00	nat. median $18,375 0.7× median
33967 CPT	Insert I-aort Percut Device	1	$13,073.00	$13,073.00	$13,073.00	nat. median $2,976 outlier · 4.4×

Other procedures at this hospital

Browse this hospital's 15,620 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

J1414	HCPCS	Inj, Beqvez, Per Tx Dose	2	1	—	—	$2,672,250.00	$3,563,000.00	$3,117,625.00	2026-03-17
J1411	HCPCS	Inj, Hemgenix, Per Tx Dose	2	1	—	—	$2,672,250.00	$3,563,000.00	$3,117,625.00	2026-03-17
J1413	HCPCS	Inj Delandistrogene Mox Rokl	2	1	—	—	$2,443,200.00	$3,257,600.00	$2,850,400.00	2026-03-17
J3394	HCPCS	Inj, Lovotibeglogene Autotem	2	1	—	—	$2,366,850.00	$3,155,800.00	$2,761,325.00	2026-03-17
J3393	HCPCS	Inj, Betibeglogene Autotemce	2	1	—	—	$2,137,800.00	$2,850,400.00	$2,494,100.00	2026-03-17
J3399	HCPCS	Inj Onase Abepar-xioi Treat	2	1	—	—	$1,826,067.30	$2,434,756.39	$2,130,411.85	2026-03-17
J3392	HCPCS	Inj, Exagamglogene Autotem	2	1	—	—	$1,679,700.00	$2,239,600.00	$1,959,650.00	2026-03-17
Q2054	HCPCS	Lisocabtagene Mara Car Pos T	2	1	—	—	$405,686.03	$540,914.71	$473,300.37	2026-03-17
Q2055	HCPCS	Idecabtagene Vicleucel Car	2	1	—	—	$403,366.54	$537,822.05	$470,594.30	2026-03-17
Q2056	HCPCS	Ciltacabtagene Car-pos T	2	1	—	—	$398,589.38	$531,452.50	$465,020.94	2026-03-17
Q2041	HCPCS	Axicabtagene Ciloleucel Car+	2	1	—	—	$384,483.33	$512,644.44	$448,563.89	2026-03-17
Q2053	HCPCS	Brexucabtagene Car Pos T	2	1	—	—	$352,737.00	$470,316.00	$411,526.50	2026-03-17
90288	CPT	Botulism Ig IV	2	1	—	—	$37,186.27	$74,372.54	$55,779.40	2026-03-17
Q2043	HCPCS	Sipuleucel-t Auto Cd54+	2	1	—	—	$47,797.02	$63,729.37	$55,763.19	2026-03-17
J9226	HCPCS	Supprelin La Implant	2	1	—	—	$36,285.26	$72,570.51	$54,427.88	2026-03-17
J9029	HCPCS	Instill Adstiladrin, Tx Dose	2	1	—	—	$45,810.00	$61,080.00	$53,445.00	2026-03-17
J9266	HCPCS	Pegaspargase Injection	2	1	—	—	$21,701.77	$43,403.54	$32,552.65	2026-03-17
J9600	HCPCS	Porfimer Sodium Injection	2	1	—	—	$18,163.26	$36,326.51	$27,244.89	2026-03-17
J7310	HCPCS	All Outpatient	2	1	—	—	$12,948.96	$25,897.92	$19,423.44	2026-03-17
0409T	CPT	Insj/rplc Car Modulj Pls Gn	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
0414T	CPT	Rmvl & Rpl Car Modulj Pls Gn	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
33231	CPT	Insrt Pulse Gen W/mult Leads	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
33270	CPT	Ins/rep Subq Defibrillator	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
0408T	CPT	Insj/rplc Cardiac Modulj Sys	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
0520T	CPT	Rmv&rplcmt Pg Wcs Lv Battery	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
0515T	CPT	Insj Wcs Lv Compl Sys	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
64568	CPT	Opn Impltj Crnl Nrv Nea&pg	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
33230	CPT	Insrt Pulse Gen W/dual Leads	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
33264	CPT	Pf 33264 Rmvl & Replc Defib Gen Mult Leads	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
33289	CPT	Tcat Impl Wrls P-art Prs Snr	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
0424T	CPT	Op Surgery	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
33262	CPT	Pf 33262 Remvl & Replc Defib Gen Single Lead	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
33249	CPT	Pf 33249 Insertion Perm Implant Defibrillator Single Or Dual	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
0614T	CPT	Rmvl&rplcmt Ss Impl Dfb Pg	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
33263	CPT	Pf 33263 Rmvl & Replc Defib Gen Dual Leads	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
33240	CPT	Insrt Pulse Gen W/singl Lead	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
0571T	CPT	Insj/rplcmt Icds Ss Eltrd	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
0100T	CPT	Prosth Retina Receive&gen	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
C9760	HCPCS	Non-blind Interatrial Shunt	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
61886	CPT	Implant Neurostim Arrays	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
69930	CPT	Implant Cochlear Device	1	1	—	—	$15,564.00	$15,564.00	$15,564.00	2026-03-17
37231	CPT	All Other Professional	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
0308T	CPT	Insj Ocular Telescope Prosth	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
C9782	HCPCS	Blind Myocar Trpl Bon Marrow	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
37227	CPT	All Other Professional	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
62361	CPT	Implant Spine Infusion Pump	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
0268T	CPT	Non Rvu Services	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
0427T	CPT	Op Surgery	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
63685	CPT	Ins/rplc Spi Npg/rcvr Pocket	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
62362	CPT	Implant Spine Infusion Pump	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
64590	CPT	Ins/rpl Prph Sac/gstr Npg/r	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
93591	CPT	Perq Transcath Cls Aortic	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
C9758	HCPCS	Blind Interatrial Shunt Ide	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
93590	CPT	Perq Transcath Cls Mitral	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
64582	CPT	Opn Mpltj Hpglsl Nstm Ary Pg	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
61885	CPT	Insrt/redo Neurostim 1 Array	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
33274	CPT	Tcat Insj/rpl Perm Ldls Pm	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
33968	CPT	Remove Aortic Assist Device	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
0431T	CPT	Op Surgery	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
0266T	CPT	Non Rvu Services	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
33967	CPT	Insert I-aort Percut Device	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
36906	CPT	Thrmbc/nfs Dialysis Circuit	1	1	—	—	$13,073.00	$13,073.00	$13,073.00	2026-03-17
J1412	HCPCS	Inj Roctavian Ml 2x10^13vc G	2	1	—	—	$8,908.62	$11,878.16	$10,393.39	2026-03-17
J9216	HCPCS	Interferon Gamma 1-b Inj	2	1	—	—	$6,588.13	$13,176.26	$9,882.19	2026-03-17
33225	CPT	Pf 33225 Insertion Pacing Elect	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
93656	CPT	Compre Ep Eval Abltj Atr Fib	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
93582	CPT	Perq Transcath Closure Pda	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
54410	CPT	Remove/replace Penis Prosth	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
53447	CPT	Remove/replace Ur Sphincter	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
22633	CPT	Arthrd Cmbn 1ntrspc Lumbar	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
93653	CPT	Compre Ep Eval Tx Svt	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
93581	CPT	Transcath Closure Of Vsd	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
33224	CPT	Insert Pacing Lead & Connect	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
93580	CPT	Transcath Closure Of Asd	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
54416	CPT	Remv/repl Penis Contain Pros	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
54405	CPT	Insert Multi-comp Penis Pros	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
53445	CPT	Insert Uro/ves Nck Sphincter	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
33208	CPT	Pf 33208 Ins Perm Pacemaker Av	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
33820	CPT	Repair Pda By Ligation	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
54401	CPT	Insert Self-contd Prosthesis	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
33824	CPT	Repair Pda Div 18 Yrs&older	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
93654	CPT	Compre Ep Eval Tx Vt	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
33214	CPT	Pf 33214 Upgrade Implanted Pace	1	1	—	—	$7,794.00	$7,794.00	$7,794.00	2026-03-17
Q0224	HCPCS	Inj, Pemivibart, 4500 Mg	2	1	—	—	$5,026.51	$10,053.00	$7,539.76	2026-03-17
J0600	HCPCS	Edetate Calcium Disodium Inj	2	1	—	—	$4,645.22	$9,290.42	$6,967.82	2026-03-17
J9015	HCPCS	Aldesleukin Injection	2	1	—	—	$4,323.32	$8,646.64	$6,484.98	2026-03-17
A9593	HCPCS	Gallium Ga-68 Psma-11 Ucsf	2	1	—	—	$4,196.10	$8,392.21	$6,294.15	2026-03-17
A9594	HCPCS	Gallium Ga-68 Psma-11, Ucla	2	1	—	—	$4,196.10	$8,392.21	$6,294.15	2026-03-17
J9219	HCPCS	Leuprolide Acetate Implant	2	1	—	—	$4,121.53	$8,243.05	$6,182.29	2026-03-17
J0716	HCPCS	Centruroides Immune F(ab)	2	1	—	—	$4,085.51	$8,171.01	$6,128.26	2026-03-17
J1162	HCPCS	Digoxin Immune Fab (ovine)	2	1	—	—	$3,870.93	$7,741.86	$5,806.39	2026-03-17
A9608	HCPCS	Flotufolastat F18 Diag 1 Mci	2	1	—	—	$3,830.19	$7,660.38	$5,745.28	2026-03-17
J9225	HCPCS	Vantas Implant	2	1	—	—	$3,795.62	$7,591.24	$5,693.43	2026-03-17
A9591	HCPCS	Fluoroestradiol F 18	2	1	—	—	$3,594.03	$7,188.05	$5,391.04	2026-03-17
33285	CPT	Ins Subq Cardiac Rhythm Mntr Inc Programming	42	15	$8,801.00	$5,588.64 36% off	$1,901.02	$8,801.00	$5,368.61	2026-03-17
J0480	HCPCS	Basiliximab	2	1	—	—	$3,556.07	$7,112.12	$5,334.10	2026-03-17
27447	CPT	Pf 27447 Arthropl Kne Tib Fem	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0411T	CPT	Insj/rplc Car Modulj Vnt Elt	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
36903	CPT	Intro Cath Dialysis Circuit	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
37182	CPT	Insert Hepatic Shunt (tips)	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27284	CPT	Arthrodesis Hip Joint	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27295	CPT	Amputation Of Leg At Hip	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
36837	CPT	Prq Av Fstl Crt Uxtr Sep Acs	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27279	CPT	Arthrd Si Jt Plmt Tartclr Dv	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27280	CPT	Arthr Si Jt Opn B1grf Instrm	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0572T	CPT	Insertion Ss Dfb Electrode	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22861	CPT	Rev Rplcm Arthrp 1ntrspc Crv	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
37229	CPT	All Other Professional	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0797T	CPT	Tcat Ins 2chmbr Ldls Pm Rv	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0517T	CPT	Insj Wcs Lv Both Compnt Pg	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22862	CPT	Rev Rplcm Rthrp 1ntrspc Lmbr	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
24361	CPT	Reconstruct Elbow Joint	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0793T	CPT	Prq Tcat Thrm Ablt Nrv P-art	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0803T	CPT	Tcat Rmv&rpl2chmb Ldls Pm Rv	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27138	CPT	Revise Hip Joint Replacement	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0809T	CPT	Op Surgery	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0525T	CPT	Insj/rplcmt Compl Iims	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0526T	CPT	Insj/rplcmt Iims Eltrd Only	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0234T	CPT	Trluml Perip Athrc Renal Art	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27290	CPT	Amputation Of Leg At Hip	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
37225	CPT	All Other Professional	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27134	CPT	Revise Hip Joint Replacement	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0775T	CPT	Op Surgery	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27137	CPT	Revise Hip Joint Replacement	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27446	CPT	Revision Of Knee Joint	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
37241	CPT	Vasc Embolize/occlude Venous	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
C9783	HCPCS	Blind Cor Sinus Reducer Impl	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27130	CPT	Pf 27130 Arthropl Hip Ttl	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
C9780	HCPCS	Insert Cv Cath Inf & Sup App	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
C9773	HCPCS	Revasc Lithotr-stent Tib/per	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22849	CPT	Reinsert Spinal Fixation	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27132	CPT	Total Hip Arthroplasty	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
C9767	HCPCS	Revasc Lithotrip-stent-ather	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
C9774	HCPCS	Revasc Lithotr-ather Tib/per	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22819	CPT	Kyphectomy 3 Or More	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22812	CPT	Arthrd Ant Dfrm 8+ Vrt Sgm	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
C9607	HCPCS	Perc D-e Cor Revasc Chro Sin	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
C9602	HCPCS	Perc D-e Cor Stent Ather S	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
C9604	HCPCS	Perc D-e Cor Revasc T Cabg S	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
C9765	HCPCS	Revasc Intra Lithotrip-stent	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
37242	CPT	Vasc Embolize/occlude Artery	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
20838	CPT	Replantation Foot Complete	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
43647	CPT	Lap Impl Electrode Antrum	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
33902	CPT	Perq P-art Revsc 1 Abnor Uni	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
20802	CPT	Replantation Arm Complete	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
20805	CPT	Replant Forearm Complete	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22857	CPT	Tot Disc Arthrp 1ntrspc Lmbr	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
20808	CPT	Replantation Hand Complete	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22802	CPT	Arthrd Pst Dfrm 7-12 Vrt Sgm	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
32656	CPT	Thoracoscopy W/pleurectomy	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22600	CPT	Arthrd Pst Tq 1ntrspc Crv	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22610	CPT	Arthrd Pst Tq 1ntrspc Thrc	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22590	CPT	Arthrd Pst Tq Craniocervical	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22630	CPT	Arthrd Pst Tq 1ntrspc Lum	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
92925	CPT	Op Surgery	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
37236	CPT	Open/perq Place Stent 1st	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
69714	CPT	Impl Oi Implt Skull Perq Esp	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22556	CPT	Arthrd Ant Ntrbd Min Dsc Thc	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
64583	CPT	Rev/rplct Hpglsl Nstm Ary Pg	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
64575	CPT	Opn Impltj Nea Perph Nerve	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
64580	CPT	Opn Impltj Nea Neuromuscular	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22586	CPT	Arthrd Pre-sac Ntrbdy L5-s1	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
64581	CPT	Opn Impltj Nea Sacral Nerve	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
63282	CPT	Bx/exc Idrl Spine Lesn Lmbr	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
63272	CPT	Excise Intrspinl Lesion Lmbr	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
63287	CPT	Bx/exc Idrl Imed Lesn Thrlmb	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
63190	CPT	Incise Spine Nrv >2 Segmnts	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
63185	CPT	Incise Spine Nrv Half Segmnt	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
63191	CPT	Incise Spine Accessory Nerve	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
25446	CPT	Arthrp W/prostc Dst Rds&crps	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22533	CPT	Arthrd Lat Xtrcvtry Tq Lmbr	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
63252	CPT	Revise Spine Cord Vsl Thrlmb	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
63277	CPT	Bx/exc Xdrl Spine Lesn Lmbr	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22548	CPT	Arthrd Ant Toral/xoral C1-c2	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0645T	CPT	Tcat Impltj C Sins Rdctj Dev	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
63200	CPT	Release Spinal Cord Lumbar	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
63290	CPT	Bx/exc Xdrl/idrl Lsn Any Lvl	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
61626	CPT	Tcat Perm Occls/embol Noncns	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
25441	CPT	Arthrp W/prostc Dstl Rds	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0632T	CPT	Perq Tcat US Abltj Nrv P-art	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22558	CPT	Arthrd Ant Ntrbd Min Dsc Lum	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
25442	CPT	Arthrp W/prostc Dstl Ulna	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
56637	CPT	Vlvctmy Rad Comp Bi Lymphad	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
56634	CPT	Vlvctmy Rad Comp Uni Lymphad	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
61623	CPT	Evasc Temp Balo Artl Occ H/n	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
92924	CPT	Prq Trluml C Athrc 1 Art&/br	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
56632	CPT	Vlvctmy Rad Prtl Bi Lymphad	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22532	CPT	Arthrd Lat Xtrcvtry Tq Thrc	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
56633	CPT	Vulvectomy Radical Complete	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22595	CPT	Arthrd Pst Tq Atlas-axis	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
61624	CPT	Tcat Perm Occls/embolj Cns	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
63655	CPT	Implant Neuroelectrodes	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0620T	CPT	Evasc Ven Artlz Tibl/prnl Vn	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
53451	CPT	Tprnl Balo Cntnc Dev Bi	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
53440	CPT	Male Sling Procedure	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
C9766	HCPCS	Revasc Intra Lithotrip-ather	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
53444	CPT	Insert Tandem Cuff	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
54400	CPT	Insert Semi-rigid Prosthesis	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22808	CPT	Arthrd Ant Dfrm 2-3 Vrt Sgm	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
55866	CPT	Laps Surg Prst8ect Rpbic Rad	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22804	CPT	Arthrd Pst Dfrm 13+ Vrt Sgm	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
C9600	HCPCS	Perc Drug-el Cor Stent Sing	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
47370	CPT	Laparo Ablate Liver Tumor Rf	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22810	CPT	Arthrd Ant Dfrm 4-7 Vrt Sgm	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
43774	CPT	Pf 43774 Lap Gastric Wband	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22818	CPT	Kyphectomy 1-2 Segments	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
47371	CPT	Laparo Ablate Liver Cryosurg	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
37243	CPT	Vasc Embolize/occlude Organ	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0505T	CPT	Ev Fempop Artl Revsc	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
C9772	HCPCS	Revasc Lithotrip Tibi/perone	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
37238	CPT	Open/perq Place Stent Same	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
C9775	HCPCS	Revasc Lith-sten-ath Tib/per	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
37244	CPT	Vasc Embolize/occlude Bleed	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
50542	CPT	Laparo Ablate Renal Mass	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
37230	CPT	All Other Professional	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0426T	CPT	Op Surgery	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
37226	CPT	All Other Professional	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
37183	CPT	Revision Tips	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
36905	CPT	Thrmbc/nfs Dialysis Circuit	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
37221	CPT	All Other Professional	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
37233	CPT	All Other Professional	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0516T	CPT	Insj Wcs Lv Eltrd Only	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
55873	CPT	Cryoablate Prostate	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
56631	CPT	Vlvctmy Rad Prtl Uni Lymphad	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0398T	CPT	All Other Professional	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
33903	CPT	Perq P-art Revsc 1 Abnor Bi	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
24366	CPT	Reconstruct Head Of Radius	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
24370	CPT	Revise Reconst Elbow Joint	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
33900	CPT	Perq P-art Revsc 1 Nm Nt Uni	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
24363	CPT	Replace Elbow Joint	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
33822	CPT	Repair Pda Div<18 Years	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
33901	CPT	Perq P-art Revsc 1 Nm Nt Bi	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
33271	CPT	Insj Subq Impltbl Dfb Elctrd	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
33228	CPT	Pf 33228 Remove Replace Pulse G	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0238T	CPT	Trluml Perip Athrc Iliac Art	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
33229	CPT	Pf 33229 Remove Replace Pulse G	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
33221	CPT	Insert Pulse Gen Mult Leads	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
33212	CPT	Insert Pulse Gen Sngl Lead	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
33213	CPT	Insert Pulse Gen Dual Leads	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
33207	CPT	Pf 33207 Ins Perm Pacemaker Ven	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0527T	CPT	Insj/rplcmt Iims Implt Mntr	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27286	CPT	Arthrd Hip Jt Sbtrchc Osteot	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0410T	CPT	Insj/rplc Car Modulj Atr Elt	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
32652	CPT	Thoracoscopy Rem Totl Cortex	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0237T	CPT	Trluml Perip Athrc Brchiocph	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
32655	CPT	Thoracoscopy Resect Bullae	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
32650	CPT	Thoracoscopy W/pleurodesis	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27592	CPT	Amputate Leg At Thigh	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
32651	CPT	Thoracoscopy Remove Cortex	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
0236T	CPT	Trluml Perip Athrc Abd Aorta	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27590	CPT	Amputate Leg At Thigh	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27486	CPT	Revise/replace Knee Joint	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27487	CPT	Revise/replace Knee Joint	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
24371	CPT	Revise Reconst Elbow Joint	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27591	CPT	Amputate Leg At Thigh	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
33227	CPT	Remove&replace Pm Gen Singl	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
36836	CPT	Prq Av Fstl Crtj Uxtr 1 Acs	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
22800	CPT	Arthrd Pst Dfrm<6 Vrt Sgm	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
33206	CPT	Pf 33206 Ins Perm Pacemaker Atr	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
23470	CPT	Reconstruct Shoulder Joint	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
27880	CPT	Pf 27880 Amput Leg Bel Kne Bka	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
23472	CPT	Reconstruct Shoulder Joint	1	1	—	—	$5,005.00	$5,005.00	$5,005.00	2026-03-17
J7504	HCPCS	Lymphocyte Immune Globulin	2	1	—	—	$3,325.60	$6,651.20	$4,988.40	2026-03-17
J2507	HCPCS	Pegloticase Injection	2	1	—	—	$2,710.47	$7,227.90	$4,969.18	2026-03-17
J9200	HCPCS	Floxuridine Injection	2	1	—	—	$3,198.39	$6,396.79	$4,797.59	2026-03-17
35206	CPT	Ed 35206 Rpr Bld Vesl Dir Uppr Extr	42	15	$7,407.00	$4,703.45 36% off	$1,495.00	$7,407.00	$4,518.27	2026-03-17
J0801	HCPCS	Inj. Acthar Gel To 40 Units	2	1	—	—	$2,922.55	$5,845.10	$4,383.83	2026-03-17
Q4351	HCPCS	Enclose Tl Matrix, Per Sq Cm	2	1	—	—	$2,920.39	$5,840.78	$4,380.59	2026-03-17
J3316	HCPCS	Inj., Triptorelin Xr 3.75 Mg	2	1	—	—	$2,894.12	$5,788.25	$4,341.18	2026-03-17
J0225	HCPCS	Inj, Vutrisiran, 1 Mg	2	1	—	—	$3,644.98	$4,859.97	$4,252.48	2026-03-17
Q4342	HCPCS	Theramend, Per Sq Cm	2	1	—	—	$2,725.70	$5,451.39	$4,088.55	2026-03-17
Q4350	HCPCS	Palisade Dm Matrix Per Sq Cm	2	1	—	—	$2,725.70	$5,451.39	$4,088.55	2026-03-17
A9601	HCPCS	Flortaucipir Inj 1 Millicuri	2	1	—	—	$2,725.70	$5,451.39	$4,088.55	2026-03-17
Q4346	HCPCS	Shelter Dm Matrix Per Sq Cm	2	1	—	—	$2,725.70	$5,451.39	$4,088.55	2026-03-17
J0802	HCPCS	Inj. (ani), Up To 40 Units	2	1	—	—	$2,648.47	$5,296.94	$3,972.70	2026-03-17
Q4303	HCPCS	Complete Aa, Per Sq Cm	2	1	—	—	$2,605.66	$5,211.34	$3,908.50	2026-03-17
G0390	HCPCS	Trauma Activation Full W Ccare	41	15	$6,117.00	$3,884.30 36% off	$1,321.27	$6,117.00	$3,731.37	2026-03-17
J7352	HCPCS	Afamelanotide Implant, 1 Mg	2	1	—	—	$2,453.57	$4,907.14	$3,680.36	2026-03-17
C9067	HCPCS	Gallium Ga-68 Dotatoc	2	1	—	—	$2,360.92	$4,721.84	$3,541.38	2026-03-17
J2993	HCPCS	Reteplase Injection	2	1	—	—	$2,352.69	$4,705.38	$3,529.03	2026-03-17
Q4353	HCPCS	Xceed Tl Matrix Per Sq Cm	2	1	—	—	$2,297.37	$4,594.74	$3,446.05	2026-03-17
Q4341	HCPCS	Simplimax, Per Sq Cm	2	1	—	—	$2,287.80	$4,575.59	$3,431.70	2026-03-17
28825	CPT	Tx Rm 28825 Amputate Toe Interphalangeal Joint	42	15	$5,594.00	$3,552.19 36% off	$1,208.30	$5,594.00	$3,412.34	2026-03-17
Q4313	HCPCS	Dermabind Fm, Per Sq Cm	2	1	—	—	$2,238.97	$4,477.93	$3,358.45	2026-03-17
A9586	HCPCS	Florbetapir F18	2	1	—	—	$2,225.26	$4,450.52	$3,337.89	2026-03-17
J9286	HCPCS	Inj Glofitamab Gxbm, 2.5 Mg	2	1	—	—	$2,221.38	$4,442.75	$3,332.07	2026-03-17
Q4204	HCPCS	Xwrap 1 Sq Cm	2	1	—	—	$2,219.49	$4,438.99	$3,329.24	2026-03-17
J9268	HCPCS	Pentostatin Injection	2	1	—	—	$2,190.60	$4,381.21	$3,285.90	2026-03-17
90396	CPT	Varicella-zoster Ig IM	2	1	—	—	$1,776.19	$4,736.49	$3,256.34	2026-03-17
Q4169	HCPCS	Artacent Wound, Per Sq Cm	2	1	—	—	$2,157.19	$4,314.39	$3,235.79	2026-03-17
J9229	HCPCS	Inj Inotuzumab Ozogam 0.1 Mg	2	1	—	—	$2,130.96	$4,261.92	$3,196.44	2026-03-17
Q4264	HCPCS	Cocoon Membrane, Per Sq Cm	2	1	—	—	$2,102.68	$4,205.36	$3,154.02	2026-03-17
74174	CPT	CTA Abd&plvs W/contrast	43	15	$5,154.00	$3,272.79 36% off	$500.00	$5,154.00	$3,143.94	2026-03-17
Q4246	HCPCS	Coretext Or Protext, Per Cc	2	1	—	—	$2,089.70	$4,179.40	$3,134.55	2026-03-17
26418	CPT	Ed 26418 Rpr Ext Tendon Finger Each	42	15	$5,009.00	$3,180.72 36% off	$722.00	$5,009.00	$3,055.49	2026-03-17
26236	CPT	Ed 26236 Part Exc Dist Phalanx	42	15	$4,969.00	$3,155.32 36% off	$722.00	$4,969.00	$3,031.09	2026-03-17
Q4344	HCPCS	Tri Membrane Wrap, Per Sq Cm	2	1	—	—	$1,985.86	$3,971.73	$2,978.80	2026-03-17
27000	CPT	Tx Rm 27000 Tenotomy Adductor Hip Perc	42	15	$4,828.00	$3,065.78 36% off	$1,042.85	$4,828.00	$2,945.08	2026-03-17
Q4294	HCPCS	Amnio Quad-core, Per Sq Cm	2	1	—	—	$1,946.92	$3,893.85	$2,920.39	2026-03-17
Q4161	HCPCS	Bio-connekt Per Square Cm	2	1	—	—	$1,946.92	$3,893.85	$2,920.39	2026-03-17

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