Hospital

DEER LODGE MEDICAL CENTER

Deer Lodge, MT · CCN 271314 · Rates published

1,237 distinct procedures filed

6 distinct payers

13,057 rate rows

2026-01-01 last MRF observed

Data quality

13,036 of 13,057 rate rows are consumer-grade (99.8%)

21 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
percent-of-charges filed in the dollar field — excluded from medians	15
placeholder amount (≤ $0.02) — excluded from medians	6

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
J2350 HCPCS	Ocrelizumab 300 Mg/10ml IV Soln	6	$18,015.73	$42,831.50	$40,623.69	nat. median $133 outlier · 305.5×
J3380 HCPCS	Vedolizumab 300 Mg IV Solr	6	$8,169.46	$19,422.49	$18,421.33	nat. median $59 outlier · 313.3×
J2327 HCPCS	Risankizumab-rzaa 600 Mg/10ml IV Soln	6	$7,375.28	$17,534.37	$16,630.54	nat. median $48 outlier · 346.7×
J3101 HCPCS	Tenecteplase 50 Mg IV Kit	6	$6,673.53	$16,544.99	$15,538.86	nat. median $498 outlier · 31.2×
J2323 HCPCS	Natalizumab 300 Mg/15ml IV Conc	6	$6,547.41	$15,566.14	$15,245.19	nat. median $50 outlier · 302.2×
PX-36010208 CDM	Hc Operating Room Services Level 8 First Hr	6	$6,401.93	$15,220.27	$14,906.45	—
PX-75010272 CDM	Hc Endoscopy/Gastrointestinal Procedure Level 6	6	$5,979.24	$14,215.35	$13,922.25	—
PX-36010371 CDM	Hc Pain Room Services Level 6	6	$5,694.46	$13,538.29	$13,259.15	—
J9271 HCPCS	Pembrolizumab 100 Mg/4ml IV Soln	6	$5,250.57	$12,482.97	$12,225.59	nat. median $127 outlier · 96.3×
PX-36010206 CDM	Hc Operating Room Services Level 6 First Hr	6	$4,994.33	$11,873.77	$11,628.95	—
PX-36010207 CDM	Hc Operating Room Services Level 7 First Hr	6	$4,878.05	$11,597.32	$11,358.20	—
PX-75010319 CDM	Hc Endoscopy/Gastrointestinal Procedure Level 5	6	$4,710.36	$11,198.65	$10,967.75	—
PX-36010005 CDM	Hc Pain Room Services Level 5	6	$4,710.36	$11,198.65	$10,967.75	—
J0517 HCPCS	Benralizumab 30 Mg/ml Subq Sosy	6	$4,516.50	$10,737.76	$10,516.37	nat. median $404 outlier · 26.0×
PX-36010205 CDM	Hc Operating Room Services Level 5 First Hr	6	$4,281.55	$10,179.18	$9,969.30	—
J1932 HCPCS	Lanreotide Acetate 120 Mg/0.5ml Subq Soln	6	$4,164.19	$9,900.17	$9,696.04	nat. median $76 outlier · 126.8×
PX-36010204 CDM	Hc Operating Room Services Level 4 First Hr	6	$3,805.01	$9,046.22	$8,859.70	—
PX-36010203 CDM	Hc Operating Room Services Level 3 First Hr	6	$3,409.25	$8,105.32	$7,938.20	—
J2997 HCPCS	Alteplase 100 Mg IV Solr	6	$225.13	$16,828.01	$7,720.07	nat. median $428 outlier · 18.0×
J0565 HCPCS	Bezlotoxumab 1000 Mg/40ml IV Soln	6	$3,316.66	$7,885.20	$7,478.74	nat. median $121 outlier · 62.0×
PX-4050842MDL CDM	Hc Linq Device	6	$3,204.43	$7,618.38	$7,461.30	—
J1306 HCPCS	Inclisiran Sodium 284 Mg/1.5ml Subq Sosy	6	$2,959.19	$7,035.33	$6,672.69	nat. median $25 outlier · 264.8×
PX-36010202 CDM	Hc Operating Room Services Level 2 First Hr	6	$2,854.37	$6,786.12	$6,646.20	—
PX-75010318 CDM	Hc Endoscopy/Gastrointestinal Procedure Level 4	6	$2,669.54	$6,346.71	$6,215.85	—
PX-36010004 CDM	Hc Pain Room Services Level 4	6	$2,669.54	$6,346.71	$6,215.85	—
PX-36010201 CDM	Hc Operating Room Services Level 1 First Hr	6	$2,299.90	$5,467.89	$5,355.15	—
Q5115 HCPCS	Rituximab-abbs 500 Mg/50ml IV Soln	6	$2,278.26	$5,416.46	$5,304.78	nat. median $368 outlier · 14.4×
J3111 HCPCS	Romosozumab-aqqg 105 Mg/1.17ml Subq Sosy	6	$2,294.34	$5,454.68	$5,173.51	nat. median $19 outlier · 272.3×
J3262 HCPCS	Tocilizumab 400 Mg/20ml IV Soln	6	$2,136.09	$5,078.44	$4,973.73	nat. median $1,287 outlier · 3.9×
G0390 HCPCS	Hc Ed Trauma Activation Full With Critical Care G0390 Cdm	6	$2,132.62	$5,070.19	$4,965.65	nat. median $3,280 1.5× median
13160 CPT	Extensive Or Complicated Repair Wound Reopening	6	$2,121.19	$5,043.03	$4,939.05	nat. median $2,668 1.9× median
20525 CPT	Complicated Remove Foreign Body In Deep Muscle/tendon	6	$2,032.66	$4,832.54	$4,732.90	nat. median $2,969 1.6× median
PX-75010317 CDM	Hc Endoscopy/Gastrointestinal Procedure Level 3	6	$1,962.89	$4,666.67	$4,570.45	—
PX-36010003 CDM	Hc Pain Room Services Level 3	6	$1,962.89	$4,666.67	$4,570.45	—
27087 CPT	Remove Foreign Body In Tissue Or Muscle Of Pelvis Or Hip	6	$1,941.67	$4,616.23	$4,521.05	nat. median $3,466 1.3× median
74178 CPT	CT Scan Of Abdomen And Pelvis Before And After Contrast	6	$1,924.94	$4,576.46	$4,340.56	nat. median $539 outlier · 8.1×
46270 CPT	Repair Of Abnormal Anal Drainage Tract	6	$1,851.91	$4,402.83	$4,312.05	nat. median $3,043 1.4× median
J3358 HCPCS	Ustekinumab 130 Mg/26ml IV Soln	6	$1,849.14	$4,396.24	$4,305.60	nat. median $38 outlier · 113.5×
72158 CPT	MRI Scan Of Lower Spinal Canal Before And After Contrast	6	$1,834.78	$4,362.09	$4,137.24	nat. median $616 outlier · 6.7×
72156 CPT	MRI Scan Of Upper Spinal Canal Before And After Contrast	6	$1,824.58	$4,337.84	$4,114.24	nat. median $625 outlier · 6.6×
72157 CPT	MRI Scan Of Middle Spinal Canal Before And After Contrast	6	$1,811.52	$4,306.80	$4,084.80	nat. median $624 outlier · 6.5×
71552 CPT	MRI Scan Of Chest Before And After Contrast	6	$1,752.36	$4,166.15	$4,080.25	nat. median $691 outlier · 5.9×
70553 CPT	MRI Scan Of Brain Before And After Contrast	6	$1,800.91	$4,281.58	$4,060.88	nat. median $616 outlier · 6.6×
74183 CPT	MRI Scan Of Abdomen Before And After Contrast	6	$1,764.60	$4,195.25	$3,979.00	nat. median $611 outlier · 6.5×
72197 CPT	MRI Scan Of Pelvis Before And After Contrast	6	$1,751.14	$4,163.24	$3,948.64	nat. median $606 outlier · 6.5×
70543 CPT	MRI Scan Of Bone Of Eye Socket, Face, And/or Neck	6	$1,746.65	$4,152.57	$3,938.52	nat. median $605 outlier · 6.5×
73723 CPT	MRI Scan Of Leg Joint Before And After Contrast	6	$1,731.96	$4,117.65	$3,905.40	nat. median $756 outlier · 5.2×
74177 CPT	CT Scan Of Abdomen And Pelvis With Contrast	6	$1,710.74	$4,067.21	$3,857.56	nat. median $501 outlier · 7.7×
70546 CPT	MRI Scan Of Blood Vessels Of Head Before And After Contrast	6	$1,654.03	$3,932.38	$3,851.30	nat. median $625 outlier · 6.2×
73220 CPT	MRI Scan Of Arm Before And After Contrast	6	$1,650.36	$3,923.65	$3,842.75	nat. median $737 outlier · 5.2×

Other procedures at this hospital

Browse this hospital's 1,237 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

J2350	HCPCS	Ocrelizumab 300 Mg/10ml IV Soln	6	6	$44,156.19	$44,156.19	$18,015.73	$42,831.50	$40,623.69	2026-01-01
J3380	HCPCS	Vedolizumab 300 Mg IV Solr	6	6	$20,023.19	$20,023.19	$8,169.46	$19,422.49	$18,421.33	2026-01-01
J2327	HCPCS	Risankizumab-rzaa 600 Mg/10ml IV Soln	6	6	$18,076.67	$18,076.67	$7,375.28	$17,534.37	$16,630.54	2026-01-01
J3101	HCPCS	Tenecteplase 50 Mg IV Kit	22	6	$16,706.69	$16,356.69	$6,673.53	$16,544.99	$15,538.86	2026-01-01
J2323	HCPCS	Natalizumab 300 Mg/15ml IV Conc	11	6	$16,047.57	$16,047.57	$6,547.41	$15,566.14	$15,245.19	2026-01-01
PX-36010208	CDM	Hc Operating Room Services Level 8 First Hr	11	6	$15,691.00	$15,691.00	$6,401.93	$15,220.27	$14,906.45	2026-01-01
PX-75010272	CDM	Hc Endoscopy/Gastrointestinal Procedure Level 6	11	6	$14,655.00	$14,655.00	$5,979.24	$14,215.35	$13,922.25	2026-01-01
PX-36010371	CDM	Hc Pain Room Services Level 6	11	6	$13,957.00	$13,957.00	$5,694.46	$13,538.29	$13,259.15	2026-01-01
J9271	HCPCS	Pembrolizumab 100 Mg/4ml IV Soln	11	6	$12,869.04	$12,869.04	$5,250.57	$12,482.97	$12,225.59	2026-01-01
PX-36010206	CDM	Hc Operating Room Services Level 6 First Hr	11	6	$12,241.00	$12,241.00	$4,994.33	$11,873.77	$11,628.95	2026-01-01
PX-36010207	CDM	Hc Operating Room Services Level 7 First Hr	11	6	$11,956.00	$11,956.00	$4,878.05	$11,597.32	$11,358.20	2026-01-01
PX-36010005	CDM	Hc Pain Room Services Level 5	11	6	$11,545.00	$11,545.00	$4,710.36	$11,198.65	$10,967.75	2026-01-01
PX-75010319	CDM	Hc Endoscopy/Gastrointestinal Procedure Level 5	11	6	$11,545.00	$11,545.00	$4,710.36	$11,198.65	$10,967.75	2026-01-01
J0517	HCPCS	Benralizumab 30 Mg/ml Subq Sosy	11	6	$11,069.86	$11,069.86	$4,516.50	$10,737.76	$10,516.37	2026-01-01
PX-36010205	CDM	Hc Operating Room Services Level 5 First Hr	11	6	$10,494.00	$10,494.00	$4,281.55	$10,179.18	$9,969.30	2026-01-01
J1932	HCPCS	Lanreotide Acetate 120 Mg/0.5ml Subq Soln	11	6	$10,206.36	$10,206.36	$4,164.19	$9,900.17	$9,696.04	2026-01-01
PX-36010204	CDM	Hc Operating Room Services Level 4 First Hr	11	6	$9,326.00	$9,326.00	$3,805.01	$9,046.22	$8,859.70	2026-01-01
PX-36010203	CDM	Hc Operating Room Services Level 3 First Hr	11	6	$8,356.00	$8,356.00	$3,409.25	$8,105.32	$7,938.20	2026-01-01
J2997	HCPCS	Alteplase 100 Mg IV Solr	18	6	$8,674.24	$8,674.24	$225.13	$16,828.01	$7,720.07	2026-01-01
J0565	HCPCS	Bezlotoxumab 1000 Mg/40ml IV Soln	6	6	$8,129.07	$8,129.07	$3,316.66	$7,885.20	$7,478.74	2026-01-01
PX-4050842MDL	CDM	Hc Linq Device	11	6	$7,854.00	$7,854.00	$3,204.43	$7,618.38	$7,461.30	2026-01-01
J1306	HCPCS	Inclisiran Sodium 284 Mg/1.5ml Subq Sosy	6	6	$7,252.92	$7,252.92	$2,959.19	$7,035.33	$6,672.69	2026-01-01
PX-36010202	CDM	Hc Operating Room Services Level 2 First Hr	11	6	$6,996.00	$6,996.00	$2,854.37	$6,786.12	$6,646.20	2026-01-01
PX-36010004	CDM	Hc Pain Room Services Level 4	11	6	$6,543.00	$6,543.00	$2,669.54	$6,346.71	$6,215.85	2026-01-01
PX-75010318	CDM	Hc Endoscopy/Gastrointestinal Procedure Level 4	11	6	$6,543.00	$6,543.00	$2,669.54	$6,346.71	$6,215.85	2026-01-01
PX-36010201	CDM	Hc Operating Room Services Level 1 First Hr	11	6	$5,637.00	$5,637.00	$2,299.90	$5,467.89	$5,355.15	2026-01-01
Q5115	HCPCS	Rituximab-abbs 500 Mg/50ml IV Soln	11	6	$5,583.98	$5,583.98	$2,278.26	$5,416.46	$5,304.78	2026-01-01
J3111	HCPCS	Romosozumab-aqqg 105 Mg/1.17ml Subq Sosy	6	6	$5,623.38	$5,623.38	$2,294.34	$5,454.68	$5,173.51	2026-01-01
J3262	HCPCS	Tocilizumab 400 Mg/20ml IV Soln	11	6	$5,235.51	$5,235.51	$2,136.09	$5,078.44	$4,973.73	2026-01-01
G0390	HCPCS	Hc Ed Trauma Activation Full With Critical Care G0390 Cdm	11	6	$5,227.00	$5,227.00	$2,132.62	$5,070.19	$4,965.65	2026-01-01
13160	CPT	Extensive Or Complicated Repair Wound Reopening	11	6	$5,199.00	$5,199.00	$2,121.19	$5,043.03	$4,939.05	2026-01-01
20525	CPT	Complicated Remove Foreign Body In Deep Muscle/tendon	11	6	$4,982.00	$4,982.00	$2,032.66	$4,832.54	$4,732.90	2026-01-01
PX-36010003	CDM	Hc Pain Room Services Level 3	11	6	$4,811.00	$4,811.00	$1,962.89	$4,666.67	$4,570.45	2026-01-01
PX-75010317	CDM	Hc Endoscopy/Gastrointestinal Procedure Level 3	11	6	$4,811.00	$4,811.00	$1,962.89	$4,666.67	$4,570.45	2026-01-01
27087	CPT	Remove Foreign Body In Tissue Or Muscle Of Pelvis Or Hip	11	6	$4,759.00	$4,759.00	$1,941.67	$4,616.23	$4,521.05	2026-01-01
74178	CPT	CT Scan Of Abdomen And Pelvis Before And After Contrast	6	6	$4,718.00	$4,718.00	$1,924.94	$4,576.46	$4,340.56	2026-01-01
46270	CPT	Repair Of Abnormal Anal Drainage Tract	11	6	$4,539.00	$4,539.00	$1,851.91	$4,402.83	$4,312.05	2026-01-01
J3358	HCPCS	Ustekinumab 130 Mg/26ml IV Soln	11	6	$4,532.21	$4,532.21	$1,849.14	$4,396.24	$4,305.60	2026-01-01
72158	CPT	MRI Scan Of Lower Spinal Canal Before And After Contrast	6	6	$4,497.00	$4,497.00	$1,834.78	$4,362.09	$4,137.24	2026-01-01
72156	CPT	MRI Scan Of Upper Spinal Canal Before And After Contrast	6	6	$4,472.00	$4,472.00	$1,824.58	$4,337.84	$4,114.24	2026-01-01
72157	CPT	MRI Scan Of Middle Spinal Canal Before And After Contrast	6	6	$4,440.00	$4,440.00	$1,811.52	$4,306.80	$4,084.80	2026-01-01
71552	CPT	MRI Scan Of Chest Before And After Contrast	11	6	$4,295.00	$4,295.00	$1,752.36	$4,166.15	$4,080.25	2026-01-01
70553	CPT	MRI Scan Of Brain Before And After Contrast	6	6	$4,414.00	$4,414.00	$1,800.91	$4,281.58	$4,060.88	2026-01-01
74183	CPT	MRI Scan Of Abdomen Before And After Contrast	6	6	$4,325.00	$4,325.00	$1,764.60	$4,195.25	$3,979.00	2026-01-01
72197	CPT	MRI Scan Of Pelvis Before And After Contrast	6	6	$4,292.00	$4,292.00	$1,751.14	$4,163.24	$3,948.64	2026-01-01
70543	CPT	MRI Scan Of Bone Of Eye Socket, Face, And/or Neck	6	6	$4,281.00	$4,281.00	$1,746.65	$4,152.57	$3,938.52	2026-01-01
73723	CPT	MRI Scan Of Leg Joint Before And After Contrast	6	6	$4,245.00	$4,245.00	$1,731.96	$4,117.65	$3,905.40	2026-01-01
74177	CPT	CT Scan Of Abdomen And Pelvis With Contrast	6	6	$4,193.00	$4,193.00	$1,710.74	$4,067.21	$3,857.56	2026-01-01
70546	CPT	MRI Scan Of Blood Vessels Of Head Before And After Contrast	11	6	$4,054.00	$4,054.00	$1,654.03	$3,932.38	$3,851.30	2026-01-01
73220	CPT	MRI Scan Of Arm Before And After Contrast	11	6	$4,045.00	$4,045.00	$1,650.36	$3,923.65	$3,842.75	2026-01-01
57415	CPT	Removal Of Impacted Foreign Body In Vagina Under Anesthesia	11	6	$4,025.00	$4,025.00	$1,642.20	$3,904.25	$3,823.75	2026-01-01
PX-36010002	CDM	Hc Pain Room Services Level 2	11	6	$3,987.00	$3,987.00	$1,626.70	$3,867.39	$3,787.65	2026-01-01
74174	CPT	CT Scan Of Blood Vessels Of Abdomen And Pelvis W/contrast	6	6	$4,066.00	$4,066.00	$1,658.93	$3,944.02	$3,740.72	2026-01-01
20102	CPT	Exploration Of Wound Of Abdomen, Back, Or Flank	11	6	$3,885.00	$3,885.00	$1,585.08	$3,768.45	$3,690.75	2026-01-01
73720	CPT	MRI Scan Of Leg Before And After Contrast	6	6	$4,005.00	$4,005.00	$1,634.04	$3,884.85	$3,684.60	2026-01-01
70549	CPT	MRI Scan Of Blood Vessels Of Neck Before And After Contrast	6	6	$3,996.00	$3,996.00	$1,630.37	$3,876.12	$3,676.32	2026-01-01
J1602	HCPCS	Golimumab 50 Mg/4ml IV Soln	6	6	$3,937.82	$3,937.82	$1,606.63	$3,819.69	$3,622.80	2026-01-01
64624	CPT	Destroy Nerve Branches Of Knee Using Imaging Guidance	11	6	$3,768.00	$3,768.00	$1,537.34	$3,654.96	$3,579.60	2026-01-01
26951	CPT	Amputation Of Finger Or Thumb With Direct Closure	11	6	$3,728.00	$3,728.00	$1,521.02	$3,616.16	$3,541.60	2026-01-01
72147	CPT	MRI Scan Of Middle Spinal Canal With Contrast	11	6	$3,702.00	$3,702.00	$1,510.42	$3,590.94	$3,516.90	2026-01-01
73223	CPT	MRI Scan Of Arm Joint Before And After Contrast	6	6	$3,812.00	$3,812.00	$1,555.30	$3,697.64	$3,507.04	2026-01-01
93015	CPT	Drug-induced Heart Stress Test With Electrocardiogram	11	6	$3,681.00	$3,681.00	$1,501.85	$3,570.57	$3,496.95	2026-01-01
70542	CPT	MRI Scan Of Bone Of Eye Socket, Face, Neck W/contrast	11	6	$3,606.00	$3,606.00	$1,471.25	$3,497.82	$3,425.70	2026-01-01
70552	CPT	MRI Scan Of Brain With Contrast	11	6	$3,602.00	$3,602.00	$1,469.62	$3,493.94	$3,421.90	2026-01-01
27372	CPT	Removal Of Foreign Body In Tissue Of Thigh Or Knee	11	6	$3,585.00	$3,585.00	$1,462.68	$3,477.45	$3,405.75	2026-01-01
J0897	HCPCS	Denosumab 60 Mg/ml Subq Sosy	6	6	$3,696.74	$3,696.74	$1,508.27	$3,585.84	$3,401.00	2026-01-01
72142	CPT	MRI Scan Of Upper Spinal Canal With Contrast	11	6	$3,546.00	$3,546.00	$1,446.77	$3,439.62	$3,368.70	2026-01-01
72149	CPT	MRI Scan Of Lower Spinal Canal With Contrast	11	6	$3,541.00	$3,541.00	$1,444.73	$3,434.77	$3,363.95	2026-01-01
46040	CPT	Drainage Of Abscess In Rectum	11	6	$3,463.00	$3,463.00	$1,412.90	$3,359.11	$3,289.85	2026-01-01
73722	CPT	MRI Scan Of Leg Joint With Contrast	11	6	$3,453.00	$3,453.00	$1,408.82	$3,349.41	$3,280.35	2026-01-01
65235	CPT	Removal Of Foreign Body In Eye Or Lens	11	6	$3,402.00	$3,402.00	$1,388.02	$3,299.94	$3,231.90	2026-01-01
Q5111	HCPCS	Pegfilgrastim-cbqv 6 Mg/0.6ml Subq Sosy	11	6	$3,351.27	$3,351.27	$1,367.32	$3,250.73	$3,183.71	2026-01-01
J2315	HCPCS	Naltrexone 380 Mg IM Susr	11	6	$3,331.15	$3,331.15	$1,359.11	$3,231.22	$3,164.59	2026-01-01
73719	CPT	MRI Scan Of Leg With Contrast	11	6	$3,317.00	$3,317.00	$1,353.34	$3,217.49	$3,151.15	2026-01-01
15273	CPT	Hc Graft Trunk/Arm/Leg Total Gte 100 Sq/Cm 1st 100 Sq/Cm Cdm	11	6	$3,273.00	$3,273.00	$1,335.38	$3,174.81	$3,109.35	2026-01-01
72127	CPT	CT Scan Of Upper Spine Before And After Contrast	11	6	$3,268.00	$3,268.00	$1,333.34	$3,169.96	$3,104.60	2026-01-01
73219	CPT	MRI Scan Of Arm With Contrast	11	6	$3,268.00	$3,268.00	$1,333.34	$3,169.96	$3,104.60	2026-01-01
74176	CPT	CT Scan Of Abdomen And Pelvis Without Contrast	6	6	$3,368.00	$3,368.00	$1,374.14	$3,266.96	$3,098.56	2026-01-01
74182	CPT	MRI Scan Of Abdomen With Contrast	11	6	$3,256.00	$3,256.00	$1,328.45	$3,158.32	$3,093.20	2026-01-01
72196	CPT	MRI Scan Of Pelvis With Contrast	11	6	$3,255.00	$3,255.00	$1,328.04	$3,157.35	$3,092.25	2026-01-01
70548	CPT	MRI Scan Of Blood Vessels Of Neck With Contrast	11	6	$3,254.00	$3,254.00	$1,327.63	$3,156.38	$3,091.30	2026-01-01
19083	CPT	Biopsy Breast Using Ultrasound, First Growth	6	6	$3,291.00	$3,291.00	$1,342.73	$3,192.27	$3,027.72	2026-01-01
PX-36010001	CDM	Hc Pain Room Services Level 1	11	6	$3,161.00	$3,161.00	$1,289.69	$3,066.17	$3,002.95	2026-01-01
71551	CPT	MRI Scan Of Chest With Contrast	11	6	$3,144.00	$3,144.00	$1,282.75	$3,049.68	$2,986.80	2026-01-01
45915	CPT	Removal Of Stool/foreign Body In Rectum Under General Anesthesia	11	6	$3,125.00	$3,125.00	$1,275.00	$3,031.25	$2,968.75	2026-01-01
72194	CPT	CT Scan Of Pelvis Before And After Contrast	11	6	$3,078.00	$3,078.00	$1,255.82	$2,985.66	$2,924.10	2026-01-01
10005	CPT	Fine Needle Biopsy Using Ultrasound Guidance, 1st Growth	6	6	$3,174.00	$3,174.00	$1,294.99	$3,078.78	$2,920.08	2026-01-01
J0129	HCPCS	Abatacept 250 Mg IV Solr	11	6	$3,055.58	$3,055.58	$1,246.68	$2,963.91	$2,902.80	2026-01-01
Q4101	HCPCS	Hc Apligraf Per Sq Cm	11	6	$3,051.00	$3,051.00	$1,244.81	$2,959.47	$2,898.45	2026-01-01
72141	CPT	MRI Scan Of Upper Spinal Canal Without Contrast	6	6	$3,092.00	$3,092.00	$1,261.54	$2,999.24	$2,844.64	2026-01-01
99291	CPT	Critical Care, First 30-74 Minutes	11	6	$2,991.00	$2,991.00	$1,220.33	$2,901.27	$2,841.45	2026-01-01
72146	CPT	MRI Scan Of Middle Spinal Canal Without Contrast	6	6	$3,083.00	$3,083.00	$1,257.86	$2,990.51	$2,836.36	2026-01-01
72148	CPT	MRI Scan Of Lower Spinal Canal Without Contrast	6	6	$3,072.00	$3,072.00	$1,253.38	$2,979.84	$2,826.24	2026-01-01
74181	CPT	MRI Scan Of Abdomen Without Contrast	6	6	$3,049.00	$3,049.00	$1,243.99	$2,957.53	$2,805.08	2026-01-01
72133	CPT	CT Scan Of Lower Spine Before And After Contrast	11	6	$2,949.00	$2,949.00	$1,203.19	$2,860.53	$2,801.55	2026-01-01
70551	CPT	MRI Scan Of Brain Without Contrast	6	6	$3,032.00	$3,032.00	$1,237.06	$2,941.04	$2,789.44	2026-01-01
72195	CPT	MRI Scan Of Pelvis Without Contrast	11	6	$2,932.00	$2,932.00	$1,196.26	$2,844.04	$2,785.40	2026-01-01
28193	CPT	Complicated Removal Of Foreign Body In Foot	11	6	$2,930.00	$2,930.00	$1,195.44	$2,842.10	$2,783.50	2026-01-01
71270	CPT	CT Scan Of Chest Before And After Contrast	6	6	$3,023.00	$3,023.00	$1,233.38	$2,932.31	$2,781.16	2026-01-01
71275	CPT	CT Blood Vessels Chest With Contrast	6	6	$3,020.00	$3,020.00	$1,232.16	$2,929.40	$2,778.40	2026-01-01
70540	CPT	MRI Scan Of Bone Of Eye Socket, Face, Neck W/contrast	6	6	$3,019.00	$3,019.00	$1,231.75	$2,928.43	$2,777.48	2026-01-01
J1745	HCPCS	Infliximab 100 Mg IV Solr	6	6	$3,001.02	$3,001.02	$1,224.42	$2,910.99	$2,760.94	2026-01-01
74170	CPT	CT Scan Of Abdomen Before And After Contrast	6	6	$2,995.00	$2,995.00	$1,221.96	$2,905.15	$2,755.40	2026-01-01
PX-75010316	CDM	Hc Endoscopy/Gastrointestinal Procedure Level 2	11	6	$2,889.00	$2,889.00	$1,178.71	$2,802.33	$2,744.55	2026-01-01
71550	CPT	MRI Scan Of Chest Without Contrast	11	6	$2,882.00	$2,882.00	$1,175.86	$2,795.54	$2,737.90	2026-01-01
74175	CPT	CT Scan Of Blood Vessels Of Arm With Contrast	6	6	$2,959.00	$2,959.00	$1,207.27	$2,870.23	$2,722.28	2026-01-01
75635	CPT	CT Scan Of Abdominal Aorta And Both Leg Arteries W/contrast	6	6	$2,955.00	$2,955.00	$1,205.64	$2,866.35	$2,718.60	2026-01-01
73706	CPT	CT Scan Of Blood Vessels Of Neck With Contrast	6	6	$2,952.00	$2,952.00	$1,204.42	$2,863.44	$2,715.84	2026-01-01
73721	CPT	MRI Scan Of Leg Joint Without Contrast	6	6	$2,949.00	$2,949.00	$1,203.19	$2,860.53	$2,713.08	2026-01-01
70547	CPT	MRI Scan Of Blood Vessels Of Neck Without Contrast	11	6	$2,853.00	$2,853.00	$1,164.02	$2,767.41	$2,710.35	2026-01-01
73221	CPT	MRI Scan Of Arm Joint Without Contrast	6	6	$2,934.00	$2,934.00	$1,197.07	$2,845.98	$2,699.28	2026-01-01
43215	CPT	Removal Of Foreign Bodies In Esophagus W/endoscope	11	6	$2,830.00	$2,830.00	$1,154.64	$2,745.10	$2,688.50	2026-01-01
72130	CPT	CT Scan Of Middle Spine Before And After Contrast	11	6	$2,827.00	$2,827.00	$1,153.42	$2,742.19	$2,685.65	2026-01-01
70545	CPT	MRI Scan Of Blood Vessels Of Head With Contrast	6	6	$2,914.00	$2,914.00	$1,188.91	$2,826.58	$2,680.88	2026-01-01
73718	CPT	MRI Scan Of Leg Without Contrast	6	6	$2,909.00	$2,909.00	$1,186.87	$2,821.73	$2,676.28	2026-01-01
70496	CPT	CT Scan Of Blood Vessels Of Head With Contrast	6	6	$2,897.00	$2,897.00	$1,181.98	$2,810.09	$2,665.24	2026-01-01
70336	CPT	MRI Scan Of Jaw Joint	11	6	$2,797.00	$2,797.00	$1,141.18	$2,713.09	$2,657.15	2026-01-01
70544	CPT	MRI Scan Of Blood Vessels Of Head Without Contrast	6	6	$2,876.00	$2,876.00	$1,173.41	$2,789.72	$2,645.92	2026-01-01
70498	CPT	CT Scan Of Blood Vessels Of Neck With Contrast	6	6	$2,869.00	$2,869.00	$1,170.55	$2,782.93	$2,639.48	2026-01-01
45005	CPT	Drainage Of Superficial Rectal Abscess	11	6	$2,743.00	$2,743.00	$1,119.14	$2,660.71	$2,605.85	2026-01-01
15275	CPT	Hc Face/Neck/Hand/Feet/Genitalia Total To 100 Sq/Cm 1st 25 Sq/Cm Cdm	6	6	$2,781.00	$2,781.00	$1,134.65	$2,697.57	$2,558.52	2026-01-01
70488	CPT	CT Scan Of Face Before And After Contrast	11	6	$2,691.00	$2,691.00	$1,097.93	$2,610.27	$2,556.45	2026-01-01
20103	CPT	Exploration Of Wound Of Arm Or Leg	11	6	$2,667.00	$2,667.00	$1,088.14	$2,586.99	$2,533.65	2026-01-01
73702	CPT	CT Scan Of Leg Before And After Contrast	11	6	$2,663.00	$2,663.00	$1,086.50	$2,583.11	$2,529.85	2026-01-01
70492	CPT	CT Scan Of Soft Tissue Of Neck Before And After Contrast	6	6	$2,747.00	$2,747.00	$1,120.78	$2,664.59	$2,527.24	2026-01-01
73202	CPT	CT Scan Of Arm Before And After Contrast	11	6	$2,653.00	$2,653.00	$1,082.42	$2,573.41	$2,520.35	2026-01-01
72132	CPT	CT Scan Of Lower Spine With Contrast	11	6	$2,652.00	$2,652.00	$1,082.02	$2,572.44	$2,519.40	2026-01-01
70470	CPT	CT Scan Of Head Or Brain Before And After Contrast	6	6	$2,737.00	$2,737.00	$1,116.70	$2,654.89	$2,518.04	2026-01-01
PX-40508059MDL	CDM	Hc Mirena Intrauterine System	11	6	$2,639.00	$2,639.00	$1,076.71	$2,559.83	$2,507.05	2026-01-01
72126	CPT	CT Scan Of Upper Spine With Contrast	11	6	$2,636.00	$2,636.00	$1,075.49	$2,556.92	$2,504.20	2026-01-01
70482	CPT	CT Scan Of Cranial Cavity Before And After Contrast	11	6	$2,615.00	$2,615.00	$1,066.92	$2,536.55	$2,484.25	2026-01-01
23625	CPT	Closed Treat Upper Arm Bone Broken At Shoulder Joint	11	6	$2,583.00	$2,583.00	$1,053.86	$2,505.51	$2,453.85	2026-01-01
72129	CPT	CT Scan Of Middle Spine With Contrast	11	6	$2,557.00	$2,557.00	$1,043.26	$2,480.29	$2,429.15	2026-01-01
12020	CPT	Simple Closure Of Surface Wound Reopening	11	6	$2,540.00	$2,540.00	$1,036.32	$2,463.80	$2,413.00	2026-01-01
73218	CPT	MRI Scan Of Arm Without Contrast	6	6	$2,595.00	$2,595.00	$1,058.76	$2,517.15	$2,387.40	2026-01-01
74160	CPT	CT Scan Of Abdomen With Contrast	6	6	$2,570.00	$2,570.00	$1,048.56	$2,492.90	$2,364.40	2026-01-01
71260	CPT	CT Scan Of Chest With Contrast	6	6	$2,554.00	$2,554.00	$1,042.03	$2,477.38	$2,349.68	2026-01-01
11044	CPT	Removal Of Bone, 20.0 Sq Cm Or Less	11	6	$2,430.00	$2,430.00	$991.44	$2,357.10	$2,308.50	2026-01-01
PX-12010009	CDM	Hc R&b-semi-private Med Surg With Tele	6	6	$2,423.00	$2,423.00	$2,156.47	$3,525.12	$2,301.85	2026-01-01
70481	CPT	CT Scan Of Cranial Cavity With Contrast	11	6	$2,408.00	$2,408.00	$982.46	$2,335.76	$2,287.60	2026-01-01
72193	CPT	CT Scan Of Pelvis With Contrast	6	6	$2,466.00	$2,466.00	$1,006.13	$2,392.02	$2,268.72	2026-01-01
93306	CPT	Ultrasound Heart W/color Blood Flow, Rate, Direction	6	6	$2,430.00	$2,430.00	$991.44	$2,357.10	$2,235.60	2026-01-01
70487	CPT	CT Scan Of Face With Contrast	6	6	$2,426.00	$2,426.00	$989.81	$2,353.22	$2,231.92	2026-01-01
32556	CPT	Drain Fluid From Chest Cavity With Insert Indwelling Tube	11	6	$2,342.00	$2,342.00	$955.54	$2,271.74	$2,224.90	2026-01-01
23605	CPT	Closed Treatment Of Broken Top Of Upper Arm Bone	11	6	$2,336.00	$2,336.00	$953.09	$2,265.92	$2,219.20	2026-01-01
70491	CPT	CT Scan Of Soft Tissue Of Neck With Contrast	6	6	$2,407.00	$2,407.00	$982.06	$2,334.79	$2,214.44	2026-01-01
93351	CPT	Ultrasound Heart W/ecg During Rest, Exercise, Drug Stress	11	6	$2,321.00	$2,321.00	$946.97	$2,251.37	$2,204.95	2026-01-01
21315	CPT	Closed Treatment Of Broken Nose Bone W/manipulation	11	6	$2,314.00	$2,314.00	$944.11	$2,244.58	$2,198.30	2026-01-01
10140	CPT	Drainage Of Blood Or Fluid Accumulation	11	6	$2,285.00	$2,285.00	$932.28	$2,216.45	$2,170.75	2026-01-01
24605	CPT	Repair Of Dislocated Elbow Under Anesthesia	11	6	$2,240.00	$2,240.00	$913.92	$2,172.80	$2,128.00	2026-01-01
73701	CPT	CT Scan Of Leg With Contrast Material	6	6	$2,302.00	$2,302.00	$939.22	$2,232.94	$2,117.84	2026-01-01
11010	CPT	Remove Foreign Material From Skin And Tissue	11	6	$2,219.00	$2,219.00	$905.35	$2,152.43	$2,108.05	2026-01-01
73201	CPT	CT Scan Of Arm With Contrast	6	6	$2,290.00	$2,290.00	$934.32	$2,221.30	$2,106.80	2026-01-01
70460	CPT	CT Scan Head Or Brain With Contrast	6	6	$2,281.00	$2,281.00	$930.65	$2,212.57	$2,098.52	2026-01-01
12037	CPT	Intermediate Repair Wound Of Body, More Than 30.0 Cm	11	6	$2,195.00	$2,195.00	$895.56	$2,129.15	$2,085.25	2026-01-01
99285	CPT	Emergency Department Visit Level 5	11	6	$2,180.00	$2,180.00	$889.44	$2,114.60	$2,071.00	2026-01-01
72128	CPT	CT Scan Of Middle Spine Without Contrast	11	6	$2,180.00	$2,180.00	$889.44	$2,114.60	$2,071.00	2026-01-01
64999	CPT	Other Procedure On Nervous System	11	6	$2,179.00	$2,179.00	$889.03	$2,113.63	$2,070.05	2026-01-01
93350	CPT	Ultrasound Heart During Rest, Exercise, Drug Stress	6	6	$2,247.00	$2,247.00	$916.78	$2,179.59	$2,067.24	2026-01-01
J7168	HCPCS	Prothrombin Complex Conc Human 500 Units IV Kit	11	6	$2,170.62	$2,170.62	$885.61	$2,105.50	$2,062.09	2026-01-01
72125	CPT	CT Scan Of Upper Spine Without Contrast	6	6	$2,228.00	$2,228.00	$909.02	$2,161.16	$2,049.76	2026-01-01
72131	CPT	CT Scan Of Lower Spine Without Contrast	6	6	$2,204.00	$2,204.00	$899.23	$2,137.88	$2,027.68	2026-01-01
PX-12010001	CDM	Hc R&b-semi-private	6	6	$2,107.00	$2,107.00	$1,875.23	$3,525.12	$2,001.65	2026-01-01
PX-11010001	CDM	Hc R&b- Private	6	6	$2,107.00	$2,107.00	$1,875.23	$3,525.12	$2,001.65	2026-01-01
J1439	HCPCS	Ferric Carboxymaltose 100 Mg/2ml IV Soln	12	6	$2,160.26	$2,126.70	$867.69	$2,128.00	$1,986.43	2026-01-01
PX-12010004	CDM	Hc R&b-semi-private Swing Bed	6	6	$2,043.00	$2,043.00	$1,818.27	$3,085.50	$1,940.85	2026-01-01
PX-11010007	CDM	Hc R&b- Private Swing	6	6	$2,043.00	$2,043.00	$1,818.27	$3,085.50	$1,940.85	2026-01-01
23655	CPT	Closed Treatment Of Dislocated Shoulder	11	6	$2,041.00	$2,041.00	$832.73	$1,979.77	$1,938.95	2026-01-01
40652	CPT	Repair Of Vertical Lip Wound Extending To Half Of Lip	11	6	$1,987.00	$1,987.00	$810.70	$1,927.39	$1,887.65	2026-01-01
74150	CPT	CT Scan Of Abdomen Without Contrast	6	6	$2,040.00	$2,040.00	$832.32	$1,978.80	$1,876.80	2026-01-01
72192	CPT	CT Scan Of Pelvis Without Contrast	6	6	$2,031.00	$2,031.00	$828.65	$1,970.07	$1,868.52	2026-01-01
71250	CPT	CT Scan Of Chest Without Contrast	6	6	$2,010.00	$2,010.00	$820.08	$1,949.70	$1,849.20	2026-01-01
40650	CPT	Repair Of Lip And Border	11	6	$1,941.00	$1,941.00	$791.93	$1,882.77	$1,843.95	2026-01-01
75574	CPT	CT Scan Of Heart, Coronary Arteries And Bypass Graft	11	6	$1,934.00	$1,934.00	$789.07	$1,875.98	$1,837.30	2026-01-01
43200	CPT	Exam Esophagus W/endoscope Through Mouth	11	6	$1,932.00	$1,932.00	$788.26	$1,874.04	$1,835.40	2026-01-01
70490	CPT	CT Scan Of Soft Tissue Of Neck Without Contrast	11	6	$1,930.00	$1,930.00	$787.44	$1,872.10	$1,833.50	2026-01-01
46050	CPT	Drainage Of Superficial Rectal Abscess Surrounding Anus	11	6	$1,911.00	$1,911.00	$779.69	$1,853.67	$1,815.45	2026-01-01
25605	CPT	Closed Treatment Of Broken Or Growth Plate Forearm Bone	11	6	$1,907.00	$1,907.00	$778.06	$1,849.79	$1,811.65	2026-01-01
20520	CPT	Removal Of Foreign Body In Muscle Or Tendon	11	6	$1,904.00	$1,904.00	$776.83	$1,846.88	$1,808.80	2026-01-01
70480	CPT	CT Scan Of Cranial Cavity Without Contrast	6	6	$1,945.00	$1,945.00	$793.56	$1,886.65	$1,789.40	2026-01-01
24620	CPT	Closed Treatment Of Broken And Dislocated Forearm Bones	11	6	$1,876.00	$1,876.00	$765.41	$1,819.72	$1,782.20	2026-01-01
70450	CPT	CT Scan Head Or Brain Without Contrast	6	6	$1,936.00	$1,936.00	$789.89	$1,877.92	$1,781.12	2026-01-01
73700	CPT	CT Scan Of Leg Without Contrast	6	6	$1,934.00	$1,934.00	$789.07	$1,875.98	$1,779.28	2026-01-01
PX-37010121	CDM	Hc Anesthesia Gen 1st Hour Cdm	11	6	$1,856.00	$1,856.00	$757.25	$1,800.32	$1,763.20	2026-01-01
70486	CPT	CT Scan Of Face Without Contrast	6	6	$1,911.00	$1,911.00	$779.69	$1,853.67	$1,758.12	2026-01-01
73200	CPT	CT Scan Of Arm Without Contrast	6	6	$1,886.00	$1,886.00	$769.49	$1,829.42	$1,735.12	2026-01-01
23931	CPT	Drainage Of Fluid Filled Sac In Elbow Joint	11	6	$1,791.00	$1,791.00	$730.73	$1,737.27	$1,701.45	2026-01-01
49083	CPT	Drainage Of Fluid From Abdominal Cavity	11	6	$1,741.00	$1,741.00	$710.33	$1,688.77	$1,653.95	2026-01-01
J0490	HCPCS	Belimumab 120 Mg IV Solr	12	6	$3,033.01	$2,571.24	$591.39	$4,478.03	$1,644.77	2026-01-01
27252	CPT	Closed Treatment Of Dislocated Hip Under Anesthesia	11	6	$1,713.00	$1,713.00	$698.90	$1,661.61	$1,627.35	2026-01-01
11442	CPT	Remove Noncancer Skin Growth Of Head, 1.1-2.0 Cm	11	6	$1,698.00	$1,698.00	$692.78	$1,647.06	$1,613.10	2026-01-01
27510	CPT	Closed Treatment Of Broken Thigh Bone At Knee Area	11	6	$1,691.00	$1,691.00	$689.93	$1,640.27	$1,606.45	2026-01-01
27238	CPT	Closed Treatment Of Broken Below Neck Of Thigh Bone	11	6	$1,691.00	$1,691.00	$689.93	$1,640.27	$1,606.45	2026-01-01
26705	CPT	Closed Treatment Of Dislocated Hand Joint At Base Of Finger	11	6	$1,691.00	$1,691.00	$689.93	$1,640.27	$1,606.45	2026-01-01
26645	CPT	Closed Treatment Of Broken Thumb At Wrist With Manipulation	11	6	$1,691.00	$1,691.00	$689.93	$1,640.27	$1,606.45	2026-01-01
15271	CPT	Hc Graft Trunk/Arm/Leg Total To 100 Sq/Cm 1st 25 Sqcm Or Less Cdm	11	6	$1,685.00	$1,685.00	$687.48	$1,634.45	$1,600.75	2026-01-01
PX-36010225	CDM	Hc Operating Room Services Level 8 Addl 15 Min	11	6	$1,646.00	$1,646.00	$671.57	$1,596.62	$1,563.70	2026-01-01
27562	CPT	Closed Treatment Of Dislocated Kneecap Under Anesthesia	11	6	$1,613.00	$1,613.00	$658.10	$1,564.61	$1,532.35	2026-01-01
76604	CPT	Ultrasound Scan Of Chest	6	6	$1,659.00	$1,659.00	$676.87	$1,609.23	$1,526.28	2026-01-01
25565	CPT	Closed Treatment Of Broken Midpart Of Both Forearm Bones	11	6	$1,516.00	$1,516.00	$618.53	$1,470.52	$1,440.20	2026-01-01
23665	CPT	Closed Treatment Dislocated Shoulder/broken Upper Arm Bone	11	6	$1,512.00	$1,512.00	$616.90	$1,466.64	$1,436.40	2026-01-01
15274	CPT	Hc Graft Trunk/Arm/Leg Total Gte 100 Sq/Cm Ea Addl 100 Sq/Cm Cdm	11	6	$1,492.00	$1,492.00	$608.74	$1,447.24	$1,417.40	2026-01-01
99284	CPT	Emergency Department Visit Level 4	11	6	$1,481.00	$1,481.00	$604.25	$1,436.57	$1,406.95	2026-01-01
27752	CPT	Closed Treatment Of Middle Part Of Broken Shin Bone	11	6	$1,470.00	$1,470.00	$599.76	$1,425.90	$1,396.50	2026-01-01
J0248	HCPCS	Remdesivir 100 Mg IV Solr	11	6	$1,456.81	$1,456.81	$594.38	$1,413.11	$1,383.97	2026-01-01
J7325	HCPCS	Hc Pr Rx Hyaluronan Or Derivative (Synvisc Or Synvisc-one) Inj 1	12	6	$1,499.66	$1,412.33	$576.23	$1,539.39	$1,355.84	2026-01-01
93925	CPT	Ultrasound Of Leg Arteries Or Artery Grafts	6	6	$1,458.00	$1,458.00	$594.86	$1,414.26	$1,341.36	2026-01-01
J0881	HCPCS	Darbepoetin Alfa 300 Mcg/0.6ml Injection Sosy	24	6	$2,704.07	$2,246.64	$337.20	$7,392.79	$1,337.97	2026-01-01
93975	CPT	Ultrasound Abdomen And Pelvis Artery And Vein Blood Flow	6	6	$1,454.00	$1,454.00	$593.23	$1,410.38	$1,337.68	2026-01-01
J0585	HCPCS	Onabotulinumtoxina 100 Units Injection Solr	6	6	$1,453.50	$1,453.50	$593.03	$1,409.90	$1,337.22	2026-01-01
94002	CPT	Initial Hospital Inpatient Or Observation Vent Management	9	5	$1,401.00	$1,401.00	$571.61	$1,358.97	$1,330.95	2026-01-01
93970	CPT	Ultrasound Arm Or Leg Veins With Compression And Maneuvers	6	6	$1,425.00	$1,425.00	$581.40	$1,382.25	$1,311.00	2026-01-01
Q5108	HCPCS	Pegfilgrastim-jmdb 6 Mg/0.6ml Subq Sosy	6	6	$1,392.55	$1,392.55	$568.16	$1,350.77	$1,281.14	2026-01-01
93308	CPT	Ultrasound Of Heart, Follow-up	6	6	$1,353.00	$1,353.00	$552.02	$1,312.41	$1,244.76	2026-01-01
26742	CPT	Closed Treatment Of Broken Finger Or Hand At Base Of Finger	11	6	$1,292.00	$1,292.00	$527.14	$1,253.24	$1,227.40	2026-01-01
28190	CPT	Removal Of Foreign Body Of Foot Tissue	11	6	$1,278.00	$1,278.00	$521.42	$1,239.66	$1,214.10	2026-01-01
74185	CPT	MRI Scan Of Blood Vessels Of Abdomen	11	6	$1,264.00	$1,264.00	$515.71	$1,226.08	$1,200.80	2026-01-01
J1451	HCPCS	Fomepizole 1.5 Gm/1.5ml IV Soln	11	6	$1,238.76	$1,238.76	$505.41	$1,201.60	$1,176.82	2026-01-01
J9217	HCPCS	Leuprolide Acetate (6 Month) 45 Mg Subq Kit	6	6	$1,262.66	$1,262.66	$515.17	$1,224.78	$1,161.65	2026-01-01
49082	CPT	Drainage Of Fluid From Abdominal Cavity	11	6	$1,213.00	$1,213.00	$494.90	$1,176.61	$1,152.35	2026-01-01
93880	CPT	Ultrasound Of Both Sides Of Head And Neck Blood Flow	6	6	$1,247.00	$1,247.00	$508.78	$1,209.59	$1,147.24	2026-01-01
60100	CPT	Needle Biopsy Of Thyroid Through Skin	6	6	$1,246.00	$1,246.00	$508.37	$1,208.62	$1,146.32	2026-01-01
J0588	HCPCS	Incobotulinumtoxina 100 Units IM Solr	11	6	$1,205.00	$1,205.00	$491.64	$1,168.85	$1,144.75	2026-01-01
13151	CPT	Simple Repair Surface Wound Of Head, 1.1-2.5 Cm	11	6	$1,197.00	$1,197.00	$488.38	$1,161.09	$1,137.15	2026-01-01
PX-36010223	CDM	Hc Operating Room Services Level 7 Addl 15 Min	11	6	$1,196.00	$1,196.00	$487.97	$1,160.12	$1,136.20	2026-01-01
76700	CPT	Complete Ultrasound Scan Of Abdomen	6	6	$1,195.00	$1,195.00	$487.56	$1,159.15	$1,099.40	2026-01-01
13120	CPT	Complicated Repair Wound Of Scalp, Limbs, 1.1-2.5 Cm	11	6	$1,143.00	$1,143.00	$466.34	$1,108.71	$1,085.85	2026-01-01
12036	CPT	Repair Wound Of Scalp, Underarms, Trunk, Limbs, 20.1-30cm	11	6	$1,133.00	$1,133.00	$462.26	$1,099.01	$1,076.35	2026-01-01
J9155	HCPCS	Degarelix Acetate(240 Mg Dose) 120 Mg/vial Subq Solr	12	6	$1,345.93	$1,188.83	$456.82	$1,525.04	$1,074.87	2026-01-01
Q4194	HCPCS	Novachor 1 Sq Cm	6	6	$1,161.00	$1,161.00	$473.69	$1,126.17	$1,068.12	2026-01-01
41252	CPT	Reparir Lacerated Tongue Or Floor Of Mouth, > 2.6 Cm	11	6	$1,111.00	$1,111.00	$453.29	$1,077.67	$1,055.45	2026-01-01
93017	CPT	Exercise Or Drug-induced Heart Stress Test With ECG	6	6	$1,127.00	$1,127.00	$459.82	$1,093.19	$1,036.84	2026-01-01
45300	CPT	Exam Rectum And Lower Large Bowel W/endoscope	11	6	$1,084.00	$1,084.00	$442.27	$1,051.48	$1,029.80	2026-01-01
13152	CPT	Complicated Repair Wound Of Head, 2.6-7.5 Cm	11	6	$1,063.00	$1,063.00	$433.70	$1,031.11	$1,009.85	2026-01-01
92950	CPT	Manual Attempt To Restore Blood Circulation And Breathing	9	5	$1,062.00	$1,062.00	$433.30	$1,030.14	$1,008.90	2026-01-01
13101	CPT	Complicated Repair Wound Of Trunk, 2.6-7.5 Cm	11	6	$1,056.00	$1,056.00	$430.85	$1,024.32	$1,003.20	2026-01-01
36430	CPT	Transfusion Of Blood Or Blood Products	6	6	$1,087.00	$1,087.00	$443.50	$1,054.39	$1,000.04	2026-01-01
J2354	HCPCS	Octreotide Acetate 1000 Mcg/ml Injection Soln	11	6	$1,042.14	$1,042.14	$425.19	$1,010.88	$990.03	2026-01-01
93352	CPT	Injection Of X-ray Contrast During Ultrasound Of Heart	6	6	$1,074.00	$1,074.00	$438.19	$1,041.78	$988.08	2026-01-01
0202U	CPT	Test Respiratory Disease Agents From Nose Throat	6	6	$1,063.00	$1,063.00	$433.70	$1,031.11	$977.96	2026-01-01
86366	CPT	Muscle-specific Kinase (MuSK) Antibody	11	6	$1,000.00	$1,000.00	$408.00	$970.00	$950.00	2026-01-01
Q5103	HCPCS	Infliximab-dyyb 100 Mg IV Solr	6	6	$1,031.53	$1,031.53	$420.86	$1,000.58	$949.00	2026-01-01
87150	CPT	Identification Of Organisms By Genetic Analysis, Amplified	11	6	$992.00	$992.00	$404.74	$962.24	$942.40	2026-01-01
93930	CPT	Ultrasound Of Arm Arteries Or Artery Grafts	6	6	$1,023.00	$1,023.00	$417.38	$992.31	$941.16	2026-01-01
51720	CPT	Instillation Of Anti-cancer Drug Into Bladder	11	6	$986.00	$986.00	$402.29	$956.42	$936.70	2026-01-01
87507	CPT	Test By Nucleic Acid For Multiple Gastrointestinal Pathogen 12-25	6	6	$1,015.00	$1,015.00	$414.12	$984.55	$933.80	2026-01-01
76856	CPT	Complete Ultrasound Scan Of Pelvis	6	6	$1,014.00	$1,014.00	$413.71	$983.58	$932.88	2026-01-01
23675	CPT	Closed Treat Dislocated Shoulder,broken Neck Upper Arm Bone	11	6	$977.00	$977.00	$398.62	$947.69	$928.15	2026-01-01
PX-36010221	CDM	Hc Operating Room Services Level 6 Addl 15 Min	11	6	$975.00	$975.00	$397.80	$945.75	$926.25	2026-01-01
15272	CPT	Hc Graft Trunk/Arm/Leg Total To 100 Sq/Cm Ea Addl 25 Sq/Cm Cdm	11	6	$972.00	$972.00	$396.58	$942.84	$923.40	2026-01-01
PX-75010315	CDM	Hc Endoscopy/Gastrointestinal Procedure Level 1	11	6	$965.00	$965.00	$393.72	$936.05	$916.75	2026-01-01
74251	CPT	Double Contrast X-ray Of Small Intestine	11	6	$944.00	$944.00	$385.15	$915.68	$896.80	2026-01-01
13132	CPT	Complicated Repair Wound Of Body, 2.6-7.5 Cm	11	6	$940.00	$940.00	$383.52	$911.80	$893.00	2026-01-01
76770	CPT	Complete Ultrasound Scan Behind Abdominal Cavity	6	6	$961.00	$961.00	$392.09	$932.17	$884.12	2026-01-01
11042	CPT	Removal Of Skin And Tissue, 20.0 Sq Cm Or Less	11	6	$928.00	$928.00	$378.62	$900.16	$881.60	2026-01-01
99283	CPT	Emergency Department Visit Level 3	11	6	$924.00	$924.00	$376.99	$896.28	$877.80	2026-01-01
93971	CPT	Ultrasound One Limb Veins W/compression And Maneuvers	6	6	$953.00	$953.00	$388.82	$924.41	$876.76	2026-01-01
PX-36010217	CDM	Hc Operating Room Services Level 4 Addl 15 Min	11	6	$917.00	$917.00	$374.14	$889.49	$871.15	2026-01-01
76870	CPT	Ultrasound Scan Of Scrotum	6	6	$937.00	$937.00	$382.30	$908.89	$862.04	2026-01-01
24505	CPT	Closed Treatment Of Broken Middle Part Of Upper Arm Bone	11	6	$902.00	$902.00	$368.02	$874.94	$856.90	2026-01-01
Q5104	HCPCS	Infliximab-abda 100 Mg IV Solr	6	6	$930.82	$930.82	$379.77	$902.90	$856.36	2026-01-01
PX-36010219	CDM	Hc Operating Room Services Level 5 Addl 15 Min	11	6	$898.00	$898.00	$366.38	$871.06	$853.10	2026-01-01
76705	CPT	Limited Ultrasound Scan Of Abdomen	6	6	$925.00	$925.00	$377.40	$897.25	$851.00	2026-01-01
PX-37010129	CDM	Hc Anesthesia Regional 1st Hour Cdm	11	6	$894.00	$894.00	$364.75	$867.18	$849.30	2026-01-01
90651	HCPCS	Hc Pr Rx 9vhpv Vaccine 2/3 Dose IM 0.5 Ml	11	6	$888.00	$888.00	$362.30	$861.36	$843.60	2026-01-01
90649	HCPCS	Hc Pr Rx 4vhpv Vaccine 3 Dose IM 0.5 Ml	11	6	$888.00	$888.00	$362.30	$861.36	$843.60	2026-01-01
96416	CPT	Hc Chemo IV Infusion Prolong Via Portable Or Implantable Pump > 8hrs Cdm	11	6	$886.00	$886.00	$361.49	$859.42	$841.70	2026-01-01
13121	CPT	Complicated Repair Wound Of Scalp, Limbs, 2.6-7.5 Cm	11	6	$885.00	$885.00	$361.08	$858.45	$840.75	2026-01-01
PX-40500135MDL	CDM	Hc Groshong 8.0 Fr Single Lumen Cath	11	6	$885.00	$885.00	$361.08	$858.45	$840.75	2026-01-01
51100	CPT	Needle Aspiration Of Bladder	11	6	$880.00	$880.00	$359.04	$853.60	$836.00	2026-01-01
74246	CPT	Double Contrast X-ray Of Upper Digestive Tract	11	6	$860.00	$860.00	$350.88	$834.20	$817.00	2026-01-01
76536	CPT	Ultrasound Scan Of Head And Neck Soft Tissue	6	6	$878.00	$878.00	$358.22	$851.66	$807.76	2026-01-01
76830	CPT	Ultrasound Uterus, Ovaries, Tubes, Cervix And Pelvic Area	6	6	$870.00	$870.00	$354.96	$843.90	$800.40	2026-01-01
31500	CPT	Emergent Insert Breathing Tube Into Windpipe W/endoscope	11	6	$832.00	$832.00	$339.46	$807.04	$790.40	2026-01-01
93926	CPT	Ultrasound Of One Leg Arteries Or Artery Grafts	6	6	$859.00	$859.00	$350.47	$833.23	$790.28	2026-01-01
96413	CPT	Hc Chemo IV Infusion Initial Hr Cdm	6	6	$857.00	$857.00	$349.66	$831.29	$788.44	2026-01-01
12051	CPT	Intermediate Repair Wound Of Head, 2.5 Cm Or Less	11	6	$828.00	$828.00	$337.82	$803.16	$786.60	2026-01-01
J9280	HCPCS	Mitomycin 40 Mg IV Solr	11	6	$816.75	$816.75	$333.23	$792.25	$775.91	2026-01-01
93923	CPT	Complete Ultrasound Study Of Arm And Leg Arteries	6	6	$833.00	$833.00	$339.86	$808.01	$766.36	2026-01-01
74240	CPT	Single Contrast X-ray Of Upper Digestive Tract	11	6	$806.00	$806.00	$328.85	$781.82	$765.70	2026-01-01
90677	CPT	Hc Pr Rx Pneumococcal Conj 20 Valent Vaccine (Pcv20) IM 1 Ea	11	6	$800.00	$800.00	$326.40	$776.00	$760.00	2026-01-01
43762	CPT	Replacement Of Stomach Stoma Tube	11	6	$793.00	$793.00	$323.54	$769.21	$753.35	2026-01-01
99292	CPT	Critical Care, Each Additional 30 Minutes	11	6	$792.00	$792.00	$323.14	$768.24	$752.40	2026-01-01
90710	HCPCS	Hc Pr Rx Measles Mumps Rubella Varicella Vaccine Live Sq 0.5 Ml	11	6	$792.00	$792.00	$323.14	$768.24	$752.40	2026-01-01
92953	CPT	Temporary Pacemaker To Regulate Heart Beat	11	6	$792.00	$792.00	$323.14	$768.24	$752.40	2026-01-01
12052	CPT	Intermediate Repair Wound Of Head, 2.6-5.0 Cm	11	6	$789.00	$789.00	$321.91	$765.33	$749.55	2026-01-01
PX-36010215	CDM	Hc Operating Room Services Level 3 Addl 15 Min	11	6	$785.00	$785.00	$320.28	$761.45	$745.75	2026-01-01
12035	CPT	Repair Wound Of Scalp,underarms, Trunk, Limbs, 12.6-20cm	11	6	$785.00	$785.00	$320.28	$761.45	$745.75	2026-01-01
76942	CPT	Ultrasonic Guidance For Needle Placement	6	6	$809.00	$809.00	$330.07	$784.73	$744.28	2026-01-01
76881	CPT	Complete Ultrasound Scan Of Joint	6	6	$800.00	$800.00	$326.40	$776.00	$736.00	2026-01-01
12045	CPT	Intermediate Repair Wound Of Body, 12.6-20.0 Cm	11	6	$773.00	$773.00	$315.38	$749.81	$734.35	2026-01-01
20610	CPT	Aspiration And/or Injection Of Fluid From Large Joint	11	6	$765.00	$765.00	$312.12	$742.05	$726.75	2026-01-01
C9046	HCPCS	Cocaine Hcl 40 Mg/ml Intranasal Soln	11	6	$764.88	$764.88	$312.07	$741.93	$726.64	2026-01-01
J1610	HCPCS	Glucagon 1 Mg Injection Solr	6	6	$781.20	$781.20	$318.73	$757.76	$718.70	2026-01-01
76805	CPT	Ultrasound OB After 14 Wks Single Fetus	11	6	$749.00	$749.00	$305.59	$726.53	$711.55	2026-01-01
64405	CPT	Inject Anesthetic Agent/steroid, Neck & Head Nerve	11	6	$744.00	$744.00	$303.55	$721.68	$706.80	2026-01-01
PX-40500474MDL	CDM	Hc Thoracic Vent Set	11	6	$728.00	$728.00	$297.02	$706.16	$691.60	2026-01-01
12044	CPT	Intermediate Repair Wound Of Body, 7.6-12.5 Cm	11	6	$727.00	$727.00	$296.62	$705.19	$690.65	2026-01-01
13131	CPT	Complicated Repair Wound Of Body, 1.1-2.5 Cm	11	6	$720.00	$720.00	$293.76	$698.40	$684.00	2026-01-01
J1442	HCPCS	Filgrastim 300 Mcg/ml Injection Soln	11	6	$715.14	$715.14	$291.78	$693.69	$679.38	2026-01-01

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