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Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

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 — reasonRows
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
$414
outlier · 98.0×
J3380
HCPCS 		Vedolizumab 300 Mg IV Solr 6 $8,169.46 $19,422.49 $18,421.33 nat. median
$155
outlier · 119.2×
J2327
HCPCS 		Risankizumab-rzaa 600 Mg/10ml IV Soln 6 $7,375.28 $17,534.37 $16,630.54 nat. median
$1,767
outlier · 9.4×
J3101
HCPCS 		Tenecteplase 50 Mg IV Kit 6 $6,673.53 $16,544.99 $15,538.86 nat. median
$3,787
outlier · 4.1×
J2323
HCPCS 		Natalizumab 300 Mg/15ml IV Conc 6 $6,547.41 $15,566.14 $15,245.19 nat. median
$180
outlier · 84.8×
PX-36010208
CDM 		Hc Operating Room Services Level 8 First Hr 6 $6,401.93 $15,220.27 $14,906.45 nat. median
$14,906
1.0× median
PX-75010272
CDM 		Hc Endoscopy/Gastrointestinal Procedure Level 6 6 $5,979.24 $14,215.35 $13,922.25 nat. median
$3,738
outlier · 3.7×
PX-36010371
CDM 		Hc Pain Room Services Level 6 6 $5,694.46 $13,538.29 $13,259.15 nat. median
$1,470
outlier · 9.0×
J9271
HCPCS 		Pembrolizumab 100 Mg/4ml IV Soln 6 $5,250.57 $12,482.97 $12,225.59 nat. median
$275
outlier · 44.5×
PX-36010206
CDM 		Hc Operating Room Services Level 6 First Hr 6 $4,994.33 $11,873.77 $11,628.95 nat. median
$11,629
1.0× median
PX-36010207
CDM 		Hc Operating Room Services Level 7 First Hr 6 $4,878.05 $11,597.32 $11,358.20 nat. median
$11,358
1.0× median
PX-75010319
CDM 		Hc Endoscopy/Gastrointestinal Procedure Level 5 6 $4,710.36 $11,198.65 $10,967.75 nat. median
$3,738
outlier · 2.9×
PX-36010005
CDM 		Hc Pain Room Services Level 5 6 $4,710.36 $11,198.65 $10,967.75 nat. median
$1,470
outlier · 7.5×
J0517
HCPCS 		Benralizumab 30 Mg/ml Subq Sosy 6 $4,516.50 $10,737.76 $10,516.37 nat. median
$919
outlier · 11.4×
PX-36010205
CDM 		Hc Operating Room Services Level 5 First Hr 6 $4,281.55 $10,179.18 $9,969.30 nat. median
$9,969
1.0× median
J1932
HCPCS 		Lanreotide Acetate 120 Mg/0.5ml Subq Soln 6 $4,164.19 $9,900.17 $9,696.04 nat. median
$115
outlier · 84.6×
PX-36010204
CDM 		Hc Operating Room Services Level 4 First Hr 6 $3,805.01 $9,046.22 $8,859.70 nat. median
$8,860
1.0× median
PX-36010203
CDM 		Hc Operating Room Services Level 3 First Hr 6 $3,409.25 $8,105.32 $7,938.20 nat. median
$7,938
1.0× median
J2997
HCPCS 		Alteplase 100 Mg IV Solr 6 $225.13 $16,828.01 $7,720.07 nat. median
$500
outlier · 15.4×
J0565
HCPCS 		Bezlotoxumab 1000 Mg/40ml IV Soln 6 $3,316.66 $7,885.20 $7,478.74 nat. median
$159
outlier · 47.1×
PX-4050842MDL
CDM 		Hc Linq Device 6 $3,204.43 $7,618.38 $7,461.30 nat. median
$7,461
1.0× median
J1306
HCPCS 		Inclisiran Sodium 284 Mg/1.5ml Subq Sosy 6 $2,959.19 $7,035.33 $6,672.69 nat. median
$44
outlier · 152.6×
PX-36010202
CDM 		Hc Operating Room Services Level 2 First Hr 6 $2,854.37 $6,786.12 $6,646.20 nat. median
$6,646
1.0× median
PX-75010318
CDM 		Hc Endoscopy/Gastrointestinal Procedure Level 4 6 $2,669.54 $6,346.71 $6,215.85 nat. median
$3,738
1.7× median
PX-36010004
CDM 		Hc Pain Room Services Level 4 6 $2,669.54 $6,346.71 $6,215.85 nat. median
$1,470
outlier · 4.2×
PX-36010201
CDM 		Hc Operating Room Services Level 1 First Hr 6 $2,299.90 $5,467.89 $5,355.15 nat. median
$5,355
1.0× median
Q5115
HCPCS 		Rituximab-abbs 500 Mg/50ml IV Soln 6 $2,278.26 $5,416.46 $5,304.78 nat. median
$839
outlier · 6.3×
J3111
HCPCS 		Romosozumab-aqqg 105 Mg/1.17ml Subq Sosy 6 $2,294.34 $5,454.68 $5,173.51 nat. median
$696
outlier · 7.4×
J3262
HCPCS 		Tocilizumab 400 Mg/20ml IV Soln 6 $2,136.09 $5,078.44 $4,973.73 nat. median
$1,413
outlier · 3.5×
G0390
HCPCS 		Hc Ed Trauma Activation Full With Critical Care G0390 Cdm 6 $2,132.62 $5,070.19 $4,965.65 nat. median
$3,197
1.6× median
13160
CPT 		Extensive Or Complicated Repair Wound Reopening 6 $2,121.19 $5,043.03 $4,939.05 nat. median
$2,654
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
$2,884
1.6× median
PX-75010317
CDM 		Hc Endoscopy/Gastrointestinal Procedure Level 3 6 $1,962.89 $4,666.67 $4,570.45 nat. median
$1,869
outlier · 2.4×
PX-36010003
CDM 		Hc Pain Room Services Level 3 6 $1,962.89 $4,666.67 $4,570.45 nat. median
$1,470
outlier · 3.1×
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
$3,420
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
$1,027
outlier · 4.2×
46270
CPT 		Repair Of Abnormal Anal Drainage Tract 6 $1,851.91 $4,402.83 $4,312.05 nat. median
$2,850
1.5× median
J3358
HCPCS 		Ustekinumab 130 Mg/26ml IV Soln 6 $1,849.14 $4,396.24 $4,305.60 nat. median
$264
outlier · 16.3×
72158
CPT 		MRI Scan Of Lower Spinal Canal Before And After Contrast 6 $1,834.78 $4,362.09 $4,137.24 nat. median
$1,097
outlier · 3.8×
72156
CPT 		MRI Scan Of Upper Spinal Canal Before And After Contrast 6 $1,824.58 $4,337.84 $4,114.24 nat. median
$1,110
outlier · 3.7×
72157
CPT 		MRI Scan Of Middle Spinal Canal Before And After Contrast 6 $1,811.52 $4,306.80 $4,084.80 nat. median
$1,114
outlier · 3.7×
71552
CPT 		MRI Scan Of Chest Before And After Contrast 6 $1,752.36 $4,166.15 $4,080.25 nat. median
$1,103
outlier · 3.7×
70553
CPT 		MRI Scan Of Brain Before And After Contrast 6 $1,800.91 $4,281.58 $4,060.88 nat. median
$1,136
outlier · 3.6×
74183
CPT 		MRI Scan Of Abdomen Before And After Contrast 6 $1,764.60 $4,195.25 $3,979.00 nat. median
$1,105
outlier · 3.6×
72197
CPT 		MRI Scan Of Pelvis Before And After Contrast 6 $1,751.14 $4,163.24 $3,948.64 nat. median
$1,074
outlier · 3.7×
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
$1,087
outlier · 3.6×
73723
CPT 		MRI Scan Of Leg Joint Before And After Contrast 6 $1,731.96 $4,117.65 $3,905.40 nat. median
$1,199
outlier · 3.3×
74177
CPT 		CT Scan Of Abdomen And Pelvis With Contrast 6 $1,710.74 $4,067.21 $3,857.56 nat. median
$976
outlier · 4.0×
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
$1,073
outlier · 3.6×
73220
CPT 		MRI Scan Of Arm Before And After Contrast 6 $1,650.36 $3,923.65 $3,842.75 nat. median
$1,136
outlier · 3.4×

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.

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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
             
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
43762 CPT Replacement Of Stomach Stoma Tube 11 6 $793.00 $793.00 $323.54 $769.21 $753.35 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
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
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
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
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
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
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
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
51100 CPT Needle Aspiration Of Bladder 11 6 $880.00 $880.00 $359.04 $853.60 $836.00 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
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
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
64405 CPT Inject Anesthetic Agent/steroid, Neck & Head Nerve 11 6 $744.00 $744.00 $303.55 $721.68 $706.80 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
74251 CPT Double Contrast X-ray Of Small Intestine 11 6 $944.00 $944.00 $385.15 $915.68 $896.80 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
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
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
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
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
76705 CPT Limited Ultrasound Scan Of Abdomen 6 6 $925.00 $925.00 $377.40 $897.25 $851.00 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
76805 CPT Ultrasound OB After 14 Wks Single Fetus 11 6 $749.00 $749.00 $305.59 $726.53 $711.55 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
76856 CPT Complete Ultrasound Scan Of Pelvis 6 6 $1,014.00 $1,014.00 $413.71 $983.58 $932.88 2026-01-01
76870 CPT Ultrasound Scan Of Scrotum 6 6 $937.00 $937.00 $382.30 $908.89 $862.04 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
76942 CPT Ultrasonic Guidance For Needle Placement 6 6 $809.00 $809.00 $330.07 $784.73 $744.28 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
87150 CPT Identification Of Organisms By Genetic Analysis, Amplified 11 6 $992.00 $992.00 $404.74 $962.24 $942.40 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
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
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
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
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
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
92953 CPT Temporary Pacemaker To Regulate Heart Beat 11 6 $792.00 $792.00 $323.14 $768.24 $752.40 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
96413 CPT Hc Chemo IV Infusion Initial Hr Cdm 6 6 $857.00 $857.00 $349.66 $831.29 $788.44 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
99283 CPT Emergency Department Visit Level 3 11 6 $924.00 $924.00 $376.99 $896.28 $877.80 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
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
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
99292 CPT Critical Care, Each Additional 30 Minutes 11 6 $792.00 $792.00 $323.14 $768.24 $752.40 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
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
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
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
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
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
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
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
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
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
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
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
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
J1442 HCPCS Filgrastim 300 Mcg/ml Injection Soln 11 6 $715.14 $715.14 $291.78 $693.69 $679.38 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
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
J1610 HCPCS Glucagon 1 Mg Injection Solr 6 6 $781.20 $781.20 $318.73 $757.76 $718.70 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
J9280 HCPCS Mitomycin 40 Mg IV Solr 11 6 $816.75 $816.75 $333.23 $792.25 $775.91 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
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
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-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-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
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
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
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-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-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-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
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-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
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-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
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-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-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
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
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
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
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
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
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
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
PX-37010129 CDM Hc Anesthesia Regional 1st Hour Cdm 11 6 $894.00 $894.00 $364.75 $867.18 $849.30 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
PX-40500474MDL CDM Hc Thoracic Vent Set 11 6 $728.00 $728.00 $297.02 $706.16 $691.60 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
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
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-75010315 CDM Hc Endoscopy/Gastrointestinal Procedure Level 1 11 6 $965.00 $965.00 $393.72 $936.05 $916.75 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
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
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-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
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
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
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
Q5104 HCPCS Infliximab-abda 100 Mg IV Solr 6 6 $930.82 $930.82 $379.77 $902.90 $856.36 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
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
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
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