Price Transparencybeta Hospital negotiated rates

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

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Hospital

BITTERROOT HEALTH - DALY HOSPITAL

Hamilton, MT · CCN 271340 · Rates published

Your selected procedure

You selected 27447 (CPT)

Arthroplasty knee condyle and plateau medial AND lateral compartments w/wo patella resurfacing

This hospital’s price: $2,038 across 6 payers · range $1,078-$3,890

Source: https://www.bitterroothealth.org/media/c1e61f6ecc874f84b74bd5b772c706f2/810240726_bitterroot-health-hospital_standardcharges.xlsx · observed 2026-07-31

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.

20,162 distinct procedures filed
6 distinct payers
215,061 rate rows
2026-07-31 last MRF observed
Data quality

145,227 of 215,061 rate rows are consumer-grade (67.5%)

69,834 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 61,936
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 7,670
placeholder amount (≤ $0.02) — excluded from medians 125
exceeds 10× this hospital's gross charge — excluded from medians 67
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 36
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.bitterroothealth.org/media/c1e61f6ecc874f84b74bd5b772c706f2/810240726_bitterroot-health-hospital_standardcharges.xlsx
Found on page https://www.bitterroothealth.org/patients-and-visitors/billing-and-financial-services/pricing-tool/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-08-03
Content fingerprint 955968c18825c1d3… · 13,133,480 bytes · first seen 2026-05-15

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
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 6 $604,078.63 $627,912.07 $615,995.35 nat. median
$691,418
0.9× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 6 $600,136.50 $601,716.37 $600,926.44 nat. median
$631,793
1.0× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 6 $572,420.60 $601,104.71 $586,762.66 nat. median
$610,161
1.0× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 6 $560,291.16 $589,847.69 $575,069.43 nat. median
$624,417
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 6 $545,534.75 $558,718.59 $552,126.67 nat. median
$588,565
0.9× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 6 $525,699.79 $530,951.92 $528,325.85 nat. median
$577,541
0.9× median
Q0480
HCPCS 		Dme Pos 6 $86,797.56 $104,999.93 $95,898.74 nat. median
$111,503
0.9× median
K1007
HCPCS 		Bil Hkaf Pc S/d Micro Sensor 6 $95,583.53 $95,583.53 $95,583.53 nat. median
$97,404
1.0× median
A9543
HCPCS 		Y90 Ibritumomab, Rx 6 $80,546.25 $90,125.66 $85,335.96 nat. median
$63,643
1.3× median
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 6 $77,699.25 $80,535.91 $79,117.58 nat. median
$69,291
1.1× median
A9699
HCPCS 		Radiopharm Rx Agent Noc 6 $73,507.89 $73,507.89 $73,507.89 nat. median
$4,125
outlier · 17.8×
L8702
HCPCS 		Ewhf S/d Uprt Micro Sensor 6 $69,165.33 $69,165.33 $69,165.33 nat. median
$70,178
1.0× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 6 $61,858.18 $62,800.40 $62,329.29 nat. median
$65,655
0.9× median
J2350
HCPCS 		Ocrelizumab 300 Mg/10 Ml Inj Sol [mdmh] 6 $62.72 $67,592.10 $62,184.73 nat. median
$331
outlier · 188.0×
J3245
HCPCS 		Tildrakizumab 100 mg/mL Pfs Sol [mdmh] 6 $142.62 $62,054.88 $57,090.48 nat. median
$256
outlier · 222.9×
J9226
HCPCS 		Supprelin La Implant 6 $55,618.19 $57,581.37 $56,599.78 nat. median
$55,200
1.0× median
J9334
HCPCS 		Efgartigimod Alfa-hyaluronidase Qvfc 180 Mg-2000 units/mL Sol [mdmh] 6 $40.63 $56,782.79 $52,240.17 nat. median
$77
outlier · 680.7×
L7181
HCPCS 		Dme Pos 6 $38,537.58 $50,142.75 $44,340.17 nat. median
$50,449
0.9× median
J3357
HCPCS 		Ustekinumab 90 mg/mL SubQ Sol [mdmh] 6 $182.54 $47,730.60 $43,912.15 nat. median
$12,959
outlier · 3.4×
L2006
HCPCS 		Dme Pos 6 $40,484.87 $40,484.87 $40,484.87 nat. median
$39,921
1.0× median
L7180
HCPCS 		Dme Pos 6 $33,771.95 $43,942.00 $38,856.97 nat. median
$46,980
0.8× median
L8701
HCPCS 		Ewh S/d Uprt Micro Sensor 6 $35,154.95 $35,154.95 $35,154.95 nat. median
$35,670
1.0× median
J9266
HCPCS 		Pegaspargase Injection 6 $33,199.71 $34,476.62 $33,838.17 nat. median
$32,688
1.0× median
677T
OTHER 		Laps Repos Lead Isdss 1st Ld 6 $30,962.13 $30,962.13 $30,962.13 nat. median
$10,309
outlier · 3.0×
674T
OTHER 		Laps Insj Nw/rpcmt Prm Isdss 6 $30,962.13 $30,962.13 $30,962.13 nat. median
$29,925
1.0× median
675T
OTHER 		Laps Insj Nw/rpcmt Isdss 1ld 6 $30,962.13 $30,962.13 $30,962.13 nat. median
$12,139
outlier · 2.6×
33231
CPT 		Insrt Pulse Gen W/mult Leads 5 $348.70 $30,818.44 $30,818.44 nat. median
$29,955
1.0× median
33249
CPT 		Insj/rplcmt Defib W/lead(s) 5 $820.60 $30,818.44 $30,818.44 nat. median
$31,420
1.0× median
33264
CPT 		Rmvl & Rplcmt Dfb Gen Mlt Ld 5 $349.25 $30,818.44 $30,818.44 nat. median
$31,464
1.0× median
33270
CPT 		Ins/rep Subq Defibrillator 5 $500.50 $30,818.44 $30,818.44 nat. median
$31,963
1.0× median
J9144
HCPCS 		Daratumumab-hyaluronidase Fihj 1800 Mg-30,000 Units/15 Ml Sol [mdmh] 6 $63.05 $32,826.96 $30,200.80 nat. median
$202
outlier · 149.4×
64582
CPT 		Opn Mpltj Hpglsl Nstm Ary Pg 5 $770.00 $30,063.48 $30,063.48 nat. median
$28,070
1.1× median
69930
CPT 		Implant Cochlear Device 5 $975.15 $29,718.47 $29,718.47 nat. median
$29,361
1.0× median
J1932
HCPCS 		Lanreotide 120 Mg/0.5 Ml Sol [mdmh] 6 $27.58 $32,013.57 $29,452.48 nat. median
$104
outlier · 282.1×
J9228
HCPCS 		Ipilimumab 5 mg/mL 10mL Sol [mdmh] 6 $216.93 $30,716.96 $28,259.60 nat. median
$8,184
outlier · 3.5×
J3380
HCPCS 		Vedolizumab 300 Mg Rec [mdmh] 6 $22.96 $29,433.66 $27,078.96 nat. median
$150
outlier · 180.8×
L5856
HCPCS 		Dme Pos 6 $23,072.63 $30,020.69 $26,546.66 nat. median
$30,017
0.9× median
L6880
HCPCS 		Dme Pos 6 $23,025.82 $29,959.79 $26,492.81 nat. median
$30,016
0.9× median
61886
CPT 		Implant Neurostim Arrays 5 $546.15 $26,162.39 $26,162.39 nat. median
$27,176
1.0× median
33263
CPT 		Rmvl & Rplcmt Dfb Gen 2 Lead 5 $334.40 $22,916.60 $22,916.60 nat. median
$23,228
1.0× median
33230
CPT 		Insrt Pulse Gen W/dual Leads 5 $333.85 $22,916.60 $22,916.60 nat. median
$22,374
1.0× median
33262
CPT 		Rmvl& Replc Pulse Gen 1 Lead 5 $319.55 $22,916.60 $22,916.60 nat. median
$23,104
1.0× median
33240
CPT 		Insrt Pulse Gen W/singl Lead 5 $319.00 $22,916.60 $22,916.60 nat. median
$21,987
1.0× median
J3101
HCPCS 		Tenecteplase 50 Mg IV Inj [mdmh] 6 $176.25 $29,870.13 $22,277.03 nat. median
$3,475
outlier · 6.4×
680T
OTHER 		Insj/rplcmt Pg Only Isdss 6 $22,110.52 $22,110.52 $22,110.52 nat. median
$20,856
1.1× median
681T
OTHER 		Rlcj Pulse Gen Only Isdss 6 $22,110.52 $22,110.52 $22,110.52 nat. median
$4,070
outlier · 5.4×
J1299
HCPCS 		Eculizumab 10 mg/mL Sol 30 Ml [mdmh] 6 $48.61 $23,482.80 $21,956.42 nat. median
$1,363
outlier · 16.1×
414T
OTHER 		Rmvl & Rpl Car Modulj Pls Gn 2 $615.19 $21,930.03 $21,930.03 nat. median
$23,560
0.9× median
409T
OTHER 		Insj/rplc Car Modulj Pls Gn 2 $582.06 $21,930.03 $21,930.03 nat. median
$24,281
0.9× median
J1162
HCPCS 		Digoxin Immune Fab 40 Mg Inj [mdmh] 6 $5,390.44 $23,507.35 $21,626.76 nat. median
$7,100
outlier · 3.0×

Other procedures at this hospital

Browse this hospital's 20,162 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
Q2042 HCPCS Tisagenlecleucel Car-pos T 10 6 — — $604,078.63 $627,912.07 $615,995.35 2026-07-31
Q2056 HCPCS Ciltacabtagene Car-pos T 10 6 — — $600,136.50 $601,716.37 $600,926.44 2026-07-31
Q2055 HCPCS Idecabtagene Vicleucel Car 10 6 — — $572,420.60 $601,104.71 $586,762.66 2026-07-31
Q2054 HCPCS Lisocabtagene Mara Car Pos T 10 6 — — $560,291.16 $589,847.69 $575,069.43 2026-07-31
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 10 6 — — $545,534.75 $558,718.59 $552,126.67 2026-07-31
Q2053 HCPCS Brexucabtagene Car Pos T 10 6 — — $525,699.79 $530,951.92 $528,325.85 2026-07-31
Q0480 HCPCS Dme Pos 10 6 — — $86,797.56 $104,999.93 $95,898.74 2026-07-31
K1007 HCPCS Bil Hkaf Pc S/d Micro Sensor 10 6 — — $95,583.53 $95,583.53 $95,583.53 2026-07-31
A9543 HCPCS Y90 Ibritumomab, Rx 10 6 — — $80,546.25 $90,125.66 $85,335.96 2026-07-31
J9029 HCPCS Instill Adstiladrin, Tx Dose 10 6 — — $77,699.25 $80,535.91 $79,117.58 2026-07-31
A9699 HCPCS Radiopharm Rx Agent Noc 10 6 — — $73,507.89 $73,507.89 $73,507.89 2026-07-31
L8702 HCPCS Ewhf S/d Uprt Micro Sensor 10 6 — — $69,165.33 $69,165.33 $69,165.33 2026-07-31
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 10 6 — — $61,858.18 $62,800.40 $62,329.29 2026-07-31
J2350 HCPCS Ocrelizumab 300 Mg/10 Ml Inj Sol [mdmh] 10 6 $67,592.10 $67,592.10 $62.72 $67,592.10 $62,184.73 2026-07-31
J3245 HCPCS Tildrakizumab 100 mg/mL Pfs Sol [mdmh] 10 6 $62,054.88 $62,054.88 $142.62 $62,054.88 $57,090.48 2026-07-31
J9226 HCPCS Supprelin La Implant 10 6 — — $55,618.19 $57,581.37 $56,599.78 2026-07-31
J9334 HCPCS Efgartigimod Alfa-hyaluronidase Qvfc 180 Mg-2000 units/mL Sol [mdmh] 10 6 $56,782.80 $56,782.80 $40.63 $56,782.79 $52,240.17 2026-07-31
L7181 HCPCS Dme Pos 10 6 — — $38,537.58 $50,142.75 $44,340.17 2026-07-31
J3357 HCPCS Ustekinumab 90 mg/mL SubQ Sol [mdmh] 10 6 $47,730.60 $47,730.60 $182.54 $47,730.60 $43,912.15 2026-07-31
L2006 HCPCS Dme Pos 10 6 — — $40,484.87 $40,484.87 $40,484.87 2026-07-31
L7180 HCPCS Dme Pos 10 6 — — $33,771.95 $43,942.00 $38,856.97 2026-07-31
L8701 HCPCS Ewh S/d Uprt Micro Sensor 10 6 — — $35,154.95 $35,154.95 $35,154.95 2026-07-31
J9266 HCPCS Pegaspargase Injection 10 6 — — $33,199.71 $34,476.62 $33,838.17 2026-07-31
677T OTHER Laps Repos Lead Isdss 1st Ld 10 6 — — $30,962.13 $30,962.13 $30,962.13 2026-07-31
675T OTHER Laps Insj Nw/rpcmt Isdss 1ld 10 6 — — $30,962.13 $30,962.13 $30,962.13 2026-07-31
674T OTHER Laps Insj Nw/rpcmt Prm Isdss 10 6 — — $30,962.13 $30,962.13 $30,962.13 2026-07-31
33270 CPT Ins/rep Subq Defibrillator 9 5 — — $500.50 $30,818.44 $30,818.44 2026-07-31
33264 CPT Rmvl & Rplcmt Dfb Gen Mlt Ld 9 5 — — $349.25 $30,818.44 $30,818.44 2026-07-31
33231 CPT Insrt Pulse Gen W/mult Leads 9 5 — — $348.70 $30,818.44 $30,818.44 2026-07-31
33249 CPT Insj/rplcmt Defib W/lead(s) 9 5 — — $820.60 $30,818.44 $30,818.44 2026-07-31
J9144 HCPCS Daratumumab-hyaluronidase Fihj 1800 Mg-30,000 Units/15 Ml Sol [mdmh] 10 6 $32,826.96 $32,826.96 $63.05 $32,826.96 $30,200.80 2026-07-31
64582 CPT Opn Mpltj Hpglsl Nstm Ary Pg 9 5 — — $770.00 $30,063.48 $30,063.48 2026-07-31
69930 CPT Implant Cochlear Device 9 5 — — $975.15 $29,718.47 $29,718.47 2026-07-31
J1932 HCPCS Lanreotide 120 Mg/0.5 Ml Sol [mdmh] 10 6 $32,013.57 $32,013.57 $27.58 $32,013.57 $29,452.48 2026-07-31
J9228 HCPCS Ipilimumab 5 mg/mL 10mL Sol [mdmh] 10 6 $30,716.96 $30,716.96 $216.93 $30,716.96 $28,259.60 2026-07-31
J3380 HCPCS Vedolizumab 300 Mg Rec [mdmh] 10 6 $29,433.66 $29,433.66 $22.96 $29,433.66 $27,078.96 2026-07-31
L5856 HCPCS Dme Pos 10 6 — — $23,072.63 $30,020.69 $26,546.66 2026-07-31
L6880 HCPCS Dme Pos 10 6 — — $23,025.82 $29,959.79 $26,492.81 2026-07-31
61886 CPT Implant Neurostim Arrays 9 5 — — $546.15 $26,162.39 $26,162.39 2026-07-31
33262 CPT Rmvl& Replc Pulse Gen 1 Lead 9 5 — — $319.55 $22,916.60 $22,916.60 2026-07-31
33263 CPT Rmvl & Rplcmt Dfb Gen 2 Lead 9 5 — — $334.40 $22,916.60 $22,916.60 2026-07-31
33240 CPT Insrt Pulse Gen W/singl Lead 9 5 — — $319.00 $22,916.60 $22,916.60 2026-07-31
33230 CPT Insrt Pulse Gen W/dual Leads 9 5 — — $333.85 $22,916.60 $22,916.60 2026-07-31
J3101 HCPCS Tenecteplase 50 Mg IV Inj [mdmh] 34 6 $24,214.17 $24,214.17 $176.25 $29,870.13 $22,277.03 2026-07-31
680T OTHER Insj/rplcmt Pg Only Isdss 10 6 — — $22,110.52 $22,110.52 $22,110.52 2026-07-31
681T OTHER Rlcj Pulse Gen Only Isdss 10 6 — — $22,110.52 $22,110.52 $22,110.52 2026-07-31
J1299 HCPCS Eculizumab 10 mg/mL Sol 30 Ml [mdmh] 10 6 $23,482.80 $23,482.80 $48.61 $23,482.80 $21,956.42 2026-07-31
409T OTHER Insj/rplc Car Modulj Pls Gn 6 2 — — $582.06 $21,930.03 $21,930.03 2026-07-31
414T OTHER Rmvl & Rpl Car Modulj Pls Gn 6 2 — — $615.19 $21,930.03 $21,930.03 2026-07-31
J1162 HCPCS Digoxin Immune Fab 40 Mg Inj [mdmh] 10 6 $23,507.35 $23,507.35 $5,390.44 $23,507.35 $21,626.76 2026-07-31
J2506 HCPCS Pergfilgrastim 6mg/0.6ml sol[MDMH] 10 6 $23,104.77 $23,104.77 $21.68 $23,104.76 $21,256.38 2026-07-31
L8614 HCPCS Dme Pos 10 6 — — $18,363.90 $23,893.99 $21,128.94 2026-07-31
J9306 HCPCS Pertuzumab 420 Mg/14 Ml Sol [mdmh] 10 6 $22,811.88 $22,811.88 $19.77 $22,811.88 $20,986.92 2026-07-31
Q0483 HCPCS Dme Pos 10 6 — — $18,069.37 $23,510.77 $20,790.07 2026-07-31
L5858 HCPCS Dme Pos 10 6 — — $17,875.27 $23,258.20 $20,566.74 2026-07-31
L6975 HCPCS Dme Pos 10 6 — — $17,852.60 $23,228.71 $20,540.65 2026-07-31
L5973 HCPCS Dme Pos 10 6 — — $16,774.79 $21,826.33 $19,300.56 2026-07-31
L6970 HCPCS Dme Pos 10 6 — — $16,662.86 $21,680.69 $19,171.78 2026-07-31
L6965 HCPCS Dme Pos 10 6 — — $16,459.65 $21,416.29 $18,937.97 2026-07-31
C9363 HCPCS Wound Matrix 4x5 Bilayer Sheet 10 6 $19,845.70 $19,845.70 $6,747.53 $19,845.70 $18,853.41 2026-07-31
J2329 HCPCS Ublituximab Xiiy 150 Mg/6 Ml Sol [mdmh] 10 6 $19,998.00 $19,998.00 $74.48 $19,998.00 $18,398.16 2026-07-31
J0517 HCPCS Benralizumab 30 mg/mL Sol [mdmh] 10 6 $19,841.07 $19,841.07 $177.17 $19,841.07 $18,253.78 2026-07-31
J9271 HCPCS Pembrolizumab 25 mg/mL Sol [mdmh] 10 6 $19,614.84 $19,614.84 $71.40 $19,614.84 $18,045.65 2026-07-31
Q0489 HCPCS Dme Pos 10 6 — — $15,665.18 $20,382.57 $18,023.88 2026-07-31
308T OTHER Insj Ocular Telescope Prosth 10 6 — — $2,332.97 $23,084.33 $17,896.49 2026-07-31
J0717 HCPCS Certolizumab 200 mg/mL Kit [mdmh] 15 6 $19,442.01 $19,442.01 $4.32 $19,442.01 $17,886.65 2026-07-31
L6960 HCPCS Dme Pos 10 6 — — $15,191.96 $19,766.86 $17,479.41 2026-07-31
L6955 HCPCS Dme Pos 10 6 — — $15,062.80 $19,598.79 $17,330.79 2026-07-31
268T OTHER Implt/rpl Crtd Sns Dev Gen 6 2 — — $425.37 $17,106.04 $17,106.04 2026-07-31
64580 CPT Opn Impltj Nea Neuromuscular 9 5 — — $230.45 $17,106.04 $17,106.04 2026-07-31
408T OTHER Insj/rplc Cardiac Modulj Sys 10 6 — — $1,301.88 $21,930.03 $16,772.99 2026-07-31
33229 CPT Remv&replc Pm Gen Mult Leads 9 5 — — $318.45 $16,407.39 $16,407.39 2026-07-31
33221 CPT Insert Pulse Gen Mult Leads 9 5 — — $305.25 $16,407.39 $16,407.39 2026-07-31
A0431 HCPCS Rotary Wing Air Transport 10 6 — — $16,119.45 $16,119.45 $16,119.45 2026-07-31
Q0481 HCPCS Dme Pos 10 6 — — $14,003.79 $18,220.88 $16,112.33 2026-07-31
C9775 HCPCS Revasc Lith-sten-ath Tib/per 10 6 — — $16,064.00 $16,064.00 $16,064.00 2026-07-31
C9774 HCPCS Revasc Lithotr-ather Tib/per 10 6 — — $16,064.00 $16,064.00 $16,064.00 2026-07-31
C9773 HCPCS Revasc Lithotr-stent Tib/per 10 6 — — $16,064.00 $16,064.00 $16,064.00 2026-07-31
L5859 HCPCS Dme Pos 10 6 — — $13,955.06 $18,157.47 $16,056.26 2026-07-31
J2802 HCPCS romiPLOStim 500 Mcg Rec Sq [mdmh] 10 6 $17,171.75 $17,171.75 $11.41 $17,171.74 $16,055.58 2026-07-31
C9766 HCPCS Revasc Intra Lithotrip-ather 10 6 — — $16,020.39 $16,020.39 $16,020.39 2026-07-31
C9767 HCPCS Revasc Lithotrip-stent-ather 10 6 — — $16,020.39 $16,020.39 $16,020.39 2026-07-31
33274 CPT Tcat Insj/rpl Perm Ldls Pm 9 5 — — $429.00 $16,020.39 $16,020.39 2026-07-31
238T OTHER Trluml Perip Athrc Iliac Art 10 6 — — $14,846.45 $15,563.68 $15,025.76 2026-07-31
93582 CPT Perq Transcath Closure Pda 9 5 — — $677.05 $14,846.45 $14,846.45 2026-07-31
C9606 HCPCS Perc D-e Cor Revasc W Ami S 10 6 — — $14,846.45 $14,846.45 $14,846.45 2026-07-31
92933 CPT Prq Card Stent/ath/angio 9 5 — — $675.95 $14,846.45 $14,846.45 2026-07-31
37231 CPT Tib/per Revasc Stent & Ather 9 5 — — $811.25 $18,160.61 $14,846.45 2026-07-31
37227 CPT Fem/popl Revasc Stnt & Ather 9 5 — — $783.75 $17,235.72 $14,846.45 2026-07-31
C9602 HCPCS Perc D-e Cor Stent Ather S 10 6 — — $14,846.45 $14,846.45 $14,846.45 2026-07-31
C9607 HCPCS Perc D-e Cor Revasc Chro Sin 10 6 — — $14,846.45 $14,846.45 $14,846.45 2026-07-31
L6945 HCPCS Dme Pos 10 6 — — $12,873.02 $16,749.59 $14,811.31 2026-07-31
36906 CPT Thrmbc/nfs Dialysis Circuit 9 5 — — $573.10 $14,775.90 $14,775.90 2026-07-31
22869 CPT Insj Stablj Dev Without Dcmprn 9 5 — — $386.65 $14,697.92 $14,697.92 2026-07-31
L6950 HCPCS Dme Pos 10 6 — — $12,577.10 $16,364.57 $14,470.83 2026-07-31
37230 CPT Tib/per Revasc W/stent 10 6 — — $745.25 $14,846.45 $14,300.95 2026-07-31
37229 CPT Tib/per Revasc W/ather 10 6 — — $759.00 $14,846.45 $14,289.91 2026-07-31
L5991 HCPCS Dme Pos 10 6 — — $11,817.16 $16,679.61 $14,248.39 2026-07-31
81416 CPT Exome Sequence Analysis 10 6 — — $10,800.00 $17,400.00 $14,100.00 2026-07-31
54401 CPT Insert Self-contd Prosthesis 9 5 — — $574.20 $13,973.43 $13,973.43 2026-07-31
54416 CPT Remv/repl Penis Contain Pros 9 5 — — $664.40 $13,973.43 $13,973.43 2026-07-31
A0430 HCPCS Fixed Wing Air Transport 10 6 — — $13,864.40 $13,864.40 $13,864.40 2026-07-31
Q5111 HCPCS Pegfilgrastim Cbqv 6 Mg/0.6 Ml Sq Sol [mdmh] 10 6 $15,030.00 $15,030.00 $163.66 $15,030.00 $13,827.60 2026-07-31
L8687 HCPCS Implt Nrostm Pls Gen Dua Rec 10 6 — — $13,498.34 $13,842.34 $13,670.34 2026-07-31
505T OTHER Ev Fempop Artl Revsc 10 6 — — $9,718.36 $14,846.45 $13,564.43 2026-07-31
620T OTHER Evasc Ven Artlz Tibl/prnl Vn 10 6 — — $5,562.44 $16,064.00 $13,438.61 2026-07-31
Q0479 HCPCS Dme Pos 10 6 — — $11,545.44 $15,022.22 $13,283.83 2026-07-31
J2323 HCPCS Natalizumab 300 Mg/15 Ml Con Inj Sol [mdmh] 10 6 $14,140.58 $14,140.58 $26.44 $14,140.57 $13,009.32 2026-07-31
J9299 HCPCS Nivolumab 10 mg/mL 12mL Sol [mdmh] 18 6 $13,472.86 $13,472.86 $38.94 $25,899.12 $13,003.94 2026-07-31
L7191 HCPCS Dme Pos 10 6 — — $11,211.03 $14,587.10 $12,899.07 2026-07-31
L6940 HCPCS Dme Pos 10 6 — — $11,065.15 $14,397.31 $12,731.23 2026-07-31
64628 CPT Trml Dstrj Ios Bvn 1st 2 L/s 9 5 — — $393.25 $12,593.29 $12,593.29 2026-07-31
69716 CPT Impl Oi Implt Sk Tc Esp<100 9 5 — — $496.65 $12,593.29 $12,593.29 2026-07-31
69719 CPT Rplcm Oi Implt Sk Tc Esp<100 9 5 — — $520.30 $12,593.29 $12,593.29 2026-07-31
L7186 HCPCS Dme Pos 10 6 — — $10,942.15 $14,237.25 $12,589.70 2026-07-31
J1306 HCPCS Inclisiran 284 Mg/1.5 Ml Sq [mdmh] 10 6 $13,650.00 $13,650.00 $13.32 $13,650.00 $12,558.00 2026-07-31
686T OTHER Histotripsy Mal Hepatcel Tis 10 6 — — $12,500.50 $12,500.50 $12,500.50 2026-07-31
C9758 HCPCS Blind Interatrial Shunt Ide 10 6 — — $12,500.50 $12,500.50 $12,500.50 2026-07-31
613T OTHER Perq Tcat Intratrl Septl Sht 10 6 — — $1,845.56 $16,020.39 $12,476.68 2026-07-31
315U OTHER Onc Cutan Sq Cll Ca Mrna 40 10 6 — — $12,325.00 $12,325.00 $12,325.00 2026-07-31
629T OTHER Perq Njx Algc CT Lmbr 1st 6 2 — — $397.50 $12,314.76 $12,314.76 2026-07-31
627T OTHER Perq Njx Algc Fluor Lmbr 1st 6 2 — — $441.67 $12,314.76 $12,314.76 2026-07-31
C9757 HCPCS Spine Device Implant Surgery 10 6 — — $11,899.39 $11,899.39 $11,899.39 2026-07-31
J1303 HCPCS Ravulizumab 100 mg/mL Sol 11mL Vial [mdmh] 18 6 $43,111.73 $43,111.73 $239.02 $43,111.72 $11,757.74 2026-07-31
93581 CPT Transcath Closure Of Vsd 10 6 — — $1,341.45 $14,846.45 $11,470.20 2026-07-31
93580 CPT Transcath Closure Of Asd 10 6 — — $988.35 $14,846.45 $11,381.92 2026-07-31
93590 CPT Perq Transcath Cls Mitral 10 6 — — $1,193.50 $14,775.90 $11,380.30 2026-07-31
93591 CPT Perq Transcath Cls Aortic 10 6 — — $988.35 $14,775.90 $11,329.01 2026-07-31
22867 CPT Insj Stablj Dev W/dcmprn 10 6 — — $825.00 $14,697.92 $11,229.69 2026-07-31
93656 CPT Compre Ep Eval Abltj Atr Fib 10 6 — — $935.00 $14,362.24 $11,005.43 2026-07-31
54410 CPT Remove/replace Penis Prosth 10 6 — — $834.90 $13,973.43 $10,688.80 2026-07-31
54405 CPT Insert Multi-comp Penis Pros 10 6 — — $798.60 $13,973.43 $10,679.72 2026-07-31
53447 CPT Remove/replace Ur Sphincter 10 6 — — $785.40 $13,973.43 $10,676.42 2026-07-31
53445 CPT Insert Uro/ves Nck Sphincter 10 6 — — $715.00 $13,973.43 $10,658.82 2026-07-31
C9765 HCPCS Revasc Intra Lithotrip-stent 10 6 — — $10,510.46 $10,510.46 $10,510.46 2026-07-31
L8685 HCPCS Implt Nrostm Pls Gen Sng Rec 10 6 — — $10,371.93 $10,636.26 $10,504.09 2026-07-31
69714 CPT Impl Oi Implt Skull Perq Esp 9 5 — — $367.40 $10,224.00 $10,224.00 2026-07-31
237T OTHER Trluml Perip Athrc Brchiocph 10 6 — — $9,627.86 $11,960.90 $10,211.12 2026-07-31
C9772 HCPCS Revasc Lithotrip Tibi/perone 10 6 — — $10,042.94 $10,042.94 $10,042.94 2026-07-31
L6935 HCPCS Dme Pos 10 6 — — $8,655.94 $11,262.58 $9,959.26 2026-07-31
211U OTHER Onc Pan-tum Dna&rna Gnrj Seq 10 6 — — $7,609.50 $12,259.75 $9,934.62 2026-07-31
D7949 HCPCS Reconstruct Midface W/graft 10 6 — — $9,927.21 $9,927.21 $9,927.21 2026-07-31
63655 CPT 63655 Laminect Implant Electrode Epidural 10 6 $2,580.00 $2,580.00 $600.60 $17,106.04 $9,843.02 2026-07-31
A9572 HCPCS Indium In-111 Pentetreotide 10 6 — — $9,671.09 $9,963.91 $9,817.50 2026-07-31
267U OTHER Rare Do Id Opt Gen Mapg&seq 10 6 — — $9,772.03 $9,772.03 $9,772.03 2026-07-31
36903 CPT Intro Cath Dialysis Circuit 9 5 — — $351.45 $9,748.31 $9,748.31 2026-07-31
676T OTHER Laps Insj Nw/rpcmt Isdss Ea 10 6 — — $9,747.99 $9,747.99 $9,747.99 2026-07-31
37241 CPT Vasc Embolize/occlude Venous 9 5 — — $481.25 $9,627.86 $9,627.86 2026-07-31
37238 CPT Open/perq Place Stent Same 9 5 — — $332.20 $9,627.86 $9,627.86 2026-07-31
37244 CPT Vasc Embolize/occlude Bleed 10 6 — — $756.25 $10,092.73 $9,627.86 2026-07-31
37236 CPT Open/perq Place Stent 1st 9 5 — — $481.25 $9,627.86 $9,627.86 2026-07-31
37226 CPT Fem/popl Revasc W/stent 9 5 — — $563.20 $12,502.47 $9,627.86 2026-07-31
C9600 HCPCS Perc Drug-el Cor Stent Sing 10 6 — — $9,627.86 $9,627.86 $9,627.86 2026-07-31
C9604 HCPCS Perc D-e Cor Revasc T Cabg S 10 6 — — $9,627.86 $9,627.86 $9,627.86 2026-07-31
37225 CPT Fem/popl Revas W/ather 9 5 — — $646.25 $13,497.29 $9,627.86 2026-07-31
37243 CPT Vasc Embolize/occlude Organ 9 5 — — $645.70 $13,211.78 $9,627.86 2026-07-31
37242 CPT Vasc Embolize/occlude Artery 9 5 — — $539.00 $10,902.46 $9,627.86 2026-07-31
236T OTHER Trluml Perip Athrc Abd Aorta 10 6 — — $9,245.14 $9,627.86 $9,532.18 2026-07-31
L6925 HCPCS Dme Pos 10 6 — — $8,276.00 $10,768.21 $9,522.10 2026-07-31
33206 CPT Insert Heart Pm Atrial 9 5 — — $392.70 $9,493.45 $9,493.45 2026-07-31
33214 CPT Upgrade Of Pacemaker System 9 5 — — $417.45 $9,493.45 $9,493.45 2026-07-31
J9356 HCPCS Hyaluronidase-trastuzumab 10,000 Units-600 Mg/5 Ml Sq [mdmh] 10 6 $10,266.83 $10,266.83 $78.23 $10,266.83 $9,445.48 2026-07-31
L5857 HCPCS Dme Pos 10 6 — — $8,176.55 $10,638.82 $9,407.68 2026-07-31
L8679 HCPCS Dme Pos 10 6 — — $8,128.64 $10,576.49 $9,352.57 2026-07-31
L6930 HCPCS Dme Pos 10 6 — — $8,062.36 $10,490.26 $9,276.31 2026-07-31
J0630 HCPCS Calcitonin 200 Intl units/mL Inj [mdmh] 18 6 $9,605.45 $9,605.45 $1,339.06 $16,644.39 $9,221.23 2026-07-31
L5615 HCPCS Dme Pos 10 6 — — $7,980.30 $10,411.41 $9,195.85 2026-07-31
81552 CPT Onc Uveal Mlnma Mrna 15 Gene 10 6 — — $6,998.40 $11,275.20 $9,136.80 2026-07-31
53451 CPT Tprnl Balo Cntnc Dev Bi 10 6 — — $1,164.12 $11,729.96 $9,088.50 2026-07-31
L8619 HCPCS Dme Pos 10 6 — — $7,883.50 $10,257.52 $9,070.51 2026-07-31
94U OTHER Genome Rapid Sequence Alys 10 6 — — $6,823.98 $10,994.19 $8,909.08 2026-07-31
L6920 HCPCS Dme Pos 10 6 — — $7,673.33 $9,984.07 $8,828.70 2026-07-31
64583 CPT Rev/rplct Hpglsl Nstm Ary Pg 10 6 — — $797.50 $11,483.38 $8,811.91 2026-07-31
L7190 HCPCS Dme Pos 10 6 — — $7,638.45 $9,938.68 $8,788.57 2026-07-31
L8688 HCPCS Implt Nrostm Pls Gen Dua Non 10 6 — — $8,613.13 $8,832.64 $8,722.89 2026-07-31
J9173 HCPCS Durvalumab 50 mg/mL Sol 10 Ml [mdmh] 10 6 $9,431.07 $9,431.07 $100.33 $9,431.07 $8,676.58 2026-07-31
234T OTHER Trluml Perip Athrc Renal Art 10 6 — — $5,529.31 $9,627.86 $8,603.22 2026-07-31
Q5115 HCPCS riTUXimab Abbs 10 mg/mL Sol [mdmh] 10 6 $9,284.14 $9,284.14 $37.71 $9,284.13 $8,541.40 2026-07-31
J1451 HCPCS Fomepizole 1 g/mL Sol [mdmh] 10 6 $9,205.23 $9,205.23 $11.04 $9,205.22 $8,468.81 2026-07-31
81529 CPT Onc Cutan Mlnma Mrna 31 Gene 10 6 — — $6,473.70 $10,429.85 $8,451.77 2026-07-31
Q5108 HCPCS Pegfilgrastim Jmdb 6 Mg/0.6 Ml Sq Pfs [mdmh] 18 6 $15,030.00 $15,030.00 $122.48 $15,030.00 $8,416.80 2026-07-31
C9780 HCPCS Insert Cv Cath Inf & Sup App 10 6 — — $8,250.50 $8,250.50 $8,250.50 2026-07-31
J3247 HCPCS secukinumab125mg/5mL Vial [mdmh] 10 6 $8,883.00 $8,883.00 $19.23 $8,883.00 $8,172.36 2026-07-31
37228 CPT Tib/per Revasc W/tla 10 6 — — $591.25 $9,627.86 $8,003.69 2026-07-31
L5987 HCPCS Dme Pos 10 6 — — $6,918.96 $9,002.52 $7,960.74 2026-07-31
265U OTHER Rar Do Whl Gn&mtcdrl DNA Als 10 6 — — $7,939.91 $7,939.91 $7,939.91 2026-07-31
295U OTHER Onc Brst Dux Carc 7 Proteins 10 6 — — $7,880.75 $7,880.75 $7,880.75 2026-07-31
28715 CPT Fusion Of Foot Bones 10 6 — — $738.10 $10,224.00 $7,852.52 2026-07-31
24498 CPT Reinforce Humerus 10 6 — — $675.40 $10,224.00 $7,836.85 2026-07-31
27745 CPT Reinforce Tibia 10 6 — — $576.95 $10,224.00 $7,812.24 2026-07-31
J9225 HCPCS Vantas Implant 10 6 — — $7,413.78 $8,049.72 $7,731.75 2026-07-31
L8627 HCPCS Dme Pos 10 6 — — $6,678.34 $8,689.44 $7,683.89 2026-07-31
27412 CPT Autologous Chondrocyte Implantation (aci), Knee 10 6 $5,001.00 $5,001.00 $1,360.70 $10,224.00 $7,612.50 2026-07-31
39503 CPT Repair Of Diaphragm Hernia 10 6 — — $5,990.05 $9,206.30 $7,598.18 2026-07-31
22856 CPT 22856 Cervical Arthroplasty Anterior Approach 10 6 $4,934.00 $4,934.00 $1,322.75 $10,224.00 $7,579.00 2026-07-31
335U OTHER Rare Ds Whl Gen Seq Feta 10 6 — — $7,575.67 $7,575.67 $7,575.67 2026-07-31
92987 CPT Revision Of Mitral Valve 10 6 — — $1,285.90 $9,627.86 $7,542.37 2026-07-31
520T OTHER Rmv&rplcmt Pg Wcs Lv Battery 10 6 — — $820.25 $9,747.99 $7,516.06 2026-07-31
515T OTHER Insj Wcs Lv Compl Sys 10 6 — — $818.67 $9,747.99 $7,515.66 2026-07-31
22612 CPT 22612 Arthrdsis Post/posterolat 1; Lumb 10 6 $4,802.00 $4,802.00 $1,294.15 $10,224.00 $7,513.00 2026-07-31
92990 CPT Revision Of Pulmonary Valve 10 6 — — $1,004.85 $9,627.86 $7,472.11 2026-07-31
Q5114 HCPCS Trastuzumab Dkst 420 Mg Rec [mdmh] 10 6 $8,119.18 $8,119.18 $50.79 $8,119.17 $7,469.64 2026-07-31
19298 CPT Place Breast Rad Tube/caths 9 5 — — $316.25 $7,464.32 $7,464.32 2026-07-31
61626 CPT Transcath Occlusion Non-cns 10 6 — — $913.00 $9,627.86 $7,449.15 2026-07-31
36905 CPT Thrmbc/nfs Dialysis Circuit 10 6 — — $495.00 $9,748.31 $7,434.98 2026-07-31
92943 CPT Prq Card Revasc Chronic 1vsl 10 6 — — $677.05 $9,627.86 $7,390.16 2026-07-31
92941 CPT Prq Card Revasc Mi 1 Vsl 10 6 — — $677.05 $9,627.86 $7,390.16 2026-07-31
92997 CPT Pul Art Balloon Repr Percut 10 6 — — $658.90 $9,627.86 $7,385.62 2026-07-31
92924 CPT Prq Card Angio/athrect 1 Art 10 6 — — $645.70 $9,627.86 $7,382.32 2026-07-31
92928 CPT Prq Card Stent W/angio 1 Vsl 10 6 — — $602.80 $9,627.86 $7,371.60 2026-07-31
92937 CPT Prq Revasc Byp Graft 1 Vsl 10 6 — — $602.25 $9,627.86 $7,371.46 2026-07-31
33285 CPT Insj Subq Car Rhythm Mntr 9 5 — — $84.15 $7,370.99 $7,370.99 2026-07-31
33289 CPT Tcat Impl Wrls P-art Prs Snr 9 5 — — $330.00 $7,370.99 $7,370.99 2026-07-31
61623 CPT Endovasc Tempory Vessel Occl 10 6 — — $547.25 $9,627.86 $7,357.71 2026-07-31
37221 CPT Iliac Revasc W/stent 10 6 — — $536.25 $9,627.86 $7,354.96 2026-07-31
L5280 HCPCS Dme Pos 10 6 — — $6,387.59 $8,311.14 $7,349.36 2026-07-31
Q0224 HCPCS Injection, Pemivibart, For The Pre-exposure Prophylaxis Only, For Certain Adults… 10 6 — — $7,142.48 $7,515.13 $7,328.81 2026-07-31
326U OTHER Trgt Gen Seq Alys Pnl 83+ 10 6 — — $7,250.00 $7,250.00 $7,250.00 2026-07-31
33224 CPT Insert Pacing Lead & Connect 10 6 — — $497.20 $9,493.45 $7,244.39 2026-07-31
L8609 HCPCS Dme Pos 10 6 — — $6,279.08 $8,169.96 $7,224.52 2026-07-31
27415 CPT Osteochondral Allograft, Knee, Open 10 6 $4,177.00 $4,177.00 $1,100.00 $10,224.00 $7,200.50 2026-07-31
L5250 HCPCS Dme Pos 10 6 — — $6,164.65 $8,021.07 $7,092.86 2026-07-31
D7948 HCPCS Reconstruct Midface No Graft 10 6 — — $7,003.13 $7,003.13 $7,003.13 2026-07-31
L7185 HCPCS Dme Pos 10 6 — — $6,037.36 $7,855.45 $6,946.40 2026-07-31
Q5116 HCPCS Trastuzumab Qyyp 420 Mg Rec [mdmh] 10 6 $7,446.82 $7,446.82 $21.88 $7,446.81 $6,851.07 2026-07-31
55873 CPT Cryoablate Prostate 10 6 — — $748.00 $8,948.06 $6,825.01 2026-07-31
27428 CPT Ligamentous Reconstruction (Augmentation), Knee; Intra-articular (Open) 10 6 $3,416.00 $3,416.00 $856.90 $10,224.00 $6,820.00 2026-07-31
47135 CPT Transplantation Of Liver 10 6 — — $4,950.00 $8,626.12 $6,788.06 2026-07-31
24435 CPT Repair Of Nonunion Or Malunion, Humerus; With Iliac Or Other Autograft (includes… 10 6 $3,301.00 $3,301.00 $824.45 $10,224.00 $6,762.50 2026-07-31
J7310 HCPCS Ganciclovir Long Act Implant 10 6 — — $6,672.40 $6,842.45 $6,757.43 2026-07-31
J1459 HCPCS Immune Globulin 10% (privigen) 100mL[MDMH] 34 6 $7,035.00 $7,035.00 $53.35 $24,115.68 $6,753.60 2026-07-31
61697 CPT 61697 Surgery Complex Aneurysm, Carotid 10 6 $12,795.00 $12,795.00 $3,487.00 $12,795.00 $6,731.71 2026-07-31
L8686 HCPCS Implt Nrostm Pls Gen Sng Non 10 6 — — $6,618.24 $6,786.91 $6,702.57 2026-07-31
L7170 HCPCS Dme Pos 10 6 — — $5,819.24 $7,571.64 $6,695.44 2026-07-31
L8682 HCPCS Dme Pos 10 6 — — $5,807.79 $7,556.75 $6,682.27 2026-07-31
61576 CPT 61576 Transorl-skull Base; W/split Tongue 10 6 $12,715.00 $12,715.00 $3,042.05 $12,715.00 $6,681.11 2026-07-31
61682 CPT 61682 Surg Av Malform; Supratent Complex 10 6 $12,550.00 $12,550.00 $3,487.55 $12,550.00 $6,637.66 2026-07-31
65770 CPT Revise Cornea With Implant 10 6 — — $1,085.70 $8,449.85 $6,608.81 2026-07-31
Q5120 HCPCS Pegfilgrastim Bmez 6 Mg/0.6 Ml Sol [mdmh] 10 6 $7,065.96 $7,065.96 $26.81 $7,065.96 $6,606.67 2026-07-31
L5341 HCPCS Dme Pos 10 6 — — $5,737.82 $7,465.71 $6,601.77 2026-07-31
33216 CPT Insert 1 Electrode Pm-defib 9 5 — — $309.10 $6,545.34 $6,545.34 2026-07-31
33211 CPT Insert Card Electrodes Dual 9 5 — — $172.70 $6,545.34 $6,545.34 2026-07-31
33217 CPT Insert 2 Electrode Pm-defib 9 5 — — $307.45 $6,545.34 $6,545.34 2026-07-31
33227 CPT Remove&replace Pm Gen Singl 9 5 — — $288.75 $6,545.34 $6,545.34 2026-07-31
J7165 HCPCS Prothrombin Complex 1000u Range [mdmh] 20 6 $9,431.08 $9,431.08 $2,249.10 $12,247.17 $6,515.77 2026-07-31
43116 CPT Partial Removal Of Esophagus 10 6 — — $5,114.45 $7,869.08 $6,491.77 2026-07-31
L5270 HCPCS Dme Pos 10 6 — — $5,623.29 $7,316.67 $6,469.98 2026-07-31
81554 CPT Pulm Ds Ipf Mrna 190 Gen Alg 10 6 — — $4,950.00 $7,975.00 $6,462.50 2026-07-31
212U OTHER Rare Ds Gen DNA Alys Proband 10 6 — — $4,927.68 $7,939.04 $6,433.36 2026-07-31
D7941 HCPCS Bone Cutting Ramus Closed 10 6 — — $6,425.11 $6,425.11 $6,425.11 2026-07-31
33935 CPT Transplantation Heart/lung 10 6 — — $5,047.90 $7,797.37 $6,422.64 2026-07-31
D7943 HCPCS Cutting Ramus Open W/graft 10 6 — — $6,399.76 $6,399.76 $6,399.76 2026-07-31
50542 CPT Laparo Ablate Renal Mass 10 6 — — $1,174.80 $8,069.91 $6,346.13 2026-07-31
49605 CPT Repair Umbilical Lesion 10 6 — — $4,789.95 $7,894.43 $6,342.19 2026-07-31
47371 CPT Laparo Ablate Liver Cryosurg 10 6 — — $1,144.00 $8,069.91 $6,338.43 2026-07-31
47370 CPT Laparo Ablate Liver Tumor Rf 10 6 — — $1,144.00 $8,069.91 $6,338.43 2026-07-31
22513 CPT Perq Vertebral Augmentation 10 6 — — $475.75 $8,849.21 $6,322.79 2026-07-31
22514 CPT Perq Vertebral Augmentation 9 5 — — $439.45 $8,810.30 $6,322.79 2026-07-31
32854 CPT Lung Transplant With Bypass 10 6 — — $4,950.00 $7,660.41 $6,305.20 2026-07-31
33945 CPT Transplantation Of Heart 10 6 — — $4,922.50 $7,683.06 $6,302.78 2026-07-31
L7008 HCPCS Dme Pos 10 6 — — $5,477.30 $7,126.73 $6,302.02 2026-07-31
27279 CPT Arthrodesis, Sacroiliac Joint, Percutaneous Or Minimally Invasive, Image Guide, … 10 6 $2,371.00 $2,371.00 $667.15 $10,224.00 $6,297.50 2026-07-31
D7946 HCPCS Reconstruction Maxilla Total 10 6 — — $6,294.62 $6,294.62 $6,294.62 2026-07-31
A9571 HCPCS Indium In-111 Auto Platelet 10 6 — — $6,007.77 $6,554.10 $6,280.94 2026-07-31
A9570 HCPCS Indium In-111 Auto Wbc 10 6 — — $6,007.77 $6,554.10 $6,280.94 2026-07-31
D5915 HCPCS Orbital Prosthesis 10 6 — — $6,270.90 $6,270.90 $6,270.90 2026-07-31
A9542 HCPCS In111 Ibritumomab, Dx 10 6 — — $5,976.49 $6,471.02 $6,223.76 2026-07-31
D7858 HCPCS Tmj Reconstruction 10 6 — — $6,175.46 $6,175.46 $6,175.46 2026-07-31
D7780 HCPCS Reduct Compnd Facial Bone Fx 10 6 — — $6,161.98 $6,161.98 $6,161.98 2026-07-31
214U OTHER Rare Ds Xom DNA Alys Proband 10 6 — — $4,702.14 $7,575.67 $6,138.90 2026-07-31
24365 CPT Arthroplasty Of The Radial Head 10 6 $1,976.00 $1,976.00 $474.10 $10,224.00 $6,100.00 2026-07-31
L5331 HCPCS Dme Pos 10 6 — — $5,299.08 $6,894.84 $6,096.96 2026-07-31
235T OTHER Trluml Perip Athrc Visceral 10 6 — — $6,095.60 $6,095.60 $6,095.60 2026-07-31
300U OTHER Onc Pan Tum Whl Gen Seq&opt 10 6 — — $6,065.54 $6,065.54 $6,065.54 2026-07-31
806T OTHER Tcat S&ivc Prstc Vl Impl Opn 10 6 — — $6,035.66 $6,035.66 $6,035.66 2026-07-31
D7947 HCPCS Reconstruct Maxilla Segment 10 6 — — $6,032.57 $6,032.57 $6,032.57 2026-07-31
J9355 HCPCS Trastuzumab 150 Mg Rec Sdv [mdmh] 10 6 $6,545.34 $6,545.34 $90.44 $6,545.34 $6,021.71 2026-07-31
38573 CPT Laps Pelvic Lymphadec 10 6 — — $1,100.00 $7,595.42 $5,971.57 2026-07-31
61520 CPT 61520 Craniect-post Fosa; Cerebellopontin 10 6 $11,302.00 $11,302.00 $3,139.95 $11,302.00 $5,946.14 2026-07-31
47142 CPT Partial Removal Donor Liver 10 6 — — $4,369.20 $7,522.38 $5,945.79 2026-07-31
32853 CPT Lung Transplant Double 10 6 — — $4,646.40 $7,226.36 $5,936.38 2026-07-31
81425 CPT Genome Sequence Analysis 10 6 — — $4,528.08 $7,295.24 $5,911.66 2026-07-31
A9604 HCPCS Sm 153 Lexidronam 10 6 — — $5,820.61 $5,968.94 $5,894.77 2026-07-31
L8683 HCPCS Dme Pos 10 6 — — $5,112.20 $6,651.68 $5,881.94 2026-07-31
242U OTHER Trgt Gen Seq Alys Pnl 55-74 10 6 — — $4,500.00 $7,250.00 $5,875.00 2026-07-31
43123 CPT Partial Removal Of Esophagus 10 6 — — $4,571.60 $7,129.84 $5,850.72 2026-07-31
519T OTHER Rmv&rplcmt Pg Wcs Lv Both 10 6 — — $1,164.12 $7,370.99 $5,819.27 2026-07-31
19357 CPT Tiss Xpndr Plmt Brst Rcnstj 10 6 — — $816.20 $7,464.32 $5,802.29 2026-07-31
D7490 HCPCS Maxilla Or Mandible Resectio 10 6 — — $5,800.71 $5,800.71 $5,800.71 2026-07-31
43108 CPT Removal Of Esophagus 10 6 — — $4,557.85 $7,038.18 $5,798.02 2026-07-31
J3032 HCPCS Eptinezumab Jjmr 100 mg/mL Sol [mdmh] 10 6 $6,279.00 $6,279.00 $20.96 $6,279.00 $5,776.68 2026-07-31
19342 CPT Insj/rplcmt Brst Implt Sep D 10 6 — — $576.40 $7,464.32 $5,742.34 2026-07-31
J9264 HCPCS PACLitaxel Protein-bound 100 Mg Rec [mdmh] 18 6 $5,972.61 $5,972.61 $16.37 $6,616.33 $5,733.70 2026-07-31
L6570 HCPCS Dme Pos 10 6 — — $4,976.29 $6,474.85 $5,725.57 2026-07-31
19325 CPT Breast Augmentation W/implt 10 6 — — $446.60 $7,464.32 $5,709.89 2026-07-31
516T OTHER Insj Wcs Lv Eltrd Only 10 6 — — $685.64 $7,370.99 $5,699.65 2026-07-31
L5702 HCPCS Dme Pos 10 6 — — $4,937.59 $6,424.49 $5,681.04 2026-07-31
517T OTHER Insj Wcs Lv Both Compnt Pg 10 6 — — $575.75 $7,370.99 $5,672.18 2026-07-31
43113 CPT Removal Of Esophagus 10 6 — — $4,403.30 $6,877.50 $5,640.40 2026-07-31
518T OTHER Rmvl Pg Wcs Lv Battery Only 10 6 — — $392.77 $7,370.99 $5,626.43 2026-07-31
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