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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

NEMAHA COUNTY HOSPITAL

Auburn, NE · CCN 281324 · Rates published

1,241 distinct procedures filed
21 distinct payers
49,383 rate rows
2026-08-10 last MRF observed
Data quality

49,370 of 49,383 rate rows are consumer-grade (100.0%)

13 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
placeholder amount (≤ $0.02) — excluded from medians 13
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://nemahacountyhospital.com/wp-content/uploads/2022/10/470471042_Nemaha-County-Hospital_standard-charges.csv
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-11
Content fingerprint 62a47044173abd8a… · 601,940 bytes · first seen 2026-05-05

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
J1930
HCPCS 		Lanreotide (somatuline) inj:120mg/0.5mL+ 10 $11,276.50 $20,047.10 $11,502.03 nat. median
$261
outlier · 44.0×
J3380
HCPCS 		Vedolizumab (entyvio) Ivpb:300mg + 10 $10,614.13 $18,869.57 $10,826.41 nat. median
$59
outlier · 184.1×
J1459
HCPCS 		Immune Globulin (PRIVIGEN):40gm/400mL + 10 $10,244.61 $18,212.64 $10,449.50 nat. median
$968
outlier · 10.8×
J3101
HCPCS 		Tenecteplase (tnkase) Inj:25mg - Stroke+ 10 $9,565.91 $17,229.12 $9,885.21 nat. median
$498
outlier · 19.9×
J2353
HCPCS 		SandoSTATIN(OCTREOTIDE)INJ:30MG + 10 $8,062.82 $14,333.90 $8,224.08 nat. median
$1,956
outlier · 4.2×
J9271
HCPCS 		Pembrolizumab (keytruda) Ivpb:100mg + 10 $7,157.02 $12,723.60 $7,300.17 nat. median
$127
outlier · 57.5×
J1449
HCPCS 		Eflapegrastim-xnst inj:13.2mg/0.6mL* 10 $5,810.62 $10,329.98 $5,926.83 nat. median
$39
outlier · 152.1×
J1162
HCPCS 		Digoxin Immune Fab (DigiFab) Inj:40mg 10 $5,453.49 $9,695.09 $5,562.56 nat. median
$6,265
0.9× median
J2356
HCPCS 		Tezepelumab (tezspire) inj:210mg/1.91mL 10 $5,350.75 $9,512.45 $5,457.77 nat. median
$43
outlier · 126.0×
Q5111
HCPCS 		Pegfilgrastim-cbqv (udenyca) Inj:6mg + 10 $4,869.72 $8,657.28 $4,967.11 nat. median
$665
outlier · 7.5×
78816
CPT 		CT Pet/ct Whole Body-initial 10 $4,696.38 $8,349.12 $4,790.31 nat. median
$1,696
outlier · 2.8×
J1306
HCPCS 		Inclisiran (leqvio) inj:284mg/1.5mL 10 $4,593.91 $8,166.96 $4,685.79 nat. median
$25
outlier · 185.9×
J2426
HCPCS 		Paliperidone (invega Sustenna) Inj:234mg 10 $4,467.58 $7,942.37 $4,556.93 nat. median
$2,528
1.8× median
J0897
HCPCS 		Denosumab (xgeva) Injection:120mg 10 $2,503.47 $7,777.30 $4,374.73 nat. median
$86
outlier · 50.9×
0360
RC 		10 $1,765.80 $9,638.40 $4,294.00 nat. median
$1,707
outlier · 2.5×
J0840
HCPCS 		Crotalidae Polyvalent (crofab) Inj:1gm 10 $4,002.99 $7,116.43 $4,083.05 nat. median
$3,496
1.2× median
404
OTHER 		CT Pet/ct Limited Area 11 $3,573.04 $6,391.68 $3,928.22 nat. median
$2,134
1.8× median
78815
CPT 		CT Pet/ct Skull Base-mid Thigh Initial 10 $3,821.04 $6,792.96 $3,897.46 nat. median
$1,679
outlier · 2.3×
78451
CPT 		Nmmyoperfsingle 10 $3,718.44 $6,610.56 $3,792.81 nat. median
$1,355
outlier · 2.8×
J1439
HCPCS 		Ferric Carboxymaltose inj:750mg/15mL + 10 $3,707.40 $6,590.93 $3,781.54 nat. median
$5
outlier · 752.5×
J0401
HCPCS 		ARIPiprazole (abilify MAINTENA)inj:400mg 10 $3,529.66 $6,274.94 $3,600.25 nat. median
$22
outlier · 160.3×
J2802
HCPCS 		Romiplostim (nplate) Inj:125mcg + 10 $1,966.84 $6,327.12 $3,527.81 nat. median
$43
outlier · 81.8×
78814
CPT 		CT Pet/ct Limited Area 10 $3,425.76 $6,090.24 $3,494.28 nat. median
$1,613
outlier · 2.2×
J3111
HCPCS 		Romosozumab (evenity) inj:210mg/2.34mL+ 10 $3,398.57 $6,041.90 $3,466.54 nat. median
$19
outlier · 182.4×
73720
CPT 		Mr Lo Ext No Joint Wwo Bil 10 $2,021.22 $6,108.48 $3,439.79 nat. median
$754
outlier · 4.6×
74174
CPT 		CT CTA Abd & Pel With & Without Cont 10 $3,363.66 $5,979.84 $3,430.93 nat. median
$549
outlier · 6.2×
J9217
HCPCS 		Leuprolide (eligard) Injection: 45mg 10 $1,843.96 $6,030.82 $3,335.24 nat. median
$2,144
1.6× median
74178
CPT 		CT Abdomen/pelvis W&without Cont 10 $3,195.18 $5,680.32 $3,259.08 nat. median
$539
outlier · 6.1×
360
OTHER 		Addtnl Injection W/flouro Csp/thor/s2 11 $619.50 $8,985.60 $3,079.80 nat. median
$16,601
outlier · 0.2×
75557
CPT 		Mr Cardiac 10 $2,920.32 $5,191.68 $2,978.73 nat. median
$307
outlier · 9.7×
73702
CPT 		CT Lo Ext Wwocon-bi 10 $1,728.00 $5,222.40 $2,940.80 nat. median
$369
outlier · 8.0×
73218
CPT 		Mr Up Ext No Jnt-bi 10 $1,721.52 $5,203.20 $2,929.88 nat. median
$553
outlier · 5.3×
C1897
HCPCS 		Lead Neurostim Test Kit 10 $2,824.74 $5,021.76 $2,881.23 nat. median
$1,214
outlier · 2.4×
74177
CPT 		CT Abdomen/pelvis W Cont 10 $2,769.66 $4,923.84 $2,825.05 nat. median
$501
outlier · 5.6×
73202
CPT 		CT Up Ext W&wo Con-bi 10 $1,630.26 $4,926.72 $2,774.38 nat. median
$399
outlier · 7.0×
73718
CPT 		Mr Lo Ext No Jnt-bi 10 $1,629.72 $4,925.76 $2,773.65 nat. median
$505
outlier · 5.5×
90375
CPT 		Rabies Immune Globulin soln:300iu/mL 3mL 10 $2,645.78 $4,703.62 $2,698.70 nat. median
$789
outlier · 3.4×
78452
CPT 		Nmmyoperfmulti 10 $2,631.96 $4,679.04 $2,684.60 nat. median
$1,464
1.8× median
95811
CPT 		Rt Sleep Study/split N 10 $2,602.80 $4,627.20 $2,654.86 nat. median
$1,412
1.9× median
J3032
HCPCS 		Eptinezumab-jjmr (vyepti) inj:100mg/mL + 10 $2,597.29 $4,617.41 $2,649.24 nat. median
$35
outlier · 75.6×
Q5108
HCPCS 		Pegfilgrastim-jmdb (fulphila) Inj:6mg + 10 $2,570.13 $4,569.12 $2,621.53 nat. median
$418
outlier · 6.3×
J7168
HCPCS 		Prothrombin Complex (kcentra) Inj:1000u 10 $2,566.00 $4,561.78 $2,617.32 nat. median
$589
outlier · 4.4×
72156
CPT 		Mr C Spine W&without Con 10 $2,534.76 $4,506.24 $2,585.46 nat. median
$625
outlier · 4.1×
72157
CPT 		Mr T Spine W&without Con 10 $2,516.94 $4,474.56 $2,567.28 nat. median
$624
outlier · 4.1×
74183
CPT 		Mr Abdomen W&wo Contrast 10 $2,501.82 $4,447.68 $2,551.86 nat. median
$611
outlier · 4.2×
73221
CPT 		Mr Up Ext Jnt-bi 10 $1,492.56 $4,511.04 $2,540.17 nat. median
$547
outlier · 4.6×
72158
CPT 		Mr L Spine W&without Con 10 $2,482.38 $4,413.12 $2,532.03 nat. median
$616
outlier · 4.1×
95810
CPT 		Rt Full Sleep Study 10 $2,464.56 $4,381.44 $2,513.85 nat. median
$1,446
1.7× median
70553
CPT 		Mr Brain W&without Cont 10 $2,364.66 $4,203.84 $2,411.95 nat. median
$616
outlier · 3.9×
612
OTHER 		Mr C Spine W Contr 11 $1,856.14 $4,064.64 $2,397.17 nat. median
$6,246
outlier · 0.4×

Other procedures at this hospital

Browse this hospital's 1,241 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
             
94726 CPT Rt Plethysmography 13 10 $700.00 $700.00 $378.00 $672.00 $385.56 2026-08-10
87506 CPT Enteric Pathogens Panel By Pcr(test8446) 13 10 $700.00 $700.00 $378.00 $672.00 $385.56 2026-08-10
72114 CPT Xr Spine Ls Min 6 Views 13 10 $700.00 $700.00 $378.00 $672.00 $385.56 2026-08-10
96416 CPT Chemo Prolonged Infusion 8+hrs 13 10 $702.00 $702.00 $379.08 $673.92 $386.66 2026-08-10
27246 CPT Treat Thigh Fracture 13 10 $703.00 $703.00 $379.62 $674.88 $387.21 2026-08-10
81232 CPT Dihydropyrimidine Dehydrogenase (dpyd) 13 10 $705.00 $705.00 $380.70 $676.80 $388.31 2026-08-10
72052 CPT Xr Spine Cervical 6 Views Or More 13 10 $706.00 $706.00 $381.24 $677.76 $388.86 2026-08-10
J0561 HCPCS Penicillin-g (bicillin LA)inj:1.2mmu/2mL 13 10 $708.90 $708.90 $382.81 $680.54 $390.46 2026-08-10
J3489 HCPCS Zoledronic Acid (zometa) inj:4mg/5mL 26 10 $625.00 $625.00 $145.80 $940.80 $394.20 2026-08-10
64484 CPT Njx Aa&/strd Tfrm Epi L/s Ea 13 10 $725.00 $725.00 $391.50 $696.00 $399.33 2026-08-10
23600 CPT Cltx Prox Humrl Fx Without Mnpj 13 10 $726.00 $726.00 $392.04 $696.96 $399.88 2026-08-10
52000 CPT Phys Pro Fee-cystoscopy 26 10 $712.50 $712.50 $40.50 $1,296.00 $400.50 2026-08-10
402 OTHER US Abdomen 231 11 $600.00 $600.00 $227.74 $832.32 $402.00 2026-07-05
76830 CPT US Transvaginal 13 10 $733.00 $733.00 $395.82 $703.68 $403.74 2026-08-10
74220 CPT Xr Esophagus 13 10 $740.00 $740.00 $399.60 $710.40 $407.59 2026-08-10
Q5106 HCPCS Epoetin Alfa (retacrit) Inj: 3,000u/mL 26 10 $708.08 $708.08 $78.17 $1,220.54 $412.76 2026-08-10
410 OTHER Rt Aerosol/mdi Tx-1 154 11 $588.00 $588.00 $74.34 $1,370.88 $413.00 2026-07-05
761 OTHER Amnio-ther Fld Redu/s1 143 11 $560.00 $560.00 $49.56 $2,899.20 $413.00 2026-07-05
76000 CPT Xr Fluoroscopy Up To 1 Hour 13 10 $750.00 $750.00 $405.00 $720.00 $413.10 2026-08-10
87633 CPT Respiratory Viral Panel Pcr, #10345 13 10 $751.00 $751.00 $405.54 $720.96 $413.65 2026-08-10
76870 CPT US Scrotum/content 13 10 $752.00 $752.00 $406.08 $721.92 $414.20 2026-08-10
74455 CPT Xr Urethrocysio Void 13 10 $754.00 $754.00 $407.16 $723.84 $415.30 2026-08-10
87507 CPT Gastrointestinal Pathogen Panel #8384 13 10 $757.00 $757.00 $408.78 $726.72 $416.96 2026-08-10
76705 CPT US Abdomen Limit 13 10 $757.00 $757.00 $408.78 $726.72 $416.96 2026-08-10
J1610 HCPCS Glucagon (GlucaGen) Injection:1mg 13 10 $768.60 $768.60 $415.04 $737.86 $423.34 2026-08-10
76801 CPT US Preg Uterus Rt W/image 1st Trimester 13 10 $773.00 $773.00 $417.42 $742.08 $425.77 2026-08-10
74430 CPT Xr Cystogram 13 10 $790.00 $790.00 $426.60 $758.40 $435.13 2026-08-10
25600 CPT Treat Fracture Radius/ulna 13 10 $791.00 $791.00 $427.14 $759.36 $435.68 2026-08-10
88262 CPT ~chromosome Analysis 13 10 $792.00 $792.00 $427.68 $760.32 $436.23 2026-08-10
88271 CPT ~cytogenetics, DNA Probe 13 10 $792.00 $792.00 $427.68 $760.32 $436.23 2026-08-10
90677 CPT Pneumococcal (prevnar 20) vaccine:0.5mL 13 10 $794.45 $794.45 $429.00 $762.67 $437.58 2026-08-10
88230 CPT ~tissue Culture Nonneoplastic Disorder 13 10 $799.00 $799.00 $431.46 $767.04 $440.09 2026-08-10
28755 CPT Phys Pro Fee-fusion Of Big Toe Joint 13 10 $800.00 $800.00 $432.00 $768.00 $440.64 2026-08-10
88184 CPT ~flow Cytometry 13 10 $801.00 $801.00 $432.54 $768.96 $441.19 2026-08-10
11406 CPT Exc Tr-ext B9+marg >4.0 Cm 13 10 $803.00 $803.00 $433.62 $770.88 $442.29 2026-08-10
P9016 HCPCS Nch Bld Proc Fee-ldc 13 10 $810.00 $810.00 $437.40 $777.60 $446.15 2026-08-10
P9040 HCPCS Nch Bld Proc Fee Ldcirr 13 10 $815.00 $815.00 $440.10 $782.40 $448.90 2026-08-10
93226 CPT Holter Analysis 13 10 $816.00 $816.00 $440.64 $783.36 $449.45 2026-08-10
75809 CPT Xr Shunt Series 13 10 $817.00 $817.00 $441.18 $784.32 $450.00 2026-08-10
28750 CPT Phys Pro Fee-fusion Of Big Toe Joint 26 10 $668.50 $668.50 $246.78 $844.80 $456.96 2026-08-10
P9019 HCPCS Nch Platelet Proc Fee-ldc 13 10 $832.00 $832.00 $449.28 $798.72 $458.27 2026-08-10
76942 CPT US Guide, Cyst Asp Or Nedl Bx 13 10 $832.00 $832.00 $449.28 $798.72 $458.27 2026-08-10
390 OTHER Nch Bld Proc Fee-ldc 55 11 $632.00 $632.00 $119.18 $865.92 $459.61 2026-07-05
88360 CPT ~surgical Path Xiii 88360 13 10 $836.00 $836.00 $451.44 $802.56 $460.47 2026-08-10
74300 CPT Xr Oper Cholangiogr 13 10 $838.00 $838.00 $452.52 $804.48 $461.57 2026-08-10
88341 CPT ~surgical Path Viii 88341 13 10 $842.00 $842.00 $454.68 $808.32 $463.77 2026-08-10
51720 CPT Chemo Bladder Insti 13 10 $856.00 $856.00 $462.24 $821.76 $471.48 2026-08-10
76856 CPT US Pelvic Nonpreg 13 10 $861.00 $861.00 $464.94 $826.56 $474.24 2026-08-10
74450 CPT Xr Urethrocystography 13 10 $872.00 $872.00 $470.88 $837.12 $480.30 2026-08-10
81273 CPT Kit(d816v) Mutation By ddPCR Arup 13 10 $874.00 $874.00 $471.96 $839.04 $481.40 2026-08-10
93882 CPT Carotid Dop-ltd 13 10 $880.00 $880.00 $475.20 $844.80 $484.70 2026-08-10
81270 CPT Jak-2(v617f Mutation, Qual) W Rflx #7758 13 10 $883.00 $883.00 $476.82 $847.68 $486.36 2026-08-10
76770 CPT US Retroperitoneal Complete 13 10 $890.00 $890.00 $480.60 $854.40 $490.21 2026-08-10
76805 CPT US Pelvis Com OB > 14wks 13 10 $893.00 $893.00 $482.22 $857.28 $491.86 2026-08-10
52351 CPT Cystouretero & Or Pyeloscope 26 10 $827.00 $827.00 $396.90 $882.24 $501.23 2026-08-10
93990 CPT Dialysis Graft Duplex Doppler 13 10 $928.00 $928.00 $501.12 $890.88 $511.14 2026-08-10
99284 CPT ER Visit -4 13 10 $930.00 $930.00 $502.20 $892.80 $512.24 2026-08-10
45331 CPT Sigmoidoscopy With Biopsy 26 10 $926.00 $926.00 $38.88 $1,708.80 $515.16 2026-08-10
93979 CPT Abdominal Vessels Duplex Limited Doppler 13 10 $941.00 $941.00 $508.14 $903.36 $518.30 2026-08-10
370 OTHER Anes Equip 121-150 132 11 $783.00 $783.00 $220.66 $1,054.08 $518.80 2026-07-05
25605 CPT Closed Tx Radial Fx W Manipulation 13 10 $948.00 $948.00 $511.92 $910.08 $522.16 2026-08-10
81206 CPT Bcr-abl1, Major (p210) #8340 13 10 $950.00 $950.00 $513.00 $912.00 $523.26 2026-08-10
77075 CPT Xr Bone Survey Complet 13 10 $960.00 $960.00 $518.40 $921.60 $528.77 2026-08-10
93931 CPT Arterial Dop-up Lmt 13 10 $960.00 $960.00 $518.40 $921.60 $528.77 2026-08-10
11772 CPT Remove Pilonidal Cyst Compl 13 10 $964.00 $964.00 $520.56 $925.44 $530.97 2026-08-10
J7323 HCPCS Hyaluronate (euflexxa) inj:20mg/2mL+ 13 10 $973.70 $973.70 $525.80 $934.75 $536.31 2026-08-10
21933 CPT Exc Back Tum Deep 5 Cm/> 13 10 $983.00 $983.00 $530.82 $943.68 $541.44 2026-08-10
76700 CPT US Abdomen 13 10 $984.00 $984.00 $531.36 $944.64 $541.99 2026-08-10
93923 CPT Art Seg Upper 13 10 $1,002.00 $1,002.00 $541.08 $961.92 $551.90 2026-08-10
64555 CPT Implant Neuroelectrodes 13 10 $1,010.00 $1,010.00 $545.40 $969.60 $556.31 2026-08-10
93924 CPT Ankle/arm Index With Exer 13 10 $1,011.00 $1,011.00 $545.94 $970.56 $556.86 2026-08-10
93926 CPT Arterial Dop-lo Lmt 13 10 $1,012.00 $1,012.00 $546.48 $971.52 $557.41 2026-08-10
36430 CPT Blood Administration 1-4 Hrs 39 10 $870.00 $870.00 $378.00 $998.40 $561.60 2026-08-10
93308 CPT Limited Echo 13 10 $1,032.00 $1,032.00 $557.28 $990.72 $568.43 2026-08-10
64491 CPT Inj Paravert F Jnt C/t 2 Lev 13 10 $1,036.00 $1,036.00 $559.44 $994.56 $570.63 2026-08-10
52310 CPT Phys Pro Fee-cystoscopy & Treatment 26 10 $1,003.00 $1,003.00 $75.60 $1,791.36 $571.02 2026-08-10
94660 CPT Rt Cpap/bipap Management 13 10 $1,041.00 $1,041.00 $562.14 $999.36 $573.38 2026-08-10
0278 RC — 897 10 $876.00 $876.00 $67.50 $18,468.00 $581.20 2026-08-10
77001 CPT Xr Fluoroscopy/venous Access Device 13 10 $1,058.00 $1,058.00 $571.32 $1,015.68 $582.75 2026-08-10
29876 CPT Knee Arthroscopy/surgery 13 10 $1,059.00 $1,059.00 $571.86 $1,016.64 $583.30 2026-08-10
J1410 HCPCS Estrogen (premarin) Injection:25mg 13 10 $1,059.95 $1,059.95 $572.37 $1,017.55 $583.82 2026-08-10
92950 CPT Resuscitation Fee 13 10 $1,063.00 $1,063.00 $574.02 $1,020.48 $585.50 2026-08-10
64418 CPT Njx Aa&/strd Sprscap Nrv 13 10 $1,077.00 $1,077.00 $581.58 $1,033.92 $593.21 2026-08-10
64480 CPT Addtnl Injection W/flouro Csp/thor/s2 13 10 $1,100.00 $1,100.00 $594.00 $1,056.00 $605.88 2026-08-10
255 OTHER CT Pet/fluorodeoxyglucose Fdg Up To 45ml 11 11 $1,012.00 $1,012.00 $597.08 $971.52 $609.02 2026-07-05
482 OTHER Stress Testing 11 11 $1,032.00 $1,032.00 $608.88 $990.72 $621.06 2026-07-05
52287 CPT Phys Pro Fee-cystoscopy Chemodenervation 26 10 $1,113.00 $1,113.00 $84.24 $1,987.20 $633.78 2026-08-10
77002 CPT Xr Fluoroscopy/needle Placement 13 10 $1,157.00 $1,157.00 $624.78 $1,110.72 $637.28 2026-08-10
93978 CPT Abdominal Vessels Duplex Comp Doppler 13 10 $1,159.00 $1,159.00 $625.86 $1,112.64 $638.38 2026-08-10
93930 CPT Arterial Dop-up Bi 13 10 $1,160.00 $1,160.00 $626.40 $1,113.60 $638.93 2026-08-10
921 OTHER Abdominal Vessels Duplex Comp Doppler 187 11 $1,042.00 $1,042.00 $59.00 $1,377.60 $641.92 2026-07-05
Q5101 HCPCS Filgrastim-sndz (ZARXIO)inj:480mcg/0.8mL 13 10 $1,205.00 $1,205.00 $650.70 $1,156.80 $663.71 2026-08-10
66821 CPT Yag Laser 13 10 $1,207.00 $1,207.00 $651.78 $1,158.72 $664.82 2026-08-10
94640 CPT Rt Aerosol/mdi Tx-1 78 10 $1,085.00 $1,085.00 $167.40 $1,785.60 $676.30 2026-08-10
64486 CPT Tap Block Unil By Injection 13 10 $1,228.00 $1,228.00 $663.12 $1,178.88 $676.38 2026-08-10
93971 CPT Venous Dop-ltd 13 10 $1,233.00 $1,233.00 $665.82 $1,183.68 $679.14 2026-08-10
81315 CPT Pml/rara Quant By Pcr #8554 13 10 $1,244.00 $1,244.00 $671.76 $1,194.24 $685.20 2026-08-10
635 OTHER Procrit(epoetin)inj:20,000u Esrd* 11 11 $1,141.15 $1,141.15 $673.28 $1,095.50 $686.74 2026-07-05
74400 CPT Xr Ivpw/wo Kub W/wo To 13 10 $1,248.00 $1,248.00 $673.92 $1,198.08 $687.40 2026-08-10
93975 CPT Abdominal Vessels & Organs (renal) Doppl 13 10 $1,250.00 $1,250.00 $675.00 $1,200.00 $688.50 2026-08-10
90675 CPT Rabies Vaccine Injection: 2.5iu/mL 13 10 $1,266.85 $1,266.85 $684.10 $1,216.18 $697.78 2026-08-10
62323 CPT Njx Interlaminar Lmbr/sac 13 10 $1,297.00 $1,297.00 $700.38 $1,245.12 $714.39 2026-08-10
74420 CPT Xr Urography, Retrograde, W/wo Kub 13 10 $1,299.00 $1,299.00 $701.46 $1,247.04 $715.49 2026-08-10
22903 CPT Exc Abd Les Sc 3 Cm/> 13 10 $1,302.00 $1,302.00 $703.08 $1,249.92 $717.14 2026-08-10
93925 CPT Arterial Dop-lo Bi 13 10 $1,304.00 $1,304.00 $704.16 $1,251.84 $718.24 2026-08-10
J7324 HCPCS Hyaluronate (orthovisc) inj:30mg/2mL + 13 10 $1,312.10 $1,312.10 $708.53 $1,259.62 $722.70 2026-08-10
93017 CPT Stress Testing 13 10 $1,338.00 $1,338.00 $722.52 $1,284.48 $736.97 2026-08-10
45378 CPT Colonoscopy Screen-not High Risk 26 10 $1,254.50 $1,254.50 $175.50 $2,096.64 $745.68 2026-08-10
43235 CPT Endoscopy 26 10 $1,340.00 $1,340.00 $61.56 $2,463.36 $747.54 2026-08-10
64483 CPT Njx Aa&/strd Tfrm Epi L/s1 13 10 $1,364.00 $1,364.00 $736.56 $1,309.44 $751.29 2026-08-10
99285 CPT ER Visit -5 13 10 $1,420.00 $1,420.00 $766.80 $1,363.20 $782.14 2026-08-10
56605 CPT Biopsy Of Vulva/perineum 13 10 $1,460.00 $1,460.00 $788.40 $1,401.60 $804.17 2026-08-10
64490 CPT Inj Paravert F Jnt C/t 1 Lev 13 10 $1,465.00 $1,465.00 $791.10 $1,406.40 $806.92 2026-08-10
78305 CPT Nm Bone Mult 13 10 $1,468.00 $1,468.00 $792.72 $1,409.28 $808.57 2026-08-10
78070 CPT Nm Parathyroid Image 13 10 $1,468.00 $1,468.00 $792.72 $1,409.28 $808.57 2026-08-10
78290 CPT Nm Meckel's Scan 13 10 $1,468.00 $1,468.00 $792.72 $1,409.28 $808.57 2026-08-10
78300 CPT Nm Bone Limited 13 10 $1,468.00 $1,468.00 $792.72 $1,409.28 $808.57 2026-08-10
14040 CPT Phys Pro Fee-tis Trnfr F/c/c/m/n/a/g/h/f 13 10 $1,495.00 $1,495.00 $807.30 $1,435.20 $823.45 2026-08-10
0120 RC — 39 10 $1,500.00 $1,500.00 $378.00 $1,658.88 $826.20 2026-08-10
26440 CPT Release Palm/finger Tendon 13 10 $1,523.00 $1,523.00 $822.42 $1,462.08 $838.87 2026-08-10
684 OTHER ER-trauma Response Code 11 11 $1,400.00 $1,400.00 $826.00 $1,344.00 $842.52 2026-07-05
710 OTHER Monitored Recovery 110 11 $1,283.50 $1,283.50 $137.47 $1,874.88 $842.52 2026-07-05
391 OTHER Blood Administration 11 11 $1,400.00 $1,400.00 $826.00 $1,344.00 $842.52 2026-07-05
93970 CPT Venous Dop-bil 13 10 $1,533.00 $1,533.00 $827.82 $1,471.68 $844.38 2026-08-10
J0248 HCPCS Remdesivir (veklury) Ivpb:100mg 13 10 $1,543.00 $1,543.00 $833.22 $1,481.28 $849.88 2026-08-10
43450 CPT Endo W/dilatation 26 10 $1,549.00 $1,549.00 $39.96 $2,903.04 $852.00 2026-08-10
45330 CPT Flexible Sigmoidoscopy 13 10 $1,573.00 $1,573.00 $849.42 $1,510.08 $866.41 2026-08-10
64493 CPT Inj Paravert F Jnt L/s 1 Lev 13 10 $1,595.00 $1,595.00 $861.30 $1,531.20 $878.53 2026-08-10
93880 CPT Carotid Dop-bil 13 10 $1,596.00 $1,596.00 $861.84 $1,532.16 $879.08 2026-08-10
43239 CPT Endo W/bx 26 10 $1,512.00 $1,512.00 $197.64 $2,551.68 $893.34 2026-08-10
93886 CPT Trancranial Dop 13 10 $1,629.00 $1,629.00 $879.66 $1,563.84 $897.25 2026-08-10
75820 CPT Xr Venography Uni 13 10 $1,664.00 $1,664.00 $898.56 $1,597.44 $916.53 2026-08-10
45380 CPT Colonoscopy W/bx Or Forcep Polypectomy 26 10 $1,591.00 $1,591.00 $227.34 $2,650.56 $947.55 2026-08-10
90389 CPT Tetanus Immune Globulin Inj: 250units 13 10 $1,752.75 $1,752.75 $946.49 $1,682.64 $965.41 2026-08-10
J0585 HCPCS OnabotulinumtoxinA (botox)inj:100 Units+ 13 10 $1,757.70 $1,757.70 $949.16 $1,687.39 $968.14 2026-08-10
45381 CPT Colonoscopy With Directed Submucosal Inj 13 10 $1,788.00 $1,788.00 $965.52 $1,716.48 $984.83 2026-08-10
76380 CPT CT Limited Or F/u Study 13 10 $1,794.00 $1,794.00 $968.76 $1,722.24 $988.14 2026-08-10
56821 CPT Exam Biopsy Of Vulva W Scope 13 10 $1,814.00 $1,814.00 $979.56 $1,741.44 $999.15 2026-08-10
92960 CPT Cardioversion 13 10 $1,820.00 $1,820.00 $982.80 $1,747.20 $1,002.46 2026-08-10
88374 CPT ~fish Auto Professional 13 10 $1,838.00 $1,838.00 $992.52 $1,764.48 $1,012.37 2026-08-10
0722 RC — 13 10 $1,845.00 $1,845.00 $996.30 $1,771.20 $1,016.23 2026-08-10
78701 CPT Nm Renal W/vasc 13 10 $1,884.00 $1,884.00 $1,017.36 $1,808.64 $1,037.71 2026-08-10
45385 CPT Colonoscopy W/polypectomy 26 10 $1,755.50 $1,755.50 $235.98 $2,951.04 $1,039.74 2026-08-10
64479 CPT Tfesi With Imaging Cervical/thoracic/s4 13 10 $1,900.00 $1,900.00 $1,026.00 $1,824.00 $1,046.52 2026-08-10
78708 CPT Nm Renal Scan Lasix Washout (mag3) 13 10 $1,930.00 $1,930.00 $1,042.20 $1,852.80 $1,063.04 2026-08-10
93350 CPT Stress Echo 13 10 $1,950.00 $1,950.00 $1,053.00 $1,872.00 $1,074.06 2026-08-10
P9032 HCPCS Nch Platelet Proc Fee Ldcirr 13 10 $1,950.00 $1,950.00 $1,053.00 $1,872.00 $1,074.06 2026-08-10
45333 CPT Sigmoidoscopy With Polypectomy 13 10 $1,959.00 $1,959.00 $1,057.86 $1,880.64 $1,079.02 2026-08-10
78306 CPT Nm Bone Total 13 10 $1,993.00 $1,993.00 $1,076.22 $1,913.28 $1,097.74 2026-08-10
99291 CPT ER-critical Care 13 10 $2,000.00 $2,000.00 $1,080.00 $1,920.00 $1,101.60 2026-08-10
722 OTHER Birthing Service 11 11 $1,845.00 $1,845.00 $1,088.55 $1,771.20 $1,110.32 2026-07-05
341 OTHER Nm Bone 3 Phase 165 11 $1,836.00 $1,836.00 $731.01 $4,001.28 $1,134.99 2026-07-05
70486 CPT CT Maxiloface Without C 13 10 $2,062.00 $2,062.00 $1,113.48 $1,979.52 $1,135.75 2026-08-10
750 OTHER Flex Sig Colon/s10 11 11 $1,925.00 $1,925.00 $1,135.75 $1,848.00 $1,158.47 2026-07-05
78227 CPT Nm Hepatobiliary Imaging With & Without Gbef 13 10 $2,130.00 $2,130.00 $1,150.20 $2,044.80 $1,173.20 2026-08-10
78226 CPT Nm Hepatobiliary Imaging Without Gbef 13 10 $2,157.00 $2,157.00 $1,164.78 $2,070.72 $1,188.08 2026-08-10
G0390 HCPCS ER-trauma Response Code 13 10 $2,180.00 $2,180.00 $1,177.20 $2,092.80 $1,200.74 2026-08-10
54360 CPT Penis Plastic Surgery 26 10 $1,983.00 $1,983.00 $943.92 $2,129.28 $1,209.70 2026-08-10
78215 CPT Nm Liver & Spleen 13 10 $2,236.00 $2,236.00 $1,207.44 $2,146.56 $1,231.59 2026-08-10
78761 CPT Nm Testicular Image 13 10 $2,243.00 $2,243.00 $1,211.22 $2,153.28 $1,235.44 2026-08-10
70450 CPT CT Head Without Cont 13 10 $2,244.00 $2,244.00 $1,211.76 $2,154.24 $1,236.00 2026-08-10
55250 CPT Vasectomy 13 10 $2,261.00 $2,261.00 $1,220.94 $2,170.56 $1,245.36 2026-08-10
78315 CPT Nm Bone 3 Phase 13 10 $2,331.00 $2,331.00 $1,258.74 $2,237.76 $1,283.91 2026-08-10
70490 CPT CT Soft Tissue Neck Without Cont 13 10 $2,383.00 $2,383.00 $1,286.82 $2,287.68 $1,312.56 2026-08-10
70487 CPT CT Maxiloface With Co 13 10 $2,395.00 $2,395.00 $1,293.30 $2,299.20 $1,319.17 2026-08-10
120 OTHER Rm Chg Icf 33 11 $1,190.00 $1,190.00 $230.75 $5,579.40 $1,330.00 2026-07-05
70480 CPT CT Orbit/sella/temporal Without 13 10 $2,415.00 $2,415.00 $1,304.10 $2,318.40 $1,330.18 2026-08-10
64721 CPT Carpal Tunnel Surgery 13 10 $2,442.00 $2,442.00 $1,318.68 $2,344.32 $1,345.05 2026-08-10
78472 CPT Nm Gated Blood 13 10 $2,449.00 $2,449.00 $1,322.46 $2,351.04 $1,348.91 2026-08-10
66850 CPT Removal Of Lens Material 13 10 $2,469.00 $2,469.00 $1,333.26 $2,370.24 $1,359.93 2026-08-10
72192 CPT CT Pelvis Without Cont 13 10 $2,529.00 $2,529.00 $1,365.66 $2,427.84 $1,392.97 2026-08-10
70460 CPT CT Head With Cont 13 10 $2,544.00 $2,544.00 $1,373.76 $2,442.24 $1,401.24 2026-08-10
71250 CPT CT Chest Without Cont 13 10 $2,545.00 $2,545.00 $1,374.30 $2,443.20 $1,401.79 2026-08-10
351 OTHER CT Head With Cont 132 11 $2,226.00 $2,226.00 $1,118.64 $2,726.40 $1,408.81 2026-07-05
93306 CPT Echo With Color Doppler 13 10 $2,574.00 $2,574.00 $1,389.96 $2,471.04 $1,417.76 2026-08-10
70491 CPT CT Soft Tissue Neck With Cont 13 10 $2,622.00 $2,622.00 $1,415.88 $2,517.12 $1,444.20 2026-08-10
72128 CPT CT T Spine Without Cont 13 10 $2,643.00 $2,643.00 $1,427.22 $2,537.28 $1,455.76 2026-08-10
72125 CPT CT C Spine Without Cont 13 10 $2,670.00 $2,670.00 $1,441.80 $2,563.20 $1,470.64 2026-08-10
72129 CPT CT T Spine W Con 13 10 $2,691.00 $2,691.00 $1,453.14 $2,583.36 $1,482.20 2026-08-10
74150 CPT CT Abdomen Without Cont 13 10 $2,697.00 $2,697.00 $1,456.38 $2,589.12 $1,485.51 2026-08-10
72131 CPT CT L Spine Without Cont 13 10 $2,700.00 $2,700.00 $1,458.00 $2,592.00 $1,487.16 2026-08-10
72127 CPT CT Cspine W&without Con 13 10 $2,704.00 $2,704.00 $1,460.16 $2,595.84 $1,489.36 2026-08-10
70482 CPT CT Orbt/sella/temporal W&without 13 10 $2,713.00 $2,713.00 $1,465.02 $2,604.48 $1,494.32 2026-08-10
43251 CPT Endo With Snare Polypectomy 13 10 $2,730.00 $2,730.00 $1,474.20 $2,620.80 $1,503.68 2026-08-10
J7325 HCPCS Hyaluronate (synvisc One) inj:48mg/6mL+ 26 10 $2,352.32 $2,352.32 $676.73 $3,313.39 $1,533.42 2026-08-10
70481 CPT CT Orbit/sella/temporal W/co 13 10 $2,805.00 $2,805.00 $1,514.70 $2,692.80 $1,544.99 2026-08-10
71260 CPT CT Chest With Contra 13 10 $2,817.00 $2,817.00 $1,521.18 $2,704.32 $1,551.60 2026-08-10
44388 CPT Colonoscopy Thru Stoma Spx 13 10 $2,828.00 $2,828.00 $1,527.12 $2,714.88 $1,557.66 2026-08-10
70488 CPT CT Maxiloface W&without 13 10 $2,832.00 $2,832.00 $1,529.28 $2,718.72 $1,559.87 2026-08-10
74160 CPT CT Abdomen With Cont 13 10 $2,853.00 $2,853.00 $1,540.62 $2,738.88 $1,571.43 2026-08-10
72132 CPT CT L Spine With Cont 13 10 $2,872.00 $2,872.00 $1,550.88 $2,757.12 $1,581.90 2026-08-10
72133 CPT CT Lspine W&without Con 13 10 $2,891.00 $2,891.00 $1,561.14 $2,775.36 $1,592.36 2026-08-10
70470 CPT CT Head W&without Cont 13 10 $2,933.00 $2,933.00 $1,583.82 $2,815.68 $1,615.50 2026-08-10
70492 CPT CT Soft Tissue Neck W&without Cont 13 10 $2,952.00 $2,952.00 $1,594.08 $2,833.92 $1,625.96 2026-08-10
72193 CPT CT Pelvis With Contr 13 10 $2,956.00 $2,956.00 $1,596.24 $2,837.76 $1,628.16 2026-08-10
73721 CPT Mr Lo Ext Jnt-bi Wo 26 10 $2,889.00 $2,889.00 $1,505.52 $2,870.40 $1,630.74 2026-08-10
72130 CPT CT Tspine W&without Con 13 10 $2,970.00 $2,970.00 $1,603.80 $2,851.20 $1,635.88 2026-08-10
73725 CPT Mr MRA Lo Ext W Or Without Lt 13 10 $3,016.00 $3,016.00 $1,628.64 $2,895.36 $1,661.21 2026-08-10
36573 CPT Picc Insertion 13 10 $3,020.00 $3,020.00 $1,630.80 $2,899.20 $1,663.42 2026-08-10
72191 CPT CT CTA Pelvis With Cont 13 10 $3,077.00 $3,077.00 $1,661.58 $2,953.92 $1,694.81 2026-08-10
93312 CPT Tee 13 10 $3,126.00 $3,126.00 $1,688.04 $3,000.96 $1,721.80 2026-08-10
72194 CPT CT Pelvis W&without Con 13 10 $3,147.00 $3,147.00 $1,699.38 $3,021.12 $1,733.37 2026-08-10
352 OTHER CT Abdomen/pelvis W Cont 352 11 $2,641.50 $2,641.50 $88.50 $5,424.96 $1,734.89 2026-07-05
71270 CPT CT Chest W&without Cont 13 10 $3,198.00 $3,198.00 $1,726.92 $3,070.08 $1,761.46 2026-08-10
73701 CPT CT Lo Ext W/con-bi 26 10 $2,944.50 $2,944.50 $1,432.62 $3,106.56 $1,764.91 2026-08-10
70498 CPT CT CTA Neck W&wo 13 10 $3,301.00 $3,301.00 $1,782.54 $3,168.96 $1,818.19 2026-08-10
70496 CPT CT CTA Head W&wo 13 10 $3,337.00 $3,337.00 $1,801.98 $3,203.52 $1,838.02 2026-08-10
74170 CPT CT Abdomen W&without Co 13 10 $3,339.00 $3,339.00 $1,803.06 $3,205.44 $1,839.12 2026-08-10
72195 CPT Mr Pelvis Without 13 10 $3,350.00 $3,350.00 $1,809.00 $3,216.00 $1,845.18 2026-08-10
70540 CPT Mr Orbit Neck Without Contrast 13 10 $3,395.00 $3,395.00 $1,833.30 $3,259.20 $1,869.97 2026-08-10
70547 CPT Mr MRA Of Neck Without Contrast 13 10 $3,460.00 $3,460.00 $1,868.40 $3,321.60 $1,905.77 2026-08-10
70548 CPT Mr MRA Of Neck With Contrast 13 10 $3,508.00 $3,508.00 $1,894.32 $3,367.68 $1,932.21 2026-08-10
72147 CPT Mr T Spine W/cont 13 10 $3,568.00 $3,568.00 $1,926.72 $3,425.28 $1,965.25 2026-08-10
J1561 HCPCS Immune Globulin (gamunex-c):10gm/100ml + 13 10 $3,572.10 $3,572.10 $1,928.93 $3,429.22 $1,967.51 2026-08-10
74175 CPT CT CTA Abdomen With Cont 13 10 $3,631.00 $3,631.00 $1,960.74 $3,485.76 $1,999.95 2026-08-10
74181 CPT Mr Abdomen Without Contrast 13 10 $3,648.00 $3,648.00 $1,969.92 $3,502.08 $2,009.32 2026-08-10
73722 CPT Mr Lo Ext Jnt-r W Cont 13 10 $3,650.00 $3,650.00 $1,971.00 $3,504.00 $2,010.42 2026-08-10
70545 CPT Mr Brain Mra/mrv W&without Contrast 13 10 $3,675.00 $3,675.00 $1,984.50 $3,528.00 $2,024.19 2026-08-10
70544 CPT Mr Brain Mra/mrv Without Contrast 13 10 $3,675.00 $3,675.00 $1,984.50 $3,528.00 $2,024.19 2026-08-10
72148 CPT Mr L Spine Without Cont 13 10 $3,686.00 $3,686.00 $1,990.44 $3,538.56 $2,030.25 2026-08-10
72141 CPT Mr C Spine Without Cont 13 10 $3,724.00 $3,724.00 $2,010.96 $3,575.04 $2,051.18 2026-08-10
J9264 HCPCS Paclitaxel-protien Bound Inj: 100mg+ 13 10 $3,732.90 $3,732.90 $2,015.77 $3,583.58 $2,056.08 2026-08-10
71275 CPT CT CTA Chest With Contra 13 10 $3,736.00 $3,736.00 $2,017.44 $3,586.56 $2,057.79 2026-08-10
73723 CPT Mr Lo Ext Jnt-l W&without Cont 13 10 $3,745.00 $3,745.00 $2,022.30 $3,595.20 $2,062.75 2026-08-10
72142 CPT Mr C Spine W Contr 13 10 $3,750.00 $3,750.00 $2,025.00 $3,600.00 $2,065.50 2026-08-10
73220 CPT Mr Upper Extremity Non Joint W & Wo Con 13 10 $3,754.00 $3,754.00 $2,027.16 $3,603.84 $2,067.70 2026-08-10
J1451 HCPCS Fomepizole (antizol) inj:1500mg/1.5mL 13 10 $3,780.00 $3,780.00 $2,041.20 $3,628.80 $2,082.02 2026-08-10
74185 CPT Mr Abdomen MRA W/wo 13 10 $3,833.00 $3,833.00 $2,069.82 $3,679.68 $2,111.22 2026-08-10
72146 CPT Mr T Spine Without Cont 13 10 $3,836.00 $3,836.00 $2,071.44 $3,682.56 $2,112.87 2026-08-10
70551 CPT Mr Brain Without Cont 13 10 $3,852.00 $3,852.00 $2,080.08 $3,697.92 $2,121.68 2026-08-10
73200 CPT CT Up Ext Wo Con-bi 26 10 $3,120.00 $3,120.00 $1,247.94 $3,771.84 $2,123.89 2026-08-10
75635 CPT CT CTA Runoff 13 10 $3,905.00 $3,905.00 $2,108.70 $3,748.80 $2,150.87 2026-08-10
J2357 HCPCS Xolair(omalizumab)inj:150mg + 13 10 $3,915.45 $3,915.45 $2,114.34 $3,758.83 $2,156.63 2026-08-10
71550 CPT Mr Chest 13 10 $3,934.00 $3,934.00 $2,124.36 $3,776.64 $2,166.85 2026-08-10
610 OTHER Mr Abdomen MRA W/wo 187 11 $3,349.00 $3,349.00 $1,499.78 $4,885.44 $2,174.74 2026-07-05
611 OTHER Mr Brain Limited 99 11 $3,463.00 $3,463.00 $1,812.48 $3,750.72 $2,189.49 2026-07-05
44394 CPT Colonoscopy Thru Stoma With Polypectomy 13 10 $3,994.00 $3,994.00 $2,156.76 $3,834.24 $2,199.90 2026-08-10
70543 CPT Mr Orbit Fac Neck W&wo 13 10 $3,996.00 $3,996.00 $2,157.84 $3,836.16 $2,201.00 2026-08-10
J0875 HCPCS Dalbavancin (dalvance) Ivpb: 500mg 13 10 $4,056.40 $4,056.40 $2,190.46 $3,894.14 $2,234.27 2026-08-10
73700 CPT CT Lo Ext Wo Con-bi 26 10 $3,298.00 $3,298.00 $1,319.22 $3,986.88 $2,245.09 2026-08-10
70549 CPT Mr MRA Of Neck W & Without Contrast 13 10 $4,149.00 $4,149.00 $2,240.46 $3,983.04 $2,285.27 2026-08-10
72149 CPT Mr L Spine W/cont 13 10 $4,162.00 $4,162.00 $2,247.48 $3,995.52 $2,292.43 2026-08-10
70552 CPT Mr Brain W Contrast 13 10 $4,191.00 $4,191.00 $2,263.14 $4,023.36 $2,308.40 2026-08-10
74176 CPT CT Abdomen/pelvis Without Cont 13 10 $4,200.00 $4,200.00 $2,268.00 $4,032.00 $2,313.36 2026-08-10
920 OTHER Rt Full Sleep Study 33 11 $3,855.00 $3,855.00 $283.20 $4,062.72 $2,319.94 2026-07-05
73223 CPT Mr Upper Extremity Without & W Contrast 13 10 $4,250.00 $4,250.00 $2,295.00 $4,080.00 $2,340.90 2026-08-10
74182 CPT Mr Abdomen With Contrast 13 10 $4,264.00 $4,264.00 $2,302.56 $4,093.44 $2,348.61 2026-08-10
49440 CPT Xr Gastrostomy Tube Pl 13 10 $4,300.00 $4,300.00 $2,322.00 $4,128.00 $2,368.44 2026-08-10
73201 CPT CT Up Ext W/con-bi 26 10 $3,506.00 $3,506.00 $1,402.38 $4,238.40 $2,386.67 2026-08-10
72197 CPT Mr Pelvis W/wo Contrast 13 10 $4,348.00 $4,348.00 $2,347.92 $4,174.08 $2,394.88 2026-08-10
612 OTHER Mr C Spine W Contr 99 11 $3,458.00 $3,458.00 $1,856.14 $4,064.64 $2,397.17 2026-07-05
70553 CPT Mr Brain W&without Cont 13 10 $4,379.00 $4,379.00 $2,364.66 $4,203.84 $2,411.95 2026-08-10
95810 CPT Rt Full Sleep Study 13 10 $4,564.00 $4,564.00 $2,464.56 $4,381.44 $2,513.85 2026-08-10
72158 CPT Mr L Spine W&without Con 13 10 $4,597.00 $4,597.00 $2,482.38 $4,413.12 $2,532.03 2026-08-10
73221 CPT Mr Up Ext Jnt-bi 26 10 $3,731.50 $3,731.50 $1,492.56 $4,511.04 $2,540.17 2026-08-10
74183 CPT Mr Abdomen W&wo Contrast 13 10 $4,633.00 $4,633.00 $2,501.82 $4,447.68 $2,551.86 2026-08-10
72157 CPT Mr T Spine W&without Con 13 10 $4,661.00 $4,661.00 $2,516.94 $4,474.56 $2,567.28 2026-08-10
72156 CPT Mr C Spine W&without Con 13 10 $4,694.00 $4,694.00 $2,534.76 $4,506.24 $2,585.46 2026-08-10
J7168 HCPCS Prothrombin Complex (kcentra) Inj:1000u 13 10 $4,751.85 $4,751.85 $2,566.00 $4,561.78 $2,617.32 2026-08-10
Q5108 HCPCS Pegfilgrastim-jmdb (fulphila) Inj:6mg + 13 10 $4,759.50 $4,759.50 $2,570.13 $4,569.12 $2,621.53 2026-08-10
J3032 HCPCS Eptinezumab-jjmr (vyepti) inj:100mg/mL + 13 10 $4,809.80 $4,809.80 $2,597.29 $4,617.41 $2,649.24 2026-08-10
95811 CPT Rt Sleep Study/split N 13 10 $4,820.00 $4,820.00 $2,602.80 $4,627.20 $2,654.86 2026-08-10
78452 CPT Nmmyoperfmulti 13 10 $4,874.00 $4,874.00 $2,631.96 $4,679.04 $2,684.60 2026-08-10
90375 CPT Rabies Immune Globulin soln:300iu/mL 3mL 13 10 $4,899.60 $4,899.60 $2,645.78 $4,703.62 $2,698.70 2026-08-10
73718 CPT Mr Lo Ext No Jnt-bi 26 10 $4,074.50 $4,074.50 $1,629.72 $4,925.76 $2,773.65 2026-08-10
73202 CPT CT Up Ext W&wo Con-bi 26 10 $4,075.50 $4,075.50 $1,630.26 $4,926.72 $2,774.38 2026-08-10
74177 CPT CT Abdomen/pelvis W Cont 13 10 $5,129.00 $5,129.00 $2,769.66 $4,923.84 $2,825.05 2026-08-10
C1897 HCPCS Lead Neurostim Test Kit 13 10 $5,231.00 $5,231.00 $2,824.74 $5,021.76 $2,881.23 2026-08-10
73218 CPT Mr Up Ext No Jnt-bi 26 10 $4,304.00 $4,304.00 $1,721.52 $5,203.20 $2,929.88 2026-08-10
73702 CPT CT Lo Ext Wwocon-bi 26 10 $4,320.00 $4,320.00 $1,728.00 $5,222.40 $2,940.80 2026-08-10
75557 CPT Mr Cardiac 13 10 $5,408.00 $5,408.00 $2,920.32 $5,191.68 $2,978.73 2026-08-10
360 OTHER Addtnl Injection W/flouro Csp/thor/s2 583 11 $4,400.00 $4,400.00 $619.50 $8,985.60 $3,079.80 2026-07-05
74178 CPT CT Abdomen/pelvis W&without Cont 13 10 $5,917.00 $5,917.00 $3,195.18 $5,680.32 $3,259.08 2026-08-10
J9217 HCPCS Leuprolide (eligard) Injection: 45mg 26 10 $4,848.43 $4,848.43 $1,843.96 $6,030.82 $3,335.24 2026-08-10
74174 CPT CT CTA Abd & Pel With & Without Cont 13 10 $6,229.00 $6,229.00 $3,363.66 $5,979.84 $3,430.93 2026-08-10
73720 CPT Mr Lo Ext No Joint Wwo Bil 26 10 $5,053.00 $5,053.00 $2,021.22 $6,108.48 $3,439.79 2026-08-10
J3111 HCPCS Romosozumab (evenity) inj:210mg/2.34mL+ 13 10 $6,293.65 $6,293.65 $3,398.57 $6,041.90 $3,466.54 2026-08-10
78814 CPT CT Pet/ct Limited Area 13 10 $6,344.00 $6,344.00 $3,425.76 $6,090.24 $3,494.28 2026-08-10
J2802 HCPCS Romiplostim (nplate) Inj:125mcg + 26 10 $5,116.52 $5,116.52 $1,966.84 $6,327.12 $3,527.81 2026-08-10
J0401 HCPCS ARIPiprazole (abilify MAINTENA)inj:400mg 13 10 $6,536.40 $6,536.40 $3,529.66 $6,274.94 $3,600.25 2026-08-10
J1439 HCPCS Ferric Carboxymaltose inj:750mg/15mL + 13 10 $6,865.55 $6,865.55 $3,707.40 $6,590.93 $3,781.54 2026-08-10
78451 CPT Nmmyoperfsingle 13 10 $6,886.00 $6,886.00 $3,718.44 $6,610.56 $3,792.81 2026-08-10
78815 CPT CT Pet/ct Skull Base-mid Thigh Initial 13 10 $7,076.00 $7,076.00 $3,821.04 $6,792.96 $3,897.46 2026-08-10
404 OTHER CT Pet/ct Limited Area 33 11 $6,454.00 $6,454.00 $3,573.04 $6,391.68 $3,928.22 2026-07-05
J0840 HCPCS Crotalidae Polyvalent (crofab) Inj:1gm 13 10 $7,412.95 $7,412.95 $4,002.99 $7,116.43 $4,083.05 2026-08-10
0360 RC — 559 10 $6,420.00 $6,420.00 $1,765.80 $9,638.40 $4,294.00 2026-08-10
J0897 HCPCS Denosumab (xgeva) Injection:120mg 26 10 $6,368.70 $6,368.70 $2,503.47 $7,777.30 $4,374.73 2026-08-10
J2426 HCPCS Paliperidone (invega Sustenna) Inj:234mg 13 10 $8,273.30 $8,273.30 $4,467.58 $7,942.37 $4,556.93 2026-08-10
J1306 HCPCS Inclisiran (leqvio) inj:284mg/1.5mL 13 10 $8,507.25 $8,507.25 $4,593.91 $8,166.96 $4,685.79 2026-08-10
78816 CPT CT Pet/ct Whole Body-initial 13 10 $8,697.00 $8,697.00 $4,696.38 $8,349.12 $4,790.31 2026-08-10
Q5111 HCPCS Pegfilgrastim-cbqv (udenyca) Inj:6mg + 13 10 $9,018.00 $9,018.00 $4,869.72 $8,657.28 $4,967.11 2026-08-10
J2356 HCPCS Tezepelumab (tezspire) inj:210mg/1.91mL 13 10 $9,908.80 $9,908.80 $5,350.75 $9,512.45 $5,457.77 2026-08-10
J1162 HCPCS Digoxin Immune Fab (DigiFab) Inj:40mg 13 10 $10,099.05 $10,099.05 $5,453.49 $9,695.09 $5,562.56 2026-08-10
J1449 HCPCS Eflapegrastim-xnst inj:13.2mg/0.6mL* 13 10 $10,760.40 $10,760.40 $5,810.62 $10,329.98 $5,926.83 2026-08-10
J9271 HCPCS Pembrolizumab (keytruda) Ivpb:100mg + 13 10 $13,253.75 $13,253.75 $7,157.02 $12,723.60 $7,300.17 2026-08-10
J2353 HCPCS SandoSTATIN(OCTREOTIDE)INJ:30MG + 13 10 $14,931.15 $14,931.15 $8,062.82 $14,333.90 $8,224.08 2026-08-10
J3101 HCPCS Tenecteplase (tnkase) Inj:25mg - Stroke+ 26 10 $17,830.83 $17,830.83 $9,565.91 $17,229.12 $9,885.21 2026-08-10
J1459 HCPCS Immune Globulin (PRIVIGEN):40gm/400mL + 13 10 $18,971.50 $18,971.50 $10,244.61 $18,212.64 $10,449.50 2026-08-10
J3380 HCPCS Vedolizumab (entyvio) Ivpb:300mg + 13 10 $19,655.80 $19,655.80 $10,614.13 $18,869.57 $10,826.41 2026-08-10
J1930 HCPCS Lanreotide (somatuline) inj:120mg/0.5mL+ 13 10 $20,882.40 $20,882.40 $11,276.50 $20,047.10 $11,502.03 2026-08-10
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