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

AVERA ST ANTHONY'S HOSPITAL

O' Neill, NE · CCN 281329 · Rates published

1,323 distinct procedures filed
5 distinct payers
19,836 rate rows
2026-05-09 last MRF observed
Data quality

19,783 of 19,836 rate rows are consumer-grade (99.7%)

53 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 20
exceeds 10× this hospital's gross charge — excluded from medians 16
placeholder amount (≤ $0.02) — excluded from medians 9
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 8
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.avera.org/app/files/public/2ee985f1-c8f5-4aff-9e24-196f8b6c838b/470463911_avera-st-anthonys-hospital_standardcharges.csv
Discovered viaDiscovered by HANK (automated)
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-10-21
Content fingerprint 6c2c74f4ac50ad51… · 5,384,505 bytes · first seen 2026-05-09

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
J9347
HCPCS 		Tremelimumab-actl 300 Mg/15 Ml 5 $199.38 $167,010.00 $142,837.50 nat. median
$2,840
outlier · 50.3×
862
OTHER 		Ms-DRG 862 1 $84,076.84 $84,076.84 $84,076.84 nat. median
$2,877
outlier · 29.2×
314
OTHER 		Ms-DRG 314 1 $74,245.41 $74,245.41 $74,245.41 nat. median
$19,076
outlier · 3.9×
326
OTHER 		Ms-DRG 326 1 $60,310.30 $60,310.30 $60,310.30 nat. median
$40,057
1.5× median
J2350
HCPCS 		Ocrelizumab 300 Mg/10 Ml 5 $6.09 $65,621.56 $56,123.71 nat. median
$518
outlier · 108.3×
J9334
HCPCS 		Efgart-hyalu-qvfc 1008Mg/5.6Ml 5 $560.66 $54,893.01 $46,947.98 nat. median
$83
outlier · 566.8×
347
OTHER 		Ms-DRG 347 1 $46,761.62 $46,761.62 $46,761.62 nat. median
$22,982
outlier · 2.0×
580
OTHER 		Ms-DRG 580 1 $44,614.89 $44,614.89 $44,614.89 nat. median
$14,328
outlier · 3.1×
J9272
HCPCS 		Dostarlimab-gxly 500 Mg/10 Ml 5 $8,526.00 $50,176.04 $42,913.71 nat. median
$794
outlier · 54.1×
J9022
HCPCS 		Atezolizumab 1200 Mg/20 Ml Vl 5 $1.26 $46,985.49 $40,184.96 nat. median
$6,910
outlier · 5.8×
J9203
HCPCS 		Gemtuzumab Ozogamicin 4.5 Mg 5 $97.98 $42,592.79 $36,428.05 nat. median
$689
outlier · 52.9×
323
OTHER 		Ms-DRG 323 1 $35,650.87 $35,650.87 $35,650.87 nat. median
$6,578
outlier · 5.4×
133
OTHER 		Ms-DRG 133 1 $34,672.12 $34,672.12 $34,672.12 nat. median
$6,244
outlier · 5.6×
J9042
HCPCS 		Brentuximab Vedotin 50 Mg Vial 5 $8,327.21 $40,300.14 $34,467.22 nat. median
$971
outlier · 35.5×
J3357
HCPCS 		Ustekinumab 45 Mg/0.5 Ml Syr 5 $8.96 $39,712.59 $33,964.72 nat. median
$14,970
outlier · 2.3×
J9043
HCPCS 		Cabazitaxel 60 Mg/1.5 Ml Vial 5 $7.02 $39,669.58 $33,927.93 nat. median
$738
outlier · 46.0×
248
OTHER 		Ms-DRG 248 1 $32,953.66 $32,953.66 $32,953.66 nat. median
$19,537
1.7× median
J9144
HCPCS 		Daratumumab Hyaluronida 1800Mg 5 $382.98 $33,610.25 $31,265.46 nat. median
$213
outlier · 146.9×
542
OTHER 		Ms-DRG 542 1 $29,182.97 $29,182.97 $29,182.97 nat. median
$14,203
outlier · 2.1×
283
OTHER 		Ms-DRG 283 1 $28,486.19 $28,486.19 $28,486.19 nat. median
$18,682
1.5× median
249
OTHER 		Ms-DRG 249 1 $28,286.14 $28,286.14 $28,286.14 nat. median
$12,128
outlier · 2.3×
J1930
HCPCS 		Lanreotide Acet 120mg/0.5ml Sy 5 $2.24 $32,541.75 $27,831.76 nat. median
$5,088
outlier · 5.5×
787
OTHER 		Ms-DRG 787 1 $27,745.35 $27,745.35 $27,745.35 nat. median
$9,980
outlier · 2.8×
897
OTHER 		Ms-DRG 897 1 $26,837.34 $26,837.34 $26,837.34 nat. median
$27,087
1.0× median
55
OTHER 		Ms-DRG 55 1 $26,176.79 $26,176.79 $26,176.79 nat. median
$11,551
outlier · 2.3×
J3380
HCPCS 		Vedolizumab 300 Mg Vial 5 $72.63 $30,299.73 $25,914.25 nat. median
$168
outlier · 154.7×
617
OTHER 		Ms-DRG 617 2 $12,962.88 $25,889.84 $25,889.84 nat. median
$18,479
1.4× median
J3101
HCPCS 		Tenecteplase 50 Mg/10 Ml Syrng 5 $0.41 $30,005.60 $25,662.68 nat. median
$3,824
outlier · 6.7×
J2323
HCPCS 		Natalizumab 300 Mg/15 Ml Vial 5 $0.11 $28,998.37 $24,801.24 nat. median
$206
outlier · 120.2×
J9306
HCPCS 		Pertuzumab 420 Mg/14 Ml Vial 5 $508.34 $26,202.87 $24,113.98 nat. median
$81
outlier · 298.0×
J9063
HCPCS 		Mirvetuximab Soravtansine-gynx 5 $20.18 $28,011.81 $23,957.47 nat. median
$211
outlier · 113.7×
J9228
HCPCS 		Ipilimumab 5 Mg/ml 10 Ml Vial 5 $1,054.59 $27,929.41 $23,886.99 nat. median
$9,011
outlier · 2.7×
139
OTHER 		Ms-DRG 139 1 $23,521.65 $23,521.65 $23,521.65 nat. median
$11,769
2.0× median
551
OTHER 		Ms-DRG 551 1 $22,657.80 $22,657.80 $22,657.80 nat. median
$15,030
1.5× median
140
OTHER 		Ms-DRG 140 1 $22,529.07 $22,529.07 $22,529.07 nat. median
$29,006
0.8× median
J9332
HCPCS 		Efgartigimod Alfa-fcab 400 Mg 5 $7.91 $25,992.48 $22,230.41 nat. median
$113
outlier · 196.3×
536
OTHER 		Ms-DRG 536 1 $21,883.40 $21,883.40 $21,883.40 nat. median
$7,905
outlier · 2.8×
426
OTHER 		Ms-DRG 426 1 $21,852.78 $21,852.78 $21,852.78 nat. median
$74,561
outlier · 0.3×
J0717
HCPCS 		Certolizumab Pegol 400 Mg Kit 5 $3.42 $24,592.04 $20,532.01 nat. median
$1,573
outlier · 13.0×
539
OTHER 		Ms-DRG 539 1 $19,947.00 $19,947.00 $19,947.00 nat. median
$16,424
1.2× median
948
OTHER 		Ms-DRG 948 2 $9,729.64 $19,392.24 $19,392.24 nat. median
$68
outlier · 285.5×
J0517
HCPCS 		Benralizumab 30 Mg/ml Syringe 5 $3.11 $21,515.55 $18,401.46 nat. median
$919
outlier · 20.0×
J2353
HCPCS 		Octreotide (Depot) 20 Mg Syr 5 $17.33 $24,782.58 $18,086.50 nat. median
$5,568
outlier · 3.2×
540
OTHER 		Ms-DRG 540 1 $17,908.80 $17,908.80 $17,908.80 nat. median
$9,538
1.9× median
425
OTHER 		Ms-DRG 425 1 $17,135.53 $17,135.53 $17,135.53 nat. median
$13,012
1.3× median
J9271
HCPCS 		Pembrolizumab 100 Mg/4 Ml Vial 5 $13.37 $19,580.11 $16,746.15 nat. median
$280
outlier · 59.7×
871
OTHER 		Ms-DRG 871 1 $16,679.18 $16,679.18 $16,679.18 nat. median
$8,129
outlier · 2.1×
694
OTHER 		Ms-DRG 694 1 $16,385.12 $16,385.12 $16,385.12 nat. median
$7,533
outlier · 2.2×
541
OTHER 		Ms-DRG 541 1 $16,375.61 $16,375.61 $16,375.61 nat. median
$7,287
outlier · 2.2×
179
OTHER 		Ms-DRG 179 1 $16,193.72 $16,193.72 $16,193.72 nat. median
$7,931
outlier · 2.0×

Other procedures at this hospital

Browse this hospital's 1,323 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
             
J9347 HCPCS Tremelimumab-actl 300 Mg/15 Ml 8 5 $175,800.00 $170,526.00 $199.38 $167,010.00 $142,837.50 2026-05-09
862 OTHER Ms-DRG 862 2 1 — — $84,076.84 $84,076.84 $84,076.84 2026-05-09
314 OTHER Ms-DRG 314 2 1 — — $74,245.41 $74,245.41 $74,245.41 2026-05-09
326 OTHER Ms-DRG 326 2 1 — — $60,310.30 $60,310.30 $60,310.30 2026-05-09
J2350 HCPCS Ocrelizumab 300 Mg/10 Ml 8 5 $69,075.00 $67,003.07 $6.09 $65,621.56 $56,123.71 2026-05-09
J9334 HCPCS Efgart-hyalu-qvfc 1008Mg/5.6Ml 8 5 $57,782.00 $56,048.66 $560.66 $54,893.01 $46,947.98 2026-05-09
347 OTHER Ms-DRG 347 2 1 — — $46,761.62 $46,761.62 $46,761.62 2026-05-09
580 OTHER Ms-DRG 580 1 1 — — $44,614.89 $44,614.89 $44,614.89 2026-05-09
J9272 HCPCS Dostarlimab-gxly 500 Mg/10 Ml 8 5 $52,816.00 $51,232.37 $8,526.00 $50,176.04 $42,913.71 2026-05-09
J9022 HCPCS Atezolizumab 1200 Mg/20 Ml Vl 8 5 $49,458.00 $47,974.66 $1.26 $46,985.49 $40,184.96 2026-05-09
J9203 HCPCS Gemtuzumab Ozogamicin 4.5 Mg 8 5 $44,834.00 $43,489.48 $97.98 $42,592.79 $36,428.05 2026-05-09
323 OTHER Ms-DRG 323 2 1 — — $35,650.87 $35,650.87 $35,650.87 2026-05-09
133 OTHER Ms-DRG 133 2 1 — — $34,672.12 $34,672.12 $34,672.12 2026-05-09
J9042 HCPCS Brentuximab Vedotin 50 Mg Vial 8 5 $42,421.00 $41,148.56 $8,327.21 $40,300.14 $34,467.22 2026-05-09
J3357 HCPCS Ustekinumab 45 Mg/0.5 Ml Syr 8 5 $41,802.00 $40,548.65 $8.96 $39,712.59 $33,964.72 2026-05-09
J9043 HCPCS Cabazitaxel 60 Mg/1.5 Ml Vial 8 5 $41,757.00 $40,504.73 $7.02 $39,669.58 $33,927.93 2026-05-09
248 OTHER Ms-DRG 248 2 1 — — $32,953.66 $32,953.66 $32,953.66 2026-05-09
J9144 HCPCS Daratumumab Hyaluronida 1800Mg 10 5 $34,681.00 $33,641.14 $382.98 $33,610.25 $31,265.46 2026-05-09
542 OTHER Ms-DRG 542 2 1 — — $29,182.97 $29,182.97 $29,182.97 2026-05-09
283 OTHER Ms-DRG 283 2 1 — — $28,486.19 $28,486.19 $28,486.19 2026-05-09
249 OTHER Ms-DRG 249 2 1 — — $28,286.14 $28,286.14 $28,286.14 2026-05-09
J1930 HCPCS Lanreotide Acet 120mg/0.5ml Sy 8 5 $34,254.00 $33,226.84 $2.24 $32,541.75 $27,831.76 2026-05-09
787 OTHER Ms-DRG 787 1 1 — — $27,745.35 $27,745.35 $27,745.35 2026-05-09
897 OTHER Ms-DRG 897 1 1 — — $26,837.34 $26,837.34 $26,837.34 2026-05-09
55 OTHER Ms-DRG 55 2 1 — — $26,176.79 $26,176.79 $26,176.79 2026-05-09
J3380 HCPCS Vedolizumab 300 Mg Vial 8 5 $31,894.00 $30,937.62 $72.63 $30,299.73 $25,914.25 2026-05-09
617 OTHER Ms-DRG 617 3 2 — — $12,962.88 $25,889.84 $25,889.84 2026-05-09
J3101 HCPCS Tenecteplase 50 Mg/10 Ml Syrng 10 5 $31,584.00 $30,637.29 $0.41 $30,005.60 $25,662.68 2026-05-09
J2323 HCPCS Natalizumab 300 Mg/15 Ml Vial 8 5 $30,524.00 $29,608.86 $0.11 $28,998.37 $24,801.24 2026-05-09
J9306 HCPCS Pertuzumab 420 Mg/14 Ml Vial 10 5 $26,748.00 $25,946.27 $508.34 $26,202.87 $24,113.98 2026-05-09
J9063 HCPCS Mirvetuximab Soravtansine-gynx 8 5 $29,486.00 $28,601.54 $20.18 $28,011.81 $23,957.47 2026-05-09
J9228 HCPCS Ipilimumab 5 Mg/ml 10 Ml Vial 8 5 $29,399.00 $28,517.40 $1,054.59 $27,929.41 $23,886.99 2026-05-09
139 OTHER Ms-DRG 139 2 1 — — $23,521.65 $23,521.65 $23,521.65 2026-05-09
551 OTHER Ms-DRG 551 2 1 — — $22,657.80 $22,657.80 $22,657.80 2026-05-09
140 OTHER Ms-DRG 140 2 1 — — $22,529.07 $22,529.07 $22,529.07 2026-05-09
J9332 HCPCS Efgartigimod Alfa-fcab 400 Mg 8 5 $27,360.00 $26,539.69 $7.91 $25,992.48 $22,230.41 2026-05-09
536 OTHER Ms-DRG 536 2 1 — — $21,883.40 $21,883.40 $21,883.40 2026-05-09
426 OTHER Ms-DRG 426 2 1 — — $21,852.78 $21,852.78 $21,852.78 2026-05-09
J0717 HCPCS Certolizumab Pegol 400 Mg Kit 14 5 $22,189.00 $21,523.52 $3.42 $24,592.04 $20,532.01 2026-05-09
539 OTHER Ms-DRG 539 2 1 — — $19,947.00 $19,947.00 $19,947.00 2026-05-09
948 OTHER Ms-DRG 948 3 2 — — $9,729.64 $19,392.24 $19,392.24 2026-05-09
J0517 HCPCS Benralizumab 30 Mg/ml Syringe 8 5 $22,647.00 $21,968.51 $3.11 $21,515.55 $18,401.46 2026-05-09
J2353 HCPCS Octreotide (Depot) 20 Mg Syr 17 5 $19,038.00 $18,467.27 $17.33 $24,782.58 $18,086.50 2026-05-09
540 OTHER Ms-DRG 540 2 1 — — $17,908.80 $17,908.80 $17,908.80 2026-05-09
425 OTHER Ms-DRG 425 2 1 — — $17,135.53 $17,135.53 $17,135.53 2026-05-09
J9271 HCPCS Pembrolizumab 100 Mg/4 Ml Vial 8 5 $20,610.00 $19,992.32 $13.37 $19,580.11 $16,746.15 2026-05-09
871 OTHER Ms-DRG 871 1 1 — — $16,679.18 $16,679.18 $16,679.18 2026-05-09
694 OTHER Ms-DRG 694 2 1 — — $16,385.12 $16,385.12 $16,385.12 2026-05-09
541 OTHER Ms-DRG 541 2 1 — — $16,375.61 $16,375.61 $16,375.61 2026-05-09
179 OTHER Ms-DRG 179 2 1 — — $16,193.72 $16,193.72 $16,193.72 2026-05-09
834 OTHER Ms-DRG 834 2 1 — — $16,193.72 $16,193.72 $16,193.72 2026-05-09
645 OTHER Ms-DRG 645 2 1 — — $16,193.72 $16,193.72 $16,193.72 2026-05-09
292 OTHER Ms-DRG 292 2 1 — — $16,160.20 $16,160.20 $16,160.20 2026-05-09
563 OTHER Ms-DRG 563 3 2 — — $16,160.20 $22,657.80 $16,160.20 2026-05-09
469 OTHER Ms-DRG 469 2 1 — — $16,133.73 $16,133.73 $16,133.73 2026-05-09
194 OTHER Ms-DRG 194 2 1 — — $15,482.98 $15,482.98 $15,482.98 2026-05-09
J9173 HCPCS Durvalumab 500 Mg/10 Ml Vial 8 5 $18,675.00 $18,115.28 $16.91 $17,741.77 $15,173.88 2026-05-09
J9047 HCPCS Carfilzomib 60 Mg Vial 17 5 $15,722.00 $15,251.12 $81.21 $28,285.05 $14,936.66 2026-05-09
Q5120 HCPCS Pegfilgrastim-bmez 6 Mg/0.6 Ml 8 5 $17,813.00 $17,279.13 $4,279.65 $16,922.86 $14,473.50 2026-05-09
340 OTHER Ms-DRG 340 2 1 — — $14,448.34 $14,448.34 $14,448.34 2026-05-09
463 OTHER Ms-DRG 463 2 1 — — $13,753.90 $13,753.90 $13,753.90 2026-05-09
349 OTHER Ms-DRG 349 2 1 — — $13,645.94 $13,645.94 $13,645.94 2026-05-09
137 OTHER Ms-DRG 137 2 1 — — $13,634.90 $13,634.90 $13,634.90 2026-05-09
872 OTHER Ms-DRG 872 2 1 — — $12,961.68 $12,961.68 $12,961.68 2026-05-09
373 OTHER Ms-DRG 373 2 1 — — $12,961.68 $12,961.68 $12,961.68 2026-05-09
83 OTHER Ms-DRG 83 2 1 — — $12,961.68 $12,961.68 $12,961.68 2026-05-09
690 OTHER Ms-DRG 690 2 1 — — $12,928.16 $12,928.16 $12,928.16 2026-05-09
470 OTHER Ms-DRG 470 2 1 — — $12,537.44 $12,537.44 $12,537.44 2026-05-09
308 OTHER Ms-DRG 308 2 1 — — $12,504.80 $12,504.80 $12,504.80 2026-05-09
291 OTHER Ms-DRG 291 2 1 — — $12,504.80 $12,504.80 $12,504.80 2026-05-09
J9299 HCPCS Nivolumab 240 Mg/24 Ml Vial 14 5 $29,002.00 $28,132.67 $6.84 $27,552.61 $12,284.26 2026-05-09
807 OTHER Ms-DRG 807 1 1 — — $11,494.09 $11,494.09 $11,494.09 2026-05-09
90375 CPT Rabies Ig (Human) 300 U/Ml 5Ml 8 5 $14,033.00 $13,612.27 $146.90 $13,331.61 $11,402.03 2026-05-09
J2426 HCPCS Paliperidone Palm 234mg/1.5ml 8 5 $13,509.00 $13,104.45 $793.38 $12,834.25 $10,976.67 2026-05-09
J2182 HCPCS Mepolizumab 100 Mg Vial 8 5 $13,430.00 $13,027.31 $6.38 $12,758.71 $10,912.06 2026-05-09
J9317 HCPCS Sacituzumab Gov-hziy 180Mg 8 5 $13,365.00 $12,964.15 $4,156.37 $12,696.85 $10,859.15 2026-05-09
J3111 HCPCS Romosozumab-aqqg 210 Mg/2.34Ml 10 5 $11,243.00 $10,906.13 $1.56 $11,611.99 $10,135.95 2026-05-09
J9352 HCPCS Trabectedin 1 Mg Vial 8 5 $12,058.00 $11,696.30 $95.82 $11,455.14 $9,797.16 2026-05-09
375 OTHER Ms-DRG 375 2 1 — — $9,729.64 $9,729.64 $9,729.64 2026-05-09
195 OTHER Ms-DRG 195 2 1 — — $9,729.64 $9,729.64 $9,729.64 2026-05-09
389 OTHER Ms-DRG 389 2 1 — — $9,696.12 $9,696.12 $9,696.12 2026-05-09
552 OTHER Ms-DRG 552 2 1 — — $9,696.12 $9,696.12 $9,696.12 2026-05-09
310 OTHER Ms-DRG 310 2 1 — — $9,696.12 $9,696.12 $9,696.12 2026-05-09
522 OTHER Ms-DRG 522 2 1 — — $9,412.12 $9,412.12 $9,412.12 2026-05-09
418 OTHER Ms-DRG 418 1 1 — — $9,412.12 $9,412.12 $9,412.12 2026-05-09
689 OTHER Ms-DRG 689 2 1 — — $9,412.12 $9,412.12 $9,412.12 2026-05-09
641 OTHER Ms-DRG 641 2 1 — — $9,378.60 $9,378.60 $9,378.60 2026-05-09
J1569 HCPCS Immune Glob Gamagar 20gr/200ml 14 5 $9,803.00 $9,509.65 $21.77 $12,792.79 $9,313.57 2026-05-09
240 OTHER Ms-DRG 240 2 1 — — $9,283.17 $9,283.17 $9,283.17 2026-05-09
383 OTHER Ms-DRG 383 2 1 — — $9,183.02 $9,183.02 $9,183.02 2026-05-09
J1459 HCPCS Immune Glob Privige 20gr/200ml 14 5 $9,521.00 $9,236.07 $0.29 $16,988.72 $9,045.63 2026-05-09
561 OTHER Ms-DRG 561 2 1 — — $8,563.92 $8,563.92 $8,563.92 2026-05-09
Q5111 HCPCS Pegfilgrastim-cbqv 6 Mg/0.6 Ml 14 5 $8,925.00 $8,657.25 $1,112.40 $14,309.98 $8,478.75 2026-05-09
560 OTHER Ms-DRG 560 2 1 — — $7,994.36 $7,994.36 $7,994.36 2026-05-09
806 OTHER Ms-DRG 806 1 1 — — $7,742.77 $7,742.77 $7,742.77 2026-05-09
J3032 HCPCS Eptinezumab-jjmr 100Mg/Ml Vial 10 5 $8,470.00 $8,215.91 $90.03 $24,358.03 $7,635.72 2026-05-09
Q5108 HCPCS Pegfilgrastim-jmdb 6 Mg/0.6 Ml 10 5 $8,047.00 $7,806.07 $5,230.88 $7,645.13 $7,254.83 2026-05-09
J0897 HCPCS Denosumab 60 Mg/ml Syringe 17 5 $7,589.00 $7,362.20 $9.69 $12,955.30 $7,210.41 2026-05-09
Q5122 HCPCS Pegfilgrastim 6 Mg/0.6 Ml Syr 10 5 $7,949.00 $7,710.76 $3,939.75 $7,551.78 $7,142.57 2026-05-09
78451 CPT Myocard Perf Spect Rest Or Str 10 5 $7,593.00 $7,365.21 $4,935.45 $7,231.00 $6,845.09 2026-05-09
683 OTHER Ms-DRG 683 2 1 — — $6,497.60 $6,497.60 $6,497.60 2026-05-09
74174 CPT CTA Abd&Pelv Wwo Dye 8 5 $6,802.00 $6,597.94 $4,421.30 $6,461.90 $6,461.90 2026-05-09
392 OTHER Ms-DRG 392 2 1 — — $6,285.92 $6,285.92 $6,285.92 2026-05-09
190 OTHER Ms-DRG 190 2 1 — — $6,285.92 $6,285.92 $6,285.92 2026-05-09
581 OTHER Ms-DRG 581 2 1 — — $6,279.80 $6,279.80 $6,279.80 2026-05-09
74183 CPT MRI Abdomen Wwo Dye 11 5 $7,332.00 $7,112.04 $619.08 $6,965.40 $6,254.20 2026-05-09
74178 CPT CT Abd & Pelv Wwo Contrast 12 5 $7,221.00 $7,004.37 $479.88 $6,877.00 $6,159.51 2026-05-09
78452 CPT Myocard Perf Spect Rest Stress 12 5 $7,177.00 $6,961.69 $1,435.40 $6,818.15 $5,895.90 2026-05-09
95811 CPT Polysomnogram W CPap 12 5 $6,706.00 $6,504.82 $1,277.20 $6,370.70 $5,720.22 2026-05-09
J9264 HCPCS Paclitaxel Protein-bd 100mg Vl 8 5 $7,032.00 $6,821.54 $17.39 $6,680.89 $5,713.92 2026-05-09
74177 CPT CT Abd & Pelv W Contrast 13 5 $6,536.00 $6,339.92 $227.52 $6,224.00 $5,575.21 2026-05-09
70553 CPT MRI Brain Wwo Contrast 20 5 $6,023.00 $5,842.31 $729.77 $6,007.80 $5,394.37 2026-05-09
74176 CPT CT Abd & Pelvis Wo Contrast 12 5 $5,962.00 $5,783.14 $95.04 $5,678.00 $5,374.74 2026-05-09
72158 CPT MRI Lumbar Spine Wwo Dye 11 5 $5,649.00 $5,479.53 $340.97 $5,649.00 $5,366.55 2026-05-09
81210 CPT Braf C Kit 8 5 $6,463.00 $6,269.11 $4,200.95 $6,139.85 $5,309.35 2026-05-09
J0129 HCPCS Abatacept 250 Mg Vial 8 5 $6,467.00 $6,273.62 $588.00 $6,144.27 $5,254.97 2026-05-09
73223 CPT MRI Joint Ue Wwo Dye Rt 18 5 $6,107.00 $5,923.79 $597.27 $5,801.65 $5,209.27 2026-05-09
95810 CPT Polysomnogram 12 5 $6,040.00 $5,858.80 $1,208.00 $5,738.00 $5,152.12 2026-05-09
72157 CPT MRI Chest Spine Wwo Dye 11 5 $5,320.00 $5,160.40 $535.35 $5,320.00 $5,054.00 2026-05-09
73220 CPT MRI Ue Wwo Dye Rt 18 5 $5,750.00 $5,577.50 $319.79 $5,462.50 $4,904.75 2026-05-09
72156 CPT MRI Neck Spine Wwo Dye 11 5 $5,320.00 $5,160.40 $340.05 $5,320.00 $4,812.70 2026-05-09
74181 CPT MRI Abdomen Wo Dye 10 5 $5,431.00 $5,268.07 $544.29 $5,159.45 $4,773.02 2026-05-09
J2357 HCPCS Omalizumab 150 Mg Vial 8 5 $5,462.00 $5,298.57 $9.26 $5,189.32 $4,438.23 2026-05-09
72149 CPT MRI Lumbar Spine W Dye 8 5 $5,447.00 $5,283.59 $386.03 $5,174.65 $4,425.68 2026-05-09
70551 CPT MRI Brain Wo Contrast 12 5 $4,870.00 $4,723.90 $447.03 $4,870.00 $4,390.31 2026-05-09
J7298 HCPCS Levonorgestrel 20 MCG/24Hr IUD 10 5 $5,355.00 $5,194.89 $217.08 $5,087.78 $4,351.39 2026-05-09
70549 CPT MRA Neck Wwo Contrast 11 5 $5,027.00 $4,876.19 $666.92 $5,431.00 $4,288.03 2026-05-09
70546 CPT MRA Head Wwo Contrast 8 5 $5,276.00 $5,117.72 $545.48 $5,012.20 $4,286.75 2026-05-09
72148 CPT MRI Lumbar Spine Wo Dye 12 5 $5,245.00 $5,087.65 $315.18 $4,982.75 $4,261.56 2026-05-09
72141 CPT MRI Neck Spine Wo Dye 11 5 $4,890.00 $4,743.30 $233.96 $4,645.50 $4,171.17 2026-05-09
73720 CPT MRI Le Wwo Dye Lt 21 5 $4,376.00 $4,244.72 $233.96 $4,167.00 $4,157.20 2026-05-09
73222 CPT MRI Joint Ue W Dye Rt 8 5 $5,003.00 $4,852.91 $530.75 $4,752.85 $4,064.94 2026-05-09
72129 CPT CT Thoracic Spine W Contrast 8 5 $4,898.00 $4,751.06 $128.15 $4,653.10 $3,979.62 2026-05-09
72197 CPT MRI Pelvis Wwo Dye 8 5 $4,881.00 $4,734.57 $618.17 $4,636.95 $3,965.81 2026-05-09
75635 CPT CTA Abdominal Arteries 11 5 $4,612.00 $4,473.64 $592.68 $4,381.40 $3,934.04 2026-05-09
70543 CPT MRI Orbit Face Neck Wwo Cont 9 5 $4,608.00 $4,469.76 $335.45 $4,377.60 $3,930.62 2026-05-09
J1439 HCPCS Ferric Carboxymalt 750mg/15ml 10 5 $4,350.00 $4,219.78 $11.91 $4,424.13 $3,921.79 2026-05-09
73723 CPT MRI Joint Le Wwo Dye Lt 8 5 $4,678.00 $4,537.66 $657.06 $4,444.10 $3,800.88 2026-05-09
71270 CPT CT Thorax Wwo Contrast 9 5 $4,410.00 $4,277.70 $82.17 $4,189.50 $3,761.73 2026-05-09
74160 CPT CT Abdomen W Dye 10 5 $4,156.00 $4,031.32 $706.77 $3,958.00 $3,746.64 2026-05-09
74170 CPT CT Abdomen Wwo Dye 12 5 $4,572.00 $4,434.84 $58.22 $4,343.40 $3,714.75 2026-05-09
Q5115 HCPCS Rituximab-abbs 100Mg/10Ml Via 17 5 $2,282.00 $2,213.81 $1,483.48 $15,001.78 $3,708.00 2026-05-09
73221 CPT MRI Joint Ue Wo Dye Lt 22 5 $3,899.00 $3,782.03 $408.12 $3,899.00 $3,704.05 2026-05-09
Q5116 HCPCS Trastuzumab Qyyp 150Mg Vial 17 5 $3,848.00 $3,732.73 $2,501.32 $10,885.89 $3,655.77 2026-05-09
71260 CPT CT Thorax W Contrast 13 5 $4,126.00 $4,002.22 $80.31 $3,919.70 $3,519.48 2026-05-09
C8929 HCPCS Echo M Mode 2d W Contrast 12 5 $3,997.00 $3,877.09 $2,598.05 $3,806.00 $3,512.57 2026-05-09
72194 CPT CT Pelvis Wwo Dye 8 5 $4,288.00 $4,159.36 $719.64 $4,073.60 $3,484.00 2026-05-09
252 OTHER Ms-DRG 252 2 1 — — $3,444.25 $3,444.25 $3,444.25 2026-05-09
J9217 HCPCS Leuprolide Acetate 45 Mg Syr 26 5 $4,281.00 $4,152.89 $1.47 $6,077.93 $3,417.46 2026-05-09
J7318 HCPCS HyaluronateStablized 60Mg/3Ml 8 5 $4,171.00 $4,046.03 $3.30 $3,962.60 $3,389.07 2026-05-09
95805 CPT Multiple Sleep Latency Test 8 5 $4,104.00 $3,980.88 $2,667.60 $3,898.80 $3,371.43 2026-05-09
72146 CPT MRI Chest Spine Wo Dye 12 5 $3,737.00 $3,624.89 $390.63 $5,138.00 $3,368.90 2026-05-09
640 OTHER Ms-DRG 640 2 1 — — $3,326.83 $3,326.83 $3,326.83 2026-05-09
73721 CPT MRI Joint Le Wo Dye Lt 23 5 $3,899.00 $3,782.03 $315.18 $3,704.05 $3,325.85 2026-05-09
72125 CPT CT Cervical Spine Wo Contrast 12 5 $3,641.00 $3,531.77 $172.58 $3,467.00 $3,282.36 2026-05-09
70470 CPT CT Head/Brain Wwo Contrast 10 5 $3,641.00 $3,531.77 $241.32 $3,467.00 $3,282.36 2026-05-09
71250 CPT CT Thorax Wo Contrast 12 5 $3,842.00 $3,726.74 $71.13 $3,649.90 $3,277.23 2026-05-09
73702 CPT CT Le Wwo Dye Lt 8 5 $4,027.00 $3,906.19 $57.30 $3,825.65 $3,271.94 2026-05-09
395 OTHER Ms-DRG 395 2 1 — — $3,265.56 $3,265.56 $3,265.56 2026-05-09
374 OTHER Ms-DRG 374 2 1 — — $3,265.56 $3,265.56 $3,265.56 2026-05-09
554 OTHER Ms-DRG 554 2 1 — — $3,265.56 $3,265.56 $3,265.56 2026-05-09
794 OTHER Ms-DRG 794 1 1 — — $3,249.82 $3,249.82 $3,249.82 2026-05-09
Q5107 HCPCS Bevacizumab Awwb 100Mg/4Ml Vil 14 5 $3,269.00 $3,171.38 $2,125.15 $11,426.28 $3,232.47 2026-05-09
813 OTHER Ms-DRG 813 2 1 — — $3,232.04 $3,232.04 $3,232.04 2026-05-09
603 OTHER Ms-DRG 603 1 1 — — $3,232.04 $3,232.04 $3,232.04 2026-05-09
637 OTHER Ms-DRG 637 2 1 — — $3,232.04 $3,232.04 $3,232.04 2026-05-09
72193 CPT CT Pelvis W Dye 8 5 $3,962.00 $3,843.14 $593.33 $3,763.90 $3,219.12 2026-05-09
70492 CPT CT Soft Tissue Neck Wwo Cont 11 5 $3,773.00 $3,659.81 $422.85 $3,584.35 $3,218.37 2026-05-09
844 OTHER Ms-DRG 844 2 1 — — $3,159.72 $3,159.72 $3,159.72 2026-05-09
951 OTHER Ms-DRG 951 2 1 — — $3,159.72 $3,159.72 $3,159.72 2026-05-09
70491 CPT CT Soft Tissue Neck W Cont 11 5 $3,544.00 $3,437.68 $357.53 $3,366.80 $3,128.35 2026-05-09
71271 CPT Ldct For Lung Cancer Screen 12 5 $3,467.00 $3,362.99 $101.48 $3,301.00 $3,125.50 2026-05-09
70544 CPT MRA Head Wo Contrast 10 5 $3,458.00 $3,354.26 $408.12 $4,626.50 $3,117.39 2026-05-09
73718 CPT MRI Le Wo Dye Lt 19 5 $3,650.00 $3,540.50 $56.39 $3,467.50 $3,113.45 2026-05-09
70496 CPT CT Angiography Head W Cont 11 5 $3,641.00 $3,531.77 $246.84 $3,458.95 $3,105.77 2026-05-09
72131 CPT CT Lumbar Spine Wo Contrast 12 5 $3,641.00 $3,531.77 $234.87 $3,458.95 $3,105.77 2026-05-09
23472 CPT Arthroplasty Total Shoulder Lt 12 5 $1,472.00 $1,427.84 $1,398.40 $3,971.97 $3,003.59 2026-05-09
73701 CPT CT Le W Dye Rt 8 5 $3,671.00 $3,560.87 $268.01 $3,487.45 $2,982.69 2026-05-09
73218 CPT MRI Ue Wo Dye Lt 16 5 $3,650.00 $3,540.50 $79.40 $3,467.50 $2,965.62 2026-05-09
74150 CPT CT Abdomen Wo Dye 8 5 $3,641.00 $3,531.77 $791.13 $3,458.95 $2,958.31 2026-05-09
72192 CPT CT Pelvis Wo Dye 8 5 $3,641.00 $3,531.77 $597.02 $3,458.95 $2,958.31 2026-05-09
71275 CPT CTA Chest Wwo Contrast 10 5 $3,302.00 $3,202.94 $672.62 $3,136.90 $2,890.31 2026-05-09
351 OTHER Ms-DRG 351 2 1 — — $2,883.32 $2,883.32 $2,883.32 2026-05-09
59412 CPT External Version 8 5 $3,484.00 $3,379.48 $2,264.60 $3,309.80 $2,862.11 2026-05-09
795 OTHER Ms-DRG 795 1 1 — — $2,861.14 $2,861.14 $2,861.14 2026-05-09
72128 CPT CT Thoracic Spine Wo Contrast 11 5 $3,342.00 $3,241.74 $107.93 $6,131.30 $2,850.73 2026-05-09
73700 CPT CT Le Wo Dye Lt 23 5 $3,315.00 $3,215.55 $76.65 $3,157.00 $2,827.70 2026-05-09
70450 CPT CT Head/Brain Wo Contrast 11 5 $2,971.00 $2,881.87 $1,440.40 $2,829.00 $2,822.45 2026-05-09
70460 CPT CT Head/Brain W Contrast 10 5 $3,306.00 $3,206.82 $61.91 $3,140.70 $2,821.23 2026-05-09
70482 CPT CT Orbit Wwo Contrast 8 5 $3,467.00 $3,362.99 $261.57 $3,293.65 $2,816.93 2026-05-09
70498 CPT CT Angiography Neck W Cont 12 5 $3,248.00 $3,150.56 $278.39 $3,085.60 $2,796.49 2026-05-09
27130 CPT Arthroplasty Total Hip Lt 12 5 $3,492.00 $3,387.24 $1,517.31 $3,699.72 $2,743.14 2026-05-09
74175 CPT CTA Abdom Wwo Dye 10 5 $3,120.00 $3,026.40 $82.17 $2,964.00 $2,741.90 2026-05-09
27447 CPT Total Knee Arthroplasty Lt 12 5 $3,394.00 $3,292.18 $1,515.73 $3,695.94 $2,739.20 2026-05-09
J0585 HCPCS Botul Tox Type A 100 Unit Vial 10 5 $3,035.00 $2,944.34 $59.81 $2,904.15 $2,736.41 2026-05-09
70480 CPT CT Orbit Wo Contrast 10 5 $3,075.00 $2,982.75 $192.56 $2,921.25 $2,702.29 2026-05-09
70487 CPT CT Maxillofacial W Contrast 8 5 $3,270.00 $3,171.90 $268.29 $3,106.50 $2,656.88 2026-05-09
70481 CPT CT Orbit W Contrast 8 5 $3,270.00 $3,171.90 $80.31 $3,106.50 $2,656.88 2026-05-09
C1776 HCPCS Comp Fem 2 Kn Lt Crcte RTn 262 5 $2,900.00 $2,813.00 $390.00 $7,975.25 $2,642.40 2026-05-09
27245 CPT Fx Inter/Peri/Sub Fem W Imp Lt 6 5 $1,189.00 $1,153.33 $1,129.55 $3,360.59 $2,561.05 2026-05-09
38505 CPT Needle Biopsy Lymph Nodes Lt 8 5 $3,080.00 $2,987.60 $2,002.00 $2,926.00 $2,530.22 2026-05-09
93306 CPT Tte W Doppler Complete 18 5 $3,351.00 $3,250.47 $222.88 $3,183.45 $2,525.16 2026-05-09
72195 CPT MRI Pelvis Wo Dye 8 5 $2,652.00 $2,572.44 $1,723.80 $3,876.00 $2,519.40 2026-05-09
G0416 HCPCS Prostate Sat Biopsy 8 5 $3,060.00 $2,968.20 $1,989.00 $2,907.00 $2,513.79 2026-05-09
Q5118 HCPCS Bevacizumab/BVZR 100Mg/4Ml 14 5 $2,163.00 $2,098.69 $1,406.34 $7,465.58 $2,510.63 2026-05-09
J3304 HCPCS Triamcinolone Acetonide 32 Mg 8 5 $3,037.00 $2,946.00 $520.65 $2,885.25 $2,467.65 2026-05-09
Q5103 HCPCS Infliximab-dyyb 100 Mg Vial 10 5 $2,590.00 $2,513.24 $1,684.13 $9,862.65 $2,461.42 2026-05-09
94002 CPT Vent Assist & Mgmt First Day 8 5 $2,995.00 $2,905.15 $1,946.75 $2,845.25 $2,460.39 2026-05-09
70486 CPT CT Maxillofacial Wo Contrast 12 5 $2,808.00 $2,723.76 $187.95 $2,667.60 $2,395.22 2026-05-09
27446 CPT Revision Of Knee Joint Lt 6 5 $1,278.00 $1,239.66 $1,214.10 $3,164.50 $2,394.89 2026-05-09
73200 CPT CT Ue Wo Dye Rt 21 5 $2,768.00 $2,684.96 $70.19 $2,636.00 $2,361.10 2026-05-09
J0248 HCPCS Remdesivir 100 Mg Vial 8 5 $2,874.00 $2,787.96 $70.71 $2,730.48 $2,335.27 2026-05-09
47564 CPT Lap Cholecystectomy/Explr 6 5 $2,750.00 $2,667.50 $1,297.98 $3,008.15 $2,328.91 2026-05-09
29827 CPT Arthro Rotator Cuff Repair Lt 12 5 $2,661.00 $2,581.17 $1,270.13 $2,933.17 $2,306.86 2026-05-09
J1670 HCPCS Tetanus Imm Glob (Hum) 250u/ml 10 5 $2,499.00 $2,424.90 $8.27 $2,374.91 $2,253.66 2026-05-09
29807 CPT Shoulder Arthroscopy Lt 6 5 $2,661.00 $2,581.17 $1,229.55 $2,837.02 $2,239.32 2026-05-09
113 OTHER Room Pediatric Unit 8 5 $2,343.00 $2,272.71 $1,522.95 $19,097.61 $2,225.85 2026-05-09
J7326 HCPCS Hyaluronate Crosslink 30mg/3ml 10 5 $2,655.00 $2,575.63 $1,175.00 $2,522.53 $2,157.42 2026-05-09
87154 CPT Culture Id By Amp Prb 6 Or 6+ 11 5 $2,496.00 $2,421.12 $1,622.40 $2,371.20 $2,129.09 2026-05-09
112 OTHER Room Womens Ctr 6 5 $2,343.00 $2,272.71 $1,522.95 $2,225.85 $2,112.22 2026-05-09
111 OTHER Room Medical Unit Priv 6 5 $2,343.00 $2,272.71 $1,522.95 $2,225.85 $2,112.22 2026-05-09
36556 CPT Insert Non-tunnel Cv Catheter 15 5 $3,226.00 $3,129.22 $99.69 $3,064.70 $2,096.90 2026-05-09
78227 CPT Hida With Ef w/Pharm 11 5 $2,408.00 $2,335.76 $1,565.20 $2,287.60 $2,054.02 2026-05-09
78226 CPT Hepatobiliary Scan Without Ef 8 5 $2,419.00 $2,346.43 $1,572.35 $2,298.05 $1,987.21 2026-05-09
29828 CPT Arthroscopy Bicep Tenodesis Lt 6 5 $2,362.00 $2,291.14 $1,090.90 $2,518.94 $1,984.94 2026-05-09
J1745 HCPCS Infliximab 100 Mg Vial 14 5 $4,417.00 $4,284.51 $1.46 $4,196.17 $1,960.73 2026-05-09
93880 CPT Extracranial Bilat Study 13 5 $2,043.00 $1,981.71 $1,327.95 $1,945.00 $1,940.85 2026-05-09
93351 CPT Stress Tte Complete 14 5 $2,894.00 $2,807.18 $260.45 $2,749.30 $1,902.80 2026-05-09
360 OTHER Cataract 112 5 $2,362.00 $2,291.14 $529.10 $5,952.70 $1,850.60 2026-05-09
10005 CPT Fna Biopsy W US 1st Lesion 10 5 $2,100.00 $2,037.00 $1,365.00 $1,995.00 $1,845.65 2026-05-09
750 OTHER Colonoscopy 24 5 $2,237.00 $2,169.89 $928.85 $3,363.00 $1,837.70 2026-05-09
C8930 HCPCS Stress Echo W Contrast 12 5 $2,144.00 $2,079.68 $408.20 $2,036.80 $1,828.83 2026-05-09
25608 CPT Fx Distal Radius Open Rt 6 5 $2,056.00 $1,994.32 $988.36 $2,270.16 $1,821.33 2026-05-09
78582 CPT Lung Perfusion & Ventilation 8 5 $2,188.00 $2,122.36 $1,422.20 $2,078.60 $1,797.44 2026-05-09
99291 CPT Critical Care 1st 30-74 Min 17 5 $2,643.00 $2,563.71 $228.45 $2,510.85 $1,757.60 2026-05-09
19083 CPT Biopsy Breast 1st Lesion Lt 18 5 $2,133.00 $2,069.01 $1,386.45 $2,026.35 $1,752.26 2026-05-09
J0666 HCPCS Bupivac Liposome 1.3% Pf 20 Ml 11 5 $1,773.00 $1,720.10 $1,152.64 $1,713.62 $1,684.64 2026-05-09
19084 CPT Biopsy Breast Addl Lesion Rt 8 5 $2,031.00 $1,970.07 $1,320.15 $1,929.45 $1,668.47 2026-05-09
27814 CPT Open Fx Bimalleolar Ankle Rt 6 5 $1,932.00 $1,874.04 $914.90 $2,109.80 $1,668.23 2026-05-09
29887 CPT Knee Arthroscopy/Drainage Rt 6 5 $1,919.00 $1,861.43 $897.62 $2,062.03 $1,647.10 2026-05-09
C1771 HCPCS Sling Urth .3mm Thk Retropubic 8 5 $1,996.00 $1,936.12 $1,297.40 $1,896.20 $1,639.71 2026-05-09
25607 CPT Fx Distal Radius Open Lt 6 5 $1,886.00 $1,829.42 $885.05 $2,027.31 $1,637.37 2026-05-09
23430 CPT Tenodesis Long Tendon Bicep Lt 12 5 $1,867.00 $1,810.99 $889.69 $2,047.70 $1,627.92 2026-05-09
272 OTHER Catheter Cecostomy 10.2Fr 24cm 72 5 $1,776.00 $1,723.03 $121.90 $4,123.00 $1,536.76 2026-05-09
J9155 HCPCS Degarelix 80 Mg Vial 14 5 $1,612.00 $1,564.32 $135.29 $2,088.22 $1,532.07 2026-05-09
80230 CPT Infliximab Qn w/Reflex To Ab,S 8 5 $1,862.00 $1,806.14 $1,210.30 $1,768.90 $1,529.63 2026-05-09
93017 CPT Cardiovascular Stress Test 12 5 $1,783.00 $1,729.51 $356.60 $1,693.85 $1,520.90 2026-05-09
78306 CPT Bone Scan Whole Body 11 5 $1,675.00 $1,624.75 $1,088.75 $1,675.00 $1,515.25 2026-05-09
78315 CPT Bone Scan 3 Phase 10 5 $1,669.00 $1,618.93 $1,084.85 $1,834.45 $1,504.61 2026-05-09
47563 CPT Lap Cholecystectomy/Graph 6 5 $1,768.00 $1,714.96 $835.38 $1,935.98 $1,500.93 2026-05-09
29824 CPT Shoulder Arthroscopy Rt 6 5 $1,679.00 $1,628.63 $809.89 $1,857.88 $1,485.74 2026-05-09
27405 CPT Repair Collateral Knee Lig Rt 6 5 $1,689.00 $1,638.33 $809.04 $1,858.08 $1,483.70 2026-05-09
78071 CPT Parathyroid Planar Img W Spect 8 5 $1,771.00 $1,717.87 $1,151.15 $1,682.45 $1,454.88 2026-05-09
78708 CPT Renal Imaging Func Pharm Inter 8 5 $1,760.00 $1,707.20 $1,144.00 $1,672.00 $1,445.84 2026-05-09
29876 CPT Knee Arthroscopy/Drainage Rt 6 5 $1,690.00 $1,639.30 $780.27 $1,796.23 $1,428.54 2026-05-09
J7323 HCPCS Hyaluronate (Euflexxa)20MG/2ML 8 5 $1,501.00 $1,456.40 $975.94 $1,787.24 $1,426.37 2026-05-09
36573 CPT Insert Picc >5 Yrs W Img Gde 17 5 $2,170.00 $2,104.90 $99.83 $2,061.50 $1,410.50 2026-05-09
52310 CPT Cystoscopy And Treatment 14 5 $2,136.00 $2,071.92 $161.50 $2,029.20 $1,404.42 2026-05-09
J7325 HCPCS Hylan Polymer A&b 48mg/6ml Syr 17 5 $2,147.00 $2,083.07 $20.80 $2,040.13 $1,395.88 2026-05-09
47562 CPT Laparoscopic Cholecystectomy 6 5 $1,628.00 $1,579.16 $767.72 $1,779.51 $1,382.34 2026-05-09
24605 CPT Dislocation Elbow W Anes Lt 8 5 $1,643.00 $1,593.71 $1,067.95 $1,560.85 $1,349.72 2026-05-09
99285 CPT Emergency Room Visit Level 5 18 5 $1,853.00 $1,797.41 $184.62 $1,760.35 $1,331.38 2026-05-09
129 OTHER Room Swing Bed Skilled 6 5 $1,461.00 $1,417.17 $949.65 $1,387.95 $1,317.09 2026-05-09
84150 CPT Prostaglandin F2a 8 5 $1,589.00 $1,541.33 $1,032.85 $1,509.55 $1,305.37 2026-05-09
29823 CPT Shoulder Arthroscopy Rt 6 5 $1,557.00 $1,510.29 $709.76 $1,726.20 $1,299.74 2026-05-09
49520 CPT Rerepair Ing Hernia Reduce Bi 6 5 $728.00 $706.16 $691.60 $1,707.97 $1,290.72 2026-05-09
93970 CPT Venous Duplex 8 5 $1,566.00 $1,519.02 $1,017.90 $1,487.70 $1,286.47 2026-05-09
26615 CPT Fx Metacarpal Open 6 5 $1,439.00 $1,395.83 $694.62 $1,590.01 $1,284.18 2026-05-09
26055 CPT Incision Tendon Sheath Finger 15 5 $1,643.00 $1,593.71 $353.70 $1,560.85 $1,268.40 2026-05-09
51600 CPT Injection For Bladder X-ray 8 5 $1,544.00 $1,497.68 $1,003.60 $1,466.80 $1,268.39 2026-05-09
32551 CPT Insertion Chest Tube Lt 22 5 $1,609.00 $1,560.73 $181.56 $1,528.55 $1,256.63 2026-05-09
93975 CPT Vascular Study 9 5 $1,436.00 $1,392.92 $933.40 $1,364.20 $1,224.91 2026-05-09
66821 CPT Capsulotomy Yag Cataract Lt 22 5 $1,365.00 $1,324.05 $260.00 $1,300.00 $1,199.67 2026-05-09
C1726 HCPCS Dil Escp 240Cm Od15-18 24 5 $1,456.00 $1,413.10 $450.32 $3,363.00 $1,196.76 2026-05-09
29881 CPT Knee Arthroscopy/Drainage Lt 6 5 $1,357.00 $1,316.29 $649.46 $1,489.54 $1,191.88 2026-05-09
P9037 HCPCS Platelet Pheresis Leuk Red Irr 10 5 $1,449.00 $1,405.53 $276.00 $1,376.55 $1,190.36 2026-05-09
27810 CPT Fx Bimalleolar Ankle W Man Rt 14 5 $1,643.00 $1,593.71 $511.91 $1,560.85 $1,186.30 2026-05-09
25605 CPT Fx Distal Radius W Man Rt 20 5 $1,456.00 $1,412.32 $616.32 $1,560.85 $1,180.76 2026-05-09
G0390 HCPCS Trauma Team Level 4 8 5 $1,392.00 $1,350.24 $904.80 $1,322.40 $1,143.53 2026-05-09
684 OTHER Trauma Team Evaluation Level 4 8 5 $1,392.00 $1,350.24 $904.80 $1,322.40 $1,143.53 2026-05-09
C8924 HCPCS Tte 2d W Contrast Limited 10 5 $1,265.00 $1,227.05 $822.25 $1,265.00 $1,140.40 2026-05-09
29848 CPT Wrist Arthroscopy/Surgery Bi 12 5 $1,645.00 $1,595.65 $614.70 $1,875.30 $1,140.39 2026-05-09
J1610 HCPCS Glucagon 1 Mg Emergency Kit 9 5 $1,327.00 $1,287.61 $98.91 $1,261.06 $1,132.30 2026-05-09
76700 CPT Ultrasound Abdomen Complete 12 5 $1,373.00 $1,331.81 $273.72 $1,304.35 $1,127.92 2026-05-09
Q5101 HCPCS Filgrastim-sndz 300 Mcg/0.5 Ml 14 5 $1,046.00 $1,015.41 $680.43 $2,902.40 $1,126.85 2026-05-09
11404 CPT Exc Ben Lesion 3.1-4.0 Trunk 17 5 $1,688.00 $1,637.36 $194.76 $1,603.60 $1,122.52 2026-05-09
95819 CPT EEG Wake And Sleep 8 5 $1,366.00 $1,325.02 $887.90 $1,297.70 $1,122.17 2026-05-09
72114 CPT X-ray Lumbosacral 6 Views 8 5 $1,381.00 $1,339.57 $84.00 $1,311.95 $1,122.06 2026-05-09
95816 CPT EEG Routine 10 5 $1,240.00 $1,202.80 $806.00 $1,356.60 $1,117.86 2026-05-09
94726 CPT Pft Plethysmography 12 5 $1,231.00 $1,194.07 $800.15 $1,172.00 $1,109.74 2026-05-09
49505 CPT Prp I/Hern Init Reduc >5 Yr 18 5 $1,288.00 $1,249.36 $610.57 $1,834.45 $1,103.76 2026-05-09
P9035 HCPCS Platelet Pheresis Leuko Reduc 8 5 $1,338.00 $1,297.86 $869.70 $1,271.10 $1,099.16 2026-05-09
24655 CPT Fx Radial Head/Neck W Man Lt 14 5 $1,643.00 $1,593.71 $485.23 $1,560.85 $1,097.91 2026-05-09
82731 CPT Fetal Fibronectin 8 5 $1,336.00 $1,295.92 $868.40 $1,269.20 $1,097.53 2026-05-09
90675 CPT Rabies Vax Pcec/Pf 2.5Unit Vl 8 5 $1,347.00 $1,307.03 $125.24 $1,280.08 $1,094.80 2026-05-09
29875 CPT Knee Arthroscopy/Drainage Lt 6 5 $1,239.00 $1,201.83 $595.16 $1,366.20 $1,093.90 2026-05-09
23675 CPT Closed Tx Shoulder Dislocate L 6 5 $502.00 $486.94 $476.90 $1,382.00 $1,088.47 2026-05-09
A9562 HCPCS Radiophar Tc99M Mertiatide 8 5 $1,313.00 $1,273.61 $853.45 $1,247.35 $1,078.63 2026-05-09
49083 CPT Abd Paracentesis W Imaging 10 5 $1,182.00 $1,146.54 $768.30 $4,237.00 $1,065.58 2026-05-09
46040 CPT Incision Rectal Abscess 8 5 $1,286.00 $1,247.42 $835.90 $1,221.70 $1,056.45 2026-05-09
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