|
J2350
|
HCPCS
|
Injection, Ocrelizumab, 1 Mg
|
12
|
12
|
$34,905.00
|
$34,905.00
|
$15,358.20
|
$33,159.75
|
$24,258.97
|
2026-02-10
|
|
J9228
|
HCPCS
|
Injection, Ipilimumab, 1 Mg
|
24
|
12
|
$37,885.60
|
$37,885.60
|
$7,787.21
|
$55,169.35
|
$21,182.71
|
2026-02-10
|
|
J1303
|
HCPCS
|
Injection, Ravulizumab-cwvz, 10 Mg
|
24
|
12
|
$32,310.62
|
$32,310.62
|
$6,240.65
|
$47,916.05
|
$17,833.42
|
2026-02-10
|
|
J3357
|
HCPCS
|
Ustekinumab, For Subcutaneous Injection, 1 Mg
|
12
|
12
|
$22,107.55
|
$22,107.55
|
$9,727.32
|
$21,002.17
|
$15,364.74
|
2026-02-10
|
|
J9144
|
HCPCS
|
Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj
|
12
|
12
|
$17,971.60
|
$17,971.60
|
$7,907.50
|
$17,073.02
|
$12,490.26
|
2026-02-10
|
|
J2323
|
HCPCS
|
Injection, Natalizumab, 1 Mg
|
12
|
12
|
$17,301.85
|
$17,301.85
|
$7,612.81
|
$16,436.76
|
$12,024.78
|
2026-02-10
|
|
J3380
|
HCPCS
|
Injection, Vedolizumab, Intravenous, 1 Mg
|
12
|
12
|
$16,995.55
|
$16,995.55
|
$7,478.04
|
$16,145.77
|
$11,811.90
|
2026-02-10
|
|
J9022
|
HCPCS
|
Injection, Atezolizumab, 10 Mg
|
24
|
12
|
$16,961.95
|
$16,961.95
|
$5,617.85
|
$20,098.25
|
$10,719.06
|
2026-02-10
|
|
J3101
|
HCPCS
|
Injection, Tenecteplase, 1 Mg
|
12
|
12
|
$15,308.75
|
$15,308.75
|
$6,735.85
|
$14,543.31
|
$10,639.58
|
2026-02-10
|
|
J2506
|
HCPCS
|
Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg
|
12
|
12
|
$14,213.35
|
$14,213.35
|
$6,253.87
|
$13,502.68
|
$9,878.27
|
2026-02-10
|
|
6200992
|
CDM
|
Strattice 10 X 20 Cm Lifecell Tissue
|
12
|
12
|
$13,462.50
|
$13,462.50
|
$5,923.50
|
$12,789.38
|
$9,356.44
|
2026-02-10
|
|
J9303
|
HCPCS
|
Injection, Panitumumab, 10 Mg
|
12
|
12
|
$13,161.00
|
$13,161.00
|
$5,790.84
|
$12,502.95
|
$9,146.90
|
2026-02-10
|
|
J9306
|
HCPCS
|
Injection, Pertuzumab, 1 Mg
|
12
|
12
|
$13,089.10
|
$13,089.10
|
$5,759.20
|
$12,434.65
|
$9,096.92
|
2026-02-10
|
|
J9302
|
HCPCS
|
Injection, Ofatumumab, 10 Mg
|
12
|
12
|
$13,010.45
|
$13,010.45
|
$5,724.60
|
$12,359.93
|
$9,042.26
|
2026-02-10
|
|
J0896
|
HCPCS
|
Injection, Luspatercept-aamt, 0.25 Mg
|
24
|
12
|
$15,223.85
|
$15,223.85
|
$3,640.01
|
$21,066.20
|
$8,808.05
|
2026-02-10
|
|
J0517
|
HCPCS
|
Injection, Benralizumab, 1 Mg
|
12
|
12
|
$11,921.20
|
$11,921.20
|
$5,245.33
|
$11,325.14
|
$8,285.24
|
2026-02-10
|
|
6210030
|
CDM
|
Mesh Phasix St 8x10
|
12
|
12
|
$11,804.00
|
$11,804.00
|
$5,193.76
|
$11,213.80
|
$8,203.78
|
2026-02-10
|
|
J9271
|
HCPCS
|
Injection, Pembrolizumab, 1 Mg
|
12
|
12
|
$11,676.70
|
$11,676.70
|
$5,137.75
|
$11,092.87
|
$8,115.31
|
2026-02-10
|
|
J2783
|
HCPCS
|
Injection, Rasburicase, 0.5 Mg
|
12
|
12
|
$11,303.25
|
$11,303.25
|
$4,973.43
|
$10,738.09
|
$7,855.76
|
2026-02-10
|
|
J2353
|
HCPCS
|
Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg
|
24
|
12
|
$11,866.58
|
$11,866.58
|
$4,218.81
|
$13,437.70
|
$7,666.28
|
2026-02-10
|
|
6200299
|
CDM
|
Hip Prosthesis
|
12
|
12
|
$9,670.00
|
$9,670.00
|
$4,254.80
|
$9,186.50
|
$6,720.65
|
2026-02-10
|
|
J9354
|
HCPCS
|
Injection, Ado-trastuzumab Emtansine, 1 Mg
|
24
|
12
|
$10,239.12
|
$10,239.12
|
$3,508.96
|
$11,878.18
|
$6,538.82
|
2026-02-10
|
|
Q5108
|
HCPCS
|
Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg
|
12
|
12
|
$9,395.40
|
$9,395.40
|
$4,133.98
|
$8,925.63
|
$6,529.80
|
2026-02-10
|
|
Q5111
|
HCPCS
|
Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg
|
12
|
12
|
$9,395.40
|
$9,395.40
|
$4,133.98
|
$8,925.63
|
$6,529.80
|
2026-02-10
|
|
J0135
|
HCPCS
|
Injection, Adalimumab, 20 Mg
|
12
|
12
|
$9,032.75
|
$9,032.75
|
$3,974.41
|
$8,581.11
|
$6,277.76
|
2026-02-10
|
|
50590
|
HCPCS
|
Shock Wave Crushing Of Kidney Stones
|
12
|
12
|
$8,127.25
|
$8,127.25
|
$3,575.99
|
$7,720.89
|
$5,648.44
|
2026-02-10
|
|
J0717
|
HCPCS
|
Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm…
|
24
|
12
|
$8,643.12
|
$8,643.12
|
$2,598.02
|
$10,812.57
|
$5,308.65
|
2026-02-10
|
|
5410106
|
CDM
|
Drsg Dermal Regeneration 4x10
|
12
|
12
|
$7,512.75
|
$7,512.75
|
$3,305.61
|
$7,137.11
|
$5,221.36
|
2026-02-10
|
|
J3590
|
HCPCS
|
Unclassified Biologics
|
12
|
12
|
$7,494.20
|
$7,494.20
|
$3,297.45
|
$7,119.49
|
$5,208.47
|
2026-02-10
|
|
J2182
|
HCPCS
|
Injection, Mepolizumab, 1 Mg
|
12
|
12
|
$7,435.80
|
$7,435.80
|
$3,271.75
|
$7,064.01
|
$5,167.88
|
2026-02-10
|
|
J1602
|
HCPCS
|
Injection, Golimumab, 1 Mg, For Intravenous Use
|
24
|
12
|
$8,559.12
|
$8,559.12
|
$2,077.59
|
$11,776.63
|
$4,970.07
|
2026-02-10
|
|
6210085
|
CDM
|
Mesh Phasix St 15x20
|
12
|
12
|
$7,054.50
|
$7,054.50
|
$3,103.98
|
$6,701.78
|
$4,902.88
|
2026-02-10
|
|
J7168
|
HCPCS
|
Prothrombin Complex Concentrate (human), Kcentra, Per I.u. Of Factor Ix Activity
|
12
|
12
|
$7,031.95
|
$7,031.95
|
$3,094.06
|
$6,680.35
|
$4,887.20
|
2026-02-10
|
|
J9299
|
HCPCS
|
Injection, Nivolumab, 1 Mg
|
24
|
12
|
$9,265.23
|
$9,265.23
|
$1,299.14
|
$14,798.96
|
$4,829.61
|
2026-02-10
|
|
78815
|
HCPCS
|
Nuclear Medicine Study From Skull Base To Mid-thigh With CT Scan
|
12
|
12
|
$6,804.00
|
$6,804.00
|
$2,993.76
|
$6,463.80
|
$4,728.78
|
2026-02-10
|
|
78608
|
HCPCS
|
Nuclear Medicine Study Of Brain With Metabolic Evaluation
|
12
|
12
|
$6,804.00
|
$6,804.00
|
$2,993.76
|
$6,463.80
|
$4,728.78
|
2026-02-10
|
|
78459
|
HCPCS
|
Nuclear Medicine Study Of Heart Muscle With Metabolic Evaluation
|
12
|
12
|
$6,804.00
|
$6,804.00
|
$2,993.76
|
$6,463.80
|
$4,728.78
|
2026-02-10
|
|
78816
|
HCPCS
|
Nuclear Medicine Study Whole Body With CT Scan
|
12
|
12
|
$6,804.00
|
$6,804.00
|
$2,993.76
|
$6,463.80
|
$4,728.78
|
2026-02-10
|
|
78814
|
HCPCS
|
Nuclear Medicine Study Limited Area With CT Scan
|
12
|
12
|
$6,804.00
|
$6,804.00
|
$2,993.76
|
$6,463.80
|
$4,728.78
|
2026-02-10
|
|
78813
|
HCPCS
|
Nuclear Medicine Study Whole Body
|
12
|
12
|
$6,804.00
|
$6,804.00
|
$2,993.76
|
$6,463.80
|
$4,728.78
|
2026-02-10
|
|
J2796
|
HCPCS
|
Injection, Romiplostim, 10 Micrograms
|
24
|
12
|
$7,683.77
|
$7,683.77
|
$2,316.62
|
$9,597.38
|
$4,723.45
|
2026-02-10
|
|
5401064
|
CDM
|
Primatrix-10cm X 12cm
|
12
|
12
|
$6,680.75
|
$6,680.75
|
$2,939.53
|
$6,346.71
|
$4,643.12
|
2026-02-10
|
|
5401063
|
CDM
|
Primatrix - 8cm X 12cm
|
12
|
12
|
$6,167.00
|
$6,167.00
|
$2,713.48
|
$5,858.65
|
$4,286.06
|
2026-02-10
|
|
6210111
|
CDM
|
Mesh Phasix 6x8
|
12
|
12
|
$6,102.00
|
$6,102.00
|
$2,684.88
|
$5,796.90
|
$4,240.89
|
2026-02-10
|
|
58573
|
HCPCS
|
Removal Of Uterus, Tubes, And/or Ovaries Through Abdomen Using An Endoscope, Mor…
|
8
|
8
|
$4,278.75
|
$4,278.75
|
$998.12
|
$4,278.75
|
$4,171.78
|
2026-02-10
|
|
J9358
|
HCPCS
|
Injection, Fam-trastuzumab Deruxtecan-nxki, 1 Mg
|
12
|
12
|
$5,872.30
|
$5,872.30
|
$2,583.81
|
$5,578.69
|
$4,081.25
|
2026-02-10
|
|
6202600
|
CDM
|
Lithotripsy Supply
|
12
|
12
|
$5,764.75
|
$5,764.75
|
$2,536.49
|
$5,476.51
|
$4,006.50
|
2026-02-10
|
|
49406
|
HCPCS
|
Drainage Of Fluid Collection Of Abdominal Cavity By Tube Using Imaging Guidance
|
12
|
12
|
$5,578.50
|
$5,578.50
|
$2,454.54
|
$5,299.58
|
$3,877.06
|
2026-02-10
|
|
58572
|
HCPCS
|
Removal Of Uterus Through Abdomen Using An Endoscope, More Than 250.0 G
|
8
|
8
|
$3,724.25
|
$3,724.25
|
$854.02
|
$3,724.25
|
$3,631.14
|
2026-02-10
|
|
58571
|
HCPCS
|
Removal Of Uterus, Tubes, And/or Ovaries Through Abdomen Using An Endoscope, 250…
|
8
|
8
|
$3,677.25
|
$3,677.25
|
$748.43
|
$3,677.25
|
$3,585.32
|
2026-02-10
|
|
6202501
|
CDM
|
Laser Turp Supply Pack
|
12
|
12
|
$5,147.25
|
$5,147.25
|
$2,264.79
|
$4,889.89
|
$3,577.34
|
2026-02-10
|
|
74174
|
HCPCS
|
CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast
|
12
|
12
|
$5,138.75
|
$5,138.75
|
$2,261.05
|
$4,881.81
|
$3,571.43
|
2026-02-10
|
|
J9312
|
HCPCS
|
Injection, Rituximab, 10 Mg
|
24
|
12
|
$6,481.77
|
$6,481.77
|
$1,076.06
|
$9,992.05
|
$3,475.61
|
2026-02-10
|
|
J0401
|
HCPCS
|
Injection, Aripiprazole (abilify Maintena), 1 Mg
|
24
|
12
|
$5,226.40
|
$5,226.40
|
$1,997.97
|
$5,616.35
|
$3,457.54
|
2026-02-10
|
|
J3111
|
HCPCS
|
Injection, Romosozumab-aqqg, 1 Mg
|
12
|
12
|
$4,955.75
|
$4,955.75
|
$2,180.53
|
$4,707.96
|
$3,444.24
|
2026-02-10
|
|
J9400
|
HCPCS
|
Injection, Ziv-aflibercept, 1 Mg
|
24
|
12
|
$5,582.70
|
$5,582.70
|
$1,700.29
|
$6,936.05
|
$3,441.78
|
2026-02-10
|
|
6200975
|
CDM
|
Trinity Bone Graft 5cc
|
12
|
12
|
$4,935.75
|
$4,935.75
|
$2,171.73
|
$4,688.96
|
$3,430.35
|
2026-02-10
|
|
58544
|
HCPCS
|
Partial Removal Of Uterus, Tubes, And/or Ovaries With Retention Of Cervix Using …
|
8
|
8
|
$3,515.25
|
$3,515.25
|
$731.45
|
$3,515.25
|
$3,427.37
|
2026-02-10
|
|
58293
|
HCPCS
|
Vaginal Hysterectomy, For Uterus Greater Than 250 G; With Colpo-urethrocystopexy…
|
5
|
5
|
$3,380.75
|
$3,380.75
|
$3,211.71
|
$3,380.75
|
$3,380.75
|
2026-02-10
|
|
5410181
|
CDM
|
Drsg Stravix 3cmx6cm
|
12
|
12
|
$4,836.00
|
$4,836.00
|
$2,127.84
|
$4,594.20
|
$3,361.02
|
2026-02-10
|
|
58152
|
HCPCS
|
Removal Of Uterus And Cervix Through Abdomen With Repair Of Vagina
|
8
|
8
|
$3,352.75
|
$3,352.75
|
$992.99
|
$3,352.75
|
$3,268.93
|
2026-02-10
|
|
58554
|
HCPCS
|
Removal Of Uterus, Tubes, And/or Ovaries Through Vagina Using An Endoscope, More…
|
8
|
8
|
$3,328.25
|
$3,328.25
|
$1,055.18
|
$3,328.25
|
$3,245.05
|
2026-02-10
|
|
J9395
|
HCPCS
|
Injection, Fulvestrant, 25 Mg
|
12
|
12
|
$4,592.60
|
$4,592.60
|
$2,020.74
|
$4,362.97
|
$3,191.86
|
2026-02-10
|
|
58292
|
HCPCS
|
Removal Of Uterus, Tubes, And/or Ovaries With Repair Of Herniated Bowel Through …
|
8
|
8
|
$3,252.00
|
$3,252.00
|
$1,047.99
|
$3,252.00
|
$3,170.70
|
2026-02-10
|
|
64561
|
HCPCS
|
Insertion Of Sacral Nerve Neurostimulator Electrode Array
|
8
|
8
|
$3,212.25
|
$3,212.25
|
$250.31
|
$3,212.25
|
$3,131.94
|
2026-02-10
|
|
58294
|
HCPCS
|
Removal Of Uterus With Repair Of Herniated Bowel Through Vagina. 250.0 G Or More
|
8
|
8
|
$3,203.00
|
$3,203.00
|
$974.19
|
$3,203.00
|
$3,122.93
|
2026-02-10
|
|
58552
|
HCPCS
|
Removal Of Uterus, Tubes, And/or Ovaries Through Vagina Using An Endoscope, 250.…
|
8
|
8
|
$3,199.25
|
$3,199.25
|
$797.31
|
$3,199.25
|
$3,119.27
|
2026-02-10
|
|
58543
|
HCPCS
|
Partial Removal Of Uterus With Retention Of Cervix Using An Endoscope, More Than…
|
8
|
8
|
$3,192.75
|
$3,192.75
|
$676.45
|
$3,192.75
|
$3,112.93
|
2026-02-10
|
|
J0897
|
HCPCS
|
Injection, Denosumab, 1 Mg
|
24
|
12
|
$4,932.20
|
$4,932.20
|
$1,584.20
|
$5,950.75
|
$3,088.28
|
2026-02-10
|
|
58291
|
HCPCS
|
Removal Of Uterus, Tubes, And/or Ovaries Through Vagina, More Than 250.0 G
|
8
|
8
|
$3,167.00
|
$3,167.00
|
$995.11
|
$3,167.00
|
$3,087.82
|
2026-02-10
|
|
J3358
|
HCPCS
|
Ustekinumab, For Intravenous Injection, 1 Mg
|
12
|
12
|
$4,409.80
|
$4,409.80
|
$1,940.31
|
$4,189.31
|
$3,064.81
|
2026-02-10
|
|
J9330
|
HCPCS
|
Injection, Temsirolimus, 1 Mg
|
12
|
12
|
$4,400.45
|
$4,400.45
|
$1,936.20
|
$4,180.43
|
$3,058.32
|
2026-02-10
|
|
58542
|
HCPCS
|
Partial Removal Of Uterus, Tubes, And/or Ovaries With Retention Of Cervix Using …
|
8
|
8
|
$3,134.75
|
$3,134.75
|
$669.56
|
$3,134.75
|
$3,056.38
|
2026-02-10
|
|
J9305
|
HCPCS
|
Injection, Pemetrexed, Not Otherwise Specified, 10 Mg
|
24
|
12
|
$5,638.15
|
$5,638.15
|
$952.34
|
$8,656.31
|
$3,032.71
|
2026-02-10
|
|
70553
|
HCPCS
|
MRI Scan Of Brain Before And After Contrast
|
12
|
12
|
$4,348.50
|
$4,348.50
|
$1,913.34
|
$4,131.08
|
$3,022.21
|
2026-02-10
|
|
71275
|
HCPCS
|
CT Scan Of Blood Vessels Of Chest With Contrast
|
12
|
12
|
$4,322.25
|
$4,322.25
|
$1,901.79
|
$4,106.14
|
$3,003.97
|
2026-02-10
|
|
J9217
|
HCPCS
|
Leuprolide Acetate (for Depot Suspension), 7.5 Mg
|
96
|
12
|
$4,089.80
|
$4,089.80
|
$16.41
|
$15,539.67
|
$2,960.40
|
2026-02-10
|
|
58553
|
HCPCS
|
Removal Of Uterus Through Vagina Using An Endoscope, More Than 250.0
|
8
|
8
|
$3,006.00
|
$3,006.00
|
$897.63
|
$3,006.00
|
$2,930.85
|
2026-02-10
|
|
58570
|
HCPCS
|
Removal Of Uterus Through Abdomen Using An Endoscope, 250.0 G Or Less
|
8
|
8
|
$2,994.00
|
$2,994.00
|
$659.51
|
$2,994.00
|
$2,919.15
|
2026-02-10
|
|
J1568
|
HCPCS
|
Injection, Immune Globulin, (octagam), Intravenous, Non-lyophilized (e.g., Liqui…
|
24
|
12
|
$5,249.80
|
$5,249.80
|
$1,036.84
|
$7,735.99
|
$2,910.81
|
2026-02-10
|
|
58150
|
HCPCS
|
Removal Of Uterus And Cervix Through Abdomen
|
8
|
8
|
$2,966.00
|
$2,966.00
|
$842.70
|
$2,966.00
|
$2,891.85
|
2026-02-10
|
|
72156
|
HCPCS
|
MRI Scan Of Upper Spinal Canal Before And After Contrast
|
12
|
12
|
$4,113.50
|
$4,113.50
|
$1,809.94
|
$3,907.83
|
$2,858.89
|
2026-02-10
|
|
5401062
|
CDM
|
Primatrix - 8cm X 8cm
|
12
|
12
|
$4,111.50
|
$4,111.50
|
$1,809.06
|
$3,905.93
|
$2,857.49
|
2026-02-10
|
|
74178
|
HCPCS
|
CT Scan Of Abdomen And Pelvis Before And After Contrast
|
12
|
12
|
$5,995.75
|
$5,995.75
|
$2,638.13
|
$5,695.96
|
$2,841.39
|
2026-02-10
|
|
J2426
|
HCPCS
|
Injection, Paliperidone Palmitate Extended Release (invega Sustenna), 1 Mg
|
48
|
12
|
$4,310.30
|
$4,310.30
|
$1,164.33
|
$6,729.52
|
$2,815.36
|
2026-02-10
|
|
58550
|
HCPCS
|
Removal Of Uterus Through Vagina Using An Endoscope, 250.0 G Or Less
|
8
|
8
|
$2,877.00
|
$2,877.00
|
$716.19
|
$2,877.00
|
$2,805.07
|
2026-02-10
|
|
J0875
|
HCPCS
|
Injection, Dalbavancin, 5 Mg
|
12
|
12
|
$4,029.70
|
$4,029.70
|
$1,773.07
|
$3,828.22
|
$2,800.64
|
2026-02-10
|
|
58290
|
HCPCS
|
Removal Of Uterus Through Vagina, More Than 250.0 G
|
8
|
8
|
$2,845.75
|
$2,845.75
|
$921.47
|
$2,845.75
|
$2,774.61
|
2026-02-10
|
|
6200622
|
CDM
|
Nails-titanium Ctf/11mm Distal/sterile
|
12
|
12
|
$3,978.75
|
$3,978.75
|
$1,750.65
|
$3,779.81
|
$2,765.23
|
2026-02-10
|
|
6200623
|
CDM
|
Nails-titanium Ctf/12mm Distal/sterile
|
12
|
12
|
$3,978.75
|
$3,978.75
|
$1,750.65
|
$3,779.81
|
$2,765.23
|
2026-02-10
|
|
6200621
|
CDM
|
Nails-titanium Ctf/10mm Distal/sterile
|
12
|
12
|
$3,978.75
|
$3,978.75
|
$1,750.65
|
$3,779.81
|
$2,765.23
|
2026-02-10
|
|
J1438
|
HCPCS
|
Injection, Etanercept, 25 Mg (code May Be Used For Medicare When Drug Administer…
|
12
|
12
|
$3,952.20
|
$3,952.20
|
$1,738.97
|
$3,754.59
|
$2,746.78
|
2026-02-10
|
|
58541
|
HCPCS
|
Partial Removal Of Uterus With Retention Of Cervix Using An Endoscope, 250.0 G O…
|
8
|
8
|
$2,812.50
|
$2,812.50
|
$593.83
|
$2,812.50
|
$2,742.19
|
2026-02-10
|
|
Q5119
|
HCPCS
|
Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg
|
24
|
12
|
$5,046.57
|
$5,046.57
|
$865.57
|
$7,719.65
|
$2,722.13
|
2026-02-10
|
|
6200592
|
CDM
|
Wrist Jack / External Fixation Device
|
12
|
12
|
$3,883.75
|
$3,883.75
|
$1,708.85
|
$3,689.56
|
$2,699.20
|
2026-02-10
|
|
58267
|
HCPCS
|
Removal Of Uterus With Repair For Incontinence, 250.0 G Or Less
|
8
|
8
|
$2,751.75
|
$2,751.75
|
$856.59
|
$2,751.75
|
$2,682.95
|
2026-02-10
|
|
58263
|
HCPCS
|
Removal Of Uterus, Tubes, And/or Ovaries With Repair Of Herniated Bowel Through …
|
8
|
8
|
$2,751.75
|
$2,751.75
|
$799.93
|
$2,751.75
|
$2,682.95
|
2026-02-10
|
|
6210319
|
CDM
|
Implant Endomaxx 19x70 Maxx197
|
12
|
12
|
$3,837.75
|
$3,837.75
|
$1,688.61
|
$3,645.86
|
$2,667.24
|
2026-02-10
|
|
J1459
|
HCPCS
|
Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui…
|
36
|
12
|
$3,919.95
|
$3,919.95
|
$956.45
|
$7,041.78
|
$2,663.26
|
2026-02-10
|
|
74262
|
HCPCS
|
Diagnostic CT Scan Of Large Intestine With Contrast
|
12
|
12
|
$3,826.00
|
$3,826.00
|
$1,683.44
|
$3,634.70
|
$2,659.07
|
2026-02-10
|
|
J9264
|
HCPCS
|
Injection, Paclitaxel Protein-bound Particles, 1 Mg
|
12
|
12
|
$3,821.50
|
$3,821.50
|
$1,681.46
|
$3,630.43
|
$2,655.94
|
2026-02-10
|
|
6200613
|
CDM
|
Plate-3.5mm Lcp Proximal Humerus/long
|
12
|
12
|
$3,813.50
|
$3,813.50
|
$1,677.94
|
$3,622.83
|
$2,650.39
|
2026-02-10
|
|
74175
|
HCPCS
|
CT Scan Of Blood Vessels Of Abdomen With Contrast
|
12
|
12
|
$3,812.00
|
$3,812.00
|
$1,677.28
|
$3,621.40
|
$2,649.34
|
2026-02-10
|
|
77047
|
HCPCS
|
MRI Scan Of Both Breasts Without Contrast
|
12
|
12
|
$3,812.00
|
$3,812.00
|
$1,677.28
|
$3,621.40
|
$2,649.34
|
2026-02-10
|
|
75635
|
HCPCS
|
CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast
|
12
|
12
|
$3,812.00
|
$3,812.00
|
$1,677.28
|
$3,621.40
|
$2,649.34
|
2026-02-10
|
|
6210102
|
CDM
|
Catheter Spyglass
|
12
|
12
|
$3,790.00
|
$3,790.00
|
$1,667.60
|
$3,600.50
|
$2,634.05
|
2026-02-10
|
|
72149
|
HCPCS
|
MRI Scan Of Lower Spinal Canal With Contrast
|
12
|
12
|
$3,789.25
|
$3,789.25
|
$1,667.27
|
$3,599.79
|
$2,633.53
|
2026-02-10
|
|
J9355
|
HCPCS
|
Injection, Trastuzumab, Excludes Biosimilar, 10 Mg
|
12
|
12
|
$3,775.00
|
$3,775.00
|
$1,661.00
|
$3,586.25
|
$2,623.62
|
2026-02-10
|
|
J9035
|
HCPCS
|
Injection, Bevacizumab, 10 Mg
|
24
|
12
|
$4,707.10
|
$4,707.10
|
$941.31
|
$6,911.11
|
$2,616.65
|
2026-02-10
|
|
95808
|
HCPCS
|
Sleep Study In Sleep Lab
|
12
|
12
|
$3,744.25
|
$3,744.25
|
$1,647.47
|
$3,557.04
|
$2,602.26
|
2026-02-10
|
|
95812
|
HCPCS
|
Measurement Of Brain Wave Activity (eeg), 41-60 Minutes
|
12
|
12
|
$3,744.25
|
$3,744.25
|
$1,647.47
|
$3,557.04
|
$2,602.26
|
2026-02-10
|
|
95827
|
HCPCS
|
Electroencephalogram (eeg); All Night Recording
|
12
|
12
|
$3,744.25
|
$3,744.25
|
$1,647.47
|
$3,557.04
|
$2,602.26
|
2026-02-10
|
|
95813
|
HCPCS
|
Measurement Of Brain Wave Activity (eeg), 61-119 Minutes
|
12
|
12
|
$3,744.25
|
$3,744.25
|
$1,647.47
|
$3,557.04
|
$2,602.26
|
2026-02-10
|
|
95807
|
HCPCS
|
Sleep Study Including Heart Rate And Breathing Attended By Technician
|
12
|
12
|
$3,744.25
|
$3,744.25
|
$1,647.47
|
$3,557.04
|
$2,602.26
|
2026-02-10
|
|
J9214
|
HCPCS
|
Injection, Interferon, Alfa-2b, Recombinant, 1 Million Units
|
12
|
12
|
$3,727.95
|
$3,727.95
|
$1,640.30
|
$3,541.55
|
$2,590.93
|
2026-02-10
|
|
74261
|
HCPCS
|
Diagnostic CT Scan Of Large Intestine Without Contrast
|
12
|
12
|
$3,698.75
|
$3,698.75
|
$1,627.45
|
$3,513.81
|
$2,570.63
|
2026-02-10
|
|
71552
|
HCPCS
|
MRI Scan Of Chest Before And After Contrast
|
12
|
12
|
$3,693.00
|
$3,693.00
|
$1,624.92
|
$3,508.35
|
$2,566.64
|
2026-02-10
|
|
81163
|
HCPCS
|
Gene Analysis (breast Cancer 1 And 2) Of Full Sequence
|
12
|
12
|
$3,655.75
|
$3,655.75
|
$1,608.53
|
$3,472.96
|
$2,540.74
|
2026-02-10
|
|
81211
|
HCPCS
|
Brca1&2 Seq & Com Dup/del
|
12
|
12
|
$3,655.75
|
$3,655.75
|
$1,608.53
|
$3,472.96
|
$2,540.74
|
2026-02-10
|
|
72197
|
HCPCS
|
MRI Scan Of Pelvis Before And After Contrast
|
12
|
12
|
$3,648.25
|
$3,648.25
|
$1,605.23
|
$3,465.84
|
$2,535.53
|
2026-02-10
|
|
200012
|
CDM
|
Intensive Care Unit - General Classification
|
6
|
6
|
$2,658.00
|
$2,658.00
|
$2,525.10
|
$2,525.10
|
$2,525.10
|
2026-02-10
|
|
70546
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head Before And After Contrast
|
12
|
12
|
$3,623.50
|
$3,623.50
|
$1,594.34
|
$3,442.33
|
$2,518.34
|
2026-02-10
|
|
74183
|
HCPCS
|
MRI Scan Of Abdomen Before And After Contrast
|
12
|
12
|
$3,620.00
|
$3,620.00
|
$1,592.80
|
$3,439.00
|
$2,515.90
|
2026-02-10
|
|
59514
|
HCPCS
|
Cesarean Delivery
|
8
|
8
|
$2,579.25
|
$2,579.25
|
$710.53
|
$2,579.25
|
$2,514.77
|
2026-02-10
|
|
71270
|
HCPCS
|
CT Scan Of Chest Before And After Contrast
|
12
|
12
|
$3,593.00
|
$3,593.00
|
$1,580.92
|
$3,413.35
|
$2,497.14
|
2026-02-10
|
|
74177
|
HCPCS
|
CT Scan Of Abdomen And Pelvis With Contrast
|
12
|
12
|
$5,138.75
|
$5,138.75
|
$2,261.05
|
$4,881.81
|
$2,491.05
|
2026-02-10
|
|
J1448
|
HCPCS
|
Injection, Trilaciclib, 1mg
|
12
|
12
|
$3,578.65
|
$3,578.65
|
$1,574.61
|
$3,399.72
|
$2,487.16
|
2026-02-10
|
|
74263
|
HCPCS
|
Screening CT Scan Of Large Intestine
|
12
|
12
|
$3,569.00
|
$3,569.00
|
$1,570.36
|
$3,390.55
|
$2,480.45
|
2026-02-10
|
|
72157
|
HCPCS
|
MRI Scan Of Middle Spinal Canal Before And After Contrast
|
12
|
12
|
$3,554.75
|
$3,554.75
|
$1,564.09
|
$3,377.01
|
$2,470.55
|
2026-02-10
|
|
73723
|
HCPCS
|
MRI Scan Of Leg Joint Before And After Contrast
|
12
|
12
|
$3,542.75
|
$3,542.75
|
$1,558.81
|
$3,365.61
|
$2,462.21
|
2026-02-10
|
|
73220
|
HCPCS
|
MRI Scan Of Arm Before And After Contrast
|
12
|
12
|
$3,542.75
|
$3,542.75
|
$1,558.81
|
$3,365.61
|
$2,462.21
|
2026-02-10
|
|
73720
|
HCPCS
|
MRI Scan Of Leg Before And After Contrast
|
12
|
12
|
$3,542.75
|
$3,542.75
|
$1,558.81
|
$3,365.61
|
$2,462.21
|
2026-02-10
|
|
73223
|
HCPCS
|
MRI Scan Of Arm Joint Before And After Contrast
|
12
|
12
|
$3,542.75
|
$3,542.75
|
$1,558.81
|
$3,365.61
|
$2,462.21
|
2026-02-10
|
|
J9033
|
HCPCS
|
Injection, Bendamustine Hydrochloride, 1 Mg
|
24
|
12
|
$4,417.17
|
$4,417.17
|
$890.30
|
$6,470.40
|
$2,459.53
|
2026-02-10
|
|
58180
|
HCPCS
|
Removal Of Uterus Through Abdomen
|
8
|
8
|
$2,518.50
|
$2,518.50
|
$786.50
|
$2,518.50
|
$2,455.54
|
2026-02-10
|
|
6210031
|
CDM
|
Mesh Ventralight 12x14
|
12
|
12
|
$3,524.75
|
$3,524.75
|
$1,550.89
|
$3,348.51
|
$2,449.70
|
2026-02-10
|
|
58262
|
HCPCS
|
Removal Of Uterus, Tubes, And/or Ovaries Through Vagina, 250.0 G Or Less
|
8
|
8
|
$2,501.75
|
$2,501.75
|
$746.80
|
$2,501.75
|
$2,439.20
|
2026-02-10
|
|
58270
|
HCPCS
|
Removal Of Uterus With Repair Of Herniated Bowel Through Vagina, 250.0 G Or Less
|
8
|
8
|
$2,501.75
|
$2,501.75
|
$722.63
|
$2,501.75
|
$2,439.20
|
2026-02-10
|
|
27222
|
HCPCS
|
Closed Treatment Of Broken Hip Socket With Manipulation
|
8
|
8
|
$2,496.75
|
$2,496.75
|
$826.35
|
$2,496.75
|
$2,434.33
|
2026-02-10
|
|
72142
|
HCPCS
|
MRI Scan Of Upper Spinal Canal With Contrast
|
12
|
12
|
$3,498.25
|
$3,498.25
|
$1,539.23
|
$3,323.34
|
$2,431.28
|
2026-02-10
|
|
19081
|
HCPCS
|
Biopsy Of Breast And Placement Of Locating Device Using X-ray With Needle, First…
|
12
|
12
|
$3,457.75
|
$3,457.75
|
$1,521.41
|
$3,284.86
|
$2,403.14
|
2026-02-10
|
|
72147
|
HCPCS
|
MRI Scan Of Middle Spinal Canal With Contrast
|
12
|
12
|
$3,451.25
|
$3,451.25
|
$1,518.55
|
$3,278.69
|
$2,398.62
|
2026-02-10
|
|
6200612
|
CDM
|
Plate-3.5mm Lcp Proximal Humerus/stnrd
|
12
|
12
|
$3,450.75
|
$3,450.75
|
$1,518.33
|
$3,278.21
|
$2,398.27
|
2026-02-10
|
|
70552
|
HCPCS
|
MRI Scan Of Brain With Contrast
|
12
|
12
|
$3,447.25
|
$3,447.25
|
$1,516.79
|
$3,274.89
|
$2,395.84
|
2026-02-10
|
|
19083
|
HCPCS
|
Biopsy Of Breast And Placement Of Locating Device Using Ultrasound, First Growth
|
12
|
12
|
$3,422.00
|
$3,422.00
|
$1,505.68
|
$3,250.90
|
$2,378.29
|
2026-02-10
|
|
Q5107
|
HCPCS
|
Injection, Bevacizumab-awwb, Biosimilar, (mvasi), 10 Mg
|
24
|
12
|
$4,174.30
|
$4,174.30
|
$847.55
|
$6,101.23
|
$2,327.89
|
2026-02-10
|
|
58260
|
HCPCS
|
Removal Of Uterus Through Vagina, 250.0 G Or Less
|
8
|
8
|
$2,376.75
|
$2,376.75
|
$676.52
|
$2,376.75
|
$2,317.33
|
2026-02-10
|
|
57280
|
HCPCS
|
Attachment Of Vagina To Rear Pelvic Bone
|
8
|
8
|
$2,367.25
|
$2,367.25
|
$783.72
|
$2,367.25
|
$2,308.07
|
2026-02-10
|
|
74170
|
HCPCS
|
CT Scan Of Abdomen Before And After Contrast
|
12
|
12
|
$3,303.25
|
$3,303.25
|
$1,453.43
|
$3,138.09
|
$2,295.76
|
2026-02-10
|
|
72194
|
HCPCS
|
CT Scan Of Pelvis Before And After Contrast
|
12
|
12
|
$3,303.25
|
$3,303.25
|
$1,453.43
|
$3,138.09
|
$2,295.76
|
2026-02-10
|
|
6210011
|
CDM
|
Mesh Phasix St Ops 11cm
|
12
|
12
|
$3,279.25
|
$3,279.25
|
$1,442.87
|
$3,115.29
|
$2,279.08
|
2026-02-10
|
|
71551
|
HCPCS
|
MRI Scan Of Chest With Contrast
|
12
|
12
|
$3,267.50
|
$3,267.50
|
$1,437.70
|
$3,104.13
|
$2,270.91
|
2026-02-10
|
|
73219
|
HCPCS
|
MRI Scan Of Arm With Contrast
|
12
|
12
|
$3,266.50
|
$3,266.50
|
$1,437.26
|
$3,103.18
|
$2,270.22
|
2026-02-10
|
|
59151
|
HCPCS
|
Removal Of Ovarian Or Tubal Pregnancy With Removal Of Ovary And/or Tube Using An…
|
8
|
8
|
$2,321.25
|
$2,321.25
|
$602.50
|
$2,321.25
|
$2,263.22
|
2026-02-10
|
|
6210015
|
CDM
|
Mesh Phasix St Echo 2 4.5'
|
12
|
12
|
$3,249.00
|
$3,249.00
|
$1,429.56
|
$3,086.55
|
$2,258.06
|
2026-02-10
|
|
74182
|
HCPCS
|
MRI Scan Of Abdomen With Contrast
|
12
|
12
|
$3,230.50
|
$3,230.50
|
$1,421.42
|
$3,068.98
|
$2,245.20
|
2026-02-10
|
|
J0129
|
HCPCS
|
Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere…
|
12
|
12
|
$3,224.20
|
$3,224.20
|
$1,418.65
|
$3,062.99
|
$2,240.82
|
2026-02-10
|
|
70549
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck Before And After Contrast
|
12
|
12
|
$3,222.25
|
$3,222.25
|
$1,417.79
|
$3,061.14
|
$2,239.47
|
2026-02-10
|
|
J1439
|
HCPCS
|
Injection, Ferric Carboxymaltose, 1 Mg
|
12
|
12
|
$3,214.00
|
$3,214.00
|
$1,414.16
|
$3,053.30
|
$2,233.73
|
2026-02-10
|
|
70543
|
HCPCS
|
MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast
|
12
|
12
|
$3,211.50
|
$3,211.50
|
$1,413.06
|
$3,050.93
|
$2,231.99
|
2026-02-10
|
|
70548
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck With Contrast
|
12
|
12
|
$3,184.50
|
$3,184.50
|
$1,401.18
|
$3,025.28
|
$2,213.23
|
2026-02-10
|
|
3900160
|
CDM
|
MRA Renal Arteries W/contrast
|
12
|
12
|
$3,184.50
|
$3,184.50
|
$1,401.18
|
$3,025.28
|
$2,213.23
|
2026-02-10
|
|
57284
|
HCPCS
|
Repair Of Vaginal Wall Defect Through Abdomen
|
8
|
8
|
$2,256.75
|
$2,256.75
|
$672.47
|
$2,256.75
|
$2,200.33
|
2026-02-10
|
|
6202020
|
CDM
|
Tfna Nail 04.037.161s
|
12
|
12
|
$3,164.50
|
$3,164.50
|
$1,392.38
|
$3,006.28
|
$2,199.33
|
2026-02-10
|
|
6202012
|
CDM
|
Tfna Nail 04.037.157s
|
12
|
12
|
$3,164.50
|
$3,164.50
|
$1,392.38
|
$3,006.28
|
$2,199.33
|
2026-02-10
|
|
6202015
|
CDM
|
Tfna Nail 04.037.159s
|
12
|
12
|
$3,164.50
|
$3,164.50
|
$1,392.38
|
$3,006.28
|
$2,199.33
|
2026-02-10
|
|
6210050
|
CDM
|
Tfna Nail 04.037.154s
|
12
|
12
|
$3,164.50
|
$3,164.50
|
$1,392.38
|
$3,006.28
|
$2,199.33
|
2026-02-10
|
|
6202010
|
CDM
|
Tfna Nail 04.037.155s
|
12
|
12
|
$3,164.50
|
$3,164.50
|
$1,392.38
|
$3,006.28
|
$2,199.33
|
2026-02-10
|
|
6210018
|
CDM
|
Tfna Nail 04.037.164s
|
12
|
12
|
$3,164.50
|
$3,164.50
|
$1,392.38
|
$3,006.28
|
$2,199.33
|
2026-02-10
|
|
6210034
|
CDM
|
Tfna Nail 04.037.152s
|
12
|
12
|
$3,164.50
|
$3,164.50
|
$1,392.38
|
$3,006.28
|
$2,199.33
|
2026-02-10
|
|
6200625
|
CDM
|
Tfna Nail 04.037.160s
|
12
|
12
|
$3,164.50
|
$3,164.50
|
$1,392.38
|
$3,006.28
|
$2,199.33
|
2026-02-10
|
|
6210071
|
CDM
|
Tfna Nail 04.037.162s
|
12
|
12
|
$3,164.50
|
$3,164.50
|
$1,392.38
|
$3,006.28
|
$2,199.33
|
2026-02-10
|
|
6202011
|
CDM
|
Tfna Nail 04.037.156s
|
12
|
12
|
$3,164.50
|
$3,164.50
|
$1,392.38
|
$3,006.28
|
$2,199.33
|
2026-02-10
|
|
6202025
|
CDM
|
Tfna Nail 04.037.165s
|
12
|
12
|
$3,164.50
|
$3,164.50
|
$1,392.38
|
$3,006.28
|
$2,199.33
|
2026-02-10
|
|
6202021
|
CDM
|
Tfna Nail 04.037.163s
|
12
|
12
|
$3,164.50
|
$3,164.50
|
$1,392.38
|
$3,006.28
|
$2,199.33
|
2026-02-10
|
|
6210049
|
CDM
|
Tfna Nail 04.037.153s
|
12
|
12
|
$3,164.50
|
$3,164.50
|
$1,392.38
|
$3,006.28
|
$2,199.33
|
2026-02-10
|
|
6202013
|
CDM
|
Tfna Nail 04.037.158s
|
12
|
12
|
$3,164.50
|
$3,164.50
|
$1,392.38
|
$3,006.28
|
$2,199.33
|
2026-02-10
|
|
78452
|
HCPCS
|
Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect
|
12
|
12
|
$4,549.50
|
$4,549.50
|
$2,001.78
|
$4,322.03
|
$2,180.72
|
2026-02-10
|
|
73218
|
HCPCS
|
MRI Scan Of Arm Without Contrast
|
24
|
12
|
$3,120.12
|
$3,120.12
|
$1,372.69
|
$2,964.48
|
$2,168.39
|
2026-02-10
|
|
72191
|
HCPCS
|
CT Scan Of Blood Vessels Of Pelvis With Contrast
|
12
|
12
|
$3,119.75
|
$3,119.75
|
$1,372.69
|
$2,963.76
|
$2,168.23
|
2026-02-10
|
|
72146
|
HCPCS
|
MRI Scan Of Middle Spinal Canal Without Contrast
|
12
|
12
|
$3,081.25
|
$3,081.25
|
$1,355.75
|
$2,927.19
|
$2,141.47
|
2026-02-10
|
|
72141
|
HCPCS
|
MRI Scan Of Upper Spinal Canal Without Contrast
|
12
|
12
|
$3,081.25
|
$3,081.25
|
$1,355.75
|
$2,927.19
|
$2,141.47
|
2026-02-10
|
|
5410180
|
CDM
|
Drsg Stravix 2cmx4cm
|
12
|
12
|
$3,062.50
|
$3,062.50
|
$1,347.50
|
$2,909.38
|
$2,128.44
|
2026-02-10
|
|
74176
|
HCPCS
|
CT Scan Of Abdomen And Pelvis Without Contrast
|
12
|
12
|
$4,625.00
|
$4,625.00
|
$2,035.00
|
$4,393.75
|
$2,126.41
|
2026-02-10
|
|
58740
|
HCPCS
|
Removal Of Scar Tissue Of Ovaries Or Fallopian Tubes
|
8
|
8
|
$2,172.75
|
$2,172.75
|
$745.69
|
$2,172.75
|
$2,118.43
|
2026-02-10
|
|
5410099
|
CDM
|
Allograft 8x8
|
12
|
12
|
$3,032.00
|
$3,032.00
|
$1,334.08
|
$2,880.40
|
$2,107.24
|
2026-02-10
|
|
72195
|
HCPCS
|
MRI Scan Of Pelvis Without Contrast
|
12
|
12
|
$3,026.75
|
$3,026.75
|
$1,331.77
|
$2,875.41
|
$2,103.59
|
2026-02-10
|
|
6200626
|
CDM
|
Nails-titanium Ctf/235mm Length/sterile
|
12
|
12
|
$3,019.00
|
$3,019.00
|
$1,328.36
|
$2,868.05
|
$2,098.20
|
2026-02-10
|
|
5409433
|
CDM
|
Apligraf
|
12
|
12
|
$3,010.00
|
$3,010.00
|
$1,324.40
|
$2,859.50
|
$2,091.95
|
2026-02-10
|
|
C8929
|
HCPCS
|
Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi…
|
12
|
12
|
$3,009.75
|
$3,009.75
|
$1,324.29
|
$2,859.26
|
$2,091.78
|
2026-02-10
|
|
J9145
|
HCPCS
|
Injection, Daratumumab, 10 Mg
|
24
|
12
|
$3,723.62
|
$3,723.62
|
$768.22
|
$5,416.24
|
$2,083.61
|
2026-02-10
|
|
6210009
|
CDM
|
Mesh Phasix Mesh 4x6
|
12
|
12
|
$2,981.00
|
$2,981.00
|
$1,311.64
|
$2,831.95
|
$2,071.80
|
2026-02-10
|
|
58285
|
HCPCS
|
Removal Of Uterus, Vagina, And Pelvic Lymph Nodes Through Vagina
|
8
|
8
|
$2,047.50
|
$2,047.50
|
$1,189.09
|
$2,116.58
|
$2,047.50
|
2026-02-10
|
|
J1745
|
HCPCS
|
Injection, Infliximab, Excludes Biosimilar, 10 Mg
|
12
|
12
|
$2,936.00
|
$2,936.00
|
$1,291.84
|
$2,789.20
|
$2,040.52
|
2026-02-10
|
|
73222
|
HCPCS
|
MRI Scan Of Arm Joint With Contrast
|
12
|
12
|
$2,904.25
|
$2,904.25
|
$1,277.87
|
$2,759.04
|
$2,018.45
|
2026-02-10
|
|
73722
|
HCPCS
|
MRI Scan Of Leg Joint With Contrast
|
12
|
12
|
$2,904.25
|
$2,904.25
|
$1,277.87
|
$2,759.04
|
$2,018.45
|
2026-02-10
|
|
73719
|
HCPCS
|
MRI Scan Of Leg With Contrast
|
12
|
12
|
$2,903.50
|
$2,903.50
|
$1,277.54
|
$2,758.33
|
$2,017.93
|
2026-02-10
|
|
95811
|
HCPCS
|
Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older)
|
32
|
12
|
$3,744.25
|
$3,744.25
|
$118.91
|
$4,353.38
|
$2,016.30
|
2026-02-10
|
|
57260
|
HCPCS
|
Plastic Repair Of Vagina And Tissue Separating Vagina, Rectum, And Bladder
|
8
|
8
|
$2,067.25
|
$2,067.25
|
$628.19
|
$2,067.25
|
$2,015.57
|
2026-02-10
|
|
J7326
|
HCPCS
|
Hyaluronan Or Derivative, Gel-one, For Intra-articular Injection, Per Dose
|
12
|
12
|
$2,897.70
|
$2,897.70
|
$1,274.99
|
$2,752.82
|
$2,013.91
|
2026-02-10
|
|
70542
|
HCPCS
|
MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast
|
12
|
12
|
$2,881.75
|
$2,881.75
|
$1,267.97
|
$2,737.66
|
$2,002.82
|
2026-02-10
|
|
72193
|
HCPCS
|
CT Scan Of Pelvis With Contrast
|
12
|
12
|
$2,879.00
|
$2,879.00
|
$1,266.76
|
$2,735.05
|
$2,000.91
|
2026-02-10
|
|
72127
|
HCPCS
|
CT Scan Of Upper Spine Before And After Contrast
|
12
|
12
|
$2,855.50
|
$2,855.50
|
$1,256.42
|
$2,712.73
|
$1,984.58
|
2026-02-10
|
|
70492
|
HCPCS
|
CT Scan Of Soft Tissue Of Neck Before And After Contrast
|
12
|
12
|
$2,845.75
|
$2,845.75
|
$1,252.13
|
$2,703.46
|
$1,977.80
|
2026-02-10
|
|
93312
|
HCPCS
|
Ultrasound Of Heart With Probe In Esophagus, With Report
|
12
|
12
|
$2,844.50
|
$2,844.50
|
$1,251.58
|
$2,702.28
|
$1,976.93
|
2026-02-10
|
|
3900070
|
CDM
|
Mr Heart For Morphology Without
|
12
|
12
|
$2,842.00
|
$2,842.00
|
$1,250.48
|
$2,699.90
|
$1,975.19
|
2026-02-10
|
|
74181
|
HCPCS
|
MRI Scan Of Abdomen Without Contrast
|
12
|
12
|
$2,842.00
|
$2,842.00
|
$1,250.48
|
$2,699.90
|
$1,975.19
|
2026-02-10
|
|
71550
|
HCPCS
|
MRI Scan Of Chest Without Contrast
|
12
|
12
|
$2,842.00
|
$2,842.00
|
$1,250.48
|
$2,699.90
|
$1,975.19
|
2026-02-10
|
|
70540
|
HCPCS
|
MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast
|
12
|
12
|
$2,842.00
|
$2,842.00
|
$1,250.48
|
$2,699.90
|
$1,975.19
|
2026-02-10
|
|
70482
|
HCPCS
|
CT Scan Of Cranial Cavity Before And After Contrast
|
12
|
12
|
$2,839.50
|
$2,839.50
|
$1,249.38
|
$2,697.53
|
$1,973.46
|
2026-02-10
|
|
70545
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head With Contrast
|
24
|
12
|
$2,954.88
|
$2,954.88
|
$1,161.16
|
$3,107.21
|
$1,973.09
|
2026-02-10
|
|
72158
|
HCPCS
|
MRI Scan Of Lower Spinal Canal Before And After Contrast
|
24
|
12
|
$3,280.75
|
$3,280.75
|
$904.86
|
$4,279.75
|
$1,967.94
|
2026-02-10
|
|
70547
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck Without Contrast
|
12
|
12
|
$2,828.50
|
$2,828.50
|
$1,244.54
|
$2,687.08
|
$1,965.81
|
2026-02-10
|
|
3900161
|
CDM
|
MRA Renal Arteries Without Contrast
|
12
|
12
|
$2,826.50
|
$2,826.50
|
$1,243.66
|
$2,685.18
|
$1,964.42
|
2026-02-10
|
|
77046
|
HCPCS
|
MRI Scan Of 1 Breast Without Contrast
|
12
|
12
|
$2,813.50
|
$2,813.50
|
$1,237.94
|
$2,672.83
|
$1,955.38
|
2026-02-10
|
|
J9202
|
HCPCS
|
Goserelin Acetate Implant, Per 3.6 Mg
|
24
|
12
|
$3,218.42
|
$3,218.42
|
$928.71
|
$4,109.84
|
$1,954.34
|
2026-02-10
|
|
74160
|
HCPCS
|
CT Scan Of Abdomen With Contrast
|
24
|
12
|
$2,815.75
|
$2,815.75
|
$1,211.10
|
$2,735.05
|
$1,940.82
|
2026-02-10
|
|
19082
|
HCPCS
|
Biopsy Of Breast And Placement Of Locating Device Using X-ray With Needle, Each …
|
12
|
12
|
$2,790.00
|
$2,790.00
|
$1,227.60
|
$2,650.50
|
$1,939.05
|
2026-02-10
|
|
72126
|
HCPCS
|
CT Scan Of Upper Spine With Contrast
|
12
|
12
|
$2,789.50
|
$2,789.50
|
$1,227.38
|
$2,650.03
|
$1,938.71
|
2026-02-10
|
|
J2407
|
HCPCS
|
Injection, Oritavancin (orbactiv), 10 Mg
|
12
|
12
|
$2,778.15
|
$2,778.15
|
$1,222.39
|
$2,639.24
|
$1,930.82
|
2026-02-10
|
|
J7307
|
HCPCS
|
Etonogestrel (contraceptive) Implant System, Including Implant And Supplies
|
12
|
12
|
$2,774.20
|
$2,774.20
|
$1,220.65
|
$2,635.49
|
$1,928.07
|
2026-02-10
|
|
57270
|
HCPCS
|
Repair Of Protrusion Of Intestine Into Rectum Or Vagina Through Abdomen
|
8
|
8
|
$1,974.25
|
$1,974.25
|
$657.71
|
$1,974.25
|
$1,924.89
|
2026-02-10
|
|
64581
|
HCPCS
|
Insertion Of Sacral Nerve Neurostimulator Electrode
|
8
|
8
|
$1,970.25
|
$1,970.25
|
$541.70
|
$1,970.25
|
$1,920.99
|
2026-02-10
|
|
51840
|
HCPCS
|
Simple Suture Of Bladder Neck To Vaginal Wall And Pubic Bone With Urethra Suspen…
|
8
|
8
|
$1,934.25
|
$1,934.25
|
$573.17
|
$1,934.25
|
$1,885.89
|
2026-02-10
|
|
70491
|
HCPCS
|
CT Scan Of Soft Tissue Of Neck With Contrast
|
12
|
12
|
$2,701.50
|
$2,701.50
|
$1,188.66
|
$2,566.43
|
$1,877.55
|
2026-02-10
|
|
70551
|
HCPCS
|
MRI Scan Of Brain Without Contrast
|
24
|
12
|
$2,821.75
|
$2,821.75
|
$1,097.14
|
$2,992.50
|
$1,877.41
|
2026-02-10
|
|
72125
|
HCPCS
|
CT Scan Of Upper Spine Without Contrast
|
12
|
12
|
$2,688.75
|
$2,688.75
|
$1,183.05
|
$2,554.31
|
$1,868.68
|
2026-02-10
|
|
59121
|
HCPCS
|
Removal Of Ovarian Or Tubal Pregnancy
|
8
|
8
|
$1,915.00
|
$1,915.00
|
$638.04
|
$1,915.00
|
$1,867.12
|
2026-02-10
|
|
59120
|
HCPCS
|
Removal Of Ovarian Or Tubal Pregnancy With Removal Of Ovaries
|
8
|
8
|
$1,912.25
|
$1,912.25
|
$638.10
|
$1,912.25
|
$1,864.45
|
2026-02-10
|
|
72130
|
HCPCS
|
CT Scan Of Middle Spine Before And After Contrast
|
12
|
12
|
$2,675.25
|
$2,675.25
|
$1,177.11
|
$2,541.49
|
$1,859.30
|
2026-02-10
|
|
72133
|
HCPCS
|
CT Scan Of Lower Spine Before And After Contrast
|
12
|
12
|
$2,675.25
|
$2,675.25
|
$1,177.11
|
$2,541.49
|
$1,859.30
|
2026-02-10
|
|
72132
|
HCPCS
|
CT Scan Of Lower Spine With Contrast
|
12
|
12
|
$2,675.25
|
$2,675.25
|
$1,177.11
|
$2,541.49
|
$1,859.30
|
2026-02-10
|
|
58661
|
HCPCS
|
Removal Of Ovaries And/or Tubes Using An Endoscope
|
8
|
8
|
$1,876.00
|
$1,876.00
|
$530.75
|
$1,876.00
|
$1,829.10
|
2026-02-10
|
|
58563
|
HCPCS
|
Exam Of Uterus With Destruction Of Lining Of Uterus Using An Endoscope
|
8
|
8
|
$1,869.75
|
$1,869.75
|
$197.40
|
$1,869.75
|
$1,823.01
|
2026-02-10
|
|
3000474
|
CDM
|
Cytogenetics Medicare Ip Only
|
12
|
12
|
$2,622.00
|
$2,622.00
|
$1,153.68
|
$2,490.90
|
$1,822.29
|
2026-02-10
|
|
73202
|
HCPCS
|
CT Scan Of Arm Before And After Contrast
|
24
|
12
|
$2,621.50
|
$2,621.50
|
$1,153.46
|
$2,490.43
|
$1,821.94
|
2026-02-10
|
|
5400032
|
CDM
|
Drsg Dermal Regeneration 2x2
|
12
|
12
|
$2,613.50
|
$2,613.50
|
$1,149.94
|
$2,482.83
|
$1,816.38
|
2026-02-10
|
|
59150
|
HCPCS
|
Removal Of Ovarian Or Tubal Pregnancy Using An Endoscope
|
8
|
8
|
$1,854.25
|
$1,854.25
|
$619.11
|
$1,854.25
|
$1,807.89
|
2026-02-10
|
|
57288
|
HCPCS
|
Creation Of Sling Around Urethra In Female To Control Leakage
|
8
|
8
|
$1,851.75
|
$1,851.75
|
$608.23
|
$1,851.75
|
$1,805.45
|
2026-02-10
|
|
58925
|
HCPCS
|
Removal Of Cysts Of Ovaries
|
8
|
8
|
$1,835.25
|
$1,835.25
|
$631.63
|
$1,835.25
|
$1,789.37
|
2026-02-10
|
|
70460
|
HCPCS
|
CT Scan Head Or Brain With Contrast
|
12
|
12
|
$2,564.25
|
$2,564.25
|
$1,128.27
|
$2,436.04
|
$1,782.15
|
2026-02-10
|
|
77049
|
HCPCS
|
MRI Scan Of Both Breasts
|
24
|
12
|
$3,040.12
|
$3,040.12
|
$755.48
|
$4,145.09
|
$1,775.49
|
2026-02-10
|
|
70496
|
HCPCS
|
CT Scan Of Blood Vessels Of Head With Contrast
|
12
|
12
|
$2,550.00
|
$2,550.00
|
$1,122.00
|
$2,422.50
|
$1,772.25
|
2026-02-10
|
|
70498
|
HCPCS
|
CT Scan Of Blood Vessels Of Neck With Contrast
|
12
|
12
|
$2,550.00
|
$2,550.00
|
$1,122.00
|
$2,422.50
|
$1,772.25
|
2026-02-10
|
|
58561
|
HCPCS
|
Removal Of Growth Of Muscle Of Uterus Using An Endoscope
|
8
|
8
|
$1,814.25
|
$1,814.25
|
$285.42
|
$1,814.25
|
$1,768.89
|
2026-02-10
|
|
27301
|
HCPCS
|
Drainage Of Deep Abscess Or Blood Accumulation Of Thigh Or Knee
|
8
|
8
|
$1,809.50
|
$1,809.50
|
$438.42
|
$1,809.50
|
$1,764.26
|
2026-02-10
|
|
57282
|
HCPCS
|
Repair Of Pelvic Ligaments Through Vagina
|
8
|
8
|
$1,805.50
|
$1,805.50
|
$563.00
|
$1,805.50
|
$1,760.37
|
2026-02-10
|
|
58662
|
HCPCS
|
Destruction Or Removal Of Ovary Or Growth Of Pelvis Using An Endoscope
|
8
|
8
|
$1,805.50
|
$1,805.50
|
$585.46
|
$1,805.50
|
$1,760.37
|
2026-02-10
|
|
58720
|
HCPCS
|
Removal Of Uterine Tubes And Ovaries
|
8
|
8
|
$1,802.50
|
$1,802.50
|
$630.90
|
$1,802.50
|
$1,757.44
|
2026-02-10
|
|
5409441
|
CDM
|
Allograft 4x8
|
12
|
12
|
$2,496.50
|
$2,496.50
|
$1,098.46
|
$2,371.68
|
$1,735.07
|
2026-02-10
|
|
J9055
|
HCPCS
|
Injection, Cetuximab, 10 Mg
|
24
|
12
|
$2,774.75
|
$2,774.75
|
$876.63
|
$3,379.29
|
$1,728.94
|
2026-02-10
|
|
58660
|
HCPCS
|
Removal Of Scar Tissue Of Ovaries Or Fallopian Tubes Using An Endoscope
|
8
|
8
|
$1,773.00
|
$1,773.00
|
$565.20
|
$1,773.00
|
$1,728.67
|
2026-02-10
|
|
Q5103
|
HCPCS
|
Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg
|
12
|
12
|
$2,460.15
|
$2,460.15
|
$1,082.47
|
$2,337.14
|
$1,709.80
|
2026-02-10
|
|
72129
|
HCPCS
|
CT Scan Of Middle Spine With Contrast
|
12
|
12
|
$2,453.50
|
$2,453.50
|
$1,079.54
|
$2,330.83
|
$1,705.18
|
2026-02-10
|
|
74150
|
HCPCS
|
CT Scan Of Abdomen Without Contrast
|
12
|
12
|
$2,451.00
|
$2,451.00
|
$1,078.44
|
$2,328.45
|
$1,703.44
|
2026-02-10
|
|
78227
|
HCPCS
|
Nuclear Medicine Study Of Liver And Bile Duct System With Use Of Drugs
|
12
|
12
|
$2,427.25
|
$2,427.25
|
$1,067.99
|
$2,305.89
|
$1,686.94
|
2026-02-10
|
|
J7298
|
HCPCS
|
Levonorgestrel-releasing Intrauterine Contraceptive System (mirena), 52 Mg
|
12
|
12
|
$2,388.80
|
$2,388.80
|
$1,051.07
|
$2,269.36
|
$1,660.22
|
2026-02-10
|
|
1500039
|
CDM
|
Operating Room Services - General Classification
|
12
|
12
|
$2,373.25
|
$2,373.25
|
$1,044.23
|
$2,254.59
|
$1,649.41
|
2026-02-10
|
|
Q0138
|
HCPCS
|
Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd …
|
12
|
12
|
$2,372.20
|
$2,372.20
|
$1,043.77
|
$2,253.59
|
$1,648.68
|
2026-02-10
|
|
95806
|
HCPCS
|
Sleep Study Including Heart Rate, Breathing, Airflow, And Effort
|
20
|
12
|
$3,744.25
|
$3,744.25
|
$42.92
|
$3,557.04
|
$1,647.47
|
2026-02-10
|
|
70544
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head Without Contrast
|
36
|
12
|
$2,639.00
|
$2,639.00
|
$869.88
|
$3,025.28
|
$1,639.66
|
2026-02-10
|
|
58700
|
HCPCS
|
Removal Of Uterine Tubes
|
8
|
8
|
$1,681.00
|
$1,681.00
|
$661.39
|
$1,681.00
|
$1,638.97
|
2026-02-10
|
|
6200195
|
CDM
|
Advantage Fit-transvaginal Sling 850-211
|
12
|
12
|
$2,353.75
|
$2,353.75
|
$1,035.65
|
$2,236.06
|
$1,635.86
|
2026-02-10
|
|
6200451
|
CDM
|
Monarc + Subfacial Hammock
|
12
|
12
|
$2,352.00
|
$2,352.00
|
$1,034.88
|
$2,234.40
|
$1,634.64
|
2026-02-10
|
|
57250
|
HCPCS
|
Repair Of Herniated Rectum Into Vaginal Wall
|
8
|
8
|
$1,676.50
|
$1,676.50
|
$498.68
|
$1,676.50
|
$1,634.59
|
2026-02-10
|
|
57240
|
HCPCS
|
Repair Of Bladder Hernia Into Vaginal Wall
|
8
|
8
|
$1,666.00
|
$1,666.00
|
$499.10
|
$1,666.00
|
$1,624.35
|
2026-02-10
|
|
72192
|
HCPCS
|
CT Scan Of Pelvis Without Contrast
|
24
|
12
|
$2,360.00
|
$2,360.00
|
$998.36
|
$2,328.45
|
$1,617.00
|
2026-02-10
|
|
70481
|
HCPCS
|
CT Scan Of Cranial Cavity With Contrast
|
12
|
12
|
$2,326.25
|
$2,326.25
|
$1,023.55
|
$2,209.94
|
$1,616.74
|
2026-02-10
|
|
200008
|
CDM
|
Room & Board - Private (one Bed) - Obstetrics (ob)
|
6
|
6
|
$1,694.00
|
$1,694.00
|
$1,609.30
|
$1,609.30
|
$1,609.30
|
2026-02-10
|
|
73201
|
HCPCS
|
CT Scan Of Arm With Contrast
|
24
|
12
|
$2,314.50
|
$2,314.50
|
$1,018.38
|
$2,198.78
|
$1,608.58
|
2026-02-10
|
|
5401061
|
CDM
|
Primatrix - 6cm X 6cm
|
12
|
12
|
$2,313.50
|
$2,313.50
|
$1,017.94
|
$2,197.83
|
$1,607.88
|
2026-02-10
|
|
13160
|
HCPCS
|
Extensive Or Complicated Repair Of Surface Wound Reopening
|
8
|
8
|
$1,642.00
|
$1,642.00
|
$675.75
|
$1,642.00
|
$1,600.95
|
2026-02-10
|
|
72131
|
HCPCS
|
CT Scan Of Lower Spine Without Contrast
|
12
|
12
|
$2,281.25
|
$2,281.25
|
$1,003.75
|
$2,167.19
|
$1,585.47
|
2026-02-10
|
|
90376
|
HCPCS
|
Rabies Immune Globulin For Injection Beneath The Skin And/or Into Muscle, Heat-t…
|
12
|
12
|
$2,279.15
|
$2,279.15
|
$1,002.83
|
$2,165.19
|
$1,584.01
|
2026-02-10
|
|
6210070
|
CDM
|
Tfna Nail 04.037.212s
|
12
|
12
|
$2,258.00
|
$2,258.00
|
$993.52
|
$2,145.10
|
$1,569.31
|
2026-02-10
|
|
6210064
|
CDM
|
Tfna Nail 04.037.242s
|
12
|
12
|
$2,258.00
|
$2,258.00
|
$993.52
|
$2,145.10
|
$1,569.31
|
2026-02-10
|
|
6210063
|
CDM
|
Tfna Nail 04.037.142s
|
12
|
12
|
$2,258.00
|
$2,258.00
|
$993.52
|
$2,145.10
|
$1,569.31
|
2026-02-10
|
|
6210067
|
CDM
|
Tfna Nail 04.037.012s
|
12
|
12
|
$2,258.00
|
$2,258.00
|
$993.52
|
$2,145.10
|
$1,569.31
|
2026-02-10
|
|
6210069
|
CDM
|
Tfna Nail 04.037.112s
|
12
|
12
|
$2,258.00
|
$2,258.00
|
$993.52
|
$2,145.10
|
$1,569.31
|
2026-02-10
|
|
6210068
|
CDM
|
Tfna Nail 04.037.042s
|
12
|
12
|
$2,258.00
|
$2,258.00
|
$993.52
|
$2,145.10
|
$1,569.31
|
2026-02-10
|
|
6200980
|
CDM
|
Ventralight St Mesh 7x9
|
12
|
12
|
$2,256.00
|
$2,256.00
|
$992.64
|
$2,143.20
|
$1,567.92
|
2026-02-10
|
|
72128
|
HCPCS
|
CT Scan Of Middle Spine Without Contrast
|
12
|
12
|
$2,253.50
|
$2,253.50
|
$991.54
|
$2,140.83
|
$1,566.18
|
2026-02-10
|
|
6207290
|
CDM
|
Premium Plus Ceea 28 Stapler
|
12
|
12
|
$2,253.50
|
$2,253.50
|
$991.54
|
$2,140.83
|
$1,566.18
|
2026-02-10
|
|
6207300
|
CDM
|
Premium Plus Ceea 31 Stapler
|
12
|
12
|
$2,253.50
|
$2,253.50
|
$991.54
|
$2,140.83
|
$1,566.18
|
2026-02-10
|
|
6200109
|
CDM
|
Premium Plus Ceea 25
|
12
|
12
|
$2,253.50
|
$2,253.50
|
$991.54
|
$2,140.83
|
$1,566.18
|
2026-02-10
|
|
73701
|
HCPCS
|
CT Scan Of Leg With Contrast Material
|
36
|
12
|
$2,229.50
|
$2,229.50
|
$980.98
|
$2,182.39
|
$1,564.41
|
2026-02-10
|
|
Q5115
|
HCPCS
|
Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg
|
12
|
12
|
$2,243.75
|
$2,243.75
|
$987.25
|
$2,131.56
|
$1,559.40
|
2026-02-10
|
|
5410179
|
CDM
|
Drsg Grafix 3cm X 4cm
|
12
|
12
|
$2,241.75
|
$2,241.75
|
$986.37
|
$2,129.66
|
$1,558.01
|
2026-02-10
|
|
70488
|
HCPCS
|
CT Scan Of Face Before And After Contrast
|
12
|
12
|
$2,229.50
|
$2,229.50
|
$980.98
|
$2,118.03
|
$1,549.51
|
2026-02-10
|
|
43771
|
HCPCS
|
Adjustment Of Stomach Reduction Device Using An Endoscope
|
8
|
8
|
$1,543.50
|
$1,543.50
|
$1,066.71
|
$1,898.74
|
$1,543.50
|
2026-02-10
|
|
19286
|
HCPCS
|
Placement Of Locating Device In Breast Using Ultrasound Guidance, Each Additiona…
|
12
|
12
|
$2,205.75
|
$2,205.75
|
$970.53
|
$2,095.46
|
$1,532.99
|
2026-02-10
|
|
81503
|
HCPCS
|
Genetic Profiling On Oncology Biopsy Of Ovarian Lesions, Assays Of Five Proteins
|
12
|
12
|
$2,189.50
|
$2,189.50
|
$963.38
|
$2,080.03
|
$1,521.70
|
2026-02-10
|
|
77048
|
HCPCS
|
MRI Scan Of 1 Breast
|
24
|
12
|
$2,563.12
|
$2,563.12
|
$678.04
|
$3,405.99
|
$1,520.73
|
2026-02-10
|
|
J9155
|
HCPCS
|
Injection, Degarelix, 1 Mg
|
24
|
12
|
$2,589.07
|
$2,589.07
|
$649.75
|
$3,516.38
|
$1,515.76
|
2026-02-10
|
|
200009
|
CDM
|
Room & Board - Private (one Bed) - Medical/surgical/gyn
|
6
|
6
|
$1,584.00
|
$1,584.00
|
$1,504.80
|
$1,504.80
|
$1,504.80
|
2026-02-10
|
|
J0881
|
HCPCS
|
Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use)
|
84
|
12
|
$2,090.10
|
$2,090.10
|
$352.84
|
$8,303.29
|
$1,502.49
|
2026-02-10
|
|
70470
|
HCPCS
|
CT Scan Of Head Or Brain Before And After Contrast
|
12
|
12
|
$2,862.25
|
$2,862.25
|
$1,259.39
|
$2,719.14
|
$1,498.02
|
2026-02-10
|
|
J2357
|
HCPCS
|
Injection, Omalizumab, 5 Mg
|
24
|
12
|
$2,394.78
|
$2,394.78
|
$765.16
|
$2,898.02
|
$1,497.14
|
2026-02-10
|
|
72148
|
HCPCS
|
MRI Scan Of Lower Spinal Canal Without Contrast
|
24
|
12
|
$2,418.62
|
$2,418.62
|
$643.39
|
$3,206.25
|
$1,485.00
|
2026-02-10
|
|
J3262
|
HCPCS
|
Injection, Tocilizumab, 1 Mg
|
24
|
12
|
$3,093.15
|
$3,093.15
|
$212.94
|
$5,417.23
|
$1,484.39
|
2026-02-10
|