Price Transparency 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

SIDNEY REGIONAL MEDICAL CENTER

Sidney, NE · CCN 281357 · Rates published

2,781 distinct procedures filed
12 distinct payers
391,832 rate rows
2026-01-09 last MRF observed
Data quality

123,686 of 391,832 rate rows are consumer-grade (31.6%)

268,146 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
professional (physician) fee — not the facility price 267,678
placeholder amount (≤ $0.02) — excluded from medians 186
percent-of-charges filed in the dollar field — excluded from medians 114
per-diem day rate — not a per-procedure price 84
exceeds 10× this hospital's gross charge — excluded from medians 80
template filing: same amount across many unrelated codes — excluded 4
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sthpiprd.blob.core.windows.net/machine-readable-files/8186/470408242_cheyenne-county-hospital-association-inc_standardcharges.csv
Found on page https://www.sidneyrmc.com/cms-hpt.txt
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-19
Content fingerprint c4631800ca99bce1… · 58,585,604 bytes · first seen 2026-05-15

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
Q2056
HCPCS 		Ciltacabtagene Car-pos T 1 $534,747.21 $534,747.21 $534,747.21 nat. median
$675,122
0.8× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 1 $493,075.45 $493,075.45 $493,075.45 nat. median
$674,188
0.7× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 1 $487,597.46 $487,597.46 $487,597.46 nat. median
$620,080
0.8× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 1 $487,597.46 $487,597.46 $487,597.46 nat. median
$634,511
0.8× median
J1566
HCPCS 		Immune Glob,gamma(igg) 10 Gram-gly-gluc-iga 0 To 50 Mcg/ml IV Solution|discarded… 12 $83.17 $609,579.60 $393,946.00 nat. median
$626
outlier · 629.3×
J9223
HCPCS 		Lurbinectedin 4 Mg Intravenous Solution 12 $211.49 $84,526.76 $81,939.21 nat. median
$627
outlier · 130.7×
J0840
HCPCS 		Crotalidae Polyval Immune Fab Solution For Injection 12 $2,098.66 $84,356.73 $81,774.38 nat. median
$3,427
outlier · 23.9×
C1820
HCPCS 		Implantable Pulse Generator 12 $28,787.28 $70,528.84 $68,369.79 nat. median
$22,013
outlier · 3.1×
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 1 $67,315.72 $67,315.72 $67,315.72 nat. median
$69,774
1.0× median
C1822
HCPCS 		Inceptiv 12 $25,935.00 $63,540.75 $61,595.62 nat. median
$31,540
2.0× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 2 $57,567.44 $58,780.78 $58,174.11 nat. median
$66,682
0.9× median
J9226
HCPCS 		Supprelin La Implant 2 $47,253.48 $48,985.99 $48,119.74 nat. median
$60,368
0.8× median
J0875
HCPCS 		Dalbavancin 500 Mg Intravenous Solution 12 $16.03 $56,948.17 $37,190.64 nat. median
$1,069
outlier · 34.8×
J7330
HCPCS 		Cultured Chondrocytes Implnt 1 $36,120.26 $36,120.26 $36,120.26 nat. median
$76,377
outlier · 0.5×
C1767
HCPCS 		Nrstm Axonics Impl Axonics Snm 12 $13,282.14 $32,541.24 $31,545.08 nat. median
$22,478
1.4× median
J9266
HCPCS 		Pegaspargase Injection 2 $27,328.35 $27,949.69 $27,639.02 nat. median
$34,109
0.8× median
J9176
HCPCS 		Elotuzumab 300 Mg Intravenous Solution|discarded Drug Not Administe 12 $7.80 $64,436.33 $23,917.17 nat. median
$2,586
outlier · 9.2×
J9144
HCPCS 		Daratumumab 1,800 Mg-hyaluronidase-fihj 30,000 Unit/15 Ml Subcut Soln 12 $51.73 $24,466.31 $23,717.34 nat. median
$233
outlier · 101.8×
J1162
HCPCS 		Digoxin Immune Fab 40 Mg Intravenous Solution 12 $5,064.09 $24,038.26 $23,302.40 nat. median
$7,316
outlier · 3.2×
J2350
HCPCS 		Ocrelizumab 30 Mg/ml Intravenous Solution|discarded Drug Not Administe 12 $62.29 $30,172.30 $19,499.10 nat. median
$712
outlier · 27.4×
J7310
HCPCS 		Fee Schedule 1 $19,200.42 $19,200.42 $19,200.42 nat. median
$19,181
1.0× median
J9600
HCPCS 		Porfimer Sodium Injection 1 $19,143.46 $19,143.46 $19,143.46 nat. median
$31,644
0.6× median
50590
CPT 		Hb Or Lithotripsy 12 $7,959.60 $19,501.02 $18,904.05 nat. median
$4,400
outlier · 4.3×
J0565
HCPCS 		Bezlotoxumab 25 Mg/ml Intravenous Solution 12 $42.26 $18,562.38 $17,994.14 nat. median
$144
outlier · 125.1×
J9358
HCPCS 		Fam-trastuzumab Deruxtecan-nxki 100 Mg Intravenous Solution 12 $28.47 $18,120.10 $17,565.40 nat. median
$110
outlier · 160.2×
J2427
HCPCS 		Paliperidone Palmitate (3 Month) 819 Mg/2.63 Ml Intramuscular Syringe 12 $12.92 $17,616.56 $17,077.28 nat. median
$4,091
outlier · 4.2×
J9063
HCPCS 		Mirvetuximab Soravtansine-gynx 5 Mg/ml Intravenous Solution 12 $69.62 $16,820.06 $16,305.16 nat. median
$214
outlier · 76.1×
J3380
HCPCS 		Vedolizumab 300 Mg Intravenous Solution 12 $23.16 $15,627.66 $15,149.26 nat. median
$288
outlier · 52.6×
J9307
HCPCS 		Pralatrexate 40 Mg/2 Ml (20 Mg/ml) Intravenous Solution|discarded Drug Not Admin… 12 $317.24 $25,713.46 $13,473.67 nat. median
$827
outlier · 16.3×
J0841
HCPCS 		Antivenin Crotalidae (equine) Solution For Injection 12 $1,110.13 $13,291.65 $12,884.76 nat. median
$1,767
outlier · 7.3×
J3101
HCPCS 		Tenecteplase 50 Mg Intravenous Solution (for Stemi) 12 $162.30 $12,780.56 $12,034.94 nat. median
$5,949
outlier · 2.0×
Q4122
HCPCS 		Decellularized Dermis 12 $4,998.44 $12,246.19 $11,871.31 nat. median
$244
outlier · 48.7×
50593
CPT 		Hb Radiant Ablation Renal Tumor Unil Perc Cryo 12 $4,422.40 $10,834.88 $10,503.20 nat. median
$10,316
1.0× median
C1889
HCPCS 		Aquablation 12 $645.24 $22,902.60 $9,273.19 nat. median
$2,393
outlier · 3.9×
J1932
HCPCS 		Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe 12 $46.66 $9,525.18 $9,233.59 nat. median
$81
outlier · 114.1×
J9119
HCPCS 		Cemiplimab-rwlc 50 Mg/ml Intravenous Solution 12 $29.21 $17,368.29 $9,196.67 nat. median
$91
outlier · 100.8×
27329
CPT 		Hb Rad Resect Tumor Soft Tissue Thigh/knee <5cm 12 $3,708.40 $9,085.58 $8,807.45 nat. median
$3,253
outlier · 2.7×
J9316
HCPCS 		Pertuzumab 600 Mg-trastuzumab 600 Mg-hyaluronid-zzxf/10 Ml Subcut Soln|discarded… 12 $69.24 $16,742.40 $8,772.91 nat. median
$283
outlier · 31.0×
78816
CPT 		Hb Radiant Pet/ct Tumor Image Full Body 12 $3,654.80 $8,954.26 $8,680.15 nat. median
$2,707
outlier · 3.2×
J9047
HCPCS 		Carfilzomib 30 Mg Intravenous Solution|discarded Drug Not Administe 12 $50.01 $30,112.36 $8,398.69 nat. median
$1,668
outlier · 5.0×
J9356
HCPCS 		Trastuzumab 600 Mg-hyaluronidase-oysk 10,000 Unit/5 Ml Subcut Solution 12 $69.89 $8,449.94 $8,191.27 nat. median
$126
outlier · 65.0×
11770
CPT 		Hb Excision Of Pilonidal Cyst 12 $3,365.60 $8,245.72 $7,993.30 nat. median
$2,862
outlier · 2.8×
J9228
HCPCS 		Ipilimumab 50 Mg/10 Ml (5 Mg/ml) Intravenous Solution 12 $182.19 $15,084.20 $7,987.22 nat. median
$9,906
0.8× median
78815
CPT 		Hb Radiant Pet/ct Tumor Image Skul-thigh 12 $3,360.00 $8,232.00 $7,820.40 nat. median
$2,794
outlier · 2.8×
52284
CPT 		Hb Cysto W/dilat Rx Balo Cath Urtl Strix/sten Male 12 $3,290.40 $8,061.48 $7,814.70 nat. median
$5,359
1.5× median
J9022
HCPCS 		Atezolizumab 840 Mg/14 Ml (60 Mg/ml) Intravenous Solution 12 $88.98 $16,460.77 $7,683.24 nat. median
$6,951
1.1× median
74174
CPT 		Hb Radiant-CT Angio Abd & Pelv Wo & W Contrast 12 $3,284.40 $8,046.78 $7,644.44 nat. median
$958
outlier · 8.0×
24655
CPT 		Hb Closed Tx Radial Head/neck Fx W Manip 12 $3,204.80 $7,851.76 $7,611.40 nat. median
$1,605
outlier · 4.7×
J2323
HCPCS 		Natalizumab 300 Mg/15 Ml Intravenous Solution|discarded Drug Not Administe 12 $25.68 $14,242.64 $7,463.06 nat. median
$201
outlier · 37.2×
37609
CPT 		Hb Ligation Or Biopsy Temporal Artery 12 $3,134.80 $7,680.26 $7,445.15 nat. median
$1,912
outlier · 3.9×

Other procedures at this hospital

Browse this hospital's 2,781 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
             
Q2056 HCPCS Ciltacabtagene Car-pos T 2 1 — — $534,747.21 $534,747.21 $534,747.21 2026-01-09
Q2054 HCPCS Lisocabtagene Mara Car Pos T 2 1 — — $493,075.45 $493,075.45 $493,075.45 2026-01-09
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 2 1 — — $487,597.46 $487,597.46 $487,597.46 2026-01-09
Q2053 HCPCS Brexucabtagene Car Pos T 2 1 — — $487,597.46 $487,597.46 $487,597.46 2026-01-09
J1566 HCPCS Immune Glob,gamma(igg) 10 Gram-gly-gluc-iga 0 To 50 Mcg/ml IV Solution|discarded… 66 12 $414,680.00 $414,680.00 $83.17 $609,579.60 $393,946.00 2026-01-09
J9223 HCPCS Lurbinectedin 4 Mg Intravenous Solution 40 12 $86,251.80 $86,251.80 $211.49 $84,526.76 $81,939.21 2026-01-09
J0840 HCPCS Crotalidae Polyval Immune Fab Solution For Injection 40 12 $86,078.30 $86,078.30 $2,098.66 $84,356.73 $81,774.38 2026-01-09
C1820 HCPCS Implantable Pulse Generator 38 12 $71,968.20 $71,968.20 $28,787.28 $70,528.84 $68,369.79 2026-01-09
J9029 HCPCS Instill Adstiladrin, Tx Dose 2 1 — — $67,315.72 $67,315.72 $67,315.72 2026-01-09
C1822 HCPCS Inceptiv 38 12 $64,837.50 $64,837.50 $25,935.00 $63,540.75 $61,595.62 2026-01-09
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 4 2 — — $57,567.44 $58,780.78 $58,174.11 2026-01-09
J9226 HCPCS Supprelin La Implant 4 2 — — $47,253.48 $48,985.99 $48,119.74 2026-01-09
J0875 HCPCS Dalbavancin 500 Mg Intravenous Solution 66 12 $58,110.38 $58,110.38 $16.03 $56,948.17 $37,190.64 2026-01-09
J7330 HCPCS Cultured Chondrocytes Implnt 2 1 — — $36,120.26 $36,120.26 $36,120.26 2026-01-09
C1767 HCPCS Nrstm Axonics Impl Axonics Snm 38 12 $33,205.35 $33,205.35 $13,282.14 $32,541.24 $31,545.08 2026-01-09
J9266 HCPCS Pegaspargase Injection 4 2 — — $27,328.35 $27,949.69 $27,639.02 2026-01-09
J9176 HCPCS Elotuzumab 300 Mg Intravenous Solution|discarded Drug Not Administe 92 12 $36,985.32 $36,985.32 $7.80 $64,436.33 $23,917.17 2026-01-09
J9144 HCPCS Daratumumab 1,800 Mg-hyaluronidase-fihj 30,000 Unit/15 Ml Subcut Soln 40 12 $24,965.62 $24,965.62 $51.73 $24,466.31 $23,717.34 2026-01-09
J1162 HCPCS Digoxin Immune Fab 40 Mg Intravenous Solution 40 12 $24,528.84 $24,528.84 $5,064.09 $24,038.26 $23,302.40 2026-01-09
J2350 HCPCS Ocrelizumab 30 Mg/ml Intravenous Solution|discarded Drug Not Administe 66 12 $20,525.37 $20,525.37 $62.29 $30,172.30 $19,499.10 2026-01-09
J7310 HCPCS Fee Schedule 2 1 — — $19,200.42 $19,200.42 $19,200.42 2026-01-09
J9600 HCPCS Porfimer Sodium Injection 2 1 — — $19,143.46 $19,143.46 $19,143.46 2026-01-09
50590 CPT Hb Or Lithotripsy 38 12 $19,899.00 $19,899.00 $7,959.60 $19,501.02 $18,904.05 2026-01-09
J0565 HCPCS Bezlotoxumab 25 Mg/ml Intravenous Solution 40 12 $18,941.20 $18,941.20 $42.26 $18,562.38 $17,994.14 2026-01-09
J9358 HCPCS Fam-trastuzumab Deruxtecan-nxki 100 Mg Intravenous Solution 40 12 $18,489.90 $18,489.90 $28.47 $18,120.10 $17,565.40 2026-01-09
J2427 HCPCS Paliperidone Palmitate (3 Month) 819 Mg/2.63 Ml Intramuscular Syringe 40 12 $17,976.08 $17,976.08 $12.92 $17,616.56 $17,077.28 2026-01-09
J9063 HCPCS Mirvetuximab Soravtansine-gynx 5 Mg/ml Intravenous Solution 40 12 $17,163.33 $17,163.33 $69.62 $16,820.06 $16,305.16 2026-01-09
J3380 HCPCS Vedolizumab 300 Mg Intravenous Solution 40 12 $15,946.59 $15,946.59 $23.16 $15,627.66 $15,149.26 2026-01-09
J9307 HCPCS Pralatrexate 40 Mg/2 Ml (20 Mg/ml) Intravenous Solution|discarded Drug Not Admin… 66 12 $14,182.82 $14,182.82 $317.24 $25,713.46 $13,473.67 2026-01-09
J0841 HCPCS Antivenin Crotalidae (equine) Solution For Injection 40 12 $13,562.91 $13,562.91 $1,110.13 $13,291.65 $12,884.76 2026-01-09
J3101 HCPCS Tenecteplase 50 Mg Intravenous Solution (for Stemi) 66 12 $12,668.36 $12,668.36 $162.30 $12,780.56 $12,034.94 2026-01-09
Q4122 HCPCS Decellularized Dermis 38 12 $12,496.11 $12,496.11 $4,998.44 $12,246.19 $11,871.31 2026-01-09
50593 CPT Hb Radiant Ablation Renal Tumor Unil Perc Cryo 38 12 $11,056.00 $11,056.00 $4,422.40 $10,834.88 $10,503.20 2026-01-09
C1889 HCPCS Aquablation 234 12 $10,117.50 $10,117.50 $645.24 $22,902.60 $9,273.19 2026-01-09
J1932 HCPCS Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe 40 12 $9,719.57 $9,719.57 $46.66 $9,525.18 $9,233.59 2026-01-09
J9119 HCPCS Cemiplimab-rwlc 50 Mg/ml Intravenous Solution 66 12 $17,722.74 $17,722.74 $29.21 $17,368.29 $9,196.67 2026-01-09
27329 CPT Hb Rad Resect Tumor Soft Tissue Thigh/knee <5cm 38 12 $9,271.00 $9,271.00 $3,708.40 $9,085.58 $8,807.45 2026-01-09
J9316 HCPCS Pertuzumab 600 Mg-trastuzumab 600 Mg-hyaluronid-zzxf/10 Ml Subcut Soln|discarded… 66 12 $9,234.64 $9,234.64 $69.24 $16,742.40 $8,772.91 2026-01-09
78816 CPT Hb Radiant Pet/ct Tumor Image Full Body 38 12 $9,137.00 $9,137.00 $3,654.80 $8,954.26 $8,680.15 2026-01-09
J9047 HCPCS Carfilzomib 30 Mg Intravenous Solution|discarded Drug Not Administe 118 12 $20,484.60 $20,484.60 $50.01 $30,112.36 $8,398.69 2026-01-09
J9356 HCPCS Trastuzumab 600 Mg-hyaluronidase-oysk 10,000 Unit/5 Ml Subcut Solution 40 12 $8,622.39 $8,622.39 $69.89 $8,449.94 $8,191.27 2026-01-09
11770 CPT Hb Excision Of Pilonidal Cyst 38 12 $8,414.00 $8,414.00 $3,365.60 $8,245.72 $7,993.30 2026-01-09
J9228 HCPCS Ipilimumab 50 Mg/10 Ml (5 Mg/ml) Intravenous Solution 66 12 $15,392.04 $15,392.04 $182.19 $15,084.20 $7,987.22 2026-01-09
78815 CPT Hb Radiant Pet/ct Tumor Image Skul-thigh 38 12 $8,400.00 $8,400.00 $3,360.00 $8,232.00 $7,820.40 2026-01-09
52284 CPT Hb Cysto W/dilat Rx Balo Cath Urtl Strix/sten Male 38 12 $8,226.00 $8,226.00 $3,290.40 $8,061.48 $7,814.70 2026-01-09
J9022 HCPCS Atezolizumab 840 Mg/14 Ml (60 Mg/ml) Intravenous Solution 118 12 $14,504.08 $14,504.08 $88.98 $16,460.77 $7,683.24 2026-01-09
74174 CPT Hb Radiant-CT Angio Abd & Pelv Wo & W Contrast 38 12 $8,211.00 $8,211.00 $3,284.40 $8,046.78 $7,644.44 2026-01-09
24655 CPT Hb Closed Tx Radial Head/neck Fx W Manip 38 12 $8,012.00 $8,012.00 $3,204.80 $7,851.76 $7,611.40 2026-01-09
J2323 HCPCS Natalizumab 300 Mg/15 Ml Intravenous Solution|discarded Drug Not Administe 66 12 $7,855.85 $7,855.85 $25.68 $14,242.64 $7,463.06 2026-01-09
37609 CPT Hb Ligation Or Biopsy Temporal Artery 38 12 $7,837.00 $7,837.00 $3,134.80 $7,680.26 $7,445.15 2026-01-09
78814 CPT Hb Radiant Pet/ct Tumor Image Limited 38 12 $7,782.00 $7,782.00 $3,112.80 $7,626.36 $7,392.90 2026-01-09
66986 CPT Hb Exchange Intraocular Lens 38 12 $7,533.00 $7,533.00 $3,013.20 $7,382.34 $7,156.35 2026-01-09
22514 CPT Hb Perq Vert Agmntj Cavity Crtj Uni/bi Cannulj Lmbr 38 12 $7,385.00 $7,385.00 $2,954.00 $7,237.30 $7,015.75 2026-01-09
J0637 HCPCS Caspofungin IV Solution 7 Mg/ml 40 12 $7,298.78 $7,298.78 $7.03 $7,152.80 $6,933.84 2026-01-09
J0402 HCPCS Aripiprazole ER (2 Month) 720 Mg/2.4 Ml Susp, Extended Rel IM Syringe 40 12 $7,246.78 $7,246.78 $6.16 $7,101.84 $6,884.44 2026-01-09
52276 CPT Hb Cystourethroscopy With Dviu 38 12 $6,998.00 $6,998.00 $2,799.20 $6,858.04 $6,648.10 2026-01-09
21552 CPT Hb Exc Soft Tumor Neck/chest Perq Eg 3 Cm 38 12 $6,937.00 $6,937.00 $2,774.80 $6,798.26 $6,590.15 2026-01-09
J9306 HCPCS Pertuzumab 420 Mg/14 Ml (30 Mg/ml) Intravenous Solution|discarded Drug Not Admin… 66 12 $6,787.75 $6,787.75 $16.35 $12,306.18 $6,448.36 2026-01-09
J2353 HCPCS Octreotide,microspheres ER 10 Mg Intramuscular Susp, Extended Release 92 12 $7,294.09 $7,294.09 $223.19 $10,703.93 $6,432.47 2026-01-09
63650 CPT Hb Impl. Neurostim Electrode Epid 38 12 $6,712.00 $6,712.00 $2,684.80 $6,577.76 $6,376.40 2026-01-09
J3315 HCPCS Triptorelin Pamoate 22.5 Mg IM Suspension 40 12 $6,676.34 $6,676.34 $432.90 $6,542.81 $6,342.52 2026-01-09
J1306 HCPCS Inclisiran 284 Mg/1.5 Ml Subcutaneous Syringe 40 12 $6,600.14 $6,600.14 $12.85 $6,468.14 $6,270.13 2026-01-09
J0600 HCPCS Edetate Calcium Disodium Inj 4 2 — — $6,051.11 $6,462.69 $6,256.90 2026-01-09
20525 CPT Hb Rmvl Foreign Body Muscle/tendon Sheath Deep/comp 38 12 $6,565.00 $6,565.00 $2,626.00 $6,433.70 $6,236.75 2026-01-09
70546 CPT Hb Radiant-MRA Head W/o&w Cont 38 12 $6,538.00 $6,538.00 $2,615.20 $6,407.24 $6,211.10 2026-01-09
J2997 HCPCS Alteplase 2 Mg Intra-catheter Solution 92 12 $8,167.61 $8,167.61 $94.15 $14,807.88 $6,195.13 2026-01-09
74178 CPT Hb Radiant-CT Abdomen And Pelvis Without W Contrast 38 12 $6,515.00 $6,515.00 $2,606.00 $6,384.70 $6,189.25 2026-01-09
53854 CPT Hb Gi-trurl Dstrj Prst8 Tiss Rf Wv Thermotherapy 38 12 $6,508.00 $6,508.00 $2,603.20 $6,377.84 $6,182.60 2026-01-09
64635 CPT Hb Dest L/s Facet Jnt Single Level W Image 38 12 $6,358.00 $6,358.00 $2,543.20 $6,230.84 $6,040.10 2026-01-09
C1763 HCPCS Novabone Bioactive Strip 178 12 $7,875.00 $7,875.00 $1,978.00 $8,937.60 $6,019.20 2026-01-09
78452 CPT Hb Radiant-hrt Muscle Image Spect-multiple 38 12 $6,402.00 $6,402.00 $2,560.80 $6,273.96 $5,960.26 2026-01-09
14020 CPT Hb Tissue Tran Scalp Lt 10 Sq Cm 38 12 $6,237.00 $6,237.00 $2,494.80 $6,112.26 $5,925.15 2026-01-09
J9225 HCPCS Vantas Implant 2 1 — — $5,848.76 $5,848.76 $5,848.76 2026-01-09
72157 CPT Hb Radiant-mr T-spine With/without Contrast 38 12 $6,139.00 $6,139.00 $1,864.07 $6,016.22 $5,832.05 2026-01-09
95811 CPT Hb Sleep Study With Cpap 38 12 $6,176.00 $6,176.00 $2,470.40 $6,052.48 $5,749.86 2026-01-09
55500 CPT Hb Exc Hydrocele Sprmatic Cord Uni Spx 38 12 $6,022.00 $6,022.00 $2,408.80 $5,901.56 $5,720.90 2026-01-09
59414 CPT Hb Delivery Of Placenta Only (outborn) 38 12 $5,977.00 $5,977.00 $2,390.80 $5,857.46 $5,678.15 2026-01-09
C1747 HCPCS Ureteroscope Flx Lithovue Std 66 12 $5,940.00 $5,940.00 $2,376.00 $9,761.54 $5,643.00 2026-01-09
J9177 HCPCS Enfortumab Vedotin-ejfv 20 Mg Intravenous Solution 40 12 $5,932.53 $5,932.53 $36.69 $5,813.88 $5,635.90 2026-01-09
72158 CPT Hb Radiant-mr L-spine With/without Contrast 38 12 $5,928.00 $5,928.00 $2,371.20 $5,809.44 $5,631.60 2026-01-09
27337 CPT Hb Exc Tumor Soft Tiss Thigh/knee Subq Eg 3cm 38 12 $5,903.00 $5,903.00 $2,361.20 $5,784.94 $5,607.85 2026-01-09
73223 CPT Hb Radiant-MRI Any Jt Up Extrem W/o&w/cont 38 12 $5,869.00 $5,869.00 $2,347.60 $5,751.62 $5,575.55 2026-01-09
64633 CPT Hb Dest Cerv/thor Facet Jnt Single Level W Image 38 12 $5,850.00 $5,850.00 $2,340.00 $5,733.00 $5,557.50 2026-01-09
27328 CPT Hb Exc Tumor Soft Tissue Thigh/knee Subfasc <5cm 38 12 $5,797.00 $5,797.00 $2,318.80 $5,681.06 $5,507.15 2026-01-09
72156 CPT Hb Radiant-mr C-spine With/without Contrast 38 12 $5,908.00 $5,908.00 $1,864.07 $5,789.84 $5,500.35 2026-01-09
J0139 HCPCS Adalimumab 40 Mg/0.4 Ml Subcutaneous Pen Kit 38 12 $5,780.86 $5,780.86 $2,312.34 $5,665.24 $5,491.81 2026-01-09
J9271 HCPCS Pembrolizumab 25 Mg/ml Intravenous Solution|discarded Drug Not Administe 66 12 $5,755.48 $5,755.48 $59.46 $10,434.69 $5,467.70 2026-01-09
74183 CPT Hb Radiant-mr Abdomen W + Without Contrast 38 12 $5,754.00 $5,754.00 $2,301.60 $5,638.92 $5,466.30 2026-01-09
J9219 HCPCS Leuprolide Acetate Implant 2 1 — — $5,456.52 $5,456.52 $5,456.52 2026-01-09
19301 CPT Hb Mastectomy Partial; Lumpectomy 38 12 $5,738.00 $5,738.00 $2,295.20 $5,623.24 $5,451.10 2026-01-09
72147 CPT Hb Radiant MRI T-spine With Contrast 38 12 $5,701.00 $5,701.00 $2,280.40 $5,586.98 $5,415.95 2026-01-09
J0225 HCPCS Inj, Vutrisiran, 1 Mg 4 2 — — $5,231.32 $5,593.65 $5,412.48 2026-01-09
J1437 HCPCS Ferric Derisomaltose 100 Mg Iron/ml Intravenous Solution 40 12 $5,640.82 $5,640.82 $21.14 $5,528.00 $5,358.77 2026-01-09
14021 CPT Hb Tissue Tran Scalp 10.1-30.0 Sq Cm 38 12 $5,637.00 $5,637.00 $2,254.80 $5,524.26 $5,355.15 2026-01-09
46040 CPT Hb I&d Perirectal Abscess 38 12 $5,621.00 $5,621.00 $2,248.40 $5,508.58 $5,339.95 2026-01-09
72142 CPT Hb Radiant MRI C-spine With Contrast 38 12 $5,602.00 $5,602.00 $2,240.80 $5,489.96 $5,321.90 2026-01-09
74177 CPT Hb Radiant-CT Abdomen And Pelvis W Contrast 38 12 $5,678.00 $5,678.00 $2,271.20 $5,564.44 $5,286.22 2026-01-09
70543 CPT Hb Radiant-MRI Orbit Face & Nec W/o&w Cont 38 12 $5,521.00 $5,521.00 $2,208.40 $5,410.58 $5,244.95 2026-01-09
70549 CPT Hb Radiant-MRA Neck W + Without Contrast 38 12 $5,462.00 $5,462.00 $2,184.80 $5,352.76 $5,188.90 2026-01-09
25630 CPT Hb Closed Tx Wrist Fx Not Without Manip Each Bone 38 12 $5,447.00 $5,447.00 $2,178.80 $5,338.06 $5,174.65 2026-01-09
95810 CPT Hb Sleep Study 38 12 $5,553.00 $5,553.00 $2,221.20 $5,441.94 $5,169.84 2026-01-09
73220 CPT Hb Radiant-MRI Up Extrem Not Jt W/o&w/cont 38 12 $5,363.00 $5,363.00 $2,145.20 $5,255.74 $5,094.85 2026-01-09
42808 CPT Hb Exc/dstrj Les Pharynx Any Meth 38 12 $5,339.00 $5,339.00 $2,135.60 $5,232.22 $5,072.05 2026-01-09
27842 CPT Hb Cltx Ankle Dislc Req Anes +-prq Skel Fixj 38 12 $5,326.00 $5,326.00 $2,130.40 $5,219.48 $5,059.70 2026-01-09
31622 CPT Hb Bronchoscopy Diagnostic-resp 38 12 $5,250.00 $5,250.00 $2,100.00 $5,145.00 $4,987.50 2026-01-09
66989 CPT Hb Xcpsl Ctrc Rmvl Cplx Insj 1+ 38 12 $5,229.00 $5,229.00 $2,091.60 $5,124.42 $4,967.55 2026-01-09
C1897 HCPCS Quattrode Trial Lead Kit, 60cm 38 12 $5,187.60 $5,187.60 $2,075.04 $5,083.85 $4,928.22 2026-01-09
J0517 HCPCS Benralizumab 30 Mg/ml Subcutaneous Syringe|discarded Drug Not Administe 66 12 $5,145.66 $5,145.66 $175.17 $9,329.08 $4,888.38 2026-01-09
73723 CPT Hb Radiant-MRI Any Jt Lw Extrem W/o&w/cont 38 12 $5,128.00 $5,128.00 $2,051.20 $5,025.44 $4,871.60 2026-01-09
J0480 HCPCS Basiliximab 4 2 — — $4,756.22 $4,968.88 $4,862.55 2026-01-09
72149 CPT Hb Radiant-mr L-spine W Contrast 38 12 $5,093.00 $5,093.00 $2,037.20 $4,991.14 $4,838.35 2026-01-09
70552 CPT Hb Radiant-mr Imag Brain; With Cont 38 12 $5,045.00 $5,045.00 $2,018.00 $4,944.10 $4,792.75 2026-01-09
73222 CPT Hb Radiant-MRI Any Jt Up Extrem W/cont 38 12 $4,955.00 $4,955.00 $1,982.00 $4,855.90 $4,707.25 2026-01-09
72132 CPT Hb Radiant-CT L-spine With Contrast 38 12 $4,941.00 $4,941.00 $1,976.40 $4,842.18 $4,693.95 2026-01-09
73720 CPT Hb Radiant-MRI Low Extrem Not Jnt W/o&w Cont 38 12 $4,908.00 $4,908.00 $1,963.20 $4,809.84 $4,662.60 2026-01-09
70553 CPT Hb Radiant-MRI Brain W/o&w Cont 38 12 $4,995.00 $4,995.00 $1,998.00 $4,895.10 $4,650.35 2026-01-09
72146 CPT Hb Radiant-mr T-spine Without Contrast 38 12 $4,888.00 $4,888.00 $1,782.91 $4,790.24 $4,643.60 2026-01-09
70544 CPT Hb Radiant-MRA Head Without Cont 38 12 $4,876.00 $4,876.00 $1,950.40 $4,778.48 $4,632.20 2026-01-09
20670 CPT Hb Removal Int Fixation Dev Superficial 38 12 $4,874.00 $4,874.00 $1,949.60 $4,776.52 $4,630.30 2026-01-09
L8606 HCPCS Bulkamid Urethral Bulking System 38 12 $4,872.00 $4,872.00 $1,948.80 $4,774.56 $4,628.40 2026-01-09
C1776 HCPCS Bi-mentum Altrx Liner 1,102 12 $7,026.00 $7,026.00 $169.80 $43,822.17 $4,547.20 2026-01-09
C1778 HCPCS 16 Lead Tricentrus 262 12 $7,064.88 $7,064.88 $90.56 $13,965.00 $4,540.24 2026-01-09
72197 CPT Hb Radiant-mr Pelvis W + Without Contrast 38 12 $4,766.00 $4,766.00 $1,906.40 $4,670.68 $4,527.70 2026-01-09
52287 CPT Hb Cysto Injection(s) Chemodenervation Bladder 38 12 $4,713.00 $4,713.00 $1,885.20 $4,618.74 $4,477.35 2026-01-09
J9055 HCPCS Cetuximab 100 Mg/50 Ml Intravenous Solution 66 12 $4,704.00 $4,704.00 $77.90 $9,219.84 $4,468.80 2026-01-09
71550 CPT Hb Radiant Mr Chest Without Contrast 38 12 $4,689.00 $4,689.00 $1,875.60 $4,595.22 $4,454.55 2026-01-09
C1765 HCPCS Trial Screening Lead Kit 38 12 $4,677.12 $4,677.12 $1,870.85 $4,583.58 $4,443.27 2026-01-09
0200 RC Hb Room & Board ICU 16 7 $4,606.00 $4,606.00 $4,237.52 $4,513.88 $4,421.76 2026-01-09
73722 CPT Hb Radiant-MRI Any Jt Low Extrem; W/cont 38 12 $4,646.00 $4,646.00 $1,858.40 $4,553.08 $4,413.70 2026-01-09
74176 CPT Hb Radiant-CT Abdomen And Pelvis Without Contrast 38 12 $4,727.00 $4,727.00 $1,890.80 $4,632.46 $4,400.84 2026-01-09
C1771 HCPCS Altis Midurethral Incision Sli 38 12 $4,622.50 $4,622.50 $1,849.00 $4,530.05 $4,391.38 2026-01-09
72195 CPT Hb Radiant-mr Pelvis Without Contrast 38 12 $4,620.00 $4,620.00 $1,848.00 $4,527.60 $4,389.00 2026-01-09
73706 CPT Hb Radiant-CT Angio Low Ext W/wo Cont 38 12 $4,611.00 $4,611.00 $1,724.26 $4,518.78 $4,380.45 2026-01-09
54001 CPT Hb Slitting Of Prepuce - Except Nb 38 12 $4,595.00 $4,595.00 $1,838.00 $4,503.10 $4,365.25 2026-01-09
J7168 HCPCS Hum Prothrombin Cplx 4 Factor 1000 Units (volume) 122 12 $5,000.04 $5,000.04 $1,039.78 $28,609.14 $4,363.20 2026-01-09
J0401 HCPCS Aripiprazole ER 400 Mg Suspension, Extended Rel.intramuscular Syringe 66 12 $5,680.82 $5,680.82 $7.22 $5,567.20 $4,359.83 2026-01-09
74181 CPT Hb Radiant-mr Abdomen Without Contrast 38 12 $4,579.00 $4,579.00 $1,831.60 $4,487.42 $4,350.05 2026-01-09
72191 CPT Hb Radiant-CT Angiography Pelvis W Without 38 12 $4,555.00 $4,555.00 $1,822.00 $4,463.90 $4,327.25 2026-01-09
J0800 HCPCS Chemo Drugs 2 1 — — $4,324.37 $4,324.37 $4,324.37 2026-01-09
74175 CPT Hb Radiant-CT Angio Abd W/wo Cont 38 12 $4,535.00 $4,535.00 $1,814.00 $4,444.30 $4,308.25 2026-01-09
52224 CPT Hb Cysto W/destruct Minor Les Lt 0.5 66 12 $8,332.00 $8,332.00 $1,770.40 $8,165.36 $4,248.96 2026-01-09
95805 CPT Hb Multi Sleep Latency Test 38 12 $4,398.00 $4,398.00 $1,759.20 $4,310.04 $4,178.10 2026-01-09
72133 CPT Hb Radiant-CT L-spine With & Without Contrast 38 12 $4,396.00 $4,396.00 $1,758.40 $4,308.08 $4,176.20 2026-01-09
64421 CPT Hb Inj Intercostal Nerves Multiple 38 12 $4,390.00 $4,390.00 $1,756.00 $4,302.20 $4,170.50 2026-01-09
C8908 HCPCS Hb Radiant MRI Breast Bilat W And Without Cntrst 38 12 $4,356.00 $4,356.00 $1,742.40 $4,268.88 $4,138.20 2026-01-09
71552 CPT Hb Radiant-mr Chest W + Without Contrast 38 12 $4,352.00 $4,352.00 $1,740.80 $4,264.96 $4,134.40 2026-01-09
J2356 HCPCS Tezepelumab-ekko 210 Mg/1.91 Ml (110 Mg/ml) Subcutaneous Syringe|discarded Drug … 66 12 $4,348.42 $4,348.42 $18.87 $7,883.69 $4,131.00 2026-01-09
15839 CPT Hb Excise Excess Skin/subq Tissue Other 38 12 $4,345.00 $4,345.00 $1,738.00 $4,258.10 $4,127.75 2026-01-09
14040 CPT Hb Tissue Tran Forehead Eq Lt 10 Sq Cm 38 12 $4,257.00 $4,257.00 $1,702.80 $4,171.86 $4,044.15 2026-01-09
66982 CPT Hb Complex Cataract 38 12 $4,248.00 $4,248.00 $1,699.20 $4,163.04 $4,035.60 2026-01-09
G0390 HCPCS Hb Full Trauma Activation (level Iii Trauma Center) 66 12 $5,034.00 $5,034.00 $1,678.00 $4,933.32 $4,027.20 2026-01-09
27825 CPT Hb Cls Tx Fx Dist Tibia W/manip 38 12 $4,214.00 $4,214.00 $1,685.60 $4,129.72 $4,003.30 2026-01-09
J9200 HCPCS Floxuridine Injection 4 2 — — $3,952.26 $4,020.09 $3,986.18 2026-01-09
J0348 HCPCS Anidulafungin 100 Mg Intravenous Solution|discarded Drug Not Administe 66 12 $4,193.40 $4,193.40 $0.49 $7,602.63 $3,983.73 2026-01-09
74170 CPT Hb Radiant-CT Abdomen With & Without Contrast 38 12 $4,182.00 $4,182.00 $1,672.80 $4,098.36 $3,972.90 2026-01-09
52281 CPT Hb Cysto W/urethral Calib/dilation 38 12 $4,153.00 $4,153.00 $1,661.20 $4,069.94 $3,945.35 2026-01-09
27570 CPT Hb Optime-manipulatn Knee Jt+anesthesia 38 12 $4,145.00 $4,145.00 $1,658.00 $4,062.10 $3,937.75 2026-01-09
75635 CPT Hb Radiant-CT Angio Abd Art/bil Low Leg W/without Ctrst S&i 38 12 $4,139.00 $4,139.00 $1,655.60 $4,056.22 $3,932.05 2026-01-09
72148 CPT Hb Radiant-mr L-spine Without Contrast 38 12 $4,176.00 $4,176.00 $1,670.40 $4,092.48 $3,887.86 2026-01-09
78830 CPT Hb Radiant-rp Loclzj Tum Spect W/ct 1 Area/acquisj 1 Day Imaging 38 12 $4,086.00 $4,086.00 $1,634.40 $4,004.28 $3,881.70 2026-01-09
Q5111 HCPCS Pegfilgrastim-cbqv 6 Mg/0.6 Ml Subcutaneous Syringe 66 12 $7,472.72 $7,472.72 $141.26 $7,323.27 $3,877.74 2026-01-09
36573 CPT Hb Insertion Picc W/rs&i 5 Yr/> 38 12 $4,079.00 $4,079.00 $1,631.60 $3,997.42 $3,875.05 2026-01-09
J9371 HCPCS Chemo Drugs 2 1 — — $3,872.67 $3,872.67 $3,872.67 2026-01-09
94003 CPT Hb Ventilator Subsq Daily 38 12 $4,068.00 $4,068.00 $1,627.20 $3,986.64 $3,864.60 2026-01-09
70481 CPT Hb Radiant-CT Post Fossa With Contrast 38 12 $4,026.00 $4,026.00 $1,610.40 $3,945.48 $3,824.70 2026-01-09
58999 CPT Hb Dilitation Of Vagina 38 12 $4,025.00 $4,025.00 $1,610.00 $3,944.50 $3,823.75 2026-01-09
64625 CPT Hb Radiofrequency Abltj Nrv Nrvtg Si Jt W/img Gdn 38 12 $4,016.00 $4,016.00 $1,606.40 $3,935.68 $3,815.20 2026-01-09
52001 CPT Hb Csto W/irrg&evac Mlt Obstructing Clots 38 12 $4,014.00 $4,014.00 $1,605.60 $3,933.72 $3,813.30 2026-01-09
36556 CPT Hb Radiant Insert Nt Cv Cath Eq Or Gt 5 Age 38 12 $4,011.00 $4,011.00 $1,604.40 $3,930.78 $3,810.45 2026-01-09
78451 CPT Hb Radiant-myocardial Spect Single Study At Rest Or Stress 38 12 $3,999.00 $3,999.00 $1,599.60 $3,919.02 $3,799.05 2026-01-09
72194 CPT Hb Radiant-CT Pelvis With & Without Contrast 38 12 $3,989.00 $3,989.00 $1,595.60 $3,909.22 $3,789.55 2026-01-09
72141 CPT Hb Radiant-mr C-spine Without Contrast 38 12 $3,983.00 $3,983.00 $1,593.20 $3,903.34 $3,783.85 2026-01-09
73206 CPT Hb Radiant-CT Angio Upper Extrem Without W Contrast 38 12 $3,977.00 $3,977.00 $1,590.80 $3,897.46 $3,778.15 2026-01-09
70551 CPT Hb Radiant-mr Imag Brain; Without Cont 38 12 $4,054.00 $4,054.00 $1,621.60 $3,972.92 $3,774.27 2026-01-09
42104 CPT Hb Excision Lesion Palate/uvula Wo Closure 38 12 $3,963.00 $3,963.00 $1,585.20 $3,883.74 $3,764.85 2026-01-09
52315 CPT Hb Scope Bladder, Complex Removal Stone, Stent,fb 38 12 $3,959.00 $3,959.00 $1,583.60 $5,413.35 $3,761.05 2026-01-09
57522 CPT Hb Cone Cervix Loop Electrode W Without 38 12 $3,948.00 $3,948.00 $1,579.20 $3,869.04 $3,750.60 2026-01-09
71270 CPT Hb Radiant-CT Chest With & Without Contrast 38 12 $3,931.00 $3,931.00 $1,572.40 $3,852.38 $3,734.45 2026-01-09
J9023 HCPCS Avelumab 20 Mg/ml Intravenous Solution 40 12 $3,925.28 $3,925.28 $98.08 $3,846.77 $3,729.01 2026-01-09
C1762 HCPCS Arthrex Cancellous 1-4mm 15.0cc 150 12 $5,973.00 $5,973.00 $931.00 $8,297.86 $3,725.57 2026-01-09
C1787 HCPCS Axonics Remote Control 38 12 $3,911.52 $3,911.52 $1,564.61 $3,833.29 $3,715.95 2026-01-09
J0897 HCPCS Denosumab 60 Mg/ml Subcutaneous Syringe 66 12 $3,907.46 $3,907.46 $26.24 $6,691.58 $3,712.09 2026-01-09
73218 CPT Hb Radiant MRI Up Extrem Not Jt Without Cont 38 12 $3,871.00 $3,871.00 $1,548.40 $3,793.58 $3,677.45 2026-01-09
93351 CPT Hb Radiant Ccl Stress Echo Complete Pharm 38 12 $3,865.00 $3,865.00 $1,546.00 $3,787.70 $3,671.75 2026-01-09
23700 CPT Hb Manipulation Shoulder Under Anesthesia 38 12 $3,846.00 $3,846.00 $1,538.40 $3,769.08 $3,653.70 2026-01-09
J2507 HCPCS Pegloticase Injection 4 2 — — $3,595.42 $3,700.21 $3,647.82 2026-01-09
78803 CPT Hb Radiant-tumor Localization Spect/acquisj Sngl Day Img 38 12 $3,838.00 $3,838.00 $1,535.20 $3,761.24 $3,646.10 2026-01-09
81162 CPT Hb Brca1/brca2 Gene Analysis Sendout 38 12 $3,831.00 $3,831.00 $1,532.40 $3,754.38 $3,639.45 2026-01-09
14301 CPT Hb Derm Skin Tissue Trnsfr Defect 30.1 To 60.0 Sq Cm 38 12 $3,824.00 $3,824.00 $1,529.60 $3,747.52 $3,632.80 2026-01-09
Q4310 HCPCS Procenta, Per 100 Mg 2 1 — — $3,614.18 $3,614.18 $3,614.18 2026-01-09
71275 CPT Hb Radiant-CT Angio Chest Without With Ctrst Noncoronary 38 12 $3,800.00 $3,800.00 $1,520.00 $3,724.00 $3,610.00 2026-01-09
J7504 HCPCS Lymphocyte Immune Globulin 4 2 — — $3,384.35 $3,831.69 $3,608.02 2026-01-09
57135 CPT Hb Excision Vaginal Cyst Or Tumor 38 12 $3,784.00 $3,784.00 $1,513.60 $3,708.32 $3,594.80 2026-01-09
20680 CPT Hb Removal Int Fixation Dev Deep 38 12 $3,773.00 $3,773.00 $1,509.20 $3,955.68 $3,584.35 2026-01-09
0278 RC Mtp Dorsal Plate (right) 1,130 12 $5,920.20 $5,920.20 $76.80 $44,688.00 $3,573.90 2026-01-09
J0801 HCPCS Inj. Acthar Gel To 40 Units 2 1 — — $3,572.61 $3,572.61 $3,572.61 2026-01-09
J0802 HCPCS Inj. (ani), Up To 40 Units 2 1 — — $3,567.22 $3,567.22 $3,567.22 2026-01-09
72126 CPT Hb Radiant-CT C-spine With Contrast 38 12 $3,749.00 $3,749.00 $1,499.60 $3,674.02 $3,561.55 2026-01-09
73221 CPT Hb Radiant Mr Any Jt Up Extrem Without Cont 38 12 $3,742.00 $3,742.00 $1,496.80 $3,667.16 $3,554.90 2026-01-09
73718 CPT Hb Radiant-MRI Low Extrem Not Jt Without Contrst 38 12 $3,738.00 $3,738.00 $1,439.31 $3,663.24 $3,551.10 2026-01-09
52310 CPT Hb Cysto W/rem Fb/stone/stent Simple 66 12 $4,245.00 $4,245.00 $1,480.00 $4,160.10 $3,515.00 2026-01-09
C8930 HCPCS Hb Radiant Ccl-rad Stress Echo W/wo Contr W/ecg 38 12 $3,632.00 $3,632.00 $1,452.80 $3,559.36 $3,450.40 2026-01-09
99291 CPT Hb E&m Critical Care Ill /injured First 30-74 Minutes 38 12 $3,612.00 $3,612.00 $1,444.80 $3,539.76 $3,431.40 2026-01-09
70496 CPT Hb Radiant-CT Angiography Head With Without Cont 38 12 $3,601.00 $3,601.00 $1,440.40 $3,528.98 $3,420.95 2026-01-09
A9584 HCPCS Hb Radiant Ioflupane I-123 Dx Per Study To 5 Mci 38 12 $3,600.00 $3,600.00 $1,440.00 $3,528.00 $3,420.00 2026-01-09
94002 CPT Hb Ventilator Initial Day 38 12 $3,584.00 $3,584.00 $1,433.60 $3,512.32 $3,404.80 2026-01-09
27266 CPT Hb Closed Rx Post Hip Fix Disloc,anesth 38 12 $3,583.00 $3,583.00 $1,433.20 $3,511.34 $3,403.85 2026-01-09
73702 CPT Hb Radiant-CT Lower Extremity W & Without Contrast 38 12 $3,577.00 $3,577.00 $1,430.80 $3,505.46 $3,398.15 2026-01-09
23665 CPT Hb Closed Tx Shldr Dsloc W/fx W/man 38 12 $3,572.00 $3,572.00 $1,428.80 $3,500.56 $3,393.40 2026-01-09
0722 RC Hb Vaginal Delivery Level 3 94 12 $4,369.00 $4,369.00 $1,382.00 $5,137.16 $3,385.90 2026-01-09
19120 CPT Hb Exc Brst Cyst Tumr/les Open 1 Or More 38 12 $3,549.00 $3,549.00 $1,419.60 $3,478.02 $3,371.55 2026-01-09
25622 CPT Hb Closed Rx Navicular Fx 38 12 $3,537.00 $3,537.00 $1,414.80 $3,466.26 $3,360.15 2026-01-09
J2506 HCPCS Pegfilgrastim 6 Mg/0.6 Ml Subcutaneous Syringe|discarded Drug Not Administe 92 12 $6,519.77 $6,519.77 $97.03 $7,601.01 $3,347.99 2026-01-09
J2315 HCPCS Naltrexone ER 380 Mg Intramuscular Suspension,extended Release 40 12 $3,521.81 $3,521.81 $4.21 $3,451.37 $3,345.72 2026-01-09
76498 CPT Hb Radiant-li-fraumeni Screening 38 12 $3,514.00 $3,514.00 $1,405.60 $3,443.72 $3,338.30 2026-01-09
J1950 HCPCS Leuprolide 11.25 Mg (3 Month) Intramuscular Syringe Kit|discarded Drug Not Admin… 118 12 $4,315.23 $4,315.23 $637.08 $7,823.52 $3,336.29 2026-01-09
72129 CPT Hb Radiant-CT T-spine With Contrast 38 12 $3,496.00 $3,496.00 $1,398.40 $3,426.08 $3,321.20 2026-01-09
70498 CPT Hb Radiant-CT Angio Neck Without With Cont 38 12 $3,494.00 $3,494.00 $1,397.60 $3,424.12 $3,319.30 2026-01-09
93312 CPT Echo Transesophageal 38 12 $3,491.00 $3,491.00 $1,396.40 $3,421.18 $3,316.45 2026-01-09
L8699 HCPCS Stem Accolade C Cs 132 Nk 94 12 $5,643.58 $5,643.58 $710.75 $7,364.70 $3,306.60 2026-01-09
10180 CPT Hb I/d Post Op Wound Infection 38 12 $3,473.00 $3,473.00 $1,389.20 $3,403.54 $3,299.35 2026-01-09
64634 CPT Hb Dest Cerv/thor Facet Jnt Each Addl W Image 38 12 $3,462.00 $3,462.00 $1,384.80 $3,392.76 $3,288.90 2026-01-09
J9308 HCPCS Ramucirumab 10 Mg/ml Intravenous Solution 118 12 $6,578.80 $6,578.80 $73.83 $16,762.78 $3,284.14 2026-01-09
C8929 HCPCS Hb Radiant Ccl Tte Cmplt W Sp/color Flw Dppler W Cntrst 38 12 $3,454.00 $3,454.00 $1,381.60 $3,384.92 $3,281.30 2026-01-09
24505 CPT Hb Closed Tx Humeral Shaft Fx W Manip 38 12 $3,435.00 $3,435.00 $1,374.00 $3,366.30 $3,263.25 2026-01-09
23073 CPT Hb Shoulder Exc Tumor Soft Tissue Subfascial 5+cm 38 12 $3,433.00 $3,433.00 $1,373.20 $3,364.34 $3,261.35 2026-01-09
Q4246 HCPCS Coretext Or Protext, Per Cc 4 2 — — $3,146.08 $3,360.07 $3,253.07 2026-01-09
21930 CPT Hb Exc Tumor Soft Tissue Back/flank Lt 3 Cm 66 12 $3,424.00 $3,424.00 $1,369.60 $5,119.52 $3,252.80 2026-01-09
70487 CPT Hb Radiant-CT Maxlofce Area With Contrast 38 12 $3,374.00 $3,374.00 $1,349.60 $3,306.52 $3,205.30 2026-01-09
72130 CPT Hb Radiant CT T-spine With & Without Contrast 38 12 $3,370.00 $3,370.00 $1,348.00 $3,302.60 $3,201.50 2026-01-09
72131 CPT Hb Radiant-CT L-spine - Non Contrast 38 12 $3,364.00 $3,364.00 $1,345.60 $3,296.72 $3,195.80 2026-01-09
J3032 HCPCS Eptinezumab-jjmr 100 Mg/ml Intravenous Solution 40 12 $3,363.75 $3,363.75 $19.13 $3,296.48 $3,195.56 2026-01-09
J9179 HCPCS Eribulin 1 Mg/2 Ml (0.5 Mg/ml) Intravenous Solution 40 12 $3,359.15 $3,359.15 $139.71 $3,291.97 $3,191.19 2026-01-09
70470 CPT Hb Radiant-CT Brain W & Wo Contrast 38 12 $3,358.00 $3,358.00 $1,343.20 $3,290.84 $3,190.10 2026-01-09
73701 CPT Hb Radiant-CT Lower Extremity With Contrast 38 12 $3,354.00 $3,354.00 $1,341.60 $3,286.92 $3,186.30 2026-01-09
74160 CPT Hb Radiant-CT Abdomen With Contrast 38 12 $3,344.00 $3,344.00 $1,337.60 $3,277.12 $3,176.80 2026-01-09
72127 CPT Hb Radiant-CT C-spine With & Without Contrast 38 12 $3,333.00 $3,333.00 $1,333.20 $3,266.34 $3,166.35 2026-01-09
72125 CPT Hb Radiant-CT C-spine Without Contrast 38 12 $3,401.00 $3,401.00 $1,360.40 $3,332.98 $3,166.33 2026-01-09
24605 CPT Hb Closed Rx Elbow Dislocatn 38 12 $3,330.00 $3,330.00 $1,332.00 $3,263.40 $3,163.50 2026-01-09
49440 CPT Hb Radiant-insert Perc Gastrostomy W Flouro 38 12 $3,330.00 $3,330.00 $1,332.00 $3,263.40 $3,163.50 2026-01-09
72193 CPT Hb Radiant-CT Pelvis With Contrast 38 12 $3,321.00 $3,321.00 $1,328.40 $3,254.58 $3,154.95 2026-01-09
21931 CPT Hb Exc Tumor Soft Tissue Back/flank Eg 3 Cm 38 12 $3,321.00 $3,321.00 $1,328.40 $3,254.58 $3,154.95 2026-01-09
J0129 HCPCS Abatacept (with Maltose) 250 Mg Intravenous Solution 40 12 $3,320.62 $3,320.62 $45.41 $3,254.21 $3,154.59 2026-01-09
72128 CPT Hb Radiant-CT T-spine - Non Contrast 38 12 $3,311.00 $3,311.00 $1,324.40 $3,244.78 $3,145.45 2026-01-09
70460 CPT Hb Radiant-CT Head/brain W/contrast 38 12 $3,291.00 $3,291.00 $1,316.40 $3,225.18 $3,126.45 2026-01-09
71250 CPT Hb Radiant-CT Chest - Non Contrast 38 12 $3,291.00 $3,291.00 $1,316.40 $3,225.18 $3,063.92 2026-01-09
70488 CPT Hb Radiant-CT Face W / Wo Contrast 38 12 $3,225.00 $3,225.00 $1,290.00 $3,160.50 $3,063.75 2026-01-09
73721 CPT Hb Radiant-MRI Any Jt Low Extrem; Without Cont 38 12 $3,283.00 $3,283.00 $1,313.20 $3,217.34 $3,056.47 2026-01-09
24071 CPT Hb Exc Tumor Upper Arm Subq Eg 3 Cm 38 12 $3,207.00 $3,207.00 $1,282.80 $3,142.86 $3,046.65 2026-01-09
J9299 HCPCS Nivolumab 40 Mg/4 Ml Intravenous Solution 222 12 $3,874.97 $3,874.97 $32.96 $14,053.50 $3,042.28 2026-01-09
72192 CPT Hb Radiant-CT Pelvis - Non Contrast 38 12 $3,196.00 $3,196.00 $1,278.40 $3,132.08 $3,036.20 2026-01-09
J2426 HCPCS Paliperidone Palmitate 156 Mg/ml Intramuscular Syringe 66 12 $4,748.18 $4,748.18 $15.14 $4,653.22 $3,032.05 2026-01-09
42860 CPT Hb Tonsil Tags Excision 38 12 $3,191.00 $3,191.00 $1,276.40 $3,127.18 $3,031.45 2026-01-09
70491 CPT Hb Radiant-CT Soft Tissue Neck W/contrst 38 12 $3,189.00 $3,189.00 $1,275.60 $3,125.22 $3,029.55 2026-01-09
J9217 HCPCS Leuprolide 30 Mg (4 Month) Intramuscular Syringe Kit|discarded Drug Not Administ… 326 12 $6,064.88 $6,064.88 $140.40 $17,541.15 $3,016.77 2026-01-09
36569 CPT Hb Insert Picc Without Port/pump Gt 5 Age-default 38 12 $3,169.00 $3,169.00 $1,267.60 $3,105.62 $3,010.55 2026-01-09
78582 CPT Hb Radiant-lung Ventilat&perfus Imaging 38 12 $3,144.00 $3,144.00 $1,257.60 $3,081.12 $2,986.80 2026-01-09
64530 CPT Hb Celiac Plexus Block W Or Without Fluoro 38 12 $3,122.00 $3,122.00 $1,248.80 $3,059.56 $2,965.90 2026-01-09
93306 CPT Tte W/doppler Complete 38 12 $3,163.00 $3,163.00 $1,265.20 $3,099.74 $2,944.75 2026-01-09
70480 CPT Hb Radiant-CT Post Fossa - Non Contrast 38 12 $3,094.00 $3,094.00 $1,237.60 $3,032.12 $2,939.30 2026-01-09
C9359 HCPCS Magnet Os 1.5cc 38 12 $3,087.60 $3,087.60 $1,235.04 $3,025.85 $2,933.22 2026-01-09
10081 CPT Hb Emerg I&d Pilonidal Cyst Complex 38 12 $3,079.00 $3,079.00 $1,231.60 $3,017.42 $2,925.05 2026-01-09
15120 CPT Hb Split Graft 1st 100 Sq Sm Face 38 12 $3,077.00 $3,077.00 $1,230.80 $3,015.46 $2,923.15 2026-01-09
Q4197 HCPCS Hb Cc Puraply Xt, Per Sq Cm 40 12 $3,077.00 $3,077.00 $128.93 $3,015.46 $2,923.15 2026-01-09
71260 CPT Hb Radiant-CT Chest With Contrast 38 12 $3,137.00 $3,137.00 $1,202.43 $3,074.26 $2,920.55 2026-01-09
J9305 HCPCS Pemetrexed Disodium 100 Mg Intravenous Powder For Solution|discarded Drug Not Ad… 92 12 $3,153.56 $3,153.56 $4.21 $6,953.60 $2,909.16 2026-01-09
20200 CPT Hb Biopsy Muscle Superficial 38 12 $3,062.00 $3,062.00 $1,224.80 $3,000.76 $2,908.90 2026-01-09
70490 CPT Hb Radiant-CT Soft Tiss Neck Without Contrst 38 12 $3,058.00 $3,058.00 $1,223.20 $2,996.84 $2,905.10 2026-01-09
64721 CPT Hb Revise Median N/carpal Tunnel Surg 38 12 $3,050.00 $3,050.00 $1,220.00 $2,989.00 $2,897.50 2026-01-09
57061 CPT Hb Destruction Vaginal Lesion Simple 38 12 $3,029.00 $3,029.00 $1,211.60 $2,968.42 $2,877.55 2026-01-09
J9286 HCPCS Inj Glofitamab Gxbm, 2.5 Mg 2 1 — — $2,869.69 $2,869.69 $2,869.69 2026-01-09
0173 RC Hb Newborn Room/level Iii 16 7 $3,003.00 $3,003.00 $2,762.76 $2,942.94 $2,867.86 2026-01-09
38505 CPT Hb Radiant-bx Lymph Node Percutaneous 38 12 $3,013.00 $3,013.00 $1,205.20 $2,952.74 $2,862.35 2026-01-09
64490 CPT Hb Inj Pv Fct Jt C/t W Image Lev 1 38 12 $2,991.00 $2,991.00 $1,196.40 $2,931.18 $2,841.45 2026-01-09
73201 CPT Hb Radiant-CT Upper Extremity With Contrast 38 12 $2,985.00 $2,985.00 $1,194.00 $2,925.30 $2,835.75 2026-01-09
43235 CPT Hb Gi-flex Egd +/- Specimen Collection 38 12 $2,985.00 $2,985.00 $1,155.94 $2,925.30 $2,835.75 2026-01-09
78315 CPT Hb Radiant-3 Phase Bone 38 12 $2,973.00 $2,973.00 $1,189.20 $2,913.54 $2,824.35 2026-01-09
64479 CPT Hb Inj(s) Foramen Cerv/thor Sngl W Image 38 12 $2,949.00 $2,949.00 $1,179.60 $2,890.02 $2,801.55 2026-01-09
25535 CPT Hb Closed Rx Ulna Shaft Fx,manipulatn 38 12 $2,941.00 $2,941.00 $1,176.40 $2,882.18 $2,793.95 2026-01-09
23655 CPT Hb Closed Rx Shldr Disloc,anesthesia 38 12 $2,918.00 $2,918.00 $1,167.20 $2,859.64 $2,772.10 2026-01-09
75989 CPT Hb Radiant Radiological Guidance Prq DRG W/plmt Cath Rs&i 38 12 $2,901.00 $2,901.00 $1,160.40 $2,842.98 $2,755.95 2026-01-09
47000 CPT Hb Radiant-biopsy Liver Needle Percutaneous 38 12 $2,897.00 $2,897.00 $1,158.80 $2,839.06 $2,752.15 2026-01-09
J9229 HCPCS Inj Inotuzumab Ozogam 0.1 Mg 4 2 — — $2,734.96 $2,744.31 $2,739.64 2026-01-09
64493 CPT Hb Inj Pv Fct Jt L/s W Image Lev 1 38 12 $2,862.00 $2,862.00 $1,144.80 $3,191.44 $2,718.90 2026-01-09
Q0222 HCPCS Fee Schedule 2 1 — — $2,710.25 $2,710.25 $2,710.25 2026-01-09
64483 CPT Hb Inj(s) Foramen/epi Lum/scrl Sngl W Image 38 12 $2,887.00 $2,887.00 $1,154.80 $2,829.26 $2,687.80 2026-01-09
10140 CPT Hb I&d Hematoma/seroma/fluid Collect 94 12 $3,854.00 $3,854.00 $1,124.80 $4,111.10 $2,671.40 2026-01-09
J3401 HCPCS Vyjuvek 5x10^9pfu/ml, 0.1 Ml 2 1 — — $2,670.24 $2,670.24 $2,670.24 2026-01-09
27372 CPT Hb Remv Foreign Body,knee/thigh,deep 38 12 $2,809.00 $2,809.00 $1,123.60 $2,752.82 $2,668.55 2026-01-09
10061 CPT Hb I&d Abscess Complex/multiple 38 12 $2,809.00 $2,809.00 $778.94 $2,752.82 $2,668.55 2026-01-09
21932 CPT Hb Exc Tumor Soft Tiss Back/flank Subfascial <5cm 38 12 $2,809.00 $2,809.00 $1,123.60 $2,752.82 $2,668.55 2026-01-09
74150 CPT Hb Radiant-CT Abdomen - Non Contrast 38 12 $2,799.00 $2,799.00 $1,119.60 $2,743.02 $2,659.05 2026-01-09
78227 CPT Hb Radiant-hepatobil Syst Image W/drug 38 12 $2,787.00 $2,787.00 $1,114.80 $2,731.26 $2,647.65 2026-01-09
51102 CPT Hb Asp Bladder W/suprapubic Cath 66 12 $2,775.00 $2,775.00 $1,110.00 $5,247.90 $2,636.25 2026-01-09
11446 CPT Hb Exc Face-mm B9+marg Over 4.0 Cm 38 12 $2,765.00 $2,765.00 $1,106.00 $2,709.70 $2,626.75 2026-01-09
25605 CPT Hb Closed Tx Dist Rad/ulna Fx Manip 38 12 $2,764.00 $2,764.00 $1,105.60 $2,729.37 $2,625.80 2026-01-09
49320 CPT Hb Laparoscopy Diagnostic; Abdomen, Peritoneum & Omentum 38 12 $2,763.00 $2,763.00 $1,105.20 $2,707.74 $2,624.85 2026-01-09
40654 CPT Hb Repair Lip Full Thickness Complex 38 12 $2,753.00 $2,753.00 $1,101.20 $2,697.94 $2,615.35 2026-01-09
J2993 HCPCS Reteplase Injection 2 1 — — $2,605.99 $2,605.99 $2,605.99 2026-01-09
69436 CPT Hb Bmt Tympanostomy With Tube General Anesthesia Unilateral 38 12 $2,742.00 $2,742.00 $1,027.12 $3,815.46 $2,604.90 2026-01-09
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