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

BEATRICE COMMUNITY HOSPITAL & HEALTH CENTER, INC

Beatrice, NE · CCN 281364 · Rates published

3,640 distinct procedures filed
9 distinct payers
38,757 rate rows
2025-11-07 last MRF observed
Data quality

38,757 of 38,757 rate rows are consumer-grade (100.0%)

Every filed rate row passes our consumer-grade checks — none are excluded from the medians.

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://secure.claraprice.net/price-transparency/RNAV-1731102747513/machine-readable/470379834_beatrice-community-hospital_standardcharges.json
Found on page https://secure.claraprice.net/price-transparency/beatrice-community-hospital-ne
Discovered viaDiscovered by HANK
Last fetch success · 2026-06-16
Content fingerprint 5a034ffd95d70d33… · 6,721,207 bytes · first seen 2026-06-16

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
119469
CDM 		Ustekinumab 90 Mg/ml Subcutaneous Syringe 9 $15,079.00 $54,435.00 $53,868.00 nat. median
$160
outlier · 337.5×
180349
CDM 		Ocrelizumab 30 Mg/ml Intravenous Solution 9 $11,157.00 $40,277.00 $39,857.00 nat. median
$39,857
1.0× median
78073
CPT 		Canakinumab (Pf) 150 Mg/ml Subcutaneous Solution 9 $6,578.00 $39,473.00 $39,062.00 nat. median
$12,966
outlier · 3.0×
C1767
HCPCS 		Interstim X Neurostimulator 9 $6,113.00 $36,684.00 $36,301.00 nat. median
$22,478
1.6× median
187610
CDM 		Tildrakizumab-asmn 100 Mg/ml Subcutaneous Syringe 9 $9,735.00 $35,144.00 $34,778.00 nat. median
$2,773
outlier · 12.5×
CP17624571377121553
CDM 		Uterine And Adnexa Procedures For Non-malignancy Without Cc Or Mcc 9 $2,917.00 $32,074.00 $31,740.00 nat. median
$31,740
1.0× median
C1820
HCPCS 		Interstim Ii Neurostimulator 9 $4,671.00 $28,032.00 $27,740.00 nat. median
$22,013
1.3× median
181954
CDM 		Guselkumab 100 Mg/ml Subcutaneous Syringe 9 $7,636.00 $27,565.00 $27,278.00 nat. median
$27,278
1.0× median
Q4196
HCPCS 		Puraply Am 8cm X 16cm 9 $4,400.00 $26,400.00 $26,125.00 nat. median
$286
outlier · 91.4×
74347
CPT 		Leuprolide Acetate (6 Month) 45 Mg Intramuscular Syringe Kit 9 $4,075.00 $24,455.00 $24,200.00 nat. median
$810
outlier · 29.9×
194061
CDM 		Luspatercept-aamt 75 Mg Subcutaneous Solution 9 $6,623.00 $23,909.00 $23,660.00 nat. median
$23,660
1.0× median
Q4186
HCPCS 		Epifix 7cm X 7cm 9 $3,737.00 $22,426.00 $22,192.00 nat. median
$398
outlier · 55.7×
207144
CDM 		Ublituximab-xiiy 25 Mg/ml Intravenous Solution 9 $6,099.00 $22,017.00 $21,787.00 nat. median
$15,817
1.4× median
C1776
HCPCS 		Femoral Tc3 Cemented Size 4 Ri 9 $3,600.00 $21,605.00 $21,380.00 nat. median
$3,432
outlier · 6.2×
196736
CDM 		Daratumumab 1,800 Mg-hyaluronidase-fihj 30,000 Unit/15 Ml Subcut Soln 9 $5,785.00 $20,884.00 $20,666.00 nat. median
$20,666
1.0× median
74501
CPT 		Risankizumab-rzaa 60 Mg/ml Intravenous Solution 9 $3,434.00 $20,604.00 $20,389.00 nat. median
$25,502
0.8× median
168531
CDM 		Vedolizumab 300 Mg Intravenous Solution 9 $5,170.00 $18,663.00 $18,469.00 nat. median
$18,469
1.0× median
C1781
HCPCS 		Mesh Phasix St 15cm X 20cm 9 $3,048.00 $18,293.00 $18,102.00 nat. median
$1,362
outlier · 13.3×
C1762
HCPCS 		Amniotic Allograft Liquid 2ml 9 $3,038.00 $18,228.00 $18,039.00 nat. median
$2,935
outlier · 6.1×
Q4278
HCPCS 		Epieffect 3x5 Cm 9 $3,000.00 $18,000.00 $17,813.00 nat. median
$357
outlier · 49.9×
40120
CDM 		Natalizumab 300 Mg/15 Ml Intravenous Solution 9 $4,789.00 $17,287.00 $17,107.00 nat. median
$118
outlier · 145.1×
74368
CPT 		Leuprolide 30 Mg (4 Month) Intramuscular Syringe Kit 9 $2,757.00 $16,547.00 $16,374.00 nat. median
$89
outlier · 183.1×
33734
CPT 		Nivolumab 240 Mg/24 Ml Intravenous Solution 9 $2,608.00 $15,651.00 $15,488.00 nat. median
$13,054
1.2× median
A2019
HCPCS 		Kerecis Shield Spiral 30mm 9 $2,361.00 $14,170.00 $14,022.00 nat. median
$552
outlier · 25.4×
119619
CDM 		Kit For Preparation Of Tc-99m-medronate Sodium 20 Mg IV Solution 9 $3,888.00 $14,034.00 $13,888.00 nat. median
$62
outlier · 222.2×
159381
CDM 		Pertuzumab 420 Mg/14 Ml (30 Mg/ml) Intravenous Solution 9 $3,822.00 $13,798.00 $13,654.00 nat. median
$13,654
1.0× median
78082
CPT 		Octreotide,microspheres ER 30 Mg Intramuscular Susp, Extended Release 9 $2,223.00 $13,338.00 $13,199.00 nat. median
$13,130
1.0× median
198520
CDM 		Ravulizumab-cwvz 100 Mg/ml Intravenous Solution 9 $3,669.00 $13,245.00 $13,107.00 nat. median
$13,107
1.0× median
81696
CDM 		Eculizumab 300 Mg/30 Ml Intravenous Solution 9 $3,664.00 $13,228.00 $13,090.00 nat. median
$1,997
outlier · 6.6×
172818
CDM 		Paliperidone Palmitate (3 Month) 819 Mg/2.63 Ml Intramuscular Syringe 9 $3,658.00 $13,207.00 $13,069.00 nat. median
$10,584
1.2× median
74334
CPT 		Leuprolide Acetate 22.5 Mg (3 Month) Intramuscular Syringe Kit 9 $2,098.00 $12,592.00 $12,461.00 nat. median
$9,998
1.2× median
202803
CDM 		Efgartigimod Alfa-fcab 20 Mg/ml Intravenous Solution 9 $3,488.00 $12,591.00 $12,460.00 nat. median
$12,329
1.0× median
91495
CDM 		Certolizumab Pegol 400 Mg (200 Mg X 2 Vials) Subcutaneous Kit 9 $3,386.00 $12,225.00 $12,097.00 nat. median
$25
outlier · 490.8×
63026
CPT 		Pembrolizumab 25 Mg/ml Intravenous Solution 9 $1,968.00 $11,809.00 $11,686.00 nat. median
$1,968
outlier · 5.9×
97853
CDM 		Certolizumab Pegol 400 Mg/2 Ml (200 Mg/ml X2) Subcutaneous Syringe Kit 9 $3,218.00 $11,617.00 $11,496.00 nat. median
$29
outlier · 398.9×
9002
CDM 		Alteplase 100 Mg Intravenous Solution 9 $3,038.00 $10,967.00 $10,853.00 nat. median
$192
outlier · 56.5×
C1897
HCPCS 		Lead Kit Is2 28cm 9 $1,821.00 $10,930.00 $10,816.00 nat. median
$1,137
outlier · 9.5×
74366
CPT 		Leuprolide Acetate 11.25 Mg (3 Month) Intramuscular Syringe Kit 9 $1,781.00 $10,685.00 $10,574.00 nat. median
$89
outlier · 118.2×
31017
CPT 		Benralizumab 30 Mg/ml Subcutaneous Syringe 9 $1,774.00 $10,644.00 $10,534.00 nat. median
$4,323
outlier · 2.4×
C1777
HCPCS 		Actis Collared High Size 8 9 $1,760.00 $10,560.00 $10,450.00 nat. median
$5,141
outlier · 2.0×
184667
CDM 		Tenecteplase 50 Mg Intravenous Solution 9 $2,868.00 $10,353.00 $10,245.00 nat. median
$16
outlier · 640.3×
364SU278
CDM 		Femoral Stem Sz 9 Std Collar C 9 $1,680.00 $10,080.00 $9,975.00 nat. median
$9,975
1.0× median
66984
CPT 		Removal Of Cataract With Insertion Of Lens 9 $1,607.00 $9,643.00 $9,543.00 nat. median
$2,924
outlier · 3.3×
172799
CDM 		Immune Glob,gamm(igg) 10 %-pro-iga 0 To 50 Mcg/ml Intravenous Solution 9 $2,627.00 $9,482.00 $9,383.00 nat. median
$3,812
outlier · 2.5×
Q4100
HCPCS 		Allo Adi Dermal Matrix Meshed 9 $1,558.00 $9,348.00 $9,251.00 nat. median
$1,878
outlier · 4.9×
120051
CDM 		Kit Preparation Of Tc 99m-sestamibi Combo No.1 IV Solution 9 $2,553.00 $9,216.00 $9,120.00 nat. median
$93
outlier · 98.5×
101010
CDM 		Collagenase Clostridium Histolyticum 0.9 Mg Solution For Injection 9 $2,441.00 $8,812.00 $8,720.00 nat. median
$261
outlier · 33.4×
206169
CDM 		Eflapegrastim-xnst 13.2 Mg/0.6 Ml Subcutaneous Syringe 9 $2,418.00 $8,727.00 $8,636.00 nat. median
$1,904
outlier · 4.5×
32267
CDM 		Pegfilgrastim 6 Mg/0.6 Ml Subcutaneous Syringe 9 $2,397.00 $8,652.00 $8,562.00 nat. median
$1,344
outlier · 6.4×
171445
CDM 		Pegfilgrastim 6 Mg/0.6 Ml (Deliverable) Wearable Subcutaneous Injector 9 $2,397.00 $8,652.00 $8,562.00 nat. median
$8
outlier · 1057.0×

Other procedures at this hospital

Browse this hospital's 3,640 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
73721 CPT MRI Scan Of Leg Joint 45 9 $2,823.00 $2,823.00 $301.00 $5,006.00 $2,654.00 2025-11-07
78081 CPT Octreotide,microspheres ER 10 Mg Intramuscular Susp, Extended Release 27 9 $7,455.00 $7,455.00 $84.00 $9,150.00 $7,008.00 2025-11-07
70553 CPT MRI Scan 27 9 $3,900.00 $3,900.00 $518.00 $3,753.00 $3,666.00 2025-11-07
73221 CPT Hc MRI Upper Extremity Joint 27 9 $2,884.00 $2,884.00 $417.00 $4,927.00 $2,711.00 2025-11-07
45378 CPT Diagnostic Exam Of Large Bowel Using An Endoscope 27 9 $2,460.00 $2,460.00 $149.00 $5,445.00 $2,312.00 2025-11-07
59510 CPT Obstetric Care, Planned Cesarean Delivery 18 9 $16,457.50 $16,457.50 $906.00 $26,161.00 $5,437.00 2025-11-07
59610 CPT Obstetric Care, Planned Vaginal Delivery (post Delivery By Cesarean Section) 18 9 $9,295.50 $9,295.50 $853.00 $12,727.00 $5,121.00 2025-11-07
59400 CPT Obstetric Care, Planned Vaginal Delivery 18 9 $9,120.50 $9,120.50 $712.00 $13,239.00 $4,272.00 2025-11-07
78815 CPT Hc PET W/ctskull Base To Mid Thigh 18 9 $5,003.50 $5,003.50 $681.00 $5,520.00 $4,087.00 2025-11-07
73223 CPT Hc MRI Upper Extremity Joint Without & With Contrast 18 9 $5,828.50 $5,828.50 $678.00 $7,121.00 $4,069.00 2025-11-07
74364 CPT Leuprolide 3.75 Mg Intramuscular Syringe Kit 18 9 $4,465.00 $4,465.00 $658.00 $4,624.00 $3,948.00 2025-11-07
64624 CPT Hc Destruct Neurolytic Agt Genicular Nrv W/img 18 9 $5,427.00 $5,427.00 $631.00 $6,631.00 $3,789.00 2025-11-07
73723 CPT Hc MRI Lower Extremity Joint Without & With Contrast 18 9 $5,223.50 $5,223.50 $597.00 $6,447.00 $3,582.00 2025-11-07
73720 CPT Hc MRI Lower Extrem Oth/thn Jt Without & W/contr Matr 18 9 $5,130.00 $5,130.00 $597.00 $6,268.00 $3,582.00 2025-11-07
73220 CPT Hc MRI Upper Extremity Without & With Contrast 18 9 $5,130.00 $5,130.00 $597.00 $6,268.00 $3,582.00 2025-11-07
74183 CPT Cc MRI Pancreas With Contrast 18 9 $4,145.00 $4,145.00 $580.00 $4,477.00 $3,481.00 2025-11-07
72198 CPT Cc Mra; Pelvis W Or Wo Contrast 18 9 $3,540.50 $3,540.50 $553.00 $3,482.00 $3,316.00 2025-11-07
73719 CPT Hc MRI Lower Ext Other Than Joint With Contrast 18 9 $4,705.50 $4,705.50 $547.00 $5,749.00 $3,285.00 2025-11-07
73222 CPT Hc MRI Upper Extremity Joint With Contrast 18 9 $4,705.50 $4,705.50 $547.00 $5,749.00 $3,285.00 2025-11-07
73722 CPT Hc MRI Lower Extremity Joint With Contrast 18 9 $4,789.00 $4,789.00 $547.00 $5,910.00 $3,285.00 2025-11-07
73718 CPT Hc MRI Lower Ext Other Than Joint Without Contrast 18 9 $4,664.00 $4,664.00 $543.00 $5,699.00 $3,256.00 2025-11-07
C8914 HCPCS Hc MRA Lower Extremity Without & With Contrast 18 9 $4,277.50 $4,277.50 $498.00 $5,226.00 $2,987.00 2025-11-07
73218 CPT Hc MRI Upper Extremity Without Contrast 18 9 $4,275.00 $4,275.00 $497.00 $5,223.00 $2,985.00 2025-11-07
73706 CPT Hc CT Angio Lower Extremity 18 9 $4,050.00 $4,050.00 $480.00 $4,896.00 $2,880.00 2025-11-07
47562 CPT Removal Of Gallbladder Using An Endoscope 18 9 $12,066.00 $12,066.00 $374.00 $20,920.00 $2,866.00 2025-11-07
73725 CPT Cc Hc Mra/mrv Lwr Ext W Or Without Contrast 18 9 $3,036.50 $3,036.50 $474.00 $2,987.00 $2,844.00 2025-11-07
73202 CPT Hc CT Upper Extremity Without & With Contrast 18 9 $4,000.00 $4,000.00 $465.00 $4,887.00 $2,793.00 2025-11-07
73702 CPT Hc CT Lower Extremity Without & With Contrast 18 9 $3,999.00 $3,999.00 $465.00 $4,885.00 $2,793.00 2025-11-07
73219 CPT Hc MRI Upper Extremity With Contrast 18 9 $3,921.50 $3,921.50 $456.00 $4,791.00 $2,738.00 2025-11-07
49187 CPT Pr Open Exc/dstrj Intra-abdl Tumor/cst 5.1-10 Cm 18 9 $3,171.00 $3,171.00 $435.00 $3,479.00 $2,609.00 2025-11-07
29826 CPT Shaving Of Shoulder Bone Using Endoscope 18 9 $12,400.00 $12,400.00 $239.00 $22,371.00 $2,582.50 2025-11-07
73201 CPT Hc CT Clavicle With Contrast 18 9 $3,571.00 $3,571.00 $408.00 $4,407.00 $2,449.00 2025-11-07
43281 CPT Pr Laps Rpr Paraesphgl Hrna Incl Fundplsty Without Mesh 18 9 $2,958.50 $2,958.50 $406.00 $3,246.00 $2,435.00 2025-11-07
38724 CPT Pr Cervical Lymphadec Modified Radical Neck Dsj 18 9 $2,843.00 $2,843.00 $390.00 $3,119.00 $2,340.00 2025-11-07
73701 CPT Hc CT Lower Extremity With Contrast 18 9 $3,313.50 $3,313.50 $386.00 $4,048.00 $2,314.00 2025-11-07
119469 CDM Ustekinumab 90 Mg/ml Subcutaneous Syringe 9 9 $56,703.00 $56,703.00 $15,079.00 $54,435.00 $53,868.00 2025-11-07
180349 CDM Ocrelizumab 30 Mg/ml Intravenous Solution 9 9 $41,955.00 $41,955.00 $11,157.00 $40,277.00 $39,857.00 2025-11-07
78073 CPT Canakinumab (Pf) 150 Mg/ml Subcutaneous Solution 9 9 $41,118.00 $41,118.00 $6,578.00 $39,473.00 $39,062.00 2025-11-07
C1767 HCPCS Interstim X Neurostimulator 9 9 $38,212.00 $38,212.00 $6,113.00 $36,684.00 $36,301.00 2025-11-07
187610 CDM Tildrakizumab-asmn 100 Mg/ml Subcutaneous Syringe 9 9 $36,608.00 $36,608.00 $9,735.00 $35,144.00 $34,778.00 2025-11-07
CP17624571377121553 CDM Uterine And Adnexa Procedures For Non-malignancy Without Cc Or Mcc 9 9 $33,410.00 $33,410.00 $2,917.00 $32,074.00 $31,740.00 2025-11-07
C1820 HCPCS Interstim Ii Neurostimulator 9 9 $29,200.00 $29,200.00 $4,671.00 $28,032.00 $27,740.00 2025-11-07
181954 CDM Guselkumab 100 Mg/ml Subcutaneous Syringe 9 9 $28,714.00 $28,714.00 $7,636.00 $27,565.00 $27,278.00 2025-11-07
Q4196 HCPCS Puraply Am 8cm X 16cm 9 9 $27,500.00 $27,500.00 $4,400.00 $26,400.00 $26,125.00 2025-11-07
74347 CPT Leuprolide Acetate (6 Month) 45 Mg Intramuscular Syringe Kit 9 9 $25,474.00 $25,474.00 $4,075.00 $24,455.00 $24,200.00 2025-11-07
194061 CDM Luspatercept-aamt 75 Mg Subcutaneous Solution 9 9 $24,905.00 $24,905.00 $6,623.00 $23,909.00 $23,660.00 2025-11-07
Q4186 HCPCS Epifix 7cm X 7cm 9 9 $23,360.00 $23,360.00 $3,737.00 $22,426.00 $22,192.00 2025-11-07
207144 CDM Ublituximab-xiiy 25 Mg/ml Intravenous Solution 9 9 $22,934.00 $22,934.00 $6,099.00 $22,017.00 $21,787.00 2025-11-07
C1776 HCPCS Femoral Tc3 Cemented Size 4 Ri 9 9 $22,505.00 $22,505.00 $3,600.00 $21,605.00 $21,380.00 2025-11-07
196736 CDM Daratumumab 1,800 Mg-hyaluronidase-fihj 30,000 Unit/15 Ml Subcut Soln 9 9 $21,754.00 $21,754.00 $5,785.00 $20,884.00 $20,666.00 2025-11-07
74501 CPT Risankizumab-rzaa 60 Mg/ml Intravenous Solution 9 9 $21,462.00 $21,462.00 $3,434.00 $20,604.00 $20,389.00 2025-11-07
168531 CDM Vedolizumab 300 Mg Intravenous Solution 9 9 $19,441.00 $19,441.00 $5,170.00 $18,663.00 $18,469.00 2025-11-07
C1781 HCPCS Mesh Phasix St 15cm X 20cm 9 9 $19,055.00 $19,055.00 $3,048.00 $18,293.00 $18,102.00 2025-11-07
C1762 HCPCS Amniotic Allograft Liquid 2ml 9 9 $18,988.00 $18,988.00 $3,038.00 $18,228.00 $18,039.00 2025-11-07
Q4278 HCPCS Epieffect 3x5 Cm 9 9 $18,750.00 $18,750.00 $3,000.00 $18,000.00 $17,813.00 2025-11-07
40120 CDM Natalizumab 300 Mg/15 Ml Intravenous Solution 9 9 $18,007.00 $18,007.00 $4,789.00 $17,287.00 $17,107.00 2025-11-07
74368 CPT Leuprolide 30 Mg (4 Month) Intramuscular Syringe Kit 9 9 $17,236.00 $17,236.00 $2,757.00 $16,547.00 $16,374.00 2025-11-07
33734 CPT Nivolumab 240 Mg/24 Ml Intravenous Solution 9 9 $16,303.00 $16,303.00 $2,608.00 $15,651.00 $15,488.00 2025-11-07
A2019 HCPCS Kerecis Shield Spiral 30mm 9 9 $14,760.00 $14,760.00 $2,361.00 $14,170.00 $14,022.00 2025-11-07
119619 CDM Kit For Preparation Of Tc-99m-medronate Sodium 20 Mg IV Solution 9 9 $14,619.00 $14,619.00 $3,888.00 $14,034.00 $13,888.00 2025-11-07
159381 CDM Pertuzumab 420 Mg/14 Ml (30 Mg/ml) Intravenous Solution 9 9 $14,373.00 $14,373.00 $3,822.00 $13,798.00 $13,654.00 2025-11-07
78082 CPT Octreotide,microspheres ER 30 Mg Intramuscular Susp, Extended Release 9 9 $13,894.00 $13,894.00 $2,223.00 $13,338.00 $13,199.00 2025-11-07
198520 CDM Ravulizumab-cwvz 100 Mg/ml Intravenous Solution 9 9 $13,797.00 $13,797.00 $3,669.00 $13,245.00 $13,107.00 2025-11-07
81696 CDM Eculizumab 300 Mg/30 Ml Intravenous Solution 9 9 $13,779.00 $13,779.00 $3,664.00 $13,228.00 $13,090.00 2025-11-07
172818 CDM Paliperidone Palmitate (3 Month) 819 Mg/2.63 Ml Intramuscular Syringe 9 9 $13,757.00 $13,757.00 $3,658.00 $13,207.00 $13,069.00 2025-11-07
74334 CPT Leuprolide Acetate 22.5 Mg (3 Month) Intramuscular Syringe Kit 9 9 $13,117.00 $13,117.00 $2,098.00 $12,592.00 $12,461.00 2025-11-07
202803 CDM Efgartigimod Alfa-fcab 20 Mg/ml Intravenous Solution 9 9 $13,116.00 $13,116.00 $3,488.00 $12,591.00 $12,460.00 2025-11-07
91495 CDM Certolizumab Pegol 400 Mg (200 Mg X 2 Vials) Subcutaneous Kit 9 9 $12,734.00 $12,734.00 $3,386.00 $12,225.00 $12,097.00 2025-11-07
63026 CPT Pembrolizumab 25 Mg/ml Intravenous Solution 9 9 $12,301.00 $12,301.00 $1,968.00 $11,809.00 $11,686.00 2025-11-07
97853 CDM Certolizumab Pegol 400 Mg/2 Ml (200 Mg/ml X2) Subcutaneous Syringe Kit 9 9 $12,101.00 $12,101.00 $3,218.00 $11,617.00 $11,496.00 2025-11-07
9002 CDM Alteplase 100 Mg Intravenous Solution 9 9 $11,424.00 $11,424.00 $3,038.00 $10,967.00 $10,853.00 2025-11-07
C1897 HCPCS Lead Kit Is2 28cm 9 9 $11,385.00 $11,385.00 $1,821.00 $10,930.00 $10,816.00 2025-11-07
74366 CPT Leuprolide Acetate 11.25 Mg (3 Month) Intramuscular Syringe Kit 9 9 $11,130.00 $11,130.00 $1,781.00 $10,685.00 $10,574.00 2025-11-07
31017 CPT Benralizumab 30 Mg/ml Subcutaneous Syringe 9 9 $11,088.00 $11,088.00 $1,774.00 $10,644.00 $10,534.00 2025-11-07
C1777 HCPCS Actis Collared High Size 8 9 9 $11,000.00 $11,000.00 $1,760.00 $10,560.00 $10,450.00 2025-11-07
184667 CDM Tenecteplase 50 Mg Intravenous Solution 9 9 $10,784.00 $10,784.00 $2,868.00 $10,353.00 $10,245.00 2025-11-07
364SU278 CDM Femoral Stem Sz 9 Std Collar C 9 9 $10,500.00 $10,500.00 $1,680.00 $10,080.00 $9,975.00 2025-11-07
66984 CPT Removal Of Cataract With Insertion Of Lens 9 9 $10,045.00 $10,045.00 $1,607.00 $9,643.00 $9,543.00 2025-11-07
172799 CDM Immune Glob,gamm(igg) 10 %-pro-iga 0 To 50 Mcg/ml Intravenous Solution 9 9 $9,877.00 $9,877.00 $2,627.00 $9,482.00 $9,383.00 2025-11-07
Q4100 HCPCS Allo Adi Dermal Matrix Meshed 9 9 $9,738.00 $9,738.00 $1,558.00 $9,348.00 $9,251.00 2025-11-07
120051 CDM Kit Preparation Of Tc 99m-sestamibi Combo No.1 IV Solution 9 9 $9,600.00 $9,600.00 $2,553.00 $9,216.00 $9,120.00 2025-11-07
101010 CDM Collagenase Clostridium Histolyticum 0.9 Mg Solution For Injection 9 9 $9,179.00 $9,179.00 $2,441.00 $8,812.00 $8,720.00 2025-11-07
206169 CDM Eflapegrastim-xnst 13.2 Mg/0.6 Ml Subcutaneous Syringe 9 9 $9,091.00 $9,091.00 $2,418.00 $8,727.00 $8,636.00 2025-11-07
171445 CDM Pegfilgrastim 6 Mg/0.6 Ml (Deliverable) Wearable Subcutaneous Injector 9 9 $9,013.00 $9,013.00 $2,397.00 $8,652.00 $8,562.00 2025-11-07
32267 CDM Pegfilgrastim 6 Mg/0.6 Ml Subcutaneous Syringe 9 9 $9,013.00 $9,013.00 $2,397.00 $8,652.00 $8,562.00 2025-11-07
87861 CDM Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe 9 9 $9,005.00 $9,005.00 $2,395.00 $8,645.00 $8,555.00 2025-11-07
364SU270 CDM Kit Lead Tined, 28cm 9 9 $8,888.00 $8,888.00 $1,422.00 $8,532.00 $8,444.00 2025-11-07
364SU272 CDM Tibial Tray Rtng Pltfm Mbt Kee 9 9 $8,805.00 $8,805.00 $1,409.00 $8,453.00 $8,365.00 2025-11-07
63025 CPT Bezlotoxumab 25 Mg/ml Intravenous Solution 9 9 $8,345.00 $8,345.00 $1,335.00 $8,011.00 $7,928.00 2025-11-07
78063 CPT Secukinumab 150 Mg/ml Subcutaneous Pen Injector 9 9 $8,125.00 $8,125.00 $1,300.00 $7,800.00 $7,719.00 2025-11-07
188807 CDM Kit For The Prep Of Tc-99m-tilmanocept 250 Mcg Solution For Injection 9 9 $7,987.00 $7,987.00 $2,124.00 $7,668.00 $7,588.00 2025-11-07
170626 CDM Immune Glob G 40 Gram/400 Ml(10%)-gly-iga Ave 46 Mcg/ml Injection Soln 9 9 $7,725.00 $7,725.00 $2,054.00 $7,416.00 $7,339.00 2025-11-07
208591 CDM Aripiprazole ER (2 Month) 960 Mg/3.2 Ml Susp, Extended Rel IM Syringe 9 9 $7,526.00 $7,526.00 $2,001.00 $7,225.00 $7,150.00 2025-11-07
106804 CDM Denosumab 120 Mg/1.7 Ml (70 Mg/ml) Subcutaneous Solution 9 9 $7,443.00 $7,443.00 $1,979.00 $7,145.00 $7,071.00 2025-11-07
42820 CPT Removal Of Tonsils And Adenoid Glands, Patient Younger Than Age 12 9 9 $7,114.00 $7,114.00 $1,138.00 $6,829.00 $6,758.00 2025-11-07
74174 CPT Hc CT Angio, Abdomen And Pelvis W Contrast 9 9 $7,033.00 $7,033.00 $1,125.00 $6,752.00 $6,681.00 2025-11-07
94427 CPT Immune Glob,gamma (Igg) 10 %-gly-iga Over 50 Mcg/ml Injection Solution 9 9 $6,960.00 $6,960.00 $1,113.00 $6,682.00 $6,612.00 2025-11-07
96987 CDM Degarelix 120 Mg Subcutaneous Solution 9 9 $6,395.00 $6,395.00 $1,701.00 $6,139.00 $6,075.00 2025-11-07
93566 CDM Romiplostim 250 Mcg Subcutaneous Solution 9 9 $6,243.00 $6,243.00 $1,660.00 $5,993.00 $5,931.00 2025-11-07
7060003100 CDM Cc Surgery E <Base Rate> 9 9 $6,145.00 $6,145.00 $1,634.00 $5,899.00 $5,838.00 2025-11-07
28224 CDM Linezolid 600 Mg Tablet 9 9 $5,860.00 $5,860.00 $1,558.00 $5,626.00 $5,567.00 2025-11-07
9003 CDM Alteplase 50 Mg Intravenous Solution 9 9 $5,827.00 $5,827.00 $1,550.00 $5,594.00 $5,536.00 2025-11-07
C1787 HCPCS Smart Programmer Kit X 9 9 $5,800.00 $5,800.00 $928.00 $5,568.00 $5,510.00 2025-11-07
74178 CPT Hc CT Abd And Pelv Without And With Contrast 9 9 $5,700.00 $5,700.00 $912.00 $5,472.00 $5,415.00 2025-11-07
211259 CDM Pegfilgrastim-cbqv 6 Mg/0.6 Ml (Deliverable) Wearable Subcut Injector 9 9 $5,453.00 $5,453.00 $1,450.00 $5,235.00 $5,180.00 2025-11-07
28124 CPT Hc Part Remv Phalanx Of Toe 9 9 $5,400.00 $5,400.00 $864.00 $5,184.00 $5,130.00 2025-11-07
C1771 HCPCS Solyx Blue Sling System 9 9 $5,399.00 $5,399.00 $864.00 $5,183.00 $5,129.00 2025-11-07
116631 CDM Darbepoetin Alfa 300 Mcg/0.6 Ml In Polysorbate Injection Syringe 9 9 $5,164.00 $5,164.00 $1,373.00 $4,957.00 $4,906.00 2025-11-07
181491 CDM Aripiprazole Lauroxil ER 1,064 Mg/3.9 Ml Suspension,ext.rel IM Syringe 9 9 $5,020.00 $5,020.00 $1,335.00 $4,819.00 $4,769.00 2025-11-07
178685 CDM Ustekinumab 130 Mg/26 Ml Intravenous Solution 9 9 $4,931.00 $4,931.00 $1,311.00 $4,734.00 $4,684.00 2025-11-07
74177 CPT CT Scan Of Abdomen And Pelvis With Contrast 9 9 $4,900.00 $4,900.00 $784.00 $4,704.00 $4,655.00 2025-11-07
7050003100 CDM Cc Surgery D <Base Rate> 9 9 $4,826.00 $4,826.00 $1,283.00 $4,633.00 $4,585.00 2025-11-07
C8908 HCPCS Hc MRI Breast MRI Without & With Contrast Bilateral 9 9 $4,734.00 $4,734.00 $757.00 $4,545.00 $4,497.00 2025-11-07
77049 CPT Hc MRI Breast W&without Contrast W/cad Bilat 9 9 $4,734.00 $4,734.00 $757.00 $4,545.00 $4,497.00 2025-11-07
Q4160 HCPCS Nushield 4cm X 6cm 24 Sq Cm 9 9 $4,688.00 $4,688.00 $750.00 $4,500.00 $4,454.00 2025-11-07
119135 CDM Paliperidone Palmitate 234 Mg/1.5 Ml Intramuscular Syringe 9 9 $4,677.00 $4,677.00 $1,244.00 $4,490.00 $4,443.00 2025-11-07
72156 CPT Hc MRI Cervical Spine MRI Without & With Contrast 9 9 $4,664.00 $4,664.00 $746.00 $4,477.00 $4,431.00 2025-11-07
71552 CPT Hc MRI Chest Without And With Contrast 9 9 $4,664.00 $4,664.00 $746.00 $4,477.00 $4,431.00 2025-11-07
69032 CPT Pegfilgrastim-apgf 6 Mg/0.6 Ml Subcutaneous Syringe 9 9 $4,646.00 $4,646.00 $743.00 $4,460.00 $4,414.00 2025-11-07
95811 CPT Hc Comp Sleep Disorder Study W/init Cpap/bipap 9 9 $4,643.00 $4,643.00 $743.00 $4,457.00 $4,411.00 2025-11-07
78452 CPT Hc Myocardial Perfusion Spect Multi W/wm&ej 9 9 $4,638.00 $4,638.00 $742.00 $4,452.00 $4,406.00 2025-11-07
72157 CPT Hc MRI Thoracic Spine Without & With Contrast 9 9 $4,588.00 $4,588.00 $734.00 $4,404.00 $4,359.00 2025-11-07
75635 CPT Hc CT Angio Lower Ext Runoff 9 9 $4,586.00 $4,586.00 $734.00 $4,403.00 $4,357.00 2025-11-07
165470 CDM Golimumab 12.5 Mg/ml Intravenous Solution 9 9 $4,557.00 $4,557.00 $1,212.00 $4,375.00 $4,329.00 2025-11-07
78100 CPT Inclisiran 284 Mg/1.5 Ml Subcutaneous Syringe 9 9 $4,526.00 $4,526.00 $724.00 $4,345.00 $4,300.00 2025-11-07
41675 CDM Palivizumab 100 Mg/ml Intramuscular Solution 9 9 $4,511.00 $4,511.00 $1,200.00 $4,331.00 $4,285.00 2025-11-07
104604 CDM Rifaximin 550 Mg Tablet 9 9 $4,424.00 $4,424.00 $1,176.00 $4,247.00 $4,203.00 2025-11-07
72158 CPT Hc MRI Lumbar Spine Without & With Contrast 9 9 $4,420.00 $4,420.00 $707.00 $4,243.00 $4,199.00 2025-11-07
95810 CPT Sleep Study 9 9 $4,388.00 $4,388.00 $702.00 $4,212.00 $4,169.00 2025-11-07
29313 CDM Crotalidae Polyval Immune Fab Solution For Injection 9 9 $4,297.00 $4,297.00 $1,143.00 $4,125.00 $4,082.00 2025-11-07
105502 CDM Denosumab 60 Mg/ml Subcutaneous Syringe 9 9 $4,265.00 $4,265.00 $1,134.00 $4,094.00 $4,052.00 2025-11-07
78816 CPT Hc PET W/diagnostic CT Whole Body 9 9 $4,257.00 $4,257.00 $681.00 $4,087.00 $4,044.00 2025-11-07
Q4197 HCPCS Puraply Xt 4.91x4.91 Extra Fen 9 9 $4,250.00 $4,250.00 $680.00 $4,080.00 $4,038.00 2025-11-07
26070 CPT Cc Fb Hand 9 9 $4,249.00 $4,249.00 $680.00 $4,079.00 $4,037.00 2025-11-07
20240 CPT Hc Biopsy Bone Open Superficial 9 9 $4,238.00 $4,238.00 $678.00 $4,068.00 $4,026.00 2025-11-07
168835 CDM Hum Prothrombin Cplx, 4-factor 1,000 Unit (800-1,240 Unit) IV Solution 9 9 $4,222.00 $4,222.00 $1,123.00 $4,053.00 $4,011.00 2025-11-07
15240 CPT Hc Full Thick Grft Head,fac,hand <20sqc 9 9 $4,205.00 $4,205.00 $673.00 $4,037.00 $3,995.00 2025-11-07
74176 CPT Hc CT Abdomen And Pelvis Without Contrast 9 9 $4,200.00 $4,200.00 $672.00 $4,032.00 $3,990.00 2025-11-07
72142 CPT Hc MRI Cervical Spine MRI With Contrast 9 9 $4,197.00 $4,197.00 $671.00 $4,029.00 $3,987.00 2025-11-07
177927 CDM Carfilzomib 30 Mg Intravenous Solution 9 9 $4,191.00 $4,191.00 $1,114.00 $4,023.00 $3,981.00 2025-11-07
C8902 HCPCS Hc MRA Without Fol W/contrast Abdomen 9 9 $4,189.00 $4,189.00 $670.00 $4,021.00 $3,980.00 2025-11-07
174447 CDM Aripiprazole Lauroxil ER 882 Mg/3.2 Ml Suspension, Ext.rel. IM Syringe 9 9 $4,185.00 $4,185.00 $1,113.00 $4,018.00 $3,976.00 2025-11-07
81404 CPT Hc Molecular Path Proc Lvl 5 Sgdd4 9 9 $4,153.00 $4,153.00 $664.00 $3,987.00 $3,945.00 2025-11-07
25270 CPT Hc Reforearm Tend/musc,exten,prim,ea 9 9 $4,146.00 $4,146.00 $663.00 $3,980.00 $3,939.00 2025-11-07
25260 CPT Hc Repair Muscle,flexor, Forearm/wrist,single 9 9 $4,146.00 $4,146.00 $663.00 $3,980.00 $3,939.00 2025-11-07
189951 CDM Pegfilgrastim-cbqv 6 Mg/0.6 Ml Subcutaneous Syringe 9 9 $4,132.00 $4,132.00 $1,099.00 $3,967.00 $3,925.00 2025-11-07
9347 CDM Calcitonin (Salmon) 200 Unit/ml Injection Solution 9 9 $4,122.00 $4,122.00 $1,096.00 $3,957.00 $3,916.00 2025-11-07
27337 CPT Hc Exc Tumor,soft Tissue Thigh Or Knee 3cm Or Greater 9 9 $4,098.00 $4,098.00 $656.00 $3,934.00 $3,893.00 2025-11-07
107754 CDM Immune Glob G 20 Gram/200 Ml(10%)-gly-iga Ave 46 Mcg/ml Injection Soln 9 9 $4,081.00 $4,081.00 $1,085.00 $3,918.00 $3,877.00 2025-11-07
74181 CPT Hc MRI Abdomen Without Contrast 9 9 $4,044.00 $4,044.00 $647.00 $3,882.00 $3,842.00 2025-11-07
205769 CDM Pegfilgrastim-pbbk 6 Mg/0.6 Ml Subcutaneous Syringe 9 9 $4,030.00 $4,030.00 $1,072.00 $3,869.00 $3,829.00 2025-11-07
77048 CPT Hc MRI Breast W&without Contrast W/cad Unilat 9 9 $4,006.00 $4,006.00 $641.00 $3,846.00 $3,806.00 2025-11-07
38500 CPT Hc Biopsy/excision, Lymph Node(s) 9 9 $4,000.00 $4,000.00 $640.00 $3,840.00 $3,800.00 2025-11-07
74185 CPT Cc Mra; Abdomen W/wo Contrast 9 9 $3,990.00 $3,990.00 $638.00 $3,830.00 $3,791.00 2025-11-07
72191 CPT Hc CT Angio Pelvis 9 9 $3,962.00 $3,962.00 $634.00 $3,804.00 $3,764.00 2025-11-07
52234 CPT Cc Fac Cysto W/fulg Sm Bladder Tumor 9 9 $3,877.00 $3,877.00 $620.00 $3,722.00 $3,683.00 2025-11-07
52235 CPT Cc Np Cysto W/fulg, Treat Med Les 9 9 $3,877.00 $3,877.00 $620.00 $3,722.00 $3,683.00 2025-11-07
45382 CPT Cc Colonoscopy W/control Bleeding 9 9 $3,859.00 $3,859.00 $617.00 $3,705.00 $3,666.00 2025-11-07
74175 CPT Hc CT Angio Abdomen 9 9 $3,856.00 $3,856.00 $617.00 $3,702.00 $3,663.00 2025-11-07
170553 CDM Bortezomib 3.5 Mg Injection Powder For Solution (2.5 Mg/ml) 9 9 $3,839.00 $3,839.00 $1,021.00 $3,685.00 $3,647.00 2025-11-07
35839 CDM Bortezomib 3.5 Mg Injection Powder For Solution 9 9 $3,839.00 $3,839.00 $1,021.00 $3,685.00 $3,647.00 2025-11-07
171410 CDM Aripiprazole ER 400 Mg Suspension, Extended Rel.intramuscular Syringe 9 9 $3,832.00 $3,832.00 $1,019.00 $3,679.00 $3,640.00 2025-11-07
72146 CPT Hc MRI Thoracic Spine Without Contrast 9 9 $3,788.00 $3,788.00 $606.00 $3,636.00 $3,599.00 2025-11-07
186452 CDM Pegfilgrastim-jmdb 6 Mg/0.6 Ml Subcutaneous Syringe 9 9 $3,772.00 $3,772.00 $1,003.00 $3,621.00 $3,583.00 2025-11-07
C8901 HCPCS Hc Mra; Abdomen Wo Contrast 9 9 $3,770.00 $3,770.00 $603.00 $3,619.00 $3,582.00 2025-11-07
Q4159 HCPCS Affinity 2.5 X 2.5 9 9 $3,750.00 $3,750.00 $600.00 $3,600.00 $3,563.00 2025-11-07
181188 CDM Trastuzumab 150 Mg Intravenous Solution 9 9 $3,745.00 $3,745.00 $996.00 $3,595.00 $3,558.00 2025-11-07
54001 CPT Cc Hc Slitting Of Prepuce 9 9 $3,733.00 $3,733.00 $597.00 $3,584.00 $3,546.00 2025-11-07
72197 CPT Hc MRI Pelvis Without & With Contrast 9 9 $3,716.00 $3,716.00 $594.00 $3,567.00 $3,530.00 2025-11-07
70546 CPT Hc MRA Head Without Contrast Follow With Contrast 9 9 $3,707.00 $3,707.00 $593.00 $3,559.00 $3,522.00 2025-11-07
71555 CPT Cc Mra; Chest W Or Wo Contrast 9 9 $3,702.00 $3,702.00 $592.00 $3,554.00 $3,517.00 2025-11-07
71270 CPT Hc CT Thorax Without & With Contrast 9 9 $3,701.00 $3,701.00 $592.00 $3,553.00 $3,516.00 2025-11-07
70549 CPT Hc MRA Neck Without & With Contrast 9 9 $3,693.00 $3,693.00 $591.00 $3,545.00 $3,508.00 2025-11-07
70543 CPT Hc MRI Soft Tissue Neck Without And With Contrast 9 9 $3,693.00 $3,693.00 $591.00 $3,545.00 $3,508.00 2025-11-07
40475 CDM Paclitaxel Protein-bound 100 Mg Intravenous Suspension 9 9 $3,661.00 $3,661.00 $974.00 $3,515.00 $3,478.00 2025-11-07
36556 CPT Hc An Insert Non Tunneled Cv Cath 9 9 $3,650.00 $3,650.00 $584.00 $3,504.00 $3,468.00 2025-11-07
A2001 HCPCS IM Ac Placental Ecm 5x5 9 9 $3,648.00 $3,648.00 $584.00 $3,502.00 $3,466.00 2025-11-07
72147 CPT Hc MRI Thoracic Spine With Contrast 9 9 $3,627.00 $3,627.00 $580.00 $3,482.00 $3,446.00 2025-11-07
74182 CPT Hc MRI Abdomen W/contrast 9 9 $3,627.00 $3,627.00 $580.00 $3,482.00 $3,446.00 2025-11-07
C8920 HCPCS Hc MRA Pelvis With & Without Contrast 9 9 $3,627.00 $3,627.00 $580.00 $3,482.00 $3,446.00 2025-11-07
71275 CPT Hc CT Angio Chest 9 9 $3,600.00 $3,600.00 $576.00 $3,456.00 $3,420.00 2025-11-07
116630 CDM Darbepoetin Alfa 200 Mcg/0.4 Ml In Polysorbate Injection Syringe 9 9 $3,591.00 $3,591.00 $955.00 $3,447.00 $3,411.00 2025-11-07
72194 CPT Hc CT Pelvis Without & With Contrast 9 9 $3,546.00 $3,546.00 $567.00 $3,404.00 $3,369.00 2025-11-07
24182 CPT Baricitinib 2 Mg Tablet 9 9 $3,539.00 $3,539.00 $566.00 $3,397.00 $3,362.00 2025-11-07
70552 CPT Hc MRI Brain MRI With Contrast 9 9 $3,536.00 $3,536.00 $566.00 $3,395.00 $3,359.00 2025-11-07
70545 CPT Hc MRA Head With Contrast 9 9 $3,533.00 $3,533.00 $565.00 $3,392.00 $3,356.00 2025-11-07
71551 CPT Hc MRI Chest With Contrast 9 9 $3,525.00 $3,525.00 $564.00 $3,384.00 $3,349.00 2025-11-07
32187 CPT Abatacept (With Maltose) 250 Mg Intravenous Solution 9 9 $3,523.00 $3,523.00 $564.00 $3,382.00 $3,347.00 2025-11-07
52310 CPT Hc Remove Foreigh Body/stent Via Bladder, 9 9 $3,523.00 $3,523.00 $564.00 $3,382.00 $3,347.00 2025-11-07
72141 CPT Hc MRI Cervical Spine MRI Without Contrast 9 9 $3,500.00 $3,500.00 $560.00 $3,360.00 $3,325.00 2025-11-07
175183 CDM Bendamustine 25 Mg/ml Intravenous Solution 9 9 $3,491.00 $3,491.00 $928.00 $3,351.00 $3,316.00 2025-11-07
10631 CDM Mitomycin 40 Mg Intravenous Solution 9 9 $3,474.00 $3,474.00 $924.00 $3,335.00 $3,300.00 2025-11-07
77047 CPT Hc MRI Breast Without Contrast Bilat 9 9 $3,472.00 $3,472.00 $555.00 $3,333.00 $3,298.00 2025-11-07
90ROOM31 CDM Hc Room Nurs Tele Private 9 9 $3,458.00 $3,458.00 $553.00 $3,320.00 $3,285.00 2025-11-07
72149 CPT Hc MRI Lumbar Spine With Contrast 9 9 $3,447.00 $3,447.00 $551.00 $3,309.00 $3,275.00 2025-11-07
189520 CDM Omalizumab 150 Mg/ml Subcutaneous Syringe 9 9 $3,438.00 $3,438.00 $914.00 $3,300.00 $3,266.00 2025-11-07
36151 CDM Omalizumab 150 Mg Subcutaneous Solution 9 9 $3,438.00 $3,438.00 $914.00 $3,300.00 $3,266.00 2025-11-07
31032 CPT Factor Xa,inactivated-zhzo (Recombinant) 200 Mg Intravenous Solution 9 9 $3,410.00 $3,410.00 $546.00 $3,274.00 $3,240.00 2025-11-07
45334 CPT Cc Fac Sigmoidoscopy 9 9 $3,393.00 $3,393.00 $543.00 $3,257.00 $3,223.00 2025-11-07
44394 CPT Cc Fac Col/stoma Rem Tum/polyp By Snare 9 9 $3,393.00 $3,393.00 $543.00 $3,257.00 $3,223.00 2025-11-07
15275 CPT Hc Appl Skin Subs Scalp,mouth 1st 25 Sq Cm 9 9 $3,377.00 $3,377.00 $540.00 $3,242.00 $3,208.00 2025-11-07
15271 CPT Hc Appl Skin Subs Trunk, 1st 25 Sq Cm 9 9 $3,377.00 $3,377.00 $540.00 $3,242.00 $3,208.00 2025-11-07
15115 CPT Cc Epi Autogrft Fce Hnd Ft 1s 100 9 9 $3,377.00 $3,377.00 $540.00 $3,242.00 $3,208.00 2025-11-07
15110 CPT Cc Epi Auto Trnk,arm,leg 1st 100 9 9 $3,377.00 $3,377.00 $540.00 $3,242.00 $3,208.00 2025-11-07
72196 CPT Hc MRI Pelvis With Contrast 9 9 $3,370.00 $3,370.00 $539.00 $3,235.00 $3,202.00 2025-11-07
70551 CPT Hc MRI Brain MRI Without Contrast 9 9 $3,370.00 $3,370.00 $539.00 $3,235.00 $3,202.00 2025-11-07
70542 CPT Hc MRI Orbit Face Neck MRI With Contrast 9 9 $3,370.00 $3,370.00 $539.00 $3,235.00 $3,202.00 2025-11-07
72133 CPT Hc CT Lumbar Spine Without & With Contrast 9 9 $3,359.00 $3,359.00 $537.00 $3,225.00 $3,191.00 2025-11-07
70544 CPT Hc MRA Head Without Contrast 9 9 $3,357.00 $3,357.00 $537.00 $3,223.00 $3,189.00 2025-11-07
194093 CDM Romiplostim 125 Mcg Subcutaneous Solution 9 9 $3,352.00 $3,352.00 $891.00 $3,218.00 $3,184.00 2025-11-07
71550 CPT Hc MRI Chest Without Contrast 9 9 $3,348.00 $3,348.00 $536.00 $3,214.00 $3,181.00 2025-11-07
74170 CPT Hc CT Abdomen Without & With Contrast 9 9 $3,339.00 $3,339.00 $534.00 $3,205.00 $3,172.00 2025-11-07
72130 CPT Hc CT Thoracic Spine Without & With Contrast 9 9 $3,332.00 $3,332.00 $533.00 $3,199.00 $3,165.00 2025-11-07
70548 CPT Hc MRA Neck With Contrast 9 9 $3,235.00 $3,235.00 $518.00 $3,106.00 $3,073.00 2025-11-07
186480 CDM Aripiprazole Lauroxil,submic. ER 675 Mg/2.4 Ml Susp,ext.rel.im Syringe 9 9 $3,235.00 $3,235.00 $860.00 $3,106.00 $3,073.00 2025-11-07
C8929 HCPCS Hc Echo Complete W/color Flow Doppler With Cont 9 9 $3,226.00 $3,226.00 $516.00 $3,097.00 $3,065.00 2025-11-07
7040003100 CDM Cc Surgery C <Base Rate> 9 9 $3,226.00 $3,226.00 $858.00 $3,097.00 $3,065.00 2025-11-07
191214 CDM Romosozumab-aqqg 210 Mg/2.34 Ml(105 Mg/1.17 Ml X2)subcutaneous Syringe 9 9 $3,217.00 $3,217.00 $855.00 $3,088.00 $3,056.00 2025-11-07
191219 CDM Romosozumab-aqqg 105 Mg/1.17 Ml Subcutaneous Syringe 9 9 $3,217.00 $3,217.00 $855.00 $3,088.00 $3,056.00 2025-11-07
70540 CPT Hc MRI Orbit Face Neck MRI Without Contrast 9 9 $3,202.00 $3,202.00 $512.00 $3,074.00 $3,042.00 2025-11-07
72148 CPT MRI Scan Of Lower Spinal Canal 9 9 $3,200.00 $3,200.00 $512.00 $3,072.00 $3,040.00 2025-11-07
Q4101 HCPCS Apligraf 9 9 $3,188.00 $3,188.00 $510.00 $3,060.00 $3,029.00 2025-11-07
33772 CPT Nivolumab 40 Mg/4 Ml Intravenous Solution 9 9 $3,181.00 $3,181.00 $509.00 $3,054.00 $3,022.00 2025-11-07
174445 CDM Aripiprazole Lauroxil ER 662 Mg/2.4 Ml Suspension, Ext.rel. IM Syringe 9 9 $3,175.00 $3,175.00 $844.00 $3,048.00 $3,016.00 2025-11-07
70496 CPT Hc CT Angio Head 9 9 $3,167.00 $3,167.00 $507.00 $3,040.00 $3,009.00 2025-11-07
119134 CDM Paliperidone Palmitate 156 Mg/ml Intramuscular Syringe 9 9 $3,164.00 $3,164.00 $841.00 $3,037.00 $3,006.00 2025-11-07
119445 CDM Tocilizumab 200 Mg/10 Ml (20 Mg/ml) Intravenous Solution 9 9 $3,162.00 $3,162.00 $841.00 $3,036.00 $3,004.00 2025-11-07
72193 CPT CT Scan Of Pelvis With Contrast 9 9 $3,160.00 $3,160.00 $506.00 $3,034.00 $3,002.00 2025-11-07
78451 CPT Hc Myocardial Perfusion Spect Single W/wm&ej 9 9 $3,075.00 $3,075.00 $492.00 $2,952.00 $2,921.00 2025-11-07
70547 CPT Hc MRA Neck Without Contrast 9 9 $3,072.00 $3,072.00 $491.00 $2,949.00 $2,918.00 2025-11-07
21552 CPT Hc Exc Tumor Soft Tissue Neck/ant Thorax Subq +3cm 9 9 $3,000.00 $3,000.00 $480.00 $2,880.00 $2,850.00 2025-11-07
11044 CPT Hc Debride Skin,sq,muscle,bone,full 20 1st 20 Sqcm Or Less 9 9 $2,999.00 $2,999.00 $480.00 $2,879.00 $2,849.00 2025-11-07
44202 CPT Pr Laps Enterect Rescj 1 Small Intest Rescj & Ana 9 9 $2,979.00 $2,979.00 $477.00 $2,860.00 $2,830.00 2025-11-07
72129 CPT Hc CT Thoracic Spine With Contrast 9 9 $2,979.00 $2,979.00 $477.00 $2,860.00 $2,830.00 2025-11-07
72132 CPT Hc CT Lumbar Spine With Contrast 9 9 $2,973.00 $2,973.00 $476.00 $2,854.00 $2,824.00 2025-11-07
72195 CPT Hc MRI Pelvis Without Contrast 9 9 $2,954.00 $2,954.00 $473.00 $2,836.00 $2,806.00 2025-11-07
1030000021 CDM Cc Lens Procedure Operating Room 9 9 $2,943.00 $2,943.00 $783.00 $2,825.00 $2,796.00 2025-11-07
77046 CPT Hc MRI Breast Without Contrast Unilat 9 9 $2,938.00 $2,938.00 $470.00 $2,820.00 $2,791.00 2025-11-07
Q4106 HCPCS Dermagraft 9 9 $2,938.00 $2,938.00 $470.00 $2,820.00 $2,791.00 2025-11-07
70470 CPT Hc CT Head Without & With Contrast 9 9 $2,933.00 $2,933.00 $469.00 $2,816.00 $2,786.00 2025-11-07
41805 CPT Cc Removal Foreign Body, Gum 9 9 $2,926.00 $2,926.00 $468.00 $2,809.00 $2,780.00 2025-11-07
70482 CPT Hc CT Orbit,sella,po-fos, Ear Without & With Contrast 9 9 $2,909.00 $2,909.00 $465.00 $2,793.00 $2,764.00 2025-11-07
72127 CPT Hc CT Cervical Spine Without & With Contrast 9 9 $2,909.00 $2,909.00 $465.00 $2,793.00 $2,764.00 2025-11-07
164460 CDM Aripiprazole ER 300 Mg Intramuscular Suspension,extended Release 9 9 $2,908.00 $2,908.00 $773.00 $2,792.00 $2,763.00 2025-11-07
171408 CDM Aripiprazole ER 300 Mg Suspension, Extended Rel. Intramuscular Syringe 9 9 $2,908.00 $2,908.00 $773.00 $2,792.00 $2,763.00 2025-11-07
54150 CPT Hc Circumcision Clamp Newborn 9 9 $2,896.00 $2,896.00 $463.00 $2,780.00 $2,751.00 2025-11-07
44388 CPT Cc Fac Colonoscopy Thru Stoma; Diagnostic 9 9 $2,885.00 $2,885.00 $462.00 $2,770.00 $2,741.00 2025-11-07
35207 CPT Cc Fac Repair Blood Vessel Hand 9 9 $2,862.00 $2,862.00 $458.00 $2,748.00 $2,719.00 2025-11-07
70336 CPT Hc MRI Temporomandibular Joint 9 9 $2,852.00 $2,852.00 $456.00 $2,738.00 $2,709.00 2025-11-07
19283 CPT Hc Plcmt Breast Local Device First Lesion Incl Stertac Guid 9 9 $2,838.00 $2,838.00 $454.00 $2,724.00 $2,696.00 2025-11-07
19081 CPT Hc Biop Breast With Dvce Plcmt First Lesion Incl Stertac Guid 9 9 $2,838.00 $2,838.00 $454.00 $2,724.00 $2,696.00 2025-11-07
78473 CPT Hc Gated Heart Muga Exercise Study 9 9 $2,825.00 $2,825.00 $452.00 $2,712.00 $2,684.00 2025-11-07
11438 CDM Succimer 100 Mg Capsule 9 9 $2,822.00 $2,822.00 $750.00 $2,709.00 $2,681.00 2025-11-07
78320 CPT Hc Bone Imaging Spect 9 9 $2,807.00 $2,807.00 $449.00 $2,695.00 $2,667.00 2025-11-07
23796 CDM Infliximab 100 Mg Intravenous Solution 9 9 $2,800.00 $2,800.00 $745.00 $2,688.00 $2,660.00 2025-11-07
70488 CPT Hc CT Maxillofacial Without & W Contrast 9 9 $2,796.00 $2,796.00 $447.00 $2,684.00 $2,656.00 2025-11-07
70498 CPT Hc CT Angio Neck 9 9 $2,796.00 $2,796.00 $447.00 $2,684.00 $2,656.00 2025-11-07
71260 CPT Hc CT Thorax With Contrast 9 9 $2,794.00 $2,794.00 $447.00 $2,682.00 $2,654.00 2025-11-07
74160 CPT Hc CT Abdomen With Contrast 9 9 $2,786.00 $2,786.00 $446.00 $2,675.00 $2,647.00 2025-11-07
72128 CPT Hc CT Thoracic Spine Without Contrast 9 9 $2,767.00 $2,767.00 $443.00 $2,656.00 $2,629.00 2025-11-07
72126 CPT Hc CT Cervical Spine With Contrast 9 9 $2,728.00 $2,728.00 $436.00 $2,619.00 $2,592.00 2025-11-07
72192 CPT Hc CT Pelvis Without Contrast 9 9 $2,725.00 $2,725.00 $436.00 $2,616.00 $2,589.00 2025-11-07
74150 CPT Hc CT Abdomen Without Contrast 9 9 $2,725.00 $2,725.00 $436.00 $2,616.00 $2,589.00 2025-11-07
45331 CPT Cc Fac Sigmoidoscopy Flexible With Biopsy 9 9 $2,689.00 $2,689.00 $430.00 $2,581.00 $2,555.00 2025-11-07
28232 CPT Cc Incision Of Toe Tendon 9 9 $2,680.00 $2,680.00 $429.00 $2,573.00 $2,546.00 2025-11-07
27762 CPT Hc Closed Tx Medial Malleolus Fx W/manip 9 9 $2,680.00 $2,680.00 $429.00 $2,573.00 $2,546.00 2025-11-07
72125 CPT Hc CT Cervical Spine Without Contrast 9 9 $2,670.00 $2,670.00 $427.00 $2,563.00 $2,537.00 2025-11-07
60227 CPT Raltegravir 400 Mg Tablet 9 9 $2,669.00 $2,669.00 $427.00 $2,562.00 $2,536.00 2025-11-07
27327 CPT Hc Exc Tumor,soft Tissue Thigh Or Knee,sq Less Than 3cm 9 9 $2,662.00 $2,662.00 $426.00 $2,556.00 $2,529.00 2025-11-07
71250 CPT Hc CT Thorax Without Contrast 9 9 $2,638.00 $2,638.00 $422.00 $2,532.00 $2,506.00 2025-11-07
72131 CPT Hc CT Lumbar Spine Without Contrast 9 9 $2,635.00 $2,635.00 $422.00 $2,530.00 $2,503.00 2025-11-07
52281 CPT Cc Cystoscopy,dil Urethral Stricture 9 9 $2,627.00 $2,627.00 $420.00 $2,522.00 $2,496.00 2025-11-07
70460 CPT Hc CT Head With Contrast 9 9 $2,612.00 $2,612.00 $418.00 $2,508.00 $2,481.00 2025-11-07
78608 CPT Hc PET Brain Metabolism 9 9 $2,607.00 $2,607.00 $417.00 $2,503.00 $2,477.00 2025-11-07
93306 CPT Hc Echo Av Opt 9 9 $2,581.00 $2,581.00 $413.00 $2,478.00 $2,452.00 2025-11-07
36569 CPT Hc Insert Periph Inserted Cv Cath 5yrs Or Older 9 9 $2,561.00 $2,561.00 $410.00 $2,459.00 $2,433.00 2025-11-07
31045 CPT Durvalumab 50 Mg/ml Intravenous Solution 9 9 $2,558.00 $2,558.00 $409.00 $2,456.00 $2,430.00 2025-11-07
10778 CDM Ondansetron Hcl 4 Mg Tablet 9 9 $2,557.00 $2,557.00 $680.00 $2,455.00 $2,429.00 2025-11-07
151693 CDM Rivaroxaban 10 Mg Tablet 9 9 $2,555.00 $2,555.00 $679.00 $2,453.00 $2,427.00 2025-11-07
27266 CPT Hc Closed Tx Post Hip Athro Disloc W/anes 9 9 $2,555.00 $2,555.00 $409.00 $2,453.00 $2,427.00 2025-11-07
154556 CDM Rivaroxaban 15 Mg Tablet 9 9 $2,555.00 $2,555.00 $679.00 $2,453.00 $2,427.00 2025-11-07
33009 CDM Voriconazole 200 Mg Tablet 9 9 $2,548.00 $2,548.00 $678.00 $2,446.00 $2,421.00 2025-11-07
168716 CDM Dalbavancin 500 Mg Intravenous Solution 9 9 $2,493.00 $2,493.00 $663.00 $2,393.00 $2,368.00 2025-11-07
28011 CPT Hc Incision Subcut Toe Multiple Tendon 9 9 $2,490.00 $2,490.00 $398.00 $2,390.00 $2,366.00 2025-11-07
70492 CPT Hc CT Soft Tissue Neck Without & With Contrast 9 9 $2,489.00 $2,489.00 $398.00 $2,389.00 $2,365.00 2025-11-07
58280 CPT Pr Vag Hyster W/tot/prtl Vaginect W/rpr Enterocele 9 9 $2,473.00 $2,473.00 $396.00 $2,374.00 $2,349.00 2025-11-07
23655 CPT Hc Closed Tx Shoulder Disloc W/manip W/anes 9 9 $2,470.00 $2,470.00 $395.00 $2,371.00 $2,347.00 2025-11-07
30371 CPT Belatacept 250 Mg Intravenous Solution 9 9 $2,468.00 $2,468.00 $395.00 $2,369.00 $2,345.00 2025-11-07
28192 CPT Hc Removal Fb Foot, Deep 9 9 $2,462.00 $2,462.00 $394.00 $2,364.00 $2,339.00 2025-11-07
10121 CPT Cc Remove Foreign Body Complicatd 9 9 $2,462.00 $2,462.00 $394.00 $2,364.00 $2,339.00 2025-11-07
G0121 HCPCS Cc Hc Colon Ca Scrn Not Hi Rsk Ind 9 9 $2,460.00 $2,460.00 $394.00 $2,362.00 $2,337.00 2025-11-07
G0105 HCPCS Cc Hc Colorectal Scrn; Hi Risk Ind 9 9 $2,460.00 $2,460.00 $394.00 $2,362.00 $2,337.00 2025-11-07
45330 CPT Cc Flexible Sigmoidoscopy Procedure 9 9 $2,460.00 $2,460.00 $394.00 $2,362.00 $2,337.00 2025-11-07
87903 CPT Cc Pheno Infect Agent Drug Resist 1-10 9 9 $2,454.00 $2,454.00 $393.00 $2,356.00 $2,331.00 2025-11-07
115944 CDM Palivizumab 50 Mg/0.5 Ml Intramuscular Solution 9 9 $2,453.00 $2,453.00 $652.00 $2,355.00 $2,330.00 2025-11-07
50200 CPT Hc Renal Biopsy,perq Needle 9 9 $2,440.00 $2,440.00 $390.00 $2,342.00 $2,318.00 2025-11-07
41010 CPT Hc Incision Of Tongue Fold 9 9 $2,418.00 $2,418.00 $387.00 $2,321.00 $2,297.00 2025-11-07
70491 CPT Hc CT Soft Tissue Neck With Contrast 9 9 $2,414.00 $2,414.00 $386.00 $2,317.00 $2,293.00 2025-11-07
70481 CPT Hc CT Orbit, Sella, Po-fos, Ear With Contrast 9 9 $2,410.00 $2,410.00 $386.00 $2,314.00 $2,290.00 2025-11-07
119133 CDM Paliperidone Palmitate 117 Mg/0.75 Ml Intramuscular Syringe 9 9 $2,407.00 $2,407.00 $640.00 $2,311.00 $2,287.00 2025-11-07
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