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Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

WALLOWA MEMORIAL HOSPITAL

Enterprise, OR · CCN 381306 · Rates published

5,314 distinct procedures filed
15 distinct payers
60,241 rate rows
2026-07-17 last MRF observed
Data quality

59,319 of 60,241 rate rows are consumer-grade (98.5%)

922 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 410
per-diem day rate — not a per-procedure price 282
placeholder amount (≤ $0.02) — excluded from medians 99
exceeds 10× this hospital's gross charge — excluded from medians 81
percent-of-charges filed in the dollar field — excluded from medians 36
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 14
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbWCHCENTERPRISEOR&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/Wallowa_County_Health.aspx
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-13
Content fingerprint 9427321d3becae8b… · 6,737,660 bytes · first seen 2026-07-17

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
J2350
HCPCS 		Ocrelizumab 300 Mg/10ml IV Soln 8 $31,353.52 $32,343.63 $31,353.52 nat. median
$133
outlier · 235.8×
J9144
HCPCS 		Daratumumab-hyaluronidase-fihj 1800-30000 Mg-ut/15ml Subq Soln 8 $18,877.98 $19,474.13 $18,877.98 nat. median
$114
outlier · 164.9×
J9022
HCPCS 		Atezolizumab 1200 Mg/20ml IV Soln 8 $12,284.34 $22,044.25 $17,020.84 nat. median
$1,229
outlier · 13.9×
J3380
HCPCS 		Vedolizumab 300 Mg IV Solr 8 $16,973.56 $17,509.56 $16,973.56 nat. median
$59
outlier · 288.6×
J9301
HCPCS 		Obinutuzumab 1000 Mg/40ml IV Soln 8 $16,146.50 $16,656.39 $16,146.50 nat. median
$170
outlier · 95.1×
J9223
HCPCS 		Lurbinectedin 4 Mg IV Solr 8 $15,734.00 $16,230.86 $15,734.00 nat. median
$452
outlier · 34.8×
J9228
HCPCS 		Ipilimumab 50 Mg/10ml IV Soln 8 $15,675.86 $16,170.89 $15,675.86 nat. median
$6,073
outlier · 2.6×
J2323
HCPCS 		Natalizumab 300 Mg/15ml IV Conc 8 $14,860.77 $15,330.06 $14,860.77 nat. median
$50
outlier · 294.6×
J9042
HCPCS 		Brentuximab Vedotin 50 Mg IV Solr 8 $14,340.81 $14,793.68 $14,340.81 nat. median
$555
outlier · 25.8×
32994
CPT 		Hc Pr 32994 Ablate Pulm Tumor Perq Crybl 8 $14,273.75 $14,724.50 $14,273.75 nat. median
$10,042
1.4× median
J0896
HCPCS 		Luspatercept-aamt 25 Mg Subq Solr 8 $6,350.98 $19,654.56 $12,802.22 nat. median
$228
outlier · 56.2×
J9311
HCPCS 		Rituximab-hyaluronidase Human 1600-26800 Mg -ut/13.4ml Subq Soln 8 $12,074.25 $12,455.55 $12,074.25 nat. median
$79
outlier · 153.1×
J9306
HCPCS 		Pertuzumab 420 Mg/14ml IV Soln 8 $11,755.88 $12,127.12 $11,755.88 nat. median
$43
outlier · 275.5×
31298
CPT 		Hc Pr 31298 Nasal/Sinus Ndsc W/Sins Dilat 8 $8,949.95 $9,232.58 $8,949.95 nat. median
$6,943
1.3× median
43288
CPT 		Hc Pr 43288 Esphg Thrsc Moblj 8 $8,842.60 $9,121.84 $8,842.60 nat. median
$6,391
1.4× median
J9308
HCPCS 		Ramucirumab 100 Mg/10ml IV Soln 8 $2,934.55 $14,732.30 $8,654.26 nat. median
$300
outlier · 28.9×
55874
CPT 		Hc Pr 55874 Tprnl Plmt Biodegrdabl Matrl W/Img Guidance 8 $8,594.65 $8,866.06 $8,594.65 nat. median
$5,364
1.6× median
43287
CPT 		Hc Pr 43287 Esphg Dstl 2/3 W/Laps Moblj 8 $8,474.00 $8,741.60 $8,474.00 nat. median
$6,315
1.3× median
J0517
HCPCS 		Benralizumab 30 Mg/ml Subq Sosy 8 $8,070.70 $8,325.56 $8,070.70 nat. median
$404
outlier · 20.0×
J1162
HCPCS 		Digoxin Immune Fab 40 Mg IV Solr 8 $7,937.93 $8,188.61 $7,937.93 nat. median
$6,265
1.3× median
J9299
HCPCS 		Nivolumab 100 Mg/10ml IV Soln 8 $6,292.12 $15,436.72 $7,530.96 nat. median
$1,811
outlier · 4.2×
43286
CPT 		Hc Pr 43286 Esphg Tot W/Laps Moblj 8 $7,419.50 $7,653.80 $7,419.50 nat. median
$5,887
1.3× median
45388
CPT 		Hc Pr 45388 Colonoscopy W/Ablation 8 $7,192.45 $7,419.58 $7,192.45 nat. median
$1,618
outlier · 4.4×
J2997
HCPCS 		Alteplase 100 Mg IV Solr 8 $514.17 $13,437.62 $6,778.34 nat. median
$428
outlier · 15.8×
J2353
HCPCS 		Octreotide Acetate 10 Mg IM Kit 8 $5,789.07 $10,449.51 $6,764.70 nat. median
$1,956
outlier · 3.5×
J2182
HCPCS 		Mepolizumab 100 Mg/ml Subq Sosy 8 $6,644.23 $6,854.05 $6,644.23 nat. median
$80
outlier · 83.4×
J1950
HCPCS 		Leuprolide Acetate (3 Month) 11.25 Mg IM Kit 8 $6,576.18 $6,783.84 $6,576.18 nat. median
$3,343
2.0× median
J2506
HCPCS 		Pegfilgrastim 6 Mg/0.6ml Subq Sosy 8 $6,364.85 $6,565.84 $6,364.85 nat. median
$916
outlier · 7.0×
59510
CPT 		Hc Pr 59510 Total OB/Cesarean Delivery/Pp Car 8 $6,312.75 $6,512.10 $6,312.75 nat. median
$3,349
1.9× median
36010152
CDM 		Operating Room Services - General Classification 6 $6,173.57 $6,624.00 $6,292.80 —
J9352
HCPCS 		Trabectedin 1 Mg IV Solr 8 $6,210.42 $6,406.53 $6,210.42 nat. median
$779
outlier · 8.0×
J0565
HCPCS 		Bezlotoxumab 1000 Mg/40ml IV Soln 8 $6,104.46 $6,297.24 $6,104.46 nat. median
$121
outlier · 50.6×
3253621WWM
CDM 		Hc Or Allograft P.l.#0741531 6 $5,905.15 $6,336.00 $6,019.20 —
33927
CPT 		Hc Pr 33927 Impltj Tot Rplcmt Hrt Sys 8 $6,016.35 $6,206.34 $6,016.35 nat. median
$5,395
1.1× median
20610001
CDM 		Intensive Care Unit - Intermediate ICU 5 $5,752.25 $6,055.00 $5,873.35 —
17310001
CDM 		Nursery - Newborn - Level Iii 5 $5,686.70 $5,986.00 $5,806.42 —
0173
RC 		8 $5,686.70 $5,866.28 $5,686.70 nat. median
$4,400
1.3× median
59400
CPT 		Hc Pr 59400 Total OB/Vaginal Delivery/Pp Care 8 $5,677.20 $5,856.48 $5,677.20 nat. median
$2,933
1.9× median
J9312
HCPCS 		Rituximab 100 Mg/10ml IV Soln 8 $1,927.29 $9,537.02 $5,616.61 nat. median
$739
outlier · 7.6×
36010151
CDM 		Operating Room Services - General Classification 6 $5,506.26 $5,908.00 $5,612.60 —
J9145
HCPCS 		Daratumumab 400 Mg/20ml IV Soln 8 $5,609.20 $5,786.33 $5,609.20 nat. median
$1,066
outlier · 5.3×
J9358
HCPCS 		Fam-trastuzumab Deruxtec-nxki 100 Mg IV Solr 8 $5,566.35 $5,742.13 $5,566.35 nat. median
$67
outlier · 83.0×
29999
CPT 		Hc Pr 29999 Arthroscopy Of Joint 8 $5,461.55 $5,634.02 $5,461.55 nat. median
$842
outlier · 6.5×
12010011
CDM 		Room & Board - Semi-private (two Beds) - General Classification 5 $5,339.00 $5,620.00 $5,451.40 —
Q5115
HCPCS 		Rituximab-abbs 500 Mg/50ml IV Soln 8 $5,028.32 $5,187.11 $5,028.32 nat. median
$368
outlier · 13.7×
Q5119
HCPCS 		Rituximab-pvvr 500 Mg/50ml IV Soln 8 $4,984.88 $5,142.30 $4,984.88 nat. median
$318
outlier · 15.7×
0206
RC 		8 $4,259.80 $5,705.56 $4,962.61 nat. median
$3,135
1.6× median
36010150
CDM 		Operating Room Services - General Classification 6 $4,838.94 $5,192.00 $4,932.40 —
J3590
HCPCS 		Dulaglutide 0.75 Mg/0.5ml Subq Soaj 8 $712.43 $9,115.85 $4,785.86 nat. median
$1,549
outlier · 3.1×
20610002
CDM 		Intensive Care Unit - Intermediate ICU 5 $4,621.75 $4,865.00 $4,719.05 —

Other procedures at this hospital

Browse this hospital's 5,314 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
             
J2350 HCPCS Ocrelizumab 300 Mg/10ml IV Soln 9 8 $33,003.70 $29,703.33 $31,353.52 $32,343.63 $31,353.52 2026-07-17
J9144 HCPCS Daratumumab-hyaluronidase-fihj 1800-30000 Mg-ut/15ml Subq Soln 9 8 $19,871.56 $17,884.40 $18,877.98 $19,474.13 $18,877.98 2026-07-17
J9022 HCPCS Atezolizumab 1200 Mg/20ml IV Soln 18 8 $17,712.51 $15,941.26 $12,284.34 $22,044.25 $17,020.84 2026-07-17
J3380 HCPCS Vedolizumab 300 Mg IV Solr 9 8 $17,866.90 $16,080.21 $16,973.56 $17,509.56 $16,973.56 2026-07-17
J9301 HCPCS Obinutuzumab 1000 Mg/40ml IV Soln 9 8 $16,996.32 $15,296.69 $16,146.50 $16,656.39 $16,146.50 2026-07-17
J9223 HCPCS Lurbinectedin 4 Mg IV Solr 9 8 $16,562.10 $14,905.89 $15,734.00 $16,230.86 $15,734.00 2026-07-17
J9228 HCPCS Ipilimumab 50 Mg/10ml IV Soln 9 8 $16,500.91 $14,850.82 $15,675.86 $16,170.89 $15,675.86 2026-07-17
J2323 HCPCS Natalizumab 300 Mg/15ml IV Conc 9 8 $15,642.92 $14,078.63 $14,860.77 $15,330.06 $14,860.77 2026-07-17
J9042 HCPCS Brentuximab Vedotin 50 Mg IV Solr 9 8 $15,095.59 $13,586.03 $14,340.81 $14,793.68 $14,340.81 2026-07-17
32994 CPT Hc Pr 32994 Ablate Pulm Tumor Perq Crybl 9 8 $15,025.00 $13,522.50 $14,273.75 $14,724.50 $14,273.75 2026-07-17
J0896 HCPCS Luspatercept-aamt 25 Mg Subq Solr 18 8 $13,370.45 $12,033.41 $6,350.98 $19,654.56 $12,802.22 2026-07-17
J9311 HCPCS Rituximab-hyaluronidase Human 1600-26800 Mg -ut/13.4ml Subq Soln 9 8 $12,709.74 $11,438.77 $12,074.25 $12,455.55 $12,074.25 2026-07-17
J9306 HCPCS Pertuzumab 420 Mg/14ml IV Soln 9 8 $12,374.61 $11,137.15 $11,755.88 $12,127.12 $11,755.88 2026-07-17
31298 CPT Hc Pr 31298 Nasal/Sinus Ndsc W/Sins Dilat 9 8 $9,421.00 $8,478.90 $8,949.95 $9,232.58 $8,949.95 2026-07-17
43288 CPT Hc Pr 43288 Esphg Thrsc Moblj 9 8 $9,308.00 $8,377.20 $8,842.60 $9,121.84 $8,842.60 2026-07-17
J9308 HCPCS Ramucirumab 100 Mg/10ml IV Soln 18 8 $9,060.98 $8,154.88 $2,934.55 $14,732.30 $8,654.26 2026-07-17
55874 CPT Hc Pr 55874 Tprnl Plmt Biodegrdabl Matrl W/Img Guidance 9 8 $9,047.00 $8,142.30 $8,594.65 $8,866.06 $8,594.65 2026-07-17
43287 CPT Hc Pr 43287 Esphg Dstl 2/3 W/Laps Moblj 9 8 $8,920.00 $8,028.00 $8,474.00 $8,741.60 $8,474.00 2026-07-17
J0517 HCPCS Benralizumab 30 Mg/ml Subq Sosy 9 8 $8,495.47 $7,645.92 $8,070.70 $8,325.56 $8,070.70 2026-07-17
J1162 HCPCS Digoxin Immune Fab 40 Mg IV Solr 9 8 $8,355.72 $7,520.15 $7,937.93 $8,188.61 $7,937.93 2026-07-17
J9299 HCPCS Nivolumab 100 Mg/10ml IV Soln 27 8 $7,927.33 $7,134.60 $6,292.12 $15,436.72 $7,530.96 2026-07-17
43286 CPT Hc Pr 43286 Esphg Tot W/Laps Moblj 9 8 $7,810.00 $7,029.00 $7,419.50 $7,653.80 $7,419.50 2026-07-17
45388 CPT Hc Pr 45388 Colonoscopy W/Ablation 9 8 $7,571.00 $6,813.90 $7,192.45 $7,419.58 $7,192.45 2026-07-17
J2997 HCPCS Alteplase 100 Mg IV Solr 18 8 $7,126.55 $6,413.89 $514.17 $13,437.62 $6,778.34 2026-07-17
J2353 HCPCS Octreotide Acetate 10 Mg IM Kit 27 8 $7,120.74 $6,408.67 $5,789.07 $10,449.51 $6,764.70 2026-07-17
J2182 HCPCS Mepolizumab 100 Mg/ml Subq Sosy 9 8 $6,993.93 $6,294.54 $6,644.23 $6,854.05 $6,644.23 2026-07-17
J1950 HCPCS Leuprolide Acetate (3 Month) 11.25 Mg IM Kit 9 8 $6,922.29 $6,230.06 $6,576.18 $6,783.84 $6,576.18 2026-07-17
J2506 HCPCS Pegfilgrastim 6 Mg/0.6ml Subq Sosy 9 8 $6,699.84 $6,029.86 $6,364.85 $6,565.84 $6,364.85 2026-07-17
59510 CPT Hc Pr 59510 Total OB/Cesarean Delivery/Pp Car 9 8 $6,645.00 $5,980.50 $6,312.75 $6,512.10 $6,312.75 2026-07-17
36010152 CDM Operating Room Services - General Classification 6 6 $6,624.00 $6,624.00 $6,173.57 $6,624.00 $6,292.80 2026-07-09
J9352 HCPCS Trabectedin 1 Mg IV Solr 9 8 $6,537.28 $5,883.55 $6,210.42 $6,406.53 $6,210.42 2026-07-17
J0565 HCPCS Bezlotoxumab 1000 Mg/40ml IV Soln 9 8 $6,425.75 $5,783.18 $6,104.46 $6,297.24 $6,104.46 2026-07-17
3253621WWM CDM Hc Or Allograft P.l.#0741531 6 6 $6,336.00 $6,336.00 $5,905.15 $6,336.00 $6,019.20 2026-07-09
33927 CPT Hc Pr 33927 Impltj Tot Rplcmt Hrt Sys 9 8 $6,333.00 $5,699.70 $6,016.35 $6,206.34 $6,016.35 2026-07-17
20610001 CDM Intensive Care Unit - Intermediate ICU 5 5 $6,055.00 $6,055.00 $5,752.25 $6,055.00 $5,873.35 2026-07-09
17310001 CDM Nursery - Newborn - Level Iii 5 5 $5,986.00 $5,986.00 $5,686.70 $5,986.00 $5,806.42 2026-07-09
0173 RC — 9 8 $5,986.00 $5,387.40 $5,686.70 $5,866.28 $5,686.70 2026-07-17
59400 CPT Hc Pr 59400 Total OB/Vaginal Delivery/Pp Care 9 8 $5,976.00 $5,378.40 $5,677.20 $5,856.48 $5,677.20 2026-07-17
J9312 HCPCS Rituximab 100 Mg/10ml IV Soln 18 8 $5,880.19 $5,292.18 $1,927.29 $9,537.02 $5,616.61 2026-07-17
36010151 CDM Operating Room Services - General Classification 6 6 $5,908.00 $5,908.00 $5,506.26 $5,908.00 $5,612.60 2026-07-09
J9145 HCPCS Daratumumab 400 Mg/20ml IV Soln 9 8 $5,904.42 $5,313.98 $5,609.20 $5,786.33 $5,609.20 2026-07-17
J9358 HCPCS Fam-trastuzumab Deruxtec-nxki 100 Mg IV Solr 9 8 $5,859.32 $5,273.39 $5,566.35 $5,742.13 $5,566.35 2026-07-17
29999 CPT Hc Pr 29999 Arthroscopy Of Joint 9 8 $5,749.00 $5,174.10 $5,461.55 $5,634.02 $5,461.55 2026-07-17
12010011 CDM Room & Board - Semi-private (two Beds) - General Classification 5 5 $5,620.00 $5,620.00 $5,339.00 $5,620.00 $5,451.40 2026-07-09
Q5115 HCPCS Rituximab-abbs 500 Mg/50ml IV Soln 9 8 $5,292.97 $4,763.67 $5,028.32 $5,187.11 $5,028.32 2026-07-17
Q5119 HCPCS Rituximab-pvvr 500 Mg/50ml IV Soln 9 8 $5,247.24 $4,722.52 $4,984.88 $5,142.30 $4,984.88 2026-07-17
0206 RC — 18 8 $5,153.00 $4,637.70 $4,259.80 $5,705.56 $4,962.61 2026-07-17
36010150 CDM Operating Room Services - General Classification 6 6 $5,192.00 $5,192.00 $4,838.94 $5,192.00 $4,932.40 2026-07-09
J3590 HCPCS Dulaglutide 0.75 Mg/0.5ml Subq Soaj 18 8 $5,025.91 $4,523.32 $712.43 $9,115.85 $4,785.86 2026-07-17
20610002 CDM Intensive Care Unit - Intermediate ICU 5 5 $4,865.00 $4,865.00 $4,621.75 $4,865.00 $4,719.05 2026-07-09
J0897 HCPCS Denosumab 120 Mg/1.7ml Subq Soln 18 8 $4,826.51 $4,343.86 $3,718.30 $5,624.25 $4,643.90 2026-07-17
81162 HCPCS Gene Analysis (breast Cancer 1 And 2) Of Full Sequence And Analysis For Duplicat… 6 6 $4,797.00 $4,797.00 $4,470.80 $4,797.00 $4,557.15 2026-07-09
3253689WWM CDM Hc Or Graft 8 Layer 13x15 6 6 $4,796.00 $4,796.00 $4,469.87 $4,796.00 $4,556.20 2026-07-09
J9177 HCPCS Enfortumab Vedotin-ejfv 20 Mg IV Solr 9 8 $4,770.18 $4,293.16 $4,531.67 $4,674.78 $4,531.67 2026-07-17
58575 CPT Hc Pr 58575 Laps Tot Hyst Resj Mal 9 8 $4,766.00 $4,289.40 $4,527.70 $4,670.68 $4,527.70 2026-07-17
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 6 6 $4,756.00 $4,756.00 $4,432.59 $4,756.00 $4,518.20 2026-07-09
C9482 HCPCS Sotalol Hcl 150 Mg/10ml IV Soln 9 8 $4,717.18 $4,245.46 $4,481.32 $4,622.84 $4,481.32 2026-07-17
3253630WWM CDM Hc Or Allograft Pl 6 6 $4,716.00 $4,716.00 $4,395.31 $4,716.00 $4,480.20 2026-07-09
3253637WWM CDM Hc Or Allograft Btb 17817000 6 6 $4,716.00 $4,716.00 $4,395.31 $4,716.00 $4,480.20 2026-07-09
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 6 6 $4,694.00 $4,694.00 $4,374.81 $4,694.00 $4,459.30 2026-07-09
44180 CPT Hc Pr 44180 Laparoscopy Enterolysis 9 8 $4,646.00 $4,181.40 $4,413.70 $4,553.08 $4,413.70 2026-07-17
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 6 6 $4,638.00 $4,638.00 $4,322.62 $4,638.00 $4,406.10 2026-07-09
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 6 6 $4,638.00 $4,638.00 $4,322.62 $4,638.00 $4,406.10 2026-07-09
70471 HCPCS Computed Tomographic Angiography (cta), Head And Neck, With Contrast Material(s)… 6 6 $4,614.00 $4,614.00 $4,300.25 $4,614.00 $4,383.30 2026-07-09
81162 CPT Gene Analysis (breast Cancer 1, 2) Full Sequence 9 8 $4,612.00 $4,150.80 $4,381.40 $4,519.76 $4,381.40 2026-07-17
70549 CPT MRI Scan Of Blood Vessels Of Neck Before And After Contrast 9 8 $4,573.00 $4,115.70 $4,344.35 $4,481.54 $4,344.35 2026-07-17
A0434 HCPCS Hc Specialty Care Transport 15 14 $4,473.00 $4,025.70 $4,249.35 $4,652.00 $4,338.81 2026-07-17
36010149 CDM Operating Room Services - General Classification 6 6 $4,476.00 $4,476.00 $4,171.63 $4,476.00 $4,252.20 2026-07-09
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 6 6 $4,470.00 $4,470.00 $4,166.04 $4,470.00 $4,246.50 2026-07-09
44141 CPT Hc Pr 44141 Partial Removal Of Colon, With Skin Level Cecostomy Or Colos 9 8 $4,435.00 $3,991.50 $4,213.25 $4,346.30 $4,213.25 2026-07-17
3253696WWM CDM Hc Or Mesh Composite 14x11 6 6 $4,352.00 $4,352.00 $4,056.06 $4,352.00 $4,134.40 2026-07-09
17210001 CDM Nursery - Newborn - Level Ii 5 5 $4,242.00 $4,242.00 $4,029.90 $4,242.00 $4,114.74 2026-07-09
74178 CPT CT Scan Of Abdomen And Pelvis Before And After Contrast 9 8 $4,326.00 $3,893.40 $4,109.70 $4,239.48 $4,109.70 2026-07-17
44144 CPT Hc Pr 44144 Partial Removal Of Colon, With Resection 9 8 $4,311.00 $3,879.90 $4,095.45 $4,224.78 $4,095.45 2026-07-17
3253707WWM CDM Hc Or Mesh Composix 10x14 6 6 $4,309.00 $4,309.00 $4,015.99 $4,309.00 $4,093.55 2026-07-09
72158 CPT MRI Scan Of Lower Spinal Canal Before And After Contrast 9 8 $4,275.00 $3,847.50 $4,061.25 $4,189.50 $4,061.25 2026-07-17
72157 CPT MRI Scan Of Middle Spinal Canal Before And After Contrast 9 8 $4,275.00 $3,847.50 $4,061.25 $4,189.50 $4,061.25 2026-07-17
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 6 6 $4,247.00 $4,247.00 $3,958.20 $4,247.00 $4,034.65 2026-07-09
0172 RC — 9 8 $4,242.00 $3,817.80 $4,029.90 $4,157.16 $4,029.90 2026-07-17
J9035 HCPCS Bevacizumab 100 Mg/4ml IV Soln 18 8 $4,186.73 $3,768.05 $1,649.68 $6,504.22 $4,003.44 2026-07-17
70553 HCPCS MRI Scan Of Brain Before And After Contrast 6 6 $4,191.00 $4,191.00 $3,906.01 $4,191.00 $3,981.45 2026-07-09
70552 HCPCS MRI Scan Of Brain With Contrast 6 6 $4,145.00 $4,145.00 $3,863.14 $4,145.00 $3,937.75 2026-07-09
44143 CPT Hc Pr 44143 Partial Removal Of Colon, Hartmann Procedure 9 8 $4,122.00 $3,709.80 $3,915.90 $4,039.56 $3,915.90 2026-07-17
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 6 6 $4,120.00 $4,120.00 $3,839.84 $4,120.00 $3,914.00 2026-07-09
74177 CPT CT Scan Of Abdomen And Pelvis With Contrast 9 8 $4,120.00 $3,708.00 $3,914.00 $4,037.60 $3,914.00 2026-07-17
21406 CPT Treat Broken Eye Bone 18 8 $4,036.50 $3,632.85 $2,119.45 $5,725.16 $3,868.14 2026-07-17
38573 CPT Hc Pr 38573 Laps Pelvic Lymphadec 9 8 $4,071.00 $3,663.90 $3,867.45 $3,989.58 $3,867.45 2026-07-17
71552 HCPCS MRI Scan Of Chest Before And After Contrast 6 6 $4,018.00 $4,018.00 $3,744.78 $4,018.00 $3,817.10 2026-07-09
3254049WWM CDM Hc Or Tissue #43917000 6 6 $3,996.00 $3,996.00 $3,724.27 $3,996.00 $3,796.20 2026-07-09
70552 CPT MRI Scan Of Brain With Contrast 9 8 $3,985.00 $3,586.50 $3,785.75 $3,905.30 $3,785.75 2026-07-17
72149 CPT MRI Scan Of Lower Spinal Canal With Contrast 9 8 $3,961.00 $3,564.90 $3,762.95 $3,881.78 $3,762.95 2026-07-17
66984 CPT Removal Of Cataract By Inserting Prosthetic Lens 9 8 $3,933.00 $3,539.70 $3,736.35 $3,854.34 $3,736.35 2026-07-17
J3358 HCPCS Ustekinumab 130 Mg/26ml IV Soln 9 8 $3,914.00 $3,522.60 $3,718.30 $3,835.72 $3,718.30 2026-07-17
J2357 HCPCS Omalizumab 150 Mg/ml Subq Sosy 9 8 $3,914.00 $3,522.60 $3,718.30 $3,835.72 $3,718.30 2026-07-17
Q5103 HCPCS Infliximab-dyyb 100 Mg IV Solr 9 8 $3,914.00 $3,522.60 $3,718.30 $3,835.72 $3,718.30 2026-07-17
J0330 HCPCS Succinylcholine Chloride 20 Mg/ml Injection Soln (narrator Wrapper) 9 8 $3,914.00 $3,522.60 $3,718.30 $3,835.72 $3,718.30 2026-07-17
74174 CPT CT Scan Of Blood Vessels Of Abdomen And Pelvis W/contrast 9 8 $3,914.00 $3,522.60 $3,718.30 $3,835.72 $3,718.30 2026-07-17
Q5106 HCPCS Epoetin Alfa-epbx 40000 Unit/ml Injection Soln 9 8 $3,914.00 $3,522.60 $3,718.30 $3,835.72 $3,718.30 2026-07-17
71552 CPT MRI Scan Of Chest Before And After Contrast 9 8 $3,863.00 $3,476.70 $3,669.85 $3,785.74 $3,669.85 2026-07-17
70553 CPT MRI Scan Of Brain Before And After Contrast 9 8 $3,863.00 $3,476.70 $3,669.85 $3,785.74 $3,669.85 2026-07-17
44204 CPT Hc Pr 44204 Laparoscopy Partial Colectomy 9 8 $3,831.00 $3,447.90 $3,639.45 $3,754.38 $3,639.45 2026-07-17
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 6 6 $3,800.00 $3,800.00 $3,541.60 $3,800.00 $3,610.00 2026-07-09
15730 CPT Hc Pr 15730 Mdfc Flap W/Prsrv Vasc Pedcl 9 8 $3,794.00 $3,414.60 $3,604.30 $3,718.12 $3,604.30 2026-07-17
36010148 CDM Operating Room Services - General Classification 6 6 $3,760.00 $3,760.00 $3,504.32 $3,760.00 $3,572.00 2026-07-09
74182 CPT MRI Scan Of Abdomen With Contrast 9 8 $3,756.00 $3,380.40 $3,568.20 $3,680.88 $3,568.20 2026-07-17
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 6 6 $3,755.00 $3,755.00 $3,499.66 $3,755.00 $3,567.25 2026-07-09
71555 CPT MRI Scan Of Blood Vessels Of Chest 9 8 $3,730.00 $3,357.00 $3,543.50 $3,655.40 $3,543.50 2026-07-17
3253697WWM CDM Hc Or Mesh Composite 12x8 6 6 $3,666.00 $3,666.00 $3,416.71 $3,666.00 $3,482.70 2026-07-09
J0881 HCPCS Darbepoetin Alfa 100 Mcg/0.5ml Injection Sosy 45 8 $3,650.81 $3,285.73 $1,213.06 $5,903.35 $3,468.27 2026-07-17
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 6 6 $3,633.00 $3,633.00 $3,385.96 $3,633.00 $3,451.35 2026-07-09
72142 CPT MRI Scan Of Upper Spinal Canal With Contrast 9 8 $3,628.00 $3,265.20 $3,446.60 $3,555.44 $3,446.60 2026-07-17
72147 CPT MRI Scan Of Middle Spinal Canal With Contrast 9 8 $3,610.00 $3,249.00 $3,429.50 $3,537.80 $3,429.50 2026-07-17
72196 CPT MRI Scan Of Pelvis With Contrast 9 8 $3,592.00 $3,232.80 $3,412.40 $3,520.16 $3,412.40 2026-07-17
45550 CPT Hc Pr 45550 Repair Rectum/Remove Sigmoid 9 8 $3,543.00 $3,188.70 $3,365.85 $3,472.14 $3,365.85 2026-07-17
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 6 6 $3,521.00 $3,521.00 $3,281.57 $3,521.00 $3,344.95 2026-07-09
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 6 6 $3,521.00 $3,521.00 $3,281.57 $3,521.00 $3,344.95 2026-07-09
74176 CPT CT Scan Of Abdomen And Pelvis Without Contrast 9 8 $3,502.00 $3,151.80 $3,326.90 $3,431.96 $3,326.90 2026-07-17
J1568 HCPCS Immune Globulin (human) 30 Gm/300ml IV Soln 27 8 $3,443.24 $3,098.92 $1,793.59 $5,061.56 $3,271.08 2026-07-17
20822 CPT Reattachment Of Part Of Cutoff Finger 18 8 $3,383.50 $3,045.15 $2,145.10 $4,418.82 $3,248.20 2026-07-17
36561 CPT Hc Pr 36561 Insert Tunneled Cv Cath W/Port > 5 9 8 $3,409.00 $3,068.10 $3,238.55 $3,340.82 $3,238.55 2026-07-17
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 6 6 $3,409.00 $3,409.00 $3,177.19 $3,409.00 $3,238.55 2026-07-09
73720 HCPCS MRI Scan Of Leg Before And After Contrast 6 6 $3,409.00 $3,409.00 $3,177.19 $3,409.00 $3,238.55 2026-07-09
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 6 6 $3,409.00 $3,409.00 $3,177.19 $3,409.00 $3,238.55 2026-07-09
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 6 6 $3,409.00 $3,409.00 $3,177.19 $3,409.00 $3,238.55 2026-07-09
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 6 6 $3,409.00 $3,409.00 $3,177.19 $3,409.00 $3,238.55 2026-07-09
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 6 6 $3,402.00 $3,402.00 $3,170.66 $3,402.00 $3,231.90 2026-07-09
J9041 HCPCS Bortezomib 3.5 Mg Injection Solr 9 8 $3,388.68 $3,049.81 $3,219.25 $3,320.91 $3,219.25 2026-07-17
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 6 6 $3,354.00 $3,354.00 $3,125.93 $3,354.00 $3,186.30 2026-07-09
70543 CPT MRI Scan Of Bone Of Eye Socket, Face, And/or Neck 9 8 $3,348.00 $3,013.20 $3,180.60 $3,281.04 $3,180.60 2026-07-17
20205 CPT Biopsy Of Muscle 18 8 $3,291.00 $2,961.90 $3,003.90 $3,351.60 $3,173.88 2026-07-17
43840 CPT Hc Pr 43840 Repair Of Stomach Lesion 9 8 $3,340.00 $3,006.00 $3,173.00 $3,273.20 $3,173.00 2026-07-17
Q5111 HCPCS Pegfilgrastim-cbqv 6 Mg/0.6ml Subq Sosy 9 8 $3,313.64 $2,982.28 $3,147.96 $3,247.37 $3,147.96 2026-07-17
C8929 HCPCS Ultrasound Heart W/color Flow, Rate, Direction And Valve 9 8 $3,300.00 $2,970.00 $3,135.00 $3,234.00 $3,135.00 2026-07-17
J9355 HCPCS Trastuzumab 150 Mg IV Solr 9 8 $3,297.30 $2,967.57 $3,132.44 $3,231.35 $3,132.44 2026-07-17
44140 CPT Hc Pr 44140 Partial Removal Of Colon With Anastomosis 9 8 $3,290.00 $2,961.00 $3,125.50 $3,224.20 $3,125.50 2026-07-17
74185 CPT MRI Scan Of Blood Vessels Of Abdomen 9 8 $3,288.00 $2,959.20 $3,123.60 $3,222.24 $3,123.60 2026-07-17
70547 CPT MRI Scan Of Blood Vessels Of Neck Without Contrast 9 8 $3,271.00 $2,943.90 $3,107.45 $3,205.58 $3,107.45 2026-07-17
3253706WWM CDM Hc Or Mesh Composix 8x10 6 6 $3,271.00 $3,271.00 $3,048.57 $3,271.00 $3,107.45 2026-07-09
74181 HCPCS MRI Scan Of Abdomen Without Contrast 6 6 $3,268.00 $3,268.00 $3,045.78 $3,268.00 $3,104.60 2026-07-09
70544 CPT MRI Scan Of Blood Vessels Of Head Without Contrast 9 8 $3,245.00 $2,920.50 $3,082.75 $3,180.10 $3,082.75 2026-07-17
72156 CPT MRI Scan Of Upper Spinal Canal Before And After Contrast 9 8 $3,245.00 $2,920.50 $3,082.75 $3,180.10 $3,082.75 2026-07-17
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 6 6 $3,241.00 $3,241.00 $3,020.61 $3,241.00 $3,078.95 2026-07-09
73725 CPT MRI Scan Of Blood Vessels Of Leg 9 8 $3,225.00 $2,902.50 $3,063.75 $3,160.50 $3,063.75 2026-07-17
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 6 6 $3,200.00 $3,200.00 $2,982.40 $3,200.00 $3,040.00 2026-07-09
73220 HCPCS MRI Scan Of Arm Before And After Contrast 6 6 $3,186.00 $3,186.00 $2,969.35 $3,186.00 $3,026.70 2026-07-09
27252 CPT Closed Treatment Of Dislocated Hip Under Anesthesia 18 8 $3,128.00 $2,815.20 $2,711.30 $3,333.96 $3,014.41 2026-07-17
27447 CPT Hc Pr 27447 Arthrp Kne Condyle&Platu Medial&Lat Compartments 9 8 $3,158.00 $2,842.20 $3,000.10 $3,094.84 $3,000.10 2026-07-17
73719 CPT MRI Scan Of Leg With Contrast 9 8 $3,144.00 $2,829.60 $2,986.80 $3,081.12 $2,986.80 2026-07-17
73222 CPT MRI Scan Of Arm Joint With Contrast 9 8 $3,144.00 $2,829.60 $2,986.80 $3,081.12 $2,986.80 2026-07-17
73723 CPT MRI Scan Of Leg Joint Before And After Contrast 9 8 $3,142.00 $2,827.80 $2,984.90 $3,079.16 $2,984.90 2026-07-17
74183 CPT MRI Scan Of Abdomen Before And After Contrast 9 8 $3,142.00 $2,827.80 $2,984.90 $3,079.16 $2,984.90 2026-07-17
72197 CPT MRI Scan Of Pelvis Before And After Contrast 9 8 $3,142.00 $2,827.80 $2,984.90 $3,079.16 $2,984.90 2026-07-17
73223 CPT MRI Scan Of Arm Joint Before And After Contrast 9 8 $3,142.00 $2,827.80 $2,984.90 $3,079.16 $2,984.90 2026-07-17
73720 CPT MRI Scan Of Leg Before And After Contrast 9 8 $3,142.00 $2,827.80 $2,984.90 $3,079.16 $2,984.90 2026-07-17
74181 CPT MRI Scan Of Abdomen Without Contrast 9 8 $3,142.00 $2,827.80 $2,984.90 $3,079.16 $2,984.90 2026-07-17
81229 CPT Genome-wide Microarray Analysis 9 8 $3,141.00 $2,826.90 $2,983.95 $3,078.18 $2,983.95 2026-07-17
J7326 HCPCS Hc Pr Rx Hyaluronan Or Derivative (gel-one) Inj 1 Ea 9 8 $3,135.00 $2,821.50 $2,978.25 $3,072.30 $2,978.25 2026-07-17
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 6 6 $3,129.00 $3,129.00 $2,916.23 $3,129.00 $2,972.55 2026-07-09
71270 HCPCS CT Scan Of Chest Before And After Contrast 6 6 $3,105.00 $3,105.00 $2,893.86 $3,105.00 $2,949.75 2026-07-09
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 6 6 $3,102.00 $3,102.00 $2,891.06 $3,102.00 $2,946.90 2026-07-09
J9264 HCPCS Paclitaxel Protein-bound Part 100 Mg IV Susr 9 8 $3,087.12 $2,778.41 $2,932.76 $3,025.38 $2,932.76 2026-07-17
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 6 6 $3,076.00 $3,076.00 $2,866.83 $3,076.00 $2,922.20 2026-07-09
70546 CPT MRI Scan Of Blood Vessels Of Head Before And After Contrast 9 8 $3,076.00 $2,768.40 $2,922.20 $3,014.48 $2,922.20 2026-07-17
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 6 6 $3,076.00 $3,076.00 $2,866.83 $3,076.00 $2,922.20 2026-07-09
58291 CPT Hc Pr 58291 Vaginal Hysterectomy Incl Tubes/Ovary(S) Complex 9 8 $3,063.00 $2,756.70 $2,909.85 $3,001.74 $2,909.85 2026-07-17
73218 HCPCS MRI Scan Of Arm Without Contrast 6 6 $3,054.00 $3,054.00 $2,846.33 $3,054.00 $2,901.30 2026-07-09
12010001 CDM Room & Board - Semi-private (two Beds) - General Classification 5 5 $2,990.00 $2,990.00 $2,840.50 $2,990.00 $2,900.30 2026-07-09
73722 CPT MRI Scan Of Leg Joint With Contrast 9 8 $3,052.00 $2,746.80 $2,899.40 $2,990.96 $2,899.40 2026-07-17
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 6 6 $3,043.00 $3,043.00 $2,836.08 $3,043.00 $2,890.85 2026-07-09
71551 HCPCS MRI Scan Of Chest With Contrast 6 6 $3,042.00 $3,042.00 $2,835.14 $3,042.00 $2,889.90 2026-07-09
49618 CPT Hc Pr 49618 Rpr Aa Hernia Recr > 10 Cm Ncrc8/Strangulated Cdm 9 8 $3,036.00 $2,732.40 $2,884.20 $2,975.28 $2,884.20 2026-07-17
12210001 CDM Room & Board - Semi-private (two Beds) - Obstetrics (ob) 5 5 $2,970.00 $2,970.00 $2,821.50 $2,970.00 $2,880.90 2026-07-09
27245 CPT Hc Pr 27245 Tx Inter/PR/Subtrchntric Fem Fx Imed Implt Screw Cdm 9 8 $3,025.00 $2,722.50 $2,873.75 $2,964.50 $2,873.75 2026-07-17
44120 CPT Hc Pr 44120 Removal Of Small Intestine, Single Resection 9 8 $2,996.00 $2,696.40 $2,846.20 $2,936.08 $2,846.20 2026-07-17
73219 CPT MRI Scan Of Arm With Contrast 9 8 $2,995.00 $2,695.50 $2,845.25 $2,935.10 $2,845.25 2026-07-17
44320 CPT Colostomy/Skin Level Cecostomy 9 8 $2,994.00 $2,694.60 $2,844.30 $2,934.12 $2,844.30 2026-07-17
25606 CPT Place Stabilizing Device For Broken Forearm Bone 18 8 $2,961.50 $2,665.35 $1,593.15 $4,161.08 $2,838.58 2026-07-17
25260 CPT Primary Repair Tendon/muscle Of Palm Side Of Forearm/wrist 18 8 $2,943.50 $2,649.15 $2,657.15 $3,028.20 $2,838.28 2026-07-17
72148 CPT MRI Scan Of Lower Spinal Canal Without Contrast 9 8 $2,987.00 $2,688.30 $2,837.65 $2,927.26 $2,837.65 2026-07-17
58570 CPT Hc Pr 58570 Tlh Uterus 250 G Or Less 9 8 $2,984.00 $2,685.60 $2,834.80 $2,924.32 $2,834.80 2026-07-17
36010147 CDM Operating Room Services - General Classification 6 6 $2,984.00 $2,984.00 $2,781.09 $2,984.00 $2,834.80 2026-07-09
26548 CPT Repair Of Joint Between Finger And Palm 9 8 $2,980.00 $2,682.00 $2,831.00 $2,920.40 $2,831.00 2026-07-17
35840 CPT Hc Pr 35840 Explore Abdominal Vessels 9 8 $2,964.00 $2,667.60 $2,815.80 $2,904.72 $2,815.80 2026-07-17
70551 HCPCS MRI Scan Of Brain Without Contrast 6 6 $2,962.00 $2,962.00 $2,760.58 $2,962.00 $2,813.90 2026-07-09
0122 RC — 9 8 $2,954.00 $2,658.60 $2,806.30 $2,894.92 $2,806.30 2026-07-17
27236 CPT Hc Pr 27236 Optx Fem Fx Prox End Nck Int Fixj/Prostc Rplcmt 9 8 $2,947.00 $2,652.30 $2,799.65 $2,888.06 $2,799.65 2026-07-17
73218 CPT MRI Scan Of Arm Without Contrast 9 8 $2,936.00 $2,642.40 $2,789.20 $2,877.28 $2,789.20 2026-07-17
73220 CPT MRI Scan Of Arm Before And After Contrast 9 8 $2,936.00 $2,642.40 $2,789.20 $2,877.28 $2,789.20 2026-07-17
72198 CPT MRI Scan Of Blood Vessels Of Pelvis 9 8 $2,929.00 $2,636.10 $2,782.55 $2,870.42 $2,782.55 2026-07-17
72159 CPT MRI Scan Of Blood Vessels Of Spinal Canal 9 8 $2,929.00 $2,636.10 $2,782.55 $2,870.42 $2,782.55 2026-07-17
71551 CPT MRI Scan Of Chest With Contrast 9 8 $2,925.00 $2,632.50 $2,778.75 $2,866.50 $2,778.75 2026-07-17
19307 CPT Hc Pr 19307 Mast Mod Rad 9 8 $2,911.00 $2,619.90 $2,765.45 $2,852.78 $2,765.45 2026-07-17
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 6 6 $2,906.00 $2,906.00 $2,708.39 $2,906.00 $2,760.70 2026-07-09
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 6 6 $2,906.00 $2,906.00 $2,708.39 $2,906.00 $2,760.70 2026-07-09
72146 CPT MRI Scan Of Middle Spinal Canal Without Contrast 9 8 $2,884.00 $2,595.60 $2,739.80 $2,826.32 $2,739.80 2026-07-17
44125 CPT Hc Pr 44125 Removal Of Small Intestine, With Enterostomy 9 8 $2,882.00 $2,593.80 $2,737.90 $2,824.36 $2,737.90 2026-07-17
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 6 6 $2,879.00 $2,879.00 $2,683.23 $2,879.00 $2,735.05 2026-07-09
36569 HCPCS Insertion Of Tube For Infusion (5 Years Or Older) 9 6 $2,864.00 $2,864.00 $3.97 $2,864.00 $2,720.80 2026-07-09
71270 CPT CT Scan Of Chest Before And After Contrast 9 8 $2,862.00 $2,575.80 $2,718.90 $2,804.76 $2,718.90 2026-07-17
74175 CPT CT Scan Of Blood Vessels Of Arm With Contrast 9 8 $2,859.00 $2,573.10 $2,716.05 $2,801.82 $2,716.05 2026-07-17
59410 CPT Hc Pr 59410 Vag Delivery W/Postpartum 9 8 $2,852.00 $2,566.80 $2,709.40 $2,794.96 $2,709.40 2026-07-17
73718 HCPCS MRI Scan Of Leg Without Contrast 6 6 $2,850.00 $2,850.00 $2,656.20 $2,850.00 $2,707.50 2026-07-09
70496 CPT CT Scan Of Blood Vessels Of Head With Contrast 9 8 $2,835.00 $2,551.50 $2,693.25 $2,778.30 $2,693.25 2026-07-17
19305 CPT Hc Pr 19305 Mast Radical 9 8 $2,835.00 $2,551.50 $2,693.25 $2,778.30 $2,693.25 2026-07-17
70498 CPT CT Scan Of Blood Vessels Of Neck With Contrast 9 8 $2,835.00 $2,551.50 $2,693.25 $2,778.30 $2,693.25 2026-07-17
81413 CPT Test For Detecting Genes Associated With Heart Disease 9 8 $2,826.00 $2,543.40 $2,684.70 $2,769.48 $2,684.70 2026-07-17
81414 CPT Test For Detecting Genes Associated With Heart Disease 9 8 $2,826.00 $2,543.40 $2,684.70 $2,769.48 $2,684.70 2026-07-17
27552 CPT Closed Treatment Of Dislocated Knee Under Anesthesia 18 8 $2,784.50 $2,506.05 $1,945.60 $3,450.58 $2,675.99 2026-07-17
17110001 CDM Nursery - Newborn - Level I 5 5 $2,749.00 $2,749.00 $2,611.55 $2,749.00 $2,666.53 2026-07-09
71275 CPT CT Blood Vessels Chest With Contrast 9 8 $2,805.00 $2,524.50 $2,664.75 $2,748.90 $2,664.75 2026-07-17
44005 CPT Hc Pr 44005 Freeing Of Bowel Adhesion 18 8 $2,762.50 $2,486.25 $2,544.10 $2,790.06 $2,664.55 2026-07-17
12010009 CDM Room & Board - Semi-private (two Beds) - General Classification 5 5 $2,732.00 $2,732.00 $2,595.40 $2,732.00 $2,650.04 2026-07-09
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 6 6 $2,786.00 $2,786.00 $2,596.55 $2,786.00 $2,646.70 2026-07-09
58553 CPT Hc Pr 58553 Laparo-vaginal Hysterectomy Complex 9 8 $2,768.00 $2,491.20 $2,629.60 $2,712.64 $2,629.60 2026-07-17
73706 HCPCS CT Scan Of Blood Vessels Of Lower Leg With Contrast 6 6 $2,760.00 $2,760.00 $2,572.32 $2,760.00 $2,622.00 2026-07-09
71550 CPT MRI Scan Of Chest Without Contrast 9 8 $2,754.00 $2,478.60 $2,616.30 $2,698.92 $2,616.30 2026-07-17
72195 HCPCS MRI Scan Of Pelvis Without Contrast 6 6 $2,739.00 $2,739.00 $2,552.75 $2,739.00 $2,602.05 2026-07-09
19303 CPT Hc Pr 19303 Mast Simple Complete 9 8 $2,731.00 $2,457.90 $2,594.45 $2,676.38 $2,594.45 2026-07-17
70551 CPT MRI Scan Of Brain Without Contrast 9 8 $2,730.00 $2,457.00 $2,593.50 $2,675.40 $2,593.50 2026-07-17
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 6 6 $2,713.00 $2,713.00 $2,528.52 $2,713.00 $2,577.35 2026-07-09
3253277WWM CDM Hc Or Mesh Ventralex #001030 6 6 $2,703.00 $2,703.00 $2,519.20 $2,703.00 $2,567.85 2026-07-09
19318 CPT Hc Pr 19318 Reduction Of Large Breast 9 8 $2,688.00 $2,419.20 $2,553.60 $2,634.24 $2,553.60 2026-07-17
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 6 6 $2,682.00 $2,682.00 $2,499.62 $2,682.00 $2,547.90 2026-07-09
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 6 6 $2,682.00 $2,682.00 $2,499.62 $2,682.00 $2,547.90 2026-07-09
3253698WWM CDM Hc Or Mesh Composite 10x8 6 6 $2,682.00 $2,682.00 $2,499.62 $2,682.00 $2,547.90 2026-07-09
49999 CPT Hc Pr 49999 Abdomen Surgery Procedure 9 8 $2,680.00 $2,412.00 $2,546.00 $2,626.40 $2,546.00 2026-07-17
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 6 6 $2,678.00 $2,678.00 $2,495.90 $2,678.00 $2,544.10 2026-07-09
73206 CPT CT Scan Of Blood Vessels Of Arm With Contrast 9 8 $2,678.00 $2,410.20 $2,544.10 $2,624.44 $2,544.10 2026-07-17
72141 CPT MRI Scan Of Upper Spinal Canal Without Contrast 9 8 $2,678.00 $2,410.20 $2,544.10 $2,624.44 $2,544.10 2026-07-17
75635 CPT CT Scan Of Abdominal Aorta And Both Leg Arteries W/contrast 9 8 $2,678.00 $2,410.20 $2,544.10 $2,624.44 $2,544.10 2026-07-17
49617 CPT Hc Pr 49617 Rpr Aa Hernia Recr > 10 Cm Reducible Cdm 9 8 $2,676.00 $2,408.40 $2,542.20 $2,622.48 $2,542.20 2026-07-17
3252911WWM CDM Hc Or Portacath#0603590 6 6 $2,664.00 $2,664.00 $2,482.85 $2,664.00 $2,530.80 2026-07-09
47600 CPT Hc Pr 47600 Cholecystectomy 9 8 $2,658.00 $2,392.20 $2,525.10 $2,604.84 $2,525.10 2026-07-17
73721 CPT MRI Scan Of Leg Joint Without Contrast 9 8 $2,653.00 $2,387.70 $2,520.35 $2,599.94 $2,520.35 2026-07-17
73706 CPT CT Scan Of Blood Vessels Of Neck With Contrast 9 8 $2,653.00 $2,387.70 $2,520.35 $2,599.94 $2,520.35 2026-07-17
0171 RC — 9 8 $2,643.00 $2,378.70 $2,510.85 $2,590.14 $2,510.85 2026-07-17
29827 CPT Hc Pr 29827 Shldr Arthroscop,Surg,W/Rotat Cuff Repr 9 8 $2,641.00 $2,376.90 $2,508.95 $2,588.18 $2,508.95 2026-07-17
14350 CPT Repair Of Tissue Loss Of Finger Or Toe 18 8 $2,622.00 $2,359.80 $2,480.45 $2,580.34 $2,501.35 2026-07-17
A0433 HCPCS Hc Ambulance Ground Als2 Emrgency 15 14 $2,577.00 $2,319.30 $2,448.15 $2,796.00 $2,499.69 2026-07-17
73718 CPT MRI Scan Of Leg Without Contrast 9 8 $2,627.00 $2,364.30 $2,495.65 $2,574.46 $2,495.65 2026-07-17
43249 CPT Hc Pr 43249 Esoph Egd Dilation <30 Mm 9 8 $2,623.00 $2,360.70 $2,491.85 $2,570.54 $2,491.85 2026-07-17
29806 CPT Hc Pr 29806 Shoulder Arthroscopy/Surgery 9 8 $2,622.00 $2,359.80 $2,490.90 $2,569.56 $2,490.90 2026-07-17
70336 HCPCS MRI Scan Of Jaw Joint 6 6 $2,620.00 $2,620.00 $2,441.84 $2,620.00 $2,489.00 2026-07-09
11012 CPT Remove Foreign Material From Skin, Tissue, Muscle 18 8 $2,590.50 $2,331.45 $2,433.90 $2,566.62 $2,488.05 2026-07-17
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 6 6 $2,618.00 $2,618.00 $2,439.98 $2,618.00 $2,487.10 2026-07-09
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 6 6 $2,607.00 $2,607.00 $2,429.72 $2,607.00 $2,476.65 2026-07-09
72130 CPT CT Scan Of Middle Spine Before And After Contrast 9 8 $2,597.00 $2,337.30 $2,467.15 $2,545.06 $2,467.15 2026-07-17
15733 CPT Hc Pr 15733 Musc Myoq/Fscq Flp H&n Pedcl 9 8 $2,588.00 $2,329.20 $2,458.60 $2,536.24 $2,458.60 2026-07-17
70540 CPT MRI Scan Of Bone Of Eye Socket, Face, Neck W/contrast 9 8 $2,575.00 $2,317.50 $2,446.25 $2,523.50 $2,446.25 2026-07-17
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 6 6 $2,573.00 $2,573.00 $2,398.04 $2,573.00 $2,444.35 2026-07-09
29807 CPT Hc Pr 29807 Shldr Arthroscop,Surg,Repair,Slap Lesion 9 8 $2,560.00 $2,304.00 $2,432.00 $2,508.80 $2,432.00 2026-07-17
J0129 HCPCS Abatacept 250 Mg IV Solr 9 8 $2,554.90 $2,299.41 $2,427.16 $2,503.80 $2,427.16 2026-07-17
72133 CPT CT Scan Of Lower Spine Before And After Contrast 9 8 $2,553.00 $2,297.70 $2,425.35 $2,501.94 $2,425.35 2026-07-17
59426 CPT Hc Pr 59426 Antepartum Care Only (7 Or More) 9 8 $2,546.00 $2,291.40 $2,418.70 $2,495.08 $2,418.70 2026-07-17
20102 CPT Exploration Of Wound Of Abdomen, Back, Or Flank 18 8 $2,507.00 $2,256.30 $2,289.50 $2,551.92 $2,417.80 2026-07-17
65235 CPT Removal Of Foreign Body In Eye Or Lens 9 8 $2,525.00 $2,272.50 $2,398.75 $2,474.50 $2,398.75 2026-07-17
72195 CPT MRI Scan Of Pelvis Without Contrast 9 8 $2,524.00 $2,271.60 $2,397.80 $2,473.52 $2,397.80 2026-07-17
70336 CPT MRI Scan Of Jaw Joint 9 8 $2,519.00 $2,267.10 $2,393.05 $2,468.62 $2,393.05 2026-07-17
70548 CPT MRI Scan Of Blood Vessels Of Neck With Contrast 9 8 $2,517.00 $2,265.30 $2,391.15 $2,466.66 $2,391.15 2026-07-17
58150 CPT Remove Uterus Cervix Via Abdomen W/wo Tubes Or Ovaries 9 8 $2,507.00 $2,256.30 $2,381.65 $2,456.86 $2,381.65 2026-07-17
49596 CPT Hc Pr 49596 Rpr Aa Hernia 1st > 10 Cm Ncrc8/Strangulated Cdm 9 8 $2,505.00 $2,254.50 $2,379.75 $2,454.90 $2,379.75 2026-07-17
93306 CPT Ultrasound Heart W/color Blood Flow, Rate, Direction 9 8 $2,500.00 $2,250.00 $2,375.00 $2,450.00 $2,375.00 2026-07-17
3254034WWM CDM Hc Or Tight Rope #ar-8926ss 6 6 $2,491.00 $2,491.00 $2,321.61 $2,491.00 $2,366.45 2026-07-09
71260 HCPCS CT Scan Of Chest With Contrast 6 6 $2,487.00 $2,487.00 $2,317.88 $2,487.00 $2,362.65 2026-07-09
RX-21044 CDM Lupron Depot 11.25 Mg 3mo Kit 6 6 $2,483.64 $2,483.64 $2,314.76 $2,483.64 $2,359.46 2026-07-09
72194 CPT CT Scan Of Pelvis Before And After Contrast 9 8 $2,480.00 $2,232.00 $2,356.00 $2,430.40 $2,356.00 2026-07-17
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 6 6 $2,475.00 $2,475.00 $2,306.70 $2,475.00 $2,351.25 2026-07-09
70545 CPT MRI Scan Of Blood Vessels Of Head With Contrast 9 8 $2,474.00 $2,226.60 $2,350.30 $2,424.52 $2,350.30 2026-07-17
74170 CPT CT Scan Of Abdomen Before And After Contrast 9 8 $2,472.00 $2,224.80 $2,348.40 $2,422.56 $2,348.40 2026-07-17
73221 CPT MRI Scan Of Arm Joint Without Contrast 9 8 $2,472.00 $2,224.80 $2,348.40 $2,422.56 $2,348.40 2026-07-17
74160 HCPCS CT Scan Of Abdomen With Contrast 6 6 $2,459.00 $2,459.00 $2,291.79 $2,459.00 $2,336.05 2026-07-09
27823 CPT Hc Pr 27823 Open Treatment Of Ankle Fracture W/Fixation 9 8 $2,441.00 $2,196.90 $2,318.95 $2,392.18 $2,318.95 2026-07-17
59514 CPT Hc Pr 59514 Cesarean Delivery Only 18 8 $2,392.50 $2,153.25 $2,160.30 $2,460.78 $2,306.98 2026-07-17
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 6 6 $2,425.00 $2,425.00 $2,260.10 $2,425.00 $2,303.75 2026-07-09
58571 CPT Hc Pr 58571 Tlh W/t/o 250 G Or Less 9 8 $2,413.00 $2,171.70 $2,292.35 $2,364.74 $2,292.35 2026-07-17
44025 CPT Hc Pr 44025 Incision Of Large Bowel 9 8 $2,410.00 $2,169.00 $2,289.50 $2,361.80 $2,289.50 2026-07-17
29888 CPT Hc Pr 29888 Knee Scope,Aid Ant Cruciate Repair 9 8 $2,409.00 $2,168.10 $2,288.55 $2,360.82 $2,288.55 2026-07-17
J9055 HCPCS Cetuximab 100 Mg/50ml IV Soln 18 8 $2,380.95 $2,142.86 $1,540.56 $3,077.46 $2,286.24 2026-07-17
70470 CPT CT Scan Of Head Or Brain Before And After Contrast 9 8 $2,403.00 $2,162.70 $2,282.85 $2,354.94 $2,282.85 2026-07-17
3253998WWM CDM Hc Or Plate #02-111-531 6 6 $2,389.00 $2,389.00 $2,226.55 $2,389.00 $2,269.55 2026-07-09
70492 CPT CT Scan Of Soft Tissue Of Neck Before And After Contrast 9 8 $2,379.00 $2,141.10 $2,260.05 $2,331.42 $2,260.05 2026-07-17
58180 CPT Hc Pr 58180 Partial Hysterectomy 9 8 $2,371.00 $2,133.90 $2,252.45 $2,323.58 $2,252.45 2026-07-17
49418 CPT Hc Pr 49418 Insert Perit Cath Comp 9 8 $2,368.00 $2,131.20 $2,249.60 $2,320.64 $2,249.60 2026-07-17
59409 CPT Hc Pr Ed 59409 Vaginal Delivery Cdm 9 8 $2,346.00 $2,111.40 $2,228.70 $2,299.08 $2,228.70 2026-07-17
13152 CPT Complicated Repair Wound Of Head, 2.6-7.5 Cm 18 8 $2,315.00 $2,083.50 $2,171.70 $2,297.12 $2,226.80 2026-07-17
72127 CPT CT Scan Of Upper Spine Before And After Contrast 9 8 $2,331.00 $2,097.90 $2,214.45 $2,284.38 $2,214.45 2026-07-17
J3262 HCPCS Tocilizumab 200 Mg/10ml IV Soln 27 8 $2,319.82 $2,087.84 $881.53 $4,546.84 $2,203.83 2026-07-17
72126 HCPCS CT Scan Of Upper Spine With Contrast 6 6 $2,319.00 $2,319.00 $2,161.31 $2,319.00 $2,203.05 2026-07-09
49594 CPT Hc Pr 49594 Rpr Aa Hernia 1st 3-10 Cm Ncrc8/Strangulated Cdm 9 8 $2,314.00 $2,082.60 $2,198.30 $2,267.72 $2,198.30 2026-07-17
49595 CPT Hc Pr 49595 Rpr Aa Hernia 1st > 10 Cm Reducible Cdm 9 8 $2,314.00 $2,082.60 $2,198.30 $2,267.72 $2,198.30 2026-07-17
27301 CPT Drain Abscess Or Blood Accumulation Of Thigh Or Knee 18 8 $2,280.50 $2,052.45 $1,801.20 $2,611.70 $2,194.91 2026-07-17
G0390 HCPCS Hc Ed Trauma Activation Full With Critical Care G0390 Cdm 9 8 $2,308.00 $2,077.20 $2,192.60 $2,261.84 $2,192.60 2026-07-17
49615 CPT Hc Pr 49615 Rpr Aa Hernia Recr 3-10 Cm Reducible Cdm 9 8 $2,307.00 $2,076.30 $2,191.65 $2,260.86 $2,191.65 2026-07-17
49614 CPT Hc Pr 49614 Rpr Aa Hernia Recr < 3 Cm Ncrc8/Strangulated Cdm 9 8 $2,307.00 $2,076.30 $2,191.65 $2,260.86 $2,191.65 2026-07-17
49616 CPT Hc Pr 49616 Rpr Aa Hernia Recr 3-10 Cm Ncrc8/Strangulated Cdm 9 8 $2,307.00 $2,076.30 $2,191.65 $2,260.86 $2,191.65 2026-07-17
72132 HCPCS CT Scan Of Lower Spine With Contrast 6 6 $2,302.00 $2,302.00 $2,145.46 $2,302.00 $2,186.90 2026-07-09
44050 CPT Hc Pr 44050 Reduce Bowel Obstruction 9 8 $2,302.00 $2,071.80 $2,186.90 $2,255.96 $2,186.90 2026-07-17
27880 CPT Hc Pr 27880 Amputation Leg Through Tibia & Fibula Cdm 9 8 $2,299.00 $2,069.10 $2,184.05 $2,253.02 $2,184.05 2026-07-17
71260 CPT CT Scan Of Chest With Contrast 9 8 $2,292.00 $2,062.80 $2,177.40 $2,246.16 $2,177.40 2026-07-17
58262 CPT Hc Pr 58262 Vaginal Hysterectomy Incl Tubes/Ovary(S) 9 8 $2,289.00 $2,060.10 $2,174.55 $2,243.22 $2,174.55 2026-07-17
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