Price Transparencybeta Hospital negotiated rates

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

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Hospital

SALEM HEALTH WEST VALLEY HOSPITAL

Dallas, OR · CCN 381308 · Rates published

3,842 distinct procedures filed
43 distinct payers
103,296 rate rows
2026-04-01 last MRF observed
Data quality

7,322 of 103,296 rate rows are consumer-grade (7.1%)

95,974 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 67,719
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 22,000
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 6,233
placeholder amount (≤ $0.02) — excluded from medians 11
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 10
exceeds 10× this hospital's gross charge — excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://salemhealth.org/431960221_west-valley-hospital_standardcharges.json
Found on page https://salemhealth.org/patient-guide/billing-and-financial-services/pricing/price-transparency
Discovered viaCMS hospital list
Last fetch success · 2026-08-11
Content fingerprint 15bf6545d65198d3… · 20,126,176 bytes · first seen 2026-05-09

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
Q2042
HCPCS 		Tisagenlecleucel Car-pos T 1 $1,093,877.42 $1,203,843.94 $1,148,860.68 nat. median
$691,418
1.7× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 1 $1,045,489.98 $1,150,592.14 $1,098,041.06 nat. median
$631,793
1.7× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 1 $997,206.45 $1,097,454.72 $1,047,330.58 nat. median
$610,161
1.7× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 1 $976,075.92 $1,074,199.95 $1,025,137.94 nat. median
$624,417
1.6× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 1 $950,368.98 $1,045,908.71 $998,138.84 nat. median
$588,565
1.7× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 1 $924,964.41 $1,017,950.25 $971,457.33 nat. median
$577,541
1.7× median
288
MS_DRG 		Acute And Subacute Endocarditis With Mcc 1 $159,310.50 $159,310.50 $159,310.50 nat. median
$26,771
outlier · 6.0×
J9029
HCPCS 		Inj, Adstiladrin, Per Tx Dos 1 $119,515.30 $131,530.06 $125,522.68 nat. median
$69,291
1.8× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 1 $107,762.32 $118,595.57 $113,178.95 nat. median
$65,655
1.7× median
121
MS_DRG 		Acute Major Eye Infections With Cc/Mcc 1 $108,445.14 $108,445.14 $108,445.14 nat. median
$12,162
outlier · 8.9×
52
MS_DRG 		Spinal Disorders And Injuries With Cc/Mcc 1 $108,406.62 $108,406.62 $108,406.62 nat. median
$18,884
outlier · 5.7×
548
MS_DRG 		Septic Arthritis With Mcc 1 $98,949.00 $98,949.00 $98,949.00 nat. median
$19,448
outlier · 5.1×
J9226
HCPCS 		Supprelin La Implant 1 $85,450.76 $94,041.04 $89,745.90 nat. median
$55,200
1.6× median
281
MS_DRG 		Acute Myocardial Infarction, Discharged Alive With Cc 1 $85,212.28 $85,212.28 $85,212.28 nat. median
$10,300
outlier · 8.3×
565
MS_DRG 		Other Musculoskeletal System And Connective Tissue Diagnoses With Cc 1 $83,374.58 $83,374.58 $83,374.58 nat. median
$10,671
outlier · 7.8×
300
MS_DRG 		Peripheral Vascular Disorders With Cc 4 $34,507.95 $77,267.15 $77,267.15 nat. median
$11,280
outlier · 6.8×
190
MS_DRG 		Chronic Obstructive Pulmonary Disease With Mcc 1 $73,147.20 $73,147.20 $73,147.20 nat. median
$11,661
outlier · 6.3×
559
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Mcc 8 $39,708.80 $84,925.59 $72,285.93 nat. median
$18,860
outlier · 3.8×
555
MS_DRG 		Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc 1 $70,340.70 $70,340.70 $70,340.70 nat. median
$13,763
outlier · 5.1×
74
MS_DRG 		Cranial And Peripheral Nerve Disorders Without Mcc 1 $63,978.51 $63,978.51 $63,978.51 nat. median
$11,005
outlier · 5.8×
57
MS_DRG 		Degenerative Nervous System Disorders Without Mcc 9 $40,844.95 $130,742.65 $62,285.67 nat. median
$13,109
outlier · 4.8×
56
MS_DRG 		Degenerative Nervous System Disorders With Mcc 3 $25,284.27 $65,427.71 $62,047.73 nat. median
$21,951
outlier · 2.8×
552
MS_DRG 		Medical Back Problems Without Mcc 4 $272.97 $106,379.43 $61,542.17 nat. median
$10,356
outlier · 5.9×
391
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 1 $61,467.05 $61,467.05 $61,467.05 nat. median
$13,072
outlier · 4.7×
442
MS_DRG 		Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc 1 $61,222.32 $61,222.32 $61,222.32 nat. median
$10,419
outlier · 5.9×
94
MS_DRG 		Bacterial And Tuberculous Infections Of Nervous System With Mcc 1 $60,666.64 $60,666.64 $60,666.64 nat. median
$34,805
1.7× median
101
MS_DRG 		Seizures Without Mcc 2 $43,891.82 $77,410.06 $60,650.94 nat. median
$9,703
outlier · 6.3×
637
MS_DRG 		Diabetes With Mcc 1 $59,042.60 $59,042.60 $59,042.60 nat. median
$14,602
outlier · 4.0×
602
MS_DRG 		Cellulitis With Mcc 1 $25,755.01 $92,037.04 $58,896.02 nat. median
$14,706
outlier · 4.0×
689
MS_DRG 		Kidney And Urinary Tract Infections With Mcc 3 $9,000.39 $57,776.91 $57,776.91 nat. median
$12,008
outlier · 4.8×
947
MS_DRG 		Signs And Symptoms With Mcc 11 $5,128.40 $127,001.14 $56,124.22 nat. median
$12,594
outlier · 4.5×
549
MS_DRG 		Septic Arthritis With Cc 3 $674.14 $57,119.50 $55,398.83 nat. median
$12,642
outlier · 4.4×
950
MS_DRG 		Aftercare Without Cc/Mcc 2 $40,940.87 $68,290.63 $54,615.75 nat. median
$7,484
outlier · 7.3×
J9266
HCPCS 		Pegaspargase 750 Unit/ml Inj Soln 1 $51,163.31 $56,306.71 $53,735.01 nat. median
$32,688
1.6× median
638
MS_DRG 		Diabetes With Cc 3 $26,290.31 $71,932.73 $52,530.10 nat. median
$9,750
outlier · 5.4×
291
MS_DRG 		Heart Failure And Shock With Mcc 1 $51,808.46 $51,808.46 $51,808.46 nat. median
$13,359
outlier · 3.9×
868
MS_DRG 		Other Infectious And Parasitic Diseases Diagnoses With Cc 2 $45,551.35 $54,702.00 $50,126.68 nat. median
$11,157
outlier · 4.5×
540
MS_DRG 		Osteomyelitis With Cc 2 $49,526.35 $49,526.35 $49,526.35 nat. median
$13,334
outlier · 3.7×
700
MS_DRG 		Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc 1 $47,893.13 $47,893.13 $47,893.13 nat. median
$7,915
outlier · 6.1×
560
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Cc 12 $7,887.16 $83,683.77 $47,664.74 nat. median
$12,112
outlier · 3.9×
949
MS_DRG 		Aftercare With Cc/Mcc 6 $217.89 $57,313.79 $46,416.99 nat. median
$12,344
outlier · 3.8×
948
MS_DRG 		Signs And Symptoms Without Mcc 13 $369.08 $123,283.47 $40,882.01 nat. median
$8,463
outlier · 4.8×
5115
OTHER 		Level 5 Musculoskeletal Procedures 5 $37,706.98 $37,706.98 $37,706.98 nat. median
$13,671
outlier · 2.8×
539
MS_DRG 		Osteomyelitis With Mcc 2 $366.00 $187,974.19 $37,162.59 nat. median
$19,527
1.9× median
438
MS_DRG 		Disorders Of Pancreas Except Malignancy With Mcc 1 $36,796.32 $36,796.32 $36,796.32 nat. median
$16,783
outlier · 2.2×
977
MS_DRG 		HIV With Or Without Other Related Condition 2 $31,107.99 $40,999.71 $36,053.85 nat. median
$14,117
outlier · 2.6×
301
MS_DRG 		Peripheral Vascular Disorders Without Cc/Mcc 1 $33,652.47 $33,652.47 $33,652.47 nat. median
$8,091
outlier · 4.2×
561
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc 8 $563.28 $54,074.67 $32,927.24 nat. median
$9,110
outlier · 3.6×
373
MS_DRG 		Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc 2 $32,814.50 $32,814.50 $32,814.50 nat. median
$8,238
outlier · 4.0×
558
MS_DRG 		Tendonitis, Myositis And Bursitis Without Mcc 2 $1,365.80 $63,081.17 $32,223.48 nat. median
$9,502
outlier · 3.4×

Other procedures at this hospital

Browse this hospital's 3,842 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
             
Q2042 HCPCS Tisagenlecleucel Car-pos T 2 1 — — $1,093,877.42 $1,203,843.94 $1,148,860.68 2026-04-01
Q2056 HCPCS Ciltacabtagene Car-pos T 2 1 — — $1,045,489.98 $1,150,592.14 $1,098,041.06 2026-04-01
Q2055 HCPCS Idecabtagene Vicleucel Car 2 1 — — $997,206.45 $1,097,454.72 $1,047,330.58 2026-04-01
Q2054 HCPCS Lisocabtagene Mara Car Pos T 2 1 — — $976,075.92 $1,074,199.95 $1,025,137.94 2026-04-01
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 2 1 — — $950,368.98 $1,045,908.71 $998,138.84 2026-04-01
Q2053 HCPCS Brexucabtagene Car Pos T 2 1 — — $924,964.41 $1,017,950.25 $971,457.33 2026-04-01
288 MS_DRG Acute And Subacute Endocarditis With Mcc 1 1 — — $159,310.50 $159,310.50 $159,310.50 2026-04-01
J9029 HCPCS Inj, Adstiladrin, Per Tx Dos 2 1 — — $119,515.30 $131,530.06 $125,522.68 2026-04-01
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 2 1 — — $107,762.32 $118,595.57 $113,178.95 2026-04-01
121 MS_DRG Acute Major Eye Infections With Cc/Mcc 1 1 — — $108,445.14 $108,445.14 $108,445.14 2026-04-01
52 MS_DRG Spinal Disorders And Injuries With Cc/Mcc 1 1 — — $108,406.62 $108,406.62 $108,406.62 2026-04-01
548 MS_DRG Septic Arthritis With Mcc 1 1 — — $98,949.00 $98,949.00 $98,949.00 2026-04-01
J9226 HCPCS Supprelin La Implant 2 1 — — $85,450.76 $94,041.04 $89,745.90 2026-04-01
281 MS_DRG Acute Myocardial Infarction, Discharged Alive With Cc 1 1 — — $85,212.28 $85,212.28 $85,212.28 2026-04-01
565 MS_DRG Other Musculoskeletal System And Connective Tissue Diagnoses With Cc 1 1 — — $83,374.58 $83,374.58 $83,374.58 2026-04-01
300 MS_DRG Peripheral Vascular Disorders With Cc 5 4 — — $34,507.95 $77,267.15 $77,267.15 2026-04-01
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 1 1 — — $73,147.20 $73,147.20 $73,147.20 2026-04-01
559 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Mcc 9 8 — — $39,708.80 $84,925.59 $72,285.93 2026-04-01
555 MS_DRG Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc 1 1 — — $70,340.70 $70,340.70 $70,340.70 2026-04-01
74 MS_DRG Cranial And Peripheral Nerve Disorders Without Mcc 1 1 — — $63,978.51 $63,978.51 $63,978.51 2026-04-01
57 MS_DRG Degenerative Nervous System Disorders Without Mcc 11 9 — — $40,844.95 $130,742.65 $62,285.67 2026-04-01
56 MS_DRG Degenerative Nervous System Disorders With Mcc 4 3 — — $25,284.27 $65,427.71 $62,047.73 2026-04-01
552 MS_DRG Medical Back Problems Without Mcc 4 4 — — $272.97 $106,379.43 $61,542.17 2026-04-01
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 1 1 — — $61,467.05 $61,467.05 $61,467.05 2026-04-01
442 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc 1 1 — — $61,222.32 $61,222.32 $61,222.32 2026-04-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 1 1 — — $60,666.64 $60,666.64 $60,666.64 2026-04-01
101 MS_DRG Seizures Without Mcc 2 2 — — $43,891.82 $77,410.06 $60,650.94 2026-04-01
637 MS_DRG Diabetes With Mcc 1 1 — — $59,042.60 $59,042.60 $59,042.60 2026-04-01
602 MS_DRG Cellulitis With Mcc 2 1 — — $25,755.01 $92,037.04 $58,896.02 2026-04-01
689 MS_DRG Kidney And Urinary Tract Infections With Mcc 3 3 — — $9,000.39 $57,776.91 $57,776.91 2026-04-01
947 MS_DRG Signs And Symptoms With Mcc 18 11 — — $5,128.40 $127,001.14 $56,124.22 2026-04-01
549 MS_DRG Septic Arthritis With Cc 4 3 — — $674.14 $57,119.50 $55,398.83 2026-04-01
950 MS_DRG Aftercare Without Cc/Mcc 2 2 — — $40,940.87 $68,290.63 $54,615.75 2026-04-01
J9266 HCPCS Pegaspargase 750 Unit/ml Inj Soln 2 1 — — $51,163.31 $56,306.71 $53,735.01 2026-04-01
638 MS_DRG Diabetes With Cc 3 3 — — $26,290.31 $71,932.73 $52,530.10 2026-04-01
291 MS_DRG Heart Failure And Shock With Mcc 1 1 — — $51,808.46 $51,808.46 $51,808.46 2026-04-01
868 MS_DRG Other Infectious And Parasitic Diseases Diagnoses With Cc 2 2 — — $45,551.35 $54,702.00 $50,126.68 2026-04-01
540 MS_DRG Osteomyelitis With Cc 2 2 — — $49,526.35 $49,526.35 $49,526.35 2026-04-01
700 MS_DRG Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc 1 1 — — $47,893.13 $47,893.13 $47,893.13 2026-04-01
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 21 12 — — $7,887.16 $83,683.77 $47,664.74 2026-04-01
949 MS_DRG Aftercare With Cc/Mcc 7 6 — — $217.89 $57,313.79 $46,416.99 2026-04-01
948 MS_DRG Signs And Symptoms Without Mcc 17 13 — — $369.08 $123,283.47 $40,882.01 2026-04-01
5115 OTHER Level 5 Musculoskeletal Procedures 5 5 — — $37,706.98 $37,706.98 $37,706.98 2025-01-01
539 MS_DRG Osteomyelitis With Mcc 3 2 — — $366.00 $187,974.19 $37,162.59 2026-04-01
438 MS_DRG Disorders Of Pancreas Except Malignancy With Mcc 1 1 — — $36,796.32 $36,796.32 $36,796.32 2026-04-01
977 MS_DRG HIV With Or Without Other Related Condition 2 2 — — $31,107.99 $40,999.71 $36,053.85 2026-04-01
301 MS_DRG Peripheral Vascular Disorders Without Cc/Mcc 1 1 — — $33,652.47 $33,652.47 $33,652.47 2026-04-01
561 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc 13 8 — — $563.28 $54,074.67 $32,927.24 2026-04-01
373 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc 2 2 — — $32,814.50 $32,814.50 $32,814.50 2026-04-01
558 MS_DRG Tendonitis, Myositis And Bursitis Without Mcc 2 2 — — $1,365.80 $63,081.17 $32,223.48 2026-04-01
554 MS_DRG Bone Diseases And Arthropathies Without Mcc 1 1 — — $30,305.61 $30,305.61 $30,305.61 2026-04-01
81416 HCPCS Exome Sequence Analysis 2 1 — — $28,800.00 $30,000.00 $29,400.00 2026-04-01
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 7 5 — — $20,058.26 $43,782.60 $29,355.72 2026-04-01
191 MS_DRG Chronic Obstructive Pulmonary Disease With Cc 1 1 — — $29,328.13 $29,328.13 $29,328.13 2026-04-01
372 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Cc 1 1 — — $29,242.86 $29,242.86 $29,242.86 2026-04-01
603 MS_DRG Cellulitis Without Mcc 7 6 — — $15,531.47 $38,705.11 $27,891.12 2026-04-01
92 MS_DRG Other Disorders Of Nervous System With Cc 2 2 — — $23,407.67 $29,389.81 $26,398.74 2026-04-01
5114 OTHER Level 4 Musculoskeletal Procedures 21 11 — — $8,887.96 $69,077.18 $25,841.24 2026-04-01
728 MS_DRG Inflammation Of The Male Reproductive System Without Mcc 3 3 — — $122.42 $42,819.97 $24,084.72 2026-04-01
556 MS_DRG Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 3 3 — — $299.08 $62,747.48 $23,785.99 2026-04-01
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 3 2 — — $3,015.05 $34,617.00 $23,030.08 2026-04-01
0315U CPT Onc Cutan Sq Cll Ca Mrna 40 2 1 — — $20,400.00 $21,250.00 $20,825.00 2026-04-01
0211U CPT Onc Pan-tum Dna&rna Gnrj Seq 2 1 — — $20,292.00 $21,137.50 $20,714.75 2026-04-01
81552 HCPCS Onc Uveal Mlnma Mrna 15 Gene 2 1 — — $18,662.40 $19,440.00 $19,051.20 2026-04-01
394 MS_DRG Other Digestive System Diagnoses With Cc 1 1 — — $18,689.64 $18,689.64 $18,689.64 2026-04-01
0094U CPT Genome Rapid Sequence Alys 2 1 — — $18,197.28 $18,955.50 $18,576.39 2026-04-01
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 1 1 — — $17,827.00 $17,827.00 $17,827.00 2026-04-01
81529 HCPCS Onc Cutan Mlnma Mrna 31 Gene 2 1 — — $17,263.20 $17,982.50 $17,622.85 2026-04-01
0267U CPT Rare Do Id Opt Gen Mapg&seq 2 1 — — $16,174.39 $16,848.33 $16,511.36 2026-04-01
5341 OTHER Level 1 Abdominal/Peritoneal/Biliary And Related Procedures 16 11 — — $4,640.12 $16,904.34 $15,016.38 2026-04-01
441 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc 1 1 — — $14,983.19 $14,983.19 $14,983.19 2026-04-01
0764 OTHER Ketorolac Tromethamine Inj 2 2 — — $12,022.12 $16,655.21 $14,338.67 2026-04-01
202 MS_DRG Bronchitis And Asthma With Cc/Mcc 1 1 — — $13,795.68 $13,795.68 $13,795.68 2026-04-01
0265U CPT Rar Do Whl Gn&mtcdrl DNA Als 2 1 — — $13,141.92 $13,689.50 $13,415.71 2026-04-01
0212U CPT Rare Ds Gen DNA Alys Proband 2 1 — — $13,140.48 $13,688.00 $13,414.24 2026-04-01
81554 HCPCS Pulm Ds Ipf Mrna 190 Gen Alg 2 1 — — $13,068.00 $13,612.50 $13,340.25 2026-04-01
0295U CPT Onc Brst Dux Carc 7 Proteins 2 1 — — $13,044.00 $13,587.50 $13,315.75 2026-04-01
Q0224 HCPCS Inj, Pemivibart, 4500 Mg 2 1 — — $12,442.82 $13,693.68 $13,068.25 2026-04-01
5361 OTHER Level 1 Laparoscopy And Related Services 13 8 — — $4,196.20 $25,475.10 $12,860.10 2026-04-01
J0600 HCPCS Edetate Calcium Disodium Inj 2 1 — — $12,209.45 $13,436.85 $12,823.15 2026-04-01
0335U CPT Rare Ds Whl Gen Seq Fetal 2 1 — — $12,539.04 $13,061.50 $12,800.27 2026-04-01
0214U CPT Rare Ds Xom DNA Alys Proband 2 1 — — $12,539.04 $13,061.50 $12,800.27 2026-04-01
81425 HCPCS Genome Sequence Analysis 2 1 — — $12,074.88 $12,578.00 $12,326.44 2026-04-01
0242U CPT Trgt Gen Seq Alys Pnl 55-74 2 1 — — $12,000.00 $12,500.00 $12,250.00 2026-04-01
0326U CPT Trgt Gen Seq Alys Pnl 83+ 2 1 — — $12,000.00 $12,500.00 $12,250.00 2026-04-01
0108U CPT Gi Barrett Esoph 9 Prtn Bmrk 2 1 — — $11,880.00 $12,375.00 $12,127.50 2026-04-01
0036U CPT Xome Tum & Nml Spec Seq Alys 2 1 — — $11,472.00 $11,950.00 $11,711.00 2026-04-01
81415 HCPCS Exome Sequence Analysis 2 1 — — $11,472.00 $11,950.00 $11,711.00 2026-04-01
0473U CPT Onc Sld Tum Bld/slv 648 Gene 2 1 — — $10,800.00 $11,250.00 $11,025.00 2026-04-01
776 MS_DRG Postpartum And Post Abortion Diagnoses Without O.r. Procedures 1 1 — — $10,678.27 $10,678.27 $10,678.27 2026-04-01
683 MS_DRG Renal Failure With Cc 3 3 — — $3,100.20 $17,192.87 $10,653.17 2026-04-01
541 MS_DRG Osteomyelitis Without Cc/Mcc 1 1 — — $10,316.84 $10,316.84 $10,316.84 2026-04-01
542 MS_DRG Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 1 1 — — $10,303.18 $10,303.18 $10,303.18 2026-04-01
0300U CPT Onc Pan Tum Whl Gen Seq&opt 2 1 — — $10,039.51 $10,457.83 $10,248.67 2026-04-01
5491 OTHER Level 1 Intraocular Procedures 5 5 — — $9,965.40 $9,965.40 $9,965.40 2025-01-01
551 MS_DRG Medical Back Problems With Mcc 1 1 — — $9,959.24 $9,959.24 $9,959.24 2026-04-01
J1162 HCPCS Digoxin Immune Fab (ovine) 2 1 — — $9,390.62 $10,334.65 $9,862.64 2026-04-01
J0225 HCPCS Inj, Vutrisiran, 1 Mg 2 1 — — $9,367.43 $10,309.12 $9,838.28 2026-04-01
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 4 4 — — $5,434.88 $16,533.11 $9,829.41 2026-04-01
0340U CPT Onc Pan Ca Alys Mrd Plasma 2 1 — — $9,408.00 $9,800.00 $9,604.00 2026-04-01
0306U CPT Onc Mrd Nxt-gnrj Alys 1st 2 1 — — $9,308.28 $9,696.13 $9,502.20 2026-04-01
81522 HCPCS Onc Breast Mrna 12 Genes 2 1 — — $9,295.20 $9,682.50 $9,488.85 2026-04-01
81519 HCPCS Oncology Breast Mrna 2 1 — — $9,295.20 $9,682.50 $9,488.85 2026-04-01
0497U CPT Onc Prst8 Mrna Rt-pcr 6 Gene 2 1 — — $9,295.20 $9,682.50 $9,488.85 2026-04-01
0288U CPT Onc Lung Mrna Quan Pcr 11&3 2 1 — — $9,295.20 $9,682.50 $9,488.85 2026-04-01
81542 HCPCS Onc Prostate Mrna 22 Cnt Gen 2 1 — — $9,295.20 $9,682.50 $9,488.85 2026-04-01
81518 HCPCS Onc Brst Mrna 11 Genes 2 1 — — $9,295.20 $9,682.50 $9,488.85 2026-04-01
81521 HCPCS Onc Breast Mrna 70 Genes 2 1 — — $9,295.20 $9,682.50 $9,488.85 2026-04-01
81541 HCPCS Onc Prostate Mrna 46 Genes 2 1 — — $9,295.20 $9,682.50 $9,488.85 2026-04-01
0047U CPT Onc Prst8 Mrna 17 Gene Alg 2 1 — — $9,295.20 $9,682.50 $9,488.85 2026-04-01
0045U CPT Onc Brst Dux Carc Is 12 Gene 2 1 — — $9,295.20 $9,682.50 $9,488.85 2026-04-01
81523 HCPCS Onc Brst Mrna 70 Cnt 31 Gene 2 1 — — $9,295.20 $9,682.50 $9,488.85 2026-04-01
J0480 HCPCS Basiliximab 2 1 — — $8,859.67 $9,750.33 $9,305.00 2026-04-01
81540 HCPCS Oncology Tum Unknown Origin 2 1 — — $9,000.00 $9,375.00 $9,187.50 2026-04-01
0258U CPT Ai Psor Mrna 50-100 Gen Alg 2 1 — — $8,820.00 $9,187.50 $9,003.75 2026-04-01
0019U CPT Onc RNA Tiss Predict Alg 2 1 — — $8,820.00 $9,187.50 $9,003.75 2026-04-01
5113 OTHER Level 3 Musculoskeletal Procedures 21 11 — — $1,056.92 $28,757.12 $8,947.62 2026-04-01
71 MS_DRG Other Cerebrovascular Disorders With Cc 1 1 — — $8,893.86 $8,893.86 $8,893.86 2026-04-01
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 5 5 — — $6,207.16 $16,599.50 $8,839.68 2026-04-01
0287U CPT Onc Thyr Dna&mrna 112 Genes 2 1 — — $8,640.00 $9,000.00 $8,820.00 2026-04-01
0362U CPT Onc Pap Thyr Ca RNA 82&10 2 1 — — $8,640.00 $9,000.00 $8,820.00 2026-04-01
0313U CPT Onc Pncrs Dna&mrna Seq 74 2 1 — — $8,640.00 $9,000.00 $8,820.00 2026-04-01
0026U CPT Onc Thyr Dna&mrna 112 Genes 2 1 — — $8,640.00 $9,000.00 $8,820.00 2026-04-01
0391U CPT Onc Sld Tum Dna&rna 437 Gen 2 1 — — $8,640.00 $9,000.00 $8,820.00 2026-04-01
81546 HCPCS Onc Thyr Mrna 10,196 Gen Alg 2 1 — — $8,640.00 $9,000.00 $8,820.00 2026-04-01
J7504 HCPCS Lymphocyte Immune Globulin 2 1 — — $8,271.19 $9,102.68 $8,686.94 2026-04-01
5182 OTHER Level 2 Vascular Procedures 2 2 — — $4,744.78 $12,596.71 $8,670.74 2026-04-01
0080U CPT Onc Lng 5 Clin Rsk Factr Alg 2 1 — — $8,448.00 $8,800.00 $8,624.00 2026-04-01
0334U CPT Onc Sld Orgn Tgsa DNA 84/+ 2 1 — — $8,400.00 $8,750.00 $8,575.00 2026-04-01
0244U CPT Onc Solid Orgn DNA 257 Genes 2 1 — — $8,400.00 $8,750.00 $8,575.00 2026-04-01
0388U CPT Onc Nonsm Cll Lng Ca 37 Gen 2 1 — — $8,400.00 $8,750.00 $8,575.00 2026-04-01
0239U CPT Trgt Gen Seq Alys Pnl 311+ 2 1 — — $8,400.00 $8,750.00 $8,575.00 2026-04-01
0037U CPT Trgt Gen Seq DNA 324 Genes 2 1 — — $8,400.00 $8,750.00 $8,575.00 2026-04-01
0016M OTHER Onc Bladder Mrna 209 Gen Alg 2 1 — — $8,375.11 $8,724.08 $8,549.60 2026-04-01
5092 OTHER Level 2 Breast/Lymphatic Surgery And Related Procedures 2 2 — — $8,548.98 $8,548.98 $8,548.98 2025-01-01
189 MS_DRG Pulmonary Edema And Respiratory Failure 3 3 — — $8,252.45 $39,932.40 $8,484.06 2026-04-01
0329U CPT Onc Neo Xome&trns Seq Alys 2 1 — — $8,251.15 $8,594.95 $8,423.05 2026-04-01
5091 OTHER Level 1 Breast/Lymphatic Surgery And Related Procedures 10 8 — — $1,325.76 $34,062.06 $8,406.34 2026-04-01
81440 HCPCS Mitochondrial Gene 2 1 — — $7,977.60 $8,310.00 $8,143.80 2026-04-01
81464 HCPCS So Gsap Cll Fr Mcrstl Ins 2 1 — — $7,892.42 $8,221.28 $8,056.85 2026-04-01
0379U CPT Tgsap Sl Or Neo Dna523&rna55 2 1 — — $7,892.42 $8,221.28 $8,056.85 2026-04-01
81558 HCPCS Trnspl Rej Kdn Mrna Qpcr 139 2 1 — — $7,776.00 $8,100.00 $7,938.00 2026-04-01
81595 HCPCS Cardiology Hrt Trnspl Mrna 2 1 — — $7,776.00 $8,100.00 $7,938.00 2026-04-01
0055U CPT Card Hrt Trnspl 96 DNA Seq 2 1 — — $7,776.00 $8,100.00 $7,938.00 2026-04-01
J9200 HCPCS Floxuridine Injection 2 1 — — $7,537.95 $8,295.73 $7,916.84 2026-04-01
0262U CPT Onc Sld Tum Rt-pcr 7 Gen 2 1 — — $7,680.00 $8,000.00 $7,840.00 2026-04-01
0266U CPT Unxpl Cnst Hrtbl Do Gn Xprsn 2 1 — — $7,680.00 $8,000.00 $7,840.00 2026-04-01
0088U CPT Trnsplj Kdn Algrft Rej 1494 2 1 — — $7,582.61 $7,898.55 $7,740.58 2026-04-01
0153U CPT Onc Breast Mrna 101 Genes 2 1 — — $7,582.61 $7,898.55 $7,740.58 2026-04-01
0253U CPT Rprdtve Med RNA Gen Prfl 238 2 1 — — $7,582.61 $7,898.55 $7,740.58 2026-04-01
0087U CPT Crd Hrt Trnspl Mrna 1283 Gen 2 1 — — $7,582.61 $7,898.55 $7,740.58 2026-04-01
J0801 HCPCS Inj. Acthar Gel To 40 Units 2 1 — — $7,358.58 $8,098.33 $7,728.45 2026-04-01
864 MS_DRG Fever And Inflammatory Conditions 1 1 — — $7,689.15 $7,689.15 $7,689.15 2026-04-01
5041 OTHER Critical Care 34 15 — — $2,337.87 $15,586.60 $7,670.30 2026-04-01
81525 HCPCS Oncology Colon Mrna 2 1 — — $7,478.40 $7,790.00 $7,634.20 2026-04-01
0248U CPT Onc Brn Sphrd Cll 12 Rx Pnl 2 1 — — $7,281.26 $7,584.65 $7,432.95 2026-04-01
0435U CPT Onc Chemo Rx Cytox Csc 14 Rx 2 1 — — $7,281.26 $7,584.65 $7,432.95 2026-04-01
0511U CPT Onc Sol Tum 3dmicroenvir 36+ 2 1 — — $7,281.26 $7,584.65 $7,432.95 2026-04-01
0172U CPT Onc Sld Tum Alys Brca1 Brca2 2 1 — — $7,272.00 $7,575.00 $7,423.50 2026-04-01
Q4328 HCPCS Most, Per Sq Cm 2 1 — — $7,011.90 $7,716.80 $7,364.35 2026-04-01
0018U CPT Onc Thyr 10 Microrna Seq Alg 2 1 — — $7,205.02 $7,505.23 $7,355.12 2026-04-01
81459 HCPCS So Neo Gsap Dna/dna&rna 2 1 — — $7,174.92 $7,473.88 $7,324.40 2026-04-01
5073 OTHER Level 3 Excision/ Biopsy/ Incision And Drainage 14 8 — — $5,456.57 $22,490.54 $7,270.48 2026-04-01
9512 OTHER Rbc Leukocytes Reduced 1 1 — — $7,219.70 $7,219.70 $7,219.70 2026-04-01
0298U CPT Onc Pan Tum Whl Trns Seq RNA 2 1 — — $7,007.04 $7,299.00 $7,153.02 2026-04-01
0250U CPT Onc Sld Org Neo DNA 505 Gene 2 1 — — $7,007.04 $7,299.00 $7,153.02 2026-04-01
81455 HCPCS Targeted Genomic Seq Analys 2 1 — — $7,007.04 $7,299.00 $7,153.02 2026-04-01
0409U CPT Onc Sld Tum DNA 80 & RNA 36 2 1 — — $7,007.04 $7,299.00 $7,153.02 2026-04-01
0048U CPT Onc Sld Org Neo DNA 468 Gene 2 1 — — $7,007.04 $7,299.00 $7,153.02 2026-04-01
0487U CPT Onc Sol Tum Cfcdna Tgsap 84 2 1 — — $7,007.04 $7,299.00 $7,153.02 2026-04-01
0444U CPT Onc Sld Orgn Neo Tgsap 361 2 1 — — $7,007.04 $7,299.00 $7,153.02 2026-04-01
81456 HCPCS Tgsap So/hl 51/< RNA Alys 2 1 — — $7,007.04 $7,299.00 $7,153.02 2026-04-01
0297U CPT Onc Pan Tum Whl Gen Seq DNA 2 1 — — $7,007.04 $7,299.00 $7,153.02 2026-04-01
0050U CPT Trgt Gen Seq DNA 194 Genes 2 1 — — $6,999.84 $7,291.50 $7,145.67 2026-04-01
J2507 HCPCS Pegloticase 8 Mg/ml IV Soln 2 1 — — $6,738.45 $7,415.86 $7,077.15 2026-04-01
81538 HCPCS Oncology Lung 2 1 — — $6,890.40 $7,177.50 $7,033.95 2026-04-01
0417U CPT Rare Ds Alys 335 Nuc Genes 2 1 — — $6,822.07 $7,106.33 $6,964.20 2026-04-01
J3316 HCPCS Inj., Triptorelin Xr 3.75 Mg 2 1 — — $6,626.42 $7,292.57 $6,959.49 2026-04-01
J0802 HCPCS Inj. (ani), Up To 40 Units 2 1 — — $6,512.15 $7,166.81 $6,839.48 2026-04-01
0118U CPT Trnsplj Don-drv Cll-fr DNA 2 1 — — $6,607.80 $6,883.13 $6,745.47 2026-04-01
0493U CPT Trnspl Med Quan Dd-cfdna Ngs 2 1 — — $6,607.80 $6,883.13 $6,745.47 2026-04-01
Q4303 HCPCS Complete Aa, Per Sq Cm 2 1 — — $6,421.09 $7,066.59 $6,743.84 2026-04-01
5313 OTHER Level 3 Lower Gi Procedures 8 6 — — $4,443.36 $17,497.71 $6,696.72 2026-04-01
Q4270 HCPCS Complete Sl Per Sq Cm 2 1 — — $6,370.81 $7,011.26 $6,691.03 2026-04-01
0213U CPT Rare Ds Gen DNA Alys Ea Comp 2 1 — — $6,503.88 $6,774.88 $6,639.38 2026-04-01
81426 HCPCS Genome Sequence Analysis 2 1 — — $6,503.88 $6,774.88 $6,639.38 2026-04-01
Q4313 HCPCS Dermabind Fm, Per Sq Cm 2 1 — — $6,307.37 $6,941.44 $6,624.40 2026-04-01
5442 OTHER Level 2 Nerve Injections 12 10 — — $1,056.76 $7,416.82 $6,529.77 2026-04-01
5183 OTHER Level 3 Vascular Procedures 4 3 — — $1,067.62 $13,398.41 $6,518.05 2026-04-01
0320U CPT Neph RNA Psttrnspl Perph Bld 2 1 — — $6,360.00 $6,625.00 $6,492.50 2026-04-01
0319U CPT Neph RNA Pretrnspl Perph Bld 2 1 — — $6,360.00 $6,625.00 $6,492.50 2026-04-01
Q4280 HCPCS Xcell Amnio Matrix Per Sq Cm 2 1 — — $6,135.03 $6,751.78 $6,443.40 2026-04-01
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 3 3 — — $6,310.05 $94,093.95 $6,310.05 2026-04-01
0215U CPT Rare Ds Xom DNA Alys Ea Comp 2 1 — — $6,179.16 $6,436.63 $6,307.90 2026-04-01
0336U CPT Rare Ds Whl Gen Seq Bld/slv 2 1 — — $6,179.16 $6,436.63 $6,307.90 2026-04-01
5163 OTHER Level 3 ENT Procedures 2 1 — — $6,239.99 $6,239.99 $6,239.99 2025-01-01
5102 OTHER Level 2 Strapping And Cast Application 1 1 — — $6,238.15 $6,238.15 $6,238.15 2026-04-01
0261U CPT Onc Clrct Ca Img Alys W/ai 2 1 — — $6,031.80 $6,283.13 $6,157.47 2026-04-01
0017M OTHER Onc Dlbcl Mrna 20 Genes Alg 2 1 — — $6,024.50 $6,275.53 $6,150.01 2026-04-01
0120U CPT Onc B Cll Lymphm Mrna 58 Gen 2 1 — — $6,024.50 $6,275.53 $6,150.01 2026-04-01
81520 HCPCS Onc Breast Mrna 58 Genes 2 1 — — $6,024.50 $6,275.53 $6,150.01 2026-04-01
0092U CPT Onc Lng 3 Prtn Bmrk Plsm Alg 2 1 — — $5,971.20 $6,220.00 $6,095.60 2026-04-01
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/Mcc 1 1 — — $6,086.07 $6,086.07 $6,086.07 2026-04-01
5072 OTHER Level 2 Excision/ Biopsy/ Incision And Drainage 25 14 — — $1,545.87 $13,113.48 $6,008.22 2026-04-01
81419 HCPCS Epilepsy Gen Seq Alys Panel 2 1 — — $5,876.54 $6,121.40 $5,998.97 2026-04-01
0276U CPT Hem Inh Thrombocytopenia 23 2 1 — — $5,876.54 $6,121.40 $5,998.97 2026-04-01
81443 HCPCS Genetic Tstg Severe Inh Cond 2 1 — — $5,876.54 $6,121.40 $5,998.97 2026-04-01
81412 HCPCS Ashkenazi Jewish Assoc Dis 2 1 — — $5,876.54 $6,121.40 $5,998.97 2026-04-01
81441 HCPCS Ibmfs Seq Alys Pnl 30 Genes 2 1 — — $5,876.54 $6,121.40 $5,998.97 2026-04-01
0492U CPT Onc Sol Tum Ctc Slctn Pd-l1 2 1 — — $5,844.00 $6,087.50 $5,965.75 2026-04-01
0490U CPT Onc Cutan/uveal Mlnma Cd146 2 1 — — $5,844.00 $6,087.50 $5,965.75 2026-04-01
0491U CPT Onc Sol Tum Ctc Slct ER Prtn 2 1 — — $5,844.00 $6,087.50 $5,965.75 2026-04-01
0337U CPT Onc Plsm Cell Do&myeloma Id 2 1 — — $5,844.00 $6,087.50 $5,965.75 2026-04-01
0338U CPT Onc Sld Tum Crcg Tum Cl Slct 2 1 — — $5,844.00 $6,087.50 $5,965.75 2026-04-01
95 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Cc 1 1 — — $5,944.81 $5,944.81 $5,944.81 2026-04-01
563 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 2 2 — — $5,875.23 $5,875.23 $5,875.23 2026-04-01
Q4343 HCPCS Dermacyte Ac Matrx Per Sq Cm 2 1 — — $5,579.47 $6,140.37 $5,859.92 2026-04-01
Q4204 HCPCS Xwrap 1 Sq Cm 2 1 — — $5,535.84 $6,092.36 $5,814.10 2026-04-01
5694 OTHER Level 4 Drug Administration 22 13 — — $339.50 $19,919.68 $5,795.66 2026-04-01
81427 HCPCS Genome Re-evaluation 2 1 — — $5,610.36 $5,844.13 $5,727.24 2026-04-01
Q4250 HCPCS Amnioamp-mp Per Sq Cm 2 1 — — $5,411.32 $5,955.32 $5,683.32 2026-04-01
Q4269 HCPCS Surgraft Xt Per Sq Cm 2 1 — — $5,409.18 $5,952.96 $5,681.07 2026-04-01
1433 OTHER Calcitonin Salmon Injection 1 1 — — $5,678.96 $5,678.96 $5,678.96 2025-01-01
0218U CPT Neuro Musc Dys Dmd Seq Alys 2 1 — — $5,469.60 $5,697.50 $5,583.55 2026-04-01
Q4248 HCPCS Dermacyte Amn Mem Allo Sq Cm 2 1 — — $5,286.53 $5,817.98 $5,552.25 2026-04-01
5374 OTHER Level 4 Urology And Related Services 3 3 — — $5,548.41 $5,548.41 $5,548.41 2025-01-01
8008 OTHER MRI And MRA With Contrast Composite 14 9 — — $5,544.01 $5,544.01 $5,544.01 2025-01-01
J9286 HCPCS Inj Glofitamab Gxbm, 2.5 Mg 2 1 — — $5,240.59 $5,767.42 $5,504.01 2026-04-01
0249U CPT Onc Brst Alys 32 Phsprtn Alg 2 1 — — $5,325.91 $5,547.83 $5,436.87 2026-04-01
0206U CPT Neuro Alzheimer Cell Aggregj 2 1 — — $5,316.96 $5,538.50 $5,427.73 2026-04-01
0303U CPT Hem Rbc Ads Whl Bld Hypoxic 2 1 — — $5,283.89 $5,504.05 $5,393.97 2026-04-01
5054 OTHER Level 4 Skin Procedures 3 3 — — $5,393.48 $5,393.48 $5,393.48 2025-01-01
0217U CPT Neuro Inh Ataxia DNA 51 Gene 2 1 — — $5,276.04 $5,495.88 $5,385.96 2026-04-01
5161 OTHER Level 1 ENT Procedures 7 7 — — $2,471.19 $10,791.96 $5,321.86 2026-04-01
Q4275 HCPCS Esano Aca, Per Sq Cm 2 1 — — $5,058.59 $5,567.12 $5,312.85 2026-04-01
J9268 HCPCS Pentostatin 10 Mg IV Solr 2 1 — — $5,052.78 $5,560.74 $5,306.76 2026-04-01
J9229 HCPCS Inj Inotuzumab Ozogam 0.1 Mg 2 1 — — $5,023.86 $5,528.91 $5,276.39 2026-04-01
Q4319 HCPCS Sanograft, Per Sq Cm 2 1 — — $5,008.50 $5,512.00 $5,260.25 2026-04-01
Q4294 HCPCS Amnio Quad-core, Per Sq Cm 2 1 — — $5,008.50 $5,512.00 $5,260.25 2026-04-01
81442 HCPCS Noonan Spectrum Disorders 2 1 — — $5,144.64 $5,359.00 $5,251.82 2026-04-01
0152U CPT Nfct Bct Fng Prst DNA >1000 2 1 — — $5,102.88 $5,315.50 $5,209.19 2026-04-01
0480U CPT Nfct Ds Csf Metag Ngs Alys 2 1 — — $5,102.88 $5,315.50 $5,209.19 2026-04-01
0323U CPT Iadna Cns Pthgn Next Gen Seq 2 1 — — $5,102.88 $5,315.50 $5,209.19 2026-04-01
Q4299 HCPCS Amnicore Pro+, Per Sq Cm 2 1 — — $4,908.33 $5,401.76 $5,155.05 2026-04-01
5312 OTHER Level 2 Lower Gi Procedures 17 10 — — $3,838.01 $9,608.49 $5,137.52 2026-04-01
682 MS_DRG Renal Failure With Mcc 1 1 — — $5,086.55 $5,086.55 $5,086.55 2026-04-01
0304U CPT Hem Rbc Ads Whl Bld Normoxic 2 1 — — $4,981.92 $5,189.50 $5,085.71 2026-04-01
81551 HCPCS Onc Prostate 3 Genes 2 1 — — $4,872.00 $5,075.00 $4,973.50 2026-04-01
0317U CPT Onc Lung Ca 4-prb Fish Assay 2 1 — — $4,872.00 $5,075.00 $4,973.50 2026-04-01
9290 OTHER Inj, Bupivacaine, Nos, 0.5mg 1 1 — — $4,972.77 $4,972.77 $4,972.77 2025-01-01
0364U CPT Onc Hl Neo Gen Seq Alys Alg 2 1 — — $4,817.40 $5,018.13 $4,917.76 2026-04-01
81408 HCPCS Hchrg Molecular Path Procedure Level 9 2 1 — — $4,800.00 $5,000.00 $4,900.00 2026-04-01
5112 OTHER Level 2 Musculoskeletal Procedures 25 14 — — $2,511.18 $11,946.60 $4,879.74 2026-04-01
J0202 HCPCS Injection, Alemtuzumab 2 1 — — $4,614.42 $5,078.31 $4,846.36 2026-04-01
0296U CPT Onc Orl&/orop Ca 20 Mlc Feat 2 1 — — $4,680.00 $4,875.00 $4,777.50 2026-04-01
0022U CPT Trgt Gen Seq Dna&rna 23 Gene 2 1 — — $4,680.00 $4,875.00 $4,777.50 2026-04-01
0090U CPT Onc Cutan Mlnma Mrna 23 Gene 2 1 — — $4,680.00 $4,875.00 $4,777.50 2026-04-01
0314U CPT Onc Cutan Mlnma Mrna 35 Gene 2 1 — — $4,680.00 $4,875.00 $4,777.50 2026-04-01
0170U CPT Neuro Asd RNA Next Gen Seq 2 1 — — $4,680.00 $4,875.00 $4,777.50 2026-04-01
0179U CPT Onc Nonsm Cll Lng Ca Alys 23 2 1 — — $4,663.70 $4,858.03 $4,760.86 2026-04-01
0114U CPT Gi Barretts Esoph Vim&ccna1 2 1 — — $4,651.22 $4,845.03 $4,748.12 2026-04-01
0506U CPT Gi Barretts Esophgl Cell 89 2 1 — — $4,651.22 $4,845.03 $4,748.12 2026-04-01
0465U CPT Onc Urthl Carc DNA Qmsp 2gen 2 1 — — $4,651.22 $4,845.03 $4,748.12 2026-04-01
Q4279 HCPCS Vendaje Ac, Per Sq Cm 2 1 — — $4,507.65 $4,960.80 $4,734.23 2026-04-01
Q4239 HCPCS Amnio-maxx Or Lite Per Sq Cm 2 1 — — $4,441.36 $4,887.84 $4,664.60 2026-04-01
0341U CPT Ftl Aneup DNA Seq Cmpr Alys 2 1 — — $4,560.48 $4,750.50 $4,655.49 2026-04-01
0067U CPT Onc Brst Imhchem Prfl 4 Bmrk 2 1 — — $4,552.80 $4,742.50 $4,647.65 2026-04-01
Q4295 HCPCS Amnio Tri-core, Per Sq Cm 2 1 — — $4,407.48 $4,850.56 $4,629.02 2026-04-01
0331U CPT Onc Hl Neo Opt Gen Mapping 2 1 — — $4,471.73 $4,658.05 $4,564.89 2026-04-01
0299U CPT Onc Pan Tum Whl Gen Opt Mapg 2 1 — — $4,471.73 $4,658.05 $4,564.89 2026-04-01
5164 OTHER Level 4 ENT Procedures 2 2 — — $4,535.53 $4,535.53 $4,535.53 2025-01-01
Q4298 HCPCS Amnicore Pro, Per Sq Cm 2 1 — — $4,307.31 $4,740.32 $4,523.82 2026-04-01
5781 OTHER Resuscitation And Cardioversion 11 7 — — $2,041.28 $11,085.49 $4,507.66 2026-04-01
81162 HCPCS Brca1&2 Seq & Full Dup/del 2 1 — — $4,379.71 $4,562.20 $4,470.95 2026-04-01
0449U CPT Car Scr Sev Inh Cond 5 Genes 2 1 — — $4,379.71 $4,562.20 $4,470.95 2026-04-01
0356U CPT Onc Orop 17 DNA Ddpcr Alg 2 1 — — $4,320.00 $4,500.00 $4,410.00 2026-04-01
Q4310 HCPCS Procenta, Per 100 Mg 2 1 — — $4,182.83 $4,603.33 $4,393.08 2026-04-01
8006 OTHER CT And CTA With Contrast Composite 20 12 — — $4,350.05 $4,350.05 $4,350.05 2025-01-01
0405U CPT Onc Pncrtc 59 Mthltn Blk Mrk 2 1 — — $4,249.15 $4,426.20 $4,337.67 2026-04-01
0318U CPT Ped Whl Gen Mthyltn Alys 50+ 2 1 — — $4,249.15 $4,426.20 $4,337.67 2026-04-01
5111 OTHER Level 1 Musculoskeletal Procedures 26 14 — — $960.93 $9,406.86 $4,316.24 2026-04-01
0292U CPT Psyc Strs Do Mrna 72 Genes 2 1 — — $4,212.00 $4,387.50 $4,299.75 2026-04-01
0291U CPT Psyc Mood Do Mrna 144 Genes 2 1 — — $4,212.00 $4,387.50 $4,299.75 2026-04-01
0398U CPT Gi Baret Esph DNA Mthyln Aly 2 1 — — $4,212.00 $4,387.50 $4,299.75 2026-04-01
0103U CPT Hered Ova Ca Pnl 24 Genes 2 1 — — $4,185.48 $4,359.88 $4,272.68 2026-04-01
0101U CPT Hered Colon Ca Do 15 Genes 2 1 — — $4,185.48 $4,359.88 $4,272.68 2026-04-01
0156U CPT Copy Number Sequence Alys 2 1 — — $4,176.00 $4,350.00 $4,263.00 2026-04-01
Q4300 HCPCS Acesso Tl, Per Sq Cm 2 1 — — $3,996.78 $4,398.58 $4,197.68 2026-04-01
J3240 HCPCS Thyrotropin Alfa 0.9 Mg IM Solr 2 1 — — $3,928.76 $4,323.72 $4,126.24 2026-04-01
5025 OTHER Level 5 Type A Ed Visits 44 17 — — $1,122.00 $9,212.64 $4,124.05 2026-04-01
Q4325 HCPCS Acapatch, Per Sq Cm 2 1 — — $3,906.63 $4,299.36 $4,102.99 2026-04-01
Q4221 HCPCS Amniowrap2 Per Sq Cm 2 1 — — $3,806.46 $4,189.12 $3,997.79 2026-04-01
Q4302 HCPCS Complete Aca, Per Sq Cm 2 1 — — $3,796.44 $4,178.10 $3,987.27 2026-04-01
81430 HCPCS Hearing Loss Sequence Analys 2 1 — — $3,900.00 $4,062.50 $3,981.25 2026-04-01
Q9991 HCPCS Buprenorph Xr 100 Mg Or Less 2 1 — — $3,638.69 $4,004.48 $3,821.59 2026-04-01
Q9992 HCPCS Buprenorphine Xr Over 100 Mg 2 1 — — $3,638.69 $4,004.48 $3,821.59 2026-04-01
0216U CPT Neuro Inh Ataxia DNA 12 Com 2 1 — — $3,688.85 $3,842.55 $3,765.70 2026-04-01
Q4301 HCPCS Activate Matrix, Per Sq Cm 2 1 — — $3,584.88 $3,945.26 $3,765.07 2026-04-01
0171U CPT Trgt Gen Seq Alys Pnl DNA 23 2 1 — — $3,645.74 $3,797.65 $3,721.69 2026-04-01
0467U CPT Onc Bldr DNA Ngs 60gen&aneup 2 1 — — $3,645.74 $3,797.65 $3,721.69 2026-04-01
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