Hospital

GRANDE RONDE HOSPITAL

La Grande, OR · CCN 381321 · Rates published

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You selected 93350 (CPT)

Ultrasound heart during rest, exercise, drug stress

This hospital’s price: $266 across 11 payers · range $144-$1,688

Source: https://www.grh.org/clientfiles/GetFile/930505325_grande-ronde-hospital_standardcharges.csv · observed 2025-02-06

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

3,417 distinct procedures filed

11 distinct payers

102,472 rate rows

2025-02-06 last MRF observed · ⚠ 20 mo old

Data quality

102,413 of 102,472 rate rows are consumer-grade (99.9%)

59 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 — reason	Rows
per-diem day rate — not a per-procedure price	30
placeholder amount (≤ $0.02) — excluded from medians	14
percent-of-charges filed in the dollar field — excluded from medians	12
exceeds 10× this hospital's gross charge — excluded from medians	2
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	1

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://www.grh.org/clientfiles/GetFile/930505325_grande-ronde-hospital_standardcharges.csv
Found on page	https://www.grh.org/patients-visitors/price-transparency/
Discovered via	CMS hospital list
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-10-01
Content fingerprint	b7c71e20344cfa74… · 71,676,408 bytes · first seen 2026-05-15

Top 50 most expensive offerings

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

Code	Description	Payers	Min $	Max $	Avg median	vs national
J9347 HCPCS	Tremelimumab-actl 300 Mg/15ml IV Soln	11	$46,388.64	$102,055.00	$96,900.71	nat. median $2,868 outlier · 33.8×
J9298 HCPCS	Nivolumab-relatlimab-rmbw 240-80 Mg/20ml IV Soln	11	$34,591.41	$76,101.10	$72,257.61	nat. median $561 outlier · 128.8×
J9043 HCPCS	Cabazitaxel 60 Mg/1.5ml IV Soln	11	$16,547.44	$36,404.37	$34,565.76	nat. median $735 outlier · 47.1×
J2350 HCPCS	Ocrelizumab 300 Mg/10ml IV Soln	11	$13,115.02	$28,853.04	$27,395.81	nat. median $470 outlier · 58.3×
J9022 HCPCS	Atezolizumab 1200 Mg/20ml IV Soln	11	$12,796.04	$28,151.29	$26,729.51	nat. median $6,785 outlier · 3.9×
J9119 HCPCS	Cemiplimab-rwlc 350 Mg/7ml IV Soln	11	$12,066.96	$26,547.31	$25,206.53	nat. median $91 outlier · 276.9×
J9144 HCPCS	Daratumumab-hyaluronidase-fihj 1800-30000 Mg-ut/15ml Subq Soln	11	$11,306.52	$24,874.35	$23,618.08	nat. median $211 outlier · 111.7×
J9042 HCPCS	Brentuximab Vedotin 50 Mg IV Solr	11	$10,471.13	$23,036.48	$21,873.02	nat. median $951 outlier · 23.0×
J9228 HCPCS	Ipilimumab 50 Mg/10ml IV Soln	11	$10,210.51	$22,463.12	$21,328.62	nat. median $9,003 outlier · 2.4×
J3380 HCPCS	Vedolizumab 300 Mg IV Solr	11	$10,167.95	$22,369.50	$21,239.72	nat. median $162 outlier · 131.1×
J9301 HCPCS	Obinutuzumab 1000 Mg/40ml IV Soln	11	$9,673.50	$21,281.70	$20,206.87	nat. median $287 outlier · 70.4×
J9223 HCPCS	Lurbinectedin 4 Mg IV Solr	11	$9,426.87	$20,739.12	$19,691.69	nat. median $617 outlier · 31.9×
J9307 HCPCS	Pralatrexate 20 Mg/ml IV Soln	11	$8,370.71	$36,657.83	$18,136.53	nat. median $897 outlier · 20.2×
J0135 HCPCS	Adalimumab 80 Mg/0.8ml Subq Ajkt	11	$7,504.36	$16,509.59	$15,675.77	nat. median $3,427 outlier · 4.6×
J9063 HCPCS	Mirvetuximab Soravtansine-gynx 100 Mg/20ml IV Soln	11	$7,319.76	$16,103.48	$15,290.17	nat. median $210 outlier · 72.7×
J9271 HCPCS	Pembrolizumab 100 Mg/4ml IV Soln	11	$6,677.95	$14,691.48	$13,949.49	nat. median $276 outlier · 50.6×
J2327 HCPCS	Risankizumab-rzaa 600 Mg/10ml IV Soln	11	$5,715.56	$12,574.24	$11,939.17	nat. median $2,076 outlier · 5.8×
J2323 HCPCS	Natalizumab 300 Mg/15ml IV Conc	11	$5,548.06	$12,205.74	$11,589.29	nat. median $197 outlier · 58.8×
J2506 HCPCS	Pegfilgrastim 6 Mg/0.6ml Subq Sosy	11	$4,668.67	$10,271.08	$9,752.34	nat. median $1,646 outlier · 5.9×
PX-36010153 CDM	Hc Operating Room Services Level 8 1st 30 Mins	11	$4,442.31	$9,773.08	$9,279.49	nat. median $3,184 outlier · 2.9×
J9311 HCPCS	Rituximab-hyaluronidase Human 1400-23400 Mg -ut/11.7ml Subq Soln	11	$4,423.75	$9,732.25	$9,240.73	nat. median $2,428 outlier · 3.8×
J1950 HCPCS	Leuprolide Acetate 3.75 Mg IM Kit	11	$1,679.74	$26,695.83	$8,996.05	nat. median $3,902 outlier · 2.3×
J9061 HCPCS	Amivantamab-vmjw 350 Mg/7ml IV Soln	11	$4,301.15	$9,462.54	$8,984.63	nat. median $68 outlier · 132.6×
J9332 HCPCS	Efgartigimod Alfa-fcab 400 Mg/20ml IV Soln	11	$4,082.85	$8,982.26	$8,528.61	nat. median $112 outlier · 75.8×
J9047 HCPCS	Carfilzomib 60 Mg IV Solr	11	$3,868.67	$8,511.08	$8,081.23	nat. median $1,607 outlier · 5.0×
J9299 HCPCS	Nivolumab 100 Mg/10ml IV Soln	11	$1,754.21	$19,726.59	$8,062.07	nat. median $2,889 outlier · 2.8×
PX-36010152 CDM	Hc Operating Room Services Level 7 1st 30 Mins	11	$3,848.53	$8,466.78	$8,039.16	nat. median $3,184 outlier · 2.5×
J0491 HCPCS	Anifrolumab-fnia 300 Mg/2ml IV Soln	11	$3,518.92	$7,741.63	$7,350.64	nat. median $65 outlier · 113.7×
J0517 HCPCS	Benralizumab 30 Mg/ml Subq Soaj	11	$3,380.94	$8,402.68	$7,175.10	nat. median $919 outlier · 7.8×
J9205 HCPCS	Irinotecan Hcl Liposome 43 Mg/10ml IV Inj	11	$3,356.62	$7,384.57	$7,011.61	nat. median $202 outlier · 34.7×
J2427 HCPCS	Paliperidone Palmitate ER 410 Mg/1.32ml IM Susy	11	$3,183.30	$13,965.43	$7,003.27	nat. median $2,599 outlier · 2.7×
J9145 HCPCS	Daratumumab 400 Mg/20ml IV Soln	11	$3,351.23	$7,372.71	$7,000.35	nat. median $609 outlier · 11.5×
J7169 HCPCS	Coag Fact Xa Inactivated-zhzo 200 Mg IV Solr	11	$3,348.09	$7,365.79	$6,993.78	nat. median $275 outlier · 25.4×
J9358 HCPCS	Fam-trastuzumab Deruxtec-nxki 100 Mg IV Solr	11	$3,325.62	$7,316.36	$6,946.84	nat. median $95 outlier · 72.9×
J0896 HCPCS	Luspatercept-aamt 25 Mg Subq Solr	11	$2,661.97	$17,539.22	$6,914.35	nat. median $4,583 1.5× median
PX-36010151 CDM	Hc Operating Room Services Level 6 1st 30 Mins	11	$3,267.95	$7,189.48	$6,826.37	nat. median $3,184 outlier · 2.1×
G0235 HCPCS	Hc PET Not Otherwise Specified	11	$3,143.93	$6,916.64	$6,567.31	nat. median $583 outlier · 11.3×
G0252 HCPCS	Hc PET Imaging Initial Dx Breast	11	$3,143.93	$6,916.64	$6,567.31	nat. median $1,836 outlier · 3.6×
J9308 HCPCS	Ramucirumab 100 Mg/10ml IV Soln	11	$2,001.84	$18,828.44	$6,481.21	nat. median $1,489 outlier · 4.4×
PX-36010150 CDM	Hc Operating Room Services Level 5 1st 30 Mins	11	$3,004.99	$6,610.97	$6,277.09	nat. median $3,184 2.0× median
J1162 HCPCS	Digoxin Immune Fab 40 Mg IV Solr	11	$2,966.66	$6,526.65	$6,197.02	nat. median $7,141 0.9× median
78815 CPT	Nuclear Medicine Study From Skull Base To Mid-thigh W/ct	11	$2,960.93	$6,514.05	$6,185.06	nat. median $2,820 outlier · 2.2×
J2799 HCPCS	Risperidone ER 200 Mg/0.56ml Subq Susy	11	$2,956.36	$6,503.98	$6,175.50	nat. median $1,131 outlier · 5.5×
J9317 HCPCS	Sacituzumab Govitecan-hziy 180 Mg IV Solr	11	$2,924.67	$6,434.28	$6,109.32	nat. median $109 outlier · 55.8×
J0791 HCPCS	Crizanlizumab-tmca 100 Mg/10ml IV Soln	11	$2,911.85	$6,406.06	$6,082.52	nat. median $354 outlier · 17.2×
J2356 HCPCS	Tezepelumab-ekko 210 Mg/1.91ml Subq Sosy	11	$2,801.04	$6,162.29	$5,851.07	nat. median $81 outlier · 72.0×
J9177 HCPCS	Enfortumab Vedotin-ejfv 20 Mg IV Solr	11	$2,707.03	$8,871.29	$5,805.07	nat. median $2,933 2.0× median
J9034 HCPCS	Bendamustine Hcl 100 Mg/4ml IV Soln	11	$2,739.36	$6,026.59	$5,722.22	nat. median $90 outlier · 63.9×
J9176 HCPCS	Elotuzumab 300 Mg IV Solr	11	$2,653.51	$7,742.33	$5,690.31	nat. median $2,651 outlier · 2.1×
PX-20610001 CDM	Hc Intensive Care Intermediate	8	$3,131.86	$5,741.75	$5,567.76	nat. median $5,568 1.0× median

Other procedures at this hospital

Browse this hospital's 3,417 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

J9347	HCPCS	Tremelimumab-actl 300 Mg/15ml IV Soln	12	11	$103,085.86	$103,085.86	$46,388.64	$102,055.00	$96,900.71	2025-02-06
J9298	HCPCS	Nivolumab-relatlimab-rmbw 240-80 Mg/20ml IV Soln	12	11	$76,869.80	$76,869.80	$34,591.41	$76,101.10	$72,257.61	2025-02-06
J9043	HCPCS	Cabazitaxel 60 Mg/1.5ml IV Soln	12	11	$36,772.09	$36,772.09	$16,547.44	$36,404.37	$34,565.76	2025-02-06
J2350	HCPCS	Ocrelizumab 300 Mg/10ml IV Soln	12	11	$29,144.48	$29,144.48	$13,115.02	$28,853.04	$27,395.81	2025-02-06
J9022	HCPCS	Atezolizumab 1200 Mg/20ml IV Soln	12	11	$28,435.65	$28,435.65	$12,796.04	$28,151.29	$26,729.51	2025-02-06
J9119	HCPCS	Cemiplimab-rwlc 350 Mg/7ml IV Soln	12	11	$26,815.46	$26,815.46	$12,066.96	$26,547.31	$25,206.53	2025-02-06
J9144	HCPCS	Daratumumab-hyaluronidase-fihj 1800-30000 Mg-ut/15ml Subq Soln	12	11	$25,125.61	$25,125.61	$11,306.52	$24,874.35	$23,618.08	2025-02-06
J9042	HCPCS	Brentuximab Vedotin 50 Mg IV Solr	12	11	$23,269.17	$23,269.17	$10,471.13	$23,036.48	$21,873.02	2025-02-06
J9228	HCPCS	Ipilimumab 50 Mg/10ml IV Soln	12	11	$22,690.02	$22,690.02	$10,210.51	$22,463.12	$21,328.62	2025-02-06
J3380	HCPCS	Vedolizumab 300 Mg IV Solr	12	11	$22,595.45	$22,595.45	$10,167.95	$22,369.50	$21,239.72	2025-02-06
J9301	HCPCS	Obinutuzumab 1000 Mg/40ml IV Soln	12	11	$21,496.67	$21,496.67	$9,673.50	$21,281.70	$20,206.87	2025-02-06
J9223	HCPCS	Lurbinectedin 4 Mg IV Solr	12	11	$20,948.61	$20,948.61	$9,426.87	$20,739.12	$19,691.69	2025-02-06
J9307	HCPCS	Pralatrexate 20 Mg/ml IV Soln	24	11	$27,814.84	$27,814.84	$8,370.71	$36,657.83	$18,136.53	2025-02-06
J0135	HCPCS	Adalimumab 80 Mg/0.8ml Subq Ajkt	12	11	$16,676.35	$16,676.35	$7,504.36	$16,509.59	$15,675.77	2025-02-06
J9063	HCPCS	Mirvetuximab Soravtansine-gynx 100 Mg/20ml IV Soln	12	11	$16,266.14	$16,266.14	$7,319.76	$16,103.48	$15,290.17	2025-02-06
J9271	HCPCS	Pembrolizumab 100 Mg/4ml IV Soln	12	11	$14,839.88	$14,839.88	$6,677.95	$14,691.48	$13,949.49	2025-02-06
J2327	HCPCS	Risankizumab-rzaa 600 Mg/10ml IV Soln	12	11	$12,701.25	$12,701.25	$5,715.56	$12,574.24	$11,939.17	2025-02-06
J2323	HCPCS	Natalizumab 300 Mg/15ml IV Conc	12	11	$12,329.03	$12,329.03	$5,548.06	$12,205.74	$11,589.29	2025-02-06
J2506	HCPCS	Pegfilgrastim 6 Mg/0.6ml Subq Sosy	12	11	$10,374.83	$10,374.83	$4,668.67	$10,271.08	$9,752.34	2025-02-06
PX-36010153	CDM	Hc Operating Room Services Level 8 1st 30 Mins	12	11	$9,871.80	$9,871.80	$4,442.31	$9,773.08	$9,279.49	2025-02-06
J9311	HCPCS	Rituximab-hyaluronidase Human 1400-23400 Mg -ut/11.7ml Subq Soln	12	11	$9,830.56	$9,830.56	$4,423.75	$9,732.25	$9,240.73	2025-02-06
J1950	HCPCS	Leuprolide Acetate 3.75 Mg IM Kit	36	11	$9,570.26	$9,570.26	$1,679.74	$26,695.83	$8,996.05	2025-02-06
J9061	HCPCS	Amivantamab-vmjw 350 Mg/7ml IV Soln	12	11	$9,558.12	$9,558.12	$4,301.15	$9,462.54	$8,984.63	2025-02-06
J9332	HCPCS	Efgartigimod Alfa-fcab 400 Mg/20ml IV Soln	12	11	$9,072.99	$9,072.99	$4,082.85	$8,982.26	$8,528.61	2025-02-06
J9047	HCPCS	Carfilzomib 60 Mg IV Solr	12	11	$8,597.05	$8,597.05	$3,868.67	$8,511.08	$8,081.23	2025-02-06
J9299	HCPCS	Nivolumab 100 Mg/10ml IV Soln	48	11	$9,177.42	$9,177.42	$1,754.21	$19,726.59	$8,062.07	2025-02-06
PX-36010152	CDM	Hc Operating Room Services Level 7 1st 30 Mins	12	11	$8,552.30	$8,552.30	$3,848.53	$8,466.78	$8,039.16	2025-02-06
J0491	HCPCS	Anifrolumab-fnia 300 Mg/2ml IV Soln	12	11	$7,819.83	$7,819.83	$3,518.92	$7,741.63	$7,350.64	2025-02-06
J0517	HCPCS	Benralizumab 30 Mg/ml Subq Soaj	24	11	$8,000.38	$8,000.38	$3,380.94	$8,402.68	$7,175.10	2025-02-06
J9205	HCPCS	Irinotecan Hcl Liposome 43 Mg/10ml IV Inj	12	11	$7,459.16	$7,459.16	$3,356.62	$7,384.57	$7,011.61	2025-02-06
J2427	HCPCS	Paliperidone Palmitate ER 410 Mg/1.32ml IM Susy	36	11	$9,391.70	$9,391.70	$3,183.30	$13,965.43	$7,003.27	2025-02-06
J9145	HCPCS	Daratumumab 400 Mg/20ml IV Soln	12	11	$7,447.18	$7,447.18	$3,351.23	$7,372.71	$7,000.35	2025-02-06
J7169	HCPCS	Coag Fact Xa Inactivated-zhzo 200 Mg IV Solr	12	11	$7,440.19	$7,440.19	$3,348.09	$7,365.79	$6,993.78	2025-02-06
J9358	HCPCS	Fam-trastuzumab Deruxtec-nxki 100 Mg IV Solr	12	11	$7,390.26	$7,390.26	$3,325.62	$7,316.36	$6,946.84	2025-02-06
J0896	HCPCS	Luspatercept-aamt 25 Mg Subq Solr	24	11	$11,815.93	$11,815.93	$2,661.97	$17,539.22	$6,914.35	2025-02-06
PX-36010151	CDM	Hc Operating Room Services Level 6 1st 30 Mins	12	11	$7,262.10	$7,262.10	$3,267.95	$7,189.48	$6,826.37	2025-02-06
G0235	HCPCS	Hc PET Not Otherwise Specified	12	11	$6,986.50	$6,986.50	$3,143.93	$6,916.64	$6,567.31	2025-02-06
G0252	HCPCS	Hc PET Imaging Initial Dx Breast	12	11	$6,986.50	$6,986.50	$3,143.93	$6,916.64	$6,567.31	2025-02-06
J9308	HCPCS	Ramucirumab 100 Mg/10ml IV Soln	24	11	$11,733.58	$11,733.58	$2,001.84	$18,828.44	$6,481.21	2025-02-06
PX-36010150	CDM	Hc Operating Room Services Level 5 1st 30 Mins	12	11	$6,677.75	$6,677.75	$3,004.99	$6,610.97	$6,277.09	2025-02-06
J1162	HCPCS	Digoxin Immune Fab 40 Mg IV Solr	12	11	$6,592.58	$6,592.58	$2,966.66	$6,526.65	$6,197.02	2025-02-06
78815	CPT	Nuclear Medicine Study From Skull Base To Mid-thigh W/ct	12	11	$6,579.85	$6,579.85	$2,960.93	$6,514.05	$6,185.06	2025-02-06
J2799	HCPCS	Risperidone ER 200 Mg/0.56ml Subq Susy	12	11	$6,569.68	$6,569.68	$2,956.36	$6,503.98	$6,175.50	2025-02-06
J9317	HCPCS	Sacituzumab Govitecan-hziy 180 Mg IV Solr	12	11	$6,499.27	$6,499.27	$2,924.67	$6,434.28	$6,109.32	2025-02-06
J0791	HCPCS	Crizanlizumab-tmca 100 Mg/10ml IV Soln	12	11	$6,470.77	$6,470.77	$2,911.85	$6,406.06	$6,082.52	2025-02-06
J2356	HCPCS	Tezepelumab-ekko 210 Mg/1.91ml Subq Sosy	12	11	$6,224.54	$6,224.54	$2,801.04	$6,162.29	$5,851.07	2025-02-06
J9177	HCPCS	Enfortumab Vedotin-ejfv 20 Mg IV Solr	24	11	$7,488.26	$7,488.26	$2,707.03	$8,871.29	$5,805.07	2025-02-06
J9034	HCPCS	Bendamustine Hcl 100 Mg/4ml IV Soln	12	11	$6,087.46	$6,087.46	$2,739.36	$6,026.59	$5,722.22	2025-02-06
J9176	HCPCS	Elotuzumab 300 Mg IV Solr	24	11	$6,858.61	$6,858.61	$2,653.51	$7,742.33	$5,690.31	2025-02-06
PX-20610001	CDM	Hc Intensive Care Intermediate	9	8	$5,799.75	$5,799.75	$3,131.86	$5,741.75	$5,567.76	2025-02-06
PX-20610002	CDM	Hc Intensive Care Intermediate W/Telemetry	9	8	$5,799.75	$5,799.75	$3,131.86	$5,741.75	$5,567.76	2025-02-06
78492	CPT	Nuclear Medicine Studies Of Blood Flow In Heart Muscle	12	11	$5,812.45	$5,812.45	$2,615.60	$5,754.33	$5,463.70	2025-02-06
SUP-ABS-2090-05	CDM	ArthroCell Plus Viable Bone Graft, 5.0 Cc	12	11	$5,600.00	$5,600.00	$2,520.00	$5,544.00	$5,264.00	2025-02-06
78459	CPT	Nuclear Medicine Study Heart Muscle W/metabolic Evaluation	12	11	$5,482.85	$5,482.85	$2,467.28	$5,428.02	$5,153.88	2025-02-06
PX-36010149	CDM	Hc Operating Room Services Level 4 1st 30 Mins	12	11	$5,258.85	$5,258.85	$2,366.48	$5,206.26	$4,943.32	2025-02-06
J2353	HCPCS	Octreotide Acetate 10 Mg IM Kit	36	11	$6,299.85	$6,299.85	$2,165.39	$9,331.83	$4,763.85	2025-02-06
J1306	HCPCS	Inclisiran Sodium 284 Mg/1.5ml Subq Sosy	12	11	$5,061.77	$5,061.77	$2,277.80	$5,011.15	$4,758.07	2025-02-06
Q5111	HCPCS	Pegfilgrastim-cbqv 6 Mg/0.6ml Subq Sosy	12	11	$4,775.68	$4,775.68	$2,149.06	$4,727.92	$4,489.14	2025-02-06
J9355	HCPCS	Trastuzumab 150 Mg IV Solr	12	11	$4,751.89	$4,751.89	$2,138.35	$4,704.37	$4,466.78	2025-02-06
27762	CPT	Closed Treatment Of Inside Portion Of Shin Bone At Ankle	12	11	$4,500.00	$4,500.00	$2,025.00	$4,455.00	$4,230.00	2025-02-06
27818	CPT	Closed Treatment Of 3 Broken Lower Leg Bones At Ankle	12	11	$4,500.00	$4,500.00	$2,025.00	$4,455.00	$4,230.00	2025-02-06
J9312	HCPCS	Rituximab 100 Mg/10ml IV Soln	24	11	$7,616.06	$7,616.06	$1,307.01	$12,204.38	$4,211.43	2025-02-06
J9179	HCPCS	Eribulin Mesylate 1 Mg/2ml IV Soln	12	11	$4,308.85	$4,308.85	$1,938.98	$4,265.76	$4,050.32	2025-02-06
PX-36010148	CDM	Hc Operating Room Services Level 3 1st 30 Mins	12	11	$4,274.20	$4,274.20	$1,923.39	$4,231.46	$4,017.75	2025-02-06
J1944	HCPCS	Aripiprazole Lauroxil ER 882 Mg/3.2ml IM Prsy	12	11	$4,263.43	$4,263.43	$1,918.54	$4,220.80	$4,007.62	2025-02-06
J9173	HCPCS	Durvalumab 120 Mg/2.4ml IV Soln	24	11	$6,955.56	$6,955.56	$1,375.76	$10,745.34	$3,955.47	2025-02-06
59510	CPT	Hc Pr 59510 Total OB/Cesarean Delivery/Pp Car	15	11	$7,764.20	$7,764.20	$2,462.00	$6,366.64	$3,903.97	2025-02-06
J9259	HCPCS	Paclitaxel Protein-bound Part 100 Mg IV Susr	12	11	$4,098.16	$4,098.16	$1,844.17	$4,057.18	$3,852.27	2025-02-06
78491	CPT	Nuclear Medicine Study Of Blood Flow In Heart Muscle	12	11	$4,092.25	$4,092.25	$1,841.51	$4,051.33	$3,846.72	2025-02-06
78608	CPT	Nuclear Medicine Brain Img PET Metabolic Eval	12	11	$4,092.25	$4,092.25	$1,841.51	$4,051.33	$3,846.72	2025-02-06
PX-17310001	CDM	Hc R&b Nursery/Level 3	9	8	$3,901.45	$3,901.45	$2,106.78	$3,862.44	$3,745.39	2025-02-06
J0717	HCPCS	Certolizumab Pegol 200 Mg/ml Subq Pskt	12	11	$3,888.53	$3,888.53	$1,749.84	$3,849.64	$3,655.22	2025-02-06
PX-72210004	CDM	Hc Vaginal Delivery Level 4 Cdm	12	11	$3,873.45	$3,873.45	$1,743.05	$3,834.72	$3,641.05	2025-02-06
J9227	HCPCS	Isatuximab-irfc 100 Mg/5ml IV Soln	24	11	$6,412.81	$6,412.81	$1,108.17	$10,259.39	$3,550.66	2025-02-06
J2182	HCPCS	Mepolizumab 100 Mg/ml Subq Sosy	24	11	$4,598.57	$4,598.57	$1,654.44	$5,465.38	$3,547.86	2025-02-06
59400	CPT	Hc Pr 59400 Total OB/Vaginal Delivery/Pp Care	15	11	$6,884.40	$6,884.40	$2,227.64	$5,645.21	$3,535.98	2025-02-06
J2796	HCPCS	Romiplostim 125 Mcg Subq Solr	36	11	$3,927.83	$3,927.83	$887.15	$7,762.23	$3,528.29	2025-02-06
J3111	HCPCS	Romosozumab-aqqg 105 Mg/1.17ml Subq Sosy	12	11	$3,751.84	$3,751.84	$1,688.33	$3,714.32	$3,526.73	2025-02-06
PX-72210003	CDM	Hc Vaginal Delivery Level 3 Cdm	12	11	$3,709.05	$3,709.05	$1,669.07	$3,671.96	$3,486.51	2025-02-06
SUP-456.411S	CDM	Nail Canltd Troc 11 X 300mm 13	12	11	$3,644.93	$3,644.93	$1,640.22	$3,608.48	$3,426.23	2025-02-06
SUP-456.413S	CDM	Nail Canltd Troc 11 X 320mm 13	12	11	$3,644.93	$3,644.93	$1,640.22	$3,608.48	$3,426.23	2025-02-06
SUP-456.415S	CDM	Nail Canltd Troc 11 X 340mm 13	12	11	$3,644.93	$3,644.93	$1,640.22	$3,608.48	$3,426.23	2025-02-06
SUP-456.414S	CDM	Nail Canltd Troc 11 X 340mm 13	12	11	$3,644.93	$3,644.93	$1,640.22	$3,608.48	$3,426.23	2025-02-06
SUP-456.410S	CDM	Nail Canltd Troc 11 X 300mm 13	12	11	$3,644.93	$3,644.93	$1,640.22	$3,608.48	$3,426.23	2025-02-06
SUP-456.412S	CDM	Nail Canltd Troc 11 X 320mm 13	12	11	$3,644.93	$3,644.93	$1,640.22	$3,608.48	$3,426.23	2025-02-06
PX-36010225	CDM	Hc Operating Room Services Level 8 Add'l 15 Min	12	11	$3,617.30	$3,617.30	$1,627.79	$3,581.13	$3,400.26	2025-02-06
PX-36010147	CDM	Hc Operating Room Services Level 2 1st 30 Mins	12	11	$3,499.90	$3,499.90	$1,574.95	$3,464.90	$3,289.91	2025-02-06
J1745	HCPCS	Infliximab 100 Mg IV Solr	12	11	$3,497.93	$3,497.93	$1,574.07	$3,462.95	$3,288.05	2025-02-06
Q5120	HCPCS	Pegfilgrastim-bmez 6 Mg/0.6ml Subq Sosy	12	11	$3,480.16	$3,480.16	$1,566.07	$3,445.36	$3,271.35	2025-02-06
PX-36010223	CDM	Hc Operating Room Services Level 7 Add'l 15 Min	12	11	$3,316.00	$3,316.00	$1,492.20	$3,282.84	$3,117.04	2025-02-06
J9035	HCPCS	Bevacizumab 100 Mg/4ml IV Soln	24	11	$5,425.32	$5,425.32	$1,115.50	$8,288.03	$3,110.69	2025-02-06
PX-72210002	CDM	Hc Vaginal Delivery Level 2 Cdm	12	11	$3,299.70	$3,299.70	$1,484.87	$3,266.70	$3,101.72	2025-02-06
J1943	HCPCS	Aripiprazole Lauroxil ER 675 Mg/2.4ml IM Prsy	12	11	$3,266.36	$3,266.36	$1,469.86	$3,233.70	$3,070.38	2025-02-06
C8929	HCPCS	Ultrasound Heart W/color Flow, Rate, Direction And Valve	12	11	$3,265.65	$3,265.65	$1,469.54	$3,232.99	$3,069.71	2025-02-06
J0897	HCPCS	Denosumab 120 Mg/1.7ml Subq Soln	24	11	$5,213.50	$5,213.50	$1,112.07	$7,876.18	$3,013.32	2025-02-06
SUP-04.037.059S	CDM	Nail Canltd Tfna 10 X 380mm 13	12	11	$3,187.02	$3,187.02	$1,434.16	$3,155.15	$2,995.80	2025-02-06
SUP-04.037.260S	CDM	Nail Canltd Tfna 12 X 400mm 13	12	11	$3,187.02	$3,187.02	$1,434.16	$3,155.15	$2,995.80	2025-02-06
SUP-04.037.262S	CDM	Nail Canltd Tfna 12 X 420mm 13	12	11	$3,187.02	$3,187.02	$1,434.16	$3,155.15	$2,995.80	2025-02-06
SUP-456.417S	CDM	Nail Canltd Troc 11 X 360mm 13	12	11	$3,167.66	$3,167.66	$1,425.45	$3,135.98	$2,977.60	2025-02-06
SUP-456.420S	CDM	Nail Canltd Troc 11 X 400mm 13	12	11	$3,167.66	$3,167.66	$1,425.45	$3,135.98	$2,977.60	2025-02-06
J2997	HCPCS	Alteplase 100 Mg IV Solr	24	11	$6,273.23	$6,273.23	$193.14	$11,996.09	$2,938.84	2025-02-06
C1889	HCPCS	Implant/insert Device, Noc	12	11	$3,091.20	$3,091.20	$1,391.04	$3,060.29	$2,905.73	2025-02-06
SUP-456.418S	CDM	Nail Canltd Troc 11 X 380mm 13	12	11	$3,075.41	$3,075.41	$1,383.93	$3,044.66	$2,890.89	2025-02-06
SUP-456.419S	CDM	Nail Canltd Troc 11 X 380mm 13	12	11	$3,075.41	$3,075.41	$1,383.93	$3,044.66	$2,890.89	2025-02-06
SUP-456.416S	CDM	Nail Canltd Troc 11 X 360mm 13	12	11	$3,075.41	$3,075.41	$1,383.93	$3,044.66	$2,890.89	2025-02-06
SUP-456.421S	CDM	Nail Canltd Troc 11 X 400mm 13	12	11	$3,075.41	$3,075.41	$1,383.93	$3,044.66	$2,890.89	2025-02-06
SUP-0010-2400	CDM	Fiber Laser Gl Moxy Bph	12	11	$3,040.00	$3,040.00	$1,368.00	$3,009.60	$2,857.60	2025-02-06
J3358	HCPCS	Ustekinumab 130 Mg/26ml IV Soln	12	11	$3,035.09	$3,035.09	$1,365.79	$3,004.74	$2,852.99	2025-02-06
SUP-SMBTT0VLX	CDM	Spacemaker Pro Access	12	11	$3,034.32	$3,034.32	$1,365.44	$3,003.98	$2,852.26	2025-02-06
SUP-SMBTTRNDX	CDM	Spacemaker™ Pro Access	12	11	$3,034.32	$3,034.32	$1,365.44	$3,003.98	$2,852.26	2025-02-06
C1783	HCPCS	Stent Trabecular Micro-bypass	12	11	$3,000.00	$3,000.00	$1,350.00	$2,970.00	$2,820.00	2025-02-06
SUP-AR-8928BC-CP	CDM	Kit Achilles Speed Anchor Brid	12	11	$2,992.80	$2,992.80	$1,346.76	$2,962.87	$2,813.23	2025-02-06
SUP-241.901	CDM	Plate 3.5 Lcp Proximal Humerus	12	11	$2,962.24	$2,962.24	$1,333.01	$2,932.62	$2,784.51	2025-02-06
J1437	HCPCS	Ferric Derisomaltose(one Dose) 1000 Mg/10ml IV Soln	12	11	$2,922.18	$2,922.18	$1,314.98	$2,892.96	$2,746.85	2025-02-06
J9023	HCPCS	Avelumab 200 Mg/10ml IV Soln	12	11	$2,904.54	$2,904.54	$1,307.04	$2,875.49	$2,730.26	2025-02-06
27137	CPT	Hc Pr 27137 Revise Hip Joint Replacement	15	11	$6,036.00	$6,036.00	$1,373.07	$4,949.52	$2,721.92	2025-02-06
23472	CPT	Hc Pr 23472 Reconstruct Shoulder Joint Arthroplasty	15	11	$5,701.20	$5,701.20	$1,356.90	$4,674.98	$2,688.64	2025-02-06
PX-72210001	CDM	Hc Vaginal Delivery Level 1 Cdm	12	11	$2,826.00	$2,826.00	$1,271.70	$2,797.74	$2,656.44	2025-02-06
SUP-AR-2600SBS-4	CDM	Speedbrg Imp Sys W/bio-comp Sw	12	11	$2,784.00	$2,784.00	$1,252.80	$2,756.16	$2,616.96	2025-02-06
27486	CPT	Hc Pr 27486 Revise/Replace Knee Joint	15	11	$5,200.10	$5,200.10	$1,320.53	$4,264.08	$2,598.40	2025-02-06
J3032	HCPCS	Eptinezumab-jjmr 100 Mg/ml IV Soln	12	11	$2,743.04	$2,743.04	$1,234.37	$2,715.61	$2,578.46	2025-02-06
J7298	HCPCS	Hc Pr Rx Levonorgestrel IUD (Mirena) IUD 5 Yr 52 Mg	24	11	$2,713.36	$2,713.36	$1,204.07	$2,723.51	$2,550.18	2025-02-06
J7296	HCPCS	Hc Pr Rx Levonorgestrel (Kyleena) IUD 19.5 Mg	12	11	$2,697.30	$2,697.30	$1,213.79	$2,670.33	$2,535.46	2025-02-06
38505	CPT	Needle Biopsy Or Removal Of Surface Lymph Nodes	12	11	$2,694.30	$2,694.30	$1,212.43	$2,667.36	$2,532.64	2025-02-06
25170	CPT	Hc Pr 25170 Resect Radius/Ulnar Tumor	15	11	$4,122.40	$4,122.40	$1,378.75	$3,380.37	$2,532.21	2025-02-06
J3240	HCPCS	Thyrotropin Alfa 0.9 Mg IM Solr	12	11	$2,677.55	$2,677.55	$1,204.90	$2,650.77	$2,516.89	2025-02-06
SUP-04.037.042S	CDM	Nail Canltd Tfna 10 X 170mm 13	12	11	$2,671.78	$2,671.78	$1,202.30	$2,645.06	$2,511.48	2025-02-06
SUP-04.037.043S	CDM	Nail Canltd Tfna 10 X 200mm 13	12	11	$2,671.78	$2,671.78	$1,202.30	$2,645.06	$2,511.48	2025-02-06
Q5135	HCPCS	Tocilizumab-aazg 400 Mg/20ml IV Soln	12	11	$2,654.34	$2,654.34	$1,194.45	$2,627.80	$2,495.08	2025-02-06
27130	CPT	Hc Pr 27130 Total Hip Arthroplasty	15	11	$5,534.25	$5,534.25	$1,206.23	$4,538.09	$2,485.37	2025-02-06
27447	CPT	Total Knee Arthroplasty	15	11	$6,277.25	$6,277.25	$1,204.74	$5,147.35	$2,482.78	2025-02-06
Q9992	HCPCS	Buprenorphine ER 300 Mg/1.5ml Subq Sosy	12	11	$2,508.50	$2,508.50	$1,128.83	$2,483.41	$2,357.99	2025-02-06
J0401	HCPCS	Aripiprazole ER 300 Mg IM Prsy	12	11	$2,501.82	$2,501.82	$1,125.82	$2,476.80	$2,351.71	2025-02-06
PX-36010221	CDM	Hc Operating Room Services Level 6 Add'l 15 Min	12	11	$2,499.15	$2,499.15	$1,124.62	$2,474.16	$2,349.20	2025-02-06
94002	CPT	Initial Hospital Inpatient Or Observation Vent Management	12	11	$2,495.00	$2,495.00	$1,122.75	$2,470.05	$2,345.30	2025-02-06
Q5119	HCPCS	Rituximab-pvvr 100 Mg/10ml IV Soln	24	11	$4,160.47	$4,160.47	$766.45	$6,551.54	$2,332.08	2025-02-06
PX-36010219	CDM	Hc Operating Room Services Level 5 Add'l 15 Min	12	11	$2,459.55	$2,459.55	$1,106.80	$2,434.95	$2,311.98	2025-02-06
Q5115	HCPCS	Rituximab-abbs 100 Mg/10ml IV Soln	24	11	$4,143.54	$4,143.54	$725.24	$6,608.69	$2,299.73	2025-02-06
27244	CPT	Tx Femoral Fracture W/Plate/Screw Type Implant	15	11	$4,854.90	$4,854.90	$1,157.04	$3,981.02	$2,273.28	2025-02-06
27245	CPT	Hc Pr 27245 Tx Femoral Fracture W/Intramedulary Type Implant	15	11	$4,713.65	$4,713.65	$1,155.66	$3,865.19	$2,273.28	2025-02-06
44120	CPT	Hc Pr 44120 Removal Of Small Intestine, Single Resection	15	11	$4,279.15	$4,279.15	$1,127.53	$3,508.90	$2,270.08	2025-02-06
SUP-04.037.242S	CDM	Nail Can Tfna 12x70mm 130d Rt	12	11	$2,408.83	$2,408.83	$1,083.97	$2,384.74	$2,264.30	2025-02-06
SUP-AR-1530P-CP	CDM	Forefoot Ib Implant	12	11	$2,399.41	$2,399.41	$1,079.73	$2,375.42	$2,255.44	2025-02-06
J9055	HCPCS	Cetuximab 100 Mg/50ml IV Soln	24	11	$3,417.40	$3,417.40	$1,040.22	$4,477.97	$2,253.81	2025-02-06
J1439	HCPCS	Ferric Carboxymaltose 750 Mg/15ml IV Soln	12	11	$2,360.08	$2,360.08	$1,062.04	$2,336.48	$2,218.47	2025-02-06
27236	CPT	Hc Pr 27236 Open Tx Thigh Fracture Without Manip	15	11	$4,663.70	$4,663.70	$1,124.84	$3,824.23	$2,208.00	2025-02-06
SUP-456.315S	CDM	Nail Canltd Troc 10 X 170mm 13	12	11	$2,336.69	$2,336.69	$1,051.51	$2,313.32	$2,196.49	2025-02-06
SUP-456.318S	CDM	Nail Canltd Troc 11 X 170mm 13	12	11	$2,336.69	$2,336.69	$1,051.51	$2,313.32	$2,196.49	2025-02-06
SUP-456.322S	CDM	Nail Canltd Troc 12 X 170mm 13	12	11	$2,336.69	$2,336.69	$1,051.51	$2,313.32	$2,196.49	2025-02-06
SUP-1020-14	CDM	Tendon Tibialis Anterior	12	11	$2,328.00	$2,328.00	$1,047.60	$2,304.72	$2,188.32	2025-02-06
J7300	HCPCS	Hc Pr Rx Intrauterine Copper Contraceptive IUD 1 Ea	12	11	$2,318.50	$2,318.50	$1,043.33	$2,295.32	$2,179.39	2025-02-06
J0875	HCPCS	Dalbavancin Hcl 500 Mg IV Solr	12	11	$2,312.00	$2,312.00	$1,040.40	$2,288.88	$2,173.28	2025-02-06
J2426	HCPCS	Paliperidone Palmitate ER 117 Mg/0.75ml IM Susy	48	11	$2,749.83	$2,749.83	$709.97	$4,656.21	$2,155.20	2025-02-06
59515	CPT	Hc Pr 59515 Cesarean Delivery W Pp Care	15	11	$4,466.15	$4,466.15	$1,219.75	$3,662.24	$2,123.15	2025-02-06
PX-27247196WGR	CDM	Hc Jada System Pp Vacuum Hemorrhage Control	12	11	$2,232.00	$2,232.00	$1,004.40	$2,209.68	$2,098.08	2025-02-06
27125	CPT	Hc Pr 27125 Partial Hip Replacement	15	11	$4,679.95	$4,679.95	$1,067.50	$3,837.56	$2,093.44	2025-02-06
19305	CPT	Hc Pr 19305 Mast Radical	15	11	$3,903.20	$3,903.20	$1,065.70	$3,200.62	$2,081.92	2025-02-06
SUP-AR-1360B-CP	CDM	Kit Medial Pat Fem Ligament Re	12	11	$2,206.40	$2,206.40	$992.88	$2,184.34	$2,074.01	2025-02-06
Q5118	HCPCS	Bevacizumab-bvzr 100 Mg/4ml IV Soln	24	11	$3,640.07	$3,640.07	$716.91	$5,630.14	$2,068.18	2025-02-06
J0221	HCPCS	Alglucosidase Alfa 50 Mg IV Solr	12	11	$2,163.63	$2,163.63	$973.63	$2,141.99	$2,033.82	2025-02-06
J3315	HCPCS	Triptorelin Pamoate 3.75 Mg IM Susr	12	11	$2,162.80	$2,162.80	$973.26	$2,141.17	$2,033.03	2025-02-06
PX-17210001	CDM	Hc R&b Nursery/Level 2	9	8	$2,117.55	$2,117.55	$1,143.48	$2,096.37	$2,032.85	2025-02-06
J7301	HCPCS	Hc Pr Rx Levonorgestrel (Skyla) IUD 13.5 Mg	12	11	$2,146.40	$2,146.40	$965.88	$2,124.94	$2,017.62	2025-02-06
24586	CPT	Hc Pr 24586 Optx Periarticular Fracture &/Dislocation Elbow Cdm	15	11	$3,645.25	$3,645.25	$1,025.15	$2,989.11	$1,968.43	2025-02-06
29806	CPT	Hc Pr 29806 Shoulder Arthroscopy/Surgery	15	11	$4,280.55	$4,280.55	$1,001.30	$3,510.05	$1,957.76	2025-02-06
29827	CPT	Hc Pr 29827 Arthroscop Rotator Cuff Repr	15	11	$4,569.90	$4,569.90	$1,009.03	$3,747.32	$1,943.68	2025-02-06
25609	CPT	Hc Pr 25609 Treat Fx Radial 3+ Frag	15	11	$3,790.70	$3,790.70	$1,005.42	$3,108.37	$1,928.96	2025-02-06
29807	CPT	Hc Pr 29807 Shldr Arthroscop,Surg,Repair,Slap Lesion	15	11	$4,067.60	$4,067.60	$978.27	$3,335.43	$1,912.32	2025-02-06
28320	CPT	Repair Of Nonhealed Broken Midfoot Bone	12	11	$1,993.35	$1,993.35	$897.01	$1,973.42	$1,873.75	2025-02-06
SUP-M0068503000	CDM	Urethral Sling System Lynx	12	11	$1,987.79	$1,987.79	$894.51	$1,967.91	$1,868.52	2025-02-06
27870	CPT	Hc Pr 27870 Fusion Of Ankle Joint Open	15	11	$3,448.00	$3,448.00	$954.16	$2,827.36	$1,861.92	2025-02-06
PX-36010146	CDM	Hc Operating Room Services Level 1 1st 30 Mins	12	11	$1,969.05	$1,969.05	$886.07	$1,949.36	$1,850.91	2025-02-06
Q5108	HCPCS	Pegfilgrastim-jmdb 6 Mg/0.6ml Subq Sosy	12	11	$1,956.52	$1,956.52	$880.43	$1,936.95	$1,839.12	2025-02-06
J7307	HCPCS	Hc Pr Rx Etonogestrel Implant 1 Ea	12	11	$1,950.70	$1,950.70	$877.82	$1,931.19	$1,833.66	2025-02-06
29888	CPT	Hc Pr 29888 Knee Arthro/Surg	15	11	$3,605.20	$3,605.20	$920.24	$2,956.26	$1,816.32	2025-02-06
29856	CPT	Hc Pr Arthrs Aid Tibial Fx Prox Unicondylar Bicondylar	15	11	$3,348.05	$3,348.05	$940.13	$2,745.40	$1,807.95	2025-02-06
27507	CPT	Hc Pr 27507 Open Treatment Of Thigh Fracture	15	11	$3,668.45	$3,668.45	$912.25	$3,008.13	$1,794.56	2025-02-06
27514	CPT	Hc Pr 27514 Orif Femoral Fx Med/Lat	15	11	$3,694.00	$3,694.00	$908.78	$3,029.08	$1,784.32	2025-02-06
60500	CPT	Hc Pr 60500 Explore Parathyroid Glands	15	11	$3,759.90	$3,759.90	$905.00	$3,083.12	$1,774.72	2025-02-06
30465	CPT	Hc Pr 30465 Repair Nasal Stenosis	15	11	$4,062.10	$4,062.10	$965.93	$3,330.92	$1,758.72	2025-02-06
SUP-M0068502110	CDM	Transvaginal Midurethral Sling	12	11	$1,862.43	$1,862.43	$838.09	$1,843.81	$1,750.68	2025-02-06
59410	CPT	Hc Pr 59410 Vag Delivery W/Postpartum	15	11	$3,551.65	$3,551.65	$987.91	$2,912.35	$1,749.64	2025-02-06
78306	CPT	Nuclear Medicine Study Of Bone And/or Joint Whole Body	11	11	$1,835.75	$1,835.75	$243.80	$1,817.39	$1,743.96	2025-02-06
PX-12210001	CDM	Hc R&b-semi-private OB	9	8	$1,812.85	$1,812.85	$978.94	$1,794.72	$1,740.34	2025-02-06
PX-12010009	CDM	Hc R&b-semi-private Med Surg With Tele	9	8	$1,812.85	$1,812.85	$978.94	$1,794.72	$1,740.34	2025-02-06
PX-12010001	CDM	Hc R&b-semi-private	9	8	$1,812.85	$1,812.85	$978.94	$1,794.72	$1,740.34	2025-02-06
SUP-AR-7523	CDM	Suture Tape Meniscus Repair Needle	12	11	$1,840.00	$1,840.00	$828.00	$1,821.60	$1,729.60	2025-02-06
1967	OTHER	Hc Pr 01967 Anesth/Analg Vag Delivery	12	11	$426.75	$426.75	$230.44	$2,522.80	$1,729.25	2025-02-06
94003	CPT	Follow-up Inpatient Or Observation Ventilation Management	12	11	$1,835.75	$1,835.75	$826.09	$1,817.39	$1,725.61	2025-02-06
58150	CPT	Remove Uterus Cervix Via Abdomen W/wo Tubes Or Ovaries	15	11	$3,943.05	$3,943.05	$954.80	$3,233.30	$1,715.73	2025-02-06
G0257	HCPCS	Hc Unsched Dialysis Esrd Pt Hos 1:1	12	11	$1,814.10	$1,814.10	$816.35	$1,795.96	$1,705.25	2025-02-06
90935	CPT	Hemodialysis Procedure With Physician Evaluation	12	11	$1,814.10	$1,814.10	$816.35	$1,795.96	$1,705.25	2025-02-06
28715	CPT	Hc Pr 28715 Fusion Of Foot Bones	15	11	$3,148.85	$3,148.85	$895.48	$2,582.06	$1,700.38	2025-02-06
26546	CPT	Hc Pr 26546 Repair Nonunion Hand	15	11	$2,764.60	$2,764.60	$994.26	$2,266.97	$1,697.87	2025-02-06
60240	CPT	Hc Pr 60240 Removal Of Thyroid	15	11	$3,459.50	$3,459.50	$856.87	$2,836.79	$1,685.12	2025-02-06
J0840	HCPCS	Crotalidae Polyval Immune Fab IV Solr	12	11	$1,774.16	$1,774.16	$798.37	$1,756.42	$1,667.71	2025-02-06
25575	CPT	Treat Fracture Radial And Ulna Shaft Fracture W/Fixation	15	11	$3,134.40	$3,134.40	$863.22	$2,570.21	$1,658.24	2025-02-06
19302	CPT	Hc Pr 19302 P-mastectomy W/Ln Removal	15	11	$3,099.90	$3,099.90	$844.26	$2,541.92	$1,656.32	2025-02-06
SUP-091233-020	CDM	Tendon Tibialis	12	11	$1,760.00	$1,760.00	$792.00	$1,742.40	$1,654.40	2025-02-06
SUP-1085-14	CDM	Tendon Achilles	12	11	$1,760.00	$1,760.00	$792.00	$1,742.40	$1,654.40	2025-02-06
SUP-M00515032	CDM	Forcep Biopsy Hot	12	11	$1,760.00	$1,760.00	$792.00	$1,742.40	$1,654.40	2025-02-06
J0841	HCPCS	Crotalidae Immune Fab (equine) IV Solr	12	11	$1,759.71	$1,759.71	$791.87	$1,742.11	$1,654.12	2025-02-06
J3262	HCPCS	Tocilizumab 200 Mg/10ml IV Soln	36	11	$1,841.15	$1,841.15	$559.09	$3,630.62	$1,650.28	2025-02-06
78315	CPT	Nuclear Medicine Bone/joint 3 Phase	11	11	$1,726.80	$1,726.80	$217.53	$1,709.53	$1,640.46	2025-02-06
J2357	HCPCS	Omalizumab 150 Mg/ml Subq Sosy	12	11	$1,742.55	$1,742.55	$784.15	$1,725.12	$1,637.99	2025-02-06
23615	CPT	Hc Pr 23615 Treat Humerus Fracture Open	15	11	$3,634.45	$3,634.45	$840.27	$2,980.25	$1,630.08	2025-02-06
49010	CPT	Hc Pr 49010 Exploration Behind Abdomen	15	11	$3,012.80	$3,012.80	$854.11	$2,470.50	$1,626.91	2025-02-06
SUP-NS2000	CDM	Endometrial Ablation Device No	12	11	$1,716.96	$1,716.96	$772.63	$1,699.79	$1,613.94	2025-02-06
15260	CPT	Hc Pr 15260 Skin Full Graft Een & Lips 20 Sq Cm Or Less	15	11	$3,808.05	$3,808.05	$805.80	$3,122.60	$1,582.72	2025-02-06
26497	CPT	Hc Pr 26497 Finger Tendon Transfer	15	11	$3,113.95	$3,113.95	$857.18	$2,553.44	$1,575.04	2025-02-06
47100	CPT	Hc Pr 47100 Wedge Biopsy Of Liver	15	11	$3,035.65	$3,035.65	$790.25	$2,489.23	$1,562.88	2025-02-06
29883	CPT	Hc Pr 29883 Arthroscopy With Meniscus Repair Medial & Lateral	15	11	$3,605.40	$3,605.40	$796.91	$2,956.43	$1,556.48	2025-02-06
25332	CPT	Hc Pr 25332 Revise Wrist Joint	15	11	$3,261.40	$3,261.40	$807.26	$2,674.35	$1,550.72	2025-02-06
59514	CPT	Hc Pr 59514 Cesarean Delivery Only	15	11	$3,989.20	$3,989.20	$822.43	$3,271.14	$1,539.12	2025-02-06
26123	CPT	Hc Pr 26123 Release Palm Contracture Partial	15	11	$3,151.15	$3,151.15	$805.69	$2,583.94	$1,535.36	2025-02-06
J0490	HCPCS	Belimumab 120 Mg IV Solr	24	11	$2,339.38	$2,339.38	$705.59	$3,079.67	$1,528.78	2025-02-06
25447	CPT	Hc Pr 25447 Repair Wrist Joint(S)	15	11	$3,208.90	$3,208.90	$766.84	$2,631.30	$1,525.12	2025-02-06
27418	CPT	Hc Pr 27418 Repair Degenerated Kneecap	15	11	$3,115.30	$3,115.30	$778.32	$2,554.55	$1,518.72	2025-02-06
25608	CPT	Hc Pr 25608 Treat Fx Rad Intra-articul	15	11	$2,864.30	$2,864.30	$793.60	$2,348.73	$1,517.44	2025-02-06
58571	CPT	Hc Pr 58571 Tlh W/t/o 250 G Or Less	15	11	$2,875.35	$2,875.35	$852.41	$2,357.79	$1,512.93	2025-02-06
SUP-082225-025	CDM	Tendon Semitendonsus	12	11	$1,608.00	$1,608.00	$723.60	$1,591.92	$1,511.52	2025-02-06
26496	CPT	Hc Pr 26496 Revise Thumb Tendon	15	11	$2,777.90	$2,777.90	$858.15	$2,277.88	$1,500.07	2025-02-06
J7168	HCPCS	Prothrombin Complex Conc Human 1000 Units IV Kit	24	11	$2,414.70	$2,414.70	$688.23	$3,267.00	$1,491.90	2025-02-06
26844	CPT	Hc Pr 26844 Fusion/Graft Of Hand Joint	15	11	$3,032.30	$3,032.30	$816.08	$2,486.49	$1,489.28	2025-02-06
78227	CPT	Nuclear Medicine Study Of Liver And Bile Duct System	11	11	$1,563.05	$1,563.05	$82.62	$1,547.42	$1,484.90	2025-02-06
26352	CPT	Hc Pr 26352 Repair/Graft Hand Tendon	15	11	$3,268.05	$3,268.05	$789.38	$2,679.80	$1,484.80	2025-02-06
28615	CPT	Hc Pr 28615 Repair Foot Dislocation	15	11	$3,088.55	$3,088.55	$790.84	$2,532.61	$1,482.88	2025-02-06
95714	CPT	Measure Brain Wave Activity W/video, 12-26 Hrs	12	11	$1,572.40	$1,572.40	$707.58	$1,556.68	$1,478.05	2025-02-06
15240	CPT	Hc Pr 15240 Skin Full Grft Face/Genit/Hf 20 Sq Cm Or Less	15	11	$3,024.50	$3,024.50	$757.39	$2,480.09	$1,474.56	2025-02-06
53447	CPT	Hc Pr 53447 Rmvl & Rplcmt Nfltl Urethral/Bladder Neck Sphinc	15	11	$3,071.50	$3,071.50	$760.17	$2,518.63	$1,473.89	2025-02-06
27381	CPT	Hc Pr 27381 Repair/Graft Kneecap Tendon	15	11	$2,894.00	$2,894.00	$780.50	$2,373.08	$1,468.80	2025-02-06
SUP-AR-1678-CP	CDM	Kit Ligament Repair	12	11	$1,560.00	$1,560.00	$702.00	$1,544.40	$1,466.40	2025-02-06
26356	CPT	Hc Pr 26356 Repair Flex Tendon,Zone 2,Hand	15	11	$3,780.80	$3,780.80	$764.80	$3,100.26	$1,458.56	2025-02-06
26541	CPT	Hc Pr 26541 Repair Hand Joint With Graft	15	11	$3,153.75	$3,153.75	$795.57	$2,586.07	$1,454.08	2025-02-06
J0881	HCPCS	Darbepoetin Alfa 100 Mcg/0.5ml Injection Sosy	84	11	$1,741.82	$1,741.82	$330.25	$3,172.98	$1,435.28	2025-02-06
14041	CPT	Hc Pr 14041 Skin Tissue Rearrangement 10.1 Sq Cm To 30.0 Sq Cm Frhd Ck	15	11	$3,047.70	$3,047.70	$725.39	$2,499.11	$1,432.96	2025-02-06
24342	CPT	Hc Pr 24342 Repair Of Ruptured Tendon	15	11	$2,962.80	$2,962.80	$737.71	$2,429.50	$1,427.84	2025-02-06
J3590	HCPCS	Dupilumab 300 Mg/2ml Subq Soaj	48	11	$1,745.00	$1,745.00	$260.99	$2,603.78	$1,425.57	2025-02-06
52649	CPT	Hc Pr 52649 Prostate Laser Enucleation	15	11	$2,581.80	$2,581.80	$777.60	$2,117.08	$1,423.06	2025-02-06
J0248	HCPCS	Remdesivir 100 Mg IV Solr	12	11	$1,511.20	$1,511.20	$680.04	$1,496.09	$1,420.53	2025-02-06
27814	CPT	Hc Pr 27814 Open Treatment Of Ankle Fracture	15	11	$3,048.50	$3,048.50	$726.70	$2,499.77	$1,419.52	2025-02-06
SUP-SBT1801	CDM	Graft Vascular Bifurated 19-9m	12	11	$1,504.00	$1,504.00	$676.80	$1,488.96	$1,413.76	2025-02-06
42725	CPT	Hc Pr 42725 Drainage Of Throat Abscess	15	11	$2,471.65	$2,471.65	$756.26	$2,026.75	$1,399.53	2025-02-06
SUP-EGIA60AMT	CDM	Staples Endo Gia Roticular 60	12	11	$1,487.86	$1,487.86	$669.54	$1,472.98	$1,398.59	2025-02-06
J7318	HCPCS	Hc Pr Rx Hyaluronan Or Derivative (Durolane) Inj 1 Mg	12	11	$1,483.20	$1,483.20	$667.44	$1,468.37	$1,394.21	2025-02-06
58260	CPT	Hc Pr 58260 Vaginal Hysterectomy	15	11	$3,234.85	$3,234.85	$786.08	$2,652.58	$1,388.58	2025-02-06
25390	CPT	Hc Pr 25390 Shorten Radius Or Ulna	15	11	$2,566.55	$2,566.55	$735.03	$2,104.57	$1,385.94	2025-02-06
27524	CPT	Hc Pr 27524 Treat Kneecap Fracture	15	11	$2,751.45	$2,751.45	$717.82	$2,256.19	$1,384.96	2025-02-06
28735	CPT	Hc Pr 28735 Arthrd Midtarsl/Tars Mlt/Transvrs W/Osteot	15	11	$2,559.20	$2,559.20	$742.42	$2,098.54	$1,381.97	2025-02-06
26370	CPT	Hc Pr 26370 Repair Finger/Hand Tendon	15	11	$2,923.90	$2,923.90	$744.61	$2,397.60	$1,373.44	2025-02-06
28725	CPT	Hc Pr 28725 Fusion Of Foot Bones	15	11	$2,541.60	$2,541.60	$741.84	$2,084.11	$1,372.46	2025-02-06
24341	CPT	Hc Pr 24341 Musc/Tendon Repair Each; Arm/Elbow	15	11	$2,732.00	$2,732.00	$719.02	$2,240.24	$1,370.88	2025-02-06
23430	CPT	Hc Pr 23430 Repair Tenodesis Of Bicep	15	11	$3,002.10	$3,002.10	$709.49	$2,461.72	$1,369.60	2025-02-06
59409	CPT	Hc Pr Ed 59409 Vaginal Delivery Cdm	15	11	$3,046.25	$3,046.25	$728.81	$2,497.93	$1,368.87	2025-02-06
PX-36010217	CDM	Hc Operating Room Services Level 4 Add'l 15 Min	12	11	$1,455.50	$1,455.50	$654.98	$1,440.94	$1,368.17	2025-02-06
29855	CPT	Hc Pr 29855 Tibial Arthroscopy/Surgery	15	11	$2,531.20	$2,531.20	$743.18	$2,075.58	$1,366.85	2025-02-06
13160	CPT	Late Closure Of Wound Extensive Or Complicated	15	11	$2,483.90	$2,483.90	$751.87	$2,036.80	$1,366.46	2025-02-06
26746	CPT	Hc Pr 26746 Open Tx Articulare Fracture	15	11	$2,632.80	$2,632.80	$712.16	$2,158.90	$1,365.76	2025-02-06
26480	CPT	Hc Pr 26480 Transplant Hand Tendon	15	11	$2,736.65	$2,736.65	$686.03	$2,244.05	$1,364.48	2025-02-06
25607	CPT	Hc Pr 25607 Treat Fx Rad Extra-articul	15	11	$2,738.10	$2,738.10	$712.77	$2,245.24	$1,351.68	2025-02-06
24575	CPT	Hc Pr 24575 Treat Humerus Fracture	15	11	$2,798.20	$2,798.20	$703.36	$2,294.52	$1,351.68	2025-02-06
27045	CPT	Hc Pr 27045 Exc Hip/Pelv Tum Deep 5 Cm/>	15	11	$2,494.90	$2,494.90	$691.46	$2,045.82	$1,347.25	2025-02-06
21554	CPT	Hc Pr 21554 Exc Neck Tum Deep 5+ Cm	15	11	$2,847.45	$2,847.45	$687.95	$2,334.91	$1,347.20	2025-02-06
27310	CPT	Hc Pr 27310 Exploration Of Knee Joint	15	11	$2,648.95	$2,648.95	$699.09	$2,172.14	$1,345.92	2025-02-06
59120	CPT	Hc Pr 59120 Tx Ectopic Pregnancy Tubal Or Ovarian	15	11	$2,978.65	$2,978.65	$750.27	$2,442.49	$1,337.69	2025-02-06
28730	CPT	Hc Pr 28730 Fusion Foot Bones,Midtarsal,Multi	15	11	$2,470.55	$2,470.55	$691.53	$2,025.85	$1,334.10	2025-02-06
J1097	HCPCS	Phenylephrine-ketorolac 1-0.3 % Intraocular Soln	12	11	$1,413.92	$1,413.92	$636.26	$1,399.78	$1,329.09	2025-02-06
L8614	HCPCS	Cochlear Baha Sound Proessor K	48	11	$2,649.12	$2,649.12	$38.48	$5,544.00	$1,328.80	2025-02-06
52601	CPT	Hc Pr 52601 Prostatectomy (Turp)	15	11	$2,777.35	$2,777.35	$685.51	$2,277.43	$1,327.52	2025-02-06
49521	CPT	Hc Pr 49521 Rerepair Inguinal Hernia Blocked	15	11	$2,596.55	$2,596.55	$668.64	$2,129.17	$1,325.44	2025-02-06
23515	CPT	Hc Pr 23515 Treat Clavicle Fracture	15	11	$2,753.00	$2,753.00	$688.37	$2,257.46	$1,324.80	2025-02-06
25628	CPT	Hc Pr 25628 Treat Wrist Bone Fracture W/Fixation	15	11	$2,748.80	$2,748.80	$690.85	$2,254.02	$1,324.16	2025-02-06
47563	CPT	Hc Pr 47563 Laparoscopy Cholecystectomy/Graph	15	11	$2,804.90	$2,804.90	$668.73	$2,300.02	$1,322.88	2025-02-06
11005	CPT	Hc Pr 11005 Debride Abdom Wall	15	11	$2,443.50	$2,443.50	$703.14	$2,003.67	$1,322.41	2025-02-06
14021	CPT	Hc Pr 14021 Skin Tissue Rearrangement 10.1 Sq Cm To 30.0 Sq Cm	15	11	$2,841.65	$2,841.65	$674.28	$2,330.15	$1,322.24	2025-02-06
26862	CPT	Hc Pr 26862 Fusion/Graft Of Finger Joint	15	11	$2,676.75	$2,676.75	$729.63	$2,194.93	$1,317.76	2025-02-06
58570	CPT	Hc Pr 58570 Tlh Uterus 250 G Or Less	15	11	$2,786.45	$2,786.45	$758.56	$2,284.89	$1,316.15	2025-02-06
21933	CPT	Hc Pr 21933 Exc Back Tum Deep 5+ Cm Subfacial	15	11	$2,436.80	$2,436.80	$692.00	$1,998.18	$1,315.87	2025-02-06
43870	CPT	Hc Pr 43870 Repair Stomach Opening	15	11	$2,518.30	$2,518.30	$659.25	$2,065.01	$1,315.20	2025-02-06
15100	CPT	Hc Pr 15100 Skin Splt Grft Trnk/Arm/Leg First 100 Sq Cm Or Less	15	11	$2,503.35	$2,503.35	$674.64	$2,052.75	$1,313.92	2025-02-06
24615	CPT	Hc Pr 24615 Treat Elbow Dislocation	15	11	$2,680.15	$2,680.15	$681.29	$2,197.72	$1,312.64	2025-02-06
J1451	HCPCS	Fomepizole 1.5 Gm/1.5ml IV Soln	12	11	$1,396.40	$1,396.40	$628.38	$1,382.44	$1,312.62	2025-02-06
24006	CPT	Hc Pr 24006 Arthrt Elbow Capsular Excision Capsular Rls Spx	15	11	$2,519.80	$2,519.80	$683.92	$2,066.24	$1,307.52	2025-02-06
27427	CPT	Hc Pr 27427 Ligmt Revision,knee,extra-artic	15	11	$3,094.70	$3,094.70	$675.99	$2,537.65	$1,306.24	2025-02-06
26420	CPT	Hc Pr 26420 Repair/Graft Finger Tendon	15	11	$2,484.80	$2,484.80	$702.82	$2,037.54	$1,298.56	2025-02-06
60220	CPT	Hc Pr 60220 Partial Removal Of Thyroid, W/wo Isthmusectomy	15	11	$2,820.20	$2,820.20	$663.96	$2,312.56	$1,291.52	2025-02-06
26350	CPT	Hc Pr Ed 26350 Repair Finger/Hand Tendon Cdm	15	11	$2,613.95	$2,613.95	$710.42	$2,143.44	$1,290.88	2025-02-06
29882	CPT	Hc Pr 29882 Knee Arthroscopy/Surgery Meniscus	15	11	$2,642.80	$2,642.80	$655.92	$2,167.10	$1,290.24	2025-02-06
57260	CPT	Hc Pr 57260 Repair Of Vagina, Combined Anteroposterior Colporrhaphy	15	11	$3,323.15	$3,323.15	$729.96	$2,724.98	$1,285.21	2025-02-06
23073	CPT	Hc Pr 23073 Exc Shoulder Tum Deep 5 Cm/>	15	11	$2,594.50	$2,594.50	$658.11	$2,127.49	$1,281.28	2025-02-06
27829	CPT	Hc Pr 27829 Open Treatment Of Distal Tibiofibular Joint	15	11	$2,559.25	$2,559.25	$671.84	$2,098.59	$1,280.00	2025-02-06
SUP-AR-2260	CDM	Kit Distal Bicep Repair	12	11	$1,360.00	$1,360.00	$612.00	$1,346.40	$1,278.40	2025-02-06
SUP-04.038.300	CDM	Blade Helical 100mm Tfna	12	11	$1,354.30	$1,354.30	$609.43	$1,340.76	$1,273.05	2025-02-06
SUP-04.038.305	CDM	Blade Helical 105mm Tfna	12	11	$1,354.30	$1,354.30	$609.43	$1,340.76	$1,273.05	2025-02-06
64831	CPT	Hc Pr 64831 Repair Of Digit Nerve	15	11	$2,402.35	$2,402.35	$664.19	$1,969.93	$1,265.28	2025-02-06
52648	CPT	Hc Pr 52648 Laser Surgery Of Prostate, Vaporization	15	11	$6,196.20	$6,196.20	$654.49	$5,080.88	$1,262.62	2025-02-06
59151	CPT	Hc Pr 59151 Ectopic Repair Lap/Sal	15	11	$2,815.15	$2,815.15	$711.40	$2,308.42	$1,257.46	2025-02-06
26850	CPT	Hc Pr 26850 Arthr Mtcpl Jnt W/wo Fix	15	11	$2,524.35	$2,524.35	$699.16	$2,069.97	$1,253.76	2025-02-06
G0378	HCPCS	Hc Hospital Observation Per Hr Cdm	24	11	$2,129.02	$2,129.02	$481.48	$3,156.22	$1,246.95	2025-02-06
J1670	HCPCS	Tetanus Immune Globulin 250 Unit/ml IM Sosy	12	11	$1,326.35	$1,326.35	$596.86	$1,313.09	$1,246.77	2025-02-06

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