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 →

Export CSV
Hospital

Bryn Mawr Rehab

Malvern, PA · CCN 393025 · Rates published

3,027 distinct procedures filed
22 distinct payers
68,624 rate rows
2026-04-01 last MRF observed
Data quality

16,461 of 68,624 rate rows are consumer-grade (24.0%)

52,163 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 49,413
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 2,678
placeholder amount (≤ $0.02) — excluded from medians 42
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 30
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.mainlinehealth.org/-/media/files/pdf/basic-content/patient-services/patient-billing/price-transparency/2026/23-1352160_bryn-mawr-rehabilitation-hospital_standardcharges.csv
Found on page https://www.mainlinehealth.org/patient-services/patient-billing/price-transparency
Discovered viaCMS hospital list
Last fetch not_modified · 2026-09-21
Content fingerprint 8963beaacdf8534e… · 16,824,187 bytes · first seen 2026-05-05

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 8 $245,394.70 $1,242,625.02 $621,312.51 nat. median
$621,313
1.0× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 8 $310,000.00 $1,188,324.78 $585,674.35 nat. median
$599,737
1.0× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 8 $328,240.00 $1,181,330.19 $582,227.02 nat. median
$579,571
1.0× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 8 $335,600.00 $1,170,367.66 $576,824.06 nat. median
$574,037
1.0× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 8 $245,394.70 $1,119,783.36 $551,893.23 nat. median
$562,501
1.0× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 8 $489,304.61 $1,027,539.68 $533,862.45 nat. median
$513,770
1.0× median
91
MS_DRG 		Other Disorders Of Nervous System With Mcc 3 $56,124.00 $303,006.00 $170,914.00 nat. median
$12,760
outlier · 13.4×
53
MS_DRG 		Spinal Disorders And Injuries Without Cc/Mcc 2 $38,226.00 $123,200.00 $80,713.00 nat. median
$6,887
outlier · 11.7×
73
MS_DRG 		Cranial And Peripheral Nerve Disorders With Mcc 3 $62,848.00 $91,903.45 $76,269.24 nat. median
$11,281
outlier · 6.8×
74
MS_DRG 		Cranial And Peripheral Nerve Disorders Without Mcc 3 $46,200.00 $69,542.25 $69,542.25 nat. median
$7,651
outlier · 9.1×
J9029
HCPCS 		Inj, Adstiladrin, Per Tx Dos 8 $63,235.61 $133,018.79 $68,092.95 nat. median
$66,211
1.0× median
101
MS_DRG 		Seizures Without Mcc 2 $66,006.00 $69,300.00 $67,653.00 nat. median
$6,782
outlier · 10.0×
94
MS_DRG 		Bacterial And Tuberculous Infections Of Nervous System With Mcc 5 $66,371.60 $184,800.00 $66,371.60 nat. median
$24,752
outlier · 2.7×
A9543
HCPCS 		Y90 Ibritumomab, Rx 8 $56,824.55 $119,331.55 $63,416.20 nat. median
$65,477
1.0× median
95
MS_DRG 		Bacterial And Tuberculous Infections Of Nervous System With Cc 5 $3,849.00 $70,287.00 $62,360.00 nat. median
$17,673
outlier · 3.5×
J7330
HCPCS 		Cultured Chondrocytes Implnt 1 $61,878.30 $68,066.13 $61,878.30 nat. median
$92,809
0.7× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 8 $55,272.32 $116,071.88 $60,525.71 nat. median
$63,499
1.0× median
56
MS_DRG 		Degenerative Nervous System Disorders With Mcc 10 $13,542.10 $284,642.00 $58,655.25 nat. median
$14,194
outlier · 4.1×
57
MS_DRG 		Degenerative Nervous System Disorders Without Mcc 14 $17,340.00 $80,784.00 $58,196.50 nat. median
$8,924
outlier · 6.5×
100
MS_DRG 		Seizures With Mcc 1 $57,750.00 $57,750.00 $57,750.00 nat. median
$13,848
outlier · 4.2×
950
MS_DRG 		Aftercare Without Cc/Mcc 10 $9,324.00 $92,555.37 $56,477.50 nat. median
$4,481
outlier · 12.6×
J9226
HCPCS 		Supprelin La Implant 7 $45,020.65 $94,543.36 $49,522.72 nat. median
$57,036
0.9× median
947
MS_DRG 		Signs And Symptoms With Mcc 9 $9,324.00 $56,925.00 $48,516.65 nat. median
$8,698
outlier · 5.6×
98
MS_DRG 		Non-bacterial Infection Of Nervous System Except Viral Meningitis With Cc 2 $48,441.00 $48,441.00 $48,441.00 nat. median
$15,725
outlier · 3.1×
71
MS_DRG 		Other Cerebrovascular Disorders With Cc 1 $47,671.00 $47,671.00 $47,671.00 nat. median
$7,755
outlier · 6.1×
949
MS_DRG 		Aftercare With Cc/Mcc 13 $18,970.93 $146,577.84 $46,043.38 nat. median
$8,367
outlier · 5.5×
96
MS_DRG 		Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc 2 $16,679.00 $73,150.00 $44,914.50 nat. median
$17,612
outlier · 2.6×
641
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 1 $40,681.00 $40,681.00 $40,681.00 nat. median
$5,850
outlier · 7.0×
559
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Mcc 13 $3,279.83 $81,732.00 $40,413.00 nat. median
$13,403
outlier · 3.0×
97
MS_DRG 		Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 2 $23,230.00 $56,712.00 $39,971.00 nat. median
$24,748
1.6× median
60
MS_DRG 		Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc 2 $33,502.00 $72,105.00 $38,288.00 nat. median
$6,744
outlier · 5.7×
52
MS_DRG 		Spinal Disorders And Injuries With Cc/Mcc 6 $5,366.43 $161,700.00 $37,743.00 nat. median
$12,739
outlier · 3.0×
844
MS_DRG 		Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses… 1 $37,168.00 $37,168.00 $37,168.00 nat. median
$8,649
outlier · 4.3×
70
MS_DRG 		Other Cerebrovascular Disorders With Mcc 1 $35,895.00 $35,895.00 $35,895.00 nat. median
$12,172
outlier · 2.9×
561
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc 11 $11,988.00 $43,208.00 $30,767.80 nat. median
$5,841
outlier · 5.3×
J9266
HCPCS 		Pegaspargase Injection 8 $27,070.53 $59,690.52 $30,555.86 nat. median
$31,084
1.0× median
560
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Cc 10 $7,200.00 $55,005.00 $27,454.00 nat. median
$8,402
outlier · 3.3×
948
MS_DRG 		Signs And Symptoms Without Mcc 11 $13,200.00 $46,200.00 $27,319.01 nat. median
$5,562
outlier · 4.9×
58
MS_DRG 		Multiple Sclerosis And Cerebellar Ataxia With Mcc 2 $26,323.00 $33,362.85 $26,323.00 nat. median
$12,201
outlier · 2.2×
J9600
HCPCS 		Porfimer Sodium Injection 8 $23,789.46 $50,879.68 $26,168.41 nat. median
$26,416
1.0× median
92
MS_DRG 		Other Disorders Of Nervous System With Cc 3 $18,900.00 $43,652.00 $24,850.00 nat. median
$7,741
outlier · 3.2×
93
MS_DRG 		Other Disorders Of Nervous System Without Cc/Mcc 3 $4,200.00 $128,304.00 $22,230.50 nat. median
$5,925
outlier · 3.8×
977
MS_DRG 		HIV With Or Without Other Related Condition 2 $16,261.00 $66,776.00 $21,537.00 nat. median
$9,300
outlier · 2.3×
59
MS_DRG 		Multiple Sclerosis And Cerebellar Ataxia With Cc 3 $15,396.00 $51,325.49 $21,537.00 nat. median
$9,035
outlier · 2.4×
J7310
HCPCS 		Ganciclovir Long Act Implant 1 $16,320.00 $17,952.00 $16,320.00 nat. median
$13,629
1.2× median
5023
OTHER 		Level 3 Type A Ed Visits 1 $13,954.50 $13,954.50 $13,954.50 nat. median
$359
outlier · 38.8×
640
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 1 $9,354.00 $9,354.00 $9,354.00 nat. median
$9,697
1.0× median
J9216
HCPCS 		Interferon Gamma 1-b Inj 1 $8,628.84 $9,491.72 $8,628.84 nat. median
$8,754
1.0× median
J0600
HCPCS 		Edetate Calcium Disodium Inj 8 $6,408.38 $13,457.59 $6,889.00 nat. median
$6,592
1.0× median
Q0224
HCPCS 		Inj, Pemivibart, 4500 Mg 2 $5,890.50 $6,583.50 $6,185.02 nat. median
$6,668
0.9× median

Other procedures at this hospital

Browse this hospital's 3,027 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 11 8 — — $245,394.70 $1,242,625.02 $621,312.51 2026-04-01
Q2056 HCPCS Ciltacabtagene Car-pos T 12 8 — — $310,000.00 $1,188,324.78 $585,674.35 2026-04-01
Q2054 HCPCS Lisocabtagene Mara Car Pos T 12 8 — — $328,240.00 $1,181,330.19 $582,227.02 2026-04-01
Q2055 HCPCS Idecabtagene Vicleucel Car 12 8 — — $335,600.00 $1,170,367.66 $576,824.06 2026-04-01
Q2041 HCPCS Axicabtagene Ciloleucel Car+ 12 8 — — $245,394.70 $1,119,783.36 $551,893.23 2026-04-01
Q2053 HCPCS Brexucabtagene Car Pos T 12 8 — — $489,304.61 $1,027,539.68 $533,862.45 2026-04-01
91 MS_DRG Other Disorders Of Nervous System With Mcc 6 3 — — $56,124.00 $303,006.00 $170,914.00 2026-04-01
53 MS_DRG Spinal Disorders And Injuries Without Cc/Mcc 2 2 — — $38,226.00 $123,200.00 $80,713.00 2026-04-01
73 MS_DRG Cranial And Peripheral Nerve Disorders With Mcc 3 3 — — $62,848.00 $91,903.45 $76,269.24 2026-04-01
74 MS_DRG Cranial And Peripheral Nerve Disorders Without Mcc 3 3 — — $46,200.00 $69,542.25 $69,542.25 2026-04-01
J9029 HCPCS Inj, Adstiladrin, Per Tx Dos 12 8 — — $63,235.61 $133,018.79 $68,092.95 2026-04-01
101 MS_DRG Seizures Without Mcc 2 2 — — $66,006.00 $69,300.00 $67,653.00 2026-04-01
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 8 5 — — $66,371.60 $184,800.00 $66,371.60 2026-04-01
A9543 HCPCS Y90 Ibritumomab, Rx 11 8 — — $56,824.55 $119,331.55 $63,416.20 2026-04-01
95 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Cc 7 5 — — $3,849.00 $70,287.00 $62,360.00 2026-04-01
J7330 HCPCS Cultured Chondrocytes Implnt 3 1 — — $61,878.30 $68,066.13 $61,878.30 2026-04-01
Q2043 HCPCS Sipuleucel-t Auto Cd54+ 12 8 — — $55,272.32 $116,071.88 $60,525.71 2026-04-01
56 MS_DRG Degenerative Nervous System Disorders With Mcc 28 10 — — $13,542.10 $284,642.00 $58,655.25 2026-04-01
57 MS_DRG Degenerative Nervous System Disorders Without Mcc 43 14 — — $17,340.00 $80,784.00 $58,196.50 2026-04-01
100 MS_DRG Seizures With Mcc 1 1 — — $57,750.00 $57,750.00 $57,750.00 2026-04-01
950 MS_DRG Aftercare Without Cc/Mcc 24 10 — — $9,324.00 $92,555.37 $56,477.50 2026-04-01
J9226 HCPCS Supprelin La Implant 9 7 — — $45,020.65 $94,543.36 $49,522.72 2026-04-01
947 MS_DRG Signs And Symptoms With Mcc 25 9 — — $9,324.00 $56,925.00 $48,516.65 2026-04-01
98 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Cc 2 2 — — $48,441.00 $48,441.00 $48,441.00 2026-04-01
71 MS_DRG Other Cerebrovascular Disorders With Cc 1 1 — — $47,671.00 $47,671.00 $47,671.00 2026-04-01
949 MS_DRG Aftercare With Cc/Mcc 33 13 — — $18,970.93 $146,577.84 $46,043.38 2026-04-01
96 MS_DRG Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc 2 2 — — $16,679.00 $73,150.00 $44,914.50 2026-04-01
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 1 1 — — $40,681.00 $40,681.00 $40,681.00 2026-04-01
559 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Mcc 30 13 — — $3,279.83 $81,732.00 $40,413.00 2026-04-01
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 2 2 — — $23,230.00 $56,712.00 $39,971.00 2026-04-01
60 MS_DRG Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc 3 2 — — $33,502.00 $72,105.00 $38,288.00 2026-04-01
52 MS_DRG Spinal Disorders And Injuries With Cc/Mcc 10 6 — — $5,366.43 $161,700.00 $37,743.00 2026-04-01
844 MS_DRG Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses… 1 1 — — $37,168.00 $37,168.00 $37,168.00 2026-04-01
70 MS_DRG Other Cerebrovascular Disorders With Mcc 1 1 — — $35,895.00 $35,895.00 $35,895.00 2026-04-01
561 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc 32 11 — — $11,988.00 $43,208.00 $30,767.80 2026-04-01
J9266 HCPCS Pegaspargase Injection 12 8 — — $27,070.53 $59,690.52 $30,555.86 2026-04-01
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 21 10 — — $7,200.00 $55,005.00 $27,454.00 2026-04-01
948 MS_DRG Signs And Symptoms Without Mcc 23 11 — — $13,200.00 $46,200.00 $27,319.01 2026-04-01
58 MS_DRG Multiple Sclerosis And Cerebellar Ataxia With Mcc 3 2 — — $26,323.00 $33,362.85 $26,323.00 2026-04-01
J9600 HCPCS Porfimer Sodium Injection 11 8 — — $23,789.46 $50,879.68 $26,168.41 2026-04-01
92 MS_DRG Other Disorders Of Nervous System With Cc 7 3 — — $18,900.00 $43,652.00 $24,850.00 2026-04-01
93 MS_DRG Other Disorders Of Nervous System Without Cc/Mcc 5 3 — — $4,200.00 $128,304.00 $22,230.50 2026-04-01
59 MS_DRG Multiple Sclerosis And Cerebellar Ataxia With Cc 3 3 — — $15,396.00 $51,325.49 $21,537.00 2026-04-01
977 MS_DRG HIV With Or Without Other Related Condition 3 2 — — $16,261.00 $66,776.00 $21,537.00 2026-04-01
J7310 HCPCS Ganciclovir Long Act Implant 3 1 — — $16,320.00 $17,952.00 $16,320.00 2026-04-01
5023 OTHER Level 3 Type A Ed Visits 1 1 — — $13,954.50 $13,954.50 $13,954.50 2026-04-01
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 1 1 — — $9,354.00 $9,354.00 $9,354.00 2026-04-01
J9216 HCPCS Interferon Gamma 1-b Inj 3 1 — — $8,628.84 $9,491.72 $8,628.84 2026-04-01
J0600 HCPCS Edetate Calcium Disodium Inj 12 8 — — $6,408.38 $13,457.59 $6,889.00 2026-04-01
Q0224 HCPCS Inj, Pemivibart, 4500 Mg 4 2 — — $5,890.50 $6,583.50 $6,185.02 2026-04-01
J1162 HCPCS Digoxin Immune Fab (ovine) 12 8 — — $4,968.58 $10,853.28 $5,592.75 2026-04-01
0326U OTHER Trgt Gen Seq Alys Pnl 83+ 8 7 — — $5,000.00 $10,500.00 $5,525.00 2026-04-01
J0225 HCPCS Inj, Vutrisiran, 1 Mg 12 8 — — $4,956.31 $10,507.64 $5,378.91 2026-04-01
J0716 HCPCS Centruroides Immune F(ab) 11 8 — — $4,871.94 $10,231.07 $5,359.13 2026-04-01
J7504 HCPCS Lymphocyte Immune Globulin 12 8 — — $4,376.29 $10,783.69 $5,314.82 2026-04-01
J9219 HCPCS Leuprolide Acetate Implant 3 1 — — $5,229.05 $5,751.96 $5,229.05 2026-04-01
J0480 HCPCS Basiliximab 12 8 — — $4,686.85 $9,842.39 $5,104.28 2026-04-01
J9225 HCPCS Vantas Implant 3 1 — — $4,971.34 $5,468.47 $4,971.34 2026-04-01
J9200 HCPCS Floxuridine Injection 12 8 — — $3,988.33 $8,668.84 $4,437.62 2026-04-01
J0801 HCPCS Inj. Acthar Gel To 40 Units 12 8 — — $3,893.43 $8,682.71 $4,355.43 2026-04-01
A9600 HCPCS Sr89 Strontium 11 8 — — $3,825.00 $8,707.30 $4,353.65 2026-04-01
J0800 HCPCS Corticotropin Injection 3 1 — — $4,144.11 $4,558.52 $4,144.11 2026-04-01
J3316 HCPCS Inj., Triptorelin Xr 3.75 Mg 12 8 — — $3,506.04 $8,016.28 $4,088.90 2026-04-01
5523 OTHER Level 3 Imaging Without Contrast 1 1 — — $3,961.09 $3,961.09 $3,961.09 2026-04-01
J2507 HCPCS Pegloticase Injection 12 8 — — $3,565.32 $7,687.75 $3,939.19 2026-04-01
A9601 HCPCS Flortaucipir Inj 1 Millicuri 11 8 — — $3,570.00 $7,791.00 $3,927.00 2026-04-01
J0802 HCPCS Inj. (ani), Up To 40 Units 12 8 — — $3,445.58 $7,422.66 $3,799.69 2026-04-01
0329U OTHER Onc Neo Xome&trns Seq Alys 8 7 — — $3,437.98 $7,219.76 $3,798.97 2026-04-01
J9015 HCPCS Aldesleukin Injection 11 8 — — $3,338.87 $7,011.63 $3,726.18 2026-04-01
A9542 HCPCS In111 Ibritumomab, Dx 3 1 — — $3,570.00 $3,927.00 $3,570.00 2026-04-01
A9604 HCPCS Sm 153 Lexidronam 11 8 — — $3,159.80 $18,269.39 $3,526.34 2026-04-01
21084 HCPCS Prepare Face/oral Prosthesis 11 8 — — $250.00 $6,781.65 $3,390.82 2026-04-01
J7352 HCPCS Afamelanotide Implant, 1 Mg 11 8 — — $2,943.42 $6,181.18 $3,237.76 2026-04-01
J2993 HCPCS Reteplase Injection 11 8 — — $2,904.58 $6,099.61 $3,195.03 2026-04-01
J9286 HCPCS Inj Glofitamab Gxbm, 2.5 Mg 12 8 — — $2,767.88 $5,812.55 $2,975.48 2026-04-01
J9229 HCPCS Inj Inotuzumab Ozogam 0.1 Mg 12 8 — — $2,658.13 $5,665.91 $2,925.84 2026-04-01
J9268 HCPCS Pentostatin Injection 12 8 — — $2,608.16 $5,477.13 $2,902.88 2026-04-01
A9515 HCPCS Choline C-11 11 8 — — $2,516.43 $5,610.00 $2,808.34 2026-04-01
Q4246 HCPCS Coretext Or Protext, Per Cc 3 1 — — $2,737.00 $3,010.70 $2,737.00 2026-04-01
J0202 HCPCS Injection, Alemtuzumab 12 8 — — $2,429.89 $5,102.77 $2,645.57 2026-04-01
A9582 HCPCS Iodine I-123 Iobenguane 11 8 — — $2,317.50 $8,597.46 $2,586.33 2026-04-01
Q2017 HCPCS Teniposide, 50 Mg 3 1 — — $2,545.87 $2,800.46 $2,545.87 2026-04-01
90396 HCPCS Varicella-zoster Ig IM 11 8 — — $2,287.76 $4,959.83 $2,516.54 2026-04-01
J7294 HCPCS Seg Acet And Eth Estr Yearly 3 1 — — $2,468.96 $2,715.86 $2,468.96 2026-04-01
J0350 HCPCS Injection Anistreplase 30 U 3 1 — — $2,461.07 $2,707.18 $2,461.07 2026-04-01
Q4206 HCPCS Fluid Flow Or Fluid Gf 1 Cc 3 1 — — $2,448.00 $2,692.80 $2,448.00 2026-04-01
Q0247 HCPCS Sotrovimab 3 1 — — $2,394.00 $2,633.40 $2,394.00 2026-04-01
J2787 HCPCS Riboflavin 5?phos Opth<=3ml 3 1 — — $2,325.60 $2,558.16 $2,325.60 2026-04-01
J3240 HCPCS Thyrotropin Injection 12 8 — — $2,078.71 $4,444.28 $2,285.72 2026-04-01
Q4310 HCPCS Procenta, Per 100 Mg 4 2 — — $2,213.14 $2,459.93 $2,236.30 2026-04-01
A9572 HCPCS Indium In-111 Pentetreotide 11 8 — — $2,000.94 $4,342.14 $2,233.05 2026-04-01
J1826 HCPCS Interferon Beta-1a Inj 3 1 — — $2,202.64 $2,422.90 $2,202.64 2026-04-01
Q9982 HCPCS Flutemetamol F18 Diagnostic 11 8 — — $1,944.01 $4,082.42 $2,169.52 2026-04-01
Q9992 HCPCS Buprenorphine Xr Over 100 Mg 12 8 — — $1,925.23 $4,234.49 $2,167.65 2026-04-01
Q9991 HCPCS Buprenorph Xr 100 Mg Or Less 12 8 — — $1,925.23 $4,234.49 $2,167.65 2026-04-01
Q0222 HCPCS Bebtelovimab 175 Mg 3 1 — — $2,142.00 $2,356.20 $2,142.00 2026-04-01
0331U OTHER Onc Hl Neo Opt Gen Mapping 8 7 — — $1,863.22 $3,912.76 $2,058.86 2026-04-01
A9586 HCPCS Florbetapir F18 11 8 — — $1,825.64 $3,833.84 $2,037.41 2026-04-01
L8693 HCPCS Aud Osseo Dev, Abutment 8 7 — — $1,822.38 $3,827.00 $2,013.73 2026-04-01
J0850 HCPCS Cytomegalovirus Imm IV /vial 12 8 — — $1,808.64 $3,798.15 $1,978.82 2026-04-01
J0840 HCPCS Crotalidae Poly Immune Fab 12 8 — — $1,755.81 $3,840.30 $1,971.17 2026-04-01
A9507 HCPCS In111 Capromab 11 8 — — $1,730.29 $4,932.32 $1,931.00 2026-04-01
J1950 HCPCS Leuprolide Acetate /3.75 Mg 12 8 — — $1,670.30 $3,633.68 $1,860.10 2026-04-01
J0578 HCPCS Inj Brixadi, More Than 7 Day 12 8 — — $1,682.54 $3,533.34 $1,815.07 2026-04-01
A4563 HCPCS Vag Inser Rectal Control Sys 8 7 — — $1,640.30 $3,444.63 $1,812.53 2026-04-01
Q9983 HCPCS Florbetaben F18 Diagnostic 11 8 — — $1,584.67 $3,327.81 $1,768.49 2026-04-01
90291 HCPCS Cmv Ig IV 3 1 — — $1,763.85 $1,940.24 $1,763.85 2026-04-01
5012 OTHER Clinic Visits And Related Services 1 1 — — $1,762.36 $1,762.36 $1,762.36 2026-04-01
Q4114 HCPCS Integra Flowable Wound Matri 4 2 — — $1,494.35 $1,910.15 $1,736.50 2026-04-01
J9026 HCPCS Inj, Tarlatamab-dlle, 1 Mg 12 8 — — $1,530.00 $3,285.74 $1,662.93 2026-04-01
A9584 HCPCS Iodine I-123 Ioflupane 11 8 — — $1,387.74 $2,914.25 $1,548.72 2026-04-01
A9589 HCPCS Insti Hexaminolevulinate Hcl 4 2 — — $1,378.41 $1,645.35 $1,495.77 2026-04-01
5522 OTHER Level 2 Imaging Without Contrast 1 1 — — $1,477.04 $1,477.04 $1,477.04 2026-04-01
J9357 HCPCS Valrubicin Injection 12 8 — — $1,323.34 $2,779.02 $1,472.88 2026-04-01
J0130 HCPCS Abciximab Injection 3 1 — — $1,375.15 $1,512.67 $1,375.15 2026-04-01
Q4174 HCPCS Palingen Or Promatrx 3 1 — — $1,361.70 $1,497.87 $1,361.70 2026-04-01
J2326 HCPCS Inj, Nusinersen, 0.1mg 11 8 — — $1,136.30 $2,688.53 $1,344.26 2026-04-01
J0630 HCPCS Calcitonin Salmon Injection 3 1 — — $1,239.41 $1,363.35 $1,239.41 2026-04-01
J7307 HCPCS Etonogestrel Implant System 3 1 — — $1,238.93 $1,362.82 $1,238.93 2026-04-01
J7296 HCPCS Kyleena, 19.5 Mg 3 1 — — $1,238.93 $1,362.82 $1,238.93 2026-04-01
J7298 HCPCS Mirena, 52 Mg 3 1 — — $1,238.93 $1,362.82 $1,238.93 2026-04-01
A9570 HCPCS Indium In-111 Auto Wbc 11 8 — — $1,103.19 $4,723.58 $1,231.16 2026-04-01
J7513 HCPCS Daclizumab, Parenteral 3 1 — — $1,230.20 $1,353.22 $1,230.20 2026-04-01
A4642 HCPCS In111 Satumomab 3 1 — — $1,210.40 $1,331.44 $1,210.40 2026-04-01
J7300 HCPCS Intraut Copper Contraceptive 3 1 — — $1,161.78 $1,277.96 $1,161.78 2026-04-01
S0145 HCPCS Pegylated Interferon Alfa-2a, 180 Mcg/ Ml 3 1 — — $1,135.68 $1,249.25 $1,135.68 2026-04-01
J0841 HCPCS Inj Crotalidae IM F(ab')2 Eq 12 8 — — $1,043.55 $2,194.82 $1,132.03 2026-04-01
J7505 HCPCS Monoclonal Antibodies 3 1 — — $1,112.45 $1,223.70 $1,112.45 2026-04-01
J3401 HCPCS Vyjuvek 5x10^9pfu/ml, 0.1 Ml 12 8 — — $1,016.67 $2,153.42 $1,102.35 2026-04-01
J0207 HCPCS Amifostine 3 1 — — $1,092.84 $1,202.12 $1,092.84 2026-04-01
J7511 HCPCS Antithymocyte Globuln Rabbit 12 8 — — $939.35 $2,098.67 $1,074.32 2026-04-01
5521 OTHER Level 1 Imaging Without Contrast 3 3 — — $169.90 $1,158.56 $1,061.26 2026-04-01
Q4231 HCPCS Corplex P, Per Cc 4 2 — — $656.14 $1,156.49 $1,051.35 2026-04-01
A9569 HCPCS Technetium Tc-99m Auto Wbc 11 8 — — $934.13 $1,961.67 $1,042.49 2026-04-01
J1438 HCPCS Etanercept Injection 3 1 — — $1,040.09 $1,144.10 $1,040.09 2026-04-01
A9521 HCPCS Tc99m Exametazime 11 8 — — $927.71 $1,948.19 $1,035.32 2026-04-01
J7301 HCPCS Skyla, 13.5 Mg 3 1 — — $1,031.61 $1,134.77 $1,031.61 2026-04-01
J7316 HCPCS Inj, Ocriplasmin, 0.125 Mg 3 1 — — $1,007.42 $1,108.16 $1,007.42 2026-04-01
A9508 HCPCS I131 Iodobenguate, Dx 11 8 — — $753.92 $2,001.32 $1,000.66 2026-04-01
A9509 HCPCS Iodine I-123 Sod Iodide Mil 3 1 — — $977.53 $1,075.28 $977.53 2026-04-01
J7297 HCPCS Liletta, 52 Mg 3 1 — — $950.37 $1,045.41 $950.37 2026-04-01
Q5147 HCPCS Inj, Aflibercept-ayyh, 1 Mg 9 7 — — $795.86 $1,804.66 $945.30 2026-04-01
Q4113 HCPCS Graftjacket Xpress 3 1 — — $935.00 $1,028.50 $935.00 2026-04-01
A9547 HCPCS In111 Oxyquinoline 11 8 — — $831.46 $2,361.79 $927.91 2026-04-01
Q4112 HCPCS Cymetra Injectable 3 1 — — $904.99 $995.49 $904.99 2026-04-01
A9602 HCPCS Fluorodopa F-18 Diag Per Mci 11 8 — — $508.84 $1,796.66 $898.33 2026-04-01
0327U OTHER Ftl Aneuploidy Trsmy DNA Seq 8 7 — — $795.00 $1,669.50 $878.48 2026-04-01
C9047 HCPCS Injection, Caplacizumab-yhdp 11 8 — — $794.83 $1,685.23 $874.31 2026-04-01
J0178 HCPCS Aflibercept Injection 12 8 — — $771.56 $1,620.27 $858.74 2026-04-01
J9248 HCPCS Inj Melphalan (hepzato) 1 Mg 12 8 — — $773.80 $1,669.50 $854.62 2026-04-01
Q4230 HCPCS Cogenex Flow Amnion 0.5 Cc 3 1 — — $850.00 $935.00 $850.00 2026-04-01
0012M OTHER Onc Mrna 5 Gen Rsk Urthl Ca 8 7 — — $760.00 $1,596.00 $839.80 2026-04-01
0013M OTHER Onc Mrna 5 Gen Recr Urthl Ca 8 7 — — $760.00 $1,596.00 $839.80 2026-04-01
A9548 HCPCS In111 Pentetate 11 8 — — $745.62 $1,565.80 $832.11 2026-04-01
J7686 HCPCS Treprostinil, Non-comp Unit 4 2 — — $760.40 $907.16 $824.69 2026-04-01
J1212 HCPCS Dimethyl Sulfoxide 50% 50 Ml 12 8 — — $714.72 $1,572.57 $805.01 2026-04-01
J9202 HCPCS Goserelin Acetate Implant 12 8 — — $705.14 $1,540.70 $788.69 2026-04-01
J2503 HCPCS Pegaptanib Sodium Injection 3 1 — — $755.86 $831.45 $755.86 2026-04-01
M0241 HCPCS Casiri And Imdev Repeat Hm 3 1 — — $750.00 $825.00 $750.00 2026-04-01
M0246 HCPCS Bamlan And Etesev Infus Home 3 1 — — $750.00 $825.00 $750.00 2026-04-01
M0248 HCPCS Sotrovimab Inf, Home Admin 3 1 — — $750.00 $825.00 $750.00 2026-04-01
M0244 HCPCS Casirivi And Imdevi Infus Hm 3 1 — — $750.00 $825.00 $750.00 2026-04-01
E1905 HCPCS Vr Cbt Therapy 8 7 — — $674.77 $1,417.02 $745.62 2026-04-01
J1954 HCPCS Leuprolide Depot Cipla 7.5mg 12 8 — — $220.74 $1,484.00 $731.40 2026-04-01
J7354 HCPCS Cantharidin Top, Applicator 12 8 — — $654.76 $1,374.99 $728.75 2026-04-01
J9348 HCPCS Inj. Naxitamab-gqgk, 1 Mg 12 8 — — $641.83 $1,440.60 $726.73 2026-04-01
A9608 HCPCS Flotufolastat F18 Diag 1 Mci 11 8 — — $651.67 $1,409.56 $716.84 2026-04-01
J7327 HCPCS Monovisc Inj Per Dose 12 8 — — $636.59 $1,336.84 $708.52 2026-04-01
N809 OTHER Other Medicine 11 7 — — $173.00 $5,081.51 $704.46 2026-04-01
J9350 HCPCS Inj Mosunetuzumab-axgb, 1 Mg 12 8 — — $640.96 $1,374.72 $703.73 2026-04-01
A9592 HCPCS Copper Cu 64 Dotatate Diag 11 8 — — $594.28 $1,247.99 $663.22 2026-04-01
90389 HCPCS Tetanus Ig IM 3 1 — — $656.17 $721.79 $656.17 2026-04-01
J1454 HCPCS Inj Fosnetupitant, Palonoset 12 8 — — $575.50 $1,208.56 $640.53 2026-04-01
J2502 HCPCS Inj, Pasireotide Long Acting 12 8 — — $526.94 $1,684.78 $637.70 2026-04-01
J1670 HCPCS Tetanus Immune Globulin Inj 12 8 — — $575.76 $1,245.31 $637.47 2026-04-01
J1290 HCPCS Ecallantide Injection 12 8 — — $564.64 $1,217.93 $624.43 2026-04-01
J9098 HCPCS Cytarabine Liposome Inj 3 1 — — $604.66 $665.13 $604.66 2026-04-01
J1743 HCPCS Idursulfase Injection 12 8 — — $542.57 $1,172.76 $601.28 2026-04-01
S0172 HCPCS Chlorambucil, Oral, 2 Mg 3 1 — — $589.12 $648.03 $589.12 2026-04-01
J1307 HCPCS Inj, Crovalimab-akkz, 10 Mg 11 8 — — $530.70 $1,158.18 $583.77 2026-04-01
J7314 HCPCS Inj., Yutiq, 0.01 Mg 12 8 — — $524.57 $1,112.77 $576.71 2026-04-01
J2840 HCPCS Inj Sebelipase Alfa 1 Mg 11 8 — — $520.71 $1,133.82 $572.78 2026-04-01
J7326 HCPCS Gel-one 12 8 — — $529.26 $1,111.44 $568.95 2026-04-01
J0740 HCPCS Cidofovir Injection 12 8 — — $326.67 $1,147.22 $565.41 2026-04-01
M0223 HCPCS Bebtelovimab Injection Home 3 1 — — $550.50 $605.55 $550.50 2026-04-01
J1945 HCPCS Lepirudin 3 1 — — $549.01 $603.91 $549.01 2026-04-01
J1430 HCPCS Ethanolamine Oleate 100 Mg 12 8 — — $497.70 $1,068.82 $547.13 2026-04-01
J1458 HCPCS Galsulfase Injection 12 8 — — $484.88 $1,068.39 $546.91 2026-04-01
J7313 HCPCS Fluocinol Acet Intravit Imp 12 8 — — $490.77 $1,046.08 $541.78 2026-04-01
J1554 HCPCS Inj. Asceniv 12 8 — — $496.68 $1,043.15 $541.70 2026-04-01
J1830 HCPCS Interferon Beta-1b / .25 Mg 3 1 — — $540.11 $594.12 $540.11 2026-04-01
A9596 HCPCS Gallium Illuccix 1 Millicure 11 8 — — $478.52 $1,159.25 $534.03 2026-04-01
J1823 HCPCS Inj. Inebilizumab-cdon, 1 Mg 12 8 — — $484.40 $1,040.64 $532.71 2026-04-01
90380 HCPCS Rsv Monoc Antb Seasn .5ml IM 3 1 — — $526.75 $579.43 $526.75 2026-04-01
90381 HCPCS Rsv Monoc Antb Seasnl 1ml IM 3 1 — — $526.75 $579.43 $526.75 2026-04-01
J3315 HCPCS Triptorelin Pamoate 12 8 — — $471.63 $997.16 $522.24 2026-04-01
J0584 HCPCS Injection, Burosumab-twza 1m 12 8 — — $469.74 $1,016.69 $521.08 2026-04-01
A9591 HCPCS Fluoroestradiol F 18 11 8 — — $460.42 $5,178.03 $513.83 2026-04-01
J0217 HCPCS Inj Velmanase Alfa-tycv 1 Mg 12 8 — — $444.98 $976.99 $495.85 2026-04-01
90378 HCPCS Rsv Mab IM 50mg 11 8 — — $436.75 $1,898.56 $487.41 2026-04-01
J9247 HCPCS Inj, Melphalan Flufenami 1mg 3 1 — — $484.50 $532.95 $484.50 2026-04-01
A9520 HCPCS Tc99 Tilmanocept Diag 0.5mci 3 1 — — $479.20 $527.12 $479.20 2026-04-01
J2770 HCPCS Quinupristin/dalfopristin 3 1 — — $475.33 $522.86 $475.33 2026-04-01
M0224 HCPCS Pemivibart Infusion 11 8 — — $429.50 $901.95 $472.45 2026-04-01
M0249 HCPCS Adm Tocilizu Covid-19 1st 11 8 — — $429.50 $901.95 $472.45 2026-04-01
M0250 HCPCS Adm Tocilizu Covid-19 2nd 11 8 — — $429.50 $901.95 $472.45 2026-04-01
J2760 HCPCS Phentolaine Mesylate Inj 12 8 — — $428.13 $907.25 $462.28 2026-04-01
C9293 HCPCS Injection, Glucarpidase 11 8 — — $419.98 $898.20 $461.98 2026-04-01
N801 OTHER Therapy Services 31 15 — — $45.00 $6,567.20 $456.56 2026-04-01
J8655 HCPCS Netupitant Palonosetron Oral 12 8 — — $409.01 $888.08 $454.61 2026-04-01
J0577 HCPCS Inj, Brixadi, 7 Days Or Less 12 8 — — $420.64 $883.34 $453.76 2026-04-01
M0240 HCPCS Casiri And Imdev Repeat 3 1 — — $450.00 $495.00 $450.00 2026-04-01
M0247 HCPCS Sotrovimab Infusion 3 1 — — $450.00 $495.00 $450.00 2026-04-01
M0243 HCPCS Casirivi And Imdevi Infusion 3 1 — — $450.00 $495.00 $450.00 2026-04-01
M0245 HCPCS Bamlan And Etesev Infusion 3 1 — — $450.00 $495.00 $450.00 2026-04-01
J2355 HCPCS Oprelvekin Injection 3 1 — — $449.58 $494.54 $449.58 2026-04-01
J3365 HCPCS Urokinase 250,000 Iu Inj 3 1 — — $440.45 $484.50 $440.45 2026-04-01
J7315 HCPCS Ophthalmic Mitomycin 3 1 — — $438.60 $482.46 $438.60 2026-04-01
J7308 HCPCS Aminolevulinic Acid Hcl Top 12 8 — — $392.09 $823.39 $430.06 2026-04-01
A2029 HCPCS Mirotract Matrix Sheet 3 1 — — $425.00 $467.50 $425.00 2026-04-01
J1410 HCPCS Inj Estrogen Conjugate 25 Mg 12 8 — — $382.89 $823.33 $423.35 2026-04-01
J0218 HCPCS Inj Olipudase Alfa-rpcp 1mg 12 8 — — $381.24 $826.69 $423.18 2026-04-01
J9307 HCPCS Pralatrexate Injection 12 8 — — $373.77 $824.52 $422.07 2026-04-01
J9352 HCPCS Injection Trabectedin 0.1mg 12 8 — — $363.83 $821.25 $420.40 2026-04-01
J9210 HCPCS Inj., Emapalumab-lzsg, 1 Mg 12 8 — — $381.50 $808.18 $415.94 2026-04-01
J3385 HCPCS Velaglucerase Alfa 12 8 — — $374.36 $800.86 $412.64 2026-04-01
J9019 HCPCS Erwinaze Injection 3 1 — — $411.14 $452.25 $411.14 2026-04-01
J2783 HCPCS Rasburicase 12 8 — — $370.46 $792.79 $408.32 2026-04-01
A9800 HCPCS Gallium Locametz 1 Millicuri 11 8 — — $362.50 $924.53 $404.55 2026-04-01
90376 HCPCS Rabies Ig Heat Treated 11 8 — — $352.44 $740.12 $393.32 2026-04-01
A9595 HCPCS Piflu F-18, Dia 1 Millicurie 11 8 — — $346.49 $727.63 $386.68 2026-04-01
J3241 HCPCS Inj. Teprotumumab-trbw 10 Mg 12 8 — — $352.56 $754.30 $386.13 2026-04-01
J9269 HCPCS Inj. Tagraxofusp-erzs 10 Mcg 12 8 — — $338.53 $749.55 $383.70 2026-04-01
J0179 HCPCS Inj, Brolucizumab-dbll, 1 Mg 12 8 — — $339.99 $726.82 $372.07 2026-04-01
J7311 HCPCS Fluocinolone Acetonide Implt 12 8 — — $340.04 $714.66 $367.93 2026-04-01
J1744 HCPCS Icatibant Injection 4 2 — — $125.32 $396.07 $360.06 2026-04-01
A9588 HCPCS Fluciclovine F-18 11 8 — — $322.27 $676.77 $359.65 2026-04-01
J9120 HCPCS Dactinomycin Injection 12 8 — — $288.80 $689.51 $356.77 2026-04-01
J9320 HCPCS Streptozocin Injection 3 1 — — $356.22 $391.84 $356.22 2026-04-01
J2504 HCPCS Pegademase Bovine, 25 Iu 3 1 — — $354.08 $389.49 $354.08 2026-04-01
J0224 HCPCS Inj. Lumasiran, 0.5 Mg 12 8 — — $318.85 $691.01 $353.73 2026-04-01
M0222 HCPCS Bebtelovimab Injection 3 1 — — $350.50 $385.55 $350.50 2026-04-01
90675 HCPCS Rabies Vaccine IM 12 8 — — $313.68 $658.73 $349.12 2026-04-01
A9506 HCPCS Tc-99m Graphite Crucible 11 8 — — $316.20 $690.06 $347.82 2026-04-01
J9281 HCPCS Mitomycin Instillation 12 8 — — $313.00 $668.92 $342.42 2026-04-01
J0177 HCPCS Inj, Aflibercept Hd, 1 Mg 12 8 — — $311.38 $653.90 $342.00 2026-04-01
A9513 HCPCS Lutetium Lu 177 Dotatat Ther 11 8 — — $305.02 $665.67 $335.52 2026-04-01
Q2049 HCPCS Imported Lipodox Inj 11 8 — — $298.74 $627.35 $333.39 2026-04-01
J1322 HCPCS Elosulfase Alfa, Injection 12 8 — — $293.94 $648.23 $331.84 2026-04-01
90684 HCPCS Pcv21 Vaccine IM 1 1 — — $327.89 $327.89 $327.89 2026-04-01
J9230 HCPCS Mechlorethamine Hcl Inj 3 1 — — $315.90 $347.49 $315.90 2026-04-01
90651 HCPCS 9vhpv Vaccine 3 Dose IM 3 1 — — $314.61 $346.07 $314.61 2026-04-01
90678 HCPCS Rsv Vacc Pref Bivalent IM 3 1 — — $313.80 $345.18 $313.80 2026-04-01
90375 HCPCS Rabies Ig Im/sc 12 8 — — $279.85 $587.69 $311.48 2026-04-01
90627 HCPCS Tic-brn Enceph Vac 0.5ml IM 3 1 — — $310.90 $341.99 $310.90 2026-04-01
90626 HCPCS Tic-brn Enceph Vac 0.25ml IM 3 1 — — $310.90 $341.99 $310.90 2026-04-01
M0239 HCPCS Bamlanivimab-xxxx Infusion 3 1 — — $309.60 $340.56 $309.60 2026-04-01
J2690 HCPCS Procainamide Hcl Injection 12 8 — — $198.57 $618.85 $305.00 2026-04-01
J3397 HCPCS Inj., Vestronidase Alfa-vjbk 11 8 — — $277.03 $587.85 $304.73 2026-04-01
90738 HCPCS Inactivated Je Vacc IM 3 1 — — $302.08 $332.29 $302.08 2026-04-01
90679 HCPCS Rsv Vacc Pref Recomb Adjt IM 3 1 — — $301.00 $331.10 $301.00 2026-04-01
90683 HCPCS Rsv Vacc Mrna Lipid Nano IM 3 1 — — $297.00 $326.70 $297.00 2026-04-01
C9074 HCPCS Injection, Lumasiran 3 1 — — $296.83 $326.51 $296.83 2026-04-01
90677 HCPCS Pcv20 Vaccine IM 4 2 — — $281.60 $312.90 $295.68 2026-04-01
99283 HCPCS Emergency Dept Visit 8 7 — — $265.89 $558.37 $293.81 2026-04-01
L8696 HCPCS Ext Antenna Phren Nerve Stim 8 7 — — $260.49 $547.03 $287.84 2026-04-01
J9052 HCPCS Inj, Carmustine (accord) 11 8 — — $259.70 $545.37 $285.67 2026-04-01
90710 HCPCS Mmrv Vaccine Sc 3 1 — — $285.16 $313.68 $285.16 2026-04-01
87913 HCPCS Nfct Agt Gntyp Alys Sarscov2 8 7 — — $257.45 $540.64 $284.49 2026-04-01
J7525 HCPCS Tacrolimus Injection 12 8 — — $255.06 $552.61 $282.88 2026-04-01
J7501 HCPCS Azathioprine Parenteral 11 8 — — $254.07 $533.54 $279.47 2026-04-01
J9042 HCPCS Brentuximab Vedotin Inj 12 8 — — $248.93 $543.14 $278.03 2026-04-01
90611 HCPCS Smallpox&monkeypox Vac 0.5ml 3 1 — — $277.00 $304.70 $277.00 2026-04-01
J9153 HCPCS Inj Daunorubicin, Cytarabine 12 8 — — $249.02 $537.78 $275.60 2026-04-01
A9607 HCPCS Lutetium Lu 177 Vipivotide 11 8 — — $248.39 $537.26 $273.23 2026-04-01
A9541 HCPCS Tc99m Sulfur Colloid 3 1 — — $272.71 $299.98 $272.71 2026-04-01
J9204 HCPCS Inj Mogamulizumab-kpkc, 1 Mg 12 8 — — $243.63 $521.84 $267.13 2026-04-01
J9050 HCPCS Carmustine Injection 12 8 — — $145.60 $500.76 $265.40 2026-04-01
J9272 HCPCS Inj, Dostarlimab-gxly, 10 Mg 12 8 — — $240.14 $511.80 $261.99 2026-04-01
J7340 HCPCS Carbidopa Levodopa ENT 100ml 12 8 — — $235.77 $511.57 $261.98 2026-04-01
70320 HCPCS Full Mouth X-ray Of Teeth 8 7 — — $232.41 $488.05 $256.81 2026-04-01
70310 HCPCS X-ray Exam Of Teeth 8 7 — — $232.41 $488.05 $256.81 2026-04-01
77084 HCPCS Magnetic Image Bone Marrow 8 7 — — $232.41 $488.05 $256.81 2026-04-01
73221 HCPCS MRI Joint Upr Extrem Without Contrast 8 7 — — $232.41 $488.05 $256.81 2026-04-01
73218 HCPCS MRI Upper Extremity Without Contrast 8 7 — — $232.41 $488.05 $256.81 2026-04-01
77054 HCPCS X-ray Of Mammary Ducts 8 7 — — $232.41 $488.05 $256.81 2026-04-01
77053 HCPCS X-ray Of Mammary Duct 8 7 — — $232.41 $488.05 $256.81 2026-04-01
77047 HCPCS MRI Breast C- Bilateral 8 7 — — $232.41 $488.05 $256.81 2026-04-01
77046 HCPCS MRI Breast C- Unilateral 8 7 — — $232.41 $488.05 $256.81 2026-04-01
76975 HCPCS Gi Endoscopic Ultrasound 8 7 — — $232.41 $488.05 $256.81 2026-04-01
70555 HCPCS Fmri Brain By Phys/psych 8 7 — — $232.41 $488.05 $256.81 2026-04-01
70554 HCPCS Fmri Brain By Tech 8 7 — — $232.41 $488.05 $256.81 2026-04-01
76831 HCPCS Echo Exam Uterus 8 7 — — $232.41 $488.05 $256.81 2026-04-01
70551 HCPCS MRI Brain Stem Without Contrast 8 7 — — $232.41 $488.05 $256.81 2026-04-01
76826 HCPCS Echo Exam Of Fetal Heart 8 7 — — $232.41 $488.05 $256.81 2026-04-01
70547 HCPCS Mr Angiography Neck Without Contrast 8 7 — — $232.41 $488.05 $256.81 2026-04-01
49465 HCPCS Fluoro Exam Of G/colon Tube 8 7 — — $232.41 $488.05 $256.81 2026-04-01
70544 HCPCS Mr Angiography Head Without Contrast 8 7 — — $232.41 $488.05 $256.81 2026-04-01
70540 HCPCS MRI Orbit/face/neck Without Contrast 8 7 — — $232.41 $488.05 $256.81 2026-04-01
76811 HCPCS OB US Detailed Sngl Fetus 8 7 — — $232.41 $488.05 $256.81 2026-04-01
See an error in this hospital's data? Submit a correction