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

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

16,513 of 68,624 rate rows are consumer-grade (24.1%)

52,111 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 52,069
placeholder amount (≤ $0.02) — excluded from medians 42
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 · 2026-05-17
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
$753,246
0.8× median
Q2056
HCPCS 		Ciltacabtagene Car-pos T 8 $310,000.00 $1,188,324.78 $585,674.35 nat. median
$674,867
0.9× median
Q2054
HCPCS 		Lisocabtagene Mara Car Pos T 8 $328,240.00 $1,181,330.19 $582,227.02 nat. median
$673,137
0.9× median
Q2055
HCPCS 		Idecabtagene Vicleucel Car 8 $335,600.00 $1,170,367.66 $576,824.06 nat. median
$625,184
0.9× median
Q2041
HCPCS 		Axicabtagene Ciloleucel Car+ 8 $245,394.70 $1,119,783.36 $551,893.23 nat. median
$634,303
0.9× median
Q2053
HCPCS 		Brexucabtagene Car Pos T 8 $489,304.61 $1,027,539.68 $533,862.45 nat. median
$619,808
0.9× median
91
MS_DRG 		Other Disorders Of Nervous System With Mcc 4 $56,124.00 $303,006.00 $170,914.00 nat. median
$17,985
outlier · 9.5×
950
MS_DRG 		Aftercare Without Cc/Mcc 12 $9,324.00 $164,885.60 $82,367.60 nat. median
$7,552
outlier · 10.9×
53
MS_DRG 		Spinal Disorders And Injuries Without Cc/Mcc 2 $38,226.00 $123,200.00 $80,713.00 nat. median
$10,562
outlier · 7.6×
73
MS_DRG 		Cranial And Peripheral Nerve Disorders With Mcc 3 $62,848.00 $91,903.45 $76,269.24 nat. median
$16,028
outlier · 4.8×
74
MS_DRG 		Cranial And Peripheral Nerve Disorders Without Mcc 3 $46,200.00 $69,542.25 $69,542.25 nat. median
$11,117
outlier · 6.3×
J9029
HCPCS 		Inj, Adstiladrin, Per Tx Dos 8 $63,235.61 $133,018.79 $68,092.95 nat. median
$69,774
1.0× median
101
MS_DRG 		Seizures Without Mcc 2 $66,006.00 $69,300.00 $67,653.00 nat. median
$9,814
outlier · 6.9×
94
MS_DRG 		Bacterial And Tuberculous Infections Of Nervous System With Mcc 6 $66,371.60 $184,800.00 $66,371.60 nat. median
$35,264
1.9× median
A9543
HCPCS 		Y90 Ibritumomab, Rx 8 $56,824.55 $119,331.55 $63,416.20 nat. median
$62,507
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
$24,991
outlier · 2.5×
J7330
HCPCS 		Cultured Chondrocytes Implnt 1 $61,878.30 $68,066.13 $61,878.30 nat. median
$76,329
0.8× median
Q2043
HCPCS 		Sipuleucel-t Auto Cd54+ 8 $55,272.32 $116,071.88 $60,525.71 nat. median
$66,682
0.9× median
56
MS_DRG 		Degenerative Nervous System Disorders With Mcc 11 $13,542.10 $284,642.00 $58,655.25 nat. median
$22,361
outlier · 2.6×
57
MS_DRG 		Degenerative Nervous System Disorders Without Mcc 16 $17,340.00 $99,598.10 $58,196.50 nat. median
$13,201
outlier · 4.4×
100
MS_DRG 		Seizures With Mcc 1 $57,750.00 $57,750.00 $57,750.00 nat. median
$19,360
outlier · 3.0×
J9226
HCPCS 		Supprelin La Implant 7 $45,020.65 $94,543.36 $49,522.72 nat. median
$60,368
0.8× median
947
MS_DRG 		Signs And Symptoms With Mcc 10 $9,324.00 $93,321.90 $48,516.65 nat. median
$12,688
outlier · 3.8×
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
$22,276
outlier · 2.2×
71
MS_DRG 		Other Cerebrovascular Disorders With Cc 1 $47,671.00 $47,671.00 $47,671.00 nat. median
$11,209
outlier · 4.3×
949
MS_DRG 		Aftercare With Cc/Mcc 14 $18,970.93 $146,577.84 $46,043.38 nat. median
$12,475
outlier · 3.7×
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
$24,796
1.8× median
641
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 1 $40,681.00 $40,681.00 $40,681.00 nat. median
$8,664
outlier · 4.7×
559
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Mcc 14 $3,279.83 $81,732.00 $40,413.00 nat. median
$19,047
outlier · 2.1×
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
$35,069
1.1× median
60
MS_DRG 		Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc 2 $33,502.00 $72,105.00 $38,288.00 nat. median
$10,102
outlier · 3.8×
52
MS_DRG 		Spinal Disorders And Injuries With Cc/Mcc 6 $5,366.43 $161,700.00 $37,743.00 nat. median
$19,131
2.0× median
844
MS_DRG 		Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses… 1 $37,168.00 $37,168.00 $37,168.00 nat. median
$12,709
outlier · 2.9×
70
MS_DRG 		Other Cerebrovascular Disorders With Mcc 1 $35,895.00 $35,895.00 $35,895.00 nat. median
$17,281
outlier · 2.1×
561
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc 12 $11,988.00 $53,784.00 $30,767.80 nat. median
$9,193
outlier · 3.3×
948
MS_DRG 		Signs And Symptoms Without Mcc 12 $13,200.00 $76,650.00 $30,678.75 nat. median
$8,515
outlier · 3.6×
J9266
HCPCS 		Pegaspargase Injection 8 $27,070.53 $59,690.52 $30,555.86 nat. median
$34,109
0.9× median
560
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Cc 11 $7,200.00 $85,932.70 $27,475.00 nat. median
$12,148
outlier · 2.3×
58
MS_DRG 		Multiple Sclerosis And Cerebellar Ataxia With Mcc 2 $26,323.00 $33,362.85 $26,323.00 nat. median
$17,928
1.5× median
J9600
HCPCS 		Porfimer Sodium Injection 8 $23,789.46 $50,879.68 $26,168.41 nat. median
$31,627
0.8× median
92
MS_DRG 		Other Disorders Of Nervous System With Cc 4 $18,900.00 $48,115.20 $24,850.00 nat. median
$11,294
outlier · 2.2×
93
MS_DRG 		Other Disorders Of Nervous System Without Cc/Mcc 3 $4,200.00 $128,304.00 $22,230.50 nat. median
$9,004
outlier · 2.5×
59
MS_DRG 		Multiple Sclerosis And Cerebellar Ataxia With Cc 3 $15,396.00 $51,325.49 $21,537.00 nat. median
$13,000
1.7× median
977
MS_DRG 		HIV With Or Without Other Related Condition 2 $16,261.00 $66,776.00 $21,537.00 nat. median
$14,373
1.5× median
J7310
HCPCS 		Ganciclovir Long Act Implant 1 $16,320.00 $17,952.00 $16,320.00 nat. median
$19,165
0.9× median
5023
OTHER 		Level 3 Type A Ed Visits 1 $13,954.50 $13,954.50 $13,954.50 nat. median
$436
outlier · 32.0×
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
$13,400
0.7× median
J9216
HCPCS 		Interferon Gamma 1-b Inj 1 $8,628.84 $9,491.72 $8,628.84 nat. median
$10,259
0.8× median
J0600
HCPCS 		Edetate Calcium Disodium Inj 8 $6,408.38 $13,457.59 $6,889.00 nat. median
$7,109
1.0× median
Q0224
HCPCS 		Inj, Pemivibart, 4500 Mg 2 $5,890.50 $6,583.50 $6,185.02 nat. median
$7,346
0.8× 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.

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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 7 4 — — $56,124.00 $303,006.00 $170,914.00 2026-04-01
950 MS_DRG Aftercare Without Cc/Mcc 27 12 — — $9,324.00 $164,885.60 $82,367.60 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 10 6 — — $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 30 11 — — $13,542.10 $284,642.00 $58,655.25 2026-04-01
57 MS_DRG Degenerative Nervous System Disorders Without Mcc 46 16 — — $17,340.00 $99,598.10 $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
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 27 10 — — $9,324.00 $93,321.90 $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 35 14 — — $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 31 14 — — $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 35 12 — — $11,988.00 $53,784.00 $30,767.80 2026-04-01
948 MS_DRG Signs And Symptoms Without Mcc 24 12 — — $13,200.00 $76,650.00 $30,678.75 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 22 11 — — $7,200.00 $85,932.70 $27,475.00 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 8 4 — — $18,900.00 $48,115.20 $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
977 MS_DRG HIV With Or Without Other Related Condition 3 2 — — $16,261.00 $66,776.00 $21,537.00 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
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 HCPCS 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 HCPCS 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 HCPCS 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
J7298 HCPCS Mirena, 52 Mg 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
J7307 HCPCS Etonogestrel Implant System 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 HCPCS 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 HCPCS Onc Mrna 5 Gen Rsk Urthl Ca 8 7 — — $760.00 $1,596.00 $839.80 2026-04-01
0013M HCPCS 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
M0244 HCPCS Casirivi And Imdevi Infus Hm 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
M0246 HCPCS Bamlan And Etesev Infus Home 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
90381 HCPCS Rsv Monoc Antb Seasnl 1ml IM 3 1 — — $526.75 $579.43 $526.75 2026-04-01
90380 HCPCS Rsv Monoc Antb Seasn .5ml 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
M0249 HCPCS Adm Tocilizu Covid-19 1st 11 8 — — $429.50 $901.95 $472.45 2026-04-01
M0224 HCPCS Pemivibart Infusion 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
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
M0247 HCPCS Sotrovimab Infusion 3 1 — — $450.00 $495.00 $450.00 2026-04-01
M0240 HCPCS Casiri And Imdev Repeat 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
71550 HCPCS MRI Chest 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
0993T HCPCS N-invas Assmt Car Rsk W/ct 8 7 — — $232.41 $488.05 $256.81 2026-04-01
0992T HCPCS N-invas Assmt Car Rsk Without CT 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
76391 HCPCS Mr Elastography 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
0944T HCPCS 3d Cntr Simula Trgt Lvr Les 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
93985 HCPCS Dup-scan Hemo Compl Bi Std 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
76017 HCPCS Mr Sfty Med Physics Xm Cstmz 8 7 — — $232.41 $488.05 $256.81 2026-04-01
0866T HCPCS Quan MRI Alys Brn W/dx MRI 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
76000 HCPCS Fluoroscope Examination 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
0865T HCPCS Quan MRI Alys Brn Without Dx MRI 8 7 — — $232.41 $488.05 $256.81 2026-04-01
75557 HCPCS Cardiac MRI For Morph 8 7 — — $232.41 $488.05 $256.81 2026-04-01
74775 HCPCS X-ray Exam Of Perineum 8 7 — — $232.41 $488.05 $256.81 2026-04-01
74740 HCPCS X-ray Female Genital Tract 8 7 — — $232.41 $488.05 $256.81 2026-04-01
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