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

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Hospital

WAGNER COMMUNITY MEMORIAL HOSPITAL - CAH

Wagner, SD · CCN 431315 · Rates published

819 distinct procedures filed
5 distinct payers
12,601 rate rows
2026-07-15 last MRF observed
Data quality

12,581 of 12,601 rate rows are consumer-grade (99.8%)

20 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
exceeds 10× this hospital's gross charge — excluded from medians 10
placeholder amount (≤ $0.02) — excluded from medians 8
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.avera.org/app/files/public/5c231d09-7aaa-4454-9d0a-a311162cb1cc/460226283_wagner-community-memorial_standardcharges.csv
Found on page https://www.avera.org/cms-hpt.txt
Discovered viaDiscovered by HANK (automated)
Last fetch success · 2026-08-01
Content fingerprint 31e360cc561b79de… · 3,314,223 bytes · first seen 2026-06-08

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
J2350
HCPCS 		Ocrelizumab 300 Mg/10 Ml 5 $6.09 $72,128.86 $61,195.65 nat. median
$331
outlier · 185.0×
J9334
HCPCS 		Efgart-hyalu-qvfc 1008Mg/5.6Ml 5 $560.66 $57,762.90 $50,466.53 nat. median
$77
outlier · 657.5×
J2327
HCPCS 		Risankizumab-rzaa 600 Mg/10 Ml 5 $68.09 $37,059.86 $32,378.61 nat. median
$961
outlier · 33.7×
760
CDM 		Misc Specialty Services - Gen 5 $23,446.78 $34,268.37 $29,398.65 nat. median
$18
outlier · 1615.8×
J3380
HCPCS 		Vedolizumab 300 Mg Vial 5 $72.63 $32,695.98 $28,910.13 nat. median
$150
outlier · 193.0×
J3101
HCPCS 		Tenecteplase 50 Mg/10 Ml Syrng 5 $0.41 $25,622.69 $21,738.83 nat. median
$3,475
outlier · 6.3×
J9332
HCPCS 		Efgartigimod Alfa-fcab 400 Mg 5 $7.91 $57,520.09 $19,641.01 nat. median
$109
outlier · 180.2×
J0717
HCPCS 		Certolizumab Pegol 400 Mg Kit 5 $3.42 $20,991.09 $17,809.28 nat. median
$1,187
outlier · 15.0×
J2353
HCPCS 		Octreotide (Depot) 20 Mg Syr 5 $17.33 $15,434.18 $13,094.69 nat. median
$5,513
outlier · 2.4×
J2356
HCPCS 		Tezepelumab-ekko 210 Mg/1.9 Ml 5 $12.98 $14,143.44 $11,999.59 nat. median
$75
outlier · 159.7×
562
MS_DRG 		Ms-DRG 562 1 $11,393.68 $11,393.68 $11,393.68 nat. median
$14,618
0.8× median
J9047
HCPCS 		Carfilzomib 60 Mg Vial 5 $81.21 $12,512.09 $10,615.52 nat. median
$1,500
outlier · 7.1×
90375
HCPCS 		Rabies Ig (Human) 300 U/Ml 5Ml 5 $146.90 $11,338.87 $9,620.14 nat. median
$1,039
outlier · 9.3×
J2182
HCPCS 		Mepolizumab 100 Mg Vial 5 $6.38 $10,838.57 $9,195.67 nat. median
$2,559
outlier · 3.6×
J3111
HCPCS 		Romosozumab-aqqg 210 Mg/2.34Ml 5 $1.56 $9,449.03 $8,016.76 nat. median
$657
outlier · 12.2×
Q5119
HCPCS 		Rituximab-pvvr 500Mg/50Ml Vial 5 $1,112.40 $14,925.58 $7,918.81 nat. median
$751
outlier · 10.5×
74178
CPT 		CT Abd & Pelv Wwo Contrast 5 $479.88 $7,790.00 $6,888.00 nat. median
$1,024
outlier · 6.7×
74177
CPT 		CT Abd & Pelv W Contrast 5 $227.52 $6,840.00 $6,048.00 nat. median
$968
outlier · 6.3×
74176
CPT 		CT Abd & Pelvis Wo Contrast 5 $95.04 $5,890.00 $5,208.00 nat. median
$697
outlier · 7.5×
J0897
HCPCS 		Denosumab 60 Mg/ml Syringe 5 $9.69 $6,103.88 $5,178.66 nat. median
$1,965
outlier · 2.6×
73223
CPT 		MRI Joint Ue Wwo Dye Lt 5 $597.27 $6,080.00 $5,158.40 nat. median
$1,177
outlier · 4.4×
72158
CPT 		MRI Lumbar Spine Wwo Dye 5 $340.97 $5,985.00 $5,077.80 nat. median
$1,103
outlier · 4.6×
70553
CPT 		MRI Brain Wwo Contrast 5 $729.77 $5,700.00 $5,040.00 nat. median
$1,137
outlier · 4.4×
73221
CPT 		MRI Joint Ue Wo Dye Lt 5 $408.12 $5,700.00 $5,040.00 nat. median
$843
outlier · 6.0×
72146
CPT 		MRI Chest Spine Wo Dye 5 $390.63 $5,605.00 $4,956.00 nat. median
$791
outlier · 6.3×
74174
CPT 		CTA Abd&Pelv Wwo Dye 5 $71.13 $5,557.50 $4,914.00 nat. median
$982
outlier · 5.0×
72157
CPT 		MRI Chest Spine Wwo Dye 5 $535.35 $5,700.00 $4,836.00 nat. median
$1,116
outlier · 4.3×
73721
CPT 		MRI Joint Le Wo Dye Lt 5 $315.18 $5,415.00 $4,788.00 nat. median
$866
outlier · 5.5×
72197
CPT 		MRI Pelvis Wwo Dye 5 $618.17 $5,605.00 $4,755.40 nat. median
$1,074
outlier · 4.4×
70551
CPT 		MRI Brain Wo Contrast 5 $447.03 $5,320.00 $4,704.00 nat. median
$791
outlier · 5.9×
74183
CPT 		MRI Abdomen Wwo Dye 5 $619.08 $5,510.00 $4,674.80 nat. median
$1,106
outlier · 4.2×
113
MS_DRG 		Ms-DRG 113 1 $4,570.80 $4,570.80 $4,570.80 nat. median
$22,527
outlier · 0.2×
73202
CPT 		CT Ue Wwo Dye Lt 5 $286.41 $5,320.00 $4,513.60 nat. median
$726
outlier · 6.2×
72141
CPT 		MRI Neck Spine Wo Dye 5 $233.96 $5,120.08 $4,452.00 nat. median
$785
outlier · 5.7×
72142
CPT 		MRI Neck Spine W Dye 5 $317.04 $5,225.00 $4,433.00 nat. median
$973
outlier · 4.6×
71275
CPT 		CTA Chest Wwo Contrast 5 $65.60 $4,940.00 $4,368.00 nat. median
$754
outlier · 5.8×
72195
CPT 		MRI Pelvis Wo Dye 5 $53.64 $5,035.00 $4,271.80 nat. median
$802
outlier · 5.3×
73720
CPT 		MRI Le Wwo Dye Lt 5 $233.96 $5,035.00 $4,271.80 nat. median
$1,142
outlier · 3.7×
72148
CPT 		MRI Lumbar Spine Wo Dye 5 $315.18 $5,809.70 $4,232.50 nat. median
$797
outlier · 5.3×
70496
CPT 		CT Angiography Head W Cont 5 $246.84 $4,655.00 $4,147.85 nat. median
$760
outlier · 5.5×
70498
CPT 		CT Angiography Neck W Cont 5 $278.39 $4,655.00 $4,116.00 nat. median
$747
outlier · 5.5×
73718
CPT 		MRI Le Wo Dye Lt 5 $56.39 $4,985.60 $4,116.00 nat. median
$886
outlier · 4.6×
70544
CPT 		MRA Head Wo Contrast 5 $408.12 $4,845.00 $4,110.60 nat. median
$820
outlier · 5.0×
73701
CPT 		CT Le W Dye Lt 5 $268.01 $5,035.00 $4,094.40 nat. median
$693
outlier · 5.9×
73201
CPT 		CT Ue W Dye Lt 5 $90.44 $5,035.00 $4,061.80 nat. median
$812
outlier · 5.0×
73702
CPT 		CT Le Wwo Dye Rt 5 $57.30 $4,750.00 $4,030.00 nat. median
$714
outlier · 5.6×
74170
CPT 		CT Abdomen Wwo Dye 5 $58.22 $4,370.00 $3,864.00 nat. median
$720
outlier · 5.4×
73200
CPT 		CT Ue Wo Dye Lt 5 $70.19 $4,600.00 $3,864.00 nat. median
$533
outlier · 7.2×
73700
CPT 		CT Le Wo Dye Lt 5 $76.65 $4,370.00 $3,864.00 nat. median
$524
outlier · 7.4×
71270
CPT 		CT Thorax Wwo Contrast 5 $82.17 $4,370.00 $3,864.00 nat. median
$681
outlier · 5.7×

Other procedures at this hospital

Browse this hospital's 819 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
             
89051 CPT Cell Count W Diff Body Fld 8 5 $453.00 $407.70 $294.45 $430.35 $369.19 2026-07-15
86922 CPT Crossmatch Ahg 11 5 $445.00 $400.50 $289.25 $445.00 $373.80 2026-07-15
82164 CPT Angiotensin Conv Enzyme 10 5 $458.00 $412.20 $297.70 $435.10 $374.81 2026-07-15
87040 CPT Culture Blood 12 5 $445.00 $400.50 $289.25 $445.00 $376.69 2026-07-15
87636 CPT Influ & CoV2 Pcr Ceph 8 5 $463.00 $416.70 $300.95 $439.85 $377.35 2026-07-15
82077 CPT Alcohol/Ethanol Auto Analyzer 12 5 $452.00 $406.80 $293.80 $429.40 $379.68 2026-07-15
92507 CPT Speech Therapy Trmt 9 5 $452.00 $406.80 $293.80 $429.40 $379.68 2026-07-15
82668 CPT Erythropoietin 8 5 $467.00 $420.30 $303.55 $443.65 $380.61 2026-07-15
90710 CPT Mmrv Subq 8 5 $473.00 $425.70 $98.13 $449.35 $381.24 2026-07-15
12014 CPT Repair Lac Simple 5.1-7.5 Cm 16 5 $534.00 $480.60 $141.36 $518.00 $383.68 2026-07-15
12004 CPT Repair Lac Simple 7.6-12.5 Cm 16 5 $534.00 $480.60 $140.14 $507.30 $383.68 2026-07-15
80143 CPT Acetaminophen 11 5 $458.00 $412.20 $297.70 $435.10 $384.72 2026-07-15
Q9957 HCPCS Perflutren Lip Micro 2.2mg/2ml 8 5 $477.00 $429.66 $47.75 $453.53 $384.78 2026-07-15
16030 CPT Dress/Debride Large Burn 8 5 $478.00 $430.20 $310.70 $454.10 $389.57 2026-07-15
99236 CPT Admit/Discharge Same Day High 6 5 $568.00 $511.20 $322.41 $436.48 $391.90 2026-07-15
73020 CPT X-ray Shoulder Rt 8 5 $488.00 $439.20 $187.95 $463.60 $393.33 2026-07-15
11046 CPT Debride Muscle Addl 20 Cm 14 5 $600.00 $540.00 $104.83 $570.00 $394.50 2026-07-15
97161 CPT Pt Eval Low Complexity 13 5 $473.00 $425.70 $307.45 $449.35 $397.32 2026-07-15
87522 CPT Hep C RNA Pcr Quant 8 5 $488.00 $439.20 $317.20 $463.60 $397.72 2026-07-15
82671 CPT Estrogen Fractionated 8 5 $488.00 $439.20 $317.20 $463.60 $397.72 2026-07-15
82140 CPT Ammonia 9 5 $474.00 $426.60 $308.10 $450.30 $398.16 2026-07-15
73140 CPT X-ray Finger(s) Lt 20 5 $474.00 $426.60 $64.68 $474.00 $398.16 2026-07-15
J0881 HCPCS Darbepoet Alfa 40mcg/0.4ml Syr 14 5 $560.00 $504.43 $246.47 $2,669.46 $398.50 2026-07-15
Q9956 HCPCS Perflutren Protein-a Microdota 8 5 $496.00 $446.80 $77.76 $471.62 $400.13 2026-07-15
64400 CPT Inj Trigeminal N Block Lt 28 5 $611.00 $549.90 $100.07 $580.45 $401.73 2026-07-15
73100 CPT X-ray Wrist 2 Views Lt 19 5 $488.00 $439.20 $66.51 $488.00 $404.32 2026-07-15
87154 CPT Culture Id By Amp Prb 6 Or 6+ 11 5 $482.00 $433.80 $313.30 $457.90 $404.88 2026-07-15
73650 CPT X-ray Heel 2 Views Lt 16 5 $503.00 $452.70 $64.68 $477.85 $405.42 2026-07-15
73600 CPT X-ray Ankle 2 Views Lt 16 5 $503.00 $452.70 $86.75 $477.85 $405.42 2026-07-15
73070 CPT X-ray Elbow Lt 16 5 $503.00 $452.70 $41.69 $477.85 $405.42 2026-07-15
73660 CPT X-ray Toe(s) 2 Views Lt 18 5 $488.00 $439.20 $66.51 $463.60 $409.92 2026-07-15
59025 CPT Fetal Non Stress 10 5 $503.00 $452.70 $326.95 $477.85 $409.94 2026-07-15
87536 CPT HIV 1 Na Quan 8 5 $503.00 $452.70 $326.95 $477.85 $409.94 2026-07-15
86200 CPT Citrulline Antibody 8 5 $503.00 $452.70 $326.95 $477.85 $409.94 2026-07-15
84630 CPT Zinc 10 5 $503.00 $452.70 $326.95 $477.85 $411.34 2026-07-15
80053 CPT Comprehensive Metabolic Panel 14 5 $488.00 $439.20 $10.56 $488.00 $413.09 2026-07-15
12013 CPT Repair Lac Simple 2.6-5.0 Cm 24 5 $534.00 $480.60 $109.90 $507.30 $417.06 2026-07-15
82043 CPT Microalbumin Quant 12 5 $507.00 $456.30 $5.80 $507.00 $425.88 2026-07-15
73501 CPT X-ray Hip Uni 1 View Rt 8 5 $474.00 $426.60 $308.10 $711.09 $427.31 2026-07-15
51798 CPT Bladder Scan 19 5 $186.00 $167.40 $120.90 $625.10 $427.70 2026-07-15
80179 CPT Salicylate 11 5 $510.00 $459.00 $331.50 $484.50 $428.40 2026-07-15
99282 CPT Emergency Room Visit Level 2 17 5 $650.00 $585.00 $64.21 $617.50 $432.25 2026-07-15
97162 CPT Pt Eval Mod Complexity 11 5 $516.00 $464.40 $335.40 $490.20 $433.44 2026-07-15
83880 CPT B Type Natriuretic Peptide 11 5 $524.00 $471.60 $340.60 $497.80 $440.16 2026-07-15
90651 CPT 9vHPV 3 Dose 8 5 $548.00 $493.20 $189.30 $520.60 $441.69 2026-07-15
J0248 HCPCS Remdesivir 100 Mg Vial 8 5 $550.00 $495.00 $70.71 $522.50 $443.30 2026-07-15
87529 CPT Hsv DNA Amp Probe 16 5 $607.50 $546.75 $240.50 $802.75 $450.38 2026-07-15
12031 CPT Repair Lac Intermed <2.5 Cm 14 5 $688.00 $619.20 $307.22 $653.60 $452.36 2026-07-15
10120 CPT I&r Foreign Body Simple 16 5 $694.00 $624.60 $215.90 $659.30 $456.31 2026-07-15
93005 CPT EKG Tracing 12 5 $553.00 $497.70 $359.45 $525.35 $464.52 2026-07-15
80069 CPT Renal Function Panel 13 5 $557.00 $501.30 $8.68 $529.15 $467.88 2026-07-15
90633 CPT Hep A Vaccine Ped/Adol 2 Dose 8 5 $582.00 $523.80 $319.14 $552.90 $469.09 2026-07-15
70360 CPT X-ray Neck Soft Tissue 8 5 $582.00 $523.80 $70.19 $552.90 $469.09 2026-07-15
73620 CPT X-ray Foot 2 Views Lt 16 5 $582.00 $523.80 $212.82 $552.90 $469.09 2026-07-15
73120 CPT X-ray Hand Lt 18 5 $574.00 $516.60 $198.99 $545.30 $469.45 2026-07-15
110 CDM Room Custodial Care 6 5 $557.00 $501.30 $362.05 $529.15 $471.50 2026-07-15
115 CDM Room Hospice Transitional I 6 5 $557.00 $501.30 $362.05 $529.15 $471.50 2026-07-15
12054 CPT Repair Lac Interm 7.6-12.5 Cm 6 5 $873.00 $785.70 $438.75 $607.18 $471.87 2026-07-15
29581 CPT Appl Multi Layer Ven Wnd Compr 8 5 $585.00 $526.50 $380.25 $555.75 $476.77 2026-07-15
86147 CPT Cardiolipin Antibody 8 5 $595.00 $535.50 $386.75 $565.25 $484.93 2026-07-15
J1610 HCPCS Glucagon 1 Mg/ml Vial 8 5 $601.00 $541.72 $98.91 $571.81 $485.13 2026-07-15
73110 CPT X-ray Wrist 3 Views Rt 23 5 $578.00 $520.20 $58.22 $578.00 $485.52 2026-07-15
73080 CPT X-ray Elbow Lt 18 5 $578.00 $520.20 $38.91 $578.00 $485.52 2026-07-15
86304 CPT Ca 125 8 5 $600.00 $540.00 $390.00 $570.00 $489.00 2026-07-15
94626 CPT Pulmonary Rehab W Cont Monitor 8 5 $600.00 $540.00 $390.00 $570.00 $489.00 2026-07-15
87476 CPT Lyme Disease DNA Amp Probe 8 5 $602.00 $541.80 $391.30 $571.90 $490.63 2026-07-15
73551 CPT X-ray Femur 1 View Lt 18 5 $587.00 $528.30 $101.48 $557.65 $493.08 2026-07-15
92523 CPT Speech Sound Lang Comprehen 8 5 $606.00 $545.40 $393.90 $575.70 $493.89 2026-07-15
92524 CPT Behavral Qualit Analys Voice 9 5 $588.00 $529.20 $382.20 $558.60 $493.92 2026-07-15
12042 CPT Repair Lac Interm 2.6-7.5 Cm 14 5 $688.00 $619.20 $396.46 $653.60 $494.33 2026-07-15
90620 CPT MenB 2 Dose IM 8 5 $614.00 $552.60 $254.82 $583.30 $494.88 2026-07-15
J1611 HCPCS Glucagon (Fresenius Kabi) Vial 8 5 $615.00 $553.73 $81.80 $584.49 $495.89 2026-07-15
12034 CPT Repair Lac Interm 7.6-12.5 Cm 14 5 $688.00 $619.20 $413.34 $653.60 $496.97 2026-07-15
93798 CPT Cardiac Rehab Ii Monitored 10 5 $610.00 $549.00 $353.42 $579.50 $497.15 2026-07-15
76010 CPT X-ray Nose To Rectum 8 5 $588.00 $529.20 $382.20 $558.60 $499.97 2026-07-15
77067 CPT Mammography Screening Digital 28 5 $602.00 $541.80 $391.30 $571.90 $505.68 2026-07-15
73560 CPT X-ray Knee 1-2 Views Lt 21 5 $606.00 $545.40 $84.00 $606.00 $509.04 2026-07-15
80280 CPT Vedolizumab 10 5 $611.00 $549.90 $397.15 $580.45 $513.24 2026-07-15
87637 CPT Influ/RSV/CoV2 Pcr Ceph 12 5 $611.00 $549.90 $397.15 $580.45 $513.24 2026-07-15
71045 CPT X-ray Chest 1 View 12 5 $606.00 $545.40 $393.90 $593.33 $516.92 2026-07-15
86617 CPT Lyme Disease Anti Western Blot 10 5 $624.00 $561.60 $405.60 $993.84 $524.16 2026-07-15
10061 CPT I&d Abscess Comp/Multiple 14 5 $804.00 $723.60 $373.43 $763.80 $528.63 2026-07-15
99214 CPT Est Patient Level 4 Mod Comp 37 5 $795.00 $715.50 $90.81 $780.90 $528.67 2026-07-15
94625 CPT Pulmonary Rehab Without Monitoring 8 5 $664.00 $597.60 $431.60 $630.80 $541.16 2026-07-15
73630 CPT X-ray Foot 3 Views Rt 23 5 $647.00 $582.30 $65.60 $614.65 $543.48 2026-07-15
70250 CPT X-ray Skull < 4 Views 8 5 $680.00 $612.00 $94.25 $646.00 $548.08 2026-07-15
83970 CPT Pth 13 5 $660.00 $594.00 $41.30 $627.00 $554.40 2026-07-15
82670 CPT Estradiol Total 12 5 $680.00 $612.00 $27.90 $646.00 $556.20 2026-07-15
74018 CPT X-ray Abdomen 11 5 $665.00 $598.50 $432.25 $631.75 $558.60 2026-07-15
94762 CPT Desaturation And Hr Study 10 5 $666.00 $599.40 $432.90 $632.70 $559.44 2026-07-15
12044 CPT Repair Lac Interm 7.6-12.5 Cm 8 5 $688.00 $619.20 $447.20 $653.60 $560.72 2026-07-15
73130 CPT X-ray Hand Rt 22 5 $668.00 $601.20 $59.16 $634.60 $561.12 2026-07-15
82747 CPT Rbc Folic Acid 10 5 $688.00 $619.20 $447.20 $653.60 $562.84 2026-07-15
73502 CPT X-ray Hip Uni 2-3 Views Lt 22 5 $660.00 $594.00 $429.00 $860.42 $562.98 2026-07-15
28190 CPT Remove Foreign Body Foot Rt 8 5 $694.00 $624.60 $451.10 $659.30 $565.61 2026-07-15
J2997 HCPCS Alteplase 2 Mg Vial 8 5 $707.00 $636.35 $37.08 $671.71 $569.89 2026-07-15
73000 CPT X-ray Collar Bone Rt 18 5 $680.00 $612.00 $187.04 $646.00 $571.20 2026-07-15
72110 CPT X-ray Lumbosacral 4 Views 11 5 $681.00 $612.90 $67.44 $646.95 $572.04 2026-07-15
72170 CPT X-ray Pelvis 1-2 Views 12 5 $681.00 $612.90 $341.88 $646.95 $572.04 2026-07-15
32554 CPT Aspirate Pleura Wo Imaging Lt 8 5 $706.00 $635.40 $458.90 $670.70 $575.39 2026-07-15
73552 CPT X-ray Femur 2 Views Rt 19 5 $695.00 $625.50 $130.01 $660.25 $583.80 2026-07-15
P9016 HCPCS Red Blood Cells Lekoreduced 11 5 $700.00 $630.00 $309.60 $665.00 $588.00 2026-07-15
83498 CPT 17Oh Progesterone 8 5 $725.00 $652.50 $471.25 $688.75 $590.88 2026-07-15
73562 CPT X-ray Knee 3 Views Lt 24 5 $704.00 $633.60 $109.76 $668.80 $591.36 2026-07-15
73030 CPT X-ray Shoulder Lt 24 5 $704.00 $633.60 $237.65 $668.80 $591.36 2026-07-15
96365 CPT Inf Therapy Med Initial 23 5 $739.00 $665.10 $451.75 $702.05 $592.84 2026-07-15
73010 CPT X-ray Shoulder Blade Lt 8 5 $737.00 $663.30 $174.17 $700.15 $594.02 2026-07-15
31500 CPT Insert Emergency Airway 17 5 $898.00 $808.20 $273.72 $853.10 $597.17 2026-07-15
87385 CPT Histoplasma Antigen 8 5 $745.00 $670.50 $484.25 $707.75 $607.17 2026-07-15
80074 CPT Acute Hepatitis Panel 8 5 $759.00 $683.10 $493.35 $721.05 $618.59 2026-07-15
73610 CPT X-ray Ankle 3 Views Lt 22 5 $741.00 $666.90 $99.63 $703.95 $622.44 2026-07-15
27250 CPT Dislocation Hip Rt 14 5 $951.00 $855.90 $340.15 $903.45 $625.28 2026-07-15
73090 CPT X-ray Forearm 2 Views Lt 19 5 $745.00 $670.50 $282.72 $707.75 $625.80 2026-07-15
70150 CPT X-ray Facial Bones 3 Views 8 5 $781.00 $702.90 $82.17 $741.95 $629.48 2026-07-15
70140 CPT X-ray Facial Bones < 3 Views 8 5 $781.00 $702.90 $66.51 $741.95 $629.48 2026-07-15
72220 CPT Sacrum Or Coccyx Min 2 View 16 5 $788.00 $709.20 $447.69 $776.15 $634.14 2026-07-15
70100 CPT X-ray Mandible < 4 Views 8 5 $704.00 $633.60 $457.60 $4,852.95 $634.65 2026-07-15
96360 CPT Inf Therapy Hyd Initial 23 5 $791.00 $711.90 $484.90 $751.45 $636.34 2026-07-15
73060 CPT X-ray Humerus Rt 17 5 $758.00 $682.20 $67.44 $720.10 $636.72 2026-07-15
90380 CPT Rsv .5mL IM 8 5 $709.00 $638.10 $460.85 $2,714.34 $639.16 2026-07-15
73564 CPT X-ray Knee 4 Lt 20 5 $780.00 $702.00 $129.06 $780.00 $655.20 2026-07-15
92610 CPT Swallow Eval Non Radiol 8 5 $804.00 $723.60 $522.60 $763.80 $655.26 2026-07-15
93926 CPT Arterial Duplex Le Lt 10 5 $781.00 $702.90 $507.65 $781.00 $656.04 2026-07-15
92950 CPT Heart/Lung Resuscitation Cpr 9 5 $788.00 $709.20 $512.20 $748.60 $661.92 2026-07-15
P9040 HCPCS Rbc Packed Leuko-reduc Irrad 8 5 $817.00 $735.30 $531.05 $776.15 $665.86 2026-07-15
A9585 HCPCS Gadobutrol Inj 10 Mm/10 Ml Vl 12 5 $800.00 $720.00 $2.69 $760.00 $672.00 2026-07-15
71046 CPT X-ray Chest 2v PA/Lateral 12 5 $793.00 $713.70 $515.45 $783.14 $676.43 2026-07-15
83921 CPT Methylmalonic Acid 8 5 $838.00 $754.20 $544.70 $796.10 $682.97 2026-07-15
84482 CPT Reverse T3 11 5 $814.00 $732.60 $15.80 $773.30 $683.76 2026-07-15
72100 CPT X-ray Lumbosacral 2-3 Views 12 5 $823.00 $740.70 $90.44 $781.85 $691.32 2026-07-15
80306 CPT Drug Screen Urine Inst Ass Obv 12 5 $831.00 $747.90 $540.15 $789.45 $698.04 2026-07-15
76816 CPT OB US Follow-up Per Fetus 8 5 $860.00 $774.00 $559.00 $817.00 $700.90 2026-07-15
82626 CPT Dhea 10 5 $835.00 $751.50 $542.75 $793.25 $701.40 2026-07-15
73590 CPT X-ray Lower Leg Lt 21 5 $838.00 $754.20 $73.88 $796.10 $703.92 2026-07-15
71100 CPT X-ray Ribs 2 Views Rt 19 5 $831.00 $747.90 $540.15 $3,616.49 $708.84 2026-07-15
Q9967 HCPCS Iopamidol-370 100 Ml Vial 12 5 $850.00 $765.00 $253.80 $807.50 $714.00 2026-07-15
93225 CPT Holter Monitor Hook Up <48 Hrs 8 5 $877.00 $789.30 $570.05 $833.15 $714.75 2026-07-15
88262 CPT Chromosome Analysis 15-20 Cell 8 5 $880.00 $792.11 $572.08 $836.11 $717.29 2026-07-15
76857 CPT Ultrasound Pelvic Limited 11 5 $860.00 $774.00 $167.00 $817.00 $722.40 2026-07-15
Q0138 HCPCS Ferumoxy 510mg/17ml (non-esrd) 8 5 $901.00 $811.25 $7.28 $856.32 $726.52 2026-07-15
93246 CPT Ext ECG >7 Days Hook Up 10 5 $877.00 $789.30 $570.05 $833.15 $736.68 2026-07-15
93242 CPT Ext ECG 48 Hrs -7days Hook Up 10 5 $877.00 $789.30 $570.05 $833.15 $736.68 2026-07-15
23650 CPT Dislocation Shoulder Wo AnesLT 28 5 $951.00 $855.90 $618.15 $903.45 $740.43 2026-07-15
11042 CPT Debride Skin Subq 20 Cm 18 5 $1,035.00 $931.50 $120.87 $983.25 $743.64 2026-07-15
74019 CPT X-ray Abdomen 10 5 $930.00 $837.00 $604.50 $883.50 $760.83 2026-07-15
J0561 HCPCS Pen G Benzathine 1200000Un/2ML 8 5 $948.00 $853.74 $260.76 $901.17 $764.57 2026-07-15
71101 CPT X-ray Ribs Uni W Chest Lt 22 5 $902.00 $811.80 $175.20 $3,427.98 $769.41 2026-07-15
99283 CPT Emergency Room Visit Level 3 19 5 $997.00 $897.30 $108.68 $947.15 $769.68 2026-07-15
24600 CPT Dislocation Elbow Wo Anes Rt 14 5 $951.00 $855.90 $618.15 $926.91 $771.26 2026-07-15
94060 CPT Evaluation Wheezing 9 5 $920.00 $828.00 $598.00 $874.00 $772.80 2026-07-15
27560 CPT Treat Kneecap Dislocation Lt 14 5 $951.00 $855.90 $618.15 $947.94 $773.76 2026-07-15
28515 CPT Treatment Toe Fracture 8 5 $951.00 $855.90 $618.15 $903.45 $775.07 2026-07-15
27818 CPT Fx Trimalleolar Ankle W Man Rt 8 5 $951.00 $855.90 $618.15 $903.45 $775.07 2026-07-15
27786 CPT Fx Distal Fibula Lt 16 5 $951.00 $855.90 $618.15 $903.45 $775.07 2026-07-15
27780 CPT Treatment Fibula Fracture Rt 8 5 $951.00 $855.90 $618.15 $903.45 $775.07 2026-07-15
26770 CPT Dislocate Finger Wo Anes Lt 8 5 $951.00 $855.90 $618.15 $903.45 $775.07 2026-07-15
26750 CPT Fx Distal Finger/Thumb Wo Man 8 5 $951.00 $855.90 $618.15 $903.45 $775.07 2026-07-15
26720 CPT Fx Finger/Thumb Wo Man 8 5 $951.00 $855.90 $618.15 $903.45 $775.07 2026-07-15
25650 CPT Fx Ulnar Styloid Lt 8 5 $951.00 $855.90 $618.15 $903.45 $775.07 2026-07-15
25500 CPT Fx Radius Rt 8 5 $951.00 $855.90 $618.15 $903.45 $775.07 2026-07-15
93922 CPT Ankle Arm Screen 10 5 $923.00 $830.70 $599.95 $923.00 $775.32 2026-07-15
72070 CPT X-ray Spine Thoracic 2 Views 10 5 $916.00 $824.40 $183.20 $1,015.91 $775.39 2026-07-15
64450 CPT Inject Anes Agent Oth Nerve Lt 8 5 $953.00 $857.70 $619.45 $905.35 $776.69 2026-07-15
11043 CPT Debride Muscle/Fascia 20 Cm 17 5 $1,200.00 $1,080.00 $294.00 $1,140.00 $798.00 2026-07-15
25600 CPT Fx Distal Radius Lt 17 5 $951.00 $855.90 $618.15 $903.45 $798.84 2026-07-15
73503 CPT X-ray Hip Uni W Pelvis 4 V Lt 22 5 $959.00 $863.10 $392.75 $931.00 $805.56 2026-07-15
73522 CPT X-ray Hips 3-4 Views Bi 8 5 $981.00 $882.90 $637.65 $931.95 $808.97 2026-07-15
70030 CPT X-ray Eye Fb Detection 8 5 $905.00 $814.50 $588.25 $5,074.70 $815.86 2026-07-15
99215 CPT Est Patient Level 5 24 5 $962.00 $865.80 $215.01 $2,582.10 $820.59 2026-07-15
23500 CPT Fx Clavicle Rt 18 5 $979.00 $881.10 $636.35 $930.05 $822.36 2026-07-15
71110 CPT X-ray Ribs Bilateral 3 Views 8 5 $1,023.00 $920.70 $47.21 $971.85 $824.54 2026-07-15
76815 CPT OB US Limited Fetus(s) 10 5 $1,017.00 $915.30 $424.09 $966.15 $828.86 2026-07-15
76801 CPT OB US < 14 Wks Single Fetus 8 5 $1,017.00 $915.30 $661.05 $966.15 $828.86 2026-07-15
93971 CPT Extremity Study Rt 20 5 $1,000.00 $900.00 $650.00 $950.00 $840.00 2026-07-15
82384 CPT Catecholamines Fract 8 5 $1,038.00 $934.20 $674.70 $986.10 $845.97 2026-07-15
76817 CPT Transvaginal US Obstetrical 11 5 $1,017.00 $915.30 $661.05 $966.15 $854.28 2026-07-15
72040 CPT X-ray Spine Cervical 2-3 Views 11 5 $1,042.00 $937.80 $551.93 $989.90 $875.28 2026-07-15
25605 CPT Fx Distal Radius W Man Rt 16 5 $951.00 $855.90 $618.15 $1,409.30 $903.45 2026-07-15
25505 CPT Fx Radial Shaft W Man Lt 14 5 $951.00 $855.90 $618.15 $1,267.81 $903.45 2026-07-15
36430 CPT Blood Administration 11 5 $1,092.00 $982.80 $512.80 $1,037.40 $917.28 2026-07-15
96413 CPT Chemotherapy Inf Initial 10 5 $1,110.00 $999.00 $721.50 $1,054.50 $932.40 2026-07-15
72072 CPT X-ray Spine Thoracic 3 Views 8 5 $1,216.00 $1,094.40 $697.55 $1,155.20 $980.10 2026-07-15
71111 CPT X-ray Ribs Bilateral 4 Views 10 5 $1,168.00 $1,051.20 $63.74 $1,134.00 $981.12 2026-07-15
76536 CPT Ultrasound Head And Neck 11 5 $1,183.00 $1,064.70 $768.95 $1,123.85 $993.72 2026-07-15
80050 CPT General Health Panel 13 5 $1,189.00 $1,070.10 $28.10 $1,129.55 $998.76 2026-07-15
72050 CPT X-ray Spine Cervical 4-5 Views 10 5 $1,210.00 $1,089.00 $746.06 $1,149.50 $1,004.30 2026-07-15
73523 CPT X-ray Hips 5 Views Bi 10 5 $1,225.00 $1,102.50 $690.20 $1,189.00 $1,029.00 2026-07-15
76604 CPT Ultrasound Chest 9 5 $1,231.00 $1,107.90 $800.15 $1,169.45 $1,034.04 2026-07-15
90675 CPT Rabies Vax Pcec/Pf 2.5Unit Vl 14 5 $1,221.00 $1,099.13 $125.24 $1,264.33 $1,034.58 2026-07-15
74022 CPT X-ray Series Abdomen 8 5 $1,303.00 $1,172.70 $661.43 $1,237.85 $1,050.22 2026-07-15
80197 CPT Tacrolimus 9 5 $1,258.00 $1,132.20 $817.70 $1,195.10 $1,056.72 2026-07-15
76706 CPT Aaa Screening Medicare 8 5 $1,431.00 $1,287.90 $930.15 $1,359.45 $1,166.26 2026-07-15
76775 CPT Ultrasound Aorta 11 5 $1,431.00 $1,287.90 $930.15 $1,431.00 $1,202.04 2026-07-15
76830 CPT Ultrasound Transvaginal 11 5 $1,431.00 $1,287.90 $930.15 $1,359.45 $1,202.04 2026-07-15
P9037 HCPCS Platelet Pheresis Leuk Red Irr 8 5 $1,515.00 $1,363.50 $984.75 $1,439.25 $1,234.72 2026-07-15
0202U CPT Respir Path 22 Targets Biofire 8 5 $1,515.00 $1,363.50 $984.75 $1,439.25 $1,234.72 2026-07-15
77080 CPT Dexa Scan 12 5 $1,473.00 $1,325.70 $88.61 $1,399.35 $1,237.32 2026-07-15
C8924 HCPCS Tte 2d W Contrast Limited 8 5 $1,547.00 $1,392.30 $1,005.55 $1,469.65 $1,260.81 2026-07-15
93308 CPT Echo Limited 14 5 $1,939.00 $1,745.10 $38.09 $1,842.05 $1,274.89 2026-07-15
111 CDM Room Medical Unit Priv 12 5 $1,952.50 $1,757.25 $344.50 $3,206.25 $1,348.62 2026-07-15
99284 CPT Emergency Room Visit Level 4 19 5 $1,803.00 $1,622.70 $184.86 $1,712.85 $1,391.92 2026-07-15
93350 CPT Stress Echo 8 5 $1,710.00 $1,539.00 $1,111.50 $1,624.50 $1,393.65 2026-07-15
99285 CPT Emergency Room Visit Level 5 17 5 $2,200.00 $1,980.00 $267.73 $2,090.00 $1,463.00 2026-07-15
76882 CPT US Extremity Nonvasc Limit Lt 16 5 $1,846.00 $1,661.40 $1,199.90 $1,753.70 $1,504.49 2026-07-15
59409 CPT Obstetrical Care 6 5 $3,023.00 $2,720.70 $1,222.50 $1,668.05 $1,564.96 2026-07-15
76700 CPT Ultrasound Abdomen Complete 8 5 $1,923.00 $1,730.70 $1,249.95 $1,826.85 $1,567.24 2026-07-15
76705 CPT Ultrasound Abdomen Limited 12 5 $1,868.00 $1,681.20 $1,214.20 $1,774.60 $1,569.12 2026-07-15
76856 CPT Ultrasound Pelvic Complete 8 5 $1,946.00 $1,751.40 $1,264.90 $1,848.70 $1,585.99 2026-07-15
J9217 HCPCS Leuprolide Acetate 22.5 Mg Syr 8 5 $2,026.00 $1,823.49 $1.47 $1,924.80 $1,633.04 2026-07-15
93975 CPT Vascular Study 10 5 $2,011.00 $1,809.90 $1,307.15 $1,910.45 $1,689.24 2026-07-15
93880 CPT Extracranial Bilat Study 11 5 $2,033.00 $1,829.70 $1,321.45 $2,033.00 $1,707.72 2026-07-15
689 CDM Trauma Team Evaluation Level 5 8 5 $2,113.00 $1,901.70 $1,373.45 $2,007.35 $1,722.10 2026-07-15
93970 CPT Venous Duplex 9 5 $2,098.00 $1,888.20 $1,363.70 $1,993.10 $1,762.32 2026-07-15
76770 CPT Ultrasound Abdo Back Wall Comp 11 5 $2,216.00 $1,994.40 $1,440.40 $2,105.20 $1,861.44 2026-07-15
93925 CPT Arterial Duplex Le Bi 8 5 $2,375.00 $2,137.50 $1,543.75 $2,256.25 $1,935.62 2026-07-15
90375 CPT Rabies Imm Glob (Human) 300u/m 8 5 $2,428.00 $2,185.31 $146.90 $2,306.71 $1,957.07 2026-07-15
Q4186 HCPCS Graft Sft Tis Epifix 2.5 Sq Cm 32 5 $2,619.00 $2,357.43 $535.37 $4,777.65 $1,963.53 2026-07-15
J1569 HCPCS Immune Glob Gammagard 5gr/50ml 14 5 $2,147.00 $1,932.60 $21.77 $7,885.55 $2,039.96 2026-07-15
15275 CPT Skin Substitute Graft 25 Sq Cm 14 5 $3,445.00 $3,100.50 $186.82 $3,272.75 $2,265.09 2026-07-15
93306 CPT Tte W Doppler Complete 17 5 $3,200.00 $2,880.00 $105.90 $3,040.00 $2,455.08 2026-07-15
129 CDM Room Swing Bed Skilled 6 5 $3,000.00 $2,700.00 $1,950.00 $2,850.00 $2,539.50 2026-07-15
99291 CPT Critical Care 1st 30-74 Min 16 5 $3,957.00 $3,561.30 $329.00 $3,759.15 $2,601.73 2026-07-15
70490 CPT CT Soft Tissue Neck Wo Cont 8 5 $3,500.00 $3,150.00 $277.47 $3,325.00 $2,821.00 2026-07-15
120 CDM Room Medical Unit Semi Private 6 5 $3,375.00 $3,037.50 $2,193.75 $3,206.25 $2,856.94 2026-07-15
J1561 HCPCS Immune Glob 10% 40 Gm/400 Ml 30 5 $5,944.00 $5,349.81 $3.60 $11,226.01 $2,868.32 2026-07-15
70480 CPT CT Orbit Wo Contrast 10 5 $3,500.00 $3,150.00 $192.56 $3,325.00 $2,901.31 2026-07-15
J1439 HCPCS Ferric Carboxymalt 750mg/15ml 8 5 $3,630.00 $3,267.77 $11.91 $3,449.32 $2,926.47 2026-07-15
72128 CPT CT Thoracic Spine Wo Contrast 11 5 $3,600.00 $3,240.00 $107.93 $3,420.00 $3,024.00 2026-07-15
70486 CPT CT Maxillofacial Wo Contrast 12 5 $3,600.00 $3,240.00 $187.95 $3,420.00 $3,024.00 2026-07-15
72192 CPT CT Pelvis Wo Dye 10 5 $3,600.00 $3,240.00 $597.02 $3,479.00 $3,024.00 2026-07-15
74150 CPT CT Abdomen Wo Dye 8 5 $3,800.00 $3,420.00 $791.13 $3,610.00 $3,062.80 2026-07-15
70487 CPT CT Maxillofacial W Contrast 8 5 $3,800.00 $3,420.00 $268.29 $3,610.00 $3,062.80 2026-07-15
71250 CPT CT Thorax Wo Contrast 11 5 $3,700.00 $3,330.00 $71.13 $3,652.00 $3,108.00 2026-07-15
70491 CPT CT Soft Tissue Neck W Cont 12 5 $3,700.00 $3,330.00 $357.53 $3,852.00 $3,132.05 2026-07-15
720 CDM Delivery Charge 8 5 $3,870.00 $3,483.00 $2,515.50 $3,676.50 $3,154.05 2026-07-15
71271 CPT Ldct For Lung Cancer Screen 10 5 $3,900.00 $3,510.00 $101.48 $3,705.00 $3,276.00 2026-07-15
70492 CPT CT Soft Tissue Neck Wwo Cont 10 5 $3,900.00 $3,510.00 $422.85 $3,705.00 $3,276.00 2026-07-15
70450 CPT CT Head/Brain Wo Contrast 12 5 $4,000.00 $3,600.00 $24.20 $3,800.00 $3,360.00 2026-07-15
72193 CPT CT Pelvis W Dye 11 5 $4,000.00 $3,600.00 $593.33 $3,852.00 $3,360.00 2026-07-15
70460 CPT CT Head/Brain W Contrast 8 5 $4,200.00 $3,780.00 $61.91 $3,990.00 $3,385.20 2026-07-15
G0390 HCPCS Trauma Team Level 5 8 5 $4,159.00 $3,743.10 $2,703.35 $3,951.05 $3,389.59 2026-07-15
71260 CPT CT Thorax W Contrast 12 5 $4,100.00 $3,690.00 $80.31 $3,895.00 $3,470.65 2026-07-15
74160 CPT CT Abdomen W Dye 12 5 $4,200.00 $3,780.00 $706.77 $3,990.00 $3,528.00 2026-07-15
70470 CPT CT Head/Brain Wwo Contrast 8 5 $4,400.00 $3,960.00 $241.32 $4,180.00 $3,546.40 2026-07-15
72125 CPT CT Cervical Spine Wo Contrast 12 5 $4,400.00 $3,960.00 $172.58 $4,180.00 $3,696.00 2026-07-15
Q5115 HCPCS Rituximab-abbs 100Mg/10Ml Via 14 5 $2,140.00 $1,926.81 $1,391.59 $9,270.52 $3,708.00 2026-07-15
72131 CPT CT Lumbar Spine Wo Contrast 10 5 $4,450.00 $4,005.00 $234.87 $4,227.50 $3,738.00 2026-07-15
C8929 HCPCS Echo M Mode 2d W Contrast 16 5 $5,242.00 $4,717.80 $97.63 $4,979.90 $3,766.38 2026-07-15
194 MS_DRG Ms-DRG 194 2 1 — — $3,820.24 $3,820.24 $3,820.24 2026-07-15
641 MS_DRG Ms-DRG 641 2 1 — — $3,820.24 $3,820.24 $3,820.24 2026-07-15
71270 CPT CT Thorax Wwo Contrast 9 5 $4,600.00 $4,140.00 $82.17 $4,370.00 $3,864.00 2026-07-15
73700 CPT CT Le Wo Dye Lt 21 5 $4,600.00 $4,140.00 $76.65 $4,370.00 $3,864.00 2026-07-15
73200 CPT CT Ue Wo Dye Lt 18 5 $4,600.00 $4,140.00 $70.19 $4,600.00 $3,864.00 2026-07-15
74170 CPT CT Abdomen Wwo Dye 10 5 $4,600.00 $4,140.00 $58.22 $4,370.00 $3,864.00 2026-07-15
73702 CPT CT Le Wwo Dye Rt 8 5 $5,000.00 $4,500.00 $57.30 $4,750.00 $4,030.00 2026-07-15
73201 CPT CT Ue W Dye Lt 16 5 $5,050.00 $4,545.00 $90.44 $5,035.00 $4,061.80 2026-07-15
73701 CPT CT Le W Dye Lt 20 5 $5,300.00 $4,770.00 $268.01 $5,035.00 $4,094.40 2026-07-15
70544 CPT MRA Head Wo Contrast 8 5 $5,100.00 $4,590.00 $408.12 $4,845.00 $4,110.60 2026-07-15
73718 CPT MRI Le Wo Dye Lt 20 5 $4,900.00 $4,410.00 $56.39 $4,985.60 $4,116.00 2026-07-15
70498 CPT CT Angiography Neck W Cont 11 5 $4,900.00 $4,410.00 $278.39 $4,655.00 $4,116.00 2026-07-15
70496 CPT CT Angiography Head W Cont 12 5 $4,900.00 $4,410.00 $246.84 $4,655.00 $4,147.85 2026-07-15
72148 CPT MRI Lumbar Spine Wo Dye 12 5 $5,000.00 $4,500.00 $315.18 $5,809.70 $4,232.50 2026-07-15
72195 CPT MRI Pelvis Wo Dye 8 5 $5,300.00 $4,770.00 $53.64 $5,035.00 $4,271.80 2026-07-15
73720 CPT MRI Le Wwo Dye Lt 16 5 $5,300.00 $4,770.00 $233.96 $5,035.00 $4,271.80 2026-07-15
71275 CPT CTA Chest Wwo Contrast 12 5 $5,200.00 $4,680.00 $65.60 $4,940.00 $4,368.00 2026-07-15
72142 CPT MRI Neck Spine W Dye 8 5 $5,500.00 $4,950.00 $317.04 $5,225.00 $4,433.00 2026-07-15
72141 CPT MRI Neck Spine Wo Dye 11 5 $5,300.00 $4,770.00 $233.96 $5,120.08 $4,452.00 2026-07-15
73202 CPT CT Ue Wwo Dye Lt 8 5 $5,600.00 $5,040.00 $286.41 $5,320.00 $4,513.60 2026-07-15
113 MS_DRG Ms-DRG 113 2 1 — — $4,570.80 $4,570.80 $4,570.80 2026-07-15
74183 CPT MRI Abdomen Wwo Dye 8 5 $5,800.00 $5,220.00 $619.08 $5,510.00 $4,674.80 2026-07-15
70551 CPT MRI Brain Wo Contrast 11 5 $5,600.00 $5,040.00 $447.03 $5,320.00 $4,704.00 2026-07-15
72197 CPT MRI Pelvis Wwo Dye 8 5 $5,900.00 $5,310.00 $618.17 $5,605.00 $4,755.40 2026-07-15
73721 CPT MRI Joint Le Wo Dye Lt 20 5 $5,700.00 $5,130.00 $315.18 $5,415.00 $4,788.00 2026-07-15
72157 CPT MRI Chest Spine Wwo Dye 8 5 $6,000.00 $5,400.00 $535.35 $5,700.00 $4,836.00 2026-07-15
74174 CPT CTA Abd&Pelv Wwo Dye 12 5 $5,850.00 $5,265.00 $71.13 $5,557.50 $4,914.00 2026-07-15
72146 CPT MRI Chest Spine Wo Dye 12 5 $5,900.00 $5,310.00 $390.63 $5,605.00 $4,956.00 2026-07-15
70553 CPT MRI Brain Wwo Contrast 12 5 $6,000.00 $5,400.00 $729.77 $5,700.00 $5,040.00 2026-07-15
73221 CPT MRI Joint Ue Wo Dye Lt 20 5 $6,000.00 $5,400.00 $408.12 $5,700.00 $5,040.00 2026-07-15
72158 CPT MRI Lumbar Spine Wwo Dye 8 5 $6,300.00 $5,670.00 $340.97 $5,985.00 $5,077.80 2026-07-15
73223 CPT MRI Joint Ue Wwo Dye Lt 16 5 $6,400.00 $5,760.00 $597.27 $6,080.00 $5,158.40 2026-07-15
J0897 HCPCS Denosumab 60 Mg/ml Syringe 8 5 $6,425.00 $5,782.63 $9.69 $6,103.88 $5,178.66 2026-07-15
74176 CPT CT Abd & Pelvis Wo Contrast 12 5 $6,200.00 $5,580.00 $95.04 $5,890.00 $5,208.00 2026-07-15
74177 CPT CT Abd & Pelv W Contrast 12 5 $7,200.00 $6,480.00 $227.52 $6,840.00 $6,048.00 2026-07-15
74178 CPT CT Abd & Pelv Wwo Contrast 11 5 $8,200.00 $7,380.00 $479.88 $7,790.00 $6,888.00 2026-07-15
Q5119 HCPCS Rituximab-pvvr 500Mg/50Ml Vial 10 5 $9,427.00 $8,484.43 $1,112.40 $14,925.58 $7,918.81 2026-07-15
J3111 HCPCS Romosozumab-aqqg 210 Mg/2.34Ml 8 5 $9,946.00 $8,951.72 $1.56 $9,449.03 $8,016.76 2026-07-15
J2182 HCPCS Mepolizumab 100 Mg Vial 8 5 $11,409.00 $10,268.12 $6.38 $10,838.57 $9,195.67 2026-07-15
90375 HCPCS Rabies Ig (Human) 300 U/Ml 5Ml 8 5 $11,935.00 $10,742.08 $146.90 $11,338.87 $9,620.14 2026-07-15
J9047 HCPCS Carfilzomib 60 Mg Vial 8 5 $13,170.00 $11,853.56 $81.21 $12,512.09 $10,615.52 2026-07-15
562 MS_DRG Ms-DRG 562 2 1 — — $11,393.68 $11,393.68 $11,393.68 2026-07-15
J2356 HCPCS Tezepelumab-ekko 210 Mg/1.9 Ml 8 5 $14,887.00 $13,399.05 $12.98 $14,143.44 $11,999.59 2026-07-15
J2353 HCPCS Octreotide (Depot) 20 Mg Syr 8 5 $16,246.00 $14,621.86 $17.33 $15,434.18 $13,094.69 2026-07-15
J0717 HCPCS Certolizumab Pegol 400 Mg Kit 8 5 $22,095.00 $19,886.29 $3.42 $20,991.09 $17,809.28 2026-07-15
J9332 HCPCS Efgartigimod Alfa-fcab 400 Mg 10 5 $23,382.00 $21,043.94 $7.91 $57,520.09 $19,641.01 2026-07-15
J3101 HCPCS Tenecteplase 50 Mg/10 Ml Syrng 8 5 $26,971.00 $24,274.13 $0.41 $25,622.69 $21,738.83 2026-07-15
J3380 HCPCS Vedolizumab 300 Mg Vial 11 5 $34,416.00 $30,975.14 $72.63 $32,695.98 $28,910.13 2026-07-15
760 CDM Misc Specialty Services - Gen 8 5 $36,071.00 $32,464.77 $23,446.78 $34,268.37 $29,398.65 2026-07-15
J2327 HCPCS Risankizumab-rzaa 600 Mg/10 Ml 10 5 $39,010.00 $35,109.34 $68.09 $37,059.86 $32,378.61 2026-07-15
J9334 HCPCS Efgart-hyalu-qvfc 1008Mg/5.6Ml 10 5 $60,803.00 $54,722.75 $560.66 $57,762.90 $50,466.53 2026-07-15
J2350 HCPCS Ocrelizumab 300 Mg/10 Ml 8 5 $75,925.00 $68,332.61 $6.09 $72,128.86 $61,195.65 2026-07-15
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