Price Transparency 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

MEDICAL CITY MENTAL HEALTH AND WELLNESS CENTER

Frisco, TX · CCN 454161 · Rates published

3,978 distinct procedures filed
4 distinct payers
20,033 rate rows
2024-10-01 last MRF observed · ⚠ 20 mo old
Data quality

12,329 of 20,033 rate rows are consumer-grade (61.5%)

7,704 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 7,569
per-diem day rate — not a per-procedure price 123
placeholder amount (≤ $0.02) — excluded from medians 12

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 20 months old.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

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://stctrprodsnsvc00455826e6.blob.core.windows.net/pt-final-posting-files/62-1682203_MEDICAL-CITY-FRISCO_standardcharges.json?si=pt-json-access-policy&spr=https&sv=2024-11-04&sr=c&sig=o5IofreS%2F7ETlsnhPakPWCwHVVUZRobywQ5wUKGjVuQ%3D
Found on page https://medicalcityhealthcare.com/about/legal/pricing-transparency-cms-required-file-of-standard-charges.dot
Discovered viaCMS hospital list
Last fetch Latest re-check couldn't be parsed — showing last good data · 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
9138
OTHER 		Inj, Hemgenix, Per Tx Dos 3 $3,672,900.00 $3,893,274.00 $3,727,993.50 nat. median
$3,746,358
1.0× median
773
OTHER 		Inj, Beqvez, Per Tx Dose 3 $3,605,000.00 $3,821,300.00 $3,659,075.00 nat. median
$3,605,000
1.0× median
714
OTHER 		Inj Delandistrogene Mox R 3 $3,325,455.00 $3,524,982.30 $3,375,336.83 nat. median
$13,041
outlier · 258.8×
748
OTHER 		Inj, Lovotibeglogene Auto 3 $3,286,000.00 $3,483,160.00 $3,335,290.00 nat. median
$17,963
outlier · 185.7×
746
OTHER 		Inj, Betibeglogene Autote 3 $2,968,000.00 $3,146,080.00 $3,012,520.00 nat. median
$21,896
outlier · 137.6×
9141
OTHER 		Inj Onase Abepar-xioi Tre 3 $2,388,614.00 $2,531,930.84 $2,424,443.21 nat. median
$2,588,981
0.9× median
9194
OTHER 		Tisagenlecleucel Car-pos 3 $529,192.90 $560,944.47 $537,130.79 nat. median
$566,531
0.9× median
9498
OTHER 		Ciltacabtagene Car-pos T 3 $527,123.40 $558,750.80 $535,030.25 nat. median
$587,650
0.9× median
9422
OTHER 		Idecabtagene Vicleucel Ca 3 $526,587.60 $558,182.86 $534,486.42 nat. median
$558,082
1.0× median
9413
OTHER 		Lisocabtagene Car Pos T 3 $516,726.10 $547,729.67 $524,476.99 nat. median
$562,201
0.9× median
9035
OTHER 		Axicabtagene Ciloleucel C 3 $489,456.00 $518,823.36 $496,797.84 nat. median
$532,192
0.9× median
9391
OTHER 		Brexucabtagene Car Pos T 3 $460,530.40 $488,162.22 $467,438.35 nat. median
$489,450
1.0× median
1907
OTHER 		New Technology - Level 52 3 $148,181.70 $157,072.60 $150,404.42 nat. median
$153,199
1.0× median
1908
OTHER 		New Technology - Level 52 3 $148,181.70 $157,072.60 $150,404.42 nat. median
$152,962
1.0× median
1905
OTHER 		New Technology - Level 51 3 $133,606.50 $141,622.89 $135,610.60 nat. median
$137,903
1.0× median
1906
OTHER 		New Technology - Level 51 3 $133,606.50 $141,622.89 $135,610.60 nat. median
$138,020
1.0× median
1904
OTHER 		New Technology - Level 50 3 $119,031.30 $126,173.18 $120,816.77 nat. median
$120,174
1.0× median
1903
OTHER 		New Technology - Level 50 3 $119,031.30 $126,173.18 $120,816.77 nat. median
$119,935
1.0× median
1901
OTHER 		New Technology - Level 49 3 $104,456.10 $110,723.47 $106,022.94 nat. median
$105,693
1.0× median
1902
OTHER 		New Technology - Level 49 3 $104,456.10 $110,723.47 $106,022.94 nat. median
$105,172
1.0× median
1599
OTHER 		New Technology - Level 48 3 $92,310.09 $97,848.70 $93,694.74 nat. median
$95,288
1.0× median
1585
OTHER 		New Technology - Level 48 3 $92,310.09 $97,848.70 $93,694.74 nat. median
$95,360
1.0× median
1598
OTHER 		New Technology - Level 47 3 $82,593.29 $87,548.89 $83,832.19 nat. median
$85,322
1.0× median
1584
OTHER 		New Technology - Level 47 3 $82,593.29 $87,548.89 $83,832.19 nat. median
$85,390
1.0× median
1583
OTHER 		New Technology - Level 46 3 $72,876.48 $77,249.07 $73,969.62 nat. median
$75,344
1.0× median
1597
OTHER 		New Technology - Level 46 3 $72,876.48 $77,249.07 $73,969.62 nat. median
$75,284
1.0× median
1643
OTHER 		Y90 Ibritumomab, Rx 3 $65,476.58 $69,405.17 $66,458.73 nat. median
$61,939
1.1× median
717
OTHER 		Instill Adstiladrin, Tx D 3 $63,354.77 $67,156.06 $64,305.09 nat. median
$20,101
outlier · 3.2×
1596
OTHER 		New Technology - Level 45 3 $63,159.69 $66,949.27 $64,107.09 nat. median
$65,191
1.0× median
1582
OTHER 		New Technology - Level 45 3 $63,159.69 $66,949.27 $64,107.09 nat. median
$65,571
1.0× median
9273
OTHER 		Sipuleucel-t Auto Cd54+ 3 $55,015.23 $58,316.14 $55,840.46 nat. median
$56,092
1.0× median
1581
OTHER 		New Technology - Level 44 3 $53,442.89 $56,649.46 $54,244.54 nat. median
$55,106
1.0× median
1595
OTHER 		New Technology - Level 44 3 $53,442.89 $56,649.46 $54,244.54 nat. median
$55,161
1.0× median
5244
OTHER 		Level 4 Blood Product Exc 3 $50,591.66 $53,627.16 $51,350.54 nat. median
$63,188
0.8× median
1142
OTHER 		Supprelin La Implant 3 $45,350.21 $48,071.22 $46,030.46 nat. median
$45,345
1.0× median
1594
OTHER 		New Technology - Level 43 3 $43,726.09 $46,349.66 $44,381.98 nat. median
$45,133
1.0× median
1580
OTHER 		New Technology - Level 43 3 $43,726.09 $46,349.66 $44,381.98 nat. median
$45,289
1.0× median
1579
OTHER 		New Technology - Level 42 3 $34,009.29 $36,049.85 $34,519.43 nat. median
$35,350
1.0× median
1593
OTHER 		New Technology - Level 42 3 $34,009.29 $36,049.85 $34,519.43 nat. median
$35,103
1.0× median
5166
OTHER 		Cochlear Implant Procedur 3 $31,046.54 $32,909.33 $31,512.24 nat. median
$33,509
0.9× median
5232
OTHER 		Level 2 Icd And Similar P 3 $30,458.26 $32,285.76 $30,915.13 nat. median
$32,531
1.0× median
5465
OTHER 		Level 5 Neurostimulator A 3 $28,748.41 $30,473.31 $29,179.64 nat. median
$31,444
0.9× median
843
OTHER 		Pegaspargase Injection 3 $27,070.53 $28,694.76 $27,476.59 nat. median
$26,099
1.1× median
5200
OTHER 		Implantation Wireless Pa 3 $26,908.22 $28,522.71 $27,311.85 nat. median
$28,997
0.9× median
1592
OTHER 		New Technology - Level 41 3 $26,721.69 $28,324.99 $27,122.51 nat. median
$27,776
1.0× median
1578
OTHER 		New Technology - Level 41 3 $26,721.69 $28,324.99 $27,122.51 nat. median
$27,615
1.0× median
856
OTHER 		Porfimer Sodium Injection 3 $23,870.14 $25,302.35 $24,228.19 nat. median
$32,385
0.7× median
5213
OTHER 		Level 3 Electrophysiologi 3 $21,988.33 $23,307.63 $22,318.15 nat. median
$26,257
0.8× median
1577
OTHER 		New Technology - Level 40 3 $21,863.29 $23,175.09 $22,191.24 nat. median
$22,726
1.0× median
1591
OTHER 		New Technology - Level 40 3 $21,863.29 $23,175.09 $22,191.24 nat. median
$22,566
1.0× median

Other procedures at this hospital

Browse this hospital's 3,978 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
             
9138 OTHER Inj, Hemgenix, Per Tx Dos 4 3 — — $3,672,900.00 $3,893,274.00 $3,727,993.50 2024-10-01
773 OTHER Inj, Beqvez, Per Tx Dose 4 3 — — $3,605,000.00 $3,821,300.00 $3,659,075.00 2024-10-01
714 OTHER Inj Delandistrogene Mox R 4 3 — — $3,325,455.00 $3,524,982.30 $3,375,336.83 2024-10-01
748 OTHER Inj, Lovotibeglogene Auto 4 3 — — $3,286,000.00 $3,483,160.00 $3,335,290.00 2024-10-01
746 OTHER Inj, Betibeglogene Autote 4 3 — — $2,968,000.00 $3,146,080.00 $3,012,520.00 2024-10-01
9141 OTHER Inj Onase Abepar-xioi Tre 4 3 — — $2,388,614.00 $2,531,930.84 $2,424,443.21 2024-10-01
9194 OTHER Tisagenlecleucel Car-pos 4 3 — — $529,192.90 $560,944.47 $537,130.79 2024-10-01
9498 OTHER Ciltacabtagene Car-pos T 4 3 — — $527,123.40 $558,750.80 $535,030.25 2024-10-01
9422 OTHER Idecabtagene Vicleucel Ca 4 3 — — $526,587.60 $558,182.86 $534,486.42 2024-10-01
9413 OTHER Lisocabtagene Car Pos T 4 3 — — $516,726.10 $547,729.67 $524,476.99 2024-10-01
9035 OTHER Axicabtagene Ciloleucel C 4 3 — — $489,456.00 $518,823.36 $496,797.84 2024-10-01
9391 OTHER Brexucabtagene Car Pos T 4 3 — — $460,530.40 $488,162.22 $467,438.35 2024-10-01
1907 OTHER New Technology - Level 52 4 3 — — $148,181.70 $157,072.60 $150,404.42 2024-10-01
1908 OTHER New Technology - Level 52 4 3 — — $148,181.70 $157,072.60 $150,404.42 2024-10-01
1906 OTHER New Technology - Level 51 4 3 — — $133,606.50 $141,622.89 $135,610.60 2024-10-01
1905 OTHER New Technology - Level 51 4 3 — — $133,606.50 $141,622.89 $135,610.60 2024-10-01
1903 OTHER New Technology - Level 50 4 3 — — $119,031.30 $126,173.18 $120,816.77 2024-10-01
1904 OTHER New Technology - Level 50 4 3 — — $119,031.30 $126,173.18 $120,816.77 2024-10-01
1902 OTHER New Technology - Level 49 4 3 — — $104,456.10 $110,723.47 $106,022.94 2024-10-01
1901 OTHER New Technology - Level 49 4 3 — — $104,456.10 $110,723.47 $106,022.94 2024-10-01
1599 OTHER New Technology - Level 48 4 3 — — $92,310.09 $97,848.70 $93,694.74 2024-10-01
1585 OTHER New Technology - Level 48 4 3 — — $92,310.09 $97,848.70 $93,694.74 2024-10-01
1584 OTHER New Technology - Level 47 4 3 — — $82,593.29 $87,548.89 $83,832.19 2024-10-01
1598 OTHER New Technology - Level 47 4 3 — — $82,593.29 $87,548.89 $83,832.19 2024-10-01
1583 OTHER New Technology - Level 46 4 3 — — $72,876.48 $77,249.07 $73,969.62 2024-10-01
1597 OTHER New Technology - Level 46 4 3 — — $72,876.48 $77,249.07 $73,969.62 2024-10-01
1643 OTHER Y90 Ibritumomab, Rx 4 3 — — $65,476.58 $69,405.17 $66,458.73 2024-10-01
717 OTHER Instill Adstiladrin, Tx D 4 3 — — $63,354.77 $67,156.06 $64,305.09 2024-10-01
1582 OTHER New Technology - Level 45 4 3 — — $63,159.69 $66,949.27 $64,107.09 2024-10-01
1596 OTHER New Technology - Level 45 4 3 — — $63,159.69 $66,949.27 $64,107.09 2024-10-01
9273 OTHER Sipuleucel-t Auto Cd54+ 4 3 — — $55,015.23 $58,316.14 $55,840.46 2024-10-01
1581 OTHER New Technology - Level 44 4 3 — — $53,442.89 $56,649.46 $54,244.54 2024-10-01
1595 OTHER New Technology - Level 44 4 3 — — $53,442.89 $56,649.46 $54,244.54 2024-10-01
5244 OTHER Level 4 Blood Product Exc 4 3 — — $50,591.66 $53,627.16 $51,350.54 2024-10-01
1142 OTHER Supprelin La Implant 4 3 — — $45,350.21 $48,071.22 $46,030.46 2024-10-01
1594 OTHER New Technology - Level 43 4 3 — — $43,726.09 $46,349.66 $44,381.98 2024-10-01
1580 OTHER New Technology - Level 43 4 3 — — $43,726.09 $46,349.66 $44,381.98 2024-10-01
1593 OTHER New Technology - Level 42 4 3 — — $34,009.29 $36,049.85 $34,519.43 2024-10-01
1579 OTHER New Technology - Level 42 4 3 — — $34,009.29 $36,049.85 $34,519.43 2024-10-01
5166 OTHER Cochlear Implant Procedur 4 3 — — $31,046.54 $32,909.33 $31,512.24 2024-10-01
5232 OTHER Level 2 Icd And Similar P 4 3 — — $30,458.26 $32,285.76 $30,915.13 2024-10-01
5465 OTHER Level 5 Neurostimulator A 4 3 — — $28,748.41 $30,473.31 $29,179.64 2024-10-01
843 OTHER Pegaspargase Injection 4 3 — — $27,070.53 $28,694.76 $27,476.59 2024-10-01
5200 OTHER Implantation Wireless Pa 4 3 — — $26,908.22 $28,522.71 $27,311.85 2024-10-01
1592 OTHER New Technology - Level 41 4 3 — — $26,721.69 $28,324.99 $27,122.51 2024-10-01
1578 OTHER New Technology - Level 41 4 3 — — $26,721.69 $28,324.99 $27,122.51 2024-10-01
856 OTHER Porfimer Sodium Injection 4 3 — — $23,870.14 $25,302.35 $24,228.19 2024-10-01
5213 OTHER Level 3 Electrophysiologi 4 3 — — $21,988.33 $23,307.63 $22,318.15 2024-10-01
1577 OTHER New Technology - Level 40 4 3 — — $21,863.29 $23,175.09 $22,191.24 2024-10-01
1591 OTHER New Technology - Level 40 4 3 — — $21,863.29 $23,175.09 $22,191.24 2024-10-01
5231 OTHER Level 1 Icd And Similar P 4 3 — — $21,822.62 $23,131.98 $22,149.96 2024-10-01
5464 OTHER Level 4 Neurostimulator A 4 3 — — $20,252.57 $21,467.72 $20,556.36 2024-10-01
5378 OTHER Level 8 Urology And Relat 4 3 — — $18,675.20 $19,795.71 $18,955.33 2024-10-01
5224 OTHER Level 4 Pacemaker And Sim 4 3 — — $18,039.58 $19,121.95 $18,310.18 2024-10-01
1295 OTHER Sm 153 Lexidronam 4 3 — — $17,259.85 $18,295.44 $17,518.75 2024-10-01
5116 OTHER Level 6 Musculoskeletal P 4 3 — — $17,253.42 $18,288.63 $17,512.22 2024-10-01
2616 OTHER Brachytx, Non-str,yttrium 4 3 — — $17,177.01 $18,207.63 $17,434.67 2024-10-01
1576 OTHER New Technology - Level 39 4 3 — — $17,004.89 $18,025.18 $17,259.97 2024-10-01
1590 OTHER New Technology - Level 39 4 3 — — $17,004.89 $18,025.18 $17,259.97 2024-10-01
5471 OTHER Implantation Of Drug Infu 4 3 — — $16,511.16 $17,501.83 $16,758.83 2024-10-01
5094 OTHER Level 4 Breast/Lymphatic 4 3 — — $16,314.52 $17,293.39 $16,559.24 2024-10-01
5194 OTHER Level 4 Endovascular Proc 4 3 — — $16,234.16 $17,208.21 $16,477.67 2024-10-01
5496 OTHER Level 6 Intraocular Proce 4 3 — — $16,062.25 $17,025.99 $16,303.18 2024-10-01
5495 OTHER Level 5 Intraocular Proce 4 3 — — $14,612.53 $15,489.28 $14,831.72 2024-10-01
5463 OTHER Level 3 Neurostimulator A 4 3 — — $12,611.39 $13,368.07 $12,800.56 2024-10-01
5115 OTHER Level 5 Musculoskeletal P 4 3 — — $12,184.69 $12,915.77 $12,367.46 2024-10-01
1589 OTHER New Technology - Level 38 4 3 — — $12,146.49 $12,875.28 $12,328.68 2024-10-01
1575 OTHER New Technology - Level 38 4 3 — — $12,146.49 $12,875.28 $12,328.68 2024-10-01
713 OTHER Inj Roctavian Ml 2x10^13v 4 3 — — $12,007.81 $12,728.28 $12,187.92 2024-10-01
81416 CPT Exome (eg, Unexplained Constitutional Or Heritable Disorder Or Syndrome); Sequen… 4 3 — — $12,000.00 $12,720.00 $12,180.00 2024-10-01
5377 OTHER Level 7 Urology And Relat 4 3 — — $11,884.45 $12,597.52 $12,062.72 2024-10-01
5494 OTHER Level 4 Intraocular Proce 4 3 — — $11,477.42 $12,166.07 $11,649.58 2024-10-01
5193 OTHER Level 3 Endovascular Proc 4 3 — — $10,184.96 $10,796.06 $10,337.74 2024-10-01
5223 OTHER Level 3 Pacemaker And Sim 4 3 — — $9,886.03 $10,479.19 $10,034.32 2024-10-01
5362 OTHER Level 2 Laparoscopy And R 4 3 — — $9,530.00 $10,101.80 $9,672.95 2024-10-01
1537 OTHER New Technology - Level 37 4 3 — — $9,474.37 $10,042.83 $9,616.49 2024-10-01
1574 OTHER New Technology - Level 37 4 3 — — $9,474.37 $10,042.83 $9,616.49 2024-10-01
1573 OTHER New Technology - Level 36 4 3 — — $8,988.52 $9,527.84 $9,123.35 2024-10-01
1536 OTHER New Technology - Level 36 4 3 — — $8,988.52 $9,527.84 $9,123.35 2024-10-01
5093 OTHER Level 3 Breast/Lymphatic 4 3 — — $8,727.26 $9,250.90 $8,858.17 2024-10-01
5376 OTHER Level 6 Urology And Relat 4 3 — — $8,528.83 $9,040.56 $8,656.76 2024-10-01
1572 OTHER New Technology - Level 35 4 3 — — $8,502.69 $9,012.85 $8,630.23 2024-10-01
1535 OTHER New Technology - Level 35 4 3 — — $8,502.69 $9,012.85 $8,630.23 2024-10-01
0315U CPT Oncology (cutaneous Squamous Cell Carcinoma), Mrna Gene Expression Profiling By … 4 3 — — $8,500.00 $9,010.00 $8,627.50 2024-10-01
0211U CPT Onc Pan-tumor DNA & RNA Next-generation Sequencing 4 3 — — $8,455.00 $8,962.30 $8,581.83 2024-10-01
1534 OTHER New Technology - Level 34 4 3 — — $8,016.85 $8,497.86 $8,137.10 2024-10-01
1571 OTHER New Technology - Level 34 4 3 — — $8,016.85 $8,497.86 $8,137.10 2024-10-01
5881 OTHER Ancillary Outpatient Serv 4 3 — — $8,004.13 $8,484.37 $8,124.19 2024-10-01
5222 OTHER Level 2 Pacemaker And Sim 4 3 — — $7,865.37 $8,337.29 $7,983.35 2024-10-01
81552 CPT Oncology (uveal Melanoma), Mrna, Gene Expression Profiling By Real-time Rt-pcr O… 4 3 — — $7,776.00 $8,242.56 $7,892.64 2024-10-01
0094U CPT Genome (eg, Unexplained Constitutional Or Heritable Disorder Or Syndrome), Rapid… 4 3 — — $7,582.20 $8,037.13 $7,695.93 2024-10-01
1570 OTHER New Technology - Level 33 4 3 — — $7,531.01 $7,982.87 $7,643.98 2024-10-01
1533 OTHER New Technology - Level 33 4 3 — — $7,531.01 $7,982.87 $7,643.98 2024-10-01
5627 OTHER Level 7 Radiation Therapy 4 3 — — $7,209.52 $7,642.09 $7,317.66 2024-10-01
81529 CPT Oncology (cutaneous Melanoma), Mrna, Gene Expression Profiling By Real-time Rt-p… 4 3 — — $7,193.00 $7,624.58 $7,300.90 2024-10-01
1532 OTHER New Technology - Level 32 4 3 — — $7,045.17 $7,467.88 $7,150.85 2024-10-01
1569 OTHER New Technology - Level 32 4 3 — — $7,045.17 $7,467.88 $7,150.85 2024-10-01
5342 OTHER Level 2 Abdominal/Periton 4 3 — — $7,004.27 $7,424.52 $7,109.34 2024-10-01
5416 OTHER Level 6 Gynecologic Proce 4 3 — — $6,995.90 $7,415.66 $7,100.84 2024-10-01
5212 OTHER Level 2 Electrophysiologi 4 3 — — $6,914.10 $7,328.95 $7,017.82 2024-10-01
0267U CPT Rare Constitutional And Other Heritable Disorders, Identification Of Copy Number… 4 3 — — $6,739.33 $7,143.69 $6,840.42 2024-10-01
5114 OTHER Level 4 Musculoskeletal P 4 3 — — $6,623.29 $7,020.69 $6,722.64 2024-10-01
1568 OTHER New Technology - Level 31 4 3 — — $6,559.33 $6,952.89 $6,657.72 2024-10-01
1531 OTHER New Technology - Level 31 4 3 — — $6,559.33 $6,952.89 $6,657.72 2024-10-01
5155 OTHER Level 5 Airway Endoscopy 4 3 — — $6,336.51 $6,716.70 $6,431.56 2024-10-01
5462 OTHER Level 2 Neurostimulator A 4 3 — — $6,331.74 $6,711.64 $6,426.72 2024-10-01
5432 OTHER Level 2 Nerve Procedures 4 3 — — $6,167.22 $6,537.26 $6,259.73 2024-10-01
1274 OTHER Edetate Calcium Disodium 4 3 — — $6,086.32 $6,451.50 $6,177.61 2024-10-01
1567 OTHER New Technology - Level 30 4 3 — — $6,073.49 $6,437.90 $6,164.59 2024-10-01
1530 OTHER New Technology - Level 30 4 3 — — $6,073.49 $6,437.90 $6,164.59 2024-10-01
5092 OTHER Level 2 Breast/Lymphatic 4 3 — — $6,037.28 $6,399.52 $6,127.84 2024-10-01
1529 OTHER New Technology - Level 29 4 3 — — $5,587.65 $5,922.90 $5,671.47 2024-10-01
1566 OTHER New Technology - Level 29 4 3 — — $5,587.65 $5,922.90 $5,671.47 2024-10-01
81554 CPT Pulmonary Disease (idiopathic Pulmonary Fibrosis ºipf»), Mrna, Gene Expression A… 4 3 — — $5,500.00 $5,830.00 $5,582.50 2024-10-01
0265U CPT Rare Constitutional And Other Heritable Disorders, Whole Genome And Mitochondria… 4 3 — — $5,475.80 $5,804.35 $5,557.93 2024-10-01
0212U CPT Rare Ds Whl Gen & Mitochdrl DNA Seq Alys Proband 4 3 — — $5,475.20 $5,803.71 $5,557.33 2024-10-01
0295U CPT Oncology (breast Ductal Carcinoma In Situ), Protein Expression Profiling By Immu… 4 3 — — $5,435.00 $5,761.10 $5,516.52 2024-10-01
5165 OTHER Level 5 ENT Procedures 4 3 — — $5,421.69 $5,746.99 $5,503.01 2024-10-01
5361 OTHER Level 1 Laparoscopy And R 4 3 — — $5,341.90 $5,662.41 $5,422.02 2024-10-01
5192 OTHER Level 2 Endovascular Proc 4 3 — — $5,291.61 $5,609.11 $5,370.98 2024-10-01
5331 OTHER Complex Gi Procedures 4 3 — — $5,276.41 $5,592.99 $5,355.56 2024-10-01
0214U CPT Rare Ds Whl Xom & Mitochdrl DNA Seq Alys Proband 4 3 — — $5,224.60 $5,538.08 $5,302.97 2024-10-01
0335U CPT Rare Diseases, Whole Genome Sequence Analysis, Incl Small Sequence Changes, Copy… 4 3 — — $5,224.60 $5,538.08 $5,302.97 2024-10-01
1528 OTHER New Technology - Level 28 4 3 — — $5,101.81 $5,407.91 $5,178.34 2024-10-01
1565 OTHER New Technology - Level 28 4 3 — — $5,101.81 $5,407.91 $5,178.34 2024-10-01
5184 OTHER Level 4 Vascular Procedur 4 3 — — $5,087.64 $5,392.90 $5,163.95 2024-10-01
81425 CPT Genome (eg, Unexplained Constitutional Or Heritable Disorder Or Syndrome); Seque… 4 3 — — $5,031.20 $5,333.07 $5,106.67 2024-10-01
0242U CPT Targeted Genomic Sequence Analysis Panel, Solid Organ Neoplasm, Cell-free Circul… 4 3 — — $5,000.00 $5,300.00 $5,075.00 2024-10-01
0326U CPT Target Genomic Sequence Analysis Panel, Solid Organ Neoplasm, Cell-free Circulat… 4 3 — — $5,000.00 $5,300.00 $5,075.00 2024-10-01
0108U CPT Gastroenterology (Barrett's Esophagus), Whole Slide-digital Imaging, Including M… 4 3 — — $4,950.00 $5,247.00 $5,024.25 2024-10-01
9009 OTHER Inj, Vutrisiran, 1 Mg 4 3 — — $4,926.00 $5,221.56 $4,999.89 2024-10-01
1687 OTHER Digoxin Immune Fab (ovine 4 3 — — $4,888.10 $5,181.39 $4,961.43 2024-10-01
5493 OTHER Level 3 Intraocular Proce 4 3 — — $4,838.77 $5,129.10 $4,911.35 2024-10-01
1431 OTHER Centruroides Immune F(ab) 4 3 — — $4,804.24 $5,092.50 $4,876.31 2024-10-01
5375 OTHER Level 5 Urology And Relat 4 3 — — $4,790.46 $5,077.89 $4,862.32 2024-10-01
81415 CPT Exome (eg, Unexplained Constitutional Or Heritable Disorder Or Syndrome); Sequen… 4 3 — — $4,780.00 $5,066.80 $4,851.70 2024-10-01
0036U CPT Exome (ie, Somatic Mutations), Paired Formalin-fixed Paraffin-embedded Tumor Tis… 4 3 — — $4,780.00 $5,066.80 $4,851.70 2024-10-01
1527 OTHER New Technology - Level 27 4 3 — — $4,615.97 $4,892.92 $4,685.20 2024-10-01
1564 OTHER New Technology - Level 27 4 3 — — $4,615.97 $4,892.92 $4,685.20 2024-10-01
5415 OTHER Level 5 Gynecologic Proce 4 3 — — $4,604.89 $4,881.18 $4,673.97 2024-10-01
1683 OTHER Basiliximab 4 3 — — $4,588.77 $4,864.10 $4,657.60 2024-10-01
0473U CPT Oncology (solid Tumor),nextgeneration Sequencing (ngs) Of DNA From Formalin-fixe… 4 3 — — $4,500.00 $4,770.00 $4,567.50 2024-10-01
0762 RC — 2 2 — — $4,150.00 $4,550.00 $4,350.00 2024-10-01
5243 OTHER Level 3 Blood Product Exc 4 3 — — $4,284.47 $4,541.54 $4,348.74 2024-10-01
0300U CPT Oncology (pan Tumor), Whole Genome Sequencing And Optical Genome Mapping Of Pair… 4 3 — — $4,183.13 $4,434.12 $4,245.88 2024-10-01
701 OTHER Sr89 Strontium 4 3 — — $4,146.34 $4,395.12 $4,208.53 2024-10-01
1563 OTHER New Technology - Level 26 4 3 — — $4,130.13 $4,377.93 $4,192.08 2024-10-01
1526 OTHER New Technology - Level 26 4 3 — — $4,130.13 $4,377.93 $4,192.08 2024-10-01
890 OTHER Lymphocyte Immune Globuli 4 3 — — $3,968.45 $4,206.55 $4,027.97 2024-10-01
807 OTHER Aldesleukin Injection 4 3 — — $3,943.00 $4,179.58 $4,002.14 2024-10-01
0306U CPT Oncology (minimal Residual Disease [mrd]), Next-generation Targeted Sequencing A… 4 3 — — $3,878.45 $4,111.16 $3,936.62 2024-10-01
81519 CPT Oncology (breast), Mrna, Gene Expression Profiling By Real-time Rt-pcr Of 21 Gen… 4 3 — — $3,873.00 $4,105.38 $3,931.10 2024-10-01
81518 CPT Oncology (breast), Mrna, Gene Expression Profiling By Real-time Rt-pcr Of 11 Gen… 4 3 — — $3,873.00 $4,105.38 $3,931.10 2024-10-01
81521 CPT Oncology (breast), Mrna, Microarray Gene Expression Profiling Of 70 Content Gene… 4 3 — — $3,873.00 $4,105.38 $3,931.10 2024-10-01
0047U CPT Oncology (prostate), Mrna, Gene Expression Profiling By Real-time Rt-pcr Of 17 G… 4 3 — — $3,873.00 $4,105.38 $3,931.10 2024-10-01
0045U CPT Oncology (breast Ductal Carcinoma In Situ), Mrna, Gene Expression Progiling By R… 4 3 — — $3,873.00 $4,105.38 $3,931.10 2024-10-01
81541 CPT Oncology (prostate), Mrna Gene Expression Profiling By Real-time Rt-pcr Of 46 Ge… 4 3 — — $3,873.00 $4,105.38 $3,931.10 2024-10-01
81523 CPT Oncology (breast), Mrna, Next-generation Sequencing Gene Expression Profiling Of… 4 3 — — $3,873.00 $4,105.38 $3,931.10 2024-10-01
81542 CPT Oncology (prostate), Mrna, Microarray Gene Expression Profiling Of 22 Content Ge… 4 3 — — $3,873.00 $4,105.38 $3,931.10 2024-10-01
0288U CPT Oncology (lung), Mrna, Quantitative Pcr Analysis Of 11 Genes (bag1,brca1,cdc6, C… 4 3 — — $3,873.00 $4,105.38 $3,931.10 2024-10-01
81522 CPT Oncology (breast), Mrna, Gene Expression Profiling By Rt-pcr Of 12 Genes (8 Cont… 4 3 — — $3,873.00 $4,105.38 $3,931.10 2024-10-01
827 OTHER Floxuridine Injection 4 3 — — $3,858.03 $4,089.51 $3,915.90 2024-10-01
5492 OTHER Level 2 Intraocular Proce 4 3 — — $3,764.19 $3,990.04 $3,820.65 2024-10-01
9268 OTHER Inj. Acthar Gel To 40 Uni 4 3 — — $3,750.08 $3,975.08 $3,806.33 2024-10-01
81540 CPT Oncology (tumor Of Unknown Origin), Mrna, Gene Expression Profiling By Real-time… 4 3 — — $3,750.00 $3,975.00 $3,806.25 2024-10-01
709 OTHER Flortaucipir Inj 1 Millic 4 3 — — $3,710.00 $3,932.60 $3,765.65 2024-10-01
0258U CPT Autoimmune (psoriasis), Mrna, Next-generation Sequencing, Gene Expression Profil… 4 3 — — $3,675.00 $3,895.50 $3,730.12 2024-10-01
0019U CPT Oncology, Rna, Gene Expression By Whole Transcriptome Sequencing, Formalin-fixed… 4 3 — — $3,675.00 $3,895.50 $3,730.12 2024-10-01
1525 OTHER New Technology - Level 25 4 3 — — $3,644.29 $3,862.94 $3,698.95 2024-10-01
1562 OTHER New Technology - Level 25 4 3 — — $3,644.29 $3,862.94 $3,698.95 2024-10-01
5221 OTHER Level 1 Pacemaker And Sim 4 3 — — $3,635.66 $3,853.80 $3,690.19 2024-10-01
0026U CPT Oncology (thyroid), DNA And Mrna Of 112 Genes, Next-generation Sequencing, Fine … 4 3 — — $3,600.00 $3,816.00 $3,654.00 2024-10-01
0362U CPT Oncology (papillary Thyroid Cancer), Gene-expression Profiling Via Targeted Hybr… 4 3 — — $3,600.00 $3,816.00 $3,654.00 2024-10-01
81546 CPT Oncology (thyroid), Mrna, Gene Expression Analysis Of 10,196 Genes, Utilizing Fi… 4 3 — — $3,600.00 $3,816.00 $3,654.00 2024-10-01
0313U CPT Oncology (pancreas), DNA And Mrna Next-generation Sequencing Analysis Of 74 Gene… 4 3 — — $3,600.00 $3,816.00 $3,654.00 2024-10-01
0287U CPT Oncology (thyroid), DNA And Mrna, Next Generation Sequencing Analysis Of 112 Gen… 4 3 — — $3,600.00 $3,816.00 $3,654.00 2024-10-01
0391U CPT Oncology, DNA And RNA By Nex-gen Sequencing, Utilizing Ffpe Tissue, 437 Genes, I… 4 3 — — $3,600.00 $3,816.00 $3,654.00 2024-10-01
0340U CPT Oncology (pan-cancer), Analysis Of Mrd From Plasma, With Assays Personalized To … 4 3 — — $3,590.00 $3,805.40 $3,643.85 2024-10-01
5504 OTHER Level 4 Extraocular, Repa 4 3 — — $3,579.53 $3,794.30 $3,633.23 2024-10-01
5303 OTHER Level 3 Upper Gi Procedur 4 3 — — $3,545.62 $3,758.36 $3,598.80 2024-10-01
5091 OTHER Level 1 Breast/Lymphatic 4 3 — — $3,528.94 $3,740.67 $3,581.88 2024-10-01
0080U CPT Oncology (lung), Mass Spectrometric Analysis Of Galectin-3-binding Protein And S… 4 3 — — $3,520.00 $3,731.20 $3,572.80 2024-10-01
0244U CPT Oncology (solid Organ), Dna, Comprehensive Genomic Profiling, 257 Genes, Interro… 4 3 — — $3,500.00 $3,710.00 $3,552.50 2024-10-01
0239U CPT Targeted Genomic Sequence Analysis Panel, Solid Organ Neoplasm, Cell-free Dna, A… 4 3 — — $3,500.00 $3,710.00 $3,552.50 2024-10-01
0037U CPT Targeted Genomic Sequence Analysis, Solid Organ Neoplasm, DNA Analysis Of 324 Ge… 4 3 — — $3,500.00 $3,710.00 $3,552.50 2024-10-01
0016M CPT Oncology (bladder), Mrna, Microarray Gene Expression Profiling Of 219 Genes, Uti… 4 3 — — $3,489.63 $3,699.01 $3,541.98 2024-10-01
9281 OTHER Injection, Pegloticase 4 3 — — $3,482.15 $3,691.08 $3,534.39 2024-10-01
5154 OTHER Level 4 Airway Endoscopy 4 3 — — $3,467.00 $3,675.02 $3,519.01 2024-10-01
0329U CPT Oncology (neoplasia), Exome And Transcriptome Sequence Analysis For Sequence Var… 4 3 — — $3,437.98 $3,644.26 $3,489.55 2024-10-01
9016 OTHER Inj., Triptorelin Xr 3.75 4 3 — — $3,418.49 $3,623.60 $3,469.77 2024-10-01
9275 OTHER Inj. (ani), Up To 40 Unit 4 3 — — $3,416.97 $3,621.99 $3,468.22 2024-10-01
81440 CPT Nuclear Encoded Mitochondrial Genes (eg, Neurologic Or Myopathic Phenotypes), Ge… 4 3 — — $3,324.00 $3,523.44 $3,373.86 2024-10-01
5055 OTHER Level 5 Skin Procedures 4 3 — — $3,321.45 $3,520.74 $3,371.27 2024-10-01
0055U CPT Cardiology (heart Transplant), Cell-free Dna, Pcr Assay Of 96 DNA Target Sequenc… 4 3 — — $3,240.00 $3,434.40 $3,288.60 2024-10-01
81595 CPT Cardiology (heart Transplant), Mrna, Gene Expression Profiling By Real-time Quan… 4 3 — — $3,240.00 $3,434.40 $3,288.60 2024-10-01
5374 OTHER Level 4 Urology And Relat 4 3 — — $3,227.51 $3,421.16 $3,275.93 2024-10-01
5341 OTHER Level 1 Abdominal/Periton 4 3 — — $3,202.99 $3,395.17 $3,251.03 2024-10-01
0266U CPT Unexplained Constitutional Or Other Heritable Disorders Or Syndromes, Tissue-spe… 4 3 — — $3,200.00 $3,392.00 $3,248.00 2024-10-01
0262U CPT Oncology (solid Tumor), Gene Expression Profiling By Real-time Rt-pcr Of 7 Gene … 4 3 — — $3,200.00 $3,392.00 $3,248.00 2024-10-01
0253U CPT Reproductive Medicine, RNA Gene Expression Profile 238 Genes By Next-generation … 4 3 — — $3,159.42 $3,348.99 $3,206.81 2024-10-01
0088U CPT Transplantation Medicine (kidney Allograft Rejection), Microarray Gene Expressio… 4 3 — — $3,159.42 $3,348.99 $3,206.81 2024-10-01
0087U CPT Cardiology (heart Transplant), Mrna Gene Expression Progiling By Microarray Of 1… 4 3 — — $3,159.42 $3,348.99 $3,206.81 2024-10-01
0153U CPT Oncology (breast), Mrna, Gene Expression Profiling By Next-generation Sequencing… 4 3 — — $3,159.42 $3,348.99 $3,206.81 2024-10-01
1524 OTHER New Technology - Level 24 4 3 — — $3,158.45 $3,347.95 $3,205.82 2024-10-01
1561 OTHER New Technology - Level 24 4 3 — — $3,158.45 $3,347.95 $3,205.82 2024-10-01
5461 OTHER Level 1 Neurostimulator A 4 3 — — $3,150.09 $3,339.09 $3,197.34 2024-10-01
81525 CPT Oncology (colon), Mrna, Gene Expression Profiling By Real-time Rt-pcr Of 12 Gene… 4 3 — — $3,116.00 $3,302.96 $3,162.74 2024-10-01
9070 OTHER Inj Luxturna 1 Billion Ve 4 3 — — $3,084.46 $3,269.53 $3,130.73 2024-10-01
0248U CPT Oncology, Spheroid Cell Culture In 3d Microenvironment, 12 Drug Panel, Response … 4 3 — — $3,033.86 $3,215.89 $3,079.37 2024-10-01
0172U CPT Oncology (solid Tumor As Indicated By The Label), Somatic Mutation Analyis Of Br… 4 3 — — $3,030.00 $3,211.80 $3,075.45 2024-10-01
5191 OTHER Level 1 Endovascular Proc 4 3 — — $3,016.80 $3,197.81 $3,062.06 2024-10-01
0018U CPT Oncology (thyroid), microRNA Profiling By Rt-pcr Of 10 miRNA Sequences, Utilizin… 4 3 — — $3,002.09 $3,182.22 $3,047.12 2024-10-01
5113 OTHER Level 3 Musculoskeletal P 4 3 — — $2,996.69 $3,176.49 $3,041.64 2024-10-01
5164 OTHER Level 4 ENT Procedures 4 3 — — $2,980.74 $3,159.59 $3,025.45 2024-10-01
5183 OTHER Level 3 Vascular Procedur 4 3 — — $2,951.00 $3,128.06 $2,995.27 2024-10-01
0409U CPT Oncology (solid Tumor), DNA (80 Genes) & RNA (36 Genes), By Next-generation Sequ… 4 3 — — $2,919.60 $3,094.78 $2,963.39 2024-10-01
81456 CPT Solid Organ Or Hematolymphoid Neoplasm Or Disorder, 51 Or Greater Genes, Genomic… 4 3 — — $2,919.60 $3,094.78 $2,963.39 2024-10-01
0250U CPT Oncology (Solid Organ Neoplasm), Targeted Genomic Sequence DNA Analysis Of 505 G… 4 3 — — $2,919.60 $3,094.78 $2,963.39 2024-10-01
0048U CPT Oncology (solid Organ Neoplasia), Dna, Targeted Sequencing Of Protein-coding Exo… 4 3 — — $2,919.60 $3,094.78 $2,963.39 2024-10-01
81455 CPT Solid Organ Or Hematolymphoid Neoplasm Or Disorder, 51 Or Greater Genes, Genomic… 4 3 — — $2,919.60 $3,094.78 $2,963.39 2024-10-01
0298U CPT Oncology (pan Tumor) Whole Genome Sequencing Of Paired Malignant And Normal DNA … 4 3 — — $2,919.60 $3,094.78 $2,963.39 2024-10-01
0297U CPT Oncology (pan Tumor) Whole Genome Sequencing Of Paired Malignant And Normal DNA … 4 3 — — $2,919.60 $3,094.78 $2,963.39 2024-10-01
0050U CPT Targeted Genomic Sequence Analysis Panel, Acute Myelogenous Leukemia, DNA Analys… 4 3 — — $2,916.60 $3,091.60 $2,960.35 2024-10-01
5414 OTHER Level 4 Gynecologic Proce 4 3 — — $2,894.41 $3,068.08 $2,937.82 2024-10-01
9396 OTHER Afamelanotide Implant, 1 4 3 — — $2,873.33 $3,045.73 $2,916.43 2024-10-01
81538 CPT Oncology (lung), Mass Spectrometric 8-protein Signature, Including Amyloid A, Ut… 4 3 — — $2,871.00 $3,043.26 $2,914.07 2024-10-01
9005 OTHER Reteplase Injection 4 3 — — $2,777.14 $2,943.76 $2,818.80 2024-10-01
0118U CPT Transplantation Medicine, Quantification Of Donor-derived Cell-free DNA Using Wh… 4 3 — — $2,753.25 $2,918.45 $2,794.55 2024-10-01
0213U CPT Rare Ds Whl Gen & Mitochdrl DNA Seq Alys Ea Cmprtr 4 3 — — $2,709.95 $2,872.55 $2,750.60 2024-10-01
81426 CPT Genome (eg, Unexplained Constitutional Or Heritable Disorder Or Syndrome); Seque… 4 3 — — $2,709.95 $2,872.55 $2,750.60 2024-10-01
720 OTHER Inj Glofitamab Gxbm, 2.5 4 3 — — $2,701.04 $2,863.10 $2,741.56 2024-10-01
1560 OTHER New Technology - Level 23 4 3 — — $2,672.61 $2,832.96 $2,712.70 2024-10-01
1523 OTHER New Technology - Level 23 4 3 — — $2,672.61 $2,832.96 $2,712.70 2024-10-01
0320U CPT Nephrology (renal Transplant), RNA Expression By Select Transcriptome Sequencing… 4 3 — — $2,650.00 $2,809.00 $2,689.75 2024-10-01
0319U CPT "Nephrology (renal Transplant), RNA Expression By Select Transcriptome Sequencin… 4 3 — — $2,650.00 $2,809.00 $2,689.75 2024-10-01
5073 OTHER Level 3 Excision/ Biopsy/ 4 3 — — $2,630.68 $2,788.52 $2,670.14 2024-10-01
9028 OTHER Inj Inotuzumab Ozogam 0.1 4 3 — — $2,618.85 $2,775.98 $2,658.13 2024-10-01
5313 OTHER Level 3 Lower Gi Procedur 4 3 — — $2,599.48 $2,755.45 $2,638.47 2024-10-01
0336U CPT Rare Diseases, Whole Genome Sequence Analysis, Incl Small Sequence Changes, Copy… 4 3 — — $2,574.65 $2,729.13 $2,613.27 2024-10-01
0215U CPT Rare Ds Whl Xom & Mitochdrl DNA Seq Alys Ea Cmprtr 4 3 — — $2,574.65 $2,729.13 $2,613.27 2024-10-01
844 OTHER Pentostatin Injection 4 3 — — $2,541.77 $2,694.28 $2,579.90 2024-10-01
0261U CPT Oncology (colorectal Cancer), Image Analysis With Artificial Intelligence Assess… 4 3 — — $2,513.25 $2,664.05 $2,550.95 2024-10-01
0120U CPT Oncology (b-cell Lymphoma Classification), Mrna, Gene Expression Profiling By Fl… 4 3 — — $2,510.21 $2,660.82 $2,547.86 2024-10-01
81520 CPT Oncology (breast), Mrna Gene Expression Profiling By Hybrid Capture Of 58 Genes … 4 3 — — $2,510.21 $2,660.82 $2,547.86 2024-10-01
0017M CPT Oncology (diffuse Large B-cell Lymphoma ºdlbcl»), Mrna, Gene Expression Profilin… 4 3 — — $2,510.21 $2,660.82 $2,547.86 2024-10-01
8011 OTHER Comprehensive Observation 2 1 — — $2,534.13 $2,534.13 $2,534.13 2024-10-01
0092U CPT Oncology (lung), Three Protein Biomarkers, Immunoassay Using Q4 Magnetic Nanosen… 4 3 — — $2,488.00 $2,637.28 $2,525.32 2024-10-01
0276U CPT Hematology (inherited Thrombocytopenia), Geonomic Sequence Analysis Of 42 Genes,… 4 3 — — $2,448.56 $2,595.47 $2,485.29 2024-10-01
81412 CPT Ashkenazi Jewish Associated Disorders (eg, Bloom Syndrome, Canavan Disease, Cyst… 4 3 — — $2,448.56 $2,595.47 $2,485.29 2024-10-01
81443 CPT Genetic Testing For Severe Inherited Conditions (eg, Cystic Fibrosis, Ashkenazi … 4 3 — — $2,448.56 $2,595.47 $2,485.29 2024-10-01
81419 CPT Epilepsy Genomic Sequence Analysis Panel, Must Include Analyses For Aldh7a1, Cac… 4 3 — — $2,448.56 $2,595.47 $2,485.29 2024-10-01
81441 CPT Inherited Bone Marrow Failure Syndromes (ibmfs) (eg, Fanconi Anemia, Dyskeratosi… 4 3 — — $2,448.56 $2,595.47 $2,485.29 2024-10-01
0337U CPT Oncology (Plasma Cell Disorders And Myeloma), Circulating Plasma Cell Immunologi… 4 3 — — $2,435.00 $2,581.10 $2,471.53 2024-10-01
0338U CPT Oncology (Solid Tumor), Circulating Tumor Cell Selection, Id, Morphological Char… 4 3 — — $2,435.00 $2,581.10 $2,471.53 2024-10-01
9401 OTHER Bebtelovimab 175 Mg 4 3 — — $2,394.00 $2,537.64 $2,429.91 2024-10-01
1809 OTHER Injection, Alemtuzumab 4 3 — — $2,337.69 $2,477.95 $2,372.76 2024-10-01
81427 CPT Genome (eg, Unexplained Constitutional Or Heritable Disorder Or Syndrome); Re-ev… 4 3 — — $2,337.65 $2,477.91 $2,372.72 2024-10-01
0218U CPT Neuro Muscular Dystrophy Dmd Seq Alys Bld/Saliva 4 3 — — $2,279.00 $2,415.74 $2,313.18 2024-10-01
9135 OTHER Varicella-zoster Ig, IM 4 3 — — $2,250.71 $2,385.75 $2,284.47 2024-10-01
0249U CPT Oncology (breast), Semiquantitative Analysis Of 32 Phosphoproteins And Protein A… 4 3 — — $2,219.13 $2,352.28 $2,252.41 2024-10-01
0206U CPT Neurology Alzheimer Disease Cell Aggregation 4 3 — — $2,215.40 $2,348.32 $2,248.63 2024-10-01
0303U CPT Hematology, Red Blood Cell (rbc) Adhesion To Endothelial/subendothelial Adhesion… 4 3 — — $2,201.62 $2,333.72 $2,234.64 2024-10-01
0217U CPT Neuro Inh Ataxia Genomic DNA Seq Alys 51 Bld/Slv 4 3 — — $2,198.35 $2,330.25 $2,231.32 2024-10-01
1522 OTHER New Technology - Level 22 4 3 — — $2,186.77 $2,317.97 $2,219.57 2024-10-01
1559 OTHER New Technology - Level 22 4 3 — — $2,186.77 $2,317.97 $2,219.57 2024-10-01
5503 OTHER Level 3 Extraocular, Repa 4 3 — — $2,163.43 $2,293.23 $2,195.88 2024-10-01
5491 OTHER Level 1 Intraocular Proce 4 3 — — $2,157.47 $2,286.92 $2,189.83 2024-10-01
81442 CPT Noonan Spectrum Disorders (eg, Noonan Syndrome, Cardio-facio-cutaneous Syndrome,… 4 3 — — $2,143.60 $2,272.22 $2,175.76 2024-10-01
0323U CPT Infectious Agent Detection By Nucleic Acid (dna/rna), Central Nervous System Pat… 4 3 — — $2,126.20 $2,253.77 $2,158.09 2024-10-01
0152U CPT Infectious Disease (bacteria, Fungi, Parasites, And DNA Viruses), Dna, Pcr And N… 4 3 — — $2,126.20 $2,253.77 $2,158.09 2024-10-01
0304U CPT Hematology, Red Blood Cell (rbc) Adhesion To Endothelial/subendothelial Adhesion… 4 3 — — $2,075.80 $2,200.35 $2,106.94 2024-10-01
9108 OTHER Thyrotropin Injection 4 3 — — $2,073.34 $2,197.74 $2,104.44 2024-10-01
0317U CPT Oncology (lung Cancer), Four-probe Fish (3q29, 3p22.1, 10q22.3, 10cen) Assay, Wh… 4 3 — — $2,030.00 $2,151.80 $2,060.45 2024-10-01
81551 CPT Oncology (prostate), Promoter Methylation Profiling By Real-time Pcr Of 3 Genes … 4 3 — — $2,030.00 $2,151.80 $2,060.45 2024-10-01
81408 CPT Molecular Pathology Procedure, Level 9 (eg, Analysis Of >50 Exons In A Single Ge… 4 3 — — $2,000.00 $2,120.00 $2,030.00 2024-10-01
0022U CPT Targeted Genomic Sequence Analysis Panel, Cholangiocarcinoma And Non-small Cell … 4 3 — — $1,950.00 $2,067.00 $1,979.25 2024-10-01
0090U CPT Oncology (cutaneous Melanoma), Mrna Gene Expression Profiling By Rt-pcr Of 23 Ge… 4 3 — — $1,950.00 $2,067.00 $1,979.25 2024-10-01
0170U CPT Neurology (autism Spectrum Disorder [asd]), Rna, Next-generation Sequencing, Sal… 4 3 — — $1,950.00 $2,067.00 $1,979.25 2024-10-01
0314U CPT Oncology (cutaneous Melanoma), Mrna Gene Expression Profiling By Rt-pcr Of 35 Ge… 4 3 — — $1,950.00 $2,067.00 $1,979.25 2024-10-01
0296U CPT Oncology (oral And/or Oropharyngeal Cancer), Gene Expression Profiling By RNA Se… 4 3 — — $1,950.00 $2,067.00 $1,979.25 2024-10-01
0179U CPT Oncology (non-small Cell Lung Cancer), Cell-free Dna, Targeted Sesquence Analysi… 4 3 — — $1,943.21 $2,059.80 $1,972.36 2024-10-01
9073 OTHER Buprenorph Xr 100 Mg Or L 4 3 — — $1,943.06 $2,059.64 $1,972.20 2024-10-01
9239 OTHER Buprenorphine Xr Over 100 4 3 — — $1,943.06 $2,059.64 $1,972.20 2024-10-01
0114U CPT Gastroenterology (Barrett's Esophagus), Vim And Ccna1 Methylation Analysis, Esop… 4 3 — — $1,938.01 $2,054.29 $1,967.08 2024-10-01
1852 OTHER Interferon Beta-1a Inj 4 3 — — $1,910.69 $2,025.33 $1,939.35 2024-10-01
0341U CPT Fetal Aneuploidy DNA Sequencing Comparative Analysis, Fetal DNA From Products Of… 4 3 — — $1,900.20 $2,014.21 $1,928.70 2024-10-01
0067U CPT Oncology (breast), Immunohistochemistry, Protein Expression Profiling Of 4 Bioma… 4 3 — — $1,897.00 $2,010.82 $1,925.45 2024-10-01
1521 OTHER New Technology - Level 21 4 3 — — $1,895.26 $2,008.98 $1,923.69 2024-10-01
1558 OTHER New Technology - Level 21 4 3 — — $1,895.26 $2,008.98 $1,923.69 2024-10-01
5373 OTHER Level 3 Urology And Relat 4 3 — — $1,885.70 $1,998.84 $1,913.99 2024-10-01
0331U CPT Oncology (hematolymphoid Neoplasia), Optical Genome Mapping For Copy Number Alte… 4 3 — — $1,863.22 $1,975.01 $1,891.17 2024-10-01
0299U CPT Oncology (pan Tumor), Whole Genome Optical Genome Mapping Of Paired Malignant An… 4 3 — — $1,863.22 $1,975.01 $1,891.17 2024-10-01
1083 OTHER Adalimumab Injection 4 3 — — $1,834.49 $1,944.56 $1,862.01 2024-10-01
81162 CPT Brca1 (brca1, DNA Repair Associated), Brca2 (brca2, DNA Repair Associated) (eg, … 4 3 — — $1,824.88 $1,934.37 $1,852.26 2024-10-01
903 OTHER Cytomegalovirus Imm IV /v 4 3 — — $1,814.94 $1,923.83 $1,842.16 2024-10-01
0356U CPT Oncology Evaluation Of 17 DNA Biomarkers Using Droplet Digital Pcr, Cell-free Dn… 4 3 — — $1,800.00 $1,908.00 $1,827.00 2024-10-01
1520 OTHER New Technology - Level 20 4 3 — — $1,798.09 $1,905.98 $1,825.07 2024-10-01
1557 OTHER New Technology - Level 20 4 3 — — $1,798.09 $1,905.98 $1,825.07 2024-10-01
5431 OTHER Level 1 Nerve Procedures 4 3 — — $1,787.53 $1,894.78 $1,814.35 2024-10-01
0405U CPT Oncology (pancreatic), 59 Methylation Haplotype Block Markers, Next-generation S… 4 3 — — $1,770.48 $1,876.71 $1,797.03 2024-10-01
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