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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

NORTH COUNTRY HOSPITAL AND HEALTH CENTER

Newport, VT · CCN 471304 · Rates published

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You selected 59510 (HCPCS)

This facility hasn’t published a payer-negotiated rate for this exact code. See its full rate list below.

4,556 distinct procedures filed
6 distinct payers
213,470 rate rows
2026-01-01 last MRF observed
Data quality

124,754 of 213,470 rate rows are consumer-grade (58.4%)

88,716 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
professional (physician) fee — not the facility price 67,438
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 10,023
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 7,863
per-diem day rate — not a per-procedure price 3,117
template filing: same amount across many unrelated codes — excluded 134
placeholder amount (≤ $0.02) — excluded from medians 74
percent-of-charges filed in the dollar field — excluded from medians 66
exceeds 10× this hospital's gross charge — excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://northcountryhospital.org/wp-content/uploads/030185556_north-country-hospital-and-health-center-inc_standardcharges.csv
Found on page https://northcountryhospital.com/financial-services/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-01
Content fingerprint 6a94e04ff8fe0e1c… · 50,284,902 bytes · first seen 2026-08-01

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 Sol 6 $7,097.18 $26,614.44 $24,248.71 nat. median
$133
outlier · 182.4×
C1767
HCPCS 		Interstim Nervestimulator 6 $4,764.04 $17,865.14 $16,277.13 nat. median
$25,172
0.6× median
J9271
HCPCS 		Pembrolizumab 25 mg/mL Sol 6 $4,112.68 $15,422.56 $14,051.67 nat. median
$127
outlier · 110.6×
J2327
HCPCS 		Risankizumab Rzaa 60 mg/mL Sol 6 $3,625.09 $13,594.10 $12,385.73 nat. median
$48
outlier · 258.2×
J3380
HCPCS 		Vedolizumab 300 Mg Pow 6 $3,119.97 $11,699.88 $10,659.89 nat. median
$59
outlier · 181.3×
9399351
CDM 		Rt Polysomnography W/cpap Charge 6 $2,725.50 $10,220.63 $9,312.13 —
J3101
HCPCS 		Tenecteplase 50 Mg Pow 6 $2,586.23 $9,698.37 $8,836.30 nat. median
$498
outlier · 17.7×
47490
HCPCS 		47490 US Cholecystostomy, Perc 6 $2,436.18 $9,181.35 $8,323.62 nat. median
$4,010
outlier · 2.1×
47532
HCPCS 		47532 Xr Chole Perc-new Acc: Pro Fee 6 $2,436.18 $9,181.35 $8,323.62 nat. median
$3,747
outlier · 2.2×
19101
HCPCS 		19101 Biopsy Of Breast; Open, Incisional ProFee 6 $2,416.50 $9,107.10 $8,256.38 nat. median
$3,715
outlier · 2.2×
47531
HCPCS 		47531 Xr Chole Perc-exist Acc: Prof 6 $2,344.38 $8,835.30 $8,009.97 nat. median
$3,714
outlier · 2.2×
78831
HCPCS 		78831 Nm Spect Multi Area Or Multi Day 6 $2,246.04 $8,464.73 $7,673.97 nat. median
$1,341
outlier · 5.7×
8078488
CDM 		Rt Polysomnography Charge 6 $2,204.40 $8,266.50 $7,531.70 —
36556
HCPCS 		36556 Central Venous Catheter Place>2yr Hosp P 6 $2,190.00 $8,253.45 $7,482.50 nat. median
$2,885
outlier · 2.6×
78816
HCPCS 		78816 Nm PET Scan: Whole Body Profee- Initial 6 $2,114.88 $8,547.98 $7,482.31 nat. median
$1,696
outlier · 4.4×
J9332
HCPCS 		Efgartigimod Alfa 400 Mg/20 Ml Sol 6 $2,142.00 $8,032.50 $7,318.50 nat. median
$84
outlier · 86.6×
70498
HCPCS 		70498 CT Angio Neck Profee 6 $2,030.88 $7,653.83 $6,938.84 nat. median
$355
outlier · 19.6×
59412
HCPCS 		59412 External Cephalic Version, With Or Without Tocolysis 6 $2,007.48 $7,565.63 $6,858.89 nat. median
$3,311
outlier · 2.1×
33210
HCPCS 		33210 Pacemaker Or Implantable Defibrillator ProFee 6 $1,986.00 $7,447.50 $6,785.50 nat. median
$8,372
0.8× median
78815
HCPCS 		78815 Nm PET Scan: Eyes To Thigh Profee-initia 6 $1,963.14 $7,414.20 $6,717.76 nat. median
$1,679
outlier · 4.0×
J2993
HCPCS 		Reteplase 10 Units IV Kit 6 $1,964.36 $7,366.36 $6,711.57 nat. median
$3,172
outlier · 2.1×
70496
HCPCS 		70496 CT Angio Brain/Head Profee 6 $1,961.04 $7,390.58 $6,700.22 nat. median
$364
outlier · 18.4×
73720
HCPCS 		73720 MRI Foot With + Without Contrast Left Profee 6 $1,914.00 $7,213.28 $6,539.50 nat. median
$754
outlier · 8.7×
9849103
CDM 		Sure Scan Pacing Lead 6 $1,857.34 $6,965.02 $6,345.91 —
95811
HCPCS 		95811 Psg With Cpap - Tech Portion 6 $1,577.40 $10,220.63 $6,178.92 nat. median
$1,412
outlier · 4.4×
10978845
CDM 		Linq Ii System 6 $1,798.20 $6,743.25 $6,143.85 —
2120844
CDM 		Room/bed ICU 6 $5,894.56 $6,656.40 $6,138.68 nat. median
$3,446
1.8× median
73220
HCPCS 		73220 MRI Ue Non Joint With + Without Contrast Profee 6 $1,773.36 $6,683.40 $6,058.98 nat. median
$737
outlier · 8.2×
74178
HCPCS 		74178 CT Abdomen And Pelvis With + Without Contrast Profee 6 $1,737.12 $6,546.83 $5,935.16 nat. median
$539
outlier · 11.0×
9846544
CDM 		Fracture Kyphon First Express 10/2 6 $1,710.00 $6,412.50 $5,842.50 —
73723
HCPCS 		73723 MRI Ankle With + Without Contrast Left Profee 6 $1,608.90 $6,684.30 $5,827.13 nat. median
$756
outlier · 7.7×
J0517
HCPCS 		Benralizumab 30 mg/mL 6 $1,704.79 $6,392.97 $5,824.71 nat. median
$404
outlier · 14.4×
75635
HCPCS 		75635 CT Angio Abdomen Aorta + Iliofemoral Profee 6 $1,701.42 $6,412.28 $5,813.19 nat. median
$355
outlier · 16.4×
95783
HCPCS 		Psg W/cpap Younger Than 6 Yrs Old- Physician 6 $1,654.26 $6,234.53 $5,652.06 nat. median
$1,198
outlier · 4.7×
95810
HCPCS 		95810 Polysomnography -tech Portion 6 $1,355.94 $8,266.50 $5,586.01 nat. median
$1,446
outlier · 3.9×
74175
HCPCS 		74175 CT Angio Abdomen Profee 6 $1,634.70 $6,160.73 $5,585.23 nat. median
$355
outlier · 15.7×
72158
HCPCS 		72158 MRI Spine Lumbar With + Without Contrast Profee 6 $1,627.68 $6,134.40 $5,561.24 nat. median
$616
outlier · 9.0×
73223
HCPCS 		73223 MRI Finger(s) With + Without Contrast Left 6 $1,601.52 $6,472.35 $5,538.59 nat. median
$757
outlier · 7.3×
70553
HCPCS 		70553 MRI Brain With + Without Contrast Profee 6 $1,599.54 $6,658.88 $5,531.74 nat. median
$616
outlier · 9.0×
00597019705
NDC 		idaruCIZUmab 2.5 G/50 Ml 6 $1,594.08 $5,977.80 $5,446.44 —
597019705
NDC 		idaruCIZUmab 2.5 G/50 Ml 6 $1,594.08 $5,977.80 $5,429.83 —
9821367
CDM 		00597-0197-05 - idaruCIZUmab 2.5 G/50 Ml [ncty] 6 $1,594.08 $5,977.80 $5,429.83 —
58805
HCPCS 		58805 US Asp Ovarian Cyst(s) Abd 6 $1,588.86 $5,987.93 $5,428.61 nat. median
$3,380
1.6× median
9846713
CDM 		Body Djd Ii Variax Elbow 6 $1,560.77 $5,852.89 $5,332.63 —
71275
HCPCS 		71275 CT Angio Chest Profee 6 $1,552.86 $5,852.25 $5,305.61 nat. median
$365
outlier · 14.5×
72156
HCPCS 		72156 MRI Spine Cervical With + Without Contrast Profee 6 $1,547.16 $5,830.88 $5,286.13 nat. median
$625
outlier · 8.5×
9839144
CDM 		Del10205 Birthing Greater ?20 Hr Charge 6 $1,538.88 $5,770.80 $5,257.84 —
1378486-8
CDM 		Level 2 6 $1,527.30 $5,727.38 $5,218.28 —
9839152
CDM 		Del10205 Birthing Greater ?20 Hr Charge 6 $1,531.20 $5,742.00 $5,215.65 —
72197
HCPCS 		72197 MRI Pelvis With + Without Contrast Profee 6 $1,522.92 $5,739.53 $5,203.31 nat. median
$606
outlier · 8.6×

Other procedures at this hospital

Browse this hospital's 4,556 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
             
J2350 HCPCS Ocrelizumab 300 Mg/10 Ml Sol 21 6 $29,571.60 $23,657.28 20% off $7,097.18 $26,614.44 $24,248.71 2026-01-01
C1767 HCPCS Interstim Nervestimulator 21 6 $19,850.16 $15,880.13 $4,764.04 $17,865.14 $16,277.13 2026-01-01
J9271 HCPCS Pembrolizumab 25 mg/mL Sol 21 6 $17,136.18 $13,708.94 20% off $4,112.68 $15,422.56 $14,051.67 2026-01-01
J2327 HCPCS Risankizumab Rzaa 60 mg/mL Sol 21 6 $15,104.55 $12,083.64 20% off $3,625.09 $13,594.10 $12,385.73 2026-01-01
J3380 HCPCS Vedolizumab 300 Mg Pow 21 6 $12,999.87 $10,399.90 $3,119.97 $11,699.88 $10,659.89 2026-01-01
9399351 CDM Rt Polysomnography W/cpap Charge 11 6 $11,356.25 $9,085.00 20% off $2,725.50 $10,220.63 $9,312.13 2026-01-01
J3101 HCPCS Tenecteplase 50 Mg Pow 21 6 $10,775.97 $8,620.78 $2,586.23 $9,698.37 $8,836.30 2026-01-01
47532 HCPCS 47532 Xr Chole Perc-new Acc: Pro Fee 21 6 $10,201.50 $8,161.20 20% off $2,436.18 $9,181.35 $8,323.62 2026-01-01
47490 HCPCS 47490 US Cholecystostomy, Perc 21 6 $10,201.50 $8,161.20 20% off $2,436.18 $9,181.35 $8,323.62 2026-01-01
19101 HCPCS 19101 Biopsy Of Breast; Open, Incisional ProFee 21 6 $10,119.00 $8,095.20 20% off $2,416.50 $9,107.10 $8,256.38 2026-01-01
47531 HCPCS 47531 Xr Chole Perc-exist Acc: Prof 21 6 $9,817.00 $7,853.60 $2,344.38 $8,835.30 $8,009.97 2026-01-01
78831 HCPCS 78831 Nm Spect Multi Area Or Multi Day 21 6 $9,405.25 $7,524.20 20% off $2,246.04 $8,464.73 $7,673.97 2026-01-01
8078488 CDM Rt Polysomnography Charge 11 6 $9,185.00 $7,348.00 20% off $2,204.40 $8,266.50 $7,531.70 2026-01-01
36556 HCPCS 36556 Central Venous Catheter Place>2yr Hosp P 21 6 $9,170.50 $7,336.40 20% off $2,190.00 $8,253.45 $7,482.50 2026-01-01
78816 HCPCS 78816 Nm PET Scan: Whole Body Profee- Initial 42 6 $9,153.25 $7,322.60 $2,114.88 $8,547.98 $7,482.31 2026-01-01
J9332 HCPCS Efgartigimod Alfa 400 Mg/20 Ml Sol 21 6 $8,925.00 $7,140.00 20% off $2,142.00 $8,032.50 $7,318.50 2026-01-01
70498 HCPCS 70498 CT Angio Neck Profee 21 6 $8,504.25 $6,803.40 20% off $2,030.88 $7,653.83 $6,938.84 2026-01-01
59412 HCPCS 59412 External Cephalic Version, With Or Without Tocolysis 21 6 $8,406.25 $6,725.00 20% off $2,007.48 $7,565.63 $6,858.89 2026-01-01
33210 HCPCS 33210 Pacemaker Or Implantable Defibrillator ProFee 11 6 $8,275.00 $6,620.00 20% off $1,986.00 $7,447.50 $6,785.50 2026-01-01
78815 HCPCS 78815 Nm PET Scan: Eyes To Thigh Profee-initia 42 6 $8,220.75 $6,576.60 $1,963.14 $7,414.20 $6,717.76 2026-01-01
J2993 HCPCS Reteplase 10 Units IV Kit 21 6 $8,184.84 $6,547.87 20% off $1,964.36 $7,366.36 $6,711.57 2026-01-01
70496 HCPCS 70496 CT Angio Brain/Head Profee 21 6 $8,211.75 $6,569.40 20% off $1,961.04 $7,390.58 $6,700.22 2026-01-01
73720 HCPCS 73720 MRI Foot With + Without Contrast Left Profee 42 6 $8,014.75 $6,411.80 20% off $1,914.00 $7,213.28 $6,539.50 2026-01-01
9849103 CDM Sure Scan Pacing Lead 21 6 $7,738.91 $6,191.13 $1,857.34 $6,965.02 $6,345.91 2026-01-01
95811 HCPCS 95811 Psg With Cpap - Tech Portion 84 6 $11,299.75 $9,039.80 20% off $1,577.40 $10,220.63 $6,178.92 2026-01-01
10978845 CDM Linq Ii System 21 6 $7,492.50 $5,994.00 20% off $1,798.20 $6,743.25 $6,143.85 2026-01-01
2120844 CDM Room/bed ICU 15 6 $7,396.00 $5,916.80 20% off $5,894.56 $6,656.40 $6,138.68 2026-01-01
73220 HCPCS 73220 MRI Ue Non Joint With + Without Contrast Profee 42 6 $7,426.00 $5,940.80 20% off $1,773.36 $6,683.40 $6,058.98 2026-01-01
74178 HCPCS 74178 CT Abdomen And Pelvis With + Without Contrast Profee 21 6 $7,274.25 $5,819.40 20% off $1,737.12 $6,546.83 $5,935.16 2026-01-01
9846544 CDM Fracture Kyphon First Express 10/2 21 6 $7,125.00 $5,700.00 20% off $1,710.00 $6,412.50 $5,842.50 2026-01-01
73723 HCPCS 73723 MRI Ankle With + Without Contrast Left Profee 126 6 $7,106.25 $5,685.00 20% off $1,608.90 $6,684.30 $5,827.13 2026-01-01
J0517 HCPCS Benralizumab 30 mg/mL 21 6 $7,103.30 $5,682.64 20% off $1,704.79 $6,392.97 $5,824.71 2026-01-01
75635 HCPCS 75635 CT Angio Abdomen Aorta + Iliofemoral Profee 21 6 $7,124.75 $5,699.80 20% off $1,701.42 $6,412.28 $5,813.19 2026-01-01
95783 HCPCS Psg W/cpap Younger Than 6 Yrs Old- Physician 21 6 $6,927.25 $5,541.80 20% off $1,654.26 $6,234.53 $5,652.06 2026-01-01
95810 HCPCS 95810 Polysomnography -tech Portion 84 6 $9,139.25 $7,311.40 20% off $1,355.94 $8,266.50 $5,586.01 2026-01-01
74175 HCPCS 74175 CT Angio Abdomen Profee 21 6 $6,845.25 $5,476.20 20% off $1,634.70 $6,160.73 $5,585.23 2026-01-01
72158 HCPCS 72158 MRI Spine Lumbar With + Without Contrast Profee 21 6 $6,816.00 $5,452.80 20% off $1,627.68 $6,134.40 $5,561.24 2026-01-01
73223 HCPCS 73223 MRI Finger(s) With + Without Contrast Left 63 6 $6,706.25 $5,365.00 20% off $1,601.52 $6,472.35 $5,538.59 2026-01-01
70553 HCPCS 70553 MRI Brain With + Without Contrast Profee 31 6 $6,698.00 $5,358.40 20% off $1,599.54 $6,658.88 $5,531.74 2026-01-01
00597019705 NDC idaruCIZUmab 2.5 G/50 Ml 11 6 $6,642.00 $5,313.60 $1,594.08 $5,977.80 $5,446.44 2026-01-01
597019705 NDC idaruCIZUmab 2.5 G/50 Ml 10 6 $6,642.00 $5,313.60 $1,594.08 $5,977.80 $5,429.83 2025-11-14
9821367 CDM 00597-0197-05 - idaruCIZUmab 2.5 G/50 Ml [ncty] 10 6 $6,642.00 $5,313.60 $1,594.08 $5,977.80 $5,429.83 2025-11-14
58805 HCPCS 58805 US Asp Ovarian Cyst(s) Abd 21 6 $6,653.25 $5,322.60 $1,588.86 $5,987.93 $5,428.61 2026-01-01
9846713 CDM Body Djd Ii Variax Elbow 21 6 $6,503.21 $5,202.57 $1,560.77 $5,852.89 $5,332.63 2026-01-01
71275 HCPCS 71275 CT Angio Chest Profee 21 6 $6,502.50 $5,202.00 20% off $1,552.86 $5,852.25 $5,305.61 2026-01-01
72156 HCPCS 72156 MRI Spine Cervical With + Without Contrast Profee 21 6 $6,478.75 $5,183.00 20% off $1,547.16 $5,830.88 $5,286.13 2026-01-01
9839144 CDM Del10205 Birthing Greater ?20 Hr Charge 11 6 $6,412.00 $5,129.60 $1,538.88 $5,770.80 $5,257.84 2026-01-01
1378486-8 CDM Level 2 11 6 $6,363.75 $5,091.00 20% off $1,527.30 $5,727.38 $5,218.28 2026-01-01
9839152 CDM Del10205 Birthing Greater ?20 Hr Charge 10 6 $6,380.00 $5,104.00 20% off $1,531.20 $5,742.00 $5,215.65 2025-11-14
72197 HCPCS 72197 MRI Pelvis With + Without Contrast Profee 21 6 $6,377.25 $5,101.80 20% off $1,522.92 $5,739.53 $5,203.31 2026-01-01
1378486 CDM Level 2 10 6 $6,332.00 $5,065.60 $1,519.68 $5,698.80 $5,176.41 2025-11-14
95782 HCPCS 95782 Psg Younger 6 Yrs Old- Physician 21 6 $6,291.00 $5,032.80 20% off $1,502.34 $5,661.90 $5,133.00 2026-01-01
J2353 HCPCS Octreotide 20 Mg IM Inj 42 6 $5,870.19 $4,696.15 20% off $1,408.85 $8,513.40 $5,063.04 2026-01-01
94002 HCPCS Rt Ventilator Services Initial Charge 21 6 $6,156.75 $4,925.40 20% off $1,470.24 $5,541.08 $5,023.32 2026-01-01
78227 HCPCS 78227 Nm Hepatobilary With Ef: Prof 21 6 $6,155.25 $4,924.20 20% off $1,469.94 $5,539.73 $5,022.30 2026-01-01
1378485-6 CDM Level 1 11 6 $6,038.75 $4,831.00 20% off $1,449.30 $5,434.88 $4,951.78 2026-01-01
J1162 HCPCS Digoxin Immune Fab 40 Mg Inj 21 6 $6,002.36 $4,801.89 $1,440.57 $5,402.12 $4,921.94 2026-01-01
93975 HCPCS 93975 US Duplex Scan Art/ven:comp Pr 21 6 $6,025.25 $4,820.20 20% off $1,438.86 $5,422.73 $4,916.11 2026-01-01
1378485 CDM Level 1 10 6 $6,008.75 $4,807.00 20% off $1,442.10 $5,407.88 $4,912.16 2025-11-14
70549 HCPCS 70549 MRA Neck With + Without Contrast Profee 21 6 $5,975.75 $4,780.60 $1,427.04 $5,378.18 $4,875.72 2026-01-01
73718 HCPCS 73718 MRI Foot Without Contrast Left Profee 84 6 $5,784.75 $4,627.80 $1,372.26 $5,232.38 $4,726.39 2026-01-01
54150 HCPCS 54150 Excision Procedures On The Penis 21 6 $5,746.00 $4,596.80 $1,372.20 $5,171.40 $4,688.35 2026-01-01
J0565 HCPCS Bezlotoxumab 1000 Mg/ 40 Ml Sol 21 6 $5,700.00 $4,560.00 20% off $1,368.00 $5,130.00 $4,674.00 2026-01-01
74177 HCPCS 74177 CT Abd & Pelvis W/contrast ProFee 42 6 $5,723.25 $4,578.60 $1,366.74 $5,153.85 $4,671.03 2026-01-01
73222 HCPCS 73222 MRI Shoulder With Contrast Left 147 6 $5,665.75 $4,532.60 $1,240.86 $5,431.95 $4,640.61 2026-01-01
73722 HCPCS 73722 MRI Hip With Contrast Right 126 6 $5,675.25 $4,540.20 20% off $1,303.14 $5,482.35 $4,630.54 2026-01-01
73719 HCPCS 73719 MRI Foot With Contrast Left Profee 84 6 $5,553.75 $4,443.00 20% off $1,326.24 $5,205.60 $4,621.47 2026-01-01
78582 HCPCS 78582 Nm Lung Perf/vent(v/q): Prof 21 6 $5,544.25 $4,435.40 20% off $1,324.02 $4,989.83 $4,523.74 2026-01-01
73219 HCPCS 73219 MRI Ue Non Joint With Contrast Lt Profee 42 6 $5,543.75 $4,435.00 20% off $1,323.90 $4,989.38 $4,523.33 2026-01-01
9839143 CDM Del10200 Birthing 10-20 Hours L2 Charge 11 6 $5,445.50 $4,356.40 20% off $1,306.92 $4,900.95 $4,465.31 2026-01-01
9839151 CDM Del10200 Birthing 10-20 Hours L2 Charge 10 6 $5,418.50 $4,334.80 $1,300.44 $4,876.65 $4,429.62 2025-11-14
73218 HCPCS 73218 MRI Ue Non Joint Without Contrast Profee 21 6 $5,411.00 $4,328.80 $1,292.16 $4,869.90 $4,414.88 2026-01-01
4232581 CDM Room/bed: Intermediate 15 6 $5,273.00 $4,218.40 20% off $4,202.85 $4,745.70 $4,376.59 2026-01-01
94003 HCPCS Rt Ventilator Services Subsequent Charge 21 6 $5,207.75 $4,166.20 20% off $1,243.62 $4,686.98 $4,249.04 2026-01-01
78306 HCPCS 78306 Nm Bone Scan, Whole Body 21 6 $5,201.75 $4,161.40 20% off $1,242.18 $4,681.58 $4,244.12 2026-01-01
74174 HCPCS 74174 CT Angio Abdomen And Pelvis Profee 21 6 $5,187.75 $4,150.20 20% off $1,238.88 $4,668.98 $4,232.84 2026-01-01
70481 HCPCS 70481 CT Orbit Sella Etc. Or Iac With Cont Profee 21 6 $5,173.50 $4,138.80 $1,235.46 $4,656.15 $4,221.16 2026-01-01
72191 HCPCS 72191 CT Angio Pelvis Profee 21 6 $5,141.00 $4,112.80 $1,227.72 $4,626.90 $4,194.71 2026-01-01
9849085 CDM Stent Colonic Wallflex 21 6 $5,095.70 $4,076.56 20% off $1,222.97 $4,586.13 $4,178.47 2026-01-01
78814 HCPCS 78814 Nm PET Scan:limited Profee-initial 21 6 $5,102.00 $4,081.60 20% off $1,218.36 $4,591.80 $4,162.73 2026-01-01
74183 HCPCS 74183 MRI Abdomen With + Without Contrast Profee 21 6 $5,018.25 $4,014.60 20% off $1,198.38 $4,516.43 $4,094.47 2026-01-01
73206 HCPCS 73206 CT Angio Upper Extremity Right 63 6 $4,929.50 $3,943.60 20% off $1,177.20 $8,872.88 $4,071.15 2026-01-01
70551 HCPCS 70551 MRI Brain Without Contrast Profee 31 6 $4,926.75 $3,941.40 20% off $1,176.54 $4,770.23 $4,068.87 2026-01-01
72148 HCPCS 72148 MRI Spine Lumbar Without Contrast Profee 21 6 $4,939.50 $3,951.60 20% off $1,179.60 $4,445.55 $4,030.30 2026-01-01
73706 HCPCS 73706 CT Angio Lower Extremity Right 63 6 $4,852.25 $3,881.80 $1,158.72 $8,733.38 $4,007.24 2026-01-01
72146 HCPCS 72146 MRI Spine Thoracic Without Contrast Profee 21 6 $4,884.75 $3,907.80 $1,166.52 $4,396.28 $3,985.61 2026-01-01
81229 HCPCS Chromosomal Microarray, Congenital Mayo 21 6 $4,883.00 $3,906.40 20% off $1,166.10 $4,394.70 $3,984.18 2026-01-01
70543 HCPCS 70543 MRI Neck With +without Contrast Profee 21 6 $4,881.00 $3,904.80 $1,165.62 $4,392.90 $3,982.54 2026-01-01
93306 HCPCS 93306 Echocardiography 2-d W/dopp ProFee 21 6 $4,825.50 $3,860.40 20% off $1,152.36 $4,342.95 $3,937.23 2026-01-01
C8929 HCPCS C8929 Ue Echo Complete With Contrast 21 6 $4,825.50 $3,860.40 20% off $1,152.36 $4,342.95 $3,937.23 2026-01-01
72141 HCPCS 72141 MRI Spine Cervical Without Contrast Profee 21 6 $4,818.75 $3,855.00 20% off $1,150.74 $4,336.88 $3,931.70 2026-01-01
99291 HCPCS 99291 Critical Care E&m-unstabl ProFee 21 6 $4,814.00 $3,851.20 20% off $1,149.60 $4,332.60 $3,927.80 2026-01-01
12410929 CDM Micromatrix Flex 5cc 21 6 $4,616.07 $3,692.86 $1,107.86 $4,154.46 $3,785.18 2026-01-01
70480 HCPCS 70480 CT Orbit Sella Etc. Or Iac Without Cont Profee 21 6 $4,524.25 $3,619.40 20% off $1,080.42 $4,071.83 $3,691.44 2026-01-01
95805 HCPCS 95805 Multiple Sleep Latency Study- Physician 21 6 $4,511.25 $3,609.00 20% off $1,077.30 $4,060.13 $3,680.78 2026-01-01
10121 HCPCS 10121 Incision & Removal Foreign Body Subq Tiss Compl TechFee 21 6 $4,509.00 $3,607.20 20% off $1,076.76 $4,058.10 $3,678.93 2026-01-01
20206 HCPCS 20206 CT Bx Soft Tissue Biopsy 21 6 $4,509.00 $3,607.20 20% off $1,076.76 $4,058.10 $3,678.93 2026-01-01
36569 HCPCS 36569 Insertion Of Peripherally Inserted Central Venous Catheter 21 6 $4,506.25 $3,605.00 20% off $1,076.10 $4,055.63 $3,676.68 2026-01-01
71552 HCPCS 71552 MRI Chest With + Without Contrast Profee 21 6 $4,463.75 $3,571.00 20% off $1,065.96 $4,017.38 $3,642.03 2026-01-01
27842 HCPCS 27842 Cltx Ankle Dislc Req Anes W/wo Prq Skel Fixj TechFee 21 6 $4,462.25 $3,569.80 $1,065.60 $4,016.03 $3,640.80 2026-01-01
23655 HCPCS 23655 Clsd Tx Shoulder Dislc W/manipulation Req Anes TechFee 21 6 $4,462.25 $3,569.80 $1,065.60 $4,016.03 $3,640.80 2026-01-01
27810 HCPCS 27810 Closed Tx Bimalleolar Ankle Fracture W/manj TechFee 21 6 $4,462.25 $3,569.80 $1,065.60 $4,016.03 $3,640.80 2026-01-01
70546 HCPCS 70546 MRA Brain/Head With + Without Contrast Profee 21 6 $4,432.25 $3,545.80 $1,058.46 $3,989.03 $3,616.41 2026-01-01
41115 HCPCS Frenectomy 21 6 $4,335.25 $3,468.20 20% off $1,035.30 $3,901.73 $3,537.28 2026-01-01
10047288 CDM Pain Clinic Level 2 Procedure 11 6 $4,286.25 $3,429.00 20% off $1,028.70 $3,857.63 $3,514.73 2026-01-01
1378487 CDM Level 3 21 6 $4,295.00 $3,436.00 20% off $1,025.70 $3,865.50 $3,504.48 2026-01-01
10047300 CDM Pain Clinic Level 2 Procedure 10 6 $4,265.00 $3,412.00 20% off $1,023.60 $3,838.50 $3,486.64 2025-11-14
9821371-395 CDM 44206-0439-40 - Immune Globulin **Privigen** 10% IV Sol 400 Ml 11 6 $4,224.00 $3,379.20 20% off $1,013.76 $3,801.60 $3,463.68 2026-01-01
72149 HCPCS 72149 MRI Spine Lumbar With Contrast Profee 21 6 $4,232.75 $3,386.20 20% off $1,010.82 $3,809.48 $3,453.64 2026-01-01
72157 HCPCS 72157 MRI Spine Thoracic With + Without Contrast Profee 21 6 $4,184.00 $3,347.20 20% off $999.18 $3,765.60 $3,413.87 2026-01-01
J2182 HCPCS Mepolizumab 100 Mg Pow 21 6 $4,111.02 $3,288.82 $986.64 $3,699.92 $3,371.04 2026-01-01
12153309 CDM Micromatrix, 1000 Mg 10 6 $4,077.00 $3,261.60 20% off $978.48 $3,669.30 $3,332.95 2025-11-14
93880 HCPCS 93880 US Carotid Bilat: Prof 21 6 $4,040.75 $3,232.60 20% off $964.98 $3,636.68 $3,297.02 2026-01-01
70544 HCPCS 70544 MRA Brain/Head Without Contrast Profee 21 6 $3,993.50 $3,194.80 $953.70 $3,594.15 $3,258.48 2026-01-01
19083 HCPCS 19083 US Bx Breast Vac Core Prof 21 6 $3,992.00 $3,193.60 20% off $953.34 $3,592.80 $3,257.25 2026-01-01
77001 HCPCS 77001 Xr Fluoro Cvad Pro Fee 21 6 $3,893.25 $3,114.60 20% off $929.76 $3,503.93 $3,176.68 2026-01-01
78459 HCPCS 78459 Nm PET Cardiac Metabolic Prof 21 6 $3,873.00 $3,098.40 20% off $924.90 $3,485.70 $3,160.08 2026-01-01
78491 HCPCS 78491 Nm PET Cardiac Perf Single: Prof 21 6 $3,873.00 $3,098.40 20% off $924.90 $3,485.70 $3,160.08 2026-01-01
78492 HCPCS 78492 Nm PET Cardiac Perf Multi:prof 21 6 $3,873.00 $3,098.40 20% off $924.90 $3,485.70 $3,160.08 2026-01-01
78608 HCPCS 78608 Nm PET Brain Metabolic Prof 21 6 $3,873.00 $3,098.40 20% off $924.90 $3,485.70 $3,160.08 2026-01-01
78609 HCPCS 78609 Nm PET Brain: Perfusion Prof 21 6 $3,873.00 $3,098.40 20% off $924.90 $3,485.70 $3,160.08 2026-01-01
J3111 HCPCS Romosozumab-aqqg (Evenity) 105 Mg/1.17 Ml Sol 53 6 $3,894.10 $3,115.28 $901.28 $3,549.04 $3,158.65 2026-01-01
8163851 CDM Room/bed: Private With Telemetry 8 6 $3,766.00 $3,012.80 $3,016.57 $3,389.40 $3,135.20 2026-01-01
10085430 CDM Room/bed: Semi-private Telemetry 15 6 $3,765.00 $3,012.00 20% off $3,000.55 $3,388.50 $3,124.95 2026-01-01
70552 HCPCS 70552 MRI Brain With Contrast Profee 31 6 $3,757.00 $3,005.60 20% off $897.18 $3,800.93 $3,102.75 2026-01-01
J2997 HCPCS Alteplase 100 Mg IV Inj 63 6 $6,407.48 $5,125.98 20% off $143.03 $11,502.69 $3,067.38 2026-01-01
73221 HCPCS 73221 MRI Elbow Without Contrast Left Profee 63 6 $3,757.00 $3,005.60 20% off $897.18 $3,381.30 $3,065.37 2026-01-01
73721 HCPCS 73721 MRI Ankle Without Contrast Left Profee 126 6 $3,731.75 $2,985.40 20% off $442.56 $6,748.65 $3,041.07 2026-01-01
9884496 CDM Del10145 Birthing < 10 Hours L1 Charge 11 6 $3,696.50 $2,957.20 20% off $887.16 $3,326.85 $3,031.13 2026-01-01
74170 HCPCS 74170 CT Abdomen With + Without Contrast Profee 21 6 $3,702.50 $2,962.00 20% off $884.16 $3,332.25 $3,020.88 2026-01-01
72195 HCPCS 72195 MRI Pelvis Without Contrast Profee 21 6 $3,695.25 $2,956.20 20% off $882.42 $3,325.73 $3,014.94 2026-01-01
9884500 CDM Del10145 Birthing < 10 Hours L1 Charge 10 6 $3,678.00 $2,942.40 20% off $882.72 $3,310.20 $3,006.77 2025-11-14
72196 HCPCS 72196 MRI Pelvis With Contrast Profee 21 6 $3,646.50 $2,917.20 20% off $870.78 $3,281.85 $2,975.17 2026-01-01
74176 HCPCS 74176 CT Abdomen And Pelvis Without Contrast 32 6 $3,616.25 $2,893.00 20% off $863.64 $3,254.85 $2,958.05 2026-01-01
74420 HCPCS 74420 Xr Urography Retrograde Prof 21 6 $3,622.25 $2,897.80 $865.02 $3,260.03 $2,955.49 2026-01-01
9680488 CDM Room/bed: Semi Private Peds 8 6 $3,509.00 $2,807.20 20% off $2,810.71 $3,158.10 $2,921.24 2026-01-01
8081565 CDM Room/bed: Private 8 6 $3,509.00 $2,807.20 20% off $2,810.71 $3,158.10 $2,921.24 2026-01-01
8163849 CDM Room/bed: OB 8 6 $3,509.00 $2,807.20 20% off $2,810.71 $3,158.10 $2,921.24 2026-01-01
8078890 CDM Room/bed: Semi-private 15 6 $3,509.00 $2,807.20 20% off $2,797.09 $3,158.10 $2,912.47 2026-01-01
2120840 CDM Room/bed: Inpatient 15 6 $3,509.00 $2,807.20 20% off $2,797.09 $3,158.10 $2,912.47 2026-01-01
70490 HCPCS 70490 CT Neck Soft Tissue Without Contrast Profee 21 6 $3,568.00 $2,854.40 20% off $852.06 $3,211.20 $2,911.21 2026-01-01
73040 HCPCS 73040 Xr Arthrogram Shoulder Bilat 63 6 $3,507.50 $2,806.00 20% off $837.60 $6,313.05 $2,896.70 2026-01-01
70547 HCPCS 70547 MRA Neck Without Contrast Profee 21 6 $3,545.50 $2,836.40 20% off $846.66 $3,190.95 $2,892.76 2026-01-01
12709997 CDM Mesh, Phasix St 7x10 Cm 21 6 $3,568.95 $2,855.16 20% off $831.60 $3,212.06 $2,875.95 2026-01-01
70542 HCPCS 70542 MRI Face Neck Orbit With Contrast Profee 21 6 $3,519.25 $2,815.40 20% off $840.42 $3,167.33 $2,871.44 2026-01-01
72130 HCPCS 72130 CT Spine Thoracic With + Without Contrast Profee 21 6 $3,476.75 $2,781.40 20% off $830.28 $3,129.08 $2,836.79 2026-01-01
9849051 CDM Mesh Phasix St 3x4 Biologic 10 6 $3,465.00 $2,772.00 20% off $831.60 $3,118.50 $2,832.64 2025-11-14
93017 HCPCS 93017 Cardiac Stress Test Opnch 21 6 $3,466.25 $2,773.00 20% off $827.76 $3,119.63 $2,828.18 2026-01-01
73700 HCPCS 73700 CT Lower Extremity Without Contrast Bilat Profee 63 6 $3,411.00 $2,728.80 $814.56 $6,140.03 $2,817.02 2026-01-01
73200 HCPCS 73200 CT Upper Ext Bilat Without Cont 63 6 $3,403.75 $2,723.00 20% off $812.82 $6,126.53 $2,811.00 2026-01-01
71270 HCPCS 71270 CT Chest With + Without Contrast Profee 21 6 $3,443.25 $2,754.60 20% off $822.24 $3,098.93 $2,809.32 2026-01-01
78014 HCPCS 78014 Nm Thyroid Uptake &scan Prof 21 6 $3,439.75 $2,751.80 $821.46 $3,095.78 $2,806.66 2026-01-01
72128 HCPCS 72128 CT Spine Thoracic Without Contrast Profee 21 6 $3,427.25 $2,741.80 $818.46 $3,084.53 $2,796.41 2026-01-01
93976 HCPCS 93976 US Duplex Scan Art/ven:lim Pro 21 6 $3,425.50 $2,740.40 20% off $818.04 $3,082.95 $2,794.97 2026-01-01
74185 HCPCS 74185 MRA Abdomen With + Without Contrast Profee 21 6 $3,400.25 $2,720.20 20% off $811.98 $3,060.23 $2,774.27 2026-01-01
78226 HCPCS 78226 Nm Hepatobiliary Without Ef: Prof 21 6 $3,396.75 $2,717.40 20% off $811.14 $3,057.08 $2,771.40 2026-01-01
70470 HCPCS 70470 CT Brain/Head With + Without Contrast Profee 21 6 $3,380.00 $2,704.00 20% off $807.18 $3,042.00 $2,757.87 2026-01-01
77075 HCPCS 77075 Xr Osseous Survey Compl Prof 21 6 $3,378.25 $2,702.60 20% off $806.76 $3,040.43 $2,756.43 2026-01-01
70482 HCPCS 70482 CT Orbit Sella Etc. Or Iac With + Without Cont Profee 21 6 $3,371.50 $2,697.20 20% off $805.14 $3,034.35 $2,750.90 2026-01-01
76936 HCPCS 76936 US Guidance Comp Repair: Prof 21 6 $3,342.75 $2,674.20 20% off $798.24 $3,008.48 $2,727.32 2026-01-01
93930 HCPCS US Dupp Upp Ext Art Bilat Profee 21 6 $3,342.25 $2,673.80 $798.12 $3,008.03 $2,726.91 2026-01-01
71550 HCPCS 71550 MRI Chest Without Contrast Profee 21 6 $3,339.25 $2,671.40 20% off $797.46 $3,005.33 $2,724.66 2026-01-01
73701 HCPCS 73701 CT Knee With Contrast Left 63 6 $3,290.75 $2,632.60 20% off $785.88 $5,922.90 $2,717.84 2026-01-01
46320 HCPCS 46320 Excision Of Thrombosed Hemorrhoid, External ProFee 21 6 $3,323.25 $2,658.60 20% off $793.62 $2,990.93 $2,711.54 2026-01-01
74182 HCPCS 74182 MRI Abdomen With Contrast Profee 21 6 $3,318.75 $2,655.00 20% off $792.54 $2,986.88 $2,707.85 2026-01-01
73725 HCPCS 73725 MRA Lower Extremity With + Without Cnt Left Profee 168 6 $3,285.50 $2,628.40 20% off $507.00 $3,267.23 $2,694.11 2026-01-01
9839142 CDM Nrs10115 Nursery Level 3 Charge 15 6 $3,243.00 $2,594.40 20% off $2,585.03 $2,918.70 $2,691.69 2026-01-01
4232588 CDM Room/bed: Nursery Level 3 15 6 $3,243.00 $2,594.40 20% off $2,584.83 $2,918.70 $2,691.69 2026-01-01
74181 HCPCS 74181 MRI Abdomen Without Contrast Profee 42 6 $3,272.00 $2,617.60 20% off $781.38 $2,944.80 $2,669.72 2026-01-01
72133 HCPCS 72133 CT Spine Lumbar With + Without Contrast Profee 21 6 $3,249.00 $2,599.20 20% off $775.86 $2,924.10 $2,650.86 2026-01-01
72127 HCPCS 72127 CT Spine Cervical With + Without Contrast Profee 21 6 $3,249.00 $2,599.20 20% off $775.86 $2,924.10 $2,650.86 2026-01-01
Q4137 HCPCS Amnio Excel Amniotic Allograft Membrane 10cm X10cm 42 6 $7,461.75 $5,969.40 20% off $625.32 $11,086.20 $2,650.64 2026-01-01
74250 HCPCS 74250 Xr Sbft Single Contrast Pro Fee 21 6 $3,223.50 $2,578.80 $769.80 $2,901.15 $2,630.15 2026-01-01
71551 HCPCS 71551 MRI Chest With Contrast Profee 21 6 $3,199.50 $2,559.60 20% off $764.04 $2,879.55 $2,610.47 2026-01-01
81420 HCPCS MaterniT21 Plus Mayo 21 6 $3,195.50 $2,556.40 20% off $763.08 $2,875.95 $2,607.19 2026-01-01
J3358 HCPCS Ustekinumab 130 Mg/26 Ml Sol 21 6 $3,177.72 $2,542.18 $762.65 $2,859.95 $2,605.73 2026-01-01
1378486-7 CDM Level 2 11 6 $3,174.25 $2,539.40 20% off $761.82 $2,856.83 $2,602.89 2026-01-01
78452 HCPCS 78452 Nm Myocard Multi W.wm.ef: Prof 21 6 $3,159.75 $2,527.80 $754.56 $2,843.78 $2,578.08 2026-01-01
72142 HCPCS 72142 MRI Spine Cervical With Contrast Profee 21 6 $3,127.50 $2,502.00 20% off $746.88 $2,814.75 $2,551.84 2026-01-01
32408 HCPCS 32408 CT Bx Lung Percw/guidance:needle 21 6 $3,118.75 $2,495.00 20% off $744.78 $2,806.88 $2,544.67 2026-01-01
78598 HCPCS 78598 Nm Lung V/q W/diff Quant:prof 21 6 $3,117.25 $2,493.80 $744.42 $2,805.53 $2,543.44 2026-01-01
9846693 CDM Tube Dynamization/distraction 21 6 $3,092.63 $2,474.10 20% off $742.23 $2,783.37 $2,535.96 2026-01-01
70548 HCPCS 70548 MRA Neck With Contrast Profee 21 6 $3,104.25 $2,483.40 20% off $741.30 $2,793.83 $2,532.78 2026-01-01
70336 HCPCS 70336 MRI Tmj Profee 21 6 $3,095.75 $2,476.60 20% off $739.26 $2,786.18 $2,525.81 2026-01-01
93925 HCPCS US Extrem Low Arterial-bil Pro 21 6 $3,092.50 $2,474.00 20% off $738.48 $2,783.25 $2,523.14 2026-01-01
71260 HCPCS 71260 CT Chest With Contrast Profee 21 6 $3,081.00 $2,464.80 $735.78 $2,772.90 $2,513.92 2026-01-01
73225 HCPCS 73225 MRA Upper Extremity With + Without Cnt Left Profee 42 6 $3,032.50 $2,426.00 20% off $724.20 $2,729.25 $2,474.35 2026-01-01
9849105 CDM Programmer For Neurostimulator 21 6 $3,012.75 $2,410.20 20% off $723.06 $2,711.48 $2,470.46 2026-01-01
1378485-5 CDM Level 1 11 6 $3,012.75 $2,410.20 20% off $723.06 $2,711.48 $2,470.46 2026-01-01
74160 HCPCS 74160 CT Abdomen With Contrast Profee 21 6 $3,019.25 $2,415.40 20% off $721.02 $2,717.33 $2,463.49 2026-01-01
C1771 HCPCS Sling Tvt Vag Gynecare Device 21 6 $3,001.44 $2,401.15 20% off $720.35 $2,701.30 $2,461.18 2026-01-01
74280 HCPCS 74280 Xr Barium Enema Ac* Pro Fee 21 6 $3,013.25 $2,410.60 20% off $719.58 $2,711.93 $2,458.57 2026-01-01
58822 HCPCS 58822 US Drain Ovarian Abscess Abd 21 6 $3,012.25 $2,409.80 $719.34 $2,711.03 $2,457.75 2026-01-01
13216286 CDM Tyrx Antibiotic Pouch 11 6 $2,992.50 $2,394.00 20% off $718.20 $2,693.25 $2,453.85 2026-01-01
72193 HCPCS 72193 CT Pelvis With Contrast Profee 21 6 $3,001.75 $2,401.40 20% off $716.82 $2,701.58 $2,449.14 2026-01-01
70491 HCPCS 70491 CT Neck Soft Tissue With Contrast Profee 21 6 $2,993.00 $2,394.40 20% off $714.72 $2,693.70 $2,441.96 2026-01-01
23650 HCPCS 23650 Clsd Tx Shoulder Dislc W/manipulation Without Anes ProFee 21 6 $2,970.50 $2,376.40 $709.38 $2,673.45 $2,423.72 2026-01-01
70492 HCPCS 70492 CT Neck Soft Tissue With + Without Contrast Profee 21 6 $2,965.50 $2,372.40 $708.18 $2,668.95 $2,419.62 2026-01-01
73115 HCPCS 73115 Xr Arthrogram Wrist Bilat 63 6 $2,921.75 $2,337.40 $697.74 $5,258.93 $2,413.02 2026-01-01
71555 HCPCS 71555 MRA Chest With + Without Contrast Profee 21 6 $2,952.25 $2,361.80 $705.00 $2,657.03 $2,408.75 2026-01-01
J1602 HCPCS Golimumab 50 Mg/4 Ml 21 6 $2,924.40 $2,339.52 20% off $701.86 $2,631.96 $2,398.01 2026-01-01
70540 HCPCS 70540 MRI Face Neck Orbit Without Contrast Profee 21 6 $2,895.75 $2,316.60 20% off $691.50 $2,606.18 $2,362.63 2026-01-01
9921042 CDM Ncty Pacu 21 6 $2,890.75 $2,312.60 20% off $690.30 $2,601.68 $2,358.53 2026-01-01
70545 HCPCS 70545 MRA Brain/Head With Contrast Profee 21 6 $2,883.00 $2,306.40 $688.50 $2,594.70 $2,352.38 2026-01-01
93978 HCPCS US Duplex Aorta/ivc Comp Prof 21 6 $2,872.00 $2,297.60 20% off $685.86 $2,584.80 $2,343.36 2026-01-01
74300 HCPCS 74300 Xr Cholangiogram Operative 21 6 $2,862.75 $2,290.20 20% off $683.64 $2,576.48 $2,335.77 2026-01-01
74251 HCPCS 74251 Xr Sbft Enteroclysis Double Cont Prof 21 6 $2,857.25 $2,285.80 $682.32 $2,571.53 $2,331.26 2026-01-01
94621 HCPCS Pulmonary Stress Testing 21 6 $2,842.00 $2,273.60 20% off $678.66 $2,557.80 $2,318.76 2026-01-01
76812 HCPCS 76812 US OB Fetal Anat, Ea Add: Prof 21 6 $2,807.25 $2,245.80 $670.38 $2,526.53 $2,290.47 2026-01-01
72147 HCPCS 72147 MRI Spine Thoracic With Contrast Profee 21 6 $2,765.25 $2,212.20 20% off $660.36 $2,488.73 $2,256.23 2026-01-01
70486 HCPCS 70486 CT Maxillofacial Without Contrast Profee 42 6 $2,621.50 $2,097.20 20% off $626.04 $3,353.18 $2,255.26 2026-01-01
78315 HCPCS 78315 Nm Bone Scan, 3 Phase: Prof 21 6 $2,718.50 $2,174.80 $649.20 $2,446.65 $2,218.10 2026-01-01
72131 HCPCS 72131 CT Spine Lumbar Without Contrast Profee 21 6 $2,671.75 $2,137.40 $638.04 $2,404.58 $2,179.97 2026-01-01
J3032 HCPCS Eptinezumab-jjmr 100 mg/mL Sol 21 6 $2,651.60 $2,121.28 $636.38 $2,386.44 $2,174.31 2026-01-01
78195 HCPCS 78195 Nm Lymphography:prof 21 6 $2,663.00 $2,130.40 $635.94 $2,396.70 $2,172.80 2026-01-01
74283 HCPCS 74283 Xr Barium Enema Therapeutic Pf 21 6 $2,638.00 $2,110.40 $630.00 $2,374.20 $2,152.50 2026-01-01
72125 HCPCS 72125 CT Spine Cervical Without Contrast Profee 21 6 $2,628.75 $2,103.00 20% off $627.78 $2,365.88 $2,144.92 2026-01-01
9839140 CDM Nrs10105 Nursery Level 2 Charge 15 6 $2,575.00 $2,060.00 20% off $2,052.56 $2,317.50 $2,137.25 2026-01-01
4232587 CDM Room/bed: Nursery Level 2 15 6 $2,575.00 $2,060.00 20% off $2,052.16 $2,317.50 $2,137.25 2026-01-01
49082 HCPCS 49082 Abdominal Paracentesis (diagnostic Or Therapeutic) Withou 21 6 $2,615.25 $2,092.20 20% off $624.54 $2,353.73 $2,133.85 2026-01-01
J0897 HCPCS Denosumab 120 Mg/1.7 Ml 63 6 $2,600.93 $2,080.74 20% off $609.98 $4,207.17 $2,132.76 2026-01-01
78013 HCPCS 78013 Nm Thyroid Scan(i123)prof 42 6 $2,616.00 $2,092.80 $591.24 $2,493.00 $2,129.89 2026-01-01
P9035 HCPCS E3057 Aph Plt Acda Lr Irr 2 21 6 $2,581.50 $2,065.20 20% off $616.50 $2,323.35 $2,106.38 2026-01-01
78103 HCPCS 78103 Nm Bone Marrow Multiple: Prof 21 6 $2,577.75 $2,062.20 20% off $615.60 $2,319.98 $2,103.30 2026-01-01
50430 HCPCS 50430 Xr Urography Antegrade Prof 21 6 $2,576.75 $2,061.40 $615.36 $2,319.08 $2,102.48 2026-01-01
8163847 CDM Room/bed Newborn 8 6 $2,515.00 $2,012.00 20% off $2,014.52 $2,263.50 $2,093.74 2026-01-01
9839141 CDM Nrs10110 Nursery Level 1 Charge 15 6 $2,515.00 $2,012.00 20% off $2,004.50 $2,263.50 $2,087.45 2026-01-01
2120838 CDM Room/bed: Nursery Level 1 15 6 $2,515.00 $2,012.00 20% off $2,004.10 $2,263.50 $2,087.45 2026-01-01
73525 HCPCS 73525 Xr Arthrogram Hip Bilat 63 6 $2,518.25 $2,014.60 20% off $601.38 $4,532.18 $2,079.77 2026-01-01
72194 HCPCS 72194 CT Pelvis With + Without Contrast Profee 21 6 $2,544.25 $2,035.40 $607.56 $2,289.83 $2,075.83 2026-01-01
74150 HCPCS 74150 CT Abdomen Without Contrast Profee 21 6 $2,531.50 $2,025.20 20% off $604.56 $2,278.35 $2,065.58 2026-01-01
72192 HCPCS 72192 CT Pelvis Without Contrast Profee 21 6 $2,528.25 $2,022.60 20% off $603.78 $2,275.43 $2,062.92 2026-01-01
77076 HCPCS 77076 Xr Osseous Survey Child Prof 21 6 $2,515.00 $2,012.00 20% off $600.60 $2,263.50 $2,052.05 2026-01-01
Q5111 HCPCS Pegfilgrastim Cbqv 6 Mg/0.6 Ml 21 6 $2,502.11 $2,001.69 $600.51 $2,251.90 $2,051.73 2026-01-01
76885 HCPCS 76885 US Infant Hips With Manip: Prof 21 6 $2,499.25 $1,999.40 $596.82 $2,249.33 $2,039.14 2026-01-01
78300 HCPCS 78300 Nm Bone Scan, Limited: Prof 21 6 $2,495.50 $1,996.40 $595.92 $2,245.95 $2,036.06 2026-01-01
13258327 CDM Nail Troch 170mm D10x170mm 130deg 11 6 $2,460.00 $1,968.00 20% off $590.40 $2,214.00 $2,017.20 2026-01-01
13258321 CDM Nail Troch 170mm D9x170mm 130deg 11 6 $2,460.00 $1,968.00 20% off $590.40 $2,214.00 $2,017.20 2026-01-01
13258324 CDM Nail Troch 170mm D10x170mm 125deg (8125-0170s) 11 6 $2,460.00 $1,968.00 20% off $590.40 $2,214.00 $2,017.20 2026-01-01
71250 HCPCS 71250 CT Chest Without Contrast Profee 21 6 $2,466.50 $1,973.20 20% off $589.02 $2,219.85 $2,012.49 2026-01-01
L3900 HCPCS L3900 Wrist - Tenodesis Orthosis 21 6 $2,455.75 $1,964.60 20% off $586.44 $2,210.18 $2,003.67 2026-01-01
70460 HCPCS 70460 CT Brain/Head With Contrast Profee 21 6 $2,451.50 $1,961.20 20% off $585.42 $2,206.35 $2,000.19 2026-01-01
81479 HCPCS .gamma-globin Full Gene Sequencing Mayo 21 6 $2,399.50 $1,919.60 20% off $573.00 $2,159.55 $1,957.75 2026-01-01
76811 HCPCS 76811 US OB Fetal Detail >14 Wk:prof 21 6 $2,373.25 $1,898.60 20% off $566.76 $2,135.93 $1,936.43 2026-01-01
J0875 HCPCS Dalbavancin 500 Mg Pow 21 6 $2,360.07 $1,888.06 $566.42 $2,124.06 $1,935.26 2026-01-01
76700 HCPCS 76700 US Abdomen Complete: Prof 21 6 $2,370.25 $1,896.20 20% off $566.04 $2,133.23 $1,933.97 2026-01-01
C8924 HCPCS C8924 Ue Echo Limited With Contrast 21 6 $2,370.25 $1,896.20 20% off $566.04 $2,133.23 $1,933.97 2026-01-01
77021 HCPCS 77021 MRI Guided Needle Placement Profee 21 6 $2,361.75 $1,889.40 $564.00 $2,125.58 $1,927.00 2026-01-01
74410 HCPCS 74410 Xr Ivp Without Tomos Pro Fee 21 6 $2,357.50 $1,886.00 20% off $562.98 $2,121.75 $1,923.52 2026-01-01
J9355 HCPCS Trastuzumab 150 Mg Pow 21 6 $2,337.63 $1,870.10 20% off $561.03 $2,103.87 $1,916.86 2026-01-01
75822 HCPCS 75822 Xr Venogram Ext Bilat Prof 21 6 $2,339.25 $1,871.40 $558.60 $2,105.33 $1,908.55 2026-01-01
12014 HCPCS 12014 Simple Repair F/e/e/n/l/m 5.1cm-7.5 Cm ProFee 42 6 $2,313.25 $1,850.60 20% off $552.42 $2,094.75 $1,896.89 2026-01-01
49406 HCPCS 49406 CT Drain Appendix Abscess,perc 21 6 $2,322.25 $1,857.80 20% off $554.58 $2,090.03 $1,894.82 2026-01-01
49405 HCPCS 49405 CT Drain Liver Abscess,perc 21 6 $2,317.75 $1,854.20 20% off $553.50 $2,085.98 $1,891.13 2026-01-01
71271 HCPCS 71271 CT Low Dose Lung Screening 21 6 $2,306.50 $1,845.20 20% off $550.80 $2,075.85 $1,881.90 2026-01-01
72198 HCPCS 72198 MRA Pelvis With + Without Contrast Profee 63 6 $2,986.25 $2,389.00 20% off $501.78 $2,701.13 $1,881.68 2026-01-01
73201 HCPCS 73201 CT Upper Ext Bilat W Cont 63 6 $2,262.25 $1,809.80 20% off $540.24 $4,071.83 $1,868.33 2026-01-01
78264 HCPCS 78264 Nm Gastric Emptying Study:prof 21 6 $2,289.25 $1,831.40 $546.66 $2,060.33 $1,867.76 2026-01-01
74455 HCPCS 74455 Xr Void Cystourethrogram Prof 21 6 $2,287.75 $1,830.20 20% off $546.30 $2,058.98 $1,866.53 2026-01-01
75809 HCPCS 75809 Xr Shuntogram Prof 21 6 $2,284.50 $1,827.60 20% off $545.58 $2,056.05 $1,864.07 2026-01-01
92960 HCPCS 92960 Phy Cardioversion External ProFee 21 6 $2,283.00 $1,826.40 $545.22 $2,054.70 $1,862.84 2026-01-01
70450 HCPCS 70450 CT Brain/Head Without Contrast Profee 21 6 $2,279.75 $1,823.80 20% off $544.44 $2,051.78 $1,860.17 2026-01-01
77085 HCPCS 77085 Bm Bmd Dxa Hip, Spine, Fx Assess 21 6 $2,260.75 $1,808.60 20% off $539.88 $2,034.68 $1,844.59 2026-01-01
76770 HCPCS 76770 US Retroperitoneal Cmpl:prof 21 6 $2,243.25 $1,794.60 20% off $535.68 $2,018.93 $1,830.24 2026-01-01
12069671 CDM Micromatrix, 500 Mg 10 6 $2,227.50 $1,782.00 20% off $534.60 $2,004.75 $1,820.98 2025-11-14
78451 HCPCS 78451 Nm Myocard Single W/wm/ef:prof 21 6 $2,228.75 $1,783.00 20% off $532.26 $2,005.88 $1,818.56 2026-01-01
70488 HCPCS 70488 CT Maxillofacial With + Without Contrast Profee 42 6 $3,551.00 $2,840.80 $503.22 $3,211.88 $1,812.83 2026-01-01
9820988-156 CDM 00003-2187-10 - Abatacept 250 Mg IV Inj [ncty] 11 6 $2,204.19 $1,763.35 20% off $529.01 $1,983.77 $1,807.44 2026-01-01
J0129 HCPCS Abatacept 250 Mg IV Inj 21 6 $2,204.19 $1,763.35 20% off $529.01 $1,983.77 $1,807.44 2026-01-01
78278 HCPCS 78278 Nm Gi Bleed:prof 21 6 $2,210.00 $1,768.00 20% off $527.76 $1,989.00 $1,803.18 2026-01-01
78472 HCPCS 78472 Nm Muga: Prof 21 6 $2,202.50 $1,762.00 20% off $525.96 $1,982.25 $1,797.03 2026-01-01
76800 HCPCS 76800 US Spinal Canal: Prof 21 6 $2,171.25 $1,737.00 20% off $518.52 $1,954.13 $1,771.61 2026-01-01
78803 HCPCS 78803 Nm Spect: Prof 21 6 $2,169.50 $1,735.60 20% off $518.10 $1,952.55 $1,770.18 2026-01-01
72126 HCPCS 72126 CT Spine Cervical With Contrast Profee 21 6 $2,166.50 $1,733.20 20% off $517.38 $1,949.85 $1,767.72 2026-01-01
72129 HCPCS 72129 CT Spine Thoracic With Contrast Profee 21 6 $2,166.50 $1,733.20 20% off $517.38 $1,949.85 $1,767.72 2026-01-01
72132 HCPCS 72132 CT Spine Lumbar With Contrast Profee 21 6 $2,166.50 $1,733.20 20% off $517.38 $1,949.85 $1,767.72 2026-01-01
74740 HCPCS 74740 Xr Hysterosalpingography: Prof 21 6 $2,158.25 $1,726.60 20% off $515.40 $1,942.43 $1,760.95 2026-01-01
9847473 CDM Cath Kit Edge 90 Procedure 21 6 $2,140.50 $1,712.40 $513.72 $1,926.45 $1,755.21 2026-01-01
74270 HCPCS 74270 Xr Be Single Contrast Pro Fee 21 6 $2,150.00 $1,720.00 20% off $513.42 $1,935.00 $1,754.19 2026-01-01
76100 HCPCS 76100 Xr Volume Rad Pro Fee 21 6 $2,144.25 $1,715.40 $512.04 $1,929.83 $1,749.47 2026-01-01
76801 HCPCS 76801 US Ob, 1st Trimester, Prof 21 6 $2,134.75 $1,707.80 20% off $509.82 $1,921.28 $1,741.89 2026-01-01
93882 HCPCS US Carotid Unilat/ltd Prof 21 6 $2,133.50 $1,706.80 20% off $509.52 $1,920.15 $1,740.86 2026-01-01
9821370-393 CDM 44206-0438-20 - Immune Globulin **Privigen** 10% IV Sol 200 Ml 11 6 $2,112.00 $1,689.60 20% off $506.88 $1,900.80 $1,731.84 2026-01-01
94060 HCPCS 94060 Pft Phys Review & Interp ProFee 21 6 $2,113.25 $1,690.60 20% off $504.66 $1,901.93 $1,724.26 2026-01-01
76870 HCPCS 76870 Pocus US Scrotum Contents Prof 21 6 $2,102.75 $1,682.20 20% off $502.14 $1,892.48 $1,715.65 2026-01-01
93931 HCPCS 93931 US Dup Upp Ext Art Rt 42 6 $2,088.00 $1,670.40 $498.60 $1,879.20 $1,703.55 2026-01-01
J2802 HCPCS 55513-0223-01 - romiPLOStim 125 Mcg Pow [ncty] 22 6 $1,966.47 $1,573.18 $471.95 $3,539.24 $1,696.08 2026-01-01
J2796 HCPCS romiPLOStim 125 Mcg Pow 42 6 $2,949.48 $2,359.59 $471.95 $3,539.24 $1,696.08 2026-01-01
93979 HCPCS US Duplex Aorta/ivs Lim Prof 21 6 $2,068.50 $1,654.80 20% off $493.98 $1,861.65 $1,687.77 2026-01-01
76536 HCPCS 76536 Pocus US Soft Tissue Hd/neck Prof 21 6 $2,068.25 $1,654.60 20% off $493.92 $1,861.43 $1,687.56 2026-01-01
9847662 CDM Kit Tightrope Knotless 21 6 $2,056.95 $1,645.56 $493.67 $1,851.26 $1,686.70 2026-01-01
10626258 CDM Kit Jada System Vacuum-induced Hemorrhage 21 6 $2,092.50 $1,674.00 20% off $466.20 $1,883.25 $1,676.09 2026-01-01
9847472 CDM Cath Kit Edge 180 Procedure 21 6 $2,038.50 $1,630.80 20% off $489.24 $1,834.65 $1,671.57 2026-01-01
9847638 CDM Cath Kit Edge 45 Procedure 21 6 $2,038.50 $1,630.80 20% off $489.24 $1,834.65 $1,671.57 2026-01-01
20606 HCPCS 20606 US Arthrocent Asp/inj W/guide Medum Jt 21 6 $2,033.75 $1,627.00 20% off $485.70 $1,830.38 $1,659.48 2026-01-01
64450 HCPCS 64450 Injection, Anesthetic Agent; Other Peripheral Nerve Or Bra 21 6 $2,033.75 $1,627.00 20% off $485.70 $1,830.38 $1,659.48 2026-01-01
73702 HCPCS 73702 CT Knee Bilat W&wo Cont 63 6 $1,989.00 $1,591.20 20% off $474.96 $3,579.98 $1,642.57 2026-01-01
99292 HCPCS 99292 Critical Care E&m-unstabl ProFee 21 6 $1,999.50 $1,599.60 20% off $477.48 $1,799.55 $1,631.39 2026-01-01
19285 HCPCS 19285 US Breast Needle Loc Unilateral 21 6 $1,993.50 $1,594.80 20% off $476.04 $1,794.15 $1,626.47 2026-01-01
10080 HCPCS 10080 Incision And Drainage Of Pilonidal Cyst; Simple 21 6 $1,993.50 $1,594.80 20% off $476.04 $1,794.15 $1,626.47 2026-01-01
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