|
Q2057
|
HCPCS
|
Afamitresgene Autoleucel
|
2
|
1
|
—
|
—
|
$1,810,957.00
|
$1,810,957.00
|
$1,810,957.00
|
2026-04-01
|
|
Q2056
|
HCPCS
|
Ciltacabtagene Autoleucel 100000000 Cells IV Susp
|
2
|
1
|
—
|
—
|
$1,380,976.49
|
$1,380,976.49
|
$1,380,976.49
|
2026-04-01
|
|
Q2042
|
HCPCS
|
Tisagenlecleucel 600000000 Cells IV Susp
|
2
|
1
|
—
|
—
|
$1,331,348.56
|
$1,331,348.56
|
$1,331,348.56
|
2026-04-01
|
|
Q2054
|
HCPCS
|
Lisocabtagene Mara Car Pos T
|
2
|
1
|
—
|
—
|
$1,321,172.91
|
$1,321,172.91
|
$1,321,172.91
|
2026-04-01
|
|
Q2055
|
HCPCS
|
Idecabtagene Vicleucel Car
|
2
|
1
|
—
|
—
|
$1,311,492.07
|
$1,311,492.07
|
$1,311,492.07
|
2026-04-01
|
|
Q2041
|
HCPCS
|
Axicabtagene Ciloleucel 200000000 Cells IV Susp
|
2
|
1
|
—
|
—
|
$1,250,651.76
|
$1,250,651.76
|
$1,250,651.76
|
2026-04-01
|
|
Q2053
|
HCPCS
|
Brexucabtagene Autoleucel 200000000 Cells IV Susp
|
2
|
1
|
—
|
—
|
$1,150,207.97
|
$1,150,207.97
|
$1,150,207.97
|
2026-04-01
|
|
Q2058
|
HCPCS
|
Obecbtge Autol Up To 400 Mil
|
2
|
1
|
—
|
—
|
$653,887.50
|
$653,887.50
|
$653,887.50
|
2026-04-01
|
|
J3402
|
HCPCS
|
Inj. Remestemcel-l-rknd/ Td
|
2
|
1
|
—
|
—
|
$473,922.20
|
$473,922.20
|
$473,922.20
|
2026-04-01
|
|
177
|
MS_DRG
|
Respiratory Infections And Inflammations With Mcc
|
2
|
1
|
—
|
—
|
$439,039.36
|
$439,039.36
|
$439,039.36
|
2026-04-01
|
|
18
|
MS_DRG
|
Chimeric Antigen Receptor (Car) T-cell And Other Immunotherapies
|
16
|
7
|
—
|
—
|
$42,027.98
|
$801,480.97
|
$351,056.44
|
2026-04-01
|
|
14
|
MS_DRG
|
Allogeneic Bone Marrow Transplant
|
14
|
6
|
—
|
—
|
$108,259.75
|
$495,211.36
|
$251,201.56
|
2026-04-01
|
|
372
|
MS_DRG
|
Major Gastrointestinal Disorders And Peritoneal Infections With Cc
|
2
|
1
|
—
|
—
|
$249,436.37
|
$249,436.37
|
$249,436.37
|
2026-04-01
|
|
840
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Mcc
|
4
|
2
|
—
|
—
|
$60,632.53
|
$376,680.95
|
$218,656.74
|
2026-04-01
|
|
97
|
MS_DRG
|
Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc
|
2
|
1
|
—
|
—
|
$218,445.08
|
$218,445.08
|
$218,445.08
|
2026-04-01
|
|
J7330
|
HCPCS
|
Cultured Chondrocytes Implnt
|
2
|
1
|
—
|
—
|
$196,756.69
|
$196,756.69
|
$196,756.69
|
2026-04-01
|
|
J9029
|
HCPCS
|
Inj, Adstiladrin, Per Tx Dos
|
2
|
1
|
—
|
—
|
$151,045.76
|
$151,045.76
|
$151,045.76
|
2026-04-01
|
|
178
|
MS_DRG
|
Respiratory Infections And Inflammations With Cc
|
2
|
1
|
—
|
—
|
$144,394.94
|
$144,394.94
|
$144,394.94
|
2026-04-01
|
|
A9543
|
HCPCS
|
Y90 Ibritumomab, Rx
|
2
|
1
|
—
|
—
|
$133,537.69
|
$133,537.69
|
$133,537.69
|
2026-04-01
|
|
Q2043
|
HCPCS
|
Sipuleucel-t 50000000 Cells IV Susp
|
2
|
1
|
—
|
—
|
$127,849.66
|
$127,849.66
|
$127,849.66
|
2026-04-01
|
|
16
|
MS_DRG
|
Autologous Bone Marrow Transplant With Cc/Mcc
|
8
|
4
|
—
|
—
|
$68,827.99
|
$120,784.43
|
$109,912.86
|
2026-04-01
|
|
A9699
|
HCPCS
|
Radiopharm Rx Agent Noc
|
2
|
1
|
—
|
—
|
$109,733.56
|
$109,733.56
|
$109,733.56
|
2026-04-01
|
|
J9226
|
HCPCS
|
Supprelin La Implant
|
2
|
1
|
—
|
—
|
$101,485.55
|
$101,485.55
|
$101,485.55
|
2026-04-01
|
|
391
|
MS_DRG
|
Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc
|
2
|
1
|
—
|
—
|
$98,508.71
|
$98,508.71
|
$98,508.71
|
2026-04-01
|
|
846
|
MS_DRG
|
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc
|
2
|
1
|
—
|
—
|
$80,375.85
|
$80,375.85
|
$80,375.85
|
2026-04-01
|
|
837
|
MS_DRG
|
Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemot…
|
2
|
1
|
—
|
—
|
$75,124.86
|
$75,124.86
|
$75,124.86
|
2026-04-01
|
|
J9266
|
HCPCS
|
Pegaspargase 750 Unit/ml Ij Soln
|
2
|
1
|
—
|
—
|
$66,796.54
|
$66,796.54
|
$66,796.54
|
2026-04-01
|
|
175
|
MS_DRG
|
Pulmonary Embolism With Mcc Or Acute Cor Pulmonale
|
4
|
2
|
—
|
—
|
$34,348.38
|
$97,323.85
|
$65,836.12
|
2026-04-01
|
|
999
|
MS_DRG
|
Ungroupable
|
12
|
4
|
—
|
—
|
$17,758.33
|
$175,158.01
|
$58,123.91
|
2026-04-01
|
|
423
|
MS_DRG
|
Other Hepatobiliary Or Pancreas O.r. Procedures With Mcc
|
2
|
1
|
—
|
—
|
$57,319.67
|
$57,319.67
|
$57,319.67
|
2026-04-01
|
|
J9600
|
HCPCS
|
Porfimer Sodium Injection
|
2
|
1
|
—
|
—
|
$56,936.79
|
$56,936.79
|
$56,936.79
|
2026-04-01
|
|
25
|
MS_DRG
|
Craniotomy And Endovascular Intracranial Procedures With Mcc
|
2
|
1
|
—
|
—
|
$56,269.68
|
$56,269.68
|
$56,269.68
|
2026-04-01
|
|
206
|
MS_DRG
|
Other Respiratory System Diagnoses Without Mcc
|
2
|
1
|
—
|
—
|
$55,921.54
|
$55,921.54
|
$55,921.54
|
2026-04-01
|
|
542
|
MS_DRG
|
Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With…
|
2
|
1
|
—
|
—
|
$54,035.84
|
$54,035.84
|
$54,035.84
|
2026-04-01
|
|
202
|
MS_DRG
|
Bronchitis And Asthma With Cc/Mcc
|
4
|
2
|
—
|
—
|
$44,795.06
|
$57,420.99
|
$51,108.02
|
2026-04-01
|
|
841
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Cc
|
10
|
4
|
—
|
—
|
$18,956.97
|
$58,384.18
|
$48,721.28
|
2026-04-01
|
|
809
|
MS_DRG
|
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co…
|
16
|
7
|
—
|
—
|
$6,872.73
|
$133,997.97
|
$47,873.82
|
2026-04-01
|
|
5661
|
OTHER
|
Therapeutic Nuclear Medicine
|
32
|
10
|
—
|
—
|
$108.62
|
$116,791.93
|
$45,735.58
|
2026-04-01
|
|
153
|
MS_DRG
|
Otitis Media And Uri Without Mcc
|
2
|
1
|
—
|
—
|
$42,515.29
|
$42,515.29
|
$42,515.29
|
2026-04-01
|
|
418
|
MS_DRG
|
Laparoscopic Cholecystectomy Without C.d.e. With Cc
|
2
|
1
|
—
|
—
|
$42,472.08
|
$42,472.08
|
$42,472.08
|
2026-04-01
|
|
194
|
MS_DRG
|
Simple Pneumonia And Pleurisy With Cc
|
2
|
1
|
—
|
—
|
$41,809.65
|
$41,809.65
|
$41,809.65
|
2026-04-01
|
|
824
|
MS_DRG
|
Lymphoma And Non-acute Leukemia With Other Procedures With Cc
|
2
|
1
|
—
|
—
|
$37,531.17
|
$37,531.17
|
$37,531.17
|
2026-04-01
|
|
871
|
MS_DRG
|
Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc
|
6
|
3
|
—
|
—
|
$16,660.31
|
$82,839.46
|
$34,999.74
|
2026-04-01
|
|
315
|
MS_DRG
|
Other Circulatory System Diagnoses With Cc
|
6
|
3
|
—
|
—
|
$30,011.39
|
$73,276.50
|
$34,646.82
|
2026-04-01
|
|
847
|
MS_DRG
|
Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc
|
6
|
3
|
—
|
—
|
$14,287.75
|
$44,161.32
|
$34,634.66
|
2026-04-01
|
|
371
|
MS_DRG
|
Major Gastrointestinal Disorders And Peritoneal Infections With Mcc
|
2
|
1
|
—
|
—
|
$30,498.94
|
$30,498.94
|
$30,498.94
|
2026-04-01
|
|
808
|
MS_DRG
|
Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co…
|
6
|
2
|
—
|
—
|
$18,650.22
|
$341,173.32
|
$30,273.31
|
2026-04-01
|
|
75
|
MS_DRG
|
Viral Meningitis With Cc/Mcc
|
2
|
1
|
—
|
—
|
$29,987.40
|
$29,987.40
|
$29,987.40
|
2026-04-01
|
|
J1412
|
HCPCS
|
Inj Roctavian Ml 2x10^13vc G
|
2
|
1
|
—
|
—
|
$29,501.22
|
$29,501.22
|
$29,501.22
|
2026-04-01
|
|
865
|
MS_DRG
|
Viral Illness With Mcc
|
2
|
1
|
—
|
—
|
$28,916.84
|
$28,916.84
|
$28,916.84
|
2026-04-01
|
|
392
|
MS_DRG
|
Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc
|
4
|
2
|
—
|
—
|
$18,822.16
|
$38,460.90
|
$28,641.53
|
2026-04-01
|
|
563
|
MS_DRG
|
Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit…
|
2
|
1
|
—
|
—
|
$27,210.03
|
$27,210.03
|
$27,210.03
|
2026-04-01
|
|
814
|
MS_DRG
|
Reticuloendothelial And Immunity Disorders With Mcc
|
18
|
8
|
—
|
—
|
$19,767.28
|
$52,876.64
|
$26,598.09
|
2026-04-01
|
|
842
|
MS_DRG
|
Lymphoma And Non-acute Leukemia Without Cc/Mcc
|
4
|
2
|
—
|
—
|
$11,044.70
|
$39,207.82
|
$25,126.26
|
2026-04-01
|
|
J9216
|
HCPCS
|
Interferon Gamma 1-b Inj
|
2
|
1
|
—
|
—
|
$23,856.21
|
$23,856.21
|
$23,856.21
|
2026-04-01
|
|
919
|
MS_DRG
|
Complications Of Treatment With Mcc
|
2
|
1
|
—
|
—
|
$20,689.72
|
$20,689.72
|
$20,689.72
|
2026-04-01
|
|
815
|
MS_DRG
|
Reticuloendothelial And Immunity Disorders With Cc
|
6
|
2
|
—
|
—
|
$8,169.46
|
$48,991.42
|
$19,767.28
|
2026-04-01
|
|
872
|
MS_DRG
|
Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc
|
2
|
1
|
—
|
—
|
$18,970.35
|
$18,970.35
|
$18,970.35
|
2026-04-01
|
|
811
|
MS_DRG
|
Red Blood Cell Disorders With Mcc
|
2
|
1
|
—
|
—
|
$18,822.16
|
$18,822.16
|
$18,822.16
|
2026-04-01
|
|
375
|
MS_DRG
|
Digestive Malignancy With Cc
|
2
|
1
|
—
|
—
|
$18,602.82
|
$18,602.82
|
$18,602.82
|
2026-04-01
|
|
Q0224
|
HCPCS
|
Inj, Pemivibart, 4500 Mg
|
2
|
1
|
—
|
—
|
$17,011.65
|
$17,011.65
|
$17,011.65
|
2026-04-01
|
|
5244
|
OTHER
|
Level 4 Blood Product Exchange And Related Services
|
6
|
2
|
—
|
—
|
$10,013.25
|
$64,511.22
|
$16,645.14
|
2026-04-01
|
|
5184
|
OTHER
|
Level 4 Vascular Procedures
|
10
|
4
|
—
|
—
|
$3,640.99
|
$38,366.60
|
$16,573.74
|
2026-04-01
|
|
81416
|
HCPCS
|
Exome Sequence Analysis
|
2
|
1
|
—
|
—
|
$16,500.00
|
$16,500.00
|
$16,500.00
|
2026-04-01
|
|
602
|
MS_DRG
|
Cellulitis With Mcc
|
4
|
2
|
—
|
—
|
$13,269.94
|
$19,380.19
|
$16,325.06
|
2026-04-01
|
|
5313
|
OTHER
|
Level 3 Lower Gi Procedures
|
4
|
2
|
—
|
—
|
$15,745.43
|
$16,624.25
|
$16,184.84
|
2026-04-01
|
|
J0600
|
HCPCS
|
Edetate Calcium Disodium Inj
|
2
|
1
|
—
|
—
|
$14,592.75
|
$14,592.75
|
$14,592.75
|
2026-04-01
|
|
Q4310
|
HCPCS
|
Procenta, Per 100 Mg
|
2
|
1
|
—
|
—
|
$13,959.71
|
$13,959.71
|
$13,959.71
|
2026-04-01
|
|
5114
|
OTHER
|
Level 4 Musculoskeletal Procedures
|
4
|
2
|
—
|
—
|
$7,951.86
|
$19,523.08
|
$13,737.47
|
2026-04-01
|
|
5242
|
OTHER
|
Level 2 Blood Product Exchange And Related Services
|
40
|
12
|
—
|
—
|
$781.01
|
$54,716.90
|
$13,562.81
|
2026-04-01
|
|
J7504
|
HCPCS
|
Lymphocyte Immune Globulin
|
2
|
1
|
—
|
—
|
$12,473.64
|
$12,473.64
|
$12,473.64
|
2026-04-01
|
|
189
|
MS_DRG
|
Pulmonary Edema And Respiratory Failure
|
2
|
1
|
—
|
—
|
$12,225.04
|
$12,225.04
|
$12,225.04
|
2026-04-01
|
|
J1162
|
HCPCS
|
Digoxin Immune Fab (ovine)
|
2
|
1
|
—
|
—
|
$12,142.43
|
$12,142.43
|
$12,142.43
|
2026-04-01
|
|
J0225
|
HCPCS
|
Inj, Vutrisiran, 1 Mg
|
2
|
1
|
—
|
—
|
$11,772.47
|
$11,772.47
|
$11,772.47
|
2026-04-01
|
|
864
|
MS_DRG
|
Fever And Inflammatory Conditions
|
2
|
1
|
—
|
—
|
$11,723.79
|
$11,723.79
|
$11,723.79
|
2026-04-01
|
|
0315U
|
OTHER
|
Onc Cutan Sq Cll Ca Mrna 40
|
2
|
1
|
—
|
—
|
$11,687.50
|
$11,687.50
|
$11,687.50
|
2026-04-01
|
|
389
|
MS_DRG
|
Gastrointestinal Obstruction With Cc
|
2
|
1
|
—
|
—
|
$11,674.55
|
$11,674.55
|
$11,674.55
|
2026-04-01
|
|
0211U
|
OTHER
|
Onc Pan-tum Dna&rna Gnrj Seq
|
2
|
1
|
—
|
—
|
$11,625.62
|
$11,625.62
|
$11,625.62
|
2026-04-01
|
|
J0841
|
HCPCS
|
Inj Crotalidae IM F(ab')2 Eq
|
2
|
1
|
—
|
—
|
$11,574.13
|
$11,574.13
|
$11,574.13
|
2026-04-01
|
|
812
|
MS_DRG
|
Red Blood Cell Disorders Without Mcc
|
2
|
1
|
—
|
—
|
$11,346.52
|
$11,346.52
|
$11,346.52
|
2026-04-01
|
|
A9571
|
HCPCS
|
Indium In-111 Auto Platelet
|
2
|
1
|
—
|
—
|
$11,273.82
|
$11,273.82
|
$11,273.82
|
2026-04-01
|
|
J0480
|
HCPCS
|
Basiliximab
|
2
|
1
|
—
|
—
|
$11,235.51
|
$11,235.51
|
$11,235.51
|
2026-04-01
|
|
J9225
|
HCPCS
|
Vantas Implant
|
2
|
1
|
—
|
—
|
$11,067.40
|
$11,067.40
|
$11,067.40
|
2026-04-01
|
|
5243
|
OTHER
|
Level 3 Blood Product Exchange And Related Services
|
6
|
3
|
—
|
—
|
$7,875.80
|
$21,394.19
|
$10,916.26
|
2026-04-01
|
|
81552
|
HCPCS
|
Onc Uveal Mlnma Mrna 15 Gene
|
2
|
1
|
—
|
—
|
$10,692.00
|
$10,692.00
|
$10,692.00
|
2026-04-01
|
|
0094U
|
OTHER
|
Genome Rapid Sequence Alys
|
2
|
1
|
—
|
—
|
$10,425.52
|
$10,425.52
|
$10,425.52
|
2026-04-01
|
|
0582U
|
OTHER
|
Rare Ds Rpd Whlgen DNA Vrnts
|
2
|
1
|
—
|
—
|
$10,425.52
|
$10,425.52
|
$10,425.52
|
2026-04-01
|
|
0426U
|
OTHER
|
Genome Ultra-rapid Seq Alys
|
2
|
1
|
—
|
—
|
$10,425.52
|
$10,425.52
|
$10,425.52
|
2026-04-01
|
|
5375
|
OTHER
|
Level 5 Urology And Related Services
|
20
|
7
|
—
|
—
|
$1,217.82
|
$24,431.63
|
$10,402.33
|
2026-04-01
|
|
848
|
MS_DRG
|
Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc
|
2
|
1
|
—
|
—
|
$10,290.99
|
$10,290.99
|
$10,290.99
|
2026-04-01
|
|
J9200
|
HCPCS
|
Floxuridine 0.5 G Ij Solr
|
2
|
1
|
—
|
—
|
$9,999.06
|
$9,999.06
|
$9,999.06
|
2026-04-01
|
|
81529
|
HCPCS
|
Onc Cutan Mlnma Mrna 31 Gene
|
2
|
1
|
—
|
—
|
$9,890.38
|
$9,890.38
|
$9,890.38
|
2026-04-01
|
|
J0801
|
HCPCS
|
Inj. Acthar Gel To 40 Units
|
2
|
1
|
—
|
—
|
$9,805.45
|
$9,805.45
|
$9,805.45
|
2026-04-01
|
|
A9600
|
HCPCS
|
Sr89 Strontium
|
2
|
1
|
—
|
—
|
$9,743.90
|
$9,743.90
|
$9,743.90
|
2026-04-01
|
|
A9542
|
HCPCS
|
In111 Ibritumomab, Dx
|
2
|
1
|
—
|
—
|
$9,660.03
|
$9,660.03
|
$9,660.03
|
2026-04-01
|
|
5111
|
OTHER
|
Level 1 Musculoskeletal Procedures
|
4
|
2
|
—
|
—
|
$6,904.92
|
$12,336.95
|
$9,620.94
|
2026-04-01
|
|
5613
|
OTHER
|
Level 3 Therapeutic Radiation Treatment Preparation
|
38
|
11
|
—
|
—
|
$965.90
|
$23,672.29
|
$9,440.40
|
2026-04-01
|
|
0267U
|
OTHER
|
Rare Do Id Opt Gen Mapg&seq
|
2
|
1
|
—
|
—
|
$9,266.58
|
$9,266.58
|
$9,266.58
|
2026-04-01
|
|
5183
|
OTHER
|
Level 3 Vascular Procedures
|
42
|
13
|
—
|
—
|
$1,527.75
|
$15,545.34
|
$9,192.83
|
2026-04-01
|
|
J2507
|
HCPCS
|
Pegloticase Injection
|
2
|
1
|
—
|
—
|
$8,856.70
|
$8,856.70
|
$8,856.70
|
2026-04-01
|
|
J3316
|
HCPCS
|
Inj., Triptorelin Xr 3.75 Mg
|
2
|
1
|
—
|
—
|
$8,847.73
|
$8,847.73
|
$8,847.73
|
2026-04-01
|
|
5524
|
OTHER
|
Level 4 Imaging Without Contrast
|
2
|
1
|
—
|
—
|
$8,627.65
|
$8,627.65
|
$8,627.65
|
2026-04-01
|
|
948
|
MS_DRG
|
Signs And Symptoms Without Mcc
|
2
|
1
|
—
|
—
|
$8,379.39
|
$8,379.39
|
$8,379.39
|
2026-04-01
|
|
J0802
|
HCPCS
|
Inj. (ani), Up To 40 Units
|
2
|
1
|
—
|
—
|
$8,346.59
|
$8,346.59
|
$8,346.59
|
2026-04-01
|
|
J1826
|
HCPCS
|
Interferon Beta-1a Inj
|
2
|
1
|
—
|
—
|
$7,940.16
|
$7,940.16
|
$7,940.16
|
2026-04-01
|
|
J9015
|
HCPCS
|
Aldesleukin Injection
|
2
|
1
|
—
|
—
|
$7,846.34
|
$7,846.34
|
$7,846.34
|
2026-04-01
|
|
Q4246
|
HCPCS
|
Coretext Or Protext, Per Cc
|
2
|
1
|
—
|
—
|
$7,567.00
|
$7,567.00
|
$7,567.00
|
2026-04-01
|
|
0265U
|
OTHER
|
Rar Do Whl Gn&mtcdrl DNA Als
|
2
|
1
|
—
|
—
|
$7,529.22
|
$7,529.22
|
$7,529.22
|
2026-04-01
|
|
0212U
|
OTHER
|
Rare Ds Gen DNA Alys Proband
|
2
|
1
|
—
|
—
|
$7,528.40
|
$7,528.40
|
$7,528.40
|
2026-04-01
|
|
0295U
|
OTHER
|
Onc Brst Dux Carc 7 Proteins
|
2
|
1
|
—
|
—
|
$7,473.12
|
$7,473.12
|
$7,473.12
|
2026-04-01
|
|
81554
|
HCPCS
|
Pulm Ds Ipf Mrna 190 Gen Alg
|
2
|
1
|
—
|
—
|
$7,438.20
|
$7,438.20
|
$7,438.20
|
2026-04-01
|
|
A9604
|
HCPCS
|
Sm 153 Lexidronam
|
2
|
1
|
—
|
—
|
$7,425.53
|
$7,425.53
|
$7,425.53
|
2026-04-01
|
|
5154
|
OTHER
|
Level 4 Airway Endoscopy
|
28
|
9
|
—
|
—
|
$777.32
|
$26,828.24
|
$7,190.62
|
2026-04-01
|
|
0335U
|
OTHER
|
Rare Ds Whl Gen Seq Fetal
|
2
|
1
|
—
|
—
|
$7,183.83
|
$7,183.83
|
$7,183.83
|
2026-04-01
|
|
0214U
|
OTHER
|
Rare Ds Xom DNA Alys Proband
|
2
|
1
|
—
|
—
|
$7,183.83
|
$7,183.83
|
$7,183.83
|
2026-04-01
|
|
J3398
|
HCPCS
|
Inj Luxturna 1 Billion Vec G
|
2
|
1
|
—
|
—
|
$7,112.98
|
$7,112.98
|
$7,112.98
|
2026-04-01
|
|
81425
|
HCPCS
|
Genome Sequence Analysis
|
2
|
1
|
—
|
—
|
$6,917.90
|
$6,917.90
|
$6,917.90
|
2026-04-01
|
|
0532U
|
OTHER
|
Rare Ds Whlgen&mitochdrl DNA
|
2
|
1
|
—
|
—
|
$6,917.90
|
$6,917.90
|
$6,917.90
|
2026-04-01
|
|
0567U
|
OTHER
|
Rare Ds Whl Gen Seq Srs&lrs
|
2
|
1
|
—
|
—
|
$6,917.90
|
$6,917.90
|
$6,917.90
|
2026-04-01
|
|
J7352
|
HCPCS
|
Afamelanotide Implant, 1 Mg
|
2
|
1
|
—
|
—
|
$6,917.04
|
$6,917.04
|
$6,917.04
|
2026-04-01
|
|
0242U
|
OTHER
|
Trgt Gen Seq Alys Pnl 55-74
|
2
|
1
|
—
|
—
|
$6,875.00
|
$6,875.00
|
$6,875.00
|
2026-04-01
|
|
J7294
|
HCPCS
|
Seg Acet And Eth Estr Yearly
|
2
|
1
|
—
|
—
|
$6,825.95
|
$6,825.95
|
$6,825.95
|
2026-04-01
|
|
J2993
|
HCPCS
|
Reteplase Injection
|
2
|
1
|
—
|
—
|
$6,825.76
|
$6,825.76
|
$6,825.76
|
2026-04-01
|
|
0108U
|
OTHER
|
Gi Barrett Esoph 9 Prtn Bmrk
|
2
|
1
|
—
|
—
|
$6,806.25
|
$6,806.25
|
$6,806.25
|
2026-04-01
|
|
5694
|
OTHER
|
Level 4 Drug Administration
|
44
|
14
|
—
|
—
|
$414.88
|
$21,173.85
|
$6,776.57
|
2026-04-01
|
|
5073
|
OTHER
|
Level 3 Excision/ Biopsy/ Incision And Drainage
|
42
|
13
|
—
|
—
|
$867.68
|
$26,417.29
|
$6,743.19
|
2026-04-01
|
|
J9286
|
HCPCS
|
Glofitamab-gxbm 10 Mg/10ml IV Soln
|
2
|
1
|
—
|
—
|
$6,682.44
|
$6,682.44
|
$6,682.44
|
2026-04-01
|
|
Q4114
|
HCPCS
|
Integra Flowable Wound Matri
|
2
|
1
|
—
|
—
|
$6,651.72
|
$6,651.72
|
$6,651.72
|
2026-04-01
|
|
J9229
|
HCPCS
|
Inj Inotuzumab Ozogam 0.1 Mg
|
2
|
1
|
—
|
—
|
$6,619.41
|
$6,619.41
|
$6,619.41
|
2026-04-01
|
|
0036U
|
OTHER
|
Xome Tum & Nml Spec Seq Alys
|
2
|
1
|
—
|
—
|
$6,572.50
|
$6,572.50
|
$6,572.50
|
2026-04-01
|
|
81415
|
HCPCS
|
Exome Sequence Analysis
|
2
|
1
|
—
|
—
|
$6,572.50
|
$6,572.50
|
$6,572.50
|
2026-04-01
|
|
J2787
|
HCPCS
|
Riboflavin 5?phos Opth<=3ml
|
2
|
1
|
—
|
—
|
$6,429.60
|
$6,429.60
|
$6,429.60
|
2026-04-01
|
|
9511
|
OTHER
|
Cryoprecipitate Each Unit
|
2
|
1
|
—
|
—
|
$6,252.44
|
$6,252.44
|
$6,252.44
|
2026-04-01
|
|
5594
|
OTHER
|
Level 4 Nuclear Medicine And Related Services
|
42
|
13
|
—
|
—
|
$910.62
|
$15,026.77
|
$6,219.37
|
2026-04-01
|
|
0473U
|
OTHER
|
Onc Sld Tum Bld/slv 648 Gene
|
2
|
1
|
—
|
—
|
$6,187.50
|
$6,187.50
|
$6,187.50
|
2026-04-01
|
|
Q4162
|
HCPCS
|
Amnio Bio And Woundex Flow
|
2
|
1
|
—
|
—
|
$6,031.67
|
$6,031.67
|
$6,031.67
|
2026-04-01
|
|
9525
|
OTHER
|
Platelets, Hla-m, L/r, Unit
|
20
|
8
|
—
|
—
|
$671.08
|
$8,980.90
|
$5,986.35
|
2026-04-01
|
|
J9268
|
HCPCS
|
Pentostatin 10 Mg IV Solr
|
2
|
1
|
—
|
—
|
$5,962.19
|
$5,962.19
|
$5,962.19
|
2026-04-01
|
|
A9515
|
HCPCS
|
Choline C-11
|
2
|
1
|
—
|
—
|
$5,913.61
|
$5,913.61
|
$5,913.61
|
2026-04-01
|
|
5153
|
OTHER
|
Level 3 Airway Endoscopy
|
22
|
8
|
—
|
—
|
$1,141.95
|
$15,467.50
|
$5,856.71
|
2026-04-01
|
|
0300U
|
OTHER
|
Onc Pan Tum Whl Gen Seq&opt
|
2
|
1
|
—
|
—
|
$5,751.80
|
$5,751.80
|
$5,751.80
|
2026-04-01
|
|
J0202
|
HCPCS
|
Injection, Alemtuzumab
|
2
|
1
|
—
|
—
|
$5,750.69
|
$5,750.69
|
$5,750.69
|
2026-04-01
|
|
0425U
|
OTHER
|
Genom Rpd Seq Alys Ea Cmprtr
|
2
|
1
|
—
|
—
|
$5,629.79
|
$5,629.79
|
$5,629.79
|
2026-04-01
|
|
90396
|
HCPCS
|
Varicella-zoster Ig IM
|
2
|
1
|
—
|
—
|
$5,553.97
|
$5,553.97
|
$5,553.97
|
2026-04-01
|
|
A9582
|
HCPCS
|
Iodine I-123 Iobenguane
|
2
|
1
|
—
|
—
|
$5,446.13
|
$5,446.13
|
$5,446.13
|
2026-04-01
|
|
0306U
|
OTHER
|
Onc Mrd Nxt-gnrj Alys 1st
|
2
|
1
|
—
|
—
|
$5,332.87
|
$5,332.87
|
$5,332.87
|
2026-04-01
|
|
0560U
|
OTHER
|
Onc Mrd Gsa Cfdna Baseline
|
2
|
1
|
—
|
—
|
$5,332.87
|
$5,332.87
|
$5,332.87
|
2026-04-01
|
|
81542
|
HCPCS
|
Onc Prostate Mrna 22 Cnt Gen
|
2
|
1
|
—
|
—
|
$5,325.38
|
$5,325.38
|
$5,325.38
|
2026-04-01
|
|
0497U
|
OTHER
|
Onc Prst8 Mrna Rt-pcr 6 Gene
|
2
|
1
|
—
|
—
|
$5,325.38
|
$5,325.38
|
$5,325.38
|
2026-04-01
|
|
0578U
|
OTHER
|
Onc Cutan Mln RNA Qpcr 10gen
|
2
|
1
|
—
|
—
|
$5,325.38
|
$5,325.38
|
$5,325.38
|
2026-04-01
|
|
81521
|
HCPCS
|
Onc Breast Mrna 70 Genes
|
2
|
1
|
—
|
—
|
$5,325.38
|
$5,325.38
|
$5,325.38
|
2026-04-01
|
|
81518
|
HCPCS
|
Onc Brst Mrna 11 Genes
|
2
|
1
|
—
|
—
|
$5,325.38
|
$5,325.38
|
$5,325.38
|
2026-04-01
|
|
81522
|
HCPCS
|
Onc Breast Mrna 12 Genes
|
2
|
1
|
—
|
—
|
$5,325.38
|
$5,325.38
|
$5,325.38
|
2026-04-01
|
|
81541
|
HCPCS
|
Onc Prostate Mrna 46 Genes
|
2
|
1
|
—
|
—
|
$5,325.38
|
$5,325.38
|
$5,325.38
|
2026-04-01
|
|
0045U
|
OTHER
|
Onc Brst Dux Carc Is 12 Gene
|
2
|
1
|
—
|
—
|
$5,325.38
|
$5,325.38
|
$5,325.38
|
2026-04-01
|
|
81519
|
HCPCS
|
Hc Onc Br Mrna Pcr 21 Mor
|
2
|
1
|
—
|
—
|
$5,325.38
|
$5,325.38
|
$5,325.38
|
2026-04-01
|
|
0288U
|
OTHER
|
Onc Lung Mrna Quan Pcr 11&3
|
2
|
1
|
—
|
—
|
$5,325.38
|
$5,325.38
|
$5,325.38
|
2026-04-01
|
|
0047U
|
OTHER
|
Onc Prst8 Mrna 17 Gene Alg
|
2
|
1
|
—
|
—
|
$5,325.38
|
$5,325.38
|
$5,325.38
|
2026-04-01
|
|
81523
|
HCPCS
|
Onc Brst Mrna 70 Cnt 31 Gene
|
2
|
1
|
—
|
—
|
$5,325.38
|
$5,325.38
|
$5,325.38
|
2026-04-01
|
|
9521
|
OTHER
|
Platelets Leukoreduced Irrad
|
16
|
6
|
—
|
—
|
$1,026.92
|
$25,429.68
|
$5,293.87
|
2026-04-01
|
|
0583U
|
OTHER
|
Rare Ds Rpd Whlgen Cmptr DNA
|
2
|
1
|
—
|
—
|
$5,212.76
|
$5,212.76
|
$5,212.76
|
2026-04-01
|
|
81540
|
HCPCS
|
Oncology Tum Unknown Origin
|
2
|
1
|
—
|
—
|
$5,156.25
|
$5,156.25
|
$5,156.25
|
2026-04-01
|
|
90291
|
HCPCS
|
Cmv Ig IV
|
2
|
1
|
—
|
—
|
$5,102.95
|
$5,102.95
|
$5,102.95
|
2026-04-01
|
|
0258U
|
OTHER
|
Ai Psor Mrna 50-100 Gen Alg
|
2
|
1
|
—
|
—
|
$5,053.12
|
$5,053.12
|
$5,053.12
|
2026-04-01
|
|
0019U
|
OTHER
|
Onc RNA Tiss Predict Alg
|
2
|
1
|
—
|
—
|
$5,053.12
|
$5,053.12
|
$5,053.12
|
2026-04-01
|
|
5626
|
OTHER
|
Level 6 Radiation Therapy
|
32
|
10
|
—
|
—
|
$981.70
|
$13,563.33
|
$5,038.20
|
2026-04-01
|
|
0485U
|
OTHER
|
Onc Sol Tum Cfdna&rna Ngs Gm
|
2
|
1
|
—
|
—
|
$5,018.04
|
$5,018.04
|
$5,018.04
|
2026-04-01
|
|
J3240
|
HCPCS
|
Thyrotropin Alfa 0.9 Mg IM Solr
|
2
|
1
|
—
|
—
|
$4,995.25
|
$4,995.25
|
$4,995.25
|
2026-04-01
|
|
0391U
|
OTHER
|
Onc Sld Tum Dna&rna 437 Gen
|
2
|
1
|
—
|
—
|
$4,950.00
|
$4,950.00
|
$4,950.00
|
2026-04-01
|
|
0287U
|
OTHER
|
Onc Thyr Dna&mrna 112 Genes
|
2
|
1
|
—
|
—
|
$4,950.00
|
$4,950.00
|
$4,950.00
|
2026-04-01
|
|
0313U
|
OTHER
|
Onc Pncrs Dna&mrna Seq 74
|
2
|
1
|
—
|
—
|
$4,950.00
|
$4,950.00
|
$4,950.00
|
2026-04-01
|
|
0362U
|
OTHER
|
Onc Pap Thyr Ca RNA 82&10
|
2
|
1
|
—
|
—
|
$4,950.00
|
$4,950.00
|
$4,950.00
|
2026-04-01
|
|
0026U
|
OTHER
|
Onc Thyr Dna&mrna 112 Genes
|
2
|
1
|
—
|
—
|
$4,950.00
|
$4,950.00
|
$4,950.00
|
2026-04-01
|
|
81546
|
HCPCS
|
Onc Thyr Mrna 10,196 Gen Alg
|
2
|
1
|
—
|
—
|
$4,950.00
|
$4,950.00
|
$4,950.00
|
2026-04-01
|
|
0340U
|
OTHER
|
Onc Pan Ca Alys Mrd Plasma
|
2
|
1
|
—
|
—
|
$4,936.25
|
$4,936.25
|
$4,936.25
|
2026-04-01
|
|
0080U
|
OTHER
|
Onc Lng 5 Clin Rsk Factr Alg
|
2
|
1
|
—
|
—
|
$4,840.00
|
$4,840.00
|
$4,840.00
|
2026-04-01
|
|
0239U
|
OTHER
|
Trgt Gen Seq Alys Pnl 311+
|
2
|
1
|
—
|
—
|
$4,812.50
|
$4,812.50
|
$4,812.50
|
2026-04-01
|
|
0037U
|
OTHER
|
Trgt Gen Seq DNA 324 Genes
|
2
|
1
|
—
|
—
|
$4,812.50
|
$4,812.50
|
$4,812.50
|
2026-04-01
|
|
0388U
|
OTHER
|
Onc Nonsm Cll Lng Ca 37 Gen
|
2
|
1
|
—
|
—
|
$4,812.50
|
$4,812.50
|
$4,812.50
|
2026-04-01
|
|
0334U
|
OTHER
|
Onc Sld Orgn Tgsa DNA 84/+
|
2
|
1
|
—
|
—
|
$4,812.50
|
$4,812.50
|
$4,812.50
|
2026-04-01
|
|
0244U
|
OTHER
|
Onc Solid Orgn DNA 257 Genes
|
2
|
1
|
—
|
—
|
$4,812.50
|
$4,812.50
|
$4,812.50
|
2026-04-01
|
|
5624
|
OTHER
|
Level 4 Radiation Therapy
|
14
|
5
|
—
|
—
|
$1,130.39
|
$12,163.20
|
$4,799.65
|
2026-04-01
|
|
0016M
|
OTHER
|
Onc Bladder Mrna 209 Gen Alg
|
2
|
1
|
—
|
—
|
$4,798.24
|
$4,798.24
|
$4,798.24
|
2026-04-01
|
|
5415
|
OTHER
|
Level 5 Gynecologic Procedures
|
14
|
6
|
—
|
—
|
$2,531.17
|
$52,207.76
|
$4,752.91
|
2026-04-01
|
|
A9572
|
HCPCS
|
Indium In-111 Pentetreotide
|
2
|
1
|
—
|
—
|
$4,702.21
|
$4,702.21
|
$4,702.21
|
2026-04-01
|
|
Q9991
|
HCPCS
|
Buprenorphine ER 100 Mg/0.5ml Sc Sosy
|
2
|
1
|
—
|
—
|
$4,696.55
|
$4,696.55
|
$4,696.55
|
2026-04-01
|
|
Q9992
|
HCPCS
|
Buprenorphine ER 300 Mg/1.5ml Sc Sosy
|
2
|
1
|
—
|
—
|
$4,696.55
|
$4,696.55
|
$4,696.55
|
2026-04-01
|
|
Q4113
|
HCPCS
|
Graftjacket Xpress
|
2
|
1
|
—
|
—
|
$4,694.13
|
$4,694.13
|
$4,694.13
|
2026-04-01
|
|
5443
|
OTHER
|
Level 3 Nerve Injections
|
2
|
1
|
—
|
—
|
$4,686.55
|
$4,686.55
|
$4,686.55
|
2026-04-01
|
|
5442
|
OTHER
|
Level 2 Nerve Injections
|
34
|
12
|
—
|
—
|
$622.52
|
$11,103.25
|
$4,680.06
|
2026-04-01
|
|
9530
|
OTHER
|
Plate Pheres Leukoredu Irrad
|
42
|
13
|
—
|
—
|
$350.00
|
$6,893.33
|
$4,671.76
|
2026-04-01
|
|
5674
|
OTHER
|
Level 4 Pathology
|
2
|
1
|
—
|
—
|
$4,629.97
|
$4,629.97
|
$4,629.97
|
2026-04-01
|
|
81440
|
HCPCS
|
Mitochondrial Gene
|
2
|
1
|
—
|
—
|
$4,570.50
|
$4,570.50
|
$4,570.50
|
2026-04-01
|
|
Q9982
|
HCPCS
|
Flutemetamol F18 Diagnostic
|
2
|
1
|
—
|
—
|
$4,568.42
|
$4,568.42
|
$4,568.42
|
2026-04-01
|
|
0379U
|
OTHER
|
Tgsap Sl Or Neo Dna523&rna55
|
2
|
1
|
—
|
—
|
$4,521.70
|
$4,521.70
|
$4,521.70
|
2026-04-01
|
|
0539U
|
OTHER
|
Onc Sol Tumor Cfctdna 152gen
|
2
|
1
|
—
|
—
|
$4,521.70
|
$4,521.70
|
$4,521.70
|
2026-04-01
|
|
81464
|
HCPCS
|
So Gsap Cll Fr Mcrstl Ins
|
2
|
1
|
—
|
—
|
$4,521.70
|
$4,521.70
|
$4,521.70
|
2026-04-01
|
|
A9553
|
HCPCS
|
Cr51 Chromate
|
2
|
1
|
—
|
—
|
$4,507.21
|
$4,507.21
|
$4,507.21
|
2026-04-01
|
|
9536
|
OTHER
|
Platelets Pheresis Path Redu
|
42
|
13
|
—
|
—
|
$580.16
|
$7,114.74
|
$4,483.92
|
2026-04-01
|
|
5072
|
OTHER
|
Level 2 Excision/ Biopsy/ Incision And Drainage
|
42
|
13
|
—
|
—
|
$867.81
|
$18,382.49
|
$4,470.98
|
2026-04-01
|
|
0576U
|
OTHER
|
Trnsplj Med Lar Quan Ddcfdna
|
2
|
1
|
—
|
—
|
$4,455.00
|
$4,455.00
|
$4,455.00
|
2026-04-01
|
|
81558
|
HCPCS
|
Trnspl Rej Kdn Mrna Qpcr 139
|
2
|
1
|
—
|
—
|
$4,455.00
|
$4,455.00
|
$4,455.00
|
2026-04-01
|
|
81595
|
HCPCS
|
Cardiology Hrt Trnspl Mrna
|
2
|
1
|
—
|
—
|
$4,455.00
|
$4,455.00
|
$4,455.00
|
2026-04-01
|
|
0055U
|
OTHER
|
Card Hrt Trnspl 96 DNA Seq
|
2
|
1
|
—
|
—
|
$4,455.00
|
$4,455.00
|
$4,455.00
|
2026-04-01
|
|
5312
|
OTHER
|
Level 2 Lower Gi Procedures
|
34
|
11
|
—
|
—
|
$350.00
|
$13,880.00
|
$4,434.99
|
2026-04-01
|
|
0262U
|
OTHER
|
Onc Sld Tum Rt-pcr 7 Gen
|
2
|
1
|
—
|
—
|
$4,400.00
|
$4,400.00
|
$4,400.00
|
2026-04-01
|
|
0266U
|
OTHER
|
Unxpl Cnst Hrtbl Do Gn Xprsn
|
2
|
1
|
—
|
—
|
$4,400.00
|
$4,400.00
|
$4,400.00
|
2026-04-01
|
|
5593
|
OTHER
|
Level 3 Nuclear Medicine And Related Services
|
20
|
8
|
—
|
—
|
$1,203.03
|
$13,196.70
|
$4,360.28
|
2026-04-01
|
|
0087U
|
OTHER
|
Crd Hrt Trnspl Mrna 1283 Gen
|
2
|
1
|
—
|
—
|
$4,344.20
|
$4,344.20
|
$4,344.20
|
2026-04-01
|
|
0088U
|
OTHER
|
Trnsplj Kdn Algrft Rej 1494
|
2
|
1
|
—
|
—
|
$4,344.20
|
$4,344.20
|
$4,344.20
|
2026-04-01
|
|
0253U
|
OTHER
|
Rprdtve Med RNA Gen Prfl 238
|
2
|
1
|
—
|
—
|
$4,344.20
|
$4,344.20
|
$4,344.20
|
2026-04-01
|
|
0153U
|
OTHER
|
Onc Breast Mrna 101 Genes
|
2
|
1
|
—
|
—
|
$4,344.20
|
$4,344.20
|
$4,344.20
|
2026-04-01
|
|
J0840
|
HCPCS
|
Crotalidae Poly Immune Fab
|
2
|
1
|
—
|
—
|
$4,292.32
|
$4,292.32
|
$4,292.32
|
2026-04-01
|
|
A9586
|
HCPCS
|
Florbetapir F18
|
2
|
1
|
—
|
—
|
$4,290.25
|
$4,290.25
|
$4,290.25
|
2026-04-01
|
|
81525
|
HCPCS
|
Oncology Colon Mrna
|
2
|
1
|
—
|
—
|
$4,284.50
|
$4,284.50
|
$4,284.50
|
2026-04-01
|
|
J0850
|
HCPCS
|
Cytomegalovirus Imm IV /vial
|
2
|
1
|
—
|
—
|
$4,249.58
|
$4,249.58
|
$4,249.58
|
2026-04-01
|
|
0525U
|
OTHER
|
Onc Sphrd Cell Cul 11-rx Pnl
|
2
|
1
|
—
|
—
|
$4,171.56
|
$4,171.56
|
$4,171.56
|
2026-04-01
|
|
0248U
|
OTHER
|
Onc Brn Sphrd Cll 12 Rx Pnl
|
2
|
1
|
—
|
—
|
$4,171.56
|
$4,171.56
|
$4,171.56
|
2026-04-01
|
|
0435U
|
OTHER
|
Onc Chemo Rx Cytox Csc 14 Rx
|
2
|
1
|
—
|
—
|
$4,171.56
|
$4,171.56
|
$4,171.56
|
2026-04-01
|
|
0511U
|
OTHER
|
Onc Sol Tum 3dmicroenvir 36+
|
2
|
1
|
—
|
—
|
$4,171.56
|
$4,171.56
|
$4,171.56
|
2026-04-01
|
|
0172U
|
OTHER
|
Onc Sld Tum Alys Brca1 Brca2
|
2
|
1
|
—
|
—
|
$4,166.25
|
$4,166.25
|
$4,166.25
|
2026-04-01
|
|
J1950
|
HCPCS
|
Leuprolide Acetate /3.75 Mg
|
2
|
1
|
—
|
—
|
$4,145.09
|
$4,145.09
|
$4,145.09
|
2026-04-01
|
|
5302
|
OTHER
|
Level 2 Upper Gi Procedures
|
34
|
11
|
—
|
—
|
$665.27
|
$9,067.55
|
$4,131.61
|
2026-04-01
|
|
0018U
|
OTHER
|
Onc Thyr 10 Microrna Seq Alg
|
2
|
1
|
—
|
—
|
$4,127.87
|
$4,127.87
|
$4,127.87
|
2026-04-01
|
|
0543U
|
OTHER
|
Onc Sol Tum Ngs DNA 517 Gens
|
2
|
1
|
—
|
—
|
$4,110.63
|
$4,110.63
|
$4,110.63
|
2026-04-01
|
|
81459
|
HCPCS
|
Hc So Neo Ga, Cnv,Msi,Tmb,Rarrngmnt
|
2
|
1
|
—
|
—
|
$4,110.63
|
$4,110.63
|
$4,110.63
|
2026-04-01
|
|
0538U
|
OTHER
|
Onc Sol Tum Ngts Ffpe 600gen
|
2
|
1
|
—
|
—
|
$4,110.63
|
$4,110.63
|
$4,110.63
|
2026-04-01
|
|
A9507
|
HCPCS
|
In111 Capromab
|
2
|
1
|
—
|
—
|
$4,066.18
|
$4,066.18
|
$4,066.18
|
2026-04-01
|
|
0250U
|
OTHER
|
Onc Sld Org Neo DNA 505 Gene
|
2
|
1
|
—
|
—
|
$4,014.45
|
$4,014.45
|
$4,014.45
|
2026-04-01
|
|
81455
|
HCPCS
|
Hc Tar Sq Pl Org Hemly 51 Mr
|
2
|
1
|
—
|
—
|
$4,014.45
|
$4,014.45
|
$4,014.45
|
2026-04-01
|
|
0444U
|
OTHER
|
Onc Sld Orgn Neo Tgsap 361
|
2
|
1
|
—
|
—
|
$4,014.45
|
$4,014.45
|
$4,014.45
|
2026-04-01
|
|
0298U
|
OTHER
|
Onc Pan Tum Whl Trns Seq RNA
|
2
|
1
|
—
|
—
|
$4,014.45
|
$4,014.45
|
$4,014.45
|
2026-04-01
|
|
0585U
|
OTHER
|
Tgsap So Neo Cfdna 521 Genes
|
2
|
1
|
—
|
—
|
$4,014.45
|
$4,014.45
|
$4,014.45
|
2026-04-01
|
|
0530U
|
OTHER
|
Onc Pan-sol Tum Ctdna 77 Gen
|
2
|
1
|
—
|
—
|
$4,014.45
|
$4,014.45
|
$4,014.45
|
2026-04-01
|
|
0586U
|
OTHER
|
Onc Mrna Gen Xprsn 216 Genes
|
2
|
1
|
—
|
—
|
$4,014.45
|
$4,014.45
|
$4,014.45
|
2026-04-01
|
|
81456
|
HCPCS
|
Hc Tgsap So/hematolymphoid Neo/do 51/<rna Analysis
|
2
|
1
|
—
|
—
|
$4,014.45
|
$4,014.45
|
$4,014.45
|
2026-04-01
|
|
0409U
|
OTHER
|
Onc Sld Tum DNA 80 & RNA 36
|
2
|
1
|
—
|
—
|
$4,014.45
|
$4,014.45
|
$4,014.45
|
2026-04-01
|
|
0297U
|
OTHER
|
Onc Pan Tum Whl Gen Seq DNA
|
2
|
1
|
—
|
—
|
$4,014.45
|
$4,014.45
|
$4,014.45
|
2026-04-01
|
|
0592U
|
OTHER
|
Onc Hl Neo DNA Tgs 417 Genes
|
2
|
1
|
—
|
—
|
$4,014.45
|
$4,014.45
|
$4,014.45
|
2026-04-01
|
|
0048U
|
OTHER
|
Onc Sld Org Neo DNA 468 Gene
|
2
|
1
|
—
|
—
|
$4,014.45
|
$4,014.45
|
$4,014.45
|
2026-04-01
|
|
0487U
|
OTHER
|
Onc Sol Tum Cfcdna Tgsap 84
|
2
|
1
|
—
|
—
|
$4,014.45
|
$4,014.45
|
$4,014.45
|
2026-04-01
|
|
0571U
|
OTHER
|
Onc Sol Tum Dna80&rna10g Ngs
|
2
|
1
|
—
|
—
|
$4,014.45
|
$4,014.45
|
$4,014.45
|
2026-04-01
|
|
0050U
|
OTHER
|
Trgt Gen Seq DNA 194 Genes
|
2
|
1
|
—
|
—
|
$4,010.32
|
$4,010.32
|
$4,010.32
|
2026-04-01
|
|
J0578
|
HCPCS
|
Inj Brixadi, More Than 7 Day
|
2
|
1
|
—
|
—
|
$3,948.49
|
$3,948.49
|
$3,948.49
|
2026-04-01
|
|
81538
|
HCPCS
|
Oncology Lung
|
2
|
1
|
—
|
—
|
$3,947.62
|
$3,947.62
|
$3,947.62
|
2026-04-01
|
|
A4642
|
HCPCS
|
In111 Satumomab
|
2
|
1
|
—
|
—
|
$3,939.52
|
$3,939.52
|
$3,939.52
|
2026-04-01
|
|
0417U
|
OTHER
|
Rare Ds Alys 335 Nuc Genes
|
2
|
1
|
—
|
—
|
$3,908.48
|
$3,908.48
|
$3,908.48
|
2026-04-01
|
|
0540U
|
OTHER
|
Trnsplj Med Quan Dd-cfdna
|
2
|
1
|
—
|
—
|
$3,785.72
|
$3,785.72
|
$3,785.72
|
2026-04-01
|
|
0493U
|
OTHER
|
Trnspl Med Quan Dd-cfdna Ngs
|
2
|
1
|
—
|
—
|
$3,785.72
|
$3,785.72
|
$3,785.72
|
2026-04-01
|
|
0118U
|
OTHER
|
Trnsplj Don-drv Cll-fr DNA
|
2
|
1
|
—
|
—
|
$3,785.72
|
$3,785.72
|
$3,785.72
|
2026-04-01
|
|
81426
|
HCPCS
|
Genome Sequence Analysis
|
2
|
1
|
—
|
—
|
$3,726.18
|
$3,726.18
|
$3,726.18
|
2026-04-01
|
|
0213U
|
OTHER
|
Rare Ds Gen DNA Alys Ea Comp
|
2
|
1
|
—
|
—
|
$3,726.18
|
$3,726.18
|
$3,726.18
|
2026-04-01
|
|
Q9983
|
HCPCS
|
Florbetaben F18 Diagnostic
|
2
|
1
|
—
|
—
|
$3,723.97
|
$3,723.97
|
$3,723.97
|
2026-04-01
|
|
J9026
|
HCPCS
|
Inj, Tarlatamab-dlle, 1 Mg
|
2
|
1
|
—
|
—
|
$3,681.49
|
$3,681.49
|
$3,681.49
|
2026-04-01
|
|
0319U
|
OTHER
|
Neph RNA Pretrnspl Perph Bld
|
2
|
1
|
—
|
—
|
$3,643.75
|
$3,643.75
|
$3,643.75
|
2026-04-01
|
|
0320U
|
OTHER
|
Neph RNA Psttrnspl Perph Bld
|
2
|
1
|
—
|
—
|
$3,643.75
|
$3,643.75
|
$3,643.75
|
2026-04-01
|
|
A2034
|
HCPCS
|
Found Drs Solo, Per Sq Cm
|
2
|
1
|
—
|
—
|
$3,615.29
|
$3,615.29
|
$3,615.29
|
2026-04-01
|
|
J7307
|
HCPCS
|
Etonogestrel Implant System
|
2
|
1
|
—
|
—
|
$3,596.51
|
$3,596.51
|
$3,596.51
|
2026-04-01
|
|
J7296
|
HCPCS
|
Kyleena, 19.5 Mg
|
2
|
1
|
—
|
—
|
$3,588.29
|
$3,588.29
|
$3,588.29
|
2026-04-01
|
|
J7298
|
HCPCS
|
Levonorgestrel 20 Mcg/day Iu IUD
|
2
|
1
|
—
|
—
|
$3,588.29
|
$3,588.29
|
$3,588.29
|
2026-04-01
|
|
0336U
|
OTHER
|
Rare Ds Whl Gen Seq Bld/slv
|
2
|
1
|
—
|
—
|
$3,540.14
|
$3,540.14
|
$3,540.14
|
2026-04-01
|
|
0215U
|
OTHER
|
Rare Ds Xom DNA Alys Ea Comp
|
2
|
1
|
—
|
—
|
$3,540.14
|
$3,540.14
|
$3,540.14
|
2026-04-01
|
|
5673
|
OTHER
|
Level 3 Pathology
|
42
|
13
|
—
|
—
|
$134.31
|
$10,683.40
|
$3,529.80
|
2026-04-01
|
|
5572
|
OTHER
|
Level 2 Imaging With Contrast
|
44
|
14
|
—
|
—
|
$310.34
|
$20,140.43
|
$3,465.01
|
2026-04-01
|
|
0261U
|
OTHER
|
Onc Clrct Ca Img Alys W/ai
|
2
|
1
|
—
|
—
|
$3,455.72
|
$3,455.72
|
$3,455.72
|
2026-04-01
|
|
81520
|
HCPCS
|
Onc Breast Mrna 58 Genes
|
2
|
1
|
—
|
—
|
$3,451.54
|
$3,451.54
|
$3,451.54
|
2026-04-01
|
|
0017M
|
OTHER
|
Onc Dlbcl Mrna 20 Genes Alg
|
2
|
1
|
—
|
—
|
$3,451.54
|
$3,451.54
|
$3,451.54
|
2026-04-01
|
|
0120U
|
OTHER
|
Onc B Cll Lymphm Mrna 58 Gen
|
2
|
1
|
—
|
—
|
$3,451.54
|
$3,451.54
|
$3,451.54
|
2026-04-01
|
|
0092U
|
OTHER
|
Onc Lng 3 Prtn Bmrk Plsm Alg
|
2
|
1
|
—
|
—
|
$3,421.00
|
$3,421.00
|
$3,421.00
|
2026-04-01
|
|
5571
|
OTHER
|
Level 1 Imaging With Contrast
|
40
|
12
|
—
|
—
|
$219.79
|
$13,274.11
|
$3,395.99
|
2026-04-01
|
|
Q4174
|
HCPCS
|
Palingen Or Promatrx
|
2
|
1
|
—
|
—
|
$3,387.53
|
$3,387.53
|
$3,387.53
|
2026-04-01
|
|
J0630
|
HCPCS
|
Calcitonin (salmon) 200 Unit/ml Ij Soln
|
2
|
1
|
—
|
—
|
$3,368.02
|
$3,368.02
|
$3,368.02
|
2026-04-01
|
|
81419
|
HCPCS
|
Epilepsy Gen Seq Alys Panel
|
2
|
1
|
—
|
—
|
$3,366.77
|
$3,366.77
|
$3,366.77
|
2026-04-01
|
|
81443
|
HCPCS
|
Genetic Tstg Severe Inh Cond
|
2
|
1
|
—
|
—
|
$3,366.77
|
$3,366.77
|
$3,366.77
|
2026-04-01
|
|
0276U
|
OTHER
|
Hem Inh Thrombocytopenia 23
|
2
|
1
|
—
|
—
|
$3,366.77
|
$3,366.77
|
$3,366.77
|
2026-04-01
|
|
81412
|
HCPCS
|
Ashkenazi Jewish Assoc Dis
|
2
|
1
|
—
|
—
|
$3,366.77
|
$3,366.77
|
$3,366.77
|
2026-04-01
|
|
81441
|
HCPCS
|
Ibmfs Seq Alys Pnl 30 Genes
|
2
|
1
|
—
|
—
|
$3,366.77
|
$3,366.77
|
$3,366.77
|
2026-04-01
|
|
A9589
|
HCPCS
|
Insti Hexaminolevulinate Hcl
|
2
|
1
|
—
|
—
|
$3,348.21
|
$3,348.21
|
$3,348.21
|
2026-04-01
|
|
0338U
|
OTHER
|
Onc Sld Tum Crcg Tum Cl Slct
|
2
|
1
|
—
|
—
|
$3,348.12
|
$3,348.12
|
$3,348.12
|
2026-04-01
|
|
0491U
|
OTHER
|
Onc Sol Tum Ctc Slct ER Prtn
|
2
|
1
|
—
|
—
|
$3,348.12
|
$3,348.12
|
$3,348.12
|
2026-04-01
|
|
0337U
|
OTHER
|
Onc Plsm Cell Do&myeloma Id
|
2
|
1
|
—
|
—
|
$3,348.12
|
$3,348.12
|
$3,348.12
|
2026-04-01
|
|
0490U
|
OTHER
|
Onc Cutan/uveal Mlnma Cd146
|
2
|
1
|
—
|
—
|
$3,348.12
|
$3,348.12
|
$3,348.12
|
2026-04-01
|
|
0492U
|
OTHER
|
Onc Sol Tum Ctc Slctn Pd-l1
|
2
|
1
|
—
|
—
|
$3,348.12
|
$3,348.12
|
$3,348.12
|
2026-04-01
|
|
J7300
|
HCPCS
|
Intraut Copper Contraceptive
|
2
|
1
|
—
|
—
|
$3,346.40
|
$3,346.40
|
$3,346.40
|
2026-04-01
|
|
5301
|
OTHER
|
Level 1 Upper Gi Procedures
|
40
|
11
|
—
|
—
|
$514.02
|
$8,441.04
|
$3,324.97
|
2026-04-01
|
|
5241
|
OTHER
|
Level 1 Blood Product Exchange And Related Services
|
42
|
13
|
—
|
—
|
$423.62
|
$8,121.68
|
$3,277.50
|
2026-04-01
|
|
A9584
|
HCPCS
|
Iodine I-123 Ioflupane
|
2
|
1
|
—
|
—
|
$3,261.19
|
$3,261.19
|
$3,261.19
|
2026-04-01
|
|
81427
|
HCPCS
|
Genome Re-evaluation
|
2
|
1
|
—
|
—
|
$3,214.27
|
$3,214.27
|
$3,214.27
|
2026-04-01
|
|
J7299
|
HCPCS
|
Intraut Copp Cont (miudella)
|
2
|
1
|
—
|
—
|
$3,211.98
|
$3,211.98
|
$3,211.98
|
2026-04-01
|
|
5413
|
OTHER
|
Level 3 Gynecologic Procedures
|
2
|
1
|
—
|
—
|
$3,211.95
|
$3,211.95
|
$3,211.95
|
2026-04-01
|
|
0218U
|
OTHER
|
Neuro Musc Dys Dmd Seq Alys
|
2
|
1
|
—
|
—
|
$3,133.62
|
$3,133.62
|
$3,133.62
|
2026-04-01
|
|
5625
|
OTHER
|
Level 5 Radiation Therapy
|
38
|
11
|
—
|
—
|
$1,084.57
|
$13,803.66
|
$3,101.41
|
2026-04-01
|
|
5591
|
OTHER
|
Level 1 Nuclear Medicine And Related Services
|
36
|
11
|
—
|
—
|
$266.89
|
$8,819.41
|
$3,077.52
|
2026-04-01
|
|
J9357
|
HCPCS
|
Valrubicin Injection
|
2
|
1
|
—
|
—
|
$3,062.85
|
$3,062.85
|
$3,062.85
|
2026-04-01
|
|
0249U
|
OTHER
|
Onc Brst Alys 32 Phsprtn Alg
|
2
|
1
|
—
|
—
|
$3,051.30
|
$3,051.30
|
$3,051.30
|
2026-04-01
|
|
0206U
|
OTHER
|
Neuro Alzheimer Cell Aggregj
|
2
|
1
|
—
|
—
|
$3,046.18
|
$3,046.18
|
$3,046.18
|
2026-04-01
|
|
A9568
|
HCPCS
|
Technetium Tc99m Arcitumomab
|
2
|
1
|
—
|
—
|
$3,045.48
|
$3,045.48
|
$3,045.48
|
2026-04-01
|
|
0303U
|
OTHER
|
Hem Rbc Ads Whl Bld Hypoxic
|
2
|
1
|
—
|
—
|
$3,027.23
|
$3,027.23
|
$3,027.23
|
2026-04-01
|
|
0217U
|
OTHER
|
Neuro Inh Ataxia DNA 51 Gene
|
2
|
1
|
—
|
—
|
$3,022.73
|
$3,022.73
|
$3,022.73
|
2026-04-01
|
|
J2326
|
HCPCS
|
Inj, Nusinersen, 0.1mg
|
2
|
1
|
—
|
—
|
$3,022.45
|
$3,022.45
|
$3,022.45
|
2026-04-01
|