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

PACIFICA HOSPITAL OF THE VALLEY

Sun Valley, CA · CCN 050378 · Rates published

6,012 distinct procedures filed
16 distinct payers
40,834 rate rows
2025-11-19 last MRF observed
Data quality

39,229 of 40,834 rate rows are consumer-grade (96.1%)

1,605 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
exceeds 10× this hospital's gross charge — excluded from medians 1,035
per-diem day rate — not a per-procedure price 570
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://secure.claraprice.net/price-transparency/ZFYY-1731000747134/machine-readable/330737312_pacifica-hospital-of-the-valley_standardcharges.json
Found on page https://secure.claraprice.net/price-transparency/pacifica-hospital-of-the-valley-ca
Discovered viaDiscovered by HANK
Last fetch success · 2026-06-16
Content fingerprint eb4296cf0d72d08f… · 7,971,806 bytes · first seen 2026-06-16

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
CP17629817107454746
CDM 		Uterine And Adnexa Procedures For Non-malignancy Without Cc Or Mcc 5 $12,636.00 $25,272.00 $25,272.00 nat. median
$25,272
1.0× median
TNK
CDM 		Tnkase 50mg Vial 6 $11,513.00 $23,025.00 $23,025.00 nat. median
$23,025
1.0× median
360120211
CDM 		Surgery Level 5 1st 30min 5 $9,227.00 $18,454.00 $18,454.00 nat. median
$18,454
1.0× median
29826
CPT 		Shaving Of Shoulder Bone Using Endoscope 5 $9,171.00 $18,342.00 $18,342.00 nat. median
$3,466
outlier · 5.3×
360120246
CDM 		Surgery Level 4 1st 30min 5 $7,098.00 $14,195.00 $14,195.00 nat. median
$14,195
1.0× median
360458550
CDM 		Bronchoscopy 5 $6,197.00 $12,393.00 $12,393.00 nat. median
$12,393
1.0× median
27447
CPT 		Kneetotal 13 $3,544.00 $15,247.00 $12,198.00 nat. median
$12,649
1.0× median
27130
CPT 		Hiptotal 13 $2,823.00 $15,247.00 $12,198.00 nat. median
$13,100
0.9× median
360220220
CDM 		Surgery Level 3 1st 30min 5 $5,460.00 $10,920.00 $10,920.00 nat. median
$10,920
1.0× median
55866
CPT 		Surgical Removal Of Prostate And Surrounding Lymph Nodes Using An Endoscope 13 $7,632.00 $69,592.00 $9,778.50 nat. median
$10,517
0.9× median
27004852
CDM 		Penile Prosthesisinf 5 $4,652.00 $9,304.00 $9,304.00 nat. median
$9,304
1.0× median
360120240
CDM 		Surgery Level 2 1st 30min 5 $4,199.00 $8,398.00 $8,398.00 nat. median
$8,398
1.0× median
ACTIVASE
CDM 		Activase 100mg Vial 6 $4,088.00 $8,176.00 $8,176.00 nat. median
$8,176
1.0× median
23405
CPT 		Hibiclens 4% Liquid 13 $2.00 $8,288.00 $6,631.00 nat. median
$6,437
1.0× median
24134
CPT 		Neo-synephrine 0.25% Spray 13 $2.00 $8,288.00 $6,631.00 nat. median
$6,708
1.0× median
360120188
CDM 		Surgery Level 1 1st 30min 5 $3,222.00 $6,443.00 $6,443.00 nat. median
$6,443
1.0× median
360520279
CDM 		Surgery Level 5 Add 15min 5 $2,937.00 $5,874.00 $5,874.00 nat. median
$5,874
1.0× median
6362965443
CDM 		Octagam 10% Ivig 20mg 5 $2,782.00 $5,563.00 $5,563.00 nat. median
$5,563
1.0× median
47562
CPT 		Removal Of Gallbladder Using An Endoscope 13 $4,278.00 $25,236.00 $5,481.50 nat. median
$5,956
0.9× median
54408
CPT 		Imuran 50mg Tablet 13 $1.00 $5,995.00 $4,796.00 nat. median
$5,556
0.9× median
J1162
HCPCS 		Digoxin Immune Fab 40 Mg Vial 13 $983.00 $11,056.00 $4,777.00 nat. median
$7,308
0.7× median
25087054
CDM 		Crolalidae Polyvalent Immu Inj 5 $2,365.00 $4,730.00 $4,730.00 nat. median
$4,730
1.0× median
360125325
CDM 		Surgery Level 4 Add 15min 5 $2,258.00 $4,515.00 $4,515.00 nat. median
$4,515
1.0× median
21000001
CDM 		Room Charge Ccu 5 $2,195.00 $4,390.00 $4,390.00 nat. median
$3,646
1.2× median
20000003
CDM 		Room Charge Surge Unit ICU 5 $2,177.00 $4,354.00 $4,354.00 nat. median
$2,908
1.5× median
20000001
CDM 		D.o. Room Charge ICU 5 $2,172.00 $4,344.00 $4,344.00 nat. median
$3,643
1.2× median
ALTEPL50VL
CDM 		Activase 100mg Vial 6 $2,028.00 $4,056.00 $4,056.00 nat. median
$4,056
1.0× median
750256352
CDM 		Egd W/procedure 5 $1,927.00 $3,854.00 $3,854.00 nat. median
$3,854
1.0× median
19120
CPT 		Removal Of One Or More Breast Growth, Open Procedure 13 $2,826.00 $15,293.00 $3,621.00 nat. median
$3,650
1.0× median
NLASTA6MG
CDM 		Neulasta 6 Mg/0.6 Ml Syringe 6 $1,800.00 $3,600.00 $3,600.00 nat. median
$3,600
1.0× median
DIGIFAB
CDM 		Digifab 40mg Vial 5 $1,784.00 $3,568.00 $3,568.00 nat. median
$3,568
1.0× median
92975
CPT 		Thromb Coronary By Ic Inf 5 $1,764.00 $3,527.00 $3,527.00 nat. median
$1,848
1.9× median
77012
CPT 		CT Guided Needle Placement 5 $1,758.00 $3,516.00 $3,516.00 nat. median
$1,006
outlier · 3.5×
360212023
CDM 		Surgery Level 3 Add 15min 5 $1,738.00 $3,475.00 $3,475.00 nat. median
$3,475
1.0× median
J9211
HCPCS 		Idarubicin Hcl 1mg/ml Vial 5 $1,727.00 $3,453.00 $3,453.00 nat. median
$226
outlier · 15.3×
J2997
HCPCS 		Activase(alteplase) 50 Mg Vial 13 $71.00 $12,168.00 $3,356.00 nat. median
$545
outlier · 6.2×
25087332
CDM 		Rituxan 500 Mg 5 $1,674.00 $3,348.00 $3,348.00 nat. median
$3,348
1.0× median
49505
CPT 		Repair Of Groin Hernia Patient Age 5 Years Or Older 13 $2,565.00 $18,765.00 $3,286.50 nat. median
$3,829
0.9× median
20400000
CDM 		Room Chg Acute Bhu 5 $1,602.00 $3,204.00 $3,204.00 nat. median
$3,204
1.0× median
29881
CPT 		Removal Of One Knee Cartilage Using An Endoscope 13 $2,400.00 $18,342.00 $3,075.00 nat. median
$3,869
0.8× median
72198
CPT 		MRA Pelvis W/wo Contrast 5 $1,514.00 $3,027.00 $3,027.00 nat. median
$1,149
outlier · 2.6×
RETAVASE
CDM 		Retavase Full Kit 6 $1,508.00 $3,016.00 $3,016.00 nat. median
$3,016
1.0× median
25145
CPT 		Cytotec 100 Mcg Tablet 13 $1.00 $3,750.00 $3,000.00 nat. median
$3,485
0.9× median
90283
CPT 		Immuneglobulin 10 Gm 5 $1,482.00 $2,964.00 $2,964.00 nat. median
$85
outlier · 35.0×
75716
CPT 		Angio, Extremity, Bilateral 13 $1,985.00 $3,969.00 $2,954.00 nat. median
$3,281
0.9× median
75743
CPT 		Angio, Pulmonary,bilateral,sel 13 $1,619.00 $3,693.00 $2,954.00 nat. median
$3,174
0.9× median
36555
CPT 		Ins Non-tun Cvc <5 Yrs Old 13 $1,768.00 $3,693.00 $2,954.00 nat. median
$2,693
1.1× median
36556
CPT 		Ins Non-tun Cvc >5 Yrs Old 13 $1,768.00 $3,693.00 $2,954.00 nat. median
$2,458
1.2× median
93505
CPT 		Endomyocardial Biopsy 13 $1,668.00 $3,693.00 $2,954.00 nat. median
$3,652
0.8× median
27000479
CDM 		Graft:bovine 5 $1,467.00 $2,934.00 $2,934.00 nat. median
$1,467
outlier · 2.0×

Other procedures at this hospital

Browse this hospital's 6,012 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
             
CP17629817107454746 CDM Uterine And Adnexa Procedures For Non-malignancy Without Cc Or Mcc 5 5 $25,272.00 $25,272.00 $12,636.00 $25,272.00 $25,272.00 2025-11-19
TNK CDM Tnkase 50mg Vial 6 6 $23,025.00 $23,025.00 $11,513.00 $23,025.00 $23,025.00 2025-11-19
360120211 CDM Surgery Level 5 1st 30min 5 5 $18,454.00 $18,454.00 $9,227.00 $18,454.00 $18,454.00 2025-11-19
29826 CPT Shaving Of Shoulder Bone Using Endoscope 5 5 $18,342.00 $18,342.00 $9,171.00 $18,342.00 $18,342.00 2025-11-19
360120246 CDM Surgery Level 4 1st 30min 5 5 $14,195.00 $14,195.00 $7,098.00 $14,195.00 $14,195.00 2025-11-19
360458550 CDM Bronchoscopy 5 5 $12,393.00 $12,393.00 $6,197.00 $12,393.00 $12,393.00 2025-11-19
27447 CPT Kneetotal 14 13 $7,087.00 $7,087.00 $3,544.00 $15,247.00 $12,198.00 2025-11-19
27130 CPT Hiptotal 14 13 $5,646.00 $5,646.00 $2,823.00 $15,247.00 $12,198.00 2025-11-19
360220220 CDM Surgery Level 3 1st 30min 5 5 $10,920.00 $10,920.00 $5,460.00 $10,920.00 $10,920.00 2025-11-19
55866 CPT Surgical Removal Of Prostate And Surrounding Lymph Nodes Using An Endoscope 14 13 $69,592.00 $69,592.00 $7,632.00 $69,592.00 $9,778.50 2025-11-19
27004852 CDM Penile Prosthesisinf 5 5 $9,304.00 $9,304.00 $4,652.00 $9,304.00 $9,304.00 2025-11-19
360120240 CDM Surgery Level 2 1st 30min 5 5 $8,398.00 $8,398.00 $4,199.00 $8,398.00 $8,398.00 2025-11-19
ACTIVASE CDM Activase 100mg Vial 6 6 $8,176.00 $8,176.00 $4,088.00 $8,176.00 $8,176.00 2025-11-19
23405 CPT Hibiclens 4% Liquid 14 13 $4.00 $4.00 $2.00 $8,288.00 $6,631.00 2025-11-19
24134 CPT Neo-synephrine 0.25% Spray 14 13 $3.00 $3.00 $2.00 $8,288.00 $6,631.00 2025-11-19
360120188 CDM Surgery Level 1 1st 30min 5 5 $6,443.00 $6,443.00 $3,222.00 $6,443.00 $6,443.00 2025-11-19
360520279 CDM Surgery Level 5 Add 15min 5 5 $5,874.00 $5,874.00 $2,937.00 $5,874.00 $5,874.00 2025-11-19
6362965443 CDM Octagam 10% Ivig 20mg 5 5 $5,563.00 $5,563.00 $2,782.00 $5,563.00 $5,563.00 2025-11-19
47562 CPT Removal Of Gallbladder Using An Endoscope 14 13 $25,236.00 $25,236.00 $4,278.00 $25,236.00 $5,481.50 2025-11-19
54408 CPT Imuran 50mg Tablet 14 13 $1.00 $1.00 $1.00 $5,995.00 $4,796.00 2025-11-19
J1162 HCPCS Digoxin Immune Fab 40 Mg Vial 19 13 $11,056.00 $11,056.00 $983.00 $11,056.00 $4,777.00 2025-11-19
25087054 CDM Crolalidae Polyvalent Immu Inj 5 5 $4,730.00 $4,730.00 $2,365.00 $4,730.00 $4,730.00 2025-11-19
360125325 CDM Surgery Level 4 Add 15min 5 5 $4,515.00 $4,515.00 $2,258.00 $4,515.00 $4,515.00 2025-11-19
21000001 CDM Room Charge Ccu 5 5 $4,390.00 $4,390.00 $2,195.00 $4,390.00 $4,390.00 2025-11-19
20000003 CDM Room Charge Surge Unit ICU 5 5 $4,354.00 $4,354.00 $2,177.00 $4,354.00 $4,354.00 2025-11-19
20000001 CDM D.o. Room Charge ICU 5 5 $4,344.00 $4,344.00 $2,172.00 $4,344.00 $4,344.00 2025-11-19
ALTEPL50VL CDM Activase 100mg Vial 6 6 $4,056.00 $4,056.00 $2,028.00 $4,056.00 $4,056.00 2025-11-19
750256352 CDM Egd W/procedure 5 5 $3,854.00 $3,854.00 $1,927.00 $3,854.00 $3,854.00 2025-11-19
19120 CPT Removal Of One Or More Breast Growth, Open Procedure 14 13 $15,293.00 $15,293.00 $2,826.00 $15,293.00 $3,621.00 2025-11-19
NLASTA6MG CDM Neulasta 6 Mg/0.6 Ml Syringe 6 6 $3,600.00 $3,600.00 $1,800.00 $3,600.00 $3,600.00 2025-11-19
DIGIFAB CDM Digifab 40mg Vial 5 5 $3,568.00 $3,568.00 $1,784.00 $3,568.00 $3,568.00 2025-11-19
92975 CPT Thromb Coronary By Ic Inf 5 5 $3,527.00 $3,527.00 $1,764.00 $3,527.00 $3,527.00 2025-11-19
77012 CPT CT Guided Needle Placement 5 5 $3,516.00 $3,516.00 $1,758.00 $3,516.00 $3,516.00 2025-11-19
360212023 CDM Surgery Level 3 Add 15min 5 5 $3,475.00 $3,475.00 $1,738.00 $3,475.00 $3,475.00 2025-11-19
J9211 HCPCS Idarubicin Hcl 1mg/ml Vial 5 5 $3,453.00 $3,453.00 $1,727.00 $3,453.00 $3,453.00 2025-11-19
J2997 HCPCS Activase(alteplase) 50 Mg Vial 29 13 $10,068.00 $10,068.00 $71.00 $12,168.00 $3,356.00 2025-11-19
25087332 CDM Rituxan 500 Mg 5 5 $3,348.00 $3,348.00 $1,674.00 $3,348.00 $3,348.00 2025-11-19
49505 CPT Repair Of Groin Hernia Patient Age 5 Years Or Older 14 13 $18,765.00 $18,765.00 $2,565.00 $18,765.00 $3,286.50 2025-11-19
20400000 CDM Room Chg Acute Bhu 5 5 $3,204.00 $3,204.00 $1,602.00 $3,204.00 $3,204.00 2025-11-19
29881 CPT Removal Of One Knee Cartilage Using An Endoscope 14 13 $18,342.00 $18,342.00 $2,400.00 $18,342.00 $3,075.00 2025-11-19
72198 CPT MRA Pelvis W/wo Contrast 5 5 $3,027.00 $3,027.00 $1,514.00 $3,027.00 $3,027.00 2025-11-19
RETAVASE CDM Retavase Full Kit 6 6 $3,016.00 $3,016.00 $1,508.00 $3,016.00 $3,016.00 2025-11-19
25145 CPT Cytotec 100 Mcg Tablet 14 13 $1.00 $1.00 $1.00 $3,750.00 $3,000.00 2025-11-19
90283 CPT Immuneglobulin 10 Gm 5 5 $2,964.00 $2,964.00 $1,482.00 $2,964.00 $2,964.00 2025-11-19
36556 CPT Ins Non-tun Cvc >5 Yrs Old 14 13 $3,536.00 $3,536.00 $1,768.00 $3,693.00 $2,954.00 2025-11-19
75743 CPT Angio, Pulmonary,bilateral,sel 14 13 $3,238.00 $3,238.00 $1,619.00 $3,693.00 $2,954.00 2025-11-19
75716 CPT Angio, Extremity, Bilateral 14 13 $3,969.00 $3,969.00 $1,985.00 $3,969.00 $2,954.00 2025-11-19
93505 CPT Endomyocardial Biopsy 14 13 $3,336.00 $3,336.00 $1,668.00 $3,693.00 $2,954.00 2025-11-19
36555 CPT Ins Non-tun Cvc <5 Yrs Old 14 13 $3,536.00 $3,536.00 $1,768.00 $3,693.00 $2,954.00 2025-11-19
27000161 CDM Graft:bovine 5 5 $2,934.00 $2,934.00 $1,467.00 $2,934.00 $2,934.00 2025-11-19
27000479 CDM Graft:bovine 5 5 $2,934.00 $2,934.00 $1,467.00 $2,934.00 $2,934.00 2025-11-19
CROFAB CDM Crofab 6 6 $2,899.00 $2,899.00 $1,450.00 $2,899.00 $2,899.00 2025-11-19
59612 CPT Delivery Charge 14 13 $407.00 $407.00 $204.00 $3,622.00 $2,898.00 2025-11-19
J9178 HCPCS Epirubicin 2mg/ml 25ml 5 5 $2,858.00 $2,858.00 $1,429.00 $2,858.00 $2,858.00 2025-11-19
J2993 HCPCS Reteplase 18.1 Mg Kit 14 13 $11,042.00 $11,042.00 $2,215.00 $11,042.00 $2,837.50 2025-11-19
36001730 CDM Holmuim Laser 5 5 $2,807.00 $2,807.00 $1,404.00 $2,807.00 $2,807.00 2025-11-19
6362965440 CDM Octagam 5% 200ml 5 5 $2,781.00 $2,781.00 $1,391.00 $2,781.00 $2,781.00 2025-11-19
6362965444 CDM Octagam 10% Ivig 10mg 5 5 $2,781.00 $2,781.00 $1,391.00 $2,781.00 $2,781.00 2025-11-19
J2426 HCPCS Invega 234 Mg Syr 24 13 $5,065.00 $5,065.00 $11.00 $5,065.00 $2,772.00 2025-11-19
360122120 CDM Surgery Level 2 Add 15min 5 5 $2,672.00 $2,672.00 $1,336.00 $2,672.00 $2,672.00 2025-11-19
36001731 CDM Endoscopy Video System Proc 5 5 $2,636.00 $2,636.00 $1,318.00 $2,636.00 $2,636.00 2025-11-19
38305 CPT Hydrea 500mg Capsule 14 13 $1.00 $1.00 $1.00 $3,292.00 $2,634.00 2025-11-19
45028575 CDM Drain Bl W/supracath Insertion 5 5 $2,581.00 $2,581.00 $1,291.00 $2,581.00 $2,581.00 2025-11-19
25087278 CDM Sandolar 5 5 $2,546.00 $2,546.00 $1,273.00 $2,546.00 $2,546.00 2025-11-19
71080174 CDM Pacu Complex 1st 30min 5 5 $2,519.00 $2,519.00 $1,260.00 $2,519.00 $2,519.00 2025-11-19
J2430 HCPCS Pamidronate Disodium 90 30mgvl 5 5 $2,483.00 $2,483.00 $1,242.00 $2,483.00 $2,483.00 2025-11-19
45085621 CDM Transthoracic Echo F/u Or Limi 5 5 $2,469.00 $2,469.00 $1,235.00 $2,469.00 $2,469.00 2025-11-19
75989 CPT Guidance Perc Drainage W/cath 5 5 $2,469.00 $2,469.00 $1,235.00 $2,469.00 $2,469.00 2025-11-19
ADRIAMYCIN CDM Doxil 50mg/25ml Liposomal Vial 6 6 $2,371.00 $2,371.00 $1,186.00 $2,371.00 $2,371.00 2025-11-19
C1768 HCPCS Graft Gortex 1" 5 5 $2,306.00 $2,306.00 $1,153.00 $2,306.00 $2,306.00 2025-11-19
12000039 CDM Room Chg-neuro3 Vent Adlt 5 5 $2,283.00 $2,283.00 $1,142.00 $2,283.00 $2,283.00 2025-11-19
12000037 CDM Room Charge-neuro Vent 5 5 $2,283.00 $2,283.00 $1,142.00 $2,283.00 $2,283.00 2025-11-19
12000043 CDM Room Chg-neuro2s Vent Adult 5 5 $2,283.00 $2,283.00 $1,142.00 $2,283.00 $2,283.00 2025-11-19
12300039 CDM Bed Hold-psa Vent 5 5 $2,262.00 $2,262.00 $1,131.00 $2,262.00 $2,262.00 2025-11-19
12000045 CDM Bed Hold Neuro2s Vent Adult 5 5 $2,262.00 $2,262.00 $1,131.00 $2,262.00 $2,262.00 2025-11-19
12300037 CDM Room Charge-peds Neuro Vent 5 5 $2,262.00 $2,262.00 $1,131.00 $2,262.00 $2,262.00 2025-11-19
12100036 CDM Room Charge Med/surg 5 5 $2,257.00 $2,257.00 $1,129.00 $2,257.00 $2,257.00 2025-11-19
12100038 CDM Room Charge Surge Unit Acute 5 5 $2,257.00 $2,257.00 $1,129.00 $2,257.00 $2,257.00 2025-11-19
45023517 CDM Complx Repair Trunk 2.6cm-7.5c 5 5 $2,240.00 $2,240.00 $1,120.00 $2,240.00 $2,240.00 2025-11-19
16900000 CDM Room Chargeacute Admin Day 5 5 $2,236.00 $2,236.00 $1,118.00 $2,236.00 $2,236.00 2025-11-19
66984 CPT Removal Of Cataract With Insertion Of Lens 14 13 $27,945.00 $27,945.00 $1,728.00 $27,945.00 $2,214.00 2025-11-19
25081310 CDM Streptokinase Kit Kit 5 5 $2,197.00 $2,197.00 $1,099.00 $2,197.00 $2,197.00 2025-11-19
25980283 CDM Activated Factor Ix Concn 500v 5 5 $2,197.00 $2,197.00 $1,099.00 $2,197.00 $2,197.00 2025-11-19
45085623 CDM Intrmd Wnd Rpr Sclp/ax/tr/ext 5 5 $2,195.00 $2,195.00 $1,098.00 $2,195.00 $2,195.00 2025-11-19
12300027 CDM Room Charge Ped 5 5 $2,190.00 $2,190.00 $1,095.00 $2,190.00 $2,190.00 2025-11-19
12200018 CDM Room Charge-OB 5 5 $2,190.00 $2,190.00 $1,095.00 $2,190.00 $2,190.00 2025-11-19
RITUXAN CDM Rituxan 500mg 6 6 $2,171.00 $2,171.00 $1,086.00 $2,171.00 $2,171.00 2025-11-19
ACTEMRA20 CDM Actemra Inj 6 6 $2,153.00 $2,153.00 $1,077.00 $2,153.00 $2,153.00 2025-11-19
27053411 CDM Graft Impra 5 5 $2,146.00 $2,146.00 $1,073.00 $2,146.00 $2,146.00 2025-11-19
360120196 CDM Surgery Level 1 Add 15min 5 5 $2,056.00 $2,056.00 $1,028.00 $2,056.00 $2,056.00 2025-11-19
74185 CPT MRA Abd W/wo Contrast 5 5 $2,039.00 $2,039.00 $1,020.00 $2,039.00 $2,039.00 2025-11-19
25100002 CDM Pegasys 180 Mcg/ml 5 5 $2,033.00 $2,033.00 $1,017.00 $2,033.00 $2,033.00 2025-11-19
71555 CPT MRI Chest Angio 5 5 $1,987.00 $1,987.00 $994.00 $1,987.00 $1,987.00 2025-11-19
750453785 CDM Colonoscopy W/proc 5 5 $1,986.00 $1,986.00 $993.00 $1,986.00 $1,986.00 2025-11-19
750432531 CDM Egd Dx 5 5 $1,986.00 $1,986.00 $993.00 $1,986.00 $1,986.00 2025-11-19
12000038 CDM Room Chg-neuro3 Non Vent Adlt 5 5 $1,978.00 $1,978.00 $989.00 $1,978.00 $1,978.00 2025-11-19
12000036 CDM Room Charge-neuro Non Vent 5 5 $1,978.00 $1,978.00 $989.00 $1,978.00 $1,978.00 2025-11-19
12000042 CDM Room Chg-neuro2s Non Vent Adl 5 5 $1,978.00 $1,978.00 $989.00 $1,978.00 $1,978.00 2025-11-19
25980196 CDM Streptokinase 1.5 Mmu/vial Via 5 5 $1,968.00 $1,968.00 $984.00 $1,968.00 $1,968.00 2025-11-19
370120121 CDM Anesth General 1st 60min 5 5 $1,963.00 $1,963.00 $982.00 $1,963.00 $1,963.00 2025-11-19
12300038 CDM Bed Hold-psa Non-vent 5 5 $1,958.00 $1,958.00 $979.00 $1,958.00 $1,958.00 2025-11-19
12400027 CDM Room Charge Psychiatric Acute 5 5 $1,958.00 $1,958.00 $979.00 $1,958.00 $1,958.00 2025-11-19
12000040 CDM Bedhold Asa3 Non Vent 5 5 $1,958.00 $1,958.00 $979.00 $1,958.00 $1,958.00 2025-11-19
12300036 CDM Room Charge-peds Neuro Nonvent 5 5 $1,958.00 $1,958.00 $979.00 $1,958.00 $1,958.00 2025-11-19
12000044 CDM Bed Hold Neuro2s Non Vent Adl 5 5 $1,958.00 $1,958.00 $979.00 $1,958.00 $1,958.00 2025-11-19
J0840 HCPCS Crofab (Antivenim) 14 13 $1,475.00 $1,475.00 $738.00 $2,437.00 $1,950.00 2025-11-19
71020287 CDM Pacu Standard 1st 30min 5 5 $1,936.00 $1,936.00 $968.00 $1,936.00 $1,936.00 2025-11-19
55700 CPT Biopsy Of Prostate Gland 14 13 $13,033.00 $13,033.00 $1,510.00 $13,033.00 $1,935.00 2025-11-19
A9521 HCPCS Ceretec Wbc Labeling 5 5 $1,924.00 $1,924.00 $962.00 $1,924.00 $1,924.00 2025-11-19
45086453 CDM Clsd Tx Radial Shaft Fx W/mani 5 5 $1,905.00 $1,905.00 $953.00 $1,905.00 $1,905.00 2025-11-19
54001 CPT Prednisone 10mg 14 13 $6.00 $6.00 $3.00 $2,360.00 $1,888.00 2025-11-19
45096583 CDM Closed Tx Lunate Dislocation W 5 5 $1,849.00 $1,849.00 $925.00 $1,849.00 $1,849.00 2025-11-19
80100003 CDM Hemoperfusion 5 5 $1,845.00 $1,845.00 $923.00 $1,845.00 $1,845.00 2025-11-19
45086574 CDM Clsd Tx Bimalleolar Ankle Fx W 5 5 $1,814.00 $1,814.00 $907.00 $1,814.00 $1,814.00 2025-11-19
45068359 CDM Closed Tx Femoral Fx With Mani 5 5 $1,814.00 $1,814.00 $907.00 $1,814.00 $1,814.00 2025-11-19
45098563 CDM Clsd Tx Trimalleolar Ankle Fx 5 5 $1,814.00 $1,814.00 $907.00 $1,814.00 $1,814.00 2025-11-19
45035748 CDM Shoulder Disloc W/fx Tube 5 5 $1,814.00 $1,814.00 $907.00 $1,814.00 $1,814.00 2025-11-19
45063859 CDM Clsd Tx Medial Malleolus Fx With 5 5 $1,802.00 $1,802.00 $901.00 $1,802.00 $1,802.00 2025-11-19
OCTA20G CDM Octagam 10% (20000 Mg) 200 Ml Vial 6 6 $1,795.00 $1,795.00 $898.00 $1,795.00 $1,795.00 2025-11-19
36200 CPT Introduction Catheter, Aorta 5 5 $1,780.00 $1,780.00 $890.00 $1,780.00 $1,780.00 2025-11-19
27000134 CDM Holter Valve 5 5 $1,775.00 $1,775.00 $888.00 $1,775.00 $1,775.00 2025-11-19
36100 CPT Cerebral Uni-inj 10 5 $1,738.50 $1,738.50 $857.00 $1,764.00 $1,713.00 2025-11-19
45084527 CDM Clsd Tx Tibial Shaft Fx W/mani 5 5 $1,711.00 $1,711.00 $856.00 $1,711.00 $1,711.00 2025-11-19
45036752 CDM Clsd Tx Distal Radial Fx W/man 5 5 $1,711.00 $1,711.00 $856.00 $1,711.00 $1,711.00 2025-11-19
48132675 CDM Biopal 7 Biotome 5 5 $1,699.00 $1,699.00 $850.00 $1,699.00 $1,699.00 2025-11-19
36001738 CDM Linvatec Pump & 5 5 $1,695.00 $1,695.00 $848.00 $1,695.00 $1,695.00 2025-11-19
99292 CPT Critical Care Add't 30 Min 5 5 $1,694.00 $1,694.00 $847.00 $1,694.00 $1,694.00 2025-11-19
750555685 CDM Colonoscopy Dx 5 5 $1,687.00 $1,687.00 $844.00 $1,687.00 $1,687.00 2025-11-19
45065278 CDM Cmplx Rpr Face//nk/ax/g/h/fea 5 5 $1,687.00 $1,687.00 $844.00 $1,687.00 $1,687.00 2025-11-19
45084518 CDM OB US >= 14 Wks Single Fetus 5 5 $1,685.00 $1,685.00 $843.00 $1,685.00 $1,685.00 2025-11-19
45028659 CDM Complx Rpr Eyld/nose/ear/lips 5 5 $1,672.00 $1,672.00 $836.00 $1,672.00 $1,672.00 2025-11-19
J3262 HCPCS Tocilizumab 20 Mg/ml 20 Ml 19 13 $6,673.00 $6,673.00 $5.00 $6,673.00 $1,668.00 2025-11-19
25980311 CDM Immune Globulin 10%vl 1gm Vial 5 5 $1,648.00 $1,648.00 $824.00 $1,648.00 $1,648.00 2025-11-19
34000010 CDM Indium Ptpa 5 5 $1,641.00 $1,641.00 $821.00 $1,641.00 $1,641.00 2025-11-19
25980299 CDM Aldesleukin 22mu Vial 5 5 $1,637.00 $1,637.00 $819.00 $1,637.00 $1,637.00 2025-11-19
25080085 CDM Ipratropium Bromide 17mcg/dose 5 5 $1,630.00 $1,630.00 $815.00 $1,630.00 $1,630.00 2025-11-19
27001138 CDM Sphincterotome 5 5 $1,624.00 $1,624.00 $812.00 $1,624.00 $1,624.00 2025-11-19
27000476 CDM Carrion Penile 5 5 $1,620.00 $1,620.00 $810.00 $1,620.00 $1,620.00 2025-11-19
25100020 CDM Imogam Rabies 150 U 5 5 $1,620.00 $1,620.00 $810.00 $1,620.00 $1,620.00 2025-11-19
80100019 CDM Plasma Apheresis 5 5 $1,608.00 $1,608.00 $804.00 $1,608.00 $1,608.00 2025-11-19
27000649 CDM Cutter Linear 75mm Green Tct75 5 5 $1,602.00 $1,602.00 $801.00 $1,602.00 $1,602.00 2025-11-19
750453312 CDM Sigmodoscopy W/procedure 5 5 $1,576.00 $1,576.00 $788.00 $1,576.00 $1,576.00 2025-11-19
45068593 CDM Treatment Clsd Elbow Disl Without 5 5 $1,570.00 $1,570.00 $785.00 $1,570.00 $1,570.00 2025-11-19
45055252 CDM Trachstomy Cricthyroid Emrgncy 5 5 $1,561.00 $1,561.00 $781.00 $1,561.00 $1,561.00 2025-11-19
36569 CPT Picc Ins Wo Port/pump Wo IM 5+ 19 13 $2,461.00 $2,461.00 $1,045.00 $2,461.00 $1,559.00 2025-11-19
370120147 CDM Anesth Mac/reg 1st 60min 5 5 $1,550.00 $1,550.00 $775.00 $1,550.00 $1,550.00 2025-11-19
32408 CPT Biopsy Percutaneous Lung/medi 14 13 $4,681.00 $4,681.00 $1,202.00 $4,681.00 $1,540.50 2025-11-19
69205 CPT Removl Fb Ext Aud Canal W/anes 14 13 $4,165.00 $4,165.00 $1,202.00 $4,165.00 $1,540.50 2025-11-19
10140 CPT I&d Hematoma 14 13 $3,412.00 $3,412.00 $1,202.00 $3,412.00 $1,540.50 2025-11-19
23655 CPT Clsd Tx Shldr Dis W/man W/anes 14 13 $4,113.00 $4,113.00 $1,192.00 $4,113.00 $1,527.00 2025-11-19
12000041 CDM Bedhold Asa3 Vent 5 5 $1,508.00 $1,508.00 $754.00 $1,508.00 $1,508.00 2025-11-19
J0637 HCPCS Caspofungin Acetate 70mg Ivpb 15 5 $1,508.00 $1,508.00 $65.00 $1,943.00 $1,508.00 2025-11-19
12000031 CDM Bed Hold-asa Vent 5 5 $1,508.00 $1,508.00 $754.00 $1,508.00 $1,508.00 2025-11-19
25990131 CDM Peginterferon Alfa-2b 80mcg 5 5 $1,505.00 $1,505.00 $753.00 $1,505.00 $1,505.00 2025-11-19
ANTIZOL CDM Antizol 6 6 $1,504.00 $1,504.00 $752.00 $1,504.00 $1,504.00 2025-11-19
32551 CPT Chest Tube Insertion 14 13 $1,738.00 $1,738.00 $869.00 $1,855.00 $1,484.00 2025-11-19
93503 CPT Swan Ganz Catheter 14 13 $788.00 $788.00 $394.00 $1,855.00 $1,484.00 2025-11-19
75822 CPT Venography Extremity Bilateral 14 13 $1,479.00 $1,479.00 $740.00 $1,855.00 $1,484.00 2025-11-19
36573 CPT In Picc Wo Port/pump W/img 5+ 14 13 $2,375.00 $2,375.00 $1,187.00 $2,375.00 $1,484.00 2025-11-19
25087300 CDM Carimune Nf 12gm Vial 5 5 $1,480.00 $1,480.00 $740.00 $1,480.00 $1,480.00 2025-11-19
360428563 CDM Aborted Surgical Case 5 5 $1,470.00 $1,470.00 $735.00 $1,470.00 $1,470.00 2025-11-19
25080938 CDM Becaplermin 15 Gm Gel 5 5 $1,453.00 $1,453.00 $727.00 $1,453.00 $1,453.00 2025-11-19
VELCADE3.5 CDM Velcade 3.5 Mg Injection 6 6 $1,451.00 $1,451.00 $726.00 $1,451.00 $1,451.00 2025-11-19
C1780 HCPCS Lens Intraocular 5 5 $1,446.00 $1,446.00 $723.00 $1,446.00 $1,446.00 2025-11-19
27000618 CDM Ax55g Articulator 5 5 $1,442.00 $1,442.00 $721.00 $1,442.00 $1,442.00 2025-11-19
80100018 CDM Bicarbonate Dialysis 5 5 $1,436.00 $1,436.00 $718.00 $1,436.00 $1,436.00 2025-11-19
45059638 CDM Cl Tx Post Hip Disloc Without Anes 5 5 $1,435.00 $1,435.00 $718.00 $1,435.00 $1,435.00 2025-11-19
45062859 CDM Complx Rpr Eyld/nose/ear/lips 5 5 $1,431.00 $1,431.00 $716.00 $1,431.00 $1,431.00 2025-11-19
45035298 CDM Cmplx Rpr Fh/ck/ch/m/n/ax/g/h/ 5 5 $1,431.00 $1,431.00 $716.00 $1,431.00 $1,431.00 2025-11-19
25087046 CDM Snake Antivenin Equine Inject 5 5 $1,430.00 $1,430.00 $715.00 $1,430.00 $1,430.00 2025-11-19
73725 CPT MRA Lower Ext W/wo Contrast 5 5 $1,415.00 $1,415.00 $708.00 $1,415.00 $1,415.00 2025-11-19
41828 CPT Fluphenazine Hcl 5mg/2ml Inj 14 13 $5.00 $5.00 $3.00 $1,767.00 $1,413.00 2025-11-19
45027585 CDM Straight Catheter Insertion 5 5 $1,397.00 $1,397.00 $699.00 $1,397.00 $1,397.00 2025-11-19
45034285 CDM Cl Tx Articular Fx Mcp/ip Jnt 5 5 $1,397.00 $1,397.00 $699.00 $1,397.00 $1,397.00 2025-11-19
45025484 CDM Cl Tx Prox Fib/shaft Fx W Mani 5 5 $1,397.00 $1,397.00 $699.00 $1,397.00 $1,397.00 2025-11-19
6362965439 CDM Octagam 5% 100ml 5 5 $1,391.00 $1,391.00 $696.00 $1,391.00 $1,391.00 2025-11-19
36001740 CDM Beach Chair 5 5 $1,381.00 $1,381.00 $691.00 $1,381.00 $1,381.00 2025-11-19
27010304 CDM Eye Lens 5 5 $1,351.00 $1,351.00 $676.00 $1,351.00 $1,351.00 2025-11-19
36001741 CDM Knee Ice Pad & Cooler 5 5 $1,350.00 $1,350.00 $675.00 $1,350.00 $1,350.00 2025-11-19
45034251 CDM Clsd Tx Distal Radial Fx Without M 5 5 $1,338.00 $1,338.00 $669.00 $1,338.00 $1,338.00 2025-11-19
45065390 CDM Intrmd Wnd Rpr Fc/er/el/n/l/mm 5 5 $1,320.00 $1,320.00 $660.00 $1,320.00 $1,320.00 2025-11-19
45075418 CDM Intrmd Wnd Rpr Sclp/ax/tr/ext 5 5 $1,320.00 $1,320.00 $660.00 $1,320.00 $1,320.00 2025-11-19
45032623 CDM Intrmd Wnd Rpr Nk/hnd/ft/gen 2 5 5 $1,320.00 $1,320.00 $660.00 $1,320.00 $1,320.00 2025-11-19
78452 CPT Myocard Spect Sngl 14 13 $2,275.00 $2,275.00 $1,053.00 $2,275.00 $1,316.00 2025-11-19
78453 CPT Myocard Spect Multi 14 13 $2,108.00 $2,108.00 $1,053.00 $2,108.00 $1,316.00 2025-11-19
78111 CPT Ansaid 100mg Tablet 14 13 $1.00 $1.00 $1.00 $1,645.00 $1,316.00 2025-11-19
25081235 CDM Dinoprostone 20 Ms Supp. Vag 5 5 $1,296.00 $1,296.00 $648.00 $1,296.00 $1,296.00 2025-11-19
27009883 CDM Camino 1104hc 5 5 $1,280.00 $1,280.00 $640.00 $1,280.00 $1,280.00 2025-11-19
45065388 CDM Intrmd Wnd Rpr Fc/er/el/n/l/mm 5 5 $1,265.00 $1,265.00 $633.00 $1,265.00 $1,265.00 2025-11-19
270207444 CDM Sealer Enseal Tissue Lg 20cm 5 5 $1,262.00 $1,262.00 $631.00 $1,262.00 $1,262.00 2025-11-19
C1776 HCPCS Acetabular Component 25 5 $1,261.00 $1,261.00 $60.00 $3,177.00 $1,261.00 2025-11-19
27000429 CDM Hip:astn-more Solid 5 5 $1,247.00 $1,247.00 $624.00 $1,247.00 $1,247.00 2025-11-19
J9263 HCPCS Eloxatin 100mg 10 5 $1,870.00 $1,870.00 $608.00 $2,525.00 $1,239.00 2025-11-19
36001725 CDM Cutter Linear 75mm Blue 5 5 $1,224.00 $1,224.00 $612.00 $1,224.00 $1,224.00 2025-11-19
27000133 CDM Hydrocephalus Shunt 5 5 $1,217.00 $1,217.00 $609.00 $1,217.00 $1,217.00 2025-11-19
27000451 CDM Hydrocephalus Shunt3 5 5 $1,217.00 $1,217.00 $609.00 $1,217.00 $1,217.00 2025-11-19
CARIMUNE12 CDM Carimune Nf 12 Gram Vial 5 5 $1,212.00 $1,212.00 $606.00 $1,212.00 $1,212.00 2025-11-19
12000030 CDM Bed Hold-asa Non Vent 5 5 $1,203.00 $1,203.00 $602.00 $1,203.00 $1,203.00 2025-11-19
45095672 CDM Intrmd Wnd Rpr Sclp/ax/tr/ext 5 5 $1,187.00 $1,187.00 $594.00 $1,187.00 $1,187.00 2025-11-19
88237 CPT Cml Chromosome / Fish Profile 5 5 $1,184.00 $1,184.00 $592.00 $1,184.00 $1,184.00 2025-11-19
27054032 CDM Tube Linton 5 5 $1,183.00 $1,183.00 $592.00 $1,183.00 $1,183.00 2025-11-19
270207445 CDM Sealer Enseal Tissue Crvd 37cm 5 5 $1,176.00 $1,176.00 $588.00 $1,176.00 $1,176.00 2025-11-19
27010410 CDM Sutjre:auto Eea 5 5 $1,171.00 $1,171.00 $586.00 $1,171.00 $1,171.00 2025-11-19
45065382 CDM Intrmd Wnd Rpr Fc/er/el/ns/lip 5 5 $1,167.00 $1,167.00 $584.00 $1,167.00 $1,167.00 2025-11-19
45084521 CDM US Guide Needle Asp/bx/inj 5 5 $1,162.00 $1,162.00 $581.00 $1,162.00 $1,162.00 2025-11-19
36001742 CDM Mini-c-arm 5 5 $1,151.00 $1,151.00 $576.00 $1,151.00 $1,151.00 2025-11-19
45069876 CDM Peripheral Nerve Block 5 5 $1,150.00 $1,150.00 $575.00 $1,150.00 $1,150.00 2025-11-19
45023518 CDM Repair Complex Trunk Each Addl 5 5 $1,147.00 $1,147.00 $574.00 $1,147.00 $1,147.00 2025-11-19
45075485 CDM Ussoft Tissue Head/neck 5 5 $1,146.00 $1,146.00 $573.00 $1,146.00 $1,146.00 2025-11-19
45085321 CDM Ankle/foot Immobilizer 5 5 $1,144.00 $1,144.00 $572.00 $1,144.00 $1,144.00 2025-11-19
45084157 CDM Intrmd Wnd Rpr Sclp/ax/tr/ext 5 5 $1,143.00 $1,143.00 $572.00 $1,143.00 $1,143.00 2025-11-19
45052326 CDM Pericardiocentesis Initial 5 5 $1,132.00 $1,132.00 $566.00 $1,132.00 $1,132.00 2025-11-19
45065381 CDM Intrmd Wnd Rpr Fc/er/el/ns/lip 5 5 $1,131.00 $1,131.00 $566.00 $1,131.00 $1,131.00 2025-11-19
45068596 CDM Clsd Tx Fx Foot Phalanges W/ma 5 5 $1,131.00 $1,131.00 $566.00 $1,131.00 $1,131.00 2025-11-19
45385 CPT Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope 14 13 $61,772.00 $61,772.00 $875.00 $61,772.00 $1,121.00 2025-11-19
45380 CPT Biopsy Exam Of Large Bowel Using An Endoscope 14 13 $61,772.00 $61,772.00 $875.00 $61,772.00 $1,121.00 2025-11-19
27010804 CDM Tube Blakemore Adult 20fr 39"l 5 5 $1,111.00 $1,111.00 $556.00 $1,111.00 $1,111.00 2025-11-19
80100001 CDM Acute Hemodialysis 5 5 $1,108.00 $1,108.00 $554.00 $1,108.00 $1,108.00 2025-11-19
27010344 CDM Tct Linear Cutter 55 5 5 $1,106.00 $1,106.00 $553.00 $1,106.00 $1,106.00 2025-11-19
45032951 CDM Intrmd Wnd Rpr Nk/hnd/ft/gen 7 5 5 $1,105.00 $1,105.00 $553.00 $1,105.00 $1,105.00 2025-11-19
93618 CPT Vantin 200mg Tab**non Formulary** 14 13 $5.00 $5.00 $3.00 $1,379.00 $1,103.00 2025-11-19
45023516 CDM Repair Comp Trunk 1.1cm-2.5cm 5 5 $1,100.00 $1,100.00 $550.00 $1,100.00 $1,100.00 2025-11-19
ACTEMRA10 CDM Actemra Inj 6 6 $1,077.00 $1,077.00 $539.00 $1,077.00 $1,077.00 2025-11-19
J0630 HCPCS Miacalcin 200 Un/ml Vial 2ml 13 12 $132.00 $132.00 $66.00 $1,123.00 $1,070.00 2025-11-19
45082541 CDM Intrmd Wnd Rpr Nk/hnd/ft/gen 1 5 5 $1,070.00 $1,070.00 $535.00 $1,070.00 $1,070.00 2025-11-19
45065399 CDM Intrmd Wnd Rpr Fc/er/el/n/l/mm 5 5 $1,065.00 $1,065.00 $533.00 $1,065.00 $1,065.00 2025-11-19
2502345346 CDM Valganciclovir 450mg Tablet 5 5 $1,057.00 $1,057.00 $529.00 $1,057.00 $1,057.00 2025-11-19
45025478 CDM Usretroperitoneal Limited 5 5 $1,051.00 $1,051.00 $526.00 $1,051.00 $1,051.00 2025-11-19
25087393 CDM Desmopressin 0.1 Tab 5 5 $1,043.00 $1,043.00 $522.00 $1,043.00 $1,043.00 2025-11-19
27561 CPT Xigris 20 Mg 5 5 $1,038.00 $1,038.00 $519.00 $1,038.00 $1,038.00 2025-11-19
12000029 CDM S.n.f Room Charge 5 5 $1,033.00 $1,033.00 $517.00 $1,033.00 $1,033.00 2025-11-19
45032651 CDM Complx Repair Sclp/arms/legs 1 5 5 $1,032.00 $1,032.00 $516.00 $1,032.00 $1,032.00 2025-11-19
74248 CPT X-ray Fluoro Up Gi W/sm Bowel 5 5 $1,031.00 $1,031.00 $516.00 $1,031.00 $1,031.00 2025-11-19
27000483 CDM Usci Bif:knitted 5 5 $1,030.00 $1,030.00 $515.00 $1,030.00 $1,030.00 2025-11-19
40261 CPT Cellcept 200 Mg * Non Form* 5 5 $1,027.00 $1,027.00 $514.00 $1,027.00 $1,027.00 2025-11-19
4501326 CDM Drainage Of Finger Abscess Com 5 5 $1,020.00 $1,020.00 $510.00 $1,020.00 $1,020.00 2025-11-19
45065398 CDM Intrmd Wnd Rpr Fc/er/el/n/l/mm 5 5 $1,014.00 $1,014.00 $507.00 $1,014.00 $1,014.00 2025-11-19
76937 CPT U/s Guid Vasc Acc Needle ENT 5 5 $1,014.00 $1,014.00 $507.00 $1,014.00 $1,014.00 2025-11-19
Z7610 HCPCS Tray Multi Perc Trach 10 5 $1,084.50 $1,084.50 $504.00 $1,162.00 $1,007.00 2025-11-19
J9045 HCPCS Carboplatin 450 Mg/vial Vial 10 5 $1,830.00 $1,830.00 $183.00 $3,294.00 $1,006.50 2025-11-19
45095624 CDM Intrmd Wnd Rpr Sclp/ax/tr/ext 5 5 $989.00 $989.00 $495.00 $989.00 $989.00 2025-11-19
73225 CPT MRA Upper Ext W/wo Contrast 5 5 $979.00 $979.00 $490.00 $979.00 $979.00 2025-11-19
45015242 CDM Ultrasound Testicular 5 5 $977.00 $977.00 $489.00 $977.00 $977.00 2025-11-19
25087433 CDM Lidoderm 5% Patch 5 5 $977.00 $977.00 $489.00 $977.00 $977.00 2025-11-19
45084516 CDM OB US < 14 Wks Single Fetus 5 5 $963.00 $963.00 $482.00 $963.00 $963.00 2025-11-19
FLEBOGAM10 CDM Felbogamma 5% 10gm Vial 6 6 $957.00 $957.00 $479.00 $957.00 $957.00 2025-11-19
FLEBO10 CDM Immune Globulin 10% 10gm Vial 6 6 $957.00 $957.00 $479.00 $957.00 $957.00 2025-11-19
27010349 CDM Tpv 30 Reloader Linear 5 5 $954.00 $954.00 $477.00 $954.00 $954.00 2025-11-19
27000648 CDM Blue 55 Reloader 5 5 $949.00 $949.00 $475.00 $949.00 $949.00 2025-11-19
76942 CPT U/s Guided Needle Placement 5 5 $937.00 $937.00 $469.00 $937.00 $937.00 2025-11-19
45086531 CDM Ultrasound Chest 5 5 $925.00 $925.00 $463.00 $925.00 $925.00 2025-11-19
25087447 CDM Symbicort 160/4.5 Mcg Inh 5 5 $924.00 $924.00 $462.00 $924.00 $924.00 2025-11-19
INVEGA117 CDM Invega Sustenna 117mg/0.75ml 6 6 $916.00 $916.00 $458.00 $916.00 $916.00 2025-11-19
18743 CPT Isuprel 0.2mg/ml Ampule 5 5 $915.00 $915.00 $458.00 $915.00 $915.00 2025-11-19
J0348 HCPCS Eraxis 100 Mg 10 5 $1,364.50 $1,364.50 $451.00 $1,828.00 $907.50 2025-11-19
270207369 CDM Cutter Linear 45mm Artcl 340mm 5 5 $900.00 $900.00 $450.00 $900.00 $900.00 2025-11-19
27000462 CDM Pin Set:rush 5 5 $899.00 $899.00 $450.00 $899.00 $899.00 2025-11-19
27000144 CDM Pin Set Rush 5 5 $899.00 $899.00 $450.00 $899.00 $899.00 2025-11-19
OCTA10 CDM Octagam 5% (10000 Mg) 200 Ml Vial 6 6 $898.00 $898.00 $449.00 $898.00 $898.00 2025-11-19
OCTA10G CDM Octagam 10% (10000 Mg) 100 Ml Vial 6 6 $898.00 $898.00 $449.00 $898.00 $898.00 2025-11-19
45075482 CDM Pulmonary Stress Test/simple 5 5 $897.00 $897.00 $449.00 $897.00 $897.00 2025-11-19
27000208 CDM Trv 30 Stapler 5 5 $897.00 $897.00 $449.00 $897.00 $897.00 2025-11-19
27010336 CDM Trv 30 Stapler 5 5 $897.00 $897.00 $449.00 $897.00 $897.00 2025-11-19
27000608 CDM Cloutier Bretainer 5 5 $888.00 $888.00 $444.00 $888.00 $888.00 2025-11-19
71080182 CDM Pacu Complex Addl 15min 5 5 $882.00 $882.00 $441.00 $882.00 $882.00 2025-11-19
45378 CPT Diagnostic Exam Of Large Bowel Using An Endoscope 14 13 $5,873.00 $5,873.00 $678.00 $5,873.00 $868.00 2025-11-19
25087144 CDM Win Rho 1.5 Mu Inj 5 5 $865.00 $865.00 $433.00 $865.00 $865.00 2025-11-19
36001062 CDM Sht Stay Surg Catar 1st 30 Min 5 5 $864.00 $864.00 $432.00 $864.00 $864.00 2025-11-19
36001089 CDM Sht Stay Surg Arthro 30 Min 5 5 $864.00 $864.00 $432.00 $864.00 $864.00 2025-11-19
27000557 CDM Tray-total Joint 5 5 $862.00 $862.00 $431.00 $862.00 $862.00 2025-11-19
49082 CPT Paracentesis Abd Without Imaging 14 13 $2,625.00 $2,625.00 $672.00 $2,625.00 $861.00 2025-11-19
43239 CPT Biopsy Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 14 13 $8,190.00 $8,190.00 $672.00 $8,190.00 $861.00 2025-11-19
43235 CPT Diagnostic Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 14 13 $61,772.00 $61,772.00 $672.00 $61,772.00 $861.00 2025-11-19
49083 CPT Paracentesis Abdomen W/imaging 14 13 $2,993.00 $2,993.00 $672.00 $2,993.00 $861.00 2025-11-19
45063529 CDM Cmplx Rpr Fh/ck/ch/m/n/ax/g/h/ 5 5 $852.00 $852.00 $426.00 $852.00 $852.00 2025-11-19
36000882 CDM O/r Hour(s) 5 5 $852.00 $852.00 $426.00 $852.00 $852.00 2025-11-19
J0878 HCPCS Cubicin 500mg / Daptomycin Inj 5 5 $851.00 $851.00 $426.00 $851.00 $851.00 2025-11-19
45330 CPT Sigmodoscopy Dx 14 13 $1,166.00 $1,166.00 $583.00 $1,166.00 $847.00 2025-11-19
64483 CPT Injection(s) Of Anesthetic Into Lower Spine Using Imaging Guidance 19 13 $1,550.00 $1,550.00 $292.00 $1,550.00 $845.00 2025-11-19
62280 CPT Subarachnoid 14 13 $372.00 $372.00 $186.00 $1,056.00 $845.00 2025-11-19
64530 CPT Celiac Plexus 14 13 $584.00 $584.00 $292.00 $1,056.00 $845.00 2025-11-19
62322 CPT Injection(s) Of Therapeutic Substance 14 13 $1,550.00 $1,550.00 $676.00 $1,550.00 $845.00 2025-11-19
64479 CPT Transforaminal Epidural Cerv 14 13 $416.00 $416.00 $208.00 $1,056.00 $845.00 2025-11-19
64430 CPT Pudental Nerve 14 13 $372.00 $372.00 $186.00 $1,056.00 $845.00 2025-11-19
64520 CPT Lumbar Sympathetic 14 13 $466.00 $466.00 $233.00 $1,056.00 $845.00 2025-11-19
64421 CPT Intercostal Multiple 14 13 $372.00 $372.00 $186.00 $1,056.00 $845.00 2025-11-19
62282 CPT Epidural Lumbar Caudal 14 13 $416.00 $416.00 $208.00 $1,056.00 $845.00 2025-11-19
64600 CPT Trigeminal Nerve 14 13 $372.00 $372.00 $186.00 $1,056.00 $845.00 2025-11-19
64415 CPT Brachial Plexus 14 13 $416.00 $416.00 $208.00 $1,056.00 $845.00 2025-11-19
64417 CPT Axillary Nerve Block 14 13 $416.00 $416.00 $208.00 $1,056.00 $845.00 2025-11-19
88267 CPT Chrom Anal Amnio-l01 5 5 $845.00 $845.00 $423.00 $845.00 $845.00 2025-11-19
64510 CPT Stellate Ganglion 14 13 $372.00 $372.00 $186.00 $1,056.00 $845.00 2025-11-19
99291 CPT Critical Care, 1st Hour 14 13 $5,422.00 $5,422.00 $658.00 $5,422.00 $843.00 2025-11-19
J2785 HCPCS Lexiscan 0.4 Mg Syringe 5 5 $838.00 $838.00 $419.00 $838.00 $838.00 2025-11-19
27010348 CDM Tcr 75 Reloader 5 5 $825.00 $825.00 $413.00 $825.00 $825.00 2025-11-19
99053 CPT Service(s) Provided 10pm-8am 5 5 $821.00 $821.00 $411.00 $821.00 $821.00 2025-11-19
12000001 CDM Vip Room Rate 5 5 $821.00 $821.00 $411.00 $821.00 $821.00 2025-11-19
93320 CPT Doppler Echo 5 5 $821.00 $821.00 $411.00 $821.00 $821.00 2025-11-19
27000640 CDM Craniotomy Tray 5 5 $821.00 $821.00 $411.00 $821.00 $821.00 2025-11-19
88309 CPT Surg Path Level Vi 5 5 $810.00 $810.00 $405.00 $810.00 $810.00 2025-11-19
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