Price Transparencybeta 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

Your selected procedure

You selected 45378 (CPT)

Diagnostic exam of large bowel using an endoscope

This hospital’s price: $1,220 across 13 payers · range $952-$5,873

Source: https://secure.claraprice.net/price-transparency/ZFYY-1731000747134/machine-readable/330737312_pacifica-hospital-of-the-valley_standardcharges.json · observed 2025-11-19

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

6,012 distinct procedures filed
16 distinct payers
46,864 rate rows
2025-11-19 last MRF observed
Data quality

45,226 of 46,864 rate rows are consumer-grade (96.5%)

1,638 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 1,063
per-diem day rate — not a per-procedure price 570
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 5
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbPacificaSunValleyCA&type=CDMWithoutLabel
Found on page https://pacificahospital.com/services/phv-pricing-information/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-08

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
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
$3,950
outlier · 4.6×
27130
CPT 		Hiptotal 13 $2,823.00 $20,540.00 $16,432.00 nat. median
$12,734
1.3× median
27447
CPT 		Kneetotal 13 $3,544.00 $20,540.00 $16,432.00 nat. median
$12,374
1.3× median
360120246
CDM 		Surgery Level 4 1st 30min 5 $7,098.00 $14,195.00 $14,195.00 nat. median
$14,195
1.0× median
55866
CPT 		Surgical Removal Of Prostate And Surrounding Lymph Nodes Using An Endoscope 13 $10,884.00 $69,592.00 $13,945.00 nat. median
$10,013
1.4× median
55700
CPT 		Biopsy Of Prostate Gland 5 $6,517.00 $13,033.00 $13,033.00 nat. median
$1,997
outlier · 6.5×
360458550
CDM 		Bronchoscopy 5 $6,197.00 $12,393.00 $12,393.00 nat. median
$12,393
1.0× median
J2993
HCPCS 		Reteplase 18.1 Mg Kit 5 $5,521.00 $11,042.00 $11,042.00 nat. median
$3,172
outlier · 3.5×
360220220
CDM 		Surgery Level 3 1st 30min 5 $5,460.00 $10,920.00 $10,920.00 nat. median
$10,920
1.0× median
27004852
CDM 		Penile Prosthesisinf 5 $4,652.00 $9,304.00 $9,304.00 nat. median
$9,304
1.0× median
23405
CPT 		Hibiclens 4% Liquid 13 $2.00 $11,609.00 $9,287.00 nat. median
$4,789
1.9× median
24134
CPT 		Neo-synephrine 0.25% Spray 13 $2.00 $11,609.00 $9,287.00 nat. median
$5,470
1.7× 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
47562
CPT 		Removal Of Gallbladder Using An Endoscope 13 $6,190.00 $25,236.00 $7,931.50 nat. median
$6,043
1.3× median
54408
CPT 		Imuran 50mg Tablet 13 $1.00 $8,578.00 $6,863.00 nat. median
$5,504
1.2× 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
J1162
HCPCS 		Digoxin Immune Fab 40 Mg Vial 13 $983.00 $11,056.00 $5,383.00 nat. median
$6,265
0.9× median
J9041
HCPCS 		Bortezomib 3.5mg Inj 5 $2,657.00 $5,314.00 $5,314.00 nat. median
$89
outlier · 60.0×
J2997
HCPCS 		Activase(alteplase) 50 Mg Vial 13 $92.00 $12,324.00 $5,176.00 nat. median
$428
outlier · 12.1×
19120
CPT 		Removal Of One Or More Breast Growth, Open Procedure 13 $4,009.00 $15,293.00 $5,136.50 nat. median
$3,683
1.4× median
25087054
CDM 		Crolalidae Polyvalent Immu Inj 5 $2,365.00 $4,730.00 $4,730.00 nat. median
$4,730
1.0× median
49505
CPT 		Repair Of Groin Hernia Patient Age 5 Years Or Older 13 $3,666.00 $18,765.00 $4,697.50 nat. median
$4,049
1.2× 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
$3,795
1.2× median
20000003
CDM 		Room Charge Surge Unit ICU 5 $2,177.00 $4,354.00 $4,354.00 nat. median
$4,354
1.0× median
20000001
CDM 		D.o. Room Charge ICU 5 $2,172.00 $4,344.00 $4,344.00 nat. median
$3,395
1.3× median
29881
CPT 		Removal Of One Knee Cartilage Using An Endoscope 13 $3,350.00 $18,342.00 $4,292.50 nat. median
$3,680
1.2× median
25145
CPT 		Cytotec 100 Mcg Tablet 13 $1.00 $5,235.00 $4,188.00 nat. median
$3,256
1.3× median
ALTEPL50VL
CDM 		Activase 100mg Vial 6 $2,028.00 $4,056.00 $4,056.00 nat. median
$4,056
1.0× median
36555
CPT 		Ins Non-tun Cvc <5 Yrs Old 13 $1,768.00 $5,052.00 $4,041.00 nat. median
$2,968
1.4× median
36556
CPT 		Ins Non-tun Cvc >5 Yrs Old 13 $1,768.00 $5,052.00 $4,041.00 nat. median
$2,885
1.4× median
75743
CPT 		Angio, Pulmonary,bilateral,sel 13 $1,619.00 $5,052.00 $4,041.00 nat. median
$3,197
1.3× median
93505
CPT 		Endomyocardial Biopsy 13 $1,668.00 $5,052.00 $4,041.00 nat. median
$3,500
1.2× median
75716
CPT 		Angio, Extremity, Bilateral 13 $1,985.00 $5,052.00 $4,041.00 nat. median
$3,197
1.3× median
750256352
CDM 		Egd W/procedure 5 $1,927.00 $3,854.00 $3,854.00 nat. median
$3,854
1.0× median
J9312
HCPCS 		Rituzimab 500mg Ivpb 13 $2,931.00 $10,398.00 $3,755.50 nat. median
$739
outlier · 5.1×
38305
CPT 		Hydrea 500mg Capsule 13 $1.00 $4,647.00 $3,718.00 nat. median
$2,870
1.3× 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
$1,519
outlier · 2.3×
77012
CPT 		CT Guided Needle Placement 5 $1,758.00 $3,516.00 $3,516.00 nat. median
$679
outlier · 5.2×
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
$193
outlier · 17.9×
25087332
CDM 		Rituxan 500 Mg 5 $1,674.00 $3,348.00 $3,348.00 nat. median
$3,348
1.0× median

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
27447 CPT Kneetotal 14 13 $7,087.00 $7,087.00 $3,544.00 $20,540.00 $16,432.00 2025-11-19
27130 CPT Hiptotal 14 13 $5,646.00 $5,646.00 $2,823.00 $20,540.00 $16,432.00 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
55866 CPT Surgical Removal Of Prostate And Surrounding Lymph Nodes Using An Endoscope 14 13 $69,592.00 $69,592.00 $10,884.00 $69,592.00 $13,945.00 2025-11-19
55700 CPT Biopsy Of Prostate Gland 5 5 $13,033.00 $13,033.00 $6,517.00 $13,033.00 $13,033.00 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
J2993 HCPCS Reteplase 18.1 Mg Kit 5 5 $11,042.00 $11,042.00 $5,521.00 $11,042.00 $11,042.00 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
27004852 CDM Penile Prosthesisinf 5 5 $9,304.00 $9,304.00 $4,652.00 $9,304.00 $9,304.00 2025-11-19
23405 CPT Hibiclens 4% Liquid 14 13 $4.00 $4.00 $2.00 $11,609.00 $9,287.00 2025-11-19
24134 CPT Neo-synephrine 0.25% Spray 14 13 $3.00 $3.00 $2.00 $11,609.00 $9,287.00 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
47562 CPT Removal Of Gallbladder Using An Endoscope 14 13 $25,236.00 $25,236.00 $6,190.00 $25,236.00 $7,931.50 2025-11-19
54408 CPT Imuran 50mg Tablet 14 13 $1.00 $1.00 $1.00 $8,578.00 $6,863.00 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
J1162 HCPCS Digoxin Immune Fab 40 Mg Vial 19 13 $11,056.00 $11,056.00 $983.00 $11,056.00 $5,383.00 2025-11-19
J9041 HCPCS Bortezomib 3.5mg Inj 5 5 $5,314.00 $5,314.00 $2,657.00 $5,314.00 $5,314.00 2025-11-19
J2997 HCPCS Activase(alteplase) 50 Mg Vial 47 13 $10,068.00 $10,068.00 $92.00 $12,324.00 $5,176.00 2025-11-19
19120 CPT Removal Of One Or More Breast Growth, Open Procedure 14 13 $15,293.00 $15,293.00 $4,009.00 $15,293.00 $5,136.50 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
49505 CPT Repair Of Groin Hernia Patient Age 5 Years Or Older 14 13 $18,765.00 $18,765.00 $3,666.00 $18,765.00 $4,697.50 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
29881 CPT Removal Of One Knee Cartilage Using An Endoscope 14 13 $18,342.00 $18,342.00 $3,350.00 $18,342.00 $4,292.50 2025-11-19
25145 CPT Cytotec 100 Mcg Tablet 14 13 $1.00 $1.00 $1.00 $5,235.00 $4,188.00 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
36555 CPT Ins Non-tun Cvc <5 Yrs Old 14 13 $3,536.00 $3,536.00 $1,768.00 $5,052.00 $4,041.00 2025-11-19
75743 CPT Angio, Pulmonary,bilateral,sel 14 13 $3,238.00 $3,238.00 $1,619.00 $5,052.00 $4,041.00 2025-11-19
93505 CPT Endomyocardial Biopsy 14 13 $3,336.00 $3,336.00 $1,668.00 $5,052.00 $4,041.00 2025-11-19
75716 CPT Angio, Extremity, Bilateral 14 13 $3,969.00 $3,969.00 $1,985.00 $5,052.00 $4,041.00 2025-11-19
36556 CPT Ins Non-tun Cvc >5 Yrs Old 14 13 $3,536.00 $3,536.00 $1,768.00 $5,052.00 $4,041.00 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
J9312 HCPCS Rituzimab 500mg Ivpb 14 13 $10,398.00 $10,398.00 $2,931.00 $10,398.00 $3,755.50 2025-11-19
38305 CPT Hydrea 500mg Capsule 14 13 $1.00 $1.00 $1.00 $4,647.00 $3,718.00 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
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
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
J9355 HCPCS Herceptin 440 Mg Mov 14 13 $7,288.00 $7,288.00 $2,472.00 $7,288.00 $3,168.00 2025-11-19
66984 CPT Removal Of Cataract With Insertion Of Lens 14 13 $27,945.00 $27,945.00 $2,363.00 $27,945.00 $3,027.50 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
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
J2426 HCPCS Invega 117 Mg Syringe 42 13 $3,377.00 $3,377.00 $1,444.00 $5,065.00 $2,948.50 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
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
36001730 CDM Holmuim Laser 5 5 $2,807.00 $2,807.00 $1,404.00 $2,807.00 $2,807.00 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
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
54001 CPT Prednisone 10mg 14 13 $6.00 $6.00 $3.00 $3,344.00 $2,676.00 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
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
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
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
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
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
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
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
32408 CPT Biopsy Percutaneous Lung/medi 14 13 $4,681.00 $4,681.00 $1,691.00 $4,681.00 $2,167.00 2025-11-19
J3262 HCPCS Tocilizumab 20mg/ml 10ml 28 13 $5,004.50 $5,004.50 $866.00 $6,673.00 $2,164.00 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
69205 CPT Removl Fb Ext Aud Canal W/anes 14 13 $4,165.00 $4,165.00 $1,691.00 $4,165.00 $2,114.00 2025-11-19
36569 CPT Picc Ins Wo Port/pump Wo IM 5+ 19 13 $2,461.00 $2,461.00 $1,045.00 $2,518.00 $2,090.00 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
32551 CPT Chest Tube Insertion 14 13 $1,738.00 $1,738.00 $869.00 $2,518.00 $2,015.00 2025-11-19
93503 CPT Swan Ganz Catheter 14 13 $788.00 $788.00 $394.00 $2,518.00 $2,015.00 2025-11-19
36573 CPT In Picc Wo Port/pump W/img 5+ 14 13 $2,375.00 $2,375.00 $1,188.00 $2,518.00 $2,015.00 2025-11-19
75822 CPT Venography Extremity Bilateral 14 13 $1,479.00 $1,479.00 $740.00 $2,518.00 $2,015.00 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
750432531 CDM Egd Dx 5 5 $1,986.00 $1,986.00 $993.00 $1,986.00 $1,986.00 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
41828 CPT Fluphenazine Hcl 5mg/2ml Inj 14 13 $5.00 $5.00 $3.00 $2,482.00 $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
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
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
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
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
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
A9521 HCPCS Ceretec Wbc Labeling 5 5 $1,924.00 $1,924.00 $962.00 $1,924.00 $1,924.00 2025-11-19
J0840 HCPCS Crofab (Antivenim) 14 13 $1,475.00 $1,475.00 $738.00 $2,384.00 $1,907.00 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
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
J2506 HCPCS Pegfilgrastim 6 Mg 14 13 $11,831.00 $11,831.00 $1,375.00 $11,831.00 $1,762.00 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
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
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
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
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
750555685 CDM Colonoscopy Dx 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
78111 CPT Ansaid 100mg Tablet 14 13 $1.00 $1.00 $1.00 $2,071.00 $1,657.00 2025-11-19
78452 CPT Myocard Spect Sngl 14 13 $2,275.00 $2,275.00 $1,138.00 $2,275.00 $1,657.00 2025-11-19
78453 CPT Myocard Spect Multi 14 13 $2,108.00 $2,108.00 $1,054.00 $2,108.00 $1,657.00 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
45385 CPT Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope 14 13 $61,772.00 $61,772.00 $1,225.00 $61,772.00 $1,570.00 2025-11-19
45380 CPT Biopsy Exam Of Large Bowel Using An Endoscope 14 13 $61,772.00 $61,772.00 $1,225.00 $61,772.00 $1,570.00 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
93618 CPT Vantin 200mg Tab**non Formulary** 14 13 $5.00 $5.00 $3.00 $1,948.00 $1,558.00 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
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
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
12000041 CDM Bedhold Asa3 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
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
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
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
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
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
45027585 CDM Straight Catheter Insertion 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
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
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
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
J9185 HCPCS Fludarabine 25mg/ml Ivpb 5 5 $1,261.00 $1,261.00 $631.00 $1,261.00 $1,261.00 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
45378 CPT Diagnostic Exam Of Large Bowel Using An Endoscope 14 13 $5,873.00 $5,873.00 $952.00 $5,873.00 $1,220.00 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
45330 CPT Sigmodoscopy Dx 14 13 $1,166.00 $1,166.00 $583.00 $1,488.00 $1,190.00 2025-11-19
49083 CPT Paracentesis Abdomen W/imaging 14 13 $2,993.00 $2,993.00 $929.00 $2,993.00 $1,190.00 2025-11-19
49082 CPT Paracentesis Abd Without Imaging 14 13 $2,625.00 $2,625.00 $929.00 $2,625.00 $1,190.00 2025-11-19
43235 CPT Diagnostic Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 14 13 $61,772.00 $61,772.00 $929.00 $61,772.00 $1,190.00 2025-11-19
43239 CPT Biopsy Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 14 13 $8,190.00 $8,190.00 $929.00 $8,190.00 $1,190.00 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
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
64479 CPT Transforaminal Epidural Cerv 14 13 $416.00 $416.00 $208.00 $1,415.00 $1,132.00 2025-11-19
64430 CPT Pudental Nerve 14 13 $372.00 $372.00 $186.00 $1,415.00 $1,132.00 2025-11-19
62322 CPT Injection(s) Of Therapeutic Substance 14 13 $1,550.00 $1,550.00 $775.00 $1,550.00 $1,132.00 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 $1,132.00 2025-11-19
64510 CPT Stellate Ganglion 14 13 $372.00 $372.00 $186.00 $1,415.00 $1,132.00 2025-11-19
64415 CPT Brachial Plexus 14 13 $416.00 $416.00 $208.00 $1,415.00 $1,132.00 2025-11-19
62282 CPT Epidural Lumbar Caudal 14 13 $416.00 $416.00 $208.00 $1,415.00 $1,132.00 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
62280 CPT Subarachnoid 14 13 $372.00 $372.00 $186.00 $1,415.00 $1,132.00 2025-11-19
64600 CPT Trigeminal Nerve 14 13 $372.00 $372.00 $186.00 $1,415.00 $1,132.00 2025-11-19
64421 CPT Intercostal Multiple 14 13 $372.00 $372.00 $186.00 $1,415.00 $1,132.00 2025-11-19
64520 CPT Lumbar Sympathetic 14 13 $466.00 $466.00 $233.00 $1,415.00 $1,132.00 2025-11-19
64530 CPT Celiac Plexus 14 13 $584.00 $584.00 $292.00 $1,415.00 $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
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
23655 CPT Clsd Tx Shldr Dis W/man W/anes 28 13 $2,275.00 $2,275.00 $219.00 $4,113.00 $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
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
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
85097 CPT Bone Marrow Smear 14 13 $474.00 $474.00 $237.00 $1,289.00 $1,031.00 2025-11-19
88309 CPT Surg Path Level Vi 14 13 $810.00 $810.00 $405.00 $1,289.00 $1,031.00 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
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
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
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
FLEBO10 CDM Immune Globulin 10% 10gm Vial 6 6 $957.00 $957.00 $479.00 $957.00 $957.00 2025-11-19
FLEBOGAM10 CDM Felbogamma 5% 10gm Vial 6 6 $957.00 $957.00 $479.00 $957.00 $957.00 2025-11-19
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
15050 CPT Megace 40mg/ml Oral Susp 14 13 $133.00 $133.00 $67.00 $1,182.00 $946.00 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
10140 CPT Drain Hematoma 28 13 $1,764.50 $1,764.50 $59.00 $3,412.00 $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
62323 CPT Injection(s) Of Therapeutic Substance 14 13 $1,550.00 $1,550.00 $723.00 $1,550.00 $903.00 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
OCTA10G CDM Octagam 10% (10000 Mg) 100 Ml Vial 6 6 $898.00 $898.00 $449.00 $898.00 $898.00 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
27000208 CDM Trv 30 Stapler 5 5 $897.00 $897.00 $449.00 $897.00 $897.00 2025-11-19
45075482 CDM Pulmonary Stress Test/simple 5 5 $897.00 $897.00 $449.00 $897.00 $897.00 2025-11-19
27010336 CDM Trv 30 Stapler 5 5 $897.00 $897.00 $449.00 $897.00 $897.00 2025-11-19
50431 CPT Njx Px Nfrosgrm &/Urtrgrm Exis 14 13 $236.00 $236.00 $118.00 $1,116.00 $892.00 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
25087144 CDM Win Rho 1.5 Mu Inj 5 5 $865.00 $865.00 $433.00 $865.00 $865.00 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
36001062 CDM Sht Stay Surg Catar 1st 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
36000882 CDM O/r Hour(s) 5 5 $852.00 $852.00 $426.00 $852.00 $852.00 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
J0878 HCPCS Cubicin 500mg / Daptomycin Inj 5 5 $851.00 $851.00 $426.00 $851.00 $851.00 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
27000640 CDM Craniotomy Tray 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
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