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

6,011 distinct procedures filed
17 distinct payers
50,259 rate rows
2026-10-29 last MRF observed
Data quality

44,278 of 50,259 rate rows are consumer-grade (88.1%)

5,981 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
professional (physician) fee — not the facility price 4,352
exceeds 10× this hospital's gross charge — excluded from medians 1,054
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 · 2026-11-10

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
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
$3,011
outlier · 6.1×
27130
CPT 		Hiptotal 13 $2,823.00 $20,540.00 $16,432.00 nat. median
$13,117
1.3× median
27447
CPT 		Kneetotal 13 $3,544.00 $20,540.00 $16,432.00 nat. median
$12,793
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
$10,505
1.3× median
55700
CPT 		Biopsy Of Prostate Gland 5 $6,517.00 $13,033.00 $13,033.00 nat. median
$2,090
outlier · 6.2×
360458550
CDM 		Bronchoscopy 5 $6,197.00 $12,393.00 $12,393.00 nat. median
$12,393
1.0× median
CP17629817107454746
CDM 		Uterine And Adnexa Procedures For Non-malignancy Without Cc Or Mcc 14 $9,681.00 $25,272.00 $12,101.00 nat. median
$12,101
1.0× median
J2993
HCPCS 		Reteplase 18.1 Mg Kit 5 $5,521.00 $11,042.00 $11,042.00 nat. median
$3,474
outlier · 3.2×
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
$6,211
1.5× median
24134
CPT 		Neo-synephrine 0.25% Spray 13 $2.00 $11,609.00 $9,287.00 nat. median
$6,519
1.4× 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
$6,019
1.3× median
54408
CPT 		Imuran 50mg Tablet 13 $1.00 $8,578.00 $6,863.00 nat. median
$5,479
1.3× 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
J1162
HCPCS 		Digoxin Immune Fab 38 Mg/vl 13 $983.00 $11,056.00 $5,711.00 nat. median
$7,098
0.8× median
6362965443
CDM 		Octagam 10% Ivig 20mg 5 $2,782.00 $5,563.00 $5,563.00 nat. median
$5,563
1.0× median
J9041
HCPCS 		Bortezomib 3.5mg Inj 5 $2,657.00 $5,314.00 $5,314.00 nat. median
$142
outlier · 37.5×
J2997
HCPCS 		Activase(alteplase) 50 Mg Vial 13 $92.00 $12,302.00 $5,167.00 nat. median
$504
outlier · 10.2×
19120
CPT 		Removal Of One Or More Breast Growth, Open Procedure 13 $4,009.00 $15,293.00 $5,136.50 nat. median
$3,680
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
$3,867
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
$3,572
1.2× median
20000003
CDM 		Room Charge Surge Unit ICU 5 $2,177.00 $4,354.00 $4,354.00 nat. median
$3,151
1.4× median
20000001
CDM 		D.o. Room Charge ICU 5 $2,172.00 $4,344.00 $4,344.00 nat. median
$3,665
1.2× median
29881
CPT 		Removal Of One Knee Cartilage Using An Endoscope 13 $3,350.00 $18,342.00 $4,292.50 nat. median
$3,821
1.1× median
25145
CPT 		Cytotec 100 Mcg Tablet 13 $1.00 $5,235.00 $4,188.00 nat. median
$3,407
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
75743
CPT 		Angio, Pulmonary,bilateral,sel 13 $1,619.00 $5,052.00 $4,041.00 nat. median
$3,226
1.3× median
93505
CPT 		Endomyocardial Biopsy 13 $1,668.00 $5,052.00 $4,041.00 nat. median
$3,652
1.1× median
36555
CPT 		Ins Non-tun Cvc <5 Yrs Old 13 $1,768.00 $5,052.00 $4,041.00 nat. median
$2,689
1.5× median
75716
CPT 		Angio, Extremity, Bilateral 13 $1,985.00 $5,052.00 $4,041.00 nat. median
$3,306
1.2× median
36556
CPT 		Ins Non-tun Cvc >5 Yrs Old 13 $1,768.00 $5,052.00 $4,041.00 nat. median
$2,477
1.6× median
750256352
CDM 		Egd W/procedure 5 $1,927.00 $3,854.00 $3,854.00 nat. median
$3,854
1.0× median
38305
CPT 		Hydrea 500mg Capsule 13 $1.00 $4,647.00 $3,718.00 nat. median
$2,896
1.3× median
J9312
HCPCS 		Rituzimab 500mg Ivpb 13 $2,884.00 $10,398.00 $3,695.00 nat. median
$1,109
outlier · 3.3×
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
$1,834
1.9× median
77012
CPT 		CT Guided Needle Placement 5 $1,758.00 $3,516.00 $3,516.00 nat. median
$971
outlier · 3.6×
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
$241
outlier · 14.3×
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 6,011 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
360428563 CDM Aborted Surgical Case 5 5 $1,470.00 $1,470.00 $735.00 $1,470.00 $1,470.00 2026-10-29
C1776 HCPCS Acetabular Component 25 5 $1,261.00 $1,261.00 $60.00 $3,177.00 $1,261.00 2026-10-29
ACTEMRA20 CDM Actemra Inj 6 6 $2,153.00 $2,153.00 $1,077.00 $2,153.00 $2,153.00 2026-10-29
ACTEMRA10 CDM Actemra Inj 6 6 $1,077.00 $1,077.00 $539.00 $1,077.00 $1,077.00 2026-10-29
ACTIVASE CDM Activase 100mg Vial 6 6 $8,176.00 $8,176.00 $4,088.00 $8,176.00 $8,176.00 2026-10-29
ALTEPL50VL CDM Activase 100mg Vial 6 6 $4,056.00 $4,056.00 $2,028.00 $4,056.00 $4,056.00 2026-10-29
J2997 HCPCS Activase(alteplase) 50 Mg Vial 47 13 $6,712.00 $6,712.00 $92.00 $12,302.00 $5,167.00 2026-10-29
25980283 CDM Activated Factor Ix Concn 500v 5 5 $2,197.00 $2,197.00 $1,099.00 $2,197.00 $2,197.00 2026-10-29
80100001 CDM Acute Hemodialysis 5 5 $1,108.00 $1,108.00 $554.00 $1,108.00 $1,108.00 2026-10-29
25980299 CDM Aldesleukin 22mu Vial 5 5 $1,637.00 $1,637.00 $819.00 $1,637.00 $1,637.00 2026-10-29
370120121 CDM Anesth General 1st 60min 5 5 $1,963.00 $1,963.00 $982.00 $1,963.00 $1,963.00 2026-10-29
370120147 CDM Anesth Mac/reg 1st 60min 5 5 $1,550.00 $1,550.00 $775.00 $1,550.00 $1,550.00 2026-10-29
75716 CPT Angio, Extremity, Bilateral 14 13 $3,969.00 $3,969.00 $1,985.00 $5,052.00 $4,041.00 2026-10-29
75743 CPT Angio, Pulmonary,bilateral,sel 14 13 $3,238.00 $3,238.00 $1,619.00 $5,052.00 $4,041.00 2026-10-29
45085321 CDM Ankle/foot Immobilizer 5 5 $1,144.00 $1,144.00 $572.00 $1,144.00 $1,144.00 2026-10-29
78111 CPT Ansaid 100mg Tablet 14 13 $1.00 $1.00 $1.00 $2,071.00 $1,657.00 2026-10-29
ANTIZOL CDM Antizol 6 6 $1,504.00 $1,504.00 $752.00 $1,504.00 $1,504.00 2026-10-29
27000618 CDM Ax55g Articulator 5 5 $1,442.00 $1,442.00 $721.00 $1,442.00 $1,442.00 2026-10-29
64417 CPT Axillary Nerve Block 14 13 $416.00 $416.00 $208.00 $1,415.00 $1,132.00 2026-10-29
36001740 CDM Beach Chair 5 5 $1,381.00 $1,381.00 $691.00 $1,381.00 $1,381.00 2026-10-29
25080938 CDM Becaplermin 15 Gm Gel 5 5 $1,453.00 $1,453.00 $727.00 $1,453.00 $1,453.00 2026-10-29
12000044 CDM Bed Hold Neuro2s Non Vent Adl 5 5 $1,958.00 $1,958.00 $979.00 $1,958.00 $1,958.00 2026-10-29
12000045 CDM Bed Hold Neuro2s Vent Adult 5 5 $2,262.00 $2,262.00 $1,131.00 $2,262.00 $2,262.00 2026-10-29
12000030 CDM Bed Hold-asa Non Vent 5 5 $1,203.00 $1,203.00 $602.00 $1,203.00 $1,203.00 2026-10-29
12000031 CDM Bed Hold-asa Vent 5 5 $1,508.00 $1,508.00 $754.00 $1,508.00 $1,508.00 2026-10-29
12300038 CDM Bed Hold-psa Non-vent 5 5 $1,958.00 $1,958.00 $979.00 $1,958.00 $1,958.00 2026-10-29
12300039 CDM Bed Hold-psa Vent 5 5 $2,262.00 $2,262.00 $1,131.00 $2,262.00 $2,262.00 2026-10-29
12000040 CDM Bedhold Asa3 Non Vent 5 5 $1,958.00 $1,958.00 $979.00 $1,958.00 $1,958.00 2026-10-29
12000041 CDM Bedhold Asa3 Vent 5 5 $1,508.00 $1,508.00 $754.00 $1,508.00 $1,508.00 2026-10-29
80100018 CDM Bicarbonate Dialysis 5 5 $1,436.00 $1,436.00 $718.00 $1,436.00 $1,436.00 2026-10-29
48132675 CDM Biopal 7 Biotome 5 5 $1,699.00 $1,699.00 $850.00 $1,699.00 $1,699.00 2026-10-29
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 2026-10-29
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 2026-10-29
55700 CPT Biopsy Of Prostate Gland 5 5 $13,033.00 $13,033.00 $6,517.00 $13,033.00 $13,033.00 2026-10-29
32408 CPT Biopsy Percutaneous Lung/medi 14 13 $4,681.00 $4,681.00 $1,691.00 $4,681.00 $2,167.00 2026-10-29
27000648 CDM Blue 55 Reloader 5 5 $949.00 $949.00 $475.00 $949.00 $949.00 2026-10-29
85097 CPT Bone Marrow Smear 14 13 $474.00 $474.00 $237.00 $1,289.00 $1,031.00 2026-10-29
J9041 HCPCS Bortezomib 3.5mg Inj 5 5 $5,314.00 $5,314.00 $2,657.00 $5,314.00 $5,314.00 2026-10-29
64415 CPT Brachial Plexus 14 13 $416.00 $416.00 $208.00 $1,415.00 $1,132.00 2026-10-29
360458550 CDM Bronchoscopy 5 5 $12,393.00 $12,393.00 $6,197.00 $12,393.00 $12,393.00 2026-10-29
27009883 CDM Camino 1104hc 5 5 $1,280.00 $1,280.00 $640.00 $1,280.00 $1,280.00 2026-10-29
J9045 HCPCS Carboplatin 450 Mg/vial Vial 10 5 $1,830.00 $1,830.00 $183.00 $3,294.00 $1,006.50 2026-10-29
CARIMUNE12 CDM Carimune Nf 12 Gram Vial 5 5 $1,212.00 $1,212.00 $606.00 $1,212.00 $1,212.00 2026-10-29
25087300 CDM Carimune Nf 12gm Vial 5 5 $1,480.00 $1,480.00 $740.00 $1,480.00 $1,480.00 2026-10-29
27000476 CDM Carrion Penile 5 5 $1,620.00 $1,620.00 $810.00 $1,620.00 $1,620.00 2026-10-29
J0637 HCPCS Caspofungin Acetate 70mg Ivpb 15 5 $1,508.00 $1,508.00 $65.00 $1,943.00 $1,508.00 2026-10-29
64530 CPT Celiac Plexus 14 13 $584.00 $584.00 $292.00 $1,415.00 $1,132.00 2026-10-29
40261 CPT Cellcept 200 Mg * Non Form* 5 5 $1,027.00 $1,027.00 $514.00 $1,027.00 $1,027.00 2026-10-29
36100 CPT Cerebral Uni-inj 10 5 $1,738.50 $1,738.50 $857.00 $1,764.00 $1,713.00 2026-10-29
A9521 HCPCS Ceretec Wbc Labeling 14 13 $1,924.00 $1,924.00 $742.00 $1,924.00 $945.00 2026-10-29
32551 CPT Chest Tube Insertion 14 13 $1,738.00 $1,738.00 $869.00 $2,518.00 $2,015.00 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
45068359 CDM Closed Tx Femoral Fx With Mani 5 5 $1,814.00 $1,814.00 $907.00 $1,814.00 $1,814.00 2026-10-29
45096583 CDM Closed Tx Lunate Dislocation W 5 5 $1,849.00 $1,849.00 $925.00 $1,849.00 $1,849.00 2026-10-29
27000608 CDM Cloutier Bretainer 5 5 $888.00 $888.00 $444.00 $888.00 $888.00 2026-10-29
45086574 CDM Clsd Tx Bimalleolar Ankle Fx W 5 5 $1,814.00 $1,814.00 $907.00 $1,814.00 $1,814.00 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
45063859 CDM Clsd Tx Medial Malleolus Fx With 5 5 $1,802.00 $1,802.00 $901.00 $1,802.00 $1,802.00 2026-10-29
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 2026-10-29
23655 CPT Clsd Tx Shldr Dis W/man W/anes 14 13 $4,113.00 $4,113.00 $1,646.00 $4,113.00 $2,058.00 2026-10-29
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 2026-10-29
45098563 CDM Clsd Tx Trimalleolar Ankle Fx 5 5 $1,814.00 $1,814.00 $907.00 $1,814.00 $1,814.00 2026-10-29
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 2026-10-29
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 2026-10-29
750555685 CDM Colonoscopy Dx 5 5 $1,687.00 $1,687.00 $844.00 $1,687.00 $1,687.00 2026-10-29
750453785 CDM Colonoscopy W/proc 5 5 $1,986.00 $1,986.00 $993.00 $1,986.00 $1,986.00 2026-10-29
45032651 CDM Complx Repair Sclp/arms/legs 1 5 5 $1,032.00 $1,032.00 $516.00 $1,032.00 $1,032.00 2026-10-29
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 2026-10-29
45028659 CDM Complx Rpr Eyld/nose/ear/lips 5 5 $1,672.00 $1,672.00 $836.00 $1,672.00 $1,672.00 2026-10-29
45062859 CDM Complx Rpr Eyld/nose/ear/lips 5 5 $1,431.00 $1,431.00 $716.00 $1,431.00 $1,431.00 2026-10-29
99291 CPT Critical Care, 1st Hour 14 13 $5,422.00 $5,422.00 $846.00 $5,422.00 $1,083.50 2026-10-29
99292 CPT Critical Cr Addl 30m 5 5 $1,694.00 $1,694.00 $847.00 $1,694.00 $1,694.00 2026-10-29
CROFAB CDM Crofab 6 6 $2,899.00 $2,899.00 $1,450.00 $2,899.00 $2,899.00 2026-10-29
J0840 HCPCS Crofab (Antivenim) 14 13 $1,475.00 $1,475.00 $738.00 $2,555.00 $2,044.00 2026-10-29
25087054 CDM Crolalidae Polyvalent Immu Inj 5 5 $4,730.00 $4,730.00 $2,365.00 $4,730.00 $4,730.00 2026-10-29
77012 CPT CT Guided Needle Placement 5 5 $3,516.00 $3,516.00 $1,758.00 $3,516.00 $3,516.00 2026-10-29
270207369 CDM Cutter Linear 45mm Artcl 340mm 5 5 $900.00 $900.00 $450.00 $900.00 $900.00 2026-10-29
36001725 CDM Cutter Linear 75mm Blue 5 5 $1,224.00 $1,224.00 $612.00 $1,224.00 $1,224.00 2026-10-29
27000649 CDM Cutter Linear 75mm Green Tct75 5 5 $1,602.00 $1,602.00 $801.00 $1,602.00 $1,602.00 2026-10-29
25145 CPT Cytotec 100 Mcg Tablet 14 13 $1.00 $1.00 $1.00 $5,235.00 $4,188.00 2026-10-29
20000001 CDM D.o. Room Charge ICU 5 5 $4,344.00 $4,344.00 $2,172.00 $4,344.00 $4,344.00 2026-10-29
25087393 CDM Desmopressin 0.1 Tab 5 5 $1,043.00 $1,043.00 $522.00 $1,043.00 $1,043.00 2026-10-29
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 2026-10-29
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 2026-10-29
DIGIFAB CDM Digifab 40mg Vial 5 5 $3,568.00 $3,568.00 $1,784.00 $3,568.00 $3,568.00 2026-10-29
J1162 HCPCS Digoxin Immune Fab 38 Mg/vl 19 13 $1,966.00 $1,966.00 $983.00 $11,056.00 $5,711.00 2026-10-29
25081235 CDM Dinoprostone 20 Ms Supp. Vag 5 5 $1,296.00 $1,296.00 $648.00 $1,296.00 $1,296.00 2026-10-29
ADRIAMYCIN CDM Doxil 50mg/25ml Liposomal Vial 6 6 $2,371.00 $2,371.00 $1,186.00 $2,371.00 $2,371.00 2026-10-29
45028575 CDM Drain Bl W/supracath Insertion 5 5 $2,581.00 $2,581.00 $1,291.00 $2,581.00 $2,581.00 2026-10-29
10140 CPT Drain Hematoma 14 13 $3,412.00 $3,412.00 $1,691.00 $3,412.00 $2,114.00 2026-10-29
4501326 CDM Drainage Of Finger Abscess Com 5 5 $1,020.00 $1,020.00 $510.00 $1,020.00 $1,020.00 2026-10-29
750432531 CDM Egd Dx 5 5 $1,986.00 $1,986.00 $993.00 $1,986.00 $1,986.00 2026-10-29
750256352 CDM Egd W/procedure 5 5 $3,854.00 $3,854.00 $1,927.00 $3,854.00 $3,854.00 2026-10-29
J9263 HCPCS Eloxatin 100mg 10 5 $1,870.00 $1,870.00 $608.00 $2,525.00 $1,239.00 2026-10-29
93505 CPT Endomyocardial Biopsy 14 13 $3,336.00 $3,336.00 $1,668.00 $5,052.00 $4,041.00 2026-10-29
36001731 CDM Endoscopy Video System Proc 5 5 $2,636.00 $2,636.00 $1,318.00 $2,636.00 $2,636.00 2026-10-29
62282 CPT Epidural Lumbar Caudal 14 13 $416.00 $416.00 $208.00 $1,415.00 $1,132.00 2026-10-29
J9178 HCPCS Epirubicin 2mg/ml 25ml 5 5 $2,858.00 $2,858.00 $1,429.00 $2,858.00 $2,858.00 2026-10-29
J0348 HCPCS Eraxis 100 Mg 10 5 $1,364.50 $1,364.50 $451.00 $1,828.00 $907.50 2026-10-29
27010304 CDM Eye Lens 5 5 $1,351.00 $1,351.00 $676.00 $1,351.00 $1,351.00 2026-10-29
FLEBOGAM10 CDM Felbogamma 5% 10gm Vial 6 6 $957.00 $957.00 $479.00 $957.00 $957.00 2026-10-29
J9185 HCPCS Fludarabine 25mg/ml Ivpb 5 5 $1,261.00 $1,261.00 $631.00 $1,261.00 $1,261.00 2026-10-29
41828 CPT Fluphenazine Hcl 5mg/2ml Inj 14 13 $5.00 $5.00 $3.00 $2,482.00 $1,986.00 2026-10-29
C1768 HCPCS Graft Gortex 1" 5 5 $2,306.00 $2,306.00 $1,153.00 $2,306.00 $2,306.00 2026-10-29
27053411 CDM Graft Impra 5 5 $2,146.00 $2,146.00 $1,073.00 $2,146.00 $2,146.00 2026-10-29
27000479 CDM Graft:bovine 5 5 $2,934.00 $2,934.00 $1,467.00 $2,934.00 $2,934.00 2026-10-29
27000161 CDM Graft:bovine 5 5 $2,934.00 $2,934.00 $1,467.00 $2,934.00 $2,934.00 2026-10-29
75989 CPT Guidance Perc Drainage W/cath 5 5 $2,469.00 $2,469.00 $1,235.00 $2,469.00 $2,469.00 2026-10-29
80100003 CDM Hemoperfusion 5 5 $1,845.00 $1,845.00 $923.00 $1,845.00 $1,845.00 2026-10-29
J9355 HCPCS Herceptin 440 Mg Mov 14 13 $7,288.00 $7,288.00 $2,424.00 $7,288.00 $3,106.00 2026-10-29
23405 CPT Hibiclens 4% Liquid 14 13 $4.00 $4.00 $2.00 $11,609.00 $9,287.00 2026-10-29
27000429 CDM Hip:astn-more Solid 5 5 $1,247.00 $1,247.00 $624.00 $1,247.00 $1,247.00 2026-10-29
27130 CPT Hiptotal 14 13 $5,646.00 $5,646.00 $2,823.00 $20,540.00 $16,432.00 2026-10-29
36001730 CDM Holmuim Laser 5 5 $2,807.00 $2,807.00 $1,404.00 $2,807.00 $2,807.00 2026-10-29
27000134 CDM Holter Valve 5 5 $1,775.00 $1,775.00 $888.00 $1,775.00 $1,775.00 2026-10-29
38305 CPT Hydrea 500mg Capsule 14 13 $1.00 $1.00 $1.00 $4,647.00 $3,718.00 2026-10-29
27000133 CDM Hydrocephalus Shunt 5 5 $1,217.00 $1,217.00 $609.00 $1,217.00 $1,217.00 2026-10-29
27000451 CDM Hydrocephalus Shunt3 5 5 $1,217.00 $1,217.00 $609.00 $1,217.00 $1,217.00 2026-10-29
10080 CPT I & D Pilonidal Cyst 14 13 $1,785.00 $1,785.00 $725.00 $1,785.00 $906.00 2026-10-29
J9211 HCPCS Idarubicin Hcl 1mg/ml Vial 5 5 $3,453.00 $3,453.00 $1,727.00 $3,453.00 $3,453.00 2026-10-29
FLEBO10 CDM Immune Globulin 10% 10gm Vial 6 6 $957.00 $957.00 $479.00 $957.00 $957.00 2026-10-29
25980311 CDM Immune Globulin 10%vl 1gm Vial 5 5 $1,648.00 $1,648.00 $824.00 $1,648.00 $1,648.00 2026-10-29
90283 CPT Immuneglobulin 10 Gm 5 5 $2,964.00 $2,964.00 $1,482.00 $2,964.00 $2,964.00 2026-10-29
25100020 CDM Imogam Rabies 150 U 5 5 $1,620.00 $1,620.00 $810.00 $1,620.00 $1,620.00 2026-10-29
54408 CPT Imuran 50mg Tablet 14 13 $1.00 $1.00 $1.00 $8,578.00 $6,863.00 2026-10-29
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 2026-10-29
36569 CPT In Picc Wo Port/pump Wo Img 5+ 19 13 $2,090.00 $2,090.00 $1,045.00 $2,518.00 $2,090.00 2026-10-29
34000010 CDM Indium Ptpa 5 5 $1,641.00 $1,641.00 $821.00 $1,641.00 $1,641.00 2026-10-29
64420 CPT Inj, Anesthetic Agt 14 13 $372.00 $372.00 $186.00 $1,129.00 $903.00 2026-10-29
64483 CPT Injection(s) Of Anesthetic Into Lower Spine Using Imaging Guidance 19 13 $584.00 $584.00 $292.00 $1,550.00 $1,132.00 2026-10-29
62322 CPT Injection(s) Of Therapeutic Substance 14 13 $1,550.00 $1,550.00 $775.00 $1,550.00 $1,132.00 2026-10-29
62323 CPT Injection(s) Of Therapeutic Substance 14 13 $1,550.00 $1,550.00 $723.00 $1,550.00 $903.00 2026-10-29
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 2026-10-29
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 2026-10-29
64421 CPT Intercostal Multiple 14 13 $372.00 $372.00 $186.00 $1,415.00 $1,132.00 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
45095624 CDM Intrmd Wnd Rpr Sclp/ax/tr/ext 5 5 $989.00 $989.00 $495.00 $989.00 $989.00 2026-10-29
36200 CPT Introduction Catheter, Aorta 5 5 $1,780.00 $1,780.00 $890.00 $1,780.00 $1,780.00 2026-10-29
J2426 HCPCS Invega 117 Mg Syringe 42 13 $3,377.00 $3,377.00 $1,445.00 $5,065.00 $2,950.00 2026-10-29
INVEGA117 CDM Invega Sustenna 117mg/0.75ml 6 6 $916.00 $916.00 $458.00 $916.00 $916.00 2026-10-29
25080085 CDM Ipratropium Bromide 17mcg/dose 5 5 $1,630.00 $1,630.00 $815.00 $1,630.00 $1,630.00 2026-10-29
18743 CPT Isuprel 0.2mg/ml Ampule 5 5 $915.00 $915.00 $458.00 $915.00 $915.00 2026-10-29
36001741 CDM Knee Ice Pad & Cooler 5 5 $1,350.00 $1,350.00 $675.00 $1,350.00 $1,350.00 2026-10-29
27447 CPT Kneetotal 14 13 $7,087.00 $7,087.00 $3,544.00 $20,540.00 $16,432.00 2026-10-29
C1780 HCPCS Lens Intraocular 5 5 $1,446.00 $1,446.00 $723.00 $1,446.00 $1,446.00 2026-10-29
25087433 CDM Lidoderm 5% Patch 5 5 $977.00 $977.00 $489.00 $977.00 $977.00 2026-10-29
36001738 CDM Linvatec Pump & 5 5 $1,695.00 $1,695.00 $848.00 $1,695.00 $1,695.00 2026-10-29
62270 CPT Lumbar Puncture 14 13 $1,337.00 $1,337.00 $669.00 $1,337.00 $903.00 2026-10-29
64520 CPT Lumbar Sympathetic 14 13 $466.00 $466.00 $233.00 $1,415.00 $1,132.00 2026-10-29
15050 CPT Megace 40mg/ml Oral Susp 14 13 $133.00 $133.00 $67.00 $1,182.00 $946.00 2026-10-29
36001742 CDM Mini-c-arm 5 5 $1,151.00 $1,151.00 $576.00 $1,151.00 $1,151.00 2026-10-29
74185 CPT MRA Abd W/wo Contrast 5 5 $2,039.00 $2,039.00 $1,020.00 $2,039.00 $2,039.00 2026-10-29
73725 CPT MRA Lower Ext W/wo Contrast 5 5 $1,415.00 $1,415.00 $708.00 $1,415.00 $1,415.00 2026-10-29
73225 CPT MRA Upper Ext W/wo Contrast 5 5 $979.00 $979.00 $490.00 $979.00 $979.00 2026-10-29
71555 CPT MRI Chest Angio 5 5 $1,987.00 $1,987.00 $994.00 $1,987.00 $1,987.00 2026-10-29
78453 CPT Myocard Spect Multi 14 13 $2,108.00 $2,108.00 $1,054.00 $2,108.00 $1,657.00 2026-10-29
78452 CPT Myocard Spect Sngl 14 13 $2,275.00 $2,275.00 $1,138.00 $2,275.00 $1,657.00 2026-10-29
24134 CPT Neo-synephrine 0.25% Spray 14 13 $3.00 $3.00 $2.00 $11,609.00 $9,287.00 2026-10-29
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 2026-10-29
50431 CPT Njx Px Nfrosgrm &/Urtrgrm Exis 14 13 $236.00 $236.00 $118.00 $1,116.00 $892.00 2026-10-29
36000882 CDM O/r Hour(s) 5 5 $852.00 $852.00 $426.00 $852.00 $852.00 2026-10-29
45084516 CDM OB US < 14 Wks Single Fetus 5 5 $963.00 $963.00 $482.00 $963.00 $963.00 2026-10-29
45084518 CDM OB US >= 14 Wks Single Fetus 5 5 $1,685.00 $1,685.00 $843.00 $1,685.00 $1,685.00 2026-10-29
OCTA10G CDM Octagam 10% (10000 Mg) 100 Ml Vial 6 6 $898.00 $898.00 $449.00 $898.00 $898.00 2026-10-29
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 2026-10-29
6362965444 CDM Octagam 10% Ivig 10mg 5 5 $2,781.00 $2,781.00 $1,391.00 $2,781.00 $2,781.00 2026-10-29
6362965443 CDM Octagam 10% Ivig 20mg 5 5 $5,563.00 $5,563.00 $2,782.00 $5,563.00 $5,563.00 2026-10-29
OCTA10 CDM Octagam 5% (10000 Mg) 200 Ml Vial 6 6 $898.00 $898.00 $449.00 $898.00 $898.00 2026-10-29
6362965439 CDM Octagam 5% 100ml 5 5 $1,391.00 $1,391.00 $696.00 $1,391.00 $1,391.00 2026-10-29
6362965440 CDM Octagam 5% 200ml 5 5 $2,781.00 $2,781.00 $1,391.00 $2,781.00 $2,781.00 2026-10-29
71080174 CDM Pacu Complex 1st 30min 5 5 $2,519.00 $2,519.00 $1,260.00 $2,519.00 $2,519.00 2026-10-29
71080182 CDM Pacu Complex Addl 15min 5 5 $882.00 $882.00 $441.00 $882.00 $882.00 2026-10-29
71020287 CDM Pacu Standard 1st 30min 5 5 $1,936.00 $1,936.00 $968.00 $1,936.00 $1,936.00 2026-10-29
J2430 HCPCS Pamidronate Disodium 90 30mgvl 5 5 $2,483.00 $2,483.00 $1,242.00 $2,483.00 $2,483.00 2026-10-29
49082 CPT Paracentesis Abd Without Imaging 14 13 $2,625.00 $2,625.00 $929.00 $2,625.00 $1,190.00 2026-10-29
49083 CPT Paracentesis Abdomen W/imaging 14 13 $2,993.00 $2,993.00 $929.00 $2,993.00 $1,190.00 2026-10-29
25100002 CDM Pegasys 180 Mcg/ml 5 5 $2,033.00 $2,033.00 $1,017.00 $2,033.00 $2,033.00 2026-10-29
J2506 HCPCS Pegfilgrastim 6 Mg 14 13 $11,831.00 $11,831.00 $1,932.00 $11,831.00 $2,475.50 2026-10-29
25990131 CDM Peginterferon Alfa-2b 80mcg 5 5 $1,505.00 $1,505.00 $753.00 $1,505.00 $1,505.00 2026-10-29
27004852 CDM Penile Prosthesisinf 5 5 $9,304.00 $9,304.00 $4,652.00 $9,304.00 $9,304.00 2026-10-29
45052326 CDM Pericardiocentesis Initial 5 5 $1,132.00 $1,132.00 $566.00 $1,132.00 $1,132.00 2026-10-29
45069876 CDM Peripheral Nerve Block 5 5 $1,150.00 $1,150.00 $575.00 $1,150.00 $1,150.00 2026-10-29
27000144 CDM Pin Set Rush 5 5 $899.00 $899.00 $450.00 $899.00 $899.00 2026-10-29
27000462 CDM Pin Set:rush 5 5 $899.00 $899.00 $450.00 $899.00 $899.00 2026-10-29
80100019 CDM Plasma Apheresis 5 5 $1,608.00 $1,608.00 $804.00 $1,608.00 $1,608.00 2026-10-29
54001 CPT Prednisone 10mg 14 13 $6.00 $6.00 $3.00 $3,344.00 $2,676.00 2026-10-29
64430 CPT Pudental Nerve 14 13 $372.00 $372.00 $186.00 $1,415.00 $1,132.00 2026-10-29
45075482 CDM Pulmonary Stress Test/simple 5 5 $897.00 $897.00 $449.00 $897.00 $897.00 2026-10-29
11760 CPT Reconst. Nail Bed 14 13 $173.00 $173.00 $87.00 $1,182.00 $946.00 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
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 2026-10-29
45023518 CDM Repair Complex Trunk Each Addl 5 5 $1,147.00 $1,147.00 $574.00 $1,147.00 $1,147.00 2026-10-29
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 2026-10-29
RETAVASE CDM Retavase Full Kit 6 6 $3,016.00 $3,016.00 $1,508.00 $3,016.00 $3,016.00 2026-10-29
J2993 HCPCS Reteplase 18.1 Mg Kit 5 5 $11,042.00 $11,042.00 $5,521.00 $11,042.00 $11,042.00 2026-10-29
25087332 CDM Rituxan 500 Mg 5 5 $3,348.00 $3,348.00 $1,674.00 $3,348.00 $3,348.00 2026-10-29
RITUXAN CDM Rituxan 500mg 6 6 $2,171.00 $2,171.00 $1,086.00 $2,171.00 $2,171.00 2026-10-29
J9312 HCPCS Rituzimab 500mg Ivpb 14 13 $10,398.00 $10,398.00 $2,884.00 $10,398.00 $3,695.00 2026-10-29
21000001 CDM Room Charge Ccu 5 5 $4,390.00 $4,390.00 $2,195.00 $4,390.00 $4,390.00 2026-10-29
12100036 CDM Room Charge Med/surg 5 5 $2,257.00 $2,257.00 $1,129.00 $2,257.00 $2,257.00 2026-10-29
12300027 CDM Room Charge Ped 5 5 $2,190.00 $2,190.00 $1,095.00 $2,190.00 $2,190.00 2026-10-29
12400027 CDM Room Charge Psychiatric Acute 5 5 $1,958.00 $1,958.00 $979.00 $1,958.00 $1,958.00 2026-10-29
12100038 CDM Room Charge Surge Unit Acute 5 5 $2,257.00 $2,257.00 $1,129.00 $2,257.00 $2,257.00 2026-10-29
20000003 CDM Room Charge Surge Unit ICU 5 5 $4,354.00 $4,354.00 $2,177.00 $4,354.00 $4,354.00 2026-10-29
12000036 CDM Room Charge-neuro Non Vent 5 5 $1,978.00 $1,978.00 $989.00 $1,978.00 $1,978.00 2026-10-29
12000037 CDM Room Charge-neuro Vent 5 5 $2,283.00 $2,283.00 $1,142.00 $2,283.00 $2,283.00 2026-10-29
12200018 CDM Room Charge-OB 5 5 $2,190.00 $2,190.00 $1,095.00 $2,190.00 $2,190.00 2026-10-29
12300036 CDM Room Charge-peds Neuro Nonvent 5 5 $1,958.00 $1,958.00 $979.00 $1,958.00 $1,958.00 2026-10-29
12300037 CDM Room Charge-peds Neuro Vent 5 5 $2,262.00 $2,262.00 $1,131.00 $2,262.00 $2,262.00 2026-10-29
16900000 CDM Room Chargeacute Admin Day 5 5 $2,236.00 $2,236.00 $1,118.00 $2,236.00 $2,236.00 2026-10-29
20400000 CDM Room Chg Acute Bhu 5 5 $3,204.00 $3,204.00 $1,602.00 $3,204.00 $3,204.00 2026-10-29
12000042 CDM Room Chg-neuro2s Non Vent Adl 5 5 $1,978.00 $1,978.00 $989.00 $1,978.00 $1,978.00 2026-10-29
12000043 CDM Room Chg-neuro2s Vent Adult 5 5 $2,283.00 $2,283.00 $1,142.00 $2,283.00 $2,283.00 2026-10-29
12000038 CDM Room Chg-neuro3 Non Vent Adlt 5 5 $1,978.00 $1,978.00 $989.00 $1,978.00 $1,978.00 2026-10-29
12000039 CDM Room Chg-neuro3 Vent Adlt 5 5 $2,283.00 $2,283.00 $1,142.00 $2,283.00 $2,283.00 2026-10-29
12000029 CDM S.n.f Room Charge 5 5 $1,033.00 $1,033.00 $517.00 $1,033.00 $1,033.00 2026-10-29
25087278 CDM Sandolar 5 5 $2,546.00 $2,546.00 $1,273.00 $2,546.00 $2,546.00 2026-10-29
270207445 CDM Sealer Enseal Tissue Crvd 37cm 5 5 $1,176.00 $1,176.00 $588.00 $1,176.00 $1,176.00 2026-10-29
270207444 CDM Sealer Enseal Tissue Lg 20cm 5 5 $1,262.00 $1,262.00 $631.00 $1,262.00 $1,262.00 2026-10-29
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 2026-10-29
45035748 CDM Shoulder Disloc W/fx Tube 5 5 $1,814.00 $1,814.00 $907.00 $1,814.00 $1,814.00 2026-10-29
36001089 CDM Sht Stay Surg Arthro 30 Min 5 5 $864.00 $864.00 $432.00 $864.00 $864.00 2026-10-29
36001062 CDM Sht Stay Surg Catar 1st 30 Min 5 5 $864.00 $864.00 $432.00 $864.00 $864.00 2026-10-29
45330 CPT Sigmodoscopy Dx 14 13 $1,166.00 $1,166.00 $583.00 $1,488.00 $1,190.00 2026-10-29
750453312 CDM Sigmodoscopy W/procedure 5 5 $1,576.00 $1,576.00 $788.00 $1,576.00 $1,576.00 2026-10-29
25087046 CDM Snake Antivenin Equine Inject 5 5 $1,430.00 $1,430.00 $715.00 $1,430.00 $1,430.00 2026-10-29
27001138 CDM Sphincterotome 5 5 $1,624.00 $1,624.00 $812.00 $1,624.00 $1,624.00 2026-10-29
64510 CPT Stellate Ganglion 14 13 $372.00 $372.00 $186.00 $1,415.00 $1,132.00 2026-10-29
45027585 CDM Straight Catheter Insertion 5 5 $1,397.00 $1,397.00 $699.00 $1,397.00 $1,397.00 2026-10-29
25980196 CDM Streptokinase 1.5 Mmu/vial Via 5 5 $1,968.00 $1,968.00 $984.00 $1,968.00 $1,968.00 2026-10-29
25081310 CDM Streptokinase Kit Kit 5 5 $2,197.00 $2,197.00 $1,099.00 $2,197.00 $2,197.00 2026-10-29
62280 CPT Subarachnoid 14 13 $372.00 $372.00 $186.00 $1,415.00 $1,132.00 2026-10-29
88309 CPT Surg Path Level Vi 14 13 $810.00 $810.00 $405.00 $1,289.00 $1,031.00 2026-10-29
360120188 CDM Surgery Level 1 1st 30min 5 5 $6,443.00 $6,443.00 $3,222.00 $6,443.00 $6,443.00 2026-10-29
360120196 CDM Surgery Level 1 Add 15min 5 5 $2,056.00 $2,056.00 $1,028.00 $2,056.00 $2,056.00 2026-10-29
360120240 CDM Surgery Level 2 1st 30min 5 5 $8,398.00 $8,398.00 $4,199.00 $8,398.00 $8,398.00 2026-10-29
360122120 CDM Surgery Level 2 Add 15min 5 5 $2,672.00 $2,672.00 $1,336.00 $2,672.00 $2,672.00 2026-10-29
360220220 CDM Surgery Level 3 1st 30min 5 5 $10,920.00 $10,920.00 $5,460.00 $10,920.00 $10,920.00 2026-10-29
360212023 CDM Surgery Level 3 Add 15min 5 5 $3,475.00 $3,475.00 $1,738.00 $3,475.00 $3,475.00 2026-10-29
360120246 CDM Surgery Level 4 1st 30min 5 5 $14,195.00 $14,195.00 $7,098.00 $14,195.00 $14,195.00 2026-10-29
360125325 CDM Surgery Level 4 Add 15min 5 5 $4,515.00 $4,515.00 $2,258.00 $4,515.00 $4,515.00 2026-10-29
360120211 CDM Surgery Level 5 1st 30min 5 5 $18,454.00 $18,454.00 $9,227.00 $18,454.00 $18,454.00 2026-10-29
360520279 CDM Surgery Level 5 Add 15min 5 5 $5,874.00 $5,874.00 $2,937.00 $5,874.00 $5,874.00 2026-10-29
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 2026-10-29
27010410 CDM Sutjre:auto Eea 5 5 $1,171.00 $1,171.00 $586.00 $1,171.00 $1,171.00 2026-10-29
93503 CPT Swan Ganz Catheter 14 13 $788.00 $788.00 $394.00 $2,518.00 $2,015.00 2026-10-29
25087447 CDM Symbicort 160/4.5 Mcg Inh 5 5 $924.00 $924.00 $462.00 $924.00 $924.00 2026-10-29
27010344 CDM Tct Linear Cutter 55 5 5 $1,106.00 $1,106.00 $553.00 $1,106.00 $1,106.00 2026-10-29
92975 CPT Thromb Coronary By Ic Inf 5 5 $3,527.00 $3,527.00 $1,764.00 $3,527.00 $3,527.00 2026-10-29
TNK CDM Tnkase 50mg Vial 6 6 $23,025.00 $23,025.00 $11,513.00 $23,025.00 $23,025.00 2026-10-29
J3262 HCPCS Tocilizumab 20mg/ml 10ml 28 13 $5,004.50 $5,004.50 $852.00 $6,673.00 $2,130.00 2026-10-29
27010349 CDM Tpv 30 Reloader Linear 5 5 $954.00 $954.00 $477.00 $954.00 $954.00 2026-10-29
45055252 CDM Trachstomy Cricthyroid Emrgncy 5 5 $1,561.00 $1,561.00 $781.00 $1,561.00 $1,561.00 2026-10-29
64479 CPT Transforaminal Epidural Cerv 14 13 $416.00 $416.00 $208.00 $1,415.00 $1,132.00 2026-10-29
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 2026-10-29
Z7610 HCPCS Tray Multi Perc Trach 10 5 $1,084.50 $1,084.50 $504.00 $1,162.00 $1,007.00 2026-10-29
27000557 CDM Tray-total Joint 5 5 $862.00 $862.00 $431.00 $862.00 $862.00 2026-10-29
45068593 CDM Treatment Clsd Elbow Disl Without 5 5 $1,570.00 $1,570.00 $785.00 $1,570.00 $1,570.00 2026-10-29
64600 CPT Trigeminal Nerve 14 13 $372.00 $372.00 $186.00 $1,415.00 $1,132.00 2026-10-29
27000208 CDM Trv 30 Stapler 5 5 $897.00 $897.00 $449.00 $897.00 $897.00 2026-10-29
27010336 CDM Trv 30 Stapler 5 5 $897.00 $897.00 $449.00 $897.00 $897.00 2026-10-29
27010804 CDM Tube Blakemore Adult 20fr 39"l 5 5 $1,111.00 $1,111.00 $556.00 $1,111.00 $1,111.00 2026-10-29
27054032 CDM Tube Linton 5 5 $1,183.00 $1,183.00 $592.00 $1,183.00 $1,183.00 2026-10-29
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 2026-10-29
76942 CPT U/s Guided Needle Placement 5 5 $937.00 $937.00 $469.00 $937.00 $937.00 2026-10-29
45086531 CDM Ultrasound Chest 5 5 $925.00 $925.00 $463.00 $925.00 $925.00 2026-10-29
45015242 CDM Ultrasound Testicular 5 5 $977.00 $977.00 $489.00 $977.00 $977.00 2026-10-29
45084521 CDM US Guide Needle Asp/bx/inj 5 5 $1,162.00 $1,162.00 $581.00 $1,162.00 $1,162.00 2026-10-29
27000483 CDM Usci Bif:knitted 5 5 $1,030.00 $1,030.00 $515.00 $1,030.00 $1,030.00 2026-10-29
45025478 CDM Usretroperitoneal Limited 5 5 $1,051.00 $1,051.00 $526.00 $1,051.00 $1,051.00 2026-10-29
45075485 CDM Ussoft Tissue Head/neck 5 5 $1,146.00 $1,146.00 $573.00 $1,146.00 $1,146.00 2026-10-29
CP17629817107454746 CDM Uterine And Adnexa Procedures For Non-malignancy Without Cc Or Mcc 16 14 $25,272.00 $25,272.00 $9,681.00 $25,272.00 $12,101.00 2026-10-29
2502345346 CDM Valganciclovir 450mg Tablet 5 5 $1,057.00 $1,057.00 $529.00 $1,057.00 $1,057.00 2026-10-29
93618 CPT Vantin 200mg Tab**non Formulary** 14 13 $5.00 $5.00 $3.00 $1,948.00 $1,558.00 2026-10-29
VELCADE3.5 CDM Velcade 3.5 Mg Injection 6 6 $1,451.00 $1,451.00 $726.00 $1,451.00 $1,451.00 2026-10-29
75822 CPT Venography Extremity Bilateral 14 13 $1,479.00 $1,479.00 $740.00 $2,518.00 $2,015.00 2026-10-29
25087144 CDM Win Rho 1.5 Mu Inj 5 5 $865.00 $865.00 $433.00 $865.00 $865.00 2026-10-29
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 2026-10-29
27561 CPT Xigris 20 Mg 5 5 $1,038.00 $1,038.00 $519.00 $1,038.00 $1,038.00 2026-10-29
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