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Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

DAVIS COUNTY HOSPITAL

Bloomfield, IA · CCN 161327 · Rates published

3,336 distinct procedures filed
18 distinct payers
65,924 rate rows
2026-10-19 last MRF observed
Data quality

63,928 of 65,924 rate rows are consumer-grade (97.0%)

1,996 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
template filing: same amount across many unrelated codes — excluded 836
per-diem day rate — not a per-procedure price 400
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 324
percent-of-charges filed in the dollar field — excluded from medians 189
exceeds 10× this hospital's gross charge — excluded from medians 141
exceeds 3× this hospital's gross charge for a DRG stay — excluded 106
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbDCHBLOOMFIELDIA&type=CDMWithoutLabel&fileType=CSV
Found on page https://apps.para-hcfs.com/PTT/FinalLinks/DavisCounty.aspx
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-30
Content fingerprint efe35f9591e8fd5f… · 31,486,690 bytes · first seen 2026-10-20

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
493
MS_DRG 		Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 4 $40,739.03 $42,368.59 $41,859.35 nat. median
$23,542
1.8× median
522
MS_DRG 		Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 4 $39,215.88 $40,784.51 $40,294.32 nat. median
$20,545
2.0× median
481
MS_DRG 		Hip And Femur Procedures Except Major Joint With Cc 4 $16,643.57 $39,270.96 $38,798.95 nat. median
$20,302
1.9× median
314
MS_DRG 		Other Circulatory System Diagnoses With Mcc 7 $33,032.87 $150,582.98 $34,354.18 nat. median
$19,968
1.7× median
462
MS_DRG 		Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 4 $32,963.32 $34,281.85 $33,869.81 nat. median
$26,460
1.3× median
157
MS_DRG 		Dental And Oral Diseases With Mcc 8 $15,004.00 $44,765.20 $33,248.06 nat. median
$16,383
outlier · 2.0×
280
MS_DRG 		Acute Myocardial Infarction, Discharged Alive With Mcc 8 $14,263.75 $39,064.75 $31,417.37 nat. median
$15,657
outlier · 2.0×
8964042_1
CDM 		Ocrevus 300 Mg/10 Ml Vial 15 $29,065.00 $55,223.50 $31,390.20 nat. median
$31,390
1.0× median
378
MS_DRG 		Gastrointestinal Hemorrhage With Cc 8 $17,645.50 $42,446.50 $29,863.25 nat. median
$10,022
outlier · 3.0×
439
MS_DRG 		Disorders Of Pancreas Except Malignancy With Cc 8 $14,602.06 $45,391.00 $29,698.07 nat. median
$8,937
outlier · 3.3×
603
MS_DRG 		Cellulitis Without Mcc 8 $14,108.26 $43,993.00 $28,742.29 nat. median
$8,986
outlier · 3.2×
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc 8 $11,143.40 $30,984.20 $28,039.50 nat. median
$15,388
1.8× median
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 4 $25,991.62 $27,981.71 $27,645.39 nat. median
$18,642
1.5× median
560
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Cc 4 $21,957.93 $27,813.54 $27,479.24 nat. median
$11,479
outlier · 2.4×
559
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Mcc 4 $23,468.78 $27,813.54 $27,479.24 nat. median
$18,115
1.5× median
J3245
HCPCS 		Injection, Tildrakizumab, 1 Mg 17 $302.72 $48,288.50 $26,431.60 nat. median
$256
outlier · 103.2×
571
MS_DRG 		Skin Debridement With Cc 4 $25,034.59 $26,035.98 $25,723.04 nat. median
$16,358
1.6× median
377
MS_DRG 		Gastrointestinal Hemorrhage With Mcc 4 $21,600.39 $25,920.24 $25,608.70 nat. median
$17,298
1.5× median
536
MS_DRG 		Fractures Of Hip And Pelvis Without Mcc 8 $13,475.35 $35,849.80 $24,459.68 nat. median
$8,433
outlier · 2.9×
640
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 8 $13,222.00 $28,102.60 $24,447.38 nat. median
$12,850
1.9× median
872
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 8 $14,163.39 $34,004.19 $24,308.12 nat. median
$10,401
outlier · 2.3×
178
MS_DRG 		Respiratory Infections And Inflammations With Cc 8 $11,792.00 $31,632.80 $22,956.06 nat. median
$10,198
outlier · 2.3×
71
MS_DRG 		Other Cerebrovascular Disorders With Cc 4 $12,596.50 $21,272.90 $21,017.22 nat. median
$10,551
2.0× median
194
MS_DRG 		Simple Pneumonia And Pleurisy With Cc 8 $11,699.55 $26,580.15 $20,097.56 nat. median
$8,516
outlier · 2.4×
193
MS_DRG 		Simple Pneumonia And Pleurisy With Mcc 4 $8,045.00 $19,819.02 $19,580.82 nat. median
$12,868
1.5× median
8935574_1
CDM 		Lupron Depot 45 Mg 6 Month Kit 15 $18,082.50 $34,356.75 $19,529.10 nat. median
$19,529
1.0× median
683
MS_DRG 		Renal Failure With Cc 8 $11,132.11 $26,012.71 $19,389.80 nat. median
$9,108
outlier · 2.1×
308
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders With Mcc 4 $18,846.37 $19,600.22 $19,364.64 nat. median
$11,986
1.6× median
444
MS_DRG 		Disorders Of The Biliary Tract With Mcc 8 $9,126.20 $20,081.23 $18,810.40 nat. median
$16,157
1.2× median
65
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 4 $17,354.51 $18,048.69 $17,831.76 nat. median
$10,473
1.7× median
190
MS_DRG 		Chronic Obstructive Pulmonary Disease With Mcc 4 $15,638.25 $18,021.57 $17,804.96 nat. median
$11,062
1.6× median
9004596_1
CDM 		Skyrizi 600 Mg/10 Ml Vial 15 $16,060.00 $30,514.00 $17,344.80 nat. median
$17,345
1.0× median
698
MS_DRG 		Other Kidney And Urinary Tract Diagnoses With Mcc 7 $7,696.62 $23,080.01 $17,144.62 nat. median
$15,903
1.1× median
552
MS_DRG 		Medical Back Problems Without Mcc 8 $8,625.00 $18,545.40 $16,743.49 nat. median
$9,830
1.7× median
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 4 $15,081.71 $16,207.84 $16,013.03 nat. median
$12,282
1.3× median
947
MS_DRG 		Signs And Symptoms With Mcc 4 $15,540.99 $16,162.63 $15,968.36 nat. median
$12,117
1.3× median
914
MS_DRG 		Traumatic Injury Without Mcc 8 $7,555.00 $22,435.60 $15,772.15 nat. median
$9,256
1.7× median
388
MS_DRG 		Gastrointestinal Obstruction With Mcc 5 $5,537.00 $15,457.40 $14,985.00 nat. median
$14,318
1.0× median
394
MS_DRG 		Other Digestive System Diagnoses With Cc 8 $5,452.00 $15,372.40 $14,902.38 nat. median
$9,683
1.5× median
558
MS_DRG 		Tendonitis, Myositis And Bursitis Without Mcc 8 $8,431.00 $18,351.40 $14,691.72 nat. median
$9,057
1.6× median
440
MS_DRG 		Disorders Of Pancreas Except Malignancy Without Cc/mcc 8 $5,342.00 $15,262.40 $14,160.77 nat. median
$6,861
outlier · 2.1×
865
MS_DRG 		Viral Illness With Mcc 7 $13,536.21 $41,533.00 $14,077.65 nat. median
$14,518
1.0× median
690
MS_DRG 		Kidney And Urinary Tract Infections Without Mcc 4 $9,338.85 $13,667.17 $13,502.90 nat. median
$8,376
1.6× median
812
MS_DRG 		Red Blood Cell Disorders Without Mcc 4 $11,294.50 $13,558.67 $13,395.70 nat. median
$9,307
1.4× median
638
MS_DRG 		Diabetes With Cc 4 $12,877.22 $13,392.31 $13,231.34 nat. median
$9,225
1.4× median
202
MS_DRG 		Bronchitis And Asthma With Cc/mcc 4 $11,697.79 $12,849.82 $12,695.37 nat. median
$9,796
1.3× median
8852747_1
CDM 		Tysabri 300 Mg/15 Ml Vial 15 $11,555.00 $21,954.50 $12,479.40 nat. median
$12,479
1.0× median
310
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 8 $6,824.00 $16,744.40 $12,473.22 nat. median
$6,284
2.0× median
72
MS_DRG 		Other Cerebrovascular Disorders Without Cc/mcc 5 $8,927.00 $18,375.00 $12,118.58 nat. median
$8,126
1.5× median
8801548_1
CDM 		Entyvio 300 Mg Vial 15 $11,102.50 $21,094.75 $11,990.70 nat. median
$11,991
1.0× median

Other procedures at this hospital

Browse this hospital's 3,336 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
             
493 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 4 4 $58,203.48 $58,203.48 $40,739.03 $42,368.59 $41,859.35 2026-10-19
522 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 4 4 $50,819.60 $50,819.60 $39,215.88 $40,784.51 $40,294.32 2026-10-19
481 MS_DRG Hip And Femur Procedures Except Major Joint With Cc 4 4 $16,643.57 $16,643.57 $16,643.57 $39,270.96 $38,798.95 2026-10-19
314 MS_DRG Other Circulatory System Diagnoses With Mcc 7 7 $51,378.98 $51,378.98 $33,032.87 $150,582.98 $34,354.18 2026-10-19
462 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 4 4 $91,435.58 $91,435.58 $32,963.32 $34,281.85 $33,869.81 2026-10-19
157 MS_DRG Dental And Oral Diseases With Mcc 8 8 $15,004.00 $15,004.00 $15,004.00 $44,765.20 $33,248.06 2026-10-19
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 8 8 $14,263.75 $14,263.75 $14,263.75 $39,064.75 $31,417.37 2026-10-19
8964042_1 CDM Ocrevus 300 Mg/10 Ml Vial 15 15 $58,130.00 $58,130.00 $29,065.00 $55,223.50 $31,390.20 2026-10-19
378 MS_DRG Gastrointestinal Hemorrhage With Cc 8 8 $17,645.50 $17,645.50 $17,645.50 $42,446.50 $29,863.25 2026-10-19
439 MS_DRG Disorders Of Pancreas Except Malignancy With Cc 8 8 $20,590.00 $20,590.00 $14,602.06 $45,391.00 $29,698.07 2026-10-19
603 MS_DRG Cellulitis Without Mcc 8 8 $19,192.00 $19,192.00 $14,108.26 $43,993.00 $28,742.29 2026-10-19
177 MS_DRG Respiratory Infections And Inflammations With Mcc 8 8 $11,143.40 $11,143.40 $11,143.40 $30,984.20 $28,039.50 2026-10-19
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 4 4 $25,991.62 $25,991.62 $25,991.62 $27,981.71 $27,645.39 2026-10-19
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 4 4 $21,957.93 $21,957.93 $21,957.93 $27,813.54 $27,479.24 2026-10-19
559 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Mcc 4 4 $23,468.78 $23,468.78 $23,468.78 $27,813.54 $27,479.24 2026-10-19
J3245 HCPCS Injection, Tildrakizumab, 1 Mg 17 17 $50,830.00 $50,830.00 $302.72 $48,288.50 $26,431.60 2026-10-19
571 MS_DRG Skin Debridement With Cc 4 4 $31,876.42 $31,876.42 $25,034.59 $26,035.98 $25,723.04 2026-10-19
377 MS_DRG Gastrointestinal Hemorrhage With Mcc 4 4 $21,600.39 $21,600.39 $21,600.39 $25,920.24 $25,608.70 2026-10-19
536 MS_DRG Fractures Of Hip And Pelvis Without Mcc 8 8 $16,009.00 $16,009.00 $13,475.35 $35,849.80 $24,459.68 2026-10-19
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 8 8 $13,222.00 $13,222.00 $13,222.00 $28,102.60 $24,447.38 2026-10-19
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 8 8 $14,163.39 $14,163.39 $14,163.39 $34,004.19 $24,308.12 2026-10-19
178 MS_DRG Respiratory Infections And Inflammations With Cc 8 8 $11,792.00 $11,792.00 $11,792.00 $31,632.80 $22,956.06 2026-10-19
71 MS_DRG Other Cerebrovascular Disorders With Cc 4 4 $12,596.50 $12,596.50 $12,596.50 $21,272.90 $21,017.22 2026-10-19
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 8 8 $11,699.55 $11,699.55 $11,699.55 $26,580.15 $20,097.56 2026-10-19
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 4 4 $8,153.50 $8,153.50 $8,045.00 $19,819.02 $19,580.82 2026-10-19
8935574_1 CDM Lupron Depot 45 Mg 6 Month Kit 15 15 $36,165.00 $36,165.00 $18,082.50 $34,356.75 $19,529.10 2026-10-19
683 MS_DRG Renal Failure With Cc 8 8 $11,132.11 $11,132.11 $11,132.11 $26,012.71 $19,389.80 2026-10-19
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 4 4 $29,298.00 $29,298.00 $18,846.37 $19,600.22 $19,364.64 2026-10-19
444 MS_DRG Disorders Of The Biliary Tract With Mcc 8 8 $9,126.20 $9,126.20 $9,126.20 $20,081.23 $18,810.40 2026-10-19
65 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 4 4 $21,890.00 $21,890.00 $17,354.51 $18,048.69 $17,831.76 2026-10-19
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 4 4 $15,638.25 $15,638.25 $15,638.25 $18,021.57 $17,804.96 2026-10-19
9004596_1 CDM Skyrizi 600 Mg/10 Ml Vial 15 15 $32,120.00 $32,120.00 $16,060.00 $30,514.00 $17,344.80 2026-10-19
698 MS_DRG Other Kidney And Urinary Tract Diagnoses With Mcc 7 7 $7,696.62 $7,696.62 $7,696.62 $23,080.01 $17,144.62 2026-10-19
552 MS_DRG Medical Back Problems Without Mcc 8 8 $8,625.00 $8,625.00 $8,625.00 $18,545.40 $16,743.49 2026-10-19
189 MS_DRG Pulmonary Edema And Respiratory Failure 4 4 $15,081.71 $15,081.71 $15,081.71 $16,207.84 $16,013.03 2026-10-19
947 MS_DRG Signs And Symptoms With Mcc 4 4 $23,396.73 $23,396.73 $15,540.99 $16,162.63 $15,968.36 2026-10-19
914 MS_DRG Traumatic Injury Without Mcc 8 8 $7,555.00 $7,555.00 $7,555.00 $22,435.60 $15,772.15 2026-10-19
388 MS_DRG Gastrointestinal Obstruction With Mcc 5 5 $5,537.00 $5,537.00 $5,537.00 $15,457.40 $14,985.00 2026-10-19
394 MS_DRG Other Digestive System Diagnoses With Cc 8 8 $5,452.00 $5,452.00 $5,452.00 $15,372.40 $14,902.38 2026-10-19
558 MS_DRG Tendonitis, Myositis And Bursitis Without Mcc 8 8 $8,431.00 $8,431.00 $8,431.00 $18,351.40 $14,691.72 2026-10-19
440 MS_DRG Disorders Of Pancreas Except Malignancy Without Cc/mcc 8 8 $5,342.00 $5,342.00 $5,342.00 $15,262.40 $14,160.77 2026-10-19
865 MS_DRG Viral Illness With Mcc 7 7 $16,732.00 $16,732.00 $13,536.21 $41,533.00 $14,077.65 2026-10-19
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 4 4 $9,338.85 $9,338.85 $9,338.85 $13,667.17 $13,502.90 2026-10-19
812 MS_DRG Red Blood Cell Disorders Without Mcc 4 4 $11,294.50 $11,294.50 $11,294.50 $13,558.67 $13,395.70 2026-10-19
638 MS_DRG Diabetes With Cc 4 4 $15,535.00 $15,535.00 $12,877.22 $13,392.31 $13,231.34 2026-10-19
202 MS_DRG Bronchitis And Asthma With Cc/mcc 4 4 $11,697.79 $11,697.79 $11,697.79 $12,849.82 $12,695.37 2026-10-19
8852747_1 CDM Tysabri 300 Mg/15 Ml Vial 15 15 $23,110.00 $23,110.00 $11,555.00 $21,954.50 $12,479.40 2026-10-19
310 MS_DRG Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 8 8 $6,824.00 $6,824.00 $6,824.00 $16,744.40 $12,473.22 2026-10-19
72 MS_DRG Other Cerebrovascular Disorders Without Cc/mcc 5 5 $8,927.00 $8,927.00 $8,927.00 $18,375.00 $12,118.58 2026-10-19
8801548_1 CDM Entyvio 300 Mg Vial 15 15 $22,205.00 $22,205.00 $11,102.50 $21,094.75 $11,990.70 2026-10-19
948 MS_DRG Signs And Symptoms Without Mcc 4 4 $18,290.61 $18,290.61 $11,623.58 $12,088.52 $11,943.22 2026-10-19
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 7 7 $7,283.00 $7,283.00 $7,283.00 $21,455.00 $11,880.56 2026-10-19
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 4 4 $18,530.67 $18,530.67 $11,380.15 $11,835.36 $11,693.10 2026-10-19
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 4 4 $11,981.42 $11,981.42 $10,719.42 $11,148.20 $11,014.20 2026-10-19
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 15 15 $20,565.00 $20,565.00 $302.72 $19,536.75 $10,693.80 2026-10-19
70 MS_DRG Other Cerebrovascular Disorders With Mcc 2 2 $5,324.00 $5,324.00 $5,324.00 $14,772.00 $10,048.00 2026-10-19
J3101 HCPCS Injection, Tenecteplase, 1 Mg 17 17 $19,255.00 $19,255.00 $302.72 $18,292.25 $10,012.60 2026-10-19
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/mcc 4 4 $9,414.00 $9,414.00 $9,187.58 $9,555.08 $9,440.24 2026-10-19
8977441_1 CDM Gammagard Liquid 10% Vial 15 15 $15,745.00 $15,745.00 $7,872.50 $14,957.75 $8,502.30 2026-10-19
433 MS_DRG Cirrhosis And Alcoholic Hepatitis With Cc 4 4 $3,464.00 $3,464.00 $3,464.00 $8,424.20 $8,188.00 2026-10-19
292 MS_DRG Heart Failure And Shock With Cc 4 4 $2,908.79 $2,908.79 $2,908.79 $7,868.99 $7,632.79 2026-10-19
8920251_2 CDM Dupixent 200 Mg/1.14 Ml Syring 2 2 $10,500.00 $10,500.00 $7,350.00 $7,875.00 $7,612.50 2026-10-19
305 MS_DRG Hypertension Without Mcc 4 4 $2,770.00 $2,770.00 $2,770.00 $7,730.20 $7,494.00 2026-10-19
73 MS_DRG Cranial And Peripheral Nerve Disorders With Mcc 1 1 $6,559.00 $6,559.00 $6,559.00 $6,559.00 $6,559.00 2026-10-19
52 MS_DRG Spinal Disorders And Injuries With Cc/mcc 2 2 $4,472.00 $4,472.00 $4,099.00 $8,823.00 $6,461.00 2026-10-19
8961028_1 CDM Tezspire 210 Mg/1.91 Ml Syring 15 15 $11,915.00 $11,915.00 $5,957.50 $11,319.25 $6,434.10 2026-10-19
8836987_1 CDM Ruxience 500 Mg/50 Ml Vial 15 15 $11,095.00 $11,095.00 $5,547.50 $10,540.25 $5,991.30 2026-10-19
8973368_1 CDM Sandostatin Lar Depot 10 Mg Kt 15 15 $10,695.00 $10,695.00 $5,347.50 $10,160.25 $5,775.30 2026-10-19
8930242_1 CDM Leqvio 284 Mg/1.5 Ml Syringe 15 15 $10,680.00 $10,680.00 $5,340.00 $10,146.00 $5,767.20 2026-10-19
836 MS_DRG Acute Leukemia Without Cc/mcc 1 1 $5,479.64 $5,479.64 $5,479.64 $5,479.64 $5,479.64 2026-10-19
291 MS_DRG Heart Failure And Shock With Mcc 1 1 $5,336.00 $5,336.00 $5,336.00 $5,336.00 $5,336.00 2026-10-19
8785764_1 CDM Nucala 100 Mg/ml Powder Vial 15 15 $9,350.00 $9,350.00 $4,675.00 $8,882.50 $5,049.00 2026-10-19
8884683_1 CDM Eligard 45 Mg Syringe Kit 15 15 $8,945.00 $8,945.00 $4,472.50 $8,497.75 $4,830.30 2026-10-19
8977783_1 CDM Xolair 300 Mg/2 Ml Syringe 15 15 $8,575.00 $8,575.00 $4,287.50 $8,146.25 $4,630.50 2026-10-19
8735911_1 CDM Tl Primary Hip Stem With Long Neck Size 3 - 15 15 $8,438.00 $8,438.00 $4,219.00 $8,016.10 $4,556.52 2026-10-19
563 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 1 1 $4,321.00 $4,321.00 $4,321.00 $4,321.00 $4,321.00 2026-10-19
8861795_1 CDM Kcentra 1,000 Unit Vial 15 15 $7,470.00 $7,470.00 $3,735.00 $7,096.50 $4,033.80 2026-10-19
9048073_1 CDM Achilles Spdbrg Bc With Kl Dx Cc, 3.9mm - 15 15 $7,238.00 $7,238.00 $3,619.00 $6,876.10 $3,908.52 2026-10-19
8988516_1 CDM Speedbridge Fibertak Imp Syst 4.75 Mm - 15 15 $6,938.00 $6,938.00 $3,469.00 $6,591.10 $3,746.52 2026-10-19
884 MS_DRG Organic Disturbances And Intellectual Disability 1 1 $3,743.00 $3,743.00 $3,743.00 $3,743.00 $3,743.00 2026-10-19
J1569 HCPCS Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 17 17 $7,145.00 $7,145.00 $302.72 $6,787.75 $3,715.40 2026-10-19
8736097_1 CDM Biofoam Shell Size 56mm Group F 15 15 $6,772.00 $6,772.00 $3,386.00 $6,433.40 $3,656.88 2026-10-19
8979966_1 CDM Fulphila 6 Mg/0.6 Ml Syringe 15 15 $6,465.00 $6,465.00 $3,232.50 $6,141.75 $3,491.10 2026-10-19
8692006_1 CDM Trigen Intertan Nail 11.5mm X 42cm Left - 15 15 $6,338.00 $6,338.00 $3,169.00 $6,021.10 $3,422.52 2026-10-19
8983188_1 CDM Stelara 130 Mg/26 Ml Vial 15 15 $6,270.00 $6,270.00 $3,135.00 $5,956.50 $3,385.80 2026-10-19
78816 HCPCS Nuclear Medicine Study Whole Body With CT Scan 17 17 $6,412.00 $6,412.00 $302.72 $6,091.40 $3,334.24 2026-10-19
78815 HCPCS Nuclear Medicine Study From Skull Base To Mid-thigh With CT Scan 17 17 $6,412.00 $6,412.00 $302.72 $6,091.40 $3,334.24 2026-10-19
8735288_1 CDM Cs Primary Knee Femur Size 3 Left - 15 15 $6,001.00 $6,001.00 $3,000.50 $5,700.95 $3,240.54 2026-10-19
9017905_1 CDM Calcium Sulfate Biobeads, 20 Cc - 15 15 $5,625.00 $5,625.00 $2,812.50 $5,343.75 $3,037.50 2026-10-19
8735346_1 CDM Primary Knee Tibia Base Sz 4 Co/cr Nonpo - 15 15 $5,551.00 $5,551.00 $2,775.50 $5,273.45 $2,997.54 2026-10-19
8944190_1 CDM Lupron Depot 3.75 Mg Kit 15 15 $5,395.00 $5,395.00 $2,697.50 $5,125.25 $2,913.30 2026-10-19
8734698_1 CDM Operating Room Services - General Classification 15 15 $5,145.00 $5,145.00 $2,572.50 $4,887.75 $2,778.30 2026-10-19
8815406_1 CDM Aranesp 200 Mcg/0.4 Ml Syringe 15 15 $5,070.00 $5,070.00 $2,535.00 $4,816.50 $2,737.80 2026-10-19
629594_1 CDM MRI Spine Cervical With + Without Contrast 2 2 $3,697.00 $3,697.00 $2,587.90 $2,772.75 $2,680.32 2026-10-19
8877502_1 CDM Scp Knee Kit 5cc Accuportend-del11gax120mm - 15 15 $4,862.00 $4,862.00 $2,431.00 $4,618.90 $2,625.48 2026-10-19
8871423_1 CDM Galileo Troch Nail 11mmx20cmx125 - 15 15 $4,704.00 $4,704.00 $2,352.00 $4,468.80 $2,540.16 2026-10-19
J7327 HCPCS Hyaluronan Or Derivative, Monovisc, For Intra-articular Injection, Per Dose 17 17 $4,645.00 $4,645.00 $302.72 $4,412.75 $2,415.40 2026-10-19
8691993_1 CDM Trigen Meta-nail 8.5mm Tibial 33cm - 15 15 $4,448.00 $4,448.00 $2,224.00 $4,225.60 $2,401.92 2026-10-19
8691982_1 CDM Trigen Intertan Nail 11.5mm X 38cm Left - 15 15 $4,315.00 $4,315.00 $2,157.50 $4,099.25 $2,330.10 2026-10-19
282 MS_DRG Acute Myocardial Infarction, Discharged Alive Without Cc/mcc 1 1 $2,295.00 $2,295.00 $2,295.00 $2,295.00 $2,295.00 2026-10-19
8748423_1 CDM Primary Hip Cross Linked Poly Liner 36mm Grp F - 15 15 $4,232.00 $4,232.00 $2,116.00 $4,020.40 $2,285.28 2026-10-19
8692001_1 CDM Intertan 10s 10mm X 18cm 125d - 15 15 $4,208.00 $4,208.00 $2,104.00 $3,997.60 $2,272.32 2026-10-19
8850298_1 CDM Eligard 22.5 Mg Syringe Kit 15 15 $4,195.00 $4,195.00 $2,097.50 $3,985.25 $2,265.30 2026-10-19
8691988_1 CDM Intertan 1.5 10mmx36cm 125d Lt - 15 15 $4,163.00 $4,163.00 $2,081.50 $3,954.85 $2,248.02 2026-10-19
8691989_1 CDM Intertan 1.5 10mmx40cm 125d Lt - 15 15 $4,163.00 $4,163.00 $2,081.50 $3,954.85 $2,248.02 2026-10-19
J7325 HCPCS Hyaluronan Or Derivative, Synvisc Or Synvisc-one, For Intra-articular Injection,… 18 17 $4,240.00 $4,240.00 $302.72 $4,028.00 $2,204.80 2026-10-19
8735915_1 CDM Primary Hip Fem Head 40mm Sleeve Needed - 15 15 $4,050.00 $4,050.00 $2,025.00 $3,847.50 $2,187.00 2026-10-19
59409 HCPCS Vaginal Delivery 33 17 $6,237.00 $6,237.00 $302.72 $5,925.15 $2,185.30 2026-10-19
8820743_1 CDM Injectafer 750 Mg/15 Ml Vial 15 15 $4,040.00 $4,040.00 $2,020.00 $3,838.00 $2,181.60 2026-10-19
8949246_1 CDM Botox 200 Unit Vial 15 15 $3,930.00 $3,930.00 $1,965.00 $3,733.50 $2,122.20 2026-10-19
281 MS_DRG Acute Myocardial Infarction, Discharged Alive With Cc 1 1 $2,119.00 $2,119.00 $2,119.00 $2,119.00 $2,119.00 2026-10-19
Q4133 HCPCS Grafix Prime, Grafixpl Prime, Stravix And Stravixpl, Per Square Centimeter 15 15 $4,010.00 $4,010.00 $302.72 $3,809.50 $2,085.20 2026-10-19
78452 HCPCS Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 17 17 $4,010.00 $4,010.00 $302.72 $3,809.50 $2,085.20 2026-10-19
535 MS_DRG Fractures Of Hip And Pelvis With Mcc 1 1 $2,082.00 $2,082.00 $2,082.00 $2,082.00 $2,082.00 2026-10-19
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 17 17 $3,981.00 $3,981.00 $302.72 $3,781.95 $2,070.12 2026-10-19
36561 HCPCS Insertion Of Central Venous Tube With Port (5 Years Or Older) 33 17 $5,191.00 $5,191.00 $274.05 $4,931.45 $2,067.43 2026-10-19
26418 HCPCS Repair Of Tendon On Top Side Of Finger 33 17 $5,508.00 $5,508.00 $302.72 $5,232.60 $2,051.00 2026-10-19
J0897 HCPCS Injection, Denosumab, 1 Mg 17 17 $3,910.00 $3,910.00 $302.72 $3,714.50 $2,033.20 2026-10-19
9049025_1 CDM Femoral Head Biolox 28mm Delta Ceramic - 15 15 $3,739.00 $3,739.00 $1,869.50 $3,552.05 $2,019.06 2026-10-19
19083 HCPCS Biopsy Of Breast And Placement Of Locating Device Using Ultrasound, First Growth 50 17 $3,986.00 $3,986.00 $122.19 $3,786.70 $1,993.00 2026-10-19
73220 HCPCS MRI Scan Of Arm Before And After Contrast 34 17 $3,807.00 $3,807.00 $302.72 $3,616.65 $1,979.64 2026-10-19
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 34 17 $3,757.00 $3,757.00 $302.72 $3,569.15 $1,953.64 2026-10-19
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 34 17 $3,756.00 $3,756.00 $302.72 $3,568.20 $1,953.12 2026-10-19
73720 HCPCS MRI Scan Of Leg Before And After Contrast 34 17 $3,756.00 $3,756.00 $302.72 $3,568.20 $1,953.12 2026-10-19
27134 HCPCS Revision Of Thigh Bone And Hip Joint Prosthesis 16 16 $6,102.00 $6,102.00 $1,526.47 $6,285.06 $1,946.25 2026-10-19
8737190_1 CDM Cs Primary Knee Tibia Insert Size 6 Right - 15 15 $3,600.00 $3,600.00 $1,800.00 $3,420.00 $1,944.00 2026-10-19
8735348_1 CDM Cs Primary Knee Tibia Insert Size 4 Left - 15 15 $3,600.00 $3,600.00 $1,800.00 $3,420.00 $1,944.00 2026-10-19
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 17 17 $3,720.00 $3,720.00 $302.72 $3,534.00 $1,934.40 2026-10-19
95805 HCPCS Sleep Study, Multiple Trials 17 17 $3,720.00 $3,720.00 $302.72 $3,534.00 $1,934.40 2026-10-19
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 17 17 $3,720.00 $3,720.00 $302.72 $3,534.00 $1,934.40 2026-10-19
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 17 17 $3,697.00 $3,697.00 $302.72 $3,512.15 $1,922.44 2026-10-19
71552 HCPCS MRI Scan Of Chest Before And After Contrast 17 17 $3,697.00 $3,697.00 $302.72 $3,512.15 $1,922.44 2026-10-19
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 17 17 $3,697.00 $3,697.00 $302.72 $3,512.15 $1,922.44 2026-10-19
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 17 17 $3,697.00 $3,697.00 $302.72 $3,512.15 $1,922.44 2026-10-19
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 17 17 $3,697.00 $3,697.00 $302.72 $3,512.15 $1,922.44 2026-10-19
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 17 17 $3,697.00 $3,697.00 $302.72 $3,512.15 $1,922.44 2026-10-19
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 17 17 $3,697.00 $3,697.00 $302.72 $3,512.15 $1,922.44 2026-10-19
Q4105 HCPCS Integra Dermal Regeneration Template (drt) Or Integra Omnigraft Dermal Regenerat… 15 15 $3,675.00 $3,675.00 $302.72 $3,491.25 $1,911.00 2026-10-19
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 17 17 $3,662.00 $3,662.00 $302.72 $3,478.90 $1,904.24 2026-10-19
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 17 17 $3,646.00 $3,646.00 $302.72 $3,463.70 $1,895.92 2026-10-19
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 17 17 $3,638.00 $3,638.00 $302.72 $3,456.10 $1,891.76 2026-10-19
70553 HCPCS MRI Scan Of Brain Before And After Contrast 17 17 $3,636.00 $3,636.00 $302.72 $3,454.20 $1,890.72 2026-10-19
78803 HCPCS Nuclear Medicine Study, Spect Imaging, 1 Area Or Single Acquisition, Single Day … 17 17 $3,624.00 $3,624.00 $302.72 $3,442.80 $1,884.48 2026-10-19
78606 HCPCS Nuclear Medicine Study Of Brain And Blood Flow, 4 Static Views Or More 17 17 $3,624.00 $3,624.00 $302.72 $3,442.80 $1,884.48 2026-10-19
8753098_1 CDM Speed Graft - Spd-001 15 15 $3,488.00 $3,488.00 $1,744.00 $3,313.60 $1,883.52 2026-10-19
9048271_1 CDM Peek, Meniscal Root Repair Kit - 15 15 $3,488.00 $3,488.00 $1,744.00 $3,313.60 $1,883.52 2026-10-19
8734696_1 CDM Operating Room Services - General Classification 15 15 $3,465.00 $3,465.00 $1,732.50 $3,291.75 $1,871.10 2026-10-19
27252 HCPCS Closed Treatment Of Dislocated Hip Under Anesthesia 33 17 $3,675.00 $3,675.00 $302.72 $3,491.25 $1,837.50 2026-10-19
71555 HCPCS MRI Scan Of Blood Vessels Of Chest 17 17 $3,532.00 $3,532.00 $302.72 $3,355.40 $1,836.64 2026-10-19
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 17 17 $3,521.00 $3,521.00 $302.72 $3,344.95 $1,830.92 2026-10-19
8748419_1 CDM Primary Hip Fem Head 36mm Sleeve Needed - 15 15 $3,386.00 $3,386.00 $1,693.00 $3,216.70 $1,828.44 2026-10-19
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 17 17 $3,515.00 $3,515.00 $302.72 $3,339.25 $1,827.80 2026-10-19
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 34 17 $3,355.00 $3,355.00 $302.72 $3,187.25 $1,744.60 2026-10-19
8691932_1 CDM Intertan 10mm X 20cm 125d - 15 15 $3,228.00 $3,228.00 $1,614.00 $3,066.60 $1,743.12 2026-10-19
8691927_1 CDM Interan 10mm X 18cm 125d - 15 15 $3,228.00 $3,228.00 $1,614.00 $3,066.60 $1,743.12 2026-10-19
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 17 17 $3,337.00 $3,337.00 $302.72 $3,170.15 $1,735.24 2026-10-19
27132 HCPCS Total Hip Replacement After Previous Hip Surgery 16 16 $5,333.00 $5,333.00 $1,355.45 $5,492.99 $1,728.20 2026-10-19
C9359 HCPCS Porous Purified Collagen Matrix Bone Void Filler (integra Mozaik Osteoconductive… 41 15 $3,135.00 $3,135.00 $302.72 $7,837.50 $1,726.76 2026-10-19
55700 HCPCS Biopsy Of Prostate Gland 24 17 $3,276.00 $3,276.00 $242.80 $3,112.20 $1,703.52 2026-10-19
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 17 17 $3,208.00 $3,208.00 $302.72 $3,047.60 $1,668.16 2026-10-19
8735913_1 CDM Primary Hip Liner Poly 40mm Group F - 15 15 $3,075.00 $3,075.00 $1,537.50 $2,921.25 $1,660.50 2026-10-19
442 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc 1 1 $1,655.00 $1,655.00 $1,655.00 $1,655.00 $1,655.00 2026-10-19
8777411_1 CDM Durolane 60 Mg/3 Ml Syringe 15 15 $3,020.00 $3,020.00 $1,510.00 $2,869.00 $1,630.80 2026-10-19
8691992_1 CDM 4cc Prodense Injectable Bone Graft Sub - 15 15 $3,005.00 $3,005.00 $1,502.50 $2,854.75 $1,622.70 2026-10-19
20102 HCPCS Exploration Of Wound Of Abdomen, Back, Or Flank 33 17 $4,501.00 $4,501.00 $218.21 $4,275.95 $1,612.00 2026-10-19
P9037 HCPCS Platelets, Pheresis, Leukocytes Reduced, Irradiated, Each Unit 17 17 $3,085.00 $3,085.00 $302.72 $2,930.75 $1,604.20 2026-10-19
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 17 17 $3,027.00 $3,027.00 $302.72 $2,875.65 $1,574.04 2026-10-19
25624 HCPCS Closed Treatment Of Broken Wrist Bone Near Base Of Thumb With Manipulation 33 17 $4,758.00 $4,758.00 $302.72 $4,520.10 $1,572.00 2026-10-19
27130 HCPCS Replacement Of Thigh Bone And Hip Joint With Prosthesis 17 17 $4,198.00 $4,198.00 $1,047.43 $4,323.94 $1,571.15 2026-10-19
J7318 HCPCS Hyaluronan Or Derivative, Durolane, For Intra-articular Injection, 1 Mg 17 17 $3,020.00 $3,020.00 $302.72 $2,869.00 $1,570.40 2026-10-19
27447 HCPCS Replacement Of Knee Joint, Both Sides Of Knee 68 17 $3,924.00 $3,924.00 $1,045.50 $6,062.58 $1,568.25 2026-10-19
J0485 HCPCS Injection, Belatacept, 1 Mg 17 17 $3,005.00 $3,005.00 $302.72 $2,854.75 $1,562.60 2026-10-19
70552 HCPCS MRI Scan Of Brain With Contrast 17 17 $2,961.00 $2,961.00 $302.72 $2,812.95 $1,539.72 2026-10-19
312 MS_DRG Syncope And Collapse 1 1 $1,531.00 $1,531.00 $1,531.00 $1,531.00 $1,531.00 2026-10-19
8734694_1 CDM Operating Room Services - General Classification 15 15 $2,835.00 $2,835.00 $1,417.50 $2,693.25 $1,530.90 2026-10-19
8734691_1 CDM Operating Room Services - General Classification 15 15 $2,835.00 $2,835.00 $1,417.50 $2,693.25 $1,530.90 2026-10-19
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 17 17 $2,927.00 $2,927.00 $302.72 $2,780.65 $1,522.04 2026-10-19
74182 HCPCS MRI Scan Of Abdomen With Contrast 17 17 $2,927.00 $2,927.00 $302.72 $2,780.65 $1,522.04 2026-10-19
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 17 17 $2,927.00 $2,927.00 $302.72 $2,780.65 $1,522.04 2026-10-19
8928588_1 CDM Dupixent 300 Mg/2 Ml Syringe 15 15 $2,792.50 $2,792.50 $1,396.25 $2,652.88 $1,507.95 2026-10-19
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 34 17 $2,898.00 $2,898.00 $302.72 $2,753.10 $1,506.96 2026-10-19
44141 HCPCS Partial Removal Of Large Bowel With Creation Of Opening To Skin 16 16 $4,431.00 $4,431.00 $1,126.75 $4,084.40 $1,506.25 2026-10-19
23472 HCPCS Prosthetic Repair Of Shoulder Joint, Total Shoulder 16 16 $4,447.00 $4,447.00 $1,175.60 $4,580.41 $1,498.89 2026-10-19
27486 HCPCS Revision Of Component Of Total Knee Joint Prosthesis 16 16 $4,396.00 $4,396.00 $1,149.74 $4,527.88 $1,465.92 2026-10-19
72191 HCPCS CT Scan Of Blood Vessels Of Pelvis With Contrast 17 17 $2,797.00 $2,797.00 $302.72 $2,657.15 $1,454.44 2026-10-19
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 17 17 $2,797.00 $2,797.00 $302.72 $2,657.15 $1,454.44 2026-10-19
73706 HCPCS CT Scan Of Blood Vessels Of Lower Leg With Contrast 17 17 $2,797.00 $2,797.00 $302.72 $2,657.15 $1,454.44 2026-10-19
P9035 HCPCS Platelets, Pheresis, Leukocytes Reduced, Each Unit 17 17 $2,776.00 $2,776.00 $302.72 $2,637.20 $1,443.52 2026-10-19
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 17 17 $2,771.00 $2,771.00 $302.72 $2,632.45 $1,440.92 2026-10-19
8734690_1 CDM Operating Room Services - General Classification 15 15 $2,663.00 $2,663.00 $1,331.50 $2,529.85 $1,438.02 2026-10-19
38222 HCPCS Biopsy And Aspiration Of Bone Marrow Sample For Diagnosis 17 17 $2,707.00 $2,707.00 $302.72 $2,571.65 $1,435.79 2026-10-19
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 17 17 $2,743.00 $2,743.00 $302.72 $2,605.85 $1,426.36 2026-10-19
73202 HCPCS CT Scan Of Arm Before And After Contrast 51 17 $2,743.00 $2,743.00 $302.72 $2,605.85 $1,426.36 2026-10-19
70488 HCPCS CT Scan Of Face Before And After Contrast 17 17 $2,743.00 $2,743.00 $302.72 $2,605.85 $1,426.36 2026-10-19
71270 HCPCS CT Scan Of Chest Before And After Contrast 17 17 $2,743.00 $2,743.00 $302.72 $2,605.85 $1,426.36 2026-10-19
73702 HCPCS CT Scan Of Leg Before And After Contrast 51 17 $2,743.00 $2,743.00 $302.72 $2,605.85 $1,426.36 2026-10-19
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 17 17 $2,743.00 $2,743.00 $302.72 $2,605.85 $1,426.36 2026-10-19
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 17 17 $2,743.00 $2,743.00 $302.72 $2,605.85 $1,426.36 2026-10-19
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 17 17 $2,743.00 $2,743.00 $302.72 $2,605.85 $1,426.36 2026-10-19
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 17 17 $2,740.00 $2,740.00 $302.72 $2,603.00 $1,424.80 2026-10-19
27828 HCPCS Treatment Of Broken Lower Weight Bearing Joint Of Both Lower Leg Bones 16 16 $4,180.00 $4,180.00 $1,113.63 $4,305.40 $1,419.88 2026-10-19
C8928 HCPCS Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi… 17 17 $2,728.00 $2,728.00 $302.72 $2,591.60 $1,418.56 2026-10-19
73222 HCPCS MRI Scan Of Arm Joint With Contrast 34 17 $2,709.00 $2,709.00 $302.72 $2,573.55 $1,408.68 2026-10-19
73722 HCPCS MRI Scan Of Leg Joint With Contrast 34 17 $2,709.00 $2,709.00 $302.72 $2,573.55 $1,408.68 2026-10-19
8912133_1 CDM Zoladex 3.6 Mg Implant Syrn 15 15 $2,590.00 $2,590.00 $1,295.00 $2,460.50 $1,398.60 2026-10-19
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 17 17 $2,665.00 $2,665.00 $302.72 $2,531.75 $1,385.80 2026-10-19
8827475_1 CDM Aranesp 100 Mcg/0.5 Ml Syringe 15 15 $2,555.00 $2,555.00 $1,277.50 $2,427.25 $1,379.70 2026-10-19
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 17 17 $2,642.00 $2,642.00 $294.87 $2,509.90 $1,373.84 2026-10-19
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 17 17 $2,632.00 $2,632.00 $294.87 $2,500.40 $1,368.64 2026-10-19
C1776 HCPCS Joint Device (implantable) 1,471 15 $2,370.00 $2,370.00 $54.00 $10,687.50 $1,350.00 2026-10-19
70551 HCPCS MRI Scan Of Brain Without Contrast 17 17 $2,596.00 $2,596.00 $294.87 $2,466.20 $1,349.92 2026-10-19
8748052_1 CDM Room & Board - Other - Sterile Environment 9 9 $1,408.00 $1,408.00 $844.80 $1,625.82 $1,337.60 2026-10-19
2120847_1 CDM Room & Board - Semi-private (two Beds) - Other 9 9 $1,408.00 $1,408.00 $844.80 $1,625.82 $1,337.60 2026-10-19
8983621_1 CDM Knotless Tensionable Fibertak Biceps Kit - 15 15 $2,475.00 $2,475.00 $1,237.50 $2,351.25 $1,336.50 2026-10-19
J0881 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 69 17 $2,555.00 $2,555.00 $302.72 $7,281.75 $1,328.60 2026-10-19
G0390 HCPCS Trauma Response Team Associated With Hospital Critical Care Service 15 15 $2,549.00 $2,549.00 $302.72 $2,421.55 $1,325.48 2026-10-19
8691751_1 CDM External Fixator Disital Kit - 15 15 $2,439.00 $2,439.00 $1,219.50 $2,317.05 $1,317.06 2026-10-19
8953397_1 CDM Dynaclip 14mm X 14mm X 14mm Inserter * 15 15 $2,400.00 $2,400.00 $1,200.00 $2,280.00 $1,296.00 2026-10-19
73218 HCPCS MRI Scan Of Arm Without Contrast 34 17 $2,485.00 $2,485.00 $294.87 $2,360.75 $1,292.20 2026-10-19
27245 HCPCS Treatment Of Broken Neck Of Thigh Bone With Bone Implant 16 16 $2,850.00 $2,850.00 $1,009.36 $2,935.50 $1,286.93 2026-10-19
27513 HCPCS Treatment Of Broken Thigh Bone In Knee Area 16 16 $3,965.00 $3,965.00 $997.59 $4,083.95 $1,271.93 2026-10-19
74160 HCPCS CT Scan Of Abdomen With Contrast 17 17 $2,439.00 $2,439.00 $302.72 $2,317.05 $1,268.28 2026-10-19
73701 HCPCS CT Scan Of Leg With Contrast Material 51 17 $2,439.00 $2,439.00 $302.72 $2,317.05 $1,268.28 2026-10-19
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 17 17 $2,439.00 $2,439.00 $302.72 $2,317.05 $1,268.28 2026-10-19
72193 HCPCS CT Scan Of Pelvis With Contrast 17 17 $2,439.00 $2,439.00 $302.72 $2,317.05 $1,268.28 2026-10-19
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 17 17 $2,439.00 $2,439.00 $302.72 $2,317.05 $1,268.28 2026-10-19
70460 HCPCS CT Scan Head Or Brain With Contrast 17 17 $2,439.00 $2,439.00 $302.72 $2,317.05 $1,268.28 2026-10-19
72132 HCPCS CT Scan Of Lower Spine With Contrast 17 17 $2,439.00 $2,439.00 $302.72 $2,317.05 $1,268.28 2026-10-19
70487 HCPCS CT Scan Of Face With Contrast 17 17 $2,439.00 $2,439.00 $302.72 $2,317.05 $1,268.28 2026-10-19
73201 HCPCS CT Scan Of Arm With Contrast 51 17 $2,439.00 $2,439.00 $302.72 $2,317.05 $1,268.28 2026-10-19
8692132_1 CDM Implant System Cpr Mini Scorpion & Micro - 15 15 $2,348.00 $2,348.00 $1,174.00 $2,230.60 $1,267.92 2026-10-19
8944189_1 CDM Renflexis 100 Mg Vial 15 15 $2,335.00 $2,335.00 $1,167.50 $2,218.25 $1,260.90 2026-10-19
27536 HCPCS Treatment Of Broken Shin Bone On Both Sides Of Upper End 16 16 $3,804.00 $3,804.00 $984.01 $3,918.12 $1,254.62 2026-10-19
72195 HCPCS MRI Scan Of Pelvis Without Contrast 17 17 $2,412.00 $2,412.00 $294.87 $2,291.40 $1,254.24 2026-10-19
27236 HCPCS Treatment Of Upper End Of Broken Thigh Bone With Placement Of Stabilizing Device… 16 16 $3,652.00 $3,652.00 $983.52 $3,761.56 $1,253.99 2026-10-19
74181 HCPCS MRI Scan Of Abdomen Without Contrast 17 17 $2,411.00 $2,411.00 $294.87 $2,290.45 $1,253.72 2026-10-19
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 17 17 $2,407.00 $2,407.00 $302.72 $2,286.65 $1,251.64 2026-10-19
27470 HCPCS Repair Of Nonhealed Broken Thigh Bone 16 16 $3,777.00 $3,777.00 $978.97 $3,890.31 $1,248.19 2026-10-19
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 34 17 $2,400.00 $2,400.00 $294.87 $2,280.00 $1,248.00 2026-10-19
90375 HCPCS Rabies Immune Globulin For Injection 17 17 $2,345.00 $2,345.00 $302.72 $2,227.75 $1,243.79 2026-10-19
73718 HCPCS MRI Scan Of Leg Without Contrast 34 17 $2,359.00 $2,359.00 $294.87 $2,241.05 $1,226.68 2026-10-19
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 34 17 $2,359.00 $2,359.00 $294.87 $2,241.05 $1,226.68 2026-10-19
43425 HCPCS Repair Of Abnormal Drainage Tract Of Esophagus Through Chest Or Abdomen 16 16 $5,569.00 $5,569.00 $1,008.99 $3,226.40 $1,221.57 2026-10-19
C1889 HCPCS Implantable/insertable Device, Not Otherwise Classified 28 15 $1,430.00 $1,430.00 $302.72 $22,562.50 $1,215.50 2026-10-19
93350 HCPCS Ultrasound Of Heart During Rest, Exercise And/or Drug-induced Stress With Report 17 17 $2,306.00 $2,306.00 $302.72 $2,190.70 $1,199.12 2026-10-19
2120840_1 CDM Room & Board - Semi-private (two Beds) - General Classification 9 9 $1,261.00 $1,261.00 $756.60 $1,456.08 $1,197.95 2026-10-19
8002766_1 CDM Room & Board - Semi-private (two Beds) - General Classification 9 9 $1,261.00 $1,261.00 $756.60 $1,456.08 $1,197.95 2026-10-19
27301 HCPCS Drainage Of Deep Abscess Or Blood Accumulation Of Thigh Or Knee 24 16 $1,324.00 $1,324.00 $437.61 $2,068.24 $1,197.65 2026-10-19
27428 HCPCS Reconstruction Ligaments Inside Knee Joint 16 16 $3,507.00 $3,507.00 $939.24 $3,612.21 $1,197.53 2026-10-19
71550 HCPCS MRI Scan Of Chest Without Contrast 17 17 $2,297.00 $2,297.00 $294.87 $2,182.15 $1,194.44 2026-10-19
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 17 17 $2,297.00 $2,297.00 $302.72 $2,182.15 $1,194.44 2026-10-19
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 17 17 $2,297.00 $2,297.00 $294.87 $2,182.15 $1,194.44 2026-10-19
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 17 17 $2,297.00 $2,297.00 $294.87 $2,182.15 $1,194.44 2026-10-19
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 17 17 $2,297.00 $2,297.00 $302.72 $2,182.15 $1,194.44 2026-10-19
24675 HCPCS Closed Treatment Of Broken Forearm Bone On Small Finger Side At Elbow With Manip… 33 17 $2,386.00 $2,386.00 $302.72 $2,266.70 $1,193.00 2026-10-19
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 17 17 $2,276.00 $2,276.00 $302.72 $2,162.20 $1,183.52 2026-10-19
93612 HCPCS Insertion Of Temporary Pacemaker Electrode For Diagnostic Lower Heart Pacing 17 17 $2,228.00 $2,228.00 $302.72 $7,186.68 $1,181.73 2026-10-19
8700461_1 CDM Coolief Lumbar Mcka3-17-100-4 15 15 $2,172.00 $2,172.00 $1,086.00 $2,063.40 $1,172.88 2026-10-19
8739069_1 CDM Coolief Lumbar Mcka3-17-75-4 15 15 $2,172.00 $2,172.00 $1,086.00 $2,063.40 $1,172.88 2026-10-19
8814546_1 CDM Veklury 100 Mg Vial 15 15 $2,168.42 $2,168.42 $1,084.21 $2,060.00 $1,170.95 2026-10-19
72159 HCPCS MRI Scan Of Blood Vessels Of Spinal Canal 17 17 $2,245.00 $2,245.00 $302.72 $2,132.75 $1,167.40 2026-10-19
13152 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 2.6-7.5 Cm 33 17 $2,334.00 $2,334.00 $259.12 $2,217.30 $1,167.00 2026-10-19
8957929_1 CDM Cable Accord Small Trochanteric Grip 75mm - 15 15 $2,150.00 $2,150.00 $1,075.00 $2,042.50 $1,161.00 2026-10-19
4903027_1 CDM Room & Board - Other - Other 9 9 $1,222.00 $1,222.00 $733.20 $1,411.04 $1,160.90 2026-10-19
46040 HCPCS Drainage Of Deep Abscess In Rectum 33 17 $2,304.00 $2,304.00 $302.72 $2,188.80 $1,152.00 2026-10-19
8988589_1 CDM Plate Clav Frac Central Third Rt - 15 15 $2,126.00 $2,126.00 $1,063.00 $2,019.70 $1,148.04 2026-10-19
8935695_1 CDM Gamunex-c 5 Gram/50 Ml Vial 15 15 $2,120.00 $2,120.00 $1,060.00 $2,014.00 $1,144.80 2026-10-19
A0434 HCPCS Specialty Care Transport (sct) 28 15 $1,775.00 $1,775.00 $302.72 $2,090.00 $1,144.00 2026-10-19
70336 HCPCS MRI Scan Of Jaw Joint 17 17 $2,188.00 $2,188.00 $294.87 $2,078.60 $1,137.76 2026-10-19
64635 HCPCS Destruction Of Lower Or Sacral Spinal Facet Joint Nerves Using Imaging Guidance,… 115 17 $1,670.00 $1,670.00 $162.49 $5,155.65 $1,135.26 2026-10-19
8953395_1 CDM Dynaclip 12mm X 12mm X 12mm Inserter * 15 15 $2,100.00 $2,100.00 $1,050.00 $1,995.00 $1,134.00 2026-10-19
78802 HCPCS Nuclear Medicine Study, Whole Body 17 17 $2,174.00 $2,174.00 $302.72 $2,065.30 $1,130.48 2026-10-19
49900 HCPCS Suture Of Postsurgical Opening In Abdominal Wall 33 17 $2,171.00 $2,171.00 $302.72 $4,787.84 $1,128.92 2026-10-19
72129 HCPCS CT Scan Of Middle Spine With Contrast 17 17 $2,164.00 $2,164.00 $302.72 $2,055.80 $1,125.28 2026-10-19
25609 HCPCS Treatment Of 3 Or More Broken Lower Forearm Bone Pieces On Thumb Side Inside Wri… 16 16 $3,302.00 $3,302.00 $878.21 $3,401.06 $1,119.72 2026-10-19
71260 HCPCS CT Scan Of Chest With Contrast 17 17 $2,112.00 $2,112.00 $302.72 $2,006.40 $1,098.24 2026-10-19
J3304 HCPCS Injection, Triamcinolone Acetonide, Preservative-free, Extended-release, Microsp… 27 17 $2,100.00 $2,100.00 $17.49 $2,403.40 $1,092.00 2026-10-19
87902 HCPCS Analysis Test By Nucleic Acid For Hepatitis C Virus 17 17 $2,095.00 $2,095.00 $167.25 $1,990.25 $1,089.40 2026-10-19
8863608_1 CDM Coolief Shoulder Mcka2-17-50-2 15 15 $1,995.00 $1,995.00 $997.50 $1,895.25 $1,077.30 2026-10-19
8920027_1 CDM Coolief Multi Advanced, 17g X 50mm, 1 Knee 15 15 $1,995.00 $1,995.00 $997.50 $1,895.25 $1,077.30 2026-10-19
8863610_1 CDM Coolief Advanced Kit Rf, 17g X 75mm X 4mm Back -(obsolete) 15 15 $1,995.00 $1,995.00 $997.50 $1,895.25 $1,077.30 2026-10-19
9049029_1 CDM Volar Distal Rad Plt Ti Wide Lt 3h - 15 15 $1,988.00 $1,988.00 $994.00 $1,888.60 $1,073.52 2026-10-19
27823 HCPCS Treatment Of 3 Broken Lower Leg Bones At Ankle With Fixation Of Posterior Lip 16 16 $3,181.00 $3,181.00 $837.38 $3,276.43 $1,067.66 2026-10-19
8949245_1 CDM Botox 100 Unit Vial 15 15 $1,965.00 $1,965.00 $982.50 $1,866.75 $1,061.10 2026-10-19
8815505_1 CDM Xolair 150 Mg/ml Syringe 15 15 $1,960.53 $1,960.53 $980.27 $1,862.50 $1,058.69 2026-10-19
78700 HCPCS Nuclear Medicine Study Of Kidney 17 17 $2,035.00 $2,035.00 $302.72 $1,933.25 $1,058.20 2026-10-19
78709 HCPCS Nuclear Medicine Studies Of Kidney, Blood Flow, And Function 17 17 $2,035.00 $2,035.00 $302.72 $1,933.25 $1,058.20 2026-10-19
78740 HCPCS Nuclear Medicine Study To Assess Urine Flow 17 17 $2,035.00 $2,035.00 $302.72 $1,933.25 $1,058.20 2026-10-19
78761 HCPCS Nuclear Medicine Study Of Testicle And Blood Flow 17 17 $2,035.00 $2,035.00 $302.72 $1,933.25 $1,058.20 2026-10-19
78701 HCPCS Nuclear Medicine Study Of Kidney And Blood Flow 17 17 $2,035.00 $2,035.00 $302.72 $1,933.25 $1,058.20 2026-10-19
78707 HCPCS Nuclear Medicine Study Of Kidney, Blood Flow, And Function 17 17 $2,035.00 $2,035.00 $302.72 $1,933.25 $1,058.20 2026-10-19
78708 HCPCS Nuclear Medicine Study Of Kidney, Blood, Flow, And Function With Drug Administra… 17 17 $2,035.00 $2,035.00 $302.72 $1,933.25 $1,058.20 2026-10-19
8970312_1 CDM Coolief Multi Advanced, 17g X 150mm X 4mm - Back 15 15 $1,942.00 $1,942.00 $971.00 $1,844.90 $1,048.68 2026-10-19
8935295_1 CDM Coolief Advanced 17ga X 150mm X 4mm (Hip) 15 15 $1,942.00 $1,942.00 $971.00 $1,844.90 $1,048.68 2026-10-19
8911898_1 CDM Coolief Multi Advanced, 17g X 75mm X 4mm - Back - 15 15 $1,942.00 $1,942.00 $971.00 $1,844.90 $1,048.68 2026-10-19
8955447_1 CDM Coolief Multi Advanced, 17g X 100mm X 4mm - Back 15 15 $1,942.00 $1,942.00 $971.00 $1,844.90 $1,048.68 2026-10-19
4903012_1 CDM Room & Board - Other - Other 9 9 $1,076.00 $1,076.00 $645.60 $1,242.46 $1,022.20 2026-10-19
8747087_1 CDM Grafix Prime 3 X 4 Cm * 15 15 $1,883.00 $1,883.00 $941.50 $1,788.85 $1,016.82 2026-10-19
36573 HCPCS Insertion Of Tube For Infusion With Imaging Guidance And Review By Radiologist, … 33 17 $2,306.00 $2,306.00 $67.61 $2,190.70 $1,010.65 2026-10-19
27514 HCPCS Treatment Of Broken Side Of Lower End Of Thigh Bone 16 16 $3,033.00 $3,033.00 $789.24 $3,123.99 $1,006.28 2026-10-19
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