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

DAVIS COUNTY HOSPITAL

Bloomfield, IA · CCN 161327 · Rates published

Your selected procedure

You selected 27447 (HCPCS)

Replacement of knee joint, both sides of knee

This hospital’s price: $1,568 across 17 payers · range $1,046-$6,063

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbDCHBLOOMFIELDIA&type=CDMWithoutLabel&fileType=CSV · observed 2026-04-10

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.

3,317 distinct procedures filed
18 distinct payers
66,422 rate rows
2026-04-10 last MRF observed
Data quality

64,797 of 66,422 rate rows are consumer-grade (97.6%)

1,625 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 837
per-diem day rate — not a per-procedure price 289
percent-of-charges filed in the dollar field — excluded from medians 209
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 204
exceeds 3× this hospital's gross charge for a DRG stay — excluded 71
exceeds 10× this hospital's gross charge — excluded from medians 15
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 · 2026-08-14
Content fingerprint fe9b3b0b0257a35c… · 31,489,849 bytes · first seen 2026-05-08

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
462
MS_DRG 		Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 9 $54,861.35 $86,863.80 $81,328.78 nat. median
$27,791
outlier · 2.9×
493
MS_DRG 		Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 9 $34,922.09 $104,533.95 $55,293.31 nat. median
$24,545
outlier · 2.3×
314
MS_DRG 		Other Circulatory System Diagnoses With Mcc 9 $30,827.39 $84,760.39 $48,810.03 nat. median
$20,500
outlier · 2.4×
522
MS_DRG 		Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 9 $30,491.76 $100,625.64 $48,278.62 nat. median
$21,659
outlier · 2.2×
872
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 13 $8,498.03 $39,875.79 $37,644.52 nat. median
$11,029
outlier · 3.4×
603
MS_DRG 		Cellulitis Without Mcc 13 $11,515.20 $51,332.50 $35,504.79 nat. median
$9,525
outlier · 3.7×
536
MS_DRG 		Fractures Of Hip And Pelvis Without Mcc 13 $9,605.40 $41,721.40 $33,912.02 nat. median
$8,921
outlier · 3.8×
8964042_1
CDM 		Ocrevus 300 Mg/10 Ml Vial 15 $29,065.00 $55,223.50 $32,959.71 nat. median
$32,960
1.0× median
571
MS_DRG 		Skin Debridement With Cc 9 $19,125.85 $64,237.29 $30,282.60 nat. median
$17,113
1.8× median
683
MS_DRG 		Renal Failure With Cc 13 $6,679.27 $33,247.42 $29,498.11 nat. median
$9,596
outlier · 3.1×
308
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders With Mcc 10 $17,578.80 $60,520.20 $28,565.55 nat. median
$12,590
outlier · 2.3×
J3245
HCPCS 		Injection, Tildrakizumab, 1 Mg 17 $9,318.95 $48,288.50 $27,997.16 nat. median
$256
outlier · 109.3×
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 9 $15,594.97 $69,037.91 $24,692.04 nat. median
$19,136
1.3× median
641
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 13 $7,188.85 $27,505.41 $24,225.42 nat. median
$8,588
outlier · 2.8×
812
MS_DRG 		Red Blood Cell Disorders Without Mcc 13 $6,776.70 $33,452.65 $23,538.50 nat. median
$9,785
outlier · 2.4×
559
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Mcc 9 $14,081.27 $68,622.99 $22,295.34 nat. median
$18,860
1.2× median
947
MS_DRG 		Signs And Symptoms With Mcc 9 $14,038.04 $39,877.27 $22,226.89 nat. median
$12,594
1.8× median
377
MS_DRG 		Gastrointestinal Hemorrhage With Mcc 9 $12,960.23 $63,951.75 $20,520.37 nat. median
$18,028
1.1× median
8935574_1
CDM 		Lupron Depot 45 Mg 6mo Kit 15 $18,082.50 $34,356.75 $20,505.56 nat. median
$20,506
1.0× median
439
MS_DRG 		Disorders Of Pancreas Except Malignancy With Cc 10 $12,354.00 $51,812.20 $20,075.25 nat. median
$9,456
outlier · 2.1×
9004596_1
CDM 		Skyrizi 600 Mg/10 Ml Vial 15 $16,060.00 $30,514.00 $18,212.04 nat. median
$18,212
1.0× median
392
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 10 $11,118.40 $37,263.99 $18,067.40 nat. median
$8,659
outlier · 2.1×
948
MS_DRG 		Signs And Symptoms Without Mcc 9 $10,974.37 $29,825.41 $17,376.08 nat. median
$8,463
outlier · 2.1×
481
MS_DRG 		Hip And Femur Procedures Except Major Joint With Cc 9 $9,986.14 $35,927.87 $16,643.57 nat. median
$21,418
0.8× median
560
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Cc 6 $13,174.76 $21,957.93 $15,919.50 nat. median
$12,112
1.3× median
190
MS_DRG 		Chronic Obstructive Pulmonary Disease With Mcc 9 $9,382.95 $44,463.74 $14,856.34 nat. median
$11,661
1.3× median
638
MS_DRG 		Diabetes With Cc 9 $9,321.00 $33,042.19 $14,758.25 nat. median
$9,750
1.5× median
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 10 $9,049.03 $39,988.81 $14,704.67 nat. median
$12,892
1.1× median
8852747_1
CDM 		Tysabri 300 Mg/15 Ml Vial 15 $11,555.00 $21,954.50 $13,103.37 nat. median
$13,103
1.0× median
8801548_1
CDM 		Entyvio 300 Mg Vial 15 $11,102.50 $21,094.75 $12,590.24 nat. median
$12,590
1.0× median
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 15 $10,282.50 $19,536.75 $11,660.36 nat. median
$1,555
outlier · 7.5×
202
MS_DRG 		Bronchitis And Asthma With Cc/mcc 9 $7,018.67 $31,703.72 $11,112.90 nat. median
$10,254
1.1× median
157
MS_DRG 		Dental And Oral Diseases With Mcc 6 $9,002.40 $15,004.00 $10,877.90 nat. median
$16,954
0.6× median
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 17 $5,840.67 $18,292.25 $10,605.65 nat. median
$3,475
outlier · 3.1×
194
MS_DRG 		Simple Pneumonia And Pleurisy With Cc 8 $7,019.73 $34,660.27 $9,944.61 nat. median
$9,038
1.1× median
71
MS_DRG 		Other Cerebrovascular Disorders With Cc 7 $7,557.90 $25,452.70 $9,447.38 nat. median
$11,142
0.8× median
195
MS_DRG 		Simple Pneumonia And Pleurisy Without Cc/mcc 9 $5,648.40 $23,574.79 $8,943.30 nat. median
$7,228
1.2× median
8977441_1
CDM 		Gammagard Liquid 10% Vial 15 $7,872.50 $14,957.75 $8,927.42 nat. median
$8,927
1.0× median
444
MS_DRG 		Disorders Of The Biliary Tract With Mcc 10 $5,475.72 $21,982.40 $8,898.05 nat. median
$16,694
0.5× median
552
MS_DRG 		Medical Back Problems Without Mcc 10 $5,175.00 $21,481.20 $8,409.38 nat. median
$10,356
0.8× median
558
MS_DRG 		Tendonitis, Myositis And Bursitis Without Mcc 10 $5,058.60 $21,287.20 $8,220.23 nat. median
$9,502
0.9× median
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc 6 $6,686.04 $11,143.40 $8,078.97 nat. median
$16,167
outlier · 0.5×
8920251_2
CDM 		Dupixent 200 Mg/1.14 Ml Syring 2 $7,350.00 $7,875.00 $7,612.50 nat. median
$7,612
1.0× median
690
MS_DRG 		Kidney And Urinary Tract Infections Without Mcc 6 $5,603.31 $9,338.85 $6,770.67 nat. median
$8,869
0.8× median
8961028_1
CDM 		Tezspire 210 Mg/1.91 Ml Syring 15 $5,957.50 $11,319.25 $6,755.81 nat. median
$6,756
1.0× median
C1889
HCPCS 		Implantable/insertable Device, Not Otherwise Classified 15 $715.00 $22,562.50 $6,616.75 nat. median
$2,377
outlier · 2.8×
8836987_1
CDM 		Ruxience 500 Mg/50 Ml Vial 15 $5,547.50 $10,540.25 $6,290.87 nat. median
$6,291
1.0× median
8973368_1
CDM 		Sandostatin Lar Depot 10 Mg Kt 15 $5,347.50 $10,160.25 $6,064.07 nat. median
$6,064
1.0× median
8930242_1
CDM 		Leqvio 284 Mg/1.5 Ml Syringe 15 $5,340.00 $10,146.00 $6,055.56 nat. median
$6,056
1.0× median
193
MS_DRG 		Simple Pneumonia And Pleurisy With Mcc 6 $4,892.10 $8,045.00 $5,911.29 nat. median
$13,455
outlier · 0.4×

Other procedures at this hospital

Browse this hospital's 3,317 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
             
462 MS_DRG Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc 9 9 $91,435.58 $91,435.58 $54,861.35 $86,863.80 $81,328.78 2026-04-10
493 MS_DRG Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc 9 9 $58,203.48 $58,203.48 $34,922.09 $104,533.95 $55,293.31 2026-04-10
314 MS_DRG Other Circulatory System Diagnoses With Mcc 9 9 $51,378.98 $51,378.98 $30,827.39 $84,760.39 $48,810.03 2026-04-10
522 MS_DRG Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc 9 9 $50,819.60 $50,819.60 $30,491.76 $100,625.64 $48,278.62 2026-04-10
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 13 13 $14,163.39 $14,163.39 $8,498.03 $39,875.79 $37,644.52 2026-04-10
603 MS_DRG Cellulitis Without Mcc 13 13 $19,192.00 $19,192.00 $11,515.20 $51,332.50 $35,504.79 2026-04-10
536 MS_DRG Fractures Of Hip And Pelvis Without Mcc 13 13 $16,009.00 $16,009.00 $9,605.40 $41,721.40 $33,912.02 2026-04-10
8964042_1 CDM Ocrevus 300 Mg/10 Ml Vial 15 15 $58,130.00 $58,130.00 $29,065.00 $55,223.50 $32,959.71 2026-04-10
571 MS_DRG Skin Debridement With Cc 9 9 $31,876.42 $31,876.42 $19,125.85 $64,237.29 $30,282.60 2026-04-10
683 MS_DRG Renal Failure With Cc 13 13 $11,132.11 $11,132.11 $6,679.27 $33,247.42 $29,498.11 2026-04-10
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 10 10 $29,298.00 $29,298.00 $17,578.80 $60,520.20 $28,565.55 2026-04-10
J3245 HCPCS Injection, Tildrakizumab, 1 Mg 17 17 $50,830.00 $50,830.00 $9,318.95 $48,288.50 $27,997.16 2026-04-10
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 9 9 $25,991.62 $25,991.62 $15,594.97 $69,037.91 $24,692.04 2026-04-10
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 13 13 $11,981.42 $11,981.42 $7,188.85 $27,505.41 $24,225.42 2026-04-10
812 MS_DRG Red Blood Cell Disorders Without Mcc 13 13 $11,294.50 $11,294.50 $6,776.70 $33,452.65 $23,538.50 2026-04-10
559 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Mcc 9 9 $23,468.78 $23,468.78 $14,081.27 $68,622.99 $22,295.34 2026-04-10
947 MS_DRG Signs And Symptoms With Mcc 9 9 $23,396.73 $23,396.73 $14,038.04 $39,877.27 $22,226.89 2026-04-10
377 MS_DRG Gastrointestinal Hemorrhage With Mcc 9 9 $21,600.39 $21,600.39 $12,960.23 $63,951.75 $20,520.37 2026-04-10
8935574_1 CDM Lupron Depot 45 Mg 6mo Kit 15 15 $36,165.00 $36,165.00 $18,082.50 $34,356.75 $20,505.56 2026-04-10
439 MS_DRG Disorders Of Pancreas Except Malignancy With Cc 10 10 $20,590.00 $20,590.00 $12,354.00 $51,812.20 $20,075.25 2026-04-10
9004596_1 CDM Skyrizi 600 Mg/10 Ml Vial 15 15 $32,120.00 $32,120.00 $16,060.00 $30,514.00 $18,212.04 2026-04-10
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 10 10 $18,530.67 $18,530.67 $11,118.40 $37,263.99 $18,067.40 2026-04-10
948 MS_DRG Signs And Symptoms Without Mcc 9 9 $18,290.61 $18,290.61 $10,974.37 $29,825.41 $17,376.08 2026-04-10
481 MS_DRG Hip And Femur Procedures Except Major Joint With Cc 9 9 $16,643.57 $16,643.57 $9,986.14 $35,927.87 $16,643.57 2026-04-10
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 6 6 $21,957.93 $21,957.93 $13,174.76 $21,957.93 $15,919.50 2026-04-10
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 9 9 $15,638.25 $15,638.25 $9,382.95 $44,463.74 $14,856.34 2026-04-10
638 MS_DRG Diabetes With Cc 9 9 $15,535.00 $15,535.00 $9,321.00 $33,042.19 $14,758.25 2026-04-10
189 MS_DRG Pulmonary Edema And Respiratory Failure 10 10 $15,081.71 $15,081.71 $9,049.03 $39,988.81 $14,704.67 2026-04-10
8852747_1 CDM Tysabri 300 Mg/15 Ml Vial 15 15 $23,110.00 $23,110.00 $11,555.00 $21,954.50 $13,103.37 2026-04-10
8801548_1 CDM Entyvio 300 Mg Vial 15 15 $22,205.00 $22,205.00 $11,102.50 $21,094.75 $12,590.24 2026-04-10
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 15 15 $20,565.00 $20,565.00 $10,282.50 $19,536.75 $11,660.36 2026-04-10
202 MS_DRG Bronchitis And Asthma With Cc/mcc 9 9 $11,697.79 $11,697.79 $7,018.67 $31,703.72 $11,112.90 2026-04-10
157 MS_DRG Dental And Oral Diseases With Mcc 6 6 $15,004.00 $15,004.00 $9,002.40 $15,004.00 $10,877.90 2026-04-10
J3101 HCPCS Injection, Tenecteplase, 1 Mg 17 17 $19,255.00 $19,255.00 $5,840.67 $18,292.25 $10,605.65 2026-04-10
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 8 8 $11,699.55 $11,699.55 $7,019.73 $34,660.27 $9,944.61 2026-04-10
71 MS_DRG Other Cerebrovascular Disorders With Cc 7 7 $12,596.50 $12,596.50 $7,557.90 $25,452.70 $9,447.38 2026-04-10
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/mcc 9 9 $9,414.00 $9,414.00 $5,648.40 $23,574.79 $8,943.30 2026-04-10
8977441_1 CDM Gammagard Liquid 10% Vial 15 15 $15,745.00 $15,745.00 $7,872.50 $14,957.75 $8,927.42 2026-04-10
444 MS_DRG Disorders Of The Biliary Tract With Mcc 10 10 $9,126.20 $9,126.20 $5,475.72 $21,982.40 $8,898.05 2026-04-10
552 MS_DRG Medical Back Problems Without Mcc 10 10 $8,625.00 $8,625.00 $5,175.00 $21,481.20 $8,409.38 2026-04-10
558 MS_DRG Tendonitis, Myositis And Bursitis Without Mcc 10 10 $8,431.00 $8,431.00 $5,058.60 $21,287.20 $8,220.23 2026-04-10
177 MS_DRG Respiratory Infections And Inflammations With Mcc 6 6 $11,143.40 $11,143.40 $6,686.04 $11,143.40 $8,078.97 2026-04-10
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 2026-04-10
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 6 6 $9,338.85 $9,338.85 $5,603.31 $9,338.85 $6,770.67 2026-04-10
8961028_1 CDM Tezspire 210 Mg/1.91 Ml Syring 15 15 $11,915.00 $11,915.00 $5,957.50 $11,319.25 $6,755.81 2026-04-10
C1889 HCPCS Implantable/insertable Device, Not Otherwise Classified 30 15 $12,590.00 $12,590.00 $715.00 $22,562.50 $6,616.75 2026-04-10
8836987_1 CDM Ruxience 500 Mg/50 Ml Vial 15 15 $11,095.00 $11,095.00 $5,547.50 $10,540.25 $6,290.87 2026-04-10
8973368_1 CDM Sandostatin Lar Depot 10 Mg Kt 15 15 $10,695.00 $10,695.00 $5,347.50 $10,160.25 $6,064.07 2026-04-10
8930242_1 CDM Leqvio 284 Mg/1.5 Ml Syringe 15 15 $10,680.00 $10,680.00 $5,340.00 $10,146.00 $6,055.56 2026-04-10
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 6 6 $8,153.50 $8,153.50 $4,892.10 $8,045.00 $5,911.29 2026-04-10
8785764_1 CDM Nucala 100 Mg/ml Powder Vial 15 15 $9,350.00 $9,350.00 $4,675.00 $8,882.50 $5,301.45 2026-04-10
8884683_1 CDM Eligard 45 Mg Syringe Kit 15 15 $8,945.00 $8,945.00 $4,472.50 $8,497.75 $5,071.82 2026-04-10
8977783_1 CDM Xolair 300 Mg/2 Ml Syringe 15 15 $8,575.00 $8,575.00 $4,287.50 $8,146.25 $4,862.03 2026-04-10
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 $4,784.35 2026-04-10
8861795_1 CDM Kcentra 1,000 Unit Vial 15 15 $7,470.00 $7,470.00 $3,735.00 $7,096.50 $4,235.49 2026-04-10
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 $4,103.95 2026-04-10
291 MS_DRG Heart Failure And Shock With Mcc 7 7 $5,336.00 $5,336.00 $3,201.60 $11,580.44 $4,002.00 2026-04-10
394 MS_DRG Other Digestive System Diagnoses With Cc 6 6 $5,452.00 $5,452.00 $3,271.20 $5,452.00 $3,952.70 2026-04-10
J1569 HCPCS Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 17 17 $7,145.00 $7,145.00 $2,434.64 $6,787.75 $3,935.47 2026-04-10
8988516_1 CDM Speedbridge Fibertak Imp Syst 4.75 Mm - 15 15 $6,938.00 $6,938.00 $3,469.00 $6,591.10 $3,933.85 2026-04-10
440 MS_DRG Disorders Of Pancreas Except Malignancy Without Cc/mcc 6 6 $5,342.00 $5,342.00 $3,205.20 $5,342.00 $3,872.95 2026-04-10
70 MS_DRG Other Cerebrovascular Disorders With Mcc 6 6 $5,324.00 $5,324.00 $3,194.40 $5,324.00 $3,859.90 2026-04-10
8736097_1 CDM Biofoam Shell Size 56mm Group F 15 15 $6,772.00 $6,772.00 $3,386.00 $6,433.40 $3,839.72 2026-04-10
8979966_1 CDM Fulphila 6 Mg/0.6 Ml Syringe 15 15 $6,465.00 $6,465.00 $3,232.50 $6,141.75 $3,665.66 2026-04-10
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 $3,593.65 2026-04-10
8983188_1 CDM Stelara 130 Mg/26 Ml Vial 15 15 $6,270.00 $6,270.00 $3,135.00 $5,956.50 $3,555.09 2026-04-10
78816 HCPCS Nuclear Medicine Study Whole Body With CT Scan 17 17 $6,412.00 $6,412.00 $1,549.02 $6,091.40 $3,531.73 2026-04-10
78815 HCPCS Nuclear Medicine Study From Skull Base To Mid-thigh With CT Scan 17 17 $6,412.00 $6,412.00 $1,549.02 $6,091.40 $3,531.73 2026-04-10
8735288_1 CDM Cs Primary Knee Femur Size 3 Left - 15 15 $6,001.00 $6,001.00 $3,000.50 $5,700.95 $3,402.57 2026-04-10
52 MS_DRG Spinal Disorders And Injuries With Cc/mcc 7 7 $4,472.00 $4,472.00 $2,683.20 $10,343.44 $3,354.00 2026-04-10
9017905_1 CDM Calcium Sulfate Biobeads, 20 Cc - 15 15 $5,625.00 $5,625.00 $2,812.50 $5,343.75 $3,189.38 2026-04-10
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 $3,147.42 2026-04-10
8944190_1 CDM Lupron Depot 3.75 Mg Kit 15 15 $5,395.00 $5,395.00 $2,697.50 $5,125.25 $3,058.97 2026-04-10
8734698_1 CDM Operating Room Services - General Classification 15 15 $5,145.00 $5,145.00 $2,572.50 $4,887.75 $2,917.22 2026-04-10
8815406_1 CDM Aranesp 200 Mcg/0.4 Ml Syringe 15 15 $5,070.00 $5,070.00 $2,535.00 $4,816.50 $2,874.69 2026-04-10
8877502_1 CDM Scp Knee Kit 5cc Accuportend-del11gax120mm - 15 15 $4,862.00 $4,862.00 $2,431.00 $4,618.90 $2,756.75 2026-04-10
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 2026-04-10
8871423_1 CDM Galileo Troch Nail 11mmx20cmx125 - 15 15 $4,704.00 $4,704.00 $2,352.00 $4,468.80 $2,667.17 2026-04-10
59409 HCPCS Vaginal Delivery 33 17 $6,237.00 $6,237.00 $631.69 $5,925.15 $2,575.51 2026-04-10
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 $2,558.99 2026-04-10
J7327 HCPCS Hyaluronan Or Derivative, Monovisc, For Intra-articular Injection, Per Dose 17 17 $4,645.00 $4,645.00 $593.79 $4,412.75 $2,558.47 2026-04-10
8691993_1 CDM Trigen Meta-nail 8.5mm Tibial 33cm - 15 15 $4,448.00 $4,448.00 $2,224.00 $4,225.60 $2,522.02 2026-04-10
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 $2,446.61 2026-04-10
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 $2,399.54 2026-04-10
8692001_1 CDM Intertan 10s 10mm X 18cm 125d - 15 15 $4,208.00 $4,208.00 $2,104.00 $3,997.60 $2,385.94 2026-04-10
8850298_1 CDM Eligard 22.5 Mg Syringe Kit 15 15 $4,195.00 $4,195.00 $2,097.50 $3,985.25 $2,378.57 2026-04-10
8691989_1 CDM Intertan 1.5 10mmx40cm 125d Lt - 15 15 $4,163.00 $4,163.00 $2,081.50 $3,954.85 $2,360.42 2026-04-10
8691988_1 CDM Intertan 1.5 10mmx36cm 125d Lt - 15 15 $4,163.00 $4,163.00 $2,081.50 $3,954.85 $2,360.42 2026-04-10
J7325 HCPCS Hyaluronan Or Derivative, Synvisc Or Synvisc-one, For Intra-articular Injection,… 18 17 $4,240.00 $4,240.00 $310.61 $4,028.00 $2,312.49 2026-04-10
8735915_1 CDM Primary Hip Fem Head 40mm Sleeve Needed - 15 15 $4,050.00 $4,050.00 $2,025.00 $3,847.50 $2,296.35 2026-04-10
8820743_1 CDM Injectafer 750 Mg/15 Ml Vial 15 15 $4,040.00 $4,040.00 $2,020.00 $3,838.00 $2,290.68 2026-04-10
59414 HCPCS Delivery Of Placenta 33 17 $4,580.00 $4,580.00 $71.10 $4,351.00 $2,290.00 2026-04-10
Q4133 HCPCS Grafix Prime, Grafixpl Prime, Stravix And Stravixpl, Per Square Centimeter 15 15 $4,010.00 $4,010.00 $2,005.00 $3,809.50 $2,273.67 2026-04-10
8949246_1 CDM Botox 200 Unit Vial 15 15 $3,930.00 $3,930.00 $1,965.00 $3,733.50 $2,228.31 2026-04-10
78452 HCPCS Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 17 17 $4,010.00 $4,010.00 $1,113.13 $3,809.50 $2,208.71 2026-04-10
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 17 17 $3,981.00 $3,981.00 $375.49 $3,781.95 $2,192.73 2026-04-10
J0897 HCPCS Injection, Denosumab, 1 Mg 17 17 $3,910.00 $3,910.00 $1,091.72 $3,714.50 $2,153.63 2026-04-10
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 $2,152.44 2026-04-10
9049025_1 CDM Femoral Head Biolox 28mm Delta Ceramic - 15 15 $3,739.00 $3,739.00 $1,869.50 $3,552.05 $2,120.01 2026-04-10
26418 HCPCS Repair Of Tendon On Top Side Of Finger 33 17 $5,508.00 $5,508.00 $571.93 $5,232.60 $2,102.28 2026-04-10
73220 HCPCS MRI Scan Of Arm Before And After Contrast 34 17 $3,807.00 $3,807.00 $505.09 $3,616.65 $2,096.90 2026-04-10
59300 HCPCS Episiotomy Or Repair Of Vagina 33 17 $4,189.00 $4,189.00 $115.77 $3,979.55 $2,094.50 2026-04-10
Q4105 HCPCS Integra Dermal Regeneration Template (drt) Or Integra Omnigraft Dermal Regenerat… 15 15 $3,675.00 $3,675.00 $1,837.50 $3,491.25 $2,083.73 2026-04-10
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 34 17 $3,757.00 $3,757.00 $505.09 $3,569.15 $2,069.36 2026-04-10
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 34 17 $3,756.00 $3,756.00 $505.09 $3,568.20 $2,068.80 2026-04-10
73720 HCPCS MRI Scan Of Leg Before And After Contrast 34 17 $3,756.00 $3,756.00 $505.09 $3,568.20 $2,068.80 2026-04-10
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 17 17 $3,720.00 $3,720.00 $899.51 $3,534.00 $2,048.98 2026-04-10
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 17 17 $3,720.00 $3,720.00 $899.51 $3,534.00 $2,048.98 2026-04-10
95805 HCPCS Sleep Study, Multiple Trials 17 17 $3,720.00 $3,720.00 $899.51 $3,534.00 $2,048.98 2026-04-10
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 $2,041.20 2026-04-10
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 $2,041.20 2026-04-10
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 17 17 $3,697.00 $3,697.00 $505.09 $3,512.15 $2,036.31 2026-04-10
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 17 17 $3,697.00 $3,697.00 $505.09 $3,512.15 $2,036.31 2026-04-10
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 17 17 $3,697.00 $3,697.00 $601.87 $3,512.15 $2,036.31 2026-04-10
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 $505.09 $3,512.15 $2,036.31 2026-04-10
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 17 17 $3,697.00 $3,697.00 $505.09 $3,512.15 $2,036.31 2026-04-10
71552 HCPCS MRI Scan Of Chest Before And After Contrast 17 17 $3,697.00 $3,697.00 $505.09 $3,512.15 $2,036.31 2026-04-10
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 17 17 $3,697.00 $3,697.00 $505.09 $3,512.15 $2,036.31 2026-04-10
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 17 17 $3,662.00 $3,662.00 $375.49 $3,478.90 $2,017.03 2026-04-10
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 17 17 $3,646.00 $3,646.00 $505.09 $3,463.70 $2,008.22 2026-04-10
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 17 17 $3,638.00 $3,638.00 $464.04 $3,456.10 $2,003.81 2026-04-10
70553 HCPCS MRI Scan Of Brain Before And After Contrast 17 17 $3,636.00 $3,636.00 $505.09 $3,454.20 $2,002.71 2026-04-10
78803 HCPCS Nuclear Medicine Study, Spect Imaging, 1 Area Or Single Acquisition, Single Day … 17 17 $3,624.00 $3,624.00 $1,113.13 $3,442.80 $1,996.10 2026-04-10
78606 HCPCS Nuclear Medicine Study Of Brain And Blood Flow, 4 Static Views Or More 17 17 $3,624.00 $3,624.00 $442.84 $3,442.80 $1,996.10 2026-04-10
27252 HCPCS Closed Treatment Of Dislocated Hip Under Anesthesia 33 17 $3,675.00 $3,675.00 $647.07 $3,491.25 $1,984.50 2026-04-10
8753098_1 CDM Speed Graft - Spd-001 15 15 $3,488.00 $3,488.00 $1,744.00 $3,313.60 $1,977.70 2026-04-10
9048271_1 CDM Peek, Meniscal Root Repair Kit - 15 15 $3,488.00 $3,488.00 $1,744.00 $3,313.60 $1,977.70 2026-04-10
8734696_1 CDM Operating Room Services - General Classification 15 15 $3,465.00 $3,465.00 $1,732.50 $3,291.75 $1,964.66 2026-04-10
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 2026-04-10
71555 HCPCS MRI Scan Of Blood Vessels Of Chest 17 17 $3,532.00 $3,532.00 $601.87 $3,355.40 $1,945.43 2026-04-10
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 17 17 $3,521.00 $3,521.00 $601.87 $3,344.95 $1,939.37 2026-04-10
72198 HCPCS MRI Scan Of Blood Vessels Of Pelvis 17 17 $3,515.00 $3,515.00 $601.87 $3,339.25 $1,936.06 2026-04-10
C9359 HCPCS Porous Purified Collagen Matrix Bone Void Filler (integra Mozaik Osteoconductive… 45 15 $3,135.00 $3,135.00 $1,376.50 $7,837.50 $1,927.10 2026-04-10
44141 HCPCS Partial Removal Of Large Bowel With Creation Of Opening To Skin 16 16 $4,431.00 $4,431.00 $1,506.25 $4,563.93 $1,920.47 2026-04-10
8748419_1 CDM Primary Hip Fem Head 36mm Sleeve Needed - 15 15 $3,386.00 $3,386.00 $1,693.00 $3,216.70 $1,919.86 2026-04-10
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 34 17 $3,355.00 $3,355.00 $601.87 $3,187.25 $1,847.93 2026-04-10
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 17 17 $3,337.00 $3,337.00 $601.87 $3,170.15 $1,838.02 2026-04-10
8691932_1 CDM Intertan 10mm X 20cm 125d - 15 15 $3,228.00 $3,228.00 $1,614.00 $3,066.60 $1,830.28 2026-04-10
8691927_1 CDM Interan 10mm X 18cm 125d - 15 15 $3,228.00 $3,228.00 $1,614.00 $3,066.60 $1,830.28 2026-04-10
55700 HCPCS Biopsy Of Prostate Gland 24 17 $3,276.00 $3,276.00 $242.80 $3,112.20 $1,769.04 2026-04-10
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 17 17 $3,208.00 $3,208.00 $375.49 $3,047.60 $1,766.97 2026-04-10
8735913_1 CDM Primary Hip Liner Poly 40mm Group F - 15 15 $3,075.00 $3,075.00 $1,537.50 $2,921.25 $1,743.53 2026-04-10
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 2026-04-10
8777411_1 CDM Durolane 60 Mg/3 Ml Syringe 15 15 $3,020.00 $3,020.00 $1,510.00 $2,869.00 $1,712.34 2026-04-10
8691992_1 CDM 4cc Prodense Injectable Bone Graft Sub - 15 15 $3,005.00 $3,005.00 $1,502.50 $2,854.75 $1,703.84 2026-04-10
P9037 HCPCS Platelets, Pheresis, Leukocytes Reduced, Irradiated, Each Unit 17 17 $3,085.00 $3,085.00 $388.46 $2,930.75 $1,699.22 2026-04-10
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 17 17 $3,027.00 $3,027.00 $464.04 $2,875.65 $1,667.27 2026-04-10
J7318 HCPCS Hyaluronan Or Derivative, Durolane, For Intra-articular Injection, 1 Mg 17 17 $3,020.00 $3,020.00 $593.79 $2,869.00 $1,663.42 2026-04-10
J0485 HCPCS Injection, Belatacept, 1 Mg 17 17 $3,005.00 $3,005.00 $1,349.44 $2,854.75 $1,655.15 2026-04-10
20102 HCPCS Exploration Of Wound Of Abdomen, Back, Or Flank 33 17 $4,501.00 $4,501.00 $218.21 $4,275.95 $1,652.30 2026-04-10
70552 HCPCS MRI Scan Of Brain With Contrast 17 17 $2,961.00 $2,961.00 $505.09 $2,812.95 $1,630.92 2026-04-10
38222 HCPCS Biopsy And Aspiration Of Bone Marrow Sample For Diagnosis 17 17 $2,707.00 $2,707.00 $1,353.50 $2,571.65 $1,624.20 2026-04-10
74182 HCPCS MRI Scan Of Abdomen With Contrast 17 17 $2,927.00 $2,927.00 $505.09 $2,780.65 $1,612.19 2026-04-10
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 17 17 $2,927.00 $2,927.00 $601.87 $2,780.65 $1,612.19 2026-04-10
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 17 17 $2,927.00 $2,927.00 $601.87 $2,780.65 $1,612.19 2026-04-10
25624 HCPCS Closed Treatment Of Broken Wrist Bone Near Base Of Thumb With Manipulation 33 17 $4,758.00 $4,758.00 $404.21 $4,520.10 $1,611.30 2026-04-10
8734691_1 CDM Operating Room Services - General Classification 15 15 $2,835.00 $2,835.00 $1,417.50 $2,693.25 $1,607.45 2026-04-10
8734694_1 CDM Operating Room Services - General Classification 15 15 $2,835.00 $2,835.00 $1,417.50 $2,693.25 $1,607.45 2026-04-10
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 34 17 $2,898.00 $2,898.00 $464.04 $2,753.10 $1,596.22 2026-04-10
8928588_1 CDM Dupixent 300 Mg/2 Ml Syringe 15 15 $2,792.50 $2,792.50 $1,396.25 $2,652.88 $1,583.35 2026-04-10
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 2026-04-10
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 2026-04-10
43425 HCPCS Repair Of Abnormal Drainage Tract Of Esophagus Through Chest Or Abdomen 16 16 $5,569.00 $5,569.00 $1,221.57 $5,736.07 $1,557.51 2026-04-10
73706 HCPCS CT Scan Of Blood Vessels Of Lower Leg With Contrast 17 17 $2,797.00 $2,797.00 $464.04 $2,657.15 $1,540.59 2026-04-10
72191 HCPCS CT Scan Of Blood Vessels Of Pelvis With Contrast 17 17 $2,797.00 $2,797.00 $464.04 $2,657.15 $1,540.59 2026-04-10
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 17 17 $2,797.00 $2,797.00 $464.04 $2,657.15 $1,540.59 2026-04-10
P9035 HCPCS Platelets, Pheresis, Leukocytes Reduced, Each Unit 17 17 $2,776.00 $2,776.00 $388.46 $2,637.20 $1,529.02 2026-04-10
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 17 17 $2,771.00 $2,771.00 $464.04 $2,632.45 $1,526.27 2026-04-10
71270 HCPCS CT Scan Of Chest Before And After Contrast 17 17 $2,743.00 $2,743.00 $375.49 $2,605.85 $1,510.84 2026-04-10
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 17 17 $2,743.00 $2,743.00 $375.49 $2,605.85 $1,510.84 2026-04-10
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 17 17 $2,743.00 $2,743.00 $375.49 $2,605.85 $1,510.84 2026-04-10
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 17 17 $2,743.00 $2,743.00 $375.49 $2,605.85 $1,510.84 2026-04-10
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 17 17 $2,743.00 $2,743.00 $375.49 $2,605.85 $1,510.84 2026-04-10
73702 HCPCS CT Scan Of Leg Before And After Contrast 51 17 $2,743.00 $2,743.00 $375.49 $2,605.85 $1,510.84 2026-04-10
70488 HCPCS CT Scan Of Face Before And After Contrast 17 17 $2,743.00 $2,743.00 $375.49 $2,605.85 $1,510.84 2026-04-10
73202 HCPCS CT Scan Of Arm Before And After Contrast 51 17 $2,743.00 $2,743.00 $375.49 $2,605.85 $1,510.84 2026-04-10
8734690_1 CDM Operating Room Services - General Classification 15 15 $2,663.00 $2,663.00 $1,331.50 $2,529.85 $1,509.92 2026-04-10
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 17 17 $2,740.00 $2,740.00 $375.49 $2,603.00 $1,509.19 2026-04-10
C8928 HCPCS Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi… 17 17 $2,728.00 $2,728.00 $544.94 $2,591.60 $1,502.58 2026-04-10
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 2026-04-10
73222 HCPCS MRI Scan Of Arm Joint With Contrast 34 17 $2,709.00 $2,709.00 $505.09 $2,573.55 $1,492.12 2026-04-10
73722 HCPCS MRI Scan Of Leg Joint With Contrast 34 17 $2,709.00 $2,709.00 $505.09 $2,573.55 $1,492.12 2026-04-10
8912133_1 CDM Zoladex 3.6 Mg Implant Syrn 15 15 $2,590.00 $2,590.00 $1,295.00 $2,460.50 $1,468.53 2026-04-10
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 17 17 $2,665.00 $2,665.00 $464.04 $2,531.75 $1,467.88 2026-04-10
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 2026-04-10
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 17 17 $2,642.00 $2,642.00 $294.87 $2,509.90 $1,455.21 2026-04-10
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 17 17 $2,632.00 $2,632.00 $294.87 $2,500.40 $1,449.71 2026-04-10
J0881 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 77 17 $2,555.00 $2,555.00 $522.50 $7,281.75 $1,448.69 2026-04-10
8827475_1 CDM Aranesp 100 Mcg/0.5 Ml Syringe 15 15 $2,555.00 $2,555.00 $1,277.50 $2,427.25 $1,448.69 2026-04-10
G0390 HCPCS Trauma Response Team Associated With Hospital Critical Care Service 15 15 $2,549.00 $2,549.00 $1,274.50 $2,421.55 $1,445.28 2026-04-10
70551 HCPCS MRI Scan Of Brain Without Contrast 17 17 $2,596.00 $2,596.00 $294.87 $2,466.20 $1,429.88 2026-04-10
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 2026-04-10
C1776 HCPCS Joint Device (implantable) 1,695 15 $2,370.00 $2,370.00 $54.00 $10,687.50 $1,417.50 2026-04-10
90375 HCPCS Rabies Immune Globulin For Injection 17 17 $2,345.00 $2,345.00 $1,172.50 $2,227.75 $1,407.00 2026-04-10
8983621_1 CDM Knotless Tensionable Fibertak Biceps Kit - 15 15 $2,475.00 $2,475.00 $1,237.50 $2,351.25 $1,403.33 2026-04-10
8691751_1 CDM External Fixator Disital Kit - 15 15 $2,439.00 $2,439.00 $1,219.50 $2,317.05 $1,382.91 2026-04-10
73218 HCPCS MRI Scan Of Arm Without Contrast 34 17 $2,485.00 $2,485.00 $294.87 $2,360.75 $1,368.74 2026-04-10
8953397_1 CDM Dynaclip 14mm X 14mm X 14mm Inserter * 15 15 $2,400.00 $2,400.00 $1,200.00 $2,280.00 $1,360.80 2026-04-10
72193 HCPCS CT Scan Of Pelvis With Contrast 17 17 $2,439.00 $2,439.00 $375.49 $2,317.05 $1,343.40 2026-04-10
70487 HCPCS CT Scan Of Face With Contrast 17 17 $2,439.00 $2,439.00 $375.49 $2,317.05 $1,343.40 2026-04-10
70460 HCPCS CT Scan Head Or Brain With Contrast 17 17 $2,439.00 $2,439.00 $375.49 $2,317.05 $1,343.40 2026-04-10
72132 HCPCS CT Scan Of Lower Spine With Contrast 17 17 $2,439.00 $2,439.00 $375.49 $2,317.05 $1,343.40 2026-04-10
73701 HCPCS CT Scan Of Leg With Contrast Material 51 17 $2,439.00 $2,439.00 $375.49 $2,317.05 $1,343.40 2026-04-10
73201 HCPCS CT Scan Of Arm With Contrast 51 17 $2,439.00 $2,439.00 $375.49 $2,317.05 $1,343.40 2026-04-10
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 17 17 $2,439.00 $2,439.00 $375.49 $2,317.05 $1,343.40 2026-04-10
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 17 17 $2,439.00 $2,439.00 $375.49 $2,317.05 $1,343.40 2026-04-10
74160 HCPCS CT Scan Of Abdomen With Contrast 17 17 $2,439.00 $2,439.00 $375.49 $2,317.05 $1,343.40 2026-04-10
2120847_1 CDM Room & Board - Semi-private (two Beds) - Other 9 9 $1,408.00 $1,408.00 $844.80 $2,205.41 $1,337.60 2026-04-10
8748052_1 CDM Room & Board - Other - Sterile Environment 9 9 $1,408.00 $1,408.00 $844.80 $2,205.41 $1,337.60 2026-04-10
93612 HCPCS Insertion Of Temporary Pacemaker Electrode For Diagnostic Lower Heart Pacing 17 17 $2,228.00 $2,228.00 $1,114.00 $7,186.68 $1,336.80 2026-04-10
8692132_1 CDM Implant System Cpr Mini Scorpion & Micro - 15 15 $2,348.00 $2,348.00 $1,174.00 $2,230.60 $1,331.32 2026-04-10
72195 HCPCS MRI Scan Of Pelvis Without Contrast 17 17 $2,412.00 $2,412.00 $294.87 $2,291.40 $1,328.53 2026-04-10
74181 HCPCS MRI Scan Of Abdomen Without Contrast 17 17 $2,411.00 $2,411.00 $294.87 $2,290.45 $1,327.98 2026-04-10
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 17 17 $2,407.00 $2,407.00 $464.04 $2,286.65 $1,325.78 2026-04-10
8944189_1 CDM Renflexis 100 Mg Vial 15 15 $2,335.00 $2,335.00 $1,167.50 $2,218.25 $1,323.95 2026-04-10
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 34 17 $2,400.00 $2,400.00 $294.87 $2,280.00 $1,321.92 2026-04-10
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 34 17 $2,359.00 $2,359.00 $294.87 $2,241.05 $1,299.34 2026-04-10
73718 HCPCS MRI Scan Of Leg Without Contrast 34 17 $2,359.00 $2,359.00 $294.87 $2,241.05 $1,299.34 2026-04-10
10121 HCPCS Removal Of Foreign Body From Tissue, Accessed Beneath The Skin, Complex 33 17 $2,583.00 $2,583.00 $158.09 $2,453.85 $1,291.50 2026-04-10
24675 HCPCS Closed Treatment Of Broken Forearm Bone On Small Finger Side At Elbow With Manip… 33 17 $2,386.00 $2,386.00 $383.65 $2,266.70 $1,288.44 2026-04-10
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 2026-04-10
J3304 HCPCS Injection, Triamcinolone Acetonide, Preservative-free, Extended-release, Microsp… 27 17 $2,100.00 $2,100.00 $17.49 $2,403.40 $1,285.20 2026-04-10
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 2026-04-10
93350 HCPCS Ultrasound Of Heart During Rest, Exercise And/or Drug-induced Stress With Report 17 17 $2,306.00 $2,306.00 $544.94 $2,190.70 $1,270.14 2026-04-10
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 $1,265.19 2026-04-10
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 17 17 $2,297.00 $2,297.00 $601.87 $2,182.15 $1,265.19 2026-04-10
71550 HCPCS MRI Scan Of Chest Without Contrast 17 17 $2,297.00 $2,297.00 $294.87 $2,182.15 $1,265.19 2026-04-10
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 17 17 $2,297.00 $2,297.00 $294.87 $2,182.15 $1,265.19 2026-04-10
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 17 17 $2,297.00 $2,297.00 $601.87 $2,182.15 $1,265.19 2026-04-10
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 $1,260.36 2026-04-10
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 2026-04-10
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 2026-04-10
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 17 17 $2,276.00 $2,276.00 $375.49 $2,162.20 $1,253.62 2026-04-10
27470 HCPCS Repair Of Nonhealed Broken Thigh Bone 16 16 $3,777.00 $3,777.00 $978.97 $3,890.31 $1,248.19 2026-04-10
72159 HCPCS MRI Scan Of Blood Vessels Of Spinal Canal 17 17 $2,245.00 $2,245.00 $601.87 $2,132.75 $1,236.55 2026-04-10
8739069_1 CDM Coolief Lumbar Mcka3-17-75-4 15 15 $2,172.00 $2,172.00 $1,086.00 $2,063.40 $1,231.52 2026-04-10
8700461_1 CDM Coolief Lumbar Mcka3-17-100-4 15 15 $2,172.00 $2,172.00 $1,086.00 $2,063.40 $1,231.52 2026-04-10
49900 HCPCS Suture Of Postsurgical Opening In Abdominal Wall 33 17 $2,171.00 $2,171.00 $714.02 $4,787.84 $1,230.96 2026-04-10
8814546_1 CDM Veklury 100 Mg Vial 15 15 $2,168.42 $2,168.42 $1,084.21 $2,060.00 $1,229.49 2026-04-10
78802 HCPCS Nuclear Medicine Study, Whole Body 17 17 $2,174.00 $2,174.00 $1,087.00 $2,065.30 $1,226.17 2026-04-10
8957929_1 CDM Cable Accord Small Trochanteric Grip 75mm - 15 15 $2,150.00 $2,150.00 $1,075.00 $2,042.50 $1,219.05 2026-04-10
8988589_1 CDM Plate Clav Frac Central Third Rt - 15 15 $2,126.00 $2,126.00 $1,063.00 $2,019.70 $1,205.44 2026-04-10
70336 HCPCS MRI Scan Of Jaw Joint 17 17 $2,188.00 $2,188.00 $294.87 $2,078.60 $1,205.15 2026-04-10
8935695_1 CDM Gamunex-c 5 Gram/50 Ml Vial 15 15 $2,120.00 $2,120.00 $1,060.00 $2,014.00 $1,202.04 2026-04-10
47605 HCPCS Removal Of Gallbladder With X-ray Study Of Bile Ducts 16 16 $2,754.00 $2,754.00 $941.79 $2,836.62 $1,200.79 2026-04-10
8002766_1 CDM Room & Board - Semi-private (two Beds) - General Classification 9 9 $1,261.00 $1,261.00 $756.60 $1,975.16 $1,197.95 2026-04-10
2120840_1 CDM Room & Board - Semi-private (two Beds) - General Classification 9 9 $1,261.00 $1,261.00 $756.60 $1,975.16 $1,197.95 2026-04-10
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 2026-04-10
27428 HCPCS Reconstruction Ligaments Inside Knee Joint 16 16 $3,507.00 $3,507.00 $939.24 $3,612.21 $1,197.53 2026-04-10
26775 HCPCS Closed Treatment Of Dislocated Finger Joint With Manipulation Under Anesthesia 33 17 $2,810.00 $2,810.00 $324.65 $2,669.50 $1,194.03 2026-04-10
72129 HCPCS CT Scan Of Middle Spine With Contrast 17 17 $2,164.00 $2,164.00 $375.49 $2,055.80 $1,191.93 2026-04-10
8953395_1 CDM Dynaclip 12mm X 12mm X 12mm Inserter * 15 15 $2,100.00 $2,100.00 $1,050.00 $1,995.00 $1,190.70 2026-04-10
A0434 HCPCS Specialty Care Transport (sct) 30 15 $1,987.50 $1,987.50 $887.50 $2,090.00 $1,188.00 2026-04-10
71260 HCPCS CT Scan Of Chest With Contrast 17 17 $2,112.00 $2,112.00 $375.49 $2,006.40 $1,163.29 2026-04-10
4903027_1 CDM Room & Board - Other - Other 9 9 $1,222.00 $1,222.00 $733.20 $1,914.07 $1,160.90 2026-04-10
46040 HCPCS Drainage Of Deep Abscess In Rectum 33 17 $2,304.00 $2,304.00 $392.03 $2,188.80 $1,159.78 2026-04-10
44005 HCPCS Release Of Intestinal Scar Tissue 16 16 $2,689.00 $2,689.00 $906.22 $2,769.67 $1,155.43 2026-04-10
87902 HCPCS Analysis Test By Nucleic Acid For Hepatitis C Virus 17 17 $2,095.00 $2,095.00 $167.25 $1,990.25 $1,153.93 2026-04-10
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 $1,153.00 2026-04-10
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 $1,146.39 2026-04-10
47600 HCPCS Removal Of Gallbladder 16 16 $3,316.00 $3,316.00 $897.61 $3,415.48 $1,144.45 2026-04-10
8920027_1 CDM Coolief Multi Advanced, 17g X 50mm, 1 Knee 15 15 $1,995.00 $1,995.00 $997.50 $1,895.25 $1,131.17 2026-04-10
8863608_1 CDM Coolief Shoulder Mcka2-17-50-2 15 15 $1,995.00 $1,995.00 $997.50 $1,895.25 $1,131.17 2026-04-10
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 $1,131.17 2026-04-10
9049029_1 CDM Volar Distal Rad Plt Ti Wide Lt 3h - 15 15 $1,988.00 $1,988.00 $994.00 $1,888.60 $1,127.20 2026-04-10
78740 HCPCS Nuclear Medicine Study To Assess Urine Flow 17 17 $2,035.00 $2,035.00 $442.84 $1,933.25 $1,120.88 2026-04-10
78700 HCPCS Nuclear Medicine Study Of Kidney 17 17 $2,035.00 $2,035.00 $442.84 $1,933.25 $1,120.88 2026-04-10
78709 HCPCS Nuclear Medicine Studies Of Kidney, Blood Flow, And Function 17 17 $2,035.00 $2,035.00 $442.84 $1,933.25 $1,120.88 2026-04-10
78701 HCPCS Nuclear Medicine Study Of Kidney And Blood Flow 17 17 $2,035.00 $2,035.00 $442.84 $1,933.25 $1,120.88 2026-04-10
78708 HCPCS Nuclear Medicine Study Of Kidney, Blood, Flow, And Function With Drug Administra… 17 17 $2,035.00 $2,035.00 $442.84 $1,933.25 $1,120.88 2026-04-10
78707 HCPCS Nuclear Medicine Study Of Kidney, Blood Flow, And Function 17 17 $2,035.00 $2,035.00 $442.84 $1,933.25 $1,120.88 2026-04-10
78761 HCPCS Nuclear Medicine Study Of Testicle And Blood Flow 17 17 $2,035.00 $2,035.00 $442.84 $1,933.25 $1,120.88 2026-04-10
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 2026-04-10
8949245_1 CDM Botox 100 Unit Vial 15 15 $1,965.00 $1,965.00 $982.50 $1,866.75 $1,114.16 2026-04-10
78582 HCPCS Nuclear Medicine Study Of Lung Ventilation And Circulation 17 17 $1,886.00 $1,886.00 $943.00 $1,791.70 $1,113.13 2026-04-10
8815505_1 CDM Xolair 150 Mg/ml Syringe 15 15 $1,960.53 $1,960.53 $980.27 $1,862.50 $1,111.62 2026-04-10
8935295_1 CDM Coolief Advanced 17ga X 150mm X 4mm (Hip) 15 15 $1,942.00 $1,942.00 $971.00 $1,844.90 $1,101.11 2026-04-10
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 $1,101.11 2026-04-10
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 $1,101.11 2026-04-10
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 $1,101.11 2026-04-10
78215 HCPCS Nuclear Medicine Study Of Liver And Spleen 17 17 $1,820.00 $1,820.00 $910.00 $1,729.00 $1,092.00 2026-04-10
G0260 HCPCS Injection Procedure For Sacroiliac Joint; Provision Of Anesthetic, Steroid And/o… 29 17 $2,140.00 $2,140.00 $114.70 $2,033.00 $1,070.00 2026-04-10
8747087_1 CDM Grafix Prime 3 X 4 Cm * 15 15 $1,883.00 $1,883.00 $941.50 $1,788.85 $1,067.66 2026-04-10
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 2026-04-10
78472 HCPCS Nuclear Medicine Study Of Heart Pumping Function By Labeling Red Blood Cells Wit… 17 17 $1,915.00 $1,915.00 $442.84 $1,819.25 $1,054.78 2026-04-10
78466 HCPCS Nuclear Medicine Study Of Heart Muscle Following Heart Attack 17 17 $1,915.00 $1,915.00 $442.84 $1,819.25 $1,054.78 2026-04-10
72131 HCPCS CT Scan Of Lower Spine Without Contrast 17 17 $1,911.00 $1,911.00 $136.70 $1,815.45 $1,052.58 2026-04-10
27265 HCPCS Closed Treatment Of Dislocated Hip Prosthesis 33 17 $1,938.00 $1,938.00 $444.62 $1,841.10 $1,046.52 2026-04-10
36569 HCPCS Insertion Of Tube For Infusion (5 Years Or Older) 48 17 $1,885.00 $1,885.00 $78.39 $1,844.90 $1,043.47 2026-04-10
C8929 HCPCS Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By Wi… 17 17 $1,885.00 $1,885.00 $544.94 $1,790.75 $1,038.26 2026-04-10
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 17 17 $1,885.00 $1,885.00 $544.94 $1,790.75 $1,038.26 2026-04-10
72128 HCPCS CT Scan Of Middle Spine Without Contrast 17 17 $1,869.00 $1,869.00 $136.70 $1,775.55 $1,029.45 2026-04-10
72125 HCPCS CT Scan Of Upper Spine Without Contrast 17 17 $1,869.00 $1,869.00 $136.70 $1,775.55 $1,029.45 2026-04-10
64493 HCPCS Injection Of Lower Or Sacral Spine Facet Joint Using Imaging Guidance, Single Le… 99 17 $2,945.00 $2,945.00 $76.35 $4,197.10 $1,026.06 2026-04-10
4903012_1 CDM Room & Board - Other - Other 9 9 $1,076.00 $1,076.00 $645.60 $1,685.39 $1,022.20 2026-04-10
8714852_1 CDM Gammagard Liquid 10% Vial 15 15 $1,790.00 $1,790.00 $895.00 $1,700.50 $1,014.93 2026-04-10
62323 HCPCS Injection Of Substance Into Lower Spine Canal Using Imaging Guidance 33 17 $2,029.00 $2,029.00 $83.66 $1,927.55 $1,014.50 2026-04-10
62321 HCPCS Injection Of Substance Into Middle Or Upper Spine Canal Using Imaging Guidance 33 17 $2,029.00 $2,029.00 $89.69 $1,927.55 $1,014.50 2026-04-10
64624 HCPCS Destruction Of Nerve Branches Of Knee Using Imaging Guidance 115 17 $1,475.00 $1,475.00 $125.06 $4,995.10 $1,012.49 2026-04-10
78227 HCPCS Nuclear Medicine Study Of Liver And Bile Duct System With Use Of Drugs 17 17 $1,838.00 $1,838.00 $442.84 $1,746.10 $1,012.37 2026-04-10
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