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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

BOONE COUNTY HOSPITAL

Boone, IA · CCN 161372 · Rates published

5,214 distinct procedures filed
32 distinct payers
173,166 rate rows
2026-05-18 last MRF observed
Data quality

170,400 of 173,166 rate rows are consumer-grade (98.4%)

2,766 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 1,508
exceeds 10× this hospital's gross charge — excluded from medians 389
percent-of-charges filed in the dollar field — excluded from medians 303
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 276
per-diem day rate — not a per-procedure price 223
exceeds 3× this hospital's gross charge for a DRG stay — excluded 36
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 31
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbBCHBOONEIA&type=CDMWithoutLabel&fileType=CSV
Found on page https://www.boonehospital.com/patients-and-visitors/price-transparency
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-08-17
Content fingerprint da6012d37a2c81da… · 75,847,044 bytes · first seen 2026-07-17

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
628
MS_DRG 		Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 15 $16,294.12 $39,733.34 $27,669.27 nat. median
$36,547
0.8× median
336
MS_DRG 		Peritoneal Adhesiolysis With Cc 15 $13,491.15 $32,976.52 $27,075.46 nat. median
$21,326
1.3× median
72
MS_DRG 		Other Cerebrovascular Disorders Without Cc/mcc 15 $6,488.39 $35,236.53 $25,963.76 nat. median
$8,545
outlier · 3.0×
314
MS_DRG 		Other Circulatory System Diagnoses With Mcc 15 $15,610.77 $31,017.79 $23,803.39 nat. median
$20,500
1.2× median
539
MS_DRG 		Osteomyelitis With Mcc 15 $11,008.67 $30,308.86 $22,332.84 nat. median
$19,527
1.1× median
963
MS_DRG 		Other Multiple Significant Trauma With Mcc 15 $13,263.49 $34,915.01 $21,844.63 nat. median
$26,745
0.8× median
445
MS_DRG 		Disorders Of The Biliary Tract With Cc 15 $7,097.46 $29,232.36 $21,539.63 nat. median
$11,531
1.9× median
J2350
HCPCS 		Injection, Ocrelizumab, 1 Mg 21 $59.60 $44,467.22 $21,484.69 nat. median
$331
outlier · 65.0×
551
MS_DRG 		Medical Back Problems With Mcc 15 $10,782.17 $27,492.45 $20,257.59 nat. median
$16,668
1.2× median
504
MS_DRG 		Foot Procedures With Cc 15 $14,889.68 $26,689.05 $19,665.62 nat. median
$18,380
1.1× median
57
MS_DRG 		Degenerative Nervous System Disorders Without Mcc 15 $12,231.35 $24,762.96 $18,587.55 nat. median
$13,109
1.4× median
542
MS_DRG 		Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 15 $11,777.60 $22,975.17 $17,777.51 nat. median
$17,869
1.0× median
565
MS_DRG 		Other Musculoskeletal System And Connective Tissue Diagnoses With Cc 15 $8,771.64 $20,904.94 $17,496.70 nat. median
$10,671
1.6× median
330
MS_DRG 		Major Small And Large Bowel Procedures With Cc 15 $10,189.16 $32,013.73 $17,302.35 nat. median
$24,077
0.7× median
305
MS_DRG 		Hypertension Without Mcc 15 $5,247.53 $22,752.80 $16,765.22 nat. median
$8,505
2.0× median
571
MS_DRG 		Skin Debridement With Cc 15 $9,269.35 $23,507.43 $16,761.12 nat. median
$17,113
1.0× median
572
MS_DRG 		Skin Debridement Without Cc/mcc 15 $11,028.11 $19,767.37 $16,230.05 nat. median
$12,156
1.3× median
948
MS_DRG 		Signs And Symptoms Without Mcc 15 $4,907.39 $22,024.53 $16,228.60 nat. median
$8,463
1.9× median
592
MS_DRG 		Skin Ulcers With Mcc 15 $10,576.06 $33,574.58 $15,963.86 nat. median
$19,351
0.8× median
444
MS_DRG 		Disorders Of The Biliary Tract With Mcc 15 $10,344.01 $18,541.15 $15,613.60 nat. median
$16,694
0.9× median
04011764
CDM 		Ilumya 100 Mg/ml Syringe 20 $13,426.66 $31,110.55 $15,104.99 nat. median
$15,105
1.0× median
432
MS_DRG 		Cirrhosis And Alcoholic Hepatitis With Mcc 15 $8,505.28 $26,567.08 $14,359.30 nat. median
$19,576
0.7× median
301
MS_DRG 		Peripheral Vascular Disorders Without Cc/mcc 15 $4,556.65 $19,244.25 $14,179.98 nat. median
$8,091
1.8× median
880
MS_DRG 		Acute Adjustment Reaction And Psychosocial Dysfunction 15 $5,227.83 $18,886.03 $13,916.02 nat. median
$9,293
1.5× median
853
MS_DRG 		Infectious And Parasitic Diseases With O.r. Procedures With Mcc 12 $9,332.87 $37,228.89 $13,911.26 nat. median
$47,707
outlier · 0.3×
617
MS_DRG 		Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 15 $9,110.92 $25,424.20 $13,752.34 nat. median
$19,257
0.7× median
65
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 15 $8,622.40 $16,310.59 $13,735.23 nat. median
$11,101
1.2× median
200
MS_DRG 		Pneumothorax With Cc 15 $6,364.15 $18,498.86 $13,630.74 nat. median
$11,584
1.2× median
100
MS_DRG 		Seizures With Mcc 15 $8,928.73 $17,970.99 $13,477.33 nat. median
$19,081
0.7× median
312
MS_DRG 		Syncope And Collapse 15 $5,808.87 $18,134.97 $13,362.61 nat. median
$9,409
1.4× median
787
MS_DRG 		Cesarean Section Without Sterilization With Cc 15 $5,909.62 $15,750.53 $13,248.91 nat. median
$11,354
1.2× median
389
MS_DRG 		Gastrointestinal Obstruction With Cc 15 $5,633.12 $17,790.36 $13,108.69 nat. median
$8,854
1.5× median
91
MS_DRG 		Other Disorders Of Nervous System With Mcc 15 $8,663.75 $23,246.20 $13,077.35 nat. median
$17,843
0.7× median
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 15 $8,588.72 $25,264.20 $12,964.10 nat. median
$19,136
0.7× median
184
MS_DRG 		Major Chest Trauma With Cc 15 $6,818.68 $15,755.68 $12,936.25 nat. median
$11,192
1.2× median
180
MS_DRG 		Respiratory Neoplasms With Mcc 15 $7,811.76 $25,409.51 $12,758.61 nat. median
$17,700
0.7× median
812
MS_DRG 		Red Blood Cell Disorders Without Mcc 15 $5,497.52 $20,641.28 $12,754.14 nat. median
$9,785
1.3× median
175
MS_DRG 		Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 15 $8,391.75 $19,647.76 $12,666.80 nat. median
$14,505
0.9× median
640
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 15 $8,208.25 $19,412.65 $12,389.82 nat. median
$13,243
0.9× median
73
MS_DRG 		Cranial And Peripheral Nerve Disorders With Mcc 15 $7,325.34 $21,541.67 $12,245.75 nat. median
$15,878
0.8× median
593
MS_DRG 		Skin Ulcers With Cc 15 $4,895.27 $16,573.74 $12,212.23 nat. median
$12,396
1.0× median
689
MS_DRG 		Kidney And Urinary Tract Infections With Mcc 15 $7,867.88 $17,205.26 $12,161.94 nat. median
$12,008
1.0× median
149
MS_DRG 		Dysequilibrium 15 $5,985.38 $14,392.43 $12,119.94 nat. median
$8,398
1.4× median
419
MS_DRG 		Laparoscopic Cholecystectomy Without C.d.e. Without Cc/mcc 15 $7,937.47 $18,253.44 $11,981.08 nat. median
$14,273
0.8× median
511
MS_DRG 		Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc 15 $6,983.45 $31,262.69 $11,858.68 nat. median
$20,373
0.6× median
66
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc 15 $6,987.61 $15,971.32 $11,768.34 nat. median
$8,021
1.5× median
04011842
CDM 		Skyrizi 600 Mg/10 Ml Vial 20 $10,343.66 $23,967.03 $11,636.62 nat. median
$11,637
1.0× median
379
MS_DRG 		Gastrointestinal Hemorrhage Without Cc/mcc 15 $4,639.98 $15,681.36 $11,554.68 nat. median
$7,380
1.6× median
394
MS_DRG 		Other Digestive System Diagnoses With Cc 15 $6,537.63 $13,721.10 $11,551.34 nat. median
$10,183
1.1× median
562
MS_DRG 		Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 15 $6,685.75 $22,242.10 $11,353.17 nat. median
$14,618
0.8× median

Other procedures at this hospital

Browse this hospital's 5,214 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
             
J2350 HCPCS Injection, Ocrelizumab, 1 Mg 21 21 $46,807.60 $37,446.08 $59.60 $44,467.22 $21,484.69 2026-05-18
628 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Mcc 15 15 $30,743.63 $24,594.90 20% off $16,294.12 $39,733.34 $27,669.27 2026-05-18
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 12 12 $17,609.19 $14,087.35 20% off $9,332.87 $37,228.89 $13,911.26 2026-05-18
72 MS_DRG Other Cerebrovascular Disorders Without Cc/mcc 15 15 $37,091.08 $29,672.86 20% off $6,488.39 $35,236.53 $25,963.76 2026-05-18
963 MS_DRG Other Multiple Significant Trauma With Mcc 15 15 $25,025.45 $20,020.36 20% off $13,263.49 $34,915.01 $21,844.63 2026-05-18
592 MS_DRG Skin Ulcers With Mcc 15 15 $19,954.83 $15,963.86 20% off $10,576.06 $33,574.58 $15,963.86 2026-05-18
336 MS_DRG Peritoneal Adhesiolysis With Cc 15 15 $34,712.13 $27,769.70 20% off $13,491.15 $32,976.52 $27,075.46 2026-05-18
C1776 HCPCS Joint Device (implantable) 220 20 $4,487.24 $3,589.79 20% off $656.27 $32,537.96 $2,579.98 2026-05-18
330 MS_DRG Major Small And Large Bowel Procedures With Cc 15 15 $19,224.83 $15,379.86 20% off $10,189.16 $32,013.73 $17,302.35 2026-05-18
511 MS_DRG Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc 15 15 $13,176.32 $10,541.05 20% off $6,983.45 $31,262.69 $11,858.68 2026-05-18
04011764 CDM Ilumya 100 Mg/ml Syringe 20 20 $32,747.95 $26,198.36 20% off $13,426.66 $31,110.55 $15,104.99 2026-05-18
314 MS_DRG Other Circulatory System Diagnoses With Mcc 15 15 $29,754.24 $23,803.39 20% off $15,610.77 $31,017.79 $23,803.39 2026-05-18
539 MS_DRG Osteomyelitis With Mcc 15 15 $31,904.06 $25,523.25 $11,008.67 $30,308.86 $22,332.84 2026-05-18
445 MS_DRG Disorders Of The Biliary Tract With Cc 15 15 $30,770.90 $24,616.72 20% off $7,097.46 $29,232.36 $21,539.63 2026-05-18
64 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Mcc 17 15 $11,828.05 $9,462.44 $6,268.87 $28,771.21 $9,462.44 2026-05-18
551 MS_DRG Medical Back Problems With Mcc 15 15 $28,939.42 $23,151.54 $10,782.17 $27,492.45 $20,257.59 2026-05-18
504 MS_DRG Foot Procedures With Cc 15 15 $28,093.74 $22,474.99 20% off $14,889.68 $26,689.05 $19,665.62 2026-05-18
432 MS_DRG Cirrhosis And Alcoholic Hepatitis With Mcc 15 15 $16,047.71 $12,838.16 20% off $8,505.28 $26,567.08 $14,359.30 2026-05-18
854 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Cc 15 15 $10,976.20 $8,780.96 20% off $5,817.38 $25,474.82 $9,878.58 2026-05-18
617 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 15 15 $17,190.42 $13,752.34 $9,110.92 $25,424.20 $13,752.34 2026-05-18
180 MS_DRG Respiratory Neoplasms With Mcc 15 15 $14,739.17 $11,791.34 $7,811.76 $25,409.51 $12,758.61 2026-05-18
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 15 15 $16,205.13 $12,964.10 20% off $8,588.72 $25,264.20 $12,964.10 2026-05-18
57 MS_DRG Degenerative Nervous System Disorders Without Mcc 15 15 $23,234.44 $18,587.55 20% off $12,231.35 $24,762.96 $18,587.55 2026-05-18
205 MS_DRG Other Respiratory System Diagnoses With Mcc 15 15 $8,412.50 $6,730.00 20% off $4,458.63 $24,289.48 $7,571.25 2026-05-18
04011842 CDM Skyrizi 600 Mg/10 Ml Vial 20 20 $25,228.45 $20,182.76 20% off $10,343.66 $23,967.03 $11,636.62 2026-05-18
571 MS_DRG Skin Debridement With Cc 15 15 $20,951.40 $16,761.12 20% off $9,269.35 $23,507.43 $16,761.12 2026-05-18
91 MS_DRG Other Disorders Of Nervous System With Mcc 15 15 $16,346.69 $13,077.35 20% off $8,663.75 $23,246.20 $13,077.35 2026-05-18
757 MS_DRG Infections, Female Reproductive System With Mcc 15 15 $13,729.11 $10,983.29 $5,142.23 $23,109.05 $10,983.29 2026-05-18
04011686 CDM Invega Hafyera 1,092 Mg/3.5 Ml 20 20 $24,294.90 $19,435.92 20% off $9,960.91 $23,080.16 $11,206.03 2026-05-18
542 MS_DRG Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 15 15 $22,221.89 $17,777.51 20% off $11,777.60 $22,975.17 $17,777.51 2026-05-18
56 MS_DRG Degenerative Nervous System Disorders With Mcc 12 12 $11,885.87 $9,508.70 $6,299.51 $22,805.19 $9,389.84 2026-05-18
305 MS_DRG Hypertension Without Mcc 15 15 $23,950.32 $19,160.26 $5,247.53 $22,752.80 $16,765.22 2026-05-18
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 15 15 $12,468.31 $9,974.64 20% off $6,608.20 $22,527.82 $11,221.47 2026-05-18
438 MS_DRG Disorders Of Pancreas Except Malignancy With Mcc 15 15 $9,598.33 $7,678.66 20% off $5,087.11 $22,330.26 $8,638.50 2026-05-18
562 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 15 15 $12,614.63 $10,091.70 20% off $6,685.75 $22,242.10 $11,353.17 2026-05-18
811 MS_DRG Red Blood Cell Disorders With Mcc 15 15 $11,615.60 $9,292.48 20% off $6,156.27 $22,095.15 $9,429.95 2026-05-18
948 MS_DRG Signs And Symptoms Without Mcc 15 15 $23,183.72 $18,546.98 $4,907.39 $22,024.53 $16,228.60 2026-05-18
73 MS_DRG Cranial And Peripheral Nerve Disorders With Mcc 15 15 $13,821.39 $11,057.11 20% off $7,325.34 $21,541.67 $12,245.75 2026-05-18
682 MS_DRG Renal Failure With Mcc 15 15 $11,661.59 $9,329.27 20% off $6,180.64 $21,533.51 $10,205.67 2026-05-18
565 MS_DRG Other Musculoskeletal System And Connective Tissue Diagnoses With Cc 15 15 $22,005.20 $17,604.16 20% off $8,771.64 $20,904.94 $17,496.70 2026-05-18
27138 HCPCS Revision Of Thigh Bone Prosthesis 23 23 $3,260.00 $2,608.00 20% off $1,336.60 $20,873.30 $1,913.62 2026-05-18
23472 HCPCS Prosthetic Repair Of Shoulder Joint, Total Shoulder 47 24 $4,017.00 $3,213.60 20% off $1,175.60 $20,873.30 $1,861.88 2026-05-18
27130 HCPCS Replacement Of Thigh Bone And Hip Joint With Prosthesis 94 24 $3,305.25 $2,644.20 20% off $1,047.43 $20,873.30 $1,852.46 2026-05-18
602 MS_DRG Cellulitis With Mcc 15 15 $8,105.40 $6,484.32 20% off $4,295.86 $20,728.59 $7,294.86 2026-05-18
812 MS_DRG Red Blood Cell Disorders Without Mcc 17 15 $21,727.66 $17,382.13 $5,497.52 $20,641.28 $12,754.14 2026-05-18
348 MS_DRG Anal And Stomal Procedures With Cc 15 15 $8,266.73 $6,613.38 20% off $4,381.37 $20,121.23 $7,440.06 2026-05-18
572 MS_DRG Skin Debridement Without Cc/mcc 15 15 $20,807.76 $16,646.21 $11,028.11 $19,767.37 $16,230.05 2026-05-18
175 MS_DRG Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 15 15 $15,833.50 $12,666.80 20% off $8,391.75 $19,647.76 $12,666.80 2026-05-18
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 15 15 $15,487.27 $12,389.82 $8,208.25 $19,412.65 $12,389.82 2026-05-18
301 MS_DRG Peripheral Vascular Disorders Without Cc/mcc 15 15 $20,257.11 $16,205.69 $4,556.65 $19,244.25 $14,179.98 2026-05-18
880 MS_DRG Acute Adjustment Reaction And Psychosocial Dysfunction 15 15 $19,880.03 $15,904.02 20% off $5,227.83 $18,886.03 $13,916.02 2026-05-18
291 MS_DRG Heart Failure And Shock With Mcc 15 15 $11,407.05 $9,125.64 20% off $6,045.74 $18,743.25 $9,145.11 2026-05-18
444 MS_DRG Disorders Of The Biliary Tract With Mcc 15 15 $19,517.00 $15,613.60 20% off $10,344.01 $18,541.15 $15,613.60 2026-05-18
200 MS_DRG Pneumothorax With Cc 15 15 $19,472.48 $15,577.98 20% off $6,364.15 $18,498.86 $13,630.74 2026-05-18
419 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. Without Cc/mcc 15 15 $14,976.35 $11,981.08 20% off $7,937.47 $18,253.44 $11,981.08 2026-05-18
312 MS_DRG Syncope And Collapse 15 15 $19,089.44 $15,271.55 20% off $5,808.87 $18,134.97 $13,362.61 2026-05-18
04011600 CDM Somatuline Depot 120 Mg/0.5 Ml 20 20 $19,070.50 $15,256.40 20% off $7,818.91 $18,116.98 $8,796.27 2026-05-18
100 MS_DRG Seizures With Mcc 15 15 $16,846.66 $13,477.33 $8,928.73 $17,970.99 $13,477.33 2026-05-18
23616 HCPCS Treatment Of Broken Upper Arm Bone With Replacement 23 23 $3,160.00 $2,528.00 20% off $1,295.60 $17,913.60 $1,854.92 2026-05-18
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 15 15 $12,840.86 $10,272.69 $6,805.66 $17,894.25 $10,272.69 2026-05-18
389 MS_DRG Gastrointestinal Obstruction With Cc 15 15 $18,726.70 $14,981.36 20% off $5,633.12 $17,790.36 $13,108.69 2026-05-18
983 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis Without Cc/mcc 15 15 $6,993.11 $5,594.49 $3,706.35 $17,750.57 $6,293.80 2026-05-18
04011896 CDM Fabrazyme 35mg Vial 20 20 $18,636.85 $14,909.48 $7,641.11 $17,705.01 $8,596.24 2026-05-18
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 15 15 $9,342.99 $7,474.39 20% off $4,951.78 $17,696.69 $8,408.69 2026-05-18
689 MS_DRG Kidney And Urinary Tract Infections With Mcc 15 15 $15,202.43 $12,161.94 20% off $7,867.88 $17,205.26 $12,161.94 2026-05-18
917 MS_DRG Poisoning And Toxic Effects Of Drugs With Mcc 15 15 $7,452.42 $5,961.94 $3,949.78 $17,090.97 $6,707.18 2026-05-18
593 MS_DRG Skin Ulcers With Cc 15 15 $17,446.05 $13,956.84 $4,895.27 $16,573.74 $12,212.23 2026-05-18
04011376 CDM Invega Trinza 819mg Inj 20 20 $17,444.30 $13,955.44 $7,152.16 $16,572.09 $8,046.18 2026-05-18
388 MS_DRG Gastrointestinal Obstruction With Mcc 15 15 $12,712.40 $10,169.92 20% off $6,737.57 $16,341.56 $10,169.92 2026-05-18
65 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 15 15 $17,169.04 $13,735.23 20% off $8,622.40 $16,310.59 $13,735.23 2026-05-18
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 15 15 $7,922.10 $6,337.68 20% off $4,198.71 $16,271.36 $7,092.91 2026-05-18
66 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc 15 15 $16,811.92 $13,449.53 20% off $6,987.61 $15,971.32 $11,768.34 2026-05-18
346 MS_DRG Minor Small And Large Bowel Procedures Without Cc/mcc 15 15 $13,171.59 $10,537.27 20% off $6,980.94 $15,814.21 $10,537.27 2026-05-18
184 MS_DRG Major Chest Trauma With Cc 15 15 $16,584.93 $13,267.94 20% off $6,818.68 $15,755.68 $12,936.25 2026-05-18
04003020 CDM Activase 100 Mg Vial 20 20 $16,581.65 $13,265.32 20% off $6,798.48 $15,752.57 $7,648.28 2026-05-18
787 MS_DRG Cesarean Section Without Sterilization With Cc 15 15 $16,561.14 $13,248.91 20% off $5,909.62 $15,750.53 $13,248.91 2026-05-18
379 MS_DRG Gastrointestinal Hemorrhage Without Cc/mcc 15 15 $16,506.69 $13,205.35 20% off $4,639.98 $15,681.36 $11,554.68 2026-05-18
04010668 CDM Lupron Depot 45 Mg 6mo Kit 20 20 $16,496.00 $13,196.80 20% off $6,763.36 $15,671.20 $7,608.78 2026-05-18
784 MS_DRG Cesarean Section With Sterilization With Cc 15 15 $8,748.15 $6,998.52 $4,636.52 $15,495.83 $6,998.52 2026-05-18
433 MS_DRG Cirrhosis And Alcoholic Hepatitis With Cc 15 15 $13,737.52 $10,990.02 $6,964.13 $15,035.41 $10,990.02 2026-05-18
04010218 CDM Tysabri 300mg/15ml Vial 20 20 $15,450.00 $12,360.00 20% off $6,334.50 $14,677.50 $7,126.32 2026-05-18
189 MS_DRG Pulmonary Edema And Respiratory Failure 17 15 $12,369.78 $9,895.82 20% off $6,555.98 $14,633.77 $9,648.43 2026-05-18
04011168 CDM Envtyvio 300mg Pwvl 20 20 $15,243.95 $12,195.16 20% off $6,250.02 $14,481.75 $7,031.27 2026-05-18
728 MS_DRG Inflammation Of The Male Reproductive System Without Mcc 15 15 $15,154.30 $12,123.44 $3,816.52 $14,396.59 $10,608.01 2026-05-18
149 MS_DRG Dysequilibrium 15 15 $15,149.93 $12,119.94 20% off $5,985.38 $14,392.43 $12,119.94 2026-05-18
884 MS_DRG Organic Disturbances And Intellectual Disability 15 15 $10,342.04 $8,273.63 20% off $5,481.28 $14,291.12 $9,307.84 2026-05-18
304 MS_DRG Hypertension With Mcc 15 15 $13,050.66 $10,440.53 $6,916.85 $14,183.15 $10,440.53 2026-05-18
863 MS_DRG Postoperative And Post-traumatic Infections Without Mcc 15 15 $9,154.81 $7,323.85 $4,852.05 $14,178.25 $7,323.85 2026-05-18
19357 HCPCS Reconstruction Of Breast Using Tissue Expander 23 23 $3,500.00 $2,800.00 20% off $1,435.00 $14,079.40 $2,054.50 2026-05-18
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 15 15 $9,521.24 $7,616.99 20% off $5,046.26 $14,046.01 $7,616.99 2026-05-18
552 MS_DRG Medical Back Problems Without Mcc 15 15 $12,798.44 $10,238.75 20% off $6,083.86 $13,917.02 $10,238.75 2026-05-18
897 MS_DRG Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc 14 14 $14,641.74 $11,713.39 20% off $7,760.12 $13,909.66 $10,840.15 2026-05-18
C1762 HCPCS Connective Tissue, Human (includes Fascia Lata) 42 22 $9,075.12 $7,260.10 $3,720.80 $13,871.31 $6,083.66 2026-05-18
178 MS_DRG Respiratory Infections And Inflammations With Cc 15 15 $12,571.87 $10,057.50 $6,663.09 $13,745.59 $10,057.50 2026-05-18
387 MS_DRG Inflammatory Bowel Disease Without Cc/mcc 15 15 $11,908.96 $9,527.17 $5,074.05 $13,726.00 $9,527.17 2026-05-18
394 MS_DRG Other Digestive System Diagnoses With Cc 15 15 $14,439.18 $11,551.34 20% off $6,537.63 $13,721.10 $11,551.34 2026-05-18
439 MS_DRG Disorders Of Pancreas Except Malignancy With Cc 15 15 $5,778.05 $4,622.44 20% off $3,062.36 $13,711.31 $5,200.24 2026-05-18
281 MS_DRG Acute Myocardial Infarction, Discharged Alive With Cc 15 15 $11,291.96 $9,033.57 $5,984.74 $13,554.57 $9,033.57 2026-05-18
600 MS_DRG Non-malignant Breast Disorders With Cc/mcc 15 15 $12,415.13 $9,932.10 20% off $5,597.51 $13,507.22 $9,932.10 2026-05-18
788 MS_DRG Cesarean Section Without Sterilization Without Cc/mcc 15 15 $9,054.68 $7,243.74 20% off $4,798.98 $13,477.83 $7,243.74 2026-05-18
603 MS_DRG Cellulitis Without Mcc 17 15 $10,083.08 $8,066.46 20% off $4,502.10 $13,247.62 $7,864.80 2026-05-18
785 MS_DRG Cesarean Section With Sterilization Without Cc/mcc 15 15 $6,156.26 $4,925.01 $3,262.82 $13,095.78 $5,540.63 2026-05-18
293 MS_DRG Heart Failure And Shock Without Cc/mcc 15 15 $13,770.28 $11,016.22 20% off $3,901.37 $13,081.77 $9,639.20 2026-05-18
311 MS_DRG Angina Pectoris 15 15 $13,742.73 $10,994.18 20% off $3,999.09 $13,055.59 $9,619.91 2026-05-18
686 MS_DRG Kidney And Urinary Tract Neoplasms With Mcc 12 12 $7,499.80 $5,999.84 20% off $3,974.89 $12,992.69 $5,924.84 2026-05-18
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 17 15 $10,623.94 $8,499.15 20% off $5,630.69 $12,932.51 $8,286.68 2026-05-18
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 15 15 $13,600.22 $10,880.17 20% off $5,130.11 $12,920.20 $10,065.52 2026-05-18
563 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 15 15 $4,530.35 $3,624.28 20% off $2,401.08 $12,757.82 $4,077.31 2026-05-18
535 MS_DRG Fractures Of Hip And Pelvis With Mcc 15 15 $6,989.03 $5,591.22 20% off $3,704.19 $12,653.32 $6,290.13 2026-05-18
536 MS_DRG Fractures Of Hip And Pelvis Without Mcc 14 14 $4,189.35 $3,351.48 20% off $2,220.36 $12,530.48 $3,560.95 2026-05-18
282 MS_DRG Acute Myocardial Infarction, Discharged Alive Without Cc/mcc 15 15 $13,107.50 $10,486.00 20% off $6,946.98 $12,452.13 $10,045.40 2026-05-18
465 MS_DRG Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective … 12 12 $8,183.24 $6,546.59 20% off $4,337.12 $12,444.22 $6,464.76 2026-05-18
842 MS_DRG Lymphoma And Non-acute Leukemia Without Cc/mcc 13 13 $4,142.65 $3,314.12 $2,195.60 $12,354.53 $3,314.12 2026-05-18
558 MS_DRG Tendonitis, Myositis And Bursitis Without Mcc 15 15 $12,989.65 $10,391.72 20% off $3,796.07 $12,340.16 $10,131.92 2026-05-18
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 15 15 $10,181.09 $8,144.87 20% off $4,510.43 $12,339.85 $8,144.87 2026-05-18
292 MS_DRG Heart Failure And Shock With Cc 15 15 $9,666.54 $7,733.23 20% off $5,123.27 $12,336.58 $7,733.23 2026-05-18
176 MS_DRG Pulmonary Embolism Without Mcc 15 15 $12,958.71 $10,366.97 $6,064.16 $12,310.77 $10,366.97 2026-05-18
01200040 CDM Prodense 20ml 20 20 $12,886.50 $10,309.20 $5,283.47 $12,242.18 $5,943.90 2026-05-18
440 MS_DRG Disorders Of Pancreas Except Malignancy Without Cc/mcc 15 15 $10,292.52 $8,234.02 $4,468.01 $12,217.40 $8,234.02 2026-05-18
605 MS_DRG Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc 15 15 $6,335.33 $5,068.26 20% off $3,357.72 $12,217.40 $5,701.80 2026-05-18
683 MS_DRG Renal Failure With Cc 15 15 $8,735.22 $6,988.18 $4,629.67 $12,166.78 $6,988.18 2026-05-18
638 MS_DRG Diabetes With Cc 15 15 $10,364.07 $8,291.26 $4,911.93 $12,091.68 $8,291.26 2026-05-18
382 MS_DRG Complicated Peptic Ulcer Without Cc/mcc 15 15 $12,163.95 $9,731.16 20% off $5,753.57 $11,949.64 $9,731.16 2026-05-18
373 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/mcc 15 15 $10,991.32 $8,793.06 $4,367.26 $11,912.08 $8,793.06 2026-05-18
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 15 15 $12,512.47 $10,009.98 $5,223.29 $11,886.85 $10,009.98 2026-05-18
202 MS_DRG Bronchitis And Asthma With Cc/mcc 15 15 $8,210.09 $6,568.07 20% off $4,351.35 $11,601.87 $6,568.07 2026-05-18
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 15 15 $12,166.29 $9,733.03 20% off $4,521.04 $11,557.98 $9,733.03 2026-05-18
197 MS_DRG Interstitial Lung Disease With Cc 15 15 $10,895.56 $8,716.45 $5,774.65 $11,556.16 $8,716.45 2026-05-18
192 MS_DRG Chronic Obstructive Pulmonary Disease Without Cc/mcc 15 15 $8,846.76 $7,077.41 $4,492.25 $11,552.89 $7,077.41 2026-05-18
84 MS_DRG Traumatic Stupor And Coma >1 Hour Without Cc/mcc 15 15 $10,681.07 $8,544.86 $5,660.97 $11,309.62 $8,544.86 2026-05-18
04011758 CDM Paliperidone Palmitate 546 Mg 20 20 $11,629.80 $9,303.84 $4,768.22 $11,048.31 $5,364.24 2026-05-18
04010642 CDM Sandostatin Lar 30mg/octreotid 20 20 $11,514.60 $9,211.68 20% off $4,720.99 $10,938.87 $5,311.11 2026-05-18
01204003 CDM Operating Room Services - General Classification 20 20 $11,392.44 $9,113.95 20% off $4,670.90 $10,822.82 $5,254.76 2026-05-18
01204002 CDM Operating Room Services - General Classification 20 20 $11,140.14 $8,912.11 20% off $4,567.46 $10,583.13 $5,138.39 2026-05-18
177 MS_DRG Respiratory Infections And Inflammations With Mcc 12 12 $6,016.05 $4,812.84 20% off $3,188.51 $10,555.66 $4,752.68 2026-05-18
896 MS_DRG Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc 12 12 $3,925.97 $3,140.78 $2,080.76 $10,507.18 $3,101.52 2026-05-18
04008586 CDM Lupron Depot-4 Month Kit 20 20 $10,997.20 $8,797.76 20% off $4,508.85 $10,447.34 $5,072.45 2026-05-18
101 MS_DRG Seizures Without Mcc 15 15 $6,864.51 $5,491.61 $3,638.19 $10,277.76 $5,685.39 2026-05-18
152 MS_DRG Otitis Media And Uri With Mcc 15 15 $8,366.44 $6,693.15 20% off $4,434.21 $9,980.62 $6,693.15 2026-05-18
639 MS_DRG Diabetes Without Cc/mcc 15 15 $5,914.36 $4,731.49 $3,134.61 $9,939.80 $4,731.49 2026-05-18
179 MS_DRG Respiratory Infections And Inflammations Without Cc/mcc 15 15 $9,052.46 $7,241.97 $4,797.80 $9,755.30 $7,241.96 2026-05-18
01204001 CDM Operating Room Services - General Classification 20 20 $10,143.07 $8,114.46 $4,158.66 $9,635.92 $4,678.49 2026-05-18
806 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Cc 15 15 $6,131.15 $4,904.92 $3,249.51 $9,588.77 $4,904.92 2026-05-18
918 MS_DRG Poisoning And Toxic Effects Of Drugs Without Mcc 15 15 $6,860.60 $5,488.48 20% off $3,636.12 $9,520.20 $5,488.48 2026-05-18
637 MS_DRG Diabetes With Mcc 12 12 $4,777.39 $3,821.91 20% off $2,532.02 $9,499.64 $3,774.14 2026-05-18
04008344 CDM Rituxan (rituximab) 100mg Vial 20 20 $9,935.20 $7,948.16 20% off $4,073.43 $9,438.44 $4,582.61 2026-05-18
01203003 CDM Operating Room Services - General Classification 20 20 $9,832.06 $7,865.65 $4,031.14 $9,340.46 $4,535.04 2026-05-18
04008452 CDM Neulasta 6 Mg/0.6 Ml Syringe 20 20 $9,797.85 $7,838.28 20% off $4,017.12 $9,307.96 $4,519.26 2026-05-18
204 MS_DRG Respiratory Signs And Symptoms 15 15 $7,775.47 $6,220.38 $4,121.00 $9,174.07 $6,220.38 2026-05-18
303 MS_DRG Atherosclerosis Without Mcc 15 15 $9,191.87 $7,353.50 $4,871.69 $9,108.76 $7,353.50 2026-05-18
01203002 CDM Operating Room Services - General Classification 20 20 $9,583.43 $7,666.74 20% off $3,929.21 $9,104.26 $4,420.35 2026-05-18
684 MS_DRG Renal Failure Without Cc/mcc 15 15 $8,006.57 $6,405.26 $3,774.10 $9,067.94 $6,405.26 2026-05-18
04011442 CDM Neulasta Onpro Kit 20 20 $9,468.10 $7,574.48 20% off $3,881.92 $8,994.70 $4,367.16 2026-05-18
04011822 CDM Dificid 200 Mg Tablet 20 20 $9,279.15 $7,423.32 20% off $3,804.45 $8,815.19 $4,280.01 2026-05-18
390 MS_DRG Gastrointestinal Obstruction Without Cc/mcc 15 15 $9,100.88 $7,280.70 20% off $3,758.95 $8,645.83 $7,280.70 2026-05-18
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/mcc 15 15 $5,876.91 $4,701.53 $3,114.76 $8,627.12 $4,701.53 2026-05-18
807 MS_DRG Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc 15 15 $3,888.51 $3,110.81 $2,060.91 $8,481.81 $3,235.48 2026-05-18
832 MS_DRG Other Antepartum Diagnoses Without O.r. Procedures With Cc 15 15 $8,323.94 $6,659.15 20% off $3,432.45 $8,393.64 $6,659.15 2026-05-18
Q5123 HCPCS Injection, Rituximab-arrx, Biosimilar, (riabni), 10 Mg 41 21 $2,774.00 $2,219.20 20% off $20.26 $8,235.36 $2,635.30 2026-05-18
436 MS_DRG Malignancy Of Hepatobiliary System Or Pancreas With Cc 12 12 $4,243.91 $3,395.13 $2,249.27 $7,861.82 $3,352.69 2026-05-18
04006670 CDM Lupron Depot 22.5 Mg 3mo Kit 20 20 $8,247.90 $6,598.32 20% off $3,381.64 $7,835.51 $3,804.35 2026-05-18
310 MS_DRG Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 15 15 $6,795.53 $5,436.43 $3,601.63 $7,832.00 $5,436.43 2026-05-18
04011914 CDM Alteplase 50mg Vial 20 20 $8,171.15 $6,536.92 $3,350.17 $7,762.59 $3,768.94 2026-05-18
04009496 CDM Aranesp 200 Mcg/0.4 Ml Syringe 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
04010764 CDM 300 Mcg/0.6ml (chemo) 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
04011836 CDM Omalizumab 300 Mg/2ml Syring 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
04011448 CDM Privigen 10% 40gm Vial 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
04011076 CDM Aranesp 500mcg/1ml (non-chemo) 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
04011400 CDM Aristada 1064 Mg Inj 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
04011390 CDM Nucala 100mg Vial 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
04007702 CDM Miacalcin 400 Unit/2 Ml Vial 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
04011468 CDM Nulojix 250 Mg Vial 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
04008500 CDM Aranesp 200mcg/0.4ml Syringe ( 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
04011590 CDM Humira Pen 40 Mg/0.8 Ml 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
04011164 CDM Lupron Depot 15mg 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
04010756 CDM Aranesp 300 Mcg/0.6 Ml Syringe 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
04011944 CDM Nyvepria 6 Mg/0.06 Ml Syringe 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
04011528 CDM Lupron Depot 11.25 Mg 3mo Kit 20 20 $8,125.00 $6,500.00 20% off $3,331.25 $7,718.75 $3,747.66 2026-05-18
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 46 23 $5,990.92 $4,792.74 $356.43 $7,588.51 $3,275.04 2026-05-18
73720 HCPCS MRI Scan Of Leg Before And After Contrast 69 23 $3,993.95 $3,195.16 20% off $356.43 $7,588.51 $2,795.77 2026-05-18
699 MS_DRG Other Kidney And Urinary Tract Diagnoses With Cc 14 12 $4,689.97 $3,751.98 $2,485.68 $7,507.29 $3,587.83 2026-05-18
01203001 CDM Operating Room Services - General Classification 20 20 $7,892.08 $6,313.66 20% off $3,235.75 $7,497.48 $3,640.22 2026-05-18
951 MS_DRG Other Factors Influencing Health Status 15 15 $5,122.84 $4,098.27 20% off $2,715.11 $7,471.18 $4,098.27 2026-05-18
921 MS_DRG Complications Of Treatment Without Cc/mcc 15 15 $7,361.03 $5,888.82 20% off $3,901.35 $7,361.79 $5,888.82 2026-05-18
04011460 CDM Gamunex-c 40 Gram/400 Ml Vial 20 20 $7,636.40 $6,109.12 20% off $3,130.92 $7,254.58 $3,522.29 2026-05-18
04011814 CDM Monoferric 1,000 Mg/10 Ml Vial 20 20 $7,352.25 $5,881.80 20% off $3,014.42 $6,984.64 $3,391.22 2026-05-18
01202004 CDM Operating Room Services - General Classification 20 20 $7,045.82 $5,636.66 $2,888.79 $6,693.53 $3,249.89 2026-05-18
01202003 CDM Operating Room Services - General Classification 20 20 $6,794.65 $5,435.72 $2,785.81 $6,454.92 $3,134.03 2026-05-18
04010140 CDM Xgeva 120 Mg/1.7 Ml Vial 20 20 $6,788.75 $5,431.00 20% off $2,783.39 $6,449.31 $3,131.32 2026-05-18
776 MS_DRG Postpartum And Post Abortion Diagnoses Without O.r. Procedures 15 15 $5,796.43 $4,637.14 20% off $3,072.11 $6,364.21 $4,637.14 2026-05-18
04011210 CDM Actemra 20 20 $6,687.20 $5,349.76 $2,741.75 $6,352.84 $3,084.47 2026-05-18
04011212 CDM Abilify Maintena 400mg Susp Sy 20 20 $6,633.20 $5,306.56 $2,719.61 $6,301.54 $3,059.56 2026-05-18
04011804 CDM Perseris ER 90 Mg Syringe Kit 20 20 $6,268.45 $5,014.76 $2,570.06 $5,955.03 $2,891.32 2026-05-18
01200744 CDM Total Knee Navigation 20 20 $6,160.64 $4,928.51 20% off $2,525.86 $5,852.61 $2,841.60 2026-05-18
43415 HCPCS Suture Of Wound Or Injury To Esophagus Through Chest Or Abdomen 24 24 $2,850.00 $2,280.00 20% off $1,042.99 $5,686.00 $2,267.12 2026-05-18
04011242 CDM Ryanodex 250mg 20 20 $5,931.60 $4,745.28 20% off $2,431.96 $5,635.02 $2,735.95 2026-05-18
04011516 CDM Evenity 210 Mg Dose-2 Syringes 20 20 $5,931.25 $4,745.00 20% off $2,431.81 $5,634.69 $2,735.78 2026-05-18
01243268 CDM Operating Room Services - General Classification 20 20 $5,829.61 $4,663.69 $2,390.14 $5,538.13 $2,688.90 2026-05-18
01243258 CDM Operating Room Services - General Classification 20 20 $5,829.61 $4,663.69 $2,390.14 $5,538.13 $2,688.90 2026-05-18
04011800 CDM Fulphila 6 Mg/0.6 Ml Syringe 20 20 $5,817.15 $4,653.72 $2,385.03 $5,526.29 $2,683.16 2026-05-18
01202002 CDM Operating Room Services - General Classification 20 20 $5,795.31 $4,636.25 $2,376.08 $5,505.54 $2,673.09 2026-05-18
04008516 CDM Gamunex-c 20 Gram/200 Ml Vial 20 20 $5,606.60 $4,485.28 20% off $2,298.71 $5,326.27 $2,586.05 2026-05-18
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 92 23 $4,201.47 $3,361.18 20% off $243.77 $5,321.86 $2,296.80 2026-05-18
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 69 23 $2,800.98 $2,240.78 20% off $243.77 $5,321.86 $1,960.69 2026-05-18
01243246 CDM Operating Room Services - General Classification 20 20 $5,566.24 $4,452.99 20% off $2,282.16 $5,287.93 $2,567.43 2026-05-18
01243252 CDM Operating Room Services - General Classification 20 20 $5,566.24 $4,452.99 20% off $2,282.16 $5,287.93 $2,567.43 2026-05-18
01243267 CDM Operating Room Services - General Classification 20 20 $5,566.24 $4,452.99 20% off $2,282.16 $5,287.93 $2,567.43 2026-05-18
01243255 CDM Operating Room Services - General Classification 20 20 $5,566.24 $4,452.99 20% off $2,282.16 $5,287.93 $2,567.43 2026-05-18
01243257 CDM Operating Room Services - General Classification 20 20 $5,566.24 $4,452.99 20% off $2,282.16 $5,287.93 $2,567.43 2026-05-18
73718 HCPCS MRI Scan Of Leg Without Contrast 69 23 $2,733.51 $2,186.81 $243.77 $5,193.67 $1,913.46 2026-05-18
44156 HCPCS Removal Of Large Bowel And Rectum And Creation Of Opening From End Of Small Bowe… 24 24 $5,000.00 $4,000.00 20% off $1,294.79 $5,125.00 $2,158.57 2026-05-18
04011356 CDM Simponi Aria 50mg/4ml Sdv 20 20 $5,305.25 $4,244.20 20% off $2,175.15 $5,039.99 $2,447.05 2026-05-18
01243251 CDM Operating Room Services - General Classification 20 20 $5,303.16 $4,242.53 $2,174.30 $5,038.00 $2,446.08 2026-05-18
01243243 CDM Operating Room Services - General Classification 20 20 $5,303.16 $4,242.53 $2,174.30 $5,038.00 $2,446.08 2026-05-18
01243249 CDM Operating Room Services - General Classification 20 20 $5,303.16 $4,242.53 $2,174.30 $5,038.00 $2,446.08 2026-05-18
01243254 CDM Operating Room Services - General Classification 20 20 $5,303.16 $4,242.53 $2,174.30 $5,038.00 $2,446.08 2026-05-18
01243245 CDM Operating Room Services - General Classification 20 20 $5,303.16 $4,242.53 $2,174.30 $5,038.00 $2,446.08 2026-05-18
01202001 CDM Operating Room Services - General Classification 20 20 $5,261.48 $4,209.18 20% off $2,157.21 $4,998.41 $2,426.86 2026-05-18
44158 HCPCS Removal Of Large Bowel And Rectum With Attachment Of Small Bowel To Anus And Cre… 24 24 $5,200.00 $4,160.00 20% off $1,801.37 $4,991.00 $2,103.36 2026-05-18
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 23 23 $5,209.88 $4,167.90 20% off $179.20 $4,949.39 $2,344.45 2026-05-18
04010256 CDM Velcade 3.5 Mg Vial 20 20 $5,209.75 $4,167.80 $2,136.00 $4,949.26 $2,403.00 2026-05-18
04011366 CDM Stelara 130mg/26ml Vial 20 20 $5,200.00 $4,160.00 20% off $2,132.00 $4,940.00 $2,398.50 2026-05-18
44211 HCPCS Removal Of Large Bowel And Rectum With Attachment Of Small Bowel To Anus And Cre… 24 24 $5,200.00 $4,160.00 20% off $1,711.05 $4,940.00 $2,061.35 2026-05-18
44157 HCPCS Removal Of Large Bowel And Rectum With Attachment Of Small Bowel To Anus 24 24 $5,100.00 $4,080.00 20% off $1,755.98 $4,869.00 $2,058.53 2026-05-18
01243242 CDM Operating Room Services - General Classification 20 20 $5,066.71 $4,053.37 $2,077.35 $4,813.37 $2,337.02 2026-05-18
01243256 CDM Operating Room Services - General Classification 20 20 $5,066.71 $4,053.37 $2,077.35 $4,813.37 $2,337.02 2026-05-18
01243266 CDM Operating Room Services - General Classification 20 20 $5,066.71 $4,053.37 $2,077.35 $4,813.37 $2,337.02 2026-05-18
01243248 CDM Operating Room Services - General Classification 20 20 $5,066.71 $4,053.37 $2,077.35 $4,813.37 $2,337.02 2026-05-18
44151 HCPCS Removal Of Large Bowel With Creation Of Small Bowel Opening To Skin Through Abdo… 24 24 $5,000.00 $4,000.00 20% off $1,135.92 $4,792.00 $2,022.83 2026-05-18
04010984 CDM Invega Sustenna 156 Mg/ml Syrg 20 20 $5,004.50 $4,003.60 20% off $2,051.85 $4,754.28 $2,308.33 2026-05-18
04011250 CDM Invega Sustenna 234 Mg/1.5ml S 20 20 $5,004.35 $4,003.48 20% off $2,051.78 $4,754.13 $2,308.26 2026-05-18
59510 HCPCS Cesarean Delivery With Care Before And After Delivery 24 24 $3,876.00 $3,100.80 $1,550.40 $4,754.03 $2,585.68 2026-05-18
04011200 CDM Invega Sustenna 117mg/0.75ml 20 20 $5,004.05 $4,003.24 20% off $2,051.66 $4,753.85 $2,308.12 2026-05-18
44155 HCPCS Removal Of Large Bowel And Rectum And Creation Of Opening From End Of Small Bowe… 24 24 $5,000.00 $4,000.00 20% off $1,431.46 $4,750.00 $1,990.75 2026-05-18
44212 HCPCS Removal Of Large Bowel And Rectum With Creation Of Opening From Small Bowel To S… 24 24 $5,000.00 $4,000.00 20% off $1,597.48 $4,750.00 $1,974.86 2026-05-18
01243253 CDM Operating Room Services - General Classification 20 20 $4,935.74 $3,948.59 20% off $2,023.65 $4,688.95 $2,276.61 2026-05-18
01243244 CDM Operating Room Services - General Classification 20 20 $4,935.74 $3,948.59 20% off $2,023.65 $4,688.95 $2,276.61 2026-05-18
01243237 CDM Operating Room Services - General Classification 20 20 $4,935.74 $3,948.59 20% off $2,023.65 $4,688.95 $2,276.61 2026-05-18
01243250 CDM Operating Room Services - General Classification 20 20 $4,935.74 $3,948.59 20% off $2,023.65 $4,688.95 $2,276.61 2026-05-18
01243240 CDM Operating Room Services - General Classification 20 20 $4,935.74 $3,948.59 20% off $2,023.65 $4,688.95 $2,276.61 2026-05-18
04010670 CDM Dacogen 50mg Vial 20 20 $4,806.75 $3,845.40 20% off $1,970.77 $4,566.41 $2,217.11 2026-05-18
C1771 HCPCS Repair Device, Urinary, Incontinence, With Sling Graft 40 20 $4,124.78 $3,299.83 $1,429.58 $4,524.66 $2,094.99 2026-05-18
01201012 CDM Operating Room Services - General Classification 20 20 $4,745.79 $3,796.63 20% off $1,945.77 $4,508.50 $2,188.99 2026-05-18
04009912 CDM Prolia 60 Mg/ml Syringe 20 20 $4,725.60 $3,780.48 20% off $1,937.50 $4,489.32 $2,179.69 2026-05-18
70553 HCPCS MRI Scan Of Brain Before And After Contrast 23 23 $4,719.99 $3,775.99 20% off $356.43 $4,483.99 $2,124.00 2026-05-18
04011378 CDM Dalvance 500mg Vial 20 20 $4,696.65 $3,757.32 $1,925.63 $4,461.82 $2,166.33 2026-05-18
01243239 CDM Operating Room Services - General Classification 20 20 $4,619.64 $3,695.71 20% off $1,894.05 $4,388.66 $2,130.80 2026-05-18
01243236 CDM Operating Room Services - General Classification 20 20 $4,619.64 $3,695.71 20% off $1,894.05 $4,388.66 $2,130.80 2026-05-18
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 23 23 $4,570.59 $3,656.47 20% off $356.43 $4,342.06 $2,056.77 2026-05-18
01243247 CDM Operating Room Services - General Classification 20 20 $4,539.97 $3,631.98 $1,861.39 $4,312.97 $2,094.07 2026-05-18
01243241 CDM Operating Room Services - General Classification 20 20 $4,539.97 $3,631.98 $1,861.39 $4,312.97 $2,094.07 2026-05-18
59400 HCPCS Vaginal Delivery With Care Before And After Delivery 24 24 $3,486.00 $2,788.80 $1,394.40 $4,305.28 $2,338.73 2026-05-18
04011414 CDM Privigen 10% 20gm Vial 20 20 $4,531.35 $3,625.08 20% off $1,857.85 $4,304.78 $2,090.09 2026-05-18
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 46 23 $4,330.60 $3,464.48 $356.43 $4,296.81 $1,897.74 2026-05-18
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 23 23 $4,521.54 $3,617.23 20% off $356.43 $4,295.46 $2,034.69 2026-05-18
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 23 23 $4,519.27 $3,615.42 $356.43 $4,293.31 $2,033.67 2026-05-18
44150 HCPCS Removal Of Large Bowel With Attachment Of Small Bowel To Rectum Or Creation Of O… 24 24 $4,500.00 $3,600.00 20% off $1,256.02 $4,275.00 $1,790.95 2026-05-18
01201011 CDM Operating Room Services - General Classification 20 20 $4,498.30 $3,598.64 20% off $1,844.30 $4,273.39 $2,074.84 2026-05-18
19083 HCPCS Biopsy Of Breast And Placement Of Locating Device Using Ultrasound, First Growth 97 24 $2,239.60 $1,791.68 $122.19 $4,255.24 $1,687.37 2026-05-18
04011474 CDM Monovisc 88 Mg/4 Ml Syringe 20 20 $4,365.00 $3,492.00 20% off $1,789.65 $4,146.75 $2,013.36 2026-05-18
04011628 CDM Vivitrol 380 Mg Vial-diluent 20 20 $4,333.40 $3,466.72 20% off $1,776.69 $4,116.73 $1,998.78 2026-05-18
04009678 CDM Antizol 1g/ml Inj 1.5ml Sdv 20 20 $4,320.00 $3,456.00 20% off $1,771.20 $4,104.00 $1,992.60 2026-05-18
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 23 23 $4,297.86 $3,438.29 $356.43 $4,082.97 $1,934.04 2026-05-18
01200033 CDM Essure (non Surgical Steril) 20 20 $4,293.90 $3,435.12 $1,760.50 $4,079.21 $1,980.56 2026-05-18
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 23 23 $4,248.54 $3,398.83 20% off $356.43 $4,036.11 $1,911.84 2026-05-18
44141 HCPCS Partial Removal Of Large Bowel With Creation Of Opening To Skin 24 24 $2,500.00 $2,000.00 20% off $1,000.00 $4,034.00 $1,708.16 2026-05-18
27132 HCPCS Total Hip Replacement After Previous Hip Surgery 24 24 $3,900.00 $3,120.00 20% off $1,355.45 $4,017.00 $2,001.10 2026-05-18
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 23 23 $4,220.47 $3,376.38 $356.43 $4,009.45 $1,899.21 2026-05-18
04010260 CDM Forteo 560 Mcg/2.24 Ml Pen Inj 20 20 $4,203.25 $3,362.60 20% off $1,723.33 $3,993.09 $1,938.75 2026-05-18
44210 HCPCS Removal Of Large Bowel With Attachment Of Small Bowel To Rectum Or Creation Of S… 24 24 $4,200.00 $3,360.00 20% off $1,375.70 $3,990.00 $1,689.22 2026-05-18
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 23 23 $4,091.75 $3,273.40 20% off $356.43 $3,887.16 $1,841.29 2026-05-18
77049 HCPCS MRI Scan Of Both Breasts 23 23 $4,048.95 $3,239.16 20% off $314.41 $3,846.50 $1,822.03 2026-05-18
73220 HCPCS MRI Scan Of Arm Before And After Contrast 46 23 $4,045.26 $3,236.21 $356.43 $3,843.00 $1,820.37 2026-05-18
01200725 CDM Breast Tissue Expander 20 20 $4,001.03 $3,200.82 20% off $1,640.42 $3,800.98 $1,845.47 2026-05-18
04010608 CDM Lupron Depot 3.75 Mg Kit 20 20 $4,000.00 $3,200.00 20% off $1,640.00 $3,800.00 $1,845.00 2026-05-18
04011546 CDM Zyprexa Relprevv 405 Mg Vl Kit 20 20 $4,000.00 $3,200.00 20% off $1,640.00 $3,800.00 $1,845.00 2026-05-18
04007298 CDM Remicade 100 Mg Vial 20 20 $4,000.00 $3,200.00 20% off $1,640.00 $3,800.00 $1,845.00 2026-05-18
04010844 CDM Interferon 2b 20 20 $4,000.00 $3,200.00 20% off $1,640.00 $3,800.00 $1,845.00 2026-05-18
04011104 CDM Actemra 200mg/10ml Vial 20 20 $4,000.00 $3,200.00 20% off $1,640.00 $3,800.00 $1,845.00 2026-05-18
04011586 CDM Xolair 150 Mg/ml Syringe 20 20 $4,000.00 $3,200.00 20% off $1,640.00 $3,800.00 $1,845.00 2026-05-18
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 23 23 $3,993.95 $3,195.16 20% off $356.43 $3,794.25 $1,797.28 2026-05-18
C5273 HCPCS Application Of Low Cost Skin Substitute Graft To Trunk, Arms, Legs, Total Wound … 14 14 $3,671.03 $2,936.82 20% off $47.00 $3,781.16 $2,477.94 2026-05-18
01201010 CDM Operating Room Services - General Classification 20 20 $3,946.04 $3,156.83 20% off $1,617.88 $3,748.74 $1,820.11 2026-05-18
01243235 CDM Operating Room Services - General Classification 20 20 $3,946.04 $3,156.83 20% off $1,617.88 $3,748.74 $1,820.11 2026-05-18
01243238 CDM Operating Room Services - General Classification 20 20 $3,946.04 $3,156.83 20% off $1,617.88 $3,748.74 $1,820.11 2026-05-18
04010368 CDM Orencia 250mg Inj Vial 20 20 $3,942.70 $3,154.16 20% off $1,616.51 $3,745.57 $1,818.57 2026-05-18
04011810 CDM Euflexxa 1% 20 Mg/2 Ml Syringe 20 20 $3,913.70 $3,130.96 $1,604.62 $3,718.02 $1,805.20 2026-05-18
75989 HCPCS Review By Radiologist Of Image For Drainage Of Fluid 23 23 $3,868.92 $3,095.14 $104.73 $3,675.47 $1,741.01 2026-05-18
71550 HCPCS MRI Scan Of Chest Without Contrast 23 23 $3,821.02 $3,056.82 $243.77 $3,629.97 $1,719.46 2026-05-18
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 41 22 $3,594.50 $2,875.60 20% off $877.34 $3,591.72 $1,701.34 2026-05-18
04011046 CDM Orbactiv 400mg Vial 20 20 $3,752.10 $3,001.68 20% off $1,538.36 $3,564.50 $1,730.65 2026-05-18
01200735 CDM Foot (subtalar Mba Implant) 20 20 $3,715.84 $2,972.67 20% off $1,523.49 $3,530.05 $1,713.93 2026-05-18
15734 HCPCS Creation Of Muscle Graft To Trunk 24 24 $3,000.00 $2,400.00 20% off $1,200.00 $3,349.00 $1,706.80 2026-05-18
0707T OTHER Injection Of Bone-substitute Material Into Defect Of Bone Using Imaging Guidance… 10 10 $3,244.00 $2,595.20 20% off $1,297.60 $3,341.32 $2,676.30 2026-05-18
44799 HCPCS Other Procedure On Small Bowel 14 14 $2,540.00 $2,032.00 20% off $47.00 $2,616.20 $1,714.50 2026-05-18
49655 HCPCS Laparoscopy, Surgical, Repair, Incisional Hernia (includes Mesh Insertion, When … 16 16 $2,300.00 $1,840.00 20% off $47.00 $2,369.00 $1,978.00 2026-05-18
477 MS_DRG Biopsies Of Musculoskeletal System And Connective Tissue With Mcc 11 11 $2,465.03 $1,972.02 20% off $1,306.47 $2,341.78 $1,922.72 2026-05-18
49656 HCPCS Laparoscopy, Surgical, Repair, Recurrent Incisional Hernia (includes Mesh Insert… 16 16 $2,100.00 $1,680.00 20% off $47.00 $2,163.00 $1,746.90 2026-05-18
49561 HCPCS Repair Initial Incisional Or Ventral Hernia; Incarcerated Or Strangulated 23 16 $1,944.00 $1,555.20 20% off $47.00 $2,079.00 $1,767.00 2026-05-18
00900001 CDM Intensive Care Unit - General Classification 14 14 $2,182.68 $1,746.14 20% off $1,156.82 $2,073.55 $1,769.72 2026-05-18
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