Hospital

HANSEN FAMILY HOSPITAL

Iowa Falls, IA · CCN 161380 · Rates published

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You selected 93350 (HCPCS)

Ultrasound of heart during rest, exercise and/or drug-induced stress with report

This hospital’s price: $995 across 18 payers · range $779-$1,698

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbEMHIOWAFALLSIA&type=CDMWithoutLabel&fileType=CSV · observed 2026-07-10

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.

2,458 distinct procedures filed

20 distinct payers

68,516 rate rows

2026-07-10 last MRF observed

Data quality

67,534 of 68,516 rate rows are consumer-grade (98.6%)

982 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 — reason	Rows
per-diem day rate — not a per-procedure price	384
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	348
exceeds 10× this hospital's gross charge — excluded from medians	162
percent-of-charges filed in the dollar field — excluded from medians	64
exceeds 3× this hospital's gross charge for a DRG stay — excluded	22
placeholder amount (≤ $0.02) — excluded from medians	2

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbEMHIOWAFALLSIA&type=CDMWithoutLabel&fileType=CSV
Found on page	https://apps.para-hcfs.com/PTT/FinalLinks/Hansen_Family_Hospital.aspx
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-10-17
Content fingerprint	69242e72ebd3f6c6… · 30,803,142 bytes · first seen 2026-07-31

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
91 MS_DRG	Other Disorders Of Nervous System With Mcc	8	$22,173.54	$131,543.25	$127,842.54	nat. median $17,070 outlier · 7.5×
565 MS_DRG	Other Musculoskeletal System And Connective Tissue Diagnoses With Cc	8	$17,190.02	$85,190.95	$82,771.26	nat. median $10,106 outlier · 8.2×
300 MS_DRG	Peripheral Vascular Disorders With Cc	7	$16,020.45	$83,144.43	$81,531.30	nat. median $10,846 outlier · 7.5×
560 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Cc	7	$23,953.59	$74,701.71	$73,278.36	nat. median $11,478 outlier · 6.4×
561 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc	7	$21,493.33	$63,845.90	$62,612.33	nat. median $8,661 outlier · 7.2×
539 MS_DRG	Osteomyelitis With Mcc	7	$18,344.01	$55,943.53	$54,994.63	nat. median $18,853 outlier · 2.9×
394 MS_DRG	Other Digestive System Diagnoses With Cc	8	$13,087.96	$55,236.00	$53,812.65	nat. median $9,688 outlier · 5.6×
949 MS_DRG	Aftercare With Cc/mcc	8	$17,258.54	$47,876.82	$46,595.81	nat. median $11,791 outlier · 4.0×
689 MS_DRG	Kidney And Urinary Tract Infections With Mcc	8	$16,411.34	$46,949.15	$45,668.14	nat. median $11,515 outlier · 4.0×
947 MS_DRG	Signs And Symptoms With Mcc	8	$13,919.59	$46,940.81	$45,659.79	nat. median $12,113 outlier · 3.8×
566 MS_DRG	Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/mcc	6	$9,829.99	$82,320.85	$45,259.86	nat. median $7,961 outlier · 5.7×
56 MS_DRG	Degenerative Nervous System Disorders With Mcc	5	$40,450.58	$120,242.91	$42,068.61	nat. median $21,152 2.0× median
388 MS_DRG	Gastrointestinal Obstruction With Mcc	8	$15,587.51	$40,410.85	$39,414.51	nat. median $14,325 outlier · 2.8×
602 MS_DRG	Cellulitis With Mcc	6	$19,772.10	$58,689.98	$38,993.88	nat. median $14,036 outlier · 2.8×
380 MS_DRG	Complicated Peptic Ulcer With Mcc	8	$16,968.20	$36,895.10	$36,041.09	nat. median $18,519 1.9× median
563 MS_DRG	Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit…	8	$12,169.13	$36,221.05	$35,224.71	nat. median $9,158 outlier · 3.8×
194 MS_DRG	Simple Pneumonia And Pleurisy With Cc	8	$12,335.76	$35,865.98	$35,011.97	nat. median $8,522 outlier · 4.1×
872 MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	8	$13,397.87	$31,522.34	$30,810.67	nat. median $10,410 outlier · 3.0×
177 MS_DRG	Respiratory Infections And Inflammations With Mcc	8	$14,892.04	$31,497.79	$30,786.11	nat. median $15,405 2.0× median
64 MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	8	$14,772.08	$31,377.83	$30,666.15	nat. median $19,268 1.6× median
184 MS_DRG	Major Chest Trauma With Cc	8	$9,494.35	$26,100.10	$25,388.42	nat. median $10,707 outlier · 2.4×
948 MS_DRG	Signs And Symptoms Without Mcc	6	$10,410.88	$38,745.09	$24,533.16	nat. median $7,971 outlier · 3.1×
698 MS_DRG	Other Kidney And Urinary Tract Diagnoses With Mcc	8	$11,611.85	$24,896.45	$24,327.11	nat. median $15,915 1.5× median
871 MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	3	$16,670.10	$25,062.36	$24,098.42	nat. median $18,659 1.3× median
559 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Mcc	3	$10,920.78	$24,911.73	$23,953.59	nat. median $18,115 1.3× median
291 MS_DRG	Heart Failure And Shock With Mcc	8	$10,865.37	$24,149.97	$23,580.63	nat. median $12,775 1.8× median
392 MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	8	$10,192.85	$23,906.74	$23,337.40	nat. median $8,186 outlier · 2.9×
390 MS_DRG	Gastrointestinal Obstruction Without Cc/mcc	7	$7,886.42	$23,803.28	$23,170.68	nat. median $6,125 outlier · 3.8×
690 MS_DRG	Kidney And Urinary Tract Infections Without Mcc	6	$11,770.44	$33,435.05	$22,458.60	nat. median $8,379 outlier · 2.7×
897 MS_DRG	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	8	$9,520.75	$22,805.35	$22,236.01	nat. median $8,362 outlier · 2.7×
603 MS_DRG	Cellulitis Without Mcc	8	$9,350.20	$22,634.80	$22,065.46	nat. median $8,991 outlier · 2.5×
433 MS_DRG	Cirrhosis And Alcoholic Hepatitis With Cc	7	$8,154.55	$21,186.11	$20,806.55	nat. median $10,769 1.9× median
682 MS_DRG	Renal Failure With Mcc	3	$14,712.82	$21,361.47	$20,539.88	nat. median $14,443 1.4× median
299 MS_DRG	Peripheral Vascular Disorders With Mcc	3	$19,700.46	$20,488.48	$20,094.47	nat. median $15,769 1.3× median
175 MS_DRG	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	8	$7,082.05	$20,366.65	$19,797.31	nat. median $13,735 1.4× median
552 MS_DRG	Medical Back Problems Without Mcc	6	$11,841.27	$25,125.87	$19,212.82	nat. median $9,833 2.0× median
371 MS_DRG	Major Gastrointestinal Disorders And Peritoneal Infections With Mcc	8	$9,466.47	$20,420.46	$19,192.69	nat. median $16,931 1.1× median
557 MS_DRG	Tendonitis, Myositis And Bursitis With Mcc	6	$12,338.13	$25,369.69	$19,127.60	nat. median $14,502 1.3× median
551 MS_DRG	Medical Back Problems With Mcc	3	$18,219.98	$19,515.08	$18,764.50	nat. median $16,106 1.2× median
71 MS_DRG	Other Cerebrovascular Disorders With Cc	3	$18,320.65	$19,053.48	$18,687.07	nat. median $10,562 1.8× median
J3245 HCPCS	Injection, Tildrakizumab, 1 Mg	16	$15,711.02	$34,228.80	$18,534.89	nat. median $256 outlier · 72.3×
8613520 CDM	Pharmacy Added From Trans - Tildrakizumab 100 Mg / 1 Ml Soln Subcutaneous On Cal…	16	$15,711.02	$34,228.80	$18,534.89	nat. median $18,535 1.0× median
59 MS_DRG	Multiple Sclerosis And Cerebellar Ataxia With Cc	3	$8,173.25	$18,897.99	$18,171.15	nat. median $12,349 1.5× median
389 MS_DRG	Gastrointestinal Obstruction With Cc	8	$7,696.72	$17,660.17	$17,233.17	nat. median $8,347 outlier · 2.1×
100 MS_DRG	Seizures With Mcc	3	$9,218.07	$17,827.41	$17,141.74	nat. median $18,371 0.9× median
193 MS_DRG	Simple Pneumonia And Pleurisy With Mcc	3	$13,999.92	$17,751.29	$17,068.55	nat. median $12,877 1.3× median
964 MS_DRG	Other Multiple Significant Trauma With Cc	3	$7,005.75	$17,652.49	$16,973.55	nat. median $14,949 1.1× median
440 MS_DRG	Disorders Of Pancreas Except Malignancy Without Cc/mcc	8	$7,198.90	$17,162.35	$16,735.35	nat. median $6,865 outlier · 2.4×
J3380 HCPCS	Injection, Vedolizumab, Intravenous, 1 Mg	18	$15,653.08	$34,102.57	$16,710.26	nat. median $155 outlier · 108.1×
J1930 HCPCS	Injection, Lanreotide, 1 Mg	18	$12,114.02	$34,930.48	$16,288.08	nat. median $5,088 outlier · 3.2×

Other procedures at this hospital

Browse this hospital's 2,458 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

91	MS_DRG	Other Disorders Of Nervous System With Mcc	8	8	$45,193.35	$45,193.35	$22,173.54	$131,543.25	$127,842.54	2026-07-10
565	MS_DRG	Other Musculoskeletal System And Connective Tissue Diagnoses With Cc	8	8	$28,731.40	$28,731.40	$17,190.02	$85,190.95	$82,771.26	2026-07-10
300	MS_DRG	Peripheral Vascular Disorders With Cc	7	7	$27,760.30	$27,760.30	$16,020.45	$83,144.43	$81,531.30	2026-07-10
560	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Cc	7	7	$25,833.36	$25,833.36	$23,953.59	$74,701.71	$73,278.36	2026-07-10
561	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc	7	7	$21,493.33	$21,493.33	$21,493.33	$63,845.90	$62,612.33	2026-07-10
539	MS_DRG	Osteomyelitis With Mcc	7	7	$23,364.63	$23,364.63	$18,344.01	$55,943.53	$54,994.63	2026-07-10
394	MS_DRG	Other Digestive System Diagnoses With Cc	8	8	$22,024.50	$22,024.50	$13,087.96	$55,236.00	$53,812.65	2026-07-10
949	MS_DRG	Aftercare With Cc/mcc	8	8	$17,986.47	$17,986.47	$17,258.54	$47,876.82	$46,595.81	2026-07-10
689	MS_DRG	Kidney And Urinary Tract Infections With Mcc	8	8	$17,058.80	$17,058.80	$16,411.34	$46,949.15	$45,668.14	2026-07-10
947	MS_DRG	Signs And Symptoms With Mcc	8	8	$17,050.46	$17,050.46	$13,919.59	$46,940.81	$45,659.79	2026-07-10
566	MS_DRG	Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/mcc	6	6	$29,182.45	$29,182.45	$9,829.99	$82,320.85	$45,259.86	2026-07-10
56	MS_DRG	Degenerative Nervous System Disorders With Mcc	5	5	$42,053.55	$42,053.55	$40,450.58	$120,242.91	$42,068.61	2026-07-10
388	MS_DRG	Gastrointestinal Obstruction With Mcc	8	8	$17,162.80	$17,162.80	$15,587.51	$40,410.85	$39,414.51	2026-07-10
602	MS_DRG	Cellulitis With Mcc	6	6	$25,478.48	$25,478.48	$19,772.10	$58,689.98	$38,993.88	2026-07-10
380	MS_DRG	Complicated Peptic Ulcer With Mcc	8	8	$16,968.20	$16,968.20	$16,968.20	$36,895.10	$36,041.09	2026-07-10
563	MS_DRG	Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit…	8	8	$12,973.00	$12,973.00	$12,169.13	$36,221.05	$35,224.71	2026-07-10
194	MS_DRG	Simple Pneumonia And Pleurisy With Cc	8	8	$15,939.08	$15,939.08	$12,335.76	$35,865.98	$35,011.97	2026-07-10
872	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	8	8	$14,916.59	$14,916.59	$13,397.87	$31,522.34	$30,810.67	2026-07-10
177	MS_DRG	Respiratory Infections And Inflammations With Mcc	8	8	$14,892.04	$14,892.04	$14,892.04	$31,497.79	$30,786.11	2026-07-10
64	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	8	8	$14,772.08	$14,772.08	$14,772.08	$31,377.83	$30,666.15	2026-07-10
184	MS_DRG	Major Chest Trauma With Cc	8	8	$9,494.35	$9,494.35	$9,494.35	$26,100.10	$25,388.42	2026-07-10
948	MS_DRG	Signs And Symptoms Without Mcc	6	6	$12,935.01	$12,935.01	$10,410.88	$38,745.09	$24,533.16	2026-07-10
698	MS_DRG	Other Kidney And Urinary Tract Diagnoses With Mcc	8	8	$11,611.85	$11,611.85	$11,611.85	$24,896.45	$24,327.11	2026-07-10
871	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	3	3	$16,670.10	$16,670.10	$16,670.10	$25,062.36	$24,098.42	2026-07-10
559	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Mcc	3	3	$10,920.78	$10,920.78	$10,920.78	$24,911.73	$23,953.59	2026-07-10
291	MS_DRG	Heart Failure And Shock With Mcc	8	8	$10,865.37	$10,865.37	$10,865.37	$24,149.97	$23,580.63	2026-07-10
392	MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	8	8	$10,622.14	$10,622.14	$10,192.85	$23,906.74	$23,337.40	2026-07-10
390	MS_DRG	Gastrointestinal Obstruction Without Cc/mcc	7	7	$10,518.68	$10,518.68	$7,886.42	$23,803.28	$23,170.68	2026-07-10
690	MS_DRG	Kidney And Urinary Tract Infections Without Mcc	6	6	$13,508.15	$13,508.15	$11,770.44	$33,435.05	$22,458.60	2026-07-10
897	MS_DRG	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	8	8	$9,520.75	$9,520.75	$9,520.75	$22,805.35	$22,236.01	2026-07-10
603	MS_DRG	Cellulitis Without Mcc	8	8	$9,350.20	$9,350.20	$9,350.20	$22,634.80	$22,065.46	2026-07-10
433	MS_DRG	Cirrhosis And Alcoholic Hepatitis With Cc	7	7	$8,154.55	$8,154.55	$8,154.55	$21,186.11	$20,806.55	2026-07-10
682	MS_DRG	Renal Failure With Mcc	3	3	$14,712.82	$14,712.82	$14,712.82	$21,361.47	$20,539.88	2026-07-10
299	MS_DRG	Peripheral Vascular Disorders With Mcc	3	3	$25,930.60	$25,930.60	$19,700.46	$20,488.48	$20,094.47	2026-07-10
175	MS_DRG	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	8	8	$7,082.05	$7,082.05	$7,082.05	$20,366.65	$19,797.31	2026-07-10
552	MS_DRG	Medical Back Problems Without Mcc	6	6	$11,841.27	$11,841.27	$11,841.27	$25,125.87	$19,212.82	2026-07-10
371	MS_DRG	Major Gastrointestinal Disorders And Peritoneal Infections With Mcc	8	8	$9,466.47	$9,466.47	$9,466.47	$20,420.46	$19,192.69	2026-07-10
557	MS_DRG	Tendonitis, Myositis And Bursitis With Mcc	6	6	$12,338.13	$12,338.13	$12,338.13	$25,369.69	$19,127.60	2026-07-10
551	MS_DRG	Medical Back Problems With Mcc	3	3	$18,219.98	$18,219.98	$18,219.98	$19,515.08	$18,764.50	2026-07-10
71	MS_DRG	Other Cerebrovascular Disorders With Cc	3	3	$56,170.15	$56,170.15	$18,320.65	$19,053.48	$18,687.07	2026-07-10
J3245	HCPCS	Injection, Tildrakizumab, 1 Mg	16	16	$34,228.80	$34,228.80	$15,711.02	$34,228.80	$18,534.89	2026-07-10
8613520	CDM	Pharmacy Added From Trans - Tildrakizumab 100 Mg / 1 Ml Soln Subcutaneous On Cal…	16	16	$34,228.80	$34,228.80	$15,711.02	$34,228.80	$18,534.89	2026-07-10
59	MS_DRG	Multiple Sclerosis And Cerebellar Ataxia With Cc	3	3	$8,173.25	$8,173.25	$8,173.25	$18,897.99	$18,171.15	2026-07-10
389	MS_DRG	Gastrointestinal Obstruction With Cc	8	8	$7,696.72	$7,696.72	$7,696.72	$17,660.17	$17,233.17	2026-07-10
100	MS_DRG	Seizures With Mcc	3	3	$9,218.07	$9,218.07	$9,218.07	$17,827.41	$17,141.74	2026-07-10
193	MS_DRG	Simple Pneumonia And Pleurisy With Mcc	3	3	$13,999.92	$13,999.92	$13,999.92	$17,751.29	$17,068.55	2026-07-10
964	MS_DRG	Other Multiple Significant Trauma With Cc	3	3	$7,005.75	$7,005.75	$7,005.75	$17,652.49	$16,973.55	2026-07-10
440	MS_DRG	Disorders Of Pancreas Except Malignancy Without Cc/mcc	8	8	$7,198.90	$7,198.90	$7,198.90	$17,162.35	$16,735.35	2026-07-10
J3380	HCPCS	Injection, Vedolizumab, Intravenous, 1 Mg	18	18	$34,102.57	$34,102.57	$15,653.08	$34,102.57	$16,710.26	2026-07-10
J1930	HCPCS	Injection, Lanreotide, 1 Mg	54	18	$29,124.68	$29,124.68	$12,114.02	$34,930.48	$16,288.08	2026-07-10
65	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	3	3	$10,833.13	$10,833.13	$10,833.13	$16,165.66	$15,543.90	2026-07-10
683	MS_DRG	Renal Failure With Cc	8	8	$5,890.85	$5,890.85	$5,890.85	$15,854.30	$15,427.30	2026-07-10
J0896	HCPCS	Injection, Luspatercept-aamt, 0.25 Mg	32	16	$25,176.57	$25,176.57	$5,806.67	$37,702.45	$14,978.06	2026-07-10
Q4197	HCPCS	Puraply Xt, Per Square Centimeter	36	18	$23,700.00	$23,700.00	$6,885.00	$32,400.00	$14,887.80	2026-07-10
189	MS_DRG	Pulmonary Edema And Respiratory Failure	3	3	$7,068.60	$7,068.60	$7,068.60	$14,516.86	$13,958.52	2026-07-10
J3101	HCPCS	Injection, Tenecteplase, 1 Mg	16	16	$25,546.53	$25,546.53	$11,725.86	$25,546.53	$13,833.44	2026-07-10
638	MS_DRG	Diabetes With Cc	4	4	$19,835.56	$19,835.56	$11,533.73	$39,762.46	$11,879.74	2026-07-10
439	MS_DRG	Disorders Of Pancreas Except Malignancy With Cc	8	8	$4,833.30	$4,833.30	$4,833.30	$13,601.76	$11,317.45	2026-07-10
980152	CDM	Pharmacy Added From Trans - Golimumab + Sodium Chloride 0.9% Intravenous Solutio…	16	16	$19,819.22	$19,819.22	$9,097.02	$19,819.22	$10,732.10	2026-07-10
72	MS_DRG	Other Cerebrovascular Disorders Without Cc/mcc	3	3	$10,685.60	$10,685.60	$10,487.19	$10,906.68	$10,685.60	2026-07-10
176	MS_DRG	Pulmonary Embolism Without Mcc	3	3	$17,927.50	$17,927.50	$10,417.11	$10,833.79	$10,625.45	2026-07-10
558	MS_DRG	Tendonitis, Myositis And Bursitis Without Mcc	5	5	$8,158.65	$8,158.65	$8,158.65	$17,837.43	$10,304.17	2026-07-10
693589	CDM	Pharmacy Added From Trans - Abatacept + Sodium Chloride 0.9% Intravenous Solutio…	16	16	$18,441.29	$18,441.29	$8,464.55	$18,441.29	$9,985.95	2026-07-10
101	MS_DRG	Seizures Without Mcc	3	3	$6,710.60	$6,710.60	$6,710.60	$10,195.65	$9,803.51	2026-07-10
J2997	HCPCS	Injection, Alteplase Recombinant, 1 Mg	50	18	$15,648.76	$15,648.76	$313.46	$31,036.95	$9,389.26	2026-07-10
J2353	HCPCS	Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg	50	18	$14,838.78	$14,838.78	$5,534.98	$21,769.09	$8,889.26	2026-07-10
J2506	HCPCS	Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg	16	16	$15,136.67	$15,136.67	$6,947.73	$15,136.67	$8,196.51	2026-07-10
8958177	CDM	Flexband Twist	16	16	$14,987.50	$14,987.50	$6,879.26	$14,987.50	$8,115.73	2026-07-10
Q5111	HCPCS	Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg	16	16	$14,697.62	$14,697.62	$6,746.21	$14,697.62	$7,958.76	2026-07-10
J9312	HCPCS	Injection, Rituximab, 10 Mg	16	16	$14,617.98	$14,617.98	$6,709.65	$14,617.98	$7,915.64	2026-07-10
8834289	CDM	Viaflow 2.0cc	16	16	$14,055.00	$14,055.00	$6,451.25	$14,055.00	$7,610.78	2026-07-10
Q5120	HCPCS	Injection, Pegfilgrastim-bmez (ziextenzo), Biosimilar, 0.5 Mg	16	16	$13,821.34	$13,821.34	$6,344.00	$13,821.34	$7,484.25	2026-07-10
Q5122	HCPCS	Injection, Pegfilgrastim-apgf (nyvepria), Biosimilar, 0.5 Mg	16	16	$13,819.47	$13,819.47	$6,343.14	$13,819.47	$7,483.24	2026-07-10
544	MS_DRG	Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With…	5	5	$5,420.90	$5,420.90	$5,420.90	$15,194.57	$7,482.75	2026-07-10
951	MS_DRG	Other Factors Influencing Health Status	3	3	$4,400.73	$4,400.73	$4,400.73	$7,411.49	$7,126.43	2026-07-10
980212	CDM	Pharmacy Added From Trans - Immune Globulin Intravenous And Subcutaneous + Sodiu…	16	16	$13,120.89	$13,120.89	$6,022.49	$13,120.89	$7,104.96	2026-07-10
V2790	HCPCS	Amniotic Membrane For Surgical Reconstruction, Per Procedure	32	16	$11,918.00	$11,918.00	$4,010.74	$15,098.00	$6,937.53	2026-07-10
J0565	HCPCS	Injection, Bezlotoxumab, 10 Mg	18	18	$13,956.80	$13,956.80	$6,406.17	$13,956.80	$6,838.83	2026-07-10
8950019	CDM	Lapidus Plate - Standard Ortholoc 2 Lapifuse	16	16	$12,235.00	$12,235.00	$5,615.87	$12,235.00	$6,625.26	2026-07-10
8822004	CDM	Flexband Solo Kit	16	16	$11,985.00	$11,985.00	$5,501.12	$11,985.00	$6,489.88	2026-07-10
C1763	HCPCS	Connective Tissue, Non-human (includes Synthetic)	16	16	$11,187.50	$11,187.50	$5,135.06	$11,187.50	$6,058.03	2026-07-10
8831742	CDM	Lapidus Plate - Crosscheck Lap Screw	16	16	$10,716.00	$10,716.00	$4,918.64	$10,716.00	$5,802.72	2026-07-10
728	MS_DRG	Inflammation Of The Male Reproductive System Without Mcc	6	6	$2,417.45	$2,417.45	$2,417.45	$5,738.60	$5,627.90	2026-07-10
8857758	CDM	Flexband 0.7 X 32 Cm	16	16	$10,185.00	$10,185.00	$4,674.92	$10,185.00	$5,515.18	2026-07-10
J2407	HCPCS	Injection, Oritavancin (orbactiv), 10 Mg	16	16	$10,025.38	$10,025.38	$4,601.65	$10,025.38	$5,428.74	2026-07-10
8754539	CDM	Pharmacy Added From Trans - Romosozumab 210 Mg / 2.34 Ml Soln Subcutaneous *qMon…	16	16	$9,601.80	$9,601.80	$4,407.23	$9,601.80	$5,199.38	2026-07-10
Q4159	HCPCS	Affinity, Per Square Centimeter	54	18	$10,353.00	$10,353.00	$619.65	$11,592.00	$5,072.97	2026-07-10
Q5115	HCPCS	Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg	16	16	$9,040.98	$9,040.98	$4,149.81	$9,040.98	$4,895.69	2026-07-10
J2357	HCPCS	Injection, Omalizumab, 5 Mg	32	16	$7,713.34	$7,713.34	$2,157.18	$10,726.93	$4,811.70	2026-07-10
602712	CDM	Pharmacy Added From Trans - inFLIXimab + Sodium Chloride 0.9% Intravenous Soluti…	16	16	$8,862.89	$8,862.89	$4,068.06	$8,862.89	$4,799.25	2026-07-10
J3111	HCPCS	Injection, Romosozumab-aqqg, 1 Mg	18	18	$9,601.77	$9,601.77	$4,407.21	$9,601.77	$4,704.87	2026-07-10
Q4195	HCPCS	Puraply, Per Square Centimeter	90	18	$8,550.00	$8,550.00	$1,241.14	$38,400.00	$4,659.75	2026-07-10
8827404	CDM	Speedbrg Imp Sys W/bio-comp Swvlk & Ndl	16	16	$8,187.00	$8,187.00	$3,757.83	$8,187.00	$4,433.26	2026-07-10
8754057	CDM	Myosure Polyp Removal Kit	16	16	$7,725.00	$7,725.00	$3,545.78	$7,725.00	$4,183.09	2026-07-10
8939523	CDM	Staple Nitinol 18 X 15 Easyfuse	16	16	$7,695.00	$7,695.00	$3,532.01	$7,695.00	$4,166.85	2026-07-10
8939525	CDM	Staple Nitinol, 18 X 20 Easyfuse	16	16	$7,695.00	$7,695.00	$3,532.01	$7,695.00	$4,166.85	2026-07-10
Q0222	HCPCS	Injection, Bebtelovimab, 175 Mg	16	16	$7,676.50	$7,676.50	$3,523.51	$7,676.50	$4,156.82	2026-07-10
J1459	HCPCS	Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui…	16	16	$7,297.20	$7,297.20	$3,349.41	$7,297.20	$3,951.43	2026-07-10
J1602	HCPCS	Injection, Golimumab, 1 Mg, For Intravenous Use	16	16	$7,143.74	$7,143.74	$3,278.98	$7,143.74	$3,868.34	2026-07-10
8873320	CDM	Staple Nitinol 10 X 10	16	16	$6,951.00	$6,951.00	$3,190.51	$6,951.00	$3,763.97	2026-07-10
8931856	CDM	Smart Toe Ii Implant	16	16	$6,837.00	$6,837.00	$3,138.18	$6,837.00	$3,702.23	2026-07-10
Q4124	HCPCS	Oasis Ultra Tri-layer Wound Matrix, Per Square Centimeter	90	18	$6,475.00	$6,475.00	$1,085.54	$26,320.00	$3,681.30	2026-07-10
8826381	CDM	Staple Nitinol 8x8	16	16	$6,762.00	$6,762.00	$3,103.76	$6,762.00	$3,661.62	2026-07-10
8939521	CDM	Staple Nitinol 12x12 Fuseforce	16	16	$6,757.50	$6,757.50	$3,101.69	$6,757.50	$3,659.18	2026-07-10
J0897	HCPCS	Injection, Denosumab, 1 Mg	48	16	$6,619.48	$6,619.48	$15.15	$9,575.82	$3,584.45	2026-07-10
J1950	HCPCS	Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg	16	16	$6,451.41	$6,451.41	$2,961.20	$6,451.41	$3,493.44	2026-07-10
Q5108	HCPCS	Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg	16	16	$6,400.86	$6,400.86	$2,937.99	$6,400.86	$3,466.07	2026-07-10
J1569	HCPCS	Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),…	34	18	$7,538.69	$7,538.69	$605.53	$7,538.69	$3,464.03	2026-07-10
52441	HCPCS	Insertion Of Implant In Urethra Within Prostate Gland Using An Endoscope, 1 Impl…	18	18	$7,052.41	$7,052.41	$3,151.50	$7,052.41	$3,437.72	2026-07-10
8826387	CDM	5th Met Y-plate	16	16	$6,201.00	$6,201.00	$2,846.26	$6,201.00	$3,357.84	2026-07-10
J2315	HCPCS	Injection, Naltrexone, Depot Form, 1 Mg	16	16	$5,970.00	$5,970.00	$2,740.23	$5,970.00	$3,232.76	2026-07-10
J9041	HCPCS	Injection, Bortezomib, 0.1 Mg	16	16	$5,959.72	$5,959.72	$2,735.51	$5,959.72	$3,227.18	2026-07-10
4898801	CDM	Esophyx Cartridge	16	16	$5,848.00	$5,848.00	$2,684.23	$5,848.00	$3,166.69	2026-07-10
4898802	CDM	Esophyx Device Kit	16	16	$5,848.00	$5,848.00	$2,684.23	$5,848.00	$3,166.69	2026-07-10
J9355	HCPCS	Injection, Trastuzumab, Excludes Biosimilar, 10 Mg	16	16	$5,795.92	$5,795.92	$2,660.33	$5,795.92	$3,138.49	2026-07-10
Q4102	HCPCS	Oasis Wound Matrix, Per Square Centimeter	36	18	$5,069.50	$5,069.50	$1,550.04	$6,762.00	$3,107.14	2026-07-10
Q5136	HCPCS	Injection, Denosumab-bbdz (jubbonti/wyost), Biosimilar, 1 Mg	16	16	$5,667.18	$5,667.18	$2,601.24	$5,667.18	$3,068.78	2026-07-10
J0875	HCPCS	Injection, Dalbavancin, 5 Mg	16	16	$5,644.43	$5,644.43	$2,590.79	$5,644.43	$3,056.46	2026-07-10
8928945	CDM	Fibulink Syndesmosis Repair Kit/ Ss	16	16	$5,376.00	$5,376.00	$2,467.58	$5,376.00	$2,911.11	2026-07-10
Q4103	HCPCS	Oasis Burn Matrix, Per Square Centimeter	90	18	$4,585.00	$4,585.00	$1,060.29	$24,500.00	$2,910.60	2026-07-10
8826377	CDM	Implant Medium Cannulated	16	16	$5,160.00	$5,160.00	$2,368.44	$5,160.00	$2,794.14	2026-07-10
5014900	CDM	Mesh Dual 18x24cm	16	16	$4,918.00	$4,918.00	$2,257.36	$4,918.00	$2,663.10	2026-07-10
J1568	HCPCS	Injection, Immune Globulin, (octagam), Intravenous, Non-lyophilized (e.g., Liqui…	16	16	$4,764.50	$4,764.50	$2,186.91	$4,764.50	$2,579.97	2026-07-10
J1306	HCPCS	Injection, Inclisiran, 1 Mg	16	16	$4,708.18	$4,708.18	$2,161.05	$4,708.18	$2,549.48	2026-07-10
J0129	HCPCS	Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere…	32	16	$4,689.17	$4,689.17	$2,064.94	$4,879.56	$2,528.05	2026-07-10
J3262	HCPCS	Injection, Tocilizumab, 1 Mg	50	18	$4,124.15	$4,124.15	$662.77	$9,361.09	$2,474.49	2026-07-10
Q4186	HCPCS	Epifix, Per Square Centimeter	216	18	$3,872.00	$3,872.00	$826.20	$27,097.00	$2,452.99	2026-07-10
95811	HCPCS	Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older)	18	18	$4,064.00	$4,064.00	$1,865.38	$4,064.00	$2,438.40	2026-07-10
9040471	CDM	G7 Osseoti 3 Hole Shell	16	16	$4,500.00	$4,500.00	$2,065.50	$4,500.00	$2,436.75	2026-07-10
8904367	CDM	Spade Two-step Hammer Toe Implant	16	16	$4,485.00	$4,485.00	$2,058.62	$4,485.00	$2,428.63	2026-07-10
Q5119	HCPCS	Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg	36	18	$4,329.00	$4,329.00	$700.53	$7,131.80	$2,399.85	2026-07-10
15273	HCPCS	Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.…	34	18	$3,445.35	$3,445.35	$1,581.42	$4,962.01	$2,325.20	2026-07-10
8829775	CDM	Posterior Stabilized Legion Femoral Component	16	16	$4,050.00	$4,050.00	$1,858.95	$4,050.00	$2,193.07	2026-07-10
Q4196	HCPCS	Puraply Am, Per Square Centimeter	126	18	$3,960.00	$3,960.00	$619.65	$15,390.00	$2,177.18	2026-07-10
74174	HCPCS	CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast	18	18	$4,499.00	$4,499.00	$737.26	$4,499.00	$2,141.97	2026-07-10
J1439	HCPCS	Injection, Ferric Carboxymaltose, 1 Mg	16	16	$3,847.95	$3,847.95	$1,766.21	$3,847.95	$2,083.66	2026-07-10
11426	HCPCS	Removal Of Noncancer Skin Growth Of Scalp, Neck, Hands, Feet, Or Genitals, More …	18	18	$3,458.25	$3,458.25	$1,587.34	$5,934.94	$2,074.95	2026-07-10
8808503	CDM	Operating Room Services - Minor Surgery	16	16	$3,763.62	$3,763.62	$1,727.50	$3,763.62	$2,038.00	2026-07-10
J0585	HCPCS	Injection, Onabotulinumtoxina, 1 Unit	34	18	$4,407.78	$4,407.78	$1,096.50	$4,407.78	$2,027.58	2026-07-10
36573	HCPCS	Insertion Of Tube For Infusion With Imaging Guidance And Review By Radiologist, …	18	18	$3,378.00	$3,378.00	$1,550.50	$3,378.00	$2,026.80	2026-07-10
15277	HCPCS	Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout…	34	18	$4,374.41	$4,374.41	$750.27	$4,374.41	$2,010.04	2026-07-10
8852062	CDM	Alloderm Tissue Graft 4x7	16	16	$3,711.00	$3,711.00	$1,703.35	$3,711.00	$2,009.51	2026-07-10
70549	HCPCS	MRI Scan Of Blood Vessels Of Neck Before And After Contrast	18	18	$4,182.00	$4,182.00	$703.64	$4,182.00	$1,991.05	2026-07-10
J0485	HCPCS	Injection, Belatacept, 1 Mg	16	16	$3,639.33	$3,639.33	$1,670.45	$3,639.33	$1,970.70	2026-07-10
95810	HCPCS	Sleep Study In Sleep Lab (6 Years Or Older)	18	18	$3,280.00	$3,280.00	$1,505.52	$3,280.00	$1,968.00	2026-07-10
74183	HCPCS	MRI Scan Of Abdomen Before And After Contrast	18	18	$4,086.00	$4,086.00	$1,091.76	$4,086.00	$1,945.35	2026-07-10
Q4160	HCPCS	Nushield, Per Square Centimeter	126	18	$3,968.00	$3,968.00	$544.37	$6,660.00	$1,917.51	2026-07-10
C1776	HCPCS	Joint Device (implantable)	384	16	$3,228.75	$3,228.75	$401.63	$11,400.00	$1,901.03	2026-07-10
44140	HCPCS	Partial Removal Of Large Bowel With Connection	15	15	$3,253.00	$3,253.00	$1,044.30	$4,166.23	$1,892.17	2026-07-10
J9394	HCPCS	Injection, Fulvestrant (fresenius Kabi) Not Therapeutically Equivalent To J9395,…	16	16	$3,472.87	$3,472.87	$1,594.05	$3,472.87	$1,880.56	2026-07-10
70548	HCPCS	MRI Scan Of Blood Vessels Of Neck With Contrast	18	18	$3,944.00	$3,944.00	$703.64	$3,944.00	$1,877.74	2026-07-10
Q4101	HCPCS	Apligraf, Per Square Centimeter	18	18	$3,828.00	$3,828.00	$1,757.05	$3,828.00	$1,875.72	2026-07-10
J0881	HCPCS	Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use)	64	16	$3,341.16	$3,341.16	$632.66	$5,344.82	$1,858.32	2026-07-10
J9395	HCPCS	Injection, Fulvestrant, 25 Mg	32	16	$3,632.85	$3,632.85	$292.03	$6,629.48	$1,839.58	2026-07-10
73223	HCPCS	MRI Scan Of Arm Joint Before And After Contrast	34	18	$3,834.00	$3,834.00	$1,091.76	$3,834.00	$1,825.37	2026-07-10
70553	HCPCS	MRI Scan Of Brain Before And After Contrast	18	18	$3,834.00	$3,834.00	$1,091.76	$3,834.00	$1,825.37	2026-07-10
70552	HCPCS	MRI Scan Of Brain With Contrast	18	18	$3,834.00	$3,834.00	$1,091.76	$3,834.00	$1,825.37	2026-07-10
72158	HCPCS	MRI Scan Of Lower Spinal Canal Before And After Contrast	18	18	$3,765.00	$3,765.00	$1,091.76	$3,765.00	$1,792.52	2026-07-10
J1745	HCPCS	Injection, Infliximab, Excludes Biosimilar, 10 Mg	32	16	$2,877.31	$2,877.31	$744.52	$4,132.56	$1,759.45	2026-07-10
6818782	CDM	Operating Room Services - Minor Surgery	16	16	$3,248.62	$3,248.62	$1,491.12	$3,248.62	$1,759.12	2026-07-10
Q4187	HCPCS	Epicord, Per Square Centimeter	72	18	$3,180.00	$3,180.00	$922.59	$9,360.00	$1,757.25	2026-07-10
72197	HCPCS	MRI Scan Of Pelvis Before And After Contrast	18	18	$3,627.00	$3,627.00	$1,091.76	$3,627.00	$1,726.82	2026-07-10
71552	HCPCS	MRI Scan Of Chest Before And After Contrast	18	18	$3,616.00	$3,616.00	$1,091.76	$3,616.00	$1,721.58	2026-07-10
70543	HCPCS	MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast	18	18	$3,616.00	$3,616.00	$1,091.76	$3,616.00	$1,721.58	2026-07-10
70545	HCPCS	MRI Scan Of Blood Vessels Of Head With Contrast	18	18	$3,616.00	$3,616.00	$703.64	$3,616.00	$1,721.58	2026-07-10
71555	HCPCS	MRI Scan Of Blood Vessels Of Chest	18	18	$3,607.00	$3,607.00	$703.64	$3,607.00	$1,717.29	2026-07-10
71551	HCPCS	MRI Scan Of Chest With Contrast	18	18	$3,598.00	$3,598.00	$1,091.76	$3,598.00	$1,713.01	2026-07-10
Q4106	HCPCS	Dermagraft, Per Square Centimeter	18	18	$3,487.50	$3,487.50	$1,600.76	$3,487.50	$1,708.88	2026-07-10
C1783	HCPCS	Ocular Implant, Aqueous Drainage Assist Device	16	16	$3,125.00	$3,125.00	$1,434.38	$3,125.00	$1,692.19	2026-07-10
72156	HCPCS	MRI Scan Of Upper Spinal Canal Before And After Contrast	18	18	$3,551.00	$3,551.00	$1,091.76	$3,551.00	$1,690.63	2026-07-10
72157	HCPCS	MRI Scan Of Middle Spinal Canal Before And After Contrast	18	18	$3,551.00	$3,551.00	$1,091.76	$3,551.00	$1,690.63	2026-07-10
72142	HCPCS	MRI Scan Of Upper Spinal Canal With Contrast	18	18	$3,551.00	$3,551.00	$1,091.76	$3,551.00	$1,690.63	2026-07-10
74182	HCPCS	MRI Scan Of Abdomen With Contrast	18	18	$3,524.00	$3,524.00	$1,091.76	$3,524.00	$1,677.78	2026-07-10
1378484	CDM	Operating Room Services - General Classification	16	16	$3,090.00	$3,090.00	$1,418.31	$3,090.00	$1,673.24	2026-07-10
70546	HCPCS	MRI Scan Of Blood Vessels Of Head Before And After Contrast	18	18	$3,511.00	$3,511.00	$703.64	$3,511.00	$1,671.59	2026-07-10
45379	HCPCS	Removal Of Foreign Bodies In Large Bowel Using A Flexible Endoscope	18	18	$2,733.00	$2,733.00	$1,254.45	$3,062.92	$1,639.80	2026-07-10
72149	HCPCS	MRI Scan Of Lower Spinal Canal With Contrast	18	18	$3,426.00	$3,426.00	$1,091.76	$3,426.00	$1,631.12	2026-07-10
8937786	CDM	Himax	16	16	$3,000.00	$3,000.00	$1,377.00	$3,000.00	$1,624.50	2026-07-10
1376942	CDM	Operating Room Services - Minor Surgery	16	16	$2,990.00	$2,990.00	$1,372.41	$2,990.00	$1,619.09	2026-07-10
8789616	CDM	Operating Room Services - Minor Surgery	16	16	$2,990.00	$2,990.00	$1,372.41	$2,990.00	$1,619.09	2026-07-10
74181	HCPCS	MRI Scan Of Abdomen Without Contrast	18	18	$3,394.00	$3,394.00	$780.81	$3,394.00	$1,615.88	2026-07-10
8933152	CDM	Puraply Mz 500mg	16	16	$2,900.00	$2,900.00	$1,331.10	$2,900.00	$1,570.35	2026-07-10
15275	HCPCS	Application Of Skin Substitute Graft To Wound Of Face, Scalp, Eyelids, Mouth, Ne…	18	18	$2,582.21	$2,582.21	$1,185.23	$3,697.88	$1,549.33	2026-07-10
8771756	CDM	Ventralex St Hernia Patch Small	16	16	$2,743.20	$2,743.20	$1,259.13	$2,743.20	$1,485.45	2026-07-10
73220	HCPCS	MRI Scan Of Arm Before And After Contrast	18	18	$3,115.00	$3,115.00	$1,091.76	$3,115.00	$1,483.05	2026-07-10
Q4133	HCPCS	Grafix Prime, Grafixpl Prime, Stravix And Stravixpl, Per Square Centimeter	126	18	$2,838.00	$2,838.00	$274.48	$6,950.00	$1,480.32	2026-07-10
21931	HCPCS	Removal Of Growth Under Skin Of Back Or Lower Sides, 3.0 Cm Or More	18	18	$2,456.77	$2,456.77	$1,127.66	$4,338.72	$1,474.06	2026-07-10
9017871	CDM	G7 Vit E High Wall Lnr	16	16	$2,700.00	$2,700.00	$1,239.30	$2,700.00	$1,462.05	2026-07-10
70551	HCPCS	MRI Scan Of Brain Without Contrast	18	18	$2,967.00	$2,967.00	$780.81	$2,967.00	$1,412.59	2026-07-10
78451	HCPCS	Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect	34	18	$3,064.00	$3,064.00	$794.07	$3,064.00	$1,409.44	2026-07-10
36569	HCPCS	Insertion Of Tube For Infusion (5 Years Or Older)	34	18	$2,345.00	$2,345.00	$1,076.36	$3,242.06	$1,407.00	2026-07-10
28010	HCPCS	Repair Of Toe Tendon	18	18	$2,343.44	$2,343.44	$1,075.64	$5,806.26	$1,406.06	2026-07-10
24075	HCPCS	Removal Of Growth Under Skin Of Upper Arm Or Elbow, Less Than 3.0 Cm	18	18	$2,340.00	$2,340.00	$1,074.06	$4,338.72	$1,404.00	2026-07-10
47563	HCPCS	Removal Of Gallbladder With X-ray Study Of Bile Ducts Using An Endoscope	15	15	$2,219.00	$2,219.00	$607.09	$2,285.57	$1,399.70	2026-07-10
73723	HCPCS	MRI Scan Of Leg Joint Before And After Contrast	18	18	$2,939.00	$2,939.00	$1,091.76	$2,939.00	$1,399.26	2026-07-10
1378487	CDM	Operating Room Services - General Classification	16	16	$2,575.00	$2,575.00	$1,181.93	$2,575.00	$1,394.37	2026-07-10
72195	HCPCS	MRI Scan Of Pelvis Without Contrast	18	18	$2,913.00	$2,913.00	$780.81	$2,913.00	$1,386.88	2026-07-10
72141	HCPCS	MRI Scan Of Upper Spinal Canal Without Contrast	18	18	$2,913.00	$2,913.00	$780.81	$2,913.00	$1,386.88	2026-07-10
72146	HCPCS	MRI Scan Of Middle Spinal Canal Without Contrast	18	18	$2,913.00	$2,913.00	$780.81	$2,913.00	$1,386.88	2026-07-10
72148	HCPCS	MRI Scan Of Lower Spinal Canal Without Contrast	18	18	$2,913.00	$2,913.00	$780.81	$2,913.00	$1,386.88	2026-07-10
11770	HCPCS	Simple Removal Of Cyst Of Tailbone	18	18	$2,277.08	$2,277.08	$1,045.18	$3,204.21	$1,366.25	2026-07-10
8937784	CDM	Dynaforce Mtp Plate	16	16	$2,500.00	$2,500.00	$1,147.50	$2,500.00	$1,353.75	2026-07-10
8808501	CDM	Operating Room Services - Minor Surgery	16	16	$2,484.36	$2,484.36	$1,140.32	$2,484.36	$1,345.28	2026-07-10
1376935	CDM	Operating Room Services - Minor Surgery	16	16	$2,484.36	$2,484.36	$1,140.32	$2,484.36	$1,345.28	2026-07-10
72196	HCPCS	MRI Scan Of Pelvis With Contrast	18	18	$2,825.00	$2,825.00	$1,091.76	$2,825.00	$1,344.99	2026-07-10
70540	HCPCS	MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast	18	18	$2,800.00	$2,800.00	$780.81	$2,800.00	$1,333.08	2026-07-10
78708	HCPCS	Nuclear Medicine Study Of Kidney, Blood, Flow, And Function With Drug Administra…	18	18	$2,791.00	$2,791.00	$973.34	$2,791.00	$1,328.80	2026-07-10
78709	HCPCS	Nuclear Medicine Studies Of Kidney, Blood Flow, And Function	18	18	$2,791.00	$2,791.00	$973.34	$2,791.00	$1,328.80	2026-07-10
20103	HCPCS	Exploration Of Wound Of Arm Or Leg	18	18	$2,760.75	$2,760.75	$1,103.22	$2,760.75	$1,314.39	2026-07-10
8771758	CDM	Ventralex St Hernia Patch Med	16	16	$2,419.50	$2,419.50	$1,110.55	$2,419.50	$1,310.16	2026-07-10
36571	HCPCS	Insertion Of Central Venous Tube With Port For Infusion (5 Years Or Older)	18	18	$2,179.00	$2,179.00	$1,000.16	$3,242.06	$1,307.40	2026-07-10
47562	HCPCS	Removal Of Gallbladder Using An Endoscope	15	15	$2,076.00	$2,076.00	$561.02	$2,138.28	$1,287.40	2026-07-10
J1561	HCPCS	Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liquid)…	66	18	$2,769.04	$2,769.04	$57.28	$5,448.08	$1,273.76	2026-07-10
73722	HCPCS	MRI Scan Of Leg Joint With Contrast	18	18	$2,672.00	$2,672.00	$1,091.76	$2,672.00	$1,272.14	2026-07-10
74178	HCPCS	CT Scan Of Abdomen And Pelvis Before And After Contrast	18	18	$2,640.00	$2,640.00	$896.94	$2,640.00	$1,256.90	2026-07-10
73720	HCPCS	MRI Scan Of Leg Before And After Contrast	18	18	$2,600.00	$2,600.00	$1,091.76	$2,600.00	$1,237.86	2026-07-10
73222	HCPCS	MRI Scan Of Arm Joint With Contrast	34	18	$1,923.00	$1,923.00	$882.66	$2,672.00	$1,235.26	2026-07-10
5014926	CDM	Hernia Patch 8.0	16	16	$2,276.00	$2,276.00	$1,044.68	$2,276.00	$1,232.45	2026-07-10
71550	HCPCS	MRI Scan Of Chest Without Contrast	18	18	$2,585.00	$2,585.00	$780.81	$2,585.00	$1,230.72	2026-07-10
72132	HCPCS	CT Scan Of Lower Spine With Contrast	18	18	$2,567.00	$2,567.00	$896.94	$2,567.00	$1,222.15	2026-07-10
5014901	CDM	Ligasure Atlas	16	16	$2,236.00	$2,236.00	$1,026.32	$2,236.00	$1,210.80	2026-07-10
77084	HCPCS	MRI Scan Of Bone Marrow	18	18	$2,530.00	$2,530.00	$780.81	$2,530.00	$1,204.53	2026-07-10
70336	HCPCS	MRI Scan Of Jaw Joint	18	18	$2,529.00	$2,529.00	$780.81	$2,529.00	$1,204.06	2026-07-10
C8902	HCPCS	Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Abdom…	18	18	$2,529.00	$2,529.00	$703.64	$2,529.00	$1,204.06	2026-07-10
C8901	HCPCS	Magnetic Resonance Angiography Without Contrast, Abdomen	18	18	$2,529.00	$2,529.00	$703.64	$2,529.00	$1,204.06	2026-07-10
11406	HCPCS	Removal Of Noncancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm	18	18	$1,996.87	$1,996.87	$916.56	$5,934.94	$1,198.12	2026-07-10
74177	HCPCS	CT Scan Of Abdomen And Pelvis With Contrast	18	18	$2,508.00	$2,508.00	$896.94	$2,508.00	$1,194.05	2026-07-10
4898835	CDM	Ligasure Impact	16	16	$2,205.00	$2,205.00	$1,012.10	$2,205.00	$1,194.01	2026-07-10
23071	HCPCS	Removal Of Growth Under Skin Of Shoulder Area, 3.0 Cm Or More	18	18	$1,957.50	$1,957.50	$898.49	$4,338.72	$1,174.50	2026-07-10
44970	HCPCS	Removal Of Appendix Using An Endoscope	15	15	$1,304.00	$1,304.00	$514.00	$1,878.78	$1,173.80	2026-07-10
59426	HCPCS	Predelivery Care, 7 Or More Visits	15	15	$1,854.67	$1,854.67	$627.05	$2,235.01	$1,171.60	2026-07-10
78195	HCPCS	Nuclear Medicine Study Of Lymphatic System	34	18	$1,952.00	$1,952.00	$895.97	$2,333.78	$1,171.20	2026-07-10
73719	HCPCS	MRI Scan Of Leg With Contrast	18	18	$2,361.00	$2,361.00	$1,083.70	$2,361.00	$1,171.07	2026-07-10
8968843	CDM	Ortholoc 3di Crosscheck Lag Plate Screw	16	16	$2,151.00	$2,151.00	$987.31	$2,151.00	$1,164.76	2026-07-10
8834013	CDM	Operating Room Services - Minor Surgery	16	16	$2,144.46	$2,144.46	$984.31	$2,144.46	$1,161.22	2026-07-10
8789618	CDM	Operating Room Services - Minor Surgery	16	16	$2,144.46	$2,144.46	$984.31	$2,144.46	$1,161.22	2026-07-10
7928787	CDM	Ventrio Hernia Patch 3.1 X 4.7	16	16	$2,130.00	$2,130.00	$977.67	$2,130.00	$1,153.39	2026-07-10
J0248	HCPCS	Injection, Remdesivir, 1 Mg	32	16	$2,134.32	$2,134.32	$883.71	$2,343.35	$1,143.51	2026-07-10
74176	HCPCS	CT Scan Of Abdomen And Pelvis Without Contrast	18	18	$2,376.00	$2,376.00	$896.94	$2,376.00	$1,131.21	2026-07-10
26080	HCPCS	Incision Of Finger Joint For Exploration, Fluid Drainage, Or Removal Of Foreign …	18	18	$1,869.75	$1,869.75	$858.22	$3,754.22	$1,121.85	2026-07-10
14040	HCPCS	Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, Genitals, Han…	15	15	$1,664.00	$1,664.00	$504.99	$1,786.68	$1,120.50	2026-07-10
70544	HCPCS	MRI Scan Of Blood Vessels Of Head Without Contrast	18	18	$2,348.00	$2,348.00	$703.64	$2,348.00	$1,117.88	2026-07-10
1378486	CDM	Operating Room Services - General Classification	16	16	$2,060.00	$2,060.00	$945.54	$2,060.00	$1,115.49	2026-07-10
78264	HCPCS	Nuclear Medicine Study Of Stomach To Assess Emptying	18	18	$2,340.00	$2,340.00	$973.34	$2,340.00	$1,114.08	2026-07-10
78452	HCPCS	Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect	34	18	$2,417.00	$2,417.00	$656.83	$2,417.00	$1,111.82	2026-07-10
8789621	CDM	Operating Room Services - Minor Surgery	16	16	$2,046.61	$2,046.61	$939.39	$2,046.61	$1,108.24	2026-07-10
5014923	CDM	Hernia Patch 6.4cm	16	16	$2,045.00	$2,045.00	$938.66	$2,045.00	$1,107.37	2026-07-10
J1451	HCPCS	Injection, Fomepizole, 15 Mg	16	16	$2,035.01	$2,035.01	$934.07	$2,035.01	$1,101.96	2026-07-10
64415	HCPCS	Injection Of Anesthetic Agent And/or Steroid Into Arm Nerve Bundle (brachial Ple…	18	18	$1,834.00	$1,834.00	$841.81	$2,756.80	$1,100.40	2026-07-10
73221	HCPCS	MRI Scan Of Arm Joint Without Contrast	18	18	$2,302.00	$2,302.00	$780.81	$2,302.00	$1,095.98	2026-07-10
73721	HCPCS	MRI Scan Of Leg Joint Without Contrast	18	18	$2,302.00	$2,302.00	$780.81	$2,302.00	$1,095.98	2026-07-10
93306	HCPCS	Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu…	18	18	$2,300.00	$2,300.00	$971.81	$2,300.00	$1,095.03	2026-07-10
72126	HCPCS	CT Scan Of Upper Spine With Contrast	18	18	$2,294.00	$2,294.00	$896.94	$2,294.00	$1,092.17	2026-07-10
75635	HCPCS	CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast	18	18	$2,294.00	$2,294.00	$737.26	$2,294.00	$1,092.17	2026-07-10
78494	HCPCS	Nuclear Medicine Study Of Heart Pumping Function By Labeling Red Blood Cells Wit…	18	18	$2,292.00	$2,292.00	$973.34	$2,292.00	$1,091.22	2026-07-10
70492	HCPCS	CT Scan Of Soft Tissue Of Neck Before And After Contrast	18	18	$2,289.00	$2,289.00	$896.94	$2,289.00	$1,089.80	2026-07-10
5014882	CDM	Tissue Patch 10x15cm	16	16	$2,005.00	$2,005.00	$920.30	$2,005.00	$1,085.71	2026-07-10
74170	HCPCS	CT Scan Of Abdomen Before And After Contrast	18	18	$2,262.00	$2,262.00	$896.94	$2,262.00	$1,076.94	2026-07-10
78262	HCPCS	Nuclear Medicine Study Of Stomach And Esophagus To Assess Reflux	18	18	$2,217.00	$2,217.00	$973.34	$2,217.00	$1,071.12	2026-07-10
71270	HCPCS	CT Scan Of Chest Before And After Contrast	18	18	$2,239.00	$2,239.00	$896.94	$2,239.00	$1,065.99	2026-07-10
72127	HCPCS	CT Scan Of Upper Spine Before And After Contrast	18	18	$2,211.00	$2,211.00	$896.94	$2,211.00	$1,052.66	2026-07-10
78472	HCPCS	Nuclear Medicine Study Of Heart Pumping Function By Labeling Red Blood Cells Wit…	18	18	$2,117.00	$2,117.00	$971.70	$2,117.00	$1,046.97	2026-07-10
8679796	CDM	Operating Room Services - Minor Surgery	16	16	$1,912.92	$1,912.92	$878.03	$1,912.92	$1,035.85	2026-07-10
70498	HCPCS	CT Scan Of Blood Vessels Of Neck With Contrast	18	18	$2,172.00	$2,172.00	$737.26	$2,172.00	$1,034.09	2026-07-10
70491	HCPCS	CT Scan Of Soft Tissue Of Neck With Contrast	18	18	$2,171.00	$2,171.00	$896.94	$2,171.00	$1,033.61	2026-07-10
8051521	CDM	Het Bipolar Forcep	16	16	$1,893.00	$1,893.00	$868.89	$1,893.00	$1,025.06	2026-07-10
49505	HCPCS	Repair Of Groin Hernia (5 Years Or Older)	15	15	$1,180.00	$1,180.00	$451.41	$1,632.78	$1,022.90	2026-07-10
78582	HCPCS	Nuclear Medicine Study Of Lung Ventilation And Circulation	18	18	$1,703.00	$1,703.00	$781.68	$2,333.78	$1,021.80	2026-07-10
J1670	HCPCS	Injection, Tetanus Immune Globulin, Human, Up To 250 Units	16	16	$1,885.81	$1,885.81	$865.59	$1,885.81	$1,021.17	2026-07-10
8836007	CDM	Snap Off Screw 2.0mm X 14mm	16	16	$1,884.00	$1,884.00	$864.76	$1,884.00	$1,020.19	2026-07-10
2120839	CDM	Room & Board - Private (one Bed) - General Classification	9	9	$1,272.00	$1,272.00	$788.64	$1,710.20	$1,017.60	2026-07-10
7876763	CDM	Room & Board - Private (one Bed) - General Classification	9	9	$1,272.00	$1,272.00	$788.64	$1,710.20	$1,017.60	2026-07-10
78707	HCPCS	Nuclear Medicine Study Of Kidney, Blood Flow, And Function	18	18	$1,754.00	$1,754.00	$805.09	$1,754.00	$1,012.87	2026-07-10
5014909	CDM	Power Port 8fr	16	16	$1,868.00	$1,868.00	$857.41	$1,868.00	$1,011.52	2026-07-10
93350	HCPCS	Ultrasound Of Heart During Rest, Exercise And/or Drug-induced Stress With Report	18	18	$1,698.00	$1,698.00	$779.38	$1,698.00	$995.30	2026-07-10
P9035	HCPCS	Platelets, Pheresis, Leukocytes Reduced, Each Unit	34	18	$1,931.25	$1,931.25	$569.18	$2,085.75	$993.02	2026-07-10
70470	HCPCS	CT Scan Of Head Or Brain Before And After Contrast	18	18	$2,066.00	$2,066.00	$896.94	$2,066.00	$992.61	2026-07-10
72194	HCPCS	CT Scan Of Pelvis Before And After Contrast	18	18	$2,059.00	$2,059.00	$896.94	$2,059.00	$990.91	2026-07-10
78315	HCPCS	Nuclear Medicine Study Of Bone Taken At Different Times	18	18	$1,654.00	$1,654.00	$759.19	$1,654.00	$982.87	2026-07-10
72133	HCPCS	CT Scan Of Lower Spine Before And After Contrast	18	18	$2,025.00	$2,025.00	$896.94	$2,025.00	$982.71	2026-07-10
21012	HCPCS	Removal Of Growth Under Skin Of Face Or Scalp, 2.0 Cm Or More	18	18	$1,622.25	$1,622.25	$744.61	$4,338.72	$973.35	2026-07-10
72193	HCPCS	CT Scan Of Pelvis With Contrast	18	18	$1,976.00	$1,976.00	$896.94	$1,976.00	$970.87	2026-07-10
74160	HCPCS	CT Scan Of Abdomen With Contrast	18	18	$1,923.00	$1,923.00	$882.66	$1,923.00	$958.07	2026-07-10
71260	HCPCS	CT Scan Of Chest With Contrast	18	18	$1,906.00	$1,906.00	$874.85	$1,906.00	$953.97	2026-07-10
4869701	CDM	Comprehensive Cbde L	16	16	$1,754.00	$1,754.00	$805.09	$1,754.00	$949.79	2026-07-10
J9202	HCPCS	Goserelin Acetate Implant, Per 3.6 Mg	18	18	$1,929.95	$1,929.95	$885.85	$1,929.95	$945.68	2026-07-10
73702	HCPCS	CT Scan Of Leg Before And After Contrast	18	18	$1,838.00	$1,838.00	$843.64	$1,838.00	$942.13	2026-07-10
73202	HCPCS	CT Scan Of Arm Before And After Contrast	18	18	$1,838.00	$1,838.00	$843.64	$1,838.00	$942.13	2026-07-10
70487	HCPCS	CT Scan Of Face With Contrast	18	18	$1,703.00	$1,703.00	$781.68	$1,703.00	$942.13	2026-07-10
70460	HCPCS	CT Scan Head Or Brain With Contrast	18	18	$1,759.00	$1,759.00	$807.38	$1,759.00	$942.13	2026-07-10
70482	HCPCS	CT Scan Of Cranial Cavity Before And After Contrast	18	18	$1,774.00	$1,774.00	$814.27	$1,774.00	$942.13	2026-07-10
70488	HCPCS	CT Scan Of Face Before And After Contrast	18	18	$1,774.00	$1,774.00	$814.27	$1,774.00	$942.13	2026-07-10
46260	HCPCS	Removal Of Multiple Hemorrhoid Groups	15	15	$1,155.00	$1,155.00	$434.31	$1,526.65	$942.10	2026-07-10
72191	HCPCS	CT Scan Of Blood Vessels Of Pelvis With Contrast	18	18	$1,976.00	$1,976.00	$737.26	$1,976.00	$940.77	2026-07-10
8904365	CDM	Morphix Xt Suture Anchor	16	16	$1,725.00	$1,725.00	$791.78	$1,725.00	$934.09	2026-07-10
70547	HCPCS	MRI Scan Of Blood Vessels Of Neck Without Contrast	18	18	$1,961.00	$1,961.00	$703.64	$1,961.00	$933.63	2026-07-10
73701	HCPCS	CT Scan Of Leg With Contrast Material	34	18	$1,694.00	$1,694.00	$734.40	$1,694.00	$928.47	2026-07-10
73201	HCPCS	CT Scan Of Arm With Contrast	34	18	$1,653.00	$1,653.00	$734.40	$1,653.00	$928.47	2026-07-10
15278	HCPCS	Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout…	34	18	$1,782.47	$1,782.47	$709.16	$3,697.88	$927.00	2026-07-10
5014924	CDM	Hernia Patch 4.3	16	16	$1,710.00	$1,710.00	$784.89	$1,710.00	$925.96	2026-07-10

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