Price Transparencybeta Hospital negotiated rates

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

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Hospital

FREDERICK HEALTH HOSPITAL

Frederick, MD · CCN 210005 · Rates published

24,445 distinct procedures filed
2 distinct payers
48,656 rate rows
2026-05-28 last MRF observed
Data quality

47,273 of 48,656 rate rows are consumer-grade (97.2%)

1,383 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 1,383
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.frederickhealth.org/documents/page%20links/billing%20&%20finance/CdmPublicPricing.csv
Found on page https://www.frederickhealth.org/about/billing-financial-assistance/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-08-11
Content fingerprint 4481d637618dc6e9… · 726,134 bytes · first seen 2026-05-05

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
A9543
HCPCS 		Y-90 Zevalin 1 $99,545.31 $119,641.32 $109,593.32 nat. median
$63,643
1.7× median
15009
CDM 		Y-90 Zevalin 1 $99,545.31 $119,641.32 $109,593.32 nat. median
$2
outlier · 54796.7×
75987015003A
NDC 		Uplizna 1 $96,364.29 $115,818.10 $106,091.19 nat. median
$106,091
1.0× median
PHAR002249
CDM 		Uplizna 1 $96,364.29 $115,818.10 $106,091.19 nat. median
$106,091
1.0× median
PHAR002267
CDM 		Imjudo 1 $81,367.57 $97,793.88 $89,580.73 nat. median
$89,581
1.0× median
00310453530A
NDC 		Imjudo 1 $81,367.57 $97,793.88 $89,580.73 nat. median
$89,581
1.0× median
3232822
NDC 		Ipilimumab * 1 $83,903.76 $83,903.76 $83,903.76 nat. median
$69,157
1.2× median
PHAR000539
CDM 		Sipuleucel-t/lactated Ringers * 1 $72,587.78 $87,241.65 $79,914.71 nat. median
$79,915
1.0× median
30237890006
NDC 		Sipuleucel-t/lactated Ringers * 1 $72,587.78 $87,241.65 $79,914.71 nat. median
$2
outlier · 38054.6×
PHAR000395
CDM 		Ipilimumab * 1 $69,810.57 $83,903.76 $76,857.17 nat. median
$76,857
1.0× median
P0803
HCPCS 		Generator Sentiva 1 $70,444.56 $70,444.56 $70,444.56 nat. median
$70,445
1.0× median
00003232822
NDC 		Ipilimumab * 1 $69,810.57 $69,810.57 $69,810.57 nat. median
$44,609
1.6× median
R7198
HCPCS 		Generator Vns Aspiresr 106 1 $62,613.15 $62,613.15 $62,613.15 nat. median
$62,613
1.0× median
PHAR000727
CDM 		Pegloticase * 1 $55,805.42 $67,071.30 $61,438.36 nat. median
$61,438
1.0× median
75987008010A
NDC 		Pegloticase * 1 $55,805.42 $67,071.30 $61,438.36 nat. median
$61,438
1.0× median
PHAR002302
CDM 		Spevigo 1 $53,912.08 $64,795.74 $59,353.91 nat. median
$59,354
1.0× median
00597003510A
NDC 		Spevigo 1 $53,912.08 $64,795.74 $59,353.91 nat. median
$59,354
1.0× median
63899
CDM 		Mesh Surgical Phasix 14inx14in 1 $55,635.00 $55,635.00 $55,635.00 nat. median
$16,487
outlier · 3.4×
25682002801A
NDC 		Ravulizumab-cwvz * 1 $49,515.08 $59,511.08 $54,513.08 nat. median
$278
outlier · 195.8×
PHAR001928
CDM 		Ravulizumab-cwvz * 1 $49,515.08 $59,511.08 $54,513.08 nat. median
$54,513
1.0× median
R8288
HCPCS 		Dcs Proclaim Complete System 1 $50,290.02 $50,290.02 $50,290.02 nat. median
$50,290
1.0× median
R8287
HCPCS 		Dcs Proclaim Ipg & Controller 1 $49,341.15 $49,341.15 $49,341.15 nat. median
$49,341
1.0× median
R8708
HCPCS 		Generator Ipg Dcs Prodigy 1 $49,341.15 $49,341.15 $49,341.15 nat. median
$49,341
1.0× median
EP038
CDM 		Icd Quadra Assura Crt-d 40 1 $48,290.64 $48,290.64 $48,290.64 nat. median
$48,291
1.0× median
EP009
CDM 		Icd Quadra Assura Cd3265-40 1 $48,290.64 $48,290.64 $48,290.64 nat. median
$48,291
1.0× median
EP073
CDM 		Icd Ilesto Hf-t 383546 1 $46,859.07 $46,859.07 $46,859.07 nat. median
$46,859
1.0× median
CA713
CDM 		Claria MRI Crt-d Dtma1d1 1 $46,055.12 $46,055.12 $46,055.12 nat. median
$46,055
1.0× median
CA703
CDM 		Claria MRI Quad Crt-d Dtma1q1 1 $46,055.12 $46,055.12 $46,055.12 nat. median
$46,055
1.0× median
CA714
CDM 		Claria MRI Crt-d Dtma1d4 1 $46,055.12 $46,055.12 $46,055.12 nat. median
$46,055
1.0× median
CA712
CDM 		Claria MRI Quad Crt-d Dtma1qq 1 $46,055.12 $46,055.12 $46,055.12 nat. median
$46,055
1.0× median
EP211
CDM 		Icd Amplia MRI Dtmb1d1 1 $46,054.69 $46,054.69 $46,054.69 nat. median
$46,055
1.0× median
EP210
CDM 		Icd Amplia MRI Quad Dtmb1q1 1 $46,054.69 $46,054.69 $46,054.69 nat. median
$46,055
1.0× median
EP141
CDM 		Icd Amplia MRI Quad Dtmb1qq 1 $46,036.75 $46,036.75 $46,036.75 nat. median
$46,037
1.0× median
EP142
CDM 		Icd Amplia MRI Dtmb1d4 1 $46,036.75 $46,036.75 $46,036.75 nat. median
$46,037
1.0× median
C1822
HCPCS 		Kit Ipg Remote/charger 1 $45,027.67 $45,027.67 $45,027.67 nat. median
$32,176
1.4× median
P1350
HCPCS 		Kit Ipg Remote/charger 1 $45,027.67 $45,027.67 $45,027.67 nat. median
$45,028
1.0× median
R7871
HCPCS 		Mesh Phasix St 25x30 1 $44,059.02 $44,059.02 $44,059.02 nat. median
$44,059
1.0× median
EP002
CDM 		Sjm Quadra Assura Cd3265-40q 1 $43,518.81 $43,518.81 $43,518.81 nat. median
$43,519
1.0× median
EP025
CDM 		Icd Viva Xt Dtba1d4 1 $43,438.67 $43,438.67 $43,438.67 nat. median
$43,439
1.0× median
EP020
CDM 		Icd Viva Xt Dtba1d1 1 $43,438.67 $43,438.67 $43,438.67 nat. median
$43,439
1.0× median
EP111
CDM 		Crt-d Viva Quad Dtba1q1 1 $43,425.58 $43,425.58 $43,425.58 nat. median
$43,426
1.0× median
EP166
CDM 		Crt-d Quadra Assura Mp Df4 1 $43,128.72 $43,128.72 $43,128.72 nat. median
$43,129
1.0× median
EP165
CDM 		Crt-d Quadra Assura Mp 1 $43,128.72 $43,128.72 $43,128.72 nat. median
$43,129
1.0× median
EP167
CDM 		Crt-d Quadra Assura Mp, Merlin 1 $43,128.72 $43,128.72 $43,128.72 nat. median
$43,129
1.0× median
EP168
CDM 		Crt-d Quadra Assura Mp Df4 Mer 1 $43,128.72 $43,128.72 $43,128.72 nat. median
$43,129
1.0× median
CL990
CDM 		Bsc Icd Incepta N161 1 $42,946.20 $42,946.20 $42,946.20 nat. median
$42,946
1.0× median
EP017
CDM 		Icd Incepta N160 1 $42,946.20 $42,946.20 $42,946.20 nat. median
$42,946
1.0× median
50474098386A
NDC 		Rystiggo 1 $38,751.32 $46,574.36 $42,662.84 nat. median
$42,663
1.0× median
PHAR002533
CDM 		Rystiggo 1 $38,751.32 $46,574.36 $42,662.84 nat. median
$42,663
1.0× median
EP041
CDM 		Icd Unify Assura Crt-d 40 Df4 1 $41,800.98 $41,800.98 $41,800.98 nat. median
$41,801
1.0× median

Other procedures at this hospital

Browse this hospital's 24,445 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
             
15009 CDM Y-90 Zevalin 2 1 $110,700.32 $108,486.31 $99,545.31 $119,641.32 $109,593.32 2025-08-04
A9543 HCPCS Y-90 Zevalin 2 1 $110,700.32 $108,486.31 $99,545.31 $119,641.32 $109,593.32 2025-08-04
75987015003A NDC Uplizna 2 1 $107,162.82 $105,019.57 $96,364.29 $115,818.10 $106,091.19 2025-08-04
PHAR002249 CDM Uplizna 2 1 $107,162.82 $105,019.57 $96,364.29 $115,818.10 $106,091.19 2025-08-04
00310453530A NDC Imjudo 2 1 $90,485.58 $88,675.87 $81,367.57 $97,793.88 $89,580.73 2025-08-04
PHAR002267 CDM Imjudo 2 1 $90,485.58 $88,675.87 $81,367.57 $97,793.88 $89,580.73 2025-08-04
3232822 NDC Ipilimumab * 1 1 $84,751.28 $83,056.25 $83,903.76 $83,903.76 $83,903.76 2025-08-04
30237890006 NDC Sipuleucel-t/lactated Ringers * 2 1 $80,721.93 $79,107.49 $72,587.78 $87,241.65 $79,914.71 2025-08-04
PHAR000539 CDM Sipuleucel-t/lactated Ringers * 2 1 $80,721.93 $79,107.49 $72,587.78 $87,241.65 $79,914.71 2025-08-04
PHAR000395 CDM Ipilimumab * 2 1 $77,633.50 $76,080.83 $69,810.57 $83,903.76 $76,857.17 2025-08-04
P0803 HCPCS Generator Sentiva 2 1 $71,156.12 $69,733.00 $70,444.56 $70,444.56 $70,444.56 2025-08-04
00003232822 NDC Ipilimumab * 1 1 $70,515.72 $69,105.41 $69,810.57 $69,810.57 $69,810.57 2025-03-17
R7198 HCPCS Generator Vns Aspiresr 106 2 1 $63,245.61 $61,980.70 $62,613.15 $62,613.15 $62,613.15 2025-08-04
75987008010A NDC Pegloticase * 2 1 $62,058.95 $60,817.77 $55,805.42 $67,071.30 $61,438.36 2025-08-04
PHAR000727 CDM Pegloticase * 2 1 $62,058.95 $60,817.77 $55,805.42 $67,071.30 $61,438.36 2025-08-04
PHAR002302 CDM Spevigo 2 1 $59,953.44 $58,754.38 $53,912.08 $64,795.74 $59,353.91 2025-08-04
00597003510A NDC Spevigo 2 1 $59,953.44 $58,754.38 $53,912.08 $64,795.74 $59,353.91 2025-08-04
63899 CDM Mesh Surgical Phasix 14inx14in 2 1 $56,196.97 $55,073.03 $55,635.00 $55,635.00 $55,635.00 2025-08-04
PHAR001928 CDM Ravulizumab-cwvz * 2 1 $55,063.71 $53,962.44 $49,515.08 $59,511.08 $54,513.08 2025-08-04
25682002801A NDC Ravulizumab-cwvz * 2 1 $55,063.71 $53,962.44 $49,515.08 $59,511.08 $54,513.08 2025-08-04
R8288 HCPCS Dcs Proclaim Complete System 2 1 $50,798.00 $49,782.04 $50,290.02 $50,290.02 $50,290.02 2025-08-04
R8708 HCPCS Generator Ipg Dcs Prodigy 2 1 $49,839.55 $48,842.76 $49,341.15 $49,341.15 $49,341.15 2025-08-04
R8287 HCPCS Dcs Proclaim Ipg & Controller 2 1 $49,839.55 $48,842.76 $49,341.15 $49,341.15 $49,341.15 2025-08-04
EP038 CDM Icd Quadra Assura Crt-d 40 2 1 $48,778.42 $47,802.85 $48,290.64 $48,290.64 $48,290.64 2025-08-04
EP009 CDM Icd Quadra Assura Cd3265-40 2 1 $48,778.42 $47,802.85 $48,290.64 $48,290.64 $48,290.64 2025-08-04
EP073 CDM Icd Ilesto Hf-t 383546 2 1 $47,332.40 $46,385.75 $46,859.07 $46,859.07 $46,859.07 2025-08-04
CA714 CDM Claria MRI Crt-d Dtma1d4 2 1 $46,520.33 $45,589.92 $46,055.12 $46,055.12 $46,055.12 2025-08-04
CA703 CDM Claria MRI Quad Crt-d Dtma1q1 2 1 $46,520.33 $45,589.92 $46,055.12 $46,055.12 $46,055.12 2025-08-04
CA713 CDM Claria MRI Crt-d Dtma1d1 2 1 $46,520.33 $45,589.92 $46,055.12 $46,055.12 $46,055.12 2025-08-04
CA712 CDM Claria MRI Quad Crt-d Dtma1qq 2 1 $46,520.33 $45,589.92 $46,055.12 $46,055.12 $46,055.12 2025-08-04
EP210 CDM Icd Amplia MRI Quad Dtmb1q1 2 1 $46,519.89 $45,589.49 $46,054.69 $46,054.69 $46,054.69 2025-08-04
EP211 CDM Icd Amplia MRI Dtmb1d1 2 1 $46,519.89 $45,589.49 $46,054.69 $46,054.69 $46,054.69 2025-08-04
EP141 CDM Icd Amplia MRI Quad Dtmb1qq 2 1 $46,501.77 $45,571.73 $46,036.75 $46,036.75 $46,036.75 2025-08-04
EP142 CDM Icd Amplia MRI Dtmb1d4 2 1 $46,501.77 $45,571.73 $46,036.75 $46,036.75 $46,036.75 2025-08-04
C1822 HCPCS Kit Ipg Remote/charger 2 1 $45,482.49 $44,572.84 $45,027.67 $45,027.67 $45,027.67 2025-08-04
P1350 HCPCS Kit Ipg Remote/charger 2 1 $45,482.49 $44,572.84 $45,027.67 $45,027.67 $45,027.67 2025-08-04
R7871 HCPCS Mesh Phasix St 25x30 2 1 $44,504.06 $43,613.98 $44,059.02 $44,059.02 $44,059.02 2025-08-04
EP002 CDM Sjm Quadra Assura Cd3265-40q 2 1 $43,958.39 $43,079.22 $43,518.81 $43,518.81 $43,518.81 2025-08-04
EP025 CDM Icd Viva Xt Dtba1d4 2 1 $43,877.44 $42,999.89 $43,438.67 $43,438.67 $43,438.67 2025-08-04
EP020 CDM Icd Viva Xt Dtba1d1 2 1 $43,877.44 $42,999.89 $43,438.67 $43,438.67 $43,438.67 2025-08-04
EP111 CDM Crt-d Viva Quad Dtba1q1 2 1 $43,864.22 $42,986.94 $43,425.58 $43,425.58 $43,425.58 2025-08-04
EP168 CDM Crt-d Quadra Assura Mp Df4 Mer 2 1 $43,564.37 $42,693.08 $43,128.72 $43,128.72 $43,128.72 2025-08-04
EP165 CDM Crt-d Quadra Assura Mp 2 1 $43,564.37 $42,693.08 $43,128.72 $43,128.72 $43,128.72 2025-08-04
EP167 CDM Crt-d Quadra Assura Mp, Merlin 2 1 $43,564.37 $42,693.08 $43,128.72 $43,128.72 $43,128.72 2025-08-04
EP166 CDM Crt-d Quadra Assura Mp Df4 2 1 $43,564.37 $42,693.08 $43,128.72 $43,128.72 $43,128.72 2025-08-04
CL990 CDM Bsc Icd Incepta N161 2 1 $43,380.00 $42,512.40 $42,946.20 $42,946.20 $42,946.20 2025-08-04
EP017 CDM Icd Incepta N160 2 1 $43,380.00 $42,512.40 $42,946.20 $42,946.20 $42,946.20 2025-08-04
PHAR002533 CDM Rystiggo 2 1 $43,093.78 $42,231.90 $38,751.32 $46,574.36 $42,662.84 2025-08-04
50474098386A NDC Rystiggo 2 1 $43,093.78 $42,231.90 $38,751.32 $46,574.36 $42,662.84 2025-08-04
EP011 CDM Sum Unify Assura Cd32575-40q 2 1 $42,223.21 $41,378.75 $41,800.98 $41,800.98 $41,800.98 2025-08-04
CL911 CDM St Jude Unify Cd3231-40 2 1 $42,223.21 $41,378.75 $41,800.98 $41,800.98 $41,800.98 2025-08-04
EP040 CDM Icd Unify Assura Crt-d 40 2 1 $42,223.21 $41,378.75 $41,800.98 $41,800.98 $41,800.98 2025-08-04
CL928 CDM St Jude Unify Cd3231-40q 2 1 $42,223.21 $41,378.75 $41,800.98 $41,800.98 $41,800.98 2025-08-04
EP004 CDM Sjm Unify Asura Cd3257-40 2 1 $42,223.21 $41,378.75 $41,800.98 $41,800.98 $41,800.98 2025-08-04
EP041 CDM Icd Unify Assura Crt-d 40 Df4 2 1 $42,223.21 $41,378.75 $41,800.98 $41,800.98 $41,800.98 2025-08-04
R8468 HCPCS Aortoiliac Artery 2 1 $42,171.92 $41,328.48 $41,750.20 $41,750.20 $41,750.20 2025-08-04
64601 CDM Pulse Gene V1 Implantable 1 1 $41,803.80 $40,967.72 $41,385.76 $41,385.76 $41,385.76 2025-08-04
EP039 CDM Icd Quadra Assura Crt-d 40 Df4 2 1 $41,794.40 $40,958.51 $41,376.46 $41,376.46 $41,376.46 2025-08-04
EP143 CDM Icd Complia MRI Quad Dtmc1qq 2 1 $41,500.87 $40,670.85 $41,085.86 $41,085.86 $41,085.86 2025-08-04
CL906 CDM Bs Cognis He Is1/df1/lv1 2 1 $41,452.01 $40,622.97 $41,037.49 $41,037.49 $41,037.49 2025-08-04
P1714 HCPCS Femoral Condyle Whole Right 2 1 $41,120.10 $40,297.70 $40,708.90 $40,708.90 $40,708.90 2025-08-04
EP127 CDM Icd Punctua N051 2 1 $40,573.32 $39,761.85 $40,167.58 $40,167.58 $40,167.58 2025-08-04
EP087 CDM Crt-d Inogen X4 G146 2 1 $40,488.03 $39,678.27 $40,083.15 $40,083.15 $40,083.15 2025-08-04
EP079 CDM Icd Punctua N050 2 1 $40,488.03 $39,678.27 $40,083.15 $40,083.15 $40,083.15 2025-08-04
EP086 CDM Crt-d Inogen X4 Df4 G148 2 1 $40,488.03 $39,678.27 $40,083.15 $40,083.15 $40,083.15 2025-08-04
EP158 CDM Crt-d Dynagen X4 Df4 G158 2 1 $40,422.92 $39,614.46 $40,018.69 $40,018.69 $40,018.69 2025-08-04
EP135 CDM Icd Energen Crt-d N141 2 1 $40,422.92 $39,614.46 $40,018.69 $40,018.69 $40,018.69 2025-08-04
EP161 CDM Crt-d Dynagen G151 2 1 $40,422.92 $39,614.46 $40,018.69 $40,018.69 $40,018.69 2025-08-04
EP159 CDM Crt-d Dynagen X4 G156 2 1 $40,422.92 $39,614.46 $40,018.69 $40,018.69 $40,018.69 2025-08-04
EP160 CDM Crt-d Dynagen Df4 G150 2 1 $40,422.92 $39,614.46 $40,018.69 $40,018.69 $40,018.69 2025-08-04
CB003 CDM Dynagen Crt-d G154 2 1 $39,584.69 $38,793.00 $39,188.85 $39,188.85 $39,188.85 2025-08-04
P1533 HCPCS Ctag Cmds 26mmx26mmx10cm 2 1 $39,575.45 $38,783.94 $39,179.69 $39,179.69 $39,179.69 2025-08-04
50242015001A NDC Ocrelizumab * 2 1 $39,462.10 $38,672.87 $35,485.60 $42,649.37 $39,067.49 2025-08-04
PHAR001394 CDM Ocrelizumab * 2 1 $39,462.10 $38,672.87 $35,485.60 $42,649.37 $39,067.49 2025-08-04
P0847 HCPCS Tag Conform Thor 40x40x10 2 1 $39,433.51 $38,644.84 $39,039.18 $39,039.18 $39,039.18 2025-08-04
CL959 CDM Medt Protecta Xt D314trg 2 1 $38,868.47 $38,091.10 $38,479.79 $38,479.79 $38,479.79 2025-08-04
CB225 CDM Emblem S-icd MRI 2 1 $38,381.85 $37,614.21 $37,998.03 $37,998.03 $37,998.03 2025-08-04
R2991 HCPCS Kit Restore Sensor Ipg 2 1 $38,146.43 $37,383.50 $37,764.96 $37,764.96 $37,764.96 2025-08-04
R4421 HCPCS Kit Ipg Surescan Ultra MRI 2 1 $38,146.43 $37,383.50 $37,764.96 $37,764.96 $37,764.96 2025-08-04
R2870 HCPCS Kit Restore Ultra Ipg 2 1 $38,146.43 $37,383.50 $37,764.96 $37,764.96 $37,764.96 2025-08-04
R4875 HCPCS Kit Ipg Surescan Restore MRI 2 1 $38,146.43 $37,383.50 $37,764.96 $37,764.96 $37,764.96 2025-08-04
PHAR001580 CDM PEGaspargase * 2 1 $38,060.62 $37,299.40 $34,225.34 $41,134.68 $37,680.01 2025-08-04
72694095401A NDC PEGaspargase * 2 1 $38,060.62 $37,299.40 $34,225.34 $41,134.68 $37,680.01 2025-08-04
R4738 HCPCS Generator Vns Aspirehc 105 2 1 $37,631.93 $36,879.29 $37,255.61 $37,255.61 $37,255.61 2025-08-04
EP198 CDM Evera MRI Xt Dr Ddmb1d1 2 1 $37,564.60 $36,813.31 $37,188.96 $37,188.96 $37,188.96 2025-08-04
EP199 CDM Evera MRI S Dr Ddmc3d1 2 1 $36,748.53 $36,013.56 $36,381.04 $36,381.04 $36,381.04 2025-08-04
R4309 HCPCS Precisn Spectra Pulse Genrator 2 1 $36,612.91 $35,880.65 $36,246.78 $36,246.78 $36,246.78 2025-08-04
P0810 HCPCS Battery Dcs 2 1 $36,443.57 $35,714.70 $36,079.14 $36,079.14 $36,079.14 2025-08-04
C1820 HCPCS Battery Dcs 2 1 $36,443.57 $35,714.70 $36,079.14 $36,079.14 $36,079.14 2025-08-04
CB135 CDM Gallant Hf Crt-d 2 1 $36,417.38 $35,689.03 $36,053.21 $36,053.21 $36,053.21 2025-08-04
R2992 HCPCS Kit Prime Advanced Ipg 2 1 $36,229.52 $35,504.93 $35,867.22 $35,867.22 $35,867.22 2025-08-04
EP051 CDM Icd Incepta E162 2 1 $35,999.63 $35,279.64 $35,639.64 $35,639.64 $35,639.64 2025-08-04
CL989 CDM Bsc Icd Incepta E163 2 1 $35,999.63 $35,279.64 $35,639.64 $35,639.64 $35,639.64 2025-08-04
EP104 CDM Crt-d Viva Quad Xt Dtba1qq 2 1 $35,672.68 $34,959.23 $35,315.96 $35,315.96 $35,315.96 2025-08-04
P0705 HCPCS Pulse Generator Prime 16 2 1 $35,503.21 $34,793.15 $35,148.18 $35,148.18 $35,148.18 2025-08-04
P1148 HCPCS Kit Wavewriter Alpha 32 Ipg 2 1 $35,503.21 $34,793.15 $35,148.18 $35,148.18 $35,148.18 2025-08-04
61427 CDM Generator Ipg Dcs Wavewrtr 2 1 $35,462.76 $34,753.50 $35,108.13 $35,108.13 $35,108.13 2025-08-04
30006 CDM Vagus Nerve Stim Generator 2 1 $35,460.85 $34,751.63 $35,106.24 $35,106.24 $35,106.24 2025-08-04
CB132 CDM Entrant Hf Crt-d 2 1 $35,459.03 $34,749.85 $35,104.44 $35,104.44 $35,104.44 2025-08-04
R6606 HCPCS Xenmatrix Antibiotic 19x28 2 1 $34,860.31 $34,163.10 $34,511.71 $34,511.71 $34,511.71 2025-08-04
CL184 CDM St Jude Promote Crt-d 3211-36q 2 1 $34,704.02 $34,009.94 $34,356.98 $34,356.98 $34,356.98 2025-08-04
R8734 HCPCS Dcs Proclaim 7 Elite Ipg 2 1 $34,688.86 $33,995.08 $34,341.97 $34,341.97 $34,341.97 2025-08-04
14964 CDM Quadramet-initial 2 1 $34,683.58 $33,989.91 $34,336.75 $34,336.75 $34,336.75 2025-08-04
A9604 HCPCS Quadramet-initial 2 1 $34,683.58 $33,989.91 $34,336.75 $34,336.75 $34,336.75 2025-08-04
P0657 HCPCS Custom Glen Baseplate (vrs) 2 1 $34,543.67 $33,852.80 $34,198.24 $34,198.24 $34,198.24 2025-08-04
EP144 CDM Icd Evera MRI Xt Dr Ddmb1d4 2 1 $34,532.74 $33,842.09 $34,187.42 $34,187.42 $34,187.42 2025-08-04
EP145 CDM Icd Evera MRI S Dr Ddmc3d4 2 1 $33,782.03 $33,106.39 $33,444.21 $33,444.21 $33,444.21 2025-08-04
CB624 CDM Vigilant X4 Crt-d (g247) 2 1 $33,775.00 $33,099.50 $33,437.25 $33,437.25 $33,437.25 2025-08-04
CB533 CDM Momentum Crt-d (g126) 2 1 $33,705.00 $33,030.90 $33,367.95 $33,367.95 $33,367.95 2025-08-04
62559 CDM Kit Generator Implant Pulse 2 1 $33,589.79 $32,917.99 $33,253.89 $33,253.89 $33,253.89 2025-08-04
CB500 CDM Momentum X4 Crt-d (g138) 2 1 $33,584.12 $32,912.44 $33,248.28 $33,248.28 $33,248.28 2025-08-04
CB471 CDM Momentum Crt-d (g125) 2 1 $33,584.12 $32,912.44 $33,248.28 $33,248.28 $33,248.28 2025-08-04
CL999 CDM Sjm Icd Ellipse Dr Cd2311-36q 2 1 $33,547.21 $32,876.27 $33,211.74 $33,211.74 $33,211.74 2025-08-04
EP033 CDM Icd Ellipse Dr36 Df4 2 1 $33,547.21 $32,876.27 $33,211.74 $33,211.74 $33,211.74 2025-08-04
C1866 HCPCS Gore Tag Stent Graft 2 1 $33,540.41 $32,869.60 $33,205.00 $33,205.00 $33,205.00 2025-08-04
C1865 HCPCS Gore Tag Stent Graft 2 1 $33,540.41 $32,869.60 $33,205.00 $33,205.00 $33,205.00 2025-08-04
EP216 CDM Gallant Hf Crt-d Icd D 1 1 $33,464.39 $32,795.10 $33,129.75 $33,129.75 $33,129.75 2025-08-04
EP217 CDM Gallant Hf Crt-d Icd B 1 1 $33,464.39 $32,795.10 $33,129.75 $33,129.75 $33,129.75 2025-08-04
CB623 CDM Cobalt Xt Quad Crt-d (dtpa2qq) 2 1 $32,713.00 $32,058.74 $32,385.87 $32,385.87 $32,385.87 2025-08-04
CB619 CDM Cobalt Xt Crt-d (dtpa2d1) 2 1 $32,713.00 $32,058.74 $32,385.87 $32,385.87 $32,385.87 2025-08-04
62620 CDM Generator Implantable Pulse 2 1 $32,621.05 $31,968.63 $32,294.84 $32,294.84 $32,294.84 2025-08-04
EP031 CDM Icd Fortify Assura Dr40 Df4 2 1 $32,583.19 $31,931.53 $32,257.36 $32,257.36 $32,257.36 2025-08-04
EP027 CDM Icd Evera Xt Dr Ddbb1d1 2 1 $32,467.51 $31,818.16 $32,142.83 $32,142.83 $32,142.83 2025-08-04
EP062 CDM Icd Evera Xt Ddbb1d4 2 1 $32,467.51 $31,818.16 $32,142.83 $32,142.83 $32,142.83 2025-08-04
EP220 CDM Defib Gallant Hr Crt-d Df-1 1 1 $32,464.39 $31,815.10 $32,139.74 $32,139.74 $32,139.74 2025-08-04
CB627 CDM Df-1 Gallant Crt-d (cdhfa500t) 2 1 $32,462.00 $31,812.76 $32,137.38 $32,137.38 $32,137.38 2025-08-04
CC727 CDM Pacemaker D224vrc 2 1 $32,347.97 $31,701.01 $32,024.49 $32,024.49 $32,024.49 2025-08-04
EP195 CDM Itrevia 7 Hf-t 393014 2 1 $31,989.23 $31,349.45 $31,669.34 $31,669.34 $31,669.34 2025-08-04
CL965 CDM Medt Protecta Xt-dr D314drg 2 1 $31,715.61 $31,081.30 $31,398.46 $31,398.46 $31,398.46 2025-08-04
S2095 HCPCS Sir-spheres Microspheres 2 1 $31,628.94 $30,996.36 $31,312.65 $31,312.65 $31,312.65 2025-08-04
61114 CDM Sir-spheres Microspheres 2 1 $31,628.94 $30,996.36 $31,312.65 $31,312.65 $31,312.65 2025-08-04
CA989 CDM Imperia Hf-t Df4 393009 2 1 $31,628.94 $30,996.36 $31,312.65 $31,312.65 $31,312.65 2025-08-04
47335017795A NDC Tildrakizumab-asmn Syr 1 1 $31,431.73 $30,803.10 $31,117.42 $31,117.42 $31,117.42 2025-08-04
PHAR002632 CDM Tildrakizumab-asmn Syr 1 1 $31,431.73 $30,803.10 $31,117.42 $31,117.42 $31,117.42 2025-08-04
CL982 CDM Sjm Icd Ellipsecd1311-36q 2 1 $31,040.79 $30,419.97 $30,730.38 $30,730.38 $30,730.38 2025-08-04
EP032 CDM Icd Ellipse Dr36 2 1 $31,040.79 $30,419.97 $30,730.38 $30,730.38 $30,730.38 2025-08-04
EP037 CDM Icd Ellipse Vr36 Df4 2 1 $31,040.79 $30,419.97 $30,730.38 $30,730.38 $30,730.38 2025-08-04
CL918 CDM St Jude Fortify Dr Cd2231-40q 2 1 $30,869.21 $30,251.83 $30,560.52 $30,560.52 $30,560.52 2025-08-04
CL983 CDM Bsc Icd Incepta E161 2 1 $30,848.00 $30,231.04 $30,539.52 $30,539.52 $30,539.52 2025-08-04
CL984 CDM Bs Icd Incepta Vr E160 2 1 $30,848.00 $30,231.04 $30,539.52 $30,539.52 $30,539.52 2025-08-04
C1722 HCPCS Bs Icd Incepta Vr E160 2 1 $30,848.00 $30,231.04 $30,539.52 $30,539.52 $30,539.52 2025-08-04
C1721 HCPCS Bsc Icd Incepta E161 2 1 $30,848.00 $30,231.04 $30,539.52 $30,539.52 $30,539.52 2025-08-04
CB453 CDM Complia Crt-d (dtmc1d1) 2 1 $30,705.48 $30,091.37 $30,398.42 $30,398.42 $30,398.42 2025-08-04
CB452 CDM Complia Quad Crt-d (dtmc1qq) 2 1 $30,705.48 $30,091.37 $30,398.42 $30,398.42 $30,398.42 2025-08-04
EP215 CDM Vigilant El Icd Dr 1 1 $30,702.44 $30,088.39 $30,395.42 $30,395.42 $30,395.42 2025-08-04
EP197 CDM Visia Af MRI Vr Dvfb1d1 2 1 $30,437.41 $29,828.66 $30,133.03 $30,133.03 $30,133.03 2025-08-04
EP185 CDM Icd Visia Af MRI Vr Dvfb1d4 2 1 $30,437.41 $29,828.66 $30,133.03 $30,133.03 $30,133.03 2025-08-04
EP146 CDM Icd Evera MRI Xt Vr Dvmb1d4 2 1 $30,413.43 $29,805.16 $30,109.29 $30,109.29 $30,109.29 2025-08-04
CB095 CDM Micra Av Mc1vr1 2 1 $30,188.09 $29,584.33 $29,886.21 $29,886.21 $29,886.21 2025-08-04
CL992 CDM Sjm Fortify Dr Cd2231-40 2 1 $30,076.79 $29,475.25 $29,776.02 $29,776.02 $29,776.02 2025-08-04
CL994 CDM Sjm Icd Fortify Vr Cd1257-40q 2 1 $30,076.79 $29,475.25 $29,776.02 $29,776.02 $29,776.02 2025-08-04
EP035 CDM Icd Fortify Assura Vr40 Df4 2 1 $30,076.79 $29,475.25 $29,776.02 $29,776.02 $29,776.02 2025-08-04
CL907 CDM St Jude Fortify Vr Cd1231-40q 2 1 $30,076.79 $29,475.25 $29,776.02 $29,776.02 $29,776.02 2025-08-04
EP030 CDM Icd Fortify Assura Dr40 2 1 $30,076.79 $29,475.25 $29,776.02 $29,776.02 $29,776.02 2025-08-04
EP010 CDM Sjm Icd Fortify Cd2257-40 2 1 $30,076.79 $29,475.25 $29,776.02 $29,776.02 $29,776.02 2025-08-04
EP155 CDM Icd Dynagen El Dr D153 2 1 $29,989.95 $29,390.15 $29,690.05 $29,690.05 $29,690.05 2025-08-04
EP154 CDM Icd Dynagen El Dr Df4 D152 2 1 $29,989.95 $29,390.15 $29,690.05 $29,690.05 $29,690.05 2025-08-04
EP082 CDM Icd Inogen Mini Dr Df4 D012 2 1 $28,919.99 $28,341.59 $28,630.79 $28,630.79 $28,630.79 2025-08-04
CL915 CDM Bs Teligen Is-1/df-1-vr E102 2 1 $28,919.99 $28,341.59 $28,630.79 $28,630.79 $28,630.79 2025-08-04
CB134 CDM Gallant Dr Icd 2 1 $28,750.56 $28,175.55 $28,463.06 $28,463.06 $28,463.06 2025-08-04
EP036 CDM Icd Ellipse Vr36 2 1 $28,727.20 $28,152.66 $28,439.93 $28,439.93 $28,439.93 2025-08-04
C0424 HCPCS Med Dorsal Column Stim 37712 2 1 $28,561.90 $27,990.66 $28,276.28 $28,276.28 $28,276.28 2025-08-04
Q4152 HCPCS Deermaspan 16x20CM 2 1 $28,495.66 $27,925.75 $28,210.71 $28,210.71 $28,210.71 2025-08-04
62296 CDM Deermaspan 16x20CM 2 1 $28,495.66 $27,925.75 $28,210.71 $28,210.71 $28,210.71 2025-08-04
50474098284A NDC Rystiggo 2 1 $28,374.50 $27,807.01 $25,515.27 $30,666.24 $28,090.76 2025-08-04
PHAR002491 CDM Rystiggo 2 1 $28,374.50 $27,807.01 $25,515.27 $30,666.24 $28,090.76 2025-08-04
EP026 CDM Icd Evera Xt Vr Dvbb1d1 2 1 $28,341.57 $27,774.74 $28,058.15 $28,058.15 $28,058.15 2025-08-04
EP049 CDM Icd Evera Dvbb1d4 2 1 $28,341.57 $27,774.74 $28,058.15 $28,058.15 $28,058.15 2025-08-04
EP187 CDM Icd Visia Af Vr Dvab1d4 2 1 $28,318.35 $27,751.98 $28,035.17 $28,035.17 $28,035.17 2025-08-04
EP188 CDM Icd Visia Af Vr Dvab1d1 2 1 $28,318.35 $27,751.98 $28,035.17 $28,035.17 $28,035.17 2025-08-04
P0571 HCPCS Excluder Conform 36x14.5x14 2 1 $27,988.05 $27,428.29 $27,708.17 $27,708.17 $27,708.17 2025-08-04
P0281 HCPCS Excluder Coniform Aaa 15fr 2 1 $27,988.05 $27,428.29 $27,708.17 $27,708.17 $27,708.17 2025-08-04
EP156 CDM Icd Dynagen El Vr Df4 D150 2 1 $27,911.07 $27,352.85 $27,631.96 $27,631.96 $27,631.96 2025-08-04
EP157 CDM Icd Dynagen El Vr D151 2 1 $27,911.07 $27,352.85 $27,631.96 $27,631.96 $27,631.96 2025-08-04
31827 CDM Xenmatrix Ab 19x28cm 1151928 2 1 $27,888.26 $27,330.49 $27,609.38 $27,609.38 $27,609.38 2025-08-04
CA895 CDM Dynagen Mini Vr D020 2 1 $27,839.96 $27,283.16 $27,561.56 $27,561.56 $27,561.56 2025-08-04
CB131 CDM Entrant Dr Icd 2 1 $27,792.21 $27,236.37 $27,514.29 $27,514.29 $27,514.29 2025-08-04
EP012 CDM Icd Protecta Xtvr D314vrm 2 1 $27,763.20 $27,207.94 $27,485.57 $27,485.57 $27,485.57 2025-08-04
CL925 CDM St Jude Fortify Vr Cd 1231-40 2 1 $27,763.20 $27,207.94 $27,485.57 $27,485.57 $27,485.57 2025-08-04
CL973 CDM Medtronic Protecta D314vrg 2 1 $27,763.20 $27,207.94 $27,485.57 $27,485.57 $27,485.57 2025-08-04
EP034 CDM Icd Fortify Assura Vr40 2 1 $27,763.20 $27,207.94 $27,485.57 $27,485.57 $27,485.57 2025-08-04
PHAR000513 CDM Brentuximab Vedotin * 2 1 $27,534.99 $26,984.29 $24,760.35 $29,758.92 $27,259.64 2025-08-04
51144005001 NDC Brentuximab Vedotin * 2 1 $27,534.99 $26,984.29 $24,760.35 $29,758.92 $27,259.64 2025-08-04
EP084 CDM Icd Inogen Mini Vr Df4 D010 2 1 $27,474.01 $26,924.53 $27,199.27 $27,199.27 $27,199.27 2025-08-04
EP059 CDM Icd Punctua E050 2 1 $27,474.01 $26,924.53 $27,199.27 $27,199.27 $27,199.27 2025-08-04
EP100 CDM Icd Energen Df4 Vr E140 2 1 $27,474.01 $26,924.53 $27,199.27 $27,199.27 $27,199.27 2025-08-04
PHAR001886 CDM Pertuzumab/trastuzumab/hy-zzxf 2 1 $27,465.86 $26,916.54 $24,698.19 $29,684.21 $27,191.20 2025-08-04
50242024501A NDC Pertuzumab/trastuzumab/hy-zzxf 2 1 $27,465.86 $26,916.54 $24,698.19 $29,684.21 $27,191.20 2025-08-04
EP136 CDM Icd Inogen El Icd Vr D140 2 1 $27,429.84 $26,881.24 $27,155.54 $27,155.54 $27,155.54 2025-08-04
P0396 HCPCS Exclud Confom Aaa 28.5x14.5x12 2 1 $27,405.05 $26,856.95 $27,131.00 $27,131.00 $27,131.00 2025-08-04
P0397 HCPCS Excluder Aaa 20x12x12 2 1 $27,405.05 $26,856.95 $27,131.00 $27,131.00 $27,131.00 2025-08-04
P0395 HCPCS Excludr Conform Aaa 26x14.5x12 2 1 $27,405.05 $26,856.95 $27,131.00 $27,131.00 $27,131.00 2025-08-04
P0149 HCPCS Excluder Conform Aaa 18fr 2 1 $27,405.05 $26,856.95 $27,131.00 $27,131.00 $27,131.00 2025-08-04
24582411 NDC Cabazitaxel * 1 1 $27,316.76 $26,770.42 $27,043.59 $27,043.59 $27,043.59 2025-08-04
B9727 HCPCS Penile Cylinder 700cx 21cm 1 1 $27,145.45 $26,602.54 $26,873.99 $26,873.99 $26,873.99 2025-08-04
C2622 HCPCS Penile Cylinder 700cx 21cm 1 1 $27,145.45 $26,602.54 $26,873.99 $26,873.99 $26,873.99 2025-08-04
P1998 HCPCS Alloderm Select Restore 2 1 $27,010.35 $26,470.14 $26,740.24 $26,740.24 $26,740.24 2025-08-04
EP069 CDM Icd Punctua Dr E053 2 1 $26,991.98 $26,452.14 $26,722.06 $26,722.06 $26,722.06 2025-08-04
EP083 CDM Icd Inogen Mini Dr D013 2 1 $26,991.98 $26,452.14 $26,722.06 $26,722.06 $26,722.06 2025-08-04
CB357 CDM Momentum El Icd Dr 2 1 $26,867.30 $26,329.95 $26,598.62 $26,598.62 $26,598.62 2025-08-04
C1002 HCPCS Med Dorsal Column Rechgr 377 2 1 $26,645.00 $26,112.10 $26,378.55 $26,378.55 $26,378.55 2025-08-04
EP090 CDM Icd Punctua E052 2 1 $26,606.39 $26,074.26 $26,340.33 $26,340.33 $26,340.33 2025-08-04
CB133 CDM Gallant Vr Icd 2 1 $26,580.71 $26,049.10 $26,314.90 $26,314.90 $26,314.90 2025-08-04
00173089803A NDC Jemperli 2 1 $26,573.21 $26,041.74 $23,895.49 $28,719.47 $26,307.48 2025-08-04
PHAR002389 CDM Jemperli 2 1 $26,573.21 $26,041.74 $23,895.49 $28,719.47 $26,307.48 2025-08-04
P1995 HCPCS Graft Endovas Prox Body Aaa 2 1 $26,298.18 $25,772.22 $26,035.20 $26,035.20 $26,035.20 2025-08-04
P1343 HCPCS Triflanged Acet Comp Lt Sz24 2 1 $26,118.86 $25,596.48 $25,857.67 $25,857.67 $25,857.67 2025-08-04
EP076 CDM Icd Punctua E051 2 1 $26,027.99 $25,507.43 $25,767.71 $25,767.71 $25,767.71 2025-08-04
EP085 CDM Icd Inogen Mini Vr D011 2 1 $26,027.99 $25,507.43 $25,767.71 $25,767.71 $25,767.71 2025-08-04
EP139 CDM Icd Energen E141 2 1 $25,986.16 $25,466.44 $25,726.30 $25,726.30 $25,726.30 2025-08-04
P0622 HCPCS Liner Triflange Acet Comp Lt 2 1 $25,898.16 $25,380.20 $25,639.18 $25,639.18 $25,639.18 2025-08-04
CB130 CDM Entrant Vr Icd 2 1 $25,857.42 $25,340.27 $25,598.85 $25,598.85 $25,598.85 2025-08-04
R1428 HCPCS Channel Ipg 16 2 1 $25,524.56 $25,014.07 $25,269.31 $25,269.31 $25,269.31 2025-08-04
PHAR000286 CDM Cabazitaxel * 2 1 $25,022.58 $24,522.12 $22,501.12 $27,043.59 $24,772.35 2025-08-04
CB501 CDM Momentum El Vr (d120) 2 1 $24,948.21 $24,449.25 $24,698.73 $24,698.73 $24,698.73 2025-08-04
P1297 HCPCS Prosthesis Penile Tactra 11mm 2 1 $24,583.58 $24,091.91 $24,337.74 $24,337.74 $24,337.74 2025-08-04
PHAR002315 CDM Briumvi 2 1 $24,558.01 $24,066.85 $22,083.37 $26,541.51 $24,312.44 2025-08-04
73150015006A NDC Briumvi 2 1 $24,558.01 $24,066.85 $22,083.37 $26,541.51 $24,312.44 2025-08-04
C1882 HCPCS Bs Cognis He Is1/df1/lv1 4 1 $24,557.29 $24,066.14 $7,585.94 $41,037.49 $24,311.71 2025-08-04
CB532 CDM Rivacor7 Dr-t (429534) 2 1 $23,689.80 $23,216.00 $23,452.90 $23,452.90 $23,452.90 2025-08-04
CB449 CDM Primo MRI Dr (ddmd3d4) 2 1 $23,604.84 $23,132.74 $23,368.79 $23,368.79 $23,368.79 2025-08-04
CB448 CDM Primo MRI Dr (ddmd3d1) 2 1 $23,604.84 $23,132.74 $23,368.79 $23,368.79 $23,368.79 2025-08-04
P1005 HCPCS Graft Fem Hcon Med Fs/a Rt 2 1 $23,604.84 $23,132.74 $23,368.79 $23,368.79 $23,368.79 2025-08-04
CB024 CDM Evera S Dr Ddbc3d1 2 1 $23,577.96 $23,106.40 $23,342.18 $23,342.18 $23,342.18 2025-08-04
PHAR001191 CDM Atezolizumab * 2 1 $23,370.39 $22,902.99 $21,015.42 $25,257.96 $23,136.69 2025-08-04
50242091701 NDC Atezolizumab * 2 1 $23,370.39 $22,902.99 $21,015.42 $25,257.96 $23,136.69 2025-08-04
R7010 HCPCS Excluder Trunk Aaa 23x14x12 2 1 $23,272.62 $22,807.17 $23,039.90 $23,039.90 $23,039.90 2025-08-04
R8012 HCPCS Johnson Rt Triflange Sz 24 2 1 $23,194.56 $22,730.67 $22,962.62 $22,962.62 $22,962.62 2025-08-04
R7009 HCPCS Excluder Trunk Aaa 23x14x16 2 1 $23,188.40 $22,724.63 $22,956.51 $22,956.51 $22,956.51 2025-08-04
P1004 HCPCS Excluder Aaa 28.5mmx12mmx12cm 2 1 $23,188.40 $22,724.63 $22,956.51 $22,956.51 $22,956.51 2025-08-04
R5011 HCPCS Kit Prime Advanced MRI Battery 2 1 $23,112.00 $22,649.76 $22,880.88 $22,880.88 $22,880.88 2025-08-04
R7558 HCPCS Mesh Phasix St 8x10 2 1 $23,020.08 $22,559.68 $22,789.88 $22,789.88 $22,789.88 2025-08-04
P1601 HCPCS Excl 2 Branch 23mmx14.5mmx10cm 2 1 $22,742.21 $22,287.37 $22,514.79 $22,514.79 $22,514.79 2025-08-04
62069 CDM Excluder Aaa Endoprosthesis 2 1 $22,737.41 $22,282.66 $22,510.03 $22,510.03 $22,510.03 2025-08-04
00024582411 NDC Cabazitaxel * 1 1 $22,728.40 $22,273.83 $22,501.12 $22,501.12 $22,501.12 2025-03-17
61052 CDM Graft Trunk Excluder 28.5x12 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R7231 HCPCS Excluder Trunk Aaa 25x14x12 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R7116 HCPCS Excluder Trunk Aaa 26x14x12 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R7817 HCPCS Excluder Trunk Aaa 28x14x18 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R7117 HCPCS Excluder Trunk Aaa 23x12x18 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R6490 HCPCS Excluder Trunk Aaa 23mmx12mm 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R7420 HCPCS Trunk Excluder Aaa 26x12x18 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R8052 HCPCS Excluder Trunk 23mm X 12 Cm 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R6548 HCPCS Excluder Trunk Aaa 28x12x18 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R6493 HCPCS Excluder Trunk Aaa 12x14 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R3641 HCPCS Graft Excluder Aortic Aaaev 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R4257 HCPCS Excluder Trunk C3 35x14.5x16 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R2693 HCPCS Excluder C3 28mmx14.5mmx14cm 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R2692 HCPCS Excluder C3 26MMx14.5MMx14CM 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R4346 HCPCS Graft Xclud Aortic 31x14.5x15 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R6247 HCPCS Excluder Aaaev C3 26x12x16 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R3096 HCPCS Excluder C3 Aaa Trunk 16cm 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R7621 HCPCS Excluder Trunk 23mmX12mmX14cm 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R2215 HCPCS Exluder C3 Trunk 14cm 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R6667 HCPCS Excluder Trunk Aaa 26x14x18 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R6147 HCPCS Excluder Trunk Aaa 31x14.5x17 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R6168 HCPCS Excluder Trunk Aaa 35x14.4x14 2 1 $22,705.28 $22,251.17 $22,478.22 $22,478.22 $22,478.22 2025-08-04
R4317 HCPCS Gore Excluder 26x14x16 Cm 2 1 $22,678.51 $22,224.94 $22,451.72 $22,451.72 $22,451.72 2025-08-04
P0620 HCPCS Excluder Iliac Branch 23x12x10 2 1 $22,660.64 $22,207.43 $22,434.03 $22,434.03 $22,434.03 2025-08-04
62425 CDM Graft Fen Stent 32mm Prox Body 2 1 $22,399.59 $21,951.60 $22,175.60 $22,175.60 $22,175.60 2025-08-04
R7395 HCPCS Johnson Lt Ha Triflange Sz 24 2 1 $21,852.73 $21,415.68 $21,634.21 $21,634.21 $21,634.21 2025-08-04
C1768 HCPCS Aortoiliac Artery 4 1 $21,656.66 $21,223.53 $1,129.98 $41,750.20 $21,440.09 2025-08-04
R1585 HCPCS Graft Stent Bifurcated Main Bo 2 1 $21,651.44 $21,218.41 $21,434.92 $21,434.92 $21,434.92 2025-08-04
3232711 NDC Ipilimumab * 1 1 $21,611.65 $21,179.42 $21,395.53 $21,395.53 $21,395.53 2025-08-04
31677 CDM Interstim Ii Neurostimulator 2 1 $21,574.77 $21,143.27 $21,359.02 $21,359.02 $21,359.02 2025-08-04
00169720501A NDC Coagulation Fact Viia Recomb * 2 1 $21,574.00 $21,142.52 $19,400.04 $23,316.48 $21,358.26 2025-08-04
13837 CDM Coagulation Fact Viia Recomb * 2 1 $21,574.00 $21,142.52 $19,400.04 $23,316.48 $21,358.26 2025-08-04
R9622 HCPCS Alloderm Select 16x20 Cm 2 1 $21,457.49 $21,028.34 $21,242.92 $21,242.92 $21,242.92 2025-08-04
R9032 HCPCS Alloderm Perf Med 16x20 2 1 $21,457.49 $21,028.34 $21,242.92 $21,242.92 $21,242.92 2025-08-04
69306 CDM Alloderm 16x20 Extra Thick Per 2 1 $21,457.49 $21,028.34 $21,242.92 $21,242.92 $21,242.92 2025-08-04
R3050 HCPCS Cup Spear Rt Triblange Sz23 Ha 2 1 $21,277.67 $20,852.12 $21,064.90 $21,064.90 $21,064.90 2025-08-04
69427 CDM Allogrft Fem Condyl Hemi Fresh 2 1 $21,160.32 $20,737.11 $20,948.72 $20,948.72 $20,948.72 2025-08-04
P0662 HCPCS Cartiform, 20 X 25mm Disc 2 1 $21,110.02 $20,687.82 $20,898.92 $20,898.92 $20,898.92 2025-08-04
PHAR001814 CDM Daratumumab/hyaluronidase * 2 1 $20,931.59 $20,512.96 $18,822.37 $22,622.19 $20,722.28 2025-08-04
57894050301A NDC Daratumumab/hyaluronidase * 2 1 $20,931.59 $20,512.96 $18,822.37 $22,622.19 $20,722.28 2025-08-04
CB625 CDM Df-1 Gallant Dr Icd (cddra500t 2 1 $20,868.00 $20,450.64 $20,659.32 $20,659.32 $20,659.32 2025-08-04
EP218 CDM Gallant Dr Icd Df1 Connector 1 1 $20,867.49 $20,450.14 $20,658.81 $20,658.81 $20,658.81 2025-08-04
CB094 CDM Micra Vr Mc1vr01 2 1 $20,604.56 $20,192.47 $20,398.51 $20,398.51 $20,398.51 2025-08-04
R6201 HCPCS Cup Custom Triflange Sz26 2 1 $20,510.90 $20,100.68 $20,305.79 $20,305.79 $20,305.79 2025-08-04
31238 CDM Pump Synchromed 2 1 $20,223.00 $19,818.54 $20,020.77 $20,020.77 $20,020.77 2025-08-04
R4763 HCPCS Pump Infusion Synchromed Ii 2 1 $20,223.00 $19,818.54 $20,020.77 $20,020.77 $20,020.77 2025-08-04
C1772 HCPCS Pump Infusion Synchromed Ii 2 1 $20,223.00 $19,818.54 $20,020.77 $20,020.77 $20,020.77 2025-08-04
CB451 CDM Primo MRI Vr (dvmd3d4) 2 1 $20,150.47 $19,747.46 $19,948.97 $19,948.97 $19,948.97 2025-08-04
CB450 CDM Primo MRI Vr (dvmd3d1) 2 1 $20,150.47 $19,747.46 $19,948.97 $19,948.97 $19,948.97 2025-08-04
CB515 CDM Intica Neo Vr-t Dx (429559) 2 1 $20,150.47 $19,747.46 $19,948.97 $19,948.97 $19,948.97 2025-08-04
P1340 HCPCS Persona Rev Complex Primary Cc 2 1 $20,150.47 $19,747.46 $19,948.97 $19,948.97 $19,948.97 2025-08-04
PHAR000394 CDM Ipilimumab * 2 1 $19,796.61 $19,400.68 $17,801.76 $21,395.53 $19,598.65 2025-08-04
R5030 HCPCS Excluder Aaa Trunk 28x14x18 2 1 $19,638.69 $19,245.92 $19,442.31 $19,442.31 $19,442.31 2025-08-04
R6563 HCPCS Excluder Trunk Aaa 26x14x14 2 1 $19,638.69 $19,245.92 $19,442.31 $19,442.31 $19,442.31 2025-08-04
R3488 HCPCS Excluder Aaaev 14.5x12x18 2 1 $19,638.69 $19,245.92 $19,442.31 $19,442.31 $19,442.31 2025-08-04
R2869 HCPCS Trunk Aaaev Excluder C3 2 1 $19,638.69 $19,245.92 $19,442.31 $19,442.31 $19,442.31 2025-08-04
C0229 HCPCS Gore Stent Trunk Ips Lat 2 1 $19,638.69 $19,245.92 $19,442.31 $19,442.31 $19,442.31 2025-08-04
C2164 HCPCS Gore Excluder Vasc Graft 1xuse 2 1 $19,638.69 $19,245.92 $19,442.31 $19,442.31 $19,442.31 2025-08-04
R2457 HCPCS Excluder Gore Aaa C3 23x12x18 2 1 $19,638.69 $19,245.92 $19,442.31 $19,442.31 $19,442.31 2025-08-04
R1979 HCPCS C3 Excluder Trunk 2 1 $19,638.69 $19,245.92 $19,442.31 $19,442.31 $19,442.31 2025-08-04
R4197 HCPCS Stent Trunk Ips Lat 12cm 2 1 $19,638.69 $19,245.92 $19,442.31 $19,442.31 $19,442.31 2025-08-04
B9986 HCPCS Stent Trunk Ips Lat 28x12x16 2 1 $19,638.69 $19,245.92 $19,442.31 $19,442.31 $19,442.31 2025-08-04
R3077 HCPCS Stent Trunk Excluder 26x12 2 1 $19,638.69 $19,245.92 $19,442.31 $19,442.31 $19,442.31 2025-08-04
R2153 HCPCS Excluder C3 Trunk 12cm 2 1 $19,638.69 $19,245.92 $19,442.31 $19,442.31 $19,442.31 2025-08-04
R2152 HCPCS Excluder C3 Trunk 18cm 2 1 $19,638.69 $19,245.92 $19,442.31 $19,442.31 $19,442.31 2025-08-04
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