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

LIVINGSTON HEALTHCARE

Livingston, MT · CCN 271317 · Rates published

4,425 distinct procedures filed
14 distinct payers
93,515 rate rows
2026-06-25 last MRF observed
Data quality

90,769 of 93,515 rate rows are consumer-grade (97.1%)

2,746 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 1,470
per-diem day rate — not a per-procedure price 644
template filing: same amount across many unrelated codes — excluded 560
percent-of-charges filed in the dollar field — excluded from medians 50
exceeds 10× this hospital's gross charge — excluded from medians 22
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbLivingstonHCMT&type=CDMWithoutLabel&fileType=CSV
Found on page https://www.livingstonhealthcare.org/cms-hpt.txt
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-11-03
Content fingerprint e9bef5e8c3940c74… · 52,144,871 bytes · first seen 2026-08-01

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
J2350
HCPCS 		Injection, Ocrelizumab, 1 Mg 14 $22,852.96 $49,680.35 $47,196.33 nat. median
$518
outlier · 91.1×
J2507
HCPCS 		Injection, Pegloticase, 1 Mg 14 $20,573.80 $44,725.65 $42,489.37 nat. median
$9,222
outlier · 4.6×
J9334
HCPCS 		Injection, Efgartigimod Alfa, 2 Mg And Hyaluronidase-qvfc 14 $18,284.08 $39,748.00 $37,760.60 nat. median
$83
outlier · 455.9×
J9043
HCPCS 		Injection, Cabazitaxel, 1 Mg 14 $16,381.31 $35,611.55 $33,830.97 nat. median
$738
outlier · 45.8×
J3245
HCPCS 		Injection, Tildrakizumab, 1 Mg 14 $14,872.08 $32,330.60 $30,714.07 nat. median
$256
outlier · 119.9×
J9228
HCPCS 		Injection, Ipilimumab, 1 Mg 14 $9,137.65 $79,457.45 $28,207.44 nat. median
$9,011
outlier · 3.1×
J9144
HCPCS 		Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj 14 $12,254.93 $26,641.15 $25,309.09 nat. median
$213
outlier · 118.9×
J3590
HCPCS 		Unclassified Biologics 14 $12,024.06 $26,139.25 $24,832.29 nat. median
$782
outlier · 31.7×
J9301
HCPCS 		Injection, Obinutuzumab, 10 Mg 14 $9,907.96 $21,539.05 $20,462.10 nat. median
$285
outlier · 71.7×
J2323
HCPCS 		Injection, Natalizumab, 1 Mg 14 $9,896.97 $21,515.15 $20,439.39 nat. median
$206
outlier · 99.0×
J9022
HCPCS 		Injection, Atezolizumab, 10 Mg 14 $9,686.17 $30,081.25 $20,004.06 nat. median
$6,910
outlier · 2.9×
J1299
HCPCS 		Injection, Eculizumab, 2 Mg 14 $9,073.78 $19,725.60 $18,739.32 nat. median
$2,928
outlier · 6.4×
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 14 $8,370.02 $18,195.70 $17,285.92 nat. median
$168
outlier · 103.2×
J9042
HCPCS 		Injection, Brentuximab Vedotin, 1 Mg 14 $8,280.00 $18,000.00 $17,100.00 nat. median
$971
outlier · 17.6×
J1930
HCPCS 		Injection, Lanreotide, 1 Mg 14 $8,280.00 $18,000.00 $17,100.00 nat. median
$5,088
outlier · 3.4×
J1932
HCPCS 		Injection, Lanreotide, (cipla), 1 Mg 14 $8,280.00 $18,000.00 $17,100.00 nat. median
$113
outlier · 151.7×
J9306
HCPCS 		Injection, Pertuzumab, 1 Mg 14 $7,906.27 $17,187.55 $16,328.17 nat. median
$81
outlier · 201.8×
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 14 $7,439.74 $18,000.00 $15,364.68 nat. median
$1,651
outlier · 9.3×
J9332
HCPCS 		Injection, Efgartigimod Alfa-fcab, 2mg 14 $7,319.38 $15,911.70 $15,116.12 nat. median
$113
outlier · 133.5×
7334823_1
CDM 		Aeq Ascend Flex Std Size 8b__dwf608b 14 $7,204.98 $15,663.00 $14,879.85 nat. median
$14,880
1.0× median
7364477_1
CDM 		Aeq Ascend Flex Sz 5b__dwf605b 14 $7,204.98 $15,663.00 $14,879.85 nat. median
$14,880
1.0× median
7334829_1
CDM 		Aeq Asc Flex Ptc Hum Std,7b__dwf607b 14 $7,204.98 $15,663.00 $14,879.85 nat. median
$14,880
1.0× median
7334812_1
CDM 		Aeq Ascend Flex Std Sz 6b__dwf606b 14 $7,204.98 $15,663.00 $14,879.85 nat. median
$14,880
1.0× median
7334826_1
CDM 		Aeq Ascend Flex Sz 6c__dwf606c 14 $7,204.98 $15,663.00 $14,879.85 nat. median
$14,880
1.0× median
7364468_1
CDM 		Aeq Ascend Flex Ptc 6a 127.5__dwf606a 14 $7,204.98 $15,663.00 $14,879.85 nat. median
$14,880
1.0× median
J9223
HCPCS 		Injection, Lurbinectedin, 0.1 Mg 14 $6,989.98 $15,195.60 $14,435.82 nat. median
$617
outlier · 23.4×
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 14 $6,870.15 $14,935.10 $14,188.35 nat. median
$3,824
outlier · 3.7×
J1459
HCPCS 		Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 14 $6,866.33 $14,926.80 $14,180.46 nat. median
$1,388
outlier · 10.2×
J2427
HCPCS 		Injection, Paliperidone Palmitate Extended Release (invega Hafyera, Or Invega Tr… 14 $6,816.28 $22,226.50 $14,077.10 nat. median
$2,505
outlier · 5.6×
J9271
HCPCS 		Injection, Pembrolizumab, 1 Mg 14 $6,702.61 $14,570.90 $13,842.36 nat. median
$280
outlier · 49.4×
8948124_1
CDM 		Operating Room Services - General Classification 14 $6,440.00 $14,000.00 $13,300.00 nat. median
$13,300
1.0× median
8920784_1
CDM 		Labor Room/delivery - Delivery Room 14 $6,438.62 $13,997.00 $13,297.15 nat. median
$13,297
1.0× median
8024990_1
CDM 		Labor Room/delivery - Delivery Room 14 $6,338.34 $13,779.00 $13,090.05 nat. median
$13,090
1.0× median
C1832
HCPCS 		Autograft Suspension, Including Cell Processing And Application, And All System… 14 $6,325.00 $13,750.00 $13,062.50 nat. median
$9,075
1.4× median
7367952_1
CDM 		Integra Matrix Wound Dress__54051 14 $5,795.31 $12,598.50 $11,968.58 nat. median
$11,969
1.0× median
8410219_1
CDM 		Operating Room Services - General Classification 14 $5,786.80 $12,580.00 $11,951.00 nat. median
$846
outlier · 14.1×
7334825_1
CDM 		Flex Shoulder Sys Head 52x23__dwf153 14 $5,598.94 $12,171.60 $11,563.02 nat. median
$11,563
1.0× median
7364462_1
CDM 		Aequalis Hum Head Shoulder__dwf146 14 $5,598.94 $12,171.60 $11,563.02 nat. median
$11,563
1.0× median
7334810_1
CDM 		Aeq Rev Ii Glenoid 36x35__dwd182 14 $5,544.79 $12,053.90 $11,451.21 nat. median
$11,451
1.0× median
J1162
HCPCS 		Injection, Digoxin Immune Fab (ovine), Per Vial 14 $5,425.06 $11,793.60 $11,203.92 nat. median
$7,155
1.6× median
7334821_1
CDM 		Aeq Rev Ctr Glen Sz 42__dwd193 14 $5,381.86 $11,699.70 $11,114.72 nat. median
$11,115
1.0× median
7364474_1
CDM 		Aeq Rev Ii Glenoid Bp 36__dwd180 14 $5,381.86 $11,699.70 $11,114.72 nat. median
$11,115
1.0× median
J0517
HCPCS 		Injection, Benralizumab, 1 Mg 14 $5,316.66 $11,557.95 $10,980.05 nat. median
$919
outlier · 12.0×
7422079_1
CDM 		Aequalis Hum Head 46mmx17mm__dwf046 14 $5,301.87 $11,525.80 $10,949.51 nat. median
$10,950
1.0× median
C1763
HCPCS 		Connective Tissue, Non-human (includes Synthetic) 14 $5,106.00 $11,100.00 $10,545.00 nat. median
$2,296
outlier · 4.6×
Q5111
HCPCS 		Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg 14 $4,830.00 $10,521.00 $9,975.00 nat. median
$1,974
outlier · 5.1×
7400369_1
CDM 		Polarstem Collar Lat Ti/ha 6__75018417 14 $4,818.13 $10,474.20 $9,950.49 nat. median
$9,950
1.0× median
7365886_1
CDM 		Polarstem Lateral Sz 5__75 100 478 14 $4,818.13 $10,474.20 $9,950.49 nat. median
$9,950
1.0× median
7400373_1
CDM 		Polrstm Stem Std Ti/ha 0 No-c__75100463 14 $4,818.13 $10,474.20 $9,950.49 nat. median
$9,950
1.0× median
7400404_1
CDM 		Polarstem Collar Lat Ti/ha 11__75102211 14 $4,818.13 $10,474.20 $9,950.49 nat. median
$9,950
1.0× median

Other procedures at this hospital

Browse this hospital's 4,425 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 14 14 $49,680.35 $47,196.33 $22,852.96 $49,680.35 $47,196.33 2026-06-25
J2507 HCPCS Injection, Pegloticase, 1 Mg 14 14 $44,725.65 $42,489.37 $20,573.80 $44,725.65 $42,489.37 2026-06-25
J9334 HCPCS Injection, Efgartigimod Alfa, 2 Mg And Hyaluronidase-qvfc 14 14 $39,748.00 $37,760.60 $18,284.08 $39,748.00 $37,760.60 2026-06-25
J9043 HCPCS Injection, Cabazitaxel, 1 Mg 14 14 $35,611.55 $33,830.97 $16,381.31 $35,611.55 $33,830.97 2026-06-25
J3245 HCPCS Injection, Tildrakizumab, 1 Mg 14 14 $32,330.60 $30,714.07 $14,872.08 $32,330.60 $30,714.07 2026-06-25
J9228 HCPCS Injection, Ipilimumab, 1 Mg 28 14 $49,660.95 $47,177.90 $9,137.65 $79,457.45 $28,207.44 2026-06-25
J9144 HCPCS Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj 14 14 $26,641.15 $25,309.09 $12,254.93 $26,641.15 $25,309.09 2026-06-25
J3590 HCPCS Unclassified Biologics 14 14 $26,139.25 $24,832.29 $12,024.06 $26,139.25 $24,832.29 2026-06-25
J9301 HCPCS Injection, Obinutuzumab, 10 Mg 14 14 $21,539.05 $20,462.10 $9,907.96 $21,539.05 $20,462.10 2026-06-25
J2323 HCPCS Injection, Natalizumab, 1 Mg 14 14 $21,515.15 $20,439.39 $9,896.97 $21,515.15 $20,439.39 2026-06-25
J9022 HCPCS Injection, Atezolizumab, 10 Mg 28 14 $25,569.08 $24,290.62 $9,686.17 $30,081.25 $20,004.06 2026-06-25
J1299 HCPCS Injection, Eculizumab, 2 Mg 14 14 $19,725.60 $18,739.32 $9,073.78 $19,725.60 $18,739.32 2026-06-25
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 14 14 $18,195.70 $17,285.92 $8,370.02 $18,195.70 $17,285.92 2026-06-25
J9042 HCPCS Injection, Brentuximab Vedotin, 1 Mg 14 14 $18,000.00 $17,100.00 $8,280.00 $18,000.00 $17,100.00 2026-06-25
J1930 HCPCS Injection, Lanreotide, 1 Mg 14 14 $18,000.00 $17,100.00 $8,280.00 $18,000.00 $17,100.00 2026-06-25
J1932 HCPCS Injection, Lanreotide, (cipla), 1 Mg 14 14 $18,000.00 $17,100.00 $8,280.00 $18,000.00 $17,100.00 2026-06-25
J9306 HCPCS Injection, Pertuzumab, 1 Mg 14 14 $17,187.55 $16,328.17 $7,906.27 $17,187.55 $16,328.17 2026-06-25
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 28 14 $17,086.67 $16,232.34 $7,439.74 $18,000.00 $15,364.68 2026-06-25
J9332 HCPCS Injection, Efgartigimod Alfa-fcab, 2mg 14 14 $15,911.70 $15,116.12 $7,319.38 $15,911.70 $15,116.12 2026-06-25
7334823_1 CDM Aeq Ascend Flex Std Size 8b__dwf608b 14 14 $15,663.00 $14,879.85 $7,204.98 $15,663.00 $14,879.85 2026-06-25
7364477_1 CDM Aeq Ascend Flex Sz 5b__dwf605b 14 14 $15,663.00 $14,879.85 $7,204.98 $15,663.00 $14,879.85 2026-06-25
7334829_1 CDM Aeq Asc Flex Ptc Hum Std,7b__dwf607b 14 14 $15,663.00 $14,879.85 $7,204.98 $15,663.00 $14,879.85 2026-06-25
7334812_1 CDM Aeq Ascend Flex Std Sz 6b__dwf606b 14 14 $15,663.00 $14,879.85 $7,204.98 $15,663.00 $14,879.85 2026-06-25
7334826_1 CDM Aeq Ascend Flex Sz 6c__dwf606c 14 14 $15,663.00 $14,879.85 $7,204.98 $15,663.00 $14,879.85 2026-06-25
7364468_1 CDM Aeq Ascend Flex Ptc 6a 127.5__dwf606a 14 14 $15,663.00 $14,879.85 $7,204.98 $15,663.00 $14,879.85 2026-06-25
J9223 HCPCS Injection, Lurbinectedin, 0.1 Mg 14 14 $15,195.60 $14,435.82 $6,989.98 $15,195.60 $14,435.82 2026-06-25
J3101 HCPCS Injection, Tenecteplase, 1 Mg 14 14 $14,935.10 $14,188.35 $6,870.15 $14,935.10 $14,188.35 2026-06-25
J1459 HCPCS Injection, Immune Globulin (privigen), Intravenous, Non-lyophilized (e.g., Liqui… 14 14 $14,926.80 $14,180.46 $6,866.33 $14,926.80 $14,180.46 2026-06-25
J2427 HCPCS Injection, Paliperidone Palmitate Extended Release (invega Hafyera, Or Invega Tr… 28 14 $18,522.25 $17,596.14 $6,816.28 $22,226.50 $14,077.10 2026-06-25
J9271 HCPCS Injection, Pembrolizumab, 1 Mg 14 14 $14,570.90 $13,842.36 $6,702.61 $14,570.90 $13,842.36 2026-06-25
8948124_1 CDM Operating Room Services - General Classification 14 14 $14,000.00 $13,300.00 $6,440.00 $14,000.00 $13,300.00 2026-06-25
8920784_1 CDM Labor Room/delivery - Delivery Room 14 14 $13,997.00 $13,297.15 $6,438.62 $13,997.00 $13,297.15 2026-06-25
8024990_1 CDM Labor Room/delivery - Delivery Room 14 14 $13,779.00 $13,090.05 $6,338.34 $13,779.00 $13,090.05 2026-06-25
C1832 HCPCS Autograft Suspension, Including Cell Processing And Application, And All System … 14 14 $13,750.00 $13,062.50 $6,325.00 $13,750.00 $13,062.50 2026-06-25
7367952_1 CDM Integra Matrix Wound Dress__54051 14 14 $12,598.50 $11,968.58 $5,795.31 $12,598.50 $11,968.58 2026-06-25
8410219_1 CDM Operating Room Services - General Classification 14 14 $12,580.00 $11,951.00 $5,786.80 $12,580.00 $11,951.00 2026-06-25
7334825_1 CDM Flex Shoulder Sys Head 52x23__dwf153 14 14 $12,171.60 $11,563.02 $5,598.94 $12,171.60 $11,563.02 2026-06-25
7364462_1 CDM Aequalis Hum Head Shoulder__dwf146 14 14 $12,171.60 $11,563.02 $5,598.94 $12,171.60 $11,563.02 2026-06-25
7334810_1 CDM Aeq Rev Ii Glenoid 36x35__dwd182 14 14 $12,053.90 $11,451.21 $5,544.79 $12,053.90 $11,451.21 2026-06-25
J1162 HCPCS Injection, Digoxin Immune Fab (ovine), Per Vial 14 14 $11,793.60 $11,203.92 $5,425.06 $11,793.60 $11,203.92 2026-06-25
7334821_1 CDM Aeq Rev Ctr Glen Sz 42__dwd193 14 14 $11,699.70 $11,114.72 $5,381.86 $11,699.70 $11,114.72 2026-06-25
7364474_1 CDM Aeq Rev Ii Glenoid Bp 36__dwd180 14 14 $11,699.70 $11,114.72 $5,381.86 $11,699.70 $11,114.72 2026-06-25
J0517 HCPCS Injection, Benralizumab, 1 Mg 14 14 $11,557.95 $10,980.05 $5,316.66 $11,557.95 $10,980.05 2026-06-25
7422079_1 CDM Aequalis Hum Head 46mmx17mm__dwf046 14 14 $11,525.80 $10,949.51 $5,301.87 $11,525.80 $10,949.51 2026-06-25
C1763 HCPCS Connective Tissue, Non-human (includes Synthetic) 14 14 $11,100.00 $10,545.00 $5,106.00 $11,100.00 $10,545.00 2026-06-25
Q5111 HCPCS Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg 28 14 $10,510.50 $9,984.98 $4,830.00 $10,521.00 $9,975.00 2026-06-25
7400369_1 CDM Polarstem Collar Lat Ti/ha 6__75018417 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7365886_1 CDM Polarstem Lateral Sz 5__75 100 478 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400373_1 CDM Polrstm Stem Std Ti/ha 0 No-c__75100463 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400404_1 CDM Polarstem Collar Lat Ti/ha 11__75102211 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7365893_1 CDM Polarstem Std Ti Ha Sz 3__75 100 466 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400381_1 CDM Polrstm Stem Std Ti/ha 8 No-c__75100471 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400376_1 CDM Polrstm Stem Std Ti/ha 3 No-c__75100466 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400394_1 CDM Polarstem Valgus Ti/ha 0__75102072 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400397_1 CDM Polarstem Valgus Ti/ha 3__75102075 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400382_1 CDM Polrstm Stem Std Ti/ha 9 No-c__75100472 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400378_1 CDM Polrstm Stem Std Ti/ha 5 No-c__75100468 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400389_1 CDM Polrstm Stem Latti/ha 7 No-c__75100480 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400388_1 CDM Polrstm Stem Latti/ha 6 No-c__75100479 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400401_1 CDM Polarstem Valgus Ti/ha 7__75102079 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400390_1 CDM Polrstm Stem Latti/ha 8 No-c__75100481 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400386_1 CDM Polrstm Stem Latti/ha 4 No-c__75100477 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400398_1 CDM Polarstem Valgus Ti/ha 4__75102076 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400395_1 CDM Polarstem Valgus Ti/ha 1__75102073 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400371_1 CDM Polarstem Collar Lat Ti/ha 8__75018419 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400402_1 CDM Polarstem Collar Lat Ti/ha 9__75102209 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400393_1 CDM Polrstm Stem Latti/ha 11 No-c__75100510 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400396_1 CDM Polarstem Valgus Ti/ha 2__75102074 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400385_1 CDM Polrstm Stem Latti/ha 2 No-c__75100475 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400403_1 CDM Polarstem Collar Lat Ti/ha 10__75102210 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7366128_1 CDM Polarstem Lateral 126deg Sz9__75100482 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400399_1 CDM Polarstem Valgus Ti/ha 5__75102077 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400392_1 CDM Polrstm Stem Std Ti/ha 11 No-c__75100509 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400377_1 CDM Polrstm Stem Std Ti/ha 4 No-c__75100467 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400384_1 CDM Polrstm Stem Latti/ha 1 No-c__75100474 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400379_1 CDM Polrstm Stem Std Ti/ha 6 No-c__75100469 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400372_1 CDM Polrstm Stem Std Ti/ha 01 No-c__75100462 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400383_1 CDM Polrstm Stem Std Ti/ha 10 No-c__75100473 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400387_1 CDM Polrstm Stem Latti/ha 5 No-c__75100478 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400400_1 CDM Polarstem Valgus Ti/ha 6__75102078 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400391_1 CDM Polrstm Stem Latti/ha 10 No-c__75100483 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400375_1 CDM Polrstm Stem Std Ti/ha 2 No-c__75100465 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400374_1 CDM Polrstm Stem Std Ti/ha 1 No-c__75100464 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400370_1 CDM Polarstem Collar Lat Ti/ha 7__75018418 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
7400380_1 CDM Polrstm Stem Std Ti/ha 7 No-c__75100470 14 14 $10,474.20 $9,950.49 $4,818.13 $10,474.20 $9,950.49 2026-06-25
J2353 HCPCS Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg 56 14 $11,066.55 $10,513.23 $3,925.78 $14,931.15 $9,877.35 2026-06-25
8929635_1 CDM Trinity Elite Extra Large 16cc__410004 14 14 $10,274.60 $9,760.87 $4,726.32 $10,274.60 $9,760.87 2026-06-25
7400085_1 CDM Jrny2 Bcs Fem Oxin Lf Sz 2__74022122 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400079_1 CDM Jrny2 Bcs Fem Oxin R Sz 3__74022113 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400086_1 CDM Jrny2 Bcs Fem Oxin Lf Sz 3__74022123 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400078_1 CDM Jrny2 Bcs Fem Oxin R Sz 2__74022112 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7365874_1 CDM Bi Cruciate Stab Jrny Bcs Sz 4__74022114 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400065_1 CDM Jrny2 Cr Fem Ox Np R Sz5__74021155 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7365895_1 CDM Bi Cruciate Stab Jrny Sz 5__74022115 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400090_1 CDM Jrny2 Bcs Fem Oxin Lf Sz 9__74022129 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400095_1 CDM Journey Tibia Base Np Lf Sz 1__74022221 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400096_1 CDM Journey Tibia Base Np Lf Sz 2__74022222 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400073_1 CDM Jrny2 Cr Fem Ox Np Lf Sz 7__74021167 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400061_1 CDM Jrny2 Cr Fem Ox Np R Sz 1__74021151 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400068_1 CDM Jrny2 Cr Fem Ox Np Lf Sz 10__74021160 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400062_1 CDM Jrny2 Cr Fem Ox Np R Sz 2__74021152 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400060_1 CDM Jrny2 Cr Fem Ox Np R Sz 10__74021150 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400098_1 CDM Journey Tibia Base Np Lf Sz 6__74022226 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400072_1 CDM Jrny2 Cr Fem Ox Np Lf Sz 5__74021165 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400097_1 CDM Journey Tibia Base Np Lf Sz 4__74022224 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400063_1 CDM Jrny2 Cr Fem Ox Np R Sz 3__74021153 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400089_1 CDM Jrny2 Bcs Fem Oxin Lf Sz 8__74022128 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400074_1 CDM Jrny2 Cr Fem Ox Np Lf Sz 8__74021168 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400080_1 CDM Jrny2 Bcs Fem Oxin R Sz 6__74022116 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400088_1 CDM Jrny2 Bcs Fem Oxin Lf Sz 6__74022126 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400070_1 CDM Jrny2 Cr Fem Ox Np Lf Sz 2__74021162 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400091_1 CDM Journey Tibia Base Np R Sz 1__74022211 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400094_1 CDM Journey Tibia Base Np R Sz 8__74022218 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7365878_1 CDM Bi Cruciate Stab Jrny Bcs Sz 7__74022117 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400067_1 CDM Jrny2 Cr Fem Ox Np R Sz 9__74021159 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400084_1 CDM Jrny2 Bcs Fem Oxin Lf Sz 1__74022121 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7366122_1 CDM Journey Ii Cr Femoral Oxi Sz8__74021158 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400083_1 CDM Jrny2 Bcs Fem Oxin Lf Sz 10__74022120 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400092_1 CDM Journey Tibia Base Np R Sz 2__74022212 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7366124_1 CDM Journey Ii Bcs Femoral Oxi Sz7__74022127 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7365869_1 CDM Cruciate Retain Journey Sz 6 L__74021166 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400064_1 CDM Jrny2 Cr Fem Ox Np R Sz 4__74021154 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400076_1 CDM Jrny2 Bcs Fem Oxin R Sz 10__74022110 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400087_1 CDM Jrny2 Bcs Fem Oxin Lf Sz 4__74022124 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400081_1 CDM Jrny2 Bcs Fem Oxin R Sz 8__74022118 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7365897_1 CDM Journey Ii Cr Oxi Fem Sz 4 L__74021164 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400066_1 CDM Jrny2 Cr Fem Ox Np R Sz 7__74021157 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400071_1 CDM Jrny2 Cr Fem Ox Np Lf Sz 3__74021163 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400069_1 CDM Jrny2 Cr Fem Ox Np Lf Sz 1__74021161 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7365877_1 CDM Cruciate Retain Journey Sz 6 R__74021156 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7365890_1 CDM Bi Cruciate Stab Jrny Bcs Sz 5__74022125 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400099_1 CDM Journey Tibia Base Np Lf Sz 7__74022227 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400093_1 CDM Journey Tibia Base Np R Sz 7__74022217 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400075_1 CDM Jrny2 Cr Fem Ox Np Lf Sz 9__74021169 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400077_1 CDM Jrny2 Bcs Fem Oxin R Sz 1__74022111 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7400082_1 CDM Jrny2 Bcs Fem Oxin R Sz 9__74022119 14 14 $10,194.60 $9,684.87 $4,689.52 $10,194.60 $9,684.87 2026-06-25
7366133_1 CDM Polarstem Lateral Ccd 126dg S3__75100476 14 14 $9,760.00 $9,272.00 $4,489.60 $9,760.00 $9,272.00 2026-06-25
J0896 HCPCS Injection, Luspatercept-aamt, 0.25 Mg 28 14 $14,752.55 $14,014.92 $4,318.48 $20,117.10 $9,253.87 2026-06-25
J9033 HCPCS Injection, Bendamustine Hydrochloride, 1 Mg 14 14 $9,733.15 $9,246.49 $4,477.25 $9,733.15 $9,246.49 2026-06-25
J2356 HCPCS Injection, Tezepelumab-ekko, 1 Mg 14 14 $9,695.35 $9,210.58 $4,459.86 $9,695.35 $9,210.58 2026-06-25
J1306 HCPCS Injection, Inclisiran, 1 Mg 14 14 $9,402.75 $8,932.61 $4,325.27 $9,402.75 $8,932.61 2026-06-25
8410218_1 CDM Operating Room Services - General Classification 14 14 $9,393.00 $8,923.35 $4,320.78 $9,393.00 $8,923.35 2026-06-25
8028195_1 CDM Intensive Care Unit - Medical 10 10 $8,930.25 $8,483.74 $8,037.23 $8,930.25 $8,483.74 2026-06-25
8919460_1 CDM Labor Room/delivery - Delivery Room 14 14 $8,737.00 $8,300.15 $4,019.02 $8,737.00 $8,300.15 2026-06-25
J9354 HCPCS Injection, Ado-trastuzumab Emtansine, 1 Mg 28 14 $10,293.03 $9,778.38 $3,993.19 $11,905.20 $8,246.81 2026-06-25
J9299 HCPCS Injection, Nivolumab, 1 Mg 56 14 $9,257.65 $8,794.77 $1,565.31 $20,417.05 $8,081.75 2026-06-25
7334828_1 CDM Aeq Rev Ii Thread Bp 29__dwe835 14 14 $8,321.40 $7,905.33 $3,827.84 $8,321.40 $7,905.33 2026-06-25
7334820_1 CDM Aeq Rev Ii Thread Bp 29__dwe840 14 14 $8,321.40 $7,905.33 $3,827.84 $8,321.40 $7,905.33 2026-06-25
7364478_1 CDM Aeq Rev Ii Thread Bp 25__dwe730 14 14 $8,321.40 $7,905.33 $3,827.84 $8,321.40 $7,905.33 2026-06-25
8917770_1 CDM Labor Room/delivery - Delivery Room 14 14 $8,165.00 $7,756.75 $3,755.90 $8,165.00 $7,756.75 2026-06-25
7367953_1 CDM Primatrix 8x8__607-001-880 14 14 $8,087.80 $7,683.41 $3,720.39 $8,087.80 $7,683.41 2026-06-25
8402091_1 CDM Labor Room/delivery - Delivery Room 14 14 $8,038.00 $7,636.10 $3,697.48 $8,038.00 $7,636.10 2026-06-25
8024989_1 CDM Labor Room/delivery - Delivery Room 14 14 $8,038.00 $7,636.10 $3,697.48 $8,038.00 $7,636.10 2026-06-25
8929634_1 CDM Trinity Elite Large 10.6cc__410003 14 14 $7,899.20 $7,504.24 $3,633.63 $7,899.20 $7,504.24 2026-06-25
J0630 HCPCS Injection, Calcitonin Salmon, Up To 400 Units 14 14 $7,890.15 $7,495.64 $3,629.47 $7,890.15 $7,495.64 2026-06-25
7364467_1 CDM Affiniti Cortiloc Glen Size 52__0020063 14 14 $7,795.20 $7,405.44 $3,585.79 $7,795.20 $7,405.44 2026-06-25
7334824_1 CDM Affiniti Cortiloc Glen Size 56__0020064 14 14 $7,795.20 $7,405.44 $3,585.79 $7,795.20 $7,405.44 2026-06-25
7422078_1 CDM Affiniti Cortiloc Pegged Glen__20062 14 14 $7,795.20 $7,405.44 $3,585.79 $7,795.20 $7,405.44 2026-06-25
7364460_1 CDM Affiniti Cort Glen Size 40__0020060 14 14 $7,795.20 $7,405.44 $3,585.79 $7,795.20 $7,405.44 2026-06-25
J9999 HCPCS Not Otherwise Classified, Antineoplastic Drugs 28 14 $12,113.47 $11,507.80 $2,864.40 $18,000.00 $7,253.48 2026-06-25
J9034 HCPCS Injection, Bendamustine Hcl (bendeka), 1 Mg 14 14 $7,421.40 $7,050.33 $3,413.84 $7,421.40 $7,050.33 2026-06-25
J9317 HCPCS Injection, Sacituzumab Govitecan-hziy, 2.5 Mg 14 14 $7,226.80 $6,865.46 $3,324.33 $7,226.80 $6,865.46 2026-06-25
8339183_1 CDM Ryanodex 250 Mg Vial 14 14 $7,106.50 $6,751.18 $3,268.99 $7,106.50 $6,751.18 2026-06-25
J9217 HCPCS Leuprolide Acetate (for Depot Suspension), 7.5 Mg 84 14 $10,716.48 $10,180.65 $1,570.81 $24,339.45 $6,717.56 2026-06-25
8928709_1 CDM Strand Plus Fibers Large__02-7300-100 14 14 $7,042.50 $6,690.38 $3,239.55 $7,042.50 $6,690.38 2026-06-25
7334811_1 CDM Flex Shoulder Sys Rev Tray 6__dwf521 14 14 $7,025.20 $6,673.94 $3,231.59 $7,025.20 $6,673.94 2026-06-25
7364476_1 CDM Flex Shoulder Sys Rev Tray__dwf520 14 14 $7,025.20 $6,673.94 $3,231.59 $7,025.20 $6,673.94 2026-06-25
J9308 HCPCS Injection, Ramucirumab, 5 Mg 28 14 $11,738.92 $11,151.98 $1,799.98 $19,564.85 $6,456.41 2026-06-25
J1569 HCPCS Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),… 70 14 $6,929.60 $6,583.12 $802.10 $20,758.70 $6,368.31 2026-06-25
J9358 HCPCS Injection, Fam-trastuzumab Deruxtecan-nxki, 1 Mg 14 14 $6,675.25 $6,341.49 $3,070.62 $6,675.25 $6,341.49 2026-06-25
8028194_1 CDM Intensive Care Unit - General Classification 10 10 $6,532.05 $6,205.45 $5,878.85 $6,532.05 $6,205.45 2026-06-25
J2802 HCPCS Injection, Romiplostim, 1 Microgram 42 14 $6,607.25 $6,276.89 $1,519.70 $13,214.50 $6,078.67 2026-06-25
8919464_1 CDM Labor Room/delivery - Delivery Room 14 14 $6,241.00 $5,928.95 $2,870.86 $6,241.00 $5,928.95 2026-06-25
J1561 HCPCS Injection, Immune Globulin, (gamunex-c/gammaked), Non-lyophilized (e.g., Liquid)… 56 14 $9,113.10 $8,657.44 $887.29 $24,276.60 $5,837.18 2026-06-25
J9303 HCPCS Injection, Panitumumab, 10 Mg 28 14 $10,271.70 $9,758.12 $1,890.00 $16,434.70 $5,834.33 2026-06-25
7334802_1 CDM Accolade Ii 127 Hip Stem Sz3__6721-0330 14 14 $6,117.10 $5,811.25 $2,813.87 $6,117.10 $5,811.25 2026-06-25
C1783 HCPCS Ocular Implant, Aqueous Drainage Assist Device 14 14 $6,117.10 $5,811.25 $2,813.87 $6,117.10 $5,811.25 2026-06-25
7364446_1 CDM Accolade Ii 127 Hip Stem Sz 6__6721-0635 14 14 $6,117.10 $5,811.25 $2,813.87 $6,117.10 $5,811.25 2026-06-25
7334805_1 CDM Accolade Ii 132 Hip Stem Sz6__6720-0635 14 14 $6,117.10 $5,811.25 $2,813.87 $6,117.10 $5,811.25 2026-06-25
Q9991 HCPCS Injection, Buprenorphine Extended-release (sublocade), Less Than Or Equal To 100… 14 14 $6,087.65 $5,783.27 $2,800.32 $6,087.65 $5,783.27 2026-06-25
Q9992 HCPCS Injection, Buprenorphine Extended-release (sublocade), Greater Than 100 Mg 14 14 $6,087.65 $5,783.27 $2,800.32 $6,087.65 $5,783.27 2026-06-25
J1428 HCPCS Injection, Eteplirsen, 10 Mg 28 14 $10,295.42 $9,780.66 $1,395.55 $17,557.05 $5,555.02 2026-06-25
8919458_1 CDM Labor Room/delivery - Delivery Room 14 14 $5,832.00 $5,540.40 $2,682.72 $5,832.00 $5,540.40 2026-06-25
8410217_1 CDM Operating Room Services - General Classification 14 14 $5,821.00 $5,529.95 $2,677.66 $5,821.00 $5,529.95 2026-06-25
7334809_1 CDM Aeq Rev Ii Glenoid Bp 25__dwd170 14 14 $5,793.30 $5,503.64 $2,664.92 $5,793.30 $5,503.64 2026-06-25
8024988_1 CDM Labor Room/delivery - Delivery Room 14 14 $5,742.00 $5,454.90 $2,641.32 $5,742.00 $5,454.90 2026-06-25
8402090_1 CDM Labor Room/delivery - Delivery Room 14 14 $5,742.00 $5,454.90 $2,641.32 $5,742.00 $5,454.90 2026-06-25
J1451 HCPCS Injection, Fomepizole, 15 Mg 14 14 $5,670.00 $5,386.50 $2,608.20 $5,670.00 $5,386.50 2026-06-25
7322494_1 CDM Prox Lat Hum Plate R 6hol L125__627236 14 14 $5,645.20 $5,362.94 $2,596.79 $5,645.20 $5,362.94 2026-06-25
7322490_1 CDM Prox Lat Hum Plate L 6hol L125__627206 14 14 $5,645.20 $5,362.94 $2,596.79 $5,645.20 $5,362.94 2026-06-25
8931479_1 CDM Ed Trauma Activation No Pre Notification 14 14 $5,501.00 $5,225.95 $2,530.46 $5,501.00 $5,225.95 2026-06-25
J1943 HCPCS Injection, Aripiprazole Lauroxil, (aristada Initio), 1 Mg 14 14 $5,452.40 $5,179.78 $2,508.10 $5,452.40 $5,179.78 2026-06-25
8582053_1 CDM Micromatrix Mm1000__mm0500 14 14 $5,429.00 $5,157.55 $2,497.34 $5,429.00 $5,157.55 2026-06-25
J3247 HCPCS Injection, Secukinumab, Intravenous, 1 Mg 14 14 $5,383.10 $5,113.95 $2,476.23 $5,383.10 $5,113.95 2026-06-25
7334813_1 CDM Implant Sys Bio Achilles Speed__ar-8928bc-cp 14 14 $5,336.00 $5,069.20 $2,454.56 $5,336.00 $5,069.20 2026-06-25
J0401 HCPCS Injection, Aripiprazole (abilify Maintena), 1 Mg 28 14 $6,324.38 $6,008.15 $2,451.59 $7,319.20 $5,063.07 2026-06-25
J9319 HCPCS Injection, Romidepsin, Lyophilized, 0.1 Mg 14 14 $5,320.05 $5,054.05 $2,447.22 $5,320.05 $5,054.05 2026-06-25
Q5108 HCPCS Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg 14 14 $5,260.50 $4,997.48 $2,419.83 $5,260.50 $4,997.48 2026-06-25
7400185_1 CDM Jrny2 Isrt Xlpe Dd Lf 3-4 9mm__74025741 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7365872_1 CDM Journey Ii Xlpe Insert Sz 5 L__74025763 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400235_1 CDM Jrny2 Bcs Xlpd Isrt 3-4-r 10mm__74027232 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400211_1 CDM Jrny2 Isrt Xlpe Dd R 7-8 18mm__74025777 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400229_1 CDM Jrny2 Bcs Xlpd Isrt 1-2 L 11mm__74027223 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400258_1 CDM Jrny2 Bcs Xlpd Isrt 5-6 L 11mm__74027263 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400172_1 CDM Jrny2 Isrt Xlp Dd Lf 1-2 10mm__74025722 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400190_1 CDM Jrny2 Isrt Xlpe Dd Lf 3-4 15mm__74025746 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400256_1 CDM Jrny2 Bcs Xlpd Isrt 5-6 R 21mm__74027258 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400223_1 CDM Jrny2 Bcs Xlpd Isrt 1-2 R 13mm__74027215 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400236_1 CDM Jrny2 Bcs Xlpd Isrt 3-4-r 11mm__74027233 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400251_1 CDM Jrny2 Bcs Xlpd Isrt 5-6 R 11mm__74027253 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400257_1 CDM Jrny2 Bcs Xlpd Isrt 5-6 L 10mm__74027262 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400275_1 CDM Jrny2 Bcs Xlpd Isrt 7-8 L 12mm__74027284 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400140_1 CDM Jrny2 Cr Isrt Xlp R 5-6 15mm__74025656 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400166_1 CDM Jrny2 Isrt Xlp Dd R 1-2 12mm__74025714 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400191_1 CDM Jrny2 Isrt Xlpe Dd Lf 3-4 18mm__74025747 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400175_1 CDM Jrny2 Isrt Xlp Dd Lf 1-2 13mm__74025725 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400183_1 CDM Jrny2 Isrt Xlpe Dd R 3-4 15mm__74025736 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400237_1 CDM Jrny2 Bcs Xlpd Isrt 3-4-r 12mm__74027234 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400243_1 CDM Jrny2 Bcs Xlpd Isrt 3-4 L 10mm__74027242 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400244_1 CDM Jrny2 Bcs Xlpd Isrt 3-4 L 11mm__74027243 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400168_1 CDM Jrny2 Isrt Xlp Dd R 1-2 15mm__74025716 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400207_1 CDM Jrny2 Isrt Xlpe Dd R 7-8 11mm__74025773 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400212_1 CDM Jrny2 Isrt Xlpe Dd Lf 7-8 9mm__74025781 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400245_1 CDM Jrny2 Bcs Xlpd Isrt 3-4 L 12mm__74027244 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400252_1 CDM Jrny2 Bcs Xlpd Isrt 5-6 R 12mm__74027254 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400276_1 CDM Jrny2 Bcs Xlpd Isrt 7-8 L 13mm__74027285 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400160_1 CDM Jrny2 Cr Isrt Xlp Lf 7-8 13mm__74025685 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400230_1 CDM Jrny2 Bcs Xlpd Isrt 1-2 L 12mm__74027224 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7366120_1 CDM Journey Ii Deep Dished Xlpe 10__74025752 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400199_1 CDM Jrny2 Isrt Xlpe Dd Lf 5-6 10mm__74025762 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400161_1 CDM Jrny2 Cr Isrt Xlp Lf 7-8 15mm__74025686 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400162_1 CDM Jrny2 Cr Isrt Xlp Lf 7-8 18mm__74025687 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400224_1 CDM Jrny2 Bcs Xlpd Isrt 1-2 R 15mm__74027216 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400167_1 CDM Jrny2 Isrt Xlp Dd R 1-2 13mm__74025715 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400221_1 CDM Jrny2 Bcs Xlpd Isrt 1-2 R 11mm__74027213 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400231_1 CDM Jrny2 Bcs Xlpd Isrt 1-2 L 13mm__74027225 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400205_1 CDM Jrny2 Isrt Xlpe Dd R 7-8 9mm__74025771 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400133_1 CDM Jrny2 Cr Isrt Xlp Lf 3-4 15mm__74025646 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400165_1 CDM Jrny2 Isrt Xlp Dd R 1-2 11mm__74025713 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400222_1 CDM Jrny2 Bcs Xlpd Isrt 1-2 R 12mm__74027214 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400126_1 CDM Jrny2 Cr Isrt Xlp R 3-4 15mm__74025636 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400184_1 CDM Jrny2 Isrt Xlpe Dd R 3-4 18mm__74025737 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400209_1 CDM Jrny2 Isrt Xlpe Dd R 7-8 13mm__74025775 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400228_1 CDM Jrny2 Bcs Xlpd Isrt 1-2 L 10mm__74027222 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400163_1 CDM Jrny2 Isrt Xlp Dd R 1-2 9mm__74025711 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400164_1 CDM Jrny2 Isrt Xlp Dd R 1-2 10mm__74025712 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400273_1 CDM Jrny2 Bcs Xlpd Isrt 7-8 L 10mm__74027282 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400277_1 CDM Jrny2 Bcs Xlpd Isrt 7-8 L 15mm__74027286 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400240_1 CDM Jrny2 Bcs Xlpd Isrt 3-4-r 18mm__74027237 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7365883_1 CDM Journey Ii Xlpe Insert Sz 3 4__74027245 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400196_1 CDM Jrny2 Isrt Xlpe Dd R 5-6 15mm__74025756 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400254_1 CDM Jrny2 Bcs Xlpd Isrt 5-6 R 15mm__74027256 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400210_1 CDM Jrny2 Isrt Xlpe Dd R 7-8 15mm__74025776 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400213_1 CDM Jrny2 Isrt Xlpe Dd Lf 7-8 10mm__74025782 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400264_1 CDM Jrny2 Bcs Xlpd Isrt 7-8 R 9mm__74027271 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400145_1 CDM Jrny2 Cr Isrt Xlp Lf 5-6 12mm__74025664 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400176_1 CDM Jrny2 Isrt Xlp Dd Lf 1-2 15mm__74025726 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400198_1 CDM Jrny2 Isrt Xlpe Dd Lf 5-6 9mm__74025761 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400200_1 CDM Jrny2 Isrt Xlpe Dd Lf 5-6 12mm__74025764 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400232_1 CDM Jrny2 Bcs Xlpd Isrt 1-2 L 15mm__74027226 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400144_1 CDM Jrny2 Cr Isrt Xlp Lf 5-6 11mm__74025663 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400249_1 CDM Jrny2 Bcs Xlpd Isrt 5-6 R 9mm__74027251 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400272_1 CDM Jrny2 Bcs Xlpd Isrt 7-8 L 9mm__74027281 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400274_1 CDM Jrny2 Bcs Xlpd Isrt 7-8 L 11mm__74027283 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400278_1 CDM Jrny2 Bcs Xlpd Isrt 7-8 L 18mm__74027287 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400279_1 CDM Jrny2 Bcs Xlpd Isrt 7-8 L 21mm__74027288 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400186_1 CDM Jrny2 Isrt Xlpe Dd Lf 3-4 10mm__74025742 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400202_1 CDM Jrny2 Isrt Xlpe Dd Lf 5-6 15mm__74025766 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400156_1 CDM Jrny2 Cr Isrt Xlp Lf 7-8 9mm__74025681 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400206_1 CDM Jrny2 Isrt Xlpe Dd R 7-8 10mm__74025772 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400155_1 CDM Jrny2 Cr Isrt Xlp R 7-8 18mm__74025677 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400261_1 CDM Jrny2 Bcs Xlpd Isrt 5-6 L 15mm__74027266 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400262_1 CDM Jrny2 Bcs Xlpd Isrt 5-6 L 18mm__74027267 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400157_1 CDM Jrny2 Cr Isrt Xlp Lf 7-8 10mm__74025682 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400158_1 CDM Jrny2 Cr Isrt Xlp Lf 7-8 11mm__74025683 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400179_1 CDM Jrny2 Isrt Xlpe Dd R 3-4 10mm__74025732 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400246_1 CDM Jrny2 Bcs Xlpd Isrt 3-4 L 15mm__74027246 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400203_1 CDM Jrny2 Isrt Xlpe Dd Lf 5-6 18mm__74025767 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400131_1 CDM Jrny2 Cr Isrt Xlp Lf 3-4 12mm__74025644 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400238_1 CDM Jrny2 Bcs Xlpd Isrt 3-4-r 13mm__74027235 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400239_1 CDM Jrny2 Bcs Xlpd Isrt 3-4-r 15mm__74027236 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400247_1 CDM Jrny2 Bcs Xlpd Isrt 3-4 L 18mm__74027247 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400266_1 CDM Jrny2 Bcs Xlpd Isrt 7-8 R 11mm__74027273 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400127_1 CDM Jrny2 Cr Isrt Xlp R 3-4 18mm__74025637 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400195_1 CDM Jrny2 Isrt Xlpe Dd R 5-6 13mm__74025755 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400192_1 CDM Jrny2 Isrt Xlpe Dd R 5-6 9mm__74025751 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400219_1 CDM Jrny2 Bcs Xlpd Isrt 1-2 R 9mm__74027211 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400248_1 CDM Jrny2 Bcs Xlpd Isrt 3-4 L 21mm__74027248 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400141_1 CDM Jrny2 Cr Isrt Xlp R 5-6 18mm__74025657 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400181_1 CDM Jrny2 Isrt Xlpe Dd R 3-4 12mm__74025734 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400234_1 CDM Jrny2 Bcs Xlpd Isrt 1-2 L 21mm__74027228 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400250_1 CDM Jrny2 Bcs Xlpd Isrt 5-6 R 10mm__74027252 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400135_1 CDM Jrny2 Cr Isrt Xlp R 5-6 9mm__74025651 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400194_1 CDM Jrny2 Isrt Xlpe Dd R 5-6 12mm__74025754 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400201_1 CDM Jrny2 Isrt Xlpe Dd Lf 5-6 13mm__74025765 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400142_1 CDM Jrny2 Cr Isrt Xlp Lf 5-6 9mm__74025661 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400188_1 CDM Jrny2 Isrt Xlpe Dd Lf 3-4 12mm__74025744 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400204_1 CDM Jrny2 Isrt Xlpe Dd Lf 5-6 21mm__74025768 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400260_1 CDM Jrny2 Bcs Xlpd Isrt 5-6 L 13mm__74027265 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
7400270_1 CDM Jrny2 Bcs Xlpd Isrt 7-8 R 18mm__74027277 14 14 $5,173.20 $4,914.54 $2,379.67 $5,173.20 $4,914.54 2026-06-25
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