Hospital

CENTRAL MONTANA MEDICAL CENTER

Lewistown, MT · CCN 271345 · Rates published

5,337 distinct procedures filed

19 distinct payers

127,542 rate rows

2025-11-21 last MRF observed

Data quality

124,208 of 127,542 rate rows are consumer-grade (97.4%)

3,334 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	2,031
per-diem day rate — not a per-procedure price	899
percent-of-charges filed in the dollar field — excluded from medians	366
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	35
exceeds 10× this hospital's gross charge — excluded from medians	3

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

Source MRF file	https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbCMMCLewistownMT&type=CDMWithoutLabel&fileType=CSV
Found on page	https://www.cmmc.health/cms-hpt.txt
Discovered via	Discovered by HANK (automated)
Last fetch	not_modified · 2026-10-27
Content fingerprint	086077694e62269d… · 63,682,513 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
469 MS_DRG	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc…	2	$128,530.26	$275,492.26	$202,011.26	nat. median $29,471 outlier · 6.9×
483 MS_DRG	Major Joint Or Limb Reattachment Procedures Of Upper Extremities	2	$103,358.13	$207,458.04	$155,408.09	nat. median $25,356 outlier · 6.1×
455 MS_DRG	Combined Anterior And Posterior Spinal Fusion Without Cc/mcc	2	$69,820.10	$137,973.99	$103,897.04	nat. median $38,810 outlier · 2.7×
475 MS_DRG	Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc	2	$45,921.91	$135,642.35	$90,782.13	nat. median $21,230 outlier · 4.3×
335 MS_DRG	Peritoneal Adhesiolysis With Mcc	2	$49,592.84	$118,643.11	$84,117.98	nat. median $33,110 outlier · 2.5×
J9321 HCPCS	Injection, Epcoritamab-bysp, 0.16 Mg	18	$41,987.66	$198,055.00	$74,468.68	nat. median $1,454 outlier · 51.2×
330 MS_DRG	Major Small And Large Bowel Procedures With Cc	2	$37,422.76	$101,389.93	$69,406.35	nat. median $22,949 outlier · 3.0×
467 MS_DRG	Revision Of Hip Or Knee Replacement With Cc	2	$42,459.36	$96,184.76	$69,322.06	nat. median $32,637 outlier · 2.1×
474 MS_DRG	Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc	2	$31,354.79	$85,061.70	$58,208.24	nat. median $39,984 1.5× median
J0896 HCPCS	Injection, Luspatercept-aamt, 0.25 Mg	18	$28,617.62	$134,988.75	$50,755.78	nat. median $4,583 outlier · 11.1×
492 MS_DRG	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc	2	$27,786.97	$70,102.81	$48,944.89	nat. median $33,640 1.5× median
J2327 HCPCS	Injection, Risankizumab-rzaa, Intravenous, 1 Mg	18	$26,827.81	$126,546.25	$47,581.40	nat. median $2,076 outlier · 22.9×
J1303 HCPCS	Injection, Ravulizumab-cwvz, 10 Mg	18	$24,903.51	$117,469.38	$44,168.49	nat. median $5,977 outlier · 7.4×
493 MS_DRG	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc	2	$23,530.76	$62,905.51	$43,218.13	nat. median $23,542 1.8× median
J3357 HCPCS	Ustekinumab, For Subcutaneous Injection, 1 Mg	18	$23,514.51	$110,917.50	$41,704.98	nat. median $14,744 outlier · 2.8×
617 MS_DRG	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	2	$28,838.51	$50,345.03	$39,591.77	nat. median $18,284 outlier · 2.2×
J0775 HCPCS	Injection, Collagenase, Clostridium Histolyticum, 0.01 Mg	18	$16,804.45	$79,266.25	$29,804.11	nat. median $114 outlier · 261.8×
J9332 HCPCS	Injection, Efgartigimod Alfa-fcab, 2mg	18	$16,093.45	$75,912.50	$28,543.10	nat. median $112 outlier · 253.8×
J9042 HCPCS	Injection, Brentuximab Vedotin, 1 Mg	18	$15,913.25	$75,062.50	$28,223.50	nat. median $951 outlier · 29.7×
J9119 HCPCS	Injection, Cemiplimab-rwlc, 1 Mg	18	$15,913.25	$75,062.50	$28,223.50	nat. median $91 outlier · 310.0×
J9145 HCPCS	Injection, Daratumumab, 10 Mg	18	$15,913.25	$75,062.50	$28,223.50	nat. median $609 outlier · 46.3×
J9022 HCPCS	Injection, Atezolizumab, 10 Mg	18	$15,913.25	$75,062.50	$28,223.50	nat. median $6,785 outlier · 4.2×
J2783 HCPCS	Injection, Rasburicase, 0.5 Mg	18	$15,697.01	$74,042.50	$27,839.98	nat. median $1,587 outlier · 17.5×
J9144 HCPCS	Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj	18	$15,348.14	$72,396.88	$27,221.22	nat. median $211 outlier · 128.7×
J3101 HCPCS	Injection, Tenecteplase, 1 Mg	18	$15,127.79	$71,357.50	$26,830.42	nat. median $3,820 outlier · 7.0×
J9228 HCPCS	Injection, Ipilimumab, 1 Mg	18	$14,128.08	$66,641.88	$25,057.35	nat. median $9,003 outlier · 2.8×
7714292_1 CDM	Knee Journey Ii Oxi With Veri &__lwn	18	$13,785.83	$47,079.91	$24,450.34	nat. median $24,450 1.0× median
J9301 HCPCS	Injection, Obinutuzumab, 10 Mg	18	$12,376.03	$58,377.50	$21,949.94	nat. median $287 outlier · 76.5×
419 MS_DRG	Laparoscopic Cholecystectomy Without C.d.e. Without Cc/mcc	2	$14,147.17	$27,444.54	$20,795.85	nat. median $13,553 1.5× median
J3380 HCPCS	Injection, Vedolizumab, Intravenous, 1 Mg	18	$11,583.15	$54,637.50	$20,543.70	nat. median $162 outlier · 126.8×
J9223 HCPCS	Injection, Lurbinectedin, 0.1 Mg	18	$11,477.15	$54,137.50	$20,355.70	nat. median $617 outlier · 33.0×
J2323 HCPCS	Injection, Natalizumab, 1 Mg	18	$11,289.13	$53,250.63	$20,022.24	nat. median $197 outlier · 101.5×
C1602 HCPCS	Orthopedic/device/drug Matrix/absorbable Bone Void Filler, Antimicrobial-eluting…	18	$11,075.92	$37,825.33	$19,644.09	nat. median $6,302 outlier · 3.1×
8262054_1 CDM	Inspace Balloon US Medium__lwn	18	$10,876.13	$37,143.01	$19,289.74	nat. median $19,290 1.0× median
J2353 HCPCS	Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg	18	$10,273.92	$72,543.13	$19,190.90	nat. median $5,573 outlier · 3.4×
J9299 HCPCS	Injection, Nivolumab, 1 Mg	18	$10,633.13	$50,156.25	$18,858.76	nat. median $2,889 outlier · 6.5×
J1299 HCPCS	Injection, Eculizumab, 2 Mg	18	$10,384.82	$48,985.00	$18,418.36	nat. median $2,911 outlier · 6.3×
J9309 HCPCS	Injection, Polatuzumab Vedotin-piiq, 1 Mg	18	$5,328.49	$78,062.50	$16,549.25	nat. median $4,472 outlier · 3.7×
J1306 HCPCS	Injection, Inclisiran, 1 Mg	18	$9,061.94	$42,745.00	$16,072.12	nat. median $44 outlier · 364.0×
9012287_1 CDM	Stem Hum Perserve Pf 12mm Exac__lwn	18	$8,749.64	$29,880.84	$15,518.22	nat. median $15,518 1.0× median
J1437 HCPCS	Injection, Ferric Derisomaltose, 10 Mg	18	$8,614.62	$40,635.00	$15,278.76	nat. median $46 outlier · 335.2×
7714237_1 CDM	Kyphopak Express Ii Tray First__lwn	18	$8,504.25	$29,042.81	$15,083.00	nat. median $15,083 1.0× median
8736091_1 CDM	Tibial Wedge 3-4 15 Ltmd Rtla__lwn	18	$8,416.40	$28,742.80	$14,927.20	nat. median $14,927 1.0× median
J9306 HCPCS	Injection, Pertuzumab, 1 Mg	18	$8,220.04	$38,773.75	$14,578.94	nat. median $80 outlier · 183.2×
J9271 HCPCS	Injection, Pembrolizumab, 1 Mg	18	$7,859.90	$37,075.00	$13,940.20	nat. median $276 outlier · 50.6×
9224315_1 CDM	Proteios 5cc__lwn	18	$7,818.83	$26,702.03	$13,867.35	nat. median $13,867 1.0× median
8092118_1 CDM	Cartiva Implant 8mm__lwn	18	$7,757.21	$26,491.61	$13,758.08	nat. median $13,758 1.0× median
8058385_1 CDM	Cartiva Implant 10mm__lwn	18	$7,757.21	$26,491.61	$13,758.08	nat. median $13,758 1.0× median
J0565 HCPCS	Injection, Bezlotoxumab, 10 Mg	18	$7,753.90	$36,575.00	$13,752.20	nat. median $159 outlier · 86.3×
J1950 HCPCS	Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg	18	$3,612.88	$62,108.13	$13,166.92	nat. median $3,902 outlier · 3.4×

Other procedures at this hospital

Browse this hospital's 5,337 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

469	MS_DRG	Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc…	2	2	$131,602.48	$111,862.11	$128,530.26	$275,492.26	$202,011.26	2025-11-21
483	MS_DRG	Major Joint Or Limb Reattachment Procedures Of Upper Extremities	2	2	$100,864.60	$85,734.91	$103,358.13	$207,458.04	$155,408.09	2025-11-21
455	MS_DRG	Combined Anterior And Posterior Spinal Fusion Without Cc/mcc	2	2	$69,159.61	$58,785.67	$69,820.10	$137,973.99	$103,897.04	2025-11-21
475	MS_DRG	Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc	2	2	$47,693.92	$40,539.83	$45,921.91	$135,642.35	$90,782.13	2025-11-21
335	MS_DRG	Peritoneal Adhesiolysis With Mcc	2	2	$51,539.75	$43,808.79	$49,592.84	$118,643.11	$84,117.98	2025-11-21
J9321	HCPCS	Injection, Epcoritamab-bysp, 0.16 Mg	18	18	$79,222.00	$67,338.70	$41,987.66	$198,055.00	$74,468.68	2025-11-21
330	MS_DRG	Major Small And Large Bowel Procedures With Cc	2	2	$38,943.03	$33,101.58	$37,422.76	$101,389.93	$69,406.35	2025-11-21
467	MS_DRG	Revision Of Hip Or Knee Replacement With Cc	2	2	$43,089.20	$36,625.82	$42,459.36	$96,184.76	$69,322.06	2025-11-21
474	MS_DRG	Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc	2	2	$32,659.15	$27,760.28	$31,354.79	$85,061.70	$58,208.24	2025-11-21
J0896	HCPCS	Injection, Luspatercept-aamt, 0.25 Mg	18	18	$53,995.50	$45,896.18	$28,617.62	$134,988.75	$50,755.78	2025-11-21
492	MS_DRG	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc	2	2	$28,727.40	$24,418.29	$27,786.97	$70,102.81	$48,944.89	2025-11-21
J2327	HCPCS	Injection, Risankizumab-rzaa, Intravenous, 1 Mg	18	18	$50,618.50	$43,025.73	$26,827.81	$126,546.25	$47,581.40	2025-11-21
J1303	HCPCS	Injection, Ravulizumab-cwvz, 10 Mg	18	18	$46,987.75	$39,939.59	$24,903.51	$117,469.38	$44,168.49	2025-11-21
493	MS_DRG	Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc	2	2	$24,379.07	$20,722.21	$23,530.76	$62,905.51	$43,218.13	2025-11-21
J3357	HCPCS	Ustekinumab, For Subcutaneous Injection, 1 Mg	18	18	$44,367.00	$37,711.95	$23,514.51	$110,917.50	$41,704.98	2025-11-21
617	MS_DRG	Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With…	2	2	$29,802.36	$25,332.01	$28,838.51	$50,345.03	$39,591.77	2025-11-21
J0775	HCPCS	Injection, Collagenase, Clostridium Histolyticum, 0.01 Mg	18	18	$31,706.50	$26,950.53	$16,804.45	$79,266.25	$29,804.11	2025-11-21
J9332	HCPCS	Injection, Efgartigimod Alfa-fcab, 2mg	18	18	$30,365.00	$25,810.25	$16,093.45	$75,912.50	$28,543.10	2025-11-21
J9145	HCPCS	Injection, Daratumumab, 10 Mg	18	18	$30,025.00	$25,521.25	$15,913.25	$75,062.50	$28,223.50	2025-11-21
J9119	HCPCS	Injection, Cemiplimab-rwlc, 1 Mg	18	18	$30,025.00	$25,521.25	$15,913.25	$75,062.50	$28,223.50	2025-11-21
J9042	HCPCS	Injection, Brentuximab Vedotin, 1 Mg	18	18	$30,025.00	$25,521.25	$15,913.25	$75,062.50	$28,223.50	2025-11-21
J9022	HCPCS	Injection, Atezolizumab, 10 Mg	18	18	$30,025.00	$25,521.25	$15,913.25	$75,062.50	$28,223.50	2025-11-21
J2783	HCPCS	Injection, Rasburicase, 0.5 Mg	18	18	$29,617.00	$25,174.45	$15,697.01	$74,042.50	$27,839.98	2025-11-21
J9144	HCPCS	Injection, Daratumumab, 10 Mg And Hyaluronidase-fihj	18	18	$28,958.75	$24,614.94	$15,348.14	$72,396.88	$27,221.22	2025-11-21
J3101	HCPCS	Injection, Tenecteplase, 1 Mg	18	18	$28,543.00	$24,261.55	$15,127.79	$71,357.50	$26,830.42	2025-11-21
J9228	HCPCS	Injection, Ipilimumab, 1 Mg	18	18	$26,656.75	$22,658.24	$14,128.08	$66,641.88	$25,057.35	2025-11-21
7714292_1	CDM	Knee Journey Ii Oxi With Veri &__lwn	18	18	$26,011.00	$22,109.35	$13,785.83	$47,079.91	$24,450.34	2025-11-21
J9301	HCPCS	Injection, Obinutuzumab, 10 Mg	18	18	$23,351.00	$19,848.35	$12,376.03	$58,377.50	$21,949.94	2025-11-21
419	MS_DRG	Laparoscopic Cholecystectomy Without C.d.e. Without Cc/mcc	2	2	$14,680.01	$12,478.01	$14,147.17	$27,444.54	$20,795.85	2025-11-21
J3380	HCPCS	Injection, Vedolizumab, Intravenous, 1 Mg	18	18	$21,855.00	$18,576.75	$11,583.15	$54,637.50	$20,543.70	2025-11-21
J9223	HCPCS	Injection, Lurbinectedin, 0.1 Mg	18	18	$21,655.00	$18,406.75	$11,477.15	$54,137.50	$20,355.70	2025-11-21
J2323	HCPCS	Injection, Natalizumab, 1 Mg	18	18	$21,300.25	$18,105.21	$11,289.13	$53,250.63	$20,022.24	2025-11-21
C1602	HCPCS	Orthopedic/device/drug Matrix/absorbable Bone Void Filler, Antimicrobial-eluting…	18	18	$20,897.97	$17,763.27	$11,075.92	$37,825.33	$19,644.09	2025-11-21
8262054_1	CDM	Inspace Balloon US Medium__lwn	18	18	$20,521.00	$17,442.85	$10,876.13	$37,143.01	$19,289.74	2025-11-21
J2353	HCPCS	Injection, Octreotide, Depot Form For Intramuscular Injection, 1 Mg	36	18	$24,201.00	$20,570.85	$10,273.92	$72,543.13	$19,190.90	2025-11-21
J9299	HCPCS	Injection, Nivolumab, 1 Mg	18	18	$20,062.50	$17,053.13	$10,633.13	$50,156.25	$18,858.76	2025-11-21
J1299	HCPCS	Injection, Eculizumab, 2 Mg	18	18	$19,594.00	$16,654.90	$10,384.82	$48,985.00	$18,418.36	2025-11-21
J9309	HCPCS	Injection, Polatuzumab Vedotin-piiq, 1 Mg	36	18	$20,639.38	$17,543.47	$5,328.49	$78,062.50	$16,549.25	2025-11-21
J1306	HCPCS	Injection, Inclisiran, 1 Mg	18	18	$17,098.00	$14,533.30	$9,061.94	$42,745.00	$16,072.12	2025-11-21
9012287_1	CDM	Stem Hum Perserve Pf 12mm Exac__lwn	18	18	$16,508.75	$14,032.44	$8,749.64	$29,880.84	$15,518.22	2025-11-21
J1437	HCPCS	Injection, Ferric Derisomaltose, 10 Mg	18	18	$16,254.00	$13,815.90	$8,614.62	$40,635.00	$15,278.76	2025-11-21
7714237_1	CDM	Kyphopak Express Ii Tray First__lwn	18	18	$16,045.75	$13,638.89	$8,504.25	$29,042.81	$15,083.00	2025-11-21
8736091_1	CDM	Tibial Wedge 3-4 15 Ltmd Rtla__lwn	18	18	$15,880.00	$13,498.00	$8,416.40	$28,742.80	$14,927.20	2025-11-21
J9306	HCPCS	Injection, Pertuzumab, 1 Mg	18	18	$15,509.50	$13,183.08	$8,220.04	$38,773.75	$14,578.94	2025-11-21
J9271	HCPCS	Injection, Pembrolizumab, 1 Mg	18	18	$14,830.00	$12,605.50	$7,859.90	$37,075.00	$13,940.20	2025-11-21
9224315_1	CDM	Proteios 5cc__lwn	18	18	$14,752.50	$12,539.63	$7,818.83	$26,702.03	$13,867.35	2025-11-21
8092118_1	CDM	Cartiva Implant 8mm__lwn	18	18	$14,636.25	$12,440.81	$7,757.21	$26,491.61	$13,758.08	2025-11-21
8058385_1	CDM	Cartiva Implant 10mm__lwn	18	18	$14,636.25	$12,440.81	$7,757.21	$26,491.61	$13,758.08	2025-11-21
J0565	HCPCS	Injection, Bezlotoxumab, 10 Mg	18	18	$14,630.00	$12,435.50	$7,753.90	$36,575.00	$13,752.20	2025-11-21
J1950	HCPCS	Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg	36	18	$15,830.00	$13,455.50	$3,612.88	$62,108.13	$13,166.92	2025-11-21
J2506	HCPCS	Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg	36	18	$18,697.88	$15,893.19	$6,986.73	$60,533.13	$13,128.83	2025-11-21
Q5122	HCPCS	Injection, Pegfilgrastim-apgf (nyvepria), Biosimilar, 0.5 Mg	18	18	$13,825.25	$11,751.46	$7,327.38	$34,563.13	$12,995.74	2025-11-21
J2182	HCPCS	Injection, Mepolizumab, 1 Mg	18	18	$13,460.50	$11,441.43	$7,134.07	$33,651.25	$12,652.88	2025-11-21
J2997	HCPCS	Injection, Alteplase Recombinant, 1 Mg	36	18	$20,763.12	$17,648.65	$605.92	$100,957.50	$12,130.56	2025-11-21
J9177	HCPCS	Injection, Enfortumab Vedotin-ejfv, 0.25 Mg	18	18	$12,664.50	$10,764.83	$6,712.19	$31,661.25	$11,904.64	2025-11-21
J9308	HCPCS	Injection, Ramucirumab, 5 Mg	36	18	$14,593.00	$12,404.05	$3,873.77	$54,692.50	$11,594.81	2025-11-21
J9303	HCPCS	Injection, Panitumumab, 10 Mg	36	18	$15,037.75	$12,782.09	$4,693.68	$53,048.75	$11,246.34	2025-11-21
9045608_1	CDM	Cut Guide Custom Lgnp V0100109__lwn	18	18	$11,802.00	$10,031.70	$6,255.06	$21,361.62	$11,093.88	2025-11-21
8985397_1	CDM	Stem Echo Por Fem Rpp Nc 13x14__lwn	18	18	$11,802.00	$10,031.70	$6,255.06	$21,361.62	$11,093.88	2025-11-21
9224316_1	CDM	Bone Void Filler A-grix 5cc__lwn	18	18	$11,787.95	$10,019.76	$6,247.61	$21,336.19	$11,080.67	2025-11-21
9012288_1	CDM	Glenoid Post Aug Rt Lg Exac__lwn	18	18	$11,703.00	$9,947.55	$6,202.59	$21,182.43	$11,000.82	2025-11-21
8939735_1	CDM	Bioinductive Implant Ads Lg__lwn	18	18	$11,637.25	$9,891.66	$6,167.74	$21,063.42	$10,939.01	2025-11-21
Q4104	HCPCS	Integra Bilayer Matrix Wound Dressing (bmwd), Per Square Centimeter	36	18	$14,078.10	$11,966.39	$5,741.25	$31,355.81	$10,615.90	2025-11-21
C9363	HCPCS	Skin Substitute, Integra Meshed Bilayer Wound Matrix, Per Square Centimeter	36	18	$12,837.00	$10,911.45	$5,729.43	$26,903.39	$10,594.05	2025-11-21
J7168	HCPCS	Prothrombin Complex Concentrate (human), Kcentra, Per I.u. Of Factor Ix Activity	18	18	$10,992.00	$9,343.20	$5,825.76	$27,480.00	$10,332.48	2025-11-21
8339183_1	CDM	Ryanodex 250 Mg Vial	18	18	$10,963.75	$9,319.19	$5,810.79	$19,844.39	$10,305.92	2025-11-21
J9173	HCPCS	Injection, Durvalumab, 10 Mg	36	18	$11,998.50	$10,198.72	$2,849.81	$46,550.00	$9,868.60	2025-11-21
7405958_1	CDM	Kypho Tray__lwn	18	18	$10,194.25	$8,665.11	$5,402.95	$18,451.59	$9,582.60	2025-11-21
8881630_1	CDM	Bioinductive Implant Ads Med.__lwn	18	18	$10,102.75	$8,587.34	$5,354.46	$18,285.98	$9,496.58	2025-11-21
Q5111	HCPCS	Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg	36	18	$13,067.88	$11,107.69	$5,059.12	$41,475.63	$9,450.05	2025-11-21
J9358	HCPCS	Injection, Fam-trastuzumab Deruxtecan-nxki, 1 Mg	18	18	$10,025.00	$8,521.25	$5,313.25	$25,062.50	$9,423.50	2025-11-21
J9176	HCPCS	Injection, Elotuzumab, 1 Mg	18	18	$10,025.00	$8,521.25	$5,313.25	$25,062.50	$9,423.50	2025-11-21
Q5116	HCPCS	Injection, Trastuzumab-qyyp, Biosimilar, (trazimera), 10 Mg	18	18	$10,025.00	$8,521.25	$5,313.25	$25,062.50	$9,423.50	2025-11-21
Q5119	HCPCS	Injection, Rituximab-pvvr, Biosimilar, (ruxience), 10 Mg	18	18	$10,025.00	$8,521.25	$5,313.25	$25,062.50	$9,423.50	2025-11-21
J9034	HCPCS	Injection, Bendamustine Hcl (bendeka), 1 Mg	18	18	$10,025.00	$8,521.25	$5,313.25	$25,062.50	$9,423.50	2025-11-21
7406391_1	CDM	I Stent__lwn	18	18	$9,644.25	$8,197.61	$5,111.45	$17,456.09	$9,065.60	2025-11-21
9223595_1	CDM	Staple Reflex Ultra 25x 20mm__lwn	18	18	$9,610.20	$8,168.67	$5,093.41	$17,394.46	$9,033.59	2025-11-21
C1762	HCPCS	Connective Tissue, Human (includes Fascia Lata)	18	18	$9,347.00	$7,944.95	$4,953.91	$16,918.07	$8,786.18	2025-11-21
J1602	HCPCS	Injection, Golimumab, 1 Mg, For Intravenous Use	18	18	$9,320.00	$7,922.00	$4,939.60	$23,300.00	$8,760.80	2025-11-21
C9399	HCPCS	Unclassified Drugs Or Biologicals	18	18	$9,295.00	$7,900.75	$4,926.35	$23,237.50	$8,737.30	2025-11-21
9244950_1	CDM	Proteios 2.5cc__lwn	18	18	$9,258.95	$7,870.11	$4,907.24	$16,758.70	$8,703.41	2025-11-21
9306769_1	CDM	Bone Bio Evans 8mm Meun__lwn	18	18	$9,230.85	$7,846.22	$4,892.35	$16,707.84	$8,677.00	2025-11-21
9212732_1	CDM	Bone Bio Utility 12mm Meun__lwn	18	18	$9,230.85	$7,846.22	$4,892.35	$16,707.84	$8,677.00	2025-11-21
9224314_1	CDM	Bone Bio Evans 12mm Meun__lwn	18	18	$9,230.85	$7,846.22	$4,892.35	$16,707.84	$8,677.00	2025-11-21
9224323_1	CDM	Bone Bio Evans 6mm Meun__lwn	18	18	$9,230.85	$7,846.22	$4,892.35	$16,707.84	$8,677.00	2025-11-21
Q4107	HCPCS	Graftjacket, Per Square Centimeter	18	18	$9,128.34	$7,759.09	$4,838.02	$16,522.30	$8,580.64	2025-11-21
C1889	HCPCS	Implantable/insertable Device, Not Otherwise Classified	108	18	$11,591.25	$9,852.56	$3,243.70	$30,571.81	$8,366.18	2025-11-21
J3358	HCPCS	Ustekinumab, For Intravenous Injection, 1 Mg	18	18	$8,820.00	$7,497.00	$4,674.60	$22,050.00	$8,290.80	2025-11-21
Q5108	HCPCS	Injection, Pegfilgrastim-jmdb (fulphila), Biosimilar, 0.5 Mg	18	18	$8,795.00	$7,475.75	$4,661.35	$21,987.50	$8,267.30	2025-11-21
9300667_1	CDM	Nail Fix Trim Cann 4.5 X 70mm__lwn	18	18	$8,753.15	$7,440.18	$4,639.17	$15,843.20	$8,227.96	2025-11-21
9060178_1	CDM	Nail Fix Trim Cann 3.0 X 50mm__lwn	18	18	$8,753.15	$7,440.18	$4,639.17	$15,843.20	$8,227.96	2025-11-21
8846161_1	CDM	Micromatrix 1000mg__lwn	18	18	$8,624.00	$7,330.40	$4,570.72	$15,609.44	$8,106.56	2025-11-21
J3032	HCPCS	Injection, Eptinezumab-jjmr, 1 Mg	18	18	$8,560.00	$7,276.00	$4,536.80	$21,400.00	$8,046.40	2025-11-21
J3240	HCPCS	Injection, Thyrotropin Alpha, 0.9 Mg, Provided In 1.1 Mg Vial	18	18	$8,472.75	$7,201.84	$4,490.56	$21,181.88	$7,964.39	2025-11-21
9012286_1	CDM	Head Hum Tall 50x23 Exac__lwn	18	18	$8,384.25	$7,126.61	$4,443.65	$15,175.49	$7,881.19	2025-11-21
9060179_1	CDM	Staple Compression 9 X 10mm__lwn	18	18	$8,289.50	$7,046.08	$4,393.44	$15,004.00	$7,792.14	2025-11-21
9104880_1	CDM	Staple Compression 15 X 15mm__lwn	18	18	$8,289.50	$7,046.08	$4,393.44	$15,004.00	$7,792.14	2025-11-21
9104881_1	CDM	Nail Fix Trim Cann 2.4 X 50mm__lwn	18	18	$8,289.50	$7,046.08	$4,393.44	$15,004.00	$7,792.14	2025-11-21
7932064_1	CDM	Ac Repair System Low Profile__lwn	18	18	$8,259.75	$7,020.79	$4,377.67	$14,950.15	$7,764.16	2025-11-21
Q5136	HCPCS	Injection, Denosumab-bbdz (jubbonti/wyost), Biosimilar, 1 Mg	36	18	$10,806.00	$9,185.10	$3,821.70	$36,003.13	$7,632.66	2025-11-21
9272697_1	CDM	Staple Reflex Max 15x18mm__lwn	18	18	$8,092.80	$6,878.88	$4,289.18	$14,647.97	$7,607.23	2025-11-21
9272698_1	CDM	Staple Reflex Max 18x20mm__lwn	18	18	$8,092.80	$6,878.88	$4,289.18	$14,647.97	$7,607.23	2025-11-21
9272696_1	CDM	Staple Reflex Max 15x15mm__lwn	18	18	$8,092.80	$6,878.88	$4,289.18	$14,647.97	$7,607.23	2025-11-21
9223596_1	CDM	Staple Reflex Max 18x 18mm__lwn	18	18	$8,092.80	$6,878.88	$4,289.18	$14,647.97	$7,607.23	2025-11-21
9272699_1	CDM	Staple Reflex Max 20x20mm__lwn	18	18	$8,092.80	$6,878.88	$4,289.18	$14,647.97	$7,607.23	2025-11-21
9104878_1	CDM	Bone Wedge Cotton 7mm Medu__lwn	18	18	$7,966.35	$6,771.40	$4,222.17	$14,419.09	$7,488.37	2025-11-21
9104883_1	CDM	Bone Wedge Cotton 5mm Meun__lwn	18	18	$7,966.35	$6,771.40	$4,222.17	$14,419.09	$7,488.37	2025-11-21
J9312	HCPCS	Injection, Rituximab, 10 Mg	36	18	$9,420.38	$8,007.32	$2,503.06	$35,295.00	$7,482.54	2025-11-21
19499	HCPCS	Other Procedure On Breast	46	18	$8,266.25	$7,026.31	$47.50	$14,961.91	$7,439.63	2025-11-21
J9355	HCPCS	Injection, Trastuzumab, Excludes Biosimilar, 10 Mg	18	18	$7,817.25	$6,644.66	$4,143.14	$19,543.13	$7,348.22	2025-11-21
J0875	HCPCS	Injection, Dalbavancin, 5 Mg	18	18	$7,784.75	$6,617.04	$4,125.92	$19,461.88	$7,317.66	2025-11-21
8868495_1	CDM	Bone Wedge Bi Evans 6mm Tril__lwn	18	18	$7,735.00	$6,574.75	$4,099.55	$14,000.35	$7,270.90	2025-11-21
8092109_1	CDM	Shell Acetab G7 Pps Ltd 52e__lwn	18	18	$7,577.25	$6,440.66	$4,015.94	$13,714.82	$7,122.61	2025-11-21
9198615_1	CDM	Micromatrix Flex 5cc__lwn	18	18	$7,550.75	$6,418.14	$4,001.90	$13,666.86	$7,097.70	2025-11-21
J0840	HCPCS	Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram	18	18	$7,417.50	$6,304.88	$3,931.28	$18,543.75	$6,972.45	2025-11-21
J2802	HCPCS	Injection, Romiplostim, 1 Microgram	36	18	$9,851.38	$8,373.67	$3,484.35	$32,821.25	$6,958.11	2025-11-21
J9264	HCPCS	Injection, Paclitaxel Protein-bound Particles, 1 Mg	18	18	$7,396.25	$6,286.81	$3,920.01	$18,490.63	$6,952.48	2025-11-21
9012281_1	CDM	Mesh Phasix St Rectangle 3x4"__lwn	18	18	$7,361.00	$6,256.85	$3,901.33	$13,323.41	$6,919.34	2025-11-21
8216049_1	CDM	Graft Presut 10x235 215689030__lwn	18	18	$7,340.50	$6,239.43	$3,890.47	$13,286.31	$6,900.07	2025-11-21
C1776	HCPCS	Joint Device (implantable)	1,836	18	$8,023.12	$6,819.66	$134.49	$77,537.59	$6,819.46	2025-11-21
J0897	HCPCS	Injection, Denosumab, 1 Mg	36	18	$8,263.25	$7,023.77	$3,601.35	$24,328.75	$6,727.05	2025-11-21
9104875_1	CDM	Ossio Implant Kit 2.9x19 Strt__lwn	18	18	$7,109.30	$6,042.91	$3,767.93	$12,867.83	$6,682.74	2025-11-21
9104876_1	CDM	Ossio Implant Kit 2.5x16 Strt__lwn	18	18	$7,109.30	$6,042.91	$3,767.93	$12,867.83	$6,682.74	2025-11-21
9012283_1	CDM	Stem Fem Echo Fx Std 7mm__lwn	18	18	$7,081.25	$6,019.06	$3,753.06	$12,817.06	$6,656.38	2025-11-21
8868496_1	CDM	Bone Wedge Bi Cotton 8mm Tril__lwn	18	18	$7,072.25	$6,011.41	$3,748.29	$12,800.77	$6,647.91	2025-11-21
9236990_1	CDM	Amnion Patch Ss Dual Lay 4x4cm__lwn	18	18	$7,032.01	$5,977.21	$3,726.97	$12,727.94	$6,610.09	2025-11-21
8190059_1	CDM	Hydroset Xt 5cc__lwn	18	18	$6,993.50	$5,944.48	$3,706.56	$12,658.24	$6,573.90	2025-11-21
8518102_1	CDM	Bone Wedge Lapidus 5mm__lwn	18	18	$6,985.25	$5,937.46	$3,702.18	$12,643.30	$6,566.14	2025-11-21
8610062_1	CDM	Bone Wedge Lapidus 8mm__lwn	18	18	$6,985.25	$5,937.46	$3,702.18	$12,643.30	$6,566.14	2025-11-21
77373	HCPCS	Delivery Of Radiation Therapy Per Dose To 1 Or More Lesions Not To Exceed 5 Dose…	18	18	$6,800.00	$5,780.00	$3,604.00	$12,308.00	$6,392.00	2025-11-21
Q5117	HCPCS	Injection, Trastuzumab-anns, Biosimilar, (kanjinti), 10 Mg	36	18	$8,594.00	$7,304.91	$3,421.95	$26,828.75	$6,391.93	2025-11-21
J9227	HCPCS	Injection, Isatuximab-irfc, 10 Mg	36	18	$7,742.50	$6,581.12	$2,058.39	$29,003.13	$6,148.66	2025-11-21
49190	HCPCS	Removal Or Destruction Of Growth(s) In The Abdomen, More Than 30.0 Cm	9	9	$7,574.00	$6,437.90	$2,790.32	$7,574.00	$6,059.20	2025-11-21
7597869_1	CDM	Pinnacle Unicortical Bone Wedg__lwn	18	18	$6,317.25	$5,369.66	$3,348.14	$11,434.22	$5,938.22	2025-11-21
J9047	HCPCS	Injection, Carfilzomib, 1 Mg	54	18	$6,472.25	$5,501.41	$1,152.35	$25,062.50	$5,825.03	2025-11-21
8518101_1	CDM	Pack Meniscal Root Repair Ub__lwn	18	18	$6,094.25	$5,180.11	$3,229.95	$11,030.59	$5,728.59	2025-11-21
J0129	HCPCS	Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere…	18	18	$6,009.00	$5,107.65	$3,184.77	$15,022.50	$5,648.46	2025-11-21
9104877_1	CDM	Ossio Implant 2.5x16 Strt__lwn	18	18	$5,915.05	$5,027.79	$3,134.98	$10,706.24	$5,560.15	2025-11-21
J2357	HCPCS	Injection, Omalizumab, 5 Mg	54	18	$5,831.75	$4,956.99	$934.79	$34,674.38	$5,481.84	2025-11-21
Q5115	HCPCS	Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg	36	18	$6,573.75	$5,587.69	$1,586.29	$25,386.25	$5,381.89	2025-11-21
J1745	HCPCS	Injection, Infliximab, Excludes Biosimilar, 10 Mg	18	18	$5,715.25	$4,857.96	$3,029.08	$14,288.13	$5,372.34	2025-11-21
15273	HCPCS	Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.…	18	18	$5,711.75	$4,854.99	$3,027.23	$10,338.27	$5,369.05	2025-11-21
Q5107	HCPCS	Injection, Bevacizumab-awwb, Biosimilar, (mvasi), 10 Mg	36	18	$6,574.00	$5,587.90	$1,655.19	$25,062.50	$5,313.25	2025-11-21
Q5118	HCPCS	Injection, Bevacizumab-bvzr, Biosimilar, (zirabev), 10 Mg	36	18	$6,376.62	$5,420.13	$1,445.97	$25,062.50	$5,313.25	2025-11-21
Q5113	HCPCS	Injection, Trastuzumab-pkrb, Biosimilar, (herzuma), 10 Mg	36	18	$6,836.88	$5,811.34	$1,933.84	$25,062.50	$5,313.25	2025-11-21
J3262	HCPCS	Injection, Tocilizumab, 1 Mg	54	18	$5,645.50	$4,798.68	$1,204.82	$25,062.50	$5,313.25	2025-11-21
7957950_1	CDM	Graft Ant Tib 2017366-1000__lwn	18	18	$5,641.25	$4,795.06	$2,989.86	$10,210.66	$5,302.77	2025-11-21
7941915_1	CDM	Graft Ant Tib 2018381-1008__lwn	18	18	$5,641.25	$4,795.06	$2,989.86	$10,210.66	$5,302.77	2025-11-21
Q5126	HCPCS	Injection, Bevacizumab-maly, Biosimilar, (alymsys), 10 Mg	36	18	$6,243.12	$5,306.65	$1,331.49	$24,935.00	$5,286.22	2025-11-21
90375	HCPCS	Rabies Immune Globulin For Injection	36	18	$5,884.50	$5,001.83	$1,088.75	$24,286.88	$5,142.23	2025-11-21
J3111	HCPCS	Injection, Romosozumab-aqqg, 1 Mg	18	18	$5,290.50	$4,496.93	$2,803.97	$13,226.25	$4,973.07	2025-11-21
49189	HCPCS	Removal Or Destruction Of Growth(s) In The Abdomen, 20.1 To 30.0 Cm	9	9	$6,144.00	$5,222.40	$2,263.49	$6,144.00	$4,915.20	2025-11-21
J0490	HCPCS	Injection, Belimumab, 10 Mg	36	18	$5,963.00	$5,068.56	$1,449.29	$22,978.75	$4,871.50	2025-11-21
9012284_1	CDM	Plate Replicator 1.5 Os Exac__lwn	18	18	$5,127.00	$4,357.95	$2,717.31	$9,279.87	$4,819.38	2025-11-21
J7318	HCPCS	Hyaluronan Or Derivative, Durolane, For Intra-articular Injection, 1 Mg	18	18	$5,120.00	$4,352.00	$2,713.60	$12,800.00	$4,812.80	2025-11-21
8028195_1	CDM	Room & Board - Other - Sterile Environment	13	13	$4,972.00	$4,226.20	$4,474.80	$4,972.00	$4,773.12	2025-11-21
47361	HCPCS	Control Of Bleeding Of Liver With Exploration, Removal Of Tissue, Suture Or Caut…	14	14	$6,757.00	$5,743.45	$2,909.67	$5,299.80	$4,711.89	2025-11-21
7849937_1	CDM	Cement Mixer Rally Aio Ab 70gm__lwn	18	18	$4,965.75	$4,220.89	$2,631.85	$8,988.01	$4,667.81	2025-11-21
50433	HCPCS	Placement Of Tube Of Kidney And Urinary Tube Through New Skin Access Using Imagi…	32	19	$8,394.00	$7,134.90	$241.27	$15,193.14	$4,448.82	2025-11-21
9023764_1	CDM	Graft Post Tib 2324039-1002__lwn	18	18	$4,692.45	$3,988.58	$2,487.00	$8,493.33	$4,410.90	2025-11-21
J9055	HCPCS	Injection, Cetuximab, 10 Mg	36	18	$5,854.25	$4,976.11	$1,858.58	$20,504.38	$4,346.93	2025-11-21
Q4137	HCPCS	Amnioexcel, Amnioexcel Plus Or Biodexcel, Per Square Centimeter	77	18	$4,330.75	$3,681.14	$47.50	$24,675.28	$4,244.14	2025-11-21
9023789_1	CDM	Liner R3 20 Deg 36 X 58mm__lwn	18	18	$4,510.05	$3,833.54	$2,390.33	$8,163.19	$4,239.45	2025-11-21
8899884_1	CDM	Kit Distal Biceps 2 Incision__lwn	18	18	$4,497.50	$3,822.88	$2,383.68	$8,140.48	$4,227.66	2025-11-21
49188	HCPCS	Removal Or Destruction Of Growth(s) In The Abdomen, 10.1 To 20.0 Cm	9	9	$5,282.00	$4,489.70	$1,945.83	$5,282.00	$4,225.60	2025-11-21
8868494_1	CDM	Putty Dbm Mc 100 5cc Tril__lwn	18	18	$4,420.00	$3,757.00	$2,342.60	$8,000.20	$4,154.80	2025-11-21
8872684_1	CDM	Jada System__lwn	18	18	$4,404.25	$3,743.61	$2,334.25	$7,971.69	$4,139.99	2025-11-21
8028194_1	CDM	Intensive Care Unit - General Classification	13	13	$4,309.00	$3,662.65	$3,878.10	$4,309.00	$4,136.64	2025-11-21
7729869_1	CDM	Putty Grafton Dbf 6cc Mdt__lwn	18	18	$4,391.75	$3,732.99	$2,327.63	$7,949.07	$4,128.24	2025-11-21
95811	HCPCS	Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older)	18	18	$4,396.25	$3,736.81	$1,343.70	$7,957.21	$4,088.51	2025-11-21
J1439	HCPCS	Injection, Ferric Carboxymaltose, 1 Mg	18	18	$4,282.50	$3,640.13	$2,269.73	$10,706.25	$4,025.56	2025-11-21
22510	HCPCS	Stabilization Of Upper Spine Bone	18	18	$4,212.00	$3,580.20	$2,232.36	$7,623.72	$3,959.28	2025-11-21
J1162	HCPCS	Injection, Digoxin Immune Fab (ovine), Per Vial	18	18	$4,201.75	$3,571.49	$2,226.93	$10,504.38	$3,949.64	2025-11-21
7941916_1	CDM	Graft Presutured 1916744-1006__lwn	18	18	$4,129.00	$3,509.65	$2,188.37	$7,473.49	$3,881.26	2025-11-21
J3424	HCPCS	Injection, Hydroxocobalamin, Intravenous, 25 Mg	18	18	$4,091.00	$3,477.35	$2,168.23	$10,227.50	$3,845.54	2025-11-21
95810	HCPCS	Sleep Study In Sleep Lab (6 Years Or Older)	18	18	$4,056.25	$3,447.81	$1,283.97	$7,341.81	$3,772.31	2025-11-21
C9781	HCPCS	Arthroscopy, Shoulder, Surgical; With Implantation Of Subacromial Spacer (e.g., …	5	5	$4,398.00	$3,738.30	$3,518.40	$4,398.00	$3,738.30	2025-11-21
J7307	HCPCS	Etonogestrel (contraceptive) Implant System, Including Implant And Supplies	18	18	$3,956.00	$3,362.60	$2,096.68	$9,890.00	$3,718.64	2025-11-21
50432	HCPCS	Placement Of Tube Of Kidney Using Imaging Guidance With Review By Radiologist	50	19	$4,058.25	$3,449.51	$194.12	$8,854.97	$3,713.30	2025-11-21
45385	HCPCS	Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope With Mechanical S…	32	19	$6,985.07	$5,937.31	$242.52	$12,642.98	$3,702.09	2025-11-21
C1880	HCPCS	Vena Cava Filter	18	18	$3,933.97	$3,343.87	$2,085.00	$7,120.49	$3,697.93	2025-11-21
59510	HCPCS	Cesarean Delivery With Care Before And After Delivery	14	14	$5,103.00	$4,337.55	$2,607.76	$4,094.40	$3,640.21	2025-11-21
47120	HCPCS	Partial Removal Of Liver Lobe	14	14	$5,178.00	$4,401.30	$2,263.93	$4,080.60	$3,627.94	2025-11-21
36584	HCPCS	Replacement Of Peripherally Inserted Central Venous Tube (picc) With Review By R…	18	18	$3,836.25	$3,260.81	$2,033.21	$6,943.61	$3,606.07	2025-11-21
8860521_1	CDM	Suture Pass Firstpass Mini Str__lwn	18	18	$3,828.25	$3,254.01	$2,028.97	$6,929.13	$3,598.56	2025-11-21
8986201_1	CDM	Tightrope Ii Rt-ib__lwn	18	18	$3,812.25	$3,240.41	$2,020.49	$6,900.17	$3,583.51	2025-11-21
8889549_1	CDM	Endoclot Phs Hemo Spray__lwn	18	18	$3,788.75	$3,220.44	$2,008.04	$6,857.64	$3,561.43	2025-11-21
49187	HCPCS	Removal Or Destruction Of Growth(s) In The Abdomen, 5.1 To 10.0 Cm	9	9	$4,420.00	$3,757.00	$1,628.38	$4,420.00	$3,536.00	2025-11-21
22511	HCPCS	Stabilization Of Lower Spine Bone	18	18	$3,730.50	$3,170.93	$1,977.17	$6,752.21	$3,506.68	2025-11-21
Q4118	HCPCS	Matristem Micromatrix, 1 Mg	18	18	$3,723.25	$3,164.76	$1,973.32	$6,739.08	$3,499.86	2025-11-21
49618	HCPCS	Repair Of Recurrent Entrapped Hernia Of Abdomen, More Than 10 Cm In Length	9	9	$4,335.00	$3,684.75	$1,206.74	$4,335.00	$3,468.00	2025-11-21
J9217	HCPCS	Leuprolide Acetate (for Depot Suspension), 7.5 Mg	54	18	$3,530.00	$3,000.50	$943.40	$60,795.00	$3,371.15	2025-11-21
59400	HCPCS	Vaginal Delivery With Care Before And After Delivery	14	14	$4,600.00	$3,910.00	$2,348.31	$3,691.80	$3,282.27	2025-11-21
7395296_1	CDM	Labor Room/delivery - Delivery Room	18	18	$3,481.25	$2,959.06	$1,845.06	$6,301.06	$3,272.38	2025-11-21
Q5104	HCPCS	Injection, Infliximab-abda, Biosimilar, (renflexis), 10 Mg	18	18	$3,440.75	$2,924.64	$1,823.60	$8,601.88	$3,234.31	2025-11-21
66984	HCPCS	Removal Of Cataract With Insertion Of Prosthetic Lens	18	18	$3,420.75	$2,907.64	$1,813.00	$6,191.56	$3,215.51	2025-11-21
7395307_1	CDM	Labor Room/delivery - Delivery Room	18	18	$3,400.00	$2,890.00	$1,802.00	$6,154.00	$3,196.00	2025-11-21
C1771	HCPCS	Repair Device, Urinary, Incontinence, With Sling Graft	18	18	$3,366.25	$2,861.31	$1,784.11	$6,092.91	$3,164.28	2025-11-21
7714222_1	CDM	Distal Bicep Implant Delivery__lwn	18	18	$3,304.00	$2,808.40	$1,751.12	$5,980.24	$3,105.76	2025-11-21
8736085_1	CDM	Clamp 5 Pin 2-30 Post Hoff3__lwn	18	18	$3,255.75	$2,767.39	$1,725.55	$5,892.91	$3,060.40	2025-11-21
9224317_1	CDM	Graft Gracilis Single Strand__lwn	18	18	$3,203.40	$2,722.89	$1,697.80	$5,798.15	$3,011.19	2025-11-21
G6016	HCPCS	Compensator-based Beam Modulation Treatment Delivery Of Inverse Planned Treatmen…	18	18	$3,200.00	$2,720.00	$1,696.00	$5,792.00	$3,008.00	2025-11-21
77386	HCPCS	Delivery Of Complex High Precision Radiation Treatment	18	18	$3,200.00	$2,720.00	$1,696.00	$5,792.00	$3,008.00	2025-11-21
Q5123	HCPCS	Injection, Rituximab-arrx, Biosimilar, (riabni), 10 Mg	36	18	$5,149.12	$4,376.76	$144.82	$25,062.50	$2,998.19	2025-11-21
43633	HCPCS	Removal Of Lower Portion Of Stomach With Reattachment Of Upper Portion Of Remain…	14	14	$4,272.00	$3,631.20	$1,867.70	$3,367.80	$2,994.21	2025-11-21
15277	HCPCS	Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Face, Scalp, Eyelids, Mout…	18	18	$3,165.50	$2,690.68	$1,677.72	$5,729.56	$2,975.57	2025-11-21
27134	HCPCS	Revision Of Thigh Bone And Hip Joint Prosthesis	14	14	$4,994.00	$4,244.90	$1,854.24	$3,323.40	$2,954.73	2025-11-21
8881631_1	CDM	Bone Anchors (3) Ads.__lwn	18	18	$3,141.50	$2,670.28	$1,665.00	$5,686.12	$2,953.01	2025-11-21
7404948_1	CDM	Lens Precision Multifocal__lwn	18	18	$3,139.00	$2,668.15	$1,663.67	$5,681.59	$2,950.66	2025-11-21
8939728_1	CDM	Accupass Dir Crescent Xl__lwn	18	18	$3,135.25	$2,664.96	$1,661.68	$5,674.80	$2,947.14	2025-11-21
8028202_1	CDM	Room & Board - Other - Sterile Environment	13	13	$3,068.00	$2,607.80	$2,761.20	$3,068.00	$2,945.28	2025-11-21
8028141_1	CDM	Room & Board - Other - Sterile Environment	13	13	$3,068.00	$2,607.80	$2,761.20	$3,068.00	$2,945.28	2025-11-21
8028232_1	CDM	Coronary Care Unit - General Classification	13	13	$3,068.00	$2,607.80	$2,761.20	$3,068.00	$2,945.28	2025-11-21
8028187_1	CDM	Room & Board - Other - Sterile Environment	13	13	$3,068.00	$2,607.80	$2,761.20	$3,068.00	$2,945.28	2025-11-21
8028185_1	CDM	Room & Board - Other - Sterile Environment	13	13	$3,068.00	$2,607.80	$2,761.20	$3,068.00	$2,945.28	2025-11-21
7405934_1	CDM	Rf Ablation Catheter Cf7-7-100__lwn	18	18	$3,121.50	$2,653.28	$1,654.40	$5,649.92	$2,934.22	2025-11-21
7405935_1	CDM	Rf Ablation Catheter Cf7-3-60__lwn	18	18	$3,121.50	$2,653.28	$1,654.40	$5,649.92	$2,934.22	2025-11-21
7405938_1	CDM	Rf Ablation Catheter Cf7-7-60__lwn	18	18	$3,121.50	$2,653.28	$1,654.40	$5,649.92	$2,934.22	2025-11-21
44150	HCPCS	Removal Of Large Bowel With Attachment Of Small Bowel To Rectum Or Creation Of O…	14	14	$5,672.00	$4,821.20	$1,791.43	$3,249.60	$2,889.12	2025-11-21
22633	HCPCS	Fusion Of Spine In Lower Back With Partial Removal Of Spine Bone And Disc	14	14	$6,219.00	$5,286.15	$1,775.03	$3,220.20	$2,862.99	2025-11-21
49596	HCPCS	Initial Repair Of Entrapped Hernia Of Abdomen, More Than 10 Cm In Length	9	9	$3,577.00	$3,040.45	$995.58	$3,577.00	$2,861.60	2025-11-21
J7325	HCPCS	Hyaluronan Or Derivative, Synvisc Or Synvisc-one, For Intra-articular Injection,…	18	18	$3,027.25	$2,573.16	$1,604.44	$7,568.13	$2,845.61	2025-11-21
J7326	HCPCS	Hyaluronan Or Derivative, Gel-one, For Intra-articular Injection, Per Dose	18	18	$3,020.00	$2,567.00	$1,600.60	$7,550.00	$2,838.80	2025-11-21
J0248	HCPCS	Injection, Remdesivir, 1 Mg	18	18	$3,020.00	$2,567.00	$1,600.60	$7,550.00	$2,838.80	2025-11-21
90380	HCPCS	Respiratory Syncytial Virus Antibody, 0.5 Ml Dosage For Injection Into Muscle	18	18	$3,011.50	$2,559.78	$1,596.10	$7,528.75	$2,830.81	2025-11-21
G6015	HCPCS	Intensity Modulated Treatment Delivery, Single Or Multiple Fields/arcs,via Narro…	18	18	$3,000.00	$2,550.00	$1,590.00	$5,430.00	$2,820.00	2025-11-21
77385	HCPCS	Delivery Of Simple High Precision Radiation Treatment	18	18	$3,000.00	$2,550.00	$1,590.00	$5,430.00	$2,820.00	2025-11-21
44207	HCPCS	Partial Removal Of Large Bowel And Reattachment To Rectum Using An Endoscope	14	14	$5,949.00	$5,056.65	$1,743.23	$3,161.40	$2,810.70	2025-11-21
37766	HCPCS	Removal Of Varicose Veins Of Arm Or Leg, More Than 20 Incisions	18	18	$2,985.25	$2,537.46	$1,582.18	$5,403.30	$2,806.14	2025-11-21
8881632_1	CDM	Tendon Anchors (8) Ads__lwn	18	18	$2,968.00	$2,522.80	$1,573.04	$5,372.08	$2,789.92	2025-11-21
8922499_1	CDM	Reamer Convex 18mm Tril__lwn	18	18	$2,952.75	$2,509.84	$1,564.96	$5,344.48	$2,775.59	2025-11-21
8922498_1	CDM	Reamer Convex 20mm Tril__lwn	18	18	$2,952.75	$2,509.84	$1,564.96	$5,344.48	$2,775.59	2025-11-21
8922497_1	CDM	Reamer Concave 22mm Tril__lwn	18	18	$2,952.75	$2,509.84	$1,564.96	$5,344.48	$2,775.59	2025-11-21
7068639_1	CDM	Labor Room/delivery - Delivery Room	18	18	$2,952.75	$2,509.84	$1,564.96	$5,344.48	$2,775.59	2025-11-21
7714294_1	CDM	Cut Guide Custom Jii V0200112__lwn	18	18	$2,948.75	$2,506.44	$1,562.84	$5,337.24	$2,771.82	2025-11-21
7714297_1	CDM	Cut Guide Custom Jii V0100112__lwn	18	18	$2,948.75	$2,506.44	$1,562.84	$5,337.24	$2,771.82	2025-11-21
49186	HCPCS	Removal Or Destruction Of Growth(s) In The Abdomen, 5.0 Cm Or Less	9	9	$3,459.00	$2,940.15	$1,274.56	$3,459.00	$2,767.20	2025-11-21
7079761_1	CDM	Operating Room Services - General Classification	18	18	$2,934.25	$2,494.11	$1,555.15	$5,310.99	$2,758.19	2025-11-21
7079762_1	CDM	Gastro - Intestinal (gi) Services - General Classification	18	18	$2,934.25	$2,494.11	$1,555.15	$5,310.99	$2,758.19	2025-11-21
27487	HCPCS	Revision Of Thigh And Lower Leg Bone Components Of Total Knee Joint Prosthesis	14	14	$7,522.00	$6,393.70	$1,710.44	$3,052.80	$2,714.15	2025-11-21
C8902	HCPCS	Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Abdom…	18	18	$2,873.00	$2,442.05	$1,522.69	$5,200.13	$2,700.62	2025-11-21
95805	HCPCS	Sleep Study, Multiple Trials	36	18	$3,432.50	$2,917.62	$935.92	$7,341.81	$2,696.40	2025-11-21
20982	HCPCS	Destruction Of Growths And Adjacent Soft Tissue	18	18	$2,863.75	$2,434.19	$1,517.79	$5,183.39	$2,691.93	2025-11-21
8736084_1	CDM	Coupler Rod-rod-pin Hoff3__lwn	18	18	$2,859.75	$2,430.79	$1,515.67	$5,176.15	$2,688.16	2025-11-21
7395306_1	CDM	Labor Room/delivery - Delivery Room	18	18	$2,857.50	$2,428.88	$1,514.48	$5,172.08	$2,686.06	2025-11-21
7578670_1	CDM	Synthecure Bead Kit Small__lwn	18	18	$2,849.50	$2,422.08	$1,510.24	$5,157.60	$2,678.53	2025-11-21
78451	HCPCS	Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect	18	18	$2,867.75	$2,437.59	$721.30	$5,190.63	$2,667.01	2025-11-21
8870206_1	CDM	Reamer 7.0 Mdsh__lwn	18	18	$2,821.50	$2,398.28	$1,495.40	$5,106.92	$2,652.22	2025-11-21
8518111_1	CDM	Drill Bit Stepped 7.5mm Mdsh__lwn	18	18	$2,821.50	$2,398.28	$1,495.40	$5,106.92	$2,652.22	2025-11-21
22551	HCPCS	Fusion Of Upper Spine Bone With Removal Of Disc And Release Of Spinal Cord Or Ne…	14	14	$6,046.00	$5,139.10	$1,667.78	$2,962.80	$2,634.14	2025-11-21
6301986_1	CDM	Labor Room/delivery - Delivery Room	18	18	$2,792.50	$2,373.63	$1,480.03	$5,054.43	$2,624.95	2025-11-21
8931479_1	CDM	Ed Trauma Activation No Pre Notification	18	18	$2,792.00	$2,373.20	$1,479.76	$5,053.52	$2,624.48	2025-11-21
G0390	HCPCS	Trauma Response Team Associated With Hospital Critical Care Service	18	18	$2,792.00	$2,373.20	$1,479.76	$5,053.52	$2,624.48	2025-11-21
8889729_1	CDM	Reamer Concave 8mm Tril__lwn	18	18	$2,788.75	$2,370.44	$1,478.04	$5,047.64	$2,621.43	2025-11-21
8889730_1	CDM	Reamer Convex 8mm Tril__lwn	18	18	$2,788.75	$2,370.44	$1,478.04	$5,047.64	$2,621.43	2025-11-21
72130	HCPCS	CT Scan Of Middle Spine Before And After Contrast	18	18	$2,797.75	$2,378.09	$437.63	$5,063.93	$2,601.91	2025-11-21
A0434	HCPCS	Specialty Care Transport (sct)	18	18	$2,759.75	$2,345.79	$1,462.67	$4,995.15	$2,594.16	2025-11-21
50435	HCPCS	Replacement Of Kidney Drainage Tube Using Imaging Guidance With Review By Radiol…	32	19	$4,892.25	$4,158.41	$94.97	$8,854.97	$2,592.89	2025-11-21
50434	HCPCS	Conversion Of Kidney Tube To Nephroureteral Tube Using Imaging Guidance And Stud…	32	19	$4,892.25	$4,158.41	$181.19	$8,854.97	$2,592.89	2025-11-21
44143	HCPCS	Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin	14	14	$3,706.00	$3,150.10	$1,596.54	$2,904.60	$2,582.39	2025-11-21
44227	HCPCS	Closure Of Opening From Large Or Small Bowel To Skin Using An Endoscope	14	14	$3,706.00	$3,150.10	$1,598.72	$2,904.00	$2,581.86	2025-11-21
8868499_1	CDM	Drill Reamer 7mm Mdsh__lwn	18	18	$2,742.75	$2,331.34	$1,453.66	$4,964.38	$2,578.19	2025-11-21
8868500_1	CDM	Drill Reamer 9mm Mdsh__lwn	18	18	$2,742.75	$2,331.34	$1,453.66	$4,964.38	$2,578.19	2025-11-21
60254	HCPCS	Removal Of Thyroid And Surrounding Lymph Nodes With Extensive Neck Removal	14	14	$5,516.00	$4,688.60	$1,617.59	$2,892.00	$2,571.18	2025-11-21
44145	HCPCS	Partial Removal Of Large Bowel And Reattachment To Rectum	14	14	$3,480.00	$2,958.00	$1,593.65	$2,883.60	$2,563.73	2025-11-21
49622	HCPCS	Repair Of Entrapped Hernia Next To Stoma	9	9	$3,201.00	$2,720.85	$907.97	$3,201.00	$2,560.80	2025-11-21
64530	HCPCS	Injection Of Anesthetic Agent Into Abdominal Sympathetic Nerve Bundle	18	18	$2,722.25	$2,313.91	$1,442.79	$4,927.27	$2,558.91	2025-11-21
64680	HCPCS	Injection Of Agent To Destroy Abdominal Nerve Bundle	18	18	$2,722.25	$2,313.91	$1,442.79	$4,927.27	$2,558.91	2025-11-21
8120055_1	CDM	Coupler Pin-rod Hoff3__lwn	18	18	$2,721.50	$2,313.28	$1,442.40	$4,925.92	$2,558.22	2025-11-21
8122058_1	CDM	Bone Block Asr 6x14x11__lwn	18	18	$2,714.75	$2,307.54	$1,438.82	$4,913.70	$2,551.86	2025-11-21
8868507_1	CDM	Reamer Concave 24mm Tril__lwn	18	18	$2,714.75	$2,307.54	$1,438.82	$4,913.70	$2,551.86	2025-11-21
8868508_1	CDM	Reamer Convex 24mm Tril__lwn	18	18	$2,714.75	$2,307.54	$1,438.82	$4,913.70	$2,551.86	2025-11-21
43860	HCPCS	Revision Of Surgically Created Connection Of Stomach To Small Bowel	14	14	$3,640.00	$3,094.00	$1,589.79	$2,863.20	$2,545.59	2025-11-21
22856	HCPCS	Insertion Of Artificial Upper Spine Disc, Anterior Approach	14	14	$5,790.00	$4,921.50	$1,591.71	$2,842.80	$2,527.45	2025-11-21
8985273_1	CDM	Lag Screw Dhs/dcs 100mm__lwn	18	18	$2,682.00	$2,279.70	$1,421.46	$4,854.42	$2,521.08	2025-11-21
7714296_1	CDM	Bone Cement Rally Hv 40gm__lwn	18	18	$2,668.50	$2,268.23	$1,414.31	$4,829.99	$2,508.39	2025-11-21
A0433	HCPCS	Advanced Life Support, Level 2 (als 2)	18	18	$2,663.50	$2,263.98	$1,411.66	$4,820.94	$2,503.69	2025-11-21
44626	HCPCS	Closure Of Surgically Created Large Or Small Bowel Opening With Bowel Removal An…	14	14	$3,339.00	$2,838.15	$1,534.70	$2,791.80	$2,482.11	2025-11-21
7813886_1	CDM	Tritanium Patella A32 Cem__lwn	18	18	$2,634.00	$2,238.90	$1,396.02	$4,767.54	$2,475.96	2025-11-21
49020	HCPCS	Drainage Of Abdominal Abscess Or Infection	14	14	$3,535.00	$3,004.75	$1,548.54	$2,781.60	$2,473.03	2025-11-21
7068638_1	CDM	Labor Room/delivery - Delivery Room	18	18	$2,630.75	$2,236.14	$1,394.30	$4,761.66	$2,472.90	2025-11-21
49617	HCPCS	Repair Of Recurrent Sliding Hernia Of Abdomen, More Than 10 Cm In Length	9	9	$3,090.00	$2,626.50	$861.53	$3,090.00	$2,472.00	2025-11-21
8736158_1	CDM	Spade Pilot Drill 2.6mm Tril__lwn	18	18	$2,629.75	$2,235.29	$1,393.77	$4,759.85	$2,471.97	2025-11-21
8736067_1	CDM	Sorbafix Mesh Tacker 30__lwn	18	18	$2,629.75	$2,235.29	$1,393.77	$4,759.85	$2,471.97	2025-11-21
C8912	HCPCS	Magnetic Resonance Angiography With Contrast, Lower Extremity	36	18	$2,627.75	$2,233.59	$1,392.71	$4,756.23	$2,470.09	2025-11-21
C8913	HCPCS	Magnetic Resonance Angiography Without Contrast, Lower Extremity	36	18	$2,627.75	$2,233.59	$1,392.71	$4,756.23	$2,470.09	2025-11-21
C8914	HCPCS	Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Lower…	36	18	$2,627.75	$2,233.59	$1,392.71	$4,756.23	$2,470.09	2025-11-21
C8900	HCPCS	Magnetic Resonance Angiography With Contrast, Abdomen	18	18	$2,622.50	$2,229.13	$1,389.93	$4,746.73	$2,465.15	2025-11-21
L3967	HCPCS	Shoulder Elbow Wrist Hand Orthosis, Abduction Positioning (airplane Design), Tho…	18	18	$2,611.50	$2,219.78	$1,384.10	$4,726.82	$2,454.81	2025-11-21
L3978	HCPCS	Shoulder Elbow Wrist Hand Finger Orthosis, Abduction Positioning (airplane Desig…	18	18	$2,611.50	$2,219.78	$1,384.10	$4,726.82	$2,454.81	2025-11-21
22612	HCPCS	Fusion Of Spine In Lower Back	14	14	$5,636.00	$4,790.60	$1,548.88	$2,760.00	$2,453.84	2025-11-21
Q5103	HCPCS	Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg	18	18	$2,608.75	$2,217.44	$1,382.64	$6,521.88	$2,452.22	2025-11-21
G0259	HCPCS	Injection Procedure For Sacroiliac Joint; Arthrography	46	19	$2,722.25	$2,313.91	$47.50	$4,927.27	$2,450.03	2025-11-21
9060180_1	CDM	Anchor 4.75 Ossio Blk/wht__lwn	18	18	$2,599.25	$2,209.36	$1,377.60	$4,704.64	$2,443.30	2025-11-21
22630	HCPCS	Fusion Of Lower Spine Bone And Partial Removal Of Spine Bone Or Disc Through Bac…	14	14	$5,100.00	$4,335.00	$1,538.64	$2,735.40	$2,431.97	2025-11-21
94002	HCPCS	Initial Hospital Inpatient Or Observation Ventilation Assistance And Management	34	18	$2,612.25	$2,220.41	$169.59	$4,729.53	$2,430.09	2025-11-21
70542	HCPCS	MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast	18	18	$2,612.50	$2,220.63	$598.13	$4,728.63	$2,429.63	2025-11-21
73719	HCPCS	MRI Scan Of Leg With Contrast	90	18	$2,612.50	$2,220.63	$585.07	$4,728.63	$2,429.63	2025-11-21
73219	HCPCS	MRI Scan Of Arm With Contrast	90	18	$2,612.50	$2,220.63	$808.08	$4,728.63	$2,429.63	2025-11-21
72196	HCPCS	MRI Scan Of Pelvis With Contrast	36	18	$2,612.50	$2,220.63	$586.00	$4,728.63	$2,429.63	2025-11-21

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