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

CENTRAL MONTANA MEDICAL CENTER

Lewistown, MT · CCN 271345 · Rates published

Your selected procedure

You selected 93306 (HCPCS)

Ultrasound of heart with color-depicted blood flow, rate, direction and valve function

This hospital’s price: $734 across 19 payers · range $65-$3,806

Source: https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbCMMCLewistownMT&type=CDMWithoutLabel&fileType=CSV · observed 2025-11-21

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

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 — reasonRows
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 viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-10-19
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
$29,492
outlier · 6.8×
483
MS_DRG 		Major Joint Or Limb Reattachment Procedures Of Upper Extremities 2 $103,358.13 $207,458.04 $155,408.09 nat. median
$25,358
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
$38,944
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
$21,232
outlier · 4.3×
335
MS_DRG 		Peritoneal Adhesiolysis With Mcc 2 $49,592.84 $118,643.11 $84,117.98 nat. median
$33,175
outlier · 2.5×
J9321
HCPCS 		Injection, Epcoritamab-bysp, 0.16 Mg 18 $41,987.66 $198,055.00 $74,468.68 nat. median
$1,458
outlier · 51.1×
330
MS_DRG 		Major Small And Large Bowel Procedures With Cc 2 $37,422.76 $101,389.93 $69,406.35 nat. median
$22,965
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
$32,654
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
$40,003
1.5× median
J0896
HCPCS 		Injection, Luspatercept-aamt, 0.25 Mg 18 $28,617.62 $134,988.75 $50,755.78 nat. median
$4,569
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
$33,682
1.5× median
J2327
HCPCS 		Injection, Risankizumab-rzaa, Intravenous, 1 Mg 18 $26,827.81 $126,546.25 $47,581.40 nat. median
$1,767
outlier · 26.9×
J1303
HCPCS 		Injection, Ravulizumab-cwvz, 10 Mg 18 $24,903.51 $117,469.38 $44,168.49 nat. median
$5,631
outlier · 7.8×
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
$23,553
1.8× median
J3357
HCPCS 		Ustekinumab, For Subcutaneous Injection, 1 Mg 18 $23,514.51 $110,917.50 $41,704.98 nat. median
$14,697
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
$18,303
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 · 255.3×
J9042
HCPCS 		Injection, Brentuximab Vedotin, 1 Mg 18 $15,913.25 $75,062.50 $28,223.50 nat. median
$962
outlier · 29.3×
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
$611
outlier · 46.2×
J9022
HCPCS 		Injection, Atezolizumab, 10 Mg 18 $15,913.25 $75,062.50 $28,223.50 nat. median
$6,720
outlier · 4.2×
J2783
HCPCS 		Injection, Rasburicase, 0.5 Mg 18 $15,697.01 $74,042.50 $27,839.98 nat. median
$1,590
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
$3,787
outlier · 7.1×
J9228
HCPCS 		Injection, Ipilimumab, 1 Mg 18 $14,128.08 $66,641.88 $25,057.35 nat. median
$8,966
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
$286
outlier · 76.7×
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
$155
outlier · 132.9×
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
$180
outlier · 111.4×
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
$5,623
outlier · 3.4×
J9299
HCPCS 		Injection, Nivolumab, 1 Mg 18 $10,633.13 $50,156.25 $18,858.76 nat. median
$2,849
outlier · 6.6×
J1299
HCPCS 		Injection, Eculizumab, 2 Mg 18 $10,384.82 $48,985.00 $18,418.36 nat. median
$2,885
outlier · 6.4×
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 · 367.5×
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
$45
outlier · 338.3×
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
$75
outlier · 194.2×
J9271
HCPCS 		Injection, Pembrolizumab, 1 Mg 18 $7,859.90 $37,075.00 $13,940.20 nat. median
$275
outlier · 50.8×
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 · 86.6×
J1950
HCPCS 		Injection, Leuprolide Acetate (for Depot Suspension), Per 3.75 Mg 18 $3,612.88 $62,108.13 $13,166.92 nat. median
$3,921
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.

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
             
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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