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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

GOTHENBURG HEALTH

Gothenburg, NE · CCN 281313 · Rates published

3,680 distinct procedures filed
4 distinct payers
23,918 rate rows
2025-06-11 last MRF observed · ⚠ 16 mo old
Data quality

23,918 of 23,918 rate rows are consumer-grade (100.0%)

Every filed rate row passes our consumer-grade checks — none are excluded from the medians.

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 16 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://secure.claraprice.net/price-transparency/YTLS-1743523485849/machine-readable/470532605_gothenburg-health_standardcharges.json
Found on page https://secure.claraprice.net/price-transparency/gothenburg-health-ne
Discovered viaDiscovered by HANK
Last fetch success · 2026-09-25
Content fingerprint 062680d52462d4cb… · 4,693,822 bytes · first seen 2026-06-15

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
CP17805909631404387
CDM 		Cabazitaxel 60mg/1.5ml [Gmh] 4 $21,183.00 $33,131.00 $21,742.00 —
64590
CPT 		64590 Implant Of Neurolog Devic 4 $14,577.00 $22,798.00 $18,523.50 nat. median
$18,089
1.0× median
4507205
CDM 		Brentuximab Vedotin 50 Mg Pow [Gmh] 4 $18,003.00 $28,157.00 $18,478.00 —
4507085
CDM 		Luspatercept Aamt 75 Mg Pow [Gmh] 4 $17,852.00 $27,921.00 $18,323.00 —
4507047
CDM 		Atezolizumab 1200 Mg/20 Ml Sol [Gmh] 4 $16,606.00 $25,972.00 $17,044.00 —
4506039
CDM 		Pegfilgrastim On-body 6 Mg/0.6 Ml Sol [Gmh] 4 $15,770.00 $24,664.00 $16,186.00 —
4507166
CDM 		Daratumumab-hyaluronidase Fihj 1800 Mg-30,000 Units/15 Ml Sol [Gmh] 4 $14,795.00 $23,140.00 $15,186.00 —
4301933
CDM 		Interstim X Neurostimulator (c) 4 $11,248.00 $17,592.00 $14,293.50 nat. median
$216
outlier · 66.2×
4507068
CDM 		Vedolizumab 300 Mg Pow [Gmh] 4 $13,819.00 $21,613.00 $14,184.00 —
53850
CPT 		53850 Microwave Thermo Therapy 4 $10,713.00 $16,756.00 $13,614.00 nat. median
$3,676
outlier · 3.7×
4507002
CDM 		Tenecteplase 50 Mg Pow 4 $12,235.00 $19,136.00 $12,558.00 —
4507121
CDM 		Nivolumab 240 Mg/ 24 Ml Sol [Gmh] 4 $11,503.00 $17,990.00 $11,806.00 —
4507127
CDM 		Lurbinectedin 4 Mg Pow 4 $11,285.00 $17,651.00 $11,583.00 —
4505027
CDM 		Immune Globulin Intravenous 10% Sol [Gmh] 4 $11,107.00 $17,371.00 $11,400.00 —
4507204
CDM 		Eflapegrastim Xnst 13.2 Mg/0.6 Ml Sol [Gmh] 4 $11,061.00 $17,299.00 $11,353.00 —
4507203
CDM 		Pegfilgrastim Cbqv 6 Mg/0.6 Ml Sol [Gmh] 4 $10,263.00 $16,051.00 $10,534.00 —
4506024
CDM 		Pertuzumab 420 Mg/14 Ml Sol [Gmh] 4 $10,078.00 $15,762.00 $10,344.00 —
4506026
CDM 		Leuprolide 22.5 Mg/3 Months Pwd 4 $9,497.00 $14,854.00 $9,748.00 —
4503752
CDM 		Pegfilgrastim 6. Mg Soln [Gmh] 4 $9,467.00 $14,806.00 $9,716.00 —
4501075
CDM 		Certolizumab Kit [Gmh] 4 $8,850.00 $13,842.00 $9,084.00 —
4505097
CDM 		Pembrolizumab 25 Mg/ml Sol [Gmh] 4 $8,548.00 $13,370.00 $8,774.00 —
4507035
CDM 		Leuprolide 11.25 Mg/3 Months Pwd [Gmh] 4 $7,972.00 $12,468.00 $8,182.00 —
4505070
CDM 		Immune Globulin Intravenous And Subcutaneous 10% Sol [Gmh] 4 $7,729.00 $12,088.00 $7,933.00 —
4309625
CDM 		Assert Iq Cardiac Monitor 4 $6,077.00 $9,504.00 $7,722.00 —
4502013
CDM 		Rituximab 500 Mg/50 Ml IV Sol [Gmh] 4 $6,951.00 $10,871.00 $7,134.00 —
4309583
CDM 		Jot Dx Dm4500 4 $5,386.00 $8,424.00 $6,844.50 —
4507086
CDM 		Rituximab Abbs 10 Mg/ml 500mg Sol [Gmh] 4 $6,259.00 $9,789.00 $6,424.00 —
4507088
CDM 		Pegfilgrastim Jmdb 6 Mg/0.6 Ml Sol [Gmh] 4 $6,163.00 $9,638.00 $6,325.00 —
47562
CPT 		Removal Of Gallbladder Using An Endoscope 4 $4,928.00 $7,708.00 $6,262.50 nat. median
$6,043
1.0× median
4505017
CDM 		Pemetrexed 500 Mg Pow [Gmh] 4 $5,986.00 $9,363.00 $6,144.00 —
4507169
CDM 		Durvalumab 50 Mg/ml Sol [Gmh] 4 $5,945.00 $9,298.00 $6,102.00 —
4507206
CDM 		Nivolumab 120 Mg/ 12 Ml Sol [Gmh] 4 $5,881.00 $9,199.00 $6,037.00 —
59400
CPT 		Obstetric Care, Planned Vaginal Delivery 4 $4,665.00 $7,296.00 $5,928.00 nat. median
$2,933
outlier · 2.0×
4506012
CDM 		Darbepoetin Alfa 500 Mcg/ml Sol [Gmh] 4 $5,713.00 $8,936.00 $5,864.00 —
4505033
CDM 		Immune Globulin Intravenous 10% Sol [Gmh] 4 $5,559.00 $8,695.00 $5,706.00 —
70471
CPT 		CT Angio Head/neck With Contrast 4 $4,266.00 $6,672.00 $5,421.50 nat. median
$410
outlier · 13.2×
64581
CPT 		64581 Incision Implnt Neuro Ele 4 $4,186.00 $6,546.00 $5,319.00 nat. median
$6,173
0.9× median
4301924
CDM 		Lead Kit Is2 28cm (c) 4 $4,152.00 $6,494.00 $5,276.50 nat. median
$5
outlier · 1055.3×
4501042
CDM 		Denosumab 120 Mg/1.7 Ml Sol [Gmh] 4 $5,094.00 $7,967.00 $5,228.00 —
4507164
CDM 		Inclisiran 284 Mg/1.5 Ml Sol {Gmh] 4 $4,982.00 $7,791.00 $5,113.00 —
4506064
CDM 		Rabies Immune Globulin, Human 300 Units/ml 5 Ml Sol [Gmh] 4 $4,950.00 $7,742.00 $5,081.00 —
76497
CPT 		CT Whole Body Low Dose 4 $3,990.00 $6,240.00 $5,070.00 nat. median
$95
outlier · 53.6×
74174
CPT 		CT Angio Abdomen Pelvis 4 $3,928.00 $6,144.00 $4,992.00 nat. median
$549
outlier · 9.1×
4503842
CDM 		Polyvalent Immune Fab, Anti Snake [Gmh] 4 $4,723.00 $7,387.00 $4,848.00 —
74178
CPT 		CT Abdomen +Pelvis With + Without Cont 4 $3,775.00 $5,904.00 $4,797.50 nat. median
$539
outlier · 8.9×
58291
CPT 		58291 Vaginal Hysterectomy, For Uterus Greater Than 250g With Removal Of Tube(s)… 4 $3,550.00 $5,553.00 $4,511.50 nat. median
$5,041
0.9× median
72157
CPT 		MRI Spine Thoracic With + Without Cont 4 $3,500.00 $5,474.00 $4,447.50 nat. median
$624
outlier · 7.1×
4507210
CDM 		Acetic Acid 5% Solution 50 Ml [Gmh] 4 $4,308.00 $6,737.00 $4,421.00 —
72156
CPT 		MRI Spine Cervical With + Without Cont 4 $3,384.00 $5,293.00 $4,301.00 nat. median
$625
outlier · 6.9×
58280
CPT 		58280 Vaginal Hysterectomy, With Total Or Partial Vaginectomy With Repair Of ENT… 4 $3,383.00 $5,292.00 $4,299.50 nat. median
$4,320
1.0× median

Other procedures at this hospital

Browse this hospital's 3,680 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
             
10140 CPT 10140 I&d Hematoma Seroma/fluid Collection Techfee 6 4 $2,254.00 $2,029.00 $1,384.00 $2,164.00 $1,758.00 2025-06-11
11044 CPT 11044 Debridement Skin, Sq Tissue, Muscle, Bon Tech Fee 6 4 $2,346.00 $2,111.00 $1,440.00 $2,252.00 $1,830.00 2025-06-11
13160 CPT 13160 Secondary Closure Surg Wound Exten/comp 6 4 $3,760.00 $3,384.00 $2,308.00 $3,610.00 $2,933.00 2025-06-11
4309958 CDM 2.7 Cannulated Drill Bit 310.67 6 4 $1,840.00 $1,656.00 $1,129.00 $1,766.00 $1,435.00 2025-06-11
27267 CPT 27267 Cltx Proximal End/head Femur Without Man 6 4 $4,055.00 $3,650.00 $2,489.00 $3,893.00 $3,163.00 2025-06-11
38221 CPT 38221 Bone Marrow Biopsy 6 4 $2,000.00 $1,800.00 $1,228.00 $1,920.00 $1,560.00 2025-06-11
38222 CPT 38222 Diagnostic Bone Marrow; Biopsy(ies) And Aspiration(s) 6 4 $2,800.00 $2,520.00 $1,719.00 $2,688.00 $2,184.00 2025-06-11
49553 CPT 49553 Repair Initial Femoral Hernia, Any Age Incarcerated Or Strangulated 6 4 $3,300.00 $2,970.00 $2,026.00 $3,168.00 $2,574.00 2025-06-11
53850 CPT 53850 Microwave Thermo Therapy 6 4 $17,454.00 $15,709.00 $10,713.00 $16,756.00 $13,614.00 2025-06-11
57010 CPT 57010 Colpotomy; With Exploration With Drainage Of Pelvic Abscess 6 4 $2,013.00 $1,812.00 $1,236.00 $1,932.00 $1,570.00 2025-06-11
57130 CPT 57130 Excision Of Vaginal Septum 6 4 $2,084.00 $1,876.00 $1,279.00 $2,001.00 $1,625.50 2025-06-11
57230 CPT 57230 Plastic Repair Of Urethrocele 6 4 $1,757.00 $1,581.00 $1,078.00 $1,687.00 $1,370.50 2025-06-11
57265 CPT 57265 Combined Anterposterior Colporrhaphy With Enterocele Repair 6 4 $4,077.00 $3,669.00 $2,502.00 $3,914.00 $3,180.50 2025-06-11
57268 CPT 57268 Repair Of Enterocele, Vaginal Approach 6 4 $2,367.00 $2,130.00 $1,453.00 $2,272.00 $1,846.00 2025-06-11
57270 CPT 57270 Repair Of Enterocele, Abdominal Approach 6 4 $3,651.00 $3,286.00 $2,241.00 $3,505.00 $2,847.50 2025-06-11
57300 CPT 57300 Closure Of Rectovaginal Fistula; Vaginal Or Transanal Approach 6 4 $2,869.00 $2,582.00 $1,761.00 $2,754.00 $2,237.50 2025-06-11
57310 CPT 57310 Closure Of Urethrovaginal Fistula 6 4 $2,084.00 $1,876.00 $1,279.00 $2,001.00 $1,625.50 2025-06-11
57320 CPT 57320 Closure Of Vesicovaginal Fistula; Vaginal Approach 6 4 $2,338.00 $2,104.00 $1,435.00 $2,244.00 $1,823.50 2025-06-11
57540 CPT 57540 Excision Of Cervical Stump; Abdominal Approach 6 4 $4,071.00 $3,664.00 $2,499.00 $3,908.00 $3,175.50 2025-06-11
57545 CPT 57545 Excision Of Cervical Stump; Abdominal Approach With Pelvic Floor Repair 6 4 $4,295.00 $3,866.00 $2,636.00 $4,123.00 $3,350.00 2025-06-11
57550 CPT 57550 Excision Of Cervical Stump, Vaginal Approach 6 4 $2,126.00 $1,913.00 $1,305.00 $2,041.00 $1,658.00 2025-06-11
57555 CPT 57555 Excision Of Cervical Stump, Vaginal Approach With Anterior And/or Posterio… 6 4 $3,136.00 $2,822.00 $1,925.00 $3,011.00 $2,446.00 2025-06-11
57556 CPT 57556 Excision Of Cervical Stump, Vaginal Approach With Repair Of Enterocele 6 4 $2,950.00 $2,655.00 $1,811.00 $2,832.00 $2,301.50 2025-06-11
58270 CPT 58270 Vaginal Hysterectomy, For Uterus 250g Or Less With Repair Of Enterocele 6 4 $4,782.00 $4,304.00 $2,935.00 $4,591.00 $3,730.00 2025-06-11
58280 CPT 58280 Vaginal Hysterectomy, With Total Or Partial Vaginectomy With Repair Of Ent… 6 4 $5,512.00 $4,961.00 $3,383.00 $5,292.00 $4,299.50 2025-06-11
58290 CPT 58290 Vaginal Hysterectomy, For Uterus Greater Than 250g 6 4 $5,331.00 $4,798.00 $3,272.00 $5,118.00 $4,158.50 2025-06-11
58291 CPT 58291 Vaginal Hysterectomy, For Uterus Greater Than 250g With Removal Of Tube(s)… 6 4 $5,784.00 $5,206.00 $3,550.00 $5,553.00 $4,511.50 2025-06-11
58670 CPT 58670 Laparoscopy, Surgical; With Fulguration Of Oviducts (With Or Without Trans… 6 4 $2,300.00 $2,070.00 $1,412.00 $2,208.00 $1,794.00 2025-06-11
CP17805908878497799 CDM 58673 Laparoscopy Salpingostomy . 6 4 $1,920.00 $1,728.00 $1,178.00 $1,843.00 $1,498.00 2025-06-11
58700 CPT 58700 Salpingectomy, Complete Or Partial, Unilateral Or Bilateral 6 4 $3,600.00 $3,240.00 $2,210.00 $3,456.00 $2,808.00 2025-06-11
58740 CPT 58740 Lysis Of Adhesion (Salpingolysis, Ovariolysis) 6 4 $3,889.00 $3,500.00 $2,387.00 $3,733.00 $3,033.50 2025-06-11
58770 CPT 58770 Salpingostomy (Salpingoneostomy) 6 4 $4,719.00 $4,247.00 $2,897.00 $4,530.00 $3,681.00 2025-06-11
58800 CPT 58800 Drainage Of Ovarian Cyst(s), Unilateral Or Bilateral; Vaginal Approach 6 4 $1,705.00 $1,535.00 $1,047.00 $1,637.00 $1,330.00 2025-06-11
58805 CPT 58805 Drainage Of Ovarian Cyst(s), Unilateral Or Bilateral; Abdominal Approach 6 4 $1,944.00 $1,750.00 $1,193.00 $1,866.00 $1,516.50 2025-06-11
58822 CPT 58822 Drainage Of Ovarian Abscess; Abdominal Approach 6 4 $4,018.00 $3,616.00 $2,466.00 $3,857.00 $3,134.00 2025-06-11
58825 CPT 58825 Transposition, Ovary(s) 6 4 $3,964.00 $3,568.00 $2,433.00 $3,805.00 $3,092.00 2025-06-11
58900 CPT 58900 Biopsy Of Ovary, Unilateral Or Bilateral 6 4 $2,423.00 $2,181.00 $1,487.00 $2,326.00 $1,889.50 2025-06-11
58920 CPT 58920 Wedge Resection Or Bisection Of Ovary, Unilateral Or Bilateral 6 4 $3,901.00 $3,511.00 $2,394.00 $3,745.00 $3,043.00 2025-06-11
59821 CPT 58921 Treatment Of Missed Abortion, Completed Surgically, Second Trimester 6 4 $1,937.00 $1,743.00 $1,189.00 $1,860.00 $1,510.50 2025-06-11
58925 CPT 58925 Ovarian Cystectomy, Unilateral Or Bilateral 6 4 $3,720.00 $3,348.00 $2,283.00 $3,571.00 $2,902.00 2025-06-11
59070 CPT 59070 Transabdominal Amnioninfusion Including Ultrasound Guidance 6 4 $1,719.00 $1,547.00 $1,055.00 $1,650.00 $1,341.00 2025-06-11
59100 CPT 59100 Hysterectomy, Abdominal 6 4 $3,531.00 $3,178.00 $2,167.00 $3,390.00 $2,754.50 2025-06-11
59130 CPT 59130 Surgical Treatment Of Ectopic Pregnancy, Abdominal Pregnancy 6 4 $3,479.00 $3,131.00 $2,135.00 $3,340.00 $2,713.50 2025-06-11
CP17805908878498491 CDM 59150 Treat Ectopic Pregnancy . 6 4 $2,310.00 $2,079.00 $1,418.00 $2,218.00 $1,801.50 2025-06-11
59830 CPT 59830 Treatment Of Septic Abortion, Completed Surgically 6 4 $1,841.00 $1,657.00 $1,130.00 $1,767.00 $1,436.00 2025-06-11
59870 CPT 59870 Uterine Evacuation And Curettage For Hydatidiform Mole 6 4 $2,034.00 $1,831.00 $1,248.00 $1,953.00 $1,586.50 2025-06-11
64415 CPT 64415brachial Plexus, Single 6 4 $2,671.00 $2,404.00 $1,639.00 $2,564.00 $2,083.50 2025-06-11
64416 CPT 64416brachial Plexus, Continuous Infusion By Catheter (Including Catheter Placem… 6 4 $2,671.00 $2,404.00 $1,639.00 $2,564.00 $2,083.50 2025-06-11
64417 CPT 64417axillary Nerve 6 4 $2,671.00 $2,404.00 $1,639.00 $2,564.00 $2,083.50 2025-06-11
64445 CPT 64445 Anesth Sciatic Nerve, Single 6 4 $2,078.00 $1,870.00 $1,275.00 $1,995.00 $1,621.00 2025-06-11
64446 CPT 64446sciatic Nerve, Continuous Infusion By Catheter (Including Catheter Placment… 6 4 $2,078.00 $1,870.00 $1,275.00 $1,995.00 $1,621.00 2025-06-11
64447 CPT 64447 Anesth Femoral Nerve, Single 6 4 $2,018.00 $1,816.00 $1,239.00 $1,937.00 $1,574.00 2025-06-11
64448 CPT 64448 Anesth Femoral Nerve, Continuous Infusion By Catheter (Including Catheter … 6 4 $2,078.00 $1,870.00 $1,275.00 $1,995.00 $1,621.00 2025-06-11
64450 CPT 64450 N Block Other Peripheral . 6 4 $2,671.00 $2,404.00 $1,639.00 $2,564.00 $2,083.50 2025-06-11
64479 CPT 64479 Anesth Injection(s) Anesthetic Agent And/or Steriod, Transforaminal Epidur… 6 4 $2,307.00 $2,076.00 $1,416.00 $2,215.00 $1,799.50 2025-06-11
64486 CPT 64486transversus Abdominis Plane (Tap) Block Unilateral 6 4 $2,078.00 $1,870.00 $1,275.00 $1,995.00 $1,621.00 2025-06-11
64488 CPT 64488transversus Abdominis Plane (Tap) Block (Abdominal Plane Block, Rectus Shea… 6 4 $2,950.00 $2,655.00 $1,811.00 $2,832.00 $2,301.50 2025-06-11
64581 CPT 64581 Incision Implnt Neuro Ele 6 4 $6,819.00 $6,137.00 $4,186.00 $6,546.00 $5,319.00 2025-06-11
64585 CPT 64585 Removal Of Test Lead 6 4 $3,961.00 $3,565.00 $2,431.00 $3,803.00 $3,089.50 2025-06-11
64590 CPT 64590 Implant Of Neurolog Devic 6 4 $23,748.00 $21,373.00 $14,577.00 $22,798.00 $18,523.50 2025-06-11
95811 CPT 95811 Sleep Study W Cpap 6 4 $5,200.00 $4,680.00 $3,192.00 $4,992.00 $4,056.00 2025-06-11
36262 CPT 99211 Removal Of Cadd Pump Charge 6 4 $3,640.00 $3,276.00 $2,234.00 $3,494.00 $2,839.00 2025-06-11
99291 CPT 99291fac Ed Critical Care 6 4 $1,750.00 $1,575.00 $1,074.00 $1,680.00 $1,365.50 2025-06-11
4507168 CDM Abatacept 250 Mg Pow [Gmh] 7 4 $3,653.00 $3,288.00 $2,242.00 $3,507.00 $2,301.00 2025-06-11
4507210 CDM Acetic Acid 5% Solution 50 Ml [Gmh] 7 4 $7,018.00 $6,316.00 $4,308.00 $6,737.00 $4,421.00 2025-06-11
CP17805909631288591 CDM Alemtuzumab 30mg/1ml Vial [Gmh] 7 4 $4,286.00 $3,857.00 $2,631.00 $4,115.00 $2,700.00 2025-06-11
4300265 CDM Allograft 7.5mm X 280mm 6 4 $2,682.00 $2,414.00 $1,646.00 $2,575.00 $2,092.00 2025-06-11
4301167 CDM Amnion Matrix 4x8 6 4 $5,030.00 $4,527.00 $3,087.00 $4,829.00 $3,923.50 2025-06-11
4300992 CDM Aqueous Shunt Non Valve Express ( Sightpath ) 6 4 $2,079.00 $1,871.00 $1,276.00 $1,996.00 $1,621.50 2025-06-11
4309625 CDM Assert Iq Cardiac Monitor 6 4 $9,900.00 $8,910.00 $6,077.00 $9,504.00 $7,722.00 2025-06-11
4507047 CDM Atezolizumab 1200 Mg/20 Ml Sol [Gmh] 7 4 $27,054.00 $24,349.00 $16,606.00 $25,972.00 $17,044.00 2025-06-11
4507143 CDM Bendamustine 25 Mg/ml 4ml Sol [Gmh] 7 4 $5,987.00 $5,388.00 $3,675.00 $5,748.00 $3,772.00 2025-06-11
4507069 CDM Bevacizumab Awwb 25 Mg/ml Sol [Gmh] 7 4 $6,748.00 $6,073.00 $4,142.00 $6,478.00 $4,251.00 2025-06-11
43239 CPT Biopsy Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 6 4 $3,855.00 $3,470.00 $2,366.00 $3,701.00 $3,007.00 2025-06-11
45380 CPT Biopsy Exam Of Large Bowel Using An Endoscope 6 4 $5,236.00 $4,712.00 $3,214.00 $5,027.00 $4,084.00 2025-06-11
4502022 CDM Bortezomib 3.5mg Sdv [Gmh] 7 4 $3,897.00 $3,507.00 $2,392.00 $3,741.00 $2,455.00 2025-06-11
4305513 CDM Bottle To Bottle Hose 6 4 $2,849.00 $2,564.00 $1,749.00 $2,735.00 $2,222.50 2025-06-11
4507205 CDM Brentuximab Vedotin 50 Mg Pow [Gmh] 7 4 $29,330.00 $26,397.00 $18,003.00 $28,157.00 $18,478.00 2025-06-11
4300783 CDM C-qur Mesh 10 X 14 6 4 $2,559.00 $2,303.00 $1,571.00 $2,457.00 $1,996.00 2025-06-11
CP17805909631404387 CDM Cabazitaxel 60mg/1.5ml [Gmh] 7 4 $34,511.00 $31,060.00 $21,183.00 $33,131.00 $21,742.00 2025-06-11
4309959 CDM Cannulated Hex Screwdriver 314.29 6 4 $3,000.00 $2,700.00 $1,841.00 $2,880.00 $2,340.00 2025-06-11
93350 CPT Cardiac Echocardiogram With Stress 6 4 $1,800.00 $1,620.00 $1,105.00 $1,728.00 $1,404.00 2025-06-11
4300974 CDM Cataract W/astigmatism Symfony,toric,multifocal Toric, Acrysof Iq ( Sightpath ) 6 4 $1,750.00 $1,575.00 $1,074.00 $1,680.00 $1,365.50 2025-06-11
4300986 CDM Cataract W/astigmatism Tecnis Syngergy Toric ( Sightpath ) 6 4 $1,950.00 $1,755.00 $1,197.00 $1,872.00 $1,521.50 2025-06-11
4300987 CDM Cataract W/ext Depth Alcon Vivity, Panoptix ( Sightpath ) 6 4 $1,750.00 $1,575.00 $1,074.00 $1,680.00 $1,365.50 2025-06-11
4501075 CDM Certolizumab Kit [Gmh] 7 4 $14,419.00 $12,977.00 $8,850.00 $13,842.00 $9,084.00 2025-06-11
4507073 CDM Cetuximab 2 Mg/ml 200mg Sol [Gmh] 7 4 $3,948.00 $3,553.00 $2,423.00 $3,790.00 $2,487.00 2025-06-11
4301119 CDM Cmc Tightrope 1.1mm 6 4 $1,790.00 $1,611.00 $1,099.00 $1,718.00 $1,396.50 2025-06-11
74178 CPT CT Abdomen +Pelvis With + Without Cont 6 4 $6,150.00 $5,535.00 $3,775.00 $5,904.00 $4,797.50 2025-06-11
74176 CPT CT Abdomen +Pelvis Without Cont 6 4 $4,625.00 $4,163.00 $2,839.00 $4,440.00 $3,607.50 2025-06-11
49180 CPT CT Abdomen Biopsy 6 4 $2,300.00 $2,070.00 $1,412.00 $2,208.00 $1,794.00 2025-06-11
74170 CPT CT Abdomen With + Without Cont 6 4 $3,400.00 $3,060.00 $2,087.00 $3,264.00 $2,652.00 2025-06-11
74160 CPT CT Abdomen With Cont 6 4 $3,000.00 $2,700.00 $1,841.00 $2,880.00 $2,340.00 2025-06-11
74150 CPT CT Abdomen Without Cont 6 4 $2,700.00 $2,430.00 $1,657.00 $2,592.00 $2,106.00 2025-06-11
74174 CPT CT Angio Abdomen Pelvis 6 4 $6,400.00 $5,760.00 $3,928.00 $6,144.00 $4,992.00 2025-06-11
74175 CPT CT Angio Abdomen With + Without Cont 6 4 $3,725.00 $3,353.00 $2,286.00 $3,576.00 $2,905.50 2025-06-11
75635 CPT CT Angio Chest +Abdomen +Pelvis W/runoff 6 4 $3,900.00 $3,510.00 $2,394.00 $3,744.00 $3,042.00 2025-06-11
71275 CPT CT Angio Chest With Cont 6 4 $3,700.00 $3,330.00 $2,271.00 $3,552.00 $2,886.00 2025-06-11
CP17805908877493841 CDM CT Angio Head + Perfusion 6 4 $3,100.00 $2,790.00 $1,903.00 $2,976.00 $2,418.00 2025-06-11
3760109-TC CDM CT Angio Head +Angio Neck With + Without Cont 7 4 $3,156.00 $2,840.00 $1,937.00 $3,030.00 $1,988.00 2025-06-11
70496 CPT CT Angio Head With + Without Cont 6 4 $3,500.00 $3,150.00 $2,148.00 $3,360.00 $2,730.00 2025-06-11
70471 CPT CT Angio Head/neck With Contrast 6 4 $6,950.00 $6,255.00 $4,266.00 $6,672.00 $5,421.50 2025-06-11
73706 CPT CT Angio Le Bil 6 4 $3,000.00 $2,700.00 $1,841.00 $2,880.00 $2,340.00 2025-06-11
70498 CPT CT Angio Neck With + Without Cont 6 4 $3,450.00 $3,105.00 $2,118.00 $3,312.00 $2,691.50 2025-06-11
73206 CPT CT Angio Ue Lt 6 4 $3,300.00 $2,970.00 $2,026.00 $3,168.00 $2,574.00 2025-06-11
77012 CPT CT Biopsy 6 4 $2,500.00 $2,250.00 $1,535.00 $2,400.00 $1,950.00 2025-06-11
71271 CPT CT Chest Low Dose Screen Without Cont 6 4 $2,011.00 $1,810.00 $1,234.00 $1,931.00 $1,568.50 2025-06-11
71270 CPT CT Chest With + Without Cont 6 4 $3,475.00 $3,128.00 $2,133.00 $3,336.00 $2,710.50 2025-06-11
71260 CPT CT Chest With Cont 6 4 $2,850.00 $2,565.00 $1,749.00 $2,736.00 $2,223.50 2025-06-11
71250 CPT CT Chest Without Cont 6 4 $2,650.00 $2,385.00 $1,627.00 $2,544.00 $2,067.50 2025-06-11
70470 CPT CT Head Or Brain With + Without Cont 6 4 $3,500.00 $3,150.00 $2,148.00 $3,360.00 $2,730.00 2025-06-11
70460 CPT CT Head Or Brain With Cont 6 4 $2,600.00 $2,340.00 $1,596.00 $2,496.00 $2,028.00 2025-06-11
70482 CPT CT Iac With + Without Cont 6 4 $2,800.00 $2,520.00 $1,719.00 $2,688.00 $2,184.00 2025-06-11
70481 CPT CT Iac With Cont 6 4 $2,700.00 $2,430.00 $1,657.00 $2,592.00 $2,106.00 2025-06-11
70480 CPT CT Iac Without Cont 6 4 $2,600.00 $2,340.00 $1,596.00 $2,496.00 $2,028.00 2025-06-11
73702 CPT CT Le With + Without Cont Bil 6 4 $3,500.00 $3,150.00 $2,148.00 $3,360.00 $2,730.00 2025-06-11
73701 CPT CT Le With Cont Lt 6 4 $2,800.00 $2,520.00 $1,719.00 $2,688.00 $2,184.00 2025-06-11
73700 CPT CT Le Without Cont Lt 6 4 $2,550.00 $2,295.00 $1,565.00 $2,448.00 $1,989.50 2025-06-11
47000 CPT CT Liver Biopsy 12 4 $2,750.00 $2,475.00 $1,535.00 $2,880.00 $2,107.50 2025-06-11
76380 CPT CT Ltd Or Localized Fol-up 6 4 $1,790.00 $1,611.00 $1,099.00 $1,718.00 $1,396.50 2025-06-11
72194 CPT CT Pelvis With + Without Cont 6 4 $3,300.00 $2,970.00 $2,026.00 $3,168.00 $2,574.00 2025-06-11
72192 CPT CT Pelvis Without Cont 6 4 $2,675.00 $2,408.00 $1,642.00 $2,568.00 $2,086.50 2025-06-11
70450 CPT CT Scan 6 4 $2,300.00 $2,070.00 $1,412.00 $2,208.00 $1,794.00 2025-06-11
74177 CPT CT Scan Of Abdomen And Pelvis With Contrast 6 4 $5,300.00 $4,770.00 $3,253.00 $5,088.00 $4,134.00 2025-06-11
72193 CPT CT Scan Of Pelvis With Contrast 6 4 $3,042.00 $2,738.00 $1,867.00 $2,920.00 $2,372.50 2025-06-11
70488 CPT CT Sinus Or Facial With + Without Cont 6 4 $2,900.00 $2,610.00 $1,780.00 $2,784.00 $2,262.00 2025-06-11
70487 CPT CT Sinus Or Facial With Cont 6 4 $2,600.00 $2,340.00 $1,596.00 $2,496.00 $2,028.00 2025-06-11
70486 CPT CT Sinus Or Facial Without Cont 6 4 $2,200.00 $1,980.00 $1,350.00 $2,112.00 $1,716.00 2025-06-11
70492 CPT CT Soft Tissue Neck With + Without Cont 6 4 $3,100.00 $2,790.00 $1,903.00 $2,976.00 $2,418.00 2025-06-11
70491 CPT CT Soft Tissue Neck With Cont 6 4 $2,750.00 $2,475.00 $1,688.00 $2,640.00 $2,145.50 2025-06-11
70490 CPT CT Soft Tissue Neck Without Contrast 6 4 $2,400.00 $2,160.00 $1,473.00 $2,304.00 $1,872.00 2025-06-11
72127 CPT CT Spine Cervical With + Without Cont 6 4 $3,000.00 $2,700.00 $1,841.00 $2,880.00 $2,340.00 2025-06-11
72126 CPT CT Spine Cervical With Cont 6 4 $3,375.00 $3,038.00 $2,072.00 $3,240.00 $2,632.50 2025-06-11
72125 CPT CT Spine Cervical Without Cont 6 4 $2,725.00 $2,453.00 $1,673.00 $2,616.00 $2,125.50 2025-06-11
72133 CPT CT Spine Lumbar With + Without Cont 6 4 $2,900.00 $2,610.00 $1,780.00 $2,784.00 $2,262.00 2025-06-11
72132 CPT CT Spine Lumbar With Cont 6 4 $3,000.00 $2,700.00 $1,841.00 $2,880.00 $2,340.00 2025-06-11
72131 CPT CT Spine Lumbar Without Cont 6 4 $2,700.00 $2,430.00 $1,657.00 $2,592.00 $2,106.00 2025-06-11
72130 CPT CT Spine Thoracic With + Without Cont 6 4 $2,970.00 $2,673.00 $1,823.00 $2,851.00 $2,316.50 2025-06-11
72129 CPT CT Spine Thoracic With Cont 6 4 $2,700.00 $2,430.00 $1,657.00 $2,592.00 $2,106.00 2025-06-11
72128 CPT CT Spine Thoracic Without Cont 6 4 $2,725.00 $2,453.00 $1,673.00 $2,616.00 $2,125.50 2025-06-11
73202 CPT CT Ue With Cont Lt 6 4 $3,000.00 $2,700.00 $1,841.00 $2,880.00 $2,340.00 2025-06-11
73200 CPT CT Ue Without Cont Lt 6 4 $2,400.00 $2,160.00 $1,473.00 $2,304.00 $1,872.00 2025-06-11
76497 CPT CT Whole Body Low Dose 6 4 $6,500.00 $5,850.00 $3,990.00 $6,240.00 $5,070.00 2025-06-11
4504019 CDM Curosurf 240mg/3ml (Poractant Alfa) (Surfactant) Refrigerator [Gmh] 7 4 $2,855.00 $2,570.00 $1,752.00 $2,741.00 $1,799.00 2025-06-11
4507059 CDM Dalbavancin 500 Mg Pow [Gmh] 7 4 $4,290.00 $3,861.00 $2,633.00 $4,118.00 $2,703.00 2025-06-11
4507166 CDM Daratumumab-hyaluronidase Fihj 1800 Mg-30,000 Units/15 Ml Sol [Gmh] 7 4 $24,104.00 $21,694.00 $14,795.00 $23,140.00 $15,186.00 2025-06-11
4504003 CDM Darbepoetin Alfa 150 Mcg/0.3 Ml Inj Sol [Gmh] 7 4 $2,806.00 $2,525.00 $1,722.00 $2,694.00 $1,768.00 2025-06-11
4506012 CDM Darbepoetin Alfa 500 Mcg/ml Sol [Gmh] 7 4 $9,308.00 $8,377.00 $5,713.00 $8,936.00 $5,864.00 2025-06-11
3450010 CDM Delivery Charge 6 4 $2,500.00 $2,250.00 $1,535.00 $2,400.00 $1,950.00 2025-06-11
4501042 CDM Denosumab 120 Mg/1.7 Ml Sol [Gmh] 7 4 $8,299.00 $7,469.00 $5,094.00 $7,967.00 $5,228.00 2025-06-11
4501085 CDM Denosumab 60 Mg/ml Sol 1 Ml [Gmh] 7 4 $4,307.00 $3,876.00 $2,644.00 $4,135.00 $2,713.00 2025-06-11
4507223 CDM Denosumab Bbdz 60 Mg/ml Sol [Gmh] 7 4 $3,870.00 $3,483.00 $2,375.00 $3,715.00 $2,438.00 2025-06-11
43235 CPT Diagnostic Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 6 4 $4,541.00 $4,087.00 $2,787.00 $4,359.00 $3,542.00 2025-06-11
4507169 CDM Durvalumab 50 Mg/ml Sol [Gmh] 7 4 $9,685.00 $8,717.00 $5,945.00 $9,298.00 $6,102.00 2025-06-11
4507204 CDM Eflapegrastim Xnst 13.2 Mg/0.6 Ml Sol [Gmh] 7 4 $18,020.00 $16,218.00 $11,061.00 $17,299.00 $11,353.00 2025-06-11
4505057 CDM Ferric Carboxymaltose (As Elemental Iron) 50 Mg/ml 15 Ml Sol [Gmh] 7 4 $3,701.00 $3,331.00 $2,272.00 $3,553.00 $2,332.00 2025-06-11
4302169 CDM Fetal Pillow (c) 6 4 $1,937.00 $1,743.00 $1,189.00 $1,860.00 $1,510.50 2025-06-11
4301141 CDM Forefoot Internal Brace Kit 6 4 $2,511.00 $2,260.00 $1,541.00 $2,411.00 $1,958.50 2025-06-11
G0390 HCPCS G0390 Trauma Team Response Charge 6 4 $2,033.00 $1,830.00 $1,248.00 $1,952.00 $1,586.00 2025-06-11
4300999 CDM Glaukos Istent Sightpath 6 4 $3,800.00 $3,420.00 $2,332.00 $3,648.00 $2,964.00 2025-06-11
4507140 CDM Golimumab 50 Mg/4 Ml Sol [Gmh] 7 4 $4,818.00 $4,336.00 $2,957.00 $4,625.00 $3,035.00 2025-06-11
4507027 CDM Hylan G-f 20 48 Mg/6 Ml Sol [Gmh] 7 4 $3,307.00 $2,976.00 $2,030.00 $3,175.00 $2,083.00 2025-06-11
4505041 CDM Immune Globulin Intravenous 10% 5 Gm Sol [Gmh] 7 4 $2,279.00 $2,051.00 $1,399.00 $2,188.00 $1,436.00 2025-06-11
4505063 CDM Immune Globulin Intravenous 10% 10 Gm Sol [Gmh] 7 4 $4,539.00 $4,085.00 $2,786.00 $4,357.00 $2,860.00 2025-06-11
4505027 CDM Immune Globulin Intravenous 10% Sol [Gmh] 7 4 $18,095.00 $16,286.00 $11,107.00 $17,371.00 $11,400.00 2025-06-11
4505033 CDM Immune Globulin Intravenous 10% Sol [Gmh] 7 4 $9,057.00 $8,151.00 $5,559.00 $8,695.00 $5,706.00 2025-06-11
4507076 CDM Immune Globulin Intravenous And Subcutaneous 10% 20 Gm Sol Gamunex-c [Gmh] 7 4 $4,660.00 $4,194.00 $2,860.00 $4,474.00 $2,936.00 2025-06-11
4505070 CDM Immune Globulin Intravenous And Subcutaneous 10% Sol [Gmh] 7 4 $12,592.00 $11,333.00 $7,729.00 $12,088.00 $7,933.00 2025-06-11
4507164 CDM Inclisiran 284 Mg/1.5 Ml Sol {Gmh] 7 4 $8,116.00 $7,304.00 $4,982.00 $7,791.00 $5,113.00 2025-06-11
4501063 CDM Infliximab 100 Mg IV Inj (Remicade Brand Name) [Gmh] 7 4 $2,823.00 $2,541.00 $1,733.00 $2,710.00 $1,778.00 2025-06-11
4507137 CDM Infliximab Dyyb 100 Mg Pow [Gmh] 7 4 $2,291.00 $2,062.00 $1,406.00 $2,199.00 $1,443.00 2025-06-11
64483 CPT Injection(s) Of Anesthetic Into Lower Spine Using Imaging Guidance 6 4 $2,150.00 $1,935.00 $1,320.00 $2,064.00 $1,677.50 2025-06-11
62323 CPT Injection(s) Of Therapeutic Substance 6 4 $2,150.00 $1,935.00 $1,320.00 $2,064.00 $1,677.50 2025-06-11
4301135 CDM Internal Brace (c) 6 4 $2,691.00 $2,422.00 $1,652.00 $2,583.00 $2,099.00 2025-06-11
4301933 CDM Interstim X Neurostimulator (c) 6 4 $18,325.00 $16,493.00 $11,248.00 $17,592.00 $14,293.50 2025-06-11
J7300 HCPCS Intrauterine Copper Contraceptive Charge 6 4 $2,278.00 $2,050.00 $1,398.00 $2,187.00 $1,777.00 2025-06-11
C1783 HCPCS Istent 6 4 $3,848.00 $3,463.00 $2,362.00 $3,694.00 $3,001.50 2025-06-11
4300934 CDM Ivantis Hydrus Microstent ( Sightpath ) 6 4 $2,584.00 $2,326.00 $1,586.00 $2,481.00 $2,015.50 2025-06-11
J7296 HCPCS J7296 Kyleena Iud. 6 4 $2,430.00 $2,187.00 $1,492.00 $2,333.00 $1,895.50 2025-06-11
J7301 HCPCS J7301 Skyla Iud. 6 4 $2,119.00 $1,907.00 $1,301.00 $2,034.00 $1,653.00 2025-06-11
J7307 HCPCS J7307 Nexplanon 6 4 $2,313.00 $2,082.00 $1,420.00 $2,220.00 $1,804.00 2025-06-11
4300277 CDM Jada System (c) 6 4 $2,511.00 $2,260.00 $1,541.00 $2,411.00 $1,958.50 2025-06-11
4309583 CDM Jot Dx Dm4500 6 4 $8,775.00 $7,898.00 $5,386.00 $8,424.00 $6,844.50 2025-06-11
4301924 CDM Lead Kit Is2 28cm (c) 6 4 $6,765.00 $6,089.00 $4,152.00 $6,494.00 $5,276.50 2025-06-11
4507035 CDM Leuprolide 11.25 Mg/3 Months Pwd [Gmh] 7 4 $12,988.00 $11,689.00 $7,972.00 $12,468.00 $8,182.00 2025-06-11
4506026 CDM Leuprolide 22.5 Mg/3 Months Pwd 7 4 $15,473.00 $13,926.00 $9,497.00 $14,854.00 $9,748.00 2025-06-11
4507007 CDM Leuprolide 22.5 Mg/3 Months Pwd (Eligard)[gmh] 7 4 $3,272.00 $2,945.00 $2,008.00 $3,141.00 $2,061.00 2025-06-11
4507114 CDM Leuprolide 45 Mg/6 Months Pwd [Gmh] 7 4 $6,524.00 $5,872.00 $4,004.00 $6,263.00 $4,110.00 2025-06-11
4507127 CDM Lurbinectedin 4 Mg Pow 7 4 $18,386.00 $16,547.00 $11,285.00 $17,651.00 $11,583.00 2025-06-11
4507085 CDM Luspatercept Aamt 75 Mg Pow [Gmh] 7 4 $29,084.00 $26,176.00 $17,852.00 $27,921.00 $18,323.00 2025-06-11
19081 CPT Ma Stereotactic Loc Rt. 6 4 $3,600.00 $3,240.00 $2,210.00 $3,456.00 $2,808.00 2025-06-11
4309033 CDM Mid-urethral Sling 6 4 $2,088.00 $1,879.00 $1,282.00 $2,004.00 $1,628.50 2025-06-11
J7298 HCPCS Mirena Intrauterine System 6 4 $2,545.00 $2,291.00 $1,562.00 $2,443.00 $1,985.00 2025-06-11
74185 CPT MRA Abdomen With + Without Cont 6 4 $3,400.00 $3,060.00 $2,087.00 $3,264.00 $2,652.00 2025-06-11
70544 CPT MRA Head Venography Without Cont 12 4 $4,406.50 $3,966.00 $2,332.00 $4,812.00 $3,346.00 2025-06-11
70546 CPT MRA Head With + Without Cont 6 4 $4,100.00 $3,690.00 $2,517.00 $3,936.00 $3,198.00 2025-06-11
70549 CPT MRA Neck With + Without Cont 6 4 $4,300.00 $3,870.00 $2,639.00 $4,128.00 $3,354.00 2025-06-11
70548 CPT MRA Neck With Cont 6 4 $3,749.00 $3,374.00 $2,301.00 $3,599.00 $2,924.50 2025-06-11
70547 CPT MRA Neck Without Cont 6 4 $3,575.00 $3,218.00 $2,194.00 $3,432.00 $2,788.50 2025-06-11
74183 CPT MRI Abdomen With + Without Cont 6 4 $4,700.00 $4,230.00 $2,885.00 $4,512.00 $3,666.00 2025-06-11
74182 CPT MRI Abdomen With Cont 6 4 $3,900.00 $3,510.00 $2,394.00 $3,744.00 $3,042.00 2025-06-11
74181 CPT MRI Abdomen Without Cont 6 4 $3,425.00 $3,083.00 $2,102.00 $3,288.00 $2,671.50 2025-06-11
70551 CPT MRI Brain Without Cont 6 4 $4,000.00 $3,600.00 $2,455.00 $3,840.00 $3,120.00 2025-06-11
71552 CPT MRI Chest With + Without Cont 6 4 $4,200.00 $3,780.00 $2,578.00 $4,032.00 $3,276.00 2025-06-11
71550 CPT MRI Chest Without Cont 6 4 $3,800.00 $3,420.00 $2,332.00 $3,648.00 $2,964.00 2025-06-11
70542 CPT MRI Face Neck Orbit With Cont 6 4 $4,000.00 $3,600.00 $2,455.00 $3,840.00 $3,120.00 2025-06-11
70540 CPT MRI Face Neck Orbit Without Cont 6 4 $3,600.00 $3,240.00 $2,210.00 $3,456.00 $2,808.00 2025-06-11
73723 CPT MRI Le Joint With + Without Cont Lt 6 4 $3,875.00 $3,488.00 $2,378.00 $3,720.00 $3,022.50 2025-06-11
73722 CPT MRI Le Joint With Cont Lt 12 4 $3,750.00 $3,375.00 $2,271.00 $3,648.00 $2,917.50 2025-06-11
73718 CPT MRI Le Non Joint Without Cont Bil 6 4 $3,200.00 $2,880.00 $1,964.00 $3,072.00 $2,496.00 2025-06-11
72197 CPT MRI Pelvis With + Without Cont 6 4 $4,500.00 $4,050.00 $2,762.00 $4,320.00 $3,510.00 2025-06-11
72196 CPT MRI Pelvis With Cont 6 4 $3,800.00 $3,420.00 $2,332.00 $3,648.00 $2,964.00 2025-06-11
72195 CPT MRI Pelvis Without Cont 6 4 $3,500.00 $3,150.00 $2,148.00 $3,360.00 $2,730.00 2025-06-11
70553 CPT MRI Scan 6 4 $4,500.00 $4,050.00 $2,762.00 $4,320.00 $3,510.00 2025-06-11
73721 CPT MRI Scan Of Leg Joint 6 4 $2,900.00 $2,610.00 $1,780.00 $2,784.00 $2,262.00 2025-06-11
72148 CPT MRI Scan Of Lower Spinal Canal 6 4 $3,850.00 $3,465.00 $2,363.00 $3,696.00 $3,003.50 2025-06-11
70543 CPT MRI Soft Tissue Neck With + Without Cont 6 4 $4,300.00 $3,870.00 $2,639.00 $4,128.00 $3,354.00 2025-06-11
72156 CPT MRI Spine Cervical With + Without Cont 6 4 $5,514.00 $4,963.00 $3,384.00 $5,293.00 $4,301.00 2025-06-11
72141 CPT MRI Spine Cervical Without Cont 6 4 $4,000.00 $3,600.00 $2,455.00 $3,840.00 $3,120.00 2025-06-11
72158 CPT MRI Spine Lumbar With + Without Cont 6 4 $4,600.00 $4,140.00 $2,823.00 $4,416.00 $3,588.00 2025-06-11
72149 CPT MRI Spine Lumbar With Cont 6 4 $5,000.00 $4,500.00 $3,069.00 $4,800.00 $3,900.00 2025-06-11
72157 CPT MRI Spine Thoracic With + Without Cont 6 4 $5,702.00 $5,132.00 $3,500.00 $5,474.00 $4,447.50 2025-06-11
72146 CPT MRI Spine Thoracic Without Cont 6 4 $4,000.00 $3,600.00 $2,455.00 $3,840.00 $3,120.00 2025-06-11
73223 CPT MRI Ue Joint With + Without Cont Bil 6 4 $4,100.00 $3,690.00 $2,517.00 $3,936.00 $3,198.00 2025-06-11
73222 CPT MRI Ue Joint With Cont Lt 6 4 $3,800.00 $3,420.00 $2,332.00 $3,648.00 $2,964.00 2025-06-11
73221 CPT MRI Ue Joint Without Cont Bil 6 4 $2,875.00 $2,588.00 $1,765.00 $2,760.00 $2,242.50 2025-06-11
73220 CPT MRI Ue Non Joint With + Without Cont Bil 6 4 $3,900.00 $3,510.00 $2,394.00 $3,744.00 $3,042.00 2025-06-11
73218 CPT MRI Ue Non Joint Without Cont Bil 6 4 $3,000.00 $2,700.00 $1,841.00 $2,880.00 $2,340.00 2025-06-11
4505038 CDM Naltrexone 380 Mg Pwd [Gmh] 7 4 $4,077.00 $3,669.00 $2,502.00 $3,914.00 $2,569.00 2025-06-11
4507206 CDM Nivolumab 120 Mg/ 12 Ml Sol [Gmh] 7 4 $9,582.00 $8,624.00 $5,881.00 $9,199.00 $6,037.00 2025-06-11
4507121 CDM Nivolumab 240 Mg/ 24 Ml Sol [Gmh] 7 4 $18,740.00 $16,866.00 $11,503.00 $17,990.00 $11,806.00 2025-06-11
78456 CPT Nm Acute Venous Thrombosis Imaging, Peptide 6 4 $2,000.00 $1,800.00 $1,228.00 $1,920.00 $1,560.00 2025-06-11
78315 CPT Nm Bone Imagine 3 Phase 12 4 $2,411.50 $2,170.50 $1,473.00 $2,326.00 $1,879.00 2025-06-11
78306 CPT Nm Bone Imaging Whole Body 12 4 $2,040.00 $1,836.50 $1,243.00 $1,973.00 $1,589.00 2025-06-11
78264 CPT Nm Gastric Empty 6 4 $1,800.00 $1,620.00 $1,105.00 $1,728.00 $1,404.00 2025-06-11
78452 CPT Nm Heart Image (3d) Multiple Study Tomographic Spect Multi Study At Rest Of Stre… 6 4 $4,450.00 $4,005.00 $2,731.00 $4,272.00 $3,471.50 2025-06-11
78451 CPT Nm Heart Image (3d) Single Tomographic Spect Multi Study At Rest Of Stress 6 4 $2,425.00 $2,183.00 $1,488.00 $2,328.00 $1,891.50 2025-06-11
78227 CPT Nm Hepatobillary Imag W/wo Gbef 6 4 $2,075.00 $1,868.00 $1,274.00 $1,992.00 $1,618.50 2025-06-11
78464 CPT Nm Imagingresting, Myo 6 4 $1,945.00 $1,751.00 $1,194.00 $1,867.00 $1,517.00 2025-06-11
78202 CPT Nm Liver Imaging (3d) W/vascular Flow 6 4 $1,700.00 $1,530.00 $1,043.00 $1,632.00 $1,326.00 2025-06-11
78598 CPT Nm Lung Quantification Study 6 4 $2,200.00 $1,980.00 $1,350.00 $2,112.00 $1,716.00 2025-06-11
78472 CPT Nm Mugagated Blood Pool 6 4 $1,805.00 $1,625.00 $1,108.00 $1,733.00 $1,408.00 2025-06-11
78582 CPT Nm Pulmonary Ventilation/perfusion Imaging 6 4 $2,100.00 $1,890.00 $1,289.00 $2,016.00 $1,638.00 2025-06-11
4309015 CDM Novasure Ablation Device 6 4 $1,852.00 $1,667.00 $1,137.00 $1,778.00 $1,444.50 2025-06-11
4309031 CDM Novasure St Device Kit 6 4 $2,327.00 $2,094.00 $1,428.00 $2,234.00 $1,815.00 2025-06-11
59510 CPT Obstetric Care, Planned Cesarean Delivery 6 4 $5,303.00 $4,773.00 $3,255.00 $5,091.00 $4,136.50 2025-06-11
59400 CPT Obstetric Care, Planned Vaginal Delivery 6 4 $7,600.00 $6,840.00 $4,665.00 $7,296.00 $5,928.00 2025-06-11
4507163 CDM Omalizumab 300 Mg/2 Ml Sol [Gmh] 7 4 $6,668.00 $6,001.00 $4,093.00 $6,401.00 $4,201.00 2025-06-11
4505047 CDM Paclitaxel 6 Mg/ml 50 Ml Vial [Gmh] 7 4 $3,703.00 $3,333.00 $2,273.00 $3,555.00 $2,333.00 2025-06-11
4507015 CDM Paclitaxel Protein-bound 100 Mg Pow [Gmh] 7 4 $3,984.00 $3,586.00 $2,445.00 $3,825.00 $2,510.00 2025-06-11
4503752 CDM Pegfilgrastim 6. Mg Soln [Gmh] 7 4 $15,423.00 $13,881.00 $9,467.00 $14,806.00 $9,716.00 2025-06-11
4507203 CDM Pegfilgrastim Cbqv 6 Mg/0.6 Ml Sol [Gmh] 7 4 $16,720.00 $15,048.00 $10,263.00 $16,051.00 $10,534.00 2025-06-11
4507088 CDM Pegfilgrastim Jmdb 6 Mg/0.6 Ml Sol [Gmh] 7 4 $10,040.00 $9,036.00 $6,163.00 $9,638.00 $6,325.00 2025-06-11
4506039 CDM Pegfilgrastim On-body 6 Mg/0.6 Ml Sol [Gmh] 7 4 $25,692.00 $23,123.00 $15,770.00 $24,664.00 $16,186.00 2025-06-11
4505097 CDM Pembrolizumab 25 Mg/ml Sol [Gmh] 7 4 $13,927.00 $12,534.00 $8,548.00 $13,370.00 $8,774.00 2025-06-11
4505017 CDM Pemetrexed 500 Mg Pow [Gmh] 7 4 $9,753.00 $8,778.00 $5,986.00 $9,363.00 $6,144.00 2025-06-11
4506024 CDM Pertuzumab 420 Mg/14 Ml Sol [Gmh] 7 4 $16,419.00 $14,777.00 $10,078.00 $15,762.00 $10,344.00 2025-06-11
4302071 CDM Plantar Fascia Endoblade 6 4 $1,969.00 $1,772.00 $1,209.00 $1,890.00 $1,535.50 2025-06-11
95808 CPT Polysomnogram With Cpap Sp 6 4 $3,954.00 $3,559.00 $2,427.00 $3,796.00 $3,084.00 2025-06-11
4503842 CDM Polyvalent Immune Fab, Anti Snake [Gmh] 7 4 $7,695.00 $6,926.00 $4,723.00 $7,387.00 $4,848.00 2025-06-11
CP17805908878005520 CDM Posterior Colporrhaphy; Repair Rectocele With Or Without Perineorrhaphy Charge 6 4 $1,982.00 $1,784.00 $1,217.00 $1,903.00 $1,546.00 2025-06-11
4308118 CDM Puraplyam Mz 500mg 6 4 $2,088.00 $1,879.00 $1,282.00 $2,004.00 $1,628.50 2025-06-11
4506064 CDM Rabies Immune Globulin, Human 300 Units/ml 5 Ml Sol [Gmh] 7 4 $8,065.00 $7,259.00 $4,950.00 $7,742.00 $5,081.00 2025-06-11
66984 CPT Removal Of Cataract With Insertion Of Lens 12 4 $3,871.00 $3,484.00 $2,128.00 $4,104.00 $2,958.50 2025-06-11
47562 CPT Removal Of Gallbladder Using An Endoscope 6 4 $8,029.00 $7,226.00 $4,928.00 $7,708.00 $6,262.50 2025-06-11
29881 CPT Removal Of One Knee Cartilage Using An Endoscope 6 4 $3,730.00 $3,357.00 $2,289.00 $3,581.00 $2,909.50 2025-06-11
45385 CPT Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope 6 4 $4,437.00 $3,993.00 $2,723.00 $4,260.00 $3,460.50 2025-06-11
42820 CPT Removal Of Tonsils And Adenoid Glands, Patient Younger Than Age 12 6 4 $5,035.00 $4,532.00 $3,090.00 $4,834.00 $3,927.50 2025-06-11
4507202 CDM Reslizumab 100 Mg/ 10 Ml Sol [Gmh] 7 4 $2,641.00 $2,377.00 $1,621.00 $2,535.00 $1,664.00 2025-06-11
4502010 CDM Rituxan 100mg/10ml Vial (Rituximab) [Gmh] 7 4 $2,305.00 $2,075.00 $1,415.00 $2,213.00 $1,452.00 2025-06-11
4502013 CDM Rituximab 500 Mg/50 Ml IV Sol [Gmh] 7 4 $11,324.00 $10,192.00 $6,951.00 $10,871.00 $7,134.00 2025-06-11
4507086 CDM Rituximab Abbs 10 Mg/ml 500mg Sol [Gmh] 7 4 $10,197.00 $9,177.00 $6,259.00 $9,789.00 $6,424.00 2025-06-11
4507103 CDM Romiplostim 125 Mcg Pow [Gmh] 7 4 $3,025.00 $2,723.00 $1,857.00 $2,904.00 $1,906.00 2025-06-11
4507165 CDM Romosozumab 210 Mg/2.34 Ml Sol [Gmh] 7 4 $6,029.00 $5,426.00 $3,701.00 $5,788.00 $3,798.00 2025-06-11
3100010 CDM Room/bed: Acute 6 4 $1,940.00 $1,746.00 $1,191.00 $1,862.00 $1,513.00 2025-06-11
3150040 CDM Room/bed: Ccu 6 4 $1,945.00 $1,751.00 $1,194.00 $1,867.00 $1,517.00 2025-06-11
3100012 CDM Room/bed: OB 6 4 $3,515.00 $3,164.00 $2,158.00 $3,374.00 $2,741.50 2025-06-11
4507162 CDM Secukinumab 25 Mg/ml 5ml Sol [Gmh] 7 4 $5,096.00 $4,586.00 $3,128.00 $4,892.00 $3,210.00 2025-06-11
29826 CPT Shaving Of Shoulder Bone Using Endoscope 6 4 $5,145.00 $4,631.00 $3,158.00 $4,939.00 $4,013.00 2025-06-11
95810 CPT Sleep Study 6 4 $4,600.00 $4,140.00 $2,823.00 $4,416.00 $3,588.00 2025-06-11
4301943 CDM Smart Programmer Kit X (c) 6 4 $3,003.00 $2,703.00 $1,843.00 $2,883.00 $2,342.50 2025-06-11
4506059 CDM Sodium Hyaluronate 30 Mg/3 Ml Sol [Gmh] 7 4 $2,780.00 $2,502.00 $1,706.00 $2,669.00 $1,751.00 2025-06-11
4301122 CDM Speed Bridge Kit 6 4 $2,784.00 $2,506.00 $1,709.00 $2,673.00 $2,171.50 2025-06-11
4507002 CDM Tenecteplase 50 Mg Pow 7 4 $19,933.00 $17,940.00 $12,235.00 $19,136.00 $12,558.00 2025-06-11
4300872 CDM Titanium Tacker 5mm (c) 6 4 $2,000.00 $1,800.00 $1,228.00 $1,920.00 $1,560.00 2025-06-11
4507193 CDM Tocilizumab 20 Mg/ml Sol 7 4 $6,394.00 $5,755.00 $3,925.00 $6,138.00 $4,028.00 2025-06-11
4309016 CDM Trans-vag Tape ( C ) 6 4 $1,935.00 $1,742.00 $1,188.00 $1,858.00 $1,509.50 2025-06-11
4505098 CDM Trastuzumab 150mg Mdv [Gmh] 7 4 $3,790.00 $3,411.00 $2,326.00 $3,638.00 $2,388.00 2025-06-11
4507219 CDM Trastuzumab Dkst 420 Mg Pow [Gmh] 7 4 $6,350.00 $5,715.00 $3,898.00 $6,096.00 $4,001.00 2025-06-11
3610525 CDM Trauma Team Activation Charge 6 4 $2,033.00 $1,830.00 $1,248.00 $1,952.00 $1,586.00 2025-06-11
4506076 CDM Triamcinolone Ophthalmic 40 Mg/ml Sus [Gmh] 7 4 $2,286.00 $2,057.00 $1,403.00 $2,195.00 $1,440.00 2025-06-11
19083 CPT US Breast Biopsy Lt 6 4 $2,775.00 $2,498.00 $1,703.00 $2,664.00 $2,164.50 2025-06-11
93880 CPT US Carotid Duplex Bil 6 4 $1,750.00 $1,575.00 $1,074.00 $1,680.00 $1,365.50 2025-06-11
93306 CPT US Echo 2d Comp 6 4 $2,550.00 $2,295.00 $1,565.00 $2,448.00 $1,989.50 2025-06-11
CP17805908878019097 CDM Vaginal Hysterectomy, For Uterus 250g Or Less 6 4 $2,201.00 $1,981.00 $1,351.00 $2,113.00 $1,717.00 2025-06-11
4507068 CDM Vedolizumab 300 Mg Pow [Gmh] 7 4 $22,514.00 $20,263.00 $13,819.00 $21,613.00 $14,184.00 2025-06-11
4300773 CDM Ventralex Mesh Medium ( C ) 6 4 $1,938.00 $1,744.00 $1,190.00 $1,860.00 $1,511.50 2025-06-11
4308903 CDM Vessica Insitu Sling Kit 6 4 $1,970.00 $1,773.00 $1,209.00 $1,891.00 $1,536.50 2025-06-11
4501167 CDM Zoledronic Acid 4 Mg/ 5 Ml Soln [Gmh] 7 4 $2,234.00 $2,011.00 $1,371.00 $2,145.00 $1,407.00 2025-06-11
4505024 CDM Zoledronic Acid 5 Mg/100 Ml Sol [Gmh] 7 4 $2,622.00 $2,360.00 $1,609.00 $2,517.00 $1,652.00 2025-06-11
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