Price Transparency 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

COZAD COMMUNITY HOSPITAL

Cozad, NE · CCN 281327 · Rates published

4,576 distinct procedures filed
6 distinct payers
38,469 rate rows
2025-05-12 last MRF observed · ⚠ 13 mo old
Data quality

38,391 of 38,469 rate rows are consumer-grade (99.8%)

78 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
exceeds 10× this hospital's gross charge — excluded from medians 78

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 13 months old.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/YWBX-1689949782535/machine-readable/476007486_cozad-community-hospital_standardcharges.json
Found on page https://secure.claraprice.net/price-transparency/cozad-community-ne
Discovered viaDiscovered by HANK
Last fetch success · 2026-06-16
Content fingerprint 369ef222a20f90b9… · 7,459,976 bytes · first seen 2026-06-16

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
5501417
CDM 		Nf-nystatin Powder 6 $62,244.00 $111,150.00 $101,147.00 nat. median
$101,147
1.0× median
J1930
HCPCS 		Nf-lanreotide 120mg/0.5ml Inj 6 $47,807.00 $85,370.00 $77,687.00 nat. median
$5,898
outlier · 13.2×
35206
CPT 		ER Fac ER Phys-artery Ligation 6 $7,522.00 $13,432.00 $12,223.00 nat. median
$3,725
outlier · 3.3×
26735
CPT 		ER Fac Open Tx Phalangeal Shaft 6 $7,441.00 $13,288.00 $12,092.00 nat. median
$3,781
outlier · 3.2×
J2323
HCPCS 		Tysabri 300mg/15ml Inj 6 $7,172.00 $12,807.00 $11,654.00 nat. median
$201
outlier · 58.1×
J9302
HCPCS 		Kesimpta 20mg/0.4ml Pen (Special Order) 6 $6,666.00 $11,903.00 $10,832.00 nat. median
$241
outlier · 45.0×
26765
CPT 		ER Fac Opn Tx Dist. Phalan. Frac 6 $5,916.00 $10,565.00 $9,614.00 nat. median
$3,497
outlier · 2.7×
6001072
CDM 		Artacentwound4x8cm 6 $5,890.00 $10,517.00 $9,570.00 nat. median
$2,398
outlier · 4.0×
J2506
HCPCS 		Pegfilgrastim 6 Mg/0.6ml 6 $5,607.00 $10,012.00 $9,111.00 nat. median
$2,076
outlier · 4.4×
90000396
CDM 		Amnioheal Plus 4x8 6 $5,289.00 $9,445.00 $8,595.00 nat. median
$22
outlier · 383.7×
56700
CPT 		ER Fac ER Phys Hymenotomy W/drng 6 $5,100.00 $9,107.00 $8,287.00 nat. median
$3,139
outlier · 2.6×
J0517
HCPCS 		Fasenra 30mg/ml Inj (Spec Order) 6 $4,815.00 $8,598.00 $7,824.00 nat. median
$919
outlier · 8.5×
Q4169
HCPCS 		Artacent Wound 4x6cm 6 $4,635.00 $10,517.00 $7,614.00 nat. median
$1,416
outlier · 5.4×
80000570
CDM 		Osteo Viable Matrix 6 $4,479.00 $7,999.00 $7,279.00 nat. median
$149
outlier · 49.0×
5501610
CDM 		Nf-enbrel Subcutaneous Solution 25mg/0.5 6 $4,010.00 $7,161.00 $6,517.00 nat. median
$6,517
1.0× median
81162
CPT 		Brca 1 7 2 Genetics Full Sequence (Rl) 6 $3,989.00 $7,123.00 $6,482.00 nat. median
$1,825
outlier · 3.6×
J1569
HCPCS 		Gammagard 10% 30g/300ml (Spec Ord) 6 $3,773.00 $6,737.00 $6,131.00 nat. median
$1,048
outlier · 5.9×
51102
CPT 		Aspiration Bladder Ins Suprapubic Cath 6 $3,442.00 $6,146.00 $5,593.00 nat. median
$2,391
outlier · 2.3×
J2356
HCPCS 		Tezspire 210mg/1.91ml Inj (Spec Order) 6 $3,418.00 $6,103.00 $5,554.00 nat. median
$66
outlier · 83.9×
5501596
CDM 		**nf-abatacept125mg/1ml Autoinjector 6 $3,259.00 $5,820.00 $5,296.00 nat. median
$5,296
1.0× median
6001083
CDM 		Tactoset Bone Sub 4g 6 $3,209.00 $5,731.00 $5,215.00 nat. median
$5,215
1.0× median
5501138
CDM 		Nf-remicade Powder For Inj 100mg 6 $3,139.00 $5,605.00 $5,101.00 nat. median
$5,101
1.0× median
5501070
CDM 		Nf-nystatin Powder 6 $3,112.00 $5,557.00 $5,057.00 nat. median
$5,057
1.0× median
74178
CPT 		CT Abdomen Pelvis Wo W 6 $3,106.00 $5,546.00 $5,047.00 nat. median
$977
outlier · 5.2×
J1306
HCPCS 		Inclisiran 284mg/1.5ml Inj (Spec Order) 6 $3,058.00 $5,460.00 $4,969.00 nat. median
$57
outlier · 87.9×
90000970
CDM 		Anatomical St Implant 7mm 6 $3,020.00 $5,393.00 $4,908.00 nat. median
$94
outlier · 52.4×
J0840
HCPCS 		Crotilidae Polyvalent Inj 6 $3,009.00 $5,373.00 $4,889.00 nat. median
$3,427
1.4× median
5501226
CDM 		Nf-xolair Subq Pwd For Soln 150mg 6 $2,974.00 $5,310.00 $4,832.00 nat. median
$4,832
1.0× median
J0630
HCPCS 		Calcitonin 400u/2ml Inj (Special Order) 6 $2,946.00 $5,260.00 $4,787.00 nat. median
$1,885
outlier · 2.5×
74174
CPT 		CTA Abdomen Pelvis Wo W 6 $2,927.00 $5,226.00 $4,756.00 nat. median
$958
outlier · 5.0×
21490
CPT 		Reduction Of Tmj 6 $2,876.00 $5,135.00 $4,673.00 nat. median
$3,544
1.3× median
80000560
CDM 		Fusion Bone Graft Strips 50x25x8 6 $2,866.00 $5,117.00 $4,656.00 nat. median
$30
outlier · 157.8×
C1762
HCPCS 		Amnion Thin 6 $2,816.00 $5,029.00 $4,576.00 nat. median
$2,935
1.6× median
6001095
CDM 		Amnion Thin 4x8 6 $2,816.00 $5,029.00 $4,576.00 nat. median
$2,816
1.6× median
J9304
HCPCS 		Dantrolene 250mg Inj (Surgery) 6 $2,752.00 $4,914.00 $4,472.00 nat. median
$66
outlier · 67.5×
90000945
CDM 		Supermx Niti Staple W/instrs,20w X 20l 6 $2,695.00 $4,813.00 $4,380.00 nat. median
$10
outlier · 448.5×
78452
CPT 		Nm Lexiscan Cardiolyte Multi 6 $2,685.00 $4,794.00 $4,363.00 nat. median
$1,765
outlier · 2.5×
95811
CPT 		Polysomnography Split 6 $2,683.00 $4,791.00 $4,360.00 nat. median
$2,026
outlier · 2.2×
J1459
HCPCS 		Immune Globulin 10% 20g/200ml (Spec Ord) 6 $870.00 $9,048.00 $4,342.00 nat. median
$1,228
outlier · 3.5×
1058507
CDM 		Major Surgery 6 $2,661.00 $4,752.00 $4,324.00 nat. median
$4,324
1.0× median
80000595
CDM 		Ortho Bone Stimulator 6 $2,646.00 $4,725.00 $4,300.00 nat. median
$4,300
1.0× median
9999116
CDM 		Nail Fibula 2 3x145mm 6 $2,646.00 $4,725.00 $4,300.00 nat. median
$4,300
1.0× median
90000530
CDM 		Bmwd 2x2 1 Pk 6 $2,646.00 $4,725.00 $4,300.00 nat. median
$2,646
1.6× median
90000466
CDM 		Amnioheal Plus 4x4 6 $2,639.00 $4,712.00 $4,288.00 nat. median
$28
outlier · 153.1×
74177
CPT 		CT Scan Of Abdomen And Pelvis With Contrast 6 $2,592.00 $4,628.00 $4,211.00 nat. median
$928
outlier · 4.5×
90001255
CDM 		Peg Broach Tibial Infinity 6 $2,501.00 $4,466.00 $4,064.00 nat. median
$109
outlier · 37.3×
90000765
CDM 		2.4mm Va Lcp Kit 6 $2,495.00 $4,455.00 $4,054.00 nat. median
$80
outlier · 50.8×
70553
CPT 		MRI Scan 6 $2,452.00 $4,379.00 $3,985.00 nat. median
$1,122
outlier · 3.6×
55700
CPT 		Biopsy Of Prostate Gland 6 $2,421.00 $4,323.00 $3,934.00 nat. median
$2,135
1.8× median
6001098
CDM 		Pf Knee Kit 3cc Accuport Side-del 11gx12 6 $2,421.00 $4,323.00 $3,934.00 nat. median
$3,934
1.0× median

Other procedures at this hospital

Browse this hospital's 4,576 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 ER Fac I & D Hematoma 7 6 $2,793.00 $2,514.00 $1,564.00 $2,793.00 $2,542.00 2025-05-12
1058501 CDM Egd/colonoscopy Surgery 7 6 $2,263.00 $2,037.00 $1,267.00 $2,263.00 $2,059.00 2025-05-12
1058504 CDM Minor Surgery 7 6 $2,715.00 $2,444.00 $1,520.00 $2,715.00 $2,471.00 2025-05-12
1058507 CDM Major Surgery 7 6 $4,752.00 $4,277.00 $2,661.00 $4,752.00 $4,324.00 2025-05-12
1059000 CDM Use Of Laser Equipment 7 6 $3,501.00 $3,151.00 $1,961.00 $3,501.00 $3,186.00 2025-05-12
11044 CPT ER Fac Debridement Skin/sub/tiss 7 6 $2,750.00 $2,475.00 $1,540.00 $2,750.00 $2,503.00 2025-05-12
12020 CPT ER Fac Tx Of Sf Wnd Dehiscence 7 6 $2,457.00 $2,211.00 $1,376.00 $2,457.00 $2,236.00 2025-05-12
12037 CPT ER Fac ER Phys-int Lac > 30.0cm 7 6 $2,408.00 $2,167.00 $1,348.00 $2,408.00 $2,191.00 2025-05-12
1251300 CDM Birthing Service-vag Del 7 6 $2,335.00 $2,102.00 $1,308.00 $2,335.00 $2,125.00 2025-05-12
15273 CPT Apligraf First 100 Sq Cm 14 6 $4,313.00 $3,882.00 $2,325.00 $4,474.00 $3,819.50 2025-05-12
15275 CPT Dermagraft First 25 Sq Cm 14 6 $2,350.50 $2,115.50 $1,267.00 $2,438.00 $2,082.00 2025-05-12
15277 CPT Dermagraft First 100 Sq Cm 14 6 $3,112.00 $2,801.00 $1,267.00 $3,961.00 $2,218.00 2025-05-12
19083 CPT US Breast Biopsy Right 7 6 $2,282.00 $2,054.00 $1,278.00 $2,282.00 $2,077.00 2025-05-12
20101 CPT ER Fac Exploration Wound Chest 7 6 $2,756.00 $2,480.00 $1,543.00 $2,756.00 $2,508.00 2025-05-12
20103 CPT ER Fac Phys Foreign Body Removal 7 6 $2,921.00 $2,629.00 $1,636.00 $2,921.00 $2,658.00 2025-05-12
20553 CPT Inject Trigger Points 3/> 7 6 $1,766.00 $1,589.00 $989.00 $1,766.00 $1,607.00 2025-05-12
21012 CPT ER Fac Excision, Tumor Subq > 2 Cm 7 6 $2,439.00 $2,195.00 $1,366.00 $2,439.00 $2,219.00 2025-05-12
21320 CPT ER Fac Closed Tx Of Nasal Fx W/stabiliz 7 6 $3,102.00 $2,792.00 $1,737.00 $3,102.00 $2,823.00 2025-05-12
21490 CPT Reduction Of Tmj 7 6 $5,135.00 $4,622.00 $2,876.00 $5,135.00 $4,673.00 2025-05-12
23655 CPT ER Fac Closed Tx Disc W Manip Anes 7 6 $1,974.00 $1,777.00 $1,105.00 $1,974.00 $1,796.00 2025-05-12
24200 CPT ER Fac Remove Foreign Body Elbow 7 6 $2,264.00 $2,038.00 $1,268.00 $2,264.00 $2,060.00 2025-05-12
24605 CPT ER Fac Dis Elbow/closed With Anes 7 6 $3,472.00 $3,125.00 $1,944.00 $3,472.00 $3,160.00 2025-05-12
24655 CPT ER Fac Closed Reduc Radial Head 7 6 $2,241.00 $2,017.00 $1,255.00 $2,241.00 $2,039.00 2025-05-12
25605 CPT ER Fac Closed Tx Fx Radius/ulna W Manip 7 6 $3,017.00 $2,715.00 $1,690.00 $3,017.00 $2,745.00 2025-05-12
26350 CPT ER Fac ER Phys Repair Flexor Tendon 7 6 $4,038.00 $3,634.00 $2,261.00 $4,038.00 $3,675.00 2025-05-12
26735 CPT ER Fac Open Tx Phalangeal Shaft 7 6 $13,288.00 $11,959.00 $7,441.00 $13,288.00 $12,092.00 2025-05-12
26765 CPT ER Fac Opn Tx Dist. Phalan. Frac 7 6 $10,565.00 $9,509.00 $5,916.00 $10,565.00 $9,614.00 2025-05-12
27240 CPT ER Fac Closed Reduction Femoral Fx 7 6 $2,241.00 $2,017.00 $1,255.00 $2,241.00 $2,039.00 2025-05-12
27252 CPT Treat Hip Dislocation 7 6 $2,391.00 $2,152.00 $1,339.00 $2,391.00 $2,176.00 2025-05-12
27266 CPT ER Fac Reduction-hip 7 6 $3,510.00 $3,159.00 $1,966.00 $3,510.00 $3,194.00 2025-05-12
27618 CPT Excise Tumor Leg/ankle Subq < 3cm 7 6 $2,602.00 $2,342.00 $1,457.00 $2,602.00 $2,368.00 2025-05-12
27762 CPT ER Fac Closed Tx Ankle Dislocate 7 6 $3,274.00 $2,947.00 $1,833.00 $3,274.00 $2,979.00 2025-05-12
27810 CPT ER Fac Closed Tx Bimall Ankle Man 7 6 $3,115.00 $2,804.00 $1,744.00 $3,115.00 $2,835.00 2025-05-12
27818 CPT ER Fac Closed Tx Ankle W/maniper Fac Clo 7 6 $1,767.00 $1,590.00 $990.00 $1,767.00 $1,608.00 2025-05-12
27842 CPT ER Fac Closed Tx Ankle W/anesthe 7 6 $3,950.00 $3,555.00 $2,212.00 $3,950.00 $3,595.00 2025-05-12
30310 CPT ER Fac Removal Of Foreign Body Req Anesv 7 6 $3,102.00 $2,792.00 $1,737.00 $3,102.00 $2,823.00 2025-05-12
35206 CPT ER Fac ER Phys-artery Ligation 7 6 $13,432.00 $12,089.00 $7,522.00 $13,432.00 $12,223.00 2025-05-12
36620 CPT ER Fac Art Cath/cannulizn For Sampling/m 7 6 $2,726.00 $2,453.00 $1,527.00 $2,726.00 $2,481.00 2025-05-12
37799 CPT ER Fac Suture Of Artery 7 6 $2,536.00 $2,282.00 $1,420.00 $2,536.00 $2,308.00 2025-05-12
46040 CPT ER Fac I & D Perirectal Abcess 7 6 $2,631.00 $2,368.00 $1,473.00 $2,631.00 $2,394.00 2025-05-12
46050 CPT ER Fac Incise/drain Abcess/perir 7 6 $1,955.00 $1,760.00 $1,095.00 $1,955.00 $1,779.00 2025-05-12
51102 CPT Aspiration Bladder Ins Suprapubic Cath 7 6 $6,146.00 $5,531.00 $3,442.00 $6,146.00 $5,593.00 2025-05-12
5501070 CDM Nf-nystatin Powder 7 6 $5,557.00 $5,001.00 $3,112.00 $5,557.00 $5,057.00 2025-05-12
5501138 CDM Nf-remicade Powder For Inj 100mg 7 6 $5,605.00 $5,045.00 $3,139.00 $5,605.00 $5,101.00 2025-05-12
5501186 CDM Nf-tagrisso Oral Tablet 40mg 7 6 $2,362.00 $2,126.00 $1,323.00 $2,362.00 $2,149.00 2025-05-12
5501187 CDM Nf-osimertinib 40mg Tablet 7 6 $2,362.00 $2,126.00 $1,323.00 $2,362.00 $2,149.00 2025-05-12
5501226 CDM Nf-xolair Subq Pwd For Soln 150mg 7 6 $5,310.00 $4,779.00 $2,974.00 $5,310.00 $4,832.00 2025-05-12
5501232 CDM Nf-palbococlib 125mg Capsule 7 6 $2,710.00 $2,439.00 $1,518.00 $2,710.00 $2,466.00 2025-05-12
5501396 CDM Nf-semaglutide 0.25mg Or 0.5mg Dose Pen 7 6 $2,595.00 $2,336.00 $1,453.00 $2,595.00 $2,361.00 2025-05-12
5501417 CDM Nf-nystatin Powder 7 6 $111,150.00 $100,035.00 $62,244.00 $111,150.00 $101,147.00 2025-05-12
5501504 CDM Nf-dulaglutide 0.75mg/0.5ml Solution 7 6 $2,026.00 $1,823.00 $1,135.00 $2,026.00 $1,844.00 2025-05-12
5501507 CDM Nf-dexcom G6 Receiver 7 6 $1,825.00 $1,643.00 $1,022.00 $1,825.00 $1,661.00 2025-05-12
5501596 CDM **nf-abatacept125mg/1ml Autoinjector 7 6 $5,820.00 $5,238.00 $3,259.00 $5,820.00 $5,296.00 2025-05-12
5501610 CDM Nf-enbrel Subcutaneous Solution 25mg/0.5 7 6 $7,161.00 $6,445.00 $4,010.00 $7,161.00 $6,517.00 2025-05-12
5501621 CDM Nf-dulaglutide 1.5mg/0.5ml Solution 7 6 $2,127.00 $1,914.00 $1,191.00 $2,127.00 $1,936.00 2025-05-12
5501668 CDM Nf-tysabri Intravenous Solution 20mg/1ml 7 6 $2,513.00 $2,262.00 $1,407.00 $2,513.00 $2,287.00 2025-05-12
5501700 CDM Nf-trulicity Subq Soln 4.5mg/0.5ml 7 6 $2,127.00 $1,914.00 $1,191.00 $2,127.00 $1,936.00 2025-05-12
5501925 CDM Nf-tysabri Intravenous Solution 20mg/1ml 7 6 $2,626.00 $2,363.00 $1,471.00 $2,626.00 $2,390.00 2025-05-12
5501939 CDM Nf-ibrance Oral Tablet 75mg 7 6 $3,446.00 $3,101.00 $1,930.00 $3,446.00 $3,136.00 2025-05-12
5501940 CDM Nf-ibrance Oral Capsule 75mg 7 6 $3,446.00 $3,101.00 $1,930.00 $3,446.00 $3,136.00 2025-05-12
5502078 CDM Nf-ibrance Oral Tablet 125mg 7 6 $3,653.00 $3,288.00 $2,046.00 $3,653.00 $3,324.00 2025-05-12
5502105 CDM Nf-tysabri Intravenous Solution 20mg/1ml 7 6 $2,626.00 $2,363.00 $1,471.00 $2,626.00 $2,390.00 2025-05-12
55700 CPT Biopsy Of Prostate Gland 7 6 $4,323.00 $3,891.00 $2,421.00 $4,323.00 $3,934.00 2025-05-12
56700 CPT ER Fac ER Phys Hymenotomy W/drng 7 6 $9,107.00 $8,196.00 $5,100.00 $9,107.00 $8,287.00 2025-05-12
59400 CPT Obstetric Care, Planned Vaginal Delivery 7 6 $3,615.00 $3,254.00 $2,024.00 $3,615.00 $3,290.00 2025-05-12
59510 CPT Obstetric Care, Planned Cesarean Delivery 7 6 $3,984.00 $3,586.00 $2,231.00 $3,984.00 $3,625.00 2025-05-12
6000248 CDM Flex 60 Articulatirs 7 6 $2,108.00 $1,897.00 $1,180.00 $2,108.00 $1,918.00 2025-05-12
6000445 CDM Multifire Endo Gia 2.5mm (Single) 7 6 $2,402.00 $2,162.00 $1,345.00 $2,402.00 $2,186.00 2025-05-12
6001072 CDM Artacentwound4x8cm 7 6 $10,517.00 $9,465.00 $5,890.00 $10,517.00 $9,570.00 2025-05-12
600108 CDM Cr Mb Instrument Kit 7 6 $2,440.00 $2,196.00 $1,366.00 $2,440.00 $2,220.00 2025-05-12
6001083 CDM Tactoset Bone Sub 4g 7 6 $5,731.00 $5,158.00 $3,209.00 $5,731.00 $5,215.00 2025-05-12
6001084 CDM Ar Impant System Internal Brace 7 6 $2,691.00 $2,422.00 $1,507.00 $2,691.00 $2,449.00 2025-05-12
6001085 CDM Ar Impant System Internal Brace 7 6 $2,691.00 $2,422.00 $1,507.00 $2,691.00 $2,449.00 2025-05-12
6001087 CDM Ar Fiber Suture Anchor 1.3mm Suture Tape 7 6 $3,255.00 $2,930.00 $1,823.00 $3,255.00 $2,962.00 2025-05-12
6001091 CDM Accufill Pf Bone Sub. 30cc 7 6 $4,023.00 $3,621.00 $2,253.00 $4,023.00 $3,661.00 2025-05-12
6001094 CDM Bio-comp Swvlkc-cld 4.75x19.1mm 7 6 $3,200.00 $2,880.00 $1,792.00 $3,200.00 $2,912.00 2025-05-12
6001095 CDM Amnion Thin 4x8 7 6 $5,029.00 $4,526.00 $2,816.00 $5,029.00 $4,576.00 2025-05-12
6001098 CDM Pf Knee Kit 3cc Accuport Side-del 11gx12 7 6 $4,323.00 $3,891.00 $2,421.00 $4,323.00 $3,934.00 2025-05-12
6001099 CDM Fusion Small Bone Graft 3.75 7 6 $1,962.00 $1,766.00 $1,099.00 $1,962.00 $1,785.00 2025-05-12
6001109 CDM Cr Mb Reamer Kt 7 6 $2,537.00 $2,283.00 $1,421.00 $2,537.00 $2,309.00 2025-05-12
600112 CDM Cr 9x9x9 Dynafrce Impl Kt 7 6 $2,713.00 $2,442.00 $1,519.00 $2,713.00 $2,469.00 2025-05-12
62304 CPT Rf Mylogram Lumbar Spine 7 6 $2,729.00 $2,456.00 $1,528.00 $2,729.00 $2,483.00 2025-05-12
67715 CPT Ectropian Procedure 7 6 $2,251.00 $2,026.00 $1,261.00 $2,251.00 $2,048.00 2025-05-12
70336 CPT Mr Temporomandibular Joints Tmj 7 6 $4,004.00 $3,604.00 $2,242.00 $4,004.00 $3,644.00 2025-05-12
70450 CPT CT Scan 7 6 $2,136.00 $1,922.00 $1,196.00 $2,136.00 $1,944.00 2025-05-12
70460 CPT CT Head W 7 6 $2,150.00 $1,935.00 $1,204.00 $2,150.00 $1,957.00 2025-05-12
70470 CPT CT Head Wo W 7 6 $3,328.00 $2,995.00 $1,864.00 $3,328.00 $3,028.00 2025-05-12
70480 CPT CT Orbit Iac Temporal Bones 7 6 $2,491.00 $2,242.00 $1,395.00 $2,491.00 $2,267.00 2025-05-12
70486 CPT CT Facial Bones Wo 7 6 $1,982.00 $1,784.00 $1,110.00 $1,982.00 $1,804.00 2025-05-12
70487 CPT CT Facial W 7 6 $1,846.00 $1,661.00 $1,034.00 $1,846.00 $1,680.00 2025-05-12
70490 CPT CT Soft Tissue Neck Wo 7 6 $1,960.00 $1,764.00 $1,098.00 $1,960.00 $1,784.00 2025-05-12
70491 CPT CT Soft Tissue Neck W 7 6 $2,404.00 $2,164.00 $1,346.00 $2,404.00 $2,188.00 2025-05-12
70496 CPT CTA Brain Wo W 7 6 $3,370.00 $3,033.00 $1,887.00 $3,370.00 $3,067.00 2025-05-12
70498 CPT CTA Neck Wo W 7 6 $2,976.00 $2,678.00 $1,667.00 $2,976.00 $2,708.00 2025-05-12
70540 CPT Mr Orbit Face Neck Wo 7 6 $3,951.00 $3,556.00 $2,213.00 $3,951.00 $3,595.00 2025-05-12
70543 CPT Mr Orbit Face Neck Wo W 7 6 $3,641.00 $3,277.00 $2,039.00 $3,641.00 $3,313.00 2025-05-12
70544 CPT Mr MRA Brain Wo 7 6 $3,034.00 $2,731.00 $1,699.00 $3,034.00 $2,761.00 2025-05-12
70545 CPT Mr MRA Brain W 7 6 $3,426.00 $3,083.00 $1,919.00 $3,426.00 $3,118.00 2025-05-12
70546 CPT Mr MRA Brain Wo W 7 6 $3,681.00 $3,313.00 $2,061.00 $3,681.00 $3,350.00 2025-05-12
70547 CPT MRA Neck Wo 7 6 $3,794.00 $3,415.00 $2,125.00 $3,794.00 $3,453.00 2025-05-12
70548 CPT Mr MRA Neck W 7 6 $2,983.00 $2,685.00 $1,670.00 $2,983.00 $2,715.00 2025-05-12
70549 CPT Mr MRA Neck Wo W 7 6 $3,695.00 $3,326.00 $2,069.00 $3,695.00 $3,362.00 2025-05-12
70551 CPT Mr Head Wo 7 6 $3,846.00 $3,461.00 $2,154.00 $3,846.00 $3,500.00 2025-05-12
70553 CPT MRI Scan 7 6 $4,379.00 $3,941.00 $2,452.00 $4,379.00 $3,985.00 2025-05-12
71250 CPT CT Chest Wo 7 6 $2,748.00 $2,473.00 $1,539.00 $2,748.00 $2,501.00 2025-05-12
71260 CPT CT Chest W 7 6 $2,855.00 $2,570.00 $1,599.00 $2,855.00 $2,598.00 2025-05-12
71270 CPT CT Chest Wo W 7 6 $2,963.00 $2,667.00 $1,659.00 $2,963.00 $2,696.00 2025-05-12
71271 CPT CT Lung Screening Low Dose Ldct 7 6 $1,866.00 $1,679.00 $1,045.00 $1,866.00 $1,698.00 2025-05-12
71275 CPT CTA Chest Wo W 7 6 $3,342.00 $3,008.00 $1,872.00 $3,342.00 $3,041.00 2025-05-12
72125 CPT CT Cervical Spine Wo 7 6 $2,451.00 $2,206.00 $1,373.00 $2,451.00 $2,230.00 2025-05-12
72126 CPT CT Cervical With Contrast 7 6 $2,475.00 $2,228.00 $1,386.00 $2,475.00 $2,252.00 2025-05-12
72127 CPT CT Cervical W & Without Contrast 7 6 $2,748.00 $2,473.00 $1,539.00 $2,748.00 $2,501.00 2025-05-12
72128 CPT CT Thoracic Spine Wo 7 6 $2,371.00 $2,134.00 $1,328.00 $2,371.00 $2,158.00 2025-05-12
72129 CPT CT Thoracic With Contrast 7 6 $2,449.00 $2,204.00 $1,371.00 $2,449.00 $2,229.00 2025-05-12
72130 CPT CT Thoracic W & Without Contrast 7 6 $2,721.00 $2,449.00 $1,524.00 $2,721.00 $2,476.00 2025-05-12
72131 CPT CT Lumbar Spine Wo 7 6 $2,453.00 $2,208.00 $1,374.00 $2,453.00 $2,232.00 2025-05-12
72132 CPT CT Lumbar Spine W 7 6 $2,597.00 $2,337.00 $1,454.00 $2,597.00 $2,363.00 2025-05-12
72133 CPT CT Lumbar Spine Wow 7 6 $2,650.00 $2,385.00 $1,484.00 $2,650.00 $2,412.00 2025-05-12
72141 CPT Mr Cervical Spine Wo 7 6 $3,690.00 $3,321.00 $2,066.00 $3,690.00 $3,358.00 2025-05-12
72142 CPT Mr C-spine W 7 6 $3,394.00 $3,055.00 $1,901.00 $3,394.00 $3,089.00 2025-05-12
72146 CPT Mr Thoracic Spine Wo 7 6 $3,784.00 $3,406.00 $2,119.00 $3,784.00 $3,443.00 2025-05-12
72148 CPT MRI Scan Of Lower Spinal Canal 7 6 $3,573.00 $3,216.00 $2,001.00 $3,573.00 $3,251.00 2025-05-12
72156 CPT Mr Cervical Spine Wo W 7 6 $3,699.00 $3,329.00 $2,071.00 $3,699.00 $3,366.00 2025-05-12
72157 CPT Mr Thoracic Spine Wo W 7 6 $3,225.00 $2,903.00 $1,806.00 $3,225.00 $2,935.00 2025-05-12
72158 CPT Mr Lumbar Spine Wo W 7 6 $4,176.00 $3,758.00 $2,339.00 $4,176.00 $3,800.00 2025-05-12
72192 CPT CT Pelvis Wo 7 6 $2,344.00 $2,110.00 $1,313.00 $2,344.00 $2,133.00 2025-05-12
72193 CPT CT Scan Of Pelvis With Contrast 7 6 $2,451.00 $2,206.00 $1,373.00 $2,451.00 $2,230.00 2025-05-12
72194 CPT CT Pelvis Wo W 7 6 $2,436.00 $2,192.00 $1,364.00 $2,436.00 $2,217.00 2025-05-12
72195 CPT Mr Pelvis Wo 7 6 $2,955.00 $2,660.00 $1,655.00 $2,955.00 $2,689.00 2025-05-12
72197 CPT Mr Pelvis Wo W 7 6 $3,098.00 $2,788.00 $1,735.00 $3,098.00 $2,819.00 2025-05-12
73200 CPT CT Upper Extremity Lt Wo 14 6 $1,990.00 $1,791.00 $1,073.00 $2,064.00 $1,763.00 2025-05-12
73201 CPT CT Upper Extremity Lt W 14 6 $2,279.00 $2,051.50 $1,229.00 $2,364.00 $2,018.50 2025-05-12
73202 CPT CT Upper Extremity Lt Wo W 7 6 $2,236.00 $2,012.00 $1,252.00 $2,236.00 $2,035.00 2025-05-12
73218 CPT Mr Upper Extremity Non Joint Wo Lt 14 6 $2,124.00 $1,912.00 $1,145.00 $2,203.00 $1,881.50 2025-05-12
73220 CPT Mr Upper Extremity Non Joint Wo W Lt 14 6 $2,993.50 $2,694.50 $1,614.00 $3,105.00 $2,651.50 2025-05-12
73221 CPT Mr Upper Extremity Joint Wo Lt 7 6 $2,663.00 $2,397.00 $1,491.00 $2,663.00 $2,423.00 2025-05-12
73222 CPT Mr Upper Extremity Joint W Lt 7 6 $2,784.00 $2,506.00 $1,559.00 $2,784.00 $2,533.00 2025-05-12
73223 CPT Mr Upper Extremity Joint Wo W Lt 7 6 $2,879.00 $2,591.00 $1,612.00 $2,879.00 $2,620.00 2025-05-12
73700 CPT CT Lower Extremity Lt Wo 7 6 $2,227.00 $2,004.00 $1,247.00 $2,227.00 $2,027.00 2025-05-12
73701 CPT CT Lower Extremity Lt W 14 6 $2,197.00 $1,977.50 $1,184.00 $2,279.00 $1,946.00 2025-05-12
73702 CPT CT Lower Extremity Lt Wo W 7 6 $2,381.00 $2,143.00 $1,333.00 $2,381.00 $2,167.00 2025-05-12
73706 CPT CTA Low Extremity 7 6 $2,040.00 $1,836.00 $1,142.00 $2,040.00 $1,856.00 2025-05-12
73718 CPT Mr Lower Extremity Non Joint Wo Lt 7 6 $2,733.00 $2,460.00 $1,530.00 $2,733.00 $2,487.00 2025-05-12
73720 CPT Mr Lower Extremity Non Joint Wo W Lt 14 6 $2,976.00 $2,678.50 $1,604.00 $3,087.00 $2,635.50 2025-05-12
73721 CPT MRI Scan Of Leg Joint 7 6 $2,613.00 $2,352.00 $1,463.00 $2,613.00 $2,378.00 2025-05-12
73723 CPT Mr Lower Extremity Joint Wo W Lt 14 6 $2,755.00 $2,479.50 $1,485.00 $2,858.00 $2,439.50 2025-05-12
74150 CPT CT Abdomen Wo 7 6 $2,419.00 $2,177.00 $1,355.00 $2,419.00 $2,201.00 2025-05-12
74160 CPT CT Abdomen W 7 6 $2,623.00 $2,361.00 $1,469.00 $2,623.00 $2,387.00 2025-05-12
74170 CPT CT Abdomen Wo W 7 6 $3,179.00 $2,861.00 $1,780.00 $3,179.00 $2,893.00 2025-05-12
74174 CPT CTA Abdomen Pelvis Wo W 7 6 $5,226.00 $4,703.00 $2,927.00 $5,226.00 $4,756.00 2025-05-12
74175 CPT CTA Abdomen Wo W 7 6 $2,979.00 $2,681.00 $1,668.00 $2,979.00 $2,711.00 2025-05-12
74176 CPT CT Abdomen Pelvis Wo 7 6 $4,262.00 $3,836.00 $2,387.00 $4,262.00 $3,878.00 2025-05-12
74177 CPT CT Scan Of Abdomen And Pelvis With Contrast 7 6 $4,628.00 $4,165.00 $2,592.00 $4,628.00 $4,211.00 2025-05-12
74178 CPT CT Abdomen Pelvis Wo W 7 6 $5,546.00 $4,991.00 $3,106.00 $5,546.00 $5,047.00 2025-05-12
74181 CPT Mr Abdomen Wo 7 6 $3,290.00 $2,961.00 $1,842.00 $3,290.00 $2,994.00 2025-05-12
74182 CPT Mr Abdomen W 7 6 $3,225.00 $2,903.00 $1,806.00 $3,225.00 $2,935.00 2025-05-12
74183 CPT Mr Abdomen Wo W 7 6 $4,016.00 $3,614.00 $2,249.00 $4,016.00 $3,655.00 2025-05-12
75635 CPT CTA Abdomen Pelvis W Runoff 7 6 $3,500.00 $3,150.00 $1,960.00 $3,500.00 $3,185.00 2025-05-12
76080 CPT Rf Fistulagram Injection Abscess 7 6 $2,043.00 $1,839.00 $1,144.00 $2,043.00 $1,859.00 2025-05-12
77012 CPT CT Guided Needle Placement 7 6 $1,805.00 $1,625.00 $1,011.00 $1,805.00 $1,643.00 2025-05-12
78201 CPT **Liver Imagry 7 6 $1,774.00 $1,597.00 $993.00 $1,774.00 $1,614.00 2025-05-12
78202 CPT Nm Liver Image W/vasc Flow 7 6 $1,774.00 $1,597.00 $993.00 $1,774.00 $1,614.00 2025-05-12
78205 CPT **Liver Imaging(spect)3d 7 6 $1,791.00 $1,612.00 $1,003.00 $1,791.00 $1,630.00 2025-05-12
78227 CPT Nm Hida Scan 7 6 $2,324.00 $2,092.00 $1,301.00 $2,324.00 $2,115.00 2025-05-12
78315 CPT Nm Bone-three Phase Stud 7 6 $2,096.00 $1,886.00 $1,174.00 $2,096.00 $1,907.00 2025-05-12
78320 CPT Nm Bone-tomographic(spect) 7 6 $2,150.00 $1,935.00 $1,204.00 $2,150.00 $1,957.00 2025-05-12
78451 CPT Nm Cardiolyte Single 7 6 $1,774.00 $1,597.00 $993.00 $1,774.00 $1,614.00 2025-05-12
78452 CPT Nm Lexiscan Cardiolyte Multi 7 6 $4,794.00 $4,315.00 $2,685.00 $4,794.00 $4,363.00 2025-05-12
78456 CPT **Acute Venous Thrombosis I 7 6 $1,774.00 $1,597.00 $993.00 $1,774.00 $1,614.00 2025-05-12
78472 CPT Nm Gated Blood Pool (Muga) 7 6 $3,515.00 $3,164.00 $1,968.00 $3,515.00 $3,199.00 2025-05-12
78582 CPT **Lung Perfusion 14 6 $2,093.50 $1,884.00 $986.00 $2,426.00 $1,620.50 2025-05-12
80000553 CDM Anika Ultos 8mm Calcaneal Plate 7 6 $3,452.00 $3,107.00 $1,933.00 $3,452.00 $3,141.00 2025-05-12
80000560 CDM Fusion Bone Graft Strips 50x25x8 7 6 $5,117.00 $4,605.00 $2,866.00 $5,117.00 $4,656.00 2025-05-12
80000561 CDM 6.5mmx65mm Headless Cannulated Screw 7 6 $2,448.00 $2,203.00 $1,371.00 $2,448.00 $2,228.00 2025-05-12
80000565 CDM Hammtech Smll Impl 7 6 $3,192.00 $2,873.00 $1,788.00 $3,192.00 $2,905.00 2025-05-12
80000566 CDM Hammtech Mdm Impl 7 6 $3,192.00 $2,873.00 $1,788.00 $3,192.00 $2,905.00 2025-05-12
80000567 CDM Super 20x20x20mm Imp 7 6 $3,437.00 $3,093.00 $1,925.00 $3,437.00 $3,128.00 2025-05-12
80000568 CDM Super 20x20x20mm Imp Style B 7 6 $3,437.00 $3,093.00 $1,925.00 $3,437.00 $3,128.00 2025-05-12
80000570 CDM Osteo Viable Matrix 7 6 $7,999.00 $7,199.00 $4,479.00 $7,999.00 $7,279.00 2025-05-12
80000571 CDM Pre Hydrrated Cotton Wedge 7 6 $4,320.00 $3,888.00 $2,419.00 $4,320.00 $3,931.00 2025-05-12
80000580 CDM Universal Short Plate 7 6 $3,362.00 $3,026.00 $1,883.00 $3,362.00 $3,059.00 2025-05-12
80000583 CDM Hdless Cann Scrw 6.5x80mm/30mm Thrd 7 6 $2,080.00 $1,872.00 $1,165.00 $2,080.00 $1,893.00 2025-05-12
80000591 CDM Plantr Lapid Plt Right 7 6 $2,990.00 $2,691.00 $1,674.00 $2,990.00 $2,721.00 2025-05-12
80000595 CDM Ortho Bone Stimulator 7 6 $4,725.00 $4,253.00 $2,646.00 $4,725.00 $4,300.00 2025-05-12
81162 CPT Brca 1 7 2 Genetics Full Sequence (Rl) 7 6 $7,123.00 $6,411.00 $3,989.00 $7,123.00 $6,482.00 2025-05-12
81408 CPT Neurofibromatosis Type (Rl) 7 6 $3,000.00 $2,700.00 $1,680.00 $3,000.00 $2,730.00 2025-05-12
81479 CPT Neurofibromatosis Type 1 (Rl) 7 6 $1,938.00 $1,744.00 $1,085.00 $1,938.00 $1,764.00 2025-05-12
85597 CPT Antiphospholipid Syndrome (Rl) 7 6 $2,046.00 $1,841.00 $1,146.00 $2,046.00 $1,862.00 2025-05-12
90000034 CDM Circ Bow Stap 25 7 6 $2,141.00 $1,927.00 $1,199.00 $2,141.00 $1,948.00 2025-05-12
90000036 CDM Kugel Hernia Patch Lg Oval 7 6 $1,866.00 $1,679.00 $1,045.00 $1,866.00 $1,698.00 2025-05-12
90000219 CDM Arthrex Instrument Usuage Kit 7 6 $2,700.00 $2,430.00 $1,512.00 $2,700.00 $2,457.00 2025-05-12
90000265 CDM Right Standard 5 Hole Volar Plate 7 6 $1,854.00 $1,669.00 $1,038.00 $1,854.00 $1,687.00 2025-05-12
90000278 CDM Hammer Fix Implant Med 7 6 $2,919.00 $2,627.00 $1,635.00 $2,919.00 $2,656.00 2025-05-12
90000315 CDM Impl Sys, Bio-com Achilles Speedbr 7 6 $3,480.00 $3,132.00 $1,949.00 $3,480.00 $3,167.00 2025-05-12
90000326 CDM Haerfix Implant Small 7 6 $2,919.00 $2,627.00 $1,635.00 $2,919.00 $2,656.00 2025-05-12
90000353 CDM Tiso Custom Fabricated 7 6 $3,105.00 $2,795.00 $1,739.00 $3,105.00 $2,826.00 2025-05-12
90000360 CDM Short Bend Plate 7 6 $1,964.00 $1,768.00 $1,100.00 $1,964.00 $1,787.00 2025-05-12
90000385 CDM Cannulated Drill 6.5mm 7 6 $1,788.00 $1,609.00 $1,001.00 $1,788.00 $1,627.00 2025-05-12
90000396 CDM Amnioheal Plus 4x8 7 6 $9,445.00 $8,501.00 $5,289.00 $9,445.00 $8,595.00 2025-05-12
90000448 CDM 15mm Articular Comptoe2 7 6 $4,058.00 $3,652.00 $2,272.00 $4,058.00 $3,693.00 2025-05-12
90000464 CDM Tendon Tissue 7 6 $2,603.00 $2,343.00 $1,458.00 $2,603.00 $2,369.00 2025-05-12
90000466 CDM Amnioheal Plus 4x4 7 6 $4,712.00 $4,241.00 $2,639.00 $4,712.00 $4,288.00 2025-05-12
90000482 CDM Lynx Suprapubic Sling 7 6 $2,426.00 $2,183.00 $1,359.00 $2,426.00 $2,208.00 2025-05-12
90000530 CDM Bmwd 2x2 1 Pk 7 6 $4,725.00 $4,253.00 $2,646.00 $4,725.00 $4,300.00 2025-05-12
90000653 CDM Hammer Fix Implant Large 7 6 $2,919.00 $2,627.00 $1,635.00 $2,919.00 $2,656.00 2025-05-12
90000693 CDM Imp Sys Bioc Achilles Speedb With Jump 7 6 $3,192.00 $2,873.00 $1,788.00 $3,192.00 $2,905.00 2025-05-12
90000765 CDM 2.4mm Va Lcp Kit 7 6 $4,455.00 $4,010.00 $2,495.00 $4,455.00 $4,054.00 2025-05-12
90000790 CDM Metacarpal Neck Plate Left 1.3mm 7 6 $1,764.00 $1,588.00 $988.00 $1,764.00 $1,605.00 2025-05-12
90000793 CDM 2mmx15mm Nerve Cap 7 6 $2,960.00 $2,664.00 $1,658.00 $2,960.00 $2,694.00 2025-05-12
90000816 CDM Allograft Graftlink 7 6 $3,450.00 $3,105.00 $1,932.00 $3,450.00 $3,140.00 2025-05-12
90000840 CDM Implant Pkg Toemate Xs 7 6 $2,877.00 $2,589.00 $1,611.00 $2,877.00 $2,618.00 2025-05-12
90000869 CDM Bi-cortical Cotton Wedge 5mm 7 6 $3,150.00 $2,835.00 $1,764.00 $3,150.00 $2,867.00 2025-05-12
90000872 CDM 2.4mm Va-lcp 2-clmn Vlr Dstl 7 6 $2,789.00 $2,510.00 $1,562.00 $2,789.00 $2,538.00 2025-05-12
90000877 CDM Stardrive Screwdriver T8 7 6 $2,906.00 $2,615.00 $1,627.00 $2,906.00 $2,644.00 2025-05-12
90000892 CDM Dynaforce Plate St Inst Kit 7 6 $2,440.00 $2,196.00 $1,366.00 $2,440.00 $2,220.00 2025-05-12
90000894 CDM Motoband Max Distal Vero 15mm 7 6 $3,781.00 $3,403.00 $2,117.00 $3,781.00 $3,441.00 2025-05-12
90000895 CDM Implant Kit Dynaforce Himax 15x15x15 7 6 $2,969.00 $2,672.00 $1,663.00 $2,969.00 $2,702.00 2025-05-12
90000896 CDM Implt Sngl Pack Dynaforce Himax 15x18x18 7 6 $2,850.00 $2,565.00 $1,596.00 $2,850.00 $2,594.00 2025-05-12
90000900 CDM Implt Sngl Pack Dynaforce Himax 15x15x15 7 6 $2,850.00 $2,565.00 $1,596.00 $2,850.00 $2,594.00 2025-05-12
90000914 CDM Dynanite Pip Str 14mm 7 6 $3,656.00 $3,290.00 $2,047.00 $3,656.00 $3,327.00 2025-05-12
90000928 CDM 6.5mmx60mm Headless Cannulated Screw 7 6 $2,448.00 $2,203.00 $1,371.00 $2,448.00 $2,228.00 2025-05-12
90000929 CDM 6.5mmx60mm Headed Cannulated Screw 7 6 $2,448.00 $2,203.00 $1,371.00 $2,448.00 $2,228.00 2025-05-12
90000945 CDM Supermx Niti Staple W/instrs,20w X 20l 7 6 $4,813.00 $4,332.00 $2,695.00 $4,813.00 $4,380.00 2025-05-12
90000947 CDM Dyna Bunion Strl Plt Kit 7 6 $2,287.00 $2,058.00 $1,281.00 $2,287.00 $2,081.00 2025-05-12
90000948 CDM Dynabunion Intrument Kit 7 6 $2,713.00 $2,442.00 $1,519.00 $2,713.00 $2,469.00 2025-05-12
90000951 CDM Dyna 18m Strl Prp Kit 7 6 $1,777.00 $1,599.00 $995.00 $1,777.00 $1,617.00 2025-05-12
90000952 CDM Dynabunion Plate Lft Pck Out 7 6 $4,120.00 $3,708.00 $2,307.00 $4,120.00 $3,749.00 2025-05-12
90000956 CDM 5th Met Screw 4.5x50mm 7 6 $1,990.00 $1,791.00 $1,114.00 $1,990.00 $1,811.00 2025-05-12
90000960 CDM Ar Speed Bridge 7 6 $2,784.00 $2,506.00 $1,559.00 $2,784.00 $2,533.00 2025-05-12
90000965 CDM Lapidus Plate Lc Alpha 18mm 7 6 $3,666.00 $3,299.00 $2,053.00 $3,666.00 $3,336.00 2025-05-12
90000966 CDM Implt Sngl Pack Dynaforce Himax 18x18x18 7 6 $3,088.00 $2,779.00 $1,729.00 $3,088.00 $2,810.00 2025-05-12
90000970 CDM Anatomical St Implant 7mm 7 6 $5,393.00 $4,854.00 $3,020.00 $5,393.00 $4,908.00 2025-05-12
90000971 CDM Biocomp Swivelock Cft 4.75x19.1mm 7 6 $3,290.00 $2,961.00 $1,842.00 $3,290.00 $2,994.00 2025-05-12
90000998 CDM Accufill Bone Substitute Material 3cc 7 6 $3,416.00 $3,074.00 $1,913.00 $3,416.00 $3,109.00 2025-05-12
90000999 CDM Disposables Kit For Dx Fibertak 7 6 $2,475.00 $2,228.00 $1,386.00 $2,475.00 $2,252.00 2025-05-12
90001000 CDM Dx Fibertak Suture Anchor St+ Ndls 7 6 $3,255.00 $2,930.00 $1,823.00 $3,255.00 $2,962.00 2025-05-12
90001001 CDM Ib Kit, Bc, W/cc Ft+ Jump Start 7 6 $2,691.00 $2,422.00 $1,507.00 $2,691.00 $2,449.00 2025-05-12
90001005 CDM Mini Bunion Inst Kit Packout Assembly-st 7 6 $2,440.00 $2,196.00 $1,366.00 $2,440.00 $2,220.00 2025-05-12
90001006 CDM Mis Bunion 3.5mm Short Plate Packout-ste 7 6 $3,666.00 $3,299.00 $2,053.00 $3,666.00 $3,336.00 2025-05-12
90001061 CDM Distractor Small Straight 1.6/2.4mm 7 6 $3,908.00 $3,517.00 $2,188.00 $3,908.00 $3,556.00 2025-05-12
90001239 CDM Reamer Mpj Cone 20mm 7 6 $2,899.00 $2,609.00 $1,623.00 $2,899.00 $2,638.00 2025-05-12
90001240 CDM Reamer Mpj Cup 20mm 7 6 $2,899.00 $2,609.00 $1,623.00 $2,899.00 $2,638.00 2025-05-12
90001254 CDM Peg Broach Tibial Anterior Infinity 7 6 $1,924.00 $1,732.00 $1,077.00 $1,924.00 $1,751.00 2025-05-12
90001255 CDM Peg Broach Tibial Infinity 7 6 $4,466.00 $4,019.00 $2,501.00 $4,466.00 $4,064.00 2025-05-12
90001265 CDM Guides Prophecy Infinity Patient Specifi 7 6 $3,752.00 $3,377.00 $2,101.00 $3,752.00 $3,414.00 2025-05-12
90001272 CDM Implant Instrument Kit Sterile Mdm 7 6 $1,764.00 $1,588.00 $988.00 $1,764.00 $1,605.00 2025-05-12
90001309 CDM Instrument Kit Style B15mm 7 6 $1,764.00 $1,588.00 $988.00 $1,764.00 $1,605.00 2025-05-12
90001311 CDM Instrument Kit Style A 11mm 7 6 $1,764.00 $1,588.00 $988.00 $1,764.00 $1,605.00 2025-05-12
90001315 CDM Scp Cmpl F&a Kit 3cc End Del 15gx60mm 7 6 $4,185.00 $3,767.00 $2,344.00 $4,185.00 $3,808.00 2025-05-12
90001334 CDM Reamer Mpj Cone18mm 7 6 $2,578.00 $2,320.00 $1,444.00 $2,578.00 $2,346.00 2025-05-12
90001335 CDM Reamer Mpj Cup 18mm 7 6 $2,578.00 $2,320.00 $1,444.00 $2,578.00 $2,346.00 2025-05-12
92960 CPT Cardioversion Electric Ex 7 6 $2,312.00 $2,081.00 $1,295.00 $2,312.00 $2,104.00 2025-05-12
93306 CPT Echo Complete 7 6 $2,501.00 $2,251.00 $1,401.00 $2,501.00 $2,276.00 2025-05-12
95805 CPT Mslt 7 6 $1,762.00 $1,586.00 $987.00 $1,762.00 $1,603.00 2025-05-12
95810 CPT Sleep Study 7 6 $4,212.00 $3,791.00 $2,359.00 $4,212.00 $3,833.00 2025-05-12
95811 CPT Polysomnography Split 7 6 $4,791.00 $4,312.00 $2,683.00 $4,791.00 $4,360.00 2025-05-12
99291 CPT ER Room Critical Level 6 7 6 $1,953.00 $1,758.00 $1,094.00 $1,953.00 $1,777.00 2025-05-12
9999116 CDM Nail Fibula 2 3x145mm 7 6 $4,725.00 $4,253.00 $2,646.00 $4,725.00 $4,300.00 2025-05-12
C1734 HCPCS Bonus Triad Allograft 1cc 14 6 $4,952.00 $4,457.00 $708.00 $8,640.00 $3,051.00 2025-05-12
C1762 HCPCS Amnion Thin 7 6 $5,029.00 $4,526.00 $2,816.00 $5,029.00 $4,576.00 2025-05-12
C1763 HCPCS Magriderm 14 6 $4,186.00 $3,767.50 $1,310.00 $6,032.00 $2,859.00 2025-05-12
C1776 HCPCS Art Fixation Comp Phalange Df-p 49 6 $4,432.00 $3,989.00 $1,145.00 $17,454.00 $3,439.00 2025-05-12
CP17241042983595006 CDM Intensive Care Inpatient 7 6 $2,575.00 $2,318.00 $1,442.00 $2,575.00 $2,343.00 2025-05-12
CP17241042983595504 CDM Inpatient W/telemetry 7 6 $1,950.00 $1,755.00 $1,092.00 $1,950.00 $1,775.00 2025-05-12
CP17241042983598963 CDM Isolation W/telemetry 7 6 $2,025.00 $1,823.00 $1,134.00 $2,025.00 $1,843.00 2025-05-12
CP17241042983623001 CDM Swingbed Isolation W/tele 7 6 $1,875.00 $1,688.00 $1,050.00 $1,875.00 $1,706.00 2025-05-12
J0129 HCPCS Abatacept 250mg Inj (Special Order) 7 6 $2,500.00 $2,250.00 $1,400.00 $2,500.00 $2,275.00 2025-05-12
J0517 HCPCS Fasenra 30mg/ml Inj (Spec Order) 7 6 $8,598.00 $7,738.00 $4,815.00 $8,598.00 $7,824.00 2025-05-12
J0630 HCPCS Calcitonin 400u/2ml Inj (Special Order) 7 6 $5,260.00 $4,734.00 $2,946.00 $5,260.00 $4,787.00 2025-05-12
J0717 HCPCS Cerolizumab 200mg/1ml Sq Inj 7 6 $4,284.00 $3,856.00 $2,399.00 $4,284.00 $3,898.00 2025-05-12
J0840 HCPCS Crotilidae Polyvalent Inj 7 6 $5,373.00 $4,836.00 $3,009.00 $5,373.00 $4,889.00 2025-05-12
J0881 HCPCS Darbepoetin 200mcg/0.4ml Inj 28 6 $3,576.00 $3,218.50 $573.00 $6,502.00 $2,734.50 2025-05-12
J0897 HCPCS Denosumab 120 Mg/1.7ml Inj (Spec Ord) 14 6 $3,700.50 $3,330.50 $1,588.00 $4,565.00 $2,609.00 2025-05-12
J1306 HCPCS Inclisiran 284mg/1.5ml Inj (Spec Order) 7 6 $5,460.00 $4,914.00 $3,058.00 $5,460.00 $4,969.00 2025-05-12
J1438 HCPCS Etanercept 50mg/ml Syringe 7 6 $3,151.00 $2,836.00 $1,765.00 $3,151.00 $2,867.00 2025-05-12
J1439 HCPCS Ferric Carboxymaltose 750mg/15ml Inj (So 7 6 $2,463.00 $2,217.00 $1,379.00 $2,463.00 $2,241.00 2025-05-12
J1459 HCPCS Immune Globulin 10% 20g/200ml (Spec Ord) 21 6 $4,771.00 $4,294.00 $870.00 $9,048.00 $4,342.00 2025-05-12
J1568 HCPCS Octagam 10% 10g/100ml (Spec Ord) 14 6 $4,456.00 $4,010.50 $1,741.00 $5,803.00 $3,179.50 2025-05-12
J1569 HCPCS Gammagard 10% 30g/300ml (Spec Ord) 7 6 $6,737.00 $6,063.00 $3,773.00 $6,737.00 $6,131.00 2025-05-12
J1745 HCPCS Remicade 100mg Inj (Special Order) 7 6 $2,382.00 $2,144.00 $1,334.00 $2,382.00 $2,168.00 2025-05-12
J1930 HCPCS Nf-lanreotide 120mg/0.5ml Inj 7 6 $85,370.00 $76,833.00 $47,807.00 $85,370.00 $77,687.00 2025-05-12
J2323 HCPCS Tysabri 300mg/15ml Inj 7 6 $12,807.00 $11,526.00 $7,172.00 $12,807.00 $11,654.00 2025-05-12
J2356 HCPCS Tezspire 210mg/1.91ml Inj (Spec Order) 7 6 $6,103.00 $5,493.00 $3,418.00 $6,103.00 $5,554.00 2025-05-12
J2426 HCPCS Invega Sustenna 117mg IM Inj (Spec Ord) 21 6 $3,896.00 $3,506.00 $1,753.00 $5,362.00 $3,003.00 2025-05-12
J2506 HCPCS Pegfilgrastim 6 Mg/0.6ml 7 6 $10,012.00 $9,011.00 $5,607.00 $10,012.00 $9,111.00 2025-05-12
J2997 HCPCS Alteplase 100mg Inj 14 6 $6,784.00 $6,105.50 $206.00 $13,201.00 $3,880.00 2025-05-12
J3262 HCPCS Actemra 200mg/10ml Inj (Special Order) 21 6 $2,550.00 $2,295.00 $654.00 $4,437.00 $2,321.00 2025-05-12
J3315 HCPCS Trelstar 3.75mg Inj (Special Order) 7 6 $1,777.00 $1,599.00 $995.00 $1,777.00 $1,617.00 2025-05-12
J7296 HCPCS Levonorgestrel 19.5mg IUD (Clinic) 7 6 $2,140.00 $1,926.00 $1,198.00 $2,140.00 $1,947.00 2025-05-12
J7298 HCPCS Levonorgestrel 52mg IUD (Clinic) 7 6 $2,140.00 $1,926.00 $1,198.00 $2,140.00 $1,947.00 2025-05-12
J7301 HCPCS Levonorgestrel 13.5mg IUD (Clinic) 7 6 $1,782.00 $1,604.00 $998.00 $1,782.00 $1,622.00 2025-05-12
J7307 HCPCS Etonogestrol 68mg Implant 7 6 $2,101.00 $1,891.00 $1,177.00 $2,101.00 $1,912.00 2025-05-12
J9217 HCPCS Eligard 22.5mg Kit (Spec Ord) 14 6 $5,639.50 $5,075.50 $1,457.00 $8,677.00 $3,730.50 2025-05-12
J9302 HCPCS Kesimpta 20mg/0.4ml Pen (Special Order) 7 6 $11,903.00 $10,713.00 $6,666.00 $11,903.00 $10,832.00 2025-05-12
J9304 HCPCS Dantrolene 250mg Inj (Surgery) 7 6 $4,914.00 $4,423.00 $2,752.00 $4,914.00 $4,472.00 2025-05-12
J9395 HCPCS Fulvestrant 500mg/10ml Inj (Spec Ord) 7 6 $3,141.00 $2,827.00 $1,759.00 $3,141.00 $2,858.00 2025-05-12
Q4106 HCPCS Dermagraf 7 6 $2,250.00 $2,025.00 $1,260.00 $2,250.00 $2,048.00 2025-05-12
Q4125 HCPCS Arthroflex 40x70mm 7 6 $3,815.00 $3,434.00 $2,136.00 $3,815.00 $3,472.00 2025-05-12
Q4169 HCPCS Artacent Wound 4x6cm 14 6 $9,396.50 $8,456.50 $4,635.00 $10,517.00 $7,614.00 2025-05-12
Q5103 HCPCS Inflectra 100mg Inj (Special Order) 7 6 $1,930.00 $1,737.00 $1,081.00 $1,930.00 $1,756.00 2025-05-12
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