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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

BUTLER COUNTY HEALTH

David City, NE · CCN 281332 · Rates published

2,844 distinct procedures filed
12 distinct payers
48,145 rate rows
2026-07-06 last MRF observed
Data quality

47,090 of 48,145 rate rows are consumer-grade (97.8%)

1,055 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 678
per-diem day rate — not a per-procedure price 377
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://secure.claraprice.net/price-transparency/XJEN-1744822433611/machine-readable/470551144_butler-county-health_standardcharges.json
Found on page https://secure.claraprice.net/price-transparency/butler-county-health-ne
Discovered viaDiscovered by HANK
Last fetch success · 2026-11-03
Content fingerprint 73d4ced4264f8f2c… · 13,203,480 bytes · first seen 2026-11-03

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
CP17833751143591268
CDM 		Major Joint Replacement Or Reattachment Of Lower Extremity Without Mcc 10 $50,765.00 $52,368.00 $51,780.00 nat. median
$51,780
1.0× median
162525522
CDM 		Ocrelizumab 300 Mg/10 Ml Sol [Bchc] 11 $14,730.00 $41,517.00 $40,648.50 nat. median
$40,648
1.0× median
C1820
HCPCS 		Generator Prospera Ipg 12 $13,195.00 $37,191.00 $36,053.00 nat. median
$22,950
1.6× median
C1826
HCPCS 		Impl Inceptiv Ins 12 $12,191.00 $34,362.00 $33,310.00 nat. median
$29,401
1.1× median
29826
CPT 		Shaving Of Shoulder Bone Using Endoscope 12 $398.00 $29,759.00 $26,932.50 nat. median
$3,011
outlier · 8.9×
80330209
CDM 		Alteplase 100 Mg IV Inj[bchc] 11 $8,940.00 $25,198.00 $24,670.50 nat. median
$24,670
1.0× median
199846757
CDM 		Immune Globulin Intravenous 40g 10% Sol [Bchc] 11 $8,032.00 $22,638.00 $22,164.50 nat. median
$22,164
1.0× median
47562
CPT 		Removal Of Gallbladder Using An Endoscope 12 $1,475.00 $21,108.00 $19,103.00 nat. median
$6,019
outlier · 3.2×
197304306
CDM 		Tenecteplase 25 Mg Pow[bchc] 11 $6,389.00 $18,008.00 $17,630.50 nat. median
$17,630
1.0× median
184545230
CDM 		Tenecteplase 50 Mg Pow [Bchc] 11 $6,203.00 $17,484.00 $17,118.50 nat. median
$17,118
1.0× median
3610039
CDM 		Impl Lapiplasty System 4 Sk39 12 $5,669.00 $15,978.00 $15,489.00 nat. median
$593
outlier · 26.1×
3610014
CDM 		Impl Lapiplasty System 2 Sk14 12 $5,559.00 $15,669.00 $15,190.00 nat. median
$170
outlier · 89.4×
29881
CPT 		Removal Of One Knee Cartilage Using An Endoscope 12 $1,226.00 $16,521.00 $14,952.00 nat. median
$3,821
outlier · 3.9×
49505
CPT 		Repair Of Groin Hernia Patient Age 5 Years Or Older 12 $1,167.00 $15,861.00 $14,354.00 nat. median
$3,867
outlier · 3.7×
80348683
CDM 		Leuprolide 22.5 Mg/3 Mon (Lupron) Kit [Bchc] 11 $4,815.00 $13,572.00 $13,288.50 nat. median
$13,288
1.0× median
80357877
CDM 		Pegfilgrastim 6 Mg/0.6 Ml Subq Inj[bchc] 11 $4,800.00 $13,528.00 $13,245.00 nat. median
$13,245
1.0× median
175608572
CDM 		Alteplase 50 Mg Pow[bchc] 11 $4,479.00 $12,623.00 $12,359.50 nat. median
$12,360
1.0× median
42820
CPT 		Removal Of Tonsils And Adenoid Glands, Patient Younger Than Age 12 12 $664.00 $13,271.00 $12,010.00 nat. median
$5,506
outlier · 2.2×
80362061
CDM 		Rituximab 10 Mg/ml IV Sol[bchc] 11 $3,515.00 $9,906.00 $9,699.00 nat. median
$9,699
1.0× median
194126446
CDM 		Capsaicin Topical 8% Kit (4 Patches) [Bchc] 11 $3,435.00 $9,680.00 $9,478.00 nat. median
$9,478
1.0× median
197383339
CDM 		Tezepelumab Ekko 210 Mg/1.91 Ml Sol[bchc] 11 $3,269.00 $9,215.00 $9,022.50 nat. median
$9,022
1.0× median
161275755
CDM 		Pegfilgrastim Cbqv 6 Mg/0.6 Ml Sol [Bchc] 11 $3,124.00 $8,806.00 $8,622.00 nat. median
$8,622
1.0× median
140058861
CDM 		Pegfilgrastim Jmdb 6 Mg/0.6 Ml Sol[bchc] 11 $3,124.00 $8,806.00 $8,622.00 nat. median
$8,622
1.0× median
Q4197
HCPCS 		Puraply Am Xt Ef (4.91x4.91) 24.1sq Cm 12 $85.00 $8,637.00 $8,372.00 nat. median
$207
outlier · 40.5×
118054648
CDM 		Pegfilgrastim Bmez 6 Mg/0.6 Ml Sol [Bchc] 11 $2,938.00 $8,281.00 $8,108.00 nat. median
$8,108
1.0× median
183567832
CDM 		Darbepoetin Alfa 300 Mcg/0.6 Ml Sol [Bchc] 11 $2,897.00 $8,164.00 $7,993.50 nat. median
$7,994
1.0× median
94617
CPT 		94617 Exercise Test For Bronchospasm Charge 12 $179.00 $8,448.00 $7,570.00 nat. median
$182
outlier · 41.5×
C1778
HCPCS 		Impl Lead 5mm 1x8 MRI 12 $516.00 $24,255.00 $7,496.00 nat. median
$4,400
1.7× median
186363310
CDM 		Mepolizumab 100 Mg Pow[bchc] 11 $2,697.00 $7,602.00 $7,443.00 nat. median
$7,443
1.0× median
80369449
CDM 		Denosumab 120 Mg/1.7 Ml[bchc] 11 $2,583.00 $7,279.00 $7,127.50 nat. median
$7,128
1.0× median
186778302
CDM 		Inclisiran 284 Mg/1.5 Ml (Leqvio) Sol [Bchc] 11 $2,526.00 $7,119.00 $6,970.00 nat. median
$6,970
1.0× median
70546
CPT 		MRA Brain/head With + Without Contrast 12 $905.00 $7,569.00 $6,893.00 nat. median
$1,055
outlier · 6.5×
189961396
CDM 		Dantrolene 250 Mg Pow[bchc] 11 $2,482.00 $6,994.00 $6,848.00 nat. median
$6,848
1.0× median
43239
CPT 		Biopsy Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 12 $325.00 $7,139.00 $6,461.00 nat. median
$1,370
outlier · 4.7×
43235
CPT 		Diagnostic Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 12 $287.00 $7,139.00 $6,461.00 nat. median
$1,312
outlier · 4.9×
74178
CPT 		CT Abdomen And Pelvis With + Without Contrast 12 $802.00 $7,065.00 $6,434.00 nat. median
$1,023
outlier · 6.3×
70545
CPT 		MRA Brain/head With Contrast 12 $613.00 $6,984.00 $6,360.00 nat. median
$878
outlier · 7.2×
C1767
HCPCS 		Interstim, Neurostimulatorfull Implant 12 $1,422.00 $23,995.00 $6,260.50 nat. median
$23,834
outlier · 0.3×
80357449
CDM 		Palivizumab 100 Mg/ml IM Sol [Bchc] 11 $2,225.00 $6,271.00 $6,140.00 nat. median
$6,140
1.0× median
Q4159
HCPCS 		Affinity (2.5x2.5) 6.25sq Cm 12 $282.00 $6,218.00 $6,028.00 nat. median
$634
outlier · 9.5×
70471
CPT 		CT Angio Head/neck 12 $2,173.00 $6,519.00 $5,997.00 nat. median
$859
outlier · 7.0×
74174
CPT 		CT Angio Abdomen And Pelvis 12 $882.00 $6,540.00 $5,957.00 nat. median
$980
outlier · 6.1×
C9359
HCPCS 		Bone Matrix Cellular V92 2.5cc 12 $2,165.00 $6,103.00 $5,917.00 nat. median
$1,472
outlier · 4.0×
80361453
CDM 		Rabies Immune Globulin 150 Intl Units/ml 10 Ml[bchc] 11 $2,124.00 $5,988.00 $5,863.00 nat. median
$5,863
1.0× median
45385
CPT 		Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope 12 $598.00 $6,360.00 $5,756.00 nat. median
$1,666
outlier · 3.5×
199844864
CDM 		Immune Globulin Intravenous 10g 10% Sol [Bchc] 11 $2,021.00 $5,697.00 $5,577.50 nat. median
$5,578
1.0× median
74177
CPT 		CT Scan Of Abdomen And Pelvis With Contrast 12 $711.00 $6,093.00 $5,549.00 nat. median
$970
outlier · 5.7×
45380
CPT 		Biopsy Exam Of Large Bowel Using An Endoscope 12 $472.00 $6,084.00 $5,506.50 nat. median
$1,558
outlier · 3.5×
74185
CPT 		MRA Abdomen With + Without Contrast 12 $878.00 $6,029.00 $5,491.00 nat. median
$1,240
outlier · 4.4×
195162970
CDM 		Romosozumab 210 Mg/ 2.34 Ml Sol [Bchc] 11 $1,970.00 $5,552.00 $5,435.50 nat. median
$5,436
1.0× median

Other procedures at this hospital

Browse this hospital's 2,844 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
             
36571 CPT 36571 Picc Line Insertion 16 12 $3,886.00 $3,886.00 $708.00 $4,120.00 $3,692.00 2026-07-06
64555 CPT 64555 Fac Fee, Percutaneous Implant Of Neurostimulator Electrode Array; Peripher… 29 12 $9,340.00 $9,340.00 $275.00 $9,902.00 $3,248.00 2026-07-06
92960 CPT 92960 Cardioversion Charge 16 12 $1,911.00 $1,911.00 $215.00 $2,026.00 $1,815.00 2026-07-06
93306 CPT 93306 2d Echo Complete Tech Fee 16 12 $2,710.00 $2,710.00 $395.00 $2,873.00 $2,575.00 2026-07-06
94002 CPT 94002 Ventilator Mgmt Initial Day 16 12 $1,858.00 $1,858.00 $182.00 $1,970.00 $1,765.00 2026-07-06
94617 CPT 94617 Exercise Test For Bronchospasm Charge 16 12 $7,968.00 $7,968.00 $179.00 $8,448.00 $7,570.00 2026-07-06
95811 CPT 95811 Psg/split Charge 16 12 $5,627.00 $5,627.00 $1,217.00 $5,966.00 $5,346.00 2026-07-06
A0433 HCPCS A0433 Als 2 Techfee 15 12 $1,825.00 $1,825.00 $635.00 $1,789.00 $1,734.00 2026-07-06
Q4159 HCPCS Affinity (2.5x2.5) 6.25sq Cm 14 12 $6,345.00 $6,345.00 $282.00 $6,218.00 $6,028.00 2026-07-06
80330209 CDM Alteplase 100 Mg IV Inj[bchc] 14 11 $25,712.00 $25,712.00 $8,940.00 $25,198.00 $24,670.50 2026-07-06
175608572 CDM Alteplase 50 Mg Pow[bchc] 14 11 $12,881.00 $12,881.00 $4,479.00 $12,623.00 $12,359.50 2026-07-06
84182 CPT Amphiphysin Wb, Ser Unmc 16 12 $1,933.00 $1,933.00 $33.00 $1,894.00 $1,836.00 2026-07-06
Q4101 HCPCS Apligraf 14 12 $3,626.00 $3,626.00 $36.00 $3,553.00 $3,445.00 2026-07-06
3854095 CDM Audeo Infinio I90 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3854091 CDM Audeo Infinio Sphere I90 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3854078 CDM Audeo P90-r 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3700010 CDM Bchc Labor And Delivery Charges 15 12 $3,650.00 $3,650.00 $1,269.00 $3,577.00 $3,468.00 2026-07-06
88374 CPT Bill Only Ap 88374 Comp Asst Morphomet Mult Prob 16 12 $2,660.00 $2,660.00 $557.00 $2,607.00 $2,527.00 2026-07-06
43239 CPT Biopsy Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 14 12 $6,734.00 $6,734.00 $325.00 $7,139.00 $6,461.00 2026-07-06
45380 CPT Biopsy Exam Of Large Bowel Using An Endoscope 14 12 $5,739.00 $5,739.00 $472.00 $6,084.00 $5,506.50 2026-07-06
55700 CPT Biopsy Of Prostate Gland 14 12 $4,608.00 $4,608.00 $306.00 $4,885.00 $4,421.50 2026-07-06
C9359 HCPCS Bone Matrix Cellular V92 2.5cc 15 12 $6,228.00 $6,228.00 $2,165.00 $6,103.00 $5,917.00 2026-07-06
80335015 CDM Calcitonin 200 Intl Units/ml Inj Sol[bchc] 14 11 $2,921.00 $2,921.00 $1,016.00 $2,863.00 $2,802.50 2026-07-06
194126446 CDM Capsaicin Topical 8% Kit (4 Patches) [Bchc] 14 11 $9,878.00 $9,878.00 $3,435.00 $9,680.00 $9,478.00 2026-07-06
C1729 HCPCS Cathpleurx Peritoneal Starter Kit 30 12 $2,733.50 $2,733.50 $937.00 $2,718.00 $2,634.00 2026-07-06
74178 CPT CT Abdomen And Pelvis With + Without Contrast 16 12 $6,773.00 $6,773.00 $802.00 $7,065.00 $6,434.00 2026-07-06
74176 CPT CT Abdomen And Pelvis Without Contrast 16 12 $5,088.00 $5,088.00 $449.00 $5,307.00 $4,834.00 2026-07-06
74170 CPT CT Abdomen With + Without Contrast 16 12 $3,775.00 $3,775.00 $599.00 $3,938.00 $3,586.00 2026-07-06
74160 CPT CT Abdomen With Contrast 16 12 $3,279.00 $3,279.00 $531.00 $3,420.00 $3,115.00 2026-07-06
74150 CPT CT Abdomen Without Contrast 16 12 $2,990.00 $2,990.00 $335.00 $3,119.00 $2,841.00 2026-07-06
74175 CPT CT Angio Abdomen 16 12 $4,098.00 $4,098.00 $646.00 $4,275.00 $3,893.00 2026-07-06
74174 CPT CT Angio Abdomen And Pelvis 16 12 $6,270.00 $6,270.00 $882.00 $6,540.00 $5,957.00 2026-07-06
75635 CPT CT Angio Abdomen Aorta + Iliofemoral 16 12 $4,395.00 $4,395.00 $711.00 $4,584.00 $4,175.00 2026-07-06
70496 CPT CT Angio Brain/head 16 12 $3,814.00 $3,814.00 $640.00 $3,978.00 $3,623.00 2026-07-06
71275 CPT CT Angio Chest 16 12 $4,180.00 $4,180.00 $648.00 $4,360.00 $3,971.00 2026-07-06
70471 CPT CT Angio Head/neck 16 12 $6,250.00 $6,250.00 $2,173.00 $6,519.00 $5,997.00 2026-07-06
73706 CPT CT Angio Lower Extremity Left 16 12 $4,121.00 $4,121.00 $654.00 $4,299.00 $3,915.00 2026-07-06
70498 CPT CT Angio Neck 16 12 $3,810.00 $3,810.00 $640.00 $3,974.00 $3,620.00 2026-07-06
70470 CPT CT Brain/head With + Without Contrast 16 12 $3,275.00 $3,275.00 $427.00 $3,416.00 $3,111.00 2026-07-06
70460 CPT CT Brain/head With Contrast 16 12 $2,873.00 $2,873.00 $365.00 $2,997.00 $2,729.00 2026-07-06
71270 CPT CT Chest With + Without Contrast 16 12 $3,819.00 $3,819.00 $519.00 $3,984.00 $3,628.00 2026-07-06
71260 CPT CT Chest With Contrast 16 12 $3,152.00 $3,152.00 $438.00 $3,288.00 $2,994.00 2026-07-06
71250 CPT CT Chest Without Contrast 16 12 $2,902.00 $2,902.00 $354.00 $3,027.00 $2,757.00 2026-07-06
70482 CPT CT Iac With + Without Contrast 31 12 $3,100.00 $3,100.00 $605.00 $3,234.00 $2,943.00 2026-07-06
70481 CPT CT Iac With Contrast 16 12 $3,355.00 $3,355.00 $598.00 $3,500.00 $3,187.00 2026-07-06
73701 CPT CT Lower Extremity With Contrast Left 16 12 $3,154.00 $3,154.00 $502.00 $3,290.00 $2,996.00 2026-07-06
73702 CPT CT Lower Extremity W/+without Contrast Left 16 12 $3,826.00 $3,826.00 $578.00 $3,991.00 $3,635.00 2026-07-06
73700 CPT CT Lower Extremity Without Contrast Left 16 12 $2,806.00 $2,806.00 $360.00 $2,927.00 $2,666.00 2026-07-06
70488 CPT CT Maxillofacial With + Without Contrast 16 12 $3,190.00 $3,190.00 $454.00 $3,327.00 $3,031.00 2026-07-06
70487 CPT CT Maxillofacial With Contrast 16 12 $2,814.00 $2,814.00 $373.00 $2,935.00 $2,673.00 2026-07-06
70486 CPT CT Maxillofacial Without Contrast 16 12 $2,374.00 $2,374.00 $310.00 $2,476.00 $2,255.00 2026-07-06
70492 CPT CT Neck Soft Tissue With + Without Contrast 16 12 $3,445.00 $3,445.00 $545.00 $3,593.00 $3,273.00 2026-07-06
70491 CPT CT Neck Soft Tissue With Contrast 16 12 $3,012.00 $3,012.00 $452.00 $3,142.00 $2,861.00 2026-07-06
70490 CPT CT Neck Soft Tissue Without Contrast 16 12 $2,625.00 $2,625.00 $368.00 $2,738.00 $2,494.00 2026-07-06
70480 CPT CT Orbits Sella Without Contrast 31 12 $2,981.00 $2,981.00 $393.00 $3,109.00 $2,644.00 2026-07-06
72194 CPT CT Pelvis With + Without Contrast 16 12 $3,649.00 $3,649.00 $578.00 $3,806.00 $3,467.00 2026-07-06
72192 CPT CT Pelvis Without Contrast 16 12 $2,940.00 $2,940.00 $325.00 $3,067.00 $2,793.00 2026-07-06
70450 CPT CT Scan 16 12 $2,542.00 $2,542.00 $258.00 $2,652.00 $2,415.00 2026-07-06
74177 CPT CT Scan Of Abdomen And Pelvis With Contrast 16 12 $5,841.00 $5,841.00 $711.00 $6,093.00 $5,549.00 2026-07-06
72193 CPT CT Scan Of Pelvis With Contrast 16 12 $3,346.00 $3,346.00 $520.00 $3,490.00 $3,179.00 2026-07-06
72126 CPT CT Spine Cervical With Contrast 16 12 $3,711.00 $3,711.00 $506.00 $3,871.00 $3,525.00 2026-07-06
72125 CPT CT Spine Cervical Without Contrast 16 12 $2,995.00 $2,995.00 $367.00 $3,124.00 $2,845.00 2026-07-06
72133 CPT CT Spine Lumbar With + Without Contrast 16 12 $3,180.00 $3,180.00 $584.00 $3,317.00 $3,021.00 2026-07-06
72132 CPT CT Spine Lumbar With Contrast 16 12 $3,304.00 $3,304.00 $506.00 $3,446.00 $3,139.00 2026-07-06
72131 CPT CT Spine Lumbar Without Contrast 16 12 $2,908.00 $2,908.00 $360.00 $3,033.00 $2,763.00 2026-07-06
72130 CPT CT Spine Thoracic With + Without Contrast 16 12 $3,250.00 $3,250.00 $584.00 $3,390.00 $3,088.00 2026-07-06
72129 CPT CT Spine Thoracic With Contrast 16 12 $2,960.00 $2,960.00 $509.00 $3,088.00 $2,812.00 2026-07-06
72128 CPT CT Spine Thoracic Without Contrast 16 12 $2,995.00 $2,995.00 $360.00 $3,124.00 $2,845.00 2026-07-06
73201 CPT CT Upper Extremity With Contrast Left 16 12 $2,883.00 $2,883.00 $496.00 $3,007.00 $2,739.00 2026-07-06
73202 CPT CT Upper Extremity W/+without Contrast Left 16 12 $3,386.00 $3,386.00 $579.00 $3,532.00 $3,217.00 2026-07-06
73200 CPT CT Upper Extremity Without Contrast Left 16 12 $2,625.00 $2,625.00 $360.00 $2,738.00 $2,494.00 2026-07-06
3854007 CDM D Moxi Fit 9 Xs Xm Xp 15 12 $1,838.00 $1,838.00 $639.00 $1,801.00 $1,746.00 2026-07-06
3854008 CDM D Moxi Fit 9 Xup 15 12 $1,838.00 $1,838.00 $639.00 $1,801.00 $1,746.00 2026-07-06
3854009 CDM D Moxi Jump R 9 Xs Xm Xp 15 12 $1,838.00 $1,838.00 $639.00 $1,801.00 $1,746.00 2026-07-06
3854010 CDM D Moxi Jump R 9 Xup 15 12 $1,838.00 $1,838.00 $639.00 $1,801.00 $1,746.00 2026-07-06
3854005 CDM D Moxi Jump R T 9 15 12 $1,838.00 $1,838.00 $639.00 $1,801.00 $1,746.00 2026-07-06
3854006 CDM D Stride P R 9 15 12 $1,838.00 $1,838.00 $639.00 $1,801.00 $1,746.00 2026-07-06
189961396 CDM Dantrolene 250 Mg Pow[bchc] 14 11 $7,137.00 $7,137.00 $2,482.00 $6,994.00 $6,848.00 2026-07-06
98528315 CDM Darbepoetin Alfa 100 Mcg/ml Sol 14 11 $2,294.00 $2,294.00 $798.00 $2,248.00 $2,201.00 2026-07-06
183567832 CDM Darbepoetin Alfa 300 Mcg/0.6 Ml Sol [Bchc] 14 11 $8,331.00 $8,331.00 $2,897.00 $8,164.00 $7,993.50 2026-07-06
80369449 CDM Denosumab 120 Mg/1.7 Ml[bchc] 14 11 $7,428.00 $7,428.00 $2,583.00 $7,279.00 $7,127.50 2026-07-06
80369513 CDM Denosumab 60 Mg/ml[bchc] 14 11 $4,046.00 $4,046.00 $1,407.00 $3,965.00 $3,882.50 2026-07-06
43235 CPT Diagnostic Exam Of Esophagus, Stomach Or Small Bowel Using An Endoscope 14 12 $6,734.00 $6,734.00 $287.00 $7,139.00 $6,461.00 2026-07-06
45378 CPT Diagnostic Exam Of Large Bowel Using An Endoscope 14 12 $4,673.00 $4,673.00 $433.00 $4,954.00 $4,483.50 2026-07-06
3854001 CDM Dx Moxi Fit 9 15 12 $1,838.00 $1,838.00 $639.00 $1,801.00 $1,746.00 2026-07-06
3854000 CDM Dx Moxi Jump R T 9 15 12 $1,838.00 $1,838.00 $639.00 $1,801.00 $1,746.00 2026-07-06
3854002 CDM Dx Moxi Move R 9 15 12 $1,838.00 $1,838.00 $639.00 $1,801.00 $1,746.00 2026-07-06
3854003 CDM Dx Moxi Stride P R 9 15 12 $1,838.00 $1,838.00 $639.00 $1,801.00 $1,746.00 2026-07-06
3854004 CDM Dx Stride M9 15 12 $1,838.00 $1,838.00 $639.00 $1,801.00 $1,746.00 2026-07-06
P9037 HCPCS E3046 Aph Plt Acda Lr Irr 15 12 $2,365.00 $2,365.00 $822.00 $2,318.00 $2,247.00 2026-07-06
4120011 CDM Encephalopathy, Csf Unmc 15 12 $1,866.00 $1,866.00 $713.00 $1,829.00 $1,773.00 2026-07-06
3856000 CDM Enolv Al 2400 Standard R Wireless 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3853015 CDM Enzo 3d 9 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
Q4186 HCPCS Epifix 7cm X 7cm 79 12 $7,039.00 $7,039.00 $180.00 $22,141.00 $5,384.00 2026-07-06
80369575 CDM Epoetin Alfa 40,000 Units/ml Preservative-free[bchc] 14 11 $2,314.00 $2,314.00 $805.00 $2,268.00 $2,220.00 2026-07-06
136322188 CDM Eptinezumab Jjmr 100 Mg/ml Sol [Bchc] 14 11 $3,983.00 $3,983.00 $1,385.00 $3,903.00 $3,822.00 2026-07-06
171554621 CDM Etanercept 50 Mg/ml Sol [Bchc] 14 11 $2,441.00 $2,441.00 $849.00 $2,392.00 $2,342.00 2026-07-06
64633 CPT Fac Fee, Destruction By Neurolytic Agent Cer 29 12 $5,870.00 $5,870.00 $162.00 $6,223.00 $2,041.00 2026-07-06
64635 CPT Fac Fee, Destruction By Neurolytic Agent Lum 29 12 $5,900.00 $5,900.00 $163.00 $6,255.00 $2,051.00 2026-07-06
63650 CPT Fac Fee, Implant Neuroelectrodes 29 12 $12,315.00 $12,315.00 $350.00 $13,056.00 $4,282.00 2026-07-06
63685 CPT Fac Fee, Ins/rplc Spi Npg/rcvr Pocket 29 12 $11,030.00 $11,030.00 $288.00 $11,694.00 $3,835.00 2026-07-06
82035264 CDM Ferric Carboxymaltose (As Elemental Iron) 50 Mg/ml Sol [Bchc] 14 11 $4,289.00 $4,289.00 $1,491.00 $4,203.00 $4,115.50 2026-07-06
167806115 CDM Filgrastim 300 Mcg/0.5 Ml Sol [Bchc] 14 11 $1,980.00 $1,980.00 $688.00 $1,940.00 $1,900.00 2026-07-06
165500816 CDM Filgrastim 480 Mcg/0.8 Ml Sol [Bchc] 14 11 $1,971.00 $1,971.00 $685.00 $1,932.00 $1,891.00 2026-07-06
C1820 HCPCS Generator Prospera Ipg 15 12 $37,950.00 $37,950.00 $13,195.00 $37,191.00 $36,053.00 2026-07-06
3856078 CDM Genesis Ai 24 Cic Nw 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3856079 CDM Genesis Ai 24 Itc R 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3856075 CDM Genesis Ai24 Ric Rt 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3611907 CDM Graft Spreader 15 12 $1,875.00 $1,875.00 $652.00 $1,838.00 $1,781.00 2026-07-06
CDM CDM Guided Release Inst Sn20 15 12 $2,538.00 $2,538.00 $882.00 $2,487.00 $2,411.00 2026-07-06
3856025 CDM Halo 2 I2400 15 12 $1,898.00 $1,898.00 $660.00 $1,860.00 $1,803.00 2026-07-06
3856026 CDM Halo I 110 15 12 $1,898.00 $1,898.00 $660.00 $1,860.00 $1,803.00 2026-07-06
3856024 CDM Halo Iq I2400 15 12 $1,938.00 $1,938.00 $674.00 $1,899.00 $1,841.00 2026-07-06
80372700 CDM Hydroxocobalamin 5 G Pow [Bchc] 14 11 $2,797.00 $2,797.00 $973.00 $2,741.00 $2,683.50 2026-07-06
80369831 CDM Hylan G-f 20 48 Mg/6 Ml[bchc] 14 11 $2,960.00 $2,960.00 $1,029.00 $2,901.00 $2,840.00 2026-07-06
199844864 CDM Immune Globulin Intravenous 10g 10% Sol [Bchc] 14 11 $5,813.00 $5,813.00 $2,021.00 $5,697.00 $5,577.50 2026-07-06
199846757 CDM Immune Globulin Intravenous 40g 10% Sol [Bchc] 14 11 $23,100.00 $23,100.00 $8,032.00 $22,638.00 $22,164.50 2026-07-06
C1776 HCPCS Impl Aesculap Obturator Screw 720 12 $3,239.50 $3,239.50 $3.00 $37,037.00 $2,949.00 2026-07-06
Q4125 HCPCS Impl Arth Arthoflex Biowasher 10x14x2.0 45 12 $1,980.00 $1,980.00 $343.00 $3,265.00 $1,881.00 2026-07-06
L8699 HCPCS Impl Dynanite Pip Ar-4158ds 30 12 $4,277.00 $4,277.00 $1,196.00 $5,013.00 $3,370.00 2026-07-06
C1826 HCPCS Impl Inceptiv Ins 15 12 $35,063.00 $35,063.00 $12,191.00 $34,362.00 $33,310.00 2026-07-06
3612415 CDM Impl Lapidus Wedge 15 12 $4,868.00 $4,868.00 $1,693.00 $4,771.00 $4,625.00 2026-07-06
3610014 CDM Impl Lapiplasty System 2 Sk14 15 12 $15,989.00 $15,989.00 $5,559.00 $15,669.00 $15,190.00 2026-07-06
3610039 CDM Impl Lapiplasty System 4 Sk39 15 12 $16,304.00 $16,304.00 $5,669.00 $15,978.00 $15,489.00 2026-07-06
C1778 HCPCS Impl Lead 5mm 1x8 MRI 105 12 $7,890.00 $7,890.00 $516.00 $24,255.00 $7,496.00 2026-07-06
3611401 CDM Impl Meteric Superstaple 21401 15 12 $3,630.00 $3,630.00 $1,262.00 $3,557.00 $3,449.00 2026-07-06
3611110 CDM Impl Synth Speed Implant 11x10x10 (se-1110) 15 12 $3,067.00 $3,067.00 $1,066.00 $3,006.00 $2,914.00 2026-07-06
3611108 CDM Impl Synth Speed Implant 11x8x8 (se-1108) 15 12 $3,067.00 $3,067.00 $1,066.00 $3,006.00 $2,914.00 2026-07-06
3619021 CDM Impl Tissuetak Tendon Anchor 15 12 $2,407.00 $2,407.00 $837.00 $2,359.00 $2,287.00 2026-07-06
186778302 CDM Inclisiran 284 Mg/1.5 Ml (Leqvio) Sol [Bchc] 14 11 $7,264.00 $7,264.00 $2,526.00 $7,119.00 $6,970.00 2026-07-06
80347475 CDM Infliximab 100 Mg IV Inj[bchc] 14 11 $3,455.00 $3,455.00 $1,201.00 $3,386.00 $3,315.00 2026-07-06
149964582 CDM Infliximab Dyyb 100 Mg Pow [Bchc] 14 11 $2,528.00 $2,528.00 $879.00 $2,477.00 $2,426.00 2026-07-06
64483 CPT Injection(s) Of Anesthetic Into Lower Spine Using Imaging Guidance 42 12 $3,470.00 $3,470.00 $94.00 $4,030.00 $3,297.00 2026-07-06
62323 CPT Injection(s) Of Therapeutic Substance 42 12 $2,730.00 $2,730.00 $84.00 $3,354.00 $2,594.00 2026-07-06
3858018 CDM Intent 1 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
C1767 HCPCS Interstim, Neurostimulatorfull Implant 30 12 $14,287.50 $14,287.50 $1,422.00 $23,995.00 $6,260.50 2026-07-06
59899 CPT Jada System 16 12 $4,060.00 $4,060.00 $1,128.00 $4,304.00 $3,857.00 2026-07-06
86711 CPT Jcv Ab, Stratify Unmc 16 12 $3,027.00 $3,027.00 $31.00 $2,966.00 $2,876.00 2026-07-06
3700011 CDM Labor Service Only Charge 15 12 $1,950.00 $1,950.00 $678.00 $1,911.00 $1,853.00 2026-07-06
94556898 CDM Leuprolide 22.5 Mg/3 Mon (Eligard) Pow [Bchc] 14 11 $2,929.00 $2,929.00 $1,018.00 $2,870.00 $2,810.50 2026-07-06
80348683 CDM Leuprolide 22.5 Mg/3 Mon (Lupron) Kit [Bchc] 14 11 $13,849.00 $13,849.00 $4,815.00 $13,572.00 $13,288.50 2026-07-06
3853018 CDM Linx 3d 9 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3856018 CDM Livio 2400 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3856016 CDM Livio 2400 Custom Chargeable 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3856017 CDM Livio 2400 Rechargable 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3856003 CDM Livio Edge Ai 2400 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3856001 CDM Livio Edge Ai 2400 Custom Rechargeable 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3856002 CDM Livio Edge Ai 2400 Standard Rechargeable 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3853010 CDM Lnx Quattro 9 Non-rechargable Custom 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3854080 CDM Lumity 90-r Ric 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
CP17833751143591268 CDM Major Joint Replacement Or Reattachment Of Lower Extremity Without Mcc 11 10 $53,437.00 $53,437.00 $50,765.00 $52,368.00 $51,780.00 2026-07-06
186363310 CDM Mepolizumab 100 Mg Pow[bchc] 14 11 $7,757.00 $7,757.00 $2,697.00 $7,602.00 $7,443.00 2026-07-06
19281 CPT Mg Device Plcmnt With Mammo Guide Left 16 12 $2,057.00 $2,057.00 $238.00 $2,181.00 $1,954.00 2026-07-06
161060113 CDM Micafungin 100 Mg / 100 Ml Soln-IV [Bchc] 14 11 $2,821.00 $2,821.00 $981.00 $2,765.00 $2,707.00 2026-07-06
3852066 CDM Moment 440 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3852001 CDM Moment 440 (All Other Forms) 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3852067 CDM Moment 440 Mric R D 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3852000 CDM Moment Mric R 312 D 440 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3858000 CDM More 1 Minirite/minibte-r 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3858001 CDM More 1 Minirite/minibte-t 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
76498 CPT Mr Unlisted Procedure 16 12 $5,206.00 $5,206.00 $204.00 $5,430.00 $4,946.00 2026-07-06
74185 CPT MRA Abdomen With + Without Contrast 16 12 $5,780.00 $5,780.00 $878.00 $6,029.00 $5,491.00 2026-07-06
70546 CPT MRA Brain/head With + Without Contrast 16 12 $7,256.00 $7,256.00 $905.00 $7,569.00 $6,893.00 2026-07-06
70545 CPT MRA Brain/head With Contrast 16 12 $6,695.00 $6,695.00 $613.00 $6,984.00 $6,360.00 2026-07-06
70544 CPT MRA Brain/head Without Contrast 16 12 $4,129.00 $4,129.00 $617.00 $4,307.00 $3,923.00 2026-07-06
70549 CPT MRA Neck With + Without Contrast 16 12 $4,941.00 $4,941.00 $947.00 $5,154.00 $4,694.00 2026-07-06
70548 CPT MRA Neck With Contrast 16 12 $3,771.00 $3,771.00 $683.00 $3,934.00 $3,582.00 2026-07-06
70547 CPT MRA Neck Without Contrast 16 12 $3,720.00 $3,720.00 $620.00 $3,880.00 $3,534.00 2026-07-06
74183 CPT MRI Abdomen With + Without Contrast 16 12 $5,125.00 $5,125.00 $889.00 $5,346.00 $4,869.00 2026-07-06
74181 CPT MRI Abdomen Without Contrast 16 12 $3,922.00 $3,922.00 $544.00 $4,091.00 $3,726.00 2026-07-06
70552 CPT MRI Brain With Contrast 16 12 $4,691.00 $4,691.00 $700.00 $4,893.00 $4,456.00 2026-07-06
70551 CPT MRI Brain Without Contrast 16 12 $4,324.00 $4,324.00 $505.00 $4,510.00 $4,108.00 2026-07-06
71552 CPT MRI Chest With + Without Contrast 16 12 $4,557.00 $4,557.00 $1,097.00 $4,753.00 $4,329.00 2026-07-06
71551 CPT MRI Chest With Contrast 16 12 $5,579.00 $5,579.00 $994.00 $5,819.00 $5,300.00 2026-07-06
71550 CPT MRI Chest Without Contrast 16 12 $4,398.00 $4,398.00 $668.00 $4,588.00 $4,178.00 2026-07-06
70543 CPT MRI Face Neck Orbit With + Without Contrast 16 12 $4,648.00 $4,648.00 $882.00 $4,848.00 $4,416.00 2026-07-06
70542 CPT MRI Face Neck Orbit With Contrast 16 12 $5,487.00 $5,487.00 $702.00 $5,723.00 $5,213.00 2026-07-06
70540 CPT MRI Face Neck Orbit Without Contrast 16 12 $3,922.00 $3,922.00 $590.00 $4,091.00 $3,726.00 2026-07-06
73723 CPT MRI Le Joint With + Without Contrast Left 16 12 $4,163.00 $4,163.00 $1,022.00 $4,342.00 $3,955.00 2026-07-06
73720 CPT MRI Lower Extremity With + Without Cnt Left 16 12 $4,044.00 $4,044.00 $886.00 $4,218.00 $3,842.00 2026-07-06
73718 CPT MRI Lower Extremity Without Contrast Left 16 12 $3,626.00 $3,626.00 $583.00 $3,782.00 $3,445.00 2026-07-06
72197 CPT MRI Pelvis With + Without Contrast 16 12 $5,123.00 $5,123.00 $888.00 $5,344.00 $4,867.00 2026-07-06
72196 CPT MRI Pelvis With Contrast 16 12 $4,468.00 $4,468.00 $703.00 $4,661.00 $4,245.00 2026-07-06
72195 CPT MRI Pelvis Without Contrast 16 12 $3,768.00 $3,768.00 $602.00 $3,930.00 $3,580.00 2026-07-06
70553 CPT MRI Scan 16 12 $4,913.00 $4,913.00 $827.00 $5,125.00 $4,667.00 2026-07-06
73721 CPT MRI Scan Of Leg Joint 16 12 $3,118.00 $3,118.00 $519.00 $3,252.00 $2,962.00 2026-07-06
72148 CPT MRI Scan Of Lower Spinal Canal 16 12 $4,141.00 $4,141.00 $493.00 $4,319.00 $3,934.00 2026-07-06
72156 CPT MRI Spine Cervical With + Without Contrast 16 12 $5,201.00 $5,201.00 $832.00 $5,425.00 $4,941.00 2026-07-06
72142 CPT MRI Spine Cervical With Contrast 16 12 $4,505.00 $4,505.00 $713.00 $4,699.00 $4,280.00 2026-07-06
72141 CPT MRI Spine Cervical Without Contrast 16 12 $4,277.00 $4,277.00 $492.00 $4,461.00 $4,063.00 2026-07-06
72158 CPT MRI Spine Lumbar With + Without Contrast 16 12 $5,057.00 $5,057.00 $831.00 $5,275.00 $4,804.00 2026-07-06
72149 CPT MRI Spine Lumbar With Contrast 16 12 $5,475.00 $5,475.00 $704.00 $5,711.00 $5,201.00 2026-07-06
72157 CPT MRI Spine Thoracic With + Without Contrast 16 12 $5,186.00 $5,186.00 $835.00 $5,410.00 $4,927.00 2026-07-06
72147 CPT MRI Spine Thoracic With Contrast 16 12 $5,194.00 $5,194.00 $709.00 $5,418.00 $4,934.00 2026-07-06
72146 CPT MRI Spine Thoracic Without Contrast 16 12 $4,304.00 $4,304.00 $493.00 $4,490.00 $4,089.00 2026-07-06
70336 CPT MRI Tmj 16 12 $4,090.00 $4,090.00 $670.00 $4,266.00 $3,886.00 2026-07-06
73223 CPT MRI Ue Joint With + Without Contrast Left 16 12 $4,570.00 $4,570.00 $1,025.00 $4,767.00 $4,342.00 2026-07-06
73221 CPT MRI Ue Joint Without Contrast Lt 16 12 $3,078.00 $3,078.00 $519.00 $3,211.00 $2,924.00 2026-07-06
73220 CPT MRI Upper Extremity With + Without Cnt Left 16 12 $4,270.00 $4,270.00 $1,084.00 $4,454.00 $4,057.00 2026-07-06
73218 CPT MRI Upper Extremity Without Contrast Left 16 12 $3,488.00 $3,488.00 $656.00 $3,638.00 $3,314.00 2026-07-06
3856031 CDM Muse I2400 Cic 15 12 $1,898.00 $1,898.00 $660.00 $1,860.00 $1,803.00 2026-07-06
3856032 CDM Muse I2400 Custom 15 12 $1,898.00 $1,898.00 $660.00 $1,860.00 $1,803.00 2026-07-06
3856033 CDM Muse I2400 Standard 15 12 $1,938.00 $1,938.00 $674.00 $1,899.00 $1,841.00 2026-07-06
3856052 CDM Muse Iq I2000 Rechargable 15 12 $1,938.00 $1,938.00 $674.00 $1,899.00 $1,841.00 2026-07-06
3856028 CDM Muse Iq I2400 Cic 15 12 $1,938.00 $1,938.00 $674.00 $1,899.00 $1,841.00 2026-07-06
3856029 CDM Muse Iq I2400 Custom 15 12 $1,938.00 $1,938.00 $674.00 $1,899.00 $1,841.00 2026-07-06
3856027 CDM Muse Iq I2400 Rechargeable 15 12 $2,238.00 $2,238.00 $778.00 $2,193.00 $2,126.00 2026-07-06
3856030 CDM Muse Iq I2400 Standard 15 12 $1,938.00 $1,938.00 $674.00 $1,899.00 $1,841.00 2026-07-06
191082722 CDM Naltrexone 380 Mg Pow[bchc] 14 11 $3,649.00 $3,649.00 $1,269.00 $3,576.00 $3,501.50 2026-07-06
78305 CPT Nm Bone Imaging Multiple Areas 16 12 $2,768.00 $2,768.00 $634.00 $2,887.00 $2,630.00 2026-07-06
78306 CPT Nm Bone Imaging Whole Body 16 12 $2,197.00 $2,197.00 $684.00 $2,292.00 $2,087.00 2026-07-06
78803 CPT Nm Bone Spect 16 12 $2,827.00 $2,827.00 $770.00 $2,949.00 $2,686.00 2026-07-06
78315 CPT Nm Bone Three Phase Study 16 12 $2,750.00 $2,750.00 $783.00 $2,869.00 $2,613.00 2026-07-06
78472 CPT Nm Cardiac Muga 16 12 $2,452.00 $2,452.00 $519.00 $2,558.00 $2,329.00 2026-07-06
78264 CPT Nm Gastric Emptying Study 16 12 $2,376.00 $2,376.00 $756.00 $2,478.00 $2,257.00 2026-07-06
78278 CPT Nm Gastrointestinal Blood Loss Imaging 16 12 $2,619.00 $2,619.00 $789.00 $2,732.00 $2,488.00 2026-07-06
78226 CPT Nm Hepatobiliary Imaging 16 12 $2,428.00 $2,428.00 $746.00 $2,533.00 $2,307.00 2026-07-06
78290 CPT Nm Intestine Imaging Meckels 16 12 $2,835.00 $2,835.00 $746.00 $2,957.00 $2,693.00 2026-07-06
78709 CPT Nm Kidney Imaging Multiple W/+without Pharm 16 12 $2,292.00 $2,292.00 $797.00 $2,391.00 $2,177.00 2026-07-06
78708 CPT Nm Kidney Imaging Single With Pharm 16 12 $2,027.00 $2,027.00 $402.00 $2,114.00 $1,926.00 2026-07-06
78707 CPT Nm Kidney Imaging Single Without Pharm 16 12 $2,466.00 $2,466.00 $526.00 $2,572.00 $2,343.00 2026-07-06
78215 CPT Nm Liver/spleen Imaging 16 12 $2,274.00 $2,274.00 $439.00 $2,372.00 $2,160.00 2026-07-06
78216 CPT Nm Liver/spleen Imaging With Vascular Flow 16 12 $2,619.00 $2,619.00 $289.00 $2,732.00 $2,488.00 2026-07-06
78195 CPT Nm Lymphoscintigraphy 16 12 $2,246.00 $2,246.00 $781.00 $2,343.00 $2,134.00 2026-07-06
78451 CPT Nm PET Myocardial Perf Single Study 16 12 $4,837.00 $4,837.00 $769.00 $5,045.00 $4,595.00 2026-07-06
Q4160 HCPCS Nushield 3x4 12 Sq Cm 40 12 $2,385.00 $2,385.00 $453.00 $3,842.00 $2,266.00 2026-07-06
162525522 CDM Ocrelizumab 300 Mg/10 Ml Sol [Bchc] 14 11 $42,364.00 $42,364.00 $14,730.00 $41,517.00 $40,648.50 2026-07-06
80356507 CDM Omalizumab 150 Mg Subq Inj[bchc] 14 11 $3,060.00 $3,060.00 $1,064.00 $2,999.00 $2,936.00 2026-07-06
3852999 CDM Omnia 9 Rechargeable 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
150010021 CDM Onabotulinumtoxina 100 Units Pow[bchc] 14 11 $1,932.00 $1,932.00 $672.00 $1,893.00 $1,853.50 2026-07-06
155469325 CDM Onabotulinumtoxina 200 Units Pow[bchc] 14 11 $2,815.00 $2,815.00 $979.00 $2,759.00 $2,701.00 2026-07-06
3853001 CDM One 9 Non-rechargeable 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3853000 CDM One 9 Rechargeable 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3858006 CDM Opn Play 1 Minirite,minirite-t, Btepp 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
80370739 CDM Oritavancin 400 Mg Pow[bchc] 14 11 $2,094.00 $2,094.00 $728.00 $2,052.00 $2,009.00 2026-07-06
3858014 CDM Oticon Real 1 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
112052499 CDM Paliperidone 156 Mg/ml Sus[bchc] 14 11 $5,129.00 $5,129.00 $1,783.00 $5,026.00 $4,921.50 2026-07-06
80357449 CDM Palivizumab 100 Mg/ml IM Sol [Bchc] 14 11 $6,399.00 $6,399.00 $2,225.00 $6,271.00 $6,140.00 2026-07-06
80357507 CDM Palivizumab 50 Mg/0.5 Ml IM Sol [Bchc] 14 11 $3,397.00 $3,397.00 $1,181.00 $3,329.00 $3,259.50 2026-07-06
C1787 HCPCS Patient Programmer 45 12 $5,200.00 $5,200.00 $1,217.00 $5,297.00 $4,940.00 2026-07-06
80357877 CDM Pegfilgrastim 6 Mg/0.6 Ml Subq Inj[bchc] 14 11 $13,804.00 $13,804.00 $4,800.00 $13,528.00 $13,245.00 2026-07-06
118054648 CDM Pegfilgrastim Bmez 6 Mg/0.6 Ml Sol [Bchc] 14 11 $8,450.00 $8,450.00 $2,938.00 $8,281.00 $8,108.00 2026-07-06
161275755 CDM Pegfilgrastim Cbqv 6 Mg/0.6 Ml Sol [Bchc] 14 11 $8,986.00 $8,986.00 $3,124.00 $8,806.00 $8,622.00 2026-07-06
140058861 CDM Pegfilgrastim Jmdb 6 Mg/0.6 Ml Sol[bchc] 14 11 $8,986.00 $8,986.00 $3,124.00 $8,806.00 $8,622.00 2026-07-06
145935648 CDM Pegfilgrastim Pbbk 6 Mg/0.6 Ml Sol[bchc] 14 11 $5,388.00 $5,388.00 $1,873.00 $5,280.00 $5,170.00 2026-07-06
150010371 CDM Penicillin G Benzathine La 2,400,000 Units/4 Ml Sus[bchc] 14 11 $2,241.00 $2,241.00 $779.00 $2,196.00 $2,150.50 2026-07-06
3854087 CDM Phonak Audeo L90-rt 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3854085 CDM Phonak L90-rl 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3854086 CDM Phonak Lumity 90 Slims 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3854088 CDM Phonak Naida L90-sp 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3856046 CDM Picasso 2000 Iic 15 12 $1,998.00 $1,998.00 $695.00 $1,958.00 $1,898.00 2026-07-06
3856044 CDM Picasso I2000 15 12 $1,998.00 $1,998.00 $695.00 $1,958.00 $1,898.00 2026-07-06
3856045 CDM Picasso I2000/2000 Cic 15 12 $1,998.00 $1,998.00 $695.00 $1,958.00 $1,898.00 2026-07-06
3856019 CDM Picasso I2400 Custom 15 12 $2,198.00 $2,198.00 $764.00 $2,154.00 $2,088.00 2026-07-06
3856020 CDM Picasso I2400/2400 Cic 15 12 $2,198.00 $2,198.00 $764.00 $2,154.00 $2,088.00 2026-07-06
3856021 CDM Picasso I2400/2400 Iic 15 12 $2,398.00 $2,398.00 $834.00 $2,350.00 $2,278.00 2026-07-06
189702355 CDM Prothrombin Complex 1000 Unit/vial Pow [Bchc] 14 11 $3,562.00 $3,562.00 $1,239.00 $3,491.00 $3,418.00 2026-07-06
Q4196 HCPCS Puraply Am 5x5 25 Sq Cm 53 12 $3,696.00 $3,696.00 $118.00 $6,334.00 $2,793.00 2026-07-06
Q4197 HCPCS Puraply Am Xt Ef (4.91x4.91) 24.1sq Cm 14 12 $8,813.00 $8,813.00 $85.00 $8,637.00 $8,372.00 2026-07-06
80361453 CDM Rabies Immune Globulin 150 Intl Units/ml 10 Ml[bchc] 14 11 $6,110.00 $6,110.00 $2,124.00 $5,988.00 $5,863.00 2026-07-06
80361513 CDM Rabies Immune Globulin 150 Intl Units/ml 2 Ml[bchc] 14 11 $1,962.00 $1,962.00 $682.00 $1,923.00 $1,882.50 2026-07-06
93646031 CDM Remdesivir 100 Mg Pow [Bchc] 14 11 $1,884.00 $1,884.00 $655.00 $1,846.00 $1,808.00 2026-07-06
47562 CPT Removal Of Gallbladder Using An Endoscope 14 12 $19,909.00 $19,909.00 $1,475.00 $21,108.00 $19,103.00 2026-07-06
29881 CPT Removal Of One Knee Cartilage Using An Endoscope 14 12 $15,583.00 $15,583.00 $1,226.00 $16,521.00 $14,952.00 2026-07-06
45385 CPT Removal Of Polyps Or Growths Of Large Bowel Using An Endoscope 14 12 $5,999.00 $5,999.00 $598.00 $6,360.00 $5,756.00 2026-07-06
42820 CPT Removal Of Tonsils And Adenoid Glands, Patient Younger Than Age 12 14 12 $12,517.00 $12,517.00 $664.00 $13,271.00 $12,010.00 2026-07-06
49505 CPT Repair Of Groin Hernia Patient Age 5 Years Or Older 14 12 $14,960.00 $14,960.00 $1,167.00 $15,861.00 $14,354.00 2026-07-06
3853045 CDM Resound Nexia 9 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
80362061 CDM Rituximab 10 Mg/ml IV Sol[bchc] 14 11 $10,108.00 $10,108.00 $3,515.00 $9,906.00 $9,699.00 2026-07-06
150032221 CDM Romiplostim 125 Mcg Pow[bchc] 14 11 $2,975.00 $2,975.00 $1,034.00 $2,916.00 $2,854.50 2026-07-06
195162970 CDM Romosozumab 210 Mg/ 2.34 Ml Sol [Bchc] 14 11 $5,665.00 $5,665.00 $1,970.00 $5,552.00 $5,435.50 2026-07-06
3100080 CDM Room/bed: Private 15 12 $2,815.00 $2,815.00 $1,605.00 $5,391.00 $2,759.00 2026-07-06
3150005 CDM Room/bed: Snf 15 12 $1,900.00 $1,900.00 $1,083.00 $5,391.00 $1,862.00 2026-07-06
113272831 CDM Ropivacaine 0.2% Sol 14 11 $2,114.00 $2,114.00 $735.00 $2,072.00 $2,028.00 2026-07-06
78452 CPT Rt Stress Test Myoview Charge 16 12 $5,118.00 $5,118.00 $1,069.00 $5,339.00 $4,862.00 2026-07-06
118766221 CDM Semaglutide 2 Mg/1.5 Ml (0.25 Mg Or 0.5 Mg Dose) Sol[bchc] 14 11 $2,161.00 $2,161.00 $751.00 $2,118.00 $2,073.50 2026-07-06
139316526 CDM Semaglutide 2 Mg/3 Ml (0.25 Mg Or 0.5 Mg Dose) Sol[bchc] 14 11 $2,161.00 $2,161.00 $751.00 $2,118.00 $2,073.50 2026-07-06
29826 CPT Shaving Of Shoulder Bone Using Endoscope 14 12 $28,069.00 $28,069.00 $398.00 $29,759.00 $26,932.50 2026-07-06
3859001 CDM Signia Pure C&g Bct 7ix 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3859003 CDM Signia Silk C&g 7ix 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
95810 CPT Sleep Study 16 12 $4,946.00 $4,946.00 $1,161.00 $5,244.00 $4,699.00 2026-07-06
112039853 CDM Sodium Hyaluronate 20 Mg/ml Sol[bchc] 14 11 $2,413.00 $2,413.00 $839.00 $2,365.00 $2,315.00 2026-07-06
3856149 CDM Starkey Signature Series 24 Cic R Nw 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3854012 CDM T Moxi Fit Now Pro 15 12 $1,838.00 $1,838.00 $639.00 $1,801.00 $1,746.00 2026-07-06
3854013 CDM T Stride M P P Dura Pro 15 12 $1,838.00 $1,838.00 $639.00 $1,801.00 $1,746.00 2026-07-06
197304306 CDM Tenecteplase 25 Mg Pow[bchc] 14 11 $18,375.00 $18,375.00 $6,389.00 $18,008.00 $17,630.50 2026-07-06
184545230 CDM Tenecteplase 50 Mg Pow [Bchc] 14 11 $17,841.00 $17,841.00 $6,203.00 $17,484.00 $17,118.50 2026-07-06
197383339 CDM Tezepelumab Ekko 210 Mg/1.91 Ml Sol[bchc] 14 11 $9,403.00 $9,403.00 $3,269.00 $9,215.00 $9,022.50 2026-07-06
81645957 CDM Thp Sodium Polystyrene Sulfonate 15 G/60 Ml Sus Ud(240ml)[bchc] 14 11 $4,320.00 $4,320.00 $1,502.00 $4,234.00 $4,145.00 2026-07-06
182130623 CDM Tocilizumab 20 Mg/ml Sol 200mg [Bchc] 14 11 $2,870.00 $2,870.00 $998.00 $2,813.00 $2,754.00 2026-07-06
4260016 CDM Treatment Rm/t6 Charge 15 12 $1,985.00 $1,985.00 $690.00 $1,945.00 $1,886.00 2026-07-06
0561T CPT Trumatch Custom Block 30 12 $3,027.00 $3,027.00 $961.00 $3,225.00 $2,708.00 2026-07-06
55707 CPT US Biopsy Prostate 16 12 $1,944.00 $1,944.00 $676.00 $2,061.00 $1,865.50 2026-07-06
125010924 CDM Ustekinumab 5 Mg/ml Sol[bchc] 14 11 $4,571.00 $4,571.00 $1,589.00 $4,480.00 $4,385.50 2026-07-06
3853048 CDM Vivia 9 Rechargeable 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3852083 CDM Widex Allure 440 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3852079 CDM Widex Smart Ric 440 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
3856034 CDM Z Series I110 Cic 15 12 $1,898.00 $1,898.00 $660.00 $1,860.00 $1,803.00 2026-07-06
3858023 CDM Zeal Cic 15 12 $2,100.00 $2,100.00 $730.00 $2,058.00 $1,995.00 2026-07-06
80368491 CDM Zoledronic Acid 5 Mg/100 Ml IV Sol [Bchc] 14 11 $3,210.00 $3,210.00 $1,116.00 $3,146.00 $3,080.00 2026-07-06
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