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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

TRI VALLEY HEALTH SYSTEM

Cambridge, NE · CCN 281348 · Rates published

4,186 distinct procedures filed
24 distinct payers
126,760 rate rows
2026-02-24 last MRF observed
Data quality

123,412 of 126,760 rate rows are consumer-grade (97.4%)

3,348 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
per-diem day rate — not a per-procedure price 1,524
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 1,440
percent-of-charges filed in the dollar field — excluded from medians 303
exceeds 10× this hospital's gross charge — excluded from medians 69
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 12
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbTVHCAMBRIDGENE&type=CDMWithoutLabel
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-13
Content fingerprint 3205d10d2c6d581c… · 40,858,900 bytes · first seen 2026-05-07

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
J2350
HCPCS 		Injection, Ocrelizumab, 1 Mg 24 $32,214.42 $65,771.11 $47,465.93 nat. median
$133
outlier · 357.0×
J1932
HCPCS 		Injection, Lanreotide, (cipla), 1 Mg 24 $14,916.96 $36,601.53 $23,592.55 nat. median
$76
outlier · 308.6×
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 24 $15,048.48 $30,723.98 $22,173.00 nat. median
$498
outlier · 44.5×
2780230
CDM 		Medtronic Intellis Adaptive 24 $14,688.00 $29,988.00 $21,641.85 —
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 24 $12,341.76 $25,197.76 $18,184.81 nat. median
$916
outlier · 19.9×
2780507
CDM 		Axonics Neurostimulator 24 $11,664.00 $23,814.00 $17,186.17 —
J0717
HCPCS 		Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm… 24 $11,489.32 $23,457.37 $16,928.80 nat. median
$29
outlier · 583.3×
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 24 $11,249.97 $22,968.68 $16,576.12 nat. median
$59
outlier · 281.9×
J0517
HCPCS 		Injection, Benralizumab, 1 Mg 24 $11,245.92 $22,960.42 $16,570.16 nat. median
$404
outlier · 41.0×
C1772
HCPCS 		Infusion Pump, Programmable (implantable) 24 $11,232.00 $22,932.00 $16,549.65 nat. median
$18,271
0.9× median
2780550
CDM 		Aurora Silo Cortical Bone Dowl 24 $10,176.00 $20,776.00 $14,993.70 —
2780415
CDM 		Posterior Sacroiliac Fusion 24 $10,080.00 $20,580.00 $14,852.25 —
2719220
CDM 		Synchromed Ii Pump 24 $9,861.12 $20,133.12 $14,529.74 —
2780295
CDM 		Djo Humeral Stem 53310108 24 $9,598.68 $19,597.30 $14,143.05 —
2780685
CDM 		Psn Fem Cr Cmt Tin Std Sz9l 24 $9,179.52 $18,741.52 $13,525.45 —
J2997
HCPCS 		Injection, Alteplase Recombinant, 1 Mg 24 $371.15 $34,537.16 $13,113.12 nat. median
$428
outlier · 30.6×
2780750
CDM 		Total Hip Implant Kit (rm) 24 $8,592.00 $17,542.00 $12,659.77 —
2780565
CDM 		Arthrex Cartiform 20mm Disc 24 $8,160.00 $16,660.00 $12,023.25 —
3600412
CDM 		Operating Room Services - General Classification 24 $7,824.96 $15,975.96 $11,529.59 —
3600411
CDM 		Operating Room Services - General Classification 24 $7,582.08 $15,480.08 $11,171.72 —
3600410
CDM 		Operating Room Services - General Classification 24 $7,419.36 $15,147.86 $10,931.97 —
2780185
CDM 		Depuy Global Unite Fx Rsa Sz1 24 $7,264.32 $14,831.32 $10,703.52 —
3600409
CDM 		Operating Room Services - General Classification 24 $7,258.08 $14,818.58 $10,694.33 —
3600408
CDM 		Operating Room Services - General Classification 24 $7,095.84 $14,487.34 $10,455.28 —
J2182
HCPCS 		Injection, Mepolizumab, 1 Mg 24 $6,838.43 $13,961.80 $10,076.00 nat. median
$80
outlier · 126.5×
3600407
CDM 		Operating Room Services - General Classification 24 $6,609.60 $13,494.60 $9,738.83 —
2780745
CDM 		Total Knee Implant Kit (rm) 24 $6,600.00 $13,475.00 $9,724.69 —
3600326
CDM 		Operating Room Services - General Classification 24 $6,568.80 $13,411.30 $9,678.72 —
2501790
CDM 		Ryanodex 250 Mg Vial 24 $6,383.04 $13,032.04 $9,405.01 —
2724020
CDM 		Arthrex Amnion Thick 24 $6,336.00 $12,936.00 $9,335.70 —
3600406
CDM 		Operating Room Services - General Classification 24 $6,284.64 $12,831.14 $9,260.03 —
2780430
CDM 		Osteoxcell 10cc(osxl-010) 24 $6,240.00 $12,740.00 $9,194.25 —
2719900
CDM 		Medtronic Wireless Neurostimul 24 $6,177.60 $12,612.60 $9,102.31 —
3600324
CDM 		Operating Room Services - General Classification 24 $6,082.08 $12,417.58 $8,961.56 —
3600405
CDM 		Operating Room Services - General Classification 24 $5,960.64 $12,169.64 $8,782.63 —
2719150
CDM 		Itotal Cr-ipoly-implant Kit 24 $5,856.00 $11,956.00 $8,628.45 —
3600323
CDM 		Operating Room Services - General Classification 24 $5,838.72 $11,920.72 $8,602.99 —
J0875
HCPCS 		Injection, Dalbavancin, 5 Mg 24 $5,796.00 $11,833.50 $8,540.05 nat. median
$49
outlier · 172.7×
3600322
CDM 		Operating Room Services - General Classification 24 $5,595.84 $11,424.84 $8,245.12 —
3600404
CDM 		Operating Room Services - General Classification 24 $5,555.04 $11,341.54 $8,185.01 —
3600321
CDM 		Operating Room Services - General Classification 24 $5,352.96 $10,928.96 $7,887.25 —
E0616
HCPCS 		Implantable Cardiac Event Recorder With Memory, Activator And Programmer 24 $5,184.00 $10,584.00 $7,638.30 nat. median
$1,818
outlier · 4.2×
3600403
CDM 		Operating Room Services - General Classification 24 $5,149.44 $10,513.44 $7,587.38 —
3600320
CDM 		Operating Room Services - General Classification 24 $5,110.08 $10,433.08 $7,529.39 nat. median
$79
outlier · 95.3×
J3111
HCPCS 		Injection, Romosozumab-aqqg, 1 Mg 24 $5,042.83 $10,295.78 $7,430.30 nat. median
$19
outlier · 391.1×
C1762
HCPCS 		Connective Tissue, Human (includes Fascia Lata) 24 $1,847.04 $19,580.40 $7,265.20 nat. median
$2,848
outlier · 2.6×
3600319
CDM 		Operating Room Services - General Classification 24 $4,866.24 $9,935.24 $7,170.10 —
J0881
HCPCS 		Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 24 $3,343.68 $15,038.10 $7,096.14 nat. median
$899
outlier · 7.9×
2719110
CDM 		Triathlon Cr Fem Component 24 $4,763.29 $9,725.05 $7,018.41 —
3600402
CDM 		Operating Room Services - General Classification 24 $4,744.80 $9,687.30 $6,991.16 —

Other procedures at this hospital

Browse this hospital's 4,186 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
             
J2350 HCPCS Injection, Ocrelizumab, 1 Mg 24 24 $67,113.38 $60,402.04 $32,214.42 $65,771.11 $47,465.93 2026-02-24
J1932 HCPCS Injection, Lanreotide, (cipla), 1 Mg 48 24 $34,212.75 $30,791.47 $14,916.96 $36,601.53 $23,592.55 2026-02-24
J3101 HCPCS Injection, Tenecteplase, 1 Mg 24 24 $31,351.00 $28,215.90 $15,048.48 $30,723.98 $22,173.00 2026-02-24
2780230 CDM Medtronic Intellis Adaptive 24 24 $30,600.00 $27,540.00 $14,688.00 $29,988.00 $21,641.85 2026-02-24
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 24 24 $25,712.00 $23,140.80 $12,341.76 $25,197.76 $18,184.81 2026-02-24
2780507 CDM Axonics Neurostimulator 24 24 $24,300.00 $21,870.00 $11,664.00 $23,814.00 $17,186.17 2026-02-24
J0717 HCPCS Injection, Certolizumab Pegol, 1 Mg (code May Be Used For Medicare When Drug Adm… 24 24 $23,936.09 $21,542.48 $11,489.32 $23,457.37 $16,928.80 2026-02-24
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 24 24 $23,437.43 $21,093.69 $11,249.97 $22,968.68 $16,576.12 2026-02-24
J0517 HCPCS Injection, Benralizumab, 1 Mg 24 24 $23,429.00 $21,086.10 $11,245.92 $22,960.42 $16,570.16 2026-02-24
C1772 HCPCS Infusion Pump, Programmable (implantable) 24 24 $23,400.00 $21,060.00 $11,232.00 $22,932.00 $16,549.65 2026-02-24
2780550 CDM Aurora Silo Cortical Bone Dowl 24 24 $21,200.00 $19,080.00 $10,176.00 $20,776.00 $14,993.70 2026-02-24
2780415 CDM Posterior Sacroiliac Fusion 24 24 $21,000.00 $18,900.00 $10,080.00 $20,580.00 $14,852.25 2026-02-24
2719220 CDM Synchromed Ii Pump 24 24 $20,544.00 $18,489.60 $9,861.12 $20,133.12 $14,529.74 2026-02-24
2780295 CDM Djo Humeral Stem 53310108 24 24 $19,997.24 $17,997.52 $9,598.68 $19,597.30 $14,143.05 2026-02-24
2780685 CDM Psn Fem Cr Cmt Tin Std Sz9l 24 24 $19,124.00 $17,211.60 $9,179.52 $18,741.52 $13,525.45 2026-02-24
J2997 HCPCS Injection, Alteplase Recombinant, 1 Mg 72 24 $18,541.00 $16,686.90 $371.15 $34,537.16 $13,113.12 2026-02-24
2780750 CDM Total Hip Implant Kit (rm) 24 24 $17,900.00 $16,110.00 $8,592.00 $17,542.00 $12,659.77 2026-02-24
2780565 CDM Arthrex Cartiform 20mm Disc 24 24 $17,000.00 $15,300.00 $8,160.00 $16,660.00 $12,023.25 2026-02-24
3600412 CDM Operating Room Services - General Classification 24 24 $16,302.00 $14,671.80 $7,824.96 $15,975.96 $11,529.59 2026-02-24
3600411 CDM Operating Room Services - General Classification 24 24 $15,796.00 $14,216.40 $7,582.08 $15,480.08 $11,171.72 2026-02-24
3600410 CDM Operating Room Services - General Classification 24 24 $15,457.00 $13,911.30 $7,419.36 $15,147.86 $10,931.97 2026-02-24
2780185 CDM Depuy Global Unite Fx Rsa Sz1 24 24 $15,134.00 $13,620.60 $7,264.32 $14,831.32 $10,703.52 2026-02-24
3600409 CDM Operating Room Services - General Classification 24 24 $15,121.00 $13,608.90 $7,258.08 $14,818.58 $10,694.33 2026-02-24
3600408 CDM Operating Room Services - General Classification 24 24 $14,783.00 $13,304.70 $7,095.84 $14,487.34 $10,455.28 2026-02-24
J2182 HCPCS Injection, Mepolizumab, 1 Mg 24 24 $14,246.73 $12,822.06 $6,838.43 $13,961.80 $10,076.00 2026-02-24
3600407 CDM Operating Room Services - General Classification 24 24 $13,770.00 $12,393.00 $6,609.60 $13,494.60 $9,738.83 2026-02-24
2780745 CDM Total Knee Implant Kit (rm) 24 24 $13,750.00 $12,375.00 $6,600.00 $13,475.00 $9,724.69 2026-02-24
3600326 CDM Operating Room Services - General Classification 24 24 $13,685.00 $12,316.50 $6,568.80 $13,411.30 $9,678.72 2026-02-24
2501790 CDM Ryanodex 250 Mg Vial 24 24 $13,298.00 $11,968.20 $6,383.04 $13,032.04 $9,405.01 2026-02-24
2724020 CDM Arthrex Amnion Thick 24 24 $13,200.00 $11,880.00 $6,336.00 $12,936.00 $9,335.70 2026-02-24
3600406 CDM Operating Room Services - General Classification 24 24 $13,093.00 $11,783.70 $6,284.64 $12,831.14 $9,260.03 2026-02-24
2780430 CDM Osteoxcell 10cc(osxl-010) 24 24 $13,000.00 $11,700.00 $6,240.00 $12,740.00 $9,194.25 2026-02-24
2719900 CDM Medtronic Wireless Neurostimul 24 24 $12,870.00 $11,583.00 $6,177.60 $12,612.60 $9,102.31 2026-02-24
3600324 CDM Operating Room Services - General Classification 24 24 $12,671.00 $11,403.90 $6,082.08 $12,417.58 $8,961.56 2026-02-24
3600405 CDM Operating Room Services - General Classification 24 24 $12,418.00 $11,176.20 $5,960.64 $12,169.64 $8,782.63 2026-02-24
2719150 CDM Itotal Cr-ipoly-implant Kit 24 24 $12,200.00 $10,980.00 $5,856.00 $11,956.00 $8,628.45 2026-02-24
3600323 CDM Operating Room Services - General Classification 24 24 $12,164.00 $10,947.60 $5,838.72 $11,920.72 $8,602.99 2026-02-24
J0875 HCPCS Injection, Dalbavancin, 5 Mg 24 24 $12,075.00 $10,867.50 $5,796.00 $11,833.50 $8,540.05 2026-02-24
3600322 CDM Operating Room Services - General Classification 24 24 $11,658.00 $10,492.20 $5,595.84 $11,424.84 $8,245.12 2026-02-24
3600404 CDM Operating Room Services - General Classification 24 24 $11,573.00 $10,415.70 $5,555.04 $11,341.54 $8,185.01 2026-02-24
3600321 CDM Operating Room Services - General Classification 24 24 $11,152.00 $10,036.80 $5,352.96 $10,928.96 $7,887.25 2026-02-24
E0616 HCPCS Implantable Cardiac Event Recorder With Memory, Activator And Programmer 24 24 $10,800.00 $9,720.00 $5,184.00 $10,584.00 $7,638.30 2026-02-24
3600403 CDM Operating Room Services - General Classification 24 24 $10,728.00 $9,655.20 $5,149.44 $10,513.44 $7,587.38 2026-02-24
3600320 CDM Operating Room Services - General Classification 24 24 $10,646.00 $9,581.40 $5,110.08 $10,433.08 $7,529.39 2026-02-24
J3111 HCPCS Injection, Romosozumab-aqqg, 1 Mg 24 24 $10,505.90 $9,455.31 $5,042.83 $10,295.78 $7,430.30 2026-02-24
C1762 HCPCS Connective Tissue, Human (includes Fascia Lata) 96 24 $11,490.00 $10,341.00 $1,847.04 $19,580.40 $7,265.20 2026-02-24
3600319 CDM Operating Room Services - General Classification 24 24 $10,138.00 $9,124.20 $4,866.24 $9,935.24 $7,170.10 2026-02-24
J0881 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 48 24 $11,155.50 $10,039.95 $3,343.68 $15,038.10 $7,096.14 2026-02-24
2719110 CDM Triathlon Cr Fem Component 24 24 $9,923.52 $8,931.17 $4,763.29 $9,725.05 $7,018.41 2026-02-24
3600402 CDM Operating Room Services - General Classification 24 24 $9,885.00 $8,896.50 $4,744.80 $9,687.30 $6,991.16 2026-02-24
2780630 CDM Reunion Tsa Press Fit Humeral 24 24 $9,738.90 $8,765.01 $4,674.67 $9,544.12 $6,887.84 2026-02-24
3600318 CDM Operating Room Services - General Classification 24 24 $9,631.00 $8,667.90 $4,622.88 $9,438.38 $6,811.52 2026-02-24
J7165 HCPCS Injection, Prothrombin Complex Concentrate, Human-lans, Per I.u. Of Factor Ix Ac… 24 24 $9,613.33 $8,652.00 $4,614.40 $9,421.06 $6,799.03 2026-02-24
2724025 CDM Arthrex Speedbridge 24 24 $9,553.50 $8,598.15 $4,585.68 $9,362.43 $6,756.72 2026-02-24
3600212 CDM Operating Room Services - General Classification 24 24 $9,483.00 $8,534.70 $4,551.84 $9,293.34 $6,706.85 2026-02-24
2780480 CDM Depuy Actis Collared Std Sz7 24 24 $9,200.00 $8,280.00 $4,416.00 $9,016.00 $6,506.70 2026-02-24
2780780 CDM J&j Femoral Stem 12/14 Taper 24 24 $9,200.00 $8,280.00 $4,416.00 $9,016.00 $6,506.70 2026-02-24
3600211 CDM Operating Room Services - General Classification 24 24 $9,144.00 $8,229.60 $4,389.12 $8,961.12 $6,467.10 2026-02-24
3600317 CDM Operating Room Services - General Classification 24 24 $9,124.00 $8,211.60 $4,379.52 $8,941.52 $6,452.95 2026-02-24
3600401 CDM Operating Room Services - General Classification 24 24 $9,042.00 $8,137.80 $4,340.16 $8,861.16 $6,394.95 2026-02-24
2780680 CDM Psn Tib Stm 5*sm E L 24 24 $8,924.00 $8,031.60 $4,283.52 $8,745.52 $6,311.50 2026-02-24
78816 HCPCS Nuclear Medicine Study Whole Body With CT Scan 24 24 $8,822.00 $7,939.80 $4,234.56 $8,645.56 $6,239.36 2026-02-24
3600210 CDM Operating Room Services - General Classification 24 24 $8,807.00 $7,926.30 $4,227.36 $8,630.86 $6,228.75 2026-02-24
3600209 CDM Operating Room Services - General Classification 24 24 $8,740.00 $7,866.00 $4,195.20 $8,565.20 $6,181.36 2026-02-24
3600316 CDM Operating Room Services - General Classification 24 24 $8,617.00 $7,755.30 $4,136.16 $8,444.66 $6,094.38 2026-02-24
2780275 CDM Depuy Attune Crs Fb Tib Base 7 24 24 $8,130.20 $7,317.18 $3,902.50 $7,967.60 $5,750.09 2026-02-24
3600208 CDM Operating Room Services - General Classification 24 24 $8,129.00 $7,316.10 $3,901.92 $7,966.42 $5,749.24 2026-02-24
2780110 CDM Depuy Femoral Stem Trilock 7 24 24 $8,000.00 $7,200.00 $3,840.00 $7,840.00 $5,658.00 2026-02-24
2780105 CDM Depuy Femoral Stem Trilock 6 24 24 $8,000.00 $7,200.00 $3,840.00 $7,840.00 $5,658.00 2026-02-24
2780115 CDM Depuy Femoral Stem Trilock 8 24 24 $8,000.00 $7,200.00 $3,840.00 $7,840.00 $5,658.00 2026-02-24
2780175 CDM Arthrex Artroflex Allograft 24 24 $7,894.00 $7,104.60 $3,789.12 $7,736.12 $5,583.03 2026-02-24
3600207 CDM Operating Room Services - General Classification 24 24 $7,879.00 $7,091.10 $3,781.92 $7,721.42 $5,572.43 2026-02-24
3600315 CDM Operating Room Services - General Classification 24 24 $7,858.00 $7,072.20 $3,771.84 $7,700.84 $5,557.57 2026-02-24
78815 HCPCS Nuclear Medicine Study From Skull Base To Mid-thigh With CT Scan 24 24 $7,651.00 $6,885.90 $3,672.48 $7,497.98 $5,411.17 2026-02-24
78608 HCPCS Nuclear Medicine Study Of Brain With Metabolic Evaluation 24 24 $7,651.00 $6,885.90 $3,672.48 $7,497.98 $5,411.17 2026-02-24
3600113 CDM Operating Room Services - General Classification 24 24 $7,546.00 $6,791.40 $3,622.08 $7,395.08 $5,336.91 2026-02-24
3600206 CDM Operating Room Services - General Classification 24 24 $7,541.00 $6,786.90 $3,619.68 $7,390.18 $5,333.37 2026-02-24
J0897 HCPCS Injection, Denosumab, 1 Mg 24 24 $7,500.00 $6,750.00 $3,600.00 $7,350.00 $5,304.38 2026-02-24
Q4151 HCPCS Amnioband Or Guardian, Per Square Centimeter 24 24 $7,450.00 $6,705.00 $3,576.00 $7,301.00 $5,269.02 2026-02-24
2719130 CDM Triathlon Cr X3 Tibial Insert 24 24 $7,283.12 $6,554.81 $3,495.90 $7,137.46 $5,150.99 2026-02-24
3600112 CDM Operating Room Services - General Classification 24 24 $7,207.00 $6,486.30 $3,459.36 $7,062.86 $5,097.15 2026-02-24
3600314 CDM Operating Room Services - General Classification 24 24 $7,098.00 $6,388.20 $3,407.04 $6,956.04 $5,020.06 2026-02-24
3600205 CDM Operating Room Services - General Classification 24 24 $7,014.00 $6,312.60 $3,366.72 $6,873.72 $4,960.65 2026-02-24
2780495 CDM Axonic Tined Lead Kit 12010 24 24 $7,000.00 $6,300.00 $3,360.00 $6,860.00 $4,950.75 2026-02-24
2780170 CDM Depuy Femoral Stabilizer 24 24 $7,000.00 $6,300.00 $3,360.00 $6,860.00 $4,950.75 2026-02-24
2719400 CDM Platelet Derived Growth Factor 24 24 $6,990.00 $6,291.00 $3,355.20 $6,850.20 $4,943.68 2026-02-24
2780690 CDM Psn Mc Ve Saf L 11mm8-11 Ef 24 24 $6,986.00 $6,287.40 $3,353.28 $6,846.28 $4,940.85 2026-02-24
2709979 CDM Zimmer Accufill 24 24 $6,912.00 $6,220.80 $3,317.76 $6,773.76 $4,888.51 2026-02-24
3600111 CDM Operating Room Services - General Classification 24 24 $6,868.00 $6,181.20 $3,296.64 $6,730.64 $4,857.40 2026-02-24
3600109 CDM Operating Room Services - General Classification 24 24 $6,532.00 $5,878.80 $3,135.36 $6,401.36 $4,619.76 2026-02-24
2780980 CDM Lapiplasty Speed Flt 28x13x11 24 24 $6,524.00 $5,871.60 $3,131.52 $6,393.52 $4,614.10 2026-02-24
73225 HCPCS MRI Scan Of Blood Vessels Of Arm 24 24 $6,516.00 $5,864.40 $3,127.68 $6,385.68 $4,608.44 2026-02-24
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 24 24 $6,489.00 $5,840.10 $3,114.72 $6,359.22 $4,589.35 2026-02-24
2719085 CDM Ventrio Med Oval Patch 11x 14 24 24 $6,432.20 $5,788.98 $3,087.46 $6,303.56 $4,549.17 2026-02-24
2780245 CDM Depuy Biolox Revision 36+ 1.5 24 24 $6,431.10 $5,787.99 $3,086.93 $6,302.48 $4,548.40 2026-02-24
3600313 CDM Operating Room Services - General Classification 24 24 $6,338.00 $5,704.20 $3,042.24 $6,211.24 $4,482.55 2026-02-24
J3032 HCPCS Injection, Eptinezumab-jjmr, 1 Mg 24 24 $6,307.00 $5,676.30 $3,027.36 $6,180.86 $4,460.62 2026-02-24
3600204 CDM Operating Room Services - General Classification 24 24 $6,254.00 $5,628.60 $3,001.92 $6,128.92 $4,423.14 2026-02-24
3600108 CDM Operating Room Services - General Classification 24 24 $6,193.00 $5,573.70 $2,972.64 $6,069.14 $4,380.00 2026-02-24
2780695 CDM All Poly Pat Ve 35mm Dia 24 24 $6,136.00 $5,522.40 $2,945.28 $6,013.28 $4,339.68 2026-02-24
2780345 CDM Conformis Hip Stem Rt Sz14 24 24 $6,100.00 $5,490.00 $2,928.00 $5,978.00 $4,314.23 2026-02-24
59510 HCPCS Cesarean Delivery With Care Before And After Delivery 24 24 $6,164.00 $5,547.60 $247.51 $6,040.72 $4,282.74 2026-02-24
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 24 24 $6,038.00 $5,434.20 $2,898.24 $5,917.24 $4,270.38 2026-02-24
78451 HCPCS Nuclear Medicine Study Of Heart Muscle At Rest And With Stress And Spect 24 24 $6,008.00 $5,407.20 $2,883.84 $5,887.84 $4,249.16 2026-02-24
2719120 CDM Triathlon Prim Tib Baseplate 24 24 $5,925.06 $5,332.55 $2,844.03 $5,806.56 $4,190.49 2026-02-24
2780705 CDM Cannula Ti Tfna 11/130 380rt 24 24 $5,878.60 $5,290.74 $2,821.73 $5,761.03 $4,157.64 2026-02-24
3600107 CDM Operating Room Services - General Classification 24 24 $5,855.00 $5,269.50 $2,810.40 $5,737.90 $4,140.95 2026-02-24
74175 HCPCS CT Scan Of Blood Vessels Of Abdomen With Contrast 24 24 $5,820.00 $5,238.00 $2,793.60 $5,703.60 $4,116.19 2026-02-24
59610 HCPCS Vaginal Delivery And Care Before And After Delivery After Previous Cesarean Deli… 24 24 $5,805.00 $5,224.50 $247.51 $5,688.90 $4,033.32 2026-02-24
74185 HCPCS MRI Scan Of Blood Vessels Of Abdomen 24 24 $5,696.00 $5,126.40 $2,734.08 $5,582.08 $4,028.49 2026-02-24
2780555 CDM Toe 1st Mtp Imp W/grommets 24 24 $5,690.50 $5,121.45 $2,731.44 $5,576.69 $4,024.61 2026-02-24
2780285 CDM Djo Glenoid Baseplate 58032204 24 24 $5,689.48 $5,120.53 $2,730.95 $5,575.69 $4,023.88 2026-02-24
3600312 CDM Operating Room Services - General Classification 24 24 $5,578.00 $5,020.20 $2,677.44 $5,466.44 $3,945.04 2026-02-24
J7325 HCPCS Hyaluronan Or Derivative, Synvisc Or Synvisc-one, For Intra-articular Injection,… 24 24 $5,519.00 $4,967.10 $2,649.12 $5,408.62 $3,903.32 2026-02-24
3600106 CDM Operating Room Services - General Classification 24 24 $5,518.00 $4,966.20 $2,648.64 $5,407.64 $3,902.61 2026-02-24
59400 HCPCS Vaginal Delivery With Care Before And After Delivery 24 24 $5,600.00 $5,040.00 $247.51 $5,488.00 $3,890.88 2026-02-24
72191 HCPCS CT Scan Of Blood Vessels Of Pelvis With Contrast 24 24 $5,466.00 $4,919.40 $2,623.68 $5,356.68 $3,865.83 2026-02-24
3600104 CDM Operating Room Services - General Classification 24 24 $5,324.00 $4,791.60 $2,555.52 $5,217.52 $3,765.40 2026-02-24
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 24 24 $5,299.00 $4,769.10 $2,543.52 $5,193.02 $3,747.72 2026-02-24
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 24 24 $5,251.00 $4,725.90 $2,520.48 $5,145.98 $3,713.77 2026-02-24
3600203 CDM Operating Room Services - General Classification 24 24 $5,240.00 $4,716.00 $2,515.20 $5,135.20 $3,705.99 2026-02-24
63650 HCPCS Insertion Of Spinal Neurostimulator Electrode Array Through Skin 72 24 $4,106.00 $3,695.40 $350.06 $7,443.10 $3,695.40 2026-02-24
2780535 CDM Smith Nephew Bioinductive Impl 24 24 $5,199.96 $4,679.96 $2,495.98 $5,095.96 $3,677.67 2026-02-24
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 24 24 $5,188.00 $4,669.20 $2,490.24 $5,084.24 $3,669.22 2026-02-24
73725 HCPCS MRI Scan Of Blood Vessels Of Leg 48 24 $5,425.50 $4,882.95 $2,165.76 $6,212.22 $3,661.11 2026-02-24
3600302 CDM Operating Room Services - General Classification 24 24 $5,167.00 $4,650.30 $2,480.16 $5,063.66 $3,654.36 2026-02-24
2708795 CDM 6ft Mtp Crosscheck Plate 24 24 $5,132.00 $4,618.80 $2,463.36 $5,029.36 $3,629.61 2026-02-24
2719930 CDM Medtronic Recharger 24 24 $5,100.00 $4,590.00 $2,448.00 $4,998.00 $3,606.97 2026-02-24
7210148 CDM Labor Room/delivery - Labor 24 24 $5,084.00 $4,575.60 $2,440.32 $4,982.32 $3,595.66 2026-02-24
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 24 24 $5,047.00 $4,542.30 $2,422.56 $4,946.06 $3,569.49 2026-02-24
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 24 24 $5,047.00 $4,542.30 $2,422.56 $4,946.06 $3,569.49 2026-02-24
2719095 CDM Ventrio St 8x10 Xl Oval 24 24 $5,034.20 $4,530.78 $2,416.42 $4,933.52 $3,560.44 2026-02-24
2780381 CDM Stryker Accolade Ii 6720-0837 24 24 $5,000.00 $4,500.00 $2,400.00 $4,900.00 $3,536.25 2026-02-24
2780120 CDM Depuy Acetabular Cup - 52mm 24 24 $5,000.00 $4,500.00 $2,400.00 $4,900.00 $3,536.25 2026-02-24
2719485 CDM Accolade Ii 127 Degree 24 24 $5,000.00 $4,500.00 $2,400.00 $4,900.00 $3,536.25 2026-02-24
2780800 CDM Pinn Sector W/gription 60mm 24 24 $5,000.00 $4,500.00 $2,400.00 $4,900.00 $3,536.25 2026-02-24
3600105 CDM Operating Room Services - General Classification 24 24 $4,985.00 $4,486.50 $2,392.80 $4,885.30 $3,525.64 2026-02-24
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 24 24 $4,944.00 $4,449.60 $2,373.12 $4,845.12 $3,496.65 2026-02-24
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 24 24 $4,883.00 $4,394.70 $2,343.84 $4,785.34 $3,453.50 2026-02-24
71270 HCPCS CT Scan Of Chest Before And After Contrast 24 24 $4,883.00 $4,394.70 $2,343.84 $4,785.34 $3,453.50 2026-02-24
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 24 24 $4,883.00 $4,394.70 $2,343.84 $4,785.34 $3,453.50 2026-02-24
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 24 24 $4,883.00 $4,394.70 $2,343.84 $4,785.34 $3,453.50 2026-02-24
7210147 CDM Labor Room/delivery - Labor 24 24 $4,881.00 $4,392.90 $2,342.88 $4,783.38 $3,452.09 2026-02-24
7210146 CDM Labor Room/delivery - Labor 24 24 $4,881.00 $4,392.90 $2,342.88 $4,783.38 $3,452.09 2026-02-24
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 24 24 $4,841.00 $4,356.90 $2,323.68 $4,744.18 $3,423.80 2026-02-24
2780210 CDM Arthrex Tight Rope Ar1860cstcp 24 24 $4,820.00 $4,338.00 $2,313.60 $4,723.60 $3,408.94 2026-02-24
3600311 CDM Operating Room Services - General Classification 24 24 $4,818.00 $4,336.20 $2,312.64 $4,721.64 $3,407.53 2026-02-24
2780350 CDM Conformis Cordera Acet Cup Rt 24 24 $4,800.00 $4,320.00 $2,304.00 $4,704.00 $3,394.80 2026-02-24
7210145 CDM Labor Room/delivery - Labor 24 24 $4,775.00 $4,297.50 $2,292.00 $4,679.50 $3,377.12 2026-02-24
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 24 24 $4,763.00 $4,286.70 $2,286.24 $4,667.74 $3,368.63 2026-02-24
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 24 24 $4,738.00 $4,264.20 $2,274.24 $4,643.24 $3,350.95 2026-02-24
71550 HCPCS MRI Scan Of Chest Without Contrast 24 24 $4,714.00 $4,242.60 $2,262.72 $4,619.72 $3,333.98 2026-02-24
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 24 24 $4,635.00 $4,171.50 $2,224.80 $4,542.30 $3,278.11 2026-02-24
70553 HCPCS MRI Scan Of Brain Before And After Contrast 24 24 $4,635.00 $4,171.50 $2,224.80 $4,542.30 $3,278.11 2026-02-24
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 24 24 $4,619.00 $4,157.10 $2,217.12 $4,526.62 $3,266.79 2026-02-24
72126 HCPCS CT Scan Of Upper Spine With Contrast 24 24 $4,619.00 $4,157.10 $2,217.12 $4,526.62 $3,266.79 2026-02-24
72129 HCPCS CT Scan Of Middle Spine With Contrast 24 24 $4,619.00 $4,157.10 $2,217.12 $4,526.62 $3,266.79 2026-02-24
72132 HCPCS CT Scan Of Lower Spine With Contrast 24 24 $4,619.00 $4,157.10 $2,217.12 $4,526.62 $3,266.79 2026-02-24
70336 HCPCS MRI Scan Of Jaw Joint 24 24 $4,607.00 $4,146.30 $2,211.36 $4,514.86 $3,258.30 2026-02-24
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 24 24 $6,456.00 $5,810.40 $3,044.64 $6,326.88 $3,242.53 2026-02-24
74160 HCPCS CT Scan Of Abdomen With Contrast 24 24 $4,577.00 $4,119.30 $2,196.96 $4,485.46 $3,237.09 2026-02-24
7210144 CDM Labor Room/delivery - Labor 24 24 $4,562.00 $4,105.80 $2,189.76 $4,470.76 $3,226.48 2026-02-24
7210143 CDM Labor Room/delivery - Labor 24 24 $4,562.00 $4,105.80 $2,189.76 $4,470.76 $3,226.48 2026-02-24
74182 HCPCS MRI Scan Of Abdomen With Contrast 24 24 $4,532.00 $4,078.80 $2,175.36 $4,441.36 $3,205.26 2026-02-24
72193 HCPCS CT Scan Of Pelvis With Contrast 24 24 $4,501.00 $4,050.90 $2,160.48 $4,410.98 $3,183.33 2026-02-24
2728579 CDM Boston Sci Lithovue Scope 24 24 $4,500.00 $4,050.00 $2,160.00 $4,410.00 $3,182.62 2026-02-24
7210048 CDM Labor Room/delivery - Labor 24 24 $4,474.00 $4,026.60 $2,147.52 $4,384.52 $3,164.23 2026-02-24
7210142 CDM Labor Room/delivery - Labor 24 24 $4,456.00 $4,010.40 $2,138.88 $4,366.88 $3,151.51 2026-02-24
2780670 CDM Graftlink - Zorc 9.0l=70mm 24 24 $4,435.20 $3,991.68 $2,128.90 $4,346.50 $3,136.80 2026-02-24
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 24 24 $4,429.00 $3,986.10 $2,125.92 $4,340.42 $3,132.41 2026-02-24
2780107 CDM Depey Dxtend Ecc Epiphysis 1 24 24 $4,400.00 $3,960.00 $2,112.00 $4,312.00 $3,111.90 2026-02-24
Q4186 HCPCS Epifix, Per Square Centimeter 96 24 $4,284.00 $3,855.60 $1,202.40 $7,793.94 $3,105.30 2026-02-24
2780290 CDM Djo Glenoid Head 50832103 24 24 $4,384.54 $3,946.09 $2,104.58 $4,296.85 $3,100.97 2026-02-24
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 24 24 $4,378.00 $3,940.20 $2,101.44 $4,290.44 $3,096.34 2026-02-24
7210047 CDM Labor Room/delivery - Labor 24 24 $4,357.00 $3,921.30 $2,091.36 $4,269.86 $3,081.49 2026-02-24
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 24 24 $4,355.00 $3,919.50 $2,090.40 $4,267.90 $3,080.07 2026-02-24
70481 HCPCS CT Scan Of Cranial Cavity With Contrast 24 24 $4,355.00 $3,919.50 $2,090.40 $4,267.90 $3,080.07 2026-02-24
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 24 24 $4,355.00 $3,919.50 $2,090.40 $4,267.90 $3,080.07 2026-02-24
73202 HCPCS CT Scan Of Arm Before And After Contrast 24 24 $4,355.00 $3,919.50 $2,090.40 $4,267.90 $3,080.07 2026-02-24
73702 HCPCS CT Scan Of Leg Before And After Contrast 24 24 $4,355.00 $3,919.50 $2,090.40 $4,267.90 $3,080.07 2026-02-24
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 24 24 $4,355.00 $3,919.50 $2,090.40 $4,267.90 $3,080.07 2026-02-24
7210141 CDM Labor Room/delivery - Labor 24 24 $4,350.00 $3,915.00 $2,088.00 $4,263.00 $3,076.54 2026-02-24
66984 HCPCS Removal Of Cataract With Insertion Of Prosthetic Lens 24 24 $4,329.00 $3,896.10 $2,077.92 $4,242.42 $3,061.68 2026-02-24
70552 HCPCS MRI Scan Of Brain With Contrast 24 24 $4,326.00 $3,893.40 $2,076.48 $4,239.48 $3,059.57 2026-02-24
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 24 24 $4,326.00 $3,893.40 $2,076.48 $4,239.48 $3,059.57 2026-02-24
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 24 24 $4,326.00 $3,893.40 $2,076.48 $4,239.48 $3,059.57 2026-02-24
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 24 24 $4,326.00 $3,893.40 $2,076.48 $4,239.48 $3,059.57 2026-02-24
73220 HCPCS MRI Scan Of Arm Before And After Contrast 24 24 $4,326.00 $3,893.40 $2,076.48 $4,239.48 $3,059.57 2026-02-24
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 24 24 $4,326.00 $3,893.40 $2,076.48 $4,239.48 $3,059.57 2026-02-24
3600103 CDM Operating Room Services - General Classification 24 24 $4,313.00 $3,881.70 $2,070.24 $4,226.74 $3,050.37 2026-02-24
C1778 HCPCS Lead, Neurostimulator (implantable) 24 24 $4,290.00 $3,861.00 $2,059.20 $4,204.20 $3,034.11 2026-02-24
2780100 CDM Synesmosis Tightrope 24 24 $4,272.00 $3,844.80 $2,050.56 $4,186.56 $3,021.37 2026-02-24
7210046 CDM Labor Room/delivery - Labor 24 24 $4,265.00 $3,838.50 $2,047.20 $4,179.70 $3,016.42 2026-02-24
2780165 CDM Depuy Tibial Base 24 24 $4,250.00 $3,825.00 $2,040.00 $4,165.00 $3,005.82 2026-02-24
7210140 CDM Labor Room/delivery - Labor 24 24 $4,244.00 $3,819.60 $2,037.12 $4,159.12 $3,001.57 2026-02-24
3600202 CDM Operating Room Services - General Classification 24 24 $4,226.00 $3,803.40 $2,028.48 $4,141.48 $2,988.84 2026-02-24
71552 HCPCS MRI Scan Of Chest Before And After Contrast 24 24 $4,223.00 $3,800.70 $2,027.04 $4,138.54 $2,986.72 2026-02-24
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 24 24 $4,223.00 $3,800.70 $2,027.04 $4,138.54 $2,986.72 2026-02-24
2780645 CDM Baseplate 28mmx10.05mm 24 24 $4,209.30 $3,788.37 $2,020.46 $4,125.11 $2,977.02 2026-02-24
2710003 CDM Jada Hermorahage Control Systm 24 24 $4,185.00 $3,766.50 $2,008.80 $4,101.30 $2,959.84 2026-02-24
7210045 CDM Labor Room/delivery - Labor 24 24 $4,172.00 $3,754.80 $2,002.56 $4,088.56 $2,950.64 2026-02-24
7210139 CDM Labor Room/delivery - Labor 24 24 $4,138.00 $3,724.20 $1,986.24 $4,055.24 $2,926.60 2026-02-24
72196 HCPCS MRI Scan Of Pelvis With Contrast 24 24 $4,120.00 $3,708.00 $1,977.60 $4,037.60 $2,913.87 2026-02-24
70551 HCPCS MRI Scan Of Brain Without Contrast 24 24 $4,120.00 $3,708.00 $1,977.60 $4,037.60 $2,913.87 2026-02-24
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 24 24 $4,120.00 $3,708.00 $1,977.60 $4,037.60 $2,913.87 2026-02-24
74181 HCPCS MRI Scan Of Abdomen Without Contrast 24 24 $4,120.00 $3,708.00 $1,977.60 $4,037.60 $2,913.87 2026-02-24
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 24 24 $4,120.00 $3,708.00 $1,977.60 $4,037.60 $2,913.87 2026-02-24
75635 HCPCS CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast 24 24 $4,092.00 $3,682.80 $1,964.16 $4,010.16 $2,894.07 2026-02-24
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 24 24 $4,090.00 $3,681.00 $1,963.20 $4,008.20 $2,892.65 2026-02-24
70460 HCPCS CT Scan Head Or Brain With Contrast 24 24 $4,090.00 $3,681.00 $1,963.20 $4,008.20 $2,892.65 2026-02-24
73701 HCPCS CT Scan Of Leg With Contrast Material 24 24 $4,090.00 $3,681.00 $1,963.20 $4,008.20 $2,892.65 2026-02-24
73201 HCPCS CT Scan Of Arm With Contrast 24 24 $4,090.00 $3,681.00 $1,963.20 $4,008.20 $2,892.65 2026-02-24
7210044 CDM Labor Room/delivery - Labor 24 24 $4,079.00 $3,671.10 $1,957.92 $3,997.42 $2,884.88 2026-02-24
7210138 CDM Labor Room/delivery - Labor 24 24 $4,032.00 $3,628.80 $1,935.36 $3,951.36 $2,851.63 2026-02-24
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 24 24 $4,017.00 $3,615.30 $1,928.16 $3,936.66 $2,841.03 2026-02-24
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 24 24 $4,017.00 $3,615.30 $1,928.16 $3,936.66 $2,841.03 2026-02-24
2780625 CDM Gyencare Tvt Obtrtr W/laser 24 24 $4,011.92 $3,610.73 $1,925.72 $3,931.68 $2,837.43 2026-02-24
2780400 CDM Depuy Pinnacle Md Liner Sz 47 24 24 $4,000.00 $3,600.00 $1,920.00 $3,920.00 $2,829.00 2026-02-24
2780160 CDM Depuy Tibial Insert 24 24 $4,000.00 $3,600.00 $1,920.00 $3,920.00 $2,829.00 2026-02-24
2780725 CDM Implant System Fastthread 24 24 $3,990.00 $3,591.00 $1,915.20 $3,910.20 $2,821.93 2026-02-24
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 24 24 $5,618.00 $5,056.20 $2,696.64 $5,505.64 $2,821.64 2026-02-24
7210043 CDM Labor Room/delivery - Labor 24 24 $3,987.00 $3,588.30 $1,913.76 $3,907.26 $2,819.81 2026-02-24
2719090 CDM Ventrio St Lg Oval 24 24 $3,986.80 $3,588.12 $1,913.66 $3,907.06 $2,819.66 2026-02-24
2722610 CDM Hyprocure 24 24 $3,980.00 $3,582.00 $1,910.40 $3,900.40 $2,814.86 2026-02-24
78452 HCPCS Nuclear Medicine Studies Of Heart Muscle At Rest And With Stress And Spect 24 24 $5,555.00 $4,999.50 $2,359.65 $5,443.90 $2,790.00 2026-02-24
7210137 CDM Labor Room/delivery - Labor 24 24 $3,926.00 $3,533.40 $1,884.48 $3,847.48 $2,776.66 2026-02-24
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 24 24 $3,914.00 $3,522.60 $1,878.72 $3,835.72 $2,768.18 2026-02-24
73720 HCPCS MRI Scan Of Leg Before And After Contrast 24 24 $3,914.00 $3,522.60 $1,878.72 $3,835.72 $2,768.18 2026-02-24
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 24 24 $3,914.00 $3,522.60 $1,878.72 $3,835.72 $2,768.18 2026-02-24
99468 HCPCS Initial Inpatient Hospital Critical Care Of Newborn Per Day (28 Days Or Younger) 24 24 $3,974.00 $3,576.60 $247.51 $3,894.52 $2,761.14 2026-02-24
2723110 CDM Orthalign Plus Naviaton Unit 24 24 $3,885.00 $3,496.50 $1,864.80 $3,807.30 $2,747.66 2026-02-24
2780300 CDM Djo Socket Insert Sm 50902032 24 24 $3,866.12 $3,479.51 $1,855.74 $3,788.80 $2,734.32 2026-02-24
73222 HCPCS MRI Scan Of Arm Joint With Contrast 24 24 $3,863.00 $3,476.70 $1,854.24 $3,785.74 $2,732.11 2026-02-24
70488 HCPCS CT Scan Of Face Before And After Contrast 24 24 $3,825.00 $3,442.50 $1,836.00 $3,748.50 $2,705.23 2026-02-24
2780635 CDM Humeral Cup 32mm Dx2mm Thk 24 24 $3,825.00 $3,442.50 $1,836.00 $3,748.50 $2,705.23 2026-02-24
2780665 CDM Glenosphere 32mm D X 6mm Thk 24 24 $3,825.00 $3,442.50 $1,836.00 $3,748.50 $2,705.23 2026-02-24
2719872 CDM Arthrex Speedprg Imp Sys 24 24 $3,820.00 $3,438.00 $1,833.60 $3,743.60 $2,701.70 2026-02-24
7210136 CDM Labor Room/delivery - Labor 24 24 $3,820.00 $3,438.00 $1,833.60 $3,743.60 $2,701.70 2026-02-24
70542 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast 24 24 $3,811.00 $3,429.90 $1,829.28 $3,734.78 $2,695.33 2026-02-24
73219 HCPCS MRI Scan Of Arm With Contrast 24 24 $3,811.00 $3,429.90 $1,829.28 $3,734.78 $2,695.33 2026-02-24
7210042 CDM Labor Room/delivery - Labor 24 24 $3,801.00 $3,420.90 $1,824.48 $3,724.98 $2,688.26 2026-02-24
2780830 CDM Ar 2371bl Knotless Ac Tiro Rp 24 24 $3,750.00 $3,375.00 $1,800.00 $3,675.00 $2,652.19 2026-02-24
2714760 CDM Lynx System 24 24 $3,750.00 $3,375.00 $1,800.00 $3,675.00 $2,652.19 2026-02-24
2711880 CDM Achilles Suturebridge 24 24 $3,720.00 $3,348.00 $1,785.60 $3,645.60 $2,630.97 2026-02-24
7210135 CDM Labor Room/delivery - Labor 24 24 $3,714.00 $3,342.60 $1,782.72 $3,639.72 $2,626.72 2026-02-24
7210041 CDM Labor Room/delivery - Labor 24 24 $3,708.00 $3,337.20 $1,779.84 $3,633.84 $2,622.48 2026-02-24
7210040 CDM Labor Room/delivery - Labor 24 24 $3,708.00 $3,337.20 $1,779.84 $3,633.84 $2,622.48 2026-02-24
15273 HCPCS Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.… 72 24 $3,362.00 $3,025.80 $155.95 $5,242.02 $2,619.94 2026-02-24
2780720 CDM Tendon Flexifgraft 24 24 $3,660.38 $3,294.34 $1,756.98 $3,587.17 $2,588.81 2026-02-24
2780435 CDM Depuy Dxtend Modular Hum Stem 24 24 $3,640.00 $3,276.00 $1,747.20 $3,567.20 $2,574.39 2026-02-24
2780106 CDM Depuy Extend Humeral Stem D10 24 24 $3,640.00 $3,276.00 $1,747.20 $3,567.20 $2,574.39 2026-02-24
7210039 CDM Labor Room/delivery - Labor 24 24 $3,616.00 $3,254.40 $1,735.68 $3,543.68 $2,557.41 2026-02-24
78205 HCPCS Liver Imaging (spect) 24 24 $3,614.00 $3,252.60 $1,734.72 $3,541.72 $2,556.00 2026-02-24
74400 HCPCS Imaging Of Urinary Tract With Injection Of Contrast Into A Vein 24 24 $3,609.00 $3,248.10 $1,732.32 $3,536.82 $2,552.47 2026-02-24
7210134 CDM Labor Room/delivery - Labor 24 24 $3,608.00 $3,247.20 $1,731.84 $3,535.84 $2,551.76 2026-02-24
2716675 CDM Advantage Fit System Transvagi 24 24 $3,605.88 $3,245.29 $1,730.82 $3,533.76 $2,550.26 2026-02-24
73722 HCPCS MRI Scan Of Leg Joint With Contrast 24 24 $3,605.00 $3,244.50 $1,730.40 $3,532.90 $2,549.64 2026-02-24
73719 HCPCS MRI Scan Of Leg With Contrast 24 24 $3,605.00 $3,244.50 $1,730.40 $3,532.90 $2,549.64 2026-02-24
2705103 CDM Canulated Top 6.5 804-06-318 24 24 $3,600.00 $3,240.00 $1,728.00 $3,528.00 $2,546.10 2026-02-24
Q4159 HCPCS Affinity, Per Square Centimeter 48 24 $3,637.50 $3,273.75 $1,656.00 $3,748.50 $2,536.48 2026-02-24
70487 HCPCS CT Scan Of Face With Contrast 24 24 $3,563.00 $3,206.70 $1,710.24 $3,491.74 $2,519.93 2026-02-24
72131 HCPCS CT Scan Of Lower Spine Without Contrast 48 24 $3,545.00 $3,190.50 $1,701.60 $3,474.10 $2,507.20 2026-02-24
72128 HCPCS CT Scan Of Middle Spine Without Contrast 48 24 $3,545.00 $3,190.50 $1,701.60 $3,474.10 $2,507.20 2026-02-24
72125 HCPCS CT Scan Of Upper Spine Without Contrast 24 24 $3,545.00 $3,190.50 $1,701.60 $3,474.10 $2,507.20 2026-02-24
7210038 CDM Labor Room/delivery - Labor 24 24 $3,523.00 $3,170.70 $1,691.04 $3,452.54 $2,491.64 2026-02-24
7200001 CDM Labor Room/delivery - General Classification 24 24 $3,505.00 $3,154.50 $1,682.40 $3,434.90 $2,478.91 2026-02-24
72195 HCPCS MRI Scan Of Pelvis Without Contrast 24 24 $3,502.00 $3,151.80 $1,680.96 $3,431.96 $2,476.79 2026-02-24
70540 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast 24 24 $3,502.00 $3,151.80 $1,680.96 $3,431.96 $2,476.79 2026-02-24
7210133 CDM Labor Room/delivery - Labor 24 24 $3,501.00 $3,150.90 $1,680.48 $3,430.98 $2,476.08 2026-02-24
2780840 CDM Arthrex Knotless Ac Tightrope 24 24 $3,490.00 $3,141.00 $1,675.20 $3,420.20 $2,468.30 2026-02-24
2702974 CDM Rsa Halfmoon Reamr/plner Sz 32 24 24 $3,489.75 $3,140.78 $1,675.08 $3,419.96 $2,468.13 2026-02-24
2702978 CDM Rsa Halfmoon Reamr/plnr Sz36 24 24 $3,489.75 $3,140.78 $1,675.08 $3,419.96 $2,468.13 2026-02-24
2780180 CDM Arthrex Speedbridge 4.75x19.1 24 24 $3,480.00 $3,132.00 $1,670.40 $3,410.40 $2,461.23 2026-02-24
81229 HCPCS Genome-wide Microarray Analysis For Copy Number And Single Nucleotide Polymorphi… 24 24 $3,469.00 $3,122.10 $1,665.12 $3,399.62 $2,453.45 2026-02-24
7210037 CDM Labor Room/delivery - Labor 24 24 $3,430.00 $3,087.00 $1,646.40 $3,361.40 $2,425.87 2026-02-24
2719140 CDM Triathlon Asymmetric X3 Patell 24 24 $3,426.80 $3,084.12 $1,644.86 $3,358.26 $2,423.61 2026-02-24
78320 HCPCS Bone And/or Joint Imaging; Tomographic (spect) 24 24 $3,410.00 $3,069.00 $1,636.80 $3,341.80 $2,411.72 2026-02-24
2719893 CDM Arthrex Meniscal Root Rep Kit 24 24 $3,400.00 $3,060.00 $1,632.00 $3,332.00 $2,404.65 2026-02-24
7210132 CDM Labor Room/delivery - Labor 24 24 $3,395.00 $3,055.50 $1,629.60 $3,327.10 $2,401.11 2026-02-24
74176 HCPCS CT Scan Of Abdomen And Pelvis Without Contrast 24 24 $4,723.00 $4,250.70 $2,217.82 $4,628.54 $2,372.12 2026-02-24
21558 HCPCS Extensive Removal Of Growth Of Neck Or Front Of Chest, 5.0 Cm Or More 48 24 $3,102.00 $2,791.80 $1,099.61 $3,551.74 $2,365.89 2026-02-24
74150 HCPCS CT Scan Of Abdomen Without Contrast 24 24 $3,337.00 $3,003.30 $1,601.76 $3,270.26 $2,360.10 2026-02-24
2719495 CDM Fusionflex 24 24 $3,330.00 $2,997.00 $1,598.40 $3,263.40 $2,355.14 2026-02-24
73218 HCPCS MRI Scan Of Arm Without Contrast 24 24 $3,296.00 $2,966.40 $1,582.08 $3,230.08 $2,331.10 2026-02-24
73718 HCPCS MRI Scan Of Leg Without Contrast 24 24 $3,296.00 $2,966.40 $1,582.08 $3,230.08 $2,331.10 2026-02-24
7210131 CDM Labor Room/delivery - Labor 24 24 $3,289.00 $2,960.10 $1,578.72 $3,223.22 $2,326.14 2026-02-24
70480 HCPCS CT Scan Of Cranial Cavity Without Contrast 24 24 $3,281.00 $2,952.90 $1,574.88 $3,215.38 $2,320.49 2026-02-24
71260 HCPCS CT Scan Of Chest With Contrast 24 24 $4,619.00 $4,157.10 $1,476.09 $4,526.62 $2,319.89 2026-02-24
73206 HCPCS CT Scan Of Blood Vessels Of Arm With Contrast 48 24 $3,223.00 $2,900.70 $1,547.04 $3,158.54 $2,279.47 2026-02-24
3600201 CDM Operating Room Services - General Classification 24 24 $3,212.00 $2,890.80 $1,541.76 $3,147.76 $2,271.68 2026-02-24
2780465 CDM Plate Metatarsal T 7 Hole 24 24 $3,200.00 $2,880.00 $1,536.00 $3,136.00 $2,263.20 2026-02-24
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 24 24 $3,200.00 $2,880.00 $1,536.00 $3,136.00 $2,263.20 2026-02-24
1200005 CDM Room & Board - Semi-private (two Beds) - General Classification 12 12 $2,425.00 $2,182.50 $2,182.50 $2,376.50 $2,255.25 2026-02-24
7210130 CDM Labor Room/delivery - Labor 24 24 $3,183.00 $2,864.70 $1,527.84 $3,119.34 $2,251.18 2026-02-24
2719525 CDM Hammertoe Med 24 24 $3,180.00 $2,862.00 $1,526.40 $3,116.40 $2,249.05 2026-02-24
2780850 CDM Arthrex Connect Pre-sut Tendon 24 24 $3,162.00 $2,845.80 $1,517.76 $3,098.76 $2,236.32 2026-02-24
7210036 CDM Labor Room/delivery - Labor 24 24 $3,152.00 $2,836.80 $1,512.96 $3,088.96 $2,229.25 2026-02-24
7210035 CDM Labor Room/delivery - Labor 24 24 $3,152.00 $2,836.80 $1,512.96 $3,088.96 $2,229.25 2026-02-24
7210034 CDM Labor Room/delivery - Labor 24 24 $3,152.00 $2,836.80 $1,512.96 $3,088.96 $2,229.25 2026-02-24
2780835 CDM Ar 2370bl Kl Ac Ttrp Rep W/db 24 24 $3,144.00 $2,829.60 $1,509.12 $3,081.12 $2,223.59 2026-02-24
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