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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

CHASE COUNTY COMMUNITY HOSPITAL

Imperial, NE · CCN 281351 · Rates published

3,271 distinct procedures filed
4 distinct payers
15,284 rate rows
2025-12-02 last MRF observed
Data quality

15,282 of 15,284 rate rows are consumer-grade (100.0%)

2 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
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://secure.claraprice.net/price-transparency/QSJB-1666892650444/machine-readable/476000803_chase-county-hospital_standardcharges.json
Found on page https://secure.claraprice.net/price-transparency/chase-county-ne
Discovered viaDiscovered by HANK
Last fetch success · 2026-09-25
Content fingerprint 237ccf3bc08edd5b… · 3,495,949 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
1601800
CDM 		Tri Ts Femur Right 4 $5,467.00 $14,838.00 $11,714.50 nat. median
$635
outlier · 18.4×
1601818
CDM 		Rest Mod Conical Distal Stem 4 $5,300.00 $14,385.00 $11,356.50 nat. median
$150
outlier · 75.7×
1601743
CDM 		Reunion Tsa Modular Humeral Stem 4 $5,300.00 $14,385.00 $11,356.50 nat. median
$1,299
outlier · 8.7×
1601929
CDM 		Confirm Rx Icm (Impant Cardiac Monitor) 4 $5,096.00 $13,832.00 $10,920.00 nat. median
$549
outlier · 19.9×
CP17640152376526652
CDM 		Obinutuzumab 25 Mg/ml40 Ml Sdpf [Chas] 4 $4,930.00 $13,381.00 $10,563.50 nat. median
$10,564
1.0× median
C1764
HCPCS 		Assert-iq Icm El (Implant Cardiac Monitor) 4 $4,900.00 $13,300.00 $10,500.00 nat. median
$7,740
1.4× median
CP17640152376551914
CDM 		Tysabri(natalizumab) 300mg/15ml [Chas] 4 $4,855.00 $13,177.00 $10,402.50 nat. median
$10,402
1.0× median
C1849
HCPCS 		Restrata-12.5cm X 17.5cm 4 $4,717.00 $12,802.00 $10,107.00 nat. median
$1,415
outlier · 7.1×
CP17640152376557667
CDM 		Tenecteplase 25 Mg (Tnkase) Rec [Chas] 4 $4,539.00 $12,321.00 $9,726.50 nat. median
$9,726
1.0× median
CP17640152376524450
CDM 		Nivolumab 10 Mg/ml24 Ml Sdpf [Chas] 4 $4,370.00 $11,863.00 $9,365.50 nat. median
$9,366
1.0× median
CP17640152376558526
CDM 		Tenecteplase (Tnk) 50 Mg Rec [Chas] 4 $4,283.00 $11,624.00 $9,177.00 nat. median
$9,177
1.0× median
23410
CPT 		23410-repair Rotator Cuff Acute-surg Tech 4 $4,219.00 $11,451.00 $9,040.50 nat. median
$6,849
1.3× median
CP17640152376476589
CDM 		Eflapegrastim Xnst 13.2 Mg/0.6 Ml Syrn [Chas] 4 $4,104.00 $11,139.00 $8,793.50 nat. median
$8,794
1.0× median
50590
CPT 		50590 Lithotripsy Esl 4 $4,068.00 $11,043.00 $8,718.00 nat. median
$4,382
2.0× median
1601817
CDM 		Rest Mod Prox Cone Body 4 $3,725.00 $10,110.00 $7,981.50 nat. median
$150
outlier · 53.2×
CP17640152376524168
CDM 		Neulasta Onpro Kit 6mg/0.6ml [Chas] 4 $3,513.00 $9,534.00 $7,527.00 nat. median
$7,527
1.0× median
CP17640152376430764
CDM 		Ado-trastuzumab Emtansine 160 Mg Rec [Chas] 4 $3,469.00 $9,415.00 $7,433.00 nat. median
$7,433
1.0× median
CP17640152376535038
CDM 		Pegfilgrastim 6 Mg/0.6 Ml Syringe [Chas] 4 $3,411.00 $9,259.00 $7,309.50 nat. median
$7,310
1.0× median
CP17640152376531430
CDM 		Pembrolizumab 25 Mg/ml4 Ml Sdv [Chas] 4 $3,319.00 $9,010.00 $7,113.00 nat. median
$7,113
1.0× median
1601964
CDM 		Triathlon Cr Fem Component-beaded W/pa 4 $2,924.00 $7,937.00 $6,266.00 nat. median
$466
outlier · 13.4×
1601918
CDM 		Reunion Tsa Cemented Humeral Stem 4 $2,860.00 $7,763.00 $6,129.00 nat. median
$2,024
outlier · 3.0×
64561
CPT 		64561 Implant Neuroelectrodesop Tech 4 $2,831.00 $7,684.00 $6,066.00 nat. median
$6,594
0.9× median
CP17640152376494957
CDM 		Immune Globulin 10%30 Gm / 300 Ml [Chas] 4 $2,785.00 $7,560.00 $5,968.50 nat. median
$5,968
1.0× median
73725
CPT 		MRA Lower Ext With + Without Contrast 4 $2,728.00 $7,404.00 $5,845.50 nat. median
$1,248
outlier · 4.7×
1601680
CDM 		Secur-fit Max 132 Hip Stem #9 4 $2,708.00 $7,351.00 $5,803.50 nat. median
$1,256
outlier · 4.6×
CP17640152376490629
CDM 		Leuprolide 11.25 Mg/3 Months Kit [Chas] 4 $2,685.00 $7,287.00 $5,753.00 nat. median
$5,753
1.0× median
27726
CPT 		27726 Repair Fibula Nonunioned Tech 4 $2,682.00 $7,280.00 $5,747.50 nat. median
$7,265
0.8× median
1602009
CDM 		Restrata-10cm X 12.5cm 4 $2,640.00 $7,167.00 $5,658.00 nat. median
$4,814
1.2× median
74178
CPT 		CT Abdomen/pelvis W/wo Contrastcap Panel 4 $2,626.00 $7,127.00 $5,626.50 nat. median
$1,024
outlier · 5.5×
CP17640152376549064
CDM 		Rituximab 10mg/ml50 Ml Sdv [Chas] 4 $2,574.00 $6,985.00 $5,514.50 nat. median
$5,514
1.0× median
74174
CPT 		CT Angiography Abdomen/pelvis With + Without C 4 $2,560.00 $6,947.00 $5,484.50 nat. median
$988
outlier · 5.5×
52287
CPT 		52287-cysto With Botox-tech 4 $2,501.00 $6,788.00 $5,359.00 nat. median
$2,262
outlier · 2.4×
72157
CPT 		MRI Spine Thoracic With + Without Contrast 4 $2,399.00 $6,512.00 $5,141.00 nat. median
$1,105
outlier · 4.7×
72156
CPT 		MRI Spine Cervical With + Without Contrast 4 $2,399.00 $6,512.00 $5,141.00 nat. median
$1,103
outlier · 4.7×
72158
CPT 		MRI Spine Lumbar With + Without Contrast 4 $2,399.00 $6,512.00 $5,141.00 nat. median
$1,093
outlier · 4.7×
Q4197
HCPCS 		Puraply Am Xt Ef (4.91 X 4.91) 25 Sq Cm 4 $2,398.00 $6,509.00 $5,139.00 nat. median
$210
outlier · 24.4×
125000
CDM 		Lithotripsy Kidney Without Charge 4 $2,391.00 $6,489.00 $5,123.50 nat. median
$249
outlier · 20.6×
CP17640152376493434
CDM 		Leuprolide 22.5 Mg/3 Months Pwd[chas] 4 $2,388.00 $6,481.00 $5,116.50 nat. median
$5,116
1.0× median
CP17640152376475679
CDM 		Durvalumab 50 Mg/ml10 Ml Sol [Chas] 4 $2,380.00 $6,460.00 $5,100.00 nat. median
$5,100
1.0× median
Q4151
HCPCS 		Amnioband Membrane 24 Sq Cm 4 $2,373.00 $6,441.00 $5,085.00 nat. median
$368
outlier · 13.8×
51102
CPT 		51102 Drain Bl W/cath Insertion -ed Tech 4 $2,350.00 $6,379.00 $5,036.50 nat. median
$2,377
outlier · 2.1×
74177
CPT 		CT Scan Of Abdomen And Pelvis With Contrast 4 $2,265.00 $6,147.00 $4,853.00 nat. median
$974
outlier · 5.0×
70546
CPT 		MRA Head With + Without Contrast 4 $2,240.00 $6,080.00 $4,800.00 nat. median
$1,070
outlier · 4.5×
74175
CPT 		CT Angiography Abdomen With + Without Contrast 4 $2,200.00 $5,973.00 $4,715.50 nat. median
$714
outlier · 6.6×
78452
CPT 		Nm Myocardial Spect Multi Rest/stress 4 $2,188.00 $5,939.00 $4,689.00 nat. median
$1,816
outlier · 2.6×
43245
CPT 		43245egd With Dilation Of Gastric/duodenal 4 $2,188.00 $5,938.00 $4,688.00 nat. median
$2,200
outlier · 2.1×
72191
CPT 		CT Angiography Pelvis With + Without Contrast 4 $2,154.00 $5,847.00 $4,616.00 nat. median
$632
outlier · 7.3×
1602155
CDM 		Z1 Std Col Cmtless Sz 3 4 $2,116.00 $5,743.00 $4,534.00 nat. median
$2,652
1.7× median
1602149
CDM 		Z1 Std Col Cmtless Sz 4 4 $2,116.00 $5,743.00 $4,534.00 nat. median
$5,622
0.8× median
CP17640152376552582
CDM 		Trastuzumab Anns 420 Mg Rec [Chas] 4 $2,088.00 $5,668.00 $4,474.50 nat. median
$4,474
1.0× median

Other procedures at this hospital

Browse this hospital's 3,271 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
             
1601800 CDM Tri Ts Femur Right 4 4 $15,619.00 $15,619.00 $5,467.00 $14,838.00 $11,714.50 2025-12-02
1601818 CDM Rest Mod Conical Distal Stem 4 4 $15,142.00 $15,142.00 $5,300.00 $14,385.00 $11,356.50 2025-12-02
1601743 CDM Reunion Tsa Modular Humeral Stem 4 4 $15,142.00 $15,142.00 $5,300.00 $14,385.00 $11,356.50 2025-12-02
1601929 CDM Confirm Rx Icm (Impant Cardiac Monitor) 4 4 $14,560.00 $14,560.00 $5,096.00 $13,832.00 $10,920.00 2025-12-02
CP17640152376526652 CDM Obinutuzumab 25 Mg/ml40 Ml Sdpf [Chas] 4 4 $14,085.00 $14,085.00 $4,930.00 $13,381.00 $10,563.50 2025-12-02
C1764 HCPCS Assert-iq Icm El (Implant Cardiac Monitor) 4 4 $14,000.00 $14,000.00 $4,900.00 $13,300.00 $10,500.00 2025-12-02
CP17640152376551914 CDM Tysabri(natalizumab) 300mg/15ml [Chas] 4 4 $13,870.00 $13,870.00 $4,855.00 $13,177.00 $10,402.50 2025-12-02
C1849 HCPCS Restrata-12.5cm X 17.5cm 4 4 $13,476.00 $13,476.00 $4,717.00 $12,802.00 $10,107.00 2025-12-02
CP17640152376557667 CDM Tenecteplase 25 Mg (Tnkase) Rec [Chas] 4 4 $12,969.00 $12,969.00 $4,539.00 $12,321.00 $9,726.50 2025-12-02
CP17640152376524450 CDM Nivolumab 10 Mg/ml24 Ml Sdpf [Chas] 4 4 $12,487.00 $12,487.00 $4,370.00 $11,863.00 $9,365.50 2025-12-02
CP17640152376558526 CDM Tenecteplase (Tnk) 50 Mg Rec [Chas] 4 4 $12,236.00 $12,236.00 $4,283.00 $11,624.00 $9,177.00 2025-12-02
23410 CPT 23410-repair Rotator Cuff Acute-surg Tech 4 4 $12,054.00 $12,054.00 $4,219.00 $11,451.00 $9,040.50 2025-12-02
CP17640152376476589 CDM Eflapegrastim Xnst 13.2 Mg/0.6 Ml Syrn [Chas] 4 4 $11,725.00 $11,725.00 $4,104.00 $11,139.00 $8,793.50 2025-12-02
50590 CPT 50590 Lithotripsy Esl 4 4 $11,624.00 $11,624.00 $4,068.00 $11,043.00 $8,718.00 2025-12-02
1601817 CDM Rest Mod Prox Cone Body 4 4 $10,642.00 $10,642.00 $3,725.00 $10,110.00 $7,981.50 2025-12-02
CP17640152376524168 CDM Neulasta Onpro Kit 6mg/0.6ml [Chas] 4 4 $10,036.00 $10,036.00 $3,513.00 $9,534.00 $7,527.00 2025-12-02
CP17640152376430764 CDM Ado-trastuzumab Emtansine 160 Mg Rec [Chas] 4 4 $9,911.00 $9,911.00 $3,469.00 $9,415.00 $7,433.00 2025-12-02
CP17640152376535038 CDM Pegfilgrastim 6 Mg/0.6 Ml Syringe [Chas] 4 4 $9,746.00 $9,746.00 $3,411.00 $9,259.00 $7,309.50 2025-12-02
CP17640152376531430 CDM Pembrolizumab 25 Mg/ml4 Ml Sdv [Chas] 4 4 $9,484.00 $9,484.00 $3,319.00 $9,010.00 $7,113.00 2025-12-02
1601964 CDM Triathlon Cr Fem Component-beaded W/pa 4 4 $8,355.00 $8,355.00 $2,924.00 $7,937.00 $6,266.00 2025-12-02
1601918 CDM Reunion Tsa Cemented Humeral Stem 4 4 $8,172.00 $8,172.00 $2,860.00 $7,763.00 $6,129.00 2025-12-02
64561 CPT 64561 Implant Neuroelectrodesop Tech 4 4 $8,088.00 $8,088.00 $2,831.00 $7,684.00 $6,066.00 2025-12-02
CP17640152376494957 CDM Immune Globulin 10%30 Gm / 300 Ml [Chas] 4 4 $7,958.00 $7,958.00 $2,785.00 $7,560.00 $5,968.50 2025-12-02
73725 CPT MRA Lower Ext With + Without Contrast 4 4 $7,794.00 $7,794.00 $2,728.00 $7,404.00 $5,845.50 2025-12-02
1601680 CDM Secur-fit Max 132 Hip Stem #9 4 4 $7,738.00 $7,738.00 $2,708.00 $7,351.00 $5,803.50 2025-12-02
CP17640152376490629 CDM Leuprolide 11.25 Mg/3 Months Kit [Chas] 4 4 $7,671.00 $7,671.00 $2,685.00 $7,287.00 $5,753.00 2025-12-02
27726 CPT 27726 Repair Fibula Nonunioned Tech 4 4 $7,663.00 $7,663.00 $2,682.00 $7,280.00 $5,747.50 2025-12-02
1602009 CDM Restrata-10cm X 12.5cm 4 4 $7,544.00 $7,544.00 $2,640.00 $7,167.00 $5,658.00 2025-12-02
74178 CPT CT Abdomen/pelvis W/wo Contrastcap Panel 4 4 $7,502.00 $7,502.00 $2,626.00 $7,127.00 $5,626.50 2025-12-02
CP17640152376549064 CDM Rituximab 10mg/ml50 Ml Sdv [Chas] 4 4 $7,353.00 $7,353.00 $2,574.00 $6,985.00 $5,514.50 2025-12-02
74174 CPT CT Angiography Abdomen/pelvis With + Without C 4 4 $7,313.00 $7,313.00 $2,560.00 $6,947.00 $5,484.50 2025-12-02
52287 CPT 52287-cysto With Botox-tech 4 4 $7,145.00 $7,145.00 $2,501.00 $6,788.00 $5,359.00 2025-12-02
72158 CPT MRI Spine Lumbar With + Without Contrast 4 4 $6,855.00 $6,855.00 $2,399.00 $6,512.00 $5,141.00 2025-12-02
72157 CPT MRI Spine Thoracic With + Without Contrast 4 4 $6,855.00 $6,855.00 $2,399.00 $6,512.00 $5,141.00 2025-12-02
72156 CPT MRI Spine Cervical With + Without Contrast 4 4 $6,855.00 $6,855.00 $2,399.00 $6,512.00 $5,141.00 2025-12-02
Q4197 HCPCS Puraply Am Xt Ef (4.91 X 4.91) 25 Sq Cm 4 4 $6,852.00 $6,852.00 $2,398.00 $6,509.00 $5,139.00 2025-12-02
125000 CDM Lithotripsy Kidney Without Charge 4 4 $6,831.00 $6,831.00 $2,391.00 $6,489.00 $5,123.50 2025-12-02
CP17640152376493434 CDM Leuprolide 22.5 Mg/3 Months Pwd[chas] 4 4 $6,822.00 $6,822.00 $2,388.00 $6,481.00 $5,116.50 2025-12-02
CP17640152376475679 CDM Durvalumab 50 Mg/ml10 Ml Sol [Chas] 4 4 $6,800.00 $6,800.00 $2,380.00 $6,460.00 $5,100.00 2025-12-02
Q4151 HCPCS Amnioband Membrane 24 Sq Cm 4 4 $6,780.00 $6,780.00 $2,373.00 $6,441.00 $5,085.00 2025-12-02
51102 CPT 51102 Drain Bl W/cath Insertion -ed Tech 4 4 $6,715.00 $6,715.00 $2,350.00 $6,379.00 $5,036.50 2025-12-02
74177 CPT CT Scan Of Abdomen And Pelvis With Contrast 4 4 $6,471.00 $6,471.00 $2,265.00 $6,147.00 $4,853.00 2025-12-02
70546 CPT MRA Head With + Without Contrast 4 4 $6,400.00 $6,400.00 $2,240.00 $6,080.00 $4,800.00 2025-12-02
74175 CPT CT Angiography Abdomen With + Without Contrast 4 4 $6,287.00 $6,287.00 $2,200.00 $5,973.00 $4,715.50 2025-12-02
78452 CPT Nm Myocardial Spect Multi Rest/stress 4 4 $6,252.00 $6,252.00 $2,188.00 $5,939.00 $4,689.00 2025-12-02
43245 CPT 43245egd With Dilation Of Gastric/duodenal 4 4 $6,251.00 $6,251.00 $2,188.00 $5,938.00 $4,688.00 2025-12-02
72191 CPT CT Angiography Pelvis With + Without Contrast 4 4 $6,155.00 $6,155.00 $2,154.00 $5,847.00 $4,616.00 2025-12-02
1602149 CDM Z1 Std Col Cmtless Sz 4 4 4 $6,045.00 $6,045.00 $2,116.00 $5,743.00 $4,534.00 2025-12-02
1602155 CDM Z1 Std Col Cmtless Sz 3 4 4 $6,045.00 $6,045.00 $2,116.00 $5,743.00 $4,534.00 2025-12-02
CP17640152376552582 CDM Trastuzumab Anns 420 Mg Rec [Chas] 4 4 $5,966.00 $5,966.00 $2,088.00 $5,668.00 $4,474.50 2025-12-02
72147 CPT MRI Spine Thoracic With Contrast 4 4 $5,961.00 $5,961.00 $2,086.00 $5,663.00 $4,471.00 2025-12-02
72149 CPT MRI Spine Lumbar With Contrast 4 4 $5,961.00 $5,961.00 $2,086.00 $5,663.00 $4,471.00 2025-12-02
72142 CPT MRI Spine Cervical With Contrast 4 4 $5,961.00 $5,961.00 $2,086.00 $5,663.00 $4,471.00 2025-12-02
1601972 CDM Ossiofiber Trimmable Fixation Nail System 2.4 X 30mm 4 4 $5,859.00 $5,859.00 $2,051.00 $5,566.00 $4,394.50 2025-12-02
70553 CPT MRI Scan 4 4 $5,817.00 $5,817.00 $2,036.00 $5,526.00 $4,363.00 2025-12-02
72197 CPT MRI Pelvis With + Without Contrast 4 4 $5,807.00 $5,807.00 $2,032.00 $5,517.00 $4,355.50 2025-12-02
71270 CPT CT Chest W/wo Contrastcap Panel 4 4 $5,757.00 $5,757.00 $2,015.00 $5,469.00 $4,317.50 2025-12-02
CP17640152376523509 CDM Nivolumab 10 Mg/ml10 Ml Sdpf [Chas] 4 4 $5,660.00 $5,660.00 $1,981.00 $5,377.00 $4,245.00 2025-12-02
CP17640152376506299 CDM Mepolizumab 100 Mg Vial [Chas] 4 4 $5,626.00 $5,626.00 $1,969.00 $5,345.00 $4,219.50 2025-12-02
70549 CPT MRA Neck With + Without Contrast 4 4 $5,609.00 $5,609.00 $1,963.00 $5,329.00 $4,206.50 2025-12-02
70545 CPT MRA Head With Contrast 4 4 $5,564.00 $5,564.00 $1,947.00 $5,286.00 $4,173.00 2025-12-02
CP17640152376469451 CDM Denosumab 120mg/1.7 Ml Sol[chas] 4 4 $5,545.00 $5,545.00 $1,941.00 $5,268.00 $4,159.00 2025-12-02
74176 CPT CT Abdomen/pelvis Without Contrastcap Panel 4 4 $5,517.00 $5,517.00 $1,931.00 $5,241.00 $4,138.00 2025-12-02
1601657 CDM Cruciate Retaining Femoral 4 4 $5,452.00 $5,452.00 $1,908.00 $5,179.00 $4,089.00 2025-12-02
72148 CPT MRI Scan Of Lower Spinal Canal 4 4 $5,421.00 $5,421.00 $1,897.00 $5,150.00 $4,066.00 2025-12-02
72141 CPT MRI Spine Cervical Without Contrast 4 4 $5,421.00 $5,421.00 $1,897.00 $5,150.00 $4,066.00 2025-12-02
72146 CPT MRI Spine Thoracic Without Contrast 4 4 $5,421.00 $5,421.00 $1,897.00 $5,150.00 $4,066.00 2025-12-02
1601965 CDM Triathlon Tritanium Baseplate 4 4 $5,404.00 $5,404.00 $1,891.00 $5,134.00 $4,053.00 2025-12-02
CP17640152376445173 CDM Antivenin Crotalidae Polyvlnt 1 Gm Vial[chas] 4 4 $5,398.00 $5,398.00 $1,889.00 $5,128.00 $4,048.50 2025-12-02
1601834 CDM Plate Crossdeck 4 4 $5,372.00 $5,372.00 $1,880.00 $5,103.00 $4,029.00 2025-12-02
74170 CPT CT Abdomen With + Without Contrast 4 4 $5,307.00 $5,307.00 $1,857.00 $5,042.00 $3,980.50 2025-12-02
78205 CPT Nm Liver Imaging Spect 4 4 $5,172.00 $5,172.00 $1,810.00 $4,913.00 $3,879.00 2025-12-02
27266 CPT 27266-treat Hip Dislocation -ed Tech 4 4 $5,138.00 $5,138.00 $1,798.00 $4,881.00 $3,853.50 2025-12-02
23665 CPT Treat Dislocation/fracture 4 4 $5,138.00 $5,138.00 $1,798.00 $4,881.00 $3,853.50 2025-12-02
71275 CPT CT Angiography Chest With Contrast 4 4 $5,126.00 $5,126.00 $1,794.00 $4,870.00 $3,844.50 2025-12-02
59510 CPT Obstetric Care, Planned Cesarean Delivery 4 4 $5,098.00 $5,098.00 $1,784.00 $4,843.00 $3,823.50 2025-12-02
75635 CPT CT Angiography Aorta With Runoff 4 4 $5,065.00 $5,065.00 $1,773.00 $4,812.00 $3,798.50 2025-12-02
70544 CPT MRA Head Without Contrast 4 4 $5,060.00 $5,060.00 $1,771.00 $4,807.00 $3,795.00 2025-12-02
70552 CPT MRI Brain With Contrast 4 4 $5,059.00 $5,059.00 $1,771.00 $4,806.00 $3,794.50 2025-12-02
74183 CPT MRI Abdomen With + Without Contrast 4 4 $5,054.00 $5,054.00 $1,769.00 $4,801.00 $3,790.50 2025-12-02
72196 CPT MRI Pelvis With Contrast 4 4 $5,049.00 $5,049.00 $1,767.00 $4,797.00 $3,787.00 2025-12-02
1601971 CDM Ossiofiber Hammertoe Fixation Implant 2.9 X 19mm,angles 10 Degree 4 4 $5,021.00 $5,021.00 $1,757.00 $4,770.00 $3,766.00 2025-12-02
26951 CPT 26951 Amputation Of Finger/thumb Ed Tech 4 4 $5,019.00 $5,019.00 $1,757.00 $4,768.00 $3,764.50 2025-12-02
71552 CPT MRI Chest With + Without Contrast 4 4 $4,982.00 $4,982.00 $1,744.00 $4,733.00 $3,736.50 2025-12-02
CP17640152376494629 CDM Immune Globulin IV-sq 10% Sol20 Gm / 200 Ml [Chas] 4 4 $4,931.00 $4,931.00 $1,726.00 $4,684.00 $3,698.50 2025-12-02
73723 CPT MRI Le Joint With + Without Contrast Right 4 4 $4,895.00 $4,895.00 $1,713.00 $4,650.00 $3,671.00 2025-12-02
73223 CPT MRI Ue Joint With + Without Contrast Left 4 4 $4,895.00 $4,895.00 $1,713.00 $4,650.00 $3,671.00 2025-12-02
70548 CPT MRA Neck With Contrast 4 4 $4,878.00 $4,878.00 $1,707.00 $4,634.00 $3,658.50 2025-12-02
1602004 CDM Plate Maxforce Mtp, Std, 5-5, Right 4 4 $4,779.00 $4,779.00 $1,673.00 $4,540.00 $3,584.00 2025-12-02
CP17640152376460157 CDM Dantrolene 250 Mg Rec [Chas] 4 4 $4,763.00 $4,763.00 $1,667.00 $4,525.00 $3,572.50 2025-12-02
1601741 CDM Solar Shoulder Bipolar Humeral Head 4 4 $4,736.00 $4,736.00 $1,658.00 $4,499.00 $3,552.00 2025-12-02
42821 CPT Tonsillectomy & Adenoidectomy]12 Y/o 4 4 $4,727.00 $4,727.00 $1,654.00 $4,491.00 $3,545.00 2025-12-02
1601956 CDM Flexigraft (Bisected Pat. Ligament) 4 4 $4,722.00 $4,722.00 $1,653.00 $4,486.00 $3,541.50 2025-12-02
72192 CPT CT Pelvis Without Contrast 4 4 $4,706.00 $4,706.00 $1,647.00 $4,471.00 $3,529.50 2025-12-02
70492 CPT CT Soft Tissue Neck With + Without Contrast 4 4 $4,706.00 $4,706.00 $1,647.00 $4,471.00 $3,529.50 2025-12-02
70543 CPT MRI Neck Soft Tissue With + Without Contrast 4 4 $4,683.00 $4,683.00 $1,639.00 $4,449.00 $3,512.00 2025-12-02
59400 CPT Obstetric Care, Planned Vaginal Delivery 4 4 $4,635.00 $4,635.00 $1,622.00 $4,403.00 $3,476.50 2025-12-02
74160 CPT CT Abdomen With Contrast 4 4 $4,614.00 $4,614.00 $1,615.00 $4,383.00 $3,460.50 2025-12-02
70551 CPT MRI Brain Without Contrast 4 4 $4,598.00 $4,598.00 $1,609.00 $4,368.00 $3,448.50 2025-12-02
72195 CPT MRI Pelvis Without Contrast 4 4 $4,592.00 $4,592.00 $1,607.00 $4,362.00 $3,444.00 2025-12-02
CP17640152376495820 CDM Leuprolide 45 Mg/6 Months Syringe [Chas] 4 4 $4,578.00 $4,578.00 $1,602.00 $4,349.00 $3,433.50 2025-12-02
1601602 CDM Plate Small Mtp 4 4 $4,518.00 $4,518.00 $1,581.00 $4,292.00 $3,388.50 2025-12-02
74185 CPT MRA Abdomen With + Without Contrast 4 4 $4,485.00 $4,485.00 $1,570.00 $4,261.00 $3,363.50 2025-12-02
1601801 CDM Tri Ts Baseplate 4 4 $4,477.00 $4,477.00 $1,567.00 $4,253.00 $3,358.00 2025-12-02
72194 CPT CT Pelvis With + Without Contrast 4 4 $4,463.00 $4,463.00 $1,562.00 $4,240.00 $3,347.50 2025-12-02
70547 CPT MRA Neck Without Contrast 4 4 $4,435.00 $4,435.00 $1,552.00 $4,213.00 $3,326.50 2025-12-02
73720 CPT MRI Lower Extremity W + Without Contrast Lt 4 4 $4,424.00 $4,424.00 $1,548.00 $4,203.00 $3,318.00 2025-12-02
Q4118 HCPCS Micromatrix, 1000mg 4 4 $4,403.00 $4,403.00 $1,541.00 $4,183.00 $3,302.50 2025-12-02
74182 CPT MRI Abdomen With Contrast 4 4 $4,393.00 $4,393.00 $1,538.00 $4,173.00 $3,294.50 2025-12-02
71551 CPT MRI Chest With Contrast 4 4 $4,332.00 $4,332.00 $1,516.00 $4,115.00 $3,249.00 2025-12-02
15273 CPT 15273skin Sub Grft T/arm/lg Child -tech 4 4 $4,322.00 $4,322.00 $1,513.00 $4,106.00 $3,241.50 2025-12-02
CP17640152376482910 CDM Goserlin Acetate Implant 10.8mg [Chas] 4 4 $4,318.00 $4,318.00 $1,511.00 $4,102.00 $3,238.50 2025-12-02
70470 CPT CT Head Or Brain With + Without Contrast 4 4 $4,262.00 $4,262.00 $1,492.00 $4,049.00 $3,196.50 2025-12-02
73222 CPT MRI Ue Joint With Contrast Left 4 4 $4,256.00 $4,256.00 $1,490.00 $4,043.00 $3,192.00 2025-12-02
73722 CPT MRI Le Joint With Contrast Left 4 4 $4,256.00 $4,256.00 $1,490.00 $4,043.00 $3,192.00 2025-12-02
72130 CPT CT Spine Thoracic With + Without Contrast 4 4 $4,198.00 $4,198.00 $1,469.00 $3,988.00 $3,148.50 2025-12-02
70488 CPT CT Maxillofacial With + Without Contrast 4 4 $4,198.00 $4,198.00 $1,469.00 $3,988.00 $3,148.50 2025-12-02
74150 CPT CT Abdomen Without Contrast 4 4 $4,194.00 $4,194.00 $1,468.00 $3,984.00 $3,145.50 2025-12-02
70336 CPT MRI Tmj 4 4 $4,176.00 $4,176.00 $1,462.00 $3,967.00 $3,132.00 2025-12-02
77084 CPT MRI Bone Marrow Blood 4 4 $4,176.00 $4,176.00 $1,462.00 $3,967.00 $3,132.00 2025-12-02
73220 CPT MRI Upper Extremity With + Without Contrast Rt 4 4 $4,146.00 $4,146.00 $1,451.00 $3,939.00 $3,109.50 2025-12-02
36569 CPT Insertion Of Picc 4 4 $4,141.00 $4,141.00 $1,449.00 $3,934.00 $3,105.50 2025-12-02
73219 CPT MRI Upper Extremity With Contrast Rt 4 4 $4,136.00 $4,136.00 $1,448.00 $3,929.00 $3,102.00 2025-12-02
1601802 CDM Tibial Bearing Insert -ps 4 4 $4,130.00 $4,130.00 $1,446.00 $3,924.00 $3,097.50 2025-12-02
1601808 CDM Tibial Bearing Insertcs 4 4 $4,130.00 $4,130.00 $1,446.00 $3,924.00 $3,097.50 2025-12-02
1601982 CDM Anterior Midshaft Plate 7 Hole 4 4 $4,127.00 $4,127.00 $1,444.00 $3,921.00 $3,095.00 2025-12-02
71260 CPT CT Chest W/contrast 4 4 $4,112.00 $4,112.00 $1,439.00 $3,906.00 $3,084.00 2025-12-02
70491 CPT CT Soft Tissue Neck With Contrast 4 4 $4,092.00 $4,092.00 $1,432.00 $3,887.00 $3,069.00 2025-12-02
70542 CPT MRI Neck Soft Tissue With Contrast 4 4 $4,072.00 $4,072.00 $1,425.00 $3,868.00 $3,054.00 2025-12-02
1601607 CDM Mini Ignite Bma Kit/dbm 4 4 $4,033.00 $4,033.00 $1,412.00 $3,831.00 $3,025.00 2025-12-02
125004 CDM Or-intermediate First 30 Charge 4 4 $4,016.00 $4,016.00 $1,406.00 $3,815.00 $3,012.00 2025-12-02
1601904 CDM Primary Tritanium Hemi Cluster Hole Cup 4 4 $4,016.00 $4,016.00 $1,406.00 $3,815.00 $3,012.00 2025-12-02
1601943 CDM Restrata-2.5cm X 7.5cm 4 4 $4,016.00 $4,016.00 $1,406.00 $3,815.00 $3,012.00 2025-12-02
1601916 CDM Quickclip Pro 4 4 $3,996.00 $3,996.00 $1,399.00 $3,796.00 $2,997.00 2025-12-02
74181 CPT MRI Abdomen Without Contrast 4 4 $3,994.00 $3,994.00 $1,398.00 $3,794.00 $2,995.50 2025-12-02
1601659 CDM Tibial Bearing Insert-cr 4 4 $3,971.00 $3,971.00 $1,390.00 $3,772.00 $2,978.00 2025-12-02
71550 CPT MRI Chest Without Contrast 4 4 $3,939.00 $3,939.00 $1,379.00 $3,742.00 $2,954.00 2025-12-02
71555 CPT 71555 MRA Chest Without Contrast 4 4 $3,935.00 $3,935.00 $1,377.00 $3,738.00 $2,951.50 2025-12-02
1601627 CDM Hyprocure 4 4 $3,934.00 $3,934.00 $1,377.00 $3,737.00 $2,950.50 2025-12-02
1602153 CDM G7 Vit E Neutral Lnr 32mm B 4 4 $3,934.00 $3,934.00 $1,377.00 $3,737.00 $2,950.50 2025-12-02
1602148 CDM G7 Vit E Neutral Lnr 32mm C 4 4 $3,934.00 $3,934.00 $1,377.00 $3,737.00 $2,950.50 2025-12-02
1601973 CDM Ossiofiber Cannulated Trimmable Fixation Nail System 3.0x50mm 4 4 $3,926.00 $3,926.00 $1,374.00 $3,730.00 $2,944.50 2025-12-02
72131 CPT CT Spine Lumbar Without Contrast 4 4 $3,902.00 $3,902.00 $1,366.00 $3,707.00 $2,926.50 2025-12-02
71250 CPT CT Chest Without Contrastcap Panel 4 4 $3,886.00 $3,886.00 $1,360.00 $3,692.00 $2,914.50 2025-12-02
72193 CPT CT Scan Of Pelvis With Contrast 4 4 $3,882.00 $3,882.00 $1,359.00 $3,688.00 $2,911.50 2025-12-02
73721 CPT MRI Scan Of Leg Joint 4 4 $3,869.00 $3,869.00 $1,354.00 $3,676.00 $2,901.50 2025-12-02
73221 CPT MRI Ue Joint Without Contrast Left 4 4 $3,869.00 $3,869.00 $1,354.00 $3,676.00 $2,901.50 2025-12-02
1601927 CDM Screw Compression Cannulated 4 4 $3,822.00 $3,822.00 $1,338.00 $3,631.00 $2,866.50 2025-12-02
Q4166 HCPCS Wound Matrix 3-layer 7 X 10 4 4 $3,817.00 $3,817.00 $1,336.00 $3,626.00 $2,863.00 2025-12-02
CP17640152376530039 CDM Pegfilgrastim Jmdb 6 Mg/0.6 Ml [Chas] 4 4 $3,776.00 $3,776.00 $1,322.00 $3,587.00 $2,832.00 2025-12-02
73218 CPT MRI Upper Extremity Without Contrast Lt 4 4 $3,761.00 $3,761.00 $1,316.00 $3,573.00 $2,821.00 2025-12-02
72125 CPT CT Spine Cervical Without Contrast 4 4 $3,746.00 $3,746.00 $1,311.00 $3,559.00 $2,809.50 2025-12-02
70487 CPT CT Maxillofacial With Contrast 4 4 $3,745.00 $3,745.00 $1,311.00 $3,558.00 $2,809.00 2025-12-02
70490 CPT CT Soft Tissue Neck Without Contrast 4 4 $3,719.00 $3,719.00 $1,302.00 $3,533.00 $2,789.50 2025-12-02
70460 CPT CT Head Or Brain With Contrast 4 4 $3,708.00 $3,708.00 $1,298.00 $3,523.00 $2,781.00 2025-12-02
70540 CPT MRI Neck Soft Tissue Without Contrast 4 4 $3,703.00 $3,703.00 $1,296.00 $3,518.00 $2,777.50 2025-12-02
1601804 CDM Tri Cemented Stem 4 4 $3,701.00 $3,701.00 $1,295.00 $3,516.00 $2,776.00 2025-12-02
1601761 CDM Omnifit Eon (Cemented Hip Stem) 4 4 $3,692.00 $3,692.00 $1,292.00 $3,507.00 $2,769.00 2025-12-02
70496 CPT CT Angiography Head With + Without Contrast 4 4 $3,692.00 $3,692.00 $1,292.00 $3,507.00 $2,769.00 2025-12-02
1601922 CDM Humeral Sutureplate, 3-hole 4 4 $3,665.00 $3,665.00 $1,283.00 $3,482.00 $2,748.50 2025-12-02
1601658 CDM Primary Tibial Baseplate 4 4 $3,665.00 $3,665.00 $1,283.00 $3,482.00 $2,748.50 2025-12-02
73701 CPT CT Lower Extremity With Contrast Left 4 4 $3,651.00 $3,651.00 $1,278.00 $3,468.00 $2,738.00 2025-12-02
54150 CPT Circumcision Charge 4 4 $3,648.00 $3,648.00 $1,277.00 $3,466.00 $2,736.00 2025-12-02
CP17640152376480035 CDM Golimumab 50 Mg/4 Ml Sol [Chas] 4 4 $3,624.00 $3,624.00 $1,268.00 $3,443.00 $2,718.00 2025-12-02
1601788 CDM Reunion Tsa Single Radius Humeral Head 4 4 $3,568.00 $3,568.00 $1,249.00 $3,390.00 $2,676.00 2025-12-02
1601677 CDM Trident Psl Ha Cluster 50mm 4 4 $3,550.00 $3,550.00 $1,243.00 $3,373.00 $2,662.50 2025-12-02
1601678 CDM Trident 10 Degreex3 Insert 36mm Id 4 4 $3,550.00 $3,550.00 $1,243.00 $3,373.00 $2,662.50 2025-12-02
1601751 CDM C-taper Cocr Lfit Head 4 4 $3,550.00 $3,550.00 $1,243.00 $3,373.00 $2,662.50 2025-12-02
1601750 CDM Biolox Delta Univer Taper Anatonic Head 4 4 $3,550.00 $3,550.00 $1,243.00 $3,373.00 $2,662.50 2025-12-02
1601681 CDM C-taper Biolox Delta Head 36mm/-5 4 4 $3,550.00 $3,550.00 $1,243.00 $3,373.00 $2,662.50 2025-12-02
70498 CPT CT Angiography Neck W/wo Contrast 4 4 $3,550.00 $3,550.00 $1,243.00 $3,373.00 $2,662.50 2025-12-02
1602137 CDM Carbofix Distal Volar Radius Plate 3 Holes-right 4 4 $3,500.00 $3,500.00 $1,225.00 $3,325.00 $2,625.00 2025-12-02
1602152 CDM G7 Pps Ltd Acet Shell 46b 4 4 $3,500.00 $3,500.00 $1,225.00 $3,325.00 $2,625.00 2025-12-02
73201 CPT CT Upper Extremity With Contrast Left 4 4 $3,500.00 $3,500.00 $1,225.00 $3,325.00 $2,625.00 2025-12-02
1602147 CDM G7 Pps Ltd Acet Shell 48c 4 4 $3,500.00 $3,500.00 $1,225.00 $3,325.00 $2,625.00 2025-12-02
73718 CPT MRI Le Without Contrast Lt 4 4 $3,498.00 $3,498.00 $1,224.00 $3,323.00 $2,623.50 2025-12-02
81162 CPT Brca1 & Brca2 Panel Pspc 4 4 $3,473.00 $3,473.00 $1,216.00 $3,299.00 $2,605.00 2025-12-02
72128 CPT CT Spine Thoracic Without Contrast 4 4 $3,464.00 $3,464.00 $1,212.00 $3,291.00 $2,598.00 2025-12-02
45384 CPT Lesion Remove Colonoscopy 4 4 $3,399.00 $3,399.00 $1,190.00 $3,229.00 $2,549.00 2025-12-02
70482 CPT CT Iac With + Without Contrast 4 4 $3,396.00 $3,396.00 $1,189.00 $3,226.00 $2,547.00 2025-12-02
70450 CPT CT Scan 4 4 $3,371.00 $3,371.00 $1,180.00 $3,202.00 $2,528.00 2025-12-02
1601805 CDM Tri Stem Extender 4 4 $3,359.00 $3,359.00 $1,176.00 $3,191.00 $2,519.50 2025-12-02
CP17640152376479892 CDM Doxorubicin Liposomal 2 Mg/ml Dsp25 Ml Sdv [Chas] 4 4 $3,356.00 $3,356.00 $1,175.00 $3,188.00 $2,517.00 2025-12-02
1601803 CDM Tri Rm/ll Ti B Aug 4 4 $3,336.00 $3,336.00 $1,168.00 $3,169.00 $2,502.00 2025-12-02
120000 CDM Delivery Service 4 4 $3,334.00 $3,334.00 $1,167.00 $3,167.00 $2,500.50 2025-12-02
25520 CPT 25520-treat Fracture Of Radiused Tech 4 4 $3,331.00 $3,331.00 $1,166.00 $3,164.00 $2,498.50 2025-12-02
73700 CPT CT Lower Extremity Without Contrast Left 4 4 $3,319.00 $3,319.00 $1,162.00 $3,153.00 $2,489.50 2025-12-02
72133 CPT CT Spine Lumbar With + Without Contrast 4 4 $3,296.00 $3,296.00 $1,154.00 $3,131.00 $2,472.00 2025-12-02
1602008 CDM Speedbridge Kit 4 4 $3,294.00 $3,294.00 $1,153.00 $3,129.00 $2,470.50 2025-12-02
CP17640152376466313 CDM Denosumab 60 Mg[chas] 4 4 $3,240.00 $3,240.00 $1,134.00 $3,078.00 $2,430.00 2025-12-02
43250 CPT Egd With Polypectemy By Hot Biopsy Forceps 4 4 $3,190.00 $3,190.00 $1,117.00 $3,031.00 $2,392.50 2025-12-02
73200 CPT CT Upper Extremity Without Contrast Left 4 4 $3,183.00 $3,183.00 $1,114.00 $3,024.00 $2,387.00 2025-12-02
73706 CPT CT Angiography Lower Extremity Left 4 4 $3,167.00 $3,167.00 $1,108.00 $3,009.00 $2,375.00 2025-12-02
1601877 CDM Plate Iso 4 4 $3,083.00 $3,083.00 $1,079.00 $2,929.00 $2,312.00 2025-12-02
1601988 CDM Suture Anchor Biocomposite Suture Tak Small Joint 4 4 $3,083.00 $3,083.00 $1,079.00 $2,929.00 $2,312.00 2025-12-02
1601966 CDM Tritanium Asymmetric Metal Backed Patella 4 4 $3,083.00 $3,083.00 $1,079.00 $2,929.00 $2,312.00 2025-12-02
64479 CPT Inj Foramen Epidural C/t 4 4 $3,077.00 $3,077.00 $1,077.00 $2,923.00 $2,308.00 2025-12-02
43251 CPT Remove Lesion Snare Tech 4 4 $3,069.00 $3,069.00 $1,074.00 $2,916.00 $2,301.50 2025-12-02
43249 CPT Esoph Egd Dilation <30 Mm- Facility 4 4 $3,069.00 $3,069.00 $1,074.00 $2,916.00 $2,301.50 2025-12-02
47562 CPT Removal Of Gallbladder Using An Endoscope 8 4 $5,467.50 $5,467.50 $450.00 $9,167.00 $2,299.50 2025-12-02
52310 CPT 52310 -cystoscopy And Treatment -tech 4 4 $3,050.00 $3,050.00 $1,068.00 $2,898.00 $2,287.50 2025-12-02
93306 CPT US Echocardiogram Complete 4 4 $3,048.00 $3,048.00 $1,067.00 $2,896.00 $2,286.00 2025-12-02
1601608 CDM Fusion Flex Allograft 4 4 $3,031.00 $3,031.00 $1,061.00 $2,879.00 $2,273.50 2025-12-02
78227 CPT Nm Hida Scan With Cck 4 4 $3,013.00 $3,013.00 $1,055.00 $2,862.00 $2,259.50 2025-12-02
CP17640152376423795 CDM Abatacept 250 Mg Rec [Chas] 4 4 $3,001.00 $3,001.00 $1,050.00 $2,851.00 $2,251.00 2025-12-02
CP17640152376436624 CDM Ado-trastuzumab Emtansine 100 Mg Rec [Chas] 4 4 $3,001.00 $3,001.00 $1,050.00 $2,851.00 $2,251.00 2025-12-02
36556 CPT 36556 Insertion Of Central Line Clinic Charge 4 4 $2,998.00 $2,998.00 $1,049.00 $2,848.00 $2,248.50 2025-12-02
45331 CPT 45331-sigmoidoscopy & Biopsy-tech 4 4 $2,992.00 $2,992.00 $1,047.00 $2,842.00 $2,244.00 2025-12-02
CP17640152376545661 CDM Romosozumab 105 Mg/1.17 Ml Sol [Chas] 4 4 $2,977.00 $2,977.00 $1,042.00 $2,828.00 $2,233.00 2025-12-02
78582 CPT Nm Lung Ventilation & Perfusion 4 4 $2,974.00 $2,974.00 $1,041.00 $2,825.00 $2,230.50 2025-12-02
1601872 CDM Implant Large Cannulated 4 4 $2,964.00 $2,964.00 $1,037.00 $2,816.00 $2,223.00 2025-12-02
1602020 CDM Tritanium Symmetric Metal Backed Patella 4 4 $2,964.00 $2,964.00 $1,037.00 $2,816.00 $2,223.00 2025-12-02
1601974 CDM Internal Brace Kit W/cc Ft And Jumpstart 4 4 $2,955.00 $2,955.00 $1,034.00 $2,807.00 $2,216.00 2025-12-02
1601987 CDM K-less Tightrope Assembly W/inserter 4 4 $2,955.00 $2,955.00 $1,034.00 $2,807.00 $2,216.00 2025-12-02
70481 CPT CT Iac With Contrast 4 4 $2,951.00 $2,951.00 $1,033.00 $2,803.00 $2,213.00 2025-12-02
1601944 CDM Micromatrix, 500mg 4 4 $2,949.00 $2,949.00 $1,032.00 $2,802.00 $2,212.00 2025-12-02
44385 CPT Endoscopic Evaluation Of Small Intestinal Pouch; Diagnostic, With/without Collec… 4 4 $2,918.00 $2,918.00 $1,021.00 $2,772.00 $2,188.50 2025-12-02
CP17640152376480505 CDM Hyaluronanate Sodium 88 Mg/4 Ml Syrn [Chas] 4 4 $2,905.00 $2,905.00 $1,017.00 $2,760.00 $2,179.00 2025-12-02
49083 CPT 49083- Abd Paracentesis With Imaging -tech 4 4 $2,892.00 $2,892.00 $1,012.00 $2,747.00 $2,169.00 2025-12-02
CP17640152376541850 CDM Prothrombin Complex 500 Units[chas] 4 4 $2,881.00 $2,881.00 $1,008.00 $2,737.00 $2,160.50 2025-12-02
23605 CPT 23605 Cltx Prox Humrl Fx W/manj W/wo Skeletal Tracj Techfee 4 4 $2,844.00 $2,844.00 $995.00 $2,702.00 $2,133.00 2025-12-02
27818 CPT 27818 Cltx Trimalleolar Ankle Fx W/manipulation Techfee 4 4 $2,824.00 $2,824.00 $988.00 $2,683.00 $2,118.00 2025-12-02
CP17640152376491059 CDM Leuprolide 22.5 Mg/3 Months [Chas] 4 4 $2,801.00 $2,801.00 $980.00 $2,661.00 $2,101.00 2025-12-02
CP17640152376521567 CDM Nivolumab 10 Mg/ml4 Ml Sdpf [Chas] 4 4 $2,801.00 $2,801.00 $980.00 $2,661.00 $2,101.00 2025-12-02
CP17640152376514766 CDM Mitomycin 40 Mg Rec [Chas] 4 4 $2,801.00 $2,801.00 $980.00 $2,661.00 $2,101.00 2025-12-02
78306 CPT Nm Bone Imaging Whole Body 4 4 $2,782.00 $2,782.00 $974.00 $2,643.00 $2,086.50 2025-12-02
1601764 CDM Uhr Universal Head Bipolar Component 4 4 $2,775.00 $2,775.00 $971.00 $2,636.00 $2,081.50 2025-12-02
1601779 CDM Stimulan Paste Kit Rapid Cure 10cc 4 4 $2,775.00 $2,775.00 $971.00 $2,636.00 $2,081.50 2025-12-02
25565 CPT 25565 Closed Tx Radial&ulnar Shaft Fractures W/manj Techfee 4 4 $2,748.00 $2,748.00 $962.00 $2,611.00 $2,061.00 2025-12-02
125007 CDM Or-simple First 30 Min Charge 4 4 $2,706.00 $2,706.00 $947.00 $2,571.00 $2,029.50 2025-12-02
70480 CPT CT Iac Without Contrast 4 4 $2,685.00 $2,685.00 $940.00 $2,551.00 $2,013.50 2025-12-02
1601740 CDM Solar Shoulder Bipolar Modular Head 4 4 $2,672.00 $2,672.00 $935.00 $2,538.00 $2,004.00 2025-12-02
CP17640152376481101 CDM Hyaluronate Sod 48 Mg/6 Ml Syringe[chas] 4 4 $2,655.00 $2,655.00 $929.00 $2,522.00 $1,991.00 2025-12-02
1601709 CDM Asymmetric Patella 4 4 $2,634.00 $2,634.00 $922.00 $2,502.00 $1,975.50 2025-12-02
43247 CPT Operative Upper Gi Charge 4 4 $2,631.00 $2,631.00 $921.00 $2,499.00 $1,973.50 2025-12-02
70486 CPT CT Maxillofacial Without Contrast 4 4 $2,620.00 $2,620.00 $917.00 $2,489.00 $1,965.00 2025-12-02
78315 CPT Nm Bone Three Phase Study 4 4 $2,612.00 $2,612.00 $914.00 $2,481.00 $1,959.00 2025-12-02
43255 CPT 43255-egd Control Bleeding Polyp-surg Tech 4 4 $2,587.00 $2,587.00 $905.00 $2,458.00 $1,940.50 2025-12-02
24605 CPT 24605 Dislocation Elbow W/anes Techfee 4 4 $2,569.00 $2,569.00 $899.00 $2,441.00 $1,926.50 2025-12-02
25505 CPT 25505-treat Fracture Of Radius-ER Tech 4 4 $2,564.00 $2,564.00 $897.00 $2,436.00 $1,923.00 2025-12-02
1601503 CDM Mesh Composite 15x20cm 4 4 $2,563.00 $2,563.00 $897.00 $2,435.00 $1,922.50 2025-12-02
Q4101 HCPCS Apligraf 44 Sq Cm 4 4 $2,559.00 $2,559.00 $896.00 $2,431.00 $1,919.50 2025-12-02
G0105 HCPCS Colorectal Screen; Hi Risk Ind 4 4 $2,552.00 $2,552.00 $893.00 $2,424.00 $1,914.00 2025-12-02
78472 CPT Nm Cardiac Blood Pool Gated Single 4 4 $2,543.00 $2,543.00 $890.00 $2,416.00 $1,907.50 2025-12-02
CP17640152376474973 CDM Ferric Carboxymaltose (Elemental Iron) 50 Mg/ml15 Ml Sdv [Chas] 4 4 $2,516.00 $2,516.00 $881.00 $2,390.00 $1,887.00 2025-12-02
78290 CPT Nm Bowel Image (Meckel`s) 4 4 $2,511.00 $2,511.00 $879.00 $2,385.00 $1,883.00 2025-12-02
21320 CPT 21320 Closed Tx Nose Fx W/stabljed Tech 4 4 $2,494.00 $2,494.00 $873.00 $2,369.00 $1,870.50 2025-12-02
21315 CPT 21315- Closed Tx Nose Fx Without Stablj -ER Tech 4 4 $2,494.00 $2,494.00 $873.00 $2,369.00 $1,870.50 2025-12-02
52000 CPT Cystourethroscopy Charge 4 4 $2,479.00 $2,479.00 $868.00 $2,355.00 $1,859.00 2025-12-02
1601660 CDM Symmetric Patella 4 4 $2,462.00 $2,462.00 $862.00 $2,339.00 $1,846.50 2025-12-02
54160 CPT Circumcision Neonate Charge 4 4 $2,417.00 $2,417.00 $846.00 $2,296.00 $1,813.00 2025-12-02
62321 CPT Epidural Cervical Or Thoracic W/imaging Guidance 4 4 $2,415.00 $2,415.00 $845.00 $2,294.00 $1,811.50 2025-12-02
CP17640152376523204 CDM Onabotulinumtoxina 200 Units Rec [Chas] 4 4 $2,412.00 $2,412.00 $844.00 $2,291.00 $1,809.00 2025-12-02
G0121 HCPCS Cscope Screening Charge 4 4 $2,400.00 $2,400.00 $840.00 $2,280.00 $1,800.00 2025-12-02
36573 CPT 36573- Insj Picc Rs&i 5 Yr+ -tech 4 4 $2,393.00 $2,393.00 $838.00 $2,273.00 $1,794.50 2025-12-02
44388 CPT Colonoscopy Thru Stoma Spxfacility 4 4 $2,388.00 $2,388.00 $836.00 $2,269.00 $1,791.00 2025-12-02
64451 CPT 64451 Injection Anesthetic Sacroiliac Joint 4 4 $2,368.00 $2,368.00 $829.00 $2,250.00 $1,776.00 2025-12-02
49020 CPT 49020-drainage Abdom Abscess Open Tech 4 4 $2,350.00 $2,350.00 $823.00 $2,233.00 $1,762.50 2025-12-02
CP17640152376475750 CDM Durvalumab 50 Mg/ml2.4 Ml Sol [Chas] 4 4 $2,327.00 $2,327.00 $814.00 $2,211.00 $1,745.00 2025-12-02
45388 CPT Colonoscopy With Ablation-tech 4 4 $2,301.00 $2,301.00 $805.00 $2,186.00 $1,726.00 2025-12-02
78278 CPT Nm Gi Bleed Scan 4 4 $2,275.00 $2,275.00 $796.00 $2,161.00 $1,706.50 2025-12-02
1601491 CDM Aris Trans-obturator Kit 4 4 $2,263.00 $2,263.00 $792.00 $2,150.00 $1,697.50 2025-12-02
CP17640151597113408 CDM Dbx Bone Matrix Paste 4 4 $2,255.00 $2,255.00 $789.00 $2,142.00 $1,691.00 2025-12-02
45381 CPT Cscope W/injection Charge 4 4 $2,251.00 $2,251.00 $788.00 $2,138.00 $1,688.00 2025-12-02
105002 CDM Room/bed: Acute Isolation 4 4 $2,247.00 $2,247.00 $786.00 $2,135.00 $1,685.50 2025-12-02
105001 CDM Room/bed: Acute Monitored 4 4 $2,247.00 $2,247.00 $786.00 $2,135.00 $1,685.50 2025-12-02
CP17640152376484832 CDM Hyaluronate Sodium/cross Linkd 30mg/3mlsyringe[chas] 4 4 $2,233.00 $2,233.00 $782.00 $2,121.00 $1,675.00 2025-12-02
78264 CPT Nm Gastric Emptying Study 4 4 $2,218.00 $2,218.00 $776.00 $2,107.00 $1,663.50 2025-12-02
1602150 CDM Biolox Delta Hd 12/14 32x-3.5 4 4 $2,217.00 $2,217.00 $776.00 $2,106.00 $1,663.00 2025-12-02
1601763 CDM C-taper Lfit Interhead 4 4 $2,158.00 $2,158.00 $755.00 $2,050.00 $1,618.50 2025-12-02
1601816 CDM V40 Corc Lfit Head 4 4 $2,158.00 $2,158.00 $755.00 $2,050.00 $1,618.50 2025-12-02
CP17640152376478215 CDM Epoetin Alfa 40,000 Units/ml Pf Sdv [Chas] 4 4 $2,151.00 $2,151.00 $753.00 $2,043.00 $1,613.00 2025-12-02
CP17640152376521013 CDM Omalizumab 150 Mg Vial[chas] 4 4 $2,151.00 $2,151.00 $753.00 $2,043.00 $1,613.00 2025-12-02
1601977 CDM Internalbrace Ligament Augmentaion Repair 4 4 $2,125.00 $2,125.00 $744.00 $2,019.00 $1,593.50 2025-12-02
93350 CPT US Echo 2d Complete-stress 4 4 $2,094.00 $2,094.00 $733.00 $1,989.00 $1,570.50 2025-12-02
C1713 HCPCS Omega, 4.75mm Peek Knotless Anchor System, Dbl-dbl 8 4 $2,258.50 $2,258.50 $583.00 $2,708.00 $1,567.00 2025-12-02
45330 CPT 45330 Sigmoidoscopy Dx Pttech 4 4 $2,083.00 $2,083.00 $729.00 $1,979.00 $1,562.00 2025-12-02
93880 CPT US Carotid Duplex Bilateral 4 4 $2,066.00 $2,066.00 $723.00 $1,963.00 $1,549.50 2025-12-02
1601942 CDM Restrata-2.5cm X 2.5cm 4 4 $2,062.00 $2,062.00 $722.00 $1,959.00 $1,546.50 2025-12-02
G0390 HCPCS G0390 Trauma Charge 4 4 $2,060.00 $2,060.00 $721.00 $1,957.00 $1,545.00 2025-12-02
J7298 HCPCS J7298 IUD Mirena Charge Chas 4 4 $2,046.00 $2,046.00 $716.00 $1,944.00 $1,534.50 2025-12-02
78305 CPT Nm Bone Joint Imaging Multi 4 4 $2,035.00 $2,035.00 $712.00 $1,933.00 $1,526.50 2025-12-02
23655 CPT 23655 Clsd Tx Shoulder Dislc W/manipulation Req Anes Techfee 8 4 $2,135.00 $2,135.00 $596.00 $2,439.00 $1,523.50 2025-12-02
P9037 HCPCS Aph Plt Acda Lr Irr 1 4 4 $2,022.00 $2,022.00 $708.00 $1,921.00 $1,516.50 2025-12-02
1601945 CDM Wound Matrix 3-layer 5 X 5 Cm 4 4 $2,011.00 $2,011.00 $704.00 $1,910.00 $1,508.00 2025-12-02
78708 CPT Nm Kidney Imaging With Flow With Pharm 4 4 $2,009.00 $2,009.00 $703.00 $1,909.00 $1,506.50 2025-12-02
J7296 HCPCS J7296 IUD Kyleena (Levonorgestrel) 17.5 Mcg/hr [Chas] 4 4 $1,983.00 $1,983.00 $694.00 $1,884.00 $1,487.00 2025-12-02
78320 CPT Nm Bone Spect 4 4 $1,983.00 $1,983.00 $694.00 $1,884.00 $1,487.00 2025-12-02
J7307 HCPCS J7307 Etonogestrel Implant (Implanon) 4 4 $1,979.00 $1,979.00 $693.00 $1,880.00 $1,484.00 2025-12-02
CP17640152376541806 CDM Rituximab 10mg/1 Ml10 Ml Sdv [Chas] 4 4 $1,942.00 $1,942.00 $680.00 $1,845.00 $1,456.50 2025-12-02
93970 CPT Dup-scan Xtr Veins Complete Bilateral Study 4 4 $1,935.00 $1,935.00 $677.00 $1,838.00 $1,451.50 2025-12-02
CP17640152376482156 CDM Hydroxocobalamin 5 G Rec[chas] 4 4 $1,908.00 $1,908.00 $668.00 $1,813.00 $1,431.00 2025-12-02
CP17640152376476695 CDM Ferumoxytol 510 Mg/17 Ml [Chas] 4 4 $1,872.00 $1,872.00 $655.00 $1,778.00 $1,404.00 2025-12-02
1601548 CDM Ligasure Impact 36mm-18cm 4 4 $1,845.00 $1,845.00 $646.00 $1,753.00 $1,384.00 2025-12-02
93017 CPT 93017 Exercise Stress Test Chargetracing [Chas] 4 4 $1,841.00 $1,841.00 $644.00 $1,749.00 $1,380.50 2025-12-02
88185 CPT Flow Cytometry Ea Addl Marker, Pspc 4 4 $1,825.00 $1,825.00 $639.00 $1,734.00 $1,368.50 2025-12-02
64493 CPT Facet Joint Inj 4 4 $1,810.00 $1,810.00 $634.00 $1,720.00 $1,357.50 2025-12-02
64490 CPT Inject Paravertebral Facet Joint Single Level 4 4 $1,802.00 $1,802.00 $631.00 $1,712.00 $1,351.50 2025-12-02
1601968 CDM Pack Tx- Bone Procedure 4 4 $1,783.00 $1,783.00 $624.00 $1,694.00 $1,337.00 2025-12-02
78300 CPT Nm Bone Joint Imaging Limited 4 4 $1,777.00 $1,777.00 $622.00 $1,688.00 $1,333.00 2025-12-02
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