Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

GORDON MEMORIAL HOSPITAL DISTRICT

Gordon, NE · CCN 281358 · Rates published

3,489 distinct procedures filed
4 distinct payers
22,120 rate rows
2026-06-09 last MRF observed
Data quality

21,996 of 22,120 rate rows are consumer-grade (99.4%)

124 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
template filing: same amount across many unrelated codes — excluded 61
per-diem day rate — not a per-procedure price 39
exceeds 10× this hospital's gross charge — excluded from medians 24
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://secure.claraprice.net/price-transparency/FSVG-1715881425274/machine-readable/470533032_gordon-memorial-hospital_standardcharges.json
Found on page https://secure.claraprice.net/price-transparency/gordon-memorial-ne
Discovered viaDiscovered by HANK
Last fetch success · 2026-09-25
Content fingerprint af8c790f3a96bee7… · 9,018,995 bytes · first seen 2026-09-25

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
2501216
CDM 		Ocrelizumab 300mg/10ml Vial 4 $20,012.00 $39,606.00 $39,190.00 nat. median
$39,190
1.0× median
74501
CPT 		Skyrizi 600mg/10ml Vial 4 $9,798.00 $19,392.00 $19,188.00 nat. median
$21,368
0.9× median
2500009
CDM 		Activase 100mg Vial 4 $6,336.00 $12,541.00 $12,409.00 nat. median
$19
outlier · 653.1×
74334
CPT 		Leuprolide Acetate 22.5mg Syringe Kit 4 $6,305.00 $12,478.00 $12,347.00 nat. median
$1,244
outlier · 9.9×
2500383
CDM 		Neulasta 6 Mg/0.6 Ml Inj 4 $6,285.00 $12,438.00 $12,307.00 nat. median
$3
outlier · 4102.3×
2502137
CDM 		Neulasta Onpro Kit 6mg/0.6ml 4 $6,285.00 $12,438.00 $12,307.00 nat. median
$12,307
1.0× median
2500538
CDM 		Tnkase 50mg Vial 4 $6,213.00 $12,297.00 $12,167.00 nat. median
$26
outlier · 459.1×
2500380
CDM 		Natalizumab 300mg/15ml Vial 4 $6,147.00 $12,167.00 $12,039.00 nat. median
$3
outlier · 4013.0×
2501807-#N
CDM 		Gamunex-c 10% 400ml Vial 4 $6,000.00 $11,876.00 $11,751.00 nat. median
$11,751
1.0× median
31017
CPT 		Fasenra 30mg/ml Syringe 4 $5,725.00 $11,332.00 $11,212.00 nat. median
$13,950
0.8× median
58551
CPT 		Lavh < 250g With Removal Of Tubes/ovaries 4 $1,394.00 $21,850.00 $11,040.00 nat. median
$6,500
1.7× median
27137
CPT 		Pf Mc Revise Hip Joint Replacement 4 $1,187.00 $37,050.00 $10,653.00 nat. median
$10,335
1.0× median
57265
CPT 		Combine A/p Colporrhapy Enterocele Rpr 4 $702.00 $38,000.00 $10,284.00 nat. median
$5,176
2.0× median
900024
CDM 		Or D 256-270 4 $5,126.00 $10,146.00 $10,039.00 nat. median
$10,039
1.0× median
900023
CDM 		Or D 241-255 4 $4,910.00 $9,719.00 $9,616.00 nat. median
$9,616
1.0× median
2500483
CDM 		Rituximab 500mg/50ml Vial 4 $4,871.00 $9,640.00 $9,538.00 nat. median
$10
outlier · 953.8×
27415
CPT 		Pfmc Pr Osteochondral Knee Allograft 4 $1,136.00 $32,300.00 $9,503.50 nat. median
$9,751
1.0× median
78082
CPT 		Nf-sandostatin Lar Depot Kit 30mg 4 $4,782.00 $9,464.00 $9,364.00 nat. median
$16,258
0.6× median
2501655
CDM 		Eligard 22.5mg Syringe 4 $4,592.00 $9,088.00 $8,992.00 nat. median
$8,992
1.0× median
43282
CPT 		Laparoscopy Para Hernia Fundoplasty Mesh 4 $1,414.00 $30,875.00 $8,933.00 nat. median
$10,473
0.9× median
900022
CDM 		Or D 226-240 4 $4,469.00 $8,845.00 $8,751.00 nat. median
$8,751
1.0× median
58292
CPT 		Pf Mc Vag Hyst Uter>250g Rmv&rpr Enteroc 4 $1,048.00 $30,400.00 $8,623.00 nat. median
$7,010
1.2× median
900021
CDM 		Or D 211-225 4 $4,397.00 $8,702.00 $8,610.00 nat. median
$8,610
1.0× median
900097
CDM 		Or C 231-245 4 $4,397.00 $8,702.00 $8,610.00 nat. median
$519
outlier · 16.6×
2501292
CDM 		Udenyca 6mg/0.6ml Syringe 4 $4,329.00 $8,567.00 $8,477.00 nat. median
$6
outlier · 1412.8×
900124
CDM 		Or D 196-210 4 $4,325.00 $8,560.00 $8,469.00 nat. median
$1,429
outlier · 5.9×
58285
CPT 		Pfmc Vaginal Hysterectomy Radical 4 $1,189.00 $28,500.00 $8,411.50 nat. median
$3,740
outlier · 2.2×
900096
CDM 		Or C 216-230 4 $4,291.00 $8,493.00 $8,404.00 nat. median
$2,474
outlier · 3.4×
900095
CDM 		Or C 211-215 4 $4,190.00 $8,294.00 $8,206.00 nat. median
$1,280
outlier · 6.4×
900123
CDM 		Or D 181-195 4 $4,181.00 $8,275.00 $8,187.00 nat. median
$893
outlier · 9.2×
900122
CDM 		Or D 166-180 4 $4,104.00 $8,123.00 $8,037.00 nat. median
$8,037
1.0× median
900059
CDM 		Or Major Level 5 First Hour 4 $4,094.00 $8,104.00 $8,018.00 nat. median
$8,018
1.0× median
900094
CDM 		Or C 196-210 4 $4,085.00 $8,085.00 $7,999.00 nat. median
$375
outlier · 21.3×
58263
CPT 		Pfmc Vag Hystomy Uter<250g Rmv&rpr Enter 4 $800.00 $28,500.00 $7,967.50 nat. median
$5,192
1.5× median
900093
CDM 		Or C 181-195 4 $3,979.00 $7,876.00 $7,793.00 nat. median
$1,928
outlier · 4.0×
900092
CDM 		Or C 166-180 4 $3,883.00 $7,686.00 $7,605.00 nat. median
$519
outlier · 14.7×
74366
CPT 		Lupron Depot 11.25mg Syringe Kit 4 $3,853.00 $7,627.00 $7,546.00 nat. median
$8,742
0.9× median
66984
CPT 		Removal Of Cataract With Insertion Of Lens 4 $3,840.00 $7,600.00 $7,520.00 nat. median
$2,550
outlier · 2.9×
900091
CDM 		Or C 151-165 4 $3,778.00 $7,477.00 $7,398.00 nat. median
$7,398
1.0× median
900064
CDM 		Or B 196-210 4 $3,773.00 $7,467.00 $7,388.00 nat. median
$7,388
1.0× median
58294
CPT 		Pf Mc Vag Hyst Uterus>250g Rpr Enterocel 4 $974.00 $25,650.00 $7,347.00 nat. median
$5,111
1.4× median
78100
CPT 		Leqvio 284mg/1.5ml Syringe 4 $3,720.00 $7,363.00 $7,285.00 nat. median
$8,125
0.9× median
2500125
CDM 		Crotalidae Polyvalent Immune Fab Vial 4 $3,684.00 $7,291.00 $7,215.00 nat. median
$7
outlier · 1030.7×
900090
CDM 		Or C 136-150 4 $3,677.00 $7,277.00 $7,200.00 nat. median
$3,677
2.0× median
2501202
CDM 		Trelstar 22.5 Mg Injection 4 $3,654.00 $7,231.00 $7,155.00 nat. median
$7,155
1.0× median
2501762
CDM 		Cimzia 200mg Syringe 4 $3,628.00 $7,181.00 $7,105.00 nat. median
$7,105
1.0× median
900120
CDM 		Or D 136-150 4 $3,595.00 $7,116.00 $7,041.00 nat. median
$7,041
1.0× median
25609
CPT 		Pfmc Pr Distalradiusfx,intra-artic3+frag 4 $880.00 $23,275.00 $7,029.50 nat. median
$7,138
1.0× median
900063
CDM 		Or B 181-195 4 $3,576.00 $7,078.00 $7,003.00 nat. median
$7,003
1.0× median
900089
CDM 		Or C 121-135 4 $3,571.00 $7,068.00 $6,994.00 nat. median
$6,994
1.0× median

Other procedures at this hospital

Browse this hospital's 3,489 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
             
2501216 CDM Ocrelizumab 300mg/10ml Vial 5 4 $41,691.00 $41,691.00 $20,012.00 $39,606.00 $39,190.00 2026-06-09
74501 CPT Skyrizi 600mg/10ml Vial 5 4 $20,413.00 $20,413.00 $9,798.00 $19,392.00 $19,188.00 2026-06-09
2500009 CDM Activase 100mg Vial 5 4 $13,201.00 $13,201.00 $6,336.00 $12,541.00 $12,409.00 2026-06-09
74334 CPT Leuprolide Acetate 22.5mg Syringe Kit 5 4 $13,135.00 $13,135.00 $6,305.00 $12,478.00 $12,347.00 2026-06-09
2502137 CDM Neulasta Onpro Kit 6mg/0.6ml 5 4 $13,093.00 $13,093.00 $6,285.00 $12,438.00 $12,307.00 2026-06-09
2500383 CDM Neulasta 6 Mg/0.6 Ml Inj 5 4 $13,093.00 $13,093.00 $6,285.00 $12,438.00 $12,307.00 2026-06-09
2500538 CDM Tnkase 50mg Vial 5 4 $12,944.00 $12,944.00 $6,213.00 $12,297.00 $12,167.00 2026-06-09
2500380 CDM Natalizumab 300mg/15ml Vial 5 4 $12,807.00 $12,807.00 $6,147.00 $12,167.00 $12,039.00 2026-06-09
2501807-#N CDM Gamunex-c 10% 400ml Vial 5 4 $12,501.00 $12,501.00 $6,000.00 $11,876.00 $11,751.00 2026-06-09
31017 CPT Fasenra 30mg/ml Syringe 5 4 $11,928.00 $11,928.00 $5,725.00 $11,332.00 $11,212.00 2026-06-09
58551 CPT Lavh < 250g With Removal Of Tubes/ovaries 9 4 $23,000.00 $23,000.00 $1,394.00 $21,850.00 $11,040.00 2026-06-09
27137 CPT Pf Mc Revise Hip Joint Replacement 10 4 $20,861.00 $20,861.00 $1,187.00 $37,050.00 $10,653.00 2026-06-09
57265 CPT Combine A/p Colporrhapy Enterocele Rpr 10 4 $20,720.00 $20,720.00 $702.00 $38,000.00 $10,284.00 2026-06-09
900024 CDM Or D 256-270 5 4 $10,680.00 $10,680.00 $5,126.00 $10,146.00 $10,039.00 2026-06-09
900023 CDM Or D 241-255 5 4 $10,230.00 $10,230.00 $4,910.00 $9,719.00 $9,616.00 2026-06-09
2500483 CDM Rituximab 500mg/50ml Vial 5 4 $10,147.00 $10,147.00 $4,871.00 $9,640.00 $9,538.00 2026-06-09
27415 CPT Pfmc Pr Osteochondral Knee Allograft 10 4 $18,414.00 $18,414.00 $1,136.00 $32,300.00 $9,503.50 2026-06-09
78082 CPT Nf-sandostatin Lar Depot Kit 30mg 5 4 $9,962.00 $9,962.00 $4,782.00 $9,464.00 $9,364.00 2026-06-09
2501655 CDM Eligard 22.5mg Syringe 5 4 $9,566.00 $9,566.00 $4,592.00 $9,088.00 $8,992.00 2026-06-09
43282 CPT Laparoscopy Para Hernia Fundoplasty Mesh 10 4 $17,442.50 $17,442.50 $1,414.00 $30,875.00 $8,933.00 2026-06-09
900022 CDM Or D 226-240 5 4 $9,310.00 $9,310.00 $4,469.00 $8,845.00 $8,751.00 2026-06-09
58292 CPT Pf Mc Vag Hyst Uter>250g Rmv&rpr Enteroc 10 4 $16,992.50 $16,992.50 $1,048.00 $30,400.00 $8,623.00 2026-06-09
900021 CDM Or D 211-225 5 4 $9,160.00 $9,160.00 $4,397.00 $8,702.00 $8,610.00 2026-06-09
900097 CDM Or C 231-245 5 4 $9,160.00 $9,160.00 $4,397.00 $8,702.00 $8,610.00 2026-06-09
2501292 CDM Udenyca 6mg/0.6ml Syringe 5 4 $9,018.00 $9,018.00 $4,329.00 $8,567.00 $8,477.00 2026-06-09
900124 CDM Or D 196-210 5 4 $9,010.00 $9,010.00 $4,325.00 $8,560.00 $8,469.00 2026-06-09
58285 CPT Pfmc Vaginal Hysterectomy Radical 10 4 $16,275.50 $16,275.50 $1,189.00 $28,500.00 $8,411.50 2026-06-09
900096 CDM Or C 216-230 5 4 $8,940.00 $8,940.00 $4,291.00 $8,493.00 $8,404.00 2026-06-09
900095 CDM Or C 211-215 5 4 $8,730.00 $8,730.00 $4,190.00 $8,294.00 $8,206.00 2026-06-09
900123 CDM Or D 181-195 5 4 $8,710.00 $8,710.00 $4,181.00 $8,275.00 $8,187.00 2026-06-09
900122 CDM Or D 166-180 5 4 $8,550.00 $8,550.00 $4,104.00 $8,123.00 $8,037.00 2026-06-09
900059 CDM Or Major Level 5 First Hour 5 4 $8,530.00 $8,530.00 $4,094.00 $8,104.00 $8,018.00 2026-06-09
900094 CDM Or C 196-210 5 4 $8,510.00 $8,510.00 $4,085.00 $8,085.00 $7,999.00 2026-06-09
58263 CPT Pfmc Vag Hystomy Uter<250g Rmv&rpr Enter 10 4 $15,808.00 $15,808.00 $800.00 $28,500.00 $7,967.50 2026-06-09
900093 CDM Or C 181-195 5 4 $8,290.00 $8,290.00 $3,979.00 $7,876.00 $7,793.00 2026-06-09
900092 CDM Or C 166-180 5 4 $8,090.00 $8,090.00 $3,883.00 $7,686.00 $7,605.00 2026-06-09
74366 CPT Lupron Depot 11.25mg Syringe Kit 5 4 $8,028.00 $8,028.00 $3,853.00 $7,627.00 $7,546.00 2026-06-09
66984 CPT Removal Of Cataract With Insertion Of Lens 5 4 $8,000.00 $8,000.00 $3,840.00 $7,600.00 $7,520.00 2026-06-09
900091 CDM Or C 151-165 5 4 $7,870.00 $7,870.00 $3,778.00 $7,477.00 $7,398.00 2026-06-09
900064 CDM Or B 196-210 5 4 $7,860.00 $7,860.00 $3,773.00 $7,467.00 $7,388.00 2026-06-09
58294 CPT Pf Mc Vag Hyst Uterus>250g Rpr Enterocel 10 4 $14,412.50 $14,412.50 $974.00 $25,650.00 $7,347.00 2026-06-09
78100 CPT Leqvio 284mg/1.5ml Syringe 5 4 $7,750.00 $7,750.00 $3,720.00 $7,363.00 $7,285.00 2026-06-09
2500125 CDM Crotalidae Polyvalent Immune Fab Vial 5 4 $7,675.00 $7,675.00 $3,684.00 $7,291.00 $7,215.00 2026-06-09
900090 CDM Or C 136-150 5 4 $7,660.00 $7,660.00 $3,677.00 $7,277.00 $7,200.00 2026-06-09
2501202 CDM Trelstar 22.5 Mg Injection 5 4 $7,612.00 $7,612.00 $3,654.00 $7,231.00 $7,155.00 2026-06-09
2501762 CDM Cimzia 200mg Syringe 5 4 $7,559.00 $7,559.00 $3,628.00 $7,181.00 $7,105.00 2026-06-09
900120 CDM Or D 136-150 5 4 $7,490.00 $7,490.00 $3,595.00 $7,116.00 $7,041.00 2026-06-09
25609 CPT Pfmc Pr Distalradiusfx,intra-artic3+frag 10 4 $13,460.00 $13,460.00 $880.00 $23,275.00 $7,029.50 2026-06-09
900063 CDM Or B 181-195 5 4 $7,450.00 $7,450.00 $3,576.00 $7,078.00 $7,003.00 2026-06-09
900089 CDM Or C 121-135 5 4 $7,440.00 $7,440.00 $3,571.00 $7,068.00 $6,994.00 2026-06-09
2501364-JA CDM Gamunex-c 10% 200ml Vial 5 4 $7,354.00 $7,354.00 $3,530.00 $6,986.00 $6,913.00 2026-06-09
900119 CDM Or D 121-135 5 4 $7,340.00 $7,340.00 $3,523.00 $6,973.00 $6,900.00 2026-06-09
58553 CPT Lavh > 250g With Removal Of Tubes/ovaries 10 4 $13,337.50 $13,337.50 $898.00 $23,750.00 $6,795.50 2026-06-09
900088 CDM Or C 106-120 5 4 $7,220.00 $7,220.00 $3,466.00 $6,859.00 $6,787.00 2026-06-09
900118 CDM Or D 106-120 5 4 $7,190.00 $7,190.00 $3,451.00 $6,831.00 $6,759.00 2026-06-09
58270 CPT Pfmc Vag Hyst Uterus<250g Rpr Enterocele 10 4 $13,245.00 $13,245.00 $723.00 $23,750.00 $6,708.00 2026-06-09
900057 CDM Or Major Level 4 First Hour 5 4 $7,110.00 $7,110.00 $3,413.00 $6,755.00 $6,683.00 2026-06-09
70471 CPT CT Angio Head And Neck With 5 4 $7,100.00 $7,100.00 $3,408.00 $6,745.00 $6,674.00 2026-06-09
900117 CDM Or D 91-105 5 4 $7,030.00 $7,030.00 $3,374.00 $6,679.00 $6,608.00 2026-06-09
900087 CDM Or C 91-105 5 4 $7,020.00 $7,020.00 $3,370.00 $6,669.00 $6,599.00 2026-06-09
66982 CPT Cataract Complex Extracapsular Intraocul 20 4 $9,000.00 $9,000.00 $593.00 $10,925.00 $6,580.00 2026-06-09
900116 CDM Or D 76-90 5 4 $6,880.00 $6,880.00 $3,302.00 $6,536.00 $6,467.00 2026-06-09
900086 CDM Or C 76-90 5 4 $6,800.00 $6,800.00 $3,264.00 $6,460.00 $6,392.00 2026-06-09
900062 CDM Or B 166-180 5 4 $6,800.00 $6,800.00 $3,264.00 $6,460.00 $6,392.00 2026-06-09
29828 CPT Arthroscopy Biceps Tenodesis 10 4 $12,229.50 $12,229.50 $765.00 $21,375.00 $6,330.50 2026-06-09
900115 CDM Or D 61-75 5 4 $6,730.00 $6,730.00 $3,230.00 $6,394.00 $6,326.00 2026-06-09
58660 CPT Laparoscopy Lysis 10 4 $12,557.50 $12,557.50 $565.00 $22,800.00 $6,289.50 2026-06-09
900085 CDM Or C 61-75 5 4 $6,590.00 $6,590.00 $3,163.00 $6,261.00 $6,195.00 2026-06-09
900061 CDM Or B 151-165 5 4 $6,590.00 $6,590.00 $3,163.00 $6,261.00 $6,195.00 2026-06-09
900114 CDM Or D 46-60 5 4 $6,580.00 $6,580.00 $3,158.00 $6,251.00 $6,185.00 2026-06-09
2501389 CDM Ziextenzo 6mg/0.6ml Syringe 5 4 $6,513.00 $6,513.00 $3,126.00 $6,187.00 $6,122.00 2026-06-09
69032 CPT Nyvepria 6mg/0.6ml Syringe 5 4 $6,513.00 $6,513.00 $3,126.00 $6,187.00 $6,122.00 2026-06-09
900113 CDM Or D 31-45 5 4 $6,420.00 $6,420.00 $3,082.00 $6,099.00 $6,035.00 2026-06-09
90009901 CDM Pilotgraft Btb Tendon 5 4 $6,408.00 $6,408.00 $3,076.00 $6,088.00 $6,024.00 2026-06-09
2500542-JA CDM Tocilizumab 400mg/20ml Vial 5 4 $6,374.00 $6,374.00 $3,060.00 $6,055.00 $5,992.00 2026-06-09
900084 CDM Or C 46-60 5 4 $6,370.00 $6,370.00 $3,058.00 $6,052.00 $5,988.00 2026-06-09
900083 CDM Or C 31-45 5 4 $6,150.00 $6,150.00 $2,952.00 $5,843.00 $5,781.00 2026-06-09
900112 CDM Or D 16-30 5 4 $6,120.00 $6,120.00 $2,938.00 $5,814.00 $5,753.00 2026-06-09
2502104 CDM Nf-vivitrol IM Pwd For Susp ER 380mg 5 4 $6,085.00 $6,085.00 $2,921.00 $5,781.00 $5,720.00 2026-06-09
27822 CPT Open Fx Tx Trimall Ankle Fx 10 4 $10,825.00 $10,825.00 $752.00 $18,525.00 $5,701.50 2026-06-09
C1788 HCPCS Port Central Venous Access 5 4 $6,000.00 $6,000.00 $2,880.00 $5,700.00 $5,640.00 2026-06-09
900111 CDM Or D 1-15 5 4 $5,950.00 $5,950.00 $2,856.00 $5,653.00 $5,593.00 2026-06-09
900082 CDM Or C 16-30 5 4 $5,920.00 $5,920.00 $2,842.00 $5,624.00 $5,565.00 2026-06-09
25447 CPT Pf Mc Repair Wrist Joints 10 4 $10,488.50 $10,488.50 $677.00 $18,050.00 $5,499.00 2026-06-09
74174 CPT CT Angio Abd Pelv W 5 4 $5,850.00 $5,850.00 $795.00 $5,558.00 $5,499.00 2026-06-09
58550 CPT Lavh < 250g 10 4 $10,733.50 $10,733.50 $716.00 $19,000.00 $5,497.00 2026-06-09
2501454 CDM Invega Sustenna 234mg/1.5ml Syringe 5 4 $5,844.00 $5,844.00 $2,805.00 $5,552.00 $5,493.00 2026-06-09
25608 CPT Open Fx Tx Radial 2 Fragments 10 4 $10,481.00 $10,481.00 $701.00 $18,050.00 $5,492.00 2026-06-09
2501386 CDM Synagis 100mg/ml Vial 5 4 $5,776.00 $5,776.00 $2,772.00 $5,487.00 $5,429.00 2026-06-09
47600 CPT Open Cholecystectomy 10 4 $10,375.50 $10,375.50 $897.00 $18,050.00 $5,391.50 2026-06-09
900055 CDM Or Major Level 3 First Hour 5 4 $5,690.00 $5,690.00 $2,731.00 $5,406.00 $5,349.00 2026-06-09
900081 CDM Or C 1-15 5 4 $5,650.00 $5,650.00 $2,712.00 $5,368.00 $5,311.00 2026-06-09
58291 CPT Pfmc Vag Hyst Uter>250g Rmvl Tube/ovary 10 4 $9,951.50 $9,951.50 $995.00 $17,100.00 $5,224.00 2026-06-09
58267 CPT Pfmc Vag Hyst Uter<250g Multi-pexy Endo 10 4 $9,881.00 $9,881.00 $857.00 $17,100.00 $5,157.00 2026-06-09
27524 CPT Open Tx Fx Patellar With 10 4 $9,852.50 $9,852.50 $638.00 $17,100.00 $5,130.00 2026-06-09
90009908 CDM Microport Cs/cr Fem Size 4 Primary Right 5 4 $5,400.00 $5,400.00 $2,592.00 $5,130.00 $5,076.00 2026-06-09
90009909 CDM Microport Cs Insrt Impl Sz 5 Right 10mm 5 4 $5,250.00 $5,250.00 $2,520.00 $4,988.00 $4,935.00 2026-06-09
27310 CPT Arthrotomy Knee With Exploration 10 4 $9,339.50 $9,339.50 $624.00 $16,150.00 $4,877.50 2026-06-09
2501846 CDM Benlysta 400mg Vial 5 4 $5,179.00 $5,179.00 $2,486.00 $4,920.00 $4,868.00 2026-06-09
72156 CPT Mr Spine Cerv Wo W 5 4 $5,175.00 $5,175.00 $751.00 $4,916.00 $4,865.00 2026-06-09
72157 CPT Mr Spine Thoracic Wo W 5 4 $5,150.00 $5,150.00 $753.00 $4,893.00 $4,841.00 2026-06-09
25607 CPT Pf Mc Treat Fx Rad Extra-articul 10 4 $9,164.50 $9,164.50 $633.00 $15,675.00 $4,829.00 2026-06-09
2501836 CDM Stelara 130mg/26ml Vial 5 4 $5,087.00 $5,087.00 $2,442.00 $4,833.00 $4,782.00 2026-06-09
95811 CPT Sleep Study Thera Titrati 5 4 $5,076.00 $5,076.00 $1,071.00 $4,822.00 $4,771.00 2026-06-09
23515 CPT Open Fx Tx Clavicle 10 4 $9,094.00 $9,094.00 $616.00 $15,675.00 $4,762.00 2026-06-09
74183 CPT Mr Abd Wo W 5 4 $5,030.00 $5,030.00 $802.00 $4,779.00 $4,728.00 2026-06-09
90000150 CDM Omni Surgical System 5 4 $5,000.00 $5,000.00 $2,400.00 $4,750.00 $4,700.00 2026-06-09
80009909 CDM Implant System, Suture Loc 5 4 $5,000.00 $5,000.00 $2,400.00 $4,750.00 $4,700.00 2026-06-09
58290 CPT Pf Mc Vaginal Hysterectomy Uterus>250g 10 4 $8,895.00 $8,895.00 $921.00 $15,200.00 $4,690.50 2026-06-09
72158 CPT Mr Spine Lumbar Wo W 5 4 $4,950.00 $4,950.00 $749.00 $4,703.00 $4,653.00 2026-06-09
81229 CPT Chromosome Microarray Postnatal (Ref) 5 4 $4,920.00 $4,920.00 $2,362.00 $4,674.00 $4,625.00 2026-06-09
1501000 CDM C-section Delivery 5 4 $4,910.00 $4,910.00 $2,357.00 $4,665.00 $4,615.00 2026-06-09
900038 CDM Or A Minor 106-120 5 4 $4,890.00 $4,890.00 $2,347.00 $4,646.00 $4,597.00 2026-06-09
27650 CPT Pf Mc Pr Repair Achilles Tendon, Primary 10 4 $8,761.50 $8,761.50 $573.00 $15,200.00 $4,563.50 2026-06-09
71552 CPT Mr Chest Wo W 5 4 $4,850.00 $4,850.00 $2,328.00 $4,608.00 $4,559.00 2026-06-09
29824 CPT Arthroscopy Shoulder With Clavicle 10 4 $8,556.00 $8,556.00 $580.00 $14,725.00 $4,485.50 2026-06-09
90009904 CDM Microport Tib Base Cocr Non Por Sz 5 5 4 $4,770.00 $4,770.00 $2,290.00 $4,532.00 $4,484.00 2026-06-09
58562 CPT Hysteroscopy Rmvl Impacted Foreign Body 10 4 $9,160.00 $9,160.00 $178.00 $17,100.00 $4,472.00 2026-06-09
24359 CPT Pf Mcrepair Elbow Deb/attch Open 10 4 $8,528.50 $8,528.50 $560.00 $14,725.00 $4,459.50 2026-06-09
29879 CPT Knee Arthro/surg Abrasion Chondroplasty 10 4 $8,513.00 $8,513.00 $565.00 $14,725.00 $4,445.00 2026-06-09
49402 CPT Pfmc Rmv Peritoneal Fb From Pert Cavity 10 4 $8,449.00 $8,449.00 $713.00 $14,725.00 $4,384.00 2026-06-09
72197 CPT Mr Sacrum Wo W 5 4 $4,650.00 $4,650.00 $801.00 $4,418.00 $4,371.00 2026-06-09
70546 CPT Mr Angio Head Wo W 5 4 $4,650.00 $4,650.00 $2,232.00 $4,418.00 $4,371.00 2026-06-09
70553 CPT MRI Scan 5 4 $4,650.00 $4,650.00 $746.00 $4,418.00 $4,371.00 2026-06-09
2500456-JB CDM Prolia 60mg/1ml Injection 5 4 $4,636.00 $4,636.00 $2,225.00 $4,404.00 $4,358.00 2026-06-09
73223 CPT Mr Joint Lt Upper Wo W 5 4 $4,600.00 $4,600.00 $924.00 $4,370.00 $4,324.00 2026-06-09
900037 CDM Or A Minor 91-105 5 4 $4,600.00 $4,600.00 $2,208.00 $4,370.00 $4,324.00 2026-06-09
27792 CPT Pf Mc Treatment Of Ankle Fracture 10 4 $8,257.50 $8,257.50 $554.00 $14,250.00 $4,319.50 2026-06-09
2500287 CDM Leuprolide Acetate 45mg Inj 5 4 $4,553.00 $4,553.00 $2,185.00 $4,325.00 $4,280.00 2026-06-09
74175 CPT CT Angio Abd Wo W 5 4 $4,550.00 $4,550.00 $583.00 $4,323.00 $4,277.00 2026-06-09
71551 CPT Mr Chest W 5 4 $4,550.00 $4,550.00 $2,184.00 $4,323.00 $4,277.00 2026-06-09
70549 CPT Mr Angio Neck Wo W 5 4 $4,550.00 $4,550.00 $854.00 $4,323.00 $4,277.00 2026-06-09
70543 CPT Mr Neck Wo W 5 4 $4,550.00 $4,550.00 $796.00 $4,323.00 $4,277.00 2026-06-09
24685 CPT Open Fx Tx Ulnar Proximal 10 4 $8,063.00 $8,063.00 $565.00 $13,775.00 $4,252.50 2026-06-09
67914 CPT Repair Of Entropion; Suture Technique 5 4 $4,500.00 $4,500.00 $2,160.00 $4,275.00 $4,230.00 2026-06-09
58671 CPT Laparoscopic Tubal Ligation Occlude Ovi 10 4 $8,364.50 $8,364.50 $304.00 $15,200.00 $4,186.50 2026-06-09
73220 CPT Mr Ue W Wo 5 4 $4,450.00 $4,450.00 $978.00 $4,228.00 $4,183.00 2026-06-09
78582 CPT Nm Pulmonary Ventilation And Perfusion 5 4 $4,450.00 $4,450.00 $2,136.00 $4,228.00 $4,183.00 2026-06-09
2502011 CDM Nf-mirena Insert ER 52mg 5 4 $4,372.00 $4,372.00 $2,099.00 $4,153.00 $4,110.00 2026-06-09
26480 CPT Pf Mc Transplant Hand Tendon 10 4 $7,284.00 $7,284.00 $609.00 $11,400.00 $4,100.00 2026-06-09
70552 CPT Mr Brain W 5 4 $4,350.00 $4,350.00 $631.00 $4,133.00 $4,089.00 2026-06-09
72142 CPT Mr Spine Cerv W 5 4 $4,350.00 $4,350.00 $2,088.00 $4,133.00 $4,089.00 2026-06-09
73723 CPT Mr Hips Bilat Wo W 5 4 $4,350.00 $4,350.00 $922.00 $4,133.00 $4,089.00 2026-06-09
72149 CPT Mr Spine Lumbar W 5 4 $4,350.00 $4,350.00 $2,088.00 $4,133.00 $4,089.00 2026-06-09
72147 CPT Mr Spine Thoracic W 5 4 $4,350.00 $4,350.00 $2,088.00 $4,133.00 $4,089.00 2026-06-09
95810 CPT Sleep Study 5 4 $4,320.00 $4,320.00 $1,022.00 $4,104.00 $4,061.00 2026-06-09
2502105 CDM Naltrexone 380mg Syringe 5 4 $4,300.00 $4,300.00 $2,064.00 $4,085.00 $4,042.00 2026-06-09
2501599 CDM Dalbavancin 500mg Vial 5 4 $4,270.00 $4,270.00 $2,050.00 $4,057.00 $4,014.00 2026-06-09
900053 CDM Or Major Level 2 First Hour 5 4 $4,270.00 $4,270.00 $2,050.00 $4,057.00 $4,014.00 2026-06-09
70542 CPT Mr Neck W 5 4 $4,250.00 $4,250.00 $2,040.00 $4,038.00 $3,995.00 2026-06-09
71550 CPT Mr Chest Hilar Mediastein 5 4 $4,250.00 $4,250.00 $2,040.00 $4,038.00 $3,995.00 2026-06-09
71555 CPT Mr Angio Chest W 10 4 $4,400.00 $4,400.00 $2,040.00 $4,323.00 $3,995.00 2026-06-09
70548 CPT Mr Angio Neck W 5 4 $4,250.00 $4,250.00 $2,040.00 $4,038.00 $3,995.00 2026-06-09
24515 CPT Rasburicase 1.5mg Vial 10 4 $6,974.00 $6,974.00 $1,275.00 $10,726.00 $3,972.00 2026-06-09
2501455 CDM Invega Sustenna 156mg/1ml Syringe 5 4 $4,175.00 $4,175.00 $2,004.00 $3,966.00 $3,925.00 2026-06-09
73720 CPT Mr Low Ext Lt Wo W 5 4 $4,150.00 $4,150.00 $799.00 $3,943.00 $3,901.00 2026-06-09
27380 CPT Pf Mc Repair Of Kneecap Tendon 10 4 $7,321.50 $7,321.50 $543.00 $12,350.00 $3,900.50 2026-06-09
900036 CDM Or A Minor 76-90 5 4 $4,100.00 $4,100.00 $1,968.00 $3,895.00 $3,854.00 2026-06-09
23590 CPT Triptorelin 11.25 Mg Injection 5 4 $4,099.00 $4,099.00 $1,968.00 $3,894.00 $3,853.00 2026-06-09
51706 CPT Injectafer 750mg/15ml Vial 5 4 $4,059.00 $4,059.00 $1,948.00 $3,856.00 $3,815.00 2026-06-09
70551 CPT Mr Brain Wo 5 4 $4,050.00 $4,050.00 $456.00 $3,848.00 $3,807.00 2026-06-09
72196 CPT Mr Sacrum W 5 4 $4,050.00 $4,050.00 $1,944.00 $3,848.00 $3,807.00 2026-06-09
71275 CPT CT Pe Angio Chest W 5 4 $4,050.00 $4,050.00 $585.00 $3,848.00 $3,807.00 2026-06-09
72146 CPT Mr Spine Thoracic Wo 5 4 $4,050.00 $4,050.00 $445.00 $3,848.00 $3,807.00 2026-06-09
72141 CPT Mr Spine Cerv Wo 5 4 $4,050.00 $4,050.00 $444.00 $3,848.00 $3,807.00 2026-06-09
74182 CPT Mr Abd W 5 4 $4,050.00 $4,050.00 $1,944.00 $3,848.00 $3,807.00 2026-06-09
75635 CPT CT Angio W Runoff 5 4 $4,050.00 $4,050.00 $642.00 $3,848.00 $3,807.00 2026-06-09
70544 CPT Mr Angio Head Wo 5 4 $4,050.00 $4,050.00 $557.00 $3,848.00 $3,807.00 2026-06-09
73222 CPT Mr Joint Lt Upper W 5 4 $4,050.00 $4,050.00 $744.00 $3,848.00 $3,807.00 2026-06-09
73722 CPT Mr Hips Bilat W 5 4 $4,050.00 $4,050.00 $748.00 $3,848.00 $3,807.00 2026-06-09
9046200 CDM Fissurectomy W Sphincterotomy When Permd 5 4 $4,000.00 $4,000.00 $1,920.00 $3,800.00 $3,760.00 2026-06-09
70547 CPT Mr Angio Neck Wo 5 4 $3,950.00 $3,950.00 $1,896.00 $3,753.00 $3,713.00 2026-06-09
70540 CPT Mr Neck Wo 5 4 $3,950.00 $3,950.00 $1,896.00 $3,753.00 $3,713.00 2026-06-09
32187 CPT Nf-orencia Intravenous Pwd For Soln 250m 10 4 $4,557.00 $4,557.00 $1,848.00 $5,001.00 $3,638.50 2026-06-09
74185 CPT Mr Abdomen W/wo Contrast 5 4 $3,850.00 $3,850.00 $1,848.00 $3,658.00 $3,619.00 2026-06-09
78598 CPT Nm Quant Ventilation And Perfusion 5 4 $3,850.00 $3,850.00 $1,848.00 $3,658.00 $3,619.00 2026-06-09
2502108 CDM Denosumab-bbdz 60mg/ml Syringe 5 4 $3,850.00 $3,850.00 $1,848.00 $3,658.00 $3,619.00 2026-06-09
21933 CPT Exc Tumor Subfas Back/flank >5cm 10 4 $6,726.50 $6,726.50 $626.00 $11,400.00 $3,570.00 2026-06-09
90009911 CDM Palacose R+g Pro 80 Bone Cement 5 4 $3,790.00 $3,790.00 $1,819.00 $3,601.00 $3,563.00 2026-06-09
90009910 CDM Atlas, Dt With Gfs And Drill Bit 5 4 $3,790.00 $3,790.00 $1,819.00 $3,601.00 $3,563.00 2026-06-09
900035 CDM Or A Minor 61-75 5 4 $3,770.00 $3,770.00 $1,810.00 $3,582.00 $3,544.00 2026-06-09
74181 CPT Mr Abd Wo 5 4 $3,750.00 $3,750.00 $491.00 $3,563.00 $3,525.00 2026-06-09
72194 CPT CT Pelvis Wo W 5 4 $3,750.00 $3,750.00 $1,800.00 $3,563.00 $3,525.00 2026-06-09
2501179 CDM Xolair 150mg Syringe 5 4 $3,729.00 $3,729.00 $1,790.00 $3,543.00 $3,505.00 2026-06-09
2501363-JA CDM Gamunex-c 10% 100ml Vial 5 4 $3,677.00 $3,677.00 $1,765.00 $3,493.00 $3,456.00 2026-06-09
64624 CPT Des Neur Genicular Nerve Branches 15 4 $4,300.00 $4,300.00 $125.00 $6,128.00 $3,440.00 2026-06-09
72195 CPT Mr Sacrum Wo 5 4 $3,650.00 $3,650.00 $543.00 $3,468.00 $3,431.00 2026-06-09
73219 CPT Mr Upper Ext L W 5 4 $3,650.00 $3,650.00 $1,752.00 $3,468.00 $3,431.00 2026-06-09
71270 CPT CT Thorax Wo W 5 4 $3,650.00 $3,650.00 $468.00 $3,468.00 $3,431.00 2026-06-09
70496 CPT CT Angio Head W & Wo 5 4 $3,650.00 $3,650.00 $577.00 $3,468.00 $3,431.00 2026-06-09
24358 CPT Pf Mc Repair Elbow With Deb Open 10 4 $6,428.00 $6,428.00 $455.00 $10,925.00 $3,404.00 2026-06-09
2500966 CDM Simponi Aria 50mg/4ml Vial 5 4 $3,599.00 $3,599.00 $1,728.00 $3,419.00 $3,383.00 2026-06-09
22511 CPT Perc Vertebroplasty Lumbo Sacral Single 10 4 $6,376.00 $6,376.00 $332.00 $10,925.00 $3,354.50 2026-06-09
74170 CPT CT Pancreas Wo W 5 4 $3,550.00 $3,550.00 $541.00 $3,373.00 $3,337.00 2026-06-09
70488 CPT CT Sinuses Wo W 5 4 $3,550.00 $3,550.00 $1,704.00 $3,373.00 $3,337.00 2026-06-09
73719 CPT Mr Low Ext Lt W 5 4 $3,550.00 $3,550.00 $1,704.00 $3,373.00 $3,337.00 2026-06-09
70498 CPT CT Angio Neck Wo W 5 4 $3,550.00 $3,550.00 $577.00 $3,373.00 $3,337.00 2026-06-09
81479 CPT Snca Alpha Synuclein DNA Seque (Ref) 5 4 $3,532.00 $3,532.00 $1,695.00 $3,355.00 $3,320.00 2026-06-09
27695 CPT Pf Mc Repair Of Ankle Ligament 10 4 $6,325.50 $6,325.50 $427.00 $10,925.00 $3,306.50 2026-06-09
64635 CPT Pf Bilat Dest Neuro,lum/sacr Sng Fct Jnt 14 4 $5,500.00 $5,500.00 $163.00 $7,838.00 $3,300.00 2026-06-09
59400 CPT Obstetric Care, Planned Vaginal Delivery 5 4 $3,492.00 $3,492.00 $1,676.00 $3,317.00 $3,282.00 2026-06-09
1100004 CDM Anesthesia Level 4 5 4 $3,475.00 $3,475.00 $1,668.00 $3,301.00 $3,267.00 2026-06-09
22901 CPT Excision Of Lipoma 10 4 $6,150.00 $6,150.00 $573.00 $10,450.00 $3,257.50 2026-06-09
72132 CPT CT Spine Lumbar W (Do Not Order) 5 4 $3,423.00 $3,423.00 $1,643.00 $3,252.00 $3,218.00 2026-06-09
64479 CPT Pf Mc Blat Tfesi Inj Cer/thora Sing Lvl 15 4 $4,000.00 $4,000.00 $110.00 $5,558.00 $3,200.00 2026-06-09
57240 CPT Anterior Colporrhapy With Cysto 10 4 $6,063.50 $6,063.50 $499.00 $10,450.00 $3,175.50 2026-06-09
46932 CPT Nf-micafungin Sodium 100mg Vial 5 4 $3,366.00 $3,366.00 $1,616.00 $3,198.00 $3,164.00 2026-06-09
72130 CPT CT Spine Thoracic Wo W 5 4 $3,350.00 $3,350.00 $1,608.00 $3,183.00 $3,149.00 2026-06-09
72127 CPT CT Spine Cerv Wo W 5 4 $3,350.00 $3,350.00 $1,608.00 $3,183.00 $3,149.00 2026-06-09
73218 CPT Mr Upper Ext Lt Wo 5 4 $3,350.00 $3,350.00 $592.00 $3,183.00 $3,149.00 2026-06-09
72133 CPT CT Spine Lumbar Wo W 5 4 $3,350.00 $3,350.00 $1,608.00 $3,183.00 $3,149.00 2026-06-09
70482 CPT CT Temp Orbit Iac Wo W 5 4 $3,350.00 $3,350.00 $1,608.00 $3,183.00 $3,149.00 2026-06-09
2501923 CDM Synvisc-one 48mg/6ml Syringe 5 4 $3,287.00 $3,287.00 $1,578.00 $3,123.00 $3,090.00 2026-06-09
2501201 CDM Eligard 30mg Injectable Suspension 5 4 $3,252.00 $3,252.00 $1,561.00 $3,089.00 $3,057.00 2026-06-09
73702 CPT CT Lower Ext Lt Wo W 5 4 $3,250.00 $3,250.00 $1,560.00 $3,088.00 $3,055.00 2026-06-09
78458 CPT Venous Thrombosis Bilateral 5 4 $3,250.00 $3,250.00 $1,560.00 $3,088.00 $3,055.00 2026-06-09
73206 CPT CT Angio Upper Ext Rt Wo W 5 4 $3,250.00 $3,250.00 $1,560.00 $3,088.00 $3,055.00 2026-06-09
74160 CPT CT Adrenals Protocol W Abd 9 4 $3,550.00 $3,550.00 $479.00 $3,373.00 $3,055.00 2026-06-09
73718 CPT Mr Low Ext Lt Wo 5 4 $3,250.00 $3,250.00 $526.00 $3,088.00 $3,055.00 2026-06-09
73202 CPT CT Upper Ext Lt Wo W 5 4 $3,250.00 $3,250.00 $1,560.00 $3,088.00 $3,055.00 2026-06-09
72193 CPT CT Scan Of Pelvis With Contrast 5 4 $3,250.00 $3,250.00 $469.00 $3,088.00 $3,055.00 2026-06-09
70492 CPT CT Neck Wo W 5 4 $3,250.00 $3,250.00 $1,560.00 $3,088.00 $3,055.00 2026-06-09
72126 CPT CT Spine Cerv W 5 4 $3,250.00 $3,250.00 $1,560.00 $3,088.00 $3,055.00 2026-06-09
74178 CPT CT Abd Pelvis Wo W 5 4 $6,250.00 $6,250.00 $724.00 $5,875.00 $3,045.00 2026-06-09
900034 CDM Or A Minor 46-60 5 4 $3,200.00 $3,200.00 $1,536.00 $3,040.00 $3,008.00 2026-06-09
49593 CPT Pfmc Rpr Antr Abd Hernia Any Reduc3-10cm 10 4 $5,854.50 $5,854.50 $463.00 $10,450.00 $2,977.00 2026-06-09
2501731-JZ CDM Romosozumab-aqqg 105mg/1.17ml Syringe 5 4 $3,155.00 $3,155.00 $1,514.00 $2,997.00 $2,966.00 2026-06-09
57520 CPT Conization Cervix Cone Biopsy 10 4 $5,843.00 $5,843.00 $248.00 $10,450.00 $2,966.00 2026-06-09
57250 CPT Pf Mc Posterior Colporrhapy With Cysto 10 4 $5,563.50 $5,563.50 $499.00 $9,500.00 $2,935.50 2026-06-09
26727 CPT Pf Mc Treat Finger Fracture Each 10 4 $5,418.00 $5,418.00 $416.00 $9,025.00 $2,914.50 2026-06-09
74364 CPT Leuprolide 3.75mg Syringe Kit 5 4 $3,088.00 $3,088.00 $1,482.00 $2,934.00 $2,903.00 2026-06-09
2500064 CDM Bortezomib 3.5mg Sdv 5 4 $3,078.00 $3,078.00 $1,477.00 $2,924.00 $2,893.00 2026-06-09
73701 CPT CT Low Ext Lt W 5 4 $3,050.00 $3,050.00 $453.00 $2,898.00 $2,867.00 2026-06-09
70481 CPT CT Orbit Outer Mid Inner Ear W 5 4 $3,050.00 $3,050.00 $1,464.00 $2,898.00 $2,867.00 2026-06-09
72191 CPT CT Angio Pelvis Wo W 5 4 $3,050.00 $3,050.00 $1,464.00 $2,898.00 $2,867.00 2026-06-09
78472 CPT Nm Cardiac Blood Pool, Muga 5 4 $3,050.00 $3,050.00 $1,464.00 $2,898.00 $2,867.00 2026-06-09
73201 CPT CT Upper Ext Lt W 10 4 $3,150.00 $3,150.00 $1,464.00 $3,088.00 $2,867.00 2026-06-09
27425 CPT Lateral Retinacular Release Open 10 4 $5,361.00 $5,361.00 $402.00 $9,025.00 $2,860.50 2026-06-09
46255 CPT Hemorrhoidectomy Internal External Singl 15 4 $3,563.00 $3,563.00 $320.00 $5,225.00 $2,850.00 2026-06-09
G0390 HCPCS Trauma Response Team 5 4 $3,000.00 $3,000.00 $1,440.00 $2,850.00 $2,820.00 2026-06-09
900017 CDM Or A 91-105 5 4 $3,000.00 $3,000.00 $1,440.00 $2,850.00 $2,820.00 2026-06-09
73221 CPT Mr Joint Lt Upper Wo 9 4 $3,550.00 $3,550.00 $468.00 $3,373.00 $2,816.00 2026-06-09
64640 CPT Dest Neurolytic, Peripheral Nerve 15 4 $3,500.00 $3,500.00 $104.00 $4,988.00 $2,800.00 2026-06-09
74150 CPT CT Adrenals Protocol Wo Abd 9 4 $3,550.00 $3,550.00 $302.00 $3,373.00 $2,773.00 2026-06-09
81460 CPT Mitop Mitrochandral Full Genom (Ref) 5 4 $2,948.00 $2,948.00 $1,415.00 $2,801.00 $2,771.00 2026-06-09
23472 CPT Arthroplasty Total Shoulder Glenohumeral 10 4 $20,385.50 $20,385.50 $1,176.00 $36,100.00 $2,767.00 2026-06-09
58673 CPT Laparoscopic Salpingostomy 10 4 $5,111.00 $5,111.00 $637.00 $8,550.00 $2,740.50 2026-06-09
74177 CPT CT Scan Of Abdomen And Pelvis With Contrast 5 4 $5,500.00 $5,500.00 $641.00 $5,170.00 $2,721.00 2026-06-09
900016 CDM Or A 76-90 5 4 $2,870.00 $2,870.00 $1,378.00 $2,727.00 $2,698.00 2026-06-09
49651 CPT Laparoscopic Surg Repair Rec Ing Hernia 10 4 $5,055.50 $5,055.50 $490.00 $8,550.00 $2,687.50 2026-06-09
70487 CPT CT Facial Bones W 5 4 $2,850.00 $2,850.00 $1,368.00 $2,708.00 $2,679.00 2026-06-09
72131 CPT CT Spine Lumbar Wo 5 4 $2,850.00 $2,850.00 $325.00 $2,708.00 $2,679.00 2026-06-09
70491 CPT CT Neck W 5 4 $2,850.00 $2,850.00 $408.00 $2,708.00 $2,679.00 2026-06-09
78457 CPT Venous Thrombosis Unilateral 5 4 $2,850.00 $2,850.00 $1,368.00 $2,708.00 $2,679.00 2026-06-09
72128 CPT CT Spine Thoracic Wo 5 4 $2,850.00 $2,850.00 $325.00 $2,708.00 $2,679.00 2026-06-09
70460 CPT CT Head W 5 4 $2,850.00 $2,850.00 $1,368.00 $2,708.00 $2,679.00 2026-06-09
900051 CDM Or Major Level 1 First Hour 5 4 $2,850.00 $2,850.00 $1,368.00 $2,708.00 $2,679.00 2026-06-09
72125 CPT CT Spine Cervical Wo 5 4 $2,850.00 $2,850.00 $331.00 $2,708.00 $2,679.00 2026-06-09
900033 CDM Or A Minor 31-45 5 4 $2,820.00 $2,820.00 $1,354.00 $2,679.00 $2,651.00 2026-06-09
64490 CPT Inj Paraverte Facet, Cer/thor Sng Lvl 15 4 $3,300.00 $3,300.00 $88.00 $4,703.00 $2,640.00 2026-06-09
2500479-JZ CDM Remicade 100mg Vial 5 4 $2,803.00 $2,803.00 $1,345.00 $2,663.00 $2,635.00 2026-06-09
11772 CPT Excisional Pilondial Cyst Or Sinus-compl 10 4 $4,717.00 $4,717.00 $517.00 $7,600.00 $2,601.00 2026-06-09
46261 CPT Hemorrhoidectomy With Fissurectomy 10 4 $4,825.00 $4,825.00 $469.00 $8,075.00 $2,586.50 2026-06-09
73700 CPT CT Low Ext Lt Wo 9 4 $3,050.00 $3,050.00 $325.00 $2,898.00 $2,585.00 2026-06-09
73200 CPT CT Upper Ext Lt Wo 5 4 $2,750.00 $2,750.00 $325.00 $2,613.00 $2,585.00 2026-06-09
71250 CPT CT Chest Wo 5 4 $2,750.00 $2,750.00 $320.00 $2,613.00 $2,585.00 2026-06-09
78451 CPT Nm Myocardial Spect Single 5 4 $2,750.00 $2,750.00 $1,320.00 $2,613.00 $2,585.00 2026-06-09
72192 CPT CT Pelvis Wo 5 4 $2,750.00 $2,750.00 $293.00 $2,613.00 $2,585.00 2026-06-09
49592 CPT Int Rpr Antr Abd Hernia With Ttl Defect <3 10 4 $5,062.50 $5,062.50 $385.00 $9,025.00 $2,577.00 2026-06-09
900015 CDM Or A 61-75 5 4 $2,730.00 $2,730.00 $1,310.00 $2,594.00 $2,566.00 2026-06-09
43281 CPT Laparoscopy Para Hernia With Fundoplasty 10 4 $15,576.50 $15,576.50 $1,259.00 $27,550.00 $2,543.00 2026-06-09
27130 CPT Arthroplasty Total Hip 10 4 $17,978.00 $17,978.00 $1,048.00 $31,825.00 $2,517.50 2026-06-09
2501922 CDM Durolane 60mg/3ml Syringe 5 4 $2,676.00 $2,676.00 $1,284.00 $2,542.00 $2,515.00 2026-06-09
27447 CPT Arthroplasty Total Knee 10 4 $17,975.00 $17,975.00 $1,046.00 $31,825.00 $2,514.50 2026-06-09
93306 CPT US Echo Doppler 5 4 $2,650.00 $2,650.00 $348.00 $2,518.00 $2,491.00 2026-06-09
70480 CPT CT Orbit Wo 5 4 $2,650.00 $2,650.00 $354.00 $2,518.00 $2,491.00 2026-06-09
27252 CPT Clsd Tx Hip Dislocation W/anes 5 4 $2,645.00 $2,645.00 $1,270.00 $2,513.00 $2,486.00 2026-06-09
63661 CPT Pf Rmv Spinal Neurostim Electrode Perc 10 4 $4,603.50 $4,603.50 $280.00 $7,790.00 $2,446.50 2026-06-09
1100003 CDM Anesthesia Level 3 5 4 $2,592.00 $2,592.00 $1,244.00 $2,462.00 $2,436.00 2026-06-09
70490 CPT CT Neck Wo 5 4 $2,575.00 $2,575.00 $1,236.00 $2,446.00 $2,421.00 2026-06-09
59612 CPT Vaginal Delivery 10 4 $2,768.00 $2,768.00 $1,234.00 $2,818.00 $2,416.00 2026-06-09
900014 CDM Or A 46-60 5 4 $2,550.00 $2,550.00 $1,224.00 $2,423.00 $2,397.00 2026-06-09
78579 CPT Nm Pulmonary Ventilation 5 4 $2,550.00 $2,550.00 $1,224.00 $2,423.00 $2,397.00 2026-06-09
70486 CPT CT Sinus Comp Wo 5 4 $2,550.00 $2,550.00 $280.00 $2,423.00 $2,397.00 2026-06-09
75574 CPT CT Angio Heart W 3d Image 5 4 $2,550.00 $2,550.00 $642.00 $2,423.00 $2,397.00 2026-06-09
77012 CPT CT Guidance Needle Placement 5 4 $2,550.00 $2,550.00 $307.00 $2,423.00 $2,397.00 2026-06-09
78452 CPT Nm Myocardial Spect Multiple 5 4 $4,850.00 $4,850.00 $965.00 $4,559.00 $2,360.00 2026-06-09
11446 CPT Cl Excision Benign Lesion/margins >4.0cm 5 4 $2,500.00 $2,500.00 $1,200.00 $2,375.00 $2,350.00 2026-06-09
74176 CPT CT Abd Pelvis Wo 5 4 $4,850.00 $4,850.00 $405.00 $4,559.00 $2,328.00 2026-06-09
46260 CPT Hemorrhoidectomy Internal External 2< 10 4 $4,300.00 $4,300.00 $435.00 $7,125.00 $2,322.50 2026-06-09
78227 CPT Nm Hepatoductal System, Gb With Cck 5 4 $2,450.00 $2,450.00 $909.00 $2,328.00 $2,303.00 2026-06-09
78014 CPT Thyroid Uptake Multiple 5 4 $2,450.00 $2,450.00 $1,176.00 $2,328.00 $2,303.00 2026-06-09
59426 CPT Cl Antepartum 7 Or More Visi 5 4 $2,351.00 $2,351.00 $1,128.00 $2,233.00 $2,210.00 2026-06-09
78580 CPT Nm Pulmonary Perfusion 5 4 $2,350.00 $2,350.00 $1,128.00 $2,233.00 $2,209.00 2026-06-09
900013 CDM Or A 31-45 5 4 $2,340.00 $2,340.00 $1,123.00 $2,223.00 $2,200.00 2026-06-09
26951 CPT Amp Finger Thumb Direct C 10 4 $2,444.50 $2,444.50 $639.00 $2,427.00 $2,194.00 2026-06-09
49613 CPT Pf Mc Rep Recurrent Abd Hernia W/mesh 10 4 $4,288.00 $4,288.00 $342.00 $7,600.00 $2,193.50 2026-06-09
11771 CPT Excision Pilonidal Cyst Or Sinus-extensi 10 4 $4,012.00 $4,012.00 $397.00 $6,650.00 $2,166.50 2026-06-09
69080 CPT Infliximab-dyyb 100mg Vial 5 4 $2,271.00 $2,271.00 $1,090.00 $2,157.00 $2,135.00 2026-06-09
29827 CPT Arthroscopy Rotator Cuff Rpr 10 4 $14,613.50 $14,613.50 $885.00 $25,650.00 $2,119.50 2026-06-09
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