Price Transparency Hospital negotiated rates

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

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Hospital

COMMUNITY HOSPITAL

Mccook, NE · CCN 281363 · Rates published

6,196 distinct procedures filed
11 distinct payers
121,322 rate rows
2025-12-27 last MRF observed
Data quality

108,420 of 121,322 rate rows are consumer-grade (89.4%)

12,902 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 7,444
professional (physician) fee — not the facility price 4,442
placeholder amount (≤ $0.02) — excluded from medians 824
per-diem day rate — not a per-procedure price 128
percent-of-charges filed in the dollar field — excluded from medians 54
exceeds 10× this hospital's gross charge — excluded from medians 10
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://communitymccook.pt.panaceainc.com/MRFDownload/communitymccook/communitymccook
Found on page https://chmccook.org/patients/price-transparency
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-16
Content fingerprint 91fe5337ed4b0f8f… · 20,339,979 bytes · first seen 2026-05-09

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
67279
HCPCS 		Inebilizumab-cdon 10 Mg/ml Vial 9 $71,289.55 $131,611.48 $130,240.53 nat. median
$242
outlier · 537.2×
01261
CDM 		Membrance Wrap 4x6cm 9 $22,651.20 $41,817.60 $41,382.00 nat. median
$41,382
1.0× median
67409
HCPCS 		Tremelimumab-actl 20 Mg/ml Vial 9 $21,099.31 $38,952.58 $38,546.82 nat. median
$70
outlier · 549.3×
66659
HCPCS 		Ipilimumab 200 Mg/40 Ml (5 Mg/ml) Soln 9 $17,747.53 $32,764.68 $32,423.38 nat. median
$32,423
1.0× median
66908
HCPCS 		Ledipasvir-sofosbuvir 90-400 Mg Tab 9 $15,164.60 $27,996.19 $27,704.57 nat. median
$300
outlier · 92.5×
66685
HCPCS 		Ustekinumab 90 Mg/ml Syrg 9 $13,971.55 $25,793.63 $25,524.94 nat. median
$31
outlier · 823.4×
28361
CDM 		Mesh Permacol 20x30 9 $13,295.07 $24,544.74 $24,289.07 nat. median
$844
outlier · 28.8×
67344
HCPCS 		Lenvatinib 10 Mg/day (10 Mg X 1) Cap 9 $12,612.60 $23,284.80 $23,042.25 nat. median
$10,086
outlier · 2.3×
67303
HCPCS 		Lenvatinib 8 Mg/day (4 Mg X 2) Cap 9 $12,190.88 $22,506.24 $22,271.80 nat. median
$4
outlier · 6186.6×
66570
HCPCS 		SORAfenib 200 Mg Tab 9 $10,795.20 $19,929.60 $19,722.00 nat. median
$130
outlier · 152.0×
66206
HCPCS 		Lenalidomide 10 Mg Cap 9 $10,126.15 $18,694.44 $18,499.70 nat. median
$18,500
1.0× median
539
MS_DRG 		Osteomyelitis With Mcc 1 $17,881.00 $17,881.00 $17,881.00 nat. median
$19,718
0.9× median
66731
HCPCS 		Crizotinib 250 Mg Cap 9 $9,665.04 $17,843.15 $17,657.28 nat. median
$2,295
outlier · 7.7×
540
MS_DRG 		Osteomyelitis With Cc 1 $17,007.00 $17,007.00 $17,007.00 nat. median
$13,478
1.3× median
66969
HCPCS 		Ocrelizumab 300mg/10ml Vial 9 $9,254.33 $17,084.91 $16,906.94 nat. median
$611
outlier · 27.7×
67398
HCPCS 		Teprotumumab-trbw 500 Mg Solr 9 $9,105.79 $16,810.68 $16,635.57 nat. median
$16,636
1.0× median
03140
CDM 		Lithrotripsy 9 $8,636.55 $15,944.40 $15,778.31 nat. median
$15,778
1.0× median
24209
CDM 		Interstim Neurostimulator 9 $8,420.10 $15,544.80 $15,382.88 nat. median
$960
outlier · 16.0×
67448
HCPCS 		Acalabrutinib Maleate 100 Mg Tab 9 $8,231.16 $15,195.98 $15,037.69 nat. median
$15,038
1.0× median
67340
HCPCS 		Quizartinib 26.5 Mg Tab 9 $7,949.76 $14,676.48 $14,523.60 nat. median
$2,073
outlier · 7.0×
67104
HCPCS 		Polatuzumab Vedotin-piiq 140 Mg Solr 9 $7,800.00 $14,400.00 $14,250.00 nat. median
$7,460
1.9× median
67430
HCPCS 		Enzalutamide 80 Mg Tab 9 $7,751.00 $14,309.54 $14,160.48 nat. median
$4,118
outlier · 3.4×
66935
HCPCS 		Niraparib 100 Mg Cap 9 $7,670.00 $14,160.00 $14,012.50 nat. median
$136
outlier · 103.0×
67443
HCPCS 		Guselkumab 200 Mg/20 Ml (10 Mg/ml) Vial 9 $7,570.76 $13,976.79 $13,831.20 nat. median
$13,831
1.0× median
67420
HCPCS 		Pertuzumab-trastuzumab-hy-zzxf (1200mg-600mg-30000u/15ml) 1200 Mg-600mg-30000 Un… 9 $7,236.60 $13,359.87 $13,220.70 nat. median
$4,213
outlier · 3.1×
67239
HCPCS 		Nivolumab/relatlimab (240-80/20ml) 240-80mg/20ml Vial 9 $7,121.02 $13,146.50 $13,009.56 nat. median
$13,010
1.0× median
541
MS_DRG 		Osteomyelitis Without Cc/mcc 1 $12,928.00 $12,928.00 $12,928.00 nat. median
$9,247
1.4× median
67294
HCPCS 		Dabrafenib 75 Mg Cap 9 $7,013.87 $12,948.68 $12,813.80 nat. median
$3
outlier · 4745.9×
66756
HCPCS 		Ustekinumab 45 Mg/0.5 Ml Syrg 9 $6,985.77 $12,896.81 $12,762.47 nat. median
$2,295
outlier · 5.6×
67017
HCPCS 		Venetoclax 100 Mg Tab 9 $6,712.23 $12,391.81 $12,262.73 nat. median
$6,712
1.8× median
66906
HCPCS 		Everolimus 10 Mg Tab 9 $6,693.82 $12,357.83 $12,229.10 nat. median
$400
outlier · 30.6×
66905
HCPCS 		Everolimus 5 Mg Tab 9 $6,693.82 $12,357.83 $12,229.10 nat. median
$7,460
1.6× median
805
MS_DRG 		Vaginal Delivery Without Sterilization Or D&c With Mcc 1 $12,174.00 $12,174.00 $12,174.00 nat. median
$10,237
1.2× median
77373
HCPCS 		Radiation Tx Delivery, Sb 9 $6,367.92 $11,756.16 $11,633.70 nat. median
$3,714
outlier · 3.1×
67062
HCPCS 		Ibrutinib 420 Mg Tab 9 $6,277.81 $11,589.81 $11,469.08 nat. median
$180
outlier · 63.5×
67362
HCPCS 		Luspatercept-aamt 75 Mg Solr 9 $6,167.31 $11,385.81 $11,267.21 nat. median
$11,267
1.0× median
43534
CDM 		Zimmer Knee Coated Basepl 9 $6,082.44 $11,229.12 $11,112.15 nat. median
$6,082
1.8× median
28344
CDM 		Mesh Permacol Large 9 $6,043.22 $11,156.71 $11,040.49 nat. median
$45
outlier · 247.2×
77295
HCPCS 		3-d Radiotherapy Plan 9 $5,753.93 $10,622.64 $10,511.99 nat. median
$1,863
outlier · 5.6×
77301
HCPCS 		Radiotherapy Dose Plan IM 9 $5,753.80 $10,622.40 $10,511.75 nat. median
$2,773
outlier · 3.8×
67423
HCPCS 		Cemiplimab-rwlc 50 Mg/ml Vial 9 $5,680.98 $10,487.96 $10,378.71 nat. median
$10,379
1.0× median
66959
HCPCS 		Enzalutamide 40 Mg Cap 9 $5,670.70 $10,468.98 $10,359.93 nat. median
$266
outlier · 38.9×
43501
CDM 		Zimmer Hip Epoch Stem 9 $5,616.00 $10,368.00 $10,260.00 nat. median
$5,616
1.8× median
43527
CDM 		Zimmer Hip Acetabular Rev 9 $5,503.68 $10,160.64 $10,054.80 nat. median
$10,055
1.0× median
67213
HCPCS 		Abiraterone 500 Mg Tab 9 $5,463.11 $10,085.74 $9,980.68 nat. median
$7,460
1.3× median
67415
HCPCS 		Paliperidone Palm (3 Month) 819 Mg/2.63 Ml Syrg 9 $5,373.00 $9,919.38 $9,816.06 nat. median
$2,450
outlier · 4.0×
67224
HCPCS 		Selpercatinib 80 Mg Cap 9 $5,356.00 $9,888.00 $9,785.00 nat. median
$7,875
1.2× median
67406
HCPCS 		Imetelstat 188 Mg Vial 9 $5,293.87 $9,773.30 $9,671.49 nat. median
$21
outlier · 456.6×
43529
CDM 		Zimmer Hip Acetabular Cag 9 $5,235.36 $9,665.28 $9,564.60 nat. median
$2,256
outlier · 4.2×
67391
HCPCS 		Risankizumab-rzaa 60 Mg/ml Vial 9 $5,205.02 $9,609.27 $9,509.18 nat. median
$2,344
outlier · 4.1×

Other procedures at this hospital

Browse this hospital's 6,196 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
             
67279 HCPCS Inebilizumab-cdon 10 Mg/ml Vial 18 9 $137,095.29 $123,385.76 $71,289.55 $131,611.48 $130,240.53 2025-12-27
01261 CDM Membrance Wrap 4x6cm 18 9 $43,560.00 $39,204.00 $22,651.20 $41,817.60 $41,382.00 2025-12-27
67409 HCPCS Tremelimumab-actl 20 Mg/ml Vial 18 9 $40,575.60 $36,518.04 $21,099.31 $38,952.58 $38,546.82 2025-12-27
66659 HCPCS Ipilimumab 200 Mg/40 Ml (5 Mg/ml) Soln 18 9 $34,129.87 $30,716.88 $17,747.53 $32,764.68 $32,423.38 2025-12-27
66908 HCPCS Ledipasvir-sofosbuvir 90-400 Mg Tab 18 9 $29,162.70 $26,246.43 $15,164.60 $27,996.19 $27,704.57 2025-12-27
66685 HCPCS Ustekinumab 90 Mg/ml Syrg 18 9 $26,868.36 $24,181.52 $13,971.55 $25,793.63 $25,524.94 2025-12-27
28361 CDM Mesh Permacol 20x30 18 9 $25,567.44 $23,010.70 $13,295.07 $24,544.74 $24,289.07 2025-12-27
67344 HCPCS Lenvatinib 10 Mg/day (10 Mg X 1) Cap 18 9 $24,255.00 $21,829.50 $12,612.60 $23,284.80 $23,042.25 2025-12-27
67303 HCPCS Lenvatinib 8 Mg/day (4 Mg X 2) Cap 18 9 $23,444.00 $21,099.60 $12,190.88 $22,506.24 $22,271.80 2025-12-27
66570 HCPCS SORAfenib 200 Mg Tab 18 9 $20,760.00 $18,684.00 $10,795.20 $19,929.60 $19,722.00 2025-12-27
66206 HCPCS Lenalidomide 10 Mg Cap 18 9 $19,473.37 $17,526.03 $10,126.15 $18,694.44 $18,499.70 2025-12-27
66731 HCPCS Crizotinib 250 Mg Cap 18 9 $18,586.61 $16,727.95 $9,665.04 $17,843.15 $17,657.28 2025-12-27
66969 HCPCS Ocrelizumab 300mg/10ml Vial 18 9 $17,796.78 $16,017.10 $9,254.33 $17,084.91 $16,906.94 2025-12-27
67398 HCPCS Teprotumumab-trbw 500 Mg Solr 18 9 $17,511.13 $15,760.02 $9,105.79 $16,810.68 $16,635.57 2025-12-27
03140 CDM Lithrotripsy 18 9 $16,608.75 $14,947.88 $8,636.55 $15,944.40 $15,778.31 2025-12-27
24209 CDM Interstim Neurostimulator 18 9 $16,192.50 $14,573.25 $8,420.10 $15,544.80 $15,382.88 2025-12-27
67448 HCPCS Acalabrutinib Maleate 100 Mg Tab 18 9 $15,829.15 $14,246.24 $8,231.16 $15,195.98 $15,037.69 2025-12-27
67340 HCPCS Quizartinib 26.5 Mg Tab 18 9 $15,288.00 $13,759.20 $7,949.76 $14,676.48 $14,523.60 2025-12-27
67104 HCPCS Polatuzumab Vedotin-piiq 140 Mg Solr 18 9 $15,000.00 $13,500.00 $7,800.00 $14,400.00 $14,250.00 2025-12-27
67430 HCPCS Enzalutamide 80 Mg Tab 18 9 $14,905.77 $13,415.19 $7,751.00 $14,309.54 $14,160.48 2025-12-27
66935 HCPCS Niraparib 100 Mg Cap 18 9 $14,750.00 $13,275.00 $7,670.00 $14,160.00 $14,012.50 2025-12-27
67443 HCPCS Guselkumab 200 Mg/20 Ml (10 Mg/ml) Vial 18 9 $14,559.16 $13,103.24 $7,570.76 $13,976.79 $13,831.20 2025-12-27
67420 HCPCS Pertuzumab-trastuzumab-hy-zzxf (1200mg-600mg-30000u/15ml) 1200 Mg-600mg-30000 Un… 18 9 $13,916.53 $12,524.88 $7,236.60 $13,359.87 $13,220.70 2025-12-27
67239 HCPCS Nivolumab/relatlimab (240-80/20ml) 240-80mg/20ml Vial 18 9 $13,694.27 $12,324.84 $7,121.02 $13,146.50 $13,009.56 2025-12-27
67294 HCPCS Dabrafenib 75 Mg Cap 18 9 $13,488.21 $12,139.39 $7,013.87 $12,948.68 $12,813.80 2025-12-27
66756 HCPCS Ustekinumab 45 Mg/0.5 Ml Syrg 18 9 $13,434.18 $12,090.76 $6,985.77 $12,896.81 $12,762.47 2025-12-27
67017 HCPCS Venetoclax 100 Mg Tab 18 9 $12,908.14 $11,617.33 $6,712.23 $12,391.81 $12,262.73 2025-12-27
66905 HCPCS Everolimus 5 Mg Tab 18 9 $12,872.74 $11,585.47 $6,693.82 $12,357.83 $12,229.10 2025-12-27
66906 HCPCS Everolimus 10 Mg Tab 18 9 $12,872.74 $11,585.47 $6,693.82 $12,357.83 $12,229.10 2025-12-27
77373 HCPCS Radiation Tx Delivery, Sb 18 9 $12,246.00 $11,021.40 $6,367.92 $11,756.16 $11,633.70 2025-12-27
67062 HCPCS Ibrutinib 420 Mg Tab 18 9 $12,072.72 $10,865.45 $6,277.81 $11,589.81 $11,469.08 2025-12-27
67362 HCPCS Luspatercept-aamt 75 Mg Solr 18 9 $11,860.22 $10,674.20 $6,167.31 $11,385.81 $11,267.21 2025-12-27
43534 CDM Zimmer Knee Coated Basepl 18 9 $11,697.00 $10,527.30 $6,082.44 $11,229.12 $11,112.15 2025-12-27
28344 CDM Mesh Permacol Large 18 9 $11,621.57 $10,459.41 $6,043.22 $11,156.71 $11,040.49 2025-12-27
77295 HCPCS 3-d Radiotherapy Plan 18 9 $11,065.25 $9,958.73 $5,753.93 $10,622.64 $10,511.99 2025-12-27
77301 HCPCS Radiotherapy Dose Plan IM 18 9 $11,065.00 $9,958.50 $5,753.80 $10,622.40 $10,511.75 2025-12-27
67423 HCPCS Cemiplimab-rwlc 50 Mg/ml Vial 18 9 $10,924.96 $9,832.46 $5,680.98 $10,487.96 $10,378.71 2025-12-27
66959 HCPCS Enzalutamide 40 Mg Cap 18 9 $10,905.19 $9,814.67 $5,670.70 $10,468.98 $10,359.93 2025-12-27
43501 CDM Zimmer Hip Epoch Stem 18 9 $10,800.00 $9,720.00 $5,616.00 $10,368.00 $10,260.00 2025-12-27
43527 CDM Zimmer Hip Acetabular Rev 18 9 $10,584.00 $9,525.60 $5,503.68 $10,160.64 $10,054.80 2025-12-27
67213 HCPCS Abiraterone 500 Mg Tab 18 9 $10,505.98 $9,455.38 $5,463.11 $10,085.74 $9,980.68 2025-12-27
67415 HCPCS Paliperidone Palm (3 Month) 819 Mg/2.63 Ml Syrg 18 9 $10,332.69 $9,299.42 $5,373.00 $9,919.38 $9,816.06 2025-12-27
67224 HCPCS Selpercatinib 80 Mg Cap 18 9 $10,300.00 $9,270.00 $5,356.00 $9,888.00 $9,785.00 2025-12-27
67406 HCPCS Imetelstat 188 Mg Vial 18 9 $10,180.52 $9,162.47 $5,293.87 $9,773.30 $9,671.49 2025-12-27
43529 CDM Zimmer Hip Acetabular Cag 18 9 $10,068.00 $9,061.20 $5,235.36 $9,665.28 $9,564.60 2025-12-27
67391 HCPCS Risankizumab-rzaa 60 Mg/ml Vial 18 9 $10,009.66 $9,008.69 $5,205.02 $9,609.27 $9,509.18 2025-12-27
66747 HCPCS Abiraterone 250 Mg Tab 18 9 $9,976.36 $8,978.72 $5,187.71 $9,577.31 $9,477.54 2025-12-27
67247 HCPCS Daratumumab-hyaluronidase-fihj 1800 Mg-30000 Unit/15 Ml Vial 18 9 $9,972.52 $8,975.27 $5,185.71 $9,573.62 $9,473.89 2025-12-27
66919 HCPCS Lanreotide 120 Mg/0.5 Ml Syrg 18 9 $9,944.00 $8,949.60 $5,170.88 $9,546.24 $9,446.80 2025-12-27
66272 HCPCS Dasatinib 100 Mg Tab 18 9 $9,875.35 $8,887.82 $5,135.18 $9,480.34 $9,381.58 2025-12-27
66768 HCPCS Pembrolizumab 100mg/4ml Vial 18 9 $9,869.92 $8,882.93 $5,132.36 $9,475.12 $9,376.42 2025-12-27
66990 HCPCS Atezolizumab 1200 Mg/20 Ml (60 Mg/ml) Soln 18 9 $9,848.64 $8,863.78 $5,121.29 $9,454.69 $9,356.21 2025-12-27
66838 HCPCS Sildenafil 10 Mg/ml Susr 18 9 $9,817.01 $8,835.31 $5,104.85 $9,424.33 $9,326.16 2025-12-27
66520 HCPCS Leuprolide (6 Month) 45 Mg Sykt 18 9 $9,816.91 $8,835.22 $5,104.79 $9,424.23 $9,326.06 2025-12-27
66902 HCPCS Cabazitaxel 10 Mg/ml (first Dilution) Soln 18 9 $9,667.84 $8,701.06 $5,027.28 $9,281.13 $9,184.45 2025-12-27
66751 HCPCS Vedolizumab 300 Mg Vial 18 9 $9,359.91 $8,423.92 $4,867.15 $8,985.51 $8,891.91 2025-12-27
67421 HCPCS Pertuzumab-trastuzumab-hy-zzxf (600mg-600mg-20000u/10ml) 600 Mg-600 Mg-20000 Uni… 18 9 $9,277.32 $8,349.59 $4,824.21 $8,906.23 $8,813.45 2025-12-27
66658 HCPCS Ipilimumab 50 Mg/10 Ml (5 Mg/ml) Soln 18 9 $9,054.74 $8,149.27 $4,708.46 $8,692.55 $8,602.00 2025-12-27
67364 HCPCS Obinutuzumab 1000 Mg/40 Ml Vial 18 9 $9,000.29 $8,100.26 $4,680.15 $8,640.28 $8,550.28 2025-12-27
78816 HCPCS PET CT Whole Body 18 9 $8,884.50 $7,996.05 $4,619.94 $8,529.12 $8,440.28 2025-12-27
66080 HCPCS Natalizumab 300 Mg/15 Ml Vial 18 9 $8,879.22 $7,991.30 $4,617.19 $8,524.05 $8,435.26 2025-12-27
66370 HCPCS Imatinib 400 Mg Tab 18 9 $8,782.29 $7,904.06 $4,566.79 $8,431.00 $8,343.18 2025-12-27
43623 CDM Depuy Hip Cup Duraloc 18 9 $8,557.17 $7,701.45 $4,449.73 $8,214.88 $8,129.31 2025-12-27
43530 CDM Zimmer Knee Femur 18 9 $8,550.00 $7,695.00 $4,446.00 $8,208.00 $8,122.50 2025-12-27
67229 HCPCS Ofatumumab 20 Mg/0.4 Ml Pnij 18 9 $8,522.66 $7,670.39 $4,431.78 $8,181.75 $8,096.53 2025-12-27
00640 HCPCS Alteplase 100 Mg Solr 18 9 $8,492.35 $7,643.12 $4,416.02 $8,152.66 $8,067.73 2025-12-27
43602 CDM Depuy Hip Stem Cementless 18 9 $8,400.00 $7,560.00 $4,368.00 $8,064.00 $7,980.00 2025-12-27
66676 HCPCS Nilotinib 150 Mg Cap 18 9 $8,290.47 $7,461.42 $4,311.04 $7,958.85 $7,875.95 2025-12-27
66329 HCPCS Leuprolide (4 Month) 30 Mg Sykt 18 9 $8,284.72 $7,456.25 $4,308.05 $7,953.33 $7,870.48 2025-12-27
66878 HCPCS Dimethyl Fumarate 240 Mg Cpdr 18 9 $8,275.89 $7,448.30 $4,303.46 $7,944.85 $7,862.10 2025-12-27
67435 HCPCS Lurbinectedin 4 Mg Solr 18 9 $8,250.00 $7,425.00 $4,290.00 $7,920.00 $7,837.50 2025-12-27
28346 CDM Permacol Mesh 15x20 18 9 $8,190.00 $7,371.00 $4,258.80 $7,862.40 $7,780.50 2025-12-27
66949 HCPCS Imatinib 100 Mg Tab 18 9 $8,132.48 $7,319.23 $4,228.89 $7,807.18 $7,725.86 2025-12-27
67107 HCPCS Atezolizumab 840 Mg/14 Ml (60 Mg/ml) Soln 18 9 $8,112.56 $7,301.30 $4,218.53 $7,788.06 $7,706.93 2025-12-27
67451 HCPCS Nivolumab-hyaluronidase-nvhy 600 Mg-10000 Unit/5 Ml Vial 18 9 $8,101.94 $7,291.75 $4,213.01 $7,777.86 $7,696.84 2025-12-27
57384 HCPCS Tenecteplase 50 Mg Vial 18 9 $8,089.83 $7,280.85 $4,206.71 $7,766.24 $7,685.34 2025-12-27
66951 HCPCS Nivolumab 240mg/24ml Vial 18 9 $7,943.08 $7,148.77 $4,130.40 $7,625.36 $7,545.93 2025-12-27
67225 HCPCS Selpercatinib 40 Mg Cap 18 9 $7,909.16 $7,118.24 $4,112.76 $7,592.79 $7,513.70 2025-12-27
43772 CDM Biomet Hip Stem Cementles 18 9 $7,800.00 $7,020.00 $4,056.00 $7,488.00 $7,410.00 2025-12-27
43773 CDM Biomet Hip Stem Modular 18 9 $7,800.00 $7,020.00 $4,056.00 $7,488.00 $7,410.00 2025-12-27
66358 HCPCS Lenalidomide 5 Mg Cap 18 9 $7,774.62 $6,997.16 $4,042.80 $7,463.64 $7,385.89 2025-12-27
78815 HCPCS PET CT Skull Base - Mid T 18 9 $7,701.50 $6,931.35 $4,004.78 $7,393.44 $7,316.43 2025-12-27
66641 HCPCS Teriflunomide 14 Mg Tab 18 9 $7,521.93 $6,769.74 $3,911.40 $7,221.05 $7,145.83 2025-12-27
66868 HCPCS Ramucirumab 10 Mg/ml Soln 18 9 $7,503.93 $6,753.54 $3,902.04 $7,203.77 $7,128.73 2025-12-27
43781 CDM Biomet Hip Cup Metal On M 18 9 $7,500.00 $6,750.00 $3,900.00 $7,200.00 $7,125.00 2025-12-27
43702 CDM Stryker Knee Cemented Fem 18 9 $7,200.00 $6,480.00 $3,744.00 $6,912.00 $6,840.00 2025-12-27
43663 CDM Depuy Knee Tibia Coated R 18 9 $7,200.00 $6,480.00 $3,744.00 $6,912.00 $6,840.00 2025-12-27
43825 CDM Knee, Attune Tibial Basep 18 9 $7,087.50 $6,378.75 $3,685.50 $6,804.00 $6,733.13 2025-12-27
66145 HCPCS Tobramycin 300 Mg/5 Ml Nebu 18 9 $7,003.75 $6,303.38 $3,641.95 $6,723.60 $6,653.56 2025-12-27
66726 HCPCS Panitumumab 400 Mg/20 Ml (20 Mg/ml) Soln 18 9 $6,992.28 $6,293.05 $3,635.99 $6,712.59 $6,642.67 2025-12-27
43555 CDM Zimmer Uni Knee Femur 18 9 $6,900.00 $6,210.00 $3,588.00 $6,624.00 $6,555.00 2025-12-27
66637 HCPCS Pertuzumab 420 Mg/14 Ml (30 Mg/ml) Vial 18 9 $6,820.49 $6,138.44 $3,546.65 $6,547.67 $6,479.47 2025-12-27
67339 HCPCS Mirvetuximab Soravtansine-gynx 5 Mg/ml Vial 18 9 $6,782.35 $6,104.12 $3,526.82 $6,511.06 $6,443.23 2025-12-27
78608 HCPCS PET CT Brain Imaging, Met 18 9 $6,760.00 $6,084.00 $3,515.20 $6,489.60 $6,422.00 2025-12-27
43661 CDM Depuy Knee Tibia Uncoated 18 9 $6,750.00 $6,075.00 $3,510.00 $6,480.00 $6,412.50 2025-12-27
43817 CDM Knee Femoral Adapter 18 9 $6,722.26 $6,050.03 $3,495.58 $6,453.37 $6,386.15 2025-12-27
66156 HCPCS Adalimumab 40 Mg/0.8 Ml Pnkt 18 9 $6,680.33 $6,012.30 $3,473.77 $6,413.12 $6,346.31 2025-12-27
43621 CDM Depuy Hip Cup Acetabular 18 9 $6,674.82 $6,007.34 $3,470.91 $6,407.83 $6,341.08 2025-12-27
03088 CDM Surgery Room Major Level 18 9 $6,640.00 $5,976.00 $3,452.80 $6,374.40 $6,308.00 2025-12-27
43652 CDM Depuy Knee Femur Coated 18 9 $6,600.00 $5,940.00 $3,432.00 $6,336.00 $6,270.00 2025-12-27
43604 CDM Depuy Hip Stem Modular 18 9 $6,600.00 $5,940.00 $3,432.00 $6,336.00 $6,270.00 2025-12-27
67105 HCPCS Rituximab-hyaluronidasehuman 1400 Mg/11.7 Ml (120 Mg/ml) Soln 18 9 $6,576.58 $5,918.92 $3,419.82 $6,313.52 $6,247.75 2025-12-27
74174 HCPCS CT Angio Abdomen/pelvis 18 9 $6,383.50 $5,745.15 $3,319.42 $6,128.16 $6,064.33 2025-12-27
66608 HCPCS Ado-trastuzumab Emtansine 160 Mg Solr 18 9 $6,383.40 $5,745.06 $3,319.37 $6,128.06 $6,064.23 2025-12-27
66023 HCPCS Octreotide Acetate 30 Mg Kit 18 9 $6,337.09 $5,703.38 $3,295.29 $6,083.61 $6,020.24 2025-12-27
26470 CDM Optilume, 30fr X 5cm, Dcb 18 9 $6,336.25 $5,702.63 $3,294.85 $6,082.80 $6,019.44 2025-12-27
26469 CDM Optilume, 24fr X 5cm, Dcb 18 9 $6,336.25 $5,702.63 $3,294.85 $6,082.80 $6,019.44 2025-12-27
67365 HCPCS Efgartigimod Alfa-fcab 20 Mg/ml Vial 18 9 $6,314.19 $5,682.77 $3,283.38 $6,061.62 $5,998.48 2025-12-27
00258 CDM Augment Bone Graft 18 9 $6,300.00 $5,670.00 $3,276.00 $6,048.00 $5,985.00 2025-12-27
43552 CDM Zimmer Knee Femoral Block 18 9 $6,237.00 $5,613.30 $3,243.24 $5,987.52 $5,925.15 2025-12-27
66124 HCPCS Leuprolide (3 Month) 22.5 Mg Kit 18 9 $6,213.52 $5,592.17 $3,231.03 $5,964.98 $5,902.84 2025-12-27
66778 HCPCS Deferasirox 500 Mg Tbdp 18 9 $6,173.29 $5,555.96 $3,210.11 $5,926.36 $5,864.63 2025-12-27
43701 CDM Stryker Knee Triathlon/pk 18 9 $6,080.00 $5,472.00 $3,161.60 $5,836.80 $5,776.00 2025-12-27
43813 CDM Knee Tibia Tray Uncoated 18 9 $6,048.00 $5,443.20 $3,144.96 $5,806.08 $5,745.60 2025-12-27
66602 HCPCS Ixabepilone 45 Mg Solr 18 9 $6,043.68 $5,439.31 $3,142.71 $5,801.93 $5,741.50 2025-12-27
43786 CDM Biomet Hip Ceramic Or E1 18 9 $6,000.00 $5,400.00 $3,120.00 $5,760.00 $5,700.00 2025-12-27
43662 CDM Depuy Knee Tibia Coated 18 9 $6,000.00 $5,400.00 $3,120.00 $5,760.00 $5,700.00 2025-12-27
43536 CDM Zimmer Knee Tibia Uncoat 18 9 $6,000.00 $5,400.00 $3,120.00 $5,760.00 $5,700.00 2025-12-27
43711 CDM Stryker Knee Cementless T 18 9 $6,000.00 $5,400.00 $3,120.00 $5,760.00 $5,700.00 2025-12-27
24207 CDM Interstim Lead (28-33-41) 18 9 $5,913.00 $5,321.70 $3,074.76 $5,676.48 $5,617.35 2025-12-27
66852 HCPCS Glatiramer 40 Mg/ml Syrg 18 9 $5,909.28 $5,318.35 $3,072.83 $5,672.91 $5,613.82 2025-12-27
43808 CDM Hip Stem Cemented 18 9 $5,880.00 $5,292.00 $3,057.60 $5,644.80 $5,586.00 2025-12-27
67068 HCPCS Tofacitinib 11 Mg Tb24 18 9 $5,860.59 $5,274.53 $3,047.51 $5,626.17 $5,567.56 2025-12-27
67073 HCPCS Tofacitinib 5 Mg Tab 18 9 $5,860.59 $5,274.53 $3,047.51 $5,626.17 $5,567.56 2025-12-27
65917 HCPCS Crotalidae Polyvalent Immune Fab Vial 18 9 $5,831.88 $5,248.69 $3,032.58 $5,598.60 $5,540.29 2025-12-27
43721 CDM Stryker Knee X3 Inserts 18 9 $5,760.00 $5,184.00 $2,995.20 $5,529.60 $5,472.00 2025-12-27
43660 CDM Depuy Knee Tibia Uncoated 18 9 $5,760.00 $5,184.00 $2,995.20 $5,529.60 $5,472.00 2025-12-27
43710 CDM Stryker Knee Cemented Tib 18 9 $5,760.00 $5,184.00 $2,995.20 $5,529.60 $5,472.00 2025-12-27
66592 HCPCS Certolizumab Pegol 200 Mg/ml X 2 Sykt 18 9 $5,702.61 $5,132.35 $2,965.36 $5,474.51 $5,417.48 2025-12-27
43601 CDM Depuy Hip Stem Cemented 18 9 $5,600.00 $5,040.00 $2,912.00 $5,376.00 $5,320.00 2025-12-27
43771 CDM Biomet Hip Stem Cemented 18 9 $5,600.00 $5,040.00 $2,912.00 $5,376.00 $5,320.00 2025-12-27
43515 CDM Zimmer Hip Cup 18 9 $5,440.00 $4,896.00 $2,828.80 $5,222.40 $5,168.00 2025-12-27
43651 CDM Depuy Knee Femur Pfj 18 9 $5,440.00 $4,896.00 $2,828.80 $5,222.40 $5,168.00 2025-12-27
66227 HCPCS Tolvaptan 30 Mg Tab 18 9 $5,396.43 $4,856.79 $2,806.14 $5,180.57 $5,126.61 2025-12-27
66885 HCPCS Sirolimus 2 Mg Tab 18 9 $5,395.76 $4,856.18 $2,805.80 $5,179.93 $5,125.97 2025-12-27
43821 CDM Knee Femoral Adapter Bolt 18 9 $5,376.00 $4,838.40 $2,795.52 $5,160.96 $5,107.20 2025-12-27
43824 CDM Knee, Attune Femur 18 9 $5,376.00 $4,838.40 $2,795.52 $5,160.96 $5,107.20 2025-12-27
43804 CDM Hip Acetabular Shell Cup 18 9 $5,376.00 $4,838.40 $2,795.52 $5,160.96 $5,107.20 2025-12-27
95811 HCPCS Sleep Study Split Night 36 9 $5,359.00 $4,823.10 $2,786.68 $5,144.64 $5,091.05 2025-12-27
26475 CDM Lad Ligament Augmentation 18 9 $5,298.81 $4,768.93 $2,755.38 $5,086.86 $5,033.87 2025-12-27
67126 HCPCS Capecitabine 500 Mg Tab 18 9 $5,286.76 $4,758.08 $2,749.12 $5,075.29 $5,022.42 2025-12-27
66874 HCPCS Leuprolide (3 Month) 11.25 Mg Sykt 18 9 $5,214.26 $4,692.83 $2,711.42 $5,005.69 $4,953.55 2025-12-27
43826 CDM Knee, Attune Insert 18 9 $5,208.00 $4,687.20 $2,708.16 $4,999.68 $4,947.60 2025-12-27
66808 HCPCS Tolvaptan 15 Mg Tab 18 9 $5,201.97 $4,681.77 $2,705.02 $4,993.89 $4,941.87 2025-12-27
39921 CDM Bone Matrix, Bio4 Vialble 18 9 $5,167.80 $4,651.02 $2,687.26 $4,961.09 $4,909.41 2025-12-27
43624 CDM Depuy Hip Cup Gription 18 9 $5,120.00 $4,608.00 $2,662.40 $4,915.20 $4,864.00 2025-12-27
67301 HCPCS Pimavanserin 34 Mg Cap 18 9 $5,120.00 $4,608.00 $2,662.40 $4,915.20 $4,864.00 2025-12-27
43650 CDM Depuy Knee Femur Uncoated 18 9 $5,120.00 $4,608.00 $2,662.40 $4,915.20 $4,864.00 2025-12-27
43676 CDM Depuy Uni Knee Femur 18 9 $5,120.00 $4,608.00 $2,662.40 $4,915.20 $4,864.00 2025-12-27
66667 HCPCS Valganciclovir 450 Mg Tab 18 9 $5,118.50 $4,606.65 $2,661.62 $4,913.76 $4,862.58 2025-12-27
72149 HCPCS Lumbar Spine With Contras 18 9 $5,093.00 $4,583.70 $2,648.36 $4,889.28 $4,838.35 2025-12-27
66821 HCPCS IdaruCIZUMAB 5 Gram Soln 18 9 $5,076.90 $4,569.21 $2,639.99 $4,873.82 $4,823.06 2025-12-27
01255 CDM Graft Jacket, 5x5 Standar 18 9 $5,057.25 $4,551.53 $2,629.77 $4,854.96 $4,804.39 2025-12-27
72157 HCPCS T-spine Wo/w Contrast 18 9 $4,964.75 $4,468.28 $2,581.67 $4,766.16 $4,716.51 2025-12-27
43671 CDM Depuy Knee Insert Rp Or R 18 9 $4,960.00 $4,464.00 $2,579.20 $4,761.60 $4,712.00 2025-12-27
72156 HCPCS C-spine, Wo/w Contrast 18 9 $4,890.25 $4,401.23 $2,542.93 $4,694.64 $4,645.74 2025-12-27
66642 HCPCS Fingolimod 0.5 Mg Cap 18 9 $4,872.68 $4,385.41 $2,533.79 $4,677.77 $4,629.05 2025-12-27
39937 HCPCS Filgrastim 480 Mcg/1.6 Ml Soln 18 9 $4,832.99 $4,349.69 $2,513.15 $4,639.67 $4,591.34 2025-12-27
74183 HCPCS Abdomen W Without Contrast 18 9 $4,818.00 $4,336.20 $2,505.36 $4,625.28 $4,577.10 2025-12-27
43782 CDM Biomet Hip Cup Highly Por 18 9 $4,800.00 $4,320.00 $2,496.00 $4,608.00 $4,560.00 2025-12-27
43677 CDM Depuy Uni Knee Tibia 18 9 $4,785.00 $4,306.50 $2,488.20 $4,593.60 $4,545.75 2025-12-27
72197 HCPCS Prostate W Without Contrast 18 9 $4,766.25 $4,289.63 $2,478.45 $4,575.60 $4,527.94 2025-12-27
95810 HCPCS Sleep Study Baseline 36 9 $4,711.25 $4,240.13 $2,449.85 $4,522.80 $4,475.69 2025-12-27
72158 HCPCS L-spine Wo/w Contrast 18 9 $4,707.25 $4,236.53 $2,447.77 $4,518.96 $4,471.89 2025-12-27
66461 HCPCS RiTUXimab 500 Mg/50 Ml Vial 18 9 $4,697.60 $4,227.84 $2,442.75 $4,509.70 $4,462.72 2025-12-27
43810 CDM Hip Head Ceramic 18 9 $4,677.75 $4,209.98 $2,432.43 $4,490.64 $4,443.86 2025-12-27
03087 CDM Surgery Room Major Level 18 9 $4,650.00 $4,185.00 $2,418.00 $4,464.00 $4,417.50 2025-12-27
77385 HCPCS Radiation Tx Delivery, IM 18 9 $4,635.50 $4,171.95 $2,410.46 $4,450.08 $4,403.73 2025-12-27
43542 CDM Zimmer Knee Insert Mobile 18 9 $4,620.00 $4,158.00 $2,402.40 $4,435.20 $4,389.00 2025-12-27
70549 HCPCS Angiography Neck Wo/w Con 18 9 $4,596.00 $4,136.40 $2,389.92 $4,412.16 $4,366.20 2025-12-27
70546 HCPCS Angiography Head Wo/w Con 18 9 $4,584.75 $4,126.28 $2,384.07 $4,401.36 $4,355.51 2025-12-27
70553 HCPCS Brain, Wo/w Contrast 18 9 $4,570.25 $4,113.23 $2,376.53 $4,387.44 $4,341.74 2025-12-27
18220 HCPCS Digoxin Immune Fab 40 Mg Solr 18 9 $4,535.30 $4,081.77 $2,358.36 $4,353.89 $4,308.54 2025-12-27
67311 HCPCS Lanreotide (cipla) 120 Mg/0.5 Ml Syrg 18 9 $4,528.37 $4,075.53 $2,354.75 $4,347.24 $4,301.95 2025-12-27
66607 HCPCS Dalfampridine 10 Mg Tb12 18 9 $4,469.76 $4,022.78 $2,324.28 $4,290.97 $4,246.27 2025-12-27
43777 CDM Biomet Hip Head Non-metal 18 9 $4,455.00 $4,009.50 $2,316.60 $4,276.80 $4,232.25 2025-12-27
43520 CDM Zimmer Hip Liner 18 9 $4,455.00 $4,009.50 $2,316.60 $4,276.80 $4,232.25 2025-12-27
43556 CDM Zimmer Uni Knee Tibia 18 9 $4,455.00 $4,009.50 $2,316.60 $4,276.80 $4,232.25 2025-12-27
43612 CDM Depuy Hip Head Non Metal 18 9 $4,455.00 $4,009.50 $2,316.60 $4,276.80 $4,232.25 2025-12-27
71552 HCPCS Chest Without W Contrast 18 9 $4,448.50 $4,003.65 $2,313.22 $4,270.56 $4,226.08 2025-12-27
74185 HCPCS Angiography Abdomen 18 9 $4,440.75 $3,996.68 $2,309.19 $4,263.12 $4,218.71 2025-12-27
01244 CDM Ureteroscope, Lithovue, S 18 9 $4,440.00 $3,996.00 $2,308.80 $4,262.40 $4,218.00 2025-12-27
70552 HCPCS Brain With Contrast 18 9 $4,437.25 $3,993.53 $2,307.37 $4,259.76 $4,215.39 2025-12-27
77386 HCPCS Radiation Tx Delivery, IM 18 9 $4,408.00 $3,967.20 $2,292.16 $4,231.68 $4,187.60 2025-12-27
73223 HCPCS Upper Ext Jts Wo/w Contr 36 9 $4,403.00 $3,962.70 $2,289.56 $4,226.88 $4,182.85 2025-12-27
73220 HCPCS Upper Extr Wo/w Contrast 36 9 $4,401.25 $3,961.13 $2,288.65 $4,225.20 $4,181.19 2025-12-27
67253 HCPCS Tezepelumab-ekko 210 Mg/1.91 Ml Syrg 18 9 $4,368.52 $3,931.67 $2,271.63 $4,193.78 $4,150.09 2025-12-27
70545 HCPCS Angiography Head W/contr 18 9 $4,350.25 $3,915.23 $2,262.13 $4,176.24 $4,132.74 2025-12-27
43811 CDM Hip Liner Acetabular High 18 9 $4,331.25 $3,898.13 $2,252.25 $4,158.00 $4,114.69 2025-12-27
43812 CDM Hip Stem Fracture 18 9 $4,331.25 $3,898.13 $2,252.25 $4,158.00 $4,114.69 2025-12-27
43803 CDM Hip Head Metal >36mm 18 9 $4,331.25 $3,898.13 $2,252.25 $4,158.00 $4,114.69 2025-12-27
70543 HCPCS Orbits, Face, Neck, Soft 18 9 $4,324.25 $3,891.83 $2,248.61 $4,151.28 $4,108.04 2025-12-27
67033 HCPCS Durvalumab 50 Mg/ml Soln 18 9 $4,294.66 $3,865.19 $2,233.22 $4,122.87 $4,079.93 2025-12-27
43500 CDM Zimmer Hip Fracture Stem 18 9 $4,290.00 $3,861.00 $2,230.80 $4,118.40 $4,075.50 2025-12-27
43510 CDM Zimmer Hip Non Metal 18 9 $4,290.00 $3,861.00 $2,230.80 $4,118.40 $4,075.50 2025-12-27
43541 CDM Zimmer Knee Insert Flex, 18 9 $4,290.00 $3,861.00 $2,230.80 $4,118.40 $4,075.50 2025-12-27
77470 HCPCS Special Radiation Trmt 18 9 $4,287.75 $3,858.98 $2,229.63 $4,116.24 $4,073.36 2025-12-27
72142 HCPCS Cervical Spine With Contr 18 9 $4,278.75 $3,850.88 $2,224.95 $4,107.60 $4,064.81 2025-12-27
72147 HCPCS Thoracic Spine With Contr 18 9 $4,278.75 $3,850.88 $2,224.95 $4,107.60 $4,064.81 2025-12-27
67188 HCPCS Enfortumab-vedotin-ejfv 30 Mg/3 Ml Solr 18 9 $4,213.50 $3,792.15 $2,191.02 $4,044.96 $4,002.83 2025-12-27
01256 CDM Viaflow Flowable Placenta 18 9 $4,207.50 $3,786.75 $2,187.90 $4,039.20 $3,997.13 2025-12-27
73219 HCPCS Upper Extremity W/contras 18 9 $4,202.50 $3,782.25 $2,185.30 $4,034.40 $3,992.38 2025-12-27
73723 HCPCS Low Ext Joints Wo/w Cont 18 9 $4,179.50 $3,761.55 $2,173.34 $4,012.32 $3,970.53 2025-12-27
43611 CDM Depuy Hip Head >36mm 18 9 $4,125.00 $3,712.50 $2,145.00 $3,960.00 $3,918.75 2025-12-27
43664 CDM Depuy Knee Tibia Poly 18 9 $4,125.00 $3,712.50 $2,145.00 $3,960.00 $3,918.75 2025-12-27
43600 CDM Depuy Hip Stem Fracture 18 9 $4,125.00 $3,712.50 $2,145.00 $3,960.00 $3,918.75 2025-12-27
43776 CDM Biomet Hip Head Metal >36 18 9 $4,125.00 $3,712.50 $2,145.00 $3,960.00 $3,918.75 2025-12-27
43770 CDM Biomet Stem Hip Fracture 18 9 $4,125.00 $3,712.50 $2,145.00 $3,960.00 $3,918.75 2025-12-27
43626 CDM Depuy Hip Liner Crosslink 18 9 $4,125.00 $3,712.50 $2,145.00 $3,960.00 $3,918.75 2025-12-27
43700 CDM Stryker Knee Scorpio Ceme 18 9 $4,125.00 $3,712.50 $2,145.00 $3,960.00 $3,918.75 2025-12-27
67363 HCPCS Luspatercept-aamt 25 Mg Solr 18 9 $4,113.14 $3,701.83 $2,138.83 $3,948.61 $3,907.48 2025-12-27
72146 HCPCS Thoracic Spine 18 9 $4,108.50 $3,697.65 $2,136.42 $3,944.16 $3,903.08 2025-12-27
74182 HCPCS Abdomen W/contrast 18 9 $4,100.75 $3,690.68 $2,132.39 $3,936.72 $3,895.71 2025-12-27
71550 HCPCS Chest 18 9 $4,091.50 $3,682.35 $2,127.58 $3,927.84 $3,886.93 2025-12-27
66961 HCPCS Nelarabine 250 Mg/50 Ml Vial 18 9 $4,084.37 $3,675.93 $2,123.87 $3,921.00 $3,880.15 2025-12-27
67386 HCPCS Bictegrav-emtricit-tenofov Ala 50-200-25 Mg Tab 18 9 $4,068.54 $3,661.69 $2,115.64 $3,905.80 $3,865.11 2025-12-27
73720 HCPCS Lower Ext Wo/w Contrast L 36 9 $4,048.50 $3,643.65 $2,105.22 $3,886.56 $3,846.08 2025-12-27
70551 HCPCS Brain 18 9 $4,043.00 $3,638.70 $2,102.36 $3,881.28 $3,840.85 2025-12-27
67333 HCPCS Pegfilgrastim-cbqv 6 Mg/0.6 Ml Syrg 18 9 $4,028.88 $3,625.99 $2,095.02 $3,867.72 $3,827.44 2025-12-27
75635 HCPCS CT Angio Aorta W/runoff 18 9 $4,005.25 $3,604.73 $2,082.73 $3,845.04 $3,804.99 2025-12-27
67148 HCPCS Ado-trastuzumab Emtansine 100 Mg Solr 18 9 $3,989.63 $3,590.67 $2,074.61 $3,830.04 $3,790.15 2025-12-27
72141 HCPCS Cervical Spine 18 9 $3,979.75 $3,581.78 $2,069.47 $3,820.56 $3,780.76 2025-12-27
67310 HCPCS Nivolumab 120 Mg/12 Ml Vial 18 9 $3,971.53 $3,574.38 $2,065.20 $3,812.67 $3,772.95 2025-12-27
01248 CDM Allograft 18 9 $3,968.94 $3,572.05 $2,063.85 $3,810.18 $3,770.49 2025-12-27
01254 CDM Beads, Stimulan, Rapid Cu 18 9 $3,960.00 $3,564.00 $2,059.20 $3,801.60 $3,762.00 2025-12-27
43506 CDM Zimmer Hip Head >36mm 18 9 $3,960.00 $3,564.00 $2,059.20 $3,801.60 $3,762.00 2025-12-27
77049 HCPCS Breast Bilateral W Without Co 18 9 $3,959.25 $3,563.33 $2,058.81 $3,800.88 $3,761.29 2025-12-27
01245 CDM Ignite Power Mixer 18 9 $3,948.00 $3,553.20 $2,052.96 $3,790.08 $3,750.60 2025-12-27
19081 HCPCS Breast Biopsy, W Plcmt Lc 18 9 $3,924.00 $3,531.60 $2,040.48 $3,767.04 $3,727.80 2025-12-27
28347 CDM Mesh Permacol 10x10 18 9 $3,873.87 $3,486.48 $2,014.41 $3,718.92 $3,680.18 2025-12-27
70544 HCPCS Angiography Head Without Cont 18 9 $3,871.75 $3,484.58 $2,013.31 $3,716.88 $3,678.16 2025-12-27
70548 HCPCS Angiography Neck W/contra 18 9 $3,868.00 $3,481.20 $2,011.36 $3,713.28 $3,674.60 2025-12-27
72196 HCPCS Pelvis W Contrast 18 9 $3,839.00 $3,455.10 $1,996.28 $3,685.44 $3,647.05 2025-12-27
73218 HCPCS Upper Extremity Without Contr 36 9 $3,818.50 $3,436.65 $1,985.62 $3,665.76 $3,627.58 2025-12-27
43805 CDM Hip Bipolar Head Liner Se 18 9 $3,811.50 $3,430.35 $1,981.98 $3,659.04 $3,620.93 2025-12-27
71275 HCPCS CT Angio Chest 18 9 $3,800.50 $3,420.45 $1,976.26 $3,648.48 $3,610.48 2025-12-27
67195 HCPCS Bezlotoxumab 25 Mg/ml Soln 18 9 $3,800.00 $3,420.00 $1,976.00 $3,648.00 $3,610.00 2025-12-27
67209 HCPCS Pegfilgrastim-bmez 6 Mg/0.6 Ml Syrg 18 9 $3,788.14 $3,409.33 $1,969.83 $3,636.61 $3,598.73 2025-12-27
67390 HCPCS Pegfilgrastim-apgf 6 Mg/0.6 Ml Syrg 18 9 $3,787.63 $3,408.87 $1,969.57 $3,636.12 $3,598.25 2025-12-27
71551 HCPCS Chest W Contrast 18 9 $3,776.50 $3,398.85 $1,963.78 $3,625.44 $3,587.68 2025-12-27
73722 HCPCS Lower Ext Joints W/contr 18 9 $3,762.25 $3,386.03 $1,956.37 $3,611.76 $3,574.14 2025-12-27
67425 HCPCS Abacavir-dolutegravir-lamivud 600-50-300 Mg Tab 18 9 $3,761.02 $3,384.92 $1,955.73 $3,610.58 $3,572.97 2025-12-27
73706 HCPCS CT Lower Ext Angiogram An 18 9 $3,746.50 $3,371.85 $1,948.18 $3,596.64 $3,559.18 2025-12-27
65998 HCPCS Darbepoetin Alfa 500 Mcg/ml Syrg 18 9 $3,729.73 $3,356.76 $1,939.46 $3,580.54 $3,543.24 2025-12-27
74175 HCPCS CT Angio Aorta W/contrast 18 9 $3,725.50 $3,352.95 $1,937.26 $3,576.48 $3,539.23 2025-12-27
74170 HCPCS Abdomen Without W/contrast 18 9 $3,715.25 $3,343.73 $1,931.93 $3,566.64 $3,529.49 2025-12-27
28333 CDM Gore Tex Dual Mesh Lg 18 9 $3,712.50 $3,341.25 $1,930.50 $3,564.00 $3,526.88 2025-12-27
70547 HCPCS Angiography Neck Without Cont 18 9 $3,687.00 $3,318.30 $1,917.24 $3,539.52 $3,502.65 2025-12-27
66281 HCPCS Nitazoxanide 500 Mg Tab 18 9 $3,684.78 $3,316.30 $1,916.09 $3,537.39 $3,500.54 2025-12-27
77338 HCPCS Design Mlc Device For Imr 18 9 $3,680.25 $3,312.23 $1,913.73 $3,533.04 $3,496.24 2025-12-27
73206 HCPCS CT Upper Ext Angiograph A 18 9 $3,678.00 $3,310.20 $1,912.56 $3,530.88 $3,494.10 2025-12-27
70542 HCPCS Orbit, Face, Neck, Soft T 18 9 $3,666.75 $3,300.08 $1,906.71 $3,520.08 $3,483.41 2025-12-27
12385 CDM Implant, Hyprocure Sinus 18 9 $3,661.60 $3,295.44 $1,904.03 $3,515.14 $3,478.52 2025-12-27
65995 HCPCS Octreotide Acetate 20 Mg Kit 18 9 $3,634.70 $3,271.23 $1,890.04 $3,489.31 $3,452.97 2025-12-27
43535 CDM Zimmer Knee Tibia Uncoate 18 9 $3,630.00 $3,267.00 $1,887.60 $3,484.80 $3,448.50 2025-12-27
43780 CDM Biomet Hip Cup 18 9 $3,630.00 $3,267.00 $1,887.60 $3,484.80 $3,448.50 2025-12-27
43620 CDM Depuy Hip Cup 18 9 $3,630.00 $3,267.00 $1,887.60 $3,484.80 $3,448.50 2025-12-27
74181 HCPCS Abdomen 18 9 $3,619.25 $3,257.33 $1,882.01 $3,474.48 $3,438.29 2025-12-27
73222 HCPCS Upper Extremity W/contras 18 9 $3,610.00 $3,249.00 $1,877.20 $3,465.60 $3,429.50 2025-12-27
72195 HCPCS Pelvis Without Contrast 36 9 $4,190.88 $3,771.79 $1,867.06 $4,599.60 $3,428.93 2025-12-27
67001 HCPCS Mepolizumab 100 Mg Solr 18 9 $3,602.82 $3,242.54 $1,873.47 $3,458.71 $3,422.68 2025-12-27
73225 HCPCS Angio Upper Ext Wo Or W C 18 9 $3,590.50 $3,231.45 $1,867.06 $3,446.88 $3,410.98 2025-12-27
67226 HCPCS Inclisiran 284 Mg/1.5 Ml Syrg 18 9 $3,587.73 $3,228.96 $1,865.62 $3,444.22 $3,408.34 2025-12-27
28359 CDM Physiomesh 15x20 18 9 $3,571.70 $3,214.53 $1,857.28 $3,428.83 $3,393.12 2025-12-27
43790 CDM Biomet Hip Partial Endopr 18 9 $3,540.00 $3,186.00 $1,840.80 $3,398.40 $3,363.00 2025-12-27
43630 CDM Depuy Hip Partial Endopro 18 9 $3,540.00 $3,186.00 $1,840.80 $3,398.40 $3,363.00 2025-12-27
66562 HCPCS Carfilzomib 60 Mg Solr 18 9 $3,537.19 $3,183.47 $1,839.34 $3,395.70 $3,360.33 2025-12-27
73725 HCPCS Angiography Lower Extrem 18 9 $3,519.25 $3,167.33 $1,830.01 $3,378.48 $3,343.29 2025-12-27
09508 CDM Arthroflex, 4x7 18 9 $3,519.00 $3,167.10 $1,829.88 $3,378.24 $3,343.05 2025-12-27
43599 CDM Staple Kit, Fuseforce, La 18 9 $3,514.40 $3,162.96 $1,827.49 $3,373.82 $3,338.68 2025-12-27
38979 CDM Dynanite Pip, Straight, 1 18 9 $3,505.75 $3,155.18 $1,822.99 $3,365.52 $3,330.46 2025-12-27
38980 CDM Dynanite Pip, Straight, 1 18 9 $3,505.75 $3,155.18 $1,822.99 $3,365.52 $3,330.46 2025-12-27
38981 CDM Dynanite Pip, Straight, 1 18 9 $3,505.75 $3,155.18 $1,822.99 $3,365.52 $3,330.46 2025-12-27
40040 CDM Dbm Putty, Allosync, 2.5c 18 9 $3,505.75 $3,155.18 $1,822.99 $3,365.52 $3,330.46 2025-12-27
08163 HCPCS Penicillin G Benzathine 1200000 Unit/2 Ml Syrg 18 9 $3,505.61 $3,155.05 $1,822.92 $3,365.39 $3,330.33 2025-12-27
43816 CDM Knee Taper Stem 18 9 $3,497.82 $3,148.04 $1,818.87 $3,357.91 $3,322.93 2025-12-27
43819 CDM Knee Modular Stem 18 9 $3,497.82 $3,148.04 $1,818.87 $3,357.91 $3,322.93 2025-12-27
72194 HCPCS Pelvis Without -w/contrast 18 9 $3,496.50 $3,146.85 $1,818.18 $3,356.64 $3,321.68 2025-12-27
66837 HCPCS Pegfilgrastim (Onpro Kit) 6 Mg/0.6 Ml Syin 18 9 $3,488.05 $3,139.25 $1,813.79 $3,348.53 $3,313.65 2025-12-27
65683 HCPCS Pegfilgrastim 6 Mg/0.6ml Syrg 18 9 $3,488.05 $3,139.25 $1,813.79 $3,348.53 $3,313.65 2025-12-27
71270 HCPCS Chest Without W/contrast 18 9 $3,472.75 $3,125.48 $1,805.83 $3,333.84 $3,299.11 2025-12-27
70496 HCPCS CT Angio Brain 18 9 $3,467.50 $3,120.75 $1,803.10 $3,328.80 $3,294.13 2025-12-27
43818 CDM Knee Tibia Insert 18 9 $3,465.00 $3,118.50 $1,801.80 $3,326.40 $3,291.75 2025-12-27
70498 HCPCS CT Angio Neck 18 9 $3,464.75 $3,118.28 $1,801.67 $3,326.16 $3,291.51 2025-12-27
66995 HCPCS Plazomicin 500mg/10ml Vial 18 9 $3,459.00 $3,113.10 $1,798.68 $3,320.64 $3,286.05 2025-12-27
67408 HCPCS Tremelimumab-actl 20 Mg/ml Vial 18 9 $3,448.93 $3,104.04 $1,793.44 $3,310.97 $3,276.48 2025-12-27
37547 CDM Sinuplasty Balloon Spin 18 9 $3,412.50 $3,071.25 $1,774.50 $3,276.00 $3,241.88 2025-12-27
66511 HCPCS Interferon Beta-1b 0.3 Mg Kit 18 9 $3,402.51 $3,062.26 $1,769.31 $3,266.41 $3,232.38 2025-12-27
539 MS_DRG Osteomyelitis With Mcc 2 1 — — $17,881.00 $17,881.00 $17,881.00 2025-12-27
540 MS_DRG Osteomyelitis With Cc 2 1 — — $17,007.00 $17,007.00 $17,007.00 2025-12-27
541 MS_DRG Osteomyelitis Without Cc/mcc 2 1 — — $12,928.00 $12,928.00 $12,928.00 2025-12-27
805 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Mcc 2 1 — — $12,174.00 $12,174.00 $12,174.00 2025-12-27
791 MS_DRG Prematurity With Major Problems 2 1 — — $9,237.00 $9,237.00 $9,237.00 2025-12-27
202 MS_DRG Bronchitis And Asthma With Cc/mcc 2 1 — — $8,536.00 $8,536.00 $8,536.00 2025-12-27
806 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Cc 2 1 — — $8,101.00 $8,101.00 $8,101.00 2025-12-27
542 MS_DRG Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With… 2 1 — — $8,025.00 $8,025.00 $8,025.00 2025-12-27
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 2 1 — — $7,739.00 $7,739.00 $7,739.00 2025-12-27
794 MS_DRG Neonate With Other Significant Problems 2 1 — — $3,895.00 $3,895.00 $3,895.00 2025-12-27
795 MS_DRG Normal Newborn 2 1 — — $3,715.00 $3,715.00 $3,715.00 2025-12-27
639 MS_DRG Diabetes Without Cc/mcc 2 1 — — $3,402.00 $3,402.00 $3,402.00 2025-12-27
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