Hospital

BEATRICE COMMUNITY HOSPITAL & HEALTH CENTER, INC

Beatrice, NE · CCN 281364 · Rates published

4,353 distinct procedures filed

10 distinct payers

53,653 rate rows

2026-11-06 last MRF observed

Data quality

43,339 of 53,653 rate rows are consumer-grade (80.8%)

10,314 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 — reason	Rows
professional (physician) fee — not the facility price	10,307
per-diem day rate — not a per-procedure price	4
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	2
exceeds 10× this hospital's gross charge — excluded from medians	1

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://secure.claraprice.net/price-transparency/RNAV-1731102747513/machine-readable/470379834_beatrice-community-hospital_standardcharges.json
Found on page	https://secure.claraprice.net/price-transparency/beatrice-community-hospital-ne
Discovered via	Discovered by HANK
Last fetch	success · 2026-11-06
Content fingerprint	1abf4a10eca8866e… · 9,287,003 bytes · first seen 2026-11-06

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
119469 CDM	Ustekinumab 90 Mg/ml Subcutaneous Syringe	10	$9,293.00	$54,435.00	$53,584.50	nat. median $359 outlier · 149.2×
180349 CDM	Ocrelizumab 30 Mg/ml Intravenous Solution	10	$6,876.00	$40,277.00	$39,647.50	nat. median $39,648 1.0× median
180284 CDM	Canakinumab (Pf) 150 Mg/ml Subcutaneous Solution	10	$6,739.00	$39,473.00	$38,856.50	nat. median $3,138 outlier · 12.4×
C1767 HCPCS	Interstim X Neurostimulator	10	$6,262.00	$36,684.00	$36,110.00	nat. median $23,834 1.5× median
187610 CDM	Tildrakizumab-asmn 100 Mg/ml Subcutaneous Syringe	10	$5,999.00	$35,144.00	$34,595.00	nat. median $2,817 outlier · 12.3×
CP17624571377121553 CDM	Uterine And Adnexa Procedures For Non-malignancy Without Cc Or Mcc	8	$31,405.00	$32,074.00	$31,740.00	nat. median $31,740 1.0× median
C1820 HCPCS	Interstim Ii Neurostimulator	10	$4,785.00	$28,032.00	$27,594.00	nat. median $22,950 1.2× median
181954 CDM	Guselkumab 100 Mg/ml Subcutaneous Syringe	10	$4,706.00	$27,565.00	$27,134.50	nat. median $27,134 1.0× median
Q4196 HCPCS	Puraply Am 8cm X 16cm	10	$4,507.00	$26,400.00	$25,987.50	nat. median $312 outlier · 83.4×
151268 CDM	Leuprolide Acetate (6 Month) 45 Mg Intramuscular Syringe Kit	10	$4,175.00	$24,455.00	$24,073.00	nat. median $24,073 1.0× median
194061 CDM	Luspatercept-aamt 75 Mg Subcutaneous Solution	10	$4,082.00	$23,909.00	$23,535.50	nat. median $23,536 1.0× median
Q4186 HCPCS	Epifix 7cm X 7cm	10	$3,828.00	$22,426.00	$22,075.00	nat. median $449 outlier · 49.2×
207144 CDM	Ublituximab-xiiy 25 Mg/ml Intravenous Solution	10	$3,759.00	$22,017.00	$21,672.50	nat. median $17 outlier · 1307.1×
C1776 HCPCS	Femoral Tc3 Cemented Size 4 Ri	10	$3,688.00	$21,605.00	$21,267.50	nat. median $3,388 outlier · 6.3×
196736 CDM	Daratumumab 1,800 Mg-hyaluronidase-fihj 30,000 Unit/15 Ml Subcut Soln	10	$3,565.00	$20,884.00	$20,557.50	nat. median $20,558 1.0× median
204772 CDM	Risankizumab-rzaa 60 Mg/ml Intravenous Solution	10	$3,517.00	$20,604.00	$20,281.50	nat. median $189 outlier · 107.2×
168531 CDM	Vedolizumab 300 Mg Intravenous Solution	10	$3,186.00	$18,663.00	$18,372.00	nat. median $18,372 1.0× median
C1781 HCPCS	Mesh Phasix St 15cm X 20cm	10	$3,123.00	$18,293.00	$18,007.00	nat. median $1,415 outlier · 12.7×
C1762 HCPCS	Amniotic Allograft Liquid 2ml	10	$3,112.00	$18,228.00	$17,944.00	nat. median $2,937 outlier · 6.1×
Q4278 HCPCS	Epieffect 3x5 Cm	10	$3,073.00	$18,000.00	$17,719.00	nat. median $345 outlier · 51.4×
40120 CDM	Natalizumab 300 Mg/15 Ml Intravenous Solution	10	$2,951.00	$17,287.00	$17,017.00	nat. median $345 outlier · 49.3×
21108 CDM	Leuprolide 30 Mg (4 Month) Intramuscular Syringe Kit	10	$2,825.00	$16,547.00	$16,288.00	nat. median $908 outlier · 17.9×
183862 CDM	Nivolumab 240 Mg/24 Ml Intravenous Solution	10	$2,672.00	$15,651.00	$15,406.50	nat. median $70 outlier · 220.1×
A2019 HCPCS	Kerecis Shield Spiral 30mm	10	$2,419.00	$14,170.00	$13,948.00	nat. median $544 outlier · 25.7×
119619 CDM	Kit For Preparation Of Tc-99m-medronate Sodium 20 Mg IV Solution	10	$2,396.00	$14,034.00	$13,815.00	nat. median $83 outlier · 165.8×
159381 CDM	Pertuzumab 420 Mg/14 Ml (30 Mg/ml) Intravenous Solution	10	$2,356.00	$13,798.00	$13,582.50	nat. median $13,582 1.0× median
171960 CDM	Octreotide,microspheres ER 30 Mg Intramuscular Susp, Extended Release	10	$2,277.00	$13,338.00	$13,129.50	nat. median $13,130 1.0× median
198520 CDM	Ravulizumab-cwvz 100 Mg/ml Intravenous Solution	10	$2,261.00	$13,245.00	$13,038.00	nat. median $13,038 1.0× median
81696 CDM	Eculizumab 300 Mg/30 Ml Intravenous Solution	10	$2,258.00	$13,228.00	$13,021.00	nat. median $3,068 outlier · 4.2×
172818 CDM	Paliperidone Palmitate (3 Month) 819 Mg/2.63 Ml Intramuscular Syringe	10	$2,255.00	$13,207.00	$13,000.50	nat. median $13,000 1.0× median
21045 CDM	Leuprolide Acetate 22.5 Mg (3 Month) Intramuscular Syringe Kit	10	$2,150.00	$12,592.00	$12,395.50	nat. median $8,254 1.5× median
202803 CDM	Efgartigimod Alfa-fcab 20 Mg/ml Intravenous Solution	10	$2,150.00	$12,591.00	$12,394.50	nat. median $12,329 1.0× median
91495 CDM	Certolizumab Pegol 400 Mg (200 Mg X 2 Vials) Subcutaneous Kit	10	$2,087.00	$12,225.00	$12,033.50	nat. median $150 outlier · 80.4×
171476 CDM	Pembrolizumab 25 Mg/ml Intravenous Solution	10	$2,016.00	$11,809.00	$11,624.50	nat. median $755 outlier · 15.4×
97853 CDM	Certolizumab Pegol 400 Mg/2 Ml (200 Mg/ml X2) Subcutaneous Syringe Kit	10	$1,983.00	$11,617.00	$11,435.50	nat. median $31 outlier · 366.3×
9002 CDM	Alteplase 100 Mg Intravenous Solution	10	$1,872.00	$10,967.00	$10,796.00	nat. median $235 outlier · 45.9×
C1897 HCPCS	Lead Kit Is2 28cm	10	$1,866.00	$10,930.00	$10,759.00	nat. median $1,170 outlier · 9.2×
21044 CDM	Leuprolide Acetate 11.25 Mg (3 Month) Intramuscular Syringe Kit	10	$1,824.00	$10,685.00	$10,518.00	nat. median $4,977 outlier · 2.1×
183207 CDM	Benralizumab 30 Mg/ml Subcutaneous Syringe	10	$1,817.00	$10,644.00	$10,478.50	nat. median $10,423 1.0× median
C1777 HCPCS	Actis Collared High Size 8	10	$1,803.00	$10,560.00	$10,395.00	nat. median $5,557 1.9× median
184667 CDM	Tenecteplase 50 Mg Intravenous Solution	10	$1,767.00	$10,353.00	$10,191.00	nat. median $892 outlier · 11.4×
364SU278 CDM	Femoral Stem Sz 9 Std Collar C	10	$1,721.00	$10,080.00	$9,922.50	nat. median $9,922 1.0× median
66984 CPT	Removal Of Cataract With Insertion Of Lens	10	$1,155.00	$9,643.00	$9,442.00	nat. median $2,910 outlier · 3.2×
172799 CDM	Immune Glob,gamm(igg) 10 %-pro-iga 0 To 50 Mcg/ml Intravenous Solution	10	$1,619.00	$9,482.00	$9,333.50	nat. median $4,073 outlier · 2.3×
Q4100 HCPCS	Allo Adi Dermal Matrix Meshed	10	$1,596.00	$9,348.00	$9,202.50	nat. median $1,909 outlier · 4.8×
120051 CDM	Kit Preparation Of Tc 99m-sestamibi Combo No.1 IV Solution	10	$1,573.00	$9,216.00	$9,072.00	nat. median $5 outlier · 1680.0×
171959 CDM	Octreotide,microspheres ER 20 Mg Intramuscular Susp, Extended Release	10	$1,562.00	$9,150.00	$9,006.50	nat. median $275 outlier · 32.8×
101010 CDM	Collagenase Clostridium Histolyticum 0.9 Mg Solution For Injection	10	$1,504.00	$8,812.00	$8,674.00	nat. median $261 outlier · 33.2×
206169 CDM	Eflapegrastim-xnst 13.2 Mg/0.6 Ml Subcutaneous Syringe	10	$1,490.00	$8,727.00	$8,591.00	nat. median $1,904 outlier · 4.5×
32267 CDM	Pegfilgrastim 6 Mg/0.6 Ml Subcutaneous Syringe	10	$1,477.00	$8,652.00	$8,517.00	nat. median $1,962 outlier · 4.3×

Other procedures at this hospital

Browse this hospital's 4,353 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

70287	CDM	Abatacept (With Maltose) 250 Mg Intravenous Solution	10	10	$3,523.00	$3,523.00	$577.00	$3,382.00	$3,329.50	2026-11-06
C1777	HCPCS	Actis Collared High Size 8	10	10	$11,000.00	$11,000.00	$1,803.00	$10,560.00	$10,395.00	2026-11-06
Q4159	HCPCS	Affinity 2.5 X 2.5	10	10	$3,750.00	$3,750.00	$615.00	$3,600.00	$3,544.00	2026-11-06
Q4100	HCPCS	Allo Adi Dermal Matrix Meshed	10	10	$9,738.00	$9,738.00	$1,596.00	$9,348.00	$9,202.50	2026-11-06
9002	CDM	Alteplase 100 Mg Intravenous Solution	10	10	$11,424.00	$11,424.00	$1,872.00	$10,967.00	$10,796.00	2026-11-06
9003	CDM	Alteplase 50 Mg Intravenous Solution	10	10	$5,827.00	$5,827.00	$955.00	$5,594.00	$5,506.50	2026-11-06
C1762	HCPCS	Amniotic Allograft Liquid 2ml	10	10	$18,988.00	$18,988.00	$3,112.00	$18,228.00	$17,944.00	2026-11-06
Q4101	HCPCS	Apligraf	10	10	$3,188.00	$3,188.00	$522.00	$3,060.00	$3,013.00	2026-11-06
208591	CDM	Aripiprazole ER (2 Month) 960 Mg/3.2 Ml Susp, Extended Rel IM Syringe	10	10	$7,526.00	$7,526.00	$1,233.00	$7,225.00	$7,112.00	2026-11-06
164460	CDM	Aripiprazole ER 300 Mg Intramuscular Suspension,extended Release	10	10	$2,908.00	$2,908.00	$477.00	$2,792.00	$2,748.50	2026-11-06
171408	CDM	Aripiprazole ER 300 Mg Suspension, Extended Rel. Intramuscular Syringe	10	10	$2,908.00	$2,908.00	$477.00	$2,792.00	$2,748.50	2026-11-06
171410	CDM	Aripiprazole ER 400 Mg Suspension, Extended Rel.intramuscular Syringe	10	10	$3,832.00	$3,832.00	$628.00	$3,679.00	$3,621.00	2026-11-06
181491	CDM	Aripiprazole Lauroxil ER 1,064 Mg/3.9 Ml Suspension,ext.rel IM Syringe	10	10	$5,020.00	$5,020.00	$823.00	$4,819.00	$4,744.00	2026-11-06
174445	CDM	Aripiprazole Lauroxil ER 662 Mg/2.4 Ml Suspension, Ext.rel. IM Syringe	10	10	$3,175.00	$3,175.00	$520.00	$3,048.00	$3,000.50	2026-11-06
174447	CDM	Aripiprazole Lauroxil ER 882 Mg/3.2 Ml Suspension, Ext.rel. IM Syringe	10	10	$4,185.00	$4,185.00	$686.00	$4,018.00	$3,955.00	2026-11-06
186480	CDM	Aripiprazole Lauroxil,submic. ER 675 Mg/2.4 Ml Susp,ext.rel.im Syringe	10	10	$3,235.00	$3,235.00	$530.00	$3,106.00	$3,057.00	2026-11-06
186575	CDM	Baricitinib 2 Mg Tablet	10	10	$3,539.00	$3,539.00	$580.00	$3,397.00	$3,344.50	2026-11-06
175183	CDM	Bendamustine 25 Mg/ml Intravenous Solution	10	10	$3,491.00	$3,491.00	$572.00	$3,351.00	$3,299.00	2026-11-06
183207	CDM	Benralizumab 30 Mg/ml Subcutaneous Syringe	10	10	$11,088.00	$11,088.00	$1,817.00	$10,644.00	$10,478.50	2026-11-06
179514	CDM	Bezlotoxumab 25 Mg/ml Intravenous Solution	10	10	$8,345.00	$8,345.00	$1,368.00	$8,011.00	$7,886.00	2026-11-06
35839	CDM	Bortezomib 3.5 Mg Injection Powder For Solution	10	10	$3,839.00	$3,839.00	$629.00	$3,685.00	$3,628.00	2026-11-06
170553	CDM	Bortezomib 3.5 Mg Injection Powder For Solution (2.5 Mg/ml)	10	10	$3,839.00	$3,839.00	$629.00	$3,685.00	$3,628.00	2026-11-06
9347	CDM	Calcitonin (Salmon) 200 Unit/ml Injection Solution	10	10	$4,122.00	$4,122.00	$676.00	$3,957.00	$3,895.50	2026-11-06
180284	CDM	Canakinumab (Pf) 150 Mg/ml Subcutaneous Solution	10	10	$41,118.00	$41,118.00	$6,739.00	$39,473.00	$38,856.50	2026-11-06
177927	CDM	Carfilzomib 30 Mg Intravenous Solution	10	10	$4,191.00	$4,191.00	$687.00	$4,023.00	$3,960.50	2026-11-06
45382	CPT	Cc Colonoscopy W/control Bleeding	10	10	$3,859.00	$3,859.00	$632.00	$3,705.00	$3,627.00	2026-11-06
15110	CPT	Cc Epi Auto Trnk,arm,leg 1st 100	10	10	$3,377.00	$3,377.00	$553.00	$3,242.00	$3,174.00	2026-11-06
15115	CPT	Cc Epi Autogrft Fce Hnd Ft 1s 100	10	10	$3,377.00	$3,377.00	$553.00	$3,242.00	$3,174.00	2026-11-06
44394	CPT	Cc Fac Col/stoma Rem Tum/polyp By Snare	10	10	$3,393.00	$3,393.00	$556.00	$3,257.00	$3,189.00	2026-11-06
44388	CPT	Cc Fac Colonoscopy Thru Stoma; Diagnostic	10	10	$2,885.00	$2,885.00	$473.00	$2,770.00	$2,712.00	2026-11-06
52234	CPT	Cc Fac Cysto W/fulg Sm Bladder Tumor	10	10	$3,877.00	$3,877.00	$516.00	$3,722.00	$3,644.00	2026-11-06
35207	CPT	Cc Fac Repair Blood Vessel Hand	10	10	$2,862.00	$2,862.00	$469.00	$2,748.00	$2,690.00	2026-11-06
45334	CPT	Cc Fac Sigmoidoscopy	10	10	$3,393.00	$3,393.00	$556.00	$3,257.00	$3,189.00	2026-11-06
45331	CPT	Cc Fac Sigmoidoscopy Flexible With Biopsy	10	10	$2,689.00	$2,689.00	$441.00	$2,581.00	$2,528.00	2026-11-06
26070	CPT	Cc Fb Hand	10	10	$4,249.00	$4,249.00	$696.00	$4,079.00	$3,994.00	2026-11-06
73722	CPT	Cc Hc MRI Ankle W Contrast	19	10	$4,789.00	$4,789.00	$561.00	$5,910.00	$3,285.00	2026-11-06
73723	CPT	Cc Hc MRI Ankle W Wo Contrast	19	10	$5,223.50	$5,223.50	$611.00	$6,447.00	$3,582.00	2026-11-06
73222	CPT	Cc Hc MRI Elbow W Contrast	19	10	$4,705.50	$4,705.50	$561.00	$5,749.00	$3,285.00	2026-11-06
73223	CPT	Cc Hc MRI Elbow W Wo Contrast	19	10	$5,828.50	$5,828.50	$695.00	$7,121.00	$4,069.00	2026-11-06
73221	CPT	Cc Hc MRI Shoulder Wo Contrast	28	10	$2,884.00	$2,884.00	$390.00	$4,927.00	$2,608.00	2026-11-06
54001	CPT	Cc Hc Slitting Of Prepuce	10	10	$3,733.00	$3,733.00	$423.00	$3,584.00	$3,509.00	2026-11-06
28232	CPT	Cc Incision Of Toe Tendon	10	10	$2,680.00	$2,680.00	$439.00	$2,573.00	$2,519.00	2026-11-06
1030000021	CDM	Cc Lens Procedure Operating Room	10	10	$2,943.00	$2,943.00	$482.00	$2,825.00	$2,781.00	2026-11-06
73725	CPT	Cc MRA Lower Extermity W	19	10	$3,036.50	$3,036.50	$485.00	$2,987.00	$2,844.00	2026-11-06
74185	CPT	Cc Mra; Abdomen W/wo Contrast	10	10	$3,990.00	$3,990.00	$643.00	$3,830.00	$3,751.00	2026-11-06
71555	CPT	Cc Mra; Chest W Or Wo Contrast	10	10	$3,702.00	$3,702.00	$607.00	$3,554.00	$3,480.00	2026-11-06
72198	CPT	Cc Mra; Pelvis W Or Wo Contrast	19	10	$3,540.50	$3,540.50	$566.00	$3,482.00	$3,316.00	2026-11-06
1010074183	CDM	Cc MRI Pancreas With Contrast	10	10	$3,626.00	$3,626.00	$594.00	$3,481.00	$3,408.00	2026-11-06
52235	CPT	Cc Np Cysto W/fulg, Treat Med Les	10	10	$3,877.00	$3,877.00	$605.00	$3,722.00	$3,644.00	2026-11-06
41805	CPT	Cc Removal Foreign Body, Gum	10	10	$2,926.00	$2,926.00	$480.00	$2,809.00	$2,750.00	2026-11-06
7040003100	CDM	Cc Surgery C <Base Rate>	10	10	$3,226.00	$3,226.00	$529.00	$3,097.00	$3,048.50	2026-11-06
7050003100	CDM	Cc Surgery D <Base Rate>	10	10	$4,826.00	$4,826.00	$791.00	$4,633.00	$4,560.50	2026-11-06
7060003100	CDM	Cc Surgery E <Base Rate>	10	10	$6,145.00	$6,145.00	$1,007.00	$5,899.00	$5,807.00	2026-11-06
91495	CDM	Certolizumab Pegol 400 Mg (200 Mg X 2 Vials) Subcutaneous Kit	10	10	$12,734.00	$12,734.00	$2,087.00	$12,225.00	$12,033.50	2026-11-06
97853	CDM	Certolizumab Pegol 400 Mg/2 Ml (200 Mg/ml X2) Subcutaneous Syringe Kit	10	10	$12,101.00	$12,101.00	$1,983.00	$11,617.00	$11,435.50	2026-11-06
101010	CDM	Collagenase Clostridium Histolyticum 0.9 Mg Solution For Injection	10	10	$9,179.00	$9,179.00	$1,504.00	$8,812.00	$8,674.00	2026-11-06
29313	CDM	Crotalidae Polyval Immune Fab Solution For Injection	10	10	$4,297.00	$4,297.00	$704.00	$4,125.00	$4,060.50	2026-11-06
74177	CPT	CT Scan Of Abdomen And Pelvis With Contrast	10	10	$4,900.00	$4,900.00	$578.00	$4,704.00	$4,606.00	2026-11-06
72193	CPT	CT Scan Of Pelvis With Contrast	10	10	$3,160.00	$3,160.00	$433.00	$3,034.00	$2,970.00	2026-11-06
196736	CDM	Daratumumab 1,800 Mg-hyaluronidase-fihj 30,000 Unit/15 Ml Subcut Soln	10	10	$21,754.00	$21,754.00	$3,565.00	$20,884.00	$20,557.50	2026-11-06
116630	CDM	Darbepoetin Alfa 200 Mcg/0.4 Ml In Polysorbate Injection Syringe	10	10	$3,591.00	$3,591.00	$589.00	$3,447.00	$3,393.50	2026-11-06
116631	CDM	Darbepoetin Alfa 300 Mcg/0.6 Ml In Polysorbate Injection Syringe	10	10	$5,164.00	$5,164.00	$846.00	$4,957.00	$4,880.00	2026-11-06
96987	CDM	Degarelix 120 Mg Subcutaneous Solution	10	10	$6,395.00	$6,395.00	$1,048.00	$6,139.00	$6,043.00	2026-11-06
106804	CDM	Denosumab 120 Mg/1.7 Ml (70 Mg/ml) Subcutaneous Solution	10	10	$7,443.00	$7,443.00	$1,220.00	$7,145.00	$7,033.50	2026-11-06
105502	CDM	Denosumab 60 Mg/ml Subcutaneous Syringe	10	10	$4,265.00	$4,265.00	$699.00	$4,094.00	$4,030.50	2026-11-06
Q4106	HCPCS	Dermagraft	10	10	$2,938.00	$2,938.00	$481.00	$2,820.00	$2,776.50	2026-11-06
81696	CDM	Eculizumab 300 Mg/30 Ml Intravenous Solution	10	10	$13,779.00	$13,779.00	$2,258.00	$13,228.00	$13,021.00	2026-11-06
202803	CDM	Efgartigimod Alfa-fcab 20 Mg/ml Intravenous Solution	10	10	$13,116.00	$13,116.00	$2,150.00	$12,591.00	$12,394.50	2026-11-06
206169	CDM	Eflapegrastim-xnst 13.2 Mg/0.6 Ml Subcutaneous Syringe	10	10	$9,091.00	$9,091.00	$1,490.00	$8,727.00	$8,591.00	2026-11-06
Q4278	HCPCS	Epieffect 3x5 Cm	10	10	$18,750.00	$18,750.00	$3,073.00	$18,000.00	$17,719.00	2026-11-06
Q4186	HCPCS	Epifix 7cm X 7cm	10	10	$23,360.00	$23,360.00	$3,828.00	$22,426.00	$22,075.00	2026-11-06
190073	CDM	Factor Xa,inactivated-zhzo (Recombinant) 200 Mg Intravenous Solution	10	10	$3,410.00	$3,410.00	$559.00	$3,274.00	$3,222.50	2026-11-06
364SU278	CDM	Femoral Stem Sz 9 Std Collar C	10	10	$10,500.00	$10,500.00	$1,721.00	$10,080.00	$9,922.50	2026-11-06
C1776	HCPCS	Femoral Tc3 Cemented Size 4 Ri	10	10	$22,505.00	$22,505.00	$3,688.00	$21,605.00	$21,267.50	2026-11-06
165470	CDM	Golimumab 12.5 Mg/ml Intravenous Solution	10	10	$4,557.00	$4,557.00	$747.00	$4,375.00	$4,306.50	2026-11-06
181954	CDM	Guselkumab 100 Mg/ml Subcutaneous Syringe	10	10	$28,714.00	$28,714.00	$4,706.00	$27,565.00	$27,134.50	2026-11-06
36556	CPT	Hc An Insert Non Tunneled Cv Cath	10	10	$3,650.00	$3,650.00	$438.00	$3,504.00	$3,431.00	2026-11-06
15275	CPT	Hc Appl Skin Subs Scalp,mouth 1st 25 Sq Cm	10	10	$3,377.00	$3,377.00	$338.00	$3,242.00	$3,174.00	2026-11-06
15271	CPT	Hc Appl Skin Subs Trunk, 1st 25 Sq Cm	10	10	$3,377.00	$3,377.00	$322.00	$3,242.00	$3,174.00	2026-11-06
19081	CPT	Hc Biop Breast With Dvce Plcmt First Lesion Incl Stertac Guid	10	10	$2,838.00	$2,838.00	$465.00	$2,724.00	$2,668.00	2026-11-06
20240	CPT	Hc Biopsy Bone Open Superficial	10	10	$4,238.00	$4,238.00	$298.00	$4,068.00	$3,984.00	2026-11-06
38500	CPT	Hc Biopsy/excision, Lymph Node(s)	10	10	$4,000.00	$4,000.00	$656.00	$3,840.00	$3,760.00	2026-11-06
78320	CPT	Hc Bone Imaging Spect	10	10	$2,807.00	$2,807.00	$460.00	$2,695.00	$2,653.00	2026-11-06
54150	CPT	Hc Circumcision Clamp Newborn	10	10	$2,896.00	$2,896.00	$314.00	$2,780.00	$2,722.00	2026-11-06
95811	CPT	Hc Comp Sleep Disorder Study W/init Cpap/bipap	10	10	$4,643.00	$4,643.00	$761.00	$4,457.00	$4,364.00	2026-11-06
74178	CPT	Hc CT Abd And Pelv Without And With Contrast	10	10	$5,700.00	$5,700.00	$647.00	$5,472.00	$5,358.00	2026-11-06
74176	CPT	Hc CT Abdomen And Pelvis Without Contrast	10	10	$4,200.00	$4,200.00	$354.00	$4,032.00	$3,948.00	2026-11-06
74160	CPT	Hc CT Abdomen With Contrast	10	10	$2,786.00	$2,786.00	$441.00	$2,675.00	$2,619.00	2026-11-06
74170	CPT	Hc CT Abdomen Without & With Contrast	10	10	$3,339.00	$3,339.00	$469.00	$3,205.00	$3,139.00	2026-11-06
74150	CPT	Hc CT Abdomen Without Contrast	10	10	$2,725.00	$2,725.00	$263.00	$2,616.00	$2,562.00	2026-11-06
74175	CPT	Hc CT Angio Abdomen	10	10	$3,856.00	$3,856.00	$507.00	$3,702.00	$3,625.00	2026-11-06
71275	CPT	Hc CT Angio Chest	10	10	$3,600.00	$3,600.00	$508.00	$3,456.00	$3,384.00	2026-11-06
70496	CPT	Hc CT Angio Head	10	10	$3,167.00	$3,167.00	$502.00	$3,040.00	$2,977.00	2026-11-06
75635	CPT	Hc CT Angio Lower Ext Runoff	10	10	$4,586.00	$4,586.00	$558.00	$4,403.00	$4,311.00	2026-11-06
73706	CPT	Hc CT Angio Lower Extremity	19	10	$4,050.00	$4,050.00	$492.00	$4,896.00	$2,880.00	2026-11-06
70498	CPT	Hc CT Angio Neck	10	10	$2,796.00	$2,796.00	$458.00	$2,684.00	$2,628.00	2026-11-06
72191	CPT	Hc CT Angio Pelvis	10	10	$3,962.00	$3,962.00	$505.00	$3,804.00	$3,724.00	2026-11-06
74174	CPT	Hc CT Angio, Abdomen And Pelvis W Contrast	10	10	$7,033.00	$7,033.00	$726.00	$6,752.00	$6,611.00	2026-11-06
72126	CPT	Hc CT Cervical Spine With Contrast	10	10	$2,728.00	$2,728.00	$324.00	$2,619.00	$2,564.00	2026-11-06
72127	CPT	Hc CT Cervical Spine Without & With Contrast	10	10	$2,909.00	$2,909.00	$376.00	$2,793.00	$2,734.00	2026-11-06
70470	CPT	Hc CT Head Without & With Contrast	10	10	$2,933.00	$2,933.00	$333.00	$2,816.00	$2,757.00	2026-11-06
73702	CPT	Hc CT Lower Extremity Without & With Contrast	19	10	$3,999.00	$3,999.00	$374.00	$4,885.00	$2,793.00	2026-11-06
72132	CPT	Hc CT Lumbar Spine With Contrast	10	10	$2,973.00	$2,973.00	$325.00	$2,854.00	$2,795.00	2026-11-06
72133	CPT	Hc CT Lumbar Spine Without & With Contrast	10	10	$3,359.00	$3,359.00	$377.00	$3,225.00	$3,157.00	2026-11-06
70488	CPT	Hc CT Maxillofacial Without & W Contrast	10	10	$2,796.00	$2,796.00	$353.00	$2,684.00	$2,628.00	2026-11-06
70482	CPT	Hc CT Orbit,sella,po-fos, Ear Without & With Contrast	10	10	$2,909.00	$2,909.00	$402.00	$2,793.00	$2,734.00	2026-11-06
72194	CPT	Hc CT Pelvis Without & With Contrast	10	10	$3,546.00	$3,546.00	$453.00	$3,404.00	$3,333.00	2026-11-06
72192	CPT	Hc CT Pelvis Without Contrast	10	10	$2,725.00	$2,725.00	$256.00	$2,616.00	$2,562.00	2026-11-06
72129	CPT	Hc CT Thoracic Spine With Contrast	10	10	$2,979.00	$2,979.00	$326.00	$2,860.00	$2,800.00	2026-11-06
72130	CPT	Hc CT Thoracic Spine Without & With Contrast	10	10	$3,332.00	$3,332.00	$381.00	$3,199.00	$3,132.00	2026-11-06
72128	CPT	Hc CT Thoracic Spine Without Contrast	10	10	$2,767.00	$2,767.00	$250.00	$2,656.00	$2,601.00	2026-11-06
71260	CPT	Hc CT Thorax With Contrast	10	10	$2,794.00	$2,794.00	$320.00	$2,682.00	$2,626.00	2026-11-06
71270	CPT	Hc CT Thorax Without & With Contrast	10	10	$3,701.00	$3,701.00	$376.00	$3,553.00	$3,479.00	2026-11-06
73202	CPT	Hc CT Upper Extremity Without & With Contrast	19	10	$4,000.00	$4,000.00	$453.00	$4,887.00	$2,793.00	2026-11-06
11044	CPT	Hc Debride Skin,sq,muscle,bone,full 20 1st 20 Sqcm Or Less	10	10	$2,999.00	$2,999.00	$491.00	$2,879.00	$2,819.00	2026-11-06
64624	CPT	Hc Destruct Neurolytic Agt Genicular Nrv W/img	19	10	$5,427.00	$5,427.00	$647.00	$6,631.00	$3,789.00	2026-11-06
C8929	HCPCS	Hc Echo Complete W/color Flow Doppler With Cont	10	10	$3,226.00	$3,226.00	$529.00	$3,097.00	$3,048.50	2026-11-06
21552	CPT	Hc Exc Tumor Soft Tissue Neck/ant Thorax Subq +3cm	10	10	$3,000.00	$3,000.00	$492.00	$2,880.00	$2,820.00	2026-11-06
15240	CPT	Hc Full Thick Grft Head,fac,hand <20sqc	10	10	$4,205.00	$4,205.00	$689.00	$4,037.00	$3,953.00	2026-11-06
78473	CPT	Hc Gated Heart Muga Exercise Study	10	10	$2,825.00	$2,825.00	$463.00	$2,712.00	$2,656.00	2026-11-06
81404	CPT	Hc Molecular Path Proc Lvl 5 Sgdd4	10	10	$4,153.00	$4,153.00	$456.00	$3,987.00	$3,904.00	2026-11-06
70545	CPT	Hc MRA Head With Contrast	10	10	$3,533.00	$3,533.00	$435.00	$3,392.00	$3,321.00	2026-11-06
70544	CPT	Hc MRA Head Without Contrast	10	10	$3,357.00	$3,357.00	$412.00	$3,223.00	$3,156.00	2026-11-06
70546	CPT	Hc MRA Head Without Contrast Follow With Contrast	10	10	$3,707.00	$3,707.00	$608.00	$3,559.00	$3,485.00	2026-11-06
C8914	HCPCS	Hc MRA Lower Extremity Without & With Contrast	20	10	$4,277.50	$4,277.50	$510.00	$5,226.00	$2,987.00	2026-11-06
70548	CPT	Hc MRA Neck With Contrast	10	10	$3,235.00	$3,235.00	$471.00	$3,106.00	$3,041.00	2026-11-06
70549	CPT	Hc MRA Neck Without & With Contrast	10	10	$3,693.00	$3,693.00	$605.00	$3,545.00	$3,471.00	2026-11-06
70547	CPT	Hc MRA Neck Without Contrast	10	10	$3,072.00	$3,072.00	$413.00	$2,949.00	$2,888.00	2026-11-06
C8920	HCPCS	Hc MRA Pelvis With & Without Contrast	10	10	$3,627.00	$3,627.00	$594.00	$3,482.00	$3,427.50	2026-11-06
C8902	HCPCS	Hc MRA Without Fol W/contrast Abdomen	10	10	$4,189.00	$4,189.00	$687.00	$4,021.00	$3,959.00	2026-11-06
C8901	HCPCS	Hc Mra; Abdomen Wo Contrast	10	10	$3,770.00	$3,770.00	$618.00	$3,619.00	$3,563.00	2026-11-06
74182	CPT	Hc MRI Abdomen W/contrast	10	10	$3,627.00	$3,627.00	$578.00	$3,482.00	$3,409.00	2026-11-06
74183	CPT	Hc MRI Abdomen Without And With Contrast	10	10	$4,664.00	$4,664.00	$646.00	$4,477.00	$4,384.00	2026-11-06
74181	CPT	Hc MRI Abdomen Without Contrast	10	10	$4,044.00	$4,044.00	$375.00	$3,882.00	$3,801.00	2026-11-06
70552	CPT	Hc MRI Brain MRI With Contrast	10	10	$3,536.00	$3,536.00	$519.00	$3,395.00	$3,324.00	2026-11-06
70551	CPT	Hc MRI Brain MRI Without Contrast	10	10	$3,370.00	$3,370.00	$377.00	$3,235.00	$3,168.00	2026-11-06
C8908	HCPCS	Hc MRI Breast MRI Without & With Contrast Bilateral	10	10	$4,734.00	$4,734.00	$776.00	$4,545.00	$4,473.50	2026-11-06
77049	CPT	Hc MRI Breast W&without Contrast W/cad Bilat	10	10	$4,734.00	$4,734.00	$655.00	$4,545.00	$4,450.00	2026-11-06
77048	CPT	Hc MRI Breast W&without Contrast W/cad Unilat	10	10	$4,006.00	$4,006.00	$642.00	$3,846.00	$3,766.00	2026-11-06
77047	CPT	Hc MRI Breast Without Contrast Bilat	10	10	$3,472.00	$3,472.00	$420.00	$3,333.00	$3,264.00	2026-11-06
77046	CPT	Hc MRI Breast Without Contrast Unilat	10	10	$2,938.00	$2,938.00	$407.00	$2,820.00	$2,762.00	2026-11-06
72142	CPT	Hc MRI Cervical Spine MRI With Contrast	10	10	$4,197.00	$4,197.00	$527.00	$4,029.00	$3,945.00	2026-11-06
72156	CPT	Hc MRI Cervical Spine MRI Without & With Contrast	10	10	$4,664.00	$4,664.00	$613.00	$4,477.00	$4,384.00	2026-11-06
72141	CPT	Hc MRI Cervical Spine MRI Without Contrast	10	10	$3,500.00	$3,500.00	$366.00	$3,360.00	$3,290.00	2026-11-06
71551	CPT	Hc MRI Chest With Contrast	10	10	$3,525.00	$3,525.00	$578.00	$3,384.00	$3,314.00	2026-11-06
71552	CPT	Hc MRI Chest Without And With Contrast	10	10	$4,664.00	$4,664.00	$764.00	$4,477.00	$4,384.00	2026-11-06
71550	CPT	Hc MRI Chest Without Contrast	10	10	$3,348.00	$3,348.00	$549.00	$3,214.00	$3,147.00	2026-11-06
73719	CPT	Hc MRI Lower Ext Other Than Joint With Contrast	19	10	$4,705.50	$4,705.50	$503.00	$5,749.00	$3,285.00	2026-11-06
73718	CPT	Hc MRI Lower Ext Other Than Joint Without Contrast	19	10	$4,664.00	$4,664.00	$426.00	$5,699.00	$3,256.00	2026-11-06
73720	CPT	Hc MRI Lower Extrem Oth/thn Jt Without & W/contr Matr	19	10	$5,130.00	$5,130.00	$611.00	$6,268.00	$3,582.00	2026-11-06
72149	CPT	Hc MRI Lumbar Spine With Contrast	10	10	$3,447.00	$3,447.00	$517.00	$3,309.00	$3,240.00	2026-11-06
72158	CPT	Hc MRI Lumbar Spine Without & With Contrast	10	10	$4,420.00	$4,420.00	$612.00	$4,243.00	$4,155.00	2026-11-06
70540	CPT	Hc MRI Orbit Face Neck MRI Without Contrast	10	10	$3,202.00	$3,202.00	$432.00	$3,074.00	$3,010.00	2026-11-06
70542	CPT	Hc MRI Orbit Face Neck MRI With Contrast	10	10	$3,370.00	$3,370.00	$511.00	$3,235.00	$3,168.00	2026-11-06
72196	CPT	Hc MRI Pelvis With Contrast	10	10	$3,370.00	$3,370.00	$514.00	$3,235.00	$3,168.00	2026-11-06
72197	CPT	Hc MRI Pelvis Without & With Contrast	10	10	$3,716.00	$3,716.00	$609.00	$3,567.00	$3,493.00	2026-11-06
72195	CPT	Hc MRI Pelvis Without Contrast	10	10	$2,954.00	$2,954.00	$437.00	$2,836.00	$2,777.00	2026-11-06
70543	CPT	Hc MRI Soft Tissue Neck Without And With Contrast	10	10	$3,693.00	$3,693.00	$605.00	$3,545.00	$3,471.00	2026-11-06
70336	CPT	Hc MRI Temporomandibular Joint	10	10	$2,852.00	$2,852.00	$467.00	$2,738.00	$2,681.00	2026-11-06
72147	CPT	Hc MRI Thoracic Spine With Contrast	10	10	$3,627.00	$3,627.00	$522.00	$3,482.00	$3,409.00	2026-11-06
72157	CPT	Hc MRI Thoracic Spine Without & With Contrast	10	10	$4,588.00	$4,588.00	$614.00	$4,404.00	$4,313.00	2026-11-06
72146	CPT	Hc MRI Thoracic Spine Without Contrast	10	10	$3,788.00	$3,788.00	$366.00	$3,636.00	$3,561.00	2026-11-06
73219	CPT	Hc MRI Upper Extremity With Contrast	19	10	$3,921.50	$3,921.50	$467.00	$4,791.00	$2,738.00	2026-11-06
73220	CPT	Hc MRI Upper Extremity Without & With Contrast	19	10	$5,130.00	$5,130.00	$611.00	$6,268.00	$3,582.00	2026-11-06
73218	CPT	Hc MRI Upper Extremity Without Contrast	19	10	$4,275.00	$4,275.00	$510.00	$5,223.00	$2,985.00	2026-11-06
78452	CPT	Hc Myocardial Perfusion Spect Multi W/wm&ej	10	10	$4,638.00	$4,638.00	$760.00	$4,452.00	$4,360.00	2026-11-06
78451	CPT	Hc Myocardial Perfusion Spect Single W/wm&ej	10	10	$3,075.00	$3,075.00	$504.00	$2,952.00	$2,891.00	2026-11-06
28124	CPT	Hc Part Remv Phalanx Of Toe	10	10	$5,400.00	$5,400.00	$885.00	$5,184.00	$5,076.00	2026-11-06
78815	CPT	Hc PET W/diagnostic CT Skull To Midthigh	19	10	$5,003.50	$5,003.50	$698.00	$5,520.00	$4,087.00	2026-11-06
78816	CPT	Hc PET W/diagnostic CT Whole Body	10	10	$4,257.00	$4,257.00	$698.00	$4,087.00	$4,002.00	2026-11-06
19283	CPT	Hc Plcmt Breast Local Device First Lesion Incl Stertac Guid	10	10	$2,838.00	$2,838.00	$465.00	$2,724.00	$2,668.00	2026-11-06
25270	CPT	Hc Reforearm Tend/musc,exten,prim,ea	10	10	$4,146.00	$4,146.00	$679.00	$3,980.00	$3,897.00	2026-11-06
52310	CPT	Hc Remove Foreigh Body/stent Via Bladder,	10	10	$3,523.00	$3,523.00	$577.00	$3,382.00	$3,312.00	2026-11-06
25260	CPT	Hc Repair Muscle,flexor, Forearm/wrist,single	10	10	$4,146.00	$4,146.00	$679.00	$3,980.00	$3,897.00	2026-11-06
90ROOM31	CDM	Hc Room Nurs Tele Private	10	10	$3,458.00	$3,458.00	$567.00	$3,320.00	$3,268.00	2026-11-06
168835	CDM	Hum Prothrombin Cplx, 4-factor 1,000 Unit (800-1,240 Unit) IV Solution	10	10	$4,222.00	$4,222.00	$692.00	$4,053.00	$3,990.00	2026-11-06
A2001	HCPCS	IM Ac Placental Ecm 5x5	10	10	$3,648.00	$3,648.00	$598.00	$3,502.00	$3,447.50	2026-11-06
107754	CDM	Immune Glob G 20 Gram/200 Ml(10%)-gly-iga Ave 46 Mcg/ml Injection Soln	10	10	$4,081.00	$4,081.00	$669.00	$3,918.00	$3,856.50	2026-11-06
170626	CDM	Immune Glob G 40 Gram/400 Ml(10%)-gly-iga Ave 46 Mcg/ml Injection Soln	10	10	$7,725.00	$7,725.00	$1,266.00	$7,416.00	$7,300.50	2026-11-06
172799	CDM	Immune Glob,gamm(igg) 10 %-pro-iga 0 To 50 Mcg/ml Intravenous Solution	10	10	$9,877.00	$9,877.00	$1,619.00	$9,482.00	$9,333.50	2026-11-06
172798	CDM	Immune Glob,gamma (Igg) 10 %-gly-iga Over 50 Mcg/ml Injection Solution	10	10	$6,960.00	$6,960.00	$1,141.00	$6,682.00	$6,577.00	2026-11-06
202705	CDM	Inclisiran 284 Mg/1.5 Ml Subcutaneous Syringe	10	10	$4,526.00	$4,526.00	$742.00	$4,345.00	$4,277.00	2026-11-06
23796	CDM	Infliximab 100 Mg Intravenous Solution	10	10	$2,800.00	$2,800.00	$459.00	$2,688.00	$2,646.00	2026-11-06
C1820	HCPCS	Interstim Ii Neurostimulator	10	10	$29,200.00	$29,200.00	$4,785.00	$28,032.00	$27,594.00	2026-11-06
C1767	HCPCS	Interstim X Neurostimulator	10	10	$38,212.00	$38,212.00	$6,262.00	$36,684.00	$36,110.00	2026-11-06
A2019	HCPCS	Kerecis Shield Spiral 30mm	10	10	$14,760.00	$14,760.00	$2,419.00	$14,170.00	$13,948.00	2026-11-06
119619	CDM	Kit For Preparation Of Tc-99m-medronate Sodium 20 Mg IV Solution	10	10	$14,619.00	$14,619.00	$2,396.00	$14,034.00	$13,815.00	2026-11-06
188807	CDM	Kit For The Prep Of Tc-99m-tilmanocept 250 Mcg Solution For Injection	10	10	$7,987.00	$7,987.00	$1,309.00	$7,668.00	$7,548.00	2026-11-06
364SU270	CDM	Kit Lead Tined, 28cm	10	10	$8,888.00	$8,888.00	$1,457.00	$8,532.00	$8,399.50	2026-11-06
120051	CDM	Kit Preparation Of Tc 99m-sestamibi Combo No.1 IV Solution	10	10	$9,600.00	$9,600.00	$1,573.00	$9,216.00	$9,072.00	2026-11-06
87861	CDM	Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe	10	10	$9,005.00	$9,005.00	$1,476.00	$8,645.00	$8,510.00	2026-11-06
C1897	HCPCS	Lead Kit Is2 28cm	10	10	$11,385.00	$11,385.00	$1,866.00	$10,930.00	$10,759.00	2026-11-06
13691	CDM	Leuprolide 3.75 Mg Intramuscular Syringe Kit	10	10	$4,113.00	$4,113.00	$674.00	$3,948.00	$3,886.50	2026-11-06
21108	CDM	Leuprolide 30 Mg (4 Month) Intramuscular Syringe Kit	10	10	$17,236.00	$17,236.00	$2,825.00	$16,547.00	$16,288.00	2026-11-06
152369	CDM	Leuprolide 7.5 Mg Intramuscular Syringe Kit	10	10	$4,817.00	$4,817.00	$789.00	$4,624.00	$4,552.00	2026-11-06
151268	CDM	Leuprolide Acetate (6 Month) 45 Mg Intramuscular Syringe Kit	10	10	$25,474.00	$25,474.00	$4,175.00	$24,455.00	$24,073.00	2026-11-06
21044	CDM	Leuprolide Acetate 11.25 Mg (3 Month) Intramuscular Syringe Kit	10	10	$11,130.00	$11,130.00	$1,824.00	$10,685.00	$10,518.00	2026-11-06
21045	CDM	Leuprolide Acetate 22.5 Mg (3 Month) Intramuscular Syringe Kit	10	10	$13,117.00	$13,117.00	$2,150.00	$12,592.00	$12,395.50	2026-11-06
28224	CDM	Linezolid 600 Mg Tablet	10	10	$5,860.00	$5,860.00	$960.00	$5,626.00	$5,537.50	2026-11-06
194061	CDM	Luspatercept-aamt 75 Mg Subcutaneous Solution	10	10	$24,905.00	$24,905.00	$4,082.00	$23,909.00	$23,535.50	2026-11-06
174835	CDM	Mepolizumab 100 Mg Subcutaneous Solution	10	10	$6,859.00	$6,859.00	$1,124.00	$6,585.00	$6,481.50	2026-11-06
C1781	HCPCS	Mesh Phasix St 15cm X 20cm	10	10	$19,055.00	$19,055.00	$3,123.00	$18,293.00	$18,007.00	2026-11-06
10631	CDM	Mitomycin 40 Mg Intravenous Solution	10	10	$3,474.00	$3,474.00	$569.00	$3,335.00	$3,283.00	2026-11-06
70553	CPT	MRI Scan	28	10	$3,900.00	$3,900.00	$530.00	$3,753.00	$3,387.00	2026-11-06
72148	CPT	MRI Scan Of Lower Spinal Canal	10	10	$3,200.00	$3,200.00	$367.00	$3,072.00	$3,008.00	2026-11-06
40120	CDM	Natalizumab 300 Mg/15 Ml Intravenous Solution	10	10	$18,007.00	$18,007.00	$2,951.00	$17,287.00	$17,017.00	2026-11-06
183862	CDM	Nivolumab 240 Mg/24 Ml Intravenous Solution	10	10	$16,303.00	$16,303.00	$2,672.00	$15,651.00	$15,406.50	2026-11-06
171078	CDM	Nivolumab 40 Mg/4 Ml Intravenous Solution	10	10	$3,181.00	$3,181.00	$521.00	$3,054.00	$3,006.00	2026-11-06
Q4160	HCPCS	Nushield 4cm X 6cm 24 Sq Cm	10	10	$4,688.00	$4,688.00	$768.00	$4,500.00	$4,430.50	2026-11-06
59510	CPT	Obstetric Care, Planned Cesarean Delivery	19	10	$16,457.50	$16,457.50	$928.00	$26,161.00	$5,437.00	2026-11-06
59400	CPT	Obstetric Care, Planned Vaginal Delivery	19	10	$9,120.50	$9,120.50	$729.00	$13,239.00	$4,272.00	2026-11-06
59610	CPT	Obstetric Care, Planned Vaginal Delivery (post Delivery By Cesarean Section)	19	10	$9,295.50	$9,295.50	$874.00	$12,727.00	$5,121.00	2026-11-06
180349	CDM	Ocrelizumab 30 Mg/ml Intravenous Solution	10	10	$41,955.00	$41,955.00	$6,876.00	$40,277.00	$39,647.50	2026-11-06
171961	CDM	Octreotide,microspheres ER 10 Mg Intramuscular Susp, Extended Release	10	10	$7,455.00	$7,455.00	$1,222.00	$7,157.00	$7,045.00	2026-11-06
171959	CDM	Octreotide,microspheres ER 20 Mg Intramuscular Susp, Extended Release	10	10	$9,531.00	$9,531.00	$1,562.00	$9,150.00	$9,006.50	2026-11-06
171960	CDM	Octreotide,microspheres ER 30 Mg Intramuscular Susp, Extended Release	10	10	$13,894.00	$13,894.00	$2,277.00	$13,338.00	$13,129.50	2026-11-06
36151	CDM	Omalizumab 150 Mg Subcutaneous Solution	10	10	$3,438.00	$3,438.00	$563.00	$3,300.00	$3,249.00	2026-11-06
189520	CDM	Omalizumab 150 Mg/ml Subcutaneous Syringe	10	10	$3,438.00	$3,438.00	$563.00	$3,300.00	$3,249.00	2026-11-06
40475	CDM	Paclitaxel Protein-bound 100 Mg Intravenous Suspension	10	10	$3,661.00	$3,661.00	$600.00	$3,515.00	$3,459.50	2026-11-06
172818	CDM	Paliperidone Palmitate (3 Month) 819 Mg/2.63 Ml Intramuscular Syringe	10	10	$13,757.00	$13,757.00	$2,255.00	$13,207.00	$13,000.50	2026-11-06
119134	CDM	Paliperidone Palmitate 156 Mg/ml Intramuscular Syringe	10	10	$3,164.00	$3,164.00	$519.00	$3,037.00	$2,990.00	2026-11-06
119135	CDM	Paliperidone Palmitate 234 Mg/1.5 Ml Intramuscular Syringe	10	10	$4,677.00	$4,677.00	$766.00	$4,490.00	$4,419.50	2026-11-06
41675	CDM	Palivizumab 100 Mg/ml Intramuscular Solution	10	10	$4,511.00	$4,511.00	$739.00	$4,331.00	$4,262.50	2026-11-06
171445	CDM	Pegfilgrastim 6 Mg/0.6 Ml (Deliverable) Wearable Subcutaneous Injector	10	10	$9,013.00	$9,013.00	$1,477.00	$8,652.00	$8,517.00	2026-11-06
32267	CDM	Pegfilgrastim 6 Mg/0.6 Ml Subcutaneous Syringe	10	10	$9,013.00	$9,013.00	$1,477.00	$8,652.00	$8,517.00	2026-11-06
198936	CDM	Pegfilgrastim-apgf 6 Mg/0.6 Ml Subcutaneous Syringe	10	10	$4,646.00	$4,646.00	$761.00	$4,460.00	$4,390.50	2026-11-06
211259	CDM	Pegfilgrastim-cbqv 6 Mg/0.6 Ml (Deliverable) Wearable Subcut Injector	10	10	$5,453.00	$5,453.00	$894.00	$5,235.00	$5,153.00	2026-11-06
189951	CDM	Pegfilgrastim-cbqv 6 Mg/0.6 Ml Subcutaneous Syringe	10	10	$4,132.00	$4,132.00	$677.00	$3,967.00	$3,904.50	2026-11-06
186452	CDM	Pegfilgrastim-jmdb 6 Mg/0.6 Ml Subcutaneous Syringe	10	10	$3,772.00	$3,772.00	$618.00	$3,621.00	$3,564.50	2026-11-06
205769	CDM	Pegfilgrastim-pbbk 6 Mg/0.6 Ml Subcutaneous Syringe	10	10	$4,030.00	$4,030.00	$660.00	$3,869.00	$3,808.50	2026-11-06
171476	CDM	Pembrolizumab 25 Mg/ml Intravenous Solution	10	10	$12,301.00	$12,301.00	$2,016.00	$11,809.00	$11,624.50	2026-11-06
159381	CDM	Pertuzumab 420 Mg/14 Ml (30 Mg/ml) Intravenous Solution	10	10	$14,373.00	$14,373.00	$2,356.00	$13,798.00	$13,582.50	2026-11-06
23472	CPT	Pr Arthroplasty Glenohumeral Joint Total Shoulder	1	1	—	—	$3,012.00	$3,012.00	$3,012.00	2026-11-06
27130	CPT	Pr Arthrp Acetblr/prox Fem Prostc Agrft/algrft	1	1	—	—	$2,674.00	$2,674.00	$2,674.00	2026-11-06
27447	CPT	Pr Arthrp Kne Condyle&platu Medial&lat Compartments	1	1	—	—	$2,671.00	$2,671.00	$2,671.00	2026-11-06
59515	CPT	Pr Cesarean Delivery Only W/postpartum Care	1	1	—	—	$2,657.00	$2,657.00	$2,657.00	2026-11-06
59622	CPT	Pr Cesarean Dlvry & Postpartum Care Attempted Vba	1	1	—	—	$2,748.00	$2,748.00	$2,748.00	2026-11-06
47610	CPT	Pr Cholecystectomy W/exploration Common Duct	1	1	—	—	$2,549.00	$2,549.00	$2,549.00	2026-11-06
44640	CPT	Pr Closure Intestinal Cutaneous Fistula	1	1	—	—	$2,843.00	$2,843.00	$2,843.00	2026-11-06
44661	CPT	Pr Clsr Enteroves Fstl W/intestine&/bladder Rescj	1	1	—	—	$3,161.00	$3,161.00	$3,161.00	2026-11-06
44626	CPT	Pr Clsr Ntrstm Lg/sm Rescj & Colorectal Anastomosis	1	1	—	—	$3,235.00	$3,235.00	$3,235.00	2026-11-06
44140	CPT	Pr Colectomy Partial W/anastomosis	1	1	—	—	$2,735.00	$2,735.00	$2,735.00	2026-11-06
44145	CPT	Pr Colectomy Prtl W/coloproctostomy	1	1	—	—	$3,373.00	$3,373.00	$3,373.00	2026-11-06
44144	CPT	Pr Colectomy Prtl W/colost/ileost & Mucofistula	1	1	—	—	$3,585.00	$3,585.00	$3,585.00	2026-11-06
44143	CPT	Pr Colectomy Prtl W/end Colostomy & Clsr Dstl Sgmt	1	1	—	—	$3,352.00	$3,352.00	$3,352.00	2026-11-06
44160	CPT	Pr Colectomy Prtl W/rmvl Terminal Ileum & Ileocolos	1	1	—	—	$2,535.00	$2,535.00	$2,535.00	2026-11-06
44141	CPT	Pr Colectomy Prtl W/skin Level Cecost/colostomy	1	1	—	—	$3,680.00	$3,680.00	$3,680.00	2026-11-06
27132	CPT	Pr Conv Prev Hip Tot Hip Arthrp W/wo Agrft/algrft	1	1	—	—	$3,471.00	$3,471.00	$3,471.00	2026-11-06
49020	CPT	Pr Drainage Periton Abscess/local Peritonitis Open	1	1	—	—	$3,253.00	$3,253.00	$3,253.00	2026-11-06
44130	CPT	Pr Enteroenterost Anast Int W/wo Cutan Ntrstm Spx	1	1	—	—	$2,685.00	$2,685.00	$2,685.00	2026-11-06
27337	CPT	Pr Excison Tumor Soft Tissue Thigh/knee Subq 3 Cm/>	10	10	$4,098.00	$4,098.00	$672.00	$3,934.00	$3,852.00	2026-11-06
43840	CPT	Pr Gastrorrhaphy Sutr Prf8 Duol/gstr Ulcer Wnd/inj	1	1	—	—	$2,767.00	$2,767.00	$2,767.00	2026-11-06
58565	CPT	Pr Hysteroscopy Bi Tube Occlusion W/perm Implnts	1	1	—	—	$3,309.00	$3,309.00	$3,309.00	2026-11-06
58558	CPT	Pr Hysteroscopy Bx Endometrium&/polypc W/wo D&c	1	1	—	—	$2,617.00	$2,617.00	$2,617.00	2026-11-06
58563	CPT	Pr Hysteroscopy Endometrial Ablation	1	1	—	—	$4,143.00	$4,143.00	$4,143.00	2026-11-06
44204	CPT	Pr Laparoscopy Colectomy Partial W/anastomosis	1	1	—	—	$3,136.00	$3,136.00	$3,136.00	2026-11-06
58573	CPT	Pr Laparoscopy Tot Hysterectomy >250 G W/tube/ovar	1	1	—	—	$2,547.00	$2,547.00	$2,547.00	2026-11-06
44207	CPT	Pr Laps Colectomy Prtl W/colopxtstmy Lw Anast	1	1	—	—	$3,707.00	$3,707.00	$3,707.00	2026-11-06
44202	CPT	Pr Laps Enterect Rescj 1 Small Intest Rescj & Ana	10	10	$2,979.00	$2,979.00	$488.00	$2,860.00	$2,811.50	2026-11-06
58554	CPT	Pr Laps Vaginal Hysterect > 250 Gm Rmvl Tube&/ovar	1	1	—	—	$2,723.00	$2,723.00	$2,723.00	2026-11-06
49187	CPT	Pr Open Exc/dstrj Intra-abdl Tumor/cst 5.1-10 Cm	19	10	$3,624.00	$3,624.00	$445.00	$3,479.00	$2,609.00	2026-11-06
27513	CPT	Pr Open Tx Femoral Supracondylar Fracture W/xtn	1	1	—	—	$2,564.00	$2,564.00	$2,564.00	2026-11-06
27506	CPT	Pr Optx Fem Shft Fx W/insj Imed Implt W/wo Screw	1	1	—	—	$2,796.00	$2,796.00	$2,796.00	2026-11-06
64555	CPT	Pr Prq Impltj Neurostimulator Eltrd Peripheral Nrv	1	1	—	—	$4,328.00	$4,328.00	$4,328.00	2026-11-06
23474	CPT	Pr Revis Shoulder Arthrplsty Humeral&glenoid Compnt	1	1	—	—	$3,612.00	$3,612.00	$3,612.00	2026-11-06
23473	CPT	Pr Revis Shoulder Arthrplsty Humeral/glenoid Compnt	1	1	—	—	$3,348.00	$3,348.00	$3,348.00	2026-11-06
27134	CPT	Pr Revj Tot Hip Arthrp Bth W/wo Agrft/algrft	1	1	—	—	$3,942.00	$3,942.00	$3,942.00	2026-11-06
27138	CPT	Pr Revj Tot Hip Arthrp Fem Only W/wo Algrft	1	1	—	—	$3,161.00	$3,161.00	$3,161.00	2026-11-06
27487	CPT	Pr Revj Tot Knee Arthrp Fem&entire Tibial Compone	1	1	—	—	$3,639.00	$3,639.00	$3,639.00	2026-11-06
59618	CPT	Pr Routine Obstetrical Care Attempted Vbac	1	1	—	—	$5,420.00	$5,420.00	$5,420.00	2026-11-06
58200	CPT	Pr Tot Abd Hyst W/paraortic & Pelvic Lymph Node Sam	1	1	—	—	$2,829.00	$2,829.00	$2,829.00	2026-11-06
27245	CPT	Pr Tx Inter/pr/subtrchntric Fem Fx Imed Impltscrew	1	1	—	—	$2,562.00	$2,562.00	$2,562.00	2026-11-06
27244	CPT	Pr Tx Inter/pr/subtrchntric Femoral Fx Screw Implt	1	1	—	—	$2,565.00	$2,565.00	$2,565.00	2026-11-06
Q4196	HCPCS	Puraply Am 8cm X 16cm	10	10	$27,500.00	$27,500.00	$4,507.00	$26,400.00	$25,987.50	2026-11-06
Q4197	HCPCS	Puraply Xt 4.91x4.91 Extra Fen	10	10	$4,250.00	$4,250.00	$697.00	$4,080.00	$4,016.50	2026-11-06
88608	CDM	Raltegravir 400 Mg Tablet	10	10	$2,669.00	$2,669.00	$437.00	$2,562.00	$2,522.50	2026-11-06
198520	CDM	Ravulizumab-cwvz 100 Mg/ml Intravenous Solution	10	10	$13,797.00	$13,797.00	$2,261.00	$13,245.00	$13,038.00	2026-11-06
66984	CPT	Removal Of Cataract With Insertion Of Lens	10	10	$10,045.00	$10,045.00	$1,155.00	$9,643.00	$9,442.00	2026-11-06
42820	CPT	Removal Of Tonsils And Adenoid Glands, Patient Younger Than Age 12	10	10	$7,114.00	$7,114.00	$623.00	$6,829.00	$6,687.00	2026-11-06
104604	CDM	Rifaximin 550 Mg Tablet	10	10	$4,424.00	$4,424.00	$725.00	$4,247.00	$4,181.00	2026-11-06
204772	CDM	Risankizumab-rzaa 60 Mg/ml Intravenous Solution	10	10	$21,462.00	$21,462.00	$3,517.00	$20,604.00	$20,281.50	2026-11-06
194093	CDM	Romiplostim 125 Mcg Subcutaneous Solution	10	10	$3,352.00	$3,352.00	$549.00	$3,218.00	$3,167.50	2026-11-06
93566	CDM	Romiplostim 250 Mcg Subcutaneous Solution	10	10	$6,243.00	$6,243.00	$1,023.00	$5,993.00	$5,899.50	2026-11-06
191219	CDM	Romosozumab-aqqg 105 Mg/1.17 Ml Subcutaneous Syringe	10	10	$3,217.00	$3,217.00	$527.00	$3,088.00	$3,040.00	2026-11-06
191214	CDM	Romosozumab-aqqg 210 Mg/2.34 Ml(105 Mg/1.17 Ml X2)subcutaneous Syringe	10	10	$3,217.00	$3,217.00	$527.00	$3,088.00	$3,040.00	2026-11-06
171657	CDM	Secukinumab 150 Mg/ml Subcutaneous Pen Injector	10	10	$8,125.00	$8,125.00	$1,332.00	$7,800.00	$7,678.50	2026-11-06
95810	CPT	Sleep Study	10	10	$4,388.00	$4,388.00	$719.00	$4,212.00	$4,125.00	2026-11-06
C1787	HCPCS	Smart Programmer Kit X	10	10	$5,800.00	$5,800.00	$951.00	$5,568.00	$5,481.00	2026-11-06
C1771	HCPCS	Solyx Blue Sling System	10	10	$5,399.00	$5,399.00	$885.00	$5,183.00	$5,102.00	2026-11-06
11438	CDM	Succimer 100 Mg Capsule	10	10	$2,822.00	$2,822.00	$462.00	$2,709.00	$2,667.00	2026-11-06
184667	CDM	Tenecteplase 50 Mg Intravenous Solution	10	10	$10,784.00	$10,784.00	$1,767.00	$10,353.00	$10,191.00	2026-11-06
364SU272	CDM	Tibial Tray Rtng Pltfm Mbt Kee	10	10	$8,805.00	$8,805.00	$1,443.00	$8,453.00	$8,321.00	2026-11-06
187610	CDM	Tildrakizumab-asmn 100 Mg/ml Subcutaneous Syringe	10	10	$36,608.00	$36,608.00	$5,999.00	$35,144.00	$34,595.00	2026-11-06
119445	CDM	Tocilizumab 200 Mg/10 Ml (20 Mg/ml) Intravenous Solution	10	10	$3,162.00	$3,162.00	$518.00	$3,036.00	$2,988.00	2026-11-06
181188	CDM	Trastuzumab 150 Mg Intravenous Solution	10	10	$3,745.00	$3,745.00	$614.00	$3,595.00	$3,539.00	2026-11-06
207144	CDM	Ublituximab-xiiy 25 Mg/ml Intravenous Solution	10	10	$22,934.00	$22,934.00	$3,759.00	$22,017.00	$21,672.50	2026-11-06
178685	CDM	Ustekinumab 130 Mg/26 Ml Intravenous Solution	10	10	$4,931.00	$4,931.00	$808.00	$4,734.00	$4,659.50	2026-11-06
119469	CDM	Ustekinumab 90 Mg/ml Subcutaneous Syringe	10	10	$56,703.00	$56,703.00	$9,293.00	$54,435.00	$53,584.50	2026-11-06
CP17624571377121553	CDM	Uterine And Adnexa Procedures For Non-malignancy Without Cc Or Mcc	8	8	$33,410.00	$33,410.00	$31,405.00	$32,074.00	$31,740.00	2026-11-06
168531	CDM	Vedolizumab 300 Mg Intravenous Solution	10	10	$19,441.00	$19,441.00	$3,186.00	$18,663.00	$18,372.00	2026-11-06

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