Hospital

Madonna Rehabilitation Specialty Hospital Lincoln

Lincoln, NE · CCN 282000 · Rates published

2,264 distinct procedures filed

11 distinct payers

27,844 rate rows

2026-05-04 last MRF observed

Data quality

26,355 of 27,844 rate rows are consumer-grade (94.7%)

1,489 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	1,158
per-diem day rate — not a per-procedure price	311
percent-of-charges filed in the dollar field — excluded from medians	20

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

Source MRF file	https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbMRHLINCOLNNE&type=CDMWithoutLabel&fileType=CSV
Found on page	https://apps.para-hcfs.com/PTT/FinalLinks/Madonna_Lincoln_V2.aspx
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-10-25
Content fingerprint	ef5bc6f3d5a06354… · 9,349,668 bytes · first seen 2026-05-08

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
11044 HCPCS	Removal Of Bone, 20.0 Sq Cm Or Less	10	$10,277.10	$29,118.45	$23,123.47	nat. median $1,751 outlier · 13.2×
94006058_1 CDM	Cardiac Cath Lab	10	$7,329.60	$20,767.20	$16,491.60	nat. median $16,492 1.0× median
94000011_1 CDM	Operating Room Services - General Classification	10	$5,783.70	$16,387.15	$13,013.33	nat. median $13,013 1.0× median
94002010_1 CDM	Operating Room Services - General Classification	10	$5,087.38	$14,414.24	$11,446.60	nat. median $11,447 1.0× median
94002024_1 CDM	Gastro - Intestinal (gi) Services - General Classification	10	$5,005.20	$14,181.40	$11,261.70	nat. median $11,262 1.0× median
94007660_1 CDM	Lab Pathological-general	10	$4,018.80	$11,386.60	$9,042.30	nat. median $2,657 outlier · 3.4×
94007507_1 CDM	Gastro - Intestinal (gi) Services - General Classification	10	$3,556.20	$10,075.90	$8,001.45	nat. median $8,001 1.0× median
92961 HCPCS	Internal Shock To Heart To Regulate Heart Beat	10	$3,001.80	$8,505.10	$6,754.05	nat. median $941 outlier · 7.2×
94002074_1 CDM	Med/surg Supp-other Implants	10	$2,730.11	$7,735.31	$6,142.74	nat. median $6,143 1.0× median
25082926_1 CDM	Procrit 40,000 Units/ml Vial	10	$2,636.15	$7,469.10	$5,931.35	nat. median $5,931 1.0× median
25096513_1 CDM	Privigen 10% Vial	10	$2,508.23	$7,106.64	$5,643.51	nat. median $1,322 outlier · 4.3×
94006072_1 CDM	MRI-spine	10	$2,425.20	$6,871.40	$5,456.70	nat. median $5,783 0.9× median
94007527_1 CDM	Nuclear Med Diag-bryan	10	$2,321.40	$6,577.30	$5,223.15	nat. median $5,223 1.0× median
11700133_1 CDM	Room & Board - Semi-private (two Beds) - Rehabilitation	8	$4,395.00	$6,226.25	$4,944.38	nat. median $4,944 1.0× median
74178 HCPCS	CT Scan Of Abdomen And Pelvis Before And After Contrast	10	$2,045.25	$5,794.88	$4,601.82	nat. median $1,024 outlier · 4.5×
94000010_1 CDM	CT Scan Body	10	$2,043.72	$5,790.54	$4,598.37	nat. median $4,598 1.0× median
25218652_1 CDM	Santyl Ointment	10	$2,023.58	$5,733.48	$4,553.06	nat. median $4,553 1.0× median
94007609_1 CDM	Operating Room Services - General Classification	10	$2,016.39	$5,713.11	$4,536.88	nat. median $5,141 0.9× median
94006105_1 CDM	MRI-brain	10	$2,016.00	$5,712.00	$4,536.00	nat. median $4,536 1.0× median
94007669_1 CDM	Room & Board - Private (one Bed) - General Classification	9	$3,792.00	$5,372.00	$4,424.00	nat. median $4,424 1.0× median
74177 HCPCS	CT Scan Of Abdomen And Pelvis With Contrast	10	$1,949.57	$5,602.86	$4,416.76	nat. median $974 outlier · 4.5×
94000018_1 CDM	MRI Brain	10	$1,935.60	$5,484.20	$4,355.10	nat. median $4,355 1.0× median
94006075_1 CDM	Operating Room Services - Minor Surgery	10	$1,926.00	$5,457.00	$4,333.50	nat. median $6,454 0.7× median
94000008_1 CDM	CT Scan	10	$1,799.70	$5,099.15	$4,049.32	nat. median $4,049 1.0× median
94007574_1 CDM	Nm Lung Scan	10	$1,752.00	$4,964.00	$3,942.00	nat. median $3,942 1.0× median
94006073_1 CDM	Recovery Room - General Classification	10	$1,748.40	$4,953.80	$3,933.90	nat. median $1,789 outlier · 2.2×
94007601_1 CDM	Oncology-general	10	$1,692.00	$4,794.00	$3,807.00	nat. median $2,567 1.5× median
94006107_1 CDM	EEG	10	$1,687.50	$4,781.25	$3,796.88	nat. median $3,797 1.0× median
25094442_1 CDM	Mycophenolate 200 Mg/ml Susp	10	$1,587.23	$4,497.15	$3,571.27	nat. median $3,701 1.0× median
94000019_1 CDM	MRI Spinal Cord	10	$1,587.00	$4,496.50	$3,570.75	nat. median $3,571 1.0× median
94000009_1 CDM	CT Scan Head	10	$1,560.72	$4,422.04	$3,511.62	nat. median $3,512 1.0× median
94007542_1 CDM	Supplies/other Implants	10	$1,518.00	$4,301.00	$3,415.50	nat. median $3,416 1.0× median
94000020_1 CDM	Recovery Room - General Classification	10	$1,448.30	$4,103.52	$3,258.68	nat. median $3,259 1.0× median
25089327_1 CDM	Erythromycin 400 Mg/5 Ml Susp	10	$1,443.30	$4,089.36	$3,247.43	nat. median $3,247 1.0× median
94002023_1 CDM	Recovery Room - General Classification	10	$1,433.10	$4,060.44	$3,224.47	nat. median $3,224 1.0× median
94006054_1 CDM	Anesthesia	10	$1,348.35	$3,820.33	$3,033.79	nat. median $2,241 1.4× median
74176 HCPCS	CT Scan Of Abdomen And Pelvis Without Contrast	10	$1,324.32	$3,777.66	$2,989.44	nat. median $694 outlier · 4.3×
94007606_1 CDM	Laboratory Pathological-cystology	10	$1,323.90	$3,751.05	$2,978.77	nat. median $1,178 outlier · 2.5×
25094448_1 CDM	Procrit 20,000 Units/ml Vial	10	$1,318.08	$3,734.55	$2,965.67	nat. median $2,966 1.0× median
11700101_1 CDM	Room & Board - Semi-private (two Beds) - Rehabilitation	8	$2,611.20	$3,699.20	$2,937.60	nat. median $2,938 1.0× median
94000012_1 CDM	Anesthesia	10	$1,286.80	$3,645.93	$2,895.30	nat. median $2,895 1.0× median
94002067_1 CDM	Drugs/detail Code	10	$1,285.11	$3,641.15	$2,891.50	nat. median $2,892 1.0× median
71275 HCPCS	CT Scan Of Blood Vessels Of Chest With Contrast	10	$1,283.33	$3,636.09	$2,887.48	nat. median $754 outlier · 3.8×
11300042_1 CDM	Room & Board - Semi-private (two Beds) - Medical/surgical/gyn	9	$2,468.18	$3,496.59	$2,879.55	nat. median $2,880 1.0× median
94006077_1 CDM	CT Scan	10	$1,272.00	$3,604.00	$2,862.00	nat. median $3,134 0.9× median
25097402_1 CDM	Remdesivir (veklury) Injection	10	$1,266.88	$3,589.48	$2,850.47	nat. median $2,943 1.0× median
70498 HCPCS	CT Scan Of Blood Vessels Of Neck With Contrast	10	$1,258.60	$3,566.03	$2,831.85	nat. median $739 outlier · 3.8×
70496 HCPCS	CT Scan Of Blood Vessels Of Head With Contrast	10	$1,258.60	$3,566.03	$2,831.85	nat. median $747 outlier · 3.8×
25093633_1 CDM	Spiriva Respimat 2.5 Mcg Inh	10	$1,256.23	$3,559.32	$2,826.52	nat. median $2,964 1.0× median
11300101_1 CDM	Room & Board - Semi-private (two Beds) - Medical/surgical/gyn	9	$2,410.97	$3,415.53	$2,812.79	nat. median $2,813 1.0× median

Other procedures at this hospital

Browse this hospital's 2,264 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

11044	HCPCS	Removal Of Bone, 20.0 Sq Cm Or Less	10	10	$34,257.00	$34,257.00	$10,277.10	$29,118.45	$23,123.47	2026-05-04
94006058_1	CDM	Cardiac Cath Lab	10	10	$24,432.00	$24,432.00	$7,329.60	$20,767.20	$16,491.60	2026-05-04
94000011_1	CDM	Operating Room Services - General Classification	10	10	$19,279.00	$19,279.00	$5,783.70	$16,387.15	$13,013.33	2026-05-04
94002010_1	CDM	Operating Room Services - General Classification	10	10	$16,957.93	$16,957.93	$5,087.38	$14,414.24	$11,446.60	2026-05-04
94002024_1	CDM	Gastro - Intestinal (gi) Services - General Classification	10	10	$16,684.00	$16,684.00	$5,005.20	$14,181.40	$11,261.70	2026-05-04
94007660_1	CDM	Lab Pathological-general	10	10	$13,396.00	$13,396.00	$4,018.80	$11,386.60	$9,042.30	2026-05-04
94007507_1	CDM	Gastro - Intestinal (gi) Services - General Classification	10	10	$11,854.00	$11,854.00	$3,556.20	$10,075.90	$8,001.45	2026-05-04
92961	HCPCS	Internal Shock To Heart To Regulate Heart Beat	10	10	$10,006.00	$10,006.00	$3,001.80	$8,505.10	$6,754.05	2026-05-04
94002074_1	CDM	Med/surg Supp-other Implants	10	10	$9,100.36	$9,100.36	$2,730.11	$7,735.31	$6,142.74	2026-05-04
25082926_1	CDM	Procrit 40,000 Units/ml Vial	10	10	$8,787.18	$8,787.18	$2,636.15	$7,469.10	$5,931.35	2026-05-04
25096513_1	CDM	Privigen 10% Vial	10	10	$8,360.75	$8,360.75	$2,508.23	$7,106.64	$5,643.51	2026-05-04
94006072_1	CDM	MRI-spine	10	10	$8,084.00	$8,084.00	$2,425.20	$6,871.40	$5,456.70	2026-05-04
94007527_1	CDM	Nuclear Med Diag-bryan	10	10	$7,738.00	$7,738.00	$2,321.40	$6,577.30	$5,223.15	2026-05-04
11700133_1	CDM	Room & Board - Semi-private (two Beds) - Rehabilitation	8	8	$7,325.00	$7,325.00	$4,395.00	$6,226.25	$4,944.38	2026-05-04
74178	HCPCS	CT Scan Of Abdomen And Pelvis Before And After Contrast	10	10	$6,817.50	$6,817.50	$2,045.25	$5,794.88	$4,601.82	2026-05-04
94000010_1	CDM	CT Scan Body	10	10	$6,812.40	$6,812.40	$2,043.72	$5,790.54	$4,598.37	2026-05-04
25218652_1	CDM	Santyl Ointment	10	10	$6,745.27	$6,745.27	$2,023.58	$5,733.48	$4,553.06	2026-05-04
94007609_1	CDM	Operating Room Services - General Classification	10	10	$6,721.30	$6,721.30	$2,016.39	$5,713.11	$4,536.88	2026-05-04
94006105_1	CDM	MRI-brain	10	10	$6,720.00	$6,720.00	$2,016.00	$5,712.00	$4,536.00	2026-05-04
94007669_1	CDM	Room & Board - Private (one Bed) - General Classification	9	9	$6,320.00	$6,320.00	$3,792.00	$5,372.00	$4,424.00	2026-05-04
74177	HCPCS	CT Scan Of Abdomen And Pelvis With Contrast	20	10	$6,545.08	$6,545.08	$1,949.57	$5,602.86	$4,416.76	2026-05-04
94000018_1	CDM	MRI Brain	10	10	$6,452.00	$6,452.00	$1,935.60	$5,484.20	$4,355.10	2026-05-04
94006075_1	CDM	Operating Room Services - Minor Surgery	10	10	$6,420.00	$6,420.00	$1,926.00	$5,457.00	$4,333.50	2026-05-04
94000008_1	CDM	CT Scan	10	10	$5,999.00	$5,999.00	$1,799.70	$5,099.15	$4,049.32	2026-05-04
94007574_1	CDM	Nm Lung Scan	10	10	$5,840.00	$5,840.00	$1,752.00	$4,964.00	$3,942.00	2026-05-04
94006073_1	CDM	Recovery Room - General Classification	10	10	$5,828.00	$5,828.00	$1,748.40	$4,953.80	$3,933.90	2026-05-04
94007601_1	CDM	Oncology-general	10	10	$5,640.00	$5,640.00	$1,692.00	$4,794.00	$3,807.00	2026-05-04
94006107_1	CDM	EEG	10	10	$5,625.00	$5,625.00	$1,687.50	$4,781.25	$3,796.88	2026-05-04
25094442_1	CDM	Mycophenolate 200 Mg/ml Susp	10	10	$5,290.77	$5,290.77	$1,587.23	$4,497.15	$3,571.27	2026-05-04
94000019_1	CDM	MRI Spinal Cord	10	10	$5,290.00	$5,290.00	$1,587.00	$4,496.50	$3,570.75	2026-05-04
94000009_1	CDM	CT Scan Head	10	10	$5,202.40	$5,202.40	$1,560.72	$4,422.04	$3,511.62	2026-05-04
94007542_1	CDM	Supplies/other Implants	10	10	$5,060.00	$5,060.00	$1,518.00	$4,301.00	$3,415.50	2026-05-04
94000020_1	CDM	Recovery Room - General Classification	10	10	$4,827.67	$4,827.67	$1,448.30	$4,103.52	$3,258.68	2026-05-04
25089327_1	CDM	Erythromycin 400 Mg/5 Ml Susp	10	10	$4,811.01	$4,811.01	$1,443.30	$4,089.36	$3,247.43	2026-05-04
94002023_1	CDM	Recovery Room - General Classification	10	10	$4,776.99	$4,776.99	$1,433.10	$4,060.44	$3,224.47	2026-05-04
94006054_1	CDM	Anesthesia	10	10	$4,494.50	$4,494.50	$1,348.35	$3,820.33	$3,033.79	2026-05-04
74176	HCPCS	CT Scan Of Abdomen And Pelvis Without Contrast	20	10	$4,429.35	$4,429.35	$1,324.32	$3,777.66	$2,989.44	2026-05-04
94007606_1	CDM	Laboratory Pathological-cystology	10	10	$4,413.00	$4,413.00	$1,323.90	$3,751.05	$2,978.77	2026-05-04
25094448_1	CDM	Procrit 20,000 Units/ml Vial	10	10	$4,393.59	$4,393.59	$1,318.08	$3,734.55	$2,965.67	2026-05-04
11700101_1	CDM	Room & Board - Semi-private (two Beds) - Rehabilitation	8	8	$4,352.00	$4,352.00	$2,611.20	$3,699.20	$2,937.60	2026-05-04
94000012_1	CDM	Anesthesia	10	10	$4,289.33	$4,289.33	$1,286.80	$3,645.93	$2,895.30	2026-05-04
94002067_1	CDM	Drugs/detail Code	10	10	$4,283.70	$4,283.70	$1,285.11	$3,641.15	$2,891.50	2026-05-04
71275	HCPCS	CT Scan Of Blood Vessels Of Chest With Contrast	10	10	$4,277.75	$4,277.75	$1,283.33	$3,636.09	$2,887.48	2026-05-04
11300042_1	CDM	Room & Board - Semi-private (two Beds) - Medical/surgical/gyn	9	9	$4,113.64	$4,113.64	$2,468.18	$3,496.59	$2,879.55	2026-05-04
94006077_1	CDM	CT Scan	10	10	$4,240.00	$4,240.00	$1,272.00	$3,604.00	$2,862.00	2026-05-04
25097402_1	CDM	Remdesivir (veklury) Injection	10	10	$4,222.92	$4,222.92	$1,266.88	$3,589.48	$2,850.47	2026-05-04
70498	HCPCS	CT Scan Of Blood Vessels Of Neck With Contrast	10	10	$4,195.33	$4,195.33	$1,258.60	$3,566.03	$2,831.85	2026-05-04
70496	HCPCS	CT Scan Of Blood Vessels Of Head With Contrast	10	10	$4,195.33	$4,195.33	$1,258.60	$3,566.03	$2,831.85	2026-05-04
25093633_1	CDM	Spiriva Respimat 2.5 Mcg Inh	10	10	$4,187.44	$4,187.44	$1,256.23	$3,559.32	$2,826.52	2026-05-04
11300101_1	CDM	Room & Board - Semi-private (two Beds) - Medical/surgical/gyn	9	9	$4,018.28	$4,018.28	$2,410.97	$3,415.53	$2,812.79	2026-05-04
70470	HCPCS	CT Scan Of Head Or Brain Before And After Contrast	10	10	$4,141.00	$4,141.00	$1,242.30	$3,519.85	$2,795.18	2026-05-04
94002007_1	CDM	CT Scan	10	10	$4,116.00	$4,116.00	$1,234.80	$3,498.60	$2,778.30	2026-05-04
74170	HCPCS	CT Scan Of Abdomen Before And After Contrast	10	10	$4,106.00	$4,106.00	$1,231.80	$3,490.10	$2,771.55	2026-05-04
94002069_1	CDM	Sterile Supply	10	10	$4,076.34	$4,076.34	$1,222.90	$3,464.89	$2,751.53	2026-05-04
94000014_1	CDM	Respiratory Service	10	10	$3,947.33	$3,947.33	$1,184.20	$3,355.23	$2,664.45	2026-05-04
11700103_1	CDM	Room & Board - Semi-private (two Beds) - Rehabilitation	8	8	$3,918.84	$3,918.84	$2,351.31	$3,331.02	$2,645.22	2026-05-04
70460	HCPCS	CT Scan Head Or Brain With Contrast	10	10	$3,912.00	$3,912.00	$1,173.60	$3,325.20	$2,640.60	2026-05-04
74174	HCPCS	CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast	10	10	$3,861.00	$3,861.00	$1,158.30	$3,281.85	$2,606.18	2026-05-04
70491	HCPCS	CT Scan Of Soft Tissue Of Neck With Contrast	10	10	$3,836.50	$3,836.50	$1,150.95	$3,261.03	$2,589.64	2026-05-04
94000029_1	CDM	Carotid Duplex Scan	10	10	$3,808.67	$3,808.67	$1,142.60	$3,237.37	$2,570.85	2026-05-04
11700001_1	CDM	Room & Board - Semi-private (two Beds) - Rehabilitation	8	8	$3,750.48	$3,750.48	$2,250.29	$3,187.90	$2,531.57	2026-05-04
L0464	HCPCS	Tlso, Triplanar Control, Modular Segmented Spinal System, Four Rigid Plastic She…	10	10	$3,749.00	$3,749.00	$1,124.70	$3,186.65	$2,530.57	2026-05-04
94007631_1	CDM	Med/surg Supp-other Implants	10	10	$3,746.25	$3,746.25	$1,123.88	$3,184.31	$2,528.72	2026-05-04
25096764_1	CDM	Combivent Respimat 20-100 Mcg	10	10	$3,717.10	$3,717.10	$1,115.13	$3,159.54	$2,509.05	2026-05-04
94002073_1	CDM	Blood Storage/processing	10	10	$3,708.00	$3,708.00	$1,112.40	$3,151.80	$2,502.90	2026-05-04
72193	HCPCS	CT Scan Of Pelvis With Contrast	10	10	$3,642.00	$3,642.00	$1,092.60	$3,095.70	$2,458.35	2026-05-04
94000016_1	CDM	Emergency Room	10	10	$3,628.78	$3,628.78	$1,088.63	$3,084.46	$2,449.43	2026-05-04
71260	HCPCS	CT Scan Of Chest With Contrast	10	10	$3,594.00	$3,594.00	$1,078.20	$3,054.90	$2,425.95	2026-05-04
25096457_1	CDM	Atovaquone 750 Mg/5 Ml Susp	10	10	$3,593.24	$3,593.24	$1,077.97	$3,054.26	$2,425.44	2026-05-04
94002011_1	CDM	Anesthesia	10	10	$3,538.58	$3,538.58	$1,061.58	$3,007.80	$2,388.55	2026-05-04
94000023_1	CDM	Specialty Services - Treatment Room	10	10	$3,525.06	$3,525.06	$1,057.52	$2,996.30	$2,379.41	2026-05-04
G0378	HCPCS	Hospital Observation Service, Per Hour	10	10	$3,520.00	$3,520.00	$1,056.00	$2,992.00	$2,376.00	2026-05-04
11300040_1	CDM	Room & Board - Semi-private (two Beds) - Medical/surgical/gyn	9	9	$3,373.01	$3,373.01	$2,023.81	$2,867.06	$2,361.11	2026-05-04
94007526_1	CDM	Room & Board - Semi-private (two Beds) - General Classification	9	9	$3,372.00	$3,372.00	$2,023.20	$2,866.20	$2,360.40	2026-05-04
94002068_1	CDM	All Inclusive Rate - All-inclusive Room And Board Plus Ancillary	9	9	$3,366.00	$3,366.00	$2,019.60	$2,861.10	$2,356.20	2026-05-04
25095790_1	CDM	Clobetasol 0.05% Ointment	10	10	$3,444.15	$3,444.15	$1,033.25	$2,927.53	$2,324.80	2026-05-04
11300060_1	CDM	Subacute Care - General Classification	9	9	$3,305.98	$3,305.98	$1,983.59	$2,810.08	$2,314.19	2026-05-04
11300001_1	CDM	Room & Board - Semi-private (two Beds) - Medical/surgical/gyn	9	9	$3,305.50	$3,305.50	$1,983.30	$2,809.68	$2,313.85	2026-05-04
25097523_1	CDM	Bevespi Aerosphere Inhaler	10	10	$3,393.95	$3,393.95	$1,018.18	$2,884.85	$2,290.91	2026-05-04
70490	HCPCS	CT Scan Of Soft Tissue Of Neck Without Contrast	10	10	$3,377.40	$3,377.40	$1,013.22	$2,870.79	$2,279.74	2026-05-04
72126	HCPCS	CT Scan Of Upper Spine With Contrast	10	10	$3,352.00	$3,352.00	$1,005.60	$2,849.20	$2,262.60	2026-05-04
72132	HCPCS	CT Scan Of Lower Spine With Contrast	10	10	$3,352.00	$3,352.00	$1,005.60	$2,849.20	$2,262.60	2026-05-04
11300033_1	CDM	Room & Board - Semi-private (two Beds) - Rehabilitation	8	8	$3,297.00	$3,297.00	$1,978.20	$2,802.45	$2,225.48	2026-05-04
11700105_1	CDM	Room & Board - Semi-private (two Beds) - Rehabilitation	8	8	$3,284.74	$3,284.74	$1,970.84	$2,792.03	$2,217.20	2026-05-04
74150	HCPCS	CT Scan Of Abdomen Without Contrast	20	10	$3,280.66	$3,280.66	$974.20	$2,816.90	$2,213.61	2026-05-04
25094883_1	CDM	Octagam 10% Vial	10	10	$3,260.60	$3,260.60	$978.18	$2,771.51	$2,200.90	2026-05-04
73700	HCPCS	CT Scan Of Leg Without Contrast	10	10	$3,256.00	$3,256.00	$976.80	$2,767.60	$2,197.80	2026-05-04
11700003_1	CDM	Room & Board - Semi-private (two Beds) - Rehabilitation	8	8	$3,225.84	$3,225.84	$1,935.51	$2,741.97	$2,177.45	2026-05-04
72129	HCPCS	CT Scan Of Middle Spine With Contrast	10	10	$3,192.00	$3,192.00	$957.60	$2,713.20	$2,154.60	2026-05-04
72127	HCPCS	CT Scan Of Upper Spine Before And After Contrast	10	10	$3,191.00	$3,191.00	$957.30	$2,712.35	$2,153.93	2026-05-04
72131	HCPCS	CT Scan Of Lower Spine Without Contrast	10	10	$3,146.33	$3,146.33	$943.90	$2,674.38	$2,123.77	2026-05-04
94006074_1	CDM	Supply/implants	10	10	$3,137.42	$3,137.42	$941.23	$2,666.81	$2,117.76	2026-05-04
72128	HCPCS	CT Scan Of Middle Spine Without Contrast	10	10	$3,121.00	$3,121.00	$936.30	$2,652.85	$2,106.68	2026-05-04
72125	HCPCS	CT Scan Of Upper Spine Without Contrast	10	10	$3,105.80	$3,105.80	$931.74	$2,639.93	$2,096.41	2026-05-04
94000032_1	CDM	EEG	10	10	$3,102.00	$3,102.00	$930.60	$2,636.70	$2,093.85	2026-05-04
94006055_1	CDM	Perivascular Lab	10	10	$3,041.33	$3,041.33	$912.40	$2,585.13	$2,052.90	2026-05-04
93017	HCPCS	Exercise Or Drug-induced Heart Stress Test With Electrocardiogram (ecg)	10	10	$3,036.00	$3,036.00	$910.80	$2,580.60	$2,049.30	2026-05-04
70487	HCPCS	CT Scan Of Face With Contrast	10	10	$3,021.50	$3,021.50	$906.45	$2,568.28	$2,039.52	2026-05-04
L0637	HCPCS	Lumbar-sacral Orthosis, Sagittal-coronal Control, With Rigid Anterior And Poster…	10	10	$3,004.00	$3,004.00	$901.20	$2,553.40	$2,027.70	2026-05-04
94002071_1	CDM	Blood/admin	10	10	$2,984.00	$2,984.00	$895.20	$2,536.40	$2,014.20	2026-05-04
94007641_1	CDM	Echocardiology	10	10	$2,982.00	$2,982.00	$894.60	$2,534.70	$2,012.85	2026-05-04
71250	HCPCS	CT Scan Of Chest Without Contrast	10	10	$2,918.31	$2,918.31	$875.49	$2,480.56	$1,969.86	2026-05-04
94002027_1	CDM	Diagnostic Peri Vasc Lab	10	10	$2,912.00	$2,912.00	$873.60	$2,475.20	$1,965.60	2026-05-04
25097534_1	CDM	Breyna 160-4.5 Mcg Inhaler	10	10	$2,902.28	$2,902.28	$870.68	$2,466.94	$1,959.04	2026-05-04
72192	HCPCS	CT Scan Of Pelvis Without Contrast	10	10	$2,890.33	$2,890.33	$867.10	$2,456.78	$1,950.97	2026-05-04
11700107_1	CDM	Room & Board - Semi-private (two Beds) - Rehabilitation	8	8	$2,870.78	$2,870.78	$1,722.47	$2,440.16	$1,937.78	2026-05-04
25097550_1	CDM	Dulera 200 Mcg-5 Mcg Inhaler	10	10	$2,775.28	$2,775.28	$832.58	$2,358.99	$1,873.32	2026-05-04
25095693_1	CDM	Budesonide-formoterol 160-4.5	10	10	$2,760.28	$2,760.28	$828.08	$2,346.24	$1,863.19	2026-05-04
25096512_1	CDM	Dulera 100 Mcg-5 Mcg Inhaler	10	10	$2,748.46	$2,748.46	$824.54	$2,336.19	$1,855.21	2026-05-04
25096602_1	CDM	Valganciclovir Hcl 50 Mg/ml	10	10	$2,722.54	$2,722.54	$816.76	$2,314.16	$1,837.72	2026-05-04
94007627_1	CDM	Anesthesia	10	10	$2,707.00	$2,707.00	$812.10	$2,300.95	$1,827.22	2026-05-04
11700005_1	CDM	Room & Board - Semi-private (two Beds) - Rehabilitation	8	8	$2,606.25	$2,606.25	$1,563.75	$2,215.31	$1,759.21	2026-05-04
70486	HCPCS	CT Scan Of Face Without Contrast	20	10	$2,586.54	$2,586.54	$765.03	$2,229.55	$1,745.01	2026-05-04
L0460	HCPCS	Tlso, Triplanar Control, Modular Segmented Spinal System, Two Rigid Plastic Shel…	10	10	$2,532.00	$2,532.00	$759.60	$2,152.20	$1,709.10	2026-05-04
94007537_1	CDM	Nuclear Med-pharmacy	10	10	$2,524.00	$2,524.00	$757.20	$2,145.40	$1,703.70	2026-05-04
94002001_1	CDM	Pharmacy	10	10	$2,520.21	$2,520.21	$756.06	$2,142.18	$1,701.14	2026-05-04
93312	HCPCS	Ultrasound Of Heart With Probe In Esophagus, With Report	20	10	$5,170.28	$5,170.28	$143.96	$8,381.57	$1,683.05	2026-05-04
73200	HCPCS	CT Scan Of Arm Without Contrast	30	10	$2,489.67	$2,489.67	$734.70	$2,133.50	$1,672.90	2026-05-04
94002076_1	CDM	Pathology Lab	10	10	$2,436.75	$2,436.75	$731.03	$2,071.24	$1,644.81	2026-05-04
25077710_1	CDM	Itraconazole 10 Mg/ml Solution	10	10	$2,413.70	$2,413.70	$724.11	$2,051.65	$1,629.25	2026-05-04
25092313_1	CDM	Santyl Ointment	10	10	$2,383.99	$2,383.99	$715.20	$2,026.39	$1,609.20	2026-05-04
25092008_1	CDM	Estradiol 0.01% Cream	10	10	$2,340.39	$2,340.39	$702.12	$1,989.33	$1,579.76	2026-05-04
70450	HCPCS	CT Scan Head Or Brain Without Contrast	20	10	$2,229.15	$2,229.15	$590.70	$2,115.91	$1,504.86	2026-05-04
94007628_1	CDM	Recovery Room - General Classification	10	10	$2,224.00	$2,224.00	$667.20	$1,890.40	$1,501.20	2026-05-04
94002004_1	CDM	Radiology	10	10	$2,199.00	$2,199.00	$659.70	$1,869.15	$1,484.32	2026-05-04
L1932	HCPCS	Ankle Foot Orthosis, Rigid Anterior Tibial Section, Total Carbon Fiber Or Equal …	10	10	$2,197.18	$2,197.18	$659.15	$1,867.60	$1,483.09	2026-05-04
11300037_1	CDM	Room & Board - Semi-private (two Beds) - Rehabilitation	8	8	$2,187.95	$2,187.95	$1,312.77	$1,859.76	$1,476.87	2026-05-04
L1843	HCPCS	Knee Orthosis, Single Upright, Thigh And Calf, With Adjustable Flexion And Exten…	10	10	$2,155.14	$2,155.14	$646.54	$1,831.87	$1,454.72	2026-05-04
25168451_1	CDM	Lidocaine 5% Ointment	10	10	$2,154.16	$2,154.16	$646.25	$1,831.04	$1,454.06	2026-05-04
11700007_1	CDM	Room & Board - Semi-private (two Beds) - Rehabilitation	8	8	$2,142.17	$2,142.17	$1,285.30	$1,820.85	$1,445.97	2026-05-04
94007637_1	CDM	Lab Pathological-histology	10	10	$2,131.00	$2,131.00	$639.30	$1,811.35	$1,438.43	2026-05-04
L1951	HCPCS	Ankle Foot Orthosis, Spiral, (institute Of Rehabilitative Medicine Type), Plasti…	10	10	$2,118.00	$2,118.00	$635.40	$1,800.30	$1,429.65	2026-05-04
A6513	HCPCS	Compression Burn Mask, Face And/or Neck, Plastic Or Equal, Custom Fabricated	10	10	$1,961.38	$1,961.38	$588.41	$1,667.17	$1,323.93	2026-05-04
25096630_1	CDM	Teflaro 600 Mg Vial	10	10	$1,959.97	$1,959.97	$587.99	$1,665.98	$1,322.98	2026-05-04
25096598_1	CDM	Cyclosporine Modified 100mg/ml	10	10	$1,953.07	$1,953.07	$585.92	$1,660.11	$1,318.33	2026-05-04
25096755_1	CDM	Dificid 200 Mg Tablet	10	10	$1,947.86	$1,947.86	$584.36	$1,655.68	$1,314.80	2026-05-04
L1845	HCPCS	Knee Orthosis, Double Upright, Thigh And Calf, With Adjustable Flexion And Exten…	10	10	$1,937.00	$1,937.00	$581.10	$1,646.45	$1,307.47	2026-05-04
P9037	HCPCS	Platelets, Pheresis, Leukocytes Reduced, Irradiated, Each Unit	10	10	$1,926.49	$1,926.49	$577.95	$1,637.52	$1,300.38	2026-05-04
L1970	HCPCS	Ankle Foot Orthosis, Plastic With Ankle Joint, Custom Fabricated	10	10	$1,919.55	$1,919.55	$575.87	$1,631.62	$1,295.70	2026-05-04
94002014_1	CDM	Respiratory Service	10	10	$1,893.00	$1,893.00	$567.90	$1,609.05	$1,277.78	2026-05-04
94006053_1	CDM	Blood Stor/proc-other	10	10	$1,854.00	$1,854.00	$556.20	$1,575.90	$1,251.45	2026-05-04
25093268_1	CDM	Potassium Chloride 20meq/15ml	10	10	$1,847.13	$1,847.13	$554.14	$1,570.06	$1,246.82	2026-05-04
25095928_1	CDM	Levetiracetam 100 Mg/ml Soln	10	10	$1,796.19	$1,796.19	$538.86	$1,526.76	$1,212.43	2026-05-04
25097541_1	CDM	Tolvaptan 30 Mg Tablet	10	10	$1,780.12	$1,780.12	$534.04	$1,513.10	$1,201.58	2026-05-04
94002003_1	CDM	Lab-ste	10	10	$1,772.62	$1,772.62	$531.78	$1,506.72	$1,196.51	2026-05-04
25097017_1	CDM	Bexsero Prefilled Syringe	10	10	$1,740.28	$1,740.28	$522.08	$1,479.23	$1,174.68	2026-05-04
94007651_1	CDM	Nuclear Med Dx Radiopharm	10	10	$1,736.00	$1,736.00	$520.80	$1,475.60	$1,171.80	2026-05-04
25094392_1	CDM	First Lansoprazole (dps/prevacid) 3mg/ml Suspension	10	10	$1,727.89	$1,727.89	$518.37	$1,468.70	$1,166.33	2026-05-04
94006113_1	CDM	Blood Stor/proc-bl Admin	10	10	$1,724.00	$1,724.00	$517.20	$1,465.40	$1,163.70	2026-05-04
25093010_1	CDM	Tacrolimus 0.1% Ointment	10	10	$1,698.20	$1,698.20	$509.46	$1,443.47	$1,146.28	2026-05-04
25231358_1	CDM	Clobetasol 0.05% Cream	10	10	$1,684.27	$1,684.27	$505.28	$1,431.63	$1,136.88	2026-05-04
25094953_1	CDM	Loteprednol Etabonate 0.5% Drp	10	10	$1,672.05	$1,672.05	$501.62	$1,421.24	$1,128.63	2026-05-04
25090382_1	CDM	Ofloxacin 0.3% Ear Drops	10	10	$1,616.71	$1,616.71	$485.01	$1,374.20	$1,091.28	2026-05-04
94000013_1	CDM	Other Imaging Svc -ultrasound	10	10	$1,614.00	$1,614.00	$484.20	$1,371.90	$1,089.45	2026-05-04
94007629_1	CDM	Pharmacy-general	10	10	$1,589.73	$1,589.73	$476.92	$1,351.27	$1,073.07	2026-05-04
25084153_1	CDM	Ciproflox-dexameth Otic Susp	10	10	$1,578.97	$1,578.97	$473.69	$1,342.12	$1,065.80	2026-05-04
25117508_1	CDM	Sucralfate 1 Gm/10 Ml Susp	10	10	$1,558.39	$1,558.39	$467.52	$1,324.63	$1,051.91	2026-05-04
3000285_3	CDM	Immunoperoxidase Stain-each Additional [i]	10	10	$1,546.26	$1,546.26	$463.88	$1,314.32	$1,043.73	2026-05-04
94007634_1	CDM	Med/surg Supp-non Sterile	10	10	$1,477.50	$1,477.50	$443.25	$1,255.88	$997.32	2026-05-04
94007599_1	CDM	Med/surg Supplies/devices-general	10	10	$1,442.31	$1,442.31	$432.69	$1,225.96	$973.56	2026-05-04
25225905_1	CDM	Sulfamethoxazole-tmp Susp	10	10	$1,403.20	$1,403.20	$420.96	$1,192.72	$947.16	2026-05-04
25093808_1	CDM	Cathflo Activase 2 Mg Vial	10	10	$1,401.35	$1,401.35	$420.40	$1,191.14	$945.90	2026-05-04
25097269_1	CDM	Buprenorphine 20 Mcg/hr Patch	10	10	$1,394.39	$1,394.39	$418.32	$1,185.23	$941.21	2026-05-04
94000003_1	CDM	Lab-blgh	10	10	$1,380.20	$1,380.20	$414.06	$1,173.17	$931.63	2026-05-04
L1832	HCPCS	Knee Orthosis, Adjustable Knee Joints (unicentric Or Polycentric), Positional Or…	10	10	$1,372.14	$1,372.14	$411.64	$1,166.32	$926.19	2026-05-04
25094712_1	CDM	Glucagon 1 Mg Emergency Kit	10	10	$1,367.75	$1,367.75	$410.33	$1,162.59	$923.23	2026-05-04
25096037_1	CDM	Clobetasol 0.05% Solution	10	10	$1,345.08	$1,345.08	$403.52	$1,143.32	$907.93	2026-05-04
L5000	HCPCS	Partial Foot, Shoe Insert With Longitudinal Arch, Toe Filler	10	10	$1,333.00	$1,333.00	$399.90	$1,133.05	$899.78	2026-05-04
25096946_1	CDM	Zerbaxa 1.5 Gram Vial	10	10	$1,304.11	$1,304.11	$391.23	$1,108.49	$880.27	2026-05-04
25097047_1	CDM	Valacyclovir 50mg/ml Susp	10	10	$1,285.09	$1,285.09	$385.53	$1,092.33	$867.43	2026-05-04
25096337_1	CDM	Relistor 12 Mg/0.6 Ml Syringe	10	10	$1,271.73	$1,271.73	$381.52	$1,080.97	$858.41	2026-05-04
25095664_1	CDM	Linezolid 600 Mg Tablet	10	10	$1,247.16	$1,247.16	$374.15	$1,060.09	$841.83	2026-05-04
94006114_1	CDM	Drugs Id/detail Code	10	10	$1,240.91	$1,240.91	$372.27	$1,054.78	$837.62	2026-05-04
25097204_1	CDM	Vancomycin 50 Mg/ml Oral Soln	10	10	$1,223.87	$1,223.87	$367.16	$1,040.29	$826.11	2026-05-04
L5410	HCPCS	Immediate Post Surgical Or Early Fitting, Application Of Initial Rigid Dressing,…	10	10	$1,209.80	$1,209.80	$362.94	$1,028.33	$816.62	2026-05-04
80605056_1	CDM	Hemodlysis-offsite	10	10	$1,203.00	$1,203.00	$360.90	$1,022.55	$812.03	2026-05-04
27051774_1	CDM	Rectal Flexi Seal Kit	10	10	$1,198.87	$1,198.87	$359.66	$1,019.04	$809.24	2026-05-04
94007603_1	CDM	Laboratory-chemistry	10	10	$1,185.00	$1,185.00	$355.50	$1,007.25	$799.88	2026-05-04
27144744_1	CDM	Bivona Custom Trach-495	10	10	$1,176.00	$1,176.00	$352.80	$999.60	$793.80	2026-05-04
25094469_1	CDM	Plenvu Powder Packets	10	10	$1,163.29	$1,163.29	$348.99	$988.80	$785.22	2026-05-04
94007652_1	CDM	Anesthesia/incident Rad	10	10	$1,156.00	$1,156.00	$346.80	$982.60	$780.30	2026-05-04
25097018_1	CDM	Meningococcal Vacc (menveo)	10	10	$1,155.91	$1,155.91	$346.77	$982.52	$780.24	2026-05-04
27144715_1	CDM	Custom 7.0 Tts Trach	10	10	$1,152.42	$1,152.42	$345.73	$979.55	$777.88	2026-05-04
3002815_3	CDM	Plt-pher-irr X1[i]	10	10	$1,151.08	$1,151.08	$345.32	$978.42	$776.98	2026-05-04
94007630_1	CDM	Med/surg Supp/devices-sterile	10	10	$1,149.00	$1,149.00	$344.70	$976.65	$775.58	2026-05-04
25097302_1	CDM	Buprenorphine 15 Mcg/hr Patch	10	10	$1,136.18	$1,136.18	$340.85	$965.75	$766.92	2026-05-04
25097535_1	CDM	Paxlovid 300-100 Mg Dose Pack	10	10	$1,129.54	$1,129.54	$338.86	$960.11	$762.44	2026-05-04
25093201_1	CDM	Ertapenem 1 Gram Vial	10	10	$1,121.64	$1,121.64	$336.49	$953.40	$757.11	2026-05-04
27442450_1	CDM	Knee Orthosis	10	10	$1,115.00	$1,115.00	$334.50	$947.75	$752.62	2026-05-04
Q0081	HCPCS	Infusion Therapy, Using Other Than Chemotherapeutic Drugs, Per Visit	10	10	$1,094.57	$1,094.57	$328.37	$930.39	$738.84	2026-05-04
L3760	HCPCS	Elbow Orthosis (eo), With Adjustable Position Locking Joint(s), Prefabricated, I…	10	10	$1,093.19	$1,093.19	$327.96	$929.21	$737.90	2026-05-04
J1820	HCPCS	Humalog 100 Unit/ml Vial	50	10	$1,163.43	$1,163.43	$76.11	$1,806.60	$736.75	2026-05-04
25093603_1	CDM	Moxifloxacin 0.5% Eye Drops	10	10	$1,091.12	$1,091.12	$327.34	$927.45	$736.50	2026-05-04
94007638_1	CDM	Nucl Med-diag Radiopharmaceut	10	10	$1,080.00	$1,080.00	$324.00	$918.00	$729.00	2026-05-04
L3761	HCPCS	Elbow Orthosis (eo), With Adjustable Position Locking Joint(s), Prefabricated, O…	10	10	$1,068.61	$1,068.61	$320.58	$908.32	$721.32	2026-05-04
94006002_1	CDM	Lab	10	10	$1,063.93	$1,063.93	$319.18	$904.34	$718.15	2026-05-04
94000015_1	CDM	Speech Pathology Eval	11	11	$1,094.00	$1,094.00	$125.00	$929.90	$711.10	2026-05-04
94006028_1	CDM	Pharmacy	10	10	$1,001.25	$1,001.25	$300.38	$851.06	$675.85	2026-05-04
94007608_1	CDM	CT-head Scan	10	10	$1,000.00	$1,000.00	$300.00	$850.00	$675.00	2026-05-04
94000022_1	CDM	Gastro - Intestinal (gi) Services - General Classification	10	10	$972.00	$972.00	$291.60	$826.20	$656.10	2026-05-04
P9016	HCPCS	Red Blood Cells, Leukocytes Reduced, Each Unit	30	10	$995.97	$995.97	$148.40	$1,258.00	$647.38	2026-05-04
25093036_1	CDM	Venofer 100 Mg/5 Ml Vial	10	10	$957.98	$957.98	$287.39	$814.28	$646.64	2026-05-04
27144714_1	CDM	Custom 6.0 Tts Trach	10	10	$951.81	$951.81	$285.54	$809.04	$642.47	2026-05-04
94006001_1	CDM	Med/surg Supplies	10	10	$934.00	$934.00	$280.20	$793.90	$630.45	2026-05-04
25096227_1	CDM	First Mouthwash (dps/magic Mou	10	10	$932.43	$932.43	$279.73	$792.56	$629.39	2026-05-04
94000021_1	CDM	EKG/ECG	10	10	$926.33	$926.33	$277.90	$787.38	$625.27	2026-05-04
94000004_1	CDM	Radiology	10	10	$917.00	$917.00	$275.10	$779.45	$618.97	2026-05-04
25094276_1	CDM	Ibandronate Sodium 150 Mg Tab	10	10	$904.50	$904.50	$271.35	$768.83	$610.54	2026-05-04
32086653_3	CDM	Shunt Series	10	10	$895.00	$895.00	$268.50	$760.75	$604.12	2026-05-04
94007523_1	CDM	Pathology Lab-bryan	10	10	$892.00	$892.00	$267.60	$758.20	$602.10	2026-05-04
25096495_1	CDM	Fondaparinux 5 Mg/0.4 Ml Syr	10	10	$880.98	$880.98	$264.29	$748.83	$594.66	2026-05-04
87507	HCPCS	Detection Test By Nucleic Acid For Digestive Tract Pathogen, Multiple Types Or S…	10	10	$871.06	$871.06	$261.32	$740.40	$587.97	2026-05-04
25133000_1	CDM	Fluconazole 40 Mg/ml Susp	10	10	$857.44	$857.44	$257.23	$728.83	$578.78	2026-05-04
94002072_1	CDM	Specialty Services - Treatment Room	10	10	$851.00	$851.00	$255.30	$723.35	$574.42	2026-05-04
25097293_1	CDM	Cresemba 186 Mg Capsule	10	10	$829.96	$829.96	$248.99	$705.46	$560.22	2026-05-04
73502	HCPCS	X-ray Of Hip, 2-3 Views	20	10	$829.21	$829.21	$247.26	$709.09	$559.59	2026-05-04
25095885_1	CDM	Dorzolamide-timolol Eye Drops	10	10	$818.93	$818.93	$245.68	$696.09	$552.77	2026-05-04
25094341_1	CDM	Tigecycline 50 Mg Vial	10	10	$813.70	$813.70	$244.11	$691.65	$549.25	2026-05-04
25096911_1	CDM	Buprenorphine 10 Mcg/hr Patch	10	10	$793.33	$793.33	$238.00	$674.33	$535.50	2026-05-04
27144743_1	CDM	Bivona Custom Trach-325	10	10	$789.95	$789.95	$236.99	$671.46	$533.22	2026-05-04
72100	HCPCS	X-ray Of Lower And Sacral Spine, 2-3 Views	10	10	$770.00	$770.00	$231.00	$654.50	$519.75	2026-05-04
27052038_1	CDM	Therabond 3d 6" X 96"	10	10	$766.49	$766.49	$229.95	$651.51	$517.38	2026-05-04
25097369_1	CDM	Buprenorphine 7.5 Mcg/hr Patch	10	10	$765.35	$765.35	$229.60	$650.54	$516.61	2026-05-04
25093102_1	CDM	Gabapentin 250 Mg/5 Ml Soln	10	10	$761.44	$761.44	$228.43	$647.22	$513.97	2026-05-04
27052220_1	CDM	Sherlock Power Picc Kit	10	10	$748.87	$748.87	$224.66	$636.54	$505.49	2026-05-04
94007607_1	CDM	Radiology-diagnostic-general	10	10	$745.00	$745.00	$223.50	$633.25	$502.88	2026-05-04
94000034_1	CDM	Holter Monitor	10	10	$744.00	$744.00	$223.20	$632.40	$502.20	2026-05-04
72050	HCPCS	X-ray Of Upper Spine, 4-5 Views	10	10	$738.29	$738.29	$221.49	$627.54	$498.34	2026-05-04
73501	HCPCS	X-ray Of Hip, 1 View	20	10	$727.16	$727.16	$216.40	$623.05	$490.69	2026-05-04
27052234_1	CDM	Power-port Picc Sgle Lumen 8fr	10	10	$724.09	$724.09	$217.23	$615.48	$488.76	2026-05-04
25097561_1	CDM	Olanzapine (dps/zyprexa) 2.5mg/5ml Suspension	10	10	$723.36	$723.36	$217.01	$614.86	$488.26	2026-05-04
25092016_1	CDM	Linezolid 600 Mg/300 Ml-d5w	10	10	$717.85	$717.85	$215.36	$610.17	$484.55	2026-05-04
27054460_1	CDM	Prevlon Airtap Barriatric	10	10	$715.47	$715.47	$214.64	$608.15	$482.94	2026-05-04
J0835	HCPCS	Cortrosyn 0.25 Mg Vial	10	10	$710.37	$710.37	$213.11	$603.81	$479.50	2026-05-04
25096005_1	CDM	Azelastine 0.1% (137 Mcg) Spry	10	10	$708.81	$708.81	$212.64	$602.49	$478.45	2026-05-04
25093435_1	CDM	Recothrom 5,000 Unit Vial	10	10	$706.92	$706.92	$212.08	$600.88	$477.17	2026-05-04
25123803_1	CDM	Clindamycin Ph 1% Gel	10	10	$698.60	$698.60	$209.58	$593.81	$471.55	2026-05-04
94006005_1	CDM	Urology	10	10	$683.56	$683.56	$205.07	$581.02	$461.40	2026-05-04
25093798_1	CDM	Urea 40% Cream	10	10	$675.41	$675.41	$202.62	$574.10	$455.90	2026-05-04
25080920_1	CDM	Fosfomycin 3 Gm Sachet	10	10	$673.02	$673.02	$201.90	$572.06	$454.28	2026-05-04
P9040	HCPCS	Red Blood Cells, Leukocytes Reduced, Irradiated, Each Unit	10	10	$666.14	$666.14	$199.84	$566.22	$449.64	2026-05-04
94000005_1	CDM	Radiology Chest	10	10	$663.00	$663.00	$198.90	$563.55	$447.52	2026-05-04
73562	HCPCS	X-ray Of Knee, 3 Views	20	10	$660.66	$660.66	$196.60	$566.10	$445.81	2026-05-04
25096515_1	CDM	Imatinib Mesylate 100 Mg Tab	10	10	$659.36	$659.36	$197.81	$560.45	$445.06	2026-05-04
L0174	HCPCS	Cervical, Collar, Semi-rigid, Thermoplastic Foam, Two Piece With Thoracic Extens…	10	10	$656.22	$656.22	$196.87	$557.79	$442.95	2026-05-04
25094389_1	CDM	Triple Antibiotic Solution	10	10	$655.26	$655.26	$196.58	$556.97	$442.30	2026-05-04
25096321_1	CDM	Clinimix E 4.25%-5% Solution	10	10	$645.72	$645.72	$193.72	$548.86	$435.86	2026-05-04
73120	HCPCS	X-ray Of Hand, 2 Views	10	10	$645.00	$645.00	$193.50	$548.25	$435.38	2026-05-04
25269416_1	CDM	Ipratropium 0.06% Spray	10	10	$642.11	$642.11	$192.63	$545.79	$433.43	2026-05-04
L1930	HCPCS	Ankle Foot Orthosis, Plastic Or Other Material, Prefabricated, Includes Fitting …	10	10	$639.51	$639.51	$191.85	$543.58	$431.67	2026-05-04
25074485_1	CDM	Latanoprost 0.005% Eye Drops	10	10	$637.03	$637.03	$191.11	$541.48	$430.00	2026-05-04
94656	HCPCS	Respiratory Service	20	10	$636.86	$636.86	$187.20	$552.25	$429.56	2026-05-04
27058616_1	CDM	Videoscope Flexible Bronch	10	10	$632.78	$632.78	$189.83	$537.86	$427.12	2026-05-04
94007501_1	CDM	Drugsid/detail Code	10	10	$626.81	$626.81	$188.04	$532.79	$423.09	2026-05-04
25235052_1	CDM	Tobramycin-dexameth Ophth Susp	10	10	$625.13	$625.13	$187.54	$531.36	$421.96	2026-05-04
25096540_1	CDM	Micafungin 100 Mg Vial	10	10	$622.94	$622.94	$186.88	$529.50	$420.49	2026-05-04
94006032_1	CDM	Specialty Services - Treatment Room	10	10	$622.00	$622.00	$186.60	$528.70	$419.85	2026-05-04
25096195_1	CDM	Ceftriaxone 2 Gm Vial	10	10	$608.73	$608.73	$182.62	$517.42	$410.89	2026-05-04
92607	HCPCS	Evaluation With Prescription Of Speech-generating And Alternative Communication …	11	11	$628.50	$628.50	$125.00	$534.23	$408.53	2026-05-04
94006022_1	CDM	Prosthetics	10	10	$600.00	$600.00	$180.00	$510.00	$405.00	2026-05-04
73080	HCPCS	X-ray Of Elbow, Minimum Of 3 Views	20	10	$600.50	$600.50	$175.80	$522.75	$404.98	2026-05-04
73030	HCPCS	X-ray Of Shoulder, Minimum Of 2 Views	20	10	$598.74	$598.74	$179.22	$510.07	$404.12	2026-05-04
73560	HCPCS	X-ray Of Knee, 1-2 Views	20	10	$596.09	$596.09	$177.43	$510.64	$402.25	2026-05-04
94006030_1	CDM	Path/hystology	10	10	$592.00	$592.00	$177.60	$503.20	$399.60	2026-05-04
25095224_1	CDM	Asmanex Twisthaler 220 Mcg #14	10	10	$590.37	$590.37	$177.11	$501.81	$398.50	2026-05-04
71101	HCPCS	X-ray Of Ribs On Side Of Body, Minimum Of 3 Views	10	10	$584.50	$584.50	$175.35	$496.83	$394.54	2026-05-04
36430	HCPCS	Transfusion Of Blood Or Blood Products	20	10	$1,045.47	$1,045.47	$87.88	$1,528.30	$394.20	2026-05-04
94006004_1	CDM	Pic/picc Placement	11	11	$606.07	$606.07	$181.82	$515.16	$393.95	2026-05-04
92610	HCPCS	Evaluation Of Swallowing Function	21	11	$625.95	$625.95	$125.00	$532.06	$388.22	2026-05-04
92597	HCPCS	Evaluation For Use Of Voice Artificial Device To Supplement Oral Speech	21	11	$596.18	$596.18	$125.00	$506.75	$387.52	2026-05-04
25094921_1	CDM	Fluticasone Prop 50 Mcg Spray	10	10	$567.32	$567.32	$170.20	$482.22	$382.94	2026-05-04
29405	HCPCS	Application Of Short Leg Cast	11	11	$585.57	$585.57	$150.00	$497.73	$380.62	2026-05-04
73610	HCPCS	X-ray Of Ankle, Minimum Of 3 Views	10	10	$563.00	$563.00	$168.90	$478.55	$380.02	2026-05-04
90837	HCPCS	Psychotherapy, 1 Hour	20	10	$562.66	$562.66	$158.96	$506.13	$378.98	2026-05-04
94000001_1	CDM	Pharmacy	10	10	$557.28	$557.28	$167.18	$473.69	$376.17	2026-05-04
94000045_1	CDM	Non-sterile Supplies	10	10	$556.86	$556.86	$167.06	$473.33	$375.88	2026-05-04
25088857_1	CDM	Hydrocortisone 2.5% Cream	10	10	$555.51	$555.51	$166.65	$472.18	$374.97	2026-05-04
25175902_1	CDM	Phytonadione 5 Mg Tablet	10	10	$553.82	$553.82	$166.15	$470.75	$373.83	2026-05-04
73630	HCPCS	X-ray Of Foot, Minimum Of 3 Views	10	10	$550.00	$550.00	$165.00	$467.50	$371.25	2026-05-04
L3809	HCPCS	Wrist Hand Finger Orthosis, Without Joint(s), Prefabricated, Off-the-shelf, Any …	10	10	$548.82	$548.82	$164.65	$466.50	$370.45	2026-05-04
74019	HCPCS	X-ray Of Abdomen, 2 Views	10	10	$547.00	$547.00	$164.10	$464.95	$369.23	2026-05-04
25096939_1	CDM	Buprenorphine 5 Mcg/hr Patch	10	10	$544.36	$544.36	$163.31	$462.71	$367.44	2026-05-04
90839	HCPCS	Psychotherapy For Crisis, First Hour	20	10	$542.16	$542.16	$144.10	$513.40	$366.13	2026-05-04
73010	HCPCS	X-ray Of Shoulder Blade	20	10	$541.00	$541.00	$158.40	$470.90	$364.85	2026-05-04
25096403_1	CDM	Voriconazole 200 Mg Tablet	10	10	$540.43	$540.43	$162.13	$459.36	$364.79	2026-05-04
73130	HCPCS	X-ray Of Hand, Minimum Of 3 Views	10	10	$539.00	$539.00	$161.70	$458.15	$363.83	2026-05-04
L4396	HCPCS	Static Or Dynamic Ankle Foot Orthosis, Including Soft Interface Material, Adjust…	10	10	$537.00	$537.00	$161.10	$456.45	$362.48	2026-05-04
25226457_1	CDM	Sulfamylon 8.5% Cream	10	10	$535.00	$535.00	$160.50	$454.75	$361.12	2026-05-04
73110	HCPCS	X-ray Of Wrist, Minimum Of 3 Views	20	10	$530.34	$530.34	$157.80	$454.47	$357.87	2026-05-04
29065	HCPCS	Application Of Shoulder To Hand Cast	11	11	$550.00	$550.00	$125.00	$467.50	$357.50	2026-05-04
72070	HCPCS	X-ray Of Middle Spine, 2 Views	10	10	$526.40	$526.40	$157.92	$447.44	$355.32	2026-05-04
25295812_1	CDM	Cefdinir 125 Mg/5 Ml Susp	10	10	$526.16	$526.16	$157.85	$447.24	$355.15	2026-05-04
87497	HCPCS	Detection Test By Nucleic Acid For Cytomegalovirus, Quantification	10	10	$526.14	$526.14	$157.84	$447.22	$355.14	2026-05-04
72040	HCPCS	X-ray Of Upper Spine, 2-3 Views	10	10	$525.32	$525.32	$157.60	$446.52	$354.59	2026-05-04
G0193	HCPCS	Rev - Speech Therapy	11	11	$544.51	$544.51	$125.00	$462.83	$353.93	2026-05-04
73060	HCPCS	X-ray Of Upper Arm, Minimum Of 2 Views	20	10	$521.50	$521.50	$152.70	$453.90	$351.70	2026-05-04
70210	HCPCS	X-ray Of Paranasal Sinus, 1-2 Views	10	10	$516.00	$516.00	$154.80	$438.60	$348.30	2026-05-04
25119009_1	CDM	Clonidine 0.3 Mg/day Patch	10	10	$514.60	$514.60	$154.38	$437.41	$347.36	2026-05-04
73590	HCPCS	X-ray Of Lower Leg, 2 Views	20	10	$514.34	$514.34	$153.30	$440.02	$347.09	2026-05-04
73552	HCPCS	X-ray Of Thigh Bone, Minimum 2 Views	20	10	$510.41	$510.41	$152.50	$435.63	$344.48	2026-05-04

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