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

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Hospital

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 — reasonRows
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 viaDiscovered by HANK
Last fetch not_modified · 2026-10-26
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.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
25074485_1 CDM Latanoprost 0.005% Eye Drops 10 10 $637.03 $637.03 $191.11 $541.48 $430.00 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
25080920_1 CDM Fosfomycin 3 Gm Sachet 10 10 $673.02 $673.02 $201.90 $572.06 $454.28 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
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
25088857_1 CDM Hydrocortisone 2.5% Cream 10 10 $555.51 $555.51 $166.65 $472.18 $374.97 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
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
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
25092016_1 CDM Linezolid 600 Mg/300 Ml-d5w 10 10 $717.85 $717.85 $215.36 $610.17 $484.55 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
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
25093036_1 CDM Venofer 100 Mg/5 Ml Vial 10 10 $957.98 $957.98 $287.39 $814.28 $646.64 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
25093201_1 CDM Ertapenem 1 Gram Vial 10 10 $1,121.64 $1,121.64 $336.49 $953.40 $757.11 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
25093435_1 CDM Recothrom 5,000 Unit Vial 10 10 $706.92 $706.92 $212.08 $600.88 $477.17 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
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
25093798_1 CDM Urea 40% Cream 10 10 $675.41 $675.41 $202.62 $574.10 $455.90 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
25094276_1 CDM Ibandronate Sodium 150 Mg Tab 10 10 $904.50 $904.50 $271.35 $768.83 $610.54 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
25094389_1 CDM Triple Antibiotic Solution 10 10 $655.26 $655.26 $196.58 $556.97 $442.30 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
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
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
25094469_1 CDM Plenvu Powder Packets 10 10 $1,163.29 $1,163.29 $348.99 $988.80 $785.22 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
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
25094921_1 CDM Fluticasone Prop 50 Mcg Spray 10 10 $567.32 $567.32 $170.20 $482.22 $382.94 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
25095224_1 CDM Asmanex Twisthaler 220 Mcg #14 10 10 $590.37 $590.37 $177.11 $501.81 $398.50 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
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
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
25095885_1 CDM Dorzolamide-timolol Eye Drops 10 10 $818.93 $818.93 $245.68 $696.09 $552.77 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
25096005_1 CDM Azelastine 0.1% (137 Mcg) Spry 10 10 $708.81 $708.81 $212.64 $602.49 $478.45 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
25096195_1 CDM Ceftriaxone 2 Gm Vial 10 10 $608.73 $608.73 $182.62 $517.42 $410.89 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
25096321_1 CDM Clinimix E 4.25%-5% Solution 10 10 $645.72 $645.72 $193.72 $548.86 $435.86 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
25096403_1 CDM Voriconazole 200 Mg Tablet 10 10 $540.43 $540.43 $162.13 $459.36 $364.79 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
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
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
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
25096515_1 CDM Imatinib Mesylate 100 Mg Tab 10 10 $659.36 $659.36 $197.81 $560.45 $445.06 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
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
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
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
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
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
25096911_1 CDM Buprenorphine 10 Mcg/hr Patch 10 10 $793.33 $793.33 $238.00 $674.33 $535.50 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
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
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
25097018_1 CDM Meningococcal Vacc (menveo) 10 10 $1,155.91 $1,155.91 $346.77 $982.52 $780.24 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
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
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
25097293_1 CDM Cresemba 186 Mg Capsule 10 10 $829.96 $829.96 $248.99 $705.46 $560.22 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
25097369_1 CDM Buprenorphine 7.5 Mcg/hr Patch 10 10 $765.35 $765.35 $229.60 $650.54 $516.61 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
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
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
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
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
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
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
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
25119009_1 CDM Clonidine 0.3 Mg/day Patch 10 10 $514.60 $514.60 $154.38 $437.41 $347.36 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
25133000_1 CDM Fluconazole 40 Mg/ml Susp 10 10 $857.44 $857.44 $257.23 $728.83 $578.78 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
25175902_1 CDM Phytonadione 5 Mg Tablet 10 10 $553.82 $553.82 $166.15 $470.75 $373.83 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
25225905_1 CDM Sulfamethoxazole-tmp Susp 10 10 $1,403.20 $1,403.20 $420.96 $1,192.72 $947.16 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
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
25235052_1 CDM Tobramycin-dexameth Ophth Susp 10 10 $625.13 $625.13 $187.54 $531.36 $421.96 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
25295812_1 CDM Cefdinir 125 Mg/5 Ml Susp 10 10 $526.16 $526.16 $157.85 $447.24 $355.15 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
27052038_1 CDM Therabond 3d 6" X 96" 10 10 $766.49 $766.49 $229.95 $651.51 $517.38 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
27052234_1 CDM Power-port Picc Sgle Lumen 8fr 10 10 $724.09 $724.09 $217.23 $615.48 $488.76 2026-05-04
27054460_1 CDM Prevlon Airtap Barriatric 10 10 $715.47 $715.47 $214.64 $608.15 $482.94 2026-05-04
27058616_1 CDM Videoscope Flexible Bronch 10 10 $632.78 $632.78 $189.83 $537.86 $427.12 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
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
27144743_1 CDM Bivona Custom Trach-325 10 10 $789.95 $789.95 $236.99 $671.46 $533.22 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
27442450_1 CDM Knee Orthosis 10 10 $1,115.00 $1,115.00 $334.50 $947.75 $752.62 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
29405 HCPCS Application Of Short Leg Cast 11 11 $585.57 $585.57 $150.00 $497.73 $380.62 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
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
32086653_3 CDM Shunt Series 10 10 $895.00 $895.00 $268.50 $760.75 $604.12 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
72070 HCPCS X-ray Of Middle Spine, 2 Views 10 10 $526.40 $526.40 $157.92 $447.44 $355.32 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
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
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
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
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
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
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
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
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
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
73010 HCPCS X-ray Of Shoulder Blade 20 10 $541.00 $541.00 $158.40 $470.90 $364.85 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
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
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
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
73120 HCPCS X-ray Of Hand, 2 Views 10 10 $645.00 $645.00 $193.50 $548.25 $435.38 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
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
73501 HCPCS X-ray Of Hip, 1 View 20 10 $727.16 $727.16 $216.40 $623.05 $490.69 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
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
73560 HCPCS X-ray Of Knee, 1-2 Views 20 10 $596.09 $596.09 $177.43 $510.64 $402.25 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
73590 HCPCS X-ray Of Lower Leg, 2 Views 20 10 $514.34 $514.34 $153.30 $440.02 $347.09 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
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
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
74019 HCPCS X-ray Of Abdomen, 2 Views 10 10 $547.00 $547.00 $164.10 $464.95 $369.23 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
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
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
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
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
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
80605056_1 CDM Hemodlysis-offsite 10 10 $1,203.00 $1,203.00 $360.90 $1,022.55 $812.03 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
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
90837 HCPCS Psychotherapy, 1 Hour 20 10 $562.66 $562.66 $158.96 $506.13 $378.98 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
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
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
92610 HCPCS Evaluation Of Swallowing Function 21 11 $625.95 $625.95 $125.00 $532.06 $388.22 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
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
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
94000001_1 CDM Pharmacy 10 10 $557.28 $557.28 $167.18 $473.69 $376.17 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
94000004_1 CDM Radiology 10 10 $917.00 $917.00 $275.10 $779.45 $618.97 2026-05-04
94000005_1 CDM Radiology Chest 10 10 $663.00 $663.00 $198.90 $563.55 $447.52 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
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
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
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
94000012_1 CDM Anesthesia 10 10 $4,289.33 $4,289.33 $1,286.80 $3,645.93 $2,895.30 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
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
94000015_1 CDM Speech Pathology Eval 11 11 $1,094.00 $1,094.00 $125.00 $929.90 $711.10 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
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
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
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
94000021_1 CDM EKG/ECG 10 10 $926.33 $926.33 $277.90 $787.38 $625.27 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
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
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
94000032_1 CDM EEG 10 10 $3,102.00 $3,102.00 $930.60 $2,636.70 $2,093.85 2026-05-04
94000034_1 CDM Holter Monitor 10 10 $744.00 $744.00 $223.20 $632.40 $502.20 2026-05-04
94000045_1 CDM Non-sterile Supplies 10 10 $556.86 $556.86 $167.06 $473.33 $375.88 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
94002003_1 CDM Lab-ste 10 10 $1,772.62 $1,772.62 $531.78 $1,506.72 $1,196.51 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
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
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
94002011_1 CDM Anesthesia 10 10 $3,538.58 $3,538.58 $1,061.58 $3,007.80 $2,388.55 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
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
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
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
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
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
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
94002071_1 CDM Blood/admin 10 10 $2,984.00 $2,984.00 $895.20 $2,536.40 $2,014.20 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
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
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
94002076_1 CDM Pathology Lab 10 10 $2,436.75 $2,436.75 $731.03 $2,071.24 $1,644.81 2026-05-04
94006001_1 CDM Med/surg Supplies 10 10 $934.00 $934.00 $280.20 $793.90 $630.45 2026-05-04
94006002_1 CDM Lab 10 10 $1,063.93 $1,063.93 $319.18 $904.34 $718.15 2026-05-04
94006004_1 CDM Pic/picc Placement 11 11 $606.07 $606.07 $181.82 $515.16 $393.95 2026-05-04
94006005_1 CDM Urology 10 10 $683.56 $683.56 $205.07 $581.02 $461.40 2026-05-04
94006022_1 CDM Prosthetics 10 10 $600.00 $600.00 $180.00 $510.00 $405.00 2026-05-04
94006028_1 CDM Pharmacy 10 10 $1,001.25 $1,001.25 $300.38 $851.06 $675.85 2026-05-04
94006030_1 CDM Path/hystology 10 10 $592.00 $592.00 $177.60 $503.20 $399.60 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
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
94006054_1 CDM Anesthesia 10 10 $4,494.50 $4,494.50 $1,348.35 $3,820.33 $3,033.79 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
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
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
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
94006074_1 CDM Supply/implants 10 10 $3,137.42 $3,137.42 $941.23 $2,666.81 $2,117.76 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
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
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
94006107_1 CDM EEG 10 10 $5,625.00 $5,625.00 $1,687.50 $4,781.25 $3,796.88 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
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
94007501_1 CDM Drugsid/detail Code 10 10 $626.81 $626.81 $188.04 $532.79 $423.09 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
94007523_1 CDM Pathology Lab-bryan 10 10 $892.00 $892.00 $267.60 $758.20 $602.10 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
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
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
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
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
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
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
94007603_1 CDM Laboratory-chemistry 10 10 $1,185.00 $1,185.00 $355.50 $1,007.25 $799.88 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
94007607_1 CDM Radiology-diagnostic-general 10 10 $745.00 $745.00 $223.50 $633.25 $502.88 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
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
94007627_1 CDM Anesthesia 10 10 $2,707.00 $2,707.00 $812.10 $2,300.95 $1,827.22 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
94007629_1 CDM Pharmacy-general 10 10 $1,589.73 $1,589.73 $476.92 $1,351.27 $1,073.07 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
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
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
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
94007638_1 CDM Nucl Med-diag Radiopharmaceut 10 10 $1,080.00 $1,080.00 $324.00 $918.00 $729.00 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
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
94007652_1 CDM Anesthesia/incident Rad 10 10 $1,156.00 $1,156.00 $346.80 $982.60 $780.30 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
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
94656 HCPCS Respiratory Service 20 10 $636.86 $636.86 $187.20 $552.25 $429.56 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
G0193 HCPCS Rev - Speech Therapy 11 11 $544.51 $544.51 $125.00 $462.83 $353.93 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
J0835 HCPCS Cortrosyn 0.25 Mg Vial 10 10 $710.37 $710.37 $213.11 $603.81 $479.50 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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