Price Transparencybeta Hospital negotiated rates

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

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Hospital

Mid-jefferson Extended Care Hospital

Beaumont, TX · CCN 452083 · Rates published

10,568 distinct procedures filed
14 distinct payers
170,042 rate rows
2026-06-01 last MRF observed
Data quality

52,835 of 170,042 rate rows are consumer-grade (31.1%)

117,207 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
per-diem day rate — not a per-procedure price 116,237
placeholder amount (≤ $0.02) — excluded from medians 960
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 10
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.midjeffextendedcare.com/siteuploads/mid-jefferson-hospital/472560012_Mid-Jeff-Extended-Care-Hospital-standardcharges.csv
Found on page https://www.midjeffextendedcare.com/price-transparency-files
Discovered viaDiscovered by HANK
Last fetch success · 2026-11-03
Content fingerprint 398b53c3af4d67fb… · 35,014,757 bytes · first seen 2026-11-03

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
PH007217
CDM 		Avonex 5 $41,461.44 $41,461.44 $41,461.44 nat. median
$41,461
1.0× median
PH018359
CDM 		Immun Glob G(Igg)/Pro/Iga 0-50 5 $36,149.76 $36,149.76 $36,149.76 nat. median
$36,837
1.0× median
PH007153
CDM 		Taltz Autoinjector 5 $33,195.46 $33,195.46 $33,195.46 nat. median
$33,195
1.0× median
PH007070
CDM 		Immune Globul 40 Gm 5 $28,558.08 $28,558.08 $28,558.08 nat. median
$28,558
1.0× median
79095008
CDM 		Infergen 15, 15mcg Sol 5 $21,726.00 $21,726.00 $21,726.00 nat. median
$21,726
1.0× median
PH007166
CDM 		Ninlaro 5 $21,398.40 $21,398.40 $21,398.40 nat. median
$21,720
1.0× median
PH007078
CDM 		Paliperidone 234 Mg 5 $17,131.92 $17,131.92 $17,131.92 nat. median
$17,132
1.0× median
79000461
CDM 		Neulasta 1, 10mg Syr 5 $16,872.00 $16,872.00 $16,872.00 nat. median
$16,872
1.0× median
32000001
CDM 		Outside Services-radiology 5 $12,227.33 $12,227.33 $12,227.33 nat. median
$124
outlier · 98.6×
79095090
CDM 		Retavase 1, 10.8unit Kit 5 $12,064.50 $12,064.50 $12,064.50 nat. median
$12,064
1.0× median
27000057
CDM 		Matristem Plsx Mtrx Xs 10x15cm 5 $11,700.00 $11,700.00 $11,700.00 nat. median
$79
outlier · 148.8×
PH006768
CDM 		Formoterol Fumarate 5 $11,440.08 $11,440.08 $11,440.08 nat. median
$11,440
1.0× median
79094864
CDM 		Rebif 1, 22mcg/.5 Syg 5 $11,220.50 $11,220.50 $11,220.50 nat. median
$11,220
1.0× median
79094988
CDM 		Sandostat La 1, 20mg Syr 5 $11,207.25 $11,207.25 $11,207.25 nat. median
$11,207
1.0× median
79006060
CDM 		Activase 1, 50mg Vl 5 $11,063.25 $11,063.25 $11,063.25 nat. median
$5,639
2.0× median
27000056
CDM 		Matristem Plsx Mtrx Xs 8x16cm 5 $9,600.00 $9,600.00 $9,600.00 nat. median
$141
outlier · 68.2×
32099002
CDM 		CT Angio Abd Artery 5 $9,381.00 $9,381.00 $9,381.00 nat. median
$9,381
1.0× median
PH018671
CDM 		Teriparatide 5 $9,192.62 $9,192.62 $9,192.62 nat. median
$9,193
1.0× median
27094803
CDM 		R Aka Prosthesis 5 $8,921.06 $8,921.06 $8,921.06 nat. median
$8,921
1.0× median
PH018737
CDM 		Dalbavancin Hcl 5 $8,539.82 $8,539.82 $8,539.82 nat. median
$8,540
1.0× median
79095054
CDM 		Eloxatin 1, 100mg Vl 5 $8,520.50 $8,520.50 $8,520.50 nat. median
$8,520
1.0× median
79096070
CDM 		Campath 1, 30mg Inj 5 $8,472.00 $8,472.00 $8,472.00 nat. median
$8,472
1.0× median
27000042
CDM 		Matristem Pl Sx Matrix 10x15cm 5 $8,250.00 $8,250.00 $8,250.00 nat. median
$1,732
outlier · 4.8×
32099021
CDM 		MRI Thoracic Spine W/Contrast 5 $8,000.00 $8,000.00 $8,000.00 nat. median
$8,000
1.0× median
79095414
CDM 		Taxotere 2, 40mg Vl 5 $7,907.50 $7,907.50 $7,907.50 nat. median
$7,908
1.0× median
79094502
CDM 		Invega Suste 1, 234mg Syr 5 $7,548.50 $7,548.50 $7,548.50 nat. median
$7,548
1.0× median
79095368
CDM 		Aranesp 1, 300 Mcg Inj 5 $7,410.00 $7,410.00 $7,410.00 nat. median
$3,710
2.0× median
32099001
CDM 		CT Abd & Pelvis Without Contrast 5 $7,141.00 $7,141.00 $7,141.00 nat. median
$7,141
1.0× median
PH007071
CDM 		Immune Globul 10 Gm 5 $7,139.52 $7,139.52 $7,139.52 nat. median
$7,140
1.0× median
27000054
CDM 		Matristem Plsx Mtrx Xs 6x15cm 5 $6,900.00 $6,900.00 $6,900.00 nat. median
$199
outlier · 34.6×
79096446
CDM 		Byetta 10 Mcg Cart 1,10mcg Inj 5 $6,553.00 $6,553.00 $6,553.00 nat. median
$6,553
1.0× median
25005196
CDM 		Byetta 10 Mcg Cartridge 5 $6,553.00 $6,553.00 $6,553.00 nat. median
$6,553
1.0× median
79013984
CDM 		Argatroban 2, 100mg/ML Sdv 5 $6,304.75 $6,304.75 $6,304.75 nat. median
$6,305
1.0× median
27000015
CDM 		Graftjacket Skin Substitute4x8 5 $6,056.16 $6,056.16 $6,056.16 nat. median
$295
outlier · 20.5×
27000033
CDM 		Matristem Sx Matrix Rs 10x15cm 5 $6,000.00 $6,000.00 $6,000.00 nat. median
$113
outlier · 53.3×
PH007072
CDM 		Mycophenolate mofetiL 5 $5,798.00 $5,798.00 $5,798.00 nat. median
$5,798
1.0× median
79095350
CDM 		Aranesp 1, 200mcg Sdv 5 $5,558.50 $5,558.50 $5,558.50 nat. median
$5,558
1.0× median
79095398
CDM 		Aranesp 1, 150 Mcg Vl 5 $5,558.50 $5,558.50 $5,558.50 nat. median
$2,784
2.0× median
79096078
CDM 		Antizol 2, 1g Vl 5 $5,459.50 $5,459.50 $5,459.50 nat. median
$2,735
2.0× median
79095146
CDM 		Aranesp 1, 500mcg Syr 5 $5,326.25 $5,326.25 $5,326.25 nat. median
$2,668
2.0× median
79095010
CDM 		Apidra 100, 100 Unit Ctr 5 $5,320.00 $5,320.00 $5,320.00 nat. median
$5,320
1.0× median
32049300
CDM 		Venogram Renal, Bilateral 5 $5,287.00 $5,287.00 $5,287.00 nat. median
$5,287
1.0× median
79094954
CDM 		Hycamtin 1, 4mg Vl 5 $5,224.50 $5,224.50 $5,224.50 nat. median
$5,224
1.0× median
79095208
CDM 		Nplate Ds 0, 250 Mcg Inj 5 $5,202.00 $5,202.00 $5,202.00 nat. median
$5,202
1.0× median
35004001
CDM 		CT Abd & Pelvis With Contrast 5 $5,106.12 $5,106.12 $5,106.12 nat. median
$9,196
0.6× median
27000053
CDM 		Matristem Plsx Mtrx Xs 7x10cm 5 $5,100.00 $5,100.00 $5,100.00 nat. median
$367
outlier · 13.9×
79092002
CDM 		Ergoloid Mes 5, Pwd 5 $5,040.00 $5,040.00 $5,040.00 nat. median
$5,040
1.0× median
79094576
CDM 		Invega Suste 1, 78mg Syr 5 $5,032.25 $5,032.25 $5,032.25 nat. median
$5,032
1.0× median
79094504
CDM 		Invega Suste 1, 156mg Syr 5 $5,032.25 $5,032.25 $5,032.25 nat. median
$5,032
1.0× median
79094580
CDM 		Invega Suste 1, Syr 5 $5,032.00 $5,032.00 $5,032.00 nat. median
$5,032
1.0× median

Other procedures at this hospital

Browse this hospital's 10,568 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
             
ROOMOICU CDM Outside Cvicu Room & Board 5 5 $2,233.69 $2,233.69 $2,233.69 $2,233.69 $2,233.69 2026-06-01
PH018788 CDM Triamcinolone Acetonide 5 5 $3,684.24 $3,684.24 $3,684.24 $3,684.24 $3,684.24 2026-06-01
PH018737 CDM Dalbavancin Hcl 5 5 $8,539.82 $8,539.82 $8,539.82 $8,539.82 $8,539.82 2026-06-01
PH018671 CDM Teriparatide 5 5 $9,192.62 $9,192.62 $9,192.62 $9,192.62 $9,192.62 2026-06-01
PH018547 CDM Argatroban 5 5 $2,521.92 $2,521.92 $2,521.92 $2,521.92 $2,521.92 2026-06-01
PH018502 CDM Ponatinib Hcl 5 5 $3,622.40 $3,622.40 $3,622.40 $3,622.40 $3,622.40 2026-06-01
PH018444 CDM Semaglutide 5 5 $4,788.38 $4,788.38 $4,788.38 $4,788.38 $4,788.38 2026-06-01
PH018359 CDM Immun Glob G(Igg)/Pro/Iga 0-50 5 5 $36,149.76 $36,149.76 $36,149.76 $36,149.76 $36,149.76 2026-06-01
PH007236 CDM Xiidra 5 5 $4,758.08 $4,758.08 $4,758.08 $4,758.08 $4,758.08 2026-06-01
PH007224 CDM Palbociclib 5 5 $3,762.74 $3,762.74 $3,762.74 $3,762.74 $3,762.74 2026-06-01
PH007222 CDM Palbociclib 5 5 $3,762.74 $3,762.74 $3,762.74 $3,762.74 $3,762.74 2026-06-01
PH007217 CDM Avonex 5 5 $41,461.44 $41,461.44 $41,461.44 $41,461.44 $41,461.44 2026-06-01
PH007169 CDM Prevnar 13 5 5 $2,240.48 $2,240.48 $2,240.48 $2,240.48 $2,240.48 2026-06-01
PH007166 CDM Ninlaro 5 5 $21,398.40 $21,398.40 $21,398.40 $21,398.40 $21,398.40 2026-06-01
PH007153 CDM Taltz Autoinjector 5 5 $33,195.46 $33,195.46 $33,195.46 $33,195.46 $33,195.46 2026-06-01
PH007139 CDM Revlimid 5 5 $4,279.44 $4,279.44 $4,279.44 $4,279.44 $4,279.44 2026-06-01
PH007118 CDM Promacta 5 5 $2,266.12 $2,266.12 $2,266.12 $2,266.12 $2,266.12 2026-06-01
PH007107 CDM Mekinist 5 5 $2,169.55 $2,169.55 $2,169.55 $2,169.55 $2,169.55 2026-06-01
PH007102 CDM Lenalidomide 5 5 $4,279.44 $4,279.44 $4,279.44 $4,279.44 $4,279.44 2026-06-01
PH007078 CDM Paliperidone 234 Mg 5 5 $17,131.92 $17,131.92 $17,131.92 $17,131.92 $17,131.92 2026-06-01
PH007072 CDM Mycophenolate mofetiL 5 5 $5,798.00 $5,798.00 $5,798.00 $5,798.00 $5,798.00 2026-06-01
PH007071 CDM Immune Globul 10 Gm 5 5 $7,139.52 $7,139.52 $7,139.52 $7,139.52 $7,139.52 2026-06-01
PH007070 CDM Immune Globul 40 Gm 5 5 $28,558.08 $28,558.08 $28,558.08 $28,558.08 $28,558.08 2026-06-01
PH007024 CDM Semaglutide 5 5 $4,788.38 $4,788.38 $4,788.38 $4,788.38 $4,788.38 2026-06-01
PH006954 CDM Ibrutinib 5 5 $2,902.72 $2,902.72 $2,902.72 $2,902.72 $2,902.72 2026-06-01
PH006933 CDM Glatiramer Acetate 5 5 $2,097.19 $2,097.19 $2,097.19 $2,097.19 $2,097.19 2026-06-01
PH006932 CDM Dasatinib 5 5 $2,919.41 $2,919.41 $2,919.41 $2,919.41 $2,919.41 2026-06-01
PH006912 CDM Tolvaptan 5 5 $2,184.20 $2,184.20 $2,184.20 $2,184.20 $2,184.20 2026-06-01
PH006892 CDM Osimertinib Mesylate 5 5 $2,820.92 $2,820.92 $2,820.92 $2,820.92 $2,820.92 2026-06-01
PH006833 CDM Penicillin G Benzathine 5 5 $3,629.86 $3,629.86 $3,629.86 $3,629.86 $3,629.86 2026-06-01
PH006805 CDM Tolvaptan 5 5 $2,496.95 $2,496.95 $2,496.95 $2,496.95 $2,496.95 2026-06-01
PH006768 CDM Formoterol Fumarate 5 5 $11,440.08 $11,440.08 $11,440.08 $11,440.08 $11,440.08 2026-06-01
PH006315 CDM Procrit 20000 Unit 5 5 $2,565.60 $2,565.60 $2,565.60 $2,565.60 $2,565.60 2026-06-01
PH006290 CDM Neupogen 480 Mcg 5 5 $2,550.86 $2,550.86 $2,550.86 $2,550.86 $2,550.86 2026-06-01
PH006285 CDM Aranesp 100 Mcg 5 5 $3,715.20 $3,715.20 $3,715.20 $3,715.20 $3,715.20 2026-06-01
PH006284 CDM Aranesp 60 Mcg 5 5 $2,229.12 $2,229.12 $2,229.12 $2,229.12 $2,229.12 2026-06-01
PH006282 CDM Aranesp 100 Mcg 5 5 $3,715.20 $3,715.20 $3,715.20 $3,715.20 $3,715.20 2026-06-01
PH006281 CDM Aranesp 60 Mcg 5 5 $2,229.12 $2,229.12 $2,229.12 $2,229.12 $2,229.12 2026-06-01
PH005960 CDM Zoledronic Acid 4 Mg 5 5 $3,353.16 $3,353.16 $3,353.16 $3,353.16 $3,353.16 2026-06-01
PH005594 CDM Spiriva Respimat 2.5 Mcg 5 5 $2,531.47 $2,531.47 $2,531.47 $2,531.47 $2,531.47 2026-06-01
PH005591 CDM Combivent Respimat 20-100 Mcg 5 5 $2,419.30 $2,419.30 $2,419.30 $2,419.30 $2,419.30 2026-06-01
PH005258 CDM Advair Hfa 230-21mcg 5 5 $2,110.66 $2,110.66 $2,110.66 $2,110.66 $2,110.66 2026-06-01
PH005060 CDM Premarin 30GMmg Cream/ .625 Mg 5 5 $2,212.08 $2,212.08 $2,212.08 $2,212.08 $2,212.08 2026-06-01
PH005042 CDM Lumigan 5ml Drops 0.01 % 5 5 $2,532.96 $2,532.96 $2,532.96 $2,532.96 $2,532.96 2026-06-01
ICUI CDM ICU/Intermediate Care Room 5 5 $2,135.00 $2,135.00 $2,135.00 $2,135.00 $2,135.00 2026-06-01
92000016 CDM Duplex Extracranial Carotid Bi 5 5 $2,240.40 $2,240.40 $2,240.40 $2,240.40 $2,240.40 2026-06-01
80200002 CDM Inp Peritoneal Dialyss Repeatd 5 5 $3,663.00 $3,663.00 $3,663.00 $3,663.00 $3,663.00 2026-06-01
80100002 CDM Hemodialysis 5 5 $3,586.80 $3,586.80 $3,586.80 $3,586.80 $3,586.80 2026-06-01
79096872 CDM Forteo Pen 2, 20mcg/Ds Pen 5 5 $4,955.75 $4,955.75 $4,955.75 $4,955.75 $4,955.75 2026-06-01
79096476 CDM Allopurinol 1, 500mg Vl 5 5 $2,332.50 $2,332.50 $2,332.50 $2,332.50 $2,332.50 2026-06-01
79096446 CDM Byetta 10 Mcg Cart 1,10mcg Inj 5 5 $6,553.00 $6,553.00 $6,553.00 $6,553.00 $6,553.00 2026-06-01
79096300 CDM Vivitrol 1, 380 Mg Kit 5 5 $3,840.00 $3,840.00 $3,840.00 $3,840.00 $3,840.00 2026-06-01
79096298 CDM Remodulin 20, 10mg/ML Inj 5 5 $2,948.00 $2,948.00 $2,948.00 $2,948.00 $2,948.00 2026-06-01
79096078 CDM Antizol 2, 1g Vl 5 5 $5,459.50 $5,459.50 $5,459.50 $5,459.50 $5,459.50 2026-06-01
79096070 CDM Campath 1, 30mg Inj 5 5 $8,472.00 $8,472.00 $8,472.00 $8,472.00 $8,472.00 2026-06-01
79096050 CDM Cellcept 175, 200mg/ML Btl 5 5 $2,905.25 $2,905.25 $2,905.25 $2,905.25 $2,905.25 2026-06-01
79095756 CDM Corvert 10, 0.1mg/ML Vl 5 5 $2,171.00 $2,171.00 $2,171.00 $2,171.00 $2,171.00 2026-06-01
79095430 CDM Digibind 1, 38mg Vl 5 5 $2,911.75 $2,911.75 $2,911.75 $2,911.75 $2,911.75 2026-06-01
79095414 CDM Taxotere 2, 40mg Vl 5 5 $7,907.50 $7,907.50 $7,907.50 $7,907.50 $7,907.50 2026-06-01
79095398 CDM Aranesp 1, 150 Mcg Vl 5 5 $5,558.50 $5,558.50 $5,558.50 $5,558.50 $5,558.50 2026-06-01
79095394 CDM Diuril Sod 1, 500mg Vl 5 5 $2,078.50 $2,078.50 $2,078.50 $2,078.50 $2,078.50 2026-06-01
79095368 CDM Aranesp 1, 300 Mcg Inj 5 5 $7,410.00 $7,410.00 $7,410.00 $7,410.00 $7,410.00 2026-06-01
79095352 CDM Aranesp 1, 100mcg Sdv 5 5 $2,371.25 $2,371.25 $2,371.25 $2,371.25 $2,371.25 2026-06-01
79095350 CDM Aranesp 1, 200mcg Sdv 5 5 $5,558.50 $5,558.50 $5,558.50 $5,558.50 $5,558.50 2026-06-01
79095336 CDM Gammagard 1, 5gm Sol 5 5 $2,573.75 $2,573.75 $2,573.75 $2,573.75 $2,573.75 2026-06-01
79095320 CDM Avonex 0, 30mcg/.5 Kit 5 5 $3,674.50 $3,674.50 $3,674.50 $3,674.50 $3,674.50 2026-06-01
79095286 CDM Humira 1, 40mg/0.8 Inj 5 5 $4,302.50 $4,302.50 $4,302.50 $4,302.50 $4,302.50 2026-06-01
79095258 CDM Rebif 1, 44mcg/.5 Ctr 5 5 $2,472.75 $2,472.75 $2,472.75 $2,472.75 $2,472.75 2026-06-01
79095234 CDM Faslodex D 5, 50mg/ML Syr 5 5 $3,969.50 $3,969.50 $3,969.50 $3,969.50 $3,969.50 2026-06-01
79095216 CDM Pegasys 1, 180mcg/M Vl 5 5 $2,764.75 $2,764.75 $2,764.75 $2,764.75 $2,764.75 2026-06-01
79095214 CDM Peg-intron 1, 120mcg/. Kit 5 5 $2,767.75 $2,767.75 $2,767.75 $2,767.75 $2,767.75 2026-06-01
79095208 CDM Nplate Ds 0, 250 Mcg Inj 5 5 $5,202.00 $5,202.00 $5,202.00 $5,202.00 $5,202.00 2026-06-01
79095200 CDM Remicade 1, 100mg Inj 5 5 $3,312.50 $3,312.50 $3,312.50 $3,312.50 $3,312.50 2026-06-01
79095196 CDM Relistor 1, 25mg Vl 5 5 $2,717.75 $2,717.75 $2,717.75 $2,717.75 $2,717.75 2026-06-01
79095146 CDM Aranesp 1, 500mcg Syr 5 5 $5,326.25 $5,326.25 $5,326.25 $5,326.25 $5,326.25 2026-06-01
79095144 CDM Aranesp 1, 0.5mg Syr 5 5 $4,168.75 $4,168.75 $4,168.75 $4,168.75 $4,168.75 2026-06-01
79095142 CDM Aranesp 1, 100mcg Syr 5 5 $2,779.25 $2,779.25 $2,779.25 $2,779.25 $2,779.25 2026-06-01
79095090 CDM Retavase 1, 10.8unit Kit 5 5 $12,064.50 $12,064.50 $12,064.50 $12,064.50 $12,064.50 2026-06-01
79095088 CDM Winrho Sdf 1, 5000 U Vl 5 5 $4,153.00 $4,153.00 $4,153.00 $4,153.00 $4,153.00 2026-06-01
79095086 CDM Rituxan 10, 10mg/ML Vl 5 5 $2,875.50 $2,875.50 $2,875.50 $2,875.50 $2,875.50 2026-06-01
79095068 CDM Natrecor 1, 1.5mg Vl 5 5 $3,472.00 $3,472.00 $3,472.00 $3,472.00 $3,472.00 2026-06-01
79095054 CDM Eloxatin 1, 100mg Vl 5 5 $8,520.50 $8,520.50 $8,520.50 $8,520.50 $8,520.50 2026-06-01
79095010 CDM Apidra 100, 100 Unit Ctr 5 5 $5,320.00 $5,320.00 $5,320.00 $5,320.00 $5,320.00 2026-06-01
79095008 CDM Infergen 15, 15mcg Sol 5 5 $21,726.00 $21,726.00 $21,726.00 $21,726.00 $21,726.00 2026-06-01
79095004 CDM Cyclosporine 100, 100mg/ML Sol 5 5 $2,396.25 $2,396.25 $2,396.25 $2,396.25 $2,396.25 2026-06-01
79094988 CDM Sandostat La 1, 20mg Syr 5 5 $11,207.25 $11,207.25 $11,207.25 $11,207.25 $11,207.25 2026-06-01
79094954 CDM Hycamtin 1, 4mg Vl 5 5 $5,224.50 $5,224.50 $5,224.50 $5,224.50 $5,224.50 2026-06-01
79094864 CDM Rebif 1, 22mcg/.5 Syg 5 5 $11,220.50 $11,220.50 $11,220.50 $11,220.50 $11,220.50 2026-06-01
79094580 CDM Invega Suste 1, Syr 5 5 $5,032.00 $5,032.00 $5,032.00 $5,032.00 $5,032.00 2026-06-01
79094576 CDM Invega Suste 1, 78mg Syr 5 5 $5,032.25 $5,032.25 $5,032.25 $5,032.25 $5,032.25 2026-06-01
79094506 CDM Invega Suste 1, Syr 5 5 $5,032.00 $5,032.00 $5,032.00 $5,032.00 $5,032.00 2026-06-01
79094504 CDM Invega Suste 1, 156mg Syr 5 5 $5,032.25 $5,032.25 $5,032.25 $5,032.25 $5,032.25 2026-06-01
79094502 CDM Invega Suste 1, 234mg Syr 5 5 $7,548.50 $7,548.50 $7,548.50 $7,548.50 $7,548.50 2026-06-01
79094434 CDM Isovue-300 100, 0.61 Btl 5 5 $2,579.00 $2,579.00 $2,579.00 $2,579.00 $2,579.00 2026-06-01
79094376 CDM Vaprisol 100, 0.02mg Bag 5 5 $2,521.25 $2,521.25 $2,521.25 $2,521.25 $2,521.25 2026-06-01
79094348 CDM Dilaudid Pca 250, 1mg Bag 5 5 $3,750.00 $3,750.00 $3,750.00 $3,750.00 $3,750.00 2026-06-01
79094190 CDM Zyprexa 1, 300mg Vl 5 5 $3,816.00 $3,816.00 $3,816.00 $3,816.00 $3,816.00 2026-06-01
79094062 CDM Indocin IV 1, 1mg Sdv 5 5 $2,570.50 $2,570.50 $2,570.50 $2,570.50 $2,570.50 2026-06-01
79092698 CDM Edecrin IV 1, 50mg Vl 5 5 $2,759.25 $2,759.25 $2,759.25 $2,759.25 $2,759.25 2026-06-01
79092076 CDM Cipro 500, 500mg/5m Sus 5 5 $2,625.50 $2,625.50 $2,625.50 $2,625.50 $2,625.50 2026-06-01
79092002 CDM Ergoloid Mes 5, Pwd 5 5 $5,040.00 $5,040.00 $5,040.00 $5,040.00 $5,040.00 2026-06-01
79066554 CDM Gammar-p IV 1, 10gm Vl 5 5 $4,800.00 $4,800.00 $4,800.00 $4,800.00 $4,800.00 2026-06-01
79017483 CDM Risperdal Co 2, 50mg Ctr 5 5 $2,516.25 $2,516.25 $2,516.25 $2,516.25 $2,516.25 2026-06-01
79016217 CDM Zometa 5, 4mg/5ml Vl 5 5 $4,299.00 $4,299.00 $4,299.00 $4,299.00 $4,299.00 2026-06-01
79015832 CDM Botox Thptc 1, 100u Vl 5 5 $2,520.00 $2,520.00 $2,520.00 $2,520.00 $2,520.00 2026-06-01
79013984 CDM Argatroban 2, 100mg/ML Sdv 5 5 $6,304.75 $6,304.75 $6,304.75 $6,304.75 $6,304.75 2026-06-01
79013147 CDM Lupron Depot 1, 7.5mg Kit 5 5 $3,280.75 $3,280.75 $3,280.75 $3,280.75 $3,280.75 2026-06-01
79012432 CDM Forteo 3, 250mcg Syg 5 5 $3,543.00 $3,543.00 $3,543.00 $3,543.00 $3,543.00 2026-06-01
79008365 CDM Procrit 1, 40mu/ML Vl 5 5 $3,110.50 $3,110.50 $3,110.50 $3,110.50 $3,110.50 2026-06-01
79006060 CDM Activase 1, 50mg Vl 5 5 $11,063.25 $11,063.25 $11,063.25 $11,063.25 $11,063.25 2026-06-01
79002358 CDM Darbepoetin Alfa 5 5 $2,223.00 $2,223.00 $2,223.00 $2,223.00 $2,223.00 2026-06-01
79000461 CDM Neulasta 1, 10mg Syr 5 5 $16,872.00 $16,872.00 $16,872.00 $16,872.00 $16,872.00 2026-06-01
74013500 CDM Sleep Study 5 5 $2,250.00 $2,250.00 $2,250.00 $2,250.00 $2,250.00 2026-06-01
61854013 CDM MRA Neck Without Contrast 5 5 $2,512.40 $2,512.40 $2,512.40 $2,512.40 $2,512.40 2026-06-01
61854011 CDM MRA Neck W/Contrast 5 5 $2,930.80 $2,930.80 $2,930.80 $2,930.80 $2,930.80 2026-06-01
61854010 CDM MRA Neck W/Wo Contrast 5 5 $3,985.60 $3,985.60 $3,985.60 $3,985.60 $3,985.60 2026-06-01
61854007 CDM MRA Head Without Contrast 5 5 $2,512.40 $2,512.40 $2,512.40 $2,512.40 $2,512.40 2026-06-01
61854003 CDM MRA Abd W/Wo Contrast 5 5 $3,750.00 $3,750.00 $3,750.00 $3,750.00 $3,750.00 2026-06-01
61654009 CDM MRA Lower Ext W/Wo Contrast 5 5 $4,379.20 $4,379.20 $4,379.20 $4,379.20 $4,379.20 2026-06-01
61099000 CDM Lower Ext Joint, Left W/Cont 5 5 $2,997.60 $2,997.60 $2,997.60 $2,997.60 $2,997.60 2026-06-01
61098000 CDM Lower Ext Joint, Right Without Con 5 5 $2,763.60 $2,763.60 $2,763.60 $2,763.60 $2,763.60 2026-06-01
61097000 CDM MRI Lwr Ext Jnt Bilat Without Cont 5 5 $2,763.60 $2,763.60 $2,763.60 $2,763.60 $2,763.60 2026-06-01
61096000 CDM Lower Extremity Joint, Right 5 5 $2,763.60 $2,763.60 $2,763.60 $2,763.60 $2,763.60 2026-06-01
61095000 CDM Lower Extremity, Bilateral 5 5 $2,763.60 $2,763.60 $2,763.60 $2,763.60 $2,763.60 2026-06-01
61082000 CDM Upper Ext Joint Ltd Without Cont 5 5 $2,763.60 $2,763.60 $2,763.60 $2,763.60 $2,763.60 2026-06-01
61081000 CDM Upper Ext Joint, Rt W/Contast 5 5 $2,894.40 $2,894.40 $2,894.40 $2,894.40 $2,894.40 2026-06-01
61080000 CDM Upper Ext Joint, Lt W/Contrast 5 5 $2,894.40 $2,894.40 $2,894.40 $2,894.40 $2,894.40 2026-06-01
61079000 CDM Upper Ext Joint, Lt W/Wo Cont 5 5 $2,100.00 $2,100.00 $2,100.00 $2,100.00 $2,100.00 2026-06-01
61078000 CDM Upper Ext Joint 5 5 $2,763.60 $2,763.60 $2,763.60 $2,763.60 $2,763.60 2026-06-01
61077000 CDM Upper Ext Left Without Contrast 5 5 $2,664.40 $2,664.40 $2,664.40 $2,664.40 $2,664.40 2026-06-01
61076000 CDM Thoracic Spine Without Contrast 5 5 $3,138.80 $3,138.80 $3,138.80 $3,138.80 $3,138.80 2026-06-01
61075000 CDM Thoracic Spine W/Contrast 5 5 $3,342.80 $3,342.80 $3,342.80 $3,342.80 $3,342.80 2026-06-01
61074000 CDM MRI Thoracic Spine W/Wo Contra 5 5 $4,380.40 $4,380.40 $4,380.40 $4,380.40 $4,380.40 2026-06-01
61066000 CDM MRI Pelvis Without Contrast 5 5 $2,098.80 $2,098.80 $2,098.80 $2,098.80 $2,098.80 2026-06-01
61065000 CDM Pelvis W/Contrast 5 5 $3,165.20 $3,165.20 $3,165.20 $3,165.20 $3,165.20 2026-06-01
61064000 CDM MRI Pelvis W/Wo Contrast 5 5 $3,986.40 $3,986.40 $3,986.40 $3,986.40 $3,986.40 2026-06-01
61058000 CDM Neck Without Contrast 5 5 $2,914.00 $2,914.00 $2,914.00 $2,914.00 $2,914.00 2026-06-01
61054000 CDM MRI Lumbar Spine Without Contrast 5 5 $2,475.60 $2,475.60 $2,475.60 $2,475.60 $2,475.60 2026-06-01
61053000 CDM Lumbar Spine W/Contrast 5 5 $2,930.40 $2,930.40 $2,930.40 $2,930.40 $2,930.40 2026-06-01
61052000 CDM MRI Lumbar Spine W/Wo Contrast 5 5 $4,380.40 $4,380.40 $4,380.40 $4,380.40 $4,380.40 2026-06-01
61050000 CDM Liver 5 5 $3,116.40 $3,116.40 $3,116.40 $3,116.40 $3,116.40 2026-06-01
61048000 CDM Lower Ext Joint Rt Without Contr 5 5 $2,763.60 $2,763.60 $2,763.60 $2,763.60 $2,763.60 2026-06-01
61047000 CDM Lower Ext Joint W/Contrast 5 5 $2,997.60 $2,997.60 $2,997.60 $2,997.60 $2,997.60 2026-06-01
61046000 CDM Lower Ext Joint Rt W/Wo Cont 5 5 $4,379.20 $4,379.20 $4,379.20 $4,379.20 $4,379.20 2026-06-01
61045000 CDM Lower Ext Joint Lt Without Contr 5 5 $2,763.60 $2,763.60 $2,763.60 $2,763.60 $2,763.60 2026-06-01
61044000 CDM Lower Extr Rt Without Contrast 5 5 $2,763.60 $2,763.60 $2,763.60 $2,763.60 $2,763.60 2026-06-01
61042000 CDM Kidney, W/Contrast 5 5 $3,116.40 $3,116.40 $3,116.40 $3,116.40 $3,116.40 2026-06-01
61040000 CDM Hip, Left 5 5 $2,763.60 $2,763.60 $2,763.60 $2,763.60 $2,763.60 2026-06-01
61038000 CDM MRI Head Without Contrast 5 5 $2,697.60 $2,697.60 $2,697.60 $2,697.60 $2,697.60 2026-06-01
61037000 CDM MRI Head W/Contrast 5 5 $4,380.40 $4,380.40 $4,380.40 $4,380.40 $4,380.40 2026-06-01
61036000 CDM MRI Head Wo/W Contrast 5 5 $4,380.40 $4,380.40 $4,380.40 $4,380.40 $4,380.40 2026-06-01
61029000 CDM Cervical Spine Without Contrast 5 5 $2,853.60 $2,853.60 $2,853.60 $2,853.60 $2,853.60 2026-06-01
61028000 CDM Cervical Spine W/Contrast 5 5 $3,372.80 $3,372.80 $3,372.80 $3,372.80 $3,372.80 2026-06-01
61027000 CDM MRI Cervical Spine W/Wo Dye 5 5 $4,310.00 $4,310.00 $4,310.00 $4,310.00 $4,310.00 2026-06-01
61025000 CDM MRI Chest Without Contrast 5 5 $2,782.00 $2,782.00 $2,782.00 $2,782.00 $2,782.00 2026-06-01
61024000 CDM Chest W/Contrast 5 5 $3,037.60 $3,037.60 $3,037.60 $3,037.60 $3,037.60 2026-06-01
61023000 CDM Chest Wo/W Contrast 5 5 $4,310.00 $4,310.00 $4,310.00 $4,310.00 $4,310.00 2026-06-01
61021000 CDM MRI Cardiac Function Ltd 5 5 $2,240.00 $2,240.00 $2,240.00 $2,240.00 $2,240.00 2026-06-01
61020000 CDM MRI Cardiac Function Complete 5 5 $2,240.00 $2,240.00 $2,240.00 $2,240.00 $2,240.00 2026-06-01
61018000 CDM MRI Bone Marrow Blood Supply 5 5 $2,740.80 $2,740.80 $2,740.80 $2,740.80 $2,740.80 2026-06-01
61016000 CDM Carotid Artery 5 5 $2,797.00 $2,797.00 $2,797.00 $2,797.00 $2,797.00 2026-06-01
61014000 CDM MRI Abdomen Without Contrast 5 5 $3,116.40 $3,116.40 $3,116.40 $3,116.40 $3,116.40 2026-06-01
61013000 CDM MRI Abdomen W/Contrast 5 5 $3,295.60 $3,295.60 $3,295.60 $3,295.60 $3,295.60 2026-06-01
61012000 CDM MRI Brain Without Contrast 5 5 $2,697.60 $2,697.60 $2,697.60 $2,697.60 $2,697.60 2026-06-01
61011000 CDM MRI Brain W/Contrast 5 5 $4,380.40 $4,380.40 $4,380.40 $4,380.40 $4,380.40 2026-06-01
61010000 CDM MRI Brain Wo/W Contrast 5 5 $4,380.40 $4,380.40 $4,380.40 $4,380.40 $4,380.40 2026-06-01
61009000 CDM Kidney, W/Wo Contrast 5 5 $4,379.20 $4,379.20 $4,379.20 $4,379.20 $4,379.20 2026-06-01
61008000 CDM Kidney, Without Contrast 5 5 $3,116.40 $3,116.40 $3,116.40 $3,116.40 $3,116.40 2026-06-01
61004000 CDM Upper Ext Joint, Rt W/Wo Cont 5 5 $2,100.00 $2,100.00 $2,100.00 $2,100.00 $2,100.00 2026-06-01
61003000 CDM Upper Ext Right Without Cont 5 5 $2,664.40 $2,664.40 $2,664.40 $2,664.40 $2,664.40 2026-06-01
61002000 CDM MRI Abdomen Wo/W Contrast 5 5 $4,379.20 $4,379.20 $4,379.20 $4,379.20 $4,379.20 2026-06-01
61000000 CDM MRI Lwr Ext Joint, W/Wo 5 5 $2,997.60 $2,997.60 $2,997.60 $2,997.60 $2,997.60 2026-06-01
48300016 CDM Echo Tee Complete W Pro Fee 5 5 $3,217.60 $3,217.60 $3,217.60 $3,217.60 $3,217.60 2026-06-01
48093308 CDM Echo 2d Limited 5 5 $2,367.00 $2,367.00 $2,367.00 $2,367.00 $2,367.00 2026-06-01
48093306 CDM Echo 2 D 5 5 $2,367.00 $2,367.00 $2,367.00 $2,367.00 $2,367.00 2026-06-01
48092960 CDM Cardioversion Electric Electiv 5 5 $2,500.00 $2,500.00 $2,500.00 $2,500.00 $2,500.00 2026-06-01
48014000 CDM Dobutamine Stress Echo 5 5 $3,880.80 $3,880.80 $3,880.80 $3,880.80 $3,880.80 2026-06-01
48013500 CDM Stress Echo 5 5 $3,880.80 $3,880.80 $3,880.80 $3,880.80 $3,880.80 2026-06-01
41000100 CDM Ventilator Mgmt Each Addl Day 5 5 $3,313.00 $3,313.00 $3,313.00 $3,313.00 $3,313.00 2026-06-01
40218000 CDM Doppler, Carotid 5 5 $2,240.40 $2,240.40 $2,240.40 $2,240.40 $2,240.40 2026-06-01
40213000 CDM Carotid Duplex Scan, Complete 5 5 $2,240.40 $2,240.40 $2,240.40 $2,240.40 $2,240.40 2026-06-01
36036569 CDM Picc Line Insertion 5 5 $2,551.00 $2,551.00 $2,551.00 $2,551.00 $2,551.00 2026-06-01
36005001 CDM Insert Tunneled Cv Cath 5 5 $2,303.00 $2,303.00 $2,303.00 $2,303.00 $2,303.00 2026-06-01
36001422 CDM Tracheostomy, Planned 5 5 $3,357.00 $3,357.00 $3,357.00 $3,357.00 $3,357.00 2026-06-01
36001010 CDM Hysteroscopy W/Biopsy 5 5 $3,611.00 $3,611.00 $3,611.00 $3,611.00 $3,611.00 2026-06-01
36000079 CDM I&d Complex Postop Wnd Infect 5 5 $2,177.00 $2,177.00 $2,177.00 $2,177.00 $2,177.00 2026-06-01
35079000 CDM Upper Extremity Without Contrast 5 5 $2,095.20 $2,095.20 $2,095.20 $2,095.20 $2,095.20 2026-06-01
35077000 CDM Upper Extremity W/Wo Contrast 5 5 $3,623.00 $3,623.00 $3,623.00 $3,623.00 $3,623.00 2026-06-01
35075000 CDM CT Thoracic Spine Without Contrast 5 5 $2,758.00 $2,758.00 $2,758.00 $2,758.00 $2,758.00 2026-06-01
35074000 CDM Thoracic Spine W/Contrast 5 5 $3,980.00 $3,980.00 $3,980.00 $3,980.00 $3,980.00 2026-06-01
35073706 CDM CTA Lower Ext W/wo Dye 5 5 $3,600.00 $3,600.00 $3,600.00 $3,600.00 $3,600.00 2026-06-01
35072000 CDM Thoracic Spine W/Wo Contrast 5 5 $4,676.00 $4,676.00 $4,676.00 $4,676.00 $4,676.00 2026-06-01
35069000 CDM Sinuses W/Contrast 5 5 $2,211.60 $2,211.60 $2,211.60 $2,211.60 $2,211.60 2026-06-01
35068000 CDM Sinuses W/Wo Contrast 5 5 $2,993.60 $2,993.60 $2,993.60 $2,993.60 $2,993.60 2026-06-01
35066000 CDM CT Sella Turcica Without Contrast 5 5 $2,136.80 $2,136.80 $2,136.80 $2,136.80 $2,136.80 2026-06-01
35065000 CDM CT Sella Turcica W/Contrast 5 5 $2,586.00 $2,586.00 $2,586.00 $2,586.00 $2,586.00 2026-06-01
35064000 CDM CT Sella Turcica W/Wo Contrast 5 5 $3,334.40 $3,334.40 $3,334.40 $3,334.40 $3,334.40 2026-06-01
35061000 CDM CT Pelvis Without Contrast 5 5 $3,233.00 $3,233.00 $3,233.00 $3,233.00 $3,233.00 2026-06-01
35060000 CDM CT Pelvis W/Contrast 5 5 $3,687.00 $3,687.00 $3,687.00 $3,687.00 $3,687.00 2026-06-01
35058000 CDM CT Pelvis W/Wo Contrast 5 5 $4,233.00 $4,233.00 $4,233.00 $4,233.00 $4,233.00 2026-06-01
35056000 CDM Orbits Without Contrast 5 5 $2,356.00 $2,356.00 $2,356.00 $2,356.00 $2,356.00 2026-06-01
35055000 CDM Orbits W/Contrast 5 5 $2,765.00 $2,765.00 $2,765.00 $2,765.00 $2,765.00 2026-06-01
35053000 CDM Orbits W/Wo Contrast 5 5 $3,742.00 $3,742.00 $3,742.00 $3,742.00 $3,742.00 2026-06-01
35050000 CDM Soft Tissue Neck W/Contrast 5 5 $3,080.00 $3,080.00 $3,080.00 $3,080.00 $3,080.00 2026-06-01
35049000 CDM Soft Tissue Neck W/Wo Contrast 5 5 $3,298.00 $3,298.00 $3,298.00 $3,298.00 $3,298.00 2026-06-01
35047000 CDM Maxillofacial Without Contrast 5 5 $2,473.00 $2,473.00 $2,473.00 $2,473.00 $2,473.00 2026-06-01
35046000 CDM Maxillofacial W/Contrast 5 5 $2,765.00 $2,765.00 $2,765.00 $2,765.00 $2,765.00 2026-06-01
35044000 CDM Maxillofacial W/Wo Contrast 5 5 $3,742.00 $3,742.00 $3,742.00 $3,742.00 $3,742.00 2026-06-01
35042000 CDM CT Lumbar Spine Without Contrast 5 5 $3,284.00 $3,284.00 $3,284.00 $3,284.00 $3,284.00 2026-06-01
35041000 CDM Lumbar Spine W/Contrast 5 5 $3,609.00 $3,609.00 $3,609.00 $3,609.00 $3,609.00 2026-06-01
35039000 CDM Lumbar Spine W/Wo Contrast 5 5 $4,515.00 $4,515.00 $4,515.00 $4,515.00 $4,515.00 2026-06-01
35037000 CDM Lower Extremity Without Contrast 5 5 $2,619.00 $2,619.00 $2,619.00 $2,619.00 $2,619.00 2026-06-01
35036000 CDM Lower Extremity W/Contrast 5 5 $3,004.00 $3,004.00 $3,004.00 $3,004.00 $3,004.00 2026-06-01
35035000 CDM Lower Extremity W/Wo Contrast 5 5 $3,350.00 $3,350.00 $3,350.00 $3,350.00 $3,350.00 2026-06-01
35032000 CDM CT Iac W/Contrast 5 5 $2,586.00 $2,586.00 $2,586.00 $2,586.00 $2,586.00 2026-06-01
35031000 CDM CT Iac W/Wo Contrast 5 5 $3,334.40 $3,334.40 $3,334.40 $3,334.40 $3,334.40 2026-06-01
35029000 CDM CT Head Without Contrast 5 5 $2,389.00 $2,389.00 $2,389.00 $2,389.00 $2,389.00 2026-06-01
35028000 CDM CT Head W/Contrast 5 5 $3,298.00 $3,298.00 $3,298.00 $3,298.00 $3,298.00 2026-06-01
35024000 CDM CT Head W/Wo Contrast 5 5 $3,724.00 $3,724.00 $3,724.00 $3,724.00 $3,724.00 2026-06-01
35021000 CDM CT Cervical Spine Without Contras 5 5 $3,125.60 $3,125.60 $3,125.60 $3,125.60 $3,125.60 2026-06-01
35020000 CDM CT Cervical Spine W/Contrast 5 5 $4,385.00 $4,385.00 $4,385.00 $4,385.00 $4,385.00 2026-06-01
35016000 CDM CT Chest Without Contrast 5 5 $3,227.00 $3,227.00 $3,227.00 $3,227.00 $3,227.00 2026-06-01
35015000 CDM CT Chest W/Contrast 5 5 $3,623.00 $3,623.00 $3,623.00 $3,623.00 $3,623.00 2026-06-01
35013000 CDM CT Chest W/Wo Contrast 5 5 $3,016.40 $3,016.40 $3,016.40 $3,016.40 $3,016.40 2026-06-01
35005000 CDM CT Abdomen Without Contrast 5 5 $3,928.00 $3,928.00 $3,928.00 $3,928.00 $3,928.00 2026-06-01
35004001 CDM CT Abd & Pelvis With Contrast 5 5 $5,106.12 $5,106.12 $5,106.12 $5,106.12 $5,106.12 2026-06-01
35004000 CDM CT Abdomen W/Contrast 5 5 $4,308.00 $4,308.00 $4,308.00 $4,308.00 $4,308.00 2026-06-01
35002000 CDM CT Abdomen W/Wo Contrast 5 5 $4,658.00 $4,658.00 $4,658.00 $4,658.00 $4,658.00 2026-06-01
35000013 CDM CT Maxillofacial Limited 5 5 $2,473.00 $2,473.00 $2,473.00 $2,473.00 $2,473.00 2026-06-01
35000010 CDM CT Guided Ndl Place W Biopsy 5 5 $2,267.20 $2,267.20 $2,267.20 $2,267.20 $2,267.20 2026-06-01
35000008 CDM CT Scan Needle Guided Biopsy 5 5 $3,679.00 $3,679.00 $3,679.00 $3,679.00 $3,679.00 2026-06-01
35000007 CDM CT Abscess Drainage Specimen 5 5 $2,242.00 $2,242.00 $2,242.00 $2,242.00 $2,242.00 2026-06-01
35000001 CDM CT Chest Limited 5 5 $2,616.00 $2,616.00 $2,616.00 $2,616.00 $2,616.00 2026-06-01
34100070 CDM Nm Tumor Localize Spect 5 5 $2,498.00 $2,498.00 $2,498.00 $2,498.00 $2,498.00 2026-06-01
34100049 CDM Nm Myocardial Perfusmultiple S 5 5 $2,940.00 $2,940.00 $2,940.00 $2,940.00 $2,940.00 2026-06-01
34064000 CDM Renal Function 5 5 $2,219.20 $2,219.20 $2,219.20 $2,219.20 $2,219.20 2026-06-01
34010000 CDM Brain Spect 5 5 $2,498.00 $2,498.00 $2,498.00 $2,498.00 $2,498.00 2026-06-01
34005000 CDM Bone Scan, Multiple 5 5 $2,084.00 $2,084.00 $2,084.00 $2,084.00 $2,084.00 2026-06-01
32099052 CDM Hida Scan 5 5 $2,253.00 $2,253.00 $2,253.00 $2,253.00 $2,253.00 2026-06-01
32099023 CDM Echo 2d W/Doppler Tte 5 5 $2,300.00 $2,300.00 $2,300.00 $2,300.00 $2,300.00 2026-06-01
32099021 CDM MRI Thoracic Spine W/Contrast 5 5 $8,000.00 $8,000.00 $8,000.00 $8,000.00 $8,000.00 2026-06-01
32099020 CDM MRI Shoulder, Elbow, Wrist 5 5 $2,898.00 $2,898.00 $2,898.00 $2,898.00 $2,898.00 2026-06-01
32099019 CDM MRI Neck C-spine 5 5 $3,506.00 $3,506.00 $3,506.00 $3,506.00 $3,506.00 2026-06-01
32099018 CDM MRI Lower Extremity 5 5 $2,898.00 $2,898.00 $2,898.00 $2,898.00 $2,898.00 2026-06-01
32099017 CDM MRI Leg/Foot 5 5 $4,473.00 $4,473.00 $4,473.00 $4,473.00 $4,473.00 2026-06-01
32099014 CDM CTA Lower Extremity 5 5 $2,368.00 $2,368.00 $2,368.00 $2,368.00 $2,368.00 2026-06-01
32099013 CDM CTA Chest 5 5 $2,545.00 $2,545.00 $2,545.00 $2,545.00 $2,545.00 2026-06-01
32099012 CDM CT Scan Of Neck Tissue 5 5 $3,112.00 $3,112.00 $3,112.00 $3,112.00 $3,112.00 2026-06-01
32099011 CDM CT Scan Of Neck Spine 5 5 $3,357.00 $3,357.00 $3,357.00 $3,357.00 $3,357.00 2026-06-01
32099010 CDM CT Scan Of Neck 5 5 $3,617.00 $3,617.00 $3,617.00 $3,617.00 $3,617.00 2026-06-01
32099009 CDM CT Leg 5 5 $3,247.00 $3,247.00 $3,247.00 $3,247.00 $3,247.00 2026-06-01
32099008 CDM CT Face/Jaw 5 5 $2,930.00 $2,930.00 $2,930.00 $2,930.00 $2,930.00 2026-06-01
32099007 CDM CT Abd Aorta 5 5 $4,242.00 $4,242.00 $4,242.00 $4,242.00 $4,242.00 2026-06-01
32099006 CDM CT Head/Brain Without Contrast 5 5 $3,038.00 $3,038.00 $3,038.00 $3,038.00 $3,038.00 2026-06-01
32099005 CDM CT Head/Brain W/Wo Contrast 5 5 $4,591.00 $4,591.00 $4,591.00 $4,591.00 $4,591.00 2026-06-01
32099004 CDM CT Angio Head W/Contrast 5 5 $2,137.00 $2,137.00 $2,137.00 $2,137.00 $2,137.00 2026-06-01
32099003 CDM CT Angio Of Aorta 5 5 $2,519.00 $2,519.00 $2,519.00 $2,519.00 $2,519.00 2026-06-01
32099002 CDM CT Angio Abd Artery 5 5 $9,381.00 $9,381.00 $9,381.00 $9,381.00 $9,381.00 2026-06-01
32099001 CDM CT Abd & Pelvis Without Contrast 5 5 $7,141.00 $7,141.00 $7,141.00 $7,141.00 $7,141.00 2026-06-01
32083100 CDM Myelogram, Cervical Spine 5 5 $2,562.00 $2,562.00 $2,562.00 $2,562.00 $2,562.00 2026-06-01
32073300 CDM Arteriogram Upper Ext, Bilat 5 5 $2,443.60 $2,443.60 $2,443.60 $2,443.60 $2,443.60 2026-06-01
32069000 CDM Arteriogram Renal, Bilat 5 5 $4,427.60 $4,427.60 $4,427.60 $4,427.60 $4,427.60 2026-06-01
32067100 CDM Arteriogram Pulmonary, Bilat 5 5 $2,938.00 $2,938.00 $2,938.00 $2,938.00 $2,938.00 2026-06-01
32063200 CDM Arteriogram Lower Ext, Bilat 5 5 $3,055.00 $3,055.00 $3,055.00 $3,055.00 $3,055.00 2026-06-01
32049300 CDM Venogram Renal, Bilateral 5 5 $5,287.00 $5,287.00 $5,287.00 $5,287.00 $5,287.00 2026-06-01
32044200 CDM Aortagram Thoracic 5 5 $2,086.00 $2,086.00 $2,086.00 $2,086.00 $2,086.00 2026-06-01
32043200 CDM Aortagram Abdomen 5 5 $2,437.60 $2,437.60 $2,437.60 $2,437.60 $2,437.60 2026-06-01
32042100 CDM Aortagram Abd W Bilat Femu 5 5 $4,658.80 $4,658.80 $4,658.80 $4,658.80 $4,658.80 2026-06-01
32039000 CDM Ureteral Stent Procedure 5 5 $2,297.00 $2,297.00 $2,297.00 $2,297.00 $2,297.00 2026-06-01
32036200 CDM Angiogram Renal Unilateral 5 5 $4,220.80 $4,220.80 $4,220.80 $4,220.80 $4,220.80 2026-06-01
32035000 CDM Angiogram Renal, Bilat 5 5 $3,026.00 $3,026.00 $3,026.00 $3,026.00 $3,026.00 2026-06-01
32033000 CDM Angiogram Pulmonary, Bilat 5 5 $3,673.00 $3,673.00 $3,673.00 $3,673.00 $3,673.00 2026-06-01
32031100 CDM Angiogram Extremity, Bilat 5 5 $2,443.60 $2,443.60 $2,443.60 $2,443.60 $2,443.60 2026-06-01
32023200 CDM Angiogram Carotid/Cervi Bilat 5 5 $4,620.00 $4,620.00 $4,620.00 $4,620.00 $4,620.00 2026-06-01
32021200 CDM Angiogram Adrenal Bilateral 5 5 $2,430.00 $2,430.00 $2,430.00 $2,430.00 $2,430.00 2026-06-01
32000001 CDM Outside Services-radiology 5 5 $12,227.33 $12,227.33 $12,227.33 $12,227.33 $12,227.33 2026-06-01
30076381 CDM Nm Acute Gi Blood Loss 5 5 $2,364.00 $2,364.00 $2,364.00 $2,364.00 $2,364.00 2026-06-01
27200011 CDM Apligraf 5 5 $5,001.26 $5,001.26 $5,001.26 $5,001.26 $5,001.26 2026-06-01
27094803 CDM R Aka Prosthesis 5 5 $8,921.06 $8,921.06 $8,921.06 $8,921.06 $8,921.06 2026-06-01
27000057 CDM Matristem Plsx Mtrx Xs 10x15cm 5 5 $11,700.00 $11,700.00 $11,700.00 $11,700.00 $11,700.00 2026-06-01
27000056 CDM Matristem Plsx Mtrx Xs 8x16cm 5 5 $9,600.00 $9,600.00 $9,600.00 $9,600.00 $9,600.00 2026-06-01
27000054 CDM Matristem Plsx Mtrx Xs 6x15cm 5 5 $6,900.00 $6,900.00 $6,900.00 $6,900.00 $6,900.00 2026-06-01
27000053 CDM Matristem Plsx Mtrx Xs 7x10cm 5 5 $5,100.00 $5,100.00 $5,100.00 $5,100.00 $5,100.00 2026-06-01
27000051 CDM Matristem Plsx Mtrx Xs 4x12cm 5 5 $3,600.00 $3,600.00 $3,600.00 $3,600.00 $3,600.00 2026-06-01
27000042 CDM Matristem Pl Sx Matrix 10x15cm 5 5 $8,250.00 $8,250.00 $8,250.00 $8,250.00 $8,250.00 2026-06-01
27000039 CDM Matristem Pl Sx Matrix 6x15cm 5 5 $4,500.00 $4,500.00 $4,500.00 $4,500.00 $4,500.00 2026-06-01
27000038 CDM Matristem Pl Sx Matrix 7x10cm 5 5 $3,750.00 $3,750.00 $3,750.00 $3,750.00 $3,750.00 2026-06-01
27000036 CDM Matristem Pl Sx Matrix 4x12cm 5 5 $2,625.00 $2,625.00 $2,625.00 $2,625.00 $2,625.00 2026-06-01
27000033 CDM Matristem Sx Matrix Rs 10x15cm 5 5 $6,000.00 $6,000.00 $6,000.00 $6,000.00 $6,000.00 2026-06-01
27000032 CDM Matristem Sx Matrix Rs 8x16cm 5 5 $4,500.00 $4,500.00 $4,500.00 $4,500.00 $4,500.00 2026-06-01
27000030 CDM Matristem Sx Matrix Rs 6x15cm 5 5 $2,850.00 $2,850.00 $2,850.00 $2,850.00 $2,850.00 2026-06-01
27000029 CDM Matristem Sx Matrix Rs 7x10cm 5 5 $2,625.00 $2,625.00 $2,625.00 $2,625.00 $2,625.00 2026-06-01
27000017 CDM Graftjacket Skin Sub Liquid 5 5 $3,872.00 $3,872.00 $3,872.00 $3,872.00 $3,872.00 2026-06-01
27000015 CDM Graftjacket Skin Substitute4x8 5 5 $6,056.16 $6,056.16 $6,056.16 $6,056.16 $6,056.16 2026-06-01
27000014 CDM Graftjacket Skin Substitute4x4 5 5 $3,028.96 $3,028.96 $3,028.96 $3,028.96 $3,028.96 2026-06-01
27000007 CDM Amniofill 5 5 $3,450.00 $3,450.00 $3,450.00 $3,450.00 $3,450.00 2026-06-01
27000006 CDM Theraskin Real Skin Wound Grft 5 5 $2,625.00 $2,625.00 $2,625.00 $2,625.00 $2,625.00 2026-06-01
25005196 CDM Byetta 10 Mcg Cartridge 5 5 $6,553.00 $6,553.00 $6,553.00 $6,553.00 $6,553.00 2026-06-01
22000000 CDM Covid 19 Charge 5 5 $2,190.00 $2,190.00 $2,190.00 $2,190.00 $2,190.00 2026-06-01
20000001 CDM ICU 5 5 $2,135.00 $2,135.00 $2,135.00 $2,135.00 $2,135.00 2026-06-01
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