|
C9765
|
HCPCS
|
Revascularization, Endovascular, Open Or Percutaneous, Lower Extremity Artery(ie…
|
8
|
8
|
$50,000.00
|
$42,500.00
|
$18,000.00
|
$47,500.00
|
$42,500.00
|
2026-02-04
|
|
J2327
|
HCPCS
|
Injection, Risankizumab-rzaa, Intravenous, 1 Mg
|
8
|
8
|
$31,771.25
|
$27,005.56
|
$11,437.65
|
$30,182.69
|
$27,005.56
|
2026-02-04
|
|
J3380
|
HCPCS
|
Injection, Vedolizumab, Intravenous, 1 Mg
|
8
|
8
|
$26,490.50
|
$22,516.93
|
$9,536.58
|
$25,165.98
|
$22,516.93
|
2026-02-04
|
|
J3101
|
HCPCS
|
Injection, Tenecteplase, 1 Mg
|
8
|
8
|
$22,198.20
|
$18,868.47
|
$7,991.35
|
$21,088.29
|
$18,868.47
|
2026-02-04
|
|
J1569
|
HCPCS
|
Injection, Immune Globulin, (gammagard Liquid), Non-lyophilized, (e.g., Liquid),…
|
8
|
8
|
$15,693.00
|
$13,339.05
|
$5,649.48
|
$14,908.35
|
$13,339.05
|
2026-02-04
|
|
Q5115
|
HCPCS
|
Injection, Rituximab-abbs, Biosimilar, (truxima), 10 Mg
|
8
|
8
|
$13,698.00
|
$11,643.30
|
$4,931.28
|
$13,013.10
|
$11,643.30
|
2026-02-04
|
|
Q5111
|
HCPCS
|
Injection, Pegfilgrastim-cbqv (udenyca), Biosimilar, 0.5 Mg
|
8
|
8
|
$13,527.00
|
$11,497.95
|
$4,869.72
|
$12,850.65
|
$11,497.95
|
2026-02-04
|
|
Q5122
|
HCPCS
|
Injection, Pegfilgrastim-apgf (nyvepria), Biosimilar, 0.5 Mg
|
8
|
8
|
$12,717.00
|
$10,809.45
|
$4,578.12
|
$12,081.15
|
$10,809.45
|
2026-02-04
|
|
C1734
|
HCPCS
|
Orthopedic/device/drug Matrix For Opposing Bone-to-bone Or Soft Tissue-to Bone (…
|
24
|
8
|
$9,787.80
|
$8,319.63
|
$3,320.64
|
$10,538.20
|
$8,762.80
|
2026-02-04
|
|
27696611_1
|
CDM
|
Viabahn 8mm X 15cm Endoprosthesis W Heparin
|
8
|
8
|
$9,940.00
|
$8,449.00
|
$3,578.40
|
$9,443.00
|
$8,449.00
|
2026-02-04
|
|
C1762
|
HCPCS
|
Connective Tissue, Human (includes Fascia Lata)
|
72
|
8
|
$9,424.00
|
$8,010.40
|
$2,298.24
|
$19,744.80
|
$7,819.69
|
2026-02-04
|
|
C1764
|
HCPCS
|
Event Recorder, Cardiac (implantable)
|
16
|
8
|
$8,995.00
|
$7,645.75
|
$2,880.00
|
$9,490.50
|
$7,600.00
|
2026-02-04
|
|
27725336_1
|
CDM
|
Viabahn Stent 7fr X10 X120
|
8
|
8
|
$8,920.00
|
$7,582.00
|
$3,211.20
|
$8,474.00
|
$7,582.00
|
2026-02-04
|
|
37799
|
HCPCS
|
Other Procedure On Blood Vessel
|
10
|
8
|
$8,960.00
|
$7,616.00
|
$174.64
|
$8,512.00
|
$7,580.16
|
2026-02-04
|
|
J0565
|
HCPCS
|
Injection, Bezlotoxumab, 10 Mg
|
8
|
8
|
$8,741.52
|
$7,430.29
|
$3,146.95
|
$8,304.44
|
$7,430.29
|
2026-02-04
|
|
27983135_1
|
CDM
|
Nail Long Distal 11mm 380mm X 125' Rt
|
8
|
8
|
$8,616.90
|
$7,324.37
|
$3,102.08
|
$8,186.06
|
$7,324.37
|
2026-02-04
|
|
27992288_1
|
CDM
|
Tfna Nail 11mm X 420mm 130' Left
|
8
|
8
|
$8,598.52
|
$7,308.74
|
$3,095.47
|
$8,168.59
|
$7,308.74
|
2026-02-04
|
|
27992287_1
|
CDM
|
Tfna Nail 11mm X 400mm 130' Left
|
8
|
8
|
$8,598.52
|
$7,308.74
|
$3,095.47
|
$8,168.59
|
$7,308.74
|
2026-02-04
|
|
27994880_1
|
CDM
|
Tfna Nail 12mm X 380mm 130' Left
|
8
|
8
|
$8,598.52
|
$7,308.74
|
$3,095.47
|
$8,168.59
|
$7,308.74
|
2026-02-04
|
|
27696670_1
|
CDM
|
Operating Room Services - General Classification
|
8
|
8
|
$8,584.00
|
$7,296.40
|
$3,090.24
|
$8,154.80
|
$7,296.40
|
2026-02-04
|
|
28062047_1
|
CDM
|
Viabahn 018 6mm X10
|
8
|
8
|
$8,466.00
|
$7,196.10
|
$3,047.76
|
$8,042.70
|
$7,196.10
|
2026-02-04
|
|
28705269_1
|
CDM
|
Trochanteric Grip, 4-hole Plate, 190 Mm
|
8
|
8
|
$8,174.00
|
$6,947.90
|
$2,942.64
|
$7,765.30
|
$6,947.90
|
2026-02-04
|
|
28705275_1
|
CDM
|
Cable Plate, 10-hole Curved, 290 Mm
|
8
|
8
|
$8,114.00
|
$6,896.90
|
$2,921.04
|
$7,708.30
|
$6,896.90
|
2026-02-04
|
|
27994872_1
|
CDM
|
Tfna Nail 12mm X 340mm 130' Left
|
8
|
8
|
$8,036.00
|
$6,830.60
|
$2,892.96
|
$7,634.20
|
$6,830.60
|
2026-02-04
|
|
28062046_1
|
CDM
|
Viabahn 018 6mm X 5
|
8
|
8
|
$7,996.00
|
$6,796.60
|
$2,878.56
|
$7,596.20
|
$6,796.60
|
2026-02-04
|
|
27696671_1
|
CDM
|
Viabahn Vbx 8mm X 59mm 135cm Balloon Expandable W Heparin
|
8
|
8
|
$7,948.00
|
$6,755.80
|
$2,861.28
|
$7,550.60
|
$6,755.80
|
2026-02-04
|
|
C1874
|
HCPCS
|
Stent, Coated/covered, With Delivery System
|
80
|
8
|
$7,879.00
|
$6,697.15
|
$86.40
|
$9,443.00
|
$6,627.65
|
2026-02-04
|
|
25683930_1
|
CDM
|
Labor Room/delivery - General Classification
|
8
|
8
|
$7,630.00
|
$6,485.50
|
$2,746.80
|
$7,248.50
|
$6,485.50
|
2026-02-04
|
|
26792516_1
|
CDM
|
Graft Aflex301
|
8
|
8
|
$7,610.78
|
$6,469.16
|
$2,739.88
|
$7,230.24
|
$6,469.16
|
2026-02-04
|
|
27992285_1
|
CDM
|
Tfna Nail 11mm X 360mm 130' Left
|
8
|
8
|
$7,594.02
|
$6,454.92
|
$2,733.85
|
$7,214.32
|
$6,454.92
|
2026-02-04
|
|
27701325_1
|
CDM
|
Graft Bovine Collagen 5mm X 46cm
|
8
|
8
|
$7,478.00
|
$6,356.30
|
$2,692.08
|
$7,104.10
|
$6,356.30
|
2026-02-04
|
|
28470019_1
|
CDM
|
Diamondback 360 Microcrown 4fr, 1.25mm X 145cm
|
8
|
8
|
$7,390.00
|
$6,281.50
|
$2,660.40
|
$7,020.50
|
$6,281.50
|
2026-02-04
|
|
27696669_1
|
CDM
|
Viabahn Balloon Expandable With Heparin 8mm X 29mm X 135cm
|
8
|
8
|
$7,008.00
|
$5,956.80
|
$2,522.88
|
$6,657.60
|
$5,956.80
|
2026-02-04
|
|
28893008_1
|
CDM
|
Valvulotome Eze-sit 91cm W/cutting Heads & Tributary Sleeves
|
8
|
8
|
$6,798.00
|
$5,778.30
|
$2,447.28
|
$6,458.10
|
$5,778.30
|
2026-02-04
|
|
C1783
|
HCPCS
|
Ocular Implant, Aqueous Drainage Assist Device
|
8
|
8
|
$6,750.00
|
$5,737.50
|
$2,430.00
|
$6,412.50
|
$5,737.50
|
2026-02-04
|
|
27753571_1
|
CDM
|
Valvulotome 1.5 Hydro 98cm
|
8
|
8
|
$6,598.00
|
$5,608.30
|
$2,375.28
|
$6,268.10
|
$5,608.30
|
2026-02-04
|
|
20955
|
HCPCS
|
Bone Graft At Lower Leg With Microvascular Connection
|
7
|
6
|
$6,495.00
|
$5,520.75
|
$345.00
|
$6,170.25
|
$5,520.75
|
2026-02-04
|
|
Q4187
|
HCPCS
|
Epicord, Per Square Centimeter
|
8
|
8
|
$6,420.00
|
$5,457.00
|
$2,311.20
|
$6,099.00
|
$5,457.00
|
2026-02-04
|
|
28705288_1
|
CDM
|
Cable Plate, 10-hole Straight, 290 Mm
|
8
|
8
|
$6,418.00
|
$5,455.30
|
$2,310.48
|
$6,097.10
|
$5,455.30
|
2026-02-04
|
|
74177
|
HCPCS
|
CT Scan Of Abdomen And Pelvis With Contrast
|
8
|
8
|
$6,410.00
|
$5,448.50
|
$2,307.60
|
$6,089.50
|
$5,448.50
|
2026-02-04
|
|
74178
|
HCPCS
|
CT Scan Of Abdomen And Pelvis Before And After Contrast
|
16
|
8
|
$6,315.00
|
$5,367.75
|
$2,228.40
|
$6,118.00
|
$5,448.24
|
2026-02-04
|
|
74174
|
HCPCS
|
CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast
|
16
|
8
|
$6,315.00
|
$5,367.75
|
$2,228.40
|
$6,118.00
|
$5,448.24
|
2026-02-04
|
|
73720
|
HCPCS
|
MRI Scan Of Leg Before And After Contrast
|
16
|
8
|
$7,112.50
|
$6,045.62
|
$2,048.40
|
$8,108.25
|
$5,405.50
|
2026-02-04
|
|
75635
|
HCPCS
|
CT Scan Of Abdominal Aorta And Both Leg Arteries With Contrast
|
8
|
8
|
$6,220.00
|
$5,287.00
|
$2,239.20
|
$5,909.00
|
$5,287.00
|
2026-02-04
|
|
3015855_1
|
CDM
|
Nursery - Newborn - Level Iii
|
7
|
7
|
$5,640.00
|
$4,794.00
|
$4,512.00
|
$5,358.00
|
$5,273.40
|
2026-02-04
|
|
33440
|
HCPCS
|
Replacement Of Aortic And Pulmonary Valves And Enlargement Of Outflow Tract From…
|
13
|
8
|
$6,988.00
|
$5,939.80
|
$345.00
|
$7,101.25
|
$5,167.99
|
2026-02-04
|
|
27719602_1
|
CDM
|
Quick Clear Aspiration Cath & Pump
|
8
|
8
|
$6,000.00
|
$5,100.00
|
$2,160.00
|
$5,700.00
|
$5,100.00
|
2026-02-04
|
|
33019
|
HCPCS
|
Drainage Of Heart Sac Using Tube And CT Imaging Guidance
|
23
|
8
|
$6,000.00
|
$5,100.00
|
$178.31
|
$7,410.00
|
$5,100.00
|
2026-02-04
|
|
26035347_1
|
CDM
|
Graft Injectable Miig 15cc
|
8
|
8
|
$5,960.00
|
$5,066.00
|
$2,145.60
|
$5,662.00
|
$5,066.00
|
2026-02-04
|
|
45346
|
HCPCS
|
Destruction Of Polyp Or Growth Of Lower Large Bowel Using A Flexible Endoscope
|
8
|
8
|
$5,943.00
|
$5,051.55
|
$2,139.48
|
$5,645.85
|
$5,051.55
|
2026-02-04
|
|
72156
|
HCPCS
|
MRI Scan Of Upper Spinal Canal Before And After Contrast
|
8
|
8
|
$5,920.00
|
$5,032.00
|
$2,131.20
|
$5,624.00
|
$5,032.00
|
2026-02-04
|
|
72158
|
HCPCS
|
MRI Scan Of Lower Spinal Canal Before And After Contrast
|
8
|
8
|
$5,920.00
|
$5,032.00
|
$2,131.20
|
$5,624.00
|
$5,032.00
|
2026-02-04
|
|
72157
|
HCPCS
|
MRI Scan Of Middle Spinal Canal Before And After Contrast
|
8
|
8
|
$5,920.00
|
$5,032.00
|
$2,131.20
|
$5,624.00
|
$5,032.00
|
2026-02-04
|
|
70543
|
HCPCS
|
MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast
|
16
|
8
|
$5,721.00
|
$4,862.85
|
$1,987.92
|
$5,624.00
|
$5,008.32
|
2026-02-04
|
|
72197
|
HCPCS
|
MRI Scan Of Pelvis Before And After Contrast
|
16
|
8
|
$5,805.00
|
$4,934.25
|
$2,048.40
|
$5,624.00
|
$5,008.32
|
2026-02-04
|
|
Q4186
|
HCPCS
|
Epifix, Per Square Centimeter
|
40
|
8
|
$5,979.00
|
$5,082.15
|
$1,072.08
|
$13,315.91
|
$4,958.36
|
2026-02-04
|
|
9259111_1
|
CDM
|
Intensive Care Unit - General Classification
|
7
|
7
|
$5,285.00
|
$4,492.25
|
$4,228.00
|
$5,020.75
|
$4,941.48
|
2026-02-04
|
|
25774824_1
|
CDM
|
Wristjack
|
8
|
8
|
$5,800.00
|
$4,930.00
|
$2,088.00
|
$5,510.00
|
$4,930.00
|
2026-02-04
|
|
28078553_1
|
CDM
|
Hanarostent Col Uncovered 25dm X 9cm
|
8
|
8
|
$5,775.00
|
$4,908.75
|
$2,079.00
|
$5,486.25
|
$4,908.75
|
2026-02-04
|
|
70553
|
HCPCS
|
MRI Scan Of Brain Before And After Contrast
|
8
|
8
|
$5,740.00
|
$4,879.00
|
$2,066.40
|
$5,453.00
|
$4,879.00
|
2026-02-04
|
|
73223
|
HCPCS
|
MRI Scan Of Arm Joint Before And After Contrast
|
16
|
8
|
$6,412.50
|
$5,450.62
|
$1,846.80
|
$7,310.25
|
$4,873.50
|
2026-02-04
|
|
25683929_1
|
CDM
|
Labor Room/delivery - General Classification
|
8
|
8
|
$5,600.00
|
$4,760.00
|
$2,016.00
|
$5,320.00
|
$4,760.00
|
2026-02-04
|
|
28575
|
HCPCS
|
Closed Treatment Of Dislocated Ankle Joint Under Anesthesia
|
8
|
8
|
$5,590.00
|
$4,751.50
|
$2,012.40
|
$5,310.50
|
$4,751.50
|
2026-02-04
|
|
J0897
|
HCPCS
|
Injection, Denosumab, 1 Mg
|
23
|
8
|
$5,631.75
|
$4,786.99
|
$345.00
|
$5,497.89
|
$4,741.93
|
2026-02-04
|
|
73220
|
HCPCS
|
MRI Scan Of Arm Before And After Contrast
|
16
|
8
|
$6,225.00
|
$5,291.25
|
$1,792.80
|
$7,096.50
|
$4,731.00
|
2026-02-04
|
|
27384765_1
|
CDM
|
Myosure Fms-xl Tissue Removal (50-601xl)
|
8
|
8
|
$5,557.32
|
$4,723.72
|
$2,000.64
|
$5,279.45
|
$4,723.72
|
2026-02-04
|
|
71552
|
HCPCS
|
MRI Scan Of Chest Before And After Contrast
|
8
|
8
|
$5,520.00
|
$4,692.00
|
$1,987.20
|
$5,244.00
|
$4,692.00
|
2026-02-04
|
|
74183
|
HCPCS
|
MRI Scan Of Abdomen Before And After Contrast
|
16
|
8
|
$5,415.00
|
$4,602.75
|
$1,911.60
|
$5,244.00
|
$4,669.92
|
2026-02-04
|
|
73723
|
HCPCS
|
MRI Scan Of Leg Joint Before And After Contrast
|
16
|
8
|
$6,125.00
|
$5,206.25
|
$1,764.00
|
$6,982.50
|
$4,655.00
|
2026-02-04
|
|
26035971_1
|
CDM
|
Therma Choice Ballon Uterine
|
8
|
8
|
$5,475.48
|
$4,654.16
|
$1,971.17
|
$5,201.71
|
$4,654.16
|
2026-02-04
|
|
J0875
|
HCPCS
|
Injection, Dalbavancin, 5 Mg
|
8
|
8
|
$5,433.50
|
$4,618.48
|
$1,956.06
|
$5,161.83
|
$4,618.48
|
2026-02-04
|
|
0441T
|
OTHER
|
Freezing Destruction Of Nerve In Leg, Accessed Through The Skin, Using Imaging G…
|
8
|
8
|
$5,400.00
|
$4,590.00
|
$1,944.00
|
$5,130.00
|
$4,590.00
|
2026-02-04
|
|
V2623
|
HCPCS
|
Prosthetic Eye, Plastic, Custom
|
8
|
8
|
$5,400.00
|
$4,590.00
|
$1,944.00
|
$5,130.00
|
$4,590.00
|
2026-02-04
|
|
28475347_1
|
CDM
|
Jada System - Vacumm Induced Hemorrhage System (jada-2002)
|
8
|
8
|
$5,400.00
|
$4,590.00
|
$1,944.00
|
$5,130.00
|
$4,590.00
|
2026-02-04
|
|
27701321_1
|
CDM
|
Graft Bovine Collagen 5mm X 40cm
|
8
|
8
|
$5,378.00
|
$4,571.30
|
$1,936.08
|
$5,109.10
|
$4,571.30
|
2026-02-04
|
|
Q4196
|
HCPCS
|
Puraply Am, Per Square Centimeter
|
32
|
8
|
$5,390.00
|
$4,581.50
|
$1,512.00
|
$11,286.00
|
$4,559.50
|
2026-02-04
|
|
70546
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head Before And After Contrast
|
8
|
8
|
$5,310.00
|
$4,513.50
|
$1,911.60
|
$5,044.50
|
$4,513.50
|
2026-02-04
|
|
27945087_1
|
CDM
|
Fibulink Syndesmosis Repair Kit/ss
|
8
|
8
|
$5,273.60
|
$4,482.56
|
$1,898.50
|
$5,009.92
|
$4,482.56
|
2026-02-04
|
|
C9358
|
HCPCS
|
Dermal Substitute, Native, Non-denatured Collagen, Fetal Bovine Origin (surgimen…
|
16
|
8
|
$5,268.00
|
$4,477.80
|
$1,698.48
|
$5,527.10
|
$4,482.10
|
2026-02-04
|
|
27384750_1
|
CDM
|
Myosure Reach Tissue Removal
|
8
|
8
|
$5,246.68
|
$4,459.68
|
$1,888.80
|
$4,984.35
|
$4,459.68
|
2026-02-04
|
|
74176
|
HCPCS
|
CT Scan Of Abdomen And Pelvis Without Contrast
|
24
|
8
|
$5,300.00
|
$4,505.00
|
$1,068.48
|
$5,234.50
|
$4,435.30
|
2026-02-04
|
|
C2623
|
HCPCS
|
Catheter, Transluminal Angioplasty, Drug-coated, Non-laser
|
32
|
8
|
$5,200.00
|
$4,420.00
|
$1,476.00
|
$5,510.00
|
$4,433.40
|
2026-02-04
|
|
26638187_1
|
CDM
|
Allosource, Allowrap, Double Sided Membrane 4x4 Cm
|
8
|
8
|
$5,196.00
|
$4,416.60
|
$1,870.56
|
$4,936.20
|
$4,416.60
|
2026-02-04
|
|
Q4101
|
HCPCS
|
Apligraf, Per Square Centimeter
|
8
|
8
|
$5,180.00
|
$4,403.00
|
$1,864.80
|
$4,921.00
|
$4,403.00
|
2026-02-04
|
|
28387666_1
|
CDM
|
Trice - Tenex Txb Procedure Pack (internal Component - 557-1002-001)
|
8
|
8
|
$5,180.00
|
$4,403.00
|
$1,864.80
|
$4,921.00
|
$4,403.00
|
2026-02-04
|
|
70549
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck Before And After Contrast
|
8
|
8
|
$5,130.00
|
$4,360.50
|
$1,846.80
|
$4,873.50
|
$4,360.50
|
2026-02-04
|
|
27500715_1
|
CDM
|
Pleurx Peritoneal Catheter Starter Kit W/bottles
|
8
|
8
|
$5,128.00
|
$4,358.80
|
$1,846.08
|
$4,871.60
|
$4,358.80
|
2026-02-04
|
|
A4353
|
HCPCS
|
Intermittent Urinary Catheter, With Insertion Supplies
|
8
|
8
|
$5,128.00
|
$4,358.80
|
$1,846.08
|
$4,871.60
|
$4,358.80
|
2026-02-04
|
|
27873874_1
|
CDM
|
Graft Fusion Bioline 8mm-40cm Peripheral
|
8
|
8
|
$5,100.00
|
$4,335.00
|
$1,836.00
|
$4,845.00
|
$4,335.00
|
2026-02-04
|
|
27994885_1
|
CDM
|
Tfna Short Nail 11mm 130'
|
8
|
8
|
$5,073.70
|
$4,312.65
|
$1,826.53
|
$4,820.02
|
$4,312.65
|
2026-02-04
|
|
27365
|
HCPCS
|
Extensive Removal Of Growth Of Thigh Or Knee Bone
|
7
|
6
|
$5,070.00
|
$4,309.50
|
$345.00
|
$4,816.50
|
$4,309.50
|
2026-02-04
|
|
28422662_1
|
CDM
|
Spider Rx Filter 6mm (zammit)
|
8
|
8
|
$5,049.00
|
$4,291.65
|
$1,817.64
|
$4,796.55
|
$4,291.65
|
2026-02-04
|
|
Q4100
|
HCPCS
|
Skin Substitute, Not Otherwise Specified
|
72
|
8
|
$5,020.00
|
$4,267.00
|
$1,130.76
|
$13,524.68
|
$4,279.18
|
2026-02-04
|
|
26035864_1
|
CDM
|
Dermograft Aflex200
|
8
|
8
|
$4,974.00
|
$4,227.90
|
$1,790.64
|
$4,725.30
|
$4,227.90
|
2026-02-04
|
|
74185
|
HCPCS
|
MRI Scan Of Blood Vessels Of Abdomen
|
8
|
8
|
$4,970.00
|
$4,224.50
|
$1,789.20
|
$4,721.50
|
$4,224.50
|
2026-02-04
|
|
64561
|
HCPCS
|
Insertion Of Sacral Nerve Neurostimulator Electrode Array
|
16
|
8
|
$10,744.00
|
$9,132.40
|
$271.19
|
$19,211.85
|
$4,177.76
|
2026-02-04
|
|
J0129
|
HCPCS
|
Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere…
|
8
|
8
|
$4,851.25
|
$4,123.56
|
$1,746.45
|
$4,608.69
|
$4,123.56
|
2026-02-04
|
|
24620
|
HCPCS
|
Closed Treatment Of Broken And Dislocated Forearm Bones At Elbow With Manipulati…
|
8
|
8
|
$4,827.00
|
$4,102.95
|
$1,737.72
|
$4,585.65
|
$4,102.95
|
2026-02-04
|
|
29043317_1
|
CDM
|
Endoclot Phs 3g (replacing Hemospray 911225)
|
8
|
8
|
$4,800.00
|
$4,080.00
|
$1,728.00
|
$4,560.00
|
$4,080.00
|
2026-02-04
|
|
26035847_1
|
CDM
|
Novasure Sterile Kit
|
8
|
8
|
$4,784.00
|
$4,066.40
|
$1,722.24
|
$4,544.80
|
$4,066.40
|
2026-02-04
|
|
27873875_1
|
CDM
|
Graft Bioline 8mm-80cm Peripheral
|
8
|
8
|
$4,760.00
|
$4,046.00
|
$1,713.60
|
$4,522.00
|
$4,046.00
|
2026-02-04
|
|
70542
|
HCPCS
|
MRI Scan Of Bone Of Eye Socket, Face, And/or Neck With Contrast
|
8
|
8
|
$4,720.00
|
$4,012.00
|
$1,699.20
|
$4,484.00
|
$4,012.00
|
2026-02-04
|
|
28348783_1
|
CDM
|
Tightrope Ii Rt Implant System W/flipcutter & Fiberstick
|
8
|
8
|
$4,652.56
|
$3,954.68
|
$1,674.92
|
$4,419.93
|
$3,954.68
|
2026-02-04
|
|
25683928_1
|
CDM
|
Labor Room/delivery - General Classification
|
8
|
8
|
$4,650.00
|
$3,952.50
|
$1,674.00
|
$4,417.50
|
$3,952.50
|
2026-02-04
|
|
27813717_1
|
CDM
|
Venaseal
|
8
|
8
|
$4,618.00
|
$3,925.30
|
$1,662.48
|
$4,387.10
|
$3,925.30
|
2026-02-04
|
|
J2357
|
HCPCS
|
Injection, Omalizumab, 5 Mg
|
8
|
8
|
$4,616.00
|
$3,923.60
|
$1,661.76
|
$4,385.20
|
$3,923.60
|
2026-02-04
|
|
59618
|
HCPCS
|
Cesarean Delivery And Care Before And After Delivery Following Attempted Vaginal…
|
13
|
8
|
$4,730.00
|
$4,020.50
|
$345.00
|
$4,807.00
|
$3,915.31
|
2026-02-04
|
|
73219
|
HCPCS
|
MRI Scan Of Arm With Contrast
|
16
|
8
|
$5,150.00
|
$4,377.50
|
$1,483.20
|
$5,871.00
|
$3,914.00
|
2026-02-04
|
|
25683725_1
|
CDM
|
Nursery - Newborn - Level Iii
|
7
|
7
|
$4,185.00
|
$3,557.25
|
$3,348.00
|
$3,975.75
|
$3,912.98
|
2026-02-04
|
|
73719
|
HCPCS
|
MRI Scan Of Leg With Contrast
|
16
|
8
|
$5,137.50
|
$4,366.88
|
$1,479.60
|
$5,856.75
|
$3,904.50
|
2026-02-04
|
|
26035313_1
|
CDM
|
Kit Wrist Fixator Radiolucent
|
8
|
8
|
$4,580.22
|
$3,893.19
|
$1,648.88
|
$4,351.21
|
$3,893.19
|
2026-02-04
|
|
J3262
|
HCPCS
|
Injection, Tocilizumab, 1 Mg
|
24
|
8
|
$4,553.00
|
$3,870.05
|
$655.65
|
$7,785.49
|
$3,851.84
|
2026-02-04
|
|
72147
|
HCPCS
|
MRI Scan Of Middle Spinal Canal With Contrast
|
8
|
8
|
$4,520.00
|
$3,842.00
|
$1,627.20
|
$4,294.00
|
$3,842.00
|
2026-02-04
|
|
59510
|
HCPCS
|
Cesarean Delivery With Care Before And After Delivery
|
13
|
8
|
$4,220.00
|
$3,587.00
|
$345.00
|
$5,142.35
|
$3,841.91
|
2026-02-04
|
|
J3111
|
HCPCS
|
Injection, Romosozumab-aqqg, 1 Mg
|
8
|
8
|
$4,506.75
|
$3,830.74
|
$1,622.43
|
$4,281.41
|
$3,830.74
|
2026-02-04
|
|
26035998_1
|
CDM
|
Screwdriver Blade 1.5/ 2.0mm
|
8
|
8
|
$4,460.00
|
$3,791.00
|
$1,605.60
|
$4,237.00
|
$3,791.00
|
2026-02-04
|
|
70552
|
HCPCS
|
MRI Scan Of Brain With Contrast
|
8
|
8
|
$4,440.00
|
$3,774.00
|
$1,598.40
|
$4,218.00
|
$3,774.00
|
2026-02-04
|
|
45110
|
HCPCS
|
Removal Of Rectum With Creation Of Opening From Large Bowel To Skin Through Abdo…
|
5
|
5
|
$4,430.00
|
$3,765.50
|
$345.00
|
$4,208.50
|
$3,765.50
|
2026-02-04
|
|
74175
|
HCPCS
|
CT Scan Of Blood Vessels Of Abdomen With Contrast
|
24
|
8
|
$4,380.00
|
$3,723.00
|
$1,400.40
|
$6,118.00
|
$3,709.25
|
2026-02-04
|
|
72142
|
HCPCS
|
MRI Scan Of Upper Spinal Canal With Contrast
|
8
|
8
|
$4,350.00
|
$3,697.50
|
$1,566.00
|
$4,132.50
|
$3,697.50
|
2026-02-04
|
|
72149
|
HCPCS
|
MRI Scan Of Lower Spinal Canal With Contrast
|
8
|
8
|
$4,350.00
|
$3,697.50
|
$1,566.00
|
$4,132.50
|
$3,697.50
|
2026-02-04
|
|
C8908
|
HCPCS
|
Magnetic Resonance Imaging Without Contrast Followed By With Contrast, Breast; B…
|
8
|
8
|
$4,350.00
|
$3,697.50
|
$1,566.00
|
$4,132.50
|
$3,697.50
|
2026-02-04
|
|
44141
|
HCPCS
|
Partial Removal Of Large Bowel With Creation Of Opening To Skin
|
5
|
5
|
$4,345.00
|
$3,693.25
|
$345.00
|
$4,127.75
|
$3,693.25
|
2026-02-04
|
|
73718
|
HCPCS
|
MRI Scan Of Leg Without Contrast
|
16
|
8
|
$4,837.50
|
$4,111.88
|
$1,393.20
|
$5,514.75
|
$3,676.50
|
2026-02-04
|
|
74181
|
HCPCS
|
MRI Scan Of Abdomen Without Contrast
|
16
|
8
|
$4,590.00
|
$3,901.50
|
$1,393.20
|
$5,044.50
|
$3,676.50
|
2026-02-04
|
|
59610
|
HCPCS
|
Vaginal Delivery And Care Before And After Delivery After Previous Cesarean Deli…
|
13
|
8
|
$4,220.00
|
$3,587.00
|
$345.00
|
$4,289.25
|
$3,644.86
|
2026-02-04
|
|
27134
|
HCPCS
|
Revision Of Thigh Bone And Hip Joint Prosthesis
|
20
|
8
|
$4,895.00
|
$4,160.75
|
$345.00
|
$4,650.25
|
$3,620.03
|
2026-02-04
|
|
44144
|
HCPCS
|
Partial Removal Of Large Bowel With Creation Of 2 Openings From Small Or Large B…
|
5
|
5
|
$4,230.00
|
$3,595.50
|
$345.00
|
$4,018.50
|
$3,595.50
|
2026-02-04
|
|
70548
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck With Contrast
|
8
|
8
|
$4,230.00
|
$3,595.50
|
$1,522.80
|
$4,018.50
|
$3,595.50
|
2026-02-04
|
|
15273
|
HCPCS
|
Skin Substitute Graft To Wound 100.0 Sq Cm Or More Of Trunk, Arms, Or Legs, 100.…
|
24
|
8
|
$4,240.00
|
$3,604.00
|
$170.18
|
$4,511.55
|
$3,587.04
|
2026-02-04
|
|
15271
|
HCPCS
|
Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C…
|
24
|
8
|
$4,240.00
|
$3,604.00
|
$75.14
|
$4,511.55
|
$3,587.04
|
2026-02-04
|
|
70496
|
HCPCS
|
CT Scan Of Blood Vessels Of Head With Contrast
|
8
|
8
|
$4,210.00
|
$3,578.50
|
$1,515.60
|
$3,999.50
|
$3,578.50
|
2026-02-04
|
|
26945088_1
|
CDM
|
Anterior Tibial Tendon Graft
|
8
|
8
|
$4,208.16
|
$3,576.94
|
$1,514.94
|
$3,997.75
|
$3,576.94
|
2026-02-04
|
|
27850949_1
|
CDM
|
Closurefast 7cm Catheter
|
8
|
8
|
$4,200.00
|
$3,570.00
|
$1,512.00
|
$3,990.00
|
$3,570.00
|
2026-02-04
|
|
70498
|
HCPCS
|
CT Scan Of Blood Vessels Of Neck With Contrast
|
16
|
8
|
$4,125.00
|
$3,506.25
|
$1,458.00
|
$3,990.00
|
$3,553.20
|
2026-02-04
|
|
25778433_1
|
CDM
|
Aris Sling
|
8
|
8
|
$4,180.00
|
$3,553.00
|
$1,504.80
|
$3,971.00
|
$3,553.00
|
2026-02-04
|
|
72196
|
HCPCS
|
MRI Scan Of Pelvis With Contrast
|
8
|
8
|
$4,180.00
|
$3,553.00
|
$1,504.80
|
$3,971.00
|
$3,553.00
|
2026-02-04
|
|
G0257
|
HCPCS
|
Unscheduled Or Emergency Dialysis Treatment For An Esrd Patient In A Hospital Ou…
|
8
|
8
|
$4,170.00
|
$3,544.50
|
$1,501.20
|
$3,961.50
|
$3,544.50
|
2026-02-04
|
|
25919984_16
|
CDM
|
37228 Tib/per Revasc W/tla
|
2
|
2
|
$5,660.00
|
$4,811.00
|
$2,264.00
|
$4,811.00
|
$3,537.50
|
2026-02-04
|
|
25776803_1
|
CDM
|
Enseal Impact Tissue Fusion
|
8
|
8
|
$4,159.92
|
$3,535.93
|
$1,497.57
|
$3,951.92
|
$3,535.93
|
2026-02-04
|
|
73222
|
HCPCS
|
MRI Scan Of Arm Joint With Contrast
|
32
|
8
|
$3,916.00
|
$3,328.60
|
$1,409.76
|
$5,580.30
|
$3,524.40
|
2026-02-04
|
|
70545
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head With Contrast
|
8
|
8
|
$4,110.00
|
$3,493.50
|
$1,479.60
|
$3,904.50
|
$3,493.50
|
2026-02-04
|
|
70540
|
HCPCS
|
MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Without Contrast
|
8
|
8
|
$4,110.00
|
$3,493.50
|
$1,479.60
|
$3,904.50
|
$3,493.50
|
2026-02-04
|
|
71551
|
HCPCS
|
MRI Scan Of Chest With Contrast
|
8
|
8
|
$4,110.00
|
$3,493.50
|
$1,479.60
|
$3,904.50
|
$3,493.50
|
2026-02-04
|
|
59400
|
HCPCS
|
Vaginal Delivery With Care Before And After Delivery
|
13
|
8
|
$4,918.00
|
$4,180.30
|
$345.00
|
$4,672.10
|
$3,487.39
|
2026-02-04
|
|
C1771
|
HCPCS
|
Repair Device, Urinary, Incontinence, With Sling Graft
|
8
|
8
|
$4,100.00
|
$3,485.00
|
$1,476.00
|
$3,895.00
|
$3,485.00
|
2026-02-04
|
|
28699092_1
|
CDM
|
Allograft Axis Dermis 4cm X 7cm (dr. Johns)
|
8
|
8
|
$4,034.00
|
$3,428.90
|
$1,452.24
|
$3,832.30
|
$3,428.90
|
2026-02-04
|
|
33018
|
HCPCS
|
Drainage Of Heart Sac Using Tube And Imaging Guidance (5 Years Or Younger Or Any…
|
23
|
8
|
$4,000.00
|
$3,400.00
|
$245.41
|
$4,940.00
|
$3,400.00
|
2026-02-04
|
|
28641200_1
|
CDM
|
Tyrx Absorbable Antibacterial Envelope, Large (dr. Hoppe) **do Not Reorder**
|
8
|
8
|
$3,990.00
|
$3,391.50
|
$1,436.40
|
$3,790.50
|
$3,391.50
|
2026-02-04
|
|
27095231_1
|
CDM
|
Quickset Kit 8cc
|
8
|
8
|
$3,990.00
|
$3,391.50
|
$1,436.40
|
$3,790.50
|
$3,391.50
|
2026-02-04
|
|
90935
|
HCPCS
|
Hemodialysis Procedure With Physician Evaluation
|
8
|
8
|
$3,960.00
|
$3,366.00
|
$1,425.60
|
$3,762.00
|
$3,366.00
|
2026-02-04
|
|
73722
|
HCPCS
|
MRI Scan Of Leg Joint With Contrast
|
40
|
8
|
$3,960.00
|
$3,366.00
|
$1,285.20
|
$5,087.25
|
$3,366.00
|
2026-02-04
|
|
27754029_1
|
CDM
|
Graft Gore 8x40 Propaten Thin Walled
|
8
|
8
|
$3,948.00
|
$3,355.80
|
$1,421.28
|
$3,750.60
|
$3,355.80
|
2026-02-04
|
|
36584
|
HCPCS
|
Replacement Of Peripherally Inserted Central Venous Tube (picc) With Review By R…
|
8
|
8
|
$3,920.00
|
$3,332.00
|
$1,411.20
|
$3,724.00
|
$3,332.00
|
2026-02-04
|
|
43860
|
HCPCS
|
Revision Of Surgically Created Connection Of Stomach To Small Bowel
|
5
|
5
|
$3,920.00
|
$3,332.00
|
$345.00
|
$3,724.00
|
$3,332.00
|
2026-02-04
|
|
28132114_1
|
CDM
|
Hemospray 7fr (do Not Reorder - Endoclot 871062 Is Replacement)
|
8
|
8
|
$3,900.00
|
$3,315.00
|
$1,404.00
|
$3,705.00
|
$3,315.00
|
2026-02-04
|
|
70544
|
HCPCS
|
MRI Scan Of Blood Vessels Of Head Without Contrast
|
8
|
8
|
$3,870.00
|
$3,289.50
|
$1,393.20
|
$3,676.50
|
$3,289.50
|
2026-02-04
|
|
72146
|
HCPCS
|
MRI Scan Of Middle Spinal Canal Without Contrast
|
8
|
8
|
$3,870.00
|
$3,289.50
|
$1,393.20
|
$3,676.50
|
$3,289.50
|
2026-02-04
|
|
72141
|
HCPCS
|
MRI Scan Of Upper Spinal Canal Without Contrast
|
8
|
8
|
$3,870.00
|
$3,289.50
|
$1,393.20
|
$3,676.50
|
$3,289.50
|
2026-02-04
|
|
70551
|
HCPCS
|
MRI Scan Of Brain Without Contrast
|
8
|
8
|
$3,870.00
|
$3,289.50
|
$1,393.20
|
$3,676.50
|
$3,289.50
|
2026-02-04
|
|
72195
|
HCPCS
|
MRI Scan Of Pelvis Without Contrast
|
8
|
8
|
$3,870.00
|
$3,289.50
|
$1,393.20
|
$3,676.50
|
$3,289.50
|
2026-02-04
|
|
72148
|
HCPCS
|
MRI Scan Of Lower Spinal Canal Without Contrast
|
8
|
8
|
$3,870.00
|
$3,289.50
|
$1,393.20
|
$3,676.50
|
$3,289.50
|
2026-02-04
|
|
71275
|
HCPCS
|
CT Scan Of Blood Vessels Of Chest With Contrast
|
24
|
8
|
$3,880.00
|
$3,298.00
|
$1,209.60
|
$4,151.50
|
$3,282.48
|
2026-02-04
|
|
25711344_1
|
CDM
|
Intensive Care Unit - Intermediate ICU
|
7
|
7
|
$3,475.00
|
$2,953.75
|
$2,780.00
|
$3,301.25
|
$3,249.13
|
2026-02-04
|
|
73221
|
HCPCS
|
MRI Scan Of Arm Joint Without Contrast
|
16
|
8
|
$4,275.00
|
$3,633.75
|
$1,231.20
|
$4,873.50
|
$3,249.00
|
2026-02-04
|
|
73721
|
HCPCS
|
MRI Scan Of Leg Joint Without Contrast
|
16
|
8
|
$4,275.00
|
$3,633.75
|
$1,231.20
|
$4,873.50
|
$3,249.00
|
2026-02-04
|
|
25776457_1
|
CDM
|
Self Centering Hip 46-28
|
8
|
8
|
$3,822.00
|
$3,248.70
|
$1,375.92
|
$3,630.90
|
$3,248.70
|
2026-02-04
|
|
25778375_1
|
CDM
|
Cpr Mini Scorpion Micro Suturelasso
|
8
|
8
|
$3,800.00
|
$3,230.00
|
$1,368.00
|
$3,610.00
|
$3,230.00
|
2026-02-04
|
|
73218
|
HCPCS
|
MRI Scan Of Arm Without Contrast
|
32
|
8
|
$3,590.00
|
$3,051.50
|
$1,249.20
|
$4,944.75
|
$3,182.50
|
2026-02-04
|
|
25683612_1
|
CDM
|
Labor Room/delivery - General Classification
|
8
|
8
|
$3,720.00
|
$3,162.00
|
$1,339.20
|
$3,534.00
|
$3,162.00
|
2026-02-04
|
|
71550
|
HCPCS
|
MRI Scan Of Chest Without Contrast
|
8
|
8
|
$3,720.00
|
$3,162.00
|
$1,339.20
|
$3,534.00
|
$3,162.00
|
2026-02-04
|
|
28345900_1
|
CDM
|
Omnilink Elite 7.0mmx39mm, 135cm
|
8
|
8
|
$3,708.00
|
$3,151.80
|
$1,334.88
|
$3,522.60
|
$3,151.80
|
2026-02-04
|
|
28345901_1
|
CDM
|
Omnilink Elite 7.0mmx59mm, 135cm
|
8
|
8
|
$3,708.00
|
$3,151.80
|
$1,334.88
|
$3,522.60
|
$3,151.80
|
2026-02-04
|
|
28339395_1
|
CDM
|
Omnilink Elite 8.0mmx39mm, 135cm
|
8
|
8
|
$3,708.00
|
$3,151.80
|
$1,334.88
|
$3,522.60
|
$3,151.80
|
2026-02-04
|
|
43281
|
HCPCS
|
Repair Of Hernia Of Muscle At Esophagus And Stomach Using An Endoscope
|
5
|
5
|
$3,705.00
|
$3,149.25
|
$345.00
|
$3,519.75
|
$3,149.25
|
2026-02-04
|
|
35539
|
HCPCS
|
Bypass Of Diseased Or Blocked Aorta To Upper Leg Artery With Vein
|
8
|
8
|
$4,260.00
|
$3,621.00
|
$1,929.25
|
$3,621.00
|
$3,148.15
|
2026-02-04
|
|
74170
|
HCPCS
|
CT Scan Of Abdomen Before And After Contrast
|
16
|
8
|
$3,640.00
|
$3,094.00
|
$1,285.20
|
$3,524.50
|
$3,138.66
|
2026-02-04
|
|
23200
|
HCPCS
|
Extensive Removal Of Growth Of Collar Bone
|
7
|
6
|
$3,690.00
|
$3,136.50
|
$345.00
|
$3,505.50
|
$3,136.50
|
2026-02-04
|
|
26031746_1
|
CDM
|
Operating Room Services - General Classification
|
8
|
8
|
$3,672.00
|
$3,121.20
|
$1,321.92
|
$3,488.40
|
$3,121.20
|
2026-02-04
|
|
25895003_1
|
CDM
|
Operating Room Services - General Classification
|
8
|
8
|
$3,672.00
|
$3,121.20
|
$1,321.92
|
$3,488.40
|
$3,121.20
|
2026-02-04
|
|
25894997_1
|
CDM
|
Operating Room Services - General Classification
|
8
|
8
|
$3,672.00
|
$3,121.20
|
$1,321.92
|
$3,488.40
|
$3,121.20
|
2026-02-04
|
|
25895005_1
|
CDM
|
Operating Room Services - General Classification
|
8
|
8
|
$3,672.00
|
$3,121.20
|
$1,321.92
|
$3,488.40
|
$3,121.20
|
2026-02-04
|
|
885907_1
|
CDM
|
Operating Room Services - General Classification
|
8
|
8
|
$3,672.00
|
$3,121.20
|
$1,321.92
|
$3,488.40
|
$3,121.20
|
2026-02-04
|
|
26104284_1
|
CDM
|
Operating Room Services - General Classification
|
8
|
8
|
$3,672.00
|
$3,121.20
|
$1,321.92
|
$3,488.40
|
$3,121.20
|
2026-02-04
|
|
25895008_1
|
CDM
|
Operating Room Services - General Classification
|
8
|
8
|
$3,672.00
|
$3,121.20
|
$1,321.92
|
$3,488.40
|
$3,121.20
|
2026-02-04
|
|
J0135
|
HCPCS
|
Injection, Adalimumab, 20 Mg
|
7
|
6
|
$3,670.00
|
$3,119.50
|
$345.00
|
$3,486.50
|
$3,119.50
|
2026-02-04
|
|
25895004_1
|
CDM
|
Operating Room Services - General Classification
|
8
|
8
|
$3,667.00
|
$3,116.95
|
$1,320.12
|
$3,483.65
|
$3,116.95
|
2026-02-04
|
|
44146
|
HCPCS
|
Partial Removal Of Large Bowel And Reattachment To Rectum And Creation Of Large …
|
8
|
8
|
$4,960.00
|
$4,216.00
|
$1,921.81
|
$4,216.00
|
$3,080.84
|
2026-02-04
|
|
28525250_1
|
CDM
|
Fentanyl (635 Test/kit)
|
8
|
8
|
$3,596.50
|
$3,057.03
|
$1,294.74
|
$3,416.68
|
$3,057.03
|
2026-02-04
|
|
70547
|
HCPCS
|
MRI Scan Of Blood Vessels Of Neck Without Contrast
|
8
|
8
|
$3,580.00
|
$3,043.00
|
$1,288.80
|
$3,401.00
|
$3,043.00
|
2026-02-04
|
|
72129
|
HCPCS
|
CT Scan Of Middle Spine With Contrast
|
8
|
8
|
$3,580.00
|
$3,043.00
|
$1,288.80
|
$3,401.00
|
$3,043.00
|
2026-02-04
|
|
71270
|
HCPCS
|
CT Scan Of Chest Before And After Contrast
|
16
|
8
|
$3,445.00
|
$2,928.25
|
$1,191.60
|
$3,401.00
|
$3,028.68
|
2026-02-04
|
|
31360
|
HCPCS
|
Complete Removal Of Voice Box
|
13
|
8
|
$4,244.00
|
$3,607.40
|
$345.00
|
$4,313.00
|
$3,028.52
|
2026-02-04
|
|
70470
|
HCPCS
|
CT Scan Of Head Or Brain Before And After Contrast
|
8
|
8
|
$3,550.00
|
$3,017.50
|
$1,278.00
|
$3,372.50
|
$3,017.50
|
2026-02-04
|
|
32408
|
HCPCS
|
Core Needle Biopsy Of Lung Or Center Cavity Of Chest (mediastinum), Accessed Thr…
|
8
|
8
|
$3,528.00
|
$2,998.80
|
$1,270.08
|
$3,351.60
|
$2,998.80
|
2026-02-04
|
|
28339396_1
|
CDM
|
Omnilink Elite 8.0mmx59mm, 135cm
|
8
|
8
|
$3,528.00
|
$2,998.80
|
$1,270.08
|
$3,351.60
|
$2,998.80
|
2026-02-04
|
|
C9809
|
HCPCS
|
Cryoablation Needle (e.g., Iovera System), Including Needle/tip And All Disposab…
|
24
|
8
|
$3,537.00
|
$3,006.45
|
$276.48
|
$4,531.50
|
$2,992.30
|
2026-02-04
|
|
44661
|
HCPCS
|
Closure Of Abnormal Drainage Tract From Small Bowel To Urinary Bladder With Rese…
|
5
|
5
|
$3,515.00
|
$2,987.75
|
$345.00
|
$3,339.25
|
$2,987.75
|
2026-02-04
|
|
72194
|
HCPCS
|
CT Scan Of Pelvis Before And After Contrast
|
8
|
8
|
$3,500.00
|
$2,975.00
|
$1,260.00
|
$3,325.00
|
$2,975.00
|
2026-02-04
|
|
25778420_1
|
CDM
|
Filshie Clips With Port
|
8
|
8
|
$3,495.80
|
$2,971.43
|
$1,258.49
|
$3,321.01
|
$2,971.43
|
2026-02-04
|
|
70336
|
HCPCS
|
MRI Scan Of Jaw Joint
|
8
|
8
|
$3,480.00
|
$2,958.00
|
$1,252.80
|
$3,306.00
|
$2,958.00
|
2026-02-04
|
|
36569
|
HCPCS
|
Insertion Of Tube For Infusion (5 Years Or Older)
|
25
|
8
|
$3,445.00
|
$2,928.25
|
$85.05
|
$3,933.00
|
$2,900.69
|
2026-02-04
|
|
Q5103
|
HCPCS
|
Injection, Infliximab-dyyb, Biosimilar, (inflectra), 10 Mg
|
8
|
8
|
$3,406.75
|
$2,895.74
|
$1,226.43
|
$3,236.41
|
$2,895.74
|
2026-02-04
|
|
26035333_1
|
CDM
|
Putty Dynagraft 5cc
|
8
|
8
|
$3,400.00
|
$2,890.00
|
$1,224.00
|
$3,230.00
|
$2,890.00
|
2026-02-04
|
|
72132
|
HCPCS
|
CT Scan Of Lower Spine With Contrast
|
8
|
8
|
$3,390.00
|
$2,881.50
|
$1,220.40
|
$3,220.50
|
$2,881.50
|
2026-02-04
|
|
22905
|
HCPCS
|
Extensive Removal Of Growth Of Soft Tissue Of Abdominal Wall, 5.0 Cm Or More
|
7
|
6
|
$3,390.00
|
$2,881.50
|
$345.00
|
$3,220.50
|
$2,881.50
|
2026-02-04
|
|
44212
|
HCPCS
|
Removal Of Large Bowel And Rectum With Creation Of Opening From Small Bowel To S…
|
8
|
8
|
$2,643.00
|
$2,246.55
|
$1,857.03
|
$3,322.83
|
$2,878.40
|
2026-02-04
|
|
44208
|
HCPCS
|
Partial Removal Of Large Bowel And Reattachment To Rectum And Creation Of Openin…
|
8
|
8
|
$4,680.00
|
$3,978.00
|
$1,787.76
|
$3,978.00
|
$2,875.61
|
2026-02-04
|
|
28387665_1
|
CDM
|
Trice - Tenex Tx2 Procedure Pack 554-2003-001
|
8
|
8
|
$3,380.00
|
$2,873.00
|
$1,216.80
|
$3,211.00
|
$2,873.00
|
2026-02-04
|
|
77047
|
HCPCS
|
MRI Scan Of Both Breasts Without Contrast
|
8
|
8
|
$3,375.00
|
$2,868.75
|
$1,215.00
|
$3,206.25
|
$2,868.75
|
2026-02-04
|
|
69955
|
HCPCS
|
Release Of Face Nerve
|
13
|
8
|
$4,024.00
|
$3,420.40
|
$345.00
|
$4,089.75
|
$2,859.50
|
2026-02-04
|
|
44150
|
HCPCS
|
Removal Of Large Bowel With Attachment Of Small Bowel To Rectum Or Creation Of O…
|
26
|
8
|
$4,450.00
|
$3,782.50
|
$345.00
|
$4,227.50
|
$2,855.85
|
2026-02-04
|
|
71260
|
HCPCS
|
CT Scan Of Chest With Contrast
|
16
|
8
|
$4,360.00
|
$3,706.00
|
$1,080.00
|
$5,434.00
|
$2,850.00
|
2026-02-04
|
|
25894993_1
|
CDM
|
Operating Room Services - General Classification
|
8
|
8
|
$3,348.00
|
$2,845.80
|
$1,205.28
|
$3,180.60
|
$2,845.80
|
2026-02-04
|
|
74160
|
HCPCS
|
CT Scan Of Abdomen With Contrast
|
8
|
8
|
$3,330.00
|
$2,830.50
|
$1,198.80
|
$3,163.50
|
$2,830.50
|
2026-02-04
|
|
36585
|
HCPCS
|
Replacement Of Peripherally Inserted Central Venous Tube (picc) With Port
|
8
|
8
|
$3,330.00
|
$2,830.50
|
$1,198.80
|
$3,163.50
|
$2,830.50
|
2026-02-04
|
|
2864158_1
|
CDM
|
Operating Room Services - General Classification
|
8
|
8
|
$3,326.00
|
$2,827.10
|
$1,197.36
|
$3,159.70
|
$2,827.10
|
2026-02-04
|
|
25966388_1
|
CDM
|
Operating Room Services - General Classification
|
8
|
8
|
$3,326.00
|
$2,827.10
|
$1,197.36
|
$3,159.70
|
$2,827.10
|
2026-02-04
|
|
2864101_1
|
CDM
|
Operating Room Services - General Classification
|
8
|
8
|
$3,316.00
|
$2,818.60
|
$1,193.76
|
$3,150.20
|
$2,818.60
|
2026-02-04
|
|
26035334_1
|
CDM
|
Putty Dynagraft 10cc
|
8
|
8
|
$3,300.00
|
$2,805.00
|
$1,188.00
|
$3,135.00
|
$2,805.00
|
2026-02-04
|
|
72191
|
HCPCS
|
CT Scan Of Blood Vessels Of Pelvis With Contrast
|
8
|
8
|
$3,290.00
|
$2,796.50
|
$1,184.40
|
$3,125.50
|
$2,796.50
|
2026-02-04
|
|
3015852_1
|
CDM
|
Nursery - Newborn - Level Ii
|
7
|
7
|
$2,990.00
|
$2,541.50
|
$2,392.00
|
$2,840.50
|
$2,795.65
|
2026-02-04
|
|
25777905_1
|
CDM
|
Navitracker Kt A Knee & Spine
|
8
|
8
|
$3,280.00
|
$2,788.00
|
$1,180.80
|
$3,116.00
|
$2,788.00
|
2026-02-04
|
|
25919980_16
|
CDM
|
37224 Pf Fem/popl Revasc W/tla
|
2
|
2
|
$4,460.00
|
$3,791.00
|
$1,784.00
|
$3,791.00
|
$2,787.50
|
2026-02-04
|
|
72193
|
HCPCS
|
CT Scan Of Pelvis With Contrast
|
8
|
8
|
$3,270.00
|
$2,779.50
|
$1,177.20
|
$3,106.50
|
$2,779.50
|
2026-02-04
|
|
38115
|
HCPCS
|
Repair Of Ruptured Spleen
|
5
|
5
|
$3,250.00
|
$2,762.50
|
$345.00
|
$3,087.50
|
$2,762.50
|
2026-02-04
|
|
35102
|
HCPCS
|
Repair Of Aneurysm Or Abdominal Aorta Involving Groin Arteries With Graft
|
15
|
8
|
$4,358.00
|
$3,704.30
|
$345.00
|
$4,140.10
|
$2,753.03
|
2026-02-04
|
|
27724
|
HCPCS
|
Repair Of Nonhealed Broken Shin Bone With Self Graft From Hip Or Other Bone
|
7
|
6
|
$3,215.00
|
$2,732.75
|
$345.00
|
$3,054.25
|
$2,732.75
|
2026-02-04
|
|
25777063_1
|
CDM
|
Tap 4.0mm Cann
|
8
|
8
|
$3,208.72
|
$2,727.41
|
$1,155.14
|
$3,048.28
|
$2,727.41
|
2026-02-04
|
|
29867
|
HCPCS
|
Repair Of Knee Cartilage And Bone With Donor Cartilage Graft Using An Endoscope
|
7
|
6
|
$3,205.00
|
$2,724.25
|
$345.00
|
$3,044.75
|
$2,724.25
|
2026-02-04
|
|
43820
|
HCPCS
|
Partial Removal Of Stomach With Attachment Of Stomach To Small Bowel
|
5
|
5
|
$3,200.00
|
$2,720.00
|
$345.00
|
$3,040.00
|
$2,720.00
|
2026-02-04
|
|
44207
|
HCPCS
|
Partial Removal Of Large Bowel And Reattachment To Rectum Using An Endoscope
|
13
|
8
|
$4,360.00
|
$3,706.00
|
$345.00
|
$4,180.00
|
$2,716.89
|
2026-02-04
|
|
28525313_1
|
CDM
|
S Syringe Module
|
8
|
8
|
$3,195.16
|
$2,715.89
|
$1,150.26
|
$3,035.40
|
$2,715.89
|
2026-02-04
|
|
25919980_12
|
CDM
|
37224 Pf Fem/popl Revasc W/tla
|
2
|
2
|
$4,333.00
|
$3,683.05
|
$1,733.20
|
$3,683.05
|
$2,708.12
|
2026-02-04
|
|
25919980_13
|
CDM
|
37224 Pf Fem/popl Revasc W/tla
|
2
|
2
|
$4,333.00
|
$3,683.05
|
$1,733.20
|
$3,683.05
|
$2,708.12
|
2026-02-04
|
|
27991492_1
|
CDM
|
Tfna Helical Blade 80mm
|
8
|
8
|
$3,148.25
|
$2,676.01
|
$1,133.37
|
$2,990.84
|
$2,676.01
|
2026-02-04
|
|
27269
|
HCPCS
|
Treatment Of Broken Head Of Thigh Bone
|
7
|
6
|
$3,140.00
|
$2,669.00
|
$345.00
|
$2,983.00
|
$2,669.00
|
2026-02-04
|
|
867366_1
|
CDM
|
Room & Board - Semi-private (two Beds) - General Classification
|
7
|
7
|
$2,850.00
|
$2,422.50
|
$2,280.00
|
$2,707.50
|
$2,664.75
|
2026-02-04
|
|
72126
|
HCPCS
|
CT Scan Of Upper Spine With Contrast
|
8
|
8
|
$3,130.00
|
$2,660.50
|
$1,126.80
|
$2,973.50
|
$2,660.50
|
2026-02-04
|
|
26035337_1
|
CDM
|
Gel Liquid Dynagraft 10cc
|
8
|
8
|
$3,120.00
|
$2,652.00
|
$1,123.20
|
$2,964.00
|
$2,652.00
|
2026-02-04
|
|
28675794_1
|
CDM
|
Puraply Am 4cm X 4cm 515-048
|
8
|
8
|
$3,120.00
|
$2,652.00
|
$1,123.20
|
$2,964.00
|
$2,652.00
|
2026-02-04
|
|
31225
|
HCPCS
|
Removal Of Nasal Sinus
|
13
|
8
|
$3,738.00
|
$3,177.30
|
$345.00
|
$3,800.00
|
$2,643.94
|
2026-02-04
|
|
26945089_1
|
CDM
|
Gracilis Tendon Graft
|
8
|
8
|
$3,103.08
|
$2,637.62
|
$1,117.11
|
$2,947.93
|
$2,637.62
|
2026-02-04
|
|
27487
|
HCPCS
|
Revision Of Thigh And Lower Leg Bone Components Of Total Knee Joint Prosthesis
|
15
|
8
|
$4,610.00
|
$3,918.50
|
$345.00
|
$4,379.50
|
$2,608.59
|
2026-02-04
|
|
C1876
|
HCPCS
|
Stent, Non-coated/non-covered, With Delivery System
|
24
|
8
|
$3,065.96
|
$2,606.07
|
$920.15
|
$5,585.96
|
$2,593.81
|
2026-02-04
|
|
44210
|
HCPCS
|
Removal Of Large Bowel With Attachment Of Small Bowel To Rectum Or Creation Of S…
|
8
|
8
|
$3,540.00
|
$3,009.00
|
$1,620.76
|
$3,009.00
|
$2,589.86
|
2026-02-04
|
|
58152
|
HCPCS
|
Removal Of Uterus And Cervix Through Abdomen With Repair Of Vagina
|
5
|
5
|
$3,015.00
|
$2,562.75
|
$345.00
|
$2,864.25
|
$2,562.75
|
2026-02-04
|
|
2913072_1
|
CDM
|
Operating Room Services - General Classification
|
8
|
8
|
$3,010.00
|
$2,558.50
|
$1,083.60
|
$2,859.50
|
$2,558.50
|
2026-02-04
|
|
Q4195
|
HCPCS
|
Puraply, Per Square Centimeter
|
24
|
8
|
$3,000.00
|
$2,550.00
|
$405.00
|
$9,120.00
|
$2,550.00
|
2026-02-04
|
|
44206
|
HCPCS
|
Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin…
|
8
|
8
|
$3,930.00
|
$3,340.50
|
$1,582.61
|
$3,340.50
|
$2,545.49
|
2026-02-04
|
|
28980984_1
|
CDM
|
Aerogen Pro-x Controller Kit
|
8
|
8
|
$2,994.00
|
$2,544.90
|
$1,077.84
|
$2,844.30
|
$2,544.90
|
2026-02-04
|
|
25776992_1
|
CDM
|
Catheter Kit Presep Cvc Scv02 20cm
|
8
|
8
|
$2,985.00
|
$2,537.25
|
$1,074.60
|
$2,835.75
|
$2,537.25
|
2026-02-04
|
|
25684137_1
|
CDM
|
Labor Room/delivery - General Classification
|
8
|
8
|
$2,980.00
|
$2,533.00
|
$1,072.80
|
$2,831.00
|
$2,533.00
|
2026-02-04
|
|
25683606_1
|
CDM
|
Labor Room/delivery - General Classification
|
8
|
8
|
$2,980.00
|
$2,533.00
|
$1,072.80
|
$2,831.00
|
$2,533.00
|
2026-02-04
|
|
28078796_1
|
CDM
|
Graft Darcon Hemasheild Gold 8 X 40 Gold
|
8
|
8
|
$2,976.84
|
$2,530.31
|
$1,071.66
|
$2,828.00
|
$2,530.31
|
2026-02-04
|
|
27991497_1
|
CDM
|
Tfna Helical Blade 90mm
|
8
|
8
|
$2,975.10
|
$2,528.84
|
$1,071.04
|
$2,826.35
|
$2,528.84
|
2026-02-04
|
|
27991496_1
|
CDM
|
Tfna Helical Blade 85mm
|
8
|
8
|
$2,975.10
|
$2,528.84
|
$1,071.04
|
$2,826.35
|
$2,528.84
|
2026-02-04
|
|
27991512_1
|
CDM
|
Tfna Helical Blade 95mm
|
8
|
8
|
$2,975.10
|
$2,528.84
|
$1,071.04
|
$2,826.35
|
$2,528.84
|
2026-02-04
|
|
26035913_1
|
CDM
|
Mpfl Kit/biocomposite
|
8
|
8
|
$2,974.00
|
$2,527.90
|
$1,070.64
|
$2,825.30
|
$2,527.90
|
2026-02-04
|
|
25775961_1
|
CDM
|
Stapler Ceea 29mm Powered
|
8
|
8
|
$2,971.02
|
$2,525.37
|
$1,069.57
|
$2,822.47
|
$2,525.37
|
2026-02-04
|
|
44143
|
HCPCS
|
Partial Removal Of Large Bowel With Creation Of Opening From Large Bowel To Skin
|
26
|
8
|
$3,930.00
|
$3,340.50
|
$345.00
|
$3,771.50
|
$2,514.23
|
2026-02-04
|
|
35646
|
HCPCS
|
Bypass Of Diseased Or Blocked Artery Aorta To Upper Leg And Opposite Upper Leg A…
|
13
|
8
|
$3,961.00
|
$3,366.85
|
$345.00
|
$3,876.00
|
$2,513.96
|
2026-02-04
|
|
27709
|
HCPCS
|
Incision Or Partial Removal Of Shin And Outer Lower Leg Bones
|
7
|
6
|
$2,955.00
|
$2,511.75
|
$345.00
|
$2,807.25
|
$2,511.75
|
2026-02-04
|
|
25777043_1
|
CDM
|
Drill Bit 2.0 Cann 150mm
|
8
|
8
|
$2,953.76
|
$2,510.70
|
$1,063.35
|
$2,806.07
|
$2,510.70
|
2026-02-04
|
|
28484498_1
|
CDM
|
Trialysis Triple-lumen Dialysis Catheter 13fr X 15cm, Straight
|
8
|
8
|
$2,940.52
|
$2,499.44
|
$1,058.59
|
$2,793.49
|
$2,499.44
|
2026-02-04
|
|
28484503_1
|
CDM
|
Trialysis Triple-lumen Dialysis Catheter 13fr X 20cm, Straight
|
8
|
8
|
$2,940.36
|
$2,499.31
|
$1,058.53
|
$2,793.34
|
$2,499.31
|
2026-02-04
|
|
35251
|
HCPCS
|
Repair Of Blood Vessel Of Abdomen With Vein Graft
|
8
|
8
|
$3,902.00
|
$3,316.70
|
$1,530.35
|
$3,316.70
|
$2,497.22
|
2026-02-04
|
|
27132
|
HCPCS
|
Total Hip Replacement After Previous Hip Surgery
|
15
|
8
|
$3,778.00
|
$3,211.30
|
$345.00
|
$4,042.25
|
$2,492.90
|
2026-02-04
|
|
44145
|
HCPCS
|
Partial Removal Of Large Bowel And Reattachment To Rectum
|
13
|
8
|
$3,712.00
|
$3,155.20
|
$345.00
|
$3,781.00
|
$2,492.57
|
2026-02-04
|
|
867361_1
|
CDM
|
Room & Board - Semi-private (two Beds) - General Classification
|
7
|
7
|
$2,655.00
|
$2,256.75
|
$2,124.00
|
$2,522.25
|
$2,482.43
|
2026-02-04
|
|
72131
|
HCPCS
|
CT Scan Of Lower Spine Without Contrast
|
8
|
8
|
$2,900.00
|
$2,465.00
|
$1,044.00
|
$2,755.00
|
$2,465.00
|
2026-02-04
|
|
70460
|
HCPCS
|
CT Scan Head Or Brain With Contrast
|
8
|
8
|
$2,900.00
|
$2,465.00
|
$1,044.00
|
$2,755.00
|
$2,465.00
|
2026-02-04
|
|
C8905
|
HCPCS
|
Magnetic Resonance Imaging Without Contrast Followed By With Contrast, Breast; U…
|
8
|
8
|
$2,900.00
|
$2,465.00
|
$1,044.00
|
$2,755.00
|
$2,465.00
|
2026-02-04
|
|
45563
|
HCPCS
|
Repair Of Rectal Wound With Surgically Created Opening From Large Bowel To Skin
|
8
|
8
|
$3,946.00
|
$3,354.10
|
$1,551.78
|
$3,354.10
|
$2,458.10
|
2026-02-04
|
|
73201
|
HCPCS
|
CT Scan Of Arm With Contrast
|
32
|
8
|
$2,733.00
|
$2,323.05
|
$963.72
|
$3,815.20
|
$2,456.90
|
2026-02-04
|
|
49020
|
HCPCS
|
Drainage Of Abdominal Abscess Or Infection
|
15
|
8
|
$3,535.00
|
$3,004.75
|
$345.00
|
$3,591.00
|
$2,445.99
|
2026-02-04
|
|
G0390
|
HCPCS
|
Trauma Response Team Associated With Hospital Critical Care Service
|
8
|
8
|
$2,870.00
|
$2,439.50
|
$1,033.20
|
$2,726.50
|
$2,439.50
|
2026-02-04
|
|
72128
|
HCPCS
|
CT Scan Of Middle Spine Without Contrast
|
8
|
8
|
$2,870.00
|
$2,439.50
|
$1,033.20
|
$2,726.50
|
$2,439.50
|
2026-02-04
|
|
44320
|
HCPCS
|
Creation Of Opening From Large Bowel To Skin
|
5
|
5
|
$2,865.00
|
$2,435.25
|
$345.00
|
$2,721.75
|
$2,435.25
|
2026-02-04
|
|
27530643_1
|
CDM
|
Gelport Laparoscopic System
|
8
|
8
|
$2,860.00
|
$2,431.00
|
$1,029.60
|
$2,717.00
|
$2,431.00
|
2026-02-04
|
|
44227
|
HCPCS
|
Closure Of Opening From Large Or Small Bowel To Skin Using An Endoscope
|
8
|
8
|
$4,400.00
|
$3,740.00
|
$1,502.19
|
$3,740.00
|
$2,420.94
|
2026-02-04
|
|
59622
|
HCPCS
|
Cesarean Delivery With Care After Delivery Following Vaginal Delivery Attempt Af…
|
5
|
5
|
$2,835.00
|
$2,409.75
|
$345.00
|
$2,693.25
|
$2,409.75
|
2026-02-04
|
|
27760144_1
|
CDM
|
Harmonic Focus+ 9cm Curved Shear
|
8
|
8
|
$2,832.66
|
$2,407.76
|
$1,019.76
|
$2,691.03
|
$2,407.76
|
2026-02-04
|
|
25919975_16
|
CDM
|
37220 Pf Iliac Revasc
|
2
|
2
|
$3,850.00
|
$3,272.50
|
$1,540.00
|
$3,272.50
|
$2,406.25
|
2026-02-04
|
|
25778274_1
|
CDM
|
Enseal Blunt Tip 5mm
|
8
|
8
|
$2,829.66
|
$2,405.21
|
$1,018.68
|
$2,688.18
|
$2,405.21
|
2026-02-04
|
|
37766
|
HCPCS
|
Removal Of Varicose Veins Of Arm Or Leg, More Than 20 Incisions
|
16
|
8
|
$6,050.00
|
$5,142.50
|
$296.42
|
$10,640.00
|
$2,398.50
|
2026-02-04
|
|
44626
|
HCPCS
|
Closure Of Surgically Created Large Or Small Bowel Opening With Bowel Removal An…
|
26
|
8
|
$3,855.00
|
$3,276.75
|
$345.00
|
$3,662.25
|
$2,389.69
|
2026-02-04
|
|
35566
|
HCPCS
|
Bypass Of Diseased Or Blocked Major Upper To Lower Leg Artery With Vein
|
8
|
8
|
$3,700.00
|
$3,145.00
|
$1,460.55
|
$3,145.00
|
$2,383.32
|
2026-02-04
|
|
28520721_1
|
CDM
|
Full Dental Emergency Kit
|
8
|
8
|
$2,799.96
|
$2,379.97
|
$1,007.99
|
$2,659.96
|
$2,379.97
|
2026-02-04
|
|
70491
|
HCPCS
|
CT Scan Of Soft Tissue Of Neck With Contrast
|
16
|
8
|
$4,049.00
|
$3,441.65
|
$899.28
|
$5,320.00
|
$2,373.10
|
2026-02-04
|
|
27258
|
HCPCS
|
Treatment Of Spontaneous Dislocated Hip
|
7
|
6
|
$2,785.00
|
$2,367.25
|
$345.00
|
$2,645.75
|
$2,367.25
|
2026-02-04
|
|
71250
|
HCPCS
|
CT Scan Of Chest Without Contrast
|
24
|
8
|
$2,590.00
|
$2,201.50
|
$896.40
|
$4,227.50
|
$2,365.50
|
2026-02-04
|
|
70482
|
HCPCS
|
CT Scan Of Cranial Cavity Before And After Contrast
|
8
|
8
|
$2,781.00
|
$2,363.85
|
$1,001.16
|
$2,641.95
|
$2,363.85
|
2026-02-04
|
|
27384749_1
|
CDM
|
Myosure Lite Tissue Removal
|
8
|
8
|
$2,780.00
|
$2,363.00
|
$1,000.80
|
$2,641.00
|
$2,363.00
|
2026-02-04
|
|
27428
|
HCPCS
|
Reconstruction Ligaments Inside Knee Joint
|
7
|
6
|
$2,780.00
|
$2,363.00
|
$345.00
|
$2,641.00
|
$2,363.00
|
2026-02-04
|
|
87483
|
HCPCS
|
Test For Detecting Nucleic Acid Of Organism Causing Infection Of Central Nervous…
|
8
|
8
|
$2,770.00
|
$2,354.50
|
$997.20
|
$2,631.50
|
$2,354.50
|
2026-02-04
|
|
38505
|
HCPCS
|
Needle Biopsy Or Removal Of Surface Lymph Nodes
|
13
|
8
|
$2,940.00
|
$2,499.00
|
$250.92
|
$2,793.00
|
$2,352.00
|
2026-02-04
|
|
28699062_1
|
CDM
|
Capio Slim Suture Capturing Device (dr. Johns)
|
8
|
8
|
$2,761.84
|
$2,347.56
|
$994.26
|
$2,623.75
|
$2,347.56
|
2026-02-04
|
|
27958653_1
|
CDM
|
Graft Bifurcated Hemasheild 16 X8
|
8
|
8
|
$2,753.32
|
$2,340.32
|
$991.20
|
$2,615.65
|
$2,340.32
|
2026-02-04
|
|
70488
|
HCPCS
|
CT Scan Of Face Before And After Contrast
|
8
|
8
|
$2,750.00
|
$2,337.50
|
$990.00
|
$2,612.50
|
$2,337.50
|
2026-02-04
|