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

METHODIST HOSPITAL OF CHICAGO

Chicago, IL · CCN 140197 · Rates published

5,438 distinct procedures filed
21 distinct payers
124,031 rate rows
2026-02-24 last MRF observed
Data quality

5,370 of 124,031 rate rows are consumer-grade (4.3%)

118,661 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 118,661
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.thorek.org/hubfs/files/366000085_thorek-memorial-hospital-andersonville_standardcharges.json
Found on page https://www.thorek.org/price-transparency
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-01
Content fingerprint a5ca20610eda049d… · 55,077,609 bytes · first seen 2026-08-01

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
776
APR_DRG 		Other Drug Abuse And Dependence 1 $20,535.36 $20,535.36 $20,535.36 nat. median
$6,361
outlier · 3.2×
750
APR_DRG 		Schizophrenia 6 $11,116.38 $20,460.99 $17,416.86 nat. median
$10,533
1.7× median
753
APR_DRG 		Bipolar Disorders 5 $9,263.65 $20,613.12 $16,865.28 nat. median
$9,207
1.8× median
896
MS_DRG 		Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Wi 18 $14,115.00 $14,115.00 $14,115.00 nat. median
$15,476
0.9× median
754
APR_DRG 		Depression Except Major Depressive Disorder 5 $1,874.92 $18,739.20 $13,117.44 nat. median
$6,168
outlier · 2.1×
885
MS_DRG 		Psychoses 13 $7,407.77 $20,386.21 $11,874.48 nat. median
$12,319
1.0× median
758
APR_DRG 		Behavioral Disorders 1 $11,243.52 $11,243.52 $11,243.52 nat. median
$7,468
1.5× median
751
APR_DRG 		Major Depressive Disorders And Other Or Unspecified Psychoses 5 $5,558.19 $21,859.88 $9,369.60 nat. median
$8,658
1.1× median
756
APR_DRG 		Acute Anxiety And Delirium States 1 $7,495.68 $7,495.68 $7,495.68 nat. median
$7,250
1.0× median
897
MS_DRG 		Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Wi 7 $2,577.93 $9,039.23 $6,942.49 nat. median
$8,349
0.8× median
774
APR_DRG 		Cocaine Abuse And Dependence 5 $3,788.83 $8,517.45 $6,087.10 nat. median
$6,094
1.0× median
775
APR_DRG 		Alcohol Abuse And Dependence 5 $3,697.37 $8,342.98 $5,790.09 nat. median
$9,897
0.6× median
881
MS_DRG 		Depressive Neuroses 18 $2,811.40 $8,157.37 $5,741.27 nat. median
$8,592
0.7× median
6117055300
CDM 		MRI Brain Without And W/contrast 16 $5,686.61 $5,686.61 $5,686.61 nat. median
$5,687
1.0× median
773
APR_DRG 		Opioid Abuse And Dependence 6 $5,394.48 $7,180.40 $5,535.75 nat. median
$6,741
0.8× median
894
MS_DRG 		Alcohol, Drug Abuse Or Dependence, Left Ama 7 $2,733.64 $5,560.26 $5,040.37 nat. median
$6,102
0.8× median
770
APR_DRG 		Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice 5 $1,873.92 $6,842.67 $3,710.61 nat. median
$5,488
0.7× median
3602110140
CDM 		Or First .5 Hr 16 $744.50 $3,105.00 $2,421.53 nat. median
$2,422
1.0× median
762G037900
CDM 		Observation Direct Admit 6n 16 $2,163.88 $2,342.25 $2,253.07 nat. median
$2,253
1.0× median
3611014000
CDM 		Drainage Of Hematoma/fluid 16 $1,347.12 $2,538.00 $1,942.56 nat. median
$1,943
1.0× median
3527417700
CDM 		CT Abdomen&pelv W/contrast 16 $262.68 $3,367.70 $1,875.84 nat. median
$1,876
1.0× median
1200002002
CDM 		Room Semi-private Med Stabiliz 16 $1,762.00 $1,762.00 $1,762.00 nat. median
$1,762
1.0× median
7500015030
CDM 		Colonoscopy W/polyp 16 $919.24 $2,588.00 $1,700.18 nat. median
$1,700
1.0× median
3517048700
CDM 		CT Facial/sinuses W/contrast 16 $1,622.65 $1,622.65 $1,622.65 nat. median
$1,623
1.0× median
3507212500
CDM 		CT Cervical Without Cont 3 $183.51 $4,171.61 $1,579.14 nat. median
$1,579
1.0× median
7500015020
CDM 		Colon Biop/specimen 16 $745.09 $2,500.00 $1,441.56 nat. median
$1,442
1.0× median
7500015015
CDM 		Colonoscopy 16 $436.49 $1,997.61 $1,420.30 nat. median
$1,420
1.0× median
G0379
HCPCS 		Direct Refer Hospital Observ 4 $272.98 $2,342.25 $1,258.79 nat. median
$571
outlier · 2.2×
4509928500
CDM 		E.r. Level V 16 $184.87 $2,326.57 $1,255.72 nat. median
$1,256
1.0× median
3507127500
CDM 		CT Angiogram Chest W Contrast 16 $447.80 $1,832.94 $1,151.90 nat. median
$1,152
1.0× median
7500015140
CDM 		Egd 16 $766.22 $1,558.87 $1,124.19 nat. median
$1,124
1.0× median
7500015150
CDM 		Egd Biopsy/specimen 10 $393.97 $1,937.91 $1,105.57 nat. median
$1,106
1.0× median
3507213100
CDM 		CT Lumbar Spine Without Contrast 16 $134.01 $1,188.15 $1,105.04 nat. median
$1,105
1.0× median
4501313200
CDM 		Cmpx Rpr Fccmnaxghf 2.6-7.5 Cm 16 $1,103.07 $1,103.07 $1,103.07 nat. median
$1,103
1.0× median
3507048600
CDM 		CT Facial Without Cont 2 $86.91 $2,069.80 $1,078.36 nat. median
$1,078
1.0× median
3507417400
CDM 		CT Angio Abd Pelvis W Contrast 16 $1,065.59 $1,072.30 $1,072.30 nat. median
$1,072
1.0× median
3600285209
CDM 		Prep Fee Ops 16 $1,023.85 $1,023.85 $1,023.85 nat. median
$1,024
1.0× median
G0104
HCPCS 		Ca Screen;flexi Sigmoidscope 1 $931.37 $931.37 $931.37 nat. median
$1,014
0.9× median
G0121
HCPCS 		Colon Ca Scrn Not Hi Rsk Ind 3 $866.17 $931.37 $931.37 nat. median
$1,292
0.7× median
G0105
HCPCS 		Colorectal Scrn; Hi Risk Ind 1 $931.37 $931.37 $931.37 nat. median
$1,305
0.7× median
7500015260
CDM 		Tube Replacement Peg 16 $383.11 $1,357.02 $870.07 nat. median
$870
1.0× median
3507125000
CDM 		CT Chest Without Contrast 2 $86.91 $1,367.26 $727.08 nat. median
$727
1.0× median
9219397000
CDM 		Ven Doppler Extremities Lwr Bi 16 $197.54 $1,071.78 $722.50 nat. median
$722
1.0× median
7504533000
CDM 		Sigmoidoscopy 16 $137.99 $931.37 $687.77 nat. median
$688
1.0× median
4509928200
CDM 		E.r. Level Ii 16 $129.42 $685.71 $685.71 nat. median
$686
1.0× median
9219393000
CDM 		Arterial Bilateral Uper Duplex 16 $561.20 $561.20 $561.20 nat. median
$561
1.0× median
4509636600
CDM 		Thx/proph/diag IV Inf Addon ER 16 $556.37 $556.37 $556.37 nat. median
$556
1.0× median
4027685600
CDM 		Ultrasound Pelvis Complete 16 $203.03 $881.54 $542.28 nat. median
$542
1.0× median
4109464000
CDM 		Nebulizer Tx 16 $525.32 $525.32 $525.32 nat. median
$525
1.0× median
4027677000
CDM 		Ultrasound Renal 16 $211.47 $508.49 $495.81 nat. median
$496
1.0× median

Other procedures at this hospital

Browse this hospital's 5,438 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
             
776 APR_DRG Other Drug Abuse And Dependence 1 1 — — $20,535.36 $20,535.36 $20,535.36 2026-02-24
750 APR_DRG Schizophrenia 6 6 — — $11,116.38 $20,460.99 $17,416.86 2026-02-24
753 APR_DRG Bipolar Disorders 5 5 — — $9,263.65 $20,613.12 $16,865.28 2026-02-24
896 MS_DRG Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Wi 23 18 — — $14,115.00 $14,115.00 $14,115.00 2026-02-24
754 APR_DRG Depression Except Major Depressive Disorder 5 5 — — $1,874.92 $18,739.20 $13,117.44 2026-02-24
885 MS_DRG Psychoses 15 13 — — $7,407.77 $20,386.21 $11,874.48 2026-02-24
758 APR_DRG Behavioral Disorders 1 1 — — $11,243.52 $11,243.52 $11,243.52 2026-02-24
751 APR_DRG Major Depressive Disorders And Other Or Unspecified Psychoses 5 5 — — $5,558.19 $21,859.88 $9,369.60 2026-02-24
756 APR_DRG Acute Anxiety And Delirium States 1 1 — — $7,495.68 $7,495.68 $7,495.68 2026-02-24
897 MS_DRG Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Wi 10 7 — — $2,577.93 $9,039.23 $6,942.49 2026-02-24
774 APR_DRG Cocaine Abuse And Dependence 5 5 — — $3,788.83 $8,517.45 $6,087.10 2026-02-24
775 APR_DRG Alcohol Abuse And Dependence 5 5 — — $3,697.37 $8,342.98 $5,790.09 2026-02-24
881 MS_DRG Depressive Neuroses 23 18 — — $2,811.40 $8,157.37 $5,741.27 2026-02-24
6117055300 CDM MRI Brain Without And W/contrast 23 16 $5,854.00 $5,854.00 $5,686.61 $5,686.61 $5,686.61 2026-02-24
773 APR_DRG Opioid Abuse And Dependence 6 6 — — $5,394.48 $7,180.40 $5,535.75 2026-02-24
894 MS_DRG Alcohol, Drug Abuse Or Dependence, Left Ama 7 7 — — $2,733.64 $5,560.26 $5,040.37 2026-02-24
770 APR_DRG Drug And Alcohol Abuse Or Dependence, Left Against Medical Advice 6 5 — — $1,873.92 $6,842.67 $3,710.61 2026-02-24
3602110140 CDM Or First .5 Hr 23 16 $1,547.00 $1,547.00 $744.50 $3,105.00 $2,421.53 2026-02-24
762G037900 CDM Observation Direct Admit 6n 23 16 $1,961.00 $1,961.00 $2,163.88 $2,342.25 $2,253.07 2026-02-24
3611014000 CDM Drainage Of Hematoma/fluid 23 16 $2,881.00 $2,881.00 $1,347.12 $2,538.00 $1,942.56 2026-02-24
3527417700 CDM CT Abdomen&pelv W/contrast 23 16 $3,489.00 $3,489.00 $262.68 $3,367.70 $1,875.84 2026-02-24
1200002002 CDM Room Semi-private Med Stabiliz 23 16 $1,851.00 $1,851.00 $1,762.00 $1,762.00 $1,762.00 2026-02-24
7500015030 CDM Colonoscopy W/polyp 23 16 $2,955.00 $2,955.00 $919.24 $2,588.00 $1,700.18 2026-02-24
3517048700 CDM CT Facial/sinuses W/contrast 23 16 $2,964.00 $2,964.00 $1,622.65 $1,622.65 $1,622.65 2026-02-24
3507212500 CDM CT Cervical Without Cont 3 3 $2,051.00 $2,051.00 $183.51 $4,171.61 $1,579.14 2026-02-24
7500015020 CDM Colon Biop/specimen 23 16 $2,295.00 $2,295.00 $745.09 $2,500.00 $1,441.56 2026-02-24
7500015015 CDM Colonoscopy 23 16 $2,088.00 $2,088.00 $436.49 $1,997.61 $1,420.30 2026-02-24
G0379 HCPCS Direct Refer Hospital Observ 4 4 — — $272.98 $2,342.25 $1,258.79 2026-02-24
4509928500 CDM E.r. Level V 23 16 $1,296.00 $1,296.00 $184.87 $2,326.57 $1,255.72 2026-02-24
3507127500 CDM CT Angiogram Chest W Contrast 23 16 $1,856.00 $1,856.00 $447.80 $1,832.94 $1,151.90 2026-02-24
7500015140 CDM Egd 23 16 $1,631.00 $1,631.00 $766.22 $1,558.87 $1,124.19 2026-02-24
7500015150 CDM Egd Biopsy/specimen 14 10 $1,886.00 $1,886.00 $393.97 $1,937.91 $1,105.57 2026-02-24
3507213100 CDM CT Lumbar Spine Without Contrast 23 16 $2,148.00 $2,148.00 $134.01 $1,188.15 $1,105.04 2026-02-24
4501313200 CDM Cmpx Rpr Fccmnaxghf 2.6-7.5 Cm 23 16 $1,595.25 $1,595.25 $1,103.07 $1,103.07 $1,103.07 2026-02-24
3507048600 CDM CT Facial Without Cont 2 2 $2,255.00 $2,255.00 $86.91 $2,069.80 $1,078.36 2026-02-24
3507417400 CDM CT Angio Abd Pelvis W Contrast 23 16 $1,079.00 $1,079.00 $1,065.59 $1,072.30 $1,072.30 2026-02-24
3600285209 CDM Prep Fee Ops 23 16 $133.00 $133.00 $1,023.85 $1,023.85 $1,023.85 2026-02-24
G0121 HCPCS Colon Ca Scrn Not Hi Rsk Ind 3 3 — — $866.17 $931.37 $931.37 2026-02-24
G0104 HCPCS Ca Screen;flexi Sigmoidscope 1 1 — — $931.37 $931.37 $931.37 2026-02-24
G0105 HCPCS Colorectal Scrn; Hi Risk Ind 1 1 — — $931.37 $931.37 $931.37 2026-02-24
7500015260 CDM Tube Replacement Peg 23 16 $3,253.00 $3,253.00 $383.11 $1,357.02 $870.07 2026-02-24
3507125000 CDM CT Chest Without Contrast 2 2 $1,986.00 $1,986.00 $86.91 $1,367.26 $727.08 2026-02-24
9219397000 CDM Ven Doppler Extremities Lwr Bi 23 16 $1,368.00 $1,368.00 $197.54 $1,071.78 $722.50 2026-02-24
7504533000 CDM Sigmoidoscopy 23 16 $475.00 $475.00 $137.99 $931.37 $687.77 2026-02-24
4509928200 CDM E.r. Level Ii 23 16 $423.00 $423.00 $129.42 $685.71 $685.71 2026-02-24
9219393000 CDM Arterial Bilateral Uper Duplex 23 16 $1,350.00 $1,350.00 $561.20 $561.20 $561.20 2026-02-24
4509636600 CDM Thx/proph/diag IV Inf Addon ER 23 16 $116.00 $116.00 $556.37 $556.37 $556.37 2026-02-24
4027685600 CDM Ultrasound Pelvis Complete 23 16 $954.00 $954.00 $203.03 $881.54 $542.28 2026-02-24
4109464000 CDM Nebulizer Tx 23 16 $689.00 $689.00 $525.32 $525.32 $525.32 2026-02-24
4027677000 CDM Ultrasound Renal 23 16 $933.00 $933.00 $211.47 $508.49 $495.81 2026-02-24
7100020020 CDM 1st Unit 60min Rec Rm Chg 23 16 $573.00 $573.00 $130.06 $824.69 $476.01 2026-02-24
3601204100 CDM 12041 < 2.5cm Layer Closure 23 16 $529.00 $529.00 $472.36 $472.36 $472.36 2026-02-24
272A464900 CDM Dermabond 23 16 $529.00 $529.00 $458.43 $467.92 $467.92 2026-02-24
2609636001 CDM IV Inf Hydration 0-1 Hr ER 23 16 $733.00 $733.00 $193.72 $675.97 $463.36 2026-02-24
2609637401 CDM IV Push Single/initial Drug ER 23 16 $733.00 $733.00 $193.72 $592.84 $463.36 2026-02-24
4027685700 CDM US Pelvis Limited Non OB 23 16 $826.00 $826.00 $137.26 $732.66 $461.63 2026-02-24
A4649 HCPCS Surgical Supplies 1 1 — — $458.43 $458.43 $458.43 2026-02-24
4027683000 CDM Ultrasound Trans Vaginal 23 16 $849.00 $849.00 $137.26 $784.46 $458.12 2026-02-24
2609637400 CDM IV Push Single/initial Drug 23 16 $732.00 $732.00 $172.19 $452.10 $452.10 2026-02-24
V2632 HCPCS Post Chmbr Intraocular Lens 1 1 — — $437.70 $437.70 $437.70 2026-02-24
4027653600 CDM Ultrasnd Soft Tisse Head/neck 23 16 $739.00 $739.00 $137.26 $703.00 $425.39 2026-02-24
3008007600 CDM Hepatic Function Panel 23 16 $507.00 $507.00 $414.73 $414.73 $414.73 2026-02-24
3601200100 CDM 12001 2.5cm Or Less Smple Repr 23 16 $616.00 $616.00 $228.88 $401.32 $401.32 2026-02-24
3018388000 CDM B-type Natriuretic Peptide 23 16 $528.00 $528.00 $306.77 $400.06 $400.06 2026-02-24
3527417600 CDM CT Abd & Pelvis Without Contrast 5 4 $2,126.00 $2,126.00 $197.54 $1,873.55 $381.74 2026-02-24
3517045000 CDM CT Head Without Contrast 6 5 $2,044.00 $2,044.00 $86.91 $1,564.77 $374.12 2026-02-24
4509637400 CDM Injection Initial IV Push ER 23 16 $632.00 $632.00 $172.19 $412.56 $355.88 2026-02-24
2609636501 CDM IV Inf Therapy 0-1 Hr ER 23 16 $348.00 $348.00 $355.16 $355.16 $355.16 2026-02-24
2609636500 CDM Infusion Therapy 1st Hr 23 16 $348.00 $348.00 $348.00 $348.00 $348.00 2026-02-24
4509928400 CDM E.r. Level IV 11 9 $960.00 $960.00 $252.83 $993.60 $348.00 2026-02-24
3028670100 CDM HIV-1 Antibody 23 16 $217.00 $217.00 $199.09 $486.83 $342.96 2026-02-24
2609636101 CDM Hydration Add Hour 1-8 ER 23 16 $366.00 $366.00 $233.27 $556.37 $336.12 2026-02-24
4509636500 CDM Ther/proph/diag IV Inf Init ER 23 16 $477.00 $477.00 $172.19 $461.41 $316.80 2026-02-24
3018354000 CDM Iron Assay 23 16 $369.00 $369.00 $310.72 $330.01 $310.72 2026-02-24
2609636100 CDM Hydration Add Hr 23 16 $366.00 $366.00 $37.71 $579.50 $308.61 2026-02-24
3207222000 CDM Sacrum & Coccyx 2+vw 23 16 $296.00 $296.00 $296.00 $296.00 $296.00 2026-02-24
4609476000 CDM Pulse Ox Spot Check 23 16 $191.00 $191.00 $191.00 $289.88 $289.88 2026-02-24
3601200200 CDM 12002 2.6 Cm-7.5 Cm Simpl Repr 23 16 $427.00 $427.00 $287.79 $289.48 $289.48 2026-02-24
3600285217 CDM Prep Fee Sds 23 16 $315.00 $315.00 $261.08 $280.54 $280.54 2026-02-24
3068750200 CDM Influenza A & Influenza B Pcr 23 16 $403.00 $403.00 $207.69 $328.25 $272.66 2026-02-24
3207356201 CDM 3 View Knee Lt 23 16 $522.00 $522.00 $70.52 $497.00 $265.43 2026-02-24
3207356200 CDM 3 View Knee Rt 23 16 $522.00 $522.00 $35.26 $497.00 $265.43 2026-02-24
3207210000 CDM Lumbar Spine Routine 23 16 $496.00 $496.00 $70.52 $422.00 $264.93 2026-02-24
Q9967 HCPCS Locm 300-399mg/ml Iodine,1ml 1 1 — — $260.61 $260.61 $260.61 2026-02-24
2720020410 CDM Bovie 23 16 $268.00 $268.00 $192.82 $256.98 $256.98 2026-02-24
636Q996700 CDM Optiray300-350 100ml Per Ml 23 16 $304.00 $304.00 $248.03 $260.61 $248.03 2026-02-24
3028687000 CDM Antibody Id Thhc 23 16 $951.00 $951.00 $165.03 $330.74 $247.88 2026-02-24
3008230600 CDM Vitamin D (25-hydroxy) 23 16 $307.00 $307.00 $247.56 $250.21 $247.56 2026-02-24
2720015410 CDM Hot Biopsy Fx 23 16 $86.00 $86.00 $234.05 $249.00 $234.05 2026-02-24
7629921900 CDM Observation Per Hour 6n Comp C 23 16 $108.00 $108.00 $64.90 $231.03 $231.03 2026-02-24
3700010001 CDM Anes.time 1st Hr. 23 16 $311.00 $311.00 $64.99 $297.54 $222.12 2026-02-24
3603090100 CDM Nasal Hemorr.ant.simp 23 16 $403.00 $403.00 $220.84 $220.84 $220.84 2026-02-24
3507127100 CDM Ldct For Lung Ca Screening 23 16 $228.00 $228.00 $217.00 $217.00 $217.00 2026-02-24
4509928300 CDM E.r. Level Iii 11 8 $642.00 $642.00 $68.10 $511.37 $215.39 2026-02-24
4569928300 CDM Class Iii ER Fee 23 16 $407.00 $407.00 $213.73 $213.73 $213.73 2026-02-24
4027670000 CDM Ultrasound Abdominal Survey 5 3 $1,180.00 $1,180.00 $86.91 $1,130.00 $211.47 2026-02-24
3207361000 CDM Ankle Left Min 3v 23 16 $251.00 $251.00 $183.98 $207.49 $207.49 2026-02-24
2700020203 CDM Solution Water 1000 Ml Bottle 23 16 $15.00 $15.00 $205.67 $205.67 $205.67 2026-02-24
9219392500 CDM Arterial Bilateral Low Duplex 23 16 $667.00 $667.00 $197.54 $211.47 $204.50 2026-02-24
3018030700 CDM Drug Screen 23 16 $364.00 $364.00 $40.39 $244.93 $202.19 2026-02-24
4509928100 CDM E.r. Level I 23 16 $260.00 $260.00 $144.30 $214.36 $200.43 2026-02-24
2590798123 CDM Chondroitin/hyaluronate 1 Kit 23 16 $549.00 $549.00 $199.20 $199.20 $199.20 2026-02-24
3018470200 CDM Hcg, Quant 23 16 $217.00 $217.00 $198.20 $217.00 $198.20 2026-02-24
3207363000 CDM Foot Right Min 3v 23 16 $387.00 $387.00 $67.71 $318.00 $197.93 2026-02-24
3207110100 CDM Ribs Unilat Inc Pa Chest Min3v 23 16 $304.00 $304.00 $67.71 $179.75 $178.99 2026-02-24
A9270 HCPCS Non-covered Item Or Service 3 2 — — $149.41 $192.82 $176.75 2026-02-24
3207359000 CDM Tibia And Fibia Rt 23 16 $264.00 $264.00 $175.56 $175.56 $175.56 2026-02-24
3207110000 CDM Ribs Rt 23 16 $334.00 $334.00 $67.71 $307.37 $170.61 2026-02-24
3018260700 CDM Vitamin B12 Assay 23 16 $189.00 $189.00 $168.96 $170.46 $170.46 2026-02-24
4509637200 CDM Injection IM ER 23 16 $228.00 $228.00 $166.90 $188.43 $166.90 2026-02-24
3207311000 CDM Wrist Right Min 3v 23 16 $240.00 $240.00 $165.81 $165.81 $165.81 2026-02-24
3207313000 CDM Hand Right Min 3v 23 16 $254.00 $254.00 $70.52 $209.90 $162.26 2026-02-24
G0463 HCPCS Hospital Outpt Clinic Visit 16 11 — — $105.32 $365.00 $161.87 2026-02-24
3008740000 CDM Covid & Flu A/b Rapid 23 16 $190.00 $190.00 $158.38 $158.38 $158.38 2026-02-24
3247104600 CDM Chest 2 View 23 16 $293.00 $293.00 $28.13 $243.00 $158.19 2026-02-24
3207303000 CDM Shoulder Right 23 16 $269.00 $269.00 $66.26 $154.49 $154.49 2026-02-24
3601006000 CDM 10060 I&d Absces,smpl Or Sngl 23 16 $282.00 $282.00 $153.69 $153.69 $153.69 2026-02-24
3207205000 CDM Spine Cerv-4 Or 5v 23 16 $322.00 $322.00 $33.85 $266.21 $150.03 2026-02-24
3247104500 CDM Chest 1 View 23 16 $260.00 $260.00 $35.26 $233.28 $147.63 2026-02-24
3068763500 CDM 2019-ncov Real Time-pcr 23 16 $248.00 $248.00 $41.91 $202.00 $144.96 2026-02-24
3207350200 CDM Hip Ap Lat Lt 23 16 $276.00 $276.00 $67.71 $144.29 $144.29 2026-02-24
7309300500 CDM EKG Technical 23 16 $252.00 $252.00 $32.28 $235.12 $141.50 2026-02-24
3028614100 CDM Crp,high Sensitivity 23 16 $175.00 $175.00 $137.11 $138.51 $138.51 2026-02-24
2590780744 CDM Humulin-r 100u/ml 23 16 $139.00 $139.00 $138.35 $138.35 $138.35 2026-02-24
4027687000 CDM Ultrasound Scrotum 23 16 $796.00 $796.00 $137.26 $137.26 $137.26 2026-02-24
4027688100 CDM US Xtr Non-vasc Complete 23 16 $520.00 $520.00 $131.78 $134.52 $134.52 2026-02-24
3068765100 CDM Strep A Pcr 23 16 $160.00 $160.00 $133.38 $133.38 $133.38 2026-02-24
3018032900 CDM Salicylates 23 16 $188.00 $188.00 $112.98 $133.14 $133.14 2026-02-24
6370059169 CDM Pred Forte 1%, 5ml 23 16 $48.00 $48.00 $110.23 $132.79 $132.79 2026-02-24
3207207000 CDM Spine Thorac Ap/lat 2v 23 16 $277.00 $277.00 $70.52 $229.01 $132.13 2026-02-24
510G046300 CDM Facility Fee Op Clinic Visit 15 10 $385.00 $385.00 $105.32 $365.00 $131.65 2026-02-24
3207362000 CDM Foot Ap & Lateral Right 23 16 $297.00 $297.00 $70.52 $164.12 $130.16 2026-02-24
3028678000 CDM Syphilis Total And Rpr 23 16 $155.00 $155.00 $115.92 $129.06 $129.06 2026-02-24
3207217000 CDM Pelvis 2 View 23 16 $268.00 $268.00 $128.26 $128.26 $128.26 2026-02-24
762G03780Z CDM Observation Per Hour 6n Mcd 23 16 $108.00 $108.00 $36.62 $128.16 $128.16 2026-02-24
250A957500 CDM Dotarem 20ml Vial 0.1ml 23 16 $130.00 $130.00 $126.28 $126.28 $126.28 2026-02-24
A9575 HCPCS Inj Gadoterate Meglumi 0.1ml 1 1 — — $126.28 $126.28 $126.28 2026-02-24
4509636700 CDM Tx/proph/dg Addl Seq IV Inf 23 16 $123.00 $123.00 $123.00 $123.00 $123.00 2026-02-24
2720027209 CDM Block Bite Maxi Velcro Strap 3 2 $15.00 $15.00 $1.78 $149.41 $121.96 2026-02-24
3068718600 CDM Sensitivity (mic) 23 16 $132.00 $132.00 $115.66 $121.67 $121.67 2026-02-24
3068749100 CDM Chlamydia Trachomatis By Pcr 23 16 $212.00 $212.00 $43.65 $194.50 $119.08 2026-02-24
3018224800 CDM Bilirubin Direct 23 16 $122.00 $122.00 $113.12 $113.12 $113.12 2026-02-24
2720272244 CDM Endoscopic Spot Marker 23 16 $143.00 $143.00 $108.00 $112.19 $112.19 2026-02-24
4027670500 CDM US Abdomen Lmtd 23 16 $776.00 $776.00 $86.91 $137.26 $112.08 2026-02-24
9219397100 CDM Ven Doppler Extremities Upr Rt 4 3 $515.00 $515.00 $15.22 $515.00 $112.08 2026-02-24
3068759100 CDM Neisseria Gonorrhoeae By Pcr 23 16 $212.00 $212.00 $21.82 $194.51 $108.17 2026-02-24
2580790438 CDM Flurbiprofen .03% 2.5ml Btl 23 16 $116.00 $116.00 $105.06 $128.00 $105.06 2026-02-24
3207314000 CDM Fingers Lt 23 16 $219.00 $219.00 $67.71 $141.08 $104.39 2026-02-24
3068781100 CDM Covid 19 Ag 23 16 $196.00 $196.00 $10.30 $161.23 $103.15 2026-02-24
3018272800 CDM Ferritin 23 16 $195.00 $195.00 $13.36 $173.90 $103.08 2026-02-24
3018373500 CDM Magnesium Assay 3 2 $122.00 $122.00 $5.50 $110.00 $101.70 2026-02-24
3018443600 CDM Assay Of Total Thyroxine 23 16 $101.00 $101.00 $99.87 $99.87 $99.87 2026-02-24
9409637500 CDM Injection IV Ea Add New Drug 23 16 $108.00 $108.00 $97.67 $107.23 $97.67 2026-02-24
2500797637 CDM Ciloxan Opth Sol. 2.5ml 23 16 $138.00 $138.00 $60.54 $96.72 $96.72 2026-02-24
3018415300 CDM Prostate Spec Antign 23 16 $219.00 $219.00 $12.17 $178.24 $95.20 2026-02-24
7719047100 CDM Immunization Admin Flu 23 16 $194.00 $194.00 $47.14 $93.46 $92.47 2026-02-24
3058565100 CDM Esr Non-automated 23 16 $125.00 $125.00 $86.37 $92.15 $92.15 2026-02-24
3207352300 CDM Hips Bilatrl Inc Ap Plvs Min5v 23 16 $304.00 $304.00 $87.40 $87.40 $87.40 2026-02-24
3507370000 CDM CT Lower Extremity Without Cont Rt 23 16 $1,776.00 $1,776.00 $86.91 $86.91 $86.91 2026-02-24
2590717753 CDM Tetracaine Hcl Op .5% 15ml Btl 23 16 $102.00 $102.00 $84.31 $84.31 $84.31 2026-02-24
3018360500 CDM Lactic Acid 23 16 $155.00 $155.00 $11.69 $155.00 $83.34 2026-02-24
6369071500 CDM Dipth-pertus-tetanus Vial0.5ml 23 16 $321.00 $321.00 $25.63 $105.51 $83.28 2026-02-24
3068708600 CDM Urine Culture 23 16 $153.00 $153.00 $10.73 $127.74 $81.86 2026-02-24
2720015325 CDM Acusnare Polyp Sash-1-s Disp 23 16 $103.00 $103.00 $26.10 $80.81 $80.81 2026-02-24
3008004800 CDM Basic Metabolic Panel 80048 23 16 $160.00 $160.00 $8.29 $131.76 $80.53 2026-02-24
6369071400 CDM Tetanus-diphtheria Toxoid 23 16 $62.00 $62.00 $25.63 $105.57 $75.42 2026-02-24
3207401800 CDM Abdomen Single Ant View 23 16 $204.00 $204.00 $67.71 $111.55 $73.41 2026-02-24
3018257000 CDM Urine Creatinine 23 16 $122.00 $122.00 $72.93 $72.93 $72.93 2026-02-24
G0480 HCPCS Drug Test Def 1-7 Classes 2 2 — — $34.82 $107.25 $71.03 2026-02-24
3018032000 CDM Alcohol (eth) Blood 23 16 $128.00 $128.00 $13.68 $101.96 $70.84 2026-02-24
3207306000 CDM Humerus Right Min 2v 23 16 $239.00 $239.00 $70.52 $70.52 $70.52 2026-02-24
3207308001 CDM Elbow Right 23 16 $235.00 $235.00 $70.52 $70.52 $70.52 2026-02-24
3207110002 CDM Ribs Lt 23 16 $334.00 $334.00 $70.52 $70.52 $70.52 2026-02-24
3207010000 CDM Mandible <4 Views 23 16 $444.00 $444.00 $70.52 $70.52 $70.52 2026-02-24
G0378 HCPCS Hospital Observation Per Hr 5 4 — — $36.62 $87.88 $70.31 2026-02-24
G0008 HCPCS Admin Influenza Virus Vac 2 2 — — $47.14 $93.46 $70.30 2026-02-24
2609636600 CDM Infusion Therapy Ea Add Hr Onc 23 16 $116.00 $116.00 $69.55 $69.55 $69.55 2026-02-24
2500798121 CDM Ondansetron 4mg Odt Tab 23 16 $9.00 $9.00 $55.35 $69.42 $69.42 2026-02-24
3068780700 CDM Rsv By Pcr 23 16 $128.00 $128.00 $10.30 $103.70 $69.15 2026-02-24
3207112000 CDM Sternum 2+vws 23 16 $208.00 $208.00 $67.71 $69.11 $69.11 2026-02-24
3207021000 CDM Paranasal Sns <3 Views 23 16 $331.00 $331.00 $67.71 $69.11 $69.11 2026-02-24
2590797872 CDM Neomycin-polymyx-dexameth 0.1% 23 16 $104.00 $104.00 $66.64 $68.17 $68.17 2026-02-24
3207366000 CDM Toes 2+views Right 23 16 $220.00 $220.00 $67.71 $67.71 $67.71 2026-02-24
3008537800 CDM D-dimer Assay 2 1 $166.00 $166.00 $4.51 $130.05 $67.28 2026-02-24
3068704000 CDM Cult Blood 2 1 $158.00 $158.00 $5.37 $128.05 $66.71 2026-02-24
3018255000 CDM Creatine Phosphokina Total 23 16 $122.00 $122.00 $65.99 $99.43 $65.99 2026-02-24
636J195300 CDM Levetiractam Inj 500mg/5ml Vl 23 16 $51.00 $51.00 $65.84 $65.84 $65.84 2026-02-24
J1953 HCPCS Levetiracetam Injection 1 1 — — $65.84 $65.84 $65.84 2026-02-24
J7120 HCPCS Ringers Lactate Infusion 1 1 — — $60.75 $60.75 $60.75 2026-02-24
3018455000 CDM Uric Acid Serum 23 16 $122.00 $122.00 $5.50 $108.69 $57.09 2026-02-24
4509637500 CDM Injection Ivp Add ER 23 16 $79.00 $79.00 $54.16 $72.24 $54.16 2026-02-24
J7040 HCPCS Normal Saline Solution Infus 1 1 — — $53.25 $53.25 $53.25 2026-02-24
3207308000 CDM Elbow Left 23 16 $235.00 $235.00 $33.85 $50.78 $50.78 2026-02-24
U0002 HCPCS Covid-19 Lab Test Non-cdc 3 3 — — $50.28 $202.00 $50.28 2026-02-24
2500058081 CDM Sod Chloride 0.9% 50 Ml IV 23 16 $13.00 $13.00 $47.94 $48.76 $48.76 2026-02-24
3058573000 CDM Partial Thrombo Time 2 2 $96.00 $96.00 $2.25 $94.81 $48.53 2026-02-24
J0360 HCPCS Hydralazine Hcl Injection 1 1 — — $48.08 $48.08 $48.08 2026-02-24
2580790313 CDM *dextrose 5%.45% Sod Chloride 23 16 $67.00 $67.00 $47.11 $47.11 $47.11 2026-02-24
2500058951 CDM Kcl 20meq Powder 23 16 $5.00 $5.00 $36.51 $44.71 $44.71 2026-02-24
2722114399 CDM Weck Cell Spears 23 16 $53.00 $53.00 $43.51 $43.51 $43.51 2026-02-24
87635 HCPCS Covid-19 Lab Test Non-cdc 1 1 — — $41.91 $41.91 $41.91 2026-02-24
2609637600 CDM IV Push New Drug > 30 Min 23 16 $66.00 $66.00 $14.54 $66.00 $40.27 2026-02-24
2500752859 CDM Methylpred Sod 125 23 16 $44.00 $44.00 $39.58 $42.55 $39.58 2026-02-24
4509637600 CDM Inject IV Ea Add Same Drug ER 23 16 $38.00 $38.00 $36.76 $36.76 $36.76 2026-02-24
J1631 HCPCS Haloperidol Decanoate Inj 1 1 — — $30.27 $30.27 $30.27 2026-02-24
J7030 HCPCS Normal Saline Solution Infus 6 5 — — $2.05 $84.16 $29.25 2026-02-24
J0169 HCPCS Inj Epinephrine (adrenalin) 2 2 — — $1.61 $54.32 $27.96 2026-02-24
2500774507 CDM Cyclobenzaprine 10mg 23 16 $10.00 $10.00 $7.09 $27.77 $27.77 2026-02-24
2700060605 CDM Finger Splint 23 16 $37.00 $37.00 $21.35 $26.71 $26.71 2026-02-24
J2470 HCPCS Inj Pantoprazole Sodium 40mg 1 1 — — $25.40 $25.40 $25.40 2026-02-24
2700060550 CDM Ice Pack 23 16 $33.00 $33.00 $25.32 $28.21 $25.32 2026-02-24
2700060615 CDM Ace Bandage 23 16 $23.00 $23.00 $25.13 $25.13 $25.13 2026-02-24
2500797645 CDM Maalox Es 30ml Ud 23 16 $7.00 $7.00 $23.76 $24.86 $24.86 2026-02-24
6370059456 CDM Amoxicil/clavulanate 875mg Tab 23 16 $16.00 $16.00 $20.97 $22.95 $22.95 2026-02-24
2500795262 CDM Diltiazem Hcl 5mg/ml 5ml Vial 23 16 $94.00 $94.00 $22.20 $22.20 $22.20 2026-02-24
3078100100 CDM Urinalysis With Microscopic 2 2 $71.00 $71.00 $2.06 $41.87 $21.96 2026-02-24
2500701799 CDM Doxycycline Hyclate 100 Mg Cap 23 16 $14.00 $14.00 $18.49 $20.05 $20.05 2026-02-24
2500058889 CDM Magnesium Citrate 300ml 23 16 $4.00 $4.00 $19.76 $19.76 $19.76 2026-02-24
3003641500 CDM 36415 Blood Drawing 23 16 $35.00 $35.00 $3.29 $33.48 $19.14 2026-02-24
2500791360 CDM Ketorolc Trmthmn 30mg/mlpr15mg 23 16 $36.84 $36.84 $16.99 $18.21 $18.21 2026-02-24
J1885 HCPCS Ketorolac Tromethamine Inj 1 1 — — $16.99 $16.99 $16.99 2026-02-24
3008102500 CDM Pregnancy Test, Urine 4 4 $125.00 $125.00 $1.47 $109.53 $16.67 2026-02-24
3018448100 CDM T3-free Serum 3 3 $223.00 $223.00 $13.44 $198.60 $16.60 2026-02-24
636J200301 CDM Lidocaine/pf 2% 5 Ml Vial 23 16 $49.88 $49.88 $16.59 $16.59 $16.59 2026-02-24
2720060825 CDM Kerlix 2,3,4 23 16 $20.00 $20.00 $13.83 $15.61 $15.61 2026-02-24
J2543 HCPCS Piperacillin/tazobactam 1 1 — — $14.91 $14.91 $14.91 2026-02-24
2700060742 CDM Large Basin 23 16 $20.00 $20.00 $14.29 $14.63 $14.63 2026-02-24
80320 HCPCS Drug Test Def 1-7 Classes 3 3 — — $13.68 $14.25 $14.25 2026-02-24
3018016400 CDM Valproic Acid 23 16 $195.00 $195.00 $13.27 $13.27 $13.27 2026-02-24
3008006100 CDM Lipid Panel 11 8 $416.00 $416.00 $4.60 $339.05 $13.12 2026-02-24
J2270 HCPCS Morphine Sulfate Injection 1 1 — — $12.81 $12.81 $12.81 2026-02-24
2590790701 CDM Famotidine 20mg Tab 23 16 $15.00 $15.00 $5.16 $12.65 $12.65 2026-02-24
2700060685 CDM Butterfly 23 16 $18.00 $18.00 $12.32 $15.56 $12.32 2026-02-24
2590715765 CDM Naproxen 500mg Tab 23 16 $11.00 $11.00 $12.25 $12.30 $12.30 2026-02-24
3018448400 CDM Troponin-i, Quant 3 2 $152.00 $152.00 $6.09 $129.39 $12.17 2026-02-24
2720021087 CDM Tray Suture Removal #3121 23 16 $16.00 $16.00 $11.98 $11.98 $11.98 2026-02-24
2500057687 CDM Multivitamin Tab 23 16 $4.00 $4.00 $7.70 $11.95 $11.95 2026-02-24
3008444300 CDM 84443 Thyroid Stimu Hormone 23 16 $189.00 $189.00 $11.59 $16.46 $11.59 2026-02-24
636J120000 CDM Diphenhydramine Amp 50mg/ml 23 16 $21.00 $21.00 $1.10 $19.89 $11.43 2026-02-24
636J110000 CDM Dexamethasone 23 16 $19.70 $19.70 $11.33 $11.33 $11.33 2026-02-24
J1100 HCPCS Dexamethasone Sodium Phos 1 1 — — $11.33 $11.33 $11.33 2026-02-24
2500790677 CDM Lidocaine Hcl 1% 2ml 2ml Vial 23 16 $16.00 $16.00 $11.26 $11.27 $11.27 2026-02-24
3068708100 CDM Clotest Rapid Urease 5 4 $146.00 $146.00 $6.63 $141.99 $10.73 2026-02-24
J0690 HCPCS Cefazolin Sodium Injection 1 1 — — $10.69 $10.69 $10.69 2026-02-24
J1200 HCPCS Diphenhydramine Hcl Injectio 2 2 — — $1.10 $19.89 $10.49 2026-02-24
3008005300 CDM 80053 Comprehensive Meta Panel 12 8 $306.00 $306.00 $9.20 $261.62 $10.35 2026-02-24
6370056642 CDM Bacitracin Oint 30gm 23 16 $7.00 $7.00 $9.51 $9.51 $9.51 2026-02-24
2720060840 CDM Abd Pads Each 23 16 $17.00 $17.00 $9.44 $9.44 $9.44 2026-02-24
3018372100 CDM Direct Ldl 23 16 $152.00 $152.00 $9.27 $9.27 $9.27 2026-02-24
3018303600 CDM Glycohemoglobin Aic 8 7 $146.00 $146.00 $5.50 $146.00 $9.04 2026-02-24
636J225000 CDM Midazolam Hcl 23 16 $57.00 $57.00 $9.03 $9.65 $9.03 2026-02-24
2590798096 CDM Norco 5/325mg Tab 23 16 $3.00 $3.00 $8.85 $9.23 $8.85 2026-02-24
3008443900 CDM Free T4 3 3 $129.00 $129.00 $6.72 $114.61 $8.84 2026-02-24
2500636144 CDM Lidocn 2%/epi 1:100,000 Inj Ml 23 16 $63.51 $63.51 $8.65 $8.65 $8.65 2026-02-24
2500752743 CDM Lidocaine1% Inj 20cc 23 16 $17.00 $17.00 $8.53 $8.53 $8.53 2026-02-24
6370057531 CDM Lorazepam Tab 2mg 23 16 $4.00 $4.00 $8.21 $8.42 $8.42 2026-02-24
2590718736 CDM Alprazolam .5mg Tab 23 16 $10.00 $10.00 $8.36 $9.60 $8.36 2026-02-24
6370058245 CDM Desyrel Tab 50mg 23 16 $4.00 $4.00 $7.81 $7.81 $7.81 2026-02-24
3008296200 CDM Glucose Point Of Care 4 3 $33.00 $33.00 $1.38 $26.61 $7.75 2026-02-24
2590778466 CDM Prednisone Tab 20mg 23 16 $7.00 $7.00 $7.70 $7.70 $7.70 2026-02-24
2500057077 CDM Benadryl Cap 25 Mg 23 16 $4.00 $4.00 $7.70 $7.70 $7.70 2026-02-24
2590715708 CDM Nicotine Polacrilex 2mg Gum 23 16 $8.00 $8.00 $6.67 $7.66 $7.66 2026-02-24
636J206002 CDM Lorazepam 2 Mg/ml Vial 23 16 $45.00 $45.00 $4.39 $7.62 $7.62 2026-02-24
3008502500 CDM 85025 Cbc W/diff 12 8 $158.00 $158.00 $6.04 $131.44 $7.61 2026-02-24
6370056503 CDM Tylenol Ex Strength 500mg Tab 23 16 $4.00 $4.00 $7.20 $7.45 $7.45 2026-02-24
2500057397 CDM Ibuprofen Tab 800mg 23 16 $4.00 $4.00 $7.44 $7.44 $7.44 2026-02-24
2500056620 CDM Aspirin Tab 325mg 23 16 $4.00 $4.00 $5.05 $7.16 $7.16 2026-02-24
6370056588 CDM Amoxicillin Cap 500mg 23 16 $4.00 $4.00 $6.99 $6.99 $6.99 2026-02-24
2590797731 CDM Metoprolol 25mg 23 16 $6.00 $6.00 $6.99 $6.99 $6.99 2026-02-24
6370059918 CDM Methadone 10mg Tablet 23 16 $4.00 $4.00 $6.93 $7.11 $6.93 2026-02-24
3018369000 CDM Lipase Assay 3 3 $128.00 $128.00 $6.08 $119.43 $6.75 2026-02-24
2590776361 CDM Cipro 500mg Tab 23 16 $27.00 $27.00 $6.75 $6.75 $6.75 2026-02-24
6370057387 CDM Hydroxyzine Tab 25mg 23 16 $4.00 $4.00 $6.71 $6.71 $6.71 2026-02-24
3018215000 CDM Amylase Assay 3 3 $122.00 $122.00 $5.72 $111.56 $6.35 2026-02-24
3058502700 CDM Cbc 23 16 $126.00 $126.00 $6.34 $6.34 $6.34 2026-02-24
J2004 HCPCS Inj, Lidocaine W Epinephrine 2 2 — — $3.92 $8.65 $6.29 2026-02-24
2590720310 CDM Clonazepam 1mg Tab 23 16 $11.00 $11.00 $6.28 $6.28 $6.28 2026-02-24
J2765 HCPCS Metoclopramide Hcl Injection 2 2 — — $1.22 $11.16 $6.19 2026-02-24
6370057559 CDM Meclizine Tab 12.5mg 23 16 $4.00 $4.00 $6.17 $6.17 $6.17 2026-02-24
6370056621 CDM Aspirin Tab (chewable) 81mg 23 16 $4.00 $4.00 $6.04 $7.27 $6.04 2026-02-24
6370059875 CDM Bacitracin Zinc 0.9gm Oint 23 16 $20.00 $20.00 $5.71 $5.77 $5.71 2026-02-24
2500771180 CDM Sulfatrim Ds 800-160 23 16 $13.00 $13.00 $5.56 $5.56 $5.56 2026-02-24
6370059335 CDM Sodium Chloride 1gm Tab 23 16 $4.00 $4.00 $5.12 $5.12 $5.12 2026-02-24
2590776767 CDM Ibuprofen 600mg 23 16 $8.00 $8.00 $5.11 $6.77 $5.11 2026-02-24
3078101500 CDM Microscopic Exam Of Urine 23 16 $10.00 $10.00 $3.07 $5.09 $5.09 2026-02-24
J2250 HCPCS Inj Midazolam Hydrochloride 2 2 — — $0.20 $9.66 $4.93 2026-02-24
3058500700 CDM Manual Differential Cnt 85007 23 16 $121.00 $121.00 $3.72 $5.80 $4.76 2026-02-24
636J301000 CDM Fentanyl Citrate 0.05 Mg/ml 23 16 $28.00 $28.00 $1.04 $8.20 $4.62 2026-02-24
J3010 HCPCS Fentanyl Citrate Injection 2 2 — — $1.04 $8.20 $4.62 2026-02-24
3058561000 CDM Prothrombin Time 3 2 $88.00 $88.00 $2.25 $84.94 $4.51 2026-02-24
J2060 HCPCS Lorazepam Injection 1 1 — — $4.39 $4.39 $4.39 2026-02-24
J0696 HCPCS Ceftriaxone Sodium Injection 1 1 — — $3.90 $3.90 $3.90 2026-02-24
2500058608 CDM K-dur Tab 20meq/ 1500 Mg 23 16 $4.00 $4.00 $3.01 $3.74 $3.74 2026-02-24
3018100100 CDM Urinalysis Reflex To Microscop 5 4 $71.00 $71.00 $3.07 $62.21 $3.07 2026-02-24
3058504800 CDM White Cell Count 23 16 $74.00 $74.00 $2.90 $2.90 $2.90 2026-02-24
3058504900 CDM Platelet Count 23 16 $74.00 $74.00 $2.90 $2.90 $2.90 2026-02-24
3058501400 CDM Hematocrit 23 16 $45.00 $45.00 $2.90 $2.90 $2.90 2026-02-24
3058501800 CDM Hemoglobin 23 16 $45.00 $45.00 $2.90 $2.90 $2.90 2026-02-24
Q0162 HCPCS Ondansetron Oral 1 1 — — $1.73 $1.73 $1.73 2026-02-24
250Q016200 CDM Ondansetron Hcl 4mg Tab Pr1mg 23 16 $56.00 $56.00 $1.71 $1.73 $1.71 2026-02-24
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