Hospital

Northern Montana Hospital

Havre, MT · CCN 270032 · Rates published

132 distinct procedures filed

15 distinct payers

3,181 rate rows

2026-04-02 last MRF observed

Data quality

3,167 of 3,181 rate rows are consumer-grade (99.6%)

14 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reason	Rows
exceeds 10× this hospital's gross charge — excluded from medians	14

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

Source MRF file	https://nmhcare.slicedhealth.io/pricer/810231787-1427059070_NorthernMontanaHospital_standardcharges.CSV
Found on page	https://nmhcare.org/cms-hpt.txt
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-11-02
Content fingerprint	6d681957136741ce… · 24,915,379 bytes · first seen 2026-05-17

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
28505 CPT	Open Tx Great Toe Fracture	15	$562.45	$11,037.25	$4,065.76	nat. median $3,526 1.2× median
29580 CPT	Opn Tx Intraphal Dislocation	15	$28.97	$4,848.06	$1,785.87	nat. median $221 outlier · 8.1×
0750 RC	"bronchoscopy"	15	$707.40	$4,300.00	$1,360.20	nat. median $1,869 0.7× median
36430 CPT	"blood Admin 10 Hours 2nd Flr"	15	$47.97	$2,688.88	$889.42	nat. median $708 1.3× median
36556 CPT	"insert Of Subclavian Catheter"	15	$92.45	$2,400.51	$884.27	nat. median $2,483 outlier · 0.4×
27266 CPT	"tx Hip Dislocation"	15	$629.23	$2,303.49	$848.53	nat. median $2,038 outlier · 0.4×
J0475 HCPCS	Gablofen 40,000mcg/20ml Inj	15	$544.28	$1,992.50	$733.97	nat. median $520 1.4× median
95816 CPT	EEG Electroenceplography	15	$431.06	$1,578.05	$581.30	nat. median $549 1.1× median
J2794 HCPCS	Risperdal Consta 37.5mg Inj	15	$17.84	$1,495.07	$511.83	nat. median $833 0.6× median
0278 RC	"plate 1/3 Tubular 7 Hole 81mm"	15	$255.65	$1,488.72	$509.66	nat. median $1,468 outlier · 0.3×
99292 CPT	Critical Care ER Add'l 30 Min	15	$118.12	$1,238.23	$456.12	nat. median $514 0.9× median
26705 CPT	"tx Clsd Knuckle Disloc W Man &"	15	$137.87	$504.70	$427.45	nat. median $1,677 outlier · 0.3×
24655 CPT	Tx Clsd Radial Head/neck Fx W	15	$137.87	$504.70	$427.45	nat. median $1,598 outlier · 0.3×
27840 CPT	Tx Clsd Ankle Dislocation	15	$137.87	$504.70	$427.45	nat. median $507 0.8× median
28405 CPT	Closed Tx Calcaneal Fx W/reduc	15	$137.87	$504.70	$427.45	nat. median $502 0.9× median
45330 CPT	Sigmoidoscopy Incl Specimen(s)	15	$63.50	$1,103.73	$406.58	nat. median $1,081 outlier · 0.4×
11012 CPT	Debrid Skin Bone At Fx Site	15	$127.69	$467.46	$395.91	nat. median $2,790 outlier · 0.1×
26418 CPT	"Repair Ext Tendon Fng Without Gft"	15	$123.28	$701.99	$382.22	nat. median $2,012 outlier · 0.2×
24576 CPT	"tx Clsd Humerus Condyl Fx"	15	$137.87	$504.70	$369.25	nat. median $476 0.8× median
90381 CPT	Beyfortus 100 Mg/ml	15	$265.02	$970.20	$357.39	nat. median $856 outlier · 0.4×
26605 CPT	Tx Clsd Metacarpal Fx W Manip	15	$137.87	$504.70	$349.54	nat. median $461 0.8× median
27786 CPT	Tx Clsd Dis-fibular Fx Lat M	15	$137.87	$504.70	$335.47	nat. median $435 0.8× median
99283 CPT	Level Iii Emergency Room	15	$78.36	$797.23	$293.67	nat. median $461 0.6× median
25530 CPT	Tx Clsd Ulnar Shaft Rx Wo Man	15	$137.87	$504.70	$289.04	nat. median $404 0.7× median
0900 RC		15	$90.00	$319.51	$289.01	nat. median $162 1.8× median
0272 RC	"2.9 Mm Drill Bit"	15	$4.10	$2,122.68	$282.19	nat. median $255 1.1× median
99492 CPT	Mli - CoCM 1st Mo, 70 Mins	15	$79.20	$319.51	$251.34	nat. median $135 1.9× median
0761 RC	"preadministration Serv Ivig"	15	$99.38	$703.40	$240.81	nat. median $654 outlier · 0.4×
29355 CPT	Apply Long Leg Cast Walker	15	$119.17	$647.54	$238.53	nat. median $339 0.7× median
29305 CPT	Apply Hip Spica Cast - One Leg	15	$176.88	$647.54	$238.53	nat. median $363 0.7× median
99215 CPT	Bh Visit Est Lev 5 TeleHlth	15	$72.90	$319.51	$234.50	nat. median $234 1.0× median
26720 CPT	Tx Clsd Finger Fx Each	15	$137.87	$504.70	$224.77	nat. median $368 0.6× median
21480 CPT	"tx Reset Dislocated Jaw"	15	$35.24	$608.34	$224.09	nat. median $343 0.7× median
28450 CPT	Closed Tx Cuboid Fx No Manipul	15	$137.87	$504.70	$222.96	nat. median $396 0.6× median
90791 CPT	Initial Psych Eval - TeleHlth	15	$60.00	$319.51	$213.30	nat. median $226 0.9× median
90792 CPT	Psych Eval w/Med Svc TeleHlth	15	$63.60	$319.51	$204.58	nat. median $230 0.9× median
99493 CPT	Mli - CoCM Sub Mo, 60 Mins	15	$63.30	$319.51	$203.62	nat. median $134 1.5× median
J1610 HCPCS	Glucagon 1 Mg Inj	15	$150.34	$550.37	$202.74	nat. median $363 0.6× median
90837 CPT	Psytx 60 Mins - TeleHlth	15	$60.00	$319.51	$193.00	nat. median $217 0.9× median
28490 CPT	Tx Great Toe Fx	15	$137.87	$504.70	$185.92	nat. median $335 0.6× median
28495 CPT	Tx Clsd Fx Great Toe W Manip	15	$137.87	$504.70	$185.92	nat. median $362 0.5× median
24640 CPT	Tx Radial Head Subluxation	15	$88.84	$504.70	$185.92	nat. median $348 0.5× median
90839 CPT	Psych Therapy Crisis 1st Hour	15	$57.60	$319.51	$185.28	nat. median $215 0.9× median
96360 CPT	IV Hydration - Sdc 1st Hr	15	$34.59	$499.07	$183.84	nat. median $284 0.6× median
96132 CPT	Ddb Nrpsyc Tst Eval Phy/qhp 1s	15	$57.00	$319.51	$183.35	nat. median $400 outlier · 0.5×
M0247 HCPCS	"iv Inf Sotrovimab - Er"	15	$134.25	$491.47	$181.04	nat. median $570 outlier · 0.3×
M0250 HCPCS	"iv Inf Tocilizu 2nd Dose - Sdc"	15	$134.25	$491.47	$181.04	nat. median $526 outlier · 0.3×
99282 CPT	"level Ii Emergency Room"	15	$46.41	$479.71	$176.71	nat. median $283 0.6× median
12015 CPT	Wound Repr Smpl 7.6-12.5cm Fac	15	$104.20	$455.70	$167.87	nat. median $348 outlier · 0.5×
12011 CPT	"wound Repr Smpl Face Up-2.5cm"	15	$61.95	$455.70	$167.87	nat. median $299 0.6× median

Other procedures at this hospital

Browse this hospital's 132 published procedures. Use the slice to choose what to show, then sort or filter any column.

Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code	Type	Description	Rate rows	Payers	Gross	Cash	Min $	Max $	Avg median	Last observed

0270	RC	"oxymask"	18	15	$3.51	$2.46 30% off	$8.27	$30.28	$11.15	2026-04-02
0271	RC	Oxygen	18	15	$38.25	$26.78 30% off	$10.24	$37.49	$13.81	2026-04-02
0272	RC	"2.9 Mm Drill Bit"	360	15	$585.00	$409.50 30% off	$4.10	$2,122.68	$282.19	2026-04-02
0278	RC	"plate 1/3 Tubular 7 Hole 81mm"	36	15	$1,237.05	$865.93 30% off	$255.65	$1,488.72	$509.66	2026-04-02
0300	RC	Extraction	17	14	$95.00	$66.50 30% off	$25.43	$93.10	$34.30	2026-04-02
0420	RC	—	18	15	$42.75	$29.93 30% off	$11.44	$41.90	$15.43	2026-04-02
0655	RC	"inpatient Respite - Ltc Fac"	18	15	$313.40	$219.38 30% off	$83.90	$307.13	$113.14	2026-04-02
0710	RC	Opsurg Rec Ms Add Hrs (ea P 5)	18	15	$28.25	$19.78 30% off	$7.56	$27.69	$10.20	2026-04-02
0750	RC	"bronchoscopy"	72	15	$3,197.12	$2,237.99 30% off	$707.40	$4,300.00	$1,360.20	2026-04-02
0761	RC	"preadministration Serv Ivig"	36	15	$544.50	$381.15 30% off	$99.38	$703.40	$240.81	2026-04-02
0762	RC	—	18	15	$357.50	$250.25 30% off	$95.70	$350.35	$129.06	2026-04-02
0771	RC	"admin Hepat B Booster -dialysi"	18	15	$48.50	$33.95 30% off	$12.98	$47.53	$17.51	2026-04-02
0900	RC	—	18	15	$300.00	$210.00 30% off	$90.00	$319.51	$289.01	2026-04-02
0990	RC	"legal Specimen"	18	15	$144.25	$100.98 30% off	$38.62	$141.37	$52.07	2026-04-02
11012	CPT	Debrid Skin Bone At Fx Site	18	15	$477.00	$333.90 30% off	$127.69	$467.46	$395.91	2026-04-02
12001	CPT	Wound Repr Smpl Up To 2.5cm	18	15	$465.00	$325.50 30% off	$49.71	$455.70	$167.87	2026-04-02
12011	CPT	"wound Repr Smpl Face Up-2.5cm"	18	15	$465.00	$325.50 30% off	$61.95	$455.70	$167.87	2026-04-02
12015	CPT	Wound Repr Smpl 7.6-12.5cm Fac	18	15	$465.00	$325.50 30% off	$104.20	$455.70	$167.87	2026-04-02
21480	CPT	"tx Reset Dislocated Jaw"	18	15	$620.75	$434.53 30% off	$35.24	$608.34	$224.09	2026-04-02
24576	CPT	"tx Clsd Humerus Condyl Fx"	18	15	$515.00	$360.50 30% off	$137.87	$504.70	$369.25	2026-04-02
24640	CPT	Tx Radial Head Subluxation	18	15	$515.00	$360.50 30% off	$88.84	$504.70	$185.92	2026-04-02
24655	CPT	Tx Clsd Radial Head/neck Fx W	18	15	$515.00	$360.50 30% off	$137.87	$504.70	$427.45	2026-04-02
25530	CPT	Tx Clsd Ulnar Shaft Rx Wo Man	18	15	$515.00	$360.50 30% off	$137.87	$504.70	$289.04	2026-04-02
26418	CPT	"Repair Ext Tendon Fng Without Gft"	18	15	$460.50	$322.35 30% off	$123.28	$701.99	$382.22	2026-04-02
26605	CPT	Tx Clsd Metacarpal Fx W Manip	18	15	$515.00	$360.50 30% off	$137.87	$504.70	$349.54	2026-04-02
26705	CPT	"tx Clsd Knuckle Disloc W Man &"	18	15	$515.00	$360.50 30% off	$137.87	$504.70	$427.45	2026-04-02
26720	CPT	Tx Clsd Finger Fx Each	18	15	$515.00	$360.50 30% off	$137.87	$504.70	$224.77	2026-04-02
27266	CPT	"tx Hip Dislocation"	18	15	$2,350.50	$1,645.35 30% off	$629.23	$2,303.49	$848.53	2026-04-02
27786	CPT	Tx Clsd Dis-fibular Fx Lat M	18	15	$515.00	$360.50 30% off	$137.87	$504.70	$335.47	2026-04-02
27840	CPT	Tx Clsd Ankle Dislocation	18	15	$515.00	$360.50 30% off	$137.87	$504.70	$427.45	2026-04-02
28405	CPT	Closed Tx Calcaneal Fx W/reduc	18	15	$515.00	$360.50 30% off	$137.87	$504.70	$427.45	2026-04-02
28450	CPT	Closed Tx Cuboid Fx No Manipul	18	15	$515.00	$360.50 30% off	$137.87	$504.70	$222.96	2026-04-02
28490	CPT	Tx Great Toe Fx	18	15	$515.00	$360.50 30% off	$137.87	$504.70	$185.92	2026-04-02
28495	CPT	Tx Clsd Fx Great Toe W Manip	18	15	$515.00	$360.50 30% off	$137.87	$504.70	$185.92	2026-04-02
28505	CPT	Open Tx Great Toe Fracture	18	15	$11,262.50	$7,883.75 30% off	$562.45	$11,037.25	$4,065.76	2026-04-02
29105	CPT	"apply Long Arm Splint"	18	15	$324.50	$227.15 30% off	$46.37	$318.01	$117.14	2026-04-02
29305	CPT	Apply Hip Spica Cast - One Leg	18	15	$660.75	$462.53 30% off	$176.88	$647.54	$238.53	2026-04-02
29355	CPT	Apply Long Leg Cast Walker	18	15	$660.75	$462.53 30% off	$119.17	$647.54	$238.53	2026-04-02
29505	CPT	Apply Long Leg Splint	18	15	$324.50	$227.15 30% off	$59.79	$318.01	$117.14	2026-04-02
29580	CPT	Opn Tx Intraphal Dislocation	18	15	$4,947.00	$3,462.90 30% off	$28.97	$4,848.06	$1,785.87	2026-04-02
30905	CPT	Posterior Nasal Hemorrhage	18	15	$368.00	$257.60 30% off	$98.51	$360.64	$132.85	2026-04-02
36430	CPT	"blood Admin 10 Hours 2nd Flr"	98	15	$2,351.50	$1,646.05 30% off	$47.97	$2,688.88	$889.42	2026-04-02
36556	CPT	"insert Of Subclavian Catheter"	18	15	$2,449.50	$1,714.65 30% off	$92.45	$2,400.51	$884.27	2026-04-02
43760	CPT	Change Gastrostomy Tube	18	15	$244.25	$170.98 30% off	$65.39	$239.37	$88.17	2026-04-02
43762	CPT	"Perq Replacement Gtube"	18	15	$276.25	$193.38 30% off	$41.54	$270.73	$99.73	2026-04-02
45330	CPT	Sigmoidoscopy Incl Specimen(s)	18	15	$1,126.25	$788.38 30% off	$63.50	$1,103.73	$406.58	2026-04-02
46600	CPT	"dx Anoscopy"	18	15	$185.50	$129.85 30% off	$46.44	$181.79	$66.97	2026-04-02
51700	CPT	Bladder Irrigation/lavage	18	15	$347.75	$243.43 30% off	$33.05	$340.80	$125.54	2026-04-02
65205	CPT	Remove Conjunctival Frgn Body	18	15	$371.25	$259.88 30% off	$31.97	$363.83	$134.02	2026-04-02
69000	CPT	"drain Ext Ear Abcess/hematoma"	18	15	$451.50	$316.05 30% off	$120.87	$442.47	$162.99	2026-04-02
69210	CPT	"Remove Impacted Cerumen W/inst"	18	15	$185.50	$129.85 30% off	$35.65	$181.79	$66.97	2026-04-02
85610	CPT	Protime/inr	18	15	$75.00	$52.50 30% off	$13.36	$73.50	$25.16	2026-04-02
90381	CPT	Beyfortus 100 Mg/ml	18	15	$990.00	$693.00 30% off	$265.02	$970.20	$357.39	2026-04-02
90682	CPT	Flublok (egg Free)	18	15	$151.83	$106.28 30% off	$40.64	$148.79	$54.81	2026-04-02
90710	CPT	Proquad (mmr/varicella)	18	15	$443.88	$310.72 30% off	$118.83	$484.66	$160.24	2026-04-02
90785	CPT	Psytx Cmplx I/a - TeleHlth	24	11	$20.50	$14.35 30% off	$6.00	$20.58	$17.93	2026-04-02
90791	CPT	Initial Psych Eval - TeleHlth	46	15	$237.00	$165.90 30% off	$60.00	$319.51	$213.30	2026-04-02
90792	CPT	Psych Eval w/Med Svc TeleHlth	18	15	$212.00	$148.40 30% off	$63.60	$319.51	$204.58	2026-04-02
90832	CPT	Ibh - Psych Tx 30 Min Psycholg	36	15	$104.00	$72.80 30% off	$31.20	$319.51	$100.36	2026-04-02
90833	CPT	Psytx W E/m 30 Mins TeleHlth	18	15	$95.00	$66.50 30% off	$28.50	$319.51	$91.68	2026-04-02
90834	CPT	Psytx 45 Mins - TeleHlth	36	15	$137.00	$95.90 30% off	$41.10	$319.51	$132.20	2026-04-02
90836	CPT	Psytx W E/m 45 Mins TeleHlth	18	15	$120.00	$84.00 30% off	$36.00	$319.51	$115.80	2026-04-02
90837	CPT	Psytx 60 Mins - TeleHlth	36	15	$200.00	$140.00 30% off	$60.00	$319.51	$193.00	2026-04-02
90838	CPT	Psytx W E/m 60 Mins TeleHlth	18	15	$157.00	$109.90 30% off	$47.10	$319.51	$151.50	2026-04-02
90839	CPT	Psych Therapy Crisis 1st Hour	18	15	$192.00	$134.40 30% off	$57.60	$319.51	$185.28	2026-04-02
90840	CPT	Psytx Crisis Ea Addl 30 Min	18	15	$96.00	$67.20 30% off	$28.80	$319.51	$92.64	2026-04-02
90846	CPT	Family Psytx Without Patient	36	15	$131.00	$91.70 30% off	$39.30	$319.51	$126.41	2026-04-02
90847	CPT	Family Psytx With Patient	36	15	$135.00	$94.50 30% off	$40.50	$319.51	$130.27	2026-04-02
90863	CPT	Pharmacologic Mgmt W/psytx	18	15	$35.00	$24.50 30% off	$10.50	$319.51	$34.12	2026-04-02
90885	CPT	Psychiatric Eval Of Records	18	15	$66.00	$46.20 30% off	$19.80	$319.51	$64.35	2026-04-02
90887	CPT	Interp / Explain To Family	18	15	$116.00	$81.20 30% off	$34.80	$319.51	$113.10	2026-04-02
90889	CPT	Prep Of Psychiatric Report	18	15	$2.00	$1.40 30% off	$0.60	$319.51	$1.95	2026-04-02
91322	CPT	Covid Vaccine, Moderna	18	15	$165.00	$115.50 30% off	$44.17	$161.70	$59.57	2026-04-02
95816	CPT	EEG Electroenceplography	18	15	$1,610.25	$1,127.18 30% off	$431.06	$1,578.05	$581.30	2026-04-02
96127	CPT	Emotional Behavi Asses & Score	18	15	$7.00	$4.90 30% off	$2.10	$319.51	$6.75	2026-04-02
96132	CPT	Ddb Nrpsyc Tst Eval Phy/qhp 1s	18	15	$190.00	$133.00 30% off	$57.00	$319.51	$183.35	2026-04-02
96136	CPT	Psych Test Admin/sc 1st 30min	18	15	$60.00	$42.00 30% off	$18.00	$319.51	$57.90	2026-04-02
96137	CPT	Psych Tst Admin/sc Ea Add'l 30	18	15	$54.00	$37.80 30% off	$16.20	$319.51	$52.11	2026-04-02
96360	CPT	IV Hydration - Sdc 1st Hr	18	15	$509.25	$356.48 30% off	$34.59	$499.07	$183.84	2026-04-02
96372	CPT	Inj: Meds (er Pt Only)	18	15	$114.00	$79.80 30% off	$15.99	$111.72	$41.15	2026-04-02
96375	CPT	Inj: IV Push New Drug Addon-ER	18	15	$160.75	$112.53 30% off	$16.36	$157.54	$58.03	2026-04-02
97018	CPT	Ot Paraffin Wax	18	15	$25.75	$18.03 30% off	$6.89	$25.24	$9.30	2026-04-02
97112	CPT	Ot Neuromuscular Re-ed Ea 15	18	15	$113.00	$79.10 30% off	$30.25	$110.74	$40.79	2026-04-02
97129	CPT	Ot - Cognitive Function	18	15	$93.75	$65.63 30% off	$24.54	$91.88	$33.84	2026-04-02
97530	CPT	Ot Therapeutic Activity 15 Min	18	15	$113.00	$79.10 30% off	$30.25	$110.74	$40.79	2026-04-02
97762	CPT	Ot Orthotic Prosth Fu Ea 15	18	15	$103.00	$72.10 30% off	$27.57	$100.94	$37.18	2026-04-02
98967	CPT	Hc Pro Phone Call 11-20 Min	18	15	$33.00	$23.10 30% off	$9.90	$319.51	$31.84	2026-04-02
98968	CPT	Hc Pro Phone Call 21-30 Min	18	15	$46.00	$32.20 30% off	$13.80	$319.51	$44.39	2026-04-02
99202	CPT	Office/Outpatient Visit New	18	15	$59.00	$41.30 30% off	$15.79	$57.82	$48.97	2026-04-02
99204	CPT	"Office/Outpatient Visit New"	18	15	$151.25	$105.88 30% off	$40.49	$148.23	$125.53	2026-04-02
99205	CPT	Office/Outpatient Visit New	18	15	$197.50	$138.25 30% off	$52.87	$201.71	$163.93	2026-04-02
99211	CPT	"anticoagulation Mngmt Clinic"	52	15	$32.00	$22.40 30% off	$9.30	$319.51	$35.25	2026-04-02
99212	CPT	Bh Visit Est Lev 2 TeleHlth	52	15	$77.00	$53.90 30% off	$8.16	$319.51	$52.23	2026-04-02
99213	CPT	Bh Visit Est Lev 3 TeleHlth	52	15	$122.00	$85.40 30% off	$16.06	$319.51	$88.45	2026-04-02
99214	CPT	Bh Visit Est Lev 4 TeleHlth	36	15	$172.00	$120.40 30% off	$51.60	$319.51	$165.98	2026-04-02
99215	CPT	Bh Visit Est Lev 5 TeleHlth	18	15	$243.00	$170.10 30% off	$72.90	$319.51	$234.50	2026-04-02
99281	CPT	"level I ER 25"	18	15	$290.00	$203.00 30% off	$12.63	$284.20	$104.69	2026-04-02
99282	CPT	"level Ii Emergency Room"	18	15	$489.50	$342.65 30% off	$46.41	$479.71	$176.71	2026-04-02
99283	CPT	Level Iii Emergency Room	18	15	$813.50	$569.45 30% off	$78.36	$797.23	$293.67	2026-04-02
99292	CPT	Critical Care ER Add'l 30 Min	18	15	$1,263.50	$884.45 30% off	$118.12	$1,238.23	$456.12	2026-04-02
99408	CPT	Mli - Sbirt 15-30 Mins	18	15	$57.00	$39.90 30% off	$17.10	$319.51	$55.58	2026-04-02
99409	CPT	Ibh - Sbirt Over 30 Mins	18	15	$108.00	$75.60 30% off	$32.40	$319.51	$105.30	2026-04-02
99441	CPT	Phone E/m Phys/qhp 5-10 Min	18	15	$76.00	$53.20 30% off	$22.80	$319.51	$74.10	2026-04-02
99442	CPT	Phone E/m Phys/qhp 11-20 Min	18	15	$122.00	$85.40 30% off	$36.60	$319.51	$118.95	2026-04-02
99443	CPT	Phone E/m Phys/qhp 21-30 Min	18	15	$172.00	$120.40 30% off	$51.60	$319.51	$167.70	2026-04-02
99484	CPT	Ibh - Cm For Bh Conditions	18	15	$70.00	$49.00 30% off	$21.00	$319.51	$67.55	2026-04-02
99492	CPT	Mli - CoCM 1st Mo, 70 Mins	18	15	$264.00	$184.80 30% off	$79.20	$319.51	$251.34	2026-04-02
99493	CPT	Mli - CoCM Sub Mo, 60 Mins	18	15	$211.00	$147.70 30% off	$63.30	$319.51	$203.62	2026-04-02
99494	CPT	Ibh - CoCM Add-on, Ea Addl 30	18	15	$110.00	$77.00 30% off	$33.00	$319.51	$106.15	2026-04-02
A4216	HCPCS	Sodium Chlor 0.9% Sdv 20ml	18	15	$8.00	$5.60 30% off	$2.14	$7.84	$2.75	2026-04-02
A9270	HCPCS	Catapres 0.1mg Tab	18	15	$8.00	$5.60 30% off	$2.14	$7.84	$2.89	2026-04-02
G0463	HCPCS	Office/Outpatient Facility Fee	18	15	$63.00	$44.10 30% off	$16.87	$61.74	$22.74	2026-04-02
J0475	HCPCS	Gablofen 40,000mcg/20ml Inj	18	15	$2,033.16	$1,423.21 30% off	$544.28	$1,992.50	$733.97	2026-04-02
J0833	HCPCS	Cortrosyn 0.25 Mg Inj	18	15	$266.45	$186.52 30% off	$71.33	$261.12	$96.19	2026-04-02
J1000	HCPCS	Depo-estradiol 5mg/1ml Inj	18	15	$57.60	$40.32 30% off	$15.42	$56.45	$20.79	2026-04-02
J1100	HCPCS	Dexamethasone 4mg/ml Inj	18	15	$8.00	$5.60 30% off	$2.14	$7.84	$2.89	2026-04-02
J1380	HCPCS	Delestrogen 20mg/1ml Inj	18	15	$93.53	$65.47 30% off	$25.04	$91.66	$33.76	2026-04-02
J1610	HCPCS	Glucagon 1 Mg Inj	18	15	$561.60	$393.12 30% off	$150.34	$550.37	$202.74	2026-04-02
J2060	HCPCS	Ativan Inj 2mg/ml	18	15	$12.00	$8.40 30% off	$3.21	$11.76	$4.33	2026-04-02
J2469	HCPCS	Aloxi 0.25mg/5ml	18	15	$400.00	$280.00 30% off	$56.00	$392.00	$134.20	2026-04-02
J2675	HCPCS	Progesterone 50mg/ml Inj	18	15	$9.70	$6.79 30% off	$2.60	$9.51	$3.50	2026-04-02
J2790	HCPCS	Rh Immune Glob 300mcg Inj	18	15	$295.00	$206.50 30% off	$78.97	$289.10	$106.50	2026-04-02
J2794	HCPCS	Risperdal Consta 37.5mg Inj	18	15	$1,525.58	$1,067.91 30% off	$17.84	$1,495.07	$511.83	2026-04-02
J2919	HCPCS	Solu Medrol 40mg Inj	18	15	$15.05	$10.54 30% off	$4.03	$14.75	$5.43	2026-04-02
J3300	HCPCS	Triesence 40mg/ml Inj	18	15	$300.82	$210.57 30% off	$7.74	$294.80	$100.92	2026-04-02
J3360	HCPCS	Valium Inj 10mg/2ml	18	15	$68.35	$47.85 30% off	$4.96	$66.98	$22.93	2026-04-02
J3410	HCPCS	Hydroxyzine Inj 25mg	18	15	$48.40	$33.88 30% off	$12.96	$47.43	$17.47	2026-04-02
J3430	HCPCS	Vitamin K-1 Inj 10mg(phyton	18	15	$120.60	$84.42 30% off	$32.28	$118.19	$43.54	2026-04-02
J3490	HCPCS	Calcium Chloride 1gm Inj	54	15	$37.55	$26.29 30% off	$2.54	$78.40	$13.56	2026-04-02
J7999	HCPCS	Avastin 1.25mg/0.05ml Inj	18	15	$195.00	$136.50 30% off	$52.20	$191.10	$70.40	2026-04-02
M0247	HCPCS	"iv Inf Sotrovimab - Er"	18	15	$501.50	$351.05 30% off	$134.25	$491.47	$181.04	2026-04-02
M0250	HCPCS	"iv Inf Tocilizu 2nd Dose - Sdc"	18	15	$501.50	$351.05 30% off	$134.25	$491.47	$181.04	2026-04-02

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