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

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Hospital

AVERA CREIGHTON HOSPITAL

Creighton, NE · CCN 281331 · Rates published

848 distinct procedures filed
5 distinct payers
12,536 rate rows
2026-07-15 last MRF observed
Data quality

12,505 of 12,536 rate rows are consumer-grade (99.8%)

31 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
exceeds 10× this hospital's gross charge — excluded from medians 12
percent-of-charges filed in the dollar field — excluded from medians 10
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 6
placeholder amount (≤ $0.02) — excluded from medians 2
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 1
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.avera.org/app/files/public/94f0fb48-c0d0-4b65-b98b-5628b62587c7/460225483_avera-creighton-hospital_standardcharges.csv
Discovered viaDiscovered by HANK (automated)
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-09-21
Content fingerprint 171b7afa1de13e22… · 3,257,546 bytes · first seen 2026-05-09

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
862
MS_DRG 		Ms-DRG 862 1 $207,498.78 $207,498.78 $207,498.78 nat. median
$17,367
outlier · 11.9×
325
MS_DRG 		Ms-DRG 325 1 $145,735.46 $145,735.46 $145,735.46 nat. median
$28,847
outlier · 5.1×
182
MS_DRG 		Ms-DRG 182 1 $115,441.39 $115,441.39 $115,441.39 nat. median
$8,558
outlier · 13.5×
192
MS_DRG 		Ms-DRG 192 1 $107,374.00 $107,374.00 $107,374.00 nat. median
$7,116
outlier · 15.1×
344
MS_DRG 		Ms-DRG 344 1 $99,886.82 $99,886.82 $99,886.82 nat. median
$24,613
outlier · 4.1×
308
MS_DRG 		Ms-DRG 308 1 $95,496.45 $95,496.45 $95,496.45 nat. median
$11,997
outlier · 8.0×
314
MS_DRG 		Ms-DRG 314 1 $87,150.74 $87,150.74 $87,150.74 nat. median
$19,970
outlier · 4.4×
305
MS_DRG 		Ms-DRG 305 1 $77,600.30 $77,600.30 $77,600.30 nat. median
$8,040
outlier · 9.7×
323
MS_DRG 		Ms-DRG 323 1 $74,695.78 $74,695.78 $74,695.78 nat. median
$39,076
1.9× median
322
MS_DRG 		Ms-DRG 322 1 $70,206.18 $70,206.18 $70,206.18 nat. median
$17,764
outlier · 4.0×
247
MS_DRG 		Ms-DRG 247 1 $54,967.72 $54,967.72 $54,967.72 nat. median
$12,886
outlier · 4.3×
469
MS_DRG 		Ms-DRG 469 1 $54,290.65 $54,290.65 $54,290.65 nat. median
$29,492
1.8× median
263
MS_DRG 		Ms-DRG 263 1 $50,527.23 $50,527.23 $50,527.23 nat. median
$27,006
1.9× median
463
MS_DRG 		Ms-DRG 463 1 $42,795.71 $42,795.71 $42,795.71 nat. median
$49,960
0.9× median
231
MS_DRG 		Ms-DRG 231 1 $41,103.34 $41,103.34 $41,103.34 nat. median
$77,043
0.5× median
721
MS_DRG 		Ms-DRG 721 1 $40,151.46 $40,151.46 $40,151.46 nat. median
$13,349
outlier · 3.0×
720
MS_DRG 		Ms-DRG 720 1 $36,767.75 $36,767.75 $36,767.75 nat. median
$11,306
outlier · 3.3×
45
MS_DRG 		Ms-DRG 45 1 $35,125.14 $35,125.14 $35,125.14 nat. median
$12,288
outlier · 2.9×
24
MS_DRG 		Ms-DRG 24 1 $30,625.87 $30,625.87 $30,625.87 nat. median
$36,642
0.8× median
201
MS_DRG 		Ms-DRG 201 1 $29,389.50 $29,389.50 $29,389.50 nat. median
$7,537
outlier · 3.9×
347
MS_DRG 		Ms-DRG 347 1 $26,942.76 $26,942.76 $26,942.76 nat. median
$22,221
1.2× median
J3101
HCPCS 		Tenecteplase 50 Mg/10 Ml Syrng 5 $0.41 $30,005.60 $25,662.68 nat. median
$3,787
outlier · 6.8×
241
MS_DRG 		Ms-DRG 241 1 $24,609.82 $24,609.82 $24,609.82 nat. median
$14,175
1.7× median
140
MS_DRG 		Ms-DRG 140 1 $22,251.15 $22,251.15 $22,251.15 nat. median
$38,387
0.6× median
139
MS_DRG 		Ms-DRG 139 1 $20,574.99 $20,574.99 $20,574.99 nat. median
$12,801
1.6× median
254
MS_DRG 		Ms-DRG 254 1 $20,563.02 $20,563.02 $20,563.02 nat. median
$17,502
1.2× median
351
MS_DRG 		Ms-DRG 351 1 $19,825.07 $19,825.07 $19,825.07 nat. median
$14,858
1.3× median
383
MS_DRG 		Ms-DRG 383 1 $17,831.06 $17,831.06 $17,831.06 nat. median
$13,199
1.4× median
244
MS_DRG 		Ms-DRG 244 1 $17,722.14 $17,722.14 $17,722.14 nat. median
$18,005
1.0× median
248
MS_DRG 		Ms-DRG 248 1 $16,120.10 $16,120.10 $16,120.10 nat. median
$18,397
0.9× median
420
MS_DRG 		Ms-DRG 420 1 $14,219.69 $14,219.69 $14,219.69 nat. median
$31,441
outlier · 0.5×
194
MS_DRG 		Ms-DRG 194 1 $13,663.36 $13,663.36 $13,663.36 nat. median
$8,522
1.6× median
603
MS_DRG 		Ms-DRG 603 1 $12,610.84 $12,610.84 $12,610.84 nat. median
$8,991
1.4× median
638
MS_DRG 		Ms-DRG 638 1 $12,610.84 $12,610.84 $12,610.84 nat. median
$9,230
1.4× median
Q5130
HCPCS 		Pegfilgrastim-pbbk 6 Mg/0.6 Ml 5 $0.54 $9,625.01 $8,231.92 nat. median
$353
outlier · 23.3×
392
MS_DRG 		Ms-DRG 392 1 $7,416.84 $7,416.84 $7,416.84 nat. median
$8,186
0.9× median
Q5111
HCPCS 		Pegfilgrastim-cbqv 6 Mg/0.6 Ml 5 $1,112.40 $8,478.75 $7,251.56 nat. median
$1,984
outlier · 3.7×
74178
CPT 		CT Abd & Pelv Wwo Contrast 5 $104.00 $7,679.00 $6,550.19 nat. median
$1,027
outlier · 6.4×
Q5122
HCPCS 		Pegfilgrastim 6 Mg/0.6 Ml Syr 5 $3,939.75 $7,636.19 $6,530.95 nat. median
$561
outlier · 11.6×
Q5108
HCPCS 		Pegfilgrastim-jmdb 6 Mg/0.6 Ml 5 $5,224.56 $7,635.89 $6,530.70 nat. median
$1,244
outlier · 5.2×
J0897
HCPCS 		Denosumab 60 Mg/ml Syringe 5 $9.69 $7,258.46 $6,207.89 nat. median
$1,982
outlier · 3.1×
95811
CPT 		Polysomnogram W CPap 5 $4,550.65 $6,650.95 $6,152.75 nat. median
$1,894
outlier · 3.2×
74177
CPT 		CT Abd & Pelv W Contrast 5 $227.52 $6,591.00 $5,903.61 nat. median
$976
outlier · 6.0×
95810
CPT 		Polysomnogram 5 $3,965.00 $6,100.00 $5,468.65 nat. median
$1,827
outlier · 3.0×
72158
CPT 		MRI Lumbar Spine Wwo Dye 5 $340.96 $6,346.95 $5,428.31 nat. median
$1,097
outlier · 4.9×
72157
CPT 		MRI Chest Spine Wwo Dye 5 $535.35 $6,317.50 $5,403.12 nat. median
$1,114
outlier · 4.9×
249
MS_DRG 		Ms-DRG 249 1 $5,398.38 $5,398.38 $5,398.38 nat. median
$11,553
outlier · 0.5×
70553
CPT 		MRI Brain Wwo Contrast 5 $76.50 $5,938.00 $5,318.45 nat. median
$1,136
outlier · 4.7×
78452
CPT 		Myocard Perf Spect Rest Stress 5 $289.80 $5,842.00 $5,233.15 nat. median
$1,822
outlier · 2.9×
72156
CPT 		MRI Neck Spine Wwo Dye 5 $340.05 $5,544.20 $4,741.75 nat. median
$1,110
outlier · 4.3×

Other procedures at this hospital

Browse this hospital's 848 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
             
0202U CPT Respir Path 22 Targets Biofire 8 5 $960.00 $931.20 $624.00 $912.00 $788.64 2026-07-15
10061 CPT I&d Abscess Comp/Multiple 14 5 $691.00 $670.27 $373.43 $656.45 $483.79 2026-07-15
10120 CPT I&r Foreign Body Simple 25 5 $437.00 $423.89 $215.90 $1,389.85 $410.78 2026-07-15
11042 CPT Debride Skin Subq 20 Cm 29 5 $775.00 $751.75 $9.57 $1,970.30 $661.08 2026-07-15
11043 CPT Debride Muscle/Fascia 20 Cm 14 5 $1,565.00 $1,518.05 $302.96 $1,486.75 $1,028.99 2026-07-15
111 CDM Room Medical Unit Priv 12 5 $1,241.00 $1,203.77 $219.05 $2,037.75 $857.20 2026-07-15
113 MS_DRG Ms-DRG 113 2 1 — — $4,232.63 $4,232.63 $4,232.63 2026-07-15
11402 CPT Exc Ben Lesion 1.1-2.0 Trunk 15 5 $953.00 $924.41 $236.15 $905.35 $633.75 2026-07-15
11403 CPT Exc Ben Lesion 2.1-3.0 Trunk 14 5 $813.00 $788.61 $305.50 $772.35 $534.55 2026-07-15
11750 CPT Exc Nail Matrix Part/Complete 17 5 $547.00 $530.59 $81.38 $519.65 $363.75 2026-07-15
120 CDM Room Medical Unit Semi Private 6 5 $2,043.00 $1,981.71 $1,327.95 $1,940.85 $1,831.55 2026-07-15
12004 CPT Repair Lac Simple 7.6-12.5 Cm 16 5 $530.00 $514.10 $140.14 $530.00 $380.81 2026-07-15
12005 CPT Repair Lac Simple 12.6-20.0 Cm 14 5 $504.00 $488.88 $179.19 $478.80 $347.59 2026-07-15
12011 CPT Repair Lac Simple <2.5 Cm 18 5 $530.00 $514.10 $99.67 $503.50 $380.81 2026-07-15
12013 CPT Repair Lac Simple 2.6-5.0 Cm 14 5 $530.00 $514.10 $109.90 $625.10 $380.81 2026-07-15
12014 CPT Repair Lac Simple 5.1-7.5 Cm 16 5 $530.00 $514.10 $141.36 $752.94 $413.93 2026-07-15
12042 CPT Repair Lac Interm 2.6-7.5 Cm 14 5 $566.00 $549.02 $367.90 $766.10 $445.62 2026-07-15
129 CDM Room Swing Bed Skilled 6 5 $1,704.00 $1,652.88 $1,107.60 $1,618.80 $1,527.63 2026-07-15
139 MS_DRG Ms-DRG 139 2 1 — — $20,574.99 $20,574.99 $20,574.99 2026-07-15
140 MS_DRG Ms-DRG 140 2 1 — — $22,251.15 $22,251.15 $22,251.15 2026-07-15
182 MS_DRG Ms-DRG 182 2 1 — — $115,441.39 $115,441.39 $115,441.39 2026-07-15
192 MS_DRG Ms-DRG 192 2 1 — — $107,374.00 $107,374.00 $107,374.00 2026-07-15
193 MS_DRG Ms-DRG 193 2 1 — — $3,725.18 $3,725.18 $3,725.18 2026-07-15
194 MS_DRG Ms-DRG 194 2 1 — — $13,663.36 $13,663.36 $13,663.36 2026-07-15
201 MS_DRG Ms-DRG 201 2 1 — — $29,389.50 $29,389.50 $29,389.50 2026-07-15
20605 CPT Asp/Inj Intermediate Joint Lt 22 5 $351.00 $340.47 $72.99 $1,148.55 $314.67 2026-07-15
231 MS_DRG Ms-DRG 231 2 1 — — $41,103.34 $41,103.34 $41,103.34 2026-07-15
23500 CPT Fx Clavicle Lt 8 5 $679.00 $658.63 $441.35 $645.05 $557.80 2026-07-15
23600 CPT Fx Prox Humeral Wo Man Lt 16 5 $396.00 $384.12 $257.40 $376.20 $325.31 2026-07-15
23675 CPT Clsd Tx Shldr Disloc W Man Rt 14 5 $1,643.00 $1,593.71 $1,028.83 $1,560.85 $1,211.52 2026-07-15
24 MS_DRG Ms-DRG 24 2 1 — — $30,625.87 $30,625.87 $30,625.87 2026-07-15
241 MS_DRG Ms-DRG 241 2 1 — — $24,609.82 $24,609.82 $24,609.82 2026-07-15
244 MS_DRG Ms-DRG 244 2 1 — — $17,722.14 $17,722.14 $17,722.14 2026-07-15
24530 CPT Fx Supra/Transcondylar Hum Lt 8 5 $534.00 $517.98 $347.10 $507.30 $438.68 2026-07-15
24650 CPT Fx Radial Head/Neck Wo Man Bi 19 5 $377.00 $365.69 $245.05 $358.15 $321.58 2026-07-15
247 MS_DRG Ms-DRG 247 2 1 — — $54,967.72 $54,967.72 $54,967.72 2026-07-15
248 MS_DRG Ms-DRG 248 2 1 — — $16,120.10 $16,120.10 $16,120.10 2026-07-15
249 MS_DRG Ms-DRG 249 2 1 — — $5,398.38 $5,398.38 $5,398.38 2026-07-15
254 MS_DRG Ms-DRG 254 2 1 — — $20,563.02 $20,563.02 $20,563.02 2026-07-15
25600 CPT Fx Distal Radius Lt 19 5 $396.00 $384.12 $257.40 $376.20 $337.79 2026-07-15
263 MS_DRG Ms-DRG 263 2 1 — — $50,527.23 $50,527.23 $50,527.23 2026-07-15
26600 CPT Fx Metacarpal 8 5 $416.00 $403.52 $270.40 $395.20 $341.75 2026-07-15
270 CDM Cellulos Hemost W Thromb 10ml 8 5 $2,034.00 $1,973.40 $1,322.38 $1,932.71 $1,671.28 2026-07-15
27096 CPT Inject Sacroiliac Joint Bi 20 5 $1,686.00 $1,635.42 $167.26 $1,880.94 $588.49 2026-07-15
27520 CPT Treat Kneecap Fracture Rt 8 5 $416.00 $403.52 $270.40 $395.20 $341.75 2026-07-15
27786 CPT Fx Distal Fibula Lt 18 5 $396.00 $384.12 $257.40 $376.20 $337.79 2026-07-15
305 MS_DRG Ms-DRG 305 2 1 — — $77,600.30 $77,600.30 $77,600.30 2026-07-15
308 MS_DRG Ms-DRG 308 2 1 — — $95,496.45 $95,496.45 $95,496.45 2026-07-15
30901 CPT Control Anterior Hemorrhage Rt 16 5 $480.00 $465.60 $109.69 $456.00 $344.88 2026-07-15
30903 CPT Control Anterior Hemorrhage Lt 14 5 $480.00 $465.60 $149.60 $535.80 $344.88 2026-07-15
314 MS_DRG Ms-DRG 314 2 1 — — $87,150.74 $87,150.74 $87,150.74 2026-07-15
322 MS_DRG Ms-DRG 322 2 1 — — $70,206.18 $70,206.18 $70,206.18 2026-07-15
323 MS_DRG Ms-DRG 323 2 1 — — $74,695.78 $74,695.78 $74,695.78 2026-07-15
325 MS_DRG Ms-DRG 325 2 1 — — $145,735.46 $145,735.46 $145,735.46 2026-07-15
32551 CPT Insertion Chest Tube Rt 6 5 $399.00 $387.03 $297.55 $426.94 $321.27 2026-07-15
344 MS_DRG Ms-DRG 344 2 1 — — $99,886.82 $99,886.82 $99,886.82 2026-07-15
347 MS_DRG Ms-DRG 347 2 1 — — $26,942.76 $26,942.76 $26,942.76 2026-07-15
351 MS_DRG Ms-DRG 351 2 1 — — $19,825.07 $19,825.07 $19,825.07 2026-07-15
360 CDM Or Level 1 32 5 $1,106.00 $1,072.82 $555.10 $1,292.95 $849.40 2026-07-15
36430 CPT Blood Administration 12 5 $453.00 $439.41 $93.64 $1,293.00 $386.41 2026-07-15
377 MS_DRG Ms-DRG 377 2 1 — — $4,225.96 $4,225.96 $4,225.96 2026-07-15
383 MS_DRG Ms-DRG 383 2 1 — — $17,831.06 $17,831.06 $17,831.06 2026-07-15
392 MS_DRG Ms-DRG 392 2 1 — — $7,416.84 $7,416.84 $7,416.84 2026-07-15
420 MS_DRG Ms-DRG 420 2 1 — — $14,219.69 $14,219.69 $14,219.69 2026-07-15
45 MS_DRG Ms-DRG 45 2 1 — — $35,125.14 $35,125.14 $35,125.14 2026-07-15
45378 CPT Colonoscopy Diagnostic 6 5 $997.00 $967.09 $362.29 $937.18 $393.28 2026-07-15
45380 CPT Colonoscopy W Biopsy(s) 6 5 $1,196.00 $1,160.12 $393.92 $1,124.24 $427.84 2026-07-15
45384 CPT Colonoscopy W Lesion Removal 6 5 $873.00 $846.81 $443.33 $820.62 $480.72 2026-07-15
45385 CPT Colonoscopy W Lesion Removal 6 5 $1,350.00 $1,309.50 $497.75 $1,269.00 $540.97 2026-07-15
463 MS_DRG Ms-DRG 463 2 1 — — $42,795.71 $42,795.71 $42,795.71 2026-07-15
469 MS_DRG Ms-DRG 469 2 1 — — $54,290.65 $54,290.65 $54,290.65 2026-07-15
51705 CPT Suprapubic Cath Change 9 5 $492.00 $477.24 $319.80 $467.40 $419.68 2026-07-15
603 MS_DRG Ms-DRG 603 2 1 — — $12,610.84 $12,610.84 $12,610.84 2026-07-15
638 MS_DRG Ms-DRG 638 1 1 — — $12,610.84 $12,610.84 $12,610.84 2026-07-15
64400 CPT Inj Trigeminal N Block Lt 28 5 $481.00 $466.57 $100.07 $516.06 $345.60 2026-07-15
65220 CPT Remove Foreign Body Eye Lt 14 5 $480.00 $465.60 $81.33 $456.00 $344.88 2026-07-15
684 CDM Trauma Team Evaluation Level 4 8 5 $2,233.00 $2,166.01 $1,451.45 $2,121.35 $1,834.41 2026-07-15
70030 CPT X-ray Eye Fb Detection 6 5 $397.00 $385.09 $258.05 $377.15 $355.91 2026-07-15
70100 CPT X-ray Mandible < 4 Views 6 5 $364.00 $353.08 $236.60 $345.80 $326.33 2026-07-15
70150 CPT X-ray Facial Bones 3 Views 8 5 $607.00 $588.79 $82.17 $576.65 $493.19 2026-07-15
70160 CPT X-ray Facial Bones 3 Views 8 5 $716.00 $694.52 $86.75 $680.20 $581.75 2026-07-15
70220 CPT X-ray Sinuses 3 Views 8 5 $517.00 $501.49 $94.13 $491.15 $420.06 2026-07-15
70250 CPT X-ray Skull < 4 Views 9 5 $374.00 $362.78 $94.25 $355.30 $319.02 2026-07-15
70360 CPT X-ray Neck Soft Tissue 9 5 $400.00 $388.00 $70.19 $380.00 $341.20 2026-07-15
70450 CPT CT Head/Brain Wo Contrast 10 5 $3,013.00 $2,922.61 $1,440.40 $2,869.00 $2,701.15 2026-07-15
70470 CPT CT Head/Brain Wwo Contrast 10 5 $4,376.00 $4,244.72 $241.32 $4,167.00 $3,923.09 2026-07-15
70480 CPT CT Orbit Wo Contrast 8 5 $3,152.00 $3,057.44 $192.56 $2,994.40 $2,561.00 2026-07-15
70481 CPT CT Orbit W Contrast 8 5 $3,247.00 $3,149.59 $80.31 $3,084.65 $2,638.18 2026-07-15
70482 CPT CT Orbit Wwo Contrast 10 5 $3,503.00 $3,397.91 $261.57 $3,872.00 $3,140.44 2026-07-15
70486 CPT CT Maxillofacial Wo Contrast 11 5 $2,817.00 $2,732.49 $187.95 $2,676.15 $2,402.90 2026-07-15
70487 CPT CT Maxillofacial W Contrast 8 5 $3,164.00 $3,069.08 $268.29 $3,005.80 $2,570.75 2026-07-15
70491 CPT CT Soft Tissue Neck W Cont 11 5 $3,778.00 $3,664.66 $357.52 $3,984.30 $3,222.63 2026-07-15
70492 CPT CT Soft Tissue Neck Wwo Cont 8 5 $4,194.00 $4,068.18 $422.85 $3,984.30 $3,407.62 2026-07-15
70496 CPT CT Angiography Head W Cont 12 5 $3,101.00 $3,007.97 $93.21 $2,945.95 $2,519.56 2026-07-15
70498 CPT CT Angiography Neck W Cont 12 5 $2,884.00 $2,797.48 $278.38 $2,817.00 $2,460.05 2026-07-15
70544 CPT MRA Head Wo Contrast 8 5 $4,152.00 $4,027.44 $408.12 $3,944.40 $3,373.50 2026-07-15
70551 CPT MRI Brain Wo Contrast 10 5 $4,391.00 $4,259.27 $447.03 $5,090.00 $3,936.53 2026-07-15
70553 CPT MRI Brain Wwo Contrast 20 5 $6,235.00 $6,047.95 $76.50 $5,938.00 $5,318.45 2026-07-15
71045 CPT X-ray Chest 1 View 13 5 $388.00 $376.36 $252.20 $593.33 $364.72 2026-07-15
71046 CPT X-ray Chest 2v PA/Lateral 12 5 $499.00 $484.03 $132.75 $783.13 $469.06 2026-07-15
71100 CPT X-ray Ribs 2 Views Lt 16 5 $528.00 $512.16 $343.20 $3,616.49 $498.96 2026-07-15
71101 CPT X-ray Ribs Uni W Chest Rt 18 5 $600.00 $582.00 $390.00 $3,427.98 $564.00 2026-07-15
71250 CPT CT Thorax Wo Contrast 12 5 $3,480.00 $3,375.60 $22.78 $3,314.00 $2,968.44 2026-07-15
71260 CPT CT Thorax W Contrast 12 5 $4,013.00 $3,892.61 $80.31 $3,821.00 $3,423.09 2026-07-15
71270 CPT CT Thorax Wwo Contrast 8 5 $4,385.00 $4,253.45 $82.17 $4,165.75 $3,562.81 2026-07-15
71271 CPT Ldct For Lung Cancer Screen 11 5 $3,417.00 $3,314.49 $101.47 $3,246.15 $2,914.70 2026-07-15
71275 CPT CTA Chest Wwo Contrast 8 5 $4,857.00 $4,711.29 $3,157.05 $4,614.15 $4,479.66 2026-07-15
720 MS_DRG Ms-DRG 720 2 1 — — $36,767.75 $36,767.75 $36,767.75 2026-07-15
72040 CPT X-ray Spine Cervical 2-3 Views 11 5 $499.00 $484.03 $324.35 $791.00 $474.05 2026-07-15
72070 CPT X-ray Spine Thoracic 2 Views 12 5 $533.00 $517.01 $346.45 $1,015.90 $501.02 2026-07-15
72072 CPT X-ray Spine Thoracic 3 Views 8 5 $676.00 $655.72 $439.40 $697.54 $638.82 2026-07-15
721 MS_DRG Ms-DRG 721 2 1 — — $40,151.46 $40,151.46 $40,151.46 2026-07-15
72100 CPT X-ray Lumbosacral 2-3 Views 13 5 $671.00 $650.87 $90.44 $661.00 $630.74 2026-07-15
72110 CPT X-ray Lumbosacral 4 Views 8 5 $695.00 $674.15 $67.44 $660.25 $564.69 2026-07-15
72125 CPT CT Cervical Spine Wo Contrast 12 5 $3,588.00 $3,480.36 $172.57 $3,588.00 $3,153.36 2026-07-15
72128 CPT CT Thoracic Spine Wo Contrast 8 5 $3,588.00 $3,480.36 $107.92 $3,408.60 $2,915.25 2026-07-15
72131 CPT CT Lumbar Spine Wo Contrast 11 5 $3,588.00 $3,480.36 $93.21 $3,408.60 $3,060.56 2026-07-15
72141 CPT MRI Neck Spine Wo Dye 10 5 $5,174.00 $5,018.78 $233.96 $4,915.30 $4,547.03 2026-07-15
72146 CPT MRI Chest Spine Wo Dye 8 5 $4,234.00 $4,106.98 $390.63 $4,022.30 $3,440.12 2026-07-15
72148 CPT MRI Lumbar Spine Wo Dye 12 5 $4,896.00 $4,749.12 $51.78 $4,662.00 $4,176.29 2026-07-15
72156 CPT MRI Neck Spine Wwo Dye 8 5 $5,836.00 $5,660.92 $340.05 $5,544.20 $4,741.75 2026-07-15
72157 CPT MRI Chest Spine Wwo Dye 8 5 $6,650.00 $6,450.50 $535.35 $6,317.50 $5,403.12 2026-07-15
72158 CPT MRI Lumbar Spine Wwo Dye 8 5 $6,681.00 $6,480.57 $340.96 $6,346.95 $5,428.31 2026-07-15
72170 CPT X-ray Pelvis 1-2 Views 12 5 $447.00 $433.59 $290.55 $615.00 $400.74 2026-07-15
72190 CPT X-ray Pelvis 3 Views 10 5 $672.00 $651.84 $436.80 $640.00 $602.45 2026-07-15
72192 CPT CT Pelvis Wo Dye 8 5 $2,218.00 $2,151.46 $597.01 $2,107.10 $1,802.12 2026-07-15
72195 CPT MRI Pelvis Wo Dye 6 5 $4,165.00 $4,040.05 $2,707.25 $3,956.75 $3,733.92 2026-07-15
72202 CPT X-ray Si Joints 3 Views 8 5 $353.00 $342.41 $229.45 $542.46 $333.59 2026-07-15
72220 CPT X-ray Sacrum Tailbone 9 5 $495.00 $480.15 $321.75 $470.25 $447.69 2026-07-15
73000 CPT X-ray Collar Bone Rt 18 5 $407.00 $394.79 $187.03 $386.65 $347.17 2026-07-15
73010 CPT X-ray Shoulder Blade Rt 8 5 $456.00 $442.32 $174.16 $433.20 $370.50 2026-07-15
73030 CPT X-ray Shoulder Lt 24 5 $507.00 $491.79 $237.65 $482.00 $432.47 2026-07-15
73060 CPT X-ray Humerus Lt 21 5 $469.00 $454.93 $67.44 $469.00 $400.06 2026-07-15
73070 CPT X-ray Elbow Rt 8 5 $392.00 $380.24 $41.69 $372.40 $318.50 2026-07-15
73080 CPT X-ray Elbow Lt 22 5 $475.00 $460.75 $38.91 $451.25 $405.18 2026-07-15
73090 CPT X-ray Forearm 2 Views Lt 22 5 $433.00 $420.01 $281.45 $433.00 $369.35 2026-07-15
73110 CPT X-ray Wrist 3 Views Lt 24 5 $451.00 $437.47 $58.22 $429.00 $393.98 2026-07-15
73120 CPT X-ray Hand Rt 17 5 $394.00 $382.18 $198.99 $374.30 $336.08 2026-07-15
73130 CPT X-ray Hand Lt 24 5 $469.00 $454.93 $59.16 $446.00 $400.06 2026-07-15
73200 CPT CT Ue Wo Dye Rt 19 5 $2,869.00 $2,782.93 $70.19 $2,869.00 $2,447.26 2026-07-15
73201 CPT CT Ue W Dye Rt 8 5 $3,218.00 $3,121.46 $90.44 $3,057.10 $2,614.62 2026-07-15
73202 CPT CT Ue Wwo Dye Rt 8 5 $3,417.00 $3,314.49 $286.41 $3,246.15 $2,776.31 2026-07-15
73218 CPT MRI Ue Wo Dye Rt 8 5 $3,399.00 $3,297.03 $79.39 $3,229.05 $2,761.69 2026-07-15
73221 CPT MRI Joint Ue Wo Dye Rt 23 5 $3,552.00 $3,445.44 $51.78 $3,593.00 $3,029.86 2026-07-15
73501 CPT X-ray Hip Uni 1 View Lt 11 5 $338.00 $327.86 $219.70 $711.09 $317.72 2026-07-15
73502 CPT X-ray Hip Uni 2-3 Views Lt 40 5 $479.00 $464.63 $311.35 $1,047.00 $518.70 2026-07-15
73522 CPT X-ray Hips 3-4 Views Bi 8 5 $738.00 $715.86 $479.70 $793.90 $697.41 2026-07-15
73523 CPT X-ray Hips 5 Views Bi 8 5 $774.00 $750.78 $503.10 $735.30 $690.20 2026-07-15
73552 CPT X-ray Femur 2 Views Lt 20 5 $503.00 $487.91 $130.00 $477.85 $429.06 2026-07-15
73560 CPT X-ray Knee 1-2 Views Rt 21 5 $504.00 $488.88 $84.00 $533.00 $429.91 2026-07-15
73562 CPT X-ray Knee 3 Views Lt 24 5 $524.00 $508.28 $109.75 $551.00 $446.97 2026-07-15
73564 CPT X-ray Knee 4 Lt 19 5 $579.00 $561.63 $129.06 $550.05 $493.89 2026-07-15
73590 CPT X-ray Lower Leg Rt 21 5 $459.00 $445.23 $73.88 $436.05 $391.53 2026-07-15
73610 CPT X-ray Ankle 3 Views Rt 23 5 $495.00 $480.15 $99.63 $471.00 $422.24 2026-07-15
73620 CPT X-ray Foot 2 Views Rt 9 5 $400.00 $388.00 $212.82 $380.00 $341.20 2026-07-15
73630 CPT X-ray Foot 3 Views Lt 24 5 $492.00 $477.24 $65.59 $468.00 $419.68 2026-07-15
73700 CPT CT Le Wo Dye Lt 22 5 $3,247.00 $3,149.59 $76.65 $3,092.00 $2,853.55 2026-07-15
73701 CPT CT Le W Dye Lt 8 5 $3,310.00 $3,210.70 $268.00 $3,144.50 $2,689.38 2026-07-15
73718 CPT MRI Le Wo Dye Lt 16 5 $3,939.00 $3,820.83 $56.38 $3,742.05 $3,200.44 2026-07-15
73721 CPT MRI Joint Le Wo Dye Lt 24 5 $3,723.00 $3,611.31 $315.18 $3,545.00 $3,175.72 2026-07-15
74018 CPT X-ray Abdomen 12 5 $424.00 $411.28 $275.60 $523.39 $398.56 2026-07-15
74019 CPT X-ray Abdomen 12 5 $599.00 $581.03 $389.35 $660.48 $563.06 2026-07-15
74160 CPT CT Abdomen W Dye 10 5 $2,510.00 $2,434.70 $37.51 $2,384.50 $2,039.38 2026-07-15
74170 CPT CT Abdomen Wwo Dye 8 5 $2,971.00 $2,881.87 $58.22 $2,822.45 $2,413.94 2026-07-15
74176 CPT CT Abd & Pelvis Wo Contrast 12 5 $5,114.00 $4,960.58 $95.04 $4,870.00 $4,362.24 2026-07-15
74177 CPT CT Abd & Pelv W Contrast 12 5 $6,921.00 $6,713.37 $227.52 $6,591.00 $5,903.61 2026-07-15
74178 CPT CT Abd & Pelv Wwo Contrast 11 5 $7,679.00 $7,448.63 $104.00 $7,679.00 $6,550.19 2026-07-15
74181 CPT MRI Abdomen Wo Dye 10 5 $3,929.00 $3,811.13 $544.29 $5,363.00 $3,522.35 2026-07-15
74182 CPT MRI Abdomen W Dye 8 5 $4,446.00 $4,312.62 $776.70 $4,223.70 $3,612.38 2026-07-15
74183 CPT MRI Abdomen Wwo Dye 10 5 $5,085.00 $4,932.45 $619.08 $5,632.00 $4,558.70 2026-07-15
74250 CPT Gastrografin Challenge 10 5 $599.00 $581.03 $38.14 $569.05 $486.69 2026-07-15
76010 CPT X-ray Nose To Rectum 10 5 $400.00 $388.00 $260.00 $499.96 $378.00 2026-07-15
761 CDM Anoscopy 64 5 $494.00 $479.18 $22.10 $2,185.00 $364.60 2026-07-15
76536 CPT Ultrasound Head And Neck 12 5 $885.00 $858.45 $575.25 $842.00 $793.40 2026-07-15
76604 CPT Ultrasound Chest 10 5 $651.00 $631.47 $423.15 $741.00 $583.62 2026-07-15
76641 CPT Ultrasound Breast Complete Rt 10 5 $1,089.00 $1,056.33 $707.85 $1,034.55 $898.13 2026-07-15
76642 CPT Ultrasound Breast Limited Lt 27 5 $990.00 $960.30 $643.50 $1,410.75 $930.60 2026-07-15
76700 CPT Ultrasound Abdomen Complete 11 5 $1,221.00 $1,184.37 $728.69 $1,159.95 $1,041.51 2026-07-15
76705 CPT Ultrasound Abdomen Limited 12 5 $1,038.00 $1,006.86 $674.70 $986.10 $885.41 2026-07-15
76706 CPT Aaa Screening Medicare 8 5 $437.00 $423.89 $284.05 $415.15 $359.00 2026-07-15
76770 CPT Ultrasound Abdo Back Wall Comp 11 5 $1,058.00 $1,026.26 $687.70 $1,005.10 $902.47 2026-07-15
76775 CPT Ultrasound Limited 11 5 $900.00 $873.00 $22.78 $855.00 $767.70 2026-07-15
76801 CPT OB US < 14 Wks Single Fetus 8 5 $992.00 $962.24 $644.80 $942.40 $814.93 2026-07-15
76830 CPT Ultrasound Transvaginal 11 5 $1,069.00 $1,036.93 $694.85 $1,015.55 $911.86 2026-07-15
76856 CPT Ultrasound Pelvic Complete 10 5 $1,167.00 $1,131.99 $758.55 $1,108.65 $1,046.22 2026-07-15
76870 CPT Ultrasound Scrotum 10 5 $1,099.00 $1,066.03 $714.35 $1,338.00 $985.25 2026-07-15
76882 CPT US Extremity Nonvasc Limit Lt 21 5 $710.00 $688.70 $461.50 $739.00 $605.63 2026-07-15
77065 CPT Mammography Dx Digital Lt 18 5 $523.00 $507.31 $339.95 $496.85 $446.12 2026-07-15
77066 CPT Mammography Diagnostic Digital 13 5 $609.00 $590.73 $395.85 $918.00 $572.46 2026-07-15
77067 CPT Mammography Screening Digital 20 5 $445.00 $431.65 $81.96 $422.75 $365.56 2026-07-15
78227 CPT Hida With Ef w/Pharm 8 5 $2,076.00 $2,013.72 $1,349.40 $1,972.20 $1,705.43 2026-07-15
78452 CPT Myocard Perf Spect Rest Stress 12 5 $6,135.00 $5,950.95 $289.80 $5,842.00 $5,233.15 2026-07-15
81241 CPT Factor V Leiden Mutation 8 5 $502.00 $486.94 $326.30 $476.90 $412.39 2026-07-15
81256 CPT Hemochromat Mutation 8 5 $764.00 $741.08 $496.60 $725.80 $627.62 2026-07-15
82024 CPT Acth Adrenocorticotropic Hor 10 5 $470.00 $455.90 $38.62 $446.50 $386.11 2026-07-15
82306 CPT Vitamin D 25 Oh 12 5 $413.00 $400.61 $116.70 $392.35 $339.28 2026-07-15
82523 CPT Cross Linked C Teleop 8 5 $415.00 $402.55 $269.75 $394.25 $340.93 2026-07-15
82652 CPT Vitamin D 125 Dihydroxy 8 5 $417.00 $404.49 $271.05 $396.15 $342.56 2026-07-15
82671 CPT Estrogen Fractionated 8 5 $421.00 $408.37 $273.65 $399.95 $345.85 2026-07-15
83498 CPT 17Oh Progesterone 8 5 $382.00 $370.54 $248.30 $362.90 $313.81 2026-07-15
83880 CPT B Type Natriuretic Peptide 12 5 $448.00 $434.56 $125.05 $425.60 $382.14 2026-07-15
83993 CPT Calprotectin 12 5 $606.00 $587.82 $19.63 $575.70 $497.83 2026-07-15
84305 CPT Somatomedin 9 5 $469.00 $454.93 $304.85 $445.55 $400.06 2026-07-15
84445 CPT Tsi 8 5 $540.00 $523.80 $351.00 $513.00 $443.61 2026-07-15
86053 CPT Neuromyelitis Optic Antibody 8 5 $699.00 $678.03 $454.35 $664.05 $574.23 2026-07-15
862 MS_DRG Ms-DRG 862 2 1 — — $207,498.78 $207,498.78 $207,498.78 2026-07-15
86334 CPT Immunofix Electroph Serum 11 5 $447.00 $433.59 $152.77 $424.65 $381.29 2026-07-15
86362 CPT Mog Antibody Ref 8 5 $2,221.00 $2,154.37 $1,443.65 $2,109.95 $1,824.55 2026-07-15
86480 CPT Tbint Quantiferon 11 5 $397.00 $385.09 $61.98 $377.15 $338.64 2026-07-15
86645 CPT Cmv Antibody IgM 9 5 $370.00 $358.90 $240.50 $351.50 $315.61 2026-07-15
86870 CPT Rbc Antibody Identif Panel 9 5 $367.00 $355.99 $238.55 $348.65 $313.05 2026-07-15
87040 CPT Culture Blood 12 5 $409.00 $396.73 $265.85 $389.00 $359.22 2026-07-15
87103 CPT Culture Fungus Blood 8 5 $392.00 $380.24 $254.80 $372.40 $322.03 2026-07-15
87154 CPT Culture Id By Amp Prb 6 Or 6+ 8 5 $2,074.00 $2,011.78 $1,348.10 $1,970.30 $1,703.79 2026-07-15
87338 CPT H Pylori Antigen Stool 8 5 $403.00 $390.91 $261.95 $382.85 $331.06 2026-07-15
87497 CPT Cmv Quant By Pcr 10 5 $1,167.00 $1,131.99 $267.50 $1,108.65 $958.69 2026-07-15
87631 CPT Influ And Rsv Amp Probe 10 5 $397.00 $385.09 $214.00 $377.15 $326.13 2026-07-15
87636 CPT Influ & CoV2 Pcr Ceph 11 5 $450.00 $436.50 $216.80 $427.50 $383.85 2026-07-15
87637 CPT Influ/RSV/CoV2 Pcr Ceph 13 5 $509.00 $493.73 $189.18 $483.55 $434.18 2026-07-15
87799 CPT Bk Virus Quant Pcr, Serum 10 5 $1,619.00 $1,570.43 $160.67 $1,538.05 $1,330.01 2026-07-15
90619 CPT Menacwy-tt IM 8 5 $674.00 $654.56 $160.69 $641.06 $548.28 2026-07-15
90675 CPT Rabies Vax Pcec/Pf 2.5Unit Vl 8 5 $1,347.00 $1,307.03 $125.23 $1,280.08 $1,094.80 2026-07-15
90677 CPT Pneumo 20 Valent Vacc 0.5 Ml 20 5 $965.00 $936.39 $326.00 $1,058.40 $907.43 2026-07-15
90739 CPT HepB Adult 2 Dose IM 10 5 $596.00 $578.51 $137.37 $566.58 $484.58 2026-07-15
92523 CPT Speech Sound Lang Comp Or Expr 8 5 $532.00 $516.04 $345.80 $505.40 $437.04 2026-07-15
92610 CPT Swallow Eval Non Radiol 10 5 $461.00 $447.17 $16.53 $437.95 $378.71 2026-07-15
92950 CPT Heart/Lung Resuscitation Cpr 14 5 $944.00 $915.68 $275.08 $1,135.52 $678.26 2026-07-15
93005 CPT EKG Tracing 12 5 $381.00 $369.57 $105.63 $361.95 $312.99 2026-07-15
93017 CPT Cardiovascular Stress Test 12 5 $1,529.00 $1,483.13 $993.85 $1,988.00 $1,370.75 2026-07-15
93225 CPT Holter Monitor Hook Up <48 Hrs 12 5 $798.00 $774.06 $518.70 $760.00 $701.35 2026-07-15
93226 CPT ECG Monit/Report Up To 48 Hour 12 5 $890.00 $863.30 $578.50 $847.00 $781.91 2026-07-15
93270 CPT Cardiac Event Hookup Only 12 5 $471.00 $456.87 $306.15 $448.00 $422.25 2026-07-15
93306 CPT Tte W Doppler Complete 18 5 $3,351.00 $3,250.47 $105.90 $3,183.45 $2,407.69 2026-07-15
93351 CPT Stress Tte Complete 14 5 $1,824.00 $1,769.28 $126.80 $1,732.80 $1,199.28 2026-07-15
93798 CPT Cardiac Rehab Ii Monitored 11 5 $392.00 $380.24 $254.80 $373.00 $368.48 2026-07-15
93880 CPT Extracranial Bilat Study 12 5 $2,049.00 $1,987.53 $249.67 $1,951.00 $1,747.80 2026-07-15
93925 CPT Arterial Duplex Le Bi 11 5 $1,353.00 $1,312.41 $51.78 $1,285.35 $1,154.11 2026-07-15
93970 CPT Venous Duplex 12 5 $1,566.00 $1,519.02 $1,017.90 $1,487.70 $1,403.92 2026-07-15
93971 CPT Extremity Study Rt 23 5 $1,490.00 $1,445.30 $73.61 $1,490.00 $1,270.97 2026-07-15
93976 CPT Vascular Study 10 5 $1,070.00 $1,037.90 $113.83 $1,016.50 $879.00 2026-07-15
94060 CPT Pft Pre & Post Screen Spirome 8 5 $572.00 $554.84 $371.80 $543.40 $469.90 2026-07-15
94660 CPT CPap/BiPap First Day 8 5 $1,119.00 $1,085.43 $727.35 $1,063.05 $919.26 2026-07-15
94762 CPT Desaturation And Hr Study 8 5 $446.00 $432.62 $289.90 $423.70 $366.39 2026-07-15
95810 CPT Polysomnogram 10 5 $6,100.00 $5,917.00 $3,965.00 $6,100.00 $5,468.65 2026-07-15
95811 CPT Polysomnogram W CPap 10 5 $7,001.00 $6,790.97 $4,550.65 $6,650.95 $6,152.75 2026-07-15
96105 CPT Aphasia Evaluation Per Hour 8 5 $515.00 $499.55 $334.75 $489.25 $423.08 2026-07-15
96125 CPT Cognitive Performance Test St 8 5 $488.00 $473.36 $317.20 $463.60 $400.89 2026-07-15
96360 CPT Inf Therapy Hyd Initial 32 5 $432.00 $419.04 $49.18 $501.60 $343.07 2026-07-15
96365 CPT Inf Therapy Med Initial 32 5 $502.00 $486.94 $45.13 $574.75 $394.91 2026-07-15
96413 CPT Chemotherapy Inf Initial 11 5 $748.00 $725.56 $71.05 $712.00 $638.04 2026-07-15
97550 CPT Caregiver Training 1st 30 Min. 8 5 $515.00 $499.55 $334.75 $489.25 $423.08 2026-07-15
97605 CPT Neg Pressure Wound Dme <50 Cm 10 5 $546.00 $529.62 $42.56 $518.70 $448.54 2026-07-15
99223 CPT IP/Obs Initial High Comp 6 5 $551.00 $534.47 $270.04 $517.94 $365.74 2026-07-15
99235 CPT Admit/Discharge Same Day Mod 6 5 $480.00 $465.60 $247.05 $451.20 $330.05 2026-07-15
99236 CPT Admit/Discharge Same Day High 6 5 $599.00 $581.03 $322.41 $563.06 $427.62 2026-07-15
99283 CPT Emergency Room Visit Level 3 19 5 $688.00 $667.36 $108.68 $653.60 $531.14 2026-07-15
99284 CPT Emergency Room Visit Level 4 20 5 $1,047.00 $1,015.59 $91.22 $994.65 $752.26 2026-07-15
99285 CPT Emergency Room Visit Level 5 18 5 $1,865.00 $1,809.05 $32.05 $1,771.75 $1,340.00 2026-07-15
99291 CPT Critical Care 1st 30-74 Min 14 5 $2,376.00 $2,304.72 $329.00 $2,257.20 $1,562.22 2026-07-15
A9500 HCPCS Radiophar Tc99M Sestamibi Dose 12 5 $801.00 $776.97 $520.65 $1,602.00 $718.10 2026-07-15
A9585 HCPCS Gadobutrol Inj 10 Mm/10 Ml Vl 11 5 $800.00 $776.00 $2.69 $760.00 $682.40 2026-07-15
C1726 HCPCS Dil Pebax 180Cm Od15-18 10 5 $1,148.00 $1,114.26 $746.67 $1,148.72 $1,029.83 2026-07-15
C8929 HCPCS Echo M Mode 2d W Contrast 12 5 $3,663.00 $3,553.11 $169.24 $3,488.00 $3,124.54 2026-07-15
C8930 HCPCS Stress Echo W Contrast 9 5 $2,042.00 $1,980.74 $1,327.30 $1,939.90 $1,741.83 2026-07-15
G0105 HCPCS Screening Colonoscopy Hi Risk 6 5 $897.00 $870.09 $170.90 $843.18 $381.44 2026-07-15
G0121 HCPCS Screen Colonoscopy Not Hi Risk 6 5 $897.00 $870.09 $171.02 $843.18 $381.66 2026-07-15
G0379 HCPCS Observation Assess Direct Adm 8 5 $609.00 $590.73 $395.85 $578.55 $500.30 2026-07-15
G0390 HCPCS Trauma Team Level 4 8 5 $2,233.00 $2,166.01 $1,451.45 $2,121.35 $1,834.41 2026-07-15
G0399 HCPCS Sleep Study Type Iii Portable 11 5 $1,033.00 $1,002.01 $671.45 $981.35 $881.15 2026-07-15
J0248 HCPCS Remdesivir 100 Mg Vial 8 5 $2,797.00 $2,713.73 $70.71 $2,657.78 $2,273.10 2026-07-15
J0283 HCPCS Amiodarone/D5W 150mg/100ml Bag 14 5 $443.00 $429.86 $173.21 $466.05 $397.64 2026-07-15
J0289 HCPCS Amphotericin B Liposome 50 Mg 9 5 $477.00 $462.96 $7.63 $453.42 $407.12 2026-07-15
J0561 HCPCS Pen G Benzathine 1200000Un/2ML 10 5 $1,191.00 $1,155.52 $216.00 $1,131.70 $967.89 2026-07-15
J0703 HCPCS Cefepime/D5W 1000mg/50ml Bag 14 5 $370.00 $359.09 $1.22 $382.21 $329.49 2026-07-15
J0897 HCPCS Denosumab 60 Mg/ml Syringe 8 5 $7,640.00 $7,411.27 $9.69 $7,258.46 $6,207.89 2026-07-15
J1439 HCPCS Ferric Carboxymalt 750mg/15ml 8 5 $4,349.00 $4,219.29 $11.91 $4,132.29 $3,534.20 2026-07-15
J1447 HCPCS Tbo-filgrastim 300mcg/0.5ml Sy 14 5 $752.00 $730.32 $247.20 $1,059.23 $715.26 2026-07-15
J1610 HCPCS Glucagon 1 Mg Emergency Kit 8 5 $1,327.00 $1,287.61 $98.91 $1,261.06 $1,078.54 2026-07-15
J1745 HCPCS Infliximab (Gen) 100 Mg Vial 8 5 $2,120.00 $2,056.89 $1.46 $2,014.48 $1,722.91 2026-07-15
J2020 HCPCS Linezolid 600 Mg/300 Ml Bag 8 5 $333.00 $323.04 $216.47 $968.84 $314.72 2026-07-15
J2997 HCPCS Alteplase 2 Mg Vial 8 5 $879.00 $852.77 $37.08 $835.18 $714.31 2026-07-15
J3101 HCPCS Tenecteplase 50 Mg/10 Ml Syrng 8 5 $31,584.00 $30,637.29 $0.41 $30,005.60 $25,662.68 2026-07-15
J3304 HCPCS Triamcinolone Acetonide 32 Mg 8 5 $3,065.00 $2,973.28 $520.65 $2,911.98 $2,490.51 2026-07-15
J3489 HCPCS Zoledron Ac/Man/H2O 5mg/100ml 8 5 $432.00 $419.18 $17.25 $410.53 $351.12 2026-07-15
J7325 HCPCS Hylan Polymer A&b 48mg/6ml Syr 8 5 $2,141.00 $2,077.42 $1,392.09 $2,034.59 $1,781.01 2026-07-15
J7327 HCPCS Hyaluronate Sodium 88Mg/4Ml 8 5 $3,627.00 $3,518.39 $1,488.18 $3,445.85 $2,947.11 2026-07-15
J9217 HCPCS Leuprolide Acetate 22.5 Mg Syr 8 5 $2,391.00 $2,319.99 $1.47 $2,272.15 $1,943.29 2026-07-15
L3808 HCPCS Ortho Wrist Hand Fngr Static 8 5 $1,113.00 $1,080.39 $723.97 $1,058.11 $914.99 2026-07-15
P9016 HCPCS Red Blood Cells Lekoreduced 12 5 $560.00 $543.20 $38.98 $533.00 $477.68 2026-07-15
P9035 HCPCS Platelet Pheresis Leuko Reduc 8 5 $1,714.00 $1,662.58 $1,114.10 $1,628.30 $1,408.05 2026-07-15
P9037 HCPCS Platelet Pheresis Leuk Red Irr 8 5 $1,550.00 $1,503.50 $1,007.50 $1,472.50 $1,273.33 2026-07-15
P9040 HCPCS Rbc Packed Leuko-reduc Irrad 9 5 $664.00 $644.08 $431.60 $630.80 $566.39 2026-07-15
P9047 HCPCS Albumin Human 25% 25gr/100ml 8 5 $618.00 $600.27 $402.24 $3,118.50 $584.80 2026-07-15
Q0138 HCPCS Ferumoxy 510mg/17ml (non-esrd) 8 5 $1,145.00 $1,111.35 $7.28 $1,088.43 $930.90 2026-07-15
Q5101 HCPCS Filgrastim-sndz 300 Mcg/0.5 Ml 8 5 $1,046.00 $1,015.41 $680.43 $2,902.39 $989.24 2026-07-15
Q5108 HCPCS Pegfilgrastim-jmdb 6 Mg/0.6 Ml 8 5 $8,037.00 $7,796.65 $5,224.56 $7,635.89 $6,530.70 2026-07-15
Q5111 HCPCS Pegfilgrastim-cbqv 6 Mg/0.6 Ml 8 5 $8,925.00 $8,657.25 $1,112.40 $8,478.75 $7,251.56 2026-07-15
Q5122 HCPCS Pegfilgrastim 6 Mg/0.6 Ml Syr 8 5 $8,038.00 $7,796.96 $3,939.75 $7,636.19 $6,530.95 2026-07-15
Q5130 HCPCS Pegfilgrastim-pbbk 6 Mg/0.6 Ml 8 5 $10,131.00 $9,827.64 $0.54 $9,625.01 $8,231.92 2026-07-15
Q9950 HCPCS Sulf Hexaflr Microsphre 5ml Vl 11 5 $802.00 $778.42 $187.95 $762.38 $684.53 2026-07-15
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