Price Transparency 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

AVERA CREIGHTON HOSPITAL

Creighton, NE · CCN 281331 · Rates published

849 distinct procedures filed
5 distinct payers
12,532 rate rows
2026-05-09 last MRF observed
Data quality

12,507 of 12,532 rate rows are consumer-grade (99.8%)

25 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
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 not_modified · 2026-05-17
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
OTHER 		Ms-DRG 862 1 $207,498.78 $207,498.78 $207,498.78 nat. median
$15,153
outlier · 13.7×
325
OTHER 		Ms-DRG 325 1 $145,735.46 $145,735.46 $145,735.46 nat. median
$24,525
outlier · 5.9×
182
OTHER 		Ms-DRG 182 1 $115,441.39 $115,441.39 $115,441.39 nat. median
$8,573
outlier · 13.5×
192
OTHER 		Ms-DRG 192 1 $107,374.00 $107,374.00 $107,374.00 nat. median
$6,927
outlier · 15.5×
344
OTHER 		Ms-DRG 344 1 $99,886.82 $99,886.82 $99,886.82 nat. median
$22,960
outlier · 4.4×
308
OTHER 		Ms-DRG 308 1 $95,496.45 $95,496.45 $95,496.45 nat. median
$11,836
outlier · 8.1×
314
OTHER 		Ms-DRG 314 1 $87,150.74 $87,150.74 $87,150.74 nat. median
$20,076
outlier · 4.3×
305
OTHER 		Ms-DRG 305 1 $77,600.30 $77,600.30 $77,600.30 nat. median
$56
outlier · 1379.6×
323
OTHER 		Ms-DRG 323 1 $74,695.78 $74,695.78 $74,695.78 nat. median
$31,081
outlier · 2.4×
322
OTHER 		Ms-DRG 322 1 $70,206.18 $70,206.18 $70,206.18 nat. median
$15,755
outlier · 4.5×
247
OTHER 		Ms-DRG 247 1 $54,967.72 $54,967.72 $54,967.72 nat. median
$2,024
outlier · 27.2×
469
OTHER 		Ms-DRG 469 1 $54,290.65 $54,290.65 $54,290.65 nat. median
$28,227
1.9× median
263
OTHER 		Ms-DRG 263 1 $50,527.23 $50,527.23 $50,527.23 nat. median
$26,524
1.9× median
463
OTHER 		Ms-DRG 463 1 $42,795.71 $42,795.71 $42,795.71 nat. median
$48,651
0.9× median
231
OTHER 		Ms-DRG 231 1 $41,103.34 $41,103.34 $41,103.34 nat. median
$74,989
0.5× median
721
OTHER 		Ms-DRG 721 1 $40,151.46 $40,151.46 $40,151.46 nat. median
$24
outlier · 1661.9×
720
OTHER 		Ms-DRG 720 1 $36,767.75 $36,767.75 $36,767.75 nat. median
$2,844
outlier · 12.9×
45
OTHER 		Ms-DRG 45 1 $35,125.14 $35,125.14 $35,125.14 nat. median
$10,377
outlier · 3.4×
24
OTHER 		Ms-DRG 24 1 $30,625.87 $30,625.87 $30,625.87 nat. median
$27,988
1.1× median
201
OTHER 		Ms-DRG 201 1 $29,389.50 $29,389.50 $29,389.50 nat. median
$7,601
outlier · 3.9×
347
OTHER 		Ms-DRG 347 1 $26,942.76 $26,942.76 $26,942.76 nat. median
$24,311
1.1× median
J3101
OTHER 		Tenecteplase 50 Mg/10 Ml Syrng 5 $0.41 $30,005.60 $25,662.68 nat. median
$195
outlier · 131.6×
241
OTHER 		Ms-DRG 241 1 $24,609.82 $24,609.82 $24,609.82 nat. median
$14,138
1.7× median
140
OTHER 		Ms-DRG 140 1 $22,251.15 $22,251.15 $22,251.15 nat. median
$37,242
0.6× median
139
OTHER 		Ms-DRG 139 1 $20,574.99 $20,574.99 $20,574.99 nat. median
$12,273
1.7× median
254
OTHER 		Ms-DRG 254 1 $20,563.02 $20,563.02 $20,563.02 nat. median
$16,771
1.2× median
351
OTHER 		Ms-DRG 351 1 $19,825.07 $19,825.07 $19,825.07 nat. median
$11,639
1.7× median
383
OTHER 		Ms-DRG 383 1 $17,831.06 $17,831.06 $17,831.06 nat. median
$12,462
1.4× median
244
OTHER 		Ms-DRG 244 1 $17,722.14 $17,722.14 $17,722.14 nat. median
$18,624
1.0× median
248
OTHER 		Ms-DRG 248 1 $16,120.10 $16,120.10 $16,120.10 nat. median
$2,024
outlier · 8.0×
420
OTHER 		Ms-DRG 420 1 $14,219.69 $14,219.69 $14,219.69 nat. median
$150
outlier · 95.0×
194
OTHER 		Ms-DRG 194 1 $13,663.36 $13,663.36 $13,663.36 nat. median
$8,630
1.6× median
603
OTHER 		Ms-DRG 603 1 $12,610.84 $12,610.84 $12,610.84 nat. median
$9,288
1.4× median
638
OTHER 		Ms-DRG 638 1 $12,610.84 $12,610.84 $12,610.84 nat. median
$9,351
1.3× median
Q5130
OTHER 		Pegfilgrastim-pbbk 6 Mg/0.6 Ml 5 $0.54 $9,625.01 $8,231.92 nat. median
$186
outlier · 44.2×
392
OTHER 		Ms-DRG 392 1 $7,416.84 $7,416.84 $7,416.84 nat. median
$8,098
0.9× median
Q5111
OTHER 		Pegfilgrastim-cbqv 6 Mg/0.6 Ml 5 $1,112.40 $8,478.75 $7,251.56 nat. median
$164
outlier · 44.3×
74178
OTHER 		CT Abd & Pelv Wwo Contrast 5 $104.00 $7,679.00 $6,550.19 nat. median
$495
outlier · 13.2×
Q5122
OTHER 		Pegfilgrastim 6 Mg/0.6 Ml Syr 5 $3,939.75 $7,636.19 $6,530.95 nat. median
$146
outlier · 44.6×
Q5108
OTHER 		Pegfilgrastim-jmdb 6 Mg/0.6 Ml 5 $5,224.56 $7,635.89 $6,530.70 nat. median
$137
outlier · 47.8×
J0897
OTHER 		Denosumab 60 Mg/ml Syringe 5 $9.69 $7,258.46 $6,207.89 nat. median
$32
outlier · 195.2×
95811
OTHER 		Polysomnogram W CPap 5 $4,550.65 $6,650.95 $6,152.75 nat. median
$996
outlier · 6.2×
74177
OTHER 		CT Abd & Pelv W Contrast 5 $227.52 $6,591.00 $5,903.61 nat. median
$458
outlier · 12.9×
95810
OTHER 		Polysomnogram 5 $3,965.00 $6,100.00 $5,468.65 nat. median
$979
outlier · 5.6×
72158
OTHER 		MRI Lumbar Spine Wwo Dye 5 $340.96 $6,346.95 $5,428.31 nat. median
$576
outlier · 9.4×
72157
OTHER 		MRI Chest Spine Wwo Dye 5 $535.35 $6,317.50 $5,403.12 nat. median
$630
outlier · 8.6×
249
OTHER 		Ms-DRG 249 1 $5,398.38 $5,398.38 $5,398.38 nat. median
$2,024
outlier · 2.7×
70553
OTHER 		MRI Brain Wwo Contrast 5 $76.50 $5,938.00 $5,318.45 nat. median
$596
outlier · 8.9×
78452
OTHER 		Myocard Perf Spect Rest Stress 5 $289.80 $5,842.00 $5,233.15 nat. median
$1,353
outlier · 3.9×
72156
OTHER 		MRI Neck Spine Wwo Dye 5 $340.05 $5,544.20 $4,741.75 nat. median
$564
outlier · 8.4×

Other procedures at this hospital

Browse this hospital's 849 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 OTHER Respir Path 22 Targets Biofire 8 5 $960.00 $931.20 $624.00 $912.00 $788.64 2026-05-09
10061 OTHER I&d Abscess Comp/Multiple 14 5 $691.00 $670.27 $373.43 $656.45 $483.79 2026-05-09
10120 OTHER I&r Foreign Body Simple 25 5 $437.00 $423.89 $215.90 $1,389.85 $410.78 2026-05-09
11042 OTHER Debride Skin Subq 20 Cm 29 5 $775.00 $751.75 $9.57 $1,970.30 $661.08 2026-05-09
11043 OTHER Debride Muscle/Fascia 20 Cm 14 5 $1,565.00 $1,518.05 $302.96 $1,486.75 $1,028.99 2026-05-09
111 OTHER Room Medical Unit Priv 12 5 $1,241.00 $1,203.77 $219.05 $2,037.75 $857.20 2026-05-09
113 OTHER Ms-DRG 113 2 1 — — $4,232.63 $4,232.63 $4,232.63 2026-05-09
11402 OTHER Exc Ben Lesion 1.1-2.0 Trunk 15 5 $953.00 $924.41 $236.15 $905.35 $633.75 2026-05-09
11403 OTHER Exc Ben Lesion 2.1-3.0 Trunk 14 5 $813.00 $788.61 $305.50 $772.35 $534.55 2026-05-09
11750 OTHER Exc Nail Matrix Part/Complete 17 5 $547.00 $530.59 $81.38 $519.65 $363.75 2026-05-09
120 OTHER Room Medical Unit Semi Private 6 5 $2,043.00 $1,981.71 $1,327.95 $1,940.85 $1,831.55 2026-05-09
12004 OTHER Repair Lac Simple 7.6-12.5 Cm 16 5 $530.00 $514.10 $140.14 $530.00 $380.81 2026-05-09
12005 OTHER Repair Lac Simple 12.6-20.0 Cm 14 5 $504.00 $488.88 $179.19 $478.80 $347.59 2026-05-09
12011 OTHER Repair Lac Simple <2.5 Cm 18 5 $530.00 $514.10 $99.67 $503.50 $380.81 2026-05-09
12013 OTHER Repair Lac Simple 2.6-5.0 Cm 14 5 $530.00 $514.10 $109.90 $625.10 $380.81 2026-05-09
12014 OTHER Repair Lac Simple 5.1-7.5 Cm 16 5 $530.00 $514.10 $141.36 $752.94 $413.93 2026-05-09
12042 OTHER Repair Lac Interm 2.6-7.5 Cm 14 5 $566.00 $549.02 $367.90 $766.10 $445.62 2026-05-09
129 OTHER Room Swing Bed Skilled 6 5 $1,704.00 $1,652.88 $1,107.60 $1,618.80 $1,527.63 2026-05-09
139 OTHER Ms-DRG 139 2 1 — — $20,574.99 $20,574.99 $20,574.99 2026-05-09
140 OTHER Ms-DRG 140 2 1 — — $22,251.15 $22,251.15 $22,251.15 2026-05-09
182 OTHER Ms-DRG 182 2 1 — — $115,441.39 $115,441.39 $115,441.39 2026-05-09
192 OTHER Ms-DRG 192 2 1 — — $107,374.00 $107,374.00 $107,374.00 2026-05-09
193 OTHER Ms-DRG 193 2 1 — — $3,725.18 $3,725.18 $3,725.18 2026-05-09
194 OTHER Ms-DRG 194 2 1 — — $13,663.36 $13,663.36 $13,663.36 2026-05-09
201 OTHER Ms-DRG 201 2 1 — — $29,389.50 $29,389.50 $29,389.50 2026-05-09
20605 OTHER Asp/Inj Intermediate Joint Lt 22 5 $351.00 $340.47 $72.99 $1,148.55 $314.67 2026-05-09
231 OTHER Ms-DRG 231 2 1 — — $41,103.34 $41,103.34 $41,103.34 2026-05-09
23500 OTHER Fx Clavicle Lt 8 5 $679.00 $658.63 $441.35 $645.05 $557.80 2026-05-09
23600 OTHER Fx Prox Humeral Wo Man Lt 16 5 $396.00 $384.12 $257.40 $376.20 $325.31 2026-05-09
23675 OTHER Clsd Tx Shldr Disloc W Man Rt 14 5 $1,643.00 $1,593.71 $1,028.83 $1,560.85 $1,211.52 2026-05-09
24 OTHER Ms-DRG 24 2 1 — — $30,625.87 $30,625.87 $30,625.87 2026-05-09
241 OTHER Ms-DRG 241 2 1 — — $24,609.82 $24,609.82 $24,609.82 2026-05-09
244 OTHER Ms-DRG 244 2 1 — — $17,722.14 $17,722.14 $17,722.14 2026-05-09
24530 OTHER Fx Supra/Transcondylar Hum Lt 8 5 $534.00 $517.98 $347.10 $507.30 $438.68 2026-05-09
24650 OTHER Fx Radial Head/Neck Wo Man Bi 19 5 $377.00 $365.69 $245.05 $358.15 $321.58 2026-05-09
247 OTHER Ms-DRG 247 2 1 — — $54,967.72 $54,967.72 $54,967.72 2026-05-09
248 OTHER Ms-DRG 248 2 1 — — $16,120.10 $16,120.10 $16,120.10 2026-05-09
249 OTHER Ms-DRG 249 2 1 — — $5,398.38 $5,398.38 $5,398.38 2026-05-09
254 OTHER Ms-DRG 254 2 1 — — $20,563.02 $20,563.02 $20,563.02 2026-05-09
25600 OTHER Fx Distal Radius Lt 19 5 $396.00 $384.12 $257.40 $376.20 $337.79 2026-05-09
263 OTHER Ms-DRG 263 2 1 — — $50,527.23 $50,527.23 $50,527.23 2026-05-09
26600 OTHER Fx Metacarpal 8 5 $416.00 $403.52 $270.40 $395.20 $341.75 2026-05-09
270 OTHER Cellulos Hemost W Thromb 10ml 8 5 $2,034.00 $1,973.40 $1,322.38 $1,932.71 $1,671.28 2026-05-09
27096 OTHER Inject Sacroiliac Joint Bi 20 5 $1,686.00 $1,635.42 $167.26 $1,880.94 $588.49 2026-05-09
27520 OTHER Treat Kneecap Fracture Rt 8 5 $416.00 $403.52 $270.40 $395.20 $341.75 2026-05-09
27786 OTHER Fx Distal Fibula Lt 18 5 $396.00 $384.12 $257.40 $376.20 $337.79 2026-05-09
305 OTHER Ms-DRG 305 2 1 — — $77,600.30 $77,600.30 $77,600.30 2026-05-09
308 OTHER Ms-DRG 308 2 1 — — $95,496.45 $95,496.45 $95,496.45 2026-05-09
30901 OTHER Control Anterior Hemorrhage Rt 16 5 $480.00 $465.60 $109.69 $456.00 $344.88 2026-05-09
30903 OTHER Control Anterior Hemorrhage Lt 14 5 $480.00 $465.60 $149.60 $535.80 $344.88 2026-05-09
314 OTHER Ms-DRG 314 2 1 — — $87,150.74 $87,150.74 $87,150.74 2026-05-09
322 OTHER Ms-DRG 322 2 1 — — $70,206.18 $70,206.18 $70,206.18 2026-05-09
323 OTHER Ms-DRG 323 2 1 — — $74,695.78 $74,695.78 $74,695.78 2026-05-09
325 OTHER Ms-DRG 325 2 1 — — $145,735.46 $145,735.46 $145,735.46 2026-05-09
32551 OTHER Insertion Chest Tube Rt 6 5 $399.00 $387.03 $297.55 $426.94 $321.27 2026-05-09
344 OTHER Ms-DRG 344 2 1 — — $99,886.82 $99,886.82 $99,886.82 2026-05-09
347 OTHER Ms-DRG 347 2 1 — — $26,942.76 $26,942.76 $26,942.76 2026-05-09
351 OTHER Ms-DRG 351 2 1 — — $19,825.07 $19,825.07 $19,825.07 2026-05-09
360 OTHER Or Level 1 32 5 $1,106.00 $1,072.82 $555.10 $1,292.95 $849.40 2026-05-09
36430 OTHER Blood Administration 12 5 $453.00 $439.41 $93.64 $1,293.00 $386.41 2026-05-09
377 OTHER Ms-DRG 377 2 1 — — $4,225.96 $4,225.96 $4,225.96 2026-05-09
383 OTHER Ms-DRG 383 2 1 — — $17,831.06 $17,831.06 $17,831.06 2026-05-09
392 OTHER Ms-DRG 392 2 1 — — $7,416.84 $7,416.84 $7,416.84 2026-05-09
420 OTHER Ms-DRG 420 2 1 — — $14,219.69 $14,219.69 $14,219.69 2026-05-09
45 OTHER Ms-DRG 45 2 1 — — $35,125.14 $35,125.14 $35,125.14 2026-05-09
45378 OTHER Colonoscopy Diagnostic 6 5 $997.00 $967.09 $362.29 $937.18 $393.28 2026-05-09
45380 OTHER Colonoscopy W Biopsy(s) 6 5 $1,196.00 $1,160.12 $393.92 $1,124.24 $427.84 2026-05-09
45384 OTHER Colonoscopy W Lesion Removal 6 5 $873.00 $846.81 $443.33 $820.62 $480.72 2026-05-09
45385 OTHER Colonoscopy W Lesion Removal 6 5 $1,350.00 $1,309.50 $497.75 $1,269.00 $540.97 2026-05-09
463 OTHER Ms-DRG 463 2 1 — — $42,795.71 $42,795.71 $42,795.71 2026-05-09
469 OTHER Ms-DRG 469 2 1 — — $54,290.65 $54,290.65 $54,290.65 2026-05-09
51705 OTHER Suprapubic Cath Change 9 5 $492.00 $477.24 $319.80 $467.40 $419.68 2026-05-09
603 OTHER Ms-DRG 603 2 1 — — $12,610.84 $12,610.84 $12,610.84 2026-05-09
638 OTHER Ms-DRG 638 1 1 — — $12,610.84 $12,610.84 $12,610.84 2026-05-09
64400 OTHER Inj Trigeminal N Block Lt 28 5 $481.00 $466.57 $100.07 $516.06 $345.60 2026-05-09
65220 OTHER Remove Foreign Body Eye Lt 14 5 $480.00 $465.60 $81.33 $456.00 $344.88 2026-05-09
684 OTHER Trauma Team Evaluation Level 4 8 5 $2,233.00 $2,166.01 $1,451.45 $2,121.35 $1,834.41 2026-05-09
70030 OTHER X-ray Eye Fb Detection 6 5 $397.00 $385.09 $258.05 $377.15 $355.91 2026-05-09
70100 OTHER X-ray Mandible < 4 Views 6 5 $364.00 $353.08 $236.60 $345.80 $326.33 2026-05-09
70150 OTHER X-ray Facial Bones 3 Views 8 5 $607.00 $588.79 $82.17 $576.65 $493.19 2026-05-09
70160 OTHER X-ray Facial Bones 3 Views 8 5 $716.00 $694.52 $86.75 $680.20 $581.75 2026-05-09
70220 OTHER X-ray Sinuses 3 Views 8 5 $517.00 $501.49 $94.13 $491.15 $420.06 2026-05-09
70250 OTHER X-ray Skull < 4 Views 9 5 $374.00 $362.78 $94.25 $355.30 $319.02 2026-05-09
70360 OTHER X-ray Neck Soft Tissue 9 5 $400.00 $388.00 $70.19 $380.00 $341.20 2026-05-09
70450 OTHER CT Head/Brain Wo Contrast 12 5 $3,013.00 $2,922.61 $24.20 $2,869.00 $2,570.09 2026-05-09
70470 OTHER CT Head/Brain Wwo Contrast 10 5 $4,376.00 $4,244.72 $241.32 $4,167.00 $3,923.09 2026-05-09
70480 OTHER CT Orbit Wo Contrast 8 5 $3,152.00 $3,057.44 $192.56 $2,994.40 $2,561.00 2026-05-09
70481 OTHER CT Orbit W Contrast 8 5 $3,247.00 $3,149.59 $80.31 $3,084.65 $2,638.18 2026-05-09
70482 OTHER CT Orbit Wwo Contrast 10 5 $3,503.00 $3,397.91 $261.57 $3,872.00 $3,140.44 2026-05-09
70486 OTHER CT Maxillofacial Wo Contrast 11 5 $2,817.00 $2,732.49 $187.95 $2,676.15 $2,402.90 2026-05-09
70487 OTHER CT Maxillofacial W Contrast 8 5 $3,164.00 $3,069.08 $268.29 $3,005.80 $2,570.75 2026-05-09
70491 OTHER CT Soft Tissue Neck W Cont 11 5 $3,778.00 $3,664.66 $357.52 $3,984.30 $3,222.63 2026-05-09
70492 OTHER CT Soft Tissue Neck Wwo Cont 8 5 $4,194.00 $4,068.18 $422.85 $3,984.30 $3,407.62 2026-05-09
70496 OTHER CT Angiography Head W Cont 12 5 $3,101.00 $3,007.97 $93.21 $2,945.95 $2,519.56 2026-05-09
70498 OTHER CT Angiography Neck W Cont 12 5 $2,884.00 $2,797.48 $278.38 $2,817.00 $2,460.05 2026-05-09
70544 OTHER MRA Head Wo Contrast 8 5 $4,152.00 $4,027.44 $408.12 $3,944.40 $3,373.50 2026-05-09
70551 OTHER MRI Brain Wo Contrast 10 5 $4,391.00 $4,259.27 $447.03 $5,090.00 $3,936.53 2026-05-09
70553 OTHER MRI Brain Wwo Contrast 20 5 $6,235.00 $6,047.95 $76.50 $5,938.00 $5,318.45 2026-05-09
71045 OTHER X-ray Chest 1 View 13 5 $388.00 $376.36 $252.20 $593.33 $364.72 2026-05-09
71046 OTHER X-ray Chest 2v PA/Lateral 12 5 $499.00 $484.03 $132.75 $783.13 $469.06 2026-05-09
71100 OTHER X-ray Ribs 2 Views Lt 16 5 $528.00 $512.16 $343.20 $3,616.49 $498.96 2026-05-09
71101 OTHER X-ray Ribs Uni W Chest Rt 18 5 $600.00 $582.00 $390.00 $3,427.98 $564.00 2026-05-09
71250 OTHER CT Thorax Wo Contrast 12 5 $3,480.00 $3,375.60 $22.78 $3,314.00 $2,968.44 2026-05-09
71260 OTHER CT Thorax W Contrast 12 5 $4,013.00 $3,892.61 $80.31 $3,821.00 $3,423.09 2026-05-09
71270 OTHER CT Thorax Wwo Contrast 8 5 $4,385.00 $4,253.45 $82.17 $4,165.75 $3,562.81 2026-05-09
71271 OTHER Ldct For Lung Cancer Screen 11 5 $3,417.00 $3,314.49 $101.47 $3,246.15 $2,914.70 2026-05-09
71275 OTHER CTA Chest Wwo Contrast 10 5 $4,857.00 $4,711.29 $65.59 $4,614.15 $4,268.39 2026-05-09
720 OTHER Ms-DRG 720 2 1 — — $36,767.75 $36,767.75 $36,767.75 2026-05-09
72040 OTHER X-ray Spine Cervical 2-3 Views 11 5 $499.00 $484.03 $324.35 $791.00 $474.05 2026-05-09
72070 OTHER X-ray Spine Thoracic 2 Views 12 5 $533.00 $517.01 $346.45 $1,015.90 $501.02 2026-05-09
72072 OTHER X-ray Spine Thoracic 3 Views 8 5 $676.00 $655.72 $439.40 $697.54 $638.82 2026-05-09
721 OTHER Ms-DRG 721 2 1 — — $40,151.46 $40,151.46 $40,151.46 2026-05-09
72100 OTHER X-ray Lumbosacral 2-3 Views 13 5 $671.00 $650.87 $90.44 $661.00 $630.74 2026-05-09
72110 OTHER X-ray Lumbosacral 4 Views 8 5 $695.00 $674.15 $67.44 $660.25 $564.69 2026-05-09
72125 OTHER CT Cervical Spine Wo Contrast 12 5 $3,588.00 $3,480.36 $172.57 $3,588.00 $3,153.36 2026-05-09
72128 OTHER CT Thoracic Spine Wo Contrast 8 5 $3,588.00 $3,480.36 $107.92 $3,408.60 $2,915.25 2026-05-09
72131 OTHER CT Lumbar Spine Wo Contrast 11 5 $3,588.00 $3,480.36 $93.21 $3,408.60 $3,060.56 2026-05-09
72141 OTHER MRI Neck Spine Wo Dye 10 5 $5,174.00 $5,018.78 $233.96 $4,915.30 $4,547.03 2026-05-09
72146 OTHER MRI Chest Spine Wo Dye 8 5 $4,234.00 $4,106.98 $390.63 $4,022.30 $3,440.12 2026-05-09
72148 OTHER MRI Lumbar Spine Wo Dye 12 5 $4,896.00 $4,749.12 $51.78 $4,662.00 $4,176.29 2026-05-09
72156 OTHER MRI Neck Spine Wwo Dye 8 5 $5,836.00 $5,660.92 $340.05 $5,544.20 $4,741.75 2026-05-09
72157 OTHER MRI Chest Spine Wwo Dye 8 5 $6,650.00 $6,450.50 $535.35 $6,317.50 $5,403.12 2026-05-09
72158 OTHER MRI Lumbar Spine Wwo Dye 8 5 $6,681.00 $6,480.57 $340.96 $6,346.95 $5,428.31 2026-05-09
72170 OTHER X-ray Pelvis 1-2 Views 12 5 $447.00 $433.59 $290.55 $615.00 $400.74 2026-05-09
72190 OTHER X-ray Pelvis 3 Views 10 5 $672.00 $651.84 $436.80 $640.00 $602.45 2026-05-09
72192 OTHER CT Pelvis Wo Dye 8 5 $2,218.00 $2,151.46 $597.01 $2,107.10 $1,802.12 2026-05-09
72195 OTHER MRI Pelvis Wo Dye 8 5 $4,165.00 $4,040.05 $53.64 $3,956.75 $3,384.06 2026-05-09
72202 OTHER X-ray Si Joints 3 Views 8 5 $353.00 $342.41 $229.45 $542.46 $333.59 2026-05-09
72220 OTHER X-ray Sacrum Tailbone 9 5 $495.00 $480.15 $321.75 $470.25 $447.69 2026-05-09
73000 OTHER X-ray Collar Bone Rt 18 5 $407.00 $394.79 $187.03 $386.65 $347.17 2026-05-09
73010 OTHER X-ray Shoulder Blade Rt 8 5 $456.00 $442.32 $174.16 $433.20 $370.50 2026-05-09
73030 OTHER X-ray Shoulder Lt 24 5 $507.00 $491.79 $237.65 $482.00 $432.47 2026-05-09
73060 OTHER X-ray Humerus Lt 21 5 $469.00 $454.93 $67.44 $469.00 $400.06 2026-05-09
73070 OTHER X-ray Elbow Rt 8 5 $392.00 $380.24 $41.69 $372.40 $318.50 2026-05-09
73080 OTHER X-ray Elbow Lt 22 5 $475.00 $460.75 $38.91 $451.25 $405.18 2026-05-09
73090 OTHER X-ray Forearm 2 Views Lt 22 5 $433.00 $420.01 $281.45 $433.00 $369.35 2026-05-09
73110 OTHER X-ray Wrist 3 Views Lt 24 5 $451.00 $437.47 $58.22 $429.00 $393.98 2026-05-09
73120 OTHER X-ray Hand Rt 17 5 $394.00 $382.18 $198.99 $374.30 $336.08 2026-05-09
73130 OTHER X-ray Hand Lt 24 5 $469.00 $454.93 $59.16 $446.00 $400.06 2026-05-09
73200 OTHER CT Ue Wo Dye Rt 19 5 $2,869.00 $2,782.93 $70.19 $2,869.00 $2,447.26 2026-05-09
73201 OTHER CT Ue W Dye Rt 8 5 $3,218.00 $3,121.46 $90.44 $3,057.10 $2,614.62 2026-05-09
73202 OTHER CT Ue Wwo Dye Rt 8 5 $3,417.00 $3,314.49 $286.41 $3,246.15 $2,776.31 2026-05-09
73218 OTHER MRI Ue Wo Dye Rt 8 5 $3,399.00 $3,297.03 $79.39 $3,229.05 $2,761.69 2026-05-09
73221 OTHER MRI Joint Ue Wo Dye Rt 23 5 $3,552.00 $3,445.44 $51.78 $3,593.00 $3,029.86 2026-05-09
73501 OTHER X-ray Hip Uni 1 View Lt 11 5 $338.00 $327.86 $219.70 $711.09 $317.72 2026-05-09
73502 OTHER X-ray Hip Uni 2-3 Views Lt 40 5 $479.00 $464.63 $311.35 $1,047.00 $518.70 2026-05-09
73522 OTHER X-ray Hips 3-4 Views Bi 8 5 $738.00 $715.86 $479.70 $793.90 $697.41 2026-05-09
73523 OTHER X-ray Hips 5 Views Bi 8 5 $774.00 $750.78 $503.10 $735.30 $690.20 2026-05-09
73552 OTHER X-ray Femur 2 Views Lt 20 5 $503.00 $487.91 $130.00 $477.85 $429.06 2026-05-09
73560 OTHER X-ray Knee 1-2 Views Rt 21 5 $504.00 $488.88 $84.00 $533.00 $429.91 2026-05-09
73562 OTHER X-ray Knee 3 Views Lt 24 5 $524.00 $508.28 $109.75 $551.00 $446.97 2026-05-09
73564 OTHER X-ray Knee 4 Lt 19 5 $579.00 $561.63 $129.06 $550.05 $493.89 2026-05-09
73590 OTHER X-ray Lower Leg Rt 21 5 $459.00 $445.23 $73.88 $436.05 $391.53 2026-05-09
73610 OTHER X-ray Ankle 3 Views Rt 23 5 $495.00 $480.15 $99.63 $471.00 $422.24 2026-05-09
73620 OTHER X-ray Foot 2 Views Rt 9 5 $400.00 $388.00 $212.82 $380.00 $341.20 2026-05-09
73630 OTHER X-ray Foot 3 Views Lt 24 5 $492.00 $477.24 $65.59 $468.00 $419.68 2026-05-09
73700 OTHER CT Le Wo Dye Lt 22 5 $3,247.00 $3,149.59 $76.65 $3,092.00 $2,853.55 2026-05-09
73701 OTHER CT Le W Dye Lt 8 5 $3,310.00 $3,210.70 $268.00 $3,144.50 $2,689.38 2026-05-09
73718 OTHER MRI Le Wo Dye Lt 16 5 $3,939.00 $3,820.83 $56.38 $3,742.05 $3,200.44 2026-05-09
73721 OTHER MRI Joint Le Wo Dye Lt 24 5 $3,723.00 $3,611.31 $315.18 $3,545.00 $3,175.72 2026-05-09
74018 OTHER X-ray Abdomen 12 5 $424.00 $411.28 $275.60 $523.39 $398.56 2026-05-09
74019 OTHER X-ray Abdomen 12 5 $599.00 $581.03 $389.35 $660.48 $563.06 2026-05-09
74160 OTHER CT Abdomen W Dye 10 5 $2,510.00 $2,434.70 $37.51 $2,384.50 $2,039.38 2026-05-09
74170 OTHER CT Abdomen Wwo Dye 8 5 $2,971.00 $2,881.87 $58.22 $2,822.45 $2,413.94 2026-05-09
74176 OTHER CT Abd & Pelvis Wo Contrast 12 5 $5,114.00 $4,960.58 $95.04 $4,870.00 $4,362.24 2026-05-09
74177 OTHER CT Abd & Pelv W Contrast 12 5 $6,921.00 $6,713.37 $227.52 $6,591.00 $5,903.61 2026-05-09
74178 OTHER CT Abd & Pelv Wwo Contrast 11 5 $7,679.00 $7,448.63 $104.00 $7,679.00 $6,550.19 2026-05-09
74181 OTHER MRI Abdomen Wo Dye 10 5 $3,929.00 $3,811.13 $544.29 $5,363.00 $3,522.35 2026-05-09
74182 OTHER MRI Abdomen W Dye 8 5 $4,446.00 $4,312.62 $776.70 $4,223.70 $3,612.38 2026-05-09
74183 OTHER MRI Abdomen Wwo Dye 10 5 $5,085.00 $4,932.45 $619.08 $5,632.00 $4,558.70 2026-05-09
74250 OTHER Gastrografin Challenge 10 5 $599.00 $581.03 $38.14 $569.05 $486.69 2026-05-09
76010 OTHER X-ray Nose To Rectum 10 5 $400.00 $388.00 $260.00 $499.96 $378.00 2026-05-09
761 OTHER Anoscopy 64 5 $494.00 $479.18 $22.10 $2,185.00 $364.60 2026-05-09
76536 OTHER Ultrasound Head And Neck 12 5 $885.00 $858.45 $575.25 $842.00 $793.40 2026-05-09
76604 OTHER Ultrasound Chest 10 5 $651.00 $631.47 $423.15 $741.00 $583.62 2026-05-09
76641 OTHER Ultrasound Breast Complete Rt 10 5 $1,089.00 $1,056.33 $707.85 $1,034.55 $898.13 2026-05-09
76642 OTHER Ultrasound Breast Limited Lt 27 5 $990.00 $960.30 $643.50 $1,410.75 $930.60 2026-05-09
76700 OTHER Ultrasound Abdomen Complete 11 5 $1,221.00 $1,184.37 $728.69 $1,159.95 $1,041.51 2026-05-09
76705 OTHER Ultrasound Abdomen Limited 12 5 $1,038.00 $1,006.86 $674.70 $986.10 $885.41 2026-05-09
76706 OTHER Aaa Screening Medicare 8 5 $437.00 $423.89 $284.05 $415.15 $359.00 2026-05-09
76770 OTHER Ultrasound Abdo Back Wall Comp 11 5 $1,058.00 $1,026.26 $687.70 $1,005.10 $902.47 2026-05-09
76775 OTHER Ultrasound Limited 11 5 $900.00 $873.00 $22.78 $855.00 $767.70 2026-05-09
76801 OTHER OB US < 14 Wks Single Fetus 8 5 $992.00 $962.24 $644.80 $942.40 $814.93 2026-05-09
76830 OTHER Ultrasound Transvaginal 11 5 $1,069.00 $1,036.93 $694.85 $1,015.55 $911.86 2026-05-09
76856 OTHER Ultrasound Pelvic Complete 10 5 $1,167.00 $1,131.99 $758.55 $1,108.65 $1,046.22 2026-05-09
76870 OTHER Ultrasound Scrotum 10 5 $1,099.00 $1,066.03 $714.35 $1,338.00 $985.25 2026-05-09
76882 OTHER US Extremity Nonvasc Limit Lt 21 5 $710.00 $688.70 $461.50 $739.00 $605.63 2026-05-09
77065 OTHER Mammography Dx Digital Lt 18 5 $523.00 $507.31 $339.95 $496.85 $446.12 2026-05-09
77066 OTHER Mammography Diagnostic Digital 13 5 $609.00 $590.73 $395.85 $918.00 $572.46 2026-05-09
77067 OTHER Mammography Screening Digital 20 5 $445.00 $431.65 $81.96 $422.75 $365.56 2026-05-09
78227 OTHER Hida With Ef w/Pharm 8 5 $2,076.00 $2,013.72 $1,349.40 $1,972.20 $1,705.43 2026-05-09
78452 OTHER Myocard Perf Spect Rest Stress 12 5 $6,135.00 $5,950.95 $289.80 $5,842.00 $5,233.15 2026-05-09
81241 OTHER Factor V Leiden Mutation 8 5 $502.00 $486.94 $326.30 $476.90 $412.39 2026-05-09
81256 OTHER Hemochromat Mutation 8 5 $764.00 $741.08 $496.60 $725.80 $627.62 2026-05-09
82024 OTHER Acth Adrenocorticotropic Hor 10 5 $470.00 $455.90 $38.62 $446.50 $386.11 2026-05-09
82306 OTHER Vitamin D 25 Oh 12 5 $413.00 $400.61 $116.70 $392.35 $339.28 2026-05-09
82523 OTHER Cross Linked C Teleop 8 5 $415.00 $402.55 $269.75 $394.25 $340.93 2026-05-09
82652 OTHER Vitamin D 125 Dihydroxy 8 5 $417.00 $404.49 $271.05 $396.15 $342.56 2026-05-09
82671 OTHER Estrogen Fractionated 8 5 $421.00 $408.37 $273.65 $399.95 $345.85 2026-05-09
83498 OTHER 17Oh Progesterone 8 5 $382.00 $370.54 $248.30 $362.90 $313.81 2026-05-09
83880 OTHER B Type Natriuretic Peptide 12 5 $448.00 $434.56 $125.05 $425.60 $382.14 2026-05-09
83993 OTHER Calprotectin 12 5 $606.00 $587.82 $19.63 $575.70 $497.83 2026-05-09
84305 OTHER Somatomedin 9 5 $469.00 $454.93 $304.85 $445.55 $400.06 2026-05-09
84445 OTHER Tsi 8 5 $540.00 $523.80 $351.00 $513.00 $443.61 2026-05-09
86053 OTHER Neuromyelitis Optic Antibody 8 5 $699.00 $678.03 $454.35 $664.05 $574.23 2026-05-09
862 OTHER Ms-DRG 862 2 1 — — $207,498.78 $207,498.78 $207,498.78 2026-05-09
86334 OTHER Immunofix Electroph Serum 11 5 $447.00 $433.59 $152.77 $424.65 $381.29 2026-05-09
86362 OTHER Mog Antibody Ref 8 5 $2,221.00 $2,154.37 $1,443.65 $2,109.95 $1,824.55 2026-05-09
86480 OTHER Tbint Quantiferon 11 5 $397.00 $385.09 $61.98 $377.15 $338.64 2026-05-09
86645 OTHER Cmv Antibody IgM 9 5 $370.00 $358.90 $240.50 $351.50 $315.61 2026-05-09
86870 OTHER Rbc Antibody Identif Panel 9 5 $367.00 $355.99 $238.55 $348.65 $313.05 2026-05-09
87040 OTHER Culture Blood 12 5 $409.00 $396.73 $265.85 $389.00 $359.22 2026-05-09
87103 OTHER Culture Fungus Blood 8 5 $392.00 $380.24 $254.80 $372.40 $322.03 2026-05-09
87154 OTHER 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 2026-05-09
87338 OTHER H Pylori Antigen Stool 8 5 $403.00 $390.91 $261.95 $382.85 $331.06 2026-05-09
87497 OTHER Cmv Quant By Pcr 10 5 $1,167.00 $1,131.99 $267.50 $1,108.65 $958.69 2026-05-09
87631 OTHER Influ And Rsv Amp Probe 10 5 $397.00 $385.09 $214.00 $377.15 $326.13 2026-05-09
87636 OTHER Influ & CoV2 Pcr Ceph 11 5 $450.00 $436.50 $216.80 $427.50 $383.85 2026-05-09
87637 OTHER Influ/RSV/CoV2 Pcr Ceph 13 5 $509.00 $493.73 $189.18 $483.55 $434.18 2026-05-09
87799 OTHER Bk Virus Quant Pcr, Serum 10 5 $1,619.00 $1,570.43 $160.67 $1,538.05 $1,330.01 2026-05-09
90619 OTHER Menacwy-tt IM 8 5 $674.00 $654.56 $160.69 $641.06 $548.28 2026-05-09
90675 OTHER Rabies Vax Pcec/Pf 2.5Unit Vl 8 5 $1,347.00 $1,307.03 $125.23 $1,280.08 $1,094.80 2026-05-09
90677 OTHER Pneumo 20 Valent Vacc 0.5 Ml 20 5 $965.00 $936.39 $326.00 $1,058.40 $907.43 2026-05-09
90739 OTHER HepB Adult 2 Dose IM 10 5 $596.00 $578.51 $137.37 $566.58 $484.58 2026-05-09
92523 OTHER Speech Sound Lang Comp Or Expr 8 5 $532.00 $516.04 $345.80 $505.40 $437.04 2026-05-09
92610 OTHER Swallow Eval Non Radiol 10 5 $461.00 $447.17 $16.53 $437.95 $378.71 2026-05-09
92950 OTHER Heart/Lung Resuscitation Cpr 14 5 $944.00 $915.68 $275.08 $1,135.52 $678.26 2026-05-09
93005 OTHER EKG Tracing 12 5 $381.00 $369.57 $105.63 $361.95 $312.99 2026-05-09
93017 OTHER Cardiovascular Stress Test 12 5 $1,529.00 $1,483.13 $993.85 $1,988.00 $1,370.75 2026-05-09
93225 OTHER Holter Monitor Hook Up <48 Hrs 12 5 $798.00 $774.06 $518.70 $760.00 $701.35 2026-05-09
93226 OTHER ECG Monit/Report Up To 48 Hour 12 5 $890.00 $863.30 $578.50 $847.00 $781.91 2026-05-09
93270 OTHER Cardiac Event Hookup Only 12 5 $471.00 $456.87 $306.15 $448.00 $422.25 2026-05-09
93306 OTHER Tte W Doppler Complete 18 5 $3,351.00 $3,250.47 $105.90 $3,183.45 $2,407.69 2026-05-09
93351 OTHER Stress Tte Complete 14 5 $1,824.00 $1,769.28 $126.80 $1,732.80 $1,199.28 2026-05-09
93798 OTHER Cardiac Rehab Ii Monitored 11 5 $392.00 $380.24 $254.80 $373.00 $368.48 2026-05-09
93880 OTHER Extracranial Bilat Study 12 5 $2,049.00 $1,987.53 $249.67 $1,951.00 $1,747.80 2026-05-09
93925 OTHER Arterial Duplex Le Bi 11 5 $1,353.00 $1,312.41 $51.78 $1,285.35 $1,154.11 2026-05-09
93970 OTHER Venous Duplex 12 5 $1,566.00 $1,519.02 $1,017.90 $1,487.70 $1,403.92 2026-05-09
93971 OTHER Extremity Study Rt 23 5 $1,490.00 $1,445.30 $73.61 $1,490.00 $1,270.97 2026-05-09
93976 OTHER Vascular Study 10 5 $1,070.00 $1,037.90 $113.83 $1,016.50 $879.00 2026-05-09
94060 OTHER Pft Pre & Post Screen Spirome 8 5 $572.00 $554.84 $371.80 $543.40 $469.90 2026-05-09
94660 OTHER CPap/BiPap First Day 8 5 $1,119.00 $1,085.43 $727.35 $1,063.05 $919.26 2026-05-09
94762 OTHER Desaturation And Hr Study 8 5 $446.00 $432.62 $289.90 $423.70 $366.39 2026-05-09
95810 OTHER Polysomnogram 10 5 $6,100.00 $5,917.00 $3,965.00 $6,100.00 $5,468.65 2026-05-09
95811 OTHER Polysomnogram W CPap 10 5 $7,001.00 $6,790.97 $4,550.65 $6,650.95 $6,152.75 2026-05-09
96105 OTHER Aphasia Evaluation Per Hour 8 5 $515.00 $499.55 $334.75 $489.25 $423.08 2026-05-09
96125 OTHER Cognitive Performance Test St 8 5 $488.00 $473.36 $317.20 $463.60 $400.89 2026-05-09
96360 OTHER Inf Therapy Hyd Initial 32 5 $432.00 $419.04 $49.18 $501.60 $343.07 2026-05-09
96365 OTHER Inf Therapy Med Initial 32 5 $502.00 $486.94 $45.13 $574.75 $394.91 2026-05-09
96413 OTHER Chemotherapy Inf Initial 11 5 $748.00 $725.56 $71.05 $712.00 $638.04 2026-05-09
97550 OTHER Caregiver Training 1st 30 Min. 8 5 $515.00 $499.55 $334.75 $489.25 $423.08 2026-05-09
97605 OTHER Neg Pressure Wound Dme <50 Cm 10 5 $546.00 $529.62 $42.56 $518.70 $448.54 2026-05-09
99223 OTHER IP/Obs Initial High Comp 6 5 $551.00 $534.47 $270.04 $517.94 $365.74 2026-05-09
99235 OTHER Admit/Discharge Same Day Mod 6 5 $480.00 $465.60 $247.05 $451.20 $330.05 2026-05-09
99236 OTHER Admit/Discharge Same Day High 6 5 $599.00 $581.03 $322.41 $563.06 $427.62 2026-05-09
99283 OTHER Emergency Room Visit Level 3 19 5 $688.00 $667.36 $108.68 $653.60 $531.14 2026-05-09
99284 OTHER Emergency Room Visit Level 4 20 5 $1,047.00 $1,015.59 $91.22 $994.65 $752.26 2026-05-09
99285 OTHER Emergency Room Visit Level 5 18 5 $1,865.00 $1,809.05 $32.05 $1,771.75 $1,340.00 2026-05-09
99291 OTHER Critical Care 1st 30-74 Min 14 5 $2,376.00 $2,304.72 $329.00 $2,257.20 $1,562.22 2026-05-09
A9500 OTHER Radiophar Tc99M Sestamibi Dose 12 5 $801.00 $776.97 $520.65 $1,602.00 $718.10 2026-05-09
A9585 OTHER Gadobutrol Inj 10 Mm/10 Ml Vl 11 5 $800.00 $776.00 $2.69 $760.00 $682.40 2026-05-09
C1726 OTHER Dil Pebax 180Cm Od15-18 10 5 $1,148.00 $1,114.26 $746.67 $1,148.72 $1,029.83 2026-05-09
C8929 OTHER Echo M Mode 2d W Contrast 12 5 $3,663.00 $3,553.11 $169.24 $3,488.00 $3,124.54 2026-05-09
C8930 OTHER Stress Echo W Contrast 9 5 $2,042.00 $1,980.74 $1,327.30 $1,939.90 $1,741.83 2026-05-09
G0105 OTHER Screening Colonoscopy Hi Risk 6 5 $897.00 $870.09 $170.90 $843.18 $381.44 2026-05-09
G0121 OTHER Screen Colonoscopy Not Hi Risk 6 5 $897.00 $870.09 $171.02 $843.18 $381.66 2026-05-09
G0379 OTHER Observation Assess Direct Adm 8 5 $609.00 $590.73 $395.85 $578.55 $500.30 2026-05-09
G0390 OTHER Trauma Team Level 4 8 5 $2,233.00 $2,166.01 $1,451.45 $2,121.35 $1,834.41 2026-05-09
G0399 OTHER Sleep Study Type Iii Portable 11 5 $1,033.00 $1,002.01 $671.45 $981.35 $881.15 2026-05-09
J0248 OTHER Remdesivir 100 Mg Vial 8 5 $2,797.00 $2,713.73 $70.71 $2,657.78 $2,273.10 2026-05-09
J0283 OTHER Amiodarone/D5W 150mg/100ml Bag 14 5 $443.00 $429.86 $173.21 $466.05 $397.64 2026-05-09
J0289 OTHER Amphotericin B Liposome 50 Mg 9 5 $477.00 $462.96 $7.63 $453.42 $407.12 2026-05-09
J0561 OTHER Pen G Benzathine 1200000Un/2ML 10 5 $1,191.00 $1,155.52 $216.00 $1,131.70 $967.89 2026-05-09
J0703 OTHER Cefepime/D5W 1000mg/50ml Bag 14 5 $370.00 $359.09 $1.22 $382.21 $329.49 2026-05-09
J0897 OTHER Denosumab 60 Mg/ml Syringe 8 5 $7,640.00 $7,411.27 $9.69 $7,258.46 $6,207.89 2026-05-09
J1439 OTHER Ferric Carboxymalt 750mg/15ml 8 5 $4,349.00 $4,219.29 $11.91 $4,132.29 $3,534.20 2026-05-09
J1447 OTHER Tbo-filgrastim 300mcg/0.5ml Sy 14 5 $752.00 $730.32 $247.20 $1,059.23 $715.26 2026-05-09
J1610 OTHER Glucagon 1 Mg Emergency Kit 8 5 $1,327.00 $1,287.61 $98.91 $1,261.06 $1,078.54 2026-05-09
J1745 OTHER Infliximab (Gen) 100 Mg Vial 8 5 $2,120.00 $2,056.89 $1.46 $2,014.48 $1,722.91 2026-05-09
J2020 OTHER Linezolid 600 Mg/300 Ml Bag 8 5 $333.00 $323.04 $216.47 $968.84 $314.72 2026-05-09
J2997 OTHER Alteplase 2 Mg Vial 8 5 $879.00 $852.77 $37.08 $835.18 $714.31 2026-05-09
J3101 OTHER Tenecteplase 50 Mg/10 Ml Syrng 8 5 $31,584.00 $30,637.29 $0.41 $30,005.60 $25,662.68 2026-05-09
J3304 OTHER Triamcinolone Acetonide 32 Mg 8 5 $3,065.00 $2,973.28 $520.65 $2,911.98 $2,490.51 2026-05-09
J3489 OTHER Zoledron Ac/Man/H2O 5mg/100ml 8 5 $432.00 $419.18 $17.25 $410.53 $351.12 2026-05-09
J7325 OTHER Hylan Polymer A&b 48mg/6ml Syr 8 5 $2,141.00 $2,077.42 $1,392.09 $2,034.59 $1,781.01 2026-05-09
J7327 OTHER Hyaluronate Sodium 88Mg/4Ml 8 5 $3,627.00 $3,518.39 $1,488.18 $3,445.85 $2,947.11 2026-05-09
J9217 OTHER Leuprolide Acetate 22.5 Mg Syr 8 5 $2,391.00 $2,319.99 $1.47 $2,272.15 $1,943.29 2026-05-09
L3808 OTHER Ortho Wrist Hand Fngr Static 8 5 $1,113.00 $1,080.39 $723.97 $1,058.11 $914.99 2026-05-09
P9016 OTHER Red Blood Cells Lekoreduced 12 5 $560.00 $543.20 $38.98 $533.00 $477.68 2026-05-09
P9035 OTHER Platelet Pheresis Leuko Reduc 8 5 $1,714.00 $1,662.58 $1,114.10 $1,628.30 $1,408.05 2026-05-09
P9037 OTHER Platelet Pheresis Leuk Red Irr 8 5 $1,550.00 $1,503.50 $1,007.50 $1,472.50 $1,273.33 2026-05-09
P9040 OTHER Rbc Packed Leuko-reduc Irrad 9 5 $664.00 $644.08 $431.60 $630.80 $566.39 2026-05-09
P9047 OTHER Albumin Human 25% 25gr/100ml 8 5 $618.00 $600.27 $402.24 $3,118.50 $584.80 2026-05-09
Q0138 OTHER Ferumoxy 510mg/17ml (non-esrd) 8 5 $1,145.00 $1,111.35 $7.28 $1,088.43 $930.90 2026-05-09
Q5101 OTHER Filgrastim-sndz 300 Mcg/0.5 Ml 8 5 $1,046.00 $1,015.41 $680.43 $2,902.39 $989.24 2026-05-09
Q5108 OTHER Pegfilgrastim-jmdb 6 Mg/0.6 Ml 8 5 $8,037.00 $7,796.65 $5,224.56 $7,635.89 $6,530.70 2026-05-09
Q5111 OTHER Pegfilgrastim-cbqv 6 Mg/0.6 Ml 8 5 $8,925.00 $8,657.25 $1,112.40 $8,478.75 $7,251.56 2026-05-09
Q5122 OTHER Pegfilgrastim 6 Mg/0.6 Ml Syr 8 5 $8,038.00 $7,796.96 $3,939.75 $7,636.19 $6,530.95 2026-05-09
Q5130 OTHER Pegfilgrastim-pbbk 6 Mg/0.6 Ml 8 5 $10,131.00 $9,827.64 $0.54 $9,625.01 $8,231.92 2026-05-09
Q9950 OTHER Sulf Hexaflr Microsphre 5ml Vl 11 5 $802.00 $778.42 $187.95 $762.38 $684.53 2026-05-09
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