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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

OKEENE MUNICIPAL HOSPITAL

Okeene, OK · CCN 371327 · Rates published

3,622 distinct procedures filed
34 distinct payers
78,458 rate rows
2026-08-12 last MRF observed
Data quality

77,399 of 78,458 rate rows are consumer-grade (98.7%)

1,059 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
per-diem day rate — not a per-procedure price 433
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 190
exceeds 10× this hospital's gross charge — excluded from medians 188
exceeds 3× this hospital's gross charge for a DRG stay — excluded 117
percent-of-charges filed in the dollar field — excluded from medians 75
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 32
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 24
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://apps.para-hcfs.com/PTT/FinalLinks/Reports.aspx?dbName=dbOMHOKEENEOK&type=CDMWithoutLabel&fileType=CSV
Found on page https://www.okeenehospital.com/cms-hpt.txt
Discovered viaCMS hospital list
Last fetch not_modified · 2026-10-14
Content fingerprint 450ab3444d85de12… · 23,517,048 bytes · first seen 2026-08-13

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
J3380
HCPCS 		Injection, Vedolizumab, Intravenous, 1 Mg 28 $9.95 $37,065.24 $21,349.58 nat. median
$59
outlier · 363.1×
871
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 11 $9,141.82 $29,702.93 $20,415.68 nat. median
$14,442
1.4× median
J3101
HCPCS 		Injection, Tenecteplase, 1 Mg 28 $93.33 $32,857.15 $18,925.72 nat. median
$498
outlier · 38.0×
592
MS_DRG 		Skin Ulcers With Mcc 9 $11,002.65 $54,886.00 $17,288.03 nat. median
$13,680
1.3× median
177
MS_DRG 		Respiratory Infections And Inflammations With Mcc 11 $7,236.55 $31,691.03 $16,423.98 nat. median
$11,701
1.4× median
64
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Mcc 8 $14,513.23 $153,562.40 $16,379.59 nat. median
$14,700
1.1× median
193
MS_DRG 		Simple Pneumonia And Pleurisy With Mcc 11 $5,107.65 $46,145.98 $13,814.34 nat. median
$9,802
1.4× median
559
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Mcc 7 $13,650.90 $22,541.05 $13,720.07 nat. median
$13,403
1.0× median
J0517
HCPCS 		Injection, Benralizumab, 1 Mg 28 $93.33 $23,154.32 $13,336.89 nat. median
$404
outlier · 33.0×
291
MS_DRG 		Heart Failure And Shock With Mcc 9 $6,470.50 $18,970.50 $11,468.19 nat. median
$9,572
1.2× median
J2356
HCPCS 		Injection, Tezepelumab-ekko, 1 Mg 24 $1,500.00 $17,301.08 $11,321.83 nat. median
$43
outlier · 261.5×
300
MS_DRG 		Peripheral Vascular Disorders With Cc 11 $4,936.58 $24,365.80 $11,219.43 nat. median
$7,999
1.4× median
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 9 $5,563.72 $88,674.97 $11,035.83 nat. median
$9,470
1.2× median
949
MS_DRG 		Aftercare With Cc/mcc 9 $8,334.15 $58,693.80 $10,627.59 nat. median
$8,367
1.3× median
689
MS_DRG 		Kidney And Urinary Tract Infections With Mcc 9 $5,139.00 $14,024.55 $10,364.96 nat. median
$8,710
1.2× median
640
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 8 $5,007.00 $14,037.16 $10,116.51 nat. median
$9,697
1.0× median
560
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Cc 9 $6,770.95 $76,530.58 $10,059.45 nat. median
$8,402
1.2× median
683
MS_DRG 		Renal Failure With Cc 11 $3,940.77 $16,919.10 $9,204.66 nat. median
$6,692
1.4× median
372
MS_DRG 		Major Gastrointestinal Disorders And Peritoneal Infections With Cc 9 $4,520.50 $58,389.20 $9,120.59 nat. median
$7,653
1.2× median
65
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 9 $6,176.54 $63,992.05 $9,025.01 nat. median
$7,677
1.2× median
308
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders With Mcc 7 $5,075.00 $14,552.75 $8,857.83 nat. median
$8,963
1.0× median
178
MS_DRG 		Respiratory Infections And Inflammations With Cc 9 $5,013.33 $42,285.20 $8,718.61 nat. median
$7,418
1.2× median
690
MS_DRG 		Kidney And Urinary Tract Infections Without Mcc 11 $3,537.18 $53,631.20 $8,507.85 nat. median
$6,107
1.4× median
J1437
HCPCS 		Injection, Ferric Derisomaltose, 10 Mg 28 $9.95 $14,462.65 $8,330.49 nat. median
$41
outlier · 202.7×
312
MS_DRG 		Syncope And Collapse 9 $4,143.87 $16,191.55 $7,786.00 nat. median
$6,528
1.2× median
194
MS_DRG 		Simple Pneumonia And Pleurisy With Cc 9 $4,158.75 $44,698.74 $7,199.10 nat. median
$6,156
1.2× median
561
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc 9 $4,301.32 $43,407.58 $7,181.24 nat. median
$5,841
1.2× median
872
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 7 $3,558.80 $9,141.14 $7,158.80 nat. median
$7,744
0.9× median
93
MS_DRG 		Other Disorders Of Nervous System Without Cc/mcc 9 $4,172.08 $34,932.70 $7,113.35 nat. median
$5,925
1.2× median
392
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 9 $3,373.09 $20,048.10 $6,964.17 nat. median
$5,890
1.2× median
641
MS_DRG 		Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 8 $3,194.05 $9,406.10 $6,338.44 nat. median
$5,850
1.1× median
603
MS_DRG 		Cellulitis Without Mcc 7 $2,639.20 $7,779.75 $6,239.20 nat. median
$6,621
0.9× median
191
MS_DRG 		Chronic Obstructive Pulmonary Disease With Cc 7 $4,294.48 $10,189.34 $6,201.95 nat. median
$6,349
1.0× median
556
MS_DRG 		Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 7 $4,052.79 $10,039.46 $6,110.72 nat. median
$6,105
1.0× median
948
MS_DRG 		Signs And Symptoms Without Mcc 7 $4,301.75 $9,675.64 $5,889.28 nat. median
$5,562
1.1× median
69
MS_DRG 		Transient Ischemia Without Thrombolytic 7 $4,577.36 $9,655.10 $5,876.77 nat. median
$6,174
1.0× median
195
MS_DRG 		Simple Pneumonia And Pleurisy Without Cc/mcc 9 $3,130.84 $21,763.50 $5,614.39 nat. median
$4,710
1.2× median
884
MS_DRG 		Organic Disturbances And Intellectual Disability 5 $5,443.00 $14,372.30 $5,443.00 nat. median
$7,732
0.7× median
66
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc 7 $5,035.13 $8,272.34 $5,317.52 nat. median
$5,324
1.0× median
950
MS_DRG 		Aftercare Without Cc/mcc 8 $4,617.99 $11,856.15 $5,131.69 nat. median
$4,481
1.1× median
303
MS_DRG 		Atherosclerosis Without Mcc 7 $3,539.23 $8,136.97 $4,952.73 nat. median
$5,236
0.9× median
J2506
HCPCS 		Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 24 $1,081.35 $7,209.00 $4,717.57 nat. median
$916
outlier · 5.2×
J1568
HCPCS 		Injection, Immune Globulin, (octagam), Intravenous, Non-lyophilized (e.g., Liqui… 28 $20.53 $7,692.30 $4,430.76 nat. median
$383
outlier · 11.6×
J3032
HCPCS 		Injection, Eptinezumab-jjmr, 1 Mg 28 $9.95 $7,682.67 $4,425.22 nat. median
$35
outlier · 126.4×
310
MS_DRG 		Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 7 $3,264.03 $6,842.45 $4,164.80 nat. median
$4,383
1.0× median
J1439
HCPCS 		Injection, Ferric Carboxymaltose, 1 Mg 28 $0.94 $6,378.13 $3,673.81 nat. median
$5
outlier · 731.1×
J0129
HCPCS 		Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 28 $20.53 $6,138.00 $3,535.49 nat. median
$122
outlier · 29.0×
J0840
HCPCS 		Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 28 $863.46 $5,756.40 $3,396.89 nat. median
$3,496
1.0× median
J2357
HCPCS 		Injection, Omalizumab, 5 Mg 28 $20.53 $5,832.13 $3,359.31 nat. median
$682
outlier · 4.9×
816424
OTHER 		Rmv Fecal Impaction/fb Spx Under Anes 2 $2,958.00 $3,845.40 $2,987.58 —

Other procedures at this hospital

Browse this hospital's 3,622 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
             
J3380 HCPCS Injection, Vedolizumab, Intravenous, 1 Mg 28 28 $37,065.24 $29,652.19 20% off $9.95 $37,065.24 $21,349.58 2026-08-12
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 11 11 $10,197.93 $8,158.35 $9,141.82 $29,702.93 $20,415.68 2026-08-12
J3101 HCPCS Injection, Tenecteplase, 1 Mg 28 28 $32,857.15 $26,285.72 20% off $93.33 $32,857.15 $18,925.72 2026-08-12
592 MS_DRG Skin Ulcers With Mcc 9 9 $22,386.00 $17,908.80 20% off $11,002.65 $54,886.00 $17,288.03 2026-08-12
177 MS_DRG Respiratory Infections And Inflammations With Mcc 11 11 $10,625.63 $8,500.50 20% off $7,236.55 $31,691.03 $16,423.98 2026-08-12
64 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Mcc 8 8 $59,962.40 $47,969.92 20% off $14,513.23 $153,562.40 $16,379.59 2026-08-12
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 11 11 $15,718.18 $12,574.54 20% off $5,107.65 $46,145.98 $13,814.34 2026-08-12
559 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Mcc 7 7 $13,650.90 $10,920.72 20% off $13,650.90 $22,541.05 $13,720.07 2026-08-12
J0517 HCPCS Injection, Benralizumab, 1 Mg 28 28 $23,154.32 $18,523.46 $93.33 $23,154.32 $13,336.89 2026-08-12
291 MS_DRG Heart Failure And Shock With Mcc 9 9 $6,470.50 $5,176.40 20% off $6,470.50 $18,970.50 $11,468.19 2026-08-12
J2356 HCPCS Injection, Tezepelumab-ekko, 1 Mg 24 24 $17,301.08 $13,840.86 20% off $1,500.00 $17,301.08 $11,321.83 2026-08-12
300 MS_DRG Peripheral Vascular Disorders With Cc 11 11 $8,761.80 $7,009.44 20% off $4,936.58 $24,365.80 $11,219.43 2026-08-12
189 MS_DRG Pulmonary Edema And Respiratory Failure 9 9 $36,174.97 $28,939.97 20% off $5,563.72 $88,674.97 $11,035.83 2026-08-12
949 MS_DRG Aftercare With Cc/mcc 9 9 $21,193.80 $16,955.04 $8,334.15 $58,693.80 $10,627.59 2026-08-12
689 MS_DRG Kidney And Urinary Tract Infections With Mcc 9 9 $5,139.00 $4,111.20 20% off $5,139.00 $14,024.55 $10,364.96 2026-08-12
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 8 8 $5,007.00 $4,005.60 20% off $5,007.00 $14,037.16 $10,116.51 2026-08-12
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 9 9 $29,030.58 $23,224.46 20% off $6,770.95 $76,530.58 $10,059.45 2026-08-12
683 MS_DRG Renal Failure With Cc 11 11 $6,386.40 $5,109.12 20% off $3,940.77 $16,919.10 $9,204.66 2026-08-12
372 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Cc 9 9 $20,889.20 $16,711.36 20% off $4,520.50 $58,389.20 $9,120.59 2026-08-12
65 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 9 9 $21,492.05 $17,193.64 20% off $6,176.54 $63,992.05 $9,025.01 2026-08-12
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 7 7 $5,075.00 $4,060.00 20% off $5,075.00 $14,552.75 $8,857.83 2026-08-12
178 MS_DRG Respiratory Infections And Inflammations With Cc 9 9 $14,785.20 $11,828.16 20% off $5,013.33 $42,285.20 $8,718.61 2026-08-12
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 11 11 $18,522.20 $14,817.76 20% off $3,537.18 $53,631.20 $8,507.85 2026-08-12
J1437 HCPCS Injection, Ferric Derisomaltose, 10 Mg 28 28 $14,462.65 $11,570.12 $9.95 $14,462.65 $8,330.49 2026-08-12
312 MS_DRG Syncope And Collapse 9 9 $6,191.55 $4,953.24 20% off $4,143.87 $16,191.55 $7,786.00 2026-08-12
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 9 9 $17,391.74 $13,913.39 20% off $4,158.75 $44,698.74 $7,199.10 2026-08-12
561 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue Without Cc/mcc 9 9 $14,607.58 $11,686.06 20% off $4,301.32 $43,407.58 $7,181.24 2026-08-12
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 7 7 $3,558.80 $2,847.04 20% off $3,558.80 $9,141.14 $7,158.80 2026-08-12
93 MS_DRG Other Disorders Of Nervous System Without Cc/mcc 9 9 $12,432.70 $9,946.16 20% off $4,172.08 $34,932.70 $7,113.35 2026-08-12
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 9 9 $7,548.10 $6,038.48 20% off $3,373.09 $20,048.10 $6,964.17 2026-08-12
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 8 8 $3,698.20 $2,958.56 20% off $3,194.05 $9,406.10 $6,338.44 2026-08-12
603 MS_DRG Cellulitis Without Mcc 7 7 $2,639.20 $2,111.36 $2,639.20 $7,779.75 $6,239.20 2026-08-12
191 MS_DRG Chronic Obstructive Pulmonary Disease With Cc 7 7 $19,398.23 $15,518.58 20% off $4,294.48 $10,189.34 $6,201.95 2026-08-12
556 MS_DRG Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 7 7 $7,752.21 $6,201.77 $4,052.79 $10,039.46 $6,110.72 2026-08-12
948 MS_DRG Signs And Symptoms Without Mcc 7 7 $4,657.75 $3,726.20 20% off $4,301.75 $9,675.64 $5,889.28 2026-08-12
69 MS_DRG Transient Ischemia Without Thrombolytic 7 7 $15,254.00 $12,203.20 $4,577.36 $9,655.10 $5,876.77 2026-08-12
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/mcc 9 9 $7,363.50 $5,890.80 20% off $3,130.84 $21,763.50 $5,614.39 2026-08-12
884 MS_DRG Organic Disturbances And Intellectual Disability 5 5 $5,443.00 $4,354.40 20% off $5,443.00 $14,372.30 $5,443.00 2026-08-12
66 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction Without Cc/mcc 7 7 $7,525.76 $6,020.61 $5,035.13 $8,272.34 $5,317.52 2026-08-12
950 MS_DRG Aftercare Without Cc/mcc 8 8 $4,656.15 $3,724.92 $4,617.99 $11,856.15 $5,131.69 2026-08-12
303 MS_DRG Atherosclerosis Without Mcc 7 7 $5,278.00 $4,222.40 20% off $3,539.23 $8,136.97 $4,952.73 2026-08-12
J2506 HCPCS Injection, Pegfilgrastim, Excludes Biosimilar, 0.5 Mg 24 24 $7,209.00 $5,767.20 20% off $1,081.35 $7,209.00 $4,717.57 2026-08-12
J1568 HCPCS Injection, Immune Globulin, (octagam), Intravenous, Non-lyophilized (e.g., Liqui… 28 28 $7,692.30 $6,153.84 20% off $20.53 $7,692.30 $4,430.76 2026-08-12
J3032 HCPCS Injection, Eptinezumab-jjmr, 1 Mg 28 28 $7,682.67 $6,146.14 $9.95 $7,682.67 $4,425.22 2026-08-12
310 MS_DRG Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 7 7 $5,887.00 $4,709.60 $3,264.03 $6,842.45 $4,164.80 2026-08-12
J1439 HCPCS Injection, Ferric Carboxymaltose, 1 Mg 28 28 $6,378.13 $5,102.50 20% off $0.94 $6,378.13 $3,673.81 2026-08-12
J0129 HCPCS Injection, Abatacept, 10 Mg (code May Be Used For Medicare When Drug Administere… 28 28 $6,138.00 $4,910.40 20% off $20.53 $6,138.00 $3,535.49 2026-08-12
J0840 HCPCS Injection, Crotalidae Polyvalent Immune Fab (ovine), Up To 1 Gram 28 28 $5,756.40 $4,605.12 $863.46 $5,756.40 $3,396.89 2026-08-12
J2357 HCPCS Injection, Omalizumab, 5 Mg 28 28 $5,832.13 $4,665.70 20% off $20.53 $5,832.13 $3,359.31 2026-08-12
816424 OTHER Rmv Fecal Impaction/fb Spx Under Anes 5 2 $3,944.00 $3,155.20 20% off $2,958.00 $3,845.40 $2,987.58 2026-07-31
816358 OTHER Tx Disloc Shldr Clsd W Manip W Anes 5 2 $3,902.00 $3,121.60 20% off $2,926.50 $3,804.45 $2,955.77 2026-07-31
8101515 OTHER Or Proc Room Level 5 7 2 $3,937.00 $3,149.60 20% off $2,559.05 $3,838.58 $2,952.75 2026-07-31
Q0138 HCPCS Injection, Ferumoxytol, For Treatment Of Iron Deficiency Anemia, 1 Mg (non-esrd … 28 28 $4,726.71 $3,781.37 $0.94 $4,726.71 $2,946.38 2026-08-12
8101515 CDM Specialty Services - Treatment Room 22 22 $4,695.00 $3,756.00 20% off $704.25 $4,225.50 $2,936.67 2026-08-12
816218 OTHER Tx Fx Nasal Clsd Wo Stabilization 5 2 $3,848.00 $3,078.40 20% off $2,886.00 $3,751.80 $2,914.86 2026-07-31
816882 OTHER Tx Fx Nasal Clsd W/stabilization 5 2 $3,848.00 $3,078.40 20% off $2,886.00 $3,751.80 $2,914.86 2026-07-31
8100997 OTHER Ed Proctosigmoidscpy Remvl Foreign Body 5 2 $3,581.00 $2,864.80 $2,685.75 $3,491.48 $2,712.61 2026-07-31
810715 CDM Gastro - Intestinal (gi) Services - General Classification 22 22 $4,025.00 $3,220.00 20% off $603.75 $3,622.50 $2,539.78 2026-08-12
810715 OTHER Endoscopy Services 3 7 2 $3,375.00 $2,700.00 20% off $2,193.75 $3,290.63 $2,531.25 2026-07-31
21315 HCPCS Closed Treatment Of Broken Nose Bone With Manipulation 44 28 $4,587.00 $3,669.60 20% off $45.68 $4,587.00 $2,476.98 2026-08-12
21320 HCPCS Closed Treatment Of Broken Nose Bone With Placement Of Stabilizing Device 44 28 $4,587.00 $3,669.60 20% off $69.95 $4,587.00 $2,476.98 2026-08-12
15271 HCPCS Application Of Skin Substitute Graft To Wound Of Trunk, Arms, Or Legs, 25.0 Sq C… 28 28 $3,224.00 $2,579.20 20% off $483.60 $4,847.23 $2,321.28 2026-08-12
816894 OTHER Tx Fx Elbow Disl Clsd W Ans 5 2 $3,050.00 $2,440.00 20% off $2,287.50 $2,973.75 $2,310.38 2026-07-31
816129 OTHER I&d Hematoma Seroma Fluid 5 2 $3,031.00 $2,424.80 $2,273.25 $2,955.23 $2,295.98 2026-07-31
8101017 CDM Specialty Services - Treatment Room 22 22 $3,620.00 $2,896.00 20% off $543.00 $3,258.00 $2,284.22 2026-08-12
8101017 OTHER Or Proc Room Level 4 7 2 $3,037.00 $2,429.60 20% off $1,974.05 $2,961.08 $2,277.75 2026-07-31
ERX143896 CDM Pb-hyoscy-atropine-scopolamine 16.2 Mg/5ml Po Elix 22 22 $3,416.69 $2,733.35 20% off $512.50 $3,075.02 $2,155.93 2026-08-12
32551 HCPCS Removal Of Fluid From Between Lung And Chest Cavity 28 28 $3,473.00 $2,778.40 20% off $520.95 $3,473.00 $2,062.36 2026-08-12
10180 HCPCS Complex Drainage Of Wound Infection After Surgery 28 28 $3,255.00 $2,604.00 20% off $488.25 $3,255.00 $2,053.90 2026-08-12
810714 CDM Gastro - Intestinal (gi) Services - General Classification 22 22 $3,219.00 $2,575.20 20% off $482.85 $3,000.00 $2,031.19 2026-08-12
816802 OTHER App Skin Sub High T/a/l <100cm 1st 25cm 7 2 $2,704.00 $2,163.20 20% off $1,757.60 $2,636.40 $2,028.00 2026-07-31
810714 OTHER Endoscopy Services 2 7 2 $2,700.00 $2,160.00 20% off $1,755.00 $2,632.50 $2,025.00 2026-07-31
24605 HCPCS Repair Of Dislocated Elbow Under Anesthesia 44 28 $3,637.00 $2,909.60 20% off $398.72 $3,637.00 $1,963.98 2026-08-12
J1670 HCPCS Injection, Tetanus Immune Globulin, Human, Up To 250 Units 24 24 $2,570.70 $2,056.56 $385.61 $2,570.70 $1,746.53 2026-08-12
C8902 HCPCS Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Abdom… 28 28 $2,443.00 $1,954.40 $366.45 $2,601.24 $1,723.53 2026-08-12
C8911 HCPCS Magnetic Resonance Angiography Without Contrast Followed By With Contrast, Chest… 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,446.15 $1,721.42 2026-08-12
P9035 HCPCS Platelets, Pheresis, Leukocytes Reduced, Each Unit 28 28 $2,361.00 $1,888.80 20% off $354.15 $2,381.26 $1,665.68 2026-08-12
P9034 HCPCS Platelets, Pheresis, Each Unit 28 28 $2,361.00 $1,888.80 20% off $354.15 $2,381.26 $1,665.68 2026-08-12
J0585 HCPCS Injection, Onabotulinumtoxina, 1 Unit 28 28 $2,577.96 $2,062.37 $9.95 $2,577.96 $1,626.69 2026-08-12
95811 HCPCS Sleep Study In Sleep Lab With Continuous Airway Pressure (6 Years Or Older) 28 28 $2,382.00 $1,905.60 20% off $357.30 $2,382.00 $1,624.56 2026-08-12
95810 HCPCS Sleep Study In Sleep Lab (6 Years Or Older) 28 28 $2,281.00 $1,824.80 20% off $342.15 $2,281.00 $1,589.20 2026-08-12
800335 OTHER MRI Brain With And Without Contrast 6 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,542.92 2026-07-31
800349 OTHER MRI Spine Lumbar With And Without Contrast 6 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,542.92 2026-07-31
800338 OTHER MRI Chest With And Without Contrast 6 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,542.92 2026-07-31
800347 OTHER MRI Spine Cervical With And Wo Contrast 6 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,542.92 2026-07-31
800359 OTHER MRI Upper Ext Non Jnt W And Wo Contrast 6 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,542.92 2026-07-31
800387 OTHER MRI Abdomen With And Without Contrast 6 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,542.92 2026-07-31
800353 OTHER MRI Pelvis With And Without Contrast 6 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,542.92 2026-07-31
801523 OTHER MRI MRA Abd Without Fol W/contrast 7 2 $2,049.00 $1,639.20 20% off $1,331.85 $1,997.78 $1,536.75 2026-07-31
74183 HCPCS MRI Scan Of Abdomen Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,440.00 $1,536.00 2026-08-12
801531 OTHER MRI MRA Chest Without Fol W/contrast 7 2 $2,047.00 $1,637.60 20% off $1,330.55 $1,995.83 $1,535.25 2026-07-31
800331 OTHER MRA Angio Neck With And Without Contrast 7 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,535.25 2026-07-31
800328 OTHER MRA Angio Head With And Without Contrast 7 2 $2,047.00 $1,637.60 20% off $410.00 $1,995.83 $1,535.25 2026-07-31
810713 CDM Gastro - Intestinal (gi) Services - General Classification 22 22 $2,415.00 $1,932.00 20% off $362.25 $2,173.50 $1,534.88 2026-08-12
810713 OTHER Endoscopy Services 1 7 2 $2,025.00 $1,620.00 20% off $1,316.25 $1,974.38 $1,518.75 2026-07-31
811303 OTHER Polysomn W/cpap >=6yrs 7 2 $1,998.00 $1,598.40 $1,298.70 $1,948.05 $1,498.50 2026-07-31
60038250 OTHER Lchg Platelet Pheresis 7 2 $1,981.00 $1,584.80 20% off $1,287.65 $1,931.48 $1,485.75 2026-07-31
60038540 OTHER Lchg Platelet Pheresis Lr 7 2 $1,981.00 $1,584.80 20% off $1,287.65 $1,931.48 $1,485.75 2026-07-31
99291 HCPCS Critical Care, First 30-74 Minutes 24 24 $2,263.00 $1,810.40 $339.45 $2,263.00 $1,480.90 2026-08-12
87507 HCPCS Detection Test By Nucleic Acid For Digestive Tract Pathogen, Multiple Types Or S… 28 28 $2,258.00 $1,806.40 $62.82 $2,258.00 $1,477.63 2026-08-12
800375 OTHER MRI Lower Ext Non Jnt W And Wo Contrast 6 2 $1,949.00 $1,559.20 20% off $410.00 $1,900.28 $1,469.06 2026-07-31
800348 OTHER MRI Spine Thoracic With And Wo Contrast 6 2 $1,949.00 $1,559.20 20% off $410.00 $1,900.28 $1,469.06 2026-07-31
73720 HCPCS MRI Scan Of Leg Before And After Contrast 28 28 $2,323.00 $1,858.40 $348.45 $2,323.00 $1,460.84 2026-08-12
800381 OTHER MRI Lower Ext Any Jnt W And Wo Contrast 6 2 $1,930.00 $1,544.00 20% off $410.00 $1,881.75 $1,454.74 2026-07-31
73723 HCPCS MRI Scan Of Leg Joint Before And After Contrast 28 28 $2,301.00 $1,840.80 20% off $345.15 $2,301.00 $1,454.11 2026-08-12
J0248 HCPCS Injection, Remdesivir, 1 Mg 24 24 $2,059.20 $1,647.36 20% off $308.88 $2,059.20 $1,441.44 2026-08-12
71552 HCPCS MRI Scan Of Chest Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,440.00 $1,438.33 2026-08-12
816148 OTHER Critical Care E/m 30-74 Min 5 2 $1,897.00 $1,517.60 20% off $1,422.75 $1,849.58 $1,436.98 2026-07-31
811302 OTHER Polysomn 4 Or More >=6yrs 7 2 $1,913.00 $1,530.40 $1,243.45 $1,865.18 $1,434.75 2026-07-31
70549 HCPCS MRI Scan Of Blood Vessels Of Neck Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,440.00 $1,420.94 2026-08-12
70546 HCPCS MRI Scan Of Blood Vessels Of Head Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,440.00 $1,420.94 2026-08-12
72197 HCPCS MRI Scan Of Pelvis Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,440.00 $1,408.49 2026-08-12
73220 HCPCS MRI Scan Of Arm Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,440.00 $1,408.49 2026-08-12
72158 HCPCS MRI Scan Of Lower Spinal Canal Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $362.73 $2,440.00 $1,405.44 2026-08-12
72156 HCPCS MRI Scan Of Upper Spinal Canal Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $362.73 $2,440.00 $1,405.44 2026-08-12
70553 HCPCS MRI Scan Of Brain Before And After Contrast 28 28 $2,440.00 $1,952.00 20% off $366.00 $2,440.00 $1,405.44 2026-08-12
832093 OTHER Exc Skin Subq Tissue 14 2 $3,576.00 $2,860.80 $1,158.88 $1,504.40 $1,378.64 2026-07-31
Q0249 HCPCS Injection, Tocilizumab, For Hospitalized Adults And Pediatric Patients (2 Years … 28 28 $2,103.40 $1,682.72 20% off $4.36 $2,103.40 $1,376.47 2026-08-12
72157 HCPCS MRI Scan Of Middle Spinal Canal Before And After Contrast 28 28 $2,323.00 $1,858.40 $348.45 $2,323.00 $1,338.05 2026-08-12
15830 HCPCS Removal Of Extra Skin And Tissue Of Abdomen 16 16 $4,263.00 $3,410.40 20% off $899.65 $2,536.50 $1,316.10 2026-08-12
ERX133412 CDM Combivent Respimat 20-100 Mcg 22 22 $1,995.91 $1,596.73 $299.39 $1,796.32 $1,306.12 2026-08-12
32555 HCPCS Aspiration Of Fluid From Chest Cavity Using Imaging Guidance 28 28 $1,917.00 $1,533.60 20% off $287.55 $1,999.25 $1,302.41 2026-08-12
93306 HCPCS Ultrasound Of Heart With Color-depicted Blood Flow, Rate, Direction And Valve Fu… 28 28 $1,953.00 $1,562.40 $292.95 $1,953.00 $1,278.05 2026-08-12
70543 HCPCS MRI Scan Of Bone Of Eye Socket, Face, And/or Neck Before And After Contrast 28 28 $1,986.00 $1,588.80 20% off $297.90 $1,986.00 $1,261.91 2026-08-12
800325 OTHER MRI Orbit Face Neck With And Wo Contrast 6 2 $1,665.00 $1,332.00 20% off $410.00 $1,623.38 $1,254.99 2026-07-31
800367 OTHER MRI Upper Ext Any Jnt W And Wo Contrast 6 2 $1,665.00 $1,332.00 20% off $410.00 $1,623.38 $1,254.99 2026-07-31
812798 OTHER Tte 2d Wo Con W Doppler And Color Cmpl 7 2 $1,638.00 $1,310.40 $1,064.70 $1,597.05 $1,228.50 2026-07-31
70548 HCPCS MRI Scan Of Blood Vessels Of Neck With Contrast 28 28 $1,898.00 $1,518.40 $284.70 $1,898.00 $1,211.39 2026-08-12
70545 HCPCS MRI Scan Of Blood Vessels Of Head With Contrast 28 28 $1,898.00 $1,518.40 $284.70 $1,898.00 $1,211.39 2026-08-12
833282 OTHER Hysterectomy Total Abdominal 14 2 $3,067.00 $2,453.60 20% off $1,009.23 $1,310.13 $1,200.61 2026-07-31
833717 OTHER Mastectomy Smpl Compl 14 2 $3,158.00 $2,526.40 20% off $959.08 $1,303.43 $1,194.47 2026-07-31
800327 OTHER MRA Angio Head With Contrast 7 2 $1,592.00 $1,273.60 20% off $410.00 $1,552.20 $1,194.00 2026-07-31
800330 OTHER MRA Angio Neck With Contrast 7 2 $1,592.00 $1,273.60 20% off $410.00 $1,552.20 $1,194.00 2026-07-31
73719 HCPCS MRI Scan Of Leg With Contrast 28 28 $1,716.00 $1,372.80 20% off $257.40 $1,716.00 $1,175.97 2026-08-12
800365 OTHER MRI Upper Ext Any Joint With Contrast 6 2 $1,560.00 $1,248.00 20% off $410.00 $1,521.00 $1,175.85 2026-07-31
J1442 HCPCS Injection, Filgrastim (g-csf), Excludes Biosimilars, 1 Microgram 52 28 $1,246.74 $997.39 20% off $0.94 $2,481.60 $1,164.07 2026-08-12
73223 HCPCS MRI Scan Of Arm Joint Before And After Contrast 28 28 $1,986.00 $1,588.80 20% off $297.90 $1,986.00 $1,143.93 2026-08-12
814747 CDM Intensive Care Unit - General Classification 8 8 $1,240.00 $992.00 20% off $758.88 $1,119.72 $1,116.00 2026-08-12
74181 HCPCS MRI Scan Of Abdomen Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $1,114.69 2026-08-12
73718 HCPCS MRI Scan Of Leg Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $1,106.00 2026-08-12
60004860 OTHER Lchg Respiratory Virus Pnl Pcr 7 2 $1,470.00 $1,176.00 20% off $955.50 $1,433.25 $1,102.50 2026-07-31
19303 HCPCS Simple Complete Removal Of Breast 16 16 $3,766.00 $3,012.80 $770.05 $2,536.50 $1,102.09 2026-08-12
45307 HCPCS Removal Of Foreign Bodies From Rectum And/or Lower Large Bowel Using A Rigid End… 51 28 $391.00 $312.80 20% off $58.65 $4,269.00 $1,100.00 2026-08-12
73722 HCPCS MRI Scan Of Leg Joint With Contrast 28 28 $1,716.00 $1,372.80 20% off $257.40 $1,716.00 $1,090.35 2026-08-12
812669 CDM Room & Board - Other - Sterile Environment 8 8 $1,206.00 $964.80 20% off $738.07 $1,089.02 $1,085.40 2026-08-12
803043 OTHER MRI Lower Ext Non Joint With Contrast 6 2 $1,439.00 $1,151.20 $410.00 $1,403.03 $1,084.64 2026-07-31
800334 OTHER MRI Brain With Contrast 6 2 $1,439.00 $1,151.20 $410.00 $1,403.03 $1,084.64 2026-07-31
800379 OTHER MRI Lower Ext Any Joint With Contrast 6 2 $1,439.00 $1,151.20 $410.00 $1,403.03 $1,084.64 2026-07-31
800344 OTHER MRI Spine Thoracic With Contrast 6 2 $1,439.00 $1,151.20 $410.00 $1,403.03 $1,084.64 2026-07-31
800342 OTHER MRI Spine Cervical With Contrast 6 2 $1,439.00 $1,151.20 $410.00 $1,403.03 $1,084.64 2026-07-31
70547 HCPCS MRI Scan Of Blood Vessels Of Neck Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $1,073.45 2026-08-12
72195 HCPCS MRI Scan Of Pelvis Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $1,073.45 2026-08-12
70544 HCPCS MRI Scan Of Blood Vessels Of Head Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $1,073.45 2026-08-12
73222 HCPCS MRI Scan Of Arm Joint With Contrast 28 28 $1,860.00 $1,488.00 20% off $279.00 $1,860.00 $1,071.36 2026-08-12
70552 HCPCS MRI Scan Of Brain With Contrast 28 28 $1,716.00 $1,372.80 20% off $257.40 $1,716.00 $1,053.17 2026-08-12
832645 OTHER Appendectomy Ruptured W Infection 14 2 $2,737.00 $2,189.60 20% off $876.90 $1,138.35 $1,043.19 2026-07-31
87633 HCPCS Detection Test By Nucleic Acid For Multiple Types Of Respiratory Virus, Multiple… 52 28 $1,754.00 $1,403.20 20% off $62.82 $1,754.00 $1,042.56 2026-08-12
J7307 HCPCS Etonogestrel (contraceptive) Implant System, Including Implant And Supplies 28 28 $1,600.00 $1,280.00 20% off $240.00 $1,600.00 $1,040.00 2026-08-12
23655 HCPCS Closed Treatment Of Dislocated Shoulder With Manipulation Under Anesthesia 68 28 $1,454.00 $1,163.20 $207.90 $4,653.00 $1,033.26 2026-08-12
73218 HCPCS MRI Scan Of Arm Without Contrast 28 28 $1,519.00 $1,215.20 20% off $227.85 $1,519.00 $1,032.01 2026-08-12
Q4081 HCPCS Injection, Epoetin Alfa, 100 Units (for Esrd On Dialysis) 52 28 $4,233.24 $3,386.59 20% off $0.94 $4,233.24 $1,005.39 2026-08-12
70551 HCPCS MRI Scan Of Brain Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $1,003.93 2026-08-12
73721 HCPCS MRI Scan Of Leg Joint Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $1,003.93 2026-08-12
800384 OTHER MRI Abdomen Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800351 OTHER MRI Pelvis Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800340 OTHER MRI Spine Cervical Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800361 OTHER MRI Upper Ext Any Joint Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800343 OTHER MRI Spine Thoracic Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800377 OTHER MRI Lower Ext Any Joint Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800370 OTHER MRI Lower Ext Non Joint Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800345 OTHER MRI Spine Lumbar Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800332 OTHER MRI Brain Non Contrast 6 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $998.72 2026-07-31
800326 OTHER MRA Angio Head Non Contrast 7 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $993.75 2026-07-31
800329 OTHER MRA Angio Neck Non Contrast 7 2 $1,325.00 $1,060.00 20% off $410.00 $1,291.88 $993.75 2026-07-31
72142 HCPCS MRI Scan Of Upper Spinal Canal With Contrast 28 28 $1,716.00 $1,372.80 20% off $257.40 $1,716.00 $988.41 2026-08-12
72147 HCPCS MRI Scan Of Middle Spinal Canal With Contrast 28 28 $1,716.00 $1,372.80 20% off $257.40 $1,716.00 $988.41 2026-08-12
ERX119489 CDM Wixela 250-50 Inhub 22 22 $1,482.03 $1,185.62 20% off $222.30 $1,333.83 $969.84 2026-08-12
8101015 CDM Specialty Services - Treatment Room 22 22 $1,476.00 $1,180.80 20% off $221.40 $1,328.40 $965.89 2026-08-12
800355 OTHER MRI Upper Ext Non Joint Non Contrast 6 2 $1,274.00 $1,019.20 $410.00 $1,242.15 $960.28 2026-07-31
71270 HCPCS CT Scan Of Chest Before And After Contrast 28 28 $1,508.00 $1,206.40 $226.20 $1,508.00 $958.18 2026-08-12
800276 OTHER CT Thoracic Spine With And Wo Contrast 6 2 $1,266.00 $1,012.80 20% off $300.00 $1,234.35 $954.25 2026-07-31
800261 OTHER CT Soft Tissue Neck With And Wo Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800283 OTHER CT Pelvis With And Without IV Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800268 OTHER CT Chest With And Without Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800794 OTHER CT Abdomen Pelvis Wwo Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800304 OTHER CT Abdomen With And Without IV Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800251 OTHER CT Head With And Without Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800279 OTHER CT Lumbar Spine With And Without Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
800272 OTHER CT Cervical Spine With And Wo Contrast 6 2 $1,265.00 $1,012.00 20% off $300.00 $1,233.38 $953.50 2026-07-31
93975 HCPCS Complete Ultrasound Of Abdomen And Pelvis Artery And Vein Blood Flow 28 28 $1,457.00 $1,165.60 20% off $171.28 $1,457.00 $953.46 2026-08-12
816325 OTHER Inj Aa Strd Peripheral Nerve 5 2 $1,248.00 $998.40 20% off $936.00 $1,216.80 $945.36 2026-07-31
8101015 OTHER Or Proc Room Level 3 7 2 $1,238.00 $990.40 20% off $804.70 $1,207.05 $928.50 2026-07-31
58150 HCPCS Removal Of Uterus And Cervix Through Abdomen 16 16 $3,657.00 $2,925.60 20% off $792.43 $1,505.79 $924.50 2026-08-12
J0561 HCPCS Injection, Penicillin G Benzathine, 100,000 Units 76 28 $1,461.39 $1,169.11 20% off $2.85 $2,994.62 $922.13 2026-08-12
800258 OTHER CT Maxillofacial W & Wo Contrast 6 2 $1,216.00 $972.80 20% off $300.00 $1,185.60 $916.56 2026-07-31
802888 OTHER US Art Doppler Abd Pelv Retrop 7 2 $1,222.00 $977.60 20% off $794.30 $1,191.45 $916.50 2026-07-31
72148 HCPCS MRI Scan Of Lower Spinal Canal Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $910.08 2026-08-12
73221 HCPCS MRI Scan Of Arm Joint Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $910.08 2026-08-12
72146 HCPCS MRI Scan Of Middle Spinal Canal Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $910.08 2026-08-12
72141 HCPCS MRI Scan Of Upper Spinal Canal Without Contrast 28 28 $1,580.00 $1,264.00 20% off $237.00 $1,580.00 $910.08 2026-08-12
J3489 HCPCS Injection, Zoledronic Acid, 1 Mg 28 28 $1,386.00 $1,108.80 20% off $9.95 $1,386.00 $907.00 2026-08-12
74174 HCPCS CT Scan Of Blood Vessels Of Abdomen And Pelvis With Contrast 28 28 $1,389.00 $1,111.20 $208.35 $1,389.00 $882.57 2026-08-12
26350 HCPCS Repair Of Finger Tendon Of Under Side Of Hand Other Than Upper Most Part Of Palm… 28 28 $1,209.00 $967.20 $181.35 $4,442.65 $870.48 2026-08-12
ERX82602 CDM Budesonide-formoterol 160-4.5 22 22 $1,329.78 $1,063.82 20% off $199.47 $1,196.80 $870.21 2026-08-12
72130 HCPCS CT Scan Of Middle Spine Before And After Contrast 28 28 $1,509.00 $1,207.20 20% off $226.35 $1,509.00 $869.18 2026-08-12
74170 HCPCS CT Scan Of Abdomen Before And After Contrast 28 28 $1,508.00 $1,206.40 $226.20 $1,508.00 $868.61 2026-08-12
70470 HCPCS CT Scan Of Head Or Brain Before And After Contrast 28 28 $1,508.00 $1,206.40 $181.06 $1,508.00 $868.61 2026-08-12
72133 HCPCS CT Scan Of Lower Spine Before And After Contrast 28 28 $1,508.00 $1,206.40 $226.20 $1,508.00 $868.61 2026-08-12
72194 HCPCS CT Scan Of Pelvis Before And After Contrast 28 28 $1,508.00 $1,206.40 $226.20 $1,508.00 $868.61 2026-08-12
70492 HCPCS CT Scan Of Soft Tissue Of Neck Before And After Contrast 28 28 $1,508.00 $1,206.40 $226.20 $1,508.00 $868.61 2026-08-12
72127 HCPCS CT Scan Of Upper Spine Before And After Contrast 28 28 $1,508.00 $1,206.40 $226.20 $1,508.00 $868.61 2026-08-12
74178 HCPCS CT Scan Of Abdomen And Pelvis Before And After Contrast 28 28 $1,508.00 $1,206.40 $226.20 $1,508.00 $868.61 2026-08-12
816193 OTHER Rpr Trunk Cmplx 1.1-2.5 Cm 5 2 $1,144.00 $915.20 $858.00 $1,115.40 $866.58 2026-07-31
816182 OTHER Rpr Sclp Extrm Cmplx 1.1-2.5 Cm 5 2 $1,144.00 $915.20 $858.00 $1,115.40 $866.58 2026-07-31
816292 OTHER Ed Wnd Rpr Complex Trunk 2.6-7.5cm 5 2 $1,144.00 $915.20 $858.00 $1,115.40 $866.58 2026-07-31
816183 OTHER Rpr Sclp Extrm Cmplx 2.6-7.5 Cm 5 2 $1,144.00 $915.20 $858.00 $1,115.40 $866.58 2026-07-31
70488 HCPCS CT Scan Of Face Before And After Contrast 28 28 $1,450.00 $1,160.00 20% off $217.50 $1,450.00 $835.20 2026-08-12
816178 OTHER Rpr Face/nk/hd/ft Cmplx 2.6-7.5 Cm 5 2 $1,091.00 $872.80 20% off $818.25 $1,063.73 $826.43 2026-07-31
800803 OTHER CT Abdomen Pelvis W Contrast 6 2 $1,094.00 $875.20 $300.00 $1,066.65 $824.61 2026-07-31
ERX9682 CDM Santyl Ointment 22 22 $1,257.21 $1,005.77 $188.58 $1,131.49 $822.72 2026-08-12
ERX158214 CDM Trelegy Ellipta 100-62.5-25 22 22 $1,250.18 $1,000.14 20% off $187.53 $1,125.16 $818.12 2026-08-12
800278 OTHER CT Lumbar Spine With Contrast 6 2 $1,080.00 $864.00 20% off $300.00 $1,053.00 $814.05 2026-07-31
44960 HCPCS Removal Of Ruptured Infected Appendix 16 16 $3,263.00 $2,610.40 20% off $695.70 $1,315.83 $811.65 2026-08-12
28820 HCPCS Amputation Of Toe At Joint Between Forefoot And Toes 28 28 $1,122.00 $897.60 20% off $168.30 $5,815.26 $807.84 2026-08-12
27372 HCPCS Removal Of Foreign Body Deep In Tissue Of Thigh Or Knee 28 28 $1,115.00 $892.00 20% off $167.25 $4,880.25 $802.81 2026-08-12
97610 HCPCS Therapy Procedure Using Ultrasound 28 28 $1,223.00 $978.40 20% off $183.45 $1,223.00 $800.33 2026-08-12
70498 HCPCS CT Scan Of Blood Vessels Of Neck With Contrast 28 28 $1,389.00 $1,111.20 $208.35 $1,389.00 $800.07 2026-08-12
70496 HCPCS CT Scan Of Blood Vessels Of Head With Contrast 28 28 $1,389.00 $1,111.20 $208.35 $1,389.00 $800.07 2026-08-12
800260 OTHER CT Soft Tissue Neck With Contrast 6 2 $1,050.00 $840.00 20% off $300.00 $1,023.75 $791.44 2026-07-31
15822 HCPCS Removal Of Excessive Skin Of Upper Eyelid 28 28 $1,097.00 $877.60 20% off $164.55 $4,847.23 $789.84 2026-08-12
P9040 HCPCS Red Blood Cells, Leukocytes Reduced, Irradiated, Each Unit 28 28 $1,095.00 $876.00 20% off $164.25 $2,381.26 $788.40 2026-08-12
800275 OTHER CT Thoracic Spine With Contrast 6 2 $1,045.00 $836.00 20% off $300.00 $1,018.88 $787.67 2026-07-31
800271 OTHER CT Cervical Spine With Contrast 6 2 $1,045.00 $836.00 20% off $300.00 $1,018.88 $787.67 2026-07-31
814735 CDM Room & Board - Private (one Bed) - Medical/surgical/gyn 8 8 $873.00 $698.40 20% off $534.28 $788.32 $785.70 2026-08-12
74177 HCPCS CT Scan Of Abdomen And Pelvis With Contrast 28 28 $1,304.00 $1,043.20 $195.60 $1,304.00 $784.19 2026-08-12
ERX119493 CDM Wixela 100-50 Inhub 22 22 $1,192.76 $954.21 $178.91 $1,073.48 $780.54 2026-08-12
814747 OTHER Rb ICU Medical 1 1 $1,040.00 $832.00 20% off $780.00 $780.00 $780.00 2026-07-31
99292 HCPCS Critical Care, Each Additional 30 Minutes 24 24 $1,130.00 $904.00 20% off $169.50 $1,130.00 $767.72 2026-08-12
832643 OTHER Appendectomy 14 2 $2,108.00 $1,686.40 $643.94 $835.94 $766.06 2026-07-31
800346 OTHER MRI Spine Lumbar With Contrast 6 2 $1,014.00 $811.20 $410.00 $988.65 $764.31 2026-07-31
25605 HCPCS Closed Treatment Of Broken Or Growth Plate Separate Of Forearm Bone At Wrist Wit… 28 28 $1,061.00 $848.80 20% off $159.15 $1,477.51 $763.92 2026-08-12
812669 OTHER Med/surg Unit-isolation Med/justi 1 1 $1,012.00 $809.60 20% off $759.00 $759.00 $759.00 2026-07-31
71275 HCPCS CT Scan Of Blood Vessels Of Chest With Contrast 28 28 $1,175.00 $940.00 20% off $176.25 $1,175.00 $755.04 2026-08-12
816100 CDM Room & Board - Semi-private (two Beds) - Medical/surgical/gyn 8 8 $838.00 $670.40 20% off $512.86 $756.71 $754.20 2026-08-12
93925 HCPCS Ultrasound Of Leg Arteries Or Artery Grafts 28 28 $1,149.00 $919.20 $172.35 $1,149.00 $751.90 2026-08-12
801402 OTHER CT Angio Chest W/wo Contrast 6 2 $985.00 $788.00 20% off $300.00 $960.38 $742.44 2026-07-31
72132 HCPCS CT Scan Of Lower Spine With Contrast 28 28 $1,287.00 $1,029.60 20% off $193.05 $1,287.00 $741.31 2026-08-12
13101 HCPCS Complicated Repair Of Wound Of Trunk, 2.6-7.5 Cm 44 28 $1,364.00 $1,091.20 $178.43 $1,861.80 $736.56 2026-08-12
13100 HCPCS Complicated Repair Of Wound Of Trunk, 1.1-2.5 Cm 44 28 $1,364.00 $1,091.20 $145.88 $1,861.80 $736.56 2026-08-12
J2997 HCPCS Injection, Alteplase Recombinant, 1 Mg 52 28 $733.26 $586.61 $46.66 $34,849.42 $733.26 2026-08-12
J0174 HCPCS Injection, Lecanemab-irmb, 1 Mg 24 24 $1,044.82 $835.86 $156.72 $1,044.82 $731.37 2026-08-12
P9016 HCPCS Red Blood Cells, Leukocytes Reduced, Each Unit 28 28 $1,011.00 $808.80 20% off $151.65 $2,381.26 $727.92 2026-08-12
21011 HCPCS Removal Of Growth Under Skin Of Face Or Scalp, Less Than 2.0 Cm 28 28 $1,005.00 $804.00 20% off $150.75 $4,228.57 $723.61 2026-08-12
74160 HCPCS CT Scan Of Abdomen With Contrast 28 28 $1,137.00 $909.60 20% off $170.55 $1,137.00 $722.45 2026-08-12
72193 HCPCS CT Scan Of Pelvis With Contrast 28 28 $1,137.00 $909.60 20% off $170.55 $1,137.00 $722.45 2026-08-12
811350 OTHER Duplex Artery Or Bypass Le Bilat 7 2 $963.00 $770.40 20% off $625.95 $938.93 $722.25 2026-07-31
70491 HCPCS CT Scan Of Soft Tissue Of Neck With Contrast 28 28 $1,253.00 $1,002.40 20% off $187.95 $1,253.00 $721.73 2026-08-12
70482 HCPCS CT Scan Of Cranial Cavity Before And After Contrast 28 28 $1,253.00 $1,002.40 20% off $187.95 $1,253.00 $721.73 2026-08-12
800250 OTHER CT Head With Contrast 6 2 $953.00 $762.40 20% off $300.00 $929.18 $718.33 2026-07-31
800303 OTHER CT Abdomen With IV Contrast 6 2 $953.00 $762.40 20% off $300.00 $929.18 $718.33 2026-07-31
800256 OTHER CT Maxillofacial W Contrast 6 2 $953.00 $762.40 20% off $300.00 $929.18 $718.33 2026-07-31
800267 OTHER CT Chest With Contrast 6 2 $953.00 $762.40 20% off $300.00 $929.18 $718.33 2026-07-31
800282 OTHER CT Pelvis With IV Contrast 6 2 $953.00 $762.40 20% off $300.00 $929.18 $718.33 2026-07-31
800296 OTHER CT Lower Extremity With Contrast 6 2 $953.00 $762.40 20% off $300.00 $929.18 $718.33 2026-07-31
816147 OTHER Critical Care Addl 30 Min 5 2 $948.00 $758.40 20% off $711.00 $924.30 $718.11 2026-07-31
72129 HCPCS CT Scan Of Middle Spine With Contrast 28 28 $1,246.00 $996.80 20% off $186.90 $1,246.00 $717.69 2026-08-12
72126 HCPCS CT Scan Of Upper Spine With Contrast 28 28 $1,246.00 $996.80 20% off $186.90 $1,246.00 $717.69 2026-08-12
800298 OTHER CT Lower Extremity W And Wo Contrast 6 2 $946.00 $756.80 20% off $300.00 $922.35 $713.05 2026-07-31
10140 HCPCS Drainage Of Blood Or Fluid Accumulation 92 28 $1,890.00 $1,512.00 20% off $39.15 $3,614.00 $709.17 2026-08-12
26115 HCPCS Removal (less Than 1.5 Centimeters) Tissue Beneath The Skin Growth Of Hand Or Fi… 28 28 $982.00 $785.60 20% off $147.30 $4,880.25 $707.04 2026-08-12
24301 HCPCS Relocation Of Muscle Or Tendon Of Upper Arm Or Elbow 28 28 $978.00 $782.40 20% off $146.70 $7,837.37 $704.16 2026-08-12
27752 HCPCS Closed Treatment Of Middle Part Of Broken Shin Bone With Manipulation 28 28 $971.00 $776.80 20% off $145.65 $1,477.51 $699.12 2026-08-12
72149 HCPCS MRI Scan Of Lower Spinal Canal With Contrast 28 28 $1,209.00 $967.20 $181.35 $1,209.00 $696.38 2026-08-12
26410 HCPCS Repair Of Tendon On Top Of Hand 28 28 $966.00 $772.80 20% off $144.90 $4,442.65 $695.52 2026-08-12
11044 HCPCS Removal Of Bone, 20.0 Sq Cm Or Less 28 28 $966.00 $772.80 20% off $144.90 $2,493.88 $695.52 2026-08-12
36430 HCPCS Transfusion Of Blood Or Blood Products 28 28 $965.00 $772.00 20% off $144.75 $2,381.26 $694.81 2026-08-12
13152 HCPCS Complicated Repair Of Wound Of Eyelids, Nose, Ears, Or Lip, 2.6-7.5 Cm 28 28 $962.00 $769.60 20% off $144.30 $1,861.80 $692.64 2026-08-12
60038850 OTHER Rbc Lr Irrad 7 2 $918.00 $734.40 20% off $596.70 $895.05 $688.50 2026-07-31
ERX80581 CDM Budesonide 180 Mcg/act In Aepb 22 22 $1,047.82 $838.26 $157.17 $943.04 $685.69 2026-08-12
26160 HCPCS Removal Of Growth Of Tendon Finger Or Hand 28 28 $951.00 $760.80 20% off $142.65 $4,442.65 $684.72 2026-08-12
13120 HCPCS Complicated Repair Of Wound Of Scalp, Arms, Or Legs, 1.1-2.5 Cm 44 28 $1,364.00 $1,091.20 $168.26 $1,364.00 $681.67 2026-08-12
11606 HCPCS Removal Of Cancer Skin Growth Of Body, Arms, Or Legs, More Than 4.0 Cm 28 28 $946.00 $756.80 20% off $141.90 $4,880.25 $681.12 2026-08-12
110378 OTHER Ed Emergent Level V 5 2 $899.00 $719.20 $674.25 $876.53 $680.99 2026-07-31
110377 OTHER Ed Emergent Level IV 5 2 $899.00 $719.20 $674.25 $876.53 $680.99 2026-07-31
13132 HCPCS Complicated Repair Of Wound Of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, G… 68 28 $1,301.00 $1,040.80 20% off $145.50 $1,301.00 $679.00 2026-08-12
90380 HCPCS Respiratory Syncytial Virus Antibody, 0.5 Ml Dosage For Injection Into Muscle 24 24 $970.00 $776.00 20% off $145.50 $970.00 $679.00 2026-08-12
90381 HCPCS Respiratory Syncytial Virus Antibody, 1.0 Ml Dosage For Injection Into Muscle 24 24 $970.00 $776.00 20% off $145.50 $970.00 $679.00 2026-08-12
25565 HCPCS Closed Treatment Of Broken Midpart Of Both Forearm Bones With Manipulation 28 28 $939.00 $751.20 $140.85 $1,477.51 $676.08 2026-08-12
31500 HCPCS Emergent Insertion Of Breathing Tube Into Windpipe Using An Endoscope 28 28 $927.00 $741.60 20% off $139.05 $2,214.19 $667.44 2026-08-12
J0712 HCPCS Injection, Ceftaroline Fosamil, 10 Mg 28 28 $1,019.55 $815.64 20% off $0.94 $1,019.55 $667.19 2026-08-12
45910 HCPCS Dilation Of Narrowing Of Rectum Under Anesthesia 28 28 $926.00 $740.80 20% off $138.90 $4,594.12 $666.72 2026-08-12
814457 CDM Room & Board - Semi-private (two Beds) - General Classification 8 8 $739.00 $591.20 $452.27 $667.32 $665.10 2026-08-12
27786 HCPCS Closed Treatment Of Broken Outside Lower Leg Bone At Ankle 52 28 $883.00 $706.40 20% off $132.45 $1,477.51 $662.25 2026-08-12
70487 HCPCS CT Scan Of Face With Contrast 28 28 $1,137.00 $909.60 20% off $170.55 $1,137.00 $661.54 2026-08-12
71260 HCPCS CT Scan Of Chest With Contrast 28 28 $1,137.00 $909.60 20% off $170.55 $1,137.00 $661.54 2026-08-12
73701 HCPCS CT Scan Of Leg With Contrast Material 28 28 $1,137.00 $909.60 20% off $170.55 $1,137.00 $661.54 2026-08-12
73702 HCPCS CT Scan Of Leg Before And After Contrast 28 28 $1,128.00 $902.40 20% off $169.20 $1,128.00 $658.79 2026-08-12
11646 HCPCS Removal Of Cancer Skin Growth Of Face, Ears, Eyelids, Nose, Lips, Or Mouth, More… 28 28 $914.00 $731.20 $137.10 $4,880.25 $658.08 2026-08-12
8101013 CDM Specialty Services - Treatment Room 22 22 $1,005.00 $804.00 20% off $150.75 $904.50 $657.67 2026-08-12
70460 HCPCS CT Scan Head Or Brain With Contrast 28 28 $1,137.00 $909.60 20% off $170.55 $1,137.00 $654.91 2026-08-12
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