Price Transparencybeta Hospital negotiated rates

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

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Hospital

AVERA MISSOURI RIVER HEALTH CENTER

Gettysburg, SD · CCN 431302 · Rates published

724 distinct procedures filed
5 distinct payers
9,803 rate rows
2026-05-09 last MRF observed
Data quality

9,785 of 9,803 rate rows are consumer-grade (99.8%)

18 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 4
placeholder amount (≤ $0.02) — excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.avera.org/app/files/public/5380b4cd-f869-4c7e-87f7-01531b5e668d/460234354_avera-missouri-river-center_standardcharges.csv
Discovered viaDiscovered by HANK (automated)
Last fetch not_modified · 2026-05-17
Content fingerprint 1907b8ad41357e10… · 2,779,893 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
J3245
OTHER 		Tildrakizumab-asmn 100Mg/Ml Sy 5 $5.04 $56,787.72 $46,140.03 nat. median
$139
outlier · 331.3×
J2327
OTHER 		Risankizumab-rzaa 600 Mg/10 Ml 5 $68.09 $45,688.70 $37,122.07 nat. median
$16
outlier · 2345.0×
J3380
OTHER 		Vedolizumab 300 Mg Vial 5 $72.63 $41,229.60 $33,499.05 nat. median
$24
outlier · 1419.5×
4652
OTHER 		Apr-DRG 4652 1 $21,284.59 $21,284.59 $21,284.59 nat. median
$5,262
outlier · 4.0×
177
OTHER 		Ms-DRG 177 1 $15,919.96 $15,919.96 $15,919.96 nat. median
$16,359
1.0× median
391
OTHER 		Ms-DRG 391 1 $15,306.82 $15,306.82 $15,306.82 nat. median
$9,924
1.5× median
64
OTHER 		Ms-DRG 64 1 $13,776.36 $13,776.36 $13,776.36 nat. median
$19,110
0.7× median
191
OTHER 		Ms-DRG 191 1 $13,655.90 $13,655.90 $13,655.90 nat. median
$8,914
1.5× median
872
OTHER 		Ms-DRG 872 1 $13,022.54 $13,022.54 $13,022.54 nat. median
$8,903
1.5× median
81352
OTHER 		Tp53 Somatic Mutation, Prog 5 $7,183.15 $11,051.00 $9,426.50 nat. median
$346
outlier · 27.2×
392
OTHER 		Ms-DRG 392 1 $9,198.70 $9,198.70 $9,198.70 nat. median
$8,098
1.1× median
536
OTHER 		Ms-DRG 536 1 $9,197.50 $9,197.50 $9,197.50 nat. median
$8,350
1.1× median
194
OTHER 		Ms-DRG 194 2 $9,197.50 $19,638.50 $9,197.50 nat. median
$8,630
1.1× median
195
OTHER 		Ms-DRG 195 1 $9,197.50 $9,197.50 $9,197.50 nat. median
$6,715
1.4× median
603
OTHER 		Ms-DRG 603 1 $9,197.50 $9,197.50 $9,197.50 nat. median
$9,288
1.0× median
193
OTHER 		Ms-DRG 193 1 $9,197.50 $9,197.50 $9,197.50 nat. median
$12,881
0.7× median
1391
OTHER 		Apr-DRG 1391 1 $8,240.73 $8,240.73 $8,240.73 nat. median
$3,886
outlier · 2.1×
74178
OTHER 		CT Abd & Pelv Wwo Contrast 5 $479.88 $8,718.00 $7,859.27 nat. median
$495
outlier · 15.9×
Q5111
OTHER 		Pegfilgrastim-cbqv 6 Mg/0.6 Ml 5 $1,112.40 $8,925.00 $7,251.57 nat. median
$164
outlier · 44.3×
74177
OTHER 		CT Abd & Pelv W Contrast 5 $227.52 $7,832.00 $7,060.55 nat. median
$458
outlier · 15.4×
74174
OTHER 		CTA Abd&Pelv Wwo Dye 5 $71.13 $8,409.00 $6,832.32 nat. median
$502
outlier · 13.6×
74176
OTHER 		CT Abd & Pelvis Wo Contrast 5 $95.04 $7,297.00 $6,578.24 nat. median
$302
outlier · 21.8×
153
OTHER 		Ms-DRG 153 1 $6,142.84 $6,142.84 $6,142.84 nat. median
$7,429
0.8× median
73720
OTHER 		MRI Le Wwo Dye Lt 5 $233.96 $7,130.00 $5,793.12 nat. median
$553
outlier · 10.5×
J0129
OTHER 		Abatacept 250 Mg Vial 5 $588.00 $6,454.87 $5,244.58 nat. median
$49
outlier · 106.5×
70496
OTHER 		CT Angiography Head W Cont 5 $246.84 $5,193.00 $4,933.35 nat. median
$325
outlier · 15.2×
74183
OTHER 		MRI Abdomen Wwo Dye 5 $619.08 $5,805.00 $4,716.57 nat. median
$634
outlier · 7.4×
J0585
OTHER 		Botulinum Tx Type A 200 Un Vl 5 $59.81 $5,559.00 $4,525.02 nat. median
$7
outlier · 637.3×
74175
OTHER 		CTA Abdom Wwo Dye 5 $82.17 $5,313.00 $4,316.82 nat. median
$336
outlier · 12.9×
70553
OTHER 		MRI Brain Wwo Contrast 5 $729.77 $4,515.00 $4,289.25 nat. median
$596
outlier · 7.2×
73222
OTHER 		MRI Joint Ue W Dye Lt 5 $530.75 $5,053.00 $4,105.57 nat. median
$884
outlier · 4.6×
73721
OTHER 		MRI Joint Le Wo Dye Lt 5 $315.18 $4,300.00 $4,085.00 nat. median
$442
outlier · 9.2×
71275
OTHER 		CTA Chest Wwo Contrast 5 $65.60 $4,620.00 $3,940.86 nat. median
$311
outlier · 12.7×
72157
OTHER 		MRI Chest Spine Wwo Dye 5 $535.35 $4,515.00 $3,876.45 nat. median
$630
outlier · 6.2×
73718
OTHER 		MRI Le Wo Dye Lt 5 $56.39 $4,515.00 $3,876.45 nat. median
$401
outlier · 9.7×
72156
OTHER 		MRI Neck Spine Wwo Dye 5 $340.05 $4,515.00 $3,876.45 nat. median
$564
outlier · 6.9×
72158
OTHER 		MRI Lumbar Spine Wwo Dye 5 $340.97 $4,300.00 $3,876.45 nat. median
$576
outlier · 6.7×
J1439
OTHER 		Ferric Carboxymalt 750mg/15ml 5 $11.91 $4,487.80 $3,828.09 nat. median
$1
outlier · 3112.3×
J9202
OTHER 		Goserelin 3.6 Mg Implant 5 $77.09 $4,663.34 $3,788.97 nat. median
$780
outlier · 4.9×
72141
OTHER 		MRI Neck Spine Wo Dye 5 $233.96 $4,300.00 $3,706.90 nat. median
$372
outlier · 10.0×
72148
OTHER 		MRI Lumbar Spine Wo Dye 5 $315.18 $4,300.00 $3,706.90 nat. median
$383
outlier · 9.7×
70492
OTHER 		CT Soft Tissue Neck Wwo Cont 5 $422.85 $4,318.00 $3,683.25 nat. median
$255
outlier · 14.4×
70498
OTHER 		CT Angiography Neck W Cont 5 $278.39 $4,945.00 $3,672.70 nat. median
$328
outlier · 11.2×
73221
OTHER 		MRI Joint Ue Wo Dye Rt 5 $408.12 $4,515.00 $3,667.90 nat. median
$396
outlier · 9.3×
72131
OTHER 		CT Lumbar Spine Wo Contrast 5 $234.87 $3,969.00 $3,578.06 nat. median
$164
outlier · 21.8×
72132
OTHER 		CT Lumbar Spine W Contrast 5 $313.35 $4,338.00 $3,524.62 nat. median
$437
outlier · 8.1×
72146
OTHER 		MRI Chest Spine Wo Dye 5 $390.63 $4,300.00 $3,517.65 nat. median
$372
outlier · 9.5×
70543
OTHER 		MRI Orbit Face Neck Wwo Cont 5 $335.45 $4,300.00 $3,493.75 nat. median
$604
outlier · 5.8×
73218
OTHER 		MRI Ue Wo Dye Lt 5 $79.40 $4,300.00 $3,493.75 nat. median
$416
outlier · 8.4×
71260
OTHER 		CT Thorax W Contrast 5 $80.31 $4,217.00 $3,436.15 nat. median
$260
outlier · 13.2×

Other procedures at this hospital

Browse this hospital's 724 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 7 5 $870.00 $843.90 $565.50 $870.00 $742.11 2026-05-09
10061 OTHER I&d Abscess Comp/Multiple 15 5 $457.00 $443.29 $173.85 $506.04 $395.79 2026-05-09
10120 OTHER I&r Foreign Body Simple 15 5 $517.00 $501.49 $126.55 $517.00 $399.12 2026-05-09
10160 OTHER Punc Asp Abscess Hematoma Cyst 15 5 $420.00 $407.40 $114.68 $420.00 $324.24 2026-05-09
110 OTHER Room Custodial Care 6 5 $386.00 $374.42 $250.90 $386.00 $347.98 2026-05-09
11000 OTHER Debride Infect Skin Up To 10% 13 5 $416.00 $403.52 $33.36 $416.00 $270.40 2026-05-09
11042 OTHER Debride Skin Subq 20 Cm 15 5 $416.00 $403.52 $59.40 $416.00 $270.40 2026-05-09
111 OTHER Room Medical Unit Priv 6 5 $3,164.00 $3,069.08 $2,056.60 $3,164.00 $2,852.35 2026-05-09
11102 OTHER Tangential Biopsy 1st Lesion 13 5 $416.00 $403.52 $45.38 $416.00 $270.40 2026-05-09
11104 OTHER Punch Biopsy 1st Lesion 13 5 $416.00 $403.52 $56.71 $416.00 $270.40 2026-05-09
11106 OTHER Incisional Biopsy 1st Lesion 15 5 $756.00 $733.32 $69.02 $756.00 $491.40 2026-05-09
11401 OTHER Exc Ben Lesion 0.6-1.0 Trunk 13 5 $419.00 $406.43 $126.70 $419.00 $289.52 2026-05-09
11402 OTHER Exc Ben Lesion 1.1-2.0 Trunk 15 5 $724.00 $702.28 $138.88 $724.00 $558.93 2026-05-09
11441 OTHER Exc Ben Lesion 0.6-1.0 Face 13 5 $724.00 $702.28 $158.62 $724.00 $470.60 2026-05-09
115 CPT Room Hospice Respite Care 6 5 $383.00 $371.51 $248.95 $383.00 $345.27 2026-05-09
11750 OTHER Exc Nail Matrix Part/Complete 15 5 $453.00 $439.41 $96.71 $453.00 $294.45 2026-05-09
11765 OTHER Wedge Exc Nail Fold 15 5 $504.00 $488.88 $96.00 $504.00 $327.60 2026-05-09
120 OTHER Room Medical Unit Semi Private 6 5 $2,461.00 $2,387.17 $1,599.65 $2,461.00 $2,218.59 2026-05-09
12001 OTHER Repair Lac Simple <2.5 Cm 30 5 $700.00 $679.00 $51.59 $700.00 $346.00 2026-05-09
12002 OTHER Repair Lac Simple 2.6-7.5 Cm 15 5 $700.00 $679.00 $67.93 $700.00 $455.00 2026-05-09
12004 OTHER Repair Lac Simple 7.6-12.5 Cm 14 5 $666.00 $646.02 $84.56 $666.00 $473.52 2026-05-09
12011 OTHER Repair Lac Simple <2.5 Cm 15 5 $700.00 $679.00 $64.07 $700.00 $540.40 2026-05-09
12013 OTHER Repair Lac Simple 2.6-5.0 Cm 13 5 $700.00 $679.00 $66.94 $700.00 $455.00 2026-05-09
12014 OTHER Repair Lac Simple 5.1-7.5 Cm 7 5 $666.00 $646.02 $432.90 $666.00 $568.10 2026-05-09
12015 OTHER Repair Lac Simple 7.6-12.5 Cm 13 5 $700.00 $679.00 $108.66 $700.00 $455.00 2026-05-09
12018 OTHER Repair Lac Simple >30.0 Cm 13 5 $700.00 $679.00 $197.72 $700.00 $466.70 2026-05-09
12031 OTHER Repair Lac Intermed <2.5 Cm 13 5 $430.00 $417.10 $181.84 $430.00 $339.70 2026-05-09
12041 OTHER Repair Lac Interm <2.5 Cm 15 5 $826.00 $801.22 $173.83 $826.00 $637.67 2026-05-09
12042 OTHER Repair Lac Interm 2.6-7.5 Cm 13 5 $826.00 $801.22 $235.09 $826.00 $550.12 2026-05-09
12044 OTHER Repair Lac Interm 7.6-12.5 Cm 13 5 $826.00 $801.22 $253.91 $826.00 $593.10 2026-05-09
12052 OTHER Repair Lac Interm 2.6-5.0 Cm 13 5 $826.00 $801.22 $238.97 $826.00 $559.61 2026-05-09
129 OTHER Room Swing Bed Skilled 6 5 $1,332.00 $1,292.04 $865.80 $1,332.00 $1,200.80 2026-05-09
1391 OTHER Apr-DRG 1391 2 1 — — $8,240.73 $8,240.73 $8,240.73 2026-05-09
153 OTHER Ms-DRG 153 2 1 — — $6,142.84 $6,142.84 $6,142.84 2026-05-09
177 OTHER Ms-DRG 177 2 1 — — $15,919.96 $15,919.96 $15,919.96 2026-05-09
190 OTHER Ms-DRG 190 2 1 — — $3,088.18 $3,088.18 $3,088.18 2026-05-09
191 OTHER Ms-DRG 191 2 1 — — $13,655.90 $13,655.90 $13,655.90 2026-05-09
193 OTHER Ms-DRG 193 2 1 — — $9,197.50 $9,197.50 $9,197.50 2026-05-09
194 OTHER Ms-DRG 194 3 2 — — $9,197.50 $19,638.50 $9,197.50 2026-05-09
195 OTHER Ms-DRG 195 2 1 — — $9,197.50 $9,197.50 $9,197.50 2026-05-09
20670 OTHER Remove Implant Superficial 13 5 $1,688.00 $1,637.36 $174.84 $1,688.00 $1,097.20 2026-05-09
23600 OTHER Fx Prox Humeral Wo Man Lt 14 5 $698.00 $677.06 $453.70 $698.00 $595.39 2026-05-09
24600 OTHER Dislocation Elbow Wo Anes Rt 13 5 $356.00 $345.32 $231.40 $926.91 $356.00 2026-05-09
24650 OTHER Fx Radial Head/Neck Wo Man Lt 7 5 $356.00 $345.32 $231.40 $356.00 $303.67 2026-05-09
25600 OTHER Fx Distal Radius Rt 7 5 $396.00 $384.12 $257.40 $396.00 $337.79 2026-05-09
25605 OTHER Fx Distal Radius W Man Lt 15 5 $1,643.00 $1,593.71 $396.00 $1,643.00 $1,268.40 2026-05-09
25622 OTHER Fx Carpal Scaphoid Wo Man Rt 7 5 $396.00 $384.12 $257.40 $396.00 $337.79 2026-05-09
26600 OTHER Fx Metacarpal 7 5 $396.00 $384.12 $257.40 $396.00 $337.79 2026-05-09
26720 OTHER Fx Finger/Thumb Wo Man 7 5 $491.00 $476.27 $319.15 $491.00 $418.82 2026-05-09
26750 OTHER Fx Distal Finger/Thumb Wo Man 7 5 $396.00 $384.12 $257.40 $396.00 $337.79 2026-05-09
27530 OTHER Treat Knee Fracture Rt 7 5 $416.00 $403.52 $270.40 $416.00 $354.85 2026-05-09
27780 OTHER Treatment Fibula Fracture Lt 7 5 $396.00 $384.12 $257.40 $396.00 $337.79 2026-05-09
27786 OTHER Fx Distal Fibula Lt 7 5 $396.00 $384.12 $257.40 $396.00 $337.79 2026-05-09
27808 OTHER Fx Bimalleolar Ankle Lt 8 5 $396.00 $384.12 $257.40 $396.00 $357.00 2026-05-09
27824 OTHER Fx Distal Tibia Lt 7 5 $416.00 $403.52 $270.40 $416.00 $354.85 2026-05-09
28400 OTHER Fx Calcaneus Lt 7 5 $416.00 $403.52 $270.40 $416.00 $354.85 2026-05-09
28470 OTHER Fx Metatarsal 7 5 $416.00 $403.52 $270.40 $416.00 $354.85 2026-05-09
28490 OTHER Fx Great Toe 7 5 $416.00 $403.52 $270.40 $416.00 $354.85 2026-05-09
36430 OTHER Blood Administration 9 5 $451.00 $437.47 $293.15 $748.00 $428.45 2026-05-09
36593 OTHER Declot/Thrombo Impl Vad 7 5 $432.00 $419.04 $280.80 $432.00 $368.50 2026-05-09
391 OTHER Ms-DRG 391 2 1 — — $15,306.82 $15,306.82 $15,306.82 2026-05-09
392 OTHER Ms-DRG 392 2 1 — — $9,198.70 $9,198.70 $9,198.70 2026-05-09
446 OTHER Ms-DRG 446 2 1 — — $3,088.18 $3,088.18 $3,088.18 2026-05-09
4652 OTHER Apr-DRG 4652 2 1 — — $21,284.59 $21,284.59 $21,284.59 2026-05-09
536 OTHER Ms-DRG 536 2 1 — — $9,197.50 $9,197.50 $9,197.50 2026-05-09
603 OTHER Ms-DRG 603 2 1 — — $9,197.50 $9,197.50 $9,197.50 2026-05-09
64 OTHER Ms-DRG 64 1 1 — — $13,776.36 $13,776.36 $13,776.36 2026-05-09
64483 OTHER Inj Foramen Epidural L/s Bi 12 5 $1,266.50 $1,228.51 $134.72 $312.87 $244.09 2026-05-09
64615 OTHER Chemodenerv Muscle Migraine 6 5 $159.00 $154.23 $138.83 $321.69 $248.63 2026-05-09
689 OTHER Trauma Team Evaluation Level 5 9 5 $1,409.00 $1,366.73 $915.85 $14,044.45 $1,338.55 2026-05-09
690 OTHER Ms-DRG 690 2 1 — — $3,088.18 $3,088.18 $3,088.18 2026-05-09
70030 OTHER X-ray Eye Fb Detection 6 5 $429.00 $416.13 $278.85 $429.00 $386.75 2026-05-09
70140 OTHER X-ray Facial Bones < 3 Views 10 5 $282.00 $273.54 $66.51 $282.00 $254.22 2026-05-09
70160 OTHER X-ray Facial Bones 3 Views 8 5 $371.00 $359.87 $86.75 $371.00 $301.44 2026-05-09
70250 OTHER X-ray Skull < 4 Views 10 5 $353.00 $342.41 $94.25 $353.00 $318.23 2026-05-09
70260 OTHER X-ray Skull 4 Views 10 5 $571.00 $553.87 $72.96 $571.00 $514.75 2026-05-09
70450 OTHER CT Head/Brain Wo Contrast 13 5 $2,591.00 $2,513.27 $24.20 $3,254.00 $2,461.45 2026-05-09
70470 OTHER CT Head/Brain Wwo Contrast 8 5 $3,417.00 $3,314.49 $241.32 $3,417.00 $2,776.31 2026-05-09
70480 OTHER CT Orbit Wo Contrast 9 5 $2,695.00 $2,614.15 $192.56 $2,695.00 $2,298.84 2026-05-09
70482 OTHER CT Orbit Wwo Contrast 10 5 $3,351.00 $3,250.47 $261.57 $3,351.00 $2,825.20 2026-05-09
70486 OTHER CT Maxillofacial Wo Contrast 10 5 $3,086.00 $2,993.42 $187.95 $3,086.00 $2,782.03 2026-05-09
70487 OTHER CT Maxillofacial W Contrast 8 5 $3,597.00 $3,489.09 $268.29 $3,597.00 $2,922.56 2026-05-09
70490 OTHER CT Soft Tissue Neck Wo Cont 10 5 $3,028.00 $2,937.16 $277.47 $3,028.00 $2,729.74 2026-05-09
70491 OTHER CT Soft Tissue Neck W Cont 10 5 $3,673.00 $3,562.81 $357.53 $4,112.00 $3,311.21 2026-05-09
70492 OTHER CT Soft Tissue Neck Wwo Cont 9 5 $4,318.00 $4,188.46 $422.85 $4,318.00 $3,683.25 2026-05-09
70496 OTHER CT Angiography Head W Cont 11 5 $5,193.00 $5,037.21 $246.84 $5,193.00 $4,933.35 2026-05-09
70498 OTHER CT Angiography Neck W Cont 11 5 $3,866.00 $3,750.02 $278.39 $4,945.00 $3,672.70 2026-05-09
70543 OTHER MRI Orbit Face Neck Wwo Cont 8 5 $4,300.00 $4,171.00 $335.45 $4,300.00 $3,493.75 2026-05-09
70544 OTHER MRA Head Wo Contrast 8 5 $3,890.00 $3,773.30 $408.12 $3,890.00 $3,160.62 2026-05-09
70551 OTHER MRI Brain Wo Contrast 11 5 $3,832.00 $3,717.04 $447.03 $4,300.00 $3,268.70 2026-05-09
70553 OTHER MRI Brain Wwo Contrast 11 5 $4,515.00 $4,379.55 $729.77 $4,515.00 $4,289.25 2026-05-09
71045 OTHER X-ray Chest 1 View 13 5 $403.00 $390.91 $261.95 $593.33 $382.85 2026-05-09
71046 OTHER X-ray Chest 2v PA/Lateral 13 5 $452.00 $438.44 $293.80 $783.14 $429.40 2026-05-09
71100 OTHER X-ray Ribs 2 Views Lt 18 5 $476.00 $461.72 $74.00 $3,616.49 $452.20 2026-05-09
71101 OTHER X-ray Ribs Uni W Chest Lt 20 5 $756.00 $733.32 $491.40 $3,427.98 $718.60 2026-05-09
71120 OTHER X-ray Sternum 2 Views 10 5 $346.00 $335.62 $79.40 $346.00 $311.92 2026-05-09
71250 OTHER CT Thorax Wo Contrast 11 5 $2,805.00 $2,720.85 $71.13 $2,805.00 $2,392.67 2026-05-09
71260 OTHER CT Thorax W Contrast 11 5 $3,617.00 $3,508.49 $80.31 $4,217.00 $3,436.15 2026-05-09
71271 OTHER Ldct For Lung Cancer Screen 11 5 $330.00 $320.10 $101.48 $330.00 $313.50 2026-05-09
71275 OTHER CTA Chest Wwo Contrast 11 5 $4,620.00 $4,481.40 $65.60 $4,620.00 $3,940.86 2026-05-09
72040 OTHER X-ray Spine Cervical 2-3 Views 12 5 $666.00 $646.02 $432.90 $666.00 $600.40 2026-05-09
72050 OTHER X-ray Spine Cervical 4-5 Views 10 5 $405.00 $392.85 $263.25 $746.06 $394.88 2026-05-09
72070 OTHER X-ray Spine Thoracic 2 Views 12 5 $525.00 $509.25 $341.25 $1,015.91 $498.75 2026-05-09
72072 OTHER X-ray Spine Thoracic 3 Views 11 5 $955.00 $926.35 $620.75 $955.00 $907.25 2026-05-09
72100 OTHER X-ray Lumbosacral 2-3 Views 12 5 $544.00 $527.68 $90.44 $544.00 $490.41 2026-05-09
72120 OTHER X-ray Ls Spine Bending 2-3 V 9 5 $1,070.00 $1,037.90 $152.07 $1,070.00 $912.71 2026-05-09
72125 OTHER CT Cervical Spine Wo Contrast 12 5 $3,391.00 $3,289.27 $172.58 $3,391.00 $3,056.98 2026-05-09
72128 OTHER CT Thoracic Spine Wo Contrast 11 5 $3,105.00 $3,011.85 $107.93 $3,105.00 $2,949.75 2026-05-09
72131 OTHER CT Lumbar Spine Wo Contrast 10 5 $3,969.00 $3,849.93 $234.87 $3,969.00 $3,578.06 2026-05-09
72132 OTHER CT Lumbar Spine W Contrast 8 5 $4,338.00 $4,207.86 $313.35 $4,338.00 $3,524.62 2026-05-09
72141 OTHER MRI Neck Spine Wo Dye 11 5 $3,902.00 $3,784.94 $233.96 $4,300.00 $3,706.90 2026-05-09
72146 OTHER MRI Chest Spine Wo Dye 10 5 $3,902.00 $3,784.94 $390.63 $4,300.00 $3,517.65 2026-05-09
72148 OTHER MRI Lumbar Spine Wo Dye 11 5 $3,902.00 $3,784.94 $315.18 $4,300.00 $3,706.90 2026-05-09
72156 OTHER MRI Neck Spine Wwo Dye 10 5 $4,300.00 $4,171.00 $340.05 $4,515.00 $3,876.45 2026-05-09
72157 OTHER MRI Chest Spine Wwo Dye 10 5 $4,300.00 $4,171.00 $535.35 $4,515.00 $3,876.45 2026-05-09
72158 OTHER MRI Lumbar Spine Wwo Dye 10 5 $4,300.00 $4,171.00 $340.97 $4,300.00 $3,876.45 2026-05-09
72170 OTHER X-ray Pelvis 1-2 Views 10 5 $389.00 $377.33 $252.85 $389.00 $355.72 2026-05-09
72192 OTHER CT Pelvis Wo Dye 10 5 $2,741.00 $2,658.77 $597.02 $3,681.00 $2,471.01 2026-05-09
72193 OTHER CT Pelvis W Dye 8 5 $3,105.00 $3,011.85 $593.33 $3,105.00 $2,522.82 2026-05-09
72200 OTHER X-ray Si Joints 10 5 $339.00 $328.83 $220.35 $483.57 $330.52 2026-05-09
72220 CPT Sacrum Or Coccyx Min 2 View 6 5 $774.00 $750.78 $503.10 $774.00 $697.76 2026-05-09
72220 OTHER X-ray Sacrum Tailbone 14 5 $774.00 $750.78 $447.69 $774.00 $660.22 2026-05-09
73020 OTHER X-ray Shoulder Lt 20 5 $336.00 $325.92 $187.95 $336.00 $302.90 2026-05-09
73030 OTHER X-ray Shoulder Lt 22 5 $469.00 $454.93 $237.65 $469.00 $445.55 2026-05-09
73060 OTHER X-ray Humerus Rt 18 5 $573.00 $555.81 $67.44 $573.00 $488.77 2026-05-09
73080 OTHER X-ray Elbow Lt 20 5 $598.00 $580.06 $38.91 $598.00 $539.10 2026-05-09
73090 OTHER X-ray Forearm 2 Views Lt 16 5 $626.00 $607.22 $282.72 $626.00 $508.62 2026-05-09
73110 OTHER X-ray Wrist 3 Views Lt 20 5 $410.00 $397.70 $58.22 $410.00 $369.62 2026-05-09
73120 OTHER X-ray Hand Rt 8 5 $317.00 $307.49 $198.99 $317.00 $257.56 2026-05-09
73130 OTHER X-ray Hand Lt 22 5 $532.00 $516.04 $59.16 $532.00 $505.40 2026-05-09
73140 OTHER X-ray Finger(s) Lt 20 5 $301.00 $291.97 $64.68 $301.00 $271.35 2026-05-09
73200 OTHER CT Ue Wo Dye Lt 18 5 $2,226.00 $2,159.22 $70.19 $2,750.00 $1,898.78 2026-05-09
73201 OTHER CT Ue W Dye Lt 8 5 $2,450.00 $2,376.50 $90.44 $2,450.00 $1,990.62 2026-05-09
73218 OTHER MRI Ue Wo Dye Lt 8 5 $4,300.00 $4,171.00 $79.40 $4,300.00 $3,493.75 2026-05-09
73221 OTHER MRI Joint Ue Wo Dye Rt 21 5 $4,300.00 $4,171.00 $408.12 $4,515.00 $3,667.90 2026-05-09
73222 OTHER MRI Joint Ue W Dye Lt 8 5 $5,053.00 $4,901.41 $530.75 $5,053.00 $4,105.57 2026-05-09
73502 OTHER X-ray Hip Uni 2-3 Views Rt 36 5 $345.00 $334.65 $224.25 $1,131.00 $735.15 2026-05-09
73522 OTHER X-ray Hips 3-4 Views Bi 8 5 $940.00 $911.80 $611.00 $940.00 $797.87 2026-05-09
73523 OTHER X-ray Hips 5 Views Bi 10 5 $1,301.00 $1,261.97 $690.20 $1,301.00 $1,172.85 2026-05-09
73551 OTHER X-ray Femur 1 View Rt 8 5 $389.00 $377.33 $101.48 $389.00 $316.06 2026-05-09
73552 OTHER X-ray Femur 2 Views Lt 16 5 $758.00 $735.26 $130.01 $758.00 $615.88 2026-05-09
73560 OTHER X-ray Knee 1-2 Views Lt 22 5 $318.00 $308.46 $84.00 $318.00 $302.05 2026-05-09
73562 OTHER X-ray Knee 3 Views Lt 21 5 $385.00 $373.45 $109.76 $385.00 $365.75 2026-05-09
73564 OTHER X-ray Knee 4 Rt 8 5 $525.00 $509.25 $129.06 $525.00 $426.56 2026-05-09
73565 OTHER X-ray Knees Bi 8 5 $486.00 $471.42 $267.09 $486.00 $394.88 2026-05-09
73590 OTHER X-ray Lower Leg Rt 19 5 $487.00 $472.39 $73.88 $596.00 $415.41 2026-05-09
73610 OTHER X-ray Ankle 3 Views Lt 24 5 $467.00 $452.99 $99.63 $467.00 $398.35 2026-05-09
73620 OTHER X-ray Foot 2 Views Rt 8 5 $312.00 $302.64 $202.80 $312.00 $253.50 2026-05-09
73630 OTHER X-ray Foot 3 Views Rt 23 5 $421.00 $408.37 $65.60 $421.00 $359.11 2026-05-09
73700 OTHER CT Le Wo Dye Lt 20 5 $2,571.00 $2,493.87 $76.65 $4,296.00 $2,193.06 2026-05-09
73701 OTHER CT Le W Dye Lt 16 5 $3,433.00 $3,330.01 $268.01 $3,433.00 $2,789.32 2026-05-09
73718 OTHER MRI Le Wo Dye Lt 20 5 $4,300.00 $4,171.00 $56.39 $4,515.00 $3,876.45 2026-05-09
73720 OTHER MRI Le Wwo Dye Lt 8 5 $7,130.00 $6,916.10 $233.96 $7,130.00 $5,793.12 2026-05-09
73721 OTHER MRI Joint Le Wo Dye Lt 21 5 $4,300.00 $4,171.00 $315.18 $4,300.00 $4,085.00 2026-05-09
74018 OTHER X-ray Abdomen 10 5 $448.00 $434.56 $291.20 $523.40 $425.80 2026-05-09
74019 OTHER X-ray Abdomen 12 5 $582.00 $564.54 $378.30 $660.48 $552.90 2026-05-09
74160 OTHER CT Abdomen W Dye 8 5 $2,879.00 $2,792.63 $706.77 $2,879.00 $2,339.19 2026-05-09
74170 OTHER CT Abdomen Wwo Dye 8 5 $4,113.00 $3,989.61 $58.22 $4,113.00 $3,341.81 2026-05-09
74174 OTHER CTA Abd&Pelv Wwo Dye 8 5 $8,409.00 $8,156.73 $71.13 $8,409.00 $6,832.32 2026-05-09
74175 OTHER CTA Abdom Wwo Dye 8 5 $5,313.00 $5,153.61 $82.17 $5,313.00 $4,316.82 2026-05-09
74176 OTHER CT Abd & Pelvis Wo Contrast 12 5 $7,297.00 $7,078.09 $95.04 $7,297.00 $6,578.24 2026-05-09
74177 OTHER CT Abd & Pelv W Contrast 12 5 $7,832.00 $7,597.04 $227.52 $7,832.00 $7,060.55 2026-05-09
74178 OTHER CT Abd & Pelv Wwo Contrast 10 5 $8,718.00 $8,456.46 $479.88 $8,718.00 $7,859.27 2026-05-09
74183 OTHER MRI Abdomen Wwo Dye 10 5 $5,805.00 $5,630.85 $619.08 $5,805.00 $4,716.57 2026-05-09
761 OTHER Pain Clinic Level 1 21 5 $1,107.00 $1,073.79 $712.40 $1,610.00 $1,046.50 2026-05-09
76942 OTHER US Guide For Needle Placement 10 5 $1,445.00 $1,401.65 $939.25 $1,445.00 $1,372.75 2026-05-09
77002 OTHER Needle Localization By X-ray 11 5 $1,116.00 $1,082.52 $83.48 $1,116.00 $1,060.20 2026-05-09
77067 OTHER Mammo Screen Implant Bi 17 5 $824.00 $799.28 $535.60 $826.00 $782.80 2026-05-09
77080 OTHER Dexa Scan 11 5 $609.00 $590.73 $88.61 $609.00 $578.55 2026-05-09
80048 OTHER Basic Metabolic Panel 12 5 $369.00 $357.93 $239.85 $369.00 $350.55 2026-05-09
80053 OTHER Comprehensive Metabolic Panel 12 5 $456.00 $442.32 $296.40 $456.00 $433.20 2026-05-09
80061 OTHER Lipid Panel 11 5 $279.00 $270.63 $181.35 $279.00 $265.00 2026-05-09
80069 OTHER Renal Function Panel 10 5 $427.00 $414.19 $277.55 $427.00 $405.65 2026-05-09
80074 OTHER Acute Hepatitis Panel 9 5 $362.00 $351.14 $235.30 $362.00 $343.90 2026-05-09
80076 OTHER Hepatic Function Panel 10 5 $404.00 $391.88 $262.60 $404.00 $383.80 2026-05-09
80143 OTHER Acetaminophen 10 5 $403.00 $390.91 $261.95 $403.00 $382.85 2026-05-09
80179 OTHER Salicylate 10 5 $403.00 $390.91 $261.95 $403.00 $382.85 2026-05-09
80185 OTHER Phenytoin Total 9 5 $285.00 $276.45 $185.25 $285.00 $270.75 2026-05-09
80202 OTHER Vancomycin 9 5 $362.00 $351.14 $235.30 $362.00 $343.90 2026-05-09
80203 OTHER Zonisamide 9 5 $264.00 $256.08 $171.60 $292.00 $250.80 2026-05-09
80230 OTHER Infliximab Qn w/Reflex To Ab,S 7 5 $1,773.00 $1,719.81 $1,152.45 $1,773.00 $1,512.37 2026-05-09
80299 OTHER Dexamethasone 14 5 $867.50 $841.48 $100.10 $1,581.00 $590.83 2026-05-09
80306 OTHER Drug Screen Urine Inst Ass Obv 9 5 $382.00 $370.54 $248.30 $382.00 $362.90 2026-05-09
81352 OTHER Tp53 Somatic Mutation, Prog 7 5 $11,051.00 $10,719.47 $7,183.15 $11,051.00 $9,426.50 2026-05-09
81515 OTHER Vpp 9 5 $497.00 $482.09 $323.05 $497.00 $472.15 2026-05-09
82077 OTHER Alcohol/Ethanol Auto Analyzer 10 5 $285.00 $276.45 $185.25 $285.00 $270.75 2026-05-09
82104 OTHER Alpha 1 Antitrypsin Pheno 9 5 $329.00 $319.13 $213.85 $364.00 $312.55 2026-05-09
82166 OTHER Mullerian Inhib Hormone 7 5 $346.00 $335.62 $224.90 $346.00 $295.14 2026-05-09
82378 OTHER Cea 9 5 $362.00 $351.14 $235.30 $362.00 $343.90 2026-05-09
82397 OTHER Infliximab Ab, S 7 5 $1,360.00 $1,319.20 $884.00 $1,360.00 $1,160.08 2026-05-09
82530 OTHER Cortisol Free Urine 7 5 $364.00 $353.08 $236.60 $364.00 $310.49 2026-05-09
82553 OTHER Cpk Mb Fraction 9 5 $310.00 $300.70 $201.50 $327.00 $294.50 2026-05-09
82610 OTHER Cystatin C 7 5 $446.00 $432.62 $289.90 $446.00 $380.44 2026-05-09
82627 OTHER Dheas 9 5 $320.00 $310.40 $208.00 $320.00 $304.00 2026-05-09
82653 OTHER Pancreatic Elastase 7 5 $521.00 $505.37 $338.65 $521.00 $444.41 2026-05-09
82668 OTHER Erythropoietin 7 5 $291.00 $282.27 $189.15 $291.00 $248.22 2026-05-09
82803 OTHER Blood Gas Wo Oximetry 10 5 $320.00 $310.40 $208.00 $320.00 $288.48 2026-05-09
82951 OTHER Glucose Tol 1st 3 Specimens 9 5 $426.00 $413.22 $276.90 $426.00 $404.70 2026-05-09
83880 OTHER B Type Natriuretic Peptide 11 5 $344.00 $333.68 $223.60 $344.00 $326.80 2026-05-09
83970 OTHER Pth 10 5 $362.00 $351.14 $235.30 $362.00 $343.90 2026-05-09
83993 OTHER Calprotectin 9 5 $566.00 $549.02 $367.90 $566.00 $537.70 2026-05-09
84153 OTHER Psa Total 9 5 $362.00 $351.14 $235.30 $362.00 $343.90 2026-05-09
84445 OTHER Tsi 9 5 $569.00 $551.93 $369.85 $662.00 $540.55 2026-05-09
84482 OTHER Reverse T3 9 5 $378.00 $366.66 $245.70 $378.00 $359.10 2026-05-09
84484 OTHER Troponin Quant 11 5 $264.00 $256.08 $171.60 $264.00 $250.80 2026-05-09
84702 OTHER Hcg Beta Quan Serum 9 5 $339.00 $328.83 $220.35 $339.00 $322.05 2026-05-09
85220 OTHER Factor 5 Activity 7 5 $594.00 $576.18 $386.10 $594.00 $506.68 2026-05-09
85379 OTHER D-dimer Quant 11 5 $478.00 $463.66 $310.70 $478.00 $454.10 2026-05-09
86043 OTHER Acetylcholine Mod Aby 7 5 $388.00 $376.36 $252.20 $388.00 $330.96 2026-05-09
86255 OTHER Pla2R Elisa 7 5 $467.00 $452.99 $303.55 $467.00 $398.35 2026-05-09
86256 OTHER dsDNA IgG 14 5 $633.50 $614.50 $160.55 $1,020.00 $455.00 2026-05-09
86301 OTHER Ca 19-9 9 5 $278.00 $269.66 $180.70 $278.00 $264.10 2026-05-09
86341 OTHER Islet Cell Antibody Ica 512 25 5 $1,994.00 $1,934.18 $122.85 $2,414.00 $1,700.88 2026-05-09
86480 OTHER Tbint Quantiferon 9 5 $385.00 $373.45 $250.25 $385.00 $328.41 2026-05-09
86860 OTHER Antibody Elution Rbc Ea 7 5 $523.00 $507.31 $339.95 $523.00 $446.12 2026-05-09
86870 OTHER Rbc Antibody Identif Panel 7 5 $367.00 $355.99 $238.55 $367.00 $313.05 2026-05-09
86922 OTHER Crossmatch Ahg 9 5 $333.00 $323.01 $216.45 $333.00 $316.35 2026-05-09
87040 OTHER Culture Blood 11 5 $283.00 $274.51 $183.95 $283.00 $268.85 2026-05-09
87075 OTHER Culture Anaerobe Exept Bld 9 5 $285.00 $276.45 $185.25 $285.00 $270.75 2026-05-09
87118 OTHER Mycobacterial Id, Each 7 5 $1,479.00 $1,434.63 $961.35 $1,479.00 $1,261.59 2026-05-09
872 OTHER Ms-DRG 872 1 1 — — $13,022.54 $13,022.54 $13,022.54 2026-05-09
87385 OTHER Histoplasma Antigen 7 5 $308.00 $298.76 $200.20 $308.00 $262.72 2026-05-09
87471 OTHER Bartonella DNA Amp Probe 8 5 $1,649.00 $1,599.53 $1,071.85 $1,649.00 $1,486.57 2026-05-09
87493 OTHER C Diff By Pcr 11 5 $321.00 $311.37 $208.65 $321.00 $304.95 2026-05-09
87497 OTHER Cmv Quant By Pcr 8 5 $333.00 $323.01 $216.45 $333.00 $300.20 2026-05-09
87507 OTHER Gi Pathogens Panel Ref 7 5 $1,195.00 $1,159.15 $776.75 $1,195.00 $1,019.34 2026-05-09
87529 OTHER Hsv DNA Amp Probe 7 5 $1,290.00 $1,251.30 $838.50 $1,290.00 $1,100.37 2026-05-09
87556 OTHER Mtb DNA Probe (arup) 7 5 $805.00 $780.85 $523.25 $805.00 $686.67 2026-05-09
87631 OTHER Influ And Rsv Amp Probe 9 5 $461.00 $447.17 $299.65 $486.00 $437.95 2026-05-09
87636 OTHER Influ & CoV2 Pcr Ceph 9 5 $511.00 $495.67 $332.15 $511.00 $485.45 2026-05-09
87637 OTHER Influ/RSV/CoV2 Pcr Ceph 10 5 $582.00 $564.54 $378.30 $582.00 $524.67 2026-05-09
87798 OTHER Bord Parapertussis Amp Arup 48 5 $409.00 $396.73 $127.40 $914.00 $317.48 2026-05-09
88184 OTHER Flow Cytometry First Mark 10 5 $367.00 $355.99 $238.55 $367.00 $348.65 2026-05-09
88305 OTHER Surg Path L4 9 5 $516.00 $500.52 $103.20 $516.00 $440.15 2026-05-09
88368 OTHER Morphometric Ana Ea Hematologi 7 5 $389.00 $377.33 $252.85 $389.00 $331.82 2026-05-09
88377 OTHER Morph Ana Ea Man Multpx Hema 7 5 $1,652.00 $1,602.44 $1,073.80 $1,652.00 $1,409.16 2026-05-09
90677 OTHER Pneumo Conjugate Vaccine 20 Va 10 5 $405.00 $393.04 $263.38 $405.20 $382.64 2026-05-09
90678 OTHER Rsv Vaccine Bivalent 8 5 $1,249.00 $1,212.31 $41.69 $1,249.80 $1,015.46 2026-05-09
92950 OTHER Heart/Lung Resuscitation Cpr 9 5 $1,158.00 $1,123.26 $752.70 $1,216.00 $1,100.10 2026-05-09
93005 OTHER EKG Tracing 11 5 $312.00 $302.64 $202.80 $312.00 $296.40 2026-05-09
93242 OTHER Ext ECG 48 Hrs -7days Hook Up 9 5 $319.00 $309.43 $207.35 $467.00 $303.05 2026-05-09
93246 OTHER Ext ECG >7 Days Hook Up 9 5 $491.00 $476.27 $319.15 $491.00 $466.45 2026-05-09
94660 OTHER CPap/BiPap First Day 7 5 $1,045.00 $1,013.65 $679.25 $1,045.00 $891.39 2026-05-09
96360 OTHER Inf Therapy Hyd Initial 23 5 $482.00 $467.54 $232.05 $482.00 $357.00 2026-05-09
96365 OTHER Inf Therapy Med Initial 21 5 $500.00 $485.00 $279.50 $500.00 $408.50 2026-05-09
96374 OTHER IV Push Injection Initial 21 5 $361.00 $350.17 $173.55 $361.00 $267.00 2026-05-09
96402 OTHER Injection Chemo Sq/IM Hormonal 7 5 $320.00 $310.40 $208.00 $320.00 $272.96 2026-05-09
96413 OTHER Chemotherapy Inf Initial 9 5 $914.00 $886.58 $594.10 $914.00 $868.30 2026-05-09
96415 OTHER Chemotherapy Inf Ea Addl Hr 9 5 $368.00 $356.96 $239.20 $640.00 $349.60 2026-05-09
97161 OTHER Pt Eval Low Complexity 11 5 $426.00 $413.22 $276.90 $426.00 $404.70 2026-05-09
97162 OTHER Pt Eval Mod Complexity 11 5 $426.00 $413.22 $276.90 $426.00 $404.70 2026-05-09
97163 OTHER Pt Eval High Complexity 9 5 $294.00 $285.18 $81.00 $294.00 $250.78 2026-05-09
97165 OTHER Ot Eval Low Complexity 8 5 $426.00 $413.22 $276.90 $426.00 $363.38 2026-05-09
97166 OTHER Ot Eval Mod Complexity 7 5 $426.00 $413.22 $276.90 $426.00 $363.38 2026-05-09
97167 OTHER Ot Eval High Complexity 9 5 $356.00 $345.32 $231.40 $405.00 $338.20 2026-05-09
99195 OTHER Phlebotomy Therapeutic 9 5 $516.00 $500.52 $335.40 $516.00 $490.20 2026-05-09
99205 OTHER New Patient Level 5 High Comp 6 5 $215.00 $208.55 $193.98 $382.02 $320.46 2026-05-09
99222 OTHER Inpatient Initial/Obs Mod Comp 6 5 $162.00 $157.14 $141.80 $274.01 $246.06 2026-05-09
99223 OTHER IP/Obs Initial High Comp 6 5 $322.00 $312.34 $209.42 $389.40 $334.66 2026-05-09
99282 OTHER Emergency Room Visit Level 2 15 5 $511.00 $495.67 $44.27 $511.00 $394.49 2026-05-09
99283 OTHER Emergency Room Visit Level 3 18 5 $787.00 $763.39 $74.82 $787.00 $614.64 2026-05-09
99284 OTHER Emergency Room Visit Level 4 18 5 $1,284.00 $1,245.48 $127.14 $1,284.00 $1,002.81 2026-05-09
99285 OTHER Emergency Room Visit Level 5 17 5 $2,087.00 $2,024.39 $184.62 $2,087.00 $1,611.16 2026-05-09
99291 OTHER Critical Care 1st 30-74 Min 15 5 $3,113.00 $3,019.61 $228.45 $3,113.00 $2,023.45 2026-05-09
A9585 OTHER Gadobutrol Inj 10 Mm/10 Ml Vl 19 5 $800.00 $776.00 $2.69 $800.00 $600.00 2026-05-09
G0103 OTHER Psa Screen 10 5 $362.00 $351.14 $235.30 $362.00 $343.90 2026-05-09
G0379 OTHER Observation Assess Direct Adm 9 5 $609.00 $590.73 $174.00 $609.00 $519.48 2026-05-09
G0390 OTHER Trauma Team Level 5 7 5 $1,362.00 $1,321.14 $885.30 $1,362.00 $1,161.79 2026-05-09
G0438 OTHER Annual Wellness Visit Initial 6 5 $231.00 $224.07 $92.40 $358.02 $286.56 2026-05-09
G0480 OTHER Clonidine, Serum 23 5 $2,019.00 $1,958.43 $189.80 $2,357.00 $1,595.01 2026-05-09
J0129 OTHER Abatacept 250 Mg Vial 8 5 $6,454.00 $6,261.22 $588.00 $6,454.87 $5,244.58 2026-05-09
J0131 OTHER Acetaminophen 1000mg/100ml Via 11 5 $318.00 $309.32 $145.73 $318.89 $272.01 2026-05-09
J0248 OTHER Remdesivir 100 Mg Vial 8 5 $2,847.00 $2,762.23 $70.71 $2,847.66 $2,313.72 2026-05-09
J0585 OTHER Botulinum Tx Type A 200 Un Vl 10 5 $5,559.00 $5,392.23 $59.81 $5,559.00 $4,525.02 2026-05-09
J0613 OTHER Calcium Gluc/NS (Wgcc) 1,000Mg 7 5 $340.00 $330.60 $221.53 $340.82 $323.78 2026-05-09
J0695 OTHER Ceftolozane/Tazobac 1.5gr Vial 8 5 $730.00 $708.99 $7.71 $730.92 $593.87 2026-05-09
J0744 OTHER Ciprofloxac/D5 400mg/200ml Bag 8 5 $311.00 $302.57 $5.85 $311.93 $253.44 2026-05-09
J1439 OTHER Ferric Carboxymalt 750mg/15ml 9 5 $4,487.00 $4,353.17 $11.91 $4,487.80 $3,828.09 2026-05-09
J1610 OTHER Glucagon 1 Mg/ml Vial 8 5 $794.00 $770.88 $98.91 $794.72 $645.71 2026-05-09
J1611 OTHER Glucagon (Fresenius Kabi) Vial 8 5 $794.00 $770.88 $81.80 $794.72 $645.71 2026-05-09
J1836 OTHER Metronidazole/Ns 500mg/100ml 8 5 $304.00 $295.15 $0.32 $304.28 $247.23 2026-05-09
J1956 OTHER Levofloxac/D5W 750mg/150ml Bag 10 5 $309.00 $299.90 $2.07 $309.18 $278.73 2026-05-09
J2327 OTHER Risankizumab-rzaa 600 Mg/10 Ml 8 5 $45,688.00 $44,318.04 $68.09 $45,688.70 $37,122.07 2026-05-09
J2997 OTHER Alteplase 2 Mg Vial 8 5 $879.00 $852.77 $37.08 $879.14 $714.31 2026-05-09
J3245 OTHER Tildrakizumab-asmn 100Mg/Ml Sy 8 5 $56,787.00 $55,084.09 $5.04 $56,787.72 $46,140.03 2026-05-09
J3380 OTHER Vedolizumab 300 Mg Vial 8 5 $41,229.00 $39,992.71 $72.63 $41,229.60 $33,499.05 2026-05-09
J3480 OTHER D5/Ns Kcl 20 Meq 1000 Ml Bag 26 5 $316.00 $306.80 $9.57 $948.87 $283.88 2026-05-09
J9202 OTHER Goserelin 3.6 Mg Implant 8 5 $4,663.00 $4,523.44 $77.09 $4,663.34 $3,788.97 2026-05-09
P9016 OTHER Red Blood Cells Lekoreduced 9 5 $662.00 $642.14 $430.30 $1,324.00 $628.90 2026-05-09
P9017 OTHER Plasma Fresh Frozen 9 5 $292.00 $283.24 $189.80 $584.00 $277.40 2026-05-09
P9037 OTHER Platelet Pheresis Leuk Red Irr 7 5 $2,746.00 $2,663.62 $1,784.90 $2,746.00 $2,342.34 2026-05-09
P9040 OTHER Rbc Packed Leuko-reduc Irrad 7 5 $1,056.00 $1,024.32 $686.40 $1,056.00 $900.77 2026-05-09
P9047 OTHER Albumin Human 25% 25gr/100ml 8 5 $618.00 $600.27 $402.24 $3,118.50 $587.89 2026-05-09
Q0138 OTHER Ferumoxy 510mg/17ml (non-esrd) 9 5 $1,145.00 $1,111.35 $7.28 $1,145.72 $977.30 2026-05-09
Q0139 OTHER Ferumoxytol 510 Mg/17 Ml Vial 8 5 $1,145.00 $1,111.35 $7.28 $1,145.72 $930.90 2026-05-09
Q5104 OTHER Infliximab-abda 100 Mg Vial 8 5 $1,763.00 $1,710.20 $1,146.01 $5,119.19 $1,674.94 2026-05-09
Q5110 OTHER Filgrastim-aafi 480 Mcg/0.8 Ml 8 5 $780.00 $756.91 $507.21 $927.00 $741.30 2026-05-09
Q5111 OTHER Pegfilgrastim-cbqv 6 Mg/0.6 Ml 8 5 $8,925.00 $8,657.25 $1,112.40 $8,925.00 $7,251.57 2026-05-09
Q5121 OTHER Infliximab-axxq 100 Mg Vial 8 5 $2,179.00 $2,114.48 $1,416.92 $4,302.83 $2,070.89 2026-05-09
Q9967 OTHER Iopamidol-370 100 Ml Vial 21 5 $600.00 $582.00 $58.50 $600.00 $253.80 2026-05-09
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