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

PLATTE HEALTH CENTER

Platte, SD · CCN 431306 · Rates published

800 distinct procedures filed
6 distinct payers
11,105 rate rows
2026-07-15 last MRF observed
Data quality

11,062 of 11,105 rate rows are consumer-grade (99.6%)

43 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 20
percent-of-charges filed in the dollar field — excluded from medians 9
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 8
placeholder amount (≤ $0.02) — excluded from medians 4
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.avera.org/app/files/public/33083bd4-0d43-4161-8b74-740eb128cdf4/460239781_platte-healthcare_standardcharges.csv
Found on page https://www.avera.org/cms-hpt.txt
Discovered viaDiscovered by HANK (automated)
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-10-10
Content fingerprint 2f25e7a56157f391… · 2,967,238 bytes · first seen 2026-06-08

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
7202
APR_DRG 		Apr-DRG 7202 1 $28,984.35 $28,984.35 $28,984.35 nat. median
$7,014
outlier · 4.1×
J3380
HCPCS 		Vedolizumab 300 Mg Vial 5 $72.63 $28,108.23 $25,020.96 nat. median
$59
outlier · 425.5×
1391
APR_DRG 		Apr-DRG 1391 1 $23,159.27 $23,159.27 $23,159.27 nat. median
$4,019
outlier · 5.8×
439
MS_DRG 		Ms-DRG 439 1 $20,133.07 $20,133.07 $20,133.07 nat. median
$6,417
outlier · 3.1×
J3101
HCPCS 		Tenecteplase 50 Mg/10 Ml Syrng 5 $0.41 $20,985.06 $17,197.26 nat. median
$498
outlier · 34.5×
4631
APR_DRG 		Apr-DRG 4631 1 $16,685.79 $16,685.79 $16,685.79 nat. median
$4,171
outlier · 4.0×
872
MS_DRG 		Ms-DRG 872 1 $13,788.80 $13,788.80 $13,788.80 nat. median
$7,744
1.8× median
543
MS_DRG 		Ms-DRG 543 1 $13,788.80 $13,788.80 $13,788.80 nat. median
$7,898
1.7× median
603
MS_DRG 		Ms-DRG 603 2 $10,351.18 $13,788.80 $13,788.80 nat. median
$6,621
outlier · 2.1×
J0717
HCPCS 		Certolizumab Pegol 400 Mg Kit 5 $3.42 $14,721.30 $12,064.10 nat. median
$29
outlier · 415.7×
J9312
HCPCS 		Rituximab 500 Mg/50 Ml Vial 5 $322.14 $14,142.80 $11,590.02 nat. median
$739
outlier · 15.7×
194
MS_DRG 		Ms-DRG 194 1 $10,770.40 $10,770.40 $10,770.40 nat. median
$6,156
1.7× median
312
MS_DRG 		Ms-DRG 312 1 $10,349.98 $10,349.98 $10,349.98 nat. median
$6,528
1.6× median
74178
CPT 		CT Abd & Pelv Wwo Contrast 5 $479.88 $9,481.00 $8,613.49 nat. median
$539
outlier · 16.0×
J1306
HCPCS 		Inclisiran 284mg/1.5ml Syringe 5 $5.81 $10,326.48 $8,462.55 nat. median
$25
outlier · 335.8×
74174
CPT 		CTA Abd&Pelv Wwo Dye 5 $5,361.85 $8,249.00 $7,494.22 nat. median
$549
outlier · 13.7×
566
MS_DRG 		Ms-DRG 566 1 $7,191.44 $7,191.44 $7,191.44 nat. median
$5,596
1.3× median
193
MS_DRG 		Ms-DRG 193 1 $7,191.44 $7,191.44 $7,191.44 nat. median
$9,802
0.7× median
74177
CPT 		CT Abd & Pelv W Contrast 6 $227.52 $7,379.00 $7,010.05 nat. median
$501
outlier · 14.0×
293
MS_DRG 		Ms-DRG 293 1 $6,911.16 $6,911.16 $6,911.16 nat. median
$4,186
1.7× median
640
MS_DRG 		Ms-DRG 640 1 $6,911.16 $6,911.16 $6,911.16 nat. median
$9,697
0.7× median
392
MS_DRG 		Ms-DRG 392 1 $6,864.12 $6,864.12 $6,864.12 nat. median
$5,890
1.2× median
Q5115
HCPCS 		Rituximab-abbs 500Mg/50Ml Vial 5 $3,708.00 $7,469.69 $6,121.41 nat. median
$368
outlier · 16.7×
J3111
HCPCS 		Romosozumab-aqqg 210 Mg/2.34Ml 5 $1.56 $7,450.43 $6,105.62 nat. median
$19
outlier · 321.3×
74176
CPT 		CT Abd & Pelvis Wo Contrast 6 $95.04 $6,241.00 $5,928.95 nat. median
$333
outlier · 17.8×
Q5119
HCPCS 		Rituximab-pvvr 500Mg/50Ml Vial 5 $1,112.40 $7,219.08 $5,916.03 nat. median
$318
outlier · 18.6×
J1437
HCPCS 		Ferric Derisomaltose 1,000 Mg 5 $16.52 $7,022.82 $5,755.20 nat. median
$41
outlier · 140.1×
95811
CPT 		Polysomnogram W CPap 5 $3,838.25 $5,905.00 $5,609.75 nat. median
$1,412
outlier · 4.0×
J3247
HCPCS 		Secukinumab 125 Mg/5 Ml Vial 5 $104.96 $6,417.41 $5,259.07 nat. median
$31
outlier · 170.9×
74183
CPT 		MRI Abdomen Wwo Dye 5 $619.08 $5,514.00 $5,238.30 nat. median
$611
outlier · 8.6×
95810
CPT 		Polysomnogram 5 $3,543.15 $5,451.00 $4,952.24 nat. median
$1,446
outlier · 3.4×
J1602
HCPCS 		Golimumab 50 Mg/4 Ml Vial 5 $43.11 $5,894.72 $4,830.72 nat. median
$55
outlier · 88.5×
72148
CPT 		MRI Lumbar Spine Wo Dye 6 $315.18 $5,032.00 $4,830.72 nat. median
$408
outlier · 11.8×
73221
CPT 		MRI Joint Ue Wo Dye Lt 5 $408.12 $4,867.00 $4,219.69 nat. median
$547
outlier · 7.7×
72158
CPT 		MRI Lumbar Spine Wwo Dye 5 $340.97 $5,125.00 $4,199.94 nat. median
$616
outlier · 6.8×
70553
CPT 		MRI Brain Wwo Contrast 5 $729.77 $4,331.00 $4,114.45 nat. median
$616
outlier · 6.7×
J0897
HCPCS 		Denosumab 60 Mg/ml Syringe 5 $9.69 $4,978.89 $4,080.20 nat. median
$86
outlier · 47.4×
73721
CPT 		MRI Joint Le Wo Dye Lt 5 $315.18 $4,244.00 $4,031.80 nat. median
$509
outlier · 7.9×
73723
CPT 		MRI Joint Le Wwo Dye Lt 5 $657.06 $4,880.00 $3,999.16 nat. median
$756
outlier · 5.3×
72197
CPT 		MRI Pelvis Wwo Dye 5 $618.17 $4,880.00 $3,999.16 nat. median
$606
outlier · 6.6×
71275
CPT 		CTA Chest Wwo Contrast 5 $2,682.55 $4,127.00 $3,961.92 nat. median
$365
outlier · 10.9×
78452
CPT 		Myocard Perf Spect Rest Stress 5 $2,925.00 $4,500.00 $3,901.50 nat. median
$1,464
outlier · 2.7×
73218
CPT 		MRI Ue Wo Dye Rt 5 $79.40 $4,244.00 $3,855.68 nat. median
$553
outlier · 7.0×
72195
CPT 		MRI Pelvis Wo Dye 5 $2,758.60 $4,244.00 $3,855.68 nat. median
$437
outlier · 8.8×
70549
CPT 		MRA Neck Wwo Contrast 5 $666.92 $4,113.00 $3,736.66 nat. median
$606
outlier · 6.2×
72141
CPT 		MRI Neck Spine Wo Dye 5 $233.96 $4,244.00 $3,679.55 nat. median
$429
outlier · 8.6×
70551
CPT 		MRI Brain Wo Contrast 5 $447.03 $3,847.00 $3,654.65 nat. median
$429
outlier · 8.5×
72156
CPT 		MRI Neck Spine Wwo Dye 5 $340.05 $4,457.00 $3,652.51 nat. median
$625
outlier · 5.8×
72157
CPT 		MRI Chest Spine Wwo Dye 5 $535.35 $4,457.00 $3,652.51 nat. median
$624
outlier · 5.8×
73720
CPT 		MRI Le Wwo Dye Rt 5 $233.96 $4,457.00 $3,652.51 nat. median
$754
outlier · 4.8×

Other procedures at this hospital

Browse this hospital's 800 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
0202U CPT Respir Path 22 Targets Biofire 8 5 $930.00 $930.00 $604.50 $930.00 $770.50 2026-07-15
10060 CPT I&d Abscess Simple/Single 14 5 $845.00 $845.00 $219.53 $845.00 $555.59 2026-07-15
10120 CPT I&r Foreign Body Simple 14 5 $577.00 $577.00 $215.90 $577.00 $379.38 2026-07-15
110 CDM Room Custodial Care 6 5 $453.00 $453.00 $294.45 $453.00 $411.55 2026-07-15
111 CDM Room Medical Unit Priv 6 5 $3,489.00 $3,489.00 $2,267.85 $3,489.00 $3,169.76 2026-07-15
120 CDM Room Medical Unit Semi Private 6 5 $3,489.00 $3,489.00 $2,267.85 $3,489.00 $3,169.76 2026-07-15
12001 CPT Repair Lac Simple <2.5 Cm 26 5 $577.00 $577.00 $86.23 $577.00 $450.63 2026-07-15
12002 CPT Repair Lac Simple 2.6-7.5 Cm 23 5 $577.00 $577.00 $112.84 $577.00 $445.44 2026-07-15
12004 CPT Repair Lac Simple 7.6-12.5 Cm 14 5 $577.00 $577.00 $140.14 $577.00 $379.38 2026-07-15
12005 CPT Repair Lac Simple 12.6-20.0 Cm 14 5 $577.00 $577.00 $179.19 $577.00 $379.38 2026-07-15
12011 CPT Repair Lac Simple <2.5 Cm 18 5 $577.00 $577.00 $107.01 $577.00 $450.63 2026-07-15
12013 CPT Repair Lac Simple 2.6-5.0 Cm 23 5 $577.00 $577.00 $109.90 $577.00 $445.44 2026-07-15
12014 CPT Repair Lac Simple 5.1-7.5 Cm 14 5 $577.00 $577.00 $141.36 $577.00 $379.38 2026-07-15
12015 CPT Repair Lac Simple 7.6-12.5 Cm 14 5 $577.00 $577.00 $178.06 $577.00 $379.38 2026-07-15
12034 CPT Repair Lac Interm 7.6-12.5 Cm 14 5 $845.00 $845.00 $413.34 $845.00 $566.47 2026-07-15
12053 CPT Repair Lac Interm 5.1-7.5 Cm 16 5 $845.00 $845.00 $434.18 $845.00 $626.33 2026-07-15
129 CDM Room Swing Bed Skilled 6 5 $2,442.00 $2,442.00 $1,587.30 $2,442.00 $2,218.56 2026-07-15
1391 APR_DRG Apr-DRG 1391 2 1 — — $23,159.27 $23,159.27 $23,159.27 2026-07-15
193 MS_DRG Ms-DRG 193 2 1 — — $7,191.44 $7,191.44 $7,191.44 2026-07-15
194 MS_DRG Ms-DRG 194 2 1 — — $10,770.40 $10,770.40 $10,770.40 2026-07-15
23570 CPT Fx Scapula Wo Manipulation Rt 18 5 $408.00 $408.00 $257.40 $408.00 $348.53 2026-07-15
23650 CPT Dislocation Shoulder Wo AnesRT 30 5 $408.00 $408.00 $265.20 $802.00 $402.00 2026-07-15
24530 CPT Fx Supra/Transcondylar Hum Lt 10 5 $396.00 $396.00 $257.40 $396.00 $359.76 2026-07-15
25560 CPT Fx Radius & Ulnar Shaft Lt 10 5 $408.00 $408.00 $265.20 $408.00 $370.67 2026-07-15
25600 CPT Fx Distal Radius Rt 19 5 $408.00 $408.00 $265.20 $408.00 $353.74 2026-07-15
25605 CPT Fx Distal Radius W Man Rt 14 5 $400.00 $400.00 $260.00 $1,409.30 $394.00 2026-07-15
27786 CPT Fx Distal Fibula Rt 18 5 $408.00 $408.00 $265.20 $408.00 $353.74 2026-07-15
27840 CPT Treat Ankle Dislocation 14 5 $427.00 $427.00 $277.55 $1,037.29 $420.60 2026-07-15
293 MS_DRG Ms-DRG 293 2 1 — — $6,911.16 $6,911.16 $6,911.16 2026-07-15
312 MS_DRG Ms-DRG 312 2 1 — — $10,349.98 $10,349.98 $10,349.98 2026-07-15
31500 CPT Insert Emergency Airway 8 5 $1,037.00 $1,037.00 $674.05 $1,037.00 $859.15 2026-07-15
32551 CPT Insertion Chest Tube Lt 14 5 $1,720.00 $1,720.00 $297.55 $1,720.00 $1,130.90 2026-07-15
32554 CPT Aspirate Pleura Wo Imaging Lt 22 5 $1,054.00 $1,054.00 $172.33 $1,086.00 $823.17 2026-07-15
32555 CPT Aspirate Pleura W Imaging Lt 8 5 $2,105.00 $2,105.00 $1,368.25 $2,105.00 $1,743.99 2026-07-15
360 CDM Or Level 1 48 5 $1,657.00 $1,657.00 $662.35 $2,903.00 $1,395.64 2026-07-15
36430 CPT Blood Administration 10 5 $1,230.00 $1,230.00 $799.50 $4,920.00 $1,117.45 2026-07-15
37195 CPT Thrombolytic Therapy Stroke 8 5 $468.00 $468.00 $304.20 $468.00 $387.74 2026-07-15
392 MS_DRG Ms-DRG 392 2 1 — — $6,864.12 $6,864.12 $6,864.12 2026-07-15
439 MS_DRG Ms-DRG 439 1 1 — — $20,133.07 $20,133.07 $20,133.07 2026-07-15
450 CDM Dissolve Clot Heart Vessel 8 5 $674.00 $674.00 $438.10 $674.00 $558.41 2026-07-15
4631 APR_DRG Apr-DRG 4631 2 1 — — $16,685.79 $16,685.79 $16,685.79 2026-07-15
51700 CPT Irrigation Bladder Simple 8 5 $492.00 $492.00 $319.80 $492.00 $407.62 2026-07-15
51705 CPT Suprapubic Cath Change 8 5 $468.00 $468.00 $304.20 $468.00 $387.74 2026-07-15
543 MS_DRG Ms-DRG 543 2 1 — — $13,788.80 $13,788.80 $13,788.80 2026-07-15
566 MS_DRG Ms-DRG 566 2 1 — — $7,191.44 $7,191.44 $7,191.44 2026-07-15
603 MS_DRG Ms-DRG 603 3 2 — — $10,351.18 $13,788.80 $13,788.80 2026-07-15
640 MS_DRG Ms-DRG 640 2 1 — — $6,911.16 $6,911.16 $6,911.16 2026-07-15
64450 CPT Inject Anes Agent Oth Nerve Lt 14 5 $577.00 $577.00 $83.15 $577.00 $379.38 2026-07-15
689 CDM Trauma Team Evaluation Level 5 8 5 $2,379.00 $2,379.00 $1,546.35 $2,379.00 $1,971.00 2026-07-15
70030 CPT X-ray Eye Fb Detection 9 5 $484.00 $484.00 $314.60 $484.00 $469.48 2026-07-15
70100 CPT X-ray Mandible < 4 Views 8 5 $784.00 $784.00 $509.60 $4,852.95 $752.64 2026-07-15
70110 CPT X-ray Mandible 4 Views 8 5 $859.00 $859.00 $558.35 $5,483.21 $824.64 2026-07-15
70160 CPT X-ray Facial Bones 3 Views 8 5 $784.00 $784.00 $86.75 $784.00 $642.49 2026-07-15
70250 CPT X-ray Skull < 4 Views 10 5 $787.00 $787.00 $94.25 $787.00 $714.99 2026-07-15
70450 CPT CT Head/Brain Wo Contrast 11 5 $3,000.00 $3,000.00 $1,950.00 $3,000.00 $2,850.00 2026-07-15
70470 CPT CT Head/Brain Wwo Contrast 10 5 $3,915.00 $3,915.00 $241.32 $3,915.00 $3,556.78 2026-07-15
70480 CPT CT Orbit Wo Contrast 8 5 $3,497.00 $3,497.00 $192.56 $3,497.00 $2,865.79 2026-07-15
70486 CPT CT Maxillofacial Wo Contrast 11 5 $3,062.00 $3,062.00 $187.95 $3,062.00 $2,654.75 2026-07-15
70488 CPT CT Maxillofac Wwo Contrast 8 5 $3,962.00 $3,962.00 $319.79 $3,962.00 $3,246.86 2026-07-15
70490 CPT CT Soft Tissue Neck Wo Cont 9 5 $3,000.00 $3,000.00 $277.47 $3,000.00 $2,601.00 2026-07-15
70491 CPT CT Soft Tissue Neck W Cont 12 6 $3,473.00 $3,473.00 $357.53 $3,473.00 $3,334.08 2026-07-15
70496 CPT CT Angiography Head W Cont 11 5 $3,915.00 $3,915.00 $246.84 $3,915.00 $3,394.31 2026-07-15
70498 CPT CT Angiography Neck W Cont 11 5 $3,915.00 $3,915.00 $278.39 $3,915.00 $3,394.31 2026-07-15
70544 CPT MRA Head Wo Contrast 8 5 $3,844.00 $3,844.00 $408.12 $3,844.00 $3,150.16 2026-07-15
70546 CPT MRA Head Wwo Contrast 8 5 $4,387.00 $4,387.00 $545.48 $4,387.00 $3,595.15 2026-07-15
70549 CPT MRA Neck Wwo Contrast 10 5 $4,113.00 $4,113.00 $666.92 $4,113.00 $3,736.66 2026-07-15
70551 CPT MRI Brain Wo Contrast 11 5 $3,847.00 $3,847.00 $447.03 $3,847.00 $3,654.65 2026-07-15
70553 CPT MRI Brain Wwo Contrast 11 5 $4,331.00 $4,331.00 $729.77 $4,331.00 $4,114.45 2026-07-15
710 CDM Recovery Phase 1 Per 15 Min 24 5 $412.00 $412.00 $244.40 $761.00 $370.36 2026-07-15
71045 CPT X-ray Chest 1 View 13 6 $373.00 $373.00 $242.45 $593.33 $361.81 2026-07-15
71046 CPT X-ray Chest 2v PA/Lateral 14 6 $667.00 $667.00 $433.55 $783.14 $646.99 2026-07-15
71100 CPT X-ray Ribs 2 Views Lt 8 5 $787.00 $787.00 $511.55 $3,616.49 $755.52 2026-07-15
71101 CPT X-ray Ribs Uni W Chest Lt 16 5 $924.00 $924.00 $600.60 $3,427.98 $887.04 2026-07-15
71250 CPT CT Thorax Wo Contrast 13 6 $3,250.00 $3,250.00 $71.13 $3,250.00 $3,087.50 2026-07-15
71260 CPT CT Thorax W Contrast 12 5 $3,693.00 $3,693.00 $80.31 $3,693.00 $3,355.09 2026-07-15
71270 CPT CT Thorax Wwo Contrast 8 5 $4,127.00 $4,127.00 $82.17 $4,127.00 $3,382.07 2026-07-15
71275 CPT CTA Chest Wwo Contrast 10 5 $4,127.00 $4,127.00 $2,682.55 $4,127.00 $3,961.92 2026-07-15
7202 APR_DRG Apr-DRG 7202 2 1 — — $28,984.35 $28,984.35 $28,984.35 2026-07-15
72040 CPT X-ray Spine Cervical 2-3 Views 12 5 $583.00 $583.00 $378.95 $583.00 $552.89 2026-07-15
72070 CPT X-ray Spine Thoracic 2 Views 11 5 $664.00 $664.00 $431.60 $1,015.91 $644.08 2026-07-15
72072 CPT X-ray Spine Thoracic 3 Views 9 5 $783.00 $783.00 $508.95 $783.00 $697.55 2026-07-15
72082 CPT X-ray Spine 2-3 View 10 5 $664.00 $664.00 $130.92 $664.00 $603.25 2026-07-15
72100 CPT X-ray Lumbosacral 2-3 Views 13 6 $784.00 $784.00 $90.44 $784.00 $744.80 2026-07-15
72110 CPT X-ray Lumbosacral 4 Views 8 5 $824.00 $824.00 $67.44 $824.00 $675.27 2026-07-15
72125 CPT CT Cervical Spine Wo Contrast 13 5 $3,497.00 $3,497.00 $172.58 $3,497.00 $3,322.15 2026-07-15
72128 CPT CT Thoracic Spine Wo Contrast 8 5 $3,125.00 $3,125.00 $107.93 $3,125.00 $2,560.94 2026-07-15
72129 CPT CT Thoracic Spine W Contrast 8 5 $3,587.00 $3,587.00 $128.15 $3,587.00 $2,939.55 2026-07-15
72131 CPT CT Lumbar Spine Wo Contrast 9 6 $3,747.00 $3,747.00 $234.87 $3,747.00 $3,248.65 2026-07-15
72132 CPT CT Lumbar Spine W Contrast 8 5 $4,127.00 $4,127.00 $313.35 $4,127.00 $3,382.07 2026-07-15
72141 CPT MRI Neck Spine Wo Dye 11 5 $4,244.00 $4,244.00 $233.96 $4,244.00 $3,679.55 2026-07-15
72146 CPT MRI Chest Spine Wo Dye 8 5 $4,244.00 $4,244.00 $390.63 $4,244.00 $3,477.96 2026-07-15
72148 CPT MRI Lumbar Spine Wo Dye 12 6 $5,032.00 $5,032.00 $315.18 $5,032.00 $4,830.72 2026-07-15
72156 CPT MRI Neck Spine Wwo Dye 8 5 $4,457.00 $4,457.00 $340.05 $4,457.00 $3,652.51 2026-07-15
72157 CPT MRI Chest Spine Wwo Dye 8 5 $4,457.00 $4,457.00 $535.35 $4,457.00 $3,652.51 2026-07-15
72158 CPT MRI Lumbar Spine Wwo Dye 8 5 $5,125.00 $5,125.00 $340.97 $5,125.00 $4,199.94 2026-07-15
72170 CPT X-ray Pelvis 1-2 Views 12 6 $533.00 $533.00 $341.88 $533.00 $484.23 2026-07-15
72192 CPT CT Pelvis Wo Dye 8 5 $3,497.00 $3,497.00 $597.02 $3,497.00 $2,865.79 2026-07-15
72193 CPT CT Pelvis W Dye 8 5 $3,915.00 $3,915.00 $593.33 $3,915.00 $3,208.35 2026-07-15
72195 CPT MRI Pelvis Wo Dye 6 5 $4,244.00 $4,244.00 $2,758.60 $4,244.00 $3,855.68 2026-07-15
72197 CPT MRI Pelvis Wwo Dye 8 5 $4,880.00 $4,880.00 $618.17 $4,880.00 $3,999.16 2026-07-15
72202 CPT X-ray Si Joints 3 Views 8 5 $696.00 $696.00 $452.40 $696.00 $572.94 2026-07-15
72220 CPT X-ray Sacrum Tailbone 10 5 $598.00 $598.00 $388.70 $598.00 $543.29 2026-07-15
73000 CPT X-ray Collar Bone Rt 18 5 $541.00 $541.00 $187.04 $541.00 $469.05 2026-07-15
73010 CPT X-ray Shoulder Blade Lt 18 5 $558.00 $558.00 $174.17 $558.00 $483.79 2026-07-15
73020 CPT X-ray Shoulder Lt 8 5 $503.00 $503.00 $187.95 $503.00 $412.21 2026-07-15
73030 CPT X-ray Shoulder Lt 23 5 $660.00 $660.00 $237.65 $660.00 $627.00 2026-07-15
73050 CPT X-ray Ac Joints 8 5 $664.00 $664.00 $196.25 $664.00 $544.15 2026-07-15
73060 CPT X-ray Humerus Rt 19 5 $562.00 $562.00 $67.44 $562.00 $487.25 2026-07-15
73070 CPT X-ray Elbow Lt 20 5 $533.00 $533.00 $41.69 $533.00 $484.23 2026-07-15
73080 CPT X-ray Elbow Lt 19 5 $584.00 $584.00 $38.91 $584.00 $506.33 2026-07-15
73090 CPT X-ray Forearm 2 Views Lt 21 5 $783.00 $783.00 $282.72 $783.00 $743.85 2026-07-15
73100 CPT X-ray Wrist 2 Views Lt 17 5 $541.00 $541.00 $66.51 $541.00 $469.05 2026-07-15
73110 CPT X-ray Wrist 3 Views Rt 23 5 $783.00 $783.00 $58.22 $783.00 $743.85 2026-07-15
73130 CPT X-ray Hand Rt 23 5 $541.00 $541.00 $59.16 $541.00 $513.95 2026-07-15
73140 CPT X-ray Finger(s) Lt 20 5 $475.00 $475.00 $64.68 $475.00 $431.54 2026-07-15
73200 CPT CT Ue Wo Dye Lt 20 5 $3,000.00 $3,000.00 $70.19 $3,000.00 $2,725.50 2026-07-15
73201 CPT CT Ue W Dye Rt 8 5 $3,473.00 $3,473.00 $90.44 $3,473.00 $2,846.12 2026-07-15
73218 CPT MRI Ue Wo Dye Rt 10 5 $4,244.00 $4,244.00 $79.40 $4,244.00 $3,855.68 2026-07-15
73221 CPT MRI Joint Ue Wo Dye Lt 21 5 $4,867.00 $4,867.00 $408.12 $4,867.00 $4,219.69 2026-07-15
73502 CPT X-ray Hip Uni 2-3 Views Rt 37 6 $658.00 $658.00 $427.70 $1,188.00 $772.20 2026-07-15
73522 CPT X-ray Hips 3-4 Views Bi 10 5 $996.00 $996.00 $647.40 $996.00 $904.87 2026-07-15
73523 CPT X-ray Hips 5 Views Bi 9 5 $1,107.00 $1,107.00 $690.20 $1,107.00 $959.77 2026-07-15
73551 CPT X-ray Femur 1 View Lt 16 5 $602.00 $602.00 $101.48 $602.00 $493.33 2026-07-15
73552 CPT X-ray Femur 2 Views Lt 21 5 $772.00 $772.00 $130.01 $772.00 $733.40 2026-07-15
73560 CPT X-ray Knee 1-2 Views Rt 21 5 $602.00 $602.00 $84.00 $602.00 $521.93 2026-07-15
73562 CPT X-ray Knee 3 Views Rt 23 5 $629.00 $629.00 $109.76 $629.00 $545.34 2026-07-15
73564 CPT X-ray Knee 4 Rt 19 5 $668.00 $668.00 $129.06 $668.00 $579.16 2026-07-15
73590 CPT X-ray Lower Leg Lt 20 5 $664.00 $664.00 $73.88 $664.00 $603.25 2026-07-15
73600 CPT X-ray Ankle 2 Views Lt 18 5 $516.00 $516.00 $86.75 $516.00 $447.37 2026-07-15
73610 CPT X-ray Ankle 3 Views Lt 20 5 $856.00 $856.00 $99.63 $856.00 $777.67 2026-07-15
73620 CPT X-ray Foot 2 Views Lt 20 5 $405.00 $405.00 $212.82 $405.00 $367.94 2026-07-15
73630 CPT X-ray Foot 3 Views Lt 22 5 $631.00 $631.00 $65.60 $631.00 $573.27 2026-07-15
73650 CPT X-ray Heel 2 Views Lt 8 5 $507.00 $507.00 $64.68 $507.00 $415.49 2026-07-15
73660 CPT X-ray Toe(s) 2 Views Lt 16 5 $442.00 $442.00 $66.51 $442.00 $362.22 2026-07-15
73700 CPT CT Le Wo Dye Rt 21 6 $3,497.00 $3,497.00 $76.65 $3,497.00 $3,322.15 2026-07-15
73701 CPT CT Le W Dye Lt 8 5 $3,915.00 $3,915.00 $268.01 $3,915.00 $3,208.35 2026-07-15
73718 CPT MRI Le Wo Dye Lt 20 5 $3,747.00 $3,747.00 $56.39 $3,747.00 $3,404.15 2026-07-15
73720 CPT MRI Le Wwo Dye Rt 8 5 $4,457.00 $4,457.00 $233.96 $4,457.00 $3,652.51 2026-07-15
73721 CPT MRI Joint Le Wo Dye Lt 22 5 $4,244.00 $4,244.00 $315.18 $4,244.00 $4,031.80 2026-07-15
73723 CPT MRI Joint Le Wwo Dye Lt 16 5 $4,880.00 $4,880.00 $657.06 $4,880.00 $3,999.16 2026-07-15
74018 CPT X-ray Abdomen 11 5 $591.00 $591.00 $384.15 $591.00 $561.45 2026-07-15
74019 CPT X-ray Abdomen 13 6 $950.00 $950.00 $363.41 $950.00 $823.65 2026-07-15
74022 CPT X-ray Series Abdomen 8 5 $1,321.00 $1,321.00 $661.43 $1,321.00 $1,082.56 2026-07-15
74150 CPT CT Abdomen Wo Dye 10 5 $3,000.00 $3,000.00 $791.13 $3,000.00 $2,458.50 2026-07-15
74160 CPT CT Abdomen W Dye 8 5 $3,473.00 $3,473.00 $706.77 $3,473.00 $2,846.12 2026-07-15
74170 CPT CT Abdomen Wwo Dye 10 5 $3,915.00 $3,915.00 $58.22 $3,915.00 $3,394.31 2026-07-15
74174 CPT CTA Abd&Pelv Wwo Dye 6 5 $8,249.00 $8,249.00 $5,361.85 $8,249.00 $7,494.22 2026-07-15
74175 CPT CTA Abdom Wwo Dye 8 5 $3,915.00 $3,915.00 $82.17 $3,915.00 $3,208.35 2026-07-15
74176 CPT CT Abd & Pelvis Wo Contrast 13 6 $6,241.00 $6,241.00 $95.04 $6,241.00 $5,928.95 2026-07-15
74177 CPT CT Abd & Pelv W Contrast 14 6 $7,379.00 $7,379.00 $227.52 $7,379.00 $7,010.05 2026-07-15
74178 CPT CT Abd & Pelv Wwo Contrast 10 5 $9,481.00 $9,481.00 $479.88 $9,481.00 $8,613.49 2026-07-15
74183 CPT MRI Abdomen Wwo Dye 11 5 $5,514.00 $5,514.00 $619.08 $5,514.00 $5,238.30 2026-07-15
76536 CPT Ultrasound Head And Neck 13 5 $964.00 $964.00 $626.60 $964.00 $915.80 2026-07-15
76604 CPT Ultrasound Chest 9 5 $900.00 $900.00 $585.00 $900.00 $780.30 2026-07-15
76642 CPT Ultrasound Breast Limited Lt 26 5 $442.00 $442.00 $287.30 $884.00 $428.74 2026-07-15
76700 CPT Ultrasound Abdomen Complete 12 6 $1,510.00 $1,510.00 $981.50 $1,510.00 $1,449.60 2026-07-15
76705 CPT Ultrasound Abdomen Limited 12 5 $1,333.00 $1,333.00 $866.45 $1,333.00 $1,211.03 2026-07-15
76706 CPT Aaa Screening Medicare 8 5 $769.00 $769.00 $499.85 $769.00 $637.12 2026-07-15
76770 CPT Ultrasound Abdo Back Wall Comp 11 5 $1,591.00 $1,591.00 $1,034.15 $1,591.00 $1,511.45 2026-07-15
76775 CPT Ultrasound Aorta 10 5 $769.00 $769.00 $499.85 $769.00 $698.63 2026-07-15
76817 CPT Transvaginal US Obstetrical 8 5 $737.00 $737.00 $479.05 $737.00 $610.61 2026-07-15
76830 CPT Ultrasound Transvaginal 11 5 $718.00 $718.00 $466.70 $718.00 $682.10 2026-07-15
76856 CPT Ultrasound Pelvic Complete 11 5 $1,205.00 $1,205.00 $783.25 $1,205.00 $1,044.74 2026-07-15
76870 CPT Ultrasound Scrotum 9 5 $840.00 $840.00 $546.00 $840.00 $728.28 2026-07-15
76882 CPT US Extremity Nonvasc Limit Lt 21 5 $615.00 $615.00 $399.75 $615.00 $584.25 2026-07-15
77065 CPT Mammography Dx Digital Rt 19 5 $518.00 $518.00 $336.70 $518.00 $449.11 2026-07-15
77066 CPT Mammography Diagnostic Digital 11 5 $542.00 $542.00 $352.30 $542.00 $514.90 2026-07-15
77067 CPT Mammography Screening Digital 30 6 $475.00 $475.00 $308.75 $475.00 $411.83 2026-07-15
77074 CPT X-rays Bone Survey Limited 8 5 $1,244.00 $1,244.00 $240.68 $1,244.00 $1,019.46 2026-07-15
77080 CPT Dexa Scan 12 5 $700.00 $700.00 $88.61 $700.00 $635.95 2026-07-15
771 CDM IV Infus Bamlan/Etesevim w/Mon 8 5 $571.00 $571.00 $371.15 $571.00 $473.07 2026-07-15
78226 CPT Hepatobiliary Scan Without Ef 8 5 $3,197.00 $3,197.00 $2,078.05 $3,197.00 $2,648.72 2026-07-15
78227 CPT Hida With Ef w/Pharm 11 5 $3,197.00 $3,197.00 $1,521.00 $3,197.00 $2,771.80 2026-07-15
78452 CPT Myocard Perf Spect Rest Stress 11 5 $4,500.00 $4,500.00 $2,925.00 $4,500.00 $3,901.50 2026-07-15
78582 CPT Lung Perfusion & Ventilation 8 5 $2,200.00 $2,200.00 $1,430.00 $2,200.00 $1,822.70 2026-07-15
80048 CPT Basic Metabolic Panel 14 6 $367.00 $367.00 $238.55 $367.00 $348.65 2026-07-15
80053 CPT Comprehensive Metabolic Panel 14 6 $408.00 $408.00 $198.00 $408.00 $370.67 2026-07-15
80074 CPT Acute Hepatitis Panel 10 5 $1,171.00 $1,171.00 $761.15 $1,171.00 $1,063.86 2026-07-15
80162 CPT Digoxin 8 5 $438.00 $438.00 $284.70 $438.00 $362.88 2026-07-15
80177 CPT Levetiracetam 10 5 $601.00 $601.00 $390.65 $601.00 $546.01 2026-07-15
80185 CPT Phenytoin Total 9 5 $438.00 $438.00 $284.70 $438.00 $379.75 2026-07-15
80197 CPT Tacrolimus 10 5 $709.00 $709.00 $460.85 $709.00 $644.12 2026-07-15
80202 CPT Vancomycin 9 5 $462.00 $462.00 $300.30 $462.00 $400.55 2026-07-15
80235 CPT Lacosamide 8 5 $417.00 $417.00 $271.05 $417.00 $345.49 2026-07-15
80280 CPT Vedolizumab 10 5 $1,071.00 $1,071.00 $696.15 $1,071.00 $973.00 2026-07-15
80306 CPT Drug Screen Urine Inst Ass Obv 13 5 $459.00 $459.00 $298.35 $459.00 $436.05 2026-07-15
81256 CPT Hemochromat Mutation 8 5 $1,120.00 $1,120.00 $728.00 $1,120.00 $927.92 2026-07-15
81511 CPT Maternal Ser Scrn 4 Anal 8 5 $488.00 $488.00 $317.20 $488.00 $404.31 2026-07-15
81517 CPT Enhanced Liver Fibrosis 8 5 $1,954.00 $1,954.00 $1,270.10 $1,954.00 $1,618.89 2026-07-15
82024 CPT Acth Adrenocorticotropic Hor 9 5 $798.00 $798.00 $518.70 $798.00 $691.87 2026-07-15
82088 CPT Aldosterone 8 5 $650.00 $650.00 $422.50 $650.00 $538.52 2026-07-15
82105 CPT Afp Tm 12 6 $448.00 $448.00 $272.00 $448.00 $407.01 2026-07-15
82139 CPT Amino Acid Quant 5 Or More, Ur 10 5 $428.00 $428.00 $278.20 $428.00 $388.84 2026-07-15
82140 CPT Ammonia 10 5 $534.00 $534.00 $347.10 $534.00 $442.42 2026-07-15
82164 CPT Angiotensin Conv Enzyme 8 5 $441.00 $441.00 $286.65 $441.00 $365.37 2026-07-15
82378 CPT Cea 10 5 $463.00 $463.00 $269.00 $463.00 $383.60 2026-07-15
82523 CPT Cross Linked C Teleop 8 5 $700.00 $700.00 $455.00 $700.00 $579.95 2026-07-15
82530 CPT Cortisol Free Urine 8 5 $567.00 $567.00 $368.55 $567.00 $469.76 2026-07-15
82553 CPT Cpk Mb Fraction 10 5 $541.00 $541.00 $351.65 $541.00 $491.50 2026-07-15
82626 CPT Dhea 8 5 $541.00 $541.00 $351.65 $541.00 $448.22 2026-07-15
82627 CPT Dheas 10 5 $556.00 $556.00 $361.40 $556.00 $505.12 2026-07-15
82653 CPT Pancreatic Elastase 8 5 $544.00 $544.00 $353.60 $544.00 $450.70 2026-07-15
82671 CPT Estrogen Fractionated 8 5 $811.00 $811.00 $527.15 $811.00 $671.91 2026-07-15
82728 CPT Ferritin 13 6 $414.00 $414.00 $224.00 $414.00 $358.94 2026-07-15
82785 CPT Immunoglobulin E 8 5 $463.00 $463.00 $300.95 $463.00 $383.60 2026-07-15
83001 CPT Fsh 11 5 $442.00 $442.00 $272.00 $442.00 $383.21 2026-07-15
83018 CPT Iodine Serum 19 5 $530.00 $530.00 $344.50 $560.00 $485.52 2026-07-15
83525 CPT Insulin 11 5 $473.00 $473.00 $245.00 $473.00 $410.09 2026-07-15
83789 CPT Bacterial Identification Maldi 8 5 $1,408.00 $1,408.00 $915.20 $1,408.00 $1,166.53 2026-07-15
83921 CPT Methylmalonic Acid 9 5 $409.00 $409.00 $265.85 $409.00 $354.60 2026-07-15
83970 CPT Pth 11 5 $518.00 $518.00 $336.70 $518.00 $449.11 2026-07-15
83993 CPT Calprotectin 11 5 $542.00 $542.00 $352.30 $542.00 $469.91 2026-07-15
84145 CPT Procalcitonin 9 5 $550.00 $550.00 $357.50 $550.00 $476.85 2026-07-15
84146 CPT Prolactin 11 5 $442.00 $442.00 $287.00 $442.00 $383.21 2026-07-15
84244 CPT Renin 10 5 $650.00 $650.00 $422.50 $650.00 $538.52 2026-07-15
84681 CPT C Peptide 10 5 $742.00 $742.00 $482.30 $742.00 $614.74 2026-07-15
86039 CPT Ana By Ifa Titer 12 5 $434.00 $434.00 $282.10 $434.00 $412.30 2026-07-15
86200 CPT Citrulline Antibody 11 5 $434.00 $434.00 $282.10 $434.00 $412.30 2026-07-15
86255 CPT Fluorescent NonInfect Antibody 24 5 $529.00 $529.00 $152.75 $710.00 $438.27 2026-07-15
86381 CPT Mitochondrial Antibody 8 5 $478.00 $478.00 $310.70 $478.00 $396.02 2026-07-15
86382 CPT Rabies Ab Screen 8 5 $435.00 $435.00 $282.75 $435.00 $360.40 2026-07-15
86618 CPT Lyme Disease Antibody 8 5 $549.00 $549.00 $356.85 $549.00 $454.85 2026-07-15
872 MS_DRG Ms-DRG 872 2 1 — — $13,788.80 $13,788.80 $13,788.80 2026-07-15
87305 CPT Aspergillus Galact Antigen 8 5 $2,370.00 $2,370.00 $1,540.50 $2,370.00 $1,963.55 2026-07-15
87476 CPT Lyme Disease DNA Amp Probe 8 5 $438.00 $438.00 $284.70 $438.00 $362.88 2026-07-15
87493 CPT C Diff By Pcr 11 5 $498.00 $498.00 $323.70 $498.00 $431.77 2026-07-15
87497 CPT Cmv Quant By Pcr 8 5 $969.00 $969.00 $629.85 $969.00 $802.82 2026-07-15
87522 CPT Hep C RNA Pcr Quant 8 5 $640.00 $640.00 $416.00 $640.00 $530.24 2026-07-15
87529 CPT Hsv DNA Pcr Subtype Ref 8 5 $798.00 $798.00 $518.70 $798.00 $661.14 2026-07-15
87636 CPT Influ & CoV2 Pcr Ceph 10 5 $390.00 $390.00 $253.50 $390.00 $354.31 2026-07-15
87637 CPT Influ/RSV/CoV2 Pcr Ceph 12 5 $390.00 $390.00 $253.50 $390.00 $354.31 2026-07-15
87799 CPT Bk Virus Quant Pcr, Serum 16 5 $1,774.00 $1,774.00 $281.45 $3,115.00 $1,228.88 2026-07-15
92507 CPT Speech Therapy Trmt 10 5 $537.00 $537.00 $349.05 $537.00 $487.87 2026-07-15
92522 CPT Eval St Speech Production 8 5 $680.00 $680.00 $442.00 $680.00 $563.38 2026-07-15
92523 CPT Speech Sound Lang Comprehen 8 5 $680.00 $680.00 $442.00 $680.00 $563.38 2026-07-15
92524 CPT Behavral Qualit Analys Voice 8 5 $680.00 $680.00 $442.00 $680.00 $563.38 2026-07-15
92610 CPT Swallow Eval Non Radiol 8 5 $680.00 $680.00 $442.00 $680.00 $563.38 2026-07-15
92950 CPT Heart/Lung Resuscitation Cpr 14 5 $1,329.00 $1,329.00 $275.08 $1,329.00 $873.82 2026-07-15
93017 CPT Cardiovascular Stress Test 11 5 $1,309.00 $1,309.00 $850.85 $1,309.00 $1,243.55 2026-07-15
93306 CPT Tte W Doppler Complete 12 5 $2,921.00 $2,921.00 $1,898.65 $2,921.00 $2,653.73 2026-07-15
93308 CPT Echo Limited 11 5 $1,421.00 $1,421.00 $923.65 $1,421.00 $1,349.95 2026-07-15
93321 CPT Doppler Echo Exam Heart 10 5 $632.00 $632.00 $122.80 $632.00 $523.61 2026-07-15
93325 CPT Echo Color Doppler 10 5 $843.00 $843.00 $163.60 $843.00 $698.42 2026-07-15
93880 CPT Extracranial Bilat Study 10 5 $1,869.00 $1,869.00 $373.80 $1,869.00 $1,548.47 2026-07-15
93922 CPT Ankle Arm Screen 8 5 $758.00 $758.00 $492.70 $758.00 $628.01 2026-07-15
93925 CPT Arterial Duplex Le Bi 10 5 $2,012.00 $2,012.00 $1,307.80 $2,012.00 $1,827.90 2026-07-15
93930 CPT Duplex Arterial Ue Complete 8 5 $2,012.00 $2,012.00 $1,307.80 $2,012.00 $1,666.94 2026-07-15
93970 CPT Venous Duplex 11 5 $1,608.00 $1,608.00 $1,045.20 $1,608.00 $1,394.14 2026-07-15
93971 CPT Extremity Study Rt 21 5 $1,216.00 $1,216.00 $790.40 $1,216.00 $1,155.20 2026-07-15
93976 CPT Vascular Study 11 5 $1,016.00 $1,016.00 $660.40 $1,016.00 $965.20 2026-07-15
94010 CPT Pft Screen Spirometry 8 5 $530.00 $530.00 $344.50 $530.00 $439.11 2026-07-15
94060 CPT Pft Pre & Post Screen Spirome 17 5 $747.00 $747.00 $15.59 $747.00 $576.68 2026-07-15
94660 CPT CPap/BiPap First Day 9 5 $844.00 $844.00 $548.60 $844.00 $731.75 2026-07-15
95810 CPT Polysomnogram 10 5 $5,451.00 $5,451.00 $3,543.15 $5,451.00 $4,952.24 2026-07-15
95811 CPT Polysomnogram W CPap 11 5 $5,905.00 $5,905.00 $3,838.25 $5,905.00 $5,609.75 2026-07-15
96125 CPT Cognitive Performance Test St 8 5 $680.00 $680.00 $442.00 $680.00 $563.38 2026-07-15
96360 CPT Inf Therapy Hyd Initial 13 6 $648.00 $648.00 $421.20 $648.00 $615.60 2026-07-15
96365 CPT Inf Therapy Med Initial 12 5 $648.00 $648.00 $421.20 $648.00 $588.71 2026-07-15
96413 CPT Chemotherapy Inf Initial 10 5 $682.00 $682.00 $443.30 $682.00 $619.60 2026-07-15
97162 CPT Pt Eval Mod Complexity 12 5 $380.00 $380.00 $247.00 $380.00 $345.23 2026-07-15
97163 CPT Pt Eval High Complexity 11 5 $409.00 $409.00 $265.85 $409.00 $388.55 2026-07-15
99236 CPT Admit/Discharge Same Day High 6 5 $901.00 $901.00 $322.41 $436.48 $391.90 2026-07-15
99282 CPT Emergency Room Visit Level 2 17 5 $587.00 $587.00 $64.21 $587.00 $453.16 2026-07-15
99283 CPT Emergency Room Visit Level 3 19 6 $850.00 $850.00 $108.68 $850.00 $671.50 2026-07-15
99284 CPT Emergency Room Visit Level 4 19 6 $2,003.00 $2,003.00 $184.86 $2,003.00 $1,331.99 2026-07-15
99285 CPT Emergency Room Visit Level 5 18 5 $2,482.00 $2,482.00 $267.73 $2,482.00 $1,783.32 2026-07-15
99291 CPT Critical Care 1st 30-74 Min 16 5 $3,774.00 $3,774.00 $329.00 $3,774.00 $2,481.40 2026-07-15
99292 CPT Critical Care Ea Addl 30 Min 16 5 $688.00 $688.00 $164.83 $688.00 $452.36 2026-07-15
A9500 HCPCS Radiophar Tc99M Sestamibi Dose 11 5 $380.00 $380.00 $247.00 $752.00 $361.00 2026-07-15
A9585 HCPCS Gadobutrol Inj 10 Mm/10 Ml Vl 11 5 $800.00 $800.00 $2.69 $800.00 $693.60 2026-07-15
C8924 HCPCS Tte 2d W Contrast Limited 8 5 $1,421.00 $1,421.00 $923.65 $1,421.00 $1,177.30 2026-07-15
C8929 HCPCS Echo M Mode 2d W Contrast 13 6 $2,921.00 $2,921.00 $1,898.65 $2,921.00 $2,774.95 2026-07-15
G0390 HCPCS Trauma Team Level 5 8 5 $2,379.00 $2,379.00 $1,546.35 $2,379.00 $1,971.00 2026-07-15
J0129 HCPCS Abatacept 250 Mg Vial 8 5 $4,390.00 $4,390.67 $588.00 $4,390.67 $3,598.15 2026-07-15
J0248 HCPCS Remdesivir 100 Mg Vial 8 5 $1,819.00 $1,819.34 $70.71 $1,819.34 $1,490.95 2026-07-15
J0714 HCPCS Ceftazidime/Avibactam 2.5Gm Vl 8 5 $1,118.00 $1,118.34 $0.68 $1,118.34 $916.48 2026-07-15
J0717 HCPCS Certolizumab Pegol 400 Mg Kit 8 5 $14,721.00 $14,721.30 $3.42 $14,721.30 $12,064.10 2026-07-15
J0881 HCPCS Darbepoet Alfa 40mcg/0.4ml Syr 26 5 $863.00 $863.43 $171.56 $2,669.46 $839.41 2026-07-15
J0897 HCPCS Denosumab 60 Mg/ml Syringe 8 5 $4,978.00 $4,978.89 $9.69 $4,978.89 $4,080.20 2026-07-15
J1306 HCPCS Inclisiran 284mg/1.5ml Syringe 8 5 $10,326.00 $10,326.48 $5.81 $10,326.48 $8,462.55 2026-07-15
J1437 HCPCS Ferric Derisomaltose 1,000 Mg 8 5 $7,022.00 $7,022.82 $16.52 $7,022.82 $5,755.20 2026-07-15
J1439 HCPCS Ferric Carboxymalt 750mg/15ml 10 5 $2,896.00 $2,896.93 $11.91 $2,896.93 $2,631.86 2026-07-15
J1602 HCPCS Golimumab 50 Mg/4 Ml Vial 8 5 $5,894.00 $5,894.72 $43.11 $5,894.72 $4,830.72 2026-07-15
J2357 HCPCS Omalizumab 150 Mg Vial 8 5 $3,605.00 $3,605.88 $9.26 $3,605.88 $2,955.02 2026-07-15
J3101 HCPCS Tenecteplase 50 Mg/10 Ml Syrng 8 5 $20,985.00 $20,985.06 $0.41 $20,985.06 $17,197.26 2026-07-15
J3111 HCPCS Romosozumab-aqqg 210 Mg/2.34Ml 8 5 $7,450.00 $7,450.43 $1.56 $7,450.43 $6,105.62 2026-07-15
J3247 HCPCS Secukinumab 125 Mg/5 Ml Vial 8 5 $6,417.00 $6,417.41 $104.96 $6,417.41 $5,259.07 2026-07-15
J3262 HCPCS Tocilizumab 400 Mg/20 Ml Vial 14 5 $7,981.00 $7,981.71 $2.72 $7,981.71 $1,534.03 2026-07-15
J3380 HCPCS Vedolizumab 300 Mg Vial 10 5 $27,540.00 $27,540.96 $72.63 $28,108.23 $25,020.96 2026-07-15
J9217 HCPCS Leuprolide Acetate Sq 45mg Syr 8 5 $2,350.00 $2,350.00 $1.47 $2,350.00 $1,925.83 2026-07-15
J9312 HCPCS Rituximab 500 Mg/50 Ml Vial 8 5 $14,142.00 $14,142.80 $322.14 $14,142.80 $11,590.02 2026-07-15
P9016 HCPCS Red Blood Cells Lekoreduced 10 5 $780.00 $780.00 $507.00 $780.00 $708.63 2026-07-15
Q0138 HCPCS Ferumoxy 510mg/17ml (non-esrd) 8 5 $692.00 $692.31 $7.28 $692.31 $567.35 2026-07-15
Q5101 HCPCS Filgrastim-sndz 480 Mcg/0.8ml 8 5 $985.00 $985.08 $640.30 $2,902.40 $945.68 2026-07-15
Q5103 HCPCS Infliximab-dyyb 100 Mg Vial 8 5 $1,702.00 $1,702.29 $1,106.49 $3,013.05 $1,634.20 2026-07-15
Q5104 HCPCS Infliximab-abda 100 Mg Vial 8 5 $1,160.00 $1,160.14 $754.09 $5,119.19 $1,113.74 2026-07-15
Q5115 HCPCS Rituximab-abbs 500Mg/50Ml Vial 8 5 $7,469.00 $7,469.69 $3,708.00 $7,469.69 $6,121.41 2026-07-15
Q5119 HCPCS Rituximab-pvvr 500Mg/50Ml Vial 8 5 $7,219.00 $7,219.08 $1,112.40 $7,219.08 $5,916.03 2026-07-15
Q5135 HCPCS Tocilizumab-aazg 200 Mg/10 Ml 14 5 $2,785.00 $2,785.34 $39.39 $5,570.73 $2,743.56 2026-07-15
Q9967 HCPCS Iopamidol-370 100 Ml Vial 14 6 $964.00 $964.00 $253.80 $964.00 $835.79 2026-07-15
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