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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

EUREKA COMMUNITY HEALTH SERVICES - CAH

Eureka, SD · CCN 431308 · Rates published

513 distinct procedures filed
6 distinct payers
6,534 rate rows
2026-07-15 last MRF observed
Data quality

6,512 of 6,534 rate rows are consumer-grade (99.7%)

22 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 14
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 4
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 2
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/11a2dd03-9af9-4627-8834-6553f37a9ec8/460246437_eureka-hospital_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 70f4aa0f167db4ba… · 1,727,606 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
192
MS_DRG 		Ms-DRG 192 2 $12,810.76 $18,077.65 $18,077.65 nat. median
$7,116
outlier · 2.5×
179
MS_DRG 		Ms-DRG 179 1 $12,810.76 $12,810.76 $12,810.76 nat. median
$8,200
1.6× median
690
MS_DRG 		Ms-DRG 690 1 $12,810.76 $12,810.76 $12,810.76 nat. median
$8,379
1.5× median
689
MS_DRG 		Ms-DRG 689 1 $12,037.54 $12,037.54 $12,037.54 nat. median
$11,515
1.0× median
195
MS_DRG 		Ms-DRG 195 1 $12,037.54 $12,037.54 $12,037.54 nat. median
$6,821
1.8× median
292
MS_DRG 		Ms-DRG 292 1 $9,357.24 $9,357.24 $9,357.24 nat. median
$8,955
1.0× median
74178
CPT 		CT Abd & Pelv Wwo Contrast 5 $479.88 $5,780.00 $5,491.00 nat. median
$1,027
outlier · 5.3×
J3101
HCPCS 		Tenecteplase 50 Mg/10 Ml Syrng 5 $0.41 $6,531.48 $5,306.83 nat. median
$3,787
1.4× median
74177
CPT 		CT Abd & Pelv W Contrast 5 $227.52 $5,280.00 $5,016.00 nat. median
$976
outlier · 5.1×
74176
CPT 		CT Abd & Pelvis Wo Contrast 6 $95.04 $4,762.80 $4,524.66 nat. median
$694
outlier · 6.5×
72133
CPT 		CT Lumbar Spine Wwo Contrast 5 $385.11 $3,794.00 $3,420.29 nat. median
$637
outlier · 5.4×
71275
CPT 		CTA Chest Wwo Contrast 5 $2,337.40 $3,596.00 $3,416.20 nat. median
$759
outlier · 4.5×
75635
CPT 		CTA Abdominal Arteries 5 $592.68 $3,659.39 $3,298.94 nat. median
$727
outlier · 4.5×
73701
CPT 		CT Le W Dye Lt 5 $268.01 $3,796.00 $3,084.25 nat. median
$677
outlier · 4.6×
70498
CPT 		CT Angiography Neck W Cont 5 $278.39 $3,308.24 $2,821.93 nat. median
$744
outlier · 3.8×
J1306
HCPCS 		Inclisiran 284mg/1.5ml Syringe 5 $5.81 $3,455.58 $2,807.66 nat. median
$44
outlier · 64.2×
72131
CPT 		CT Lumbar Spine Wo Contrast 5 $234.87 $2,953.80 $2,806.11 nat. median
$460
outlier · 6.1×
70491
CPT 		CT Soft Tissue Neck W Cont 5 $357.53 $3,091.65 $2,787.12 nat. median
$632
outlier · 4.4×
71270
CPT 		CT Thorax Wwo Contrast 5 $82.17 $3,345.68 $2,718.37 nat. median
$684
outlier · 4.0×
73700
CPT 		CT Le Wo Dye Lt 5 $76.65 $3,296.85 $2,678.69 nat. median
$505
outlier · 5.3×
J2426
HCPCS 		Paliperidone Palm 234mg/1.5ml 5 $793.38 $3,295.37 $2,677.49 nat. median
$2,498
1.1× median
70490
CPT 		CT Soft Tissue Neck Wo Cont 5 $277.47 $2,891.15 $2,606.37 nat. median
$453
outlier · 5.8×
70496
CPT 		CT Angiography Head W Cont 5 $246.84 $3,206.32 $2,605.14 nat. median
$752
outlier · 3.5×
70488
CPT 		CT Maxillofac Wwo Contrast 5 $319.79 $3,173.04 $2,578.10 nat. median
$639
outlier · 4.0×
71260
CPT 		CT Thorax W Contrast 5 $80.31 $2,847.52 $2,567.03 nat. median
$651
outlier · 3.9×
73200
CPT 		CT Ue Wo Dye Lt 5 $70.19 $3,000.00 $2,559.00 nat. median
$524
outlier · 4.9×
70470
CPT 		CT Head/Brain Wwo Contrast 5 $241.32 $3,064.80 $2,490.15 nat. median
$629
outlier · 4.0×
70486
CPT 		CT Maxillofacial Wo Contrast 5 $187.95 $2,601.60 $2,471.52 nat. median
$481
outlier · 5.1×
72125
CPT 		CT Cervical Spine Wo Contrast 5 $172.58 $2,539.68 $2,412.70 nat. median
$480
outlier · 5.0×
74160
CPT 		CT Abdomen W Dye 5 $706.77 $2,961.36 $2,406.11 nat. median
$655
outlier · 3.7×
750
CDM 		Colonoscopy 5 $1,547.00 $4,240.00 $2,365.12 nat. median
$3,784
0.6× median
70482
CPT 		CT Orbit Wwo Contrast 5 $261.57 $2,835.00 $2,303.44 nat. median
$663
outlier · 3.5×
72128
CPT 		CT Thoracic Spine Wo Contrast 5 $107.93 $2,520.96 $2,272.64 nat. median
$462
outlier · 4.9×
70450
CPT 		CT Head/Brain Wo Contrast 6 $1,541.80 $2,372.00 $2,253.40 nat. median
$454
outlier · 5.0×
71250
CPT 		CT Thorax Wo Contrast 6 $71.13 $2,333.76 $2,217.07 nat. median
$469
outlier · 4.7×
93306
CPT 		Tte W Doppler Complete 5 $1,520.32 $2,338.96 $2,108.57 nat. median
$993
outlier · 2.1×
72130
CPT 		CT Thoracic Spine Wwo Cont 5 $82.17 $2,592.00 $2,106.00 nat. median
$604
outlier · 3.5×
70487
CPT 		CT Maxillofacial W Contrast 5 $268.29 $2,574.00 $2,091.38 nat. median
$611
outlier · 3.4×
70460
CPT 		CT Head/Brain W Contrast 5 $61.91 $2,560.00 $2,080.00 nat. median
$582
outlier · 3.6×
J3111
HCPCS 		Romosozumab-aqqg 210 Mg/2.34Ml 5 $1.56 $2,543.74 $2,066.79 nat. median
$696
outlier · 3.0×
111
CDM 		Room Medical Unit Priv 5 $1,423.50 $2,190.00 $1,974.28 nat. median
$434
outlier · 4.5×
72192
CPT 		CT Pelvis Wo Dye 5 $597.02 $2,414.88 $1,962.09 nat. median
$463
outlier · 4.2×
C8929
HCPCS 		Echo M Mode 2d W Contrast 5 $1,413.75 $2,175.00 $1,960.76 nat. median
$1,358
1.4× median
Q5111
HCPCS 		Pegfilgrastim-cbqv 6 Mg/0.6 Ml 5 $1,112.40 $3,354.03 $1,940.25 nat. median
$1,984
1.0× median
11042
CPT 		Debride Skin Subq 20 Cm 5 $120.87 $2,826.00 $1,879.29 nat. median
$523
outlier · 3.6×
70480
CPT 		CT Orbit Wo Contrast 5 $192.56 $2,230.68 $1,812.43 nat. median
$481
outlier · 3.8×
73702
CPT 		CT Le Wwo Dye Rt 5 $57.30 $2,149.20 $1,746.22 nat. median
$708
outlier · 2.5×
Q5108
HCPCS 		Pegfilgrastim-jmdb 6 Mg/0.6 Ml 5 $1,163.49 $5,330.25 $1,700.49 nat. median
$1,244
1.4× median
74150
CPT 		CT Abdomen Wo Dye 5 $791.13 $2,062.00 $1,675.38 nat. median
$448
outlier · 3.7×
J0897
HCPCS 		Denosumab 60 Mg/ml Syringe 5 $9.69 $1,755.47 $1,531.53 nat. median
$1,982
0.8× median

Other procedures at this hospital

Browse this hospital's 513 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
             
10060 CPT I&d Abscess Simple/Single 14 5 $400.00 $400.00 $219.53 $400.00 $273.86 2026-07-15
110 CDM Room Custodial Care 6 5 $321.00 $321.00 $208.65 $321.00 $289.38 2026-07-15
11042 CPT Debride Skin Subq 20 Cm 17 5 $2,826.00 $2,826.00 $120.87 $2,826.00 $1,879.29 2026-07-15
11045 CPT Debride Skin Subq Addl 20 Cm 16 5 $770.00 $770.00 $48.41 $4,446.00 $553.25 2026-07-15
111 CDM Room Medical Unit Priv 6 5 $2,190.00 $2,190.00 $1,423.50 $2,190.00 $1,974.28 2026-07-15
11760 CPT Repair Nailbed 14 5 $1,064.00 $1,064.00 $221.56 $1,064.00 $699.58 2026-07-15
12001 CPT Repair Lac Simple <2.5 Cm 15 6 $396.00 $396.24 $86.23 $396.24 $263.50 2026-07-15
12002 CPT Repair Lac Simple 2.6-7.5 Cm 16 5 $402.00 $402.48 $112.84 $402.48 $289.18 2026-07-15
12005 CPT Repair Lac Simple 12.6-20.0 Cm 6 5 $606.00 $606.53 $179.19 $258.66 $193.13 2026-07-15
12011 CPT Repair Lac Simple <2.5 Cm 17 5 $358.00 $358.80 $107.01 $358.80 $276.99 2026-07-15
12013 CPT Repair Lac Simple 2.6-5.0 Cm 22 5 $405.00 $405.60 $109.90 $405.60 $313.12 2026-07-15
12042 CPT Repair Lac Interm 2.6-7.5 Cm 14 5 $770.00 $770.64 $396.46 $770.64 $531.30 2026-07-15
129 CDM Room Swing Bed Skilled 6 5 $1,025.00 $1,025.00 $666.25 $1,025.00 $924.04 2026-07-15
179 MS_DRG Ms-DRG 179 1 1 — — $12,810.76 $12,810.76 $12,810.76 2026-07-15
192 MS_DRG Ms-DRG 192 3 2 — — $12,810.76 $18,077.65 $18,077.65 2026-07-15
195 MS_DRG Ms-DRG 195 2 1 — — $12,037.54 $12,037.54 $12,037.54 2026-07-15
21315 CPT Fx Nasal Bone Wo Stabilization 8 5 $457.00 $457.00 $297.05 $457.00 $375.42 2026-07-15
23570 CPT Fx Scapula Wo Manipulation Rt 8 5 $619.00 $619.00 $402.35 $619.00 $508.51 2026-07-15
23600 CPT Fx Prox Humeral Wo Man Lt 8 5 $354.00 $354.00 $230.10 $354.00 $290.81 2026-07-15
24640 CPT Dislocation Nursemaid Elbow Lt 8 5 $509.00 $509.60 $331.24 $509.60 $418.63 2026-07-15
25600 CPT Fx Distal Radius Lt 8 5 $710.00 $710.00 $461.50 $710.00 $583.26 2026-07-15
26750 CPT Fx Distal Finger/Thumb Wo Man 8 5 $700.00 $700.00 $455.00 $700.00 $575.05 2026-07-15
26770 CPT Dislocate Finger Wo Anes Lt 14 5 $572.00 $572.00 $371.80 $710.47 $548.60 2026-07-15
28490 CPT Fx Great Toe 8 5 $628.00 $628.00 $408.20 $628.00 $515.90 2026-07-15
29125 CPT Apply Short Arm Splint Rt 31 6 $249.00 $249.60 $82.03 $249.60 $165.98 2026-07-15
292 MS_DRG Ms-DRG 292 2 1 — — $9,357.24 $9,357.24 $9,357.24 2026-07-15
29505 CPT Apply Long Leg Splint Lt 16 5 $312.00 $312.00 $106.28 $312.00 $224.17 2026-07-15
29580 CPT Apply Unna Boot Lt 8 5 $488.00 $488.00 $317.20 $488.00 $400.89 2026-07-15
29581 CPT Appl Multi Layer Ven Wnd Compr 14 5 $715.00 $715.00 $54.46 $715.00 $470.12 2026-07-15
30901 CPT Control Anterior Hemorrhage Lt 20 5 $500.00 $500.00 $109.69 $364.00 $140.81 2026-07-15
30903 CPT Control Anterior Hemorrhage Lt 28 5 $700.00 $700.00 $149.60 $728.00 $469.35 2026-07-15
31500 CPT Insert Emergency Airway 14 5 $754.00 $754.00 $273.72 $754.00 $495.75 2026-07-15
36430 CPT Blood Administration 16 5 $684.50 $684.90 $305.37 $900.00 $527.40 2026-07-15
450 CDM Critical Care 1st 30-74 Min 16 5 $1,087.00 $1,087.45 $390.00 $1,574.90 $811.84 2026-07-15
51701 CPT Insert Bladder Catheter 8 5 $175.00 $175.00 $113.75 $175.00 $143.76 2026-07-15
51702 CPT Cath Insert Simple Indwelling 16 5 $239.50 $239.60 $155.48 $240.00 $196.82 2026-07-15
51798 CPT Bladder Scan 8 5 $192.00 $192.00 $124.80 $192.00 $157.73 2026-07-15
56405 CPT I & D Vulva/Perineum 16 5 $322.00 $322.40 $209.56 $330.01 $282.81 2026-07-15
689 MS_DRG Ms-DRG 689 2 1 — — $12,037.54 $12,037.54 $12,037.54 2026-07-15
690 MS_DRG Ms-DRG 690 2 1 — — $12,810.76 $12,810.76 $12,810.76 2026-07-15
70450 CPT CT Head/Brain Wo Contrast 11 6 $2,372.00 $2,372.00 $1,541.80 $2,372.00 $2,253.40 2026-07-15
70460 CPT CT Head/Brain W Contrast 8 5 $2,560.00 $2,560.00 $61.91 $2,560.00 $2,080.00 2026-07-15
70470 CPT CT Head/Brain Wwo Contrast 8 5 $3,064.00 $3,064.80 $241.32 $3,064.80 $2,490.15 2026-07-15
70480 CPT CT Orbit Wo Contrast 8 5 $2,230.00 $2,230.68 $192.56 $2,230.68 $1,812.43 2026-07-15
70482 CPT CT Orbit Wwo Contrast 8 5 $2,835.00 $2,835.00 $261.57 $2,835.00 $2,303.44 2026-07-15
70486 CPT CT Maxillofacial Wo Contrast 11 5 $2,601.00 $2,601.60 $187.95 $2,601.60 $2,471.52 2026-07-15
70487 CPT CT Maxillofacial W Contrast 8 5 $2,574.00 $2,574.00 $268.29 $2,574.00 $2,091.38 2026-07-15
70488 CPT CT Maxillofac Wwo Contrast 8 5 $3,173.00 $3,173.04 $319.79 $3,173.04 $2,578.10 2026-07-15
70490 CPT CT Soft Tissue Neck Wo Cont 10 5 $2,891.00 $2,891.15 $277.47 $2,891.15 $2,606.37 2026-07-15
70491 CPT CT Soft Tissue Neck W Cont 10 5 $3,091.00 $3,091.65 $357.53 $3,091.65 $2,787.12 2026-07-15
70496 CPT CT Angiography Head W Cont 8 5 $3,206.00 $3,206.32 $246.84 $3,206.32 $2,605.14 2026-07-15
70498 CPT CT Angiography Neck W Cont 9 5 $3,308.00 $3,308.24 $278.39 $3,308.24 $2,821.93 2026-07-15
710 CDM Recovery Phase Ii 0-2 Hours 8 5 $245.00 $245.00 $159.25 $245.00 $201.27 2026-07-15
71045 CPT X-ray Chest 1 View 12 5 $303.00 $303.00 $196.95 $593.33 $287.85 2026-07-15
71046 CPT X-ray Chest 2v PA/Lateral 14 6 $363.00 $363.00 $235.95 $783.14 $344.85 2026-07-15
71100 CPT X-ray Ribs 2 Views Lt 10 5 $423.00 $423.00 $274.95 $3,616.49 $412.43 2026-07-15
71101 CPT X-ray Ribs Uni W Chest Lt 20 5 $548.00 $548.64 $356.62 $3,427.98 $534.92 2026-07-15
71110 CPT X-ray Ribs Bilateral 3 Views 8 5 $679.00 $679.00 $47.21 $679.00 $551.69 2026-07-15
71250 CPT CT Thorax Wo Contrast 11 6 $2,333.00 $2,333.76 $71.13 $2,333.76 $2,217.07 2026-07-15
71260 CPT CT Thorax W Contrast 10 5 $2,847.00 $2,847.52 $80.31 $2,847.52 $2,567.03 2026-07-15
71270 CPT CT Thorax Wwo Contrast 8 5 $3,345.00 $3,345.68 $82.17 $3,345.68 $2,718.37 2026-07-15
71271 CPT Ldct For Lung Cancer Screen 10 5 $510.00 $510.84 $101.48 $510.84 $460.52 2026-07-15
71275 CPT CTA Chest Wwo Contrast 9 5 $3,596.00 $3,596.00 $2,337.40 $3,596.00 $3,416.20 2026-07-15
72020 CPT X-ray Spine Single View 8 5 $326.00 $326.60 $212.29 $326.60 $265.37 2026-07-15
72040 CPT X-ray Spine Cervical 2-3 Views 9 5 $467.00 $467.95 $304.17 $551.93 $444.55 2026-07-15
72050 CPT X-ray Spine Cervical 4-5 Views 11 5 $542.00 $542.05 $352.33 $746.06 $514.95 2026-07-15
72070 CPT X-ray Spine Thoracic 2 Views 8 5 $385.00 $385.90 $250.84 $1,015.91 $366.61 2026-07-15
72072 CPT X-ray Spine Thoracic 3 Views 8 5 $485.00 $485.00 $315.25 $697.55 $460.75 2026-07-15
72074 CPT X-ray Spine Thoracic 4 Views 10 5 $593.00 $593.80 $45.35 $593.80 $535.31 2026-07-15
72100 CPT X-ray Lumbosacral 2-3 Views 8 5 $455.00 $455.50 $90.44 $455.50 $370.10 2026-07-15
72110 CPT X-ray Lumbosacral 4 Views 11 5 $611.00 $611.28 $67.44 $611.28 $580.72 2026-07-15
72125 CPT CT Cervical Spine Wo Contrast 11 5 $2,539.00 $2,539.68 $172.58 $2,539.68 $2,412.70 2026-07-15
72128 CPT CT Thoracic Spine Wo Contrast 10 5 $2,520.00 $2,520.96 $107.93 $2,520.96 $2,272.64 2026-07-15
72130 CPT CT Thoracic Spine Wwo Cont 8 5 $2,592.00 $2,592.00 $82.17 $2,592.00 $2,106.00 2026-07-15
72131 CPT CT Lumbar Spine Wo Contrast 11 5 $2,953.00 $2,953.80 $234.87 $2,953.80 $2,806.11 2026-07-15
72133 CPT CT Lumbar Spine Wwo Contrast 10 5 $3,794.00 $3,794.00 $385.11 $3,794.00 $3,420.29 2026-07-15
72170 CPT X-ray Pelvis 1-2 Views 9 5 $327.00 $327.60 $212.94 $341.88 $311.22 2026-07-15
72192 CPT CT Pelvis Wo Dye 8 5 $2,414.00 $2,414.88 $597.02 $2,414.88 $1,962.09 2026-07-15
72220 CPT Sacrum Or Coccyx Min 2 View 17 5 $470.00 $470.20 $305.63 $470.20 $446.69 2026-07-15
73010 CPT X-ray Shoulder Blade Rt 8 5 $309.00 $309.92 $174.17 $309.92 $251.81 2026-07-15
73030 CPT X-ray Shoulder Rt 22 5 $393.00 $393.64 $237.65 $393.64 $354.87 2026-07-15
73060 CPT X-ray Humerus Lt 16 5 $333.00 $333.45 $67.44 $333.45 $270.93 2026-07-15
73070 CPT X-ray Elbow Rt 18 5 $261.00 $261.04 $41.69 $261.04 $222.67 2026-07-15
73080 CPT X-ray Elbow Rt 17 5 $357.00 $357.00 $38.91 $371.28 $304.52 2026-07-15
73090 CPT X-ray Forearm 2 Views Lt 19 5 $392.00 $392.00 $254.80 $392.00 $334.38 2026-07-15
73100 CPT X-ray Wrist 2 Views Lt 8 5 $307.00 $307.11 $66.51 $307.11 $249.52 2026-07-15
73110 CPT X-ray Wrist 3 Views Rt 22 6 $355.00 $355.50 $58.22 $355.50 $337.73 2026-07-15
73130 CPT X-ray Hand Lt 22 5 $346.50 $346.80 $59.16 $353.60 $323.00 2026-07-15
73140 CPT X-ray Finger(s) Lt 20 5 $250.00 $250.64 $64.68 $250.64 $225.96 2026-07-15
73200 CPT CT Ue Wo Dye Lt 18 5 $3,000.00 $3,000.00 $70.19 $3,000.00 $2,559.00 2026-07-15
73501 CPT X-ray Hip Uni 1 View Lt 8 5 $273.00 $273.52 $177.79 $711.09 $259.84 2026-07-15
73502 CPT X-ray Hip Uni 2-3 Views Lt 34 5 $355.00 $355.68 $231.19 $860.42 $391.05 2026-07-15
73503 CPT X-ray Hip Uni W Pelvis 4 V Rt 8 5 $443.00 $443.00 $287.95 $443.00 $392.75 2026-07-15
73522 CPT X-ray Hips 3-4 Views Bi 8 5 $653.00 $653.40 $424.71 $793.91 $620.73 2026-07-15
73523 CPT X-ray Hips 5 Views Bi 10 5 $649.00 $649.00 $421.85 $690.20 $632.77 2026-07-15
73551 CPT X-ray Femur 1 View Lt 18 5 $236.00 $236.08 $101.48 $236.08 $201.38 2026-07-15
73552 CPT X-ray Femur 2 Views Lt 18 5 $359.00 $359.84 $130.01 $359.84 $306.94 2026-07-15
73560 CPT X-ray Knee 1-2 Views Lt 10 5 $306.00 $306.02 $84.00 $306.02 $275.88 2026-07-15
73562 CPT X-ray Knee 3 Views Lt 22 5 $361.00 $361.40 $109.76 $361.40 $343.33 2026-07-15
73564 CPT X-ray Knee 4 Lt 16 5 $403.00 $403.52 $129.06 $403.52 $327.86 2026-07-15
73565 CPT X-ray Knees Bi 10 5 $276.00 $276.31 $179.60 $276.31 $264.09 2026-07-15
73590 CPT X-ray Lower Leg Lt 18 5 $363.00 $363.00 $73.88 $363.00 $309.64 2026-07-15
73600 CPT X-ray Ankle 2 Views Lt 18 5 $283.00 $283.40 $86.75 $283.40 $241.74 2026-07-15
73610 CPT X-ray Ankle 3 Views Rt 19 5 $332.00 $332.50 $99.63 $332.50 $283.62 2026-07-15
73630 CPT X-ray Foot 3 Views Lt 21 5 $367.00 $367.12 $65.60 $367.12 $348.76 2026-07-15
73650 CPT X-ray Heel 2 Views Rt 8 5 $255.00 $255.84 $64.68 $255.84 $207.87 2026-07-15
73660 CPT X-ray Toe(s) 2 Views Lt 16 5 $251.50 $251.94 $66.51 $256.88 $204.50 2026-07-15
73700 CPT CT Le Wo Dye Lt 16 5 $3,296.00 $3,296.85 $76.65 $3,296.85 $2,678.69 2026-07-15
73701 CPT CT Le W Dye Lt 16 5 $3,796.00 $3,796.00 $268.01 $3,796.00 $3,084.25 2026-07-15
73702 CPT CT Le Wwo Dye Rt 8 5 $2,149.00 $2,149.20 $57.30 $2,149.20 $1,746.22 2026-07-15
74018 CPT X-ray Abdomen 10 5 $351.00 $351.56 $228.51 $523.40 $336.01 2026-07-15
74019 CPT X-ray Abdomen 12 6 $462.00 $462.31 $300.50 $660.48 $441.86 2026-07-15
74150 CPT CT Abdomen Wo Dye 8 5 $2,062.00 $2,062.00 $791.13 $2,062.00 $1,675.38 2026-07-15
74160 CPT CT Abdomen W Dye 8 5 $2,961.00 $2,961.36 $706.77 $2,961.36 $2,406.11 2026-07-15
74176 CPT CT Abd & Pelvis Wo Contrast 12 6 $4,762.00 $4,762.80 $95.04 $4,762.80 $4,524.66 2026-07-15
74177 CPT CT Abd & Pelv W Contrast 13 5 $5,280.00 $5,280.00 $227.52 $5,280.00 $5,016.00 2026-07-15
74178 CPT CT Abd & Pelv Wwo Contrast 11 5 $5,780.00 $5,780.00 $479.88 $5,780.00 $5,491.00 2026-07-15
750 CDM Colonoscopy 40 5 $2,767.00 $2,767.00 $1,547.00 $4,240.00 $2,365.12 2026-07-15
75635 CPT CTA Abdominal Arteries 10 5 $3,659.00 $3,659.39 $592.68 $3,659.39 $3,298.94 2026-07-15
76010 CPT X-ray Nose To Rectum 8 5 $251.00 $251.68 $163.59 $499.97 $239.10 2026-07-15
761 CDM Application/Rem Cast Or Splint 8 5 $225.00 $225.00 $146.25 $225.00 $184.84 2026-07-15
76536 CPT Ultrasound Head And Neck 10 5 $805.00 $805.33 $523.46 $805.33 $726.00 2026-07-15
76700 CPT Ultrasound Abdomen Complete 11 5 $1,040.00 $1,040.53 $676.34 $1,040.53 $988.50 2026-07-15
76705 CPT Ultrasound Abdomen Limited 19 5 $897.00 $897.52 $583.39 $920.44 $785.14 2026-07-15
76770 CPT Ultrasound Abdo Back Wall Comp 10 5 $961.00 $961.20 $624.78 $961.20 $866.52 2026-07-15
76775 CPT Ultrasound Aorta 8 5 $843.00 $843.00 $547.95 $843.00 $692.53 2026-07-15
76830 CPT Ultrasound Transvaginal 10 5 $868.00 $868.43 $564.48 $868.43 $782.89 2026-07-15
76856 CPT Ultrasound Pelvic Complete 8 5 $960.00 $960.45 $624.29 $960.45 $789.01 2026-07-15
76857 CPT Ultrasound Pelvic Limited 8 5 $486.00 $486.00 $315.90 $486.00 $399.25 2026-07-15
76870 CPT Ultrasound Scrotum 8 5 $883.00 $883.44 $574.24 $883.44 $725.75 2026-07-15
76881 CPT US Extremity Nonvasc Comp Rt 8 5 $636.00 $636.85 $413.95 $636.85 $523.17 2026-07-15
76882 CPT Ultrasound Axilla Lt 24 5 $570.00 $570.96 $371.12 $711.00 $514.72 2026-07-15
77067 CPT Mammo Screen Implant Bi 33 5 $476.00 $476.32 $298.60 $699.00 $452.50 2026-07-15
77080 CPT Dexa Scan 12 5 $620.00 $620.35 $88.61 $620.35 $559.25 2026-07-15
80048 CPT Basic Metabolic Panel 13 6 $146.00 $146.00 $94.90 $146.00 $138.70 2026-07-15
80053 CPT Comprehensive Metabolic Panel 14 6 $191.00 $191.00 $124.15 $191.00 $181.45 2026-07-15
80061 CPT Lipid Panel 14 6 $168.00 $168.00 $109.20 $168.00 $159.60 2026-07-15
80069 CPT Renal Function Panel 8 5 $167.00 $167.00 $108.55 $167.00 $137.19 2026-07-15
80076 CPT Hepatic Function Panel 11 5 $138.00 $138.65 $90.12 $138.65 $131.72 2026-07-15
80177 CPT Levetiracetam 8 5 $153.00 $153.55 $99.81 $153.55 $126.14 2026-07-15
80235 CPT Lacosamide 8 5 $244.00 $244.45 $158.89 $244.45 $200.82 2026-07-15
80299 CPT Dexamethasone 8 5 $158.00 $158.00 $102.70 $158.00 $129.80 2026-07-15
80306 CPT Drug Screen Urine Inst Ass Obv 8 5 $143.00 $143.37 $93.19 $143.37 $117.78 2026-07-15
81025 CPT Hcg Beta Qual Urine 10 5 $130.00 $130.00 $84.50 $130.00 $117.19 2026-07-15
81291 CPT Mthfr Mutation 8 5 $699.00 $699.00 $454.35 $699.00 $574.23 2026-07-15
82024 CPT Acth Adrenocorticotropic Hor 10 5 $218.00 $218.30 $141.90 $218.30 $196.80 2026-07-15
82043 CPT Microalbumin Quant 11 6 $119.00 $119.00 $77.35 $119.00 $113.05 2026-07-15
82077 CPT Alcohol/Ethanol Auto Analyzer 9 5 $162.00 $162.75 $105.79 $162.75 $138.83 2026-07-15
82105 CPT Afp Tm 9 5 $143.00 $143.52 $93.29 $143.52 $122.42 2026-07-15
82150 CPT Amylase Serum 14 6 $131.00 $131.00 $49.31 $131.00 $118.09 2026-07-15
82306 CPT Vitamin D 25 Oh 12 6 $133.00 $133.20 $86.58 $133.20 $126.54 2026-07-15
82378 CPT Cea 8 5 $145.00 $145.35 $94.48 $145.35 $119.41 2026-07-15
82530 CPT Cortisol Free Urine 10 5 $126.00 $126.80 $82.42 $126.80 $114.31 2026-07-15
82533 CPT Cortisol Total 11 5 $133.00 $133.52 $86.79 $133.52 $126.84 2026-07-15
82550 CPT Cpk Total 11 5 $147.00 $147.00 $95.55 $147.00 $139.65 2026-07-15
82607 CPT B12 12 6 $147.00 $147.00 $95.55 $147.00 $139.65 2026-07-15
82670 CPT Estradiol Total 10 5 $128.00 $128.87 $83.77 $128.87 $116.18 2026-07-15
82784 CPT Immunoglobulin IgG 10 5 $113.00 $113.80 $73.97 $113.80 $102.59 2026-07-15
82785 CPT Immunoglobulin E 10 5 $150.00 $150.00 $97.50 $150.00 $135.22 2026-07-15
82787 CPT Immunoglobulin IgG Sub 1 8 5 $263.00 $263.00 $170.95 $263.00 $216.06 2026-07-15
83001 CPT Fsh 10 5 $130.00 $130.00 $84.50 $130.00 $117.19 2026-07-15
83002 CPT Lh 10 5 $128.00 $128.93 $83.80 $128.93 $116.23 2026-07-15
83036 CPT Hemoglobin A1c 14 6 $124.00 $124.00 $80.60 $124.00 $117.80 2026-07-15
83525 CPT Insulin 11 5 $111.00 $111.08 $72.20 $111.08 $105.53 2026-07-15
83690 CPT Lipase 14 6 $133.00 $133.27 $48.23 $133.27 $120.15 2026-07-15
83880 CPT B Type Natriuretic Peptide 21 5 $267.00 $267.25 $167.14 $267.25 $244.28 2026-07-15
83921 CPT Methylmalonic Acid 10 5 $185.00 $185.07 $120.30 $185.07 $166.84 2026-07-15
83970 CPT Pth 11 5 $169.00 $169.16 $109.95 $169.16 $160.70 2026-07-15
83993 CPT Calprotectin 8 5 $220.00 $220.00 $143.00 $220.00 $180.73 2026-07-15
84144 CPT Progesterone 10 5 $144.00 $144.66 $94.03 $144.66 $130.42 2026-07-15
84153 CPT Psa Total 12 5 $173.00 $173.68 $112.89 $173.68 $156.57 2026-07-15
84207 CPT Vitamin B6 10 5 $184.00 $184.09 $119.66 $184.09 $165.96 2026-07-15
84270 CPT Sex Hormone Binding Globulin 11 5 $135.00 $135.10 $87.81 $135.10 $128.35 2026-07-15
84305 CPT Somatomedin 8 5 $242.00 $242.00 $157.30 $242.00 $198.81 2026-07-15
84402 CPT Testosterone Fre Female/Child 21 5 $157.00 $157.13 $94.58 $157.13 $138.23 2026-07-15
84403 CPT Testosterone Total Ref 21 5 $145.00 $145.50 $81.06 $145.50 $118.47 2026-07-15
84439 CPT T4 Free 12 5 $124.00 $124.00 $80.60 $124.00 $111.78 2026-07-15
84443 CPT Tsh 13 6 $150.00 $150.12 $97.58 $150.12 $142.61 2026-07-15
84445 CPT Tsi 8 5 $148.00 $148.46 $96.50 $148.46 $121.96 2026-07-15
84480 CPT T3 Total 11 5 $126.00 $126.31 $82.10 $126.31 $107.74 2026-07-15
84481 CPT T3 Free 11 5 $159.00 $159.33 $103.56 $159.33 $151.36 2026-07-15
84482 CPT Reverse T3 8 5 $124.00 $124.80 $81.12 $124.80 $102.52 2026-07-15
84484 CPT Troponin Quant 12 5 $206.00 $206.96 $134.52 $206.96 $186.57 2026-07-15
84702 CPT Hcg Beta Quan Serum 10 5 $121.00 $121.53 $78.99 $121.53 $109.56 2026-07-15
85025 CPT Cbc W Auto Diff 14 6 $145.00 $145.74 $94.73 $145.74 $138.45 2026-07-15
85027 CPT Cbc Wo Auto Diff 13 6 $129.00 $129.33 $84.06 $129.33 $122.86 2026-07-15
85730 CPT Aptt 8 5 $130.00 $130.68 $84.94 $130.68 $107.35 2026-07-15
86141 CPT C-reactive Protein High Sens 8 5 $139.00 $139.39 $90.60 $139.39 $114.51 2026-07-15
86160 CPT C1 Esterase Inhibitor 10 5 $119.00 $119.60 $77.74 $119.60 $107.82 2026-07-15
86162 CPT Complement Total 10 5 $128.00 $128.96 $83.82 $128.96 $116.25 2026-07-15
86256 CPT Pla2R Titer 8 5 $226.00 $226.50 $147.22 $226.50 $186.07 2026-07-15
86301 CPT Ca 19-9 8 5 $148.00 $148.77 $96.70 $148.77 $122.22 2026-07-15
86304 CPT Ca 125 9 5 $130.00 $130.69 $84.95 $130.69 $111.48 2026-07-15
86334 CPT Immunofix Electroph Serum 8 5 $156.00 $156.26 $101.57 $156.26 $128.37 2026-07-15
86335 CPT Immunofix Electroph Fluid 8 5 $156.00 $156.26 $101.57 $156.26 $128.37 2026-07-15
86480 CPT Tbint Quantiferon 12 5 $229.00 $229.92 $149.45 $229.92 $207.27 2026-07-15
86581 CPT Pneumococcal Antibody 8 5 $265.00 $265.00 $172.25 $265.00 $217.70 2026-07-15
86803 CPT Hcv Antibody 11 5 $134.00 $134.11 $87.17 $134.11 $127.40 2026-07-15
86850 CPT Antibody Screen 8 5 $238.00 $238.00 $154.70 $238.00 $195.51 2026-07-15
86920 CPT Crossmatch Immed Spin 8 5 $239.00 $239.00 $155.35 $239.00 $196.34 2026-07-15
86922 CPT Crossmatch Ahg 8 5 $253.00 $253.80 $164.97 $253.80 $208.50 2026-07-15
87070 CPT Culture Bacteria Oth 11 5 $114.00 $114.17 $74.21 $114.17 $108.46 2026-07-15
87077 CPT Bacterial Id Moldi-tof 23 5 $125.00 $125.23 $71.36 $125.23 $104.29 2026-07-15
87116 CPT Culture Afb 8 5 $172.00 $172.64 $112.22 $172.64 $141.82 2026-07-15
87147 CPT Culture Serol Type Agn 2 Strep 8 5 $135.00 $135.00 $87.75 $135.00 $110.91 2026-07-15
87338 CPT H Pylori Antigen Stool 8 5 $182.00 $182.24 $118.46 $182.24 $149.71 2026-07-15
87493 CPT C Diff By Pcr 10 5 $282.00 $282.90 $183.88 $282.90 $255.03 2026-07-15
87502 CPT Influenza A&b By Pcr 10 5 $239.00 $239.11 $155.42 $239.11 $215.56 2026-07-15
87507 CPT Gi Path Panel 12-25 8 5 $1,095.00 $1,095.12 $711.83 $1,095.12 $899.64 2026-07-15
87631 CPT Influ And Rsv Amp Probe 8 5 $416.00 $416.00 $270.40 $416.00 $341.75 2026-07-15
87634 CPT Rsv Pcr 8 5 $216.00 $216.00 $140.40 $216.00 $177.44 2026-07-15
87635 CPT Sars-cov-2 Amp Probe 10 5 $191.00 $191.70 $124.61 $191.70 $172.82 2026-07-15
87636 CPT Influ & CoV2 Pcr Ceph 10 5 $404.00 $404.00 $262.60 $404.00 $364.21 2026-07-15
87637 CPT Influ/RSV/CoV2 Pcr Ceph 11 5 $442.00 $442.00 $287.30 $442.00 $377.03 2026-07-15
87651 CPT Streptococcus A Amp Probe 11 5 $128.00 $128.02 $83.21 $128.02 $121.62 2026-07-15
88184 CPT Flow Cytometry First Mark 8 5 $325.00 $325.73 $211.72 $325.73 $267.59 2026-07-15
88185 CPT Flow Cytometry Ea Addit Marker 8 5 $151.00 $151.63 $98.56 $151.63 $124.56 2026-07-15
88305 CPT Surg Path L4 10 5 $182.00 $182.85 $118.85 $182.85 $164.84 2026-07-15
88313 CPT Special Stain Pas w/Diastase 10 5 $184.00 $184.08 $119.65 $184.08 $165.95 2026-07-15
88341 CPT Immunohisto Stain Add Per Spc 8 5 $181.00 $181.00 $117.65 $181.00 $148.69 2026-07-15
88342 CPT Immunohisto Stain Init Pr Spec 8 5 $269.00 $269.70 $175.31 $269.70 $221.56 2026-07-15
92523 CPT Speech Sound Lang Comp Or Expr 8 5 $409.00 $409.76 $266.34 $409.76 $336.62 2026-07-15
92610 CPT Swallow Eval Non Radiol 8 5 $298.00 $298.54 $194.05 $298.54 $245.25 2026-07-15
92977 CPT Dissolve Clot Heart Vessel 6 5 $393.00 $393.00 $84.25 $137.20 $114.73 2026-07-15
93005 CPT EKG Tracing 13 6 $240.00 $240.84 $156.55 $240.84 $228.80 2026-07-15
93306 CPT Tte W Doppler Complete 10 5 $2,338.00 $2,338.96 $1,520.32 $2,338.96 $2,108.57 2026-07-15
93798 CPT Cardiac Rehab Ii Monitored 11 5 $229.00 $229.47 $149.16 $229.47 $218.00 2026-07-15
93880 CPT Extracranial Bilat Study 8 5 $1,464.00 $1,464.48 $951.91 $1,464.48 $1,203.07 2026-07-15
93922 CPT Ankle Arm Screen 10 5 $415.00 $415.58 $270.13 $415.58 $374.64 2026-07-15
93925 CPT Arterial Duplex Le Bi 8 5 $1,389.00 $1,389.96 $903.47 $1,389.96 $1,141.86 2026-07-15
93926 CPT Arterial Duplex Le Lt 18 5 $1,096.00 $1,096.20 $595.02 $1,096.20 $867.82 2026-07-15
93970 CPT Venous Duplex 8 5 $1,290.00 $1,290.64 $838.92 $1,290.64 $1,060.27 2026-07-15
93971 CPT Extremity Study Lt 18 5 $938.00 $938.52 $610.04 $938.52 $800.56 2026-07-15
93975 CPT Vascular Study 11 5 $1,252.00 $1,252.00 $250.40 $1,252.00 $1,067.96 2026-07-15
93976 CPT Vascular Study 8 5 $707.00 $707.62 $459.95 $707.62 $581.31 2026-07-15
93978 CPT Abdomen Vascular Complete 8 5 $1,271.00 $1,271.00 $826.15 $1,271.00 $1,044.12 2026-07-15
93979 CPT Duplex Aorta Limited 8 5 $1,011.00 $1,011.00 $657.15 $1,011.00 $830.54 2026-07-15
94640 CPT Inhalation Treat Acute Initial 40 5 $161.00 $161.20 $67.60 $201.00 $145.32 2026-07-15
96360 CPT Inf Therapy Hyd Initial 19 5 $270.00 $270.00 $175.50 $353.60 $260.00 2026-07-15
96365 CPT Inf Therapy Med Initial 21 5 $467.00 $467.00 $249.44 $467.00 $364.57 2026-07-15
96366 CPT Inf Therapy Med Ea Addl Hr 19 5 $158.00 $158.00 $67.60 $158.00 $104.00 2026-07-15
96367 CPT Inf Therapy Med Sequential 10 5 $210.00 $210.50 $136.82 $210.50 $189.77 2026-07-15
96368 CPT Inf Therapy Med Concurrent 19 5 $143.00 $143.00 $81.12 $143.00 $118.56 2026-07-15
96374 CPT IV Push Injection Initial 21 5 $85.00 $85.00 $55.25 $244.40 $158.86 2026-07-15
97033 CPT Iontophoresis Pt 15 Min 8 5 $125.00 $125.28 $81.43 $125.28 $102.91 2026-07-15
97110 CPT Therapeutic Exer Pt 19 5 $126.00 $126.88 $75.86 $126.88 $108.23 2026-07-15
97112 CPT Neuromuscular Re-educ Pt 11 5 $123.00 $123.55 $80.31 $123.55 $117.37 2026-07-15
97116 CPT Gait Training 11 5 $117.00 $117.72 $76.52 $117.72 $111.83 2026-07-15
97129 CPT Cognitive Skills Development 8 5 $145.00 $145.00 $94.25 $145.00 $119.12 2026-07-15
97130 CPT Cognitive Skills Dev Ea Add 15 8 5 $145.00 $145.00 $94.25 $145.00 $119.12 2026-07-15
97140 CPT Manual Therapy Pt Each 15 Min 24 6 $122.00 $122.43 $79.58 $150.00 $117.02 2026-07-15
97161 CPT Pt Eval Low Complexity 13 6 $233.00 $233.74 $151.93 $233.74 $222.05 2026-07-15
97162 CPT Pt Eval Mod Complexity 11 5 $259.00 $259.46 $168.65 $259.46 $246.49 2026-07-15
97163 CPT Pt Eval High Complexity 10 5 $280.00 $280.80 $182.52 $280.80 $253.14 2026-07-15
97165 CPT Ot Eval Low Complexity 8 5 $235.00 $235.08 $152.80 $235.08 $193.12 2026-07-15
97166 CPT Ot Eval Mod Complexity 8 5 $260.00 $260.58 $169.38 $260.58 $214.06 2026-07-15
97530 CPT Therapeutic Activity Pt 22 6 $116.00 $116.81 $75.93 $233.62 $105.31 2026-07-15
97597 CPT Debride Wound 1st 20 Cm 14 5 $452.00 $452.00 $32.88 $452.00 $297.19 2026-07-15
97598 CPT Debride Wound Addl 20 Cm 14 5 $337.00 $337.00 $22.81 $337.00 $221.57 2026-07-15
97602 CPT Debride Wound Non-selective 16 5 $651.00 $651.00 $65.60 $651.00 $428.03 2026-07-15
97605 CPT Neg Pressure Wound Dme <50 Cm 8 5 $651.00 $651.00 $423.15 $651.00 $534.79 2026-07-15
99203 CPT New Patient Level 3 Wound Care 14 5 $190.00 $190.00 $123.50 $190.00 $148.39 2026-07-15
99204 CPT New Patient Level 4 Mod Comp 6 5 $142.00 $142.00 $207.60 $281.18 $240.41 2026-07-15
99211 CPT Care/Removal Urinary Catheter 32 5 $159.50 $159.50 $19.50 $316.00 $132.77 2026-07-15
99212 CPT Est Patient Level 2 Wound Care 17 5 $165.00 $165.00 $49.14 $165.00 $109.72 2026-07-15
99213 CPT Est Patient Level 3 Wound Care 16 5 $174.00 $174.00 $98.49 $174.00 $135.90 2026-07-15
99214 CPT Est Patient Level 4 Wound Care 14 5 $192.00 $192.00 $124.80 $205.61 $157.91 2026-07-15
99221 CPT Inpatient/Obs Initial Low Comp 6 5 $219.00 $219.00 $127.26 $194.22 $157.56 2026-07-15
99232 CPT Inpatient/Obs Subsequent Mod 6 5 $157.00 $157.25 $123.19 $166.85 $139.14 2026-07-15
99233 CPT Inpatient/Obs Subsequent High 6 5 $224.00 $224.64 $184.54 $250.08 $204.29 2026-07-15
99234 CPT Admit/Discharge Same Day Low 6 5 $286.00 $286.42 $151.37 $255.98 $187.64 2026-07-15
99238 CPT IP/Obs Discharge <30 Min 6 5 $157.00 $157.25 $126.77 $172.04 $141.97 2026-07-15
99239 CPT IP/Obs Discharge >30 Min 6 5 $230.00 $230.20 $179.47 $243.58 $204.89 2026-07-15
99282 CPT Emergency Room Visit Level 2 12 6 $427.00 $427.35 $277.78 $427.35 $405.98 2026-07-15
99283 CPT Emergency Room Visit Level 3 17 5 $579.00 $579.02 $108.68 $579.02 $447.00 2026-07-15
99284 CPT Emergency Room Visit Level 4 17 5 $799.00 $799.76 $184.86 $799.76 $531.84 2026-07-15
99285 CPT Emergency Room Visit Level 5 16 5 $1,092.00 $1,092.00 $267.73 $1,092.00 $717.99 2026-07-15
99291 CPT Critical Care 1st 30-74 Min 6 5 $550.00 $550.80 $329.00 $444.51 $405.08 2026-07-15
99292 CPT Critical Care Ea Addl 30 Min 6 5 $237.00 $237.60 $164.83 $222.78 $203.02 2026-07-15
C8929 HCPCS Echo M Mode 2d W Contrast 10 5 $2,175.00 $2,175.00 $1,413.75 $2,175.00 $1,960.76 2026-07-15
G0103 HCPCS Psa Screen 11 5 $144.00 $144.00 $93.60 $144.00 $136.80 2026-07-15
G0390 HCPCS Trauma Team Level 5 10 5 $1,188.00 $1,188.00 $772.20 $1,188.00 $1,070.98 2026-07-15
G0472 HCPCS Hcv Antibody Screen 8 5 $218.00 $218.00 $141.70 $218.00 $179.08 2026-07-15
J0248 HCPCS Remdesivir 100 Mg Vial 8 5 $639.00 $639.48 $70.71 $639.48 $519.58 2026-07-15
J0878 HCPCS Daptomycin 500 Mg Vial 6 5 $216.00 $216.15 $140.50 $216.15 $194.86 2026-07-15
J0897 HCPCS Denosumab 60 Mg/ml Syringe 10 5 $1,698.00 $1,698.86 $9.69 $1,755.47 $1,531.53 2026-07-15
J1306 HCPCS Inclisiran 284mg/1.5ml Syringe 8 5 $3,455.00 $3,455.58 $5.81 $3,455.58 $2,807.66 2026-07-15
J1561 HCPCS Immune Glob 10% 40 Gm/400 Ml 16 5 $1,753.50 $1,753.82 $3.60 $3,091.18 $395.64 2026-07-15
J1610 HCPCS Glucagon 1 Mg/ml Vial 14 5 $183.00 $183.27 $98.91 $301.65 $178.69 2026-07-15
J2426 HCPCS Paliperidone Palm 234mg/1.5ml 8 5 $3,295.00 $3,295.37 $793.38 $3,295.37 $2,677.49 2026-07-15
J3101 HCPCS Tenecteplase 50 Mg/10 Ml Syrng 8 5 $6,531.00 $6,531.48 $0.41 $6,531.48 $5,306.83 2026-07-15
J3111 HCPCS Romosozumab-aqqg 210 Mg/2.34Ml 8 5 $2,543.00 $2,543.74 $1.56 $2,543.74 $2,066.79 2026-07-15
P9016 HCPCS Red Blood Cells Lekoreduced 8 5 $482.00 $482.50 $313.62 $482.50 $396.38 2026-07-15
P9033 HCPCS Platelets Leukoreduced Irrad 8 5 $889.00 $889.95 $578.47 $889.95 $731.10 2026-07-15
Q0138 HCPCS Ferumoxy 510mg/17ml (non-esrd) 8 5 $261.00 $261.27 $7.28 $261.27 $212.28 2026-07-15
Q5108 HCPCS Pegfilgrastim-jmdb 6 Mg/0.6 Ml 8 5 $1,789.00 $1,789.99 $1,163.49 $5,330.25 $1,700.49 2026-07-15
Q5110 HCPCS Filgrastim-aafi 300 Mcg/0.5 Ml 14 5 $126.00 $126.47 $82.21 $927.00 $132.74 2026-07-15
Q5111 HCPCS Pegfilgrastim-cbqv 6 Mg/0.6 Ml 14 5 $1,990.00 $1,990.00 $1,112.40 $3,354.03 $1,940.25 2026-07-15
Q9956 HCPCS Perflutren Protein-a Microdota 8 5 $146.00 $146.70 $77.76 $146.70 $119.19 2026-07-15
Q9967 HCPCS Iopamidol-370 100 Ml Vial 12 5 $500.00 $500.00 $253.80 $500.00 $426.50 2026-07-15
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