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

MARSHALL COUNTY HEALTHCARE CENTER - CAH

Britton, SD · CCN 431312 · Rates published

626 distinct procedures filed
5 distinct payers
8,045 rate rows
2026-07-15 last MRF observed
Data quality

8,027 of 8,045 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 10
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 6
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/adabfaf5-88dc-4bc8-9cca-aad4515e53b0/460380552_marshall-county-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 46d286b5efb45ae4… · 2,501,665 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
J3245
HCPCS 		Tildrakizumab-asmn 100Mg/Ml Sy 5 $5.04 $47,879.66 $41,302.50 nat. median
$256
outlier · 161.3×
J3380
HCPCS 		Vedolizumab 300 Mg Vial 5 $72.63 $35,619.91 $30,726.85 nat. median
$168
outlier · 183.4×
J3101
HCPCS 		Tenecteplase 50 Mg/10 Ml Syrng 5 $0.41 $26,597.23 $22,943.61 nat. median
$3,824
outlier · 6.0×
J2353
HCPCS 		Octreotide (Depot) 30 Mg Syr 5 $17.33 $23,945.66 $20,656.28 nat. median
$5,568
outlier · 3.7×
J0717
HCPCS 		Certolizumab Pegol 400 Mg Kit 5 $3.42 $21,785.17 $18,792.58 nat. median
$1,573
outlier · 11.9×
J3111
HCPCS 		Romosozumab-aqqg 210 Mg/2.34Ml 5 $1.56 $9,491.39 $8,187.58 nat. median
$675
outlier · 12.1×
J1437
HCPCS 		Ferric Derisomaltose 1,000 Mg 5 $16.52 $8,911.72 $7,687.53 nat. median
$46
outlier · 168.7×
J1602
HCPCS 		Golimumab 50 Mg/4 Ml Vial 5 $43.11 $7,482.48 $6,454.62 nat. median
$273
outlier · 23.7×
Q5111
HCPCS 		Pegfilgrastim-cbqv 6 Mg/0.6 Ml 5 $1,112.40 $7,462.25 $6,437.18 nat. median
$1,974
outlier · 3.3×
Q5122
HCPCS 		Pegfilgrastim 6 Mg/0.6 Ml Syr 5 $3,939.75 $6,844.34 $5,904.15 nat. median
$561
outlier · 10.5×
J2426
HCPCS 		Paliperidone Palmit 156 Mg/ml 5 $793.38 $6,742.00 $5,815.86 nat. median
$2,499
outlier · 2.3×
J0897
HCPCS 		Denosumab 60 Mg/ml Syringe 5 $9.69 $6,345.96 $5,474.23 nat. median
$1,973
outlier · 2.8×
74178
CPT 		CT Abd & Pelv Wwo Contrast 5 $479.88 $6,071.45 $5,237.43 nat. median
$1,024
outlier · 5.1×
74177
CPT 		CT Abd & Pelv W Contrast 5 $227.52 $5,818.75 $5,019.44 nat. median
$972
outlier · 5.2×
74176
CPT 		CT Abd & Pelvis Wo Contrast 5 $95.04 $5,594.55 $4,826.03 nat. median
$694
outlier · 7.0×
73720
CPT 		MRI Le Wwo Dye Lt 5 $233.96 $5,462.50 $4,712.12 nat. median
$1,125
outlier · 4.2×
72158
CPT 		MRI Lumbar Spine Wwo Dye 5 $340.97 $5,462.50 $4,712.12 nat. median
$1,090
outlier · 4.3×
72156
CPT 		MRI Neck Spine Wwo Dye 5 $340.05 $5,462.50 $4,712.12 nat. median
$1,103
outlier · 4.3×
74183
CPT 		MRI Abdomen Wwo Dye 5 $619.08 $5,462.50 $4,712.12 nat. median
$1,099
outlier · 4.3×
72197
CPT 		MRI Pelvis Wwo Dye 5 $618.17 $5,462.50 $4,712.12 nat. median
$1,063
outlier · 4.4×
70553
CPT 		MRI Brain Wwo Contrast 5 $729.77 $5,462.50 $4,712.12 nat. median
$1,132
outlier · 4.2×
73221
CPT 		MRI Joint Ue Wo Dye Rt 5 $408.12 $5,106.25 $4,404.82 nat. median
$842
outlier · 5.2×
74181
CPT 		MRI Abdomen Wo Dye 5 $544.29 $5,106.25 $4,404.82 nat. median
$819
outlier · 5.4×
95811
CPT 		Polysomnogram W CPap 5 $3,268.85 $4,777.55 $4,166.52 nat. median
$1,894
outlier · 2.2×
70496
CPT 		CT Angiography Head W Cont 5 $246.84 $4,717.70 $4,069.64 nat. median
$746
outlier · 5.5×
70498
CPT 		CT Angiography Neck W Cont 5 $278.39 $4,717.70 $4,069.64 nat. median
$736
outlier · 5.5×
95810
CPT 		Polysomnogram 5 $3,124.55 $4,566.65 $3,982.60 nat. median
$1,827
outlier · 2.2×
70551
CPT 		MRI Brain Wo Contrast 5 $447.03 $4,512.50 $3,892.62 nat. median
$782
outlier · 5.0×
72148
CPT 		MRI Lumbar Spine Wo Dye 5 $315.18 $4,512.50 $3,892.62 nat. median
$804
outlier · 4.8×
72146
CPT 		MRI Chest Spine Wo Dye 5 $390.63 $4,512.50 $3,892.62 nat. median
$794
outlier · 4.9×
73721
CPT 		MRI Joint Le Wo Dye Lt 5 $315.18 $4,512.50 $3,892.62 nat. median
$852
outlier · 4.6×
72127
CPT 		CT Cervical Spine Wwo Cont 5 $79.40 $4,223.70 $3,643.49 nat. median
$607
outlier · 6.0×
J1439
HCPCS 		Ferric Carboxymalt 750mg/15ml 5 $11.91 $3,858.14 $3,328.15 nat. median
$14
outlier · 231.1×
72126
CPT 		CT Cervical Spine W Contrast 5 $214.92 $3,857.00 $3,327.17 nat. median
$755
outlier · 4.4×
70491
CPT 		CT Soft Tissue Neck W Cont 5 $357.53 $3,841.80 $3,314.06 nat. median
$627
outlier · 5.3×
71275
CPT 		CTA Chest Wwo Contrast 5 $2,427.10 $3,547.30 $3,242.98 nat. median
$753
outlier · 4.3×
74174
CPT 		CTA Abd&Pelv Wwo Dye 5 $2,427.10 $3,547.30 $3,242.98 nat. median
$988
outlier · 3.3×
72125
CPT 		CT Cervical Spine Wo Contrast 5 $172.58 $3,716.40 $3,205.88 nat. median
$472
outlier · 6.8×
70490
CPT 		CT Soft Tissue Neck Wo Cont 5 $277.47 $3,583.40 $3,091.15 nat. median
$448
outlier · 6.9×
70487
CPT 		CT Maxillofacial W Contrast 5 $268.29 $3,489.35 $3,010.02 nat. median
$604
outlier · 5.0×
74175
CPT 		CTA Abdom Wwo Dye 5 $82.17 $3,443.75 $2,970.69 nat. median
$714
outlier · 4.2×
75635
CPT 		CTA Abdominal Arteries 5 $592.68 $3,443.75 $2,970.69 nat. median
$719
outlier · 4.1×
71260
CPT 		CT Thorax W Contrast 5 $80.31 $3,400.05 $2,932.99 nat. median
$648
outlier · 4.5×
11042
CPT 		Debride Skin Subq 20 Cm 5 $2,237.95 $3,270.85 $2,852.52 nat. median
$523
outlier · 5.5×
71271
CPT 		Ldct For Lung Cancer Screen 5 $101.48 $3,299.35 $2,846.12 nat. median
$214
outlier · 13.3×
73706
CPT 		CTA Le Wwo Dye Lt 5 $71.13 $3,288.90 $2,837.11 nat. median
$740
outlier · 3.8×
74170
CPT 		CT Abdomen Wwo Dye 5 $58.22 $3,260.40 $2,812.52 nat. median
$710
outlier · 4.0×
71250
CPT 		CT Thorax Wo Contrast 5 $71.13 $3,195.80 $2,756.80 nat. median
$464
outlier · 5.9×
70470
CPT 		CT Head/Brain Wwo Contrast 5 $241.32 $3,187.25 $2,749.43 nat. median
$619
outlier · 4.4×
100
CDM 		Al Rent Level 1 5 $2,041.65 $2,983.95 $2,727.96 nat. median
$3
outlier · 797.6×

Other procedures at this hospital

Browse this hospital's 626 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 $834.00 $834.00 $542.10 $792.30 $690.97 2026-07-15
100 CDM Al Rent Level 1 6 5 $3,141.00 $3,141.00 $2,041.65 $2,983.95 $2,727.96 2026-07-15
101 CDM Il Apartment Level 3 6 5 $1,915.00 $1,915.00 $1,244.75 $1,819.25 $1,663.18 2026-07-15
10120 CPT I&r Foreign Body Simple 8 5 $363.00 $363.00 $235.95 $344.85 $300.75 2026-07-15
11042 CPT Debride Skin Subq 20 Cm 8 5 $3,443.00 $3,443.00 $2,237.95 $3,270.85 $2,852.52 2026-07-15
11055 CPT Pare 1 Benign Lesion 8 5 $736.00 $736.00 $478.40 $699.20 $609.78 2026-07-15
111 CDM Room Medical Unit Priv 6 5 $3,025.00 $3,025.00 $1,966.25 $2,873.75 $2,627.22 2026-07-15
11721 CPT Debride Nails 6-10 8 5 $361.00 $361.00 $234.65 $342.95 $299.09 2026-07-15
11730 CPT Avulsion Nail Plate Simp Singl 8 5 $363.00 $363.00 $235.95 $344.85 $300.75 2026-07-15
12001 CPT Repair Lac Simple <2.5 Cm 16 5 $278.50 $278.50 $126.10 $344.85 $210.12 2026-07-15
12002 CPT Repair Lac Simple 2.6-7.5 Cm 8 5 $363.00 $363.00 $235.95 $344.85 $300.75 2026-07-15
12011 CPT Repair Lac Simple <2.5 Cm 8 5 $363.00 $363.00 $235.95 $344.85 $300.75 2026-07-15
12013 CPT Repair Lac Simple 2.6-5.0 Cm 8 5 $363.00 $363.00 $235.95 $344.85 $300.75 2026-07-15
12041 CPT Repair Lac Interm <2.5 Cm 8 5 $363.00 $363.00 $235.95 $344.85 $300.75 2026-07-15
129 CDM Room Swing Bed Skilled 6 5 $1,455.00 $1,455.00 $945.75 $1,382.25 $1,263.67 2026-07-15
20610 CPT Asp/Inj Large Joint Lt 8 5 $485.00 $485.00 $315.25 $460.75 $401.82 2026-07-15
23600 CPT Fx Prox Humeral Wo Man Rt 8 5 $210.00 $210.00 $136.50 $199.50 $173.99 2026-07-15
23650 CPT Dislocation Shoulder Wo AnesLT 16 5 $776.00 $776.00 $504.40 $737.20 $642.91 2026-07-15
25500 CPT Fx Radius Lt 8 5 $210.00 $210.00 $136.50 $199.50 $173.99 2026-07-15
25600 CPT Fx Distal Radius Lt 16 5 $210.00 $210.00 $136.50 $199.50 $173.99 2026-07-15
26010 CPT Drain Finger Abscess Simple 8 5 $210.00 $210.00 $136.50 $199.50 $173.99 2026-07-15
26600 CPT Fx Metacarpal 8 5 $210.00 $210.00 $136.50 $199.50 $173.99 2026-07-15
26750 CPT Fx Distal Finger/Thumb Wo Man 8 5 $210.00 $210.00 $136.50 $199.50 $173.99 2026-07-15
27786 CPT Fx Distal Fibula Lt 8 5 $210.00 $210.00 $136.50 $199.50 $173.99 2026-07-15
28470 CPT Fx Metatarsal 8 5 $210.00 $210.00 $136.50 $199.50 $173.99 2026-07-15
28490 CPT Fx Great Toe 8 5 $210.00 $210.00 $136.50 $199.50 $173.99 2026-07-15
29105 CPT Apply Long Arm Splint Lt 8 5 $245.00 $245.00 $159.25 $232.75 $202.99 2026-07-15
29125 CPT Apply Short Arm Splint Rt 8 5 $245.00 $245.00 $159.25 $232.75 $202.99 2026-07-15
29581 CPT Appl Multi Layer Ven Wnd Compr 16 5 $571.00 $571.00 $371.15 $542.45 $473.07 2026-07-15
32556 CPT Insert Cath Pleura Wo Image Rt 8 5 $268.00 $268.00 $174.20 $254.60 $222.04 2026-07-15
36430 CPT Blood Administration 16 5 $502.00 $502.00 $321.75 $483.55 $415.64 2026-07-15
36591 CPT Blood Draw Implanted Vad 8 5 $386.00 $386.00 $250.90 $366.70 $319.80 2026-07-15
43752 CPT Nasal/Orogastric W Tube Plmt 8 5 $442.00 $442.00 $287.30 $419.90 $366.19 2026-07-15
450 CDM Inf Therapy Hydration Addl Hr 72 5 $226.00 $226.78 $74.75 $467.40 $178.88 2026-07-15
51700 CPT Irrigation Bladder Simple 8 5 $651.00 $651.00 $423.15 $618.45 $539.36 2026-07-15
51701 CPT Cath Insert Straight Non-indwe 16 5 $234.50 $234.50 $150.15 $226.10 $194.15 2026-07-15
51702 CPT Cath Insert Simple Indwelling 16 5 $339.00 $339.00 $154.70 $418.00 $256.05 2026-07-15
51703 CPT Cath Insert Compl Indwelling 8 5 $425.00 $425.00 $276.25 $403.75 $352.12 2026-07-15
51798 CPT Bladder Scan 16 5 $414.50 $414.50 $265.20 $399.95 $343.16 2026-07-15
70210 CPT X-ray Sinus < 3 Views 8 5 $309.00 $309.00 $60.99 $293.55 $253.22 2026-07-15
70220 CPT X-ray Sinuses 3 Views 8 5 $647.00 $647.00 $94.13 $614.65 $530.22 2026-07-15
70450 CPT CT Head/Brain Wo Contrast 6 5 $2,702.00 $2,702.00 $1,756.30 $2,566.90 $2,346.68 2026-07-15
70470 CPT CT Head/Brain Wwo Contrast 8 5 $3,355.00 $3,355.00 $241.32 $3,187.25 $2,749.43 2026-07-15
70480 CPT CT Orbit Wo Contrast 8 5 $2,533.00 $2,533.00 $192.56 $2,406.35 $2,075.80 2026-07-15
70481 CPT CT Orbit W Contrast 8 5 $2,641.00 $2,641.00 $80.31 $2,508.95 $2,164.30 2026-07-15
70486 CPT CT Maxillofacial Wo Contrast 8 5 $2,533.00 $2,533.00 $187.95 $2,406.35 $2,075.80 2026-07-15
70487 CPT CT Maxillofacial W Contrast 8 5 $3,673.00 $3,673.00 $268.29 $3,489.35 $3,010.02 2026-07-15
70490 CPT CT Soft Tissue Neck Wo Cont 8 5 $3,772.00 $3,772.00 $277.47 $3,583.40 $3,091.15 2026-07-15
70491 CPT CT Soft Tissue Neck W Cont 8 5 $4,044.00 $4,044.00 $357.53 $3,841.80 $3,314.06 2026-07-15
70496 CPT CT Angiography Head W Cont 8 5 $4,966.00 $4,966.00 $246.84 $4,717.70 $4,069.64 2026-07-15
70498 CPT CT Angiography Neck W Cont 8 5 $4,966.00 $4,966.00 $278.39 $4,717.70 $4,069.64 2026-07-15
70551 CPT MRI Brain Wo Contrast 8 5 $4,750.00 $4,750.00 $447.03 $4,512.50 $3,892.62 2026-07-15
70553 CPT MRI Brain Wwo Contrast 8 5 $5,750.00 $5,750.00 $729.77 $5,462.50 $4,712.12 2026-07-15
710 CDM Recovery Phase Ii 0-2 Hours 8 5 $904.00 $904.00 $587.60 $858.80 $748.96 2026-07-15
71045 CPT X-ray Chest 1 View 8 5 $361.00 $361.00 $234.65 $593.33 $328.51 2026-07-15
71046 CPT X-ray Chest 2v PA/Lateral 8 5 $439.00 $439.00 $285.35 $783.14 $399.49 2026-07-15
71100 CPT X-ray Ribs 2 Views Lt 16 5 $568.00 $568.00 $369.20 $3,616.49 $516.88 2026-07-15
71101 CPT X-ray Ribs Uni W Chest Lt 16 5 $568.00 $568.00 $369.20 $3,427.98 $516.88 2026-07-15
71120 CPT X-ray Sternum 2 Views 8 5 $422.00 $422.00 $79.40 $400.90 $345.82 2026-07-15
71250 CPT CT Thorax Wo Contrast 8 5 $3,364.00 $3,364.00 $71.13 $3,195.80 $2,756.80 2026-07-15
71260 CPT CT Thorax W Contrast 8 5 $3,579.00 $3,579.00 $80.31 $3,400.05 $2,932.99 2026-07-15
71271 CPT Ldct For Lung Cancer Screen 8 5 $3,473.00 $3,473.00 $101.48 $3,299.35 $2,846.12 2026-07-15
71275 CPT CTA Chest Wwo Contrast 6 5 $3,734.00 $3,734.00 $2,427.10 $3,547.30 $3,242.98 2026-07-15
72040 CPT X-ray Spine Cervical 2-3 Views 8 5 $534.00 $534.00 $347.10 $551.93 $485.94 2026-07-15
72050 CPT X-ray Spine Cervical 4-5 Views 8 5 $761.00 $761.00 $494.65 $746.06 $692.51 2026-07-15
72070 CPT X-ray Spine Thoracic 2 Views 8 5 $422.00 $422.00 $274.30 $1,015.91 $384.02 2026-07-15
72072 CPT X-ray Spine Thoracic 3 Views 8 5 $755.00 $755.00 $490.75 $717.25 $677.20 2026-07-15
72100 CPT X-ray Lumbosacral 2-3 Views 8 5 $518.00 $518.00 $90.44 $492.10 $424.50 2026-07-15
72110 CPT X-ray Lumbosacral 4 Views 8 5 $761.00 $761.00 $67.44 $722.95 $623.64 2026-07-15
72125 CPT CT Cervical Spine Wo Contrast 8 5 $3,912.00 $3,912.00 $172.58 $3,716.40 $3,205.88 2026-07-15
72126 CPT CT Cervical Spine W Contrast 8 5 $4,060.00 $4,060.00 $214.92 $3,857.00 $3,327.17 2026-07-15
72127 CPT CT Cervical Spine Wwo Cont 8 5 $4,446.00 $4,446.00 $79.40 $4,223.70 $3,643.49 2026-07-15
72128 CPT CT Thoracic Spine Wo Contrast 8 5 $2,686.00 $2,686.00 $107.93 $2,551.70 $2,201.18 2026-07-15
72131 CPT CT Lumbar Spine Wo Contrast 8 5 $2,686.00 $2,686.00 $234.87 $2,551.70 $2,201.18 2026-07-15
72146 CPT MRI Chest Spine Wo Dye 8 5 $4,750.00 $4,750.00 $390.63 $4,512.50 $3,892.62 2026-07-15
72148 CPT MRI Lumbar Spine Wo Dye 8 5 $4,750.00 $4,750.00 $315.18 $4,512.50 $3,892.62 2026-07-15
72156 CPT MRI Neck Spine Wwo Dye 8 5 $5,750.00 $5,750.00 $340.05 $5,462.50 $4,712.12 2026-07-15
72158 CPT MRI Lumbar Spine Wwo Dye 8 5 $5,750.00 $5,750.00 $340.97 $5,462.50 $4,712.12 2026-07-15
72170 CPT X-ray Pelvis 1-2 Views 8 5 $488.00 $488.00 $317.20 $463.60 $399.92 2026-07-15
72197 CPT MRI Pelvis Wwo Dye 8 5 $5,750.00 $5,750.00 $618.17 $5,462.50 $4,712.12 2026-07-15
72202 CPT X-ray Si Joints 3 Views 8 5 $412.00 $412.00 $267.80 $542.46 $374.92 2026-07-15
72220 CPT X-ray Sacrum Tailbone 8 5 $422.00 $422.00 $274.30 $447.69 $384.02 2026-07-15
73000 CPT X-ray Collar Bone Lt 16 5 $301.00 $301.00 $187.04 $293.55 $246.29 2026-07-15
73010 CPT X-ray Shoulder Blade Lt 16 5 $422.00 $422.00 $174.17 $400.90 $345.82 2026-07-15
73020 CPT X-ray Shoulder Lt 16 5 $309.00 $309.00 $187.95 $293.55 $253.22 2026-07-15
73030 CPT X-ray Shoulder Lt 16 5 $444.00 $444.00 $237.65 $421.80 $363.86 2026-07-15
73060 CPT X-ray Humerus Lt 16 5 $468.00 $468.00 $67.44 $444.60 $383.53 2026-07-15
73070 CPT X-ray Elbow Lt 16 5 $352.00 $352.00 $41.69 $334.40 $288.46 2026-07-15
73080 CPT X-ray Elbow Lt 16 5 $417.00 $417.00 $38.91 $396.15 $341.73 2026-07-15
73090 CPT X-ray Forearm 2 Views Lt 16 5 $386.00 $386.00 $250.90 $366.70 $316.33 2026-07-15
73100 CPT X-ray Wrist 2 Views Lt 8 5 $352.00 $352.00 $66.51 $334.40 $288.46 2026-07-15
73110 CPT X-ray Wrist 3 Views Lt 16 5 $496.00 $496.00 $58.22 $471.20 $406.47 2026-07-15
73120 CPT X-ray Hand Rt 8 5 $309.00 $309.00 $198.99 $293.55 $253.22 2026-07-15
73130 CPT X-ray Hand Lt 16 5 $496.00 $496.00 $59.16 $471.20 $406.47 2026-07-15
73140 CPT X-ray Finger(s) Lt 16 5 $309.00 $309.00 $64.68 $293.55 $253.22 2026-07-15
73200 CPT CT Ue Wo Dye Lt 16 5 $3,130.00 $3,130.00 $70.19 $2,973.50 $2,565.03 2026-07-15
73221 CPT MRI Joint Ue Wo Dye Rt 8 5 $5,375.00 $5,375.00 $408.12 $5,106.25 $4,404.82 2026-07-15
73502 CPT X-ray Hip Uni 2-3 Views Lt 28 5 $422.00 $422.00 $274.30 $860.42 $390.82 2026-07-15
73522 CPT X-ray Hips 3-4 Views Bi 8 5 $450.00 $450.00 $292.50 $793.91 $409.50 2026-07-15
73523 CPT X-ray Hips 5 Views Bi 8 5 $450.00 $450.00 $292.50 $690.20 $409.50 2026-07-15
73552 CPT X-ray Femur 2 Views Lt 16 5 $422.00 $422.00 $130.01 $400.90 $345.82 2026-07-15
73560 CPT X-ray Knee 1-2 Views Lt 16 5 $345.00 $345.00 $84.00 $327.75 $282.73 2026-07-15
73562 CPT X-ray Knee 3 Views Lt 16 5 $383.00 $383.00 $109.76 $363.85 $313.87 2026-07-15
73564 CPT X-ray Knee 4 Lt 16 5 $422.00 $422.00 $129.06 $400.90 $345.82 2026-07-15
73565 CPT X-ray Knees Bi 8 5 $594.00 $594.00 $267.09 $564.30 $486.78 2026-07-15
73590 CPT X-ray Lower Leg Lt 16 5 $402.00 $402.00 $73.88 $381.90 $329.43 2026-07-15
73600 CPT X-ray Ankle 2 Views Rt 8 5 $352.00 $352.00 $86.75 $334.40 $288.46 2026-07-15
73610 CPT X-ray Ankle 3 Views Lt 16 5 $422.00 $422.00 $99.63 $400.90 $345.82 2026-07-15
73620 CPT X-ray Foot 2 Views Lt 16 5 $301.00 $301.00 $195.65 $285.95 $246.67 2026-07-15
73630 CPT X-ray Foot 3 Views Lt 16 5 $422.00 $422.00 $65.60 $400.90 $345.82 2026-07-15
73700 CPT CT Le Wo Dye Lt 16 5 $3,130.00 $3,130.00 $76.65 $2,973.50 $2,565.03 2026-07-15
73701 CPT CT Le W Dye Lt 8 5 $3,302.00 $3,302.00 $268.01 $3,136.90 $2,705.98 2026-07-15
73706 CPT CTA Le Wwo Dye Lt 16 5 $3,462.00 $3,462.00 $71.13 $3,288.90 $2,837.11 2026-07-15
73720 CPT MRI Le Wwo Dye Lt 16 5 $5,750.00 $5,750.00 $233.96 $5,462.50 $4,712.12 2026-07-15
73721 CPT MRI Joint Le Wo Dye Lt 16 5 $4,750.00 $4,750.00 $315.18 $4,512.50 $3,892.62 2026-07-15
74018 CPT X-ray Abdomen 8 5 $331.00 $331.00 $215.15 $523.40 $301.21 2026-07-15
74019 CPT X-ray Abdomen 8 5 $513.00 $513.00 $333.45 $660.48 $466.83 2026-07-15
74022 CPT X-ray Series Abdomen 8 5 $534.00 $534.00 $347.10 $661.43 $485.94 2026-07-15
74160 CPT CT Abdomen W Dye 8 5 $3,064.00 $3,064.00 $706.77 $2,910.80 $2,510.95 2026-07-15
74170 CPT CT Abdomen Wwo Dye 8 5 $3,432.00 $3,432.00 $58.22 $3,260.40 $2,812.52 2026-07-15
74174 CPT CTA Abd&Pelv Wwo Dye 6 5 $3,734.00 $3,734.00 $2,427.10 $3,547.30 $3,242.98 2026-07-15
74175 CPT CTA Abdom Wwo Dye 8 5 $3,625.00 $3,625.00 $82.17 $3,443.75 $2,970.69 2026-07-15
74176 CPT CT Abd & Pelvis Wo Contrast 8 5 $5,889.00 $5,889.00 $95.04 $5,594.55 $4,826.03 2026-07-15
74177 CPT CT Abd & Pelv W Contrast 8 5 $6,125.00 $6,125.00 $227.52 $5,818.75 $5,019.44 2026-07-15
74178 CPT CT Abd & Pelv Wwo Contrast 8 5 $6,391.00 $6,391.00 $479.88 $6,071.45 $5,237.43 2026-07-15
74181 CPT MRI Abdomen Wo Dye 8 5 $5,375.00 $5,375.00 $544.29 $5,106.25 $4,404.82 2026-07-15
74183 CPT MRI Abdomen Wwo Dye 8 5 $5,750.00 $5,750.00 $619.08 $5,462.50 $4,712.12 2026-07-15
750 CDM Colonoscopy 48 5 $2,739.50 $2,739.50 $1,259.70 $5,063.50 $2,266.54 2026-07-15
75635 CPT CTA Abdominal Arteries 8 5 $3,625.00 $3,625.00 $592.68 $3,443.75 $2,970.69 2026-07-15
76536 CPT Ultrasound Head And Neck 8 5 $632.00 $632.00 $410.80 $600.40 $523.61 2026-07-15
76604 CPT Ultrasound Chest 8 5 $414.00 $414.00 $269.10 $393.30 $343.00 2026-07-15
76700 CPT Ultrasound Abdomen Complete 8 5 $1,002.00 $1,002.00 $651.30 $951.90 $830.15 2026-07-15
76705 CPT Ultrasound Abdomen Limited 16 5 $674.50 $674.50 $363.35 $750.50 $528.20 2026-07-15
76770 CPT Ultrasound Abdo Back Wall Comp 8 5 $1,064.00 $1,064.00 $691.60 $1,010.80 $881.52 2026-07-15
76775 CPT Ultrasound Aorta 16 5 $649.50 $649.50 $363.35 $703.00 $511.57 2026-07-15
76830 CPT Ultrasound Transvaginal 8 5 $559.00 $559.00 $363.35 $531.05 $463.13 2026-07-15
76856 CPT Ultrasound Pelvic Complete 8 5 $1,151.00 $1,151.00 $748.15 $1,093.45 $953.61 2026-07-15
76857 CPT Ultrasound Pelvic Limited 8 5 $455.00 $455.00 $295.75 $432.25 $376.97 2026-07-15
76870 CPT Ultrasound Scrotum 8 5 $559.00 $559.00 $363.35 $531.05 $463.13 2026-07-15
76881 CPT US Extremity Nonvasc Comp Lt 16 5 $550.00 $550.00 $357.50 $522.50 $455.68 2026-07-15
76882 CPT Ultrasound Axilla Lt 24 5 $528.00 $528.00 $343.20 $531.05 $449.69 2026-07-15
77067 CPT Mammography Screening Digital 24 5 $343.00 $343.00 $222.95 $446.50 $301.96 2026-07-15
77080 CPT Dexa Scan 8 5 $855.00 $855.00 $88.61 $812.25 $700.67 2026-07-15
80048 CPT Basic Metabolic Panel 8 5 $274.00 $274.00 $178.10 $260.30 $227.01 2026-07-15
80053 CPT Comprehensive Metabolic Panel 8 5 $516.00 $516.00 $335.40 $490.20 $427.50 2026-07-15
80069 CPT Renal Function Panel 8 5 $257.00 $257.00 $167.05 $244.15 $212.93 2026-07-15
80074 CPT Acute Hepatitis Panel 8 5 $465.00 $465.00 $302.25 $441.75 $385.25 2026-07-15
80076 CPT Hepatic Function Panel 8 5 $403.00 $403.00 $261.95 $382.85 $333.88 2026-07-15
80162 CPT Digoxin 8 5 $242.00 $242.00 $157.30 $229.90 $200.50 2026-07-15
80177 CPT Levetiracetam 8 5 $265.00 $265.00 $172.25 $251.75 $219.56 2026-07-15
80202 CPT Vancomycin 8 5 $269.00 $269.00 $174.85 $255.55 $222.87 2026-07-15
80235 CPT Lacosamide 8 5 $245.00 $245.00 $159.25 $232.75 $202.99 2026-07-15
80299 CPT Dexamethasone 8 5 $307.00 $307.00 $199.55 $291.65 $254.35 2026-07-15
81206 CPT Bcr/abl1 Gene Major Arup 8 5 $765.00 $765.00 $497.25 $726.75 $633.81 2026-07-15
81241 CPT Factor V Leiden Mutation 8 5 $275.00 $275.00 $178.75 $261.25 $227.84 2026-07-15
81382 CPT Hla Drb1 Class Ii Type 8 5 $320.00 $320.00 $208.00 $304.00 $265.12 2026-07-15
82024 CPT Acth Adrenocorticotropic Hor 8 5 $322.00 $322.00 $209.30 $305.90 $266.77 2026-07-15
82043 CPT Microalbumin Quant 8 5 $224.00 $224.00 $145.60 $212.80 $185.59 2026-07-15
82088 CPT Aldosterone 8 5 $225.00 $225.00 $146.25 $213.75 $186.42 2026-07-15
82104 CPT Alpha 1 Antitrypsin Pheno 8 5 $439.00 $439.00 $285.35 $417.05 $363.71 2026-07-15
82140 CPT Ammonia 8 5 $198.00 $198.00 $128.70 $188.10 $164.04 2026-07-15
82150 CPT Amylase Serum 8 5 $229.00 $229.00 $148.85 $217.55 $189.72 2026-07-15
82157 CPT Androstenedione 8 5 $264.00 $264.00 $171.60 $250.80 $218.72 2026-07-15
82166 CPT Mullerian Inhib Hormone 8 5 $198.00 $198.00 $128.70 $188.10 $164.04 2026-07-15
82270 CPT Occult Bld Colorectal Scr 8 5 $319.00 $319.00 $207.35 $303.05 $264.29 2026-07-15
82306 CPT 25 Hydvit D2 And D3 8 5 $257.00 $257.00 $167.05 $244.15 $212.93 2026-07-15
82378 CPT Cea 8 5 $249.00 $249.00 $161.85 $236.55 $206.30 2026-07-15
82384 CPT Catecholamines Fract 8 5 $215.00 $215.00 $139.75 $204.25 $178.13 2026-07-15
82550 CPT Cpk Total 8 5 $195.00 $195.00 $126.75 $185.25 $161.56 2026-07-15
82553 CPT Cpk Mb Fraction 8 5 $282.00 $282.00 $183.30 $267.90 $233.63 2026-07-15
82627 CPT Dheas 8 5 $239.00 $239.00 $155.35 $227.05 $198.01 2026-07-15
82652 CPT Vitamin D 125 Dihydroxy 8 5 $317.00 $317.00 $206.05 $301.15 $262.63 2026-07-15
82653 CPT Pancreatic Elastase 8 5 $299.00 $299.00 $194.35 $284.05 $247.72 2026-07-15
82668 CPT Erythropoietin 8 5 $250.00 $250.00 $162.50 $237.50 $207.12 2026-07-15
82728 CPT Ferritin 8 5 $207.00 $207.00 $134.55 $196.65 $171.50 2026-07-15
82951 CPT Glucose Tol 1st 3 Specimens 8 5 $716.00 $716.00 $465.40 $680.20 $593.20 2026-07-15
82977 CPT Ggt 8 5 $217.00 $217.00 $141.05 $206.15 $179.78 2026-07-15
83090 CPT Homocystine 8 5 $225.00 $225.00 $146.25 $213.75 $186.42 2026-07-15
83519 CPT Immunoassay By Ria 8 5 $252.00 $252.00 $163.80 $239.40 $208.78 2026-07-15
83880 CPT B Type Natriuretic Peptide 16 5 $275.50 $275.50 $109.85 $362.90 $204.43 2026-07-15
83921 CPT Methylmalonic Acid 8 5 $243.00 $243.00 $157.95 $230.85 $201.32 2026-07-15
83970 CPT Pth 8 5 $338.00 $338.00 $219.70 $321.10 $280.03 2026-07-15
83993 CPT Calprotectin 8 5 $335.00 $335.00 $217.75 $318.25 $277.55 2026-07-15
84153 CPT Psa Total 8 5 $208.00 $208.00 $135.20 $197.60 $172.33 2026-07-15
84155 CPT Protein Blood Spep 8 5 $209.00 $209.00 $135.85 $198.55 $173.16 2026-07-15
84156 CPT Protein Urine 16 5 $256.00 $256.00 $89.70 $355.30 $187.10 2026-07-15
84165 CPT Protein Electrophoresis 8 5 $209.00 $209.00 $135.85 $198.55 $173.16 2026-07-15
84166 CPT Protein Electrophoresis Urine 8 5 $203.00 $203.00 $131.95 $192.85 $168.19 2026-07-15
84305 CPT Somatomedin 8 5 $285.00 $285.00 $185.25 $270.75 $236.12 2026-07-15
84443 CPT Tsh 8 5 $217.00 $217.00 $141.05 $206.15 $179.78 2026-07-15
84445 CPT Tsi 8 5 $372.00 $372.00 $241.80 $353.40 $308.20 2026-07-15
84450 CPT Ast SGoT 8 5 $209.00 $209.00 $135.85 $198.55 $173.16 2026-07-15
84460 CPT Alt SGpT 8 5 $210.00 $210.00 $136.50 $199.50 $173.99 2026-07-15
84481 CPT T3 Free 8 5 $290.00 $290.00 $188.50 $275.50 $240.26 2026-07-15
84484 CPT Troponin Quant 8 5 $255.00 $255.00 $165.75 $242.25 $211.27 2026-07-15
85025 CPT Cbc W Auto Diff 8 5 $278.00 $278.00 $180.70 $264.10 $230.32 2026-07-15
85379 CPT D-dimer Quant 8 5 $401.00 $401.00 $260.65 $380.95 $332.23 2026-07-15
85730 CPT Aptt 8 5 $214.00 $214.00 $139.10 $203.30 $177.30 2026-07-15
86146 CPT Beta-2-glycoprotein IgG 8 5 $195.00 $195.00 $126.75 $185.25 $161.56 2026-07-15
86147 CPT Cardiolipin Antibody 8 5 $225.00 $225.00 $146.25 $213.75 $186.42 2026-07-15
86300 CPT Ca 15-3 8 5 $209.00 $209.00 $135.85 $198.55 $173.16 2026-07-15
86301 CPT Ca 19-9 8 5 $287.00 $287.00 $186.55 $272.65 $237.78 2026-07-15
86334 CPT Immunofix Electroph Serum 8 5 $432.00 $432.00 $280.80 $410.40 $357.91 2026-07-15
86335 CPT Immunofix Electroph Fluid 8 5 $432.00 $432.00 $280.80 $410.40 $357.91 2026-07-15
86336 CPT Inhibin A 8 5 $206.00 $206.00 $133.90 $195.70 $170.67 2026-07-15
86480 CPT Tbint Quantiferon 8 5 $216.00 $216.00 $140.40 $205.20 $178.95 2026-07-15
86618 CPT Lyme Disease Antibody 8 5 $223.00 $223.00 $144.95 $211.85 $184.75 2026-07-15
86682 CPT Helminth Antibody Nos 8 5 $331.00 $331.00 $215.15 $314.45 $274.24 2026-07-15
86706 CPT Hep B Surface Antibody 8 5 $231.00 $231.00 $150.15 $219.45 $191.38 2026-07-15
86778 CPT Toxoplasma IgM 8 5 $284.00 $284.00 $184.60 $269.80 $235.30 2026-07-15
86812 CPT Hla B27 8 5 $209.00 $209.00 $135.85 $198.55 $173.16 2026-07-15
86920 CPT Crossmatch Immed Spin 8 5 $268.00 $268.00 $174.20 $254.60 $222.04 2026-07-15
87040 CPT Culture Blood 8 5 $292.00 $292.00 $189.80 $277.40 $241.92 2026-07-15
87086 CPT Culture Urine W Col Count 8 5 $219.00 $219.00 $142.35 $208.05 $181.44 2026-07-15
87107 CPT Fungal Id Ea Organism Mold 8 5 $238.00 $238.00 $154.70 $226.10 $197.19 2026-07-15
87177 CPT Ova And Parasites Smears 8 5 $208.00 $208.00 $135.20 $197.60 $172.33 2026-07-15
87184 CPT Microbe Susceptible Disk 8 5 $225.00 $225.00 $146.25 $213.75 $186.42 2026-07-15
87255 CPT Hsv Culture With Reflex To Type 8 5 $315.00 $315.00 $204.75 $299.25 $260.98 2026-07-15
87338 CPT H Pylori Antigen Stool 8 5 $281.00 $281.00 $182.65 $266.95 $232.81 2026-07-15
87449 CPT Beta D Glucan 8 5 $293.00 $293.00 $190.45 $278.35 $242.75 2026-07-15
87493 CPT C Diff By Pcr 8 5 $312.00 $312.00 $202.80 $296.40 $258.49 2026-07-15
87502 CPT Influenza A&b By Pcr 8 5 $246.00 $246.00 $159.90 $233.70 $203.81 2026-07-15
87631 CPT Influ And Rsv Amp Probe 8 5 $342.00 $342.00 $222.30 $324.90 $283.35 2026-07-15
87636 CPT Influ & CoV2 Pcr Ceph 8 5 $422.00 $422.00 $274.30 $400.90 $349.62 2026-07-15
87637 CPT Influ/RSV/CoV2 Pcr Ceph 8 5 $573.00 $573.00 $372.45 $544.35 $474.73 2026-07-15
87899 CPT Shiga Toxin 2 8 5 $206.00 $206.00 $133.90 $195.70 $170.67 2026-07-15
88305 CPT Surg Path L4 8 5 $260.00 $260.00 $169.00 $247.00 $215.41 2026-07-15
88307 CPT Surg Path L5 8 5 $227.00 $227.00 $147.55 $215.65 $188.07 2026-07-15
88312 CPT Special Stain Pas Fungus 16 5 $269.00 $269.00 $173.55 $257.45 $222.79 2026-07-15
90715 CPT Dip/Tet/Acel Pertus 0.5ml 8 5 $210.00 $210.20 $44.93 $199.69 $172.25 2026-07-15
92507 CPT Speech Therapy Trmt 8 5 $228.00 $228.00 $148.20 $216.60 $188.90 2026-07-15
92522 CPT Eval St Speech Production 8 5 $328.00 $328.00 $213.20 $311.60 $271.75 2026-07-15
92523 CPT Speech Sound Lang Comprehen 8 5 $328.00 $328.00 $213.20 $311.60 $271.75 2026-07-15
92526 CPT Dysphagia Treatment 8 5 $390.00 $390.00 $253.50 $370.50 $323.12 2026-07-15
92610 CPT Swallow Eval Non Radiol 8 5 $328.00 $328.00 $213.20 $311.60 $271.75 2026-07-15
93005 CPT EKG Tracing 8 5 $243.00 $243.00 $157.95 $230.85 $201.32 2026-07-15
93306 CPT Tte W Doppler Complete 8 5 $2,655.00 $2,655.00 $1,725.75 $2,522.25 $2,199.67 2026-07-15
93308 CPT Echo Limited 8 5 $694.00 $694.00 $451.10 $659.30 $574.98 2026-07-15
93797 CPT Cardiac Rehab Ii Unmonitored 8 5 $344.00 $344.00 $223.60 $326.80 $285.00 2026-07-15
93798 CPT Cardiac Rehab Ii Monitored 16 5 $338.50 $338.50 $216.45 $326.80 $280.24 2026-07-15
93880 CPT Extracranial Bilat Study 8 5 $1,665.00 $1,665.00 $1,082.25 $1,581.75 $1,379.45 2026-07-15
93922 CPT Ankle Arm Screen 8 5 $358.00 $358.00 $232.70 $340.10 $296.61 2026-07-15
93925 CPT Arterial Duplex Le Bi 8 5 $939.00 $939.00 $610.35 $892.05 $777.96 2026-07-15
93926 CPT Arterial Duplex Le Lt 16 5 $675.00 $675.00 $438.75 $641.25 $559.24 2026-07-15
93970 CPT Venous Duplex 8 5 $753.00 $753.00 $489.45 $715.35 $623.86 2026-07-15
93971 CPT Extremity Study Lt 16 5 $796.50 $796.50 $512.85 $763.80 $659.61 2026-07-15
93975 CPT Vascular Study 8 5 $528.00 $528.00 $343.20 $501.60 $437.45 2026-07-15
93976 CPT Vascular Study 8 5 $371.00 $371.00 $241.15 $352.45 $307.38 2026-07-15
95810 CPT Polysomnogram 8 5 $4,807.00 $4,807.00 $3,124.55 $4,566.65 $3,982.60 2026-07-15
95811 CPT Polysomnogram W CPap 8 5 $5,029.00 $5,029.00 $3,268.85 $4,777.55 $4,166.52 2026-07-15
96360 CPT Inf Therapy Hyd Initial 16 5 $551.50 $551.50 $352.95 $532.00 $456.59 2026-07-15
96361 CPT Inf Therapy Hyd Ea Addl Hour 16 5 $205.50 $205.50 $131.95 $197.60 $170.16 2026-07-15
96365 CPT Inf Therapy Med Initial 16 5 $551.50 $551.50 $352.95 $532.00 $456.59 2026-07-15
96366 CPT Inf Therapy Med Addl Hr 16 5 $243.50 $243.50 $155.35 $235.60 $201.56 2026-07-15
96367 CPT Inf Therapy Med Sequential 16 5 $243.50 $243.50 $155.35 $235.60 $201.56 2026-07-15
96374 CPT IV Injection Initial 16 5 $365.50 $365.50 $235.30 $350.55 $302.68 2026-07-15
96375 CPT IV Injection Subsequent 16 5 $243.50 $243.50 $155.35 $235.60 $201.56 2026-07-15
96376 CPT IV Injection Ea Addl Same Drug 16 5 $243.50 $243.50 $155.35 $235.60 $201.56 2026-07-15
96402 CPT Injection Chemo Sq/IM Hormonal 8 5 $225.00 $225.00 $146.25 $213.75 $186.42 2026-07-15
96523 CPT Implanted Vad Flush 8 5 $386.00 $386.00 $250.90 $366.70 $319.80 2026-07-15
97161 CPT Pt Eval Low Complexity 8 5 $267.00 $267.00 $173.55 $253.65 $221.21 2026-07-15
97162 CPT Pt Eval Mod Complexity 8 5 $267.00 $267.00 $173.55 $253.65 $221.21 2026-07-15
97165 CPT Ot Eval Low Complexity 8 5 $257.00 $257.00 $167.05 $244.15 $212.93 2026-07-15
97597 CPT Debride Wound 1st 20 Cm 8 5 $386.00 $386.00 $250.90 $366.70 $319.80 2026-07-15
97602 CPT Debride Wound Non-selective 8 5 $804.00 $804.00 $522.60 $763.80 $666.12 2026-07-15
97605 CPT Neg Pressure Wound Dme <50 Cm 8 5 $345.00 $345.00 $224.25 $327.75 $285.84 2026-07-15
97802 CPT Mnt Indiv Initial Ea 15 Min 8 5 $204.00 $204.00 $132.60 $193.80 $169.01 2026-07-15
97803 CPT Mnt Indiv Subsequent Ea 15 Min 8 5 $204.00 $204.00 $132.60 $193.80 $169.01 2026-07-15
99213 CPT Est Patient Level 3 16 5 $239.00 $239.00 $111.15 $291.65 $181.00 2026-07-15
99282 CPT Emergency Room Visit Level 2 8 5 $536.00 $536.00 $348.40 $509.20 $444.07 2026-07-15
99283 CPT Emergency Room Visit Level 3 8 5 $776.00 $776.00 $504.40 $737.20 $642.91 2026-07-15
99284 CPT Emergency Room Visit Level 4 8 5 $1,125.00 $1,125.00 $731.25 $1,068.75 $932.07 2026-07-15
99285 CPT Emergency Room Visit Level 5 8 5 $2,094.00 $2,094.00 $1,361.10 $1,989.30 $1,734.88 2026-07-15
A9585 HCPCS Gadobutrol Inj 10 Mm/10 Ml Vl 8 5 $800.00 $800.00 $2.69 $760.00 $655.60 2026-07-15
G0103 HCPCS Psa Screen 8 5 $208.00 $208.00 $135.20 $197.60 $172.33 2026-07-15
G0378 HCPCS Observation 1st Hour 16 5 $401.50 $401.50 $95.55 $623.20 $283.02 2026-07-15
J0248 HCPCS Remdesivir 100 Mg Vial 8 5 $2,461.00 $2,461.58 $70.71 $2,338.50 $2,017.26 2026-07-15
J0283 HCPCS Amiodarone/D5W 150mg/100ml Bag 14 5 $202.00 $202.24 $131.46 $232.18 $182.31 2026-07-15
J0717 HCPCS Certolizumab Pegol 400 Mg Kit 8 5 $22,931.00 $22,931.76 $3.42 $21,785.17 $18,792.58 2026-07-15
J0881 HCPCS Darbepoetin Alfa 25 Mcg/ml Vl 8 5 $394.00 $394.28 $256.28 $2,669.46 $358.79 2026-07-15
J0897 HCPCS Denosumab 60 Mg/ml Syringe 8 5 $6,679.00 $6,679.96 $9.69 $6,345.96 $5,474.23 2026-07-15
J1437 HCPCS Ferric Derisomaltose 1,000 Mg 8 5 $9,380.00 $9,380.76 $16.52 $8,911.72 $7,687.53 2026-07-15
J1439 HCPCS Ferric Carboxymalt 750mg/15ml 8 5 $4,061.00 $4,061.20 $11.91 $3,858.14 $3,328.15 2026-07-15
J1561 HCPCS Immune Glob Gamunex 10gr/100ml 8 5 $3,109.00 $3,109.53 $3.60 $2,954.05 $2,548.26 2026-07-15
J1602 HCPCS Golimumab 50 Mg/4 Ml Vial 8 5 $7,876.00 $7,876.29 $43.11 $7,482.48 $6,454.62 2026-07-15
J2353 HCPCS Octreotide (Depot) 30 Mg Syr 8 5 $25,205.00 $25,205.96 $17.33 $23,945.66 $20,656.28 2026-07-15
J2426 HCPCS Paliperidone Palmit 156 Mg/ml 8 5 $7,096.00 $7,096.84 $793.38 $6,742.00 $5,815.86 2026-07-15
J2997 HCPCS Alteplase 2 Mg Vial 8 5 $735.00 $735.52 $37.08 $698.74 $602.76 2026-07-15
J3101 HCPCS Tenecteplase 50 Mg/10 Ml Syrng 8 5 $27,997.00 $27,997.08 $0.41 $26,597.23 $22,943.61 2026-07-15
J3111 HCPCS Romosozumab-aqqg 210 Mg/2.34Ml 8 5 $9,990.00 $9,990.94 $1.56 $9,491.39 $8,187.58 2026-07-15
J3245 HCPCS Tildrakizumab-asmn 100Mg/Ml Sy 8 5 $50,399.00 $50,399.64 $5.04 $47,879.66 $41,302.50 2026-07-15
J3380 HCPCS Vedolizumab 300 Mg Vial 8 5 $37,494.00 $37,494.64 $72.63 $35,619.91 $30,726.85 2026-07-15
J9217 HCPCS Leuprolide Acetate 22.5 Mg Syr 14 5 $2,109.00 $2,109.32 $1.47 $5,386.77 $2,003.85 2026-07-15
P9016 HCPCS Red Blood Cells Lekoreduced 8 5 $565.00 $565.00 $367.25 $536.75 $468.11 2026-07-15
Q0138 HCPCS Ferumoxy 510mg/17ml (non-esrd) 8 5 $940.00 $940.08 $7.28 $893.08 $770.39 2026-07-15
Q5101 HCPCS Filgrastim-sndz 300 Mcg/0.5 Ml 14 5 $849.00 $849.56 $552.21 $2,902.40 $945.94 2026-07-15
Q5111 HCPCS Pegfilgrastim-cbqv 6 Mg/0.6 Ml 8 5 $7,855.00 $7,855.00 $1,112.40 $7,462.25 $6,437.18 2026-07-15
Q5122 HCPCS Pegfilgrastim 6 Mg/0.6 Ml Syr 8 5 $7,204.00 $7,204.57 $3,939.75 $6,844.34 $5,904.15 2026-07-15
Q9950 HCPCS Sulf Hexaflr Microsphre 5ml Vl 8 5 $635.00 $635.00 $187.95 $603.25 $520.38 2026-07-15
Q9956 HCPCS Perflutren Protein-a Microdota 8 5 $469.00 $469.55 $77.76 $446.07 $384.80 2026-07-15
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