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

GRANT MEMORIAL HOSPITAL

Petersburg, WV · CCN 511316 · Rates published

4,944 distinct procedures filed
22 distinct payers
177,124 rate rows
2026-05-13 last MRF observed
Data quality

15,340 of 177,124 rate rows are consumer-grade (8.7%)

161,784 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 160,665
per-diem day rate — not a per-procedure price 701
exceeds 10× this hospital's gross charge — excluded from medians 403
placeholder amount (≤ $0.02) — excluded from medians 15
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://wvumedicine.org/wp-content/uploads/2026/04/881740605_Grant-Memorial-Hospital-Inc_standardcharges.csv
Found on page https://wvumedicine.org/billing-and-insurance/costs-and-charges/
Discovered viaCMS hospital list
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-10-21
Content fingerprint 420b3d5851e911cb… · 24,752,984 bytes · first seen 2026-05-13

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
J9029
HCPCS 		Instill Adstiladrin, Tx Dose 22 $101,970.00 $101,970.00 $101,970.00 nat. median
$68,400
1.5× median
J9226
HCPCS 		Supprelin La Implant 22 $73,550.30 $73,550.30 $73,550.30 nat. median
$55,159
1.3× median
J0480
HCPCS 		Basiliximab 22 $7,385.85 $7,385.85 $7,385.85 nat. median
$6,695
1.1× median
J2787
HCPCS 		Riboflavin 5'phos Opth<=3ml 22 $4,108.50 $4,108.50 $4,108.50 nat. median
$4,061
1.0× median
J3240
HCPCS 		Thyrotropin Injection 22 $3,334.93 $3,334.93 $3,334.93 nat. median
$2,976
1.1× median
J1950
HCPCS 		Leuprolide Acetate /3.75 Mg 22 $2,581.59 $2,581.59 $2,581.59 nat. median
$3,921
0.7× median
00052-4330-01
OTHER 		Nexplanon 22 $2,290.45 $2,290.45 $2,290.45 nat. median
$2,290
1.0× median
J7296
HCPCS 		Kyleena, 19.5 Mg 22 $2,290.45 $2,290.45 $2,290.45 nat. median
$1,659
1.4× median
J7298
HCPCS 		Mirena, 52 Mg 22 $2,290.45 $2,290.45 $2,290.45 nat. median
$1,679
1.4× median
J9357
HCPCS 		Valrubicin Injection 22 $2,250.35 $2,250.35 $2,250.35 nat. median
$1,799
1.3× median
00270-1316-35
OTHER 		Isovue-370 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,208
1.0× median
5003301037
OTHER 		Hchg Hospice Daily 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
94002
CPT 		Vent Mgmt Inpat Init Day 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$917
outlier · 2.4×
J3490
HCPCS 		Drugs Unclassified Injection 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$47
outlier · 46.9×
00990-7953-09
OTHER 		Lactated Ringer's 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
00407-1414-72
OTHER 		Omnipaque 350 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$0
1103331037
OTHER 		Hchg Sufentanil 50mcg/ml Inj (sufenta) - Per 1ml 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
00019-1333-11
OTHER 		Optiray 350 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
S5553
HCPCS 		Insulin; Long Acting; 5 Units 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2
outlier · 1158.9×
1103231037
OTHER 		Hchg Methotrexate Ophth 400mcg/0.1ml Per Dose 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
G0239
HCPCS 		Oth Resp Proc, Group 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$79
outlier · 28.1×
1001171037
OTHER 		Hchg Transitional Care Bed 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
00338-0017-18
OTHER 		Dextrose 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
1102831037
OTHER 		Hchg Sodium Chloride Syringe 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
00270-1111-03
OTHER 		Prohance 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,482
0.9× median
1104711037
OTHER 		Hchg Juvéderm Vollure Per 1ml Syringe 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
94667
CPT 		Initial Therapy Service To Facilitate Lung Function 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$153
outlier · 14.5×
9196051037
OTHER 		Hchg Phenol Ez Swabs Each 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
1000151037
OTHER 		Hchg OB Room 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
00270-7030-42
OTHER 		Vueway 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
00338-0017-02
OTHER 		Dextrose 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,000
1.1× median
1000201037
OTHER 		Hchg Routine Room 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
1000221037
OTHER 		Hchg Telemetry Room 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
00990-7922-02
OTHER 		Dextrose 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,000
1.1× median
00338-0049-03
OTHER 		Sodium Chloride 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,000
1.1× median
1104801037
OTHER 		Hchg Sodium Tetradecyl Sulfate (sotradecol) Per 1ml 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
00409-7100-67
OTHER 		Dextrose 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
Q9967
HCPCS 		Low Osmolar Contrast Material; 300-399 Mg/ml Iodine Concentration; Per Ml 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$65
outlier · 34.2×
1104731037
OTHER 		Hchg Belotero Balance Per 1ml Syringe 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
00990-7983-03
OTHER 		Sodium Chloride 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,242
1.0× median
00338-0117-04
OTHER 		Lactated Ringer's 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,000
1.1× median
1103371037
OTHER 		Hchg Bupivacaine Hcl Pf (marcaine) 0.25% Inj Per 1ml 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
00338-0017-04
OTHER 		Dextrose 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,000
1.1× median
94660
CPT 		Therapy Procedure Using A Positive Pressure Ventilator 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$363
outlier · 6.1×
1102741037
OTHER 		Hchg 0.9% Ns 250 Ml 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
94668
CPT 		Chest Wall Manipulation 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$136
outlier · 16.3×
J7060
HCPCS 		5% Dextrose/water (500 Ml = 1 Unit) 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$22
outlier · 101.3×
00338-0117-02
OTHER 		Lactated Ringer's 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$1,038
outlier · 2.1×
00270-1111-02
OTHER 		Prohance 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median
1000101037
OTHER 		Hchg Newborn Room 9 $2,213.50 $2,213.50 $2,213.50 nat. median
$2,214
1.0× median

Other procedures at this hospital

Browse this hospital's 4,944 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
             
00003-2327-11 OTHER Yervoy 24 22 $36,031.00 $28,824.80 20% off $284.49 $284.49 $284.49 2026-05-13
00003-3734-13 OTHER Opdivo 24 22 $45,807.84 $36,646.27 20% off $51.30 $51.30 $51.30 2026-05-13
00003-3774-12 OTHER Opdivo 24 22 $22,903.85 $18,323.08 $51.30 $51.30 $51.30 2026-05-13
00003-7125-11 OTHER Opdualag 24 22 $88,938.72 $71,150.98 $308.80 $308.80 $308.80 2026-05-13
00009-0011-03 OTHER Solu-cortef 100mg Vial 24 22 $55.08 $44.06 20% off $29.45 $29.45 $29.45 2026-05-13
00019-1333-11 OTHER Optiray 350 9 9 $52.50 $42.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00023-6082-10 OTHER Infed 24 22 $953.73 $762.98 20% off $28.58 $28.58 $28.58 2026-05-13
00024-5824-11 OTHER Jevtana 24 22 $101,855.02 $81,484.02 $347.24 $347.24 $347.24 2026-05-13
00052-4330-01 OTHER Nexplanon 24 22 $3,471.00 $2,776.80 $2,290.45 $2,290.45 $2,290.45 2026-05-13
00069-0238-01 OTHER Ruxience 24 22 $3,362.93 $2,690.34 20% off $33.74 $33.74 $33.74 2026-05-13
00069-0249-01 OTHER Ruxience 24 22 $13,451.70 $10,761.36 20% off $33.74 $33.74 $33.74 2026-05-13
00078-1000-60 OTHER Leqvio 24 22 $10,144.26 $8,115.41 $20.01 $20.01 $20.01 2026-05-13
00169-7065-15 OTHER GlucaGen HypoKit 24 22 $506.58 $405.26 20% off $310.81 $310.81 $310.81 2026-05-13
00264-1510-31 OTHER Dextrose 9 9 $7.50 $6.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00270-0445-35 OTHER Gastrografin 9 9 $16.98 $13.58 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00270-0556-15 OTHER Kinevac 24 22 $338.52 $270.82 $219.62 $219.62 $219.62 2026-05-13
00270-1111-01 OTHER Prohance 9 9 $38.01 $30.41 $2,213.50 $2,213.50 $2,213.50 2026-05-13
00270-1111-02 OTHER Prohance 9 9 $57.02 $45.62 $2,213.50 $2,213.50 $2,213.50 2026-05-13
00270-1111-03 OTHER Prohance 9 9 $76.02 $60.82 $2,213.50 $2,213.50 $2,213.50 2026-05-13
00270-1316-35 OTHER Isovue-370 18 9 $27.30 $21.84 $2,213.50 $2,213.50 $2,213.50 2026-05-13
00270-7030-42 OTHER Vueway 9 9 $78.92 $63.14 $2,213.50 $2,213.50 $2,213.50 2026-05-13
00310-4611-50 OTHER Imfinzi 24 22 $37,151.10 $29,720.88 $133.17 $133.17 $133.17 2026-05-13
00338-0017-02 OTHER Dextrose 9 9 $6.00 $4.80 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00338-0017-03 OTHER Dextrose 9 9 $3.60 $2.88 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00338-0017-04 OTHER Dextrose 9 9 $6.00 $4.80 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00338-0017-11 OTHER Dextrose 9 9 $4.95 $3.96 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00338-0017-18 OTHER Dextrose 9 9 $4.80 $3.84 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00338-0049-03 OTHER Sodium Chloride 9 9 $6.00 $4.80 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00338-0049-04 OTHER Sodium Chloride 9 9 $6.00 $4.80 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00338-0117-02 OTHER Lactated Ringer's 9 9 $2.70 $2.16 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00338-0117-04 OTHER Lactated Ringer's 9 9 $12.00 $9.60 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00338-0551-18 OTHER Dextrose 9 9 $8.10 $6.48 $2,213.50 $2,213.50 $2,213.50 2026-05-13
00407-1412-10 OTHER Omnipaque 240 9 9 $119.73 $95.78 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00407-1414-72 OTHER Omnipaque 350 9 9 $118.35 $94.68 $2,213.50 $2,213.50 $2,213.50 2026-05-13
00409-3510-21 OTHER Ertapenem 24 22 $90.96 $72.77 $21.40 $21.40 $21.40 2026-05-13
00409-7100-67 OTHER Dextrose 9 9 $6.00 $4.80 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00548-5850-00 OTHER Glucagon Emergency Kit 24 22 $505.74 $404.59 20% off $310.81 $310.81 $310.81 2026-05-13
00548-5900-00 OTHER Cortrosyn 24 22 $49.62 $39.70 $44.73 $44.73 $44.73 2026-05-13
00548-5905-00 OTHER Injection; Glucagon Hydrochloride; Per 1 Mg 24 22 $506.58 $405.26 20% off $310.81 $310.81 $310.81 2026-05-13
00562-7805-01 OTHER RhoGAM Ultra-filtered Plus 24 22 $128.00 $102.40 $128.00 $128.00 $128.00 2026-05-13
00562-7805-25 OTHER RhoGAM Ultra-filtered Plus 24 22 $128.00 $102.40 $128.00 $128.00 $128.00 2026-05-13
00641-6103-01 OTHER Robaxin 24 22 $128.00 $102.40 $128.00 $128.00 $128.00 2026-05-13
00990-7922-02 OTHER Dextrose 9 9 $15.00 $12.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00990-7922-03 OTHER Dextrose 9 9 $15.00 $12.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00990-7953-09 OTHER Lactated Ringer's 9 9 $15.00 $12.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00990-7983-02 OTHER Sodium Chloride 9 9 $15.00 $12.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00990-7983-03 OTHER Sodium Chloride 9 9 $15.00 $12.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
00990-7983-09 OTHER Sodium Chloride 9 9 $45.00 $36.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
1000071037 OTHER Hchg Intensive Care Room 10 9 $2,533.00 $2,026.40 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1000081037 OTHER Hchg Isolation Room 10 9 $1,419.00 $1,135.20 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1000101037 OTHER Hchg Newborn Room 10 9 $809.00 $647.20 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1000121037 OTHER Hchg Nn Level 2 10 9 $1,021.00 $816.80 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
1000141037 OTHER Hchg Nursery 10 9 $1,419.00 $1,135.20 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1000151037 OTHER Hchg OB Room 10 9 $1,419.00 $1,135.20 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1000201037 OTHER Hchg Routine Room 10 9 $1,419.00 $1,135.20 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1000221037 OTHER Hchg Telemetry Room 10 9 $1,419.00 $1,135.20 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1000291037 OTHER Hchg Respite Room 10 9 $367.00 $293.60 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1001171037 OTHER Hchg Transitional Care Bed 10 9 $624.00 $499.20 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
1102741037 OTHER Hchg 0.9% Ns 250 Ml 9 9 $12.00 $9.60 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
1102831037 OTHER Hchg Sodium Chloride Syringe 9 9 $2.00 $1.60 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1102991037 OTHER Hchg Gi Cocktail - Maalox Max 10ml & Lidocane Viscous 2% 5ml- Per 15ml 9 9 $4.00 $3.20 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1103231037 OTHER Hchg Methotrexate Ophth 400mcg/0.1ml Per Dose 9 9 $1.00 $0.80 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1103331037 OTHER Hchg Sufentanil 50mcg/ml Inj (sufenta) - Per 1ml 9 9 $35.00 $28.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
1103341037 OTHER Hchg Ganciclovir Ophth 2mg/0.1ml Per Dose 9 9 $1.00 $0.80 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1103371037 OTHER Hchg Bupivacaine Hcl Pf (marcaine) 0.25% Inj Per 1ml 9 9 $2.00 $1.60 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1103481037 OTHER Hchg Inject, Intravitreal Vancomycin, Per Dose 9 9 $1.00 $0.80 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1103561037 OTHER Hchg Hydralazine Per 25 Mg Tab 9 9 $1.00 $0.80 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1104071037 OTHER Hchg Clindamycin Intravitreal Inj Per 1mg/0.1ml 9 9 $20.00 $16.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
1104671037 OTHER Hchg Juvéderm Ultra Plus Xc Per (1) 0.55ml Syringe 9 9 $861.00 $688.80 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
1104681037 OTHER Hchg Juvéderm Ultra Plus Xc Per 1ml Syringe 9 9 $1,047.00 $837.60 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
1104691037 OTHER Hchg Juvéderm Volbella Xc Per (1) 0.55ml Syringe 9 9 $615.00 $492.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
1104701037 OTHER Hchg Juvéderm Volbella Xc Per 1ml Syringe 9 9 $1,128.00 $902.40 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
1104711037 OTHER Hchg Juvéderm Vollure Per 1ml Syringe 9 9 $1,128.00 $902.40 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
1104721037 OTHER Hchg Restylane Per 1ml Syringe 9 9 $899.00 $719.20 $2,213.50 $2,213.50 $2,213.50 2026-05-13
1104731037 OTHER Hchg Belotero Balance Per 1ml Syringe 9 9 $855.00 $684.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
1104741037 OTHER Hchg Belotero Balance With Lidocaine Per 1ml Syringe 9 9 $987.00 $789.60 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
1104801037 OTHER Hchg Sodium Tetradecyl Sulfate (sotradecol) Per 1ml 9 9 $78.00 $62.40 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
13533-0318-01 OTHER HyperRAB 24 22 $1,502.68 $1,202.14 20% off $478.47 $478.47 $478.47 2026-05-13
13533-0318-05 OTHER HyperRAB 24 22 $4,847.33 $3,877.86 20% off $478.47 $478.47 $478.47 2026-05-13
13533-0318-50 OTHER HyperRAB 24 22 $9,694.65 $7,755.72 $478.47 $478.47 $478.47 2026-05-13
3000031037 OTHER Hchg Delivery Charge 9 9 $1,320.00 $1,056.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
42023-0221-01 OTHER Ertapenem 24 22 $30.17 $24.14 $21.40 $21.40 $21.40 2026-05-13
42023-0221-10 OTHER Ertapenem 24 22 $30.17 $24.14 $21.40 $21.40 $21.40 2026-05-13
44206-0436-05 OTHER Privigen 24 22 $12,045.00 $9,636.00 20% off $79.68 $79.68 $79.68 2026-05-13
44206-0437-10 OTHER Privigen 24 22 $6,570.00 $5,256.00 20% off $79.68 $79.68 $79.68 2026-05-13
44206-0438-20 OTHER Privigen 24 22 $13,140.00 $10,512.00 20% off $79.68 $79.68 $79.68 2026-05-13
44206-0439-40 OTHER Privigen 24 22 $8,760.00 $7,008.00 20% off $79.68 $79.68 $79.68 2026-05-13
44206-0439-93 OTHER Injection; Immune Globulin (privigen); Intravenous; Non-lyophilized (e.g. Liquid… 24 22 $17,520.00 $14,016.00 20% off $79.68 $79.68 $79.68 2026-05-13
5003301037 OTHER Hchg Hospice Daily 10 9 $1,351.00 $1,080.80 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
50242-0037-06 OTHER Injection; Tenecteplase; 1 Mg 24 22 $12,944.20 $10,355.36 20% off $252.63 $252.63 $252.63 2026-05-13
50242-0070-01 OTHER Gazyva 24 22 $25,838.16 $20,670.53 $116.06 $116.06 $116.06 2026-05-13
50242-0120-47 OTHER TNKase 24 22 $11,434.04 $9,147.23 20% off $252.63 $252.63 $252.63 2026-05-13
50242-0176-01 OTHER TNKase 24 22 $11,431.55 $9,145.24 $252.63 $252.63 $252.63 2026-05-13
50632-0010-01 OTHER RabAvert 24 22 $978.96 $783.17 $535.82 $535.82 $535.82 2026-05-13
50632-0013-01 OTHER Rabies Vaccine For Injection Into Muscle 24 22 $978.96 $783.17 $535.82 $535.82 $535.82 2026-05-13
55513-0132-01 OTHER Kanjinti 24 22 $11,607.63 $9,286.10 $22.19 $22.19 $22.19 2026-05-13
55513-0192-01 OTHER Neulasta Onpro 24 22 $12,696.79 $10,157.43 20% off $83.62 $83.62 $83.62 2026-05-13
55513-0954-01 OTHER Vectibix 24 22 $9,988.98 $7,991.18 20% off $248.59 $248.59 $248.59 2026-05-13
55513-0956-01 OTHER Vectibix 24 22 $39,955.80 $31,964.64 20% off $248.59 $248.59 $248.59 2026-05-13
55566-4100-01 OTHER Euflexxa 24 22 $1,002.25 $801.80 20% off $210.05 $210.05 $210.05 2026-05-13
57894-0503-01 OTHER Darzalex Faspro 24 22 $29,917.58 $23,934.06 20% off $80.93 $80.93 $80.93 2026-05-13
58160-0842-43 OTHER Boostrix 24 22 $102.68 $82.14 20% off $63.21 $63.21 $63.21 2026-05-13
58160-0842-52 OTHER Boostrix 24 22 $102.68 $82.14 20% off $63.21 $63.21 $63.21 2026-05-13
58160-0884-41 OTHER Fluarix 2024-2025 Formula 24 22 $42.45 $33.96 20% off $21.07 $21.07 $21.07 2026-05-13
58160-0884-52 OTHER Fluarix 2024-2025 Formula 24 22 $42.00 $33.60 $21.07 $21.07 $21.07 2026-05-13
58160-0912-41 OTHER Fluarix 2025-2026 Formula 24 22 $42.00 $33.60 $21.07 $21.07 $21.07 2026-05-13
58160-0912-52 OTHER Fluarix 2025-2026 Formula 24 22 $42.00 $33.60 $21.07 $21.07 $21.07 2026-05-13
62935-0453-45 OTHER Eligard 24 22 $2,171.25 $1,737.00 20% off $299.15 $299.15 $299.15 2026-05-13
63323-0286-30 OTHER Naropin 24 22 $128.00 $102.40 $128.00 $128.00 $128.00 2026-05-13
63323-0593-03 OTHER Glucagon 24 22 $409.29 $327.43 20% off $310.81 $310.81 $310.81 2026-05-13
63323-0596-03 OTHER Glucagon 24 22 $409.29 $327.43 20% off $310.81 $310.81 $310.81 2026-05-13
63323-0596-11 OTHER Glucagon 24 22 $613.93 $491.14 $310.81 $310.81 $310.81 2026-05-13
63323-0842-21 OTHER Dicyclomine HCl 24 22 $22.05 $17.64 20% off $22.05 $22.05 $22.05 2026-05-13
68516-5216-09 OTHER Albutein 24 22 $123.00 $98.40 $87.58 $87.58 $87.58 2026-05-13
70461-0024-04 OTHER Fluad 2024-2025 Formula 1 1 $172.00 $137.60 20% off $121.11 $121.11 $121.11 2026-05-13
71288-0107-20 OTHER Bleomycin 24 22 $139.65 $111.72 20% off $34.68 $34.68 $34.68 2026-05-13
72266-0248-05 OTHER Sincalide 24 22 $64.36 $51.48 $48.82 $48.82 $48.82 2026-05-13
90281 CPT Human Ig IM 24 22 $286.00 $228.80 $92.80 $92.80 $92.80 2026-05-13
90371 CPT Hep B Ig IM 24 22 $498.00 $398.40 20% off $227.52 $227.52 $227.52 2026-05-13
90378 CPT Rsv Mab IM 50mg 24 22 $5,462.00 $4,369.60 $560.47 $560.47 $560.47 2026-05-13
90380 CPT Rsv Monoc Antb Seasn .5ml IM 24 22 $1,578.00 $1,262.40 $1,578.00 $1,578.00 $1,578.00 2026-05-13
90381 CPT Rsv Monoc Antb Seasn 1 Ml IM 24 22 $1,578.00 $1,262.40 $980.10 $980.10 $980.10 2026-05-13
90619 CPT Menacwy-tt Vaccine IM 24 22 $441.00 $352.80 20% off $330.38 $330.38 $330.38 2026-05-13
90620 CPT Menb-4c Vaccine IM 24 22 $458.00 $366.40 20% off $411.10 $411.10 $411.10 2026-05-13
90621 CPT Menb-fhbp Vacc 2/3 Dose IM 24 22 $509.00 $407.20 20% off $376.46 $376.46 $376.46 2026-05-13
90632 CPT Hepa Vaccine Adult IM 24 22 $195.00 $156.00 20% off $115.93 $115.93 $115.93 2026-05-13
90633 CPT Hepa Vacc Ped/adol 2 Dose IM 24 22 $98.00 $78.40 $68.72 $68.72 $68.72 2026-05-13
90636 CPT Hep A/hep B Vacc Adult IM 24 22 $286.00 $228.80 $213.39 $213.39 $213.39 2026-05-13
90647 CPT Hib Prp-omp Vacc 3 Dose IM 24 22 $83.00 $66.40 $58.58 $58.58 $58.58 2026-05-13
90648 CPT Hib Prp-t Vaccine 4 Dose IM 24 22 $37.00 $29.60 $25.21 $25.21 $25.21 2026-05-13
90651 CPT 9vhpv Vaccine 2/3 Dose IM 24 22 $871.00 $696.80 20% off $569.07 $569.07 $569.07 2026-05-13
90656 CPT Iiv3 Vacc No Prsv 0.5 Ml IM 24 22 $39.00 $31.20 20% off $21.07 $21.07 $21.07 2026-05-13
90657 CPT Iiv3 Vaccine Splt 0.25 Ml IM 24 22 $27.00 $21.60 $21.62 $21.62 $21.62 2026-05-13
90660 CPT Laiv3 Vaccine Intranasal 24 22 $73.00 $58.40 20% off $27.56 $27.56 $27.56 2026-05-13
90662 CPT Iiv No Prsv Increased Ag IM 24 22 $238.00 $190.40 20% off $121.11 $121.11 $121.11 2026-05-13
90671 CPT Pcv15 Vaccine IM 24 22 $545.00 $436.00 20% off $418.37 $418.37 $418.37 2026-05-13
90675 CPT Rabies Vaccine IM 24 22 $1,218.00 $974.40 20% off $535.82 $535.82 $535.82 2026-05-13
90677 CPT Pcv20 Vaccine IM 24 22 $727.00 $581.60 $476.29 $476.29 $476.29 2026-05-13
90678 CPT Rsv Vacc Pref Bivalent IM 24 22 $812.00 $649.60 20% off $584.10 $584.10 $584.10 2026-05-13
90679 CPT Rsv Vacc Pref Recomb Adjt IM 24 22 $684.00 $547.20 $554.40 $554.40 $554.40 2026-05-13
90680 CPT Rv5 Vacc 3 Dose Live Oral 24 22 $253.00 $202.40 20% off $189.75 $189.75 $189.75 2026-05-13
90681 CPT Rv1 Vacc 2 Dose Live Oral 24 22 $309.00 $247.20 20% off $182.97 $182.97 $182.97 2026-05-13
90691 CPT Typhoid Vaccine IM 24 22 $425.00 $340.00 20% off $180.23 $180.23 $180.23 2026-05-13
90696 CPT Dtap-ipv Vaccine 4-6 Yrs IM 25 22 $172.00 $137.60 20% off $138.00 $172.00 $172.00 2026-05-13
90698 CPT Dtap-ipv/hib Vaccine IM 24 22 $318.00 $254.40 20% off $217.26 $217.26 $217.26 2026-05-13
90700 CPT Dtap Vaccine < 7 Yrs IM 24 22 $82.00 $65.60 20% off $56.96 $56.96 $56.96 2026-05-13
90707 CPT Mmr Vaccine Sc 24 22 $233.00 $186.40 20% off $182.39 $182.39 $182.39 2026-05-13
90710 CPT Mmrv Vaccine Sc 24 22 $808.00 $646.40 20% off $218.94 $218.94 $218.94 2026-05-13
90713 CPT Poliovirus Ipv Sc/im 24 22 $123.00 $98.40 $84.18 $84.18 $84.18 2026-05-13
90714 CPT Td Vacc No Presv 7 Yrs+ IM 24 22 $139.00 $111.20 20% off $50.06 $50.06 $50.06 2026-05-13
90715 CPT Tdap Vaccine 7 Yrs/> IM 24 22 $106.00 $84.80 20% off $63.21 $63.21 $63.21 2026-05-13
90716 CPT Var Vaccine Live Subq 24 22 $548.00 $438.40 20% off $344.92 $344.92 $344.92 2026-05-13
90717 CPT Yellow Fever Vaccine Subq 24 22 $617.00 $493.60 $263.36 $263.36 $263.36 2026-05-13
90723 CPT Dtap-hep B-ipv Vaccine IM 24 22 $189.00 $151.20 20% off $187.79 $187.79 $187.79 2026-05-13
90732 CPT Ppsv23 Vacc 2 Yrs+ Subq/im 24 22 $316.00 $252.80 $220.23 $220.23 $220.23 2026-05-13
90734 CPT Menacwyd/menacwycrm Vacc IM 24 22 $313.00 $250.40 20% off $299.95 $299.95 $299.95 2026-05-13
90738 CPT Inactivated Je Vacc IM 24 22 $1,063.00 $850.40 20% off $504.42 $504.42 $504.42 2026-05-13
90739 CPT Hepb Vacc 2/4 Dose Adult IM 24 22 $380.00 $304.00 20% off $264.46 $264.46 $264.46 2026-05-13
90743 CPT Hepb Vacc 2 Dose Adolesc IM 24 22 $139.00 $111.20 20% off $124.00 $124.00 $124.00 2026-05-13
90744 CPT Hepb Vacc 3 Dose Ped/adol IM 24 22 $64.00 $51.20 $50.77 $50.77 $50.77 2026-05-13
90746 CPT Hepb Vaccine 3 Dose Adult IM 24 22 $139.00 $111.20 20% off $116.13 $116.13 $116.13 2026-05-13
90870 CPT Electroconvulsive Therapy 23 21 $1,045.00 $836.00 20% off $1,048.58 $1,048.58 $1,048.58 2026-05-13
91304 CPT Sarscov2 Vac 5mcg/0.5ml IM 24 22 $315.00 $252.00 20% off $244.53 $244.53 $244.53 2026-05-13
91319 CPT Sarscv2 Vac 10mcg Trs-suc IM 24 22 $135.00 $108.00 20% off $135.00 $135.00 $135.00 2026-05-13
91320 CPT Sarscv2 Vac 30mcg Trs-suc IM 24 22 $301.00 $240.80 $216.32 $216.32 $216.32 2026-05-13
91321 CPT Sarscov2 Vac 25 Mcg/.25ml IM 24 22 $339.00 $271.20 20% off $240.77 $240.77 $240.77 2026-05-13
91322 CPT Sarscov2 Vac 50 Mcg/0.5ml IM 24 22 $372.00 $297.60 $240.77 $240.77 $240.77 2026-05-13
9196051037 OTHER Hchg Phenol Ez Swabs Each 9 9 $13.00 $10.40 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
9196061037 OTHER Hchg Silvadene 1% Cream, Per 1 Gm 9 9 $2.00 $1.60 $2,213.50 $2,213.50 $2,213.50 2026-05-13
9196071037 OTHER Hchg Silver Nitrate Swabs - Each 9 9 $3.00 $2.40 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
9196081037 OTHER Hchg Triple Antibiotic Ointment (neosporin) Unit Dose Packets 9 9 $1.00 $0.80 $2,213.50 $2,213.50 $2,213.50 2026-05-13
94002 CPT Vent Mgmt Inpat Init Day 9 9 $1,221.00 $976.80 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
94003 CPT Vent Mgmt Inpat Subq Day 9 9 $1,221.00 $976.80 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
94640 CPT Airway Inhalation Treatment 18 9 $480.00 $384.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
94644 CPT Cbt 1st Hour 9 9 $315.00 $252.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
94645 CPT Inhalation Treatment For Acute Airway Obstruction; Each Additional Hour 9 9 $20.00 $16.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
94660 CPT Therapy Procedure Using A Positive Pressure Ventilator 27 9 $460.00 $368.00 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
94664 CPT Evaluate Pt Use Of Inhaler 18 9 $219.50 $175.60 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
94667 CPT Initial Therapy Service To Facilitate Lung Function 27 9 $273.00 $218.40 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
94668 CPT Chest Wall Manipulation 18 9 $553.00 $442.40 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
96360 CPT Infusion Into A Vein For Hydration; 31-60 Minutes 25 22 $460.00 $368.00 20% off $69.00 $336.96 $336.96 2026-05-13
96361 CPT Infusion Into A Vein For Hydration; Each Additional Hour 25 22 $864.00 $691.20 $27.00 $74.68 $74.68 2026-05-13
A2001 HCPCS Innovamatrix Ac, Per Sq Cm 24 22 $1,048.40 $838.72 20% off $1,048.40 $1,048.40 $1,048.40 2026-05-13
A9500 HCPCS Technetium Tc-99m Sestamibi; Diagnostic; Per Study Dose 24 22 $856.00 $684.80 20% off $743.46 $743.46 $743.46 2026-05-13
A9503 HCPCS Technetium Tc-99m Medronate; Diagnostic; Per Study Dose; Up To 30 Millicuries 24 22 $123.00 $98.40 $61.59 $61.59 $61.59 2026-05-13
A9510 HCPCS Tc99m Disofenin 24 22 $178.00 $142.40 $114.54 $114.54 $114.54 2026-05-13
A9513 HCPCS Lutetium Lu 177 Dotatat Ther 24 22 $556.00 $444.80 20% off $479.23 $479.23 $479.23 2026-05-13
A9516 HCPCS Iodine I-123 Sodium Iodide; Diagnostic; Per 100 Microcuries; Up To 999 Microcuri… 25 22 $350.00 $280.00 20% off $185.00 $186.40 $185.00 2026-05-13
A9537 HCPCS Technetium Tc-99m Mebrofenin; Diagnostic; Per Study Dose; Up To 15 Millicuries 24 22 $121.00 $96.80 20% off $121.00 $121.00 $121.00 2026-05-13
A9539 HCPCS Tc99m Pentetate 24 22 $165.00 $132.00 20% off $49.17 $49.17 $49.17 2026-05-13
A9540 HCPCS Technetium Tc-99m Macroaggregated Albumin; Diagnostic; Per Study Dose; Up To 10 … 24 22 $123.00 $98.40 $52.95 $52.95 $52.95 2026-05-13
A9541 HCPCS Technetium Tc-99m Sulfur Colloid; Diagnostic; Per Study Dose; Up To 20 Millicuri… 24 22 $114.00 $91.20 20% off $114.00 $114.00 $114.00 2026-05-13
A9552 HCPCS F18 Fdg 24 22 $854.00 $683.20 $647.79 $647.79 $647.79 2026-05-13
A9560 HCPCS Technetium Tc-99m Labeled Red Blood Cells; Diagnostic; Per Study Dose; Up To 30 … 24 22 $988.00 $790.40 20% off $166.40 $166.40 $166.40 2026-05-13
A9561 HCPCS Tc99m Oxidronate 24 22 $132.00 $105.60 20% off $84.28 $84.28 $84.28 2026-05-13
A9562 HCPCS Technetium Tc-99m Mertiatide; Diagnostic; Per Study Dose; Up To 15 Millicuries 24 22 $525.00 $420.00 20% off $525.00 $525.00 $525.00 2026-05-13
A9567 HCPCS Technetium Tc-99m Pentetate; Diagnostic; Aerosol; Per Study Dose; Up To 75 Milli… 24 22 $392.00 $313.60 $34.04 $34.04 $34.04 2026-05-13
A9576 HCPCS Injection; Gadoteridol; (prohance Multipack); Per Ml 9 9 $4.00 $3.20 $2,213.50 $2,213.50 $2,213.50 2026-05-13
A9595 HCPCS Piflu F-18, Dia 1 Millicurie 24 22 $1,154.00 $923.20 $957.58 $957.58 $957.58 2026-05-13
A9606 HCPCS Radium Ra223 Dichloride Ther 24 22 $317.00 $253.60 20% off $265.91 $265.91 $265.91 2026-05-13
G0239 HCPCS Oth Resp Proc, Group 18 9 $94.50 $75.60 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
G0378 HCPCS Hospital Observation Per Hr 23 22 $60.00 $48.00 20% off $708.61 $708.61 $708.61 2026-05-13
G0379 HCPCS Direct Refer Hospital Observ 24 22 $1,458.00 $1,166.40 $708.61 $708.61 $708.61 2026-05-13
J0178 HCPCS Aflibercept Injection 24 22 $1,694.00 $1,355.20 20% off $1,422.76 $1,422.76 $1,422.76 2026-05-13
J0475 HCPCS Baclofen 10 Mg Injection 24 22 $709.00 $567.20 $293.37 $293.37 $293.37 2026-05-13
J0480 HCPCS Basiliximab 24 22 $13,463.00 $10,770.40 20% off $7,385.85 $7,385.85 $7,385.85 2026-05-13
J0490 HCPCS Belimumab Injection 24 22 $162.00 $129.60 20% off $85.80 $85.80 $85.80 2026-05-13
J0491 HCPCS Inj Anifrolumab-fnia 1mg 24 22 $55.00 $44.00 20% off $28.35 $28.35 $28.35 2026-05-13
J0517 HCPCS Inj., Benralizumab, 1 Mg 24 22 $585.00 $468.00 20% off $279.68 $279.68 $279.68 2026-05-13
J0558 HCPCS Peng Benzathine/procaine Inj 24 22 $56.00 $44.80 20% off $29.01 $29.01 $29.01 2026-05-13
J0561 HCPCS Penicillin G Benzathine Inj 24 22 $85.00 $68.00 20% off $35.85 $35.85 $35.85 2026-05-13
J0565 HCPCS Inj, Bezlotoxumab, 10 Mg 24 22 $137.00 $109.60 20% off $65.77 $65.77 $65.77 2026-05-13
J0587 HCPCS Inj, Rimabotulinumtoxinb 24 22 $39.00 $31.20 20% off $21.50 $21.50 $21.50 2026-05-13
J0775 HCPCS Collagenase, Clost Hist Inj 24 22 $247.00 $197.60 20% off $109.35 $109.35 $109.35 2026-05-13
J0834 HCPCS Inj., Cosyntropin, 0.25 Mg 24 22 $90.00 $72.00 20% off $44.73 $44.73 $44.73 2026-05-13
J0875 HCPCS Injection, Dalbavancin 24 22 $27.00 $21.60 $25.23 $25.23 $25.23 2026-05-13
J0897 HCPCS Denosumab Injection 24 22 $91.00 $72.80 20% off $41.58 $41.58 $41.58 2026-05-13
J1110 HCPCS Inj Dihydroergotamine Mesylt 24 22 $130.00 $104.00 20% off $69.86 $69.86 $69.86 2026-05-13
J1120 HCPCS Acetazolamid Sodium Injectio 24 22 $31.00 $24.80 20% off $31.00 $31.00 $31.00 2026-05-13
J1212 HCPCS Dimethyl Sulfoxide 50% 50 Ml 24 22 $2,011.00 $1,608.80 20% off $1,123.35 $1,123.35 $1,123.35 2026-05-13
J1306 HCPCS Injection, Inclisiran, 1 Mg 24 22 $36.00 $28.80 20% off $20.01 $20.01 $20.01 2026-05-13
J1335 HCPCS Ertapenem Injection 24 22 $30.00 $24.00 20% off $21.40 $21.40 $21.40 2026-05-13
J1426 HCPCS Injection, Casimersen, 10 Mg 24 22 $362.00 $289.60 $274.28 $274.28 $274.28 2026-05-13
J1455 HCPCS Foscarnet Sodium Injection 24 22 $79.00 $63.20 $79.00 $79.00 $79.00 2026-05-13
J1459 HCPCS Inj Ivig Privigen 500 Mg 24 22 $110.00 $88.00 20% off $79.68 $79.68 $79.68 2026-05-13
J1460 HCPCS Gamma Globulin 1 Cc Inj 24 22 $143.00 $114.40 $83.70 $83.70 $83.70 2026-05-13
J1561 HCPCS Gamunex-c/gammaked 24 22 $178.00 $142.40 $82.15 $82.15 $82.15 2026-05-13
J1566 HCPCS Immune Globulin, Powder 24 22 $232.00 $185.60 20% off $129.53 $129.53 $129.53 2026-05-13
J1569 HCPCS Gammagard Liquid Injection 24 22 $169.00 $135.20 20% off $72.85 $72.85 $72.85 2026-05-13
J1610 HCPCS Glucagon Hydrochloride/1 Mg 24 22 $410.00 $328.00 20% off $310.81 $310.81 $310.81 2026-05-13
J1950 HCPCS Leuprolide Acetate /3.75 Mg 24 22 $5,215.00 $4,172.00 20% off $2,581.59 $2,581.59 $2,581.59 2026-05-13
J2182 HCPCS Injection, Mepolizumab, 1mg 24 22 $116.00 $92.80 20% off $50.34 $50.34 $50.34 2026-05-13
J2274 HCPCS Inj Morphine Pf Epid Ithc 24 22 $55.00 $44.00 20% off $18.55 $18.55 $18.55 2026-05-13
J2356 HCPCS Inj Tezepelumab-ekko, 1mg 24 22 $67.00 $53.60 20% off $30.67 $30.67 $30.67 2026-05-13
J2357 HCPCS Omalizumab Injection 24 22 $148.00 $118.40 $65.11 $65.11 $65.11 2026-05-13
J2406 HCPCS Injection, Oritavancin 10 Mg 24 22 $123.00 $98.40 $67.52 $67.52 $67.52 2026-05-13
J2407 HCPCS Injection, Oritavancin 24 22 $80.00 $64.00 20% off $45.54 $45.54 $45.54 2026-05-13
J2426 HCPCS Inj, Invega Sustenna, 1 Mg 24 22 $43.00 $34.40 20% off $23.63 $23.63 $23.63 2026-05-13
J2427 HCPCS Inj, Invega Hafyera/trinza 24 22 $37.00 $29.60 $20.15 $20.15 $20.15 2026-05-13
J2777 HCPCS Inj, Faricimab-svoa, 0.1mg 24 22 $72.00 $57.60 20% off $59.55 $59.55 $59.55 2026-05-13
J2778 HCPCS Ranibizumab Injection 24 22 $180.00 $144.00 20% off $180.00 $180.00 $180.00 2026-05-13
J2779 HCPCS Inj, Susvimo 0.1 Mg 24 22 $172.00 $137.60 20% off $133.29 $133.29 $133.29 2026-05-13
J2781 HCPCS Inj, Pegcetacoplan, 1mg 24 22 $452.00 $361.60 $249.91 $249.91 $249.91 2026-05-13
J2787 HCPCS Riboflavin 5'phos Opth<=3ml 24 22 $13,680.00 $10,944.00 20% off $4,108.50 $4,108.50 $4,108.50 2026-05-13
J2790 HCPCS Injection; Rho D Immune Globulin; Human; Full Dose; 300 Micrograms (1500 Iu) 25 22 $128.00 $102.40 $128.00 $133.91 $128.00 2026-05-13
J2794 HCPCS Inj Risperdal Consta, 0.5 Mg 24 22 $36.00 $28.80 20% off $20.05 $20.05 $20.05 2026-05-13
J2798 HCPCS Inj., Perseris, 0.5 Mg 24 22 $34.00 $27.20 20% off $19.17 $19.17 $19.17 2026-05-13
J2799 HCPCS Inj, Uzedy, 1 Mg 24 22 $68.00 $54.40 20% off $40.76 $40.76 $40.76 2026-05-13
J2805 HCPCS Sincalide Injection 24 22 $164.00 $131.20 20% off $164.00 $164.00 $164.00 2026-05-13
J2997 HCPCS Alteplase Recombinant 24 22 $243.00 $194.40 20% off $146.80 $146.80 $146.80 2026-05-13
J3030 HCPCS Sumatriptan Succinate / 6 Mg 24 22 $17.00 $13.60 20% off $17.00 $17.00 $17.00 2026-05-13
J3111 HCPCS Inj. Romosozumab-aqqg 1 Mg 24 22 $38.00 $30.40 20% off $17.70 $17.70 $17.70 2026-05-13
J3240 HCPCS Thyrotropin Injection 24 22 $6,067.00 $4,853.60 $3,334.93 $3,334.93 $3,334.93 2026-05-13
J3241 HCPCS Inj. Teprotumumab-trbw 10 Mg 24 22 $1,082.00 $865.60 20% off $541.20 $541.20 $541.20 2026-05-13
J3299 HCPCS Inj Xipere 1 Mg 24 22 $124.00 $99.20 20% off $80.16 $80.16 $80.16 2026-05-13
J3304 HCPCS Inj Triamcinolone Ace Xr 1mg 24 22 $65.00 $52.00 20% off $28.94 $28.94 $28.94 2026-05-13
J3315 HCPCS Triptorelin Pamoate 24 22 $2,316.00 $1,852.80 20% off $682.42 $682.42 $682.42 2026-05-13
J3396 HCPCS Verteporfin Injection 24 22 $26.00 $20.80 20% off $19.02 $19.02 $19.02 2026-05-13
J3410 HCPCS Hydroxyzine Hcl Injection 24 22 $55.00 $44.00 20% off $16.35 $16.35 $16.35 2026-05-13
J3490 HCPCS Drugs Unclassified Injection 9 9 $7.00 $5.60 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
J7060 HCPCS 5% Dextrose/water (500 Ml = 1 Unit) 9 9 $4.50 $3.60 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
J7296 HCPCS Kyleena, 19.5 Mg 24 22 $3,644.00 $2,915.20 20% off $2,290.45 $2,290.45 $2,290.45 2026-05-13
J7297 HCPCS Liletta, 52 Mg 24 22 $2,796.00 $2,236.80 $1,756.97 $1,756.97 $1,756.97 2026-05-13
J7298 HCPCS Mirena, 52 Mg 24 22 $3,644.00 $2,915.20 20% off $2,290.45 $2,290.45 $2,290.45 2026-05-13
J7300 HCPCS Intra Copp Contra (paragard) 24 22 $3,127.00 $2,501.60 20% off $2,148.30 $2,148.30 $2,148.30 2026-05-13
J7301 HCPCS Skyla, 13.5 Mg 24 22 $3,035.00 $2,428.00 20% off $1,907.17 $1,907.17 $1,907.17 2026-05-13
J7307 HCPCS Etonogestrel Implant System 24 22 $1,657.00 $1,325.60 20% off $1,657.00 $1,657.00 $1,657.00 2026-05-13
J7308 HCPCS Aminolevulinic Acid Hcl Top 24 22 $1,180.00 $944.00 20% off $647.33 $647.33 $647.33 2026-05-13
J7312 HCPCS Dexamethasone Intra Implant 24 22 $589.00 $471.20 20% off $339.26 $339.26 $339.26 2026-05-13
J7313 HCPCS Inj., Iluvien, 0.01 Mg 24 22 $1,454.00 $1,163.20 $810.07 $810.07 $810.07 2026-05-13
J7314 HCPCS Inj., Yutiq, 0.01 Mg 24 22 $1,545.00 $1,236.00 20% off $872.85 $872.85 $872.85 2026-05-13
J7321 HCPCS Hyalgan Supartz Visco-3 Dose 24 22 $712.00 $569.60 $120.62 $120.62 $120.62 2026-05-13
J7323 HCPCS Euflexxa Inj Per Dose 24 22 $1,003.00 $802.40 20% off $210.05 $210.05 $210.05 2026-05-13
J7324 HCPCS Orthovisc Inj Per Dose 24 22 $360.00 $288.00 20% off $215.56 $215.56 $215.56 2026-05-13
J7326 HCPCS Gel-one 24 22 $1,485.00 $1,188.00 20% off $820.53 $820.53 $820.53 2026-05-13
J7327 HCPCS Monovisc Inj Per Dose 24 22 $1,802.00 $1,441.60 20% off $1,178.71 $1,178.71 $1,178.71 2026-05-13
J7351 HCPCS Inj Bimatoprost Itc Imp1mcg 24 22 $608.00 $486.40 20% off $340.25 $340.25 $340.25 2026-05-13
J7402 HCPCS Mometasone Sinus Sinuva 24 22 $33.00 $26.40 20% off $18.73 $18.73 $18.73 2026-05-13
J9029 HCPCS Instill Adstiladrin, Tx Dose 24 22 $138,420.00 $110,736.00 20% off $101,970.00 $101,970.00 $101,970.00 2026-05-13
J9202 HCPCS Goserelin Acetate Implant 24 22 $3,372.00 $2,697.60 20% off $1,004.87 $1,004.87 $1,004.87 2026-05-13
J9208 HCPCS Ifosfamide Injection 24 22 $83.00 $66.40 $44.14 $44.14 $44.14 2026-05-13
J9217 HCPCS Leuprolide Acetate Suspnsion 24 22 $513.00 $410.40 20% off $299.15 $299.15 $299.15 2026-05-13
J9226 HCPCS Supprelin La Implant 24 22 $150,543.00 $120,434.40 20% off $73,550.30 $73,550.30 $73,550.30 2026-05-13
J9280 HCPCS Mitomycin Injection 24 22 $242.00 $193.60 20% off $104.53 $104.53 $104.53 2026-05-13
J9334 HCPCS Inj Efgart-alfa 2mg Hya-qvfc 24 22 $98.00 $78.40 $53.20 $53.20 $53.20 2026-05-13
J9357 HCPCS Valrubicin Injection 24 22 $4,088.00 $3,270.40 20% off $2,250.35 $2,250.35 $2,250.35 2026-05-13
P9047 HCPCS Albumin (human), 25%, 50ml 24 22 $105.00 $84.00 20% off $87.58 $87.58 $87.58 2026-05-13
Q2038 HCPCS Fluzone Vacc, 3 Yrs & >, IM 24 22 $54.00 $43.20 $54.00 $54.00 $54.00 2026-05-13
Q4101 HCPCS Apligraf 24 22 $966.00 $772.80 $50.16 $50.16 $50.16 2026-05-13
Q4159 HCPCS Affinity1 Square Cm 24 22 $683.00 $546.40 20% off $593.44 $593.44 $593.44 2026-05-13
Q4160 HCPCS Nushield 1 Square Cm 24 22 $376.00 $300.80 20% off $161.68 $161.68 $161.68 2026-05-13
Q4194 HCPCS Novachor 1 Sq Cm 24 22 $1,838.00 $1,470.40 $1,649.84 $1,649.84 $1,649.84 2026-05-13
Q4196 HCPCS Puraply Am 1 Sq Cm 25 22 $450.00 $360.00 20% off $95.00 $171.22 $171.22 2026-05-13
Q4197 HCPCS Puraply Xt 1 Sq Cm 26 22 $198.00 $158.40 20% off $192.00 $202.92 $198.00 2026-05-13
Q4199 HCPCS Cygnus Matrix, Per Sq Cm 27 22 $207.00 $165.60 20% off $207.00 $524.44 $207.00 2026-05-13
Q4210 HCPCS Axolotl Graf Dualgraf Sq Cm 24 22 $515.00 $412.00 20% off $515.00 $515.00 $515.00 2026-05-13
Q4282 HCPCS Cygnus Dual Per Sq Cm 25 22 $1,081.00 $864.80 20% off $1,081.00 $1,095.00 $1,081.00 2026-05-13
Q5107 HCPCS Inj Mvasi 10 Mg 24 22 $181.00 $144.80 $42.27 $42.27 $42.27 2026-05-13
Q9967 HCPCS Low Osmolar Contrast Material; 300-399 Mg/ml Iodine Concentration; Per Ml 9 9 $21.84 $17.47 20% off $2,213.50 $2,213.50 $2,213.50 2026-05-13
S5553 HCPCS Insulin; Long Acting; 5 Units 9 9 $50.72 $40.58 $2,213.50 $2,213.50 $2,213.50 2026-05-13
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