Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
ICATIBANT ACETATE 30 MG/3 ML SOSY per 1 mg
Low
$22
Average
$10.5k
Median
$128
High
$66.9k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
44 hospitals; the 90th percentile is 527.3× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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44 hospital rates
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $44 | $44 | — | — | — | $44 – $44 |
| 2 | Baptist Medical Center-Attala Kosciusko, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $2.4k | $2.2k | $929 | 41% | — | $1.2k – $3.7k |
| 3 | Baptist Medical Center-Yazoo Yazoo City, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $2.3k | $2.2k | $902 | 41% | — | $1.2k – $3.6k |
| 4 | Baptist Memorial Hospital - Leake Carthage, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $2.3k | $2.2k | $902 | 41% | — | $1.2k – $3.6k |
| 5 | Baptist Memorial Hospital-Calhoun Calhoun City, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $3.0k | $2.8k | $1.1k | 41% | — | $1.5k – $4.6k |
| 6 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 7 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 8 | Clarion Hospital Clarion, PA facility · fee schedule · outpatient | 1 | $130 | $130 | — | — | — | $130 – $130 |
| 9 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $162 | $162 | — | — | — | $162 – $162 |
| 10 | Hospital Service District #1, Parish of Terrebonne, State of Louisiana dba Terrebonne General Health System Houma, LA facility · fee schedule · outpatient | 1 | $66.9k | $66.9k | — | — | — | $66.9k – $66.9k |
| 11 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 12 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · fee schedule · outpatient | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 13 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $111 | $111 | — | — | — | $111 – $111 |
| 14 | MCLAREN BAY REGION CITY, MI fee schedule | 1 | $128 | $128 | — | — | — | $128 – $128 |
| 15 | MCLAREN CARO REGION CARO, MI fee schedule | 1 | $32 | $32 | — | — | — | $32 – $32 |
| 16 | MCLAREN CENTRAL MICHIGAN PLEASANT, MI fee schedule | 1 | $115 | $115 | — | — | — | $115 – $115 |
| 17 | MCLAREN FLINT FLINT, MI fee schedule | 1 | $124 | $124 | — | — | — | $124 – $124 |
| 18 | MCLAREN GREATER LANSING LANSING, MI fee schedule | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 19 | MCLAREN LAPEER REGION LAPEER, MI fee schedule | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 20 | MCLAREN MACOMB CLEMENS, MI fee schedule | 1 | $115 | $115 | — | — | — | $115 – $115 |
| 21 | MCLAREN NORTHERN MICHIGAN PETOSKEY, MI fee schedule | 1 | $115 | $115 | — | — | — | $115 – $115 |
| 22 | MCLAREN OAKLAND PONTIAC, MI fee schedule | 1 | $115 | $115 | — | — | — | $115 – $115 |
| 23 | MCLAREN PORT HURON HURON, MI fee schedule | 1 | $128 | $128 | — | — | — | $128 – $128 |
| 24 | MCLAREN THUMB REGION AXE, MI fee schedule | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 25 | McLeod Health Dillon, SC fee schedule · both | 1 | $124 | $124 | — | — | — | $124 – $124 |
← Payers reporting HCPCS J1744 · Snapshot 20261111T120946Z-9134e7f7