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

San Joaquin Valley Rehabilitation Hosp

Fresno, CA · CCN 053032 · Rates published

4,414 distinct procedures filed
59 distinct payers
235,338 rate rows
2026-07-31 last MRF observed
Data quality

217,405 of 235,338 rate rows are consumer-grade (92.4%)

17,933 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
template filing: same amount across many unrelated codes — excluded 17,850
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 80
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 3
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://sjvrehab.com/wp-content/uploads/sites/15/2025/09/030501943_san-joaquin-valley-rehab_standardcharges.csv
Found on page https://sjvrehab.com/about-us/price-transparency/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-03
Content fingerprint ae82410c96211dd7… · 9,961,822 bytes · first seen 2026-05-08

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
68875010201
OTHER 		22 $19,590.00 $99,999.99 $99,999.99 —
407
OTHER 		19 $78,030.33 $99,477.32 $87,169.12 nat. median
$2,154
outlier · 40.5×
404
OTHER 		19 $56,249.23 $71,708.00 $62,836.26 nat. median
$2,134
outlier · 29.4×
406
OTHER 		24 $34,236.80 $120,579.90 $62,813.91 nat. median
$2,154
outlier · 29.2×
1904
OTHER 		25 $59,468.51 $86,077.36 $61,750.39 nat. median
$3,015
outlier · 20.5×
1806
OTHER 		24 $56,164.88 $157,760.46 $61,322.15 nat. median
$2,186
outlier · 28.1×
106
OTHER 		24 $20,049.34 $134,624.04 $59,308.04 nat. median
$2,886
outlier · 20.6×
505
OTHER 		24 $5,787.35 $70,971.53 $52,162.18 nat. median
$2,374
outlier · 22.0×
55292070255
OTHER 		22 $19,590.00 $52,162.17 $51,333.70 —
205
OTHER 		24 $28,157.62 $87,372.35 $51,131.60 nat. median
$2,374
outlier · 21.5×
405
OTHER 		24 $44,731.62 $70,648.99 $49,228.07 nat. median
$2,154
outlier · 22.9×
1705
OTHER 		25 $33,187.19 $74,335.85 $47,955.14 nat. median
$1,526
outlier · 31.4×
105
OTHER 		24 $23,920.57 $75,247.94 $47,649.26 nat. median
$2,374
outlier · 20.1×
305
OTHER 		24 $32,293.44 $64,938.59 $44,886.91 nat. median
$2,374
outlier · 18.9×
1004
OTHER 		24 $31,187.42 $67,778.22 $44,778.68 nat. median
$2,374
outlier · 18.9×
1903
OTHER 		19 $41,656.33 $59,091.57 $43,909.27 nat. median
$3,015
outlier · 14.6×
604
OTHER 		24 $21,315.41 $89,085.37 $43,870.44 nat. median
$2,374
outlier · 18.5×
1805
OTHER 		25 $29,837.60 $68,224.21 $43,178.68 nat. median
$2,186
outlier · 19.8×
2005
OTHER 		25 $30,851.87 $61,832.47 $41,745.75 nat. median
$2,374
outlier · 17.6×
2102
OTHER 		19 $35,388.12 $54,531.59 $41,437.51 nat. median
$2,154
outlier · 19.2×
1504
OTHER 		24 $37,628.22 $84,985.63 $40,849.28 nat. median
$1,526
outlier · 26.8×
1304
OTHER 		19 $36,997.53 $50,390.42 $40,716.33 nat. median
$2,374
outlier · 17.2×
904
OTHER 		24 $32,130.97 $68,705.92 $40,359.87 nat. median
$2,154
outlier · 18.7×
403
OTHER 		19 $36,025.76 $45,926.91 $40,244.57 nat. median
$2,154
outlier · 18.7×
704
OTHER 		25 $19,263.25 $65,509.42 $40,126.93 nat. median
$1,591
outlier · 25.2×
59627022205
OTHER 		22 $19,590.00 $52,162.17 $39,676.03 —
59627033304
OTHER 		22 $19,590.00 $52,162.17 $39,676.03 —
2004
OTHER 		25 $14,642.45 $63,530.28 $39,604.58 nat. median
$2,374
outlier · 16.7×
74368303
OTHER 		22 $19,590.00 $52,162.17 $39,246.62 —
1604
OTHER 		19 $34,326.95 $55,235.11 $39,053.99 nat. median
$2,154
outlier · 18.1×
1305
OTHER 		19 $35,430.47 $48,256.31 $38,991.64 nat. median
$2,154
outlier · 18.1×
805
OTHER 		24 $30,832.76 $65,791.91 $38,917.52 nat. median
$1,526
outlier · 25.5×
104
OTHER 		24 $31,792.34 $63,080.31 $38,105.76 nat. median
$2,374
outlier · 16.1×
1103
OTHER 		19 $37,166.94 $47,190.43 $37,933.99 nat. median
$2,154
outlier · 17.6×
1704
OTHER 		25 $19,941.82 $81,654.24 $37,844.58 nat. median
$1,526
outlier · 24.8×
1204
OTHER 		19 $33,484.60 $51,381.01 $37,844.58 nat. median
$2,154
outlier · 17.6×
504
OTHER 		24 $3,356.00 $64,973.18 $37,538.70 nat. median
$2,374
outlier · 15.8×
1804
OTHER 		25 $33,021.07 $89,916.01 $37,515.17 nat. median
$2,186
outlier · 17.2×
304
OTHER 		24 $13,863.09 $57,042.75 $37,388.11 nat. median
$2,374
outlier · 15.7×
1404
OTHER 		24 $33,081.17 $58,985.44 $36,981.06 nat. median
$2,154
outlier · 17.2×
204
OTHER 		24 $30,954.62 $62,288.95 $36,256.35 nat. median
$2,374
outlier · 15.3×
603
OTHER 		24 $18,426.52 $95,835.75 $34,981.06 nat. median
$2,374
outlier · 14.7×
1003
OTHER 		24 $28,625.79 $61,498.39 $34,976.36 nat. median
$2,154
outlier · 16.2×
1203
OTHER 		24 $31,929.31 $48,997.49 $34,926.94 nat. median
$1,526
outlier · 22.9×
703
OTHER 		24 $16,965.85 $75,648.43 $34,675.18 nat. median
$1,591
outlier · 21.8×
1703
OTHER 		25 $29,198.75 $57,877.70 $33,437.54 nat. median
$2,154
outlier · 15.5×
1803
OTHER 		19 $30,197.55 $43,002.21 $33,437.53 nat. median
$2,186
outlier · 15.3×
74055402
OTHER 		22 $19,590.00 $52,162.17 $33,228.58 —
2144511
OTHER 		22 $19,590.00 $52,162.17 $33,195.46 —
2003
OTHER 		25 $13,713.00 $60,096.92 $33,124.60 nat. median
$2,374
outlier · 14.0×

Other procedures at this hospital

Browse this hospital's 4,414 published procedures. Use the slice to choose what to show, then sort or filter any column.

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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
             
68875010201 OTHER Gattex 46 22 $99,999.99 $99,999.99 $19,590.00 $99,999.99 $99,999.99 2026-05-09
407 OTHER Traumatic Spinal Cord Injury M <24.50 And A >=61.50 Tier 1 B 76 19 $87,169.12 $87,169.12 $78,030.33 $99,477.32 $87,169.12 2026-05-08
404 OTHER Traumatic Spinal Cord Injury M <31.50 And A <61.50 Tier 1 B 76 19 $62,836.26 $62,836.26 $56,249.23 $71,708.00 $62,836.26 2026-05-08
406 OTHER Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 Tier 3 D 117 24 $62,813.91 $63,760.96 $34,236.80 $120,579.90 $62,813.91 2026-05-09
1904 OTHER Guillain-barr� M <38.50 None A 99 25 $61,750.39 $63,963.32 $59,468.51 $86,077.36 $61,750.39 2026-05-09
1806 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 None A 99 24 $64,592.73 $62,957.44 $56,164.88 $157,760.46 $61,322.15 2026-05-09
106 OTHER Stroke M <41.50 And A <84.50 Tier 1 B 165 24 $68,385.66 $56,752.76 $20,049.34 $134,624.04 $59,308.04 2026-05-09
505 OTHER Non-traumatic Spinal Cord Injury M <39.50 Tier 3 D 125 24 $52,162.18 $53,688.06 $5,787.35 $70,971.53 $52,162.18 2026-05-09
55292070255 OTHER Hemin For Injection 46 22 $51,333.70 $51,333.70 $19,590.00 $52,162.17 $51,333.70 2026-05-09
205 OTHER Traumatic Brain Injury M <35.50 Tier 1 B 156 24 $56,114.70 $48,786.90 $28,157.62 $87,372.35 $51,131.60 2026-05-09
405 OTHER Traumatic Spinal Cord Injury M >=31.50 And M <41.50 Tier2 C 118 24 $49,228.07 $49,970.42 $44,731.62 $70,648.99 $49,228.07 2026-05-09
1705 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 Tier 1 B 141 25 $59,823.64 $46,183.38 23% off $33,187.19 $74,335.85 $47,955.14 2026-05-09
105 OTHER Stroke M <41.50 And A >=84.50 None A 139 24 $60,124.51 $49,896.31 $23,920.57 $75,247.94 $47,649.26 2026-05-09
305 OTHER Non-traumatic Brain Injury M <42.50 And A <78.50 Tier 1 B 157 24 $47,366.77 $43,059.86 $32,293.44 $64,938.59 $44,886.91 2026-05-09
1004 OTHER Amputation Lower Extremity M <47.50 Tier 1 B 158 24 $48,912.33 $42,841.04 $31,187.42 $67,778.22 $44,778.68 2026-05-09
1903 OTHER Guillain-barr� M >=38.50 And M <51.50 Tier 1 B 76 19 $43,909.27 $43,909.27 $41,656.33 $59,091.57 $43,909.27 2026-05-08
604 OTHER Neurological M <43.50 Tier 1 B 163 24 $60,979.78 $42,412.80 30% off $21,315.41 $89,085.37 $43,870.44 2026-05-09
1805 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 T… 119 25 $57,013.93 $44,330.44 22% off $29,837.60 $68,224.21 $43,178.68 2026-05-09
2005 OTHER Miscellaneous M <46.50 And A <77.50 Tier 1 B 162 25 $52,263.36 $40,371.63 23% off $30,851.87 $61,832.47 $41,745.75 2026-05-09
2102 OTHER Burns M <52.50 Tier 1 B 57 19 $41,437.51 $41,437.51 $35,388.12 $54,531.59 $41,437.51 2026-05-08
1504 OTHER Pulmonary M <45.50 Tier 3 D 117 24 $53,515.12 $42,142.21 21% off $37,628.22 $84,985.63 $40,849.28 2026-05-09
1304 OTHER Rheumatoid Other Arthritis M <44.50 And A >=64.50 Tier 1 B 76 19 $40,716.33 $40,716.33 $36,997.53 $50,390.42 $40,716.33 2026-05-08
904 OTHER Other Orthopedic M <44.5 Tier 1 B 160 24 $63,571.45 $38,989.29 39% off $32,130.97 $68,705.92 $40,359.87 2026-05-09
403 OTHER Traumatic Spinal Cord Injury M >=41.50 And M <47.50 Tier 1 B 76 19 $40,244.57 $40,244.57 $36,025.76 $45,926.91 $40,244.57 2026-05-08
704 OTHER Fracture Of Lower Extremity M <41.50 None A 147 25 $54,759.82 $41,243.40 25% off $19,263.25 $65,509.42 $40,126.93 2026-05-09
59627033304 OTHER Avonex Pen 30 mcg/0.5mL 46 22 $39,676.03 $39,676.03 $19,590.00 $52,162.17 $39,676.03 2026-05-09
59627022205 OTHER Avonex 46 22 $39,676.03 $39,676.03 $19,590.00 $52,162.17 $39,676.03 2026-05-09
2004 OTHER Miscellaneous M <46.50 And A >=77.50 Tier 1 B 164 25 $49,583.37 $38,301.06 23% off $14,642.45 $63,530.28 $39,604.58 2026-05-09
74368303 OTHER Lupron Depot 46 22 $39,246.62 $39,246.62 $19,590.00 $52,162.17 $39,246.62 2026-05-09
1604 OTHER Pain Syndrome M <43.50 Tier 1 B 76 19 $39,053.99 $39,053.99 $34,326.95 $55,235.11 $39,053.99 2026-05-08
1305 OTHER Rheumatoid Other Arthritis M <51.50 And A <64.50 Tier 1 B 76 19 $38,991.64 $38,991.64 $35,430.47 $48,256.31 $38,991.64 2026-05-08
805 OTHER Replacement Of Lower-extremity Joint M <42.50 Tier 1 B 158 24 $48,501.02 $37,199.88 23% off $30,832.76 $65,791.91 $38,917.52 2026-05-09
104 OTHER Stroke M >=41.50 And M <50.50 Tier 3 D 122 24 $48,082.20 $39,902.23 $31,792.34 $63,080.31 $38,105.76 2026-05-09
1103 OTHER Amputation Non-lower Extremity M <52.50 Tier 1 B 57 19 $37,933.99 $37,933.99 $37,166.94 $47,190.43 $37,933.99 2026-05-08
1704 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 139 25 $37,844.58 $39,353.99 $19,941.82 $81,654.24 $37,844.58 2026-05-09
1204 OTHER Osteoarthritis M <49.50 And A <74.50 Tier 1 B 76 19 $37,844.58 $37,844.58 $33,484.60 $51,381.01 $37,844.58 2026-05-08
504 OTHER Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 Tier 2 C 141 24 $51,075.13 $38,636.35 24% off $3,356.00 $64,973.18 $37,538.70 2026-05-09
1804 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50 T… 119 25 $37,515.17 $36,564.58 $33,021.07 $89,916.01 $37,515.17 2026-05-09
304 OTHER Non-traumatic Brain Injury M <42.50 And A >=78.50 Tier 2 C 136 24 $40,701.04 $39,044.57 $13,863.09 $57,042.75 $37,388.11 2026-05-09
1404 OTHER Cardiac M <45.50 Tier 3 D 116 24 $50,489.25 $38,377.52 24% off $33,081.17 $58,985.44 $36,981.06 2026-05-09
204 OTHER Traumatic Brain Injury M >=35.50 And M <49.50 Tier 3 D 120 24 $48,465.72 $38,088.11 21% off $30,954.62 $62,288.95 $36,256.35 2026-05-09
603 OTHER Neurological M >=43.50 And M <52.50 Tier 1 B 165 24 $46,724.55 $33,818.71 28% off $18,426.52 $95,835.75 $34,981.06 2026-05-09
1003 OTHER Amputation Lower Extremity M >=47.50 And M <55.50 Tier 2 C 117 24 $42,291.63 $33,463.42 21% off $28,625.79 $61,498.39 $34,976.36 2026-05-09
1203 OTHER Osteoarthritis M <49.50 And A >=74.50 Tier 3 D 98 24 $37,249.29 $36,088.12 $31,929.31 $48,997.49 $34,926.94 2026-05-09
703 OTHER Fracture Of Lower Extremity M >=41.50 And M <52.50 Tier 1 B 163 24 $51,111.65 $33,761.07 34% off $16,965.85 $75,648.43 $34,675.18 2026-05-09
1703 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 120 25 $46,446.91 $34,770.48 25% off $29,198.75 $57,877.70 $33,437.54 2026-05-09
1803 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50 T… 76 19 $33,437.53 $33,437.53 $30,197.55 $43,002.21 $33,437.53 2026-05-08
74055402 OTHER Humira(Cf) Pen 46 22 $33,228.58 $33,228.58 $19,590.00 $52,162.17 $33,228.58 2026-05-09
2144511 OTHER Taltz Autoinjector 46 22 $33,195.46 $33,195.46 $19,590.00 $52,162.17 $33,195.46 2026-05-09
2003 OTHER Miscellaneous M >=46.50 And M <55.50 Tier 1 B 161 25 $46,946.11 $32,034.01 32% off $13,713.00 $60,096.92 $33,124.60 2026-05-09
1503 OTHER Pulmonary M >=45.50 And M <56.50 None A 98 24 $35,072.83 $34,029.30 $30,005.27 $43,213.98 $32,985.77 2026-05-09
1403 OTHER Cardiac M >=45.50 And M <55.50 Tier 1 B 156 24 $37,713.86 $31,321.08 $26,705.36 $51,659.12 $32,461.07 2026-05-09
303 OTHER Non-traumatic Brain Injury M >=42.50 And M <52.50 Tier 2 C 136 24 $35,103.41 $33,675.18 $28,191.03 $72,084.50 $32,317.66 2026-05-09
1303 OTHER Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50 Tier 1 B 76 19 $32,242.25 $32,242.25 $29,296.37 $39,901.05 $32,242.25 2026-05-08
402 OTHER Traumatic Spinal Cord Injury M >=47.50 And M <56.50 Tier 1 B 117 24 $31,592.84 $32,069.31 $24,970.43 $41,361.92 $31,592.84 2026-05-09
503 OTHER Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50 Tier 3 D 118 24 $42,966.92 $32,502.24 24% off $26,608.05 $49,981.47 $31,578.72 2026-05-09
1603 OTHER Pain Syndrome M >=43.50 And M <58.50 Tier 1 B 76 19 $31,521.07 $31,521.07 $27,705.79 $44,581.03 $31,521.07 2026-05-08
903 OTHER Other Orthopedic M >=44.50 And M <51.50 Tier 1 B 138 24 $42,053.98 $32,538.71 23% off $27,195.76 $60,720.41 $31,395.19 2026-05-09
25682000101 OTHER Soliris 46 22 $31,310.40 $31,310.40 $19,590.00 $52,162.17 $31,310.40 2026-05-09
55513019201 OTHER Neulasta Onpro 46 22 $30,806.35 $30,806.35 $19,590.00 $52,162.17 $30,806.35 2026-05-09
55513019001 OTHER Neulasta 6 Mg 46 22 $30,806.35 $30,806.35 $19,590.00 $52,162.17 $30,806.35 2026-05-09
103 OTHER Stroke M >=50.50 And M <63.50 Tier 1 B 166 25 $37,675.17 $31,266.96 $20,525.17 $52,356.82 $30,624.07 2026-05-09
1102 OTHER Amputation Non-lower Extremity M >=52.50 And M <58.50 Tier 1 B 57 19 $30,418.72 $30,418.72 $29,804.61 $37,842.23 $30,418.72 2026-05-08
203 OTHER Traumatic Brain Injury M >=49.50 And M <61.50 Tier 2 C 136 24 $39,077.52 $30,709.31 21% off $25,808.79 $51,786.87 $30,356.58 2026-05-09
602 OTHER Neurological M >=52.50 And M <64.50 Tier 1 B 159 24 $39,653.99 $28,702.26 28% off $11,654.00 $56,945.51 $29,689.31 2026-05-09
804 OTHER Replacement Of Lower-extremity Joint M >=42.50 And M <51.50 Tier 3 D 142 25 $40,439.87 $31,017.55 23% off $23,408.00 $49,765.17 $29,585.79 2026-05-09
1902 OTHER Guillain-barr� M >=51.50 And M <66.50 Tier 1 B 76 19 $29,103.44 $29,103.44 $27,609.32 $39,164.58 $29,103.44 2026-05-08
1502 OTHER Pulmonary M >=56.50 And M <68.50 Tier 3 D 117 24 $29,023.43 $29,942.26 $15,909.35 $44,708.40 $29,023.43 2026-05-09
803 OTHER Replacement Of Lower-extremity Joint M >=51.50 And M <57.50 Tier 1 B 157 24 $39,633.93 $27,685.79 30% off $3,943.03 $61,141.75 $28,964.61 2026-05-09
1702 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 119 25 $39,086.93 $29,261.08 25% off $24,724.73 $57,635.21 $28,138.73 2026-05-09
68982085005 OTHER Octagam 46 22 $27,972.00 $27,972.00 $19,590.00 $52,162.17 $27,972.00 2026-05-09
1202 OTHER Osteoarthritis M >=49.50 And M <61.50 Tier 1 B 76 19 $27,856.38 $27,856.38 $24,646.98 $37,821.05 $27,856.38 2026-05-08
1302 OTHER Rheumatoid Other Arthritis M >=51.50 And M <62.50 Tier 3 D 98 24 $28,999.90 $28,341.08 $25,750.50 $47,795.95 $27,682.26 2026-05-09
2002 OTHER Miscellaneous M >=55.50 And M <66.50 Tier 1 B 160 25 $31,145.78 $26,750.50 $3,916.35 $47,245.03 $27,661.09 2026-05-09
502 OTHER Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 Tier 3 D 118 24 $27,550.50 $28,355.20 $23,235.60 $38,803.04 $27,550.50 2026-05-09
1002 OTHER Amputation Lower Extremity M >=55.50 And M <64.50 Tier 3 D 118 24 $36,096.35 $28,561.08 21% off $21,841.93 $65,868.14 $27,270.50 2026-05-09
2101 OTHER Burns M >=52.50 Tier 1 B 57 19 $26,905.79 $26,905.79 $22,978.75 $35,409.30 $26,905.79 2026-05-08
302 OTHER Non-traumatic Brain Injury M >=52.50 And M <65.50 Tier 3 D 117 24 $36,465.76 $27,988.14 23% off $23,507.74 $40,256.58 $26,799.91 2026-05-09
702 OTHER Fracture Of Lower Extremity M >=52.50 And M <61.50 Tier 1 B 143 24 $36,451.65 $27,454.03 25% off $21,315.41 $51,654.46 $26,710.50 2026-05-09
902 OTHER Other Orthopedic M >=51.50 And M <63.50 Tier 2 C 138 24 $35,216.35 $27,248.15 23% off $22,004.96 $52,406.69 $26,289.33 2026-05-09
1802 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50 T… 76 19 $26,025.80 $26,025.80 $23,503.45 $33,470.48 $26,025.80 2026-05-08
1602 OTHER Pain Syndrome M >=58.50 And M <65.50 Tier 1 B 76 19 $24,959.92 $24,959.92 $21,938.75 $35,301.06 $24,959.92 2026-05-08
1402 OTHER Cardiac M >=55.50 And M <68.50 Tier 3 D 118 24 $30,581.02 $25,597.56 $17,463.45 $50,448.36 $24,665.80 2026-05-09
401 OTHER Traumatic Spinal Cord Injury M >=56.50 None A 98 24 $24,496.39 $24,865.80 $16,753.72 $28,376.38 $24,496.39 2026-05-09
1101 OTHER Amputation Non-lower Extremity M >=58.50 Tier 1 B 57 19 $23,926.98 $23,926.98 $23,444.63 $29,764.61 $23,926.98 2026-05-08
802 OTHER Replacement Of Lower-extremity Joint M >=57.50 And M <63.50 Tier 3 D 123 25 $32,430.48 $24,874.03 23% off $20,041.97 $46,118.22 $23,724.63 2026-05-09
1501 OTHER Pulmonary M >=68.50 Tier 1 B 76 19 $23,603.45 $23,603.45 $21,402.28 $29,974.02 $23,603.45 2026-05-08
202 OTHER Traumatic Brain Injury M >=61.50 And M <73.50 Tier 3 D 119 24 $25,844.62 $24,658.74 $14,779.69 $76,110.01 $23,472.86 2026-05-09
601 OTHER Neurological M >=64.50 Tier 1 B 159 24 $29,817.03 $22,629.33 24% off $5,877.00 $59,715.96 $23,406.98 2026-05-09
102 OTHER Stroke M >=63.50 And M <72.50 None A 100 25 $25,350.51 $24,257.57 $21,593.67 $30,961.29 $23,164.63 2026-05-09
1201 OTHER Osteoarthritis M >=61.50 Tier 1 B 76 19 $23,009.33 $23,009.33 $20,357.58 $31,239.90 $23,009.33 2026-05-08
50633012011 OTHER Digifab 46 22 $22,958.40 $22,958.40 $18,940.68 $52,162.17 $22,958.40 2026-05-09
1701 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50 None A 98 24 $22,649.34 $23,551.69 $16,527.22 $31,461.07 $22,649.34 2026-05-09
2001 OTHER Miscellaneous M >=66.50 Tier 1 B 139 25 $22,185.81 $21,455.22 $18,863.47 $36,451.07 $22,185.81 2026-05-09
78081881 OTHER SandoSTATIN Lar Depot 46 22 $22,158.24 $22,158.24 $18,280.55 $52,162.17 $22,158.24 2026-05-09
501 OTHER Non-traumatic Spinal Cord Injury M >=60.50 Tier 3 D 117 24 $29,879.90 $22,602.28 24% off $19,368.75 $38,049.01 $21,959.93 2026-05-09
1601 OTHER Pain Syndrome M >=65.50 Tier 1 B 76 19 $21,782.28 $21,782.28 $19,145.82 $30,804.60 $21,782.28 2026-05-08
701 OTHER Fracture Of Lower Extremity M >=61.50 Tier 3 D 118 24 $29,510.49 $22,226.99 25% off $18,997.09 $38,974.29 $21,625.81 2026-05-09
1001 OTHER Amputation Lower Extremity M >=64.50 Tier 3 D 98 24 $23,564.63 $22,545.81 $19,039.42 $37,126.08 $21,526.99 2026-05-09
901 OTHER Other Orthopedic M >=63.50 Tier 3 D 118 24 $28,275.20 $21,877.57 23% off $18,086.86 $42,328.33 $21,108.17 2026-05-09
801 OTHER Replacement Of Lower-extremity Joint M >=63.50 Tier 1 B 137 24 $23,311.80 $21,939.93 $15,387.71 $37,660.50 $20,926.99 2026-05-09
1401 OTHER Cardiac M >=68.50 Tier 1 B 117 24 $20,987.53 $20,183.47 $17,080.19 $34,860.69 $20,917.58 2026-05-09
1301 OTHER Rheumatoid Other Arthritis M >=62.50 Tier 1 B 76 19 $20,731.70 $20,731.70 $18,837.59 $25,658.74 $20,731.70 2026-05-08
301 OTHER Non-traumatic Brain Injury M >=65.50 Tier 3 D 117 24 $28,204.61 $21,646.99 23% off $19,536.41 $59,403.45 $20,729.34 2026-05-09
2840001 OTHER Forteo 46 22 $20,591.47 $20,591.47 $16,987.97 $52,162.17 $20,591.47 2026-05-09
1801 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=67.50 Tier 1 B 76 19 $19,397.58 $19,397.58 $17,517.59 $24,948.15 $19,397.58 2026-05-08
101 OTHER Stroke M >=72.50 Tier 1 B 76 19 $19,117.58 $19,117.58 $17,397.59 $23,035.22 $19,117.58 2026-05-08
50458060901 OTHER Invega Trinza 46 22 $19,046.87 $19,046.87 $15,713.67 $52,162.17 $19,046.87 2026-05-09
201 OTHER Traumatic Brain Injury M >=73.50 Tier 1 B 76 19 $18,856.41 $18,856.41 $16,898.77 $23,995.22 $18,856.41 2026-05-08
68982085004 OTHER Octagam 46 22 $18,648.00 $18,648.00 $15,384.60 $52,162.17 $18,648.00 2026-05-09
55513003201 OTHER Aranesp 46 22 $18,576.00 $18,576.00 $15,325.20 $52,162.17 $18,576.00 2026-05-09
1901 OTHER Guillain-barr� M >=66.50 Tier 1 B 76 19 $18,187.00 $18,187.00 $17,254.06 $24,475.21 $18,187.00 2026-05-08
78063998 OTHER Cosentyx 46 22 $17,781.50 $17,781.50 $14,669.74 $52,162.17 $17,781.50 2026-05-09
173089201 OTHER Mepolizumab Injection 46 22 $17,706.38 $17,706.38 $14,607.76 $52,162.17 $17,706.38 2026-05-09
44206043820 OTHER Privigen 10% 46 22 $17,379.84 $17,379.84 $14,338.37 $52,162.17 $17,379.84 2026-05-09
78081181 OTHER SandoSTATIN Lar Depot 46 22 $16,912.46 $16,912.46 $13,952.78 $52,162.17 $16,912.46 2026-05-09
50458056401 OTHER Invega Sustenna 234 Mg 46 22 $16,697.76 $16,697.76 $13,775.65 $52,162.17 $16,697.76 2026-05-09
74379902 OTHER Humira 46 22 $16,614.29 $16,614.29 $13,706.79 $52,162.17 $16,614.29 2026-05-09
944270006 OTHER Gammagard Liquid 46 22 $16,273.92 $16,273.92 $13,425.99 $52,162.17 $16,273.92 2026-05-09
31626 OTHER Bronch Ins Rad Mark 46 22 $16,215.15 $16,215.15 $13,377.50 $52,162.17 $16,215.15 2026-05-09
55513073001 OTHER Denosumab 120 mg/1.7mL 46 22 $15,770.26 $15,770.26 $13,010.47 $52,162.17 $15,770.26 2026-05-09
51759063010 OTHER risperiDONE ER Inj 125 Mg/0.35 46 22 $15,375.36 $15,375.36 $12,684.67 $52,162.17 $15,375.36 2026-05-09
24201040002 OTHER Calcitonin,salmon Inj 400 Unit 46 22 $15,028.80 $15,028.80 $12,398.76 $52,162.17 $15,028.80 2026-05-09
42367054032 OTHER Ryanodex 46 22 $14,040.84 $14,040.84 $11,583.69 $52,162.17 $14,040.84 2026-05-09
59148001971 OTHER Abilify Maintena 46 22 $13,535.23 $13,535.23 $11,166.57 $52,162.17 $13,535.23 2026-05-09
59148007280 OTHER Abilify Maintena 400 Mg 46 22 $13,535.23 $13,535.23 $11,166.57 $52,162.17 $13,535.23 2026-05-09
67457067502 OTHER Miacalcin 46 22 $12,974.72 $12,974.72 $10,704.15 $52,162.17 $12,974.72 2026-05-09
70539000102 OTHER Tymlos 46 22 $12,801.60 $12,801.60 $10,561.32 $52,162.17 $12,801.60 2026-05-09
55513022101 OTHER Nplate 250 Mcg 46 22 $12,585.22 $12,585.22 $10,382.81 $52,162.17 $12,585.22 2026-05-09
31628 OTHER Transbronch Lung Biopsy Sgl 46 22 $12,329.50 $12,329.50 $10,171.84 $52,162.17 $12,329.50 2026-05-09
31629 OTHER Bronch Trnsbronch Ndl Asp 46 22 $12,329.50 $12,329.50 $10,171.84 $52,162.17 $12,329.50 2026-05-09
31653 OTHER Bronch Ebus 3 Or > Stat 46 22 $12,329.50 $12,329.50 $10,171.84 $52,162.17 $12,329.50 2026-05-09
31652 OTHER Bronch Ebus 1 Or 2 Stat 46 22 $12,329.50 $12,329.50 $10,171.84 $52,162.17 $12,329.50 2026-05-09
50474070062 OTHER Cimzia 46 22 $12,239.24 $12,239.24 $10,097.38 $52,162.17 $12,239.24 2026-05-09
55513011101 OTHER Aranesp 46 22 $11,145.60 $11,145.60 $9,195.12 $52,162.17 $11,145.60 2026-05-09
50458056301 OTHER Invega Sustenna 156 Mg 46 22 $11,132.11 $11,132.11 $9,183.99 $52,162.17 $11,132.11 2026-05-09
50458056101 OTHER Invega Sustenna 46 22 $11,131.49 $11,131.49 $9,183.48 $52,162.17 $11,131.49 2026-05-09
50458056001 OTHER Invega Sustenna 46 22 $11,131.01 $11,131.01 $9,183.08 $52,162.17 $11,131.01 2026-05-09
31600 OTHER Percutaneous Tracheostomy 46 22 $11,022.90 $11,022.90 $9,093.90 $52,162.17 $11,022.90 2026-05-09
944265804 OTHER Gammagard S-d 10 Gram 46 22 $10,764.48 $10,764.48 $8,880.69 $52,162.17 $10,764.48 2026-05-09
61953000405 OTHER Flebogamma Dif 46 22 $10,164.48 $10,164.48 $8,385.69 $52,162.17 $10,164.48 2026-05-09
59148004580 OTHER Abilify Maintena 46 22 $10,151.42 $10,151.42 $8,374.92 $52,162.17 $10,151.42 2026-05-09
67457083306 OTHER Pegfilgrastim-jmdb 46 22 $10,020.00 $10,020.00 $8,266.50 $52,162.17 $10,020.00 2026-05-09
74364203 OTHER Lupron Depot 46 22 $9,811.68 $9,811.68 $8,094.64 $52,162.17 $9,811.68 2026-05-09
68982085003 OTHER Octagam 10% 46 22 $9,324.00 $9,324.00 $7,692.30 $52,162.17 $9,324.00 2026-05-09
58406003204 OTHER EnbreL Sureclick 46 22 $9,148.70 $9,148.70 $7,547.68 $52,162.17 $9,148.70 2026-05-09
24591401 OTHER Dupixent Syringe 46 22 $9,127.68 $9,127.68 $7,530.34 $52,162.17 $9,127.68 2026-05-09
44206043710 OTHER Privigen 10% 46 22 $8,689.92 $8,689.92 $7,169.19 $52,162.17 $8,689.92 2026-05-09
31641 OTHER Bronch Dest Grth Lung 46 22 $8,633.10 $8,633.10 $7,122.31 $52,162.17 $8,633.10 2026-05-09
55513071001 OTHER Prolia 46 22 $8,573.38 $8,573.38 $7,073.04 $52,162.17 $8,573.38 2026-05-09
57970010001 OTHER Dalbavancin Hcl 46 22 $8,539.82 $8,539.82 $7,045.35 $52,162.17 $8,539.82 2026-05-09
28005 OTHER Incision, Bone Cortex, Foot 46 22 $8,491.00 $8,491.00 $7,005.07 $52,162.17 $8,491.00 2026-05-09
50458056201 OTHER Invega Sustenna 117 Mg 46 22 $8,348.78 $8,348.78 $6,887.74 $52,162.17 $8,348.78 2026-05-09
944270005 OTHER Gammagard Liquid 10% 46 22 $8,136.96 $8,136.96 $6,712.99 $52,162.17 $8,136.96 2026-05-09
64842072709 OTHER Decitabine/Cedazuridine 35/100 46 22 $7,931.30 $7,931.30 $6,543.32 $52,162.17 $7,931.30 2026-05-09
65757030001 OTHER VivitroL 46 22 $7,877.33 $7,877.33 $6,498.80 $52,162.17 $7,877.33 2026-05-09
31627 OTHER Electromag Nav Bronch 46 22 $7,754.15 $7,754.15 $6,397.18 $52,162.17 $7,754.15 2026-05-09
55513002801 OTHER Aranesp 46 22 $7,430.40 $7,430.40 $6,130.08 $52,162.17 $7,430.40 2026-05-09
55513000601 OTHER Aranesp 46 22 $7,430.40 $7,430.40 $6,130.08 $52,162.17 $7,430.40 2026-05-09
15275 OTHER Wc Apply High Cost Ss Foot 46 22 $7,332.00 $7,332.00 $6,048.90 $52,162.17 $7,332.00 2026-05-09
15271 OTHER Wc Apply High Cost Ss Leg 46 22 $7,332.00 $7,332.00 $6,048.90 $52,162.17 $7,332.00 2026-05-09
15115 OTHER Wc Epdrml Autogrft Ft 1st 100 46 22 $7,332.00 $7,332.00 $6,048.90 $52,162.17 $7,332.00 2026-05-09
15110 OTHER Wc Epdrml Autogrft Leg 1st 100 46 22 $7,332.00 $7,332.00 $6,048.90 $52,162.17 $7,332.00 2026-05-09
59676082001 OTHER Monovisc 46 22 $7,200.00 $7,200.00 $5,940.00 $52,162.17 $7,200.00 2026-05-09
9029703 OTHER Gelfilm 25x50mm 46 22 $7,140.96 $7,140.96 $5,891.29 $52,162.17 $7,140.96 2026-05-09
517065001 OTHER Injectafer 46 22 $6,862.56 $6,862.56 $5,661.61 $52,162.17 $6,862.56 2026-05-09
3218811 OTHER Orencia 46 22 $6,834.32 $6,834.32 $5,638.31 $52,162.17 $6,834.32 2026-05-09
13533080071 OTHER Gamunex-c 46 22 $6,804.00 $6,804.00 $5,613.30 $52,162.17 $6,804.00 2026-05-09
43231 OTHER Eso Flx W/end US Exm 46 22 $6,768.95 $6,768.95 $5,584.39 $52,162.17 $6,768.95 2026-05-09
43214 OTHER Eso Flx W/dil Balloon 30mm Dia 46 22 $6,768.95 $6,768.95 $5,584.39 $52,162.17 $6,768.95 2026-05-09
65162091322 OTHER Voriconazole Oral Susp (bulk) 46 22 $6,753.68 $6,753.68 $5,571.78 $52,162.17 $6,753.68 2026-05-09
4026129 OTHER Cellcept (160ml Bottle) 46 22 $6,628.18 $6,628.18 $5,468.25 $52,162.17 $6,628.18 2026-05-09
50484081015 OTHER Regranex 46 22 $6,526.56 $6,526.56 $5,384.41 $52,162.17 $6,526.56 2026-05-09
2850101 OTHER HumuLIN R U-500 82 22 $7,137.60 $3,572.36 50% off $7.12 $52,162.17 $6,513.06 2026-05-09
11044 OTHER Wc Debride Subq/musc/bone Bx/b 46 22 $6,511.00 $6,511.00 $5,371.57 $52,162.17 $6,511.00 2026-05-09
62935022305 OTHER Leuprolide Acetate 46 22 $6,504.34 $6,504.34 $5,366.08 $52,162.17 $6,504.34 2026-05-09
31624 OTHER Bronch W/alveolar Lavage 46 22 $6,439.65 $6,439.65 $5,312.71 $52,162.17 $6,439.65 2026-05-09
31623 OTHER Bronch W/brushing 46 22 $6,439.65 $6,439.65 $5,312.71 $52,162.17 $6,439.65 2026-05-09
31722062921 OTHER Atovaquone (Bulk Bottle) 46 22 $6,307.16 $6,307.16 $5,203.40 $52,162.17 $6,307.16 2026-05-09
55513022301 OTHER Romiplostim 46 22 $6,292.70 $6,292.70 $5,191.48 $52,162.17 $6,292.70 2026-05-09
78043561 OTHER Reclast 5 Mg 46 22 $6,283.44 $6,283.44 $5,183.84 $52,162.17 $6,283.44 2026-05-09
23392102 OTHER Botox 46 22 $6,201.60 $6,201.60 $5,116.32 $52,162.17 $6,201.60 2026-05-09
44146 OTHER Colec Part W Colopros W/colost 46 22 $5,934.18 $5,934.18 $4,895.70 $52,162.17 $5,934.18 2026-05-09
50458030811 OTHER RisperDAL Consta 50 Mg 46 22 $5,900.21 $5,900.21 $4,867.68 $52,162.17 $5,900.21 2026-05-09
59338077501 OTHER Feraheme 510 Mg 46 22 $5,729.38 $5,729.38 $4,726.74 $52,162.17 $5,729.38 2026-05-09
57894003001 OTHER Remicade 100 Mg 46 22 $5,605.54 $5,605.54 $4,624.57 $52,162.17 $5,605.54 2026-05-09
44208 OTHER Laparosc, Surg Colectomy, Part 46 22 $5,584.11 $5,584.11 $4,606.89 $52,162.17 $5,584.11 2026-05-09
55513002704 OTHER Aranesp 46 22 $5,572.80 $5,572.80 $4,597.56 $52,162.17 $5,572.80 2026-05-09
61958180101 OTHER Harvoni 46 22 $5,400.00 $5,400.00 $4,455.00 $52,162.17 $5,400.00 2026-05-09
944265603 OTHER Gammagard S-d 5 Gram 46 22 $5,382.24 $5,382.24 $4,440.35 $52,162.17 $5,382.24 2026-05-09
82154044901 OTHER Peginterferon Alfa-2a 46 22 $5,344.42 $5,344.42 $4,409.15 $52,162.17 $5,344.42 2026-05-09
59676034001 OTHER Procrit 46 22 $5,131.20 $5,131.20 $4,233.24 $33,133.97 $5,131.20 2026-05-09
43246 OTHER Peg 46 22 $4,875.00 $4,875.00 $4,021.88 $33,133.97 $4,875.00 2026-05-09
61958150101 OTHER Sovaldi 46 22 $4,800.00 $4,800.00 $3,960.00 $33,133.97 $4,800.00 2026-05-09
68982085002 OTHER Octagam 46 22 $4,662.00 $4,662.00 $3,846.15 $33,133.97 $4,662.00 2026-05-09
50742031025 OTHER Mafenide Acetate For Topical S 46 22 $4,661.36 $4,661.36 $3,845.62 $33,133.97 $4,661.36 2026-05-09
169477212 OTHER Semaglutide (2 Mg/dose) 46 22 $4,648.90 $4,648.90 $3,835.34 $33,133.97 $4,648.90 2026-05-09
169418113 OTHER Semaglutide 46 22 $4,648.90 $4,648.90 $3,835.34 $33,133.97 $4,648.90 2026-05-09
169413013 OTHER Semaglutide Injection 46 22 $4,648.90 $4,648.90 $3,835.34 $33,133.97 $4,648.90 2026-05-09
65757040203 OTHER Aristada 46 22 $4,637.50 $4,637.50 $3,825.94 $33,133.97 $4,637.50 2026-05-09
65757040103 OTHER Aristada 46 22 $4,633.98 $4,633.98 $3,823.03 $33,133.97 $4,633.98 2026-05-09
65757040303 OTHER Aristada 46 22 $4,633.96 $4,633.96 $3,823.01 $33,133.97 $4,633.96 2026-05-09
65757040403 OTHER Aristada 46 22 $4,586.84 $4,586.84 $3,784.14 $33,133.97 $4,586.84 2026-05-09
66794015702 OTHER Gablofen 46 22 $4,536.67 $4,536.67 $3,742.76 $33,133.97 $4,536.67 2026-05-09
65054301 OTHER Triesence 40 Mg 46 22 $4,531.20 $4,531.20 $3,738.24 $33,133.97 $4,531.20 2026-05-09
50242005121 OTHER Rituxan 46 22 $4,509.70 $4,509.70 $3,720.50 $33,133.97 $4,509.70 2026-05-09
31525 OTHER Laryngscpy Dir W/wo Trach Diag 46 22 $4,506.60 $4,506.60 $3,717.95 $33,133.97 $4,506.60 2026-05-09
31635 OTHER Bronch W/for Body Removal 46 22 $4,489.00 $4,489.00 $3,703.43 $33,133.97 $4,489.00 2026-05-09
16110081230 OTHER Fluoroplex 1 % 46 22 $4,454.16 $4,454.16 $3,674.68 $33,133.97 $4,454.16 2026-05-09
50458030711 OTHER RisperDAL Consta 37.5 Mg 46 22 $4,425.02 $4,425.02 $3,650.64 $33,133.97 $4,425.02 2026-05-09
44206043605 OTHER Privigen 46 22 $4,344.96 $4,344.96 $3,584.59 $33,133.97 $4,344.96 2026-05-09
31625 OTHER Bronch Biop Lung End 46 22 $4,313.40 $4,313.40 $3,558.55 $33,133.97 $4,313.40 2026-05-09
36569 OTHER Picc Line Insertion 46 22 $4,308.48 $4,308.48 $3,554.49 $33,133.97 $4,308.48 2026-05-09
59572041028 OTHER Revlimid 46 22 $4,279.44 $4,279.44 $3,530.54 $33,133.97 $4,279.44 2026-05-09
59572042521 OTHER Revlimid 46 22 $4,279.44 $4,279.44 $3,530.54 $33,133.97 $4,279.44 2026-05-09
59572041500 OTHER Revlimid 46 22 $4,279.44 $4,279.44 $3,530.54 $33,133.97 $4,279.44 2026-05-09
61958220101 OTHER Epclusa 46 22 $4,272.00 $4,272.00 $3,524.40 $33,133.97 $4,272.00 2026-05-09
44087002203 OTHER Rebif 22 mcg/0.5mL 46 22 $4,226.26 $4,226.26 $3,486.66 $33,133.97 $4,226.26 2026-05-09
44087004403 OTHER Rebif 46 22 $4,226.26 $4,226.26 $3,486.66 $33,133.97 $4,226.26 2026-05-09
42388002526 OTHER Cabometyx 46 22 $4,093.57 $4,093.57 $3,377.20 $33,133.97 $4,093.57 2026-05-09
42388002326 OTHER Cabometyx 46 22 $4,093.57 $4,093.57 $3,377.20 $33,133.97 $4,093.57 2026-05-09
42388002426 OTHER Cabometyx 46 22 $4,093.57 $4,093.57 $3,377.20 $33,133.97 $4,093.57 2026-05-09
310651201 OTHER Byetta 46 22 $4,079.76 $4,079.76 $3,365.80 $33,133.97 $4,079.76 2026-05-09
310652401 OTHER Byetta 46 22 $4,079.76 $4,079.76 $3,365.80 $33,133.97 $4,079.76 2026-05-09
944270004 OTHER Gammagard Liquid 10% 46 22 $4,068.48 $4,068.48 $3,356.49 $33,133.97 $4,068.48 2026-05-09
5001 OTHER Short-stay Cases, Length Of Stay Is 3 Days Or Fewer None A 19 19 $4,023.52 $4,023.52 $4,023.52 $4,023.52 $4,023.52 2026-05-08
378972055 OTHER Denavir 1 % 46 22 $3,897.55 $3,897.55 $3,215.48 $33,133.97 $3,897.55 2026-05-09
62856070430 OTHER Lenvima 46 22 $3,880.80 $3,880.80 $3,201.66 $33,133.97 $3,880.80 2026-05-09
69098038 OTHER Sutent 46 22 $3,853.62 $3,853.62 $3,179.24 $33,133.97 $3,853.62 2026-05-09
73562011201 OTHER Lipase/Protea/Amyl 20-63-84k U 46 22 $3,846.24 $3,846.24 $3,173.15 $33,133.97 $3,846.24 2026-05-09
55513002504 OTHER Darbepoetin Alfa 100 M 100 Mcg 46 22 $3,715.20 $3,715.20 $3,065.04 $33,133.97 $3,715.20 2026-05-09
55513000504 OTHER Aranesp 46 22 $3,715.20 $3,715.20 $3,065.04 $33,133.97 $3,715.20 2026-05-09
55724021121 OTHER Eucrisa 46 22 $3,661.87 $3,661.87 $3,021.05 $33,133.97 $3,661.87 2026-05-09
69018821 OTHER Ibrance 46 22 $3,653.12 $3,653.12 $3,013.82 $33,133.97 $3,653.12 2026-05-09
55513084301 OTHER Erenumab-aooe 46 22 $3,612.58 $3,612.58 $2,980.38 $33,133.97 $3,612.58 2026-05-09
60793090910 OTHER Thrombi-gel 100 Cm2 46 22 $3,556.46 $3,556.46 $2,934.08 $33,133.97 $3,556.46 2026-05-09
51759020410 OTHER Ajovy 225 mg/1.5mL Syringe 46 22 $3,519.16 $3,519.16 $2,903.30 $33,133.97 $3,519.16 2026-05-09
51759020210 OTHER Ajovy Autoinjector 46 22 $3,519.16 $3,519.16 $2,903.30 $33,133.97 $3,519.16 2026-05-09
480372056 OTHER Pyrimethamine 46 22 $3,420.00 $3,420.00 $2,821.50 $33,133.97 $3,420.00 2026-05-09
2143611 OTHER Galcanezumab-gnlm Pen 46 22 $3,390.58 $3,390.58 $2,797.23 $33,133.97 $3,390.58 2026-05-09
45330 OTHER Sigmoidoscopy Flx Diag 46 22 $3,385.95 $3,385.95 $2,793.41 $33,133.97 $3,385.95 2026-05-09
50419052435 OTHER Betaseron 46 22 $3,343.82 $3,343.82 $2,758.65 $33,133.97 $3,343.82 2026-05-09
49471000105 OTHER Pre-pen .25 Ml 46 22 $3,244.80 $3,244.80 $2,676.96 $23,640.00 $3,244.80 2026-05-09
78056751 OTHER Afinitor 10 Mg 46 22 $3,200.31 $3,200.31 $2,640.26 $23,640.00 $3,200.31 2026-05-09
173088710 OTHER Trelegy Ellipta 100-62.5 46 22 $3,156.86 $3,156.86 $2,604.41 $23,640.00 $3,156.86 2026-05-09
23923201 OTHER Botox Cosmetic 46 22 $3,148.80 $3,148.80 $2,597.76 $23,640.00 $3,148.80 2026-05-09
78068715 OTHER Promacta 46 22 $3,147.39 $3,147.39 $2,596.59 $23,640.00 $3,147.39 2026-05-09
13533063402 OTHER Hypertet S-d 250 Unit 46 22 $3,116.02 $3,116.02 $2,570.72 $23,640.00 $3,116.02 2026-05-09
23114501 OTHER Botox 100 Unit 46 22 $3,100.80 $3,100.80 $2,558.16 $23,640.00 $3,100.80 2026-05-09
310461612 OTHER Budesonide/Glycopyr/Formoterol 46 22 $3,096.67 $3,096.67 $2,554.76 $23,640.00 $3,096.67 2026-05-09
58914030180 OTHER Rectiv 46 22 $3,075.55 $3,075.55 $2,537.33 $23,640.00 $3,075.55 2026-05-09
299598035 OTHER Mirvaso 46 22 $3,060.10 $3,060.10 $2,524.59 $23,640.00 $3,060.10 2026-05-09
70510217102 OTHER Radicava 46 22 $3,053.81 $3,053.81 $2,519.39 $23,640.00 $3,053.81 2026-05-09
60793070210 OTHER Bicillin L-a 2400000 Unit 46 22 $2,999.86 $2,999.86 $2,474.89 $23,640.00 $2,999.86 2026-05-09
50458030611 OTHER RisperDAL Consta 25 Mg 46 22 $2,949.89 $2,949.89 $2,433.66 $23,640.00 $2,949.89 2026-05-09
43598000451 OTHER Augmentin 46 22 $2,935.68 $2,935.68 $2,421.93 $23,640.00 $2,935.68 2026-05-09
60793090701 OTHER Thrombi-gel 10 Cm2 46 22 $2,931.41 $2,931.41 $2,418.41 $23,640.00 $2,931.41 2026-05-09
72511077001 OTHER Evolocumab 420 mg/3.5mL 46 22 $2,919.74 $2,919.74 $2,408.78 $23,640.00 $2,919.74 2026-05-09
3085222 OTHER SpryceL 46 22 $2,919.41 $2,919.41 $2,408.51 $23,640.00 $2,919.41 2026-05-09
61958290102 OTHER Veklury 46 22 $2,877.50 $2,877.50 $2,373.94 $23,640.00 $2,877.50 2026-05-09
51672137108 OTHER clobetasoL Propionate 46 22 $2,842.36 $2,842.36 $2,344.95 $23,640.00 $2,842.36 2026-05-09
43235 OTHER Upper Gastro/Endoscopy 46 22 $2,834.00 $2,834.00 $2,338.05 $23,640.00 $2,834.00 2026-05-09
57962042028 OTHER Imbruvica 46 22 $2,809.99 $2,809.99 $2,318.24 $23,640.00 $2,809.99 2026-05-09
31622 OTHER Rt Bronchoscopy 46 22 $2,803.24 $2,803.24 $2,312.68 $23,640.00 $2,803.24 2026-05-09
59353040509 OTHER Methoxy Peg-epoetin 200 Mcg/0. 46 22 $2,769.36 $2,769.36 $2,284.72 $23,640.00 $2,769.36 2026-05-09
69238101302 OTHER Testosterone 46 22 $2,682.88 $2,682.88 $2,213.38 $23,640.00 $2,682.88 2026-05-09
128 OTHER R&b - Semi Pvt - Irf 74 35 $2,642.95 $2,642.95 $1,442.00 $23,640.00 $2,642.95 2026-07-31
118 OTHER R&b - Private - Irf 71 32 $2,642.95 $2,642.95 $1,442.00 $23,640.00 $2,642.95 2026-05-09
9379401 OTHER Corvert 46 22 $2,634.48 $2,634.48 $2,173.45 $23,640.00 $2,634.48 2026-05-09
A0426 HCPCS Amb Non Emr Als Rnd Trip 46 22 $2,600.00 $2,600.00 $2,145.00 $23,640.00 $2,600.00 2026-05-09
59148002150 OTHER Samsca 30 Mg 46 22 $2,590.29 $2,590.29 $2,136.99 $23,640.00 $2,590.29 2026-05-09
55513020901 OTHER Neupogen 46 22 $2,550.86 $2,550.86 $2,104.46 $23,640.00 $2,550.86 2026-05-09
85433101 OTHER Noxafil 46 22 $2,546.16 $2,546.16 $2,100.58 $23,640.00 $2,546.16 2026-05-09
61953000403 OTHER Flebogamma Dif 46 22 $2,541.12 $2,541.12 $2,096.43 $23,640.00 $2,541.12 2026-05-09
63323064810 OTHER Levothyroxine Sodium 46 22 $2,533.97 $2,533.97 $2,090.53 $23,640.00 $2,533.97 2026-05-09
597016061 OTHER Spiriva Respimat 46 22 $2,531.47 $2,531.47 $2,088.47 $23,640.00 $2,531.47 2026-05-09
5200010 OTHER Pneumoc 20-val Conj-dip Crm/Pf 46 22 $2,503.78 $2,503.78 $2,065.62 $23,640.00 $2,503.78 2026-05-09
59148002050 OTHER Samsca 15 Mg 46 22 $2,496.95 $2,496.95 $2,059.99 $23,640.00 $2,496.95 2026-05-09
78206018401 OTHER Adalimumab-bwwd 46 22 $2,491.20 $2,491.20 $2,055.24 $23,640.00 $2,491.20 2026-05-09
50090073200 OTHER Advair Diskus 46 22 $2,486.88 $2,486.88 $2,051.68 $23,640.00 $2,486.88 2026-05-09
43247 OTHER Egd Flx Transoral W/for Bdy Rm 46 22 $2,476.53 $2,476.53 $2,043.13 $23,640.00 $2,476.53 2026-05-09
10005 OTHER Needle Biopsy W US 1st Lesion 46 22 $2,465.40 $2,465.40 $2,033.95 $23,640.00 $2,465.40 2026-05-09
24208050405 OTHER Vyzulta 46 22 $2,451.17 $2,451.17 $2,022.21 $23,640.00 $2,451.17 2026-05-09
71571033383 OTHER Loteprednol Etabonate 0.25% Op 46 22 $2,438.50 $2,438.50 $2,011.77 $23,640.00 $2,438.50 2026-05-09
49084 OTHER Paracentesis 46 22 $2,428.80 $2,428.80 $2,003.76 $23,640.00 $2,428.80 2026-05-09
10631009160 OTHER Eurax 46 22 $2,428.42 $2,428.42 $2,003.44 $23,640.00 $2,428.42 2026-05-09
90935 OTHER Hemodialysis 47 23 $2,424.90 $2,424.90 $2,000.54 $23,640.00 $2,424.90 2026-05-09
51991082328 OTHER Everolimus 46 22 $2,422.24 $2,422.24 $1,998.35 $23,640.00 $2,422.24 2026-05-09
23320505 OTHER Bimatoprost 0.01% 5ml 46 22 $2,412.34 $2,412.34 $1,990.18 $23,640.00 $2,412.34 2026-05-09
55513054610 OTHER Neupogen 480 Mcg 46 22 $2,406.38 $2,406.38 $1,985.27 $23,640.00 $2,406.38 2026-05-09
378932232 OTHER Wixela Inhub 500/50 46 22 $2,362.52 $2,362.52 $1,949.08 $20,184.04 $2,362.52 2026-05-09
597002402 OTHER Combivent Respimat 46 22 $2,348.83 $2,348.83 $1,937.79 $20,184.04 $2,348.83 2026-05-09
55566830301 OTHER Firmagon 46 22 $2,344.56 $2,344.56 $1,934.26 $20,184.04 $2,344.56 2026-05-09
68546032512 OTHER Copaxone 40 Mg 46 22 $2,332.80 $2,332.80 $1,924.56 $20,184.04 $2,332.80 2026-05-09
C5271 HCPCS Wc Apply Low Cost Ss Leg 46 22 $2,286.00 $2,286.00 $1,885.95 $20,184.04 $2,286.00 2026-05-09
11043 OTHER Wc Debride Subq/musc Bx/bs 46 22 $2,286.00 $2,286.00 $1,885.95 $20,184.04 $2,286.00 2026-05-09
C5276 HCPCS Wc Apply Lc Ss Foot Ea > 25cm 46 22 $2,286.00 $2,286.00 $1,885.95 $20,184.04 $2,286.00 2026-05-09
12044 OTHER Wc Neck/hands/feet 7.6-12.5cm 46 22 $2,286.00 $2,286.00 $1,885.95 $20,184.04 $2,286.00 2026-05-09
C5275 HCPCS Wc Apply Low Cost Ss Foot 46 22 $2,286.00 $2,286.00 $1,885.95 $20,184.04 $2,286.00 2026-05-09
C5272 HCPCS Wc Apply Lc Ss Leg Ea >25cm 46 22 $2,286.00 $2,286.00 $1,885.95 $20,184.04 $2,286.00 2026-05-09
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