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Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

WRAY COMMUNITY DISTRICT HOSPITAL

Wray, CO · CCN 061309 · Rates published

321 distinct procedures filed
15 distinct payers
13,035 rate rows
2026-07-31 last MRF observed
Data quality

5,916 of 13,035 rate rows are consumer-grade (45.4%)

7,119 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 6,595
professional (physician) fee — not the facility price 524
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://hospitalpricedisclosure.com/download.aspx?pi=WCPVLClkHEiOwGO6Nkv94g*-*
Found on page https://hospitalpricedisclosure.com/Default
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-10-20
Content fingerprint d4ff6f696dd648bf… · 1,800,640 bytes · first seen 2026-05-09

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
331
MS_DRG 		Major Small And Large Bowel Procedures Without Cc/Mcc 1 $66,049.06 $66,049.06 $66,049.06 nat. median
$16,513
outlier · 4.0×
5115
OTHER 		Level 5 Musculoskeletal Procedures 6 $49,670.06 $49,670.06 $49,670.06 nat. median
$13,552
outlier · 3.7×
5694
OTHER 		Level 4 Drug Administration 2 $48,779.38 $48,779.38 $48,779.38 nat. median
$719
outlier · 67.8×
J2350
HCPCS 		50242-0150-01 - Ocrelizumab 300 Mg/10 Ml Sol [wcdh] 2 $25,915.70 $49,290.65 $45,733.59 nat. median
$714
outlier · 64.1×
560
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Cc 1 $42,360.00 $42,360.00 $42,360.00 nat. median
$11,464
outlier · 3.7×
5362
OTHER 		Level 2 Laparoscopy And Related Services 4 $41,162.71 $41,162.71 $41,162.71 nat. median
$11,101
outlier · 3.7×
798
MS_DRG 		Vaginal Delivery With Sterilization And/Or D&c Without Cc/Mcc 1 $40,238.97 $40,238.97 $40,238.97 nat. median
$9,220
outlier · 4.4×
5415
OTHER 		Level 5 Gynecologic Procedures 1 $39,465.81 $39,465.81 $39,465.81 nat. median
$5,277
outlier · 7.5×
5054
OTHER 		Level 4 Skin Procedures 1 $36,211.70 $36,211.70 $36,211.70 nat. median
$2,176
outlier · 16.6×
786
MS_DRG 		Cesarean Section Without Sterilization With Mcc 1 $35,112.78 $35,112.78 $35,112.78 nat. median
$14,838
outlier · 2.4×
5361
OTHER 		Level 1 Laparoscopy And Related Services 5 $30,161.51 $30,161.51 $30,161.51 nat. median
$6,437
outlier · 4.7×
768
MS_DRG 		Vaginal Delivery With O.r. Procedures Except Sterilization And/Or D&c 1 $28,716.10 $28,716.10 $28,716.10 nat. median
$10,153
outlier · 2.8×
5116
OTHER 		Level 6 Musculoskeletal Procedures 1 $27,365.04 $27,365.04 $27,365.04 nat. median
$18,629
1.5× median
787
MS_DRG 		Cesarean Section Without Sterilization With Cc 1 $27,187.11 $27,187.11 $27,187.11 nat. median
$10,903
outlier · 2.5×
189
MS_DRG 		Pulmonary Edema And Respiratory Failure 1 $26,820.00 $26,820.00 $26,820.00 nat. median
$12,249
outlier · 2.2×
379
MS_DRG 		Gastrointestinal Hemorrhage Without Cc/Mcc 1 $26,420.71 $26,420.71 $26,420.71 nat. median
$6,960
outlier · 3.8×
788
MS_DRG 		Cesarean Section Without Sterilization Without Cc/Mcc 3 $25,372.63 $25,372.63 $25,372.63 nat. median
$9,590
outlier · 2.6×
202
MS_DRG 		Bronchitis And Asthma With Cc/Mcc 1 $25,007.84 $25,007.84 $25,007.84 nat. median
$9,773
outlier · 2.6×
785
MS_DRG 		Cesarean Section With Sterilization Without Cc/Mcc 1 $24,573.09 $24,573.09 $24,573.09 nat. median
$9,456
outlier · 2.6×
5341
OTHER 		Level 1 Abdominal/Peritoneal/Biliary And Related Procedures 4 $23,277.24 $23,277.24 $23,277.24 nat. median
$3,819
outlier · 6.1×
5114
OTHER 		Level 4 Musculoskeletal Procedures 7 $22,383.37 $22,383.37 $22,383.37 nat. median
$7,727
outlier · 2.9×
561
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc 1 $21,180.00 $21,180.00 $21,180.00 nat. median
$8,641
outlier · 2.5×
5375
OTHER 		Level 5 Urology And Related Services 1 $21,152.37 $21,152.37 $21,152.37 nat. median
$5,656
outlier · 3.7×
J3380
HCPCS 		64764-0300-20 - Vedolizumab 300 Mg Rec 2 $11,604.90 $22,072.06 $20,479.23 nat. median
$204
outlier · 100.5×
806
MS_DRG 		Vaginal Delivery Without Sterilization Or D&c With Cc 3 $19,103.65 $19,103.65 $19,103.65 nat. median
$7,619
outlier · 2.5×
999
MS_DRG 		Ungroupable 5 $18,926.79 $18,926.79 $18,926.79 nat. median
$3,698
outlier · 5.1×
5414
OTHER 		Level 4 Gynecologic Procedures 4 $18,778.53 $18,778.53 $18,778.53 nat. median
$3,415
outlier · 5.5×
5183
OTHER 		Level 3 Vascular Procedures 3 $18,255.06 $18,255.06 $18,255.06 nat. median
$3,363
outlier · 5.4×
J2505
HCPCS 		Injection, Pegfilgrastim 6mg 2 $9,937.40 $18,900.55 $17,536.59 nat. median
$6,056
outlier · 2.9×
805
MS_DRG 		Vaginal Delivery Without Sterilization Or D&c With Mcc 1 $15,532.41 $15,532.41 $15,532.41 nat. median
$9,891
1.6× median
5164
OTHER 		Level 4 ENT Procedures 3 $14,791.71 $14,791.71 $14,791.71 nat. median
$3,497
outlier · 4.2×
807
MS_DRG 		Vaginal Delivery Without Sterilization Or D&c Without Cc/Mcc 5 $14,746.72 $14,746.72 $14,746.72 nat. median
$6,983
outlier · 2.1×
5073
OTHER 		Level 3 Excision/ Biopsy/ Incision And Drainage 3 $14,608.19 $14,608.19 $14,608.19 nat. median
$3,093
outlier · 4.7×
J9306
HCPCS 		Injection, Pertuzumab, 1 Mg 2 $8,193.97 $15,584.60 $14,459.94 nat. median
$91
outlier · 158.9×
J9271
HCPCS 		00006-3026-04 - Pembrolizumab 25 mg/mL Sol 2 $8,027.81 $15,268.58 $14,166.72 nat. median
$323
outlier · 43.9×
5113
OTHER 		Level 3 Musculoskeletal Procedures 5 $13,905.37 $13,905.37 $13,905.37 nat. median
$3,560
outlier · 3.9×
470
MS_DRG 		Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without… 1 $13,254.00 $13,254.00 $13,254.00 nat. median
$18,801
0.7× median
5313
OTHER 		Level 3 Lower Gi Procedures 2 $13,151.84 $13,151.84 $13,151.84 nat. median
$2,957
outlier · 4.4×
5165
OTHER 		Level 5 ENT Procedures 3 $12,557.76 $12,557.76 $12,557.76 nat. median
$6,200
outlier · 2.0×
J2323
HCPCS 		64406-0008-01 - Natalizumab 300 Mg/15 Ml Con 2 $7,039.53 $13,388.91 $12,422.70 nat. median
$252
outlier · 49.3×
5091
OTHER 		Level 1 Breast/Lymphatic Surgery And Related Procedures 2 $11,993.78 $11,993.78 $11,993.78 nat. median
$4,211
outlier · 2.8×
Q5111
HCPCS 		Injection, Udenyca 0.5 Mg 2 $6,658.36 $12,663.93 $11,750.04 nat. median
$2,014
outlier · 5.8×
J2353
HCPCS 		Octreotide Injection, Depot 2 $6,493.88 $12,351.11 $11,459.79 nat. median
$5,554
outlier · 2.1×
5041
OTHER 		Critical Care 5 $11,231.16 $11,231.16 $11,231.16 nat. median
$1,455
outlier · 7.7×
J1162
HCPCS 		Digoxin Immune Fab (ovine) 2 $6,337.82 $12,054.29 $11,184.39 nat. median
$7,098
1.6× median
5071
OTHER 		Level 1 Excision/ Biopsy/ Incision And Drainage 1 $10,933.37 $10,933.37 $10,933.37 nat. median
$775
outlier · 14.1×
5181
OTHER 		Level 1 Vascular Procedures 1 $10,589.38 $10,589.38 $10,589.38 nat. median
$674
outlier · 15.7×
Q5117
HCPCS 		Inj., Kanjinti, 10 Mg 2 $5,896.47 $11,214.85 $10,405.53 nat. median
$794
outlier · 13.1×
872
MS_DRG 		Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 3 $10,289.06 $10,289.06 $10,289.06 nat. median
$10,374
1.0× median
5111
OTHER 		Level 1 Musculoskeletal Procedures 1 $9,814.51 $9,814.51 $9,814.51 nat. median
$270
outlier · 36.3×

Other procedures at this hospital

Browse this hospital's 321 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
             
90675 OTHER — 18 2 $995.25 $746.43 25% off $439.42 $1,095.03 $818.52 2026-07-31
C9290 HCPCS — 9 2 $531.70 $398.78 25% off $271.17 $515.75 $478.53 2026-07-31
J0833 HCPCS — 9 2 $466.00 $349.50 25% off $237.66 $452.02 $419.40 2026-07-31
C9113 HCPCS — 9 2 $60.00 $45.00 25% off $30.60 $58.20 $54.00 2026-07-31
#N/A OTHER — 36 2 $63.85 $47.89 25% off $3.11 $238.23 $37.73 2026-07-31
J9271 HCPCS 00006-3026-04 - Pembrolizumab 25 mg/mL Sol 9 2 $15,740.80 $11,805.60 25% off $8,027.81 $15,268.58 $14,166.72 2026-07-31
J1453 HCPCS 00006-3061-00 - Fosaprepitant 150 Mg Rec 27 2 $997.70 $748.28 25% off $426.97 $1,015.11 $812.08 2026-07-31
J2920 HCPCS 00009-0039-32 - methylPREDNISolone 40 Mg Preservative-free Rec 18 2 $51.10 $38.33 25% off $26.01 $49.66 $46.08 2026-07-31
J2930 HCPCS 00009-0698-01 - methylPREDNISolone 1g Inj (sdv)[wcdh] 54 2 $124.50 $93.38 25% off $21.01 $251.52 $80.47 2026-07-31
J2020 HCPCS 00009-4992-02 - Linezolid 2 Mg/ml-d5% Sol 27 2 $422.60 $316.95 25% off $141.12 $480.54 $336.87 2026-07-31
J1750 HCPCS 00023-6082-10 - Iron Dextran 50 mg/mL Sol 18 2 $226.95 $170.22 25% off $112.91 $225.53 $209.25 2026-07-31
Q5119 HCPCS 00069-0249-01 - riTUXimab Pvvr 10 mg/mL Sol 18 2 $6,724.55 $5,043.41 25% off $1,143.22 $10,871.27 $3,945.09 2026-07-31
J9217 HCPCS 00074-3346-03 - Leuprolide 22.5 Mg/3 Months Kit [wcdh] 44 2 $5,650.00 $4,237.50 25% off $2,161.13 $21,444.66 $5,364.34 2026-07-31
J1950 HCPCS 00074-3663-03 - Leuprolide 11.25 Mg/3 Months Pwd 9 2 $4,638.10 $3,478.58 25% off $2,365.43 $4,498.96 $4,174.29 2026-07-31
J0630 HCPCS 00078-0149-23 - Calcitonin 200 Intl units/mL Sol 9 2 $5,650.40 $4,237.80 25% off $2,881.70 $5,480.89 $5,085.36 2026-07-31
J1815 HCPCS 00088-2220-33 - Insulin Glargine 100 units/mL SubQ Sol (blk)[wcdh] 27 2 $371.40 $278.55 25% off $13.97 $375.49 $263.23 2026-07-31
Q0144 HCPCS 00093-2026-23 - Azithromycin 200 Mg/5 Ml Rec 36 2 $181.60 $136.20 25% off $42.18 $283.24 $138.61 2026-07-31
J0735 HCPCS 00143-9724-01 - cloNIDine 100 mcg/mL Sol [wcdh] 27 2 $244.10 $183.07 25% off $100.67 $248.03 $191.48 2026-07-31
J0131 HCPCS 00264-4100-90 - Acetaminophen 10 mg/mL Sol 27 2 $275.30 $206.48 25% off $46.87 $294.01 $206.11 2026-07-31
J9201 HCPCS 00409-0182-01 - Gemcitabine 38 mg/mL Sol 81 2 $361.40 $271.05 25% off $132.91 $2,247.59 $324.36 2026-07-31
J9171 HCPCS 00409-0368-01 - DOCEtaxel 20 mg/mL Sol 54 2 $1,540.15 $1,155.11 25% off $174.16 $7,384.03 $1,284.12 2026-07-31
J1170 HCPCS 00409-1283-37 - HYDROmorphone 1 mg/mL Sol 18 2 $35.35 $26.52 25% off $16.88 $36.47 $31.45 2026-07-31
J2300 HCPCS 00409-1463-01 - Nalbuphine 10 mg/mL Inj (UD)Sol ([wcdh] 27 2 $37.60 $28.20 25% off $16.88 $51.31 $33.84 2026-07-31
J2270 HCPCS 00409-1890-01 - Morphine 2 mg/mL (1mL) Inj (carp) [wcdh] 9 2 $33.10 $24.83 25% off $16.88 $32.11 $29.79 2026-07-31
J2001 HCPCS 00409-4276-01 - Lidocaine 1% Inj (20ml) Sol (ud)[wcdh] 54 2 $43.60 $32.70 25% off $13.97 $92.15 $35.72 2026-07-31
J3475 HCPCS 00409-6729-03 - Magnesium Sulfate 20 G/500ml-sterile Water Sol [wcdh] 27 2 $47.50 $35.63 25% off $16.88 $117.95 $42.75 2026-07-31
J0696 HCPCS 00409-7332-01 - Ceftriaxone 1 G Inj (sdv)[wcdh] 81 2 $197.40 $148.05 25% off $16.88 $429.32 $148.00 2026-07-31
J2785 HCPCS 00469-6501-89 - Regadenoson 0.4 Mg/5 Ml IV (su)[wcdh] 9 2 $759.80 $569.85 25% off $387.50 $737.01 $683.82 2026-07-31
J1439 HCPCS 00517-0650-01 - Ferric Carboxymaltose (as Elemental Iron) 50 mg/mL Sol 9 2 $3,563.90 $2,672.93 25% off $1,817.59 $3,456.98 $3,207.51 2026-07-31
J1756 HCPCS 00517-2340-10 - Iron Sucrose 20 mg/mL Sol [wcdh] 9 2 $292.90 $219.68 25% off $149.38 $284.11 $263.61 2026-07-31
J7608 HCPCS 00517-7604-25 - Acetylcysteine 20% Neb Sol 4 Ml (bkl) [wcdh] 54 2 $85.25 $63.94 25% off $28.41 $153.16 $72.86 2026-07-31
J1790 HCPCS 00517-9702-25 - Droperidol 2.5 mg/mL (2ml) Inj Sol (ud)[wcdh] 18 2 $51.30 $38.48 25% off $16.88 $67.41 $33.78 2026-07-31
J1610 HCPCS 00597-0260-10 - Glucagon Recombinant 1 Mg Rec 36 2 $534.95 $401.21 25% off $258.42 $888.91 $487.26 2026-07-31
J7509 HCPCS 00603-4593-15 - methylPREDNISolone 4 Mg Tab 45 2 $69.50 $52.13 25% off $5.15 $212.24 $62.55 2026-07-31
J1200 HCPCS 00641-0376-21 - diphenhydrAMINE 50 mg/mL Inj Sol (sdv)[wcdh] 18 2 $35.35 $26.52 25% off $16.88 $36.47 $31.45 2026-07-31
J2550 HCPCS 00641-0948-35 - Promethazine 25 mg/mL Sol 9 2 $33.10 $24.83 25% off $16.88 $32.11 $29.79 2026-07-31
J3230 HCPCS 00641-1397-35 - chlorproMAZINE 25 mg/mL Inj Sol (ud)[wcdh] 9 2 $219.00 $164.25 25% off $111.69 $212.43 $197.10 2026-07-31
J9045 HCPCS 00703-4246-01 - CARBOplatin 10 mg/mL Sol 63 2 $384.00 $288.00 25% off $81.19 $422.63 $296.28 2026-07-31
J9070 HCPCS 00781-3233-94 - Cyclophosphamide 500 Mg Rec 36 2 $1,646.45 $1,234.84 25% off $547.64 $2,221.98 $1,111.04 2026-07-31
J1956 HCPCS 00781-3341-09 - Levofloxacin 250 Mg/50 Ml Sol 144 2 $82.15 $61.61 25% off $19.89 $273.15 $64.74 2026-07-31
J0290 HCPCS 00781-3404-95 - Ampicillin 1 G Rec 54 2 $65.40 $49.05 25% off $25.50 $97.58 $57.95 2026-07-31
J1569 HCPCS 00944-2700-06 - Immune Globulin Intravenous And Subcutaneous 10% Sol 18 2 $7,554.45 $5,665.84 25% off $3,083.10 $8,791.69 $5,863.94 2026-07-31
J1650 HCPCS 00955-1016-01 - Enoxaparin 300 Mg/3 Ml Sol 171 2 $120.60 $90.45 25% off $16.88 $466.57 $102.48 2026-07-31
Q9957 HCPCS 11994-0011-16 - Perflutren (lipid Microspheres) Sus 9 2 $409.40 $307.05 25% off $208.79 $397.12 $368.46 2026-07-31
J1561 HCPCS 13533-0645-71 - Immune Globulin 10% IV Sol 100 Ml (su)[wcdh] 9 2 $3,022.70 $2,267.02 25% off $1,541.58 $2,932.02 $2,720.43 2026-07-31
J9181 HCPCS 16729-0114-08 - Etoposide 20 mg/mL Sol 18 2 $71.05 $53.28 25% off $35.85 $69.65 $64.62 2026-07-31
J9280 HCPCS 16729-0116-38 - mitoMYcin 40 Mg Rec 18 2 $3,313.70 $2,485.28 25% off $1,196.15 $4,153.54 $2,275.04 2026-07-31
J0330 HCPCS 16729-0493-45 - Succinylcholine 20 mg/mL Sol 27 2 $141.50 $106.13 25% off $19.18 $141.04 $98.87 2026-07-31
J1940 HCPCS 16729-0500-08 - Furosemide 10 mg/mL Sol 27 2 $37.20 $27.90 25% off $16.88 $36.47 $32.11 2026-07-31
J0461 HCPCS 16729-0525-08 - Atropine 0.4 mg/mL Sol 54 2 $79.40 $59.55 25% off $13.97 $258.02 $64.41 2026-07-31
J2210 HCPCS 17478-0501-01 - Methylergonovine 0.2 mg/mL Inj Sol (ud)[wcdh] 27 2 $66.70 $50.02 25% off $30.91 $199.34 $60.03 2026-07-31
J0780 HCPCS 23155-0294-42 - Prochlorperazine 5 mg/mL Sol 18 2 $89.60 $67.20 25% off $19.89 $135.99 $54.66 2026-07-31
J0692 HCPCS 25021-0121-20 - Cefepime 1 G Rec 54 2 $75.10 $56.32 25% off $22.34 $247.25 $68.31 2026-07-31
J3489 HCPCS 25021-0830-82 - Zoledronic Acid 5 Mg/100 Ml Sol 90 2 $808.30 $606.23 25% off $140.76 $3,287.62 $641.23 2026-07-31
J1335 HCPCS 42023-0221-10 - Ertapenem 1 G Rec 27 2 $401.70 $301.27 25% off $199.36 $390.33 $362.16 2026-07-31
J2540 HCPCS 44567-0311-10 - Penicillin G Potassium 5,000,000 Units Rec 18 2 $156.80 $117.60 25% off $49.22 $210.59 $102.16 2026-07-31
J9267 HCPCS 47781-0595-07 - PACLitaxel 6 mg/mL Sol 54 2 $387.15 $290.37 25% off $52.22 $1,429.97 $348.36 2026-07-31
J9312 HCPCS 50242-0053-06 - Rituximab 10 mg/mL (50ml) IV Sol (ud) [wcdh] 18 2 $8,813.95 $6,610.46 25% off $1,498.38 $14,249.20 $5,170.85 2026-07-31
J2997 HCPCS 50242-0085-27 - Alteplase 100 Mg IV Inj (ud)[wcdh] 18 2 $13,999.10 $10,499.33 25% off $244.14 $26,693.92 $7,249.64 2026-07-31
J2350 HCPCS 50242-0150-01 - Ocrelizumab 300 Mg/10 Ml Sol [wcdh] 9 2 $50,815.10 $38,111.32 25% off $25,915.70 $49,290.65 $45,733.59 2026-07-31
J2543 HCPCS 55150-0121-50 - Piperacillin-tazobactam 4 G-0.5 G Rec 63 2 $105.20 $78.90 25% off $39.83 $133.38 $79.23 2026-07-31
J0456 HCPCS 55150-0174-10 - Azithromycin 500 Mg Rec [wcdh] 45 2 $63.00 $47.25 25% off $21.62 $121.35 $49.37 2026-07-31
J1953 HCPCS 55150-0177-05 - levETIRAcetam 100 mg/mL Sol 18 2 $210.85 $158.14 25% off $48.35 $317.09 $129.34 2026-07-31
J2760 HCPCS 55390-0113-01 - Phentolamine 5 Mg Inj (sdv)[wcdh] 18 2 $931.65 $698.74 25% off $239.24 $1,352.37 $583.03 2026-07-31
Q5107 HCPCS 55513-0206-01 - Bevacizumab Awwb 25 mg/mL Sol 18 2 $5,295.75 $3,971.81 25% off $1,080.33 $8,219.00 $3,188.04 2026-07-31
J1442 HCPCS 55513-0546-01 - Filgrastim 480 Mcg/1.6 Ml Sol 18 2 $1,130.25 $847.68 25% off $549.68 $1,147.22 $1,023.91 2026-07-31
J0897 HCPCS 55513-0710-01 - Denosumab 60 mg/mL Sol 18 2 $6,012.35 $4,509.27 25% off $2,159.80 $7,556.11 $4,107.85 2026-07-31
J1745 HCPCS 57894-0030-01 - Infliximab 100 Mg IV Inj (ud)[wcdh] 9 2 $3,651.90 $2,738.93 25% off $1,862.47 $3,542.34 $3,286.71 2026-07-31
J2405 HCPCS 60505-6130-05 - Ondansetron 2 mg/mL Sol 72 2 $61.85 $46.39 25% off $13.97 $607.61 $54.34 2026-07-31
J0561 HCPCS 60793-0701-10 - Penicillin G Benz 1,200,000 Units/2 Ml Im[wcdh] 9 2 $538.40 $403.80 25% off $274.58 $522.25 $484.56 2026-07-31
J1580 HCPCS 63323-0010-94 - Gentamicin 40 mg/mL Sol 36 2 $35.85 $26.89 25% off $16.88 $36.47 $31.94 2026-07-31
J2590 HCPCS 63323-0012-11 - Oxytocin 10 units/mL Sol 18 2 $35.35 $26.52 25% off $16.88 $36.47 $31.45 2026-07-31
J3411 HCPCS 63323-0013-02 - Thiamine 100 mg/mL Inj Sol (ud)[wcdh] 27 2 $75.40 $56.55 25% off $34.37 $76.24 $65.38 2026-07-31
J1100 HCPCS 63323-0165-01 - Dexamethasone 4 mg/mL (1mL) Inj Sol[WCDH] 54 2 $45.55 $34.16 25% off $13.97 $95.06 $36.38 2026-07-31
J2704 HCPCS 63323-0269-65 - Propofol 10 mg/mL Emu 100 Ml[wcdh] 45 2 $49.30 $36.98 25% off $18.51 $49.37 $42.75 2026-07-31
J3030 HCPCS 63323-0273-01 - SUMAtriptan 6 Mg/0.5 Ml Sol [wcdh] 27 2 $411.50 $308.63 25% off $151.27 $595.10 $370.35 2026-07-31
J3370 HCPCS 63323-0284-45 - Vancomycin 1 G Rec 81 2 $54.90 $41.17 25% off $19.18 $117.95 $49.41 2026-07-31
J2795 HCPCS 63323-0286-35 - Ropivacaine 0.5% Sol 54 2 $106.10 $79.57 25% off $19.18 $154.42 $92.16 2026-07-31
J0694 HCPCS 63323-0342-25 - Cefoxitin 2 G Inj [(ud)wcdh] 54 2 $83.45 $62.59 25% off $25.96 $146.76 $71.86 2026-07-31
J2354 HCPCS 63323-0377-01 - Octreotide 500 mcg/mL Sol 45 2 $300.90 $225.68 25% off $135.30 $395.08 $270.81 2026-07-31
J1630 HCPCS 63323-0474-01 - Haloperidol 5 mg/mL Sol [wcdh] 54 2 $51.45 $38.59 25% off $16.88 $151.71 $46.30 2026-07-31
J1644 HCPCS 63323-0522-77 - Heparin 50 Units/ml-d5% Sol 63 2 $55.10 $41.33 25% off $16.88 $666.88 $44.00 2026-07-31
J7131 HCPCS 63323-0530-75 - Lvp Solution With Hypertonic Saline Sodium Chloride 3% Sol 9 2 $93.10 $69.82 25% off $47.48 $90.31 $83.79 2026-07-31
J0360 HCPCS 63323-0614-01 - hydrALAZINE 20 mg/mL Sol 27 2 $99.20 $74.40 25% off $46.41 $249.29 $89.28 2026-07-31
J3105 HCPCS 63323-0665-01 - Terbutaline 1 mg/mL Sol 18 2 $87.00 $65.25 25% off $19.18 $132.31 $53.02 2026-07-31
J3480 HCPCS 63323-0965-10 - Potassium Chloride 2 mEq/mL Sol 27 2 $37.60 $28.20 25% off $16.88 $40.35 $32.11 2026-07-31
J7674 HCPCS 64281-0100-06 - Methacholine 100 Mg Rec 9 2 $435.70 $326.78 25% off $222.21 $422.63 $392.13 2026-07-31
J2323 HCPCS 64406-0008-01 - Natalizumab 300 Mg/15 Ml Con 9 2 $13,803.00 $10,352.25 25% off $7,039.53 $13,388.91 $12,422.70 2026-07-31
J3380 HCPCS 64764-0300-20 - Vedolizumab 300 Mg Rec 9 2 $22,754.70 $17,066.02 25% off $11,604.90 $22,072.06 $20,479.23 2026-07-31
Q0162 HCPCS 65862-0390-10 - Ondansetron 4 Mg Dis [wcdh] 27 2 $140.50 $105.38 25% off $26.98 $136.67 $95.81 2026-07-31
J1741 HCPCS 66220-0284-22 - Ibuprofen 800 Mg/200 Ml Sol 9 2 $164.50 $123.38 25% off $83.89 $159.56 $148.05 2026-07-31
J2310 HCPCS 67457-0292-02 - Naloxone 0.4 mg/mL Sol 45 2 $120.00 $90.00 25% off $59.72 $242.60 $113.59 2026-07-31
J2469 HCPCS 67457-0317-25 - Palonosetron 0.25 Mg/5 Ml Sol 36 2 $513.60 $385.20 25% off $148.16 $858.84 $389.65 2026-07-31
J0153 HCPCS 67457-0855-02 - Adenosine 3 mg/mL Sol 54 2 $102.15 $76.61 25% off $25.96 $264.91 $80.51 2026-07-31
P9045 HCPCS 68982-0623-02 - Albumin Human 5% Sol 27 2 $363.10 $272.33 25% off $143.21 $430.00 $301.44 2026-07-31
J7626 HCPCS 69097-0319-87 - Budesonide 0.5 Mg/2 Ml Sus 36 2 $70.30 $52.73 25% off $22.59 $75.47 $57.95 2026-07-31
J3360 HCPCS 69339-0136-32 - diazePAM 5 mg/mL Sol [wcdh] 27 2 $186.60 $139.95 25% off $34.68 $202.54 $141.98 2026-07-31
J0878 HCPCS 70594-0034-01 - DAPTOmycin 500 Mg Rec 27 2 $1,393.10 $1,044.82 25% off $441.81 $1,351.40 $947.38 2026-07-31
J9202 HCPCS 70720-0951-30 - Goserelin 10.8 Mg Imp 9 2 $6,549.50 $4,912.13 25% off $3,340.24 $6,353.01 $5,894.55 2026-07-31
P9047 HCPCS 76125-0792-10 - Albumin Human 25% Sol 36 2 $484.15 $363.11 25% off $198.08 $543.88 $393.32 2026-07-31
J7612 HCPCS 76204-0900-01 - Levalbuterol 1.25 Mg/3 Ml Sol [wcdh] 27 2 $47.40 $35.55 25% off $7.24 $67.32 $42.66 2026-07-31
J0171 HCPCS 76329-3316-01 - EPINEPHrine 0.1 mg/mL Sol 63 2 $37.60 $28.20 25% off $2.09 $70.81 $32.11 2026-07-31
J0129 HCPCS Abatacept Injection 9 2 $3,676.20 $2,757.15 25% off $1,874.86 $3,565.91 $3,308.58 2026-07-31
J0132 HCPCS Acetylcysteine Injection 45 2 $588.00 $441.00 25% off $239.24 $884.83 $493.72 2026-07-31
J0133 HCPCS Acyclovir Injection 9 2 $101.10 $75.82 25% off $51.56 $98.07 $90.99 2026-07-31
949 MS_DRG Aftercare With Cc/Mcc 1 1 — — $2,251.24 $2,251.24 $2,251.24 2024-03-01
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 1 1 — — $42,360.00 $42,360.00 $42,360.00 2024-03-01
561 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc 1 1 — — $21,180.00 $21,180.00 $21,180.00 2024-03-01
J0270 HCPCS Alprostadil For Injection 9 2 $407.70 $305.78 25% off $207.93 $395.47 $366.93 2026-07-31
J0280 HCPCS Aminophyllin 250 Mg Inj 9 2 $37.60 $28.20 25% off $19.18 $36.47 $33.84 2026-07-31
J0282 HCPCS Amiodarone Hcl 36 2 $150.25 $112.69 25% off $16.88 $260.06 $85.28 2026-07-31
J9030 HCPCS Bcg Live Intravesical 1mg 9 2 $491.30 $368.48 25% off $250.56 $476.56 $442.17 2026-07-31
J9035 HCPCS Bevacizumab Injection 18 2 $6,230.30 $4,672.73 25% off $1,271.02 $9,669.35 $3,750.65 2026-07-31
J0585 HCPCS Botox, Inj Per Unit 18 2 $2,581.45 $1,936.09 25% off $958.49 $3,184.99 $1,823.02 2026-07-31
202 MS_DRG Bronchitis And Asthma With Cc/Mcc 2 1 — — $25,007.84 $25,007.84 $25,007.84 2024-03-01
203 MS_DRG Bronchitis And Asthma Without Cc/Mcc 1 1 — — $4,883.18 $4,883.18 $4,883.18 2024-03-01
5771 OTHER Cardiac Rehabilitation 2 2 — — $2,642.73 $2,642.73 $2,642.73 2024-03-01
J0637 HCPCS Caspofungin Acetate 9 2 $1,056.10 $792.07 25% off $538.61 $1,024.42 $950.49 2026-07-31
J0698 HCPCS Cefotaxime Sodium Injection 36 2 $41.75 $31.31 25% off $16.88 $65.38 $35.05 2026-07-31
603 MS_DRG Cellulitis Without Mcc 1 1 — — $6,806.50 $6,806.50 $6,806.50 2024-03-01
785 MS_DRG Cesarean Section With Sterilization Without Cc/Mcc 1 1 — — $24,573.09 $24,573.09 $24,573.09 2024-03-01
787 MS_DRG Cesarean Section Without Sterilization With Cc 1 1 — — $27,187.11 $27,187.11 $27,187.11 2024-03-01
786 MS_DRG Cesarean Section Without Sterilization With Mcc 1 1 — — $35,112.78 $35,112.78 $35,112.78 2024-03-01
788 MS_DRG Cesarean Section Without Sterilization Without Cc/Mcc 3 3 — — $25,372.63 $25,372.63 $25,372.63 2024-03-01
J9055 HCPCS Cetuximab Injection 9 2 $4,251.70 $3,188.78 25% off $2,168.37 $4,124.15 $3,826.53 2026-07-31
J2400 HCPCS Chloroprocaine Hcl Injection 9 2 $169.60 $127.20 25% off $86.50 $164.51 $152.64 2026-07-31
J0740 HCPCS Cidofovir Injection 9 2 $2,314.10 $1,735.57 25% off $1,180.19 $2,244.68 $2,082.69 2026-07-31
J0743 HCPCS Cilastatin Sodium Injection 18 2 $227.50 $170.63 25% off $105.83 $240.07 $197.13 2026-07-31
J9060 HCPCS Cisplatin 10 Mg Injection 45 2 $273.60 $205.20 25% off $69.77 $406.91 $207.67 2026-07-31
9397 OTHER Covid-19 Vaccine Admin Dose 1 Of 2 1 1 — — $43.65 $43.65 $43.65 2024-03-01
9398 OTHER Covid-19 Vaccine Admin Dose 2 Of 2, Single Dose Product Or Additional Dose 6 5 — — $35.60 $35.60 $35.60 2024-03-01
5041 OTHER Critical Care 5 5 — — $11,231.16 $11,231.16 $11,231.16 2024-03-01
J0840 HCPCS Crotalidae Poly Immune Fab 18 2 $8,178.20 $6,133.66 25% off $3,241.51 $9,700.49 $6,165.22 2026-07-31
J8530 HCPCS Cyclophosphamide Oral 25 Mg 9 2 $108.60 $81.45 25% off $55.39 $105.34 $97.74 2026-07-31
J9100 HCPCS Cytarabine Hcl 100 Mg Inj 9 2 $161.40 $121.05 25% off $82.31 $156.56 $145.26 2026-07-31
J9130 HCPCS Dacarbazine 100 Mg Inj 27 2 $129.60 $97.20 25% off $46.41 $154.33 $108.19 2026-07-31
J0895 HCPCS Deferoxamine Mesylate Inj 18 2 $86.45 $64.84 25% off $38.10 $95.25 $70.96 2026-07-31
J0500 HCPCS Dicyclomine Injection 9 2 $307.90 $230.93 25% off $157.03 $298.66 $277.11 2026-07-31
J1162 HCPCS Digoxin Immune Fab (ovine) 9 2 $12,427.10 $9,320.33 25% off $6,337.82 $12,054.29 $11,184.39 2026-07-31
J0470 HCPCS Dimecaprol Injection 18 2 $490.25 $367.69 25% off $244.14 $486.75 $451.62 2026-07-31
J1265 HCPCS Dopamine Injection 27 2 $98.70 $74.02 25% off $16.88 $95.84 $67.18 2026-07-31
J9000 HCPCS Doxorubicin Hcl Injection 63 2 $266.60 $199.95 25% off $16.88 $424.76 $239.94 2026-07-31
J0885 HCPCS Epoetin Alfa, Non-esrd 45 2 $835.80 $626.85 25% off $237.61 $3,242.61 $752.22 2026-07-31
J9179 HCPCS Eribulin Mesylate Injection 9 2 $3,796.40 $2,847.30 25% off $1,936.16 $3,682.51 $3,416.76 2026-07-31
J7307 HCPCS Etonogestrel 68 Mg Implant (Nexplanon) 9 2 $3,069.50 $2,302.13 25% off $1,565.44 $2,977.41 $2,762.55 2026-07-31
Q0138 HCPCS Ferumoxytol, Non-esrd 9 2 $3,623.90 $2,717.93 25% off $1,848.19 $3,515.18 $3,261.51 2026-07-31
J9190 HCPCS Fluorouracil Injection 81 2 $181.20 $135.90 25% off $19.18 $322.91 $123.22 2026-07-31
J1451 HCPCS Fomepizole, 15 Mg 27 2 $3,419.00 $2,564.25 25% off $1,637.61 $4,549.98 $3,114.67 2026-07-31
J1652 HCPCS Fondaparinux Sodium 18 2 $293.95 $220.47 25% off $135.00 $313.50 $251.47 2026-07-31
793 MS_DRG Full Term Neonate With Major Problems 3 3 — — $4,301.68 $4,301.68 $4,301.68 2024-03-01
379 MS_DRG Gastrointestinal Hemorrhage Without Cc/Mcc 1 1 — — $26,420.71 $26,420.71 $26,420.71 2024-03-01
390 MS_DRG Gastrointestinal Obstruction Without Cc/Mcc 1 1 — — $2,434.75 $2,434.75 $2,434.75 2024-03-01
J1602 HCPCS Golimumab For IV Use 1mg 18 2 $10,251.35 $7,688.51 25% off $797.13 $18,371.51 $5,587.68 2026-07-31
J1626 HCPCS Granisetron Hcl Injection 27 2 $148.90 $111.68 25% off $38.71 $234.84 $134.01 2026-07-31
J1571 HCPCS Hepagam B IM Injection 9 2 $2,113.10 $1,584.82 25% off $1,077.68 $2,049.71 $1,901.79 2026-07-31
J1740 HCPCS Ibandronate Sodium Injection 9 2 $1,649.30 $1,236.97 25% off $841.14 $1,599.82 $1,484.37 2026-07-31
J1742 HCPCS Ibutilide Fumarate Injection 9 2 $1,414.30 $1,060.72 25% off $721.29 $1,371.87 $1,272.87 2026-07-31
N903 OTHER Influenza Vaccines & Pneumococcal Pneumonia Vaccines 2 2 — — $824.37 $824.37 $824.37 2024-03-01
J1110 HCPCS Inj Dihydroergotamine Mesylt 9 2 $410.80 $308.10 25% off $209.51 $398.48 $369.72 2026-07-31
J1250 HCPCS Inj Dobutamine Hcl/250 Mg 36 2 $47.15 $35.36 25% off $19.18 $48.50 $39.43 2026-07-31
J1410 HCPCS Inj Estrogen Conjugate 25 Mg 9 2 $1,023.30 $767.48 25% off $521.88 $992.60 $920.97 2026-07-31
J1951 HCPCS Inj Fensolvi 0.25 Mg 9 2 $8,474.90 $6,356.17 25% off $4,322.20 $8,220.65 $7,627.41 2026-07-31
J0670 HCPCS Inj Mepivacaine Hcl/10 Ml 18 2 $54.10 $40.58 25% off $22.54 $62.08 $42.87 2026-07-31
J2720 HCPCS Inj Protamine Sulfate/10 Mg 9 2 $279.30 $209.48 25% off $142.44 $270.92 $251.37 2026-07-31
J9355 HCPCS Inj Trastuzumab Excl Biosimi 9 2 $4,873.30 $3,654.98 25% off $2,485.38 $4,727.10 $4,385.97 2026-07-31
J9354 HCPCS Inj, Ado-trastuzumab Emt 1mg 18 2 $12,450.25 $9,337.69 25% off $4,884.32 $14,863.70 $9,289.79 2026-07-31
J9033 HCPCS Inj, Bendamustine (nos) 1mg 18 2 $5,808.20 $4,356.15 25% off $1,184.88 $9,014.31 $3,496.54 2026-07-31
J2280 HCPCS Inj, Moxifloxacin 100 Mg 18 2 $281.70 $211.28 25% off $136.02 $287.80 $253.37 2026-07-31
J9034 HCPCS Inj., Bendeka 1 Mg 9 2 $7,735.90 $5,801.93 25% off $3,945.31 $7,503.82 $6,962.31 2026-07-31
Q5117 HCPCS Inj., Kanjinti, 10 Mg 9 2 $11,561.70 $8,671.28 25% off $5,896.47 $11,214.85 $10,405.53 2026-07-31
S0164 HCPCS Injection Pantroprazole 27 2 $43.30 $32.48 25% off $19.18 $53.45 $37.47 2026-07-31
J9041 HCPCS Injection, Bortezomib, 0.1mg 9 2 $5,012.80 $3,759.60 25% off $2,556.53 $4,862.42 $4,511.52 2026-07-31
J0881 HCPCS Injection, Darbepoetin Alfa, 1 Microgram (non-esrd Use) 45 2 $4,840.80 $3,630.60 25% off $493.78 $11,738.84 $4,356.72 2026-07-31
J9395 HCPCS Injection, Fulvestrant 9 2 $2,535.40 $1,901.55 25% off $1,293.05 $2,459.34 $2,281.86 2026-07-31
J1885 HCPCS Injection, Ketorolac Tromethamine Charge 54 2 $40.00 $30.00 25% off $13.97 $51.41 $33.84 2026-07-31
J2505 HCPCS Injection, Pegfilgrastim 6mg 9 2 $19,485.10 $14,613.82 25% off $9,937.40 $18,900.55 $17,536.59 2026-07-31
J9306 HCPCS Injection, Pertuzumab, 1 Mg 9 2 $16,066.60 $12,049.95 25% off $8,193.97 $15,584.60 $14,459.94 2026-07-31
J3415 HCPCS Injection, Pyridoxine Hcl, 100 Mg 9 2 $125.60 $94.20 25% off $64.06 $121.83 $113.04 2026-07-31
Q5111 HCPCS Injection, Udenyca 0.5 Mg 9 2 $13,055.60 $9,791.70 25% off $6,658.36 $12,663.93 $11,750.04 2026-07-31
J9206 HCPCS Irinotecan Injection 72 2 $189.70 $142.28 25% off $40.24 $910.05 $147.05 2026-07-31
J7298 HCPCS IUD Mirena Charge 9 2 $4,014.20 $3,010.65 25% off $2,047.24 $3,893.77 $3,612.78 2026-07-31
J0690 HCPCS J0690 Cefazolin Sodium Injection 500mg 18 2 $64.95 $48.71 25% off $16.88 $93.90 $40.74 2026-07-31
J0702 HCPCS J0702 Injection, Betamethasone Sodium Phosphate, Per 3 Mg 36 2 $65.60 $49.20 25% off $24.68 $75.76 $55.09 2026-07-31
J2175 HCPCS J2175 Meperidine Hydrochloride Injection Per 100mg [pmho] 45 2 $50.50 $37.88 25% off $16.88 $51.80 $35.72 2026-07-31
J7318 HCPCS J7318 Durolane 20mg/mL 9 2 $3,049.00 $2,286.75 25% off $1,554.99 $2,957.53 $2,744.10 2026-07-31
J0640 HCPCS Leucovorin Calcium Injection 99 2 $197.10 $147.82 25% off $61.86 $443.58 $154.81 2026-07-31
5341 OTHER Level 1 Abdominal/Peritoneal/Biliary And Related Procedures 4 4 — — $23,277.24 $23,277.24 $23,277.24 2024-03-01
5241 OTHER Level 1 Blood Product Exchange And Related Services 2 2 — — $6,235.32 $6,235.32 $6,235.32 2024-03-01
5091 OTHER Level 1 Breast/Lymphatic Surgery And Related Procedures 2 2 — — $11,993.78 $11,993.78 $11,993.78 2024-03-01
5721 OTHER Level 1 Diagnostic Tests And Related Services 5 4 — — $431.19 $431.19 $431.19 2024-03-01
5691 OTHER Level 1 Drug Administration 4 3 — — $154.67 $154.67 $154.67 2024-03-01
5741 OTHER Level 1 Electronic Analysis Of Devices 3 3 — — $87.78 $87.78 $87.78 2024-03-01
5071 OTHER Level 1 Excision/ Biopsy/ Incision And Drainage 1 1 — — $10,933.37 $10,933.37 $10,933.37 2024-03-01
5571 OTHER Level 1 Imaging With Contrast 6 6 — — $1,780.38 $1,780.38 $1,780.38 2024-03-01
5521 OTHER Level 1 Imaging Without Contrast 11 10 — — $235.85 $235.85 $235.85 2024-03-01
5491 OTHER Level 1 Intraocular Procedures 4 3 — — $6,251.11 $6,251.11 $6,251.11 2024-03-01
5361 OTHER Level 1 Laparoscopy And Related Services 5 5 — — $30,161.51 $30,161.51 $30,161.51 2024-03-01
5311 OTHER Level 1 Lower Gi Procedures 5 4 — — $6,835.61 $6,835.61 $6,835.61 2024-03-01
5111 OTHER Level 1 Musculoskeletal Procedures 1 1 — — $9,814.51 $9,814.51 $9,814.51 2024-03-01
5441 OTHER Level 1 Nerve Injections 3 3 — — $736.39 $736.39 $736.39 2024-03-01
5431 OTHER Level 1 Nerve Procedures 5 4 — — $6,488.78 $6,488.78 $6,488.78 2024-03-01
5591 OTHER Level 1 Nuclear Medicine And Related Services 3 3 — — $1,745.67 $1,745.67 $1,745.67 2024-03-01
5671 OTHER Level 1 Pathology 6 5 — — $448.49 $448.49 $448.49 2024-03-01
5051 OTHER Level 1 Skin Procedures 5 4 — — $359.51 $359.51 $359.51 2024-03-01
5101 OTHER Level 1 Strapping And Cast Application 1 1 — — $67.88 $67.88 $67.88 2024-03-01
5181 OTHER Level 1 Vascular Procedures 1 1 — — $10,589.38 $10,589.38 $10,589.38 2024-03-01
5722 OTHER Level 2 Diagnostic Tests And Related Services 6 5 — — $799.28 $799.28 $799.28 2024-03-01
5692 OTHER Level 2 Drug Administration 8 7 — — $342.31 $342.31 $342.31 2024-03-01
5572 OTHER Level 2 Imaging With Contrast 8 7 — — $2,613.92 $2,613.92 $2,613.92 2024-03-01
5522 OTHER Level 2 Imaging Without Contrast 9 8 — — $344.40 $344.40 $344.40 2024-03-01
5362 OTHER Level 2 Laparoscopy And Related Services 4 4 — — $41,162.71 $41,162.71 $41,162.71 2024-03-01
5312 OTHER Level 2 Lower Gi Procedures 6 5 — — $8,529.17 $8,529.17 $8,529.17 2024-03-01
5732 OTHER Level 2 Minor Procedures 4 3 — — $95.26 $95.26 $95.26 2024-03-01
5112 OTHER Level 2 Musculoskeletal Procedures 5 4 — — $7,244.06 $7,244.06 $7,244.06 2024-03-01
5442 OTHER Level 2 Nerve Injections 6 5 — — $1,031.99 $1,031.99 $1,031.99 2024-03-01
5592 OTHER Level 2 Nuclear Medicine And Related Services 5 4 — — $1,897.62 $1,897.62 $1,897.62 2024-03-01
5052 OTHER Level 2 Skin Procedures 1 1 — — $500.00 $500.00 $500.00 2024-03-01
5022 OTHER Level 2 Type A Ed Visits 4 4 — — $675.00 $675.00 $675.00 2024-03-01
5302 OTHER Level 2 Upper Gi Procedures 4 3 — — $8,346.67 $8,346.67 $8,346.67 2024-03-01
5182 OTHER Level 2 Vascular Procedures 1 1 — — $5,341.05 $5,341.05 $5,341.05 2024-03-01
5723 OTHER Level 3 Diagnostic Tests And Related Services 1 1 — — $2,003.45 $2,003.45 $2,003.45 2024-03-01
5163 OTHER Level 3 ENT Procedures 2 2 — — $4,690.73 $4,690.73 $4,690.73 2024-03-01
5073 OTHER Level 3 Excision/ Biopsy/ Incision And Drainage 3 3 — — $14,608.19 $14,608.19 $14,608.19 2024-03-01
5523 OTHER Level 3 Imaging Without Contrast 8 7 — — $1,563.10 $1,563.10 $1,563.10 2024-03-01
5313 OTHER Level 3 Lower Gi Procedures 2 2 — — $13,151.84 $13,151.84 $13,151.84 2024-03-01
5733 OTHER Level 3 Minor Procedures 8 7 — — $368.20 $368.20 $368.20 2024-03-01
5113 OTHER Level 3 Musculoskeletal Procedures 5 5 — — $13,905.37 $13,905.37 $13,905.37 2024-03-01
5443 OTHER Level 3 Nerve Injections 5 4 — — $899.33 $899.33 $899.33 2024-03-01
5593 OTHER Level 3 Nuclear Medicine And Related Services 3 3 — — $6,086.07 $6,086.07 $6,086.07 2024-03-01
5023 OTHER Level 3 Type A Ed Visits 10 8 — — $1,685.26 $1,685.26 $1,685.26 2024-03-01
5373 OTHER Level 3 Urology And Related Services 2 2 — — $8,294.42 $8,294.42 $8,294.42 2024-03-01
5183 OTHER Level 3 Vascular Procedures 3 3 — — $18,255.06 $18,255.06 $18,255.06 2024-03-01
5724 OTHER Level 4 Diagnostic Tests And Related Services 5 4 — — $2,343.55 $2,343.55 $2,343.55 2024-03-01
5694 OTHER Level 4 Drug Administration 2 2 — — $48,779.38 $48,779.38 $48,779.38 2024-03-01
5164 OTHER Level 4 ENT Procedures 3 3 — — $14,791.71 $14,791.71 $14,791.71 2024-03-01
5414 OTHER Level 4 Gynecologic Procedures 4 4 — — $18,778.53 $18,778.53 $18,778.53 2024-03-01
5524 OTHER Level 4 Imaging Without Contrast 6 5 — — $1,559.22 $1,559.22 $1,559.22 2024-03-01
5734 OTHER Level 4 Minor Procedures 7 7 — — $657.50 $657.50 $657.50 2024-03-01
5114 OTHER Level 4 Musculoskeletal Procedures 8 7 — — $22,383.37 $22,383.37 $22,383.37 2024-03-01
5054 OTHER Level 4 Skin Procedures 1 1 — — $36,211.70 $36,211.70 $36,211.70 2024-03-01
5024 OTHER Level 4 Type A Ed Visits 8 6 — — $2,209.53 $2,209.53 $2,209.53 2024-03-01
5165 OTHER Level 5 ENT Procedures 3 3 — — $12,557.76 $12,557.76 $12,557.76 2024-03-01
5415 OTHER Level 5 Gynecologic Procedures 1 1 — — $39,465.81 $39,465.81 $39,465.81 2024-03-01
5115 OTHER Level 5 Musculoskeletal Procedures 7 6 — — $49,670.06 $49,670.06 $49,670.06 2024-03-01
5025 OTHER Level 5 Type A Ed Visits 6 5 — — $4,430.54 $4,430.54 $4,430.54 2024-03-01
5375 OTHER Level 5 Urology And Related Services 1 1 — — $21,152.37 $21,152.37 $21,152.37 2024-03-01
5116 OTHER Level 6 Musculoskeletal Procedures 1 1 — — $27,365.04 $27,365.04 $27,365.04 2024-03-01
470 MS_DRG Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without … 1 1 — — $13,254.00 $13,254.00 $13,254.00 2024-03-01
331 MS_DRG Major Small And Large Bowel Procedures Without Cc/Mcc 1 1 — — $66,049.06 $66,049.06 $66,049.06 2024-03-01
N804 OTHER Mammography Services 7 6 — — $303.33 $303.33 $303.33 2024-03-01
J2150 HCPCS Mannitol Injection 27 2 $37.60 $28.20 25% off $16.88 $39.96 $32.11 2026-07-31
J2185 HCPCS Meropenem 9 2 $251.80 $188.85 25% off $128.42 $244.25 $226.62 2026-07-31
J9250 HCPCS Methotrexate Sodium Inj 18 2 $184.60 $138.46 25% off $34.94 $291.68 $109.90 2026-07-31
J2248 HCPCS Micafungin Sodium Injection 9 2 $375.60 $281.70 25% off $191.56 $364.33 $338.04 2026-07-31
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 1 1 — — $3,758.54 $3,758.54 $3,758.54 2024-03-01
J2916 HCPCS Na Ferric Gluconate Complex 9 2 $241.00 $180.75 25% off $122.91 $233.77 $216.90 2026-07-31
794 MS_DRG Neonate With Other Significant Problems 5 5 — — $4,586.85 $4,586.85 $4,586.85 2024-03-01
54 MS_DRG Nervous System Neoplasms With Mcc 1 1 — — $6,720.41 $6,720.41 $6,720.41 2024-03-01
J2325 HCPCS Nesiritide Injection 9 2 $3,310.10 $2,482.57 25% off $1,688.15 $3,210.80 $2,979.09 2026-07-31
1563 OTHER New Technology - Level 26 ($4001-$4500) 1 1 — — $9,214.02 $9,214.02 $9,214.02 2024-03-01
N900 OTHER Non-covered Services 6 6 — — $1,417.18 $1,417.18 $1,417.18 2024-03-01
N700 OTHER Non-opps Clinic Services 5 4 — — $378.24 $378.24 $378.24 2024-03-01
J1050 HCPCS Noncdm Charge Record Pharmacy 72 2 $319.45 $239.59 25% off $133.37 $459.10 $283.77 2026-07-31
J1040 HCPCS Noncdm Charge Record Pharmacy 36 2 $131.35 $98.51 25% off $55.28 $135.51 $108.24 2026-07-31
795 MS_DRG Normal Newborn 5 5 — — $2,971.58 $2,971.58 $2,971.58 2024-03-01
N907 OTHER Not Billable To Fi 3 3 — — $269.60 $269.60 $269.60 2024-03-01
J2353 HCPCS Octreotide Injection, Depot 9 2 $12,733.10 $9,549.83 25% off $6,493.88 $12,351.11 $11,459.79 2026-07-31
J9263 HCPCS Oxaliplatin 81 2 $625.50 $469.13 25% off $148.16 $83,414.86 $562.95 2026-07-31
J9303 HCPCS Panitumumab Injection 18 2 $10,621.90 $7,966.42 25% off $2,166.89 $16,485.15 $6,394.40 2026-07-31
J2560 HCPCS Phenobarbital Sodium Inj 18 2 $173.55 $130.16 25% off $84.35 $176.25 $157.13 2026-07-31
J2370 HCPCS Phenylephrine Hcl Injection 18 2 $35.35 $26.52 25% off $16.88 $36.47 $31.45 2026-07-31
J1165 HCPCS Phenytoin Sodium Injection 9 2 $33.10 $24.83 25% off $16.88 $32.11 $29.79 2026-07-31
J2730 HCPCS Pralidoxime Chloride Inj 9 2 $348.30 $261.23 25% off $177.63 $337.85 $313.47 2026-07-31
792 MS_DRG Prematurity Without Major Problems 1 1 — — $2,698.96 $2,698.96 $2,698.96 2024-03-01
189 MS_DRG Pulmonary Edema And Respiratory Failure 1 1 — — $26,820.00 $26,820.00 $26,820.00 2024-03-01
5791 OTHER Pulmonary Treatment 4 4 — — $639.17 $639.17 $639.17 2024-03-01
204 MS_DRG Respiratory Signs And Symptoms 1 1 — — $6,334.03 $6,334.03 $6,334.03 2024-03-01
5781 OTHER Resuscitation And Cardioversion 1 1 — — $1,000.00 $1,000.00 $1,000.00 2024-03-01
J2790 HCPCS Rho D Immune Globulin Inj 18 2 $450.00 $337.50 25% off $217.21 $459.88 $404.61 2026-07-31
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 3 3 — — $10,289.06 $10,289.06 $10,289.06 2024-03-01
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 1 1 — — $7,592.56 $7,592.56 $7,592.56 2024-03-01
J3101 HCPCS Tenecteplase Injection 18 2 $14,454.05 $10,840.54 25% off $5,114.02 $18,314.18 $9,726.67 2026-07-31
J1670 HCPCS Tetanus Immune Globulin Injection 9 2 $1,740.00 $1,305.00 25% off $887.40 $1,687.80 $1,566.00 2026-07-31
J3243 HCPCS Tigecycline Injection 9 2 $489.50 $367.13 25% off $249.65 $474.81 $440.55 2026-07-31
J3262 HCPCS Tocilizumab Injection 9 2 $1,400.20 $1,050.15 25% off $714.10 $1,358.19 $1,260.18 2026-07-31
J9351 HCPCS Topotecan Injection 9 2 $3,619.70 $2,714.77 25% off $1,846.05 $3,511.11 $3,257.73 2026-07-31
384 MS_DRG Uncomplicated Peptic Ulcer Without Mcc 1 1 — — $1,994.78 $1,994.78 $1,994.78 2024-03-01
999 MS_DRG Ungroupable 6 5 — — $18,926.79 $18,926.79 $18,926.79 2024-03-01
694 MS_DRG Urinary Stones Without Mcc 1 1 — — $6,622.07 $6,622.07 $6,622.07 2024-03-01
768 MS_DRG Vaginal Delivery With O.r. Procedures Except Sterilization And/Or D&c 1 1 — — $28,716.10 $28,716.10 $28,716.10 2024-03-01
798 MS_DRG Vaginal Delivery With Sterilization And/Or D&c Without Cc/Mcc 1 1 — — $40,238.97 $40,238.97 $40,238.97 2024-03-01
806 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Cc 3 3 — — $19,103.65 $19,103.65 $19,103.65 2024-03-01
805 MS_DRG Vaginal Delivery Without Sterilization Or D&c With Mcc 1 1 — — $15,532.41 $15,532.41 $15,532.41 2024-03-01
807 MS_DRG Vaginal Delivery Without Sterilization Or D&c Without Cc/Mcc 5 5 — — $14,746.72 $14,746.72 $14,746.72 2024-03-01
J9357 HCPCS Valrubicin Injection 9 2 $4,396.80 $3,297.60 25% off $2,242.37 $4,264.90 $3,957.12 2026-07-31
J9360 HCPCS Vinblastine Sulfate Inj 9 2 $274.00 $205.50 25% off $139.74 $265.78 $246.60 2026-07-31
J9370 HCPCS Vincristine Sulfate 1 Mg Inj 9 2 $48.80 $36.60 25% off $24.89 $47.34 $43.92 2026-07-31
J9390 HCPCS Vinorelbine Tartrate Inj 9 2 $189.50 $142.13 25% off $96.64 $183.81 $170.55 2026-07-31
J3420 HCPCS Vitamin B12 Injection 27 2 $58.60 $43.95 25% off $19.48 $59.85 $41.96 2026-07-31
J3430 HCPCS Vitamin K Phytonadione Inj 54 2 $209.55 $157.16 25% off $18.36 $273.25 $162.07 2026-07-31
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