Price Transparency 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

DUKES MEMORIAL HOSPITAL

Peru, IN · CCN 151318 · Rates published

64,427 distinct procedures filed
60 distinct payers
4,531,308 rate rows
2026-05-13 last MRF observed
Data quality

4,386,957 of 4,531,308 rate rows are consumer-grade (96.8%)

144,351 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
per-diem day rate — not a per-procedure price 89,002
placeholder amount (≤ $0.02) — excluded from medians 21,846
exceeds 10× this hospital's gross charge — excluded from medians 18,342
template filing: same amount across many unrelated codes — excluded 11,110
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 4,051
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.dukesmemorialhosp.com/Uploads/Public/Documents/charge-masters/charge-masters-2024/522379885_dukes-memorial-hospital_standardcharges.csv
Found on page https://www.dukesmemorialhosp.com/pricing-information
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-17
Content fingerprint 0976d41fc33d65d0… · 1,133,433,130 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
011-4
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 9 $434,216.72 $647,979.12 $647,979.12 nat. median
$105,647
outlier · 6.1×
583-3
OTHER 		Neonate With Ecmo 9 $395,514.93 $588,944.20 $588,944.20 nat. median
$259,487
outlier · 2.3×
583-4
OTHER 		Neonate With Ecmo 9 $395,514.93 $588,944.20 $588,944.20 nat. median
$309,400
1.9× median
583-2
OTHER 		Neonate With Ecmo 9 $374,511.63 $558,502.30 $558,502.30 nat. median
$191,347
outlier · 2.9×
583-1
OTHER 		Neonate With Ecmo 9 $374,511.63 $558,502.30 $558,502.30 nat. median
$171,226
outlier · 3.3×
002-4
OTHER 		Heart And/or Lung Transplant 9 $360,685.28 $537,458.68 $537,458.68 nat. median
$216,800
outlier · 2.5×
588-4
OTHER 		Neonate Birth Weight < 1500 Grams With Major Procedure 9 $339,285.68 $503,124.62 $503,124.62 nat. median
$267,493
1.9× median
161-4
OTHER 		Implantable Heart Assist Systems 9 $315,431.69 $469,930.95 $469,930.95 nat. median
$202,242
outlier · 2.3×
631-4
OTHER 		Neonate Birth Weight > 2499 Grams With Other Major Procedure 9 $316,233.60 $469,136.53 $469,136.53 nat. median
$203,379
outlier · 2.3×
108087544-2255320
OTHER 		67979-0002-01 - Histrelin 50 Mg Implan 48 $200,749.18 $1,084,351.15 $433,740.46 nat. median
$433,740
1.0× median
108978003-2255320
OTHER 		69866-1030-08 - Autologous Cultured Chondrocytes 1 48 $193,561.08 $1,045,524.48 $418,209.80 nat. median
$418,210
1.0× median
108963947-2255320
OTHER 		69866-1030-05 - Autologous Cultured Chondrocytes I 48 $193,561.08 $1,045,524.48 $418,209.80 nat. median
$418,210
1.0× median
108963946-2255320
OTHER 		69866-1025-01 - Autologous Cultured Chondrocytes 0 48 $193,561.08 $1,045,524.48 $418,209.80 nat. median
$418,210
1.0× median
588-3
OTHER 		Neonate Birth Weight < 1500 Grams With Major Procedure 9 $267,470.97 $396,403.43 $396,403.43 nat. median
$165,000
outlier · 2.4×
004-4
OTHER 		Tracheostomy With Mv >96 Hours With Extensive Procedure 9 $264,547.95 $393,435.20 $393,435.20 nat. median
$110,000
outlier · 3.6×
011-3
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 9 $253,343.54 $378,177.99 $378,177.99 nat. median
$171,094
outlier · 2.2×
007-4
OTHER 		Allogeneic Bone Marrow Transplant 7 $224,142.59 $333,375.47 $333,375.47 nat. median
$172,311
1.9× median
591-4
OTHER 		Neonate Birth Weight 500-749 Grams Without Major Procedure 9 $224,358.82 $332,614.53 $332,614.53 nat. median
$156,696
outlier · 2.1×
001-4
OTHER 		Liver Transplant And/or Intestinal Transplant 7 $220,536.98 $328,688.97 $328,688.97 nat. median
$124,561
outlier · 2.6×
593-4
OTHER 		Neonate Birth Weight 750-999 Grams Without Major Procedure 9 $214,523.26 $317,330.38 $317,330.38 nat. median
$151,250
outlier · 2.1×
011-2
OTHER 		Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 9 $204,264.27 $304,837.81 $304,837.81 nat. median
$52,878
outlier · 5.8×
161-3
OTHER 		Implantable Heart Assist Systems 9 $203,905.05 $303,870.59 $303,870.59 nat. median
$152,491
2.0× median
161-2
OTHER 		Implantable Heart Assist Systems 9 $203,885.70 $303,851.24 $303,851.24 nat. median
$109,992
outlier · 2.8×
161-1
OTHER 		Implantable Heart Assist Systems 9 $202,873.05 $302,838.59 $302,838.59 nat. median
$101,352
outlier · 3.0×
002-3
OTHER 		Heart And/or Lung Transplant 7 $198,507.20 $295,712.02 $295,712.02 nat. median
$133,471
outlier · 2.2×
588-1
OTHER 		Female Reproductive System Reconstructive Procedures 9 $198,127.58 $294,207.35 $294,207.35 nat. median
$75,325
outlier · 3.9×
588-2
OTHER 		Neonate Birth Weight < 1500 Grams With Major Procedure 9 $198,127.58 $294,207.35 $294,207.35 nat. median
$153,523
1.9× median
51905029-2255322
OTHER 		30237-8900-06 - Sipuleucel-t - Susp 48 $126,121.84 $681,249.92 $272,499.97 nat. median
$272,500
1.0× median
609-4
OTHER 		Neonate Birth Weight 1500-2499 Grams With Major Procedure 9 $169,002.62 $250,369.68 $250,369.68 nat. median
$169,856
1.5× median
602-4
OTHER 		Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 9 $165,770.53 $245,243.37 $245,243.37 nat. median
$125,000
2.0× median
002-2
OTHER 		Heart And/or Lung Transplant 7 $163,464.90 $243,586.70 $243,586.70 nat. median
$106,681
outlier · 2.3×
160-4
OTHER 		Major Cardiothoracic Repair Of Heart Anomaly 9 $162,843.39 $242,358.25 $242,358.25 nat. median
$106,926
outlier · 2.3×
630-4
OTHER 		Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 9 $158,132.69 $235,523.02 $235,523.02 nat. median
$210,669
1.1× median
005-4
OTHER 		Tracheostomy With Mv >96 Hours Without Extensive Procedure 7 $154,011.10 $228,748.68 $228,748.68 nat. median
$88,000
outlier · 2.6×
009-4
OTHER 		Extracorporeal Membrane Oxygenation (ecmo) 9 $152,611.53 $227,390.60 $227,390.60 nat. median
$150,954
1.5× median
007-3
OTHER 		Allogeneic Bone Marrow Transplant 7 $148,660.10 $220,943.88 $220,943.88 nat. median
$104,111
outlier · 2.1×
607-4
OTHER 		Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 9 $148,158.63 $219,132.78 $219,132.78 nat. median
$100,015
outlier · 2.2×
002-1
OTHER 		Heart And/or Lung Transplant 7 $145,569.92 $217,018.03 $217,018.03 nat. median
$57,500
outlier · 3.8×
004-3
OTHER 		Tracheostomy With Mv >96 Hours With Extensive Procedure 9 $134,626.81 $199,957.70 $199,957.70 nat. median
$91,000
outlier · 2.2×
007-2
OTHER 		Allogeneic Bone Marrow Transplant 7 $133,323.47 $198,437.33 $198,437.33 nat. median
$74,284
outlier · 2.7×
593-3
OTHER 		Neonate Birth Weight 750-999 Grams Without Major Procedure 9 $129,612.05 $191,842.30 $191,842.30 nat. median
$112,711
1.7× median
850-4
OTHER 		Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 9 $125,727.77 $186,758.52 $186,758.52 nat. median
$54,797
outlier · 3.4×
162-4
OTHER 		Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 9 $121,851.03 $181,159.91 $181,159.91 nat. median
$80,850
outlier · 2.2×
001-3
OTHER 		Liver Transplant And/or Intestinal Transplant 7 $121,179.73 $180,772.13 $180,772.13 nat. median
$81,541
outlier · 2.2×
303-4
OTHER 		Dorsal And Lumbar Fusion Procedure For Curvature Of Back 9 $120,940.24 $180,120.92 $180,120.92 nat. median
$108,000
1.7× median
602-3
OTHER 		Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 9 $117,122.59 $172,990.93 $172,990.93 nat. median
$99,067
1.7× median
006-4
OTHER 		Pancreas Transplant 7 $114,947.03 $171,455.28 $171,455.28 nat. median
$92,449
1.9× median
006-3
OTHER 		Pancreas Transplant 7 $114,947.03 $171,455.28 $171,455.28 nat. median
$85,000
outlier · 2.0×
006-2
OTHER 		Pancreas Transplant 7 $114,947.03 $171,455.28 $171,455.28 nat. median
$67,906
outlier · 2.5×
633-4
OTHER 		Neonate Birth Weight > 2499 Grams With Major Anomaly 9 $114,277.11 $169,641.18 $169,641.18 nat. median
$74,597
outlier · 2.3×

Other procedures at this hospital

Browse this hospital's 64,427 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
             
011-4 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 9 — — $434,216.72 $647,979.12 $647,979.12 2026-05-13
583-4 OTHER Neonate With Ecmo 12 9 — — $395,514.93 $588,944.20 $588,944.20 2026-05-13
583-3 OTHER Neonate With Ecmo 12 9 — — $395,514.93 $588,944.20 $588,944.20 2026-05-13
583-2 OTHER Neonate With Ecmo 12 9 — — $374,511.63 $558,502.30 $558,502.30 2026-05-13
583-1 OTHER Neonate With Ecmo 12 9 — — $374,511.63 $558,502.30 $558,502.30 2026-05-13
002-4 OTHER Heart And/or Lung Transplant 12 9 — — $360,685.28 $537,458.68 $537,458.68 2026-05-13
588-4 OTHER Neonate Birth Weight < 1500 Grams With Major Procedure 12 9 — — $339,285.68 $503,124.62 $503,124.62 2026-05-13
161-4 OTHER Implantable Heart Assist Systems 12 9 — — $315,431.69 $469,930.95 $469,930.95 2026-05-13
631-4 OTHER Neonate Birth Weight > 2499 Grams With Other Major Procedure 12 9 — — $316,233.60 $469,136.53 $469,136.53 2026-05-13
108087544-2255320 OTHER 67979-0002-01 - Histrelin 50 Mg Implan 67 48 $1,084,351.15 $542,175.58 50% off $200,749.18 $1,084,351.15 $433,740.46 2026-05-13
108963947-2255320 OTHER 69866-1030-05 - Autologous Cultured Chondrocytes I 67 48 $1,045,524.48 $522,762.24 50% off $193,561.08 $1,045,524.48 $418,209.80 2026-05-13
108978003-2255320 OTHER 69866-1030-08 - Autologous Cultured Chondrocytes 1 67 48 $1,045,524.48 $522,762.24 50% off $193,561.08 $1,045,524.48 $418,209.80 2026-05-13
108963946-2255320 OTHER 69866-1025-01 - Autologous Cultured Chondrocytes 0 67 48 $1,045,524.48 $522,762.24 50% off $193,561.08 $1,045,524.48 $418,209.80 2026-05-13
588-3 OTHER Neonate Birth Weight < 1500 Grams With Major Procedure 12 9 — — $267,470.97 $396,403.43 $396,403.43 2026-05-13
004-4 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 12 9 — — $264,547.95 $393,435.20 $393,435.20 2026-05-13
011-3 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 9 — — $253,343.54 $378,177.99 $378,177.99 2026-05-13
007-4 OTHER Allogeneic Bone Marrow Transplant 10 7 — — $224,142.59 $333,375.47 $333,375.47 2026-05-13
591-4 OTHER Neonate Birth Weight 500-749 Grams Without Major Procedure 12 9 — — $224,358.82 $332,614.53 $332,614.53 2026-05-13
001-4 OTHER Liver Transplant And/or Intestinal Transplant 10 7 — — $220,536.98 $328,688.97 $328,688.97 2026-05-13
593-4 OTHER Neonate Birth Weight 750-999 Grams Without Major Procedure 12 9 — — $214,523.26 $317,330.38 $317,330.38 2026-05-13
011-2 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 9 — — $204,264.27 $304,837.81 $304,837.81 2026-05-13
161-3 OTHER Implantable Heart Assist Systems 12 9 — — $203,905.05 $303,870.59 $303,870.59 2026-05-13
161-2 OTHER Implantable Heart Assist Systems 12 9 — — $203,885.70 $303,851.24 $303,851.24 2026-05-13
161-1 OTHER Implantable Heart Assist Systems 12 9 — — $202,873.05 $302,838.59 $302,838.59 2026-05-13
002-3 OTHER Heart And/or Lung Transplant 10 7 — — $198,507.20 $295,712.02 $295,712.02 2026-05-13
588-2 OTHER Neonate Birth Weight < 1500 Grams With Major Procedure 12 9 — — $198,127.58 $294,207.35 $294,207.35 2026-05-13
588-1 OTHER Female Reproductive System Reconstructive Procedures 12 9 — — $198,127.58 $294,207.35 $294,207.35 2026-05-13
51905029-2255322 OTHER 30237-8900-06 - Sipuleucel-t - Susp 67 48 $681,249.92 $340,624.96 50% off $126,121.84 $681,249.92 $272,499.97 2026-05-13
609-4 OTHER Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 9 — — $169,002.62 $250,369.68 $250,369.68 2026-05-13
602-4 OTHER Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $165,770.53 $245,243.37 $245,243.37 2026-05-13
002-2 OTHER Heart And/or Lung Transplant 10 7 — — $163,464.90 $243,586.70 $243,586.70 2026-05-13
160-4 OTHER Major Cardiothoracic Repair Of Heart Anomaly 12 9 — — $162,843.39 $242,358.25 $242,358.25 2026-05-13
630-4 OTHER Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 9 — — $158,132.69 $235,523.02 $235,523.02 2026-05-13
005-4 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 10 7 — — $154,011.10 $228,748.68 $228,748.68 2026-05-13
009-4 OTHER Extracorporeal Membrane Oxygenation (ecmo) 12 9 — — $152,611.53 $227,390.60 $227,390.60 2026-05-13
007-3 OTHER Allogeneic Bone Marrow Transplant 10 7 — — $148,660.10 $220,943.88 $220,943.88 2026-05-13
607-4 OTHER Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $148,158.63 $219,132.78 $219,132.78 2026-05-13
002-1 OTHER Heart And/or Lung Transplant 10 7 — — $145,569.92 $217,018.03 $217,018.03 2026-05-13
004-3 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 12 9 — — $134,626.81 $199,957.70 $199,957.70 2026-05-13
007-2 OTHER Allogeneic Bone Marrow Transplant 10 7 — — $133,323.47 $198,437.33 $198,437.33 2026-05-13
593-3 OTHER Neonate Birth Weight 750-999 Grams Without Major Procedure 12 9 — — $129,612.05 $191,842.30 $191,842.30 2026-05-13
850-4 OTHER Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 12 9 — — $125,727.77 $186,758.52 $186,758.52 2026-05-13
162-4 OTHER Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 12 9 — — $121,851.03 $181,159.91 $181,159.91 2026-05-13
001-3 OTHER Liver Transplant And/or Intestinal Transplant 10 7 — — $121,179.73 $180,772.13 $180,772.13 2026-05-13
303-4 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 12 9 — — $120,940.24 $180,120.92 $180,120.92 2026-05-13
602-3 OTHER Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $117,122.59 $172,990.93 $172,990.93 2026-05-13
006-3 OTHER Pancreas Transplant 10 7 — — $114,947.03 $171,455.28 $171,455.28 2026-05-13
006-2 OTHER Pancreas Transplant 10 7 — — $114,947.03 $171,455.28 $171,455.28 2026-05-13
006-4 OTHER Pancreas Transplant 10 7 — — $114,947.03 $171,455.28 $171,455.28 2026-05-13
633-4 OTHER Neonate Birth Weight > 2499 Grams With Major Anomaly 12 9 — — $114,277.11 $169,641.18 $169,641.18 2026-05-13
593-2 OTHER Neonate Birth Weight 750-999 Grams Without Major Procedure 12 9 — — $113,082.04 $167,555.65 $167,555.65 2026-05-13
005-3 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 10 7 — — $111,958.25 $166,227.07 $166,227.07 2026-05-13
008-4 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 10 7 — — $111,808.05 $166,222.61 $166,222.61 2026-05-13
008-3 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 10 7 — — $111,646.80 $166,061.36 $166,061.36 2026-05-13
108329173-2255325 OTHER 71336-1001-01 - Givosiran 189 mg/mL Soln 67 48 $405,600.00 $202,800.00 50% off $75,089.94 $405,600.00 $162,240.00 2026-05-13
609-3 OTHER Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 9 — — $106,507.59 $157,422.04 $157,422.04 2026-05-13
612-4 OTHER Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $104,217.39 $153,859.46 $153,859.46 2026-05-13
611-4 OTHER Neonate Birth Weight 1500-1999 Grams With Major Anomaly 12 9 — — $102,819.42 $152,229.56 $152,229.56 2026-05-13
609-2 OTHER Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 9 — — $102,342.46 $151,921.76 $151,921.76 2026-05-13
609-1 OTHER Neonate Birth Weight 1500-2499 Grams With Major Procedure 12 9 — — $101,200.81 $150,780.11 $150,780.11 2026-05-13
863-4 OTHER Neonatal Aftercare 12 9 — — $101,102.91 $150,117.29 $150,117.29 2026-05-13
109228707-2255322 OTHER 00310-4535-30 - Tremelimumab Actl 20 mg/mL Soln 67 48 $374,654.75 $187,327.38 50% off $69,360.96 $374,654.75 $149,861.90 2026-05-13
621-4 OTHER Neonate Birth Weight 2000-2499 Grams With Major Anomaly 12 9 — — $100,498.82 $149,016.91 $149,016.91 2026-05-13
591-3 OTHER Neonate Birth Weight 500-749 Grams Without Major Procedure 12 9 — — $100,110.52 $147,993.49 $147,993.49 2026-05-13
091-4 OTHER Other Major Head And Neck Procedures 12 9 — — $96,793.55 $143,859.47 $143,859.47 2026-05-13
95380079-2255323 OTHER 00169-7208-01 - Coagulation Factor VIIa 8000 Mcg ( 67 48 $356,403.63 $178,201.82 50% off $65,982.07 $356,403.63 $142,561.46 2026-05-13
303-3 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 12 9 — — $95,465.61 $142,378.87 $142,378.87 2026-05-13
1279402-2255325 OTHER 00003-2328-22 - Ipilimumab Soln 67 48 $354,453.74 $177,226.87 50% off $65,621.08 $354,453.74 $141,781.50 2026-05-13
950-4 OTHER Extensive O.r. Procedure Unrelated To Principal Diagnosis 12 9 — — $94,822.40 $141,031.91 $141,031.91 2026-05-13
440-4 OTHER Kidney Transplant 12 9 — — $94,217.49 $140,057.84 $140,057.84 2026-05-13
440-3 OTHER Kidney Transplant 12 9 — — $93,127.44 $138,967.79 $138,967.79 2026-05-13
440-2 OTHER Kidney Transplant 12 9 — — $93,043.59 $138,883.94 $138,883.94 2026-05-13
440-1 OTHER Kidney Transplant 12 9 — — $92,985.54 $138,825.89 $138,825.89 2026-05-13
021-4 OTHER Open Craniotomy Except Trauma 12 9 — — $92,846.56 $138,009.22 $138,009.22 2026-05-13
602-2 OTHER Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $91,836.36 $135,568.66 $135,568.66 2026-05-13
607-3 OTHER Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $91,056.52 $134,562.75 $134,562.75 2026-05-13
589-3 OTHER Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 12 9 — — $90,682.79 $134,367.74 $134,367.74 2026-05-13
589-4 OTHER Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 12 9 — — $90,682.79 $134,367.74 $134,367.74 2026-05-13
163-4 OTHER Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 12 9 — — $89,471.43 $133,236.70 $133,236.70 2026-05-13
912-4 OTHER Musculoskeletal And Other Procedures For Multiple Significant Trauma 12 9 — — $88,764.32 $132,125.87 $132,125.87 2026-05-13
167-4 OTHER Other Cardiothoracic And Thoracic Vascular Procedures 12 9 — — $88,232.62 $131,273.94 $131,273.94 2026-05-13
911-4 OTHER Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 12 9 — — $88,175.76 $131,271.86 $131,271.86 2026-05-13
589-2 OTHER Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 12 9 — — $86,370.90 $127,924.41 $127,924.41 2026-05-13
589-1 OTHER Neonate Birth Weight < 500 Grams, Or Birth Weight 500-999 Grams And Gestational … 12 9 — — $86,370.90 $127,924.41 $127,924.41 2026-05-13
910-4 OTHER Craniotomy For Multiple Significant Trauma 12 9 — — $85,636.12 $127,441.76 $127,441.76 2026-05-13
165-4 OTHER Coronary Bypass With Ami Or Complex Principal Diagnosis 12 9 — — $84,332.75 $125,385.71 $125,385.71 2026-05-13
022-4 OTHER Ventricular Shunt Procedures 12 9 — — $84,179.47 $124,923.91 $124,923.91 2026-05-13
007-1 OTHER Allogeneic Bone Marrow Transplant 10 7 — — $82,742.06 $122,893.92 $122,893.92 2026-05-13
011-1 OTHER Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 12 9 — — $82,032.56 $122,184.42 $122,184.42 2026-05-13
001-2 OTHER Liver Transplant And/or Intestinal Transplant 10 7 — — $80,526.33 $120,077.11 $120,077.11 2026-05-13
009-3 OTHER Extracorporeal Membrane Oxygenation (ecmo) 12 9 — — $80,442.35 $119,929.30 $119,929.30 2026-05-13
108290516-2255322 OTHER 72187-0401-01 - Tagraxofusp 1000 mcg/mL Soln 67 48 $297,379.98 $148,689.99 50% off $55,054.85 $297,379.98 $118,952.00 2026-05-13
178-4 OTHER External Heart Assist Systems 12 9 — — $79,406.10 $118,390.37 $118,390.37 2026-05-13
104437516-2255325 OTHER 75987-0080-10 - Pegloticase 8 mg/mL Soln 67 48 $290,382.77 $145,191.39 50% off $53,759.43 $290,382.77 $116,153.11 2026-05-13
95367892-2255325 OTHER 60809-0801-01 - Pegloticase 8 mg/mL Soln 67 48 $290,382.77 $145,191.39 50% off $53,759.43 $290,382.77 $116,153.11 2026-05-13
1286149-2255325 OTHER 54396-0801-01 - Pegloticase Soln 67 48 $290,382.77 $145,191.39 50% off $53,759.43 $290,382.77 $116,153.11 2026-05-13
681-4 OTHER Other O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 12 9 — — $78,143.09 $116,133.18 $116,133.18 2026-05-13
603-4 OTHER Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 12 9 — — $78,867.96 $115,963.34 $115,963.34 2026-05-13
603-3 OTHER Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 12 9 — — $78,074.61 $115,169.99 $115,169.99 2026-05-13
004-2 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 12 9 — — $77,104.75 $114,623.02 $114,623.02 2026-05-13
863-3 OTHER Neonatal Aftercare 12 9 — — $76,776.96 $113,807.97 $113,807.97 2026-05-13
183-4 OTHER Percutaneous Structural Cardiac Procedures 12 9 — — $76,371.31 $113,743.82 $113,743.82 2026-05-13
593-1 OTHER Neonate Birth Weight 750-999 Grams Without Major Procedure 12 9 — — $75,918.76 $112,777.42 $112,777.42 2026-05-13
591-2 OTHER Neonate Birth Weight 500-749 Grams Without Major Procedure 12 9 — — $76,070.98 $112,195.05 $112,195.05 2026-05-13
634-4 OTHER Neonate Birth Weight > 2499 Grams With Respiratory Distress Syndrome Or Other Ma… 12 9 — — $75,431.01 $111,911.47 $111,911.47 2026-05-13
020-4 OTHER Open Craniotomy For Trauma 12 9 — — $75,106.67 $111,739.26 $111,739.26 2026-05-13
695-4 OTHER Chemotherapy For Acute Leukemia 12 9 — — $74,960.00 $111,363.86 $111,363.86 2026-05-13
680-4 OTHER Major O.r. Procedures For Lymphatic, Hematopoietic Or Other Neoplasms 12 9 — — $74,824.65 $111,276.39 $111,276.39 2026-05-13
304-4 OTHER Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 12 9 — — $74,605.34 $111,053.89 $111,053.89 2026-05-13
260-4 OTHER Major Pancreas, Liver And Shunt Procedures 12 9 — — $74,456.82 $110,819.19 $110,819.19 2026-05-13
612-3 OTHER Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $74,458.16 $109,899.76 $109,899.76 2026-05-13
591-1 OTHER Neonate Birth Weight 500-749 Grams Without Major Procedure 12 9 — — $73,503.88 $109,627.95 $109,627.95 2026-05-13
200-4 OTHER Cardiac Structural And Valvular Disorders 12 9 — — $72,644.36 $107,954.58 $107,954.58 2026-05-13
1282362-2255325 OTHER 54482-0301-01 - Pegaspargase 3750. Soln 67 48 $265,597.70 $132,798.85 50% off $49,170.90 $265,597.70 $106,239.08 2026-05-13
1282361-2255325 OTHER 57665-0002-02 - Pegaspargase 3750. Soln 67 48 $265,597.70 $132,798.85 50% off $49,170.90 $265,597.70 $106,239.08 2026-05-13
108107889-2255325 OTHER 72694-0954-01 - Pegaspargase 3,750 IntlUnit(s) / 5 67 48 $265,597.70 $132,798.85 50% off $49,170.90 $265,597.70 $106,239.08 2026-05-13
607-2 OTHER Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $70,869.69 $104,674.53 $104,674.53 2026-05-13
169-4 OTHER Major Abdominal Vascular Procedures 12 9 — — $70,254.92 $104,651.81 $104,651.81 2026-05-13
181-4 OTHER Lower Extremity Arterial Procedures 12 9 — — $69,778.96 $103,777.96 $103,777.96 2026-05-13
94990000-2255325 OTHER 57894-0061-03 - Ustekinumab 90 mg/mL Soln 67 48 $256,886.14 $128,443.07 50% off $47,558.10 $256,886.14 $102,754.46 2026-05-13
130-4 OTHER Respiratory System Diagnosis With Ventilator Support > 96 Hours 12 9 — — $68,674.74 $102,054.57 $102,054.57 2026-05-13
710-4 OTHER Infectious And Parasitic Diseases Including HIV With O.r. Procedure 12 9 — — $68,133.54 $101,277.72 $101,277.72 2026-05-13
108290269-2255322 OTHER 79952-0110-01 - Loncastuximab Tesirine 10 Mg Injec 69 49 $253,006.10 $126,503.05 50% off $11,381.09 $253,006.10 $101,202.44 2026-05-13
303-2 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 12 9 — — $67,687.83 $101,038.94 $101,038.94 2026-05-13
230-4 OTHER Major Small Bowel Procedures 12 9 — — $67,698.69 $100,576.91 $100,576.91 2026-05-13
1279159-2255319 OTHER 63004-7731-01 - Corticotropin 400. Soln 67 48 $248,174.25 $124,087.13 50% off $45,945.24 $248,174.25 $99,269.70 2026-05-13
622-4 OTHER Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $66,378.31 $98,064.99 $98,064.99 2026-05-13
108326359-2255325 OTHER 25682-0028-01 - Ravulizumab 100 mg/mL Soln 67 48 $244,205.83 $122,102.92 50% off $45,210.56 $244,205.83 $97,682.34 2026-05-13
166-4 OTHER Coronary Bypass Without Ami Or Complex Principal Diagnosis 12 9 — — $65,542.61 $97,549.52 $97,549.52 2026-05-13
608-4 OTHER Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 12 9 — — $66,161.26 $97,374.00 $97,374.00 2026-05-13
220-4 OTHER Major Stomach, Esophageal And Duodenal Procedures 12 9 — — $65,302.40 $97,069.40 $97,069.40 2026-05-13
321-4 OTHER Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures 12 9 — — $65,240.11 $97,040.10 $97,040.10 2026-05-13
608-3 OTHER Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 12 9 — — $65,735.56 $96,948.30 $96,948.30 2026-05-13
321-3 OTHER Spinal Fusion And Other Back And Neck Procedures Except For Disc Procedures 12 9 — — $65,072.41 $96,872.40 $96,872.40 2026-05-13
630-3 OTHER Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 9 — — $64,972.41 $96,758.04 $96,758.04 2026-05-13
630-2 OTHER Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 9 — — $64,972.41 $96,758.04 $96,758.04 2026-05-13
630-1 OTHER Neonate Birth Weight > 2499 Grams With Major Cardiovascular Procedure 12 9 — — $64,972.41 $96,758.04 $96,758.04 2026-05-13
690-4 OTHER Acute Leukemia 12 9 — — $64,484.48 $95,802.54 $95,802.54 2026-05-13
690-3 OTHER Acute Leukemia 12 9 — — $64,484.48 $95,802.54 $95,802.54 2026-05-13
611-3 OTHER Neonate Birth Weight 1500-1999 Grams With Major Anomaly 12 9 — — $64,336.91 $94,985.80 $94,985.80 2026-05-13
304-3 OTHER Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 12 9 — — $63,439.09 $94,520.97 $94,520.97 2026-05-13
1287035-2255322 OTHER 76128-0155-75 - Porfimer 75. Mg Rec Injection 67 48 $235,809.29 $117,904.65 50% off $43,656.08 $235,809.29 $94,323.72 2026-05-13
602-1 OTHER Neonate Birth Weight 1000-1249 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $63,344.06 $93,687.08 $93,687.08 2026-05-13
711-4 OTHER Post-operative, Post-trauma, Other Device Infections With O.r. Procedure 12 9 — — $62,801.57 $93,332.37 $93,332.37 2026-05-13
951-4 OTHER Moderately Extensive O.r. Procedure Unrelated To Principal Diagnosis 12 9 — — $62,596.08 $93,047.62 $93,047.62 2026-05-13
005-2 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 10 7 — — $62,226.63 $92,323.37 $92,323.37 2026-05-13
120-4 OTHER Major Respiratory And Chest Procedures 12 9 — — $62,044.07 $92,232.30 $92,232.30 2026-05-13
108503656-2255322 OTHER 72493-0103-03 - mitoMYcin 40 Mg Kit 67 48 $227,705.40 $113,852.70 50% off $42,155.78 $227,705.40 $91,082.16 2026-05-13
303-1 OTHER Dorsal And Lumbar Fusion Procedure For Curvature Of Back 12 9 — — $60,583.56 $90,448.37 $90,448.37 2026-05-13
178-3 OTHER External Heart Assist Systems 12 9 — — $60,583.33 $90,339.64 $90,339.64 2026-05-13
023-4 OTHER Spinal Procedures 12 9 — — $60,684.98 $90,204.57 $90,204.57 2026-05-13
1288223-2255323 OTHER 00169-7050-01 - Coagulation Factor VIIa Rec Inject 66 47 $222,752.40 $111,376.20 50% off $41,238.82 $222,752.40 $89,345.99 2026-05-13
39888518-2255323 OTHER 00169-7205-01 - Coagulation Factor VIIa 5000 Mcg ( 66 47 $222,752.40 $111,376.20 50% off $41,238.82 $222,752.40 $89,345.99 2026-05-13
162-3 OTHER Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 12 9 — — $59,995.46 $89,298.56 $89,298.56 2026-05-13
009-2 OTHER Extracorporeal Membrane Oxygenation (ecmo) 12 9 — — $59,368.63 $88,620.13 $88,620.13 2026-05-13
009-1 OTHER Extracorporeal Membrane Oxygenation (ecmo) 12 9 — — $59,239.63 $88,491.13 $88,491.13 2026-05-13
165-3 OTHER Coronary Bypass With Ami Or Complex Principal Diagnosis 12 9 — — $58,994.68 $87,793.50 $87,793.50 2026-05-13
030-4 OTHER Percutaneous Intracranial And Extracranial Vascular Procedures 12 9 — — $58,848.32 $87,568.42 $87,568.42 2026-05-13
930-4 OTHER Multiple Significant Trauma Without O.r. Procedure 12 9 — — $57,757.11 $85,912.30 $85,912.30 2026-05-13
179-4 OTHER Defibrillator Implants 12 9 — — $57,535.63 $85,673.79 $85,673.79 2026-05-13
089-4 OTHER Major Cranial Or Facial Bone Procedures 12 9 — — $57,610.51 $85,568.88 $85,568.88 2026-05-13
108819334-2255322 OTHER 00008-0100-01 - Inotuzumab Ozogamicin 0.9 Mg Powde 67 48 $213,605.94 $106,802.97 50% off $39,545.51 $213,605.94 $85,442.38 2026-05-13
027-4 OTHER Other Open Craniotomy 12 9 — — $56,858.24 $84,403.30 $84,403.30 2026-05-13
792-4 OTHER Extensive O.r. Procedures For Other Complications Of Treatment 12 9 — — $55,938.61 $83,239.52 $83,239.52 2026-05-13
109148166-2255320 OTHER 55566-9800-02 - Fecal Microbiota, Live Jslm Susp 67 48 $205,920.00 $102,960.00 50% off $38,122.59 $205,920.00 $82,368.00 2026-05-13
029-4 OTHER Other Percutaneous Intracranial Procedures 12 9 — — $55,159.30 $81,963.38 $81,963.38 2026-05-13
96694815-2255325 OTHER 50242-0150-01 - Ocrelizumab 300 Mg/10 Ml Soln 70 49 $204,742.51 $102,371.26 50% off $59.32 $204,742.51 $81,897.00 2026-05-13
405-4 OTHER Other Procedures For Endocrine, Nutritional And Metabolic Disorders 12 9 — — $54,501.47 $80,814.58 $80,814.58 2026-05-13
008-2 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 10 7 — — $54,276.82 $80,603.23 $80,603.23 2026-05-13
008-1 OTHER Autologous Bone Marrow Transplant Or T-cell Immunotherapy 10 7 — — $54,225.22 $80,551.63 $80,551.63 2026-05-13
631-3 OTHER Neonate Birth Weight > 2499 Grams With Other Major Procedure 12 9 — — $54,027.67 $79,950.34 $79,950.34 2026-05-13
690-2 OTHER Acute Leukemia 12 9 — — $53,324.76 $79,314.45 $79,314.45 2026-05-13
441-4 OTHER Major Bladder Procedures 12 9 — — $53,345.02 $79,252.26 $79,252.26 2026-05-13
614-4 OTHER Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 12 9 — — $53,873.63 $78,591.47 $78,591.47 2026-05-13
121-4 OTHER Other Respiratory And Chest Procedures 12 9 — — $52,794.10 $78,448.14 $78,448.14 2026-05-13
021-3 OTHER Open Craniotomy Except Trauma 12 9 — — $52,651.11 $78,298.23 $78,298.23 2026-05-13
004-1 OTHER Tracheostomy With Mv >96 Hours With Extensive Procedure 12 9 — — $52,428.55 $78,058.12 $78,058.12 2026-05-13
447-4 OTHER Other Kidney, Urinary Tract And Related Procedures 12 9 — — $52,534.43 $77,900.70 $77,900.70 2026-05-13
055-4 OTHER Head Trauma With Coma > 1 Hour Or Hemorrhage 12 9 — — $51,891.31 $77,121.40 $77,121.40 2026-05-13
614-3 OTHER Neonate Birth Weight 1500-1999 Grams With Or Without Other Significant Condition 12 9 — — $52,222.43 $76,940.27 $76,940.27 2026-05-13
163-3 OTHER Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 12 9 — — $51,653.84 $76,935.52 $76,935.52 2026-05-13
264-4 OTHER Other Hepatobiliary, Pancreas And Abdominal Procedures 12 9 — — $51,532.88 $76,544.35 $76,544.35 2026-05-13
312-4 OTHER Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses 12 9 — — $51,375.63 $76,239.22 $76,239.22 2026-05-13
622-3 OTHER Neonate Birth Weight 2000-2499 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $51,127.43 $75,527.18 $75,527.18 2026-05-13
109124434-2255325 OTHER 00078-0734-61 - Canakinumab 150 mg/mL Soln 67 48 $188,722.46 $94,361.23 50% off $34,938.76 $188,722.46 $75,488.98 2026-05-13
313-4 OTHER Knee And Lower Leg Procedures Except Foot 12 9 — — $50,603.37 $75,266.96 $75,266.96 2026-05-13
308-4 OTHER Hip And Femur Fracture Repair 12 9 — — $50,129.91 $74,569.02 $74,569.02 2026-05-13
183-3 OTHER Percutaneous Structural Cardiac Procedures 12 9 — — $49,923.70 $74,455.37 $74,455.37 2026-05-13
178-2 OTHER External Heart Assist Systems 12 9 — — $49,407.25 $73,715.50 $73,715.50 2026-05-13
162-2 OTHER Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 12 9 — — $49,006.59 $72,944.62 $72,944.62 2026-05-13
165-2 OTHER Coronary Bypass With Ami Or Complex Principal Diagnosis 12 9 — — $48,265.15 $71,827.10 $71,827.10 2026-05-13
608-2 OTHER Neonate Birth Weight 1250-1499 Grams With Or Without Significant Condition 12 9 — — $48,434.89 $71,420.76 $71,420.76 2026-05-13
043-4 OTHER Multiple Sclerosis, Other Demyelinating Disease And Inflammatory Neuropathies 12 9 — — $47,656.83 $70,758.66 $70,758.66 2026-05-13
182-4 OTHER Other Peripheral Vascular And Related Procedures 12 9 — — $47,190.08 $70,195.10 $70,195.10 2026-05-13
621-3 OTHER Neonate Birth Weight 2000-2499 Grams With Major Anomaly 12 9 — — $47,431.21 $70,070.79 $70,070.79 2026-05-13
442-4 OTHER Kidney And Urinary Tract Procedures For Malignancy 12 9 — — $46,884.44 $69,722.43 $69,722.43 2026-05-13
612-2 OTHER Neonate Birth Weight 1500-1999 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $46,872.52 $69,137.09 $69,137.09 2026-05-13
695-3 OTHER Chemotherapy For Acute Leukemia 12 9 — — $46,426.03 $69,037.41 $69,037.41 2026-05-13
603-2 OTHER Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 12 9 — — $46,788.06 $68,755.81 $68,755.81 2026-05-13
206-4 OTHER Malfunction, Reaction, Complication Of Cardiac Or Vascular Device Or Procedure 12 9 — — $46,213.94 $68,672.66 $68,672.66 2026-05-13
179-3 OTHER Defibrillator Implants 12 9 — — $45,366.28 $67,549.46 $67,549.46 2026-05-13
108031526-2255322 OTHER 50242-0105-01 - Polatuzumab Vedotin 140 Mg Powder 67 48 $168,527.78 $84,263.89 50% off $31,200.05 $168,527.78 $67,411.12 2026-05-13
607-1 OTHER Neonate Birth Weight 1250-1499 Grams With Respiratory Distress Syndrome Or Other… 12 9 — — $45,193.98 $66,705.33 $66,705.33 2026-05-13
167-3 OTHER Other Cardiothoracic And Thoracic Vascular Procedures 12 9 — — $44,680.84 $66,541.14 $66,541.14 2026-05-13
023-3 OTHER Spinal Procedures 12 9 — — $44,617.27 $66,407.89 $66,407.89 2026-05-13
224-4 OTHER Peritoneal Adhesiolysis 12 9 — — $44,727.75 $66,397.62 $66,397.62 2026-05-13
073-4 OTHER Orbit And Eye Procedures 12 9 — — $44,722.22 $66,312.82 $66,312.82 2026-05-13
029-3 OTHER Other Percutaneous Intracranial Procedures 12 9 — — $44,437.77 $66,238.49 $66,238.49 2026-05-13
108119581-2255325 OTHER 75987-0130-15 - Teprotumumab Trbw 500 Mg Powder 67 48 $165,339.30 $82,669.65 50% off $30,609.76 $165,339.30 $66,135.72 2026-05-13
192-4 OTHER Cardiac Catheterization For Other Non-coronary Conditions 12 9 — — $44,453.55 $66,086.72 $66,086.72 2026-05-13
180-4 OTHER Other Circulatory System Procedures 12 9 — — $44,366.25 $65,886.11 $65,886.11 2026-05-13
108493398-2255319 OTHER 50242-0922-01 - Emicizumab 150 mg/mL Soln 67 48 $164,301.18 $82,150.59 50% off $30,417.57 $164,301.18 $65,720.48 2026-05-13
026-4 OTHER Other Nervous System And Related Procedures 12 9 — — $44,056.35 $65,432.59 $65,432.59 2026-05-13
160-3 OTHER Major Cardiothoracic Repair Of Heart Anomaly 12 9 — — $43,839.22 $65,226.10 $65,226.10 2026-05-13
229-4 OTHER Other Digestive System And Abdominal Procedures 12 9 — — $43,840.20 $65,179.74 $65,179.74 2026-05-13
305-4 OTHER Amputation Of Lower Limb Except Toes 12 9 — — $43,913.14 $65,173.95 $65,173.95 2026-05-13
912-3 OTHER Musculoskeletal And Other Procedures For Multiple Significant Trauma 12 9 — — $43,742.45 $65,116.56 $65,116.56 2026-05-13
280-4 OTHER Alcoholic Liver Disease 12 9 — — $43,803.52 $65,080.29 $65,080.29 2026-05-13
633-3 OTHER Neonate Birth Weight > 2499 Grams With Major Anomaly 12 9 — — $43,765.51 $64,851.31 $64,851.31 2026-05-13
611-2 OTHER Neonate Birth Weight 1500-1999 Grams With Major Anomaly 12 9 — — $43,522.95 $64,275.23 $64,275.23 2026-05-13
223-4 OTHER Other Small And Large Bowel Procedures 12 9 — — $43,219.06 $64,136.78 $64,136.78 2026-05-13
910-3 OTHER Craniotomy For Multiple Significant Trauma 12 9 — — $42,891.26 $63,841.42 $63,841.42 2026-05-13
049-4 OTHER Bacterial And Tuberculous Infections Of Nervous System 12 9 — — $43,031.66 $63,777.03 $63,777.03 2026-05-13
863-2 OTHER Neonatal Aftercare 12 9 — — $43,102.39 $63,739.24 $63,739.24 2026-05-13
911-3 OTHER Extensive Abdominal Or Thoracic Procedures For Multiple Significant Trauma 12 9 — — $42,694.23 $63,495.98 $63,495.98 2026-05-13
178-1 OTHER External Heart Assist Systems 12 9 — — $42,481.67 $63,427.05 $63,427.05 2026-05-13
091-3 OTHER Other Major Head And Neck Procedures 12 9 — — $42,439.19 $63,111.68 $63,111.68 2026-05-13
261-4 OTHER Major Biliary Tract Procedures 12 9 — — $42,233.46 $62,708.61 $62,708.61 2026-05-13
166-3 OTHER Coronary Bypass Without Ami Or Complex Principal Diagnosis 12 9 — — $42,112.14 $62,661.22 $62,661.22 2026-05-13
175-4 OTHER Percutaneous Cardiac Intervention Without Ami 12 9 — — $42,018.54 $62,534.12 $62,534.12 2026-05-13
040-4 OTHER Spinal Disorders And Injuries 12 9 — — $42,115.64 $62,277.48 $62,277.48 2026-05-13
040-3 OTHER Spinal Disorders And Injuries 12 9 — — $42,115.64 $62,277.48 $62,277.48 2026-05-13
312-3 OTHER Skin Graft, Except Hand, For Musculoskeletal And Connective Tissue Diagnoses 12 9 — — $41,665.31 $61,869.17 $61,869.17 2026-05-13
631-2 OTHER Neonate Birth Weight > 2499 Grams With Other Major Procedure 12 9 — — $41,708.86 $61,660.06 $61,660.06 2026-05-13
050-4 OTHER Non-bacterial Infections Of Nervous System Except Viral Meningitis 12 9 — — $41,483.37 $61,559.03 $61,559.03 2026-05-13
95048080-2255325 OTHER 47783-0101-01 - Ecallantide 10 mg/mL Soln 67 48 $153,583.35 $76,791.68 50% off $28,433.35 $153,583.35 $61,433.34 2026-05-13
361-4 OTHER Skin Graft For Skin And Subcutaneous Tissue Diagnoses 12 9 — — $41,514.05 $61,349.82 $61,349.82 2026-05-13
108302291-2255319 OTHER 15054-1120-04 - Lanreotide 120 Mg/0.5 Ml Soln 67 48 $152,395.82 $76,197.91 50% off $28,213.50 $152,395.82 $60,958.33 2026-05-13
95304976-2255319 OTHER 15054-1120-03 - Lanreotide 120 Mg/0.5 Ml Soln 67 48 $152,395.82 $76,197.91 50% off $28,213.50 $152,395.82 $60,958.33 2026-05-13
005-1 OTHER Tracheostomy With Mv >96 Hours Without Extensive Procedure 10 7 — — $41,024.01 $60,936.37 $60,936.37 2026-05-13
304-2 OTHER Dorsal And Lumbar Fusion Procedure Except For Curvature Of Back 12 9 — — $40,822.20 $60,877.12 $60,877.12 2026-05-13
130-3 OTHER Respiratory System Diagnosis With Ventilator Support > 96 Hours 12 9 — — $40,998.11 $60,862.60 $60,862.60 2026-05-13
231-4 OTHER Major Large Bowel Procedures 12 9 — — $40,678.52 $60,388.22 $60,388.22 2026-05-13
403-4 OTHER Procedures For Obesity 12 9 — — $40,480.65 $60,156.30 $60,156.30 2026-05-13
098-4 OTHER Other Ear, Nose, Mouth And Throat Procedures 12 9 — — $40,494.37 $60,046.08 $60,046.08 2026-05-13
174-4 OTHER Percutaneous Cardiac Intervention With Ami 12 9 — — $39,890.08 $59,372.64 $59,372.64 2026-05-13
109257906-2255325 OTHER 73650-0316-01 - Teplizumab Mzwv 2 Mg/2 Ml Soln 67 48 $148,390.01 $74,195.01 50% off $27,471.89 $148,390.01 $59,356.00 2026-05-13
222-4 OTHER Other Stomach, Esophageal And Duodenal Procedures 12 9 — — $39,806.86 $59,072.93 $59,072.93 2026-05-13
024-4 OTHER Open Extracranial Vascular Procedures 12 9 — — $39,734.97 $59,064.33 $59,064.33 2026-05-13
1285618-2255327 OTHER 00187-0007-14 - Ribavirin 6. Gm Rec Powder 67 48 $146,634.21 $73,317.11 50% off $27,146.83 $146,634.21 $58,653.68 2026-05-13
165-1 OTHER Coronary Bypass With Ami Or Complex Principal Diagnosis 12 9 — — $39,416.56 $58,642.72 $58,642.72 2026-05-13
162-1 OTHER Cardiac Valve Procedures With Ami Or Complex Principal Diagnosis 12 9 — — $39,303.69 $58,534.65 $58,534.65 2026-05-13
323-4 OTHER Non-elective Or Complex Hip Joint Replacement 12 9 — — $39,085.02 $58,099.48 $58,099.48 2026-05-13
030-3 OTHER Percutaneous Intracranial And Extracranial Vascular Procedures 12 9 — — $39,047.47 $58,094.37 $58,094.37 2026-05-13
325-4 OTHER Non-elective Or Complex Knee Joint Replacement 12 9 — — $38,938.70 $57,893.58 $57,893.58 2026-05-13
309-4 OTHER Other Significant Hip And Femur Surgery 12 9 — — $38,609.45 $57,414.32 $57,414.32 2026-05-13
890-4 OTHER HIV With Multiple Major HIV Related Conditions 12 9 — — $38,650.11 $57,366.69 $57,366.69 2026-05-13
952-4 OTHER Non-extensive O.r. Procedure Unrelated To Principal Diagnosis 12 9 — — $38,659.75 $57,355.58 $57,355.58 2026-05-13
320-4 OTHER Other Musculoskeletal System And Connective Tissue Procedures 12 9 — — $38,495.27 $57,189.50 $57,189.50 2026-05-13
131-4 OTHER Cystic Fibrosis - Pulmonary Disease 12 9 — — $38,467.19 $57,099.72 $57,099.72 2026-05-13
317-4 OTHER Tendon, Muscle And Other Soft Tissue Procedures 12 9 — — $38,034.64 $56,472.49 $56,472.49 2026-05-13
169-3 OTHER Major Abdominal Vascular Procedures 12 9 — — $37,895.11 $56,436.15 $56,436.15 2026-05-13
660-4 OTHER Major Hematologic Or Immunologic Diagnoses Except Sickle Cell Crisis And Coagula… 12 9 — — $37,959.46 $56,430.29 $56,430.29 2026-05-13
260-3 OTHER Major Pancreas, Liver And Shunt Procedures 12 9 — — $37,845.33 $56,227.86 $56,227.86 2026-05-13
092-4 OTHER Facial Bone Procedures Except Major Cranial Or Facial Bone Procedures 12 9 — — $37,731.21 $56,028.62 $56,028.62 2026-05-13
089-3 OTHER Major Cranial Or Facial Bone Procedures 12 9 — — $37,645.38 $56,027.91 $56,027.91 2026-05-13
108815520-2255322 OTHER 00003-7125-11 - Nivolumab-relatlimab Rmbw 240 Mg-8 67 48 $139,606.59 $69,803.30 50% off $25,845.79 $139,606.59 $55,842.64 2026-05-13
282-4 OTHER Disorders Of Pancreas Except Malignancy 12 9 — — $37,582.65 $55,777.93 $55,777.93 2026-05-13
044-4 OTHER Intracranial Hemorrhage 12 9 — — $37,517.16 $55,756.60 $55,756.60 2026-05-13
263-4 OTHER Cholecystectomy 12 9 — — $37,268.62 $55,401.14 $55,401.14 2026-05-13
721-4 OTHER Post-operative, Post-traumatic, Other Device Infections 12 9 — — $37,171.64 $55,192.45 $55,192.45 2026-05-13
444-4 OTHER Renal Dialysis Access Device Procedures 12 9 — — $37,121.95 $55,025.74 $55,025.74 2026-05-13
120-3 OTHER Major Respiratory And Chest Procedures 12 9 — — $36,945.91 $54,973.10 $54,973.10 2026-05-13
1284898-2255322 OTHER 48818-0001-02 - PRALAtrexate Soln 67 48 $135,494.91 $67,747.46 50% off $25,084.58 $135,494.91 $54,197.96 2026-05-13
691-4 OTHER Lymphoma, Myeloma And Non-acute Leukemia 12 9 — — $36,474.36 $54,160.05 $54,160.05 2026-05-13
171-4 OTHER Permanent Cardiac Pacemaker Implant Without Ami, Heart Failure Or Shock 12 9 — — $36,375.40 $54,031.30 $54,031.30 2026-05-13
315-4 OTHER Shoulder, Upper Arm And Forearm Procedures Except Joint Replacement 12 9 — — $36,378.57 $54,010.54 $54,010.54 2026-05-13
163-2 OTHER Cardiac Valve Procedures Without Ami Or Complex Principal Diagnosis 12 9 — — $36,138.98 $53,834.24 $53,834.24 2026-05-13
794-4 OTHER Non-extensive O.r. Procedures For Other Complications Of Treatment 12 9 — — $36,211.58 $53,665.35 $53,665.35 2026-05-13
1288090-2255322 OTHER 00024-5824-11 - Cabazitaxel Soln 67 48 $133,234.40 $66,617.20 50% off $24,666.08 $133,234.40 $53,293.76 2026-05-13
179-2 OTHER Defibrillator Implants 12 9 — — $35,666.61 $53,147.51 $53,147.51 2026-05-13
001-1 OTHER Liver Transplant And/or Intestinal Transplant 10 7 — — $35,372.76 $52,666.95 $52,666.95 2026-05-13
720-4 OTHER Septicemia And Disseminated Infections 12 9 — — $35,108.90 $52,167.44 $52,167.44 2026-05-13
006-1 OTHER Pancreas Transplant 10 7 — — $34,971.13 $51,945.63 $51,945.63 2026-05-13
176-4 OTHER Insertion, Revision And Replacements Of Pacemaker And Other Cardiac Devices 12 9 — — $34,775.37 $51,697.74 $51,697.74 2026-05-13
100465516-2255319 OTHER 15054-1090-03 - Lanreotide 90 Mg/0.3 Ml Soln 67 48 $129,222.53 $64,611.27 50% off $23,923.35 $129,222.53 $51,689.02 2026-05-13
1287179-2255325 OTHER 57894-0060-03 - Ustekinumab Soln 67 48 $128,443.02 $64,221.51 50% off $23,779.04 $128,443.02 $51,377.21 2026-05-13
109227171-2255325 OTHER 57894-0640-01 - Guselkumab 100 mg/mL Soln 67 48 $127,994.36 $63,997.18 50% off $23,695.98 $127,994.36 $51,197.74 2026-05-13
109220075-2255325 OTHER 57894-0640-11 - Guselkumab 100 mg/mL Soln 67 48 $127,994.36 $63,997.18 50% off $23,695.98 $127,994.36 $51,197.74 2026-05-13
283-4 OTHER Other Disorders Of The Liver 12 9 — — $34,400.72 $51,055.00 $51,055.00 2026-05-13
314-4 OTHER Foot And Toe Procedures 12 9 — — $34,091.85 $50,577.51 $50,577.51 2026-05-13
310-4 OTHER Vertebral And Intervertebral Spinal Procedures Including Disc Procedures 12 9 — — $34,063.85 $50,522.90 $50,522.90 2026-05-13
227-4 OTHER Hernia Procedures Except Inguinal, Femoral And Umbilical 12 9 — — $33,935.98 $50,421.10 $50,421.10 2026-05-13
108927364-2255322 OTHER 50242-0245-01 - Pertuzumab-trastuz-hyaluron-zzxf 1 67 48 $125,732.34 $62,866.17 50% off $23,277.21 $125,732.34 $50,292.94 2026-05-13
850-3 OTHER Procedure With Diagnosis Of Rehabilitation, Aftercare Or Other Contact With Heal… 12 9 — — $33,764.03 $50,275.75 $50,275.75 2026-05-13
613-3 OTHER Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 12 9 — — $34,358.10 $50,146.39 $50,146.39 2026-05-13
613-4 OTHER Neonate Birth Weight 1500-1999 Grams With Congenital Or Perinatal Infection 12 9 — — $34,358.10 $50,146.39 $50,146.39 2026-05-13
020-3 OTHER Open Craniotomy For Trauma 12 9 — — $33,677.80 $50,076.75 $50,076.75 2026-05-13
603-1 OTHER Neonate Birth Weight 1000-1249 Grams With Or Without Significant Condition 12 9 — — $33,957.51 $49,930.37 $49,930.37 2026-05-13
793-4 OTHER Moderately Extensive O.r. Procedures For Other Complications Of Treatment 12 9 — — $33,531.39 $49,829.27 $49,829.27 2026-05-13
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