Hospital

REGIONAL MEDICAL CENTER

Manchester, IA · CCN 161343 · Rates published

Your selected procedure

You selected 27447 (CPT)

REPLACEMENT OF KNEE JOINT; BOTH SIDES OF KNEE

This hospital’s price: $9,359 across 4 payers · range $870-$21,246

Source: https://apim.services.craneware.com/api-pricing-transparency/api/public/acdb3a51286ee4c85247c4fa1712961d/charges/mrf · observed 2026-05-23

This is the facility’s filed rate for this code. The comparison board’s estimate also adds the surgeon and anesthesia fees, so it is usually higher.

5,688 distinct procedures filed

32 distinct payers

557,694 rate rows

2026-05-23 last MRF observed

Data quality

489,472 of 557,694 rate rows are consumer-grade (87.8%)

68,222 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 — reason	Rows
per-diem day rate — not a per-procedure price	30,920
exceeds 10× this hospital's gross charge — excluded from medians	27,514
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	9,766
placeholder amount (≤ $0.02) — excluded from medians	18
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	4

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://apim.services.craneware.com/api-pricing-transparency/api/public/acdb3a51286ee4c85247c4fa1712961d/charges/mrf
Found on page	https://www.regmedctr.org/patients-visitors/pricing-transparency/
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-08-14
Content fingerprint	dce94da5618538c1… · 37,681,595 bytes · first seen 2026-05-14

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
00009-3073-01 OTHER	Depo-medrol	23	$2,208.05	$2,208.05	$2,208.05	nat. median $172 outlier · 12.9×
00009-0003-02 OTHER	Solu-medrol 500mg Vial	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00009-0902-18 OTHER	Cleocin Phosphate	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00009-0825-01 OTHER	Solu-cortef	23	$2,208.05	$2,208.05	$2,208.05	nat. median $35 outlier · 63.9×
00006-4673-00 OTHER	Meruvax Ii	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00008-4990-20 OTHER	Tygacil	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00009-0856-08 OTHER	Hemabate	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00009-0417-01 OTHER	Depo-testosterone	23	$2,208.05	$2,208.05	$2,208.05	nat. median $40 outlier · 55.2×
00009-0775-26 OTHER	Cleocin Phosphate	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00002-8215-17 OTHER	HumuLIN R	23	$2,208.05	$2,208.05	$2,208.05	nat. median $1 outlier · 2025.7×
00006-0227-61 OTHER	Isentress	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00006-3823-10 OTHER	Cancidas	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00006-4897-00 OTHER	Pedvaxhib	23	$2,208.05	$2,208.05	$2,208.05	nat. median $20 outlier · 108.5×
00008-0923-51 OTHER	Protonix	23	$2,208.05	$2,208.05	$2,208.05	nat. median $172 outlier · 12.9×
94645 CPT	Cbt Each Addl Hour	23	$2,208.05	$2,208.05	$2,208.05	nat. median $143 outlier · 15.5×
94644 CPT	Cbt 1st Hour	23	$2,208.05	$2,208.05	$2,208.05	nat. median $183 outlier · 12.1×
94667 CPT	Chest Wall Manipulation	23	$87.82	$2,208.05	$2,208.05	nat. median $153 outlier · 14.5×
G0238 HCPCS	Oth Resp Proc, Indiv	23	$2,208.05	$2,208.05	$2,208.05	nat. median $65 outlier · 34.0×
J1327 HCPCS	Eptifibatide Injection	23	$2,208.05	$2,208.05	$2,208.05	nat. median $127 outlier · 17.4×
00009-0436-24 OTHER	R-gene 10	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00002-7597-01 OTHER	ZyPREXA IntraMuscular	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00002-7511-01 OTHER	HumaLOG Mix 75/25	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00003-0494-20 OTHER	Kenalog-10	24	$1.08	$2,208.05	$2,208.05	nat. median $2 outlier · 1162.1×
00004-0191-09 OTHER	Boniva	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00006-0277-31 OTHER	Januvia	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00006-3822-10 OTHER	Cancidas	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00006-4681-00 OTHER	M-m-r Ii	23	$2,208.05	$2,208.05	$2,208.05	nat. median $257 outlier · 8.6×
00006-4837-03 OTHER	Pneumovax 23	23	$2,208.05	$2,208.05	$2,208.05	nat. median $220 outlier · 10.0×
00006-5423-12 OTHER	Bridion	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00008-0844-02 OTHER	Protonix	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
94002 CPT	Vent Mgmt Inpat Init Day	31	$870.00	$2,208.05	$2,208.05	nat. median $920 outlier · 2.4×
90714 CPT	Td Vacc No Presv 7 Yrs+ IM	3	$18.83	$2,208.05	$2,208.05	nat. median $66 outlier · 33.2×
94003 CPT	Vent Mgmt Inpat Subq Day	23	$2,208.05	$2,208.05	$2,208.05	nat. median $824 outlier · 2.7×
94640 CPT	Inhalation Treatment For Airway Obstruction Or Sputum Production	30	$89.69	$2,208.05	$2,208.05	nat. median $194 outlier · 11.4×
94660 CPT	Pos Airway Pressure Cpap	31	$262.30	$2,208.05	$2,208.05	nat. median $367 outlier · 6.0×
94664 CPT	Evaluate Pt Use Of Inhaler	23	$87.82	$2,208.05	$2,208.05	nat. median $193 outlier · 11.4×
94668 CPT	Chest Wall Manipulation	23	$89.69	$2,208.05	$2,208.05	nat. median $136 outlier · 16.3×
G0237 HCPCS	Therapeutic Procd Strg Endur	23	$2,208.05	$2,208.05	$2,208.05	nat. median $64 outlier · 34.5×
G0239 HCPCS	Oth Resp Proc, Group	31	$79.89	$2,208.05	$2,208.05	nat. median $79 outlier · 27.8×
J0330 HCPCS	Succinycholine Chloride Inj	23	$2,208.05	$2,208.05	$2,208.05	nat. median $26 outlier · 85.2×
00009-0011-03 OTHER	Solu-cortef 100mg Vial	24	$18.46	$2,208.05	$2,208.05	nat. median $29 outlier · 75.0×
00002-8315-17 OTHER	HumuLIN N (nph)	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00002-0213-01 OTHER	HumuLIN R	23	$2,208.05	$2,208.05	$2,208.05	nat. median $13 outlier · 164.7×
S0197 HCPCS	Prenatal Vitamins; 30-day Supply	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2 outlier · 1003.7×
00002-4182-30 OTHER	Olumiant	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00002-5123-30 OTHER	Effient	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00002-8715-17 OTHER	HumuLIN 70/30	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00003-0371-13 OTHER	Nulojix	23	$2,208.05	$2,208.05	$2,208.05	nat. median $6 outlier · 398.2×
00003-2187-10 OTHER	Orencia	23	$2,208.05	$2,208.05	$2,208.05	nat. median $2,208 1.0× median
00009-3073-22 OTHER	Depo-medrol Novaplus	23	$2,208.05	$2,208.05	$2,208.05	nat. median $25 outlier · 88.2×

Other procedures at this hospital

Browse this hospital's 5,688 published procedures. Use the slice to choose what to show, then sort or filter any column.

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

00264-9577-10	OTHER	Dextrose/Heparin Sodium	50	23	$68.91	$55.13	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00228-3658-03	OTHER	rOPINIRole HCl	50	23	$2.74	$2.19 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00258-3711-01	OTHER	riMANTAdine HCl	50	23	$1.96	$1.57	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-2268-01	OTHER	Amoxicillin	50	23	$0.74	$0.59 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9357-10	OTHER	Vancomycin HCl	50	23	$65.83	$52.66 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00228-3003-11	OTHER	clonazePAM	50	23	$0.75	$0.60 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00254-2008-11	OTHER	Colchicine	50	23	$6.74	$5.39 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00056-0169-75	OTHER	Coumadin	50	23	$2.47	$1.98	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00075-2452-01	OTHER	Ddavp	50	23	$424.52	$339.62	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-2210-01	OTHER	Sucralfate	50	23	$0.80	$0.64 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0659-16	OTHER	Sorbitol 70%	50	23	$19.35	$15.48 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9315-24	OTHER	levoFLOXacin In 5% Dextrose Novaplus	50	23	$35.00	$28.00 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00168-0055-46	OTHER	Betamethasone Dipropionate	50	23	$105.65	$84.52 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00228-2778-11	OTHER	Propranolol HCl	50	23	$2.06	$1.65	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00245-5317-01	OTHER	Klor-con M10	50	23	$0.62	$0.50	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00009-5190-01	OTHER	Detrol La	50	23	$15.70	$12.56	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-0517-44	OTHER	Morphine Sulfate	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-8739-25	OTHER	predniSONE	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00065-0795-15	OTHER	Bss	50	23	$2.50	$2.00 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00075-0622-80	OTHER	Lovenox	50	23	$99.35	$79.48	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00085-0887-09	OTHER	Gyne-lotrimin 7	50	23	$7.20	$5.76 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-2065-06	OTHER	Cilostazol	50	23	$1.93	$1.54 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-7620-56	OTHER	Letrozole	50	23	$18.13	$14.50 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0646-16	OTHER	Amantadine HCl	50	23	$0.77	$0.62	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-1744-05	OTHER	guaiFENesin	50	23	$0.60	$0.48 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9310-10	OTHER	Etomidate Novaplus	50	23	$11.59	$9.27 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9729-05	OTHER	Benztropine Mesylate	50	23	$112.50	$90.00 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00168-0041-60	OTHER	Betamethasone Valerate	50	23	$72.00	$57.60 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00173-0695-04	OTHER	Advair Diskus 100/50	50	23	$54.62	$43.70	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00228-2539-10	OTHER	Carbidopa-levodopa	50	23	$0.87	$0.70	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00245-0860-70	OTHER	Vandazole	50	23	$163.04	$130.43 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00245-0147-01	OTHER	Pacerone	50	23	$7.94	$6.35 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00008-0844-02	OTHER	Protonix	50	23	$17.29	$13.83 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00009-5140-04	OTHER	Zyvox	50	23	$138.60	$110.88 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00049-0013-83	OTHER	Unasyn	50	23	$31.93	$25.54 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-0404-44	OTHER	Morphine Sulfate	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-3532-44	OTHER	LORazepam Intensol	50	23	$0.80	$0.64 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-8724-25	OTHER	predniSONE	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00065-0085-15	OTHER	Naphcon-a	50	23	$9.41	$7.53	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00065-0660-10	OTHER	Iopidine	50	23	$33.27	$26.62	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00069-1306-10	OTHER	Retacrit	50	23	$49.64	$39.71 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00074-3683-03	OTHER	Lupron Depot	50	23	$12,264.57	$9,811.66	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00078-0370-05	OTHER	Ritalin La	50	23	$13.78	$11.02 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00085-0539-01	OTHER	Intron A	50	23	$1,584.15	$1,267.32 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00088-5020-05	OTHER	Lantus SoloStar Pen Novaplus	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-1177-01	OTHER	Neomycin Sulfate	50	23	$1.49	$1.19 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-5127-01	OTHER	Benazepril Hydrochloride	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-7472-43	OTHER	Rizatriptan Benzoate	50	23	$33.25	$26.60	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00115-0533-01	OTHER	Fenofibrate Micronized	50	23	$3.15	$2.52 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0601-12	OTHER	Aluminum Hydroxide	50	23	$7.44	$5.95 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0890-20	OTHER	Vancomycin HCl	50	23	$57.72	$46.18	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-1730-30	OTHER	diphenhydrAMINE HCl	50	23	$2.92	$2.34	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00132-0202-20	OTHER	Pedia-lax	50	23	$1.50	$1.20 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9300-10	OTHER	Pantoprazole Sodium Novaplus	50	23	$14.08	$11.26 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9564-01	OTHER	Phentolamine Mesylate	50	23	$668.73	$534.98 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9722-24	OTHER	levoFLOXacin In 5% Dextrose	50	23	$35.00	$28.00 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9888-80	OTHER	Amoxicillin	50	23	$3.10	$2.48 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00168-0006-15	OTHER	Triamcinolone Acetonide	50	23	$5.58	$4.46 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00169-4060-12	OTHER	Victoza Pen	50	23	$10.87	$8.70	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00173-0388-79	OTHER	Beconase Aq	50	23	$352.03	$281.62 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00185-0704-30	OTHER	Bisoprolol/HCTZ	50	23	$1.14	$0.91 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00228-2127-10	OTHER	cloNIDine HCl	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00245-0212-11	OTHER	Midodrine HCl	50	23	$4.16	$3.33	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00056-0170-75	OTHER	Coumadin	50	23	$2.58	$2.06 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00245-0057-89	OTHER	Klor-con M10	50	23	$0.62	$0.50	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00002-8215-17	OTHER	HumuLIN R	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00006-0277-31	OTHER	Januvia	50	23	$22.92	$18.34	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00006-5423-12	OTHER	Bridion	50	23	$233.39	$186.71 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00009-0775-26	OTHER	Cleocin Phosphate	50	23	$12.19	$9.75 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00009-4992-02	OTHER	Zyvox Novaplus	50	23	$201.95	$161.56	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00023-9321-05	OTHER	Alphagan P	50	23	$233.33	$186.66 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00046-1102-81	OTHER	Premarin	50	23	$8.29	$6.63 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-0046-41	OTHER	Ipratropium Bromide	50	23	$95.71	$76.57	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-0279-03	OTHER	Naratriptan	50	23	$29.49	$23.59 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-3177-63	OTHER	dexAMETHasone	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-3527-63	OTHER	Lithium	50	23	$1.80	$1.44 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-4571-25	OTHER	Methadone HCl	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-8301-25	OTHER	Furosemide	50	23	$1.57	$1.26	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00056-0188-75	OTHER	Coumadin	50	23	$2.67	$2.14	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00065-0023-15	OTHER	Miostat	50	23	$80.42	$64.34	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00065-0397-02	OTHER	Cyclogyl	50	23	$52.99	$42.39 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00065-0648-35	OTHER	Tobradex	50	23	$273.85	$219.08 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00065-8533-02	OTHER	Ciprodex	50	23	$298.91	$239.13	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00069-0469-56	OTHER	Chantix	50	23	$10.06	$8.05	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00072-2203-60	OTHER	Eurax	50	23	$17.38	$13.90 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00074-3663-03	OTHER	Lupron Depot	50	23	$7,719.11	$6,175.29	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00078-0102-15	OTHER	Parlodel	50	23	$10.74	$8.59 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00078-0366-15	OTHER	Famvir	50	23	$11.88	$9.50 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00078-0811-81	OTHER	SandoSTATIN Lar Depot	50	23	$5,181.51	$4,145.21	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00085-0370-01	OTHER	Elocon	50	23	$65.70	$52.56 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00085-7206-07	OTHER	Dulera	50	23	$252.91	$202.33	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00087-7720-60	OTHER	Cefzil	50	23	$4.67	$3.74	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-0661-16	OTHER	Albuterol Sulfate	50	23	$0.62	$0.50	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-1003-01	OTHER	busPIRone HCl	50	23	$2.02	$1.62	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-3239-40	OTHER	Buprenorphine	50	23	$129.31	$103.45	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-4161-73	OTHER	Amoxicillin	50	23	$4.91	$3.93	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-7270-98	OTHER	Pravastatin Sodium	50	23	$4.79	$3.83 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-7382-01	OTHER	Venlafaxine HCl	50	23	$2.18	$1.74 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-8119-56	OTHER	Famciclovir	50	23	$12.69	$10.15 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-9107-29	OTHER	Mebendazole	50	23	$6.38	$5.10 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00115-2011-01	OTHER	Orphenadrine Citrate	50	23	$2.17	$1.74	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0581-04	OTHER	Haloperidol Lactate	50	23	$54.20	$43.36 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0747-10	OTHER	Sucralfate	50	23	$402.40	$321.92	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0868-50	OTHER	Nystatin	50	23	$2.35	$1.88 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0945-40	OTHER	Megestrol Acetate	50	23	$3.36	$2.69	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-1680-50	OTHER	Potassium Chloride	50	23	$14.84	$11.87 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00131-1810-67	OTHER	Vimpat	50	23	$20.01	$16.01	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00132-0081-12	OTHER	Pedia-lax Glycerin Suppositories	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-1172-01	OTHER	Captopril	50	23	$1.67	$1.34	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9284-10	OTHER	Pantoprazole Sodium	50	23	$26.91	$21.53	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9398-10	OTHER	Ertapenem	50	23	$110.40	$88.32 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9534-10	OTHER	Linezolid	50	23	$58.80	$47.04 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9593-10	OTHER	niCARdipine HCl Novaplus	50	23	$83.39	$66.71 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9684-10	OTHER	Flumazenil Novaplus	50	23	$26.91	$21.53	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9785-10	OTHER	Valproate Sodium	50	23	$71.57	$57.26	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9887-50	OTHER	Amoxicillin	50	23	$4.90	$3.92 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9924-90	OTHER	ceFAZolin Sodium	50	23	$10.00	$8.00 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00168-0003-15	OTHER	Triamcinolone Acetonide	50	23	$4.46	$3.57	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00168-0310-04	OTHER	Desonide	50	23	$438.41	$350.73	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00169-3696-19	OTHER	NovoLOG Mix 70/30 FlexPen	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00172-2416-60	OTHER	Tetracycline HCl	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00172-7310-46	OTHER	cycloSPORINE	50	23	$1.38	$1.10 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00185-0122-01	OTHER	Nitrofurantoin Monohydrate/Macrocrystals	50	23	$1.88	$1.50 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00185-0701-01	OTHER	Bisoprolol/HCTZ	50	23	$1.14	$0.91 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00186-0016-31	OTHER	Atacand	50	23	$3.53	$2.82 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00225-0525-47	OTHER	Ayr Saline Nasal	50	23	$3.18	$2.54 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
94645	CPT	Cbt Each Addl Hour	50	23	$170.00	$136.00 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
94644	CPT	Cbt 1st Hour	50	23	$212.00	$169.60 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
94667	CPT	Chest Wall Manipulation	100	23	$334.00	$267.20	$87.82	$2,208.05	$2,208.05	2026-05-23
G0238	HCPCS	Oth Resp Proc, Indiv	50	23	$84.00	$67.20	$2,208.05	$2,208.05	$2,208.05	2026-05-23
J1327	HCPCS	Eptifibatide Injection	50	23	$56.33	$45.06 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-2274-34	OTHER	Amoxicillin/Clavulanate Potassium	50	23	$3.78	$3.02 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00002-7597-01	OTHER	ZyPREXA IntraMuscular	50	23	$90.47	$72.38	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00002-7511-01	OTHER	HumaLOG Mix 75/25	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00003-0494-20	OTHER	Kenalog-10	52	24	$10.01	$8.01	$1.08	$2,208.05	$2,208.05	2026-05-23
00006-0227-61	OTHER	Isentress	50	23	$39.94	$31.95 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00006-4673-00	OTHER	Meruvax Ii	50	23	$81.94	$65.55 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00006-4897-00	OTHER	Pedvaxhib	50	23	$82.00	$65.60 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00009-0003-02	OTHER	Solu-medrol 500mg Vial	50	23	$85.28	$68.22 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00009-0436-24	OTHER	R-gene 10	50	23	$96.25	$77.00 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00009-0902-18	OTHER	Cleocin Phosphate	50	23	$17.65	$14.12 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00009-3475-22	OTHER	Depo-medrol Novaplus	50	23	$76.30	$61.04 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00023-3921-02	OTHER	Botox	50	23	$1,673.76	$1,339.01	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00023-9211-05	OTHER	Combigan	50	23	$244.96	$195.97	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00046-0749-05	OTHER	Premarin Intravenous	50	23	$662.49	$529.99 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00046-1101-81	OTHER	Premarin	50	23	$8.29	$6.63 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00052-0602-02	OTHER	Tice Bcg	50	23	$235.60	$188.48 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-0045-44	OTHER	Ipratropium Bromide	50	23	$111.67	$89.34	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-0088-13	OTHER	Calcium Acetate	50	23	$1.03	$0.82 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-0107-25	OTHER	Ramipril	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-3117-63	OTHER	Calcium Carbonate	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-3176-44	OTHER	dexAMETHasone Intensol	50	23	$32.17	$25.74	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-3270-99	OTHER	Fluticasone Propionate	50	23	$93.33	$74.66 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-3294-46	OTHER	Furosemide	72	30	$31.40	$25.12	$870.00	$2,208.05	$2,208.05	2026-05-23
00054-3553-44	OTHER	Methadone HCl Intensol	50	23	$25.35	$20.28 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-3730-63	OTHER	Propranolol HCl	50	23	$0.94	$0.75 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-8175-25	OTHER	dexAMETHasone	50	23	$1.20	$0.96 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-8179-25	OTHER	dexAMETHasone	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00056-0172-75	OTHER	Coumadin	50	23	$2.78	$2.22 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00056-0176-75	OTHER	Coumadin	50	23	$2.66	$2.13	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00064-3600-45	OTHER	Prudoxin	50	23	$226.69	$181.35 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00065-0002-03	OTHER	Nevanac	50	23	$376.14	$300.91 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00065-0246-10	OTHER	Betoptic S	50	23	$391.27	$313.02	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00065-0275-10	OTHER	Azopt	50	23	$411.88	$329.50 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00065-0411-30	OTHER	Betadine	50	23	$26.50	$21.20 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00065-0644-35	OTHER	Tobrex	50	23	$257.23	$205.78 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00065-0800-50	OTHER	Bss Plus	50	23	$68.66	$54.93	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00065-8040-54	OTHER	ICaps Lutein & Zeaxanthin	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00066-0494-25	OTHER	Benzaclin	50	23	$204.59	$163.67 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00066-9850-60	OTHER	Noritate	50	23	$206.68	$165.34 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00069-5474-02	OTHER	Cerebyx Novaplus	50	23	$147.48	$117.98 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00069-6001-21	OTHER	Cerebyx	50	23	$218.33	$174.66 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00074-3014-60	OTHER	Azmacort	50	23	$154.69	$123.75 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00074-3642-03	OTHER	Lupron Depot	50	23	$3,066.15	$2,452.92 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00075-8016-10	OTHER	PremierPro Rx Lovenox	50	23	$74.51	$59.61	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00078-0054-05	OTHER	Methergine	50	23	$1.71	$1.37	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00078-0248-15	OTHER	Neoral	50	23	$12.84	$10.27 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00078-0324-44	OTHER	Exelon	50	23	$6.25	$5.00 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00078-0408-05	OTHER	Stalevo 100	50	23	$9.18	$7.34 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00078-0508-83	OTHER	TEGretol	50	23	$2.59	$2.07 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00078-0818-81	OTHER	SandoSTATIN Lar Depot	50	23	$6,788.67	$5,430.94	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00078-0825-81	OTHER	SandoSTATIN Lar Depot	50	23	$10,165.53	$8,132.42 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00085-1264-01	OTHER	Clarinex	50	23	$8.76	$7.01	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00085-1334-01	OTHER	Clarinex	50	23	$4.46	$3.57	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00087-0405-01	OTHER	Enfamil Poly-vi-sol w/Iron	50	23	$8.56	$6.85	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00087-7718-40	OTHER	Cefzil	50	23	$22.48	$17.98 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-0041-03	OTHER	clomiPHENE Citrate	50	23	$6.86	$5.49	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-0314-01	OTHER	Ketorolac Tromethamine	50	23	$2.16	$1.73	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-0778-01	OTHER	carBAMazepine	50	23	$0.66	$0.53	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-0832-01	OTHER	clonazePAM	50	23	$0.75	$0.60 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-3123-01	OTHER	Dicloxacillin Sodium	50	23	$1.50	$1.20 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-3160-06	OTHER	Cefdinir	50	23	$5.11	$4.09	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-4127-73	OTHER	Penicillin Vk	50	23	$11.16	$8.93	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-4137-64	OTHER	Cefdinir	50	23	$99.49	$79.59 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-5742-65	OTHER	cycloSPORINE	50	23	$5.50	$4.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-6108-12	OTHER	FLUoxetine HCl	50	23	$18.51	$14.81	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-7334-01	OTHER	Mycophenolate Mofetil	50	23	$3.97	$3.18	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-7367-98	OTHER	Losartan Potassium-hydrochlorothiazide	50	23	$2.50	$2.00 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-7772-01	OTHER	cloZAPine	50	23	$3.33	$2.66 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-8035-01	OTHER	glyBURIDE Micronized	50	23	$0.66	$0.53	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-8940-01	OTHER	Acyclovir	50	23	$0.97	$0.78	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00093-8947-01	OTHER	Acyclovir	50	23	$3.67	$2.94	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00115-1472-52	OTHER	Betamethasone Dipropionate Augmented	50	23	$38.16	$30.53	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00115-1800-01	OTHER	Methylphenidate HCl	50	23	$0.70	$0.56	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00115-3511-01	OTHER	pyRIDostigmine Bromide	50	23	$1.28	$1.02 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0504-04	OTHER	Acetaminophen-codeine Phosphate	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0675-16	OTHER	Valproic Acid	50	23	$3.53	$2.82 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0675-85	OTHER	Valproic Acid	50	23	$3.53	$2.82 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0770-01	OTHER	LORazepam	50	23	$0.66	$0.53	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0772-16	OTHER	HYDROcodone Bitartrate-acetaminophen	50	23	$0.61	$0.49	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0893-16	OTHER	Chlorhexidine Gluconate	50	23	$12.00	$9.60 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0918-40	OTHER	Ibuprofen	50	23	$1.88	$1.50 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0966-00	OTHER	Children's Acetaminophen	50	23	$1.42	$1.14	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-0974-40	OTHER	Sucralfate	50	23	$12.18	$9.74 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-1781-00	OTHER	Acetaminophen Children's	50	23	$1.39	$1.11 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00121-4577-40	OTHER	Lactulose	50	23	$1.75	$1.40 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00131-2477-35	OTHER	Vimpat	50	23	$14.13	$11.30 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00132-0079-12	OTHER	Fleet Glycerin Suppositories	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00132-0301-40	OTHER	Fleet Mineral Oil Enema	50	23	$2.08	$1.66 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00135-0199-02	OTHER	Citrucel	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-1202-01	OTHER	Cortisone Acetate	50	23	$3.13	$2.50 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-1240-01	OTHER	Digoxin	50	23	$2.30	$1.84	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9375-10	OTHER	Terbutaline Sulfate Novaplus	52	24	$10.00	$8.00 20% off	$6.09	$2,208.05	$2,208.05	2026-05-23
00143-9381-10	OTHER	Doxycycline	50	23	$87.19	$69.75 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9506-10	OTHER	Etomidate	50	23	$25.75	$20.60	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9509-10	OTHER	Ketamine HCl	50	23	$52.75	$42.20	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9574-25	OTHER	levETIRAcetam Novaplus	50	23	$10.00	$8.00 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9587-25	OTHER	Glycopyrrolate Novaplus	50	23	$11.59	$9.27 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9622-01	OTHER	Labetalol HCl	50	23	$30.19	$24.15 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9637-10	OTHER	Valproate Sodium Novaplus	50	23	$71.57	$57.26	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9746-10	OTHER	Terbutaline Sulfate	50	23	$16.56	$13.25	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9784-10	OTHER	Flumazenil	50	23	$28.03	$22.42 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9787-10	OTHER	Enalaprilat	50	23	$21.98	$17.58 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9872-01	OTHER	Propranolol HCl	50	23	$33.12	$26.50	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9889-01	OTHER	Amoxicillin	50	23	$6.09	$4.87 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9919-01	OTHER	glyBURIDE Micronized	50	23	$0.61	$0.49	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9928-01	OTHER	Ciprofloxacin	50	23	$5.37	$4.30	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00143-9951-01	OTHER	Amoxicillin	50	23	$0.87	$0.70	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00168-0062-31	OTHER	Zinc Oxide	50	23	$3.23	$2.58 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00168-0203-60	OTHER	Clindamycin Phosphate	50	23	$144.23	$115.38 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00168-0323-46	OTHER	metroNIDAZOLE	50	23	$85.62	$68.50	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00168-0337-60	OTHER	Triamcinolone Acetonide	50	23	$90.00	$72.00 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00169-6432-10	OTHER	Levemir FlexPen	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00169-6438-10	OTHER	Levemir FlexTouch	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00172-3926-60	OTHER	diazePAM	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00172-5728-60	OTHER	Famotidine	50	23	$2.42	$1.94	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00173-0719-20	OTHER	Flovent Hfa	50	23	$328.60	$262.88 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00173-0881-01	OTHER	Nucala	50	23	$5,117.61	$4,094.09	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00185-0410-01	OTHER	buPROPion HCl	50	23	$1.69	$1.35 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00185-0415-60	OTHER	buPROPion HCl	50	23	$1.94	$1.55 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00185-0707-01	OTHER	Bisoprolol/HCTZ	50	23	$1.14	$0.91 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00185-1111-60	OTHER	buPROPion HCl	50	23	$3.83	$3.06 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00186-0916-12	OTHER	Pulmicort Flexhaler	50	23	$317.52	$254.02	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00186-0917-06	OTHER	Pulmicort Flexhaler	50	23	$237.12	$189.70	$2,208.05	$2,208.05	$2,208.05	2026-05-23
94002	CPT	Vent Mgmt Inpat Init Day	124	31	$939.00	$751.20	$870.00	$2,208.05	$2,208.05	2026-05-23
90714	CPT	Td Vacc No Presv 7 Yrs+ IM	6	3	$64.00	$51.20	$18.83	$2,208.05	$2,208.05	2026-05-23
94003	CPT	Vent Mgmt Inpat Subq Day	50	23	$759.00	$607.20	$2,208.05	$2,208.05	$2,208.05	2026-05-23
94640	CPT	Inhalation Treatment For Airway Obstruction Or Sputum Production	178	30	$143.00	$114.40	$89.69	$2,208.05	$2,208.05	2026-05-23
94660	CPT	Pos Airway Pressure Cpap	128	31	$713.00	$570.40 20% off	$262.30	$2,208.05	$2,208.05	2026-05-23
94664	CPT	Evaluate Pt Use Of Inhaler	100	23	$245.00	$196.00 20% off	$87.82	$2,208.05	$2,208.05	2026-05-23
94668	CPT	Chest Wall Manipulation	50	23	$181.00	$144.80	$89.69	$2,208.05	$2,208.05	2026-05-23
G0237	HCPCS	Therapeutic Procd Strg Endur	50	23	$84.00	$67.20	$2,208.05	$2,208.05	$2,208.05	2026-05-23
G0239	HCPCS	Oth Resp Proc, Group	74	31	$208.00	$166.40 20% off	$79.89	$2,208.05	$2,208.05	2026-05-23
J0330	HCPCS	Succinycholine Chloride Inj	50	23	$79.41	$63.53	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00023-0312-04	OTHER	Lacri-lube S.o.p.	50	23	$17.10	$13.68 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00002-8315-17	OTHER	HumuLIN N (nph)	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00002-0213-01	OTHER	HumuLIN R	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
S0197	HCPCS	Prenatal Vitamins; 30-day Supply	50	23	$4.50	$3.60 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00002-4182-30	OTHER	Olumiant	50	23	$109.60	$87.68	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00002-5123-30	OTHER	Effient	50	23	$18.36	$14.69	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00002-8715-17	OTHER	HumuLIN 70/30	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00003-0371-13	OTHER	Nulojix	50	23	$1,280.24	$1,024.19 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00003-2187-10	OTHER	Orencia	50	23	$1,763.36	$1,410.69	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00004-0191-09	OTHER	Boniva	50	23	$791.10	$632.88 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00006-3822-10	OTHER	Cancidas	50	23	$445.78	$356.62 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00006-3823-10	OTHER	Cancidas	50	23	$463.17	$370.54	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00006-4681-00	OTHER	M-m-r Ii	50	23	$166.49	$133.19 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00006-4837-03	OTHER	Pneumovax 23	50	23	$140.50	$112.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00008-0923-51	OTHER	Protonix	50	23	$20.70	$16.56 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00008-4990-20	OTHER	Tygacil	50	23	$180.00	$144.00 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00009-0011-03	OTHER	Solu-cortef 100mg Vial	52	24	$84.46	$67.57	$18.46	$2,208.05	$2,208.05	2026-05-23
00009-0417-01	OTHER	Depo-testosterone	50	23	$89.55	$71.64	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00009-0825-01	OTHER	Solu-cortef	50	23	$62.51	$50.01	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00009-0856-08	OTHER	Hemabate	50	23	$252.00	$201.60 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00009-3073-01	OTHER	Depo-medrol	50	23	$47.03	$37.62 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00009-3073-22	OTHER	Depo-medrol Novaplus	50	23	$43.97	$35.18	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00023-0798-15	OTHER	Refresh Tears	50	23	$10.07	$8.06	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00023-0812-30	OTHER	Fluoroplex	50	23	$420.00	$336.00 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00023-6110-01	OTHER	Zenpep	50	23	$4.52	$3.62	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00023-9163-30	OTHER	Restasis	50	23	$387.36	$309.89	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00025-2732-31	OTHER	Norpace Cr	50	23	$5.13	$4.10 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00029-6085-22	OTHER	Augmentin	50	23	$77.68	$62.14 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00046-0872-21	OTHER	Premarin Vaginal	50	23	$540.06	$432.05	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00046-1100-81	OTHER	Premarin	50	23	$8.29	$6.63 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00049-0014-83	OTHER	Unasyn	50	23	$60.29	$48.23 20% off	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00049-0520-22	OTHER	Pfizerpen Novaplus	50	23	$52.66	$42.13	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-0017-20	OTHER	predniSONE	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-0018-20	OTHER	predniSONE	50	23	$0.50	$0.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00054-0057-46	OTHER	Digoxin	50	23	$168.00	$134.40	$2,208.05	$2,208.05	$2,208.05	2026-05-23
00270-1111-02	OTHER	Prohance	50	23	$153.20	$122.56	$2,208.05	$2,208.05	$2,208.05	2026-05-23

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