Hospital

GOVE COUNTY MEDICAL CENTER

Quinter, KS · CCN 171367 · Rates published

4,741 distinct procedures filed

22 distinct payers

69,182 rate rows

2026-08-18 last MRF observed

Data quality

56,789 of 69,182 rate rows are consumer-grade (82.1%)

12,393 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	9,028
placeholder amount (≤ $0.02) — excluded from medians	1,972
per-diem day rate — not a per-procedure price	797
exceeds 10× this hospital's gross charge — excluded from medians	503
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only	57
percent-of-charges filed in the dollar field — excluded from medians	32
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	3
exceeds 3× this hospital's gross charge for a DRG stay — excluded	1

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

Source MRF file	https://apim.services.craneware.com/api-pricing-transparency/api/public/4cf51e9a0a8b4190896bc4ad80d1d24d/charges/mrf
Found on page	https://gcmc.org/financial-services/
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-10-16
Content fingerprint	801fe62d67957a61… · 14,997,932 bytes · first seen 2026-08-18

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
177 MS_DRG	Respiratory Infections And Inflammations With Mcc	1	$30,052.69	$30,052.69	$30,052.69	nat. median $11,701 outlier · 2.6×
871 MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	1	$26,527.13	$26,527.13	$26,527.13	nat. median $14,442 1.8× median
C1713 HCPCS	Anchor/screw Bn/bn,tis/bn	4	$17,785.80	$18,971.52	$18,279.85	nat. median $1,045 outlier · 17.5×
190 MS_DRG	Chronic Obstructive Pulmonary Disease With Mcc	1	$17,433.92	$17,433.92	$17,433.92	nat. median $8,303 outlier · 2.1×
787 MS_DRG	Cesarean Section Without Sterilization With Cc	1	$15,052.03	$15,052.03	$15,052.03	nat. median $8,114 1.9× median
872 MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	1	$15,048.48	$15,048.48	$15,048.48	nat. median $7,744 1.9× median
28297 CPT	Cor Hlx Vlgs Jt Arthrd	16	$8,759.70	$16,083.53	$14,475.17	nat. median $8,817 1.6× median
28735 CPT	Fusion Of Foot Bones	16	$9,444.60	$16,083.53	$14,475.17	nat. median $9,272 1.6× median
194 MS_DRG	Simple Pneumonia And Pleurisy With Cc	1	$14,155.66	$14,155.66	$14,155.66	nat. median $6,156 outlier · 2.3×
191 MS_DRG	Chronic Obstructive Pulmonary Disease With Cc	1	$13,060.47	$13,060.47	$13,060.47	nat. median $6,349 outlier · 2.1×
552 MS_DRG	Medical Back Problems Without Mcc	1	$12,579.39	$12,579.39	$12,579.39	nat. median $7,205 1.7× median
603 MS_DRG	Cellulitis Without Mcc	1	$12,370.40	$12,370.40	$12,370.40	nat. median $6,621 1.9× median
806 MS_DRG	Vaginal Delivery Without Sterilization Or D&c With Cc	1	$12,132.03	$12,132.03	$12,132.03	nat. median $5,473 outlier · 2.2×
49654 CPT	Lap Hernia Repair	5	$11,408.70	$12,885.12	$12,079.80	nat. median $3,700 outlier · 3.3×
694 MS_DRG	Urinary Stones Without Mcc	1	$11,804.04	$11,804.04	$11,804.04	nat. median $5,874 outlier · 2.0×
49653 CPT	Hernia Repair Ventral Laproscopy	5	$11,016.00	$12,441.60	$11,664.00	nat. median $4,010 outlier · 2.9×
690 MS_DRG	Kidney And Urinary Tract Infections Without Mcc	1	$11,570.74	$11,570.74	$11,570.74	nat. median $6,107 1.9× median
641 MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…	1	$10,893.12	$10,893.12	$10,893.12	nat. median $5,850 1.9× median
195 MS_DRG	Simple Pneumonia And Pleurisy Without Cc/mcc	1	$10,817.75	$10,817.75	$10,817.75	nat. median $4,710 outlier · 2.3×
948 MS_DRG	Signs And Symptoms Without Mcc	1	$10,495.28	$10,495.28	$10,495.28	nat. median $5,562 1.9× median
49652 CPT	Lap Vent/abd Hernia Repair	5	$9,180.00	$10,368.00	$9,720.00	nat. median $3,425 outlier · 2.8×
440 MS_DRG	Disorders Of Pancreas Except Malignancy Without Cc/mcc	1	$8,994.49	$8,994.49	$8,994.49	nat. median $4,897 1.8× median
807 MS_DRG	Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc	1	$8,631.66	$8,631.66	$8,631.66	nat. median $4,880 1.8× median
1200657 LOCAL	Lap Chole	4	$7,992.00	$8,524.80	$8,214.00	—
28299 CPT	Cor Hlx Vlgs Double Osteot	16	$7,143.73	$11,494.08	$8,036.69	nat. median $6,837 1.2× median
28298 CPT	Cor Hlx Vlgs Prx Phlx Osteot	16	$4,530.60	$8,929.66	$8,036.69	nat. median $6,254 1.3× median
28750 CPT	Fusion Of Big Toe Joint	16	$7,143.73	$11,699.18	$8,036.69	nat. median $7,165 1.1× median
28760 CPT	Fusion Of Big Toe Joint	16	$3,537.00	$8,929.66	$8,036.69	nat. median $6,897 1.2× median
58720 CPT	Removal Of Ovary/tube(s)	16	$1,496.85	$9,243.51	$7,981.89	nat. median $2,980 outlier · 2.7×
28270 CPT	Release Of Foot Contracture	11	$6,653.07	$8,316.34	$7,484.70	nat. median $3,254 outlier · 2.3×
44120 CPT	Removal Of Small Intestine	5	$7,038.00	$7,948.80	$7,452.00	nat. median $3,688 outlier · 2.0×
1200816 LOCAL	Repair Of Small Intestine	4	$7,176.60	$7,655.04	$7,375.95	—
28485 CPT	Optx Metatarsal Fx Each	16	$6,385.18	$10,934.61	$7,183.32	nat. median $7,199 1.0× median
1200014 LOCAL	Amputation, Leg Bilateral	4	$6,900.30	$7,360.32	$7,091.98	—
49593 CPT	Rpr Aa Hrn 1st 3-10 Rdc	16	$1,142.10	$7,799.69	$7,019.72	nat. median $6,490 1.1× median
30465 CPT	Repair Nasal Stenosis	16	$3,450.24	$7,394.58	$6,655.12	nat. median $6,091 1.1× median
60500 CPT	Explore Parathyroid Glands	16	$3,410.10	$8,831.14	$6,655.12	nat. median $5,933 1.1× median
1200482 LOCAL	Hernia Repair Incisional/ventral-bilater	4	$6,443.10	$6,872.64	$6,622.08	—
2107534 LOCAL	Surgimesh Elipses Ventral	4	$6,390.00	$6,816.00	$6,567.50	—
49592 CPT	Rpr Aa Hrn 1st < 3 Ncr/strn	16	$952.20	$7,292.95	$6,563.65	nat. median $6,267 1.0× median
58670 CPT	Laparoscopy Tubal Cautery	16	$778.50	$7,505.28	$6,563.65	nat. median $6,176 1.1× median
49651 CPT	Lap Ing Hernia Repair Recur	16	$5,834.36	$13,100.16	$6,563.65	nat. median $6,367 1.0× median
49321 CPT	Laparoscopy Biopsy	16	$5,834.36	$9,414.63	$6,563.65	nat. median $6,112 1.1× median
49320 CPT	Diag Laparo Separate Proc	16	$4,276.80	$9,414.63	$6,563.65	nat. median $6,026 1.1× median
49322 CPT	Laparoscopy Aspiration	16	$5,834.36	$9,414.63	$6,563.65	nat. median $6,092 1.1× median
47562 CPT	Removal Of Gallbladder Using An Endoscope	16	$1,369.80	$9,414.63	$6,563.65	nat. median $6,043 1.1× median
44970 CPT	Laparoscopy Appendectomy	16	$5,834.36	$8,113.92	$6,563.65	nat. median $6,065 1.1× median
49650 CPT	Repair Of Groin Hernia Using An Endoscope	16	$893.70	$10,361.28	$6,563.65	nat. median $5,726 1.1× median
58661 CPT	Laparoscopy Remove Adnexa	16	$1,355.40	$8,647.68	$6,563.65	nat. median $5,852 1.1× median
19318 CPT	Breast Reduction	16	$5,797.40	$10,026.24	$6,522.07	nat. median $6,870 0.9× median

Other procedures at this hospital

Browse this hospital's 4,741 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

00003089431	NDC	Eliquis	9	9	$13.00	$13.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00006542312	NDC	Bridion	9	9	$321.00	$321.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00023050601	NDC	Refresh	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00054060313	NDC	Desvenlafaxine Succinate	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00054350049	NDC	Lidocaine HCl Viscous	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00065074114	NDC	Tetracaine HCl	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00087606413	NDC	Glucophage Xr	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00093202694	NDC	Azithromycin	9	9	$32.00	$32.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00093342601	NDC	LORazepam	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00093417773	NDC	Cephalexin	9	9	$32.00	$32.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00093901865	NDC	cycloSPORINE, Modified	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00121043130	NDC	Milk Of Magnesia	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00121075908	NDC	prednisoLONE Sodium Phosphate	9	9	$25.00	$25.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00121176230	NDC	Mag-al Plus Xs	9	9	$7.00	$7.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00121457740	NDC	Lactulose	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00143933110	NDC	BUPivacaine HCl	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00143978410	NDC	Flumazenil	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00143988901	NDC	Amoxicillin	9	9	$7.00	$7.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00168005321	NDC	White Petrolatum	9	9	$6.76	$6.76	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00173068224	NDC	Ventolin Hfa	9	9	$51.00	$51.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00173085914	NDC	Breo Ellipta	9	9	$227.00	$227.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00173087306	NDC	Incruse Ellipta	9	9	$94.00	$94.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00173089314	NDC	Trelegy Ellipta	9	9	$408.00	$408.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00173094755	NDC	Wellbutrin Sr	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00186037028	NDC	Symbicort 160/4.5	9	9	$139.00	$139.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00264751020	NDC	Dextrose	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00310620530	NDC	Farxiga	9	9	$29.00	$29.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00338070541	NDC	Potassium Chloride	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00338104702	NDC	Nitroglycerin-dextrose	9	9	$47.00	$47.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00378026591	NDC	Dabigatran Etexilate Mesylate	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00378110101	NDC	Prazosin HCl	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00378910493	NDC	Nitroglycerin Transdermal System	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00386000102	NDC	Gebauer's Ethyl Chloride	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00406012562	NDC	HYDROcodone Bitartrate-acetaminophen	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00406051262	NDC	oxyCODONE Hcl-acetaminophen	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00409015224	NDC	metroNIDAZOLE	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00409161050	NDC	Marcaine HCl	9	9	$1.80	$1.80	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00409201610	NDC	Metoprolol Tartrate Novaplus	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00409318203	NDC	Epinephrine-lidocaine HCl	9	9	$0.66	$0.66	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00409361301	NDC	BUPivacaine Spinal	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00409428202	NDC	Lidocaine HCl	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00409428301	NDC	Lidocaine HCl	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00409488820	NDC	Sodium Chloride	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00409488850	NDC	Sodium Chloride	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00409573810	NDC	Marcaine With Epinephrine Novaplus	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00409812610	NDC	Marcaine With EPINEPHrine Novaplus	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00487930133	NDC	Sodium Chloride	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00527459313	NDC	Oseltamivir Phosphate	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00536105022	NDC	Calcium Antacid	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00536121195	NDC	Dibucaine	9	9	$9.00	$9.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00536130375	NDC	Infants' Simethicone Drops	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00536741551	NDC	Enema	9	9	$10.00	$10.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00574006930	NDC	Glutose 15	9	9	$7.00	$7.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00574705012	NDC	Bisacodyl	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00597015237	NDC	Jardiance	9	9	$23.00	$23.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00641921710	NDC	dilTIAZem HCl Novaplus	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00713052612	NDC	Promethegan	9	9	$15.00	$15.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00713067815	NDC	Nystatin	9	9	$14.25	$14.25	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904052361	NDC	Vitamin C	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904053061	NDC	Tab-a-vite	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904608561	NDC	Citalopram	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904637061	NDC	amLODIPine Besylate	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904640761	NDC	Bisacodyl	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904673061	NDC	Acetaminophen	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904686161	NDC	Divalproex Sodium	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904702761	NDC	oxyBUTYnin Chloride	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904718361	NDC	Docusate Sodium	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904725261	NDC	Senna-lax	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904726161	NDC	Sodium Bicarbonate	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904730561	NDC	Carvedilol	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904730861	NDC	Carvedilol	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904734561	NDC	FLUoxetine HCl	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904741844	NDC	Magnesium Citrate	9	9	$6.00	$6.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904750930	NDC	Aspirin Low Dose	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904759161	NDC	Ferrous Sulfate	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904791461	NDC	Ibuprofen	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00904880567	NDC	Triple Antibiotic Ointment	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00990710709	NDC	Potassium Chloride In Dextrose And Sodium Chloride	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00990711509	NDC	Potassium Chloride-sodium Chloride	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00990713809	NDC	Sodium Chloride	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00990713909	NDC	Sterile Water	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00990790209	NDC	Potassium Chloride In Dextrose And Sodium Chloride	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00990792609	NDC	Dextrose-sodium Chloride	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00990792909	NDC	Lactated Ringer's And 5% Dextrose	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00990793002	NDC	Dextrose	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00990794109	NDC	Dextrose-sodium Chloride	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00990797208	NDC	Sodium Chloride	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00990798413	NDC	Sodium Chloride	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00990798423	NDC	Sodium Chloride	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
00990925739	NDC	Potassium Chloride In Sodium Chloride	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
0120	RC	—	10	10	$150.00	$150.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
02250052848	NDC	Ayr No-drip Sinus Spray	9	9	$11.00	$11.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
0250	RC	—	18	9	$42.07	$42.07	$4,425.00	$4,425.00	$4,425.00	2026-08-18
0253	RC	—	18	9	$13.75	$13.75	$4,425.00	$4,425.00	$4,425.00	2026-08-18
0258	RC	—	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
0259	RC	—	36	9	$65.84	$65.84	$4,425.00	$4,425.00	$4,425.00	2026-08-18
0410	RC	—	9	9	$78.00	$78.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
0721	RC	—	9	9	$1,569.00	$1,569.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
0722	RC	—	9	9	$3,780.00	$3,780.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
08290306546	NDC	Bd PosiFlush	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
08290306553	NDC	Bd PosiFlush Sf	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
10006070028	NDC	Magnesium Oxide	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
10006070038	NDC	Oyster Shell Calcium With Vitamin D	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
10481011108	NDC	Lugol's Strong Iodine	9	9	$37.63	$37.63	$4,425.00	$4,425.00	$4,425.00	2026-08-18
10702025301	NDC	Butalbital-acetaminophen-caffeine	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
11523726808	NDC	MiraLAX	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
11845014028	NDC	Mason Natural Lutein	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
1200012	LOCAL	Amputation-leg	4	4	$5,828.00	$5,828.00	$5,245.20	$5,594.88	$5,390.90	2025-02-28
1200014	LOCAL	Amputation, Leg Bilateral	4	4	$7,667.00	$7,667.00	$6,900.30	$7,360.32	$7,091.98	2025-02-28
1200146	LOCAL	Laparoscopy Lymph Node Bx	4	4	$6,690.00	$6,690.00	$6,021.00	$6,422.40	$6,188.25	2025-02-28
1200154	LOCAL	Cesarean Delivery	4	4	$7,020.00	$7,020.00	$6,318.00	$6,739.20	$6,493.50	2025-02-28
1200482	LOCAL	Hernia Repair Incisional/ventral-bilater	4	4	$7,159.00	$7,159.00	$6,443.10	$6,872.64	$6,622.08	2025-02-28
1200483	LOCAL	Hernia Repair Inguinal	4	4	$6,200.00	$6,200.00	$5,580.00	$5,952.00	$5,735.00	2025-02-28
1200636	LOCAL	Mastectomy Partial Lumpectomy	4	4	$5,913.00	$5,913.00	$5,321.70	$5,676.48	$5,469.52	2025-02-28
1200657	LOCAL	Lap Chole	4	4	$8,880.00	$8,880.00	$7,992.00	$8,524.80	$8,214.00	2025-02-28
1200816	LOCAL	Repair Of Small Intestine	4	4	$7,974.00	$7,974.00	$7,176.60	$7,655.04	$7,375.95	2025-02-28
1600464	LOCAL	Cauterization Of Cervix	4	4	$6,828.00	$6,828.00	$6,145.20	$6,554.88	$6,315.90	2025-02-28
1600893	LOCAL	Removal Of Foot Lesion	4	4	$5,221.00	$5,221.00	$4,698.90	$5,012.16	$4,829.42	2025-02-28
16864068003	NDC	Dermoplast Pain & Itch Spray	9	9	$13.00	$13.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
17478071131	NDC	Lidocaine HCl	9	9	$21.95	$21.95	$4,425.00	$4,425.00	$4,425.00	2026-08-18
177	MS_DRG	Respiratory Infections And Inflammations With Mcc	1	1	$11,099.65	$11,099.65	$30,052.69	$30,052.69	$30,052.69	2025-02-28
190	MS_DRG	Chronic Obstructive Pulmonary Disease With Mcc	1	1	$17,179.30	$17,179.30	$17,433.92	$17,433.92	$17,433.92	2025-02-28
191	MS_DRG	Chronic Obstructive Pulmonary Disease With Cc	1	1	$34,529.53	$34,529.53	$13,060.47	$13,060.47	$13,060.47	2025-02-28
19318	CPT	Breast Reduction	20	16	$10,444.00	$10,444.00	$5,797.40	$10,026.24	$6,522.07	2026-08-18
194	MS_DRG	Simple Pneumonia And Pleurisy With Cc	1	1	$12,074.89	$12,074.89	$14,155.66	$14,155.66	$14,155.66	2025-02-28
195	MS_DRG	Simple Pneumonia And Pleurisy Without Cc/mcc	1	1	$7,901.58	$7,901.58	$10,817.75	$10,817.75	$10,817.75	2025-02-28
20555003300	NDC	Vitamin D3	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
20555003901	NDC	Melatonin	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
20555004000	NDC	Zinc Sulfate	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
2107534	LOCAL	Surgimesh Elipses Ventral	4	4	$7,100.00	$7,100.00	$6,390.00	$6,816.00	$6,567.50	2025-02-28
2107536	LOCAL	Surgimesh Tintra E1522	4	4	$5,300.00	$5,300.00	$4,770.00	$5,088.00	$4,902.50	2025-02-28
2107538	LOCAL	Surgimesh Tintra E2226	4	4	$5,901.00	$5,901.00	$5,310.90	$5,664.96	$5,458.42	2025-02-28
21554	CPT	Exc Neck Tum Deep 5 Cm/>	24	16	$6,038.00	$6,038.00	$1,517.40	$7,481.67	$4,914.97	2026-08-18
21922006204	NDC	Triamcinolone Acetonide	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
23155019401	NDC	NIFEdipine	9	9	$25.00	$25.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
24208053210	NDC	PreserVision	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
24385032558	NDC	Good Neighbor Pharmacy Saline Nasal Spray	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
25021067376	NDC	Glydo	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
25021067377	NDC	Glydo	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
25021068705	NDC	Rocuronium Bromide	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
27808006502	NDC	Promethazine Hcl-codeine Phosphate	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
28270	CPT	Release Of Foot Contracture	15	11	$12,475.00	$12,475.00	$6,653.07	$8,316.34	$7,484.70	2026-08-18
28297	CPT	Cor Hlx Vlgs Jt Arthrd	20	16	$9,733.00	$9,733.00	$8,759.70	$16,083.53	$14,475.17	2026-08-18
28298	CPT	Cor Hlx Vlgs Prx Phlx Osteot	20	16	$5,034.00	$5,034.00	$4,530.60	$8,929.66	$8,036.69	2026-08-18
28299	CPT	Cor Hlx Vlgs Double Osteot	20	16	$11,973.00	$11,973.00	$7,143.73	$11,494.08	$8,036.69	2026-08-18
28485	CPT	Optx Metatarsal Fx Each	20	16	$7,670.00	$7,670.00	$6,385.18	$10,934.61	$7,183.32	2026-08-18
28735	CPT	Fusion Of Foot Bones	20	16	$10,494.00	$10,494.00	$9,444.60	$16,083.53	$14,475.17	2026-08-18
28750	CPT	Fusion Of Big Toe Joint	20	16	$11,718.64	$11,718.64	$7,143.73	$11,699.18	$8,036.69	2026-08-18
28760	CPT	Fusion Of Big Toe Joint	20	16	$3,930.00	$3,930.00	$3,537.00	$8,929.66	$8,036.69	2026-08-18
30465	CPT	Repair Nasal Stenosis	20	16	$4,860.00	$4,860.00	$3,450.24	$7,394.58	$6,655.12	2026-08-18
31720	CPT	Insertion Of Tube Into Airway For Aspiration Of Secretions	14	14	$969.00	$969.00	$69.09	$4,425.00	$4,425.00	2026-08-18
31722013130	NDC	Dutasteride	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
33342008845	NDC	Rizatriptan Benzoate	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
37000002304	NDC	Metamucil MultiHealth Fiber	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
39822110001	NDC	Folic Acid	9	9	$68.00	$68.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
42571016242	NDC	Amoxicillin/Clavulanate Potassium	9	9	$25.00	$25.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
42806026793	NDC	Cholestyramine	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
43547063925	NDC	Glycopyrrolate Novaplus	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
43598008658	NDC	Doxycycline	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
43598072525	NDC	ePHEDrine Sulfate	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
440	MS_DRG	Disorders Of Pancreas Except Malignancy Without Cc/mcc	1	1	$9,921.27	$9,921.27	$8,994.49	$8,994.49	$8,994.49	2025-02-28
44120	CPT	Removal Of Small Intestine	5	5	$8,280.00	$8,280.00	$7,038.00	$7,948.80	$7,452.00	2026-08-18
44677010202	NDC	Lansinoh Lanolin	9	9	$10.00	$10.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
44970	CPT	Laparoscopy Appendectomy	20	16	$8,452.00	$8,452.00	$5,834.36	$8,113.92	$6,563.65	2026-08-18
45802000403	NDC	Hydrocortisone	9	9	$6.00	$6.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
45802006001	NDC	Bacitracin	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
45802073230	NDC	Children's Fever Reducer	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
46122044078	NDC	Good Neighbor Pharmacy Allergy Relief	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
46122056258	NDC	Good Neighbor Pharmacy Naproxen Sodium	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
46122056807	NDC	Good Neighbor Pharmacy Nicotine	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
46122073853	NDC	Good Neighbor Pharmacy Anti-diarrheal	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
46122074876	NDC	Good Neighbor Pharmacy Sore Throat Spray	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
46122075252	NDC	Good Neighbor Pharmacy Diclofenac Sodium	9	9	$16.00	$16.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
46122078815	NDC	Good Neighbor Pharmacy Nighttime Sleep Aid	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
47562	CPT	Removal Of Gallbladder Using An Endoscope	20	16	$1,522.00	$1,522.00	$1,369.80	$9,414.63	$6,563.65	2026-08-18
48582051201	NDC	Biotene Oral Balance	9	9	$18.55	$18.55	$4,425.00	$4,425.00	$4,425.00	2026-08-18
49002	CPT	Reopening Of Abdomen	5	5	$5,841.00	$5,841.00	$4,964.85	$5,607.36	$5,256.90	2026-08-18
49320	CPT	Diag Laparo Separate Proc	20	16	$4,752.00	$4,752.00	$4,276.80	$9,414.63	$6,563.65	2026-08-18
49321	CPT	Laparoscopy Biopsy	20	16	$8,408.00	$8,408.00	$5,834.36	$9,414.63	$6,563.65	2026-08-18
49322	CPT	Laparoscopy Aspiration	20	16	$6,999.00	$6,999.00	$5,834.36	$9,414.63	$6,563.65	2026-08-18
49568	CPT	Implantation Of Mesh/other Prosthesis	5	5	$6,088.00	$6,088.00	$5,174.80	$5,844.48	$5,479.20	2025-02-28
49592	CPT	Rpr Aa Hrn 1st < 3 Ncr/strn	24	16	$1,058.00	$1,058.00	$952.20	$7,292.95	$6,563.65	2026-08-18
49593	CPT	Rpr Aa Hrn 1st 3-10 Rdc	24	16	$1,269.00	$1,269.00	$1,142.10	$7,799.69	$7,019.72	2026-08-18
49650	CPT	Repair Of Groin Hernia Using An Endoscope	28	16	$7,454.00	$7,454.00	$893.70	$10,361.28	$6,563.65	2026-08-18
49651	CPT	Lap Ing Hernia Repair Recur	20	16	$13,646.00	$13,646.00	$5,834.36	$13,100.16	$6,563.65	2026-08-18
49652	CPT	Lap Vent/abd Hernia Repair	5	5	$10,800.00	$10,800.00	$9,180.00	$10,368.00	$9,720.00	2025-02-28
49653	CPT	Hernia Repair Ventral Laproscopy	5	5	$12,960.00	$12,960.00	$11,016.00	$12,441.60	$11,664.00	2025-02-28
49654	CPT	Lap Hernia Repair	5	5	$13,422.00	$13,422.00	$11,408.70	$12,885.12	$12,079.80	2025-02-28
50228011790	NDC	Rosuvastatin Calcium	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268003715	NDC	Amitriptyline Hydrochloride AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268006115	NDC	Acyclovir AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268010615	NDC	Baclofen AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268011015	NDC	Benazepril HCl AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268016815	NDC	Celecoxib AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268017315	NDC	clonazePAM AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268022215	NDC	Doxazosin Mesylate AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268033015	NDC	Fludrocortisone Acetate AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268035915	NDC	Glimepiride AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268037615	NDC	Glucosamine-chondroitin AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268040015	NDC	HYDROcodone Bitartrate-acetaminophen AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268040115	NDC	HYDROcodone Bitartrate-acetaminophen AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268040715	NDC	Hydrocortisone AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268041112	NDC	Hydrocortisone Acetate AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268041215	NDC	Hydroxychloroquine Sulfate AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268043015	NDC	Indomethacin AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268047615	NDC	Letrozole AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268056215	NDC	Midodrine HCl AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268058813	NDC	Memantine Hydrochloride AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268067113	NDC	Potassium Chloride AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268072415	NDC	Sotalol HCl AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268074115	NDC	rOPINIRole HCl AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268074514	NDC	Sucralfate AvPak	9	9	$10.00	$10.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268077915	NDC	Temazepam AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50268085515	NDC	Vitamin B12 AvPak	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50289325001	NDC	A.e.r	9	9	$6.00	$6.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50458058030	NDC	Xarelto	9	9	$56.00	$56.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50742026101	NDC	NIFEdipine	9	9	$8.96	$8.96	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50742050504	NDC	Scopolamine	9	9	$21.00	$21.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50742054905	NDC	fentaNYL Transdermal System	9	9	$10.00	$10.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50742055005	NDC	fentaNYL Transdermal System	9	9	$12.00	$12.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
50742066504	NDC	Atropine-hyoscyamine-phenobarbital-scopolamine	9	9	$15.00	$15.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
51079028520	NDC	diazePAM	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
51079059720	NDC	Cetirizine HCl	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
51079098520	NDC	busPIRone HCl	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
51552134501	NDC	Lets Kit	9	9	$35.00	$35.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
51660020030	NDC	Ezetimibe	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
51672127501	NDC	Clotrimazole	9	9	$9.00	$9.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
51801000130	NDC	Effer-k	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
52427028701	NDC	Macrodantin	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
54660	CPT	Revision Of Testis	5	5	$6,264.00	$6,264.00	$5,324.40	$6,013.44	$5,637.60	2026-08-18
55150016710	NDC	BUPivacaine HCl	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
55150020902	NDC	dexmedeTOMIDine HCl	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
55150023621	NDC	Vecuronium Bromide Novaplus	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
55150025520	NDC	Lidocaine HCl	9	9	$4.50	$4.50	$4,425.00	$4,425.00	$4,425.00	2026-08-18
552	MS_DRG	Medical Back Problems Without Mcc	1	1	$25,281.15	$25,281.15	$12,579.39	$12,579.39	$12,579.39	2025-02-28
57237004290	NDC	valACYclovir HCl	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
57237007710	NDC	Ondansetron	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
57896014514	NDC	Bacitracin Zinc	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
57896092101	NDC	Aspirin	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
58661	CPT	Laparoscopy Remove Adnexa	24	16	$1,506.00	$1,506.00	$1,355.40	$8,647.68	$6,563.65	2026-08-18
58670	CPT	Laparoscopy Tubal Cautery	24	16	$865.00	$865.00	$778.50	$7,505.28	$6,563.65	2026-08-18
58720	CPT	Removal Of Ovary/tube(s)	30	16	$1,761.00	$1,761.00	$1,496.85	$9,243.51	$7,981.89	2026-08-18
59365606501	NDC	Astringyn	9	9	$50.96	$50.96	$4,425.00	$4,425.00	$4,425.00	2026-08-18
59400	CPT	Obstetrical Care	5	5	$5,411.00	$5,411.00	$4,599.35	$5,194.56	$4,869.90	2026-08-18
59510	CPT	Cesarean Delivery	5	5	$5,927.00	$5,927.00	$5,037.95	$5,689.92	$5,334.30	2026-08-18
59651043701	NDC	Digoxin	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
59762013105	NDC	Silver sulfADIAZINE	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
603	MS_DRG	Cellulitis Without Mcc	1	1	$8,330.18	$8,330.18	$12,370.40	$12,370.40	$12,370.40	2025-02-28
60500	CPT	Explore Parathyroid Glands	20	16	$3,789.00	$3,789.00	$3,410.10	$8,831.14	$6,655.12	2026-08-18
60505082306	NDC	Calcitonin-salmon	9	9	$170.00	$170.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
60505082901	NDC	Fluticasone Propionate	9	9	$21.00	$21.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
60505622600	NDC	Atropine Sulfate	9	9	$83.00	$83.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
60687011221	NDC	Anastrozole	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
60687011301	NDC	cloNIDine HCl	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
60687012201	NDC	predniSONE	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
60687015501	NDC	metFORMIN HCl	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
60687016301	NDC	Cephalexin	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
60687019501	NDC	dilTIAZem HCl	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
60687023101	NDC	Sertraline HCl	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
60687025301	NDC	Sertraline HCl	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
60687030301	NDC	Donepezil HCl	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
60687032701	NDC	QUEtiapine Fumarate	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
60687033801	NDC	QUEtiapine Fumarate	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
60687036901	NDC	Dicyclomine HCl	9	9	$5.00	$5.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
641	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…	1	1	$8,458.09	$8,458.09	$10,893.12	$10,893.12	$10,893.12	2025-02-28
690	MS_DRG	Kidney And Urinary Tract Infections Without Mcc	1	1	$8,609.17	$8,609.17	$11,570.74	$11,570.74	$11,570.74	2025-02-28
694	MS_DRG	Urinary Stones Without Mcc	1	1	$7,525.63	$7,525.63	$11,804.04	$11,804.04	$11,804.04	2025-02-28
787	MS_DRG	Cesarean Section Without Sterilization With Cc	1	1	$26,895.74	$26,895.74	$15,052.03	$15,052.03	$15,052.03	2025-02-28
806	MS_DRG	Vaginal Delivery Without Sterilization Or D&c With Cc	1	1	$17,174.41	$17,174.41	$12,132.03	$12,132.03	$12,132.03	2025-02-28
807	MS_DRG	Vaginal Delivery Without Sterilization Or D&c Without Cc/mcc	1	1	$17,758.01	$17,758.01	$8,631.66	$8,631.66	$8,631.66	2025-02-28
871	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	1	1	$16,038.97	$16,038.97	$26,527.13	$26,527.13	$26,527.13	2025-02-28
872	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	1	1	$8,430.60	$8,430.60	$15,048.48	$15,048.48	$15,048.48	2025-02-28
90375	CPT	Rabies Ig Im/sc	9	9	$1,475.00	$1,475.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
94002	CPT	Vent Mgmt Inpat Init Day	14	14	$1,759.00	$1,759.00	$998.75	$4,425.00	$4,425.00	2026-08-18
94004	CPT	Vent Mgmt Nf Per Day	9	9	$1,175.00	$1,175.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
94375	CPT	Respiratory Flow Volume Loop	14	14	$147.00	$147.00	$116.71	$4,425.00	$4,425.00	2026-08-18
94618	CPT	Test For Exercise-induced Lung Stress	14	14	$347.00	$347.00	$170.21	$4,425.00	$4,425.00	2026-08-18
94660	CPT	Cpap Initiation&mgmt	14	14	$837.00	$837.00	$370.64	$4,425.00	$4,425.00	2026-08-18
94664	CPT	Demo&/eval Pt Use Inhaler	14	14	$138.00	$138.00	$124.20	$4,425.00	$4,425.00	2026-08-18
94667	CPT	Mnpj Chest Wall 1st	14	14	$166.00	$166.00	$141.10	$4,425.00	$4,425.00	2026-08-18
94668	CPT	Mnpj Chest Wall Sbsq	9	9	$124.00	$124.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
94669	CPT	Mechanical Chest Wall Oscill	14	14	$243.00	$243.00	$206.55	$4,425.00	$4,425.00	2026-08-18
948	MS_DRG	Signs And Symptoms Without Mcc	1	1	$8,226.26	$8,226.26	$10,495.28	$10,495.28	$10,495.28	2025-02-28
A9270	HCPCS	Eliquis	9	9	$134.00	$134.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
C1713	HCPCS	Anchor/screw Bn/bn,tis/bn	4	4	$19,762.00	$19,762.00	$17,785.80	$18,971.52	$18,279.85	2026-08-18
G0237	HCPCS	Therapeutic Procd Strg Endur	14	14	$83.00	$83.00	$65.03	$4,425.00	$4,425.00	2026-08-18
G0238	HCPCS	Oth Resp Proc, Indiv	14	14	$83.00	$83.00	$65.03	$4,425.00	$4,425.00	2026-08-18
J1162	HCPCS	Digoxin Immune Fab (ovine)	20	16	$3,758.95	$3,758.95	$3,383.05	$6,521.97	$5,869.77	2026-08-18
J1308	HCPCS	Famotidine	18	9	$75.00	$75.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
J1741	HCPCS	Ibuprofen Injection	14	14	$5.00	$5.00	$3.75	$4,425.00	$4,425.00	2026-08-18
J1920	HCPCS	Inj, Labetalol Hcl, 5mg	16	12	$30.00	$30.00	$0.42	$4,425.00	$4,425.00	2026-08-18
J7070	HCPCS	D5w Infusion	14	14	$30.00	$30.00	$4.63	$4,425.00	$4,425.00	2026-08-18
J7605	HCPCS	Arformoterol Non-comp Unit	14	14	$30.00	$30.00	$2.38	$4,425.00	$4,425.00	2026-08-18
J8501	HCPCS	Oral Aprepitant	14	14	$213.00	$213.00	$4.50	$4,425.00	$4,425.00	2026-08-18
Q0162	HCPCS	Ondansetron Oral	9	9	$2.50	$2.50	$4,425.00	$4,425.00	$4,425.00	2026-08-18
Q0167	HCPCS	Dronabinol 2.5mg Oral	14	14	$13.35	$13.35	$1.05	$4,425.00	$4,425.00	2026-08-18
Q2009	HCPCS	Fosphenytoin Inj Pe	9	9	$22.26	$22.26	$4,425.00	$4,425.00	$4,425.00	2026-08-18
Q4104	HCPCS	Integra Bmwd	4	4	$4,800.00	$4,800.00	$4,320.00	$4,608.00	$4,440.00	2026-08-18
Q9949	HCPCS	Locm 300-349 Mg/ml Iodine 1ml	9	9	$3.00	$3.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18
S0077	HCPCS	Clindamycin Phospate 300 Mg	9	9	$30.00	$30.00	$4,425.00	$4,425.00	$4,425.00	2026-08-18

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