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

Gateway Rehabilitation Hospital

Florence, KY · CCN 183030 · Rates published

4,298 distinct procedures filed
81 distinct payers
598,419 rate rows
2026-05-09 last MRF observed
Data quality

559,221 of 598,419 rate rows are consumer-grade (93.4%)

39,198 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reasonRows
template filing: same amount across many unrelated codes — excluded 39,054
exceeds 10× this hospital's gross charge — excluded from medians 142
per-diem day rate — not a per-procedure price 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://vrhgateway.com/wp-content/uploads/sites/14/2026/03/471023316_vibra-rehabilitation-hospital-of-florence_standardcharges.csv
Found on page https://vrhgateway.com/about-us/price-transparency/
Discovered viaCMS hospital list
Last fetch not_modified · 2026-05-17
Content fingerprint a31404e1647bc4fa… · 37,185,291 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code Description Payers Min $ Max $ Avg median vs national
68875010201
OTHER 		Gattex 52 $5.00 $137,212.00 $99,999.99 nat. median
$100,000
1.0× median
407
OTHER 		Traumatic Spinal Cord Injury M <24.50 And A >=61.50 Tier 2 C 30 $19,683.40 $89,195.16 $69,720.49 nat. median
$21,233
outlier · 3.3×
1806
OTHER 		Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 Tier 2 C 30 $44,897.33 $66,214.74 $52,047.47 nat. median
$52,047
1.0× median
55292070255
OTHER 		Hemin For Injection 52 $27.85 $137,212.00 $51,333.70 nat. median
$51,334
1.0× median
1904
OTHER 		Guillain-barr� M <38.50 Tier 1 B 27 $47,918.48 $69,359.34 $51,007.07 nat. median
$120,174
outlier · 0.4×
406
OTHER 		Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 Tier 1 B 27 $45,071.99 $58,632.09 $50,855.85 nat. median
$27,791
1.8× median
404
OTHER 		Traumatic Spinal Cord Injury M <31.50 And A <61.50 Tier 1 B 27 $44,417.96 $57,780.81 $50,118.31 nat. median
$3,927
outlier · 12.8×
106
OTHER 		Stroke M <41.50 And A <84.50 Tier 1 B 30 $7,881.74 $55,103.74 $43,671.19 nat. median
$41,618
1.0× median
505
OTHER 		Non-traumatic Spinal Cord Injury M <39.50 Tier 2 C 30 $10,033.06 $57,187.38 $42,031.20 nat. median
$17,169
outlier · 2.4×
405
OTHER 		Traumatic Spinal Cord Injury M >=31.50 And M <41.50 Tier 1 B 27 $35,322.93 $45,950.11 $39,856.49 nat. median
$49,246
0.8× median
59627022205
OTHER 		Avonex 52 $10.22 $137,212.00 $39,676.03 nat. median
$39,676
1.0× median
59627033304
OTHER 		Avonex Pen 30 mcg/0.5mL 52 $5.00 $137,212.00 $39,676.03 nat. median
$39,676
1.0× median
74368303
OTHER 		Lupron Depot 52 $9,811.66 $137,212.00 $39,246.62 nat. median
$39,247
1.0× median
105
OTHER 		Stroke M <41.50 And A >=84.50 Tier 3 D 30 $30,921.60 $48,447.07 $38,394.78 nat. median
$2
outlier · 23411.5×
205
OTHER 		Traumatic Brain Injury M <35.50 Tier 3 D 30 $32,555.15 $50,024.50 $37,422.16 nat. median
$17,709
outlier · 2.1×
1705
OTHER 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 Tier 3 D 30 $25,734.20 $49,711.67 $35,785.96 nat. median
$3
outlier · 13254.1×
1903
OTHER 		Guillain-barr� M >=38.50 And M <51.50 Tier 1 B 27 $32,894.49 $47,614.75 $35,015.12 nat. median
$119,935
outlier · 0.3×
1504
OTHER 		Pulmonary M <45.50 Tier 1 B 30 $27,065.00 $43,121.37 $34,999.14 nat. median
$259
outlier · 135.3×
1805
OTHER 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 N… 30 $12,314.17 $45,940.63 $34,792.48 nat. median
$38,125
0.9× median
305
OTHER 		Non-traumatic Brain Injury M <42.50 And A <78.50 Tier 1 B 30 $27,663.90 $45,208.80 $33,833.16 nat. median
$56
outlier · 601.5×
2102
OTHER 		Burns M <52.50 Tier 1 B 27 $27,944.71 $43,940.41 $33,389.48 nat. median
$34,079
1.0× median
74055402
OTHER 		Humira(Cf) Pen 52 $20.88 $137,212.00 $33,228.58 nat. median
$33,229
1.0× median
2144511
OTHER 		Taltz Autoinjector 52 $8,298.87 $137,212.00 $33,195.46 nat. median
$33,195
1.0× median
604
OTHER 		Neurological M <43.50 Tier 1 B 30 $25,911.20 $47,216.61 $33,000.81 nat. median
$14,914
outlier · 2.2×
1004
OTHER 		Amputation Lower Extremity M <47.50 Tier 3 D 30 $28,938.70 $43,810.61 $32,959.10 nat. median
$35,360
0.9× median
1304
OTHER 		Rheumatoid Other Arthritis M <44.50 And A >=64.50 Tier 1 B 27 $29,215.60 $40,603.55 $32,472.66 nat. median
$35,295
0.9× median
704
OTHER 		Fracture Of Lower Extremity M <41.50 Tier 1 B 30 $11,977.30 $52,612.01 $32,333.44 nat. median
$334
outlier · 96.9×
403
OTHER 		Traumatic Spinal Cord Injury M >=41.50 And M <47.50 Tier 1 B 27 $28,448.23 $37,006.94 $32,099.14 nat. median
$105
outlier · 305.5×
304
OTHER 		Non-traumatic Brain Injury M <42.50 And A >=78.50 Tier 2 C 30 $26,652.20 $53,084.63 $32,077.72 nat. median
$9,034
outlier · 3.6×
2005
OTHER 		Miscellaneous M <46.50 And A <77.50 Tier 1 B 30 $7,948.31 $42,112.72 $31,423.39 nat. median
$34,071
0.9× median
504
OTHER 		Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 Tier 2 C 30 $27,316.69 $64,759.70 $31,376.48 nat. median
$18,399
1.7× median
25682000101
OTHER 		Soliris 52 $7,827.60 $137,212.00 $31,310.40 nat. median
$19,882
1.6× median
1604
OTHER 		Pain Syndrome M <43.50 Tier 1 B 27 $27,106.74 $44,507.30 $31,138.32 nat. median
$44,507
0.7× median
55513019001
OTHER 		Neulasta 6 Mg 52 $7,701.59 $137,212.00 $30,806.35 nat. median
$5,436
outlier · 5.7×
55513019201
OTHER 		Neulasta Onpro 52 $7,701.59 $137,212.00 $30,806.35 nat. median
$19,562
1.6× median
104
OTHER 		Stroke M >=41.50 And M <50.50 Tier 1 B 30 $21,170.52 $38,743.63 $30,704.82 nat. median
$5
outlier · 5927.6×
1305
OTHER 		Rheumatoid Other Arthritis M <51.50 And A <64.50 Tier 3 D 30 $27,178.50 $52,345.92 $30,687.76 nat. median
$30,688
1.0× median
1103
OTHER 		Amputation Non-lower Extremity M <52.50 Tier 1 B 27 $29,349.37 $38,025.07 $30,566.42 nat. median
$12,018
outlier · 2.5×
1704
OTHER 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 30 $27,007.00 $64,062.27 $30,494.37 nat. median
$2
outlier · 19423.2×
904
OTHER 		Other Orthopedic M <44.5 Tier 2 C 30 $22,786.40 $40,603.55 $30,312.36 nat. median
$29,273
1.0× median
2004
OTHER 		Miscellaneous M <46.50 And A >=77.50 Tier 1 B 30 $3,262.84 $39,953.24 $29,811.83 nat. median
$29,270
1.0× median
1404
OTHER 		Cardiac M <45.50 Tier 2 C 30 $25,592.40 $42,909.45 $29,798.56 nat. median
$14,506
outlier · 2.1×
1204
OTHER 		Osteoarthritis M <49.50 And A <74.50 Tier 3 D 30 $26,441.56 $48,373.21 $29,512.27 nat. median
$34,070
0.9× median
204
OTHER 		Traumatic Brain Injury M >=35.50 And M <49.50 Tier 2 C 30 $20,659.80 $39,052.67 $29,214.61 nat. median
$8,657
outlier · 3.4×
1804
OTHER 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50 T… 27 $26,075.53 $37,892.35 $29,160.69 nat. median
$31,833
0.9× median
805
OTHER 		Replacement Of Lower-extremity Joint M <42.50 Tier 3 D 30 $26,133.13 $39,081.11 $28,590.85 nat. median
$7,886
outlier · 3.6×
1203
OTHER 		Osteoarthritis M <49.50 And A >=74.50 Tier 3 D 30 $25,018.70 $39,481.15 $28,143.40 nat. median
$12
outlier · 2297.4×
68982085005
OTHER 		Octagam 52 $6,993.00 $137,212.00 $27,972.00 nat. median
$27,972
1.0× median
1703
OTHER 		Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 30 $2,829.03 $37,425.95 $26,943.27 nat. median
$28,818
0.9× median
1803
OTHER 		Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50 T… 27 $23,845.90 $34,650.28 $26,666.85 nat. median
$21,840
1.2× median

Other procedures at this hospital

Browse this hospital's 4,298 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
             
68875010201 OTHER Gattex 124 52 $99,999.99 $99,999.99 $5.00 $137,212.00 $99,999.99 2026-05-09
407 OTHER Traumatic Spinal Cord Injury M <24.50 And A >=61.50 Tier 2 C 192 30 $71,281.83 $70,239.06 $19,683.40 $89,195.16 $69,720.49 2026-05-09
1806 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M <30.50 Tier 2 C 168 30 $52,047.47 $50,729.79 $44,897.33 $66,214.74 $52,047.47 2026-05-09
55292070255 OTHER Hemin For Injection 124 52 $51,333.70 $51,333.70 $27.85 $137,212.00 $51,333.70 2026-05-09
1904 OTHER Guillain-barr� M <38.50 Tier 1 B 144 27 $51,540.31 $51,540.31 $47,918.48 $69,359.34 $51,007.07 2026-05-08
406 OTHER Traumatic Spinal Cord Injury M >=24.50 And M <31.50 And A >=61.50 Tier 1 B 144 27 $51,377.26 $51,377.26 $45,071.99 $58,632.09 $50,855.85 2026-05-08
404 OTHER Traumatic Spinal Cord Injury M <31.50 And A <61.50 Tier 1 B 144 27 $50,632.15 $50,632.15 $44,417.96 $57,780.81 $50,118.31 2026-05-08
106 OTHER Stroke M <41.50 And A <84.50 Tier 1 B 219 30 $43,671.19 $45,730.18 $7,881.74 $55,103.74 $43,671.19 2026-05-09
505 OTHER Non-traumatic Spinal Cord Injury M <39.50 Tier 2 C 214 30 $44,490.24 $43,260.72 $10,033.06 $57,187.38 $42,031.20 2026-05-09
405 OTHER Traumatic Spinal Cord Injury M >=31.50 And M <41.50 Tier 1 B 144 27 $40,265.12 $40,265.12 $35,322.93 $45,950.11 $39,856.49 2026-05-08
59627022205 OTHER Avonex 124 52 $39,676.03 $39,676.03 $10.22 $137,212.00 $39,676.03 2026-05-09
59627033304 OTHER Avonex Pen 30 mcg/0.5mL 124 52 $39,676.03 $39,676.03 $5.00 $137,212.00 $39,676.03 2026-05-09
74368303 OTHER Lupron Depot 123 52 $39,246.62 $39,246.62 $9,811.66 $137,212.00 $39,246.62 2026-05-09
105 OTHER Stroke M <41.50 And A >=84.50 Tier 3 D 193 30 $38,394.78 $40,205.40 $30,921.60 $48,447.07 $38,394.78 2026-05-09
205 OTHER Traumatic Brain Injury M <35.50 Tier 3 D 192 30 $41,200.77 $39,311.46 $32,555.15 $50,024.50 $37,422.16 2026-05-09
1705 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M <36.50 Tier 3 D 192 30 $38,641.25 $37,213.60 $25,734.20 $49,711.67 $35,785.96 2026-05-09
1903 OTHER Guillain-barr� M >=38.50 And M <51.50 Tier 1 B 144 27 $35,381.17 $35,381.17 $32,894.49 $47,614.75 $35,015.12 2026-05-08
1504 OTHER Pulmonary M <45.50 Tier 1 B 215 30 $34,999.14 $33,957.32 $27,065.00 $43,121.37 $34,999.14 2026-05-09
1805 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=30.50 And M <40.50 N… 169 30 $34,792.48 $35,720.54 $12,314.17 $45,940.63 $34,792.48 2026-05-09
305 OTHER Non-traumatic Brain Injury M <42.50 And A <78.50 Tier 1 B 236 30 $34,740.06 $34,696.74 $27,663.90 $45,208.80 $33,833.16 2026-05-09
2102 OTHER Burns M <52.50 Tier 1 B 108 27 $33,389.48 $33,389.48 $27,944.71 $43,940.41 $33,389.48 2026-05-08
74055402 OTHER Humira(Cf) Pen 124 52 $33,228.58 $33,228.58 $20.88 $137,212.00 $33,228.58 2026-05-09
2144511 OTHER Taltz Autoinjector 123 52 $33,195.46 $33,195.46 $8,298.87 $137,212.00 $33,195.46 2026-05-09
604 OTHER Neurological M <43.50 Tier 1 B 239 30 $35,349.89 $34,175.35 $25,911.20 $47,216.61 $33,000.81 2026-05-09
1004 OTHER Amputation Lower Extremity M <47.50 Tier 3 D 193 30 $36,081.72 $34,520.41 $28,938.70 $43,810.61 $32,959.10 2026-05-09
1304 OTHER Rheumatoid Other Arthritis M <44.50 And A >=64.50 Tier 1 B 144 27 $32,808.38 $32,808.38 $29,215.60 $40,603.55 $32,472.66 2026-05-08
704 OTHER Fracture Of Lower Extremity M <41.50 Tier 1 B 239 30 $34,132.69 $33,233.07 $11,977.30 $52,612.01 $32,333.44 2026-05-09
403 OTHER Traumatic Spinal Cord Injury M >=41.50 And M <47.50 Tier 1 B 144 27 $32,428.24 $32,428.24 $28,448.23 $37,006.94 $32,099.14 2026-05-08
304 OTHER Non-traumatic Brain Injury M <42.50 And A >=78.50 Tier 2 C 192 30 $32,796.05 $31,461.31 $26,652.20 $53,084.63 $32,077.72 2026-05-09
2005 OTHER Miscellaneous M <46.50 And A <77.50 Tier 1 B 239 30 $31,423.39 $32,530.62 $7,948.31 $42,112.72 $31,423.39 2026-05-09
504 OTHER Non-traumatic Spinal Cord Injury M >=39.50 And M <48.50 Tier 2 C 191 30 $32,016.82 $31,132.36 $27,316.69 $64,759.70 $31,376.48 2026-05-09
25682000101 OTHER Soliris 123 52 $31,310.40 $31,310.40 $7,827.60 $137,212.00 $31,310.40 2026-05-09
1604 OTHER Pain Syndrome M <43.50 Tier 1 B 144 27 $31,468.89 $31,468.89 $27,106.74 $44,507.30 $31,138.32 2026-05-08
55513019201 OTHER Neulasta Onpro 123 52 $30,806.35 $30,806.35 $7,701.59 $137,212.00 $30,806.35 2026-05-09
55513019001 OTHER Neulasta 6 Mg 123 52 $30,806.35 $30,806.35 $7,701.59 $137,212.00 $30,806.35 2026-05-09
104 OTHER Stroke M >=41.50 And M <50.50 Tier 1 B 217 30 $32,486.18 $32,152.38 $21,170.52 $38,743.63 $30,704.82 2026-05-09
1305 OTHER Rheumatoid Other Arthritis M <51.50 And A <64.50 Tier 3 D 192 30 $32,149.53 $31,418.64 $27,178.50 $52,345.92 $30,687.76 2026-05-09
1103 OTHER Amputation Non-lower Extremity M <52.50 Tier 1 B 108 27 $30,566.42 $30,566.42 $29,349.37 $38,025.07 $30,566.42 2026-05-08
1704 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=36.50 And M <41.50… 214 30 $32,926.87 $31,710.62 $27,007.00 $64,062.27 $30,494.37 2026-05-09
904 OTHER Other Orthopedic M <44.5 Tier 2 C 216 30 $33,837.96 $31,416.75 $22,786.40 $40,603.55 $30,312.36 2026-05-09
2004 OTHER Miscellaneous M <46.50 And A >=77.50 Tier 1 B 239 30 $29,811.83 $30,862.19 $3,262.84 $39,953.24 $29,811.83 2026-05-09
1404 OTHER Cardiac M <45.50 Tier 2 C 215 30 $32,049.05 $30,923.81 $25,592.40 $42,909.45 $29,798.56 2026-05-09
1204 OTHER Osteoarthritis M <49.50 And A <74.50 Tier 3 D 169 30 $31,476.47 $30,494.37 $26,441.56 $48,373.21 $29,512.27 2026-05-09
204 OTHER Traumatic Brain Injury M >=35.50 And M <49.50 Tier 2 C 214 30 $30,849.68 $30,690.60 $20,659.80 $39,052.67 $29,214.61 2026-05-09
1804 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=40.50 And M <45.50 T… 144 27 $29,462.98 $29,462.98 $26,075.53 $37,892.35 $29,160.69 2026-05-08
805 OTHER Replacement Of Lower-extremity Joint M <42.50 Tier 3 D 169 30 $31,358.92 $29,974.88 $26,133.13 $39,081.11 $28,590.85 2026-05-09
1203 OTHER Osteoarthritis M <49.50 And A >=74.50 Tier 3 D 169 30 $30,014.70 $29,079.05 $25,018.70 $39,481.15 $28,143.40 2026-05-09
68982085005 OTHER Octagam 123 52 $27,972.00 $27,972.00 $6,993.00 $137,212.00 $27,972.00 2026-05-09
1703 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=41.50 And M <50.50… 191 30 $26,943.27 $28,017.32 $2,829.03 $37,425.95 $26,943.27 2026-05-09
1803 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=45.50 And M <55.50 T… 144 27 $26,943.27 $26,943.27 $23,845.90 $34,650.28 $26,666.85 2026-05-08
1503 OTHER Pulmonary M >=45.50 And M <56.50 Tier 3 D 191 30 $26,579.25 $27,420.10 $23,494.35 $34,820.92 $26,579.25 2026-05-09
703 OTHER Fracture Of Lower Extremity M >=41.50 And M <52.50 Tier 3 D 194 30 $27,940.54 $27,203.97 $18,511.18 $36,119.64 $26,467.39 2026-05-09
603 OTHER Neurological M >=43.50 And M <52.50 Tier 1 B 241 30 $28,187.01 $27,250.42 $15,200.88 $37,649.67 $26,313.82 2026-05-09
303 OTHER Non-traumatic Brain Injury M >=42.50 And M <52.50 Tier 1 B 216 30 $28,783.48 $27,134.76 $20,966.91 $35,355.58 $25,983.92 2026-05-09
1003 OTHER Amputation Lower Extremity M >=47.50 And M <55.50 Tier 3 D 169 30 $28,183.22 $26,964.12 $22,604.74 $39,857.40 $25,745.03 2026-05-09
1303 OTHER Rheumatoid Other Arthritis M >=44.50 And M <51.50 And A >=64.50 Tier 1 B 144 27 $25,980.13 $25,980.13 $23,134.28 $32,151.43 $25,714.28 2026-05-08
402 OTHER Traumatic Spinal Cord Injury M >=47.50 And M <56.50 Tier 1 B 144 27 $25,840.78 $25,840.78 $22,669.77 $29,489.52 $25,578.53 2026-05-08
503 OTHER Non-traumatic Spinal Cord Injury M >=48.50 And M <53.50 Tier 3 D 192 30 $25,445.47 $26,189.63 $15,865.11 $34,621.85 $25,445.47 2026-05-09
903 OTHER Other Orthopedic M >=44.50 And M <51.50 Tier 2 C 215 30 $27,140.45 $26,219.02 $22,491.50 $34,095.27 $25,297.59 2026-05-09
1603 OTHER Pain Syndrome M >=43.50 And M <58.50 Tier 1 B 144 27 $25,399.03 $25,399.03 $21,878.25 $35,922.46 $25,132.21 2026-05-08
2003 OTHER Miscellaneous M >=46.50 And M <55.50 Tier 2 C 215 30 $26,691.11 $25,812.34 $22,154.20 $45,039.91 $24,933.57 2026-05-09
1102 OTHER Amputation Non-lower Extremity M >=52.50 And M <58.50 Tier 1 B 108 27 $24,510.77 $24,510.77 $23,535.61 $30,492.48 $24,510.77 2026-05-08
1403 OTHER Cardiac M >=45.50 And M <55.50 Tier 1 B 216 30 $24,319.28 $25,237.86 $8,701.15 $33,201.78 $24,319.28 2026-05-09
103 OTHER Stroke M >=50.50 And M <63.50 Tier 1 B 221 30 $26,033.81 $25,194.26 $2,427.68 $30,357.87 $24,059.54 2026-05-09
804 OTHER Replacement Of Lower-extremity Joint M >=42.50 And M <51.50 Tier 3 D 192 30 $24,480.91 $24,993.29 $20,146.60 $32,585.60 $23,839.61 2026-05-09
203 OTHER Traumatic Brain Injury M >=49.50 And M <61.50 Tier 3 D 169 30 $25,785.60 $24,744.93 $21,733.33 $31,487.85 $23,555.22 2026-05-09
1502 OTHER Pulmonary M >=56.50 And M <68.50 Tier 3 D 192 30 $24,867.21 $24,126.85 $21,365.50 $30,638.47 $23,386.48 2026-05-09
1902 OTHER Guillain-barr� M >=51.50 And M <66.50 Tier 1 B 144 27 $23,450.94 $23,450.94 $21,802.07 $31,558.00 $23,208.32 2026-05-08
502 OTHER Non-traumatic Spinal Cord Injury M >=53.50 And M <60.50 Tier 1 B 238 30 $23,496.44 $22,848.03 $15,410.20 $31,529.30 $23,026.51 2026-05-09
50633012011 OTHER Digifab 124 52 $22,958.40 $22,958.40 $29.66 $137,212.00 $22,958.40 2026-05-09
1702 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=50.50 And M <57.50… 192 30 $24,482.33 $23,577.97 $20,120.45 $31,495.43 $22,673.60 2026-05-09
1302 OTHER Rheumatoid Other Arthritis M >=51.50 And M <62.50 Tier 1 B 144 27 $22,836.65 $22,836.65 $20,334.23 $28,260.95 $22,602.98 2026-05-08
602 OTHER Neurological M >=52.50 And M <64.50 Tier 1 B 244 30 $23,923.03 $23,127.68 $9,386.68 $31,952.36 $22,332.33 2026-05-09
902 OTHER Other Orthopedic M >=51.50 And M <63.50 Tier 1 B 238 30 $22,728.58 $21,955.99 $18,834.40 $28,376.60 $22,230.75 2026-05-09
78081881 OTHER SandoSTATIN Lar Depot 123 52 $22,158.24 $22,158.24 $5,539.56 $137,212.00 $22,158.24 2026-05-09
1002 OTHER Amputation Lower Extremity M >=55.50 And M <64.50 None A 168 30 $24,053.85 $23,013.92 $19,291.88 $29,085.69 $21,974.00 2026-05-09
2002 OTHER Miscellaneous M >=55.50 And M <66.50 Tier 1 B 241 30 $22,288.73 $21,554.99 $18,416.20 $54,064.12 $21,842.95 2026-05-09
1202 OTHER Osteoarthritis M >=49.50 And M <61.50 Tier 3 D 169 30 $23,168.44 $22,446.08 $19,462.82 $30,475.41 $21,723.73 2026-05-09
2101 OTHER Burns M >=52.50 Tier 1 B 108 27 $21,680.13 $21,680.13 $18,145.48 $28,532.07 $21,680.13 2026-05-08
302 OTHER Non-traumatic Brain Injury M >=52.50 And M <65.50 Tier 2c 214 30 $21,594.81 $22,552.26 $15,476.24 $29,383.35 $21,594.81 2026-05-09
702 OTHER Fracture Of Lower Extremity M >=52.50 And M <61.50 Tier 3 D 192 30 $22,721.00 $22,121.88 $19,245.10 $29,371.97 $21,522.76 2026-05-09
803 OTHER Replacement Of Lower-extremity Joint M >=51.50 And M <57.50 Tier 3 D 192 30 $22,648.53 $22,308.64 $17,850.50 $29,085.69 $21,278.19 2026-05-09
2840001 OTHER Forteo 124 52 $20,591.47 $20,591.47 $92.08 $137,212.00 $20,591.47 2026-05-09
1802 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=55.50 And M <67.50 T… 193 30 $21,515.18 $20,971.04 $17,724.10 $27,483.93 $20,426.91 2026-05-09
1602 OTHER Pain Syndrome M >=58.50 And M <65.50 Tier 1 B 144 27 $20,112.18 $20,112.18 $17,324.23 $28,444.86 $19,900.90 2026-05-08
1402 OTHER Cardiac M >=55.50 And M <68.50 None A 194 30 $20,625.99 $20,625.99 $13,542.13 $27,134.76 $19,875.19 2026-05-09
401 OTHER Traumatic Spinal Cord Injury M >=56.50 None A 168 30 $19,738.68 $20,036.35 $12,687.59 $22,865.09 $19,738.68 2026-05-09
1101 OTHER Amputation Non-lower Extremity M >=58.50 Tier 1 B 108 27 $19,279.86 $19,279.86 $18,513.37 $23,983.70 $19,279.86 2026-05-08
802 OTHER Replacement Of Lower-extremity Joint M >=57.50 And M <63.50 Tier 3 D 170 30 $20,969.15 $20,042.98 $16,461.07 $26,131.81 $19,116.81 2026-05-09
50458060901 OTHER Invega Trinza 124 52 $19,046.87 $19,046.87 $57.98 $137,212.00 $19,046.87 2026-05-09
202 OTHER Traumatic Brain Injury M >=61.50 And M <73.50 Tier 3 D 191 30 $18,913.94 $19,869.50 $17,452.44 $25,284.32 $18,913.94 2026-05-09
1701 OTHER Major Multiple Trauma Without Brain Or Spinal Cord Injury M >=57.50 Tier 1 B 144 27 $18,977.46 $18,977.46 $16,226.14 $25,350.68 $18,780.41 2026-05-08
102 OTHER Stroke M >=63.50 And M <72.50 Tier 3 D 193 30 $18,665.58 $19,546.25 $9,798.79 $23,553.32 $18,665.58 2026-05-09
68982085004 OTHER Octagam 123 52 $18,648.00 $18,648.00 $4,662.00 $137,212.00 $18,648.00 2026-05-09
55513003201 OTHER Aranesp 124 52 $18,576.00 $18,576.00 $5.00 $137,212.00 $18,576.00 2026-05-09
1501 OTHER Pulmonary M >=68.50 Tier 3 D 169 30 $19,602.17 $19,019.17 $16,900.60 $24,152.44 $18,436.17 2026-05-09
1201 OTHER Osteoarthritis M >=61.50 Tier 1 B 144 27 $18,540.44 $18,540.44 $16,075.64 $25,172.46 $18,349.07 2026-05-08
78063998 OTHER Cosentyx 124 52 $17,781.50 $17,781.50 $5.00 $137,212.00 $17,781.50 2026-05-09
173089201 OTHER Mepolizumab Injection 123 52 $17,706.38 $17,706.38 $4,426.60 $137,212.00 $17,706.38 2026-05-09
501 OTHER Non-traumatic Spinal Cord Injury M >=60.50 Tier 3 D 192 30 $18,730.04 $18,212.44 $15,916.90 $24,076.60 $17,694.85 2026-05-09
601 OTHER Neurological M >=64.50 Tier 3 D 195 30 $17,607.64 $18,234.25 $15,562.80 $25,191.42 $17,607.64 2026-05-09
2001 OTHER Miscellaneous M >=66.50 Tier 1 B 238 30 $17,876.86 $17,288.17 $14,837.90 $23,581.10 $17,485.31 2026-05-09
701 OTHER Fracture Of Lower Extremity M >=61.50 Tier 3 D 168 30 $17,425.63 $17,910.04 $15,778.35 $23,778.94 $17,425.63 2026-05-09
44206043820 OTHER Privigen 10% 123 52 $17,379.84 $17,379.84 $4,344.96 $137,212.00 $17,379.84 2026-05-09
1601 OTHER Pain Syndrome M >=65.50 Tier 1 B 144 27 $17,551.71 $17,551.71 $15,118.76 $24,821.71 $17,367.32 2026-05-08
1001 OTHER Amputation Lower Extremity M >=64.50 Tier 3 D 168 30 $18,987.89 $18,166.94 $15,228.38 $26,882.66 $17,346.00 2026-05-09
901 OTHER Other Orthopedic M >=63.50 Tier 3 D 192 30 $17,008.52 $17,628.50 $10,437.74 $22,783.57 $17,008.52 2026-05-09
78081181 OTHER SandoSTATIN Lar Depot 123 52 $16,912.46 $16,912.46 $4,228.12 $137,212.00 $16,912.46 2026-05-09
801 OTHER Replacement Of Lower-extremity Joint M >=63.50 None A 170 30 $18,494.94 $17,678.74 $12,735.98 $23,049.00 $16,862.53 2026-05-09
301 OTHER Non-traumatic Brain Injury M >=65.50 Tier 3 D 168 30 $18,182.11 $17,442.69 $15,427.19 $44,702.41 $16,703.27 2026-05-09
50458056401 OTHER Invega Sustenna 234 Mg 124 52 $16,697.76 $16,697.76 $37.25 $137,212.00 $16,697.76 2026-05-09
74379902 OTHER Humira 124 52 $16,614.29 $16,614.29 $5.00 $137,212.00 $16,614.29 2026-05-09
1301 OTHER Rheumatoid Other Arthritis M >=62.50 Tier 1 B 144 27 $16,705.17 $16,705.17 $14,875.35 $20,675.28 $16,534.23 2026-05-08
944270006 OTHER Gammagard Liquid 124 52 $16,273.92 $16,273.92 $7.57 $137,212.00 $16,273.92 2026-05-09
55513073001 OTHER Denosumab 120 mg/1.7mL 124 52 $15,770.26 $15,770.26 $5.00 $137,212.00 $15,770.26 2026-05-09
1401 OTHER Cardiac M >=68.50 Tier 1 B 215 30 $15,735.61 $16,263.42 $12,778.37 $21,395.74 $15,671.88 2026-05-09
1801 OTHER Major Multiple Trauma With Brain Or Spinal Cord Injury M >=67.50 Tier 1 B 144 27 $15,630.17 $15,630.17 $13,833.00 $20,102.70 $15,469.81 2026-05-08
51759063010 OTHER risperiDONE ER Inj 125 Mg/0.35 123 52 $15,375.36 $15,375.36 $3,843.84 $137,212.00 $15,375.36 2026-05-09
101 OTHER Stroke M >=72.50 Tier 1 B 144 27 $15,404.55 $15,404.55 $13,738.24 $18,561.30 $15,243.56 2026-05-08
201 OTHER Traumatic Brain Injury M >=73.50 Tier 1 B 144 27 $15,194.10 $15,194.10 $13,344.34 $19,334.84 $15,034.86 2026-05-08
24201040002 OTHER Calcitonin,salmon Inj 400 Unit 124 52 $15,028.80 $15,028.80 $5.00 $137,212.00 $15,028.80 2026-05-09
1901 OTHER Guillain-barr� M >=66.50 Tier 1 B 144 27 $14,654.71 $14,654.71 $13,624.90 $19,721.62 $14,503.08 2026-05-08
42367054032 OTHER Ryanodex 123 52 $14,040.84 $14,040.84 $3,510.21 $137,212.00 $14,040.84 2026-05-09
59148001971 OTHER Abilify Maintena 124 52 $13,535.23 $13,535.23 $5.00 $16,665.75 $13,535.23 2026-05-09
59148007280 OTHER Abilify Maintena 400 Mg 124 52 $13,535.23 $13,535.23 $12.68 $16,665.75 $13,535.23 2026-05-09
67457067502 OTHER Miacalcin 123 52 $12,974.72 $12,974.72 $3,243.68 $16,665.75 $12,974.72 2026-05-09
70539000102 OTHER Tymlos 123 52 $12,801.60 $12,801.60 $3,200.40 $16,665.75 $12,801.60 2026-05-09
55513022101 OTHER Nplate 250 Mcg 123 52 $12,585.22 $12,585.22 $3,146.31 $16,665.75 $12,585.22 2026-05-09
50474070062 OTHER Cimzia 124 52 $12,239.24 $12,239.24 $5.00 $16,665.75 $12,239.24 2026-05-09
55513011101 OTHER Aranesp 124 52 $11,145.60 $11,145.60 $22.44 $16,665.75 $11,145.60 2026-05-09
50458056301 OTHER Invega Sustenna 156 Mg 124 52 $11,132.11 $11,132.11 $5.00 $16,665.75 $11,132.11 2026-05-09
50458056101 OTHER Invega Sustenna 124 52 $11,131.49 $11,131.49 $115.78 $16,665.75 $11,131.49 2026-05-09
50458056001 OTHER Invega Sustenna 124 52 $11,131.01 $11,131.01 $125.22 $16,665.75 $11,131.01 2026-05-09
944265804 OTHER Gammagard S-d 10 Gram 124 52 $10,764.48 $10,764.48 $7.57 $16,665.75 $10,764.48 2026-05-09
61953000405 OTHER Flebogamma Dif 124 52 $10,164.48 $10,164.48 $5.00 $16,665.75 $10,164.48 2026-05-09
59148004580 OTHER Abilify Maintena 124 52 $10,151.42 $10,151.42 $5.00 $16,665.75 $10,151.42 2026-05-09
67457083306 OTHER Pegfilgrastim-jmdb 123 52 $10,020.00 $10,020.00 $2,505.00 $16,665.75 $10,020.00 2026-05-09
74364203 OTHER Lupron Depot 123 52 $9,811.68 $9,811.68 $2,452.92 $16,665.75 $9,811.68 2026-05-09
68982085003 OTHER Octagam 10% 123 52 $9,324.00 $9,324.00 $2,331.00 $16,665.75 $9,324.00 2026-05-09
58406003204 OTHER EnbreL Sureclick 124 52 $9,148.70 $9,148.70 $356.32 $16,665.75 $9,148.70 2026-05-09
24591401 OTHER Dupixent Syringe 124 52 $9,127.68 $9,127.68 $74.24 $16,665.75 $9,127.68 2026-05-09
44206043710 OTHER Privigen 10% 123 52 $8,689.92 $8,689.92 $2,172.48 $16,665.75 $8,689.92 2026-05-09
55513071001 OTHER Prolia 123 52 $8,573.38 $8,573.38 $2,143.35 $16,665.75 $8,573.38 2026-05-09
57970010001 OTHER Dalbavancin Hcl 124 52 $8,539.82 $8,539.82 $25.76 $16,665.75 $8,539.82 2026-05-09
50458056201 OTHER Invega Sustenna 117 Mg 124 52 $8,348.78 $8,348.78 $38.59 $16,665.75 $8,348.78 2026-05-09
31600 OTHER Tracheostomy 123 52 $8,209.00 $8,209.00 $2,052.25 $16,665.75 $8,209.00 2026-05-09
944270005 OTHER Gammagard Liquid 10% 124 52 $8,136.96 $8,136.96 $7.57 $16,665.75 $8,136.96 2026-05-09
64842072709 OTHER Decitabine/Cedazuridine 35/100 124 52 $7,931.30 $7,931.30 $39.95 $16,665.75 $7,931.30 2026-05-09
65757030001 OTHER VivitroL 123 52 $7,877.33 $7,877.33 $1,969.33 $16,665.75 $7,877.33 2026-05-09
55513002801 OTHER Aranesp 124 52 $7,430.40 $7,430.40 $17.40 $16,665.75 $7,430.40 2026-05-09
55513000601 OTHER Aranesp 124 52 $7,430.40 $7,430.40 $359.04 $16,665.75 $7,430.40 2026-05-09
59676082001 OTHER Monovisc 123 52 $7,200.00 $7,200.00 $1,800.00 $16,665.75 $7,200.00 2026-05-09
9029703 OTHER Gelfilm 25x50mm 124 52 $7,140.96 $7,140.96 $5.04 $16,665.75 $7,140.96 2026-05-09
517065001 OTHER Injectafer 124 52 $6,862.56 $6,862.56 $16.22 $16,665.75 $6,862.56 2026-05-09
3218811 OTHER Orencia 123 52 $6,834.32 $6,834.32 $1,708.58 $16,665.75 $6,834.32 2026-05-09
13533080071 OTHER Gamunex-c 124 52 $6,804.00 $6,804.00 $7.57 $16,665.75 $6,804.00 2026-05-09
65162091322 OTHER Voriconazole Oral Susp (bulk) 123 52 $6,753.68 $6,753.68 $1,688.42 $16,665.75 $6,753.68 2026-05-09
4026129 OTHER Cellcept (160ml Bottle) 124 52 $6,628.18 $6,628.18 $58.00 $16,665.75 $6,628.18 2026-05-09
50484081015 OTHER Regranex 123 52 $6,526.56 $6,526.56 $1,631.64 $16,665.75 $6,526.56 2026-05-09
62935022305 OTHER Leuprolide Acetate 124 52 $6,504.34 $6,504.34 $1.50 $16,665.75 $6,504.34 2026-05-09
31722062921 OTHER Atovaquone (Bulk Bottle) 124 52 $6,307.16 $6,307.16 $5.56 $16,665.75 $6,307.16 2026-05-09
55513022301 OTHER Romiplostim 123 52 $6,292.70 $6,292.70 $1,573.18 $16,665.75 $6,292.70 2026-05-09
78043561 OTHER Reclast 5 Mg 123 52 $6,283.44 $6,283.44 $1,570.86 $16,665.75 $6,283.44 2026-05-09
23392102 OTHER Botox 124 52 $6,201.60 $6,201.60 $7.76 $16,665.75 $6,201.60 2026-05-09
44146 OTHER Colec Part W Colopros W/colost 124 52 $5,934.18 $5,934.18 $6.50 $16,665.75 $5,934.18 2026-05-09
50458030811 OTHER RisperDAL Consta 50 Mg 123 52 $5,900.21 $5,900.21 $1,475.05 $16,665.75 $5,900.21 2026-05-09
59338077501 OTHER Feraheme 510 Mg 124 52 $5,729.38 $5,729.38 $5.00 $16,665.75 $5,729.38 2026-05-09
57894003001 OTHER Remicade 100 Mg 123 52 $5,605.54 $5,605.54 $1,401.39 $16,665.75 $5,605.54 2026-05-09
44208 OTHER Laparosc, Surg Colectomy, Part 124 52 $5,584.11 $5,584.11 $231.45 $16,665.75 $5,584.11 2026-05-09
55513002704 OTHER Aranesp 124 52 $5,572.80 $5,572.80 $28.80 $16,665.75 $5,572.80 2026-05-09
61958180101 OTHER Harvoni 124 52 $5,400.00 $5,400.00 $25.80 $16,665.75 $5,400.00 2026-05-09
944265603 OTHER Gammagard S-d 5 Gram 124 52 $5,382.24 $5,382.24 $5.00 $16,665.75 $5,382.24 2026-05-09
82154044901 OTHER Peginterferon Alfa-2a 123 52 $5,344.42 $5,344.42 $1,336.11 $16,665.75 $5,344.42 2026-05-09
59676034001 OTHER Procrit 123 52 $5,131.20 $5,131.20 $1,282.80 $16,665.75 $5,131.20 2026-05-09
43246 OTHER Peg 123 52 $4,875.00 $4,875.00 $1,218.75 $16,665.75 $4,875.00 2026-05-09
61958150101 OTHER Sovaldi 123 52 $4,800.00 $4,800.00 $1,200.00 $16,665.75 $4,800.00 2026-05-09
68982085002 OTHER Octagam 123 52 $4,662.00 $4,662.00 $1,165.50 $16,665.75 $4,662.00 2026-05-09
50742031025 OTHER Mafenide Acetate For Topical S 123 52 $4,661.36 $4,661.36 $1,165.34 $16,665.75 $4,661.36 2026-05-09
169477212 OTHER Semaglutide (2 Mg/dose) 123 52 $4,648.90 $4,648.90 $1,162.23 $16,665.75 $4,648.90 2026-05-09
169418113 OTHER Semaglutide 123 52 $4,648.90 $4,648.90 $1,162.23 $16,665.75 $4,648.90 2026-05-09
169413013 OTHER Semaglutide Injection 123 52 $4,648.90 $4,648.90 $1,162.23 $16,665.75 $4,648.90 2026-05-09
65757040203 OTHER Aristada 124 52 $4,637.50 $4,637.50 $5.47 $16,665.75 $4,637.50 2026-05-09
65757040103 OTHER Aristada 124 52 $4,633.98 $4,633.98 $5.14 $16,665.75 $4,633.98 2026-05-09
65757040303 OTHER Aristada 124 52 $4,633.96 $4,633.96 $15.07 $16,665.75 $4,633.96 2026-05-09
65757040403 OTHER Aristada 124 52 $4,586.84 $4,586.84 $5.00 $16,665.75 $4,586.84 2026-05-09
66794015702 OTHER Gablofen 124 52 $4,536.67 $4,536.67 $9.12 $16,665.75 $4,536.67 2026-05-09
65054301 OTHER Triesence 40 Mg 123 52 $4,531.20 $4,531.20 $1,132.80 $16,665.75 $4,531.20 2026-05-09
50242005121 OTHER Rituxan 123 52 $4,509.70 $4,509.70 $1,127.43 $16,665.75 $4,509.70 2026-05-09
16110081230 OTHER Fluoroplex 1 % 124 52 $4,454.16 $4,454.16 $133.11 $16,665.75 $4,454.16 2026-05-09
50458030711 OTHER RisperDAL Consta 37.5 Mg 123 52 $4,425.02 $4,425.02 $1,106.26 $16,665.75 $4,425.02 2026-05-09
44206043605 OTHER Privigen 123 52 $4,344.96 $4,344.96 $1,086.24 $16,665.75 $4,344.96 2026-05-09
36569 OTHER Picc Line Insertion 123 52 $4,308.48 $4,308.48 $1,077.12 $16,665.75 $4,308.48 2026-05-09
2850101 OTHER HumuLIN R U-500 240 52 $7,137.60 $3,572.36 50% off $1.78 $16,665.75 $4,282.56 2026-05-09
59572042521 OTHER Revlimid 123 52 $4,279.44 $4,279.44 $1,069.86 $16,665.75 $4,279.44 2026-05-09
59572041028 OTHER Revlimid 123 52 $4,279.44 $4,279.44 $1,069.86 $16,665.75 $4,279.44 2026-05-09
59572041500 OTHER Revlimid 123 52 $4,279.44 $4,279.44 $1,069.86 $16,665.75 $4,279.44 2026-05-09
61958220101 OTHER Epclusa 124 52 $4,272.00 $4,272.00 $84.25 $16,665.75 $4,272.00 2026-05-09
44087002203 OTHER Rebif 22 mcg/0.5mL 123 52 $4,226.26 $4,226.26 $1,056.57 $16,665.75 $4,226.26 2026-05-09
44087004403 OTHER Rebif 123 52 $4,226.26 $4,226.26 $1,056.57 $16,665.75 $4,226.26 2026-05-09
42388002326 OTHER Cabometyx 124 52 $4,093.57 $4,093.57 $37.92 $16,665.75 $4,093.57 2026-05-09
42388002426 OTHER Cabometyx 124 52 $4,093.57 $4,093.57 $5.00 $16,665.75 $4,093.57 2026-05-09
42388002526 OTHER Cabometyx 124 52 $4,093.57 $4,093.57 $19.20 $16,665.75 $4,093.57 2026-05-09
310652401 OTHER Byetta 124 52 $4,079.76 $4,079.76 $190.56 $16,665.75 $4,079.76 2026-05-09
310651201 OTHER Byetta 124 52 $4,079.76 $4,079.76 $230.40 $16,665.75 $4,079.76 2026-05-09
944270004 OTHER Gammagard Liquid 10% 124 52 $4,068.48 $4,068.48 $7.57 $16,665.75 $4,068.48 2026-05-09
378972055 OTHER Denavir 1 % 124 52 $3,897.55 $3,897.55 $5.00 $16,665.75 $3,897.55 2026-05-09
62856070430 OTHER Lenvima 124 52 $3,880.80 $3,880.80 $35.66 $16,665.75 $3,880.80 2026-05-09
69098038 OTHER Sutent 123 52 $3,853.62 $3,853.62 $963.41 $16,665.75 $3,853.62 2026-05-09
73562011201 OTHER Lipase/Protea/Amyl 20-63-84k U 124 52 $3,846.24 $3,846.24 $6.37 $16,665.75 $3,846.24 2026-05-09
55513002504 OTHER Darbepoetin Alfa 100 M 100 Mcg 124 52 $3,715.20 $3,715.20 $928.80 $16,665.75 $3,715.20 2026-05-09
55513000504 OTHER Aranesp 124 52 $3,715.20 $3,715.20 $928.80 $16,665.75 $3,715.20 2026-05-09
55724021121 OTHER Eucrisa 124 52 $3,661.87 $3,661.87 $5.00 $16,665.75 $3,661.87 2026-05-09
69018821 OTHER Ibrance 124 52 $3,653.12 $3,653.12 $34.80 $16,665.75 $3,653.12 2026-05-09
55513084301 OTHER Erenumab-aooe 124 52 $3,612.58 $3,612.58 $9.21 $16,665.75 $3,612.58 2026-05-09
60793090910 OTHER Thrombi-gel 100 Cm2 123 52 $3,556.46 $3,556.46 $889.12 $16,665.75 $3,556.46 2026-05-09
51759020410 OTHER Ajovy 225 mg/1.5mL Syringe 124 52 $3,519.16 $3,519.16 $9.36 $16,665.75 $3,519.16 2026-05-09
51759020210 OTHER Ajovy Autoinjector 124 52 $3,519.16 $3,519.16 $5.00 $16,665.75 $3,519.16 2026-05-09
480372056 OTHER Pyrimethamine 123 52 $3,420.00 $3,420.00 $855.00 $16,665.75 $3,420.00 2026-05-09
2143611 OTHER Galcanezumab-gnlm Pen 124 52 $3,390.58 $3,390.58 $7.57 $16,665.75 $3,390.58 2026-05-09
50419052435 OTHER Betaseron 124 52 $3,343.82 $3,343.82 $19.56 $16,665.75 $3,343.82 2026-05-09
49471000105 OTHER Pre-pen .25 Ml 123 52 $3,244.80 $3,244.80 $811.20 $16,665.75 $3,244.80 2026-05-09
5001 OTHER Short-stay Cases, Length Of Stay Is 3 Days Or Fewer None A 36 27 $3,242.07 $3,242.07 $3,177.22 $3,242.07 $3,242.07 2026-05-08
78056751 OTHER Afinitor 10 Mg 124 52 $3,200.31 $3,200.31 $5.00 $16,665.75 $3,200.31 2026-05-09
173088710 OTHER Trelegy Ellipta 100-62.5 123 52 $3,156.86 $3,156.86 $789.22 $16,665.75 $3,156.86 2026-05-09
23923201 OTHER Botox Cosmetic 124 52 $3,148.80 $3,148.80 $787.20 $16,665.75 $3,148.80 2026-05-09
78068715 OTHER Promacta 123 52 $3,147.39 $3,147.39 $786.85 $16,665.75 $3,147.39 2026-05-09
13533063402 OTHER Hypertet S-d 250 Unit 124 52 $3,116.02 $3,116.02 $547.78 $16,665.75 $3,116.02 2026-05-09
23114501 OTHER Botox 100 Unit 124 52 $3,100.80 $3,100.80 $33.44 $16,665.75 $3,100.80 2026-05-09
310461612 OTHER Budesonide/Glycopyr/Formoterol 124 52 $3,096.67 $3,096.67 $347.23 $16,665.75 $3,096.67 2026-05-09
58914030180 OTHER Rectiv 123 52 $3,075.55 $3,075.55 $768.89 $16,665.75 $3,075.55 2026-05-09
299598035 OTHER Mirvaso 123 52 $3,060.10 $3,060.10 $765.03 $16,665.75 $3,060.10 2026-05-09
70510217102 OTHER Radicava 123 52 $3,053.81 $3,053.81 $763.45 $16,665.75 $3,053.81 2026-05-09
60793070210 OTHER Bicillin L-a 2400000 Unit 124 52 $2,999.86 $2,999.86 $680.00 $16,665.75 $2,999.86 2026-05-09
50458030611 OTHER RisperDAL Consta 25 Mg 123 52 $2,949.89 $2,949.89 $737.47 $16,665.75 $2,949.89 2026-05-09
43598000451 OTHER Augmentin 124 52 $2,935.68 $2,935.68 $14.64 $16,665.75 $2,935.68 2026-05-09
60793090701 OTHER Thrombi-gel 10 Cm2 123 52 $2,931.41 $2,931.41 $732.85 $16,665.75 $2,931.41 2026-05-09
72511077001 OTHER Evolocumab 420 mg/3.5mL 124 52 $2,919.74 $2,919.74 $505.28 $16,665.75 $2,919.74 2026-05-09
3085222 OTHER SpryceL 123 52 $2,919.41 $2,919.41 $729.85 $16,665.75 $2,919.41 2026-05-09
61958290102 OTHER Veklury 123 52 $2,877.50 $2,877.50 $719.38 $16,665.75 $2,877.50 2026-05-09
51672137108 OTHER clobetasoL Propionate 124 52 $2,842.36 $2,842.36 $422.76 $16,665.75 $2,842.36 2026-05-09
43235 OTHER Upper Gastro/Endoscopy 123 52 $2,834.00 $2,834.00 $708.50 $16,665.75 $2,834.00 2026-05-09
57962042028 OTHER Imbruvica 124 52 $2,809.99 $2,809.99 $85.00 $16,665.75 $2,809.99 2026-05-09
31622 OTHER Rt Bronchoscopy 123 52 $2,803.24 $2,803.24 $700.81 $16,665.75 $2,803.24 2026-05-09
59353040509 OTHER Methoxy Peg-epoetin 200 Mcg/0. 123 52 $2,769.36 $2,769.36 $692.34 $16,665.75 $2,769.36 2026-05-09
69238101302 OTHER Testosterone 123 52 $2,682.88 $2,682.88 $670.72 $16,665.75 $2,682.88 2026-05-09
9379401 OTHER Corvert 124 52 $2,634.48 $2,634.48 $11.80 $16,665.75 $2,634.48 2026-05-09
A0426 OTHER Amb Non Emr Als Rnd Trip 124 52 $2,600.00 $2,600.00 $92.32 $16,665.75 $2,600.00 2026-05-09
59148002150 OTHER Samsca 30 Mg 123 52 $2,590.29 $2,590.29 $647.57 $16,665.75 $2,590.29 2026-05-09
55513020901 OTHER Neupogen 123 52 $2,550.86 $2,550.86 $637.72 $16,665.75 $2,550.86 2026-05-09
85433101 OTHER Noxafil 123 52 $2,546.16 $2,546.16 $636.54 $16,665.75 $2,546.16 2026-05-09
61953000403 OTHER Flebogamma Dif 124 52 $2,541.12 $2,541.12 $635.28 $16,665.75 $2,541.12 2026-05-09
63323064810 OTHER Levothyroxine Sodium 124 52 $2,533.97 $2,533.97 $170.28 $16,665.75 $2,533.97 2026-05-09
597016061 OTHER Spiriva Respimat 123 52 $2,531.47 $2,531.47 $632.87 $16,665.75 $2,531.47 2026-05-09
5200010 OTHER Pneumoc 20-val Conj-dip Crm/Pf 123 52 $2,503.78 $2,503.78 $625.95 $16,665.75 $2,503.78 2026-05-09
59148002050 OTHER Samsca 15 Mg 123 52 $2,496.95 $2,496.95 $624.24 $16,665.75 $2,496.95 2026-05-09
78206018401 OTHER Adalimumab-bwwd 124 52 $2,491.20 $2,491.20 $15.16 $16,665.75 $2,491.20 2026-05-09
50090073200 OTHER Advair Diskus 124 52 $2,486.88 $2,486.88 $1.50 $16,665.75 $2,486.88 2026-05-09
43247 OTHER Egd Flx Transoral W/for Bdy Rm 124 52 $2,476.53 $2,476.53 $550.00 $16,665.75 $2,476.53 2026-05-09
24208050405 OTHER Vyzulta 123 52 $2,451.17 $2,451.17 $612.79 $16,665.75 $2,451.17 2026-05-09
71571033383 OTHER Loteprednol Etabonate 0.25% Op 123 52 $2,438.50 $2,438.50 $609.63 $16,665.75 $2,438.50 2026-05-09
49084 OTHER Paracentesis 123 52 $2,428.80 $2,428.80 $607.20 $16,665.75 $2,428.80 2026-05-09
10631009160 OTHER Eurax 124 52 $2,428.42 $2,428.42 $5.00 $16,665.75 $2,428.42 2026-05-09
51991082328 OTHER Everolimus 124 52 $2,422.24 $2,422.24 $5.00 $16,665.75 $2,422.24 2026-05-09
23320505 OTHER Bimatoprost 0.01% 5ml 124 52 $2,412.34 $2,412.34 $41.95 $16,665.75 $2,412.34 2026-05-09
55513054610 OTHER Neupogen 480 Mcg 123 52 $2,406.38 $2,406.38 $601.60 $16,665.75 $2,406.38 2026-05-09
378932232 OTHER Wixela Inhub 500/50 123 52 $2,362.52 $2,362.52 $590.63 $16,665.75 $2,362.52 2026-05-09
597002402 OTHER Combivent Respimat 124 52 $2,348.83 $2,348.83 $46.90 $16,665.75 $2,348.83 2026-05-09
55566830301 OTHER Firmagon 124 52 $2,344.56 $2,344.56 $116.54 $16,665.75 $2,344.56 2026-05-09
68546032512 OTHER Copaxone 40 Mg 124 52 $2,332.80 $2,332.80 $71.09 $16,665.75 $2,332.80 2026-05-09
173086910 OTHER Anoro Ellipta 124 52 $2,279.23 $2,279.23 $5.84 $16,665.75 $2,279.23 2026-05-09
597008717 OTHER Atrovent Hfa 124 52 $2,265.89 $2,265.89 $5.00 $16,665.75 $2,265.89 2026-05-09
24208053535 OTHER Zirgan 123 52 $2,256.34 $2,256.34 $564.09 $16,665.75 $2,256.34 2026-05-09
55513002304 OTHER Aranesp 60 Mcg 124 52 $2,229.12 $2,229.12 $32.88 $16,665.75 $2,229.12 2026-05-09
55513000404 OTHER Aranesp 124 52 $2,229.12 $2,229.12 $390.00 $16,665.75 $2,229.12 2026-05-09
713063337 OTHER metroNIDAZOLE 0.75 % 123 52 $2,199.48 $2,199.48 $549.87 $16,665.75 $2,199.48 2026-05-09
49281019020 OTHER Imogam Rabies-ht 150 Unit 124 52 $2,172.31 $2,172.31 $543.08 $16,665.75 $2,172.31 2026-05-09
46087221 OTHER Premarin .625 Mg 123 52 $2,160.24 $2,160.24 $540.06 $16,665.75 $2,160.24 2026-05-09
14789001101 OTHER Isoproterenol Hcl Inj 124 52 $2,160.00 $2,160.00 $241.68 $16,665.75 $2,160.00 2026-05-09
99999998396 OTHER Tacrolimus 0.5mg/mL - 240mL Bo 123 52 $2,140.80 $2,140.80 $535.20 $16,665.75 $2,140.80 2026-05-09
69130904 OTHER Retacrit 123 52 $2,117.76 $2,117.76 $529.44 $16,665.75 $2,117.76 2026-05-09
173071720 OTHER Advair Hfa 230-21mcg 124 52 $2,110.66 $2,110.66 $5.00 $16,665.75 $2,110.66 2026-05-09
61314032601 OTHER Zarxio 123 52 $2,107.10 $2,107.10 $526.78 $16,665.75 $2,107.10 2026-05-09
37683015 OTHER Cortifoam 10 % 124 52 $2,105.28 $2,105.28 $526.32 $16,665.75 $2,105.28 2026-05-09
78068615 OTHER Promacta 123 52 $2,098.26 $2,098.26 $524.57 $16,665.75 $2,098.26 2026-05-09
49281025051 OTHER Imovax Rabies Vaccine 2.5 Unit 124 52 $2,082.29 $2,082.29 $222.36 $16,665.75 $2,082.29 2026-05-09
59353040409 OTHER Methoxy Peg-epoetin 150 Mcg/0. 123 52 $2,077.01 $2,077.01 $519.25 $16,665.75 $2,077.01 2026-05-09
61958080101 OTHER Letairis 124 52 $2,076.89 $2,076.89 $22.61 $16,665.75 $2,076.89 2026-05-09
46287002004 OTHER Carospir 124 52 $2,074.56 $2,074.56 $222.05 $16,665.75 $2,074.56 2026-05-09
42023021910 OTHER Vasopressin 40 units/100mL 123 52 $2,038.80 $2,038.80 $509.70 $16,665.75 $2,038.80 2026-05-09
173052100 OTHER Salmeterol Xinafoate 123 52 $2,032.61 $2,032.61 $508.15 $16,665.75 $2,032.61 2026-05-09
90945 OTHER Peritoneal Dialysis 124 52 $2,013.75 $2,013.75 $72.38 $16,665.75 $2,013.75 2026-05-09
51224001210 OTHER Phentolamine Mesylate 5 Mg 123 52 $2,006.40 $2,006.40 $501.60 $16,665.75 $2,006.40 2026-05-09
60793090804 OTHER Thrombi-gel 40 Cm2 123 52 $1,957.87 $1,957.87 $489.47 $16,665.75 $1,957.87 2026-05-09
173091610 OTHER Fluticasone/Vilanterol 50-25 M 124 52 $1,954.66 $1,954.66 $57.12 $16,665.75 $1,954.66 2026-05-09
173088210 OTHER Breo Ellipta 124 52 $1,954.66 $1,954.66 $488.67 $16,665.75 $1,954.66 2026-05-09
93318 OTHER Tee 123 52 $1,931.00 $1,931.00 $482.75 $16,665.75 $1,931.00 2026-05-09
63459091211 OTHER Granix 480 Mcg 124 52 $1,919.44 $1,919.44 $346.22 $16,665.75 $1,919.44 2026-05-09
456270010 OTHER Avycaz 2.5 Gram 124 52 $1,898.81 $1,898.81 $12.23 $16,665.75 $1,898.81 2026-05-09
23932110 OTHER Alphagan P - 10mL 124 52 $1,865.76 $1,865.76 $1.50 $16,665.75 $1,865.76 2026-05-09
68982085001 OTHER Octagam 123 52 $1,864.80 $1,864.80 $466.20 $16,665.75 $1,864.80 2026-05-09
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