Price Transparencybeta 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

ADVENTIST HEALTHCARE SHADY GROVE MEDICAL CENTER

Rockville, MD · CCN 210057 · Rates published

4,760 distinct procedures filed
2 distinct payers
16,506 rate rows
2025-12-31 last MRF observed
Data quality

16,501 of 16,506 rate rows are consumer-grade (100.0%)

5 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
placeholder amount (≤ $0.02) — excluded from medians 3
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.adventisthealthcare.com/app/files/public/5234573e-a91f-456f-919e-dd37620e586c/SGMC-Billing-StandardCharges.csv
Found on page https://www.adventisthealthcare.com/patients-visitors/billing-financial/price-transparency/
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-07-31
Content fingerprint 5c6f64f4f91cd6c6… · 6,154,358 bytes · first seen 2026-05-13

Top 50 most expensive offerings

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

Code Description Payers Min $ Max $ Avg median vs national
A9543
HCPCS 		Y-90 Zevalin Tx / 40mCi 1 $49,066.21 $49,066.21 $49,066.21 nat. median
$63,643
0.8× median
55292-0702-55
NDC 		Hemin 350 Mg Inj Soln 1 $38,948.62 $38,948.62 $38,948.62 nat. median
$35,712
1.1× median
64764-0300-20
NDC 		Vedolizumab 300 Mg Inj Soln 1 $32,572.49 $32,572.49 $32,572.49 nat. median
$17,564
1.9× median
69097-0870-67
NDC 		Lanreotide 120 Mg/0.5 Ml Inj Soln 1 $30,946.45 $30,946.45 $30,946.45 nat. median
$26,189
1.2× median
64406-0008-01
NDC 		Natalizumab 300 Mg/15 Ml Inj Soln 1 $30,899.69 $30,899.69 $30,899.69 nat. median
$18,288
1.7× median
50242-0085-27
NDC 		Alteplase 100 Mg Inj Soln 1 $30,625.25 $30,625.25 $30,625.25 nat. median
$30,625
1.0× median
00074-3683-03
NDC 		Leuprolide Depot 30 Mg (4 Month) Inj Susp 1 $29,876.50 $29,876.50 $29,876.50 nat. median
$19,579
1.5× median
50242-0120-47
NDC 		Tenecteplase 50 Mg Inj Soln 1 $28,874.46 $28,874.46 $28,874.46 nat. median
$15,569
1.9× median
50242-0176-01
NDC 		Tenecteplase 50 Mg Inj Soln 1 $28,874.46 $28,874.46 $28,874.46 nat. median
$28,874
1.0× median
44206-0439-40
NDC 		Immune Globulin (ivig) 10%, 40 G/400 Ml (Privigen) Inj Soln 1 $26,208.58 $26,208.58 $26,208.58 nat. median
$12,001
outlier · 2.2×
00169-7205-01
NDC 		Coagulation Factor VIIa 5,000 Mcg Inj 1 $25,955.00 $25,955.00 $25,955.00 nat. median
$5
outlier · 5534.1×
00078-0825-81
NDC 		Octreotide Lar Depot 30 Mg IM Susp 1 $24,055.70 $24,055.70 $24,055.70 nat. median
$19,567
1.2× median
50242-0120-01
NDC 		Tenecteplase 50 Mg Inj Soln 1 $23,407.04 $23,407.04 $23,407.04 nat. median
$23,407
1.0× median
51759-0960-10
NDC 		risperiDONE (Uzedy) 250 Mg/0.7 Ml SubQ Inj Susp 1 $22,294.27 $22,294.27 $22,294.27 nat. median
$22,294
1.0× median
78816
CPT 		PET Image-whole Body 1 $21,258.39 $21,258.39 $21,258.39 nat. median
$2,751
outlier · 7.7×
59148-0114-80
NDC 		ARIPiprazole (Abilify Asimtufii) 960 Mg/3.2 Ml Inj Susp 1 $20,214.86 $20,214.86 $20,214.86 nat. median
$20,215
1.0× median
00006-3026-02
NDC 		Pembrolizumab 100 Mg/4 Ml Inj Soln 1 $20,121.64 $20,121.64 $20,121.64 nat. median
$11,376
1.8× median
78815
CPT 		PET Image-w/ct-skull To Mid-thigh 1 $18,681.61 $18,681.61 $18,681.61 nat. median
$2,791
outlier · 6.7×
51759-0850-10
NDC 		risperiDONE (Uzedy) 200 Mg/0.56 Ml SubQ Inj Susp 1 $17,835.35 $17,835.35 $17,835.35 nat. median
$17,835
1.0× median
73607-0011-11
NDC 		Artesunate 110 Mg Inj Soln 1 $17,330.40 $17,330.40 $17,330.40 nat. median
$60
outlier · 289.2×
50633-0120-11
NDC 		Digoxin Immune Fab 40 Mg Inj Soln 1 $17,309.52 $17,309.52 $17,309.52 nat. median
$9,660
1.8× median
50474-0700-62
NDC 		Certolizumab 200 mg/mL Inj Soln 1 $16,758.14 $16,758.14 $16,758.14 nat. median
$16,758
1.0× median
00078-0818-81
NDC 		Octreotide Lar Depot 20 Mg IM Susp 1 $16,064.72 $16,064.72 $16,064.72 nat. median
$14,259
1.1× median
78608
CPT 		PET Brain Imaging Metabolic Evaluation 1 $15,460.65 $15,460.65 $15,460.65 nat. median
$2,413
outlier · 6.4×
78814
CPT 		PET Image-w/ct-limited Area 1 $15,460.65 $15,460.65 $15,460.65 nat. median
$2,317
outlier · 6.7×
78609
CPT 		PET Brain Imaging Perfusion Evaluation 1 $15,460.65 $15,460.65 $15,460.65 nat. median
$1,650
outlier · 9.4×
78812
CPT 		PET Image-skull To Mid-thigh 1 $15,460.65 $15,460.65 $15,460.65 nat. median
$1,853
outlier · 8.3×
50242-0044-13
NDC 		Alteplase 50 Mg Inj Soln 1 $15,312.64 $15,312.64 $15,312.64 nat. median
$5,549
outlier · 2.8×
59148-0102-80
NDC 		ARIPiprazole (Abilify Asimtufii) 720 Mg/2.4 Ml Inj Susp 1 $15,161.14 $15,161.14 $15,161.14 nat. median
$15,161
1.0× median
63459-0104-50
NDC 		Rituximab-abbs 500 Mg/50 Ml Inj Soln 1 $14,712.57 $14,712.57 $14,712.57 nat. median
$12,303
1.2× median
00002-7623-01
NDC 		PEMEtrexed 500 Mg Inj Soln 1 $14,069.64 $14,069.64 $14,069.64 nat. median
$8,265
1.7× median
67457-0187-50
NDC 		Allopurinol 500 Mg Inj Soln 1 $13,874.96 $13,874.96 $13,874.96 nat. median
$7
outlier · 1980.7×
00143-9533-01
NDC 		Allopurinol 500 Mg Inj Soln 1 $13,572.00 $13,572.00 $13,572.00 nat. median
$20,962
0.6× median
65757-0404-03
NDC 		ARIPiprazole (Aristada ER Depot) 1,064 Mg/3.9 Ml Inj Susp 1 $13,358.36 $13,358.36 $13,358.36 nat. median
$13,358
1.0× median
44206-0438-20
NDC 		Immune Globulin (ivig) 10%, 20 G/200 Ml (Privigen) Inj Soln 1 $13,104.29 $13,104.29 $13,104.29 nat. median
$4,897
outlier · 2.7×
0279
RC 		1 $374.11 $21,016.93 $12,944.12 nat. median
$215
outlier · 60.1×
63833-0387-02
NDC 		Prothrombin Complex Concentrate (human) 1000 Units (range) Inj Soln 1 $12,837.72 $12,837.72 $12,837.72 nat. median
$5
outlier · 2793.8×
00069-0249-01
NDC 		Rituximab-pvvr 500 Mg/50 Ml Inj Soln 1 $12,472.32 $12,472.32 $12,472.32 nat. median
$8,533
1.5× median
60505-6066-00
NDC 		PEMEtrexed 500 Mg Inj Soln 1 $12,414.26 $12,414.26 $12,414.26 nat. median
$11,027
1.1× median
68001-0544-41
NDC 		PEMEtrexed 500 Mg Inj Soln 1 $12,414.26 $12,414.26 $12,414.26 nat. median
$11,027
1.1× median
50458-0564-01
NDC 		Paliperidone 234 Mg/1.5 Ml IM Susp 1 $12,105.88 $12,105.88 $12,105.88 nat. median
$9,152
1.3× median
55513-0730-01
NDC 		Denosumab 120 Mg/1.7 Ml Inj Soln 1 $12,005.10 $12,005.10 $12,005.10 nat. median
$6,442
1.9× median
13533-0318-05
NDC 		Rabies Immune Glob, Human 1,500 Intl_Units/5 Ml Inj Soln 1 $11,665.68 $11,665.68 $11,665.68 nat. median
$7,890
1.5× median
00169-7202-01
NDC 		Coagulation Factor VIIa 2,000 Mcg Inj 1 $11,600.00 $11,600.00 $11,600.00 nat. median
$5
outlier · 2473.3×
78811
CPT 		PET Image-limited Area 1 $11,595.48 $11,595.48 $11,595.48 nat. median
$1,661
outlier · 7.0×
71225-0120-01
NDC 		Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 $11,392.59 $11,392.59 $11,392.59 nat. median
$10,119
1.1× median
60505-6228-00
NDC 		Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 $11,169.20 $11,169.20 $11,169.20 nat. median
$9,921
1.1× median
51759-0630-10
NDC 		risperiDONE (Uzedy) 125 Mg/0.35 Ml SubQ Inj Susp 1 $11,147.14 $11,147.14 $11,147.14 nat. median
$11,147
1.0× median
50633-0110-12
NDC 		Antivenin (crotalidae-snake Ovine) Polyvalent Inj 1 $11,129.04 $11,129.04 $11,129.04 nat. median
$4,547
outlier · 2.4×
65757-0403-03
NDC 		ARIPiprazole (Aristada ER Depot) 882 Mg/3.2 Ml Inj Susp 1 $11,073.33 $11,073.33 $11,073.33 nat. median
$11,073
1.0× median

Other procedures at this hospital

Browse this hospital's 4,760 published procedures. Use the slice to choose what to show, then sort or filter any column.

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Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code Type Description Rate rows Payers Gross Cash Min $ Max $ Avg median Last observed
             
00002-7623-01 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $14,069.64 $13,788.25 $14,069.64 $14,069.64 $14,069.64 2025-12-31
00002-7640-01 NDC PEMEtrexed 100 Mg Inj Soln 1 1 $2,813.93 $2,757.65 $2,813.93 $2,813.93 $2,813.93 2025-12-31
00003-0371-13 NDC Belatacept 250 Mg Inj Soln 1 1 $3,375.18 $3,307.68 $3,375.18 $3,375.18 $3,375.18 2025-12-31
00006-3026-02 NDC Pembrolizumab 100 Mg/4 Ml Inj Soln 1 1 $20,121.64 $19,719.21 $20,121.64 $20,121.64 $20,121.64 2025-12-31
00023-1145-01 NDC onabotulinumtoxinA 100 Units Inj Soln 1 1 $2,265.48 $2,220.17 $2,265.48 $2,265.48 $2,265.48 2025-12-31
00024-5150-10 NDC Rasburicase 1.5 Mg Inj Soln 1 1 $3,852.34 $3,775.29 $3,852.34 $3,852.34 $3,852.34 2025-12-31
00069-0249-01 NDC Rituximab-pvvr 500 Mg/50 Ml Inj Soln 1 1 $12,472.32 $12,222.87 $12,472.32 $12,472.32 $12,472.32 2025-12-31
00069-0809-01 NDC Infliximab-dyyb 100 Mg Inj Soln 1 1 $3,293.07 $3,227.21 $3,293.07 $3,293.07 $3,293.07 2025-12-31
00074-2108-03 NDC Leuprolide Depot 7.5 Mg/month Inj Susp 1 1 $7,540.29 $7,389.48 $7,540.29 $7,540.29 $7,540.29 2025-12-31
00074-3641-03 NDC Leuprolide Depot 3.75 Mg/month Inj Syringe 1 1 $6,267.86 $6,142.50 $6,267.86 $6,267.86 $6,267.86 2025-12-31
00074-3642-03 NDC Leuprolide Depot 7.5 Mg/month Inj Susp 1 1 $7,469.16 $7,319.78 $7,469.16 $7,469.16 $7,469.16 2025-12-31
00074-3683-03 NDC Leuprolide Depot 30 Mg (4 Month) Inj Susp 1 1 $29,876.50 $29,278.97 $29,876.50 $29,876.50 $29,876.50 2025-12-31
00078-0435-61 NDC Zoledronic Acid 5 Mg/ Sw 100 Ml Inj Soln 1 1 $3,771.74 $3,696.31 $3,771.74 $3,771.74 $3,771.74 2025-12-31
00078-0818-81 NDC Octreotide Lar Depot 20 Mg IM Susp 1 1 $16,064.72 $15,743.43 $16,064.72 $16,064.72 $16,064.72 2025-12-31
00078-0825-81 NDC Octreotide Lar Depot 30 Mg IM Susp 1 1 $24,055.70 $23,574.59 $24,055.70 $24,055.70 $24,055.70 2025-12-31
00143-9533-01 NDC Allopurinol 500 Mg Inj Soln 1 1 $13,572.00 $13,300.56 $13,572.00 $13,572.00 $13,572.00 2025-12-31
00169-7201-01 NDC Coagulation Factor VIIa 1,000 Mcg Inj 1 1 $5,191.00 $5,087.18 $5,191.00 $5,191.00 $5,191.00 2025-12-31
00169-7202-01 NDC Coagulation Factor VIIa 2,000 Mcg Inj 1 1 $11,600.00 $11,368.00 $11,600.00 $11,600.00 $11,600.00 2025-12-31
00169-7205-01 NDC Coagulation Factor VIIa 5,000 Mcg Inj 1 1 $25,955.00 $25,435.90 $25,955.00 $25,955.00 $25,955.00 2025-12-31
00310-0720-10 NDC Fulvestrant 250 Mg/5 Ml Inj Soln 1 1 $3,373.95 $3,306.47 $3,373.95 $3,373.95 $3,373.95 2025-12-31
0037U CPT Trgt Gen Seq DNA 324 Genes 1 1 $4,692.22 $4,598.38 $4,692.22 $4,692.22 $4,692.22 2025-12-31
00517-0710-01 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $6,026.00 $5,905.48 $6,026.00 $6,026.00 $6,026.00 2025-12-31
00517-4300-01 NDC PACLitaxel (protein-bound) 100 Mg Inj Soln 1 1 $5,703.60 $5,589.53 $5,703.60 $5,703.60 $5,703.60 2025-12-31
00591-5019-02 NDC Fulvestrant 250 Mg/5 Ml Inj Soln 1 1 $3,036.58 $2,975.85 $3,036.58 $3,036.58 $3,036.58 2025-12-31
00597-0197-05 NDC idaruCIZUmab 2.5 G/ 50 Ml Inj Soln 1 1 $8,878.19 $8,700.63 $8,878.19 $8,878.19 $8,878.19 2025-12-31
00781-3079-12 NDC Fulvestrant 250 Mg/5 Ml Inj Soln 1 1 $3,163.10 $3,099.84 $3,163.10 $3,163.10 $3,163.10 2025-12-31
00781-3158-95 NDC Bivalirudin 250 Mg Inj Soln 1 1 $3,298.08 $3,232.12 $3,298.08 $3,298.08 $3,298.08 2025-12-31
00781-3182-73 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $3,958.07 $3,878.91 $3,958.07 $3,958.07 $3,958.07 2025-12-31
00781-3182-84 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $3,958.07 $3,878.91 $3,958.07 $3,958.07 $3,958.07 2025-12-31
00781-3244-94 NDC cycloPHOSphamide Lyophilized 1,000 Mg Inj 1 1 $2,389.77 $2,341.97 $2,389.77 $2,389.77 $2,389.77 2025-12-31
00781-3492-12 NDC Fulvestrant 250 Mg/5 Ml Inj Soln 1 1 $3,163.10 $3,099.84 $3,163.10 $3,163.10 $3,163.10 2025-12-31
00781-3531-91 NDC PACLitaxel (protein-bound) 100 Mg Inj Soln 1 1 $4,948.73 $4,849.76 $4,948.73 $4,948.73 $4,948.73 2025-12-31
00944-2842-10 NDC Antihemophilic Factor Viii (recombinant) ~500 Intl_units Inj Soln 1 1 $2,320.00 $2,273.60 $2,320.00 $2,320.00 $2,320.00 2025-12-31
00944-2843-10 NDC Antihemophilic Factor Viii (recombinant) ~1,000 Intl_units Inj Soln 1 1 $4,582.00 $4,490.36 $4,582.00 $4,582.00 $4,582.00 2025-12-31
0123 RC — 1 1 $2,889.90 $2,832.10 $2,889.90 $2,889.90 $2,889.90 2025-12-31
0152U CPT Infectious Disease DNA Pcr Ngs 1 1 $2,593.33 $2,541.46 $2,593.33 $2,593.33 $2,593.33 2025-12-31
0173 RC — 1 1 $2,266.83 $2,221.50 $2,266.83 $2,266.83 $2,266.83 2025-12-31
0174 RC — 1 1 $2,766.83 $2,721.50 $2,766.83 $2,766.83 $2,766.83 2025-12-31
0202 RC — 1 1 $2,770.56 $2,715.15 $2,770.56 $2,770.56 $2,770.56 2025-12-31
0206 RC — 1 1 $1,965.26 $1,925.95 $1,965.26 $1,965.26 $1,965.26 2025-12-31
0210 RC — 1 1 $2,770.56 $2,715.15 $2,770.56 $2,770.56 $2,770.56 2025-12-31
0211U CPT Mi Cancer Seek 1 1 $9,962.94 $9,763.68 $9,962.94 $9,962.94 $9,962.94 2025-12-31
0244U CPT 0244u Oncotype Map Pan-cancer Tissue Test 1 1 $3,700.87 $3,626.86 $3,700.87 $3,700.87 $3,700.87 2025-12-31
0273 RC — 1 1 $2,757.32 $2,702.17 $2,757.32 $2,757.32 $2,757.32 2025-12-31
0274 RC — 1 1 $3,602.02 $3,529.98 $3,602.02 $3,602.02 $3,602.02 2025-12-31
0275 RC — 164 1 $10,905.83 $10,687.71 $54.36 $44,105.17 $10,905.83 2025-12-31
0277 RC — 1 1 $10,300.73 $10,094.72 $10,300.73 $10,300.73 $10,300.73 2025-12-31
0278 RC — 4,347 1 $2,456.54 $2,407.41 $0.03 $62,060.05 $2,456.54 2025-12-31
0279 RC — 9 1 $12,944.12 $12,685.24 $374.11 $21,016.93 $12,944.12 2025-12-31
0343 RC — 3 1 $2,140.62 $2,097.81 $773.64 $3,729.67 $2,140.62 2025-12-31
0636 RC — 45 1 $3,239.25 $3,174.47 $4.04 $44,708.98 $3,239.25 2025-12-31
0720 RC — 26 1 $4,398.95 $4,310.98 $451.17 $13,760.84 $4,398.95 2025-12-31
0750 RC — 1 1 $3,387.34 $3,319.60 $3,387.34 $3,387.34 $3,387.34 2025-12-31
10019-0079-01 NDC Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 1 $8,143.20 $7,980.34 $8,143.20 $8,143.20 $8,143.20 2025-12-31
10122-0510-01 NDC Poractant 120 Mg/1.5 Ml Intra-tracheal Susp 1 1 $2,084.38 $2,042.69 $2,084.38 $2,084.38 $2,084.38 2025-12-31
10122-0510-03 NDC Poractant 240 Mg/3 Ml Intra-tracheal Susp 1 1 $4,110.17 $4,027.97 $4,110.17 $4,110.17 $4,110.17 2025-12-31
10122-0620-10 NDC Cangrelor 50 Mg Inj Soln 1 1 $3,484.17 $3,414.49 $3,484.17 $3,484.17 $3,484.17 2025-12-31
11704-0620-01 NDC Atropine-pralidoxime (2.1 Mg/0.7ml-600 Mg/2 Ml) Inj Soln 1 1 $4,384.80 $4,297.10 $4,384.80 $4,384.80 $4,384.80 2025-12-31
13533-0318-01 NDC Rabies Immune Glob, Human 300 Intl_Units/mL Inj Soln 1 1 $2,471.21 $2,421.79 $2,471.21 $2,471.21 $2,471.21 2025-12-31
13533-0318-03 NDC Rabies Immune Glob, Human 900 Intl_Units/3 Ml Inj Soln 1 1 $6,999.38 $6,859.39 $6,999.38 $6,999.38 $6,999.38 2025-12-31
13533-0318-05 NDC Rabies Immune Glob, Human 1,500 Intl_Units/5 Ml Inj Soln 1 1 $11,665.68 $11,432.37 $11,665.68 $11,665.68 $11,665.68 2025-12-31
13533-0602-50 NDC Antithrombin Iii (human) 500 Intl_Units Inj Soln 1 1 $3,929.50 $3,850.91 $3,929.50 $3,929.50 $3,929.50 2025-12-31
13533-0603-20 NDC Antithrombin Iii (human) 500 Intl_Units Inj Soln 1 1 $3,929.50 $3,850.91 $3,929.50 $3,929.50 $3,929.50 2025-12-31
13533-0606-12 NDC Antithrombin Iii (human) 500 Intl_Units Inj Soln 1 1 $6,960.00 $6,820.80 $6,960.00 $6,960.00 $6,960.00 2025-12-31
13533-0634-02 NDC Tetanus Immune Globulin 250 units/mL Inj Soln 1 1 $1,936.27 $1,897.54 $1,936.27 $1,936.27 $1,936.27 2025-12-31
13533-0636-05 NDC Hepatitis B Immune Globulin, 5 Ml IM Soln 1 1 $2,296.28 $2,250.35 $2,296.28 $2,296.28 $2,296.28 2025-12-31
14789-0015-05 NDC Isoproterenol 1 Mg/5 Ml Inj Soln 1 1 $2,088.00 $2,046.24 $2,088.00 $2,088.00 $2,088.00 2025-12-31
14789-0901-10 NDC Procainamide 1000 Mg/10 Ml (mdv) Inj Soln 1 1 $2,088.00 $2,046.24 $2,088.00 $2,088.00 $2,088.00 2025-12-31
16714-0070-02 NDC Fulvestrant 250 Mg/5 Ml Inj Soln 1 1 $2,893.97 $2,836.09 $2,893.97 $2,893.97 $2,893.97 2025-12-31
16714-0749-01 NDC Decitabine 50 Mg Inj Soln 1 1 $5,455.89 $5,346.77 $5,455.89 $5,455.89 $5,455.89 2025-12-31
16714-0857-01 NDC cycloPHOSphamide Lyophilized 1,000 Mg Inj 1 1 $2,394.21 $2,346.33 $2,394.21 $2,394.21 $2,394.21 2025-12-31
16714-0928-01 NDC Decitabine 50 Mg Inj Soln 1 1 $3,901.49 $3,823.46 $3,901.49 $3,901.49 $3,901.49 2025-12-31
16729-0108-11 NDC mitoMYcin 20 Mg Inj Soln 1 1 $2,052.68 $2,011.63 $2,052.68 $2,052.68 $2,052.68 2025-12-31
16729-0224-05 NDC Decitabine 50 Mg Inj Soln 1 1 $5,656.57 $5,543.44 $5,656.57 $5,656.57 $5,656.57 2025-12-31
16729-0242-31 NDC Zoledronic Acid 4 Mg/5 Ml Inj Soln 1 1 $2,431.04 $2,382.42 $2,431.04 $2,431.04 $2,431.04 2025-12-31
16729-0251-05 NDC Bendamustine 100 Mg Inj Soln 1 1 $5,568.00 $5,456.64 $5,568.00 $5,568.00 $5,568.00 2025-12-31
16729-0267-64 NDC DOCEtaxel 80 Mg/4 Ml (mdv) Inj Soln 1 1 $4,235.74 $4,151.03 $4,235.74 $4,235.74 $4,235.74 2025-12-31
16729-0436-30 NDC Fulvestrant 250 Mg/5 Ml Inj Soln 1 1 $2,519.14 $2,468.76 $2,519.14 $2,519.14 $2,519.14 2025-12-31
24201-0400-02 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $2,784.00 $2,728.32 $2,784.00 $2,784.00 $2,784.00 2025-12-31
25021-0251-50 NDC mitoMYcin 20 Mg Inj Soln 1 1 $2,199.30 $2,155.31 $2,199.30 $2,199.30 $2,199.30 2025-12-31
36511 CPT Apheresis Wbc Therapeutic 1 1 $2,641.62 $2,588.79 $2,641.62 $2,641.62 $2,641.62 2025-12-31
36512 CPT Apheresis Rbc Exchange Transfusion 1 1 $2,641.62 $2,588.79 $2,641.62 $2,641.62 $2,641.62 2025-12-31
36513 CPT Apheresis Platelets Therapeutic 1 1 $2,641.62 $2,588.79 $2,641.62 $2,641.62 $2,641.62 2025-12-31
36514 CPT Plasmapheresis Charge 1 1 $2,641.62 $2,588.79 $2,641.62 $2,641.62 $2,641.62 2025-12-31
42023-0205-01 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $2,784.00 $2,728.32 $2,784.00 $2,784.00 $2,784.00 2025-12-31
42367-0521-25 NDC Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 1 $9,048.00 $8,867.04 $9,048.00 $9,048.00 $9,048.00 2025-12-31
43598-0051-11 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $9,261.50 $9,076.27 $9,261.50 $9,261.50 $9,261.50 2025-12-31
43598-0348-37 NDC Decitabine 50 Mg Inj Soln 1 1 $2,088.00 $2,046.24 $2,088.00 $2,088.00 $2,088.00 2025-12-31
43598-0387-11 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $2,759.64 $2,704.45 $2,759.64 $2,759.64 $2,759.64 2025-12-31
43598-0427-37 NDC Decitabine 50 Mg Inj Soln 1 1 $2,088.00 $2,046.24 $2,088.00 $2,088.00 $2,088.00 2025-12-31
43598-0865-60 NDC Bortezomib 3.5 Mg Inj Soln 1 1 $5,578.38 $5,466.81 $5,578.38 $5,578.38 $5,578.38 2025-12-31
44206-0436-05 NDC Immune Globulin (ivig) 10%, 5 G/50 Ml (Privigen) Inj Soln 1 1 $3,276.07 $3,210.55 $3,276.07 $3,276.07 $3,276.07 2025-12-31
44206-0437-10 NDC Immune Globulin (ivig) 10%, 10 G/100 Ml (Privigen) Inj Soln 1 1 $6,552.14 $6,421.10 $6,552.14 $6,552.14 $6,552.14 2025-12-31
44206-0438-20 NDC Immune Globulin (ivig) 10%, 20 G/200 Ml (Privigen) Inj Soln 1 1 $13,104.29 $12,842.20 $13,104.29 $13,104.29 $13,104.29 2025-12-31
44206-0439-40 NDC Immune Globulin (ivig) 10%, 40 G/400 Ml (Privigen) Inj Soln 1 1 $26,208.58 $25,684.41 $26,208.58 $26,208.58 $26,208.58 2025-12-31
47335-0049-40 NDC DOXOrubicin Liposomal 20 Mg/10 Ml Inj Soln 1 1 $3,372.12 $3,304.68 $3,372.12 $3,372.12 $3,372.12 2025-12-31
47335-0361-41 NDC Decitabine 50 Mg Inj Soln 1 1 $5,352.82 $5,245.76 $5,352.82 $5,352.82 $5,352.82 2025-12-31
49281-0575-15 NDC Nirsevimab-alip 50 Mg/0.5 Ml Inj Syringe 1 1 $1,935.34 $1,896.63 $1,935.34 $1,935.34 $1,935.34 2025-12-31
50242-0037-06 NDC Tenecteplase 50 Mg Inj Soln 1 1 $10,237.00 $10,032.26 $10,237.00 $10,237.00 $10,237.00 2025-12-31
50242-0040-62 NDC Omalizumab 150 Mg Inj Soln 1 1 $4,819.66 $4,723.27 $4,819.66 $4,819.66 $4,819.66 2025-12-31
50242-0044-13 NDC Alteplase 50 Mg Inj Soln 1 1 $15,312.64 $15,006.39 $15,312.64 $15,312.64 $15,312.64 2025-12-31
50242-0085-27 NDC Alteplase 100 Mg Inj Soln 1 1 $30,625.25 $30,012.75 $30,625.25 $30,625.25 $30,625.25 2025-12-31
50242-0120-01 NDC Tenecteplase 50 Mg Inj Soln 1 1 $23,407.04 $22,938.90 $23,407.04 $23,407.04 $23,407.04 2025-12-31
50242-0120-47 NDC Tenecteplase 50 Mg Inj Soln 1 1 $28,874.46 $28,296.97 $28,874.46 $28,874.46 $28,874.46 2025-12-31
50242-0136-01 NDC Tocilizumab 200 Mg/10 Ml Inj Soln 1 1 $4,621.13 $4,528.71 $4,621.13 $4,621.13 $4,621.13 2025-12-31
50242-0137-01 NDC Tocilizumab 400 Mg/20 Ml Inj Soln 1 1 $9,242.25 $9,057.41 $9,242.25 $9,242.25 $9,242.25 2025-12-31
50242-0176-01 NDC Tenecteplase 50 Mg Inj Soln 1 1 $28,874.46 $28,296.97 $28,874.46 $28,874.46 $28,874.46 2025-12-31
50458-0563-01 NDC Paliperidone 156 mg/mL IM Susp 1 1 $8,070.78 $7,909.36 $8,070.78 $8,070.78 $8,070.78 2025-12-31
50458-0564-01 NDC Paliperidone 234 Mg/1.5 Ml IM Susp 1 1 $12,105.88 $11,863.76 $12,105.88 $12,105.88 $12,105.88 2025-12-31
50474-0700-62 NDC Certolizumab 200 mg/mL Inj Soln 1 1 $16,758.14 $16,422.98 $16,758.14 $16,758.14 $16,758.14 2025-12-31
50590 CPT Extracorporeal Shock Wave Lithotripsy 1 1 $3,800.10 $3,724.10 $3,800.10 $3,800.10 $3,800.10 2025-12-31
50633-0110-12 NDC Antivenin (crotalidae-snake Ovine) Polyvalent Inj 1 1 $11,129.04 $10,906.46 $11,129.04 $11,129.04 $11,129.04 2025-12-31
50633-0120-11 NDC Digoxin Immune Fab 40 Mg Inj Soln 1 1 $17,309.52 $16,963.33 $17,309.52 $17,309.52 $17,309.52 2025-12-31
51759-0520-10 NDC risperiDONE (Uzedy) 100 Mg/0.28 Ml SubQ Inj Susp 1 1 $8,917.85 $8,739.49 $8,917.85 $8,917.85 $8,917.85 2025-12-31
51759-0630-10 NDC risperiDONE (Uzedy) 125 Mg/0.35 Ml SubQ Inj Susp 1 1 $11,147.14 $10,924.20 $11,147.14 $11,147.14 $11,147.14 2025-12-31
51759-0850-10 NDC risperiDONE (Uzedy) 200 Mg/0.56 Ml SubQ Inj Susp 1 1 $17,835.35 $17,478.64 $17,835.35 $17,835.35 $17,835.35 2025-12-31
51759-0960-10 NDC risperiDONE (Uzedy) 250 Mg/0.7 Ml SubQ Inj Susp 1 1 $22,294.27 $21,848.38 $22,294.27 $22,294.27 $22,294.27 2025-12-31
54092-0701-04 NDC Velaglucerase Alfa 400 Units Inj Soln 1 1 $5,160.04 $5,056.84 $5,160.04 $5,160.04 $5,160.04 2025-12-31
54288-0105-15 NDC Ethanol 99%, 5 Ml 1 1 $3,462.60 $3,393.35 $3,462.60 $3,462.60 $3,462.60 2025-12-31
55111-0556-10 NDC Decitabine 50 Mg Inj Soln 1 1 $2,088.00 $2,046.24 $2,088.00 $2,088.00 $2,088.00 2025-12-31
55150-0240-05 NDC Isosulfan Blue 50 Mg/5 Ml Inj Soln 1 1 $3,552.50 $3,481.45 $3,552.50 $3,552.50 $3,552.50 2025-12-31
55292-0702-55 NDC Hemin 350 Mg Inj Soln 1 1 $38,948.62 $38,169.65 $38,948.62 $38,948.62 $38,948.62 2025-12-31
55513-0221-01 NDC romiPLOStim 250 Mcg Inj Soln 1 1 $9,580.51 $9,388.90 $9,580.51 $9,580.51 $9,580.51 2025-12-31
55513-0710-01 NDC Denosumab 60 mg/mL Inj Soln 1 1 $6,526.50 $6,395.97 $6,526.50 $6,526.50 $6,526.50 2025-12-31
55513-0710-21 NDC Denosumab 60 mg/mL Inj Soln 1 1 $6,526.50 $6,395.97 $6,526.50 $6,526.50 $6,526.50 2025-12-31
55513-0730-01 NDC Denosumab 120 Mg/1.7 Ml Inj Soln 1 1 $12,005.10 $11,765.00 $12,005.10 $12,005.10 $12,005.10 2025-12-31
55566-2300-00 NDC Desmopressin 40 Mcg/10 Ml (mdv) Inj Soln 1 1 $2,858.85 $2,801.67 $2,858.85 $2,858.85 $2,858.85 2025-12-31
55566-2800-01 NDC Dinoprostone 10 Mg (vaginal) Supp 1 1 $1,914.64 $1,876.35 $1,914.64 $1,914.64 $1,914.64 2025-12-31
57970-0100-01 NDC Dalbavancin 500 Mg Inj Soln 1 1 $6,191.37 $6,067.54 $6,191.37 $6,191.37 $6,191.37 2025-12-31
58281-0563-01 NDC Pm Baclofen 40 Mg/20 Ml Intra-thecal Soln 1 1 $3,289.09 $3,223.31 $3,289.09 $3,289.09 $3,289.09 2025-12-31
58394-0634-03 NDC Factor Ix Complex (recombinant) ~500 Units Inj Soln 1 1 $2,320.00 $2,273.60 $2,320.00 $2,320.00 $2,320.00 2025-12-31
58394-0635-03 NDC Factor Ix Complex (recombinant) ~1,000 Units Inj Soln 1 1 $4,524.00 $4,433.52 $4,524.00 $4,524.00 $4,524.00 2025-12-31
58394-0637-03 NDC Factor Ix Complex (recombinant) ~3,000 Units Inj Soln 1 1 $8,874.00 $8,696.52 $8,874.00 $8,874.00 $8,874.00 2025-12-31
59148-0018-71 NDC ARIPiprazole (Abilify Maintena Depot) 300 Mg Inj Susp 1 1 $7,580.60 $7,428.99 $7,580.60 $7,580.60 $7,580.60 2025-12-31
59148-0019-71 NDC ARIPiprazole (Abilify Maintena Depot) 400 Mg Inj Susp 1 1 $10,107.46 $9,905.31 $10,107.46 $10,107.46 $10,107.46 2025-12-31
59148-0045-80 NDC ARIPiprazole (Abilify Maintena Depot) 300 Mg Inj Susp 1 1 $7,580.60 $7,428.99 $7,580.60 $7,580.60 $7,580.60 2025-12-31
59148-0046-70 NDC Decitabine 50 Mg Inj Soln 1 1 $6,251.99 $6,126.95 $6,251.99 $6,251.99 $6,251.99 2025-12-31
59148-0072-80 NDC ARIPiprazole (Abilify Maintena Depot) 400 Mg Inj Susp 1 1 $10,107.46 $9,905.31 $10,107.46 $10,107.46 $10,107.46 2025-12-31
59148-0102-80 NDC ARIPiprazole (Abilify Asimtufii) 720 Mg/2.4 Ml Inj Susp 1 1 $15,161.14 $14,857.92 $15,161.14 $15,161.14 $15,161.14 2025-12-31
59148-0114-80 NDC ARIPiprazole (Abilify Asimtufii) 960 Mg/3.2 Ml Inj Susp 1 1 $20,214.86 $19,810.56 $20,214.86 $20,214.86 $20,214.86 2025-12-31
59730-4203-01 NDC Hepatitis B Immune Globulin, 5 Ml IM Soln 1 1 $2,351.55 $2,304.52 $2,351.55 $2,351.55 $2,351.55 2025-12-31
60505-6065-00 NDC PEMEtrexed 100 Mg Inj Soln 1 1 $2,482.86 $2,433.20 $2,482.86 $2,482.86 $2,482.86 2025-12-31
60505-6066-00 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $12,414.26 $12,165.97 $12,414.26 $12,414.26 $12,414.26 2025-12-31
60505-6110-00 NDC Zoledronic Acid 4 Mg/5 Ml Inj Soln 1 1 $2,805.03 $2,748.93 $2,805.03 $2,805.03 $2,805.03 2025-12-31
60505-6228-00 NDC Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 1 $11,169.20 $10,945.82 $11,169.20 $11,169.20 $11,169.20 2025-12-31
60505-6230-04 NDC PACLitaxel (protein-bound) 100 Mg Inj Soln 1 1 $5,223.68 $5,119.21 $5,223.68 $5,223.68 $5,223.68 2025-12-31
61314-0240-63 NDC Denosumab-bbdz 60 mg/mLINJ Soln 1 1 $5,582.38 $5,470.73 $5,582.38 $5,582.38 $5,582.38 2025-12-31
61958-2901-02 NDC Remdesivir 100 Mg Inj Soln 1 1 $2,209.28 $2,165.09 $2,209.28 $2,209.28 $2,209.28 2025-12-31
62756-0529-40 NDC Desmopressin 40 Mcg/10 Ml (mdv) Inj Soln 1 1 $2,068.40 $2,027.03 $2,068.40 $2,068.40 $2,068.40 2025-12-31
63020-0049-01 NDC Bortezomib 3.5 Mg Inj Soln 1 1 $5,578.44 $5,466.87 $5,578.44 $5,578.44 $5,578.44 2025-12-31
63261-0250-21 NDC Isosulfan Blue 50 Mg/5 Ml Inj Soln 1 1 $2,207.48 $2,163.33 $2,207.48 $2,207.48 $2,207.48 2025-12-31
63323-0450-50 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $2,065.70 $2,024.39 $2,065.70 $2,065.70 $2,065.70 2025-12-31
63323-0721-10 NDC Bortezomib 3.5 Mg Inj Soln 1 1 $5,578.38 $5,466.81 $5,578.38 $5,578.38 $5,578.38 2025-12-31
63323-0865-02 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $2,784.00 $2,728.32 $2,784.00 $2,784.00 $2,784.00 2025-12-31
63459-0103-10 NDC Rituximab-abbs 100 Mg/10 Ml Inj Soln 1 1 $2,942.51 $2,883.66 $2,942.51 $2,942.51 $2,942.51 2025-12-31
63459-0104-50 NDC Rituximab-abbs 500 Mg/50 Ml Inj Soln 1 1 $14,712.57 $14,418.32 $14,712.57 $14,712.57 $14,712.57 2025-12-31
63459-0303-43 NDC Trastuzumab-pkrb 150 Mg Inj Soln 1 1 $3,795.81 $3,719.89 $3,795.81 $3,795.81 $3,795.81 2025-12-31
63459-0305-47 NDC Trastuzumab-pkrb 420 Mg Inj Soln 1 1 $10,628.27 $10,415.70 $10,628.27 $10,628.27 $10,628.27 2025-12-31
63459-0348-04 NDC Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 1 $8,608.82 $8,436.64 $8,608.82 $8,608.82 $8,608.82 2025-12-31
63459-0390-08 NDC Bendamustine 25 Mg Inj Soln 1 1 $2,585.47 $2,533.76 $2,585.47 $2,585.47 $2,585.47 2025-12-31
63459-0391-20 NDC Bendamustine 100 Mg Inj Soln 1 1 $10,341.86 $10,135.02 $10,341.86 $10,341.86 $10,341.86 2025-12-31
63833-0386-02 NDC Prothrombin Complex Concentrate (human) 500 Units (range) Inj Soln 1 1 $6,418.86 $6,290.48 $6,418.86 $6,418.86 $6,418.86 2025-12-31
63833-0387-02 NDC Prothrombin Complex Concentrate (human) 1000 Units (range) Inj Soln 1 1 $12,837.72 $12,580.97 $12,837.72 $12,837.72 $12,837.72 2025-12-31
63833-0615-02 NDC Antihemophilic Factor Viii (human)-vwf 600 Units (vwf:RCo) Inj Soln 1 1 $3,480.00 $3,410.40 $3,480.00 $3,480.00 $3,480.00 2025-12-31
63833-0616-02 NDC Antihemophilic Factor Viii (human)-vwf 1,200 Units (vwf:RCo) Inj Soln 1 1 $5,289.60 $5,183.81 $5,289.60 $5,289.60 $5,289.60 2025-12-31
64406-0008-01 NDC Natalizumab 300 Mg/15 Ml Inj Soln 1 1 $30,899.69 $30,281.70 $30,899.69 $30,899.69 $30,899.69 2025-12-31
64764-0300-20 NDC Vedolizumab 300 Mg Inj Soln 1 1 $32,572.49 $31,921.04 $32,572.49 $32,572.49 $32,572.49 2025-12-31
65219-0380-30 NDC Allopurinol 500 Mg Inj Soln 1 1 $10,092.00 $9,890.16 $10,092.00 $10,092.00 $10,092.00 2025-12-31
65219-0566-20 NDC mitoMYcin 20 Mg Inj Soln 1 1 $2,199.30 $2,155.31 $2,199.30 $2,199.30 $2,199.30 2025-12-31
65757-0300-01 NDC Naltrexone (depot) 380 Mg Inj Susp 1 1 $5,882.39 $5,764.74 $5,882.39 $5,882.39 $5,882.39 2025-12-31
65757-0402-03 NDC ARIPiprazole (Aristada ER Depot) 662 Mg/2.4 Ml Inj Susp 1 1 $8,311.31 $8,145.08 $8,311.31 $8,311.31 $8,311.31 2025-12-31
65757-0403-03 NDC ARIPiprazole (Aristada ER Depot) 882 Mg/3.2 Ml Inj Susp 1 1 $11,073.33 $10,851.86 $11,073.33 $11,073.33 $11,073.33 2025-12-31
65757-0404-03 NDC ARIPiprazole (Aristada ER Depot) 1,064 Mg/3.9 Ml Inj Susp 1 1 $13,358.36 $13,091.19 $13,358.36 $13,358.36 $13,358.36 2025-12-31
65757-0500-03 NDC ARIPiprazole (Aristada Initio ER Depot) 675 Mg/2.4 Ml Inj Susp 1 1 $8,474.53 $8,305.04 $8,474.53 $8,474.53 $8,474.53 2025-12-31
66733-0948-23 NDC Cetuximab 100 Mg/50 Ml Inj Soln 1 1 $2,910.99 $2,852.77 $2,910.99 $2,910.99 $2,910.99 2025-12-31
66733-0958-23 NDC Cetuximab 200 Mg/100 Ml Inj Soln 1 1 $5,821.97 $5,705.53 $5,821.97 $5,821.97 $5,821.97 2025-12-31
66794-0157-01 NDC Pm Baclofen 40 Mg/20 Ml Intra-thecal Soln 1 1 $3,856.07 $3,778.95 $3,856.07 $3,856.07 $3,856.07 2025-12-31
67457-0187-50 NDC Allopurinol 500 Mg Inj Soln 1 1 $13,874.96 $13,597.46 $13,874.96 $13,874.96 $13,874.96 2025-12-31
67457-0211-02 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $3,573.26 $3,501.79 $3,573.26 $3,573.26 $3,573.26 2025-12-31
67457-0220-05 NDC Isosulfan Blue 50 Mg/5 Ml Inj Soln 1 1 $4,225.38 $4,140.87 $4,225.38 $4,225.38 $4,225.38 2025-12-31
67457-0256-10 NDC Bivalirudin 250 Mg Inj Soln 1 1 $3,298.08 $3,232.12 $3,298.08 $3,298.08 $3,298.08 2025-12-31
67457-0311-05 NDC Fulvestrant 250 Mg/5 Ml Inj Soln 1 1 $3,163.10 $3,099.84 $3,163.10 $3,163.10 $3,163.10 2025-12-31
67457-0316-25 NDC Decitabine 50 Mg Inj Soln 1 1 $3,306.00 $3,239.88 $3,306.00 $3,306.00 $3,306.00 2025-12-31
67457-0519-20 NDC mitoMYcin 20 Mg Inj Soln 1 1 $2,052.68 $2,011.63 $2,052.68 $2,052.68 $2,052.68 2025-12-31
67457-0564-20 NDC Pm Baclofen 40 Mg/20 Ml Intra-thecal Soln 1 1 $2,690.53 $2,636.72 $2,690.53 $2,690.53 $2,690.53 2025-12-31
67457-0586-05 NDC Isosulfan Blue 50 Mg/5 Ml Inj Soln 1 1 $3,876.49 $3,798.96 $3,876.49 $3,876.49 $3,876.49 2025-12-31
67457-0675-02 NDC Calcitonin 400 Intl_Units/2 Ml (mdv) Inj Soln 1 1 $3,480.00 $3,410.40 $3,480.00 $3,480.00 $3,480.00 2025-12-31
68001-0484-85 NDC Fulvestrant 250 Mg/5 Ml Inj Soln 1 1 $3,373.95 $3,306.47 $3,373.95 $3,373.95 $3,373.95 2025-12-31
68001-0522-85 NDC Fulvestrant 250 Mg/5 Ml Inj Soln 1 1 $2,519.14 $2,468.76 $2,519.14 $2,519.14 $2,519.14 2025-12-31
68001-0539-41 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $2,784.00 $2,728.32 $2,784.00 $2,784.00 $2,784.00 2025-12-31
68001-0543-41 NDC PEMEtrexed 100 Mg Inj Soln 1 1 $2,482.86 $2,433.20 $2,482.86 $2,482.86 $2,482.86 2025-12-31
68001-0544-41 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $12,414.26 $12,165.97 $12,414.26 $12,414.26 $12,414.26 2025-12-31
68001-0572-41 NDC Bendamustine 100 Mg Inj Soln 1 1 $5,568.00 $5,456.64 $5,568.00 $5,568.00 $5,568.00 2025-12-31
68462-0317-32 NDC Fulvestrant 250 Mg/5 Ml Inj Soln 1 1 $3,163.10 $3,099.84 $3,163.10 $3,163.10 $3,163.10 2025-12-31
68817-0134-50 NDC PACLitaxel (protein-bound) 100 Mg Inj Soln 1 1 $5,498.61 $5,388.64 $5,498.61 $5,498.61 $5,498.61 2025-12-31
69097-0285-37 NDC Decitabine 50 Mg Inj Soln 1 1 $2,262.00 $2,216.76 $2,262.00 $2,262.00 $2,262.00 2025-12-31
69097-0870-67 NDC Lanreotide 120 Mg/0.5 Ml Inj Soln 1 1 $30,946.45 $30,327.52 $30,946.45 $30,946.45 $30,946.45 2025-12-31
69800-4203-01 NDC Hepatitis B Immune Globulin, 5 Ml IM Soln 1 1 $2,750.48 $2,695.47 $2,750.48 $2,750.48 $2,750.48 2025-12-31
70095-0031-01 NDC Desmopressin 40 Mcg/10 Ml (mdv) Inj Soln 1 1 $2,068.40 $2,027.03 $2,068.40 $2,068.40 $2,068.40 2025-12-31
70121-1754-01 NDC Bevacizumab-maly (Alymsys) 100 Mg/4 Ml Inj Soln 1 1 $2,500.73 $2,450.72 $2,500.73 $2,500.73 $2,500.73 2025-12-31
70121-1755-01 NDC Bevacizumab-maly (Alymsys) 400 Mg/16 Ml Inj Soln 1 1 $10,002.91 $9,802.85 $10,002.91 $10,002.91 $10,002.91 2025-12-31
70257-0563-01 NDC Pm Baclofen 40 Mg/20 Ml Intra-thecal Soln 1 1 $3,289.09 $3,223.31 $3,289.09 $3,289.09 $3,289.09 2025-12-31
70700-0284-98 NDC Fulvestrant 250 Mg/5 Ml Inj Soln 1 1 $3,163.10 $3,099.84 $3,163.10 $3,163.10 $3,163.10 2025-12-31
70710-1478-01 NDC Fomepizole 1.5 G/1.5 Ml Inj Soln 1 1 $5,220.00 $5,115.60 $5,220.00 $5,220.00 $5,220.00 2025-12-31
70710-1530-01 NDC DOXOrubicin Liposomal 20 Mg/10 Ml Inj Soln 1 1 $2,360.48 $2,313.27 $2,360.48 $2,360.48 $2,360.48 2025-12-31
70710-1655-01 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $3,448.45 $3,379.48 $3,448.45 $3,448.45 $3,448.45 2025-12-31
70710-1688-08 NDC Fulvestrant 250 Mg/5 Ml Inj Soln 1 1 $3,036.56 $2,975.83 $3,036.56 $3,036.56 $3,036.56 2025-12-31
70720-0950-36 NDC Goserelin Acetate 3.6 Mg Sub-q Implant 1 1 $3,911.35 $3,833.12 $3,911.35 $3,911.35 $3,911.35 2025-12-31
70720-0951-30 NDC Goserelin Acetate 10.8 Mg Sub-q Implant 1 1 $10,761.20 $10,545.98 $10,761.20 $10,761.20 $10,761.20 2025-12-31
70860-0203-50 NDC PEMEtrexed 500 Mg Inj Soln 1 1 $2,871.00 $2,813.58 $2,871.00 $2,871.00 $2,871.00 2025-12-31
70860-0218-05 NDC cycloPHOSphamide 1,000 Mg/5 Ml (mdv) Inj Soln 1 1 $2,549.10 $2,498.12 $2,549.10 $2,549.10 $2,549.10 2025-12-31
71225-0120-01 NDC Bendamustine 100 Mg/4 Ml (mdv) Inj Soln 1 1 $11,392.59 $11,164.74 $11,392.59 $11,392.59 $11,392.59 2025-12-31
72205-0031-01 NDC Decitabine 50 Mg Inj Soln 1 1 $5,657.90 $5,544.74 $5,657.90 $5,657.90 $5,657.90 2025-12-31
72603-0103-01 NDC DOXOrubicin Liposomal 20 Mg/10 Ml Inj Soln 1 1 $3,372.12 $3,304.68 $3,372.12 $3,372.12 $3,372.12 2025-12-31
72603-0105-02 NDC Fulvestrant 250 Mg/5 Ml Inj Soln 1 1 $2,893.97 $2,836.09 $2,893.97 $2,893.97 $2,893.97 2025-12-31
72603-0107-01 NDC Decitabine 50 Mg Inj Soln 1 1 $3,268.10 $3,202.74 $3,268.10 $3,268.10 $3,268.10 2025-12-31
73607-0011-11 NDC Artesunate 110 Mg Inj Soln 1 1 $17,330.40 $16,983.79 $17,330.40 $17,330.40 $17,330.40 2025-12-31
75834-0190-01 NDC Decitabine 50 Mg Inj Soln 1 1 $3,306.00 $3,239.88 $3,306.00 $3,306.00 $3,306.00 2025-12-31
77301 CPT Imrt Planning 1 1 $6,453.25 $6,324.19 $6,453.25 $6,453.25 $6,453.25 2025-12-31
77372 CPT Delivery, Linear Accelerator Based 1 1 $4,509.68 $4,419.49 $4,509.68 $4,509.68 $4,509.68 2025-12-31
77373 CPT Sbrt 1 1 $5,724.41 $5,609.93 $5,724.41 $5,724.41 $5,724.41 2025-12-31
77768 CPT Brachy Dose Lesion Over 2m Or 2 Or More Channels-77768 1 1 $2,232.07 $2,187.42 $2,232.07 $2,232.07 $2,232.07 2025-12-31
77772 CPT Hi Inten Brach Tx > 12 Ch 1 1 $2,232.07 $2,187.42 $2,232.07 $2,232.07 $2,232.07 2025-12-31
78013 CPT Nm Thyroid Imaging Only 1 1 $2,147.31 $2,104.37 $2,147.31 $2,147.31 $2,147.31 2025-12-31
78014 CPT Nm Thyroid Imaging With Uptake Multiple 1 1 $2,705.61 $2,651.50 $2,705.61 $2,705.61 $2,705.61 2025-12-31
78018 CPT Nm Thyroid Ca Met Imaging-body 1 1 $3,392.75 $3,324.90 $3,392.75 $3,392.75 $3,392.75 2025-12-31
78070 CPT Nm Parathyroid Study 1 1 $3,263.91 $3,198.64 $3,263.91 $3,263.91 $3,263.91 2025-12-31
78071 CPT Nm Parathyroid Planar Imaging W/spect 1 1 $3,736.32 $3,661.60 $3,736.32 $3,736.32 $3,736.32 2025-12-31
78075 CPT Nm Adrenal Imaging 1 1 $5,110.60 $5,008.39 $5,110.60 $5,110.60 $5,110.60 2025-12-31
78103 CPT Nm Bone Marrow Imaging Multiple Areas 1 1 $2,319.10 $2,272.71 $2,319.10 $2,319.10 $2,319.10 2025-12-31
78104 CPT Nm Bone Marrow Imaging Whole Body 1 1 $2,619.72 $2,567.33 $2,619.72 $2,619.72 $2,619.72 2025-12-31
78185 CPT Nm Spleen Imaging With Or Without Flow 1 1 $2,404.99 $2,356.89 $2,404.99 $2,404.99 $2,404.99 2025-12-31
78195 CPT Nm Lymphatic Imaging 1 1 $3,736.32 $3,661.60 $3,736.32 $3,736.32 $3,736.32 2025-12-31
78201 CPT Nm Liver Imaging Static Only 1 1 $2,104.37 $2,062.28 $2,104.37 $2,104.37 $2,104.37 2025-12-31
78215 CPT Nm Liver Spleen Scan 1 1 $2,147.31 $2,104.37 $2,147.31 $2,147.31 $2,147.31 2025-12-31
78226 CPT Nm Hida Scan Without Intervention 1 1 $3,693.38 $3,619.51 $3,693.38 $3,693.38 $3,693.38 2025-12-31
78227 CPT Nm Hida Scan With Intervention 1 1 $5,067.66 $4,966.30 $5,067.66 $5,067.66 $5,067.66 2025-12-31
78262 CPT Nm Gastroesophageal Reflux Exam 1 1 $2,619.72 $2,567.33 $2,619.72 $2,619.72 $2,619.72 2025-12-31
78264 CPT Nm Gastric Emptying Study, Solid, Liquid Or Both 1 1 $3,736.32 $3,661.60 $3,736.32 $3,736.32 $3,736.32 2025-12-31
78265 CPT Nm Gastric Emptying Study W/small Bowel Transit 1 1 $4,380.52 $4,292.91 $4,380.52 $4,380.52 $4,380.52 2025-12-31
78266 CPT Nm Gastric Emptying Study W/small Bowel&colon Transit Multi Days 1 1 $5,282.39 $5,176.74 $5,282.39 $5,282.39 $5,282.39 2025-12-31
78278 CPT Nm Bleeding Scan-gi 1 1 $3,779.27 $3,703.68 $3,779.27 $3,779.27 $3,779.27 2025-12-31
78290 CPT Nm Meckel's Scan 1 1 $3,736.32 $3,661.60 $3,736.32 $3,736.32 $3,736.32 2025-12-31
78291 CPT Nm Peritoneal-venous Shunt Patency 1 1 $2,662.67 $2,609.41 $2,662.67 $2,662.67 $2,662.67 2025-12-31
78305 CPT Nm Bone Imaging Limited Multiple Areas 1 1 $2,404.99 $2,356.89 $2,404.99 $2,404.99 $2,404.99 2025-12-31
78306 CPT Nm Bone Imaging Whole Body 1 1 $2,619.72 $2,567.33 $2,619.72 $2,619.72 $2,619.72 2025-12-31
78315 CPT Nm Bone Three Phase Study 1 1 $3,736.32 $3,661.60 $3,736.32 $3,736.32 $3,736.32 2025-12-31
78451 CPT Nm Heart Muscle Spect Single 1 1 $3,435.70 $3,366.98 $3,435.70 $3,435.70 $3,435.70 2025-12-31
78452 CPT Nm Heart Muscle Spect Multiple 1 1 $4,938.82 $4,840.04 $4,938.82 $4,938.82 $4,938.82 2025-12-31
78469 CPT Nm Myo Infarct Spect 1 1 $2,276.15 $2,230.63 $2,276.15 $2,276.15 $2,276.15 2025-12-31
78472 CPT Nm Cardiac Blood Pool Gated Single 1 1 $2,276.15 $2,230.63 $2,276.15 $2,276.15 $2,276.15 2025-12-31
78483 CPT Nm Cardiac Blood Pool Multi Rest/Stress 1 1 $2,147.31 $2,104.37 $2,147.31 $2,147.31 $2,147.31 2025-12-31
78579 CPT Nm Lung Scan Vent Only 1 1 $2,018.47 $1,978.10 $2,018.47 $2,018.47 $2,018.47 2025-12-31
78580 CPT Nm Lung Perfusion Imaging 1 1 $2,533.83 $2,483.15 $2,533.83 $2,533.83 $2,533.83 2025-12-31
78582 CPT Nm Vq Scan Complete 1 1 $3,521.59 $3,451.16 $3,521.59 $3,521.59 $3,521.59 2025-12-31
78597 CPT Nm Quantitative Lung Perfusion Only 1 1 $2,104.37 $2,062.28 $2,104.37 $2,104.37 $2,104.37 2025-12-31
78598 CPT Nm Quantitative Lung Complete 1 1 $3,306.86 $3,240.72 $3,306.86 $3,306.86 $3,306.86 2025-12-31
78601 CPT Nm Brain Imaging Ltd Static With Vascular 1 1 $2,362.04 $2,314.80 $2,362.04 $2,362.04 $2,362.04 2025-12-31
78605 CPT Nm Brain Imaging Complete Study Static 1 1 $2,190.26 $2,146.45 $2,190.26 $2,190.26 $2,190.26 2025-12-31
78606 CPT Nm Brain Imaging Comp With Vascular Flow 1 1 $3,736.32 $3,661.60 $3,736.32 $3,736.32 $3,736.32 2025-12-31
78608 CPT PET Brain Imaging Metabolic Evaluation 2 1 $15,460.65 $15,151.43 $15,460.65 $15,460.65 $15,460.65 2025-12-31
78609 CPT PET Brain Imaging Perfusion Evaluation 1 1 $15,460.65 $15,151.43 $15,460.65 $15,460.65 $15,460.65 2025-12-31
78610 CPT Nm Brain Imaging Vascular Flow Only 1 1 $2,018.47 $1,978.10 $2,018.47 $2,018.47 $2,018.47 2025-12-31
78630 CPT Nm Cisternography/Cerebrospinal 1 1 $3,822.22 $3,745.77 $3,822.22 $3,822.22 $3,822.22 2025-12-31
78645 CPT Nm Cerebro Fluid Flow Shunt Evaluation 1 1 $3,736.32 $3,661.60 $3,736.32 $3,736.32 $3,736.32 2025-12-31
78650 CPT Nm Cerebrospinal Fluid Leakage Detection 1 1 $3,779.27 $3,703.68 $3,779.27 $3,779.27 $3,779.27 2025-12-31
78701 CPT Nm Kidney Imaging With Flow 1 1 $2,362.04 $2,314.80 $2,362.04 $2,362.04 $2,362.04 2025-12-31
78707 CPT Nm Kidney Imaging With Flow Without Pharm 1 1 $2,319.10 $2,272.71 $2,319.10 $2,319.10 $2,319.10 2025-12-31
78709 CPT Nm Kidney Imaging With Flow With + Without Pharm 1 1 $3,736.32 $3,661.60 $3,736.32 $3,736.32 $3,736.32 2025-12-31
78740 CPT Nm Ureteral Reflux Study 1 1 $2,404.99 $2,356.89 $2,404.99 $2,404.99 $2,404.99 2025-12-31
78761 CPT Nm Testicular Scan With Vascular Flow 1 1 $2,233.20 $2,188.54 $2,233.20 $2,233.20 $2,233.20 2025-12-31
78800 CPT Nm Abscess Imaging Limited Area 1 1 $1,975.53 $1,936.02 $1,975.53 $1,975.53 $1,975.53 2025-12-31
78801 CPT Nm Octreoscan 1 1 $2,791.51 $2,735.68 $2,791.51 $2,791.51 $2,791.51 2025-12-31
78802 CPT Nm Abscess Imaging Whole Body 1 1 $3,521.59 $3,451.16 $3,521.59 $3,521.59 $3,521.59 2025-12-31
78803 CPT Nm Abscess Imaging Spect 1 1 $3,650.43 $3,577.42 $3,650.43 $3,650.43 $3,650.43 2025-12-31
78804 CPT Nm Tumor Localization/Whole Body 2+ Days 1 1 $6,441.94 $6,313.10 $6,441.94 $6,441.94 $6,441.94 2025-12-31
78811 CPT PET Image-limited Area 1 1 $11,595.48 $11,363.57 $11,595.48 $11,595.48 $11,595.48 2025-12-31
78812 CPT PET Image-skull To Mid-thigh 1 1 $15,460.65 $15,151.43 $15,460.65 $15,460.65 $15,460.65 2025-12-31
78814 CPT PET Image-w/ct-limited Area 1 1 $15,460.65 $15,151.43 $15,460.65 $15,460.65 $15,460.65 2025-12-31
78815 CPT PET Image-w/ct-skull To Mid-thigh 1 1 $18,681.61 $18,307.98 $18,681.61 $18,681.61 $18,681.61 2025-12-31
78816 CPT PET Image-whole Body 1 1 $21,258.39 $20,833.22 $21,258.39 $21,258.39 $21,258.39 2025-12-31
78831 CPT Nm Octreo Scan Spect 1 1 $7,644.43 $7,491.54 $7,644.43 $7,644.43 $7,644.43 2025-12-31
81229 CPT Interrogation Of Genomic Regions, Etc 6220003 1 1 $2,932.02 $2,873.38 $2,932.02 $2,932.02 $2,932.02 2025-12-31
81309 CPT Pik3ca Mutation Analysis, Tumor 1 1 $2,242.28 $2,197.43 $2,242.28 $2,242.28 $2,242.28 2025-12-31
81420 CPT Fetal Aneupoidy Genomic Sequence 1 1 $3,782.46 $3,706.81 $3,782.46 $3,782.46 $3,782.46 2025-12-31
81455 CPT 81455 Targeted Genomic Sequence Analysis Panel, DNA Analysis 1 1 $2,949.33 $2,890.34 $2,949.33 $2,949.33 $2,949.33 2025-12-31
81519 CPT Oncotype Dx Breast Cancer Assay 1 1 $4,986.41 $4,886.69 $4,986.41 $4,986.41 $4,986.41 2025-12-31
81525 CPT 81525 Oncotype Dx Colon 1 1 $5,470.96 $5,361.55 $5,470.96 $5,470.96 $5,470.96 2025-12-31
81540 CPT 81540 Oncology, Mrna, Gene Expression Profiling By Real0time Rt-pcr Of 92 Genes 1 1 $5,713.24 $5,598.98 $5,713.24 $5,713.24 $5,713.24 2025-12-31
83257-0001-11 NDC Trastuzumab-dkst 150 Mg Inj Soln 1 1 $3,272.97 $3,207.51 $3,272.97 $3,272.97 $3,272.97 2025-12-31
A9507 HCPCS In-111 Prostasint / 10mCi 1 1 $2,810.22 $2,754.02 $2,810.22 $2,810.22 $2,810.22 2025-12-31
A9542 HCPCS In-111 Zevalin Dx / 5mCi 1 1 $3,799.96 $3,723.96 $3,799.96 $3,799.96 $3,799.96 2025-12-31
A9543 HCPCS Y-90 Zevalin Tx / 40mCi 1 1 $49,066.21 $48,084.89 $49,066.21 $49,066.21 $49,066.21 2025-12-31
A9557 HCPCS Tc-99m Neurolite / 25mCi 1 1 $2,175.73 $2,132.22 $2,175.73 $2,175.73 $2,175.73 2025-12-31
A9572 HCPCS In-111 Octreoscan / 6mCi 1 1 $2,152.52 $2,109.47 $2,152.52 $2,152.52 $2,152.52 2025-12-31
A9582 HCPCS I-123 Mibg 15mCi 1 1 $2,919.93 $2,861.53 $2,919.93 $2,919.93 $2,919.93 2025-12-31
A9586 HCPCS F18-amyvid Per Dose 1 1 $5,240.40 $5,135.59 $5,240.40 $5,240.40 $5,240.40 2025-12-31
A9600 HCPCS Metastron Tx / Per mCi 1 1 $6,795.36 $6,659.45 $6,795.36 $6,795.36 $6,795.36 2025-12-31
A9604 HCPCS Quaddramet Sm153 Lexidronam Up To 50mCi 1 1 $10,658.55 $10,445.38 $10,658.55 $10,658.55 $10,658.55 2025-12-31
G0339 HCPCS Igr Linear Acc-based 1 1 $2,657.22 $2,604.08 $2,657.22 $2,657.22 $2,657.22 2025-12-31
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