Hospital

Vibra Hospital of Southeastern Michigan - DMC Campus

Detroit, MI · CCN 230283 · Rates published

Your selected procedure

You selected 93350 (CPT)

US STRESS TTE ONLY��

This hospital’s price: $1,723 across 3 payers

Source: https://vhsemichigan.com/wp-content/uploads/sites/36/2026/03/261789242_vibra-hospital-of-southeastern-michigan_standardcharges.csv · observed 2026-07-15

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

4,425 distinct procedures filed

25 distinct payers

14,718 rate rows

2026-07-15 last MRF observed

Data quality

14,679 of 14,718 rate rows are consumer-grade (99.7%)

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

Excluded — reason	Rows
per-diem day rate — not a per-procedure price	39

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

Source MRF file	https://vhsemichigan.com/wp-content/uploads/sites/36/2026/03/261789242_vibra-hospital-of-southeastern-michigan_standardcharges.csv
Found on page	https://vhsemichigan.com/about-us/price-transparency/
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-10-03
Content fingerprint	ab752c4c70a4efe0… · 3,903,905 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
4 MS_DRG	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	19	$130,734.64	$130,734.64	$130,734.64	nat. median $126,695 1.0× median
166 MS_DRG	Other Respiratory System O.r. Procedures With Mcc	19	$106,515.42	$106,515.42	$106,515.42	nat. median $35,717 outlier · 3.0×
981 MS_DRG	Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc	19	$106,501.77	$106,501.77	$106,501.77	nat. median $43,696 outlier · 2.4×
68875010201 NDC	Gattex	3	$99,999.99	$99,999.99	$99,999.99	nat. median $100,000 1.0× median
207 MS_DRG	Respiratory System Diagnosis With Ventilator Support >96 Hours	19	$88,494.35	$88,494.35	$88,494.35	nat. median $59,371 1.5× median
853 MS_DRG	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	19	$68,998.84	$68,998.84	$68,998.84	nat. median $45,430 1.5× median
500 MS_DRG	Soft Tissue Procedures With Mcc	19	$56,051.88	$56,051.88	$56,051.88	nat. median $29,690 1.9× median
939 MS_DRG	O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc	19	$53,944.88	$53,944.88	$53,944.88	nat. median $32,092 1.7× median
208 MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	19	$53,735.54	$53,735.54	$53,735.54	nat. median $25,388 outlier · 2.1×
55292070255 NDC	Hemin For Injection	3	$51,333.70	$51,333.70	$51,333.70	nat. median $19,096 outlier · 2.7×
438 MS_DRG	Disorders Of Pancreas Except Malignancy With Mcc	19	$47,678.46	$47,678.46	$47,678.46	nat. median $15,974 outlier · 3.0×
189 MS_DRG	Pulmonary Edema And Respiratory Failure	19	$44,538.43	$44,538.43	$44,538.43	nat. median $12,282 outlier · 3.6×
539 MS_DRG	Osteomyelitis With Mcc*	19	$44,110.65	$44,110.65	$44,110.65	nat. median $18,840 outlier · 2.3×
811 MS_DRG	Red Blood Cell Disorders With Mcc	19	$42,335.85	$42,335.85	$42,335.85	nat. median $13,626 outlier · 3.1×
757 MS_DRG	Infections, Female Reproductive System With Mcc	19	$42,335.85	$42,335.85	$42,335.85	nat. median $14,012 outlier · 3.0×
56 MS_DRG	Degenerative Nervous System Disorders With Mcc	19	$41,325.58	$41,325.58	$41,325.58	nat. median $21,155 2.0× median
371 MS_DRG	Major Gastrointestinal Disorders And Peritoneal Infections With Mcc	19	$40,661.17	$40,661.17	$40,661.17	nat. median $16,910 outlier · 2.4×
637 MS_DRG	Diabetes With Mcc	19	$40,237.94	$40,237.94	$40,237.94	nat. median $13,965 outlier · 2.9×
592 MS_DRG	Skin Ulcers With Mcc	19	$40,046.81	$40,046.81	$40,046.81	nat. median $18,752 outlier · 2.1×
682 MS_DRG	Renal Failure With Mcc	19	$39,714.61	$39,714.61	$39,714.61	nat. median $14,434 outlier · 2.8×
59627022205 NDC	Avonex	3	$39,676.03	$39,676.03	$39,676.03	nat. median $4,492 outlier · 8.8×
59627033304 NDC	Avonex Pen 30 mcg/0.5mL	3	$39,676.03	$39,676.03	$39,676.03	nat. median $17,711 outlier · 2.2×
74368303 NDC	Lupron Depot	3	$39,246.62	$39,246.62	$39,246.62	nat. median $39,247 1.0× median
871 MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	19	$38,631.52	$38,631.52	$38,631.52	nat. median $18,642 outlier · 2.1×
91 MS_DRG	Other Disorders Of Nervous System With Mcc	19	$37,880.64	$37,880.64	$37,880.64	nat. median $17,061 outlier · 2.2×
70 MS_DRG	Nonspecific Cerebrovascular Disorders With Mcc*	19	$37,202.58	$37,202.58	$37,202.58	nat. median $16,327 outlier · 2.3×
177 MS_DRG	Respiratory Infections And Inflammations With Mcc*	19	$36,888.57	$36,888.57	$36,888.57	nat. median $15,388 outlier · 2.4×
559 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Mcc*	19	$36,679.24	$36,679.24	$36,679.24	nat. median $18,115 outlier · 2.0×
391 MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	19	$35,241.19	$35,241.19	$35,241.19	nat. median $12,539 outlier · 2.8×
291 MS_DRG	Heart Failure And Shock With Mcc	19	$35,018.21	$35,018.21	$35,018.21	nat. median $12,770 outlier · 2.7×
444 MS_DRG	Disorders Of The Biliary Tract With Mcc*	19	$34,608.64	$34,608.64	$34,608.64	nat. median $16,157 outlier · 2.1×
299 MS_DRG	Peripheral Vascular Disorders With Mcc	19	$34,503.97	$34,503.97	$34,503.97	nat. median $15,759 outlier · 2.2×
432 MS_DRG	Cirrhosis And Alcoholic Hepatitis With Mcc	19	$33,584.71	$33,584.71	$33,584.71	nat. median $18,820 1.8× median
74055402 NDC	Humira(Cf) Pen	3	$33,228.58	$33,228.58	$33,228.58	nat. median $33,229 1.0× median
2144511 NDC	Taltz Autoinjector	3	$33,195.46	$33,195.46	$33,195.46	nat. median $33,195 1.0× median
372 MS_DRG	Major Gastrointestinal Disorders And Peritoneal Infections With Cc	19	$33,011.32	$33,011.32	$33,011.32	nat. median $10,410 outlier · 3.2×
540 MS_DRG	Osteomyelitis With Cc*	19	$32,369.66	$32,369.66	$32,369.66	nat. median $12,766 outlier · 2.5×
638 MS_DRG	Diabetes With Cc	19	$32,023.80	$32,023.80	$32,023.80	nat. median $9,225 outlier · 3.5×
558 MS_DRG	Tendonitis, Myositis And Bursitis Without Mcc	19	$31,905.48	$31,905.48	$31,905.48	nat. median $9,057 outlier · 3.5×
949 MS_DRG	Aftercare With Cc/mcc	19	$31,655.18	$31,655.18	$31,655.18	nat. median $11,796 outlier · 2.7×
193 MS_DRG	Simple Pneumonia And Pleurisy With Mcc	19	$31,632.43	$31,632.43	$31,632.43	nat. median $12,868 outlier · 2.5×
25682000101 NDC	Soliris	3	$31,310.40	$31,310.40	$31,310.40	nat. median $13,808 outlier · 2.3×
694 MS_DRG	Urinary Stones Without Mcc	19	$31,013.53	$31,013.53	$31,013.53	nat. median $8,213 outlier · 3.8×
55513019201 NDC	Neulasta Onpro	3	$30,806.35	$30,806.35	$30,806.35	nat. median $9,442 outlier · 3.3×
55513019001 NDC	Neulasta 6 Mg	3	$30,806.35	$30,806.35	$30,806.35	nat. median $9,442 outlier · 3.3×
190 MS_DRG	Chronic Obstructive Pulmonary Disease With Mcc*	19	$29,739.31	$29,739.31	$29,739.31	nat. median $11,062 outlier · 2.7×
68982085005 NDC	Octagam	3	$27,972.00	$27,972.00	$27,972.00	nat. median $12,343 outlier · 2.3×
683 MS_DRG	Renal Failure With Cc	19	$27,545.84	$27,545.84	$27,545.84	nat. median $9,108 outlier · 3.0×
0207 RC		2	$16,516.50	$34,198.00	$25,357.25	nat. median $7,332 outlier · 3.5×
0206 RC		2	$15,550.10	$34,198.00	$24,874.05	nat. median $3,149 outlier · 7.9×

Other procedures at this hospital

Browse this hospital's 4,425 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

4	MS_DRG	Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec…	20	19	$1,425,631.27	—	$130,734.64	$130,734.64	$130,734.64	2026-07-15
166	MS_DRG	Other Respiratory System O.r. Procedures With Mcc	20	19	$1,028,014.56	—	$106,515.42	$106,515.42	$106,515.42	2026-07-15
981	MS_DRG	Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc	20	19	$984,643.87	—	$106,501.77	$106,501.77	$106,501.77	2026-07-15
68875010201	NDC	Gattex	3	3	$99,999.99	—	$99,999.99	$99,999.99	$99,999.99	2026-07-15
207	MS_DRG	Respiratory System Diagnosis With Ventilator Support >96 Hours	20	19	$770,385.51	—	$88,494.35	$88,494.35	$88,494.35	2026-07-15
853	MS_DRG	Infectious And Parasitic Diseases With O.r. Procedures With Mcc	20	19	$1,170,151.11	—	$68,998.84	$68,998.84	$68,998.84	2026-07-15
500	MS_DRG	Soft Tissue Procedures With Mcc	20	19	$267,055.02	—	$56,051.88	$56,051.88	$56,051.88	2026-07-15
939	MS_DRG	O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc	20	19	$359,288.27	—	$53,944.88	$53,944.88	$53,944.88	2026-07-15
208	MS_DRG	Respiratory System Diagnosis With Ventilator Support <=96 Hours	20	19	$242,851.63	—	$53,735.54	$53,735.54	$53,735.54	2026-07-15
55292070255	NDC	Hemin For Injection	3	3	$51,333.70	—	$51,333.70	$51,333.70	$51,333.70	2026-07-15
438	MS_DRG	Disorders Of Pancreas Except Malignancy With Mcc	20	19	$920,473.10	—	$47,678.46	$47,678.46	$47,678.46	2026-07-15
189	MS_DRG	Pulmonary Edema And Respiratory Failure	20	19	$449,557.36	—	$44,538.43	$44,538.43	$44,538.43	2026-07-15
539	MS_DRG	Osteomyelitis With Mcc*	20	19	$372,567.23	—	$44,110.65	$44,110.65	$44,110.65	2026-07-15
811	MS_DRG	Red Blood Cell Disorders With Mcc	20	19	$442,462.77	—	$42,335.85	$42,335.85	$42,335.85	2026-07-15
757	MS_DRG	Infections, Female Reproductive System With Mcc	20	19	$654,586.00	—	$42,335.85	$42,335.85	$42,335.85	2026-07-15
56	MS_DRG	Degenerative Nervous System Disorders With Mcc	20	19	$557,650.61	—	$41,325.58	$41,325.58	$41,325.58	2026-07-15
371	MS_DRG	Major Gastrointestinal Disorders And Peritoneal Infections With Mcc	20	19	$331,032.76	—	$40,661.17	$40,661.17	$40,661.17	2026-07-15
637	MS_DRG	Diabetes With Mcc	20	19	$560,505.20	—	$40,237.94	$40,237.94	$40,237.94	2026-07-15
592	MS_DRG	Skin Ulcers With Mcc	20	19	$684,412.51	—	$40,046.81	$40,046.81	$40,046.81	2026-07-15
682	MS_DRG	Renal Failure With Mcc	20	19	$266,003.35	—	$39,714.61	$39,714.61	$39,714.61	2026-07-15
59627033304	NDC	Avonex Pen 30 mcg/0.5mL	3	3	$39,676.03	—	$39,676.03	$39,676.03	$39,676.03	2026-07-15
59627022205	NDC	Avonex	3	3	$39,676.03	—	$39,676.03	$39,676.03	$39,676.03	2026-07-15
74368303	NDC	Lupron Depot	3	3	$39,246.62	—	$39,246.62	$39,246.62	$39,246.62	2026-07-15
871	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	20	19	$383,354.53	—	$38,631.52	$38,631.52	$38,631.52	2026-07-15
91	MS_DRG	Other Disorders Of Nervous System With Mcc	20	19	$527,931.98	—	$37,880.64	$37,880.64	$37,880.64	2026-07-15
70	MS_DRG	Nonspecific Cerebrovascular Disorders With Mcc*	20	19	$72,078.71	—	$37,202.58	$37,202.58	$37,202.58	2026-07-15
177	MS_DRG	Respiratory Infections And Inflammations With Mcc*	20	19	$271,033.48	—	$36,888.57	$36,888.57	$36,888.57	2026-07-15
559	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Mcc*	20	19	$451,917.63	—	$36,679.24	$36,679.24	$36,679.24	2026-07-15
391	MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	20	19	$465,130.66	—	$35,241.19	$35,241.19	$35,241.19	2026-07-15
291	MS_DRG	Heart Failure And Shock With Mcc	20	19	$479,288.07	—	$35,018.21	$35,018.21	$35,018.21	2026-07-15
444	MS_DRG	Disorders Of The Biliary Tract With Mcc*	20	19	$811,087.33	—	$34,608.64	$34,608.64	$34,608.64	2026-07-15
299	MS_DRG	Peripheral Vascular Disorders With Mcc	20	19	$397,704.38	—	$34,503.97	$34,503.97	$34,503.97	2026-07-15
432	MS_DRG	Cirrhosis And Alcoholic Hepatitis With Mcc	20	19	$170,140.32	—	$33,584.71	$33,584.71	$33,584.71	2026-07-15
74055402	NDC	Humira(Cf) Pen	3	3	$33,228.58	—	$33,228.58	$33,228.58	$33,228.58	2026-07-15
2144511	NDC	Taltz Autoinjector	3	3	$33,195.46	—	$33,195.46	$33,195.46	$33,195.46	2026-07-15
372	MS_DRG	Major Gastrointestinal Disorders And Peritoneal Infections With Cc	20	19	$703,919.04	—	$33,011.32	$33,011.32	$33,011.32	2026-07-15
540	MS_DRG	Osteomyelitis With Cc*	20	19	$164,429.99	—	$32,369.66	$32,369.66	$32,369.66	2026-07-15
638	MS_DRG	Diabetes With Cc	20	19	$332,506.57	—	$32,023.80	$32,023.80	$32,023.80	2026-07-15
558	MS_DRG	Tendonitis, Myositis And Bursitis Without Mcc	20	19	$51,072.35	—	$31,905.48	$31,905.48	$31,905.48	2026-07-15
949	MS_DRG	Aftercare With Cc/mcc	20	19	$512,754.05	—	$31,655.18	$31,655.18	$31,655.18	2026-07-15
193	MS_DRG	Simple Pneumonia And Pleurisy With Mcc	20	19	$337,848.39	—	$31,632.43	$31,632.43	$31,632.43	2026-07-15
25682000101	NDC	Soliris	3	3	$31,310.40	—	$31,310.40	$31,310.40	$31,310.40	2026-07-15
694	MS_DRG	Urinary Stones Without Mcc	20	19	$535,378.38	—	$31,013.53	$31,013.53	$31,013.53	2026-07-15
55513019201	NDC	Neulasta Onpro	3	3	$30,806.35	—	$30,806.35	$30,806.35	$30,806.35	2026-07-15
55513019001	NDC	Neulasta 6 Mg	3	3	$30,806.35	—	$30,806.35	$30,806.35	$30,806.35	2026-07-15
190	MS_DRG	Chronic Obstructive Pulmonary Disease With Mcc*	20	19	$73,417.72	—	$29,739.31	$29,739.31	$29,739.31	2026-07-15
68982085005	NDC	Octagam	3	3	$27,972.00	—	$27,972.00	$27,972.00	$27,972.00	2026-07-15
683	MS_DRG	Renal Failure With Cc	20	19	$215,762.13	—	$27,545.84	$27,545.84	$27,545.84	2026-07-15
0207	RC	—	2	2	$16,516.50	—	$16,516.50	$34,198.00	$25,357.25	2026-07-15
0206	RC	—	2	2	$15,550.10	—	$15,550.10	$34,198.00	$24,874.05	2026-07-15
0120	RC	—	2	2	$15,500.10	—	$15,500.10	$34,198.00	$24,849.05	2026-07-15
50633012011	NDC	Digifab	3	3	$22,958.40	—	$22,958.40	$22,958.40	$22,958.40	2026-07-15
78081881	NDC	SandoSTATIN Lar Depot	3	3	$22,158.24	—	$22,158.24	$22,158.24	$22,158.24	2026-07-15
603	MS_DRG	Cellulitis Without Mcc	20	19	$287,446.71	—	$21,911.98	$21,911.98	$21,911.98	2026-07-15
950	MS_DRG	Aftercare Without Cc/mcc	20	19	$253,093.61	—	$21,752.70	$21,752.70	$21,752.70	2026-07-15
2840001	NDC	Forteo	3	3	$20,591.47	—	$20,591.47	$20,591.47	$20,591.47	2026-07-15
50458060901	NDC	Invega Trinza	3	3	$19,046.87	—	$19,046.87	$19,046.87	$19,046.87	2026-07-15
68982085004	NDC	Octagam	3	3	$18,648.00	—	$18,648.00	$18,648.00	$18,648.00	2026-07-15
55513003201	NDC	Aranesp	3	3	$18,576.00	—	$18,576.00	$18,576.00	$18,576.00	2026-07-15
78063998	NDC	Cosentyx	3	3	$17,781.50	—	$17,781.50	$17,781.50	$17,781.50	2026-07-15
173089201	NDC	Mepolizumab Injection	3	3	$17,706.38	—	$17,706.38	$17,706.38	$17,706.38	2026-07-15
44206043820	NDC	Privigen 10%	3	3	$17,379.84	—	$17,379.84	$17,379.84	$17,379.84	2026-07-15
78081181	NDC	SandoSTATIN Lar Depot	3	3	$16,912.46	—	$16,912.46	$16,912.46	$16,912.46	2026-07-15
50458056401	NDC	Invega Sustenna 234 Mg	3	3	$16,697.76	—	$16,697.76	$16,697.76	$16,697.76	2026-07-15
74379902	NDC	Humira	3	3	$16,614.29	—	$16,614.29	$16,614.29	$16,614.29	2026-07-15
944270006	NDC	Gammagard Liquid	3	3	$16,273.92	—	$16,273.92	$16,273.92	$16,273.92	2026-07-15
55513073001	NDC	Denosumab 120 mg/1.7mL	3	3	$15,770.26	—	$15,770.26	$15,770.26	$15,770.26	2026-07-15
51759063010	NDC	risperiDONE ER Inj 125 Mg/0.35	3	3	$15,375.36	—	$15,375.36	$15,375.36	$15,375.36	2026-07-15
24201040002	NDC	Calcitonin,salmon Inj 400 Unit	3	3	$15,028.80	—	$15,028.80	$15,028.80	$15,028.80	2026-07-15
42367054032	NDC	Ryanodex	3	3	$14,040.84	—	$14,040.84	$14,040.84	$14,040.84	2026-07-15
59148001971	NDC	Abilify Maintena	3	3	$13,535.23	—	$13,535.23	$13,535.23	$13,535.23	2026-07-15
59148007280	NDC	Abilify Maintena 400 Mg	3	3	$13,535.23	—	$13,535.23	$13,535.23	$13,535.23	2026-07-15
67457067502	NDC	Miacalcin	3	3	$12,974.72	—	$12,974.72	$12,974.72	$12,974.72	2026-07-15
70539000102	NDC	Tymlos	3	3	$12,801.60	—	$12,801.60	$12,801.60	$12,801.60	2026-07-15
55513022101	NDC	Nplate 250 Mcg	3	3	$12,585.22	—	$12,585.22	$12,585.22	$12,585.22	2026-07-15
50474070062	NDC	Cimzia	3	3	$12,239.24	—	$12,239.24	$12,239.24	$12,239.24	2026-07-15
55513011101	NDC	Aranesp	3	3	$11,145.60	—	$11,145.60	$11,145.60	$11,145.60	2026-07-15
50458056301	NDC	Invega Sustenna 156 Mg	3	3	$11,132.11	—	$11,132.11	$11,132.11	$11,132.11	2026-07-15
50458056101	NDC	Invega Sustenna	3	3	$11,131.49	—	$11,131.49	$11,131.49	$11,131.49	2026-07-15
50458056001	NDC	Invega Sustenna	3	3	$11,131.01	—	$11,131.01	$11,131.01	$11,131.01	2026-07-15
944265804	NDC	Gammagard S-d 10 Gram	3	3	$10,764.48	—	$10,764.48	$10,764.48	$10,764.48	2026-07-15
61953000405	NDC	Flebogamma Dif	3	3	$10,164.48	—	$10,164.48	$10,164.48	$10,164.48	2026-07-15
59148004580	NDC	Abilify Maintena	3	3	$10,151.42	—	$10,151.42	$10,151.42	$10,151.42	2026-07-15
67457083306	NDC	Pegfilgrastim-jmdb	3	3	$10,020.00	—	$10,020.00	$10,020.00	$10,020.00	2026-07-15
74364203	NDC	Lupron Depot	3	3	$9,811.68	—	$9,811.68	$9,811.68	$9,811.68	2026-07-15
68982085003	NDC	Octagam 10%	3	3	$9,324.00	—	$9,324.00	$9,324.00	$9,324.00	2026-07-15
58406003204	NDC	EnbreL Sureclick	3	3	$9,148.70	—	$9,148.70	$9,148.70	$9,148.70	2026-07-15
24591401	NDC	Dupixent Syringe	3	3	$9,127.68	—	$9,127.68	$9,127.68	$9,127.68	2026-07-15
44206043710	NDC	Privigen 10%	3	3	$8,689.92	—	$8,689.92	$8,689.92	$8,689.92	2026-07-15
55513071001	NDC	Prolia	3	3	$8,573.38	—	$8,573.38	$8,573.38	$8,573.38	2026-07-15
57970010001	NDC	Dalbavancin Hcl	3	3	$8,539.82	—	$8,539.82	$8,539.82	$8,539.82	2026-07-15
50458056201	NDC	Invega Sustenna 117 Mg	3	3	$8,348.78	—	$8,348.78	$8,348.78	$8,348.78	2026-07-15
31600	CPT	Tracheostomy	3	3	$8,209.00	—	$8,209.00	$8,209.00	$8,209.00	2026-07-15
944270005	NDC	Gammagard Liquid 10%	3	3	$8,136.96	—	$8,136.96	$8,136.96	$8,136.96	2026-07-15
64842072709	NDC	Decitabine/Cedazuridine 35/100	3	3	$7,931.30	—	$7,931.30	$7,931.30	$7,931.30	2026-07-15
65757030001	NDC	VivitroL	3	3	$7,877.33	—	$7,877.33	$7,877.33	$7,877.33	2026-07-15
55513000601	NDC	Aranesp	3	3	$7,430.40	—	$7,430.40	$7,430.40	$7,430.40	2026-07-15
55513002801	NDC	Aranesp	3	3	$7,430.40	—	$7,430.40	$7,430.40	$7,430.40	2026-07-15
59676082001	NDC	Monovisc	3	3	$7,200.00	—	$7,200.00	$7,200.00	$7,200.00	2026-07-15
9029703	NDC	Gelfilm 25x50mm	3	3	$7,140.96	—	$7,140.96	$7,140.96	$7,140.96	2026-07-15
517065001	NDC	Injectafer	3	3	$6,862.56	—	$6,862.56	$6,862.56	$6,862.56	2026-07-15
3218811	NDC	Orencia	3	3	$6,834.32	—	$6,834.32	$6,834.32	$6,834.32	2026-07-15
13533080071	NDC	Gamunex-c	3	3	$6,804.00	—	$6,804.00	$6,804.00	$6,804.00	2026-07-15
65162091322	NDC	Voriconazole Oral Susp (bulk)	3	3	$6,753.68	—	$6,753.68	$6,753.68	$6,753.68	2026-07-15
4026129	NDC	Cellcept (160ml Bottle)	3	3	$6,628.18	—	$6,628.18	$6,628.18	$6,628.18	2026-07-15
50484081015	NDC	Regranex	3	3	$6,526.56	—	$6,526.56	$6,526.56	$6,526.56	2026-07-15
62935022305	NDC	Leuprolide Acetate	3	3	$6,504.34	—	$6,504.34	$6,504.34	$6,504.34	2026-07-15
31722062921	NDC	Atovaquone (Bulk Bottle)	3	3	$6,307.16	—	$6,307.16	$6,307.16	$6,307.16	2026-07-15
55513022301	NDC	Romiplostim	3	3	$6,292.70	—	$6,292.70	$6,292.70	$6,292.70	2026-07-15
78043561	NDC	Reclast 5 Mg	3	3	$6,283.44	—	$6,283.44	$6,283.44	$6,283.44	2026-07-15
23392102	NDC	Botox	3	3	$6,201.60	—	$6,201.60	$6,201.60	$6,201.60	2026-07-15
81436	CPT	Hereditary Colon Ca Dsordrs	3	3	$6,141.00	—	$6,141.00	$6,141.00	$6,141.00	2026-07-15
44146	CPT	Colec Part W Colopros W/colost	3	3	$5,934.18	—	$5,934.18	$5,934.18	$5,934.18	2026-07-15
50458030811	NDC	RisperDAL Consta 50 Mg	3	3	$5,900.21	—	$5,900.21	$5,900.21	$5,900.21	2026-07-15
59338077501	NDC	Feraheme 510 Mg	3	3	$5,729.38	—	$5,729.38	$5,729.38	$5,729.38	2026-07-15
57894003001	NDC	Remicade 100 Mg	3	3	$5,605.54	—	$5,605.54	$5,605.54	$5,605.54	2026-07-15
44208	CPT	Laparosc, Surg Colectomy, Part	3	3	$5,584.11	—	$5,584.11	$5,584.11	$5,584.11	2026-07-15
55513002704	NDC	Aranesp	3	3	$5,572.80	—	$5,572.80	$5,572.80	$5,572.80	2026-07-15
61958180101	NDC	Harvoni	3	3	$5,400.00	—	$5,400.00	$5,400.00	$5,400.00	2026-07-15
944265603	NDC	Gammagard S-d 5 Gram	3	3	$5,382.24	—	$5,382.24	$5,382.24	$5,382.24	2026-07-15
82154044901	NDC	Peginterferon Alfa-2a	3	3	$5,344.42	—	$5,344.42	$5,344.42	$5,344.42	2026-07-15
59676034001	NDC	Procrit	3	3	$5,131.20	—	$5,131.20	$5,131.20	$5,131.20	2026-07-15
43246	CPT	Peg	3	3	$4,875.00	—	$4,875.00	$4,875.00	$4,875.00	2026-07-15
74181	CPT	Mr Abdomen Wo	3	3	$4,819.04	—	$4,819.04	$4,819.04	$4,819.04	2026-07-15
61958150101	NDC	Sovaldi	3	3	$4,800.00	—	$4,800.00	$4,800.00	$4,800.00	2026-07-15
68982085002	NDC	Octagam	3	3	$4,662.00	—	$4,662.00	$4,662.00	$4,662.00	2026-07-15
50742031025	NDC	Mafenide Acetate For Topical S	3	3	$4,661.36	—	$4,661.36	$4,661.36	$4,661.36	2026-07-15
169477212	NDC	Semaglutide (2 Mg/dose)	3	3	$4,648.90	—	$4,648.90	$4,648.90	$4,648.90	2026-07-15
169413013	NDC	Semaglutide Injection	3	3	$4,648.90	—	$4,648.90	$4,648.90	$4,648.90	2026-07-15
169418113	NDC	Semaglutide	3	3	$4,648.90	—	$4,648.90	$4,648.90	$4,648.90	2026-07-15
65757040203	NDC	Aristada	3	3	$4,637.50	—	$4,637.50	$4,637.50	$4,637.50	2026-07-15
65757040103	NDC	Aristada	3	3	$4,633.98	—	$4,633.98	$4,633.98	$4,633.98	2026-07-15
65757040303	NDC	Aristada	3	3	$4,633.96	—	$4,633.96	$4,633.96	$4,633.96	2026-07-15
65757040403	NDC	Aristada	3	3	$4,586.84	—	$4,586.84	$4,586.84	$4,586.84	2026-07-15
66794015702	NDC	Gablofen	3	3	$4,536.67	—	$4,536.67	$4,536.67	$4,536.67	2026-07-15
65054301	NDC	Triesence 40 Mg	3	3	$4,531.20	—	$4,531.20	$4,531.20	$4,531.20	2026-07-15
50242005121	NDC	Rituxan	3	3	$4,509.70	—	$4,509.70	$4,509.70	$4,509.70	2026-07-15
31622	CPT	Rt Bronchoscopy	3	3	$4,482.10	—	$4,482.10	$4,482.10	$4,482.10	2026-07-15
78608	CPT	PET Brain Metabolic	3	3	$4,474.60	—	$4,474.60	$4,474.60	$4,474.60	2026-07-15
16110081230	NDC	Fluoroplex 1 %	3	3	$4,454.16	—	$4,454.16	$4,454.16	$4,454.16	2026-07-15
50458030711	NDC	RisperDAL Consta 37.5 Mg	3	3	$4,425.02	—	$4,425.02	$4,425.02	$4,425.02	2026-07-15
44206043605	NDC	Privigen	3	3	$4,344.96	—	$4,344.96	$4,344.96	$4,344.96	2026-07-15
59572041500	NDC	Revlimid	3	3	$4,279.44	—	$4,279.44	$4,279.44	$4,279.44	2026-07-15
59572041028	NDC	Revlimid	3	3	$4,279.44	—	$4,279.44	$4,279.44	$4,279.44	2026-07-15
59572042521	NDC	Revlimid	3	3	$4,279.44	—	$4,279.44	$4,279.44	$4,279.44	2026-07-15
61958220101	NDC	Epclusa	3	3	$4,272.00	—	$4,272.00	$4,272.00	$4,272.00	2026-07-15
44087004403	NDC	Rebif	3	3	$4,226.26	—	$4,226.26	$4,226.26	$4,226.26	2026-07-15
44087002203	NDC	Rebif 22 mcg/0.5mL	3	3	$4,226.26	—	$4,226.26	$4,226.26	$4,226.26	2026-07-15
36569	CPT	Picc Line Insertion	3	3	$4,201.50	—	$4,201.50	$4,201.50	$4,201.50	2026-07-15
42388002426	NDC	Cabometyx	3	3	$4,093.57	—	$4,093.57	$4,093.57	$4,093.57	2026-07-15
42388002526	NDC	Cabometyx	3	3	$4,093.57	—	$4,093.57	$4,093.57	$4,093.57	2026-07-15
42388002326	NDC	Cabometyx	3	3	$4,093.57	—	$4,093.57	$4,093.57	$4,093.57	2026-07-15
310651201	NDC	Byetta	3	3	$4,079.76	—	$4,079.76	$4,079.76	$4,079.76	2026-07-15
310652401	NDC	Byetta	3	3	$4,079.76	—	$4,079.76	$4,079.76	$4,079.76	2026-07-15
944270004	NDC	Gammagard Liquid 10%	3	3	$4,068.48	—	$4,068.48	$4,068.48	$4,068.48	2026-07-15
378972055	NDC	Denavir 1 %	3	3	$3,897.55	—	$3,897.55	$3,897.55	$3,897.55	2026-07-15
62856070430	NDC	Lenvima	3	3	$3,880.80	—	$3,880.80	$3,880.80	$3,880.80	2026-07-15
90935	CPT	Hemodialysis	3	3	$3,863.25	—	$3,863.25	$3,863.25	$3,863.25	2026-07-15
69098038	NDC	Sutent	3	3	$3,853.62	—	$3,853.62	$3,853.62	$3,853.62	2026-07-15
73562011201	NDC	Lipase/Protea/Amyl 20-63-84k U	3	3	$3,846.24	—	$3,846.24	$3,846.24	$3,846.24	2026-07-15
55513000504	NDC	Aranesp	3	3	$3,715.20	—	$3,715.20	$3,715.20	$3,715.20	2026-07-15
55513002504	NDC	Darbepoetin Alfa 100 M 100 Mcg	3	3	$3,715.20	—	$3,715.20	$3,715.20	$3,715.20	2026-07-15
55724021121	NDC	Eucrisa	3	3	$3,661.87	—	$3,661.87	$3,661.87	$3,661.87	2026-07-15
69018821	NDC	Ibrance	3	3	$3,653.12	—	$3,653.12	$3,653.12	$3,653.12	2026-07-15
55513084301	NDC	Erenumab-aooe	3	3	$3,612.58	—	$3,612.58	$3,612.58	$3,612.58	2026-07-15
36000	CPT	Mid Line Cath	3	3	$3,604.15	—	$3,604.15	$3,604.15	$3,604.15	2026-07-15
2850101	NDC	HumuLIN R U-500	6	3	$3,572.36	—	$7.12	$7,137.60	$3,572.36	2026-07-15
60793090910	NDC	Thrombi-gel 100 Cm2	3	3	$3,556.46	—	$3,556.46	$3,556.46	$3,556.46	2026-07-15
51759020210	NDC	Ajovy Autoinjector	3	3	$3,519.16	—	$3,519.16	$3,519.16	$3,519.16	2026-07-15
51759020410	NDC	Ajovy 225 mg/1.5mL Syringe	3	3	$3,519.16	—	$3,519.16	$3,519.16	$3,519.16	2026-07-15
480372056	NDC	Pyrimethamine	3	3	$3,420.00	—	$3,420.00	$3,420.00	$3,420.00	2026-07-15
2143611	NDC	Galcanezumab-gnlm Pen	3	3	$3,390.58	—	$3,390.58	$3,390.58	$3,390.58	2026-07-15
50419052435	NDC	Betaseron	3	3	$3,343.82	—	$3,343.82	$3,343.82	$3,343.82	2026-07-15
49471000105	NDC	Pre-pen .25 Ml	3	3	$3,244.80	—	$3,244.80	$3,244.80	$3,244.80	2026-07-15
78056751	NDC	Afinitor 10 Mg	3	3	$3,200.31	—	$3,200.31	$3,200.31	$3,200.31	2026-07-15
173088710	NDC	Trelegy Ellipta 100-62.5	3	3	$3,156.86	—	$3,156.86	$3,156.86	$3,156.86	2026-07-15
23923201	NDC	Botox Cosmetic	3	3	$3,148.80	—	$3,148.80	$3,148.80	$3,148.80	2026-07-15
78068715	NDC	Promacta	3	3	$3,147.39	—	$3,147.39	$3,147.39	$3,147.39	2026-07-15
13533063402	NDC	Hypertet S-d 250 Unit	3	3	$3,116.02	—	$3,116.02	$3,116.02	$3,116.02	2026-07-15
23114501	NDC	Botox 100 Unit	3	3	$3,100.80	—	$3,100.80	$3,100.80	$3,100.80	2026-07-15
310461612	NDC	Budesonide/Glycopyr/Formoterol	3	3	$3,096.67	—	$3,096.67	$3,096.67	$3,096.67	2026-07-15
58914030180	NDC	Rectiv	3	3	$3,075.55	—	$3,075.55	$3,075.55	$3,075.55	2026-07-15
299598035	NDC	Mirvaso	3	3	$3,060.10	—	$3,060.10	$3,060.10	$3,060.10	2026-07-15
70510217102	NDC	Radicava	3	3	$3,053.81	—	$3,053.81	$3,053.81	$3,053.81	2026-07-15
60793070210	NDC	Bicillin L-a 2400000 Unit	3	3	$2,999.86	—	$2,999.86	$2,999.86	$2,999.86	2026-07-15
50458030611	NDC	RisperDAL Consta 25 Mg	3	3	$2,949.89	—	$2,949.89	$2,949.89	$2,949.89	2026-07-15
43598000451	NDC	Augmentin	3	3	$2,935.68	—	$2,935.68	$2,935.68	$2,935.68	2026-07-15
60793090701	NDC	Thrombi-gel 10 Cm2	3	3	$2,931.41	—	$2,931.41	$2,931.41	$2,931.41	2026-07-15
72511077001	NDC	Evolocumab 420 mg/3.5mL	3	3	$2,919.74	—	$2,919.74	$2,919.74	$2,919.74	2026-07-15
3085222	NDC	SpryceL	3	3	$2,919.41	—	$2,919.41	$2,919.41	$2,919.41	2026-07-15
72157	CPT	Mr Spine Thoracic W/wo	3	3	$2,900.44	—	$2,900.44	$2,900.44	$2,900.44	2026-07-15
72156	CPT	Mr Spine Cervical W/wo	3	3	$2,900.44	—	$2,900.44	$2,900.44	$2,900.44	2026-07-15
61958290102	NDC	Veklury	3	3	$2,877.50	—	$2,877.50	$2,877.50	$2,877.50	2026-07-15
72158	CPT	MRI Spine Lumbar W/wo	3	3	$2,855.64	—	$2,855.64	$2,855.64	$2,855.64	2026-07-15
70553	CPT	MRI Brain/stem Wo/w	3	3	$2,852.72	—	$2,852.72	$2,852.72	$2,852.72	2026-07-15
51672137108	NDC	clobetasoL Propionate	3	3	$2,842.36	—	$2,842.36	$2,842.36	$2,842.36	2026-07-15
43235	CPT	Upper Gastro/Endoscopy	3	3	$2,834.00	—	$2,834.00	$2,834.00	$2,834.00	2026-07-15
72197	CPT	Mr Pelvis W/wo	3	3	$2,828.92	—	$2,828.92	$2,828.92	$2,828.92	2026-07-15
74183	CPT	Mr Abdomen W/wo	3	3	$2,827.44	—	$2,827.44	$2,827.44	$2,827.44	2026-07-15
57962042028	NDC	Imbruvica	3	3	$2,809.99	—	$2,809.99	$2,809.99	$2,809.99	2026-07-15
59353040509	NDC	Methoxy Peg-epoetin 200 Mcg/0.	3	3	$2,769.36	—	$2,769.36	$2,769.36	$2,769.36	2026-07-15
90937	CPT	Peritoneal Dialysis	3	3	$2,688.70	—	$2,688.70	$2,688.70	$2,688.70	2026-07-15
69238101302	NDC	Testosterone	3	3	$2,682.88	—	$2,682.88	$2,682.88	$2,682.88	2026-07-15
9379401	NDC	Corvert	3	3	$2,634.48	—	$2,634.48	$2,634.48	$2,634.48	2026-07-15
A0426	HCPCS	Amb Non Emr Als Rnd Trip	3	3	$2,600.00	—	$2,600.00	$2,600.00	$2,600.00	2026-07-15
59148002150	NDC	Samsca 30 Mg	3	3	$2,590.29	—	$2,590.29	$2,590.29	$2,590.29	2026-07-15
55513020901	NDC	Neupogen	3	3	$2,550.86	—	$2,550.86	$2,550.86	$2,550.86	2026-07-15
85433101	NDC	Noxafil	3	3	$2,546.16	—	$2,546.16	$2,546.16	$2,546.16	2026-07-15
61953000403	NDC	Flebogamma Dif	3	3	$2,541.12	—	$2,541.12	$2,541.12	$2,541.12	2026-07-15
63323064810	NDC	Levothyroxine Sodium	3	3	$2,533.97	—	$2,533.97	$2,533.97	$2,533.97	2026-07-15
597016061	NDC	Spiriva Respimat	3	3	$2,531.47	—	$2,531.47	$2,531.47	$2,531.47	2026-07-15
5200010	NDC	Pneumoc 20-val Conj-dip Crm/Pf	3	3	$2,503.78	—	$2,503.78	$2,503.78	$2,503.78	2026-07-15
59148002050	NDC	Samsca 15 Mg	3	3	$2,496.95	—	$2,496.95	$2,496.95	$2,496.95	2026-07-15
78206018401	NDC	Adalimumab-bwwd	3	3	$2,491.20	—	$2,491.20	$2,491.20	$2,491.20	2026-07-15
50090073200	NDC	Advair Diskus	3	3	$2,486.88	—	$2,486.88	$2,486.88	$2,486.88	2026-07-15
43247	CPT	Egd Flx Transoral W/for Bdy Rm	3	3	$2,476.53	—	$2,476.53	$2,476.53	$2,476.53	2026-07-15
24208050405	NDC	Vyzulta	3	3	$2,451.17	—	$2,451.17	$2,451.17	$2,451.17	2026-07-15
71571033383	NDC	Loteprednol Etabonate 0.25% Op	3	3	$2,438.50	—	$2,438.50	$2,438.50	$2,438.50	2026-07-15
49084	CPT	Paracentesis	3	3	$2,428.80	—	$2,428.80	$2,428.80	$2,428.80	2026-07-15
10631009160	NDC	Eurax	3	3	$2,428.42	—	$2,428.42	$2,428.42	$2,428.42	2026-07-15
74185	CPT	MRI Angio Abdom W Or Without Contrast	3	3	$2,422.72	—	$2,422.72	$2,422.72	$2,422.72	2026-07-15
51991082328	NDC	Everolimus	3	3	$2,422.24	—	$2,422.24	$2,422.24	$2,422.24	2026-07-15
23320505	NDC	Bimatoprost 0.01% 5ml	3	3	$2,412.34	—	$2,412.34	$2,412.34	$2,412.34	2026-07-15
55513054610	NDC	Neupogen 480 Mcg	3	3	$2,406.38	—	$2,406.38	$2,406.38	$2,406.38	2026-07-15
378932232	NDC	Wixela Inhub 500/50	3	3	$2,362.52	—	$2,362.52	$2,362.52	$2,362.52	2026-07-15
597002402	NDC	Combivent Respimat	3	3	$2,348.83	—	$2,348.83	$2,348.83	$2,348.83	2026-07-15
55566830301	NDC	Firmagon	3	3	$2,344.56	—	$2,344.56	$2,344.56	$2,344.56	2026-07-15
68546032512	NDC	Copaxone 40 Mg	3	3	$2,332.80	—	$2,332.80	$2,332.80	$2,332.80	2026-07-15
72142	CPT	Mr Spine Cervical W	3	3	$2,332.16	—	$2,332.16	$2,332.16	$2,332.16	2026-07-15
72147	CPT	Mr Spine Thoracic W	3	3	$2,314.32	—	$2,314.32	$2,314.32	$2,314.32	2026-07-15
72196	CPT	Mr Pelvis W	3	3	$2,291.84	—	$2,291.84	$2,291.84	$2,291.84	2026-07-15
74182	CPT	MRI Abdomen With	3	3	$2,290.36	—	$2,290.36	$2,290.36	$2,290.36	2026-07-15
173086910	NDC	Anoro Ellipta	3	3	$2,279.23	—	$2,279.23	$2,279.23	$2,279.23	2026-07-15
597008717	NDC	Atrovent Hfa	3	3	$2,265.89	—	$2,265.89	$2,265.89	$2,265.89	2026-07-15
24208053535	NDC	Zirgan	3	3	$2,256.34	—	$2,256.34	$2,256.34	$2,256.34	2026-07-15
73720	CPT	MRI Extremity Lower Rt W/wo	3	3	$2,230.28	—	$2,230.28	$2,230.28	$2,230.28	2026-07-15
55513000404	NDC	Aranesp	3	3	$2,229.12	—	$2,229.12	$2,229.12	$2,229.12	2026-07-15
55513002304	NDC	Aranesp 60 Mcg	3	3	$2,229.12	—	$2,229.12	$2,229.12	$2,229.12	2026-07-15
73220	CPT	MRI Upper Ext W/wo Dye Lt	6	3	$2,216.04	—	$2,216.04	$2,216.04	$2,216.04	2026-07-15
713063337	NDC	metroNIDAZOLE 0.75 %	3	3	$2,199.48	—	$2,199.48	$2,199.48	$2,199.48	2026-07-15
49281019020	NDC	Imogam Rabies-ht 150 Unit	3	3	$2,172.31	—	$2,172.31	$2,172.31	$2,172.31	2026-07-15
46087221	NDC	Premarin .625 Mg	3	3	$2,160.24	—	$2,160.24	$2,160.24	$2,160.24	2026-07-15
14789001101	NDC	Isoproterenol Hcl Inj	3	3	$2,160.00	—	$2,160.00	$2,160.00	$2,160.00	2026-07-15
99999998396	NDC	Tacrolimus 0.5mg/mL - 240mL Bo	3	3	$2,140.80	—	$2,140.80	$2,140.80	$2,140.80	2026-07-15
69130904	NDC	Retacrit	3	3	$2,117.76	—	$2,117.76	$2,117.76	$2,117.76	2026-07-15
173071720	NDC	Advair Hfa 230-21mcg	3	3	$2,110.66	—	$2,110.66	$2,110.66	$2,110.66	2026-07-15
61314032601	NDC	Zarxio	3	3	$2,107.10	—	$2,107.10	$2,107.10	$2,107.10	2026-07-15
37683015	NDC	Cortifoam 10 %	3	3	$2,105.28	—	$2,105.28	$2,105.28	$2,105.28	2026-07-15
78068615	NDC	Promacta	3	3	$2,098.26	—	$2,098.26	$2,098.26	$2,098.26	2026-07-15
49281025051	NDC	Imovax Rabies Vaccine 2.5 Unit	3	3	$2,082.29	—	$2,082.29	$2,082.29	$2,082.29	2026-07-15
73223	CPT	Mr Ext Lower Joint Ww Lt	6	3	$2,081.36	—	$2,081.36	$2,081.36	$2,081.36	2026-07-15
59353040409	NDC	Methoxy Peg-epoetin 150 Mcg/0.	3	3	$2,077.01	—	$2,077.01	$2,077.01	$2,077.01	2026-07-15
61958080101	NDC	Letairis	3	3	$2,076.89	—	$2,076.89	$2,076.89	$2,076.89	2026-07-15
46287002004	NDC	Carospir	3	3	$2,074.56	—	$2,074.56	$2,074.56	$2,074.56	2026-07-15
42023021910	NDC	Vasopressin 40 units/100mL	3	3	$2,038.80	—	$2,038.80	$2,038.80	$2,038.80	2026-07-15
173052100	NDC	Salmeterol Xinafoate	3	3	$2,032.61	—	$2,032.61	$2,032.61	$2,032.61	2026-07-15
71552	CPT	Mr Chest W/wo	3	3	$2,017.80	—	$2,017.80	$2,017.80	$2,017.80	2026-07-15
71551	CPT	Mr Chest W	3	3	$2,017.80	—	$2,017.80	$2,017.80	$2,017.80	2026-07-15
71550	CPT	Mr Chest Wo	3	3	$2,017.80	—	$2,017.80	$2,017.80	$2,017.80	2026-07-15
51224001210	NDC	Phentolamine Mesylate 5 Mg	3	3	$2,006.40	—	$2,006.40	$2,006.40	$2,006.40	2026-07-15
60793090804	NDC	Thrombi-gel 40 Cm2	3	3	$1,957.87	—	$1,957.87	$1,957.87	$1,957.87	2026-07-15
173091610	NDC	Fluticasone/Vilanterol 50-25 M	3	3	$1,954.66	—	$1,954.66	$1,954.66	$1,954.66	2026-07-15
173088210	NDC	Breo Ellipta	3	3	$1,954.66	—	$1,954.66	$1,954.66	$1,954.66	2026-07-15
93318	CPT	Tee	3	3	$1,931.00	—	$1,931.00	$1,931.00	$1,931.00	2026-07-15
63459091211	NDC	Granix 480 Mcg	3	3	$1,919.44	—	$1,919.44	$1,919.44	$1,919.44	2026-07-15
456270010	NDC	Avycaz 2.5 Gram	3	3	$1,898.81	—	$1,898.81	$1,898.81	$1,898.81	2026-07-15
23932110	NDC	Alphagan P - 10mL	3	3	$1,865.76	—	$1,865.76	$1,865.76	$1,865.76	2026-07-15
68982085001	NDC	Octagam	3	3	$1,864.80	—	$1,864.80	$1,864.80	$1,864.80	2026-07-15
72146	CPT	Mr Spine Thoracic Without	3	3	$1,851.72	—	$1,851.72	$1,851.72	$1,851.72	2026-07-15
72141	CPT	Mr Spine Cervical Wo	3	3	$1,851.72	—	$1,851.72	$1,851.72	$1,851.72	2026-07-15
168016360	NDC	clobetasoL Propionate 0.05% Cr	3	3	$1,835.84	—	$1,835.84	$1,835.84	$1,835.84	2026-07-15
597013830	NDC	Gilotrif	3	3	$1,831.73	—	$1,831.73	$1,831.73	$1,831.73	2026-07-15
8065183905	NDC	Viscoat 40-30mg/ml	3	3	$1,830.14	—	$1,830.14	$1,830.14	$1,830.14	2026-07-15
72148	CPT	Mr Spine Lumbar Wo	3	3	$1,826.32	—	$1,826.32	$1,826.32	$1,826.32	2026-07-15
70551	CPT	MRI Brain Wo	3	3	$1,824.96	—	$1,824.96	$1,824.96	$1,824.96	2026-07-15
81284052201	NDC	Penicillin G Benzathine	3	3	$1,824.00	—	$1,824.00	$1,824.00	$1,824.00	2026-07-15
72195	CPT	MRI Pelvis Wo	3	3	$1,823.36	—	$1,823.36	$1,823.36	$1,823.36	2026-07-15
73221	CPT	Mr Extr Left Upper Joint Without	6	3	$1,802.40	—	$1,802.40	$1,802.40	$1,802.40	2026-07-15
73721	CPT	Mr Ext Lower Joint Without Lt	6	3	$1,800.92	—	$1,800.92	$1,800.92	$1,800.92	2026-07-15
A0429	HCPCS	Amb Emr Bls One Way	3	3	$1,800.00	—	$1,800.00	$1,800.00	$1,800.00	2026-07-15
73718	CPT	Mr Extremity Left Lower Wo	6	3	$1,796.52	—	$1,796.52	$1,796.52	$1,796.52	2026-07-15
378932132	NDC	Wixela Inhub 250/50mcg	3	3	$1,796.32	—	$1,796.32	$1,796.32	$1,796.32	2026-07-15
73719	CPT	Mr Extremity Right Lower W/wo	3	3	$1,794.92	—	$1,794.92	$1,794.92	$1,794.92	2026-07-15
73219	CPT	MRI Upper Ext With Contrast Lt	3	3	$1,791.00	—	$1,791.00	$1,791.00	$1,791.00	2026-07-15
70542	CPT	Mr Orbit, Face, Neck W	3	3	$1,787.00	—	$1,787.00	$1,787.00	$1,787.00	2026-07-15
46074905	NDC	Premarin 25 Mg	3	3	$1,766.64	—	$1,766.64	$1,766.64	$1,766.64	2026-07-15
70544	CPT	MRI Angiogram Head Without Contrast	3	3	$1,763.72	—	$1,763.72	$1,763.72	$1,763.72	2026-07-15
70547	CPT	MRI Angiography Neck	3	3	$1,748.32	—	$1,748.32	$1,748.32	$1,748.32	2026-07-15
51672130308	NDC	Econazole Nitrate 1% Cream	3	3	$1,738.80	—	$1,738.80	$1,738.80	$1,738.80	2026-07-15
23391950	NDC	Botox Cosmetic	3	3	$1,737.60	—	$1,737.60	$1,737.60	$1,737.60	2026-07-15
93350	CPT	US Stress Tte Only��	3	3	$1,723.47	—	$1,723.47	$1,723.47	$1,723.47	2026-07-15
24208060203	NDC	Prolensa	3	3	$1,712.98	—	$1,712.98	$1,712.98	$1,712.98	2026-07-15
310461639	NDC	Breztri Aerosphere 160-9-4.8	3	3	$1,707.60	—	$1,707.60	$1,707.60	$1,707.60	2026-07-15
78060715	NDC	Gilenya	3	3	$1,701.03	—	$1,701.03	$1,701.03	$1,701.03	2026-07-15
173087310	NDC	Incruse Ellipta	3	3	$1,699.68	—	$1,699.68	$1,699.68	$1,699.68	2026-07-15
66993087761	NDC	Calcipotriene	3	3	$1,694.76	—	$1,694.76	$1,694.76	$1,694.76	2026-07-15
73722	CPT	Mr Ext Lower Joint Rt With	3	3	$1,693.52	—	$1,693.52	$1,693.52	$1,693.52	2026-07-15
70557	CPT	MRI - Brain Without Contrast	3	3	$1,686.00	—	$1,686.00	$1,686.00	$1,686.00	2026-07-15
6382310	NDC	Cancidas	3	3	$1,684.22	—	$1,684.22	$1,684.22	$1,684.22	2026-07-15
69029201	NDC	Nivestym 480mcg/0.8ml	3	3	$1,681.92	—	$1,681.92	$1,681.92	$1,681.92	2026-07-15

See an error in this hospital's data? Submit a correction