Hospital

AVERA ST ANTHONY'S HOSPITAL

O' Neill, NE · CCN 281329 · Rates published

1,323 distinct procedures filed

5 distinct payers

19,836 rate rows

2026-05-09 last MRF observed

Data quality

19,783 of 19,836 rate rows are consumer-grade (99.7%)

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

Excluded — reason	Rows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	20
exceeds 10× this hospital's gross charge — excluded from medians	16
placeholder amount (≤ $0.02) — excluded from medians	9
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	8

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

Source MRF file	https://www.avera.org/app/files/public/2ee985f1-c8f5-4aff-9e24-196f8b6c838b/470463911_avera-st-anthonys-hospital_standardcharges.csv
Discovered via	Discovered by HANK (automated)
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-09-20
Content fingerprint	6c2c74f4ac50ad51… · 5,384,505 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
J9347 HCPCS	Tremelimumab-actl 300 Mg/15 Ml	5	$199.38	$167,010.00	$142,837.50	nat. median $355 outlier · 402.8×
862 OTHER	Ms-DRG 862	1	$84,076.84	$84,076.84	$84,076.84	nat. median $1,841 outlier · 45.7×
314 OTHER	Ms-DRG 314	1	$74,245.41	$74,245.41	$74,245.41	nat. median $9,440 outlier · 7.9×
326 OTHER	Ms-DRG 326	1	$60,310.30	$60,310.30	$60,310.30	nat. median $157 outlier · 384.9×
J2350 HCPCS	Ocrelizumab 300 Mg/10 Ml	5	$6.09	$65,621.56	$56,123.71	nat. median $133 outlier · 422.1×
J9334 HCPCS	Efgart-hyalu-qvfc 1008Mg/5.6Ml	5	$560.66	$54,893.01	$46,947.98	nat. median $45 outlier · 1036.2×
347 OTHER	Ms-DRG 347	1	$46,761.62	$46,761.62	$46,761.62	nat. median $9,286 outlier · 5.0×
580 OTHER	Ms-DRG 580	1	$44,614.89	$44,614.89	$44,614.89	nat. median $7,584 outlier · 5.9×
J9272 HCPCS	Dostarlimab-gxly 500 Mg/10 Ml	5	$8,526.00	$50,176.04	$42,913.71	nat. median $567 outlier · 75.7×
J9022 HCPCS	Atezolizumab 1200 Mg/20 Ml Vl	5	$1.26	$46,985.49	$40,184.96	nat. median $1,229 outlier · 32.7×
J9203 HCPCS	Gemtuzumab Ozogamicin 4.5 Mg	5	$97.98	$42,592.79	$36,428.05	nat. median $679 outlier · 53.6×
323 OTHER	Ms-DRG 323	1	$35,650.87	$35,650.87	$35,650.87	nat. median $31,278 1.1× median
133 OTHER	Ms-DRG 133	1	$34,672.12	$34,672.12	$34,672.12	—
J9042 HCPCS	Brentuximab Vedotin 50 Mg Vial	5	$8,327.21	$40,300.14	$34,467.22	nat. median $555 outlier · 62.1×
J3357 HCPCS	Ustekinumab 45 Mg/0.5 Ml Syr	5	$8.96	$39,712.59	$33,964.72	nat. median $20,264 1.7× median
J9043 HCPCS	Cabazitaxel 60 Mg/1.5 Ml Vial	5	$7.02	$39,669.58	$33,927.93	nat. median $509 outlier · 66.6×
248 OTHER	Ms-DRG 248	1	$32,953.66	$32,953.66	$32,953.66	—
J9144 HCPCS	Daratumumab Hyaluronida 1800Mg	5	$382.98	$33,610.25	$31,265.46	nat. median $114 outlier · 273.1×
542 OTHER	Ms-DRG 542	1	$29,182.97	$29,182.97	$29,182.97	nat. median $388 outlier · 75.2×
283 OTHER	Ms-DRG 283	1	$28,486.19	$28,486.19	$28,486.19	nat. median $11,654 outlier · 2.4×
249 OTHER	Ms-DRG 249	1	$28,286.14	$28,286.14	$28,286.14	—
J1930 HCPCS	Lanreotide Acet 120mg/0.5ml Sy	5	$2.24	$32,541.75	$27,831.76	nat. median $261 outlier · 106.5×
787 OTHER	Ms-DRG 787	1	$27,745.35	$27,745.35	$27,745.35	nat. median $4,507 outlier · 6.2×
897 OTHER	Ms-DRG 897	1	$26,837.34	$26,837.34	$26,837.34	nat. median $269,427 outlier · 0.1×
55 OTHER	Ms-DRG 55	1	$26,176.79	$26,176.79	$26,176.79	nat. median $5,926 outlier · 4.4×
J3380 HCPCS	Vedolizumab 300 Mg Vial	5	$72.63	$30,299.73	$25,914.25	nat. median $59 outlier · 440.7×
617 OTHER	Ms-DRG 617	2	$12,962.88	$25,889.84	$25,889.84	nat. median $8,772 outlier · 3.0×
J3101 HCPCS	Tenecteplase 50 Mg/10 Ml Syrng	5	$0.41	$30,005.60	$25,662.68	nat. median $498 outlier · 51.5×
J2323 HCPCS	Natalizumab 300 Mg/15 Ml Vial	5	$0.11	$28,998.37	$24,801.24	nat. median $50 outlier · 491.7×
J9306 HCPCS	Pertuzumab 420 Mg/14 Ml Vial	5	$508.34	$26,202.87	$24,113.98	nat. median $43 outlier · 565.2×
J9063 HCPCS	Mirvetuximab Soravtansine-gynx	5	$20.18	$28,011.81	$23,957.47	nat. median $140 outlier · 171.2×
J9228 HCPCS	Ipilimumab 5 Mg/ml 10 Ml Vial	5	$1,054.59	$27,929.41	$23,886.99	nat. median $6,073 outlier · 3.9×
139 OTHER	Ms-DRG 139	1	$23,521.65	$23,521.65	$23,521.65	nat. median $6,757 outlier · 3.5×
551 OTHER	Ms-DRG 551	1	$22,657.80	$22,657.80	$22,657.80	nat. median $6,659 outlier · 3.4×
140 OTHER	Ms-DRG 140	1	$22,529.07	$22,529.07	$22,529.07	nat. median $91 outlier · 248.0×
J9332 HCPCS	Efgartigimod Alfa-fcab 400 Mg	5	$7.91	$25,992.48	$22,230.41	nat. median $84 outlier · 263.1×
536 OTHER	Ms-DRG 536	1	$21,883.40	$21,883.40	$21,883.40	nat. median $3,444 outlier · 6.4×
426 OTHER	Ms-DRG 426	1	$21,852.78	$21,852.78	$21,852.78	nat. median $7,659 outlier · 2.9×
J0717 HCPCS	Certolizumab Pegol 400 Mg Kit	5	$3.42	$24,592.04	$20,532.01	nat. median $29 outlier · 707.5×
539 OTHER	Ms-DRG 539	1	$19,947.00	$19,947.00	$19,947.00	nat. median $353 outlier · 56.6×
948 OTHER	Ms-DRG 948	2	$9,729.64	$19,392.24	$19,392.24	nat. median $50 outlier · 385.8×
J0517 HCPCS	Benralizumab 30 Mg/ml Syringe	5	$3.11	$21,515.55	$18,401.46	nat. median $404 outlier · 45.5×
J2353 HCPCS	Octreotide (Depot) 20 Mg Syr	5	$17.33	$24,782.58	$18,086.50	nat. median $1,956 outlier · 9.2×
540 OTHER	Ms-DRG 540	1	$17,908.80	$17,908.80	$17,908.80	nat. median $336 outlier · 53.3×
425 OTHER	Ms-DRG 425	1	$17,135.53	$17,135.53	$17,135.53	nat. median $9,098 1.9× median
J9271 HCPCS	Pembrolizumab 100 Mg/4 Ml Vial	5	$13.37	$19,580.11	$16,746.15	nat. median $127 outlier · 131.9×
871 OTHER	Ms-DRG 871	1	$16,679.18	$16,679.18	$16,679.18	nat. median $12 outlier · 1430.5×
694 OTHER	Ms-DRG 694	1	$16,385.12	$16,385.12	$16,385.12	nat. median $8,822 1.9× median
541 OTHER	Ms-DRG 541	1	$16,375.61	$16,375.61	$16,375.61	nat. median $354 outlier · 46.3×
179 OTHER	Ms-DRG 179	1	$16,193.72	$16,193.72	$16,193.72	nat. median $3,438 outlier · 4.7×

Other procedures at this hospital

Browse this hospital's 1,323 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

10005	CPT	Fna Biopsy W US 1st Lesion	10	5	$2,100.00	$2,037.00	$1,365.00	$1,995.00	$1,845.65	2026-05-09
111	OTHER	Room Medical Unit Priv	6	5	$2,343.00	$2,272.71	$1,522.95	$2,225.85	$2,112.22	2026-05-09
112	OTHER	Room Womens Ctr	6	5	$2,343.00	$2,272.71	$1,522.95	$2,225.85	$2,112.22	2026-05-09
113	OTHER	Room Pediatric Unit	8	5	$2,343.00	$2,272.71	$1,522.95	$19,097.61	$2,225.85	2026-05-09
11404	CPT	Exc Ben Lesion 3.1-4.0 Trunk	17	5	$1,688.00	$1,637.36	$194.76	$1,603.60	$1,122.52	2026-05-09
129	OTHER	Room Swing Bed Skilled	6	5	$1,461.00	$1,417.17	$949.65	$1,387.95	$1,317.09	2026-05-09
133	OTHER	Ms-DRG 133	2	1	—	—	$34,672.12	$34,672.12	$34,672.12	2026-05-09
137	OTHER	Ms-DRG 137	2	1	—	—	$13,634.90	$13,634.90	$13,634.90	2026-05-09
139	OTHER	Ms-DRG 139	2	1	—	—	$23,521.65	$23,521.65	$23,521.65	2026-05-09
140	OTHER	Ms-DRG 140	2	1	—	—	$22,529.07	$22,529.07	$22,529.07	2026-05-09
179	OTHER	Ms-DRG 179	2	1	—	—	$16,193.72	$16,193.72	$16,193.72	2026-05-09
190	OTHER	Ms-DRG 190	2	1	—	—	$6,285.92	$6,285.92	$6,285.92	2026-05-09
19083	CPT	Biopsy Breast 1st Lesion Lt	18	5	$2,133.00	$2,069.01	$1,386.45	$2,026.35	$1,752.26	2026-05-09
19084	CPT	Biopsy Breast Addl Lesion Rt	8	5	$2,031.00	$1,970.07	$1,320.15	$1,929.45	$1,668.47	2026-05-09
194	OTHER	Ms-DRG 194	2	1	—	—	$15,482.98	$15,482.98	$15,482.98	2026-05-09
195	OTHER	Ms-DRG 195	2	1	—	—	$9,729.64	$9,729.64	$9,729.64	2026-05-09
23430	CPT	Tenodesis Long Tendon Bicep Lt	12	5	$1,867.00	$1,810.99	$889.69	$2,047.70	$1,627.92	2026-05-09
23472	CPT	Arthroplasty Total Shoulder Lt	12	5	$1,472.00	$1,427.84	$1,398.40	$3,971.97	$3,003.59	2026-05-09
23675	CPT	Closed Tx Shoulder Dislocate L	6	5	$502.00	$486.94	$476.90	$1,382.00	$1,088.47	2026-05-09
240	OTHER	Ms-DRG 240	2	1	—	—	$9,283.17	$9,283.17	$9,283.17	2026-05-09
24605	CPT	Dislocation Elbow W Anes Lt	8	5	$1,643.00	$1,593.71	$1,067.95	$1,560.85	$1,349.72	2026-05-09
24655	CPT	Fx Radial Head/Neck W Man Lt	14	5	$1,643.00	$1,593.71	$485.23	$1,560.85	$1,097.91	2026-05-09
248	OTHER	Ms-DRG 248	2	1	—	—	$32,953.66	$32,953.66	$32,953.66	2026-05-09
249	OTHER	Ms-DRG 249	2	1	—	—	$28,286.14	$28,286.14	$28,286.14	2026-05-09
252	OTHER	Ms-DRG 252	2	1	—	—	$3,444.25	$3,444.25	$3,444.25	2026-05-09
25605	CPT	Fx Distal Radius W Man Rt	20	5	$1,456.00	$1,412.32	$616.32	$1,560.85	$1,180.76	2026-05-09
25607	CPT	Fx Distal Radius Open Lt	6	5	$1,886.00	$1,829.42	$885.05	$2,027.31	$1,637.37	2026-05-09
25608	CPT	Fx Distal Radius Open Rt	6	5	$2,056.00	$1,994.32	$988.36	$2,270.16	$1,821.33	2026-05-09
26055	CPT	Incision Tendon Sheath Finger	15	5	$1,643.00	$1,593.71	$353.70	$1,560.85	$1,268.40	2026-05-09
26615	CPT	Fx Metacarpal Open	6	5	$1,439.00	$1,395.83	$694.62	$1,590.01	$1,284.18	2026-05-09
27130	CPT	Arthroplasty Total Hip Lt	12	5	$3,492.00	$3,387.24	$1,517.31	$3,699.72	$2,743.14	2026-05-09
272	OTHER	Catheter Cecostomy 10.2Fr 24cm	72	5	$1,776.00	$1,723.03	$121.90	$4,123.00	$1,536.76	2026-05-09
27245	CPT	Fx Inter/Peri/Sub Fem W Imp Lt	6	5	$1,189.00	$1,153.33	$1,129.55	$3,360.59	$2,561.05	2026-05-09
27405	CPT	Repair Collateral Knee Lig Rt	6	5	$1,689.00	$1,638.33	$809.04	$1,858.08	$1,483.70	2026-05-09
27446	CPT	Revision Of Knee Joint Lt	6	5	$1,278.00	$1,239.66	$1,214.10	$3,164.50	$2,394.89	2026-05-09
27447	CPT	Total Knee Arthroplasty Lt	12	5	$3,394.00	$3,292.18	$1,515.73	$3,695.94	$2,739.20	2026-05-09
27810	CPT	Fx Bimalleolar Ankle W Man Rt	14	5	$1,643.00	$1,593.71	$511.91	$1,560.85	$1,186.30	2026-05-09
27814	CPT	Open Fx Bimalleolar Ankle Rt	6	5	$1,932.00	$1,874.04	$914.90	$2,109.80	$1,668.23	2026-05-09
283	OTHER	Ms-DRG 283	2	1	—	—	$28,486.19	$28,486.19	$28,486.19	2026-05-09
291	OTHER	Ms-DRG 291	2	1	—	—	$12,504.80	$12,504.80	$12,504.80	2026-05-09
292	OTHER	Ms-DRG 292	2	1	—	—	$16,160.20	$16,160.20	$16,160.20	2026-05-09
29807	CPT	Shoulder Arthroscopy Lt	6	5	$2,661.00	$2,581.17	$1,229.55	$2,837.02	$2,239.32	2026-05-09
29823	CPT	Shoulder Arthroscopy Rt	6	5	$1,557.00	$1,510.29	$709.76	$1,726.20	$1,299.74	2026-05-09
29824	CPT	Shoulder Arthroscopy Rt	6	5	$1,679.00	$1,628.63	$809.89	$1,857.88	$1,485.74	2026-05-09
29827	CPT	Arthro Rotator Cuff Repair Lt	12	5	$2,661.00	$2,581.17	$1,270.13	$2,933.17	$2,306.86	2026-05-09
29828	CPT	Arthroscopy Bicep Tenodesis Lt	6	5	$2,362.00	$2,291.14	$1,090.90	$2,518.94	$1,984.94	2026-05-09
29848	CPT	Wrist Arthroscopy/Surgery Bi	12	5	$1,645.00	$1,595.65	$614.70	$1,875.30	$1,140.39	2026-05-09
29875	CPT	Knee Arthroscopy/Drainage Lt	6	5	$1,239.00	$1,201.83	$595.16	$1,366.20	$1,093.90	2026-05-09
29876	CPT	Knee Arthroscopy/Drainage Rt	6	5	$1,690.00	$1,639.30	$780.27	$1,796.23	$1,428.54	2026-05-09
29881	CPT	Knee Arthroscopy/Drainage Lt	6	5	$1,357.00	$1,316.29	$649.46	$1,489.54	$1,191.88	2026-05-09
29887	CPT	Knee Arthroscopy/Drainage Rt	6	5	$1,919.00	$1,861.43	$897.62	$2,062.03	$1,647.10	2026-05-09
308	OTHER	Ms-DRG 308	2	1	—	—	$12,504.80	$12,504.80	$12,504.80	2026-05-09
310	OTHER	Ms-DRG 310	2	1	—	—	$9,696.12	$9,696.12	$9,696.12	2026-05-09
314	OTHER	Ms-DRG 314	2	1	—	—	$74,245.41	$74,245.41	$74,245.41	2026-05-09
323	OTHER	Ms-DRG 323	2	1	—	—	$35,650.87	$35,650.87	$35,650.87	2026-05-09
32551	CPT	Insertion Chest Tube Lt	22	5	$1,609.00	$1,560.73	$181.56	$1,528.55	$1,256.63	2026-05-09
326	OTHER	Ms-DRG 326	2	1	—	—	$60,310.30	$60,310.30	$60,310.30	2026-05-09
340	OTHER	Ms-DRG 340	2	1	—	—	$14,448.34	$14,448.34	$14,448.34	2026-05-09
347	OTHER	Ms-DRG 347	2	1	—	—	$46,761.62	$46,761.62	$46,761.62	2026-05-09
349	OTHER	Ms-DRG 349	2	1	—	—	$13,645.94	$13,645.94	$13,645.94	2026-05-09
351	OTHER	Ms-DRG 351	2	1	—	—	$2,883.32	$2,883.32	$2,883.32	2026-05-09
360	OTHER	Cataract	112	5	$2,362.00	$2,291.14	$529.10	$5,952.70	$1,850.60	2026-05-09
36556	CPT	Insert Non-tunnel Cv Catheter	15	5	$3,226.00	$3,129.22	$99.69	$3,064.70	$2,096.90	2026-05-09
36573	CPT	Insert Picc >5 Yrs W Img Gde	17	5	$2,170.00	$2,104.90	$99.83	$2,061.50	$1,410.50	2026-05-09
373	OTHER	Ms-DRG 373	2	1	—	—	$12,961.68	$12,961.68	$12,961.68	2026-05-09
374	OTHER	Ms-DRG 374	2	1	—	—	$3,265.56	$3,265.56	$3,265.56	2026-05-09
375	OTHER	Ms-DRG 375	2	1	—	—	$9,729.64	$9,729.64	$9,729.64	2026-05-09
383	OTHER	Ms-DRG 383	2	1	—	—	$9,183.02	$9,183.02	$9,183.02	2026-05-09
38505	CPT	Needle Biopsy Lymph Nodes Lt	8	5	$3,080.00	$2,987.60	$2,002.00	$2,926.00	$2,530.22	2026-05-09
389	OTHER	Ms-DRG 389	2	1	—	—	$9,696.12	$9,696.12	$9,696.12	2026-05-09
392	OTHER	Ms-DRG 392	2	1	—	—	$6,285.92	$6,285.92	$6,285.92	2026-05-09
395	OTHER	Ms-DRG 395	2	1	—	—	$3,265.56	$3,265.56	$3,265.56	2026-05-09
418	OTHER	Ms-DRG 418	1	1	—	—	$9,412.12	$9,412.12	$9,412.12	2026-05-09
425	OTHER	Ms-DRG 425	2	1	—	—	$17,135.53	$17,135.53	$17,135.53	2026-05-09
426	OTHER	Ms-DRG 426	2	1	—	—	$21,852.78	$21,852.78	$21,852.78	2026-05-09
46040	CPT	Incision Rectal Abscess	8	5	$1,286.00	$1,247.42	$835.90	$1,221.70	$1,056.45	2026-05-09
463	OTHER	Ms-DRG 463	2	1	—	—	$13,753.90	$13,753.90	$13,753.90	2026-05-09
469	OTHER	Ms-DRG 469	2	1	—	—	$16,133.73	$16,133.73	$16,133.73	2026-05-09
470	OTHER	Ms-DRG 470	2	1	—	—	$12,537.44	$12,537.44	$12,537.44	2026-05-09
47562	CPT	Laparoscopic Cholecystectomy	6	5	$1,628.00	$1,579.16	$767.72	$1,779.51	$1,382.34	2026-05-09
47563	CPT	Lap Cholecystectomy/Graph	6	5	$1,768.00	$1,714.96	$835.38	$1,935.98	$1,500.93	2026-05-09
47564	CPT	Lap Cholecystectomy/Explr	6	5	$2,750.00	$2,667.50	$1,297.98	$3,008.15	$2,328.91	2026-05-09
49083	CPT	Abd Paracentesis W Imaging	10	5	$1,182.00	$1,146.54	$768.30	$4,237.00	$1,065.58	2026-05-09
49505	CPT	Prp I/Hern Init Reduc >5 Yr	18	5	$1,288.00	$1,249.36	$610.57	$1,834.45	$1,103.76	2026-05-09
49520	CPT	Rerepair Ing Hernia Reduce Bi	6	5	$728.00	$706.16	$691.60	$1,707.97	$1,290.72	2026-05-09
51600	CPT	Injection For Bladder X-ray	8	5	$1,544.00	$1,497.68	$1,003.60	$1,466.80	$1,268.39	2026-05-09
522	OTHER	Ms-DRG 522	2	1	—	—	$9,412.12	$9,412.12	$9,412.12	2026-05-09
52310	CPT	Cystoscopy And Treatment	14	5	$2,136.00	$2,071.92	$161.50	$2,029.20	$1,404.42	2026-05-09
536	OTHER	Ms-DRG 536	2	1	—	—	$21,883.40	$21,883.40	$21,883.40	2026-05-09
539	OTHER	Ms-DRG 539	2	1	—	—	$19,947.00	$19,947.00	$19,947.00	2026-05-09
540	OTHER	Ms-DRG 540	2	1	—	—	$17,908.80	$17,908.80	$17,908.80	2026-05-09
541	OTHER	Ms-DRG 541	2	1	—	—	$16,375.61	$16,375.61	$16,375.61	2026-05-09
542	OTHER	Ms-DRG 542	2	1	—	—	$29,182.97	$29,182.97	$29,182.97	2026-05-09
55	OTHER	Ms-DRG 55	2	1	—	—	$26,176.79	$26,176.79	$26,176.79	2026-05-09
551	OTHER	Ms-DRG 551	2	1	—	—	$22,657.80	$22,657.80	$22,657.80	2026-05-09
552	OTHER	Ms-DRG 552	2	1	—	—	$9,696.12	$9,696.12	$9,696.12	2026-05-09
554	OTHER	Ms-DRG 554	2	1	—	—	$3,265.56	$3,265.56	$3,265.56	2026-05-09
560	OTHER	Ms-DRG 560	2	1	—	—	$7,994.36	$7,994.36	$7,994.36	2026-05-09
561	OTHER	Ms-DRG 561	2	1	—	—	$8,563.92	$8,563.92	$8,563.92	2026-05-09
563	OTHER	Ms-DRG 563	3	2	—	—	$16,160.20	$22,657.80	$16,160.20	2026-05-09
580	OTHER	Ms-DRG 580	1	1	—	—	$44,614.89	$44,614.89	$44,614.89	2026-05-09
581	OTHER	Ms-DRG 581	2	1	—	—	$6,279.80	$6,279.80	$6,279.80	2026-05-09
59412	CPT	External Version	8	5	$3,484.00	$3,379.48	$2,264.60	$3,309.80	$2,862.11	2026-05-09
603	OTHER	Ms-DRG 603	1	1	—	—	$3,232.04	$3,232.04	$3,232.04	2026-05-09
617	OTHER	Ms-DRG 617	3	2	—	—	$12,962.88	$25,889.84	$25,889.84	2026-05-09
637	OTHER	Ms-DRG 637	2	1	—	—	$3,232.04	$3,232.04	$3,232.04	2026-05-09
640	OTHER	Ms-DRG 640	2	1	—	—	$3,326.83	$3,326.83	$3,326.83	2026-05-09
641	OTHER	Ms-DRG 641	2	1	—	—	$9,378.60	$9,378.60	$9,378.60	2026-05-09
645	OTHER	Ms-DRG 645	2	1	—	—	$16,193.72	$16,193.72	$16,193.72	2026-05-09
66821	CPT	Capsulotomy Yag Cataract Lt	22	5	$1,365.00	$1,324.05	$260.00	$1,300.00	$1,199.67	2026-05-09
683	OTHER	Ms-DRG 683	2	1	—	—	$6,497.60	$6,497.60	$6,497.60	2026-05-09
684	OTHER	Trauma Team Evaluation Level 4	8	5	$1,392.00	$1,350.24	$904.80	$1,322.40	$1,143.53	2026-05-09
689	OTHER	Ms-DRG 689	2	1	—	—	$9,412.12	$9,412.12	$9,412.12	2026-05-09
690	OTHER	Ms-DRG 690	2	1	—	—	$12,928.16	$12,928.16	$12,928.16	2026-05-09
694	OTHER	Ms-DRG 694	2	1	—	—	$16,385.12	$16,385.12	$16,385.12	2026-05-09
70450	CPT	CT Head/Brain Wo Contrast	11	5	$2,971.00	$2,881.87	$1,440.40	$2,829.00	$2,822.45	2026-05-09
70460	CPT	CT Head/Brain W Contrast	10	5	$3,306.00	$3,206.82	$61.91	$3,140.70	$2,821.23	2026-05-09
70470	CPT	CT Head/Brain Wwo Contrast	10	5	$3,641.00	$3,531.77	$241.32	$3,467.00	$3,282.36	2026-05-09
70480	CPT	CT Orbit Wo Contrast	10	5	$3,075.00	$2,982.75	$192.56	$2,921.25	$2,702.29	2026-05-09
70481	CPT	CT Orbit W Contrast	8	5	$3,270.00	$3,171.90	$80.31	$3,106.50	$2,656.88	2026-05-09
70482	CPT	CT Orbit Wwo Contrast	8	5	$3,467.00	$3,362.99	$261.57	$3,293.65	$2,816.93	2026-05-09
70486	CPT	CT Maxillofacial Wo Contrast	12	5	$2,808.00	$2,723.76	$187.95	$2,667.60	$2,395.22	2026-05-09
70487	CPT	CT Maxillofacial W Contrast	8	5	$3,270.00	$3,171.90	$268.29	$3,106.50	$2,656.88	2026-05-09
70491	CPT	CT Soft Tissue Neck W Cont	11	5	$3,544.00	$3,437.68	$357.53	$3,366.80	$3,128.35	2026-05-09
70492	CPT	CT Soft Tissue Neck Wwo Cont	11	5	$3,773.00	$3,659.81	$422.85	$3,584.35	$3,218.37	2026-05-09
70496	CPT	CT Angiography Head W Cont	11	5	$3,641.00	$3,531.77	$246.84	$3,458.95	$3,105.77	2026-05-09
70498	CPT	CT Angiography Neck W Cont	12	5	$3,248.00	$3,150.56	$278.39	$3,085.60	$2,796.49	2026-05-09
70543	CPT	MRI Orbit Face Neck Wwo Cont	9	5	$4,608.00	$4,469.76	$335.45	$4,377.60	$3,930.62	2026-05-09
70544	CPT	MRA Head Wo Contrast	10	5	$3,458.00	$3,354.26	$408.12	$4,626.50	$3,117.39	2026-05-09
70546	CPT	MRA Head Wwo Contrast	8	5	$5,276.00	$5,117.72	$545.48	$5,012.20	$4,286.75	2026-05-09
70549	CPT	MRA Neck Wwo Contrast	11	5	$5,027.00	$4,876.19	$666.92	$5,431.00	$4,288.03	2026-05-09
70551	CPT	MRI Brain Wo Contrast	12	5	$4,870.00	$4,723.90	$447.03	$4,870.00	$4,390.31	2026-05-09
70553	CPT	MRI Brain Wwo Contrast	20	5	$6,023.00	$5,842.31	$729.77	$6,007.80	$5,394.37	2026-05-09
71250	CPT	CT Thorax Wo Contrast	12	5	$3,842.00	$3,726.74	$71.13	$3,649.90	$3,277.23	2026-05-09
71260	CPT	CT Thorax W Contrast	13	5	$4,126.00	$4,002.22	$80.31	$3,919.70	$3,519.48	2026-05-09
71270	CPT	CT Thorax Wwo Contrast	9	5	$4,410.00	$4,277.70	$82.17	$4,189.50	$3,761.73	2026-05-09
71271	CPT	Ldct For Lung Cancer Screen	12	5	$3,467.00	$3,362.99	$101.48	$3,301.00	$3,125.50	2026-05-09
71275	CPT	CTA Chest Wwo Contrast	10	5	$3,302.00	$3,202.94	$672.62	$3,136.90	$2,890.31	2026-05-09
72114	CPT	X-ray Lumbosacral 6 Views	8	5	$1,381.00	$1,339.57	$84.00	$1,311.95	$1,122.06	2026-05-09
72125	CPT	CT Cervical Spine Wo Contrast	12	5	$3,641.00	$3,531.77	$172.58	$3,467.00	$3,282.36	2026-05-09
72128	CPT	CT Thoracic Spine Wo Contrast	11	5	$3,342.00	$3,241.74	$107.93	$6,131.30	$2,850.73	2026-05-09
72129	CPT	CT Thoracic Spine W Contrast	8	5	$4,898.00	$4,751.06	$128.15	$4,653.10	$3,979.62	2026-05-09
72131	CPT	CT Lumbar Spine Wo Contrast	12	5	$3,641.00	$3,531.77	$234.87	$3,458.95	$3,105.77	2026-05-09
72141	CPT	MRI Neck Spine Wo Dye	11	5	$4,890.00	$4,743.30	$233.96	$4,645.50	$4,171.17	2026-05-09
72146	CPT	MRI Chest Spine Wo Dye	12	5	$3,737.00	$3,624.89	$390.63	$5,138.00	$3,368.90	2026-05-09
72148	CPT	MRI Lumbar Spine Wo Dye	12	5	$5,245.00	$5,087.65	$315.18	$4,982.75	$4,261.56	2026-05-09
72149	CPT	MRI Lumbar Spine W Dye	8	5	$5,447.00	$5,283.59	$386.03	$5,174.65	$4,425.68	2026-05-09
72156	CPT	MRI Neck Spine Wwo Dye	11	5	$5,320.00	$5,160.40	$340.05	$5,320.00	$4,812.70	2026-05-09
72157	CPT	MRI Chest Spine Wwo Dye	11	5	$5,320.00	$5,160.40	$535.35	$5,320.00	$5,054.00	2026-05-09
72158	CPT	MRI Lumbar Spine Wwo Dye	11	5	$5,649.00	$5,479.53	$340.97	$5,649.00	$5,366.55	2026-05-09
72192	CPT	CT Pelvis Wo Dye	8	5	$3,641.00	$3,531.77	$597.02	$3,458.95	$2,958.31	2026-05-09
72193	CPT	CT Pelvis W Dye	8	5	$3,962.00	$3,843.14	$593.33	$3,763.90	$3,219.12	2026-05-09
72194	CPT	CT Pelvis Wwo Dye	8	5	$4,288.00	$4,159.36	$719.64	$4,073.60	$3,484.00	2026-05-09
72195	CPT	MRI Pelvis Wo Dye	8	5	$2,652.00	$2,572.44	$1,723.80	$3,876.00	$2,519.40	2026-05-09
72197	CPT	MRI Pelvis Wwo Dye	8	5	$4,881.00	$4,734.57	$618.17	$4,636.95	$3,965.81	2026-05-09
73200	CPT	CT Ue Wo Dye Rt	21	5	$2,768.00	$2,684.96	$70.19	$2,636.00	$2,361.10	2026-05-09
73218	CPT	MRI Ue Wo Dye Lt	16	5	$3,650.00	$3,540.50	$79.40	$3,467.50	$2,965.62	2026-05-09
73220	CPT	MRI Ue Wwo Dye Rt	18	5	$5,750.00	$5,577.50	$319.79	$5,462.50	$4,904.75	2026-05-09
73221	CPT	MRI Joint Ue Wo Dye Lt	22	5	$3,899.00	$3,782.03	$408.12	$3,899.00	$3,704.05	2026-05-09
73222	CPT	MRI Joint Ue W Dye Rt	8	5	$5,003.00	$4,852.91	$530.75	$4,752.85	$4,064.94	2026-05-09
73223	CPT	MRI Joint Ue Wwo Dye Rt	18	5	$6,107.00	$5,923.79	$597.27	$5,801.65	$5,209.27	2026-05-09
73700	CPT	CT Le Wo Dye Lt	23	5	$3,315.00	$3,215.55	$76.65	$3,157.00	$2,827.70	2026-05-09
73701	CPT	CT Le W Dye Rt	8	5	$3,671.00	$3,560.87	$268.01	$3,487.45	$2,982.69	2026-05-09
73702	CPT	CT Le Wwo Dye Lt	8	5	$4,027.00	$3,906.19	$57.30	$3,825.65	$3,271.94	2026-05-09
73718	CPT	MRI Le Wo Dye Lt	19	5	$3,650.00	$3,540.50	$56.39	$3,467.50	$3,113.45	2026-05-09
73720	CPT	MRI Le Wwo Dye Lt	21	5	$4,376.00	$4,244.72	$233.96	$4,167.00	$4,157.20	2026-05-09
73721	CPT	MRI Joint Le Wo Dye Lt	23	5	$3,899.00	$3,782.03	$315.18	$3,704.05	$3,325.85	2026-05-09
73723	CPT	MRI Joint Le Wwo Dye Lt	8	5	$4,678.00	$4,537.66	$657.06	$4,444.10	$3,800.88	2026-05-09
74150	CPT	CT Abdomen Wo Dye	8	5	$3,641.00	$3,531.77	$791.13	$3,458.95	$2,958.31	2026-05-09
74160	CPT	CT Abdomen W Dye	10	5	$4,156.00	$4,031.32	$706.77	$3,958.00	$3,746.64	2026-05-09
74170	CPT	CT Abdomen Wwo Dye	12	5	$4,572.00	$4,434.84	$58.22	$4,343.40	$3,714.75	2026-05-09
74174	CPT	CTA Abd&Pelv Wwo Dye	8	5	$6,802.00	$6,597.94	$4,421.30	$6,461.90	$6,461.90	2026-05-09
74175	CPT	CTA Abdom Wwo Dye	10	5	$3,120.00	$3,026.40	$82.17	$2,964.00	$2,741.90	2026-05-09
74176	CPT	CT Abd & Pelvis Wo Contrast	12	5	$5,962.00	$5,783.14	$95.04	$5,678.00	$5,374.74	2026-05-09
74177	CPT	CT Abd & Pelv W Contrast	13	5	$6,536.00	$6,339.92	$227.52	$6,224.00	$5,575.21	2026-05-09
74178	CPT	CT Abd & Pelv Wwo Contrast	12	5	$7,221.00	$7,004.37	$479.88	$6,877.00	$6,159.51	2026-05-09
74181	CPT	MRI Abdomen Wo Dye	10	5	$5,431.00	$5,268.07	$544.29	$5,159.45	$4,773.02	2026-05-09
74183	CPT	MRI Abdomen Wwo Dye	11	5	$7,332.00	$7,112.04	$619.08	$6,965.40	$6,254.20	2026-05-09
750	OTHER	Colonoscopy	24	5	$2,237.00	$2,169.89	$928.85	$3,363.00	$1,837.70	2026-05-09
75635	CPT	CTA Abdominal Arteries	11	5	$4,612.00	$4,473.64	$592.68	$4,381.40	$3,934.04	2026-05-09
76700	CPT	Ultrasound Abdomen Complete	12	5	$1,373.00	$1,331.81	$273.72	$1,304.35	$1,127.92	2026-05-09
78071	CPT	Parathyroid Planar Img W Spect	8	5	$1,771.00	$1,717.87	$1,151.15	$1,682.45	$1,454.88	2026-05-09
78226	CPT	Hepatobiliary Scan Without Ef	8	5	$2,419.00	$2,346.43	$1,572.35	$2,298.05	$1,987.21	2026-05-09
78227	CPT	Hida With Ef w/Pharm	11	5	$2,408.00	$2,335.76	$1,565.20	$2,287.60	$2,054.02	2026-05-09
78306	CPT	Bone Scan Whole Body	11	5	$1,675.00	$1,624.75	$1,088.75	$1,675.00	$1,515.25	2026-05-09
78315	CPT	Bone Scan 3 Phase	10	5	$1,669.00	$1,618.93	$1,084.85	$1,834.45	$1,504.61	2026-05-09
78451	CPT	Myocard Perf Spect Rest Or Str	10	5	$7,593.00	$7,365.21	$4,935.45	$7,231.00	$6,845.09	2026-05-09
78452	CPT	Myocard Perf Spect Rest Stress	12	5	$7,177.00	$6,961.69	$1,435.40	$6,818.15	$5,895.90	2026-05-09
78582	CPT	Lung Perfusion & Ventilation	8	5	$2,188.00	$2,122.36	$1,422.20	$2,078.60	$1,797.44	2026-05-09
787	OTHER	Ms-DRG 787	1	1	—	—	$27,745.35	$27,745.35	$27,745.35	2026-05-09
78708	CPT	Renal Imaging Func Pharm Inter	8	5	$1,760.00	$1,707.20	$1,144.00	$1,672.00	$1,445.84	2026-05-09
794	OTHER	Ms-DRG 794	1	1	—	—	$3,249.82	$3,249.82	$3,249.82	2026-05-09
795	OTHER	Ms-DRG 795	1	1	—	—	$2,861.14	$2,861.14	$2,861.14	2026-05-09
80230	CPT	Infliximab Qn w/Reflex To Ab,S	8	5	$1,862.00	$1,806.14	$1,210.30	$1,768.90	$1,529.63	2026-05-09
806	OTHER	Ms-DRG 806	1	1	—	—	$7,742.77	$7,742.77	$7,742.77	2026-05-09
807	OTHER	Ms-DRG 807	1	1	—	—	$11,494.09	$11,494.09	$11,494.09	2026-05-09
81210	CPT	Braf C Kit	8	5	$6,463.00	$6,269.11	$4,200.95	$6,139.85	$5,309.35	2026-05-09
813	OTHER	Ms-DRG 813	2	1	—	—	$3,232.04	$3,232.04	$3,232.04	2026-05-09
82731	CPT	Fetal Fibronectin	8	5	$1,336.00	$1,295.92	$868.40	$1,269.20	$1,097.53	2026-05-09
83	OTHER	Ms-DRG 83	2	1	—	—	$12,961.68	$12,961.68	$12,961.68	2026-05-09
834	OTHER	Ms-DRG 834	2	1	—	—	$16,193.72	$16,193.72	$16,193.72	2026-05-09
84150	CPT	Prostaglandin F2a	8	5	$1,589.00	$1,541.33	$1,032.85	$1,509.55	$1,305.37	2026-05-09
844	OTHER	Ms-DRG 844	2	1	—	—	$3,159.72	$3,159.72	$3,159.72	2026-05-09
862	OTHER	Ms-DRG 862	2	1	—	—	$84,076.84	$84,076.84	$84,076.84	2026-05-09
871	OTHER	Ms-DRG 871	1	1	—	—	$16,679.18	$16,679.18	$16,679.18	2026-05-09
87154	CPT	Culture Id By Amp Prb 6 Or 6+	11	5	$2,496.00	$2,421.12	$1,622.40	$2,371.20	$2,129.09	2026-05-09
872	OTHER	Ms-DRG 872	2	1	—	—	$12,961.68	$12,961.68	$12,961.68	2026-05-09
897	OTHER	Ms-DRG 897	1	1	—	—	$26,837.34	$26,837.34	$26,837.34	2026-05-09
90375	CPT	Rabies Ig (Human) 300 U/Ml 5Ml	8	5	$14,033.00	$13,612.27	$146.90	$13,331.61	$11,402.03	2026-05-09
90675	CPT	Rabies Vax Pcec/Pf 2.5Unit Vl	8	5	$1,347.00	$1,307.03	$125.24	$1,280.08	$1,094.80	2026-05-09
93017	CPT	Cardiovascular Stress Test	12	5	$1,783.00	$1,729.51	$356.60	$1,693.85	$1,520.90	2026-05-09
93306	CPT	Tte W Doppler Complete	18	5	$3,351.00	$3,250.47	$222.88	$3,183.45	$2,525.16	2026-05-09
93351	CPT	Stress Tte Complete	14	5	$2,894.00	$2,807.18	$260.45	$2,749.30	$1,902.80	2026-05-09
93880	CPT	Extracranial Bilat Study	13	5	$2,043.00	$1,981.71	$1,327.95	$1,945.00	$1,940.85	2026-05-09
93970	CPT	Venous Duplex	8	5	$1,566.00	$1,519.02	$1,017.90	$1,487.70	$1,286.47	2026-05-09
93975	CPT	Vascular Study	9	5	$1,436.00	$1,392.92	$933.40	$1,364.20	$1,224.91	2026-05-09
94002	CPT	Vent Assist & Mgmt First Day	8	5	$2,995.00	$2,905.15	$1,946.75	$2,845.25	$2,460.39	2026-05-09
94726	CPT	Pft Plethysmography	12	5	$1,231.00	$1,194.07	$800.15	$1,172.00	$1,109.74	2026-05-09
948	OTHER	Ms-DRG 948	3	2	—	—	$9,729.64	$19,392.24	$19,392.24	2026-05-09
951	OTHER	Ms-DRG 951	2	1	—	—	$3,159.72	$3,159.72	$3,159.72	2026-05-09
95805	CPT	Multiple Sleep Latency Test	8	5	$4,104.00	$3,980.88	$2,667.60	$3,898.80	$3,371.43	2026-05-09
95810	CPT	Polysomnogram	12	5	$6,040.00	$5,858.80	$1,208.00	$5,738.00	$5,152.12	2026-05-09
95811	CPT	Polysomnogram W CPap	12	5	$6,706.00	$6,504.82	$1,277.20	$6,370.70	$5,720.22	2026-05-09
95816	CPT	EEG Routine	10	5	$1,240.00	$1,202.80	$806.00	$1,356.60	$1,117.86	2026-05-09
95819	CPT	EEG Wake And Sleep	8	5	$1,366.00	$1,325.02	$887.90	$1,297.70	$1,122.17	2026-05-09
99285	CPT	Emergency Room Visit Level 5	18	5	$1,853.00	$1,797.41	$184.62	$1,760.35	$1,331.38	2026-05-09
99291	CPT	Critical Care 1st 30-74 Min	17	5	$2,643.00	$2,563.71	$228.45	$2,510.85	$1,757.60	2026-05-09
A9562	HCPCS	Radiophar Tc99M Mertiatide	8	5	$1,313.00	$1,273.61	$853.45	$1,247.35	$1,078.63	2026-05-09
C1726	HCPCS	Dil Escp 240Cm Od15-18	24	5	$1,456.00	$1,413.10	$450.32	$3,363.00	$1,196.76	2026-05-09
C1771	HCPCS	Sling Urth .3mm Thk Retropubic	8	5	$1,996.00	$1,936.12	$1,297.40	$1,896.20	$1,639.71	2026-05-09
C1776	HCPCS	Comp Fem 2 Kn Lt Crcte RTn	262	5	$2,900.00	$2,813.00	$390.00	$7,975.25	$2,642.40	2026-05-09
C8924	HCPCS	Tte 2d W Contrast Limited	10	5	$1,265.00	$1,227.05	$822.25	$1,265.00	$1,140.40	2026-05-09
C8929	HCPCS	Echo M Mode 2d W Contrast	12	5	$3,997.00	$3,877.09	$2,598.05	$3,806.00	$3,512.57	2026-05-09
C8930	HCPCS	Stress Echo W Contrast	12	5	$2,144.00	$2,079.68	$408.20	$2,036.80	$1,828.83	2026-05-09
G0390	HCPCS	Trauma Team Level 4	8	5	$1,392.00	$1,350.24	$904.80	$1,322.40	$1,143.53	2026-05-09
G0416	HCPCS	Prostate Sat Biopsy	8	5	$3,060.00	$2,968.20	$1,989.00	$2,907.00	$2,513.79	2026-05-09
J0129	HCPCS	Abatacept 250 Mg Vial	8	5	$6,467.00	$6,273.62	$588.00	$6,144.27	$5,254.97	2026-05-09
J0248	HCPCS	Remdesivir 100 Mg Vial	8	5	$2,874.00	$2,787.96	$70.71	$2,730.48	$2,335.27	2026-05-09
J0517	HCPCS	Benralizumab 30 Mg/ml Syringe	8	5	$22,647.00	$21,968.51	$3.11	$21,515.55	$18,401.46	2026-05-09
J0585	HCPCS	Botul Tox Type A 100 Unit Vial	10	5	$3,035.00	$2,944.34	$59.81	$2,904.15	$2,736.41	2026-05-09
J0666	HCPCS	Bupivac Liposome 1.3% Pf 20 Ml	11	5	$1,773.00	$1,720.10	$1,152.64	$1,713.62	$1,684.64	2026-05-09
J0717	HCPCS	Certolizumab Pegol 400 Mg Kit	14	5	$22,189.00	$21,523.52	$3.42	$24,592.04	$20,532.01	2026-05-09
J0897	HCPCS	Denosumab 60 Mg/ml Syringe	17	5	$7,589.00	$7,362.20	$9.69	$12,955.30	$7,210.41	2026-05-09
J1439	HCPCS	Ferric Carboxymalt 750mg/15ml	10	5	$4,350.00	$4,219.78	$11.91	$4,424.13	$3,921.79	2026-05-09
J1459	HCPCS	Immune Glob Privige 20gr/200ml	14	5	$9,521.00	$9,236.07	$0.29	$16,988.72	$9,045.63	2026-05-09
J1569	HCPCS	Immune Glob Gamagar 20gr/200ml	14	5	$9,803.00	$9,509.65	$21.77	$12,792.79	$9,313.57	2026-05-09
J1610	HCPCS	Glucagon 1 Mg Emergency Kit	9	5	$1,327.00	$1,287.61	$98.91	$1,261.06	$1,132.30	2026-05-09
J1670	HCPCS	Tetanus Imm Glob (Hum) 250u/ml	10	5	$2,499.00	$2,424.90	$8.27	$2,374.91	$2,253.66	2026-05-09
J1745	HCPCS	Infliximab 100 Mg Vial	14	5	$4,417.00	$4,284.51	$1.46	$4,196.17	$1,960.73	2026-05-09
J1930	HCPCS	Lanreotide Acet 120mg/0.5ml Sy	8	5	$34,254.00	$33,226.84	$2.24	$32,541.75	$27,831.76	2026-05-09
J2182	HCPCS	Mepolizumab 100 Mg Vial	8	5	$13,430.00	$13,027.31	$6.38	$12,758.71	$10,912.06	2026-05-09
J2323	HCPCS	Natalizumab 300 Mg/15 Ml Vial	8	5	$30,524.00	$29,608.86	$0.11	$28,998.37	$24,801.24	2026-05-09
J2350	HCPCS	Ocrelizumab 300 Mg/10 Ml	8	5	$69,075.00	$67,003.07	$6.09	$65,621.56	$56,123.71	2026-05-09
J2353	HCPCS	Octreotide (Depot) 20 Mg Syr	17	5	$19,038.00	$18,467.27	$17.33	$24,782.58	$18,086.50	2026-05-09
J2357	HCPCS	Omalizumab 150 Mg Vial	8	5	$5,462.00	$5,298.57	$9.26	$5,189.32	$4,438.23	2026-05-09
J2426	HCPCS	Paliperidone Palm 234mg/1.5ml	8	5	$13,509.00	$13,104.45	$793.38	$12,834.25	$10,976.67	2026-05-09
J3032	HCPCS	Eptinezumab-jjmr 100Mg/Ml Vial	10	5	$8,470.00	$8,215.91	$90.03	$24,358.03	$7,635.72	2026-05-09
J3101	HCPCS	Tenecteplase 50 Mg/10 Ml Syrng	10	5	$31,584.00	$30,637.29	$0.41	$30,005.60	$25,662.68	2026-05-09
J3111	HCPCS	Romosozumab-aqqg 210 Mg/2.34Ml	10	5	$11,243.00	$10,906.13	$1.56	$11,611.99	$10,135.95	2026-05-09
J3304	HCPCS	Triamcinolone Acetonide 32 Mg	8	5	$3,037.00	$2,946.00	$520.65	$2,885.25	$2,467.65	2026-05-09
J3357	HCPCS	Ustekinumab 45 Mg/0.5 Ml Syr	8	5	$41,802.00	$40,548.65	$8.96	$39,712.59	$33,964.72	2026-05-09
J3380	HCPCS	Vedolizumab 300 Mg Vial	8	5	$31,894.00	$30,937.62	$72.63	$30,299.73	$25,914.25	2026-05-09
J7298	HCPCS	Levonorgestrel 20 MCG/24Hr IUD	10	5	$5,355.00	$5,194.89	$217.08	$5,087.78	$4,351.39	2026-05-09
J7318	HCPCS	HyaluronateStablized 60Mg/3Ml	8	5	$4,171.00	$4,046.03	$3.30	$3,962.60	$3,389.07	2026-05-09
J7323	HCPCS	Hyaluronate (Euflexxa)20MG/2ML	8	5	$1,501.00	$1,456.40	$975.94	$1,787.24	$1,426.37	2026-05-09
J7325	HCPCS	Hylan Polymer A&b 48mg/6ml Syr	17	5	$2,147.00	$2,083.07	$20.80	$2,040.13	$1,395.88	2026-05-09
J7326	HCPCS	Hyaluronate Crosslink 30mg/3ml	10	5	$2,655.00	$2,575.63	$1,175.00	$2,522.53	$2,157.42	2026-05-09
J9022	HCPCS	Atezolizumab 1200 Mg/20 Ml Vl	8	5	$49,458.00	$47,974.66	$1.26	$46,985.49	$40,184.96	2026-05-09
J9042	HCPCS	Brentuximab Vedotin 50 Mg Vial	8	5	$42,421.00	$41,148.56	$8,327.21	$40,300.14	$34,467.22	2026-05-09
J9043	HCPCS	Cabazitaxel 60 Mg/1.5 Ml Vial	8	5	$41,757.00	$40,504.73	$7.02	$39,669.58	$33,927.93	2026-05-09
J9047	HCPCS	Carfilzomib 60 Mg Vial	17	5	$15,722.00	$15,251.12	$81.21	$28,285.05	$14,936.66	2026-05-09
J9063	HCPCS	Mirvetuximab Soravtansine-gynx	8	5	$29,486.00	$28,601.54	$20.18	$28,011.81	$23,957.47	2026-05-09
J9144	HCPCS	Daratumumab Hyaluronida 1800Mg	10	5	$34,681.00	$33,641.14	$382.98	$33,610.25	$31,265.46	2026-05-09
J9155	HCPCS	Degarelix 80 Mg Vial	14	5	$1,612.00	$1,564.32	$135.29	$2,088.22	$1,532.07	2026-05-09
J9173	HCPCS	Durvalumab 500 Mg/10 Ml Vial	8	5	$18,675.00	$18,115.28	$16.91	$17,741.77	$15,173.88	2026-05-09
J9203	HCPCS	Gemtuzumab Ozogamicin 4.5 Mg	8	5	$44,834.00	$43,489.48	$97.98	$42,592.79	$36,428.05	2026-05-09
J9217	HCPCS	Leuprolide Acetate 45 Mg Syr	26	5	$4,281.00	$4,152.89	$1.47	$6,077.93	$3,417.46	2026-05-09
J9228	HCPCS	Ipilimumab 5 Mg/ml 10 Ml Vial	8	5	$29,399.00	$28,517.40	$1,054.59	$27,929.41	$23,886.99	2026-05-09
J9264	HCPCS	Paclitaxel Protein-bd 100mg Vl	8	5	$7,032.00	$6,821.54	$17.39	$6,680.89	$5,713.92	2026-05-09
J9271	HCPCS	Pembrolizumab 100 Mg/4 Ml Vial	8	5	$20,610.00	$19,992.32	$13.37	$19,580.11	$16,746.15	2026-05-09
J9272	HCPCS	Dostarlimab-gxly 500 Mg/10 Ml	8	5	$52,816.00	$51,232.37	$8,526.00	$50,176.04	$42,913.71	2026-05-09
J9299	HCPCS	Nivolumab 240 Mg/24 Ml Vial	14	5	$29,002.00	$28,132.67	$6.84	$27,552.61	$12,284.26	2026-05-09
J9306	HCPCS	Pertuzumab 420 Mg/14 Ml Vial	10	5	$26,748.00	$25,946.27	$508.34	$26,202.87	$24,113.98	2026-05-09
J9317	HCPCS	Sacituzumab Gov-hziy 180Mg	8	5	$13,365.00	$12,964.15	$4,156.37	$12,696.85	$10,859.15	2026-05-09
J9332	HCPCS	Efgartigimod Alfa-fcab 400 Mg	8	5	$27,360.00	$26,539.69	$7.91	$25,992.48	$22,230.41	2026-05-09
J9334	HCPCS	Efgart-hyalu-qvfc 1008Mg/5.6Ml	8	5	$57,782.00	$56,048.66	$560.66	$54,893.01	$46,947.98	2026-05-09
J9347	HCPCS	Tremelimumab-actl 300 Mg/15 Ml	8	5	$175,800.00	$170,526.00	$199.38	$167,010.00	$142,837.50	2026-05-09
J9352	HCPCS	Trabectedin 1 Mg Vial	8	5	$12,058.00	$11,696.30	$95.82	$11,455.14	$9,797.16	2026-05-09
P9035	HCPCS	Platelet Pheresis Leuko Reduc	8	5	$1,338.00	$1,297.86	$869.70	$1,271.10	$1,099.16	2026-05-09
P9037	HCPCS	Platelet Pheresis Leuk Red Irr	10	5	$1,449.00	$1,405.53	$276.00	$1,376.55	$1,190.36	2026-05-09
Q5101	HCPCS	Filgrastim-sndz 300 Mcg/0.5 Ml	14	5	$1,046.00	$1,015.41	$680.43	$2,902.40	$1,126.85	2026-05-09
Q5103	HCPCS	Infliximab-dyyb 100 Mg Vial	10	5	$2,590.00	$2,513.24	$1,684.13	$9,862.65	$2,461.42	2026-05-09
Q5107	HCPCS	Bevacizumab Awwb 100Mg/4Ml Vil	14	5	$3,269.00	$3,171.38	$2,125.15	$11,426.28	$3,232.47	2026-05-09
Q5108	HCPCS	Pegfilgrastim-jmdb 6 Mg/0.6 Ml	10	5	$8,047.00	$7,806.07	$5,230.88	$7,645.13	$7,254.83	2026-05-09
Q5111	HCPCS	Pegfilgrastim-cbqv 6 Mg/0.6 Ml	14	5	$8,925.00	$8,657.25	$1,112.40	$14,309.98	$8,478.75	2026-05-09
Q5115	HCPCS	Rituximab-abbs 100Mg/10Ml Via	17	5	$2,282.00	$2,213.81	$1,483.48	$15,001.78	$3,708.00	2026-05-09
Q5116	HCPCS	Trastuzumab Qyyp 150Mg Vial	17	5	$3,848.00	$3,732.73	$2,501.32	$10,885.89	$3,655.77	2026-05-09
Q5118	HCPCS	Bevacizumab/BVZR 100Mg/4Ml	14	5	$2,163.00	$2,098.69	$1,406.34	$7,465.58	$2,510.63	2026-05-09
Q5120	HCPCS	Pegfilgrastim-bmez 6 Mg/0.6 Ml	8	5	$17,813.00	$17,279.13	$4,279.65	$16,922.86	$14,473.50	2026-05-09
Q5122	HCPCS	Pegfilgrastim 6 Mg/0.6 Ml Syr	10	5	$7,949.00	$7,710.76	$3,939.75	$7,551.78	$7,142.57	2026-05-09

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