Hospital

WEST RIVER REGIONAL MEDICAL CENTER

Hettinger, ND · CCN 351330 · Rates published

128 distinct procedures filed

82 distinct payers

1,281 rate rows

2026-02-18 last MRF observed

Data quality

1,276 of 1,281 rate rows are consumer-grade (99.6%)

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 — reason	Rows
professional (physician) fee — not the facility price	4
exceeds 10× this hospital's gross charge — excluded from medians	1

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

Source MRF file	https://machine-readable-files.com/west-river-health/450340688_West-River-Health-Services_standardcharges.csv
Found on page	https://www.wrhs.com/cms-hpt.txt
Discovered via	CMS hospital list
Last fetch	not_modified · 2026-05-19
Content fingerprint	d3c6dfe8f8cf5e46… · 10,429,216 bytes · first seen 2026-05-17

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
1200012 CDM	Swing Room	1	$1,770.44	$1,770.44	$1,770.44	nat. median $1,770 1.0× median
1200015 CDM	M/s Private Telemetry/iso	1	$1,770.44	$1,770.44	$1,770.44	nat. median $533 outlier · 3.3×
1200002 CDM	M/s Private Room	1	$1,770.44	$1,770.44	$1,770.44	nat. median $367 outlier · 4.8×
J9217 HCPCS	Leuprolide Acetate 30 Mg/syr Syr	3	$202.63	$1,529.67	$1,518.54	nat. median $1,521 1.0× median
1200010 CDM	Nys Rate	2	$1,227.40	$1,725.50	$1,476.45	nat. median $25 outlier · 57.9×
36430 CPT	Blood Administration - 1 Unit	11	$537.53	$749.70	$631.91	nat. median $699 0.9× median
96413 CPT	Chemo Admin Infuse; Up To 1 Hr	11	$444.92	$560.49	$490.06	nat. median $500 1.0× median
J1610 HCPCS	Glucagon 1 Mg/ml Vial	2	$312.83	$362.64	$337.74	nat. median $371 0.9× median
96365 CPT	IV Infusion Therapy;up To 1 Hr	28	$291.65	$562.69	$332.05	nat. median $317 1.0× median
96374 CPT	Inj; Intravenous Push	20	$66.70	$415.39	$320.89	nat. median $226 1.4× median
J1097 HCPCS	Phenylephrine/ketorolac 4 Ml Vial	10	$311.65	$357.82	$313.30	nat. median $247 1.3× median
96360 CPT	IV Infusion Hydrate;31-60 Min	5	$57.48	$401.02	$291.87	nat. median $284 1.0× median
J3030 HCPCS	SUMAtriptan 6 Mg/0.5 Ml Vial	1	$75.00	$505.25	$290.12	nat. median $57 outlier · 5.1×
J1815 HCPCS	Insulin Lispro 300 Units/3 Ml Vial	10	$3.63	$265.25	$265.25	nat. median $42 outlier · 6.4×
J2506 HCPCS	Pegfilgrastim 6 Mg/0.6 Ml Inj	1	$232.53	$232.53	$232.53	nat. median $2,076 outlier · 0.1×
G0379 HCPCS	Direct Admit To Obs Care	10	$180.60	$210.00	$195.72	nat. median $552 outlier · 0.4×
J3101 HCPCS	Tenecteplase 50 Mg/10 Ml Vial	3	$108.00	$187.63	$136.55	nat. median $5,957 outlier · 0.0×
96367 CPT	IV Infusion;addtl Sequential	12	$90.00	$203.28	$104.02	nat. median $138 0.8× median
J2280 HCPCS	Moxifloxacin/nacl 400 Mg/250 Ml Bag	2	$96.83	$103.40	$100.12	nat. median $66 1.5× median
J1745 HCPCS	inFLIXimab 100 Mg/10 Ml Vial	3	$57.89	$121.42	$99.44	nat. median $451 outlier · 0.2×
94060 CPT	Broncho Eval; Spirometry/bd	8	$92.46	$109.88	$98.59	nat. median $387 outlier · 0.3×
96415 CPT	Chemo Admin;each Addtl Hr	11	$88.70	$111.93	$97.86	nat. median $154 0.6× median
96372 CPT	Inj Subcu Or IM	16	$89.01	$126.42	$97.86	nat. median $94 1.0× median
Q5115 HCPCS	Rituximab-abbs 10 Mg/ml Ml	2	$78.64	$96.22	$87.43	nat. median $884 outlier · 0.1×
J2785 HCPCS	Regadenoson 0.4 Mg/5 Ml Pfs	14	$75.07	$360.00	$86.05	nat. median $74 1.2× median
J1459 HCPCS	Immune Globulin,gamma (igg) 50 Ml Btl	3	$85.34	$93.14	$85.34	nat. median $1,227 outlier · 0.1×
93798 CPT	Card Rehab (phase Ii) 93798	11	$73.09	$183.68	$80.41	nat. median $187 outlier · 0.4×
J1335 HCPCS	Ertapenem Sodium 1 G Vial	4	$37.17	$112.58	$79.60	nat. median $125 0.6× median
Q5104 HCPCS	Infliximab-abda 100 Mg/10 Ml Vial	10	$51.82	$74.13	$68.58	nat. median $321 outlier · 0.2×
96361 CPT	IV Infusion Hydrate; Addtl Hr	6	$57.27	$81.51	$65.51	nat. median $96 0.7× median
Q0162 HCPCS	Ondansetron 4 Mg Tab.rapdis	7	$54.51	$68.73	$64.68	nat. median $5 outlier · 14.3×
J2310 HCPCS	Naloxone 2 Mg/2 Ml Pfs	4	$12.14	$69.30	$63.72	nat. median $40 1.6× median
96375 CPT	Inj; Addtl Intravenous Push	21	$57.27	$80.19	$62.97	nat. median $113 0.6× median
96366 CPT	IV Infusion Ther;each Addtl Hr	19	$57.27	$81.51	$62.96	nat. median $105 0.6× median
Q5121 HCPCS	Infliximab-axxq 100 Mg/10 Ml Vial	1	$62.09	$62.09	$62.09	nat. median $209 outlier · 0.3×
Q0144 HCPCS	Azithromycin 500 Mg Tablet	5	$22.35	$54.50	$54.50	nat. median $22 outlier · 2.5×
G0378 HCPCS	Obs Telemetry/iso 1st Hour	35	$38.69	$1,706.40	$50.94	nat. median $103 outlier · 0.5×
J2020 HCPCS	Linezolid 600 Mg/300 Ml Bag	2	$47.31	$54.00	$50.66	nat. median $64 0.8× median
J1450 HCPCS	Fluconazole/nacl 200 Mg/100 Ml Bag	1	$50.07	$50.07	$50.07	nat. median $33 1.5× median
J7050 HCPCS	0.9 % Sodium Chloride 250 Ml Pggybk.prt	20	$1.01	$64.63	$50.07	nat. median $21 outlier · 2.4×
J7060 HCPCS	Dextrose 5%-water 500 Ml Bag	1	$46.80	$46.80	$46.80	nat. median $20 outlier · 2.3×
90715 CPT	Diph,pertuss(acell),tet Ped/pf 0.5 Ml Disp.syrin	26	$29.67	$88.64	$44.95	nat. median $86 0.5× median
J1720 HCPCS	Hydrocortisone Sod Succinate 100 Mg/2 Ml Vial	4	$33.69	$47.70	$42.50	nat. median $65 0.7× median
96376 CPT	Tx/pro/dx Inj Same Drug Adon	19	$38.32	$179.20	$42.48	nat. median $139 outlier · 0.3×
J2997 HCPCS	Alteplase 100 Mg/100 Ml Vial	1	$40.71	$40.71	$40.71	nat. median $545 outlier · 0.1×
J9332 HCPCS	Efgartigimod Alfa-fcab 400 Mg/20 Ml Vial	1	$39.44	$39.44	$39.44	nat. median $112 outlier · 0.4×
J0360 HCPCS	hydrALAZINE Hcl 20 Mg/ml Ml	13	$23.55	$41.21	$38.12	nat. median $29 1.3× median
94640 CPT	Handheld Nebulizer Initial	4	$24.84	$43.46	$38.09	nat. median $195 outlier · 0.2×
J0694 HCPCS	ceFOXitin 1 G Vial	2	$35.80	$40.18	$37.99	nat. median $33 1.1× median
90471 CPT	Immunization Administration	32	$24.13	$45.00	$36.00	nat. median $66 0.5× median

Other procedures at this hospital

Browse this hospital's 128 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

1200015	CDM	M/s Private Telemetry/iso	1	1	$2,688.00	$2,607.36	$1,770.44	$1,770.44	$1,770.44	2026-02-18
1200012	CDM	Swing Room	1	1	$475.00	$460.75	$1,770.44	$1,770.44	$1,770.44	2026-02-18
1200002	CDM	M/s Private Room	1	1	$1,896.00	$1,839.12	$1,770.44	$1,770.44	$1,770.44	2026-02-18
J9217	HCPCS	Leuprolide Acetate 30 Mg/syr Syr	3	3	$8,585.20	$8,327.64	$202.63	$1,529.67	$1,518.54	2026-02-18
1200010	CDM	Nys Rate	2	2	$1,896.00	$1,839.12	$1,227.40	$1,725.50	$1,476.45	2026-02-18
36430	CPT	Blood Administration - 1 Unit	11	11	$771.00	$747.87	$537.53	$749.70	$631.91	2026-02-18
96413	CPT	Chemo Admin Infuse; Up To 1 Hr	11	11	$646.00	$626.62	$444.92	$560.49	$490.06	2026-02-18
J1610	HCPCS	Glucagon 1 Mg/ml Vial	2	2	$225.00	$218.25	$312.83	$362.64	$337.74	2026-02-18
96365	CPT	IV Infusion Therapy;up To 1 Hr	28	28	$423.00	$410.31	$291.65	$562.69	$332.05	2026-02-18
96374	CPT	Inj; Intravenous Push	20	20	$423.00	$410.31	$66.70	$415.39	$320.89	2026-02-18
J1097	HCPCS	Phenylephrine/ketorolac 4 Ml Vial	10	10	$1,652.00	$1,602.44	$311.65	$357.82	$313.30	2026-02-18
96360	CPT	IV Infusion Hydrate;31-60 Min	5	5	$423.00	$410.31	$57.48	$401.02	$291.87	2026-02-18
J3030	HCPCS	SUMAtriptan 6 Mg/0.5 Ml Vial	2	1	$303.25	$294.15	$75.00	$505.25	$290.12	2026-02-18
J1815	HCPCS	Insulin Lispro 300 Units/3 Ml Vial	10	10	$50.00	$48.50	$3.63	$265.25	$265.25	2026-02-18
J2506	HCPCS	Pegfilgrastim 6 Mg/0.6 Ml Inj	1	1	$6,417.99	$6,225.45	$232.53	$232.53	$232.53	2026-02-18
G0379	HCPCS	Direct Admit To Obs Care	10	10	$258.00	$250.26	$180.60	$210.00	$195.72	2026-02-18
J3101	HCPCS	Tenecteplase 50 Mg/10 Ml Vial	3	3	$12,446.00	$12,072.62	$108.00	$187.63	$136.55	2026-02-18
96367	CPT	IV Infusion;addtl Sequential	12	12	$129.00	$125.13	$90.00	$203.28	$104.02	2026-02-18
J2280	HCPCS	Moxifloxacin/nacl 400 Mg/250 Ml Bag	2	2	$76.75	$74.45	$96.83	$103.40	$100.12	2026-02-18
J1745	HCPCS	inFLIXimab 100 Mg/10 Ml Vial	3	3	$1,751.73	$1,699.18	$57.89	$121.42	$99.44	2026-02-18
94060	CPT	Broncho Eval; Spirometry/bd	8	8	$160.00	$155.20	$92.46	$109.88	$98.59	2026-02-18
96372	CPT	Inj Subcu Or IM	16	16	$129.00	$125.13	$89.01	$126.42	$97.86	2026-02-18
96415	CPT	Chemo Admin;each Addtl Hr	11	11	$129.00	$125.13	$88.70	$111.93	$97.86	2026-02-18
Q5115	HCPCS	Rituximab-abbs 10 Mg/ml Ml	2	2	$6,341.63	$6,151.38	$78.64	$96.22	$87.43	2026-02-18
J2785	HCPCS	Regadenoson 0.4 Mg/5 Ml Pfs	14	14	$75.00	$72.75	$75.07	$360.00	$86.05	2026-02-18
J1459	HCPCS	Immune Globulin,gamma (igg) 50 Ml Btl	3	3	$1,125.00	$1,091.25	$85.34	$93.14	$85.34	2026-02-18
93798	CPT	Card Rehab (phase Ii) 93798	11	11	$212.00	$205.64	$73.09	$183.68	$80.41	2026-02-18
J1335	HCPCS	Ertapenem Sodium 1 G Vial	4	4	$108.00	$104.76	$37.17	$112.58	$79.60	2026-02-18
Q5104	HCPCS	Infliximab-abda 100 Mg/10 Ml Vial	10	10	$1,130.09	$1,096.19	$51.82	$74.13	$68.58	2026-02-18
96361	CPT	IV Infusion Hydrate; Addtl Hr	6	6	$83.00	$80.51	$57.27	$81.51	$65.51	2026-02-18
Q0162	HCPCS	Ondansetron 4 Mg Tab.rapdis	7	7	$22.57	$21.89	$54.51	$68.73	$64.68	2026-02-18
J2310	HCPCS	Naloxone 2 Mg/2 Ml Pfs	4	4	$82.50	$80.03	$12.14	$69.30	$63.72	2026-02-18
96375	CPT	Inj; Addtl Intravenous Push	21	21	$83.00	$80.51	$57.27	$80.19	$62.97	2026-02-18
96366	CPT	IV Infusion Ther;each Addtl Hr	19	19	$83.00	$80.51	$57.27	$81.51	$62.96	2026-02-18
Q5121	HCPCS	Infliximab-axxq 100 Mg/10 Ml Vial	1	1	$750.00	$727.50	$62.09	$62.09	$62.09	2026-02-18
Q0144	HCPCS	Azithromycin 500 Mg Tablet	5	5	$54.50	$52.87	$22.35	$54.50	$54.50	2026-02-18
G0378	HCPCS	Obs Telemetry/iso 1st Hour	35	35	$917.00	$889.49	$38.69	$1,706.40	$50.94	2026-02-18
J2020	HCPCS	Linezolid 600 Mg/300 Ml Bag	2	2	$80.00	$77.60	$47.31	$54.00	$50.66	2026-02-18
J1450	HCPCS	Fluconazole/nacl 200 Mg/100 Ml Bag	1	1	$66.00	$64.02	$50.07	$50.07	$50.07	2026-02-18
J7050	HCPCS	0.9 % Sodium Chloride 250 Ml Pggybk.prt	20	20	$66.00	$64.02	$1.01	$64.63	$50.07	2026-02-18
J7060	HCPCS	Dextrose 5%-water 500 Ml Bag	1	1	$66.00	$64.02	$46.80	$46.80	$46.80	2026-02-18
90715	CPT	Diph,pertuss(acell),tet Ped/pf 0.5 Ml Disp.syrin	26	26	$56.42	$54.73	$29.67	$88.64	$44.95	2026-02-18
J1720	HCPCS	Hydrocortisone Sod Succinate 100 Mg/2 Ml Vial	4	4	$57.50	$55.78	$33.69	$47.70	$42.50	2026-02-18
96376	CPT	Tx/pro/dx Inj Same Drug Adon	19	19	$56.00	$54.32	$38.32	$179.20	$42.48	2026-02-18
J2997	HCPCS	Alteplase 100 Mg/100 Ml Vial	1	1	$13,200.54	$12,804.52	$40.71	$40.71	$40.71	2026-02-18
J9332	HCPCS	Efgartigimod Alfa-fcab 400 Mg/20 Ml Vial	1	1	$9,285.57	$9,007.00	$39.44	$39.44	$39.44	2026-02-18
J0360	HCPCS	hydrALAZINE Hcl 20 Mg/ml Ml	13	13	$50.25	$48.74	$23.55	$41.21	$38.12	2026-02-18
94640	CPT	Handheld Nebulizer Initial	4	4	$64.00	$62.08	$24.84	$43.46	$38.09	2026-02-18
J0694	HCPCS	ceFOXitin 1 G Vial	2	2	$24.50	$23.77	$35.80	$40.18	$37.99	2026-02-18
90471	CPT	Immunization Administration	32	32	$50.00	$48.50	$24.13	$45.00	$36.00	2026-02-18
J3380	HCPCS	Vedolizumab 300 Mg Vial	1	1	$14,039.87	$13,618.67	$34.56	$34.56	$34.56	2026-02-18
J0780	HCPCS	Prochlorperazine Edisylate 10 Mg/2 Ml Vial	2	2	$38.00	$36.86	$12.06	$53.00	$32.53	2026-02-18
90714	CPT	Tetanus And Diphtheria Tox/pf 0.5 Ml Disp.syrin	12	12	$97.25	$94.33	$21.29	$80.94	$30.00	2026-02-18
J0744	HCPCS	Ciprofloxacin 400 Mg/200 Ml Bag	6	6	$66.00	$64.02	$25.04	$31.35	$29.17	2026-02-18
J3360	HCPCS	Diazepam 10 Mg/2 Ml Pfs	3	3	$84.25	$81.72	$24.75	$35.61	$29.01	2026-02-18
J2360	HCPCS	Orphenadrine Citrate 60 Mg/2 Ml Vial	14	14	$54.75	$53.11	$23.47	$48.29	$28.36	2026-02-18
J3411	HCPCS	Thiamine 200 Mg/2 Ml Vial	5	5	$35.00	$33.95	$12.21	$29.59	$26.55	2026-02-18
J2175	HCPCS	Meperidine 25 Mg/ml Disp.syrin	1	1	$21.25	$20.61	$26.32	$26.32	$26.32	2026-02-18
J2710	HCPCS	Neostigmine Methylsulfate 10 Mg/10 Ml Ml	3	3	$53.00	$51.41	$21.47	$26.04	$26.04	2026-02-18
J3370	HCPCS	Vancomycin 500 Mg/10 Ml Vial	5	5	$28.75	$27.89	$6.26	$33.94	$23.58	2026-02-18
J0897	HCPCS	Denosumab 120 Mg/1.7 Ml Vial	26	26	$5,174.75	$5,019.51	$12.77	$1,800.00	$22.76	2026-02-18
J7517	HCPCS	Mycophenolate 500 Mg Tablet	1	1	$63.00	$61.11	$22.68	$22.68	$22.68	2026-02-18
J2550	HCPCS	Promethazine 25 Mg/ml Vial	8	8	$16.00	$15.52	$1.42	$31.56	$22.56	2026-02-18
J2270	HCPCS	Morphine Sulfate/pf 30 Mg/30 Ml Ml	10	10	$49.00	$47.53	$4.32	$25.09	$22.26	2026-02-18
J3489	HCPCS	Zoledronic Acid 4 Mg/5 Ml Vial	5	5	$1,770.00	$1,716.90	$16.32	$171.79	$19.93	2026-02-18
J0295	HCPCS	Ampicillin /sulbactam 1.5 Gram Vial	2	2	$27.00	$26.19	$19.33	$19.33	$19.33	2026-02-18
J1630	HCPCS	Haloperidol Lactate 1 Mg/0.2 Ml Inj	2	2	$21.00	$20.37	$11.04	$25.02	$18.03	2026-02-18
J2543	HCPCS	Piper/tazobac 2.25 Gm Vial	10	10	$16.00	$15.52	$6.37	$22.96	$17.20	2026-02-18
J3475	HCPCS	Magnesium Sulfate 4 Meq/ml Vial	17	17	$16.00	$15.52	$2.23	$77.90	$16.61	2026-02-18
J0456	HCPCS	Azithromycin 500 Mg Vial.port	14	14	$35.25	$34.19	$4.14	$32.18	$16.37	2026-02-18
J1200	HCPCS	diphenhydrAMINE Hcl 50 Mg/ml Vial	13	13	$16.00	$15.52	$11.20	$24.44	$13.44	2026-02-18
J3105	HCPCS	Terbutaline 1 Mg/ml Vial	2	2	$16.00	$15.52	$12.14	$14.40	$13.27	2026-02-18
J2060	HCPCS	LORazepam 2 Mg/ml Ml	8	8	$16.00	$15.52	$11.44	$21.78	$13.16	2026-02-18
J0885	HCPCS	Epoetin Alfa 10,000 Units/ml Ml	1	1	$401.00	$388.97	$12.90	$12.90	$12.90	2026-02-18
J0697	HCPCS	Cefuroxime Sodium 750 Mg Vial	10	10	$16.00	$15.52	$12.07	$13.86	$12.69	2026-02-18
J0330	HCPCS	Succinylcholine 20 Mg/ml Vial	11	11	$53.00	$51.41	$2.50	$50.35	$12.48	2026-02-18
J0280	HCPCS	Aminophylline 500 Mg/20 Ml Vial	7	7	$41.00	$39.77	$10.96	$25.80	$12.24	2026-02-18
J2765	HCPCS	Metoclopramide 10 Mg/2 Ml Vial	13	13	$16.00	$15.52	$11.44	$30.98	$12.16	2026-02-18
J7325	HCPCS	Hylan G-f 20 16 Mg/2 Ml Syr	4	4	$547.85	$531.41	$10.64	$19.94	$12.15	2026-02-18
J2274	HCPCS	Morphine Sulfate 10 Mg/10 Ml Inj	16	16	$72.50	$70.33	$11.04	$14.40	$12.14	2026-02-18
J2371	HCPCS	Phenylephrine Hcl 10 Mg/ml Vial	5	5	$16.00	$15.52	$0.03	$14.79	$12.14	2026-02-18
J0702	HCPCS	Betamet Acet/betamet Na Ph 6 Mg/ml Ml	14	14	$38.75	$37.59	$7.17	$18.81	$12.06	2026-02-18
J1580	HCPCS	Gentamicin 20 Mg/2 Ml Vial	1	1	$16.00	$15.52	$11.44	$11.44	$11.44	2026-02-18
J0248	HCPCS	Remdesivir 100 Mg/20 Ml Vial	4	4	$1,587.25	$1,539.63	$10.66	$15.47	$11.21	2026-02-18
A9270	HCPCS	Acyclovir 800 Mg Tab 15 Tab Item	53	37	$41.00	$39.77	$2.75	$113.92	$10.00	2026-02-18
J3430	HCPCS	Phytonadione 10 Mg/ml Ml	3	3	$107.00	$103.79	$9.29	$11.64	$9.56	2026-02-18
J1451	HCPCS	Fomepizole 1.5 Gm/1.5 Ml Vial	1	1	$1,479.00	$1,434.63	$9.49	$9.49	$9.49	2026-02-18
J3420	HCPCS	Cyanocobalamin 1,000 Mcg/ml Ml	6	6	$24.50	$23.77	$9.06	$25.95	$9.10	2026-02-18
J7507	HCPCS	Tacrolimus Anhydrous 1 Mg Capsule	1	1	$15.75	$15.28	$8.46	$8.46	$8.46	2026-02-18
J1885	HCPCS	Ketorolac 15 Mg/ml Vial	47	43	$16.00	$15.52	$2.27	$36.80	$8.44	2026-02-18
J2185	HCPCS	Meropenem 1 Gram Vial	2	2	$46.25	$44.86	$6.22	$9.29	$7.75	2026-02-18
J0153	HCPCS	Adenosine 6 Mg/2 Ml Vial	2	2	$18.75	$18.19	$2.10	$13.40	$7.75	2026-02-18
J1265	HCPCS	Dopamine Hcl 200 Mg/5 Ml Vial	1	1	$16.00	$15.52	$7.68	$7.68	$7.68	2026-02-18
J0692	HCPCS	Cefepime Hcl 2 Gm Vial	5	5	$41.25	$40.01	$6.96	$39.21	$7.45	2026-02-18
J7509	HCPCS	methylPREDNISolone 4 Mg Tablet	2	2	$3.00	$2.91	$2.54	$12.19	$7.36	2026-02-18
J0881	HCPCS	Darbepoetin Alfa In Polysorbat 300 Mcg/0.6 Ml Disp	1	1	$3,483.00	$3,378.51	$6.83	$6.83	$6.83	2026-02-18
J2250	HCPCS	Midazolam 5 Mg/5 Ml Vial	34	34	$16.00	$15.52	$2.50	$15.20	$6.74	2026-02-18
J1650	HCPCS	Enoxaparin 30 Mg/0.3 Ml Disp.syrin	15	15	$26.25	$25.46	$5.10	$19.65	$6.59	2026-02-18
J0690	HCPCS	Cefazolin Sodium/dextrose,iso 2 Gm/50 Ml Ml	18	18	$82.00	$79.54	$4.44	$25.32	$5.92	2026-02-18
J0256	HCPCS	Alpha-1-proteinase Inhibitor 1,000 Mg Vial	2	2	$778.50	$755.15	$5.23	$5.66	$5.45	2026-02-18
Q9968	HCPCS	Methylene Blue 50 Mg/10 Ml Ampul	6	6	$351.75	$341.20	$3.02	$10.00	$5.01	2026-02-18
J7644	HCPCS	Ipratropium 0.5 Mg/2.5 Ml Ampul.neb.	1	1	$4.75	$4.61	$4.92	$4.92	$4.92	2026-02-18
J1644	HCPCS	Heparin 5,000 Units/ml Ml	11	11	$16.00	$15.52	$0.35	$4.68	$4.38	2026-02-18
J0171	HCPCS	EPINEPHrine 0.3 Mg/syr Disp.syrin	6	5	$150.00	$145.50	$1.12	$22.26	$3.78	2026-02-18
J3480	HCPCS	Water For Inj.,bacteriostatic 30 Ml Vial	15	15	$16.00	$15.52	$0.64	$59.40	$3.39	2026-02-18
J2405	HCPCS	Ondansetron 4 Mg/2 Ml Vial	37	35	$16.00	$15.52	$0.26	$24.35	$3.38	2026-02-18
J1100	HCPCS	Dexamethasone Sod Phosphate/pf 10 Mg/ml Vial	25	25	$26.25	$25.46	$0.23	$15.20	$3.36	2026-02-18
J1956	HCPCS	Levofloxacin 500 Mg/100 Ml Bag	6	6	$180.00	$174.60	$2.60	$64.80	$3.04	2026-02-18
J7168	HCPCS	Human Prothrombin Complx(pcc) 500 Unit Kit	1	1	$2,355.00	$2,284.35	$3.02	$3.02	$3.02	2026-02-18
J3010	HCPCS	Fentanyl Citrate 250 Mcg/5 Ml Vial	31	31	$16.00	$15.52	$2.21	$25.05	$2.56	2026-02-18
J0282	HCPCS	Amiodarone 150 Mg/3 Ml Ampul	2	2	$16.00	$15.52	$2.43	$2.62	$2.53	2026-02-18
J3490	HCPCS	Acebutolol 200 Mg Capsule	49	43	$5.00	$4.85	$0.37	$253.18	$2.40	2026-02-18
A9150	HCPCS	Acetaminophen 160 Mg/5 Ml Udc	26	25	$4.00	$3.88	$0.69	$11.76	$2.28	2026-02-18
J0696	HCPCS	Ceftriaxone 500 Mg Vial	21	20	$16.00	$15.52	$0.72	$12.80	$2.28	2026-02-18
J3301	HCPCS	Triamcinolone 40 Mg/ml Ml	15	15	$33.25	$32.25	$1.40	$1.54	$1.52	2026-02-18
J2704	HCPCS	Propofol 200 Mg/20 Ml Btl	39	39	$16.00	$15.52	$0.50	$66.00	$1.38	2026-02-18
J0131	HCPCS	Acetaminophen 1,000 Mg/100 Ml Bag	27	27	$12.00	$11.64	$0.34	$0.78	$0.64	2026-02-18
J1756	HCPCS	Iron Sucrose Complex 100 Mg/5 Ml Inj	11	11	$94.75	$91.91	$0.39	$1.33	$0.62	2026-02-18
J2372	CPT	Phenylephrine Hcl 500 Mcg/5 Ml Ampul	6	6	$17.50	$16.98	$0.53	$14.00	$0.61	2026-02-18
J7510	HCPCS	Prednisolone Sod Phosphate 15 Mg/5 Ml Udc	9	9	$10.00	$9.70	$0.52	$2.60	$0.57	2026-02-18
J2795	HCPCS	Ropivacaine Hcl/pf 2 Mg/ml Vial	11	11	$19.50	$18.92	$0.25	$0.42	$0.36	2026-02-18
J0461	HCPCS	Atropine Sulfate 0.4 Mg/ml Vial	5	5	$114.50	$111.07	$0.29	$0.64	$0.34	2026-02-18
J1953	HCPCS	Levetiracetam 500 Mg/5 Ml Vial	5	5	$16.00	$15.52	$0.14	$25.60	$0.23	2026-02-18
J8540	HCPCS	Dexamethasone 0.5 Mg/5 Ml Udc	12	10	$4.75	$4.61	$0.09	$11.84	$0.20	2026-02-18
J0133	HCPCS	Acyclovir Sodium 500 Mg Vial	2	2	$16.00	$15.52	$0.13	$0.25	$0.19	2026-02-18
J1642	HCPCS	Heparin Flush 1 Each Daily.chg	3	3	$45.00	$43.65	$0.18	$0.21	$0.18	2026-02-18
J7512	HCPCS	predniSONE 20 Mg Tablet	3	3	$3.00	$2.91	$0.11	$0.13	$0.11	2026-02-18
J7131	HCPCS	Sodium Chloride 3% 500 Ml Bag	1	1	$22.23	$21.56	$0.09	$0.09	$0.09	2026-02-18

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