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

LODI COMMUNITY HOSPITAL

Lodi, OH · CCN 361303 · Rates published

7,072 distinct procedures filed
31 distinct payers
610,652 rate rows
2025-06-28 last MRF observed · ⚠ 17 mo old
Data quality

364,481 of 610,652 rate rows are consumer-grade (59.7%)

246,171 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
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 209,127
per-diem day rate — not a per-procedure price 28,064
placeholder amount (≤ $0.02) — excluded from medians 7,939
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 1,007
exceeds 10× this hospital's gross charge — excluded from medians 34

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 17 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://clevelandclinic.pt.panaceainc.com/MRFDownload/clevelandclinic/akron-lodi
Found on page https://my.clevelandclinic.org/patients/billing-finance/comprehensive-hospital-charges
Discovered viaDiscovered by HANK
Last fetch Latest re-check couldn't be parsed — showing last good data · 2026-11-06
Content fingerprint f4909b4c12551579… · 13,903,918 bytes · first seen 2026-05-06

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
J3394
HCPCS 		Lyfgenia 1.7 X To 20 X 10exp6 Cell/ml Intravenous Suspension 8 $500,000.00 $4,483,344.00 $4,464,000.00 nat. median
$3,286,000
1.4× median
J3393
HCPCS 		Zynteglo 2 X 10exp6 To 20 X 10exp6 Cell/ml Intravenous Suspension 9 $500,000.00 $4,569,600.00 $4,032,000.00 nat. median
$2,994,107
1.3× median
J3399
HCPCS 		Zolgensma 2 X 10exp13 Vg/ml Intravenous Suspension Kit 18 $500,000.00 $4,934,250.00 $3,794,400.00 nat. median
$2,467,989
1.5× median
J3392
HCPCS 		Casgevy 4x10exp6 To 13x10exp6 Cell/ml Intravenous Suspension 10 $500,000.00 $4,224,000.00 $3,168,000.00 nat. median
$2,401,965
1.3× median
Q2042
HCPCS 		Kymriah 0.2 X 10exp6 To 2.5 X 10exp8 Cell Intravenous Suspension 26 $500,000.00 $2,848,960.04 $1,518,955.67 nat. median
$739,658
outlier · 2.1×
Q2056
HCPCS 		Carvykti 0.5x 10exp6 To 1x 10exp8 Cell Intravenous Suspension 26 $500,000.00 $2,505,866.40 $1,503,519.84 nat. median
$646,415
outlier · 2.3×
Q2041
HCPCS 		Yescarta Intravenous Suspension 26 $489,455.96 $2,417,184.00 $1,450,310.40 nat. median
$608,239
outlier · 2.4×
Q2054
HCPCS 		Breyanzi 1.5x To 70x10exp6 Cell/ml Intravenous Suspension 26 $500,000.00 $2,339,891.68 $1,403,935.01 nat. median
$640,950
outlier · 2.2×
Q2053
HCPCS 		Tecartus 2x10exp6 To 2x10exp8 Cell Intravenous Suspension 26 $460,530.40 $2,217,600.00 $1,330,560.00 nat. median
$592,235
outlier · 2.2×
J0225
HCPCS 		Amvuttra 25 Mg/0.5 Ml Subcutaneous Syringe 26 $4,926.00 $859,327.20 $489,816.51 nat. median
$8,223
outlier · 59.6×
927
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 2 $183,952.40 $306,569.74 $245,261.07 nat. median
$198,115
1.2× median
J2779
HCPCS 		Susvimo 10 Mg/0.1 Ml Intravitreal Solution 26 $79.08 $288,000.00 $164,160.00 nat. median
$88
outlier · 1863.5×
J9274
HCPCS 		Kimmtrak 100 Mcg/0.5 Ml Intravenous Solution 26 $214.76 $196,608.00 $112,066.56 nat. median
$418
outlier · 268.2×
J9248
HCPCS 		Hepzato (62 Mm Catheter) 50 Mg Intra-arterial Solution 26 $773.80 $180,000.00 $102,600.00 nat. median
$902
outlier · 113.8×
J9226
HCPCS 		Supprelin La 50 Mg (65 Mcg/day) Implant Kit 26 $38,799.32 $175,562.52 $100,070.63 nat. median
$55,159
1.8× median
J2777
HCPCS 		Vabysmo 6 Mg/0.05 Ml Intravitreal Solution 26 $34.25 $164,854.80 $93,967.24 nat. median
$55
outlier · 1705.2×
J9269
HCPCS 		Elzonris 1000 Mcg/ml Intravenous Solution 26 $339.03 $162,031.92 $92,358.20 nat. median
$512
outlier · 180.2×
C9293
HCPCS 		Voraxaze 1000 Unit Intravenous Solution 26 $32,758.03 $148,226.40 $90,862.78 nat. median
$30,130
outlier · 3.0×
A9543
HCPCS 		Zevalin (y-90) 3.2 Mg/2 Ml Intravenous Kit 26 $14,774.74 $148,248.86 $88,949.32 nat. median
$63,504
1.4× median
J0223
HCPCS 		Givlaari 189 Mg/ml Subcutaneous Solution 26 $112.14 $153,417.60 $87,448.03 nat. median
$153
outlier · 573.2×
J0179
HCPCS 		Beovu 6 Mg/0.05 Ml Intravitreal Syringe 26 $332.57 $147,062.88 $83,825.85 nat. median
$474
outlier · 177.0×
J0177
HCPCS 		Eylea Hd 8 Mg/0.07 Ml Intravitreal Solution For Injection 26 $333.70 $137,700.00 $78,489.00 nat. median
$461
outlier · 170.3×
J0178
HCPCS 		Eylea 2 Mg/0.05 Ml Intravitreal Syringe 26 $821.98 $136,530.00 $77,822.10 nat. median
$1,358
outlier · 57.3×
957
MS_DRG 		Other O.r. Procedures For Multiple Significant Trauma With Mcc 2 $58,313.31 $96,459.86 $77,386.58 nat. median
$67,908
1.1× median
J7352
HCPCS 		Scenesse 16 Mg Subcutaneous Implant 26 $2,873.33 $120,982.00 $72,589.20 nat. median
$3,403
outlier · 21.3×
955
MS_DRG 		Craniotomy For Multiple Significant Trauma 2 $53,399.36 $88,242.12 $70,820.74 nat. median
$61,660
1.1× median
928
MS_DRG 		Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 2 $52,244.87 $86,311.42 $69,278.15 nat. median
$61,263
1.1× median
J9600
HCPCS 		Photofrin 75 Mg Intravenous Solution 26 $23,870.14 $111,950.40 $67,170.24 nat. median
$30,234
outlier · 2.2×
J0202
HCPCS 		Lemtrada 12 Mg/1.2 Ml Intravenous Solution 26 $2,337.69 $117,798.96 $67,145.41 nat. median
$3,912
outlier · 17.2×
J9281
HCPCS 		Jelmyto 40 Mg X 2 Intra-pyelocalyceal Kit 26 $307.34 $117,504.00 $66,977.28 nat. median
$532
outlier · 125.9×
969
MS_DRG 		HIV With Extensive O.r. Procedures With Mcc 2 $49,504.68 $81,728.93 $65,616.80 nat. median
$58,234
1.1× median
J3357
HCPCS 		Stelara 45 Mg/0.5 Ml Subcutaneous Solution 26 $159.91 $104,945.34 $62,967.20 nat. median
$14,970
outlier · 4.2×
J9229
HCPCS 		Besponsa 0.9 Mg(0.25 Mg/ml Initial Concentration) Intravenous Solution 26 $2,618.85 $109,958.40 $62,676.29 nat. median
$6,174
outlier · 10.2×
J2507
HCPCS 		Krystexxa 8 Mg/ml Intravenous Solution 26 $3,482.15 $108,080.82 $61,606.07 nat. median
$9,222
outlier · 6.7×
J2778
HCPCS 		Darvocet-n 50 50 Mg-325 Mg Tab 26 $137.14 $140,400.00 $60,821.28 nat. median
$411
outlier · 147.8×
J2326
HCPCS 		Spinraza (pf) 12 Mg/5 Ml Intrathecal Solution 26 $1,231.90 $99,288.57 $59,573.14 nat. median
$2,492
outlier · 23.9×
J9359
HCPCS 		Zynlonta 10 Mg Intravenous Solution 26 $206.38 $99,959.04 $56,976.65 nat. median
$737
outlier · 77.3×
J1951
HCPCS 		Fensolvi 45 Mg Subcutaneous Syringe 26 $140.62 $98,795.04 $56,313.17 nat. median
$174
outlier · 324.4×
Q5128
HCPCS 		Cimerli 0.5 Mg/0.05 Ml Intravitreal Solution 26 $201.01 $97,920.00 $55,814.40 nat. median
$242
outlier · 230.5×
J1930
HCPCS 		Somatuline Depot 60 Mg/0.2 Ml Subcutaneous Syringe 26 $49.97 $109,584.00 $51,664.18 nat. median
$5,088
outlier · 10.2×
981
MS_DRG 		Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 2 $37,369.34 $61,434.65 $49,401.99 nat. median
$43,609
1.1× median
Q5124
HCPCS 		Byooviz 0.5 Mg/0.05 Ml Intravitreal Solution 26 $149.75 $83,800.80 $47,766.46 nat. median
$173
outlier · 276.8×
J9029
HCPCS 		Adstiladrin 3x10exp11 Vp/ml Intravesical Suspension 26 $15,912.00 $110,662.31 $46,389.60 nat. median
$68,400
0.7× median
901
MS_DRG 		Wound Debridements For Injuries With Mcc 2 $34,870.25 $57,255.35 $46,062.80 nat. median
$39,584
1.2× median
J2781
HCPCS 		Syfovre (pf) 15 Mg/0.1 Ml Intravitreal Solution 26 $147.36 $79,628.40 $45,388.19 nat. median
$173
outlier · 262.0×
933
MS_DRG 		Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 2 $34,069.68 $55,916.53 $44,993.10 nat. median
$35,943
1.3× median
J2782
HCPCS 		Izervay (pf) 2 Mg/0.1 Ml Intravitreal Solution 26 $109.53 $75,600.00 $43,092.00 nat. median
$128
outlier · 336.3×
958
MS_DRG 		Other O.r. Procedures For Multiple Significant Trauma With Cc 2 $32,392.03 $53,110.95 $42,751.49 nat. median
$38,930
1.1× median
J0638
HCPCS 		Ilaris (pf) 150 Mg/ml Subcutaneous Solution 26 $127.81 $72,797.79 $41,494.74 nat. median
$253
outlier · 164.0×
907
MS_DRG 		Other O.r. Procedures For Injuries With Mcc 2 $31,417.58 $51,481.36 $41,449.47 nat. median
$35,937
1.2× median

Other procedures at this hospital

Browse this hospital's 7,072 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
             
J3394 HCPCS Lyfgenia 1.7 X To 20 X 10exp6 Cell/ml Intravenous Suspension 9 8 — — $500,000.00 $4,483,344.00 $4,464,000.00 2025-06-28
J3393 HCPCS Zynteglo 2 X 10exp6 To 20 X 10exp6 Cell/ml Intravenous Suspension 10 9 — — $500,000.00 $4,569,600.00 $4,032,000.00 2025-06-28
J3399 HCPCS Zolgensma 2 X 10exp13 Vg/ml Intravenous Suspension Kit 30 18 — $4,972,500.00 $500,000.00 $4,934,250.00 $3,794,400.00 2025-06-28
J3392 HCPCS Casgevy 4x10exp6 To 13x10exp6 Cell/ml Intravenous Suspension 13 10 — — $500,000.00 $4,224,000.00 $3,168,000.00 2025-06-28
Q2042 HCPCS Kymriah 0.2 X 10exp6 To 2.5 X 10exp8 Cell Intravenous Suspension 88 26 $2,848,960.04 $1,851,824.03 35% off $500,000.00 $2,848,960.04 $1,518,955.67 2025-06-28
Q2056 HCPCS Carvykti 0.5x 10exp6 To 1x 10exp8 Cell Intravenous Suspension 47 26 $2,505,866.40 $1,628,813.16 35% off $500,000.00 $2,505,866.40 $1,503,519.84 2025-06-28
Q2041 HCPCS Yescarta Intravenous Suspension 47 26 $2,417,184.00 $1,571,169.60 35% off $489,455.96 $2,417,184.00 $1,450,310.40 2025-06-28
Q2054 HCPCS Breyanzi 1.5x To 70x10exp6 Cell/ml Intravenous Suspension 47 26 $2,339,891.68 $1,520,929.59 35% off $500,000.00 $2,339,891.68 $1,403,935.01 2025-06-28
Q2053 HCPCS Tecartus 2x10exp6 To 2x10exp8 Cell Intravenous Suspension 47 26 $2,217,600.00 $1,441,440.00 35% off $460,530.40 $2,217,600.00 $1,330,560.00 2025-06-28
J0225 HCPCS Amvuttra 25 Mg/0.5 Ml Subcutaneous Syringe 48 26 $859,327.20 $558,562.68 35% off $4,926.00 $859,327.20 $489,816.51 2025-06-28
927 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft 2 2 — — $183,952.40 $306,569.74 $245,261.07 2025-06-28
J2779 HCPCS Susvimo 10 Mg/0.1 Ml Intravitreal Solution 48 26 $288,000.00 $187,200.00 35% off $79.08 $288,000.00 $164,160.00 2025-06-28
J9274 HCPCS Kimmtrak 100 Mcg/0.5 Ml Intravenous Solution 48 26 $196,608.00 $127,795.20 35% off $214.76 $196,608.00 $112,066.56 2025-06-28
J9248 HCPCS Hepzato (62 Mm Catheter) 50 Mg Intra-arterial Solution 48 26 $180,000.00 $117,000.00 35% off $773.80 $180,000.00 $102,600.00 2025-06-28
J9226 HCPCS Supprelin La 50 Mg (65 Mcg/day) Implant Kit 48 26 $175,562.52 $114,115.64 35% off $38,799.32 $175,562.52 $100,070.63 2025-06-28
J2777 HCPCS Vabysmo 6 Mg/0.05 Ml Intravitreal Solution 48 26 $164,854.80 $107,155.62 35% off $34.25 $164,854.80 $93,967.24 2025-06-28
J9269 HCPCS Elzonris 1000 Mcg/ml Intravenous Solution 48 26 $162,031.92 $105,320.75 35% off $339.03 $162,031.92 $92,358.20 2025-06-28
C9293 HCPCS Voraxaze 1000 Unit Intravenous Solution 45 26 $148,226.40 $96,347.16 35% off $32,758.03 $148,226.40 $90,862.78 2025-06-28
A9543 HCPCS Zevalin (y-90) 3.2 Mg/2 Ml Intravenous Kit 48 26 $148,248.86 $96,361.76 35% off $14,774.74 $148,248.86 $88,949.32 2025-06-28
J0223 HCPCS Givlaari 189 Mg/ml Subcutaneous Solution 48 26 $153,417.60 $99,721.44 35% off $112.14 $153,417.60 $87,448.03 2025-06-28
J0179 HCPCS Beovu 6 Mg/0.05 Ml Intravitreal Syringe 48 26 $147,062.88 $95,590.87 35% off $332.57 $147,062.88 $83,825.85 2025-06-28
J0177 HCPCS Eylea Hd 8 Mg/0.07 Ml Intravitreal Solution For Injection 48 26 $137,700.00 $89,505.00 35% off $333.70 $137,700.00 $78,489.00 2025-06-28
J0178 HCPCS Eylea 2 Mg/0.05 Ml Intravitreal Syringe 48 26 $136,530.00 $88,744.50 35% off $821.98 $136,530.00 $77,822.10 2025-06-28
957 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Mcc 2 2 — — $58,313.31 $96,459.86 $77,386.58 2025-06-28
J7352 HCPCS Scenesse 16 Mg Subcutaneous Implant 48 26 $120,982.00 $78,638.30 35% off $2,873.33 $120,982.00 $72,589.20 2025-06-28
955 MS_DRG Craniotomy For Multiple Significant Trauma 2 2 — — $53,399.36 $88,242.12 $70,820.74 2025-06-28
928 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/mcc 2 2 — — $52,244.87 $86,311.42 $69,278.15 2025-06-28
J9600 HCPCS Photofrin 75 Mg Intravenous Solution 48 26 $111,950.40 $72,767.76 35% off $23,870.14 $111,950.40 $67,170.24 2025-06-28
J0202 HCPCS Lemtrada 12 Mg/1.2 Ml Intravenous Solution 48 26 $117,798.96 $76,569.32 35% off $2,337.69 $117,798.96 $67,145.41 2025-06-28
J9281 HCPCS Jelmyto 40 Mg X 2 Intra-pyelocalyceal Kit 48 26 $117,504.00 $76,377.60 35% off $307.34 $117,504.00 $66,977.28 2025-06-28
969 MS_DRG HIV With Extensive O.r. Procedures With Mcc 2 2 — — $49,504.68 $81,728.93 $65,616.80 2025-06-28
J3357 HCPCS Stelara 45 Mg/0.5 Ml Subcutaneous Solution 93 26 $104,945.34 $68,214.47 35% off $159.91 $104,945.34 $62,967.20 2025-06-28
J9229 HCPCS Besponsa 0.9 Mg(0.25 Mg/ml Initial Concentration) Intravenous Solution 48 26 $109,958.40 $71,472.96 35% off $2,618.85 $109,958.40 $62,676.29 2025-06-28
J2507 HCPCS Krystexxa 8 Mg/ml Intravenous Solution 48 26 $108,080.82 $70,252.53 35% off $3,482.15 $108,080.82 $61,606.07 2025-06-28
J2778 HCPCS Darvocet-n 50 50 Mg-325 Mg Tab 91 26 $140,400.00 $91,260.00 35% off $137.14 $140,400.00 $60,821.28 2025-06-28
J2326 HCPCS Spinraza (pf) 12 Mg/5 Ml Intrathecal Solution 48 26 $99,288.57 $64,537.57 35% off $1,231.90 $99,288.57 $59,573.14 2025-06-28
J9359 HCPCS Zynlonta 10 Mg Intravenous Solution 48 26 $99,959.04 $64,973.38 35% off $206.38 $99,959.04 $56,976.65 2025-06-28
J1951 HCPCS Fensolvi 45 Mg Subcutaneous Syringe 48 26 $98,795.04 $64,216.78 35% off $140.62 $98,795.04 $56,313.17 2025-06-28
Q5128 HCPCS Cimerli 0.5 Mg/0.05 Ml Intravitreal Solution 48 26 $97,920.00 $63,648.00 35% off $201.01 $97,920.00 $55,814.40 2025-06-28
J1930 HCPCS Somatuline Depot 60 Mg/0.2 Ml Subcutaneous Syringe 134 26 $97,296.00 $63,242.40 35% off $49.97 $109,584.00 $51,664.18 2025-06-28
981 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 2 2 — — $37,369.34 $61,434.65 $49,401.99 2025-06-28
Q5124 HCPCS Byooviz 0.5 Mg/0.05 Ml Intravitreal Solution 48 26 $83,800.80 $54,470.52 35% off $149.75 $83,800.80 $47,766.46 2025-06-28
J9029 HCPCS Adstiladrin 3x10exp11 Vp/ml Intravesical Suspension 48 26 $72,000.00 $46,800.00 35% off $15,912.00 $110,662.31 $46,389.60 2025-06-28
901 MS_DRG Wound Debridements For Injuries With Mcc 2 2 — — $34,870.25 $57,255.35 $46,062.80 2025-06-28
J2781 HCPCS Syfovre (pf) 15 Mg/0.1 Ml Intravitreal Solution 48 26 $79,628.40 $51,758.46 35% off $147.36 $79,628.40 $45,388.19 2025-06-28
933 MS_DRG Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft 2 2 — — $34,069.68 $55,916.53 $44,993.10 2025-06-28
J2782 HCPCS Izervay (pf) 2 Mg/0.1 Ml Intravitreal Solution 48 26 $75,600.00 $49,140.00 35% off $109.53 $75,600.00 $43,092.00 2025-06-28
958 MS_DRG Other O.r. Procedures For Multiple Significant Trauma With Cc 2 2 — — $32,392.03 $53,110.95 $42,751.49 2025-06-28
J0638 HCPCS Ilaris (pf) 150 Mg/ml Subcutaneous Solution 48 26 $72,797.79 $47,318.56 35% off $127.81 $72,797.79 $41,494.74 2025-06-28
907 MS_DRG Other O.r. Procedures For Injuries With Mcc 2 2 — — $31,417.58 $51,481.36 $41,449.47 2025-06-28
J2502 HCPCS Signifor Lar 60 Mg IM Suspension 48 26 $72,075.84 $46,849.30 35% off $479.84 $72,075.84 $41,083.22 2025-06-28
904 MS_DRG Skin Grafts For Injuries With Cc/mcc 2 2 — — $30,470.19 $49,897.00 $40,183.60 2025-06-28
956 MS_DRG Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma 2 2 — — $30,171.13 $49,396.88 $39,784.00 2025-06-28
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 2 2 — — $27,700.63 $45,265.39 $36,483.01 2025-06-28
J3241 HCPCS Tepezza 500 Mg Intravenous Solution 48 26 $63,040.08 $40,976.05 35% off $343.89 $63,040.08 $35,932.85 2025-06-28
J3245 HCPCS Ilumya 100 Mg/ml Subcutaneous Syringe 48 26 $62,054.88 $40,335.67 35% off $135.92 $62,054.88 $35,371.29 2025-06-28
J9042 HCPCS Adcetris 50 Mg Intravenous Solution 48 26 $58,560.00 $38,064.00 35% off $239.86 $58,560.00 $33,379.20 2025-06-28
929 MS_DRG Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/mcc 2 2 — — $25,210.04 $41,100.31 $33,155.18 2025-06-28
939 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Mcc 2 2 — — $25,160.59 $41,017.60 $33,089.10 2025-06-28
6840311006 NDC Babybig 100 Mg Intravenous Solution 45 26 $51,570.00 $33,520.50 35% off $11,396.97 $51,570.00 $31,612.41 2025-06-28
974 MS_DRG HIV With Major Related Condition With Mcc 2 2 — — $23,709.35 $38,590.66 $31,150.01 2025-06-28
J9153 HCPCS Vyxeos 44 Mg-100 Mg Intravenous Solution 48 26 $51,684.00 $33,594.60 35% off $242.50 $51,684.00 $29,459.88 2025-06-28
J7170 HCPCS Hemlibra 30 Mg/ml Subcutaneous Solution 134 26 $65,288.34 $42,437.42 35% off $52.82 $65,288.37 $29,379.76 2025-06-28
94 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Mcc 1 1 — — $28,828.85 $28,828.85 $28,828.85 2025-06-28
J9021 HCPCS Rylaze 10 Mg/0.5 Ml Intramuscular Solution 48 26 $50,240.00 $32,656.00 35% off $52.79 $50,240.00 $28,636.80 2025-06-28
963 MS_DRG Other Multiple Significant Trauma With Mcc 2 2 — — $21,626.78 $35,107.91 $28,367.35 2025-06-28
97 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Mcc 1 1 — — $28,333.52 $28,333.52 $28,333.52 2025-06-28
970 MS_DRG HIV With Extensive O.r. Procedures Without Mcc 2 2 — — $21,136.85 $34,288.60 $27,712.72 2025-06-28
959 MS_DRG Other O.r. Procedures For Multiple Significant Trauma Without Cc/mcc 2 2 — — $21,064.22 $34,167.12 $27,615.67 2025-06-28
J9203 HCPCS Mylotarg 4.5 Mg (1 Mg/ml Initial Concentration) Intravenous Solution 48 26 $48,216.00 $31,340.40 35% off $229.67 $48,216.00 $27,483.12 2025-06-28
J9043 HCPCS Jevtana 10 Mg/ml (first Dilution) Intravenous Solution 48 26 $45,947.92 $29,866.15 35% off $216.46 $45,947.92 $26,190.32 2025-06-28
J7311 HCPCS Retisert 0.59 Mg Intravitreal Implant 48 26 $45,660.00 $29,679.00 35% off $333.48 $45,660.00 $26,026.20 2025-06-28
982 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc 2 2 — — $19,552.71 $31,639.38 $25,596.04 2025-06-28
J9037 HCPCS Blenrep 100 Mg Intravenous Solution 48 26 $42,367.04 $27,538.58 35% off $46.78 $42,367.04 $25,420.22 2025-06-28
J9216 HCPCS Actimmune 100 Mcg (2 Million Unit)/0.5 Ml Subcutaneous Solution 45 26 $40,606.35 $26,394.13 35% off $8,974.00 $40,606.35 $24,891.69 2025-06-28
935 MS_DRG Non-extensive Burns 2 2 — — $17,606.14 $28,384.08 $22,995.11 2025-06-28
906 MS_DRG Hand Procedures For Injuries 2 2 — — $17,498.73 $28,204.45 $22,851.59 2025-06-28
934 MS_DRG Full Thickness Burn Without Skin Graft Or Inhalation Injury 2 2 — — $17,215.12 $27,730.17 $22,472.64 2025-06-28
J1640 HCPCS Panhematin 350 Mg Intravenous Solution 48 26 $39,385.77 $25,600.75 35% off $32.20 $39,385.77 $22,449.89 2025-06-28
J9223 HCPCS Zepzelca 4 Mg Intravenous Solution 48 26 $38,928.00 $25,303.20 35% off $203.60 $38,928.00 $22,188.96 2025-06-28
940 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services With Cc 2 2 — — $16,949.30 $27,285.62 $22,117.46 2025-06-28
J2506 HCPCS Neulasta 6 Mg/0.6 Ml Subcutaneous Syringe 48 26 $38,507.94 $25,030.16 35% off $31.14 $38,507.94 $21,949.53 2025-06-28
908 MS_DRG Other O.r. Procedures For Injuries With Cc 2 2 — — $16,220.59 $26,066.98 $21,143.78 2025-06-28
941 MS_DRG O.r. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/… 2 2 — — $15,735.30 $25,255.42 $20,495.36 2025-06-28
902 MS_DRG Wound Debridements For Injuries With Cc 2 2 — — $15,297.15 $24,522.68 $19,909.92 2025-06-28
J1323 HCPCS Elrexfio 40 Mg/ml Subcutaneous Solution 48 26 $34,769.92 $22,600.45 35% off $178.85 $34,769.92 $19,818.85 2025-06-28
J9381 HCPCS Tzield 1 Mg/ml Intravenous Solution 48 26 $34,586.28 $22,481.08 35% off $36.90 $34,586.28 $19,714.18 2025-06-28
J3380 HCPCS Entyvio 300 Mg Intravenous Solution 48 26 $33,695.67 $21,902.19 35% off $22.26 $33,695.67 $19,206.53 2025-06-28
96 MS_DRG Bacterial And Tuberculous Infections Of Nervous System Without Cc/mcc 1 1 — — $19,157.83 $19,157.83 $19,157.83 2025-06-28
95 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Cc 1 1 — — $19,157.83 $19,157.83 $19,157.83 2025-06-28
919 MS_DRG Complications Of Treatment With Mcc 2 2 — — $14,725.31 $23,566.38 $19,145.85 2025-06-28
C9047 HCPCS Cablivi 11 Mg Injection Kit 45 26 $30,858.06 $20,057.74 35% off $6,819.63 $30,858.06 $18,915.99 2025-06-28
J9273 HCPCS Tivdak 40 Mg Intravenous Solution 48 26 $32,908.80 $21,390.72 35% off $181.60 $32,908.80 $18,758.01 2025-06-28
915 MS_DRG Allergic Reactions With Mcc 2 2 — — $14,063.06 $22,458.88 $18,260.97 2025-06-28
988 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Cc 2 2 — — $13,893.83 $22,175.87 $18,034.85 2025-06-28
922 MS_DRG Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc 2 2 — — $13,688.27 $21,832.12 $17,760.19 2025-06-28
983 MS_DRG Extensive O.r. Procedures Unrelated To Principal Diagnosis Without Cc/mcc 2 2 — — $13,524.45 $21,558.15 $17,541.30 2025-06-28
J0896 HCPCS Reblozyl 25 Mg Subcutaneous Solution 91 26 $19,355.96 $12,581.37 35% off $40.62 $58,067.60 $17,420.28 2025-06-28
98 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis With Cc 1 1 — — $17,396.72 $17,396.72 $17,396.72 2025-06-28
905 MS_DRG Skin Grafts For Injuries Without Cc/mcc 2 2 — — $13,369.90 $21,299.69 $17,334.79 2025-06-28
917 MS_DRG Poisoning And Toxic Effects Of Drugs With Mcc 2 2 — — $13,304.21 $21,189.84 $17,247.03 2025-06-28
J9309 HCPCS Polivy 30 Mg Intravenous Solution 91 26 $19,143.20 $12,443.08 35% off $129.78 $89,334.76 $17,228.88 2025-06-28
913 MS_DRG Traumatic Injury With Mcc 2 2 — — $13,138.84 $20,913.29 $17,026.07 2025-06-28
J3101 HCPCS Tnkase 50 Mg Intravenous Solution 48 26 $29,870.13 $19,415.58 35% off $157.72 $29,870.13 $17,025.98 2025-06-28
J9266 HCPCS Oncaspar 750 Unit/ml Injection Solution 48 26 $25,742.56 $16,732.66 35% off $5,689.11 $47,373.43 $16,585.93 2025-06-28
J9999 HCPCS Taltz Autoinjector 80 Mg/ml Subcutaneous 134 26 $26,141.43 $16,991.93 35% off $3,771.14 $2,520,000.00 $16,024.70 2025-06-28
964 MS_DRG Other Multiple Significant Trauma With Cc 2 2 — — $12,225.45 $19,385.79 $15,805.62 2025-06-28
J0801 HCPCS Acthar H.p. 80 Unit/ml Injection Gel 88 26 $21,514.50 $13,984.43 35% off $4,754.70 $32,618.88 $15,688.38 2025-06-28
J0218 HCPCS Xenpozyme 20 Mg Intravenous Solution 48 26 $27,274.44 $17,728.39 35% off $382.56 $27,274.44 $15,546.43 2025-06-28
977 MS_DRG HIV With Or Without Other Related Condition 2 2 — — $11,775.70 $18,633.67 $15,204.68 2025-06-28
J9039 HCPCS Blincyto 35 Mcg Intravenous Solution 48 26 $26,672.48 $17,337.11 35% off $152.18 $26,672.48 $15,203.31 2025-06-28
975 MS_DRG HIV With Major Related Condition With Cc 2 2 — — $11,617.29 $18,368.75 $14,993.02 2025-06-28
91 MS_DRG Other Disorders Of Nervous System With Mcc 1 1 — — $14,719.90 $14,719.90 $14,719.90 2025-06-28
886 MS_DRG Behavioral And Developmental Disorders 1 1 — — $14,515.89 $14,515.89 $14,515.89 2025-06-28
J0717 HCPCS Cimzia Powder For Recon 400 Mg (200 Mg X 2 Vials) Subcutaneous Kit 91 26 $28,797.28 $18,718.23 35% off $4.65 $28,797.28 $14,513.83 2025-06-28
909 MS_DRG Other O.r. Procedures For Injuries Without Cc/mcc 2 2 — — $10,434.20 $18,571.72 $14,502.96 2025-06-28
896 MS_DRG Alcohol/drug Abuse Or Dependence Without Rehabilitation Therapy W Mcc 1 1 — — $14,394.57 $14,394.57 $14,394.57 2025-06-28
2433805008 NDC Gliadel Wafer 7.7 Mg Implant 45 26 $23,443.16 $15,238.05 35% off $5,180.94 $23,443.16 $14,370.66 2025-06-28
Q5111 HCPCS Udenyca 6 Mg/0.6 Ml Subcutaneous Syringe 48 26 $25,050.00 $16,282.50 35% off $143.38 $25,050.00 $14,278.50 2025-06-28
J9354 HCPCS Kadcyla 160 Mg Intravenous Solution 91 26 $30,640.32 $19,916.21 35% off $40.45 $30,640.32 $13,788.14 2025-06-28
J1602 HCPCS Simponi 50 Mg/0.5 Ml Subcutaneous Syringe 134 26 $26,273.40 $17,077.71 35% off $11.10 $45,692.85 $13,707.86 2025-06-28
J9307 HCPCS Pralatrexate 20 Mg/ml (1 Ml) Intravenous Solution 48 26 $23,913.44 $15,543.74 35% off $373.77 $23,913.44 $13,630.66 2025-06-28
947 MS_DRG Signs And Symptoms With Mcc 2 2 — — $10,572.53 $16,621.56 $13,597.05 2025-06-28
J0775 HCPCS Xiaflex 0.9 Mg Solution For Injection 48 26 $23,703.90 $15,407.54 35% off $71.16 $23,703.90 $13,511.23 2025-06-28
Q5120 HCPCS Ziextenzo 6 Mg/0.6 Ml Subcutaneous Syringe 48 26 $23,553.18 $15,309.57 35% off $43.24 $23,553.18 $13,425.31 2025-06-28
Q5122 HCPCS Nyvepria 6 Mg/0.6 Ml Subcutaneous Syringe 48 26 $23,550.00 $15,307.50 35% off $96.55 $23,550.00 $13,423.50 2025-06-28
J1961 HCPCS Sunlenca 309 Mg/ml Subcutaneous Solution 48 26 $23,400.00 $15,210.00 35% off $21.99 $23,400.00 $13,338.00 2025-06-28
J0578 HCPCS Brixadi Monthly 128 Mg/0.36 Ml Solutionextend.rel. Subcut.syringe 134 26 $22,773.33 $14,802.66 35% off $1,716.62 $34,160.01 $12,972.26 2025-06-28
903 MS_DRG Wound Debridements For Injuries Without Cc/mcc 2 2 — — $10,054.01 $15,754.43 $12,904.22 2025-06-28
J9118 HCPCS Asparlas 750 Unit/ml Intravenous Solution 45 26 $20,906.01 $13,588.91 35% off $133.92 $20,906.01 $12,543.61 2025-06-28
J7314 HCPCS Yutiq 0.18 Mg Intravitreal Implant 48 26 $21,914.00 $14,244.10 35% off $527.97 $21,914.00 $12,490.98 2025-06-28
945 MS_DRG Rehabilitation With Cc/mcc 1 1 — — $12,429.45 $12,429.45 $12,429.45 2025-06-28
J7313 HCPCS Iluvien 0.19 Mg Intravitreal Implant 48 26 $21,766.00 $14,147.90 35% off $495.38 $21,766.00 $12,406.62 2025-06-28
989 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis Without Cc/mcc 2 2 — — $9,562.54 $14,932.53 $12,247.53 2025-06-28
J2277 HCPCS Aphexda 62 Mg Subcutaneous Solution 48 26 $21,240.00 $13,806.00 35% off $25.22 $21,240.00 $12,106.80 2025-06-28
7223710401 NDC Xpovio 60 Mg/week (60 Mg X 1) Tablet 45 26 $19,672.20 $12,786.93 35% off $4,347.56 $19,672.20 $12,059.06 2025-06-28
7223710207 NDC Xpovio 40 Mg/week (40 Mg X 1) Tablet 45 26 $19,672.20 $12,786.93 35% off $4,347.56 $19,672.20 $12,059.06 2025-06-28
J0517 HCPCS Fasenra 30 Mg/ml Subcutaneous Syringe 48 26 $21,049.38 $13,682.10 35% off $167.30 $21,049.38 $11,998.15 2025-06-28
895 MS_DRG Alcohol/drug Abuse Or Dependence W Rehabilitation Therapy 1 1 — — $11,822.07 $11,822.07 $11,822.07 2025-06-28
J1290 HCPCS Kalbitor 10 Mg/ml (1 Ml) Subcutaneous Solution 48 26 $20,543.67 $13,353.39 35% off $565.83 $20,543.67 $11,709.89 2025-06-28
885 MS_DRG Psychoses 1 1 — — $11,526.10 $11,526.10 $11,526.10 2025-06-28
949 MS_DRG Aftercare With Cc/mcc 2 2 — — $8,971.38 $13,943.92 $11,457.65 2025-06-28
99 MS_DRG Non-bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/mcc 1 1 — — $11,400.15 $11,400.15 $11,400.15 2025-06-28
J1246 HCPCS Unituxin 3.5 Mg/ml Intravenous Solution 45 26 $18,285.40 $11,885.51 35% off $4,041.07 $18,285.40 $11,208.95 2025-06-28
J0480 HCPCS Simulect 20 Mg Intravenous Solution 91 26 $21,884.00 $14,224.60 35% off $3,684.86 $21,884.00 $11,204.63 2025-06-28
J9305 HCPCS Alimta 500 Mg Intravenous Solution 48 26 $19,406.40 $12,614.16 35% off $4.18 $19,406.40 $11,061.65 2025-06-28
J0870 HCPCS Rytelo 188 Mg Intravenous Solution 91 26 $48,866.48 $31,763.21 35% off $54.15 $48,866.48 $10,994.98 2025-06-28
J2406 HCPCS Kimyrsa 1200 Mg Intravenous Solution 48 26 $19,212.78 $12,488.31 35% off $42.50 $19,212.78 $10,951.28 2025-06-28
923 MS_DRG Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc 2 2 — — $8,514.68 $13,180.17 $10,847.42 2025-06-28
920 MS_DRG Complications Of Treatment With Cc 2 2 — — $8,483.77 $13,128.48 $10,806.12 2025-06-28
976 MS_DRG HIV With Major Related Condition Without Cc/mcc 2 2 — — $8,384.08 $12,961.77 $10,672.92 2025-06-28
3877917563 NDC Fentanyl Citrate (bulk) 100 % Powder 45 26 $17,296.08 $11,242.45 35% off $3,822.43 $17,296.08 $10,602.50 2025-06-28
J9352 HCPCS Yondelis 1 Mg Intravenous Solution 48 26 $17,708.84 $11,510.75 35% off $362.82 $17,708.84 $10,094.03 2025-06-28
J9200 HCPCS Floxuridine 0.5 Gram Solution For Injection 48 26 $17,474.92 $11,358.70 35% off $3,858.03 $17,474.92 $9,960.70 2025-06-28
887 MS_DRG Other Mental Disorder Diagnoses 1 1 — — $9,824.50 $9,824.50 $9,824.50 2025-06-28
J1162 HCPCS Digifab 40 Mg Intravenous Solution 48 26 $17,218.80 $11,192.22 35% off $3,805.35 $17,218.80 $9,814.72 2025-06-28
A9594 HCPCS Gallium Ga-68 Gozetotide 18.5 Mbq To 185 Mbq/ml (0.5-5 Mci/ml) IV Soln 47 26 $16,335.00 $10,617.75 35% off $372.17 $16,335.00 $9,801.00 2025-06-28
914 MS_DRG Traumatic Injury Without Mcc 2 2 — — $7,714.88 $11,842.64 $9,778.76 2025-06-28
965 MS_DRG Other Multiple Significant Trauma Without Cc/mcc 2 2 — — $7,685.51 $11,793.53 $9,739.52 2025-06-28
J1950 HCPCS Lupron Depot-ped 7.5 Mg (ped) Intramuscular Kit 306 26 $15,597.18 $10,138.17 35% off $1,432.96 $46,791.75 $9,698.15 2025-06-28
J9177 HCPCS Padcev 20 Mg Intravenous Solution 91 26 $13,483.20 $8,764.08 35% off $36.74 $20,224.80 $9,641.84 2025-06-28
J1823 HCPCS Uplizna 10 Mg/ml Intravenous Solution 48 26 $16,829.82 $10,939.38 35% off $484.40 $16,829.82 $9,592.99 2025-06-28
J2353 HCPCS Sandostatin Lar Depot 20 Mg Intramuscular Suspextended Release 134 26 $16,618.68 $10,802.14 35% off $214.88 $24,885.21 $9,540.82 2025-06-28
918 MS_DRG Poisoning And Toxic Effects Of Drugs Without Mcc 2 2 — — $7,469.14 $11,431.69 $9,450.42 2025-06-28
946 MS_DRG Rehabilitation Without Cc/mcc 1 1 — — $9,261.16 $9,261.16 $9,261.16 2025-06-28
J0217 HCPCS Lamzede 10 Mg Intravenous Solution 48 26 $15,800.40 $10,270.26 35% off $442.00 $15,800.40 $9,006.23 2025-06-28
J0391 HCPCS Artesunate 110 Mg Intravenous Solution 48 26 $14,940.00 $9,711.00 35% off $51.83 $14,940.00 $8,964.00 2025-06-28
89 MS_DRG Concussion With Cc 1 1 — — $8,918.06 $8,918.06 $8,918.06 2025-06-28
92 MS_DRG Other Disorders Of Nervous System With Cc 1 1 — — $8,814.51 $8,814.51 $8,814.51 2025-06-28
J2427 HCPCS Invega Trinza 546 Mg/1.75 Ml Intramuscular Syringe 134 26 $14,684.85 $9,545.15 35% off $12.66 $15,418.74 $8,810.91 2025-06-28
J0597 HCPCS Berinert 500 Unit (10 Ml) Intravenous Kit 48 26 $15,377.79 $9,995.56 35% off $68.36 $15,377.79 $8,765.34 2025-06-28
J9319 HCPCS Istodax 10 Mg/2 Ml Intravenous Solution 48 26 $15,353.52 $9,979.79 35% off $29.86 $15,353.52 $8,751.51 2025-06-28
J0139 HCPCS Humira(cf) Pen Crohn's-ulc Colitis-hid Sup Strt 80 Mg/0.8 Ml Subcut Kt 183 26 $15,383.60 $9,999.34 35% off $91.73 $30,767.32 $8,722.50 2025-06-28
J9207 HCPCS Ixempra 15 Mg Intravenous Solution 91 26 $9,669.88 $6,285.42 35% off $134.06 $29,009.68 $8,702.89 2025-06-28
Q5130 HCPCS Fylnetra 6 Mg/0.6 Ml Subcutaneous Syringe 48 26 $15,000.00 $9,750.00 35% off $186.19 $15,000.00 $8,550.00 2025-06-28
948 MS_DRG Signs And Symptoms Without Mcc 2 2 — — $6,772.89 $10,267.32 $8,520.10 2025-06-28
J2997 HCPCS Cathflo Activase 2 Mg Intra-catheter Solution 134 26 $15,840.66 $10,296.43 35% off $91.47 $31,681.29 $8,514.35 2025-06-28
4202315701 NDC Ethacrynate Sodium 50 Mg Intravenous Solution 45 26 $13,680.00 $8,892.00 35% off $3,023.28 $13,680.00 $8,385.84 2025-06-28
J9268 HCPCS Nipent 10 Mg Intravenous Solution 48 26 $14,166.16 $9,208.00 35% off $2,541.77 $14,166.16 $8,074.72 2025-06-28
J9358 HCPCS Enhertu 100 Mg Intravenous Solution 48 26 $14,086.80 $9,156.42 35% off $27.81 $14,086.80 $8,029.48 2025-06-28
90378 HCPCS Synagis 50 Mg/0.5 Ml Intramuscular Solution 48 26 $13,108.74 $8,520.68 35% off $719.87 $13,108.74 $7,865.24 2025-06-28
J2182 HCPCS Nucala 100 Mg Subcutaneous Solution 91 26 $12,715.86 $8,265.31 35% off $30.44 $13,678.17 $7,629.52 2025-06-28
J1744 HCPCS Icatibant 30 Mg/3 Ml Subcutaneous Syringe 91 26 $12,708.15 $8,260.30 35% off $151.64 $13,377.00 $7,624.89 2025-06-28
897 MS_DRG Alcohol/drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc 1 1 — — $7,450.60 $7,450.60 $7,450.60 2025-06-28
921 MS_DRG Complications Of Treatment Without Cc/mcc 2 2 — — $5,947.59 $8,887.15 $7,417.37 2025-06-28
J9347 HCPCS Imjudo 20 Mg/ml Intravenous Solution 48 26 $12,984.20 $8,439.73 35% off $135.45 $12,984.20 $7,401.00 2025-06-28
J3315 HCPCS Trelstar 11.25 Mg IM Suspension 91 26 $9,868.56 $6,414.56 35% off $466.73 $19,737.15 $7,388.59 2025-06-28
4236754032 NDC Ryanodex 250 Mg Intravenous Suspension 45 26 $11,931.69 $7,755.60 35% off $2,636.90 $11,931.69 $7,314.13 2025-06-28
J9321 HCPCS Epkinly 4 Mg/0.8 Ml Subcutaneous Solution 91 26 $8,078.60 $5,251.09 35% off $54.17 $96,942.96 $7,270.74 2025-06-28
90 MS_DRG Concussion Without Cc/mcc 1 1 — — $7,258.18 $7,258.18 $7,258.18 2025-06-28
J9176 HCPCS Empliciti 300 Mg Intravenous Solution 91 26 $10,709.00 $6,960.85 35% off $7.58 $14,278.52 $7,196.45 2025-06-28
916 MS_DRG Allergic Reactions Without Mcc 2 2 — — $5,765.22 $8,582.16 $7,173.69 2025-06-28
Q5108 HCPCS Fulphila 6 Mg/0.6 Ml Subcutaneous Syringe 48 26 $12,525.00 $8,141.25 35% off $135.53 $12,525.00 $7,139.25 2025-06-28
J9348 HCPCS Danyelza 4 Mg/ml Intravenous Solution 48 26 $12,511.64 $8,132.57 35% off $642.15 $12,511.64 $7,131.64 2025-06-28
5000472500 NDC Deflux 50 Mg-15 Mg/ml (1) Syringe 45 26 $11,438.85 $7,435.25 35% off $3,431.66 $11,438.85 $7,012.02 2025-06-28
J9317 HCPCS Trodelvy 180 Mg Intravenous Solution 48 26 $12,063.56 $7,841.31 35% off $34.67 $12,063.56 $6,876.23 2025-06-28
J9032 HCPCS Beleodaq 500 Mg Intravenous Solution 48 26 $11,906.08 $7,738.95 35% off $50.09 $11,906.08 $6,786.47 2025-06-28
93 MS_DRG Other Disorders Of Nervous System Without Cc/mcc 1 1 — — $6,732.71 $6,732.71 $6,732.71 2025-06-28
J0840 HCPCS Crofab Solution For Injection 48 26 $11,512.80 $7,483.32 35% off $1,762.35 $11,512.80 $6,562.30 2025-06-28
6302039002 NDC Ninlaro 3 Mg Capsule 45 26 $10,691.20 $6,949.28 35% off $2,362.76 $10,691.20 $6,553.71 2025-06-28
6302040002 NDC Ninlaro 4 Mg Capsule 45 26 $10,691.20 $6,949.28 35% off $2,362.76 $10,691.20 $6,553.71 2025-06-28
6302023002 NDC Ninlaro 2.3 Mg Capsule 45 26 $10,691.20 $6,949.28 35% off $2,362.76 $10,691.20 $6,553.71 2025-06-28
J2860 HCPCS Sylvant 100 Mg Intravenous Solution 91 26 $7,206.80 $4,684.42 35% off $157.07 $28,827.32 $6,486.12 2025-06-28
J9026 HCPCS Imdelltra 1 Mg Intravenous Solution 91 26 $7,200.00 $4,680.00 35% off $1,545.00 $72,000.00 $6,480.00 2025-06-28
950 MS_DRG Aftercare Without Cc/mcc 2 2 — — $5,162.47 $7,574.17 $6,368.32 2025-06-28
A9572 HCPCS Octreoscan 3 Mci/ml-10 Mcg Intravenous Kit 47 26 $10,558.00 $6,862.70 35% off $1,914.61 $10,558.00 $6,334.80 2025-06-28
J0598 HCPCS Cinryze 500 Unit (5 Ml) Intravenous Solution 91 26 $10,536.48 $6,848.71 35% off $64.21 $11,513.49 $6,321.89 2025-06-28
J9333 HCPCS Rystiggo 140 Mg/ml Subcutaneous Solution 48 26 $11,026.14 $7,166.99 35% off $22.80 $11,026.14 $6,284.90 2025-06-28
951 MS_DRG Other Factors Influencing Health Status 2 2 — — $5,014.87 $7,327.34 $6,171.10 2025-06-28
7223710206 NDC Xpovio 40 Mg Twice Week (40 Mg X 2) Tablet 45 26 $9,836.10 $6,393.47 35% off $2,173.78 $9,836.10 $6,029.53 2025-06-28
7223710202 NDC Xpovio 80 Mg/week (40 Mg X 2) Tablet 45 26 $9,836.10 $6,393.47 35% off $2,173.78 $9,836.10 $6,029.53 2025-06-28
7223710305 NDC Xpovio 100 Mg/week (50 Mg X 2) Tablet 45 26 $9,836.10 $6,393.47 35% off $2,173.78 $9,836.10 $6,029.53 2025-06-28
J1303 HCPCS Ultomiris 100 Mg/ml Intravenous Solution 48 26 $10,451.32 $6,793.36 35% off $220.75 $10,451.32 $5,957.25 2025-06-28
J2798 HCPCS Perseris 120 Mg Subcutaneous Extended Release Suspension Syringe 48 26 $10,435.83 $6,783.29 35% off $12.19 $10,435.83 $5,948.43 2025-06-28
A9588 HCPCS Axumin 10 Mci (370 Mbq) Intravenous Solution 47 26 $9,888.00 $6,427.20 35% off $268.42 $9,888.00 $5,932.80 2025-06-28
A9608 HCPCS Posluma 296 Mbq/ml To 5846 Mbq/ml Intravenous Solution 47 26 $9,836.00 $6,393.40 35% off $651.67 $9,836.00 $5,901.60 2025-06-28
J9334 HCPCS Vyvgart Hytrulo 1008 Mg-11200 Unit/5.6 Ml Subcutaneous Solution 48 26 $10,342.59 $6,722.68 35% off $33.13 $10,342.59 $5,895.27 2025-06-28
5913723101 NDC Gleolan 30 Mg/ml Oral Solution 45 26 $9,588.00 $6,232.20 35% off $2,118.95 $9,588.00 $5,877.44 2025-06-28
A9603 HCPCS Cytalux 3.2 Mg/1.6 Ml Intravenous Solution 45 26 $9,562.50 $6,215.63 35% off $2,113.31 $9,562.50 $5,861.81 2025-06-28
Q2055 HCPCS Abecma 300x10exp6 To 460x10exp6 Cell Intravenous Suspension 126 26 $9,569.44 $6,220.14 35% off $1,435.42 $47,847.16 $5,837.35 2025-06-28
Q5113 HCPCS Herzuma 150 Mg Intravenous Solution 91 26 $6,732.00 $4,375.80 35% off $60.44 $18,849.60 $5,654.88 2025-06-28
Q5117 HCPCS Kanjinti 420 Mg Intravenous Solution 91 26 $18,279.28 $11,881.53 35% off $24.33 $18,279.28 $5,483.78 2025-06-28
J0491 HCPCS Saphnelo 300 Mg/2 Ml (150 Mg/ml) Intravenous Solution 48 26 $9,601.14 $6,240.74 35% off $17.29 $9,601.14 $5,472.65 2025-06-28
894 MS_DRG Alcohol/drug Abuse Or Dependence, Left Ama 1 1 — — $5,456.12 $5,456.12 $5,456.12 2025-06-28
Q5112 HCPCS Ontruzant 150 Mg Intravenous Solution 91 26 $6,358.36 $4,132.93 35% off $34.17 $17,803.40 $5,341.02 2025-06-28
J2802 HCPCS Nplate 250 Mcg Subcutaneous Solution 134 26 $9,910.86 $6,442.06 35% off $10.11 $19,821.66 $5,327.09 2025-06-28
J9217 HCPCS Lupron Depot 22.5 Mg (3 Month) Intramuscular Syringe Kit 349 26 $9,756.48 $6,341.71 35% off $176.51 $46,360.77 $5,308.25 2025-06-28
J0401 HCPCS Abilify Maintena 300 Mg Intramuscular Suspensionextended Release 91 26 $7,842.00 $5,097.30 35% off $7.07 $10,455.99 $5,269.82 2025-06-28
5846803573 NDC Campath 30 Mg/ml Intravenous Solution 45 26 $8,472.00 $5,506.80 35% off $1,872.31 $8,472.00 $5,193.34 2025-06-28
J2426 HCPCS Invega Sustenna 39 Mg/0.25 Ml Intramuscular Syringe 220 26 $8,565.84 $5,567.80 35% off $14.76 $8,566.17 $5,139.58 2025-06-28
J2356 HCPCS Tezspire 210 Mg/1.91 Ml (110 Mg/ml) Subcutaneous Syringe 91 26 $8,234.70 $5,352.56 35% off $18.11 $8,811.84 $4,940.82 2025-06-28
Q5116 HCPCS Trazimera 420 Mg Intravenous Solution 91 26 $16,277.20 $10,580.18 35% off $19.17 $16,277.20 $4,883.16 2025-06-28
J0180 HCPCS Fabrazyme 35 Mg Intravenous Solution 91 26 $37,571.84 $24,421.70 35% off $223.52 $37,571.84 $4,829.83 2025-06-28
J1306 HCPCS Leqvio 284 Mg/1.5 Ml Subcutaneous Syringe 48 26 $8,279.37 $5,381.59 35% off $12.19 $8,279.37 $4,719.24 2025-06-28
J3396 HCPCS Visudyne 15 Mg Intravenous Solution 48 26 $8,206.60 $5,334.29 35% off $11.53 $8,206.60 $4,677.76 2025-06-28
A9592 HCPCS Detectnet 148 Mbq/4 Ml (4 Mci/4 Ml) Intravenous Solution 47 26 $7,700.00 $5,005.00 35% off $595.10 $7,700.00 $4,620.00 2025-06-28
J9046 HCPCS Velcade 3.5 Mg Solution For Injection 48 26 $7,694.40 $5,001.36 35% off $48.55 $7,694.40 $4,616.64 2025-06-28
Q9991 HCPCS Sublocade 100 Mg/0.5 Ml Solutionextended Release Subcutaneous Syringe 91 26 $15,244.86 $9,909.16 35% off $1,123.04 $15,244.86 $4,573.45 2025-06-28
J9047 HCPCS Kyprolis 60 Mg Intravenous Solution 134 26 $8,489.28 $5,518.03 35% off $49.58 $16,978.52 $4,562.99 2025-06-28
J9264 HCPCS Paclitaxel Protein-bound 100 Mg Intravenous Suspension 91 26 $7,867.04 $5,113.58 35% off $13.34 $7,867.04 $4,550.57 2025-06-28
Q3027 HCPCS Avonex 30 Mcg/0.5 Ml Intramuscular Syringe Kit 48 26 $7,439.25 $4,835.51 35% off $56.23 $7,439.25 $4,463.55 2025-06-28
J1438 HCPCS Enbrel 25 Mg/0.5 Ml (0.5 Ml) Subcutaneous Syringe 48 26 $7,341.84 $4,772.20 35% off $790.78 $7,341.84 $4,405.10 2025-06-28
J9318 HCPCS Romidepsin 5 Mg/ml Intravenous Solution 48 26 $7,292.92 $4,740.40 35% off $33.91 $7,292.92 $4,375.75 2025-06-28
C9399 HCPCS Antivenin Micrurus Fulvius Solution For Injection 992 26 $7,269.03 $4,724.87 35% off $0.03 $3,489,600.00 $4,361.42 2025-06-28
J9355 HCPCS Herceptin 150 Mg Intravenous Solution 48 26 $7,480.40 $4,862.26 35% off $77.94 $7,480.40 $4,263.83 2025-06-28
J3263 HCPCS Loqtorzi 240 Mg/6 Ml (40 Mg/ml) Intravenous Solution 48 26 $7,434.76 $4,832.59 35% off $38.87 $7,434.76 $4,237.81 2025-06-28
J2350 HCPCS Ocrevus 30 Mg/ml Intravenous Solution 48 26 $7,430.76 $4,829.99 35% off $59.80 $7,430.76 $4,235.53 2025-06-28
J9202 HCPCS Zoladex 3.6 Mg Subcutaneous Implant 91 26 $5,046.72 $3,280.37 35% off $674.77 $14,016.08 $4,204.82 2025-06-28
J0349 HCPCS Rezzayo 200 Mg Intravenous Solution 48 26 $7,375.20 $4,793.88 35% off $10.12 $7,375.20 $4,203.86 2025-06-28
J7351 HCPCS Durysta 10 Mcg Intracameral Implant 48 26 $7,290.00 $4,738.50 35% off $209.86 $7,290.00 $4,155.30 2025-06-28
J0897 HCPCS Prolia 60 Mg/ml Subcutaneous Syringe 91 26 $6,751.56 $4,388.51 35% off $26.96 $7,305.33 $4,050.94 2025-06-28
Q3028 HCPCS Rebif (with Albumin) 44 Mcg/0.5 Ml Subcutaneous Syringe 45 26 $6,592.98 $4,285.44 35% off $1,457.05 $6,592.98 $4,041.50 2025-06-28
J9119 HCPCS Libtayo 50 Mg/ml Intravenous Solution 48 26 $7,061.36 $4,589.88 35% off $28.24 $7,061.36 $4,024.97 2025-06-28
J0222 HCPCS Onpattro 2 Mg/ml Intravenous Solution 48 26 $7,045.20 $4,579.38 35% off $98.88 $7,045.20 $4,015.76 2025-06-28
7053900101 NDC Tymlos 80 Mcg/dose (3120 Mcg/1.56 Ml) Subcutaneous Pen Injector 45 26 $6,523.89 $4,240.53 35% off $1,441.78 $6,523.89 $3,999.14 2025-06-28
J0219 HCPCS Nexviazyme 100 Mg Intravenous Solution 48 26 $7,010.64 $4,556.92 35% off $77.75 $7,010.64 $3,996.07 2025-06-28
6887501031 NDC Gattex One-vial 5 Mg Subcutaneous Kit 45 26 $6,472.56 $4,207.16 35% off $1,430.44 $6,472.56 $3,967.68 2025-06-28
J3110 HCPCS Forteo 20 Mcg/dose (600 Mcg/2.4 Ml) Subcutaneous Pen Injector 45 26 $6,434.85 $4,182.65 35% off $1,422.10 $6,434.85 $3,944.56 2025-06-28
J9271 HCPCS Keytruda 25 Mg/ml Intravenous Solution 48 26 $6,802.40 $4,421.56 35% off $58.22 $6,802.40 $3,877.37 2025-06-28
J3032 HCPCS Vyepti 100 Mg/ml Intravenous Solution 48 26 $6,797.34 $4,418.27 35% off $18.69 $6,797.34 $3,874.48 2025-06-28
J9330 HCPCS Torisel 30 Mg/3 Ml (10 Mg/ml) (first Dilution) Intravenous Solution 91 26 $7,201.14 $4,680.74 35% off $32.21 $7,201.14 $3,823.81 2025-06-28
J3240 HCPCS Thyrogen 0.9 Mg Intramuscular Solution 48 26 $6,613.77 $4,298.95 35% off $1,461.64 $6,613.77 $3,803.00 2025-06-28
J2329 HCPCS Briumvi 25 Mg/ml Intravenous Solution 48 26 $6,666.00 $4,332.90 35% off $69.44 $6,666.00 $3,799.62 2025-06-28
Q5114 HCPCS Ogivri 150 Mg Intravenous Solution 91 26 $4,514.44 $2,934.39 35% off $54.16 $12,600.24 $3,780.07 2025-06-28
J3299 HCPCS Xipere (pf) 40 Mg/ml Suprachoroidal Suspension 48 26 $6,600.00 $4,290.00 35% off $48.40 $6,600.00 $3,762.00 2025-06-28
J9349 HCPCS Monjuvi 200 Mg Intravenous Solution 48 26 $6,568.80 $4,269.72 35% off $13.71 $6,568.80 $3,744.22 2025-06-28
J1203 HCPCS Pombiliti 105 Mg Intravenous Solution 48 26 $6,559.20 $4,263.48 35% off $88.06 $6,559.20 $3,738.74 2025-06-28
Q9983 HCPCS Neuraceq 8.1 Mci (300 Mbq) Intravenous Solution 47 26 $6,200.00 $4,030.00 35% off $1,273.76 $6,200.00 $3,720.00 2025-06-28
J0875 HCPCS Dalvance 500 Mg Intravenous Solution 48 26 $6,404.88 $4,163.17 35% off $15.61 $6,404.88 $3,650.78 2025-06-28
J9210 HCPCS Gamifant 5 Mg/ml Intravenous Solution 91 26 $6,536.88 $4,248.97 35% off $378.03 $6,536.88 $3,647.18 2025-06-28
J1786 HCPCS Cerezyme 400 Unit Intravenous Solution 48 26 $6,242.88 $4,057.87 35% off $43.62 $6,242.88 $3,558.44 2025-06-28
J2783 HCPCS Elitek 1.5 Mg Intravenous Solution 91 26 $3,926.28 $2,552.08 35% off $371.29 $19,631.37 $3,533.65 2025-06-28
J2315 HCPCS Vivitrol 380 Mg Intramuscular Suspensionextended Release 48 26 $6,085.23 $3,955.40 35% off $4.12 $6,085.23 $3,468.58 2025-06-28
0078065006 NDC Farydak 10 Mg Capsule 45 26 $5,633.00 $3,661.45 35% off $1,244.89 $5,633.00 $3,453.03 2025-06-28
0078065106 NDC Farydak 15 Mg Capsule 45 26 $5,633.00 $3,661.45 35% off $1,244.89 $5,633.00 $3,453.03 2025-06-28
0078065206 NDC Farydak 20 Mg Capsule 45 26 $5,633.00 $3,661.45 35% off $1,244.89 $5,633.00 $3,453.03 2025-06-28
J2357 HCPCS Xolair 150 Mg Subcutaneous Solution 91 26 $6,797.36 $4,418.28 35% off $38.29 $6,797.36 $3,425.87 2025-06-28
J0630 HCPCS Calcitonin (salmon) 200 Unit/ml Injection Solution 48 26 $5,635.80 $3,663.27 35% off $1,173.06 $5,635.80 $3,381.48 2025-06-28
J2327 HCPCS Skyrizi 150 Mg/ml Subcutaneous Pen Injector 91 26 $80,580.57 $52,377.37 35% off $14.63 $80,580.57 $3,360.74 2025-06-28
J9340 HCPCS Thiotepa 15 Mg Solution For Injection 91 26 $3,600.00 $2,340.00 35% off $209.02 $16,920.00 $3,240.00 2025-06-28
J9033 HCPCS Treanda 25 Mg Intravenous Powder For Solution 91 26 $3,566.16 $2,318.00 35% off $2.17 $14,264.64 $3,209.54 2025-06-28
J0129 HCPCS Orencia (with Maltose) 250 Mg Intravenous Solution 48 26 $5,449.20 $3,541.98 35% off $43.44 $5,449.20 $3,106.05 2025-06-28
J1566 HCPCS Gammagard S-d (iga < 1 Mcg/ml) 5 Gram Intravenous Solution 91 26 $4,097.16 $2,663.15 35% off $82.19 $8,194.32 $3,067.54 2025-06-28
0406113052 NDC Fentanyl Citrate (bulk) 100 % Powder 45 26 $4,999.98 $3,249.99 35% off $1,105.00 $4,999.98 $3,064.99 2025-06-28
J0490 HCPCS Benlysta 200 Mg/ml Subcutaneous Auto-injector 134 26 $5,985.32 $3,890.46 35% off $54.15 $10,155.36 $3,046.70 2025-06-28
J3385 HCPCS Vpriv 400 Unit Intravenous Solution 48 26 $5,337.96 $3,469.67 35% off $370.20 $5,337.96 $3,042.64 2025-06-28
J9286 HCPCS Columvi 1 Mg/ml Intravenous Solution 90 26 $5,052.24 $3,283.96 35% off $1,116.55 $5,052.28 $3,031.37 2025-06-28
A9547 HCPCS Indium In-111 Oxyquinoline 1 Mci/ml (37 Mbq/ml)(1 Ml) Intravenous Soln 47 26 $5,030.00 $3,269.50 35% off $772.64 $5,030.00 $3,018.00 2025-06-28
0004035009 NDC Pegasys 180 Mcg/ml Subcutaneous Solution 45 26 $4,903.16 $3,187.05 35% off $1,083.60 $4,903.16 $3,005.64 2025-06-28
J2562 HCPCS Mozobil 24 Mg/1.2 Ml (20 Mg/ml) Subcutaneous Solution 91 26 $29,904.21 $19,437.74 35% off $43.71 $29,904.21 $2,853.90 2025-06-28
J9380 HCPCS Tecvayli 10 Mg/ml Subcutaneous Solution 91 26 $3,160.72 $2,054.47 35% off $31.98 $28,446.44 $2,844.65 2025-06-28
A9505 HCPCS Thallous Chloride Tl-201 37 Mbq/ml (1 Mci/ml) Intravenous Solution 44 26 $4,603.30 $2,992.15 35% off $1,380.99 $4,603.30 $2,821.82 2025-06-28
5957273007 NDC Onureg 200 Mg Tablet 45 26 $4,496.24 $2,922.56 35% off $993.67 $4,496.24 $2,756.20 2025-06-28
5957274007 NDC Onureg 300 Mg Tablet 45 26 $4,496.24 $2,922.56 35% off $993.67 $4,496.24 $2,756.20 2025-06-28
J0739 HCPCS Apretude 600 Mg/3 Ml (200 Mg/ml) IM Suspension Extended Release 48 26 $4,830.27 $3,139.68 35% off $6.81 $4,830.27 $2,753.26 2025-06-28
J9328 HCPCS Temodar 100 Mg Intravenous Solution 48 26 $4,814.92 $3,129.70 35% off $10.40 $4,814.92 $2,744.51 2025-06-28
J7312 HCPCS Ozurdex 0.7 Mg Intravitreal Implant 48 26 $4,798.80 $3,119.22 35% off $205.62 $4,798.80 $2,735.32 2025-06-28
A9548 HCPCS Indium In-111 Dtpa 1.5 Mci/1.5 Ml Intrathecal Solution 47 26 $4,518.00 $2,936.70 35% off $715.29 $4,518.00 $2,710.80 2025-06-28
J9316 HCPCS Phesgo 1200 Mg-600 Mg-30000 Unit/15 Ml Subcutaneous Solution 91 26 $4,453.28 $2,894.63 35% off $64.58 $4,453.28 $2,671.87 2025-06-28
J9204 HCPCS Poteligeo 4 Mg/ml Intravenous Solution 48 26 $4,501.08 $2,925.70 35% off $238.85 $4,501.08 $2,565.61 2025-06-28
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