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

FULTON COUNTY MEDICAL CENTER

Mcconnellsburg, PA · CCN 391303 · Rates published

3,349 distinct procedures filed
16 distinct payers
209,670 rate rows
2026-11-02 last MRF observed
Data quality

199,800 of 209,670 rate rows are consumer-grade (95.3%)

9,870 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
percent-of-billed methodology on a DRG bundle — not comparable to case rates; shown as context only 6,128
per-diem day rate — not a per-procedure price 1,612
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians 1,306
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 755
placeholder amount (≤ $0.02) — excluded from medians 67
exceeds 10× this hospital's gross charge — excluded from medians 2
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.fcmcpa.org/docs/231401561_fulton-county-medical-center_standardcharges.csv
Found on page https://www.fcmcpa.org/getpage.php?name=Pricing_Transparency
Discovered viaDiscovered by HANK
Last fetch success · 2026-11-02
Content fingerprint fb07dd5b13ac9b4b… · 28,796,482 bytes · first seen 2026-11-02

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
J2350
HCPCS 		Ocrelizumab 16 $60.25 $49,824.90 $31,943.30 nat. median
$714
outlier · 44.8×
C9363
HCPCS 		Integra Wound Matrix Bilay Mes 16 $14,195.28 $42,683.40 $28,157.28 nat. median
$1,444
outlier · 19.5×
J2351
HCPCS 		Ocrevus Zunov 920mg/23000 Via 16 $13,897.72 $37,902.87 $26,321.43 nat. median
$78
outlier · 337.7×
J2329
HCPCS 		Briumvi 150mg/6ml Vial 16 $70.05 $38,336.17 $24,577.74 nat. median
$176
outlier · 139.3×
J3380
HCPCS 		Entyvio 300mg Vial 16 $22.88 $32,752.19 $20,997.79 nat. median
$204
outlier · 103.1×
C1764
HCPCS 		Loop Recorder #lnq11 16 $9,051.24 $24,685.20 $17,142.50 nat. median
$7,740
outlier · 2.2×
J3101
HCPCS 		Tnkase 1 Mg 16 $157.47 $27,689.63 $15,641.87 nat. median
$4,042
outlier · 3.9×
J2323
HCPCS 		Tysabri 16 $24.07 $23,385.60 $14,992.77 nat. median
$252
outlier · 59.5×
J0896
HCPCS 		Reblozyl 25mg 16 $40.68 $40,779.15 $13,593.10 nat. median
$4,571
outlier · 3.0×
Q5111
HCPCS 		Pegfilgrastim-cbqa 16 $166.05 $12,429.00 $7,968.37 nat. median
$2,014
outlier · 4.0×
J1306
HCPCS 		Leqvio 1mg 16 $12.21 $12,089.22 $7,750.54 nat. median
$51
outlier · 151.8×
A4372
HCPCS 		Active Barrier 4x4 Ac4544 16 $5.73 $15,757.20 $7,359.25 nat. median
$6
outlier · 1200.5×
J0717
HCPCS 		Cimzia 400mg/2ml Syringe Kit 16 $4.46 $11,426.40 $7,325.59 nat. median
$1,753
outlier · 4.2×
J0565
HCPCS 		Bezlotoxumab/zinplava 16 $39.89 $11,312.10 $7,252.31 nat. median
$164
outlier · 44.3×
95991
CPT 		Nim Response Rental Machine 16 $104.31 $11,052.00 $7,085.56 nat. median
$326
outlier · 21.8×
J2506
HCPCS 		Pegfilgrastim Inject [6mg 16 $55.13 $10,719.00 $6,872.07 nat. median
$1,662
outlier · 4.1×
Q4126
HCPCS 		Dermaspan 0.9mmx1.99mm 4x7cm 16 $80.92 $10,671.30 $6,841.49 nat. median
$207
outlier · 33.1×
49329
CPT 		Unlstd Laps Px Abd Pertm&omn 11 $2,669.92 $6,494.40 $5,772.80 nat. median
$6,402
0.9× median
J3111
HCPCS 		Evenity 105mg Syr 1.17ml 2pk 16 $11.16 $8,943.59 $5,733.83 nat. median
$734
outlier · 7.8×
33285
CPT 		Insj Subq Car Rhythm Mntr 16 $82.89 $8,752.50 $5,611.33 nat. median
$9,037
0.6× median
J7168
HCPCS 		Kcentra 1000 Unit Vial 16 $2,720.85 $7,420.50 $5,153.12 nat. median
$22
outlier · 232.9×
C1789
HCPCS 		Control 360 Biplanar Imp Sk12 16 $1,407.45 $17,619.30 $5,149.45 nat. median
$1,968
outlier · 2.6×
C1776
HCPCS 		Great Toe Implant Fgt-40 16 $2,607.66 $7,111.80 $4,938.75 nat. median
$3,388
1.5× median
J9214
HCPCS 		Peginterferon Alfa - 2a [ 16 $32.57 $7,229.70 $4,635.04 nat. median
$292
outlier · 15.9×
Q4125
HCPCS 		Arthroflex 2.5 X 3.5 Aflex 300 16 $1,798.50 $10,617.30 $4,416.94 nat. median
$689
outlier · 6.4×
Q5108
HCPCS 		Fulphila 6mg Pfs 16 $147.76 $6,763.50 $4,336.16 nat. median
$1,244
outlier · 3.5×
Q4124
HCPCS 		Wound Matrix 7x20 Sq Cm 16 $2,186.25 $6,261.30 $4,236.41 nat. median
$191
outlier · 22.2×
J0897
HCPCS 		Prolia 60 Mg 16 $26.75 $11,512.48 $4,221.24 nat. median
$1,990
outlier · 2.1×
J3032
HCPCS 		Vyepti 100mg/ml Sdv 16 $18.66 $6,493.26 $4,162.90 nat. median
$84
outlier · 49.8×
J0840
HCPCS 		Antivenin Crotalidae Fab( 16 $1,894.15 $6,378.30 $4,089.20 nat. median
$3,454
1.2× median
59410
CPT 		Vag Deliv/post Partum Car 16 $1,048.42 $5,124.60 $3,832.06 nat. median
$2,383
1.6× median
81448
CPT 		Hrdtry Perph Neurphy Panel Spg 16 $526.41 $5,930.10 $3,801.85 nat. median
$1,053
outlier · 3.6×
J0875
HCPCS 		Dalvance 500 Mg Vial 16 $15.79 $5,764.39 $3,695.62 nat. median
$618
outlier · 6.0×
J9217
HCPCS 		Leuprolide Acetate 22.5mg Kit 16 $180.54 $8,067.60 $3,401.84 nat. median
$1,581
outlier · 2.2×
J0129
HCPCS 		Orencia 250mg 16 $43.73 $5,197.77 $3,332.35 nat. median
$935
outlier · 3.6×
81162
CPT 		Brca1 Brca2 Gene Analysis 16 $1,642.39 $5,079.60 $3,256.59 nat. median
$1,825
1.8× median
J1451
HCPCS 		Fomepizole 1gm/ml 16 $13.13 $4,949.10 $3,172.92 nat. median
$1,035
outlier · 3.1×
72157
CPT 		MRI Thoracic Spine Wo&w Cont 16 $310.74 $4,876.20 $3,126.19 nat. median
$1,099
outlier · 2.8×
72158
CPT 		MRI Lumbar Spine Wo&w Cont 16 $309.50 $4,876.20 $3,126.19 nat. median
$1,083
outlier · 2.9×
73223
CPT 		MRI Upr Ext Joint Wo&w Cont Lt 16 $373.96 $4,876.20 $3,126.19 nat. median
$1,166
outlier · 2.7×
27059
CPT 		Resect Hip/pelv Tum 5 Cm/> 16 $1,586.19 $4,051.80 $3,029.85 nat. median
$3,321
0.9× median
786
MS_DRG 		Cesarean Section Without Sterilization With Mcc 1 $3,000.00 $3,000.00 $3,000.00 nat. median
$14,838
outlier · 0.2×
73723
CPT 		MRI Lwr Ext Joint Wo&w Cont Lt 16 $372.42 $4,596.30 $2,946.74 nat. median
$1,191
outlier · 2.5×
C1889
HCPCS 		Knotless Tight Rope Ar8925ss 16 $1,545.06 $4,213.80 $2,926.25 nat. median
$2,359
1.2× median
72197
CPT 		MRI Pelvis Wo&w Cont 16 $325.95 $4,558.50 $2,922.51 nat. median
$1,058
outlier · 2.8×
J9280
HCPCS 		Mitomycin 40mg 16 $54.16 $4,515.30 $2,894.81 nat. median
$342
outlier · 8.5×
J0714
HCPCS 		Avycaz .625 G 16 $100.20 $4,487.40 $2,876.92 nat. median
$386
outlier · 7.4×
70552
CPT 		MRI Brain W Cont 16 $261.67 $4,338.00 $2,781.14 nat. median
$956
outlier · 2.9×
72196
CPT 		MRI Pelvis W Cont 16 $259.70 $4,338.00 $2,781.14 nat. median
$941
outlier · 3.0×
G0465
HCPCS 		Actigraft Pro Autologous Prp 16 $731.42 $4,323.60 $2,771.91 nat. median
$2,122
1.3× median

Other procedures at this hospital

Browse this hospital's 3,349 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
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
             
Q4107 HCPCS A4x7 Graft Jacket Max Force Ex 37 16 $10,006.00 $7,004.20 30% off $67.27 $9,005.40 $2,654.10 2026-11-02
G0465 HCPCS Actigraft Pro Autologous Prp 37 16 $4,804.00 $3,362.80 30% off $731.42 $4,323.60 $2,771.91 2026-11-02
A4372 HCPCS Active Barrier 4x4 Ac4544 73 16 $10,935.00 $7,654.50 30% off $5.73 $15,757.20 $7,359.25 2026-11-02
289 MS_DRG Acute And Subacute Endocarditis With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
290 MS_DRG Acute And Subacute Endocarditis Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
121 MS_DRG Acute Major Eye Infections With Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
122 MS_DRG Acute Major Eye Infections Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
281 MS_DRG Acute Myocardial Infarction, Discharged Alive With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
282 MS_DRG Acute Myocardial Infarction, Discharged Alive Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
285 MS_DRG Acute Myocardial Infarction, Expired Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
615 MS_DRG Adrenal And Pituitary Procedures Without Cc/mcc 2 2 — — $2,460.15 $2,694.45 $2,577.30 2026-11-02
245 MS_DRG Aicd Generator Procedures 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
265 MS_DRG Aicd Lead Procedures 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
14 MS_DRG Allogeneic Bone Marrow Transplant 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
240 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
239 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
241 MS_DRG Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc… 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
348 MS_DRG Anal And Stomal Procedures With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
349 MS_DRG Anal And Stomal Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
311 MS_DRG Angina Pectoris 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
J0840 HCPCS Antivenin Crotalidae Fab( 19 16 $7,087.00 $4,960.90 30% off $1,894.15 $6,378.30 $4,089.20 2026-11-02
Q4125 HCPCS Arthroflex 2.5 X 3.5 Aflex 300 72 16 $7,705.00 $5,393.50 30% off $1,798.50 $10,617.30 $4,416.94 2026-11-02
302 MS_DRG Atherosclerosis With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
303 MS_DRG Atherosclerosis Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
16 MS_DRG Autologous Bone Marrow Transplant With Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
17 MS_DRG Autologous Bone Marrow Transplant Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
J0714 HCPCS Avycaz .625 G 37 16 $4,986.00 $3,490.20 30% off $100.20 $4,487.40 $2,876.92 2026-11-02
520 MS_DRG Back And Neck Procedures Except Spinal Fusion Without Cc/mcc 1 1 — — $2,694.45 $2,694.45 $2,694.45 2026-11-02
J0565 HCPCS Bezlotoxumab/zinplava 19 16 $12,569.00 $8,798.30 30% off $39.89 $11,312.10 $7,252.31 2026-11-02
410 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
408 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
409 MS_DRG Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.d.e. With… 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
81162 CPT Brca1 Brca2 Gene Analysis 19 16 $5,644.00 $3,950.80 30% off $1,642.39 $5,079.60 $3,256.59 2026-11-02
J2329 HCPCS Briumvi 150mg/6ml Vial 19 16 $42,595.74 $29,817.02 30% off $70.05 $38,336.17 $24,577.74 2026-11-02
202 MS_DRG Bronchitis And Asthma With Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
203 MS_DRG Bronchitis And Asthma Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
297 MS_DRG Cardiac Arrest, Unexplained With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
296 MS_DRG Cardiac Arrest, Unexplained With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
298 MS_DRG Cardiac Arrest, Unexplained Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
310 MS_DRG Cardiac Arrhythmia And Conduction Disorders Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
306 MS_DRG Cardiac Congenital And Valvular Disorders With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
307 MS_DRG Cardiac Congenital And Valvular Disorders Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
258 MS_DRG Cardiac Pacemaker Device Replacement With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
259 MS_DRG Cardiac Pacemaker Device Replacement Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
261 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
260 MS_DRG Cardiac Pacemaker Revision Except Device Replacement With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
262 MS_DRG Cardiac Pacemaker Revision Except Device Replacement Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
33999 CPT Cardiac Surgery Procedure 30 16 $3,081.00 $2,156.70 30% off $1,016.73 $3,211.20 $2,433.03 2026-11-02
35 MS_DRG Carotid Artery Stent Procedures With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
34 MS_DRG Carotid Artery Stent Procedures With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
36 MS_DRG Carotid Artery Stent Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
279 MS_DRG Cellulitis Age 0-17 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
278 MS_DRG Cellulitis Age >17 Without Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
784 MS_DRG Cesarean Section With Sterilization With Cc 6 6 — — $2,343.00 $3,000.00 $2,401.57 2026-11-02
783 MS_DRG Cesarean Section With Sterilization With Mcc 6 6 — — $2,343.00 $3,000.00 $2,401.57 2026-11-02
785 MS_DRG Cesarean Section With Sterilization Without Cc/mcc 6 6 — — $2,343.00 $3,000.00 $2,401.57 2026-11-02
787 MS_DRG Cesarean Section Without Sterilization With Cc 6 6 — — $2,343.00 $3,000.00 $2,401.57 2026-11-02
786 MS_DRG Cesarean Section Without Sterilization With Mcc 1 1 — — $3,000.00 $3,000.00 $3,000.00 2026-11-02
788 MS_DRG Cesarean Section Without Sterilization Without Cc/mcc 6 6 — — $2,343.00 $3,000.00 $2,401.57 2026-11-02
313 MS_DRG Chest Pain 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
18 MS_DRG Chimeric Antigen Receptor (car) T-cell And Other Immunotherapies 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
416 MS_DRG Cholecystectomy Except By Laparoscope Without C.d.e. Without Cc/mcc 2 2 — — $2,460.15 $2,694.45 $2,577.30 2026-11-02
191 MS_DRG Chronic Obstructive Pulmonary Disease With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
192 MS_DRG Chronic Obstructive Pulmonary Disease Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
J0717 HCPCS Cimzia 400mg/2ml Syringe Kit 19 16 $12,696.00 $8,887.20 30% off $4.46 $11,426.40 $7,325.59 2026-11-02
286 MS_DRG Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
287 MS_DRG Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
433 MS_DRG Cirrhosis And Alcoholic Hepatitis With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
432 MS_DRG Cirrhosis And Alcoholic Hepatitis With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
434 MS_DRG Cirrhosis And Alcoholic Hepatitis Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
381 MS_DRG Complicated Peptic Ulcer With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
C1789 HCPCS Control 360 Biplanar Imp Sk12 36 16 $11,921.00 $8,344.70 30% off $1,407.45 $17,619.30 $5,149.45 2026-11-02
325 MS_DRG Coronary Intravascular Lithotripsy Without Intraluminal Device 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
26 MS_DRG Craniotomy And Endovascular Intracranial Procedures With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
27 MS_DRG Craniotomy And Endovascular Intracranial Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
24 MS_DRG Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Wi… 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
74177 CPT CT Abdomen & Pelvis W Cont 55 16 $3,826.00 $2,678.20 30% off $292.62 $5,049.00 $2,430.40 2026-11-02
74176 CPT CT Abdomen & Pelvis Wo Cont 55 16 $3,759.00 $2,631.30 30% off $177.95 $4,869.90 $2,489.06 2026-11-02
74178 CPT CT Abdomen & Pelvis Wo&w Cont 37 16 $4,074.00 $2,851.80 30% off $328.26 $3,666.60 $2,350.70 2026-11-02
75635 CPT CTA Abd Aorta & Bil Iliofem 37 16 $3,880.00 $2,716.00 30% off $395.86 $3,666.60 $2,350.70 2026-11-02
74174 CPT CTA Abd&pel Wo&w Cont 37 16 $4,074.00 $2,851.80 30% off $366.68 $3,666.60 $2,350.70 2026-11-02
J0875 HCPCS Dalvance 500 Mg Vial 19 16 $6,404.88 $4,483.42 30% off $15.79 $5,764.39 $3,695.62 2026-11-02
294 MS_DRG Deep Vein Thrombophlebitis With Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
295 MS_DRG Deep Vein Thrombophlebitis Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
158 MS_DRG Dental And Oral Diseases With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
157 MS_DRG Dental And Oral Diseases With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
159 MS_DRG Dental And Oral Diseases Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
Q4126 HCPCS Dermaspan 0.9mmx1.99mm 4x7cm 19 16 $11,857.00 $8,299.90 30% off $80.92 $10,671.30 $6,841.49 2026-11-02
375 MS_DRG Digestive Malignancy With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
374 MS_DRG Digestive Malignancy With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
376 MS_DRG Digestive Malignancy Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
149 MS_DRG Dysequilibrium 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
147 MS_DRG Ear, Nose, Mouth And Throat Malignancy With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
146 MS_DRG Ear, Nose, Mouth And Throat Malignancy With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
148 MS_DRG Ear, Nose, Mouth And Throat Malignancy Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
3 MS_DRG Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth… 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
J3380 HCPCS Entyvio 300mg Vial 19 16 $36,391.32 $25,473.92 30% off $22.88 $32,752.19 $20,997.79 2026-11-02
150 MS_DRG Epistaxis With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
151 MS_DRG Epistaxis Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
59409 CPT ER Prof Fee Vag Delivery 79 16 $3,849.00 $2,694.30 30% off $775.55 $3,637.80 $2,599.80 2026-11-02
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
J3111 HCPCS Evenity 105mg Syr 1.17ml 2pk 19 16 $9,937.32 $6,956.12 30% off $11.16 $8,943.59 $5,733.83 2026-11-02
38 MS_DRG Extracranial Procedures With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
39 MS_DRG Extracranial Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
115 MS_DRG Extraocular Procedures Except Orbit 1 1 — — $2,694.45 $2,694.45 $2,694.45 2026-11-02
748 MS_DRG Female Reproductive System Reconstructive Procedures 2 2 — — $2,460.15 $2,694.45 $2,577.30 2026-11-02
J1451 HCPCS Fomepizole 1gm/ml 19 16 $5,499.00 $3,849.30 30% off $13.13 $4,949.10 $3,172.92 2026-11-02
Q5108 HCPCS Fulphila 6mg Pfs 19 16 $7,515.00 $5,260.50 30% off $147.76 $6,763.50 $4,336.16 2026-11-02
378 MS_DRG Gastrointestinal Hemorrhage With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
377 MS_DRG Gastrointestinal Hemorrhage With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
379 MS_DRG Gastrointestinal Hemorrhage Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
389 MS_DRG Gastrointestinal Obstruction With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
388 MS_DRG Gastrointestinal Obstruction With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
390 MS_DRG Gastrointestinal Obstruction Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
C1776 HCPCS Great Toe Implant Fgt-40 18 16 $7,902.00 $5,531.40 30% off $2,607.66 $7,111.80 $4,938.75 2026-11-02
102 MS_DRG Headaches With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
103 MS_DRG Headaches Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
292 MS_DRG Heart Failure And Shock With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
291 MS_DRG Heart Failure And Shock With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
293 MS_DRG Heart Failure And Shock Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
1 MS_DRG Heart Transplant Or Implant Of Heart Assist System With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
2 MS_DRG Heart Transplant Or Implant Of Heart Assist System Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
420 MS_DRG Hepatobiliary Diagnostic Procedures With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
422 MS_DRG Hepatobiliary Diagnostic Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
355 MS_DRG Hernia Procedures Except Inguinal And Femoral Without Cc/mcc 2 2 — — $2,460.15 $2,694.45 $2,577.30 2026-11-02
212 MS_DRG Hip & Femur Procedures Except Major Joint Age 0-17 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
81448 CPT Hrdtry Perph Neurphy Panel Spg 19 16 $6,589.00 $4,612.30 30% off $526.41 $5,930.10 $3,801.85 2026-11-02
304 MS_DRG Hypertension With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
305 MS_DRG Hypertension Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
J1561 HCPCS Immune Globulin Human 10% 110 16 $4,631.00 $3,241.70 30% off $49.58 $8,334.00 $2,672.09 2026-11-02
386 MS_DRG Inflammatory Bowel Disease With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
385 MS_DRG Inflammatory Bowel Disease With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
352 MS_DRG Inguinal And Femoral Hernia Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
33285 CPT Insj Subq Car Rhythm Mntr 37 16 $9,725.00 $6,807.50 30% off $82.89 $8,752.50 $5,611.33 2026-11-02
C9363 HCPCS Integra Wound Matrix Bilay Mes 36 16 $45,221.00 $31,654.70 30% off $14,195.28 $42,683.40 $28,157.28 2026-11-02
197 MS_DRG Interstitial Lung Disease With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
196 MS_DRG Interstitial Lung Disease With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
198 MS_DRG Interstitial Lung Disease Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
21 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
20 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
22 MS_DRG Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/… 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
117 MS_DRG Intraocular Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
J7168 HCPCS Kcentra 1000 Unit Vial 18 16 $8,245.00 $5,771.50 30% off $2,720.85 $7,420.50 $5,153.12 2026-11-02
658 MS_DRG Kidney And Ureter Procedures For Neoplasm Without Cc/mcc 1 1 — — $2,694.45 $2,694.45 $2,694.45 2026-11-02
C1889 HCPCS Knotless Tight Rope Ar8925ss 18 16 $4,682.00 $3,277.40 30% off $1,545.06 $4,213.80 $2,926.25 2026-11-02
44204 CPT Lap Partial Colectomy W/anast 31 16 $3,546.00 $2,482.20 30% off $1,287.23 $3,191.40 $2,435.30 2026-11-02
419 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. Without Cc/mcc 2 2 — — $2,460.15 $2,694.45 $2,577.30 2026-11-02
J1306 HCPCS Leqvio 1mg 19 16 $13,432.47 $9,402.73 30% off $12.21 $12,089.22 $7,750.54 2026-11-02
J9217 HCPCS Leuprolide Acetate 22.5mg Kit 37 16 $4,483.00 $3,138.10 30% off $180.54 $8,067.60 $3,401.84 2026-11-02
C1764 HCPCS Loop Recorder #lnq11 18 16 $27,428.00 $19,199.60 30% off $9,051.24 $24,685.20 $17,142.50 2026-11-02
164 MS_DRG Major Chest Procedures With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
163 MS_DRG Major Chest Procedures With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
165 MS_DRG Major Chest Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
184 MS_DRG Major Chest Trauma With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
183 MS_DRG Major Chest Trauma With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
185 MS_DRG Major Chest Trauma Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
369 MS_DRG Major Esophageal Disorders With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
370 MS_DRG Major Esophageal Disorders Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
372 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
371 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
373 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
141 MS_DRG Major Head And Neck Procedures With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
140 MS_DRG Major Head And Neck Procedures With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
142 MS_DRG Major Head And Neck Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
708 MS_DRG Major Male Pelvic Procedures Without Cc/mcc 1 1 — — $2,694.45 $2,694.45 $2,694.45 2026-11-02
508 MS_DRG Major Shoulder Or Elbow Joint Procedures Without Cc/mcc 2 2 — — $2,460.15 $2,694.45 $2,577.30 2026-11-02
436 MS_DRG Malignancy Of Hepatobiliary System Or Pancreas With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
663 MS_DRG Minor Bladder Procedures With Cc 1 1 — — $2,694.45 $2,694.45 $2,694.45 2026-11-02
345 MS_DRG Minor Small And Large Bowel Procedures With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
344 MS_DRG Minor Small And Large Bowel Procedures With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
346 MS_DRG Minor Small And Large Bowel Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
J9280 HCPCS Mitomycin 40mg 19 16 $5,017.00 $3,511.90 30% off $54.16 $4,515.30 $2,894.81 2026-11-02
137 MS_DRG Mouth Procedures With Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
138 MS_DRG Mouth Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
70546 CPT MRA Head Without & With Contrast 37 16 $4,112.00 $2,878.40 30% off $317.72 $3,700.80 $2,372.62 2026-11-02
74183 CPT MRI Abdomen Wo&w Contrast 37 16 $4,061.00 $2,842.70 30% off $327.18 $3,838.50 $2,460.91 2026-11-02
70552 CPT MRI Brain W Cont 37 16 $4,820.00 $3,374.00 30% off $261.67 $4,338.00 $2,781.14 2026-11-02
70553 CPT MRI Brain Wo&w Cont 37 16 $3,916.00 $2,741.20 30% off $308.58 $3,700.80 $2,372.62 2026-11-02
72142 CPT MRI Cervical Spine W Cont 37 16 $4,695.00 $3,286.50 30% off $266.61 $4,225.50 $2,709.02 2026-11-02
71552 CPT MRI Chest Without & With Contrast 37 16 $4,061.00 $2,842.70 30% off $454.46 $3,838.50 $2,460.91 2026-11-02
72149 CPT MRI Lumbar Spine W Cont 37 16 $4,210.00 $2,947.00 30% off $261.98 $3,789.00 $2,429.17 2026-11-02
72158 CPT MRI Lumbar Spine Wo&w Cont 37 16 $5,418.00 $3,792.60 30% off $309.50 $4,876.20 $3,126.19 2026-11-02
73723 CPT MRI Lwr Ext Joint Wo&w Cont Lt 37 16 $5,107.00 $3,574.90 30% off $372.42 $4,596.30 $2,946.74 2026-11-02
72196 CPT MRI Pelvis W Cont 37 16 $4,590.00 $3,213.00 30% off $259.70 $4,338.00 $2,781.14 2026-11-02
72197 CPT MRI Pelvis Wo&w Cont 37 16 $4,823.00 $3,376.10 30% off $325.95 $4,558.50 $2,922.51 2026-11-02
72147 CPT MRI Thoracic Spine W Cont 37 16 $4,471.00 $3,129.70 30% off $264.14 $4,225.50 $2,709.02 2026-11-02
72157 CPT MRI Thoracic Spine Wo&w Cont 37 16 $5,418.00 $3,792.60 30% off $310.74 $4,876.20 $3,126.19 2026-11-02
73223 CPT MRI Upr Ext Joint Wo&w Cont Lt 37 16 $5,160.00 $3,612.00 30% off $373.96 $4,876.20 $3,126.19 2026-11-02
123 MS_DRG Neurological Eye Disorders 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
95991 CPT Nim Response Rental Machine 37 16 $12,280.00 $8,596.00 30% off $104.31 $11,052.00 $7,085.56 2026-11-02
J2350 HCPCS Ocrelizumab 19 16 $55,361.00 $38,752.70 30% off $60.25 $49,824.90 $31,943.30 2026-11-02
J2351 HCPCS Ocrevus Zunov 920mg/23000 Via 18 16 $42,114.30 $29,480.01 30% off $13,897.72 $37,902.87 $26,321.43 2026-11-02
J2357 HCPCS Omalizumab 150 56 16 $4,040.00 $2,828.00 30% off $38.33 $5,034.18 $2,541.33 2026-11-02
23515 CPT Open Trtmnt Clavicular Fx 43 16 $3,677.00 $2,573.90 30% off $700.12 $3,474.90 $2,667.20 2026-11-02
28485 CPT Open Trtmt Mt Fx W Int Fix 43 16 $3,565.00 $2,495.50 30% off $546.91 $3,369.60 $2,586.40 2026-11-02
113 MS_DRG Orbital Procedures With Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
114 MS_DRG Orbital Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
J0129 HCPCS Orencia 250mg 19 16 $5,775.30 $4,042.71 30% off $43.73 $5,197.77 $3,332.35 2026-11-02
228 MS_DRG Other Cardiothoracic Procedures With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
229 MS_DRG Other Cardiothoracic Procedures Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
315 MS_DRG Other Circulatory System Diagnoses With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
316 MS_DRG Other Circulatory System Diagnoses Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
264 MS_DRG Other Circulatory System O.r. Procedures 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
394 MS_DRG Other Digestive System Diagnoses With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
395 MS_DRG Other Digestive System Diagnoses Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
357 MS_DRG Other Digestive System O.r. Procedures With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
356 MS_DRG Other Digestive System O.r. Procedures With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
358 MS_DRG Other Digestive System O.r. Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
125 MS_DRG Other Disorders Of The Eye Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
155 MS_DRG Other Ear, Nose, Mouth And Throat Diagnoses With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
154 MS_DRG Other Ear, Nose, Mouth And Throat Diagnoses With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
156 MS_DRG Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
319 MS_DRG Other Endovascular Cardiac Valve Procedures With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
320 MS_DRG Other Endovascular Cardiac Valve Procedures Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
215 MS_DRG Other Heart Assist System Implant 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
205 MS_DRG Other Respiratory System Diagnoses With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
206 MS_DRG Other Respiratory System Diagnoses Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
168 MS_DRG Other Respiratory System O.r. Procedures Without Cc/mcc 2 2 — — $2,460.15 $2,694.45 $2,577.30 2026-11-02
581 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/mcc 1 1 — — $2,694.45 $2,694.45 $2,694.45 2026-11-02
152 MS_DRG Otitis Media And Uri With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
153 MS_DRG Otitis Media And Uri Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
10 MS_DRG Pancreas Transplant 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
J2506 HCPCS Pegfilgrastim Inject [6mg 19 16 $11,910.00 $8,337.00 30% off $55.13 $10,719.00 $6,872.07 2026-11-02
Q5111 HCPCS Pegfilgrastim-cbqa 19 16 $13,810.00 $9,667.00 30% off $166.05 $12,429.00 $7,968.37 2026-11-02
J9214 HCPCS Peginterferon Alfa - 2a [ 19 16 $8,033.00 $5,623.10 30% off $32.57 $7,229.70 $4,635.04 2026-11-02
710 MS_DRG Penis Procedures Without Cc/mcc 1 1 — — $2,694.45 $2,694.45 $2,694.45 2026-11-02
251 MS_DRG Percutaneous Cardiovascular Procedures Without Coronary Artery Stent Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
301 MS_DRG Peripheral Vascular Disorders Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
41 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Periphe… 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
42 MS_DRG Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
336 MS_DRG Peritoneal Adhesiolysis With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
335 MS_DRG Peritoneal Adhesiolysis With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
337 MS_DRG Peritoneal Adhesiolysis Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
186 MS_DRG Pleural Effusion With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
188 MS_DRG Pleural Effusion Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
200 MS_DRG Pneumothorax With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
199 MS_DRG Pneumothorax With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
201 MS_DRG Pneumothorax Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
J0897 HCPCS Prolia 60 Mg 37 16 $5,034.00 $3,523.80 30% off $26.75 $11,512.48 $4,221.24 2026-11-02
189 MS_DRG Pulmonary Edema And Respiratory Failure 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
175 MS_DRG Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
176 MS_DRG Pulmonary Embolism Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
J0896 HCPCS Reblozyl 25mg 37 16 $15,103.44 $10,572.41 30% off $40.68 $40,779.15 $13,593.10 2026-11-02
333 MS_DRG Rectal Resection With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
332 MS_DRG Rectal Resection With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
334 MS_DRG Rectal Resection Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
27059 CPT Resect Hip/pelv Tum 5 Cm/> 31 16 $4,287.00 $3,000.90 30% off $1,586.19 $4,051.80 $3,029.85 2026-11-02
178 MS_DRG Respiratory Infections And Inflammations With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
177 MS_DRG Respiratory Infections And Inflammations With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
181 MS_DRG Respiratory Neoplasms With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
180 MS_DRG Respiratory Neoplasms With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
182 MS_DRG Respiratory Neoplasms Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
204 MS_DRG Respiratory Signs And Symptoms 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
208 MS_DRG Respiratory System Diagnosis With Ventilator Support <=96 Hours 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
207 MS_DRG Respiratory System Diagnosis With Ventilator Support >96 Hours 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
398 MS_DRG Reticuloendothelial & Immunity Disorders W Cc 1 1 — — $2,694.45 $2,694.45 $2,694.45 2026-11-02
399 MS_DRG Reticuloendothelial & Immunity Disorders Without Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
139 MS_DRG Salivary Gland Procedures 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
100 MS_DRG Seizures With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
101 MS_DRG Seizures Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
0210 RC Semi-private Cc Room 21 13 $3,101.00 $2,170.70 30% off $1,789.28 $3,009.60 $2,480.80 2026-11-02
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
19 MS_DRG Simultaneous Pancreas And Kidney Transplant With Hemodialysis 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
136 MS_DRG Sinus And Mastoid Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
502 MS_DRG Soft Tissue Procedures Without Cc/mcc 1 1 — — $2,694.45 $2,694.45 $2,694.45 2026-11-02
29 MS_DRG Spinal Procedures With Cc Or Spinal Neurostimulators 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
28 MS_DRG Spinal Procedures With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
30 MS_DRG Spinal Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
312 MS_DRG Syncope And Collapse 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
25310 CPT Tendon Transplant/transfer 43 16 $3,493.00 $2,445.10 30% off $605.52 $3,301.20 $2,533.60 2026-11-02
626 MS_DRG Thyroid, Parathyroid And Thyroglossal Procedures With Cc 1 1 — — $2,694.45 $2,694.45 $2,694.45 2026-11-02
J3101 HCPCS Tnkase 1 Mg 55 16 $24,405.00 $17,083.50 30% off $157.47 $27,689.63 $15,641.87 2026-11-02
12 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
11 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
13 MS_DRG Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
4 MS_DRG Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Nec… 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
669 MS_DRG Transurethral Procedures With Cc 1 1 — — $2,694.45 $2,694.45 $2,694.45 2026-11-02
713 MS_DRG Transurethral Prostatectomy With Cc/mcc 1 1 — — $2,694.45 $2,694.45 $2,694.45 2026-11-02
J2323 HCPCS Tysabri 19 16 $25,984.00 $18,188.80 30% off $24.07 $23,385.60 $14,992.77 2026-11-02
173 MS_DRG Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary… 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
383 MS_DRG Uncomplicated Peptic Ulcer With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
384 MS_DRG Uncomplicated Peptic Ulcer Without Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
49329 CPT Unlstd Laps Px Abd Pertm&omn 12 11 $7,216.00 $5,051.20 30% off $2,669.92 $6,494.40 $5,772.80 2026-11-02
256 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders With Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
255 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
257 MS_DRG Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
323 MS_DRG Urinary Stones W Cc, &/or Esw Lithotripsy 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
324 MS_DRG Urinary Stones Without Cc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
59410 CPT Vag Deliv/post Partum Car 31 16 $5,694.00 $3,985.80 30% off $1,048.42 $5,124.60 $3,832.06 2026-11-02
263 MS_DRG Vein Ligation And Stripping 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
33 MS_DRG Ventricular Shunt Procedures Without Cc/mcc 5 5 — — $2,343.00 $2,694.45 $2,343.00 2026-11-02
J3032 HCPCS Vyepti 100mg/ml Sdv 19 16 $7,214.73 $5,050.31 30% off $18.66 $6,493.26 $4,162.90 2026-11-02
Q4124 HCPCS Wound Matrix 7x20 Sq Cm 36 16 $6,791.00 $4,753.70 30% off $2,186.25 $6,261.30 $4,236.41 2026-11-02
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