Hospital

AVERA SACRED HEART HOSPITAL

Yankton, SD · CCN 430012 · Rates published

1,229 distinct procedures filed

6 distinct payers

15,924 rate rows

2026-07-15 last MRF observed

Data quality

15,615 of 15,924 rate rows are consumer-grade (98.1%)

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

Excluded — reason	Rows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	287
below 25% of the Medicare reference for this code — likely a mislabeled per-diem or placeholder; excluded from medians	8
exceeds 10× this hospital's gross charge — excluded from medians	8
placeholder amount (≤ $0.02) — excluded from medians	6

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

Source MRF file	https://www.avera.org/app/files/public/14ca39ed-760e-484f-8e7e-19bb3f14df01/460225483_avera-sacred-heart-hospital_standardcharges.csv
Discovered via	Discovered by HANK (automated)
Last fetch	not_modified · 2026-11-07
Content fingerprint	fca3cabb29dc525f… · 3,881,703 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code	Description	Payers	Min $	Max $	Avg median	vs national
428 MS_DRG	Ms-DRG 428	1	$153,749.51	$153,749.51	$153,749.51	nat. median $50,495 outlier · 3.0×
1824 APR_DRG	Apr-DRG 1824	1	$138,508.41	$138,508.41	$138,508.41	nat. median $43,332 outlier · 3.2×
4693 APR_DRG	Apr-DRG 4693	1	$114,628.37	$114,628.37	$114,628.37	nat. median $9,354 outlier · 12.3×
3082 APR_DRG	Apr-DRG 3082	1	$109,204.13	$109,204.13	$109,204.13	nat. median $14,227 outlier · 7.7×
2201 APR_DRG	Apr-DRG 2201	1	$88,291.73	$88,291.73	$88,291.73	nat. median $12,006 outlier · 7.4×
3031 APR_DRG	Apr-DRG 3031	1	$87,820.09	$87,820.09	$87,820.09	nat. median $34,001 outlier · 2.6×
2234 APR_DRG	Apr-DRG 2234	1	$86,465.03	$86,465.03	$86,465.03	nat. median $34,355 outlier · 2.5×
7113 APR_DRG	Apr-DRG 7113	1	$81,006.83	$81,006.83	$81,006.83	nat. median $21,011 outlier · 3.9×
7114 APR_DRG	Apr-DRG 7114	1	$81,006.83	$81,006.83	$81,006.83	nat. median $38,637 outlier · 2.1×
3042 APR_DRG	Apr-DRG 3042	1	$77,826.10	$77,826.10	$77,826.10	nat. median $28,158 outlier · 2.8×
3054 APR_DRG	Apr-DRG 3054	1	$75,230.28	$75,230.28	$75,230.28	nat. median $33,705 outlier · 2.2×
J2350 HCPCS	Ocrelizumab 300 Mg/10 Ml	5	$6.09	$86,126.02	$72,141.64	nat. median $714 outlier · 101.1×
867 MS_DRG	Ms-DRG 867	1	$70,595.63	$70,595.63	$70,595.63	nat. median $20,203 outlier · 3.5×
38 MS_DRG	Ms-DRG 38	1	$68,085.87	$68,085.87	$68,085.87	nat. median $16,160 outlier · 4.2×
3122 APR_DRG	Apr-DRG 3122	1	$67,667.53	$67,667.53	$67,667.53	nat. median $16,595 outlier · 4.1×
3253 APR_DRG	Apr-DRG 3253	2	$24,776.91	$65,602.33	$65,602.33	nat. median $22,643 outlier · 2.9×
3041 APR_DRG	Apr-DRG 3041	1	$64,958.98	$64,958.98	$64,958.98	nat. median $22,805 outlier · 2.8×
486 MS_DRG	Ms-DRG 486	1	$64,930.09	$64,930.09	$64,930.09	nat. median $20,163 outlier · 3.2×
573 MS_DRG	Ms-DRG 573	1	$62,736.70	$62,736.70	$62,736.70	nat. median $58,210 1.1× median
464 MS_DRG	Ms-DRG 464	1	$61,599.19	$61,599.19	$61,599.19	nat. median $28,658 outlier · 2.1×
9123 APR_DRG	Apr-DRG 9123	1	$57,797.15	$57,797.15	$57,797.15	nat. median $29,636 2.0× median
3133 APR_DRG	Apr-DRG 3133	1	$57,528.41	$57,528.41	$57,528.41	nat. median $21,542 outlier · 2.7×
3053 APR_DRG	Apr-DRG 3053	1	$56,283.37	$56,283.37	$56,283.37	nat. median $19,244 outlier · 2.9×
6333 APR_DRG	Apr-DRG 6333	1	$56,028.24	$56,028.24	$56,028.24	nat. median $20,624 outlier · 2.7×
602 MS_DRG	Ms-DRG 602	1	$55,861.56	$55,861.56	$55,861.56	nat. median $13,976 outlier · 4.0×
551 MS_DRG	Ms-DRG 551	1	$51,765.09	$51,765.09	$51,765.09	nat. median $16,070 outlier · 3.2×
7214 APR_DRG	Apr-DRG 7214	1	$51,296.28	$51,296.28	$51,296.28	nat. median $20,701 outlier · 2.5×
896 MS_DRG	Ms-DRG 896	1	$51,253.74	$51,253.74	$51,253.74	nat. median $15,456 outlier · 3.3×
708 MS_DRG	Ms-DRG 708	1	$50,674.11	$50,674.11	$50,674.11	nat. median $15,257 outlier · 3.3×
820 MS_DRG	Ms-DRG 820	1	$50,516.54	$50,516.54	$50,516.54	nat. median $53,708 0.9× median
69 MS_DRG	Ms-DRG 69	1	$47,319.27	$47,319.27	$47,319.27	nat. median $8,408 outlier · 5.6×
354 MS_DRG	Ms-DRG 354	1	$45,694.52	$45,694.52	$45,694.52	nat. median $16,449 outlier · 2.8×
239 MS_DRG	Ms-DRG 239	1	$43,706.61	$43,706.61	$43,706.61	nat. median $45,076 1.0× median
8174 APR_DRG	Apr-DRG 8174	1	$43,704.25	$43,704.25	$43,704.25	nat. median $12,152 outlier · 3.6×
2484 APR_DRG	Apr-DRG 2484	1	$43,404.77	$43,404.77	$43,404.77	nat. median $19,327 outlier · 2.2×
1344 APR_DRG	Apr-DRG 1344	1	$43,036.92	$43,036.92	$43,036.92	nat. median $16,009 outlier · 2.7×
3132 APR_DRG	Apr-DRG 3132	1	$43,018.94	$43,018.94	$43,018.94	nat. median $14,427 outlier · 3.0×
743 MS_DRG	Ms-DRG 743	1	$42,105.79	$42,105.79	$42,105.79	nat. median $12,357 outlier · 3.4×
853 MS_DRG	Ms-DRG 853	2	$41,172.24	$65,658.51	$41,172.24	nat. median $45,281 0.9× median
7204 APR_DRG	Apr-DRG 7204	2	$41,100.60	$77,998.10	$41,100.60	nat. median $20,645 2.0× median
2314 APR_DRG	Apr-DRG 2314	1	$41,033.49	$41,033.49	$41,033.49	nat. median $31,699 1.3× median
2302 APR_DRG	Apr-DRG 2302	1	$38,239.72	$38,239.72	$38,239.72	nat. median $12,987 outlier · 2.9×
914 MS_DRG	Ms-DRG 914	1	$37,615.05	$37,615.05	$37,615.05	nat. median $9,228 outlier · 4.1×
7922 APR_DRG	Apr-DRG 7922	1	$36,395.57	$36,395.57	$36,395.57	nat. median $13,067 outlier · 2.8×
742 MS_DRG	Ms-DRG 742	1	$36,215.67	$36,215.67	$36,215.67	nat. median $17,777 outlier · 2.0×
2312 APR_DRG	Apr-DRG 2312	1	$35,519.04	$35,519.04	$35,519.04	nat. median $12,756 outlier · 2.8×
448 MS_DRG	Ms-DRG 448	2	$35,440.04	$122,988.25	$35,440.04	nat. median $38,939 0.9× median
7102 APR_DRG	Apr-DRG 7102	1	$34,565.36	$34,565.36	$34,565.36	nat. median $12,955 outlier · 2.7×
6633 APR_DRG	Apr-DRG 6633	1	$34,500.39	$34,500.39	$34,500.39	nat. median $8,554 outlier · 4.0×
6914 APR_DRG	Apr-DRG 6914	1	$34,039.34	$34,039.34	$34,039.34	nat. median $33,245 1.0× median

Other procedures at this hospital

Browse this hospital's 1,229 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

100	MS_DRG	Ms-DRG 100	1	1	—	—	$27,789.82	$27,789.82	$27,789.82	2026-07-15
1131	APR_DRG	Apr-DRG 1131	2	1	—	—	$8,489.99	$8,489.99	$8,489.99	2026-07-15
1132	APR_DRG	Apr-DRG 1132	3	2	—	—	$4,146.27	$10,159.83	$10,159.83	2026-07-15
1133	APR_DRG	Apr-DRG 1133	2	1	—	—	$14,765.22	$14,765.22	$14,765.22	2026-07-15
1151	APR_DRG	Apr-DRG 1151	2	1	—	—	$6,589.53	$6,589.53	$6,589.53	2026-07-15
1332	APR_DRG	Apr-DRG 1332	2	1	—	—	$15,621.33	$15,621.33	$15,621.33	2026-07-15
1344	APR_DRG	Apr-DRG 1344	2	1	—	—	$43,036.92	$43,036.92	$43,036.92	2026-07-15
1351	APR_DRG	Apr-DRG 1351	2	1	—	—	$12,257.73	$12,257.73	$12,257.73	2026-07-15
1352	APR_DRG	Apr-DRG 1352	2	1	—	—	$14,155.83	$14,155.83	$14,155.83	2026-07-15
1353	APR_DRG	Apr-DRG 1353	2	1	—	—	$13,450.29	$13,450.29	$13,450.29	2026-07-15
1373	APR_DRG	Apr-DRG 1373	2	1	—	—	$19,737.75	$19,737.75	$19,737.75	2026-07-15
1381	APR_DRG	Apr-DRG 1381	2	1	—	—	$12,722.64	$12,722.64	$12,722.64	2026-07-15
1382	APR_DRG	Apr-DRG 1382	2	1	—	—	$8,941.53	$8,941.53	$8,941.53	2026-07-15
1383	APR_DRG	Apr-DRG 1383	2	1	—	—	$13,296.18	$13,296.18	$13,296.18	2026-07-15
1391	APR_DRG	Apr-DRG 1391	2	1	—	—	$10,535.03	$10,535.03	$10,535.03	2026-07-15
1392	APR_DRG	Apr-DRG 1392	2	1	—	—	$14,473.27	$14,473.27	$14,473.27	2026-07-15
1393	APR_DRG	Apr-DRG 1393	3	2	—	—	$6,845.25	$13,063.21	$13,063.21	2026-07-15
1394	APR_DRG	Apr-DRG 1394	2	1	—	—	$18,180.09	$18,180.09	$18,180.09	2026-07-15
1411	APR_DRG	Apr-DRG 1411	2	1	—	—	$8,186.27	$8,186.27	$8,186.27	2026-07-15
1412	APR_DRG	Apr-DRG 1412	2	1	—	—	$10,885.16	$10,885.16	$10,885.16	2026-07-15
1413	APR_DRG	Apr-DRG 1413	2	1	—	—	$13,988.00	$13,988.00	$13,988.00	2026-07-15
1414	APR_DRG	Apr-DRG 1414	2	1	—	—	$27,848.12	$27,848.12	$27,848.12	2026-07-15
1441	APR_DRG	Apr-DRG 1441	2	1	—	—	$11,144.84	$11,144.84	$11,144.84	2026-07-15
1451	APR_DRG	Apr-DRG 1451	2	1	—	—	$13,563.83	$13,563.83	$13,563.83	2026-07-15
153	MS_DRG	Ms-DRG 153	2	1	—	—	$6,204.41	$6,204.41	$6,204.41	2026-07-15
177	MS_DRG	Ms-DRG 177	3	2	—	—	$14,048.73	$17,876.99	$14,048.73	2026-07-15
178	MS_DRG	Ms-DRG 178	1	1	—	—	$32,734.81	$32,734.81	$32,734.81	2026-07-15
1824	APR_DRG	Apr-DRG 1824	2	1	—	—	$138,508.41	$138,508.41	$138,508.41	2026-07-15
183	MS_DRG	Ms-DRG 183	2	1	—	—	$13,762.88	$13,762.88	$13,762.88	2026-07-15
189	MS_DRG	Ms-DRG 189	3	2	—	—	$10,762.55	$51,134.69	$10,762.55	2026-07-15
190	MS_DRG	Ms-DRG 190	1	1	—	—	$25,114.05	$25,114.05	$25,114.05	2026-07-15
1901	APR_DRG	Apr-DRG 1901	2	1	—	—	$6,923.00	$6,923.00	$6,923.00	2026-07-15
1902	APR_DRG	Apr-DRG 1902	2	1	—	—	$6,923.00	$6,923.00	$6,923.00	2026-07-15
193	MS_DRG	Ms-DRG 193	4	3	—	—	$11,458.81	$60,773.58	$27,048.37	2026-07-15
194	MS_DRG	Ms-DRG 194	3	2	—	—	$6,752.17	$62,835.44	$6,752.17	2026-07-15
1942	APR_DRG	Apr-DRG 1942	2	1	—	—	$16,427.20	$16,427.20	$16,427.20	2026-07-15
1943	APR_DRG	Apr-DRG 1943	2	1	—	—	$23,960.02	$23,960.02	$23,960.02	2026-07-15
1973	APR_DRG	Apr-DRG 1973	2	1	—	—	$23,288.24	$23,288.24	$23,288.24	2026-07-15
1981	APR_DRG	Apr-DRG 1981	2	1	—	—	$9,260.73	$9,260.73	$9,260.73	2026-07-15
1992	APR_DRG	Apr-DRG 1992	2	1	—	—	$13,066.92	$13,066.92	$13,066.92	2026-07-15
200	MS_DRG	Ms-DRG 200	1	1	—	—	$23,286.49	$23,286.49	$23,286.49	2026-07-15
2011	APR_DRG	Apr-DRG 2011	2	1	—	—	$9,492.50	$9,492.50	$9,492.50	2026-07-15
2012	APR_DRG	Apr-DRG 2012	2	1	—	—	$12,387.73	$12,387.73	$12,387.73	2026-07-15
2013	APR_DRG	Apr-DRG 2013	2	1	—	—	$18,842.79	$18,842.79	$18,842.79	2026-07-15
2014	APR_DRG	Apr-DRG 2014	2	1	—	—	$19,645.67	$19,645.67	$19,645.67	2026-07-15
202	MS_DRG	Ms-DRG 202	1	1	—	—	$16,663.19	$16,663.19	$16,663.19	2026-07-15
205	MS_DRG	Ms-DRG 205	2	1	—	—	$15,298.24	$15,298.24	$15,298.24	2026-07-15
2063	APR_DRG	Apr-DRG 2063	2	1	—	—	$14,135.92	$14,135.92	$14,135.92	2026-07-15
2071	APR_DRG	Apr-DRG 2071	2	1	—	—	$9,724.27	$9,724.27	$9,724.27	2026-07-15
2072	APR_DRG	Apr-DRG 2072	2	1	—	—	$25,562.37	$25,562.37	$25,562.37	2026-07-15
2201	APR_DRG	Apr-DRG 2201	2	1	—	—	$88,291.73	$88,291.73	$88,291.73	2026-07-15
2231	APR_DRG	Apr-DRG 2231	2	1	—	—	$21,718.26	$21,718.26	$21,718.26	2026-07-15
2234	APR_DRG	Apr-DRG 2234	2	1	—	—	$86,465.03	$86,465.03	$86,465.03	2026-07-15
2301	APR_DRG	Apr-DRG 2301	2	1	—	—	$26,919.72	$26,919.72	$26,919.72	2026-07-15
2302	APR_DRG	Apr-DRG 2302	2	1	—	—	$38,239.72	$38,239.72	$38,239.72	2026-07-15
2312	APR_DRG	Apr-DRG 2312	2	1	—	—	$35,519.04	$35,519.04	$35,519.04	2026-07-15
2314	APR_DRG	Apr-DRG 2314	2	1	—	—	$41,033.49	$41,033.49	$41,033.49	2026-07-15
2331	APR_DRG	Apr-DRG 2331	2	1	—	—	$20,941.04	$20,941.04	$20,941.04	2026-07-15
2332	APR_DRG	Apr-DRG 2332	2	1	—	—	$26,823.15	$26,823.15	$26,823.15	2026-07-15
239	MS_DRG	Ms-DRG 239	2	1	—	—	$43,706.61	$43,706.61	$43,706.61	2026-07-15
2402	APR_DRG	Apr-DRG 2402	2	1	—	—	$17,166.82	$17,166.82	$17,166.82	2026-07-15
241	APR_DRG	Apr-DRG 241	2	1	—	—	$17,010.97	$17,010.97	$17,010.97	2026-07-15
2413	APR_DRG	Apr-DRG 2413	2	1	—	—	$24,222.68	$24,222.68	$24,222.68	2026-07-15
2441	APR_DRG	Apr-DRG 2441	2	1	—	—	$11,936.20	$11,936.20	$11,936.20	2026-07-15
2442	APR_DRG	Apr-DRG 2442	2	1	—	—	$15,080.90	$15,080.90	$15,080.90	2026-07-15
2453	APR_DRG	Apr-DRG 2453	2	1	—	—	$24,927.31	$24,927.31	$24,927.31	2026-07-15
2471	APR_DRG	Apr-DRG 2471	2	1	—	—	$10,140.20	$10,140.20	$10,140.20	2026-07-15
2473	APR_DRG	Apr-DRG 2473	2	1	—	—	$22,919.06	$22,919.06	$22,919.06	2026-07-15
2481	APR_DRG	Apr-DRG 2481	2	1	—	—	$12,112.35	$12,112.35	$12,112.35	2026-07-15
2482	APR_DRG	Apr-DRG 2482	2	1	—	—	$14,891.09	$14,891.09	$14,891.09	2026-07-15
2484	APR_DRG	Apr-DRG 2484	2	1	—	—	$43,404.77	$43,404.77	$43,404.77	2026-07-15
2491	APR_DRG	Apr-DRG 2491	2	1	—	—	$10,211.07	$10,211.07	$10,211.07	2026-07-15
2492	APR_DRG	Apr-DRG 2492	2	1	—	—	$12,264.21	$12,264.21	$12,264.21	2026-07-15
2493	APR_DRG	Apr-DRG 2493	2	1	—	—	$19,047.29	$19,047.29	$19,047.29	2026-07-15
2511	APR_DRG	Apr-DRG 2511	2	1	—	—	$12,827.11	$12,827.11	$12,827.11	2026-07-15
2522	APR_DRG	Apr-DRG 2522	2	1	—	—	$15,776.54	$15,776.54	$15,776.54	2026-07-15
2532	APR_DRG	Apr-DRG 2532	2	1	—	—	$17,098.88	$17,098.88	$17,098.88	2026-07-15
2533	APR_DRG	Apr-DRG 2533	2	1	—	—	$7,364.00	$7,364.00	$7,364.00	2026-07-15
2543	APR_DRG	Apr-DRG 2543	1	1	—	—	$8,449.64	$8,449.64	$8,449.64	2026-07-15
2803	APR_DRG	Apr-DRG 2803	2	1	—	—	$25,220.75	$25,220.75	$25,220.75	2026-07-15
281	MS_DRG	Ms-DRG 281	2	1	—	—	$8,026.11	$8,026.11	$8,026.11	2026-07-15
282	MS_DRG	Ms-DRG 282	2	1	—	—	$6,287.07	$6,287.07	$6,287.07	2026-07-15
2833	APR_DRG	Apr-DRG 2833	2	1	—	—	$19,395.49	$19,395.49	$19,395.49	2026-07-15
2843	APR_DRG	Apr-DRG 2843	2	1	—	—	$8,001.00	$8,001.00	$8,001.00	2026-07-15
291	MS_DRG	Ms-DRG 291	4	3	—	—	$10,736.33	$59,904.35	$21,948.53	2026-07-15
299	MS_DRG	Ms-DRG 299	1	1	—	—	$18,917.50	$18,917.50	$18,917.50	2026-07-15
3031	APR_DRG	Apr-DRG 3031	2	1	—	—	$87,820.09	$87,820.09	$87,820.09	2026-07-15
3041	APR_DRG	Apr-DRG 3041	2	1	—	—	$64,958.98	$64,958.98	$64,958.98	2026-07-15
3042	APR_DRG	Apr-DRG 3042	2	1	—	—	$77,826.10	$77,826.10	$77,826.10	2026-07-15
305	MS_DRG	Ms-DRG 305	3	2	—	—	$6,542.55	$26,487.36	$6,542.55	2026-07-15
3053	APR_DRG	Apr-DRG 3053	2	1	—	—	$56,283.37	$56,283.37	$56,283.37	2026-07-15
3054	APR_DRG	Apr-DRG 3054	2	1	—	—	$75,230.28	$75,230.28	$75,230.28	2026-07-15
308	MS_DRG	Ms-DRG 308	3	2	—	—	$10,643.02	$35,342.91	$10,643.02	2026-07-15
3081	APR_DRG	Apr-DRG 3081	2	1	—	—	$26,364.92	$26,364.92	$26,364.92	2026-07-15
3082	APR_DRG	Apr-DRG 3082	2	1	—	—	$109,204.13	$109,204.13	$109,204.13	2026-07-15
309	MS_DRG	Ms-DRG 309	3	2	—	—	$6,443.73	$27,479.82	$6,443.73	2026-07-15
311	MS_DRG	Ms-DRG 311	1	1	—	—	$6,005.22	$6,005.22	$6,005.22	2026-07-15
312	MS_DRG	Ms-DRG 312	2	1	—	—	$7,588.24	$7,588.24	$7,588.24	2026-07-15
3122	APR_DRG	Apr-DRG 3122	2	1	—	—	$67,667.53	$67,667.53	$67,667.53	2026-07-15
3132	APR_DRG	Apr-DRG 3132	2	1	—	—	$43,018.94	$43,018.94	$43,018.94	2026-07-15
3133	APR_DRG	Apr-DRG 3133	2	1	—	—	$57,528.41	$57,528.41	$57,528.41	2026-07-15
3162	APR_DRG	Apr-DRG 3162	2	1	—	—	$18,439.54	$18,439.54	$18,439.54	2026-07-15
3172	APR_DRG	Apr-DRG 3172	2	1	—	—	$30,657.50	$30,657.50	$30,657.50	2026-07-15
3253	APR_DRG	Apr-DRG 3253	3	2	—	—	$24,776.91	$65,602.33	$65,602.33	2026-07-15
3263	APR_DRG	Apr-DRG 3263	1	1	—	—	$15,503.84	$15,503.84	$15,503.84	2026-07-15
327	MS_DRG	Ms-DRG 327	2	1	—	—	$20,410.39	$20,410.39	$20,410.39	2026-07-15
330	MS_DRG	Ms-DRG 330	3	2	—	—	$20,018.56	$63,080.93	$20,018.56	2026-07-15
354	MS_DRG	Ms-DRG 354	1	1	—	—	$45,694.52	$45,694.52	$45,694.52	2026-07-15
3641	APR_DRG	Apr-DRG 3641	2	1	—	—	$15,925.05	$15,925.05	$15,925.05	2026-07-15
36482	CPT	Endoven Ther Chem Adhes 1St	8	5	$15,754.00	$15,281.38	$10,240.10	$15,281.38	$12,941.91	2026-07-15
371	MS_DRG	Ms-DRG 371	3	2	—	—	$14,002.30	$19,753.68	$14,002.30	2026-07-15
372	MS_DRG	Ms-DRG 372	3	2	—	—	$8,695.79	$25,711.71	$8,695.79	2026-07-15
377	MS_DRG	Ms-DRG 377	3	2	—	—	$15,764.95	$24,546.41	$15,764.95	2026-07-15
378	MS_DRG	Ms-DRG 378	3	2	—	—	$8,581.90	$51,544.64	$8,581.90	2026-07-15
38	MS_DRG	Ms-DRG 38	1	1	—	—	$68,085.87	$68,085.87	$68,085.87	2026-07-15
3811	APR_DRG	Apr-DRG 3811	2	1	—	—	$9,664.37	$9,664.37	$9,664.37	2026-07-15
3832	APR_DRG	Apr-DRG 3832	2	1	—	—	$15,764.22	$15,764.22	$15,764.22	2026-07-15
384	MS_DRG	Ms-DRG 384	1	1	—	—	$31,177.76	$31,177.76	$31,177.76	2026-07-15
3851	APR_DRG	Apr-DRG 3851	2	1	—	—	$7,626.72	$7,626.72	$7,626.72	2026-07-15
3852	APR_DRG	Apr-DRG 3852	2	1	—	—	$19,908.07	$19,908.07	$19,908.07	2026-07-15
3853	APR_DRG	Apr-DRG 3853	2	1	—	—	$21,044.93	$21,044.93	$21,044.93	2026-07-15
39	MS_DRG	Ms-DRG 39	3	2	—	—	$9,833.45	$30,311.22	$9,833.45	2026-07-15
392	MS_DRG	Ms-DRG 392	3	2	—	—	$6,799.20	$41,401.94	$6,799.20	2026-07-15
402	MS_DRG	Ms-DRG 402	3	2	—	—	$33,552.92	$144,985.91	$33,552.92	2026-07-15
418	MS_DRG	Ms-DRG 418	2	1	—	—	$14,412.89	$14,412.89	$14,412.89	2026-07-15
4202	APR_DRG	Apr-DRG 4202	2	1	—	—	$12,757.23	$12,757.23	$12,757.23	2026-07-15
4203	APR_DRG	Apr-DRG 4203	2	1	—	—	$21,684.29	$21,684.29	$21,684.29	2026-07-15
421	APR_DRG	Apr-DRG 421	2	1	—	—	$14,765.22	$14,765.22	$14,765.22	2026-07-15
4213	APR_DRG	Apr-DRG 4213	2	1	—	—	$10,910.48	$10,910.48	$10,910.48	2026-07-15
4221	APR_DRG	Apr-DRG 4221	2	1	—	—	$8,437.34	$8,437.34	$8,437.34	2026-07-15
4222	APR_DRG	Apr-DRG 4222	2	1	—	—	$10,223.22	$10,223.22	$10,223.22	2026-07-15
4252	APR_DRG	Apr-DRG 4252	2	1	—	—	$15,982.00	$15,982.00	$15,982.00	2026-07-15
4253	APR_DRG	Apr-DRG 4253	2	1	—	—	$29,132.82	$29,132.82	$29,132.82	2026-07-15
4261	APR_DRG	Apr-DRG 4261	2	1	—	—	$10,394.01	$10,394.01	$10,394.01	2026-07-15
4262	APR_DRG	Apr-DRG 4262	2	1	—	—	$14,077.91	$14,077.91	$14,077.91	2026-07-15
4263	APR_DRG	Apr-DRG 4263	2	1	—	—	$23,610.37	$23,610.37	$23,610.37	2026-07-15
428	MS_DRG	Ms-DRG 428	1	1	—	—	$153,749.51	$153,749.51	$153,749.51	2026-07-15
433	MS_DRG	Ms-DRG 433	1	1	—	—	$30,240.94	$30,240.94	$30,240.94	2026-07-15
439	MS_DRG	Ms-DRG 439	2	1	—	—	$21,433.29	$21,433.29	$21,433.29	2026-07-15
441	MS_DRG	Ms-DRG 441	1	1	—	—	$29,963.11	$29,963.11	$29,963.11	2026-07-15
442	MS_DRG	Ms-DRG 442	2	1	—	—	$8,411.09	$8,411.09	$8,411.09	2026-07-15
445	MS_DRG	Ms-DRG 445	2	1	—	—	$9,228.44	$9,228.44	$9,228.44	2026-07-15
446	MS_DRG	Ms-DRG 446	2	1	—	—	$6,911.70	$6,911.70	$6,911.70	2026-07-15
448	MS_DRG	Ms-DRG 448	3	2	—	—	$35,440.04	$122,988.25	$35,440.04	2026-07-15
451	MS_DRG	Ms-DRG 451	3	2	—	—	$26,791.09	$103,011.75	$26,791.09	2026-07-15
451	APR_DRG	Apr-DRG 451	2	1	—	—	$13,518.47	$13,518.47	$13,518.47	2026-07-15
452	APR_DRG	Apr-DRG 452	2	1	—	—	$17,950.03	$17,950.03	$17,950.03	2026-07-15
4631	APR_DRG	Apr-DRG 4631	2	1	—	—	$10,887.10	$10,887.10	$10,887.10	2026-07-15
4632	APR_DRG	Apr-DRG 4632	2	1	—	—	$12,805.18	$12,805.18	$12,805.18	2026-07-15
4633	APR_DRG	Apr-DRG 4633	2	1	—	—	$21,707.88	$21,707.88	$21,707.88	2026-07-15
464	MS_DRG	Ms-DRG 464	1	1	—	—	$61,599.19	$61,599.19	$61,599.19	2026-07-15
467	MS_DRG	Ms-DRG 467	2	1	—	—	$29,732.16	$29,732.16	$29,732.16	2026-07-15
468	MS_DRG	Ms-DRG 468	3	2	—	—	$22,779.18	$50,984.00	$22,779.18	2026-07-15
4692	APR_DRG	Apr-DRG 4692	2	1	—	—	$15,066.01	$15,066.01	$15,066.01	2026-07-15
4693	APR_DRG	Apr-DRG 4693	2	1	—	—	$114,628.37	$114,628.37	$114,628.37	2026-07-15
470	MS_DRG	Ms-DRG 470	2	1	—	—	$16,382.01	$16,382.01	$16,382.01	2026-07-15
480	MS_DRG	Ms-DRG 480	3	2	—	—	$24,180.10	$58,385.89	$24,180.10	2026-07-15
481	MS_DRG	Ms-DRG 481	3	2	—	—	$18,024.20	$18,388.90	$18,024.20	2026-07-15
481	APR_DRG	Apr-DRG 481	2	1	—	—	$9,404.59	$9,404.59	$9,404.59	2026-07-15
483	MS_DRG	Ms-DRG 483	2	1	—	—	$22,128.03	$22,128.03	$22,128.03	2026-07-15
486	MS_DRG	Ms-DRG 486	1	1	—	—	$64,930.09	$64,930.09	$64,930.09	2026-07-15
5011	APR_DRG	Apr-DRG 5011	2	1	—	—	$14,266.74	$14,266.74	$14,266.74	2026-07-15
5013	APR_DRG	Apr-DRG 5013	2	1	—	—	$26,441.53	$26,441.53	$26,441.53	2026-07-15
502	APR_DRG	Apr-DRG 502	2	1	—	—	$18,082.60	$18,082.60	$18,082.60	2026-07-15
5131	APR_DRG	Apr-DRG 5131	2	1	—	—	$17,482.50	$17,482.50	$17,482.50	2026-07-15
5191	APR_DRG	Apr-DRG 5191	2	1	—	—	$15,800.18	$15,800.18	$15,800.18	2026-07-15
5192	APR_DRG	Apr-DRG 5192	2	1	—	—	$20,269.71	$20,269.71	$20,269.71	2026-07-15
522	MS_DRG	Ms-DRG 522	3	2	—	—	$18,312.09	$64,129.42	$18,312.09	2026-07-15
523	APR_DRG	Apr-DRG 523	2	1	—	—	$29,588.38	$29,588.38	$29,588.38	2026-07-15
536	MS_DRG	Ms-DRG 536	3	2	—	—	$7,064.54	$23,248.53	$7,064.54	2026-07-15
5391	APR_DRG	Apr-DRG 5391	2	1	—	—	$15,376.33	$15,376.33	$15,376.33	2026-07-15
5392	APR_DRG	Apr-DRG 5392	2	1	—	—	$18,929.87	$18,929.87	$18,929.87	2026-07-15
5401	APR_DRG	Apr-DRG 5401	3	2	—	—	$4,912.30	$14,955.03	$14,955.03	2026-07-15
5402	APR_DRG	Apr-DRG 5402	3	2	—	—	$6,283.65	$19,664.86	$19,664.86	2026-07-15
5403	APR_DRG	Apr-DRG 5403	2	1	—	—	$24,815.16	$24,815.16	$24,815.16	2026-07-15
5421	APR_DRG	Apr-DRG 5421	2	1	—	—	$20,302.06	$20,302.06	$20,302.06	2026-07-15
5422	APR_DRG	Apr-DRG 5422	2	1	—	—	$13,016.97	$13,016.97	$13,016.97	2026-07-15
543	MS_DRG	Ms-DRG 543	1	1	—	—	$33,656.72	$33,656.72	$33,656.72	2026-07-15
551	MS_DRG	Ms-DRG 551	1	1	—	—	$51,765.09	$51,765.09	$51,765.09	2026-07-15
552	MS_DRG	Ms-DRG 552	2	1	—	—	$8,390.28	$8,390.28	$8,390.28	2026-07-15
553	APR_DRG	Apr-DRG 553	2	1	—	—	$12,500.00	$12,500.00	$12,500.00	2026-07-15
556	MS_DRG	Ms-DRG 556	2	1	—	—	$7,112.20	$7,112.20	$7,112.20	2026-07-15
5601	APR_DRG	Apr-DRG 5601	3	2	—	—	$2,943.61	$9,926.06	$9,926.06	2026-07-15
5602	APR_DRG	Apr-DRG 5602	2	1	—	—	$11,361.15	$11,361.15	$11,361.15	2026-07-15
5603	APR_DRG	Apr-DRG 5603	3	2	—	—	$4,254.40	$14,679.06	$14,679.06	2026-07-15
5612	APR_DRG	Apr-DRG 5612	3	2	—	—	$3,332.74	$8,795.73	$8,795.73	2026-07-15
563	MS_DRG	Ms-DRG 563	2	1	—	—	$7,783.33	$7,783.33	$7,783.33	2026-07-15
573	MS_DRG	Ms-DRG 573	1	1	—	—	$62,736.70	$62,736.70	$62,736.70	2026-07-15
574	MS_DRG	Ms-DRG 574	2	1	—	—	$30,042.88	$30,042.88	$30,042.88	2026-07-15
5813	APR_DRG	Apr-DRG 5813	2	1	—	—	$6,878.25	$6,878.25	$6,878.25	2026-07-15
592	MS_DRG	Ms-DRG 592	2	1	—	—	$17,553.16	$17,553.16	$17,553.16	2026-07-15
602	MS_DRG	Ms-DRG 602	1	1	—	—	$55,861.56	$55,861.56	$55,861.56	2026-07-15
603	MS_DRG	Ms-DRG 603	2	1	—	—	$7,670.61	$7,670.61	$7,670.61	2026-07-15
617	MS_DRG	Ms-DRG 617	3	2	—	—	$16,781.70	$47,064.29	$16,781.70	2026-07-15
6261	APR_DRG	Apr-DRG 6261	2	1	—	—	$6,971.39	$6,971.39	$6,971.39	2026-07-15
6262	APR_DRG	Apr-DRG 6262	2	1	—	—	$7,638.35	$7,638.35	$7,638.35	2026-07-15
6263	APR_DRG	Apr-DRG 6263	2	1	—	—	$13,597.08	$13,597.08	$13,597.08	2026-07-15
6331	APR_DRG	Apr-DRG 6331	2	1	—	—	$7,354.07	$7,354.07	$7,354.07	2026-07-15
6333	APR_DRG	Apr-DRG 6333	2	1	—	—	$56,028.24	$56,028.24	$56,028.24	2026-07-15
6341	APR_DRG	Apr-DRG 6341	2	1	—	—	$20,010.95	$20,010.95	$20,010.95	2026-07-15
6343	APR_DRG	Apr-DRG 6343	2	1	—	—	$14,932.41	$14,932.41	$14,932.41	2026-07-15
637	MS_DRG	Ms-DRG 637	1	1	—	—	$12,627.04	$12,627.04	$12,627.04	2026-07-15
638	MS_DRG	Ms-DRG 638	1	1	—	—	$8,148.35	$8,148.35	$8,148.35	2026-07-15
6391	APR_DRG	Apr-DRG 6391	2	1	—	—	$7,798.33	$7,798.33	$7,798.33	2026-07-15
6393	APR_DRG	Apr-DRG 6393	2	1	—	—	$8,847.28	$8,847.28	$8,847.28	2026-07-15
64	MS_DRG	Ms-DRG 64	3	2	—	—	$16,959.94	$37,563.14	$16,959.94	2026-07-15
640	MS_DRG	Ms-DRG 640	1	1	—	—	$14,501.30	$14,501.30	$14,501.30	2026-07-15
6402	APR_DRG	Apr-DRG 6402	2	1	—	—	$5,438.61	$5,438.61	$5,438.61	2026-07-15
6403	APR_DRG	Apr-DRG 6403	2	1	—	—	$12,401.90	$12,401.90	$12,401.90	2026-07-15
641	MS_DRG	Ms-DRG 641	2	2	—	—	$17,255.74	$27,822.77	$22,539.26	2026-07-15
65	MS_DRG	Ms-DRG 65	3	2	—	—	$8,850.69	$34,010.14	$8,850.69	2026-07-15
6511	APR_DRG	Apr-DRG 6511	2	1	—	—	$26,160.42	$26,160.42	$26,160.42	2026-07-15
6602	APR_DRG	Apr-DRG 6602	2	1	—	—	$21,114.61	$21,114.61	$21,114.61	2026-07-15
6612	APR_DRG	Apr-DRG 6612	2	1	—	—	$29,216.75	$29,216.75	$29,216.75	2026-07-15
6633	APR_DRG	Apr-DRG 6633	2	1	—	—	$34,500.39	$34,500.39	$34,500.39	2026-07-15
682	MS_DRG	Ms-DRG 682	3	2	—	—	$13,055.95	$45,783.53	$13,055.95	2026-07-15
683	MS_DRG	Ms-DRG 683	1	1	—	—	$14,053.90	$14,053.90	$14,053.90	2026-07-15
689	MS_DRG	Ms-DRG 689	3	2	—	—	$9,706.73	$141,331.70	$9,706.73	2026-07-15
69	MS_DRG	Ms-DRG 69	1	1	—	—	$47,319.27	$47,319.27	$47,319.27	2026-07-15
6914	APR_DRG	Apr-DRG 6914	2	1	—	—	$34,039.34	$34,039.34	$34,039.34	2026-07-15
698	MS_DRG	Ms-DRG 698	3	2	—	—	$14,607.99	$61,228.50	$14,607.99	2026-07-15
708	MS_DRG	Ms-DRG 708	1	1	—	—	$50,674.11	$50,674.11	$50,674.11	2026-07-15
7102	APR_DRG	Apr-DRG 7102	2	1	—	—	$34,565.36	$34,565.36	$34,565.36	2026-07-15
7112	APR_DRG	Apr-DRG 7112	2	1	—	—	$27,655.37	$27,655.37	$27,655.37	2026-07-15
7113	APR_DRG	Apr-DRG 7113	2	1	—	—	$81,006.83	$81,006.83	$81,006.83	2026-07-15
7114	APR_DRG	Apr-DRG 7114	2	1	—	—	$81,006.83	$81,006.83	$81,006.83	2026-07-15
7201	APR_DRG	Apr-DRG 7201	2	1	—	—	$14,501.62	$14,501.62	$14,501.62	2026-07-15
7202	APR_DRG	Apr-DRG 7202	3	2	—	—	$7,839.43	$18,171.81	$18,171.81	2026-07-15
7203	APR_DRG	Apr-DRG 7203	2	1	—	—	$27,632.34	$27,632.34	$27,632.34	2026-07-15
7204	APR_DRG	Apr-DRG 7204	3	2	—	—	$41,100.60	$77,998.10	$41,100.60	2026-07-15
7214	APR_DRG	Apr-DRG 7214	2	1	—	—	$51,296.28	$51,296.28	$51,296.28	2026-07-15
72197	CPT	MRI Pelvis Wwo Dye	11	5	$6,321.00	$6,131.37	$618.17	$6,131.37	$5,562.48	2026-07-15
7222	APR_DRG	Apr-DRG 7222	2	1	—	—	$12,689.30	$12,689.30	$12,689.30	2026-07-15
7233	APR_DRG	Apr-DRG 7233	2	1	—	—	$17,972.01	$17,972.01	$17,972.01	2026-07-15
7241	APR_DRG	Apr-DRG 7241	2	1	—	—	$12,689.30	$12,689.30	$12,689.30	2026-07-15
74174	CPT	CTA Abd&Pelv Wwo Dye	8	5	$8,770.00	$8,506.90	$613.90	$8,506.90	$7,599.20	2026-07-15
74176	CPT	CT Abd & Pelvis Wo Contrast	13	5	$6,472.00	$6,277.84	$95.04	$6,277.84	$5,520.62	2026-07-15
74177	CPT	CT Abd & Pelv W Contrast	13	5	$7,761.00	$7,528.17	$227.52	$7,528.17	$6,620.13	2026-07-15
74178	CPT	CT Abd & Pelv Wwo Contrast	11	5	$8,278.00	$8,029.66	$479.88	$8,029.66	$7,061.13	2026-07-15
742	MS_DRG	Ms-DRG 742	1	1	—	—	$36,215.67	$36,215.67	$36,215.67	2026-07-15
743	MS_DRG	Ms-DRG 743	1	1	—	—	$42,105.79	$42,105.79	$42,105.79	2026-07-15
7593	APR_DRG	Apr-DRG 7593	2	1	—	—	$30,443.44	$30,443.44	$30,443.44	2026-07-15
760	MS_DRG	Ms-DRG 760	1	1	—	—	$22,757.63	$22,757.63	$22,757.63	2026-07-15
7752	APR_DRG	Apr-DRG 7752	3	2	—	—	$1,988.60	$13,480.51	$13,480.51	2026-07-15
7753	APR_DRG	Apr-DRG 7753	2	1	—	—	$11,184.14	$11,184.14	$11,184.14	2026-07-15
786	MS_DRG	Ms-DRG 786	1	1	—	—	$17,133.34	$17,133.34	$17,133.34	2026-07-15
788	MS_DRG	Ms-DRG 788	1	1	—	—	$26,655.25	$26,655.25	$26,655.25	2026-07-15
789	MS_DRG	Ms-DRG 789	1	1	—	—	$14,424.06	$14,424.06	$14,424.06	2026-07-15
7921	APR_DRG	Apr-DRG 7921	2	1	—	—	$25,450.52	$25,450.52	$25,450.52	2026-07-15
7922	APR_DRG	Apr-DRG 7922	2	1	—	—	$36,395.57	$36,395.57	$36,395.57	2026-07-15
793	MS_DRG	Ms-DRG 793	1	1	—	—	$7,554.05	$7,554.05	$7,554.05	2026-07-15
794	MS_DRG	Ms-DRG 794	3	2	—	—	$6,519.11	$9,452.05	$6,519.11	2026-07-15
795	MS_DRG	Ms-DRG 795	2	2	—	—	$6,989.33	$7,149.33	$7,069.33	2026-07-15
806	MS_DRG	Ms-DRG 806	1	1	—	—	$20,325.27	$20,325.27	$20,325.27	2026-07-15
807	MS_DRG	Ms-DRG 807	6	5	—	—	$12,417.73	$15,865.68	$13,164.43	2026-07-15
8102	APR_DRG	Apr-DRG 8102	2	1	—	—	$14,463.15	$14,463.15	$14,463.15	2026-07-15
8111	APR_DRG	Apr-DRG 8111	2	1	—	—	$11,550.44	$11,550.44	$11,550.44	2026-07-15
812	MS_DRG	Ms-DRG 812	2	1	—	—	$8,035.63	$8,035.63	$8,035.63	2026-07-15
8123	APR_DRG	Apr-DRG 8123	2	1	—	—	$17,048.93	$17,048.93	$17,048.93	2026-07-15
813	MS_DRG	Ms-DRG 813	3	2	—	—	$13,422.13	$13,455.65	$13,422.13	2026-07-15
8134	APR_DRG	Apr-DRG 8134	2	1	—	—	$21,996.49	$21,996.49	$21,996.49	2026-07-15
8174	APR_DRG	Apr-DRG 8174	2	1	—	—	$43,704.25	$43,704.25	$43,704.25	2026-07-15
820	MS_DRG	Ms-DRG 820	2	1	—	—	$50,516.54	$50,516.54	$50,516.54	2026-07-15
846	MS_DRG	Ms-DRG 846	2	1	—	—	$22,176.58	$22,176.58	$22,176.58	2026-07-15
853	MS_DRG	Ms-DRG 853	3	2	—	—	$41,172.24	$65,658.51	$41,172.24	2026-07-15
857	MS_DRG	Ms-DRG 857	2	1	—	—	$22,068.37	$22,068.37	$22,068.37	2026-07-15
8612	APR_DRG	Apr-DRG 8612	2	1	—	—	$15,011.87	$15,011.87	$15,011.87	2026-07-15
8613	APR_DRG	Apr-DRG 8613	1	1	—	—	$7,528.15	$7,528.15	$7,528.15	2026-07-15
865	MS_DRG	Ms-DRG 865	2	1	—	—	$12,830.52	$12,830.52	$12,830.52	2026-07-15
866	MS_DRG	Ms-DRG 866	2	1	—	—	$7,671.78	$7,671.78	$7,671.78	2026-07-15
867	MS_DRG	Ms-DRG 867	1	1	—	—	$70,595.63	$70,595.63	$70,595.63	2026-07-15
871	MS_DRG	Ms-DRG 871	4	3	—	—	$17,045.29	$29,632.70	$17,045.73	2026-07-15
872	MS_DRG	Ms-DRG 872	3	2	—	—	$8,972.94	$30,444.34	$8,972.94	2026-07-15
896	MS_DRG	Ms-DRG 896	1	1	—	—	$51,253.74	$51,253.74	$51,253.74	2026-07-15
897	MS_DRG	Ms-DRG 897	1	1	—	—	$27,545.03	$27,545.03	$27,545.03	2026-07-15
91	MS_DRG	Ms-DRG 91	2	1	—	—	$14,674.64	$14,674.64	$14,674.64	2026-07-15
9123	APR_DRG	Apr-DRG 9123	2	1	—	—	$57,797.15	$57,797.15	$57,797.15	2026-07-15
914	MS_DRG	Ms-DRG 914	1	1	—	—	$37,615.05	$37,615.05	$37,615.05	2026-07-15
918	MS_DRG	Ms-DRG 918	1	1	—	—	$11,591.93	$11,591.93	$11,591.93	2026-07-15
948	MS_DRG	Ms-DRG 948	1	1	—	—	$6,922.34	$6,922.34	$6,922.34	2026-07-15
95810	CPT	Polysomnogram	13	5	$6,524.00	$6,328.28	$2,507.27	$6,328.28	$5,564.97	2026-07-15
95811	CPT	Polysomnogram W CPap	11	5	$7,497.00	$7,272.09	$2,507.27	$7,272.09	$6,394.94	2026-07-15
J0717	HCPCS	Certolizumab Pegol 400 Mg Kit	8	5	$25,886.00	$25,109.77	$3.42	$25,109.77	$21,032.67	2026-07-15
J0897	HCPCS	Denosumab 60 Mg/ml Syringe	20	5	$7,432.00	$7,209.62	$9.69	$13,322.09	$6,038.99	2026-07-15
J1569	HCPCS	Immune Glob Gamagar 30gr/300ml	8	5	$14,132.00	$13,708.84	$21.77	$13,708.84	$11,482.92	2026-07-15
J1602	HCPCS	Golimumab 50 Mg/4 Ml Vial	8	5	$8,593.00	$8,335.92	$43.11	$8,335.92	$6,982.40	2026-07-15
J2350	HCPCS	Ocrelizumab 300 Mg/10 Ml	10	5	$88,789.00	$86,126.02	$6.09	$86,126.02	$72,141.64	2026-07-15
J2353	HCPCS	Octreotide (Depot) 30 Mg Syr	8	5	$27,842.00	$27,006.83	$17.33	$27,006.83	$22,621.69	2026-07-15
J3101	HCPCS	Tenecteplase 50 Mg/10 Ml Syrng	10	5	$31,584.00	$30,637.29	$0.41	$30,637.29	$25,662.68	2026-07-15
J3380	HCPCS	Vedolizumab 300 Mg Vial	12	5	$39,149.00	$37,975.12	$72.63	$37,975.12	$33,394.62	2026-07-15
J9173	HCPCS	Durvalumab 500 Mg/10 Ml Vial	8	5	$18,222.00	$17,675.82	$16.91	$17,675.82	$14,805.77	2026-07-15
J9271	HCPCS	Pembrolizumab 100 Mg/4 Ml Vial	8	5	$26,038.00	$25,257.65	$13.37	$25,257.65	$21,156.53	2026-07-15
J9306	HCPCS	Pertuzumab 420 Mg/14 Ml Vial	8	5	$29,670.00	$28,780.39	$508.34	$28,780.39	$24,107.29	2026-07-15
J9317	HCPCS	Sacituzumab Gov-hziy 180Mg	8	5	$10,917.00	$10,589.85	$4,156.37	$10,589.85	$8,870.36	2026-07-15
Q5108	HCPCS	Pegfilgrastim-jmdb 6 Mg/0.6 Ml	10	5	$8,047.00	$7,806.07	$1,626.36	$7,806.08	$6,538.60	2026-07-15
Q5111	HCPCS	Pegfilgrastim-cbqv 6 Mg/0.6 Ml	8	5	$8,925.00	$8,657.25	$1,112.40	$8,657.25	$7,251.57	2026-07-15
Q5112	HCPCS	Trastuzumab-dttb 420 Mg Vial	8	5	$7,913.00	$7,675.65	$3,051.38	$7,675.65	$6,429.34	2026-07-15
Q5116	HCPCS	Trastuzumab Qyyp 420Mg Vial	8	5	$8,101.00	$7,858.11	$2,896.88	$7,858.11	$6,582.18	2026-07-15
Q5119	HCPCS	Rituximab-pvvr 500Mg/50Ml Vial	10	5	$10,504.00	$10,189.19	$1,112.40	$10,189.19	$8,534.76	2026-07-15
Q5122	HCPCS	Pegfilgrastim 6 Mg/0.6 Ml Syr	10	5	$7,555.00	$7,328.37	$786.12	$7,328.37	$6,138.45	2026-07-15

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