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

GREATER BALTIMORE MEDICAL CENTER

Baltimore, MD · CCN 210044 · Rates published

9,808 distinct procedures filed
34 distinct payers
67,946 rate rows
2026-01-01 last MRF observed
Data quality

15,561 of 67,946 rate rows are consumer-grade (22.9%)

52,385 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
professional (physician) fee — not the facility price 52,334
placeholder amount (≤ $0.02) — excluded from medians 47
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 4
Data source & audit trail ↓ Download audit trail (JSON)
Source MRF file https://www.gbmc.org/sites/default/files/documents/52-6049658_gbmc_standardcharges.csv
Found on page https://www.gbmc.org/billing-estimates/billing-and-financial-support/hospital-and-physician-charges
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-05-15
Content fingerprint 500c3c326314d00e… · 35,912,582 bytes · first seen 2026-05-08

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
57894-061-03
NDC 		Ustekinumab 90 Mg/ml Subcutaneous Syringe 1 $85,002.19 $85,002.19 $85,002.19 nat. median
$85,002
1.0× median
0310-4535-30
NDC 		Tremelimumab-actl 20 Mg/ml Intravenous Solution 1 $78,000.00 $78,000.00 $78,000.00 nat. median
$78,000
1.0× median
25682-028-01
NDC 		Ravulizumab-cwvz 100 Mg/ml Intravenous Solution 1 $70,586.34 $70,586.34 $70,586.34 nat. median
$70,586
1.0× median
0003-2328-22
NDC 		Ipilimumab 200 Mg/40 Ml (5 Mg/ml) Intravenous Solution 1 $63,061.44 $63,061.44 $63,061.44 nat. median
$63,061
1.0× median
63323-105-10
NDC 		Acyclovir Sodium 500 Mg Intravenous Solution 1 $55,837.61 $55,837.61 $55,837.61 nat. median
$55,838
1.0× median
50242-150-01
NDC 		Ocrelizumab 30 Mg/ml Intravenous Solution 1 $53,498.24 $53,498.24 $53,498.24 nat. median
$13,436
outlier · 4.0×
57894-060-03
NDC 		Ustekinumab 45 Mg/0.5 Ml Subcutaneous Syringe 1 $42,501.13 $42,501.13 $42,501.13 nat. median
$119,313
outlier · 0.4×
57894-060-02
NDC 		Ustekinumab 45 Mg/0.5 Ml Subcutaneous Solution 1 $38,802.02 $38,802.02 $38,802.02 nat. median
$38,802
1.0× median
0781-9261-85
NDC 		Ampicillin 1 Gram Solution For Injection 1 $36,673.96 $36,673.96 $36,673.96 nat. median
$36,674
1.0× median
57894-650-01
NDC 		Guselkumab 200 Mg/20 Ml (10 Mg/ml) Intravenous Solution 1 $36,093.79 $36,093.79 $36,093.79 nat. median
$36,094
1.0× median
55292-702-55
NDC 		Hemin 350 Mg/50 Ml Reconstituted IV Soln 1 $34,319.83 $34,319.83 $34,319.83 nat. median
$34,320
1.0× median
59572-775-01
NDC 		Luspatercept-aamt 75 Mg Subcutaneous Solution 1 $32,450.72 $32,450.72 $32,450.72 nat. median
$32,451
1.0× median
0169-7205-01
NDC 		Coagulation Factor Viia Recomb 5 Mg (5,000 Mcg) Intravenous Solution 1 $31,963.46 $31,963.46 $31,963.46 nat. median
$31,963
1.0× median
50242-105-01
NDC 		Polatuzumab Vedotin-piiq 140 Mg Intravenous Solution 1 $31,200.00 $31,200.00 $31,200.00 nat. median
$31,200
1.0× median
0074-5015-01
NDC 		Risankizumab-rzaa 60 Mg/ml Intravenous Solution 1 $31,001.70 $31,001.70 $31,001.70 nat. median
$6,431
outlier · 4.8×
55513-077-01
NDC 		Tarlatamab-dlle 10 Mg/4.2 Ml Reconstituted IV Soln 1 $29,100.00 $29,100.00 $29,100.00 nat. median
$29,100
1.0× median
15054-1120-4
NDC 		Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe 1 $28,743.97 $28,743.97 $28,743.97 nat. median
$28,744
1.0× median
0074-1055-01
NDC 		Telisotuzumab Vedotin-tllv 100 Mg/5 Ml Reconstituted IV Soln 1 $27,960.00 $27,960.00 $27,960.00 nat. median
$27,960
1.0× median
0003-7125-11
NDC 		Nivolumab 240 Mg-relatlimab-rmbw 80 Mg/20 Ml Intravenous Solution 1 $26,977.72 $26,977.72 $26,977.72 nat. median
$26,978
1.0× median
64406-008-01
NDC 		Natalizumab 300 Mg/15 Ml Intravenous Solution 1 $26,691.49 $26,691.49 $26,691.49 nat. median
$3,693
outlier · 7.2×
9999-9903-05
NDC 		Alteplase 100 Mg Ivpb (from Vial) 1 $25,660.95 $25,660.95 $25,660.95 nat. median
$25,661
1.0× median
50242-245-01
NDC 		Pertuzumab 1,200 Mg-trastuzumab 600 Mg-hyaluron-zzxf/15 Ml Subcut Soln 1 $25,413.99 $25,413.99 $25,413.99 nat. median
$25,414
1.0× median
50242-009-01
NDC 		Tenecteplase 25 Mg Intravenous Solution 1 $24,193.81 $24,193.81 $24,193.81 nat. median
$24,194
1.0× median
50242-120-47
NDC 		Tenecteplase 50 Mg Intravenous Solution 1 $24,193.81 $24,193.81 $24,193.81 nat. median
$24,194
1.0× median
50242-037-06
NDC 		Tenecteplase 50 Mg Intravenous Solution 1 $24,193.81 $24,193.81 $24,193.81 nat. median
$24,194
1.0× median
59627-333-04
NDC 		Interferon Beta-1a 30 Mcg/0.5 Ml Intramuscular Pen Kit 1 $24,114.39 $24,114.39 $24,114.39 nat. median
$24,114
1.0× median
50242-078-55
NDC 		Ranibizumab 10 Mg/0.1 Ml Intravitreal Implant Soln,initial Fill Needle 1 $24,048.50 $24,048.50 $24,048.50 nat. median
$24,048
1.0× median
A9604
CPT 		Hc Samarium Sm 153 Lexidronam 1 $23,465.38 $23,465.38 $23,465.38 nat. median
$11,409
outlier · 2.1×
9999-9903-84
NDC 		Vedolizumab 300 Mg/250 Ml Viaflex Ivpb (batched) 1 $23,186.51 $23,186.51 $23,186.51 nat. median
$23,187
1.0× median
64764-300-20
NDC 		Vedolizumab 300 Mg Intravenous Solution 1 $23,186.45 $23,186.45 $23,186.45 nat. median
$23,186
1.0× median
0173-0898-03
NDC 		Dostarlimab-gxly 50 Mg/ml Intravenous Solution 1 $22,219.00 $22,219.00 $22,219.00 nat. median
$22,219
1.0× median
0024-5824-11
NDC 		Cabazitaxel 10 Mg/ml (first Dilution) Intravenous Solution 1 $22,099.34 $22,099.34 $22,099.34 nat. median
$22,099
1.0× median
9999-9904-53
NDC 		Pembrolizumab 200 Mg Ivpb In Ns (batched) 1 $20,693.66 $20,693.66 $20,693.66 nat. median
$20,694
1.0× median
C2616
HCPCS 		Hc Yttrium- 90 Microspheres 1 $20,625.00 $20,625.00 $20,625.00 nat. median
$28,140
0.7× median
25682-001-01
NDC 		Eculizumab 300 Mg/30 Ml Intravenous Solution 1 $19,902.69 $19,902.69 $19,902.69 nat. median
$7,652
outlier · 2.6×
50242-917-01
NDC 		Atezolizumab 1,200 Mg/20 Ml (60 Mg/ml) Intravenous Solution 1 $19,697.28 $19,697.28 $19,697.28 nat. median
$19,697
1.0× median
0002-7678-01
NDC 		Ramucirumab 10 Mg/ml Intravenous Solution 1 $19,691.81 $19,691.81 $19,691.81 nat. median
$19,692
1.0× median
51144-050-01
NDC 		Brentuximab Vedotin 50 Mg Intravenous Solution 1 $19,400.00 $19,400.00 $19,400.00 nat. median
$19,400
1.0× median
25682-025-01
NDC 		Ravulizumab-cwvz 100 Mg/ml Intravenous Solution 1 $19,250.83 $19,250.83 $19,250.83 nat. median
$15,012
1.3× median
0078-0825-81
NDC 		Octreotide,microspheres ER 30 Mg Intramuscular Susp, Extended Release 1 $19,105.00 $19,105.00 $19,105.00 nat. median
$29,198
0.7× median
57894-450-01
NDC 		Teclistamab-cqyv 90 Mg/ml Subcutaneous Solution 1 $18,925.52 $18,925.52 $18,925.52 nat. median
$18,926
1.0× median
61755-008-01
NDC 		Cemiplimab-rwlc 50 Mg/ml Intravenous Solution 1 $18,842.46 $18,842.46 $18,842.46 nat. median
$18,842
1.0× median
73475-3041-5
NDC 		Efgartigimod Alfa-fcab 20 Mg/ml Intravenous Solution 1 $18,288.52 $18,288.52 $18,288.52 nat. median
$18,289
1.0× median
50242-260-01
NDC 		Pertuzumab 600 Mg-trastuzumab 600 Mg-hyaluronid-zzxf/10 Ml Subcut Soln 1 $16,942.00 $16,942.00 $16,942.00 nat. median
$16,942
1.0× median
9999-9903-83
NDC 		Pertuzumab 600 Mg-trastuzumab 600 Mg-hyaluronid-zzxf 20,000 Unit/10 Ml Syringe (… 1 $16,942.00 $16,942.00 $16,942.00 nat. median
$16,942
1.0× median
13533-800-40
NDC 		Gamunex-c 1 Gm/10 Ml Ij Soln - Pediatric (wrapped) 1 $16,897.68 $16,897.68 $16,897.68 nat. median
$16,898
1.0× median
13533-800-41
NDC 		Gamunex-c 1 Gm/10 Ml Ij Soln - Pediatric (wrapped) 1 $16,897.68 $16,897.68 $16,897.68 nat. median
$16,898
1.0× median
0480-9262-08
NDC 		Octreotide,microspheres ER 30 Mg Intramuscular Susp, Extended Release 1 $16,673.46 $16,673.46 $16,673.46 nat. median
$16,673
1.0× median
63323-389-10
NDC 		Ampicillin 1 Gram Solution For Injection 1 $15,926.12 $15,926.12 $15,926.12 nat. median
$15,926
1.0× median
57894-503-01
NDC 		Daratumumab 1,800 Mg-hyaluronidase-fihj 30,000 Unit/15 Ml Subcut Soln 1 $15,795.72 $15,795.72 $15,795.72 nat. median
$15,796
1.0× median

Other procedures at this hospital

Browse this hospital's 9,808 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
             
57894-061-03 NDC Ustekinumab 90 Mg/ml Subcutaneous Syringe 1 1 $85,002.19 $83,302.15 $85,002.19 $85,002.19 $85,002.19 2026-01-01
0310-4535-30 NDC Tremelimumab-actl 20 Mg/ml Intravenous Solution 1 1 $78,000.00 $76,440.00 $78,000.00 $78,000.00 $78,000.00 2026-01-01
25682-028-01 NDC Ravulizumab-cwvz 100 Mg/ml Intravenous Solution 1 1 $70,586.34 $69,174.61 $70,586.34 $70,586.34 $70,586.34 2026-01-01
0003-2328-22 NDC Ipilimumab 200 Mg/40 Ml (5 Mg/ml) Intravenous Solution 1 1 $63,061.44 $61,800.21 $63,061.44 $63,061.44 $63,061.44 2026-01-01
63323-105-10 NDC Acyclovir Sodium 500 Mg Intravenous Solution 1 1 $55,837.61 $54,720.86 $55,837.61 $55,837.61 $55,837.61 2026-01-01
50242-150-01 NDC Ocrelizumab 30 Mg/ml Intravenous Solution 1 1 $53,498.24 $52,428.27 $53,498.24 $53,498.24 $53,498.24 2026-01-01
57894-060-03 NDC Ustekinumab 45 Mg/0.5 Ml Subcutaneous Syringe 1 1 $42,501.13 $41,651.10 $42,501.13 $42,501.13 $42,501.13 2026-01-01
57894-060-02 NDC Ustekinumab 45 Mg/0.5 Ml Subcutaneous Solution 1 1 $38,802.02 $38,025.98 $38,802.02 $38,802.02 $38,802.02 2026-01-01
0781-9261-85 NDC Ampicillin 1 Gram Solution For Injection 1 1 $36,673.96 $35,940.49 $36,673.96 $36,673.96 $36,673.96 2026-01-01
57894-650-01 NDC Guselkumab 200 Mg/20 Ml (10 Mg/ml) Intravenous Solution 1 1 $36,093.79 $35,371.92 $36,093.79 $36,093.79 $36,093.79 2026-01-01
55292-702-55 NDC Hemin 350 Mg/50 Ml Reconstituted IV Soln 1 1 $34,319.83 $33,633.43 $34,319.83 $34,319.83 $34,319.83 2026-01-01
59572-775-01 NDC Luspatercept-aamt 75 Mg Subcutaneous Solution 1 1 $32,450.72 $31,801.70 $32,450.72 $32,450.72 $32,450.72 2026-01-01
0169-7205-01 NDC Coagulation Factor Viia Recomb 5 Mg (5,000 Mcg) Intravenous Solution 1 1 $31,963.46 $31,324.20 $31,963.46 $31,963.46 $31,963.46 2026-01-01
50242-105-01 NDC Polatuzumab Vedotin-piiq 140 Mg Intravenous Solution 1 1 $31,200.00 $30,576.00 $31,200.00 $31,200.00 $31,200.00 2026-01-01
0074-5015-01 NDC Risankizumab-rzaa 60 Mg/ml Intravenous Solution 1 1 $31,001.70 $30,381.67 $31,001.70 $31,001.70 $31,001.70 2026-01-01
55513-077-01 NDC Tarlatamab-dlle 10 Mg/4.2 Ml Reconstituted IV Soln 1 1 $29,100.00 $28,518.00 $29,100.00 $29,100.00 $29,100.00 2026-01-01
15054-1120-4 NDC Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe 1 1 $28,743.97 $28,169.09 $28,743.97 $28,743.97 $28,743.97 2026-01-01
0074-1055-01 NDC Telisotuzumab Vedotin-tllv 100 Mg/5 Ml Reconstituted IV Soln 1 1 $27,960.00 $27,400.80 $27,960.00 $27,960.00 $27,960.00 2026-01-01
0003-7125-11 NDC Nivolumab 240 Mg-relatlimab-rmbw 80 Mg/20 Ml Intravenous Solution 1 1 $26,977.72 $26,438.17 $26,977.72 $26,977.72 $26,977.72 2026-01-01
64406-008-01 NDC Natalizumab 300 Mg/15 Ml Intravenous Solution 1 1 $26,691.49 $26,157.66 $26,691.49 $26,691.49 $26,691.49 2026-01-01
9999-9903-05 NDC Alteplase 100 Mg Ivpb (from Vial) 1 1 $25,660.95 $25,147.73 $25,660.95 $25,660.95 $25,660.95 2026-01-01
50242-245-01 NDC Pertuzumab 1,200 Mg-trastuzumab 600 Mg-hyaluron-zzxf/15 Ml Subcut Soln 1 1 $25,413.99 $24,905.71 $25,413.99 $25,413.99 $25,413.99 2026-01-01
50242-037-06 NDC Tenecteplase 50 Mg Intravenous Solution 1 1 $24,193.81 $23,709.94 $24,193.81 $24,193.81 $24,193.81 2026-01-01
50242-120-47 NDC Tenecteplase 50 Mg Intravenous Solution 1 1 $24,193.81 $23,709.94 $24,193.81 $24,193.81 $24,193.81 2026-01-01
50242-009-01 NDC Tenecteplase 25 Mg Intravenous Solution 1 1 $24,193.81 $23,709.94 $24,193.81 $24,193.81 $24,193.81 2026-01-01
59627-333-04 NDC Interferon Beta-1a 30 Mcg/0.5 Ml Intramuscular Pen Kit 1 1 $24,114.39 $23,632.11 $24,114.39 $24,114.39 $24,114.39 2026-01-01
50242-078-55 NDC Ranibizumab 10 Mg/0.1 Ml Intravitreal Implant Soln,initial Fill Needle 1 1 $24,048.50 $23,567.53 $24,048.50 $24,048.50 $24,048.50 2026-01-01
A9604 CPT Hc Samarium Sm 153 Lexidronam 1 1 $23,465.38 $22,996.07 $23,465.38 $23,465.38 $23,465.38 2026-01-01
9999-9903-84 NDC Vedolizumab 300 Mg/250 Ml Viaflex Ivpb (batched) 1 1 $23,186.51 $22,722.78 $23,186.51 $23,186.51 $23,186.51 2026-01-01
64764-300-20 NDC Vedolizumab 300 Mg Intravenous Solution 1 1 $23,186.45 $22,722.72 $23,186.45 $23,186.45 $23,186.45 2026-01-01
0173-0898-03 NDC Dostarlimab-gxly 50 Mg/ml Intravenous Solution 1 1 $22,219.00 $21,774.62 $22,219.00 $22,219.00 $22,219.00 2026-01-01
0024-5824-11 NDC Cabazitaxel 10 Mg/ml (first Dilution) Intravenous Solution 1 1 $22,099.34 $21,657.36 $22,099.34 $22,099.34 $22,099.34 2026-01-01
9999-9904-53 NDC Pembrolizumab 200 Mg Ivpb In Ns (batched) 1 1 $20,693.66 $20,279.79 $20,693.66 $20,693.66 $20,693.66 2026-01-01
C2616 HCPCS Hc Yttrium- 90 Microspheres 1 1 $20,625.00 $20,212.50 $20,625.00 $20,625.00 $20,625.00 2026-01-01
25682-001-01 NDC Eculizumab 300 Mg/30 Ml Intravenous Solution 1 1 $19,902.69 $19,504.64 $19,902.69 $19,902.69 $19,902.69 2026-01-01
50242-917-01 NDC Atezolizumab 1,200 Mg/20 Ml (60 Mg/ml) Intravenous Solution 1 1 $19,697.28 $19,303.33 $19,697.28 $19,697.28 $19,697.28 2026-01-01
0002-7678-01 NDC Ramucirumab 10 Mg/ml Intravenous Solution 1 1 $19,691.81 $19,297.98 $19,691.81 $19,691.81 $19,691.81 2026-01-01
51144-050-01 NDC Brentuximab Vedotin 50 Mg Intravenous Solution 1 1 $19,400.00 $19,012.00 $19,400.00 $19,400.00 $19,400.00 2026-01-01
25682-025-01 NDC Ravulizumab-cwvz 100 Mg/ml Intravenous Solution 1 1 $19,250.83 $18,865.81 $19,250.83 $19,250.83 $19,250.83 2026-01-01
0078-0825-81 NDC Octreotide,microspheres ER 30 Mg Intramuscular Susp, Extended Release 1 1 $19,105.00 $18,722.90 $19,105.00 $19,105.00 $19,105.00 2026-01-01
57894-450-01 NDC Teclistamab-cqyv 90 Mg/ml Subcutaneous Solution 1 1 $18,925.52 $18,547.01 $18,925.52 $18,925.52 $18,925.52 2026-01-01
61755-008-01 NDC Cemiplimab-rwlc 50 Mg/ml Intravenous Solution 1 1 $18,842.46 $18,465.61 $18,842.46 $18,842.46 $18,842.46 2026-01-01
73475-3041-5 NDC Efgartigimod Alfa-fcab 20 Mg/ml Intravenous Solution 1 1 $18,288.52 $17,922.75 $18,288.52 $18,288.52 $18,288.52 2026-01-01
9999-9903-83 NDC Pertuzumab 600 Mg-trastuzumab 600 Mg-hyaluronid-zzxf 20,000 Unit/10 Ml Syringe (… 1 1 $16,942.00 $16,603.16 $16,942.00 $16,942.00 $16,942.00 2026-01-01
50242-260-01 NDC Pertuzumab 600 Mg-trastuzumab 600 Mg-hyaluronid-zzxf/10 Ml Subcut Soln 1 1 $16,942.00 $16,603.16 $16,942.00 $16,942.00 $16,942.00 2026-01-01
13533-800-41 NDC Gamunex-c 1 Gm/10 Ml Ij Soln - Pediatric (wrapped) 1 1 $16,897.68 $16,559.73 $16,897.68 $16,897.68 $16,897.68 2026-01-01
13533-800-40 NDC Gamunex-c 1 Gm/10 Ml Ij Soln - Pediatric (wrapped) 1 1 $16,897.68 $16,559.73 $16,897.68 $16,897.68 $16,897.68 2026-01-01
0480-9262-08 NDC Octreotide,microspheres ER 30 Mg Intramuscular Susp, Extended Release 1 1 $16,673.46 $16,339.99 $16,673.46 $16,673.46 $16,673.46 2026-01-01
63323-389-10 NDC Ampicillin 1 Gram Solution For Injection 1 1 $15,926.12 $15,607.60 $15,926.12 $15,926.12 $15,926.12 2026-01-01
57894-503-01 NDC Daratumumab 1,800 Mg-hyaluronidase-fihj 30,000 Unit/15 Ml Subcut Soln 1 1 $15,795.72 $15,479.81 $15,795.72 $15,795.72 $15,795.72 2026-01-01
9999-9903-77 NDC Daratumumab 1,800 Mg-hyaluronidase-fihj 30,000 Unit/15 Ml Syringe (batched) 1 1 $15,795.72 $15,479.81 $15,795.72 $15,795.72 $15,795.72 2026-01-01
0003-2327-11 NDC Ipilimumab 50 Mg/10 Ml (5 Mg/ml) Intravenous Solution 1 1 $15,765.40 $15,450.09 $15,765.40 $15,765.40 $15,765.40 2026-01-01
70504-3000-2 NDC Rho(d) Immune Globulin-maltose 15,000 Unit (3,000 Mcg)/13 Ml Inj. Soln 1 1 $15,565.95 $15,254.63 $15,565.95 $15,565.95 $15,565.95 2026-01-01
70504-3000-1 NDC Rho(d) Immune Globulin-maltose 15,000 Unit (3,000 Mcg)/13 Ml Inj. Soln 1 1 $15,565.95 $15,254.63 $15,565.95 $15,565.95 $15,565.95 2026-01-01
50242-070-01 NDC Obinutuzumab 1,000 Mg/40 Ml Intravenous Solution 1 1 $14,245.44 $13,960.53 $14,245.44 $14,245.44 $14,245.44 2026-01-01
0310-1730-30 NDC Benralizumab 30 Mg/ml Subcutaneous Syringe 1 1 $14,074.45 $13,792.96 $14,074.45 $14,074.45 $14,074.45 2026-01-01
68727-712-01 NDC Lurbinectedin 4 Mg Intravenous Solution 1 1 $14,070.00 $13,788.60 $14,070.00 $14,070.00 $14,070.00 2026-01-01
55513-956-01 NDC Panitumumab 400 Mg/20 Ml (20 Mg/ml) Intravenous Solution 1 1 $14,057.00 $13,775.86 $14,057.00 $14,057.00 $14,057.00 2026-01-01
50633-120-11 NDC Digoxin Immune Fab 40 Mg Intravenous Solution 1 1 $13,886.06 $13,608.33 $13,886.06 $13,886.06 $13,886.06 2026-01-01
0003-3734-13 NDC Nivolumab 240 Mg/24 Ml Intravenous Solution 1 1 $13,829.86 $13,553.26 $13,829.86 $13,829.86 $13,829.86 2026-01-01
50242-918-01 NDC Atezolizumab 840 Mg/14 Ml (60 Mg/ml) Intravenous Solution 1 1 $13,788.10 $13,512.33 $13,788.10 $13,788.10 $13,788.10 2026-01-01
73536-500-01 NDC Ropeginterferon Alfa-2b-njft 500 Mcg/ml Subcutaneous Syringe 1 1 $13,556.72 $13,285.59 $13,556.72 $13,556.72 $13,556.72 2026-01-01
55513-190-01 NDC Pegfilgrastim 6 Mg/0.6 Ml Subcutaneous Syringe 1 1 $13,515.11 $13,244.81 $13,515.11 $13,515.11 $13,515.11 2026-01-01
55513-192-01 NDC Pegfilgrastim 6 Mg/0.6 Ml (deliverable) Wearable Subcutaneous Injector 1 1 $13,515.11 $13,244.81 $13,515.11 $13,515.11 $13,515.11 2026-01-01
27000543 LOCAL Hc Defib Quadripolar 1 1 $13,161.81 $12,898.57 $13,161.81 $13,161.81 $13,161.81 2026-01-01
27000551 LOCAL Hc Defib Lead Quattro Secure 1 1 $13,161.81 $12,898.57 $13,161.81 $13,161.81 $13,161.81 2026-01-01
55513-222-01 NDC Romiplostim 500 Mcg Subcutaneous Solution 1 1 $13,144.16 $12,881.28 $13,144.16 $13,144.16 $13,144.16 2026-01-01
50242-044-13 NDC Alteplase 25 Mg IV Syringe (over 8 Hours) 1 1 $12,830.39 $12,573.78 $12,830.39 $12,830.39 $12,830.39 2026-01-01
50242-044-06 NDC Alteplase 25 Mg IV Syringe (over 8 Hours) 1 1 $12,830.39 $12,573.78 $12,830.39 $12,830.39 $12,830.39 2026-01-01
0078-0818-81 NDC Octreotide,microspheres ER 20 Mg Intramuscular Susp, Extended Release 1 1 $12,758.60 $12,503.43 $12,758.60 $12,758.60 $12,758.60 2026-01-01
44206-439-93 NDC Immune Glob,gamm(igg) 10 %-pro-iga 0 To 50 Mcg/ml Intravenous Solution 1 1 $12,668.75 $12,415.38 $12,668.75 $12,668.75 $12,668.75 2026-01-01
44206-439-40 NDC Immune Glob,gamm(igg) 10 %-pro-iga 0 To 50 Mcg/ml Intravenous Solution 1 1 $12,668.75 $12,415.38 $12,668.75 $12,668.75 $12,668.75 2026-01-01
72039028 LOCAL Hc C-sect Emergent With Major Surgery 1 1 $12,577.06 $12,325.52 $12,577.06 $12,577.06 $12,577.06 2026-01-01
48818-001-01 NDC Pralatrexate 20 Mg/ml (1 Ml) Intravenous Solution 1 1 $12,482.74 $12,233.09 $12,482.74 $12,482.74 $12,482.74 2026-01-01
72903-853-01 NDC Mirvetuximab Soravtansine-gynx 5 Mg/ml Intravenous Solution 1 1 $12,440.00 $12,191.20 $12,440.00 $12,440.00 $12,440.00 2026-01-01
51144-003-01 NDC Tisotumab Vedotin-tftv 40 Mg Intravenous Solution 1 1 $12,228.00 $11,983.44 $12,228.00 $12,228.00 $12,228.00 2026-01-01
25021-136-10 NDC Ampicillin 1 Gram Solution For Injection 1 1 $12,024.25 $11,783.77 $12,024.25 $12,024.25 $12,024.25 2026-01-01
50242-109-01 NDC Rituximab 1,600 Mg/13.4 Ml (120 Mg/ml)-hyaluronidase Subcutaneous Soln 1 1 $11,997.29 $11,757.34 $11,997.29 $11,997.29 $11,997.29 2026-01-01
27000569 LOCAL Hc Pacemaker Riata Model 7071/65 1 1 $11,641.79 $11,408.95 $11,641.79 $11,641.79 $11,641.79 2026-01-01
27000629 LOCAL Hc Pacemaker Adapt Dr Addrs1 1 1 $11,568.56 $11,337.19 $11,568.56 $11,568.56 $11,568.56 2026-01-01
50242-145-01 NDC Pertuzumab 420 Mg/14 Ml (30 Mg/ml) Intravenous Solution 1 1 $11,558.01 $11,326.85 $11,558.01 $11,558.01 $11,558.01 2026-01-01
27000575 LOCAL Hc Pacemaker Accent Rf Dr Pm 2210 1 1 $11,531.95 $11,301.31 $11,531.95 $11,531.95 $11,531.95 2026-01-01
27000574 LOCAL Hc Lead Lv 7120q/65cm Durata 1 1 $11,408.94 $11,180.76 $11,408.94 $11,408.94 $11,408.94 2026-01-01
0480-9259-08 NDC Octreotide,microspheres ER 20 Mg Intramuscular Susp, Extended Release 1 1 $11,134.76 $10,912.06 $11,134.76 $11,134.76 $11,134.76 2026-01-01
50242-087-01 NDC Ado-trastuzumab Emtansine 160 Mg Intravenous Solution 1 1 $11,023.30 $10,802.83 $11,023.30 $11,023.30 $11,023.30 2026-01-01
72579-121-01 NDC Tislelizumab-jsgr 10 Mg/ml Intravenous Solution 1 1 $10,926.00 $10,707.48 $10,926.00 $10,926.00 $10,926.00 2026-01-01
0078-0690-61 NDC Ofatumumab 1,000 Mg/50 Ml Intravenous Solution 1 1 $10,892.30 $10,674.45 $10,892.30 $10,892.30 $10,892.30 2026-01-01
27000567 LOCAL Hc Lead Durata Icd 1 1 $10,865.67 $10,648.36 $10,865.67 $10,865.67 $10,865.67 2026-01-01
59572-711-01 NDC Luspatercept-aamt 25 Mg Subcutaneous Solution 1 1 $10,816.93 $10,600.59 $10,816.93 $10,816.93 $10,816.93 2026-01-01
27000565 LOCAL Hc Pacemaker Zephyr 5620 1 1 $10,763.16 $10,547.90 $10,763.16 $10,763.16 $10,763.16 2026-01-01
27000572 LOCAL Hc Pacemaker Altrua 60 Dddr 1 1 $10,605.75 $10,393.64 $10,605.75 $10,605.75 $10,605.75 2026-01-01
50242-108-01 NDC Rituximab 1,400 Mg/11.7 Ml (120 Mg/ml)-hyaluronidase Subcutaneous Soln 1 1 $10,497.47 $10,287.52 $10,497.47 $10,497.47 $10,497.47 2026-01-01
27000568 LOCAL Hc Recorder Loop Dm2100 1 1 $10,455.65 $10,246.54 $10,455.65 $10,455.65 $10,455.65 2026-01-01
27000571 LOCAL Hc Lead Commercial 1156/75 1 1 $10,332.64 $10,125.99 $10,332.64 $10,332.64 $10,332.64 2026-01-01
0006-3026-01 NDC Pembrolizumab 25 Mg/ml Intravenous Solution 1 1 $10,268.72 $10,063.35 $10,268.72 $10,268.72 $10,268.72 2026-01-01
0006-3026-02 NDC Pembrolizumab 25 Mg/ml Intravenous Solution 1 1 $10,268.72 $10,063.35 $10,268.72 $10,268.72 $10,268.72 2026-01-01
0006-3026-04 NDC Pembrolizumab 25 Mg/ml Intravenous Solution 1 1 $10,268.72 $10,063.35 $10,268.72 $10,268.72 $10,268.72 2026-01-01
55513-730-01 NDC Denosumab 120 Mg/1.7 Ml (70 Mg/ml) Subcutaneous Solution 1 1 $10,058.04 $9,856.88 $10,058.04 $10,058.04 $10,058.04 2026-01-01
0078-0811-81 NDC Octreotide,microspheres ER 10 Mg Intramuscular Susp, Extended Release 1 1 $9,738.11 $9,543.35 $9,738.11 $9,738.11 $9,738.11 2026-01-01
0078-1000-60 NDC Inclisiran 284 Mg/1.5 Ml Subcutaneous Syringe 1 1 $9,662.24 $9,468.99 $9,662.24 $9,662.24 $9,662.24 2026-01-01
0173-0881-01 NDC Mepolizumab 100 Mg/ml Reconstituted Subcut Soln 1 1 $9,566.34 $9,375.02 $9,566.34 $9,566.34 $9,566.34 2026-01-01
66794-222-02 NDC Ampicillin 1 Gram Solution For Injection 1 1 $9,499.16 $9,309.17 $9,499.16 $9,499.16 $9,499.16 2026-01-01
0469-4425-30 NDC Zolbetuximab-clzb 300 Mg/15 Ml Reconstituted IV Soln 1 1 $9,408.00 $9,219.84 $9,408.00 $9,408.00 $9,408.00 2026-01-01
50242-053-06 NDC Rituximab 10 Mg/ml Concentrate,intravenous 1 1 $9,395.20 $9,207.30 $9,395.20 $9,395.20 $9,395.20 2026-01-01
70720-951-30 NDC Goserelin 10.8 Mg Subcutaneous Implant 1 1 $9,295.65 $9,109.73 $9,295.65 $9,295.65 $9,295.65 2026-01-01
60574-4113-1 NDC Palivizumab 100 Mg/ml Intramuscular Solution 1 1 $9,242.59 $9,057.74 $9,242.59 $9,242.59 $9,242.59 2026-01-01
66658-231-01 NDC Palivizumab 100 Mg/ml Intramuscular Solution 1 1 $9,242.59 $9,057.74 $9,242.59 $9,242.59 $9,242.59 2026-01-01
0211U CPT Caris Mi Cancer Seek 1 1 $9,210.05 $9,025.85 $9,210.05 $9,210.05 $9,210.05 2026-01-01
70114-120-01 NDC Pegfilgrastim-cbqv 6 Mg/0.6 Ml Subcutaneous Auto-injector 1 1 $9,091.27 $8,909.44 $9,091.27 $9,091.27 $9,091.27 2026-01-01
70114-101-01 NDC Pegfilgrastim-cbqv 6 Mg/0.6 Ml Subcutaneous Syringe 1 1 $9,091.27 $8,909.44 $9,091.27 $9,091.27 $9,091.27 2026-01-01
0173-0821-01 NDC Ofatumumab 1,000 Mg/50 Ml Intravenous Solution 1 1 $9,002.20 $8,822.16 $9,002.20 $9,002.20 $9,002.20 2026-01-01
67850-021-00 NDC Ampicillin 1 Gram Solution For Injection 1 1 $8,888.93 $8,711.15 $8,888.93 $8,888.93 $8,888.93 2026-01-01
61314-228-94 NDC Denosumab-bbdz 120 Mg/1.7 Ml (70 Mg/ml) Subcutaneous Solution 1 1 $8,777.46 $8,601.91 $8,777.46 $8,777.46 $8,777.46 2026-01-01
13533-800-25 NDC Gamunex-c 1 Gm/10 Ml Ij Soln - Pediatric (wrapped) 1 1 $8,448.84 $8,279.86 $8,448.84 $8,448.84 $8,448.84 2026-01-01
13533-800-24 NDC Gamunex-c 1 Gm/10 Ml Ij Soln - Pediatric (wrapped) 1 1 $8,448.84 $8,279.86 $8,448.84 $8,448.84 $8,448.84 2026-01-01
0069-3150-84 NDC Azithromycin 500 Mg Intravenous Solution 1 1 $8,277.19 $8,111.65 $8,277.19 $8,277.19 $8,277.19 2026-01-01
59856 CPT Induced Abort 1/> Vag Supp Dlvr Fetus D&c &/Evac 1 1 $8,041.07 $7,880.25 $8,041.07 $8,041.07 $8,041.07 2026-01-01
72039019 LOCAL Hc C-sect Emergent With Minor Surgery 1 1 $8,041.07 $7,880.25 $8,041.07 $8,041.07 $8,041.07 2026-01-01
72039020 LOCAL Hc Hysterectomy Unschd Emerg A 1 1 $7,834.89 $7,678.19 $7,834.89 $7,834.89 $7,834.89 2026-01-01
50242-077-01 NDC Trastuzumab 600 Mg-hyaluronidase-oysk 10,000 Unit/5 Ml Subcut Solution 1 1 $7,823.54 $7,667.07 $7,823.54 $7,823.54 $7,823.54 2026-01-01
61795 CPT Hc Stereotactic Volumetric Proc 1 1 $7,793.22 $7,637.36 $7,793.22 $7,793.22 $7,793.22 2026-01-01
50242-137-01 NDC Tocilizumab 400 Mg/20 Ml (20 Mg/ml) Intravenous Solution 1 1 $7,744.10 $7,589.22 $7,744.10 $7,744.10 $7,744.10 2026-01-01
0310-4611-50 NDC Durvalumab 50 Mg/ml Intravenous Solution 1 1 $7,645.96 $7,493.04 $7,645.96 $7,645.96 $7,645.96 2026-01-01
72039018 LOCAL Hc C-sect Emergent 1 1 $7,628.71 $7,476.14 $7,628.71 $7,628.71 $7,628.71 2026-01-01
0002-7623-01 NDC Pemetrexed Disodium 500 Mg Intravenous Powder For Solution 1 1 $7,509.46 $7,359.27 $7,509.46 $7,509.46 $7,509.46 2026-01-01
27000333 LOCAL Hc Cuff Lg Adult 2 Tube W Bulb 1 1 $7,472.71 $7,323.26 $7,472.71 $7,472.71 $7,472.71 2026-01-01
53852 CPT Hc Tuna 1 1 $7,358.39 $7,211.22 $7,358.39 $7,358.39 $7,358.39 2026-01-01
52648 CPT Hc Tu Contact Laser Vap Prostate 1 1 $7,358.39 $7,211.22 $7,358.39 $7,358.39 $7,358.39 2026-01-01
78459 CPT Hc PET Scan Myocardial Perfus 1 1 $7,204.65 $7,060.56 $7,204.65 $7,204.65 $7,204.65 2026-01-01
13533-318-50 NDC Rabies Immune Globulin (pf) 300 Unit/ml Intramuscular Solution 1 1 $7,192.19 $7,048.34 $7,192.19 $7,192.19 $7,192.19 2026-01-01
0409-3726-10 NDC Ampicillin 1 Gram Solution For Injection 1 1 $7,181.48 $7,037.85 $7,181.48 $7,181.48 $7,181.48 2026-01-01
55513-132-01 NDC Trastuzumab-anns 420 Mg Intravenous Solution 1 1 $7,166.22 $7,022.90 $7,166.22 $7,166.22 $7,166.22 2026-01-01
50242-227-01 NDC Omalizumab 300 Mg/2 Ml Subcutaneous Syringe 1 1 $7,098.88 $6,956.90 $7,098.88 $7,098.88 $7,098.88 2026-01-01
0003-3756-14 NDC Nivolumab 120 Mg/12 Ml Intravenous Solution 1 1 $6,914.95 $6,776.65 $6,914.95 $6,914.95 $6,914.95 2026-01-01
50242-088-01 NDC Ado-trastuzumab Emtansine 100 Mg Intravenous Solution 1 1 $6,889.56 $6,751.77 $6,889.56 $6,889.56 $6,889.56 2026-01-01
27000555 LOCAL Hc Stent Carotid Tapered 7.0-10.0 1 1 $6,874.91 $6,737.41 $6,874.91 $6,874.91 $6,874.91 2026-01-01
59821 CPT Hc 2nd Trimester Missed Abortion D&c 2 1 $6,803.98 $6,667.90 $6,185.44 $7,422.53 $6,803.98 2026-01-01
42367-540-32 NDC Dantrolene 250 Mg Intravenous Suspension 1 1 $6,774.97 $6,639.47 $6,774.97 $6,774.97 $6,774.97 2026-01-01
55390-612-10 NDC Acyclovir Sodium 500 Mg Intravenous Solution 1 1 $6,763.64 $6,628.37 $6,763.64 $6,763.64 $6,763.64 2026-01-01
68982-850-05 NDC Immune Glob,gamm(igg)10 %-malt-iga Over 50 Mcg/ml Intravenous Solution 1 1 $6,763.64 $6,628.37 $6,763.64 $6,763.64 $6,763.64 2026-01-01
0597-0197-05 NDC Idarucizumab 2.5 Gram/50 Ml Intravenous Solution 1 1 $6,755.98 $6,620.86 $6,755.98 $6,755.98 $6,755.98 2026-01-01
50242-103-01 NDC Polatuzumab Vedotin-piiq 30 Mg Intravenous Solution 1 1 $6,685.72 $6,552.01 $6,685.72 $6,685.72 $6,685.72 2026-01-01
72039013 LOCAL Hc Vaginal Birth W/Epi W/Forceps 1 1 $6,597.80 $6,465.84 $6,597.80 $6,597.80 $6,597.80 2026-01-01
72039014 LOCAL Hc Vaginal Birth After Prev Csect 1 1 $6,597.80 $6,465.84 $6,597.80 $6,597.80 $6,597.80 2026-01-01
55513-221-01 NDC Romiplostim 250 Mcg Subcutaneous Solution 1 1 $6,572.09 $6,440.65 $6,572.09 $6,572.09 $6,572.09 2026-01-01
0310-4505-25 NDC Tremelimumab-actl 20 Mg/ml Intravenous Solution 1 1 $6,500.00 $6,370.00 $6,500.00 $6,500.00 $6,500.00 2026-01-01
61314-866-01 NDC Pegfilgrastim-bmez 6 Mg/0.6 Ml Subcutaneous Syringe 1 1 $6,440.79 $6,311.97 $6,440.79 $6,440.79 $6,440.79 2026-01-01
63833-617-02 NDC Antihemophilic Factor-vwf 1,000 Unit-2,400 Unit Intravenous Solution 1 1 $6,432.73 $6,304.08 $6,432.73 $6,432.73 $6,432.73 2026-01-01
72039029 LOCAL Hc C-sect Nonemergent With Major Surgery 1 1 $6,391.62 $6,263.79 $6,391.62 $6,391.62 $6,391.62 2026-01-01
99999-849-03 NDC Bevacizumab Intravitreal Syringe 1.25 Mg/0.05 Ml 1 1 $6,375.52 $6,248.01 $6,375.52 $6,375.52 $6,375.52 2026-01-01
50242-061-01 NDC Bevacizumab 25 Mg/ml Intravenous Solution 1 1 $6,375.52 $6,248.01 $6,375.52 $6,375.52 $6,375.52 2026-01-01
44206-438-20 NDC Immune Glob,gamm(igg) 10 %-pro-iga 0 To 50 Mcg/ml Intravenous Solution 1 1 $6,334.38 $6,207.69 $6,334.38 $6,334.38 $6,334.38 2026-01-01
57894-501-01 NDC Amivantamab-vmjw 50 Mg/ml Intravenous Solution 1 1 $6,295.39 $6,169.49 $6,295.39 $6,295.39 $6,295.39 2026-01-01
27000498 LOCAL Hc Cuff Omni Sm Adult 1 1 $6,187.43 $6,063.68 $6,187.43 $6,187.43 $6,187.43 2026-01-01
27000511 LOCAL Hc Cuff Omni Kuff Adult Hp 1 1 $6,187.43 $6,063.68 $6,187.43 $6,187.43 $6,187.43 2026-01-01
27000518 LOCAL Hc Cuff Bp Lg Adult 1 1 $6,187.43 $6,063.68 $6,187.43 $6,187.43 $6,187.43 2026-01-01
59841 CPT Induced Abortion Dilation & Evacuation 1 1 $6,185.44 $6,061.73 $6,185.44 $6,185.44 $6,185.44 2026-01-01
72039022 LOCAL Hc Fetal Demise 3rd Trimester 1 1 $6,185.44 $6,061.73 $6,185.44 $6,185.44 $6,185.44 2026-01-01
72039012 LOCAL Hc Vaginal Birth W/Epidural 1 1 $6,185.44 $6,061.73 $6,185.44 $6,185.44 $6,185.44 2026-01-01
55292-820-01 NDC Sutimlimab-jome 50 Mg/ml Intravenous Solution 1 1 $6,127.26 $6,004.71 $6,127.26 $6,127.26 $6,127.26 2026-01-01
59676-960-02 NDC Doxorubicin, Pegylated Liposomal 2 Mg/ml Intravenous Suspension 1 1 $6,057.45 $5,936.30 $6,057.45 $6,057.45 $6,057.45 2026-01-01
70257-126-51 NDC Varicella-zoster Immune Glob-maltose 125 Unit/1.2 Ml IM Solution 1 1 $6,024.75 $5,904.26 $6,024.75 $6,024.75 $6,024.75 2026-01-01
0015-1911-13 NDC Ixabepilone 45 Mg Intravenous Solution 1 1 $6,005.60 $5,885.49 $6,005.60 $6,005.60 $6,005.60 2026-01-01
0069-0324-01 NDC Pegfilgrastim-apgf 6 Mg/0.6 Ml Subcutaneous Syringe 1 1 $5,977.65 $5,858.09 $5,977.65 $5,977.65 $5,977.65 2026-01-01
63459-104-50 NDC Rituximab-abbs 10 Mg/ml Intravenous Solution 1 1 $5,905.30 $5,787.19 $5,905.30 $5,905.30 $5,905.30 2026-01-01
0003-3774-12 NDC Nivolumab 100 Mg/10 Ml Intravenous Solution 1 1 $5,762.44 $5,647.19 $5,762.44 $5,762.44 $5,762.44 2026-01-01
68700 CPT Hc Plastic Rep Or Canaliculi 1 1 $5,685.75 $5,572.04 $5,685.75 $5,685.75 $5,685.75 2026-01-01
0074-1044-01 NDC Telisotuzumab Vedotin-tllv 20 Mg/1 Ml Reconstituted IV Soln 1 1 $5,592.00 $5,480.16 $5,592.00 $5,592.00 $5,592.00 2026-01-01
71225-120-01 NDC Bendamustine 25 Mg/ml Intravenous Solution (equivalent To Vivimusta) 1 1 $5,565.36 $5,454.05 $5,565.36 $5,565.36 $5,565.36 2026-01-01
24338-270-01 NDC Bendamustine 25 Mg/ml Intravenous Solution (equivalent To Vivimusta) 1 1 $5,565.34 $5,454.04 $5,565.34 $5,565.34 $5,565.34 2026-01-01
69945-050-40 NDC Indium In-111 Pentetreotide 1 1 $5,500.00 $5,390.00 $5,500.00 $5,500.00 $5,500.00 2026-01-01
51715 CPT Endoscopic Injection/Implant 1 1 $5,496.22 $5,386.30 $5,496.22 $5,496.22 $5,496.22 2026-01-01
55513-710-01 NDC Denosumab 60 Mg/ml Subcutaneous Syringe 1 1 $5,467.97 $5,358.61 $5,467.97 $5,467.97 $5,467.97 2026-01-01
55513-710-21 NDC Denosumab 60 Mg/ml Subcutaneous Syringe 1 1 $5,467.97 $5,358.61 $5,467.97 $5,467.97 $5,467.97 2026-01-01
76075-101-01 NDC Carfilzomib 60 Mg Intravenous Solution 1 1 $5,462.02 $5,352.78 $5,462.02 $5,462.02 $5,462.02 2026-01-01
63323-926-88 NDC Romidepsin 10 Mg/2 Ml Intravenous Powder For Solution 1 1 $5,455.18 $5,346.08 $5,455.18 $5,455.18 $5,455.18 2026-01-01
70257-310-51 NDC Rho(d) Immune Globulin-maltose 5,000 Unit (1,000 Mcg)/4.4 Ml Inj. Soln 1 1 $5,442.90 $5,334.04 $5,442.90 $5,442.90 $5,442.90 2026-01-01
27021838 LOCAL Cath Balloon 8mm X 40mm 80cm # 43606 1 1 $5,421.60 $5,313.17 $5,421.60 $5,421.60 $5,421.60 2026-01-01
27021836 LOCAL Cath Balloon 8mm X 40mm 80cm # 43604 1 1 $5,421.60 $5,313.17 $5,421.60 $5,421.60 $5,421.60 2026-01-01
27021839 LOCAL Cath Balloon 8mm X 40mm 80cm # 43607 1 1 $5,421.60 $5,313.17 $5,421.60 $5,421.60 $5,421.60 2026-01-01
27021837 LOCAL Cath Balloon 8mm X 40mm 80cm #43605 1 1 $5,421.60 $5,313.17 $5,421.60 $5,421.60 $5,421.60 2026-01-01
55292-811-55 NDC Dactinomycin 0.5 Mg Intravenous Solution 1 1 $5,417.08 $5,308.74 $5,417.08 $5,417.08 $5,417.08 2026-01-01
0003-4522-11 NDC Elotuzumab 400 Mg Intravenous Solution 1 1 $5,415.08 $5,306.78 $5,415.08 $5,415.08 $5,415.08 2026-01-01
27033521 LOCAL Hc Syringe Bd Insul 1 Ml Luer Look 1 1 $5,380.84 $5,273.22 $5,380.84 $5,380.84 $5,380.84 2026-01-01
72039011 LOCAL Hc Vaginal Birth W/Vacuum Forcep 1 1 $5,360.72 $5,253.51 $5,360.72 $5,360.72 $5,360.72 2026-01-01
57894-054-27 NDC Ustekinumab 130 Mg/26 Ml Intravenous Solution 1 1 $5,284.86 $5,179.17 $5,284.86 $5,284.86 $5,284.86 2026-01-01
0074-3641-03 NDC Leuprolide 3.75 Mg Intramuscular Syringe Kit 1 1 $5,251.83 $5,146.80 $5,251.83 $5,251.83 $5,251.83 2026-01-01
58468-4663-1 NDC Imiglucerase 400 Unit Intravenous Solution 1 1 $5,212.90 $5,108.65 $5,212.90 $5,212.90 $5,212.90 2026-01-01
15054-0043-1 NDC Irinotecan Liposomal 4.3 Mg/ml Intravenous 1 1 $5,166.00 $5,062.68 $5,166.00 $5,166.00 $5,166.00 2026-01-01
77301 CPT Hc Imrt Planning 1 1 $5,119.19 $5,016.81 $5,119.19 $5,119.19 $5,119.19 2026-01-01
67105 CPT Hc Argon Retino Pexy (Ret Det) 1 1 $5,117.17 $5,014.83 $5,117.17 $5,117.17 $5,117.17 2026-01-01
68982-261-82 NDC Human Prothrombin Complex Concentrate-lans 1,000 Unit/40 Ml Reconstituted IV Sol… 1 1 $5,110.31 $5,008.10 $5,110.31 $5,110.31 $5,110.31 2026-01-01
67457-833-06 NDC Pegfilgrastim-jmdb 6 Mg/0.6 Ml Subcutaneous Syringe 1 1 $5,025.11 $4,924.61 $5,025.11 $5,025.11 $5,025.11 2026-01-01
78816 CPT Hc Pet/CT Tumor Imag Full Body 1 1 $4,953.20 $4,854.14 $4,953.20 $4,953.20 $4,953.20 2026-01-01
72039010 LOCAL Hc Vaginal Birth (No Anes Unco 1 1 $4,948.35 $4,849.38 $4,948.35 $4,948.35 $4,948.35 2026-01-01
57970-100-01 NDC Dalbavancin 500 Mg Intravenous Solution 1 1 $4,928.32 $4,829.75 $4,928.32 $4,928.32 $4,928.32 2026-01-01
55513-207-01 NDC Bevacizumab-awwb 25 Mg/ml Intravenous Solution 1 1 $4,927.04 $4,828.50 $4,927.04 $4,927.04 $4,927.04 2026-01-01
66658-230-01 NDC Palivizumab 50 Mg/0.5 Ml Intramuscular Solution 1 1 $4,894.71 $4,796.82 $4,894.71 $4,894.71 $4,894.71 2026-01-01
55513-326-01 NDC Rituximab-arrx 10 Mg/ml Intravenous Solution 1 1 $4,867.10 $4,769.76 $4,867.10 $4,867.10 $4,867.10 2026-01-01
65597-406-01 NDC Fam-trastuzumab Deruxtecan-nxki 100 Mg Intravenous Solution 1 1 $4,849.00 $4,752.02 $4,849.00 $4,849.00 $4,849.00 2026-01-01
67457-847-44 NDC Trastuzumab-dkst 420 Mg Intravenous Solution 1 1 $4,685.10 $4,591.40 $4,685.10 $4,685.10 $4,685.10 2026-01-01
57894-502-20 NDC Daratumumab 20 Mg/ml Intravenous Solution 1 1 $4,635.52 $4,542.81 $4,635.52 $4,635.52 $4,635.52 2026-01-01
11900 CPT Injection Into Skin Lesions, Up To 7 1 1 $4,548.60 $4,457.63 $4,548.60 $4,548.60 $4,548.60 2026-01-01
77373 CPT Hc Stereotactic Body Rt W/Igrt 1 1 $4,541.02 $4,450.20 $4,541.02 $4,541.02 $4,541.02 2026-01-01
68982-850-04 NDC Immune Glob,gamm(igg)10 %-malt-iga Over 50 Mcg/ml Intravenous Solution 1 1 $4,509.09 $4,418.91 $4,509.09 $4,509.09 $4,509.09 2026-01-01
78492 CPT Hc PET Scan Myocardial R/s Mult 1 1 $4,502.91 $4,412.85 $4,502.91 $4,502.91 $4,502.91 2026-01-01
0069-0305-01 NDC Trastuzumab-qyyp 420 Mg/20 Ml Reconstituted IV Soln 1 1 $4,475.02 $4,385.52 $4,475.02 $4,475.02 $4,475.02 2026-01-01
0069-0306-01 NDC Trastuzumab-qyyp 420 Mg/20 Ml Reconstituted IV Soln 1 1 $4,475.02 $4,385.52 $4,475.02 $4,475.02 $4,475.02 2026-01-01
54092-701-04 NDC Velaglucerase Alfa 400 Unit Intravenous Solution 1 1 $4,457.30 $4,368.15 $4,457.30 $4,457.30 $4,457.30 2026-01-01
12302000 LOCAL Hc Pediatrics 1 1 $4,445.04 $4,356.14 $4,445.04 $4,445.04 $4,445.04 2026-01-01
12302002 LOCAL Peds Room & Board - NICU 1 1 $4,445.04 $4,356.14 $4,445.04 $4,445.04 $4,445.04 2026-01-01
74527-022-01 NDC Margetuximab-cmkb 25 Mg/ml Intravenous Solution 1 1 $4,406.40 $4,318.27 $4,406.40 $4,406.40 $4,406.40 2026-01-01
74527-022-02 NDC Margetuximab-cmkb 25 Mg/ml Intravenous Solution 1 1 $4,406.40 $4,318.27 $4,406.40 $4,406.40 $4,406.40 2026-01-01
61314-240-63 NDC Denosumab-bbdz 60 Mg/ml Subcutaneous Syringe 1 1 $4,388.73 $4,300.96 $4,388.73 $4,388.73 $4,388.73 2026-01-01
55135-132-01 NDC Sacituzumab Govitecan-hziy 180 Mg Intravenous Solution 1 1 $4,376.90 $4,289.36 $4,376.90 $4,376.90 $4,376.90 2026-01-01
78815 CPT Hc PET Scan Tumor Img Metabol 1 1 $4,352.81 $4,265.75 $4,352.81 $4,352.81 $4,352.81 2026-01-01
0003-2187-13 NDC Abatacept (with Maltose) 250 Mg Intravenous Solution 1 1 $4,327.20 $4,240.65 $4,327.20 $4,327.20 $4,327.20 2026-01-01
60574-4114-1 NDC Palivizumab 50 Mg/0.5 Ml Intramuscular Solution 1 1 $4,187.36 $4,103.61 $4,187.36 $4,187.36 $4,187.36 2026-01-01
81455 CPT Hc Targeted Genomic Seq Analys >50 Genes 3 1 $4,173.74 $4,090.27 $3,338.99 $5,286.73 $4,173.74 2026-01-01
72039017 LOCAL Hc C-section Nonemergent W / Minor Surgery 1 1 $4,123.63 $4,041.16 $4,123.63 $4,123.63 $4,123.63 2026-01-01
58925 CPT Removal Of Ovarian Cyst(S) 1 1 $4,123.63 $4,041.16 $4,123.63 $4,123.63 $4,123.63 2026-01-01
0002-8501-01 NDC Insulin Regular Human U-500(concentrate) 500 Unit/ml Subcutaneous Soln 1 1 $4,109.83 $4,027.63 $4,109.83 $4,109.83 $4,109.83 2026-01-01
27035616 LOCAL Hc Provox Activale 1 1 $4,100.40 $4,018.39 $4,100.40 $4,100.40 $4,100.40 2026-01-01
70860-100-41 NDC Azithromycin 500 Mg Intravenous Solution 1 1 $4,082.23 $4,000.59 $4,082.23 $4,082.23 $4,082.23 2026-01-01
70860-100-10 NDC Azithromycin 500 Mg Intravenous Solution 1 1 $4,082.23 $4,000.59 $4,082.23 $4,082.23 $4,082.23 2026-01-01
78206-148-01 NDC Trastuzumab-dttb 420 Mg/20 Ml Reconstituted IV Soln 1 1 $4,068.56 $3,987.19 $4,068.56 $4,068.56 $4,068.56 2026-01-01
0003-2291-11 NDC Elotuzumab 300 Mg Intravenous Solution 1 1 $4,061.34 $3,980.11 $4,061.34 $4,061.34 $4,061.34 2026-01-01
55292-122-52 NDC Ibuprofen Lysine (pf) 20 Mg/2 Ml Intravenous Solution 1 1 $4,047.02 $3,966.08 $4,047.02 $4,047.02 $4,047.02 2026-01-01
70121-1627-1 NDC Pegfilgrastim-pbbk 6 Mg/0.6 Ml Subcutaneous Syringe 1 1 $4,045.92 $3,965.00 $4,045.92 $4,045.92 $4,045.92 2026-01-01
63459-348-04 NDC Bendamustine 25 Mg/ml Intravenous Solution (equivalent To Bendeka) 1 1 $4,043.44 $3,962.57 $4,043.44 $4,043.44 $4,043.44 2026-01-01
27000871 LOCAL Hc Provox Activalve 1 1 $4,004.64 $3,924.55 $4,004.64 $4,004.64 $4,004.64 2026-01-01
27021823 LOCAL Ankle Restraints 2 1 $3,988.55 $3,908.78 $32.62 $7,944.48 $3,988.55 2026-01-01
52204 CPT Hc Cystoscopy W/Biopsy 1 1 $3,980.02 $3,900.42 $3,980.02 $3,980.02 $3,980.02 2026-01-01
0069-0342-01 NDC Bevacizumab-bvzr 25 Mg/ml Intravenous Solution 1 1 $3,955.55 $3,876.44 $3,955.55 $3,955.55 $3,955.55 2026-01-01
68152-108-09 NDC Belinostat 500 Mg Intravenous Solution 1 1 $3,942.84 $3,863.98 $3,942.84 $3,942.84 $3,942.84 2026-01-01
0002-7669-01 NDC Ramucirumab 10 Mg/ml Intravenous Solution 1 1 $3,938.36 $3,859.60 $3,938.36 $3,938.36 $3,938.36 2026-01-01
0002-4182-30 NDC Baricitinib 2 Mg Tablet 2 1 $3,931.78 $3,853.15 $253.66 $7,609.91 $3,931.78 2026-01-01
59514 CPT Cesarean Delivery Only 1 1 $3,917.45 $3,839.10 $3,917.45 $3,917.45 $3,917.45 2026-01-01
59100 CPT Hc Hysterotomy - Scheduled 1 1 $3,917.45 $3,839.10 $3,917.45 $3,917.45 $3,917.45 2026-01-01
42299 CPT Hc Palate/Uvula Augmentation/Inj 1 1 $3,790.50 $3,714.69 $3,790.50 $3,790.50 $3,790.50 2026-01-01
70436-019-82 NDC Azithromycin 500 Mg Intravenous Solution 1 1 $3,775.61 $3,700.10 $3,775.61 $3,775.61 $3,775.61 2026-01-01
1004259001 NDC Ocular Implant With Insertion Tool For Ranibizumab 1 1 $3,757.58 $3,682.43 $3,757.58 $3,757.58 $3,757.58 2026-01-01
42998-402-05 NDC Isoproterenol 0.2 Mg/ml Injection Solution 1 1 $3,720.53 $3,646.12 $3,720.53 $3,720.53 $3,720.53 2026-01-01
67228 CPT Hc Argon Retino Vasc 1 1 $3,714.69 $3,640.40 $3,714.69 $3,714.69 $3,714.69 2026-01-01
72039016 LOCAL Hc C-section Nonemergent 1 1 $3,711.26 $3,637.03 $3,711.26 $3,711.26 $3,711.26 2026-01-01
57894-449-01 NDC Teclistamab-cqyv 10 Mg/ml Subcutaneous Solution 1 1 $3,710.88 $3,636.66 $3,710.88 $3,710.88 $3,710.88 2026-01-01
0517-0710-01 NDC Fomepizole 1 Gram/ml Intravenous Solution 1 1 $3,698.27 $3,624.30 $3,698.27 $3,698.27 $3,698.27 2026-01-01
20606000 LOCAL Hc Intermediate Care 1 1 $3,689.21 $3,615.43 $3,689.21 $3,689.21 $3,689.21 2026-01-01
20106000 LOCAL Hc Intensive Care Unit 59 1 1 $3,689.21 $3,615.43 $3,689.21 $3,689.21 $3,689.21 2026-01-01
20006000 LOCAL Hc Intensive Care 1 1 $3,689.21 $3,615.43 $3,689.21 $3,689.21 $3,689.21 2026-01-01
0781-3404-85 NDC Ampicillin 1 Gram Solution For Injection 1 1 $3,667.40 $3,594.05 $3,667.40 $3,667.40 $3,667.40 2026-01-01
78814 CPT Hc Pet/CT Brain Amyloid 1 1 $3,602.33 $3,530.28 $3,602.33 $3,602.33 $3,602.33 2026-01-01
78608 CPT Hc PET Scan Brain Metabolic 1 1 $3,602.33 $3,530.28 $3,602.33 $3,602.33 $3,602.33 2026-01-01
78609 CPT Hc PET Scan Brain Perfusion 1 1 $3,602.33 $3,530.28 $3,602.33 $3,602.33 $3,602.33 2026-01-01
50242-215-01 NDC Omalizumab 150 Mg/ml Subcutaneous Syringe 1 1 $3,598.89 $3,526.91 $3,598.89 $3,598.89 $3,598.89 2026-01-01
50242-215-03 NDC Omalizumab 150 Mg/ml Subcutaneous Syringe 1 1 $3,598.89 $3,526.91 $3,598.89 $3,598.89 $3,598.89 2026-01-01
50242-040-62 NDC Omalizumab 150 Mg Subcutaneous Solution 1 1 $3,598.89 $3,526.91 $3,598.89 $3,598.89 $3,598.89 2026-01-01
77372 CPT Hc Cranial Srs 1 Session 1 1 $3,577.41 $3,505.86 $3,577.41 $3,577.41 $3,577.41 2026-01-01
55150-113-10 NDC Ampicillin 1 Gram Solution For Injection 1 1 $3,559.18 $3,487.99 $3,559.18 $3,559.18 $3,559.18 2026-01-01
50590 CPT Hc Lithotripsy (Eswl) 1 1 $3,541.26 $3,470.43 $3,541.26 $3,541.26 $3,541.26 2026-01-01
55513-954-01 NDC Panitumumab 100 Mg/5 Ml (20 Mg/ml) Intravenous Solution 1 1 $3,514.26 $3,443.97 $3,514.26 $3,514.26 $3,514.26 2026-01-01
63833-616-02 NDC Antihemophilic Factor-vwf 500 Unit-1,200 Unit Intravenous Solution 1 1 $3,499.06 $3,429.08 $3,499.06 $3,499.06 $3,499.06 2026-01-01
62756-512-40 NDC Azithromycin 500 Mg Intravenous Solution 1 1 $3,491.54 $3,421.71 $3,491.54 $3,491.54 $3,491.54 2026-01-01
44087-3535-1 NDC Avelumab 20 Mg/ml Intravenous Solution 1 1 $3,456.24 $3,387.12 $3,456.24 $3,456.24 $3,456.24 2026-01-01
13533-705-01 NDC Alpha-1-proteinase Inhibitor (human) 1,000 Mg (+/-)/20 Ml IV Solution 1 1 $3,429.92 $3,361.32 $3,429.92 $3,429.92 $3,429.92 2026-01-01
70720-950-36 NDC Goserelin 3.6 Mg Subcutaneous Implant 1 1 $3,378.66 $3,311.09 $3,378.66 $3,378.66 $3,378.66 2026-01-01
0008-1179-01 NDC Temsirolimus 30 Mg/3 Ml (10 Mg/ml) (first Dilution) Intravenous Soln 1 1 $3,341.70 $3,274.87 $3,341.70 $3,341.70 $3,341.70 2026-01-01
66490-041-01 NDC Dihydroergotamine 1 Mg/ml Injection Solution 1 1 $3,340.01 $3,273.21 $3,340.01 $3,340.01 $3,340.01 2026-01-01
17409000 LOCAL Hc NICU 1 1 $3,334.40 $3,267.71 $3,334.40 $3,334.40 $3,334.40 2026-01-01
67457-220-00 NDC Isosulfan Blue 1 % Subcutaneous Solution 1 1 $3,288.00 $3,222.24 $3,288.00 $3,288.00 $3,288.00 2026-01-01
67457-220-05 NDC Isosulfan Blue 1 % Subcutaneous Solution 1 1 $3,288.00 $3,222.24 $3,288.00 $3,288.00 $3,288.00 2026-01-01
55513-223-01 NDC Romiplostim 125 Mcg Subcutaneous Solution 1 1 $3,286.08 $3,220.36 $3,286.08 $3,286.08 $3,286.08 2026-01-01
10122-510-03 NDC Poractant Alfa 240 Mg/3 Ml Intratracheal Suspension 1 1 $3,247.78 $3,182.83 $3,247.78 $3,247.78 $3,247.78 2026-01-01
0781-3182-73 NDC Fomepizole 1 Gram/ml Intravenous Solution 1 1 $3,220.72 $3,156.31 $3,220.72 $3,220.72 $3,220.72 2026-01-01
63020-049-01 NDC Bortezomib 3.5 Mg Injection Powder For Solution 1 1 $3,206.00 $3,141.88 $3,206.00 $3,206.00 $3,206.00 2026-01-01
77610 CPT Hc Hyperthermia Interstit-simple 1 1 $3,204.01 $3,139.93 $3,204.01 $3,204.01 $3,204.01 2026-01-01
0480-3290-01 NDC Paclitaxel Protein-bound 100 Mg/20 Ml Reconstituted IV Susp 1 1 $3,200.00 $3,136.00 $3,200.00 $3,200.00 $3,200.00 2026-01-01
44206-437-91 NDC Immune Glob,gamm(igg) 10 %-pro-iga 0 To 50 Mcg/ml Intravenous Solution 1 1 $3,167.19 $3,103.84 $3,167.19 $3,167.19 $3,167.19 2026-01-01
44206-437-10 NDC Immune Glob,gamm(igg) 10 %-pro-iga 0 To 50 Mcg/ml Intravenous Solution 1 1 $3,167.19 $3,103.84 $3,167.19 $3,167.19 $3,167.19 2026-01-01
44567-212-01 NDC Ampicillin-sulbactam 15 Gram Solution For Injection 1 1 $3,140.58 $3,077.77 $3,140.58 $3,140.58 $3,140.58 2026-01-01
0469-3425-10 NDC Zolbetuximab-clzb 100 Mg/5 Ml Reconstituted IV Soln 1 1 $3,136.00 $3,073.28 $3,136.00 $3,136.00 $3,136.00 2026-01-01
50242-132-10 NDC Trastuzumab 150 Mg Intravenous Solution 1 1 $3,116.84 $3,054.50 $3,116.84 $3,116.84 $3,116.84 2026-01-01
50242-132-01 NDC Trastuzumab 150 Mg Intravenous Solution 1 1 $3,116.84 $3,054.50 $3,116.84 $3,116.84 $3,116.84 2026-01-01
66733-958-23 NDC Cetuximab 200 Mg/100 Ml Intravenous Solution 1 1 $3,107.40 $3,045.25 $3,107.40 $3,107.40 $3,107.40 2026-01-01
67684-1901-1 NDC Ethiodized Oil 480 Mg Iodine/ml For Injection 1 1 $3,087.23 $3,025.48 $3,087.23 $3,087.23 $3,087.23 2026-01-01
55513-880-02 NDC Romosozumab-aqqg 210 Mg/2.34 Ml(105 Mg/1.17 Ml X2)subcutaneous Syringe 1 1 $3,076.27 $3,014.74 $3,076.27 $3,076.27 $3,076.27 2026-01-01
17309000 LOCAL Hc Intermediate NICU 1 1 $3,067.65 $3,006.30 $3,067.65 $3,067.65 $3,067.65 2026-01-01
42998-402-01 NDC Isoproterenol 0.2 Mg/ml Injection Solution 1 1 $3,060.32 $2,999.11 $3,060.32 $3,060.32 $3,060.32 2026-01-01
99285 CPT Emergency Department Visit High Mdm 25 1 $3,059.76 $2,998.56 $1,127.28 $4,992.25 $3,059.76 2026-01-01
95811 CPT Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd 1 1 $3,051.38 $2,990.35 $3,051.38 $3,051.38 $3,051.38 2026-01-01
17156-021-01 NDC Indium In-111 Labeled Autologous Wbcs 1 1 $2,976.25 $2,916.73 $2,976.25 $2,976.25 $2,976.25 2026-01-01
0006-0227-61 NDC Raltegravir 400 Mg Tablet 2 1 $2,956.38 $2,897.25 $96.93 $5,815.83 $2,956.38 2026-01-01
17209000 LOCAL Hc Conv NICU 1 1 $2,938.40 $2,879.63 $2,938.40 $2,938.40 $2,938.40 2026-01-01
68817-134-50 NDC Paclitaxel Protein-bound 100 Mg/20 Ml Reconstituted IV Susp 1 1 $2,934.80 $2,876.10 $2,934.80 $2,934.80 $2,934.80 2026-01-01
50633-310-11 NDC Hydroxocobalamin 5 Gram Intravenous Solution 1 1 $2,925.74 $2,867.23 $2,925.74 $2,925.74 $2,925.74 2026-01-01
27000556 LOCAL Hc Flextend I Plus Bi Pos Fix 1 1 $2,924.10 $2,865.62 $2,924.10 $2,924.10 $2,924.10 2026-01-01
55513-059-01 NDC Tarlatamab-dlle 1 Mg/1.1 Ml Reconstituted IV Soln 1 1 $2,910.00 $2,851.80 $2,910.00 $2,910.00 $2,910.00 2026-01-01
81540 CPT Hc Cancer Type Id Gene Analysis 2 1 $2,893.79 $2,835.92 $222.60 $5,564.98 $2,893.79 2026-01-01
0024-5154-11 NDC Rasburicase 1.5 Mg Intravenous Solution 1 1 $2,891.84 $2,834.00 $2,891.84 $2,891.84 $2,891.84 2026-01-01
95810 CPT Polysom 6/>Yrs Sleep 4/> Addl Param Attnd 1 1 $2,886.44 $2,828.71 $2,886.44 $2,886.44 $2,886.44 2026-01-01
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