Hospital

CHI HEALTH PLAINVIEW HOSPITAL

Plainview, NE · CCN 281346 · Rates published

5,061 distinct procedures filed

19 distinct payers

990,657 rate rows

2026-02-28 last MRF observed

Data quality

988,251 of 990,657 rate rows are consumer-grade (99.8%)

2,406 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
template filing: same amount across many unrelated codes — excluded	2,166
exceeds 10× this hospital's gross charge — excluded from medians	108
per-diem day rate — not a per-procedure price	100
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	32

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

Source MRF file	https://www.chihealth.com/content/dam/chihealthcom/documents/patients-and-visitors/financial-assistance/price-transparency-standard-charges/470757164_chi-health-plainview_standardcharges.json
Found on page	https://www.chihealth.com/patients-visitors/financial-assistance
Discovered via	CMS hospital list
Last fetch	Latest re-check couldn't be parsed — showing last good data · 2026-05-18
Content fingerprint	6ec59c0c250c93f2… · 217,440,594 bytes · first seen 2026-05-05

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
J0225 HCPCS	Vutrisiran 25 Mg/0.5 Ml Subcutaneous Syringe	19	$364,020.55	$808,125.63	$566,917.25	nat. median $8,223 outlier · 68.9×
A9513 HCPCS	Lutetium Lu 177 Dotatate 10 Mci/ml (370 Mbq/ml) Intravenous Solution	19	$144,875.00	$321,622.50	$225,625.00	nat. median $468 outlier · 482.4×
J1823 HCPCS	Inebilizumab-cdon 10 Mg/ml Intravenous Solution	19	$133,183.13	$295,666.55	$207,416.35	nat. median $798 outlier · 259.8×
J2351 HCPCS	Ocrelizumab 920 Mg-hyaluronidase-ocsq 23000 Unit/23 Ml Subcut Soln	19	$125,909.85	$279,519.87	$196,089.12	nat. median $78 outlier · 2515.6×
C9293 HCPCS	Glucarpidase 1000 Unit Intravenous Solution	19	$125,580.70	$278,789.16	$195,576.50	nat. median $21,216 outlier · 9.2×
J1747 HCPCS	Spesolimab-sbzo 60 Mg/ml Intravenous Solution	19	$77,977.84	$173,110.80	$121,440.90	nat. median $94 outlier · 1295.0×
J2350 HCPCS	Ocrelizumab 30 Mg/ml Intravenous Solution	19	$60,128.62	$133,485.53	$93,642.93	nat. median $683 outlier · 137.1×
J9228 HCPCS	Ipilimumab 200 Mg/40 Ml (5 Mg/ml) Intravenous Solution	19	$27,075.46	$240,429.55	$84,204.57	nat. median $9,890 outlier · 8.5×
J0638 HCPCS	Canakinumab (pf) 150 Mg/ml Subcutaneous Solution	19	$52,227.35	$115,944.71	$81,337.67	nat. median $257 outlier · 316.7×
J9334 HCPCS	Efgartigimod Alfa 1008 Mg-hyaluron-qvfc 11200 Unit/5.6 Ml Subcut Soln	19	$48,107.65	$106,798.99	$74,921.75	nat. median $73 outlier · 1021.3×
J2507 HCPCS	Pegloticase 8 Mg/ml Intravenous Solution	19	$46,927.30	$153,038.15	$73,852.80	nat. median $8,536 outlier · 8.7×
J3241 HCPCS	Teprotumumab-trbw 500 Mg Intravenous Solution	19	$47,188.38	$104,758.21	$73,490.10	nat. median $704 outlier · 104.4×
J9298 HCPCS	Nivolumab 240 Mg-relatlimab-rmbw 80 Mg/20 Ml Intravenous Solution	19	$44,324.07	$98,399.43	$69,029.28	nat. median $561 outlier · 123.0×
J1628 HCPCS	Guselkumab 200 Mg/2 Ml Subcutaneous Syringe	19	$42,312.04	$95,177.31	$66,242.62	nat. median $208 outlier · 319.0×
J2327 HCPCS	Risankizumab-rzaa 150 Mg/ml Subcutaneous Syringe	19	$30,529.47	$146,254.08	$65,880.22	nat. median $2,241 outlier · 29.4×
J3245 HCPCS	Tildrakizumab-asmn 100 Mg/ml Subcutaneous Syringe	19	$40,619.29	$90,174.83	$63,259.55	nat. median $256 outlier · 247.1×
J1303 HCPCS	Ravulizumab-cwvz 100 Mg/ml Intravenous Solution	19	$19,532.21	$162,171.96	$58,205.96	nat. median $4,664 outlier · 12.5×
J3357 HCPCS	Ustekinumab 45 Mg/0.5 Ml Subcutaneous Solution	19	$36,891.01	$95,238.11	$58,057.97	nat. median $14,292 outlier · 4.1×
J9042 HCPCS	Brentuximab Vedotin 50 Mg Intravenous Solution	19	$35,813.10	$79,505.09	$55,774.50	nat. median $1,037 outlier · 53.8×
J9272 HCPCS	Dostarlimab-gxly 50 Mg/ml Intravenous Solution	19	$34,575.99	$76,758.70	$53,847.86	nat. median $742 outlier · 72.5×
J9043 HCPCS	Cabazitaxel 10 Mg/ml (first Dilution) Intravenous Solution	19	$34,438.46	$76,617.53	$53,691.24	nat. median $735 outlier · 73.0×
J1640 HCPCS	Hemin 350 Mg Intravenous Powder For Solution	19	$33,368.50	$74,078.06	$51,967.33	nat. median $76 outlier · 684.5×
J9144 HCPCS	Daratumumab 1800 Mg-hyaluronidase-fihj 30000 Unit/15 Ml Subcut Soln	19	$32,082.97	$71,224.19	$49,965.28	nat. median $232 outlier · 215.3×
J2329 HCPCS	Ublituximab-xiiy 25 Mg/ml Intravenous Solution	19	$31,941.14	$70,909.32	$49,744.39	nat. median $169 outlier · 294.4×
J9381 HCPCS	Teplizumab-mzwv 1 Mg/ml Intravenous Solution	19	$31,388.56	$73,338.94	$49,340.47	nat. median $56 outlier · 883.6×
J9119 HCPCS	Cemiplimab-rwlc 50 Mg/ml Intravenous Solution	19	$31,408.36	$69,726.54	$48,914.65	nat. median $91 outlier · 538.6×
J2267 HCPCS	Mirikizumab-mrkz 300 Mg/15 Ml (20 Mg/ml) Intravenous Solution	19	$29,259.33	$64,955.70	$45,567.80	nat. median $79 outlier · 580.2×
J0222 HCPCS	Patisiran (lipid Complex) 2 Mg/ml Intravenous Solution	19	$28,975.00	$64,324.50	$45,125.00	nat. median $156 outlier · 289.7×
J3380 HCPCS	Vedolizumab 300 Mg Intravenous Solution	19	$28,547.73	$63,375.96	$44,459.58	nat. median $280 outlier · 158.6×
J9301 HCPCS	Obinutuzumab 1000 Mg/40 Ml Intravenous Solution	19	$26,268.80	$58,316.73	$40,910.42	nat. median $314 outlier · 130.5×
J9309 HCPCS	Polatuzumab Vedotin-piiq 140 Mg Intravenous Solution	19	$11,809.64	$122,347.44	$40,664.42	nat. median $4,472 outlier · 9.1×
A9604 HCPCS	Hc Rp Sm 153 Tx Ds Upto 150mci	19	$25,818.86	$57,317.87	$40,209.70	nat. median $11,409 outlier · 3.5×
J0584 HCPCS	Burosumab-twza 20 Mg/ml Subcutaneous Solution	19	$10,629.25	$86,116.29	$39,566.95	nat. median $812 outlier · 48.7×
C9047 HCPCS	Caplacizumab-yhdp 11 Mg Injection Kit	19	$24,171.25	$53,660.18	$37,643.75	nat. median $2,981 outlier · 12.6×
C2624 HCPCS	Sys Del Pa Sens Cardiomems Cm2000	19	$22,417.50	$56,307.64	$35,280.00	nat. median $32,760 1.1× median
J9022 HCPCS	Atezolizumab 1200 Mg/20 Ml (60 Mg/ml) Intravenous Solution	19	$18,870.25	$76,186.08	$34,318.06	nat. median $6,911 outlier · 5.0×
J1440 HCPCS	Fecal Microbiota Live-jslm 150 Ml Rectal Suspension Enema	19	$21,960.00	$48,751.20	$34,200.00	nat. median $110 outlier · 312.0×
J0391 HCPCS	Artesunate 110 Mg Intravenous Solution	19	$16,404.43	$72,835.65	$32,808.85	nat. median $100 outlier · 328.1×
J9223 HCPCS	Lurbinectedin 4 Mg Intravenous Solution	19	$21,039.88	$46,708.53	$32,767.02	nat. median $626 outlier · 52.4×
J1932 HCPCS	Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe	19	$20,782.00	$46,136.04	$32,365.41	nat. median $80 outlier · 402.1×
J9306 HCPCS	Pertuzumab 420 Mg/14 Ml (30 Mg/ml) Intravenous Solution	19	$20,729.70	$46,019.93	$32,283.96	nat. median $85 outlier · 380.2×
J0896 HCPCS	Luspatercept-aamt 25 Mg Subcutaneous Solution	19	$12,057.94	$80,305.55	$31,471.15	nat. median $4,606 outlier · 6.8×
J9063 HCPCS	Mirvetuximab Soravtansine-gynx 5 Mg/ml Intravenous Solution	19	$19,785.84	$43,924.57	$30,814.01	nat. median $214 outlier · 143.8×
J0741 HCPCS	Cabotegravir ER 600 Mg/3 Ml-rilpivirine ER 900 Mg/3ml IM Suspensioner	19	$19,609.50	$43,533.08	$30,539.38	nat. median $67 outlier · 455.2×
J9273 HCPCS	Tisotumab Vedotin-tftv 40 Mg Intravenous Solution	19	$19,373.60	$43,009.40	$30,172.00	nat. median $549 outlier · 54.9×
J9332 HCPCS	Efgartigimod Alfa-fcab 20 Mg/ml Intravenous Solution	19	$18,880.66	$41,915.07	$29,404.31	nat. median $112 outlier · 262.1×
C2642 HCPCS	Dev Gammatile Therapy 10pk Gt-10	19	$3,224.29	$111,382.95	$29,331.85	nat. median $1,502 outlier · 19.5×
J3101 HCPCS	Tenecteplase 50 Mg Intravenous Kit	19	$18,493.34	$54,214.45	$29,104.28	nat. median $5,957 outlier · 4.9×
63685 CPT	Hc Insrt Redo Spine N Generator	19	$18,159.09	$40,313.18	$28,280.55	nat. median $21,357 1.3× median
L8687 HCPCS	Genrtr Imp Pulse MRI Prodigy 3772 Controlsys	19	$18,147.50	$40,287.45	$28,262.50	nat. median $14,605 1.9× median

Other procedures at this hospital

Browse this hospital's 5,061 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

J0225	HCPCS	Vutrisiran 25 Mg/0.5 Ml Subcutaneous Syringe	32	19	$596,755.00	$501,274.20	$364,020.55	$808,125.63	$566,917.25	2026-02-28
A9513	HCPCS	Lutetium Lu 177 Dotatate 10 Mci/ml (370 Mbq/ml) Intravenous Solution	32	19	$237,500.00	$199,500.00	$144,875.00	$321,622.50	$225,625.00	2026-02-28
J1823	HCPCS	Inebilizumab-cdon 10 Mg/ml Intravenous Solution	32	19	$218,333.00	$183,399.72	$133,183.13	$295,666.55	$207,416.35	2026-02-28
J2351	HCPCS	Ocrelizumab 920 Mg-hyaluronidase-ocsq 23000 Unit/23 Ml Subcut Soln	32	19	$206,409.59	$173,384.06	$125,909.85	$279,519.87	$196,089.12	2026-02-28
C9293	HCPCS	Glucarpidase 1000 Unit Intravenous Solution	32	19	$205,870.00	$172,930.80	$125,580.70	$278,789.16	$195,576.50	2026-02-28
J1747	HCPCS	Spesolimab-sbzo 60 Mg/ml Intravenous Solution	32	19	$127,832.52	$107,379.32	$77,977.84	$173,110.80	$121,440.90	2026-02-28
J2350	HCPCS	Ocrelizumab 30 Mg/ml Intravenous Solution	32	19	$98,571.50	$82,800.06	$60,128.62	$133,485.53	$93,642.93	2026-02-28
J9228	HCPCS	Ipilimumab 200 Mg/40 Ml (5 Mg/ml) Intravenous Solution	64	19	$110,964.80	$93,210.43	$27,075.46	$240,429.55	$84,204.57	2026-02-28
J0638	HCPCS	Canakinumab (pf) 150 Mg/ml Subcutaneous Solution	32	19	$85,618.60	$71,919.63	$52,227.35	$115,944.71	$81,337.67	2026-02-28
J9334	HCPCS	Efgartigimod Alfa 1008 Mg-hyaluron-qvfc 11200 Unit/5.6 Ml Subcut Soln	32	19	$78,865.00	$66,246.60	$48,107.65	$106,798.99	$74,921.75	2026-02-28
J2507	HCPCS	Pegloticase 8 Mg/ml Intravenous Solution	64	19	$94,970.00	$79,774.80	$46,927.30	$153,038.15	$73,852.80	2026-02-28
J3241	HCPCS	Teprotumumab-trbw 500 Mg Intravenous Solution	32	19	$77,358.00	$64,980.72	$47,188.38	$104,758.21	$73,490.10	2026-02-28
J9298	HCPCS	Nivolumab 240 Mg-relatlimab-rmbw 80 Mg/20 Ml Intravenous Solution	32	19	$72,662.40	$61,036.42	$44,324.07	$98,399.43	$69,029.28	2026-02-28
J1628	HCPCS	Guselkumab 200 Mg/2 Ml Subcutaneous Syringe	64	19	$69,823.52	$58,651.76	$42,312.04	$95,177.31	$66,242.62	2026-02-28
J2327	HCPCS	Risankizumab-rzaa 150 Mg/ml Subcutaneous Syringe	64	19	$79,024.33	$66,380.44	$30,529.47	$146,254.08	$65,880.22	2026-02-28
J3245	HCPCS	Tildrakizumab-asmn 100 Mg/ml Subcutaneous Syringe	32	19	$66,589.00	$55,934.76	$40,619.29	$90,174.83	$63,259.55	2026-02-28
J1303	HCPCS	Ravulizumab-cwvz 100 Mg/ml Intravenous Solution	64	19	$75,887.40	$63,745.43	$19,532.21	$162,171.96	$58,205.96	2026-02-28
J3357	HCPCS	Ustekinumab 45 Mg/0.5 Ml Subcutaneous Solution	64	19	$65,402.50	$54,938.11	$36,891.01	$95,238.11	$58,057.97	2026-02-28
J9042	HCPCS	Brentuximab Vedotin 50 Mg Intravenous Solution	32	19	$58,710.00	$49,316.40	$35,813.10	$79,505.09	$55,774.50	2026-02-28
J9272	HCPCS	Dostarlimab-gxly 50 Mg/ml Intravenous Solution	32	19	$56,681.95	$47,612.84	$34,575.99	$76,758.70	$53,847.86	2026-02-28
J9043	HCPCS	Cabazitaxel 10 Mg/ml (first Dilution) Intravenous Solution	64	19	$56,517.09	$47,474.36	$34,438.46	$76,617.53	$53,691.24	2026-02-28
J1640	HCPCS	Hemin 350 Mg Intravenous Powder For Solution	32	19	$54,702.45	$45,950.06	$33,368.50	$74,078.06	$51,967.33	2026-02-28
J9144	HCPCS	Daratumumab 1800 Mg-hyaluronidase-fihj 30000 Unit/15 Ml Subcut Soln	32	19	$52,595.03	$44,179.83	$32,082.97	$71,224.19	$49,965.28	2026-02-28
J2329	HCPCS	Ublituximab-xiiy 25 Mg/ml Intravenous Solution	32	19	$52,362.51	$43,984.51	$31,941.14	$70,909.32	$49,744.39	2026-02-28
J9381	HCPCS	Teplizumab-mzwv 1 Mg/ml Intravenous Solution	64	19	$52,806.65	$44,357.59	$31,388.56	$73,338.94	$49,340.47	2026-02-28
J9119	HCPCS	Cemiplimab-rwlc 50 Mg/ml Intravenous Solution	32	19	$51,489.10	$43,250.85	$31,408.36	$69,726.54	$48,914.65	2026-02-28
J2267	HCPCS	Mirikizumab-mrkz 300 Mg/15 Ml (20 Mg/ml) Intravenous Solution	32	19	$47,966.10	$40,291.53	$29,259.33	$64,955.70	$45,567.80	2026-02-28
J0222	HCPCS	Patisiran (lipid Complex) 2 Mg/ml Intravenous Solution	32	19	$47,500.00	$39,900.00	$28,975.00	$64,324.50	$45,125.00	2026-02-28
J3380	HCPCS	Vedolizumab 300 Mg Intravenous Solution	32	19	$46,799.55	$39,311.63	$28,547.73	$63,375.96	$44,459.58	2026-02-28
J9301	HCPCS	Obinutuzumab 1000 Mg/40 Ml Intravenous Solution	32	19	$43,063.60	$36,173.43	$26,268.80	$58,316.73	$40,910.42	2026-02-28
J9309	HCPCS	Polatuzumab Vedotin-piiq 140 Mg Intravenous Solution	64	19	$54,853.35	$46,076.82	$11,809.64	$122,347.44	$40,664.42	2026-02-28
A9604	HCPCS	Hc Rp Sm 153 Tx Ds Upto 150mci	32	19	$42,326.00	$35,553.84	$25,818.86	$57,317.87	$40,209.70	2026-02-28
J0584	HCPCS	Burosumab-twza 20 Mg/ml Subcutaneous Solution	160	19	$42,394.80	$35,611.64	$10,629.25	$86,116.29	$39,566.95	2026-02-28
C9047	HCPCS	Caplacizumab-yhdp 11 Mg Injection Kit	32	19	$39,625.00	$33,285.00	$24,171.25	$53,660.18	$37,643.75	2026-02-28
C2624	HCPCS	Sys Del Pa Sens Cardiomems Cm2000	64	19	$39,165.00	$32,898.60	$22,417.50	$56,307.64	$35,280.00	2026-02-28
J9022	HCPCS	Atezolizumab 1200 Mg/20 Ml (60 Mg/ml) Intravenous Solution	64	19	$43,596.96	$36,621.45	$18,870.25	$76,186.08	$34,318.06	2026-02-28
J1440	HCPCS	Fecal Microbiota Live-jslm 150 Ml Rectal Suspension Enema	32	19	$36,000.00	$30,240.00	$21,960.00	$48,751.20	$34,200.00	2026-02-28
J0391	HCPCS	Artesunate 110 Mg Intravenous Solution	64	19	$40,338.75	$33,884.55	$16,404.43	$72,835.65	$32,808.85	2026-02-28
J9223	HCPCS	Lurbinectedin 4 Mg Intravenous Solution	32	19	$34,491.60	$28,972.95	$21,039.88	$46,708.53	$32,767.02	2026-02-28
J1932	HCPCS	Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe	32	19	$34,068.85	$28,617.84	$20,782.00	$46,136.04	$32,365.41	2026-02-28
J9306	HCPCS	Pertuzumab 420 Mg/14 Ml (30 Mg/ml) Intravenous Solution	32	19	$33,983.11	$28,545.82	$20,729.70	$46,019.93	$32,283.96	2026-02-28
J0896	HCPCS	Luspatercept-aamt 25 Mg Subcutaneous Solution	64	19	$39,534.10	$33,208.65	$12,057.94	$80,305.55	$31,471.15	2026-02-28
J9063	HCPCS	Mirvetuximab Soravtansine-gynx 5 Mg/ml Intravenous Solution	32	19	$32,435.80	$27,246.08	$19,785.84	$43,924.57	$30,814.01	2026-02-28
J0741	HCPCS	Cabotegravir ER 600 Mg/3 Ml-rilpivirine ER 900 Mg/3ml IM Suspensioner	32	19	$32,146.71	$27,003.24	$19,609.50	$43,533.08	$30,539.38	2026-02-28
J9273	HCPCS	Tisotumab Vedotin-tftv 40 Mg Intravenous Solution	32	19	$31,760.00	$26,678.40	$19,373.60	$43,009.40	$30,172.00	2026-02-28
J9332	HCPCS	Efgartigimod Alfa-fcab 20 Mg/ml Intravenous Solution	32	19	$30,951.90	$25,999.60	$18,880.66	$41,915.07	$29,404.31	2026-02-28
C2642	HCPCS	Dev Gammatile Therapy 10pk Gt-10	448	19	$37,000.00	$31,080.00	$3,224.29	$111,382.95	$29,331.85	2026-02-28
J3101	HCPCS	Tenecteplase 50 Mg Intravenous Kit	64	19	$35,175.62	$29,547.53	$18,493.34	$54,214.45	$29,104.28	2026-02-28
63685	CPT	Hc Insrt Redo Spine N Generator	32	19	$29,769.00	$25,005.96	$18,159.09	$40,313.18	$28,280.55	2026-02-28
L8687	HCPCS	Genrtr Imp Pulse MRI Prodigy 3772 Controlsys	32	19	$29,750.00	$24,990.00	$18,147.50	$40,287.45	$28,262.50	2026-02-28
J9271	HCPCS	Pembrolizumab 25 Mg/ml Intravenous Solution	32	19	$29,488.60	$24,770.43	$17,988.05	$39,933.47	$28,014.17	2026-02-28
J1930	HCPCS	Lanreotide 120 Mg/0.5 Ml Subcutaneous Syringe	96	19	$38,795.00	$32,587.80	$8,812.80	$61,954.65	$27,907.50	2026-02-28
J9207	HCPCS	Ixabepilone 45 Mg Intravenous Solution	32	19	$29,044.90	$24,397.72	$17,717.39	$39,332.61	$27,592.66	2026-02-28
J0717	HCPCS	Certolizumab Pegol 400 Mg (200 Mg X 2 Vials) Subcutaneous Kit	64	19	$29,202.60	$24,530.19	$17,392.97	$40,479.95	$27,287.19	2026-02-28
J2323	HCPCS	Natalizumab 300 Mg/15 Ml Intravenous Solution	64	19	$31,455.79	$26,422.87	$12,336.03	$57,808.88	$26,040.04	2026-02-28
J0775	HCPCS	Collagenase Clostridium Histolyticum 0.9 Mg Solution For Injection	32	19	$26,169.45	$21,982.34	$15,963.37	$35,438.67	$24,860.98	2026-02-28
J0491	HCPCS	Anifrolumab-fnia 300 Mg/2 Ml (150 Mg/ml) Intravenous Solution	32	19	$26,146.85	$21,963.36	$15,949.58	$35,408.07	$24,839.51	2026-02-28
J0517	HCPCS	Benralizumab 30 Mg/ml Subcutaneous Auto-injector	64	19	$27,083.20	$22,749.89	$15,727.42	$38,437.28	$24,751.35	2026-02-28
J9286	HCPCS	Glofitamab-gxbm 1 Mg/ml Intravenous Solution	64	19	$31,934.30	$26,824.82	$7,791.96	$69,192.72	$24,233.02	2026-02-28
J0870	HCPCS	Imetelstat 188 Mg Intravenous Solution	64	19	$31,814.12	$26,723.87	$7,762.65	$68,932.31	$24,141.83	2026-02-28
C1882	HCPCS	Biv Aice Unify Assura Cd3357-40c	1,056	19	$28,875.00	$24,255.00	$3,499.88	$86,736.51	$23,844.24	2026-02-28
J9021	HCPCS	Asparaginase Erwinia Chrysanthemi-rywn 10 Mg/0.5 Ml IM Solution	32	19	$24,900.00	$20,916.00	$15,189.00	$33,719.58	$23,655.00	2026-02-28
J1162	HCPCS	Digoxin Immune Fab 40 Mg Intravenous Solution	32	19	$23,999.55	$20,159.63	$14,639.73	$32,500.20	$22,799.58	2026-02-28
J3285	HCPCS	Treprostinil Sodium 1 Mg/ml Injection Solution	128	19	$27,632.85	$23,211.60	$4,494.97	$107,767.24	$22,474.72	2026-02-28
J7504	HCPCS	Lymphocyteanti-thymo Immune Globulin 50 Mg/ml Intravenous Solution	32	19	$23,257.70	$19,536.47	$14,187.20	$31,495.58	$22,094.82	2026-02-28
J1575	HCPCS	Igg 30 Gram/300 Ml (10 %)-hyaluronidaserecomb. Subcutaneous Solution	32	19	$23,171.40	$19,463.98	$14,134.56	$31,378.71	$22,012.83	2026-02-28
J2506	HCPCS	Pegfilgrastim 6 Mg/0.6 Ml (deliverable) Wearable Subcutaneous Injector	32	19	$22,363.90	$18,785.68	$13,641.98	$30,285.20	$21,245.71	2026-02-28
36905	CPT	Hc Perq Thrmbc/nfs Dial Circuit Trluml Balo Angiop	32	19	$22,290.00	$18,723.60	$13,596.90	$30,185.12	$21,175.50	2026-02-28
J9295	HCPCS	Necitumumab 800 Mg/50 Ml (16 Mg/ml) Intravenous Solution	32	19	$21,648.75	$18,184.95	$13,205.74	$29,316.74	$20,566.32	2026-02-28
C1721	HCPCS	Defib Current Dr 36j 2207-36	1,088	19	$23,362.50	$19,624.50	$36.36	$109,040.19	$20,476.19	2026-02-28
C1722	HCPCS	Defib Momen El Icd Vr D120	1,184	19	$24,500.00	$20,580.00	$5,871.25	$101,605.63	$20,283.42	2026-02-28
J9039	HCPCS	Blinatumomab 35 Mcg Intravenous Solution	32	19	$21,210.50	$17,816.82	$12,938.41	$28,723.26	$20,149.98	2026-02-28
J2353	HCPCS	Octreotidemicrospheres ER 20 Mg Intramuscular Susp Extended Release	64	19	$26,097.12	$21,921.58	$12,748.55	$42,379.69	$20,063.28	2026-02-28
J2356	HCPCS	Tezepelumab-ekko 210 Mg/1.91 Ml (110 Mg/ml) Subcutaneous Syringe	32	19	$20,804.56	$17,475.84	$12,690.79	$28,173.54	$19,764.34	2026-02-28
J0185	HCPCS	Aprepitant 130 Mg/18 Ml (7.2 Mg/ml) Intravenous Emulsion	32	19	$20,640.60	$17,338.11	$12,590.77	$27,951.51	$19,608.57	2026-02-28
34718	CPT	Hc Evasc Rpr N/a A-iliac Ndgft	32	19	$20,149.00	$16,925.16	$12,290.89	$27,285.78	$19,141.55	2026-02-28
J7189	HCPCS	Coagulation Factor Viia Recomb 1 Mg (1000 Mcg) Intravenous Solution	96	19	$20,065.50	$16,855.02	$7,320.00	$74,399.75	$19,062.23	2026-02-28
J9354	HCPCS	Ado-trastuzumab Emtansine 100 Mg Intravenous Solution	64	19	$25,296.35	$21,248.94	$11,869.84	$42,161.60	$18,991.71	2026-02-28
34717	CPT	Hc Evasc Rpr A-iliac Ndgft	32	19	$19,821.00	$16,649.64	$12,090.81	$26,841.60	$18,829.95	2026-02-28
C1772	HCPCS	Defibrillator Emblem MRI S-icd	256	19	$21,523.25	$18,079.53	$6,832.00	$94,171.07	$18,816.00	2026-02-28
J7686	HCPCS	Treprostinil 1.74 Mg/2.9 Ml (0.6 Mg/ml) Solution For Nebulization	96	19	$19,536.00	$16,410.24	$5,672.98	$110,197.46	$18,559.20	2026-02-28
C1767	HCPCS	Generator Pk Access 502	1,824	19	$21,600.00	$18,144.00	$438.30	$119,968.99	$18,480.00	2026-02-28
J3055	HCPCS	Talquetamab-tgvs 2 Mg/ml Subcutaneous Solution	64	19	$27,828.57	$23,376.01	$2,368.67	$70,112.49	$18,420.32	2026-02-28
J0402	HCPCS	Aripiprazole ER (2 Month) 720 Mg/2.4 Ml Susp Extended Rel IM Syringe	64	19	$22,313.73	$18,743.53	$11,666.86	$34,534.08	$18,360.96	2026-02-28
J0739	HCPCS	Cabotegravir ER 600 Mg/3 Ml (200 Mg/ml) IM Suspensionextended Release	64	19	$19,202.10	$16,129.77	$11,626.09	$26,197.07	$18,201.50	2026-02-28
J9061	HCPCS	Amivantamab-vmjw 50 Mg/ml Intravenous Solution	32	19	$19,033.39	$15,988.05	$11,610.37	$25,775.02	$18,081.73	2026-02-28
J0565	HCPCS	Bezlotoxumab 25 Mg/ml Intravenous Solution	32	19	$19,000.00	$15,960.00	$11,590.00	$25,729.80	$18,050.00	2026-02-28
J9304	HCPCS	Pemetrexed 25 Mg/ml Intravenous Solution	32	19	$18,325.20	$15,393.17	$11,178.38	$24,815.99	$17,408.94	2026-02-28
C1820	HCPCS	Ipg Rechargeable 3788	864	19	$18,710.00	$15,716.40	$823.50	$92,733.73	$17,386.69	2026-02-28
J9303	HCPCS	Panitumumab 100 Mg/5 Ml (20 Mg/ml) Intravenous Solution	64	19	$21,850.88	$18,354.74	$5,331.62	$47,344.73	$16,581.33	2026-02-28
J0597	HCPCS	C1 Esterase Inhibitor 500 Unit (10 Ml) Intravenous Kit	32	19	$17,390.60	$14,608.11	$10,608.27	$23,550.36	$16,521.07	2026-02-28
J1306	HCPCS	Inclisiran 284 Mg/1.5 Ml Subcutaneous Syringe	32	19	$16,907.10	$14,201.97	$10,313.34	$22,895.60	$16,061.75	2026-02-28
J9308	HCPCS	Ramucirumab 10 Mg/ml Intravenous Solution	64	19	$21,853.07	$18,356.58	$4,356.11	$49,516.33	$15,987.60	2026-02-28
L8614	HCPCS	Elctrd Profle Nucmodiolar Slim P783831	128	19	$20,627.29	$17,326.93	$8,912.56	$37,172.97	$15,596.97	2026-02-28
J9299	HCPCS	Nivolumab 100 Mg/10 Ml Intravenous Solution	128	19	$16,270.99	$13,667.63	$3,446.18	$51,694.15	$14,969.86	2026-02-28
J1743	HCPCS	Idursulfase 6 Mg/3 Ml Intravenous Solution	32	19	$15,679.16	$13,170.50	$9,564.29	$21,232.72	$14,895.21	2026-02-28
J9352	HCPCS	Trabectedin 1 Mg Intravenous Solution	32	19	$15,486.40	$13,008.58	$9,446.71	$20,971.69	$14,712.08	2026-02-28
J2182	HCPCS	Mepolizumab 100 Mg Subcutaneous Solution	64	19	$16,860.43	$14,162.76	$9,318.79	$24,977.07	$14,665.64	2026-02-28
Q5111	HCPCS	Pegfilgrastim-cbqv 6 Mg/0.6 Ml (deliverable) Wearable Subcut Injector	64	19	$15,557.26	$13,068.10	$9,286.74	$21,518.72	$14,539.08	2026-02-28
J1437	HCPCS	Ferric Derisomaltose 100 Mg Iron/ml Intravenous Solution	32	19	$15,073.30	$12,661.58	$9,194.72	$20,412.27	$14,319.64	2026-02-28
Q5120	HCPCS	Pegfilgrastim-bmez 6 Mg/0.6 Ml Subcutaneous Syringe	32	19	$14,927.80	$12,539.36	$9,105.96	$20,215.23	$14,181.41	2026-02-28
J9358	HCPCS	Fam-trastuzumab Deruxtecan-nxki 100 Mg Intravenous Solution	32	19	$14,622.40	$12,282.82	$8,919.67	$19,801.66	$13,891.28	2026-02-28
J0180	HCPCS	Agalsidase Beta 35 Mg Intravenous Solution	64	19	$19,693.72	$16,542.73	$3,002.85	$46,672.17	$13,844.92	2026-02-28
36904	CPT	Hc Perq Thrmbc/nfs Dialysis Circuit Img Dx Angrph	32	19	$14,558.00	$12,228.72	$8,880.38	$19,714.45	$13,830.10	2026-02-28
36902	CPT	Hc Intro Cath Dialysis Circuit W/trluml Balo Angiop	32	19	$14,558.00	$12,228.72	$8,880.38	$19,714.45	$13,830.10	2026-02-28
J0598	HCPCS	C1 Esterase Inhibitor 500 Unit (5 Ml) Intravenous Solution	32	19	$14,345.70	$12,050.39	$8,750.88	$19,426.95	$13,628.42	2026-02-28
J9177	HCPCS	Enfortumab Vedotin-ejfv 20 Mg Intravenous Solution	64	19	$17,350.00	$14,574.00	$8,567.45	$27,971.01	$13,483.20	2026-02-28
J2425	HCPCS	Palifermin 6.25 Mg Intravenous Solution	32	19	$14,109.89	$11,852.31	$8,607.04	$19,107.62	$13,404.40	2026-02-28
J1950	HCPCS	Leuprolide 11.25 Mg (3 Month) Intramuscular Syringe Kit	64	19	$16,473.05	$13,837.36	$5,024.27	$33,461.75	$13,113.37	2026-02-28
J9205	HCPCS	Irinotecan Liposomal 4.3 Mg/ml Intravenous	32	19	$13,495.00	$11,335.80	$8,231.95	$18,274.93	$12,820.25	2026-02-28
A9548	HCPCS	Hc Rp Indium Dtpa 0.5 Mci	32	19	$13,156.00	$11,051.04	$8,025.16	$17,815.86	$12,498.20	2026-02-28
Q4130	HCPCS	Tiss Firm Strattice 10x20 1020002	512	19	$15,129.90	$12,709.12	$2,401.88	$63,110.14	$12,117.11	2026-02-28
22513	CPT	Hc Perq Vert Augment Thoracic	64	19	$13,110.50	$11,012.82	$7,616.46	$18,599.94	$11,986.56	2026-02-28
36566	CPT	Pc In Tun Ven Dev 2 Cth W Port	32	19	$12,578.00	$10,565.52	$7,672.58	$17,033.13	$11,949.10	2026-02-28
22514	CPT	Hc Perq Vert Augment Lumbar	32	19	$12,486.00	$10,488.24	$7,616.46	$16,908.55	$11,861.70	2026-02-28
J9317	HCPCS	Sacituzumab Govitecan-hziy 180 Mg Intravenous Solution	32	19	$12,319.80	$10,348.64	$7,515.08	$16,683.48	$11,703.81	2026-02-28
J9355	HCPCS	Trastuzumab 150 Mg Intravenous Solution	64	19	$14,354.60	$12,057.87	$4,753.19	$28,325.94	$11,655.76	2026-02-28
Q5117	HCPCS	Trastuzumab-anns 420 Mg Intravenous Solution	96	19	$17,130.60	$14,389.71	$3,801.01	$23,627.00	$11,053.52	2026-02-28
J9268	HCPCS	Pentostatin 10 Mg Intravenous Solution	32	19	$11,626.95	$9,766.64	$7,092.44	$15,745.22	$11,045.61	2026-02-28
C1896	HCPCS	Electrd Q Trak 3400	192	19	$12,945.00	$10,873.80	$5,490.00	$34,362.83	$10,800.00	2026-02-28
J2799	HCPCS	Risperidone ER 100 Mg/0.28 Ml Subcutaneous Extend Release Susp Syringe	224	19	$13,963.51	$11,729.35	$3,406.80	$37,818.82	$10,732.23	2026-02-28
90378	CPT	Palivizumab 100 Mg/ml Intramuscular Solution	128	19	$15,828.02	$13,295.55	$4,966.26	$22,272.45	$10,690.52	2026-02-28
J9176	HCPCS	Elotuzumab 300 Mg Intravenous Solution	64	19	$12,759.12	$10,717.67	$6,671.24	$19,746.68	$10,499.00	2026-02-28
J9312	HCPCS	Rituximab 10 Mg/ml Concentrateintravenous	64	19	$14,092.80	$11,837.95	$2,865.54	$31,807.45	$10,344.58	2026-02-28
J3247	HCPCS	Secukinumab 25 Mg/ml Intravenous Solution	32	19	$10,680.75	$8,971.83	$6,515.26	$14,463.88	$10,146.72	2026-02-28
J3145	HCPCS	Testosterone Undecanoate 750 Mg/3 Ml (250mg/ml) Intramuscular Solution	32	19	$10,362.41	$8,704.43	$6,321.08	$14,032.78	$9,844.29	2026-02-28
J0349	HCPCS	Rezafungin 200 Mg Intravenous Solution	32	19	$10,243.35	$8,604.42	$6,248.45	$13,871.55	$9,731.19	2026-02-28
J9173	HCPCS	Durvalumab 50 Mg/ml Intravenous Solution	64	19	$12,942.46	$10,871.67	$2,947.93	$28,508.96	$9,693.15	2026-02-28
J3358	HCPCS	Ustekinumab 130 Mg/26 Ml Intravenous Solution	32	19	$10,117.38	$8,498.60	$6,171.61	$13,700.96	$9,611.52	2026-02-28
J9023	HCPCS	Avelumab 20 Mg/ml Intravenous Solution	32	19	$10,067.40	$8,456.62	$6,141.12	$13,633.28	$9,564.03	2026-02-28
C2621	HCPCS	Cath Halo Xp 2-8-2mm D7-t20-282-rt	672	19	$10,850.00	$9,114.00	$42.70	$29,623.13	$9,472.10	2026-02-28
C1817	HCPCS	Blln Cardioseal Sz-25mm Vsb-025	288	19	$10,732.75	$9,015.51	$183.00	$48,263.69	$9,352.28	2026-02-28
J9333	HCPCS	Rozanolixizumab-noli 140 Mg/ml Subcutaneous Solution	64	19	$15,174.75	$12,746.79	$60.70	$40,964.55	$9,293.62	2026-02-28
J0219	HCPCS	Avalglucosidase Alfa-ngpt 100 Mg Intravenous Solution	32	19	$9,737.00	$8,179.08	$5,939.57	$13,185.85	$9,250.15	2026-02-28
J1944	HCPCS	Aripiprazole Lauroxil ER 662 Mg/2.4 Ml Suspension Ext.rel. IM Syringe	96	19	$10,921.76	$9,174.28	$5,858.54	$16,815.44	$9,220.00	2026-02-28
C9470	HCPCS	Aripiprazole ER 300 Mg Intramuscular Suspensionextended Release	64	19	$11,158.98	$9,373.54	$5,836.03	$17,267.00	$9,184.56	2026-02-28
J0401	HCPCS	Aripiprazole ER 300 Mg Suspension Extended Rel. Intramuscular Syringe	64	19	$11,156.88	$9,371.78	$5,833.47	$17,267.00	$9,180.53	2026-02-28
J1602	HCPCS	Golimumab 12.5 Mg/ml Intravenous Solution	32	19	$9,641.26	$8,098.66	$5,881.17	$13,056.20	$9,159.20	2026-02-28
A9572	HCPCS	Hc Rp 111 In Penetetrtd To 6mc	32	19	$9,620.00	$8,080.80	$5,868.20	$13,027.41	$9,139.00	2026-02-28
90396	CPT	Varicella-zoster Immune Glob-maltose 125 Unit/1.2 Ml IM Solution	32	19	$9,462.71	$7,948.68	$5,772.26	$12,814.41	$8,989.58	2026-02-28
J3240	HCPCS	Thyrotropin Alfa 0.9 Mg Intramuscular Solution	64	19	$9,602.55	$8,066.15	$5,684.53	$13,387.90	$8,946.15	2026-02-28
C1761	HCPCS	Cath C2 Shockwave Ivl 2.5x12mm C2ivl2512	64	19	$9,940.50	$8,350.02	$5,676.66	$14,320.67	$8,933.76	2026-02-28
J0897	HCPCS	Denosumab 60 Mg/ml Subcutaneous Syringe	96	19	$9,095.85	$7,640.52	$5,519.32	$22,538.43	$8,732.02	2026-02-28
J9330	HCPCS	Temsirolimus 30 Mg/3 Ml (10 Mg/ml) (first Dilution) Intravenous Soln	32	19	$9,147.45	$7,683.86	$5,579.95	$12,387.48	$8,690.08	2026-02-28
J3032	HCPCS	Eptinezumab-jjmr 100 Mg/ml Intravenous Solution	32	19	$9,139.15	$7,676.89	$5,574.89	$12,376.24	$8,682.20	2026-02-28
74174	CPT	Hc CT Angio Ab Pelv W Wo Contr	32	19	$9,118.00	$7,659.12	$5,561.98	$12,347.60	$8,662.10	2026-02-28
Q4114	HCPCS	Sealr Wound Matrix Flo 3 Ml Fwd301	64	19	$9,603.37	$8,066.84	$5,484.14	$13,834.99	$8,630.78	2026-02-28
C1764	HCPCS	Imp Monitor Internal Confrim Dm2100	96	19	$9,562.50	$8,032.50	$5,476.28	$13,711.28	$8,618.40	2026-02-28
23410	CPT	Hc Repair Rotator Cuff Acute	32	19	$9,062.00	$7,612.08	$5,527.82	$12,271.77	$8,608.90	2026-02-28
J0840	HCPCS	Crotalidae Polyval Immune Fab Solution For Injection	32	19	$8,953.13	$7,520.63	$5,461.41	$12,124.33	$8,505.48	2026-02-28
74178	CPT	Hc CT Abd Pelvis W Wo Contrast	34	19	$9,097.00	$7,641.48	$2,965.01	$12,319.16	$8,460.21	2026-02-28
Other Inpatient	LOCAL	No Active Code Description	19	11	—	—	$8,404.50	$8,404.50	$8,404.50	2026-02-28
32994	CPT	Hc Ablate Pulm Tumors Extnsn	32	19	$8,805.00	$7,396.20	$5,371.05	$11,923.74	$8,364.75	2026-02-28
75020022	CDM	Hc Ercp Invasive	32	19	$8,388.00	$7,045.92	$5,116.68	$11,359.03	$7,968.60	2026-02-28
J0207	HCPCS	Amifostine Crystalline 500 Mg Intravenous Solution	64	19	$9,982.33	$8,385.16	$3,049.52	$20,266.23	$7,949.43	2026-02-28
J9357	HCPCS	Valrubicin 40 Mg/ml Intravesical Solution	32	19	$8,354.00	$7,017.36	$5,095.94	$11,312.99	$7,936.30	2026-02-28
C9257	HCPCS	Bevacizumab Ophthalmic Injection	64	19	$10,493.03	$8,814.15	$2,430.67	$23,023.25	$7,883.46	2026-02-28
J9035	HCPCS	Bevacizumab 25 Mg/ml Intravenous Solution	64	19	$10,493.03	$8,814.15	$2,430.67	$23,023.25	$7,883.46	2026-02-28
J9202	HCPCS	Goserelin 10.8 Mg Subcutaneous Implant	64	19	$9,782.10	$8,216.97	$3,028.11	$19,771.46	$7,814.23	2026-02-28
J9047	HCPCS	Carfilzomib 10 Mg Intravenous Solution	96	19	$8,187.15	$6,877.21	$1,589.97	$22,174.01	$7,777.80	2026-02-28
Q4104	HCPCS	Drsng Matrix Bilayer 10x12.5cm Bmw4051	160	19	$9,360.20	$7,862.57	$2,537.66	$20,618.96	$7,683.45	2026-02-28
J2407	HCPCS	Oritavancin 400 Mg Intravenous Solution	128	19	$9,447.28	$7,935.73	$2,821.24	$20,271.84	$7,619.58	2026-02-28
49593	CPT	Pc Rpr Aa Hrn 1st 3-10 Rdc	32	19	$7,961.00	$6,687.24	$4,856.21	$10,780.79	$7,562.95	2026-02-28
A9507	HCPCS	Hc Rp Prostascint Up To 10mcg	32	19	$7,958.00	$6,684.72	$4,854.38	$10,776.73	$7,560.10	2026-02-28
J1448	HCPCS	Trilaciclib 300 Mg Intravenous Solution	32	19	$7,925.10	$6,657.09	$4,834.32	$10,732.18	$7,528.85	2026-02-28
C1785	HCPCS	Pacemaker Assurity MRI Dbl	1,376	19	$9,100.00	$7,644.00	$2.22	$26,020.96	$7,452.00	2026-02-28
14020	CPT	Hc Adjt Tis Trnsfr/reargmt Scalp/arm/leg 10 Sq Cm/<	32	19	$7,757.95	$6,516.68	$4,732.35	$10,505.82	$7,370.06	2026-02-28
J2315	HCPCS	Naltrexone ER 380 Mg Intramuscular Suspensionextended Release	32	19	$7,729.90	$6,493.12	$4,715.24	$10,467.84	$7,343.41	2026-02-28
J0875	HCPCS	Dalbavancin 500 Mg Intravenous Solution	32	19	$7,729.15	$6,492.49	$4,714.79	$10,466.82	$7,342.70	2026-02-28
Q5108	HCPCS	Pegfilgrastim-jmdb 6 Mg/0.6 Ml Subcutaneous Syringe	32	19	$7,713.75	$6,479.55	$4,705.39	$10,445.97	$7,328.07	2026-02-28
L8659	HCPCS	Imp Interphangeal Prox Sz 4 Sr Pip-4	96	19	$7,425.00	$6,237.00	$3,505.19	$16,356.03	$7,090.88	2026-02-28
J2997	HCPCS	Alteplase 2 Mg Intra-catheter Solution	128	19	$11,062.15	$9,292.21	$455.19	$57,501.71	$7,080.36	2026-02-28
C1786	HCPCS	Pacemaker 1 Chmbr Sensia Sr Sesr01	1,120	19	$8,775.00	$7,371.00	$1,990.13	$55,759.19	$7,056.00	2026-02-28
C1895	HCPCS	Lead Durata Q 58cm	512	19	$8,791.88	$7,385.18	$1,098.00	$27,260.05	$7,032.69	2026-02-28
45388	CPT	Pc Colonoscopy W Lesion Ablate	32	19	$7,321.00	$6,149.64	$4,465.81	$9,914.10	$6,954.95	2026-02-28
Q5130	HCPCS	Pegfilgrastim-pbbk 6 Mg/0.6 Ml Subcutaneous Syringe	32	19	$7,304.70	$6,135.95	$4,455.87	$9,892.03	$6,939.47	2026-02-28
90375	CPT	Rabies Immune Globulin (pf) 300 Unit/ml Intramuscular Solution	96	19	$7,285.35	$6,119.70	$1,481.36	$16,443.04	$6,921.09	2026-02-28
J9145	HCPCS	Daratumumab 20 Mg/ml Intravenous Solution	128	19	$8,998.52	$7,558.77	$2,158.15	$20,828.96	$6,919.92	2026-02-28
C1813	HCPCS	Cylinder Pmp 90-9820icotr	800	19	$8,200.00	$6,888.00	$774.70	$36,008.45	$6,825.00	2026-02-28
20983	CPT	Hc Ablate Bone Tumors Perq	32	19	$7,175.00	$6,027.00	$4,376.75	$9,716.39	$6,816.25	2026-02-28
22511	CPT	Hc Perq Lumbosacral Injection	32	19	$7,144.00	$6,000.96	$4,357.84	$9,674.41	$6,786.80	2026-02-28
L8691	HCPCS	Sound Proc Bp100 Slate Grey 92842	32	19	$7,128.00	$5,987.52	$4,348.08	$9,652.74	$6,771.60	2026-02-28
44401	CPT	Pc Colonoscopy Lesion Removal	32	19	$7,094.00	$5,958.96	$4,327.34	$9,606.70	$6,739.30	2026-02-28
E0749	HCPCS	Stimulator Bone Growth Osteo 10-1320	256	19	$8,485.38	$7,127.72	$1,830.00	$27,978.72	$6,654.64	2026-02-28
45346	CPT	Pc Sigmoidoscopy W Ablate Tumr	32	19	$6,868.00	$5,769.12	$4,189.48	$9,300.65	$6,524.60	2026-02-28
J7336	HCPCS	Capsaicin-skin Cleanser 8 % Topical Kit	64	19	$8,584.50	$7,210.99	$2,094.62	$18,600.21	$6,514.27	2026-02-28
74177	CPT	Hc CT Abdomen Pelvis W Contrst	34	19	$6,998.00	$5,878.32	$2,649.88	$9,476.70	$6,508.14	2026-02-28
78815	CPT	Hc Nm PET CT Sk To M Thgh Int	32	19	$6,785.00	$5,699.40	$4,138.85	$9,188.25	$6,445.75	2026-02-28
78816	CPT	Hc Nm PET CT Wh Bdy Initial Pi	32	19	$6,785.00	$5,699.40	$4,138.85	$9,188.25	$6,445.75	2026-02-28
36516	CPT	Hc Therp Aquaphoresis	32	19	$6,769.00	$5,685.96	$4,129.09	$9,166.58	$6,430.55	2026-02-28
Q4145	HCPCS	Epifix Injectable 160mg Ei-5200	32	19	$6,726.38	$5,650.16	$4,103.10	$9,108.87	$6,390.07	2026-02-28
36482	CPT	Hc Endoven Ther Chem Adhes 1st	32	19	$6,696.00	$5,624.64	$4,084.56	$9,067.73	$6,361.20	2026-02-28
47383	CPT	Hc Perq Abltj Lvr Cryoablation	32	19	$6,649.00	$5,585.16	$4,055.89	$9,004.08	$6,316.55	2026-02-28
A4100	HCPCS	Drsng Novosorb Btm 20x40cm Btm-2040	128	19	$7,941.12	$6,670.55	$1,475.44	$18,415.28	$6,281.60	2026-02-28
C1748	HCPCS	Duodenoscope Sgl U M00542421	32	19	$6,592.50	$5,537.70	$4,021.43	$8,927.57	$6,262.88	2026-02-28
C1777	HCPCS	Defib Ld Reliance 4frnt 64cm 0673	448	19	$8,791.88	$7,385.18	$1,721.42	$18,338.58	$6,176.25	2026-02-28
J3590	HCPCS	Anakinra 100 Mg/0.67 Ml Subcutaneous Syringe	160	19	$6,380.04	$5,359.24	$519.69	$16,526.66	$6,124.80	2026-02-28
74176	CPT	Hc CT Abd Pelvis Wo Contrast	34	19	$6,578.00	$5,525.52	$2,159.81	$8,907.93	$6,117.54	2026-02-28
C2622	HCPCS	Cyl Pnle Mal 650 16-19 72401716	192	19	$7,746.48	$6,507.05	$2,074.00	$13,530.90	$6,095.00	2026-02-28
J3262	HCPCS	Tocilizumab 200 Mg/10 Ml (20 Mg/ml) Intravenous Solution	96	19	$6,407.15	$5,382.01	$1,563.35	$17,353.27	$6,086.80	2026-02-28
Q5107	HCPCS	Bevacizumab-awwb 25 Mg/ml Intravenous Solution	64	19	$7,991.57	$6,712.92	$1,949.97	$17,315.46	$6,064.34	2026-02-28
J9349	HCPCS	Tafasitamab-cxix 200 Mg Intravenous Solution	32	19	$6,368.15	$5,349.25	$3,884.58	$8,623.75	$6,049.75	2026-02-28
A9589	HCPCS	Hexaminolevulinate 100 Mg Intravesical Solution	32	19	$6,345.00	$5,329.80	$3,870.45	$8,592.40	$6,027.75	2026-02-28
J3111	HCPCS	Romosozumab-aqqg 105 Mg/1.17 Ml Subcutaneous Syringe	64	19	$6,415.83	$5,389.30	$3,818.21	$8,900.21	$5,994.89	2026-02-28
J9179	HCPCS	Eribulin 1 Mg/2 Ml (0.5 Mg/ml) Intravenous Solution	32	19	$6,240.00	$5,241.60	$3,806.40	$8,450.21	$5,928.00	2026-02-28
J1954	HCPCS	Leuprolide 22.5 Mg (3 Month) Intramuscular Suspension	32	19	$6,238.05	$5,239.97	$3,805.22	$8,447.57	$5,926.15	2026-02-28
Q5123	HCPCS	Rituximab-arrx 10 Mg/ml Intravenous Solution	64	19	$8,042.55	$6,755.74	$1,635.32	$18,152.04	$5,903.51	2026-02-28
Q5116	HCPCS	Trastuzumab-qyyp 150 Mg Intravenous Solution	64	19	$7,317.30	$6,146.53	$2,349.24	$14,602.89	$5,896.59	2026-02-28
Q5119	HCPCS	Rituximab-pvvr 10 Mg/ml Intravenous Solution	64	19	$8,021.38	$6,737.95	$1,630.99	$18,104.30	$5,887.94	2026-02-28
27820223	CDM	Hc Ibv Valve System 6mm	32	19	$6,187.50	$5,197.50	$3,774.38	$8,379.12	$5,878.13	2026-02-28
95811	CPT	Hc Polysomnogrphy=>6 Yr Cpap	32	19	$6,081.00	$5,108.04	$3,709.41	$8,234.90	$5,776.95	2026-02-28
70552	CPT	Hc Mr Brain W Contrast	32	19	$5,991.00	$5,032.44	$3,654.51	$8,113.02	$5,691.45	2026-02-28
J2796	HCPCS	Romiplostim 125 Mcg Dilute Subcutaneous Solution	32	19	$5,961.90	$5,008.00	$3,636.76	$8,073.61	$5,663.81	2026-02-28
Q4116	HCPCS	Alldrm Rtm Rtu Thk 16x20 Sq Cm 1520320	1,088	19	$6,340.50	$5,326.02	$176.90	$58,837.10	$5,646.89	2026-02-28
C1885	HCPCS	Cath Excimer Clirpath 1.7x150r 417-156	160	19	$6,738.75	$5,660.55	$3,513.60	$10,420.57	$5,637.72	2026-02-28
A9557	HCPCS	Hc Rp Neurolite	32	19	$5,876.00	$4,935.84	$3,584.36	$7,957.28	$5,582.20	2026-02-28
J9048	HCPCS	Bortezomib 3.5 Mg Intravenous Powder For Solution	32	19	$5,867.00	$4,928.28	$3,578.87	$7,945.10	$5,573.65	2026-02-28
J9281	HCPCS	Mitomycin 40 Mg X 2 Intra-pyelocalyceal Kit	32	19	$5,806.75	$4,877.67	$3,542.12	$7,863.51	$5,516.42	2026-02-28
J0841	HCPCS	Antivenin Crotalidae (equine) Solution For Injection	32	19	$5,804.55	$4,875.83	$3,540.78	$7,860.53	$5,514.33	2026-02-28
50592	CPT	Hc Ablatn Renal Tumor 1 Or>uni	32	19	$5,728.00	$4,811.52	$3,494.08	$7,756.86	$5,441.60	2026-02-28
70551	CPT	Hc Mr Brain Wo Contrast	32	19	$5,725.00	$4,809.00	$3,492.25	$7,752.80	$5,438.75	2026-02-28
C2629	HCPCS	Shth Kt Lsr Sls Ii 12fr 50cm 500-001	128	19	$6,942.68	$5,831.85	$3,101.85	$12,366.15	$5,389.20	2026-02-28
J1566	HCPCS	Immune Globgamma(igg) 10 Gram-gly-gluc-iga 0 To 50 Mcg/ml IV Solution	64	19	$6,090.85	$5,116.32	$3,416.00	$8,912.94	$5,376.00	2026-02-28
J7511	HCPCS	Anti-thymocyte Globulin (rabbit) 25 Mg Intravenous Solution	32	19	$5,597.35	$4,701.78	$3,414.39	$7,579.94	$5,317.49	2026-02-28
J2786	HCPCS	Reslizumab 10 Mg/ml Intravenous Solution	32	19	$5,550.50	$4,662.42	$3,385.81	$7,516.49	$5,272.98	2026-02-28
Q5133	HCPCS	Tocilizumab-bavi 200 Mg/10 Ml (20 Mg/ml) Intravenous Solution	96	19	$5,550.00	$4,662.00	$1,354.20	$15,031.62	$5,272.50	2026-02-28
J8560	HCPCS	Etoposide 50 Mg Capsule	32	19	$5,511.68	$4,629.82	$3,362.13	$7,463.92	$5,236.10	2026-02-28
70546	CPT	Hc MRA Head W Wo Contrast	32	19	$5,471.00	$4,595.64	$3,337.31	$7,408.83	$5,197.45	2026-02-28
27820222	CDM	Hc Ibv Valve System 5mm	32	19	$5,445.00	$4,573.80	$3,321.45	$7,373.62	$5,172.75	2026-02-28
J2783	HCPCS	Rasburicase 1.5 Mg Intravenous Solution	96	19	$5,372.59	$4,512.98	$3,085.81	$30,267.46	$5,130.83	2026-02-28
J0490	HCPCS	Belimumab 120 Mg Intravenous Solution	64	19	$6,582.73	$5,529.49	$1,798.04	$13,837.02	$5,112.27	2026-02-28
78814	CPT	Hc Nm PET CT Limited Init Pi	32	19	$5,361.00	$4,503.24	$3,270.21	$7,259.87	$5,092.95	2026-02-28
95810	CPT	Hc Polysomnography=> 6 Yr	32	19	$5,351.00	$4,494.84	$3,264.11	$7,246.33	$5,083.45	2026-02-28
A9521	HCPCS	Hc Rp Ceretec Up To 25mci	32	19	$5,314.00	$4,463.76	$3,241.54	$7,196.22	$5,048.30	2026-02-28
70553	CPT	Hc Mr Brain W Wo Contrast	32	19	$5,301.00	$4,452.84	$3,233.61	$7,178.62	$5,035.95	2026-02-28
72156	CPT	Hc Mr Cervical W Wo Contrast	32	19	$5,258.00	$4,416.72	$3,207.38	$7,120.39	$4,995.10	2026-02-28
Q5115	HCPCS	Rituximab-abbs 10 Mg/ml Concentrate Intravenous Ach	64	19	$6,759.58	$5,678.05	$1,374.43	$15,256.42	$4,961.74	2026-02-28
72158	CPT	Hc Mr Lumbar W Wo Contrast	32	19	$5,178.00	$4,349.52	$3,158.58	$7,012.05	$4,919.10	2026-02-28
72157	CPT	Hc Mr Thoracic W Wo Contrast	32	19	$5,086.00	$4,272.24	$3,102.46	$6,887.47	$4,831.70	2026-02-28
C1821	HCPCS	Imp Coflex Sz 8 Uqi00008	128	19	$6,360.00	$5,342.40	$2,147.20	$23,790.59	$4,831.20	2026-02-28
78608	CPT	Hc Nm Brain PET Scan Init Pi	32	19	$5,056.00	$4,247.04	$3,084.16	$6,846.84	$4,803.20	2026-02-28
Q4100	HCPCS	Mtrx Dermal Allo Pliable 6x8cm Wc2068	96	19	$5,052.38	$4,244.00	$1,369.76	$11,700.29	$4,799.77	2026-02-28
74183	CPT	Hc Mr Abdomen W Wo Contrast	32	19	$5,035.00	$4,229.40	$3,071.35	$6,818.40	$4,783.25	2026-02-28
J9055	HCPCS	Cetuximab 100 Mg/50 Ml Intravenous Solution	64	19	$5,877.75	$4,937.31	$2,390.29	$10,612.87	$4,780.57	2026-02-28
J1744	HCPCS	Icatibant 30 Mg/3 Ml Subcutaneous Syringe	32	19	$4,997.15	$4,197.61	$3,048.27	$6,767.15	$4,747.30	2026-02-28
J0129	HCPCS	Abatacept (with Maltose) 250 Mg Intravenous Solution	64	19	$6,078.77	$5,106.17	$2,961.01	$9,890.34	$4,659.94	2026-02-28
Q0247	HCPCS	Sotrovimab 500 Mg/8 Ml (62.5 Mg/ml) Intravenous Solution (eua)	64	19	$6,300.00	$5,292.00	$1,281.00	$14,219.10	$4,624.41	2026-02-28
Q0222	HCPCS	Bebtelovimab 175 Mg/ 2ml (eua)	64	19	$6,300.00	$5,292.00	$1,281.00	$14,219.10	$4,624.41	2026-02-28
C1815	HCPCS	Cuff Ams 800 With Iz 720157-01	416	19	$5,665.00	$4,758.60	$1,476.81	$13,425.21	$4,617.10	2026-02-28
J0485	HCPCS	Belatacept 250 Mg Intravenous Solution	32	19	$4,849.40	$4,073.50	$2,958.14	$6,567.06	$4,606.93	2026-02-28
V2790	HCPCS	Amniofill 2000mg Af-2000	224	19	$4,827.38	$4,055.00	$484.95	$12,797.19	$4,586.02	2026-02-28
72147	CPT	Hc Mr Thoracic W Contrast	32	19	$4,811.00	$4,041.24	$2,934.71	$6,515.06	$4,570.45	2026-02-28
72197	CPT	Hc Mr Pelvis W Wo Contrast	32	19	$4,783.00	$4,017.72	$2,917.63	$6,477.14	$4,543.85	2026-02-28
C1714	HCPCS	Cath Slvrhawk Sxl 7.2cm 136cm P4033	480	19	$6,063.75	$5,093.55	$791.69	$12,638.75	$4,533.75	2026-02-28
Q5118	HCPCS	Bevacizumab-bvzr 25 Mg/ml Intravenous Solution	64	19	$5,957.57	$5,004.36	$1,453.67	$12,908.35	$4,520.85	2026-02-28
J2357	HCPCS	Omalizumab 75 Mg/0.5 Ml Subcutaneous Syringe	160	19	$6,924.80	$5,816.84	$2,112.07	$19,177.10	$4,510.18	2026-02-28
72141	CPT	Hc Mr Cervical Wo Contrast	32	19	$4,737.00	$3,979.08	$2,889.57	$6,414.85	$4,500.15	2026-02-28
72142	CPT	Hc Mr Cervical W Contrast	32	19	$4,737.00	$3,979.08	$2,889.57	$6,414.85	$4,500.15	2026-02-28
70545	CPT	Hc MRA Head W Contrast	32	19	$4,717.00	$3,962.28	$2,877.37	$6,387.77	$4,481.15	2026-02-28
70544	CPT	Hc MRA Head Wo Contrast	32	19	$4,717.00	$3,962.28	$2,877.37	$6,387.77	$4,481.15	2026-02-28
44206	CPT	Pc Lap Cole W Colostomy	32	19	$4,704.00	$3,951.36	$2,869.44	$6,370.16	$4,468.80	2026-02-28
Q4154	HCPCS	Allgrft Amniotc Biovance 4x4 Dham0044	96	19	$4,698.00	$3,946.32	$1,448.75	$10,061.03	$4,463.10	2026-02-28
J1569	HCPCS	Immune Globgamma (igg) 10 %-gly-iga Over 50 Mcg/ml Injection Solution	160	19	$4,680.00	$3,931.20	$285.48	$19,012.97	$4,446.00	2026-02-28
J1459	HCPCS	Immune Globulin (privigen) 10 G/100 Ml (10%) Intravenous Solution	128	19	$5,460.00	$4,586.40	$1,110.20	$19,717.16	$4,440.80	2026-02-28
72149	CPT	Hc Mr Lumbar W Contrast	32	19	$4,665.00	$3,918.60	$2,845.65	$6,317.35	$4,431.75	2026-02-28
49591	CPT	Pc Rpr Aa Hrn 1st < 3 Cm Rdc	32	19	$4,632.00	$3,890.88	$2,825.52	$6,272.66	$4,400.40	2026-02-28
C1778	HCPCS	Bone Sm Fix 1.6mm.	2,048	19	$5,119.16	$4,300.09	$23.67	$92,064.61	$4,383.99	2026-02-28
22510	CPT	Hc Perq Cervicothoracic Inject	64	19	$5,828.50	$4,895.94	$2,752.93	$9,674.41	$4,357.84	2026-02-28
72146	CPT	Hc Mr Thoracic Wo Contrast	32	19	$4,582.00	$3,848.88	$2,795.02	$6,204.95	$4,352.90	2026-02-28
C9460	HCPCS	Cangrelor 50 Mg Intravenous Solution	32	19	$4,569.33	$3,838.24	$2,787.30	$6,187.79	$4,340.87	2026-02-28
72148	CPT	Hc Mr Lumbar Wo Contrast	34	19	$4,665.00	$3,918.60	$1,903.01	$6,317.35	$4,338.45	2026-02-28
60254	CPT	Pc Thyrd W Radicl Nck Dissectn	32	19	$4,555.00	$3,826.20	$2,778.55	$6,168.39	$4,327.25	2026-02-28
70543	CPT	Hc Mr Orb Face Neck W Wo Cont	32	19	$4,554.00	$3,825.36	$2,777.94	$6,167.03	$4,326.30	2026-02-28
J9050	HCPCS	Carmustine 100 Mg Intravenous Solution	64	19	$5,139.12	$4,316.87	$1,952.68	$9,583.88	$4,317.07	2026-02-28
J9264	HCPCS	Paclitaxel Protein-bound 100 Mg Intravenous Suspension	128	19	$5,537.38	$4,651.40	$2,482.67	$9,784.91	$4,305.60	2026-02-28
Q5135	HCPCS	Tocilizumab-aazg 200 Mg/10 Ml (20 Mg/ml) Intravenous Solution	96	19	$4,486.20	$3,768.41	$1,094.71	$12,149.89	$4,261.89	2026-02-28
72159	CPT	Hc MRA Spinal Canal W Contrast	96	19	$4,859.00	$4,081.56	$2,698.03	$7,219.25	$4,246.08	2026-02-28
C1052	HCPCS	Hemospry 10fr G21049	64	19	$4,475.25	$3,759.21	$2,676.38	$6,179.22	$4,190.07	2026-02-28
74182	CPT	Hc Mr Abdomen W Contrast	32	19	$4,380.00	$3,679.20	$2,671.80	$5,931.40	$4,161.00	2026-02-28
J7298	HCPCS	Levonorgestrel 21 Mcg/24 Hr (up To 8 Years) 52 Mg Intrauterine Device	32	19	$4,372.68	$3,673.06	$2,667.34	$5,921.49	$4,154.05	2026-02-28
74170	CPT	Hc CT Abdomen W Wo Contrast	32	19	$4,368.00	$3,669.12	$2,664.48	$5,915.15	$4,149.60	2026-02-28
75894	CPT	Hc Embolization	32	19	$4,362.00	$3,664.08	$2,660.82	$5,907.03	$4,143.90	2026-02-28
75020023	CDM	Hc First Gastro Intestinl Serv	32	19	$4,357.00	$3,659.88	$2,657.77	$5,900.25	$4,139.15	2026-02-28
C9399	HCPCS	Evolocumab 140 Mg/ml Subcutaneous Pen Injector	192	19	$5,277.25	$4,432.89	$799.10	$47,446.84	$4,132.54	2026-02-28
73723	CPT	Hc Mr Jnt Lower Ext W Wo Cont	32	19	$4,327.00	$3,634.68	$2,639.47	$5,859.63	$4,110.65	2026-02-28
62305	CPT	Hc Myelogrphy Lmbr Inj =>2 Reg	32	19	$4,308.00	$3,618.72	$2,627.88	$5,833.90	$4,092.60	2026-02-28
73223	CPT	Hc Mr Jnt Up Ext W Wo Contrast	32	19	$4,307.00	$3,617.88	$2,627.27	$5,832.54	$4,091.65	2026-02-28
Q5114	HCPCS	Trastuzumab-dkst 150 Mg Intravenous Solution	64	19	$5,063.02	$4,252.94	$1,625.50	$10,104.10	$4,080.01	2026-02-28
71552	CPT	Hc Mr Chest W Wo Contrast	32	19	$4,276.00	$3,591.84	$2,608.36	$5,790.56	$4,062.20	2026-02-28
19085	CPT	Hc Bx Breast 1st Lesion Mr Img	64	19	$5,270.00	$4,426.80	$1,380.43	$11,208.72	$4,056.77	2026-02-28
C2618	HCPCS	Cryoprb Var Rt Ang 2.4mm Cva2400ra	128	19	$5,000.62	$4,200.52	$1,852.88	$9,125.62	$4,042.02	2026-02-28
75716	CPT	Hc Angio Extremity Bilateral	32	19	$4,237.00	$3,559.08	$2,584.57	$5,737.75	$4,025.15	2026-02-28
71270	CPT	Hc CT Chest W Wo Contrast	32	19	$4,215.00	$3,540.60	$2,571.15	$5,707.96	$4,004.25	2026-02-28
75635	CPT	Hc CT Angio Aorta Runoff	32	19	$4,215.00	$3,540.60	$2,571.15	$5,707.96	$4,004.25	2026-02-28
C1724	HCPCS	Rotablator Sys Rotlnk + 1.25mm H749236310020	480	19	$6,284.25	$5,278.77	$1,219.47	$16,826.89	$4,002.66	2026-02-28
72020003	CDM	Hc Ldr Birth	32	19	$4,196.00	$3,524.64	$2,559.56	$5,682.23	$3,986.20	2026-02-28
44204	CPT	Pc Lap Cole W Anastomosis	32	19	$4,149.00	$3,485.16	$2,530.89	$5,618.58	$3,941.55	2026-02-28
J0585	HCPCS	Onabotulinumtoxina 100 Unit Solution For Injection	64	19	$4,845.00	$4,069.80	$1,970.30	$8,748.14	$3,940.60	2026-02-28
73720	CPT	Hc Mr Lower Ext W Wo Contrast	32	19	$4,130.00	$3,469.20	$2,519.30	$5,592.85	$3,923.50	2026-02-28
Q4110	HCPCS	Graft Primatrix 4x4 607-004-440	160	19	$4,142.21	$3,479.46	$608.71	$8,802.30	$3,904.00	2026-02-28

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